Re: anemia, elevated d-dimer

'Sorry for another delay!  There's a LOT of info here, so you may want to scan everything, then come back to go over the details.  I've pasted the majority of info from links/bookmarks - and those that are inset are from various websites.  You can Google partial phrases if you want to find the actual sources.  Everything in [brackets] are comments from me.

Went to ER for the pain under right side. Blood work showed no liver problems or any of that still.

Still? In February you posted with elevated liver enzymes and low protein; about a month ago this: 

>>> just had lab results back with elevated amylase levels, and last time I had elevated liver enzymes, so now my pancreas is going bad too. <<<

Elevated amylase can certainly indicate various levels of pancreatic compromise. But one can elevated amylase levels when NOTHING is wrong with the pancreas; in fact, more amylase is created/excreted by the salivary glands than by the prancreas.  There's a grave risk in 'believing' in test results (and how the average physician remembers to interpret them).  Here are several examples of non-pancreatic causes of hyperamylasemia:

The exact mechanisms of serum amylase metabolism are still not fully understood. Humans who have had a nephrectomy or have renal insufficiency have average serum amylase levels 50% higher than healthy individuals. Therefore, the kidneys can be assumed to play a major role in amylase metabolism. However, the kidney is not the sole organ responsible for amylase clearance in humans. The extrarenal mechanisms of amylase clearance have not been clearly defined.

Because of the high serum amylase levels also observed in hepatic necrosis and cirrhosis, the liver is thought to play a role in amylase metabolism.

Renal failure results in increased S-type and P-type isoamylases.

Liver disease from hepatitis or cirrhosis also results in increased S-type and P-type isoamylases. [the symptoms associated with hepatitis & cirrhosis commonly correlate to those of a congested liver]

Parotitis is associated with increases in the S-type isoamylase. Parotitis is usually caused by trauma or surgery to the salivary gland, radiation to the neck area involving the parotid gland and subsequently causing duct obstruction, or calculi of the salivary duct.^{[2, 3, 4]}

Another cause of damage to the salivary gland is from chronic alcoholism. Salivary amylase levels are 3 times higher than normal in 10% of patients with alcoholism; this may be related to chronic liver disease.  [any condition causing excessive saliva can cause elevated amylase levels; liver flukes can cause excessive saliva & night time drooling]

Gut diseases, including mucosal inflammatory disease of the small intestine, mesenteric infarction, intestinal obstruction, appendicitis, and peritonitis, usually result in increased P-type isoamylase because of increased absorption of amylase from the intestinal lumen. Gut perforation leaks the contents into the peritoneum causing inflammation and absorption of amylase across the inflamed peritoneum. This can result in hyperamylasemia.

Intestinal obstruction - is a possible cause of elevated blood amylase and lipase. With this condition, partially digested food and fecal material are unable to pass through the intestines. According to the University of Maryland Medical Center, tumors, loss of intestinal motility, kinks in the intestine, hernias, and scar tissue may precipitate intestinal obstruction. Amylase and lipase are frequently elevated with this condition due to a backup of digestive fluids in the intestine.

Cholecystitis - Inflammation of the gallbladder is termed, cholecystitis. In most cases, cholecystitis occurs due to gallstones, explains Penn State College of Medicine's Hershey Medical Center. Cholecystitis may cause elevations in blood amylase and lipase.

 

Did show anemia, and a slightly elevated d-dimer which indicates inflammation I guess.  The full name of the d-dimer test is 'fibrin degradation fragment'.  When fibrin is excessive, broken down rapidly or fibrin is not cleared normally, d-dimer is elevated.  One reason for an elevated d-dimer is liver compromise/disease. 

What is fibrin?

Web definitions

• a white insoluble fibrous protein formed by the action of thrombin on fibrinogen when blood clots; it forms a network that traps red cells and platelets

• Fibrin (also called Factor Ia) is a fibrous protein involved in the clotting of blood, and is non-globular. It is a fibrillar protein that is polymerised to form a "mesh" that forms a hemostatic plug or clot (in conjunction with platelets) over a wound site.

• The primary end product of the coagulation cascade. Fibrin links itself into strands to form a net. This net traps blood cells and tightens itself through cross-linkages, resulting in a dense blood clot.

• This is a solid substance (formed from fibrinogen) that makes a clot harder to break up. It forms the mesh or net that holds platelets in place.

Below are a couple of excerpts of Dr Christopher and Dr. Shook on fibrin (remember, testing high on a d-dtimer does not necessarily mean you have excess fibrin (however, liver flukes & fibrin go hand in hand). First a modern definition of 'catarrh' (healers over the decades have used the word: catarrh to indicate all kinds of of congestion, build-up & mucous).  We now know that mucus discharges (as we have with cold) are a result of the immune system causing swelling that helps create the mucus that is beneficial in combatting pathogens.  However we also know that modulating the immune system with echinacea results in killing the pathogen without the inflammation & mucus production.  So it definitely may be that this swelling/mucus thing is not a normal/natural immune response, but one that happens because our immune system is so compromised.

ca·tarrh

noun /kəˈtär/ 

Excessive discharge or buildup of mucus in the nose or throat, associated with inflammation of the mucous membrane

***

Cleansing and purifying the body of catarrhal defilements:
Many of the demulcents and especially the expectorants are anti-catarrhal agents, and these are particularly valuable in purifying and cleansing the system. "It has often been said," wrote Dr. Shook, "that catarrh is the greatest curse of mankind. It may be a problem to many people, but we are not prepared to say that it is the greatest curse. In fact, in one sense, it may be one of the greatest blessings, for the simple reason that the annoyance it causes tends to call attention to a very distressing condition. Catarrh is nature's warning signal that a thorough cleansing is needed to assist the faltering eliminative organs.

A mucoid condition is often a consequence of partial decomposition or disintegration of blood plasma due to a nutritional shortage of potassium chloride, the element that chloride, the element that enables the fibrin to remain in solution in the blood. Pertaining to the origin and nature of catarrh, Dr. Shook explains further: In all inflammatory processes, there is an exudation or sweating out of fibrin from the blood into the surrounding tissue. This exuded fibrin becomes non-functional and insoluble. No new fibrin can be formed without the aid of potassium chloride. When the exudation of fibrin is from the mucous membrane, it is called catarrh. Advanced stages of fibrinous exudation in different organs and tissues is variously named cystitis, cysts, adhesions, etc. When the exudation of fibrin is excessive, the chemical balance of the blood is upset, and nature calls for potassium and chlorine. If potassium chloride is not available, the body will take these two elements from any other compound containing them, such as potassium phosphate (thus robbing the nerves) or calcium chloride (which robs the heart muscle) and so on and on until a whole series of unbalanced conditions are created which are given fancy names and made profoundly mysterious, because we consume so much sodium chloride and so little potassium chloride. Nature provides an abundance of potash and chlorine in food and herbs. Dr. Shook includes the following: bladder wrack, Irish moss, greater celand, elecampane, gravel root, wild yam, couchgrass, stinging nettle, pleurisy root, gum plant, wild cherry bark, apple (fruit, bark, apple cider vinegar), etc.

As a matter of fact, the antilithic, lithotriptic, and anticatarrhal herbs contain this most important element (potassium chloride) which enables the fibrin to become soluble again, restoring the balance to the blood, and thereby eliminating further exudations.

***

Question: What could be done for hard cartilage-like materials deposited under the skin?

Answer: Deposits of this type are generally derived from a fibrin material.  Fibrin is made by combining collagen (and albuminoid, the main organic constituent of connecting tissue and of the organic substance of the bone).  Changeable by boiling into glue or gelatin (with potassium chloride [KC 1] ).  This is a salt very similar to sodium chloride (NaC1), but very different in its chemical effects upon the various cells and tissues of the body.  It is found in the blood and lymph.  By its action on collagen (which as explained is a particular gelatinoid), it forms fibrin.  This fibrin is the builder of muscular and ligamentous structures, but unless there is sufficient potassium chloride in the blood to keep it in solution, the fibrin is thrown out as a stringy, insoluble mess which forms an excess of phlegm and catarrhal mucoid matter.  All forms of catarrh are caused in this way, as are fibroid tumors and adhesions.  Fibrin is a viscid, sticky substance which coagulates the blood when it is exposed to air or oxygen.

As you can see, the body needs plenty of potassium chloride to keep the fibrin in solution and build muscles and tissue where needed instead of coagulating and forming fibrin cysts or tumors under the skin, in various organs, or in other words where we don't want them.

To work locally on the swollen area, there is the fomentation of comfrey combination (a number of herbs combined) which we also call "bone, flesh and cartilage combination" BF&C} because of the way it acts. 
Potassium Chloride is plentiful in Comfrey, Marshmallow, Mullein and Black Walnut.  All of these are well supplied with this much needed Potassium Chloride to fight fibrin malfunction.  This formula also has a fine solvent Gravel Root in it for breaking up inorganic calcium accumulation in the unnatural swollen area.  Use as a fomentation over swollen area all night each night six days a week and drink one cup a.m. and p.m. each day.

Another great aid to increase the various Potassium Salts for healing in the body is a formula called Potassium broth.  It is made up by low heating a vegetable combination of thick potato peelings, celery stalks and leaves, beet and carrot tops, garlic and onion, black pepper corns and any other greens, such as Comfrey, Marshmallow Plants, Chickweed, etc.  The onion and garlic not only add flavor but also power to kill infection and the black pepper corns are a stimulant and also to add flavor to the Potassium formula.

***

They were checking for a pulmonary embolism blood clot in lung. I've not seen anything in your recent posts (or ever) that would indicate a pulmonary embolism --but hey, 'running needless tests to cover their butts' is part of their game-plan...along with intimidating us with the results (and then using that to manipulate the game).  There's even an article on Pubmed about the overuse of d-dimer testing.  But inflammation I think coulda been anywhere.

Here's a few other snippets that go along with your tests & issues.  I realize that these info-bytes are 'selective'; please understand that my purpose is not to "prove" to you that you have extreme liver compromise & likely a major fluke/parasite infestation, my purpose is to show you just how far off these tests, allopathy (and our own interpretation & discernment) can actually be!  Personally, I think you do have extreme liver compromise, congestion and flukes...particularly now that you've reacted so 'aggressively' to aggressive parasite treatment.  But it's my job to share information and teach - NOT to diagnose.

This first set is from the Merck Vet Manual (we can learn a LOT from vet/animal science, because the doctors/researchers are much more honest & much less conditioned by the pharmaceutical cartel); this is especially true with parasite issues (which vets definitely research completely & 'believe in' - but allopathic MDs definitely do not).

Weight loss is a common clinical sign in chronic liver disease.  [Any type of congestion or compromise degrades the liver's clearance of ammonia; benzodiazepines and liver flukes substantially increase ammonia levels.  I believe you're on the right track when suspecting hyperammonemia - something I'm continue to research.  However, I also believe that you still underestimate your 'benzo reactions', because many of the symptoms you post (particularly mental/emotional) don't correlate with excess ammonia or liver compromise, but do correlate with benzo withdrawal (and you've consistently posted many of the same symptoms/& issues in the past].

The clinical signs and severity of hepatic pathology reflect the degree of compromise of one or more of the liver’s vital functions, including blood glucose regulation; fat metabolism; production of clotting factors, albumin, fibrinogen, nonessential amino acids, and plasma proteins; bile formation and excretion; bilirubin and cholesterol metabolism; conversion of ammonia to urea; polypeptide and steroid hormone metabolism; synthesis of 25-hydroxycholecalciferol; and metabolism and/or detoxification of many drugs and toxins.

...pain may be localized to the liver by palpation over the anterior ventrolateral aspect of the abdomen or the last few ribs on the right side. Tenesmus [straining to defecate - may be painful or inneffective}.followed by rectal prolapse is seen in some ruminants with liver disease. It may be associated with diarrhea, hepatic encephalopathy, or edema of the bowel from portal hypertension. [All manner of hemorrhoids, swelling, prolapse, rectal pain & sensitivity can be caused by portal hypertension; when the liver is congested/compromised the pressure in the portal vein is typically elevated - sometimes severely.  Rocky's second liver flush produced a thrombosed/external hemorrhoid.  It seems clear to me that this portal hypertension is what causes it to be so difficult to retain CE's]

Anemia may be seen in animals with liver dysfunction due to parasitic diseases [parasites are well-known to cause anemia in humans]

Anemia in acute fascioliasis [fascioliasis is 'liver fluke disease'] results from severe hemorrhage into the peritoneal cavity as the larvae penetrate the liver capsule. Trauma and feeding activity of adult flukes within the bile ducts cause anemia and hypoproteinemia in animals with chronic fascioliasis  [Any sort of hemorrhage in the peritoneal cavity could 'test' as a bleeding ulcer].  Remember, I'm not saying that I "know" you don't have an ulcer.

A high fibrinogen concentration is associated with an inflammatory response in horses with cholangiohepatitis.  [“chol” (bile), “angio” (vessel), hepat (liver) and “itis” (inflammation) - hence cholangiohepatitis is basically inflammation of the biliary ducts throughout the liver

So, you could have tested 'high' on the d-dimter and amylase for reasons that have nothing to do with what they indicated or what you discerned.  Parasites & liver congestion could cause the same test results.

They said it was most likely a duodenal ulcer(hopefully). It appears that you've accepted what you where told at the ER is 'likely enough' that you are planning to treat yourself accordingly.  I certainly hope I'm wrong and that you've (at least) learned that it's very risky to depend upon allopathic medicine for a correct diagnosis, and it's virtually impossible to learn the cause of anything from them.

So for the anemia i'm thinking black strap molasses? Blackstrap is great for anemia.  The best herbal combo I know of is Dr. Christopher's Yellow Dock Tea combination. and the ulcer I have no idea, white oak bark? licorice root? it's been a constant burning throbing pain for 3 days now with no relief. Started slipperly elm and glutamine again last night, still immense pain upon waking. Did castor pack last night too.  Ulcers are typically caused by H. Pylori...which can be eradicated with cayenne powder & mastic gum (it's very benecial to ensure the stomach is producing enough [and acidic enough] stomach acid...as H. Pylori cannot live in high stomach acid).  In fact, one of the reasons there's such an increase in ulcers is the increase in use/prescriptions of drugs that lower stomach acid (production & acidity).

Glutamine hmmm? 'Any idea which amino-acid/chemical the brain is dangerously over-saturated with in the presence of excess ammonia?  Yep, glutamine.  Glutamine IS an essential part of the 'urea cycle' (which assists in breaking down ammonia to be removed by the kidneys - something for which primarily falls on the liver).  But when the liver cannot break ammonia down into urea (too much ammonia, liver too compromised), then the brain cells (astrocytes specifically) become overloaded with glutamine/water and start to swell (hence the mental/emotional and neurological symptoms seen in hyperammonemia).  The pH of ammonia is 11.5-ish...hence excess ammonia = excess alkalinity.  Guess what isolated amino acid increases alkalinity?  Yep, glutamine.

If you're dealing with excess ammonia (and that's a very likely possibility, since flukes and benzos elevate ammonia levels, and a compromised liver can't neutralize normal amounts of ammonia effectively enough to prevent hyperammonemia), then taking glutamine would increase the emotional/mental symptoms caused by the brain cell swelling AND increase alkalinity even further.

Warnings & possible adverse effects from glutamine:

--Do not take glutamine if you have severe liver disease with difficulty thinking or confusion (hepatic encephalopathy): Glutamine could make this condition worse. Don’t use it.

--Upper Respiratory Problems - Taking too much glutamine can cause upper respiratory problems, according to MayoClinic.com. You may experience a sore throat, mouth pain, dry mouth, runny nose, hearing problems, difficulty swallowing, chest tightness, wheezing, shortness of breath, swollen glands, stuffy nose, bad breath, unquenchable thirst, voice changes, headaches, cough and/or hoarseness when supplementing glutamine.

--Urination Problems - Excessive amounts of glutamine can cause urination problems. Dark urine, a sudden decrease in urine production, pain or a burning sensation during urination, frequent urination and/or lower back pain may signal that you are taking too much glutamine, according to MayoClinic.com

--Gastrointestinal Problems - Glutamine side effects are rare, but if you take too much of the supplement then you may experience gastrointestinal problems such as an upset stomach, loss of appetite, indigestion, vomiting, nausea, bloating, gas, flatulence, rectal bleeding, constipation, abdominal swelling, bloody stools, frequent urge to defecate, straining during bowel movements, pale colored stools, anal swelling or diarrhea. Persistent diarrhea can decrease the body of fluids and lead to dehydration.

--The Mayo Clinic recommends that medical attention be sought immediately if an individual experiences any of the following severe side effects: blood in urine or stool, blood circulation problems where hands and feet become cold or tingly, darkening of skin color, rapid heart rate or breathing, and loss of consciousness.

--Other side effects of glutamine are chills, fevers, joint pain, body aches, sore throat, stiffness, and coughing according to PDRhealth.com

--There are some concerns that glutamine could cause certain side effects based on how it works in the body. However, these theoretical problems have not been shown to be a concern in humans. Since rapidly growing tumor cells use glutamine as a fuel, there is concern that the supplement may cause or worsen cancer, although studies have not shown this to be the case.
 
--There is also concern that high doses of glutamine could cause side effects in the brain, such as psychological problems, due to a buildup of glutamate and ammonia, since the body can break down glutamine into ammonia and glutamate. In theory, the supplement may also increase the risk of seizures.
 
Mercola on glutamine (helpful or harmful?) articles.mercola.com/sites/articles/archive/2004/05/01/glutamine.aspx

Absolutely no human being (or computer) can know or predict the 'end result' of ingesting isolated chemicals.  Playing "supplement roulette" is always a VERY risky game.

I mentioned before that I'm working on a long post regarding excess ammonia (and being too alkaline - I may not have mentioned the alkaline part).  Here are the symptoms lists of hyperammonemia and alkalosis:

Symptoms of alkalosis

--slowed breathing
--confusion (that can progress to stupor or coma)
--irritability
--episodes of apnea (not breathing) - that may last up to 15 seconds
--cyanosis (blue/purple discoloration of skin from inadequate oxygen intake
--nausea, vomiting, diarrhea
--numbness or tingling in the face, hands, or feet
--twitching
--hand tremors
--rapid or irregular heatbeat
--low blood pressure
--picking at bedclothes (?)
--prolonged muscle spasms (tetany)
--convulsions
--coma

Symptoms of hyperammonemia

--inverted sleep/wake pattern
--altered cortisol levels/patterns
--lowered body temperature (hypothermia)
--irritability/combativeness
--disorientation
--lethargy & somnolence
--obtundation - mild to moderate reduction in alertness with slow response to stimulation, decreased interest in environment, and increased number of hours of sleep
--impairment or inability to perform rapidly alternating movement (dysdiadochokinesia)
--weight loss/anorexia (particularly 'muscle wasting')
--tremors
--papilledema - swelling of the optic disc (where the optic nerve enters the eyeball); usually associated with an increase in intraocular pressure
--ataxia (a neurological sign and symptom that consists of gross lack of coordination of muscle movements)
--shortness of breath - with heavy or rapid breathing
--liver enlargement
--cerebral edema
--alkalosis (due to stimulation of the respiratory drive due to ammonia, coupled with alkalinity of ammonia)
--hyperpnea OR hypopnea

   hyperpnea is energetic (deep and rapid) respiration; tachypnea is a faster than normal respiratory rate.

--hypotonia  OR hypertonia

 Hypotonia - low muscle tone, not to be confused with muscle strength, implies a certain amount of looseness or floppiness of joints; low muscle tension

 Hypertonia occurs in muscles when they have an increased level of resting activity, and an increase in resistance to stretch; spasticity; rigidity; tension

--decerebrate/decorticate posturing

Abnormal posturing is an involuntary flexion or extension of the arms and legs, indicating severe brain injury. It occurs when one set of muscles becomes incapacitated while the opposing set is not, and an external stimulus such as pain causes the working set of muscles to contract

--asterixis - Flapping movement of the hands that happens when the brain is affected by toxins (like ammonia) that are not being removed by the sick liver.
--seizures
--coma
--death

***
I've also had lots of trouble sleeping, I have to take about a tablespoon of salt and the orinthine just to sleep. I'll lay there and it'll feel hard to breathe, i'll feel very sick and very out of it mentally.  Of course, first-always identify your 'benzo status'...symptoms DO change (and common ones lessen and/or intensify) as you continue to lessen the doses.  In fact, many people find the final cuts to be the most symptomatic.  I know that's seriously tough when one is 'down to wire' and close to getting off - but don't let that cause you to increase the size of the cuts, or it will take you even longer to get off.    A tablespoon of salt daily is totally outrageous...and no matter what symptom it's bandaiding, it's worsening others (and stressing your body immensely).  Excess ammonia is a very common cause of cortisol disruption which causes insomnia and an 'inverted sleep/wake pattern'.  If you're able to sleep, but not at night...that'd definitely on the 'must consider' list.

I started the zapping, ozonated olive oil, l cysteine, and did the coq10 3grams. Immense pain since coq10. Felt parasites crawling out my eye, even saw one. Seeing & feeling parasites is always unnerving - seeing them come out to places other than the commode is especially tough.  I struggle right along with you when I read your posts, jboy.  I know it doesn't change anything, but I do care a lot (and I'm more empathic than I ever talk about).  The zapper gives me extreme anxiety and makes me feel like crap. I hate it,  If the zapper is killing critters, it'll do that.  If it's causing an 'emf overload', it'll do that.  I've been taking the IF2 as tolerable. Be cautious - you already know that the charcoal & bentonite can & will reduce the blood level of the Valium. But was taking triphala to really clean bowel. Triphala doesn't "clean" the bowels, it just 'makes you go'.  Tried juicing/superfood, just can't do it, my body needs solid food.  Your body NEEDS to assimilate nutrients desperately, and juicing/Superfood will get the nutrients into your bloodstream faster than ANY solid food.  However, if you do have issues with high ammonia levels (which = excess alkalinity) then eating/drinking strongly alkaline foods would worsen the symptoms of alkalosis.  Try juicing fruits/veggies that fall on the 'acid side' of the acid/alkaline charts and see how that makes you feel.

I assume the zapper, ozonated oil & coq10 are for parasites - why the cysteine?  What's your benzo status these days?

Anyways, that's all I got. Gonna go take some elm and glutamine and hope this stupid pain goes away. Either it's an ulcer, or a parasite bundle trying to hide from the zapping and ozonated oil.  I hope you're feeling better.  I know you'll feel a LOT better when you get rid of the critters!

Recomendations (?) - Lady's Slipper for inducing sleep (and slowing/calming 'racy brain' - if you need that); Yellow Dock tea for anemia; at the very least, one CE daily (2-3 would be better).  CE's definitely help lower ammonia levels, reduce pain ensure bowel activity...not to mention helping to keep the bile flowing and push the dead/degrading carcasses OUT.

Ok thanks, No changes really. The pain went completely away yesterday doing a salt flush, eating only oatbran/rice bran and kefir. and taking slippery elm. No pain is a very good thing - yay!  Yet pain is our bodies way of telling us something is wrong, so we want to find the true cause as soon as possible.  A tablespoon of salt at night and a salt water flush?  Dude! Be VERY careful with the salt, please. Saving up money to do a lyme test.  'Symptoms that make you think "lyme"?

jboy, I know how frustrating (and scary) it is to be in pain - and it's made worse by not knowing why.  Of course, the stress, worry & concern of all that just increases the pain.   Please be careful when using isolated supplement (you know I'd prefer that you didn't at all; but if you feel you must, be SURE to learn as much as possible first).  It's all too easy to 'do harm' whenever we give our body anything that's unnatural - and when we're compromised & desperate we can easily end up making things worse. 

I know that you can find your way through all of this effectively and safely!  I know you don't have the time and/or mental clarity to do the research on EMFs/EMRs, but I know that if you did, you'd understand how imperative it is to do everything you can to reduce & eliminate exposure.  ALL of the mental/emotional symptoms you post can also be caused by these insidious frequencies - and while you're dealing with other issues that can cause the same physical issues that cause the emotional/mental symptoms, the very last thing you need is yet another physical 'cause'!  Remember to get outside barefoot a couple of times a day; be Earthed/grounded as much as possible (but be sure to notice if being grounded around wifi and other intense generators makes it worse); be sure the cell phones are off when not essential, and never-ever sleep with the wifi on or with a cell phone in your room.  And don't forget EFT!  Stress; worry; anxiety; fear...ALL these things worsen physical issues.  Hot/cold showers working for flushing out toxic emotions, just like an herbal cleanse.  Killing parasites can cause all kinds of mental issues, so whenever you feel yourself 'going crazy', remember to stop; breath deeply; tell yourself that you're totally normal to be experiencing whatever emotion you may be dealing with... and then avail yourself to a therapy that will help you through it.   

Don't ever believe you can't get through it!  Don't ever assume things are worse than they are!  Always remember that you CAN cure yourself!  And most of all, remember that I/we do believe you, and we know that the world is a much better place because you're in it!

Blessings -

Uny

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