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Leong JY, Prebay ZJ, Ebbott D, Li M, Chung PH. Evaluating the management trends for priapism and assessing the risk of priapism after in-office intracavernosal injections: a cross-sectional analysis. Int J Impot Res 2024:10.1038/s41443-024-00861-2. [PMID: 38448610 DOI: 10.1038/s41443-024-00861-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 02/13/2024] [Accepted: 02/21/2024] [Indexed: 03/08/2024]
Abstract
We describe the management trends of patients suffering from any priapism and evaluate the risks of developing priapism after intracavernosal injections (ICI) performed in office. We queried TriNetX for two separate male adult cohorts - those presenting with any priapism based on International Classification of Disease code, N48.3 (priapism) and those who underwent ICI in office based on Current Procedural Terminology code, 54235 (injection of corpora cavernosa with pharmacologic agent[s]). We evaluated treatment options for these patients after any priapism and described demographic risks for developing priapism after ICI performed in office. There were 17,545 priapism encounters and 26,104 usages of ICI in the office. Most common treatment for any priapism was corporal irrigation/injection of medications (11.3%). Patients presenting with priapism after ICI were younger (age > 65 years, OR 0.44 [95% CI 0.38-0.51], p < 0.01) and had a higher prevalence of mood disorders (20% vs 14%), behavioral disorders (7% vs 2%) and sickle cell disease (6% vs <1%). They were less likely to have diabetes (14% vs 22%), hypertension (33% vs 40%), prostate cancer (13% vs 25%) or have taken sildenafil or tadalafil (29-30% vs 35-38%). For patients administering ICI, proper screening and counseling of priapism is important to reduce complications.
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Affiliation(s)
- Joon Yau Leong
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Zachary J Prebay
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - David Ebbott
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael Li
- Center for Digital Health and Data Science, Thomas Jefferson University, Philadelphia, PA, USA
| | - Paul H Chung
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
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2
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Ancha N, Eldin M, Woodle T, Gereta S, Hariprasad K, Butler I, Osterberg Iii EC. Current devices, outcomes, and pain management considerations in penile implant surgery: an updated review of the literature. Asian J Androl 2024:00129336-990000000-00167. [PMID: 38376174 DOI: 10.4103/aja202386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/11/2023] [Indexed: 02/21/2024] Open
Abstract
ABSTRACT Penile prosthesis surgery is a definitive treatment for erectile dysfunction (ED). The two categories of penile prosthesis are endorsed by professional guidelines, inflatable penile prosthesis (IPP) and malleable penile prosthesis (MPP). Each modality of penile prosthesis offers distinct advantages and incorporates specific design features, allowing for personalized device selection that aligns with individual needs and preferences. While the overall complication rate of penile implant surgery remains low, surgeons should maintain a high index of suspicion for complications in the perioperative time period. Multimodal analgesic regimens including nerve blocks and narcotic-free pathways should be administered to manage perioperative pain. Finally, the high patient satisfaction after penile prosthesis surgery underscores the success of this ED treatment option.
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Affiliation(s)
- Nirupama Ancha
- Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, TX 78712, USA
| | - Maya Eldin
- Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, TX 78712, USA
| | - Tarah Woodle
- Department of Urology, Brooke Army Medical Center, San Antonio, TX 78234, USA
| | - Sofia Gereta
- Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, TX 78712, USA
| | - Krishna Hariprasad
- Department of Molecular Biosciences, The University of Texas at Austin, Austin, TX 78712, USA
| | - Imani Butler
- Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, TX 78712, USA
| | - E Charles Osterberg Iii
- Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, TX 78712, USA
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Moussa M, Abou Chakra M, Papatsoris A, Dellis A, Peyromaure M, Barry Delongchamps N, Bailly H, Roux S, Yassine AA, Duquesne I. An update on the management algorithms of priapism during the last decade. Arch Ital Urol Androl 2022; 94:237-247. [PMID: 35775354 DOI: 10.4081/aiua.2022.2.237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/23/2022] [Indexed: 01/29/2023] Open
Abstract
Priapism is a persistent penile erection lasting longer than 4 hours, that needs emergency management. This disorder can induce irreversible erectile dysfunction. There are three subtypes of priapism: ischemic, non-ischemic, and stuttering priapism. If the patient has ischemic priapism (IP) of less than 24-hours (h) duration, the initial management should be a corporal blood aspiration followed by instillation of phenylephrine into the corpus cavernosum. If sympathomimetic fails or the patient has IP from 24 to 48h, surgical shunts should be performed. It is recommended that distal shunts should be attempted first. If distal shunt failed, proximal, venous shunt, or T-shunt with tunneling could be performed. If the patient had IP for 48 to 72h, proximal and venous shunt or T-shunt with tunneling is indicated, if those therapies failed, a penile prosthesis should be inserted. Non-ischemic priapism (NIP) is not a medical emergency and many patients will recover spontaneously. If the NIP does not resolve spontaneously within six months or the patient requests therapy, selective arterial embolization is indicated. The goal of the management of a patient with stuttering priapism (SP) is the prevention of future episodes. Phosphodiesterase type 5 (PDE5) inhibitor therapy is considered an effective tool to prevent stuttering episodes but it is not validated yet. The management of priapism should follow the guidelines as the future erectile function is dependent on its quick resolution. This review briefly discusses the types, pathophysiology, and diagnosis of priapism. It will discuss an updated approach to treat each type of priapism.
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Affiliation(s)
- Mohamad Moussa
- Department of Urology, Al Zahraa Hospital, University Medical Center, Lebanese University, Beirut.
| | - Mohamad Abou Chakra
- Department of Urology, Al Zahraa Hospital, University Medical Center, Lebanese University, Beirut.
| | - Athanasios Papatsoris
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens.
| | - Athanasios Dellis
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens; Department of Surgery, School of Medicine, Aretaieion Hospital, National and Kapodistrian University of Athens .
| | - Michael Peyromaure
- Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris.
| | - Nicolas Barry Delongchamps
- Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris.
| | - Hugo Bailly
- Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris.
| | - Sabine Roux
- Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris.
| | - Ahmad Abou Yassine
- Internal Medicine, Staten Island University Hospital, Staten Island, NY.
| | - Igor Duquesne
- Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris.
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Ha AS, Wallace BK, Miles C, Raup V, Punjani N, Badalato GM, Alukal JP. Exploring the Use of Exchange Transfusion in the Surgical Management of Priapism in Sickle Cell Disease: A Population-Based Analysis. J Sex Med 2021; 18:1788-1796. [PMID: 37057494 DOI: 10.1016/j.jsxm.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/08/2021] [Accepted: 07/17/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Priapism is a urologic emergency that may require surgical intervention in cases refractory to supportive care. Exchange transfusion (ET) has been previously used to manage sickle cell disease (SCD), including in priapism; however, its utilization in the context of surgical intervention has not been well-established. AIM To explore the utilization of ET, as well as other patient and hospital-level factors, associated with surgical intervention for SCD-induced priapism METHODS: Using the National Inpatient Sample (2010-2015), males diagnosed with SCD and priapism were stratified by need for surgical intervention. Survey-weighted regression models were used to analyze the association of ET to surgical intervention. Furthermore, negative binomial regression and generalized linear models with logarithmic transformation were used to compare ET vs surgery to length of hospital stay (LOS) and total hospital charges, respectively. MAIN OUTCOME MEASURES Predictors of surgical intervention among patients with SCD-related priapism RESULTS: A weighted total of 8,087 hospitalizations were identified, with 1,782 (22%) receiving surgical intervention for priapism, 484 undergoing ET (6.0%), and 149 (1.8%) receiving combined therapy of both ET and surgery. On multivariable regression, pre-existing Elixhauser comorbidities (e.g. ≥2 Elixhauser: OR: 2.20; P < 0.001), other forms of insurance (OR: 2.12; P < 0.001), and ET (OR: 1.99; P = 0.009) had increased odds of undergoing surgical intervention. In contrast, Black race (OR: 0.45; P < 0.001) and other co-existing SCD complications (e.g. infectious complications OR: 0.52; P < 0.001) reduced such odds. Compared to supportive care alone, patients undergoing ET (adjusted IRR: 1.42; 95% CI: 1.10-1.83; P = 0.007) or combined therapy (adjusted IRR: 1.42; 95% CI: 111-1.82; P < 0.001) had a longer LOS vs. surgery alone (adjusted IRR: 0.85; 95% CI: 0.74-0.97; P = 0.017). Patients receiving ET (adjusted Ratio: 2.39; 95% CI: 1.52-3.76; P < 0.001) or combined therapy (adjusted Ratio: 4.42; 95% CI: 1.67-11.71; P = 0.003) had higher ratio of mean hospital charges compared with surgery alone (adjusted Ratio: 1.09; 95% CI: 0.69-1.72; P = 0.710). CONCLUSIONS Numerous factors were associated with the need for surgical intervention, including the use of ET. Those receiving ET, as well as those with combined therapy, had a longer LOS and increased total hospital charges. Ha AS, Wallace BK, Miles C, et al. Exploring the Use of Exchange Transfusion in the Surgical Management of Priapism in Sickle Cell Disease: A Population-Based Analysis. J Sex Med 2021;18:1788-1796.
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Affiliation(s)
- Albert S Ha
- Department of Urology,Columbia University Irving Medical Center, New York, NY, USA
| | - Brendan K Wallace
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Caleb Miles
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Valary Raup
- Department of Urology,Columbia University Irving Medical Center, New York, NY, USA
| | - Nahid Punjani
- Department of Epidemiology,Columbia University Mailman School of Public Health, New York, NY, USA
| | - Gina M Badalato
- Department of Urology,Columbia University Irving Medical Center, New York, NY, USA
| | - Joseph P Alukal
- Department of Urology,Columbia University Irving Medical Center, New York, NY, USA.
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Kölükçü E, Parlaktaş BS, Kölükçü V, Firat F, Deresoy FA, Katar M, Kuyucu YE, Unsal V. Protective effects of dexmedetomidine on ischaemia-reperfusion injury in an experimental rat model of priapism. Andrologia 2021; 53:e13985. [PMID: 33474739 DOI: 10.1111/and.13985] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 12/19/2022] Open
Abstract
The study aimed to investigate the effects of dexmedetomidine against ischaemia-reperfusion injury occurring after priapism in a model of induced-priapism in rats. A total of 18 male rats were randomised into three groups. Group 1 was the control group. A priapism model was performed rats in Group 2 and then ischaemia-reperfusion injury was evaluated. Group 3 had similar procedures to the rats in Group 2. Rats in Group 3 additionally had 100 μg/kg dexmedetomidine administered intraperitoneally immediately after reperfusion. Blood and tissue samples were analysed. Biochemical analysis of blood samples revealed a decrease in the levels of the pro-inflammatory cytokines including interleukin-1 beta (IL-1 Beta), interleukin-6 (IL-6), and tumour necrosis factor-alpha (TNF-alpha) in Group 3 compared to Group 2 (p:.04, p:.009 and p:.009, respectively). Similarly, the highest malondialdehyde (MDA) level was in Group 2 (p:.002). The levels of antioxidant enzymes superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities were significantly higher in Group 3 than that of Group 2 (p:.037 and p:.045, respectively). Direct microscopic examinations revealed positive changes in desquamation, oedema, inflammation and vasocongestion scores in Group 3 compared to Group 2 (p:.007, p:.008, p:.007 and p:.006, respectively). Dexmedetomidine has a protective effect against ischaemia-reperfusion injury in penile tissue.
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Affiliation(s)
- Engin Kölükçü
- Department of Urology, Gaziosmanpasa University, Tokat, Turkey
| | | | - Vildan Kölükçü
- Department of Anesthesia and Reanimation, Tokat State Hospital, Tokat, Turkey
| | - Fatih Firat
- Department of Urology, Tokat State Hospital, Tokat, Turkey
| | - Faik A Deresoy
- Department of Pathology, Gaziosmanpasa University, Tokat, Turkey
| | - Muzaffer Katar
- Department of Biochemistry, Gaziosmanpasa University, Tokat, Turkey
| | - Yunus Emre Kuyucu
- Department of Biostatistics, Gaziosmanpasa University, Tokat, Turkey
| | - Velid Unsal
- Faculty of Health Sciences and Central Research Laboratory, Mardin Artuklu University, Mardin, Turkey
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Baumgarten AS, VanDyke ME, Yi YA, Keith CG, Fuchs JS, Ortiz NM, Cordon BH, Pagliara TJ, Ward EE, Jaderlund JW, Teeple CS, Christine BS, Yafi FA, Hudak SJ, Morey AF. Favourable multi‐institutional experience with penoscrotal decompression for prolonged ischaemic priapism. BJU Int 2020; 126:441-446. [DOI: 10.1111/bju.15127] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Adam S. Baumgarten
- Department of Urology University of Texas Southwestern Medical Center Dallas TXUSA
| | - Maia E. VanDyke
- Department of Urology University of Texas Southwestern Medical Center Dallas TXUSA
| | - Yooni A. Yi
- Department of Urology University of Texas Southwestern Medical Center Dallas TXUSA
| | - Christopher G. Keith
- Department of Urology University of Texas Southwestern Medical Center Dallas TXUSA
| | - Joceline S. Fuchs
- Department of Urology University of Texas Southwestern Medical Center Dallas TXUSA
| | - Nicolas M. Ortiz
- Department of Urology University of Texas Southwestern Medical Center Dallas TXUSA
| | - Billy H. Cordon
- Division of Urology Mount Sinai Medical Center Miami Beach FLUSA
| | | | - Ellen E. Ward
- Department of Urology University of Texas Southwestern Medical Center Dallas TXUSA
| | | | | | | | - Faysal A. Yafi
- Department of Urology University of California Irvine Orange CA USA
| | - Steven J. Hudak
- Department of Urology University of Texas Southwestern Medical Center Dallas TXUSA
| | - Allen F. Morey
- Department of Urology University of Texas Southwestern Medical Center Dallas TXUSA
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Mishra K, Loeb A, Bukavina L, Baumgarten A, Beilan J, Mendez M, DiGiorgio L, Fu L, Carrion R. Management of Priapism: A Contemporary Review. Sex Med Rev 2020; 8:131-139. [DOI: 10.1016/j.sxmr.2019.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 12/27/2018] [Accepted: 01/18/2019] [Indexed: 10/27/2022]
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Carnicelli D, Bondil P, Habold D. Priapisme veineux aigu aux urgences : procédure fondée sur une revue systématique de la littérature. ANNALES FRANCAISES DE MEDECINE D URGENCE 2019. [DOI: 10.3166/afmu-2019-0157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Le priapisme veineux aigu (PVA) est urgent en raison de séquelles érectiles éventuelles. Sa rareté et l’absence de procédure expliquent des traitements encore inégaux, peu normés.
Objectif : Optimiser la prise en charge initiale d’un PVA grâce à une procédure décisionnelle, adaptée aux urgentistes.
Matériel et méthode : Une revue systématique de la littérature recense les algorithmes schématisés ainsi que des articles de revue et mises au point récents. Les critères diagnostiques et thérapeutiques ont été analysés puis comparés pour vérifier s’ils répondaient aux besoins. La validation de cette procédure par des experts a été recherchée. Résultats : L’originalité de notre procédure réside dans sa cible (urgentistes), sa hiérarchisation, « Que faire ? Comment faire ? Quand faire ? Qui fait ? », de façon graduée et séquentielle via une chronologie détaillée, et une priorité donnée à la gazométrie caverneuse, fil conducteur de la prise en charge, facilement disponible. À cela s’ajoutent des tableaux, des check-lists (contexte étiologique et souffrance ischémique), des schémas descriptifs des traitements médicaux indiqués en première ligne (technique, matériel de ponction décompressive et d’injection intracaverneuse d’alpha-stimulant), critères de recours à l’urologue, suivi et hospitalisation. Cette procédure a été validée par le conseil scientifique du réseau nord-alpin des Urgences, le comité d’andrologie et médecine sexuelle de l’Association française d’urologie.
Conclusion : Facile à utiliser, cette procédure inédite répond à un réel besoin. Son appropriation et sa diffusion s’inscrivent dans une démarche qualité adaptée au parcours de soins du PVA en France afin de prévenir les séquelles érectiles de cette urgence affectant majoritairement des sujets jeunes.
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Rezaee ME, Ward CE, Brandes ER, Munarriz RM, Gross MS. A Review of Economic Evaluations of Erectile Dysfunction Therapies. Sex Med Rev 2019; 8:497-503. [PMID: 31326359 DOI: 10.1016/j.sxmr.2019.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/03/2019] [Accepted: 06/11/2019] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Erectile dysfunction (ED) is a common and costly urologic condition with increasing prevalence as men age. Cost-effectiveness of ED therapies and whether cost-effectiveness varies for different populations of men remains underexplored. AIM To review and summarize available published data on the economic evaluation of ED therapies and to identify gaps in the literature that still need to be addressed. METHODS All relevant peer-reviewed publications and conference abstracts were reviewed and incorporated. RESULTS There are a number of medical and surgical treatment options available for ED. The economic evaluation of phosphodiesterase-5 inhibitors, particularly sildenafil, has been well described. However, minimal research has been conducted to assess the cost-effectiveness of intracavernosal injections, intraurethral suppositories, penile prosthesis surgery, vacuum erection devices, and other emerging therapies in men with different causes of ED. CONCLUSION Available economic evaluations of ED therapies are dated, do not reflect present-day physician, pharmaceutical, and device costs, fail to account for patient comorbidities, and may not be generalizable to today's ED patients. Substantial research is needed to evaluate the cost-effectiveness of ED treatments across different patient populations, countries, and reimbursement systems. Rezaee ME, Ward CE, Brandes ER, et al. A Review of Economic Evaluations of Erectile Dysfunction Therapies. Sex Med Rev 2019;8:497-503.
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Affiliation(s)
- Michael E Rezaee
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Charlotte E Ward
- Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Center for Health Statistics, University of Chicago, Chicago, IL, USA
| | - Eileen R Brandes
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Ricardo M Munarriz
- Department of Urology, Boston University Medical Center, Boston, MA, USA
| | - Martin S Gross
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
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Tatem A, Kovac JR. Challenges surrounding penile prostheses insertion following acute priapism. Transl Androl Urol 2017; 6:S804-S805. [PMID: 29239397 PMCID: PMC5715187 DOI: 10.21037/tau.2017.11.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Alex Tatem
- Department of Urology, Indiana University, Indianapolis, Indiana, USA
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