In addition, studies have shown that over 85% of malpractice claims are either dismissed or settled out of court,14 which likely results in a high degree of underreporting. It has a great developing technique that is used for fixation and fusion in spine surgery. States were then grouped by US region and case year by 5-year intervals. A review of medicolegal malpractice suits involving cervical spine: what can we learn or change? Roy-Camille R, Roy-Camille M, Demeulenaere C: Osteosynthese du rachis dorsal, lombaire et lombo-sacre par plaque metalliques vissees dans les pedicules vertebraux et es apophyses articularies. There were no observed cases of screw misplacement outside the pedicle on routine AP and lateral radiographs. Neurologic injury. With pedicle shapes and sizes varying wildly in the scoliotic spine, misplacement of a screwas well as and under- or oversizingare real possibilities in spine surgery. Of note, the award amount for one settlement case was undisclosed. All the operations were done by one surgeon (PK). 2022 Dec;31(12):3544-3550. doi: 10.1007/s00586-022-07427-0. The rate of reoperation for screw misplacement per screw was 0.17%. In the remaining patients, the standard construct was three-segment fixation spanning four vertebrae and three discs, two above and one below the fractured vertebra, using six screws. 8 spine surgeon insights, Lumbar spinal fusion cost in the 10 largest US cities, 2 MLB players undergo offseason spine surgeries, Salem Regional Medical Center adds spine surgeon, Here's how 6 spine surgeons prepare before a busy day, Total disc replacement cost in the 10 largest US cities, Study finds surgery more effective than conventional treatment for spinal stenosis, Dr. Rick Price completes his 50th AR spine case, Orthopedic surgeon among 2 convicted in $31M Medicare fraud scheme, SSM Health sues 2 resigning orthopedic surgeons, Surgeon leaves Rothman after 12 years to establish boutique spine practice, Jury awards $9.2M in botched spine surgery case, 'The numbers don't lie': Endoscopy to become more prominent among next generation of spine surgeons, Patient sues estate of late spine surgeon, 10 surgeons on the most controversial trends in spine, Connecticut orthopedic surgeon fined, reprimanded for operating on wrong hip, Ohio neurosurgeon facing wrongful death suit, Orthopedic surgeons at SSM Health resign, plan to start independent group, Wealthiest US orthopedic surgeon has a net worth of $1.8B, Orthopedic surgeons leaving SSM Health will partner with HOPCo for independent group, Wisconsin orthopedic surgeon sanctioned in patient's death, Healthgrades' best hospitals for spine surgery: 2023, How spine surgery competition is evolving by market: New York, Arizona, California and more, Indianapolis Colts linebacker has back surgery after consultation with Dr. Robert Watkins, Former Philadelphia Eagles player wins $43.5M verdict in knee injury case, California hospital cleared in counterfeit spine implant case, Georgia orthopedic clinic settles kickback suit, 22 hospitals ranked top 25 orthopedic hospitals 3+ years in a row, Stryker vs. Johnson & Johnson vs. Zimmer Biomet: How they compare in Q3, Neurosurgeon sentenced 5 years for accepting $3.3M in bribes, 12 surgeons who are leaving orthopedic groups for private practices, SSM Health canceling procedures as 11 orthopedic surgeons begin early departure, Aetna revises lumbar disc replacement policy, Indiana orthopedic surgeon settles Medicaid fraud allegations for $700K, 2 orthopedic hospitals facing Medicare readmission penalties, University of Toledo Medical Center suspends orthopedic chair, Here's what HOPCo's 1st Wisconsin partnership will look like, 2 Florida orthopedic providers merge to form 17-physician practice, 'This system is unsustainable': Why orthopedic surgeons do not feel fairly compensated, Orthopedic surgeon convicted for $31M staged fall scheme, Orthopedic surgeon buys $2M Chicago church, plans to convert to community hub, New Hampshire orthopedic surgeon arrested for alleged patient abuse, 8th Annual Becker's Health IT + Digital Health + RCM Annual Meeting. Forty-seven intraoperative and medical complications were observed in 41 patients (36.6%). Spine 15:908912, 1990. Rather, the defense demonstrated that although the misplaced screw had in fact irritated the L4 nerve root for the six days before it was removed, the related symptoms resolved with the screws removal. Breakage of a divergent screw of a Chopin block at the lumbosacral area was seen 3 months after surgery. 1. Results: A total of 2724 screws were placed in 127 patients. The accuracy of pedicle screw placement using intraoperative image guidance systems. All case demographics are summarized in Table 1. With increasing pedicle screw usage, the number of patients with misplaced screws will likely increase proportionally. 20. One of the patients had a late wound infection develop that was treated by radical debridement and removal of instrumentation. Li HM, Zhang RJ, Shen CL. 23. Spine 24:23522357, 1999. At the trials close, the plaintiffs attorney had asked the jury to return a $5.3 million verdict and had made a prior demand to settle the medical malpractice lawsuit for $1 million. 29. Schlegel JD, Smith JA, Schleusener RN: Lumbar motion segment pathology adjacent to thoracolumbar, lumbar, and lumbosacral fusions. The https:// ensures that you are connecting to the Pedicle screw insertions are commonly used for posterior fixation to treat various spine disorders. Brodsky AE: Post-laminectomy and post-fusion stenosis of the lumbar spine. The contact form sends information by non-encrypted email, which is not secure. J Bone Joint Surg 62A:13021307, 1980. Makhni MC, Park PJ, Jimenez J, et al. single homes for sale in lehigh valley, pa single homes for sale in lehigh valley, pa Home Realizacje i porady Bez kategorii single homes for sale in lehigh valley, pa Zdeblick TA: A prospective randomized study of lumbar fusion: Preliminary results. Spine (Phila Pa 1976). Malpractice claims in spine surgery in Germany: a 5-year analysis. Br J Neurosurg. Dr. Abd-El-Barr is a consultant for Spineology. It should be used by experienced and qualified surgeons who are aware of the pitfalls associated with its use. Call Us Now For a Free Consultation | Toll Free: 800.583.8002 | Local: 312.346.0045, Cook County Surgeons Cut Common BIle Duct During Surgery, But Jury Finds for Defendants , Illinois Jury Finds in Favor of Doctor in Gallbladder Surgery that Led to Fatal Bowel Perforation , Debate Over Extent of Eye Damage Following Implant Lens Surgery Leads to $1 Million Verdict in, $75 Million Jury Verdict in Failure to Timely Diagnose Stroke, $18 Million Jury Verdict in Late Diagnosis of Breast Cancer, $300,000 Settlement for Excessive Use of Radiation, Chicago Medical Malpractice Lawyer Kreisman Law Offices Home, Contact Illinois Personal Injury Attorney Kreisman Law Offices. J Neurosurg Spine. JAMA. Spine 18:11601172, 1993. Krag MH, Beynnon BD, Pope MH, et al: An internal fixator for posterior application to short segment of the thoracic, lumbar, or lumbosacral spine. 2017;42(3):177185. Pedicle screw placement accuracy using ultra-low radiation imaging with image enhancement versus conventional fluoroscopy in minimally invasive transforaminal lumbar interbody fusion: an internally randomized controlled trial. It argued that the foot drop was unavoidable and due to the surgeons need to manipulate the right L5 nerve root in order to remove Nyquists herniated disc during the spinal fusion surgery. As part of the surgery, Dr. Taras Masnyk inserted four metal screws into the plaintiff's spine. Harrington PR, Tullos HS: Reduction of severe spondylolisthesis in children. Additional survey data have shown that 50% of physicians exhibit at least a temporary loss of self-esteem after a malpractice claim, and at least 25% experience depression.22 As stated above, the average neurosurgeon spends 27.2% of his or her entire career in an open malpractice claim,10 and each case can take an average of 5.1, 5.0, and 3.4 years for defendant verdicts, plaintiff rulings, and settlements, respectively.7,15 Likewise, neurosurgeons have a higher risk than practitioners in other specialties of being named in multiple malpractice suits given the particularly high-risk nature of the specialty.10 Even when found in favor of the defendant (surgeon), each case ultimately takes a substantial emotional and financial toll on the physician(s) involved. Spine 16(8 Suppl):S455458, 1991. Erwin WD, Dickson JH, Harrington PR: Clinical review of patients with broken Harrington rods. Placement of the pedicle screws in the thoracolumbar and lumbar spine is a technically demanding procedure. Per-patient analysis showed 23 (18.11%) of patients had all screws AP. were excluded from analysis. Yuan HA, Garfin SR, Dickman CA, Mardjetko SM: A historical cohort study of pedicle screw fixation in thoracic, lumbar and sacral spinal fusions. The physician ordered an MRI of the lumbar spine which showed that the screws had been misplaced and were puncturing the patient's lumbar nerves. government site. Administrative/technical/material support: Mehta, Wang, KD Than. This was followed by pseudarthrosis requiring revision surgery, present in 14.3% (n = 3) and 14.9% (n = 7) of plaintiff- and defendant-awarded cases, respectively (p = 0.99). Facebook Google Plus Youtube RSS Email. Pedicle screw fixation is commonly used in spinal instrumentation surgeries to connect rods to vertebrae in order to correct spine alignment, stabilize vertebrae, and reach an arthrodesis. Please enable it to take advantage of the complete set of features! The screws were needed to stabilize the spine and fix the fused vertebrae in place. South Med J 62:17, 1969. It is indicated that screws medially misplaced at a distance greater than 2-mm, especially 4 mm, may be a cause of negative effects on the neural structure and should be removed during the early phase of the postoperative period, even among patients without postoperative neurological abnormalities. leg pain. J Spinal Disord Tech. To evaluate the accuracy of pedicle screw placement using a novel classification system to determine potentially significant screw misplacement. $ = US$. Summary of background data: Weinstein JN, Spratt KF, Spengler D, Brick C, Reid S: Spinal pedicle fixation: Reliability and validity of roentgenogram-based assessment and surgical factors on successful screw placement. All Rights Reserved. Moreover, several cases stated that the surgeon used only the anteroposterior or the lateral view, but not both, and the plaintiffs counsel used this information in support of their claim. 2013;34(6):699705. Nahed BV, Babu MA, Smith TR, Heary RF. This device was used with an early version of the Cotrel-Dubousset instrumentation to provide sacral fixation and it is rarely used since the more widespread use of newer spine fixation systems. Spine 18:983991, 1993. Determining legal responsibility in otolaryngology: a review of 44 trials since 2008. 2018;28(2):186193. The last two patients had a T12L1 fracture-dislocation and a L4L5 spondylolytic spondylolisthesis at the site of plug dislodgments. Reprint requests to Pavlos Katonis, MD, 99 Minoos & Thenon Street, 71305, Heraklion, Crete, Greece. Junctional problems were recorded as pathologic changes of the adjacent motion segments, just above and below the instrumented and fused segments. It should be used by experienced and qualified surgeons who are familiar with the pitfalls associated with its use. J Bone Joint Surg 73A:11791184, 1991. Eur Spine J. We also investigated the effect of bone mineral density (BMD), diameter of pedicle screws, and the region of spine on the pullout strength of pedicle screws. However, the misplacement of pedicle screws can lead to disastrous complications because of the close proximity to neural tissue and the surrounding vessels, although rare, serious complications have been reported, such as dural tear, nerve-root irritation, neural injury . The link was not copied. Spine 16(8 Suppl):S422427, 1991. Pedicle screw insertions are commonly used for posterior fixation to treat various spine disorders, deformities, and trauma. The radiology results showed that the surgical screw placed at the right L4-5 area had breached the medial wall and was actually extending into the spinal canal. The suit claimed Dr. Friedlander failed to diagnose and treat the mispositioned screw in a timely manner, leading the plaintiff to develop pain in his right leg, numbness in his right calf and weakness in his right toes. 2014;174(11):18671868. This retrospective analysis of 68 closed medicolegal cases related to misplaced screws in spine surgery showed that neurosurgeons and orthopedic spine surgeons were equally named as the defendant (n = 32 and 31, respectively), and cases were most commonly due to misplaced lumbar pedicle screws (n = 41, 60.3%). Dalenberg DD, Asher MA, Robinson RG, Jayaraman G: The effect of a stiff spinal implant and its loosening on bone mineral content in canines. Quraishi NA, Hammett TC, Todd DB, et al. Clin Orthop 203:7598, 1986. Notwithstanding these concessions, the MDU argued that misplacement of pedicle screw tracts was common in surgery of this kind, even in experienced and competent hands. Under this theory of liability, the plaintiff needed to not only establish that she had experienced foot drop, a fact that no one was disputing, but that it was caused by the defendants negligence. Per-patient analysis reveals more concerning numbers toward screw misplacement. Disc space narrowing was the most common problem after instrumented arthrodesis and was observed in 27 patients (24.1%). Five patients had uneventful early postoperative course. Defensive medicine in neurosurgery: the Canadian experience. Pedicle screw construct have become one of the most practiced procedure in spinal surgery. 16. Submitting a contact form, sending a text message, making a phone call, or leaving a voicemail does not create an attorney-client relationship. Linking and Reprinting Policy. Legal liability in iatrogenic orbital injury. 2011;306(10):1088. Crawford MJ, Esses SI: Indications for pedicle fixation: Results of NASS/SRS faculty questionnaire: North American Spine Society and Scoliosis Research Society. Rev Chir Orthop Reparatrice Appar Mot 62:151160, 1976. PURPOSE This study aimed to compare rates of perioperative complications between robotic-assisted and conventional . Long spine fixation was necessary for patients with tuberculous spondylitis and metastatic disease. Dr. Shaffrey holds patents with, receives royalties from, and is a consultant for Medtronic, NuVasive, and Zimmer Biomet; is a stockholder in NuVasive; is a consultant for K2M, Stryker, SI Bone, and In Vivo; and has received grants from the ISSG, DePuy Synthes, and AO Spine. The case facts centered on a spinal surgery the 34 year-old plaintiff had undergone at Central DuPage Hospital. Lehmann TR, LaRocca HS: Repeat lumbar surgery: A review of patients with failure from previous lumbar surgery treated with spinal canal exploration and lumbar spine fusion. (A) Anteroposterior and (B) lateral radiographs show coronal imbalance that developed 4 years after surgery in a 57-year-old woman with L3L4 float fusion. Pullout performance comparison of pedicle screws based on cement application and design parameters Tolga Tolunay, Cemile Bagl, Teyfik Demir, Mesut E Yaman, and Arslan K Arslan Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 2015 229: 11 , 786-793 Download Citation Defensive medicine in U.S. spine neurosurgery. Please try after some time. Problems in the instrumented segments were considered those occurring from narrowing of the disc space greater than 3 mm, pseudarthrosis, and loss of reduction. J Pediatr Orthop. pedicle screw: A rigid surgical implant used to stabilize adjacent spinal segments in spinal fusion surgery. and 17.1% of the patients included had at least one screw misplaced. Reviewed submitted version of manuscript: all authors. Rothberg MB, Class J, Bishop TF, et al. Lorenz M, Zindrick M, Schwaegler P, et al: A comparison of single level fusion with and without hardware. Feb. 16, 2021 Accurate placement of pedicle screws is key to avoiding the potential complications of spinal fusion surgery and improving overall spinal fixation. The plaintiff underwent revision surgery in May 2013. Clin Orthop 227:1023, 1988. Pedicle screw instrumentation is widely used for the stabilization of the subaxial cervical, thoracic, and lumbar spine. Would you like email updates of new search results? Scarone P, Vincenzo G, Distefano D, et al. Overall reported screw misplacement is low, but it does not reflect the potential impact on patient morbidity. 2020;162(6):13791387. Spinal fusion in the United States: analysis of trends from 1998 to 2008. MeSH Neurosurgery. Excessive hemorrhage occurred in two patients (1.8%) with coagulation disorders. Except for the patient with an infected pseudarthrosis who had a flat back syndrome (sagittal imbalance) develop, coronal imbalance was observed in five patients (4.5%), and ranged from 7.5 to 12 (Fig 3). Spine 19:25842589, 1994. Thankfully, most screws are just misplaced by a millimeter or two out the front or are slightly off medially, so they are not doing real damage. Arthrodesis was questionable in eight asymptomatic patients (7.1%). There were 74 men and 38 women, with a mean age of 47 years (range, 1872 years). Among the plaintiff-awarded cases, 13 (61.9%) were decided by jury trial, 7 (33.3%) by settlement, and 1 (4.8%) by arbitration. 1). The third surgical procedure removed the pedicle screws but left the patient in an unfused state with an unstable spine. Phone/Fax: 30-2810-318361; E-mail: [emailprotected]. matte black square deadbolt; roberts point park fishing report; qr code on binax covid test; mff premium character list. Accuracy of fluoroscopically-assisted pedicle screw placement: analysis of 1,218 screws in 198 patients. Sub-analysis of adolescent idiopathic scoliotic patients showed no curve or patient characteristic that correlated with IMP or SAR. 17. Furthermore, 25 patients (22.3%) reported persistent pain in the iliac crest (donor graft site) for several months, for which they were treated with repeated lidocaine injections and analgesics. Many technological advances have been made over the past several decades in an effort to improve the accuracy of screw placement in spine surgery.3436 For example, 3D fluoroscopybased image guidance has been shown to decrease the pedicle breach rate in several studies compared to the rate with 2D fluoroscopic guidance or the freehand technique, particularly in deformity and revision surgeries.21,34,36,37 CT guidance or intraoperative confirmation has also been shown to further improve the accuracy of pedicle screw placement,3638 with reported accuracy rates of 89%100% reported in the literature, depending on the authors breach criteria.35 However, it is important to note that the use of this technology is often accompanied by a lower threshold for intraoperative screw revision, sometimes leading to higher rates of replaced screws.33 Arguably, these improved trajectories may avoid iatrogenic neurological deficits due to prolonged nerve root compression or even improve the stability of the construct;34,37 however, prospective studies of long-term outcomes and rates of revision surgery remain sparse in the literature. 2012;21(suppl 2):S196S199. A retrospective review of charts, XRs and low-dose CT scans of 127 patients who underwent spinal fusion with pedicle screws for spinal deformity was performed. Spine 6:263267, 1981. A rod is used to hold the vertebra together to allow fusion to occur. Use of the Airo mobile intraoperative CT system versus the O-arm for transpedicular screw fixation in the thoracic and lumbar spine: a retrospective cohort study of 263 patients. Orthopedics. The remaining two patients had asymptomatic junctional problems develop after two- and three-segment fusions, at the third and fourth postoperative year, respectively. Am J Transl Res. The patient had subsequent coronal imbalance and degeneration of the upper disc. Spine 18:18621866, 1993. Study supervision: Goodwin, Karikari, Shaffrey, Abd-El-Barr, KD Than. Am J Otolaryngol. A retrospective review of closed medicolegal cases with verdicts or settlements between 1995 and 2019 was performed using the Westlaw Edge legal research database (Thomson Reuters).7,14,16,23,24 A search of closed federal and state malpractice claims within the Verdicts and Settlements section consisted of the following: spine and surgery and pedicle and screw and fusion and (misplaced or misguided or mispositioned) and surgeon. Inclusion criteria consisted of malpractice claims against surgeons for complications related to misplaced pedicle and/or lateral mass screws. SECTION I SYMPOSIUM: Advances in Spine Surgery, Distribution of Spinal Disorders in 112 Patients, Classification of Complications in 64 patients. Spine 13:10121018, 1988. Spine J. 17,18,31,39 Edwards 6 showed that solid arthrodesis developed in 96% of patients without previous surgery, whereas 84% of patients having secondary operations experienced a similar result. 16,24,28 Simultaneously, the evolution of the surgical techniques has led to increased procedural safety. Call me tomorrow. 8600 Rockville Pike Plaintiff's expert was prepared to testify at trial that these complaints are characteristic of a malpositioned screw impinging upon a neural structure. Guzek RH, Mitchell SL, Krakow AR, Harshavardhana NS, Sarkissian EJ, Flynn JM. The patient suffered permanent nerve damage as a result of the puncture. Mean amounts awarded SD to plaintiffs by jury trial (n = 13) versus settlement/arbitration (n = 7), adjusted for inflation as of April 2020. 1 To be effective, the pedicle screw constructs must withstand intraoperative loading and physiological forces due to daily postoperative activities. Medical malpractice in orthopedic surgery: a Westlaw-based demographic analysis. 5. Two patients with associated injuries in the lower limbs had deep venous thrombosis develop, three patients had pneumonia develop, and four patients with neurologic impairment had urinary tract infections develop. 2018;27(9):23392347. 26 They support that after a lengthy symptom-free period, segments next to a fused segment can break down and the segment next to the adjacent segment is almost as likely to break down as the adjacent segment. 4. The amount awarded was not significantly different across US regions (p = 0.9; Fig. Pedicle screw fixation is an effective but demanding method to treat various spinal disorders and is associated with a significant complication rate. Both issues represent the most frequent and highest payouts in spine malpractice claims.10,14,22 While several studies have explored many of the factors related to malpractice claims in spine surgery, the medicolegal impact of misplaced pedicle and/or lateral mass screws has not been directly reported in the literature. Rynecki ND, Coban D, Gantz O, et al. However, despite the apparent widespread use of pedicle system fixation, few studies of problems and particularly complications have been published. Under the high-low agreement, Drs. Results: The pedicle screw system is widely used in spine surgery, and it provides rigid fixation and leads to successful subsequent deformity correction and bony fusion. 18. The instrumentation and bone graft were left in place in these patients (total infection rate, 2.7%). It is easier to confuse a jury than convince a judge: the crisis in medical malpractice. 2017 Mar;5(2):109-116. doi: 10.1016/j.jspd.2016.10.007. Ann R Coll Surg Engl. ObjectThe goal of this study was to determine the incidence of screw misplacement and complications in a group of 102 patients who underwent transpedicle screw fixation in the lumbosacral spine with conventional open technique and intraoperative. Harrington and Tullos 11 first reported the technique of transpedicle screw fixation, and Roy-Camille et al 23 popularized the first practical method of pedicle screw fixation. J Neurosurg Spine. Copyright 1944-2023 American Association of Neurological Surgeons, Copy this link, or click below to email it to a friend. Cerebrospinal fluid fistulas. Pedicle screw insertion in the thoracolumbar spine. However, we did not observe any screw breakage in patients with a degenerative lumbar spine, and the absence of broken screws in this series is because arthrodesis in almost all patients occurred in situ. Spine arthrodesis was evaluated with plain AP and lateral radiographs taken 1 year after surgery. demonstrated that the number of hospital discharges for spinal fusion increased 2.4 times (137%) from 174,223 to 413,171 (p < 0.001) between 1998 and 2008.32 The true frequency of malpositioned pedicle and lateral mass screws is likely underestimated in spine surgery given the fact that the majority of misplaced screws, as well as the potential complications related to them, are not reported in practice and may be clinically silent. 6. The plaintiff received $2.4 million for pain and suffering and loss of enjoyment of life, $2 million for lost income and approximately $123,000 for medical expenses. Accuracy of C2 pedicle screw placement using the anatomic freehand technique. 2002;27(22):24252430. The rate of misplaced pedicle screws ranges from 1.1% to 28.8%, 10 although neurologic injury from misdirected pedicle screws has been reported to occur in 0% to 12% of patients. To reinforce spinal fixation, we have proposed a construct with segmental pedicle fixation two levels above and one level below the injured level and insertion of a screw deep into the pedicle, providing more contact area between screw head and bone and reducing the moment arm of the bending stress. Intraoperative and postoperative complications were recorded by the authors and the results were evaluated by an independent observer. 28. laterally placed screws and the azygous vein on the right (T5-T11). 2013;32(1):111119. Judgment information associated with a defendant (surgeon) versus plaintiff (patient) ruling, trial versus settlement versus arbitration decision, award amount, and time to decision or case closure from index surgery was also recorded. 2014 Aug 1;14(8):1702-8. doi: 10.1016/j.spinee.2014.03.044. Twenty-one patients (18.8%) had thoracolumbar injuries, and loss of immediate postoperative deformity correction ranged from 1.4 to 4.5. L3S1 spine arthrodesis was done in the first patient but the correction of scoliosis was not sufficient and coronal imbalance persisted after surgery, which accelerated the degeneration of the level just above the arthrodesis. Each case was then carefully screened for relevance and sufficient data. While the majority of verdicts are found in favor of the defendant (surgeon), over 30% of cases in this study were found in favor of the plaintiff (patient), resulting in average inflation-adjusted payouts of over $1.2 million per claim over the past 25 years. Screws were divided into four categories: screws at risk (SAR), indeterminate misplacements (IMP), benign misplacements (BMP), accurately placed (AP). J Neurosurg Spine. Lali Sekhon, Jocelyn Idema & more: 4 spine and neurosurgeons making headlines, Spinal cord stimulation trumps medication for pain reduction 7 takeaways, Dr. Khalid Kurtom on major trends in spinal cord injury surgery.
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