Sunday, December 29, 2013

World's longest surviving heart transplant at 31 years 

Heart transplant patient is a record breaker

A man from Newport Pagnell near Milton Keynes has become the world's longest surviving heart transplant patient.
When he had the operation in 1982, John McCafferty was told that if the transplant was successful he could survive for five more years.
Thirty one years on, he says he's forever grateful to the doctors and the donor who saved his life.
Click below to watch Olivia Paterson's report.

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Monday, December 09, 2013

Killer "T" cells “learn” to hunt down and attack cancer cells, researchers claim.

New wonder drug matches and kills all kinds of cancer — human testing starts 2014

New wonder drug matches and kills all kinds of cancer — human testing starts 2014

Stanford researchers are on track to begin human trials of a potentially potent new weapon against cancer, and would-be participants are flooding in following the Post’s initial report on the discovery.
The progress comes just two months after the groundbreaking study by Dr Irv Weissman, who developed an antibody that breaks down a cancer’s defense mechanisms in the body.
A protein called CD47 tells the body not to “eat” the cancer, but the antibody developed by Dr Weissman blocks CD47 and frees up immune cells called macrophages — which can then engulf the deadly cells.
The new research shows the miraculous macrophages effectively act as intelligence gatherers for the body, pointing out cancerous cells to cancer-fighting “killer T” cells.
The T cells then “learn” to hunt down and attack the cancer, the researchers claim.
“It was completely unexpected that CD8+ T (killer T) cells would be mobilized when macrophages engulfed the cancer cells in the presence of CD47-blocking antibodies,” said MD/PhD student Diane Tseng, who works with Dr. Weissman.
The clinical implications of the process could be profound in the war on cancer.
When macrophages present “killer T” cells with a patient’s cancer, the T cells become attuned to the unique molecular markers on the cancer.
This turns them into a personalized cancer vaccine.
“Because T cells are sensitized to attack a patient’s particular cancer, the administration of CD47-blocking antibodies in a sense could act as a personalized vaccination against that cancer,” Tseng said.
The team of researchers at Stanford plan on starting a small 10-100 person phase I clinical human trial of the cancer therapy in 2014.
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Friday, December 06, 2013

Scientists used human stem cells for lung tissue

Scientists had previously converted stem cells into cells of the heart, intestine, liver, nerves and pancreas, Fox News reports.

"Now, we are finally able to make lung and airway cells," study leader Dr. Hans-Willem Snoeck, a professor of microbiology and immunology at Columbia University in New York, said in a statement.

Patients who receive lung transplants today have a poor prognosis. But future approaches involving transplants that use the patient's own stem cells to generate lung tissue could reduce the chances that a patient's immune system would reject the transplant, the researchers said. 
In the new study, Snoeck's team found evidence suggesting the cells could develop into six types of lung and airway epithelial cells.

The technology could enable researchers to model certain lung diseases.

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Wednesday, December 04, 2013

Left ventricular assist device (LVAD) and an association with substantial morbidity and mortality.

Increased rates of LVAD pump thrombosis reported at 3 centers

Starling RC. N Engl J Med. 2013;doi:10.1056/NEJMoa1313385. Today
Three US centers report increasing rates of pump thrombosis related to the use of the HeartMate II left ventricular assist device and an association with substantial morbidity and mortality.

“Pivotal trials and postmarketing approval studies of the HeartMate II provide a reference occurrence of thrombosis of 2% to 4%; however, an unexpected abrupt increase in the incidence of pump thrombosis was observed in a single-center quality review,”Randall C. Starling, MD, MPH, of Cleveland Clinic, and colleagues wrote inThe New England Journal of Medicine. “To confirm that this finding was not an isolate phenomenon, two additional experienced centers pooled data to investigate the incidence of pump thrombosis and of elevated lactate dehydrogenase (LDH) levels as its clinical biomarker (indicating hemolysis), LDH levels that may presage thrombosis and outcomes of thrombosis-management strategies.”
The analysis included data on 837 patients and 895 HeartMate II devices (Thoratec) that were implanted from 2004 to mid-2013 at Cleveland Clinic, Duke University Medical Center and Washington University Barnes-Jewish Hospital.
Confirmed pump thrombosis served as the primary endpoint. According to results, 72 pump thromboses were confirmed in 66 patients. Thirty-six additional thromboses of unique devices were suspected.
From March 2011 to January 2013, the occurrence of confirmed pump thrombosis at 3 months post-implantation increased from 2.2% to 8.4%. The median time from implantation to thrombosis decreased, from 18.6 months before March 2011 to 2.7 months after March 2011.
An increased occurrence of elevated LDH levels at 3 months post-implantation also increased during the study period. Thrombosis was presaged by LDH levels that increased from 540 IU/L to 1,490 IU/L in the weeks before diagnosis, according to the study results.
Eleven patients had their pump thrombosis managed by heart transplantation; one patient died 31 days after transplantation. Twenty-one patients had their thrombosis managed by pump replacement. In this group, mortality was similar to that of patients with no thrombosis. The researchers also reported data on 40 thromboses in 40 patients not managed by transplantation or pump replacement; in the 6 months after pump thrombosis, the actuarial mortality was 48.2%.
“Further investigation of predisposing patient and device factors and preventive and therapeutic strategies are urgently needed to resolve this important safety issue,” the researchers concluded. “We recognize that LVADs provide life-sustaining treatment for many patients with advanced heart failure. However, recommendations for LVAD therapy should account for this updated risk-benefit profile.”
Disclosure: See the full study for a list of the researchers’ relevant financial disclosures.

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Tuesday, December 03, 2013

Rehospitalization after kidney transplant caused by complexity of the condition, not poor quality of care

Most early rehospitalization after kidney transplant caused by complexity of the condition, not poor quality of care

A study of over 750 kidney transplant patients over a five-year period conducted by researchers at the Perelman School of Medicine at the University of Pennsylvania has found that 90% of early rehospitalizations (within 30 days of surgery) were caused by complex medical factors related to the transplantation process. Only nine percent of rehospitalizations – which occurred among only three percent of the entire group of patients – were categorised as potentially preventable.
The study, published online this week in the American Journal of Transplantation, found that 237 patients (nearly one-third) were rehospitalized early following surgery, with a median of nine days to rehospitalization after discharge from kidney transplant. In most of these cases, the readmissions were unplanned and occurred as a result of common postsurgical complications. Deep vein thrombosis (blood clots), post-operative pain, organ rejection, fluid imbalances including volume overload (too much fluid in the blood) or volume depletion (decrease in volume of blood plasma, potentially leading to shock), and wound infections were key complicating factors leading to early rehospitalisation.
“Nationally, high rates of early rehospitalization after kidney transplantation have been reported, but little information is available about what caused these events and whether they could be prevented,” said lead study author Meera Nair Harhay, MD, MSCE, instructor of Medicine in the Renal, Electrolyte and Hypertension Division at Penn. “Early rehospitalization has also been examined by Medicare as a hospital quality of care indicator, with financial penalties for early rehospitalization after certain medical conditions. However, our findings indicate that transplant recipients are a particularly vulnerable group that often requires additional care after undergoing surgery and being exposed to new medications.”
In the study, which is the first to use intensive chart review to assess preventability of early rehospitalization, two physicians independently examined the medical charts of the 237 readmitted transplant patients. Only 19 cases were found to be preventable readmissions by the reviewing physicians. Preventable causes of readmission identified by the study include 1) patients not having had an outpatient physician/nurse practitioner assessment before being admitted, 2) an alternative medical regimen not having been prescribed at discharge, 3) patients not having been compliant with their medication regimen, and 4) inadequate outpatient diagnostic or therapeutic procedures having been available.
The study also found that 30% of rehospitalized patients were originally discharged after their transplant on the weekend, versus 23% of patients who were not readmitted –a statistically significant finding highlighting the need for careful transitions of care when staffing is variable and more limited, such as occurs on the weekends. “If further multicenter studies confirm these findings, transplant centers should consider augmenting staffing and the oversight related to weekend discharges,” said senior author Peter Reese MD, MSCE, assistant professor of Medicine and Epidemiology at Penn.
The study also revealed how long waiting times for transplantation increase the risk of post-transplant complications. For every year of additional waiting time prior to kidney transplantation, recipients were 10% more likely to experience early rehospitalization. Kidney transplant recipients who were rehospitalized within 30 days of transplant were 55% more likely to die within a six-year follow-up period than those who were not rehospitalized. “These findings indicate that early rehospitalization may be a strong signal of patient vulnerability, and such patients may benefit from more careful clinical monitoring post-transplant,” said Harhay.
(Source: University of PennsylvaniaAmerican Journal of Transplantation
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Friday, November 29, 2013

Happy Thanksgiving Weekend

My very best wishes for a happy Thanksgiving weekend to my American friends. For us in the transplant community Thanksgiving takes on a very special meaning. Transplant recipients, their families and friends have much to be thankful for. Those of us who received transplants, such as myself, have been given a "second chance" at life and we will always be thankful and grateful to our donors and donor families for the extra time we've been given.

In the U.S. 18 people die every day while on the waiting list for a transplant. Here are the latest statistics
on waiting list numbers and transplants year to date:

The Organ Procurement and Transplantation Network (OPTN)

Waiting list candidates 120,965 as of today 1:56pm
Active waiting list candidates 77,586 as of today 1:56pm
Transplants January - August 2013 19,262 as of 11/22/2013
Donors January - August 2013 9,446 as of 11/22/2013

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Friday, November 22, 2013

Lungs that live on after donor's death give hope to transplant patients

Pair of lungs that live on after donor's death give hope to transplant patients

  • University of North Carolina found lungs kept alive by air for up to 4 hours
  • Surgeons could now recover organs from people who die suddenly at home
  • Experts predict the procedure could see thousands more transplants a year
Breakthrough: Though organ donors are still few, the new procedure could significantly boost transplant numbers
Breakthrough: Though organ donors are still few, the new procedure could significantly boost transplant numbers

A pair of lungs that survive a donor's death have been hailed as a breakthrough for transplant patients.

Scientists found the organs can live for up to four hours after someone dies.

Unlike other organs, the air left inside keeps them from deteriorating.

In a groundbreaking $4million experiment, researchers at the University of North Carolina managed to recover lungs from people who died suddenly at home by pumping air into them within an hour of death.

Experts predict the procedure could see tens of thousands more transplants a year in America and the UK - and has paved the way for tests on other parts of the body.

Before, surgeons believed organs could not be retrieved from people who died unexpectedly.

As just two to three per cent of people die in circumstances appropriate for organ donation, lung transplants are rare and doctors often tell patients not to hold out hope.

But the new procedure could ease waiting lists which fail to save thousand each year.

In the on-going, three-year study, researchers used a pump to inject a small amount of air into the lungs of someone that died at home before transporting the body to hospital.

When it reached the theatre, the lungs were still 'breathing'.

'There aren't enough lungs. We're burying them,' said Dr. Thomas Egan of the University of North Carolina, Chapel Hill, who is leading the project. 'It turns out your lungs don't die when you do.

'There are huge logistical hurdles,' he said. 'But if we're right, this would have a profound impact on the number of lungs that are available for transplant.'

Lung cells don't depend on blood flow for oxygen, Dr Egan explained. When the heart stops beating, they use what oxygen is left in the air sacs and airways.

In a series of experiments with animals, Dr Egan showed lungs stay viable for an hour, or four hours if they are ventilated, before they're cooled to await transplant. 

Currently, only 15 per cent to 20 per cent of donated lungs are usable, often because complications during the donor's hospitalization damaged them.

Just 1,700 lungs transplants are performed each year, compared with nearly 11,000 kidney transplants from deceased donors.

Dr Egan, a cardiothoracic surgeon, said doctors don't even suggest the possibility of a lung transplant to thousands who might benefit because there aren't enough donors.

However, surgeons don't know if nontraditional organs work as well, cautioned Dr. Bryan Meyers of Washington University School of Medicine in St. Louis.

And critics warn even an hour is a limited amount of time to get hold of families to get consent for the procedure.
Dr Egan blasts ethical gripes with his project, claiming the ventilation process is merely an extension of CPR.

Typically, paramedics leave the breathing tube inserted in the person's throat. That makes it simple to restart ventilation to preserve the lungs, Egan said.

'If we can get the lungs ventilated within an hour, and then removed within an hour or two and cooled, we think they'll work just fine,' he said.

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Monday, November 18, 2013

Cleveland Clinic creates transplant ethics fellowship

By Michael C. Butz, Cleveland Jewish News

A fellowship focused on developing physician expertise on the ethical issues involved in organ transplantation has been created by Cleveland Clinic, the medical center recently announced.
“Organ shortages, allocation issues and informed consent policies for living donors are among the many ethical issues that confront the transplant field,” said Dr. Eric Kodish, director of Cleveland Clinic’s Center for Ethics, Humanities and Spiritual Care, in a Nov. 7 statement. “By establishing the nation’s only current transplant ethics fellowship, we will develop experts in an area of medicine that will only become more complex in terms of ethics.”
Dr. Eric Kodish
Dr. Eric Kodish
Dr. David Shafran is the program’s first fellow. Shafran graduated from the Sackler School of Medicine in Tel Aviv, Israel; completed his pediatrics residency at Jacobi Medical Center in the Bronx, N.Y.; and is currently a pediatric nephrology fellow at University Hospitals Rainbow Babies & Children’s Hospital.
Shafran and Dr. Kathryn Weise, the program’s director, are developing a curriculum that will effectively familiarize fellows with the core ethical issues surrounding organ transplantation and provide ample material and opportunity for independent research, according to the Clinic. Once adequately established, the curriculum and program in general could potentially serve as a model for similar projects at other health care institutions.
“The goal and challenge in bioethics is to keep the conversation about the emerging issues on pace with rapid advances in medical technology,” Shafran said. “Similarly, as our medical capabilities in organ transplantation progress, it behooves us to address the commensurate ethical issues methodically and comprehensively. This fellowship represents an acknowledgement of that responsibility.”
A donation from former U.S. Treasury Secretary Robert E. Rubin and his wife, Judith, helped create the fellowship. The program’s steering committee includes Dr. David Goldfarb, director of the renal transplant program; Dr. Charles Miller, director of the liver transplant program; and Martin Smith, director of clinical ethics. Weise also directs the Cleveland Fellowship of Advanced Bioethics.

More than 120,000 people are awaiting organ transplants in the United States. In 2012, 28,051 people received organ transplants, according to the U.S. Department of Health and Human Services.
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Saturday, November 16, 2013

Alberta, Canada makes it easier to donate tissue and organs

The province  is making it easier for Albertans to register as organ donors.

Albertans will soon see wait times reduced for life-changing transplants with the proclamation of Bill 207, the Human Tissue and Organ Donation Amendment Act.  The Act was originally introduced as a private member’s bill by MLA Len Webber.

“Organ and tissue donation saves lives and we need to make sure Albertans know how important it is. An online registry will make it easy for Albertans to provide their consent to donate, ensuring all Albertans who wish to donate make it known,” said MLA Calgary Foothills Len Webber. 

The Act establishes a single agency to co-ordinate organ and tissue donations in Alberta, and creates a consent-to-donate registry. Albertans who are willing to donate their organs and/or tissue will be able to do so either online or at their local registry when they go to renew their driver’s licence or other identification. 

Alberta Premier Alison Redford
Alberta Premier Alison Redford

“I want to thank MLA Len Webber for putting this vitally important legislation forward. Our government is eager to do everything we can to reduce wait times for transplants and give Albertans in need access to the treatment that will save or drastically improve a life,” said Premier Alison Redford .

“We want to take aggressive action to increase tissue and organ donation rates in Alberta. By making it easier for Albertans to register their intent to donate and raise awareness of the need for donors, we can increase the number of organ donations in Alberta,” said Fred Horne Minister of Health.

Up until the new Act was proclaimed, consent to donate needed to be provided in writing, dated, signed and witnessed, to be legally binding. Albertans could also sign the “Universal Donor Card” on the back of the government issued Alberta Health Care Insurance Plan card.

Under the new Act, Albertans renewing their driver’s licences or other pieces of identification will be asked if they consent the donation of his or her tissue, organs or body. They then provide written consent, and the registry agent transmits that information to the Alberta Organ and Tissue Donation Agency for inclusion in the online registry. The applicant will then receive a sticker than can be put on the driver’s licence or other identification to indicate he is a donor. Albertans will also be able to directly register online.
“We are so pleased that the Government of Alberta listened to our concerns. The sad fact is that many Albertans on organ donation wait lists die before a donor is found. This Bill will make a big difference in the lives of many Albertans waiting for transplants,” saiud  Nancy MacDonald, Alberta Donates LIFE Coalition 

Alberta used to have 17 donors per one million of the population, but that has fallen over the past decade to less than 10. Ontario and British Columbia both outperformed Alberta with a donor rate of 16.3 donors per million and 11.8 donors per million, respectively, in 2011. Ontario, British Columbia and Manitoba have implemented online registries. While donor rates fluctuate, these provinces have successfully raised the public profile of the need to donate.

The donation co-ordination agency is scheduled to be operational by 2015, with full IT system integration across the province within three to five years.

Under the Building Alberta Plan, our government is investing in families and communities, living within our means, and opening new markets for Alberta’s resources to ensure we’re able to fund the services Albertans told us matter most to them. We will continue to deliver the responsible change Albertans voted for.

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Friday, November 15, 2013

Organ donation in Australia in 21st place worldwide

Organ donation in Australia is way behind the world leaders, according to international rankings that put the country in 21st place.
Australia ranks 21st for organ donation
Spain is the world leader, and France, the US, UK, Belgium and Norway are among the countries with higher proportions of donors than Australia. (see world rankings below).
The figures compiled by Sharelife Australia draw on international donor data published by the Council of Europe.
The data shows hundreds of Australians are missing out on life-saving transplants every year.
This is because a $151 million, four-year package announced by the federal government in 2008 has failed to achieve its goal of establishing Australia as a world leader.
There has been an improvement, says ShareLife spokesperson Sara Irvine, but Australia's progress is slower than many other countries.
Australia's rate of organ donation is half that of the leading countries, and 1000 more transplants could be performed a year if it reaches the level of the top five countries.
"We are still not in the top 20 nations and have long way to go," says ShareLife director Professor Allan Glanville, medical director of lung transplantation at St Vincent's Hospital in Sydney.
"Organ donation saves lives, saves money and improves quality of life.
"You only need to talk to people who have been on kidney dialysis to see how well and productive they are after a kidney transplant.
"The Spanish model is very compassionate. It is supportive of families."
Family consent is needed, even if a person has opted in as a donor.
In Spain, skilled organ donation specialists speak to family members, which improves the chances of donation.
"They support families through what is an awful process."
Prof Glanville says there are good people doing good work in Australia.
"But we need to tweak the system so we are consistent from state to state."
He questions why South Australia and Victoria have 20 deceased organ donors per million of the population and NSW has 14.
"Australia needs to increase to 30 per million to be in line with the top four or five countries.
"Change takes time, but unless we improve we are failing in our duty of care to our patients.
"I have patients who are waiting for transplants and if they don't get a transplant they may well die."

According to the National Transplant Organization in Spain this is how countries rank in organ donation per million people
Spain: 35.3
Croatia: 34.4
Portugal: 28.1
United States: 26
France: 25
Norway: 24.5
United Kingdom: 17
Sweden: 15.5
Canada: 15.4
Australia: 14.9
Israel: 10.8
Ecuador 2.0
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Tuesday, November 12, 2013

Scientists discover experimental drug that protects from fibrosis of the liver, lung and kidneys.

As a lung transplant recipient who was in end-stage respiratory failure due to pulmonary fibrosis this story caught my immediate attention. IPF, or Idiopathic Pulmonary Fibrosis, is one of he major causes of the need for lung transplants and a medical breakthrough such as this has the potential to save thousands of lives around the world.

Edinburgh scientists lead pioneering research with scar tissue to help cut organ transplants

A discovery about how tissues scar could help cut the number of patients needing organ transplants, scientists have said.
New drugs could be developed to treat fibrotic diseases that attack organs such as the liver, lung or kidneys, a study published in Nature Medicine suggests.
Experts have discovered that a molecule on certain specialised cells known as myofibroblasts acts as a "switch", regulating the production of scar tissue.
The team studied specially bred mice with fibrosis and found that removing the molecule - called alpha v integrin - from the cells protected the animals from fibrosis of the liver, lung and kidneys.
They also discovered that when the mice were treated with a new experimental drug designed to block the molecule, they were protected from liver and lung fibrosis.
Dr Neil Henderson, a Wellcome Trust clinical scientist and consultant hepatologist at the University of Edinburgh/Medical Research Council Centre for Inflammation Research, said: "When tissue scarring becomes severe, affected organs do not work properly and currently the only treatment for end-stage organ failure is transplantation.
"However the shortage of donor organs means that many patients die while waiting for surgery.
"Therefore, the development of new therapies to treat fibrosis and reduce the need for organ transplantation would potentially be a major step forward in the treatment of patients with these devastating diseases."
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Monday, November 11, 2013

Rembrance Day/Veterans Day November 11th

Veterans Day is an official United States holiday which honors people who have served in armed service, also known as veterans. It is a federal holiday that is observed on November 11. It coincides with other holidays such as Armistice Dayand Remembrance Day, which are celebrated in other parts of the world and also mark the anniversary of the end of World War I. (Major hostilities of World War I were formally ended at the 11th hour of the 11th day of the 11th month of 1918, when theArmistice with Germany went into effect.)

Remembrance Day (also known as Poppy Day or Armistice Day) is a memorial day observed in Commonwealth countries since the end of World War I to remember the members of their armed forces who have died in the line of duty. This day, or alternative dates, are also recognised as special days for war remembrances in many non-Commonwealth countries. Remembrance Day is observed on 11 November to recall the end of hostilities of World War I on that date in 1918. Hostilities formally ended "at the 11th hour of the 11th day of the 11th month," in accordance with the Armisticesigned by representatives of Germany and the Entente between 5:12 and 5:20 that morning. ("At the 11th hour" refers to thepassing of the 11th hour, or 11:00 am) World War I officially ended with the signing of the Treaty of Versailles on 28 June 1919.

Remembrance - I like this Canadian teacher's powerful message!

Back in September, on the first day of school, Martha Cothren, a social studies school teacher at Bobcaygeon (north of PeterboroughOntario) public
 school, did something not to be forgotten.  On the first day of school, with the permission of the school superintendent, the principal and the building supervisor, she removed all of the desks out of her classroom.

When the first period kids entered the room they discovered that there were
 no desks.

'Ms.. Cothren, where're our desks?'

She replied, 'You can't have a desk until you tell me how you earn the right to sit at a desk.'

They thought, 'Well, maybe it's our grades.'

No,' she said.

'Maybe it's our behavior.'

She told them, 'No, it's not even your behavior.'

And so, they came and went, the first period, second period, third period. Still no desks in the classroom.  By early afternoon television news crews
had started gathering in Ms.Cothren's classroom to report about this crazy teacher who had taken all the desks out of her room.

The final period of the day came and as the puzzled students found seats on
 the floor of the desk-less classroom, Martha Cothren said, 'Throughout the
day no one has been able to tell me just what he or she has done to earn the right to sit at the desks that are ordinarily found in this classroom. Now I
am going to tell you.'

At this point, Martha Cothren went over to the door of her classroom and opened it.

Twenty-seven (27) War Veterans, all in uniforms, walked into that classroom,
 each one carrying a school desk. The Vets began placing the school desks in rows, and then they would walk over and stand alongside the wall. By the time the last soldier had set the final desk in place, those kids started to understand, perhaps for the first timein their lives, just how the right to sit at those desks had been earned.

Martha said, 'You didn't earn the right to sit at these desks. These heroes
 did it for you. They placed the desks here for you. Now, it's up to you to sit in them. It is your responsibility to learn, to be good students, to be good citizens. They paid the price so that you could have the freedom to  get an education.  Don't ever forget it.'

By the way, this is a true story.


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