Chapter 12: Becoming Chair of Neuro-Oncology and Developing Collaborations with Neuro-Surgery

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Chapter 12: Becoming Chair of Neuro-Oncology and Developing Collaborations with Neuro-Surgery

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Dr. Yung explains that in 1990, Neuro-Surgery became a department and Dr. Raymond Sawaya [Oral History Interview] was recruited to head it. He describes the period of expansion that began for both departments at that time. Dr. Yung gives examples of research in Neuro-Oncology and their ties to the institution's status as a comprehensive cancer center. Dr. Yung explains Dr. John Mendelsohn's [Oral History Interview] continued support the combined activities of Neuro-Oncology and Neuro-Surgery, known as the Brain Tumor Program. He stresses that he and Dr. Sawaya shared a commitment to building multi-disciplinary research and care initiatives and he describes the "blessing" for this group that faculty work well together. HIPPA Next, Dr. Yung talks about his cancer diagnosis and treatment, and his decision to accept Dr. Mendelsohn's request that he take on the role as ad interim chair. He describes his goals at the time and his continued commitment to work with Neurosurgery and related fields to develop a cohesive program in patient care and research. He talks about collaborative projects, including development of an oncolytic virus -a rare example of a successful brain tumor drug.

Identifier

Chapter 12: Becoming Chair of Neuro-Oncology and Developing Collaborations with Neuro-Surgery

Publication Date

6-18-2014

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - Building the Institution; The Administrator; The Researcher; Building/Transforming the Institution; Multi-disciplinary Approaches; MD Anderson Culture; Devices, Drugs, Procedures; Discovery and Success

Transcript

Tacey Ann Rosolowski, PhD:

So Dr. LeMaistre left the institution in 1996 and I --- I’m I just trying to get a sense of, you know, he was very supportive of the department in its growth --- its expansion. You had the key period of time, you know.

Wai-Kwan Alfred Yung, MD:

So under LeMaistre we expand the Department of Neuro-Oncology. You know, in 1988. You know, wi --- with the recruitment of Dr. Levin --- Victor Levin. And then in 1990, you know, Neurosurgery become a department instead of a section. So that’s --- Again that’s, you know --- with --- with the expansion of Neuro-Oncology under Levin then, you know --- much --- b --- the Neurosurgery as well as --- as in terms of re --- research development. This is a --- a --- Neurosurgery should become a department as well, instead of a division of Head and Neck still.

Tacey Ann Rosolowski, PhD:

A division. Right. Uh-huh.

Wai-Kwan Alfred Yung, MD:

So in 1990 we recruited --- you know, the institution went out to recruit Dr. Sawaya and create th --- And --- And created the Chair --- the Department of Neurosurgery. And that creation --- or that formation of the department allowed the department to really grow and develop and flourish. And it --- it very --- it grow very quickly from 3 neurosurgeons to the current size of 12 neurosurgeons

Tacey Ann Rosolowski, PhD:

Right. Yep.

Wai-Kwan Alfred Yung, MD:

and scientists. So the --- So Tacey Ann Rosolowski And you guys share a floor here.

Wai-Kwan Alfred Yung, MD:

And we --- And then we share a floor.

Tacey Ann Rosolowski, PhD:

Right.

Wai-Kwan Alfred Yung, MD:

You know, so that’s --- You know --- under --- under LeMaistre we have that growth of Neuro-Oncology and also growth of Neurosurgery. And --- And --- And fo --- And forming a horizontal structure of, you know, Brain Tumor Program. And we successful in b --- you know, also become part of the CCSG because at that --- by ---by the mid ‘95 --- by, you know, after we have the --- the Department of Neurosurgery and Dr. Levin was instrumental of getting a program ____ (0) grant funded and also organize how _____ (0) would be part of the Cancer Core Grant --- as a --- as a program under the Cancer Center Core Grant. I don’t know whether you know the --- the Cancer Core Grant. Tacey Ann Rosolowski So I don’t know what that is. No. I don’t.

Wai-Kwan Alfred Yung, MD:

Cancer Core Grant or --- or Cancer Center Core Grant, CCSG A comprehensive cancer center as designated by NCI.

Tacey Ann Rosolowski, PhD:

Is it.

Wai-Kwan Alfred Yung, MD:

Comprehensive center --- center. In order to be a comprehensive cancer center you also need to demonstrate that you are --- you have a, you know, portfolio of research

Tacey Ann Rosolowski, PhD:

Hmm. Okay.

Wai-Kwan Alfred Yung, MD:

in patient care, laboratory research, cancer prevention. And --- And with all the grant that you get from NCI the --- the --- the --- you know, in order to gain the destination of comprehensive cancer, number one you need to have a --- a portfolio of individual research grant. Number two is also have to compete. You know, the --- the idea is that for you to become a --- a --- a comprehensive cancer center you’re also in --- in need of some Core support for the center. And ____ (0) to Core --- you know, Cancer Center Core Grant. You have to be able to get funding for that Core Grant before you get a destination of --- of comprehensive cancer center. Tacey Ann Rosolowski Uh-huh. And what exactly does the ---

Wai-Kwan Alfred Yung, MD:

And the Core Grant give the center a pot of money to support shared resources.

Tacey Ann Rosolowski, PhD:

Oh.

Wai-Kwan Alfred Yung, MD:

You know, animal facility. Shared facility for peptide synthesis. Shared facility for, you know, pharmacology

Tacey Ann Rosolowski, PhD:

Uh-huh.

Wai-Kwan Alfred Yung, MD:

studies. Shared resources for statistics. And these are shared resources that all cancer centers invested can use in the funding of that grant.

Tacey Ann Rosolowski, PhD:

Uh-huh.

Wai-Kwan Alfred Yung, MD:

In order to get a grant though you need to support it by, you know excellency in the program.

Tacey Ann Rosolowski, PhD:

Uh-huh.

Wai-Kwan Alfred Yung, MD:

So --- So --- You know, MD Anderson was designated as a comprehensive cancer center with the funding of the Core Grant. And the Core Grant is in _____ (0) --- you know --- is supported by a group of program. And the program, you know, get e --- the number of programs can be expanded. You know, if you want more money you expand the program --- Tacey Ann Rosolowski Now was that

Wai-Kwan Alfred Yung, MD:

So in --- And I --- I think we were included as a program in the Cancer Core Grant as a core program of the center. Tacey Ann Rosolowski And that was in mid ‘90s or ---

Wai-Kwan Alfred Yung, MD:

The mid ‘90s. Tacey Ann Rosolowski Mid ‘90s. Now m --- was MD Anderson already designated a comprehensive cancer center

Wai-Kwan Alfred Yung, MD:

Oh yeah. Tacey Ann Rosolowski at that time? Okay.

Wai-Kwan Alfred Yung, MD:

At that time. Yeah. Tacey Ann Rosolowski Okay. Yeah. And it just kind of makes sense that ---

Wai-Kwan Alfred Yung, MD:

No I think --- I forgot when --- when MD Anderson was designated a can --- a comprehensive cancer center. I think when I came in ‘81 we were already a comprehensive cancer center. Or maybe sooner. I don’t remember when. You ha --- You have to --- to look into the institution’s history

Tacey Ann Rosolowski, PhD:

---tion history. Right. Right.

Wai-Kwan Alfred Yung, MD:

when we get designation

Tacey Ann Rosolowski, PhD:

Yeah.

Wai-Kwan Alfred Yung, MD:

as a cancer --- a comprehensive cancer center. Tacey Ann Rosolowski Well I’m just thinking too with --- you know, with this specific change and Dr. Levin, you know, managing to get the --- the Core Grant . . .

Wai-Kwan Alfred Yung, MD:

Well he manage --- Well he did not manage to get the Core grant. He managed to make the Brain Tumor Program as part of the Core Grant Tacey Ann Rosolowski Part of the Core Grant. Okay. Okay. Cause it seems --- Because, you know, as I was mentioning, you share a floor here with Neurosurgery and though those --- yo --- it became a separate department I can imagine that there is a lot of interaction between these two _____ (0

Wai-Kwan Alfred Yung, MD:

There is a lot of interaction between the department. I think --- you know, --- I --- remember we also owe a lot of, you know, the development. Not only to Dr. LeMaistre had a vision of --- of really expanding the two departments and --- and the Brain Tumor Program. You know, and --- and I think when Dr. Mendelsohn came he continued seeing, you know, the --- the merit of the Brain Tumor Program. And, in fact, we are the --- we are the --- probably the only clinical program that was --- have the --- that given the opportunity to put the Medical Department and Surgical Department on the same floor in this building as well as a research lab in the same floor in the Research building.

Tacey Ann Rosolowski, PhD:

Oh, wow.

Wai-Kwan Alfred Yung, MD:

You know, --- you know, as opposed to the other program that, you know, like if you look at breast cancer. The Surgical Department that do breast cancer research, their laboratory in --- in in one --- in a different building than the Medical Department that do research. But here we have the Brain Tumor Program, that one that with our affiliation with, you know, the --- the researchers affiliation is with Neuro-Oncology and Neurosurgery, we have the same floor. We put them all together

Tacey Ann Rosolowski, PhD:

Right.

Wai-Kwan Alfred Yung, MD:

on one floor.

Tacey Ann Rosolowski, PhD:

Now I

Wai-Kwan Alfred Yung, MD:

So that increase the interaction tremendously. Tacey Ann Rosolowski I interviewed Dr. Sawaya last year.

Wai-Kwan Alfred Yung, MD:

Uh-huh. Uh-huh.

Tacey Ann Rosolowski, PhD:

You know, and he talked, you know, over and over underscoring his vision that the treatment of brain cancer is very much a multidisciplinary concerted activity.

Wai-Kwan Alfred Yung, MD:

Yeah. Yeah. Tacey Ann Rosolowski And so those connections are really, really key. And just to --- so you share that vision.

Wai-Kwan Alfred Yung, MD:

Sure the --- the --- I mean --- I the def --- the --- the development of --- you know, the historical development of the program in the ‘80s to the ‘90s, it really follow, you know, closely this concept of multidisciplinary. Well, you know, because when we create the Brain Tumor Clinic, it’s Neur --- it is Neuro-Oncology and Neurosurgery together with Radiation Oncology. That --- That a --- That’s a ____ ____ (0) is our main Neuro-Onco --- Radiation ____ (0). We always work together as a group. And when we develop the Science Research Laboratory we --- we develop laboratory also as --- as a group. Now when I have --- when we recruited --- because I recruited, you know, Peter Stack and work on the basic research before Dr. L --- Sawaya came in, you know. But when --- when Dr. Leavens, Milam Leavens recruited Dr. Mos --- Richard Moser --- Richard Moser has an interest in Immunology.

Tacey Ann Rosolowski, PhD:

Okay.

Wai-Kwan Alfred Yung, MD:

Yeah. So, you know, Richard and I wor --- we worked together developed the immunolo --- im --- you know, immunotherapy for Brain Tumor Clinic. So we always follow, you know, the --- the concept of multidiscipline because brain tumor we really need multidisciplinary approach because the main treatment is radiation therapy. Surgery and radiation therapy, and chemotherapy work in concert. And --- And I think the --- the --- the --- the --- the blessing we have in this group is that we all work well together as a group. And we are willing to really work together in a very, you know, collegial collaborative manner as opposed to fighting for turf from each ot --- for --- for --- for, you know, the individual group. But we’re willing to really band together.

Tacey Ann Rosolowski, PhD:

How do you ---

Wai-Kwan Alfred Yung, MD:

And go to the administrator and ask for all the resources together. Tacey Ann Rosolowski Hmm. How --- How did you and others --- how were you able to create that climate? Because it’s kind of unusual.

Wai-Kwan Alfred Yung, MD:

Well --- I mean I think it --- it does require some give and takes and some downgrading of individual ego. S --- I mean --- they --- they were fight. You know --- I think --- you know look at it and the --- there is some disagreement between Dr. Milam --- Dr. Levin --- Victor Levin and --- and Dr. Sawaya on how we should develop things. Tacey Ann Rosolowski No. I mean it’s natural.

Wai-Kwan Alfred Yung, MD:

It’s natural. And when Dr. Levin stepped down I stepped into his role. You know, I make a del --- concerted effort to work with Dr. Sawaya. You know, and we --- we have mon --- weekly meeting to talk about our, you know, concern and our vision and work together. So it --- it’s a give and take. Tacey Ann Rosolowski So, well, tell me about stepping into the role as Chair. Because let’s see you were at interim Chair for a couple of years I think and then 2002 took over as permanent Chair. Tell me about that process.

Wai-Kwan Alfred Yung, MD:

Well, in 1999 it’s --- it’s a kind of interesting time because 1999 is also the year that I was diagnosed to have cancer.

Tacey Ann Rosolowski, PhD:

Uh-huh. Okay.

Wai-Kwan Alfred Yung, MD:

0 And I --- you know, I was diagnosed to have cancer in February of ’99. And I undergo chemotherapy first and then have major surgery after chemotherapy, you know. Tacey Ann Rosolowski How long did that whole process take?

Wai-Kwan Alfred Yung, MD:

0 Well, I have chemotherapy for about five months. So I think surgery came in July ___ ____ (0) --- June or July. And then I recovered from surgery probably by end of July or early August, you know. And --- But that su --- that was also the time that Dr. Levin decided that he gonna --- he is going to step down. And --- Tacey Ann Rosolowski When it rains it pours, huh?

Wai-Kwan Alfred Yung, MD:

Yeah --- Yeah. And so Dr. Mendelsohn asked me if I would step in. You know, I was --- I was the most qualified person at that time because I had, you know, quite a bit of national reputation at that time.

Tacey Ann Rosolowski, PhD:

Uh-huh.

Wai-Kwan Alfred Yung, MD:

You know, because I run those cli --- clinical consortium and I also, you know, h --- had my research funding. So I --- you know --- for the good of the department and program I said okay, even though I just recovered from my treatment then I will take over.

Tacey Ann Rosolowski, PhD:

Uh-huh. I mean that --- I mean it ---

Wai-Kwan Alfred Yung, MD:

So --- So

Tacey Ann Rosolowski, PhD:

It just ha ---

Wai-Kwan Alfred Yung, MD:

So I --- I was put in the --- the interim fashion. I think there was some discussion, you know, between, you know, Mendelsohn, you know, --- at that time we h --- we had a Division of Cancer and at that time is --- Bob Bass is the --- is the Head of the Division of Cancer Medicine. And --- And so they --- there was _____ (0) on how to, you know, search or form --- and --- and --- and find a permanent Chair for the department. You know.

Tacey Ann Rosolowski, PhD:

Uh-huh.

Wai-Kwan Alfred Yung, MD:

So we --- I guess it took them three years to decide whether there was some argument, disagreement behind the scene, but I think we --- there was no decision on --- of, you know, a --- a candid --- a surgery candidate. Because there’s also at that time sort of a transition of the Division. Dr. [Robert] Bast [Oral History Interview] was also, you know, under considering stepping out ---

Tacey Ann Rosolowski, PhD:

Right.

Wai-Kwan Alfred Yung, MD:

--- stepping out and --- and then Dr. [Waun Ki] Hong [Oral History Interview] step in. So I was made --- Tacey Ann Rosolowski And this is as

Wai-Kwan Alfred Yung, MD:

I was made Tacey Ann Rosolowski Head of Research. I was made permanent in 2002 when Dr. Hong became the Head of Division of Cancer Medicine. It --- It take two and half year. Tacey Ann Rosolowski Right. Right. Uh-huh. Now I just wanted to --- to say that must have been a really stressful time and I know we’ll talk at a later time about your experiences as a patient, but that must --- that must have been a difficult decision to ---

Wai-Kwan Alfred Yung, MD:

That was a difficult decision. I mean --- I --- I took on them of course partly is my ambitions

Tacey Ann Rosolowski, PhD:

Uh-huh.

Wai-Kwan Alfred Yung, MD:

You know, I see something that we have developed and I don’t want to see it falter. And --- And I probably consider I’m --- I was the best person at that time to really take over. And Dr. Mendelsohn is very, you know, enthusiastic about me taking over. And, in fact, we we’re given, you know, some additional resources expanding our faculty --- you know, the number of faculty and also h --- and more start up fund to recruit scientists, you know. Tacey Ann Rosolowski Wow. Okay. So tell me about your goals. You know, now you had kind of the new mandate as Head of the epartment. Wha --- What did you want to do and how did you go about doing it?

Wai-Kwan Alfred Yung, MD:

Well, we want to at that time --- We really wanted to work very concretively with --- you know, as a program with Neurosurgery --- Neuro --- you know, Neuro-Radiation, and we wanted to --- you know, Sawaya and I said we need to develop a coe --- a cohesive program. We don’t --- look at, you know, how we do it.

Tacey Ann Rosolowski, PhD:

Hmm.

Wai-Kwan Alfred Yung, MD:

Where we need some more --- some more help whether it’s in Imaging, Radiology? If, it’s so, we’ll help, you know, increase the number of radiologist, you know, to fill that gap. ____ _____ (0)

Tacey Ann Rosolowski, PhD:

Now I want to ask

Wai-Kwan Alfred Yung, MD:

When we see that we also have a gap in --- in basic when we expand. When we work together to really, you know, put our --- to --- we --- to put our laboratory together on the Mitchell Floor. I think we’re the moving the Mitchell --- I forgot where --- because I helped the --- I was in the Design Committee for the Mitchell Building

Tacey Ann Rosolowski, PhD:

Oh ,Okay.

Wai-Kwan Alfred Yung, MD:

You know together with Mar --- with Dr. Kripke and is --- in --- in that process Dr. Kripke promised that we’ll put Neurosurgery Laboratory and ____ (0),

Tacey Ann Rosolowski, PhD:

Oh, okay.

Wai-Kwan Alfred Yung, MD:

floor so that we will work better. You know, so that we have a vision that we’re on. Now that we have this opportunity to w --- putting all the laboratory together we need to really show ou --- show our work, you know, good stuff. And we, you know, make some major impact in research. And so our goal is really expand the program and also, you know, l --- individual department wide --- in Neurology we --- I also want to expand our, you know, patient care delivery in the Neurology side as well as the Brain Tumor side. So I recruited several neurologists to create thi --- the --- the --- the, you know, capability of doing a lot of neurophysiology intraoperative, monitoring, and you know, we want to have a comprehensive ge --- Cancer Neurology Program. As well as the --- As well as the Brain Tumor Research Program. And --- And we also want to have more joint grants, collaborative grants. So we work very hard to compete for --- an --- tha --- that’s also the time that NCI created the SPORE concept.

Tacey Ann Rosolowski, PhD:

Okay. Yeah. Okay.

Wai-Kwan Alfred Yung, MD:

So we ve --- work very hard to create a SPORE Grant for brain tumor. We failed the first aroun --- first time around. We did not, you know, get high enough score to get into the first group. Tacey Ann Rosolowski Uh-huh. And is this the training grant?

Wai-Kwan Alfred Yung, MD:

No. This is the --- the SPORE Grant.

Tacey Ann Rosolowski, PhD:

Oh. Okay.

Wai-Kwan Alfred Yung, MD:

SPORE. S-P-O-R

Tacey Ann Rosolowski, PhD:

Right.

Wai-Kwan Alfred Yung, MD:

S-P-O-R-E. We were able to get the Brain Tumor SPORE Grant fina --- in the second round which is in 2000 --- let’s see when is the second round? When did we get our funding? We just got renewed in 2014 so we get our firs --- we get our funding in 2009. We compete for 2000 --- and 2004.

Tacey Ann Rosolowski, PhD:

Uh-huh.

Wai-Kwan Alfred Yung, MD:

We missed --- we did not get 2004. Tacey Ann Rosolowski So what have you been able to accomplish with that grant?

Wai-Kwan Alfred Yung, MD:

With the SPORE? Well, the SPORE Grant not only, you know, is politically important we say because, you know, it’s --- it’s kind of meaning that you are worthy of the designation of a specialized center. You have, you know, excellent clinical research translation _____ (0) that you’re worthy of that --- carry that designation that you are the specialized center in brain tumor research. So we est --- we establish our s --- our credibility that we are specialized center in brain tumor research. We are one of --- one of the, you know, biggest best Brain Tumor Center in the country. You know. Also we --- again we were able to put investigator from different department, Neuro-Oncology, Neurosurgery, Pathology and work together to combine the project into --- into the SPORE Grant. You know, And --- And lastly we al --- we --- the --- the SPORE Grant _____ (0) is also anchored by, you know, the --- the development of a virus that we developed inhouse in our program from creating the virus to --- in the laboratory --- to test the virus cl --- preclinically in mouse model. And then get NCI money to --- to prepare TMP and that, you know, the --- that --- you know, the SPORE Grant allow us to really do --- you know, to bring that virus into the clinic. Tacey Ann Rosolowski And the purpose of this virus?

Wai-Kwan Alfred Yung, MD:

Is --- It is --- It is ---It is a oncolytic virus that will kill the tumor cells and leave normal brain cell alone. You know. Tacey Ann Rosolowski So is that now in clinical trial?

Wai-Kwan Alfred Yung, MD:

So it’s now in clinical trial.

Tacey Ann Rosolowski, PhD:

Wow.

Wai-Kwan Alfred Yung, MD:

So it --- it actually, you know, is one of the --- a --- a project --- a successful project of developing a drug --- a brain tumor specific drug from scratch.

Tacey Ann Rosolowski, PhD:

Wow.

Wai-Kwan Alfred Yung, MD:

Yeah. Tacey Ann Rosolowski It --- So that’s actually in clinical human trials, obviously.

Wai-Kwan Alfred Yung, MD:

That’s in human trials now. Tacey Ann Rosolowski That’s amazing.

Wai-Kwan Alfred Yung, MD:

And then we go into Phase 2 clinical trial.

Tacey Ann Rosolowski, PhD:

Wow.

Wai-Kwan Alfred Yung, MD:

Now, of course, SPORE is not --- SPORE come in --- the SPORE Grant come in s --- the later stage of development. The early stage of developments are funding by R1 grant and also NCI’s drug development grant. The SPORE come in all --- allowing us to --- to further develop in the clinical. And --- And at the next generation of virus.

Tacey Ann Rosolowski, PhD:

( Wow. That’s amazing. Who is --- Who are the individuals involved in the development of this oncolytic virus?

Wai-Kwan Alfred Yung, MD:

0 The, you know, the scientist behind it is Juan ____ (0). You know, of course, I --- I was involved as a --- as a pusher and ki ---kicker. And --- And also finding money for it. Dr. Conrad. But Juan --- Juan ____ and his wife Candy are the two major scientists. They commissioned me, Conrad, and then we later brought on Fred Lang from Neurosurgery, you know. So again, so it’s really science, cl --- Neuro-Oncology, and Neurosurgery all work together.

Tacey Ann Rosolowski, PhD:

Wow. Hmm.

Wai-Kwan Alfred Yung, MD:

And the pathologist too. We need pathologist so Dr. Fuller was involved. And --- And Tacey Ann Rosolowski Fascinating project. Yeah. So that seems like a big landmark. Oh yeah, we’ve got about five minutes.

Wai-Kwan Alfred Yung, MD:

I think we’ve got about five minutes. We probably should wrap up this session. Tacey Ann Rosolowski Okay. Okay. Well that sounds good. I mean, we can ---

Wai-Kwan Alfred Yung, MD:

This is landmark. Yeah. Tacey Ann Rosolowski Yeah. This is a big landmark.

Wai-Kwan Alfred Yung, MD:

This is a good point to stop right now. Tacey Ann Rosolowski 0 Sounds good. With a big success after your discussion earlier of how difficult the drug trials have been. So well thank you for your time today, Dr. Yung.

Wai-Kwan Alfred Yung, MD:

Okay. Tacey Ann Rosolowski And

Wai-Kwan Alfred Yung, MD:

So we’ll schedule another but I guess

Tacey Ann Rosolowski, PhD:

Yeah.

Wai-Kwan Alfred Yung, MD:

When we go into the department ___ Tacey Ann Rosolowski Sure.

Wai-Kwan Alfred Yung, MD:

Okay.

Tacey Ann Rosolowski, PhD:

We have --- Yeah, we have another session scheduled for next week. So thanks a lot

Wai-Kwan Alfred Yung, MD:

Alright. Good.

Tacey Ann Rosolowski, PhD:

for taking the time today.

Wai-Kwan Alfred Yung, MD:

Alright.

Tacey Ann Rosolowski, PhD:

And I’m tak --- I’m turning off the recorder at twenty-five minutes after three.

Wai-Kwan Alfred Yung, MD:

Okay. Tacey Ann Rosolowski So thanks a lot.

Chapter 12: Becoming Chair of Neuro-Oncology and Developing Collaborations with Neuro-Surgery

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