Monitorización intraoperatoria de los nervios laríngeos superior e inferior en cirugía de tiroides y paratiroides
Palabras clave:
nervio laríngeo recurrente, conducción nerviosa, monitoreo intraoperatorio, tiroidectomía, paratiroidectomíaResumen
La cirugía endocrina, y particularmente la cirugía de tiroides y paratiroides, ha experimentado múltiples cambios desde la década de los años 30 cuando se evidenció la disminución de las parálisis de las cuerdas vocales con la identificación visual del nervio laríngeo recurrente durante la cirugía. Desde entonces, nuestros esfuerzos se han encaminado a lograr una menor incidencia de estas lesiones con múltiples técnicas, siendo la neuromonitorización intraoperatoria una de las herramientas útiles, sobre todo en pacientes con factores de riesgo que tienen mayor probabilidad de lesión durante la cirugía.
Este artículo pretende hacer una revisión del tema y describir la técnica de la monitorización intraoperatoria de los nervios laríngeos.
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Referencias bibliográficas
1. Lahey FH, Hoover WB. Injuries to the recurrent laryngeal nerve in thyroid operations: Their management and avoidance. Ann Surg. 1938;108:545-62.
https://doi.org/10.1097/00000658-193810000-00006
2. Riddell VH. Injury to recurrent laryngeal nerves during thyroi- dectomy; a comparison between the results of identification and non-identification in 1,022 nerves exposed to risk. Lancet. 1956;271:638-41.
https://doi.org/10.1016/S0140-6736(56)92333-9
3. Hermann M, Alk G, Roka R, Glaser K, Freissmuth M. Laryngeal recurrent nerve injury in surgery for benign thyroid diseases: Effect of nerve dissection and impact of individual surgeon in more than 27,000 nerves at risk. Ann Surg. 2002;235:261-8.
https://doi.org/10.1097/00000658-200202000-00015
4. Abadin SS, Kaplan EL, Angelos P. Malpractice litigation after thyroid surgery: The role of recurrent laryngeal nerve injuries, 1989-2009. Surgery. 2010;148:718-23.
https://doi.org/10.1016/j.surg.2010.07.019
5. Angelos P. Ethical and medicolegal issues in neuromonitoring during thyroid and parathyroid surgery: A review of the recent literature. Curr Opin Oncol. 2012;24:16-21.
https://doi.org/10.1097/CCO.0b013e32834cd596
6. Dralle H, Lorenz K, Machens A. Verdicts on malpractice claims after thyroid surgery: Emerging trends and future directions. Head Neck. 2012; Mar 20. doi: 10.1002/hed.21970.
https://doi.org/10.1002/hed.21970
7. Shedd DP, Durham C. Electrical identification of the recurrent laryngeal nerve. I. Response of the canine larynx to electrical stimulation of the recurrent laryngeal nerve. Ann Surg. 1966;163:47-50.
https://doi.org/10.1097/00000658-196601000-00006
8. Flisberg K, Lindholm T. Electrical stimulation of the human recurrent laryngeal nerve during thyroid operation. Acta Oto- laryngol Suppl. 1969;263:63-7.
https://doi.org/10.3109/00016487009131523
9. Rea JL, Davis WE, Templer JW. Recurrent nerve locating sys- tem. Ann Otol Rhinol Laryngol. 1979;88:92-4.
https://doi.org/10.1177/000348947908800115
10. Riddell V. Thyroidectomy: Prevention of bilateral recurrent nerve palsy. Results of identification of the nerve over 23 consecutive years (1946-69) with a description of an additional safety measure. Br J Surg. 1970;57:1-11.
https://doi.org/10.1002/bjs.1800570102
11. Suzuki M, Kirchner JA. Sensory fibers in the recurrent laryngeal nerve. An electrophysiological study of some laryngeal afferent fibers in the recurrent laryngeal nerve of the cat. Ann Otol Rhinol Laryngol. 1969;78:21-31.
https://doi.org/10.1177/000348946907800102
12. Tomita H. An electromyographic study of recurrent laryn- geal nerve paralysis. Nihon Jibiinkoka Gakkai Kaiho. 1967;70:963-85.
https://doi.org/10.3950/jibiinkoka.70.963
13. Peytz F, Rasmussen H, Buchthal F. Conduction time and velocity in human recurrent laryngeal nerve. Dan Med Bull. 1965;12:125-7.
14. Tschopp KP, Gottardo C. Comparison of various methods of electromyographic monitoring of the recurrent laryngeal nerve in thyroid surgery. Ann Otol Rhinol Laryngol. 2002;111:811-6.
https://doi.org/10.1177/000348940211100909
15. Petro ML, Schweinfurth JM, Petro AB. Transcricothyroid, in- traoperative monitoring of the vagus nerve. Arch Otolaryngol Head Neck Surg. 2006;132:624-8.
https://doi.org/10.1001/archotol.132.6.624
16. Eisele DW. Intraoperative electrophysiologic monitoring of the recurrent laryngeal nerve. Laryngoscope. 1996;106:443-9.
https://doi.org/10.1097/00005537-199604000-00010
17. Chiang FY, Lu IC, Chen HC, Chen HY, Tsai CJ, Hsiao PJ, et al. Anatomical variations of recurrent laryngeal nerve during thyroid surgery: How to identify and handle the variations with intraoperative neuromonitoring. Kaohsiung J Med Sci. 2010;26:575-83.
https://doi.org/10.1016/S1607-551X(10)70089-9
18. Snyder SK, Lairmore TC, Hendricks JC, Roberts JW. Elucidating mechanisms of recurrent laryngeal nerve injury during thyroidec- tomy and parathyroidectomy. J Am Coll Surg. 2008;206:123-30.
https://doi.org/10.1016/j.jamcollsurg.2007.07.017
19. Beneragama T, Serpell JW. Extralaryngeal bifurcation of the recurrent laryngeal nerve: A common variation. ANZ J Surg. 2006;76:928-31.
https://doi.org/10.1111/j.1445-2197.2006.03899.x
20. Sancho JJ, Pascual-Damieta M, Pereira JA, Carrera MJ, Fontane J, Sitges-Serra A. Risk factors for transient vocal cord palsy after thyroidectomy. Br J Surg. 2008;95:961-7.
https://doi.org/10.1002/bjs.6173
21. Serpell JW, Yeung MJ, Grodski S. The motor fibers of the re- current laryngeal nerve are located in the anterior extralaryngeal branch. Ann Surg. 2009;249:648-52.
https://doi.org/10.1097/SLA.0b013e31819ed9a4
22. Timmermann W, Hamelmann WH, Thomusch O, Sekulla C, Grond S, Neumann HJ, et al. Effectiveness and results of intraoperative neuromonitoring in thyroid surgery. Statement of the Interdisciplinary Study Group on Intraoperative Neuro- monitoring of Thyroid Surgery. Chirurg. 2004;75:916-22.
https://doi.org/10.1007/s00104-004-0858-0
23. Randolph GW, Dralle H, Abdullah H, Barczynski M, Bellantone R, Brauckhoff M, et al. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: International standards guideline statement. Laryngoscope. 2011;121(Suppl.1):S1-16.
https://doi.org/10.1002/lary.21119
24. Jonas J. Reliabilty of intraoperative recurrent laryngeal nerve monitoring in thyroid surgery. Zentralbl Chir. 2002;127:404-8.
https://doi.org/10.1055/s-2002-31981
25. Dralle H, Sekulla C, Haerting J, Timmermann W, Neumann HJ, Kruse E, et al. Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery. Surgery.2004;136:1310-22.
https://doi.org/10.1016/j.surg.2004.07.018
26. Chan WF, Lang BH, Lo CY. The role of intraoperative neu- romonitoring of recurrent laryngeal nerve during thyroidec- tomy: A comparative study on 1,000 nerves at risk. Surgery. 2006;140:866-73.
https://doi.org/10.1016/j.surg.2006.07.017
27. Barczynski M, Konturek A, Cichon S. Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy. Br J Surg. [Comparative Study Randomized Controlled Trial]. 2009;96:240-6.
https://doi.org/10.1002/bjs.6417
28. Chan WF, Lo CY. Pitfalls of intraoperative neuromonitoring for predicting postoperative recurrent laryngeal nerve function during thyroidectomy. World J Surg. 2006;30:806-12.
https://doi.org/10.1007/s00268-005-0355-8
29. Chiang FY, Lee KW, Chen HC, Chen HY, Lu IC, Kuo WR, et al. Standardization of intraoperative neuromonitoring of recurrent laryngeal nerve in thyroid operation. World J Surg. 2010;34:223-9.
https://doi.org/10.1007/s00268-009-0316-8
30. Deiner S. Highlights of anesthetic considerations for intrao- perative neuromonitoring. Semin Cardiothorac Vasc Anesth. 2010;14:51-3.
https://doi.org/10.1177/1089253210362792
31. Dionigi G, Chiang FY, Rausei S, Wu CW, Boni L, Lee KW, et al. Surgical anatomy and neurophysiology of the vagus nerve (VN) for standardized intraoperative neuromonitoring (IONM) of the inferior laryngeal nerve (ILN) during thyroidectomy. Langenbecks Arch Surg. 2010;395:893-9.
https://doi.org/10.1007/s00423-010-0693-3
32. Tomoda C, Hirokawa Y, Uruno T, Takamura Y, Ito Y, Miya A, et al. Sensitivity and specificity of intraoperative recurrent laryngeal nerve stimulation test for predicting vocal cord palsy after thyroid surgery. World J Surg. 2006;30:1230-3.
https://doi.org/10.1007/s00268-005-0351-z
33. Hamelmann WH, Meyer T, Timm S, Timmermann W. A Cri- tical Estimation of Intraoperative Neuromonitoring (IONM) in Thyroid Surgery. Zentralbl Chir. 2002;127:409-13.
https://doi.org/10.1055/s-2002-31982
34. Hermann M, Hellebart C, Freissmuth M. Neuromonitoring in thyroid surgery: Prospective evaluation of intraoperative electro- physiological responses for the prediction of recurrent laryngeal nerve injury. Ann Surg. 2004;240:9-17.
https://doi.org/10.1097/01.sla.0000132260.34503.02
35. Beldi G, Kinsbergen T, Schlumpf R. Evaluation of intraoperative recurrent nerve monitoring in thyroid surgery. World J Surg. 2004;28:589-91.
https://doi.org/10.1007/s00268-004-7226-6
36. Thomusch O, Sekulla C, Machens A, Neumann HJ, Timmermann W , Dralle H. V alidity of intra-operative neuromonitoring signals in thyroid surgery. Langenbecks Arch Surg. 2004;389:499-503.
https://doi.org/10.1007/s00423-003-0444-9
37. Angelos P. Recurrent laryngeal nerve monitoring: State of the art, ethical and legal issues. Surg Clin North Am. 2009;89:1157-69.
https://doi.org/10.1016/j.suc.2009.06.010
38. Thomusch O, Sekulla C, Walls G, Machens A, Dralle H. In- traoperative neuromonitoring of surgery for benign goiter. Am J Surg. 2002;183:673-8.
https://doi.org/10.1016/S0002-9610(02)00856-5
39. Sturgeon C, Sturgeon T, Angelos P. Neuromonitoring in thyroid surgery: attitudes, usage patterns, and predictors of use among endocrine surgeons. World J Surg. 2009;33:417-25.
https://doi.org/10.1007/s00268-008-9724-4
40. Singer MC, Rosenfeld RM, Sundaram K. Laryngeal nerve monitoring: Current utilization among head and neck surgeons. Otolaryngol Head Neck Surg. 2012;146:895-9.
https://doi.org/10.1177/0194599812439278
41. Higgins TS, Gupta R, Ketcham AS, Sataloff RT, Wadsworth JT, Sinacori JT. Recurrent laryngeal nerve monitoring versus identification alone on post-thyroidectomy true vocal fold palsy: A meta-analysis. Laryngoscope. 2011;121:1009-17.
https://doi.org/10.1002/lary.21578
42. Barczynski M, Konturek A, Stopa M, Hubalewska-Dydejczyk A, Richter P, Nowak W. Clinical value of intraoperative neu- romonitoring of the recurrent laryngeal nerves in improving outcomes of surgery for well-differentiated thyroid cancer. Pol Przegl Chir. 2011;83:196-203.
https://doi.org/10.2478/v10035-011-0030-8
43. Dionigi G, Barczynski M, Chiang FY, Dralle H, Duran-Poveda M, Iacobone M, et al. Why monitor the recurrent laryngeal nerve in thyroid surgery? J Endocrinol Invest. 2010;33:819-22.
https://doi.org/10.1007/BF03350349
https://doi.org/10.1097/00000658-193810000-00006
2. Riddell VH. Injury to recurrent laryngeal nerves during thyroi- dectomy; a comparison between the results of identification and non-identification in 1,022 nerves exposed to risk. Lancet. 1956;271:638-41.
https://doi.org/10.1016/S0140-6736(56)92333-9
3. Hermann M, Alk G, Roka R, Glaser K, Freissmuth M. Laryngeal recurrent nerve injury in surgery for benign thyroid diseases: Effect of nerve dissection and impact of individual surgeon in more than 27,000 nerves at risk. Ann Surg. 2002;235:261-8.
https://doi.org/10.1097/00000658-200202000-00015
4. Abadin SS, Kaplan EL, Angelos P. Malpractice litigation after thyroid surgery: The role of recurrent laryngeal nerve injuries, 1989-2009. Surgery. 2010;148:718-23.
https://doi.org/10.1016/j.surg.2010.07.019
5. Angelos P. Ethical and medicolegal issues in neuromonitoring during thyroid and parathyroid surgery: A review of the recent literature. Curr Opin Oncol. 2012;24:16-21.
https://doi.org/10.1097/CCO.0b013e32834cd596
6. Dralle H, Lorenz K, Machens A. Verdicts on malpractice claims after thyroid surgery: Emerging trends and future directions. Head Neck. 2012; Mar 20. doi: 10.1002/hed.21970.
https://doi.org/10.1002/hed.21970
7. Shedd DP, Durham C. Electrical identification of the recurrent laryngeal nerve. I. Response of the canine larynx to electrical stimulation of the recurrent laryngeal nerve. Ann Surg. 1966;163:47-50.
https://doi.org/10.1097/00000658-196601000-00006
8. Flisberg K, Lindholm T. Electrical stimulation of the human recurrent laryngeal nerve during thyroid operation. Acta Oto- laryngol Suppl. 1969;263:63-7.
https://doi.org/10.3109/00016487009131523
9. Rea JL, Davis WE, Templer JW. Recurrent nerve locating sys- tem. Ann Otol Rhinol Laryngol. 1979;88:92-4.
https://doi.org/10.1177/000348947908800115
10. Riddell V. Thyroidectomy: Prevention of bilateral recurrent nerve palsy. Results of identification of the nerve over 23 consecutive years (1946-69) with a description of an additional safety measure. Br J Surg. 1970;57:1-11.
https://doi.org/10.1002/bjs.1800570102
11. Suzuki M, Kirchner JA. Sensory fibers in the recurrent laryngeal nerve. An electrophysiological study of some laryngeal afferent fibers in the recurrent laryngeal nerve of the cat. Ann Otol Rhinol Laryngol. 1969;78:21-31.
https://doi.org/10.1177/000348946907800102
12. Tomita H. An electromyographic study of recurrent laryn- geal nerve paralysis. Nihon Jibiinkoka Gakkai Kaiho. 1967;70:963-85.
https://doi.org/10.3950/jibiinkoka.70.963
13. Peytz F, Rasmussen H, Buchthal F. Conduction time and velocity in human recurrent laryngeal nerve. Dan Med Bull. 1965;12:125-7.
14. Tschopp KP, Gottardo C. Comparison of various methods of electromyographic monitoring of the recurrent laryngeal nerve in thyroid surgery. Ann Otol Rhinol Laryngol. 2002;111:811-6.
https://doi.org/10.1177/000348940211100909
15. Petro ML, Schweinfurth JM, Petro AB. Transcricothyroid, in- traoperative monitoring of the vagus nerve. Arch Otolaryngol Head Neck Surg. 2006;132:624-8.
https://doi.org/10.1001/archotol.132.6.624
16. Eisele DW. Intraoperative electrophysiologic monitoring of the recurrent laryngeal nerve. Laryngoscope. 1996;106:443-9.
https://doi.org/10.1097/00005537-199604000-00010
17. Chiang FY, Lu IC, Chen HC, Chen HY, Tsai CJ, Hsiao PJ, et al. Anatomical variations of recurrent laryngeal nerve during thyroid surgery: How to identify and handle the variations with intraoperative neuromonitoring. Kaohsiung J Med Sci. 2010;26:575-83.
https://doi.org/10.1016/S1607-551X(10)70089-9
18. Snyder SK, Lairmore TC, Hendricks JC, Roberts JW. Elucidating mechanisms of recurrent laryngeal nerve injury during thyroidec- tomy and parathyroidectomy. J Am Coll Surg. 2008;206:123-30.
https://doi.org/10.1016/j.jamcollsurg.2007.07.017
19. Beneragama T, Serpell JW. Extralaryngeal bifurcation of the recurrent laryngeal nerve: A common variation. ANZ J Surg. 2006;76:928-31.
https://doi.org/10.1111/j.1445-2197.2006.03899.x
20. Sancho JJ, Pascual-Damieta M, Pereira JA, Carrera MJ, Fontane J, Sitges-Serra A. Risk factors for transient vocal cord palsy after thyroidectomy. Br J Surg. 2008;95:961-7.
https://doi.org/10.1002/bjs.6173
21. Serpell JW, Yeung MJ, Grodski S. The motor fibers of the re- current laryngeal nerve are located in the anterior extralaryngeal branch. Ann Surg. 2009;249:648-52.
https://doi.org/10.1097/SLA.0b013e31819ed9a4
22. Timmermann W, Hamelmann WH, Thomusch O, Sekulla C, Grond S, Neumann HJ, et al. Effectiveness and results of intraoperative neuromonitoring in thyroid surgery. Statement of the Interdisciplinary Study Group on Intraoperative Neuro- monitoring of Thyroid Surgery. Chirurg. 2004;75:916-22.
https://doi.org/10.1007/s00104-004-0858-0
23. Randolph GW, Dralle H, Abdullah H, Barczynski M, Bellantone R, Brauckhoff M, et al. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: International standards guideline statement. Laryngoscope. 2011;121(Suppl.1):S1-16.
https://doi.org/10.1002/lary.21119
24. Jonas J. Reliabilty of intraoperative recurrent laryngeal nerve monitoring in thyroid surgery. Zentralbl Chir. 2002;127:404-8.
https://doi.org/10.1055/s-2002-31981
25. Dralle H, Sekulla C, Haerting J, Timmermann W, Neumann HJ, Kruse E, et al. Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery. Surgery.2004;136:1310-22.
https://doi.org/10.1016/j.surg.2004.07.018
26. Chan WF, Lang BH, Lo CY. The role of intraoperative neu- romonitoring of recurrent laryngeal nerve during thyroidec- tomy: A comparative study on 1,000 nerves at risk. Surgery. 2006;140:866-73.
https://doi.org/10.1016/j.surg.2006.07.017
27. Barczynski M, Konturek A, Cichon S. Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy. Br J Surg. [Comparative Study Randomized Controlled Trial]. 2009;96:240-6.
https://doi.org/10.1002/bjs.6417
28. Chan WF, Lo CY. Pitfalls of intraoperative neuromonitoring for predicting postoperative recurrent laryngeal nerve function during thyroidectomy. World J Surg. 2006;30:806-12.
https://doi.org/10.1007/s00268-005-0355-8
29. Chiang FY, Lee KW, Chen HC, Chen HY, Lu IC, Kuo WR, et al. Standardization of intraoperative neuromonitoring of recurrent laryngeal nerve in thyroid operation. World J Surg. 2010;34:223-9.
https://doi.org/10.1007/s00268-009-0316-8
30. Deiner S. Highlights of anesthetic considerations for intrao- perative neuromonitoring. Semin Cardiothorac Vasc Anesth. 2010;14:51-3.
https://doi.org/10.1177/1089253210362792
31. Dionigi G, Chiang FY, Rausei S, Wu CW, Boni L, Lee KW, et al. Surgical anatomy and neurophysiology of the vagus nerve (VN) for standardized intraoperative neuromonitoring (IONM) of the inferior laryngeal nerve (ILN) during thyroidectomy. Langenbecks Arch Surg. 2010;395:893-9.
https://doi.org/10.1007/s00423-010-0693-3
32. Tomoda C, Hirokawa Y, Uruno T, Takamura Y, Ito Y, Miya A, et al. Sensitivity and specificity of intraoperative recurrent laryngeal nerve stimulation test for predicting vocal cord palsy after thyroid surgery. World J Surg. 2006;30:1230-3.
https://doi.org/10.1007/s00268-005-0351-z
33. Hamelmann WH, Meyer T, Timm S, Timmermann W. A Cri- tical Estimation of Intraoperative Neuromonitoring (IONM) in Thyroid Surgery. Zentralbl Chir. 2002;127:409-13.
https://doi.org/10.1055/s-2002-31982
34. Hermann M, Hellebart C, Freissmuth M. Neuromonitoring in thyroid surgery: Prospective evaluation of intraoperative electro- physiological responses for the prediction of recurrent laryngeal nerve injury. Ann Surg. 2004;240:9-17.
https://doi.org/10.1097/01.sla.0000132260.34503.02
35. Beldi G, Kinsbergen T, Schlumpf R. Evaluation of intraoperative recurrent nerve monitoring in thyroid surgery. World J Surg. 2004;28:589-91.
https://doi.org/10.1007/s00268-004-7226-6
36. Thomusch O, Sekulla C, Machens A, Neumann HJ, Timmermann W , Dralle H. V alidity of intra-operative neuromonitoring signals in thyroid surgery. Langenbecks Arch Surg. 2004;389:499-503.
https://doi.org/10.1007/s00423-003-0444-9
37. Angelos P. Recurrent laryngeal nerve monitoring: State of the art, ethical and legal issues. Surg Clin North Am. 2009;89:1157-69.
https://doi.org/10.1016/j.suc.2009.06.010
38. Thomusch O, Sekulla C, Walls G, Machens A, Dralle H. In- traoperative neuromonitoring of surgery for benign goiter. Am J Surg. 2002;183:673-8.
https://doi.org/10.1016/S0002-9610(02)00856-5
39. Sturgeon C, Sturgeon T, Angelos P. Neuromonitoring in thyroid surgery: attitudes, usage patterns, and predictors of use among endocrine surgeons. World J Surg. 2009;33:417-25.
https://doi.org/10.1007/s00268-008-9724-4
40. Singer MC, Rosenfeld RM, Sundaram K. Laryngeal nerve monitoring: Current utilization among head and neck surgeons. Otolaryngol Head Neck Surg. 2012;146:895-9.
https://doi.org/10.1177/0194599812439278
41. Higgins TS, Gupta R, Ketcham AS, Sataloff RT, Wadsworth JT, Sinacori JT. Recurrent laryngeal nerve monitoring versus identification alone on post-thyroidectomy true vocal fold palsy: A meta-analysis. Laryngoscope. 2011;121:1009-17.
https://doi.org/10.1002/lary.21578
42. Barczynski M, Konturek A, Stopa M, Hubalewska-Dydejczyk A, Richter P, Nowak W. Clinical value of intraoperative neu- romonitoring of the recurrent laryngeal nerves in improving outcomes of surgery for well-differentiated thyroid cancer. Pol Przegl Chir. 2011;83:196-203.
https://doi.org/10.2478/v10035-011-0030-8
43. Dionigi G, Barczynski M, Chiang FY, Dralle H, Duran-Poveda M, Iacobone M, et al. Why monitor the recurrent laryngeal nerve in thyroid surgery? J Endocrinol Invest. 2010;33:819-22.
https://doi.org/10.1007/BF03350349
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2012-10-01
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Dueñas, J. P.; Duque, C. S. Monitorización Intraoperatoria De Los Nervios laríngeos Superior E Inferior En cirugía De Tiroides Y Paratiroides. Rev Colomb Cir 2012, 27, 298-305.
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