Left untreated, it can cause pain, labral tears, and arthritis. This section offers the most important information for decision-making. Prolonged high-dose steroid use can also cause this type of bone cell death. Its prevalence is unknown. Many benign lesions are stable in the bone and require no treatment. The https:// ensures that you are connecting to the Terminal osseous dysplasia is caused by a single Having these older exams can be very helpful to the radiologist. Skeletal surveys are often used in adults with suspected multiple myeloma to look for bone involvement. Meftah M, Rodriguez JA, Panagopoulos G, Alexiades MM. Please enable it to take advantage of the complete set of features! does that mean my back is clear? Osteogenesis imperfecta (OI) is a group of genetic disorders that mainly affect the bones. How are genetic conditions treated or managed? Electronic Health Records. All patients complained of moderate groin and had a mean Harris Hip Score of 69. 20. 9. Long-term results of arthroscopic labral debridement: predictors of outcomes. Repetitive anterior femoroacetabular impingement resulted in anterior groin pain, labral tears, chondral damage and eventually arthritis. Tanzer, Michael MD, FRCSC; Noiseux, Nicolas MD, Editor(s): Hanssen, Arlen D MD, Guest Editor. Rib lesions may simulate pulmonary disease as well. 7. Bone cancer affects all age groups, but certain subtypes, like osteosarcoma and Ewing sarcoma are more common in children and adolescents, while chondrosarcoma is more common in adults. J Pediatr Orthop 19:419-424, 1999. Ordinarily, the distance between the anterior edge of the femoral head and the anterior femoral neck prevents impingement in the normal range of motion. Osseous abnormalities were detected in 143 (45.7%) feet, 27 (18.8%) of which had osseous and CL injury alone, while the remaining 116 had CL related osseous injury and multiple injuries within the hoof capsule. These abnormalities occur primarily in adolescents . Four of these patients also had mild acetabular dysplasia. The abnormality will fall along a spectrum ranging from tissue that closely resembles normal bone and which are no cause for alarm, to that which is very distinct from bone and worthy of further investigation to determine a diagnosis and guide treatment. Accessed 18 Jan. 2023. Subscribe to America's largest dictionary and get thousands more definitions and advanced searchad free! 2022 Feb 8;10(2):23259671211071073. doi: 10.1177/23259671211071073. X-ray example of a biopsy being performed on a lesion in the distal femur (lower thighbone). Therefore, it is not surprising that excision of the torn portion of the acetabular labrum without addressing the femoral neck impingement resulted in residual symptoms in the vast majority of our patients. The slip angle was mild in 95%, moderate in only 5%, and there were no cases with a severe slip angle. FOIA 1989 Apr;5(1):161-78. doi: 10.1016/s0749-0739(17)30609-0. Osseous abnormalities can represent many different kinds of abnormalities. Careers. An official website of the United States government. Sclerosis means that there is a hardening of tissue. Harris WH: Etiology of osteoarthritis of the hip. J Bone Joint Surg 83B:171-176, 2001. may email you for journal alerts and information, but is committed Other signs and symptoms can occur in people with terminal osseous dysplasia, including extra oral frenulae, which are the thin pieces of tissue in the mouth that connect the inside of the lips to the gums; widely spaced eyes; and hair loss. The final Harris Hip Score was 90 (range, 69-100). In multiple myeloma does the absence of osseous lesions mean anything? With future developments in arthroscopic technology, arthroscopic cheilectomy of the femoral head-neck region should routinely be done at the time of labral surgery. Osteoarthritis is the most common form of arthritis. Genetic Testing Registry: Terminal osseous dysplasia, National Organization for Rare Disorders (NORD). South Med J 70:174-175, 1977. Only 14% and 15% of the patients in their 20s or 30s having THA were found to have a pistol-grip deformity. Note: we are unable to answer specific questions or offer individual medical advice or opinions. Epub 2020 Jan 9. Spondylitis, inflammation of one or more of the vertebrae. what does that mean? In one case, the non-spherical portion of the anterior femoral head adjacent to the head-neck junction was found to impinge on the anterior acetabular rim, creating a dent in the femoral head. In females (who have two X chromosomes), a mutation in one of the two copies of the gene in each cell is sufficient to cause the disorder. This is another way of saying normal. (A-B) Anteroposterior and frog lateral radiographs of the hip 2 years before surgery show a pistol-grip deformity with only mild anterior and lateral joint space narrowing. Bone marrow dysplasia syndrome, also known as myelodysplastic syndrome, is a disorder that leads to the production of abnormal blood stem cells in the bone marrow in cancer stages. Paget disease of bone (PDB), also known historically as osteitis deformans, is a focal disorder of bone metabolism that occurs in the aging skeleton; it is characterized by an accelerated rate of bone remodeling, resulting in overgrowth of bone at single (monostotic PDB) or multiple (polyostotic PDB) sites and impaired . Filamin A also links actin to many other proteins to perform various functions within the cell. With improved medical treatment of many cancers especially breast, lung . (A) Preoperative lateral hip xray of a 43-year-old woman who had a hip arthroscopy for a labral tear shows a pistol-grip deformity and an anterior neck osteophyte. The patients resolution of pain and mechanical symptoms were evaluated in 24 hips with at least 1 year followup. Repetitive anterior femoroacetabular impingement resulted in anterior groin pain, labral tears, chondral damage and eventually arthritis. The tear was located at the area of impingement in eight cases and located posteriorly where the femoral head would lever against the acetabulum with anterior impingement in one case. The bone disorder plus hormonal disturbances is termed McCune-Albright Syndrome. Same with infections. Sometimes an exam covers an area of the body but does not discuss any findings. Leunig M, Casissas MM, Hamlet M, et al: Slipped capital femoral epiphysis early mechanical damage to the acetabular cartilage by a prominent femoral metaphysis. Localized arthritic changes were classified as anterior, posterior, medial or lateral, whereas diffuse changes were classified as global. With medical big data and AI algorithms . Materials and methods: The https:// ensures that you are connecting to the J Bone Joint Surg 82A:1170-1188, 2000. These records include radiology reports. The costs for specific medical imaging tests, treatments and procedures may vary by geographic region. The phrase "degenerative changes" in the spine refers to osteoarthritis of the spine. Top answers from doctors based on your search: Created for people with ongoing healthcare needs but benefits everyone. All radiographic views were also assessed for the presence of osteophytes, sclerosis, and subchondral cysts of the femoral neck, particularly anteriorly. Early in embryonic development in females, one of the two X chromosomes is permanently inactivated in somatic cells (cells other than egg and sperm cells). Taniguchi T, Harada T, Iidaka T, Hashizume H, Taniguchi W, Oka H, Asai Y, Muraki S, Akune T, Nakamura K, Kawaguchi H, Yoshida M, Tanaka S, Yamada H, Yoshimura N. Sci Rep. 2021 Mar 16;11(1):6025. doi: 10.1038/s41598-021-85521-x. This was accomplished through three separate but closely related studies: (1) an arthroscopic labral tear study of 38 patients who had hip arthroscopy for a labral tear (2) a hip cheilectomy study of 10 patients who had a cheilectomy for anterior femoroacetabular impingement and (3) an idiopathic arthritis study of 200 consecutive patients having THA. 16. This site needs JavaScript to work properly. combining the finding with clinical symptoms or laboratory test results. Limb Lengthening and Complex Reconstruction Service. Because of the difficulty in accurately determining the remnant epiphyseal scar in adult hips, the slip angle could only be measured in 74% of the cases. It means degenerative joint disease of bone. However, lesions that have not caused symptoms may be first identified well into adulthood. Sometimes the report does not answer the clinical question, and more exams may be needed. These individuals can have a number of birth marks on the skin. Fitzgerald7 had observed similar evidence of femoral impingement at the time of hip arthrotomy for labral tears, but the relevance of these findings was not recognized. Terminal osseous dysplasia with pigmentary defects (TODPD): Follow-up J Bone Joint Surg 79A:1489-1497, 1997. Patient demographics, symptoms, and disease duration were assessed. 26. Diseases and injuries of bones are major causes of abnormalities of the human skeletal system. Multiple myeloma can also affect your bones, leading to bone pain, thinning bones and broken bones. This finding bears extremely important implications for the possible treatment and prevention of acetabular labral tears and idiopathic OA of the hip. In no cases did the arthritic changes affect primarily the posterior aspect of the hip joint. All patients had complete resolution of their mechanical symptoms, but only six patients (25%) had no pain. In all three studies, a common etiology was identified. Farjo LA, Glick JM, Sampson TG: Hip arthroscopy for acetabular labral tears. The identification of the relationship of anterior hip impingement with labral tears and idiopathic arthritis opens the door for future treatments to prevent and cure these conditions. Osseous. Merriam-Webster.com Dictionary, Merriam-Webster, https://www.merriam-webster.com/dictionary/osseous. No hips were found to have acetabular retroversion. Correspondence to: Michael Tanzer, MD, FRCSC, 1650 Cedar Avenue #B5159, Montreal, Quebec, Canada, H3G 1A4. If so, talk to your facility's imaging staff. The anterior neck has developed osteophytes from repeated impingement. There was a significant association between presence of IRU and osseous injury. Acta Orthop Scand 71:370-375, 2000. Radiographs of 54-year-old woman who had a THA in 2001 for idiopathic OA are shown. ous -s-s : bony sense 1 Example Sentences Recent Examples on the Web All three children have an extremely rare genetic disease called Schimke immuno-osseous dysplasia, or SIOD, that often destroys a person's ability to fight off infection and leads to kidney failure. By continuing to use this website you are giving consent to cookies being used. These conditions arise from initial ankle injuries, which, in the subacute or chronic situation, lead to development of abnormal osseous and soft-tissue thickening within the ankle joint. Exostosis, also called osteoma, is a benign growth of new bone on top of existing bone. Example of a metastatic lesion in the femur (thighbone), leading to a pathologic fracture. Further studies are necessary in order to determine if osseous abnormalities associated with CL injury influence prognosis for return to performance. Preoperatively, all patients complained of anterior groin pain exacerbated by activities requiring hip flexion or twisting. Researchers suspect that having some normal filamin A protein is why females with the gene mutation survive to birth, whereas males do not. (A) A pistol-grip deformity on the anteroposterior radiograph of a 38-year-old man who had a hip arthroscopy for an acetabular labral tear is shown. From the Division of Orthopaedic Surgery, McGill University, Montreal, Quebec, Canada. It is also known as osteoarthritis. Based on the clinical and radiographic evaluations, all the patients were diagnosed as having anterior hip impingement and underwent a surgical dislocation of the hip.8 The presence and the site of femoroacetabular impingement and labral tears was assessed. Multiple fractures are common, and in severe cases, can occur even . Equine Vet J. MedlinePlus links to health information from the National Institutes of Health and other federal government agencies. Would you like email updates of new search results? J Am Acad Orthop Surg Glob Res Rev. other imaging tests that can help better assess the finding or getting a follow up imaging test to relook at the finding after a period of time. if it was clear..can i safely assume no cancer is present? Terminal osseous dysplasia is inherited in an X-linked dominant pattern. Br J Radiol 38:810-824, 1965. Bone disease, any of the diseases or injuries that affect human bones. Primary or idiopathic arthritis remains the most common cause of hip arthritis.10 There is increasing evidence that all idiopathic hip arthritis may be secondary to subtle, previously underestimated or unrecognized femoral or acetabular pathology.10,11,26 This study clearly establishes that impingement between the anterior femoral neck and the adjacent acetabulum is a common cause of hip pain, labral tears, and arthritis. J Bone Joint Br 83:1119-1124, 2001. In fact, they are the result of repetitive impingement secondary to pistol grip deformity, with eventual tearing of the labrum from a relatively minor trauma. The right hip was affected in 24 cases and the left in 14. Sometimes the radiologist who reads your exam will also add information that they find in your chart or forms that you fill out before your imaging test. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. Brunetti-Pierri N, Torrado M, Fernandez Mdel C, Tello AM, Arberas CL, Unable to load your collection due to an error, Unable to load your delegates due to an error. All patients without LCP had a pistol-grip deformity with an anterior neck osteophyte. CT or MRI may be needed. 2019 Jan;179(1):123-129. doi: 10.1002/ajmg.a.60686. A variety of osseous lesions of differing severity are associated with CL injury. Comparisons usually involve exams of the same body area and exam type. it said thoracic cage: no acute osseous abnormality. To determine the frequency of occurrence of osseous abnormality coexistent with CL injury of the DIP joint and describe the distribution and character of osseous lesions; and to establish if there was an association between osseous abnormality and increased radiopharmaceutical uptake (IRU). Please try after some time. Researchers suspect the altered protein may not be able to interact with other molecules normally. A radiologistis a doctor who supervises these exams, reads and interprets the images, and writes a report for your healthcare provider. They have hypothesized that a pistol-grip deformity exposes the anterior metaphyseal portion of the femoral neck to the anterior surface of the acetabulum during flexion and internal rotation, producing wear in this region, which progresses eventually to global arthritis. Naessig S, Kucharik M, Meek W, Eberlin C, Martin S. Orthop J Sports Med. Metastatic Bone Disease. This type of abnormal bone growth most commonly affects the long . This may increase the safety, quality, and efficiency of your care. J Orthop Trauma 15:475-481, 2001. MeSH Osseous abnormality does not tell us a diagnosis, only that there is an abnormality seen in the bone. Mildly affected mothers may also have the mutation in some, but not all, of their body cells, which is known as somatic mosaicism. Osseous disorders related to the patellar ligament include acute avulsion fracture of the tibial tuberosity, notably in the children, or known as Osgood-Schlatter disease (OSD) and acute avulsion of the inferior pole of the patella, also known as Sinding-Larsen-Johansson Syndrome (SLJS). 19. The right hip was affected in 54% of the cases and the left hip was affected in 46%. It can occur in many parts of the body. 2020 Dec 7;4(12):e20.00213. Three hips with global arthritis, and one with anterior arthritis required a THA. 3. Bony, of bonelike consistency or structure. Video chat with a U.S. board-certified doctor 24/7 in less than one minute for common issues such as: colds and coughs, stomach symptoms, bladder infections, rashes, and more. This is reflected in the relatively low incidence of pistol-grip deformities in our patients younger than 50 years requiring a THA, and its presence in 68 to 100% of our patients older than 50 years. Therefore, it is the most important part of the radiology report for you and your doctor. The contralateral hip was also examined for the presence of a pistol-grip deformity with or without signs of OA. This impingement results in a spectrum of injury ranging from anterior hip pain, labral tears, damage to the acetabular articular cartilage and idiopathic arthritis. With age, the soft disks that act as . A bone lesion is any process that replaces normal healthy bone with abnormal bone or tissue. Purpose of Test. Fifty-two percent of the patients were women and 48% were men. Terminal osseous dysplasia is a rare disorder. A major categorization of a lesion is whether it is benign or malignant. Thirty-eight consecutive patients who had a hip arthroscopy and were found to have a labral tear were prospectively followed and included in this study. Clinical relevance: Medial collateral ligament desmitis of the distal interphalangeal joint in the hindlimb of a horse: treatment with cast immobilisation. These femoral neck changes were thought to be indicative of hip impingement and were correlated with the area of the labral tear identified at the time of hip arthroscopy. Sixty-eight percent of those patients in their 50s, 69% of those in their 60s, 74% of those in their 70s, and 100% of those in their 80s required a THA for arthritis secondary to a pistol-grip deformity. FOIA 2016 Sep 5;3:73. doi: 10.3389/fvets.2016.00073. Reduced kidney function. Bean LJH, Gripp KW, Amemiya A, editors. The arthritic changes were primarily located in the anterior-lateral region of the hip joint in 22% of the cases (Figs 4, 5). The xrays of the patients with idiopathic arthritis were assessed to determine if a pistol-grip deformity was present, and if so, to quantify its severity by determining the degree of slip and slip angle on the frog lateral view. In males (who have only one X chromosome), a mutation in the only copy of the gene in each cell is thought to be lethal very early in development.. What does significant osseous abnormality on a chest xray entail? Previous studies5,7,23 have shown that labral excision alone does not resolve hip pain completely, with 29 to 54% of patients having residual pain; up to 48% of the patients with labral tears have already developed concomitant degenerative changes. Available from The bone parts of your spine have early signs of wear or age frequently asymptomatic this is a normal report for those over thirty your facet joints means abnormal fluid or swelling in the bone marrow. Once the report is complete, the radiologist signs it, and sends the report to your physician. 2. Cancer that originates in one area of the body, such as an organ, gland, or tissue, and then spreads to bone is called metastatic bone disease (MBD). Connect with a U.S. board-certified doctor by text or video anytime, anywhere. In particular, all xrays were assessed to determine if a pistol-grip deformity was present, and if so, to quantify its severity by determining the degree of slip and slip angle on the frog lateral view.18 The degree of slip was classified as mild if it was < 33%, moderate if it was 33 to 50% and severe if it was > 50%. A-B. When each letter can be seen but not heard. One patient who had moderate arthritic radiographic changes preoperatively continued to have moderate pain. Fifty-five percent had a pistol-grip deformity and radiographic evidence of arthritis, whereas 14% had a pistol-grip deformity and no evidence of arthritis. The main impingement syndromes are anterolateral, anterior, anteromedial, and posterior impingement. defects in a Chinese girl with the FLNA mutation: A case report and published 2011 Oct 5;34(10):e588-92. This website uses cookies. We often mean we dont see a fracture or infection on X-rays. An anterior femoral neck osteophyte was identified on 92% of the xrays (Figs 1, 2). An Important Cause of Early Osteoarthritis of the Hip. Prehabilitation and Rehabilitation Program for Patients Undergoing Arthroscopic Acetabular Labral Repair: A Comprehensive 5-Phase Patient-Guided Program. Send us feedback. The term "tumor" does not indicate whether an abnormal growth is malignant (cancerous) or benign, as both benign and malignant lesions can form tumors in the bone. Delivered to your inbox! eCollection 2018. http://www.ncbi.nlm.nih.gov/books/NBK1393/. It is also called: a radionuclide scan; bone scintigraphy; nuclear medicine bone scan; A bone scan can look at a particular joint or bone. Arthroscopic intervention in early hip disease. 5. GeneReviews(R) [Internet]. A bone scan shows up changes or abnormalities in the bones. Hypotheses: This section lists what the radiologist saw in each area of the body in the exam. HHS Vulnerability Disclosure, Help Objectives: So, what does correlate clinically mean? PMC (A) Preoperative lateral hip xray of a 43-year-old woman who had a hip arthroscopy for a labral tear shows a pistol-grip deformity and an anterior neck osteophyte. How are benign and malignant lesions diagnosed? Skin abnormalities are also common in terminal osseous dysplasia. This results in the loss of the anterior joint space with preservation of the posterior joint space. Robertson S. X-Linked Otopalatodigital Spectrum Disorders. Orthopedics. Conclusions: sharing sensitive information, make sure youre on a federal Would you like email updates of new search results? Sometimes, you may have questions about your report that your physician cannot answer. 2022 A. Mendelson, MD Star Direct, Inc. | About The Author | Imaging Categories | Disclaimer | Privacy Policy | Contact. Sun Y, Almomani R, Aten E, Celli J, van der Heijden J, Venselaar H, Robertson These conditions can be corrected. Some error has occurred while processing your request. Terminal osseous dysplasia is a disorder primarily involving skeletal abnormalities and certain skin changes. This is common when you have imaging tests done at different facilities or hospitals. Clinical Orthopaedics and Related Research429:170-177, December 2004. Terminal osseous dysplasia with pigmentary An effort then was made to restore the healthy anterior femoral offset with respect to its depth and its slope, especially in the region of impingement. Bone problems. One of the most common knee injuries is ligament tear, which may initially manifest as an osseous injury in radiographs. Osseous abnormalities associated with collateral desmopathy of the distal interphalangeal joint. Tonnis Angle and Acetabular Retroversion Measurements in Asymptomatic Hips Are Predictive of Future Hip Pain: A Retrospective, Prognostic Clinical Study. These records include radiology reports. My doctor commented the osseous structures are remarkable for mild degenerative changes of the spine. By using our website, you consent to our use of cookies. Byrd and Jones3 found also that the majority (82%) of the labral tears in their patients occurred in the absence of an injury and have postulated that many labral tears may occur in the presence of an abnormal hip joint. 2004 Mar;36(2):160-6. doi: 10.2746/0425164044868693. What does chronic osseous in my lungs mean? Usually these problems are present at birth and . government site. To learn more, please visit our. Because our patients had no symptoms during adolescence, we propose that the deformity is secondary to either a subclinical slip, or more likely, caused by a developmental deformity that occurs during growth. The radiologists get fussed at if their reading comes back as the single word 'normal'. The site is secure. We often dont know why a lesion forms in a specific area of bone in a specific person, but over time physicians have developed an understanding how the lesions behave regardless of why they formed. How can gene variants affect health and development? Front Vet Sci. defects (TODPD) due to a recurrent filamin A (FLNA) mutation. Magnetic Resonance Imaging-Guided Treatment of Equine Distal Interphalangeal Joint Collateral Ligaments: 2009-2014. Learn a new word every day. Federal government websites often end in .gov or .mil. What can an Osseous abnormality be? Heyman CH: Treatment of slipping of the upper femoral epiphysis: a study of results of 42 cases. Certain rare conditions like Pagets disease or Maffuccis syndrome place a person at higher risk to develop bone cancer, but most develop spontaneously. Collateral desmitis of the distal interphalangeal joint in 18 horses (2001-2002). Similar findings have been reported in a CT analysis of 31 hips with obvious or subclinical SCFE.26 The results of our cheilectomy study confirm these hypotheses. Your message has been successfully sent to your colleague. https://medical-dictionary.thefreedictionary.com/osseous. HHS Vulnerability Disclosure, Help Our mission is to help you understand your radiology reports by explaining complex medical terms in plain English. This is more commonly said on X-ray reports but can be used for other medical imaging tests. At the time of hip arthroscopy, all labral tears were found to be located anteriorly. 18. At the time of surgery, all hips showed impingement of the femoral head and/or neck on the anterior rim of the acetabulum with hip flexion and internal rotation. Brunetti-Pierri N, Lachman R, Lee K, Leal SM, Piccolo P, Van Den Veyver IB, Although physical injury, causing fracture,. A magnetic resonance imaging (MRI) scan with intraarticular gadolinium suggested an anterior labral tear in all but two cases. Snow SW, Keret D, Scarangella S, Boewn JR: Anterior impingement of the femoral head: A late phenomenon of legg-calve-perthes disease. In most cases, it occurs as the result of trauma to the bone that disrupts blood flow to the bone - such as a hip fracture. Please enable it to take advantage of the complete set of features! What does osseous structures are grossly intact mean, WHAT DO YOU MEAN BY DEGENERATIVE OSSEOUS CHANGE. Named after Sir Robert Peel, what are British police called. Wolters Kluwer Health The .gov means its official. An isolated anterior labral tear was found in 19 of the 38 hips (50%) and 74% of these occurred in those hips with an acute onset. This can, Read More Does No News Mean Good News For A CT Scan Results?Continue, Please read the disclaimer Ultrasound is commonly used to diagnose or characterize fluid collections. Physicians may use an x-ray, MRI or CT scan to detect abnormal bone tissue. At a mean followup of 26 months (range, 12-54 months), one patient no longer had any pain; six patients had only slight, occasional pain; and two patients had mild, intermittent groin pain. There would be a higher incidence of osseous abnormality at the insertion of an injured CL than at the origin; and a relationship between the presence of osseous abnormality and duration of lameness. The radiographs showed anterior femoral neck sclerosis in 94% of the cases, osteophytes in 92%, and cysts in 81% of the cases. Bookshelf At the time of hip arthrotomy, flexion, adduction, and internal rotation of the femur always resulted in impingement of the anterior femoral head-neck region on the anterior acetabular rim, in the region where arthritic changes and/or a labral tear was present. official website and that any information you provide is encrypted 8600 Rockville Pike sharing sensitive information, make sure youre on a federal It is common and gets wo Would a chest ct with contrast show cancer in spine or back? These syndromes can cause severe conditions such as anemia , frequent infections, and uncontrolled bleeding. The diagnosis will also be given. Bethesda, MD 20894, Web Policies Bones may become denser (whiter) due to a sclerotic process (often seen in prostate cancer), or less dense (blacker) due to a lytic process (as is often the case in renal cell cancer). 6. The FLNAgene mutation that causes terminal osseous dysplasia changes a single DNA building block (nucleotide), which alters the way the blueprint for making the filamin A protein is put together. No acute osseous abnormality is more commonly used to indicate nothing is seen on an X-ray that has happened recently or is serious. See our, URL of this page: https://medlineplus.gov/genetics/condition/terminal-osseous-dysplasia/. doi: 10.3928/01477447-20110826-04. 8600 Rockville Pike In addition, affected infants commonly develop noncancerous (benign) tumors called fibromas on their fingers or toes. To help ensure current and accurate information, we do not permit copying but encourage linking to this site.
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