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Elderly Immune System Needs A Boost: Older Cancer Sufferers Need Treatments Tailored To Their Aging Immune Systems

Mar 19

ScienceDaily (Oct. 14, 2009) — Elderly cancer patients need a combination of treatments tailor-made to their specific needs to successfully combat the disease. The challenge is to boost their immune response to cancer vaccines, Story Source:

Adapted from materials provided by Springer.

Journal Reference:

1. Lustgarten J. Cancer, aging and immunotherapy: lessons learned from animal models. Cancer Immunology Immunotherapy, 2009; 58 (12): 1979 DOI: 10.1007/s00262-009-0677-8

because like the rest of our organs, our immune system ages and gradually becomes less efficient as we get older.

See Also:

Health & Medicine

* Immune System

* Lymphoma

* Lupus

* Diseases and Conditions

* Elder Care

* Human Biology

Reference

* Transplant rejection

* Natural killer cell

* Immune system

* Inflammation of the kidney

Dr. Joseph Lustgarten, from the Mayo Clinic College of Medicine in the US, reviews the effects of aging on the immune system and strategies used to activate a stronger antitumor immune response in the elderly, including genetic modifications in animal models. His findings1 have just been published in the latest issue of Springer’s journal Cancer Immunology, Immunotherapy.

Aging of the immune system coincides with higher rates of cancer in the elderly. There is a wealth of research on the effects of harnessing the power of the body’s own immune defences to recognize and destroy tumors (immunotherapy), yet very little of this work takes into account the effects of aging on the immune system. Older individuals do not respond to vaccine therapy as well as younger adults.

Dr. Lustgarten’s paper summarizes some of the defects found in the old immune system which affect antitumor responses; strategies used to improve the efficiency of older people’s immune response; and the use of animal models to identify how it might be possible to manipulate the old immune system, for more effective immunotherapeutic interventions in older patients.

Vaccination strategies that effectively stimulate antitumor immune responses in both younger and older patients are dependent on combining different therapies. The therapies must keep the balance between activating a safe and effective antitumor immune response and inducing an autoimmune reaction.

Dr Lustgarten concludes: “The immune system of the elderly is very different from the young and it is difficult to extrapolate results obtained in the young, for use in the old. Our job in the next few years is to figure out how to robust the old immune system by understanding, at a molecular level, its intrinsic defects to properly stimulate antitumor responses. Only then can we successfully customize tumor vaccines to be effective for the treatment of tumors in the old.”

Story Source:

Adapted from materials provided by Springer.

Journal Reference:

1. Lustgarten J. Cancer, aging and immunotherapy: lessons learned from animal models. Cancer Immunology Immunotherapy, 2009; 58 (12): 1979 DOI: 10.1007/s00262-009-0677-8

Popularity: 5% [?]

Trouble Sleeping Leads To Increased Ratings Of Pain In Cancer Patients, Study Suggests

Mar 04

ScienceDaily
A new study suggests that sleep problems lead to increased pain and fatigue in cancer patients. The results indicate that interventions aimed at trouble sleeping would be expected to improve both pain and fatigue in this patient population.
Results show that more than half the sample reported having trouble sleeping, with 26 percent reporting moderate or severe trouble sleeping. Compared with patients who reported no trouble sleeping, patients with moderate to severe trouble sleeping reported significantly more fatigue, pain and depressed mood. Using structural equation modeling analysis to evaluate causal relations and directions of effect, the best-fitting model indicates that trouble sleeping led to increased ratings of pain.
According to the authors, the relationship between pain and sleep often has been assumed to be reciprocal. In the present study, however, a model of reciprocal causation could not be fit to the data, and models in which pain caused trouble sleeping did not fit as well as the model in which trouble sleeping caused pain.
“We believed we would find a bi-directional relationship between insomnia and pain, but instead found that trouble sleeping was more likely a cause, rather than a consequence, of pain in patients with cancer,” said lead author Edward J. Stepanski, chief operational officer at the Accelerated Community Oncology Research Network in Memphis, Tenn.
The study included demographic, clinical and patient-reported outcomes data from 11,445 cancer patients undergoing treatment at the West Clinic, a large community oncology practice in Memphis. Participants had an average age of 61.5 years, and 74 percent were female. Breast cancer was the most common form of cancer, and about 25 percent of study subjects had received chemotherapy in the last 30 days. Increases in depressed mood also led to increased ratings of pain.
Younger age and recent administration of chemotherapy were both associated with increased trouble sleeping. According to the authors, younger patients often receive more aggressive chemotherapy than older patients; therefore, younger patients may be exposed to more treatment-related toxicity.
Stepanski stated that several studies have shown that cognitive behavioral therapy (CBT) improves sleep in cancer patients who have insomnia. He believes that this type of intervention may decrease patients’ pain and fatigue by improving their sleep.

Adapted from materials provided by American Academy of Sleep Medicine, via EurekAlert!, a service of AAAS.
Journal Reference:
1.The Relation of Trouble Sleeping, Depressed Mood, Pain, and Fatigue in Patients with Cancer. Journal of Clinical Sleep Medicine, April 15, 2009

Popularity: 3% [?]

An Apple a Day? Study Shows Soluble Fiber Boosts Immune System

Mar 04

ScienceDaily (Mar. 2, 2010) — A new University of Illinois study touts the benefits of soluble fiber — found in oats, apples, and nuts, for starters — saying that it reduces the inflammation associated with obesity-related diseases and strengthens the immune system.
“Soluble fiber changes the personality of immune cells — they go from being pro-inflammatory, angry cells to anti-inflammatory, healing cells that help us recover faster from infection,” said Gregory Freund, a professor in the U of I’s College of Medicine and a faculty member in the College of Agriculture, Consumer and Environmental Sciences’ Division of Nutritional Sciences.
This happens because soluble fiber causes increased production of an anti-inflammatory protein called interleukin-4, he said.
The study will appear in the May 2010 issue of Brain, Behavior, and Immunity and is available online now.
In the experiment, laboratory mice consumed low-fat diets that were identical except that they contained either soluble or insoluble fiber. After six weeks on the diet, the animals had distinctly different responses when the scientists induced illness by introducing a substance (lipopolysaccharide) that causes the body to mimic a bacterial infection.
“Two hours after lipopolysaccharide injection, the mice fed soluble fiber were only half as sick as the other group, and they recovered 50 percent sooner. And the differences between the groups continued to be pronounced all the way out to 24 hours,” said Christina Sherry, who also worked on the study.
“In only six weeks, these animals had profound, positive changes in their immune systems,” she said.
known that obesity is linked to inflammatory conditions, such as diabetes and heart disease.
Yet, in a recent study, the U of I scientists demonstrated that fat tissue produces hormones that appear to compensate for this inflammation. “There are significant anti-inflammatory components in fat tissue and, if they were strategically unleashed, they could potentially protect obese people from further inflammatory insults, such as a heart attack or stroke. In obese animals, you can see the body compensating in an effort to protect itself,” he said.
Not all fat is bad, the researcher noted. The Mediterranean diet, which receives high marks for its health benefits, includes such foods as olive oil; salmon, tuna, sardines, and trout, which contain important omega-3 and -6 fatty acids; and plant sources of fat, such as flaxseed.
“Now we’d like to find a way to keep some of the anti-inflammatory, positive effects that develop over time with a high-fat diet while reducing that diet’s negative effects, such as high blood glucose and high triglycerides. It’s possible that supplementing a high-fat diet with soluble fiber could do that, even delaying the onset of diabetes,” he said.
This study is one of the first to provide two valuable lessons, said Sherry. The first, already noted, is that soluble fiber has direct anti-inflammatory effects and builds up the immune system. The second is that the amount of soluble fiber necessary to achieve these health benefits is a reasonable, not a pharmacological, amount.
The recommended daily dietary recommendation is 28 to 35 grams of total fiber, but most of the FDA’s health claims are for insoluble fiber, and that’s where things get a bit complicated, she said.
“Not all fiber is created equal, although you wouldn’t know that by reading nutrition labels,” said Sherry. “Most manufacturers don’t tell you how much of each type of fiber a food contains, and we think it’s important that this information be included on a product’s packaging.”
Good sources of soluble fiber are oat bran, barley, nuts, seeds, lentils, citrus fruits, apples, strawberries, and carrots. “We used a citrus-based pectin in our study,” Sherry said.
Insoluble fiber, found in whole wheat and whole-grain products, wheat bran, and green, leafy vegetables, is also valuable for providing bulk and helping food move through the digestive system, but it doesn’t provide the boost to the immune system that soluble fiber provides.
Co-authors are Stephanie S. Kim, Ryan N. Dilger, Laura L. Bauer, Morgan L. Moon, Richard I. Tapping, George C. Fahey Jr., and Kelly A. Tappenden, all from the U of I. Sherry is now a postdoctoral fellow at the University of Michigan. The research was funded by the National Institutes of Health, the American Heart Association, and the USDA among others.

________________________________________
Story Source:
Adapted from materials provided by University of Illinois at Urbana-Champaign, via EurekAlert!, a service of AAAS.

Popularity: 3% [?]

Top 20 list of high Antioxidant foods

Oct 11

Liz Weiss, MS, RD is a dietitian and co-author of THE MOMS’ GUIDE TO MEAL MAKEOVERS and hosts this segment.

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8 Ways You Can Stay Healthy at Work

Oct 10

If your business uses text messages here are some you can send to your workforce: Wash hands so You can protect yourself and others by following these key action steps.

1. Maintain a healthy lifestyle through rest, diet, exercise, and relaxation.
2. Wash your hands frequently with soap and water for 20 seconds or use an alcohol-based hand cleaner if soap and water are not available. Be sure to wash your hands after coughing, sneezing, or blowing your nose.
3. Avoid touching your nose, mouth, and eyes. Germs spread this way.
4. Cover your coughs and sneezes with a tissue, or cough and sneeze into your elbow. Dispose of tissues in no-touch trash receptacles.
5. Keep frequently touched common surfaces clean, such as telephones, computer keyboards, doorknobs, etc.
6. Do not use other workers’ phones, desks, offices, or other work tools and equipment. If you need to use a co-worker’s phone, desk, or other equipment, clean it first.
7. Don’t spread the flu! If you are sick with flu-like illness, stay home. Symptoms of flu include fever (100 degrees Fahrenheit or 38 degrees Celsius) or chills and cough or sore throat. In addition, symptoms of flu can include runny nose, body aches, headache, tiredness, diarrhea, or vomiting. CDC recommends that sick workers stay home if they are sick with flu-like illness until at least 24 hours after they are free of fever without the use of fever-reducing medicines.
8. Get vaccinated against seasonal flu, when vaccine is available in your area. If you are at higher risk for 2009 H1N1 flu complications you should receive the 2009 H1N1 flu vaccine when it becomes available. People at higher risk for 2009 H1N1 flu complications include pregnant women and people with chronic medical conditions (such as asthma, heart disease, or diabetes). For more information about priority groups for vaccination, visit www.cdc.gov/h1n1flu/vaccination/acip.htm.

For more information:

* Visit: www.flu.govExternal Web Site Icon
* Contact CDC 24 Hours/Every Day
o 1-800-CDC-INFO (232-4636)
o TTY: (888) 232-6348
o cdcinfo@cdc.gov

Popularity: 1% [?]

Health and Nutritional Supplements, You Need Both

Oct 09

ENERhance is a natural herbal supplement.

Also contains vitamins & minerals.

Increases energy without caffeine.

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Health and Nutritional Supplements, You Need Both

By: Tan Kim Kia

Health is the greatest treasure a man can have.

There are several factors that influence our health. Among them we find the pollution, stress, inadequate nutrition. All these factors are hurtful to our body.

Did you know that in a whole year we consume over four kilos and a half to five kilos of poisonous substances present in our food?

If not eliminated, these substances create a chaotic movement of our body cells and generate a favorable ground for the action of free radicals. These free radicals generate a great diversity of cancer forms.

Health depends on an adequate diet too. “Scientific evidence in support of the health benefits of nutritional supplements has grown dramatically in recent years,” said Jeffrey Blumberg, Ph.D., a professor in the School of Nutrition Science and Policy at Tufts University in Boston. “We must now work to translate this knowledge to health care providers, policy makers and consumers so the simple actions people can take to promote their health and prevent disease can be more fully realized. The impact of a rational use of dietary supplements can also help reduce health care costs which escalate every year as our population grows older.

Symptoms

Many problems such as : lack of energy, insomnia, headaches, depression, mood swings, anxiety, easy bruising, bleeding gums, slow wound healing etc. can be traced directly to deficiencies in specific vitamins and minerals.

Circumstances

Because of the methods applied nowadays in agriculture, which destroy the natural mineral substances, we cannot be sure that the agricultural products ensure us the necessary vitamins and minerals. Although all people should try to have healthy and balanced diet, few in reality do.

Nutritional Supplements to bridge your nutrition gaps

More and more people try the nutritional supplements as a way to combat the nutritional deficiencies and to ensure the necessary of vital nutrients for maintaining the quality of their life. Before you start taking nutritional supplements you must know a few things about them.

Nutritional supplements represent a support to our body. The nutritional supplements clean the human body and restore the deficiencies present inside. While taken constantly, nutritional supplements promote good health and help prevent disease. Nutritional supplements represent a good thing that we need . Here are a few things that you might consider before taking nutritional supplements:

1. Everybody can consume nutritional supplement and mostly if is diagnosed with a nutritional deficiency.

2. You must find out if you have a nutritional deficiency.

3. Ask your physician if it is safe for you to take nutritional supplements.

4. Does this supplement interacts with any drug or food you are consuming?

5. If you want to know more you can read about it or you can find more information at nutritional supplements guide from the Internet.

Quality

Regarding their quality, the nutritional supplements must be natural, easy to assimilate, must have a high nutritional value, must come from ecologically non-polluted areas and must be certified.

On the market are thousands of dietary supplements. Great companies fight for a place on the market. Each of them offers a diversity of products. These products seem to bring the same benefits to our body but they are in fact very different one from another. The difference is obvious when you read the label and you see the ingredients. The ingredients are the ones which make the products so valuable.

Research

The nutritional supplements are usually obtained after a period of research.

The research services work hard in order to offer us good products having great and rapid effects. It would be good for you when you choose to take nutritional supplements to inform upon the company which produces the products. If it is a world leadership or if it is among the greatest in the world than you may decide to consume the products it proposes to you. They are first tested over and over again and are only then offered to the public.

So we must be very careful when choosing nutritional supplements and do not forget to consult your physician!

About the Author:

Allan Tan Kim Kia is an nutrition scholar and author of Best Vitamin Supplements Guide who provides tips and advice how to choose and where to buy best vitamin supplements online. http://www.best-vitamin-supplements-guide.com

Printed From: http://www.articlesbase.com/nutrition-articles/health-and-nutritional-supplements-you-need-both-83822.html

Popularity: 1% [?]

Super Smoothie Recipe

Oct 08


Super Smoothie Recipe, Healthy Fruit Smoothy, Nutrition How to Make

Natalie shows you how to make the king of all healthy fruit smoothies.

Please visit Natalie’s website at
http://www.nutritionbynatalie.com

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Popularity: 24% [?]

Novel H1N1 Flu – Creating a Safe and Healthy Workplace

Oct 02

This podcast helps businesses understand how novel H1N1 flu can affect their business and how to keep their workers and worksites safe.

This podcast helps businesses understand how novel H1N1 flu can affect their business and how to keep their workers and worksites safe. Created: 5/20/2009 by Centers for Disease Control and Prevention (CDC). Date Released: 5/20/2009.

[Announcer] This podcast is presented by the Centers for Disease Control and Prevention. CDC – safer, healthier people.

CDC understands that businesses are concerned about the health and safety of their workers and worksites during this outbreak of novel H1N1 flu. This podcast answers many of the questions we’ve received from the business community and will provide your organization with information on resources and tools to effectively respond to the outbreak.

Novel H1N1 is a new influenza virus causing illness in people. The virus was first detected in people in the United States in April 2009; other countries have also reported people sick with the new virus. CDC expects that more cases, hospitalizations, and deaths from this outbreak will occur over the coming days and weeks.

Businesses are essential partners in protecting the public’s health and safety during this outbreak. The health of employees during an outbreak such as novel H1N1 influenza plays a critical role in the continued operations of a business. The workforce, like the public, needs clear, concise, consistent information.

H1N1 flu is a completely new disease that isn’t comparable to the seasonal flu we see each year. One of the differences is that H1N1 flu is attacking healthy teens and adults. With seasonal flu, the very young and the very old are at greatest risk because their immune systems are less effective than those of healthy adults.

It’s difficult to make accurate predictions on the length of time it may take for the novel H1N1 flu to run its course in the U.S. Past outbreaks have had different durations and affected different percentages of the population in different ways. Outbreaks of new influenza viruses usually last much longer than seasonal flu, and often come in waves. The health impact in terms of severity of each wave has also varied.

Here are some ways to protect employees and worksites:

Sick employees should stay home and not come to work. People who have the flu can spread it to others and the flu virus can spread easily when people are close together. If someone is sick with novel H1N1 flu, they’ll probably have symptoms similar to those of seasonal flu, including fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, and fatigue. A significant number of people have also reported diarrhea and vomiting.

Tell employees you don’t want them coming to work sick so they don’t worry about losing their job. Let them know their job is safe if they need to care for someone who is sick or are sick themselves. CDC recommends that people who are sick with novel H1N1 flu stay home for seven days after the onset of illness or at least 24 hours after symptoms have subsided, whichever is longer.

To stay healthy or to stop the spread of the virus, remind your employees to do these four things:

1. Cover their nose and mouth with a tissue when they cough or sneeze and then throw the tissue in the trash.

2. Wash their hands often with soap and water, especially after coughing or sneezing, or use an alcohol-based hand cleaner if soap and water aren’t available.

3. Avoid touching their eyes, nose, or mouth to prevent spreading germs.

4. Try to avoid close contact with sick people.

In order to ensure business continuity, develop a plan to protect your employees and maintain operations during this H1N1 flu outbreak. Companies that provide critical infrastructure services, such as power and telecommunications, have a special responsibility to plan for continued operation in a crisis, including consideration for significant absenteeism. Having a contingency plan is essential.

There are no special precautions for workers who handle or deliver packages, other than practicing good hand hygiene. If soap and water aren’t available to these employees, make sure they have a supply of alcohol-based hand cleaner. Instruct them to use it after each contact with customers, including after sharing a pen with customers.

Although the current H1N1 flu virus is new and scientists are still studying it, studies on other forms of flu viruses have shown that influenza virus can survive on environmental surfaces, such as books, countertops, door knobs, and money, and can infect a person for up to eight hours after being deposited on the surface. It’s important to note that in the transportation and shipping industry, banking institutions, and retail businesses – where money and goods move daily – workers have not shown an increase in infection rates during periods of seasonal influenza. To prevent the spread of the virus, it’s important to keep surfaces, especially commonly touched surfaces, such as work stations, countertops, and bathroom surfaces, clean by wiping them down with a household disinfectant, according to label directions.

Employees who need to travel for business can protect themselves by doing a few simple things. All travelers should wash their hands often with soap and water or use an alcohol-based hand cleaner. Travelers may also want to bring alcohol-based sanitizing wipes that can be used to clean hard surfaces near their seat on the airplane, such as seat arms, seatbelt, fold-down tray, and overhead bins.

For more information on how to stay healthy during travel and any updates on CDC travel notices, please visit CDC’s Travelers’ Health website at www.cdc.gov/travel.

For help in preparing your business for the novel H1N1 flu, visit www.cdc.gov/h1n1flu/business where you’ll find resources, tools, and information for businesses OR call 1-800-CDC-INFO, that’s 1-800-232-4636.

[Announcer] For the most accurate health information, visit www.cdc.gov or call 1-800-CDC-INFO, 24/7.

Page last modified Wednesday, May 20, 2009

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Safer, Healthier People
Centers for Disease Control and Prevention 1600 Clifton Rd. Atlanta, GA 30333, USA
800-CDC-INFO (800-232-4636) TTY: (888) 232-6348, 24 Hours/Every Day – cdcinfo@cdc.gov
USA.gov: The U.S. Government’s Official Web PortalHHS.govDepartment of Health and Human Services

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Contamination & Cleaning regarding the Flu

Sep 27

Start building your immune system before cold and flu season.

Learn about the benefits of ENERhance.

Natural herbal drink contains vitamins and minerals.

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How long can influenza virus remain viable on objects (such as books and doorknobs)?
Studies have shown that influenza virus can survive on environmental surfaces and can infect a person for 2 to 8 hours after being deposited on the surface.
What kills influenza virus?
Influenza virus is destroyed by heat (167-212°F [75-100°C]). In addition, several chemical germicides, including chlorine, hydrogen peroxide, detergents (soap), iodophors (iodine-based antiseptics), and alcohols are effective against human influenza viruses if used in proper concentration for a sufficient length of time.
*What if soap and water are not available and alcohol-based products are not allowed in my facility? Updated on Sept 14
If soap and water are not available and alcohol-based products are not allowed, other hand sanitizers that do not contain alcohol may be useful.
What surfaces are most likely to be sources of contamination?
Germs can be spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth. Droplets from a cough or sneeze of an infected person move through the air. Germs can be spread when a person touches respiratory droplets from another person on a surface like a desk, for example, and then touches their own eyes, mouth or nose before washing their hands.
How should waste disposal be handled to prevent the spread of influenza virus?
To prevent the spread of influenza virus, it is recommended that tissues and other disposable items used by an infected person be thrown in the trash. Additionally, persons should wash their hands with soap and water after touching used tissues and similar waste.
What household cleaning should be done to prevent the spread of influenza virus?
To prevent the spread of influenza virus it is important to keep surfaces (especially bedside tables, surfaces in the bathroom, kitchen counters and toys for children) clean by wiping them down with a household disinfectant according to directions on the product label.
How should linens, eating utensils and dishes of persons infected with influenza virus be handled?
Linens, eating utensils, and dishes belonging to those who are sick do not need to be cleaned separately, but importantly these items should not be shared without washing thoroughly first.

Linens (such as bed sheets and towels) should be washed by using household laundry soap and tumbled dry on a hot setting. Individuals should avoid “hugging” laundry prior to washing it to prevent contaminating themselves. Individuals should wash their hands with soap and water or alcohol-based hand rub immediately after handling dirty laundry.Eating utensils should be washed either in a dishwasher or by hand with water and soap.
Exposures Not Thought to Spread 2009 H1N1 Flu
Can I get infected with 2009 H1N1 virus from eating or preparing pork?
No. 2009 H1N1 viruses are not spread by food. You cannot get infected with novel HIN1 virus from eating pork or pork products. Eating properly handled and cooked pork products is safe.
Is there a risk from drinking water?
Tap water that has been treated by conventional disinfection processes does not likely pose a risk for transmission of influenza viruses. Current drinking water treatment regulations provide a high degree of protection from viruses. No research has been completed on the susceptibility of 2009 H1N1 flu virus to conventional drinking water treatment processes. However, recent studies have demonstrated that free chlorine levels typically used in drinking water treatment are adequate to inactivate highly pathogenic H5N1 avian influenza. It is likely that other influenza viruses such as 2009 H1N1 would also be similarly inactivated by chlorination. To date, there have been no documented human cases of influenza caused by exposure to influenza-contaminated drinking water.
Can 2009 H1N1 flu virus be spread through water in swimming pools, spas, water parks, interactive fountains, and other treated recreational water venues?
Influenza viruses infect the human upper respiratory tract. There has never been a documented case of influenza virus infection associated with water exposure. Recreational water that has been treated at CDC recommended disinfectant levels does not likely pose a risk for transmission of influenza viruses. No research has been completed on the susceptibility of 2009 H1N1 influenza virus to chlorine and other disinfectants used in swimming pools, spas, water parks, interactive fountains, and other treated recreational venues. However, recent studies have demonstrated that free chlorine levels recommended by CDC (1–3 parts per million [ppm or mg/L] for pools and 2–5 ppm for spas) are adequate to disinfect avian influenza A (H5N1) virus. It is likely that other influenza viruses such as 2009 H1N1 virus would also be similarly disinfected by chlorine.
Can 2009 H1N1 influenza virus be spread at recreational water venues outside of the water?
Yes, recreational water venues are no different than any other group setting. The spread of this 2009 H1N1 flu is thought to be happening in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing of people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose.
Note: Much of the information in this document is based on studies and past experience with seasonal (human) influenza. CDC believes the information applies to 2009 H1N1 (swine) viruses as well, but studies on this virus are ongoing to learn more about its characteristics. This document will be updated as new information becomes available

Popularity: 10% [?]

Flu I.Q.

Sep 26

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Popularity: 3% [?]

 
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