Join Team TOCA with Dr. Feng & the Arthritis Foundation for the Walk to Cure Arthritis!

Enjoy the beautiful Arizona weather by joining Team TOCA, Dr. Earl Feng (Orthopedic Surgeon, Arthritis & Total Joint Reconstruction) and the Arthritis Foundation in the Annual Walk for the Cure, Saturday May 5th, 2018 at the Phoenix Zoo! Dr. Feng is not only a TOCA Physician & Surgeon but also serves as a Board Member for the Arthritis Foundation!

At TOCA, each of us has an important role in helping the more than 1.2 million Arizonans living with arthritis including many our patients, our colleagues, and more than 6,000 children in Arizona alone. TOCA is proud to continue our support the 2018 Arizona Walk to Cure Arthritis on May 5th at the Phoenix Zoo. As a sponsor of the Walk to Cure Arthritis, our goal is to help more people with arthritis.

The Arthritis Foundation is the Champion of Yes for patients with arthritis who are being told “no” a lot. No, there isn’t a cure. No, you cannot play sports. No, you cannot pick-up your grandchild.

Here is how you can help!

• Through funding critical research for osteoarthritis to find better treatments and ultimately a cure.
• Giving kids living with arthritis the opportunity to attend Camp Cruz to meet other kids living with arthritis.
• Supporting programs like the Live Yes network for people in our community struggling with pain, connecting them with others with arthritis.
• Getting a patient get back on their feet so they can walk their dog.
• Helping a grandparent alleviate back pain so they can pick up their grandchild.
• Saying “YES” to a patient today!

The event features a three-mile and one-mile course, with arthritis information and activities for the entire family!

Let’s raise funds to find a cure for arthritis, then come together to support each other and walk! Every step counts, every dollar matters!  The Arthritis Foundation’s Walk to Cure Arthritis to help the more than 50 million Americans and 300,000 children with arthritis live better today and to keep the Arthritis Foundation’s promise of finding a cure for tomorrow. Be a Champion of Yes – join our team and raise funds to fight arthritis and find a cure, all while having A LOT OF FUN! If you aren’t able to join the team, we’d appreciate your donation to help reach our goal.

Click here to learn more about this event, join Team TOCA and/or Donate Today! Team TOCA

Event Location:
The Phoenix Zoo
455 N Galvin Pkwy
Phoenix , AZ 85008
Event Schedule:
Event Registration Starts 5/5/2017 6:30 am
Event Registration Ends 5/5/2017 8:00 am
Event Starts 5/5/2017 7:30 am
Event Ends 5/5/2017 10:00 am
Fees:
Walk to Cure Arthritis Registration: No Fees
Event Registration

To Learn more about Dr. Feng and TOCA visit: www.tocamd.com or call 602-277-6211

#Arthritisfoundation #WalktoCureArthritis #Results #Recovery #Relife#TOCAMD #TOCA #ArthritisPhxWalk #PhoenixZoo

(TFC/TFCC) Triangular Fibrocartilage Complex Tear

WHAT IS A TFCC TEAR?
The triangular fibrocartilage complex (TFCC) is a cartilage structure located on the small finger side of the wrist that, cushions and supports the small carpal bones in the wrist. The TFCC keeps the forearm bones (radius and ulna) stable when the hand grasps or the forearm rotates. An injury or tear to the TFCC can cause chronic wrist pain.

There are two types of TFCC tears:
1. Type 1 tears are called traumatic tears. Falling on an outstretched hand and excessive arm rotation are the most common causes.
2. Type 2 TFCC tears are degenerative or chronic. They can occur over time and with age. The degenerative process wears the cartilage down over time. Some inflammatory disorders, such as rheumatoid arthritis or gout, may also contribute to Type 2 TFCC tears.

WHAT ARE THE SYMPTOMS OF A TFCC TEAR?
• Common symptoms of a TFCC tear include:
• Pain, at the base of small finger side of the wrist
• Pain worsens as the wrist is bent from side to side
• Swelling in the wrist
• Painful clicking in the wrist
• Loss of grip strength

WHO IS LIKELY TO GET A TFCC TEAR?
Anyone can get a TCFF tear. It occurs most often in those who fall on an outstretched hand. Athletes are at risk, especially those who use a racquet, bat or club and those who put a lot of pressure on the wrist such as gymnasts. Degenerative tears are more common in people over 50. Medical attention should be sought as soon as possible after an injury to the wrist.
The hand and wrist specialists at TOCA we provide the most advanced treatment options for TFCC tears. Individualized treatment options are developed for each patient to ensure optimal outcomes.

WHAT CA– USES A TFCC TEAR?
TFCC tears are often sustained when a person falls and lands on the hand, bending the wrist backwards. They can also be present in patients with wrist fractures. Degenerative TFCC tears are more common in people over 50. A longer ulna (arm bone on the small finger side of arm) can also contribute to this condition because it puts more pressure on the TFCC.

HOW IS A TFCC TEAR DIAGNOSED?
TFCC tears are diagnosed through careful examination of the wrist. This involves some manipulation to see the extent and location of pain and immobility. An X-ray may be performed to check for fractures and other abnormalities. The most reliable imaging test is an MRI, which allows doctors to inspect the tissue and cartilage to see the extent of the injury. It is important for a patient to see a board certified physician specializing in treating wrist conditions soon after a traumatic injury.

WHAT ARE THE TREATMENTS FOR TFCC TEAR?
Treatment of a TFCC tear depends on stage of severity.
Non-surgical Treatment Options

• Rest
• Ice
• Splint or cast
• Anti-inflammatory medication, such as ibuprofen
• Cortisone injection
• Ultrasound therapy
• Surgical Treatment Options

Surgical Treatment
If no-operative management fails and the TFC tear is still painful, the next step is often a diagnostic arthroscopy. If there’s just a flap of injured tissue causing the problems, but the DRUJ is stable, the flap can be removed arthroscopically. If the TFC is torn, but the DRUJ is stable, the TFC tear can be repaired arthroscopically. If the TFC is torn and the DRUJ is unstable (loose), an open repair is usually the best treatment. The results from these surgeries are usually very good. If a TFC repair is performed, an above-elbow cast will be used for 4 weeks, and then therapy is started.

Often times, the TFC injury is either caused or exacerbated by the ulna being longer than the radius. In these cases, the ulna may have to be shortened to prevent the TFC from re-tearing. The ulnar shortening can be performed at the same time as the TFC repair. Sometimes, if the relative ulnar length is not too bad, a TFC repair is done without ulnar shortening. In these cases, if pain persists the ulnar shortening is then performed as a 2nd surgery.

Ulnar shortenings are traditionally done through a long incision: A small length of bone (usually 2-4 mm) is removed from the middle of the ulna and a plate is put on to stabilize the ulna while it heals. A short-arm cast is worn for 6 weeks and heavy activities are avoided until the bone is healed, which can take 3-4 months. However, a newer technique of ulnar shortening can be performed through a smaller incision, with a quicker healing time. In these cases, after 2 weeks only a removable splint is used. The newer type of ulnar shortening usually heals in 6 weeks. Most, but not all, patients will have this newer option available to them.

In summary, TFC tears are very common. Fortunately, there is effective treatment for them. All of the surgeries discussed here are performed as outpatient procedures (you go home the same day), and newer techniques are available that allow patients to return to activities quicker, with fewer problems.

At TOCA (The Orthopedic Clinic Association) we have some of Arizona’s most experienced physicians who treat triangular fibrocartilage complex injuries, in addition to other hand and wrist injuries, degenerative diseases and many other orthopedic needs.

To schedule an appointment contact our dedicated TOCA Team at 602-277-6211! You can also learn more about our Orthopedic Hand & Wrists Specialists here on our TOCA website.

 

#Recovery #Results #Relief #Handpain #painfree #TFC #handsurgery

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome

Carpal tunnel syndrome is a condition that causes numbness, tingling and other symptoms in the hand and arm. Carpal tunnel syndrome is caused by a compressed nerve in the carpal tunnel, a narrow passageway on the palm side of your wrist.

The anatomy of your wrist, health problems and possibly repetitive hand motions can contribute to carpal tunnel syndrome.

Proper treatment usually relieves the tingling and numbness and restores wrist and hand function. Many people get better if they rest their wrist and wear a splint. Some people need surgery.

Symptoms

Carpal tunnel syndrome symptoms usually start gradually. The first symptoms often include numbness or tingling in your thumb, index and middle fingers that comes and goes.

Carpal tunnel syndrome may also cause discomfort in your wrist and the palm of your hand. Common carpal tunnel syndrome symptoms include:

  • Tingling or numbness. You may experience tingling and numbness in your fingers or hand. Usually the thumb and index, middle or ring fingers are affected, but not your little finger. Sometimes there is a sensation like an electric shock in these fingers.

The sensation may travel from your wrist up your arm. These symptoms often occur while holding a steering wheel, phone or newspaper. The sensation may wake you from sleep.

Many people “shake out” their hands to try to relieve their symptoms. The numb feeling may become constant over time.

  • You may experience weakness in your hand and a tendency to drop objects. This may be due to the numbness in your hand or weakness of the thumb’s pinching muscles, which are also controlled by the median nerve.

When to see a doctor

See your doctor if you have persistent signs and symptoms suggestive of carpal tunnel syndrome that interfere with your normal activities and sleep patterns. Permanent nerve and muscle damage can occur without treatment.

Causes

Carpal tunnel syndrome is caused by pressure on the median nerve.

The median nerve runs from your forearm through a passageway in your wrist (carpal tunnel) to your hand. It provides sensation to the palm side of your thumb and fingers, except the little finger. It also provides nerve signals to move the muscles around the base of your thumb (motor function).

Anything that squeezes or irritates the median nerve in the carpal tunnel space may lead to carpal tunnel syndrome. A wrist fracture can narrow the carpal tunnel and irritate the nerve, as can the swelling and inflammation resulting from rheumatoid arthritis.

There is no single cause in many cases. It may be that a combination of risk factors contributes to the development of the condition.

Risk factors

A number of factors have been associated with carpal tunnel syndrome. Although they may not directly cause carpal tunnel syndrome, they may increase your chances of developing or aggravating median nerve damage. These include:

  • Anatomic factors.A wrist fracture or dislocation, or arthritis that deforms the small bones in the wrist, can alter the space within the carpal tunnel and put pressure on the median nerve.

People with smaller carpal tunnels may be more likely to have carpal tunnel syndrome.

Diagnosis

Your doctor may ask you questions and conduct one or more of the following tests to determine whether you have carpal tunnel syndrome:

  • History of symptoms. Your doctor will review the pattern of your symptoms. For example, because the median nerve doesn’t provide sensation to your little finger, symptoms in that finger may indicate a problem other than carpal tunnel syndrome.

Carpal tunnel syndrome symptoms usually occur include while holding a phone or a newspaper, gripping a steering wheel, or waking up during the night.

  • Physical examination. Your doctor will conduct a physical examination. He or she will test the feeling in your fingers and the strength of the muscles in your hand.

Bending the wrist, tapping on the nerve or simply pressing on the nerve can trigger symptoms in many people.

  • X-ray. Some doctors recommend an X-ray of the affected wrist to exclude other causes of wrist pain, such as arthritis or a fracture.
  • Electromyogram. This test measures the tiny electrical discharges produced in muscles. During this test, your doctor inserts a thin-needle electrode into specific muscles to evaluate the electrical activity when muscles contract and rest. This test can identify muscle damage and also may rule out other conditions.
  • Nerve conduction study. In a variation of electromyography, two electrodes are taped to your skin. A small shock is passed through the median nerve to see if electrical impulses are slowed in the carpal tunnel. This test may be used to diagnose your condition and rule out other conditions.
  • Gender. Carpal tunnel syndrome is generally more common in women. This may be because the carpal tunnel area is relatively smaller in women than in men.Women who have carpal tunnel syndrome may also have smaller carpal tunnels than women who don’t have the condition.
  • Nerve-damaging conditions. Some chronic illnesses, such as diabetes, increase your risk of nerve damage, including damage to your median nerve.
  • Inflammatory conditions. Illnesses that are characterized by inflammation, such as rheumatoid arthritis, can affect the lining around the tendons in your wrist and put pressure on your median nerve.
  • Alterations in the balance of body fluids. Fluid retention may increase the pressure within your carpal tunnel, irritating the median nerve. This is common during pregnancy and menopause. Carpal tunnel syndrome associated with pregnancy generally resolves on its own after pregnancy.
  • Other medical conditions. Certain conditions, such as menopause, obesity, thyroid disorders and kidney failure, may increase your chances of carpal tunnel syndrome.
  • Workplace factors. It’s possible that working with vibrating tools or on an assembly line that requires prolonged or repetitive flexing of the wrist may create harmful pressure on the median nerve or worsen existing nerve damage.

However, the scientific evidence is conflicting and these factors haven’t been established as direct causes of carpal tunnel syndrome.

Several studies have evaluated whether there is an association between computer use and carpal tunnel syndrome. However, there has not been enough quality and consistent evidence to support extensive computer use as a risk factor for carpal tunnel syndrome, although it may cause a different form of hand pain.

Treatment

Treat carpal tunnel syndrome as early as possible after symptoms start.

Take more frequent breaks to rest your hands. Avoiding activities that worsen symptoms and applying cold packs to reduce swelling also may help.

Other treatment options include wrist splinting, medications and surgery. Splinting and other conservative treatments are more likely to help if you’ve had only mild to moderate symptoms for less than 10 months.

Nonsurgical therapy

If the condition is diagnosed early, nonsurgical methods may help improve carpal tunnel syndrome, including:

  • Wrist splinting. A splint that holds your wrist still while you sleep can help relieve nighttime symptoms of tingling and numbness. Nighttime splinting may be a good option if you’re pregnant.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs, such as ibuprofen (Advil, Motrin IB, others), may help relieve pain from carpal tunnel syndrome in the short term.

There isn’t evidence, however, that these drugs improve carpal tunnel syndrome.

  • Your doctor may inject your carpal tunnel with a corticosteroid such as cortisone to relieve pain. Sometimes your doctor uses an ultrasound to guide these injections.

Corticosteroids decrease inflammation and swelling, which relieves pressure on the median nerve. Oral corticosteroids aren’t considered as effective as corticosteroid injections for treating carpal tunnel syndrome.

If carpal tunnel syndrome is caused by rheumatoid arthritis or another inflammatory arthritis, then treating the arthritis may reduce symptoms of carpal tunnel syndrome. However, this is unproved.

Surgery

Carpal tunnel release

Surgery may be appropriate if your symptoms are severe or don’t respond to other treatments.

The goal of carpal tunnel surgery is to relieve pressure by cutting the ligament pressing on the median nerve.

The surgery may be performed with two different techniques:

  • Endoscopic surgeryYour surgeon uses a telescope-like device with a tiny camera attached to it (endoscope) to see inside your carpal tunnel. Your surgeon cuts the ligament through one or two small incisions in your hand or wrist.

Endoscopic surgery may result in less pain than does open surgery in the first few days or weeks after surgery.

  • Open surgery. Your surgeon makes an incision in the palm of your hand over the carpal tunnel and cuts through the ligament to free the nerve.

Discuss the risks and benefits of each technique with your surgeon before surgery. Surgery risks may include:

  • Incomplete release of the ligament
  • Wound infections
  • Scar formation
  • Nerve or vascular injuries

During the healing process after the surgery, the ligament tissues gradually grow back together while allowing more room for the nerve. This internal healing process typically takes several months, but the skin heals in a few weeks.

Alternative Medicine

Integrate alternative therapies into your treatment plan to help you cope with carpal tunnel syndrome. You may have to experiment to find a treatment that works for you. Always check with your doctor before trying any complementary or alternative treatment.

  • Yoga. Yoga postures designed for strengthening, stretching and balancing the upper body and joints may help reduce pain and improve grip strength.
  • Hand therapy. Early research suggests that certain physical and occupational hand therapy techniques may reduce symptoms of carpal tunnel syndrome.
  • Ultrasound therapyHigh-intensity ultrasound can be used to raise the temperature of a targeted area of body tissue to reduce pain and promote healing. Research shows inconsistent results with this therapy, but a course of ultrasound therapy over several weeks may help reduce symptoms.

If you are experiencing hand or wrist pain, the specialized Orthopedic Physicians at TOCA are here to help. To learn more call 602-277-6211 or visit our website at: www.tocamd.com

#Recovery #Results #Relief #carpaltunnel #handpain #wristpaint #TOCA #TOCAMD #Handtherapy #orthopedicphysician #handpain #wristpain

 

Dr. Cummings and Vito Berlingeri talk Golf, injuries and recovery in the latest addition of the AZ Golf Insider!

Dr. Cummings and Vito Berlingeri talk Golf, injuries and recovery in the latest addition of the AZ Golf Insider. Check out the full artical by clicking here: http://staging.yudu.com/…/…/45vcVtT1Y15VmxzM/html/index.html

“When I went into his office, Dr. Cummings greeted me like he had known me for 30 years”, said Berlingeri. “He told me with surgery and physical rehab, I would be back to hitting golf balls within seven weeks.”

That’s exactly what happened, with Berlingeri able to play 18 holes just three months after surgery.

Associated with TOCA since 2001, Dr. Cummings estimates that up to 40% of the patients he sees play golf, including numerous PGA Tour professionals. No matter the skill level, he encourages all golfers to take injury prevention measures, especially keeping your core strong.

“Your body only has so much time before wear and tear happens. I’ve recommended other golfer friends with injuries go to Dr. Cummings at TOCA ever since.” (said Vito Berlingeri)

Getting an accurate diagnosis and then a plan is critical to the process, Berlingeri and his physician (Dr. Dean Cummings) agreed.

“You have to spend at least 10-15 minutes warming up in what I call a combination dynamic and static workout. That’s doing some stretches plus some movement patterns. I also recommend stretching while you’re playing.”

“At TOCA we provide an excellent assessment while looking at the whole body and not just an individual body part,” Dr. Cummings said. “We also make sure that each patient is treated with conservative therapeutic management first, and then surgery if needed. I think we have doctors in our group who are phenomenally gifted, but the good thing is they know when to operate, which is very important.”

Dr. P. Dean Cummings is an Orthopedic Surgeon & Sports Medicine Physician and Surgeon at TOCA.

To learn more about Dr. Cummings and TOCA or to schedule an appointment visit: www.tocamd.com or call 602-277-6211!

#Results #Recovery #Relife #Golf #AZGolf #AZGolfInsider #AGA#BunkertoBunker #TOCA #TOCAMD 

In honor of National Hand Therapy Week Meet TOCA’s Hand Therapy Manager Gretchen Bachman!

[vc_row][vc_column][vc_column_text css_animation=”appear”]Gretchen is the Hand Therapy Manager at TOCA. Hand Therapists, through advanced study and experience, specialize in treating disorders of the entire upper extremity. All hand therapists at TOCA are Certified Hand Therapists, certified by the Hand Therapy Certification Commission. Hand Therapists help bridge the gap between medical management with a physician and facilitate patients return to their daily work, leisure and life activities.

Gretchen graduated with her Bachelor’s Degree from Saginaw Valley State University in her home state of Michigan. She became a practicing occupational therapist in 1998, then in 2001 went on to earn her Master’s in Business Administration in Health Care Management. In 2007 she completed her Doctorate in Occupational Therapy in a Hand Therapy cohort. She has been working with TOCA since 2010.


Gretchen has peer reviewed publications in the Journal of Hand Therapy and wrote a chapter on fracture management and dislocations of the upper extremity in the book, Advanced Concepts of Hand Pathology and Surgery: Application to Hand Therapy Practice. She has presented nationally and internationally on the topics of fracture management, digital replantation, rheumatoid arthritis, custom splinting/orthosis fabrication, and various topics related to evidenced based practice.

Nationally, Gretchen has served on the Board of Directors for both the American Society of Hand Therapists (ASHT) and American Association for Hand Surgery (AAHS). She has been intimately involved on various committees, task forces, and special projects within these associations. Gretchen has also served on the Editorial Board for HAND, the official peer-reviewed journal for the AAHS.

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Internationally, Gretchen has served on the Education Committee for the International Federation of Societies for Hand Therapy (IFSHT) since 2008. She has also served as the IFSHT Special Events Chair for the 2010 International Meeting when hosted in Orlando, FL.

Gretchen was granted an award through the IFSHT in 2009 and organized a multi-discipline educational conference related to disorders of the upper extremity in Lima, Peru. The Peruvian therapist who hosted this conference won a subsequent award and grant from the IFSHT to travel to the USA, contributing to further educational outreach brought back to her home therapy community in Lima.

Gretchen is passionate about a non-profit organization called the Guatemala Healing Hands Foundation. She has been supporting and traveling on medical mission trips with this organization since 2005. The GHHF is a nonprofit organization dedicated to improving the quality and availability of health care in Guatemala through education, surgery, and therapy.

There is a Venn diagram of 3 primary areas of service: Direct patient care, education, and community outreach. Direct service care primarily specializes in the treatment of congenital and pediatric hand injuries.

Direct patient Care: Following a mandatory screening day, where upwards of 200 children are evaluated to determine their best treatment plan: surgery, therapy, or other intervention. Due to GHHF’s unique infrastructure GHHF is able to monitor children year after year to insure they receive the best possible consistent care. Depending on the severity and length of each case, surgical patients are provided with both in and

outpatient care with costs covered 100% by GHHF.

Education: Each mission, a two day educational conference is organized annually, an

d integrates the Guatemalan provider community. GHHF has a unique relationship with the Guatemala Hand Associations, and they are a trusted teaching source and a vital American group providing cutting- edge hand education to both the surgical and therapy communities to over 2,200 doctors, therapists, and students to date.

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Community Outreach: The heartbreaking reality and reasons why we meet so many children with serious hand conditions and injuries of the people in this nation cannot be ignored and disregarded. GHHF is committed to addressing the sources behind the problems seen. GHHF has teamed up with the village of Chichoy Alto, in the region of Patzun, Chimaltenango, to improve sanitation, health, education, and the overall quality of life for these 120 families. Community members of Chichoy Alto are required to collaborate and provide a portion of the labor necessary to implement these improvements. Within this community, GHHF has sponsored and constructed 55+ latrines, sponsored and constructed 21 efficient ONIL stoves, distributing crucial fertilizer needed to replenish Chichoy Alto’s barely existent crops, distributed emergency maize to families struggling with malnutrition, helped dig hillside trenches to lay piping to supply fresh water throughout the village, purchased school supplies to the 100+ elementary aged children, and have sponsored many children to attend high school and education beyond.

g4In her free time, Gretchen enjoys traveling; camping, reading, and watching her son grow. She enjoys volunteering at his elementary school, and she and her family all recently started volunteering with the Special Olympics, another organization Gretchen has supported for a long time.

‪#‎HandTherapy‬ ‪#‎Recovery‬ ‪#‎Results‬ ‪#‎Relief‬ ‪#‎Communityoutreach‬‪#‎Patientcare‬ ‪#‎GuatemalaHealingHandsFoundation‬

TOCA
602-277-6211

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This Week Is National Hand Therapy Week!

[vc_row][vc_column][vc_column_text css_animation=”appear”]Hand Therapy Week is an integrated national program established by ASHT. Throughout the week, ASHT members sponsor and organize events in their communities in an effort to raise awareness among various audiences, celebrate the benefits of hand therapy and educate the public. Hand Therapy Week is held each year during the first full week of June.

At TOCA we ❤︎ our Hand Therapists, their talent, dedication and commitment to quality patient care! Thank you: Gretchen Bachman, Connie Johnson, Stephen Desjardins, Leonie Chin-Duncan, Debbie Rhoads and Lani McEvers!

The TOCA Upper Extremity and Hand Physical Therapists of Arizona (Certified Hand Therapists) provide services that improve function, increase motion, relieve pain, increase independence in activities of daily living, increase strength and dexterity for return to home, sports or work.

TOCA’s Hand Therapists work with individuals of all ages with a variety of injuries or conditions. Their areas of expertise involve evaluation, treatment and custom splinting of the shoulder, elbow, forearm, wrist, hand and fingers.

Hand Therapy is a type of rehabilitation performed by an occupational or physical therapist on patients with conditions affecting the hands and upper extremities. Such therapy is performed by a provider with a high degree of specialization that requires continuing education, and often advanced certification. This enables the hand therapist to work with patients to hasten their return to a productive lifestyle.

To Contact the TOCA Hand Therapy Department Directly Call: 602-512-8504!

‪#‎Recovery‬ ‪#‎Results‬ ‪#‎Relife‬ ‪#‎Handtherapy‬

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