Metabolic syndrome is an emerging diagnosing in the medical field that has effects on patient attention. Becoming familiar with it and holding it go a common portion of patient attention will. if used suitably will increase the lives of those who have become affected with or are at hazard of going diagnosed with metabolic syndrome. Metabolic syndrome is a configuration of hazards factors of metabolic beginning that are accompanied by the increased hazard of cardiovascular disease and type 2 diabetes.
There are five major factors to look for ; out of these five a individual merely needs three to be diagnosing with metabolic syndrome. They are obesity. chiefly that of the waistline. insulin opposition. high blood pressure. dyslipidemia. and systemic redness. Once a individual has three or more of these a medical professional can take the necessary stairss in order to get down intervention. Leting an improved and more efficient manner to assist patients that are at hazard of metabolic syndrome would merely better their lives.
In today’s universe of self-indulgence. people have sacrificed their wellness for fugitive pleasances. Gorging and decreased activity have contributed to the diminution in wellness of many Americans. Medical professionals are get downing to see additions in abdominal fleshiness. high blood force per unit area. and insulin opposition. This has caused some medical professionals to utilize the term metabolic syndrome to depict what they are seeing. Metabolic syndrome is a group of hazard factors for diabetes and cardiovascular disease that have metabolic beginnings.
It is of import for medical professionals to be cognizant of what metabolic syndrome is. how it affects the organic structure. how to handle it. and the legitimacy of the syndrome. As Dr. Grundy has indicated in his article written in 2001. the National Cholesterol Education Program ( NCEP ) Adult Treatment Panel III ( ATP III ) introduced the metabolic syndrome as a hazard spouse to elevated low-density lipoprotein ( LDL ) -cholesterol in cholesterin guidelines.
In one survey of merely over 3400 people. about 34 % of grownups in the survey met the standards for holding metabolic syndrome ( Ervin. 2009 ) doing this a common happening in the clinical scene. The impressive Numberss of about half are flooring truly when compared to an article by Vanderploeg where she writes. “Metabolic syndrome affects 50 million Americans. about 34 % of grownups older than age 20. ” Heart disease has stretched across America and many people have found themselves hospitalized and as the figure one slayer in the provinces some have even died from it.
Since bosom disease is the figure one cause of decease in the United States ( American Heart Association ( AHA ) . 2010 ) . cut downing those factors that contribute to bosom disease should be the accent of every clinician practicing in wellness attention. One of every three deceases in the United States can be directed attributed to some signifier of cardiovascular disease ( American Heart Association. 2010 ) . With these high per centums metabolic syndrome can longer travel unnoticed or ignored by medical professionals for the wellness of the American people. Definition
Doctors have long understood the wellness hazards of fleshiness. insulin opposition. high blood pressure. and high cholesterin ; but it has merely been late that they have begun to group these wellness hazards together. Metabolic syndrome was foremost proposed in the 1980s when the association between metabolic upsets and cardiovascular disease was more clearly defined than it had been antecedently. Other names for metabolic syndrome that have been used are syndrome X. fleshiness dyslipidemia syndrome and insulin opposition syndrome.
Metabolic syndrome is a bunch of assorted metabolic provinces that have been shown to straight associate to cardiovascular disease: abdominal fleshiness. atherogenic dyslipidemia. elevated blood force per unit area. and insulin opposition with or without glucose intolerance. The ATP III guidelines further separate these features into underlying. major and emerging hazard factors ( Grundy. Brewer. Cleeman. Smith. & A ; Lenfant. 2004 ) .
The implicit in hazard factors include fleshiness. physical inaction and an atherogenic diet. The major hazard factors for cardiovascular disease in this syndrome are smoking. high blood pressure. increased LDL cholesterin and low HDL cholesterin. aging and a household history of coronary events. The emerging hazard factors are increased triglycerides. little LDL atoms. insulin opposition. a pro inflammatory and prothrombotic province every bit good as glucose intolerance.
The combination of these factors in one individual is a forecaster of that individual holding a future cardiovascular event or the oncoming of type 2 diabetes ( Meigs. 2010 ) . With so many hazard factors puting down a set of defined parametric quantities can be dashing. It is no admiration research workers frequently argue over set guidelines. However with more and more people developing these jobs. it is necessary to get down someplace.
The World Health Organization ( WHO ) was the first to try to standardise the standard 1998. “WHO published standards to specify the metabolic syndrome in an effort to harmonise coverage of prevalence through epidemiologic surveies. The standards included a step of insulin opposition. by a hyperinsulinemic euglycemic clinch. impaired fasting glucose ( IFG ) . impaired glucose tolerance ( IGT ) . or diabetes. fleshiness ( BMI & gt ; 30kg/m ) . high blood pressure ( & gt ; 140/90 millimeter Hg ) . and microalbuminemia” ( Gallagher. LeRoith. Karnieli 2008 ) .
However. the usage of a hyperinsulinemic euglycemic clinch proved to be hard in surveies. In 2001 The National Cholesterol Education Program ( NCEP ) attempted to better and simplify the WHO definition and developed the Adult Treatment Panel III ( ATP III ) . The NCEP ATP III guidelines require that a individual have at least three of the following listed standards: waist perimeter for work forces of greater than or equal to forty inches or for adult females greater than or equal to 35 inches. triglycerides greater than or equal to 150mg/dL. an high denseness lipoprotein- cholesterin ( HDL-C ) of less than 40mg/dL for work forces and less than 50mg/dL for adult females. high blood pressure greater than or equal to 130/85mm Hg and a fasting glucose greater than or equal to 100mg/dL.
The International Diabetes Federation defines metabolic syndrome as holding the abdominal fleshiness plus any two of the other hazard factors listed by the NCEP ATP III guidelines ( Bansal. S. . Blaha. M. . Blumenthal. R. . DeFilippis. A. . Golden. S. . & A ; Rouf. R. . 2008 ) . These standards proved to be more utile in the clinical scene and easier for primary doctors to utilize.
Although the standards for each organisation differ somewhat. the metabolic procedures driving those standards are basically the same. Having a familial sensitivity. a peculiar organic structure fat distribution and a reduced degree of physical activity make the likeliness of developing cardiovascular disease or diabetes greater than if these features were non present.
In the National Health and Nutrition Examination Survey III. increased organic structure weight was straight correlated with metabolic syndrome. It was found in 60 per centum of those who were corpulent. in contrast to merely five per centum of those holding a normal weight ( Meigs. 2010 ) . Disease Process
Why should medical professionals be concerned with metabolic syndrome? Inside most surveies there is ample grounds. which if taken into history. could assist them to better function the general populace. With early designation patients can take the stairss needed to halt the patterned advance of diabetes and bosom disease and hopefully be able to forestall long-run complications. The disease processes of metabolic syndrome are profoundly intertwined and have a cascading consequence on each other.
Fleshiness is by and large the first indicant that a job is present. Vanderploeg ( 2008 ) points out in her article. ” A individual is more likely to develop many of the implicit in conditions of metabolic syndrome if he or she is fleshy and if that excess weight is around the waist. bring forthing an apple-shaped organic structure. ” This is the lone constituent of metabolic syndrome that can be visually seen by medical professionals. doing fleshiness an easy point to prosecute with the patient about.
The abdominal fleshiness is of import because it normally indicates fat around the abdominal variety meats called splanchnic fat. This is the fat that increases a patient’s waist size. These fat cells non merely let go of fatty acids into the blood but can besides move as an hormone organ. let go ofing endocrines that induce insulin opposition ( Gallagher et al. . 2008 ) . Obesity besides increases the “production of inflammatory cytokines that result in insulin opposition. dyslipidemia. high blood pressure and production of prothrombotic factors” ( Gallagher. et Al. . 2008 ) . Bing fleshy is merely the beginning of issues that seem to follow it about.
Another mark of metabolic syndrome is that of going insulin resistant. “Obesity increases lipolysis. which leads to insulin opposition. The high degrees of go arounding insulin can increase fat storage in the venters by diminishing growing endocrine and replacing thin musculus mass with fat. ( Vanderploeg. 2008 ) . Simply going insulin resistant does non do a individual a diabetic.
However. that being said. it does non assist with a person’s wellness. Bernstein ( 2003. p. 39 ) wrote. ” Obesity. peculiarly splanchnic fleshiness and insulin resistance- the inability to to the full use the glucose-transporting effects of insulin- are linked. For grounds related to genetic sciences a significant part of the population has the possible when corpulence to go sufficiently insulin-resistant that the increased demands on the pancreas burns out the beta cells that produce insulin. ” Even those who feel fleshiness does non necessitate to be in the standards for metabolic syndrome recognize that it has a strong correlativity with insulin opposition and are hence intertwined ( Buse. et Al. . 2005 ) .
The cell’s opposition to insulin consequences in less consumption of glucose in the blood. High degrees of glucose in the blood cause the blood vass walls to be more permeable to lipoids. ensuing in plaque build up. The increased degree of insulin in the blood has effects on the liver’s production of cholesterin. doing more smaller. denser low-density lipoproteins ( LDL ) to be produced. It besides causes thrombocyte activation where the thrombocytes swell and become gluey ( Vanderploeg. 2008 ) .
The LDL and activated thrombocytes besides contribute to the physique of plaque in the blood vass. Ironically one of the best interventions for insulin opposition is weight loss. Most would hold that some simple weight loss would better their quality of life. Avoiding the incubus of going a diabetic is good worth the life manner alteration.
High blood pressure is normally referred to every bit high blood force per unit area. easy doing it onto the list of issues affecting metabolic syndrome. projecting itself into the pool with fleshiness and insulin opposition. It is a common status in which the force of the blood against the arteria walls is high plenty that it may finally do wellness jobs. such as bosom disease. Blood force per unit area is determined by the sum of blood the bosom pumps and the sum of opposition to blood flow in the arterias.
The more blood the bosom pumps and the narrower the arterias. the higher the blood force per unit area. A individual can hold high blood force per unit area ( high blood pressure ) for old ages without any symptoms. Uncontrolled high blood force per unit area increases the hazard of serious wellness jobs. including bosom onslaught and shot. This once more leads into why it is so critical that medical professionals learn all they can about it and the relationship it has with metabolic syndrome.
Dr. Bernstein ( 2003. pp. 39-44 ) wrote. “Insulin opposition by its nature increases the body’s demand for insulin. which therefore causes the pancreas to work harder to bring forth elevated insulin degrees ( hyperinsulinemia ) . which can indirectly do high blood force per unit area and damage the circulatory system” . The high degrees of insulin causes the blood vass to react more readily to angiotension II. a vasodilative. and decreases the blood vass response to azotic oxide. a vasodilative ( Vanderploeg. 2008 ) . The blood vass constrict and are smaller but do non react to the body’s attempts to distend.
This causes an lift in blood force per unit area. Counter-regulatory endocrines besides go into overdrive in an effort to command the high degrees of insulin in the blood but their consequence besides do vasoconstriction and high blood pressure ( Vanderploeg. 2008 ) . It is no admiration that one time insulin opposition enters the image high blood pressure is shortly to follow.
Dyslipidemia is another job associated with metabolic syndrome that is related to insulin opposition. Too many lipoids in the blood watercourse or high cholesterin tend to take towards bigger issues such as cardiovascular disease. “Fasting hypertriglyceridemia is caused by increased hepatic really low denseness lipoprotein secernment. which may be driven by increased bringing of free fatty acids to the liver coming from both splanchnic fat and upper organic structure hypodermic fat.
The decreased high-density lipoprotein cholesterin concentrations and the increased little. heavy low-density lipoprotein atom concentrations associated with upper organic structure fleshiness are likely to be an indirect effect of elevated triglyceride-rich really low denseness lipoprotein. ” ( Ausiello & A ; Goldman. 2008 ) .
The liver begins bring forthing more LDL cholesterin and less HDL cholesterin. HDL helps unclutter the blood of extra cholesterin and besides interferes with the inflammatory response of macrophages. Both of these maps help to diminish the hazard of plaque build up. With the lessening production of HDL the organic structure is at increased hazard for cardiovascular disease. It is notable for any medical professional to see these things and take appropriate actions to better guarantee the wellness of their patients.
Inflammation is by and large the body’s response to injury or damage to cells. However redness is seen in both diabetes and coronary arteria disease ( CAD ) . giving it a topographic point in measuring patients with metabolic syndrome. “Sometimes inflammatory chemicals are elevated in the blood of people who are non overtly ill or injured.
This low-grade chronic redness is associated with increased hazard of bosom disease. diabetes. malignant neoplastic disease. autoimmune upsets. and other wellness problems” ( Rosedale. 2004. p. 176 ) . Vanderploeg ( 2008 ) pointed out that “Chronic redness is a characteristic of coronary artery disease and CAD mediated by angiotension II. proinflammatory cytokines. and free fatty acids. ” As seen earlier insulin opposition causes the liver to bring forth more LDL every bit good as doing the blood vas walls to go more permeable to lipoids. ensuing in coronary artery disease.
The body’s inflammatory response causes macrophages to consume the lipoids and can tear the plaque construct up in the blood vass. In short this inflammatory response has changed stable plaque into unstable plaque ( Vanderploeg. 2008 ) .
The rupture of the plaque can ensue in wholly clogged blood vass. which can do a bosom onslaught or shot. The macrophages besides release cytokines that cause the liver to bring forth C-reactive protein ( Vanderploeg. 2008 ) . “One of the best markers for systemic redness is extremely sensitive C-reactive protein ( CRP ) . a protein that is produced during inflammation…a high degree of CRP is a extremely accurate forecaster of future bosom attack” ( Rosedale. 2004. p. 176 ) .
High degrees of CRP are signaling increased degrees of redness in the organic structure and without a individual holding an unwellness or hurt this could bespeak macrophages interrupting down lipid plaque. puting that individual at hazard for a bosom onslaught or shot. The apprehension of inflammation’s function in cardiovascular disease and diabetes is still being developed. Although CRP degrees are non one of the standards for metabolic syndrome. it is still of import to measure. as it excessively is closely related to the cascade of metabolic syndrome.
Having the ability to name a individual with metabolic syndrome early in the clinical presentation allows early intercession to take down or forestall the cardiovascular events that may take to premature decease. The curative ends of early intercession are to handle the implicit in causes of metabolic syndrome by increasing physical activity. supply intensive weight direction aid. and to handle the cardiovascular hazard factors as they arise. or if they persist after lifestyle alterations ( Meigs. 2010 ) .
Pull offing metabolic syndrome starts with a thorough appraisal of hazard factors and acknowledgment of the status. Blaha has suggested that a formal diagnosing of the syndrome in the medical record may take to better direction of the syndrome itself.
After diagnosing. a standardised hazard appraisal tool such as the Framingham hazard mark should be used to cipher the 10-year hazard of cardiovascular disease ( Blaha et al. . 2008 ) . Classifying the patient to low. medium or high hazard of a cardiovascular event within 10 old ages besides emphasizes the necessity of lifestyle alterations.
Blaha et Al. ( 2008 ) have proposed an “ABCDE” attack for the direction of metabolic syndrome in a systematic method that delineates each factor and how to handle it. It is a simple manner to verify that all metabolic provinces and intercessions have been addressed. The “A” is a reminder to order aspirin therapy for anyone with a greater than 6 % 10-year hazard when utilizing the Framingham tool. The “B” relates to maintaining the patient’s blood force per unit area below the defined standards.
First-line therapy for force per unit area control is the usage of an angiotension-converting enzyme ( ACE ) inhibitor. or if non tolerated. an angiotension receptor blocker ( ARB ) . The usage of thiazide water pills and beta blockers for force per unit area control may increase the hazard of diabetes in people with metabolic syndrome. so is non advised as a first-line intervention option in these patients ( Hilgers & A ; Mann. 2008 ) .
The “C” in the Blaha et Al ( 2008 ) attack to metabolic syndrome direction is to remind the clinician to pull off cholesterin suitably. Lipid-lowering medicines are to be prescribed to accomplish an LDL-C of less than 100mg/dL in those categorized every bit high hazard by a standardised marking tool or an LDL-C less than 130 mg/dL in intermediate hazard classs.
To aim a lowering of non-HDL-C to less than 130mg/dL in high hazard patients. a fenofibrate may be considered in add-on to the regimen. If the patient is in the intermediate hazard class the non-HDL-C should be less than 160mg/dL. Omega-3 fatty acids may be added for cholesterin control.
“D” is a reminder to forestall or command diabetes in patients with metabolic syndrome. Lifestyle direction with the add-on of pharmacotherapy should be pursued. Lifestyle alterations include dietetic alterations and weight loss as needed. The biguanide Glucophage is considered to be first-line therapy for diabetes control with the add-on of pioglitazone if fasting blood sugars can non be controlled with Glucophage entirely.
Last. the “E” in this attack is a reminder of the necessity of exercising. as exercising has been shown to better cardiovascular hazard and increase insulin sensitiveness. Increasing the sum of exercising in an person besides reduces fleshiness and lowers systolic blood force per unit area ( Blaha et al. . 2008 ) .
Buse and co-workers ( 2010 ) . on behalf of the ADA and EASD. inquiry whether the metabolic syndrome is clinically utile. Without uncertainty. because of the increased prevalence of the implicit in causes of the metabolic syndrome ( e. g. . fleshiness and sedentary life styles ) . the bunch of hazard factors portends an tremendous addition in CVD and type 2 diabetes worldwide. The fact that diabetes itself. when combined with the metabolic syndrome. is associated with greater CVD hazard represents a great challenge for the direction of patients with diabetes. At the same clip. CVD besides has important public wellness deductions for the bar of CVD and type 2 diabetes.
It is likely to supply a utile practical tool that reminds healthcare professionals of the metabolic effects of fleshiness. and identifies persons at hazard for CVD and diabetes that are likely to profit from ( lifestyle ) intercessions. The bunch of CVD hazard factors is a call to action for preventative medical specialty. as it is clearly non satisfactory merely to handle the major hazard factors one time they have reached flatly increased degrees. This would be a prescription for widespread usage of drug therapy in primary bar and would be a immense load on economically developed societies. and an even greater load on developing states.
Few would differ that it is better and more economical to observe the bunch at an earlier phase of development and to present lifestyle intercessions to forestall patterned advance to a more advanced hazard. This is a undertaking for both public wellness and clinical sectors of the health care system. An extra benefit of the new IDF standard is that the initial showing trial is simple and low-priced. i. e. . measuring of waist size. ( Alberti & A ; Zimmet. 2005 ) .
As with a batch of surveies in the medical field this excessively falls into contention over the use of the metabolic syndrome graduated table. Not to minimize the thought of everything that has been stated. but to merely indicate out that non all medical professionals fall into the same line of thought and pattern. As Krans ( 2010 ) writes. “No consolidative pathophysiological footing has been established for the metabolic syndrome. It should merely be considered as a pre-morbid status and should ( in epidemiological surveies ) exclude individuals with established diabetes or known CVDs.
In add-on to cardinal fleshiness and insulin opposition. the undermentioned factors all contribute to DM or CVD: activation of the immune system ; disordered hypothalamic-pituitary-adrenal axis ; altered glucocorticoid action ; engagement of cytokines. endocrines and other molecules from adipose tissue ; prenatal and early life influences ; high blood pressure ; alterations in blood lipoids ; multiple cistron combinations. and emphasis. The hazard factors for CVD and DM are non tantamount across the different hazard combinations that contribute to the metabolic syndrome.
The equality of the hazard factors for CVD and DM has non been established in assorted populations. CVD and DM have multiple causes. of which some do non affect the metabolic syndrome. though they do increase the hazard of developing this syndrome. ” ( Krans. 2010 ) . Yet even with all the negatives pointed out by Krans he still ends with a positive note stating that all the combined factors increase the hazard of developing metabolic syndrome. Krans is by no agencies entirely with this line of thought.
An article by the American Diabetes Association and the European Association for the Study of Diabetes wrote by Buse et Al. . ( 2005 ) points out. “While there is no inquiry that certain CVD hazard factors are prone to constellate. we found that the metabolic syndrome has been inexactly defined. there is a deficiency of certainty sing its pathogenesis. and there is considerable uncertainty sing its value as a CVD hazard marker” ( Buse et Al. . 2005 ) .
They go on to compose “Clinicians should measure and handle all CVD hazard factors without respect to whether a patient meets the standards for diagnosing of the metabolic syndrome. ” ( Buse et Al. . 2005 ) . Despite their stance on metabolic syndrome all can hold that the single constituents of metabolic syndrome should be taken earnestly and treated harmonizing to current criterions. They besides agree that weight decrease. exercising and a healthy repast program are the most good intervention program for those at hazard for cardiovascular disease and diabetes ( Kahn et al. . 2005 ) . Decision
With an dismaying per centum of American Adults being diagnosed with metabolic syndrome it would turn out prudent for medical professionals to larn more about it. Medical professionals. who find they are looking at a patient with familiar tendencies in their wellness. should at the minimal bring it up in conversation during their attention. To disregard the tendencies may ensue in more medical jobs that may hold been preventable had they been treated earlier.
In general most agree that at place interventions such as better feeding wonts and exercising can cut down the hazard of falling into the diagnosings of metabolic syndrome. Fostering the instruction of patients is lone portion of the intervention ; educating medical professionals to see things that can convey about better life style and living conditions of their patients is a worthwhile cause.
Alberti. G. . Zimmet. P. . ( 2005 ) The Metabolic Syndrome: Possibly an Etiological Mystery but Far From a Myth- Where Does the International Diabetes Federation Stand?
From the World Wide Web: March 24. 2011
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American Heart Association: From the World Wide Web: March 25. 2011 hypertext transfer protocol: //www. bosom. org/HEARTORG/Conditions/Diabetes/WhyDiabetesMatters/
Ausiello. D. Goldman. L. . ( 2008 ) Cecil Medicine Twenty-Third Edition.
Bansal. S. . Blaha. M. . Blumenthal. R. . DeFilippis. A. . Golden. S. . & A ; Rouf. R. . ( 2008 ) . A Practical “ABCDE” attack to the metabolic syndrome. Mayo
Clinic Proceedings. 83 ( 8 ) . From the World Wide Web: March 24. 2011 hypertext transfer protocol: //www. mayoclinicproceedings. com/content/83/8/932. long Bernstein. R. ( 2003 ) Dr. Bernstein’s Diabetes Solution Revised & A ; Updated. The Complete Guide to accomplishing Normal Blood Sugars. New York: Small. Brown and Company. Buse. J. . Ferrannini. E. . Kahn. R. . Stern. M. ( 2005 )
The Metabolic Syndrome: Time for a Critical Appraisal Joint Statement From the American Diabetes Association and the European Association for the Study of Diabetes.
From the World Wide Web: hypertext transfer protocol: //www. medscape. com/viewarticle/512071. Galleragher. E. . LeRoith. D. . Karnieli. E. ( 2008 ) . Endocrinology and Metabolism Clinics- 37 ( 3 ) . The Metabolic Syndrome from Insulin Resistance to Obesity and Diabetes. From the World Wide Web: March 24. 2011.
hypertext transfer protocol: //www. mdconsult. com/das/article/body/237897632-4/jorg=clinics & A ; source= & A ; sp=20975453 & A ; sid=0/N/ Grundy. S. . ( 2006 ) . Center for Human Nutrition and Metabolic Syndrome: Connecting and Reconciling Cardiovascular and Diabetes Worlds. Journal of the American College of Cardiology. 47 ( 6 ) . 1093-1098. Krans. R. ( 2010 ) From the Faculty of 1000. The Metabolic Syndrome: Useful Concept Or Clinical Tool? Report of a WHO Expert Consultation: “Exceptional” and “Changes Clinical Practice”
From the World Wide Web: hypertext transfer protocol: //www. medscape. com/viewarticle/720790. Meigs. J. ( 2010 ) . The metabolic syndrome ( insulin opposition syndrome or syndrome Ten ) . From the universe broad web: March 24. 2011 hypertext transfer protocol: //uptodate/com/online/content/topic. make? topicKey=diabetes/
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Rosedale. R. ( 2004 ) . The Rosedale Diet: Turn off Your Hunger Switch New York: HarperCollins. ( p. 176 ) . Vanderploeg. E. ( 2008 ) . Mosby’s Nursing Consult. The metabolic syndrome: Why Your Patient Is at Risk. From the World Wide Web: March 24. 2011 hypertext transfer protocol: //www. nursingconsult. com/das/stat/view/2388049052/cup? nid=192939 & A ; sid=1142497922 & A ; summaryresults=true & A ; SEQNO=1
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Subject IN THIS DOCUMENT
Atherosclerosis. Diabetes mellitus. Hypertension. Insulin opposition. Low-density lipoprotein. Metabolic syndrome. Myocardial infarction. Fleshiness
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