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A-1236 Tissue engeneering in Hand Surgery
Simon Farnebo, Linköping, Sweden
Friday, June 15, 2018 · 5:20 p.m. · 15m 18s
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so we're gonna talk about ish engineering and how it can be used in hand surgery and uh
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i'm gonna give a couple examples of how you can use 'em tissue engineering in in
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building tandem bone constructs and to get an idea of how you can use this
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a cushion to various really the use of combination of cells engineering
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using biochemical and physical factors to improve
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or replace biological tissues and it was first described by and
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longer my canteen assigns paper in ninety three and um
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three major steps a tissue engineering can be identified and
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it's really to harvest cells fabricated three dimensional scaffold
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with the cells and then replace it in the body to recreate a function or for
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or both
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if you got a problem but and you do public researches searches
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for a tissue engineering you'll find most hits on free folder
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um but there are other tissues that are um made
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through this technique searches ligaments arteries and thence
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and i'm gonna talk specifically about tendon and tandem boned functions
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see if you want to build this this construct
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you wanna use a scaffold and the sky falls could be either synthetic or of biological working
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the main benefit of using s. synthetic scaffold is that you're free from deceased transmit
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you can build as many as you like you can mass produce them
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on the other hand if you use biological tissue you will it to be
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more like the tissues that you want to replace you could even use
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to shoot that comes from the type that issue wonder places such as tend and and
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you would then use a diesel rice tendon material as an aloe graft astor scaffold
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and this would give use appears allocation properties it past the same structural
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eh integrity sick will look like it and then and i
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sit holes this same a extra so the matrix composition
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this else that you put on to this construct but actually recognise it asset tendon
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and the excess of the matrix will also have lots
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an actual chemical and biological cues that will attract
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possibly tissue from around it to trance different shape into cells that would be tendon like
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but to build a construct a nice else also you can
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use mature target cells that would be independent case
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a. t. news site or possibly a fire blast but you could also use a more clear importance l.
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that could transform into the cell you wanna have and if you use a scaffold
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that is a diesel rice tissue and at that would replace like would like
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people probably trans differentiate into the cell uh that you wanna use
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and we have to uh um major and i competitors here it does
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that korea precise and the mets cameras themselves and aces are
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perhaps the most clinically relevant because of their accessibility you can just like a section the patient
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had its expendable you can throw it away if you don't need it uh it's
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easy to spin down the period of the sites and seated onto grafts
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and we know that happens derive stem cells have a lot for the for
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the ability and they can turn into pretty much any cell type
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and they will be huh and having a phenotype
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that that will start producing proteins that may
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help the lighting of the tissue and promote intrinsic healing of the tissue you wanna recreate
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when you have your celsius scaffold you wanna up to my seat so use
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dark by for example like a section that sells tandem dance yeah
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the period of sites and put them on your telegraphed the sunrise that
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and then you can work on that issue and the cell culture
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uh to make it even more viable yeah you could use for example by reactor that will
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i tend to simulate physiological things within the body but you do it on the lab bench table
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you could use just growth factors implementation uh to increase the you live cell so it he should know cells
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a cell uh in version to use scaffold
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and you can if you use multiple cell types or multiple
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growth factors you even get synergistic effect a. f. x. and you will
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have even better cell adhesion and more cells on your constructs
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we found that in ten then tissue engineering if we wanna give cells star construct
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it's good to have a really viable carrier and we started
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using high rituals made out of the sunrise tendon
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we found that the cells love at the environment
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that has all the tendons specific proteins
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and we have better cell survival we have stronger healing we'll get back to that
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you can do various service augmentation ideas scuffles to get increasing cell adhesion
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so now i'm gonna switch over to um one of the products that we've
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been working on and it's tissue engineering on complex tendon bone ligament peers
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with this patient be eligible for patient entered construct this is they
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and uh am triceps ow balsam from the allegro non um
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it's a pretty nasty injury but the hard part he is not
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to reconstruct the coverage of this injury it's to get
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that very elastic tendon t. hugh back into this super stiff
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bone and this is the challenge because you want that
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he should healing to be really strong to construct early active motion training
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and this really goes for a lot of the most difficult i'm sold hand problems being
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inadequate healing of the tendon or ligament healing into bo
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elastic tissue hardcore and this is and
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we estimate that the approximately one million patient or your suffer from soft
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tissue injuries that could possibly be reconstructed with petitions huge solution
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so our research question would be is tradition
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dinners solution to this common clinical problematic
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and the problem is really rupture the tendon bone insertion
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and if you look at it is to get that
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less stiff ten and to heal into the more stiff opponent current strategies that we
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use is to use hardware sweet trackers with drill holes unsuited to ten then
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back into the bone or what we get we get a
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fibrous tissue formation rather than a five record which that
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you're having it and this this and this is the problem because it's not as strong as to regional tissue
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so we hypothesise that we could use it to fish engineers solution to this problem
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so what if we used a tendon bone craft
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that would enable tendon ten and yelling and bone to bone healing it's faster and it's stronger
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sore ultimate question is really tea bag rafter can a
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bonus version craft be stronger than a conventional beeper
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and what if we use many tissue engineering methods can we make it even stronger
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what if we use a a cease we use documentation of this hybrid joe can we make it even stronger
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so we set up a couple of research questions and you could use
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these questions for virtually any tissue engineering project that you huh
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and approach here is to get a good scaffold and so the first question is can competition crafts
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p. t. cells right that would preserve structures string so we wanna crap material
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can we use them in the bow asked replacement of an injured tenable insertion
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and will they be stronger than if we used a craft that was not the summarised
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will it be stronger than a credential collect repair
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what if we add cells would be even stronger can we make the cells survive in the evil
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what if we use multiple tissue engineering principles will that even improve
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our results so i'll try to go over these things i
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won't bore you with a lot of results just but you'll get an idea of how to build this type of project
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so this is our model you have the rack for your you have the cocaine use bone and
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achilles tendon insertion into the bone and this is where you had to and this is
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this is the important part that we want to replace and then the inset you see
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and h. onion niche histology picture where you have that's soft tissue
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going to depart record which and this is where the
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magic happens this is for all the forces from the tendon
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transforms that translates into the to the stiff problem
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so in our first question we wanted to the sunrise this and you use detergents
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we started using all justification to get away those cells within the five record some
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because you want this to be costing very low immune response into the
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recipient of the craft then we placed into other rat feet silly to
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craft the cell right stand and put them in other animals
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what we found was that the t. cell rice craft work
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considerably stronger then cracks stab or not decent rest
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so the sunrise station is really important and when we look at histology we find that
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the immune response is much smaller if u. t. summarise the graph to this seems
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to be a good way to go so now we have the graft
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so we take the sunrise pratt and we compare it to pull out sutures so we drill a
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hole through the cocaine is bone and we suture back tendon and we compare these two
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we find that during the first two weeks
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it's in almost forty percent increase
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in strength if you use the graph compared to the conventional repair
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this goes down a little bit it's about twenty five percent increase in strength after four weeks and we know that
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this is a very important time because this is when we want to start or early active motion training
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so if we can increase strength by using this type of graph that would be a a big step forward
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and when we look at compensation of the tissue we
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can look at college in content we find that
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with the crafts we have a lot more college in one which is the stronghold in five years
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press in that pull out repairs it heals would fibrous tissue a lot of college and
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three which is weaker and this is why they're more prone to rupture or
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what if we received the grafts would sell school they survive in the van
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how how can we tracked that someone way to do is to
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and do a a landed by rich inspection of this l. c. take a sees
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and you put on a gene this is this different gene that
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will grow in a pile of molasses and machines so you
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add cells to the graph to distract actually has two brackets on the right but it's a
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craft without cells and all the other uh for it's a a craft would cells and this
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is eight days down the line you can see it light up and that's alive cells
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and we know that the cells they live for these two weeks and we
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have reports of a live cells for a lot longer period but
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the duration of this cell survival uh may not be so important
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it's most important beginning because it helps promoting additional healing
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and it will help guide the tissue regeneration make it stronger
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so the cells to sort by what if we add the
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cells through a gel so we started using hydrogen else
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and we got this idea from from a a cardiac tissue
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and platter to she had taken the sunrise tissue
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and minced it into powder and then reconstituted it in zero or so we
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started trying out if if we could make it can then hi joe
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so you you you you get this yet tandem powder
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add serum you get this java structured that actually problem arises as it goes in the
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what when you inject it and you get thirty seven degrees goes into joe
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and the cells love that this sells just wanna stay there and they will start transforming
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into tina sites within the journal and we actually shown in a couple of models
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of achilles tendon ruptures that it heals the tendon faster
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so we moved on with the sunrise craft we took the a. s. c.s
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put it in g. l. c. d. the graphics and put them back in animals and then we compare that to
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just crafts and we found that we had a substantially
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better and stronger healing after and this is eight weeks down the line and we
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have tons of data on this but it's it really it really works
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so our experience in tandem bone insertion grabs an animal model is that
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concert tandem progress can be the sunrise with chris or structure and string
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and this may be the major findings sales and hydra
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joe's but the summarisation of grass but you can
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have a off shelf may actually be the thing that you will be using in the future
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they can be used in in the evil models and we show that they're stronger because there's just there's a
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uh and stronger in the bow reaction force to craft widths else
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and we know that if we compare it to what features it will be a lot
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stronger if we add more tissue engineering cells
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hydrogen or it will get even stronger
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