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Bile Acids and Gallstones: Epidemiology, Pathogenesis, Diagnosis, and Management

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Abstract

Gallstone disease is a major health problem in the world. There are two major types of stones, cholesterol stones and pigment stones, classified by dominant constituents such as cholesterol and/or bilirubin. Cholesterol stones and black pigment stones are primarily formed in the gallbladder, whereas brown pigment stones are frequently formed in biliary tracts. Since bile acids are dictating the solubility of cholesterol and somehow bilirubin in bile, the gallstone pathogenesis is based, at least in part, upon the defect of bile acid metabolism. In this chapter, pathogenesis and clinical management of gallstone diseases are summarized.

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References

  1. Shaffer EA. Gallstone disease: epidemiology of gallbladder stone disease. Best Pract Res Clin Gastroenterol. 2006;20(6):981–96.

    Article  PubMed  Google Scholar 

  2. Stinton LM, Shaffer EA. Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver. 2012;6:172–87.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Tazuma S, Kanno K, Kubota K, Tsuyuguchi T, Kamisawa T, Isayama H, Nakagohri T, Inui K, Academic Committee of the Japan Biliary Association. Report on the 2013 national cholelithiasis survey in Japan. J Hepato-Biliary-Pancreat Sci. 2015;22(5):392–5. doi:10.1002/jhbp.206. Epub 2015 Jan 18

    Article  Google Scholar 

  4. Ruhl CE, Everhart JE. Gallstone disease is associated with increased mortality in the United States. Gastroenterology. 2011;140(2):508–16.

    Article  PubMed  Google Scholar 

  5. Tazuma S, Kanno K, Sugiyama A, Kishikawa N. Nutritional factors (nutritional aspects) in biliary disorders: bile acid and lipid metabolism in gallstone diseases and pancreaticobiliary maljunction. J Gastroenterol Hepatol. 2013;28(Suppl 4):103–7.

    Article  CAS  PubMed  Google Scholar 

  6. Stinton LM, Shaffer EA. Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver. 2012;6(2):172–87.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Tazuma S. Gallstone disease: epidemiology, pathogenesis, and classification of biliary stones (common bile duct and intrahepatic). Best Pract Res Clin Gastroenterol. 2006;20(6):1075–83.

    Article  PubMed  Google Scholar 

  8. Shaffer EA, Small DM. Biliary lipid secretion in cholesterol gallstone disease. The effect of cholecystectomy and obesity. J Clin Invest. 1977;59:828–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Reuben A, Maton PN, Murphy GM, et al. Bile lipid secretion in obese and non-obese individuals with and without gallstones. Clin Sci. 1985;69:71–9.

    Article  CAS  PubMed  Google Scholar 

  10. Diehl AK. Epidemiology and natural history of gallstone disease. In: Cooper AD, editor. Gastroenterology clinics of North America. Philadelphia: W.B. Saunders; 1991. p. 1–19.

    Google Scholar 

  11. Tazuma S. Recent understanding of cholesterol gallstone pathogenesis: implication to non-surgical therapeutic strategy. Clin J Gastroenterol. 2008;1(3):87–92.

    Article  PubMed  Google Scholar 

  12. Carey MC. Pathogenesis of gallstones. Am J Surg. 1993;165:410–9.

    Article  CAS  PubMed  Google Scholar 

  13. Portincasa P, Moschetta A, Palasciano G. Cholesterol gallstone disease. Lancet. 2006;368(9531):230–9.

    Article  CAS  PubMed  Google Scholar 

  14. Elferink RP, Groen AK. The mechanism of biliary lipid secretion and its defects. Gastroenterol Clin N Am. 1999;28:59–74.

    Article  CAS  Google Scholar 

  15. de Vree JM, Jacquemin E, Sturm E, et al. Mutations in the MDR3 gene cause progressive familial intrahepatic cholestasis. Proc Natl Acad Sci U S A. 1998;95:282–7.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Wu JE, Basso F, Shamburek RD, et al. Hepatic ABCG5 and ABCG8 overexpression increases hepatobiliary sterol transport but does not alter aortic atherosclerosis in transgenic mice. J Biol Chem. 2004;279:22913–25.

    Article  CAS  PubMed  Google Scholar 

  17. Rothblat GH, de la Llera-Moya M, Atger V, et al. Cell cholesterol efflux: integration of new and old observations provides new insights. J Lipid Res. 1999;40:781–96.

    CAS  PubMed  Google Scholar 

  18. Oram JF, Lawn RM, ABCA. The gatekeeper for eliminating excess tissue cholesterol. J Lipid Res. 2001;42:1173–9.

    CAS  PubMed  Google Scholar 

  19. Ikemoto M, Arai H, Feng D, et al. Identification of a PDZ-domain-containing protein that interacts with the scavenger receptor class B type I. Proc Natl Acad Sci U S A. 2000;97:6538–43.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Silver DL, Nan W, Xiao X, et al. HDL particle uptake mediated by SR-BI results in selective sorting of HDL cholesterol from protein and polarized cholesterol secretion. J Biol Chem. 2001;276:25287–93.

    Article  CAS  PubMed  Google Scholar 

  21. Groen AK, Bloks VW, Bandsma RH, et al. Hepatobiliary cholesterol transport is not impaired in Abca1-null mice lacking HDL. J Clin Invest. 2001;108:843–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Drobnik W, Lindenthal B, Lieser B, et al. ATP-binding cassette transporter A1 (ABCA1) affects total body sterol metabolism. Gastroenterology. 2001;120:1203–11.

    Article  CAS  PubMed  Google Scholar 

  23. Marcus SN, Heaton KW. Deoxycholic acid and the pathogenesis of gall stones. Gut. 1988;29:522–33.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Einarsson C, Hillebrant CG, Axelson M. Effects of treatment with deoxycholic acid and chenodeoxycholic acid on the hepatic synthesis of cholesterol and bile acids in healthy subjects. Hepatology. 2001;33:1189–93.

    Article  CAS  PubMed  Google Scholar 

  25. Dowling RH. Review: pathogenesis of gallstones. Aliment Pharmacol Ther. 2000;14(Suppl 2):39–47.

    Article  PubMed  Google Scholar 

  26. Thomas LA, Veysey MJ, Bathgate T, et al. Mechanism for the transit-induced increase in colonic deoxycholic acid formation in cholesterol cholelithiasis. Gastroenterology. 2000;119:806–15.

    Article  CAS  PubMed  Google Scholar 

  27. Ginanni Corradini S, Ripani C, Della Guardia P, et al. The human gallbladder increases cholesterol solubility in bile by differential lipid absorption: a study using a new in vitro model of isolated intra-arterially perfused gallbladder. Hepatology. 1998;28:314–22.

    Article  CAS  PubMed  Google Scholar 

  28. Corradini SG, Elisei W, Giovannelli L, et al. Impaired human gallbladder lipid absorption in cholesterol gallstone disease and its effect on cholesterol solubility in bile. Gastroenterology. 2000;118:912–20.

    Article  CAS  PubMed  Google Scholar 

  29. Pellegrini CA, Ryan T, Broderick W, et al. Gallbladder filling and emptying during cholesterol gallstone formation in the prairie dog. A cholescintigraphic study. Gastroenterology. 1986;90:143–9.

    Article  CAS  PubMed  Google Scholar 

  30. Jazrawi RP, Pazzi P, Petroni ML, et al. Postprandial gallbladder motor function: refilling and turnover of bile in health and in cholelithiasis. Gastroenterology. 1995;109:582–91.

    Article  CAS  PubMed  Google Scholar 

  31. Chen Q, Amaral J, Biancani P, et al. Excess membrane cholesterol alters human gallbladder muscle contractility and membrane fluidity. Gastroenterology. 1999;116:678–85.

    Article  CAS  PubMed  Google Scholar 

  32. Chen Q, Amaral J, Oh S, et al. Gallbladder relaxation in patients with pigment and cholesterol stones. Gastroenterology. 1997;113:930–7.

    Article  CAS  PubMed  Google Scholar 

  33. Carey MC. Formation and growth of cholesterol gallstones: the new synthesis. In: Fromm H, Leuschner U, editors. Bile acids-cholestasis-gallstones. Dordrecht: Kluwer; 1996. p. 147–75.

    Google Scholar 

  34. Konikoff FM, Danino D, Weihs D, et al. Microstructural evolution of lipid aggregates in nucleating model and human biles visualized by cryogenic transmission electron microscopy. Hepatology. 2000;31:261–8.

    Article  CAS  PubMed  Google Scholar 

  35. Ochi H, Tazuma S, Kajiyama G. Lecithin hydrophobicity modulates the process of cholesterol crystal nucleation and growth in supersaturated model bile systems. Biochem J. 1996;318:139–44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Nishioka T, Tazuma S, Yamashita G, et al. Quantitative assessment on comparative potencies of cholesterol crystal promoting factors: relation to mechanistic characterization. Biochem J. 1998;332:343–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Miquel JF, Van Der Putten J, Pimentel F, et al. Increased activity in the biliary Con A-binding fraction accounts for the difference in crystallization behavior in bile from Chilean gallstone patients compared with Dutch gallstone patients. Hepatology. 2001;33:328–32.

    Article  CAS  PubMed  Google Scholar 

  38. Jirsa M, Muchova L, Draberova L, et al. Carcinoembryonic antigen-related cell adhesion molecule 1 is the 85-kilodalton pronase-resistant biliary glycoprotein in the cholesterol crystallization promoting low density protein-lipid complex. Hepatology. 2001;34:1075–82.

    Article  CAS  PubMed  Google Scholar 

  39. Paigen K. A miracle enough: the power of mice. Nat Med. 1995;1:215–20.

    Article  CAS  PubMed  Google Scholar 

  40. Lammert F, Carey MC, Paigen B. Chromosomal organization of candidate genes involved in cholesterol gallstone formation: a murine gallstone map. Gastroenterology. 2001;120:221–38.

    Article  CAS  PubMed  Google Scholar 

  41. Marschall HU, Katsika D, Rudling M, Einarsson C. The genetic background of gallstone formation: an update. Biochem Biophys Res Commun. 2010;396:58–62.

    Article  CAS  PubMed  Google Scholar 

  42. Katsika D, Grjibovski A, Einarsson C, Lammert F, Lichtenstein P, et al. Genetic and environmental influences on symptomatic gallstone disease: a Swedish study of 43,141 twin pairs. Hepatology. 2005;41:1138–43.

    Article  CAS  PubMed  Google Scholar 

  43. Bertomeu A, Ros E, Zambon D, Vela M, Perez-Ayuso RM, et al. Apolipoprotein E polymorphism and gallstones. Gastroenterology. 1996;111:1603–10.

    Article  CAS  PubMed  Google Scholar 

  44. Xue P, Niu WQ, Jiang ZY, Zheng MH, Fei J. A Meta-analysis of apolipoprotein E gene epsilon2/epsilon3/epsilon4 polymorphism for gallbladder stone disease. PLoS ONE. 2012;7:e45849.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Jiang ZY, Han TQ, Suo GJ, Feng DX, Chen S, et al. Polymorphisms at cholesterol 7alpha-hydroxylase, apolipoproteins B and E and low density lipoprotein receptor genes in patients with gallbladder stone disease. World J Gastroenterol. 2004;10:1508–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Sanchez-Cuen J, Aguilar-Medina M, Arambula-Meraz E, Romero-Navarro J, Granados J, et al. ApoB-100, ApoE and CYP7A1 gene polymorphisms in Mexican patients with cholesterol gallstone disease. World J Gastroenterol. 2010;16:4685–90.

    Article  PubMed  Google Scholar 

  47. Yu L, Li-Hawkins J, Hammer RE, Berge KE, Horton JD, et al. Overexpression of ABCG5 and ABCG8 promotes biliary cholesterol secretion and reduces fractional absorption of dietary cholesterol. J Clin Invest. 2002;110:671–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Stender S, Frikke-Schmidt R, Nordestgaard BG, Tybjaerg-Hansen A. Sterol transporter adenosine triphosphate-binding cassette transporter G8, gallstones, and biliary cancer in 62,000 individuals from the general population. Hepatology. 2011;53:640–8.

    Article  CAS  PubMed  Google Scholar 

  49. Xu HL, Cheng JR, Andreotti G, Gao YT, Rashid A, et al. Cholesterol metabolism gene polymorphisms and the risk of biliary tract cancers and stones: a population-based case-control study in Shanghai, China. Carcinogenesis. 2011;32:58–62.

    Article  PubMed  Google Scholar 

  50. Srivastava A, Srivastava A, Srivastava K, Choudhuri G, Mittal B. Role of ABCG8 D19H (rs11887534) variant in gallstone susceptibility in northern India. J Gastroenterol Hepatol. 2010;25:1758–62.

    Article  CAS  PubMed  Google Scholar 

  51. Siddapuram SP, Mahurkar S, Duvvuru NR, Mitnala S, Guduru VR, et al. Hepatic cholesterol transporter ABCG8 polymorphisms in gallstone disease in an Indian population. J Gastroenterol Hepatol. 2010;25:1093–8.

    Article  CAS  PubMed  Google Scholar 

  52. Kuo KK, Shin SJ, Chen ZC, Yang YH, Yang JF, et al. Significant association of ABCG5 604Q and ABCG8 D19H polymorphisms with gallstone disease. Br J Surg. 2008;95:1005–11.

    Article  CAS  PubMed  Google Scholar 

  53. Buch S, Schafmayer C, Volzke H, Becker C, Franke A, et al. A genome-wide association scan identifies the hepatic cholesterol transporter ABCG8 as a susceptibility factor for human gallstone disease. Nat Genet. 2007;39:995–9.

    Article  CAS  PubMed  Google Scholar 

  54. Grunhage F, Acalovschi M, Tirziu S, Walier M, Wienker TF, et al. Increased gallstone risk in humans conferred by common variant of hepatic ATP-binding cassette transporter for cholesterol. Hepatology. 2007;46:793–801.

    Article  PubMed  Google Scholar 

  55. Wang Y, Jiang ZY, Fei J, Xin L, Cai Q, et al. ATP binding cassette G8 T400K polymorphism may affect the risk of gallstone disease among Chinese males. Clin Chim Acta. 2007;384:80–5.

    Article  CAS  PubMed  Google Scholar 

  56. Katsika D, Magnusson P, Krawczyk M, Grunhage F, Lichtenstein P, et al. Gallstone disease in Swedish twins: risk is associated with ABCG8 D19H genotype. J Intern Med. 2010;268:279–85.

    Article  CAS  PubMed  Google Scholar 

  57. von Kampen O, Buch S, Nothnagel M, Azocar L, Molina H, et al. Genetic and functional identification of the likely causative variant for cholesterol gallstone disease at the ABCG5/8 lithogenic locus. Hepatology. 2013;2013(57):2407–17.

    Article  Google Scholar 

  58. Jiang Z-Y, Cai Q, Chen E-Z. Association of three common single nucleotide polymorphisms of ATP binding cassette G8 gene with gallstone disease: a meta-analysis. PLoS ONE. 2014;9(1):e87200.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Vítek L, Carey MC. New pathophysiological concepts underlying pathogenesis of pigment gallstones. Clin Res Hepatol Gastroenterol. 2012;36(2):122–9.

    Article  PubMed  Google Scholar 

  60. Schafmayer C, Hartleb J, Tepel J, Albers S, Freitag S, Volzke H, et al. Predictors of gallstone composition in 1025 symptomatic gallstones from Northern Germany. BMC Gastroenterol. 2006;6:36–44.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Cahalane MJ, Neubrand MW, Care MC. Physical-chemical pathogenesis of pigment gallstones. Semin Liver Dis. 1988;8:317–28.

    Article  CAS  PubMed  Google Scholar 

  62. Suzuki N, Nakamura Y, Kobayashi N, Sato T. On metal elements in pure pigment gallstones. Tohoku J Exp Med. 1975;116:233–40.

    Article  CAS  PubMed  Google Scholar 

  63. Tsunoda K, Shirai Y, Wakai T, Yokoyama N, Akazawa K, Hatakeyama K. Increased risk of cholelithiasis after esophagectomy. J Hepato-Biliary-Pancreat Surg. 2004;11:319–23.

    Article  Google Scholar 

  64. Robins SJ, Fasulo JM, Patton GM. Lipids of pigment gallstones. Biochim Biophys Acta. 1982;712:21–5.

    Article  CAS  PubMed  Google Scholar 

  65. Tomida S, Abei M, Yamaguchi T, et al. Long-term ursodeoxycholic acid therapy is associated with reduced risk of biliary pain and acute cholecystitis in patients with gallbladder stones: a cohort analysis. Hepatology. 1999;30:6–13.

    Article  CAS  PubMed  Google Scholar 

  66. Japanese Society of Gastroenterology. Practice guidelines for cholelithiasis 2009 (in Japanese), Tokyo, Nankodo, 2009

    Google Scholar 

  67. Lowenfels AB, Walker AM, Althaus DP, Townsend G, Domellof L. Gallstone growth, size, and risk of gallbladder cancer: an interracial study. Int J Epidemiol. 1989;18:50–4.

    Article  CAS  PubMed  Google Scholar 

  68. Ashur H, Siegal B, Oland Y, Adam YG. Calcified gallbladder (porcelain gallbladder). Arch Surg. 1978;113:594–6.

    Article  CAS  PubMed  Google Scholar 

  69. National Institutes of Health Consensus Development Conference Statement on gallstones and laparoscopic cholecystectomy. Am J Surg. 1993;165:390–8

    Google Scholar 

  70. May GR, Sutherland LR, Shaffer EA. Efficacy of bile acid therapy for gallstone dissolution: a meta-analysis of randomized trials. Aliment Pharmacol Ther. 1993;7:139–48.

    Article  CAS  PubMed  Google Scholar 

  71. Podda M, Zuin M, Battezzati PM, et al. Efficacy and safety of a combination of chenodeoxycholic acid and ursodeoxycholic acid for gallstone dissolution: a comparison with ursodeoxycholic acid alone. Gastroenterology. 1989;96:222–9.

    Article  CAS  PubMed  Google Scholar 

  72. Grundy SM, Lan SP, Lachin J. The effects of chenodiol on biliary lipids and their association with gallstone dissolution in the National Cooperative Gallstone Study (NCGS). J Clin Invest. 1984;73:1156–66.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  73. Fromm H, Roat JW, Gonzalez V, et al. Comparative efficacy and side effects of ursodeoxycholic and chenodeoxycholic acids in dissolving gallstones: a double-blind controlled study. Gastroenterology. 1983;85:1257–64.

    CAS  PubMed  Google Scholar 

  74. Erlinger S, Le Go A, Husson JM, et al. Franco-Belgian cooperative study of ursodeoxycholic acid in the medical dissolution of gallstones: a double-blind, randomized, dose-response study, and comparison with chenodeoxycholic acid. Hepatology. 1984;4:308–14.

    Article  CAS  PubMed  Google Scholar 

  75. Park YH, Igimi H, Carey MC. Dissolution of human cholesterol gallstones in stimulated chenodeoxycholate-rich and ursodeoxycholate-rich biles. An in vitro study of dissolution rates and mechanisms. Gastroenterology. 1984;87:150–8.

    CAS  PubMed  Google Scholar 

  76. Igimi H, Carey MC. Cholesterol gallstone dissolution in bile: dissolution kinetics of crystalline (anhydrate and monohydrate) cholesterol with chenodeoxycholate, ursodeoxycholate, and their glycine and taurine conjugates. J Lipid Res. 1981;22:254–70.

    CAS  PubMed  Google Scholar 

  77. Paumgartner G, Sauter GH. Extracorporeal shock wave lithotripsy of gallstones: 20th anniversary of the first treatment. Eur J Gastroenterol Hepatol. 2005;17:525–7.

    Article  PubMed  Google Scholar 

  78. Yokoe M, Takada T, Strasberg SM, et al. New diagnostic criteria and severity assessment of acute cholecystitis in revised Tokyo guidelines. J Hepato-Biliary-Pancreat Sci. 2012;19:578–85.

    Article  Google Scholar 

  79. Miura F, Takda T, Strasberg SM, et al. TG13 flowchart for the management of acute cholangitis and cholecystitis. J Hepato-Biliary-Pancreat Sci. 2013;20:47–54.

    Article  Google Scholar 

  80. Banz V, Gsponer T, Candinas D, et al. Population-based analysis of 4113 patients with acute cholecystitis: defining the optimal time-point for laparoscopic cholecystectomy. Ann Surg. 2011;254:964–70.

    Article  PubMed  Google Scholar 

  81. Riall TS, Zhang D, Townsend Jr CM, et al. Failure to perform cholecystectomy for acute cholecystitis in elderly patients is associated with increased morbidity, mortality, and cost. J Am Coll Surg. 2010;210:668–77. 677–679

    Article  PubMed  PubMed Central  Google Scholar 

  82. Lee SW, Yang SS, Chang CS, et al. Impact of the Tokyo guidelines on the management of patients with acute calculous cholecystitis. J Gastroenterol Hepatol. 2009;24:1857–61.

    Article  PubMed  Google Scholar 

  83. Moyson J, Thill V, Simoens C, et al. Laparoscopic cholecystectomy for acute cholecystitis in the elderly: a retrospective study of 100 patients. Hepato-Gastroenterology. 2008;55:1975–80.

    CAS  PubMed  Google Scholar 

  84. Ito K, Fujita N, Noda Y, et al. Percutaneous cholecystostomy versus gallbladder aspiration for acute cholecystitis: a prospective randomized controlled trial. AJR Am J Roentgenol. 2004;183:193–6.

    Article  PubMed  Google Scholar 

  85. Borzellino G, de Manzoni G, Ricci F, et al. Emergency cholecystostomy and subsequent cholecystectomy for acute gallstone cholecystitis in the elderly. Br J Surg. 1999;86:1521–5.

    Article  CAS  PubMed  Google Scholar 

  86. Akhan O, Akinci D, Ozmen MN. Percutaneous cholecystostomy. Eur J Radiol. 2002;43:229–36.

    Article  PubMed  Google Scholar 

  87. Tazuma S. Statins affect gallstone diseases: Underlying mechanism(s) are to be established. Hepatol Res. 2015;45(9):939–41.

    Article  Google Scholar 

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Acknowledgments

This work was supported in part by the Health and Labour Sciences Research Grant for intrahepatic gallstones awarded to S.T.

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  1. Department of General Medicine, Hiroshima University Hospital, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Susumu Tazuma

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  1. Department of General Medicine, Hiroshima University Hospital, Hiroshima, Japan

    Susumu Tazuma

  2. Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan

    Hajime Takikawa

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Tazuma, S. (2017). Bile Acids and Gallstones: Epidemiology, Pathogenesis, Diagnosis, and Management. In: Tazuma, S., Takikawa, H. (eds) Bile Acids in Gastroenterology. Springer, Tokyo. https://doi.org/10.1007/978-4-431-56062-3_6

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