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Blanke F, Warth F, Oehler N, Siegl J, Prall WC. Autologous platelet-rich plasma and fibrin-augmented minced cartilage implantation in chondral lesions of the knee leads to good clinical and radiological outcomes after more than 12 months: A retrospective cohort study of 71 patients. J Exp Orthop 2024; 11:e70051. [PMID: 39415804 PMCID: PMC11480521 DOI: 10.1002/jeo2.70051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 08/22/2024] [Accepted: 09/06/2024] [Indexed: 10/19/2024] Open
Abstract
Purpose The treatment of cartilage lesions remains a challenge. Matrix-associated autologous chondrocyte implantation has evolved to become the gold standard procedure. However, this two-step procedure has crucial disadvantages, and the one-step minced cartilage procedure has gained attention. This retrospective study aimed to evaluate the clinical and radiological outcome of an all-autologous minced cartilage technique in cartilage lesions at the knee joint. Methods In this retrospective cohort study, 71 patients (38.6 years ± 12.0, 39,4% female) with a magnetic resonance imaging (MRI) confirmed grade III-IV cartilage defect at the medial femur condyle (n = 20), lateral femur condyle (n = 2), lateral tibia plateau (n = 1), retropatellar (n = 28) and at the trochlea (n = 20) were included. All patients were treated with an all-autologous minced cartilage procedure (AutoCart™). Clinical knee function was evaluated by the Tegner score, visual analogue scale, the subjective and objective evaluation form of the International Knee Documentation Committee and the Knee Injury and Osteoarthritis Outcome Score (KOOS). MRI analyses were performed by magnetic resonance observation of cartilage repair tissue (MOCART) 2.0 knee score. Follow-up examination was 13.7 ± 4.2 (12-24) months postoperative. Results All clinical scores significantly improved after surgical intervention (p < 0.0001), especially the subgroup sports and recreation of KOOS showed clear changes from baseline in the follow-up examination. In the postoperative MRI evaluation, 39 of 71 patients showed a complete fill of the cartilage defect without subchondral changes in 78% of the patients in the MOCART 2.0 score in the follow-up analysis. None of the patients showed adverse effects, which are linked to the minced cartilage procedure during the time of follow-up. Conclusion An all-autologous minced cartilage technique for chondral lesions at the knee joint seems to be an effective and safe treatment method with good clinical and radiological short-term results. Level of Evidence Level IV.
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Affiliation(s)
- Fabian Blanke
- Department of Knee‐, Hip‐, Shoulder‐, and Elbow Surgery, FIFA Medical Centre of ExcellenceSchön Klinik München HarlachingMünchenGermany
- Department of Orthopedic SurgeryUniversity RostockRostockGermany
- Department of Orthopedic Sports Medicine and Arthroscopic SurgeryHessing Stiftung AugsburgAugsburgGermany
| | - Franziska Warth
- Department of Knee‐, Hip‐, Shoulder‐, and Elbow Surgery, FIFA Medical Centre of ExcellenceSchön Klinik München HarlachingMünchenGermany
- Department of Orthopedic SurgeryUniversity RostockRostockGermany
| | - Nicola Oehler
- Department of Orthopedic Sports Medicine and Arthroscopic SurgeryHessing Stiftung AugsburgAugsburgGermany
| | - Johanna Siegl
- Department of Knee‐, Hip‐, Shoulder‐, and Elbow Surgery, FIFA Medical Centre of ExcellenceSchön Klinik München HarlachingMünchenGermany
- Department of Orthopedic SurgeryUniversity RostockRostockGermany
| | - Wolf Christian Prall
- Department of Knee‐, Hip‐, Shoulder‐, and Elbow Surgery, FIFA Medical Centre of ExcellenceSchön Klinik München HarlachingMünchenGermany
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Hung VT, Dee DT, McGarry MH, Lee TQ. Evaluation of Tibiofemoral Contact Mechanics After a Novel Hybrid Procedure for Femoral Osteochondral Defect Repairs With a Subchondral Implant and Dermal Matrix. Orthop J Sports Med 2024; 12:23259671241266332. [PMID: 39286524 PMCID: PMC11403705 DOI: 10.1177/23259671241266332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 02/12/2024] [Indexed: 09/19/2024] Open
Abstract
Background There is a lack of procedures that adequately address the subchondral bone structure and function for reconstructing osteochondral defects in the femoral condyles. Purpose To biomechanically evaluate the tibiofemoral joint contact characteristics before and after reconstruction of femoral condylar osteochondral defects using a novel hybrid reconstructive procedure, which was hypothesized to restore the contact characteristics to the intact condition. Study Design Controlled laboratory study. Methods Tibiofemoral contact areas, contact forces, and mean contact pressures were measured in 8 cadaveric knees (mean age 52 ± 11 years; 6 women, 2 men) using a custom testing system and pressure mapping sensors. Five conditions were tested for each condyle: intact, 8-mm defect, 8-mm repair, 10-mm defect, and 10-mm repair. Medial femoral condylar defects were evaluated at 30° of knee flexion and lateral condylar defects were evaluated at 60° of knee flexion, with compressive loads of 50, 100, and 150 N. The defects were reconstructed with a titanium fenestrated threaded implant countersunk in the subchondral bone and an acellular dermal matrix allograft. Repeated-measures analysis of variance with Bonferroni correction for multiple comparisons was used to compare the results between the 5 testing conditions at each load. Results Medial condylar defects significantly increased mean contact pressure on the lateral side (P < .042), which was restored to the intact levels with repair. The lateral condylar defect decreased the mean contact pressure laterally while increasing the mean pressure medially. The lateral and medial mean contact pressures were restored to intact levels with the 8-mm lateral condylar defect repair. The medial mean contact pressure was restored to intact levels with the 10-mm lateral condylar defect repair. The lateral mean contact pressure decreased compared with the intact state with the lateral condylar 10-mm defect repair. Conclusion Tibiofemoral joint contact pressure was restored to the intact condition after reconstruction of osteochondral defects with dermal allograft matrix and subchondral implants for the repair of both 8- and 10-mm lateral condylar defects as well as 8-mm medial condylar defects but not completely for 10-mm medial condylar defects. Clinical Relevance The novel hybrid procedure for osteochondral defect repair restored tibiofemoral joint contact characteristics to normal in a cadaveric model.
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Affiliation(s)
- Victor T Hung
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, USA
| | - Derek T Dee
- Dee Sports Orthopaedics, Huntington Beach, California, USA
| | - Michelle H McGarry
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, USA
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, USA
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Behrendt P, Eggeling L, Lindner A, von Rehlingen-Prinz F, Krause M, Hoffmann M, Frosch KH, Akoto R, Gille J. Autologous matrix-induced chondrogenesis provides better outcomes in comparison to autologous minced cartilage implantation in the repair of knee chondral defects. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39077845 DOI: 10.1002/ksa.12387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 07/06/2024] [Accepted: 07/11/2024] [Indexed: 07/31/2024]
Abstract
PURPOSE In symptomatic mid-sized focal chondral defects, autologous matrix-induced chondrogenesis (AMIC) and minced cartilage implantation (MCI) offer two versatile treatment options. This study aimed to conduct a matched-patient analysis of patient-reported outcome measures to compare these two surgical treatment methods for focal chondral defects. METHODS At the first centre, patients underwent a single-stage procedure in which autologous cartilage was hand-minced, implanted into the defect and fixed with fibrin glue. At the second centre, patients underwent AMIC, which was fixed in place with fibrin glue. All patients were seen 2-4 years postoperatively. Postoperative outcomes were assessed using the visual analogue scale for pain (VAS), the Lysholm score and the five domains of the knee osteoarthritis outcome score (KOOS). Patients from each surgical centre were matched by age, sex, defect size and defect localisation. RESULTS In total, 48 patients from two surgical centres (24 from each site) were matched for sex, age (MCI 30.3 ± 14.9 years vs. AMIC 30.8 ± 13.7 years) and defect size (MCI 2.49 ± 1.5 cm2 vs. AMIC 2.65 ± 1.1 cm2). Significantly better scores in the AMIC cohort were noted for VAS (p = 0.004), Lysholm (p = 0.043) and the KOOS subscales for pain (p = 0.016) and quality of life (p = 0.036). There was a significantly greater proportion of positive responders for Lysholm in the AMIC group (92%) compared with the MCI group (64%). CONCLUSIONS The AMIC procedure delivers superior patient outcomes compared with hand-minced autologous cartilage implantation. These are mid-term outcomes, with follow-up between 2 and 4 years. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Peter Behrendt
- Department of Orthopaedics and Traumatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
- Department of Anatomy, Christian-Albrechts-University, Kiel, Germany
| | - Lena Eggeling
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
| | - Anja Lindner
- Department of Trauma Surgery, Orthopedics and Sportsorthopedics, Asklepios St. Georg, Hamburg, Germany
| | | | - Matthias Krause
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Hoffmann
- Department of Trauma Surgery, Orthopedics and Sportsorthopedics, Asklepios St. Georg, Hamburg, Germany
| | - Karl-Heinz Frosch
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ralph Akoto
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
| | - Justus Gille
- Department of Orthopaedic and Trauma Surgery, Regio Kliniken, Hamburg, Germany
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Gebhardt S, Vollmer M, Zimmerer A, Rochel I, Balcarek P, Niemeyer P, Wassilew GI. Factors Affecting Choice of Surgical Treatment of Cartilage Lesions of the Knee: An Analysis of Data From 5143 Patients From the German Cartilage Registry (KnorpelRegister DGOU). Orthop J Sports Med 2024; 12:23259671241255672. [PMID: 39070901 PMCID: PMC11273558 DOI: 10.1177/23259671241255672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/01/2024] [Indexed: 07/30/2024] Open
Abstract
Background Symptomatic full-thickness cartilage lesions of the knee joint are considered an indication for cartilage repair surgery. Patient- and lesion-specific factors like age, nutritional status, etiology of defect, or integrity of corresponding joint surface remain controversial in indicating cartilage repair surgery. Furthermore, the selection of the most suitable cartilage repair technique for a specific cartilage lesion remains debatable. Purpose To evaluate indications and choice of treatment method for cartilage repair surgery, depending on patient- and lesion-specific data from the German Cartilage Registry. Study Design Cross-sectional study; Level of evidence, 3. Methods A total of 6305 consecutive patients who underwent cartilage repair surgery of the knee evaluated and 5143 complete datasets were included in the analysis (follow-up rate, 81.5%). Patient-specific (age, body mass index, smoking status, previous operations, clinical leg axis) and lesion-specific (size, grading, location, etiology) data were provided by the attending surgeon at the time of surgery. Appropriate statistical tests were used to compare data depending on type and normality of data. Multivariable logistic regressions were calculated to investigate independent factors for the choice of specific cartilage repair techniques. Results The median size of treated cartilage lesions was 3.6 cm2, and most defects were of degenerative origin (54.8%). Of the registered patients, 39.2% were categorized as overweight and 19.6% as obese, while 23.3% were smokers. The most prevalently documented operative techniques were the autologous chondrocyte implantation (ACI) (52.4%), bone marrow stimulation (BMS) (17.3%), and BMS augmented with collagen scaffolds (9.3%). Independent factors that made the use of ACI more likely were bigger lesion size, previous surgery at the joint, and lesions located at the trochlea or the patella. On the contrary, BMS or augmented BMS were preferred in older patients, with damaged corresponding joint surface, and with more concomitant surgeries. Conclusion Cartilage repair surgery was indicated irrespective of nutritional status, smoking status, or etiology of the treated lesion. ACI was the most prevalent technique and was preferred for younger patients and patellar lesions. While older patients with degenerative changes to the joint were not excluded from cartilage repair surgery, the use of ACI was restricted.
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Affiliation(s)
- Sebastian Gebhardt
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Marcus Vollmer
- Institute of Bioinformatics, University Medicine Greifswald, Greifswald, Germany
| | - Alexander Zimmerer
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
- Orthopädische Klinik Paulinenhilfe, Diakonie-Klinikum Stuttgart, Stuttgart, Germany
| | - Ingo Rochel
- Klinik für Unfallchirurgie, Handchirurgie und Orthopädie, KRH Klinikum Nordstadt, Hannover, Germany
| | - Peter Balcarek
- ARCUS Sportklinik, Pforzheim, Germany
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Göttingen, Germany
| | - Philipp Niemeyer
- OCM-Orthopädische Chirurgie München, München, Germany
- Klinik für Orthopädie und Traumatologie, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Georgi I. Wassilew
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
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Liu Y, Du L, Zhang H, Li G, Luo Y, Hu Z, Xu R, Yao J, Shi Z, Chen Y, Zhang C, Jin Z, Zhang C, Xie C, Fu J, Zhu Y, Zhu Y. Bioprinted biomimetic hydrogel matrices guiding stem cell aggregates for enhanced chondrogenesis and cartilage regeneration. J Mater Chem B 2024; 12:5360-5376. [PMID: 38700242 DOI: 10.1039/d4tb00323c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Articular cartilage tissue has limited self-repair capabilities, with damage frequently progressing to irreversible degeneration. Engineered tissues constructed through bioprinting and embedded with stem cell aggregates offer promising therapeutic alternatives. Aggregates of bone marrow mesenchymal stromal cells (BMSCs) demonstrate enhanced and more rapid chondrogenic differentiation than isolated cells, thus facilitating cartilage repair. However, it remains a key challenge to precisely control biochemical microenvironments to regulate cellular adhesion and cohesion within bioprinted matrices simultaneously. Herein, this work reports a bioprintable hydrogel matrix with high cellular adhesion and aggregation properties for cartilage repair. The hydrogel comprises an enhanced cell-adhesive gelatin methacrylate and a cell-cohesive chitosan methacrylate (CHMA), both of which are subjected to photo-initiated crosslinking. By precisely adjusting the CHMA content, the mechanical stability and biochemical cues of the hydrogels are finely tuned to promote cellular aggregation, chondrogenic differentiation and cartilage repair implantation. Multi-layer constructs encapsulated with BMSCs, with high cell viability reaching 91.1%, are bioprinted and photo-crosslinked to support chondrogenic differentiation for 21 days. BMSCs rapidly form aggregates and display efficient chondrogenic differentiation both on the hydrogels and within bioprinted constructs, as evidenced by the upregulated expression of Sox9, Aggrecan and Collagen 2a1 genes, along with high protein levels. Transplantation of these BMSC-laden bioprinted hydrogels into cartilaginous defects demonstrates effective hyaline cartilage repair. Overall, this cell-responsive hydrogel scaffold holds immense promise for applications in cartilage tissue engineering.
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Affiliation(s)
- Yuetian Liu
- The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang 315010, China.
- Research Institute of Smart Medicine and Biological Engineering, Health Science Center, Ningbo University, Ningbo, Zhejiang 315211, China.
| | - Lijuan Du
- Research Institute of Smart Medicine and Biological Engineering, Health Science Center, Ningbo University, Ningbo, Zhejiang 315211, China.
| | - Hua Zhang
- Research Institute of Smart Medicine and Biological Engineering, Health Science Center, Ningbo University, Ningbo, Zhejiang 315211, China.
- State Key Laboratory of Molecular Engineering of Polymers (Fudan University), Shanghai 200438, China
| | - Guanrong Li
- The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang 315010, China.
- Research Institute of Smart Medicine and Biological Engineering, Health Science Center, Ningbo University, Ningbo, Zhejiang 315211, China.
| | - Yang Luo
- The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang 315010, China.
- Research Institute of Smart Medicine and Biological Engineering, Health Science Center, Ningbo University, Ningbo, Zhejiang 315211, China.
| | - Zeming Hu
- Research Institute of Smart Medicine and Biological Engineering, Health Science Center, Ningbo University, Ningbo, Zhejiang 315211, China.
| | - Rong Xu
- The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang 315010, China.
- Research Institute of Smart Medicine and Biological Engineering, Health Science Center, Ningbo University, Ningbo, Zhejiang 315211, China.
| | - Jie Yao
- The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang 315010, China.
| | - Zheyuan Shi
- The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang 315010, China.
- Research Institute of Smart Medicine and Biological Engineering, Health Science Center, Ningbo University, Ningbo, Zhejiang 315211, China.
| | - Yige Chen
- Research Institute of Smart Medicine and Biological Engineering, Health Science Center, Ningbo University, Ningbo, Zhejiang 315211, China.
| | - Chi Zhang
- The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang 315010, China.
| | - Zhanping Jin
- The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang 315010, China.
| | - Caihua Zhang
- The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang 315010, China.
| | - Chanchan Xie
- The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang 315010, China.
| | - Jun Fu
- Key Laboratory of Polymeric Composite and Functional Materials of Ministry of Education, Guangdong Engineering Technology Research Centre for Functional Biomaterials, School of Materials Science and Engineering, Sun Yat-Sen University, Guangzhou, 510275, China.
| | - Yabin Zhu
- Research Institute of Smart Medicine and Biological Engineering, Health Science Center, Ningbo University, Ningbo, Zhejiang 315211, China.
| | - Yingchun Zhu
- The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang 315010, China.
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Jahn J, Halm-Pozniak A, Klutzny M, Noll M, Stärke C, Lohmann CH, Bertrand J. Collagen 1 gel may improve the regenerative capacity of minced adult and preosteoarthritic cartilage. Knee Surg Sports Traumatol Arthrosc 2024; 32:821-828. [PMID: 38415965 DOI: 10.1002/ksa.12101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/10/2024] [Accepted: 02/12/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE Minced cartilage implantation (MCI) is an evolving technique for the treatment of osteochondral lesions. It was hypothesised that mincing of cartilage may affect chondrocyte viability and phenotype and that embedding in collagen 1 gel results in an improved outcome. The objective of this study was to evaluate the impact of cartilage mincing and whether collagen 1 gel mediates beneficial effects on the chondrocyte phenotype and viability. METHODS Human cartilage samples from 11 patients undergoing total knee arthroplasty were collected and minced according to the MCI protocol. Minced cartilage was cultured for 1 week with and without embedding in collagen 1 gel and was compared with unminced cartilage flakes as control. Quantitative reverse transcription-PCR and immunohistochemical staining for the chondrocyte marker genes SOX9, COL2, ACAN, COL10 and MMP13 were used to examine the chondrocyte phenotype. Cell death was assessed by the terminal deoxynucleotidyl transferase dUTP nick-end labeling assay. RESULTS Increased chondrocyte cell death of cultured cartilage after mincing was observed. Chondrocytes from minced cartilage exhibited significantly decreased expression and protein levels of homeostatic and hypertrophic chondrocyte markers. Embedding in collagen 1 gel showed no positive effect on viability. However, remarkable is the increased expression of ACAN and the preserved protein level of SOX9 in the collagen 1-embedded minced cartilage. CONCLUSIONS This study shows that the mincing of cartilage leads to increased chondrocyte death and decreased expression of chondrocyte phenotypic marker genes after 7 days. The use of collagen 1 gel may improve the stability of the phenotype, which needs to be further elucidated. LEVEL OF EVIDENCE Level III (therapeutic).
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Affiliation(s)
- Jannik Jahn
- Department of Orthopedic Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | | | - Marcus Klutzny
- Department of Orthopedic Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Michaela Noll
- Department of Orthopedic Surgery, Otto-von-Guericke University, Magdeburg, Germany
- Meidrix biomedicals GmbH, Esslingen, Germany
| | - Christian Stärke
- Department of Orthopedic Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Christoph H Lohmann
- Department of Orthopedic Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Jessica Bertrand
- Department of Orthopedic Surgery, Otto-von-Guericke University, Magdeburg, Germany
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