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Gu L, Huang R, Ni N, Gu P, Fan X. Advances and Prospects in Materials for Craniofacial Bone Reconstruction. ACS Biomater Sci Eng 2023; 9:4462-4496. [PMID: 37470754 DOI: 10.1021/acsbiomaterials.3c00399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
The craniofacial region is composed of 23 bones, which provide crucial function in keeping the normal position of brain and eyeballs, aesthetics of the craniofacial complex, facial movements, and visual function. Given the complex geometry and architecture, craniofacial bone defects not only affect the normal craniofacial structure but also may result in severe craniofacial dysfunction. Therefore, the exploration of rapid, precise, and effective reconstruction of craniofacial bone defects is urgent. Recently, developments in advanced bone tissue engineering bring new hope for the ideal reconstruction of the craniofacial bone defects. This report, presenting a first-time comprehensive review of recent advances of biomaterials in craniofacial bone tissue engineering, overviews the modification of traditional biomaterials and development of advanced biomaterials applying to craniofacial reconstruction. Challenges and perspectives of biomaterial development in craniofacial fields are discussed in the end.
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Affiliation(s)
- Li Gu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Rui Huang
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Ni Ni
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Ping Gu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Xianqun Fan
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
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Biological Effects of Bioresorbable Materials in Alveolar Ridge Augmentation: Comparison of Early and Slow Resorbing Osteosynthesis Materials. MATERIALS 2021; 14:ma14123286. [PMID: 34198634 PMCID: PMC8232082 DOI: 10.3390/ma14123286] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/09/2021] [Accepted: 06/11/2021] [Indexed: 12/14/2022]
Abstract
The purpose of this study was to investigate the bone healing properties and histological environment of a u-HA/PLLA/PGA (u-HA—uncalcined and unsintered hydroxyapatite, PLLA—Poly L-lactic acid, PGA—polyglycolic acid) composite device in humans, and to understand the histological dynamics of using this device for maxillofacial treatments. Twenty-one subjects underwent pre-implant maxillary alveolar ridge augmentation with mandibular cortical bone blocks using u-HA/PLLA or u-HA/PLLA/PGA screws for fixation. Six months later, specimens of these screws and their adjacent tissue were retrieved. A histological and immunohistochemical evaluation of these samples was performed using collagen 1a, ALP (alkaline phosphatase), and osteocalcin. We observed that alveolar bone augmentation was successful for all of the subjects. Upon histological evaluation, the u-HA/PLLA screws had merged with the bone components, and the bone was directly connected to the biomaterial. In contrast, direct bone connection was not observed for the u-HA/PLLA/PGA screw. Immunohistological findings showed that in the u-HA/PLLA group, collagen 1a was positive for fibers that penetrated vertically into the bone. Alkaline phosphatase was positive only in the u-HA/PLLA stroma, and the stroma was negative for osteocalcin. In this study, u-HA/PLLA showed a greater bioactive bone conductivity than u-HA/PLLA/PGA and a higher biocompatibility for direct bone attachment. Furthermore, u-HA/PLLA was shown to have the potential for bone formation in the stroma.
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Feasibility of Application of the Newly Developed Nano-Biomaterial, β-TCP/PDLLA, in Maxillofacial Reconstructive Surgery: A Pilot Rat Study. NANOMATERIALS 2021; 11:nano11020303. [PMID: 33503931 PMCID: PMC7912080 DOI: 10.3390/nano11020303] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/17/2021] [Accepted: 01/22/2021] [Indexed: 12/30/2022]
Abstract
This study was performed to examine the applicability of the newly developed nano-biocomposite, β-tricalcium phosphate (β-TCP)/u-HA/poly-d/l-lactide (PDLLA), to bone defects in the oral and maxillofacial area. This novel nano-biocomposite showed several advantages, including biocompatibility, biodegradability, and osteoconductivity. In addition, its optimal plasticity also allowed its utilization in irregular critical bone defect reconstructive surgery. Here, three different nano-biomaterials, i.e., β-TCP/PDLLA, β-TCP, and PDLLA, were implanted into critical bone defects in the right lateral mandible of 10-week-old Sprague–Dawley (SD) rats as bone graft substitutes. Micro-computed tomography (Micro-CT) and immunohistochemical staining for the osteogenesis biomarkers, Runx2, osteocalcin, and the leptin receptor, were performed to investigate and compare bone regeneration between the groups. Although the micro-CT results showed the highest bone mineral density (BMD) and bone volume to total volume (BV/TV) with β-TCP, immunohistochemical analysis indicated better osteogenesis-promoting ability of β-TCP/PDLLA, especially at an early stage of the bone healing process. These results confirmed that the novel nano-biocomposite, β-TCP/PDLLA, which has excellent biocompatibility, bioresorbability and bioactive/osteoconductivity, has the potential to become a next-generation biomaterial for use as a bone graft substitute in maxillofacial reconstructive surgery.
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Biomechanical Loading Comparison between Titanium and Bioactive Resorbable Screw Systems for Fixation of Intracapsular Condylar Head Fractures. MATERIALS 2020; 13:ma13143153. [PMID: 32679803 PMCID: PMC7411721 DOI: 10.3390/ma13143153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 12/15/2022]
Abstract
Osteosynthesis resorbable materials made of uncalcined and unsintered hydroxyapatite (u-HA) particles, poly-L-lactide (PLLA), are bioresorbable, and these materials have feasible bioactive/osteoconductive capacities. However, their strength and stability for fixation in mandibular condylar head fractures remain unclear. This in vitro study aimed to assess the biomechanical strength of u-HA/PLLA screws after the internal fixation of condylar head fractures. To evaluate their biomechanical behavior, 32 hemimandible replicas were divided into eight groups, each consisting of single-screw and double-screw fixations with titanium or u-HA/PLLA screws. A linear load was applied as vertical and horizontal load to each group to simulate the muscular forces in condylar head fractures. Samples were examined for 0.5, 1, 2, and 3-mm displacement loads. Two screws were needed for stable fixation of the mandibular condylar head fracture during biomechanical evaluation. After screw fixation for condylar head fractures, the titanium screws model was slightly more resistant to vertical and horizontal movement with a load for a small displacement than the u-HA/PLLA screws model. There was no statistically significant difference with load for large displacements. The u-HA/PLLA screw has a low mechanical resistance under small displacement loading compared with titanium within the limits of the mandibular head fracture model study.
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Bai Y, Sha J, Kanno T, Miyamoto K, Hideshima K, Matsuzaki Y. Comparison of the Bone Regenerative Capacity of Three-Dimensional Uncalcined and Unsintered Hydroxyapatite/Poly-d/l-Lactide and Beta-Tricalcium Phosphate Used as Bone Graft Substitutes. J INVEST SURG 2019; 34:243-256. [PMID: 31122080 DOI: 10.1080/08941939.2019.1616859] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This study compared the in vivo applicability of three-dimensional uncalcined and unsintered hydroxyapatite/poly-d/l-lactide (3D-HA/PDLLA) with beta-tricalcium phosphate (β-TCP). 3D-HA/PDLLA is a newly developed bioactive, osteoconductive, bioresorbable bone regenerative composite. We performed critical-defect surgery on the mandible body of rats; the defects were filled with one of two bone graft substitutes. After a 4-week follow-up period, the mandibular specimens were examined using hematoxylin and eosin (H&E) staining, immunohistochemistry (IHC) staining and micro-computed tomography (micro-CT). The H&E staining showed an increase in newly formed bone in both groups from week 1 to 4. The difference in the Runx2 IHC optical density (OD) scores of 3D-HA/PDLLA and β-TCP was not statistically significant (p > 0.05); however, the osteocalcin IHC OD scores of the groups differed significantly (p < 0.05). Micro-CT demonstrated a similar trabecular thickness, trabecular spacing, and bone volume per total volume in the two groups (p > 0.05), indicating that bone formation in the two groups was nearly the same from a macro-perspective of bone regeneration. These results demonstrated that a different bone regeneration pattern and earlier osteoblast differentiation occurred in 3D-HA/PDLLA compared with β-TCP. In conclusion, our study demonstrates that 3D-HA/PDLLA is feasible for clinical application as a new bioactive, osteoconductive/bioresorbable bone graft substitute for maxillofacial surgery.
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Affiliation(s)
- Yunpeng Bai
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Japan
| | - Jingjing Sha
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Japan
| | - Takahiro Kanno
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Japan
| | - Kenichi Miyamoto
- Department of Cancer Biology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Katsumi Hideshima
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Japan
| | - Yumi Matsuzaki
- Department of Cancer Biology, Shimane University Faculty of Medicine, Izumo, Japan
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Akdag O, Guray Evin S, Isik C, Tosun Z. Endoscopic-Assisted Zygomatic Arch Fracture Repair With a Preauricular Approach. Plast Surg (Oakv) 2019; 27:107-111. [PMID: 31106166 DOI: 10.1177/2292550318800327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Because of numerous negative sequelae with open techniques, endoscopic techniques are beginning to be widely used for maxillofacial fractures. Many endoscopic approaches for this area have been described according to several dissection plans and incisions. The aim of the present study was to report a new surgical incision and dissection method for zygomatic arch fracture that aims at reducing the complication rate of previously defined techniques. Material and Methods The authors operated on 8 patients with a new endoscopic-assisted surgical technique. This study focused on evaluating the complication rate and surgical comfort of these patients. Results Of the 8 patients, the plate was palpable in the zygomatic arch in one. No complications occurred due to this technique during the 1-year follow-up. Symmetrical facial contour and inconspicuous scars were obtained in all patients. Average operative time was 3 hours; hospitalization time was 1.6 days. Conclusion This study demonstrates that an endoscopic-assisted surgical approach with a preauricular mini-incision can be safely performed in isolated multifragment zygomatic arch fractures. Using individually designed plates improved our results. This technique is easy to apply, its cosmetic results are good, and its complication rate is low.
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Affiliation(s)
- Osman Akdag
- Department of Plastic Surgery, Selcuk University, Konya, Turkey
| | | | - Cemil Isik
- Department of Plastic Surgery, Selcuk University, Konya, Turkey
| | - Zekeriya Tosun
- Department of Plastic Surgery, Selcuk University, Konya, Turkey
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Kanno T, Sukegawa S, Karino M, Furuki Y. Navigation-Assisted Orbital Trauma Reconstruction Using a Bioactive Osteoconductive/Bioresorbable u-HA/PLLA System. J Maxillofac Oral Surg 2019; 18:329-338. [PMID: 31371870 DOI: 10.1007/s12663-019-01207-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Orbital fractures with orbital wall defects are common facial fractures encountered by oral-maxillofacial surgeons, because of the exposed position and thin bony walls of the midface. The primary goal of surgery is to restore the pre-injury anatomy and volume of hard tissue, and to free incarcerated or prolapsed orbital tissue from the fracture by bridging the bony defects with reconstructive implant material and restoring the maxillofacial-orbital skeleton. Numerous studies have reported orbital fracture repair with a wide variety of implant materials that offer various advantages and disadvantages. The ideal orbital implant material will allow conformation to individual patients' anatomical characteristics, remain stable over time, and are radiopaque, especially for the reconstruction of relatively large and/or complex bony walls. Based on these requirements, novel uncalcined and unsintered hydroxyapatite (u-HA) particles and poly-L-lactide (PLLA; u-HA/PLLA) composite sheets could be used as innovative, bioactive, and osteoconductive/bioresorbable implant materials for orbital reconstruction. In addition, intraoperative navigation is a powerful tool. Navigation- and computer-assisted surgeries have improved execution and predictability, allowing for greater precision, accuracy, and minimal invasiveness during orbital trauma reconstructive surgery of relatively complex and large orbital wall defects with ophthalmological malfunctions and deformities. This review presents an overview of navigation-assisted orbital trauma reconstruction using a bioactive, osteoconductive/bioresorbable u-HA/PLLA system.
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Affiliation(s)
- Takahiro Kanno
- 1Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Shimane University, 89-1 Enyacho, Izumo, Shimane Japan
| | - Shintaro Sukegawa
- 2Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu, Kagawa Japan
| | - Masaaki Karino
- 1Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Shimane University, 89-1 Enyacho, Izumo, Shimane Japan
| | - Yoshihiko Furuki
- 2Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu, Kagawa Japan
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Sukegawa S, Kawai H, Nakano K, Kanno T, Takabatake K, Nagatsuka H, Furuki Y. Feasible Advantage of Bioactive/Bioresorbable Devices Made of Forged Composites of Hydroxyapatite Particles and Poly-L-lactide in Alveolar Bone Augmentation: A Preliminary Study. Int J Med Sci 2019; 16:311-317. [PMID: 30745812 PMCID: PMC6367538 DOI: 10.7150/ijms.27986] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 10/18/2018] [Indexed: 11/23/2022] Open
Abstract
Purpose: We aimed to document the clinical usefulness of uncalcined and unsintered hydroxyapatite (u-HA) particles and poly-L-lactide (PLLA) composite materials and their advantageous properties. Methods: Between April 2016 and March 2018, five patients required anterior maxillary alveolar ridge augmentation using fixation with u-HA/PLLA screws for an onlay block bone graft harvested from the mandibular ramus at our institute. Bone biopsies were obtained from the dental implantation site following bone healing for histomorphometric and immunohistochemical (IHC) measurements. Results: Many stromal cells were positive for Osterix, RUNX2, and SOX9 but were negative for CD68. On cell counting, based on IHC staining for Osterix, RUNX2, SOX9 and CD68 from peripheral u-HA/PLLA screw or bone areas, both areas consistently showed no significant difference in terms of Osterix, RUNX2, and SOX9. Hematoxylin-eosin staining revealed direct bone connection to the biomaterials, and no inflammatory cells infiltrated the areas surrounding the bone or artificial material. Area between the bone and u-HA/PLLA screw was seamless with no boundary. Round small cells and immature fibroblasts were noted. The new bone showed the presence of bone lamellae, normal osteocytes, and osteoblasts. Conclusion: The u-HA/PLLA materials showed excellent biodegradability and bioactive osteoconductivity. In addition, this material induced no apparent inflammatory or foreign body reactions following implantation, and it directly bonded to the human bone. Therefore, this u-HA/PLLA material seems ideal and most suitable for use as a substitute for osteosynthesis.
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Affiliation(s)
- Shintaro Sukegawa
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Japan
| | - Hotaka Kawai
- Department of Oral Pathology and Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Keisuke Nakano
- Department of Oral Pathology and Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takahiro Kanno
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Japan
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Shimane, Japan
| | - Kiyofumi Takabatake
- Department of Oral Pathology and Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hitoshi Nagatsuka
- Department of Oral Pathology and Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yoshihiko Furuki
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Japan
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Bai Y, Kanno T, Tatsumi H, Miyamoto K, Sha J, Hideshima K, Matsuzaki Y. Feasibility of a Three-Dimensional Porous Uncalcined and Unsintered Hydroxyapatite/poly-d/l-lactide Composite as a Regenerative Biomaterial in Maxillofacial Surgery. MATERIALS (BASEL, SWITZERLAND) 2018; 11:E2047. [PMID: 30347816 PMCID: PMC6213607 DOI: 10.3390/ma11102047] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 10/15/2018] [Accepted: 10/17/2018] [Indexed: 12/11/2022]
Abstract
This study evaluated the feasibility of a novel three-dimensional (3D) porous composite of uncalcined and unsintered hydroxyapatite (u-HA) and poly-d/l-lactide (PDLLA) (3D-HA/PDLLA) for the bony regenerative biomaterial in maxillofacial surgery, focusing on cellular activities and osteoconductivity properties in vitro and in vivo. In the in vitro study, we assessed the proliferation and ingrowth of preosteoblastic cells (MC3T3-E1 cells) in 3D-HA/PDLLA biomaterials using 3D cell culture, and the results indicated enhanced bioactive proliferation. After osteogenic differentiation of those cells on 3D-HA/PDLLA, the osteogenesis marker genes runt-related transcription factor-2 (Runx2), and Sp7 (Osterix) were upregulated. For the in vivo study, we evaluated the utility of 3D-HA/PDLLA biomaterials compared to the conventional bone substitute of beta-tricalcium phosphate (β-TCP) in rats with critical mandibular bony defects. The implantation of 3D-HA/PDLLA biomaterials resulted in enhanced bone regeneration, by inducing high osteoconductivity as well as higher β-TCP levels. Our study thus showed that the novel composite, 3D-HA/PDLLA, is an excellent bioactive/bioresorbable biomaterial for use as a cellular scaffold, both in vitro and in vivo, and has utility in bone regenerative therapy, such as for patients with irregular maxillofacial bone defects.
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Affiliation(s)
- Yunpeng Bai
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, 89-1 Enya-Cho, Izumo, Shimane 693-8501, Japan.
| | - Takahiro Kanno
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, 89-1 Enya-Cho, Izumo, Shimane 693-8501, Japan.
| | - Hiroto Tatsumi
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, 89-1 Enya-Cho, Izumo, Shimane 693-8501, Japan.
- Division of Oral and Maxillofacial Surgery, Oki Hospital, 355 Johokumachi, Okinoshima-Cho, Oki-Gun, Shimane 685-0016, Japan.
| | - Kenichi Miyamoto
- Department of Cancer Biology, Shimane University Faculty of Medicine, 89-1 Enya-Cho, Izumo, Shimane 693-8501, Japan.
| | - Jingjing Sha
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, 89-1 Enya-Cho, Izumo, Shimane 693-8501, Japan.
| | - Katsumi Hideshima
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, 89-1 Enya-Cho, Izumo, Shimane 693-8501, Japan.
| | - Yumi Matsuzaki
- Department of Cancer Biology, Shimane University Faculty of Medicine, 89-1 Enya-Cho, Izumo, Shimane 693-8501, Japan.
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