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Rodriguez-Lorenzo, Andres
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Publications (10 of 42) Show all publications
Jensson, D., Enghag, S., Bylund, N., Jonsson, L., Wikström, J., Grindlund, M. E., . . . Rodriguez-Lorenzo, A. (2018). Cranial Nerve Coactivation and Implication for Nerve Transfers to the Facial Nerve.. Plastic and reconstructive surgery (1963), 141(4), 582e-585e
Open this publication in new window or tab >>Cranial Nerve Coactivation and Implication for Nerve Transfers to the Facial Nerve.
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2018 (English)In: Plastic and reconstructive surgery (1963), ISSN 0032-1052, E-ISSN 1529-4242, Vol. 141, no 4, p. 582e-585eArticle in journal (Refereed) Published
Abstract [en]

In reanimation surgery, effortless smile can be achieved by a nonfacial donor nerve. The underlying mechanisms for this smile development, and which is the best nonfacial neurotizer, need further clarification. The aim of the present study was therefore to further explore the natural coactivation between facial mimic muscles and muscles innervated by the most common donor nerves used in smile reanimation. The study was conducted in 10 healthy adults. Correlation between voluntary facial muscle movements and simultaneous electromyographic activity in muscles innervated by the masseter, hypoglossal, and spinal accessory nerves was assessed. The association between voluntary movements in the latter muscles and simultaneous electromyographic activity in facial muscles was also studied. Smile coactivated the masseter and tongue muscles equally. During the seven mimic movements, the masseter muscle had fewer electromyographically measured coactivations compared with the tongue (two of seven versus five of seven). The trapezius muscle demonstrated no coactivation during mimic movements. Movements of the masseter, tongue, and trapezius muscles induced electromyographically recorded coactivation in the facial muscles. Bite resulted in the strongest coactivation of the zygomaticus major muscle. The authors demonstrated coactivation between voluntary smile and the masseter and tongue muscles. During voluntary bite, strong coactivation of the zygomaticus major muscle was noted. The narrower coactivation pattern in the masseter muscle may be advantageous for central relearning and the development of a spontaneous smile. The strong coactivation between the masseter muscle and the zygomaticus major indicates that the masseter nerve may be preferred in smile reanimation.

National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-347468 (URN)10.1097/PRS.0000000000004235 (DOI)000428668900014 ()29595736 (PubMedID)
Available from: 2018-04-03 Created: 2018-04-03 Last updated: 2018-06-20Bibliographically approved
Liu, T., Freijs, C., Klein, H. J., Feinbaum, A., Svee, A., Rodriguez-Lorenzo, A., . . . Mani, M. (2018). Patients with abdominal-based free flap breast reconstruction a decade after surgery: A comprehensive long-term follow-up study. Journal of Plastic, Reconstructive & Aesthetic Surgery, 71(9), 1301-1309
Open this publication in new window or tab >>Patients with abdominal-based free flap breast reconstruction a decade after surgery: A comprehensive long-term follow-up study
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2018 (English)In: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1532-1959, Vol. 71, no 9, p. 1301-1309Article in journal (Refereed) Published
Abstract [en]

Background: Abdominal-based free flap has increasingly become the gold standard for breast reconstruction, however long-term evidence of the aesthetic outcome and quality of life is lacking. The present study aims to gain an overview of patients with abdominal-based free flap breast reconstructions in a long-term perspective.

Methods: Seventy-five patients who received abdominal-based free flap breast reconstructions between 2000-2007 in Uppsala, Sweden were invited back for photographs, 3D imaging and questionnaires. A retrospective chart review was conducted. Patient satisfaction with appearance and quality of life were assessed using the Breast-Q questionnaire. A layman panel and a professional panel rated the aesthetic appearance of the reconstructed breast from photographs and 3D images.

Results: Fifty-five patients participated with a mean age of 52 +/- 8 years at the time of reconstruction and a mean follow-up time of 11.4 +/- 1.8 years completed the study. The majority of the patients had received unilateral (85%), delayed reconstructions (73%) with prior radiation (55%). There were 53 patients with DIEP flaps, one with free TRAM flap and one with SIEA flap. Breast-Q scores in the cohort were comparable to normative values of women without breast cancer (p < 0.001). There was a high level of agreement for the aesthetic results of the reconstructions between patient, professionals and layman panels (0.89 ICC, 95% CI: 0.83 - 0.93).

Conclusion: Abdominal-based free flap reconstructions were effective in achieving a lasting positive aesthetic result and a high quality of life in patients a decade after surgery. (C) 2018 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Keywords
Breast reconstruction, DIEP, Autologous free tissue transfer, Breast-Q
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-364170 (URN)10.1016/j.bjps.2018.06.009 (DOI)000443019600014 ()30025757 (PubMedID)
Available from: 2018-11-06 Created: 2018-11-06 Last updated: 2018-11-06Bibliographically approved
Zabojova, J., Thrikutam, N., Tolley, P., Perez, J., Rozen, S. M. & Rodriguez-Lorenzo, A. (2018). Relational Anatomy of the Mimetic Muscles and Its Implications on Free Functional Muscle Inset in Facial Reanimation. Annals of Plastic Surgery, 81(2), 203-207
Open this publication in new window or tab >>Relational Anatomy of the Mimetic Muscles and Its Implications on Free Functional Muscle Inset in Facial Reanimation
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2018 (English)In: Annals of Plastic Surgery, ISSN 0148-7043, E-ISSN 1536-3708, Vol. 81, no 2, p. 203-207Article in journal (Refereed) Published
Abstract [en]

Background: The human smile is a complex coordinated activity of mimetic muscles predominantly recognizable by a superolateral pull at the commissure and elevation of the upper lip. The aim of this study was to revisit the muscles of facial expression responsible for these motions, evaluate their relational anatomy and orientation, and relate this to optimal positioning of free muscle transfer in smile reanimation.

Methods: Nineteen hemifaces from fresh cadaveric specimens were dissected. A subsuperficial muscular aponeurotic system skin flap was elevated to expose the zygomaticus major, zygomaticus minor, levator labii superioris, and levator labii superioris alaeque nasi. Muscle location, length, width, angle of pull, and any anatomic variation were noted.

Results: All specimens had zygomaticus major, levator labii superioris, and levator labii superioris alaeque nasi muscles present bilaterally. Conversely, the zygomaticus minor was present in only 10 of 19 hemifaces. There was no significant difference in muscle length, width, or line of pull between specimen sides. Of all the assessed muscles, the zygomaticus minor had the most transverse line of pull, at 31.6 degrees; the zygomaticus major was more oblique with a line of pull of 55.5 degrees; and the levator labii superioris and levator labii superioris alaeque nasi were oriented almost vertically with angles of 74.7 degrees and 79.0 degrees, respectively.

Conclusions: The mimetic muscle vector is quite vertical in comparison to the angle obtained by traditional dynamic smile reconstruction surgeries. A more vertical vector, especially at the upper lip, should be considered in smile reconstruction.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS, 2018
Keywords
facial reanimation, free muscle transfer, smile anatomy
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-361494 (URN)10.1097/SAP.0000000000001507 (DOI)000439309700016 ()29846216 (PubMedID)
Available from: 2018-09-27 Created: 2018-09-27 Last updated: 2018-09-27Bibliographically approved
Blache, L., Nysjö, F., Malmberg, F., Thor, A., Rodriguez-Lorenzo, A. & Nyström, I. (2018). SoftCut:: A Virtual Planning Tool for Soft Tissue Resection on CT Images. In: Mark Nixon; Sasan Mahmoodi; Reyer Zwiggelaar (Ed.), Medical Image Understanding and Analysis: . Paper presented at 22nd Medical Image Understanding and Analysis (MIUA), Southampton, UK, 2018 (pp. 299-310). Cham: Springer, 894
Open this publication in new window or tab >>SoftCut:: A Virtual Planning Tool for Soft Tissue Resection on CT Images
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2018 (English)In: Medical Image Understanding and Analysis / [ed] Mark Nixon; Sasan Mahmoodi; Reyer Zwiggelaar, Cham: Springer, 2018, Vol. 894, p. 299-310Conference paper, Published paper (Refereed)
Abstract [en]

With the increasing use of three-dimensional (3D) models and Computer Aided Design (CAD) in the medical domain, virtual surgical planning is now frequently used. Most of the current solutions focus on bone surgical operations. However, for head and neck oncologic resection, soft tissue ablation and reconstruction are common operations. In this paper, we propose a method to provide a fast and efficient estimation of shape and dimensions of soft tissue resections. Our approach takes advantage of a simple sketch-based interface which allows the user to paint the contour of the resection on a patient specific 3D model reconstructed from a computed tomography (CT) scan. The volume is then virtually cut and carved following this pattern. From the outline of the resection defined on the skin surface as a closed curve, we can identify which areas of the skin are inside or outside this shape. We then use distance transforms to identify the soft tissue voxels which are closer from the inside of this shape. Thus, we can propagate the shape of the resection inside the soft tissue layers of the volume. We demonstrate the usefulness of the method on patient specific CT data.

Place, publisher, year, edition, pages
Cham: Springer, 2018
Series
Communications in Computer and Information Science
National Category
Medical Image Processing
Research subject
Computerized Image Processing
Identifiers
urn:nbn:se:uu:diva-364351 (URN)10.1007/978-3-319-95921-4_28 (DOI)978-3-319-95920-7 (ISBN)
Conference
22nd Medical Image Understanding and Analysis (MIUA), Southampton, UK, 2018
Available from: 2018-10-25 Created: 2018-10-25 Last updated: 2019-03-14Bibliographically approved
Gösseringer, N., Mani, M., Cali-Cassi, L., Papadopoulos, A. & Rodriguez-Lorenzo, A. (2017). Benefits of Two or More Senior Microsurgeons Operating Simultaneously in Microsurgical Breast Reconstruction: Experience in a Swedish Medical Center. Microsurgery, 37(5), 416-420
Open this publication in new window or tab >>Benefits of Two or More Senior Microsurgeons Operating Simultaneously in Microsurgical Breast Reconstruction: Experience in a Swedish Medical Center
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2017 (English)In: Microsurgery, ISSN 0738-1085, E-ISSN 1098-2752, Vol. 37, no 5, p. 416-420Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

The aim of this study is to evaluate how the number of senior microsurgeons, performing autologous microvascular breast reconstruction together, influences operating time and postoperative complications.

METHODS:

A retrospective study was carried out in one hundred consecutive patients who underwent unilateral delayed deep inferior epigastric perforator flap reconstruction at a single institution. All patients followed our institution's surgical protocol and were divided into groups depending on the number of senior microsurgeons that simultaneously performed the procedure. Operating time and complications were compared between the groups.

RESULTS:

Sixteen of the patients were operated by one single microsurgically trained specialist, 64 by two and 20 by three specialists. The mean operating time for the one microsurgeon's group was 286 ± 84 min, for the two-microsurgeons' group 265 ± 57 min and for the three-microsurgeons' group 251 ± 59 min. There was a trend of decreasing operating times when more microsurgeons performed surgery together, however the difference between groups was not statistically significant (P = 0.251). Total flap failure rate was 2% (2/100). Both cases occurred in the group operated by one single microsurgeon (2/16) compared with two microsurgeon's group (0/64) and three microsurgeon's group (0/20; P < 0.005).

CONCLUSIONS:

By optimising the surgical experience available during microvascular breast reconstruction, operating time can be reduced and efficiency improved. In the current setting, two microsurgically trained surgeons achieved optimal operation flow with the lowest complication rate.

National Category
Clinical Medicine
Identifiers
urn:nbn:se:uu:diva-277657 (URN)10.1002/micr.30039 (DOI)000407105200010 ()26916246 (PubMedID)
Available from: 2016-02-22 Created: 2016-02-22 Last updated: 2017-11-16Bibliographically approved
Cristóbal, L., Linder, S., Lopez, B., Mani, M. & Rodriguez-Lorenzo, A. (2017). Free anterolateral thigh flap and masseter nerve transfer for reconstruction of extensive periauricular defects: Surgical technique and clinical outcomes. Microsurgery, 37(6), 479-486
Open this publication in new window or tab >>Free anterolateral thigh flap and masseter nerve transfer for reconstruction of extensive periauricular defects: Surgical technique and clinical outcomes
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2017 (English)In: Microsurgery, ISSN 0738-1085, E-ISSN 1098-2752, Vol. 37, no 6, p. 479-486Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Radical tumor ablation in the periauricular area often results in extensive soft tissue defects, including facial nerve sacrifice, bone and/or dura defects. Reconstruction of these defects should aim at restoring facial reanimation, wound closure, and facial and neck contours. We present our experience using free anterolateral thigh flap (ALT) in combination with masseter nerve to facial nerve transfer in managing complex defects in the periauricular area.

METHODS: Between 2011 and 2015 six patients underwent a combined procedure of ALT flap reconstruction and masseter nerve transfer, to reconstruct extensive, post tumor resection, periauricular defects. The ALT flap was customized according to the defect. For smile restoration, the masseter nerve was transferred to the buccal branch of the facial nerve. If the facial nerve stump was preserved, interposition of nerve grafts to the zygomatic and frontal branches was performed to provide separate eye closure. The outcomes were analyzed by assessing wound closure, contour deformity, symmetry of the face, and facial nerve function.

RESULTS: There were no partial or total flap losses. Stable wound closure and adequate volume replacement in the neck was achieved in all cases, as well as good facial tonus and symmetry. The mean follow-up time of clinical outcomes was 16.8 months. Smile restoration was graded as good or excellent in four cases, moderate in one and fair in one.

CONCLUSION: Extensive periauricular defects following oncologic resection could be adequately reconstructed in a combined procedure of free ALT flap and masseter nerve transfer to the facial nerve for smile restoration.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-307767 (URN)10.1002/micr.30086 (DOI)000411186900001 ()27501201 (PubMedID)
Available from: 2016-11-21 Created: 2016-11-21 Last updated: 2019-01-25Bibliographically approved
Natghian, H., Fransén, J., Rozen, S. M. & Rodriguez-Lorenzo, A. (2017). Qualitative and Quantitative Analysis of Smile Excursion in Facial Reanimation: A Systematic Review and Meta-analysis of 1- versus 2-stage Procedures. Plastic and reconstructive surgery (1963), 5(12), Article ID e1621.
Open this publication in new window or tab >>Qualitative and Quantitative Analysis of Smile Excursion in Facial Reanimation: A Systematic Review and Meta-analysis of 1- versus 2-stage Procedures
2017 (English)In: Plastic and reconstructive surgery (1963), ISSN 0032-1052, E-ISSN 1529-4242, Vol. 5, no 12, article id e1621Article, review/survey (Refereed) Published
Abstract [en]

Background: Free functional muscle transfer has become a common treatment modality for smile restoration in long-lasting facial paralysis, but the selection of surgical strategy between a 1-stage and a 2-stage procedure has remained a matter of debate. The aim of this study was to compare the quantitative and qualitative outcomes of smile excursion between 1-stage and 2-stage free muscle transfers in the literature.

Methods: A comprehensive review of the published literature between 1975 and end of January 2017 was conducted.

Results: The abstracts or titles of 2,743 articles were screened. A total of 24 articles met our inclusion criteria of performing a quantitative or qualitative evaluation of a free-functioning muscle transfer for smile restoration. For the purpose of meta-analysis, 7 articles providing quantitative data on a total of 254 patients were included. When comparing muscle excursion between 1-stage and 2-stage procedures, the average range of smile excursion was 11.5 mm versus 6.6 mm, respectively. For the purpose of systematic review, 17 articles were included. The result of the systematic review suggested a tendency toward superior functional results for the 1-stage procedure when comparing the quality of smile.

Conclusions: The results of this review must be interpreted with great caution. Quantitative analysis suggests that 1-stage procedures produce better excursion than 2-stage procedures. Qualitative analysis suggests that 1-stage procedures might also produce superior results when based on excursion and symmetry alone, but these comparisons do not include one important variable dictating the quality of a smile—the spontaneity of the smile. The difficulty in comparing published results calls for a consensus classification system for facial palsy.

National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-350209 (URN)10.1097/GOX.0000000000001621 (DOI)000423959400031 ()29632792 (PubMedID)
Available from: 2018-05-08 Created: 2018-05-08 Last updated: 2018-05-08Bibliographically approved
Coelho, R., Ekberg, T., Svensson, M., Mani, M. & Rodriguez-Lorenzo, A. (2017). Reconstruction of late esophagus perforation after anterior cervical spine fusion with an adipofascial anterolateral thigh free flap: A case report.. Microsurgery, 37(6), 684-688
Open this publication in new window or tab >>Reconstruction of late esophagus perforation after anterior cervical spine fusion with an adipofascial anterolateral thigh free flap: A case report.
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2017 (English)In: Microsurgery, ISSN 0738-1085, E-ISSN 1098-2752, Vol. 37, no 6, p. 684-688Article in journal (Refereed) Published
Abstract [en]

Reconstruction of late esophageal perforation usually requires flap surgery to achieve wound healing. However, restoring the continuity between the digestive tract and retropharyngeal space to allow for normal swallowing remains a technical challenge. In this report, we describe the use of a thin and pliable free adipofascial anterolateral thigh (ALT) flap in a 47-year-old tetraplegic man with a history of C5-C6 fracture presented with a large posterior esophagus wall perforation allowing an easier flap insetting for a successful wound closure. The postoperative course was uneventful and mucosalization of the flap was confirmed by esophagoscopy 4 weeks postsurgery. The patient tolerated normal diet and maintained normal swallowing during a follow-up of 3 years postoperatively. The adipofascial ALT flap may provide easier insetting due to the thin and pliable layer of adipofascial tissue for reconstructing large defects of the posterior wall of the esophagus by filling the retroesophageal space.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-335300 (URN)10.1002/micr.30170 (DOI)000411186900030 ()28397296 (PubMedID)
Available from: 2017-12-04 Created: 2017-12-04 Last updated: 2018-01-19Bibliographically approved
Bylund, N., Jensson, D., Enghag, S., Berg, T., Marsk, E., Hultcrantz, M., . . . Jonsson, L. (2017). Synkinesis in Bell's palsy in a randomised controlled trial. Clinical Otolaryngology, 42(3), 673-680
Open this publication in new window or tab >>Synkinesis in Bell's palsy in a randomised controlled trial
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2017 (English)In: Clinical Otolaryngology, ISSN 1749-4478, E-ISSN 1365-2273, Vol. 42, no 3, p. 673-680Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To study the development of synkinesis in Bell's palsy. Frequency, severity, gender aspects and predictors were analysed.

DESIGN: Data from the randomised controlled Scandinavian Bell's palsy trial including 829 patients.

MAIN OUTCOME MEASURES: Frequency and severity of synkinesis at 12 months were the main outcome measures. Mean Sunnybrook synkinesis scores, voluntary movement scores and composite scores between 6 and 12 months were compared.

RESULTS: In 743 patients with a 12-month follow-up, synkinesis frequency was 21.3%. There was no gender difference. Synkinesis was moderate to severe in 6.6% of patients. Those with synkinesis at 6 months had a synkinesis score of 4.1 (±2.8 sd), which increased to 4.7 (±3.2) (P = 0.047) at 12 months (n = 93). Sunnybrook composite score at 1 month was the best predictor for synkinesis development with receiver operating characteristics and area under the curve (AUC) 0.87. Risk for synkinesis increased with a lower Sunnybrook composite score. Furthermore, at 1 month, symmetry of voluntary movement had higher predictive value for synkinesis than resting symmetry with AUC 0.87 and 0.77, respectively. Gentle eye closure and open-mouth smile were the only independent significant predictive items (AUC 0.86).

CONCLUSIONS: Moderate-to-severe synkinesis was present in 6.6% of patients. The mean synkinesis score increased between 6 and 12 months, and outcome should therefore be evaluated after at least 12 months. Sunnybrook composite score and symmetry of voluntary movement at 1 month were good predictors for synkinesis.

National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:uu:diva-315889 (URN)10.1111/coa.12799 (DOI)000399941300024 ()27882653 (PubMedID)
Available from: 2017-02-22 Created: 2017-02-22 Last updated: 2017-06-02Bibliographically approved
Rodríguez-Lorenzo, A., Jensson, D., Weninger, W. J., Schmid, M., Meng, S. & Tzou, C.-H. J. (2016). Platysma Motor Nerve Transfer for Restoring Marginal Mandibular Nerve Function. Journal of Plastic, Reconstructive & Aesthetic Surgery, 4(12), e1164
Open this publication in new window or tab >>Platysma Motor Nerve Transfer for Restoring Marginal Mandibular Nerve Function
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2016 (English)In: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1532-1959, Vol. 4, no 12, p. e1164-Article in journal (Refereed) Published
Abstract [en]

Background: Injuries of the marginal mandibular nerve (MMN) of the facial nerve result in paralysis of the lower lip muscle depressors and an asymmetrical smile. Nerve reconstruction, when possible, is the method of choice; however, in cases of long nerve gaps or delayed nerve reconstruction, conventional nerve repairs may be difficult to perform or may provide suboptimal outcomes. Herein, we investigate the anatomical technical feasibility of transfer of the platysma motor nerve (PMN) to the MMN for restoration of lower lip function, and we present a clinical case where this nerve transfer was successfully performed.

Methods: Ten adult fresh cadavers were dissected. Measurements included the number of MMN and PMN branches, the maximal length of dissection of the PMN from the parotid, and the distance from the anterior border of the parotid to the facial artery. The PMN reach for direct coaptation to the MMN at the level of the crossing with the facial artery was assessed. We performed histomorphometric analysis of the MMN and PMN branches.

Results: The anatomy of the MMN and PMN was consistent in all dissections, with an average number of subbranches of 1.5 for the MMN and 1.2 for the PMN. The average maximal length of dissection of the PMN was 46.5 mm, and in every case, tension-free coaptation with the MMN was possible. Histomorphometric analysis demonstrated that the MMN contained an average of 3,866 myelinated fiber counts per millimeter, and the PMN contained 5,025. After a 3-year follow-up of the clinical case, complete recovery of MMN function was observed, without the need of central relearning and without functional or aesthetic impairment resulting from denervation of the platysma muscle.

Conclusions: PMN to MMN transfer is an anatomically feasible procedure for reconstruction of isolated MMN injuries. In our patient, by direct nerve coaptation, a faster and full recovery of lower lip muscle depressors was achieved without the need of central relearning because of the synergistic functions of the PMN and MMN functions and minimal donor-site morbidity.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-315905 (URN)10.1097/GOX.0000000000001164 (DOI)
Available from: 2017-02-22 Created: 2017-02-22 Last updated: 2017-11-29Bibliographically approved
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