LECTURE #6
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HUMAN ANATOMY AND PHYSIOLOGY• The Nervous System
• The Endocrine Glands
• The Hemopoietic System
• The Circulatory System
• The Respiratory Tract
• The Digestive Tract
• The Urinary Tract
• The Reproductory System
• The Locomotor System
• The Skin
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RESPIRATORY TRACT
1. Nose - Larynx
2. Trachea
3. Bronchi
4. Lungs – Pleura
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Acid reflux (gastroesophageal reflux)
Allergies
Breathing in irritating substances (smoke, fumes)
Cancer of the throat or larynx
Chronic cough
Colds or upper respiratory infections
Heavy smoking or drinking, especially together
Overuse or abuse of the voice (as in shouting or singing), which may cause swelling or growths on the vocal cords
HOARSENESS
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COUGH
Most frequent causes:
Laryngitis
Dust exposure
Smoke exposure
Cigarettes smoking
Hay fever
Bronchitis
Asthma
COPD
Lung cancer
Pneumonia
Gastro-esophageal reflux disease (GERD)
Hiatal hernia
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Causes: Air moving through constricted bronchi
• Inspiratory and expiratory
• Only expiratory
Asthma, Bronchitis, COPD, emphysema
Allergies
Heart failure
Foreign body in the airways
WHEEZING
THE LUNGS
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The Respiratory System
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The Respiratory System
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COPD
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A chronic inflammatory disease of the airways, which enter spasm and narrow (bronchoconstriction).
34.1 Mil. adult Americans including children
75% have an allergic cause:
Mast cells in the bronchial wall release histamine vasodilation + mucus secretion + muscle constriction in bronchial wall severe narrowing inspiratory and expiratory wheezing
Chest tightness, anxiety
Common allergens:
Pollen, Animal dander, Mites in house dust, Molds, Cockroach, Industrial fumes, Airborne pollutants, Smoke
ASTHMA
N.I.H. 12
ASTHMA ATTACK
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Treatment:
Hydration
Bronchodilators
Corticosteroids
ASTHMA
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An acute, severe, lung infection caused by bacteria or viruses.
Symptoms: Fever, cough, difficulty breathing,chest pain
Diagnosis: Physical examination, Chest X-ray
Treatment: Rest, antibiotics, oxygen
Prognosis: Good
Pneumococcal vaccine in people >50 y. o.
PNEUMONIA
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90% of cases are affecting the lungs (pulmonary tb.)
10% are extrapulmonary (kidneys, testicles, bones, brain)
Active disease 75% and Latent disease (25%)
Symptoms:
Pulmonary: Chronic cough, sputum (phlegm), blood in sputum (hemoptysis)
Constitutional: Fever, night sweats, fatigue, weight loss
Diagnosis: Chest X-ray, culture of body fluids
Treatment: Antibiotics curable disease. Emergence of multi-drug resistance tb.
Prevention: Screening (Mantoux reaction) and Vaccination: BCG (Bacillus Calmette-Guérin)
TUBERCULOSIS
PREVALENCE OF PULMONARY TB. PER 100,0002007 DATA
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Epidemiology of Tuberculosis
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Active Pulmonary Tb.
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Tb. skin testing(Mantoux reaction)
LUNG CANCER
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CANCER STATISTICS IN USA – 2015*
All sites Lung Breast Prostate Colon
(W)
New cases 1,658,370 221,200 231,840 220,000 132,700
Deaths 589,430 158,040 40,290 27,540 49,700
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*Published 2/15
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LUNG CANCER
BURDEN OF SUFFERING
Leading cause of cancer death
5-yr. survival rate <15%
28 % operable at time of diagnosis
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LUNG CANCER
RISK FACTORS
Active tobacco smoking (87%)
Passive smoking
Environmental factors (asbestos, metals)
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• Intense counseling against tobacco smoking
• Routine screening is not recommended in asymptomatic patients
LUNG CANCER SCREENING
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FIBERSCOPE
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BRONCHOSCOPY
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BRONCHOSCOPY IMAGE
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Brochoscopy finding
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Surgery for curative intent
Surgery for palliative intent
Radiation therapy
Systemic chemotherapy
LUNG CANCERTREATMENT
LUNG CANCER: Localized or not?
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PLEURA
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Left-sided pleural effusion
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1. Congestive heart failure
2. Pneumonia
3. Cirrhosis of liver
4. End-stage kidney disease
5. Cancer (malignant pleural effusion)
6. Pulmonary (lung) embolism
PLEURAL EFFUSIONCAUSES
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If benign – May resolve spontaneously
- Removal if re-accumulating
- Treatment of the underlying cause
If malignant – Removal
- If re-accumulating – Removal + - Intra-pleural chemotherapy
PLEURAL EFFUSION - TREATMENT
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HUMAN ANATOMY AND PHYSIOLOGY• The Nervous System
• The Endocrine Glands
• The Hemopoietic System
• The Circulatory System
• The Respiratory Tract
• The Digestive Tract
• The Urinary Tract
• The Reproductory System
• The Locomotor System
• The Skin
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The Digestive System
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Esophageal cancer
Esophageal varices (in cirrhosis of liver)
Gastric erosions
Gastric ulcers
Duodenal ulcer
UPPER GI BLEEDING(HEMATEMESIS)
Melena or hematochezia?
UGI tract bleeding
UGI tract cancer
Peptic ulcer disease
Colon cancer
Rectal hemorrhoids
LOWER GI BLEEDING
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DIARRHEA – FREQUENT CAUSES
Gastroenteritis (toxic, viral, bacterial)
Antibiotic use/overuse
Lactose intolerance
Inflammatory bowel syndrome
Bacterial/parasitic infections
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ESOPHAGEAL CANCER
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Burden of suffering: US 2015 Est. 16,980 new cases
M:F = 4:1
Risks: Heavy use of cigarettes smoking and alcohol
Presentation: Usually primary of the esophagus
Rarely metastatic cancer – malignant melanoma
CANCER OF THE ESOPHAGUS
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Limit Alcohol and Tobacco
40x
30x
20x
10x
Alcoholic Drinks Consumed per Day
Packs of Cigarettes Consumed per Day
Combination of Alcohol and Cigarettes Increases Risk for Cancer of the Esophagus
Risk Increase
AND
N.C.I. 47
CANCER OF THE ESOPHAGUSSYMPTOMS
• Progressive difficulty in swallowing (fluids solids)
• Pain on swallowing
• Vomiting blood
• Lack of appetite
• Weight loss
• Cough/hoarseness
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CANCER OF THE ESOPHAGUS
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Endoscopy – Esophageal cancer
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Adjuvant chemotherapy + Surgery (if possible)
Systemic chemotherapy if no surgery can be performed
CANCER OF THE ESOPHAGUSTREATMENT
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INTERMISSION
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ABDOMINAL CAVITY
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LAPAROSCOPY (LOOKING INTO THE ABDOMINAL CAVITY)
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• Peritonitis: Frequent, secondary to inflammation of abdominal organs: appendix, intestine, stomach, liver, pancreas
• Ascites: Benign – Cirrhosis of liver
Malignant – Cancer of ovary, liver
FLUID ACCUMULATION IN THE ABDOMEN
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ASCITES
Causes:
Cirrhosis of liver
Other chronic liver diseases
Cancer spread
Heart failure
Nephrotic syndrome
Peritonitis
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THE STOMACH
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A breach in the mucosal lining of the stomach or of the duodenum. Sometimes, it may heal spontaneously.
Symptoms: Epigastric pain
Meal-time pain in stomach ulcer
Post-prandial pain in duodenal ulcer
Diagnosis: History and symptoms
EGD
Tests for Helicobacter pylori
Complications: Vomiting blood, blood in feces Perforation
Gastric outlet obstruction
PEPTIC ULCER
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GASTRIC PEPTIC ULCER
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Diet
Antacids
Protein Pump Inhibitors (PPI)
Surgery
PEPTIC ULCER TREATMENT
Burden of suffering: US 2015 Est. 24,590 new cases
Risk factors:
Helicobacter pylori in 65-80% of cases
Obesity
Cigarettes smoking: 40% increased risk for current smokers; 82% increase for heavy smokers
Diet: Smoked foods, salt and salt-rich foods, red meat, processed meat, pickled vegetables. Nitrates and nitrites in cured meats.
Genetic
STOMACH (GASTRIC) CANCER
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STOMACH CANCER
H. pylori associated with low vitamin C in gastric
juice
H. pylori inflammation reactive O• species
cytokines cancer
_______________
Hin-Peng, L.
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Symptoms: Appear when the cancer is advanced
Heartburn
Vomiting
Bleeding
Lack of meat taste
Diagnosis: Fiberoptic endoscopy
Treatment: Surgery
STOMACH CANCER
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Degrees of infiltration of cancer of the stomach
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STOMACH CANCER
THE LIVER
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Carbohydrate metabolism
Lipids metabolism; Cholesterol synthesis;
Bile production Digestion of fats
Protein metabolism, amino acids synthesis, clotting factors
Thrombopoietin platelets production in the bone marrow
Insulin-like growth factor
LIVER FUNCTIONS
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Two types:
Obstructive: Gallstones, hepatitis, pancreatitis, cancer
Hemolytic: RBC destruction (hemolysis), neonatal (kernicterus)
JAUNDICE (ICTERUS)
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Gallstones (Biliary calculi)
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Hepatic Portal Vein
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Esophageal varices
Stomach varices
Rectal hemorrhoids
Hemorrhages (bleeding) are frequently seen:
Vomiting blood (hematemesis)
Digested blood (melena) in the stools (black)
PORTAL HYPERTENSIONVENOUS BYPASSES
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Viral diseases : Hepatitis A, B, C, D, E
Hepatitis A: Food and water contaminated with fecal material
Hepatitis B: Blood and body fluids
Hepatitis C: Blood-to-blood contact (i.v. drugs, transfusions)
HEPATITIS AND ITS TRANSMISSION
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Causes: Hepatitis B and C
Alcoholic liver disease
Congestive heart failure
Biliary cirrhosis
Hemochromatosis
CIRRHOSIS OF LIVERCAUSES
CIRRHOSIS OF LIVER AND PORTAL HYPERTENSION WITH ASCITES
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Burden of suffering: US 2015 Est. 35,660 new cases
Risk factors:
Alcoholism
Hepatitis B
Hepatitis C (23% of cases)
Cirrhosis of liver
Aflatoxin
Diabetes mellitus
HEPATOMA = LIVER CANCER (HEPATOCELLULAR CARCINOMA)
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SYMPTOMS:
Tiredness, Anorexia, weight loss
Jaundice
Pain, Abdominal bloating
Easy bruising
DIAGNOSIS:
Ultrasound
Spiral CT scan
MRI
Alpha-protein level in the blood
HEPATOCELLULAR CARCINOMA
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Chemo-embolization
Radiofrequency ablation (tumors < 3cm)
Intra-arterial radiation (Yttrium-90)
Sorafenib (tyrosine kinase inhibitor,
anti-angiogenesis, and
apoptosis)
Surgical resection (only 155 of cases)
Liver transplantation
HEPATOCELLULAR CARCINOMATREATMENT
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THE PANCREAS
Upper AbdomenDuodenum, Pancreas, and Spleen
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Acute pancreatitis: a severe inflammation of the pancreas, frequently associated with bleeding
Causes: Alcohol abuse, gallstones, cancer
Symptoms: Acute pain in the upper abdomen
Nausea and vomiting, dehydration
Hypotension
Fever, chills
Treatment: Supportive
PANCREATITIS
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Endoscopic retrograde cholangiopancreatography (ERCP)
Burden of suffering: US 2015 Est. 48,960 new cases
Risk factors:
Age: rare before 40 y.o. Usually after 65 y.o.
Cigarettes smoking
Obesity (BMI > 35)
Family history
Chronic pancreatitis (3-fold)
CANCER OF THE PANCREAS
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Symptoms:
Unexplained weight loss
Jaundice
Diabetes mellitus in the elderly
Diagnosis:
Ultrasound
CT scan
ERCP
CANCER OF THE PANCREAS
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DIGESTION
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The assembly of physical, chemical, and biological processes that make possible for the food to give us the needed energy, growth, and cell repair.
Physical: Mechanical, watering
Chemical: Enzymes
Biological: Absorption
DIGESTION (I)
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Mechanical process (chewing in the mouth), churning the food in the stomach
GI Juices added to soften the foodstuffs and enzymes split the nutritional stuff into absorbable chemical entities:
Carb. glucose
Fats fatty acids
Proteins amino-acids
Water is absorbed in the colon
DIGESTION (II)
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All the chemical processes aimed to maintain the cellular homeostasis
Catabolism = breaking down the molecules to obtain energy
Anabolism = synthesis of all compounds needed by the cells
A complete diet must supply:
• Carbohydrates (carbs), proteins, and fats
• 18 inorganic elements (minerals)
• 17 vitamins (essential for life)
• Water
METABOLISM
Carbohydrates: Supplied as starch, sugar, cellulose (fiber). Starch and sugar are essential.
Proteins: Supplied as eggs, milk, soybeans, meats, vegetables, and grains. 8 essential amino acids. Building material.
Fats and lipids: animal fats (saturated) and vegetable fats (unsaturated). 3 are essential (linoleic, linolinic, and arachidonic).
Energy value
4 Cal/Gm
4 Cal/Gm
9 Cal/Gm
CARBS, PROTEINS, LIPIDS
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Metabolism
affected
Diabetes mellitus Carbohydrates
Glucose
High cholesterol Lipids
Gout Proteins
Purines
Uric acid
DISEASES OF METABOLISM
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DIABETES MELLITUS
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Type 1 – Body’s failure to produce insulin (“Juvenile diabetes”) Cause unknown
Type 2 – Insulin resistance Insulin deficiency
(“Adult-onset diabetes”)
Causes: Obesity, Lack of exercise
90% of cases – 400 Mil. worldwide
DIABETES MELLITUS
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Weight loss
Frequent urination
Thirst
Increased hunger
Blurred vision
Headache, fatigue
Slow healing of wounds
Itchy skin
DIABETES MELLITUS - SYMPTOMS
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Acute: Diabetic ketoacidosis
Chronic: Cardiovascular disease, arterial hypertension
Stroke
Kidney failure
Foot non-healing ulcers
Diabetic retinopathy - blindness
DIABETES MELLITUS - COMPLICATIONS
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Lifestyle: Physical exercise, Control of hypertension
Diet: Low carbohydrates
Maintain HbA1c <6.5%
Medication: Metformin
Insulin
DIABETES MELLITUS - TREATMENT
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Cholesterol is a lipid substance
Necessary for: Building cell membrane
Synthesis of hormones
It is transported in the blood attached to protein
Depending on its physical density:
LDL - associated with atherosclerosis, and coronary heart disease
HDL - protective
ELEVATED CHOLESTEROL IN THE BLOOD(HYPERCHOLESTEROLEMIA)
HIGH BLOOD CHOLESTEROL
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Risk factors: Diet rich in fats, obesity, genetic factors, diabetes, low thyroid function
Screening: U.S Preventive Task Force recommends screening: M > 35 y.o. W > 45 y.o.
High total blood cholesterol >240 mg/dlDesirable total blood cholesterol <200 mg/dl; Desirable HDL >60 mg/dl Desirable LDL <100 mg/dl
Treatment: Lifestyle dietary fat Statins if diet ineffective
ELEVATED CHOLESTEROL IN THE BLOOD
COLON CANCER
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CANCER STATISTICS IN USA – 2015*
All sites Lung Breast Prostate Colon
(W)
New cases 1,658,370 221,200 231,840 220,000 132,700
Deaths 589,430 158,040 40,290 27,540 49,700
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*Published 2/15
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COLORECTAL CANCER
BURDEN OF SUFFERING
Lifetime risk in U.S. = 2.6%
Average life loss = 13 yrs.
60% of cases are advanced at time of diagnosis
5-yr. survival - localized = 91%
- regional = 60%
- distant = 6%
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COLON CANCER - INCIDENCE
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FIBERSCOPE
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PREVALENCE OF PROXIMAL VS. DISTAL COLON CANCER BY AGE GROUP
0
10
20
30
40
50
60
70
80
Pre
va
len
ce
(%
)
>50 50-59 60-69 70-79 ≥80
Age
Proximal Distal
Mantel-Haenszel Chi-Square Test
p = 0.0481
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COLONOSCOPY
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COLONOSCOPY – COLON POLYPS
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Stages in colon cancer development
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COLONOSCOPY – COLON CANCER
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Surgery
Adjuvant Chemotherapy + Surgery
Chemotherapy
COLON CANCER - TREATMENT
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END OF LECTURE #6
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