Volume 33, Issue 9 (December 2022)                   Studies in Medical Sciences 2022, 33(9): 661-675 | Back to browse issues page

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Nosrati Hashi A, Bolboli L, Anoushiravani S, Farzizadeh R. THE EFFECT OF A PERIOD OF RESISTANCE TRAINING WITH BLOOD FLOW RESTRICTION ON THE LEVEL OF IL-6, IGA AND TNF-Α IN JUDOKAS. Studies in Medical Sciences 2022; 33 (9) :661-675
URL: http://umj.umsu.ac.ir/article-1-5877-en.html
Professor of Sports Physiology, Mohaghegh Ardabili University, Ardabil, Iran (Corresponding Author) , l_bolboli@uma.ac.ir
Abstract:   (791 Views)
Background & Aims: Cytokines are a group of proteins that play the main role in inflammatory responses to pathological stimuli such as inflammation and tissue damage. Also, immunoglobulin A is the main class of antibodies in the body that undergoes changes during physical activities. The purpose of this study was to investigate the effect of a period of resistance training with blood flow restriction on the level of interleukin 6 (IL-6), IgA and TNF-α in judokas.
Materials & Methods: The present research method was interventional (semi-experimental). The statistical population of the present study was male judokas athletes in Tehran. 30 male judokas were randomly divided using available sampling method into 2 groups of training with blood flow restriction as the first group and training without blood flow restriction as the second group. Before the implementation of training programs, blood samples were taken from the subjects, and serum concentrations of IL-6, IgA and TNF-α were measured by ELISA method. Resistance exercise with blood flow restriction was an exercise with 30% intensity of one repetition maximum with cuff pressure (around the proximal area of the arm). Blood flow restriction was considered to be about 120 to 160 mmHg, which depended on the systolic pressure of each individual. Multivariate covariance test was used for inter-group comparison and dependent t-test was used for intra-group comparison at a significance level of P<0.05.
Results: The results of the inter-group comparison showed that IL6 (P=0.023), TNF-α (P<0.001) and IgA (P=0.019) in the two groups of resistance training with blood flow restriction and traditional resistance training were significantly different.
The results of the intra-group comparison showed that IL6 (P < 0.001), TNFα (P = 0.003) and IGA (P = 0.027) in the resistance training group with blood flow restriction in the post-test stage was decreased compared to the pre-test. Also, IL6 (P<0.001) and TNFα (P<0.001) in the traditional resistance training group had a significant decrease in the post-test phase compared to the pre-test.
Conclusion: According to the research results, it can be concluded that a period of traditional resistance training and resistance training along with blood flow restriction can lead to diminishment in TNF-α and IL-6 levels, which shows the improvement of the inflammatory index. Also, resistance training along with flow restriction has led to a decrease in IgA, which indicates weakening of the immune system. According to the findings of this study, in terms of immune system physiology, muscle injuries and inflammations, it is recommended to eliminate intense resistance training programs and develop appropriate training programs such as resistance training with moderate intensity blood flow restriction for athletes.

 
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Type of Study: Research | Subject: فیزیولوژی

References
1. Hall JE, Hall ME. Guyton and Hall textbook of medical physiology e-Book: Elsevier Health Sciences; 2020. [Google books]
2. Karampour S, Valizadeh R, Derakhshan Nejad M, Hedayatmanesh Z. Comparison of immunoglobulins (IgA, IgG, IgM) and cortisol serum response following resistance and high intensity interval exercises. Jundishapur Sci Med J 2017;16(1):13-23. [Google Scholar]
3. Onuegbu JA, Usman SO, Meludu SC, Olisekodiaka JM. Effect of moderate and vigorous physical exercises on serum immunoglobulins G and M of healthy male individuals in Anambra State. Int J Clin Trials 2015;2(2):47-50. [DOI:10.5455/2349-3259.ijct20150505]
4. Ponte L, Valdez R, Medina E, Martinez D, Park KS. Effects of Exercise Intensity on Cortisol, Antioxidant, and DNA damage in Smokers and Non‐Smokers. FASEB J 2015;29:675.13. [DOI:10.1096/fasebj.29.1_supplement.675.13]
5. Debnath M, Sarkar S, Chatterjee S, Dey S. Effect of training on muscle cell damage indices and cortisol level in female players of different sports discipline. Int J Appl Exer Phys 2019;8(1):24-34. [Google Scholar]
6. Nunes JP, Ribeiro AS, Silva AM, Schoenfeld BJ, Dos Santos L, Cunha PM, et al. Improvements in phase angle are related with muscle quality index after resistance training in older women. J Aging Phys Act 2019;27(4):515-20. [DOI:10.1123/japa.2018-0259] [PMID]
7. Shakiba M, Fathi M, Gholami Avval S. The effect of eight weeks of continuous and interval training on serum TNF-ɑ, IL-6 and hs-CRP levels in female. J Prac Stud Biosci Sport 2018;6(12):71-81. [Google Scholar]
8. Tartibian B, Zeynali F, Mohammad Amini Khayat S, Maleki Mansourabad S, Abdollah Zadeh N, Fakhreddin Yaghoob Nezhad F. Response of inflammatory, immune and hormonal markers to incremental exercise in the healthy girls. J Health Care 2015;17(2):154-65. [Google Scholar]
9. Silva FOCd, Macedo DV. Physical exercise, inflammatory process and adaptive condition: an overview. Rev Bras Cineantropometria Desempenho Humano 2011;13:320-8. [Google Scholar]
10. Locksley RM, Killeen N, Lenardo MJ. The TNF and TNF receptor superfamilies: integrating mammalian biology. Cell 2001;104(4):487-501. [DOI:10.1016/S0092-8674(01)00237-9] [PMID]
11. Dömling A, Li X. TNF-α: The shape of small molecules to come? Drug Discovery Today 2021;27(1):3-7. [DOI:10.1016/j.drudis.2021.06.018] [PMID]
12. Valeria Oliveira de Sousa B, de Freitas DF, Monteiro-Junior RS, Mendes IHR, Sousa JN, Guimarães VHD, et al. Physical exercise, obesity, inflammation and neutrophil extracellular traps (NETs): a review with bioinformatics analysis. Mol Biol Rep 2021;48(5):4625-35. [DOI:10.1007/s11033-021-06400-2] [PMID]
13. Vannella KM, Wynn TA. Mechanisms of organ injury and repair by macrophages. Annu Rev Physiol 2017;79:593-617. [DOI:10.1146/annurev-physiol-022516-034356] [PMID]
14. Linke A, Adams V, Schulze PC, Erbs S, Gielen S, Fiehn E, et al. Antioxidative effects of exercise training in patients with chronic heart failure: increase in radical scavenger enzyme activity in skeletal muscle. Circulation 2005;111(14):1763-70. [DOI:10.1161/01.CIR.0000165503.08661.E5] [PMID]
15. Gao S, Durstine JL, Koh H-J, Carver WE, Frizzell N, Carson JA. Acute myotube protein synthesis regulation by IL-6-related cytokines. Am J Physiol-Cell Physiol 2017;313(5):C487-C500. [DOI:10.1152/ajpcell.00112.2017] [PMID] [PMCID]
16. Fujita T, WF B, Kurita K, Sato Y, Abe T. Increased muscle volume and strength following six days of low-intensity resistance training with restricted muscle blood flow. Int J KAATSU Train Res 2008;4(1):1-8. [DOI:10.3806/ijktr.4.1]
17. Holm L, Reitelseder S, Pedersen TG, Doessing S, Petersen SG, Flyvbjerg A, et al. Changes in muscle size and MHC composition in response to resistance exercise with heavy and light loading intensity. J App Physiol 2008;105(5):1454-61. [DOI:10.1152/japplphysiol.90538.2008] [PMID]
18. Joo YB, Lee KB, Sul B, Lee H-S, Lim SH, Park Y-J. Effect of resistance exercise on serum leptin levels in a prospective longitudinal study of women patients with rheumatoid arthritis. Arthritis Res Therapy 2022;24(1):1-9. [DOI:10.1186/s13075-022-02765-2] [PMID] [PMCID]
19. Raya-González J, Castillo D, de Keijzer KL, Beato M. The effect of a weekly flywheel resistance training session on elite U-16 soccer players' physical performance during the competitive season. A randomized controlled trial. Res Sports Med 2021;29(6):571-85. [DOI:10.1080/15438627.2020.1870978] [PMID]
20. Afsharnezhad T, Amani A, Khorsandi M, Safar Zadeh S. The effects of 8-weeks unilateral resistance training on strength, time to task failure, and synergist co-activation of elbow flexor Muscles in trained and untrained limbs. J App Health Stud Sport Physiol 2018;5(1):28-36. [Google Scholar]
21. Loprinzi PD, Moore D, Loenneke JP. Does Aerobic and Resistance Exercise Influence Episodic Memory through Unique Mechanisms? Brain Sci 2020;10(12):913. [DOI:10.3390/brainsci10120913] [PMID] [PMCID]
22. Kovacevic A, Mavros Y, Heisz JJ, Singh MAF. The effect of resistance exercise on sleep: A systematic review of randomized controlled trials. Sleep Med Rev 2018;39:52-68. [DOI:10.1016/j.smrv.2017.07.002] [PMID]
23. Cook CJ, Kilduff LP, Beaven CM. Improving strength and power in trained athletes with 3 weeks of occlusion training. Int J Sports Physiol Perform 2014;9(1):166-72. [DOI:10.1123/ijspp.2013-0018] [PMID]
24. Schoenfeld BJ, Ogborn D, Krieger JW. Effects of resistance training frequency on measures of muscle hypertrophy: a systematic review and meta-analysis. Sports Med 2016;46(11):1689-97. [DOI:10.1007/s40279-016-0543-8] [PMID]
25. Nakajima T, Iida H, Kurano M, Takano H, Morita T, Meguro K, et al. Hemodynamic responses to simulated weightlessness of 24-h head-down bed rest and KAATSU blood flow restriction. Eur J Appl Physiol 2008;104(4):727-37. [DOI:10.1007/s00421-008-0834-3] [PMID]
26. Abe T, Loenneke JP, Fahs CA, Rossow LM, Thiebaud RS, Bemben MG. Exercise intensity and muscle hypertrophy in blood flow-restricted limbs and non‐restricted muscles: a brief review. Clin Physiol Funct Imaging 2012;32(4):247-52. [DOI:10.1111/j.1475-097X.2012.01126.x] [PMID]
27. Abe T, Kawamoto K, Yasuda T, CF K, Midorikawa T, Sato Y. Eight days KAATSU-resistance training improved sprint but not jump performance in collegiate male track and field athletes. Int J KAATSU Train Res 2005;1(1):19-23. [DOI:10.3806/ijktr.1.19]
28. Kraemer WJ, Volek JS, Bush JA, Putukian M, Sebastianelli WJ. Hormonal responses to consecutive days of heavy-resistance exercise with or without nutritional supplementation. J Appl Physiol 1998;85(4):1544-55. [DOI:10.1152/jappl.1998.85.4.1544] [PMID]
29. Kraemer WJ, Ratamess NA. Fundamentals of resistance training: progression and exercise prescription. Med Sci Sports Exerc 2004;36(4):674-88. [DOI:10.1249/01.MSS.0000121945.36635.61] [PMID]
30. Takarada Y, Tsuruta T, Ishii N. Cooperative effects of exercise and occlusive stimuli on muscular function in low-intensity resistance exercise with moderate vascular occlusion. Jpn J Physiol 2004;54(6):585-92. [DOI:10.2170/jjphysiol.54.585] [PMID]
31. Wernbom M, Apro W, Paulsen G, Nilsen TS, Blomstrand E, Raastad T. Acute low-load resistance exercise with and without blood flow restriction increased protein signalling and number of satellite cells in human skeletal muscle. Eur J Appl Physiol 2013;113(12):2953-65. [DOI:10.1007/s00421-013-2733-5] [PMID]
32. Takarada Y, Nakamura Y, Aruga S, Onda T, Miyazaki S, Ishii N. Rapid increase in plasma growth hormone after low-intensity resistance exercise with vascular occlusion. J Appl Physiol 2000;88(1):61-5. [DOI:10.1152/jappl.2000.88.1.61] [PMID]
33. Soltani N, Jalalvand A, Jahani MR. Comparison of Plantar Force, Pressure and Impulse During Walking in Men and Women With Flat Feet. J Sport Biomech 2021;7(2):94-107. [DOI:10.32598/biomechanics.7.2.2]
34. Faul F, Erdfelder E, Lang A-G, Buchner A. G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007;39(2):175-91. [DOI:10.3758/BF03193146] [PMID]
35. Patterson SD, Hughes L, Warmington S, Burr J, Scott BR, Owens J, et al. Blood flow restriction exercise: considerations of methodology, application, and safety. Front Pphysiol 2019;10:533. [DOI:10.3389/fphys.2019.00533] [PMID] [PMCID]
36. Porsesh M, Habibi A, Ahmadi Barati S, Fatemi SR. Comparison of the Effect of 6 Weeks Resistance Training with and without Vascular Occlusion, on Serum Levels of CRP and LDH in Active Girls. SSU J 2016;24(9):706-15. [URL]
37. Amin MN, El-Mowafy M, Mobark A, Abass N, Elgaml A. Exercise-induced downregulation of serum interleukin-6 and tumor necrosis factor-alpha in Egyptian handball players. Saudi J Biol Sci 2021;28(1):724-30. [DOI:10.1016/j.sjbs.2020.10.065] [PMID] [PMCID]
38. Rahmati S, Rajabi H, Karimzadeh L. The Chronic and Acute Effect of Submaximal Pedaling Activity along with Blood Flow Restriction on Serum BDNF and TNF-α in Active Men. J Sport Biosci 2016;8(2):247-62. [URL]
39. Walsh KB, Teijaro JR, Wilker PR, Jatzek A, Fremgen DM, Das SC, et al. Suppression of cytokine storm with a sphingosine analog provides protection against pathogenic influenza virus. Proc Natl Acad Sci 2011;108(29):12018-23. [DOI:10.1073/pnas.1107024108] [PMID] [PMCID]
40. Xiang L, Naik J, Hester RL. Exercise-induced increase in skeletal muscle vasodilatory responses in obese Zucker rats. Am J Physiol Regul 2005;288(4):R987-R91. [DOI:10.1152/ajpregu.00702.2004] [PMID]
41. Franceschi C, Campisi J. Chronic inflammation (inflammaging) and its potential contribution to age-associated diseases. Journals of Gerontology Series A: Biomed Sci Med Sci 2014;69(Suppl_1):S4-S9. [DOI:10.1093/gerona/glu057] [PMID]
42. Machado AM, de Paula H, Cardoso LD, Costa NM. Effects of brown and golden flaxseed on the lipid profile, glycemia, inflammatory biomarkers, blood pressure and body composition in overweight adolescents. Nutrition 2015;31(1):90-6. [DOI:10.1016/j.nut.2014.05.002] [PMID]
43. Spoto B, Di Betta E, Mattace-Raso F, Sijbrands E, Vilardi A, Parlongo R, et al. Pro-and anti-inflammatory cytokine gene expression in subcutaneous and visceral fat in severe obesity. Nutr Metabol Cardiovas Dis 2014;24(10):1137-43. [DOI:10.1016/j.numecd.2014.04.017] [PMID]
44. Siebert S, Tsoukas A, Robertson J, McInnes I. Cytokines as therapeutic targets in rheumatoid arthritis and other inflammatory diseases. Pharmacol Rev 2015;67(2):280-309. [DOI:10.1124/pr.114.009639] [PMID]
45. Tazawa R, Uchida K, Fujimaki H, Miyagi M, Inoue G, Sekiguchi H, et al. Elevated leptin levels induce inflammation through IL-6 in skeletal muscle of aged female rats. BMC Musculoskelet Disord 2019;20(1):1-7. [DOI:10.1186/s12891-019-2581-5] [PMID] [PMCID]
46. Liu H-L, Lin Y-G, Wu J, Sun H, Gong Z-C, Hu P-C, et al. Impact of genetic polymorphisms of leptin and TNF-α on rosiglitazone response in Chinese patients with type 2 diabetes. Eur J Clin Pharmacol 2008;64(7):663-71. [DOI:10.1007/s00228-008-0483-9] [PMID]
47. Keller C, Hellsten Y, Steensberg A, Pedersen BK. Differential regulation of IL-6 and TNF-α via calcineurin in human skeletal muscle cells. Cytokine 2006;36(3-4):141-7. [DOI:10.1016/j.cyto.2006.10.014] [PMID]
48. Fäldt J, Wernstedt I, Fitzgerald SM, Wallenius K, Bergström Gr, Jansson J-O. Reduced exercise endurance in interleukin-6-deficient mice. Endocrinology 2004;145(6):2680-6. [DOI:10.1210/en.2003-1319] [PMID]
49. Cardoso NS, Ribeiro VB, Dutra SGV, Ferriani RA, Gastaldi AC, Araújo JEd, et al. Polycystic ovary syndrome associated with increased adiposity interferes with serum levels of TNF-alpha and IL-6 differently from leptin and adiponectin. Arch Endocrin Metabol 2020;64:4-10. [DOI:10.20945/2359-3997000000197] [PMID]
50. Tomiya A, Aizawa T, Nagatomi R, Sensui H, Kokubun S. Myofibers express IL-6 after eccentric exercise. Am J Sports Med 2004;32(2):503-8. [DOI:10.1177/0095399703258788] [PMID]
51. Kaiser K, Prystaz K, Vikman A, Haffner-Luntzer M, Bergdolt S, Strauss G, et al. Pharmacological inhibition of IL-6 trans-signaling improves compromised fracture healing after severe trauma. Naunyn-Schmiedeb Arch Pharmacol 2018;391(5):523-36. [DOI:10.1007/s00210-018-1483-7] [PMID] [PMCID]
52. Kyriakopoulos G, Lambropoulou M, Valsami G, Kostomitsopoulos N, Konstandi O, Anagnostopoulos K, et al. Pro‐inflammatory cytokines/chemokines, TNF‐α, IL‐6 and MCP‐1, as biomarkers for the nephro‐and pneumoprotective effect of silibinin after hepatic ischemia/reperfusion: Confirmation by immunohistochemistry and qRT‐PCR. Basic Clin Pharmacol Toxicol 2022;130(4):457-67. [DOI:10.1111/bcpt.13704] [PMID]
53. Moura IO, Santana CC, Lourenço YRF, Souza MF, Silva ARST, Dolabella SS, et al. Chemical characterization, antioxidant activity and cytotoxicity of the unconventional food plants: sweet potato (Ipomoea batatas (L.) Lam.) leaf, major gomes (Talinum paniculatum (Jacq.) Gaertn.) and caruru (Amaranthus deflexus L.). Waste Biomass Valorization 2021;12(5):2407-31. [DOI:10.1007/s12649-020-01186-z]
54. Keller C, Keller P, Giralt M, Hidalgo J, Pedersen BK. Exercise normalises overexpression of TNF-α in knockout mice. Biochem Biophys Res Commun 2004;321(1):179-82. [DOI:10.1016/j.bbrc.2004.06.129] [PMID]
55. Petersen AMW, Pedersen BK. The anti-inflammatory effect of exercise. J Appl Physiol 2005;98(4):1154-62. [DOI:10.1152/japplphysiol.00164.2004] [PMID]
56. Kreutz G, Bongard S, Rohrmann S, Grebe D, Bastian HG, Hodapp V, editors. Does singing provide health benefits. Proceedings of the 5th Triennial ESCOM Conference; 2003: Hanover, Germany: Hanover University of Music and Drama. [Google Scholar]
57. Li T-L, Rush B. The effects of prolonged strenuous exercise on salivary secretion of IgA subclasses in men. Int J Sport Exercise Sci 2009;1(3):69-74. [Google Scholar]
58. Loenneke J, Abe T, Wilson J, Thiebaud R, Fahs C, Rossow L, et al. Blood flow restriction: an evidence based progressive model. Acta Physiologica Hungarica 2012;99(3):235-50. [DOI:10.1556/APhysiol.99.2012.3.1] [PMID]
59. Slysz JT, Burr JF. The effects of blood flow restricted electrostimulation on strength and hypertrophy. J Sport Rehabil 2018;27(3):257-62. [DOI:10.1123/jsr.2017-0002] [PMID]
60. Lixandrao ME, Ugrinowitsch C, Berton R, Vechin FC, Conceição MS, Damas F, et al. Magnitude of muscle strength and mass adaptations between high-load resistance training versus low-load resistance training associated with blood-flow restriction: a systematic review and meta-analysis. Sports Med 2018;48(2):361-78. [DOI:10.1007/s40279-017-0795-y] [PMID]
61. Areta JL, Hopkins WG. Skeletal muscle glycogen content at rest and during endurance exercise in humans: a meta-analysis. Sports Med 2018;48(9):2091-102. [DOI:10.1007/s40279-018-0941-1] [PMID]
62. Jacobson J, Chaltron C, Sherman D, Glaviano NR. Blood Flow Restriction Training in Clinical Musculoskeletal Rehabilitation: A Critically Appraised Paper. Int J Athl Therap Train 2020;25(6):303-6. [DOI:10.1123/ijatt.2019-0010]
63. Burgomaster KA, Moore DR, Schofield LM, Phillips SM, Sale DG, Gibala MJ. Resistance training with vascular occlusion: metabolic adaptations in human muscle. Med Sci Sports Exerc 2003;35(7):1203-8. [DOI:10.1249/01.MSS.0000074458.71025.71] [PMID]
64. Nielsen JL, Aagaard P, Prokhorova TA, Nygaard T, Bech RD, Suetta C, et al. Blood flow restricted training leads to myocellular macrophage infiltration and upregulation of heat shock proteins, but no apparent muscle damage. J Physiol 2017;595(14):4857-73. [DOI:10.1113/JP273907] [PMID] [PMCID]
65. Abe T, Fujita S, Nakajima T, Sakamaki M, Ozaki H, Ogasawara R, et al. Effects of low-intensity cycle training with restricted leg blood flow on thigh muscle volume and VO2max in young men. J Sports Sci Med 2010;9(3):452. [PMCID]
66. Yasuda T, Fukumura K, Tomaru T, Nakajima T. Thigh muscle size and vascular function after blood flow-restricted elastic band training in older women. Oncotarget 2016;7(23):33595. [DOI:10.18632/oncotarget.9564] [PMID] [PMCID]
67. Eirale C, Tol J, Farooq A, Smiley F, Chalabi H. Low injury rate strongly correlates with team success in Qatari professional football. Br J Sports Med 2013;47(12):807-8. [DOI:10.1136/bjsports-2012-091040] [PMID] [PMCID]
68. Taddei S, Galetta F, Virdis A, Ghiadoni L, Salvetti G, Franzoni F, et al. Physical activity prevents age-related impairment in nitric oxide availability in elderly athletes. Circulation 2000;101(25):2896-901. [DOI:10.1161/01.CIR.101.25.2896] [PMID]
69. Manimmanakorn A, Hamlin MJ, Ross JJ, Taylor R, Manimmanakorn N. Effects of low-load resistance training combined with blood flow restriction or hypoxia on muscle function and performance in netball athletes. J Sci Med Sport 2013;16(4):337-42. [DOI:10.1016/j.jsams.2012.08.009] [PMID]
70. Gielen S, Adams V, Möbius-Winkler S, Linke A, Erbs S, Yu J, et al. Anti-inflammatory effects of exercise training in the skeletal muscle of patients with chronic heart failure. J Am Coll Cardiol 2003;42(5):861-8. [DOI:10.1016/S0735-1097(03)00848-9] [PMID]
71. Chu N, Chang J, Shieh S. Plasma C-reactive protein concentrations in relation to 5-year body weight change among children: the Taipei Children Heart Study. Int J Obesity 2003;27(6):735-9. [DOI:10.1038/sj.ijo.0802274] [PMID]
72. Heidarianpour A, Keshvari M. Effects of Three Types of Exercise aerobic, resistance and concurrent on plasma CRP concentration in type II diabetes patients. J Sabzevar Univ Medical Sci 2016;23(6):916-25. [URL]
73. Madarame H, Neya M, Ochi E, Nakazato K, Sato Y, Ishii N. Cross-transfer effects of resistance training with blood flow restriction. Med Sci Sports Exerc 2008;40(2):258. [DOI:10.1249/mss.0b013e31815c6d7e] [PMID]
74. Yasuda T, Ogasawara R, Sakamaki M, Ozaki H, Sato Y, Abe T. Combined effects of low-intensity blood flow restriction training and high-intensity resistance training on muscle strength and size. Eur J Appl Physiol 2011;111(10):2525-33. [DOI:10.1007/s00421-011-1873-8] [PMID]

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