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Comparative molecular prevalence and subtypes distribution of Blastocystis sp. a potentially zoonotic infection isolated from symptomatic and asymptomatic patients in Iran: A systematic review and meta-analysis

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Abstract

Purpose

The present systematic review and meta-analysis was aimed to assess the weighted molecular prevalence of Blastocystis sp. in humans along with the comparative molecular prevalence and subtypes distribution of Blastocystis isolated from symptomatic and asymptomatic patients in Iran.

Methods

International electronic databases including Medline/PubMed, ProQuest, Scopus, Embase, and Google Scholar were explored until 4th October 2020. Heterogeneity index was evaluated among studies using Cochran’s Q test and I2 index. Finally, 23 eligible studies were qualified to be included in this review.

Results

The pooled molecular prevalence of Blastocystis sp. in Iran was reported 15.2% (95% CI 11.5–19.7). In addition, the molecular prevalence based on PCR-sequencing and STS primers was reported 12.5% (95% CI 8.6–17.7) and 19.8% (95% CI 13.1–28.8), respectively. Interestingly, there was a considerably higher prevalence among asymptomatic patients [25.1% (95% CI 20.8–30.0)] in comparison to symptomatic ones [21.0% (95% CI 15.9–27.2)]. In addition, the frequency of Blastocystis ST1, ST2, and ST3 from positive samples in symptomatic patients was 19.7%, 35.1%, and 47.4%, respectively. In addition, the prevalence of Blastocystis ST1, ST2, and ST3 from positive samples in asymptomatic patients was 27.1%, 26.8%, and 37.8%, respectively. The results obtained in Iran showed that Blastocystis is more common in asymptomatic patients compared to patients having clinical symptoms. Of note, ST3, as the most common subtype causing clinical symptoms, was the most prevalent reported subtype among both symptomatic and asymptomatic patients in the country.

Conclusions

Hence, the pathogenicity of the Blastocystis parasite is not subtype-specific and appears to be related to a variety of risk factors. Still the Blastocystis epidemiology is open to question and more large-scale studies should be performed on this aspect.

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References

  1. Scanlan PD (2012) Blastocystis: past pitfalls and future perspectives. Trends Parasitol 28:327–334. https://doi.org/10.1016/j.pt.2012.05.001

    Article  PubMed  Google Scholar 

  2. Silberman JD, Sogin ML, Leipe DD, Clark CG (1996) Human parasite finds taxonomic home. Nature 380:398. https://doi.org/10.1038/380398a0

    Article  CAS  PubMed  Google Scholar 

  3. Lokmer A, Cian A, Froment A, Gantois N, Viscogliosi E, Chabé M, Ségurel L (2019) Use of shotgun metagenomics for the identification of protozoa in the gut microbiota of healthy individuals from worldwide populations with various industrialization levels. PLoS ONE 14:e0211139. https://doi.org/10.1371/journal.pone.0211139

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Clark CG, van der Giezen M, Alfellani MA, Stensvold CR (2013) Recent developments in Blastocystis research. Adv Parasitol 82:1–32. https://doi.org/10.1016/B978-0-12-407706-5.00001-0

    Article  PubMed  Google Scholar 

  5. Asghari A, Sadraei J, Pirestani M, Mohammadpour I (2019) First molecular identification and subtype distribution of Blastocystis sp. isolated from hooded crows (Corvus cornix) and pigeons (Columba livia) in Tehran province. Iran Comp Immunol Microbiol Infect Dis 62:25–30. https://doi.org/10.1016/j.cimid.2018.11.013

    Article  PubMed  Google Scholar 

  6. Li L-H, Zhou X-N, Du Z-W, Wang X-Z, Wang L-B, Jiang J-Y, Yoshikawa H, Steinmann P, Utzinger J, Wu Z (2007) Molecular epidemiology of human Blastocystis in a village in Yunnan province, China. Parasitol Int 56:281–286. https://doi.org/10.1016/j.parint.2007.06.001

    Article  CAS  PubMed  Google Scholar 

  7. Leelayoova S, Siripattanapipong S, Thathaisong U, Naaglor T, Taamasri P, Piyaraj P, Mungthin M (2008) Drinking water: a possible source of Blastocystis spp. subtype 1 infection in school children of a rural community in central Thailand. Am J Trop Med Hyg 79:401–406. https://doi.org/10.4269/ajtmh.2008.79.401

    Article  CAS  PubMed  Google Scholar 

  8. Cian A, El Safadi D, Osman M, Moriniere R, Gantois N, Benamrouz-Vanneste S, Delgado-Viscogliosi P, Guyot K, Li L-L, Monchy S (2017) Molecular epidemiology of Blastocystis sp. in various animal groups from two French zoos and evaluation of potential zoonotic risk. PLoS ONE 12(1):e0169659. https://doi.org/10.1371/journal.pone.0169659

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Ramírez JD, Sánchez A, Hernández C, Flórez C, Bernal MC, Giraldo JC, Reyes P, López MC, García L, Cooper PJ (2016) Geographic distribution of human Blastocystis subtypes in South America. Infect Genet Evol 41:32–35. https://doi.org/10.1016/j.meegid.2016.03.017

    Article  PubMed  Google Scholar 

  10. Stensvold CR (2013) Blastocystis: genetic diversity and molecular methods for diagnosis and epidemiology. Trop Parasitol 3:26. https://doi.org/10.4103/2229-5070.113896

    Article  PubMed  PubMed Central  Google Scholar 

  11. Stensvold CR, Clark CG (2020) Pre-empting Pandora’s box: Blastocystis subtypes revisited. Trends Parasitol 36:229–232. https://doi.org/10.1016/j.pt.2019.12.009

    Article  PubMed  Google Scholar 

  12. Wawrzyniak I, Poirier P, Viscogliosi E, Dionigia M, Texier C, Delbac F, El AH (2013) Blastocystis, an unrecognized parasite: an overview of pathogenesis and diagnosis. Ther Adv Infect Dis 1:167–178. https://doi.org/10.1177/2049936113504754

    Article  PubMed  PubMed Central  Google Scholar 

  13. AbuOdeh R, Ezzedine S, Madkour M, Stensvold CR, Samie A, Nasrallah G, AlAbsi E, ElBakri A (2019) Molecular subtyping of Blastocystis from diverse animals in the United Arab Emirates. Protist 170:125679. https://doi.org/10.1016/j.protis.2019.125679

    Article  CAS  PubMed  Google Scholar 

  14. Stensvold CR, Arendrup MC, Jespersgaard C, Mølbak K, Nielsen HV (2007) Detecting Blastocystis using parasitologic and DNA-based methods: a comparative study. Diagn Microbiol Infect Dis 59:303–307. https://doi.org/10.1016/j.diagmicrobio.2007.06.003

    Article  CAS  PubMed  Google Scholar 

  15. Maloney JG, Molokin A, Santin M (2019) Next generation amplicon sequencing improves detection of Blastocystis mixed subtype infections. Infect Genet Evol 73:119–125. https://doi.org/10.1016/j.meegid.2019.04.013

    Article  CAS  PubMed  Google Scholar 

  16. Mohamed RT, El-Bali MA, Mohamed AA, Abdel-Fatah MA, El-Malky MA, Mowafy NM, Zaghlool DA, Bakri RA, Al-Harthi SA (2017) Subtyping of Blastocystis sp. isolated from symptomatic and asymptomatic individuals in Makkah. Saudi Arabia Parasit Vectors 10:1–7. https://doi.org/10.1186/s13071-017-2114-8

    Article  CAS  Google Scholar 

  17. Stensvold CR, Clark CG (2016) Current status of Blastocystis: a personal view. Parasitol Int 65:763–771. https://doi.org/10.1016/j.parint.2016.05.015

    Article  PubMed  Google Scholar 

  18. Plata JD, Castañeda X (2020) Parasites in cancer patients. Oncol Crit Care. https://doi.org/10.1007/978-3-319-74588-6_126

    Article  Google Scholar 

  19. Puthia MK, Lu J, Tan KSW (2008) Blastocystis ratti contains cysteine proteases that mediate interleukin-8 response from human intestinal epithelial cells in an NF-κB-dependent manner. Eukaryot Cell 7:435–443. https://doi.org/10.1128/EC.00371-07

    Article  CAS  PubMed  Google Scholar 

  20. Dullaert-de Boer M, Schuurs TA, Vermeer M, Ruijs GJHM, van der Zanden AGM, Weel JF, van Coppenraet LESB (2020) Distribution and relevance of Dientamoeba fragilis and Blastocystis species in gastroenteritis: results from a case–control study. Eur J Clin Microbiol Infect Dis 39:197–203. https://doi.org/10.1007/s10096-019-03710-z

    Article  Google Scholar 

  21. Kataki MM, Tavalla M, Beiromvand M (2019) Higher prevalence of Blastocystis hominis in healthy individuals than patients with gastrointestinal symptoms from Ahvaz, southwestern Iran. Comp Immunol Microbiol Infect Dis 65:160–164. https://doi.org/10.1016/j.cimid.2019.05.018

    Article  Google Scholar 

  22. Khademvatan S, Masjedizadeh R, Rahim F, Mahbodfar H, Salehi R, Yousefi-Razin E, Foroutan M (2017) Blastocystis and irritable bowel syndrome: frequency and subtypes from Iranian patients. Parasitol Int 66:142–145. https://doi.org/10.1016/j.parint.2017.01.005

    Article  PubMed  Google Scholar 

  23. Khademvatan S, Masjedizadeh R, Yousefi-Razin E, Mahbodfar H, Rahim F, Yousefi E, Foroutan M (2018) PCR-based molecular characterization of Blastocystis hominis subtypes in southwest of Iran. J Infect Public Health 11:43–47. https://doi.org/10.1016/j.jiph.2017.03.009

    Article  PubMed  Google Scholar 

  24. Salehi R, Haghighi A, Stensvold CR, Kheirandish F, Azargashb E, Raeghi S, Kohansal C, Bahrami F (2017) Prevalence and subtype identification of Blastocystis isolated from humans in Ahvaz, Southwestern Iran. Gastroenterol Hepatol from bed to bench 10:235

    Google Scholar 

  25. Khoshnood S, Rafiei A, Saki J, Alizadeh K (2015) Prevalence and genotype characterization of Blastocystis hominis among the Baghmalek people in Southwestern Iran in 2013–2014. Jundishapur J Microbiol 8(10):e23930. https://doi.org/10.5812/jjm.23930

    Article  PubMed  PubMed Central  Google Scholar 

  26. Beiromvand M, Hashemi SJ, Arjmand R, Sadjadei N, Hardanipasand L (2017) Comparative prevalence of blastocystis in patients with the irritable bowel syndrome and healthy individuals: a case control study. Jundishapur J Microbiol 10(6):e13572. https://doi.org/10.5812/jjm.13572

    Article  Google Scholar 

  27. Alinaghizade A, Mirjalali H, Mohebali M, Stensvold CR, Rezaeian M (2017) Inter-and intra-subtype variation of Blastocystis subtypes isolated from diarrheic and non-diarrheic patients in Iran. Infect Genet Evol 50:77–82. https://doi.org/10.1016/j.meegid.2017.02.016

    Article  CAS  PubMed  Google Scholar 

  28. Moosavi A, Haghighi A, Mojarad EN, Zayeri F, Alebouyeh M, Khazan H, Kazemi B, Zali MR (2012) Genetic variability of Blastocystis sp. isolated from symptomatic and asymptomatic individuals in Iran. Parasitol Res 111:2311–2315. https://doi.org/10.1007/s00436-012-3085-5

    Article  CAS  PubMed  Google Scholar 

  29. Taghipour A, Javanmard E, Mirjalali H, Haghighi A, Tabarsi P, Sohrabi MR, Zali MR (2019) Blastocystis subtype 1 (allele 4); predominant subtype among tuberculosis patients in Iran. Comp Immunol Microbiol Infect Dis 65:201–206. https://doi.org/10.1016/j.cimid.2019.06.005

    Article  PubMed  Google Scholar 

  30. Sheikh S, Asghari A, Sadraei J, Pirestani M, Zare M (2020) Blastocystis sp. subtype 9: as the first reported subtype in patients with schizophrenia in Iran. SN Compr Clin Med 2:633–639. https://doi.org/10.1007/s42399-020-00285-1

    Article  CAS  Google Scholar 

  31. Jalallou N, Iravani S, Rezaeian M, Alinaghizade A, Mirjalali H (2017) Subtypes distribution and frequency of Blastocystis sp. isolated from diarrheic and non-diarrheic patients. Iran J Parasitol 12(1):63

    PubMed  PubMed Central  Google Scholar 

  32. Mirjalali H, Abbasi MR, Naderi N, Hasani Z, Mirsamadi ES, Stensvold CR, Balaii H, Aghdaei HA, Zali MR (2017) Distribution and phylogenetic analysis of Blastocystis sp. subtypes isolated from IBD patients and healthy individuals in Iran. Eur J Clin Microbiol Infect Dis 36:2335–2342. https://doi.org/10.1007/s10096-017-3065-x

    Article  CAS  PubMed  Google Scholar 

  33. Motazedian H, Ghasemi H, Sadjjadi SM (2008) Genomic diversity of Blastocystis hominis from patients in southern Iran. Ann Trop Med Parasitol 102:85–88. https://doi.org/10.1179/136485908X252197

    Article  CAS  PubMed  Google Scholar 

  34. Haghighi L, Talebnia SE, Mikaeili F, Asgari Q, Gholizadeh F, Zomorodian K (2020) Prevalence and subtype identification of Blastocystis isolated from human in Shiraz city, southern Iran. Clin Epidemiol Glob Heal 8:840–844. https://doi.org/10.1016/j.cegh.2020.02.010

    Article  Google Scholar 

  35. Asghari A, Zare M, Hatam G, Shahabi S, Gholizadeh F, Motazedian M (2020) Molecular identification and subtypes distribution of Blastocystis sp. isolated from children and adolescent with cancer in Iran: evaluation of possible risk factors and clinical features. Acta Parasitol 65(2):462–473. https://doi.org/10.2478/s11686-020-00186-2

    Article  CAS  PubMed  Google Scholar 

  36. Sharifi Y, Abbasi F, Shahabi S, Zaraei A, Mikaeili F, Sarkari B (2020) Comparative genotyping of Blastocystis infecting cattle and human in the south of Iran. Comp Immunol Microbiol Infect Dis 72:101529. https://doi.org/10.1016/j.cimid.2020.101529

    Article  PubMed  Google Scholar 

  37. Delshad A, Saraei M, Alizadeh SA, Niaraki SR, Alipour M, Hosseinbigi B, Bozorgomid A, Hajialilo E (2020) Distribution and molecular analysis of Blastocystis subtypes from gastrointestinal symptomatic and asymptomatic patients in Iran. Afr Health Sci 20:1179–1189. https://doi.org/10.4314/ahs.v20i3.21

    Article  PubMed  PubMed Central  Google Scholar 

  38. Niaraki SR, Hajialilo E, Delshad A, Alizadeh SA, Alipour M, Heydarian P, Saraei M (2020) Molecular epidemiology of Blastocystis spp. in children referred to Qods hospital in northwest of Iran. J Parasit Dis 44:151–158. https://doi.org/10.1007/s12639-019-01177-5

    Article  PubMed  Google Scholar 

  39. Shaker D, Anvari D, Hosseini SA, Fakhar M, Mardani A, Hezarjaribi HZ, Gholami S, Gholami S (2019) Frequency and genetic diversity of Blastocystis subtypes among patients attending to health centers in Mazandaran, northern Iran. J Parasit Dis 43:537–543. https://doi.org/10.1007/s12639-019-01123-5

    Article  PubMed  PubMed Central  Google Scholar 

  40. Shirvani G, Fasihi-Harandi M, Raiesi O, Bazargan N, Zahedi MJ, Sharifi I, Kalantari-Khandani B, Nooshadokht M, Shabandoust H, Mohammadi MA (2019) Prevalence and molecular subtyping of Blastocystis from patients with irritable bowel syndrome, inflammatory bowel disease and chronic urticaria in Iran. Acta Parasitol. https://doi.org/10.2478/s11686-019-00131-y

    Article  PubMed  Google Scholar 

  41. Sardarian K, Hajilooi M, Maghsood A, Moghimbeigi A, Alikhani M (2012) A study of the genetic variability of Blastocystis hominis isolates in Hamadan, west of Iran. Jundishapur J Microbiol. https://doi.org/10.5812/jjm.4071

    Article  Google Scholar 

  42. Mohamadi J, Hallaj Zadeh J, Rostami M, Raeghi S, Mirahmadi H, Bahrami F, Shafiei R, Bozorgomid A (2019) Identification of Blastocystis sp. subtypes from human using 18s rRNA in Northwest of Iran. Armaghane danesh 23:737–746

    Google Scholar 

  43. Badparva E, Sadraee J, Kheirandish F, Frouzandeh M (2014) Genetic diversity of human Blastocystis isolates in khorramabad, Central Iran. Iran J Parasitol 9:44

    CAS  PubMed  PubMed Central  Google Scholar 

  44. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 4:1–9. https://doi.org/10.1186/2046-4053-4-1

    Article  PubMed  PubMed Central  Google Scholar 

  45. Beyhan YE, Yilmaz H, Cengiz ZT, Ekici A (2015) Clinical significance and prevalence of Blastocystis hominis in van, turkey. Saudi Med J 36(9):1118. https://doi.org/10.15537/smj.2015.9.12444

    Article  PubMed  PubMed Central  Google Scholar 

  46. Yoshikawa H, Wu Z, Kimata I, Iseki M, Ali IKMD, Hossain MB, Zaman V, Haque R, Takahashi Y (2004) Polymerase chain reaction-based genotype classification among human Blastocystis hominis populations isolated from different countries. Parasitol Res 92:22–29. https://doi.org/10.1007/s00436-003-0995-2

    Article  PubMed  Google Scholar 

  47. Wong KHS, Ng GC, Lin RTP, Yoshikawa H, Taylor MB, Tan KSW (2008) Predominance of subtype 3 among Blastocystis isolates from a major hospital in Singapore. Parasitol Res 102:663–670. https://doi.org/10.1007/s00436-007-0808-0

    Article  PubMed  Google Scholar 

  48. El Safadi D, Meloni D, Poirier P, Osman M, Cian A, Gaayeb L, Wawrzyniak I, Delbac F, El Alaoui H, Delhaes L (2013) Molecular epidemiology of Blastocystis in Lebanon and correlation between subtype 1 and gastrointestinal symptoms. Am J Trop Med Hyg 88:1203–1206. https://doi.org/10.4269/ajtmh.12-0777

    Article  PubMed  PubMed Central  Google Scholar 

  49. Abdulsalam AM, Ithoi I, Al-Mekhlafi HM, Al-Mekhlafi AM, Ahmed A, Surin J (2013) Subtype distribution of Blastocystis isolates in Sebha. Libya. PLoS One 8(12):e84372. https://doi.org/10.1371/journal.pone.0084372

    Article  CAS  PubMed  Google Scholar 

  50. Rayan HZ, Ismail OA, El Gayar EK (2007) Prevalence and clinical features of Dientamoeba fragilis infections in patients suspected to have intestinal parasitic infection. J Egypt Soc Parasitol 37:599–608

    PubMed  Google Scholar 

  51. Baldo ET, Belizario VY, De Leon WU, Kong H-H, Chung D-I (2004) Infection status of intestinal parasites in children living in residential institutions in Metro Manila, the Philippines. Korean J Parasitol 42:67. https://doi.org/10.3347/kjp.2004.42.2.67

    Article  PubMed  PubMed Central  Google Scholar 

  52. Velásquez V, Caldera R, Wong W, Cermeño G, Fuentes M, Blanco Y, Aponte M, Devera R (2005) Blastocystosis: a high prevalence of cases found in patients from Health Center of Soledad, Anzoategui State, Venezuela. Rev Soc Bras Med Trop 38:356–357. https://doi.org/10.1590/S0037-86822005000400017

    Article  PubMed  Google Scholar 

  53. Stensvold CR (2013) Comparison of sequencing (barcode region) and sequence-tagged-site PCR for Blastocystis subtyping. J Clin Microbiol 51:190–194. https://doi.org/10.1128/JCM.02541-12

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Tan TC, Suresh KG, Thong KL, Smith HV (2006) PCR fingerprinting of Blastocystis isolated from symptomatic and asymptomatic human hosts. Parasitol Res 99:459–465. https://doi.org/10.1007/s00436-006-0177-0

    Article  CAS  PubMed  Google Scholar 

  55. Özyurt M, Kurt Ö, Mølbak K, Nielsen HV, Haznedaroglu T, Stensvold CR (2008) Molecular epidemiology of Blastocystis infections in Turkey. Parasitol Int 57:300–306. https://doi.org/10.1016/j.parint.2008.01.004

    Article  PubMed  Google Scholar 

  56. Souppart L, Sanciu G, Cian A, Wawrzyniak I, Delbac F, Capron M, Dei-Cas E, Boorom K, Delhaes L, Viscogliosi E (2009) Molecular epidemiology of human Blastocystis isolates in France. Parasitol Res 105:413–421. https://doi.org/10.1007/s00436-009-1398-9

    Article  PubMed  Google Scholar 

  57. Hussein EM, Hussein AM, Eida MM, Atwa MM (2008) Pathophysiological variability of different genotypes of human Blastocystis hominis Egyptian isolates in experimentally infected rats. Parasitol Res 102:853–860. https://doi.org/10.1007/s00436-007-0833-z

    Article  PubMed  Google Scholar 

  58. Dogruman-Al F, Yoshikawa H, Kustimur S, Balaban N (2009) PCR-based subtyping of Blastocystis isolates from symptomatic and asymptomatic individuals in a major hospital in Ankara, Turkey. Parasitol Res 106:263–268. https://doi.org/10.1007/s00436-009-1658-8

    Article  PubMed  Google Scholar 

  59. Tan TC, Suresh KG, Smith HV (2008) Phenotypic and genotypic characterisation of Blastocystis hominis isolates implicates subtype 3 as a subtype with pathogenic potential. Parasitol Res 104:85–93. https://doi.org/10.1007/s00436-008-1163-5

    Article  CAS  PubMed  Google Scholar 

  60. Eroglu F, Genc A, Elgun G, Koltas IS (2009) Identification of Blastocystis hominis isolates from asymptomatic and symptomatic patients by PCR. Parasitol Res 105:1589–1592. https://doi.org/10.1007/s00436-009-1595-6

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors thank the Vice Chancellor for Research of Shiraz University of Medical Sciences for support of this study.

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Authors and Affiliations

  1. Basic Sciences in Infectious Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

    Ali Asghari & Gholamreza Hatam

  2. Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran

    Soheil Hassanipour

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  1. Ali Asghari
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AA, SH, and GH conceived and designed the study, and AA and GH critically revised the manuscript. AA, and SH searched the literature; AA, SH, and GH extracted the data. AA and SH performed the data analysis. AA wrote the manuscript. All the authors have read and approved the final manuscript.

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Correspondence to Gholamreza Hatam.

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Asghari, A., Hassanipour, S. & Hatam, G. Comparative molecular prevalence and subtypes distribution of Blastocystis sp. a potentially zoonotic infection isolated from symptomatic and asymptomatic patients in Iran: A systematic review and meta-analysis. Acta Parasit. 66, 745–759 (2021). https://doi.org/10.1007/s11686-021-00360-0

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