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Chapter 12 - Stress Response to Surgery in the Elderly

Published online by Cambridge University Press:  13 October 2018

Shamsuddin Akhtar
Affiliation:
Yale University School of Medicine
Stanley Rosenbaum
Affiliation:
Yale University School of Medicine
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Print publication year: 2018

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References

Arias, E, Kochanek, K, Xu, J, Murphy, S. Mortality in the United States, 2014. NCHS Data Brief 2015; 229:18.Google Scholar
Administration of Aging. Profile of Older Americans: 2015. Administration for Community Living, US Department of Health and Human Services, 2015, available at www.acl.gov/aging-and-disability-in-america/data…/profile-older-americans.Google Scholar
Vincent, GK VV The Next Four Decades: The Older Population in the United States: 2010 to 2050. US Department of Commerce, Economics and Statistics Administration, US Census Bureau, 2010.Google Scholar
Weiser, TG, Regenbogen, SE, Thompson, KD, et al. An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet 2008; 372(9633):139–44.CrossRefGoogle ScholarPubMed
Pearse, RM, Moreno, RP, Bauer, P, et al. Mortality after surgery in Europe: a 7 day cohort study. Lancet 2012; 380(9847):1059–65.CrossRefGoogle ScholarPubMed
Hall, M, DeFrances, C, Williams, S, Golosinskiy, A, Schwartzman, A. National Hospital Discharge Survey: 2007 summary. Natl Health Stat Report 2010; 29:1–20, 4.Google Scholar
Li, G, Warner, M, Lang, BH, Huang, L, Sun, LS Epidemiology of anesthesia-related mortality in the United States, 1999–2005. Anesthesiology 2009; 110(4):759–65.CrossRefGoogle ScholarPubMed
Speziale, G, Nasso, G, Barattoni, MC, et al. Operative and middle-term results of cardiac surgery in nonagenarians: a bridge toward routine practice. Circulation 2010; 121(2):208–13.CrossRefGoogle ScholarPubMed
Speziale, G, Nasso, G, Barattoni, MC, et al. Short-term and long-term results of cardiac surgery in elderly and very elderly patients. J Thorac Cardiovasc Surg 2011; 141(3):725–31, e1.CrossRefGoogle ScholarPubMed
Angus, DC, Linde-Zwirble, WT, Lidicker, J, et al. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001; 29(7):1303–10.CrossRefGoogle ScholarPubMed
Sjoding, MW, Prescott, HC, Wunsch, H, Iwashyna, TJ, Cooke, CR Longitudinal changes in ICU admissions among elderly patients in the United States. Crit Care Med 2016; 44(7):1353–60.CrossRefGoogle ScholarPubMed
Nguyen, YL, Angus, DC, Boumendil, A, Guidet, B. The challenge of admitting the very elderly to intensive care. Ann Intensive Care 2011; 1(1):29.CrossRefGoogle ScholarPubMed
Rydingsward, JE, Horkan, CM, Mogensen, KM, et al. Functional status in ICU survivors and out of hospital outcomes: a cohort study. Crit Care Med 2016; 44(5):869–79.CrossRefGoogle ScholarPubMed
Wunsch, H, Guerra, C, Barnato, AE, et al. Three-year outcomes for Medicare beneficiaries who survive intensive care. JAMA 2010; 303(9):849–56.CrossRefGoogle ScholarPubMed
Heyland, DK, Stelfox, HT, Garland, A, et al. Predicting performance status 1 year after critical illness in patients 80 years or older: development of a multivariable clinical prediction model. Crit Care Med 2016; 44(9):1718–26.CrossRefGoogle ScholarPubMed
Podgoreanu, MV, Schwinn, DA New paradigms in cardiovascular medicine: emerging technologies and practices: perioperative genomics. J Am Coll Cardiol 2005; 46(11):1965–77.CrossRefGoogle ScholarPubMed
Giannoudis, P, Dinopoulos, H, Chalidis, B, Hall, G. Surgical stress response. Injury 2006; 37(Suppl 5):S39.CrossRefGoogle ScholarPubMed
Finnerty, C, Mabvuure, N, Ali, A, Kozar, R, Herndon, D. The surgically induced stress response. JPEN J Parenter Enteral Nutr 2013; 37(Suppl 5):21S29S.CrossRefGoogle ScholarPubMed
Wilmore, DW From Cuthbertson to fast-track surgery: 70 years of progress in reducing stress in surgical patients. Ann Surg 2002; 236(5):643–48.CrossRefGoogle ScholarPubMed
Abdelmalak, BB, Bonilla, AM, Yang, D, et al. The hyperglycemic response to major noncardiac surgery and the added effect of steroid administration in patients with and without diabetes. Anesth Analg 2013; 116(5):1116–22.CrossRefGoogle ScholarPubMed
Li, L, Messina, JL Acute insulin resistance following injury. Trends Endocrinol Metab 2009; 20(9):429–35.CrossRefGoogle ScholarPubMed
Desborough, JP The stress response to trauma and surgery. Br J Anaesth 2000; 85(1):109–17.CrossRefGoogle ScholarPubMed
Jin, F, Chung, F. Minimizing perioperative adverse events in the elderly. Br J Anaesth 2001; 87(4):608–24.CrossRefGoogle ScholarPubMed
Cecconi, M, Corredor, C, Arulkumaran, N, et al. Clinical review: goal-directed therapy-what is the evidence in surgical patients? The effect on different risk groups. Crit Care 2013; 17(2):209.CrossRefGoogle Scholar
Cerra, F, Siegel, J, Border, J, Peters, D, McMenamy, R. Correlations between metabolic and cardiopulmonary measurements in patients after trauma, general surgery, and sepsis. J Trauma 1979; 19(8):621–29.CrossRefGoogle ScholarPubMed
Kohl, B, Deutschman, C. The inflammatory response to surgery and trauma. Curr Opin Crit Care 2006; 12(4):325–32.CrossRefGoogle ScholarPubMed
Dobson, GP Addressing the global burden of trauma in major surgery. Front Surg 2015; 2:43.CrossRefGoogle ScholarPubMed
Bartels, K, Karhausen, J, Clambey, ET, Grenz, A, Eltzschig, HK Perioperative organ injury. Anesthesiology 2013; 119(6):1474–89.CrossRefGoogle ScholarPubMed
Lowry, SF The stressed host response to infection: the disruptive signals and rhythms of systemic inflammation. Surg Clin North Am 2009; 89(2):311–26, vii.CrossRefGoogle ScholarPubMed
Watt, D. The biology of aging: implications for diseases of aging and health care in the twenty‐first century. In Nair, A, Sabbagh, M, eds., Geriatric Neurology. New York, NY: Wiley Online Library, 2014: 137.Google Scholar
Dhainaut, JF, Claessens, YE, Janes, J, Nelson, DR Underlying disorders and their impact on the host response to infection. Clin Infect Dis 2005; 41(Suppl 7):S48189.CrossRefGoogle ScholarPubMed
Gruver, AL, Hudson, LL, Sempowski, GD Immunosenescence of ageing. J Pathol 2007; 211(2):144–56.CrossRefGoogle ScholarPubMed
Opal, SM, Girard, TD, Ely, EW The immunopathogenesis of sepsis in elderly patients. Clin Infect Dis 2005; 41(Suppl 7):S50412.CrossRefGoogle ScholarPubMed
Yende, S, Tuomanen, EI, Wunderink, R, et al. Preinfection systemic inflammatory markers and risk of hospitalization due to pneumonia. Am J Respir Crit Care Med 2005; 172(11):1440–46.CrossRefGoogle ScholarPubMed
Cesari, M, Penninx, BW, Newman, AB, et al. Inflammatory markers and onset of cardiovascular events: results from the Health ABC Study. Circulation 2003; 108(19):2317–22.CrossRefGoogle ScholarPubMed
Krabbe, KS, Bruunsgaard, H, Hansen, CM, et al. Ageing is associated with a prolonged fever response in human endotoxemia. Clin Diagn Lab Immunol 2001; 8(2):333–38.CrossRefGoogle ScholarPubMed
Krabbe, KS, Bruunsgaard, H, Qvist, J, et al. Hypotension during endotoxemia in aged humans. Eur J Anaesthesiol 2001; 18(9):572–75.CrossRefGoogle ScholarPubMed
Bruunsgaard, H, Skinhoj, P, Qvist, J, Pedersen, BK Elderly humans show prolonged in vivo inflammatory activity during pneumococcal infections. J Infect Dis 1999; 180(2):551–54.CrossRefGoogle ScholarPubMed
Furman, D, Chang, J, Lartigue, L, et al. Expression of specific inflammasome gene modules stratifies older individuals into two extreme clinical and immunological states. Nat Med 2017; 23(2):174–84.CrossRefGoogle ScholarPubMed
Butcher, SK, Lord, JM Stress responses and innate immunity: aging as a contributory factor. Aging Cell 2004; 3(4):151–60.CrossRefGoogle ScholarPubMed
Bonnemeier, H, Richardt, G, Potratz, J, et al. Circadian profile of cardiac autonomic nervous modulation in healthy subjects: differing effects of aging and gender on heart rate variability. J Cardiovasc Electrophysiol 2003; 14(8):791–99.CrossRefGoogle ScholarPubMed
Thevaranjan, N, Puchta, A, Schulz, C, et al. Age-associated microbial dysbiosis promotes intestinal permeability, systemic inflammation, and macrophage dysfunction. Cell Host Microbe 2017; 21(4):455–66, e4.CrossRefGoogle ScholarPubMed
McDonald, D, Ackermann, G, Khailova, L, et al. Extreme dysbiosis of the microbiome in critical illness. mSphere 2016; 1(4).CrossRefGoogle ScholarPubMed
Codner, PA, Herron, TJ The shifting microbiome in surgical stress. Curr Surg Rep 2017; 5(4):9.CrossRefGoogle Scholar
Stavrou, G, Kotzampassi, K. Gut microbiome, surgical complications and probiotics. Ann Gastroenterol 2017; 30(1):4553.Google ScholarPubMed
Morrow, LE, Wischmeyer, P. Blurred lines: dysbiosis and probiotics in the ICU. Chest 2017; 151(2):492–99.CrossRefGoogle ScholarPubMed
Gaudilliere, B, Fragiadakis, GK, Bruggner, RV, et al. Clinical recovery from surgery correlates with single-cell immune signatures. Sci Transl Med 2014; 6(255):255ra131.CrossRefGoogle ScholarPubMed
Fragiadakis, GK, Gaudilliere, B, Ganio, EA, et al. Patient-specific immune states before surgery are strong correlates of surgical recovery. Anesthesiology 2015; 123(6):1241–55.CrossRefGoogle ScholarPubMed
Rao, LV, Pendurthi, UR Tissue factor-factor VIIa signaling. Arterioscler Thromb Vasc Biol 2005; 25(1):4756.CrossRefGoogle ScholarPubMed
Favaloro, EJ, Franchini, M, Lippi, G. Aging hemostasis: changes to laboratory markers of hemostasis as we age: a narrative review. Semin Thromb Hemost 2014; 40(6):621–33.Google ScholarPubMed
Seidler, S, Zimmermann, HW, Bartneck, M, Trautwein, C, Tacke, F. Age-dependent alterations of monocyte subsets and monocyte-related chemokine pathways in healthy adults. BMC Immunol 2010; 11:30.CrossRefGoogle ScholarPubMed
Goubareva, I, Gkaliagkousi, E, Shah, A, et al. Age decreases nitric oxide synthesis and responsiveness in human platelets and increases formation of monocyte-platelet aggregates. Cardiovasc Res 2007; 75(4):793802.CrossRefGoogle ScholarPubMed
Yamamoto, K, Takeshita, K, Saito, H. Plasminogen activator inhibitor-1 in aging. Semin Thromb Hemost 2014; 40(6):652–59.Google ScholarPubMed
Dobson, GP, Letson, HL, Sharma, R, Sheppard, FR, Cap, AP Mechanisms of early trauma-induced coagulopathy: the clot thickens or not? J Trauma Acute Care Surg 2015; 79(2):301–9.CrossRefGoogle ScholarPubMed
Schlaudecker, J, Becker, R. Inflammatory response and thrombosis in older individuals. Semin Thromb Hemost 2014; 40(6):669–74.CrossRefGoogle ScholarPubMed
Morais, JA, Chevalier, S, Gougeon, R. Protein turnover and requirements in the healthy and frail elderly. J Nutr Health Aging 2006; 10(4):272–83.Google ScholarPubMed
Schricker, T, Lattermann, R. Perioperative catabolism. Can J Anaesth 2015; 62(2):182–93.CrossRefGoogle ScholarPubMed
Alverdy, JC, Luo, JN The influence of host stress on the mechanism of infection: lost microbiomes, emergent pathobiomes, and the role of interkingdom signaling. Front Microbiol 2017; 8:322.CrossRefGoogle ScholarPubMed
Chahal, HS, Drake, WM The endocrine system and ageing. J Pathol 2007; 211(2):173–80.CrossRefGoogle ScholarPubMed
Kennedy, BK, Berger, SL, Brunet, A, et al. Geroscience: linking aging to chronic disease. Cell 2014; 159(4):709–13.CrossRefGoogle ScholarPubMed
McEwen, BS Protective and damaging effects of stress mediators. N Engl J Med 1998; 338(3):171–79.CrossRefGoogle ScholarPubMed
McEwen, BS, Seeman, T. Protective and damaging effects of mediators of stress: elaborating and testing the concepts of allostasis and allostatic load. Ann NY Acad Sci 1999; 896:3047.CrossRefGoogle ScholarPubMed
McEwen, BS, Stellar, E. Stress and the individual: mechanisms leading to disease. Arch Intern Med 1993; 153(18):2093–101.CrossRefGoogle ScholarPubMed
Seplaki, CL, Goldman, N, Glei, D, Weinstein, M. A comparative analysis of measurement approaches for physiological dysregulation in an older population. Exp Gerontol 2005; 40(5):438–49.CrossRefGoogle Scholar
Dowd, JB, Simanek, AM, Aiello, AE Socio-economic status, cortisol and allostatic load: a review of the literature. Int J Epidemiol 2009; 38(5):1297–309.CrossRefGoogle ScholarPubMed
Bartlett, DB, Firth, CM, Phillips, AC, et al. The age-related increase in low-grade systemic inflammation (inflammaging) is not driven by cytomegalovirus infection. Aging Cell 2012; 11(5):912–15.CrossRefGoogle Scholar
Franceschi, C, Monti, D, Sansoni, P, Cossarizza, A. The immunology of exceptional individuals: the lesson of centenarians. Immunol Today 1995; 16(1):1216.CrossRefGoogle ScholarPubMed
Blackburn, EH, Epel, ES, Lin, J. Human telomere biology: a contributory and interactive factor in aging, disease risks, and protection. Science 2015; 350(6265):1193–98.CrossRefGoogle ScholarPubMed
Epel, ES, Blackburn, EH, Lin, J, et al. Accelerated telomere shortening in response to life stress. Proc Natl Acad Sci USA 2004; 101(49):17312–15.CrossRefGoogle ScholarPubMed
Tomiyama, AJ, O’Donovan, A, Lin, J, et al. Does cellular aging relate to patterns of allostasis? An examination of basal and stress reactive HPA axis activity and telomere length. Physiol Behav 2012; 106(1):4045.CrossRefGoogle ScholarPubMed
Hausenloy, DJ, Yellon, DM Ischaemic conditioning and reperfusion injury. Nat Rev Cardiol 2016; 13(4):193209.CrossRefGoogle ScholarPubMed
Peretti, D, Bastide, A, Radford, H, et al. RBM3 mediates structural plasticity and protective effects of cooling in neurodegeneration. Nature 2015; 518(7538):236–39.CrossRefGoogle ScholarPubMed
Kolb, H, Eizirik, DL Resistance to type 2 diabetes mellitus: a matter of hormesis? Nat Rev Endocrinol 2011; 8(3):183–92.Google ScholarPubMed
Quinones, QJ, Zhang, Z, Ma, Q, et al. Proteomic profiling reveals adaptive responses to surgical myocardial ischemia-reperfusion in hibernating arctic ground squirrels compared to rats. Anesthesiology 2016; 124(6):1296–310.CrossRefGoogle ScholarPubMed
Kincaid, B, Bossy-Wetzel, E. Forever young: SIRT3 a shield against mitochondrial meltdown, aging, and neurodegeneration. Front Aging Neurosci 2013; 5:48.CrossRefGoogle ScholarPubMed
Longchamp, A, Harputlugil, E, Corpataux, JM, Ozaki, CK, Mitchell, JR Is overnight fasting before surgery too much or not enough? How basic aging research can guide preoperative nutritional recommendations to improve surgical outcomes: a mini-review. Gerontology 2017; 63(3):228–37.CrossRefGoogle ScholarPubMed
Hausenloy, DJ, Candilio, L, Evans, R, et al. Remote ischemic preconditioning and outcomes of cardiac surgery. N Engl J Med 2015; 373(15):1408–17.CrossRefGoogle ScholarPubMed
Xue, QL The frailty syndrome: definition and natural history. Clin Geriatr Med 2011; 27(1):115.CrossRefGoogle ScholarPubMed
Robinson, TN, Wu, DS, Pointer, L, et al. Simple frailty score predicts postoperative complications across surgical specialties. Am J Surg 2013; 206(4):544–50.CrossRefGoogle ScholarPubMed
Dasgupta, M, Rolfson, DB, Stolee, P, Borrie, MJ, Speechley, M. Frailty is associated with postoperative complications in older adults with medical problems. Arch Gerontol Geriatr 2009; 48(1):7883.CrossRefGoogle ScholarPubMed
Kristjansson, SR, Nesbakken, A, Jordhoy, MS, et al. Comprehensive geriatric assessment can predict complications in elderly patients after elective surgery for colorectal cancer: a prospective observational cohort study. Crit Rev Oncol Hematol 2010; 76(3):208–17.CrossRefGoogle ScholarPubMed
Makary, MA, Segev, DL, Pronovost, PJ, et al. Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg 2010; 210(6):901–8.CrossRefGoogle ScholarPubMed
Robinson, TN, Wallace, JI, Wu, DS, et al. Accumulated frailty characteristics predict postoperative discharge institutionalization in the geriatric patient. J Am Coll Surg 2011; 213(1):3742; discussion 44.CrossRefGoogle ScholarPubMed
Bagshaw, SM, Stelfox, HT, McDermid, RC, et al. Association between frailty and short- and long-term outcomes among critically ill patients: a multicentre prospective cohort study. CMAJ 2014; 186(2):e95102.CrossRefGoogle Scholar
Lee, DH, Buth, KJ, Martin, BJ, Yip, AM, Hirsch, GM Frail patients are at increased risk for mortality and prolonged institutional care after cardiac surgery. Circulation 2010; 121(8):973–78.CrossRefGoogle ScholarPubMed
Culley, DJ, Flaherty, D, Reddy, S, et al. Preoperative cognitive stratification of older elective surgical patients: a cross-sectional study. Anesth Analg 2016; 123(1):186–92.CrossRefGoogle ScholarPubMed
Zenilman, ME More powerful than the American Society of Anesthesiology score. JAMA Surg 2014; 149(7):640–41.CrossRefGoogle Scholar
Chow, WB, Rosenthal, RA, Merkow, RP, American College of Surgeons National Surgical Quality Improvement Program, et al. Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society. J Am Coll Surg 2012; 215(4):453–66.CrossRefGoogle Scholar
Wozniak, SE, Coleman, J, Katlic, MR. Optimal preoperative evaluation and perioperative care of the geriatric patient: a surgeon’s perspective. Anesthesiol Clin 2015; 33(3):481–89.CrossRefGoogle Scholar
Townsend, NT, Robinson, TN Surgical risk and comorbidity in older urologic patients. Clin Geriatr Med 2015; 31(4):591601.CrossRefGoogle ScholarPubMed
Murthy, S, Hepner, DL, Cooper, Z, Bader, AM, Neuman, MD Controversies in anaesthesia for noncardiac surgery in older adults. Br J Anaesth 2015; 115(Suppl 2):ii, 1525.CrossRefGoogle ScholarPubMed
Whitson, HE, Duan-Porter, W, Schmader, KE, et al. Physical resilience in older adults: systematic review and development of an emerging construct. J Gerontol A Biol Sci Med Sci 2016; 71(4):489–95.CrossRefGoogle ScholarPubMed
Graham, D, Becerril-Martinez, G. Surgical resilience: a review of resilience biomarkers and surgical recovery. Surgeon 2014; 12(6):334–44.CrossRefGoogle ScholarPubMed
Hadley, EC, Kuchel, GA, Newman, AB, et al. Report: NIA Workshop on measures of physiologic resiliencies in human aging. J Gerontol A Biol Sci Med Sci 2017; 72(7):980–90.CrossRefGoogle ScholarPubMed
Ihn, CH, Joo, JD, Choi, JW, et al. Comparison of stress hormone response, interleukin-6 and anaesthetic characteristics of two anaesthetic techniques: volatile induction and maintenance of anaesthesia using sevoflurane versus total intravenous anaesthesia using propofol and remifentanil. J Int Med Res 2009; 37(6):1760–71.CrossRefGoogle ScholarPubMed
Neuman, MD, Silber, JH, Elkassabany, NM, Ludwig, JM, Fleisher, LA Comparative effectiveness of regional versus general anesthesia for hip fracture surgery in adults. Anesthesiology 2012; 117(1):7292.CrossRefGoogle ScholarPubMed
Whiting, PS, Molina, CS, Greenberg, SE, et al. Regional anaesthesia for hip fracture surgery is associated with significantly more peri-operative complications compared with general anaesthesia. Int Orthop 2015; 39(7):1321–27.CrossRefGoogle ScholarPubMed
Brox, WT, Roberts, KC, Taksali, S, et al. The American Academy of Orthopaedic Surgeons Evidence-Based Guideline on Management of Hip Fractures in the Elderly. J Bone Joint Surg Am 2015; 97(14):1196–99.CrossRefGoogle ScholarPubMed
Schofield, PA The assessment and management of peri-operative pain in older adults. Anaesthesia 2014; 69(Suppl 1):5460.CrossRefGoogle ScholarPubMed
American Geriatrics Society. The management of chronic pain in older persons: AGS Panel on Chronic Pain in Older Persons. J Am Geriatr Soc 1998; 46(5):635–51.Google Scholar
Falzone, E, Hoffmann, C, Keita, H. Postoperative analgesia in elderly patients. Drugs Aging 2013; 30(2):8190.CrossRefGoogle ScholarPubMed
McKeown, JL Pain management issues for the geriatric surgical patient. Anesthesiol Clin 2015; 33(3):563–76.CrossRefGoogle ScholarPubMed
Fabi, DW Multimodal analgesia in the hip fracture patient. J Orthop Trauma 2016; 30(Suppl 1):S611.CrossRefGoogle ScholarPubMed
Moraca, RJ, Sheldon, DG, Thirlby, RC The role of epidural anesthesia and analgesia in surgical practice. Ann Surg 2003; 238(5):663–73.CrossRefGoogle ScholarPubMed
American Geriatrics Society Expert Panel on Postoperative Delirium in Older Adults. Postoperative delirium in older adults: best practice statement from the American Geriatrics Society. J Am Coll Surg 2015; 220(2):136–48, e1.Google Scholar
Radtke, FM, Franck, M, Lendner, J, et al. Monitoring depth of anaesthesia in a randomized trial decreases the rate of postoperative delirium but not postoperative cognitive dysfunction. Br J Anaesth 2013; 110(Suppl 1):i98105.CrossRefGoogle Scholar
Forman, DE, Arena, R, Boxer, R, et al. Prioritizing functional capacity as a principal end point for therapies oriented to older adults with cardiovascular disease: a scientific statement for healthcare professionals from the American Heart Association. Circulation 2017; 135(16):e894918.CrossRefGoogle ScholarPubMed
Shulman, MA, Myles, PS, Chan, MT, et al. Measurement of disability-free survival after surgery. Anesthesiology 2015; 122(3):524–36.CrossRefGoogle ScholarPubMed
Hodgson, CL, Udy, AA, Bailey, M, et al. The impact of disability in survivors of critical illness. Intensive Care Med 2017; 43(7):9921001.CrossRefGoogle ScholarPubMed

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