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Gould SL, Davico G, Palanca M, Viceconti M, Cristofolini L. Identification of a lumped-parameter model of the intervertebral joint from experimental data. Front Bioeng Biotechnol 2024; 12:1304334. [PMID: 39104629 PMCID: PMC11298350 DOI: 10.3389/fbioe.2024.1304334] [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] [Received: 09/29/2023] [Accepted: 07/01/2024] [Indexed: 08/07/2024] Open
Abstract
Through predictive simulations, multibody models can aid the treatment of spinal pathologies by identifying optimal surgical procedures. Critical to achieving accurate predictions is the definition of the intervertebral joint. The joint pose is often defined by virtual palpation. Intervertebral joint stiffnesses are either derived from literature, or specimen-specific stiffnesses are calculated with optimisation methods. This study tested the feasibility of an optimisation method for determining the specimen-specific stiffnesses and investigated the influence of the assigned joint pose on the subject-specific estimated stiffness. Furthermore, the influence of the joint pose and the stiffness on the accuracy of the predicted motion was investigated. A computed tomography based model of a lumbar spine segment was created. Joints were defined from virtually palpated landmarks sampled with a Latin Hypercube technique from a possible Cartesian space. An optimisation method was used to determine specimen-specific stiffnesses for 500 models. A two-factor analysis was performed by running forward dynamic simulations for ten different stiffnesses for each successfully optimised model. The optimisations calculated a large range of stiffnesses, indicating the optimised specimen-specific stiffnesses were highly sensitive to the assigned joint pose and related uncertainties. A limited number of combinations of optimised joint stiffnesses and joint poses could accurately predict the kinematics. The two-factor analysis indicated that, for the ranges explored, the joint pose definition was more important than the stiffness. To obtain kinematic prediction errors below 1 mm and 1° and suitable specimen-specific stiffnesses the precision of virtually palpated landmarks for joint definition should be better than 2.9 mm.
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Affiliation(s)
- Samuele L. Gould
- Department of Industrial Engineering, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giorgio Davico
- Department of Industrial Engineering, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Palanca
- Department of Industrial Engineering, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Marco Viceconti
- Department of Industrial Engineering, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Cristofolini
- Department of Industrial Engineering, Alma Mater Studiorum-University of Bologna, Bologna, Italy
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Masuda K, Shigematsu H, Maeda M, Okuda A, Tanaka Y. Ultrasound-guided disc pain induction test for diagnosis of discogenic lumbar pain: a cross-sectional study. J Orthop Surg Res 2023; 18:847. [PMID: 37941032 PMCID: PMC10631160 DOI: 10.1186/s13018-023-04327-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/28/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Several methods can be used to diagnose discogenic pain, but only discoblock can diagnose discogenic pain definitively. This study aimed to examine the usefulness of an ultrasound-guided disc pain induction test for a simple and accurate diagnosis of the culprit lesion. METHODS We included 41 patients with lumbar pain in whom pain was induced by an ultrasound-guided disc pain induction test. All patients had confirmed pain at L1/2 to L5/S1 based on an ultrasound-guided disc pain induction test and underwent X-ray photography and magnetic resonance imaging. Seventeen patients who required injection due to severe pain underwent discoblock procedures for discs with the most intense pain, and visual analogue scale (VAS) scores were obtained before and after the procedure for these patients. We analysed the association between painful discs and radiological findings. RESULTS Pain induction was noted in a total of 65 discs, and the pain was induced in 23 patients in only one disc. All patients had disc degeneration of Pfirrmann classification grade 1 or higher, with more significant disc degeneration in painful discs than in painless discs. There was no significant relationship between the presence or absence of pain and Modic type. The average VAS measurements improved significantly from 9.5 (pre-procedure) to 2.5 (post-procedure). These results suggest that the most painful discs were the causes of discogenic lumbar pain. CONCLUSIONS Our ultrasound-guided disc pain induction test may help diagnose disc degeneration and identify culprit lesions, even when multiple discs exhibit findings of degeneration.
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Affiliation(s)
- Keisuke Masuda
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara, 6348522, Japan
| | - Hideki Shigematsu
- Department of Orthopedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara, 6348522, Japan.
| | - Manabu Maeda
- Department of Orthopedic Surgery, Maeda Orthopaedic Clinic, 864-1, Kideracho, Nara City, Nara, 6308306, Japan
| | - Akinori Okuda
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara, 6348522, Japan
| | - Yasuhito Tanaka
- Department of Orthopedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara, 6348522, Japan
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Lerchl T, Nispel K, Baum T, Bodden J, Senner V, Kirschke JS. Multibody Models of the Thoracolumbar Spine: A Review on Applications, Limitations, and Challenges. Bioengineering (Basel) 2023; 10:bioengineering10020202. [PMID: 36829696 PMCID: PMC9952620 DOI: 10.3390/bioengineering10020202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/09/2023] Open
Abstract
Numerical models of the musculoskeletal system as investigative tools are an integral part of biomechanical and clinical research. While finite element modeling is primarily suitable for the examination of deformation states and internal stresses in flexible bodies, multibody modeling is based on the assumption of rigid bodies, that are connected via joints and flexible elements. This simplification allows the consideration of biomechanical systems from a holistic perspective and thus takes into account multiple influencing factors of mechanical loads. Being the source of major health issues worldwide, the human spine is subject to a variety of studies using these models to investigate and understand healthy and pathological biomechanics of the upper body. In this review, we summarize the current state-of-the-art literature on multibody models of the thoracolumbar spine and identify limitations and challenges related to current modeling approaches.
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Affiliation(s)
- Tanja Lerchl
- Sport Equipment and Sport Materials, School of Engineering and Design, Technical University of Munich, 85748 Garching, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
- Correspondence: ; Tel.: +49-89-289-15365
| | - Kati Nispel
- Sport Equipment and Sport Materials, School of Engineering and Design, Technical University of Munich, 85748 Garching, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Jannis Bodden
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Veit Senner
- Sport Equipment and Sport Materials, School of Engineering and Design, Technical University of Munich, 85748 Garching, Germany
| | - Jan S. Kirschke
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
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Knapik GG, Mendel E, Bourekas E, Marras WS. Computational lumbar spine models: A literature review. Clin Biomech (Bristol, Avon) 2022; 100:105816. [PMID: 36435080 DOI: 10.1016/j.clinbiomech.2022.105816] [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: 07/28/2022] [Revised: 10/26/2022] [Accepted: 11/08/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Computational spine models of various types have been employed to understand spine function, assess the risk that different activities pose to the spine, and evaluate techniques to prevent injury. The areas in which these models are applied has expanded greatly, potentially beyond the appropriate scope of each, given their capabilities. A comprehensive understanding of the components of these models provides insight into their current capabilities and limitations. METHODS The objective of this review was to provide a critical assessment of the different characteristics of model elements employed across the spectrum of lumbar spine modeling and in newer combined methodologies to help better evaluate existing studies and delineate areas for future research and refinement. FINDINGS A total of 155 studies met selection criteria and were included in this review. Most current studies use either highly detailed Finite Element models or simpler Musculoskeletal models driven with in vivo data. Many models feature significant geometric or loading simplifications that limit their realism and validity. Frequently, studies only create a single model and thus can't account for the impact of subject variability. The lack of model representation for certain subject cohorts leaves significant gaps in spine knowledge. Combining features from both types of modeling could result in more accurate and predictive models. INTERPRETATION Development of integrated models combining elements from different model types in a framework that enables the evaluation of larger populations of subjects could address existing voids and enable more realistic representation of the biomechanics of the lumbar spine.
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Affiliation(s)
- Gregory G Knapik
- Spine Research Institute, The Ohio State University, 210 Baker Systems, 1971 Neil Avenue, Columbus, OH 43210, USA.
| | - Ehud Mendel
- Department of Neurosurgery, Yale University, New Haven, CT 06510, USA
| | - Eric Bourekas
- Department of Radiology, The Ohio State University, Columbus, OH 43210, USA
| | - William S Marras
- Spine Research Institute, The Ohio State University, 210 Baker Systems, 1971 Neil Avenue, Columbus, OH 43210, USA
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Gould SL, Cristofolini L, Davico G, Viceconti M. Computational modelling of the scoliotic spine: A literature review. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2021; 37:e3503. [PMID: 34114367 PMCID: PMC8518780 DOI: 10.1002/cnm.3503] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/26/2021] [Accepted: 06/04/2021] [Indexed: 06/12/2023]
Abstract
Scoliosis is a deformity of the spine that in severe cases requires surgical treatment. There is still disagreement among clinicians as to what the aim of such treatment is as well as the optimal surgical technique. Numerical models can aid clinical decision-making by estimating the outcome of a given surgical intervention. This paper provided some background information on the modelling of the healthy spine and a review of the literature on scoliotic spine models, their validation, and their application. An overview of the methods and techniques used to construct scoliotic finite element and multibody models was given as well as the boundary conditions used in the simulations. The current limitations of the models were discussed as well as how such limitations are addressed in non-scoliotic spine models. Finally, future directions for the numerical modelling of scoliosis were addressed.
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Affiliation(s)
- Samuele L. Gould
- Department of Industrial EngineeringAlma Mater Studiorum‐University of Bologna (IT)BolognaItaly
- Medical Technology LabIRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Luca Cristofolini
- Department of Industrial EngineeringAlma Mater Studiorum‐University of Bologna (IT)BolognaItaly
| | - Giorgio Davico
- Department of Industrial EngineeringAlma Mater Studiorum‐University of Bologna (IT)BolognaItaly
- Medical Technology LabIRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Marco Viceconti
- Department of Industrial EngineeringAlma Mater Studiorum‐University of Bologna (IT)BolognaItaly
- Medical Technology LabIRCCS Istituto Ortopedico RizzoliBolognaItaly
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Remus R, Lipphaus A, Neumann M, Bender B. Calibration and validation of a novel hybrid model of the lumbosacral spine in ArtiSynth-The passive structures. PLoS One 2021; 16:e0250456. [PMID: 33901222 PMCID: PMC8075237 DOI: 10.1371/journal.pone.0250456] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 04/07/2021] [Indexed: 12/04/2022] Open
Abstract
In computational biomechanics, two separate types of models have been used predominantly to enhance the understanding of the mechanisms of action of the lumbosacral spine (LSS): Finite element (FE) and musculoskeletal multibody (MB) models. To combine advantages of both models, hybrid FE-MB models are an increasingly used alternative. The aim of this paper is to develop, calibrate, and validate a novel passive hybrid FE-MB open-access simulation model of a ligamentous LSS using ArtiSynth. Based on anatomical data from the Male Visible Human Project, the LSS model is constructed from the L1-S1 rigid vertebrae interconnected with hyperelastic fiber-reinforced FE intervertebral discs, ligaments, and facet joints. A mesh convergence study, sensitivity analyses, and systematic calibration were conducted with the hybrid functional spinal unit (FSU) L4/5. The predicted mechanical responses of the FSU L4/5, the lumbar spine (L1-L5), and the LSS were validated against literature data from in vivo and in vitro measurements and in silico models. Spinal mechanical responses considered when loaded with pure moments and combined loading modes were total and intervertebral range of motions, instantaneous axes and centers of rotation, facet joint contact forces, intradiscal pressures, disc bulges, and stiffnesses. Undesirable correlations with the FE mesh were minimized, the number of crisscrossed collagen fiber rings was reduced to five, and the individual influences of specific anatomical structures were adjusted to in vitro range of motions. Including intervertebral motion couplings for axial rotation and nonlinear stiffening under increasing axial compression, the predicted kinematic and structural mechanics responses were consistent with the comparative data. The results demonstrate that the hybrid simulation model is robust and efficient in reproducing valid mechanical responses to provide a starting point for upcoming optimizations and extensions, such as with active skeletal muscles.
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Affiliation(s)
- Robin Remus
- Chair of Product Development, Department of Mechanical Engineering, Ruhr-University Bochum, Bochum, Germany
- * E-mail:
| | - Andreas Lipphaus
- Biomechanics Research Group, Chair of Product Development, Department of Mechanical Engineering, Ruhr-University Bochum, Bochum, Germany
| | - Marc Neumann
- Chair of Product Development, Department of Mechanical Engineering, Ruhr-University Bochum, Bochum, Germany
| | - Beate Bender
- Chair of Product Development, Department of Mechanical Engineering, Ruhr-University Bochum, Bochum, Germany
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Rockenfeller R, Müller A, Damm N, Kosterhon M, Kantelhardt SR, Frank R, Gruber K. Muscle-driven and torque-driven centrodes during modeled flexion of individual lumbar spines are disparate. Biomech Model Mechanobiol 2020; 20:267-279. [PMID: 32939615 PMCID: PMC7892748 DOI: 10.1007/s10237-020-01382-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 08/24/2020] [Indexed: 11/25/2022]
Abstract
Lumbar spine biomechanics during the forward-bending of the upper body (flexion) are well investigated by both in vivo and in vitro experiments. In both cases, the experimentally observed relative motion of vertebral bodies can be used to calculate the instantaneous center of rotation (ICR). The timely evolution of the ICR, the centrode, is widely utilized for validating computer models and is thought to serve as a criterion for distinguishing healthy and degenerative motion patterns. While in vivo motion can be induced by physiological active structures (muscles), in vitro spinal segments have to be driven by external torque-applying equipment such as spine testers. It is implicitly assumed that muscle-driven and torque-driven centrodes are similar. Here, however, we show that centrodes qualitatively depend on the impetus. Distinction is achieved by introducing confidence regions (ellipses) that comprise centrodes of seven individual multi-body simulation models, performing flexion with and without preload. Muscle-driven centrodes were generally directed superior–anterior and tail-shaped, while torque-driven centrodes were located in a comparably narrow region close to the center of mass of the caudal vertebrae. We thus argue that centrodes resulting from different experimental conditions ought to be compared with caution. Finally, the applicability of our method regarding the analysis of clinical syndromes and the assessment of surgical methods is discussed.
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Affiliation(s)
- Robert Rockenfeller
- Mathematical Institute, University Koblenz-Landau, Universitätsstr. 1, 56070, Koblenz, Germany.
| | - Andreas Müller
- Institute for Medical Engineering and Information Processing (MTI Mittelrhein), University Koblenz-Landau, Universitätsstr. 1, 56070, Koblenz, Germany
- Mechanical Systems Engineering Laboratory, EMPA-Swiss Federal Laboratories for Materials Science and Technology, Ueberlandstr. 129, 8600 Dübendorf, Switzerland
| | - Nicolas Damm
- Institute for Medical Engineering and Information Processing (MTI Mittelrhein), University Koblenz-Landau, Universitätsstr. 1, 56070, Koblenz, Germany
| | - Michael Kosterhon
- Department of Neurosurgery, University Medical Centre, Johannes Gutenberg-University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Sven R Kantelhardt
- Department of Neurosurgery, University Medical Centre, Johannes Gutenberg-University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Rolfdieter Frank
- Mathematical Institute, University Koblenz-Landau, Universitätsstr. 1, 56070, Koblenz, Germany
| | - Karin Gruber
- Institute for Medical Engineering and Information Processing (MTI Mittelrhein), University Koblenz-Landau, Universitätsstr. 1, 56070, Koblenz, Germany
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Vanaclocha-Saiz A, Atienza CM, Vanaclocha V, Belloch V, Santabarbara JM, Jordá-Gómez P, Vanaclocha L. ICR in human cadaveric specimens: An essential parameter to consider in a new lumbar disc prosthesis design. NORTH AMERICAN SPINE SOCIETY JOURNAL 2020; 2:100016. [PMID: 35141586 PMCID: PMC8820058 DOI: 10.1016/j.xnsj.2020.100016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/29/2020] [Accepted: 07/15/2020] [Indexed: 06/14/2023]
Abstract
STUDY DESIGN Biomechanical study in cadaveric specimens. BACKGROUND The commercially available lumbar disc prostheses do not reproduce the intact disc's Instantaneous centre of Rotation (ICR), thus inducing an overload on adjacent anatomical structures, promoting secondary degeneration. AIM To examine biomechanical testing of cadaveric lumbar spine specimens in order to evaluate and define the ICR of intact lumbar discs. MATERIAL AND METHODS Twelve cold preserved fresh human cadaveric lumbosacral spine specimens were subjected to computerized tomography (CT), magnetic resonance imaging (MRI) and biomechanical testing. Kinematic studies were performed to analyse range of movements in order to determine ICR. RESULTS Flexoextension and lateral bending tests showed a positive linear correlation between the angle rotated and the displacement of the ICR in different axes. DISCUSSION ICR has not been taken into account in any of the available literature regarding lumbar disc prosthesis. Considering our results, neither the actual ball-and-socket nor the withdrawn elastomeric nucleus models fit the biomechanics of the lumbar spine, which could at least in part explain the failure rates of the implants in terms of postoperative failed back syndrome (low back pain). It is reasonable to consider then that an implant should also adapt the equations of the movement of the intact ICR of the joint to the post-surgical ICR. CONCLUSIONS This is the first cadaveric study on the ICR of the human lumbar spine. We have shown that it is feasible to calculate and consider this parameter in order to design future prosthesis with improved clinical and biomechanical characteristics.
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Affiliation(s)
| | - Carlos M Atienza
- Instituto de Biomecánica (IBV) Universitat Politècnica de Valencia, Valencia, Spain
- Instituto de Biomecánica de Valencia-CIBER BBN, Grupo de Tecnología Sanitaria (GTS-IBV), Valencia, Spain
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Reduced instantaneous center of rotation movement in patients with low back pain. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:154-162. [DOI: 10.1007/s00586-017-5054-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 02/16/2017] [Accepted: 03/17/2017] [Indexed: 01/14/2023]
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Aiyangar A, Zheng L, Anderst W, Zhang X. Instantaneous centers of rotation for lumbar segmental extension in vivo. J Biomech 2017; 52:113-121. [DOI: 10.1016/j.jbiomech.2016.12.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 12/14/2016] [Accepted: 12/19/2016] [Indexed: 10/20/2022]
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