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  • Distribution of Platelet-rich Plasma after Ultrasound-Guided Injection for Chronic Elbow Tendinopathies

    Abstract

    Characteristics of the spreads of platelet-rich plasma (PRP) are not widely known despite commonly use. This study aims to evaluate whether PRP stays within the injected area by using ultrasonography, to improve understanding of the spreads of intratendinous injected PRP. Thirty-nine patients (15 males, 24 females; mean age, 49.3 years), who had symptoms on their elbows (> 6 months) and diagnosed as lateral (25 elbows) or medial (14 elbows) tendinopathies of elbow, were included. The severity of tendon pathology was assessed by ultrasonography as tear or no tear. Immediately after ultrasound-guided PRP injection, ultrasound images were evaluated to assess the area of PRP distribution, which was defined as the presence of fluid or microbubbles. Ultrasound revealed that 13 elbows had tendon tear and 26 had no tear, respectively. Post-injection ultrasound confirmed the injected PRP was within the tendon in all cases. The mean distance of distribution from the injection site was 12.6 mm (5.0-26.0 mm). There was no difference in the distance of PRP distribution between tendon tear and no tear. Injected PRP spread to soft tissue outside the tendon in 20 of 39 cases. Intra-articular extension of PRP was observed in 5 cases. Although PRP remained intratendinous after the injection in all cases, some portion tended to spread outside from the injection site in a short space of time. Postinjection ultrasonographic imaging has a value for observing the spreading patterns of intratendinous PRP injection.

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  • Platelt-Rich Plasma Enhances Cartilage Integration: A BioEngineered In Vitro Model

    Abstract

    Osteoarthritis (OA) is a debilitating disease characterised by degradation of articular cartilage and subchondral bone remodeling. Current therapies for early or midstage disease do not regenerate articular cartilage, or fail to integrate the repair tissue with host tissue, and therefore there is great interest in developing biological approaches to cartilage repair. We have shown previously that platelet-rich plasma (PRP) can enhance cartilage tissue formation. PRP is obtained from a patient\'s own blood, and is an autologous source of many growth factors and other molecules which may aid in healing. This raised the question as to whether PRP could enhance cartilage integration. We hypothesise that PRP will enhance integration of bioengineered cartilage with native cartilage.

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  • Prolotherapy for Lumbar Segmental Instability Associated with Degenerative Disc Disease

    Abstract

    Prolotherapy is an injection-based therapy that may be used in the management of chronic low back pain. In principle, injection solutions are formulated to produce an inflammatory response, which in turn promotes ligamentous and tendinous regeneration.

    This case study series offers some ideas as to how Prolotherapy might be advantageous in the management of discogenic low back pain through improving vertebral segmental stability.

    When the disc is of normal height, the ligaments that hold the spine together remain at normal length. As the disc height decreases as in degenerative disc disease, the vertebrae move closer together. The resultant loss of spinal ligament tension may allow vertebral segmental instability, leading to chronic pain.

    Materials & Methods: The study analysed twenty-one male & female patients aged 35 to 73 years with chronic low back pain and MRI-confirmed low lumbar DDD (some with multi-level disease). They underwent 3 sets of fluoroscopically-guided Prolotherapy injections 1-3 weeks apart. Oswestry scores were analysed pre-Prolotherapy, at 3 months and at 1 year. All Oswestry scores were recorded on 14 patients, with the remainder only having pre and 1 year follow-up scores reported.

    Results: Pre-Prolotherapy Oswestry scores ranged in all patients from 12 to 44. 12 patients reported ADL or functional improvement scores of 80% or greater. 3 patients reported ADL or functional improvement scores of 70% at 1 year follow up. 3 patients also reported complete resolution of LBP and 100% ADL improvement at one-year follow-up with one of these patients becoming symptom-free at 3 months with results maintained at one-year follow-up. On patients for whom 3-month follow-up data was available, there was typically further improvement on ADLs and pain reduction on one-year follow-up. 3 patients reported no ADL or pain reduction benefit at all from the Prolotherapy with one of these patients actually reporting worse LBP and ADL scores at both 3 month and one-year post Prolotherapy. An inverse pattern of reduced pain scores in relation to improved ADL function was noted.

    Conclusions: These findings are consistent with the conclusions of other studies, in that Prolotherapy, in conjunction with rehabilitation would appear to be an effective part of the management pathway for discogenic low back pain associated with degenerative disc disease of the lumbar spine.

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  • Injection Therapy: Intra-articular Platelet-Rich Plasma and Stem Cell Therapy

    Abstract

    Platelet-rich plasma (PRP) has been touted in the sports medicine and orthopaedic surgery communities as a remedy with the ability to bridge the gap between conservative, pain relieving therapies and surgical interventions. Its theoretical advantages include its ability to enhance wound healing, decrease pain and improve function.

    There has also been much excitement about the multipotential nature of mesenchymal stem cells (MSCs), with the potential to regenerate different types of musculoskeletal tissue from cartilage to meniscus.

    Problems with both therapies abound. As yet, there is no common consensus as to what constitutes PRP, its preparation, or the method of its activation. Similarly, MSCs can have multiple origins, be induced in different methods and delivered in a variety of forms. Thus, at present, the evidence to substantiate the claims of either therapy is sparse or fails to be robust enough to support the arguments for its use.

    Our chapter provides an evidence-based insight into the background, preparation and clinical use of both PRP and MSCs, two therapies which have much to offer in regenerating and preserving tissue within the adult knee.

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  • Comparative effectiveness of dextrose prolotherapy versus control injections and exercise in the management of osteoarthritis pain: a systematic review and meta-analysis

    Abstract

    Background: Increasing evidence has supported the use of dextrose prolotherapy for patients with osteoarthritis. However, the real benefits may be affected by differences in injection protocols, comparative regimens, and evaluation scales.

    Methods: PubMed and Scopus were searched from the earliest record until February 2016. One single-arm study and five randomized controlled trials were included, comprising 326 participants. We estimated the effect sizes of pain reduction before and after serial dextrose injections and compared the values between dextrose rolotherapy, comparative regimens, and exercise 6 months after the initial injection.

    Results: Regarding the treatment arm using dextrose prolotherapy, the effect sizes compared with baseline were 0.65 (95% confidence interval [CI], 0.14-1.17), 0.84 (95% CI, 0.40-1.27), 0.85 (95% CI, 0.60-1.10), and 0.87 (95% CI, 0.53-1.21) after the first, second, third, and fourth or more injections, respectively. The overall effect of dextrose was better than control injections (effect size, 0.36; 95% CI, 0.10-0.63). Dextrose prolotherapy had a superior effect compared with local anesthesia (effect size, 0.38; 95% CI, 0.07-0.70) and exercise (effect size, 0.71; 95% CI, 0.30-1.11). There was an insignificant advantage of dextrose over corticosteroids (effect size, 0.31; 95% CI, -0.18 to 0.80) which was only estimated from one study.

    Conclusion: Dextrose injections decreased pain in osteoarthritis patients but did not exhibit a positive dose-response relationship following serial injections. Dextrose prolotherapy was found to provide a better herapeutic effect than exercise, local anesthetics, and probably corticosteroids when patients were retested 6 months following the initial injection.

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  • Use of Platelet-rich Plasma in an Experimental Rheumatoid Arthritis Model

    separated into: Control Group 7 (CG7) and 21 (CG21) days; Experimental Group 7 (EG7) and 21 (EG21) days. RA was induced through intraarticular knee with 100 μL Freud\'s complete adjuvant. On day 10, in GE7 and 21 were injected 100 μL PRP while those in GC7 and CG21 were injected 100 μL phosphate-buffered saline (PBS). On day 8 animals in EG7 and CG7 groups were euthanized. A second injection of 100 μL PRP and 100 μL PBS were performed on day 8 in EG21 and CG21, respectively. As result, we observed that granulation and necrosis tissue were intensely formed in CG7 while in EG7 was lightly formed with moderate osteogenesis and neovascularization. CG21 still presented moderate necrosis tissue, polymorphonuclear cells, and moderate emergence of capillaries, while EG21 showed decreased intensity of capillaries with low granulation tissue. EG21 showed bone tissue cells at a moderate level and subchondral bone formation. In conclusion, PRP intra-articular can be used as a co-adjuvant RA treatment because it was effective in controlling osteogenesis and stimulating the deposit of collagen fibers in cartilage

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  • Valutazione economica sull\'utilizzo de; plasma arricchito di piastrine vs acide ialuronico per iltrattamento dell\'osteoartrosi al ginocchio.

    Abstract

    Porpose: The incresing the incidence of total joint arthroplasty reflects the rises of osteoarthritis (OA) prevalence. OA is a degenerative pathalogy affecting joints with a significant impact on quality of life causing pain, leading to social lfe limitations and loss of work productivity. According to the worls Health Organization, OA is one of the most important causes of proples disability. The burden of the dusease is a correlated with a huge economic impact on the health care systems. Intra-articular infiltration therapies are used between the pharmacological and the surgical phases, in order to delay surgery. This work aims to carry out an economic evaluation on the use of the platelet-Rich-Plasma (PRP) therapy in the treatment of knee OA. The comparator is the hyaluronic acid,i.e. the standard therapy for drug-resistant OA that does not benefit or has short term benefits (<1 month) with intra-articular corticosteroids.

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  • Intradiscal and intra articular facet infiltrations with plasma rich in growth factors reduce pain in patients with chronic low back pain

    Abstract

    Context: Low back pain (LBP) is a complex and disabling condition, and its treatment becomes a challenge.
    Aims: The aim of our study was to assess the clinical outcome of plasma rich in growth factors (PRGF Endoret) infiltrations (one intradiscal, one intra articular facet, and one transforaminal epidural injection) under fluoroscopic guidance control in patients with chronic LBP. PRGF Endoret which has been shown to be an efficient treatment to reduce joint pain. Settings and Design: The study was designed as an observational retrospective pilot study. Eighty six patients with a history of chronic LBP and degenerative disease of the lumbar spine who met inclusion and exclusion criteria were recruited between December 2010 and January 2012. Subjects and Methods: One intradiscal, one intra articular facet, and one transforaminal epidural injection of PRGF Endoret under fluoroscopic guidance control were carried out in 86 patients with chronic LBP in the operating theater setting. Statistical Analysis Used: Descriptive statistics were performed using absolute and relative frequency distributions for qualitative variables and mean values and standard deviations for quantitative variables. The nonparametric Friedman statistical test was used to determine the possible differences between baseline and different follow up time points on pain reduction after treatment.

    Results: Pain assessment was determined using a visual analog scale (VAS) at the first visit before (baseline) and after the procedure at 1, 3, and 6 months. The pain reduction after the PRGF Endoret injections showed a statistically significant drop from 8.4

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  • Prospective randomized clinical study for the treatment of laterat epicondylitis: Comparison among PRP (Platelet-Rich-Plasma), Prolotherapy Physiotherapy and ESWT

    Abstract

    As recent knowledge proved that pathology of lateral epicondylitis is no more an inflammatory condition, but angiofibroblastic degeneration, steroid injection is no more recommended for lateral epicondylitis. It seems to be inappropriate that most of the comparative study used steroid injection as control group, as steroid injection is no more accepted as a treatment option. As control group should be treated with widely accepted proven method, the authors concluded that physiotherapy is the optimal control group treatment in designing prospective randomized control study. Ideal treatment option for lateral epicondylitis should have potential to promote healing of collagen fibres as basic pathology of lateral epicondylitis is the presence of degenerative changes including disorganized collagen fibres. Among recently highlighted treatments which have healing potential theoretically. The authors chose PRP (Platelet-Rich Plasma), prolotherapy and ESWT (Extracorpeal Shockwave Therapy) considering accessibility and national regulations. Consecutive patients who had refractory elbow pain more than 6 months were recruited into the study and randomized into 4 groups. Group A: Physiotherapy, B: ESWT, C: Prolotherapy, D: PRP. A power analysis performed before data collection indicated that a sample size of 200 patients (50 patients per group) will have 80% power which is able to detect 30% difference in DASH scoring system at a significance level of .05 (effect size=0.64). Mean and standard deviation for power analysis was determined according to preliminary study. Mean age was 52 years and mean Follow-up was 29 months (24-39). All 4 groups showed a decrease of DASH score after treatments (A: from 41.2 to 33.2, B: from 41.3 to 28.0, C: from 37.1to 16.3, D: from 41.2 to 10.6). Difference among DASH scores were not significant at initial point, 3 months and 6 months after the treatments (p>0.01). Post hoc comparisons at 18 and 24 months after treatment indicated that DASH score was better in the PRP group (p<0.01) than in the ESWT or the physiotherapy group and in the prolotherapy group (p<0.01) than in the physiotherapy group. In summary, prolotherapy and PRP showed better clinical outcome compared to ESWT and physiotherapy group and PRP showed most superior results.

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  • Physical Medicine and Rehabilitation Clinics of North America

    Abstract

    The clinical application of platelet-rich plasma (PRP) and other regenerative therapies in sports, spine, and musculoskeletal medicine has soared in the last decade. Over this period, many factors have converged to fuel this development. Advances in sci-entific understanding of tendinopathy as a degenerative cellular and connective tissue process; lack of long-term efficacy of steroid injection therapies, which has prompted the need for alternative therapies; advances in musculoskeletal ultrasound (US) to facilitate diagnosis and guide interventions; as well as translation of treatment para-digms from colleagues in oral and veterinary surgery have all contributed to the advancement of this regenerative field

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  • In vivo clinical and radiological effects of platelet-rich plasma on interstitial supraspinatus lesion: Case series

    Abstract

    Background:Rotator cuff tear (RCT) is a frequent condition of clinical relevance that can be managed with a symptomatic conservative treatment, but surgery is often needed. Biological components like leukocytes and platelet rich plasma (L-PRP) could represent an alternative curative method for interstitial RCT.

    Hypotheses:It has been hypothesized that an ultrasound guided L-PRP injection in supraspinatus interstitial RCT could induce radiological healing.

    Material and methods:A prospective case series including 25 patients was performed in order to assess the effect of L-PRP infiltration into supraspinatus interstitial RCTs. Primary outcome was tear size change determined by magnetic resonance imaging arthrogram (MRA) before and 6 months after L-PRP infiltration. Secondary outcomes were Constant score, SANE score, and pain visual analog scale (VAS) after L-PRP infiltration.

    Results:Tear volume diminution was statistically significant (P = .007), and a >50% tear volume diminution was observed in 15 patients. A statistically significant improvement of Constant score (P < .001), SANE score (P = .001), and VAS (P < .001) was observed. In 21 patients, Constant score improvement reached the minimal clinical important difference of 10.4 points.

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  • Dextrose Prolotherapy: A Narrative Review of Basic Science, Clinical Research, and Best Treatment Recommendations

    Abstract

    Background:Prolotherapy is an injection-based treatment of chronic musculoskeletal pain. A general surgeon in the United States, George Hackett, formalized injection protocols in the 1950s, based on 30 years of clinical experience.1 Prolotherapy has been identified as a regenerative injection therapy2 but is differentiated from other regenerative injection therapies, such as platelet-rich plasma (PRP) and stem cell injection by the absence of a biologic agent.

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  • MRI Documented Improvement in Patient with Juvenile Osteochondritis Dissecans Treated with Platelet Rich Plasma

    Abstract

    Osteochondritis dissecans refers to the separation of osteochondral fragments from the bed of the joint surface. Definition of lesion goes by the existence of an open epiphyseal line in a juvenile form and the absence, representing an adult form. The treatment of osteochondritis dissecans depends on age, on the epiphyseal line, its length, location and stability of the lesion. A conservative treatment is preferred in juvenile cases; a surgical intervention may be necessary for unstable lesions and those not responding to conservative approaches. Showing no positive development in symptoms and physical status for six months, our 16-year-old male patient received two intraarticular platelet rich plasma injections three months apart, focusing on the lesion of steochondritis dissecans localized in the right knee. At the end of the 18th month, the patient did not show any limitation in his physical activities and radiographic examination confirmed the successful treatment. Having obtained positive results, we believe that PRP injections are a safe, simple, and minimally invasive treatment option for juvenile OCD which doesn\'t respond to conservative therapy before a surgical approach.

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  • Ozone Improves Pain Relief, Function and Quality of Life in Patients with Knee Osteoarthritis: A Prospective Quasi-Experimental Before-After Study

    Abstract

    Background: The study was conducted to: 1) demonstrate the effectiveness of a treatment protocol with Ozone therapy in pain, function, and quality of life in patients with knee osteoarthritis; and 2) apply Ozone as a conservative treatment option with a demonstrable level of scientific evidence.

    Methods: This prospective quasi-experimental before-after study was conducted on 119 patients with knee osteoarthritis, having Kellgren-Lawrence grade 2 or more, who referred to hospital of Santa Cristina\'s University, from January 2012 to April 2016. The protocol consisted of an intra-articular infiltration of a medical mixture of Oxygen-Ozone (95% - 5%) 20mL, at a 20ug / mL concentration, during a total number of 4 sessions (once per week). Pain and quality of life were measured by visual analogical scale (VAS) and western Ontario and mc master universities index for osteoarthritis (WOMAC) at the beginning and end of the treatment.

    Results: The mean age of participants was 66.29 years. The sample was composed of 70.5% Women (n = 84) and 29.5% men (n = 35). The severity of OA according to Kellgren-Lawrence scale was 2.94

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  • Comparison between intrarticular injection of hyaluronic acid, oxygen ozone, and the combination of both in the treatment of knee osteoarthrosis.

    Abstract

    This study aimed to compare short-term clinical outcomes between intra-articular injection of hyaluronic acid (HA), oxygen ozone (O2O3), and the combination of both, in patients affected by osteoarthrosis (OA) of the knee. Seventy patients (age 45-75 years) with knee OA were randomized to intra-articular injections of HA (n=23), or O2O3 (n=23) or combined (n=24) one per week for 5 consecutive weeks. KOOS questionnaire and visual analog scale (VAS), before treatment (pre) at the end (post), and at 2 months after treatment ended (follow-up) were used as outcome measures. Analysis showed a significant effect (P < 0.05) of the conditions (pre, post and follow-up) in all parameters of the KOOS score and a significant effect (P < 0.05) of groups (HA, O2O3 and combined) for pain, symptoms, activities of daily living and quality of life. The combined group scores were higher compared to the HA and O2O3 groups, especially at follow-up. The combination of O2O3 and HA treatment led to a significantly better outcome especially at 2-month follow-up compared to HA and O2O3 given separately to patients affected by OA of the knee.

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  • Prolotherapy Injections for Diastasis Recti: A Case Report

    Abstract

    This case report detailed the history and treatment of a female postpartum patient with diastasis recti. Treatment for this patient included the use of prolotherapy, an injection-based therapy using dextrose as the active compound. The solution used during the course of therapy was composed of 6 mL of 50% dextrose, 3 mL of 1% lidocaine, and 1 mL of methylcobalamin (1000 mcg/mL). Injections were administered every 2 weeks for a total of 7 prolotherapy sessions. Following the series of prolotherapy injections, there was a marked closure observed in the diastasis, decreasing from 2.7 cm to 0.5 cm. The patient did not report any side effects, and no complications were observed or recorded. This appears to be the first case report documenting an improvement in abdominal diastasis recti following a course of prolotherapy. Within the limitations of the study design, further research is recommended to evaluate prolotherapy for diastasis recti in postpartum patients.

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  • The Effect of Subepineural Platelet-rich Plasma on Regeneration of the Sciatic Nerve in a Rat Model

    Abstract

    Background: Peripheral nerve injury is one of the most challenging of modern surgical problem. Recent advances in understanding the physiological and molecular pathways demonstrated the important role of growth factors in peripheral nerve regeneration. Platelet-rich plasma (PRP) is a biological product that has many growth factors. The aim of this study was to investigate the effect of PRP in the regeneration of sciatic nerve crush in the rat model.

    Methods: In this experimental study that established in the animal lab of the Hazrat Fatemeh Hospital in Tehran during September to October 2013, 24 healthy male Sprague-Dawley rats (200-250 g) were randomly divided into two groups. In all rats, the sciatic nerve was cut and then carefully repaired by the tension free method under a light microscope. In group 1, after the repair, 0.05

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  • The Journal of Alternative and Complementary Medicine

    Abstract

    Objective: Randomized and open-label studies assessing prolotherapy for knee osteoarthritis have found quantitative improvement on the validated Western Ontario McMaster University Osteoarthritis Index (WOMAC) compared with baseline status and control therapies. This study assessed the qualitative response of participants receiving prolotherapy, an injection-based complementary treatment for symptomatic knee osteoarthritis (OA).

    Design: Qualitative study using semi-structured in-depth interviews at 52 weeks after enrollment; transcribed responses were discussed by coauthors to identify themes; disagreement was resolved by consensus.

    Results: Participants had baseline demographic and knee OA severity similar to those of participants in three prior intervention trials, as well as similar robust follow-up WOMAC score change (19.9

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  • Protective Nature of Platelet-Rich Plasma Against Chondrocyte Death When Combined With Corticosteroids or Local Anesthetics

    Abstract

    Background: The use of corticosteroids and local anesthetics to treat osteoarthritis has established benefits, including relief of pain and increased range of motion, but may also have the potential to lead to tissue atrophy or degeneration, specifically on chondrocytes. There is growing evidence that platelet-rich plasma (PRP) has anti-inflammatory characteristics that can limit the cytotoxic effects of corticosteroids and local anesthetics.

    Hypothesis/Purpose: The purpose of this study was to determine the effects of PRP in chondrocyte cultures when combined with corticosteroids or local anesthetics. The hypothesis of this study was that PRP would (1) dampen the negative effects on chondrocyte viability and (2) improve chondrocyte proliferation seen with corticosteroid or local anesthetic treatment alone.

    Study Design: Controlled laboratory study.

    Methods: Peripheral blood was obtained from 8 healthy participants, followed by centrifugation to obtain PRP. Human chondrocytes were treated with PRP alone or in combination with corticosteroids or local anesthetics. Saline (concentration of 0.9%) served as the control. Luminescence and radioactive thymidine assays were performed to examine chondrocyte viability and proliferation, respectively. Cell exposures of 0, 5, 10, and 30 minutes were used for viability and 120 hours for proliferation.

    Results: The presence of PRP significantly limited the negative effect on chondrocyte viability at tested time points for the examined corticosteroids and local anesthetics (P < .05). PRP in addition to corticosteroids and local anesthetics significantly improved chondrocyte proliferation (P < .05).

    Conclusion: The addition of PRP can significantly reduce the cytotoxic effects of corticosteroids and/or local anesthetics applied to chondrocytes. PRP can improve the proliferation of chondrocytes compared with corticosteroids or local anesthetics alone.

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  • Platelet-Rich Plasma in Pain Medicine

    Abstract

    For the past 20 years, autologous Platelet-Rich Plasma (PRP) has been safely employed and its use has been documented in many areas, including orthopedics, sports medicine, dentistry, neurosurgery, ophthalmology, urology, wound healing, cosmetics, cardiothoracic, otorhinolaryngology and maxillofacial surgery.

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