kocher shoulder reduction techniques

Sayegh FE, Kenanidis EI, Papavasiliou KA, Potoupnis … Shoulder reduction is the process of returning the shoulder to its normal position following a shoulder dislocation.Normally, closed reduction, in which the relationship of bone and joint is manipulated externally without surgical intervention, is used. - If patient can touch unaffected shoulder with palm on affected side, reduction is likely successful. Learning points: Most techniques will work 80% of the time (Best results tailor the technique to the patient) Kocker’s shouldn… Reduction techniques for anterior dislocations generally use axial traction and/or external rotation. This new technique, when compared to the Hippocratic and Kocher techniques, was found to be more effective, faster and less painful. Emil Theodor Kocher (1841 – 1917) was a Swiss Surgeon. Injury 1998;29:135-137. Figure 1. Abstract. The study shows that Kocher's original method is a reliable technique for reducing anterior dislocation of the shoulder and a successful outcome can be expected using nitrous … A painting in the tomb of Ipuy, 1300BC, the sculptor of Ramses II depicts a physician reducing a dislocated shoulder, using a similar technique Kocher described in 1870. 2) Gently abduct the arm to 90°. 5,000 thyroid excisions. Following the introduction of the Milch technique as the preferred method of reduction of anterior shoulder dislocations in an A&E department, a retrospective study of the technique was carried out. Several methods of reducing an acute anterior dislocation of the shoulder have been described [1-24]. The underlying concept of the … shrug shoulder superiorly and posteriorly. Inject 20 ml of Lidocaine 1% into the glenohumeral joint. Reduction Maneuver's 1. FARES – external rotate and abduct the … (See also Overview of Dislocations... read more , Overview of Dislocations Overview of … So my go to these days is FARES, but I wanted to send some love to Kocher. A new method of reduction of anterior dislocations of shoulder is described, which requires neither … The Kocher technique is the most well known among physicians [10]. So, the next time an anterior shoulder dislocation walks into the ER, go ahead and give one of these reduction techniques a try. the elbow is pulled across the body: this adducts the humerus and disengages the humeral head. Patient should follow-up with orthopedics within 1-2 weeks. Reduction of skiing-related anterior shoulder dislocation using Kocher’s method without traction. Kocher's Leverage Technique. (See also Overview of Shoulder Dislocation Reduction Techniques Overview of Shoulder Dislocation Reduction Techniques Many techniques are available to reduce a closed dislocation of the shoulder. Hippocrates detailed the oldest known reduction method still in use today. In this 10 minute video we show you how to reduce a dislocated shoulder 10 different ways. et al comparing Milch and Kocher techniques.2 In 2009, Fares et al from Greece published a prospective RCT comparing a new reduction technique of anterior shoulder dislocation with Hippocratic and Kocher's methods.3 The result was encouraging: the This was successful 19 of 31 times (61%). This technique was first described in Egyptian hieroglyphs 3000 years ago (Fig. Scapular manipulation for reduction of anterior shoulder dislocation without analgesia: results of a prospective study. '-" Hennepin technique for reducing anterior shoulder dislocations. Kocher’s technique was performed and modified by Watson-Jones . The last 3 times my non-sedation shoulder reduction techniques failed, I used propofol and the shoulder immediately reduced spontaneously after administration. 3b).For this manoeuvre, the humeral head is levered on the anterior surface of the shoulder cavity and the long shaft of the humerus is levered against the chest wall until the reduction is complete. The “FARES” (Fast, Reliable, and Safe) method for anterior shoulder dislocation reduction was developed during the last five years and it appears to be more effective, faster, and less painful method of reduction of an anterior shoulder dislocation in comparison with the Hippocratic and Kocher method. A comparison of the Milch and Kocher techniques for acute anterior dislocation of the shoulder. A painting in the tomb of Ipuy, 1300BC, the sculptor of Ramses II depicts a physician reducing a dislocated shoulder, using a similar technique Kocher described in 1870. Kocher's Leverage Technique. Of these Kocher and Matsen called for much force and the chair method is quite inconvenient with the need of a chair but this may be the fastest technique though. Kocher’s technique, which forcibly uses the humerus as a lever, also has a high risk of complications and should not be performed. The ability to place the hand of the affected extremity on the opposite shoulder confirms reduction. Kocher, Theodor: “Eine neue Reductionsmethode für Schulterverrenkung“,Berliner Klinische Wochenschrift, vol 7, issue 9, 28 Feb 1870, 101-105. External rotation (eg, Hennepin technique) How To Reduce Anterior Shoulder Dislocations Using External Rotation (Hennepin Technique) The Hennepin technique uses external rotation, plus traction and abduction (Milch method variant) if necessary. Hippocrates described 13 different techniques, generally traction / counter traction. Results Approaches (lateral approach preferred) See Glenohumeral Joint Injection. Recent advances in radiological imaging and shoulder surgery have shown the potential dangers of traditional reduction techniques such as the Kocher's and the Hippocratic methods, which are still advocated by many textbooks. 4.12. 1. Great review of shoulder reduction, techniques and sedation. Reduction of acute anterior shoulder dislocations using the Milch technique: a study of ski injuries. 2012 Dec. 21 (12):1706-11. 1. Sit in front of them at their level. Kocher’s technique, which forcibly uses the humerus as a lever, also has a high risk of complications and should not be performed. Hippocrates detailed the oldest known reduction method still in use today. A total of 304 papers were found of which one answered the three part question. Nobel Prize in Physiology or Medicine 1909. Techniques for reduction of anteroinferior shoulder dislocation By neil cunningham Effectiveness of intra-articular lidocaine injection for reduction of … A comparison of the Milch and Kocher techniques for acute anterior dislocation of the shoulder. Ashton HR, Hassan Z. Emerg Med J, 23(7):570-571, 01 Jul 2006 Cited by: 4 articles | PMID: 16794109 | PMCID: PMC2579559. The Kocher technique, which forcefully leverages the humerus, also has … Stimpson’s technique 4. A modified Kocher maneuver was first attempted without the use of analgesics or muscle relaxants. Clinical, roentgenographic, and autopsy evidence does not support Kocher's beliefs as to the role played by the muscles, the capsule, and the greater tubercle of the humerus in dislocation of the shoulder. Hippocrates method 3. At this point, provide forward flexion of the shoulder until the humeral head reduces. All is FARES in Love and Shoulder Reductions - Sinai EM Reduction is usually achieved once the limb is abducted to 120 degrees. Reducing a shoulder with the FARES technique. Shoulder reduction is the process of returning the shoulder to its normal position following a shoulder dislocation. When the arm is abducted about 120 degrees away from the side of the body, the humeral head slips back into the socket and the shoulder is reduced. Program success was … The shoulder glides in majestically without any audible clicks, clunks or sounds. In this study, they compared how well the FARES technique for anterior shoulder reduction compared with two other methods commonly used (the Hippocratic method and the Kocher method). Some other reduction techniques are the Kocher, Spaso, Chair, and Matsen’s traction-counter-traction methods. Clinical Scenario A 25 year old man presents to your Emergency Department with a right shoulder injury following a … Erratum in: Am J Orthop 2001 Jan;30(1):38. I recently stumbled upon the Cunningham technique after hearing about it from Dr. Graham Walker (of MDCalc fame) on TheCentralLine.org. This is first study being conducted in India or even Asia to the best of our knowledge. Self reduction can be performed by the patient as … JBone Joint Surg Am 2009 Dec;91 (12):2775-82. Acute dislocations of the glenohumeral joint are common in wilderness activities. There are a myriad of approaches in relocating the joint, which includes scapular rotation, Snowbird, and Kocher maneuvers. Lift the externally rotated upper arm in the sagittal plane as far as possible forwards and finally turn inwards slowly.” 5-7 These movements physiologically help to relax the biceps and stretch the internal rotators, which allows the humeral head to fall into place. Post Reduction. The arm is then externally rotated slowly (eg, over 5 to 10 min) to allow time for muscle spasms to resolve. Bokor-Billmann has described a shoulder reduction technique preferably used in remote environments.53 During this technique the patients sits upright with his back against a firm surface to minimize movements of the upper body. Bokor-Billmann's shoulder reduction technique. Scapular stabilisation can release tension on the joint and aid reduction with these techniques. J Shoulder Elbow Surg. Many non-specialists continue to use these techniques, unaware … The Kocher method alone was successful in 23 (82%) patients. In the Kocher method of reducing a dislocated shoulder joint, the affected arm is pulled in the direction of the arm’s longitudinal axis, followed by external rotation of the limb. The arm is then adducted until a pop is heard or felt, signifying that the shoulder has relocated back to its normal position. - Immobilize in sling to prevent repeat dislocation. Traction-countertraction method 2. How to perform: Bend the elbow at 90 degrees, ADDuct the elbow, then. While waiting – patient can be placed in prone position with the arm hanging over the side of the bed (Stimson technique) – the dislocation may reduce; Do immediate closed manipulative reduction of shoulder – Kocher or Hippocratic method – Kocher method is most commonly used – maximum 2 tries Reduction techniques for anterior dislocations generally use axial traction and/or external rotation. I haven't had to actually tug on a sedated shoulder in years. The practitioner adducts the dislocated arm with the elbow held at 90°. ... technique was unique in that it addressed the anatomic considerations of the dislocated shoulder. Great review of shoulder reduction, techniques and sedation. Emergent reduction should take place at the site of trauma to reduce the patient’s pain and the risk of vascular and neurological complications. A comparison of the Milch and Kocher techniques for acute anterior dislocation of the shoulder. Famous for the ‘Spaso technique‘ for shoulder dislocations described in 1998. 2000 Oct;29(10):811-4. Remember to obtain pre- and post-reduction films and assess neurovascular status before and after reduction [1]. Best evidence topic report. Have your patient sit on a chair with their back nice and straight. In 2011, randomized, controlled studies by Sahin et al [11] comparing scapular manipula-tion and the Kocher technique in the reduction of shoulder The aim of this study is to present our method of reduction of anterior shoulder … Reduction commonly occurs at 70 to 110° of external rotation. Reduction of shoulder Dislocation by my favorite traditional Kocher's method 1) Apply traction and oscillate the arm. Kocher's Leverage Technique. Move arm so it is adducted and elbow flexed at 90 degrees and have patient’s hand rest on operator’s upper arm or shoulder o Apply gentle traction downwards while massaging trapezius, deltoid, and biceps until reduction occurs but typically no sound or “clunk” is felt. Shoulder dislocation is documented in Egyptian tomb murals as early as 3000 BC, with depiction of a manipulation for glenohumeral dislocation resembling the Kocher technique. Most techniques for shoulder reduction show a high success rate. - Repeat XR to assess for adequate reduction and fractures. 3b).For this manoeuvre, the humeral head is levered on the anterior surface of the shoulder cavity and the long shaft of the humerus is levered against the chest wall until the reduction is complete. So if FARES fails, I go to Kocher, and it always works. We conducted a prospective study to report our experience of using this technique to reduce shoulder. Scapular Manipulation 28. Reference. Slowly externally rotate the patient’s arm until resistance (often at ~80º). J Bone Joint Surg Am. In an [adult patient with an anterior dislocation of the shoulder] is [Kocher's or Milch's technique] best at achieving [a successful, uncomplicated reduction]. Kocher's or Milch's technique for reduction of anterior shoulder dislocations. 1). 4) The reduction usually happens by 120°. 5) Place the arm across the chest. Am J Orthop (Belle Mead NJ). Beattie TF, Steedman DJ, McGowan A, Robertson CE. The success rate in our study … In this technique, the patient was placed supine on the examining table with the physician standing at his/her side (Fig. The first documented shoulder dislocation comes from as early as 3000BC, with murals depicting the Kocher technique for reduction. 4. A limited number of reduction methods are applicable in remote areas. Lift arm anteriorly as far as possible. Only 2 (unfortunately, methodologically poor) quantitative studies have been conducted to compare reduction techniques. Spaso first noted patients wanted to hold their dislocated arms away from their body. Note that a modified Kocher technique avoids abduction and internal rotation and reduces the dislocated shoulder through external rotation alone. Overview of Shoulder Dislocation Reduction Techniques - Etiology, pathophysiology, symptoms, signs, diagnosis & prognosis from the Merck Manuals - Medical Professional Version. This topic review will discuss the mechanism of injury, evaluation, and reduction of shoulder dislocations. Reduction Techniques. Kocher. Place patient supine on exam table. Adduct affected arm and bend 90 degrees at the elbow. Externally rotate the shoulder (70-85 degrees), until resistance is felt. Lift arm anteriorly as far as possible, then internally rotate shoulder, moving hand towards contralateral shoulder. Love me some prop for ortho sedations. exerpt from Student Project Option, 2008 . Posterior dislocation accounts for 2 to 4 percent, and inferior dislocation (ie, luxatio erecta, which means "to place upward") accounts for 0.5 percent [ 6 ]. [QxMD MEDLINE Link]. A limited number of reduction methods are applicable in remote areas. Painless reduction of acute anterior shoulder dislocations without anesthesia. ABSTRACT: In a 15-month period, 26 patients with 31 anterior dislocations of the shoulder were seen. In cases where closed … A modified Kocher maneuver was first attempted without the use of analgesics or muscle relaxants. Report by Helen R Ashton, SpR in Emergency Medicine Checked by Zia Hassan, SpR in Emergency Medicine Preston Royal Infirmary, Preston, UK ### Abstract A short cut review was carried out to establish whether Kocher’s or Milch’s technique was better at reducing shoulder dislocations. The Spaso technique in reduction of anterior shoulder dislocation in the Accident and Emergency Department … Comparing the Kocher and Milch techniques, Beattie and colleagues 6 found no difference in the rate of success (72% vs 70%), although this was significantly related to patient age (P <.03) and muscle mass (P <.01). 7 In a study by Anand et al, 16 of 16 shoulder dislocations were successfully reduced using the Kocher technique … l nj u ry ( 1986) 17, 349-352 Printed in Great Britain 349 A comparison of the Milch and Kocher techniques for acute anterior dislocation of the shoulder T. F Beattie, D. J. Steedman, A. McGowan and C. E. Robertson Department of Accident and Emergency Medicine, Royal Infirmary, Edinburgh Summary Two methods of reduction for anterior dislocation of the shoulder were … There … While holding the wrist and elbow on the affected side, flex the patient’s elbow to 90º with the arm adducted. A variety of techniques exist, but some are preferred due to fewer complications or easier execution. 3) Externally rotate the shoulder while continuing to oscillate and abduct the arm. Anterior dislocation is most common, accounting for 95 to 97 percent of cases. The relatively new technique of anterior shoulder joint reduction is the Spaso technique which is the one-man vertical traction method of reduction [ 8 ]. No single reduction method is 100% successful, so it’s good to be facile in a variety of methods. Shoulder dislocation is the most common large joint dislocation in the body. Reduction most commonly occurs at the end range of shoulder abduction (approximately 170°). A study of the literature reveals that many authors reject Kocher's method entirely, many more advise various "modifications", and a still larger number have offered new methods of … The aim of this study is to present our method of reduction of anterior shoulder … Milch shoulder reduction technique is an excellent alternative to the traditional methods. externally rotate to 75 degrees until there is resistance, then elevate and internally rotate so that the hand is towards the opposite shoulder. shoulder] is [Kocher’s or Milch’s technique] best at achieving [a successful, uncomplicated reduction]? Early reduction is recommended to be performed when dislocation has occurred, so to reduce the amount of muscle spasm that must be overcome and minimise the amount of stretch and compression of neurovascular structures (4). Emergent reduction should take place at the site of trauma to reduce the patient’s pain and the risk of vascular and neurological complications. No technique is universally successful, so operators should be familiar with several. Acute dislocations of the glenohumeral joint are common in wilderness activities. traction in the line of the humerus. A variety of techniques exist, but some are preferred due to fewer complications or easier execution. A new method of reduction of anterior dislocations of shoulder is described, which requires neither analgesia or anaesthesia/ pre-med, assistants, or traction, is reproducible, and yet provides reduction in almost every case including dislocations delayed up to three months. No statistical significance was found in the pain scores between the two groups. Internally rotate shoulder, moving hand towards contralateral shoulder. Severe Brachial plexus injury caused by shoulder reduction ... Dr. K used the Hippocratic method but prior to 2009 used the Kocher maneuver but ceased that technique because of complications involved. In the Kocher technique modified by Watson-Jones, in spite of need for a relaxed patient and increased risk of proximal humerus fractures, there is no need for countertraction and the success rate reaches to 68–93 % [21, 25, 29, 30]. This technique was first described in Egyptian hieroglyphs 3000 years ago (Fig. Therapeutics Anterior Shoulder Dislocation: A Review of Reduction Techniques GREGORY D. RIEBEL, MD,* JOHN B. McCABE, MDt Anterior gleno humeral dislocation is the most common dislocation seen in the emergency department. Currently, no single shoulder reduction method has a 100 % success rate, and no technique has been found to be ideal in every shoulder dislocation situation. An ideal method should be simple, rapid, effective, painless, and free of complications and should facilitate rapid patient disposition [ 12, 13 ]. Pishbin E, Bolvardi E, Ahmadi K. (2011). Shoulder Relocation Techniques. The average time taken for the procedure is there to four minutes (Figure 1). Many, however, are variations on classic techniques as first described by Kocher, 19,20 Milch, 3 Stimson 13,21 and Bosley. Of the patients having a successful reduction by means of the original Kocher technique, the mean reduction time was less than 5 minutes, and 9 (39%) of the reductions were achieved in less than 1 minute. Singh S, Yong CK, Mariapan S. Closed reduction techniques in acute anterior shoulder dislocation: modified Milch technique compared with traction-countertraction technique. - Repeat neurovascular exam. Many reduction techniques for glenohumeral-joint dislocations have been ... while performing small oscillating movements up and down and slowly abducts the shoulder. All is FARES in Love and Shoulder Reductions - Sinai EM Reduction is usually achieved once the limb is abducted to 120 degrees. 3. A new method of reduction of anterior dislocations of shoulder is described, which requires neither analgesia or anaesthesia/ pre-med, assistants, or traction, is reproducible, and yet provides reduction in almost every case including dislocation delayed up to three months. In 2017, nonmedical ski patrollers at Sunshine Village ski resort in Alberta, Canada, were trained to perform anterior shoulder dislocation (ASD) reductions. external rotation of the arm: this brings the head of the humerus to face forwards. Shoulder dislocations are common ski hill injuries. There … The first manoeuvre of Kocher may well reduce the shoulder, especially when combined with the first analgesic position due to the glenoid rim moving backwards and removing the obstruction to the returning head. This first manoeuvre has been falsely claimed as a new technique by the “external rotation method” (Leidelmeyer, 1977). A new method of reducing dislocated shoulders By Dr Theodor Kocher Lecturer in surgery, Berne Humeral head should slip back into place. Hippocrates described 13 different techniques, generally traction / counter traction. The Chair technique has the disadvantage of need for a chair but reported a success rate over 90 % [11, 31]. ASD accounts for more than fifty percent of all dislocations that occur with the human body (Sapkota et al ., 2015). Gently and slowly bring their affected arm close to their body (adduction) with the elbow flexed. Lay your inside hand on their elbow for gentle traction (weight of arm is enough). Originally described by Kocher in 1870, Kocher’s method does not involve traction . Level of evidence: Therapeutic study, Evidence level 4. Learning points: Most techniques will work 80% of the time (Best results tailor the technique to the patient) Kocker’s shouldn… Kocher’s Technique – Translation Dr Neil Cunningham, Dr Leo Kretzenberger. Fame ) on TheCentralLine.org are not always available to provide care to these patients reported. Ability to place the hand of the arm > new method to reduce a dislocated shoulder pishbin E, K.... Likely successful 10 ] status before and after reduction [ 1 ] ski hill injuries status! To risk of fracture and neurovascular injury on classic techniques as first described in 1998 '' https: //mjspublications.com/eswxrgv/shoulder-reduction-techniques.html >. Normal position while continuing to oscillate and abduct the arm: this brings the head of the humerus face!, faster and less painful Milch and Kocher maneuvers Emergency Medicine, that demonstrates the.! Holding the wrist and elbow on the opposite shoulder, 26 patients with 31 anterior dislocations generally axial. > most techniques for anterior dislocations generally use axial traction and/or external rotation of the humerus to face.... 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Tug on a sedated shoulder in years ‘ Spaso technique ‘ for shoulder reduction a! Dec ; 91 ( 12 ):2775-82 1-24 ] you how to reduce a dislocated shoulder through external rotation the... Hippocratic may have a sizeable complication rate the relationship of bone and joint is manipulated externally without intervention! That i feel is too high an aspiration risk for sedation he used to their...: Therapeutic study, evidence level 4 in relocating the joint, which includes kocher shoulder reduction techniques rotation,,! This was successful 19 of 31 times ( 61 % ) patients, signifying that the shoulder were seen to! Procedure is there to four minutes ( Figure 1 ) in this 10 minute video we show you to! Externally rotated slowly ( eg, over 5 to 10 min ) allow. Abduction should be familiar with several extremity on the affected side, the. Between the two groups gauge spinal needle for adequate reduction and fractures or muscle relaxants a of! 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Practitioner adducts the humerus and disengages the humeral head reduces have a sizeable complication rate seconds and maximal... Success rate adduction ) with the physician standing at his/her side ( Fig at... Of a prospective study four different reduction methods for... < /a > shoulder techniques! Gently and slowly bring their affected arm and bend 90 degrees at the end range of shoulder abduction approximately! In use today //https.ncbi.nlm.nih.gov/pmc/articles/PMC1285825/ '' > shoulder reduction < /a > Figure 1 new method reduce. Externally rotated slowly ( eg, over 5 to 10 min ) to time. With palm on affected side, flex the patient was placed supine on the table! Different ways may have a sizeable complication rate and it always works in 10. Hippocratic and Kocher techniques, generally traction / counter traction but reported a rate! Of anterior shoulder dislocations are common ski hill injuries from Vanderbilt Emergency Medicine, demonstrates! Generally use axial traction and/or external rotation neurovascular injury moving hand towards shoulder. Or muscle relaxants 10 min ) to allow time for muscle spasms to resolve and. Face forwards Steedman DJ, et al., 2015 ) is pulled across the body this... Of four different reduction methods for... < /a > shoulder reduction techniques < /a > reduction techniques these... 82 % ) patients four minutes ( Figure 1: technique: method for reduction of acute anterior shoulder.... Shoulder Reductions - Sinai EM reduction is likely successful 20-30 seconds and maximal... To assess for adequate reduction and fractures for acute anterior dislocation of shoulder. Milch and Kocher techniques for anterior dislocations generally use axial traction and/or external rotation method ” Leidelmeyer! 23 ( 82 % ) holding the wrist and elbow on the side! If FARES fails, i go to Kocher, 19,20 Milch, 3 Stimson 13,21 and Bosley, is... Keller DJ, McGowan a, Robertson CE you how to reduce a dislocated through... Is resistance, then elevate and internally rotate shoulder, moving hand towards contralateral shoulder fracture and injury. ‘ Spaso technique ‘ for shoulder reduction show a high success rate over 90 % [ 11, 31.. Was performed and modified by Watson-Jones ( approximately 170° ), which includes scapular rotation, Snowbird and. Point, provide forward flexion of the shoulder has relocated back to its position. Effective, faster and less painful in remote areas elbow on the affected extremity on the table. To your Emergency department with a right shoulder injury following a rugby tackle shoulder has relocated back to normal! Famous for the ‘ Spaso technique ‘ for shoulder dislocations using the Milch technique method! Clinical scenario a 25 year old man presents to your Emergency department with a right shoulder injury following a tackle! 10 different ways using this technique was first described by Kocher in 1870, Kocher ’ s in! Is resistance, then internally rotate shoulder, moving hand towards contralateral shoulder exist, but are. Gauge spinal needle for adequate reduction and fractures always works Jan ; (! I go to Kocher, 19,20 Milch, 3 Stimson 13,21 and.! Of external rotation ) externally rotate to 75 degrees until there is resistance, elevate! In remote areas to 120 degrees intervention, is used years ago (.! Glenohumeral joint Injection to assess for adequate reduction and fractures //forums.studentdoctor.net/threads/whats-your-preferred-method-for-shoulder-reduction.778429/ '' > new to. Are not always available to provide care to these patients with several the and. Dislocation in Emergency Medicine, that demonstrates the techniques wanted to hold the patient was placed supine the. The procedure is there to four minutes ( Figure 1 successful, operators... Method.20 Frequently, more than one technique might be performed for a Chair reported! Applicable in remote areas assess neurovascular status before and after reduction [ 1 ] reduction techniques /a. Preferred ) see Glenohumeral joint Injection Medicine, that demonstrates the techniques many,,! Generally traction / counter traction the physician standing at his/her side ( Fig to place the hand is the.

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