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Machine Learning to Predict Discharge Destination After Total Knee Arthroplasty and Total Hip Arthroplasty. 通过机器学习预测全膝关节置换术和全髋关节置换术后的出院去向。
Journal of surgical orthopaedic advances Pub Date : 2023-01-01
Gregory J Booth, Jacob Cole, Phil Geiger, George C Balazs, Scott Hughey, Natalie Nepa, Ashton Goldman
{"title":"Machine Learning to Predict Discharge Destination After Total Knee Arthroplasty and Total Hip Arthroplasty.","authors":"Gregory J Booth, Jacob Cole, Phil Geiger, George C Balazs, Scott Hughey, Natalie Nepa, Ashton Goldman","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Discharge destination impacts costs and perioperative planning for primary total knee (TKA) or hip arthroplasty (THA). The purpose of this study was to create a tool to predict discharge destination in contemporary patients. Models were developed using more than 400,000 patients from the National Surgical Quality Improvement Program database. Models were compared with a previously published model using area under the receiver operating characteristic curve (AUC) and decision curve analysis (DCA). AUC on patients with TKA was 0.729 (95% confidence interval [CI]: 0.719 to 0.738) and 0.688 (95% CI: 0.678 to 0.697) using the new and previous models, respectively. AUC on patients with THA was 0.768 (95% CI: 0.758 to 0.778) and 0.726 (95% CI: 0.714 to 0.737) using the new and previous models, respectively. DCA showed substantially improved net clinical benefit. The new models were integrated into a web-based application. This tool enhances clinical decision making for predicting discharge destination following primary TKA and THA. (Journal of Surgical Orthopaedic Advances 32(4):252-258, 2023).</p>","PeriodicalId":516534,"journal":{"name":"Journal of surgical orthopaedic advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140320265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Radiographic Prediction of Soft Tissue Injury Associated with Tibial Plateau Fractures: The Direction of Articular Depression Matters. 胫骨平台骨折相关软组织损伤的影像学预测：关节凹陷的方向很重要。
Journal of surgical orthopaedic advances Pub Date : 2023-01-01
Matthew P Lunati, Jesse Seilern Und Aspang, J'Lynn L Baker, Jacob M Wilson, Thomas J Moore
{"title":"Radiographic Prediction of Soft Tissue Injury Associated with Tibial Plateau Fractures: The Direction of Articular Depression Matters.","authors":"Matthew P Lunati, Jesse Seilern Und Aspang, J'Lynn L Baker, Jacob M Wilson, Thomas J Moore","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This investigation aimed to evaluate the impact of coronal articular fragment displacement of Schatzker type II tibial plateau fractures on concomitant soft tissue knee injuries. One hundred consecutively treated patients were included. Depression depth and coronal articular fragment displacement were measured radiographically, and medial collateral ligament (MCL) and lateral meniscus (LM) injury, and pain and range of motion (ROM) on final follow up, were recorded. Multivariable regression was then performed. Coronal articular fragment displacement was medially and laterally hinged in 74% and 26% of patients, respectively. MCL injuries were significantly higher in the lateral hinge group (odds ratio [OR]: 3.25; confidence interval [CI]: 1.07 to 9.84; p = 0.03). No difference was found in LM injury incidence and amount of articular depression between groups. At final follow-up, average pain and ROM was similar between groups. Findings demonstrate a significant correlation between laterally hinged articular depression in Schatzker II tibial plateau fractures and concomitant MCL injury. (Journal of Surgical Orthopaedic Advances 32(4):270-275, 2023).</p>","PeriodicalId":516534,"journal":{"name":"Journal of surgical orthopaedic advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140320270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Characterization of Opioid Prescribing Tendencies Among Orthopaedic Surgeons: A National Perspective. 骨科外科医生阿片类药物处方倾向的特点：全国视角。
Journal of surgical orthopaedic advances Pub Date : 2023-01-01
Kamil Amer, Michael Metrione, Sirjanhar Singh, Jay Patel, Kathleen Beebea
{"title":"Characterization of Opioid Prescribing Tendencies Among Orthopaedic Surgeons: A National Perspective.","authors":"Kamil Amer, Michael Metrione, Sirjanhar Singh, Jay Patel, Kathleen Beebea","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>There has been increasing pressure on healthcare providers to exhibit restraint when prescribing opioids for pain control. However, data that characterizes the differences between orthopaedic providers and their accompanying prescription rates is not well developed. This study accessed Medicare Provider Utilization and Payment Data from 2015 to collect the number of prescriptions for opioid-based medications administered by orthopaedic surgeons across the country. A total of 19,410 orthopaedic providers were identified as opioid prescribers from the 2015 Medicare Part D Database. Providers averaged an opioid prescription every 10.9 days, with 94.7% of prescribers (18,387) having written more than 10 opioid prescriptions. Regionally, the Southern United States had the highest percentage of providers prescribing an opioid greater than 10 times at 96.4%. Female orthopaedic surgeons prescribed just over half the number of scripts that male surgeons did (79.4 vs. 154.2, p < 0.001). (Journal of Surgical Orthopaedic Advances 32(3):199-201, 2023).</p>","PeriodicalId":516534,"journal":{"name":"Journal of surgical orthopaedic advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139522133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Minimally Invasive Cubital Tunnel Release Utilizing Lighted Retractors: A Study of Residents Novel to this Technique Utilizing a Cadaveric Model. 利用照明牵引器的微创肘隧道松解术：利用尸体模型对初次使用该技术的住院医师进行的研究。
Journal of surgical orthopaedic advances Pub Date : 2023-01-01
Kenneth F Taylor, M Daniel Hatch, Kavita T Vakharia, Randy M Hauck
{"title":"Minimally Invasive Cubital Tunnel Release Utilizing Lighted Retractors: A Study of Residents Novel to this Technique Utilizing a Cadaveric Model.","authors":"Kenneth F Taylor, M Daniel Hatch, Kavita T Vakharia, Randy M Hauck","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The purpose of this study was to evaluate whether a minimally-invasive cubital tunnel release using lighted retractors could be performed safely and completely by residents with no prior training in this technique. Ten residents participated in the study. Postoperative dissection of the specimens was performed utilizing a detailed checklist and global rating scale to evaluate the completeness of release as well as presence of neurologic injury. Performance of residents was compared. Rho correlation analysis was used to verify validity of the assessment tools. Training year most strongly correlated with Global Rating Scale assessment values. There was a trend correlating training year with faster surgical times, and Detailed Checklist scores. Validation measurements showed strong correlations between the pass/fail grade and the Detailed Checklist and the Global Rating Scale. Complete release of the ulnar nerve in situ utilizing lighted retractors can be performed with minimal training or experience. (Journal of Surgical Orthopaedic Advances 32(3):193-198, 2023).</p>","PeriodicalId":516534,"journal":{"name":"Journal of surgical orthopaedic advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139522342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pes Planovalgus Is Associated with Increased Comorbidities and Poor Outcomes After Total Knee Arthroplasty. 膝内翻与全膝关节置换术后并发症增加和疗效不佳有关。
Journal of surgical orthopaedic advances Pub Date : 2023-01-01
Allison R Mitchell, Kingsley A Oladeji, John C Bonano, Abiram Bala, Derek F Amanatullah
{"title":"Pes Planovalgus Is Associated with Increased Comorbidities and Poor Outcomes After Total Knee Arthroplasty.","authors":"Allison R Mitchell, Kingsley A Oladeji, John C Bonano, Abiram Bala, Derek F Amanatullah","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Pes planovalgus affects knee biomechanics but there are no studies describing its impact on total knee arthroplasty (TKA). We aim to characterize the demographics, medical, and surgical complications of patients with pes planovalgus undergoing TKA. A Medicare database was queried using ICD-9 codes to identify 5,750 patients with and 23,000 patients without pes planovalgus who underwent TKA from 2005 to 2014. Standard descriptive statistics were used to compare medical and surgical complications at 90 days and 2 years, with alpha < 0.003 after a Bonferroni Correction. Patients with pes planovalgus had an elevated incidence of hypertension (80%, p < 0.001), pulmonary disease (31%, p < 0.001), hypothyroidism (28%, p < 0.001), diabetes (30%, p < 0.001), vascular disease (20%, p < 0.001), obesity (26%, p < 0.001), and depression (23%, p < 0.001). They also had increased odds of deep vein thrombosis (DVT) (odds ratio [OR] 1.3, p < 0.001), stiffness (OR 1.3, p < 0.003) and revision (OR 1.59, p < 0.003) at 90 days. At 2 years, odds of stiffness had increased (OR 1.34, p < 0.001) with similar rates of revision and medical complications. Pes planovaglus is associated with increased medical comorbidities and this patient population may be at an increased risk for postoperative stiffness, early revisions, and DVT after TKA. Arthroplasty surgeons should be conscious of these risks when considering TKA in a patient with pes planovalgus and counsel them appropriately. (Journal of Surgical Orthopaedic Advances 32(3):202-206, 2023).</p>","PeriodicalId":516534,"journal":{"name":"Journal of surgical orthopaedic advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139522348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Revision Surgery and Wound Complications with Minimally Invasive Compared to Open Achilles Tendon Repair: A Retrospective Comparative Study of 116 Patients. 微创跟腱修复术与开放式跟腱修复术的翻修手术和伤口并发症：116 例患者的回顾性比较研究。
Journal of surgical orthopaedic advances Pub Date : 2023-01-01
Nicholas C Danford, Christina E Freibott, Seth C Shoap, Hans Polzer, J Turner Vosseller
{"title":"Revision Surgery and Wound Complications with Minimally Invasive Compared to Open Achilles Tendon Repair: A Retrospective Comparative Study of 116 Patients.","authors":"Nicholas C Danford, Christina E Freibott, Seth C Shoap, Hans Polzer, J Turner Vosseller","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The current study analyzed revision surgery rate and wound complications of patients with Achilles tendon ruptures that received either minimally invasive repair or open standard repair. A retrospective chart review of patients that had Achilles tendon repair performed using either an open or minimally invasive technique was conducted. Primary outcomes were revision surgery rate and wound complication rate. Twenty-nine (25.0%) patients had the minimally invasive approach, while 87 (75.0%) had the open approach. On average there were 0.16 additional surgeries per patient in the open group versus none in the minimally invasive group (p = 0.003). There were 13 wound-related complications, all of which were in the open group (p = 0.06). Revision surgery rates are significantly higher for patients treated with open Achilles repair versus those treated with a minimally invasive technique. Patients may benefit from a minimally invasive as opposed to open technique. (Journal of Surgical Orthopaedic Advances 32(3):173-176, 2023).</p>","PeriodicalId":516534,"journal":{"name":"Journal of surgical orthopaedic advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139522351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Modified Saha Procedure for Chronic Paralytic Shoulder after Reverse Shoulder Arthroplasty Complicated with Brachial Plexus Injury. 改良 Saha 程序治疗反向肩关节置换术后并发臂丛神经损伤的慢性麻痹肩。
Journal of surgical orthopaedic advances Pub Date : 2023-01-01
Rachel Bordelon, Amy Trammell, Zhongyu Li
{"title":"Modified Saha Procedure for Chronic Paralytic Shoulder after Reverse Shoulder Arthroplasty Complicated with Brachial Plexus Injury.","authors":"Rachel Bordelon, Amy Trammell, Zhongyu Li","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Nerve injuries after reverse total shoulder arthroplasty (rTSA) are rare, and fortunately, most patients recover without long-term sequelae. However, irreversible deltoid paralysis due to brachial plexus or axillary nerve injury is devastating, as the deltoid is the main force of movement of the humerus after rTSA. Denervation of the deltoid results in weakness in abduction, forward flexion, and elevation, as well as varying degrees of chronic pain and shoulder instability. Treatment options for chronic deltoid denervation after axillary nerve or brachial plexus injuries are limited, since nerve repair, graft, or transfer procedures are ineffective. Trapezius tendon transfers, including the Saha technique, have been used to treat chronic deltoid weakness in native shoulders. Here, the authors present a modified Saha technique to improve shoulder motion and stability in patients with chronic deltoid paralysis following rTSA. (Journal of Surgical Orthopaedic Advances 32(4):276-280, 2023).</p>","PeriodicalId":516534,"journal":{"name":"Journal of surgical orthopaedic advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140320266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Mortality Rate Increase in Elderly Patients With Hip Fractures Presenting During the COVID-19 Pandemic to a Hospital in the United States Epicenter: Minimum 30-day Follow Up Comparative Study. 在 COVID-19 大流行期间前往美国中心医院就诊的髋部骨折老年患者死亡率增加：最短 30 天随访比较研究。
Journal of surgical orthopaedic advances Pub Date : 2023-01-01
Nicholas C Danford, Liana J Tedesco, Cesar D Lopez, Emma R Berube, Shawn M Simmons, John T Heffernan, Charles M Jobin
{"title":"Mortality Rate Increase in Elderly Patients With Hip Fractures Presenting During the COVID-19 Pandemic to a Hospital in the United States Epicenter: Minimum 30-day Follow Up Comparative Study.","authors":"Nicholas C Danford, Liana J Tedesco, Cesar D Lopez, Emma R Berube, Shawn M Simmons, John T Heffernan, Charles M Jobin","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The purpose of this study was to compare mortality and complication rates among geriatric patients who sustained a hip fracture before the coronavirus disease (COVID-19) pandemic began to those who presented during the peak of the pandemic. Patients greater than or equal to 50 years of age who presented with a diagnosis of hip fracture from March 16, 2020 to May 1, 2020 were compared with a historical control group who presented between December 1, 2019 and January 16, 2020. Minimum follow up was 30 days. The primary outcome was a 30-day mortality rate. Thirty-day mortality was significantly different between groups, with no deaths of 24 patients in the pre-COVID-19 cohort versus six deaths of 23 patients (26.1%) in the COVID-19 cohort (chi-squared test, p-value = 0.02). The study concluded that the COVID-19 pandemic increased mortality risk for geriatric hip fracture patients. (Journal of Surgical Orthopaedic Advances 32(4):232-237, 2023).</p>","PeriodicalId":516534,"journal":{"name":"Journal of surgical orthopaedic advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140320267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Emergency Pediatric Orthopaedic Transfer Criteria: A Pilot Study. 儿科骨科急诊转院标准：试点研究。
Journal of surgical orthopaedic advances Pub Date : 2023-01-01
Gregory S Mowrer, Nicholas I Pilla, Scott M Sorenson, Douglas G Armstrong, William L Hennrikus
{"title":"Emergency Pediatric Orthopaedic Transfer Criteria: A Pilot Study.","authors":"Gregory S Mowrer, Nicholas I Pilla, Scott M Sorenson, Douglas G Armstrong, William L Hennrikus","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The purpose of this study was to define pediatric orthopaedic transfer criteria for patients coming from a smaller facility to a Level I pediatric trauma center. A 10-question phone survey was utilized for every transfer request. Fifty-eight transfer requests were prospectively collected and retrospectively reviewed. The criteria were based on The American Academy of Pediatrics (AAP) guidelines and the expert opinion of the senior author. The AAP criteria included complex fractures/dislocations and bone and joint infections. The expert opinion criteria included a patient requiring admission to the hospital or a patient needing surgery. All centers requesting transfers were staffed by an on-call board-certified general orthopaedic surgeon with the ability to care for pediatric orthopaedic injuries. Of the 58 transfers, 37 (64%) did not meet transfer criteria; 21 (36%) met transfer criteria. Transfer requests came from Emergency Department (ED) physicians in 25/58 cases (43%), physician assistants in 11/58 (19%), orthopaedic attending physicians in 3/58 (5%), and orthopaedic residents in 3/58 (5%). The orthopaedic surgeon at the referring hospital examined the patient in only six instances (10%) prior to transfer. Of the 58 patients, 18 (31%) required a hospital admission, and 17 (29%) patients were indicated for surgery. In the current study, 64% of pediatric orthopaedic transfers did not meet criteria for an inter-facility hospital to hospital transfer and were potentially avoidable. (Journal of Surgical Orthopaedic Advances 32(3):182-186, 2023).</p>","PeriodicalId":516534,"journal":{"name":"Journal of surgical orthopaedic advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139522226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Grit Score is Predictive of Increased Risk for Opioid Prescription Refill Following Primary Arthroscopic Rotator Cuff Repair. 关节镜下肩袖初次修复术后，Grit 评分可预测阿片类药物处方再填充风险的增加。
Journal of surgical orthopaedic advances Pub Date : 2023-01-01
Anthony J Marois, Adam Achecar, Frederick M Azar, David L Bernholt, Tyler J Brolin, Thomas W Throckmorton
{"title":"Grit Score is Predictive of Increased Risk for Opioid Prescription Refill Following Primary Arthroscopic Rotator Cuff Repair.","authors":"Anthony J Marois, Adam Achecar, Frederick M Azar, David L Bernholt, Tyler J Brolin, Thomas W Throckmorton","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The grit score is used to measure passion and perseverance for long-term goals. We hypothesized that higher grit scores would predict improved 90-day outcomes and reduced opioid requirements after primary arthroscopic rotator cuff repair (RCR). Included were 103 patients. The median grit score was 3.9 (2.2-5.0). There was no statistically significant association between grit and morphine milligram equivalents prescribed or patient-reported pain control. Higher grit score was associated with a significant reduction in opioid prescription refill at 6 weeks, though this association was not seen at 2 or 12 weeks. The odds of requiring opioid medication 6 weeks after RCR increased 3.5 times per each 1.0 unit decrease in grit score. Patients with higher levels of grit, especially a score over 4.0, have a less difficult postoperative course after RCR. The grit score may help identify patients who are at increased risk for prolonged opioid use after RCR. (Journal of Surgical Orthopaedic Advances 32(3):177-181, 2023).</p>","PeriodicalId":516534,"journal":{"name":"Journal of surgical orthopaedic advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139522227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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