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The effect of reconstruction on positive margin rates in oral cancer: Using length of stay as a proxy measure for flap reconstruction in a national database.

Am J Otolaryngol 2021 Mar 29;42(5):103012. Epub 2021 Mar 29.

Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, United States of America. Electronic address:

Purpose: Planned flap reconstruction, allowing aggressive resections of oral cavity squamous cell carcinoma (OCSCC), may decrease positive surgical margins. The purpose of this study was to determine if length of stay (LOS), as a proxy measure for flap reconstruction, is associated with positive margin rates in OCSCC.

Materials And Methods: Data from the National Cancer Database was retrospectively collected for patients undergoing surgery for previously untreated clinical T1-3 OCSCC. Read More

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Cost and clinical outcomes of postoperative intensive care unit versus general floor management in head and neck free flap reconstructive surgery patients.

Am J Otolaryngol 2021 Apr 12;42(5):103029. Epub 2021 Apr 12.

Department of Otolaryngology- Head and Neck Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA. Electronic address:

Purpose: To compare clinical, surgical, and cost outcomes in patients undergoing head and neck free-flap reconstructive surgery in the setting of postoperative intensive care unit (ICU) against general floor management.

Methods: Retrospective analysis of head and neck free-flap reconstructive surgery patients at a single tertiary academic medical center. Clinical data was obtained from medical records. Read More

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Advantages of a New Low-Cost Negative Pressure Wound Therapy Using the "Turtle VAC": A Case Series.

JBJS Case Connect 2021 Apr 15;11(2). Epub 2021 Apr 15.

Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Case: We present a clinical case and technique guide demonstrating the use and effectiveness of a novel, low-cost negative pressure wound therapy (NPWT) device to achieve soft-tissue coverage in a 34-year-old patient with failed rotational flap and Masquelet technique on infected tibial nonunion. Local debridement was executed, NPWT initiated, and treatment culminated with complete wound healing.

Conclusion: The "Turtle VAC" offers an effective low-cost alternative to commercially vacuum-assisted closure systems for post-traumatic wounds in low-resource setting of Haiti. Read More

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Voice onset time and constriction duration in Warlpiri stops (Australia).

Phonetica 2021 Apr 13. Epub 2021 Apr 13.

College of Arts and Social Sciences, Australian National University, Canberra, Australia.

This paper presents a first detailed analysis of the Voice Onset Time (VOT) and Constriction Duration (CD) of stops /p t ʈ c k/ and flap /ɽ/ in the Indigenous Australian language Warlpiri as spoken in Lajamanu Community, in Australia's Northern Territory. The results show that Warlpiri stops are realised as voiceless, long-lag stops word-initially, as well as word-medially, where /p t k/ are also characterised by CDs in excess of 100 ms. This is similar to what has been reported for Kriol, and for the emerging mixed language Light Warlpiri, also spoken in the community, and by some of the participants. Read More

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A case report of a gastrobronchial fistula and lung abscess caused by leakage from the staple line of a gastric tube after esophagectomy for esophageal cancer.

Surg Case Rep 2021 Apr 15;7(1):95. Epub 2021 Apr 15.

Department of Surgery, Kakogawa Central City Hospital, Kakogawa, 675-8611, Japan.

Background: Gastrobronchial fistulas are rare, but life-threatening, complications of esophagectomy. They are caused by anastomotic leakage and mainly occur around anastomotic sites. In the present paper, we report a rare case of leakage from the staple line of a gastric tube after esophagectomy for esophageal cancer, which was successfully treated using an intercostal muscle flap and lung resection. Read More

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Distally Based Sural Fasciocutaneous Flaps for Reconstructing Soft Tissue Defects Proximal and Distal to the Tarsometatarsal Joints: A Comparative Analysis.

Int J Low Extrem Wounds 2021 Apr 15:15347346211002333. Epub 2021 Apr 15.

70566The Second Xiangya Hospital, Central South University, Changsha, People's Republic of China.

Distally based sural fasciocutaneous (DBSF) flaps are widely used for reconstructing soft tissue defects of the foot. The purpose of this paper was to compare the clinical efficacy of the use of flaps to repair defects in areas proximal and distal to the level of the tarsometatarsal joints in a relatively large number of patients and to analyze the effects of factors on the risk of developing partial necrosis of the flaps. Between April 2001 and December 2019, a total of 355 DBSF flaps were utilized to cover soft tissue defects in the foot. Read More

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[Research progress of clinical application of medial sural artery perforator flap].

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2021 Apr;35(4):508-513

Department of Hand and Foot Surgery, Tianjin Union Medical Center, Tianjin, 300121, P.R.China.

Objective: To review the research progress of the clinical application of the medial sural artery perforator flap (MSAPF).

Methods: The relevant domestic and abroad literature on the clinical application of MSAPF was extensively consulted, and the research progress were summarized and analyzed in aspect of its definition, anatomical characteristics, clinical application, surgical resection and improvement, and advantages and disadvantages of flaps, etc.

Results: MSAPF has the advantages of relatively constant anatomical position, thin flap texture, long vascular pedicle, large vessel diameter, no sacrifice of main blood vessels, concealed donor site, no hair, and fewer complications; it can carry nerves, tendons, and muscles to construct chimeric flaps to repair three-dimensional wounds; and can also repair wounds with high aesthetic and functional requirements such as hand, foot and ankle, head and neck, etc. Read More

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[Application of Zunyi's Suture Method for donor site of anterolateral thigh flap].

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2021 Apr;35(4):477-482

Department of Plastic Surgery and Burns, the Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P.R.China.

Objective: To investigate the effectiveness of multiple tension reduction suture of return needle vertical mattress suture and return needle horizontal mattress suture combination with intradermal intermittent continuous suture (denominated as Zunyi's Suture Method) on suturing the donor site of the anterolateral thigh flap.

Methods: Between January 2019 and December 2019, 62 patients were treated with anterolateral thigh flaps to repair wounds. There were 46 males and 16 females, aged 9-67 years (mean, 31 years). Read More

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Single flap approach with or without enamel matrix derivative in the treatment of severe supraosseous defects: a retrospective study.

Clin Oral Investig 2021 Apr 14. Epub 2021 Apr 14.

Research Centre for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Corso Giovecca 203, 44121, Ferrara, Italy.

Aim: To comparatively evaluate the clinical effectiveness of the single flap approach (SFA) with and without enamel matrix derivative (EMD) in the treatment of supraosseous defects (SDs) associated with deep pockets.

Materials And Methods: Twenty patients, each contributing one SD associated with a deep (≥ 6 mm) pocket and treated with buccal SFA either alone (SFA group; n = 10) or in combination with EMD (SFA+EMD group; n =10), were retrospectively selected. Clinical parameters (probing depth, PD; clinical attachment level, CAL; gingival recession, REC) had been assessed at pre-surgery and 12 months post-surgery. Read More

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A cartilage conserving concept of a surgical tracheostomy-introduction and analysis of safety and complications of the Visor-tracheostomy-a retrospective monocentric comparative study over 8 years.

Eur Arch Otorhinolaryngol 2021 Apr 14. Epub 2021 Apr 14.

Department Biometry and Bioinformatics, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI) Mainz, Obere Zahlbacher Straße 69, 55131, Mainz, Germany.

Introduction: For decades, surgical tracheostomy using a Bjoerk-flap has been the standard procedure to create a reliable epithelialized tracheostomy in head and neck tumour surgery. This technique is being used as the gold standard approach in every surgical subspecialty. Preparation of the Bjoerk-flap requires splitting one or two tracheal rings, causing potential tracheal instability and tissue trauma. Read More

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Assessing in-hospital morbidity after urethroplasty using the European Association of Urology Quality Criteria for standardized reporting.

World J Urol 2021 Apr 15. Epub 2021 Apr 15.

Department of Urology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy.

Purpose: To conduct a rigorous assessment of in-hospital morbidity after urethroplasty according with the European Association of Urology (EAU) guidelines for complication reporting.

Methods: We retrospectively (2015-2019) identified 469 consecutive patients receiving urethroplasty (e.g. Read More

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Petrosal Approach With Preservation of the Superior Petrosal Sinus (the Graceful Petrosal) for Resection of Giant Trigeminal Schwannoma: 2-Dimensional Operative Video.

Oper Neurosurg (Hagerstown) 2021 Apr;20(5):E342-E343

Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Trigeminal schwannomas are benign tumors amendable to curative surgical resection.1 Excellent outcomes, with preservation and improvement of cranial nerve function, including trigeminal nerve function, have been reported with microsurgical resection through skull base approaches.2 Dumbell shaped tumors, involving the middle and posterior fossa, are more challenging. Read More

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The management of deep sternal wound infection: Literature review and reconstructive algorithm.

JPRAS Open 2021 Jun 6;28:77-89. Epub 2021 Mar 6.

Department of Plastic Surgery, Royal Free London NHS Foundation Trust, Pond Street, London, United Kingdom.

Deep sternal wound infection (DSWI) is an important complication of open thoracic surgery, with a reported incidence of 0.5-6%. Given its association with increased morbidity, mortality, inpatient duration, financial burden, and re-operation rates, an aggressive approach to treatment is mandated. Read More

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Mycobacterium fortuitum and Mycobacterium abscessus infections in the foot and ankle in two immunocompetent patients.

Biomedicine (Taipei) 2020 1;10(4):52-56. Epub 2020 Dec 1.

Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore.

Nontuberculous mycobacteria (NTM) infections of the musculoskeletal system are commonly missed due to its rarity and the absence of systemic symptoms. A high clinical index of suspicion is required to recognize such infections as they may occur in immunocompetent hosts. We present two cases of foot and ankle NTM infections involving and in two such patients. Read More

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December 2020

Combined open calcaneocuboid, naviculocuneiform and subtalar dislocation: A case report and literature review.

Biomedicine (Taipei) 2020 5;10(2):48-54. Epub 2020 Jun 5.

Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore.

Open dislocations of the midfoot and subtalar joints are extremely rare injuries. Understanding the anatomy of these joints and the various injury patterns is imperative to obtain stable concentric reduction and provide good functional outcome. We present a report of a 26- year old male who was involved in a road traffic accident and sustained open dislocations of the calcaneocuboid, naviculocuneiform and subtalar joints. Read More

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Application of FACE-Q and NOSE in Nasal Reconstruction with Paramedian Frontal Flap after Skin Cancer Resection.

Plast Reconstr Surg Glob Open 2021 Apr 8;9(4):e3533. Epub 2021 Apr 8.

Division of Plastic Surgery, Medical School, Universidade de São Paulo (HCFMUSP), São Paulo, Brazil.

Introduction: Nonmelanoma skin cancer (NMSC) is responsible for high morbidity and mortality, resulting in a high cost to the health system. The nose is the leading region affected by this type of tumor and may need reconstruction by tissue transfer. The paramedian forehead flap (PFF) is one of the main options used, and the factors that influence the result should be studied. Read More

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The LN Flap for Nasal Defect Reconstruction: An 84-case Experience with a Novel Technique.

Plast Reconstr Surg Glob Open 2021 Apr 8;9(4):e3526. Epub 2021 Apr 8.

Division of Plastic & Reconstructive Surgery, Université de Montréal, Montreal, QC, Canada.

Background: The nose is a common site for cutaneous malignancy and post-ablative reconstruction. To our knowledge, a myocutaneous island flap based on the levator labii superioris alaeque nasi (LLSAN) and nasalis muscles, with vascularity from the lateral nasal and angular arteries, has not been described for reconstruction of the lower lateral nose.

Methods: A retrospective chart review of patients who underwent LLSAN-nasalis island flap reconstruction between 2015 and 2019 was performed. Read More

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Postsurgical Prosthetic Rehabilitation after Mandibular Ameloblastoma Resection: A 7-Year Follow-Up Case Report.

Case Rep Dent 2021 28;2021:5593973. Epub 2021 Mar 28.

Department of Odontostomatology, Faculty of Medicine and Health Sciences (Dentistry), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.

Ameloblastomas are benign but locally invasive odontogenic tumors most frequently located in the mandible. The gold standard of treatment is the surgical resection of the tumor with safety margins. Postsurgical defects generate a significant morbidity that needs reconstruction and oral rehabilitation to restore the oral functions. Read More

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Modified envelope flap, a novel incision design, can relieve complications after extraction of fully horizontal impacted mandibular third molar.

J Dent Sci 2021 Mar 18;16(2):718-722. Epub 2020 Sep 18.

Department of Oral and Maxillofacial Surgery, Guangxi Medical University College of Stomatology, Nanning, China.

Background/purpose: Patients always suffer from dental extraction complications of fully horizontal impacted mandibular third molar, such as pain, swelling and limited mouth opening. A novel incision, modified envelope flap (MEF), was designed to alleviate the complications through minimizing the tissue injury during this surgery procedure.

Materials And Methods: With indications of removing bilateral fully horizontal impacted mandibular the third molars, 40 patients were recruited and received dental extraction under incision with modified envelope flap (MEF) in one lateral and modified triangular flap (MTF) in the other lateral respectively. Read More

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Use of the supraclavicular artery island flap for reconstruction of maxillofacial defects: a case report and literature review.

BMC Surg 2021 Apr 14;21(1):193. Epub 2021 Apr 14.

The Third Hospital of Mianyang & Sichuan Mental Health Center, Head, Neck and Maxillofacial Surgery & Thyroid Department, Mianyang, 621000, Sichuan, China.

Background: Free flaps are widely used in maxillofacial reconstruction; however, this approach was not feasible in the current case. It was not possible because the free flap method requires microvascular anastomosis expertise, which is difficult, time-consuming and costly.

Case Presentation: An 86-year-old woman suffered squamous cell carcinoma on the right side of her face, which resulted in a large soft-tissue defect. Read More

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Outcomes of Total Knee Arthroplasty in Patients with Prior Hardware: A Case-Control Study Using Handheld Navigation.

J Knee Surg 2021 Apr 14. Epub 2021 Apr 14.

Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.

Presence of hardware in juxta-articular location poses challenge during total knee arthroplasty (TKA). When present in distal femur, it precludes the use of an intramedullary femoral jig during TKA often necessitating removal of hardware leading to prolonged surgery, higher risk of complications, and inferior results. We conducted a case-control study to assess the outcome of TKA among patients with post-traumatic arthritis using a handheld navigation system to perform bone cuts allowing retention of hardware in situ. Read More

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Use of Preoperative High-Resolution Ultrasound System to Facilitate Elevation of the Superficial Circumflex Iliac Artery Perforator Flap.

J Reconstr Microsurg 2021 Apr 14. Epub 2021 Apr 14.

Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan.

Background:  During elevation of the superficial circumflex iliac artery (SCIA) perforator (SCIP) flaps, the flap pedicle must often be converted from the superficial branch to the deep branch of the SCIA, complicating and prolonging the procedure. The goal of the present study was to demonstrate the effectiveness of high-resolution ultrasonography to decrease the conversion rate on which no previous report has focused, by making a comparison with a conventional method.

Patients And Methods:  Forty-five consecutive cases where free SCIP flap transfer was performed for reconstruction were retrospectively reviewed. Read More

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A Comparison of Patient-Reported Outcomes in Bipedicled Total Abdominal versus Unipedicled Hemiabdominal Free Flaps for Unilateral Breast Reconstruction.

J Reconstr Microsurg 2021 Apr 14. Epub 2021 Apr 14.

Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, North Carolina.

Background:  While bipedicled free flaps enable increased soft tissue volume and potential for contralateral symmetry in unilateral breast reconstruction, the influence of bipedicled flap reconstruction on patient-reported outcomes remains unclear.

Methods:  Patients undergoing unilateral free flap breast reconstruction at a single institution from 2014 to 2019 were retrospectively reviewed and sent the BREAST-Q and Decision Regret Scale. Complication rates and the BREAST-Q and Decisional Regret Scale scores (0-100) were compared between patients receiving bipedicled total abdominal and unipedicled hemiabdominal free flaps. Read More

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Use of Single Chimeric Free Flaps or Double Free Flaps for Complex Head and Neck Reconstruction.

J Reconstr Microsurg 2021 Apr 14. Epub 2021 Apr 14.

Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.

Background:  Free flaps have become the preferred reconstructive approach to restore form and function for patients presenting with complex head and neck defects. For composite, complex defects for which a regular free flap might not meet all reconstructive demands, adequate coverage can be achieved with either a single chimeric free flap or a double free flap.

Methods:  We performed a single-center retrospective chart review of patients who underwent either single chimeric free flap or double free flap reconstruction. Read More

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Stratification of Surgical Risk in DIEP Breast Reconstruction Based on Classification of Obesity.

J Reconstr Microsurg 2021 Apr 14. Epub 2021 Apr 14.

Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana.

Background:  From both a medical and surgical perspective, obese breast cancer patients are considered to possess higher risk when undergoing autologous breast reconstruction relative to nonobese patients. However, few studies have evaluated the continuum of risk across the full range of obesity. This study sought to compare surgical risk between the three World Health Organization (WHO) classes of obesity in patients undergoing deep inferior epigastric perforator (DIEP) flap breast reconstruction. Read More

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Free Flap Reconstruction of Traumatic Pediatric Foot and Ankle Defects: An Analysis of Clinical and Functional Outcomes.

J Reconstr Microsurg 2021 Apr 14. Epub 2021 Apr 14.

Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri.

Background:  Traumatic lower extremity injuries involving the foot and ankle can have devastating consequences and represent a complex reconstructive challenge. To date, there are limited reports on microsurgical reconstruction for foot and ankle defects in children. This study aims to evaluate clinical and functional outcomes of free flaps for pediatric foot and ankle injuries. Read More

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A Novel Technique for Radiographic Diagnosis of Sarcopenia that Accurately Predicts Postoperative Complications in Lower Extremity Free Flap Patients.

J Reconstr Microsurg 2021 Apr 14. Epub 2021 Apr 14.

Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center New Orleans, New Orleans, Louisiana.

Introduction:  Sarcopenia is linked to poor outcomes throughout the surgical literature and can be assessed on preoperative imaging to potentially aid in risk stratification. This study examined the effects of sarcopenia on surgical morbidity following lower extremity (LE) reconstruction, and also compared two methods of assessment, one of which is novel ("ellipse method").

Methods:  A retrospective cohort study of 50 patients receiving free flap-based reconstruction of the LE was performed. Read More

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The Need to Improve Patient-Centered Outcome Reporting Following Lower Extremity Flap Reconstruction: A Systematic Review and Meta-analysis.

J Reconstr Microsurg 2021 Apr 14. Epub 2021 Apr 14.

Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital; Washington, District of Columbia.

Introduction:  Research in lower extremity (LE) wound management involving flap reconstruction has primarily focused on surgeon-driven metrics. There has been a paucity in research that evaluates patient-centered outcomes (PCO). This systematic review and meta-analysis examines articles published between 2012 and 2020 to assess whether reporting of functional and quality of life (QOL) outcomes have increased in frequency and cohesiveness, compared with the previous two decades. Read More

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The PAP Flap Breast Reconstruction: A Practical Option for Slim Patients.

J Reconstr Microsurg 2021 Apr 14. Epub 2021 Apr 14.

Department of Plastic and Reconstructive Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Seoul, Korea.

Background:  The posterior thigh-based profunda artery perforator (PAP) flap has been an emerging option as a secondary choice in breast reconstructions. However, whether a PAP flap could consistently serve as the secondary option in slim patients has not been investigated.

Methods:  Records of immediate unilateral breast reconstructions performed from May 2017 to June 2019 were reviewed. Read More

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Redefining the Reconstructive Ladder in Vulvoperineal Reconstruction: The Role of Pedicled Perforator Flaps.

J Reconstr Microsurg 2021 Apr 14. Epub 2021 Apr 14.

Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.

Background:  Gynecological reconstruction is difficult, particularly in cases with recurrence and received previous surgeries and/or radiotherapy and necessitate secondary reconstruction. Perforator flaps can preserve other donor sites for potential later reconstruction, and they also can be better tailored to the defect. We hypothesized that the use of perforator-based flaps can better restore the defect with less complications. Read More

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