Prospective validation of the vasoactive-inotropic score and correlation to short-term outcomes in neonates and infants after cardiothoracic surgery
Purpose Prospective validation of the vasoactive-inotropic score (VIS) and inotrope score (IS) in infants after cardiovascular surgery. Methods Prospective observational study of 70 infants (≤90 days of age) undergoing cardiothoracic surgery. VIS and IS were assessed at 24 (VIS24, IS24), 48 (VIS48,...
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| Veröffentlicht in: | Intensive care medicine 2012-07, Vol.38 (7), p.1184-1190 |
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| creator | Davidson, Jesse Tong, Suhong Hancock, Hayley Hauck, Amanda da Cruz, Eduardo Kaufman, Jon |
| description | Purpose
Prospective validation of the vasoactive-inotropic score (VIS) and inotrope score (IS) in infants after cardiovascular surgery.
Methods
Prospective observational study of 70 infants (≤90 days of age) undergoing cardiothoracic surgery. VIS and IS were assessed at 24 (VIS24, IS24), 48 (VIS48, IS48), and 72 (VIS72, IS72) h after surgery. Maximum VIS and IS scores in the first 48 h were also calculated (VIS48max and IS48max). The primary outcome was length of intubation. Additional outcomes included length of intensive care (ICU) stay and hospitalization, cardiac arrest, mortality, time to negative fluid balance, peak lactate, and change in creatinine.
Results
Based on receiver-operating characteristic (ROC) analysis, the area under the curve (AUC) was highest for VIS48 to identify prolonged intubation time. AUC for the primary outcome was higher for VIS than IS at all time points assessed. On multivariate analysis VIS48 was independently associated with prolonged intubation (OR 22.3,
p
= 0.002), prolonged ICU stay (OR 8.1,
p
= 0.017), and prolonged hospitalization (OR 11.3,
p
= 0.011). VIS48max, IS48max, and IS48 were also associated with prolonged intubation, but not prolonged ICU or hospital stay. None of the scores were associated with time to negative fluid balance, peak lactate, or change in creatinine.
Conclusion
In neonates and infants, a higher VIS at 48 h after cardiothoracic surgery is strongly associated with increased length of ventilation, and prolonged ICU and total hospital stay. At all time points assessed, VIS is more predictive of poor short-term outcome than IS. VIS may be useful as an independent predictor of outcomes. |
| doi_str_mv | 10.1007/s00134-012-2544-x |
| format | Article |
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Prospective validation of the vasoactive-inotropic score (VIS) and inotrope score (IS) in infants after cardiovascular surgery.
Methods
Prospective observational study of 70 infants (≤90 days of age) undergoing cardiothoracic surgery. VIS and IS were assessed at 24 (VIS24, IS24), 48 (VIS48, IS48), and 72 (VIS72, IS72) h after surgery. Maximum VIS and IS scores in the first 48 h were also calculated (VIS48max and IS48max). The primary outcome was length of intubation. Additional outcomes included length of intensive care (ICU) stay and hospitalization, cardiac arrest, mortality, time to negative fluid balance, peak lactate, and change in creatinine.
Results
Based on receiver-operating characteristic (ROC) analysis, the area under the curve (AUC) was highest for VIS48 to identify prolonged intubation time. AUC for the primary outcome was higher for VIS than IS at all time points assessed. On multivariate analysis VIS48 was independently associated with prolonged intubation (OR 22.3,
p
= 0.002), prolonged ICU stay (OR 8.1,
p
= 0.017), and prolonged hospitalization (OR 11.3,
p
= 0.011). VIS48max, IS48max, and IS48 were also associated with prolonged intubation, but not prolonged ICU or hospital stay. None of the scores were associated with time to negative fluid balance, peak lactate, or change in creatinine.
Conclusion
In neonates and infants, a higher VIS at 48 h after cardiothoracic surgery is strongly associated with increased length of ventilation, and prolonged ICU and total hospital stay. At all time points assessed, VIS is more predictive of poor short-term outcome than IS. VIS may be useful as an independent predictor of outcomes.</description><identifier>ISSN: 0342-4642</identifier><identifier>EISSN: 1432-1238</identifier><identifier>DOI: 10.1007/s00134-012-2544-x</identifier><identifier>PMID: 22527067</identifier><identifier>CODEN: ICMED9</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer-Verlag</publisher><subject>Analysis ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Anesthesiology ; Biological and medical sciences ; Cardiac Output, Low - drug therapy ; Cardiac Output, Low - etiology ; Cardiac Output, Low - physiopathology ; Cardiac Surgical Procedures - adverse effects ; Cardiotonic Agents - therapeutic use ; Clinical outcomes ; Creatinine ; Critical Care Medicine ; Dopamine ; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care ; Emergency Medicine ; Gestational age ; Health aspects ; Heart Defects, Congenital - surgery ; Heart surgery ; Hemodynamics ; Hospitals ; Humans ; Infant ; Infant, Newborn ; Infants (Newborn) ; Intensive ; Intensive care ; Intensive care medicine ; Intensive Care Units, Pediatric - statistics & numerical data ; Intubation ; Intubation - statistics & numerical data ; Lactates ; Length of Stay - statistics & numerical data ; Logistic Models ; Medical sciences ; Medicine ; Medicine & Public Health ; Mortality ; Observational studies ; Outcome Assessment, Health Care ; Pain Medicine ; Pediatric cardiology ; Pediatric Original ; Pediatrics ; Pneumology/Respiratory System ; Postoperative Complications - epidemiology ; Postoperative period ; Predictive Value of Tests ; Prospective Studies ; ROC Curve ; Surgeons ; Vasodilator Agents - therapeutic use</subject><ispartof>Intensive care medicine, 2012-07, Vol.38 (7), p.1184-1190</ispartof><rights>Copyright jointly held by Springer and ESICM 2012</rights><rights>2015 INIST-CNRS</rights><rights>COPYRIGHT 2012 Springer</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c605t-cb8a79363aca7f2ea13a265faa6ceb14e8fa5671397b67607ea8e0b78377c4803</citedby><cites>FETCH-LOGICAL-c605t-cb8a79363aca7f2ea13a265faa6ceb14e8fa5671397b67607ea8e0b78377c4803</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00134-012-2544-x$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00134-012-2544-x$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26037806$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22527067$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Davidson, Jesse</creatorcontrib><creatorcontrib>Tong, Suhong</creatorcontrib><creatorcontrib>Hancock, Hayley</creatorcontrib><creatorcontrib>Hauck, Amanda</creatorcontrib><creatorcontrib>da Cruz, Eduardo</creatorcontrib><creatorcontrib>Kaufman, Jon</creatorcontrib><title>Prospective validation of the vasoactive-inotropic score and correlation to short-term outcomes in neonates and infants after cardiothoracic surgery</title><title>Intensive care medicine</title><addtitle>Intensive Care Med</addtitle><addtitle>Intensive Care Med</addtitle><description>Purpose
Prospective validation of the vasoactive-inotropic score (VIS) and inotrope score (IS) in infants after cardiovascular surgery.
Methods
Prospective observational study of 70 infants (≤90 days of age) undergoing cardiothoracic surgery. VIS and IS were assessed at 24 (VIS24, IS24), 48 (VIS48, IS48), and 72 (VIS72, IS72) h after surgery. Maximum VIS and IS scores in the first 48 h were also calculated (VIS48max and IS48max). The primary outcome was length of intubation. Additional outcomes included length of intensive care (ICU) stay and hospitalization, cardiac arrest, mortality, time to negative fluid balance, peak lactate, and change in creatinine.
Results
Based on receiver-operating characteristic (ROC) analysis, the area under the curve (AUC) was highest for VIS48 to identify prolonged intubation time. AUC for the primary outcome was higher for VIS than IS at all time points assessed. On multivariate analysis VIS48 was independently associated with prolonged intubation (OR 22.3,
p
= 0.002), prolonged ICU stay (OR 8.1,
p
= 0.017), and prolonged hospitalization (OR 11.3,
p
= 0.011). VIS48max, IS48max, and IS48 were also associated with prolonged intubation, but not prolonged ICU or hospital stay. None of the scores were associated with time to negative fluid balance, peak lactate, or change in creatinine.
Conclusion
In neonates and infants, a higher VIS at 48 h after cardiothoracic surgery is strongly associated with increased length of ventilation, and prolonged ICU and total hospital stay. At all time points assessed, VIS is more predictive of poor short-term outcome than IS. VIS may be useful as an independent predictor of outcomes.</description><subject>Analysis</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Anesthesiology</subject><subject>Biological and medical sciences</subject><subject>Cardiac Output, Low - drug therapy</subject><subject>Cardiac Output, Low - etiology</subject><subject>Cardiac Output, Low - physiopathology</subject><subject>Cardiac Surgical Procedures - adverse effects</subject><subject>Cardiotonic Agents - therapeutic use</subject><subject>Clinical outcomes</subject><subject>Creatinine</subject><subject>Critical Care Medicine</subject><subject>Dopamine</subject><subject>Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care</subject><subject>Emergency Medicine</subject><subject>Gestational age</subject><subject>Health aspects</subject><subject>Heart Defects, Congenital - surgery</subject><subject>Heart surgery</subject><subject>Hemodynamics</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Infants (Newborn)</subject><subject>Intensive</subject><subject>Intensive care</subject><subject>Intensive care medicine</subject><subject>Intensive Care Units, Pediatric - statistics & numerical data</subject><subject>Intubation</subject><subject>Intubation - statistics & numerical data</subject><subject>Lactates</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Logistic Models</subject><subject>Medical sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mortality</subject><subject>Observational studies</subject><subject>Outcome Assessment, Health Care</subject><subject>Pain Medicine</subject><subject>Pediatric cardiology</subject><subject>Pediatric Original</subject><subject>Pediatrics</subject><subject>Pneumology/Respiratory System</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative period</subject><subject>Predictive Value of Tests</subject><subject>Prospective Studies</subject><subject>ROC Curve</subject><subject>Surgeons</subject><subject>Vasodilator Agents - therapeutic use</subject><issn>0342-4642</issn><issn>1432-1238</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kktr3DAUhU1paaZpf0A3xVAC3SjVy5K9KYTQFwTaRbsWdzTXMwq2NJXkIfkf_cGVM9M8SooXvuh-59g6nKp6zegpo1S_T5QyIQllnPBGSnL1pFowKThhXLRPqwUVkhOpJD-qXqR0WWitGva8OuK84Zoqvah-f48hbdFmt8N6B4NbQXbB16Gv82Y-SQFulsT5kGPYOlsnGyLW4Fd1GSIOe0UOddqEmEnGONZhyjaMmGrna4_BQy7zLHG-B5_L3BeuthBXLuSiAzs7T3GN8fpl9ayHIeGrw_u4-vnp44_zL-Ti2-ev52cXxCraZGKXLehOKAEWdM8RmACumh5AWVwyiW0PjdJMdHqptKIaoUW61K3Q2sqWiuPqw953Oy1HXFn0OcJgttGNEK9NAGcebrzbmHXYGdm1UnRNMXh3MIjh14Qpm9Eli8MA5c5TMoxy2vJOSFnQt_-gl2GKvlzvhpJd00p2R61hQFOyKpmDnU3NmeZSsIY3M0Ueodbosfxk8Ni7cvyAP32EL88KR2cfFbC9wJZ2pIj9bSaMmrl6Zl89U6pn5uqZq6J5cz_MW8XfrhXg5ABAsjD0Ebx16Y5TVOiWqsLxPZfKypc-3E_qf1__A0qI9As</recordid><startdate>20120701</startdate><enddate>20120701</enddate><creator>Davidson, Jesse</creator><creator>Tong, Suhong</creator><creator>Hancock, Hayley</creator><creator>Hauck, Amanda</creator><creator>da Cruz, Eduardo</creator><creator>Kaufman, Jon</creator><general>Springer-Verlag</general><general>Springer</general><general>Springer Nature B.V</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20120701</creationdate><title>Prospective validation of the vasoactive-inotropic score and correlation to short-term outcomes in neonates and infants after cardiothoracic surgery</title><author>Davidson, Jesse ; Tong, Suhong ; Hancock, Hayley ; Hauck, Amanda ; da Cruz, Eduardo ; Kaufman, Jon</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c605t-cb8a79363aca7f2ea13a265faa6ceb14e8fa5671397b67607ea8e0b78377c4803</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Analysis</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Anesthesiology</topic><topic>Biological and medical sciences</topic><topic>Cardiac Output, Low - drug therapy</topic><topic>Cardiac Output, Low - etiology</topic><topic>Cardiac Output, Low - physiopathology</topic><topic>Cardiac Surgical Procedures - adverse effects</topic><topic>Cardiotonic Agents - therapeutic use</topic><topic>Clinical outcomes</topic><topic>Creatinine</topic><topic>Critical Care Medicine</topic><topic>Dopamine</topic><topic>Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care</topic><topic>Emergency Medicine</topic><topic>Gestational age</topic><topic>Health aspects</topic><topic>Heart Defects, Congenital - surgery</topic><topic>Heart surgery</topic><topic>Hemodynamics</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Infants (Newborn)</topic><topic>Intensive</topic><topic>Intensive care</topic><topic>Intensive care medicine</topic><topic>Intensive Care Units, Pediatric - statistics & numerical data</topic><topic>Intubation</topic><topic>Intubation - statistics & numerical data</topic><topic>Lactates</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Logistic Models</topic><topic>Medical sciences</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mortality</topic><topic>Observational studies</topic><topic>Outcome Assessment, Health Care</topic><topic>Pain Medicine</topic><topic>Pediatric cardiology</topic><topic>Pediatric Original</topic><topic>Pediatrics</topic><topic>Pneumology/Respiratory System</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative period</topic><topic>Predictive Value of Tests</topic><topic>Prospective Studies</topic><topic>ROC Curve</topic><topic>Surgeons</topic><topic>Vasodilator Agents - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Davidson, Jesse</creatorcontrib><creatorcontrib>Tong, Suhong</creatorcontrib><creatorcontrib>Hancock, Hayley</creatorcontrib><creatorcontrib>Hauck, Amanda</creatorcontrib><creatorcontrib>da Cruz, Eduardo</creatorcontrib><creatorcontrib>Kaufman, Jon</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Nursing & Allied Health Database</collection><collection>ProQuest Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Intensive care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Davidson, Jesse</au><au>Tong, Suhong</au><au>Hancock, Hayley</au><au>Hauck, Amanda</au><au>da Cruz, Eduardo</au><au>Kaufman, Jon</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prospective validation of the vasoactive-inotropic score and correlation to short-term outcomes in neonates and infants after cardiothoracic surgery</atitle><jtitle>Intensive care medicine</jtitle><stitle>Intensive Care Med</stitle><addtitle>Intensive Care Med</addtitle><date>2012-07-01</date><risdate>2012</risdate><volume>38</volume><issue>7</issue><spage>1184</spage><epage>1190</epage><pages>1184-1190</pages><issn>0342-4642</issn><eissn>1432-1238</eissn><coden>ICMED9</coden><abstract>Purpose
Prospective validation of the vasoactive-inotropic score (VIS) and inotrope score (IS) in infants after cardiovascular surgery.
Methods
Prospective observational study of 70 infants (≤90 days of age) undergoing cardiothoracic surgery. VIS and IS were assessed at 24 (VIS24, IS24), 48 (VIS48, IS48), and 72 (VIS72, IS72) h after surgery. Maximum VIS and IS scores in the first 48 h were also calculated (VIS48max and IS48max). The primary outcome was length of intubation. Additional outcomes included length of intensive care (ICU) stay and hospitalization, cardiac arrest, mortality, time to negative fluid balance, peak lactate, and change in creatinine.
Results
Based on receiver-operating characteristic (ROC) analysis, the area under the curve (AUC) was highest for VIS48 to identify prolonged intubation time. AUC for the primary outcome was higher for VIS than IS at all time points assessed. On multivariate analysis VIS48 was independently associated with prolonged intubation (OR 22.3,
p
= 0.002), prolonged ICU stay (OR 8.1,
p
= 0.017), and prolonged hospitalization (OR 11.3,
p
= 0.011). VIS48max, IS48max, and IS48 were also associated with prolonged intubation, but not prolonged ICU or hospital stay. None of the scores were associated with time to negative fluid balance, peak lactate, or change in creatinine.
Conclusion
In neonates and infants, a higher VIS at 48 h after cardiothoracic surgery is strongly associated with increased length of ventilation, and prolonged ICU and total hospital stay. At all time points assessed, VIS is more predictive of poor short-term outcome than IS. VIS may be useful as an independent predictor of outcomes.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer-Verlag</pub><pmid>22527067</pmid><doi>10.1007/s00134-012-2544-x</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Intensive care medicine, 2012-07, Vol.38 (7), p.1184-1190 |
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| language | eng |
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| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Analysis Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Anesthesiology Biological and medical sciences Cardiac Output, Low - drug therapy Cardiac Output, Low - etiology Cardiac Output, Low - physiopathology Cardiac Surgical Procedures - adverse effects Cardiotonic Agents - therapeutic use Clinical outcomes Creatinine Critical Care Medicine Dopamine Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care Emergency Medicine Gestational age Health aspects Heart Defects, Congenital - surgery Heart surgery Hemodynamics Hospitals Humans Infant Infant, Newborn Infants (Newborn) Intensive Intensive care Intensive care medicine Intensive Care Units, Pediatric - statistics & numerical data Intubation Intubation - statistics & numerical data Lactates Length of Stay - statistics & numerical data Logistic Models Medical sciences Medicine Medicine & Public Health Mortality Observational studies Outcome Assessment, Health Care Pain Medicine Pediatric cardiology Pediatric Original Pediatrics Pneumology/Respiratory System Postoperative Complications - epidemiology Postoperative period Predictive Value of Tests Prospective Studies ROC Curve Surgeons Vasodilator Agents - therapeutic use |
| title | Prospective validation of the vasoactive-inotropic score and correlation to short-term outcomes in neonates and infants after cardiothoracic surgery |
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