Articles about tattoos (och en artikel på svenska)

I always warn people about tattoos and piercings (even wearing earrings…), since I have a problem with mercury/amalgam myself, and know first hand what those things can do to your body ( I would never put a tattoo or a piercing on my body). People are very concerned about vaccines, and what the ingredients are in that, it should be the same kind of thinking about tattoos too –  there are some health hazards connected to those kind of things, here’s an article about that theme:

http://www.naturalnews.com/050189_tattoo_ink_chronic_disease_heavy_metals.html

Tattoos linked to chronic health problems; dyes, chemicals can cause long-term allergies and infections, warn scientists
Thursday, June 25, 2015 by: Jonathan Benson, staff writer

(NaturalNews)
It’s somewhat amusing when health-conscious folks try to defend tattoos, all the while ignoring the fact that everything from the needle itself to the ink being injected is a potential health hazard. A recent study found that most tattooed people who develop some kind of acute reaction following the invasive procedure also end up developing chronic health problems like constant swelling and infection.

After polling some 300 tattooed people walking through New York’s Central Park, researchers found that only about 10% recalled suffering any noticeable reactions following the procedure. But among those who did, six in 10 said they suffered severe health problems that didn’t go away for a long time; some of them still suffering to this day.

Dr. Marie Leger, a dermatologist at the New York University Langone Medical Center in New York City and co-author of the recently published paper, says she decided to investigate the issue after noticing an uptick in the number of patients coming to her because of problems with their tattoos. After speaking to friends and colleagues, she discovered that tattoo-related health problems are much more common than she previously thought.

Her paper, which was published in the journal Contact Dermatitis, contends that one in 10 people who get tattoos experience itching, swelling, redness or infection as a result of the procedure. In most cases, these adverse effects last for months or even years, though many tattooed people decide to just live with it and avoid seeing a doctor.

Claiming that she actually likes tattoos, Dr. Leger still warns that people need to be aware of the risks involved, which are probably more severe than the average person assumes. Injecting any kind of unnatural substance below the skin obviously isn’t risk-free, and since getting a tattoo is largely permanent (aside from getting it professionally removed), people need to carefully consider what they’re doing to their bodies.

“Of 300 participants, 31 (10.3%) reported experiencing an adverse tattoo reaction, 13 (4.3%) reported acute reactions, and 18 (6.0%) suffered from a chronic reaction involving a specific colour lasting for >4 months,” warns the study. “This study shows that tattoo reactions are relatively common, and that further investigation into the underlying causes is merited.”

Tattoos and vaccines both contain toxic mercury

What about the ink itself? According to Dr. Leger, tattoo ink is very loosely regulated in the U.S., meaning it may contain all sorts of hidden toxins that, once injected, can never be fully removed. Tattoos are a lot like vaccines, in fact, as recipients are typically unaware of what’s being pumped into their bodies.

Natural News can confirm, based on tests conducted in our own in-house Forensic Food Lab, that some tattoo ink contains upwards of 6,000 parts per billion (ppb) of mercury.

Other research has shown that tattoo ink often contains heavy metals like titanium, copper, chromium and iron. One study out of Italy published in 2009 identified cadmium, cobalt, chromium and nickel in all of 13 separate ink samples from a single supplier. Most of these samples also contained mercury, according to the study.

“Very few countries have any regulations controlling the composition of tattoo inks,” explains the website Science Or Not.

“Most have regulations covering colourings used in foods and cosmetics. These do not apply to tattoos, but some tattoo ink suppliers make reference to such regulations to imply that their products are safe. The wide variety of pigments used and lack of regulation means there is potential for harmful consequences.”

To see the test results of many other consumer products, including brown rice protein and cacao powder, be sure to visit the Natural News Forensic Food Lab website:
Labs.NaturalNews.com.

Sources:

http://onlinelibrary.wiley.com

http://www.livescience.com

http://www.huffingtonpost.com

http://scienceornot.net

Learn more:  http://www.naturalnews.com/050189_tattoo_ink_chronic_disease_heavy_metals.html#ixzz44UEPizY0

 

And here’s another website, treehugger.com:
http://www.treehugger.com/culture/ask-treehugger-are-tattoo-inks-toxic.html

Question: I’ve been wanting to get myself a tattoo for a few weeks, but I’ve heard that tattoo inks can be toxic. Where/How can I find a tattoo artist who uses “safe” inks?

Response: The safety of tattoo inks or pigments have recently been the subject of some attention, possibly the result of a lawsuit brought by the American Environmental Safety Institute (AESI) against Huck Spaulding Enterprises, Inc., Superior Tattoo Equipment Co., and other tattoo ink sellers in the U.S. As a result of this lawsuit, the companies must place a warning for their California customers on their tattoo ink labels, catalogs and Internet sites that reads “inks contain many heavy metals, including lead, arsenic and others” and that the ingredients have been linked to cancer and birth defects. These adverse effects have been shown for exposures that occur over long time periods to these and other heavy metals, although not explicitly from these metals in tattoos. Although the US Food and Drug Administration (FDA) has the authority to regulate tattoo pigments, tattoo pigments have not yet been approved by FDA for injection into the skin, as is done when a tattoo is made. Heavy metals are used to give tattoo pigments their permanent color. The specific ingredients that are used in the pigments differ by color and by brand, but may include not only lead and arsenic, but also antimony, beryllium, chromium, cobalt, and nickel — metals that have also been linked to bad outcomes in people. The amount of these metals in a tattoo may be substantial. For example, AESI states that the ink used for an index card sized (3″ by 5″) tattoo contains 1.23 micrograms of lead, which is more than double the amount permitted per day under California’s Proposition 65.

Certain tattoo colors may present greater health risks than others. For example, green and blue pigments produced from copper salts (Copper Pthalocyanine) are thought to be safe, as they are approved by the U.S. Food and Drug Administration (FDA) for use in contact lenses, surgical implants, and infant furniture paint. Similarly, black pigments made from carbon black or india ink, white pigments made from zinc or titanium white, purple pigments made from dioxazine/carbazole, and brown pigments made from iron oxides are thought to be have minimal (if any) health risks. Of the colors, red pigments, especially those that contain cadmium, iron oxides or mercury (cinnabar), are generally the most worrisome. Mercury in tattoo pigments, for example, has caused allergic reactions and scarring in people and has sensitized people to mercury from other sources, such as fish or dental fillings.

In light of these and other concerns, it makes sense to think twice about getting a tattoo. At a minimum, you should find out the ingredients of any tattoo pigments that will make up your new tattoo. This information may be hard to find, since the ingredients of tattoo pigments are considered to be proprietary and thus are usually not listed or otherwise revealed. Some tattoo artists, however, do mix their own tattoo pigments, in which case they should be able to tell you the ingredients. I would suggest going to only those artists that can give you this information.

And another website:

http://naturallysavvy.com/care/are-tattoos-safe-the-truth-about-tattoo-inks

ARE TATTOOS SAFE? THE TRUTH ABOUT TATTOO INKS

More than 20 percent of adults in the United States have a tattoo and, believe it or not, women beat out men in this area (23% vs 19%). But how many tattoo-toting men and women know the truth about the tattoo inks that were injected under their skin? If you are thinking about getting a tattoo, do you know which tattoo inks are safe and which ones are not?

The first truth about tattoo inks in the US is that while the Food and Drug Administration (FDA) regulates substances people ingest and some of the ingredients individuals place on their skin, the agency does not regulate inks that are placed under the skin. That means you must trust the individuals who are providing the tattoo services to use safe inks. But what are safe inks?

You don’t get any help from the FDA here either. That’s because the agency does not require the ink makers to reveal the ingredients in their products. Tattoo inks include the pigment, which can include a variety of metallic salts (e.g., oxides, selenides, sulfides), organic dyes, or plastics, and the carriers with which they are mixed to help provide an even application of the ink.

Read more about getting a tattoo

Regulation of tattoo inks differs from that of permanent makeup inks in that the states—and not the federal government–regulate the latter. Each state has its own guidelines.

Overall, the FDA has stated the following concerning tattoo and permanent makeup inks:FDA considers the inks used in intradermal tattoos, including permanent makeup, to be cosmetics…. The pigments used in the inks are color additives, which are subject to premarket approval under the Federal Food, Drug, and Cosmetic Act. However…FDA traditionally has not exercised regulatory authority for color additives on the pigments used in tattoo inks. The actual practice of tattooing is regulated by local jurisdictions.

The bottom line is that every brand and color of tattoo ink has different ingredients, according to a Northern Arizona University study, and since the makers don’t have to tell you what’s in their products, it is clearly a case of buyer beware. You can take steps to uncover the ingredients by asking for the MFSD sheet on the different tattoo inks.

Tattoo inks may be made from titanium dioxide, lead, chromium, nickel, iron oxides, ash, carbon black, and other ingredients. Some of the pigments are industrial grade and used as automobile paint. According to an Environmental Health News report, an ingredient found in black tattoo inks—benzo(a)pyrene—has caused skin cancer in animals. It also noted that tattoo inks have migrated into the lymph nodes, which play a significant role in immune system health.

Carrier ingredients may contain dangerous substances such as antifreeze, formaldehyde, methanol, denatured alcohols, and other aldehydes. Among the most popular pigments are those made from acrylonitrile butadiene styrene (ABS), a type of heat-resistant plastic that is used to make luggage, pipe fittings, appliance parts, and, when ground down, tattoo inks. These inks are popular because they produce vivid colors. In fact, you can usually tell if an ink contains ABS because of the color.

You may pay a price for brilliant color, however, as people can experience allergic reactions to these plastic-based pigments. However, pigments that have a metal base also can cause allergic reactions. For example, you may react to the cobalt or copper in blue, the cadmium sulfite in yellow, or the mercury in red cinnabar.

An additional danger from tattoo inks concerns the desire to have a tattoo removed. If you want to eliminate a tattoo using laser or ultraviolet light (the usual methods), the process may cause the release of toxic chemicals into your body, especially if the tattoo includes yellow #7 pigment.

Did you know you can get a tattoo that glows in the dark or responds to black ultraviolet light? These tattoo inks can be dangerous, as they can accumulate into one spot under your skin. Carriers that contain alcohol cause an increase in the skin’s permeability, which means the pigment and all of its chemicals are better transported into the bloodstream. Alcohol also has been shown to enhance the activity of cancer-causing substances.

What about a henna tattoo?

Is a henna tattoo safer? Not really. If you want to choose a henna tattoo, you should ask about the ingredients. Those that contain para-phenylenediamine (PPD) as well as other toxic chemicals found in dyes can cause delayed allergic reactions and hypopigmentation, scarring, and dying skin (skin necrosis). In addition, use of henna may cause you to be permanently unable to tolerate sulfa drugs, sunscreens that contain PABA, benzocaine, and hair dyes.

Read more about henna tattoos

What you should do

Since companies are not required to reveal the ingredients in their tattoo inks and you are not protected against receiving a tattoo from unqualified individuals (unless you do your homework, as noted in a previous Naturally Savvy article on tattoos), you need to take steps to ensure your safety if you want to have a tattoo. Therefore:

  • Ask to see the Material Safety Data Sheets (MSDS) for each of the pigments or carriers to be used in your tattoo. These information sheets will tell you about the safety and basic health information on each substance.
  • Have skin tests performed on each of the inks to be used in your tattoo, even if the professional insists the inks are safe.
  • Insist on inks that generally have been shown to be safe. Therefore, look for carriers that include glycerine, ethanol, and purified water rather than toxic chemicals.
  • Nontoxic choices for various different colors of pigments include the following: logwood and carbon for black; titanium dioxide for white; turmeric for yellow; monoazo (carbon-based) for green; sodium, aluminum, or copper for blue; dioxazine and carbazole for purple. Avoid red pigments made from cadmium red, iron oxide, or cinnabar and ask for naphthol.
  • Avoid neon or vividly colored pigments, which are more likely to be toxic than other pigments.
  • Consider vegan tattoo inks. Numerous companies make pigments that are animal cruelty free. You can check this list of vegan tattoo inks and ask for them by name.

The safest advice of all regarding tattoo inks? Don’t get a tattoo. If you have your heart set on getting one, do your homework and choose the safest tattoo inks available and licensed professionals.

Additional sources
The truth about tattoos: Health risks, toxicity and more
Nontoxic tattoo ink ingredients

And what Dr Mercola is saying about this theme:
http://articles.mercola.com/sites/articles/archive/2015/06/10/allergic-reaction-tattoo.aspx

About one in five US adults, or 21 percent, has at least one tattoo. This is up from 14 percent in 2008, according to a Harris poll.1 Tattoos have been around for more than 5,000 years. They were used in ancient Egypt as a way to identify peasants and slaves.2

They were discovered on a 5,000-year-old frozen mummy identified as the “Iceman,” and it’s thought his tattoos may have been placed as a therapeutic tool on areas prone to joint pain and degeneration.3

In Samoa, extensive tattoos were given as a show of courage, endurance, and dedication to cultural traditions,4 while around the world different cultures valued the designs as status symbols, signs of religious beliefs, declarations of love, beautifications, or as a form of punishment.5

In the US, tattoos, once thought of as more of a fringe or alternative practice, are becoming practically mainstream and are often used as a form of self-expression. There are still some stereotypes remaining, however.

While 73 percent of voters said they would hire someone with a visible tattoo,627 percent of respondents to a Harris poll believed people with tattoos are less intelligent and 50 percent believed they were more rebellious.

Most people getting a tattoo are not doing so to appease the views of others, of course, but there is one consideration you might not have considered: your health. If you’ve ever gotten a tattoo, or thought about it, chances are high that you weighed the artistic and social aspects of it far more than the healthaspects.

But, unbeknownst to many, a significant number of people with tattoos have experienced lasting health issues as a result.

10 Percent of People with Tattoos Experienced Abnormal Reactions

Researchers from the NYU Langone Medical Center surveyed 300 people in New York’s Central Park. Of those who had a tattoo, more than 10 percent said they developed abnormal reactions as a result, including pain, itching, and infection that sometimes required antibiotics.8,9

In 4 percent of the cases, the symptoms went away within four months, but for 6 percent symptoms such as itching, scaly skin, and swelling lasted much longer. Chronic reactions occurred more often in people with more colors in their tattoo, particularly shades of red.

Past research has also found “red pigments are the commonest cause of delayed tattoo reactions.”10 One study conducted actual skin biopsies from red tattoo reactions and determined interface dermatitis was the primary problem, in many cases due to an allergic response.

In many cases, however, “overlapping reactive patterns were identified,” which suggests the red pigment was irritating the skin and body via multiple mechanisms.11 In addition to red, pink and purple colors were also commonly involved in reactions.

The featured study’s lead author was actually motivated to conduct the study after seeing a patient who seemed to develop an intolerance to red tattoo dye after receiving her multiple tattoos. She told CNN:12

“[Dr. Marie C. Leger, assistant professor of dermatology at NYU Langone Medical Center]… got motivated to study tattoo complications after treating a patient who developed itching and raised, scaly skin around only the red parts of a tattoo on her arm. 

She had the first tattoo for years but the symptoms started after getting a more recent tattoo on her foot. In addition to the problems at the tattoo site, she developed a rash over her whole body. 

‘It was like her body decided after being exposed to red dye more than once, that it just didn’t like it,’ Leger said. There are many questions over what is causing these undesirable side effects. Leger said she suspects that allergic reactions to the dyes, especially red dye, are responsible for some of the chronic reactions lasting more than four months.” 

Tattoo Ink Is Unregulated

While tattoo parlors are often inspected to ensure safe practices (such as the use of single-use needles), however tattoo inks typically fly under the radar. Inks and ink colorings (pigments) used for tattoos are technically subject to regulation by the US Food and Drug Administration (FDA) as cosmetics and color additives.

However, the Agency states that because of other public health priorities and a “previous lack of evidence of safety concerns,” they have not traditionally regulated such products.13

It has been said that “tattoo ink is remarkably nonreactive histologically, despite the frequent use of different pigments of unknown purity and identity by tattoo artists.”14

However, University of Bradford researchers using an atomic force microscope (AFM) that allows them to examine skin with tattoos at the nano-level have found evidence that suggests otherwise. In a preliminary study (the first to use an AFM to examine tattoos), the researchers found that the tattoo process remodels collagen (your body’s main connective tissue).15

Carcinogenic Nanoparticles Found in Tattoo Ink

In 2011, a study in The British Journal of Dermatology revealed that nanoparticles are indeed found in tattoo inks,16 with black pigments containing the smallest particles (white pigments had the largest particles and colored pigments were in between).

Nanoparticles are ultramicroscopic in size, making them able to readily penetrate your skin and travel to underlying blood vessels and your bloodstream. Evidence suggests that some nanoparticles may induce toxic effects in your brain and cause nerve damage, and some may also be carcinogenic.

Further, nanoparticles from tattoo ink were found to exist in both the collagenous network of the skin as well as around blood vessels, according to the University of Bradford researchers.

This suggests the ink particles are leaving the surface of your skin and traveling elsewhere in your body, where they could potentially enter organs and other tissues. This is particularly worrisome because tattoo inks are known to contain cancer-causing compounds…

Black Tattoo Ink May Also Carry Unique Risks

While red ink appears to be associated with chronic skin reactions and those that are allergic in nature, black ink is also implicated in health problems. This might be, in part, because of its high concentration of nanoparticles.

“The black pigments were almost pure NPs [nanoparticles], i.e. particles with at least one dimension <100 nm,” researchers said in The British Journal of Dermatology.17 Writing in Experimental Dermatology, researchers highlighted the dangerous potential of tattoo inks (particularly black) even beyond nanoparticles:18

“Black tattoo inks are usually based on soot, are not regulated and may contain hazardous polycyclic aromatic hydrocarbons (PAHs). Part of PAHs possibly stay lifelong in skin, absorb UV radiation and generate singlet oxygen, which may affect skin integrity. 

Tattooing with black inks entails an injection of substantial amounts of phenol and PAHs into skin. Most of these PAHs are carcinogenic and may additionally generate deleterious singlet oxygen inside the dermis when skin is exposed to UVA (e.g. solar radiation).”

That being said, all tattoo inks have toxic potential. Some tattoo pigment may migrate from your skin into your body’s lymph nodes, for instance.19 Other potential health effects include:

  • Potentially carcinogenic20
  • May cause inflammation and DNA damage21
  • May contain carcinogenic Polycyclic Aromatic Hydrocarbons (PAHs) like benzo(a)pyrene (a Class 1 carcinogen according to the International Agency for Research on Cancer)

‘Think Before You Ink’

While I certainly value artistic and self-expression, I do urge you to “think before you ink” for the sake of your health. No systematic studies have been performed on the safety of tattoo inks, and many of those used are industrial-grade colors suitable for printers’ ink or automobile paint.22

There is much yet to be learned about how these pigments interact with your body. For instance, National Center for Toxicological Research (NCTR) studies show that Yellow 74, a common yellow tattoo ink, is broken down by enzymes and metabolized by your body.

This pigment also breaks down in sunlight, often turning colorless, but the pigments remain and it’s unknown if they are toxic. Ink breakdown products may also disperse throughout your body, again with unknown effects.23 As the number of teenagers and young adults getting tattoos increases, it’s expected that complications will too. As reported in the Journal of Cutaneous and Aesthetic Surgery:24

Unfortunately there are no legislations to promote safe tattooing, hence complications are quite common. Superficial and deep local infections, systemic infections, allergic reactions, photodermatitis, granulomatous reactions and lichenoid reactions may occur. Skin diseases localized on the tattooed area, such as eczema, psoriasis, lichen planus, and morphea can be occasionally seen.” 

Additional risks that can occur with any tattoo include:25

  • Scarring
  • Granulomas, which are small knots or bumps that may form around a material your body perceives as foreign
  • MRI complications, such as swelling or burning at the tattoo site during an MRI

Tattoo Removal Carries Its Own Set of Risks

If you do decide to get a tattoo, consider it a permanent decision. Although tattoo removal is possible using laser treatment and other methods, it is time-consuming, expensive, and may not rid you of the tattoo completely. As explained in the Journal of Cutaneous and Aesthetic Surgery:26

“…regrets after a tattoo are also seen and requests for tattoo removal are rising. Laser tattoo removal using Q-switched lasers are the safest; however, complications can occur. Acute complications include pain, blistering, crusting and pinpoint hemorrhage. Among the delayed complications pigmentary changes, hypopigmentation and hyperpigmentation, paradoxical darkening of cosmetic tattoos and allergic reactions can be seen. 

Another common complication is the presence of residual pigmentation or ghost images. Scarring and textural changes are potential irreversible complications. In addition, tattoo removal can be a prolonged tedious procedure, particularly with professional tattoos, which are difficult to erase as compared to amateur tattoos. Hence the adage, stop and think before you ink holds very much true in the present scenario.”

Och en svensk artikel om tatueringar också:

http://www.aftonbladet.se/nyheter/article20486902.ab

Flera tatueringsfärger förbjuds

De innehåller cancerframkallande ämnen, tungmetaller och arsenik.

Nu plockas 20 tatueringsfärger bort från den svenska marknaden.

– Ett väldigt nedslående resultat, säger Magnus Crona på Läkemedelsverket.

Av 29 tatueringsfärger blev bara två godkända när Läkemedelsverket lät analysera innehållet. 15 hade höga halter av förbjudna ämnen som arsenik, barium och bly. Sex innehöll aromatiska aminer som kan ge cancer, skada arvsmassan, orsaka sterilitet och framkalla allergier.

– Det är ett väldigt nedslående resultat. Det var några produkter med märkningsbrister som korrigerades men det var ändå 20 produkter som togs bort, säger Magnus Crona, utredare på enheten för kosmetiska produkter på Läkemedelsverket.

Alla utom två färger bröt mot märkningsreglerna, men detta rättades till av sju av återförsäljarna.

“Har tagit bort den”

En av färgerna som förbjuds heter True Gold från det kända märket Eternal Ink. Färgen innehöll fyra aromatiska aminer och 84 gånger för hög halt av tungmetallen barium.

Läkemedelsverkets kontroll gjordes hos återförsäljaren East Street Tattoo i Stockholm, som nu slutat sälja färgen.

– Den fick nedslag, vi har tagit bort den från sortimentet och vi har pratat med tillverkaren. Färgen i sig har gått igenom den europeiska kontrollen men de säger att det har att göra med en produktionsmiss. Vi har ringt runt till de vi sålt till och informerat om att de bör ta bort den, säger Isak som är tatuerare sedan 25 år och företagets produktansvarige.

Eternal Ink har många färger. Litar ni på dem i fortsättningen?

– Ja, det kan jag nog säga att jag gör. Självklart tar vi det på allvar men vi har ändå förtroende för leverantören och kan bara beklaga att en sån miss har skett, säger Isak.

“Fruktansvärd marknad”

Isak tycker att man som tatueringskund inte ska behöva vara orolig.

Men något han verkligen vill varna för är att handla färg på köp- och säljsajter på nätet. Nio av de nu förbjudna färgerna såldes av företag på Tradera.

– Det är fruktansvärd marknad. Det ska man absolut inte göra. 99,9 procent av det som säljs där är piratkopierade färger, säger Isak.

Missuppfattning

Det finns runt 1 600 tatueringsfärger i Läkemedelsverkets register över de som säljs i Sverige. Enligt Magnus Crona tar tatuerare för givet att färgerna är testade.

Men det är tillverkarens ansvar att se till att de inte innehåller förbjudna ämnen. Återförsäljare får inte sälja färger med förbjudna ämnen och tatuerarna får inte använda den.

Myndigheten utför bara stickprover.

– En del missuppfattar det som att anmälan betyder att de är kontrollerade. Men företaget måste kolla upp att tillverkaren kan visa upp ett analysprotokoll, säger Magnus Crona.

Frågan många ställer sig är hur många färger som skulle förbjudas om alla analyserades.

– Förmodligen skulle det vara ganska många. Vår förhoppning är att företagen ska få bättre kunskap om reglerna och bli bättre på att kontrollera sina produkter. Det är också viktigt att konsumenterna är medvetna om problemet och ställer frågor om färgerna och hygienen, säger Magnus Crona.

Billigast är sämst

Branschorganisationen Sveriges registrerade tatuerare (SRT) representerar ett hundratal av landets runt 3 000–4 000 öppet verksamma tatuerare.

Föreningens ordförande Jens Bergström är inte förvånad över resultatet, och menar att det framför allt är billiga asiatiska färger som brister.

– När man köper det billigast möjliga så får man det sämsta möjliga, säger han till TT.

 

Fotnot: Färgerna Cheyenne Ink Sensored black och Silverback Ink XXX black uppfyllde det som granskades. 

Företagen som säljer färgerna Atomic traffic red, Bella pigment BPC 301 Pure black, Killer black premium quality tattoo ink light shading, LCN Permanent make-up colour eyebrows lava brown, Panthera XP tattoo ink XX tribal black, Permanent pigment U50 toffy och Sacred color tattoo ink light grey rättade frivilligt till brister i innehållsdeklarationen.

 

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