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Published in: Neurological Sciences 12/2020

01-12-2020 | Coronavirus | COVID-19

Update on cerebrovascular manifestations of COVID-19

Authors: Reza Naeimi, Maryam Ghasemi–Kasman

Published in: Neurological Sciences | Issue 12/2020

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Abstract

The novel member of coronaviruses family, severe acute respiratory coronavirus-2 (SARS-CoV-2), with high structural homology to SARS-CoV and Middle East respiratory syndrome-related coronavirus (MERS) has spread rapidly with about 20 million cases infection and over 700,000 deaths. SARS-CoV-2 has been emerged as a worldwide disaster due to non-specific few respiratory and gastrointestinal manifestations at the onset of disease as well as long incubation period. Surprisingly, not only respiratory failure but also the underlying coagulation disorder and neurovascular involvement worsen the clinical outcome of infected patients. In this review article, we describe the probable mechanisms of SARS-CoV-2 infection and stroke occurrence. We will also discuss the cerebrovascular events following SARS-CoV-2 infection, the recommended therapies, and future prospects to better manage these patients in coronavirus disease 2019 (COVID-19) outbreak.
Literature
1.
go back to reference Wang C, Horby PW, Hayden FG, Gao GF (2020) A novel coronavirus outbreak of global health concern. Lancet 395(10223):470–473CrossRef Wang C, Horby PW, Hayden FG, Gao GF (2020) A novel coronavirus outbreak of global health concern. Lancet 395(10223):470–473CrossRef
2.
go back to reference Organization, W.H., WHO Director-General’s opening remarks at the media briefing on COVID-19-11 March 2020. 2020 Organization, W.H., WHO Director-General’s opening remarks at the media briefing on COVID-19-11 March 2020. 2020
3.
go back to reference Jin H et al (2020) Consensus for prevention and management of coronavirus disease 2019 (COVID-19) for neurologists. Stroke Vasc. Neurol:svn-2020–sv000382 Jin H et al (2020) Consensus for prevention and management of coronavirus disease 2019 (COVID-19) for neurologists. Stroke Vasc. Neurol:svn-2020–sv000382
4.
go back to reference Dalan R, Bornstein SR, el-Armouche A, Rodionov RN, Markov A, Wielockx B, Beuschlein F, Boehm BO (2020) The ACE-2 in COVID-19: foe or friend? Horm Metab Res 52(5):257–263CrossRef Dalan R, Bornstein SR, el-Armouche A, Rodionov RN, Markov A, Wielockx B, Beuschlein F, Boehm BO (2020) The ACE-2 in COVID-19: foe or friend? Horm Metab Res 52(5):257–263CrossRef
5.
go back to reference Tian S, Hu N, Lou J, Chen K, Kang X, Xiang Z, Chen H, Wang D, Liu N, Liu D, Chen G, Zhang Y, Li D, Li J, Lian H, Niu S, Zhang L, Zhang J (2020) Characteristics of COVID-19 infection in Beijing. J Inf Secur 80:401–406 Tian S, Hu N, Lou J, Chen K, Kang X, Xiang Z, Chen H, Wang D, Liu N, Liu D, Chen G, Zhang Y, Li D, Li J, Lian H, Niu S, Zhang L, Zhang J (2020) Characteristics of COVID-19 infection in Beijing. J Inf Secur 80:401–406
6.
go back to reference Cao X (2020) COVID-19: immunopathology and its implications for therapy. Nat Rev Immunol 20(5):269–270CrossRef Cao X (2020) COVID-19: immunopathology and its implications for therapy. Nat Rev Immunol 20(5):269–270CrossRef
7.
go back to reference Mao, L., et al., Neurological manifestations of hospitalized patients with COVID-19 in Wuhan, China: a retrospective case series study. 2020 Mao, L., et al., Neurological manifestations of hospitalized patients with COVID-19 in Wuhan, China: a retrospective case series study. 2020
8.
go back to reference Yavarpour-Bali H, Ghasemi-Kasman M (2020) Update on neurological manifestations of COVID-19. Life Sci 257:118063CrossRef Yavarpour-Bali H, Ghasemi-Kasman M (2020) Update on neurological manifestations of COVID-19. Life Sci 257:118063CrossRef
9.
go back to reference Montalvan V, Lee J, Bueso T, de Toledo J, Rivas K (2020) Neurological manifestations of COVID-19 and other coronavirus infections: a systematic review. Clin Neurol Neurosurg 194:105921CrossRef Montalvan V, Lee J, Bueso T, de Toledo J, Rivas K (2020) Neurological manifestations of COVID-19 and other coronavirus infections: a systematic review. Clin Neurol Neurosurg 194:105921CrossRef
10.
go back to reference Mansoor, S.R. and Ghasemi-Kasman, M, Impact of disease-modifying drugs on severity of COVID-19 infection in multiple sclerosis patients. Journal of Medical Virology. n/a(n/a) Mansoor, S.R. and Ghasemi-Kasman, M, Impact of disease-modifying drugs on severity of COVID-19 infection in multiple sclerosis patients. Journal of Medical Virology. n/a(n/a)
11.
go back to reference Wang A, Mandigo GK, Yim PD, Meyers PM, Lavine SD (2020) Stroke and mechanical thrombectomy in patients with COVID-19: technical observations and patient characteristics. J. Neurointerv. Surg 12(7):648–653CrossRef Wang A, Mandigo GK, Yim PD, Meyers PM, Lavine SD (2020) Stroke and mechanical thrombectomy in patients with COVID-19: technical observations and patient characteristics. J. Neurointerv. Surg 12(7):648–653CrossRef
12.
go back to reference Helms J et al (2020) High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med:1–10 Helms J et al (2020) High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med:1–10
13.
go back to reference Aggarwal G, Lippi G, Michael Henry B (2020) Cerebrovascular disease is associated with an increased disease severity in patients with coronavirus disease 2019 (COVID-19): a pooled analysis of published literature. Int J Stroke 15(4):385–389CrossRef Aggarwal G, Lippi G, Michael Henry B (2020) Cerebrovascular disease is associated with an increased disease severity in patients with coronavirus disease 2019 (COVID-19): a pooled analysis of published literature. Int J Stroke 15(4):385–389CrossRef
14.
go back to reference Li YC, Bai WZ, Hashikawa T (2020) The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. J Med Virol 92(6):552–555CrossRef Li YC, Bai WZ, Hashikawa T (2020) The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. J Med Virol 92(6):552–555CrossRef
15.
go back to reference Gu J, Gong E, Zhang B, Zheng J, Gao Z, Zhong Y, Zou W, Zhan J, Wang S, Xie Z, Zhuang H, Wu B, Zhong H, Shao H, Fang W, Gao D, Pei F, Li X, He Z, Xu D, Shi X, Anderson VM, Leong ASY (2005) Multiple organ infection and the pathogenesis of SARS. J Exp Med 202(3):415–424CrossRef Gu J, Gong E, Zhang B, Zheng J, Gao Z, Zhong Y, Zou W, Zhan J, Wang S, Xie Z, Zhuang H, Wu B, Zhong H, Shao H, Fang W, Gao D, Pei F, Li X, He Z, Xu D, Shi X, Anderson VM, Leong ASY (2005) Multiple organ infection and the pathogenesis of SARS. J Exp Med 202(3):415–424CrossRef
16.
go back to reference Qin, C., et al., Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clinical Infectious Diseases, 2020 Qin, C., et al., Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clinical Infectious Diseases, 2020
17.
go back to reference Mehta P et al (2020) COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet 395(10229):1033CrossRef Mehta P et al (2020) COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet 395(10229):1033CrossRef
18.
go back to reference Giannis D, Ziogas IA, Gianni P (2020) Coagulation disorders in coronavirus infected patients: COVID-19, SARS-CoV-1, MERS-CoV and lessons from the past. J Clin Virol 127:104362CrossRef Giannis D, Ziogas IA, Gianni P (2020) Coagulation disorders in coronavirus infected patients: COVID-19, SARS-CoV-1, MERS-CoV and lessons from the past. J Clin Virol 127:104362CrossRef
19.
go back to reference Connors JM, Levy JH (2020) COVID-19 and its implications for thrombosis and anticoagulation. Am. J. Hematol 135(23):2033–2040 Connors JM, Levy JH (2020) COVID-19 and its implications for thrombosis and anticoagulation. Am. J. Hematol 135(23):2033–2040
20.
go back to reference Jose, R.J. and A. Manuel, COVID-19 cytokine storm: the interplay between inflammation and coagulation. The Lancet Respiratory Medicine, 2020 Jose, R.J. and A. Manuel, COVID-19 cytokine storm: the interplay between inflammation and coagulation. The Lancet Respiratory Medicine, 2020
21.
go back to reference Leslie-Mazwi T et al (2020) Preserving access: a review of stroke thrombectomy during the COVID-19 pandemic. Am J Neuroradiol 41:1136–1141CrossRef Leslie-Mazwi T et al (2020) Preserving access: a review of stroke thrombectomy during the COVID-19 pandemic. Am J Neuroradiol 41:1136–1141CrossRef
22.
go back to reference Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z, Yu T, Xia J, Wei Y, Wu W, Xie X, Yin W, Li H, Liu M, Xiao Y, Gao H, Guo L, Xie J, Wang G, Jiang R, Gao Z, Jin Q, Wang J, Cao B (2020) Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 395(10223):497–506CrossRef Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z, Yu T, Xia J, Wei Y, Wu W, Xie X, Yin W, Li H, Liu M, Xiao Y, Gao H, Guo L, Xie J, Wang G, Jiang R, Gao Z, Jin Q, Wang J, Cao B (2020) Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 395(10223):497–506CrossRef
23.
go back to reference Machado, C. J.V. Gutierrez, Brainstem dysfunction in SARS-COV2 infection can be a potential cause of respiratory distress. 2020 Machado, C. J.V. Gutierrez, Brainstem dysfunction in SARS-COV2 infection can be a potential cause of respiratory distress. 2020
24.
go back to reference Markus HS, Brainin M (2020) COVID-19 and stroke—a global World Stroke Organization perspective. Int J Stroke 15(4):361–364CrossRef Markus HS, Brainin M (2020) COVID-19 and stroke—a global World Stroke Organization perspective. Int J Stroke 15(4):361–364CrossRef
25.
go back to reference Zeng J-H et al (2020) First case of COVID-19 complicated with fulminant myocarditis: a case report and insights. Infection:1 Zeng J-H et al (2020) First case of COVID-19 complicated with fulminant myocarditis: a case report and insights. Infection:1
26.
go back to reference Juusela A, Nazir M, Gimovsky M (2020) Two cases of COVID-19 related cardiomyopathy in pregnancy. Am J Obstet Gynecol:100113 Juusela A, Nazir M, Gimovsky M (2020) Two cases of COVID-19 related cardiomyopathy in pregnancy. Am J Obstet Gynecol:100113
27.
go back to reference Inciardi, R.M., et al., Cardiac involvement in a patient with coronavirus disease 2019 (COVID-19). JAMA cardiology, 2020 Inciardi, R.M., et al., Cardiac involvement in a patient with coronavirus disease 2019 (COVID-19). JAMA cardiology, 2020
28.
go back to reference Lippi G, Plebani M (2020) Laboratory abnormalities in patients with COVID-2019 infection. Clin. Chem. Lab. Med 58(7):1131–1134CrossRef Lippi G, Plebani M (2020) Laboratory abnormalities in patients with COVID-2019 infection. Clin. Chem. Lab. Med 58(7):1131–1134CrossRef
29.
go back to reference Oudit G et al (2009) SARS-coronavirus modulation of myocardial ACE2 expression and inflammation in patients with SARS. Eur J Clin Investig 39(7):618–625CrossRef Oudit G et al (2009) SARS-coronavirus modulation of myocardial ACE2 expression and inflammation in patients with SARS. Eur J Clin Investig 39(7):618–625CrossRef
30.
go back to reference Zhang Y, Xiao M, Zhang S, Xia P, Cao W, Jiang W, Chen H, Ding X, Zhao H, Zhang H, Wang C, Zhao J, Sun X, Tian R, Wu W, Wu D, Ma J, Chen Y, Zhang D, Xie J, Yan X, Zhou X, Liu Z, Wang J, du B, Qin Y, Gao P, Qin X, Xu Y, Zhang W, Li T, Zhang F, Zhao Y, Li Y, Zhang S (2020) Coagulopathy and antiphospholipid antibodies in patients with Covid-19. N Engl J Med 382(17):e38CrossRef Zhang Y, Xiao M, Zhang S, Xia P, Cao W, Jiang W, Chen H, Ding X, Zhao H, Zhang H, Wang C, Zhao J, Sun X, Tian R, Wu W, Wu D, Ma J, Chen Y, Zhang D, Xie J, Yan X, Zhou X, Liu Z, Wang J, du B, Qin Y, Gao P, Qin X, Xu Y, Zhang W, Li T, Zhang F, Zhao Y, Li Y, Zhang S (2020) Coagulopathy and antiphospholipid antibodies in patients with Covid-19. N Engl J Med 382(17):e38CrossRef
31.
go back to reference Harzallah, I., A. Debliquis, B. Drénou, Lupus anticoagulant is frequent in patients with Covid-19. Journal of thrombosis and haemostasis : JTH, 2020 Harzallah, I., A. Debliquis, B. Drénou, Lupus anticoagulant is frequent in patients with Covid-19. Journal of thrombosis and haemostasis : JTH, 2020
32.
go back to reference Beyrouti, R., et al., Characteristics of ischaemic stroke associated with COVID-19. Journal of Neurology, Neurosurgery & Psychiatry, 2020 Beyrouti, R., et al., Characteristics of ischaemic stroke associated with COVID-19. Journal of Neurology, Neurosurgery & Psychiatry, 2020
33.
go back to reference Avula, A., et al., COVID-19 presenting as stroke. Brain, behavior, and immunity, 2020 Avula, A., et al., COVID-19 presenting as stroke. Brain, behavior, and immunity, 2020
34.
go back to reference Hughes C et al (2020) Cerebral venous sinus thrombosis as a presentation of COVID-19. Eur J Case Rep Intern Med:7(5) Hughes C et al (2020) Cerebral venous sinus thrombosis as a presentation of COVID-19. Eur J Case Rep Intern Med:7(5)
35.
go back to reference González-Pinto, T., et al., Emergency room neurology in times of COVID-19: malignant ischemic stroke and SARS-COV2 infection. European journal of neurology, 2020 González-Pinto, T., et al., Emergency room neurology in times of COVID-19: malignant ischemic stroke and SARS-COV2 infection. European journal of neurology, 2020
36.
go back to reference Al Saiegh, F., et al., Status of SARS-CoV-2 in cerebrospinal fluid of patients with COVID-19 and stroke. Journal of Neurology, Neurosurgery & Psychiatry, 2020 Al Saiegh, F., et al., Status of SARS-CoV-2 in cerebrospinal fluid of patients with COVID-19 and stroke. Journal of Neurology, Neurosurgery & Psychiatry, 2020
37.
go back to reference Viguier, A., et al., Acute ischemic stroke complicating common carotid artery thrombosis during a severe COVID-19 infection. Journal of neuroradiology, 2020 Viguier, A., et al., Acute ischemic stroke complicating common carotid artery thrombosis during a severe COVID-19 infection. Journal of neuroradiology, 2020
38.
go back to reference Oxley TJ, Mocco J, Majidi S, Kellner CP, Shoirah H, Singh IP, de Leacy RA, Shigematsu T, Ladner TR, Yaeger KA, Skliut M, Weinberger J, Dangayach NS, Bederson JB, Tuhrim S, Fifi JT (2020) Large-vessel stroke as a presenting feature of Covid-19 in the young. N Engl J Med 382(20):e60CrossRef Oxley TJ, Mocco J, Majidi S, Kellner CP, Shoirah H, Singh IP, de Leacy RA, Shigematsu T, Ladner TR, Yaeger KA, Skliut M, Weinberger J, Dangayach NS, Bederson JB, Tuhrim S, Fifi JT (2020) Large-vessel stroke as a presenting feature of Covid-19 in the young. N Engl J Med 382(20):e60CrossRef
39.
go back to reference Yeboah, K., et al., Interventional stroke management in a COVID-19 patient. Neurology: Clinical Practice, 2020 Yeboah, K., et al., Interventional stroke management in a COVID-19 patient. Neurology: Clinical Practice, 2020
40.
go back to reference Immovilli P et al (2020) Stroke in COVID-19 patients—a case series from Italy. Int J Stroke:1747493020938294 Immovilli P et al (2020) Stroke in COVID-19 patients—a case series from Italy. Int J Stroke:1747493020938294
41.
go back to reference Klok F et al (2020) Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res Klok F et al (2020) Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res
42.
go back to reference Belani P, Schefflein J, Kihira S, Rigney B, Delman BN, Mahmoudi K, Mocco J, Majidi S, Yeckley J, Aggarwal A, Lefton D, Doshi AH (2020) COVID-19 is an independent risk factor for acute ischemic stroke. Am J Neuroradiol 41:1361–1364CrossRef Belani P, Schefflein J, Kihira S, Rigney B, Delman BN, Mahmoudi K, Mocco J, Majidi S, Yeckley J, Aggarwal A, Lefton D, Doshi AH (2020) COVID-19 is an independent risk factor for acute ischemic stroke. Am J Neuroradiol 41:1361–1364CrossRef
43.
go back to reference Siegler J et al (2020) Falling stroke rates during COVID-19 pandemic at a Comprehensive Stroke Center: Cover title: Falling stroke rates during COVID-19. J Stroke Cerebrovasc Dis:104953 Siegler J et al (2020) Falling stroke rates during COVID-19 pandemic at a Comprehensive Stroke Center: Cover title: Falling stroke rates during COVID-19. J Stroke Cerebrovasc Dis:104953
44.
go back to reference Shankar-Hari M, Phillips GS, Levy ML, Seymour CW, Liu VX, Deutschman CS, Angus DC, Rubenfeld GD, Singer M, for the Sepsis Definitions Task Force (2016) Developing a new definition and assessing new clinical criteria for septic shock: for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Jama 315(8):775–787CrossRef Shankar-Hari M, Phillips GS, Levy ML, Seymour CW, Liu VX, Deutschman CS, Angus DC, Rubenfeld GD, Singer M, for the Sepsis Definitions Task Force (2016) Developing a new definition and assessing new clinical criteria for septic shock: for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Jama 315(8):775–787CrossRef
45.
go back to reference Lyons PG, Micek ST, Hampton N, Kollef MH (2018) Sepsis-associated coagulopathy severity predicts hospital mortality. Crit Care Med 46(5):736–742CrossRef Lyons PG, Micek ST, Hampton N, Kollef MH (2018) Sepsis-associated coagulopathy severity predicts hospital mortality. Crit Care Med 46(5):736–742CrossRef
46.
go back to reference Tang N, Li D, Wang X, Sun Z (2020) Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 18(4):844–847CrossRef Tang N, Li D, Wang X, Sun Z (2020) Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 18(4):844–847CrossRef
47.
go back to reference Lippi G, Plebani M, Henry BM (2020) Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: a meta-analysis. Clin Chim Acta Lippi G, Plebani M, Henry BM (2020) Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: a meta-analysis. Clin Chim Acta
48.
go back to reference Thachil J, Tang N, Gando S, Falanga A, Cattaneo M, Levi M, Clark C, Iba T (2020) ISTH interim guidance on recognition and management of coagulopathy in COVID-19. J Thromb Haemost 18(5):1023–1026CrossRef Thachil J, Tang N, Gando S, Falanga A, Cattaneo M, Levi M, Clark C, Iba T (2020) ISTH interim guidance on recognition and management of coagulopathy in COVID-19. J Thromb Haemost 18(5):1023–1026CrossRef
49.
go back to reference Baracchini C et al (2020) Acute stroke management pathway during Coronavirus-19 pandemic. Neurol Sci:1–3 Baracchini C et al (2020) Acute stroke management pathway during Coronavirus-19 pandemic. Neurol Sci:1–3
50.
go back to reference Tang N, Bai H, Chen X, Gong J, Li D, Sun Z (2020) Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost 18(5):1094–1099CrossRef Tang N, Bai H, Chen X, Gong J, Li D, Sun Z (2020) Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost 18(5):1094–1099CrossRef
51.
go back to reference Wang T, Chen R, Liu C, Liang W, Guan W, Tang R, Tang C, Zhang N, Zhong N, Li S (2020) Attention should be paid to venous thromboembolism prophylaxis in the management of COVID-19. Lancet Haematol 7(5):e362–e363CrossRef Wang T, Chen R, Liu C, Liang W, Guan W, Tang R, Tang C, Zhang N, Zhong N, Li S (2020) Attention should be paid to venous thromboembolism prophylaxis in the management of COVID-19. Lancet Haematol 7(5):e362–e363CrossRef
52.
go back to reference Ciavarella A, Peyvandi F, Martinelli I (2020) Where do we stand with antithrombotic prophylaxis in patients with COVID-19? Thromb Res 191:29CrossRef Ciavarella A, Peyvandi F, Martinelli I (2020) Where do we stand with antithrombotic prophylaxis in patients with COVID-19? Thromb Res 191:29CrossRef
53.
go back to reference Lee M, Chen C, Ovbiagele B (2020) Covert COVID-19 complications: continuing the use of evidence-based drugs to minimize potentially lethal indirect effects of the pandemic in stroke patients. J Neurol Sci 414:116883–116883CrossRef Lee M, Chen C, Ovbiagele B (2020) Covert COVID-19 complications: continuing the use of evidence-based drugs to minimize potentially lethal indirect effects of the pandemic in stroke patients. J Neurol Sci 414:116883–116883CrossRef
54.
go back to reference Dogra S, Jain R, Cao M, Bilaloglu S, Zagzag D, Hochman S, Lewis A, Melmed K, Hochman K, Horwitz L, Galetta S, Berger J (2020) Hemorrhagic stroke and anticoagulation in COVID-19. J Stroke Cerebrovasc Dis 29:104984CrossRef Dogra S, Jain R, Cao M, Bilaloglu S, Zagzag D, Hochman S, Lewis A, Melmed K, Hochman K, Horwitz L, Galetta S, Berger J (2020) Hemorrhagic stroke and anticoagulation in COVID-19. J Stroke Cerebrovasc Dis 29:104984CrossRef
Metadata
Title
Update on cerebrovascular manifestations of COVID-19
Authors
Reza Naeimi
Maryam Ghasemi–Kasman
Publication date
01-12-2020
Publisher
Springer International Publishing
Published in
Neurological Sciences / Issue 12/2020
Print ISSN: 1590-1874
Electronic ISSN: 1590-3478
DOI
https://doi.org/10.1007/s10072-020-04837-0

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