126
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Carson J, Boelig M, Carrino JA, McFarland EG. Sternoclavicular Stress Lesions In An Adolescent Gymnast. Med Sci Sports Exerc 2008. [DOI: 10.1249/01.mss.0000322063.46824.b5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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127
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Keyurapan E, Hu SJ, Redett R, McCarthy EF, McFarland EG. Pressure ulcers of the thorax after shoulder surgery. Knee Surg Sports Traumatol Arthrosc 2007; 15:1489-93. [PMID: 17602210 DOI: 10.1007/s00167-007-0353-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Accepted: 04/12/2007] [Indexed: 10/23/2022]
Abstract
Of 896 patients having arthroscopic or combined arthroscopic and open shoulder procedures at our institution during a 10 year period, three sustained severe pressure ulcerations to the dependent, opposite thorax (one after an arthroscopic procedure, two after combined procedures). These three patients had an average age of 35 years (range 18-50 years) and an average operative time of 107 min (range 82-121 min). During surgery, each patient had an axillary roll (a bag of intravenous fluids) between the dependent thorax and the operative table. Immediate postoperative signs and symptoms included severe pain in the thorax of the nonoperative side and areas of full-thickness skin loss, and blistering. Biopsy of the lesion in one patient was consistent with skin pressure ulceration. At a minimum of 10 months of follow up, all three patients had recovered full range of motion and strength without skin grafting or additional surgery. The exact cause of these lesions is unknown, but we speculate that they resulted from a combination of the use of an intravenous fluid bag as an axillary roll, fluid between the skin and the roll, and friction from moving the patient.
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128
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Shindle MK, Khosravi AH, Cascio BM, Deune EG, McFarland EG. Surgical treatment of a tear of the pectoralis major muscle at its sternal origin. A case report. J Bone Joint Surg Am 2007; 89:2040-3. [PMID: 17768204 DOI: 10.2106/jbjs.f.00934] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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129
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Gill HS, El Rassi G, Bahk MS, Castillo RC, McFarland EG. Physical examination for partial tears of the biceps tendon. Am J Sports Med 2007; 35:1334-40. [PMID: 17369556 DOI: 10.1177/0363546507300058] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The accuracy of the physical examination for tears of the long head of the biceps remains controversial. PURPOSE The goals were 1) to characterize the occurrence of partial tears of the long head of the biceps tendon in a group of consecutive patients, and 2) to analyze the diagnostic value of various clinical tests for pathologic lesions of the proximal biceps tendon. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS Of 847 consecutive patients who underwent arthroscopic procedures for a variety of shoulder conditions, 40 were found at the time of arthroscopy to have partial biceps tendon tears. The average age of these 24 men and 16 women was 59 years (range, 18-83). Preoperative physical examinations had included 9 commonly used tests for shoulder examination. Statistical analysis included sensitivity, specificity, negative predictive value, positive predictive value, and likelihood ratios for these tests. RESULTS The prevalence rate of partial tears was 5% (40/847) of all arthroscopic procedures. The most commonly associated conditions included rotator cuff tears (85% [34/40]) and anterior instability (7.5% [3/40]). Tenderness on palpation of the long head of the biceps tendon had a sensitivity of 53%, a specificity of 54%, and a likelihood ratio of 1.13. The sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratios for Speed's test were 50%, 67%, 8%, 96%, and 1.51, respectively. CONCLUSION In patients with rotator cuff abnormality, the diagnosis of partial biceps tears cannot be made reliably with existing physical examination tests. Diagnostic arthroscopy is recommended, if clinically indicated, for potential partial tears of the long head of the biceps tendon. The treating physician should be prepared to treat unsuspected tears of the long head of the biceps tendon at the time of surgery.
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130
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Herickhoff PK, Keyurapan E, Fayad LM, Silberstein CE, McFarland EG. Scapular stress fracture in a professional baseball player: a case report and review of the literature. Am J Sports Med 2007; 35:1193-6. [PMID: 17322129 DOI: 10.1177/0363546506298278] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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131
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McFarland EG. 87. Med Sci Sports Exerc 2007. [DOI: 10.1249/01.mss.0000272290.33213.3e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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132
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McFarland EG. 231. Med Sci Sports Exerc 2007. [DOI: 10.1249/01.mss.0000272502.00902.0c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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133
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McFarland EG. 1139. Med Sci Sports Exerc 2007. [DOI: 10.1249/01.mss.0000273498.75425.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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134
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Dharamsi F, Tan EW, McFarland EG. Humeral Head Fracture in a 14-Year Old Dodgeball Player. Med Sci Sports Exerc 2007. [DOI: 10.1249/01.mss.0000273372.47198.ef] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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135
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Tan EW, Dharamsi F, McFarland EG. Traumatic Olecranon Bursitis in a Collegiate Soccer Player. Med Sci Sports Exerc 2007. [DOI: 10.1249/01.mss.0000273390.63750.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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136
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Faustin CM, El Rassi G, Toulson CE, Lin SK, McFarland EG. Isolated posterior labrum tear in a golfer: a case report. Am J Sports Med 2007; 35:312-5. [PMID: 16957007 DOI: 10.1177/0363546506293262] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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137
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Farmer KW, Hammond JW, Queale WS, Keyurapan E, McFarland EG. Shoulder arthroplasty versus hip and knee arthroplasties: a comparison of outcomes. Clin Orthop Relat Res 2007; 455:183-9. [PMID: 16980898 DOI: 10.1097/01.blo.0000238839.26423.8d] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Although outcomes of shoulder, hip, and knee arthroplasties have been well-described, there have been no studies directly comparing the outcomes of these procedures as treatments for osteoarthritis. We compared the inpatient mortality, complications, length of stay, and total charges of patients who had shoulder arthroplasty for osteoarthritis with those of patients who had hip and knee arthroplasties for osteoarthritis. A review of the Maryland Health Services Cost Review Commission discharge database identified 994 shoulder arthroplasties, 15,414 hip arthroplasties, and 34,471 knee arthroplasties performed for osteoarthritis from 1994 to 2001. There were no in-hospital deaths after shoulder arthroplasty, whereas 27 (0.18%) and 54 (0.16%) deaths occurred after hip and knee arthroplasties, respectively. Compared with patients who had hip or knee arthroplasties, patients who had shoulder arthroplasties had, on average, a lower complication rate, a shorter length of stay, and fewer total charges. The latter had 1/2 as many in-hospital complications, were 1/6 as likely to have a length of stay 6 days or greater, and were 1/10 as likely to be charged more than $15,000. We believe shoulder arthroplasty is as safe as the more commonly performed major joint arthroplasties.
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MESH Headings
- Aged
- Arthroplasty, Replacement/economics
- Arthroplasty, Replacement/mortality
- Arthroplasty, Replacement, Hip/economics
- Arthroplasty, Replacement, Hip/mortality
- Arthroplasty, Replacement, Knee/economics
- Arthroplasty, Replacement, Knee/mortality
- Female
- Hospital Charges
- Humans
- Length of Stay
- Male
- Middle Aged
- Multivariate Analysis
- Retrospective Studies
- Shoulder Injuries
- Shoulder Joint/surgery
- Survival Analysis
- United States
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Abstract
Laxity testing is an important part of the examination of any joint. In the shoulder, it presents unique challenges because of the complexity of the interactions of the glenohumeral and scapulothoracic joints. Many practitioners believe that laxity testing of the shoulder is difficult, and they are unclear about its role in evaluation of patients. The objectives of the various laxity and instability tests differ, but the clinical signs of such tests can provide helpful information about joint stability. This article summarizes the principles of shoulder laxity testing, reviews techniques for measuring shoulder laxity, and evaluates the clinical usefulness of the shoulder laxity tests. Shoulder laxity evaluation can be a valuable element of the shoulder examination in patients with shoulder pain and instability.
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139
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Demetracopoulos CA, Kapadia NS, Herickhoff PK, Cosgarea AJ, McFarland EG. Surgical stabilization of os acromiale in a fast-pitch softball pitcher. Am J Sports Med 2006; 34:1855-9. [PMID: 16766797 DOI: 10.1177/0363546506288305] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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140
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McFarland EG, Sanguanjit P, Tasaki A, Keyurapan E, Fishman EK, Fayad LM. The reverse shoulder prosthesis: A review of imaging features and complications. Skeletal Radiol 2006; 35:488-96. [PMID: 16570176 DOI: 10.1007/s00256-006-0109-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2005] [Revised: 02/21/2006] [Accepted: 02/22/2006] [Indexed: 02/02/2023]
Abstract
BACKGROUND The reverse shoulder prosthesis is a prosthesis that has been in clinical use in Europe since 1985 and was approved for use in the United States in 2004. This unique prosthesis has a baseplate attached to the glenoid, which holds a spherical component, while the humeral component includes a polyethylene insert that is flat. This design is the "reverse" configuration of that seen with a conventional arthroplasty, in which the spherical component is part of the humeral component. The indications for the reverse prosthesis are: (1) painful arthritis associated with irreparable rotator cuff tears (cuff tear arthropathy), (2) failed hemiarthroplasty with irreparable rotator cuff tears, (3) pseudoparalysis due to massive, irreparable rotator cuff tears, (4) some reconstructions after tumor resection, and (5) some fractures of the shoulder not repairable or reconstructable with other techniques. This prosthesis can produce a significant reduction in pain and some improvement in function for most of the indications mentioned. However, the unique configuration and the challenge of its insertion can result in a high incidence of a wide variety of unusual complications. Some of these complications, such as dislocation of the components, are similar to conventional shoulder replacement. Other complications, such as notching of the scapula and acromial stress fractures, are unique to this prosthesis. CONCLUSION The configuration of the reverse prosthesis, its normal radiographic appearance and potential complications associated with its use are reviewed.
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141
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Farber AJ, Castillo R, Clough M, Bahk M, McFarland EG. Clinical assessment of three common tests for traumatic anterior shoulder instability. J Bone Joint Surg Am 2006; 88:1467-74. [PMID: 16818971 DOI: 10.2106/jbjs.e.00594] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although traumatic anterior shoulder instability is common, the usefulness of various physical examination tests as tools for the diagnosis of this condition has been studied infrequently. We hypothesized that (1) such tests would be specific but not sensitive for this condition, (2) the usefulness of the anterior drawer test would be limited because of pain during the test, and (3) an anterior drawer test would be a useful adjunct for making the diagnosis if it reproduced the instability symptoms. METHODS Between 2000 and 2004, 363 patients underwent a physical examination followed by shoulder arthroscopy. Forty-six patients with traumatic anterior shoulder instability that had been noted arthroscopically or documented radiographically after the trauma were included in our study group, and the remaining patients served as controls. The clinical usefulness of three tests (anterior apprehension, relocation, and anterior drawer tests) performed during the physical examination to make a diagnosis of traumatic anterior instability then was evaluated with statistical methods to assess their sensitivity, specificity, and likelihood ratios. RESULTS If demonstration (or relief) of apprehension was used as the diagnostic criterion for a positive test, the sensitivity, specificity, and likelihood ratio were 72%, 96%, and 20.2, respectively, for the apprehension test and 81%, 92%, and 10.4, respectively, for the relocation test. If pain (or relief of pain) was used as the diagnostic criterion for a positive test, the values for the sensitivity, specificity, and likelihood ratio of both tests were lower. The anterior drawer test could be performed successfully in the physician's office for 87% of the patients. If reproduction of instability symptoms was used as the criterion for a positive anterior drawer test, the sensitivity, specificity, and likelihood ratio values of that test were 53%, 85%, and 3.6, respectively. CONCLUSIONS The three physical examination tests for traumatic anterior shoulder instability are specific but not sensitive. Apprehension is a better criterion than pain for a positive apprehension or relocation test. The anterior drawer test (when pain does not prevent it from being performed) is helpful for diagnosing traumatic anterior instability. LEVEL OF EVIDENCE Diagnostic Level I. See Instructions to Authors for a complete description of levels of evidence.
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142
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Keyurapan E, Hu SJ, Streiff MB, Fayad LM, McFarland EG. Iatrogenic symptomatic chest wall hematoma after shoulder arthroplasty. A report of two cases. J Bone Joint Surg Am 2006; 88:1603-8. [PMID: 16818988 DOI: 10.2106/jbjs.e.00500] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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143
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Devgan LL, Gill HS, Faustin C, Park HB, McFarland EG. Posterior dislocation in a voluntary subluxator: a case report. Med Sci Sports Exerc 2006; 38:613-7. [PMID: 16679973 DOI: 10.1249/01.mss.0000210210.40694.df] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Posterior instability of the shoulder is an uncommon occurrence. Its etiology has been classified as traumatic or atraumatic and its type as voluntary (individual can subluxate the shoulder posteriorly) or involuntary. Typically, patients with posterior voluntary instability do not have a history of trauma, can be treated successfully with physical therapy; and undergo surgery if the instability becomes symptomatic or develops an involuntary component. We present a patient with voluntary posterior subluxation who developed a symptomatic posterior instability after a traumatic event. PATIENT PRESENTATION This patient was unable to return to his preinjury function despite nonoperative interventions, including rehabilitation, and required operative treatment of his posterior labrum lesion. This patient had a rare combination of voluntary, atraumatic instability that coexisted with traumatic posterior shoulder instability. CONCLUSION This case emphasizes the importance of recognizing this constellation of instability patterns and documents that traumatic posterior instability, even in the presence of preexisting voluntary posterior subluxations, may require operative intervention in young, active individuals.
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144
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Robotham D, Yousem D, McFarland EG, Martire J. Neck Pain Due To Windersurfing. Med Sci Sports Exerc 2006. [DOI: 10.1249/00005768-200605001-01579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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145
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146
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McFarland EG. Clinical Workshop – The Shoulder Exam in the Throwing Athlete. Med Sci Sports Exerc 2006. [DOI: 10.1249/00005768-200605001-00052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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147
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McFarland EG. 1197. Med Sci Sports Exerc 2006. [DOI: 10.1249/00005768-200605001-01531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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148
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Richman JM, Stearns JD, Rowlingson AJ, Wu CL, McFarland EG. The introduction of a regional anesthesia rotation: effect on resident education and operating room efficiency. J Clin Anesth 2006; 18:240-1. [PMID: 16731336 DOI: 10.1016/j.jclinane.2005.08.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2004] [Accepted: 08/30/2005] [Indexed: 11/29/2022]
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149
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150
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McFarland EG, Selhi HS, Keyurapan E. Clinical evaluation of impingement: what to do and what works. Instr Course Lect 2006; 55:3-16. [PMID: 16958434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Theories about the etiologies of anterior and lateral shoulder pain have changed greatly since "impingement disease" was first described. It is thought that such pain may be caused by contact between the rotator cuff and the acromion and coracoacromial ligament, but the exact pathophysiology of rotator cuff disease remains unclear. The shoulder is notoriously difficult to examine because of the variability of the physical findings in patients with rotator cuff disease. New concepts of impingement, such as coracoid impingement and internal impingement, have been advanced. Although no test is definitive for all causes of anterior and lateral shoulder pain, as the pathophysiology of these conditions becomes better understood the ability to evaluate them clinically also improves.
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