References
Key articles
Dart RC, Mullins ME, Matoushek T, et al. Management of acetaminophen poisoning in the US and Canada: a consensus statement. JAMA Netw Open. 2023 Aug 1;6(8):e2327739.Full text Abstract
Fontana RJ, Liou I, Reuben A, et al. AASLD practice guidance on drug, herbal, and dietary supplement-induced liver injury. Hepatology. 2023 Mar 1;77(3):1036-65.Full text
Chiew AL, Gluud C, Brok J, et al. Interventions for paracetamol (acetaminophen) overdose. Cochrane Database Syst Rev. 2018 Feb 23;(2):CD003328.Full text Abstract
American College of Medical Toxicology. ACMT Position statement: duration of intravenous acetylcysteine therapy following acetaminophen overdose. J Med Toxicol. 2017 Mar;13(1):126-7.Full text Abstract
Reference articles
1. Dart RC, Mullins ME, Matoushek T, et al. Management of acetaminophen poisoning in the US and Canada: a consensus statement. JAMA Netw Open. 2023 Aug 1;6(8):e2327739.Full text Abstract
2. Rumack BH, Matthew H. Acetaminophen poisoning and toxicity. Pediatrics. 1975 Jun;55(6):871-6. Abstract
3. Rumack BH, Peterson RC, Koch GG, et al. Acetaminophen overdose. 662 cases with evaluation of oral acetylcysteine treatment. Arch Intern Med. 1981 Feb 23;141(3 spec no):380-5. Abstract
4. Smilkstein MJ, Knapp GL, Kulig KW, et al. Efficacy of oral N-acetylcysteine in the treatment of acetaminophen overdose: analysis of the national multicenter study (1976 to 1985). N Engl J Med. 1988 Dec 15;319(24):1557-62. Abstract
5. Fontana RJ, Liou I, Reuben A, et al. AASLD practice guidance on drug, herbal, and dietary supplement-induced liver injury. Hepatology. 2023 Mar 1;77(3):1036-65.Full text
6. Prescott LF. Paracetamol overdosage. Pharmacological considerations and clinical management. Drugs. 1983 Mar;25(3):290-314. Abstract
7. Stollings JL, Wheeler AP, Rice TW. Incidence and characterization of acute kidney injury after acetaminophen overdose. J Crit Care. 2016 Oct;35:191-4. Abstract
8. Wilkinson SP, Moodie H, Arroyo VA, et al. Frequency of renal impairment in paracetamol overdose compared with other causes of acute liver damage. J Clin Pathol. 1977 Feb;30(2):141-3. Abstract
9. Shah AD, Wood DM, Dargan PI. Understanding lactic acidosis in paracetamol (acetaminophen) poisoning. Br J Clin Pharmacol. 2011 Jan;71(1):20-8.Full text Abstract
10. Perananthan V, Shihana F, Chiew AL, et al. Intestinal injury in paracetamol overdose (ATOM-8). J Gastroenterol Hepatol. 2024 May;39(5):920-6.Full text Abstract
11. Yoon E, Babar A, Choudhary M, et al. Acetaminophen-induced hepatotoxicity: a comprehensive update. J Clin Transl Hepatol. 2016 Jun 28;4(2):131-42.Full text Abstract
12. Gummin DD, Mowry JB, Beuhler MC, et al. 2022 annual report of the National Poison Data System® (NPDS) from America's Poison Centers®: 40th annual report. Clin Toxicol (Phila). 2023 Oct;61(10):717-939.Full text Abstract
13. Zacharia GS, Jacob A. Acetaminophen: a liver killer or thriller. Cureus. 2023 Oct 15;15(10):e47071.Full text Abstract
14. Wolf MS, King J, Jacobson K, et al. Risk of unintentional overdose with non-prescription acetaminophen products. J Gen Intern Med. 2012 Dec;27(12):1587-93. Abstract
15. Daly FF, O'Malley GF, Heard K, et al. Prospective evaluation of repeated supratherapeutic acetaminophen (paracetamol) ingestion. Ann Emerg Med. 2004 Oct;44(4):393-8. Abstract
16. Heard K, Sloss D, Weber S, et al. Overuse of over-the-counter analgesics by emergency department patients. Ann Emerg Med. 2006 Sep;48(3):315-8. Abstract
17. Vogel J, Heard KJ, Carlson C, et al. Dental pain as a risk factor for accidental acetaminophen overdose: a case-control study. Am J Emerg Med. 2011 Nov;29(9):1125-9. Abstract
18. Kaufman DW, Kelly JP, Battista DR, et al. Five-year trends in acetaminophen use exceeding the recommended daily maximum dose. Br J Clin Pharmacol. 2019 May;85(5):1028-34.Full text Abstract
19. Harris E, Harms M, Cao D, et al. Declining rates of opioid/acetaminophen combination product overdose: 2011-2020. Hepatol Commun. 2023 Mar 24;7(4):e0067.Full text Abstract
20. Gummin DD, Mowry JB, Beuhler MC, et al. 2021 annual report of the National Poison Data System© (NPDS) from America's Poison Centers: 39th annual report. Clin Toxicol (Phila). 2022 Dec;60(12):1381-643.Full text Abstract
21. Gunnell D, Murray V, Hawton K. Use of paracetamol (acetaminophen) for suicide and nonfatal poisoning: worldwide patterns of use and misuse. Suicide Life Threat Behav. 2000 Winter;30(4):313-26. Abstract
22. Hawton K, Harriss L. Deliberate self-harm in young people: characteristics and subsequent mortality in a 20-year cohort of patients presenting to hospital. J Clin Psychiatry. 2007 Oct;68(10):1574-83. Abstract
23. Larson AM, Polson J, Fontana RJ, et al. Acetaminophen-induced acute liver failure: results of a United States multicenter, prospective study. Hepatology. 2005 Dec;42(6):1364-72.Full text Abstract
24. Torres A, Parker RM, Sanders LM, et al. Parent preferences and perceptions of milliliters and teaspoons: role of health literacy and experience. Acad Pediatr. 2018 Jan-Feb;18(1):26-34. Abstract
25. Yin HS, Parker RM, Sanders LM, et al. Effect of medication label units of measure on parent choice of dosing tool: a randomized experiment. Acad Pediatr. 2016 Nov-Dec;16(8):734-41. Abstract
26. Balıkçı BB, Güneş Ü. Accuracy of liquid drug dose measurements using different tools by caregivers: a prospective observational study. Eur J Pediatr. 2024 Feb;183(2):853-62. Abstract
27. Neville K, Galinkin JL, Green TP, et al. Metric units and the preferred dosing of orally administered liquid medications. Pediatrics. 2015 Apr;135(4):784-7.Full text
28. Berling I, Anscombe M, Isbister GK. Intravenous paracetamol toxicity in a malnourished child. Clin Toxicol (Phila). 2012 Jan;50(1):74-6. Abstract
29. Beringer RM, Thompson JP, Parry S, et al. Intravenous paracetamol overdose: two case reports and a change to national treatment guidelines. Arch Dis Child. 2011 Mar;96(3):307-8. Abstract
30. Court MH, Duan SX, von Moltke LL, et al. Interindividual variability in acetaminophen glucuronidation by human liver microsomes: identification of relevant acetaminophen UDP-glucuronosyltransferase isoforms. J Pharmacol Exp Ther. 2001 Dec;299(3):998-1006. Abstract
31. Prescott LF. Kinetics and metabolism of paracetamol and phenacetin. Br J Clin Pharmacol. 1980 Oct;10 Suppl 2:291-8S.Full text Abstract
32. Manyike PT, Kharasch ED, Kalhorn TF, et al. Contribution of CYP2E1 and CYP3A to acetaminophen reactive metabolite formation. Clin Pharmacol Ther. 2000 Mar;67(3):275-82. Abstract
33. Hazai E, Vereczkey L, Monostory K. Reduction of toxic metabolite formation of acetaminophen. Biochem Biophys Res Commun. 2002 Mar 8;291(4):1089-94. Abstract
34. Miller RP, Roberts RJ, Fischer LJ. Acetaminophen elimination kinetics in neonates, children, and adults. Clin Pharmacol Ther. 1976 Mar;19(3):284-94. Abstract
35. Tsutsumi M, Lasker JM, Shimizu M, et al. The intralobular distribution of ethanol-inducible P450IIE1 in rat and human liver. Hepatology. 1989 Oct;10(4):437-46. Abstract
36. Hawkins LC, Edwards JN, Dargan PI. Impact of restricting paracetamol pack sizes on paracetamol poisoning in the United Kingdom: a review of the literature. Drug Saf. 2007;30:465-479. Abstract
37. Bond GR, Hite LK. Population-based incidence and outcome of acetaminophen poisoning by type of ingestion. Acad Emerg Med. 1999 Nov;6(11):1115-20. Abstract
38. Kalsi SS, Dargan PI, Waring WS, et al. A review of the evidence concerning hepatic glutathione depletion and susceptibility to hepatotoxicity after paracetamol overdose. Open Access Emerg Med. 2011 Dec 23;3:87-96.Full text Abstract
39. Jiang Y, Zhou Y, Song S, et al. St. John's wort exacerbates acetaminophen-induced liver injury by activation of PXR and CYP-mediated bioactivation. Toxicol Sci. 2022 Oct 27;190(1):54-63.Full text Abstract
40. Kennedy J, Wang CC, Wu CH. Patient disclosure about herb and supplement use among adults in the US. Evid Based Complement Alternat Med. 2008 Dec;5(4):451-6.Full text Abstract
41. Achterbergh R, Lammers LA, Kuijsten L, et al. Effects of nutritional status on acetaminophen measurement and exposure. Clin Toxicol (Phila). 2019 Jan;57(1):42-9.Full text Abstract
42. What dose of paracetamol for people with low bodyweight? Drug Ther Bull. 2022 Jun;60(6):84. Abstract
43. Prescott LF. Paracetamol, alcohol and the liver. Br J Clin Pharmacol. 2000 Apr;49(4):291-301.Full text Abstract
44. Dart RC, Erdman AR, Olson KR, et al; American Association of Poison Control Centers. Acetaminophen poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2006;44(1):1-18. Abstract
45. Ghosh A, Berger I, Remien CH, et al. The role of alcohol consumption on acetaminophen induced liver injury: implications from a mathematical model. J Theor Biol. 2021 Jun 21;519:110559. Abstract
46. Lauterburg BH, Velez ME. Glutathione deficiency in alcoholics: risk factor for paracetamol hepatotoxicity. Gut. 1988 Sep;29(9):1153-7. Abstract
47. Morgan OW, Griffiths C, Majeed A. Interrupted time-series analysis of regulations to reduce paracetamol (acetaminophen) poisoning. PLoS Med. 2007 Apr;4(4):e105.Full text Abstract
48. Buckley NA, Gunnell D. Does restricting pack size of paracetamol (acetaminophen) reduce suicides? PLoS Med. 2007 Apr;4(4):e152.Full text Abstract
49. Hawton K, Bergen H, Simkin S, et al. Effect of withdrawal of co-proxamol on prescribing and deaths from drug poisoning in England and Wales: time series analysis. BMJ. 2009 Jun 18;338:b2270.Full text Abstract
50. US Food and Drug Administration. All manufacturers of prescription combination drug products with more than 325 mg of acetaminophen have discontinued marketing. Mar 2014 [internet publication].Full text
51. Green TJ, Sivilotti MLA, Langmann C, et al. When do the aminotransferases rise after acute acetaminophen overdose? Clin Toxicol (Phila). 2010;48:787-792. Abstract
52. Singer AJ, Carracio TR, Mofenson HC. The temporal profile of increased transaminase levels in patients with acetaminophen-induced liver dysfunction. Ann Emerg Med. 1995 Jul;26(1):49-53. Abstract
53. Prescott LF, Critchley JA. The treatment of acetaminophen poisoning. Annu Rev Pharmacol Toxicol. 1983;23:87-101. Abstract
54. Flanagan RJ, Mant TG. Coma and metabolic acidosis early in severe acute paracetamol poisoning. Hum Toxicol. 1986 May;5(3):179-82. Abstract
55. Roth B, Woo O, Blanc P. Early metabolic acidosis and coma after acetaminophen ingestion. Ann Emerg Med. 1999 Apr;33(4):452-6. Abstract
56. Hamlyn AN, Douglas AP, James O. The spectrum of paracetamol (acetaminophen) overdose: clinical and epidemiological studies. Postgrad Med J. 1978 Jun;54(632):400-4.Full text Abstract
57. Prescott LF, Proudfoot AT, Cregeen RJ. Paracetamol-induced acute renal failure in the absence of fulminant liver damage. Br Med J (Clin Res Ed). 1982 Feb 6;284(6313):421-2.Full text Abstract
58. O'Grady JG, Alexander GJ, Hayllar KM, et al. Early indicators of prognosis in fulminant hepatic failure. Gastroenterology. 1989 Aug;97(2):439-45. Abstract
59. Bailey B, Amre DK, Gaudreault P. Fulminant hepatic failure secondary to acetaminophen poisoning: a systematic review and meta-analysis of prognostic criteria determining the need for liver transplantation. Crit Care Med. 2003 Jan;31(1):299-305. Abstract
60. Davidson DG, Eastham WN. Acute liver necrosis following overdose of paracetamol. Br Med J. 1966 Aug 27;2(5512):497-9.Full text Abstract
61. Clark R, Borirakchanyavat V, Davidson AR, et al. Hepatic damage and death from overdose of paracetamol. Lancet. 1973 Jan 13;1(7794):66-70. Abstract
62. Lesna M, Watson AJ, Douglas AP, et al. Evaluation of paracetamol-induced damage in liver biopsies: acute changes and follow-up findings. Virchows Arch A Pathol Anat Histol. 1976 Jul 21;370(4):333-44. Abstract
63. Portmann B, Talbot IC, Day DW, et al. Histopathological changes in the liver following a paracetamol overdose: correlation with clinical and biochemical parameters. J Pathol. 1975 Nov;117(3):169-81. Abstract
64. Rumack BH. Acetaminophen hepatotoxicity: the first 35 years. J Toxicol Clin Toxicol. 2002;40(1):3-20. Abstract
65. Wong A, Graudins A. Risk prediction of hepatotoxicity in paracetamol poisoning. Clin Toxicol (Phila). 2017 Sep;55(8):879-92. Abstract
66. Wong A, Sivilotti ML, Dargan PI, et al. External validation of the paracetamol-aminotransferase multiplication product to predict hepatotoxicity from paracetamol overdose. Clin Toxicol (Phila). 2015;53(8):807-14. Abstract
67. Wong A, Sivilotti MLA, Graudins A. Accuracy of the paracetamol-aminotransferase multiplication product to predict hepatotoxicity in modified-release paracetamol overdose. Clin Toxicol (Phila). 2017 Jun;55(5):346-51. Abstract
68. Wong A, Sivilotti MLA, Gunja N, et al. Accuracy of the paracetamol-aminotransferase product to predict hepatotoxicity in paracetamol overdose treated with a 2-bag acetylcysteine regimen. Clin Toxicol (Phila). 2018 Mar;56(3):182-8. Abstract
69. O'Grady J. Timing and benefit of liver transplantation in acute liver failure. J Hepatol. 2014 Mar;60(3):663-70.Full text Abstract
70. Baquerizo A, Anselmo D, Shackleton C, et al. Phosphorus ans an early predictive factor in patients with acute liver failure. Transplantation. 2003 Jun 27;75(12):2007-14.Full text Abstract
71. Simundic AM, Bölenius K, Cadamuro J, et al. Joint EFLM-COLABIOCLI recommendation for venous blood sampling. Clin Chem Lab Med. 2018;56(12):2015-38. Abstract
72. Ferenci P, Lockwood A, Mullen K, et al. Hepatic encephalopathy - definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology. 2002 Mar;35(3):716-21. Abstract
73. Lucanie R, Chiang WK, Reilly R. Utility of acetaminophen screening in unsuspected suicidal ingestions. Vet Hum Toxicol. 2002 Jun;44(3):171-3. Abstract
74. Sporer KA, Khayam-Bashi H. Acetaminophen and salicylate serum levels in patients with suicidal ingestion or altered mental status. Am J Emerg Med. 1996 Sep;14(5):443-6. Abstract
75. Heard KJ. Acetylcysteine for acetaminophen poisoning. N Engl J Med. 2008 Jul 17;359(3):285-92.Full text Abstract
76. Chiew AL, Gluud C, Brok J, et al. Interventions for paracetamol (acetaminophen) overdose. Cochrane Database Syst Rev. 2018 Feb 23;(2):CD003328.Full text Abstract
77. Spiller HA, Winter ML, Klein-Schwartz W, et al. Efficacy of activated charcoal administered more than four hours after acetaminophen overdose. J Emerg Med. 2006 Jan;30(1):1-5. Abstract
78. Chiew AL, Isbister GK, Kirby KA, et al. Massive paracetamol overdose: an observational study of the effect of activated charcoal and increased acetylcysteine dose (ATOM-2). Clin Toxicol (Phila). 2017 Dec;55(10):1055-65. Abstract
79. Williamson K, Wahl MS, Mycyk MB. Direct comparison of 20-hour IV, 36-hour oral, and 72-hour oral acetylcysteine for treatment of acute acetaminophen poisoning. Am J Ther. 2013 Jan;20(1):37-40. Abstract
80. Green JL, Heard KJ, Reynolds KM, et al. Oral and intravenous acetylcysteine for treatment of acetaminophen toxicity: a systematic review and meta-analysis. West J Emerg Med. 2013 May;14(3):218-26.Full text Abstract
81. Betten DP, Burner EE, Thomas SC, et al. A retrospective evaluation of shortened-duration oral N-acetylcysteine for the treatment of acetaminophen poisoning. J Med Toxicol. 2009 Dec;5(4):183-90.Full text Abstract
82. Woo OF, Mueller PD, Olson KR, et al. Shorter duration of oral N-acetylcysteine therapy for acute acetaminophen overdose. Ann Emerg Med. 2000 Apr;35(4):363-8. Abstract
83. Wong A, Isbister G, McNulty R, et al. Efficacy of a two bag acetylcysteine regimen to treat paracetamol overdose (2NAC study). EClinicalMedicine. 2020 Mar 19;20:100288.Full text Abstract
84. Yip L, Dart RC, Hurlbut KM. Intravenous administration of oral N-acetylcysteine. Crit Care Med. 1998 Jan;26(1):40-3. Abstract
85. Licata A, Minissale MG, Stankevičiūtė S, et al. N-acetylcysteine for preventing acetaminophen-induced liver injury: a comprehensive review. Front Pharmacol. 2022 Aug 10;13:828565.Full text Abstract
86. Burnham K, Yang T, Smith H, et al. A review of alternative intravenous acetylcysteine regimens for acetaminophen overdose. Expert Rev Clin Pharmacol. 2021 Oct;14(10):1267-78. Abstract
87. Pettie JM, Caparrotta TM, Hunter RW, et al. Safety and efficacy of the SNAP 12-hour acetylcysteine regimen for the treatment of paracetamol overdose. EClinicalMedicine. 2019 May 2;11:11-7.Full text Abstract
88. Chiew AL, Buckley NA. SNAP - a large step in the move towards personalised dosing of acetylcysteine. EClinicalMedicine. 2019 May 7;11:3-4.Full text
89. Cattermole GN. Should N-acetylcysteine be administered orally or intravenously for the treatment of paracetamol overdose? Hong Kong J Emerg Med. 2009 Apr;16(2):106-16.Full text
90. Chiew AL, Isbister GK, Page CB, et al. Modified release paracetamol overdose: a prospective observational study (ATOM-3). Clin Toxicol (Phila). 2018 Sep;56(9):810-9. Abstract
91. Salmonson H, Sjöberg G, Brogren J. The standard treatment protocol for paracetamol poisoning may be inadequate following overdose with modified release formulation: a pharmacokinetic and clinical analysis of 53 cases. Clin Toxicol (Phila). 2018 Jan;56(1):63-8. Abstract
92. Graudins A, Chiew A, Chan B. Overdose with modified-release paracetamol results in delayed and prolonged absorption of paracetamol. Intern Med J. 2010 Jan;40(1):72-6. Abstract
93. European Medicines Agency. Modified-release paracetamol-containing products to be suspended from EU market: recommendation endorsed due to the difficulty in managing overdose. Dec 2017 [internet publication].Full text
94. American College of Medical Toxicology. ACMT Position statement: duration of intravenous acetylcysteine therapy following acetaminophen overdose. J Med Toxicol. 2017 Mar;13(1):126-7.Full text Abstract
95. Betten DP, Cantrell FL, Thomas SC, et al. A prospective evaluation of shortened course oral N-acetylcysteine for the treatment of acute acetaminophen poisoning. Ann Emerg Med. 2007 Sep;50(3):272-9. Abstract
96. Prescott LF, Illingworth RN, Critchley JA, et al. Intravenous N-acetylcysteine: the treatment of choice for paracetamol poisoning. Br Med J. 1979 Nov 3;2(6198):1097-100.Full text Abstract
97. Harrison PM, Keays R, Bray GP, et al. Improved outcome of paracetamol-induced fulminant hepatic failure by late administration of acetylcysteine. Lancet. 1990 Jun 30;335(8705):1572-3. Abstract
98. Keays P, Harrison PM, Wendon JA, et al. Intravenous acetylcysteine in paracetamol induced fulminant hepatic failure: a prospective controlled trial. BMJ. 1991 Oct 26;303(6809):1026-9.Full text Abstract
99. Bernal W, Donaldson N, Wyncoll D, et al. Blood lactate as an early predictor of outcome in paracetamol-induced acute liver failure: a cohort study. Lancet. 2002 Feb 16;359(9306):558-63. Abstract
100. Bailey B, McGuigan MA. Management of anaphylactoid reactions to intravenous N-acetylcysteine. Ann Emerg Med. 1998 Jun;31(6):710-5. Abstract
101. Pakravan N, Waring WS, Sharma S, et al. Risk factors and mechanisms of anaphylactoid reactions to acetylcysteine in acetaminophen overdose. Clin Toxicol (Phila). 2008 Sep;46(8):697-702. Abstract
102. Appelboam AV, Dargan PI, Knighton J. Fatal anaphylactoid reaction to N-acetylcysteine: caution in patients with asthma. Emerg Med J. 2002 Nov;19(6):594-5.Full text Abstract
103. Yarema M, Chopra P, Sivilotti ML, et al. Anaphylactoid reactions to intravenous N-acetylcysteine during treatment for acetaminophen poisoning. J Med Toxicol. 2018 Jun;14(2):120-7. [Erratum in: J Med Toxicol. 2018 Jun;14(2):173.] Abstract
104. Bateman DN, Dear JW, Thanacoody HK, et al. Reduction of adverse effects from intravenous acetylcysteine treatment for paracetamol poisoning: a randomised controlled trial. Lancet. 2014 Feb 22;383(9918):697-704. Abstract
105. Benson BE, Hoppu K, Troutman WG, et al; American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. Position paper update: gastric lavage for gastrointestinal decontamination. Clin Toxicol (Phila). 2013 Mar;51(3):140-6. Abstract
106. Farid NR, Glynn JP, Kerr DN. Haemodialysis in paracetamol self-poisoning. Lancet. 1972 Aug 26;2(7774):396-8. Abstract
107. Dear JW, Clarke JI, Francis B, et al. Risk stratification after paracetamol overdose using mechanistic biomarkers: results from two prospective cohort studies. Lancet Gastroenterol Hepatol. 2018 Feb;3(2):104-13.Full text Abstract
108. Sivilotti ML, Yarema MC, Juurlink DN, et al. A risk quantification instrument for acute acetaminophen overdose patients treated with N-acetylcysteine. Ann Emerg Med. 2005 Sep;46(3):263-71. Abstract
109. Baeg NJ, Bodenheimer HC Jr, Burchard K. Long-term sequellae of acetaminophen-associated fulminant hepatic failure: relevance of early histology. Am J Gastroenterol. 1988 May;83(5):569-71. Abstract
110. Craig DG, Bates CM, Davidson JS, et al. Staggered overdose pattern and delay to hospital presentation are associated with adverse outcomes following paracetamol-induced hepatotoxicity. Br J Clin Pharmacol. 2012 Feb;73(2):285-94.Full text Abstract
111. Sandilands EA, Bateman DN. Adverse reactions associated with acetylcysteine. Clin Toxicol (Phila). 2009 Feb;47(2):81-8. Abstract
112. Schmidt LE, Knudsen TT, Dalhoff K, et al. Effect of acetylcysteine on prothrombin index in paracetamol poisoning without hepatocellular injury. Lancet. 2002 Oct 12;360(9340):1151-2. Abstract
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