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Wang Z, Zhang L, Zeng X, Nie P, Wang M, Xiong Y, Xu Y. The Nomogram Model and Factors for the Postoperative Mortality of Elderly Patients with Femoral Neck Fracture Undergoing Artificial Hip Arthroplasty: A Single-Institution 6-Year Experience. Orthop Surg 2024; 16:391-400. [PMID: 38151885 PMCID: PMC10834201 DOI: 10.1111/os.13944] [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: 03/01/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 12/29/2023] Open
Abstract
OBJECTIVE Artificial hip arthroplasty (AHA) is widely accepted in elderly patients with femoral neck fractures, but it is associated with high risk of death and various postoperative complications due to old age and accompanying chronic diseases. Therefore, this study aimed to explore the risk factors for death in elderly patients with femoral neck fractures after AHA and to establish a nomogram risk prediction model, which is expected to reveal high-risk patients and improve the postoperative quality of life and survival rate of patients. METHODS Elderly patients who underwent AHA for femoral neck fractures in our hospital from September 2014 to May 2021were retrospectively analyzed. These patients were divided into a survival group and a death group according to their clinical outcomes. The following clinical data were recorded for the patients in the two groups: sex, age, underlying diseases, smoking and drinking history, preoperative nutritional risk score (NRS) and American Society of Anesthesiologists (ASA) score, as well as relevant indicators about the operation. These data were subject to univariate analysis and then logistic analysis to determine the risk factors of death. Subsequently, a nomogram risk prediction model was established and further validated with the receiver operating characteristic curve (ROC) and the Hosmer-Lemeshow test. Finally, the effects of predictive risk factors were analyzed using the Kaplan-Meier survival curve. RESULTS Follow-up was completed by 260 patients, including 206 patients in the survival group and 54 patients in the death group; the overall death rate was 20.77%, and the follow-up time, age, postoperative 1, 3 and 5-year death rates were 3.47 ± 1.93 years, 75.32 ± 9.12 years, 5.77%, 12.51%, and 25.61%, respectively. The top three causes of death in 54 patients were respiratory disease, cerebrocardiovascular disease, and digestive disease, respectively. The logistic analysis indicated that elderly patients with femoral neck fractures, the risk factors for death after AHA were age ≥ 80 years, preoperative NRS ≥ 4, HB ≤ 90 g/L, CR ≥ 110 umol/L, and ASA score ≥ 3, as well as postoperative albumin ≤ 35 g/L, the nomogram was established, and then its predictive performance was successfully validated using the ROC curve (AUC = 0.814, 95% confidence interval = 0.749-0.879) and the Hosmer-Lemeshow test (p = 0.840). Furthermore, Kaplan-Meier survival curve analysis revealed that the abovementioned six indicators were correlated with the post-AHA survival time of elderly patients with femoral neck fractures (pLog Rank < 0.05). CONCLUSION Old age, preoperatively high NRS and ASA score, anemia, poor renal function, and postoperative hypoproteinemia are the major risk factors for death in elderly patients with femoral neck fractures after AHA; they are also associated with postoperative survival. Early identification and effective interventions for optimization of modifiable risk factors are recommended to improve the postoperative quality of life and survival rates.
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Affiliation(s)
- Zewen Wang
- Department of Orthopaedics, Xinqiao Hospital, Army Military Medical University, Chongqing, China
| | - Lixiang Zhang
- Department of Orthopaedics, Xinqiao Hospital, Army Military Medical University, Chongqing, China
| | - Xiaoyan Zeng
- Department of General Surgery, Xinqiao Hospital, Army Military Medical University, Chongqing, China
| | - Piming Nie
- Department of Orthopaedics, Xinqiao Hospital, Army Military Medical University, Chongqing, China
| | - Min Wang
- Department of Orthopaedics, Xinqiao Hospital, Army Military Medical University, Chongqing, China
| | - Yan Xiong
- Department of Orthopaedics, Daping Hospital, Army Medical University, Chongqing, China
| | - Yuan Xu
- Department of Orthopaedics, Xinqiao Hospital, Army Military Medical University, Chongqing, China
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Rednah D, Brinji OS, Aldakhil M, Alshareef E, Alshehri M. Surgical Challenge in the Management of Spontaneous, Bilateral, Nontraumatic, Neglected Femoral Neck Fractures in a Patient With End-Stage Renal Disease: A Case Report and Literature Review. Cureus 2023; 15:e38633. [PMID: 37284392 PMCID: PMC10241221 DOI: 10.7759/cureus.38633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2023] [Indexed: 06/08/2023] Open
Abstract
Renal osteodystrophy is a spectrum of diseases that affect several organ systems including the musculoskeletal system by decreasing bone density which increases the risk of fractures. Fractures around the femoral neck are usually traumatic and unilateral and, rarely, bilateral and atraumatic. In this report, we present the case of a 37-year-old female patient with a known history of chronic kidney disease who sustained an atraumatic bilateral neck of femur fracture with late presentation. In addition, we present a review of neglected femoral neck fracture management in a young patient with renal disease and osteoporosis.
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Affiliation(s)
| | - Omer S Brinji
- Orthopaedic Surgery, King Abdulaziz Medical City, Jeddah, SAU
| | | | - Elaf Alshareef
- Intensive Care Unit, King Abdulaziz Medical City, Jeddah, SAU
| | - Mohammed Alshehri
- Orthopaedic Surgery, King Abdulaziz Medical City, Jeddah, SAU
- Orthopaedic Surgery, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
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Orth M, Osche D, Mörsdorf P, Holstein JH, Rollmann MF, Fritz T, Pohlemann T, Pizanis A. Minimal-invasive anterior approach to the hip provides a better surgery-related and early postoperative functional outcome than conventional lateral approach after hip hemiarthroplasty following femoral neck fractures. Arch Orthop Trauma Surg 2022; 143:3173-3181. [PMID: 36053291 DOI: 10.1007/s00402-022-04602-2] [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: 02/23/2022] [Accepted: 08/23/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Femoral neck fractures (FNF) are one of the most frequent fractures among elderly patients and commonly require surgical treatment. Bipolar hip hemiarthroplasty (BHHA) is mostly performed in these cases. MATERIAL AND METHODS In the present retrospective study geriatric patients with FNF (n = 100) treated either by anterior minimal-invasive surgery (AMIS; n = 50) or lateral conventional surgery (LCS; n = 50) were characterized (age at the time of surgery, sex, health status/ASA score, walking distance and need for walking aids before the injury) and intraoperative parameters (duration of surgery, blood loss, complications), as well as postoperative functional performance early (duration of in-patient stay, radiological leg length discrepancy, ability to full weight-bearing, mobilization with walking aids) and 12 months (radiological signs of sintering, clinical parameters, complication rate) after surgery were analyzed. RESULTS Patients in the AMIS group demonstrated a reduced blood loss intraoperatively, while the duration of surgery and complication rates did not differ between the two groups. Further, more patients in the AMIS group achieved full weight-bearing of the injured leg and were able to walk with a rollator or less support during their in-patient stay. Of interest, patients in the AMIS group achieved this level of mobility earlier than those of the LCS group, although their walking distance before the acute injury was reduced. Moreover, patients of the AMIS group showed equal leg lengths postoperatively more often than patients of the LCS group. No significant differences in functional and surgery-related performance could be observed between AMIS and LCS group at 12 months postoperatively. CONCLUSIONS In conclusion, geriatric patients treated by AMIS experience less surgery-related strain and recover faster in the early postoperative phase compared to LCS after displaced FNF. Hence, AMIS should be recommended for BHHA in these vulnerable patients.
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Affiliation(s)
- M Orth
- Department of Trauma, Hand and Reconstructive Surgery, Saarland Univesity, Kirrberger Strasse 1, D-66421, Homburg, Saarland, Germany.
| | - D Osche
- Department of Trauma, Hand and Reconstructive Surgery, Saarland Univesity, Kirrberger Strasse 1, D-66421, Homburg, Saarland, Germany
| | - P Mörsdorf
- Department of Trauma, Hand and Reconstructive Surgery, Saarland Univesity, Kirrberger Strasse 1, D-66421, Homburg, Saarland, Germany
| | - J H Holstein
- Department of Trauma, Hand and Reconstructive Surgery, Saarland Univesity, Kirrberger Strasse 1, D-66421, Homburg, Saarland, Germany.,Ethianum Clinic, Heidelberg, Germany
| | - M F Rollmann
- Department of Trauma, Hand and Reconstructive Surgery, Saarland Univesity, Kirrberger Strasse 1, D-66421, Homburg, Saarland, Germany.,BG Klinik Tuebingen on behalf of the Eberhard-Karls-University Tuebingen, Tuebingen, Germany
| | - T Fritz
- Department of Trauma, Hand and Reconstructive Surgery, Saarland Univesity, Kirrberger Strasse 1, D-66421, Homburg, Saarland, Germany
| | - T Pohlemann
- Department of Trauma, Hand and Reconstructive Surgery, Saarland Univesity, Kirrberger Strasse 1, D-66421, Homburg, Saarland, Germany
| | - A Pizanis
- Department of Trauma, Hand and Reconstructive Surgery, Saarland Univesity, Kirrberger Strasse 1, D-66421, Homburg, Saarland, Germany
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Dadwal UC, Bhatti FUR, Awosanya OD, de Andrade Staut C, Nagaraj RU, Perugini AJ, Tewari NP, Valuch CR, Sun S, Mendenhall SK, Zhou D, Mostardo SL, Blosser RJ, Li J, Kacena MA. The Effects of SRT1720 Treatment on Endothelial Cells Derived from the Lung and Bone Marrow of Young and Aged, Male and Female Mice. Int J Mol Sci 2021; 22:11097. [PMID: 34681756 PMCID: PMC8540697 DOI: 10.3390/ijms222011097] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/10/2021] [Accepted: 10/10/2021] [Indexed: 02/07/2023] Open
Abstract
Angiogenesis is critical for successful fracture healing. Age-related alterations in endothelial cells (ECs) may cause impaired bone healing. Therefore, examining therapeutic treatments to improve angiogenesis in aging may enhance bone healing. Sirtuin 1 (SIRT1) is highly expressed in ECs and its activation is known to counteract aging. Here, we examined the effects of SRT1720 treatment (SIRT1 activator) on the growth and function of bone marrow and lung ECs (BMECs and LECs, respectively), derived from young (3-4 month) and old (20-24 month) mice. While aging did not alter EC proliferation, treatment with SRT1720 significantly increased proliferation of all LECs. However, SRT1720 only increased proliferation of old female BMECs. Vessel-like tube assays showed similar vessel-like structures between young and old LECs and BMECs from both male and female mice. SRT1720 significantly improved vessel-like structures in all LECs. No age, sex, or treatment differences were found in migration related parameters of LECs. In males, old BMECs had greater migration rates than young BMECs, whereas in females, old BMECs had lower migration rates than young BMECs. Collectively, our data suggest that treatment with SRT1720 appears to enhance the angiogenic potential of LECs irrespective of age or sex. However, its role in BMECs is sex- and age-dependent.
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Affiliation(s)
- Ushashi Chand Dadwal
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (U.C.D.); (F.U.R.B.); (O.D.A.); (C.d.A.S.); (R.U.N.); (A.J.P.III); (N.P.T.); (S.S.); (S.K.M.); (D.Z.); (S.L.M.); (R.J.B.)
- Richard L. Roudebush VA Medical Center, Indianapolis, IN 46202, USA
| | - Fazal Ur Rehman Bhatti
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (U.C.D.); (F.U.R.B.); (O.D.A.); (C.d.A.S.); (R.U.N.); (A.J.P.III); (N.P.T.); (S.S.); (S.K.M.); (D.Z.); (S.L.M.); (R.J.B.)
| | - Olatundun Dupe Awosanya
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (U.C.D.); (F.U.R.B.); (O.D.A.); (C.d.A.S.); (R.U.N.); (A.J.P.III); (N.P.T.); (S.S.); (S.K.M.); (D.Z.); (S.L.M.); (R.J.B.)
| | - Caio de Andrade Staut
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (U.C.D.); (F.U.R.B.); (O.D.A.); (C.d.A.S.); (R.U.N.); (A.J.P.III); (N.P.T.); (S.S.); (S.K.M.); (D.Z.); (S.L.M.); (R.J.B.)
| | - Rohit U. Nagaraj
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (U.C.D.); (F.U.R.B.); (O.D.A.); (C.d.A.S.); (R.U.N.); (A.J.P.III); (N.P.T.); (S.S.); (S.K.M.); (D.Z.); (S.L.M.); (R.J.B.)
| | - Anthony Joseph Perugini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (U.C.D.); (F.U.R.B.); (O.D.A.); (C.d.A.S.); (R.U.N.); (A.J.P.III); (N.P.T.); (S.S.); (S.K.M.); (D.Z.); (S.L.M.); (R.J.B.)
| | - Nikhil Prasad Tewari
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (U.C.D.); (F.U.R.B.); (O.D.A.); (C.d.A.S.); (R.U.N.); (A.J.P.III); (N.P.T.); (S.S.); (S.K.M.); (D.Z.); (S.L.M.); (R.J.B.)
| | - Conner Riley Valuch
- Department of Biology, Indiana University Purdue University Indianapolis, Indianapolis, IN 46202, USA; (C.R.V.); (J.L.)
| | - Seungyup Sun
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (U.C.D.); (F.U.R.B.); (O.D.A.); (C.d.A.S.); (R.U.N.); (A.J.P.III); (N.P.T.); (S.S.); (S.K.M.); (D.Z.); (S.L.M.); (R.J.B.)
| | - Stephen Kyle Mendenhall
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (U.C.D.); (F.U.R.B.); (O.D.A.); (C.d.A.S.); (R.U.N.); (A.J.P.III); (N.P.T.); (S.S.); (S.K.M.); (D.Z.); (S.L.M.); (R.J.B.)
| | - Donghui Zhou
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (U.C.D.); (F.U.R.B.); (O.D.A.); (C.d.A.S.); (R.U.N.); (A.J.P.III); (N.P.T.); (S.S.); (S.K.M.); (D.Z.); (S.L.M.); (R.J.B.)
| | - Sarah Lyn Mostardo
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (U.C.D.); (F.U.R.B.); (O.D.A.); (C.d.A.S.); (R.U.N.); (A.J.P.III); (N.P.T.); (S.S.); (S.K.M.); (D.Z.); (S.L.M.); (R.J.B.)
| | - Rachel Jean Blosser
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (U.C.D.); (F.U.R.B.); (O.D.A.); (C.d.A.S.); (R.U.N.); (A.J.P.III); (N.P.T.); (S.S.); (S.K.M.); (D.Z.); (S.L.M.); (R.J.B.)
- Richard L. Roudebush VA Medical Center, Indianapolis, IN 46202, USA
| | - Jiliang Li
- Department of Biology, Indiana University Purdue University Indianapolis, Indianapolis, IN 46202, USA; (C.R.V.); (J.L.)
| | - Melissa Ann Kacena
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (U.C.D.); (F.U.R.B.); (O.D.A.); (C.d.A.S.); (R.U.N.); (A.J.P.III); (N.P.T.); (S.S.); (S.K.M.); (D.Z.); (S.L.M.); (R.J.B.)
- Richard L. Roudebush VA Medical Center, Indianapolis, IN 46202, USA
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Abstract
BACKGROUND Hip fractures are recognized as one of the most devastating injuries impacting older adults because of the complications that follow. Mortality rates postsurgery can range from 14% to 58% within one year of fracture. We aimed to identify factors associated with increased risk of mortality within 24 months of a femoral neck fracture in patients aged ≥50 years enrolled in the FAITH and HEALTH trials. METHODS Two multivariable Cox proportional hazards regressions were used to investigate potential prognostic factors that may be associated with mortality within 90 days and 24 months of hip fracture. RESULTS Ninety-one (4.1%) and 304 (13.5%) of 2247 participants died within 90 days and 24 months of suffering a femoral neck fracture, respectively. Older age (P < 0.001), lower body mass index (P = 0.002), American Society of Anesthesiologists (ASA) class III/IV/V (P = 0.004), use of an ambulatory aid before femoral neck fracture (P < 0.001), and kidney disease (P < 0.001) were associated with a higher risk of mortality within 24 months of femoral neck fracture. Older age (P = 0.03), lower body mass index (P = 0.02), use of an ambulatory aid before femoral neck fracture (P < 0.001), and having a comorbidity (P = 0.04) were associated with a higher risk of mortality within 90 days of femoral neck fracture. CONCLUSIONS Our analysis found that factors that are indicative of a poorer health status were associated with a higher risk of mortality within 24 months of femoral neck fracture. We did not find a difference in treatment methods (internal fixation vs. joint arthroplasty) on the risk of mortality. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Management of Secondary Hyperparathyroidism in Chronic Kidney Disease: A Focus on the Elderly. Drugs Aging 2019; 36:885-895. [DOI: 10.1007/s40266-019-00696-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Wagner DR, Karnik S, Gunderson ZJ, Nielsen JJ, Fennimore A, Promer HJ, Lowery JW, Loghmani MT, Low PS, McKinley TO, Kacena MA, Clauss M, Li J. Dysfunctional stem and progenitor cells impair fracture healing with age. World J Stem Cells 2019; 11:281-296. [PMID: 31293713 PMCID: PMC6600851 DOI: 10.4252/wjsc.v11.i6.281] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/26/2019] [Accepted: 06/13/2019] [Indexed: 02/06/2023] Open
Abstract
Successful fracture healing requires the simultaneous regeneration of both the bone and vasculature; mesenchymal stem cells (MSCs) are directed to replace the bone tissue, while endothelial progenitor cells (EPCs) form the new vasculature that supplies blood to the fracture site. In the elderly, the healing process is slowed, partly due to decreased regenerative function of these stem and progenitor cells. MSCs from older individuals are impaired with regard to cell number, proliferative capacity, ability to migrate, and osteochondrogenic differentiation potential. The proliferation, migration and function of EPCs are also compromised with advanced age. Although the reasons for cellular dysfunction with age are complex and multidimensional, reduced expression of growth factors, accumulation of oxidative damage from reactive oxygen species, and altered signaling of the Sirtuin-1 pathway are contributing factors to aging at the cellular level of both MSCs and EPCs. Because of these geriatric-specific issues, effective treatment for fracture repair may require new therapeutic techniques to restore cellular function. Some suggested directions for potential treatments include cellular therapies, pharmacological agents, treatments targeting age-related molecular mechanisms, and physical therapeutics. Advanced age is the primary risk factor for a fracture, due to the low bone mass and inferior bone quality associated with aging; a better understanding of the dysfunctional behavior of the aging cell will provide a foundation for new treatments to decrease healing time and reduce the development of complications during the extended recovery from fracture healing in the elderly.
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Affiliation(s)
- Diane R Wagner
- Department of Mechanical and Energy Engineering, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, United States
| | - Sonali Karnik
- Department of Mechanical and Energy Engineering, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, United States
| | - Zachary J Gunderson
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, United States
| | - Jeffery J Nielsen
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University, West Lafayette, IN 47907, United States
| | - Alanna Fennimore
- Department of Physical Therapy, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, United States
| | - Hunter J Promer
- Division of Biomedical Science, Marian University College of Osteopathic Medicine, Indianapolis, IN 46222, United States
| | - Jonathan W Lowery
- Division of Biomedical Science, Marian University College of Osteopathic Medicine, Indianapolis, IN 46222, United States
| | - M Terry Loghmani
- Department of Physical Therapy, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, United States
| | - Philip S Low
- Department of Chemistry, Purdue University, West Lafayette, IN 47907 United States
| | - Todd O McKinley
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, United States
| | - Melissa A Kacena
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, United States
- Richard L. Roudebush VA Medical Center, Indianapolis, IN 46202, United States
| | - Matthias Clauss
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, United States
| | - Jiliang Li
- Department of Biology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, United States
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