The titanium screws used in the orthopedic surgery that he underwent were removed 1 year later, but the eczema remained. However, in chronic cases of months to years after the operation, a CT scan is usually performed to rule out malignant tumors and possible fistula formations [13]. 66/92 had symptoms (pain, reduced motion, swelling). When hardware issues become apparent, one of the first questions patients ask themselves is: Am I allergic to the hardware? In this post, we are going to talk about allergies as they relate to spinal hardware. The skin patch test has not yet been developed as the valid standardized test for titanium allergy. of weight loss in only four months of duration. Patients can present with atopic dermatitis, pruritus, edema, urticaria, impaired healing fractures, pain, and necrosis of implants [ 3 ]. However, titanium staples are not made of pure titanium. You can find out more about our use, change your default settings, and withdraw your consent at any time with effect for the future by visiting Cookies Settings, which can also be found in the footer of the site. Medical ID Cards to Identify Metal Implants for the TSA, Trapeziectomy: Everything You Need to Know, Removing Pins and Other Surgical Implants, Problems With Metal-on-Metal Hip Replacements, Causes and Risk Factors of Contact Dermatitis, Why the Material Used for Hip Replacement Implants Matters, Allergy in total knee arthroplasty: a review of the facts, Metal hypersensitivity reactions to orthopedic implants, Biological responses to metal implants: 2019. Symptoms reported have included: 3 Anemia Weakness Numbness Pain Having a skin sensitivity to a particular metal is not thought to correlate well to having sensitivities to implanted metals. Cardiac stents and patches are often made of Nitinol, a composite of nickel and titanium. Red, swollen, watery eyes -- a condition known as allergic conjunctivitis. An interleukin-1 polymorphism additionally intensified by atopy as prognostic factor for aseptic non-mechanical complications in metal knee and hip arthroplasty. In general, allergic risk of titanium material is smaller than that of other metal materials. Hautarzt. "Patient-ReportedMetalAllergy: A Risk Factor for Poor Outcomes After Total JointArthroplasty?" This causes type IV hypersensitivity reaction through sensitization of T lymphocytes and macrophages. V. Vijayaraghavan, A. V. Sabane, and K. Tejas, Hypersensitivity to titanium: a less explored area of research, J Indian Prosthodont Soc., vol. Eleven months prior, the patient underwent cholecystectomy, or surgery to remove the gallbladder, where six titanium surgical clips were used. Summary. Juliana L. Basko-Plluska; Jacob P. Thyssen; Peter C. Schalock. 2011American Contact Dermatitis Society. However, in October 2020, the patient started having new symptoms of watery, nonbloody diarrhea associated with her chronic RLQ pain. These cookies will be stored in your browser only with your consent. It explores the causes and symptoms of a reaction and what to do if you suspect one. 3, no. Six metal surgical clips removed from the RUQ via fluoroscopic guidance. The https:// ensures that you are connecting to the In our case, the patients nonspecific symptoms due to the titanium clips were quite different from the symptoms reported in other studies and may not wholly be attributable to titanium hypersensitivity since the patient had known allergic reactions to various other allergens as well. Metals and their alloys could lead to immediate or delayed hypersensitivity reactions. Metal Allergy to Surgical Plates, Screws, and Implants, Hip Replacement Loosening Symptoms and Causes, Problems With Metal-on-Metal Hip Replacements, What Causes Metal Implants to Break Inside the Body, Trapeziectomy: Everything You Need to Know, What to Expect When Getting Your Ears Pierced, Allergic Reactions and Sensitivities Caused by Synthroid, Causes and Risk Factors of Contact Dermatitis, Metal hypersensitivity and total knee arthroplasty. Revision to titanium alloy with ceramic-on-ceramic bearing led to symptom resolution. The patient had delayed hypersensitivity reaction to nickel in the past with erythematous rash formation and severe itching. 2016;98-B(4):437-41. doi:10.1302/0301-620X.98B4.36767, Teo WZW, Schalock PC. Although inflammation is the body's natural response to anything it considers foreign and harmful, it can cause pain and other symptoms if it occurs in the absence of a genuine threat. Surgical exploration, revision to LCS prosthesis with bone graft and PMMA cement. Also, more complex immune reactions may develop around the implants, resulting in pain, inflammation, and loosening. So a person who has already had spinal hardware put in place can potentially develop an allergy to it years down the line. -, Lancet. These cookies do not store any personal information. Dr. Sinicropi performs surgery in the following Minnesota cities: Edina, Burnsville, Roseville, Woodbury, Maplewood, Stillwater. does it exst? Patients can also lower their risk for other complications after a surgery with staples by following postoperative care instructions from their surgeon. They may want to consider an implant made of different materials, such as titanium. 8487, 2019. Other case reports by Shi et al., Tawil et al., and Towers et al., mentioned hypersensitivity reactions due to titanium in different surgical procedures such as anterior cervical discectomy, dental implants, and spinal fixation devices. Symptoms. 55435 Patients who have pain around metal implants that is also associated skin changes (eczema) should be evaluated for possible metal sensitivity. The base metals are found in the highest quantities, but smaller amounts of other metals, such as nickel and aluminum, are often used. [5] Independent of the primary cause of metal sensitization, the insertion of metallic implants may result in eczematous eruptions on the skin overlying the implant or in device failure caused by delayed-type hypersensitivity (DTH) (eg, chronic inflammation, pain, loosening of joint prostheses, or restenosis of cardiac stents). 2016 Sep;31(9):1910-5. Seminal studies cited by the International Journal of Implant Dentistry report that titanium allergy symptoms include: Erythema (skin redness, in this case, in the tissues around the implant) Urticaria (hives that may be seen on the skin or gum surface) Eczema (itchy inflammation of the skin or gum tissue) Swelling or pain Metal Allergy to Surgical Plates, Screws, and Implants. fibromyalgia (widespread pain without known cause). Middle Back Pain Oftentimes Tied To Heavy Electronics Use, What to Do if Your Back Hurts When Bending Over, Preventing Back Pain When Training For A Triathlon, Titanium & metal alloys (the most common). Front Bioeng Biotechnol. 97100, 2017. Revision to conventional THR led to resolution of pain. Clinically, diagnosis of metal implant allergy is a process of excluding differential diagnoses, specifically infection. Hosoki M, Nishigawa K, Tajima T, Ueda M, Matsuka Y. J Prosthodont Res. Your healthcare provider can help you determine the cause of your problems and the appropriate treatment to consider. When they do occur, however, the associated pain, swelling, inflammation, and decreased range of motion can significantly impair the implant function. Read our, Reactions to Surgical Hardware and Implants, What Causes Metal Implants to Break Inside the Body, Hip Replacement Loosening Symptoms and Causes. If you have a known hypersensitivity to metal and are scheduled to undergo a total knee replacement, it is not clear if starting with a ceramic or titanium appliance is the best option. Implant-related Allergic Contact Dermatitis, Cobalt-chromiummolybdenum steel (ASTM F75), 1. doi:10.5435/JAAOS-D-14-00290, Saccomanno MF, Sircana G, Masci G, et al. If you notice any severe symptoms after your spine surgery, be sure to contact your surgeon. 2023 Dotdash Media, Inc. All rights reserved, Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. We obtained written informed consent from the patient for the publication of this case report and accompanying images. ALVAL = aseptic lymphocytic vasculitisassociated lesions; Co = cobalt; Cr = chromium; CT = computed tomography; F = female; M = male; MOM = metal-on-metal; Ref. Prosthetic joints containing metals nickel, chromium, and cobalt are most likely to cause a reaction. Jonathan Cluett, MD, is board-certified in orthopedic surgery. Can the human body reject surgical screws used to repair fractured bones? This requires immediate attention and an X-ray for further investigation. Pain, numbness or tingling in your teeth, gums, lips or chin after implant placement can sometimes be a sign that the nerves or surrounding structures may have been damaged during the surgery, notes the Mayo Clinic. A. Serati, B. Sharif-Kashani, Z. H. Ahmadi et al., Removing an entrapped pigtail catheter by re-enforcing a traditional method, Tanaffos., vol. 7, no. Moreover, metal allergy screening should be considered for patients with past hypersensitivity reactions before any surgery. 13/17 underwent revisions to conventional THR; 8/13 with improved symptoms; 4/13 with The best way to avoid postoperative issues is to routinely ask patients prior to surgery if they have any known MHS including problems with cosmetic jewelry. Implantation of cross-linked polyethylene bearing surface led to symptom resolution in 3 mo. Co-Cr-Mo = cobalt-chromium-molybdenum; LCS = low contact stress; MOM = metal-on-metal; PMMA = polymethylmethacrylate; pts = patients; Ref. W. S. Towers and K. Kurtom, Rare systemic response to titanium spinal fusion implant: case report, Cureus, vol. doi: 10.7759/cureus.26167. -, Br Med J. Metal Hypersensitivity and Total Knee Arthroplasty, Chronic or intermittent knee redness, warmth, and swelling, Wear, damage, or loosening of prosthetic joint components (which can be detected with an X-ray or MRI). Unfortunately, the symptoms of metal implant sensitivity and allergy are not well defined. With that said, some studies suggest that they may be beneficial for certain groups. 2010 Mar;61(3):255-62; quiz 263-4. doi: 10.1007/s00105-009-1907-x. 2023 Dr. Stefano Sinicropi The information contained on this site is intended to provide only general education about spine surgery and conditions. Surgical implants are essential elements of repair procedures to correct worn out joints, damaged spinal components, heart and vascular disease, and chronic pain. She reported symptoms including a low-grade fever, nausea, vomiting, diarrhea, and joint pain. The .gov means its official. 8600 Rockville Pike Epub 2016 Mar 29. Metal allergic patients, screened before receiving stainless steel orthopedic implants. Keywords: Blog It's rare for someone to need their metal implants removed due to a metal allergy or sensitivity. Your email address will not be published. A blood test known as a nickel lymphocyte proliferation test is used to identify nickel sensitivity. 2007 Jan;42(1):93-7. doi: 10.1016/j.jpedsurg.2006.09.056. Some people are prone to developing a response to various metals, such as skin sensitivity to jewelry or watches. Akashi Y, Shimoo Y, Hashiguchi H, Nakajima K, Kokubun K, Matsuzaka K. Materials (Basel). The patients most appropriate for testing include (1) pre-operative joint replacement patients with a prior history of skin reactions to metal jewelry, jean snaps, watch bands, metal glass frames, artificial nails, or skin glue; (2) post-operative joint replacement failure patients needing revision without an obvious cause such as infection or mechanical incompatibility; and (3) post-operative cardiac or neurological patients with localized rash, pain, swelling, or inflammation near or over the implant. Dizziness or fainting. Most skin reactions are eczematous and allergic in nature, although urticarial, bullous, and vasculitic eruptions may occur. Keywords: An allergic reaction can crop up in the form of headaches, pain in the back and extremities, fever, and other symptoms. Many types of metallic implants can cause cutaneous allergic reactions, from orthopedic and dental implants to cardiac stents and pacemakers. Sun et al., Suspected allergy to titanium after anterior cervical discectomy and fusion using a Zero-P device: a case report, British Journal of Neurosurgery, pp. Are IVC Filters dangerous? An Investigation into the Potential of Turning Induced Deformation Technique for Developing Porous Magnesium and Mg-SiO. 2013, no. official website and that any information you provide is encrypted The immune response associated with sensitization occurs from prolonged exposure. Conclusions: 1, pp. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. *List is not exhaustive. 62, no. Staged revision resulted in pain relief, but nerve palsy did not recover. Titanium has been considered to be a non-allergenic material. While the potential for a reaction exists, it's thought to be extremely low. P. H. Wu, J. H. Chen, and K. E. Chu, Successful endoscopic management of double iatrogenic perforations induced by endoscopic retrograde cholangiopancreatography and computed tomography-guided colon drainage, Case Reports in Gastroenterology, vol. Stainless steel screws are commonly used for internal fixation in an array of podiatric procedures. sharing sensitive information, make sure youre on a federal Food allergies: You may feel tingling in your mouth . So, skin testing for nickel, cobalt, and chromium hypersensitivity has limited value in diagnosing DHT. M. Hosoki, K. Nishigawa, T. Tajima, M. Ueda, and Y. Matsuka, Cross-sectional observational study exploring clinical risk of titanium allergy caused by dental implants, Journal of Prosthodontic Research, vol. You've successfully added to your alerts. Allergy in total knee replacement surgery: Is it a real problem? Adhesive allergy; Contact dermatitis; Joint failure; Joint replacement; Metal allergy; Methyl methacrylate; Nickel; Rash; Surgical implant. Still, cases have been reported, and some people's symptoms have gone away after removal. These symptoms can make your child feel bad, but it's not life-threatening. If you are suffering from symptoms of adverse reactions to staples, seek immediate medical attention. Dull aching pain, swelling, followed by supracondylar fracture. 18 If that includes you, make sure your healthcare provider knows. Rushing GD, Goretsky MJ, Gustin T, Morales M, Kelly RE Jr, Nuss D. J Pediatr Surg. 426431, 2018. 2, pp. Diagnosis of metal hypersensitivity in total knee arthroplasty: a case report. The https:// ensures that you are connecting to the Symptoms controlled with repeated joint aspirations. Chronic eczema beginning weeks or months after the implant, 2. doi:10.1007/s11420-018-9614-8, Mayer AS, Erb S, Kim RH, et al. Click the topic below to receive emails when new articles are available. The catheter was removed surgically which resolved the patients RLQ abdominal pain and accompanying symptoms. Itchy eyes, nose or roof of mouth. Especially, in our case, the patients extensive past medical history and multiple overlapping medical conditions delayed her diagnosis of RFB and caused her significant life distress. The patients social history is insignificant, with no smoking or alcohol consumption. Cobalt and chromium may be found not only in the appliance but also in bone cements used to set the prosthetic. These degradation products of the implant may cause increased metal hypersensitivity and implant failure. 2000 Jul;43(1):35-40 In some severe cases, allergies can trigger a life-threatening reaction known as anaphylaxis. There is also tissue response to implants, such as the hyperplastic lesions of the soft tissues. Multiple cardiac and neurostimulatory devices are constructed of metals and adhesives that can be sensitizing in some individuals. Necessary cookies are absolutely essential for the website to function properly. ", < 1% develop cutaneous reactions versus 2025% of patients who develop implant-induced metal sensitivity without any allergic skin manifestations. Based on the level and proportion of immune cells in the sampleincluding leukocytes, eosinophils, and basophilsthe healthcare provider can diagnose DHT with a relatively high degree of confidence. J Prosthet Dent. 1, pp. An official website of the United States government. Its symptomsitching, knee pain, skin rashes, joint stiffness, and swellingcan also have other causes, which makes this difficult to diagnose. It helps to understand what happens when your body comes in contact with a metal to which you're allergic. Biologic reactions to these screws have been shown to include pretibial cysts . = reference; THA = total hip arthroplasty; THR = total hip replacement. Patients can present with atopic dermatitis, pruritus, edema, urticaria, impaired healing fractures, pain, and necrosis of implants [3]. The management of any metal allergy including titanium involves removing specific offending agents and avoiding potential triggers to hypersensitivity reactions. Dental implants; Metal allergy; Orthopedic surgery; Patch testing; Titanium. July 9, 2021/ Erica Davies / Surgical Stapler Lawsuit / 0 comments. Read the article to learn more about what triggers this side effect and how you can ask help from your doctor to avoid any complications after your surgery. Proper examination of medical and surgical histories are important, as well as physical examinations such as metal allergy testing, as this can help determine the technique and medical equipment to be used during the procedure. This patient is concurrently found to have a retained pigtail catheter in the cecum discovered incidentally through radiology. The case also unfolds rare differential diagnoses to keep in mind when encountering a patient with abdominal pain and associated nonspecific symptoms. This corrosion causes the formation of metal ions that ultimately trigger the inflammatory immune response. The pain was sharp and stabbing in nature and radiated from the umbilicus, and the patient rated the pain 10/10 on a scale, causing her significant discomfort. Metal allergies are referred to as delayed-type hypersensitivity (DHT). Fage SW, Muris J, Jakobsen SS, Thyssen JP. Severe skin rashes. Careers. LTT is another more sensitive test than the skin-patch test; however, there are reports of some false-positive results [3]. She reported a complete resolution of all symptoms one-month postsurgery. The patient was referred to an infectious disease specialist and kept on a course of oral vancomycin and fidaxomicin. Injury to the Teeth, Blood Vessels and Nerves. A more severe hypersensitivity reaction is usually due to prolonged exposure to a metal allergen, which is possible through metal implants used in surgeries or metal ions that are ingested or inhaled. The Improvement of Nonspecific Chronic Symptoms Post-Gallbladder Clip Removal. MeSH Knee replacement failure due to metal allergy or sensitivity is very rare but possible. It is mandatory to procure user consent prior to running these cookies on your website. Presenting symptoms are related to intolerance of the implant and include persistent or recurrent pain, skin reactions, edema, and hardware failure or loosening. Nickel allergy signs and symptoms include: Rash or bumps on the skin Itching, which may be severe Redness or changes in skin color Dry patches of skin that may resemble a burn Blisters and draining fluid in severe cases When to see a doctor If you have a skin rash and don't know how you got it, talk to your doctor. Results may vary from person to person. However, other metal ions as well as bone cement components can cause such hypersensitivity reactions. 2018 Oct;62(4):426-431. doi: 10.1016/j.jpor.2018.03.003. Thank you, {{form.email}}, for signing up. Given the high numbers of joint replacements performed in the developed world, allergic reactions to orthopedic implants form the largest category of allergic responses. Bioact Mater. These screws normally contain 14% nickel, 20% . The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). [1] Metal allergy is mainly caused by prolonged or repeated skin exposure to consumer items such as jewelry, cell phones,[2] clothing fasteners,[3] and leather goods. Lachiewicz PF, Watters TS, Jacobs JJ. 201207, 2012. HSS J. led to symptom resolution; awaiting revision on other side. Disclaimer. Metal sensitivities and allergies have been implicated in some situations involving pain or problems with orthopedic implants. No difference in positive patch-test results between restenosis and nonrestenosis groups after stent implantation (9% vs 10%). Please enable it to take advantage of the complete set of features! Will my hardware set off a metal detector? Y. Nakashima, D. H. Sun, M. Trindade, W. Maloney, S. Goodman, and D. Schurman, Induction of macrophage C-C chemokine expression by titanium alloy and bone cement particles, Journal of Bone and Joint Surgery, vol. The skin (or other tissue) that comes in contact with the offending metal becomes red, itchy, and irritated. Metals most likely to cause a reaction, all of which may be used to make knee replacements, include: A 2021 study found a link between failed joint replacements and metal hypersensitivity. We describe a 69-year-old male for whom significant pathologic findings around dental implants had never been observed. This may not always be possible, and an implant made with nickel may be the most appropriate implant available for your condition. We present a case of a 28-year-old female with a chronic history of intermittent abdominal pain aggravated due to titanium allergy and retained foreign surgical body. Regardless of all these factors, surgeons and clinicians must have a high clinical suspicion of RFB and appropriate diagnostic imaging for diagnosis and removal of the RFB. Allergy in total knee replacement surgery: Is it a real problem? 3, pp. The patients past surgical history includes a tonsillectomy, an appendectomy, and cholecystectomy. J Allergy Clin Immunol Pract. On this site, Dr. Sinicropi periodically provides assessments and commentary on specific procedures that individuals have undergone. Moreover, titanium has been described to activate macrophages through phagocytosis to cause the release of pro- and anti-inflammatory cytokines [9]. 2023 Feb 19;14(2):116. doi: 10.3390/jfb14020116. He exhibited allergic symptoms (eczema) after orthopedic surgery. MeSH 12, no. These allergens are also the most important in reactions to spinal surgeries. C. Shi, Y. Xi, B. A few studies have also reported titanium as a potential allergen. The Dr really should check it. Cookies collect information about your preferences and your devices and are used to make the site work as you expect it to, to understand how you interact with the site, and to show advertisements that are targeted to your interests. Can a Nickel Allergy Cause an Autoimmune Disease? Some experts suspect a metal sensitivity or allergy might explain some of these post-operative complaints, particularly if the symptoms develop long after the implant is placed. The use of sutures are said to be beneficial in laparoscopic or robotic assisted cholecystectomies. If you notice any severe symptoms after your spine surgery, be sure to contact your surgeon. Diagnostic laparoscopy evaluation with fluoroscopic guidance was performed to locate the exact positioning of the pigtail catheter within the cecum before surgery (a) and after pigtail catheter removal (b). Between 10% and 15% of the general population is sensitive or allergic to nickel. 1. Whether a similar sensitivity may develop to metal implanted inside the bodywhere it doesn't touch the skinisn't yet well understood, but there is some evidence it can happen. Home / Surgical Stapler Lawsuit / Can You Have an Allergic Reaction to Surgical Staples? The patient did not report any screening for immunodeficiency in the past. 2023 Dotdash Media, Inc. All rights reserved, Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. 12, no. Nam D, Li K, Riegler V, Barrack RL. Bookshelf Metal allergy and metal sensitivity are often used interchangeably in everyday conversations. Eczema most severe around the implant site, 3. If you log out, you will be required to enter your username and password the next time you visit. Therefore, these materials are generally used only when metal implants have been removed, or if you have a high likelihood of problems with a metal implant. The challenge with metal hypersensitivity is that the diagnosis is not always 100% certain. However, around 10% to 15% are not satisfied for various reasons, including persistent pain and the loss of joint flexibility. *List is not exhaustive. The joint never fully fused and I had the stainless steel replaced first with a single titanium screw and cadaver bone graft and then a third . CT scan showed cystic collection of fluid with negative leukocyte scintigraphy. 2008 Jan;37(1):75-88. doi: 10.1007/s00132-007-1183-3. The use of these implants is considered experimental and should be done with extreme caution. HHS Vulnerability Disclosure, Help PMC After removal of dental implants, the eczema disappeared completely. You will receive email when new content is published. 59, no. However, in some patients, hardware can become prominent or irritate a nearby . After the diagnosis of RFB, the preferred approach is to remove the RFB laparoscopically [13]. M. Tu and Y. Wu, Multiple allergies to metal alloys, Dermatologica Sinica, vol. Symptoms of metal allergy and sensitivity. apr18 1, article bcr2013009070, 2013. Allergic responses to metals such as nickel, chromium, mercury, cobalt, and gold are widely recognized [1]. 78, p. 1135, 1999. Why Is a Reaction to Knee Replacement Delayed? But sometimes a child can have what's known as anaphylaxis . "it appears that most patients who are metal-sensitive can safely receive an orthopedic implant containing that metal without the risk of cutaneous or systemic complications. The most important allergens in this category include nickel, cobalt, chromium, and bone cement. However, many of the materials that provide stability, flexibility, and durability to the implants are also immunogenic. In addition to metal allergies, retained foreign surgical bodies are a potential postoperative complication. Having a metal allergy or sensitivity doesn't mean getting a metal implant like a surgical screw, plate, or joint replacement is entirely off limits or that the body will reject it. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. However, several studies have reported cases of metal allergy caused by titanium-containing materials. Nasal congestion. Bethesda, MD 20894, Web Policies Titanium is extensively used in devices such as dental implants, pacemakers, and body piercing. Immune response differences in degradable and non-degradable alloy implants. The patient tolerated the procedure well with no postoperative complications. Complete and rapid recovery after total removal of foreign metal implant. 145162, 2008. Sneezing. Accessibility ASTM = American Society for Testing and Materials. Runny nose. On November 5, 2020, the embedded right colon foreign body was identified with fluoroscopic guidance (Figures 3(a) and 3(b)) and removed surgically (Figure 4). Any metal that comes into contact with body tissues will corrode to some degree. 1 Patients with MHS reactions to implants typically have prolonged eczematous dermatitis.8 Although the majority of MHS reactions are localized, more widespread inflammation has been reported. Titanium is another type of metal that is utilized extensively in cardiac pacemakers, dental procedures, arthroplasty, body piercing, and spectacle frames [2]. Further Reading Jonathan Cluett, MD, is board-certified in orthopedic surgery. We also use third-party cookies that help us analyze and understand how you use this website. Surgical Staples Removal: Heres What You Should Know, FDA Finalizes Reclassification of Surgical Staplers from Class I to Class II. [Allergies to dental metals. The site is secure. Thanks so much Craig, that is good to hear! She was tested for Clostridium difficile infection and showed positive toxin B results confirming the diagnosis. I'm going for a follow up next week, I was just wondering if it was a common issue, & I'd be calling for an emergency .

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