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Volumn 5, Issue 1, 2010, Pages

Intravenous immunoglobulin for the treatment of severe Clostridium difficile colitis: An observational study and review of the literature

Author keywords

Clostridium difficile; Diarrhea; Immunity; Immunoglobulin; Nosocomial infection

Indexed keywords

CEFAZOLIN; CEFEPIME; CEFTRIAXONE; CEPHALOSPORIN; COLESTYRAMINE; IMMUNOGLOBULIN; LEVOFLOXACIN; METRONIDAZOLE; PIPERACILLIN PLUS TAZOBACTAM; PROBIOTIC AGENT; QUINOLINE DERIVED ANTIINFECTIVE AGENT; SULTAMICILLIN; VANCOMYCIN;

EID: 74949110785     PISSN: 15535592     EISSN: 15535606     Source Type: Journal    
DOI: 10.1002/jhm.542     Document Type: Article
Times cited : (75)

References (48)
  • 1
    • 2442464696 scopus 로고    scopus 로고
    • Secular trends in hospital-acquired Clostridium difficile disease in the United States, 1987-2001
    • Archibald LK, Banerjee SN, Jarvis WR. Secular trends in hospital-acquired Clostridium difficile disease in the United States, 1987-2001. J Infect Dis. 2004;189:1585-1589.
    • (2004) J Infect Dis , vol.189 , pp. 1585-1589
    • Archibald, L.K.1    Banerjee, S.N.2    Jarvis, W.R.3
  • 2
    • 0036192008 scopus 로고    scopus 로고
    • Fulminant Clostridium difficile: An underappreciated and increasing cause of death and complications
    • Dallal RM, Harbrecht BG, Boujoukas AJ, et al. Fulminant Clostridium difficile: an underappreciated and increasing cause of death and complications. Ann Surg. 2002;235:363-372.
    • (2002) Ann Surg , vol.235 , pp. 363-372
    • Dallal, R.M.1    Harbrecht, B.G.2    Boujoukas, A.J.3
  • 3
    • 28844494086 scopus 로고    scopus 로고
    • An epidemic, toxin genevariant strain of Clostridium difficile
    • McDonald LC, Killgore GE, Thompson A, et al. An epidemic, toxin genevariant strain of Clostridium difficile. N Engl J Med. 2005;353:2433-2441.
    • (2005) N Engl J Med , vol.353 , pp. 2433-2441
    • McDonald, L.C.1    Killgore, G.E.2    Thompson, A.3
  • 4
    • 4444382260 scopus 로고    scopus 로고
    • Clostridium difficile-associated diarrhea in a region of Quebec from 1991 to 2003: A changing pattern of disease severity
    • Pepin J, Valiquette L, Alary ME, et al. Clostridium difficile-associated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity. CMAJ. 2004;171:466-472.
    • (2004) CMAJ , vol.171 , pp. 466-472
    • Pepin, J.1    Valiquette, L.2    Alary, M.E.3
  • 5
    • 0019859594 scopus 로고
    • Comparison of two toxins produced by Clostridium difficile
    • Taylor NS, Thorne GM, Bartlett JG. Comparison of two toxins produced by Clostridium difficile. Infect Immun. 1981;34:1036-1043.
    • (1981) Infect Immun , vol.34 , pp. 1036-1043
    • Taylor, N.S.1    Thorne, G.M.2    Bartlett, J.G.3
  • 6
    • 0034628426 scopus 로고    scopus 로고
    • Asymptomatic carriage of Clostridium difficile and serum levels of IgG antibody against toxin A
    • Kyne L, Warny M, Qamar A, Kelly CP. Asymptomatic carriage of Clostridium difficile and serum levels of IgG antibody against toxin A. N Engl J Med. 2000;342:390-397.
    • (2000) N Engl J Med , vol.342 , pp. 390-397
    • Kyne, L.1    Warny, M.2    Qamar, A.3    Kelly, C.P.4
  • 7
    • 0028089161 scopus 로고
    • Human antibody response to Clostridium difficile toxin A in relation to clinical course of infection
    • Warny M, Vaerman JP, Avesani V, Delmee M. Human antibody response to Clostridium difficile toxin A in relation to clinical course of infection. Infect Immun. 1994;62:384-389.
    • (1994) Infect Immun , vol.62 , pp. 384-389
    • Warny, M.1    Vaerman, J.P.2    Avesani, V.3    Delmee, M.4
  • 8
    • 0025161604 scopus 로고
    • Risk factors for Clostridium difficile carriage and C. difficile-associated diarrhea in a cohort of hospitalized patients
    • McFarland LV, Surawicz CM, Stamm WE. Risk factors for Clostridium difficile carriage and C. difficile-associated diarrhea in a cohort of hospitalized patients. J Infect Dis. 1990;162:678-684.
    • (1990) J Infect Dis , vol.162 , pp. 678-684
    • McFarland, L.V.1    Surawicz, C.M.2    Stamm, W.E.3
  • 9
    • 0028913365 scopus 로고    scopus 로고
    • Rubin MS, Bodenstein LE, Kent KC. Severe Clostridium difficile colitis. Dis Colon Rectum. 1995;38:350-354.
    • Rubin MS, Bodenstein LE, Kent KC. Severe Clostridium difficile colitis. Dis Colon Rectum. 1995;38:350-354.
  • 10
    • 28844441314 scopus 로고    scopus 로고
    • A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality
    • Loo VG, Poirier L, Miller MA et al. A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med. 2005;353:2442-2449.
    • (2005) N Engl J Med , vol.353 , pp. 2442-2449
    • Loo, V.G.1    Poirier, L.2    Miller, M.A.3
  • 11
    • 4344559215 scopus 로고    scopus 로고
    • Factors associated with failure of metronidazole in Clostridium difficile-associated disease
    • Fernandez A, Anand G, Friedenberg F. Factors associated with failure of metronidazole in Clostridium difficile-associated disease. J Clin Gastroenterol. 2004;38:414-418.
    • (2004) J Clin Gastroenterol , vol.38 , pp. 414-418
    • Fernandez, A.1    Anand, G.2    Friedenberg, F.3
  • 12
    • 23944507069 scopus 로고    scopus 로고
    • Treatment of Clostridium difficile-associated disease: Old therapies and new strategies
    • Aslam S, Hamill RJ, Musher DM. Treatment of Clostridium difficile-associated disease: old therapies and new strategies. Lancet Infect Dis. 2005;5: 549-557.
    • (2005) Lancet Infect Dis , vol.5 , pp. 549-557
    • Aslam, S.1    Hamill, R.J.2    Musher, D.M.3
  • 13
    • 19344364596 scopus 로고    scopus 로고
    • Relatively poor outcome after treatment of Clostridium difficile colitis with metronidazole
    • Musher DM, Aslam S, Logan N, et al. Relatively poor outcome after treatment of Clostridium difficile colitis with metronidazole. Clin Infect Dis. 2005;40:1586-1590.
    • (2005) Clin Infect Dis , vol.40 , pp. 1586-1590
    • Musher, D.M.1    Aslam, S.2    Logan, N.3
  • 14
    • 19344363493 scopus 로고    scopus 로고
    • Increasing risk of relapse after treatment of Clostridium difficile colitis in Quebec, Canada
    • Pepin J, Alary ME, Valiquette L, et al. Increasing risk of relapse after treatment of Clostridium difficile colitis in Quebec, Canada. Clin Infect Dis. 2005;40:1591-1597.
    • (2005) Clin Infect Dis , vol.40 , pp. 1591-1597
    • Pepin, J.1    Alary, M.E.2    Valiquette, L.3
  • 15
    • 0025727765 scopus 로고
    • Treatment with intravenously administered gamma globulin of chronic relapsing colitis induced by Clostridium difficile toxin
    • Leung DY, Kelly CP, Boguniewicz M, Pothoulakis C, LaMont JT, Flores A. Treatment with intravenously administered gamma globulin of chronic relapsing colitis induced by Clostridium difficile toxin. J Pediatr. 1991; 118:633-637.
    • (1991) J Pediatr , vol.118 , pp. 633-637
    • Leung, D.Y.1    Kelly, C.P.2    Boguniewicz, M.3    Pothoulakis, C.4    LaMont, J.T.5    Flores, A.6
  • 16
    • 0028911365 scopus 로고
    • Gamma globulin administration in relapsing Clostridium difficile-induced pseudomembranous colitis with a defective antibody response to toxin A
    • Warny M, Denie C, Delmee M, Lefebvre C. Gamma globulin administration in relapsing Clostridium difficile-induced pseudomembranous colitis with a defective antibody response to toxin A. Acta Clin Belg. 1995;50: 36-39.
    • (1995) Acta Clin Belg , vol.50 , pp. 36-39
    • Warny, M.1    Denie, C.2    Delmee, M.3    Lefebvre, C.4
  • 17
    • 0028997769 scopus 로고
    • Recurrent Clostridium difficile infection in a patient with selective IgG1 deficiency treated with intravenous immune globulin and Saccharomyces boulardii
    • Hassett J, Meyers S, McFarland L, Mulligan ME. Recurrent Clostridium difficile infection in a patient with selective IgG1 deficiency treated with intravenous immune globulin and Saccharomyces boulardii. Clin Infect Dis. 1995;20(suppl 2):S266-S268.
    • (1995) Clin Infect Dis , vol.20 , Issue.SUPPL. 2
    • Hassett, J.1    Meyers, S.2    McFarland, L.3    Mulligan, M.E.4
  • 18
    • 0036719950 scopus 로고    scopus 로고
    • Intravenous immunoglobulin for recurrent Clostridium difficile diarrhoea
    • Beales IL. Intravenous immunoglobulin for recurrent Clostridium difficile diarrhoea. Gut. 2002;51:456.
    • (2002) Gut , vol.51 , pp. 456
    • Beales, I.L.1
  • 19
    • 2442705389 scopus 로고    scopus 로고
    • Descriptive study of intravenous immunoglobulin for the treatment of recurrent Clostridium difficile diarrhoea
    • Wilcox MH. Descriptive study of intravenous immunoglobulin for the treatment of recurrent Clostridium difficile diarrhoea. J Antimicrob Chemother. 2004;53:882-884.
    • (2004) J Antimicrob Chemother , vol.53 , pp. 882-884
    • Wilcox, M.H.1
  • 20
    • 31144469850 scopus 로고    scopus 로고
    • Intravenous immunoglobulin for resistant Clostridium difficile infection
    • Murphy C, Vernon M, Cullen M. Intravenous immunoglobulin for resistant Clostridium difficile infection. Age Ageing. 2006;35:85-86.
    • (2006) Age Ageing , vol.35 , pp. 85-86
    • Murphy, C.1    Vernon, M.2    Cullen, M.3
  • 21
    • 33646582618 scopus 로고    scopus 로고
    • Intravenous immunoglobulin for the treatment of severe, refractory, and recurrent Clostridium difficile diarrhea
    • McPherson S, Rees CJ, Ellis R, Soo S, Panter SJ. Intravenous immunoglobulin for the treatment of severe, refractory, and recurrent Clostridium difficile diarrhea. Dis Colon Rectum. 2006;49:640-645.
    • (2006) Dis Colon Rectum , vol.49 , pp. 640-645
    • McPherson, S.1    Rees, C.J.2    Ellis, R.3    Soo, S.4    Panter, S.J.5
  • 22
    • 0030763467 scopus 로고    scopus 로고
    • Intravenous immunoglobulin therapy for severe Clostridium difficile colitis
    • Salcedo J, Keates S, Pothoulakis C, et al. Intravenous immunoglobulin therapy for severe Clostridium difficile colitis. Gut. 1997;41:366-370.
    • (1997) Gut , vol.41 , pp. 366-370
    • Salcedo, J.1    Keates, S.2    Pothoulakis, C.3
  • 23
    • 39749084548 scopus 로고    scopus 로고
    • Chandrasekar T, Naqvi1 N, Waddington A, et. al. Intravenous immunoglobulin therapy for refractory Clostridium difficile toxin colitis in chronic kidney disease: case reports and literature review. NDT Plus. 2008;1: 20-22.
    • Chandrasekar T, Naqvi1 N, Waddington A, et. al. Intravenous immunoglobulin therapy for refractory Clostridium difficile toxin colitis in chronic kidney disease: case reports and literature review. NDT Plus. 2008;1: 20-22.
  • 24
    • 34547097261 scopus 로고    scopus 로고
    • Use of intravenous immunoglobulin for the treatment of severe Clostridium difficile colitis
    • Hassoun A, Ibrahim F. Use of intravenous immunoglobulin for the treatment of severe Clostridium difficile colitis. Am J Geriatr Pharmacother. 2007;5:48-51.
    • (2007) Am J Geriatr Pharmacother , vol.5 , pp. 48-51
    • Hassoun, A.1    Ibrahim, F.2
  • 25
    • 33847150865 scopus 로고    scopus 로고
    • Clinical outcomes of intravenous immune globulin in severe clostridium difficile-associated diarrhea
    • Juang PS, Skledar J, Zgheib NK, et al. Clinical outcomes of intravenous immune globulin in severe clostridium difficile-associated diarrhea. Am J Infect Control. 2007;35:131-137.
    • (2007) Am J Infect Control , vol.35 , pp. 131-137
    • Juang, P.S.1    Skledar, J.2    Zgheib, N.K.3
  • 26
    • 54349120031 scopus 로고    scopus 로고
    • Successful treatment of Clostridium difficile colitis with intravenous immunoglobulin
    • Koulaouzidis A, Tatham R, Moschos J, Tan CW. Successful treatment of Clostridium difficile colitis with intravenous immunoglobulin. J Gastrointestin Liver Dis. 2008;17:353-359.
    • (2008) J Gastrointestin Liver Dis , vol.17 , pp. 353-359
    • Koulaouzidis, A.1    Tatham, R.2    Moschos, J.3    Tan, C.W.4
  • 27
    • 33746684942 scopus 로고    scopus 로고
    • A durable response to relapsing Clostridium difficile colitis may require combined therapy with high-dose oral Vancomycin and intravenous immune globulin
    • Cone LA, Lopez C, Tarleton HL, et al. A durable response to relapsing Clostridium difficile colitis may require combined therapy with high-dose oral Vancomycin and intravenous immune globulin. Infect Dis Clin Pract. 2006;14:217-220.
    • (2006) Infect Dis Clin Pract , vol.14 , pp. 217-220
    • Cone, L.A.1    Lopez, C.2    Tarleton, H.L.3
  • 29
    • 33745515086 scopus 로고    scopus 로고
    • Colonic abnormalities on CT in adult hospitalized patients with Clostridium difficile colitis: Prevalence and significance of findings
    • Ash L, Baker ME, O'Malley CM Jr, Gordon SM, Delaney CP, Obuchowski NA. Colonic abnormalities on CT in adult hospitalized patients with Clostridium difficile colitis: prevalence and significance of findings. AJR Am J Roentgenol. 2006;186:1393-1400.
    • (2006) AJR Am J Roentgenol , vol.186 , pp. 1393-1400
    • Ash, L.1    Baker, M.E.2    O'Malley Jr, C.M.3    Gordon, S.M.4    Delaney, C.P.5    Obuchowski, N.A.6
  • 30
    • 0042622674 scopus 로고    scopus 로고
    • Clostridium difficile-associated diarrhea: Predictors of severity in patients presenting to the emergency department
    • Andrews CN, Raboud J, Kassen BO, Enns R. Clostridium difficile-associated diarrhea: predictors of severity in patients presenting to the emergency department. Can J Gastroenterol. 2003;17:369-373.
    • (2003) Can J Gastroenterol , vol.17 , pp. 369-373
    • Andrews, C.N.1    Raboud, J.2    Kassen, B.O.3    Enns, R.4
  • 31
    • 33846436449 scopus 로고    scopus 로고
    • Impact of emergency colectomy on survival of patients with fulminant Clostridium difficile colitis during an epidemic caused by a hypervirulent strain
    • Lamontagne F, Labbe AC, Haeck O, et al. Impact of emergency colectomy on survival of patients with fulminant Clostridium difficile colitis during an epidemic caused by a hypervirulent strain. Ann Surg. 2007;245: 267-272.
    • (2007) Ann Surg , vol.245 , pp. 267-272
    • Lamontagne, F.1    Labbe, A.C.2    Haeck, O.3
  • 32
    • 33846280438 scopus 로고    scopus 로고
    • Risk factors for severity and relapse of pseudomembranous colitis in an elderly population
    • Moshkowitz M, Ben-Baruch E, Kline Z et al. Risk factors for severity and relapse of pseudomembranous colitis in an elderly population. Colorectal Dis. 2007;9:173-177.
    • (2007) Colorectal Dis , vol.9 , pp. 173-177
    • Moshkowitz, M.1    Ben-Baruch, E.2    Kline, Z.3
  • 34
    • 0032526918 scopus 로고    scopus 로고
    • Clostridium difficile toxin a stimulates macrophage-inflammatory protein-2 production in rat intestinal epithelial cells
    • Castagliuolo I, Keates AC, Wang C, et al. Clostridium difficile toxin a stimulates macrophage-inflammatory protein-2 production in rat intestinal epithelial cells. J Immunol. 1998;160:6039-6045.
    • (1998) J Immunol , vol.160 , pp. 6039-6045
    • Castagliuolo, I.1    Keates, A.C.2    Wang, C.3
  • 35
    • 0030896270 scopus 로고    scopus 로고
    • Increased substance P responses in dorsal root ganglia, intestinal macrophages during Clostridium difficile toxin a enteritis in rats
    • Castagliuolo I, Keates AC, Qiu B, et al. Increased substance P responses in dorsal root ganglia, intestinal macrophages during Clostridium difficile toxin a enteritis in rats. Proc Natl Acad Sci U S A. 1997;94:4788-4793.
    • (1997) Proc Natl Acad Sci U S A , vol.94 , pp. 4788-4793
    • Castagliuolo, I.1    Keates, A.C.2    Qiu, B.3
  • 37
    • 0031811104 scopus 로고    scopus 로고
    • Bacterial translocation, intestinal microflora and morphological changes of intestinal mucosa in experimental models of Clostridium difficile infection
    • Naaber P, Mikelsaar RH, Salminen S, Mikelsaar M. Bacterial translocation, intestinal microflora and morphological changes of intestinal mucosa in experimental models of Clostridium difficile infection. J Med Microbiol. 1998;47:591-598.
    • (1998) J Med Microbiol , vol.47 , pp. 591-598
    • Naaber, P.1    Mikelsaar, R.H.2    Salminen, S.3    Mikelsaar, M.4
  • 38
    • 0027963265 scopus 로고
    • Immunoglobulin G directed against toxins A and B of Clostridium difficile in the general population and patients with antibiotic-associated diarrhea
    • Bacon AE, 3rd, Fekety R. Immunoglobulin G directed against toxins A and B of Clostridium difficile in the general population and patients with antibiotic-associated diarrhea. Diagn Microbiol Infect Dis. 1994;18:205-209.
    • (1994) Diagn Microbiol Infect Dis , vol.18 , pp. 205-209
    • Bacon 3rd, A.E.1    Fekety, R.2
  • 39
    • 0020551089 scopus 로고
    • Serum antibody response to toxins A and B of Clostridium difficile
    • Viscidi R, Laughon BE, Yolken R, et al. Serum antibody response to toxins A and B of Clostridium difficile. J Infect Dis. 1983;148:93-100.
    • (1983) J Infect Dis , vol.148 , pp. 93-100
    • Viscidi, R.1    Laughon, B.E.2    Yolken, R.3
  • 40
    • 33750493617 scopus 로고    scopus 로고
    • Human monoclonal antibodies directed against toxins A and B prevent Clostridium difficile-induced mortality in hamsters
    • Babcock GJ, Broering TJ, Hernandez HJ, et al. Human monoclonal antibodies directed against toxins A and B prevent Clostridium difficile-induced mortality in hamsters. Infect Immun. 2006;74:6339-6347.
    • (2006) Infect Immun , vol.74 , pp. 6339-6347
    • Babcock, G.J.1    Broering, T.J.2    Hernandez, H.J.3
  • 41
    • 0021836686 scopus 로고
    • Serum antibody response to Clostridium difficile toxins in patients with Clostridium difficile diarrhoea
    • Aronsson B, Granstrom M, Mollby R, Nord CE. Serum antibody response to Clostridium difficile toxins in patients with Clostridium difficile diarrhoea. Infection. 1985;13:97-101.
    • (1985) Infection , vol.13 , pp. 97-101
    • Aronsson, B.1    Granstrom, M.2    Mollby, R.3    Nord, C.E.4
  • 42
    • 0024391813 scopus 로고
    • Relationship between levels of Clostridium difficile toxin A and toxin B and cecal lesions in gnotobiotic mice
    • Vernet A, Corthier G, Dubos-Ramare F, Parodi AL. Relationship between levels of Clostridium difficile toxin A and toxin B and cecal lesions in gnotobiotic mice. Infect Immun. 1989;57:2123-2127.
    • (1989) Infect Immun , vol.57 , pp. 2123-2127
    • Vernet, A.1    Corthier, G.2    Dubos-Ramare, F.3    Parodi, A.L.4
  • 43
    • 0026089562 scopus 로고
    • Protection against experimental pseudomembranous colitis in gnotobiotic mice by use of monoclonal antibodies against Clostridium difficile toxin A
    • Corthier G, Muller MC, Wilkins TD, Lyerly D, L'Haridon R. Protection against experimental pseudomembranous colitis in gnotobiotic mice by use of monoclonal antibodies against Clostridium difficile toxin A. Infect Immun. 1991;59:1192-1195.
    • (1991) Infect Immun , vol.59 , pp. 1192-1195
    • Corthier, G.1    Muller, M.C.2    Wilkins, T.D.3    Lyerly, D.4    L'Haridon, R.5
  • 44
    • 0026453188 scopus 로고
    • Systemic and mucosal antibody responses to toxin A in patients infected with Clostridium difficile
    • Johnson S, Gerding DN, Janoff EN. Systemic and mucosal antibody responses to toxin A in patients infected with Clostridium difficile. J Infect Dis. 1992;166:1287-1294.
    • (1992) J Infect Dis , vol.166 , pp. 1287-1294
    • Johnson, S.1    Gerding, D.N.2    Janoff, E.N.3
  • 45
    • 34249891873 scopus 로고    scopus 로고
    • Transcutaneous immunization with Clostridium difficile toxoid A induces systemic and mucosal immune responses and toxin A-neutralizing antibodies in mice
    • Ghose C, Kalsy A, Sheikh A, et al. Transcutaneous immunization with Clostridium difficile toxoid A induces systemic and mucosal immune responses and toxin A-neutralizing antibodies in mice. Infect Immun. 2007;75:2826-2832.
    • (2007) Infect Immun , vol.75 , pp. 2826-2832
    • Ghose, C.1    Kalsy, A.2    Sheikh, A.3
  • 46
    • 0032962874 scopus 로고    scopus 로고
    • Serum antitoxin antibodies mediate systemic and mucosal protection from Clostridium difficile disease in hamsters
    • Giannasca PJ, Zhang ZX, Lei WD, et al. Serum antitoxin antibodies mediate systemic and mucosal protection from Clostridium difficile disease in hamsters. Infect Immun. 1999;67:527-538.
    • (1999) Infect Immun , vol.67 , pp. 527-538
    • Giannasca, P.J.1    Zhang, Z.X.2    Lei, W.D.3
  • 47
    • 0026527192 scopus 로고
    • Human colonic aspirates containing immunoglobulin A antibody to Clostridium difficile toxin A inhibit toxin A-receptor binding
    • Kelly CP, Pothoulakis C, Orellana J, LaMont JT. Human colonic aspirates containing immunoglobulin A antibody to Clostridium difficile toxin A inhibit toxin A-receptor binding. Gastroenterology. 1992;102:35-40.
    • (1992) Gastroenterology , vol.102 , pp. 35-40
    • Kelly, C.P.1    Pothoulakis, C.2    Orellana, J.3    LaMont, J.T.4
  • 48
    • 0029152230 scopus 로고
    • Selective neutralization of a bacterial enterotoxin by serum immunoglobulin A in response to mucosal disease
    • Johnson S, Sypura WD, Gerding DN, Ewing SL, Janoff EN. Selective neutralization of a bacterial enterotoxin by serum immunoglobulin A in response to mucosal disease. Infect Immun. 1995;63:3166-3173.
    • (1995) Infect Immun , vol.63 , pp. 3166-3173
    • Johnson, S.1    Sypura, W.D.2    Gerding, D.N.3    Ewing, S.L.4    Janoff, E.N.5


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