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  • 1
    Article
    Article
    2012
    ISSN: 0009-921X 
    Language: English
    In: Clinical orthopaedics and related research, 2012-05, Vol.470 (5), p.1518-1519
    Description: Byline: Pietro Ruggieri (1) Author Affiliation: (1) IV Department of Orthopaedics and Orthopedic Oncology, Rizzoli Institute, University of Bologna, Via Pupilli 1, 40136, Bologna, Emilia Romagna, Italy Article History: Registration Date: 03/02/2012 Online Date: 18/02/2012
    Subject(s): Surgical Orthopedics ; Medicine & Public Health ; Sports Medicine ; Orthopedics ; Surgery ; Conservative Orthopedics ; Medicine/Public Health, general ; Medicine ; Public Health, general ; Obituary
    ISSN: 0009-921X
    E-ISSN: 1528-1132
    Source: PubMed Central
    Source: Alma/SFX Local Collection
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  • 2
    Language: English
    In: Skeletal radiology, 2020-02, Vol.49 (2), p.339-339
    Description: Author Affiliation:
    Subject(s): Scapula ; Humans ; Bone Neoplasms ; Granuloma, Giant Cell ; Giant Cells ; Index Medicus
    ISSN: 0364-2348
    E-ISSN: 1432-2161
    Source: Alma/SFX Local Collection
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 3
    Language: English
    In: Clinical orthopaedics and related research, 2010-11, Vol.468 (11), p.2939-2947
    Description: The treatment of choice in sacral chordoma is surgical resection, although the risk of local recurrence and metastasis remains high. The quality of surgical margins obtained at initial surgery is the primary factor to improve survival reducing the risk of local recurrence, but proximal sacral resections are associated with substantial perioperative morbidity.We considered survivorship related to local recurrence in terms of surgical margins, level of resection, and previous surgery.We retrospectively reviewed 56 patients with sacral chordomas treated with surgical resection. Thirty-seven were resected above S3 by a combined anterior and posterior approach and 19 at or below S3 by a posterior approach. Nine of these had had previous intralesional surgery elsewhere. The minimum followup was 3 years (mean, 9.5 years; range, 3–28 years).Overall survival was 97% at 5 years, 71% at 10 years, and 47% at 15 years. Survivorship to local recurrence was 65% at 5 years and 52% at 10 years. Thirty percent of patients developed metastases. Wide margins were associated with increased survivorship to local recurrence. We found no differences in local recurrence between wide and wide-contaminated margins (that is, if the tumor or its pseudocapsule was exposed intraoperatively, but further tissue was removed to achieve wide margins). Previous intralesional surgery was associated with an increased local recurrence rate. We observed no differences in the recurrence rate in resections above S3 or at and below S3.Surgical margins affect the risk of local recurrence. Previous intralesional surgery was associated with a higher rate of local recurrence. Intraoperative contamination did not affect the risk of local recurrence when wide margins were subsequently attained.Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
    Subject(s): Surgical Orthopedics ; Medicine & Public Health ; Sports Medicine ; Surgery ; Orthopedics ; Conservative Orthopedics ; Medicine/Public Health, general ; Spinal Neoplasms - pathology ; Humans ; Middle Aged ; Orthopedic Procedures - adverse effects ; Male ; Spinal Neoplasms - mortality ; Neoplasm Recurrence, Local - surgery ; Time Factors ; Sacrum - surgery ; Adult ; Female ; Retrospective Studies ; Sacrum - pathology ; Chordoma - surgery ; Reoperation ; Risk Assessment ; Risk Factors ; Kaplan-Meier Estimate ; Proportional Hazards Models ; Survival Rate ; Treatment Outcome ; Surgical Wound Infection - etiology ; Chordoma - secondary ; Disease-Free Survival ; Italy ; Aged ; Chordoma - mortality ; Spinal Neoplasms - surgery ; Index Medicus ; Abridged Index Medicus ; MSTS 2009 Meeting ; Symposium ; Highlights of the ISOLS
    ISSN: 0009-921X
    E-ISSN: 1528-1132
    Source: PubMed Central
    Source: Alma/SFX Local Collection
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 4
    Language: English
    In: Clinical orthopaedics and related research, 2015-03, Vol.473 (3), p.891-899
    Description: Modular megaprostheses are now the most common method of reconstruction after segmental resection of the long bones in the lower extremities. Previous studies reported variable outcome and failure rates after knee megaprosthetic reconstructions.The objectives of this study were to analyze the results of a modular tumor prosthesis after resection of bone tumor around the knee with respect to (1) survivorship; (2) failure rate; (3) comparative survivorship against different sites of reconstructions and of primary and revision implants; and (4) functional results on the Musculoskeletal Tumor Society (MSTS) scoring system.Between 2003 and 2010, 247 rotating-hinge Global Modular Reconstruction System (GMRS) knee prostheses were implanted in our institute for malignant and aggressive benign tumors. During this time, that group represented 23% of the patients who had oncologic megaprosthesis reconstruction about the knee after resection of primary or metastatic bone tumors (247 of 1086 patients). In the other 77% of cases we used other types of oncologic prostheses. Before 2003 we used the older Howmedica Modular Resection System and Kotz Modular Femur/Tibia Replacement from 2003 we used mostly the GMRS but we continued to use the HMRS in some cases such as patients with poor prognoses, elderly patients, or metastatic patients. Sites included 187 distal femurs and 60 proximal tibias. Causes of megaprosthesis failure were classified according to Henderson et al. in five types: Type 1 (soft tissue failure), Type 2 (aseptic loosening), Type 3 (structural failure), Type 4 (infection), and Type 5 (tumor progression). Followup was at a minimum oncologic followup of 2 years (mean, 4 years; range, 2–8 years). Kaplan-Meier actuarial curves of implant survival to major failures were done. Functional results were analyzed according to the MSTS II system; 223 of the 247 were available for functional scoring (81%).At latest followup, among 175 treated patients for primary reconstruction, 117 are continuously disease-free, 26 have no evidence of disease after treatment of relapse, eight are alive with disease, and 24 died from disease. The overall failure rate of the megaprostheses in our series was 29.1% (72 of 247). Type 1 failure occurred in 8.5% (21 of 247) cases, Type 2 in 5.6% (14 of 247), Type 3 in 0%, Type 4 in 9.3% (23 of 247), and Type 5 in 5.6% (14 of 247). Kaplan-Meier curve showed an overall implant survival rate for all types of failures of 70% at 4 years and 58% at 8 years. Prosthetic survivorship for revisions was 80% at 5 years and for primary reconstructions was 60% at 5 years (p = 0.013). Survivorship to infection was 95% at 5 years for revision patients and 84% at 5 years for primary patients (p = 0.475). The mean MSTS score was 84 (25.2; range, 8–30) with no difference between sites of localization (24.7 in proximal tibia versus 25.4 in distal femur reconstruction; p = 0.306).Results at a minimum of 2 years with this modular prosthesis are satisfactory in terms of survivorship (both oncologic and reconstructive) and causes and rates of failure. Although these results seem comparable with other like implants, we will continue to follow this cohort, and we believe that comparative trials among the available megaprosthesis designs are called for.Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
    Subject(s): Surgical Orthopedics ; Medicine & Public Health ; Sports Medicine ; Orthopedics ; Surgery ; Conservative Orthopedics ; Medicine/Public Health, general ; Knee Prosthesis ; Humans ; Middle Aged ; Reconstructive Surgical Procedures - methods ; Male ; Treatment Outcome ; Bone Neoplasms - surgery ; Prosthesis Design ; Young Adult ; Knee Joint - surgery ; Prosthesis Failure ; Sarcoma - surgery ; Adolescent ; Aged, 80 and over ; Adult ; Female ; Aged ; Prosthesis Implantation - methods ; Child ; Databases, Factual ; Implants, Artificial ; Prosthesis ; Analysis ; Index Medicus ; Abridged Index Medicus ; Symposium ; 2013 Meetings of the Musculoskeletal Tumor Society and the International Society of Limb Salvage
    ISSN: 0009-921X
    E-ISSN: 1528-1132
    Source: PubMed Central
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 5
    Language: English
    In: Archives of orthopaedic and trauma surgery, 2021-05, Vol.141 (5), p.831-835
    Description: We report our clinical experience of a 1 year and 10 month child with traumatic anterior shoulder dislocation who underwent non-operative reduction and Desault's bandage immobilization for 10 days. No associated fractures were found and after bandage removal, full ROM of the shoulder was immediately assessed. Further research is needed to unified guideline of treatment and the time of immobilization for this type of injury in pediatric population.
    Subject(s): Literature reviews ; Pediatrics ; Fractures ; Pain ; Orthopedics ; Surgery ; Toddlers ; Patients ; Trauma ; Children & youth ; Index Medicus
    ISSN: 0936-8051
    E-ISSN: 1434-3916
    Source: Alma/SFX Local Collection
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 6
    Language: English
    In: Clinical orthopaedics and related research, 2014-01, Vol.472 (1), p.349-359
    Description: Surgical treatment of pelvic tumors with or without acetabular involvement is challenging. Primary goals of surgery include local control and maintenance of good quality of life, but the procedures are marked by significant perioperative morbidity and complications.We wished to (1) evaluate the frequency of infection after limb salvage surgical resection for bone tumors in the pelvis; (2) determine whether infection after these resections is associated with particular risk factors, including pelvic reconstruction, radiotherapy or chemotherapy, type of resection, and age; and (3) analyze treatment of these infections, particularly with respect to the need of additional surgery or hemipelvectomy.From 1975 to 2010, 270 patients with pelvic bone tumors (149 with chondrosarcoma, 40 with Ewing’s sarcoma, 27 with osteosarcoma, 18 with other primary malignant tumors, 11 with metastatic tumors, and 25 with primary benign tumors) were treated by surgical resection. Minimum followup was 1.1 years (mean, 8 years; range, 1–33 years). The resection involved the periacetabular area in 166 patients. In 137 patients reconstruction was performed; in 133 there was no reconstruction. Chart review ascertained the frequency of deep infections, how they were treated, and the frequency of resection arthroplasty or hemipelvectomies that occurred thereafter.A total of 55 patients (20%) had a deep infection develop at a mean followup of 8 months. There were 20 infections in 133 patients without reconstruction (15%) and 35 infections in 137 patients with reconstruction (26 %). Survivorship rates of the index procedures using infection as the end point were 87%, 83%, and 80% at 1 month, 1 year, and 5 years, respectively. Infection was more common in patients who underwent pelvic reconstruction after resection (univariate analysis, p = 0.0326; multivariate analysis, p = 0.0418; odds ratio, 1.7718; 95% CI, 1.0243–3.0650); no other risk factors we evaluated were associated with an increased likelihood of infection. Despite surgical débridements and antibiotics, 16 patients (46%) had the implant removed and five (9%) underwent external hemipelvectomy (four owing to infection and one as a result of persistent infection and local recurrence).Infection is a common complication of pelvic resection for bone tumors. Reconstruction after resection is associated with an increased risk of infection compared with resection alone, without significant difference in percentage between allograft and metallic prosthesis. When infection occurs, it requires removal of the implant in nearly half of the patients who have this complication develop, and external hemipelvectomy sometimes is needed to eradicate the infection.Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
    Subject(s): Surgical Orthopedics ; Medicine & Public Health ; Sports Medicine ; Orthopedics ; Surgery ; Conservative Orthopedics ; Medicine/Public Health, general ; Prognosis ; Follow-Up Studies ; Hemipelvectomy - adverse effects ; Humans ; Middle Aged ; Pelvic Bones - pathology ; Male ; Treatment Outcome ; Surgical Wound Infection - etiology ; Bone Neoplasms - surgery ; Sarcoma - pathology ; Bone Neoplasms - pathology ; Sarcoma - surgery ; Reconstructive Surgical Procedures - adverse effects ; Adult ; Female ; Aged ; Retrospective Studies ; Pelvic Bones - surgery ; Chemotherapy ; Sarcoma ; Analysis ; Bone tumors ; Health aspects ; Cancer ; Index Medicus ; Abridged Index Medicus ; Clinical Research
    ISSN: 0009-921X
    E-ISSN: 1528-1132
    Source: PubMed Central
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 7
    Language: English
    In: Journal of surgical oncology, 2012-12-15, Vol.106 (8), p.929-937
    Description: Introduction Aim of this study was to analyze (1) survival, local recurrence (LR), and metastasis rates between the three histological tumor grades; (2) whether type of treatment and tumor site influenced prognosis for each histologic grade. Methods We retrospectively studied 296 patients with central conventional chondrosarcomas (CS) (87 grade 1, 162 grade 2, and 47 grade 3). The femur was the most common site (91 cases), followed by the pelvis (82) and other less frequent sites. Type of surgery was related with histologic grade. Margins were wide in 222 cases, marginal in 23, and intralesional in 51 cases. Results At a mean of 7 years, 201 patients remained continuously NED, 33 were NED after treatment of relapse, 15 were AWD, 35 were died of disease, and 12 of other causes. Survival was 92% at 5 years and 84% at 10 years, significantly influenced by histological grading. In grade 3 CS, two factors influenced survival: type of surgery (resection vs. amputation, P = 0.051) and site (P = 0.039). The two significant factors lost their significance at multivariate analysis. Conclusion Central conventional CS with low/intermediate grade has a good prognosis, while high‐grade tumors have poor outcome. Tumor relapses are strictly related with histologic grade. J. Surg. Oncol. 2012; 106: 929–937. © 2012 Wiley Periodicals, Inc.
    Subject(s): chondrosarcoma ; surgical treatment ; prognostic factors ; clinical outcome ; grade ; Chondrosarcoma - surgery ; Prognosis ; Femoral Neoplasms - pathology ; Humans ; Middle Aged ; Neoplasm Recurrence, Local ; Male ; Treatment Outcome ; Bone Neoplasms - surgery ; Pelvis ; Bone Neoplasms - pathology ; Young Adult ; Neoplasm Metastasis ; Neoplasm Grading ; Adolescent ; Survival Analysis ; Aged, 80 and over ; Chondrosarcoma - pathology ; Adult ; Female ; Aged ; Retrospective Studies ; Femoral Neoplasms - surgery ; Patient outcomes ; Metastasis ; Index Medicus
    ISSN: 0022-4790
    E-ISSN: 1096-9098
    Source: Alma/SFX Local Collection
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 8
    Language: English
    In: Journal of clinical oncology, 2012-06-10, Vol.30 (17), p.2112-2118
    Description: We compared two chemotherapy regimens that included methotrexate (MTX), cisplatin (CDP), and doxorubicin (ADM) with or without ifosfamide (IFO) in patients with nonmetastatic osteosarcoma of the extremity. Patients age ≤ 40 years randomly received regimens with the same cumulative doses of drugs (ADM 420 mg/m(2), MTX 120 g/m(2), CDP 600 mg/m(2), and IFO 30 g/m(2)) but with different durations (arm A, 44 weeks; arm B, 34 weeks). IFO was given postoperatively when pathologic response to MTX-CDP-ADM was poor (arm A) or given in the primary phase of chemotherapy with MTX-CDP-ADM (arm B). End points of the study included pathologic response to preoperative chemotherapy, toxicity, and survival. Given the feasibility of accrual, the statistical plan only permitted detection of a 15% difference in 5-year overall survival (OS). From April 2001 to December 2006, 246 patients were enrolled. Two hundred thirty patients (94%) underwent limb salvage surgery (arm A, 92%; arm B, 96%; P = .5). Chemotherapy-induced necrosis was good in 45% of patients (48% in arm A, 42% in arm B; P = .3). Four patients died of treatment-related toxicity (arm A, n = 1; arm B, n = 3). A significantly higher incidence of hematologic toxicity was reported in arm B. With a median follow-up of 66 months (range, 1 to 104 months), 5-year OS and event-free survival (EFS) rates were not significantly different between arm A and arm B, with OS being 73% (95% CI, 65% to 81%) in arm A and 74% (95% CI, 66% to 82%) in arm B and EFS being 64% (95% CI, 56% to 73%) in arm A and 55% (95% CI, 46% to 64%) in arm B. IFO added to MTX, CDP, and ADM from the preoperative phase does not improve the good responder rate and increases hematologic toxicity. IFO should only be considered in patients who have a poor histologic response to MTX, CDP, and ADM.
    Subject(s): Biological and medical sciences ; Medical sciences ; Diseases of the osteoarticular system ; Tumors of striated muscle and skeleton ; Tumors ; Osteosarcoma - drug therapy ; Femur - pathology ; Humans ; Child, Preschool ; Male ; Tibia - pathology ; Cisplatin - administration & dosage ; Humerus - pathology ; Disease-Free Survival ; Ifosfamide - administration & dosage ; Antineoplastic Combined Chemotherapy Protocols - therapeutic use ; Chemotherapy, Adjuvant - methods ; Adolescent ; Adult ; Female ; Methotrexate - administration & dosage ; Bone Neoplasms - drug therapy ; Child ; Doxorubicin - administration & dosage
    ISSN: 0732-183X
    E-ISSN: 1527-7755
    Source: Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals
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  • 9
    Language: English
    In: Journal of surgical oncology, 2015-08, Vol.112 (4), p.344-351
    Description: Background and objectives The best treatment of sacral chordoma is surgical resection, nowadays associated with optimized radiation therapy. We analysed 1) the oncologic outcome in a large series; 2) the effect of previous intralesional surgery, resection level, tumor volume and margins on survivorship to local recurrence (LR) and 3) the complication rate. Methods We reviewed 71 patients with sacral chordomas. Forty‐eight resections were proximal to S3. Mean tumor volume was 535 cm3. Eleven received previous intralesional surgery elsewhere. Margins were wide in 44 resections, wide‐contaminated in 11, marginal in 9 and intralesional in 7. Results Overall survival was 92%, 65% and 44% at 5, 10 and 15 years. At a mean of 9.5 years 37 were NED (54.4%), 23 died with disease (33.8%) and 8 were alive with disease (11.7%). Relapses included 15 LRs, 6 distant metastases, 17 both. LR rate was significantly higher in patients with previous surgery (p=0.0217), with inadequate margins (p= 0.0339) and large tumors(p〈0.01), whereas resection level was not significant. Multivariate analysis confirmed the role of tumor volume. Complication rate was high (80.9%) with an infection rate of 41.2%. Conclusions The most prominent adverse factor for LR was previous intralesional surgery. LR rate was related with inadequate margins and tumor volume. J. Surg. Oncol. 2015; 112:344–351. © 2015 Wiley Periodicals, Inc.
    Subject(s): sacral surgery ; prognostic factors ; chordoma ; resection ; tumor ; sacrum ; Sacrum - pathology ; Chordoma - surgery ; Prognosis ; Follow-Up Studies ; Humans ; Middle Aged ; Male ; Survival Rate ; Neoplasm Recurrence, Local - mortality ; Neoplasm Recurrence, Local - surgery ; Chordoma - pathology ; Neoplasm Recurrence, Local - pathology ; Young Adult ; Sacrum - surgery ; Adult ; Female ; Aged ; Retrospective Studies ; Chordoma - mortality ; Neoplasm Staging ; Postoperative Complications ; Tumors, Embryonal ; Health aspects ; Analysis ; Surgery ; Index Medicus
    ISSN: 0022-4790
    E-ISSN: 1096-9098
    Source: Alma/SFX Local Collection
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 10
    Language: English
    In: Clinical orthopaedics and related research, 2012-06, Vol.470 (6), p.1735-1748
    Description: Amputation has been the standard surgical treatment for distal tibia osteosarcoma. Advances in surgery and chemotherapy have made limb salvage possible. However, it is unclear whether limb salvage offers any improvement in function without compromising survival.We therefore compared the survival, local recurrence, function, and complications of patients with distal tibia osteosarcoma treated with limb salvage or amputation.We retrospectively reviewed 42 patients with distal tibia osteosarcoma treated from 1985 to 2010. Nineteen patients had amputations and 23 had limb salvage and allograft reconstructions. We graded the histology using Broders classification, and staged patients using the Musculoskeletal Tumor Society (MSTS) and American Joint Committee on Cancer (AJCC) systems. The tumor grades tended to be higher in the group of patients who had amputations. We determined survival, local recurrence, MSTS function, and complications. The minimum followup was 8 months (median, 60 months; range, 8–288 months).The survival of patients who had limb salvage was similar to that of patients who had amputations: 84% at 120 and 240 months versus 74%, respectively. The incidence of local recurrence was similar: three of 23 patients who had limb salvage versus no patients who had amputations. The mean MSTS functional score tended to be higher in patients who had limb salvage compared with those who had amputations: 76% (range, 30%–93%) versus 71% (range, 50%–87%), respectively. The incidence of complications was similar.Patients treated with either limb salvage or amputation experience similar survival, local recurrence, and complications, but better function is achievable for patients treated with limb salvage versus amputation. Local recurrence and complications are more common in patients with limb salvage.Level III, retrospective comparative study. See the Guidelines for Authors for a complete description of levels of evidence.
    Subject(s): Surgical Orthopedics ; Medicine & Public Health ; Sports Medicine ; Orthopedics ; Surgery ; Conservative Orthopedics ; Medicine/Public Health, general ; Biological and medical sciences ; Orthopedic surgery ; Medical sciences ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Diseases of the osteoarticular system ; Tumors of striated muscle and skeleton ; Bone Neoplasms - mortality ; Humans ; Middle Aged ; Male ; Young Adult ; Orthopedic Procedures ; Amputation ; Aged, 80 and over ; Adult ; Female ; Child ; Osteosarcoma - diagnostic imaging ; Limb Salvage ; Osteosarcoma - mortality ; Bone Neoplasms - diagnostic imaging ; Neoplasm Recurrence, Local ; Tibia - diagnostic imaging ; Bone Neoplasms - surgery ; Tibia - surgery ; Radiography ; Osteosarcoma - surgery ; Leg - surgery ; Adolescent ; Aged ; Reconstructive Surgical Procedures ; Chemotherapy ; Osteosarcoma ; Patient outcomes ; Limb salvage ; Consulting services ; Tumors ; Cancer ; Index Medicus ; Abridged Index Medicus ; Clinical Research
    ISSN: 0009-921X
    E-ISSN: 1528-1132
    Source: PubMed Central
    Source: Alma/SFX Local Collection
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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