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[PMID]:29437061
[Au] Autor:Chraim M; Krenn S; Alrabai HM; Trnka HJ; Bock P
[Ad] Endereço:Orthopaedic Hospital Speising, Speisingerstrasse 109, A-1130, Vienna, Austria.
[Ti] Título:Mid-term follow-up of patients with hindfoot arthrodesis with retrograde compression intramedullary nail in Charcot neuroarthropathy of the hindfoot.
[So] Source:Bone Joint J;100-B(2):190-196, 2018 Feb.
[Is] ISSN:2049-4408
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIMS: Hindfoot arthrodesis with retrograde intramedullary nailing has been described as a surgical strategy to reconstruct deformities of the ankle and hindfoot in patients with Charcot arthropathy. This study presents case series of Charcot arthropathy patients treated with two different retrograde intramedullary straight compression nails in order to reconstruct the hindfoot and assess the results over a mid-term follow-up. PATIENTS AND METHODS: We performed a retrospective analysis of 18 consecutive patients and 19 operated feet with Charcot arthropathy who underwent a hindfoot arthrodesis using a retrograde intramedullary compression nail. Patients were ten men and eight women with a mean age of 63.43 years (38.5 to 79.8). We report the rate of limb salvage, complications requiring additional surgery, and fusion rate in both groups. The mean duration of follow-up was 46.36 months (37 to 70). RESULTS: The limb salvage rate was 16 of 19 limbs. Three patients had to undergo below-knee amputation due to persistent infection followed by osteomyelitis resistant to parenteral antibiotic therapy and repeated debridement. Complications including infection, hardware removal, nonunion, and persistent ulcers requiring further intervention were also observed. Postoperative functional scores revealed significant improvement compared with preoperative scores on American Orthopaedic Foot and Ankle Society (AOFAS) - Hindfoot scale, Foot Function Index (FFI), visual analogue scale (VAS), and Foot and Ankle Outcome Score (FAOS). CONCLUSION: The use of retrograde intramedullary compression nail results in good rates of limb salvage when used for hindfoot reconstruction in patients with Charcot arthropathy. Cite this article: 2018;100-B:190-6.
[Mh] Termos MeSH primário: Artrodese/métodos
Artropatia Neurogênica/cirurgia
Doenças do Pé/cirurgia
Fixação Intramedular de Fraturas
[Mh] Termos MeSH secundário: Adulto
Idoso
Amputação
Desbridamento
Feminino
Seguimentos
Seres Humanos
Salvamento de Membro
Masculino
Meia-Idade
Complicações Pós-Operatórias
Estudos Retrospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180216
[Lr] Data última revisão:
180216
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180214
[St] Status:MEDLINE
[do] DOI:10.1302/0301-620X.100B2.BJJ-2017-0374.R2


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[PMID]:29240741
[Au] Autor:Dixon J; Coulter J; Garrett M; Cutfield R
[Ad] Endereço:Endocrinology Registrar, Endocrinology and Diabetes Department, Waitemata District Health Board, Auckland.
[Ti] Título:A retrospective audit of the characteristics and treatment outcomes in patients with diabetes-related charcot neuropathic osteoarthropathy.
[So] Source:N Z Med J;130(1467):62-67, 2017 Dec 15.
[Is] ISSN:1175-8716
[Cp] País de publicação:New Zealand
[La] Idioma:eng
[Ab] Resumo:AIMS: To review the characteristics, management and outcomes one year after diagnosis in patients with diabetes related charcot neuropathic osteoarthropathy (CN) treated at the Diabetes Podiatry service, Waitemata District Health Board (WDHB) between 2000-2014. METHODS: Patients with diabetes and recorded diagnosis of CN were identified from the podiatry service records. Clinical details were retrospectively obtained from WDHB databases and patient medical records. RESULTS: Forty-one patients were included, 31 had type 2 diabetes, 10 had type 1 diabetes. At presentation, the median duration of all-type diabetes was 15 years. The median time from symptom onset to diagnosis was 17 weeks. Symptoms at presentation were: oedema (49%), warmth (73%), erythema (17%), swelling (90%) and pain (60%). Concomitant ulcers were present in 32%, deformities 83%, osteomyelitis 2% and septic arthritis 2%. Mean time to ambulation in modified shoes was 21.3 weeks (±11.5). Complication rates one year from diagnosis for ulcers, osteomyelitis, amputations and all-cause mortality were 34%, 2%, 2% and 5% respectively. CONCLUSION: Time to diagnosis of CN was shorter than previously reported, though the high rate of deformities still suggests a significant delay in diagnosis. Increased education of healthcare professionals and people with diabetes-related neuropathy is important to ensure early diagnosis and appropriate management to reduce deformities and complications.
[Mh] Termos MeSH primário: Artropatia Neurogênica/mortalidade
Artropatia Neurogênica/fisiopatologia
Diabetes Mellitus Tipo 1/complicações
Diabetes Mellitus Tipo 2/complicações
/diagnóstico por imagem
[Mh] Termos MeSH secundário: Adulto
Idoso
Amputação
Artropatia Neurogênica/etiologia
Causas de Morte
Auditoria Clínica
Bases de Dados Factuais
Feminino
/patologia
Seres Humanos
Imagem por Ressonância Magnética
Masculino
Meia-Idade
Nova Zelândia
Estudos Retrospectivos
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171221
[Lr] Data última revisão:
171221
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171215
[St] Status:MEDLINE


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[PMID]:28438957
[Au] Autor:Zanbilowicz A
[Ad] Endereço:Podiatrist, Brickyard Medical Clinic, Nanaimo, BC.
[Ti] Título:Red hot foot … keep Charcot arthropathy in mind.
[So] Source:CMAJ;189(16):E612, 2017 04 24.
[Is] ISSN:1488-2329
[Cp] País de publicação:Canada
[La] Idioma:eng
[Mh] Termos MeSH primário: Artropatia Neurogênica
Pé Diabético
[Mh] Termos MeSH secundário: Seres Humanos
[Pt] Tipo de publicação:LETTER; COMMENT
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171012
[Lr] Data última revisão:
171012
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170426
[St] Status:MEDLINE
[do] DOI:10.1503/cmaj.732939


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[PMID]:28397549
[Au] Autor:Kroin E; Schiff A; Pinzur MS; Davis ES; Chaharbakhshi E; DiSilvio FA
[Ad] Endereço:1 Department of Orthopaedic Surgery & Rehabilitation, Loyola University Health System, Maywood, IL, USA.
[Ti] Título:Functional Impairment of Patients Undergoing Surgical Correction for Charcot Foot Arthropathy.
[So] Source:Foot Ankle Int;38(7):705-709, 2017 Jul.
[Is] ISSN:1944-7876
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Investigations using the Medical Outcomes Study Short Form 36 Healthy Survey (SF-36) and the American Orthopaedic Foot & Ankle Society Diabetic Foot Questionnaire (AOFAS-DFQ) have demonstrated a poor quality of life in patients with Charcot foot arthropathy. The Short Musculoskeletal Function Assessment (SMFA) questionnaire has been widely used in patients with a broad range of musculoskeletal disorders. METHODS: Twenty-five consecutive patients undergoing operative correction for diabetes-related Charcot foot arthropathy of the midfoot completed the SMFA prior to undergoing surgery. There were 16 males and 9 females. The average body mass index (BMI) was 37.4 (range 25.8-50.2), and the average hemoglobin A was 7.5 (range 5.3-10.1) prior to surgery. RESULTS: All 25 patients exhibited significant impairment in all 6 domains of the SMFA ( P < .0001) as compared to the normative data. There was a high correlation between each of the 6 domains of the SMFA, even after correcting for BMI. CONCLUSION: Charcot foot severely impaired the quality of life in patients beyond the impact of morbid obesity. This impairment equally impacted all of the functional and emotional domains measured with the SMFA as compared with population norms. This investigation provides a benchmark for measuring the impact of operative correction of the deformity. In addition, the SMFA appears to be a valid tool for measuring impairment in this complex patient population. LEVEL OF EVIDENCE: Level II, prospective comparative investigation.
[Mh] Termos MeSH primário: Artropatia Neurogênica/cirurgia
Pé Diabético/fisiopatologia
Pé Diabético/cirurgia
Doenças Musculoesqueléticas/fisiopatologia
Doenças Musculoesqueléticas/cirurgia
[Mh] Termos MeSH secundário:
Seres Humanos
Ortopedia
Estudos Prospectivos
Qualidade de Vida
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171107
[Lr] Data última revisão:
171107
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170412
[St] Status:MEDLINE
[do] DOI:10.1177/1071100717701233


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[PMID]:28336046
[Au] Autor:Womack J
[Ad] Endereço:Piedmont Orthopaedic Associates, 35 International Drive, Greenville, SC 29615, USA. Electronic address: womackjw@gmail.com.
[Ti] Título:Charcot Arthropathy Versus Osteomyelitis: Evaluation and Management.
[So] Source:Orthop Clin North Am;48(2):241-247, 2017 Apr.
[Is] ISSN:1558-1373
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Charcot arthropathy of the foot and ankle is a severe complication of peripheral neuropathy and is most commonly seen in the developed world in association with diabetes mellitus. Correct diagnosis and differentiation from osteomyelitis of the foot and ankle are critical to guide treatment. It can exist concomitantly with osteomyelitis, typically in the setting of an advanced midfoot ulcer. Simple plain radiographs and contrasted MRI studies often yield inconclusive or confusing data. Correct use of imaging studies and a clinical algorithm can be effective tools to help make accurate and early diagnoses and guide clinical interventions for these conditions.
[Mh] Termos MeSH primário: Artropatia Neurogênica
Osteomielite
[Mh] Termos MeSH secundário: Artropatia Neurogênica/diagnóstico
Artropatia Neurogênica/terapia
Diagnóstico Diferencial
Gerenciamento Clínico
Seres Humanos
Osteomielite/diagnóstico
Osteomielite/terapia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170418
[Lr] Data última revisão:
170418
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170325
[St] Status:MEDLINE


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[PMID]:28325064
[Au] Autor:Seo DK; Lee HS; Park J; Ryu CH; Han DJ; Seo SG
[Ad] Endereço:1 Department of Orthopedic Surgery, Gangneung Asan Hospital, College of Medicine, University of Ulsan, Seoul, Republic of Korea.
[Ti] Título:Diabetic Foot Complications Despite Successful Pancreas Transplantation.
[So] Source:Foot Ankle Int;38(6):656-661, 2017 Jun.
[Is] ISSN:1944-7876
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: It is known that successful pancreas transplantation enables patients with diabetes to maintain a normal glucose level without insulin and reduces diabetes-related complications. However, we have little information about the foot-specific morbidity in patients who have undergone successful pancreas transplantation. The purpose of this study was to investigate the prevalence and predisposing factors for foot complications after successful pancreas transplantation. METHODS: This retrospective study included 218 patients (91 males, 127 females) who had undergone pancreas transplantation for diabetes. The mean age was 40.7 (range, 15-76) years. Diabetes type, transplantation type, body mass index, and diabetes duration before transplantation were confirmed. After pancreas transplantation, the occurrence and duration of foot and ankle complications were assessed. RESULTS: Twenty-two patients (10.1%) had diabetic foot complications. Fifteen patients (6.9%) had diabetic foot ulcer and 7 patients (3.2%) had Charcot arthropathy. Three patients had both diabetic foot ulcer and Charcot arthropathy. Three insufficiency fractures (1.4%) were included. Mean time of complications after transplantation was 18.5 (range, 2-77) months. Creatinine level 1 year after surgery was higher in the complication group rather than the noncomplication group ( P = .02). CONCLUSION: Complications of the foot and ankle still occurred following pancreas transplantation in patients with diabetes. LEVEL OF EVIDENCE: Level III, comparative study.
[Mh] Termos MeSH primário: Tornozelo/fisiologia
Artropatia Neurogênica/cirurgia
Pé Diabético/cirurgia
/cirurgia
Transplante de Pâncreas/normas
[Mh] Termos MeSH secundário: Pé Diabético/fisiopatologia
Feminino
Seres Humanos
Masculino
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171113
[Lr] Data última revisão:
171113
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170323
[St] Status:MEDLINE
[do] DOI:10.1177/1071100717696246


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[PMID]:28257680
[Au] Autor:Ramanujam CL; Zgonis T
[Ad] Endereço:Division of Podiatric Medicine and Surgery, Department of Orthopaedics, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, MSC 7776, San Antonio, TX 78229, USA.
[Ti] Título:Surgical Correction of the Achilles Tendon for Diabetic Foot Ulcerations and Charcot Neuroarthropathy.
[So] Source:Clin Podiatr Med Surg;34(2):275-280, 2017 Apr.
[Is] ISSN:1558-2302
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Achilles tendon pathologic conditions are implicated in contributing to the development of many diabetic foot complications including diabetic foot ulceration and Charcot neuroarthropathy. Surgical correction of the diabetic equinus deformity has been studied as an isolated or adjunctive treatment when dealing with difficult-to-close diabetic foot ulcerations or when surgically addressing the diabetic Charcot neuroarthropathy foot or ankle. This article reviews the most common indications, complications, and surgical procedures for equinus correction by either a tendo-Achilles lengthening or gastrocnemius recession for the management of diabetic foot conditions.
[Mh] Termos MeSH primário: Tendão do Calcâneo/cirurgia
Artropatia Neurogênica/cirurgia
Pé Diabético/cirurgia
Pé Equino/cirurgia
Procedimentos Ortopédicos/métodos
Tenotomia/métodos
[Mh] Termos MeSH secundário: Tendão do Calcâneo/fisiopatologia
Idoso
Artrodese/métodos
Artropatia Neurogênica/diagnóstico por imagem
Comorbidade
Pé Diabético/diagnóstico por imagem
Pé Diabético/epidemiologia
Pé Equino/diagnóstico por imagem
Pé Equino/epidemiologia
Fixadores Externos
Feminino
Seres Humanos
Masculino
Meia-Idade
Prognóstico
Recuperação de Função Fisiológica
Medição de Risco
Resultado do Tratamento
Cicatrização/fisiologia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171109
[Lr] Data última revisão:
171109
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170305
[St] Status:MEDLINE


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[PMID]:28159052
[Au] Autor:Booth S; Ballal M; Pillai A
[Ad] Endereço:University Hospital South Manchester, Manchester, UK. Electronic address: sean.booth@nhs.net.
[Ti] Título:Complex ankle arthrodesis with step-cut osteotomy in Charcot arthropathy with bone loss.
[So] Source:Foot Ankle Surg;23(1):e5-e7, 2017 Mar.
[Is] ISSN:1460-9584
[Cp] País de publicação:France
[La] Idioma:eng
[Ab] Resumo:We report a case of a complex limb salvage ankle arthrodesis in a patient with Charcot arthropathy. A step-cut osteotomy was performed in order to tackle the issues of anterior tibial bone loss; worsening leg length discrepancy; soft tissue contraction; joint instability and high risk of non-union. The construct formed by the step-cut allowed for the preservation of good bone stock; avoidance of further limb shortening; increased torsional stability and increased surface area for bony union. This resulted in a patient with a stable, plantigrade foot appropriate for footwear. We use this case to highlight this technique as an option in the operative management of complex ankle fusions with sagittal or coronal plane deformity with bone loss and subluxation of the ankle joint.
[Mh] Termos MeSH primário: Articulação do Tornozelo
Artrodese
Artropatia Neurogênica/cirurgia
Osteotomia
[Mh] Termos MeSH secundário: Adulto
Artropatia Neurogênica/diagnóstico por imagem
Feminino
Fíbula/cirurgia
Seres Humanos
Tíbia/cirurgia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171106
[Lr] Data última revisão:
171106
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170205
[St] Status:MEDLINE


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[PMID]:28111181
[Au] Autor:Snoddy MC; Lee DH; Kuhn JE
[Ad] Endereço:Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address: markcsnoddy@gmail.com.
[Ti] Título:Charcot shoulder and elbow: a review of the literature and update on treatment.
[So] Source:J Shoulder Elbow Surg;26(3):544-552, 2017 Mar.
[Is] ISSN:1532-6500
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Charcot arthropathy of the shoulder and elbow is a rare disease process initially described in the 1700s; however, it was not until the 19th century that physicians understood its association with other disease processes such as cervical spine pathology and diabetes. A primary complaint is painful or painless joint dysfunction, meaning the orthopedic surgeon is regularly the first physician to evaluate the patient. Frequently, the condition of these patients is misdiagnosed. Although the pathogenesis of the disease is controversial, the etiology is commonly due to syringomyelia. The key to successful management is a thorough history and examination along with a workup including specific laboratory testing and imaging to rule out other disease processes. Most neuropathic shoulders and elbows have historically been managed conservatively because of poor outcomes with operative interventions. Newer data have emerged hinting that early neurosurgical intervention can stabilize this degenerative process. If clinical and radiographic stabilization occurs, recent studies have outlined surgical indications that can provide surgeons with a guide as to patients in whom successful operative outcomes can be achieved in the face of failed conservative management.
[Mh] Termos MeSH primário: Artropatia Neurogênica/terapia
Articulação do Cotovelo/cirurgia
Articulação do Ombro/cirurgia
[Mh] Termos MeSH secundário: Anti-Inflamatórios não Esteroides/uso terapêutico
Artropatia Neurogênica/diagnóstico
Artropatia Neurogênica/etiologia
Diagnóstico por Imagem
Articulação do Cotovelo/diagnóstico por imagem
Seres Humanos
Procedimentos Ortopédicos
Modalidades de Fisioterapia
Articulação do Ombro/diagnóstico por imagem
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Anti-Inflammatory Agents, Non-Steroidal)
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170124
[St] Status:MEDLINE


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[PMID]:27923212
[Au] Autor:Wukich DK; Sadoskas D; Vaudreuil NJ; Fourman M
[Ad] Endereço:1 Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
[Ti] Título:Comparison of Diabetic Charcot Patients With and Without Foot Wounds.
[So] Source:Foot Ankle Int;38(2):140-148, 2017 Feb.
[Is] ISSN:1944-7876
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The primary aim of this study was to evaluate the outcomes of a series of patients with Charcot neuroarthropathy (CN) who were evaluated in a tertiary care setting. We hypothesized that those patients with CN who presented with a Charcot-related foot wound would have lower rates of successful limb salvage than patients who presented without a wound. METHODS: Two hundred forty-five patients (280 feet) were identified with diabetic CN during the time period from January 1, 2005, to June 1, 2015. This consecutive cohort of patients was treated by a single surgeon and had a mean age of 57.9 ± 10.0 years. Our CN patients were divided into 2 groups for the purpose of our analysis. Our study group included those patients who presented to our clinic with a Charcot-related foot wound. Our control group was composed of CN patients who presented without a Charcot-related foot wound. RESULTS: Overall, 78 feet (27.9%) were successfully treated nonoperatively and 202 feet (72.1%) required some type of surgery. Of the 202 feet that received surgery, 22 (10.9%) were not felt to be suitable for reconstruction and underwent a definitive transtibial amputation without an attempt at reconstruction. An additional 18 patients underwent soft tissue surgery, which included drainage of infection, posterior muscle group lengthening, or soft tissue reconstructive flap surgery. The remaining 162 feet underwent osseous surgery, which included ostectomies for osteomyelitis, exostectomies, osteotomies, and arthrodesis. Eighteen of the 180 limbs (10.0%) that underwent soft tissue or osseous reconstruction ultimately required a transtibial amputation, resulting in a successful limb salvage rate of 90.0%. Thirty-five amputations were performed in 164 feet (21.3%) with Charcot-related foot wounds compared with 5 amputations in 116 feet (4.5%) without Charcot-related foot wounds (OR 6.02, 95% CI 2.28-15.91, P < .0001). CONCLUSION: The presence of a Charcot-related foot wound at presentation increased the likelihood of a major lower extremity amputation by a factor of 6. Other risk factors that were associated with major amputation in patients included active infection at presentation, nonunion/instability after reconstruction, and a postoperative wound problem. The overall rate of successful limb salvage in patients deemed reconstructive candidates was 90%. LEVEL OF CLINICAL EVIDENCE: Level III, retrospective, case-control study.
[Mh] Termos MeSH primário: Amputação
Artropatia Neurogênica/cirurgia
Pé Diabético/cirurgia
Salvamento de Membro
[Mh] Termos MeSH secundário: Artropatia Neurogênica/complicações
Estudos de Casos e Controles
Diabetes Mellitus Tipo 2/complicações
Pé Diabético/complicações
Feminino
Seres Humanos
Masculino
Meia-Idade
Estudos Retrospectivos
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170821
[Lr] Data última revisão:
170821
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161207
[St] Status:MEDLINE
[do] DOI:10.1177/1071100716673985



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