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  • 1
    ISSN: 1433-044X
    Keywords: Schlüsselwörter Gentransfer ; Patellarsehne ; Adenovirus ; Retrovirus ; Key words Gene ; Transfer ; Patellar tendon ; Adenovi-rus ; Retrovirus
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Growth factors have the potential to enhance native repair responses in ligamentous and meniscal lesions. However, methods for applying these cytokines to sites of injury for extended periods are lacking. We suggest that local transfer of genes that encode the relevant healing factors merits investigation as a potential solution to this problem. In the present study, different viral vectors and liposomes are evaluated for their ability to deliver genes to cells of ligamentous and meniscal origin. The ACL, PCL, MCL, semitendinosus tendon, patellar tendon, and menisci were harvested from New Zealand white rabbits. Cells grown from these tissues were then investigated for their susceptibility to genetic alteration by these vectors. Based upon the ability of these vectors to convert cells in culture to a lacZ(+) phenotype, adenovirus was the most effective vector in short-term experiments. However, expression was transient. Although retrovirus gave lower initial transduction efficiencies, the percentage of transduced cells could be increased by the use of the selectable marker gene neor. Cells infected with adeno-associated virus containing the neor-gene could also be selected in this way. Liposomes showed low efficiency of gene transfer and expression. In an in vivo marker study, we injected adenovirus into the rabbit patellar tendon. Transduced cells could be observed preferentially in the subsynovial layer at a declining frequency over a 6-week period. The allogeneous transplantation of retrovirally transduced fibroblasts into the patellar tendon resulted in a greater number of transduced cells. Although the number of lacZ(+) cells declined with time, positive cells were still present 6 weeks after transplantation. Furthermore, the transplanted cells, unlike cells transduced in situ with adenovirus, migrated from the injection site and integrated into the crimp of the tendon.
    Notes: Wachstumsfaktoren sind für jeden Wundheilungsprozeß von essentieller Bedeutung. Experimentelle Untersuchungen haben gezeigt, daß die lokale Anwendung dieser Substanzen den natürlichen Heilungsprozeß bei ligamentären Verletzungen beschleunigen kann. Die Methoden für eine effiziente klinische Anwendung sind jedoch nicht ausreichend entwickelt, um eine dauerhaft hohe Konzentration an der Verletzungsstelle zu erzielen. Eine mögliche Lösung für dieses Problem ist die Synthese von Wachstumsfaktoren durch ortsständige Zellen im Kniegelenk, die hierzu durch lokalen Gentransfer angeregt werden könnten. In einem neuen experimentellen Ansatz untersuchen wir die Möglichkeit des lokalen Gentransfers in die Patellarsehne mit dem Ziel, ortsständige Zellen zur Produktion von Wachstumsfaktoren anzuregen. In einer experimentellen Studie wurden zunächst verschiedene Vektoren untersucht, die für den Gentransfer in Fibroblasten in Frage kommen. Virale Vektoren bieten neben non-viralen Vektoren, wie z. B. Liposomen, die Möglichkeit, das Genom von Zellen zu modifizieren. Hierzu wurden Zellkulturen aus dem VKB und HKB des Kaninchens angelegt. Diesen Zellkulturen wurden dann verschiedene Vektoren zugesetzt, die ein Markergen transportieren. Transduzierte Zellen sezernierten anschließend die histochemisch nachweisbare Substanz β-Galaktosidase. Die quantitative Expression dieser Substanz wurde bestimmt. Bei diesen In-vitro-Vorversuchen zeigte sich, daß Adenoviren sämtliche Wirtszellen transduzierten, wobei die Expression der Markersubstanz zeitlich begrenzt war. Retroviren hatten einen signifikant geringeren Effekt, der sich jedoch ebenso wie bei adenoassoziierten Viren durch weitere Selektionsschritte steigern ließ. Liposome zeigten generell die geringste Wirkung. In einem In-vivo-Versuch wurden Adenoviren in die Patellarsehnen von Kaninchen injiziert. Transduzierte Zellen wurden vorwiegend in der synovialen Schicht beobachtet. Die Expression ließ während des 6-wöchigen Untersuchungszeitraums nach. In einem Ex-vivo-Versuch wurden Fibroblasten zunächst mit Retroviren in vitro transduziert, anschließend selektiert und in die Patellarsehne injiziert. Dieses Verfahren resultierte in einer zahlenmäßig größeren Expression. Im Gegensatz zu der In-situ-Transduktion mit Adenoviren konnten transduzierte Zellen entfernt von der Injektionsstelle nachgewiesen werden, wo sich diese Zellen in das Crimp-Muster der Patellarsehne integrierten.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1433-044X
    Keywords: Key words Arthroscopic ACL replacement • Prospective randomized study • ACL • IKDC ; Schlüsselwörter Arthroskopischer vorderer Kreuzbandersatz • Prospektive Vergleichsstudie • IKDC • VKB
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Im Zuge der minimal-invasiven Chirurgie haben vollständig arthroskopische Verfahren zum Ersatz des vorderen Kreuzbandes (VKB) einen beträchtlichen Zulauf erhalten. Das geringere Weichteiltrauma und eine optimierte Lage des Patellarsehnentransplantats werden als Vorteile gesehen, die langfristig zu einer verbesserten Funktion und Stabilität führen sollen. In einer prospektiv randomisierten Studie wurden 40 Patienten konsekutiv 2 Operationsverfahren zugeteilt. Der Ersatz wurde in endoskopischer, transtibialer Technik oder limitiert offen über eine anteromediale und laterale Inzision durchgeführt. Präoperativ zeigte sich kein Unterschied zwischen den Gruppen hinsichtlich des Anteils chronischer Läsionen, des Ausmaßes der Instabilität sowie der Alters- oder Geschlechtsverteilung. Funktion und Stabilität wurden nach 6 Monaten sowie nach 1 und 4 Jahren evaluiert. Intraoperativ zeigte sich für das endoskopische Verfahren eine deutlich kürzere Operations- und Tourniquetzeit. Im postoperativen Verlauf bestanden keine Unterschiede hinsichtlich der Komplikationen oder der Rehabilitation. Nach 1 und 4 Jahren zeigte die Auswertung entsprechend den IKDC-Richtlinien gute bis sehr gute Ergebnisse in 70 % der Fälle. Das Ausmaß der anterioren Translation war in beiden Gruppen nach 6 Monaten signifikant reduziert. Nach 1 und 4 Jahren zeigte sich eine geringe Zunahme der Translation. Der Verlust des Aktivitätsniveaus nach der Kreuzbandverletzung konnte von den meisten Patienten im Beobachtungszeitraum nicht vollständig ausgeglichen werden. Zusammenfassend ließen sich bei der endoskopischen Technik und bei der Zweikanaltechnik während des 4jährigen Untersuchungszeitraums keine signifikanten Unterschiede in Bezug auf Rehabilitation, Funktion und Stabilität nachweisen. Wir betrachten daher beide Techniken als gleichwertig.
    Notes: Summary ACL reconstruction with patellar tendon graft has become a standard procedure. The graft can be inserted either using two tunnels and a lateral femoral incision or with a femoral half tunnel drilled from the joint, thus avoiding the lateral incision. Advantages of the single-incision technique in the early rehabilitation period have been claimed. 40 patients with ACL deficiency were included in a prospective randomized trial comparing single and two-incision technique with a follow-up period of 4 years. Preoperative data did not show any significant difference between the two groups. At follow-up no differences were observed with respect to complications or the progress of rehabilitation. Evaluation after 1 and 4 years according to the IKDC form revealed good to excellent results in 70 % of all patients. The Tegner-score increased significantly, however most patients did not regain their former activity level. ACL-reconstruction reduced anterior translation of the knee significantly at 6 months follow-up. However, we observed a slight increase of anterior translation after 1 and 4 years in both groups; stability was comparable in both groups at all time periods. We conclude that an arthroscopic singleincision technique has no advantage compared to a mini-open two-incision technique for ACL reconstruction with patellar tendon graft in terms of subjective or objective parameters.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1433-044X
    Keywords: Key words Anterior cruciate ligament • Patellar tendon transplant • Biomechanics ; Schlüsselwörter Vorderes Kreuzband • Patellarsehnentransplantat • Biomechanik
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Der endoskopische Ersatz des vorderen Kreuzbands (VKB) mit einem Patellarsehnentransplantat in einem femoralen Halbtunnel kann dazu führen, daß der tibiale Block außerhalb des Kanals zu liegen kommt. Ist in diesen Fällen eine Fixation mit Interferenzschrauben nicht möglich, kann die Verankerung des Blockes mit Staples in einer knöchernen Grube distal des Tunnels alternativ durchgeführt werden. In dieser Studie evaluierten wir die biomechanischen Parameter der Interferenzschrauben- und Stapletechnik. Patellarsehnentransplantate wurden in typischer Technik bei 55 frischen humanen Kniegelenken entnommen und auf eine Länge von 25 mm mit einem Durchmesser von 9 mm präpariert. Der tibiale Kanal wurde von anteromedial mit einem 10-mm-Bohrer zum Ansatz des VKB angelegt; 40 Präparate wurden für die Fixation mit 3 verschieden großen Interferenzschrauben (7 × 30, 9 × 20 und 9 × 30 mm) als Referenzverfahren und 15 weitere Präparate für die Fixation mit Staples verwendet. Hierzu wurde eine knöcherne Grube unterhalb des tibialen Tunnels angelegt, in der das Transplantat mit 2 Staples befestigt wurde. Die Krafteinleitung erfolgte axial zum tibialen Tunnel mit einer Geschwindigkeit von 1 mm/s auf einer Zwick-Materialprüfmaschine. Die Dislokation des Transplantats und die daraus abgeleitete Steifigkeit wurden bei 175 N Last angegeben. Bei der Fixation mit Interferenzschrauben fanden wir eine Variation der maximalen Zuglast in Abhängigkeit von der Schraubengröße zwischen 506 und 758 N. Staples wiesen eine maximale Zuglast von 588 N auf. Die Dislokation gemessen bei 175 N Last variierte bei der Schraubenfixation zwischen 3,6 und 4,7 mm und betrug bei der Fixation mit Staples 4,2 mm. Bei allen Fixationsmethoden waren die maximalen Zuglasten bis zum Transplantatversagen ausreichend, um den Lastspitzen während der Rehabilitationsphase zu widerstehen. Die in der Fixierung mit Staples erreichten Werte waren mit der Ausreißkraft der Interferenzschrauben zu vergleichen. Eine Verankerung mit Staples kann daher als eine sichere alternative Methode für die Transplantatfixierung angesehen werden.
    Notes: Summary The endoscopic single incision technique for ACL reconstruction with a femoral half-tunnel may lead to a graft/tunnel mismatch and subsequent protrusion of the block from the tibial tunnel. The typical tibial fixation with an interference screw is not possible in these cases. Fixation with staples in a bony groove inferior to the tunnel outlet can be used as an alternative technique. Current literature does not provide biomechanical data of both fixation techniques in a human model. This study was performed to evaluate primary biomechanical parameters of this technique compared to a standard interference screw fixation of the block. 55 fresh-frozen human cadaver knee joints of a younger age (mean age: 44 years) were used. Grafts were harvested from the patellar tendon midportion with bone blocks of 25 mm length and 9 mm width. A 10 mm tibial tunnel was drilled from the anteromedial cortex to the center of the tibial insertion of the ACL. 3 different sizes of interference screws (7 × 30, 9 × 20 and 9 × 30 mm) were chosen as a standard control procedure (n = 40). For tibial bone-block fixation the graft was placed through the tunnel, the screw was then inserted on the cancellous or the cortical surface respectively. 15 knees were used for staple fixation. A groove was created inferior to the tunnel outlet with a chisel. The bone block was fixed in this groove with 2 barbed stainless steel staples. Tensile testing in both of the groups was carried out under axial load parallel to the tibial tunnel in a Zwick-testing-machine with a velocity of 1 mm/sec. Dislocation of the graft and stiffness were calculated at 175 N load. Maximum load to failure using interference screws varied between 506 and 758 N. Load to failure using staples was 588 N. Dislocation of the graft ranged between 3.6 and 4.7 mm for interference screw fixation and was 4.2 mm for staples. With both fixation techniques, the recorded failure loads were sufficient to withstand the graft loads which are to be expected during the rehabilitation period. Staple fixation of the bone block outside of the tunnel resulted in fixation strength comparable to interference screw fixation.
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  • 4
    ISSN: 1433-0431
    Keywords: Key words Gene-Transfer • Adenovirus • Retrovirus • ; Liposomes ; Schlüsselwörter Gentransfer • Adenovirus • Retrovirus • ; Liposome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Eine besondere Herausforderung ist die Therapie von Verletzungen der Kapsel-Band-Strukturen sowie des Gelenkknorpels. Nicht nur die spontane Heilungsfähigkeit, sondern auch die Reparation nach konservativer oder operativer Therapie ist begrenzt. In den letzten Jahren sind daher Zytokine als Modulatoren der Heilungsvorgänge in den Blickpunkt des Interesses gerückt. In diesem Übersichtsartikel versuchen wir, den zukünftigen Stellenwert für Zytokine einzuschätzen und Konzepte für eine klinische Anwendung zu erarbeiten. Aufgrund bestehender Probleme in der Anwendung von Zytokinen führen wir das Konzept der somatischen Gentherapie in diese Überlegung ein. Wir postulieren, daß die Gentherapie zur gezielten Applikation von Wachstumsfaktoren die Behandlung zahlreicher Verletzungen verändern kann.
    Notes: Summary Soft tissue injuries often represent the greatest clinical problem. Not only do many of the most frequently injured tissues, such as the cruciate ligaments and articular cartilage, have very limited capabilities for spontaneous repair, but they also respond poorly to surgical or non-surgical intervention. In this article we try to define the role of growth factors in these conditions and to outline concepts for future treatment based upon modulation of the native repair response. We suggest that gene transfer could improve the management of such injuries, particularly when used as vehicles for the targetted delivery of growth factors.
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Knee surgery, sports traumatology, arthroscopy 4 (1996), S. 180-187 
    ISSN: 1433-7347
    Keywords: Gene transfer ; Growth factors ; Ligaments ; Cartilage, articular ; Menisci
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Sports Science
    Notes: Abstract For the orthopedic sports medicine physician soft tissue injuries often present the greatest clinical problems. Not only do many of the most frequently injured tissues, such as the cruciate ligaments and articular cartilage, have very limited capabilities for spontaneous repair, but they also respond poorly to surgical or nonsurgical intervention. In this article we try to define the role of growth factors in these conditions and to outline concepts for future treatment based upon modulation of the native repair response. We suggest that gene transfer could improve the management of such injuries, particularly when used as vehicles for the targeted delivery of growth factors. The concept of gene therapy in orthopedic sports medicine can be extended to include disorders that present as laxity or mechanical weakness of ligaments. We speculate that subtle genetic differences between individuals may account for those who appear to be injury prone. In these cases it is likely that genes encoding the structural macromolecules of the matrix are defective. Local gene supplementation in such cases could be useful in the future.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1433-7347
    Keywords: Key words Anterior cruciate ; ligament reconstruction ; Patellar ; tendon graft ; Interference screw ; Staple fixation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Sports Science
    Notes: Abstract The endoscopic single incision technique for anterior cruciate ligament (ACL) reconstruction with a femoral half-tunnel may lead to a graft/tunnel mismatch and subsequent protrusion of the block from the tibial tunnel. The typical tibial fixation with an interference screw is not possible in these cases. Fixation with staples in a bony groove inferior to the tunnel outlet can be used as an alternative technique. Current literature does not provide biomechanical data of either fixation technique in a human model. This study was performed to evaluate the primary biomechanical parameters of this technique compared with a standard interference screw fixation of the block. Fifty-five fresh-frozen relatively young (mean age 44 years) human cadaver knee joints were used. Grafts were harvested from the patellar tendon midportion with bone blocks of 25 mm length and 9 mm width. A 10-mm tibial tunnel was drilled from the anteromedial cortex to the center of the tibial insertion of the ACL. Three different sizes of interference screws (7 × 30, 9 × 20, 9 × 30 mm) were chosen as a standard control procedure (n = 40). For tibial bone-block fixation the graft was placed through the tunnel, and the screw was then inserted on the cancellous or the cortical surface, respectively. Fifteen knees were treated by staple fixation. A groove was created inferior to the tunnel outlet with a chisel. The bone block was fixed in this groove with two barbed stainless steel staples. Tensile testing in both groups was carried out under an axial load parallel to the tibial tunnel in a Zwick testing machine with a velocity of 1 mm/s. Dislocation of the graft and stiffness were calculated at 175 N load. Maximum load to failure using interference screws varied between 506 and 758 N. Load to failure using staples was 588 N. Dislocation of the graft ranged between 3.8 and 4.7 mm for interference screw fixation and was 4.7 mm for staples. Stiffness calculated at 175 N load was significantly higher in staple fixation. With either fixation technique, the recorded failure loads were sufficient to withstand the graft loads which are to be expected during the rehabilitation period. Staple fixation of the bone block outside of the tunnel resulted in a fixation strength comparable to interference screw fixation.
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    Knee surgery, sports traumatology, arthroscopy 5 (1997), S. 118-123 
    ISSN: 1433-7347
    Keywords: Key words Viral transduction ; Growth factors ; Knee ligament ; Fibroblast ; LacZ
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Sports Science
    Notes: Abstract Growth factors have the potential to enhance native repair responses in ligamentous lesions. However, methods for applying these cytokines to sites of injury for extended periods are lacking. We suggest that local transfer of genes which encode the relevant healing factors merits investigation as a potential solution to this problem. In the present study, the retroviral vectors MFG lacZ and BAG lacZ neor and adenovirus LacZ were evaluated for their ability to deliver genes to cells of ligamentous origin. The posterior and anterior cruciate ligaments, medial collateral ligament, semitendinosus tendon and patellar tendon were harvested from New Zealand white rabbits. Cells grown from these tissues were then investigated for their susceptibility to genetic alteration by these vectors in vitro. Based upon their ability to convert cells in culture to a lacZ(+) phenotype, adenovirus was the most effective vector in short-term experiments. However, expression was transient. Although retrovirus gave lower initial transduction efficiencies, the percentage of transduced cells could be increased by the use of the selectable marker gene neor. In an in vivo marker study, we injected adenovirus into the rabbit patellar tendon. Transduced cells could be observed preferentially in the subsynovial layer at a declining frequency over a 6-week period. The allogeneic transplantation of in vitro retrovirally transduced fibroblasts into the patellar tendon resulted in a greater number of transduced cells. Although the number of lacZ(+) cells declined with time, positive cells were still present 6 weeks after transplantation. Furthermore, the transplanted cells, unlike cells transduced in situ with adenovirus, migrated from the injection site and integrated into the crimp of the tendon.
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  • 8
    ISSN: 1433-7347
    Keywords: Key words Anterior cruciate ; ligament ; Patellar tendon graft ; Single-incision arthroscopy ; Two-incision arthroscopy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Sports Science
    Notes: Abstract Anterior cruciate ligament (ACL) reconstruction with patellar tendon graft has become a standard procedure. The graft can be inserted either using two tunnels and a lateral femoral incision or with a femoral half-tunnel drilled from the joint, thus avoiding the lateral incision. Advantages have been claimed for the single-incision technique in the early rehabilitation period. Forty patients with ACL deficiency were included in a prospective randomized trial comparing the single- and two-incision technique with a follow-up period of 12 months. Preoperative data did not show any significant difference between the two groups. At early follow-up no differences were observed with respect to complications or the progress of rehabilitation. Evaluation at 12 months postoperatively using the IKDC form revealed good to excellent results in 70% of patients. ACL reconstruction reduced anterior translation of the knee significantly at the 6-month and 12-month follow-up with a slight increase of MMD values at 12 months in both groups. The arthroscopic single-incision technique did not differ from the mini-open technique in terms of postoperative pain medication, incidence of effusion, postoperative range-of-motion or any rehabilitation parameters. Stability was comparable in both groups at all time periods. We conclude that an arthroscopic single-incision technique has no advantage over a mini-open two-incision technique for ACL reconstruction with patellar tendon graft in terms of subjective or objective parameters.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 1433-7347
    Keywords: Iliotibial tract ; Knee joint ; Pain receptors ; Free nerve ending ; Proprioception
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Sports Science
    Notes: Abstract Free nerve endings (FNE) are nociceptive sensory elements transmitting information on pain and inflammation from the connective tissues to the brain. They form an important part of the proprioceptive sensory system of the knee. We present a qualitative and quantitative analysis of FNEs in the distal iliotibial tract (ITT), documenting their occurrence in this structure as well as their specific distribution pattern. FNEs were found in all elements of the distal ITT, with their maximum density in the fixation sites of the distal ITT to the femur and the tibia. This finding correlates well with anatomical and biomechanical studies and stresses the importance of the deep ITT fibre system for lateral knee stability. The relative number of FNEs in the distal ITT ranges from 5 to 10 per 50 mm2 and is comparable to the frequency found in the synovial sheath of the cruciate ligaments. These findings have clinical implications for surgical procedures on the lateral side of the knee. The distinct anatomy of the distal ITT should be respected in all procedures, since extensive operations in this area may cause pain and loss of range-of-motion due to alterations of proprioceptive function.
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  • 10
    Electronic Resource
    Electronic Resource
    Springer
    Knee surgery, sports traumatology, arthroscopy 4 (1996), S. 237-241 
    ISSN: 1433-7347
    Keywords: Arthrofibrosis ; Knee arthrolysis ; Capsulotomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Sports Science
    Notes: Abstract Chronic flexion contracture of the knee is difficult to treat, especially in cases with long-standing extension deficits and with generalised arthrofibrosis. We present a technique combining arthroscopic or open anterior debridement with a posterior capsulotomy. This capsulotomy is performed via a posteromedial incision and a posteromedial arthrotomy. All scar tissue is resected, and the entire posterior capsule is detached from its femoral attachment. Of 24 patients treated with arthroscopic arthrolysis and posterior capsulotomy from 1989 to 1993, 21 were reviewed with a mean follow-up of 18 months (range 6–38 months). The mean extension deficit preoperatively was 17° (range 10–30°), and symptoms had persisted from 6 months to 7 years. Extension improved to a mean value of 2°; no patient had more than 5° of extension deficit at follow-up. The knee function improved significantly (Lysholm Score preoperative 62, postoperative 88, Tegner Scale preoperative 2.2, postoperative 4.0). No neurovascular complications were observed, and we conclude that posterior capsulotomy is a safe and efficient adjunct procedure to anterior arthrolysis and is indicated in cases with chronic flexion contracture.
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