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Medical Nutrition Therapy For Diabetic Foot Ulcer

Nutritional Treatment Of Diabetic Foot Ulcers - A Key To Success

Nutritional Treatment Of Diabetic Foot Ulcers - A Key To Success

Open Access is an initiative that aims to make scientific research freely available to all. To date our community has made over 100 million downloads. Its based on principles of collaboration, unobstructed discovery, and, most importantly, scientific progression. As PhD students, we found it difficult to access the research we needed, so we decided to create a new Open Access publisher that levels the playing field for scientists across the world. How? By making research easy to access, and puts the academic needs of the researchers before the business interests of publishers. We are a community of more than 103,000 authors and editors from 3,291 institutions spanning 160 countries, including Nobel Prize winners and some of the worlds most-cited researchers. Publishing on IntechOpen allows authors to earn citations and find new collaborators, meaning more people see your work not only from your own field of study, but from other related fields too. Patrizio Tatti and Annabel Barber (December 9th 2011). Nutritional Treatment of Diabetic Foot Ulcers - A Key to Success, Global Perspective on Diabetic Foot Ulcerations Thanh Dinh, IntechOpen, DOI: 10.5772/27418. Available from: Patrizio Tatti and Annabel Barber (December 9th 2011). Nutritional Treatment of Diabetic Foot Ulcers - A Key to Success, Global Perspective on Diabetic Foot Ulcerations Thanh Dinh, IntechOpen, DOI: 10.5772/27418. Available from: Embed this chapter on your site Copy to clipboard Embed this code snippet in the HTML of your website to show this chapter Over 21,000 IntechOpen readers like this topic Help us write another book on this subject and reach those readers Continue reading >>

Metabolic Correction Therapy For The Treatment Of A Diabetic Foot Ulcer: A Case Report

Metabolic Correction Therapy For The Treatment Of A Diabetic Foot Ulcer: A Case Report

Metabolic correction therapy for the treatment of a diabetic foot ulcer: A case report San Juan Bautista School of Medicine, Caguas, Puerto Rico University of Puerto Rico, Medical Sciences Campus, School of Public Health, San Juan, Puerto Rico Diabetes is a chronic metabolic disease that more than 29 million Americans suffer. Approximately, 1.4 million new cases are reported every year with more than 200 thousand deaths listing diabetes as the cause of death. Uncontrolled levels of glucose, known as hyperglycemic state, can eventually lead to complications such as retinopathy, hypertension, neuropathy, foot ulcers and/or amputations. Foot ulcers develop in 15% of diabetic patients and increase the risk of lower-limb amputations. This is a case report of a 63 year old patient with Type 1 diabetes mellitus presented to the clinic because of a foot ulcer after seven previous medical recommendations of amputation of the limb. The patient was started on a Metabolic Correction Therapy and GlucoCoR for glucose blood level regulation. Upon six months the foot ulcer healed and foot sensation was recovered. We propose this therapy as an affordable effective treatment mechanism to lower the risk of developing diabetic complications, having great beneficial effect in the quality of life and survival rate of diabetic patients. Diabetes is a chronic metabolic disease which, according to the World Health Organization, affects more than 400 million people [1]. In 2012, more than 29 million Americans suffered from diabetes and around 1.4 million new cases of diabetes are reported each year.2 In 2010, 234,051 death certificates indicated diabetes as the cause of death and 69,071 indicated diabetes as the underlying cause of death, placing this disease as the seventh cause of death in th Continue reading >>

Juven | Diabetic Foot Ulcers

Juven | Diabetic Foot Ulcers

Proper nutrition plays an important role in the lifelong management of diabetic complications, including foot ulcers. Your body needs the right number of calories and amount of protein every day to heal a wound. Think of calories as fuel for your body, just like gasoline is fuel for your car. Without enough fuel, your bodyand your car cant run properly. Blood sugar control is vitally important to wound healing. When blood glucose levels are high, the risk for wound complications and infections is greater. High blood glucose levels result in less oxygen and blood flow to the wound, which can increase healing time. Poor circulation may mean that oxygen and nutrients have trouble getting to the feet to help the wound heal. Follow your doctors advice on how to manage poor circulation. Eating less unhealthy fats, such as trans fat, saturated fat, and cholesterol, and eating more unsaturated fats Maintaining a healthy weight and making healthy food choices Reducing your sodium intake, which can help control your blood pressure Not Smoking! According to the American Diabetes Association, one of the biggest threats to your feet is smoking. Smoking affects the small blood vessels. It can cause decreased blood flow to the feet and make wounds heal more slowly. Protein provides the foundation for tissue growth, cell renewal, and repair of a wound. Include protein sources at every meal, such as: Vegetarian protein choices (soy, beans, or lentils) Amino acids are the building blocks of protein and play a role in wound healing. Arginine, glutamine, and a form of leucine called beta-hydroxy-beta-methylbutyrate (HMB) may prove beneficial to healing. If your wound is not healing, ask your healthcare provider about targeted amino acid therapy. Pham HT, Rich J, Veves A. Wound healing in Continue reading >>

Better Nutrition Boosts Diabetic Foot Outcomes

Better Nutrition Boosts Diabetic Foot Outcomes

The evidence documenting the role of nutrition in improving wound healing and neuropathy symptoms hasn’t been widely publicized, particularly among lower extremity healthcare practitioners. But getting that information to your diabetic patients could help save their feet. Practitioners who care for diabetic patients with neuropathy and an elevated risk of foot ulcers tend to agree on one thing: there is no one-treatment-fits-all solution. It takes a team of specialists working together, assessing patients one by one, to arrive at an effective treatment plan. And what lower extremity practitioners may not realize is that nutrition is a key part of that multidisciplinary equation. “What we don’t do well in medicine is evaluate nutritional status,” said David Armstrong, DPM, MD, PhD, professor of surgery and director of the Southern Arizona Limb Salvage Alliance at the University of Arizona in Tucson. “It is to our patients’ detriment that we don’t focus on this. If we ignore our feet, they’re going to go away. And by ignoring our nutrition, maybe we’re ignoring our feet. Whether we’ve taken it seriously in medical or nursing school, I think it’s important that we focus on it as we practice and in the research we do.” For patients with diabetes, evaluating nutritional status starts with evaluating blood glucose levels, which can affect both peripheral neuropathy and wound healing. But even blood sugar management requires more than a cookie-cutter approach, according to Wanda Howell, PhD, RD, university distinguished professor of nutrition science at the University of Arizona. “The emphasis for everybody on a team is to work with people, and follow up over the course of their management of diabetes to try to bring blood sugar within a reasonable ra Continue reading >>

How Does Nutrition Affect Diabetic Foot Ulcers?

How Does Nutrition Affect Diabetic Foot Ulcers?

How does Nutrition Affect Diabetic Foot Ulcers? Diabetic foot ulcers , or non-healing ulcers typically found on the lower extremities affect 15% of people with diabetes, and about 50% of those who do have a diabetic foot ulcer will require amputation . While these statistics may seem daunting, diabetic foot ulcers are 100% preventable. Consistently high blood sugars damage the nerve fibers in your body meaning that your body is not signaling pain properly, and decreasing blood flow to the lower parts of your body. High blood pressure also increases the risk of developing a diabetic foot ulcer. As high blood pressure puts extra stress on your blood vessels, they begin to thicken to protect themselves. Thickened blood vessels also decrease blood flow to the lower parts of your body. Blood carries oxygen to the body which is required for wounds to heal. As you walk on your feet all throughout the day, there is extra pressure, squishing your skin and potentially causing skin breakdown if there is nerve damage and not enough oxygen to make sure that damaged skin can heal. These two combining factors increase the risk of developing a non-healing ulcer. Amputation typically occurs when these wounds are unable to heal for a long period of time, with infection traveling to the bone and threatening to spread infection to the entire body. High blood sugar and blood pressure are the two factors that increase the risk of developing a diabetic foot ulcer. Both these can be managed through proper nutrition and food choices . Controlling blood sugars within a desirable range discussed with your doctor is the best way to prevent nerve damage. This is typically achieved with consistent carbohydrate intake, limiting carb intake to 45-60 grams per meal, and accurately taking medications f Continue reading >>

[full Text] Nutrition In Patients With Chronic Non-healing Ulcers: A Paradigm Shif | Cwcmr

[full Text] Nutrition In Patients With Chronic Non-healing Ulcers: A Paradigm Shif | Cwcmr

Peer reviewers approved by Dr Lucy Goodman Editor who approved publication: Professor Marco Romanelli Thomas E Serena,1 Raphael A Yaakov,1 Mark DeLegge,2 Tim A Mayhugh,1 Sarah Moore1 1SerenaGroup, Cambridge, MA, USA; 2Nutritional Healing LLC, Nashville, TN, USA Abstract: Chronic ulcers continue to pose a significant clinical and economic burden for both patients and wound care practitioners. Despite good standard of care (SOC), many wounds fail to heal. Wound healing requires a complex cascade of physiologic and immunologic processes as well as proper nutrition. An adequate balance of macro- and micronutrients is important to support the cellular activities that are necessary for repairing and remodeling of tissue. Despite being well documented in a number of clinical studies there continues to be a gap in recognizing nutritional deficits as well as appropriate clinical interventions in patients with chronic wounds. Effective management of malnutrition in patients with chronic wounds requires collaboration among multiple clinical disciplines. A holistic nutritional management approach may yield both clinical and economic benefits. Keywords: wound care, chronic wounds, parenteral nutrition, micronutrients, macronutrients, wound healing, nutrition management, malnutrition, nutrition assessment The growing prevalence of diabetes, obesity, changing lifestyle, and the aging population continues to drive an increase in the incidence of chronic wounds. Over 6 million people have chronic wounds in the USA alone and an excess of $20 billion is spent annually on treatment. 1 , 2 While many therapies have become available, management and treatment of chronic ulcers remain a challenge. Approximately a third of diabetic foot ulcer (DFU) patients treated with standard of care (SOC) Continue reading >>

Nutrition 411: The Diabetic Foot Ulcer Can Diet Make A Difference?

Nutrition 411: The Diabetic Foot Ulcer Can Diet Make A Difference?

Nutrition 411: The Diabetic Foot Ulcer Can Diet Make a Difference? Liz Friedrich, MPH, RD, CSG, LDN; and Nancy Collins, PhD, RD, LD/N, FAPWCA The statistics are shocking: 25.8 million Americans, or 8.3% of the population of the US, has been diagnosed with diabetes.1 Among the complications of the disease are diabetic foot ulcers (DFUs), which affect as many as 20% of patients with diabetes during their lifetime.2 DFUs can significantly impair a patients quality of life, require prolonged hospitalization, involve infection and gangrene, and may ultimately result in amputation. The National Pressure Ulcer Advisory Panel (NPUAP) has established evidence-based nutrition recommendations for the prevention and treatment of pressure ulcers. These guidelines focus on increasing micro- and macronutrients to promote wound healing.3 Unfortunately, no such guidelines exist for treating DFUs, and it is unclear if recommendations for pressure ulcers can be extrapolated to DFUs. However, it appears that nutrition does play an important role. A poor diet can result in altered immune function, malnutrition, and poor glycemic control, all of which are risk factors for poor healing.4,5 Achieving and maintaining a healthy body weight can help maximize wound healing because glycemic control can be negatively affected by obesity.6 Healthcare professionals (HCPs) should encourage patients with DFUs to consume a healthy diet that contains nutrient-dense foods. A registered dietitian (RD) skilled in medical nutrition therapy for diabetes can assess, treat, and monitor patients with DFUs to help them meet their complex nutritional needs. Compromised immune function is one factor associated with nonhealing wounds; it affects wound healing in a number of ways.4 Protein-energy malnutrition is asso Continue reading >>

Importance Of Diet & Proper Foot Care In Diabetic Patients

Importance Of Diet & Proper Foot Care In Diabetic Patients

The Importance of Diet and Proper Foot Care for Diabetic Patients Proper foot care is of the utmost importance for diabetic patients. Diabetic patients face a number of painful side effects. The more common ailment is Proper foot care is of the utmost importance for diabetic patients. Diabetic patients face a number of painful side effects. The more common ailment is foot ulcers, in which skin in and around the toes begins to crack and tear, leading to pain and the risk of infection. According to the AmericanPodiatricMedical Association, somewhere between 14 percent and 24 percent of all diabetic patients will develop foot ulcers. Not only that, but as the Agency for Healthcare Research & Quality Effective Health Care Program pointed out, foot ulcers can double the costs usually associated with diabetes management. Its those factors and more that illustrate the importance of self-care for most diabetic patients, specifically as it pertains to a proper dietand ongoing foot care. Without these components, diabetic patients may facemore dire health issues, especially when it comes to proper wound care. Ulcers are the result of neuropathy, in which persistent high blood sugar damages the nerves in the actual foot. High blood pressureis often the result of a poor diet: one lacking the nutrients to address diabetic-specific issues. TheNational Pressure Ulcer Advisory Panel compiled a list of nutrition-based guidelines to help reduce the risk of foot ulcers. These guidelines include: Immune function: Any well-structured nutritionplan should include the right vitamins and minerals. These substances can help improve your immune system, which can help your body heal certain wounds and overcome infections. Diabetics should emphasize zinc, vitamin A, magnesium, vitamin C and coppe Continue reading >>

Poor Nutritional Status: A Risk Factor For Diabetic Foot Ulcers?

Poor Nutritional Status: A Risk Factor For Diabetic Foot Ulcers?

by Mary Ellen Posthauer, RDN, CD, LD, FAND Part 2 in a series discussing nutritional status and diabetic foot ulcer risk. Last month, I discussed the steps that could be taken for a client who is a qualifying beneficiary under Medicare Part B, to receive the services of a dietician for Medical Nutrition Therapy (MNT) and/or to a Diabetes Self Management Training (DSMT) program for assistance in achieving glycemic control. This month we will follow a client though the assessment and treatment process . We will assume Mr. X is a 70-year-old man with Type 2 diabetes and a chronic diabetic foot ulcer. His other diagnosis includes hypertension, which is controlled with medication, hypercholesterolemia and pernicious anemia. His HbA1C runs between 8-9.5%, which is above the desired 7%, and his cholesterol/lipid levels are also elevated. His treatment plan includes a daily oral hypoglycemic, hypertensive medication, a statin, daily multivitamin, and a monthly B12 injection. Mr. X is 68" tall, weighs 250lb with a BMI of 38. His chronic diabetic foot ulcer limits his daily activity so he is sedentary and spends the majority of his day watching television or reading. On his first visit with the dietitian, they discuss his routine meal and snack pattern. In an effort to determine what he actually eats and drinks he is asked to complete a food diary for a week. It is important to not only determine what is eaten but when. For example, if he consumes his meals while watching TV, the dietitian may suggest he eat in another room so he can concentrate on just completing the meal, which will probably reduce the quantity of food he eats. It is important to establish routine meal times and consume a consistent amount of carbohydrate at each meal. Together the dietitian and Mr. X will dis Continue reading >>

Skin Care & The Wound Clinic: Increasing Skin Nutrition With Small Molecule Technology To Promote Healing Of Diabetic Foot Ulcers

Skin Care & The Wound Clinic: Increasing Skin Nutrition With Small Molecule Technology To Promote Healing Of Diabetic Foot Ulcers

Diabetes mellitus has been described as “one of the main threats to human health of the 21st century.”1 According to the most recent (2012) estimate from the American Diabetes Association, 29.1 million Americans live with diabetes.2 The percentage of Americans with diagnosed (or undiagnosed) diabetes continues to rise, and the number of people living with type 2 diabetes is likely to reach epidemic proportions, due in part to poor lifestyle choices such as the consumption of processed foods and poor nutrition habits placing an increasing population at risk.3 In fact, one study projects as many as one in three Americans will live with diabetes by 2050.4 Diabetes is frequently undiagnosed due to many symptoms being ignored, including frequent urination, increased fatigue, and irritability.5 Other early warning signs include certain skin issues.6,7 In fact, at least 30% of patients experience some skin complication, and patients living with diabetes frequently have wounds that are difficult to heal.5,6,8Hyperglycemia affects skin homeostasis by inhibiting fibroblast cell migration,9,10 keratinocyte proliferation, differentiation, migration, and protein biosynthesis, as well as by inducing endothelial cell apoptosis. Hyperglycemia also decreases immune cell functions, including phagocytosis and chemotaxis, and the prevalence of skin infections is frequently increased among diabetes patients.8,11 In addition, patients living with diabetes have up to a 25% lifetime risk of developing a diabetic foot ulcer (DFU),12and DFUs are a leading cause of morbidity that is often preceded by pain, suffering, and poor quality of life for these patients. Furthermore, DFUs are the cause of 84% of all diabetes-related lower leg amputations.13 Increasing Skin Nutrients, Decreasing Oxidati Continue reading >>

(pdf) Nutritional Treatment Of Diabetic Foot Ulcers - A Key To Success

(pdf) Nutritional Treatment Of Diabetic Foot Ulcers - A Key To Success

Diabetic Foot Ulcers (DFUs) represent a frequent occurrence in the diabetic population and up to 15% of these subjects may be expected to develop a foot ulcer at least one time in his/her life1,2. DFUs cause personal, social and economic problems and are a serious risk factor for death3,4. These ulcers can be broadly classified as neuropathic, vascular5 or mixed, although the pathogenesis is much more complex. Biochemical6, hygienic7, structural deformity8,9, dynamic, pressure, skeletal, nutritional, socioeconomic factors, reduced antibacterial activity10,11,12, workplace influences, all concur to cause and maintain the lesion. A multicenter study attributed 63 percent of diabetic foot ulcers to the critical triad of peripheral sensory neuropathy, trauma, and deformity13. Most often healing requires the cooperation of many specialists, including surgeons, podiatrists, wound nurses and endocrinologists. In many cases, the definitive treatment demands minor or major surgery. While the treatment of vascular ulcers is straightforward and requires a bypass or a radiologic procedure if the damage to the limb is to be limited or cured, the treatment of neuropathic ulcers is much more complex. Most often relief of the abnormal pressure does not lead to the healing of the ulcer, rather these wounds are characteristically chronic, with alternating periods of partial improvement and relapse. Sometimes a superimposing infection worsens the clinical condition. These ulcers in general do not lead to major amputation of the limb but frequently cause considerable economic, social and psychological burden on the patient and his relatives. The distinctive characteristic of the diabetic ulcer is the tendency to become chronic. There are many definitions of chronic. The American Heritage Continue reading >>

Treatment Of Diabetic Foot Ulcers With Therapeutic Magnetic Resonance (tmr) Improves The Quality Of Granulation Tissue

Treatment Of Diabetic Foot Ulcers With Therapeutic Magnetic Resonance (tmr) Improves The Quality Of Granulation Tissue

Treatment of diabetic foot ulcers with Therapeutic Magnetic Resonance (TMR) improves the quality of granulation tissue 1 Department of Biomedical Sciences, University of Padua 2 Metabolism Disease and Clinical Nutrition Unit, Santa Maria di Ca Foncello Hospital, Treviso 3 Department of Medicine, University of Pisa, Italy Department of Biomedical Sciences, University of Padua, via Ugo Bassi 58/B, 35131 Padova, Italy. +39.049.8276096. [email protected] Received 2017 Apr 13; Accepted 2017 Jun 25. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License ( by-nc 4.0 ) which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. This article has been cited by other articles in PMC. Diabetic foot ulcers (DFUs) often result in severely adverse outcomes, such as serious infections, hospitalization, and lower extremity amputations. In last few years, to improve the outcome of DFUs, clinicians and researchers put their attention on the application of low intensity pulsating electro- magnetic fields through Therapeutic Magnetic Resonance (TMRR). In our study, patients with DFUs have been divided into two groups: The Sham Group treated with non-functioning TMRR device, and the Active Group treated with a functioning device. Biopsies were recovered from ulcers before and after a 15-day treatment with both kind of TMRR device. To recognize signs of inflammation or healing process, the harvested biopsies were subjected to histological and molecular analyses. The histological analysis showed a change in cell population after treatment with TMRR: an increase of fibroblasts and endothelial cells with a reduction of inflammatory cells. After TMRR application, th Continue reading >>

Nutrition Can Aid In Healing Diabetic Foot Ulcers

Nutrition Can Aid In Healing Diabetic Foot Ulcers

Nutrition can aid in healing diabetic foot ulcers Please provide your email address to receive an email when new articles are posted on this topic. Receive an email when new articles are posted on this topic. In this issue, Susan Weiner, MS, RDN, CDE, CDN, talks with nutrition and wound care expert Nancy Collins, PhD, RDN, LD, NWCC, FAND, about the role of nutrition in prevention and treatment of diabetic foot ulcers. Nutrition is a critical component of healing diabetic foot ulcers, particularly as it relates to immune function, malnutrition, glycemic control, and weight loss and weight maintenance. Diabetes educators should include nutrition assessment and intervention as key components of the overall diabetes treatment plan to help patients with diabetic foot ulcers maximize their nutritional status and promote wound healing. Nutrition is not often the first thing clinicians think of when dealing with diabetic foot ulcers. How important is it, and exactly what role does nutrition play? Collins: Nutrition does indeed play an important role in the prevention and treatment of diabetic foot ulcers. A poor diet can result in altered immune function, malnutrition and poor glycemic control, all of which are risk factors for poor healing. Malnutrition and nutrient deficiencies can impair collagen synthesis, prolong inflammation, decrease phagocytosis causing dysfunction of B and T cells, and decrease the mechanical strength of the skin. Once a patient has a wound, achieving and maintaining a healthy body weight can help maximize wound healing because obesity can negatively affect glycemic control. Often just losing extra weight can help with glucose control and, in turn, wound healing. Of course, weight loss proves very challenging for most patients. This is where referral Continue reading >>

Diabetes And Wound Healing

Diabetes And Wound Healing

Diabetes can cause wounds to heal more slowly. This raises the risk that someone with diabetes will develop infections and other complications. A person who manages their diabetes well can improve wound healing and reduce the chances of developing a serious infection. Those with diabetes may find that different types of wounds are slow to heal. Minor wounds, cuts, and burns are a part of life, but for people with diabetes, they can cause serious health issues. Many people with diabetes develop wounds that are slow to heal or never heal. Wounds that do not heal well can become infected. An infection can spread locally, to surrounding tissue and bone, or to further away areas of the body. In some cases, they may even be fatal. Diabetic foot ulcers affect 15 percent of people with diabetes . These are painful sores that can ultimately lead to foot amputation. Even when a wound does not become infected, it can affect a person's health and quality of life. Cuts or injuries on the feet or legs can make it difficult to walk or exercise without pain. Keeping diabetes under control can reduce the risk of slow-healing wounds and complications, including foot ulcers. A 2013 study found a clear correlation between blood glucose and wound healing. People undergoing surgery for chronic diabetes wounds were more likely to fully heal if their blood glucose was well-controlled at the time of surgery. Diabetes makes it more difficult for the body to manage blood glucose levels. When blood glucose remains chronically high, it impairs the function of white blood cells, resulting in an inability to fight bacteria. Diabetes, particularly if uncontrolled, is also associated with poor circulation. As circulation slows, red blood cells move more slowly. This makes it more difficult for the bod Continue reading >>

Nutrition And Wound Care

Nutrition And Wound Care

Today’s Dietitian Vol. 11 No. 8 P. 12 Diabetes educators routinely talk to patients with diabetes about daily foot care, but what role do nutrition professionals play in preventing and treating wounds in these individuals? According to the American Diabetes Association (ADA), the disease affects nearly 8% of the U.S. population, and its prevalence increased 13.5% from 2005 to 2007. Optimum diabetes management has been shown to minimize the risk of complications such as retinopathy, nephropathy, neuropathy, ischemic heart disease, cerebrovascular disease, and peripheral arterial disease. About 60% to 70% of people with diabetes have some type of nervous system damage that can include impaired sensation in the extremities. More than 60% of all nontraumatic lower limb amputations are performed on people with diabetes, a rate 10 times higher than for people without diabetes, according to the ADA. The circulation and nerve damage that often occur in diabetes combine to make wound healing more problematic, leading many physicians to categorize diabetic foot wounds as the most common chronic wounds in the world. Even more frightening for people with diabetes, one half of amputees die within 18 months, and 80% won’t survive five years, according to a 2008 Diabetes Forecast article. According to Nancy Collins, PhD, RD, LD/N, FAPWCA, founder and executive director of RD411.com and a recognized authority on nutrition and wound care, there are no evidence-based nutrition therapy guidelines for diabetic wound care. But we can extrapolate appropriate therapy using research and guidelines for other types of wounds, especially pressure ulcers. The National Pressure Ulcer Advisory Panel (NPUAP) released a white paper on the role of nutrition in pressure ulcer prevention and treatmen Continue reading >>

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