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  1. Article ; Online: Twenty years of robotic surgery: a challenge for human limits.

    Boggi, Ugo / Vistoli, Fabio / Amorese, Gabriella

    Updates in surgery

    2021  Volume 73, Issue 3, Page(s) 789–793

    MeSH term(s) Humans ; Robotic Surgical Procedures
    Language English
    Publishing date 2021-05-21
    Publishing country Italy
    Document type Editorial
    ZDB-ID 2572692-4
    ISSN 2038-3312 ; 2038-131X
    ISSN (online) 2038-3312
    ISSN 2038-131X
    DOI 10.1007/s13304-021-01071-x
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Pancreas transplantation.

    Vistoli, Fabio / Kauffmann, Emanuele F / Boggi, Ugo

    Current opinion in organ transplantation

    2021  Volume 26, Issue 4, Page(s) 381–389

    Abstract: Purpose of review: To define recent changes and future directions in the practice of pancreas transplantation (PT). Two major events have occurred in the past 18 months: COVID-19 pandemic, and the first world consensus conference on PT. Several ... ...

    Abstract Purpose of review: To define recent changes and future directions in the practice of pancreas transplantation (PT). Two major events have occurred in the past 18 months: COVID-19 pandemic, and the first world consensus conference on PT. Several innovative studies were published after the consensus conference.
    Recent findings: During COVID-19 pandemic PT activity decreased. COVID-19 in transplant recipients increases mortality rates, but data from kidney transplantation show that mortality might be higher in waitlisted patients.The world consensus conference provided 49 jury deliberations on the impact of PT on management of diabetic patients and 110 practice recommendations.Recent evidence demonstrates that PT alone is safe and effective, that results of simultaneous pancreas and kidney (SPK) remain excellent despite older recipient age and higher prevalence of type 2 diabetes, that use of hepatitis C virus (HCV)-positive donors into HCV-negative recipients is associated with good outcomes, and that use of sirolimus as primary immunosuppressant and costimulation blockade does not improve results of SPK.
    Summary: COVID-19 pandemic and the first world consensus conference on PT were major events. Although COVID-19 pandemic should not reduce PT activity in the future, a major positive impact on both volume and outcomes of PT is awaited from the proceedings of the world consensus conference.
    MeSH term(s) COVID-19/epidemiology ; Consensus Development Conferences as Topic ; Donor Selection ; Graft Survival/physiology ; Humans ; Kidney Transplantation/trends ; Pancreas Transplantation/mortality ; Pancreas Transplantation/trends ; SARS-CoV-2 ; Transplant Recipients
    Language English
    Publishing date 2021-06-07
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1390429-2
    ISSN 1531-7013 ; 1087-2418
    ISSN (online) 1531-7013
    ISSN 1087-2418
    DOI 10.1097/MOT.0000000000000900
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: First world consensus conference on pancreas transplantation: Part I-Methods and results of literature search.

    Boggi, Ugo / Vistoli, Fabio / Marchetti, Piero / Kandaswamy, Raja / Berney, Thierry

    American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons

    2021  Volume 21 Suppl 3, Page(s) 1–16

    Abstract: Comprehensive evidence-based guidelines for the practice of pancreas transplantation are yet to be established. The First World Consensus Conference on Pancreas Transplantation was convened for this purpose. A steering committee selected the participants ...

    Abstract Comprehensive evidence-based guidelines for the practice of pancreas transplantation are yet to be established. The First World Consensus Conference on Pancreas Transplantation was convened for this purpose. A steering committee selected the participants and defined the questions to be addressed. A group of literature reviewers identified 597 studies to be included in summaries for guidelines production. Expert groups formulated the first draft of recommendations. Two rounds of discussion and voting occurred online, using the Delphi method (agreement rate ≥85%). After each round, critical responses of experts were reviewed, and recommendations were amended accordingly. Recommendations were finalized after live discussions. Each session was preceded by expert presentations and a summary of results of systematic literature review. Up to three voting rounds were allowed for each recommendation. To avoid potential conflicts of interest, deliberations on issues regarding the impact of pancreas transplantation on the management of diabetes were conducted by an independent jury. Recommendations on technical issues were determined by experts and validated using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Quality of evidence was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) methodology. Each recommendation received a GRADE rating (Grading of Recommendations, Assessment, Development and Evaluations).
    MeSH term(s) Consensus ; Humans ; Pancreas Transplantation
    Language English
    Publishing date 2021-07-29
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Systematic Review
    ZDB-ID 2060594-8
    ISSN 1600-6143 ; 1600-6135
    ISSN (online) 1600-6143
    ISSN 1600-6135
    DOI 10.1111/ajt.16738
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Outcomes of double-layer continuous suture hepaticojejunostomy in pancreatoduodenectomy and total pancreatectomy.

    Napoli, Niccolò / Kauffmann, Emanuele F / Caputo, Rosilde / Ginesini, Michael / Asta, Fabio / Gianfaldoni, Cesare / Amorese, Gabriella / Vistoli, Fabio / Boggi, Ugo

    HPB : the official journal of the International Hepato Pancreato Biliary Association

    2022  Volume 24, Issue 10, Page(s) 1738–1747

    Abstract: Background: This study aims to describe the technique and the results of double-layer continuous suture hepaticojejunostomy (HJ) following pancreatoduodenectomy (PD) and total pancreatectomy (TP).: Methods: A prospectively maintained database was ... ...

    Abstract Background: This study aims to describe the technique and the results of double-layer continuous suture hepaticojejunostomy (HJ) following pancreatoduodenectomy (PD) and total pancreatectomy (TP).
    Methods: A prospectively maintained database was analyzed retrospectively to identify incidence and severity of biliary leaks (BL) (ISGLS definition), as well as of HJ stenosis (HJS), cholangitis, and need for redo-HJ (in patients with a follow-up ≥3 years) in a consecutive series of 800 procedures (PD = 603; TP = 197). Predictors of biliary complications were also identified.
    Results: BLs occurred in 5 patients (0.6%), including 2 (0.3%) combined pancreatic and biliary leaks. Rates of HJS, cholangitis, and need for redo-HJ were 6.1%, 5.4%, and 2.0%, respectively. Incidence of BL was 0.6% in open procedures (4/587) and 0.4% in robotic operations (1/213). Incidence of late biliary complications was also equivalent in open and robotic procedures. Occurrence of BL was predicted by ASA IV status and duodenal cancer, HJS by any associated vascular procedure and hepatic duct size < 8 mm, cholangitis by any associated vascular procedure and normal bilirubin/hepatic enzymes, and redo HJ by history of cholecystectomy and neuroendocrine tumor/cancer.
    Discussion: Double layer continuous suture HJ is associated with low BL rates, and an acceptable incidence of late complications.
    MeSH term(s) Humans ; Pancreatectomy/adverse effects ; Pancreatectomy/methods ; Pancreaticoduodenectomy/adverse effects ; Retrospective Studies ; Biliary Tract Diseases ; Cholangitis/etiology ; Sutures/adverse effects ; Bilirubin ; Postoperative Complications/etiology
    Chemical Substances Bilirubin (RFM9X3LJ49)
    Language English
    Publishing date 2022-05-17
    Publishing country England
    Document type Journal Article
    ZDB-ID 2131251-5
    ISSN 1477-2574 ; 1365-182X
    ISSN (online) 1477-2574
    ISSN 1365-182X
    DOI 10.1016/j.hpb.2022.05.005
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Feasibility of "cold" triangle robotic pancreatoduodenectomy.

    Kauffmann, Emanuele F / Napoli, Niccolò / Ginesini, Michael / Gianfaldoni, Cesare / Asta, Fabio / Salamone, Alice / Amorese, Gabriella / Vistoli, Fabio / Boggi, Ugo

    Surgical endoscopy

    2022  Volume 36, Issue 12, Page(s) 9424–9434

    Abstract: Background: Triangle pancreatoduodenectomy adds to the conventional procedure the en bloc removal of the retroperitoneal lympho-neural tissue included in the triangular area bounded by the common hepatic artery (CHA), the superior mesenteric artery (SMA) ...

    Abstract Background: Triangle pancreatoduodenectomy adds to the conventional procedure the en bloc removal of the retroperitoneal lympho-neural tissue included in the triangular area bounded by the common hepatic artery (CHA), the superior mesenteric artery (SMA), and the superior mesenteric vein/portal vein. We herein aim to show the feasibility of "cold" triangle robotic pancreaticoduodenectomy (C-Tr-RPD) for pancreatic cancer (PDAC).
    Methods: Cold dissection corresponds to sharp arterial divestment performed using only the tips of robotic scissors. After division of the gastroduodenal artery, triangle dissection begins by lateral-to-medial divestment of the CHA and anterior-to-posterior clearance of the right side of the celiac trunk. Next, after a wide Kocher maneuver, the origin of the SMA, and the celiac trunk are identified. After mobilization of the first jejunal loop and attached mesentery, the SMA is identified at the level of the first jejunal vein and is divested along the right margin working in a distal-to-proximal direction. Vein resection and reconstruction can be performed as required. C-Tr-RPD was considered feasible if triangle dissection was successfully completed without conversion to open surgery or need to use energy devices. Postoperative complications and pathology results are presented in detail.
    Results: One hundred twenty-seven consecutive C-Tr-RPDs were successfully performed. There were three conversions to open surgery (2.3%), because of pneumoperitoneum intolerance (n = 2) and difficult digestive reconstruction. Thirty-four patients (26.7%) required associated vascular procedures. No pseudoaneurysm of the gastroduodenal artery was observed. Twenty-eight patients (22.0%) developed severe postoperative complications (≥ grade III). Overall 90-day mortality was 7.1%, declining to 2.3% after completion of the learning curve. The median number of examined lymph nodes was 42 (33-51). The rate of R1 resection (7 margins < 1 mm) was 44.1%.
    Conclusion: C-Tr-RPD is feasible, carries a risk of surgical complications commensurate to the magnitude of the procedure, and improves staging of PDAC.
    MeSH term(s) Humans ; Pancreaticoduodenectomy/methods ; Robotic Surgical Procedures/methods ; Feasibility Studies ; Pancreatic Neoplasms/surgery ; Margins of Excision ; Postoperative Complications/surgery ; Pancreatic Neoplasms
    Language English
    Publishing date 2022-07-26
    Publishing country Germany
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 639039-0
    ISSN 1432-2218 ; 0930-2794
    ISSN (online) 1432-2218
    ISSN 0930-2794
    DOI 10.1007/s00464-022-09411-7
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Safety and safety protocols for living donor nephrectomy in Italy.

    Napoli, Niccolò / Kauffmann, Emanuele F / Ginesini, Michael / Gianfaldoni, Cesare / Fiaschetti, Pamela / Lombardi, Ilaria / Cardillo, Massimo / Vistoli, Fabio / Boggi, Ugo

    Updates in surgery

    2023  Volume 76, Issue 1, Page(s) 209–218

    Abstract: Living donor kidney transplantation (LDKTx) is recommended by all scientific societies. Living donor nephrectomy (LDN) is probably one of the safest surgical procedures, but it carries some risk for healthy donors. The aim of this study is to provide a ... ...

    Abstract Living donor kidney transplantation (LDKTx) is recommended by all scientific societies. Living donor nephrectomy (LDN) is probably one of the safest surgical procedures, but it carries some risk for healthy donors. The aim of this study is to provide a snapshot of LDKTx activities in Italy and ask about safety measures implemented in LDN. Data on LDKTx were extracted from the national database. Safety measures were examined through a specific survey. Between 2001 and 2022 40,663 kidney transplants (31.4 per million population-pmp) were performed, including 4731 LDKTx (3.7 pmp). There was no postoperative death of the donor. After a median follow-up of 52.2 months [IQR:17.9-99.5], the 10-year donor survival rate was 93.38% (CI:97.52-98.94). There was evidence of renal disease in 65 donors (1.8%), including 42 (1.1%) with stage III end-stage renal disease. Twenty-nine out of 35 transplant centers (TC) involved in LDKTx responded to the survey (82.9%). Six TCs (21.4%) had a total experience of 20 or fewer LDN. Minimally invasive LDN was the first choice at 24 TC (82.8%). At 10 TC (37.0%) only one surgeon performed LDN. Nineteen TCs (65.5%) had a surgical safety checklist for LDN and 14 had a postoperative surveillance protocol. The renal artery was occluded in 3 TCs (10.3%) mainly by non-transfixion methods (including clips). Redundancy of key safety systems in the operating room was available in 22 of 29 centers (75.8%). In summary, LDKTx should be further implemented in Italy. Donor safety should be improved through the implementation of a national procedural protocol.
    MeSH term(s) Humans ; Living Donors ; Nephrectomy/adverse effects ; Nephrectomy/methods ; Kidney ; Kidney Transplantation ; Laparoscopy/methods ; Italy
    Language English
    Publishing date 2023-11-08
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2572692-4
    ISSN 2038-3312 ; 2038-131X
    ISSN (online) 2038-3312
    ISSN 2038-131X
    DOI 10.1007/s13304-023-01678-2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Ca 125 is an independent prognostic marker in resected pancreatic cancer of the head of the pancreas.

    Napoli, Niccolò / Kauffmann, Emanuele F / Ginesini, Michael / Lami, Lucrezia / Lombardo, Carlo / Vistoli, Fabio / Campani, Daniela / Boggi, Ugo

    Updates in surgery

    2023  Volume 75, Issue 6, Page(s) 1481–1496

    Abstract: The prognostic value of carbohydrate antigen 125 (Ca 125) is emerging also in pancreatic cancer (PDAC). In this study, we aim to define the prognostic value of Ca 125 in resected PDAC of the head of the pancreas. This is a single-center, retrospective ... ...

    Abstract The prognostic value of carbohydrate antigen 125 (Ca 125) is emerging also in pancreatic cancer (PDAC). In this study, we aim to define the prognostic value of Ca 125 in resected PDAC of the head of the pancreas. This is a single-center, retrospective study. Data from patients with a pre-operative assay of Ca 125 who underwent a pancreatic resection for PDAC between 2010 and 2018 were analyzed. As per National Comprehensive Cancer Guidelines, tumors were classified in resectable (R-PDAC), borderline resectable (BR-PDAC), and locally advanced (LA-PDAC). The Kaplan-Meier method was used to evaluate the overall survival. Cox proportional hazard regression was used to evaluate the role of pre-operative Ca 125 in predicting survival (while adjusting for confounders). The maximally selected log-rank statistic was used to identify a Ca 125 cut-off defining two groups with different survival probability. Inclusion criteria were met by 207 patients (R-PDAC: 80, BR-PDAC: 91, and LA-PDAC: 36). Ca 125 predicted overall survival before and after adjusting for confounding factors in all categories of anatomic resectability (R-PDAC: HR = 4.3; p = 0.0249) (BR-PDAC: HR = 7.82; p = 0.0024) (LA-PDAC: HR = 11.4; p = 0.0043). In BR-PDAC and LA-PDAC (n = 127), the division in two groups (high vs. low Ca 125) correlated with T stage (p = 0.0317), N stage (p = 0.0083), mean LN ratio (p = 0.0292), and tumor grading (p = 0.0143). This study confirmed the prognostic value of Ca125 in resected pancreatic cancer and, therefore, the importance of biologic over anatomic resectability. Ca 125 should be routinely assayed in surgical candidates with PDAC.
    MeSH term(s) Humans ; Prognosis ; Carcinoma, Pancreatic Ductal/surgery ; Retrospective Studies ; Pancreatic Neoplasms ; Pancreas/surgery ; Head and Neck Neoplasms ; Pancreatic Neoplasms
    Language English
    Publishing date 2023-08-03
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2572692-4
    ISSN 2038-3312 ; 2038-131X
    ISSN (online) 2038-3312
    ISSN 2038-131X
    DOI 10.1007/s13304-023-01587-4
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: European Consensus on the Management of Sensitized Kidney Transplant Recipients: A Delphi Study.

    Furian, Lucrezia / Bestard, Oriol / Budde, Klemens / Cozzi, Emanuele / Diekmann, Fritz / Mamode, Nizam / Naesens, Maarten / Pengel, Liset H M / Schwartz Sorensen, Soren / Vistoli, Fabio / Thaunat, Olivier

    Transplant international : official journal of the European Society for Organ Transplantation

    2024  Volume 37, Page(s) 12475

    Abstract: An increasing number of sensitized patients awaiting transplantation face limited options, leading to fatalities during dialysis and higher costs. The absence of established evidence highlights the need for collaborative consensus. Donor-specific ... ...

    Abstract An increasing number of sensitized patients awaiting transplantation face limited options, leading to fatalities during dialysis and higher costs. The absence of established evidence highlights the need for collaborative consensus. Donor-specific antibodies (DSA)-triggered antibody-mediated rejection (AMR) significantly contributes to kidney graft failure, especially in sensitized patients. The European Society for Organ Transplantation (ESOT) launched the ENGAGE initiative, categorizing sensitized candidates by AMR risk to improve patient care. A systematic review assessed induction and maintenance regimens as well as antibody removal strategies, with statements subjected to the Delphi methodology. A Likert-scale survey was distributed to 53 European experts (Nephrologists, Transplant surgeons and Immunologists) with experience in kidney transplant recipient care. A rate ≥75% with the same answer was considered consensus. Consensus was achieved in 95.3% of statements. While most recommendations aligned, two statements related to complement inhibitors for AMR prophylaxis lacked consensus. The ENGAGE consensus presents contemporary recommendations for desensitization and immunomodulation strategies, grounded in predefined risk categories. The adoption of tailored, patient-specific measures is anticipated to streamline the care of sensitized recipients undergoing renal allografts. While this approach holds the promise of enhancing transplant accessibility and fostering long-term success in transplantation outcomes, its efficacy will need to be assessed through dedicated studies.
    MeSH term(s) Humans ; Kidney Transplantation ; Delphi Technique ; Graft Rejection/prevention & control ; Graft Rejection/immunology ; Consensus ; Europe ; Isoantibodies/immunology ; Transplant Recipients
    Chemical Substances Isoantibodies
    Language English
    Publishing date 2024-04-11
    Publishing country Switzerland
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Editorial
    ZDB-ID 639435-8
    ISSN 1432-2277 ; 0934-0874
    ISSN (online) 1432-2277
    ISSN 0934-0874
    DOI 10.3389/ti.2024.12475
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Tips and tricks for robotic pancreatoduodenectomy with superior mesenteric/portal vein resection and reconstruction.

    Kauffmann, Emanuele F / Napoli, Niccolò / Ginesini, Michael / Gianfaldoni, Cesare / Asta, Fabio / Salamone, Alice / Ripolli, Allegra / Di Dato, Armando / Vistoli, Fabio / Amorese, Gabriella / Boggi, Ugo

    Surgical endoscopy

    2023  Volume 37, Issue 4, Page(s) 3233–3245

    Abstract: Background: Open pancreatoduodenectomy with vein resection (OPD-VR) is now standard of care in patients who responded to neoadjuvant therapies. Feasibility of robotic pancreatoduodenectomy (RPD) with vein resection (RPD-VR) was shown, but no study ... ...

    Abstract Background: Open pancreatoduodenectomy with vein resection (OPD-VR) is now standard of care in patients who responded to neoadjuvant therapies. Feasibility of robotic pancreatoduodenectomy (RPD) with vein resection (RPD-VR) was shown, but no study provided a detailed description of the technical challenges associated with this formidable operation. Herein, we describe the trips and tricks for technically successful RPD-VR.
    Methods: The vascular techniques used in RPD-VR were borrowed from OPD-VR, as well as from our experience with robotic transplantation of both kidney and pancreas. Vein resection was classified into 4 types according to the international study group of pancreatic surgery. Each type of vein resection was described in detail and shown in a video.
    Results: Between October 2008 and November 2021, a total of 783 pancreatoduodenectomies were performed, including 233 OPDs-VR (29.7%). RPD was performed in 256 patients (32.6%), and RPDs-VR in 36 patients (4.5% of all pancreatoduodenectomies; 15.4% of all pancreatoduodenectomies with vein resection; 14.0% of all RPDs). In RPD-VR vein resections were: 4 type 1 (11.1%), 10 type 2 (27.8%), 12 type 3 (33.3%) and 10 type 4 (27.8%). Vascular patches used in type 2 resections were made of peritoneum (n = 8), greater saphenous vein (n = 1), and deceased donor aorta (n = 1). Interposition grafts used in type 4 resections were internal left jugular vein (n = 8), venous graft from deceased donor (n = 1) and spiral saphenous vein graft (n = 1). There was one conversion to open surgery (2.8%). Ninety-day mortality was 8.3%. There was one (2.8%) partial vein thrombosis, treated with heparin infusion.
    Conclusions: We have reported 36 technically successful RPDs-VR. We hope that the tips and tricks provided herein can contribute to safer implementation of RPD-VR. Based on our experience, and according to data from the literature, we strongly advise that RPD-VR is performed by expert surgeons at high volume centers.
    MeSH term(s) Humans ; Pancreaticoduodenectomy/methods ; Portal Vein/surgery ; Robotic Surgical Procedures/methods ; Pancreatic Neoplasms/surgery ; Pancreas/surgery ; Retrospective Studies
    Language English
    Publishing date 2023-01-09
    Publishing country Germany
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 639039-0
    ISSN 1432-2218 ; 0930-2794
    ISSN (online) 1432-2218
    ISSN 0930-2794
    DOI 10.1007/s00464-022-09860-0
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Pancreatectomy with resection and reconstruction of the superior mesenteric artery.

    Boggi, Ugo / Napoli, Niccolò / Kauffmann, Emanuele F / Iacopi, Sara / Ginesini, Michael / Gianfaldoni, Cesare / Campani, Daniela / Amorese, Gabriella / Vistoli, Fabio

    The British journal of surgery

    2022  Volume 110, Issue 8, Page(s) 901–904

    MeSH term(s) Humans ; Pancreatectomy ; Mesenteric Artery, Superior/surgery ; Pancreatic Neoplasms/surgery ; Abdomen/surgery ; Portal Vein/surgery ; Hepatic Artery/surgery
    Language English
    Publishing date 2022-11-29
    Publishing country England
    Document type Journal Article
    ZDB-ID 2985-3
    ISSN 1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
    ISSN (online) 1365-2168
    ISSN 0263-1202 ; 0007-1323 ; 1355-7688
    DOI 10.1093/bjs/znac363
    Database MEDical Literature Analysis and Retrieval System OnLINE

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