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NMOSD and MS prevalence in the Indigenous populations of Australia and New Zealand

  • Original Communication
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Abstract

Background

We studied the prevalence of neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS) in Indigenous populations of Australia and New Zealand with the aim of assessing potential differences.

Methods

Cases of possible NMOSD and MS were collected from Australia and New Zealand. Clinical details, MR imaging, and serologic results were used to apply 2015 IPND diagnostic criteria for NMOSD and 2010 McDonald criteria for MS. Frequencies of self-determined ethnic ancestry were calculated for confirmed NMOSD, suspected NMOSD, and MS. Prevalence rates for NMOSD and MS according to ancestry were compared.

Results

There were 75 cases with NMOSD, 89 with suspected NMSOD, and 101 with MS. NMOSD cases were more likely to have Asian, Indigenous, or Other ancestry compared to suspected NMOSD or MS. There were no differences in the clinical phenotype of NMOSD seen in Indigenous compared to European ancestry populations. Per 100,000, the prevalence estimate for NMOSD in people with Māori ancestry was 1.50 (95% CI 0.52–2.49) which was similar to those with Asian ancestry 1.57 (95% CI 1.15–1.98). NMOSD prevalence in Australian Aboriginal and Torres Strait Islander populations was 0.38 (95% CI 0.00–0.80) per 100,000.

Conclusion

The prevalence of NMOSD in the Māori population is similar to South East Asian countries, reflecting their historical origins. The prevalence of MS in this group is intermediate between those with South East Asian and European ancestry living in New Zealand. Both NMOSD and particularly MS appear to be uncommon in the Indigenous populations of Australia.

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Acknowledgements

This project was undertaken by the Australia and New Zealand Neuromyelitis Optica (ANZ NMO) Collaboration and was supported by funding from Multiple Sclerosis Research Australia (11-038), the Brain Foundation, Griffith University, and the Gold Coast Hospital Foundation. The work in Oxford was supported by the National Health Service National Specialised Commissioning Group for Neuromyelitis Optica. We are grateful to the study participants and would like to thank the support of the members of the Australian and New Zealand Association of Neurologists and Multiple Sclerosis Nurses Australia who assisted with data collection. We are grateful to Euroimmun® who provided the M1/M23 and M23 AQP4/MOG assays for this project. Wajih Bukhari, MD, Griffith University, Gold Coast, Australia, Author, Designed and conceptualized study; major role in the acquisition of data; analyzed the data; drafted the manuscript for intellectual content. Elham Khalilidehkordi, MD, Griffith University, Gold Coast, Australia, Author, Major role in the acquisition of data; analyzed the data; drafted the manuscript for intellectual content. Deborah F Mason, MD, Chistchurch Hospital, Christchurch, NZ, Author, Designed and conceptualized study; major role in the acquisition of data; revised the manuscript for intellectual content. Michael H Barnett, MD, PhD, Brain and Mind Research Institute, Sydney, Australia, Author, Designed and conceptualized study; major role in the acquisition of data; revised the manuscript for intellectual content. Bruce V Taylor MD, Menzies Research Institute, Hobart, Australia, Author, Designed and conceptualized study; major role in the acquisition of data; revised the manuscript for intellectual content. Marzena Fabis-Pedrini, PhD, Peron Institute, Perth, Australia, Author, Major role in the acquisition of data; revised the manuscript for intellectual content. Allan G Kermode, MD, Peron Institute, Perth, Australia, Author, Designed and conceptualized study; major role in the acquisition of data; revised the manuscript for intellectual content. Sankar Subramanian, PhD, GeneCology Research Centre, Sunshine Coast, Australia, Author, Analyzed the data; revised the manuscript for intellectual content. Patrick Waters, PhD, Nuffield Department of Clinical Neurosciences, Oxford, UK, Author, Designed and conceptualized study; major role in the acquisition of data; analyzed the data; revised the manuscript for intellectual content. Simon A Broadley, MD, PhD, Griffith University, Gold Coast, Australia, Author, Designed and conceptualized study; major role in the acquisition of data; analyzed the data; revised the manuscript for intellectual content. ANZ NMO Collaboration: David Abernethy, MD, Wellington Hospital, Wellington, NZ, Author, Designed and conceptualized study; major role in the acquisition of data. Sandeep Bhuta, MD, Griffith University, Gold Coast, Australia, Author, Designed and conceptualized study; major role in the acquisition of data. Stefan Blum, MD, PhD, Princess Alexandra Hospital, Brisbane, Australia, Author, Designed and conceptualized study; major role in the acquisition of data. Mike Boggild, MD, Townsville Hospital, Townsville, Australia, Author, Designed and conceptualized study; major role in the acquisition of data. Karyn Boundy, MD, Royal Adelaide Hospital, Adelaide, Australia, Author, Designed and conceptualized study; major role in the acquisition of data. Bruce J Brew, MD, DSc, Centre for Applied Medical Research, Sydney, Australia, Author, Designed and conceptualized study; major role in the acquisition of data; revised the manuscript for intellectual content. Fabienne Brilot, PhD, Institute for Neuroscience and Muscle Research, Sydney, Australia, Author, Major role in the acquisition of data; revised the manuscript for intellectual content. Wallace J Brownlee, MD, Auckland City Hospital, Auckland, NZ, Author, Major role in the acquisition of data. Christine S Bundell, PathWest Laboratory Medicine, Perth, Australia, Author, Designed and conceptualized study; major role in the acquisition of data. Helmut Butzkueven, MD, PhD, Monash University, Melbourne, Australia, Author, Designed and conceptualized study; major role in the acquisition of data; revised the manuscript for intellectual content. William M Carroll, MD, Perron Institute for Neurological and Translational Science, Perth, Australia, Author, Designed and conceptualized study; major role in the acquisition of data; revised the manuscript for intellectual content. Celia Chen, MD, PhD, Flinders Medical Centre, Adelaide, Australia, Author, Designed and conceptualized study; major role in the acquisition of data. Laura Clarke, MD, Griffith University, Gold Coast, Australia, Author, Designed and conceptualized study; major role in the acquisition of data. Alan Coulthard, MD, PhD, University of Queensland, Brisbane, Australia, Author, Designed and conceptualized study; major role in the acquisition of data. Russell C Dale, MD, PhD, Children's Hopsital Westmead, Sydney, Australia, Author, Designed and conceptualized study; major role in the acquisition of data; revised the manuscript for intellectual content. Chandi Das, MD, Canberra Hospital, Canberra, Australia, Author, Designed and conceptualized study; major role in the acquisition of data. Keith Dear, PhD, University of Adelaide, Adelaide, Australia, Author, Designed and conceptualized study; analysed the data; revised the manuscript for intellectual content. David Fulcher, MD, PhD, Westmead Hosptial, Sydney, Australia, Author, Major role in the acquisition of data. David Gillis, MD, Pathology Queensland Central Laboratory, Brisbane, Australia, Author, Designed and conceptualized study; major role in the acquisition of data. Simon Hawke, MD, PhD, Royal Prince Alfred Hospital, Sydney, Australia, Author, Designed and conceptualized study; major role in the acquisition of data. Robert Heard, MD, Westmead Hosptial, Sydney, Australia, Author, Designed and conceptualized study; major role in the acquisition of data. Andrew P D Henderson, MD, Westmead Hosptial, Sydney, Australia, Author, Designed and conceptualized study; major role in the acquisition of data. Saman Heshmat, MD, Griffith University, Gold Coast, Australia, Author, Major role in the acquisition of data. Suzanne Hodgkinson, MD, PhD, Liverpool Hospital, Sydney, Australia, Author, Designed and conceptualized study; major role in the acquisition of data; revised the manuscript for intellectual content. Sofia Jimenez Sanchez, Griffith University, Gold Coast, Australia, Author, Major role in the acquisition of data. Trevor J Kilpatrick, MD, PhD, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia, Author, Designed and conceptualized study; major role in the acquisition of data; revised the manuscript for intellectual content. John King, MD, Royal Melbourne Hospital, Melbourne, Australia, Author, Designed and conceptualized study; major role in the acquisition of data; revised the manuscript for intellectual content. Chris Kneebone, MD, Royal Adelaide Hospital, Adelaide, Australia, Author, Designed and conceptualized study; major role in the acquisition of data. Andrew J Kornberg, MD, Royal Children's Hospital, Melbourne, Australia, Author, Major role in the acquisition of data. Jeannette Lechner-Scott, MD, PhD, Hunter Medical Research Institute, Newcastle, Australia, Author, Designed and conceptualized study; major role in the acquisition of data; revised the manuscript for intellectual content. Ming-Wei Lin, MD, Royal Prince Alfred Hospital, Sydney, Australia, Author, Major role in the acquisition of data. Chistopher Lynch, MD, University of Auckland, Auckland, NZ, Author, Designed and conceptualized study; major role in the acquisition of data. Richard A L Macdonnell, MD, Austin Health, Melbourne, Australia, Author, Designed and conceptualized study; major role in the acquisition of data; revised the manuscript for intellectual content. Mark P Marriott, MD, PhD, Royal Melbourne Hospital, Melbourne, Australia, Author, Designed and conceptualized study; major role in the acquisition of data; revised the manuscript for intellectual content. Pamela A McCombe, MD, PhD, Centre for Clinical Research, University of Queensland, Brisbane, Australia, Author, Designed and conceptualized study; major role in the acquisition of data; revised the manuscript for intellectual content. Cullen O'Gorman, MD, PhD, Griffith University, Gold Coast, Australia, Author, Designed and conceptualized study; major role in the acquisition of data; revised the manuscript for intellectual content. John D E Parratt, MD, Brain and Mind Research Institute, Sydney, Australia, Author, Designed and conceptualized study; major role in the acquisition of data; revised the manuscript for intellectual content. Michael P Pender, MD, PhD, University of Queensland, Brisbane, Australia, Author, Designed and conceptualized study; major role in the acquisition of data; revised the manuscript for intellectual content. Jennifer Pereira, MD, University of Auckland, Auckland, NZ, Author, Designed and conceptualized study; major role in the acquisition of data. John D Pollard, MD, PhD, Brain and Mind Research Institute, Sydney, Australia, Author, Designed and conceptualized study; major role in the acquisition of data; revised the manuscript for intellectual content. Kerri M Prain, Pathology Queensland Central Laboratory, Brisbane, Australia, Author, Designed and conceptualized study; major role in the acquisition of data. Sudarshini Ramanathan, MD, PhD, Institute for Neuroscience and Muscle Research, Sydney, Australia, Author, Major role in the acquisition of data; revised the manuscript for intellectual content. Stephen W Reddell, MD, PhD, Brain and Mind Research Institute, Sydney, Australia, Author, Designed and conceptualized study; major role in the acquisition of data; revised the manuscript for intellectual content. Cameron Shaw, MD, Deakin University, Geelong, Australia, Author, Designed and conceptualized study; major role in the acquisition of data. Roger A Silvestrini, , Institute for Neuroscience and Muscle Research, Sydney, Australia, Author, Designed and conceptualized study; major role in the acquisition of data. Mark Slee, MD, PhD, Flinders Medical Centre, Adelaide, Australia, Author, Designed and conceptualized study; major role in the acquisition of data; revised the manuscript for intellectual content. Judith Spies, MD, PhD, Brain and Mind Research Institute, Sydney, Australia, Author, Designed and conceptualized study; major role in the acquisition of data. James Stankovich, PhD, Menzies Research Institute, Hobart, Australia, Author, Designed and conceptualized study; analysed the data; revised the manuscript for intellectual content. Ian Sutton, MD, PhD, St Vincent's Hospital, Sydney, Australia, Author, Designed and conceptualized study; major role in the acquisition of data; revised the manuscript for intellectual content. Angela Vincent, MD, FRS, Nuffield Department of Clinical Neurosciences, Oxford, UK, Author, Designed and conceptualized study; revised the manuscript for intellectual content. Steve Vucic, MD, PhD, Westmead Hosptial, Sydney, Australia, Author, Designed and conceptualized study; major role in the acquisition of data; revised the manuscript for intellectual content. Michael Walsh, MD, Princess Alexandra Hospital, Brisbane, Australia, Author, Designed and conceptualized study; major role in the acquisition of data. Ernest Willoughby, MD, University of Auckland, Auckland, NZ, Author, Designed and conceptualized study; major role in the acquisition of data; revised the manuscript for intellectual content. Richard C Wong, MD, Pathology Queensland Central Laboratory, Brisbane, Australia, Author, Designed and conceptualized study; major role in the acquisition of data. Mark Woodhall, PhD, Nuffield Department of Clinical Neurosciences, Oxford, UK, Author, Designed and conceptualized study; major role in the acquisition of data. Eppie M Yiu, MD, Royal Children's Hospital, Melbourne, Australia, Author, Major role in the acquisition of data

Funding

Multiple Sclerosis Research Australia; Brain Foundation; Griffith University/Gold Coast Hospital Foundation; Contributing to Australian Scholarship and Science; NHS National Specialised Commissioning Group for NMO; NIHR Oxford Biomedical Research Centre.

Author information

Authors and Affiliations

  1. Menzies Health Institute Queensland, School of Medicine, Griffith University, Gold Coast Campus, Brisbane, QLD, 4222, Australia

    Wajih Bukhari, Elham Khalilidehkordi, Simon A. Broadley & Wajih Bukhari

  2. Department of Neurology, Gold Coast University Hospital, Southport, QLD, 4215, Australia

    Elham Khalilidehkordi & Simon A. Broadley

  3. New Zealand Brain Research Institute, Christchurch, 8011, New Zealand

    Deborah F. Mason

  4. Department of Medicine, University of Otago, Christchurch, 8011, New Zealand

    Deborah F. Mason

  5. Department of Neurology, Canterbury District Health Board, Christchurch, 8041, New Zealand

    Deborah F. Mason

  6. Brain and Mind Centre, University of Sydney, Camperdown, NSW, 2006, Australia

    Michael H. Barnett

  7. Menzies Institute for Medical Research, University of Tasmania,, Hobart, TAS, 7000, Australia

    Bruce V. Taylor

  8. Department of Neurology, Royal Hobart Hospital, Hobart, TAS, 7000, Australia

    Bruce V. Taylor

  9. Peron Institute, University of Western Australia, Nedlands, WA, 6009, Australia

    Marzena Fabis-Pedrini & Allan G. Kermode

  10. Institute of Immunology and Infectious Diseases, Murdoch University, Perth, WA, 6150, Australia

    Allan G. Kermode

  11. GeneCology Research Centre, University of Sunshine Coast, Sippy Downs, QLD, 4556, Australia

    Sankar Subramanian

  12. Nuffield Department of Clinical Neurosciences, John Radcliffe Infirmary, University of Oxford, Oxford, OX3 9DU, UK

    Patrick Waters

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  1. Wajih Bukhari
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  2. Elham Khalilidehkordi
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  7. Allan G. Kermode
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  8. Sankar Subramanian
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  9. Patrick Waters
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  10. Simon A. Broadley
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Consortia

The Australian and New Zealand NMO Collaboration

  • Wajih Bukhari
  • , Elham Khalilidehkordi
  • , Deborah F. Mason
  • , Michael H. Barnett
  • , Bruce V. Taylor
  • , Marzena Fabis-Pedrini
  • , Allan G. Kermode
  • , Sankar Subramanian
  • , Patrick Waters
  • , Simon A. Broadley
  • , David Abernethy
  • , Sandeep Bhuta
  • , Stefan Blum
  • , Mike Boggild
  • , Karyn Boundy
  • , Bruce J. Brew
  • , Fabienne Brilot
  • , Wallace J. Brownlee
  • , Christine S. Bundell
  • , Helmut Butzkueven
  • , William M. Carroll
  • , Celia Chen
  • , Laura Clarke
  • , Alan Coulthard
  • , Russell C. Dale
  • , Chandi Das
  • , Keith Dear
  • , David Fulcher
  • , David Gillis
  • , Simon Hawke
  • , Robert Heard
  • , Andrew P. D. Henderson
  • , Saman Heshmat
  • , Suzanne Hodgkinson
  • , Sofia Jimenez Sanchez
  • , Trevor J. Kilpatrick
  • , John King
  • , Chris Kneebone
  • , Andrew J. Kornberg
  • , Jeannette Lechner-Scott
  • , Ming-Wei Lin
  • , Chistopher Lynch
  • , Richard A. L. Macdonell
  • , Mark P. Marriott
  • , Pamela A. McCombe
  • , Cullen O’Gorman
  • , John D. E. Parratt
  • , Michael P. Pender
  • , Jennifer Pereira
  • , John D. Pollard
  • , Kerri M. Prain
  • , Sudarshini Ramanathan
  • , Stephen W. Reddell
  • , Cameron Shaw
  • , Roger A. Silvestrini
  • , Mark Slee
  • , Judith Spies
  • , James Stankovich
  • , Ian Sutton
  • , Angela Vincent
  • , Steve Vucic
  • , Michael Walsh
  • , Ernest Willoughby
  • , Richard C. Wong
  • , Mark Woodhall
  •  & Eppie M. Yiu

Corresponding author

Correspondence to Simon A. Broadley.

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Conflicts of interest

The authors declare no conflicts of interest of significance relevant to this manuscript. MHB has received honoraria for participation in advisory boards and travel sponsorship from Novartis, BioCSL, Genzyme, and Biogen Idec. MBo has received travel sponsorship and honoraria from Sanofi-Genzyme, Teva, Novartis, Biogen Idec, and Roche. BJB has received honoraria as a board member for GlaxoSmithKline, Biogen Idec, ViiV Healthcare, and Merck Serono, has received speaker honoraria from ViiV Healthcare, Boehringer Ingelheim, Abbott, Abbvie, and Biogen Idec; has received travel sponsorship from Abbott and Viiv Healthcare, and has received research support funding from EI Lilly, GlaxoSmithKline, ViiV Healthcare, and Merck Serono. SAB has received honoraria for attendance at advisory boards and travel sponsorship from Bayer-Scherring, Biogen-Idec, Merck-Serono, Novartis, and Sanofi-Genzyme, has received speakers honoraria from Biogen-Idec and Genzyme, is an investigator in clinical trials sponsored by Biogen Idec, Novartis, and Genzyme, and was the recipient of an unencumbered research grant from Biogen-Idec. HB has received honoraria for serving on scientific advisory boards for Biogen Idec, Novartis, and Sanofi-Genzyme, has received conference travel sponsorship from Novartis and Biogen Idec, has received honoraria for speaking and acting as Chair at educational events organised by Novartis, Biogen Idec, Medscape, and Merck Serono, serves on steering committees for trials conducted by Biogen Idec and Novartis, is chair (honorary) of the MSBase Foundation, which has received research support from Merck Serono, Novartis, Biogen Idec, Genzyme Sanofi, and CSL Biopharma, and has received research support form Merck Serono. WMC has been the recipient of travel sponsorship from, and provided advice to, Bayer Schering Pharma, Biogen-Idec, Novartis, Genzyme, Sanofi-Aventis, BioCSL and Merck-Serono. RCD has received research funding from the National Health and Medical Research Council, MS Research Australia, Star Scientific Foundation, Pfizer Neuroscience, Tourette Syndrome Association, University of Sydney, and the Petre Foundation and has received honoraria from Biogen-Idec and Bristol-Myers Squibb as an invited speaker. MjF-P has received travel sponsorship from Biogen-Idec and Merck Serono. RH has received honoraria, educational support, and clinic funding from Novartis, Biogen Idec, Genzyme, and BioCSL. AGK has received scientific consulting fees and/or lecture honoraria from Bayer, BioCSL, Biogen-Idec, Genzyme, Merck, Novartis, Sanofi-Aventis, and Teva. TJK has received travel sponsorship from Novartis, BioCSL, Novartis, Merck Serono, and Biogen Idec, has received speaker honoraria from Biogen Idec, BioCSL, Merck Serono, Teva, Genzyme, and Novartis, has received research support from Biogen Idec, Genzyme, GlaxoSmithKline, Bayer-Schering, and Merck Serono, and has received scientific consulting fees from GlaxoSmithKline China, Biogen-Idec, and Novartis. JK has received remuneration for advisory board activities and presentations from Bayer Healthcare, Biogen Idec, BioCSL, Genzyme, and Novartis. CK has received travel support, honoraria, and advisory board payments from Biogen Idec, Bayer, Genzyme, Novartis, and Serono. JL-S has received unencumbered funding as well as honoraria for presentations and membership on advisory boards from Sanofi Aventis, Biogen Idec, Bayer Health Care, CSL, Genzyme, Merck Serono, Novartis Australia, and Teva. RALM has received honoraria for attendance at advisory boards and travel sponsorship from Bayer-Scherring, Biogen-Idec, CSL, Merck-Serono, Novartis, and Sanofi-Genzyme. MPMa has received travel sponsorship, honoraria, trial payments, research, and clinical support from Bayer Schering, Biogen Idec, BioCSL, Genzyme, Novartis, and Sanofi Aventis Genzyme. DFM has received honoraria for attendance at advisory boards from Biogen-Idec and Novartis, and travel sponsorship from Bayer-Scherring, Biogen-Idec, and Sanofi-Genzyme. PAMcC has received honoraria or travel sponsorship from Novatis, Sanofi-Avnetis, and Biogen Idec. JAP has received travel sponsorship, honoraria for presentations, and membership on advisory boards from Biogen Idec and Novartis and Sanofi Aventis. JDP has received honoraria for seminars or advisory boards from Teva, Biogen, Sanofi-Genzyme, Novartis, Merck, Bayer and research grants or fellowships from Merck, Novartis, Bayer, Biogen, Sanofi-Genzyme and Teva. SWR has received travel sponsorship, honoraria, trial payments, research and clinical support from Aspreva, Baxter, Bayer Schering, Biogen Idec, BioCSL, Genzyme, Novartis, Sanofi Aventis Genzyme, and Servier, and is a director of Medical Safety Systems Pty Ltd. CPS has received travel sponsorship from Biogen Idec, Novartis, and Bayer-Schering. IS has received remuneration for Advisory Board activities from Biogen, CSL, and Bayer Schering and educational activities with Biogen, CSL and travel sponsorship from Biogen, Novartis, and Bayer Schering. MS has received research support from Novartis, Biogen Idec, and BioCSL. JSp has received honoraria for lectures and participation in advisory boards, and travel sponsorship from Novartis, BioCSL, Genzyme, and Biogen Idec. BVT has received travel sponsorship from Novartis and Bayer Schering. AV and the University of Oxford hold patents and receive royalties for antibody testing. PW and the University of Oxford hold patents for antibody assays and have received royalties, and have received speaker honoraria from Biogen Idec and Euroimmun® AG, and travel grants from the Guthy-Jackson Charitable Foundation. EW has received honoraria for participation in advisory boards from Biogen-Idec and Novartis, travel sponsorship from Biogen-Idec, Bayer-Schering, and Teva, and is an investigator in clinical trials funded by Biogen-Idec and Teva. MPP has received consulting fees and research funding from Atara Biotherapeutics. DA, SBh, SBl, KB, WBr, WBu, CSB, CCM, LC, AC, CD, KD, DF, DG, SHa, APDH, SHe, SHo, SJ-S, SS, AJK, M-WL, CL, CO’G, MPM, CS, RS, JSt, AV, SV, MWa, RCW, MWo, and EMY report no disclosures.

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The Australian and New Zealand NMO Collaboration authors detail are in acknowledgement.

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Bukhari, W., Khalilidehkordi, E., Mason, D.F. et al. NMOSD and MS prevalence in the Indigenous populations of Australia and New Zealand. J Neurol 269, 836–845 (2022). https://doi.org/10.1007/s00415-021-10665-9

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