Os benefícios do exercício físico em pacientes com doenças intestinais inflamatórias
Resumo
A Doença de Crohn (DC) e a Retocolite Ulcerativa (RCU) são doençasinflamatórias intestinais (DII), caracterizadas pela inflamação da mucosa intestinal. Aorigem das doençasinflamatórias intestinaisé multifatorial, envolvendo fatores ambientais, genéticos eimunológicos. Não existe cura para as doençasinflamatórias intestinais. Oobjetivo do presente estudofoi fazer uma revisão crítica sobre o papel do exercício físico na qualidade de vidados pacientes com DII. A queda da densidade mineral óssea(DMO) é reportada em pacientes com Doença de Crohn, sendoque cerca de 40% a 50%apresentam osteopenia e aproximadamente 15% desenvolvem osteoporose. As DIIpodem afetar a composição corporal, a performance muscular e o gasto energético.Existe uma relação dose-resposta e um limiar de intensidade do exercício físico quesepara os benefícios e riscos do exercício sobre o trato gastrointestinal. Na literaturacientifica existem poucos estudos relacionados às DII e o exercício físico. Éconsenso em todos os estudos que o exercício físico de baixa e moderadaintensidade promova a melhoria na qualidade de vida dos pacientes com DII,demonstrando uma ação direta nos sintomas extra-intestinas das doenças sem aexacerbação dos sintomas.É necessário o desenvolvimento de novosestudos para a compreensão dos reais benefícios da intervenção dos programas deexercício físico, tanto de endurance quanto de força, sobre os sintomas das DII.
Referências
-Aldoori,W.H.; Giovannucci E.L.; Rimm E.B.; Ascherio A.; Stampfer M.J.; Colditz G.A.e ColaboradoresProspective study of physical activity and the risk of symptomaticdiverticular disease in men. Gut. Vol. 36. 1995. p. 276-82.
-Al-Jaouni,R.; Hébuterne X.; Pouget I.; Rampal P. Energy metabolism andsubstrate oxidation in patients with Crohn's disease. Nutrition. Vol. 16. Núm. 3. 2000. p. 173-178.
-Al-Jaouni,R.; Schneider S.M.; Piche T.; Rampal P.; Hébuterne X. Effect of steroidson energy expenditure and substrate oxidation in women with Crohn's disease.The American Journal of Gastroenterology. Vol. 97. Núm. 11. 2002. p. 2843-2849.
-Ball,E. Exercise guidelines for patients with inflammatory bowel disease.Gastroenterol Nurs. Vol. 21. 1998. p. 108-111.
-Banfi,G.; Marinelli M.; Bonini P.; Gritti I.; Roi G.S. Pepsinogens andgastrointestinal symptoms in mountain marathon runners. International Journalof Sports Medicine. Vol. 17. 1996. p. 554-558.
-Bartram,S.A.; Peaston R.T.; Rawlings D.J.; Walshaw D.; Francis R.M.; ThompsonN.P. Mutifactorial analysis of risk factors for reduced bone mineral density inpatients with Crohn's disease. World Journal of Gastroenterology. Vol. 12. Núm. 35. 2006. p. 5680-5686.
-Baumgart,D.C. The Diagnosis and Treatment of Crohn’s Disease and UlcerativeColitis. Deutsches Ärzteblatt International.Dtsch Arztebl Int. Vol. 106. Núm. 8. 2009. p. 123-133.
-Behm,B.W.; Bickston S.J. Tumour necrosis factor-alpha antibody formaintenance of remission in Crohn’s disease. Cochrane Database Syst Rev. Vol. 1. 2008. CD006893.
-Berg,A.; Muller H.M.; Rathmann S.; Deibert P. The gastrointestinal system, anessential target organ of the athlete’s health and physical performance.Exercise immunology review. Vol. 5. 1999. p. 78-95.
-Bernstein,C.D. Calcium and bone tissues in inflammatory bowel disease.Gastroenterol Int. Vol. 10. 1997. p. 71-7.
-Boggild,H.; Tuchsen F.; Orhede E. Occupation, Employment Status and ChronicInflammatory Bowel Disease in Denmark. International EpidemiotoglcalAssociation. Vol. 25. Núm. 3. 1996. p. 630-637.
-Bourges,O.; Dorgeret S.; Alberti C.; Hugot J.P.; Sebag G.; Cézard J.P. Low bonemineral density in children with Crohn's disease. Archives of pediatrics. Vol. 11. Núm. 7. 2004. p. 800-806.
-Brewer, V. e Colaboradores.Role of exercise in prevention of involution bone loss. Med. SciSports Exerc. Vol. 15. 1983. p. 445.
-Brouns,F.; Beckers E. Is the gut an athletic organ? Digestion, absorption andexercise. Sports Medicine. Vol. 15. 1993. p. 242-257.
-Buchman,A.L. Metabolic Bone Disease in Inflammatory Bowel Disease. Currenttreatment options in gastroenterology. Vol. 5. Núm. 3. 2002. p. 173-180.
-Carter, M.J.; Lobo A.J.; Travis S.P. Guidelines for the managementofinflammatory bowel disease in adults. Gut. Vol. 53. 2004. p. V1-16.
-Chen,Y.C.; Chen F.P.; Chen T.J.; Chou L.F.; Hwang S.J. Patterns of traditional Chinese medicine use in patients with inflammatory bowel disease: apopulation study in Taiwan. Hepatogastroenterology. Vol. 55. Núm. 82-83. 2008. p. 467-470.
-Conklin,L.S.; Oliva-Hemker M. Nutritional considerations in pediatricinflammatory bowel disease. Expert review of gastroenterology ehepatology. Vol. 4. Núm. 3. 2010. p. 305-317.
-Cooper,C.; Coupland C.; Mitchell M. Rheumatoid arthritis, corticosteroid therapyand hip fracture. Annals of the rheumatic diseases. Vol. 54. 1995. p. 49-52.
-Cucino, C.; Sonnenberg A. Occupational Mortality From Inflammatory BowelDisease in the United States 1991–1996. The American Journal ofGastroenterology. Vol. 96. Núm. 4. 2001. p. 1101-1105.
-D’inca,R.; Varnier M.; Mestriner C. e ColaboradoresEffect of moderate exercise on Crohn’sdisease patients in remission. Italian journal of gastroenterology and hepatology. Vol. 31. 1999. p. 205-210.
-Demers,L.M.; Harrison T.S.; Halbert D.R.; Santen R.J. Effect of prolonged exerciseon plasma prostaglandin levels. Prostaglandins and medicine. Vol. 6. 1981. p. 413-418.
-Desai, H.G.; Gupte P.A. Increasing incidence of Crohn’s disease in India: is itrelated to improved sanitation? Indian journal of gastroenterology : official journalof the Indian Society of Gastroenterology. Vol. 24. 2005. p. 23 -24.
-Dotson, J.L,; Hyams J.S,; Markowitz J,; Leleiko N.S,; Mack D.R,; Evans. J.S,; Pfefferkorn, M.D.; Griffiths, A.M.; Otley A.R.; Bousvaros A.; Kugathasan S.; RoshJ.R.; Keljo D.; Carvalho R.S.; Tomer G.; Mamula P.; Kay M.H.; Kerzner B.; Oliva-Hemker M.; Langton C.R.; Crandall W. Extraintestinal Manifestations of PediatricInflammatory Bowel Disease and Their Relation to Disease Type and Severity.Journal of Pediatric Gastroenterology and Nutrition. 2010 May 4.
-Elsenbruch,S.; Langhorst J.; Popkirowa K.; Müller T.; Luedtke R.; Franken U.; PaulA.; Spahn G.; Michalsen A.; Janssen O.E.; Schedlowski M.; Dobos G.J. Effects ofmind-body therapy on quality of life and neuroendocrine and cellular immunefunctions in patients with ulcerative colitis. Psychotherapy and psychosomatics. Vol. 74. Núm. 5. 2005. p. 277-287.
-Erpecum,Van K.; Van Berge-Henegouwen G.P. Gallstones: an intestinal disease?Gut. Vol. 44. 1999. p. 435-438
-Filippi,J.; Al-Jaouni R.; Wiroth J.B.; Hébuterne X.; Schneider S.M. Nutritionaldeficiencies in patients with Crohn's disease inremission. Inflammatory BowelDiseases. Vol. 12. Núm. 3. 2006. p. 185-191.
-García-Planella,E.; Marín L.; Domènech E.; Bernal I.; Mañosa M.; Zabana Y.;Gassull M.A. Use of complementary and alternative medicine and drug abuse inpatients with inflammatory bowel disease. Medicina clínica. Vol. 128. Núm. 2.2007. p. 45-48.
-Gearry,R.B.; Ajlouni Y.; Nandurkar S.; Iser J.H.; Gibson P.R. 5-aminosalicylic acid(mesalazine) use in Crohn’s disease: A survey of the opinions and practice ofAustralian gastroenterologists. Inflammatory BowelDiseases. Vol. 13. 2007. p. 1009-1015.
-Gerasimidis,K.; Mcgrogan P.; Hassan K.; Edwards C.A. Dietary modifications,nutritional supplements and alternative medicine in paediatric patients withinflammatory bowel disease. Alimentary pharmacology etherapeutics. Vol. 27. Núm. 2. 2008. p. 155-165.
-Gupta,N.; Khera S.; Vempati R.P.; Sharma R.; Bijlani R.L Effect of yoga basedlifestyle intervention on state and trait anxiety. Indian journal of physiology andpharmacology. Vol. 50. Núm. 1. 2006. p. 41-47
-Hanauer,S.B. Inflammatory bowel disease: epidemiology, pathogenesis, andtherapeutic opportunities. Inflammatory Bowel Diseases.12 (Suppl 1):2006.
-Harpavat,M.; Greenspan S.L.; O'brien C.; Chang C.C.; Bowen A.;Keljo D.J.Alteredbone mass in children at diagnosis of Crohn disease: a pilot study. Journal ofPediatric Gastroenterology and Nutrition.. Vol. 40. Núm. 3. 2005. p. 295-300.
-Haydon,A.M.; Macinnis R.; English D.; Giles G. The effect of physical activity andbody size on survival after diagnosis with colorectal cancer. Gut. Vol. 55. 2006. p. 62-67.
-Hoffmann, JC.; Preiss JC.; Autschbach F.; Buhr Hj.; Hauser W.; Herrlinger K e ColaboradoresS3-Leitlinie Diagnostik und Therapie des Morbus Crohn“.Zeitschrift fürGastroenterologie; Vol. 46. 2008. p. 1094–146.
-Hoffmann, JC.; Zeitz M.; Bischoff SC.; Brambs HJ.; Bruch HP.; Buhr H.J. e ColaboradoresDiagnostik und Therapie der Colitis ulcerosa: Ergebnisse eineevidenzbasierten Konsensuskonferenz der Deutschen Gesellschaft fürVerdauungs-und Stoffwechselerkrankungen zusammen mit demKompetenznetz chronisch entzündliche Darmerkrankungen. Leitlinien.Zeitschrift für Gastroenterologie. Vol. 42. 2004. p. 979–983
-Irving, P.M; Gearry R.B.; Sparrow M.P.; Gibson P.R. Review article: Appropriate useof corticosteroids in Crohn’s disease. Alimentary pharmacology etherapeutics. Vol.26. 2007. p. 313–329.
-Jahnsen, J.; Falch J.A.; Mowinckel P.; Aadland E. Bone mineral density in patientswith inflammatory bowel disease: A populationbased prospective two-yearfollow-up study. Scandinavian journal of gastroenterology. Vol. 39. 2004. p. 145-153.
-Joos, S.; Rosemann T.; Szecsenyi J.; Hahn E.G.; Willich S.N.; Brinkhaus B. Use ofcomplementary and alternative medicine in Germany -a survey of patients withinflammatory bowel disease. BMC complementary and alternative medicine. Vol. 6.2006. p. 19.
-Karper,W.B. The holistic effects of long-term exercise, health education, andresource assistance on one woman with multiple debilitating medicalproblems: a case report. Holistic nursing practice. Vol. 22 Núm. 4. 2008. p. 206-209
-Kociánová,J.; Axmann K J.R. Prevalence of bone decalcification in the treatmentof Crohns disease. Vnitr n l ar stv . Vol. 38. Núm. 10. 1992. p. 945-51.
-Koffler,K.H.; Menkes A.; Redmond R.A.; Whitehead W.E.; Pratley R.E.; Hurley B.F.Strength training accelerates gastrointestinal transit in middle-aged and oldermen. Medicine and science in sports and exercise. Vol. 24. 1992. p. 415-419.
-Lee,N.; Radford-Smith G.L.; Forwood M.; Wong J.; Taaffe D.R. Body compositionand muscle strength as predictors of bone mineral density in Crohn's disease.Journal of bone and mineral metabolism. Vol. 27. Núm. 4. 2009. p. 456-463.
-Leitzmann,M.F.; Giovannucci E.L.; Rimm E.B.; Stampfer M.J.; Spiegelman D.; WingA.L.; Willett W.C. The relation of physical activity to risk for symptomaticgallstone disease in men. Annals of internal medicine. Vol.128. 1998. p. 417-425.
-Leitzmann M.F.; Rimm E.B.; Willett W.C.; Spiegelman D.; Grodstein F.; StampferM.J.; Colditz G.A.; Giovannucci E. Recreational physical activity and the risk ofcholecystectomy in women. The New England journal of medicine. Vol. 341. 1999. p. 777-784.
-Li,F.X.; Verhoef M.J.; Best A.; Otley A.; Hilsden R.J. Why patients withinflammatory bowel disease use or do not use complementary and alternativemedicine: A Canadian national survey. Canadian journal of gastroenterology. Vol. 19. Núm. 9. 2005. p. 567-573.
-Lichenstein, G.R.; Abreu M.T.; Cohen R.; Tremaine W. AmericanGastroenterological Association Institute technical review on corticosteroids,immunomodulators and infliximab in inflammatory bowel disease.Gastroenterology. Vol. 130. 2006. p. 940-987.
-Lichenstein,G.R. Management of bone loss in inflammatory bowel disease.Seminars in gastrointestinal disease. Vol. 12. Núm. 4. 2001. p. 275-283.
-Loudon,C.P.; Corroll V.; Butcher J. e ColaboradoresThe effects of physical exercise onpatients with Crohn’s disease. The American Journal of Gastroenterology. Vol. 94. 1999. p. 697-703.
-Mingrone, G.; Greco A.V.; Benedetti G. e ColaboradoresIncreased resting lipid oxidation inCrohn’s disease. Digestive diseases and sciences. Vol. 41. 1996. p. 72-76.
-Mingrone, G.; Benedetti G.; Capristo E.; De Gaetano A.; Greco Av.; Tataranni Pa.;Gasbarrini G. Twenty-four–hour energy balance in Crohn disease patients:metabolic implications of steroid treatment1,2 . The American journal of clinicalnutrition. Vol. 67. 1998. p. 118-123.
-Modlin,I.; Bloom S.; Mitchell S. Plasma vasoactive intestinal polypeptide (VIP)levels and intestinal ischaemia Experientia. Vol. 34. 1978. p. 535-536.
-Moschen, A.R.; Kaser A.; Enrich B. e ColaboradoresThe RANKL/OPG system is activated ininflammatory bowel disease and relates to the state of bone loss. Gut. Vol. 54. 2005. p. 479-487.
-Moses,F.M. The effect of exercise on the gastrointestinal tract. Sports Medicine. Vol. 9. 1990. p. 159-172.
-Narula, N.; Fedorak RN. Exercise and inflammatory bowel disease. Can JGastroenterol. Vol. 22. n. 5. 2008. p. 497-504.
-Nathan, D.M.; Iser J.H.; Gibson P.R. A single centre experience of methotrexate inthe treatment of Crohn’s disease and ulcerative colitis: A case forsubcutaneous administration. Journal of gastroenterology and hepatology. Vol. 23. 2008. p. 954-958.
-Ng, V.; Millard W.; Lebrun C.; Howard J. Low-Intensity Exercise Improves Qualityof Life in Patients With Crohn’s Disease. Clinical journal of sport medicine : officialjournal of the Canadian Academy of SportMedicine. Vol. 17. 2007. p. 384-388.
-Nishimura, J.; Ikuyama S. Glucocorticoid-induced osteoporosis: pathogenesisand management. Journal of bone and mineral metabolism. Vol. 18. Núm. 6. 2000.p. 350-352.
-Oettle,G.J. Effect of moderate exercise on bowel habit. Gut. Vol. 32. 1991. p. 941-944.
-Orlic, Z.C.; Turk T.; Sincic B.M.; Stimac D.; Cvijanovic O.; Maric I.; Tomas M.I.; Jurisic-Erzen D.; Licul V.; Bobinac D. How Activity of Inflammatory Bowel DiseaseInfluences Bone Loss. Journal of clinical densitometry : the official journal of theInternational Society for Clinical Densitometry. Vol. 13. Núm. 1. 2010. p. 36-42.
-Oshima, T.; Taira S.; Nonaka M.; Hayama Y.; Yagi K;Yukawa I.; Koh M.; Kondo M.;Kawakami K.; Kawai T.; Miyaoka M.; Sakai Y.; Moriyasu F.; Matauoka H.; YamamotoK .A study on bone mineral density in patients with Crohn's disease.Hepatogastroenterology.. Vol. 55. Núm. 88. 2008. p. 2116-2120.
-Peters, H.P.; De Vries W.R.; Van Berge-Henegouwen G.P.;, Akkermans L.M.Potential benefits and hazards of physical activity and exercise on thegastrointestinal tract. Gut. Vol. 48. 2001. p. 435-439.
-Pinsk,V.; Lemberg D.A.; Grewal K.; Barker C.C.; Schreiber,R.A.; Jacobson,K.Inflammatory bowel disease in the South Asian Pediatric Population of BritishColumbia. The American Journal of Gastroenterology.Vol.102. 2007. p. 1077-1083.
-Quadrilatero,J.; Hoffman-Goetz L. Physical activity and colon cancer (Asystematica review of potential mechanisms). The Journal of sports medicine andphysical fitness. Vol. 43. 2003. p. 121-138.
-Robinson,R.J.; Iqbal S.J.; Abrams K.; Al-Azzawi F.; Mayberry J.F. Increased boneresorption in patients with Crohn’s disease. Alimentary pharmacology etherapeutics. Vol. 12. 1998. p. 699-705.
-Rowell,L.B.; Blackmon J.R.; Bruce R.A. Indocyanine green clearance andestimated hepatic blood flow during mild to maximal exercise in upright man.The Journal of clinical investigation. Vol. 43. 1964. p.1677-1690.
-Schmidt,S.; Mellström,D.; Norjavaara,E.; Sundh,S.V.; Saalman,R. Low bonemineral density in children and adolescents with inflammatory bowel disease:A population-based study from Western Sweden. Inflammatory Bowel Diseases. Vol.15. Núm. 12. 2009. p. 1844-1850.
-Schneider,S.M.; Al-Jaouni R.; Filippi J.; Wiroth J.B.; Zeanandin G.; Arab K.;Hébuterne X. Sarcopenia is prevalent in patients with Crohn's disease in clinicalremission. Inflammatory Bowel Diseases. Vol.14. Núm. 11. 2008. p. 1562-1568.
-Schulte,C.M. Bone disease in inflammatory bowel disease. Alimentarypharmacology etherapeutics. Vol.20. (Suppl 4). 2004. p. 43-49.
-Shephard,R.J.; Shek P.N. Associations between physical activity andsusceptibility to cancer: possible mechanisms. Sports Medicine. Vol. 26. 1998. p.293-315.
-Siffledeen,J.S.; Fedorak R.N.; Siminoski K.; Jen H.; Vaudan E.; Abraham N.;Steinhart H.; Greenberg G. Randomized trial of etidronate plus calcium andvitamin D for treatment of low bone mineral density in Crohn's disease. Clinicalgastroenterology and hepatology: the official clinical practice journal of the AmericanGastroenterological Association. Vol.3. Núm. 2. 2005. p. 122-132.
-Silvennoinen,J.A.; Karttunen T.J.; Niemela S.E; Manelius J.J.; Lehtola J.K. Acontrolled study of bone mineral density in patients with inflammatory boweldisease. Gut. Vol.37. 1995.p. 71-76.
-Silverberg,M.S.; Satsangi J.; Ahmad T.; Arnott I.D.; Bernstein C.N.; Brant S.R. e ColaboradoresToward an integrated clinical, molecular and serological classification ofinflammatory bowel disease: Report of a Working Party of the 2005 MontrealWorld Congress of Gastroenterology. Canadian Journal of Gastroenterology. 2005; 19 Suppl A: 5-36.
-Sonnenberg,A. Occupational distribution of inflammatory bowel disease amongGerman employees. Gut. Vol.31. 1990. p. 1037-1040.
-Sorensen,V.Z.; Olsen B.G.; Binder V. Life prospects and quality of life in patientswith Crohn’s disease. Gut. Vol.28. 1987. p. 382-385.
-Stange,EF, Travis SP, Vermeire S, Beglinger C, Kupcinkas L, Geboes K,Barakauskiene A, Villanacci V, Von Herbay A, Warren BF, Gasche C, Tilg H,Schreiber SW, Schölmerich J, Reinisch W; European Crohn's and ColitisOrganisation. European evidence based consensus on the diagnosis andmanagement of Crohn’s disease: definitions and diagnosis. Gut 2006; 55 Suppl1:i1–15
-Stange E.F.; Travis S.P.L.; Vermeire S.; Reinisch W.; Geboes K.; Barakauskiene A.;Feakins R.; Fléjou J.F.; Herfarth H.; Hommes D.W.; Kupcinskas L.; Lakatos P.L.;Mantzaris G.J.; Schreiber S.; Villanacci V.; B.F. Warren for the European Crohn'sand Colitis Organisation. European evidence-based Consensus on the diagnosisand management of ulcerative colitis: Definitions and diagnosis. J Crohn’sColitis. Vol. 2. 2008. p. 1-23.
-Turk,N.; Cukovic-Cavka S.; Korsic M.; Turk Z. Vucelic B. Proinflammatorycytokines and receptor activator of nuclear factor kappaBligand/osteoprotegerin associated with bone deterioration in patients withCrohn's disease. European Journal of Gastroenterology eHepatology. Vol.21. Núm. 2. 2009. p. 159-166.
-Turner,C.H.; Robling A.G. Exercise as an anabolic stimulus for bone. CurrentPharmaceutical Design. Vol. 10. 2004. p. 2629-2641.
-Vahedi, H.; Momtahen S.; Olfati G.; Abtahi A.; Hosseini S.; Kazzazi A.S.; Khademi H.;Rashtak S.; Khaleghnejad R.; Tabrizian T.; Hamidi Z.; Nouraie M.; Malekzadeh F.;Merat S.; Nasseri-Moghaddam S.; Sotoudehmanesh R.; Larijani B. A case-controlstudy on risk factors of osteoporosisin patients with Crohn's disease. Archivesof Iranian Medicine. Vol. 12. Núm. 6. 2009. p. 570-575.
-Valentini, L.; Schaper L.; Buning C.; Hengstermann S.; Koernicke T.; Tillinger W.;Guglielmi FW.; Norman K.; Buhner S.; Ockenga J.; Pirlich M.; Lochs H. Malnutritionand impaired muscle strength in patients with Crohn's disease and ulcerativecolitis in remission. Nutrition. Vol.24. Núm. 7-8. 2008. p. 694-702.
-Van,Hogezand R.A.; Hamdy N.A. Skeletal morbidity in inflammatory boweldisease Scandinavian journal of gastroenterology. Suppl 2006. (243): p. 59-64.
-Van, Nieuwenhoven M.A.; Brouns F.; Brummer R.J. Gastrointestinal profile ofsymptomatic athletes at rest and during physical exercise. European Journal ofApplied Physiology. Vol. 91. 2004. p. 429-434.
-Vandewalle,H.; Lacombe C; Lelievre J.C. e ColaboradoresBlood viscosity after a 1-hsubmaximal exercise with and without drinking. International Journal of SportsMedicine. Vol.9. 1988. p. 104-107.
-Vestergaard,P.; Krogh K.; Rejnmark L.; Laurberg S.;Mosekilde L. Fracture risk isincreased in Crohn’s disease, but not in ulcerative colitis. Gut. Vol.46. 2000. p.176-181.
-Wiroth,Jb.; Filippi J.; Schneider Sm.; Al-Jaouni R.; Horvais N.; Gavarry O.; BermonS.; Hébuterne X. Muscle performance in patients with Crohn's disease in clinicalremission. Inflammatory Bowel Diseases. Vol.11. Núm. 3. 2005. p. 296-303.
-Wong, A.P.; Clark A.L.; Garnett E.A.; Acree M.; Cohen S.A.; Ferry G.D.; HeymanM.B. Use of complementary medicine in pediatric patients with inflammatorybowel disease: results from a multicenter survey. Journal of PediatricGastroenterology and Nutrition. Vol.48. Núm. 1. 2009. p. 55-60.
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