13 results on '"oral cGVHD"'
Search Results
2. Prevalence of oral chronic graft versus host disease after allogeneic stem cell transplantation.
- Author
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Yamada, Ayaka, Torihata, Sayaka, Shimoide, Takeshi, Lee, Atsushi‐Doksa, Kinoshita, Yuko, Kawaguchi, Miku, Ashida, Takashi, Matsumura, Itaru, and Enomoto, Akifumi
- Abstract
Aim: Oral cGVHD is one of the phenotypes of organ involvement of cGVHD and is a complex, frequent, and highly impactful complication of allogeneic hematopoietic cell transplantation (HSCT). Few studies have compared the incidences and risk factors of oral cGVHD, and they have not been discussed. We performed to evaluate the risk factors for oral cGVHD after allogeneic HSCT in a single center. Methods: A retrospective study of clinical hematological data of all consecutive patients who underwent HSCT for malignant hematologic disease and then developed oral chronic graft versus host disease (cGVHD) in a single center from 2012 to the present was performed to evaluate the risk factors for oral cGVHD. Allogeneic HSCT was performed for 179 patients. Assessment of individual risk factors (age, sex, primary diagnosis, stem cell source, human leukocyte antigen [HLA] matching, regimen, donor age, and status after remission induction therapy) was completed to identify the effects of covariates of the independent variables. Results: Seventy‐two (40.2%) patients were considered to have oral cGVHD within 36 months after HSCT. Statistical analysis showed that age, sex, stem cell source, HLA matching, regimen, donor age, and status after remission induction therapy were not significant factors related to oral cGVHD, whereas the primary disease was significant. Conclusion: The primary disease was a significant risk factor for oral cGVHD. The oral cGVHD was more common in myeloid neoplasms (MNs) patients than in lymphoid neoplasms (LNs) patients. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
3. Oral Chronic Graft-Versus-Host Disease: Pathogenesis, Diagnosis, Current Treatment, and Emerging Therapies
- Author
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Joe T. Nguyen, Maryam Jessri, Ana C. Costa-da-Silva, Rubina Sharma, Jacqueline W. Mays, and Nathaniel S. Treister
- Subjects
cGVHD ,chronic graft-versus-host-disease ,oral chronic graft-versus-host-disease ,oral cGVHD ,ibrutinib ,ruxolitinib ,Biology (General) ,QH301-705.5 ,Chemistry ,QD1-999 - Abstract
Chronic graft-versus-host disease (cGvHD) is a multisystem disorder that occurs in recipients of allogeneic hematopoietic (alloHCT) stem cell transplants and is characterized by both inflammatory and fibrotic manifestations. It begins with the recognition of host tissues by the non-self (allogeneic) graft and progresses to tissue inflammation, organ dysfunction and fibrosis throughout the body. Oral cavity manifestations of cGVHD include mucosal features, salivary gland dysfunction and fibrosis. This review synthesizes current knowledge on the pathogenesis, diagnosis and management of oral cGVHD, with a focus on emerging trends and novel therapeutics. Data from various clinical studies and expert consensus are integrated to provide a comprehensive overview.
- Published
- 2024
- Full Text
- View/download PDF
4. Grading of minor salivary gland immuno-histopathology post-allogenic hematopoietic cell transplantation
- Author
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V. Tollemar, H. Arvidsson, H. Häbel, N. Tudzarovski, K. Garming Legert, K. Le Blanc, G. Warfvinge, and R.V. Sugars
- Subjects
Oral cGVHD ,Histopathology ,Grading ,Large cohort ,Hematopoietic cell transplantation ,Science (General) ,Q1-390 ,Social sciences (General) ,H1-99 - Abstract
Objectives: The oral cavity commonly displays mucosal lichenoid lesions and salivary gland dysfunction, which are considered different chronic Graft-versus-Host Disease (cGVHD) pathophysiology’s. However, diagnostics of salivary gland (sg-)cGVHD are limited. The objectives of the current study are to evaluate the minor salivary gland (MSG) histo-immunopathological profiles post allogenic hematopoietic cell transplantation based on sg-cGVHD criteria. Design: Histopathology was characterized according to two published grading strategies. Firstly, the National Institute of Health (NIH) assessed peri-ductal/acinar infiltration, exocytosis, damage, and fibrosis, and a points-based grading scheme was established (0–16 points, Grade (G) 0 to IV). Second, a modified Sjögren’s Syndrome focus-score with parenchymal damage was also adapted, (0–10 points, Score 0 to 2). 146 MSG biopsies from 79 patients were compared, using the histopathological specific criteria for sg-cGVHD pathology. Quantitative immunohistochemistry for T-cells (CD4, CD8), B-cells (CD19, CD20), monocytic cells (CD68) and dendritic cells (CD1a) were also assessed. Results: The large-scale cohort validated the use of both grading schemes. GIII-GIV and score 2 signified a histopathological diagnosis of “likely” sg-cGVHD. Immunopathological severity was associated with increased T-cells (CD4 and CD8) and monocytic (CD68) infiltrate, with minimal involvement of B-cells (CD19 and CD20), and Langerhans cells (CD1a). Conclusions: Both schemes were verified as being suitable for histological grading to improve assessment and diagnosis of sg-cGVHD. The NIH cGVHD grading appears to be more beneficial for research purposes, including final diagnostics of “no/inactive”, “possible” or “likely” cGVHD. The study highlights the intricacies of sg-cGVHD pathology; and the need for standardized assessment to improve patient management associated to sg-cGVHD.
- Published
- 2023
- Full Text
- View/download PDF
5. Histopathological Grading of Oral Mucosal Chronic Graft-versus-Host Disease: Large Cohort Analysis.
- Author
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Tollemar, Victor, Tudzarovski, Nikcole, Warfvinge, Gunnar, Yarom, Naom, Remberger, Mats, Heymann, Robert, Garming Legert, Karin, and Sugars, Rachael V.
- Subjects
- *
GRAFT versus host disease , *COHORT analysis , *CHRONIC diseases , *CELL transplantation , *CELL death , *ORAL mucosa - Abstract
• This is a large cohort analysis defining oral mucosal chronic graft-versus-host disease (cGVHD) histology. • A formalized histological grading tool is described. • Histology is correlated with clinical staging to define oral mucosal cGVHD criteria. • Grades II to IV define pathological diagnostics of oral mucosal cGVHD. • Patients are stratified into groups for improved diagnostics and tailored treatments. Graft-versus-host disease (GVHD) can manifest as acute or chronic complications in patients after hematopoietic cell transplantation (HCT). Oral chronic GVHD (cGVHD) occurs in approximately 70% of HCT recipients and includes lichenoid-like mucosal reactions, restricted mouth opening, and salivary gland dysfunction. However, the underlying histopathological presentation remains to be validated in large cohorts. We characterized the histopathological features of oral mucosal cGVHD and devised a scoring model in a large patient cohort (n = 112). Oral mucosal biopsy sections (n = 303) with and without oral cGVHD were identified from archived and current HCT recipients with additional healthy controls. Histological screening was performed on hematoxylin and eosin-stained and periodic acid-Schiff-stained sections. A points-based grading tool (0 to 19, grade 0 to IV) was established based on intraepithelial lymphocytes and band-like inflammatory infiltrate, atrophic epithelium with basal cell liquefaction degeneration, including apoptosis, as well as separation of epithelium and pseudo-rete ridges. Validation involved 62 biopsy specimens, including post-HCT (n = 47) and healthy (n = 15) specimens. Remaining biopsy specimens (n = 199) were blindly graded by 3 observers. Histological severity was correlated with clinical diagnostic and distinctive features, demonstrating a spectrum of individual patient severity, including frequent signs of subclinical GVHD in healthy mucosa. However, oral cGVHD presented with significantly higher (P <.001) scores compared with HCT controls, with moderate to high positive likelihood ratios for inflammatory infiltrate, exocytosis, and basal membrane alterations. The grade II-IV biopsy specimens demonstrated a histopathological diagnosis of active mucosal lichenoid-like cGVHD, highlighting the importance of correlating clinical presentation with the dynamic histopathological processes for improved patient stratification. In addition, this tool could be used for assessing treatments, pathological processes, and immune cellular content to provide further insight into this debilitating disease. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
6. Grading of minor salivary gland immuno-histopathology post-allogenic hematopoietic cell transplantation
- Author
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Tollemar, V., Arvidsson, H., Habel, H., Tudzarovski, N., Legert, K. Garming, Le Blanc, K., Warfvinge, Gunnar, Sugars, R. V., Tollemar, V., Arvidsson, H., Habel, H., Tudzarovski, N., Legert, K. Garming, Le Blanc, K., Warfvinge, Gunnar, and Sugars, R. V.
- Abstract
Objectives: The oral cavity commonly displays mucosal lichenoid lesions and salivary gland dysfunction, which are considered different chronic Graft-versus-Host Disease (cGVHD) patho-physiology's. However, diagnostics of salivary gland (sg-)cGVHD are limited. The objectives of the current study are to evaluate the minor salivary gland (MSG) histo-immunopathological profiles post allogenic hematopoietic cell transplantation based on sg-cGVHD criteria. Design: Histopathology was characterized according to two published grading strategies. Firstly, the National Institute of Health (NIH) assessed peri-ductal/acinar infiltration, exocytosis, damage, and fibrosis, and a points-based grading scheme was established (0-16 points, Grade (G) 0 to IV). Second, a modified Sjo center dot gren's Syndrome focus-score with parenchymal damage was also adapted, (0-10 points, Score 0 to 2). 146 MSG biopsies from 79 patients were compared, using the his-topathological specific criteria for sg-cGVHD pathology. Quantitative immunohistochemistry for T-cells (CD4, CD8), B-cells (CD19, CD20), monocytic cells (CD68) and dendritic cells (CD1a) were also assessed. Results: The large-scale cohort validated the use of both grading schemes. GIII-GIV and score 2 signified a histopathological diagnosis of "likely" sg-cGVHD. Immunopathological severity was associated with increased T-cells (CD4 and CD8) and monocytic (CD68) infiltrate, with minimal involvement of B-cells (CD19 and CD20), and Langerhans cells (CD1a). Conclu-sions: Both schemes were verified as being suitable for histological grading to improve assess-ment and diagnosis of sg-cGVHD. The NIH cGVHD grading appears to be more beneficial for research purposes, including final diagnostics of "no/inactive", "possible" or "likely" cGVHD. The study highlights the intricacies of sg-cGVHD pathology; and the need for standardized assessment to improve patient management associated to sg-cGVHD.
- Published
- 2023
- Full Text
- View/download PDF
7. Grading of minor salivary gland immuno-histopathology post-allogenic hematopoietic cell transplantation.
- Author
-
Tollemar V, Arvidsson H, Häbel H, Tudzarovski N, Legert KG, Le Blanc K, Warfvinge G, and Sugars RV
- Abstract
The oral cavity commonly displays mucosal lichenoid lesions and salivary gland dysfunction, which are considered different chronic Graft-versus-Host Disease (cGVHD) pathophysiology's. However, diagnostics of salivary gland (sg-)cGVHD are limited. The objectives of the current study are to evaluate the minor salivary gland (MSG) histo-immunopathological profiles post allogenic hematopoietic cell transplantation based on sg-cGVHD criteria. Design : Histopathology was characterized according to two published grading strategies. Firstly, the National Institute of Health (NIH) assessed peri-ductal/acinar infiltration, exocytosis, damage, and fibrosis, and a points-based grading scheme was established (0-16 points, Grade (G) 0 to IV). Second, a modified Sjögren's Syndrome focus-score with parenchymal damage was also adapted, (0-10 points, Score 0 to 2). 146 MSG biopsies from 79 patients were compared, using the histopathological specific criteria for sg-cGVHD pathology. Quantitative immunohistochemistry for T-cells (CD4, CD8), B-cells (CD19, CD20), monocytic cells (CD68) and dendritic cells (CD1a) were also assessed. Results: The large-scale cohort validated the use of both grading schemes. GIII-GIV and score 2 signified a histopathological diagnosis of "likely" sg-cGVHD. Immunopathological severity was associated with increased T-cells (CD4 and CD8) and monocytic (CD68) infiltrate, with minimal involvement of B-cells (CD19 and CD20), and Langerhans cells (CD1a). Conclusions: Both schemes were verified as being suitable for histological grading to improve assessment and diagnosis of sg-cGVHD. The NIH cGVHD grading appears to be more beneficial for research purposes, including final diagnostics of "no/inactive", "possible" or "likely" cGVHD. The study highlights the intricacies of sg-cGVHD pathology; and the need for standardized assessment to improve patient management associated to sg-cGVHD., Competing Interests: The authors declare no conflict of interest., (© 2023 The Authors.)
- Published
- 2023
- Full Text
- View/download PDF
8. Oral Disease Profiles in Chronic Graft versus Host Disease.
- Author
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Bassim, C.W., Fassil, H., Mays, J.W., Edwards, D., Baird, K., Steinberg, S.M., Cowen, E.W., Naik, H., Datiles, M., Stratton, P., Gress, R.E., and Pavletic, S.Z.
- Subjects
GRAFT versus host disease ,STEM cell transplantation ,ORAL diseases ,ORAL medicine ,AUTOIMMUNE diseases ,SALIVARY gland diseases - Abstract
At least half of patients with chronic graft-versus-host-disease (cGVHD), the leading cause of morbidity and non-relapse mortality after allogeneic stem cell transplantation, have oral manifestations: mucosal lesions, salivary dysfunction, and limited mouth-opening. cGVHD may manifest in a single organ or affect multiple organ systems, including the mouth, eyes, and the skin. The interrelationship of the 3 oral manifestations of cGVHD with each other and with the specific manifestations of extraoral cGVHD has not been studied. In this analysis, we explored, in a large group of patients with cGVHD, the potential associations between: (1) oral mucosal disease and erythematous skin disease, (2) salivary gland dysfunction and lacrimal gland dysfunction, and (3) limited mouth-opening and sclerotic skin cGVHD. Study participants, enrolled in a cGVHD Natural History Protocol (NCT00331968, n = 212), underwent an oral examination evaluating: (1) mucosal cGVHD [NIH Oral Mucosal Score (OMS)], (2) salivary dysfunction (saliva flow and xerostomia), and (3) maximum mouth-opening measurement. Parameters for dysfunction (OMS > 2, saliva flow ≤ 1 mL/5 min, mouth-opening ≤ 35 mm) were analyzed for association with skin cGVHD involvement (erythema and sclerosis, skin symptoms), lacrimal dysfunction (Schirmer’s tear test, xerophthalmia), Lee cGVHD Symptom Scores, and NIH organ scores. Oral mucosal disease (31% prevalence) was associated with skin erythema (P < 0.001); salivary dysfunction (11% prevalence) was associated with lacrimal dysfunction (P = 0.010) and xerostomia with xerophthalmia (r = 0.32, P = 0.001); and limited mouth-opening (17% prevalence) was associated with skin sclerosis (P = 0.008) and skin symptoms (P = 0.001). There was no association found among these 3 oral cGVHD manifestations. This analysis supports the understanding of oral cGVHD as 3 distinct diseases: mucosal lesions, salivary gland dysfunction, and mouth sclerosis. Clear classification of oral cGVHD as 3 separate manifestations will improve clinical diagnosis, observational research data collection, and the definitions of outcome measures in clinical trials. [ABSTRACT FROM PUBLISHER]
- Published
- 2015
- Full Text
- View/download PDF
9. Histopathological Grading of Oral Mucosal Chronic Graft-versus-Host Disease: Large Cohort Analysis
- Author
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Gunnar Warfvinge, Robert Heymann, Nikcole Tudzarovski, Karin Garming Legert, Victor Tollemar, Naom Yarom, Mats Remberger, and Rachael V. Sugars
- Subjects
medicine.medical_specialty ,Medicin och hälsovetenskap ,H&E stain ,Histopathology ,Graft vs Host Disease ,Odontologi ,Gastroenterology ,Medical and Health Sciences ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,immune system diseases ,hemic and lymphatic diseases ,Internal medicine ,Biopsy ,medicine ,Humans ,Hematologi ,Grading (tumors) ,Subclinical infection ,Transplantation ,Hematopoietic cell transplantation ,medicine.diagnostic_test ,business.industry ,Oral cGVHD ,Hematopoietic Stem Cell Transplantation ,Mouth Mucosa ,Hematology ,medicine.disease ,Large cohort ,Grading ,Graft-versus-host disease ,030220 oncology & carcinogenesis ,Dentistry ,Chronic Disease ,Intraepithelial lymphocyte ,business ,Mouth Diseases ,030215 immunology - Abstract
Graft-versus-host disease (GVHD) can manifest as acute or chronic complications in patients after hematopoietic cell transplantation (HCT). Oral chronic GVHD (cGVHD) occurs in approximately 70% of HCT recipients and includes lichenoid-like mucosal reactions, restricted mouth opening, and salivary gland dysfunction. However, the underlying histopathological presentation remains to be validated in large cohorts. We characterized the histopathological features of oral mucosal cGVHD and devised a scoring model in a large patient cohort (n = 112). Oral mucosal biopsy sections (n = 303) with and without oral cGVHD were identified from archived and current HCT recipients with additional healthy controls. Histological screening was performed on hematoxylin and eosin-stained and periodic acid-Schiff-stained sections. A points-based grading tool (0 to 19, grade 0 to IV) was established based on intraepithelial lymphocytes and band-like inflammatory infiltrate, atrophic epithelium with basal cell liquefaction degeneration, including apoptosis, as well as separation of epithelium and pseudo-rete ridges. Validation involved 62 biopsy specimens, including post-HCT (n = 47) and healthy (n = 15) specimens. Remaining biopsy specimens (n = 199) were blindly graded by 3 observers. Histological severity was correlated with clinical diagnostic and distinctive features, demonstrating a spectrum of individual patient severity, including frequent signs of subclinical GVHD in healthy mucosa. However, oral cGVHD presented with significantly higher (P < .001) scores compared with HCT controls, with moderate to high positive likelihood ratios for inflammatory infiltrate, exocytosis, and basal membrane alterations. The grade II-IV biopsy specimens demonstrated a histopathological diagnosis of active mucosal lichenoid-like cGVHD, highlighting the importance of correlating clinical presentation with the dynamic histopathological processes for improved patient stratification. In addition, this tool could be used for assessing treatments, pathological processes, and immune cellular content to provide further insight into this debilitating disease.
- Published
- 2020
10. Oral chronic graft-versus-host disease: report from the International Consensus Conference on clinical practice in cGVHD.
- Author
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Meier, Johannes, Wolff, Daniel, Pavletic, Steve, Greinix, Hildegard, Gosau, Martin, Bertz, Hartmut, Lee, Stefanie, Lawitschka, Ánita, and Elad, Sharon
- Subjects
- *
GRAFT versus host disease , *MULTIPLE organ failure , *HEMATOPOIETIC stem cells , *STEM cell transplantation , *ORAL diseases , *DIPHOSPHONATES , *OSTEONECROSIS - Abstract
Chronic graft-versus-host disease (cGVHD) is a multi-organ disease that occurs post-hematopoietic stem cell transplantation, with the mouth being one of the most frequently affected organs. In 2009, the German-Austrian-Swiss working party on bone marrow and blood stem cell transplantation held a consensus conference to define clinical management of cGVHD. The consensus conference aimed to summarize the literature on diagnosis and topical treatment options for oral cGVHD and to provide recommendations for clinical practice, including routine dental and oral care as well as monitoring for secondary malignancies and bisphophonate-induced osteonecrosis of the jaw. [ABSTRACT FROM AUTHOR]
- Published
- 2011
- Full Text
- View/download PDF
11. Lower serum levels of zinc and magnesium are associated with worse oral cGVHD and dysgeusia in cGVHD patients
- Author
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Mravak-Stipetić, Marinka, Radman, Maria, Desnica, Lana, Sabol, Ivan, Serventi-Seiwerth, Ranka, Perić, Zinaida, Duraković, Nadira, Ljubas Kelečić, Dina, Bilić, Ervina, Čeović, Romana, Karas, Irena, Vukić, Tamara, Samardžić, Antonela, Kerep Zelić, Ana, Katić, Mašenjka, Vrhovac, Radovan, Pavletić, Steven Živko, and Pulanić, Drazen
- Subjects
immune system diseases ,hemic and lymphatic diseases ,oral cGVHD ,zinc ,magnesium - Abstract
Lower serum levels of zinc and magnesium are associated with worse oral cGVHD and dysgeusia in cGVHD patients
- Published
- 2019
12. Validation of the National Institutes of Health chronic GVHD Oral Mucosal Score using component-specific measures
- Author
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Bassim, C W, Fassil, H, Mays, J W, Edwards, D, Baird, K, Steinberg, S M, Williams, K M, Cowen, E W, Mitchell, S A, Cole, K, Taylor, T, Avila, D, Zhang, D, Pulanic, D, Grkovic, L, Fowler, D, Gress, R E, and Pavletic, S Z
- Published
- 2014
- Full Text
- View/download PDF
13. Validation of the National Institutes of Health chronic GVHD Oral Mucosal Score using component-specific measures
- Author
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Dan Zhang, Lana Grković, Carol W. Bassim, H. Fassil, Kristen Cole, Kirsten M. Williams, Sandra A. Mitchell, Steven Živko Pavletić, Kristin Baird, Tiffany Taylor, Ronald E. Gress, Jacqueline W. Mays, Dean P. Edwards, Daniele Avila, Seth M. Steinberg, Edward W. Cowen, Dražen Pulanić, and Daniel H. Fowler
- Subjects
Adult ,Male ,medicine.medical_specialty ,Erythema ,Adolescent ,Cross-sectional study ,Graft vs Host Disease ,Nutritional Status ,Pain ,Severity of Illness Index ,Article ,oral cGVHD ,chronic graft-versus-host disease ,validation ,Young Adult ,Quality of life ,Albumins ,Severity of illness ,medicine ,Humans ,Prospective Studies ,Young adult ,Prospective cohort study ,Child ,Oral Ulcer ,Pain Measurement ,Inflammation ,Transplantation ,business.industry ,Hematopoietic Stem Cell Transplantation ,Mouth Mucosa ,Reproducibility of Results ,Hematology ,Middle Aged ,medicine.disease ,Dermatology ,Hematologic Diseases ,United States ,stomatognathic diseases ,Graft-versus-host disease ,Cross-Sectional Studies ,National Institutes of Health (U.S.) ,Child, Preschool ,Immunology ,Quality of Life ,Female ,medicine.symptom ,business - Abstract
Oral chronic GVHD (cGVHD) is a common, late complication of alloSCT that is associated with significant patient morbidity. The NIH Oral Mucosal Score (NIH OMS) was developed to assess oral cGVHD therapeutic response, but has not been fully validated. This study’s purpose was to conduct a rigorous construct validity and internal consistency analysis of this score and its components (erythema, lichenoid, ulcers, mucoceles) using established measures of oral pain, oral function, oral-related quality-of- life, nutrition and laboratory parameters in 198 patients with cGVHD. The construct validity of the NIH OMS was supported: a moderate correlation was observed between NIH OMS and mouth pain (rho=0.43), while a weaker correlation was observed with low albumin (rho= −0.26). Total NIH OMS, erythema and lichenoid components were associated with malnutrition, oral pain and impaired oral QOL, while ulcers were only associated with oral pain. No associations were found between mucoceles and any indicator evaluated, including salivary function or xerostomia. Kappa determined between scale components was low overall (all less than or equal to0.35), supporting a conclusion that each component measures a distinct manifestation of oral cGVHD. This study supports the use of the NIH OMS and its components (erythema, lichenoid and ulcerations) to measure clinician-reported severity of oral cGVHD.
- Published
- 2013
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