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Article ; Online: Revision surgery after failed surgical treatment of midshaft clavicle fractures is often associated with positive detection of bacteria.

Hemmann, Philipp / Brunner, Julia / Histing, Tina / Körner, Daniel

Archives of orthopaedic and trauma surgery

2022 Volume 143, Issue 7, Page(s) 4133–4139

Abstract: Background: Midshaft clavicle fractures are common, and the proportion of patients treated surgically has increased in recent years. With this increase in surgical treatments, the complication rate, for instance of infection, non-union, or implant ... ...

Abstract	Background: Midshaft clavicle fractures are common, and the proportion of patients treated surgically has increased in recent years. With this increase in surgical treatments, the complication rate, for instance of infection, non-union, or implant failure, has also risen. This study evaluates the frequency of pathogen detection during revision surgeries occurring after a prior failed osteosynthesis of midshaft clavicle fractures. Methods: All patients treated in our hospital with a prior failed surgical therapy of a clavicle midshaft fracture between January 2013 and March 2022 were screened. Epidemiological data, intraoperative tissue samples, sonication, and the type of revision surgery were assessed. A postoperative follow-up at a minimum of 6 month was defined and osseous consolidation was verified. Results: Twenty-one patients (twelve male and eight female) were included with a mean age of 40.4 ± 14.1 years. Eleven of the patients showed pathogen detection (Group I), and seven remained without (Group II). A significant difference in age existed between Groups I and II (36.1 ± 12.8 and 51.6 ± 11.5, p ≤ 0.05). The three most common pathogens were Cutibacterium acnes (n = 7), Staphylococcus epidermidis (n = 4), and Staphylococcus sacchorlyticus (n = 3), respectively. Thirteen patients presented for a follow-up. In nine patients (69%), bone healing was detectable. Four patients received a second revision surgery. Conclusion: Revision surgery frequently shows pathogen detection without signs of infection. Cutibacterium acnes is the most common pathogen. Despite pathogen detection, bone healing can be achieved with revision surgery, although the rate of repeat revision surgeries is high.
MeSH term(s)	Humans ; Male ; Female ; Adult ; Middle Aged ; Reoperation ; Clavicle/surgery ; Fracture Healing ; Treatment Outcome ; Bone Plates ; Fractures, Bone/surgery ; Fractures, Bone/etiology ; Fracture Fixation, Internal/adverse effects ; Bacteria ; Propionibacterium acnes ; Retrospective Studies
Language	English
Publishing date	2022-11-16
Publishing country	Germany
Document type	Journal Article
ZDB-ID	80407-1
ISSN	1434-3916 ; 0003-9330 ; 0344-8444
ISSN (online)	1434-3916
ISSN	0003-9330 ; 0344-8444
DOI	10.1007/s00402-022-04669-x
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Article: Outcome Analysis of Distal Radius Fracture with Orthosis Versus Cast Immobilization after Palmar Plate Osteosynthesis: A Randomized Controlled Study.

Klopfer, Tim / Hemmann, Philipp / Rupprecht, Verena / Stuby, Fabian / Stöckle, Ulrich / Meder, Adrian

Journal of personalized medicine

2023 Volume 13, Issue 1

Abstract: Although the benefits of hand orthoses were shown in previous studies, they have not been able to establish themselves in clinical routines. With a focus on patient satisfaction, this study aimed to evaluate the latest generation of hand orthoses after ... ...

Abstract	Although the benefits of hand orthoses were shown in previous studies, they have not been able to establish themselves in clinical routines. With a focus on patient satisfaction, this study aimed to evaluate the latest generation of hand orthoses after palmar plate osteosynthesis for isolated distal radius fractures in comparison with circular plaster casts. 50 patients (16% dropout rate) were randomly assigned to an orthotic group (immobilization by orthosis, OG) or a control group (immobilization by a plaster cast, CG). Intra-articular fractures were present in 74% of the cases, and unstable AO C3 fractures in 26%. Questionnaires on patient satisfaction, documentation of the time required, clinical scores (DASH, SF-36), range of motion, grip measurements and radiographs were used for evaluation. The OG proved to be equivalent to the plaster treatment in terms of patient satisfaction, and stability of the reduction, as well as clinical scores DASH and SF-36. The OG was even superior in terms of personal hygiene (p = 0.011), handling (p = 0.008) and better adaptability (p = 0.013). Significantly less time was required to apply the orthosis (p < 0.001). In addition to the good results achieved so far, the study showed that the latest generation of orthoses has several advantages over plaster cast therapy, and could therefore become established in everyday clinical practice.
Language	English
Publishing date	2023-01-09
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662248-8
ISSN	2075-4426
ISSN	2075-4426
DOI	10.3390/jpm13010130
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Article: Ankle fractures of the geriatric patient: a narrative review.

Ziegler, Patrick / Bahrs, Christian / Konrads, Christian / Hemmann, Philipp / Ahrend, Marc-Daniel

EFORT open reviews

2023 Volume 8, Issue 1, Page(s) 1–10

Abstract: The present narrative review provides a summary of current concepts for the treatment of ankle fractures in elderly patients. Despite a high complication rate, open reduction and internal fixation is the gold standard for operative care. However, ... ...

Abstract	The present narrative review provides a summary of current concepts for the treatment of ankle fractures in elderly patients. Despite a high complication rate, open reduction and internal fixation is the gold standard for operative care. However, individual patient-based treatment decision considering the soft-tissue status, the fracture pattern, as well as the patient's mobility and comorbidities is mandatory to achieve sufficient patient outcomes. Due to high complication rates after surgery in the past, techniques such as fibular nails or minimal invasive techniques should be considered.
Language	English
Publishing date	2023-01-27
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2844421-8
ISSN	2058-5241 ; 2058-5241 ; 2396-7544
ISSN (online)	2058-5241
ISSN	2058-5241 ; 2396-7544
DOI	10.1530/EOR-22-0082
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Article ; Online: Leukocyte esterase and alpha-defensin in periprosthetic joint infection: predictive quality and correlation in a prospective study.

Grünwald, Leonard / Schmidutz, Florian / Döttger, Philipp / Erne, Felix / Schreiner, Anna Janine / Hemmann, Philipp

International orthopaedics

2023 Volume 47, Issue 11, Page(s) 2663–2668

Abstract: Purpose: Periprosthetic joint infection (PJI) is a rare but serious complication of total joint arthroplasty (TJA). An accurate diagnosis of PJI preoperatively does not exist. Alpha-defensin (AD) is a proven and common indicator. The diagnostic marker ... ...

Abstract	Purpose: Periprosthetic joint infection (PJI) is a rare but serious complication of total joint arthroplasty (TJA). An accurate diagnosis of PJI preoperatively does not exist. Alpha-defensin (AD) is a proven and common indicator. The diagnostic marker of leukocyte esterase (LE) promises some advantages: feasibility, availability, and fast result reporting. The aim of this study was the evaluation of the predictive quality and correlation between both diagnostic tools in the diagnosis of PJI. Methods: A prospective study was conducted between April 2018 and August 2022. All patients with suspicion of PJI on hip and knee joint were included and underwent a routine and standardized joint punction. For laboratory diagnostics of AD, the synovial liquid was analyzed by ELISA. The sample was additionally applied to a LE test strip (Combur 10 Test, Roche Diagnostics, Mannheim, Germany). Results: A total of 249 patients were examined (mean age 67.12 ± 11.89; gender distribution man/woman 139 (55.8%)/110(44.2%), hip/knee 71(28.5%)/178 (71.5%). According to EBJIS criteria, PJI was diagnosed in 54 (21.7%) patients. AD showed excellent results with an AUC of 0.930 (sensitivity/specificity 0.870/0.990). LE yielded very good results with an AUC of 0.820 (sensitivity/specificity 0.722/0.918). Both parameters showed a strong positive correlation. Conclusion: LE is a rapidly available alternative in PJI diagnostics. The simultaneous determination of both markers may enhance diagnostic reliability. A routine usage may shorten the time from diagnosis to treatment of PJI.
MeSH term(s)	Male ; Female ; Humans ; Middle Aged ; Aged ; alpha-Defensins/analysis ; Prospective Studies ; Predictive Value of Tests ; Prosthesis-Related Infections/diagnosis ; Prosthesis-Related Infections/etiology ; Reproducibility of Results ; Arthritis, Infectious/diagnosis ; Sensitivity and Specificity ; Synovial Fluid/chemistry ; Biomarkers/analysis ; Arthroplasty, Replacement, Hip/adverse effects
Chemical Substances	leukocyte esterase (EC 3.1.-) ; alpha-Defensins ; Biomarkers
Language	English
Publishing date	2023-08-16
Publishing country	Germany
Document type	Journal Article
ZDB-ID	80384-4
ISSN	1432-5195 ; 0341-2695
ISSN (online)	1432-5195
ISSN	0341-2695
DOI	10.1007/s00264-023-05914-7
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Article ; Online: Changing epidemiology of lower extremity fractures in adults over a 15-year period - a National Hospital Discharge Registry study.

Hemmann, Philipp / Friederich, Maximilian / Körner, Daniel / Klopfer, Tim / Bahrs, Christian

BMC musculoskeletal disorders

2021 Volume 22, Issue 1, Page(s) 456

Abstract: Background: Demographic changes led to an increasingly ageing population in Germany and thus to possible changes in the frequency of fractures. The primary aim of this study was to report changes in fracture rates of the lower extremities in Germany in ... ...

Abstract	Background: Demographic changes led to an increasingly ageing population in Germany and thus to possible changes in the frequency of fractures. The primary aim of this study was to report changes in fracture rates of the lower extremities in Germany in 2002 compared to 2017 and to evaluate those changes. Methods: Inpatient data from the German National Hospital Discharge Registry (ICD10) for 2002 and 2017 were evaluated. Changes in total counts and incidence rates were analysed for fractures in the following locations: femoral neck, pertrochanteric, subtrochanteric, distal femur, femoral shaft, proximal and distal tibia, tibial shaft, medial and lateral malleolus, and other parts of the lower leg (including bi- and trimalleolar fractures), calcaneus, talus, other tarsal bones, metatarsal bones, greater toe, lesser toe, other fractures of foot or unspecific fractures of foot and toe. Patients were classed into age groups by sex: 15-24, 25-34,35-44, 45-54, 55-64, 65-74, 75-84, 85-90 and > 90 years. Results: The total count for lower extremity fractures in men and women increased slightly by 4.5% from 305,764 in 2002 to 319,422 in 2017. Hip and femur fractures increased by 23.5% from 150,565 in 2002 to 185,979 in 2017. The number of these fractures among men increased by 46% and among women by 15.3%. The total count of lower leg fractures decreased by 15.4% from 131,162 in 2002 to 110,924 in 2017. Especially, younger age groups showed a decline for all tibial segments and ankle fractures. For both sexes, the number of lower leg fractures in those 75 years or older increased in all lower leg fracture locations. Most femur and lower leg fractures occurred in women. The incidence of fractures rose sharply from 2002 to 2017, especially for older cohorts. Conclusion: The total numbers of lower extremity fractures increased slightly in 2017 compared to 2002 - especially hip and femur fractures among men. The incidence of almost all lower extremity fracture types among older people increased during this time. Women were particularly affected. Therefore, focused prevention programmes should be considered including an extended fracture spectrum in the elderly.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Female ; Germany ; Hospitals ; Humans ; Incidence ; Lower Extremity ; Male ; Patient Discharge ; Registries
Language	English
Publishing date	2021-05-19
Publishing country	England
Document type	Journal Article
ISSN	1471-2474
ISSN (online)	1471-2474
DOI	10.1186/s12891-021-04291-9
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Article ; Online: Substantial changes in fracture rates in German hospitals in 2018 compared with 2002: an epidemiological study.

Hemmann, Philipp / Friederich, Maximilian / Bahrs, Christian / Jacoby, Johann / Körner, Daniel

Archives of orthopaedic and trauma surgery

2021 Volume 142, Issue 8, Page(s) 1847–1857

Abstract: Introduction: The aim of this study was to present recent epidemiological data on extremity and axial skeletal fractures in German hospitals and to compare them with older data to detect time trends.: Materials and methods: Inpatient data from the ... ...

Abstract	Introduction: The aim of this study was to present recent epidemiological data on extremity and axial skeletal fractures in German hospitals and to compare them with older data to detect time trends. Materials and methods: Inpatient data from the German National Hospital Discharge Registry were used. The absolute number and age-standardized incidence of fractures in 2002 and 2018 were analysed by fracture location according to the International Classification of Disease. Data were analysed according to age group. Male: female ratios (MFRs) and incidence rate ratios (IRRs) were calculated to compare the 2018 and 2002 data. Results: The absolute number of fractures of the nine analysed locations was 15.2% higher in 2018 than in 2002. By fracture location, the changes were as follows (absolute change + IRR): "neck" (S12): + 172%, IRR = 2.6; "rib(s), sternum, thoracic spine" (S22): + 57%, IRR = 1.3; "lumbar spine and pelvis" (S32): + 66%, IRR = 1.3; "shoulder and upper arm" (S42): + 36%, IRR = 1.2; "forearm" (S52): + 13%, IRR = 1.0; "wrist and hand level" (S62): - 32%, IRR = 0.7; "femur" (S72): + 24%, IRR = 0.9; "lower leg, including ankle" (S82): - 24%, IRR = 0.7; "foot, except ankle" (S92): - 4%, IRR = 0.9. The overall MFR changed from 0.7 in 2002 to 0.6 in 2018. The age group of 45-54 years represented a turning point, males were more often affected than females in the younger age groups, and the opposite trend was observed in the older age groups. Conclusions: The increase in the absolute fracture rates was due to increased rates of femur, shoulder, upper arm, forearm, and axial skeletal fractures, with elderly women being the main contributors. Femur fractures were found to be the most common fractures treated in German hospitals.
MeSH term(s)	Aged ; Epidemiologic Studies ; Female ; Femoral Fractures ; Fractures, Bone/epidemiology ; Hip Fractures/epidemiology ; Hospitals ; Humans ; Incidence ; Male ; Middle Aged ; Upper Extremity
Language	English
Publishing date	2021-04-12
Publishing country	Germany
Document type	Journal Article
ZDB-ID	80407-1
ISSN	1434-3916 ; 0003-9330 ; 0344-8444
ISSN (online)	1434-3916
ISSN	0003-9330 ; 0344-8444
DOI	10.1007/s00402-021-03874-4
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Article: Amount and composition of total fatty acids in red and yellow bone marrow are altered with changes in bone mineral density.

Ehnert, Sabrina / Schreiner, Anna J / Seeliger, Claudine / Ecker, Josef / Springer, Fabian / Liebisch, Gerhard / Hemmann, Philipp / Histing, Tina / Nussler, Andreas K

EXCLI journal

2023 Volume 22, Page(s) 207–220

Abstract: There is general consent that with decreasing bone mineral density the amount of marrow adipose tissue increases. While image-based techniques, claim an increase in saturated fatty acids responsible for this effect, this study shows an increase in both ... ...

Abstract	There is general consent that with decreasing bone mineral density the amount of marrow adipose tissue increases. While image-based techniques, claim an increase in saturated fatty acids responsible for this effect, this study shows an increase in both saturated and unsaturated fatty acids in the bone marrow. Using fatty acid methyl ester gas chromatography-mass spectrometry, characteristic fatty acid patterns for patients with normal BMD (N = 9), osteopenia (N = 12), and osteoporosis (N = 9) have been identified, which differ between plasma, red bone marrow and yellow bone marrow. Selected fatty acids,
Language	English
Publishing date	2023-02-13
Publishing country	Germany
Document type	Journal Article
ISSN	1611-2156
ISSN	1611-2156
DOI	10.17179/excli2023-5843
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Article: AZU1: a new promising marker for infection in orthopedic and trauma patients?

Hemmann, Philipp / Kloppenburg, Lisa / Breinbauer, Regina / Ehnert, Sabrina / Blumenstock, Gunnar / Reumann, Marie K / Erne, Felix / Jazewitsch, Johann / Schwarz, Tobias / Baumgartner, Heiko / Histing, Tina / Rollmann, Mika / Nüssler, Andreas K

EXCLI journal

2024 Volume 23, Page(s) 53–61

Abstract: Early and reliable detection of infection is vital for successful treatment. Serum markers such as C-reactive protein (CRP) and procalcitonin (PCT) are known to increase with a time lag. Azurocidin 1 (AZU1) has emerged as a promising marker for septic ... ...

Abstract	Early and reliable detection of infection is vital for successful treatment. Serum markers such as C-reactive protein (CRP) and procalcitonin (PCT) are known to increase with a time lag. Azurocidin 1 (AZU1) has emerged as a promising marker for septic patients, but its diagnostic value in orthopedic and trauma patients remains unexplored. Between July 2020 and August 2023, all patients necessitating inpatient treatment for periprosthetic joint infection (PJI), peri-implant infection (II), soft tissue infection, chronic osteomyelitis, septic arthrodesis, bone non-union with and without infection were enrolled. Patients undergoing elective total joint arthroplasty (TJA) served as the control group. Blood samples were collected and analyzed for CRP, white blood cell count (WBC), PCT, and AZU1. Based on the inclusion and exclusion criteria 222 patients were included in the study (trauma = 38, soft tissue infection = 75, TJA = 33, PJI/II = 39, others = 37). While sensitivity and specificity were comparably high for AZU1 (0.734/0.833), CRP and PCT had higher specificity (0.542/1 and 0.431/1, respectively), and WBC a slightly higher sensitivity (0.814/0.455) for septic conditions. Taken together, the area under the curve (AUC) showed the highest accuracy for AZU1 (0.790), followed by CRP (0.776), WBC (0.641), and PCT (0.656). The Youden-Index was 0.57 for AZU1, 0.54 for CRP, 0.27 for WBC, and 0.43 for PCT. Elevated AZU1 levels effectively distinguished patients with a healthy condition from those suffering from infection. However, there is evidence suggesting that trauma may influence the release of AZU1. Additional research is needed to validate the diagnostic value of this new biomarker and further explore its potential clinical applications.
Language	English
Publishing date	2024-01-03
Publishing country	Germany
Document type	Journal Article
ISSN	1611-2156
ISSN	1611-2156
DOI	10.17179/excli2023-6705
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Article ; Online: Substantial decrease in paediatric lower extremity fracture rates in German hospitals in 2017 compared with 2002: an epidemiological study.

Gonser, Christoph Emanuel / Bahrs, Christian / Hemmann, Philipp / Körner, Daniel

BMC musculoskeletal disorders

2020 Volume 21, Issue 1, Page(s) 357

Abstract: Background: There are no recent studies on the frequency of paediatric lower extremity fractures in Germany. The aims of this study were to report fracture rates of paediatric lower extremity fractures treated in German hospitals in 2002 and 2017 and to ...

Abstract	Background: There are no recent studies on the frequency of paediatric lower extremity fractures in Germany. The aims of this study were to report fracture rates of paediatric lower extremity fractures treated in German hospitals in 2002 and 2017 and to detect changes over time as well as to evaluate the gender and age distribution for each fracture location. Methods: Data from the German National Hospital Discharge Registry, which covers over 99% of all German hospitals, were used for this study. The absolute frequencies and incidence of lower extremity fractures as well as age at the time of fracture and gender were included in the data. The population was subdivided into four age groups: 0-4, 5-9, 10-14, and 15-19 years. The boy: girl ratio (BGR) for all fracture locations was calculated by dividing the absolute frequency of boys by that of girls. The fracture incidence in 2017 was compared with 2002 by calculating the incidence rate ratio (IRR). Results: The total number of fractures decreased by 39.9% from 2002 to 2017. The most common fracture locations in 2002 were femoral shaft, tibial shaft, distal tibia, and lateral and medial malleolus; the absolute number of all these fractures was lower in 2017 than in 2002 in all age groups. The incidence of hip and thigh fractures, knee and lower leg fractures, and foot fractures decreased by 39.0, 41.1, and 33.3%. Proximal tibial fractures increased both in absolute numbers and in incidence in the age groups 0-4, 10-14, and 15-19 years (IRR ≥ 1.1). The overall BGR was 2.3 in 2002 and 2.0 in 2017, indicating that the number of girls relative to that of boys who suffered a lower extremity fracture was higher in 2017 than in 2002. Furthermore, the BGR of all fracture locations increased with age in both years. Conclusions: The number of paediatric lower extremity fractures treated in German hospitals in 2017 was significantly lower than that in 2002. However, the fracture frequency in girls decreased to a lesser extent than that in boys. The incidence of proximal tibial fractures increased.
MeSH term(s)	Adolescent ; Age Distribution ; Child ; Child, Preschool ; Epidemiologic Studies ; Female ; Fractures, Bone/classification ; Fractures, Bone/epidemiology ; Germany/epidemiology ; Humans ; Incidence ; Infant ; Infant, Newborn ; Lower Extremity/injuries ; Male ; Registries ; Sex Distribution ; Young Adult
Language	English
Publishing date	2020-06-08
Publishing country	England
Document type	Journal Article
ISSN	1471-2474
ISSN (online)	1471-2474
DOI	10.1186/s12891-020-03393-0
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Article ; Online: Management of comminuted inferior patellar pole fractures with cerclage-wire-augmented separate vertical wiring: a retrospective clinical study.

Yan, Shuang G / Li, Di / Cui, Yiliang / Hua, Xingyi / Hemmann, Philipp / Schmidutz, Florian

Archives of orthopaedic and trauma surgery

2021 Volume 143, Issue 1, Page(s) 247–254

Abstract: Purpose: Comminuted inferior patellar pole fractures are challenging injuries and require effective treatment due to the extension mechanism of the knee. This study aims to evaluate the outcome of above fractures treated with a modified technique of ... ...

Abstract	Purpose: Comminuted inferior patellar pole fractures are challenging injuries and require effective treatment due to the extension mechanism of the knee. This study aims to evaluate the outcome of above fractures treated with a modified technique of cerclage-wire-augmented separate vertical wiring (SVW) with cerclage wiring passed through the proximal patella. Methods: Retrospective analysis (1/2017-1/2020) were performed for patients that were treated with three SVWs through the posterior margin of proximal fragment and directly to the anterosuperior border of patella, combined with a cerclage wiring passed through the proximal patella. Patients who experienced comminuted inferior patellar pole fractures within 3 weeks were included, and the outcome was evaluated radiologically and clinically by Bostman score after a minimum of 12 months following surgery. Further evaluation included the operation time and complication rate. Results: A total of 20 patients (10 males, 10 females) with a mean age of 54 ± 14.5 years (26-83 years) and a follow-up of 18.9 ± 6.6 months (12-36 months) were evaluated. The average operation time was 45.7 ± 8.8 min (30-60 min). At final follow-up, the average range of motion was 131.3° ± 3.5° (125°-135°), and the mean Bostman score was 29.4 ± 0.7 points (28-30) and graded excellent in all cases. Two patients experienced occasional giving way of the knee. Radiologically no loss of reduction, implant breakage, nonunion or skin irritation was observed. Conclusions: The cerclage-wire-augmented SVW with cerclage wiring passed through the proximal patella appears to be a safe and simple technique which can effectively treat the comminuted inferior patellar pole fractures.
MeSH term(s)	Male ; Female ; Humans ; Adult ; Middle Aged ; Aged ; Retrospective Studies ; Patella/surgery ; Patella/injuries ; Fractures, Bone/surgery ; Fracture Fixation, Internal/methods ; Bone Wires ; Fractures, Comminuted/surgery ; Treatment Outcome
Language	English
Publishing date	2021-07-07
Publishing country	Germany
Document type	Journal Article
ZDB-ID	80407-1
ISSN	1434-3916 ; 0003-9330 ; 0344-8444
ISSN (online)	1434-3916
ISSN	0003-9330 ; 0344-8444
DOI	10.1007/s00402-021-04034-4
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