Archive for the ‘Patients’ Category

Transplant Allows Teen to Enjoy Birthday Cake for the First Time in Years

For the first eleven years of his life, Tyson Smith did everything a normal kid would do. He went to school, played with friends and had birthday parties. His normal life changed when complications arose after a bout of H1N1 influenza. His parents took him to the doctor in their small home town of Sharon Springs, Kansas. Tyson couldn’t eat; he was weak; he was losing weight.

“By the time we took him to the children’s hospital in Denver, I had to carry him. He couldn’t walk,” remembers Tyson’s father Justin Smith. “In less than a year, he lost half his body weight. Forty-two pounds.”

Over the next several years, there were numerous surgeries and hospital stays for Tyson.

smith, tyson
Tyson Smith and his parents Wendy and Justin enjoy birthday cake together for the first time in six years. His 17th birthday party was held at the Ronald McDonald House Sept. 11, 2013.

“Every holiday, every birthday we spent in the hospital,” Smith says.

His mother quit her job to care for him. His father would make the three hour drive from Denver to Sharon Springs to continue working to support the family. Neighbors and co-workers pitched in. But Tyson’s health was still failing. He could no longer eat and received all his nutrition through a feeding tube.

“I lived for months in the hospital, ICU stays,” Tyson says. “Many times, I had to say my goodbyes to my family. I heard doctors say I wasn’t going to make it; that they could make me comfortable, but that there wasn’t really anything they could do.”

His condition worsened to the point that physicians in Denver said Tyson might be a candidate for an intestinal transplant.

“They first suggested contacting Pittsburgh, which we did,” Smith says. “But we ran into someone in Denver who had been through the same thing. She said, ‘Go to Omaha. That’s what we did. And we’re from Pittsburgh.’”

It’s a decision the Smiths are very glad they made.

“The care has been awesome,” Tyson’s mom Wendy Smith says. “He got his second chance. He’s going to make it.”

Tyson’s transplant team has every reason to be optimistic. One month and three days after having his intestine, liver and pancreas transplanted, Tyson was out of the hospital.

“He’s made an excellent recovery,” says David F. Mercer, MD, PhD, Tyson’s transplant surgeon. “He should be able to do what he wants, what activities he wants to; travel, be whatever he wants when he grows up.”

Tyson had just gotten used to eating again after so many years on feeding tubes. The idea of a birthday party with actual cake was a lot for him to process.

“It’s going to be very emotional. I haven’t done anything like that in over five years. It’s a huge milestone in my life. It’s my 17th birthday, but it’s like the first day of my life. It represents a new beginning.”

 

Dr. Wang’s research offers hope for family with history of cancer

by Vicky Cerino, UNMC public relations

 

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San Ming Wang. M.D. 

It’s not very often that those affected by breast cancer come face-to-face with researchers trying to find a cure for the disease.

Brandi Preston, 22, was one of five women who met in late summer with UNMC breast cancer researcher San Ming Wang, M.D.

Dr. Wang had just spoken about the latest in breast cancer research to the local members of Bright Pink, a support group chapter for those affected by familial breast cancer — those who carry a gene that can be passed down.

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Ben, Bailey and Brandi Preston (Photo courtesy Preston family) 

It was an emotional experience for Dr. Wang.

“I use DNA material from patients to study, but that was the first time I had direct contact with patients,” Dr. Wang said. “I learned from them all how psychologically stressful it is to have a breast cancer gene — like carrying a time bomb.

“I feel more pressure when I think about the patient,” he said. “It’s not so simple anymore to think of my research work as just science.”

Preston said meeting Dr. Wang was fascinating.

“He is doing so much amazing research,” Preston said. “It gives me a lot of hope for the future.”

Preston is facing a decision of whether or not to have a double mastectomy.

Preston’s mother carried the BRCA1 gene, as did her grandmother, great-grandmother and great- great grandmother. (Both her great-grandmother and great-great grandmother had breast and ovarian cancer.)

Preston’s mother was diagnosed with breast cancer on Thanksgiving of 2000. Before she passed away in 2005 at the age of 40, she asked Brandi to be tested for the BRCA gene when she turned 19.

The test came back positive. Preston’s brother also is positive for the BRCA I gene.

The gene requires extra vigilance. Every six months Preston has a breast exam, a yearly breast MRI, ovarian screening and a pap smear.

“Knowledge is power,” she said. “Now that I know I have this gene, I can do something about it. I can monitor.

“After each breast exam I say, ‘Whew, no cancer, I’m good for another six months.’ But why wait until I develop it? That’s why I’m thinking of having the double mastectomy.”

 

Eyeing new discoveries in Shanghai

by Tom O’Connor, UNMC public relations

 

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Shan Fan, M.D., and Carol Toris, Ph.D., of UNMC, with Tao Guo, M.D., associate professor of ophthalmology, Tenth People’s Hospital, Shanghai. 

SHANGHAI – Quan Dong Nguyen, M.D., is pumped.

The new chairman of ophthalmology and visual sciences, part of the UNMC delegation in China, is excited about the research that UNMC is doing with Tongji University and Tenth People’s Hospital in Shanghai.

The work, led by Carol Toris, Ph.D., professor of ophthalmology and visual sciences, is aimed at improving our understanding of glaucoma, the leading cause of irreversible blindness in the United States and worldwide. More than 60 million people in the world are living with glaucoma. It’s estimated that more than 80 million people will develop glaucoma by 2020.

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From left, UNMC’s Quan Dong Nguyen, M.D., UNMC’s Carol Toris, Ph.D., Fang Wang, M.D., chair of the department of ophthalmology at Tenth People’s Hospital, and UNMC’s Shan Fan, M.D.

“It’s all about aqueous humor dynamics,” Dr. Nguyen said. Glaucoma can occur when the optic nerve is damaged, and frequently this is associated with high intraocular pressure.

That’s where aqueous humor dynamics come into play. To maintain intraocular pressure at a steady level requires a fine balance between the production, circulation and drainage of ocular aqueous humor.

Dr. Toris is one of the leading experts in the world on aqueous humor dynamics — Google the term and Dr. Toris’ name is the first to appear.

Working with Tongji University and Tenth People’s Hospital researchers led by Tao Guo, M.D., Dr. Toris, along with Shan Fan, M.D., assistant professor of ophthalmology and visual sciences and also with UNMC’s delegation to Shanghai, measure fluid flow in the eyes of volunteers.

They have studied healthy Caucasian adults, an ethnic group that is prone to a certain type of glaucoma. Now in collaboration with Tenth People’s Hospital they are studying healthy Chinese adults, an ethnic group that is prone to a different kind of glaucoma.

The team will compare data to identify differences that may help explain why people may get a particular kind of glaucoma. These findings should help determine the best treatments for the particular type of glaucoma.

“With a population of 1.35 billion, China is a fertile environment for finding research subjects,” Dr. Nguyen said.

“It’s a great collaboration,” Dr. Nguyen proclaimed. “To have all these patients done on Chinese soil is indicative of how well the project is going.”

In the next two years, Dr. Nguyen said that the Truhlsen Eye Institute at UNMC, and Tongji University and Tenth People’s Hospital hope to combine forces on several other projects, expanding to other areas of significant concerns for visual loss such as age-related macular degeneration, diabetic retinopathy, and uveitis and ocular inflammation.

 

Dr. Silva: Investigate options for breast cancer treatment

by Kalani Simpson, UNMC public relations

 

VIDEO: Edibaldo Silva, M.D., Ph.D., discusses breast cancer fears
The fear of breast cancer hangs over many women like a dark cloud.

 

Edibaldo Silva, M.D., Ph.D., professor of surgical oncology, understands why some take immediate, even drastic, action in order to achieve peace of mind.
But Dr. Silva, who specializes in the research and treatment of breast cancer, counsels his patients to sit down with their team of health care providers first.
A week or two or three of gathering information won’t hurt your long-term prognosis, he said.

“What you see in the U.S. now is women have a lump in the breast and they find it’s cancer, and the next day they are having bilateral double mastectomy,” Dr. Silva said. “No consideration of counseling, genetic testing, none of that.”

In fact, Dr. Silva said, on average among women who have a double mastectomy in the U.S., only 29 percent ever even discuss the subject with a genetic counselor to see if they carry mutated BRCA genes which cause breast and incurable ovarian cancer.

Studies by the University of Michigan, the Mayo Clinic and others show most women are doing it out of fear.

Dr. Silva said it’s important to remember that only 5 percent of women who contract breast cancer have “bad genes.” The rest simply had “bad luck,” likely a one-time occurrence.

And their cancer is often best treated with lumpectomies and radiation, the effectiveness of which “we know is equivalent to mastectomy,” Dr. Silva said.
A possible option for many women diagnosed with breast cancer could be to start chemotherapy while simultaneously taking the time to gather information, Dr. Silva said.

First, it is actively fighting the cancer. Second, if surgery is necessary, it makes the surgery more effective and easier to complete. Third, in some cases, the cancer may be gone by the end of the chemo treatment.

“And by gone, I mean you can’t find it,” Dr. Silva said.

If you are worried that you carry the BRCA gene mutation, draw up your family tree, Dr. Silva said, and visit with a genetic counselor to see if you should get further testing.

“The odds are overwhelmingly in your favor that you are not a gene carrier,” Dr. Silva said.

But if you are among the statistically select few, it is serious.

The gene causes a 20 percent to 40 percent risk of developing incurable ovarian cancer, Dr. Silva said, and double mastectomy and eventual removal of ovaries are recommended.

 

Islet Cell Transplant Gives Patient Her Life Back

Facing No Other Option, Linda Elonich Agrees to Life-Changing Surgery

For seven years, Linda Elonich lived with the excruciating pain of pancreatitis attacks. The Omaha woman says it started suddenly in her sleep – pain so severe she couldn’t speak. She thought she was dying. She underwent several surgeries over the next several years, but continued attacks meant she could no longer work, travel or spend much time away from home. Her doctors brought up the idea of removing her pancreas and performing an islet cell transplant. They were cautious, but Elonich was ready.

“I said, ‘Let’s do it.’ I hurt so bad at that point, I had no fear of it. It was a chance for relief,” she recalls.

Her husband and her doctors urged caution, but a serious and extremely painful attack led them all to believe the time was right.

“The islet cell transplant is the second part of a procedure for patients who have their pancreas taken out,” explains Brian Boerner, MD, endocrinologist. “Those are patients who have no other option for treatment. As part of that, we can remove the islets, the insulin-producing cells from the pancreas and put them back into the person’s liver where they function and prevent serious diabetes.”

After a successful transplant, the liver essentially performs the function of the pancreas.

Though not the first islet cell transplant performed here, Elonich’s operation was the first done as part of the medical center’s Pancreas and Biliary Disorders Clinic.

“It went off without a hitch and went according to plan,” says Luciano Vargas, MD, the transplant surgeon who performed Elonich’s procedure.

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Transplant surgeon Luciano Vargas, MD, looks on as Linda Elonich’s islet cells are infused into her liver.

The operation took most of the day. In the first part of the surgery, Dr. Vargas removed the pancreas and sent it to our Biologics Production Facility (BPF). Scientists there spent four to six hours isolating the islet cells and prepare them for re-infusion into the patient’s liver.

“The expertise at the lab is phenomenal,” Dr. Vargas says. “You can tell by how Linda is doing.”

When the cells are ready to be infused into the liver, BPF staff brings the bags of cells to the OR where the surgical team is waiting.

Elonich says she could tell a difference as soon as she woke up from surgery. After a recent check up with both Drs. Boerner and Vargas, Elonich says she has a new outlook on life.

“It’s nice to wake up in the morning. Every day is a beautiful day,” she says. She recently traveled to Arkansas to visit her 93-year-old grandmother; something that would have been impossible before the surgery.

Elonich has praise not only for the expertise at the medical center, but for the caring personalities of everyone she’s met from the clinics to the hospital.

“These people for me are life savers. Most people going to the doctor, they dread it. It’s not like that for me. They’re like family to me now; we’ve been through something so personal and life-changing together.”

Watch more of Linda’s story.

 

UNMC team finds early heart disease warning with simple blood test

by Charlie Litton, UNeMed

 
thieleGeoff Thiele, Ph.D. 

It’s a virtual certainty that everyone over 50 – more than 98 million Americans -has coronary artery disease. So do 70 percent of 40-year-olds. About half of people in their 20s and 30s probably have it too.
Yet heart disease doesn’t kill everybody.

Understanding why has been a confounding riddle for modern medicine.

An team of researchers at UNMC believe they’ve made a potentially groundbreaking discovery — a test that determines whether a patient is harboring the dangerous type of heart disease that kills one in four Americans every year.
 
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Michael Duryee 

Unfortunately, that heart attack is too often the first indication that a patient has the lethal form of coronary artery disease. But UNMC’s new test could change that.

Geoff Thiele, Ph.D. a professor of internal medicine, and Michael Duryee, a research coordinator for the division of rheumatology and immunology, made the initial discovery. While looking for clues to help understand inflammatory conditions such as arthritis, they focused on a molecule that is a strong indicator of inflammation.

Known as MAA or malondialdehyde-acetaldehyde, the molecule also appeared to indicate the presence of coronary artery disease.

Dr. Thiele and Duryee brought in Dan Anderson, M.D., Ph.D., an assistant professor in cardiology. He has a frontline view of the battle against the world’s most prolific killer. 
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Dan Anderson, M.D., Ph.D. 

“In the current realm of understanding disease, we know that inflammation is important in cardiovascular disease,” Dr. Anderson said. “But we really don’t understand a lot about why or how.”

By current measures, Anderson said, about 30 percent of people with heart disease slip through the cracks. For those people, the first indication of trouble may be a killer heart attack.

But others with the disease suffer few, if any, ill-effects. Predicting which patients will develop the more deadly form of heart disease is little more than a guess.
Then Dr. Thiele and Duryee knocked on the door.

“From a clinical diagnostic perspective, this becomes invaluable to help understand those different groups of patients,” Dr. Anderson said.

The research team and UNMC’s technology transfer office, UNeMed Corporation, are currently in preliminary discussions with several companies on how to translate the results into products that can better factor in a patient’s risk of heart attack.

The next rounds of testing will be critical to understand how accurate the test can be, particularly studies that follow individual patients over the course of five or 10 years, Duryee said.

 

UNMC study to test ‘breakthrough’ drug in mantle cell lymphoma patients

by Vicky Cerino 

 
voseJulie Vose, M.D. 

The University of Nebraska Medical Center is involved in testing a drug the Food and Drug Administration has fast-tracked towards approval because of its dramatic results in patients with mantle cell lymphoma and other cancers.

“This experimental drug, Ibruitinib, is so promising that the FDA gave it fast track designation which rarely happens,” said Julie M. Vose, M.D., chief of the division of hematology and oncology and Neumann M. and Mildred E. Harris Professor at UNMC.

“Patients who’ve been on the treatment have had remarkable results with limited side effects. We are able to offer this to patients through an expanded access program which occurs about six months before the FDA approves it.”

The new study is targeted for patients age 18 and older with mantle cell lymphoma who’ve relapsed – meaning other treatments have failed. The study, which aims to enroll as many patients as possible, is being conducted in about 50 locations across the United States and in Puerto Rico. Those eligible for the study will be provided the drug at no cost.

The FDA designated Ibruitinib as a breakthrough therapy. The designation is intended to expedite the development and review of drugs for serious or life-threatening conditions that demonstrate the drug may have substantial improvement over available therapy. The study will remain open until the medication is FDA approved, which should be by the end of the year, Dr. Vose said.

Dr. Vose, who is principal investigator of the UNMC study, said Ibruitinib works differently than other drugs for this type of cancer. The drug, developed by Pharmacyclics, Inc and Johnson & Johnson’s Janssen Pharmaceutical division, basically poisons one of the pathways that helps the cancer grow.

“It kills the lymphoma,” she said. “It has fairly limited side effects. It’s a pill rather than an intravenous delivery, and it also has potential to be used with other treatments due to the limited side effects.”

Steven “Robert” Whisnant of Morganton, N.C., and his wife, Quteen, came from North Carolina for the trial after his physicians told him there was nothing else they could do. Whisnant has had a dramatic response to the medication as have many other patients, Dr. Vose said.

“I’m thankful that there’s somebody out there trying to find different things to help people because if I hadn’t have gotten the medication, I’d have died,” Whisnant said. “So far it seems to be working. All the tumors in my neck are gone and the ones in my stomach have shrunken. It gives us hope and I’m thankful for that.”

Mantle cell lymphoma is a rare, B-cell non-Hodgkin lymphoma that most often affects men over the age of 60. The disease may be fast or slow growing. It comprises about five percent of all non-Hodgkin lymphomas.

Dr. Vose said results thus far have seen a 75 percent response rate in patients with mantle cell lymphoma whose disease has failed all other treatments.

“We have been involved in several of the first clinical trials with this particular medication,” Dr. Vose said. “We don’t think it’s a cure but it’s been found to be able to keep patients in remission longer to control their symptoms and allow them to have a good quality of life. These patients have very limited other options. This is a breakthrough and works very quickly.”

Clinical trials began on Ibruitinib a few years ago. It also is being tested at other sites for other types of lymphoma, leukemia and multiple myeloma.

Other co-investigators in the study are UNMC physicians Jim Armitage, M.D., Phil Bierman, M.D., and Greg Bociek, M.D.

For more information about the study, contact Maribeth at 402 559-9053 or mahohens@unmc.edu. For a complete list of other study locations go to clinicaltrials.gov and search “NCT01833039.” The study is funded by the drug company.

Through world-class research and patient care, UNMC generates breakthroughs that make life better for people throughout Nebraska and beyond. Its education programs train more health professionals than any other institution in the state. Learn more at unmc.edu.

 

New laser a cutting edge treatment for retinal diseases

by Bill Citro, UNMC Physicians

 
eyeQuan Dong Nguyen, M.D., left, and Diana Do, M.D. 

A new laser is helping experts at the Truhlsen Eye Institute provide better treatment for eye diseases. This advanced laser can prevent blindness for some patients with serious conditions.

“This new laser with yellow light is currently the only one of its caliber in the U.S., and there’s only one other being used in the world right now,” said Quan Dong Nguyen, M.D., the McGaw Memorial Endowed Chair in Ophthalmology and the director of the Truhlsen Eye Institute.

On July 22, the first patient received treatment from the laser for proliferative diabetic retinopathy, the most severe stage of eye disease caused by diabetes.
“Overall, it is more effective, efficient and may be safer than traditional lasers.”
Diana Do, M.D.

“This laser is the most cutting-edge laser device available today,” said Diana Do, M.D., associate professor of ophthalmology and director of the Carl Camras Center for Innovative Clinical Research at the Truhlsen Eye Institute.

Dr. Do was the retina specialist who performed the first treatment.

“It allows us to apply a large number of laser spots in a variety of patterns. Overall, it is more effective, efficient and may be safer than traditional lasers,” she said.

Traditional lasers are limited in the number of patterns and pulsing they can accommodate, whereas the new laser allows for more nuanced and problem-specific targeting, Dr. Do said.

The laser provides treatment for various rare eye diseases, including retinal vein occlusion, neovascular glaucoma, and retinal tears. In addition, with micropulse application capability, it also can be combined with other therapies to treat diabetic macular edema, the most common cause of moderate vision loss for diabetes patients.

“With diabetes rates on the rise nationally and in Nebraska, more and more patients will be able to benefit from the superior treatment that new technology like this can bring,” Dr. Do said.

The full name of the laser is the Supra Scan Multi-spot Laser. It is manufactured by Quantel Medical, which is headquartered in Paris, France.

The Truhlsen Eye Institute, which opened in June 2013 at 3902 Leavenworth St., is the newest building on UNMC’s campus, and offers state-of-the-art eye care in many eye subspecialties as well as routine prescription and optical shop services.

To make an appointment at the Truhlsen Eye Institute, please call 402-559-2020.

 

Trial explores new treatment for ‘silent killer’

by Kalani Simpson, UNMC public relations

baxter 
Timothy Baxter, M.D.-

When diagnosed with an abdominal aortic aneurysm, all most people can do is worry, watch and wait. Timothy Baxter, M.D., professor of surgery, has compared it to being forced to live with the ticking of a time bomb.

It can take years before an aneurysm is recommended for repair — when it finally grows large enough (about 5.5 cm) that the risk of rupture outweighs the risk of surgery.

“This approach is very unsettling to patients,” Dr. Baxter said.

“Some people, every day they wake up worrying about it,” agreed Jason MacTaggart, M.D., assistant professor, surgery.

Most would rather do something, anything. Now, at least a few of them can.
UNMC is the clinical coordinating center for a $12.2 million multi-center randomized placebo-controlled clinical trial of medical management of aneurysm disease. The management would be via a pill, which some scientists believe will significantly slow aneurysm growth. The study is being conducted under the auspices of a National Institutes of Health grant.

“It’s considered a silent killer because there are no symptoms until it ruptures.”Timothy Baxter, M.D.

 

The Non-Invasive Treatment of Abdominal Aortic Aneurysm Clinical Trial (NTA3CT) aims to enroll 250 patients with the collaboration of 15 top academic medical centers across the U.S.

Fifty percent of the trial’s enrollees will receive the antibiotic doxycycline, an inexpensive generic now widely used for acne and other conditions. Dr. Baxter’s preliminary research in animal models shows the drug inhibits the enzymes which weaken aortic walls, thus causing aneurysms.

If successful, it’s an inexpensive, noninvasive, proactive approach.

Dr. MacTaggart said the surgery to repair aneurysms can come with a mortality rate of up to 3 percent — and a cost that can run from $20,000 to $100,000. More than 40,000 such procedures are done each year nationwide.

“Multiply all of that together,” Dr. MacTaggart said. “If you can change a $100,000 operation to $10 a year for some pills, it’s going to save the health care system a ton of money.”

But the study will show more than whether the pill works. It should also garner a host of invaluable information.

Aortic aneurysms affect 3 percent to 5 percent of the population, but are most common in men age 65 and older, often smokers with a family history.

“It’s considered a silent killer,” Dr. Baxter said, “because there are no symptoms until it ruptures. Most aneurysms we find by luck when imaging is done for other medical conditions.”

And then, there is only worrying and waiting as it grows. Nothing you can do.

Until now.

 

UNMC nanotechnology protects skin from cancer, early wrinkles

by Charlie Litton, UNeMed

nano

ProTransit Nanotherapy co-founder Gary Madsen (left) and UNeMed Corp. president Michael Dixon sign the licensing agreement on a technology that could make skin care products more protective against harmful UV radiation from the sun. (Photo by Jack Mayfield/UNeMed) 

Nanotechnology developed at UNMC could turn things such as sunscreen and anti-aging cosmetics into even more potent barriers protecting the skin from UV radiation that can cause wrinkles and skin cancer.

A new startup company, ProTransit Nanotherapies, L.L.C., was founded on the innovation and hopes to commercialize the nontoxic, biodegradable system within the next 18 months.

If successful, the nanotechnology could serve as a platform that can deliver targeted treatments to a vast range of ailments, including stroke and heart disease.

The root cause of many of those diseases are renegade atoms or molecules known as free radicals that damage neighboring cells. The best-known weapons against free radicals are antioxidants. But effectively delivering those antioxidants has been a challenging riddle for modern science.

Vinod Labhasetwar, Ph.D., a former faculty member at UNMC’s Department of Pharmaceutical Sciences, appears to have solved that problem.

Dr. Labhasetwar — currently a professor of biomedical engineering at the Lerner Research Institute at Cleveland Clinic in Ohio — developed nanoparticles that can carry a wide range of proteins, enzymes and even genetic materials that can be customized to deliver targeted treatments.

The first application of the nanotechnology will be to deliver a powerful blend of protective antioxidants in topical formulations to protect skin from the sun’s UV radiation — a major cause of skin cancer and premature skin aging.

ProTransit Nanotherapy was formed in collaboration with Gary Madsen, Ph.D., the entrepreneur in residence at UNeMed Corporation. UNeMed is the technology transfer office at UNMC.

Dr. Madsen will serve as the new company’s president and CEO. Dr. Labhasetwar, a co-founder of the company, will serve as the chief scientific officer.
ProTransit Nanotherapy also works with UNMC’s Center for Drug Delivery and Nanomedicine to develop facilities for the manufacture of nanoparticles and other nanomedical products.

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