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Can Diabetes Cause Liver Enzymes To Be High?

Diabetes And Nonalcoholic Fatty Liver Disease: A Pathogenic Duo

Diabetes And Nonalcoholic Fatty Liver Disease: A Pathogenic Duo

Limitation of Use: The safety and efficacy of Humulin R U-500 used in combination with other insulins has not been determined. The safety and efficacy of Humulin R U-500 delivered by continuous subcutaneous infusion has not been determined. For the Humulin R U-500 vial, particular attention should be paid to the 20-mL vial size, prominent “U-500” and warning statements on the vial label, and distinctive coloring on the vial and carton. Dosing errors have occurred when Humulin R U-500 was administered with syringes other than a U-500 insulin syringe. Patients should be prescribed U-500 syringes for use with Humulin R U-500 vials. The dose of Humulin R U-500 should always be expressed in units of insulin. DO NOT transfer Humulin R U-500 from the Humulin R U-500 KwikPen into any syringe for administration. Overdose and severe hypoglycemia can occur. Hyperglycemia or Hypoglycemia with Changes in Insulin Regimen: Changes in insulin, manufacturer, type, or method of administration should be made cautiously and only under medical supervision and the frequency of blood glucose monitoring should be increased. Hypoglycemia: Hypoglycemia is the most common adverse reaction associated with insulin, including Humulin R U-500. Severe hypoglycemia can cause seizures, may be life-threatening, or cause death. Severe hypoglycemia may develop as long as 18 to 24 hours after an injection of Humulin R U-500. Hypoglycemia can impair concentration ability and reaction time; this may place an individual and others at risk in situations where these abilities are important, such as driving or operating other machinery. Early warning symptoms of hypoglycemia may be less pronounced in patients with longstanding diabetes, in patients with diabetic nerve disease, in patients using medications th Continue reading >>

Mildly Elevated Liver Transaminase Levels In The Asymptomatic Patient

Mildly Elevated Liver Transaminase Levels In The Asymptomatic Patient

Mild elevations in liver chemistry tests such as alanine transaminase and aspartate transaminase can reveal serious underlying conditions or have transient and benign etiologies. Potential causes of liver transaminase elevations include viral hepatitis, alcohol use, medication use, steatosis or steatohepatitis, and cirrhosis. The history should be thorough, with special attention given to the use of medications, vitamins, herbs, drugs, and alcohol; family history; and any history of blood-product transfusions. Other common health conditions, such as diabetes, heart disease, and thyroid disease, can cause or augment liver transaminase elevations. The recent American Gastroenterological Association guideline regarding the evaluation and management of abnormal liver chemistry tests proposes a practical, algorithmic approach when the history and physical examination do not reveal the cause. In addition to liver chemistries, an initial serologic evaluation includes a prothrombin time; albumin; complete blood count with platelets; hepatitis A, B, and C serologies; and iron studies. Depending on the etiology, management strategies may include cessation of alcohol use, attention to medications, control of diabetes, and modification of lifestyle factors such as obesity. If elevations persist after an appropriate period of observation, further testing may include ultra-sonography and other serum studies. In some cases, biopsy may be indicated. Hepatic transaminase tests such as alanine transaminase (ALT) and aspartate transaminase (AST) often are part of standard laboratory panels in asymptomatic outpatients, similar to screening tests for blood donors and for life insurance applicants. The evaluation of an abnormal ALT or AST level in an asymptomatic patient therefore is a commo Continue reading >>

Liver Disease And Pregnancy

Liver Disease And Pregnancy

SUPREP® Bowel Prep Kit (sodium sulfate, potassium sulfate and magnesium sulfate) Oral Solution is an osmotic laxative indicated for cleansing of the colon as a preparation for colonoscopy in adults. Most common adverse reactions (>2%) are overall discomfort, abdominal distention, abdominal pain, nausea, vomiting and headache. Use is contraindicated in the following conditions: gastrointestinal (GI) obstruction, bowel perforation, toxic colitis and toxic megacolon, gastric retention, ileus, known allergies to components of the kit. Use caution when prescribing for patients with a history of seizures, arrhythmias, impaired gag reflex, regurgitation or aspiration, severe active ulcerative colitis, impaired renal function or patients taking medications that may affect renal function or electrolytes. Use can cause temporary elevations in uric acid. Uric acid fluctuations in patients with gout may precipitate an acute flare. Administration of osmotic laxative products may produce mucosal aphthous ulcerations, and there have been reports of more serious cases of ischemic colitis requiring hospitalization. Patients with impaired water handling who experience severe vomiting should be closely monitored including measurement of electrolytes. Advise all patients to hydrate adequately before, during, and after use. Each bottle must be diluted with water to a final volume of 16 ounces and ingestion of additional water as recommended is important to patient tolerance. BRIEF SUMMARY: Before prescribing, please see Full Prescribing Information and Medication Guide for SUPREP® Bowel Prep Kit (sodium sulfate, potassium sulfate and magnesium sulfate) Oral Solution. INDICATIONS AND USAGE: An osmotic laxative indicated for cleansing of the colon as a preparation for colonoscopy in adults. Continue reading >>

The Association Between Liver Enzymes And Risk Of Type 2 Diabetes: The Namwon Study

The Association Between Liver Enzymes And Risk Of Type 2 Diabetes: The Namwon Study

Abstract We examined the association between liver enzymes and development of type 2 diabetes in a general Korean population. A total of 10,667 subjects (4,201 males and 6,466 females) aged 45 to 74 years participated in a baseline examination between 2004 and 2007. Among the subjects, 8,157 (3,231 males and 4,926 females) underwent follow-up examination from 2007 to 2011, for a median follow-up period of 4.2 years. Type 2 diabetes was defined as intake of anti-diabetic agents, insulin treatment, fasting glucose concentration of more than 126 mg/dl, or hemoglobin A1c of more than 6.5% at re-examination. Associations of liver enzymes with incidence of type 2 diabetes were analyzed using logistic regression models. During the follow-up period, 548 subjects (235 males, 313 females) developed type 2 diabetes. After adjusting for comprehensive diabetes risk factor, the risk of type 2 diabetes was significantly higher in the highest alanine aminotransferase (ALT) quartile than in the lowest quartile (odds ratio (OR): 1.95, 95% confidence interval (CI): 1.18-3.21 in males; OR: 1.49, 95% CI: 1.03-2.16 in females). Similar results were observed for gamma-glutamyltransferase (GGT) quartiles, but in the fully adjusted analysis, the OR for the highest versus lowest quartiles was significant only for females (OR: 1.58, 95% CI: 0.95-2.63 in males; OR: 1.85, 95% CI: 1.23-2.79 in females). Our results suggest that serum ALT concentrations were independently associated with type 2 diabetes in both sexes, and that GGT was also independently associated but only in females. Background The liver plays an important role in maintenance of normal glucose levels during fasting as well as in the postprandial period [1], and its role in the pathogenesis of type 2 diabetes has attracted much inter Continue reading >>

Why You Should Know About Fatty Liver Disease

Why You Should Know About Fatty Liver Disease

Non-alcoholic fatty liver disease can be a problem for people with diabetes, especially type 2 diabetes. Learn more about this growing condition. Fatty liver disease is an “underappreciated problem that seems to be getting worse,” according to Mitch Lazar, MD, PhD, chief of the division of endocrinology, diabetes and metabolism at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. For many years physicians believed that fatty liver was a benign condition but in 1980 non-alcoholic fatty liver disease (NAFLD) was designated a real condition. “Fortunately with increasing knowledge and research on the disease, there is a growing awareness,” says Dina Halegoua-Demarzio, MD, director of the Fatty Liver Center at Thomas Jefferson University Hospital, also located in Philadelphia. “More awareness of the problem in doctors and patients will enable early intervention that can prevent cirrhosis, liver failure and liver cancer.” It’s a particular issue for people with type 2 diabetes. Up to 70 percent of obese type 2 diabetes patients have fatty livers, meaning at least five percent of liver cells show evidence of fat. Although fatty livers are benign and estimates vary considerably, about five to 10 percent of people with the condition will go on to develop the more serious non-alcoholic steatohepatitis (NASH) that causes inflammation, scarring and damage to the liver cells. 1 Fatty livers can also start a cascade of serious damage to the liver and attempts by the organ to regenerate itself that culminate in an abundance of scar tissue and impaired liver function. It has also been linked to increased risk of heart attack and stroke.2 Studies show that anywhere from three to 26 percent of people with NASH will progress to cirrhosis, whi Continue reading >>

Diabetes: How Do I Help Protect My Liver?

Diabetes: How Do I Help Protect My Liver?

If I have diabetes, is there anything special I need to do to take care of my liver? Answers from M. Regina Castro, M.D. You're wise to wonder about steps to protect your liver. Diabetes raises your risk of nonalcoholic fatty liver disease, a condition in which excess fat builds up in your liver even if you drink little or no alcohol. This condition occurs in at least half of those with type 2 diabetes. It isn't clear whether the condition appears more often in people with type 1 diabetes than in the general population because obesity, which is a risk factor, occurs with similar frequency in both groups. Other medical conditions, such as high cholesterol and high blood pressure, also raise your risk of nonalcoholic fatty liver disease. Fatty liver disease itself usually causes no symptoms. But it raises your risk of developing liver inflammation or scarring (cirrhosis). It's also linked to an increased risk of liver cancer, heart disease and kidney disease. Fatty liver disease may even play a role in the development of type 2 diabetes. Once you have both conditions, poorly managed type 2 diabetes can make fatty liver disease worse. Your best defense against fatty liver disease includes these strategies: Work with your health care team to achieve good control of your blood sugar. Lose weight if you need to, and try to maintain a healthy weight. Take steps to reduce high blood pressure. Keep your low-density lipoprotein (LDL, or "bad") cholesterol and triglycerides — a type of blood fat — within recommended limits. Don't drink too much alcohol. If you have diabetes, your doctor may recommend an ultrasound examination of your liver when you're first diagnosed and regular follow-up blood tests to monitor your liver function. Continue reading >>

What Causes Elevated Liver Levels In Dogs?

What Causes Elevated Liver Levels In Dogs?

Elevated liver levels in dogs are indicative of health problems that should be resolved at the earliest, under the guidance of the vet. This is because the dog’s liver is crucial to your pet’s continued good health as it’s responsible for the metabolism of fats, proteins and carbohydrates. Besides this, the liver aids in detoxifying the body and assists in the digestive process by producing bile. Elevated Liver Levels The liver produces enzymes to carry out different functions. Some of the enzymes that get elevated in pets include alanine aminotransferase (ALT) and serum glutamic pyruvic transaminase. If the dog has certain health problems or infections, the liver cells die and the amount of enzymes that are released increase by as much as four to five times the normal level. This can also cause disorders that aren’t associated with the liver such as heart failure and gastrointestinal tract inflammation. Symptoms of Elevated Liver Enzymes: Increased urination Increased thirst Diarrhea Constipation Vomiting Lethargy Depression Bleeding disorders Loss of appetite Loss of weight Anemia Jaundice Blood in the stool Causes of Elevated Liver Enzymes There are several diseases or conditions that can cause elevated liver enzymes. These diseases may be liver diseases or diseases not associated with the liver such as jaundice, pancreatitis, Cushing’s disease, infectious hepatitis, diabetes, hypothyroidism and heartworm infection. Other causes of elevated liver enzymes include metabolic disorders such as obesity and medications like corticosteroids. Jaundice Jaundice is a condition in which the liver can’t remove a substance known as bilirubin. The accumulation of bilirubin is toxic in nature and is accompanied by elevated liver enzymes. Pancreatitis Pancreatitis causes Continue reading >>

Are You Pre-diabetic?

Are You Pre-diabetic?

According to the American Diabetes Association, nearly 26 million people, or over 8% of Americans, have type II diabetes. Of these, 7 million remain undiagnosed. And, the ADA says another 79 million Americans – 1 in 4 of us – are prediabetic, meaning that without significant diet and lifestyle changes, there could be more than 100 million diabetics in the US in the foreseeable future. Given these statistics, there’s a good chance that prediabetes is of concern to you or someone you care about, and knowing more about it is, or will be, important to you. One difficulty in detecting type II diabetes and prediabetes is that the warning signs are usually imperceptible. The classic diabetes symptoms of unquenchable thirst, excessive hunger, and weight loss usually only occur in type I Diabetes, while most people find out about the more common type II diabetes from blood tests ordered by their doctor or health-care professional. Unfortunately, patients aren’t told when their blood work indicates that they may be on a path towards diabetes, and they only find out once they are already diabetic. What are the signs that your body may be on a path to developing blood sugar problems? The first, and most obvious, warning sign is an expanding waistline. We’ve all grown accustomed to the stories in the news about America’s growing belt size, and there is real reason for concern: A waist circumference (measured at the level of the belly button) of greater than 40 inches in men, and 35 inches in women, is one clear warning sign for prediabetes. There are two blood tests your doctor is likely to check to see if you have a diabetic tendency. If either or both of your fasting blood sugar or hemoglobin A1C are elevated (greater than 100 mg/dL and 6.0%, respectively) your blood s Continue reading >>

What Does Liver Disease Have To Do With Diabetes?

What Does Liver Disease Have To Do With Diabetes?

The American College of Gastroenterology released new guidelines on liver chemistry tests in December 2016. Changed level recommendations were included for ALT- alanine aminotransferase, AST- aspartate aminotransferase, and alkaline phosphatase and bilirubin levels. In the past, ALT levels were accepted at a range from 30-40 IU/L and up to 70-80 IU/L while being hospitalized (body under stress). The new acceptable levels are 19-25 IU/L for women and 29-33IU/L for men. The vast change in “normal levels” of liver enzymes were updated since “multiple studies have demonstrated that if you have ALT levels even innocuously elevated, your risk of liver related death is significantly higher” according to Paul Kwo, MD from Stanford University. Liver disease can stem from alcohol, viral hepatitis A, B or C, genetic disorders, liver injury, drugs, supplements, Lyme disease and non-alcoholic fatty liver disease – NAFLD. Liver disease can often tell us about your overall health and liver function tests should be part of the work up utilized by your MD. What does this all mean for people with type 2 diabetes? What Does the Liver Do? The liver turns food into nutrients and filters toxins from the blood. The toxins include alcohol, medications, supplements, pollutants and insecticides. When the fat content of the liver reaches 10%, due to weight gain especially around the middle section and in visceral organs (internal fat), the spongy texture of the liver becomes coarse and the function declines. Liver problems begin. Non-Alcoholic Fatty Liver Disease – NAFLD Elevated ALT levels are common in people with pre-diabetes or diabetes and are often the first documented abnormal lab test, even prior to elevated fasting blood sugars or A1C values. NAFLD is common worldwide but muc Continue reading >>

Crestor Side Effects

Crestor Side Effects

Even as the U.S. Food and Drug Administration (FDA) approved Crestor to treat cholesterol in 2003, some regulators within the agency still voiced reservations about the drug’s safety. Crestor is part of a class of cholesterol drugs called statins, and while statins have been around since the 1980s, Crestor was a powerful new version. Though the FDA knew about cases of a rare form of muscle damage during the drug’s premarketing trials, the agency believed at the time the rate was similar to other statins already on the market. But in the first year after Crestor was approved, an analysis of adverse event reports to the FDA indicated the number of rhabdomyolysis cases among Crestor users was higher than for users of other statins. Rhabdomyolysis can lead to severe kidney injury or failure. In 2005, just over a year after approving Crestor, the FDA required its manufacturer, AstraZeneca, to add a warning to the drug’s label about the risk of rhabdomyolysis and other muscle injuries. Further postmarket studies in the years after Crestor’s initial approval would highlight or examine previously unknown or underestimated risks of serious side effects. Possible Serious Side Effects of Crestor: Rhabdomyolysis (a form of serious muscle damage that can cause kidney problems) Kidney failure Hemorrhagic stroke Tendon rupture Decreased cognition, such as memory loss & amnesia Kidney damage Type 2 diabetes Muscle-related symptoms Despite reports of sometimes serious side effects, Crestor became one of the most popular brand-name drugs in the U.S. Its success is due in part to its effectiveness in addressing cardiovascular disease (CVD). In 2010, the FDA approved Crestor to prevent heart attacks, strokes and other cardiovascular disease — the leading cause of death in the U.S Continue reading >>

Abnormal Liver Function Tests (lfts) And Diabetes

Abnormal Liver Function Tests (lfts) And Diabetes

liver function tests (LFTs) generally include: serum aminotransferases, alkaline phosphatase, bilirubin, albumin (measures of clotting function such as prothrombin time may also be included in a liver function test profile) aminotransferases (alanine aminotransferase (ALT) and aspartate aminotransferase (AST)) measure the concentration of intracellular hepatic enzymes that have leaked into the circulation - these serve as a marker of hepatocyte injury alkaline phosphatase (AP), gamma-glutamyl transpeptidase (GGT), and bilirubin act as markers of biliary function and cholestasis albumin and prothrombin reflect liver synthetic function non-alcoholic fatty liver disease (NAFLD) includes a wide spectrum of liver pathology, ranging from fatty liver alone to the more severe nonalcoholic steatohepatitis (1) NAFLD is the most common cause of chronically elevated LFTs in the United States in both diabetic and nondiabetic individuals with respect to patients with NAFLD, 60-95% are obese, 28-55% have type 2 diabetes, and 20-92% have hyperlipidemia (2) if NAFLD develops in people who are not heavy drinkers then the condition generally has a benign clinical course (3,4) NAFLD is a cause of hepatic inflammation histologically resembling that of alcohol-induced liver disease but usually slowly progressive and of low-grade severity. ..However, the disorder may ultimately result in cirrhosis (4) there is evidence of associations between NAFLD and obesity, dyslipidaemia and insulin resistance (4,5) NAFLD generally results in an asymptomatic elevation of liver enzyme levels (6), including ALT and AST - ALT is primarily found in the liver whereas AST is also found in other tissues and is a less specific marker of liver integrity in the setting of marker-negative elevated LFTs, the most lik Continue reading >>

Fatty Liver: What It Is, And How To Get Rid Of It

Fatty Liver: What It Is, And How To Get Rid Of It

Fatty liver is linked to type 2. Find out more. By Franziska Spritzler, RD, CDE Fatty liver disease is becoming increasingly common in many parts of the world, affecting about 25% of people globally. It is linked to obesity, type 2 diabetes and other disorders characterized by insulin resistance. What’s more, if fatty liver isn’t addressed, it may progress to more serious liver disease and other health problems. What Is Fatty Liver? Fatty liver occurs when too much fat builds up in liver cells. Although it is normal to have a tiny amount of fat in these cells, the liver is considered fatty if more than 5% of it is fat. While drinking too much alcohol can lead to fatty liver, in many cases it does not play a role. A number of fatty liver conditions fall under the broad category of non-alcoholic liver disease (NAFLD), which is the most common liver disease in adults and children in Western countries. Non-alcoholic fatty liver (NAFL) is the initial, reversible stage of liver disease. Unfortunately, it often goes undiagnosed. Over time, NAFL may lead to a more serious liver condition known as non-alcoholic steatohepatitis, or NASH. NASH involves greater fat accumulation and inflammation that damages the liver cells. This can lead to fibrosis, or scar tissue, as liver cells are repeatedly injured and die off. Unfortunately, it is difficult to predict whether fatty liver will progress to NASH, which greatly increases the risk of cirrhosis (severe scarring that impairs liver function) and liver cancer. NAFLD is also linked to an increased risk of other diseases, including heart disease, diabetes and kidney disease. Bottom Line: Fatty liver occurs when too much fat builds up in the liver. Fatty liver is reversible at an early stage, but it sometimes progresses to advanced l Continue reading >>

High Triglycerides

High Triglycerides

When your triglyceride levels are too high, you may not have symptoms. It's a "silent" problem with big implications, such as a four-fold increase in the likelihood of having a heart attack or stroke. A simple blood test is all it takes to check your triglyceride levels. If they're too high, you can get them back under control, often by changing your daily habits. If you already know that your triglyceride levels are too high, the actions you take now might even save your life. Having high triglycerides could be a sign that you’re becoming insulin-resistant, which means your body isn’t using insulin (a hormone that controls blood sugar) properly. When insulin doesn’t do its job, glucose can't get into your cells. That raises your blood sugar levels, which can lead to pre-diabetes and, eventually, type 2 diabetes. Having diabetes makes you much more likely to have a heart attack and other heart problems, in addition to the risk from your high triglycerides. Untreated diabetes is a major health threat. To manage it well, you may need to track everything you eat, test your blood sugar, exercise, lose extra weight, take medication as directed, and keep up with your medical appointments. Many people don't know that they have diabetes. Your doctor should check on whether you do, and if so, help you get both your diabetes and your triglycerides under control. High triglyceride levels can be a clue that you have fatty liver disease. Poor eating habits lead not only to high levels of fat in the bloodstream (triglycerides) but increased storage of fat throughout the body, including in the liver. Elevations in liver function tests (like ALT and AST) can indicate that fatty liver is present. Fatty liver usually does not cause symptoms, but unless reversed, fatty liver can lea Continue reading >>

Raised Liver Enzymes In Newly Diagnosed Type 2 Diabetes Are Associated With Weight And Lipids, But Not Glycaemic Control

Raised Liver Enzymes In Newly Diagnosed Type 2 Diabetes Are Associated With Weight And Lipids, But Not Glycaemic Control

Go to: Our study shows a high incidence of elevated ALT in a well-defined population of newly diagnosed people with T2DM. Elevated ALT was used as a surrogate marker of NAFLD, which whilst both insensitive and non-specific, does suggest that this condition may be common within people with T2DM. Elevated ALT was found to have a statistically significant association with increasing age, obesity, elevated triglyceride levels, and low HDL cholesterol levels, but was not significantly associated with glycemic control. Manifestations of the metabolic syndrome, which often precedes T2DM, such as obesity, hyperinsulinemia, peripheral insulin resistance, hypertriglyceridemia, and hypertension, have been previously suggested as a cause of NAFLD.[5] This study is in keeping with the current understanding of the pathogenesis of NAFLD as a hepatic manifestation of the metabolic syndrome itself, as elevated ALT was commonly elevated in people with diagnosis of T2DM, suggesting that development of NAFLD may precede the diagnosis of T2DM. Strong epidemiological, biochemical, and therapeutic evidence support the premise that the primary pathophysiogical derangement, in most patients with NAFLD, is insulin resistance.[6] Insulin resistance leads to increased lipolysis, triglyceride synthesis, increased hepatic uptake of free fatty acids, and accumulation of hepatic triglyceride.[5,7–12] Our data, demonstrating higher serum triglycerides and lower HDL cholesterol in the raised ALT group, support this hypothesis. There are weaknesses of our study particularly the lack of comprehensive alcohol and drug history, although our cohort comes from a center where all newly diagnosed patients from a defined geographical area attended a well-recognized education program. We can therefore use our d Continue reading >>

Association Between Liver Enzymes And Incident Type 2 Diabetes In Singapore Chinese Men And Women

Association Between Liver Enzymes And Incident Type 2 Diabetes In Singapore Chinese Men And Women

Aims To assess the association between liver enzymes and the risk of type 2 diabetes (T2D) in a Chinese population. Methods A nested case–control study comprising 571 T2D cases and 571 matched controls was conducted within the Singapore Chinese Health Study. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and lactate dehydrogenase (LDH) were quantified in baseline plasma collected from them, while γ-glutamyltransferase (GGT) was assayed among 255 T2D cases with baseline hemoglobin A1c <6.5% and 255 matched controls. Participants were free of diagnosed diabetes, cardiovascular disease, and cancer at blood collections (1999–2004). Incident self-reported T2D cases were identified at follow-up II interview (2006–2010). Controls were matched to cases on age, sex, dialect group, and date of blood collection. Results Higher levels of ALT and GGT were significantly associated with increased risk of T2D (p for trend <0.001 for ALT, p for trend=0.03 for GGT), and the ORs (95% CIs) comparing highest versus lowest tertiles of ALT and GGT were 2.00 (1.01 to 3.96) and 2.38 (1.21 to 4.66), respectively. A null association was observed for AST, ALP, and LDH with T2D risk. Adding GGT (<23 vs ≥23 IU/L) or ALT (<21 vs ≥21 IU/L) to a prediction model resulted in significant gain in net reclassification improvement and integrated discrimination improvement of T2D prediction (all p<0.001). Conclusions Higher levels of GGT and ALT are associated with increased T2D risk. GGT ≥23 IU/L and ALT ≥21 IU/L may identify people at higher risk of developing T2D in this Chinese population. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others t Continue reading >>

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