Shoddy Dentistry
– 10 Examples –

Dr. Al Danenberg ● Nutritional Periodontist

January 31, 2021

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I could be ostracized for writing this article. But after 44 years in the clinical practice of periodontics, I have seen quite a bit – quite a bit of serious damage to the mouth. Frequently, this has been brought about by shoddy dentistry, which is also known as iatrogenic dentistry. And that damage has often affected the rest of the body.

Iatrogenic dentistry is any trauma or damage that has been induced by a dentist’s activity, manner, or therapy. Iatrogenic dentistry can create poor function, pain, swelling, infection, and spread of systemic inflammation. It also may result in permanent damage from no fault of the patient.

Dental Procedures

The truth is obvious. Dental problems can occur that must be repaired by a competent dentist.

For example, after a tooth is damaged from decay, fracture, or other factors, the dentist may need to use dental materials and instruments like dental drills to fix the tooth.

Another problem is gum disease. When it is present, its destructive nature can penetrate all tissues. If this infection is not treated effectively and efficiently, bacteria and inflammation can spread into the jawbone ultimately causing loss of teeth. Also, this disease can enter the blood system as well as travel the paths of nerves. The spread of bacteria and inflammation could cause severe disease in other parts of the body.

The goal of a biologically oriented dentist is to restore the mouth to proper function that is compatible with the overall health of the body. Unfortunately, some dental procedures are not performed properly. And then some procedures are not medically necessary, and the patient is not informed.

Like I said, during the course of my clinical treatment of periodontal patients, I have seen many results of shoddy dentistry. Here are the 10 most common examples of shoddy dentistry I have observed in my patients:

10 Examples of Shoddy Dentistry

  1. Poorly placed fillings in teeth
  2. Tooth procedures that cause the death of the living tissues within the tooth
  3. Trauma to the tooth initiated by a dentist that causes tooth sensitivity, mobility, or hairline fractures
  4. Toxic chemicals in tooth filling materials that harm the patient’s body
  5. Ill-fitting crowns, veneers, bridges, implants, partial dentures, or complete dentures that cause irritation, pain, swelling, inflammation, and infection
  6. Incomplete removal of excess cement under the gum tissues after crowns are cemented
  7. Failure to correctly treat active periodontal disease
  8. Unacceptable orthodontic treatment that causes future airway obstruction, grinding and gritting of teeth, improper alignment of teeth, and compromised jaw and tongue function
  9. Improper techniques when extracting teeth resulting in trauma to the jawbone and residual infection and inflammation in the healing bone socket
  10. Root canal treatment that does not resolve infection oozing out of a dead tooth into the jawbone

In many situations, shoddy dental work resulting in tooth or tissue damage can be corrected, repaired, and healed. At other times, there may be irreparable damage to the tooth, spread of chronic inflammation and infection through the body, and the progressive loss of teeth and function years down the road. Unfortunately, damage to the mouth may not be obvious immediately. Also, some damage to other organ systems of the body may be difficult to trace back to the mouth.

Reactive & Proactive

If you have fillings, crowns, root canals, or cosmetic dentistry, the structure of the tooth has been compromised. Statistics from the American Dental Association state that these teeth most likely will need further treatment as the restorative materials break down over time. If teeth become untreatable, they will need to be extracted and may need to be replaced for proper chewing and digestive function.

If you have any dental work in your mouth, you must be diligent to maintain oral health. Personal oral hygiene, regular dental checkups, and diet become vital to protect you from further dental breakdown.

If you have any dentistry in your mouth that has been identified as shoddy, you must have it corrected. If you need to find a biologically oriented dentist to help get your mouth back to health, here are three websites where you may be able to find a qualified dentist in your Zip Code area:

To further help you, my PDF describes the “4 Steps to a Healthy Mouth”. Everyone can benefit from it. Also, I suggest a healthy way of eating in my mini-eBook “Better Belly Blueprint”. This will provide your body with all the nutrients your mouth and body require to be healthy.

You need to become aware if you have shoddy dentistry. The repercussions can be severe. If you have questionable dental work, it must be evaluated and repaired. You should not ignore the potential problems, which could manifest in your mouth and the rest of your body.

 

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5 Important Tools
for a
Robust Immune System

Dr. Al Danenberg ● Nutritional Periodontist

December 13, 2020

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Image by Bruno /Germany from Pixabay

I’m obsessed with getting it right.

From all the research I’ve read and from my personal cancer journey, there is one fact that stands out above all: A robust immune system is critical for wellness.

It’s vital for healthy people; it’s vital for sick people; it’s vital for all who want to be proactive as well as those who are reactive.

A robust immune system is the ticket for fighting diseases arising from external and internal sources. It protects us from pathogens as well as our own cells which become cancerous.

I’m fixated on recreating my robust immune system and evaluating my success along the way. And I’ve assembled a toolbox – my biological measuring tools. It includes 5 biomarkers which tell me what I need to know. I’ve used these measurements to guide me on my journey to a healthier immune system.

You also can use these tools to assess your progress and success.

 

5 Important Tools

#1. Healthy Gum Tissue

Your mouth can tell a lot about the health of your immune system. One prominent sign is the gum tissue around your teeth. It should never bleed unless it is cut. Never!

If you were to scrub your nails with a nail brush, you should be concerned if the cuticles around your nails started bleeding. Similarly, when you brush your teeth with a toothbrush, you should be concerned if you see any bleeding. The gums are as tough and protective as are your cuticles.

However, if you have a compromised immune system, the gum tissues may become inflamed or infected (i.e., gingivitis). They then may bleed when you clean or rub them. They even may bleed spontaneously. This is a strong indication that your immune system is not functioning ideally.

An excellent method to determine if you have bleeding gums around any tooth is to use a TePe Easy Pick. This is a small, silicone brush used to clean between the teeth at the gum line.

If you see any bleeding when using the TePe Easy Pick around any tooth/gum area in your mouth, you have some form of gum disease. This suggests that you have a compromised immune system.

Here are two pictures demonstrating how to use the TePe Easy Pick between teeth at the gum/tooth margin.

 

#2. Ketone Breath Meter

Metabolic flexibility is necessary to support a responsive immune system. And ketosis is part of being metabolically flexible.

I want to be in ketosis 6 days a week and then cycle into a carb-burning mode on the 7th day. The benefits of ketosis and carb-cycling are documented in the medical literature. Travis Christofferson summarized the unique qualities of ketones in his book, Ketones: The Fourth Fuel.

To help me gauge my ketone levels and document how well I’m doing, I researched three options.

  1. Urine ketone strips are easy and inexpensive. But they are not accurate once your body begins to utilize its blood ketones efficiently and effectively.
  2. Blood ketone levels can be monitored with finger sticks using a blood ketone meter. The readings are accurate, but I would need to prick my finger several times a day, every day. Not for me! I don’t know about you, but it hurts when done repeatedly. Another drawback is that it only gives a static picture at that moment in time.
  3. A ketone breath meter recently came on the market that has clinical research to support its efficacy. It’s was created and is sold by MyBiosense. This meter is unique because it registers acetone levels that are blown out in the latter part of the exhale, which is called Deep Lung Sampling. The readings correlate to the mmol/L of blood ketone levels. Using this device, I can monitor my ketone levels as often as I want with no finger sticks! And the data is stored in the MyBiosense App on my phone for me to review.

My goal is to average a ketone level between 1.5 – 2.5 mmol/L per day while in ketosis. On my “carb” day, my ketone levels will drop below 0.5 mmol/L that day.

 

#3. Standard Deviation of Glycemic Variability

Glycemic variability is the up and down variations in blood glucose level. It indicates the efficiency of insulin to make glucose available as a fuel or to store it appropriately. If insulin is not effective, glucose levels will get out of control leading to diabetes and various forms of metabolic dysfunction.

Various medical papers have shown that the standard deviation of glycemic variability directly correlates with the risk of chronic disease and cancer. It is inversely correlated with the robustness of the immune system.

I want my glycemic variability to be as low as practical.

I could take finger sticks frequently using a glucometer to register my moment-in-time blood glucose level. But that would not give me a running graph 24/7. It certainly would leave me with painful fingertips. I prefer not.

However, a continuous glucose monitor (CGM) by NutriSense is a device that is worn for two continuous weeks. The CGM inserts a microfiber into the interstitial tissues and attaches to an inconspicuous area of the body with an adhesive. It is painless to insert and wear. But it registers glucose levels every 5 minutes, 24/7. The data is transferred to a NutriSense App, which calculates the standard deviation.

 

#4. Alpha Diversity of Gut Microbiome

The gut microbiome is made up of about 38 trillion microbes. Our body only has about 30 trillion human cells. We are more “microbial” than “human”!

Many studies have been published describing the variety of species in the gut. These medical papers clearly demonstrate that the greater the diversity and numbers of specific microbes, the healthier the immune system. [1],[2],[3]

A measurement including (1) the diversity of various microbial species in the gut and (2) the number of each of these species is called “Alpha Diversity”. It is generally reported as a percentile compared to the microbial ecosystem in a population of metabolically healthy individuals.

BiomeFx is a stool test marketed by Microbiome Labs and evaluated by CosmosID. Among the many biomarkers reported in this test, Alpha Diversity stands out to me as one of the most significant results.

 

#5. Blood Level of Vitamin D

Recently, blood levels of Vitamin D have been widely reported as important in the fight against the COVID-19 virus.[4] Previous to the Pandemic, much research has been published emphasizing the importance of adequate levels of Vitamin D to assure a robust innate and adaptive immune function.[5], [6],[7],[8]

Vitamin D is reported to …

  • Prevent excessive expression of inflammatory cytokines
  • Increase the “oxidative burst” potential of macrophages
  • Stimulate the expression of potent anti-microbial peptides, which exist in neutrophils, monocytes, natural killer cells, and in epithelial cells lining the respiratory tract where they play a major role in protecting the lung from infection
  • Affect the action of T cells, key players in adaptive immunity

My Personal Results

#1. Healthy Gum Tissues:

My gums do not bleed. I use the TePe Easy Picks every day.

If you have bleeding gums, you need to address your diet, the health of your gut microbiome, and your oral hygiene techniques. You also need to seek the services of a general dentist or a periodontist (a dentist specializing in periodontal disease).

 

#2. Ketones:

I stay in ketosis with my animal-based diet 6 days a week. My highest mmol/L while in ketosis has been 2.8; the lowest on those days has been 0.5. My average for 6 days running is 1.5. On my cycle day out of ketosis, I eat between 100 – 150 grams of carbs for that day, and my ketone reading drops to an average of 0.3.

 

#3. Glycemic Variability:

In July 2020, I wore the CGM from NutriSense for two weeks. My average standard deviation of glycemic variability for that time period was 10. Here is a table showing ranges and their interpretations:

 

#4. Alpha Diversity:

My Alpha Diversity was reported in the BiomeFx stool test I took in August 2020. The results indicated my Alpha Diversity was in the 98th percentile. That meant that 98% of metabolically healthy individuals had less variation of species and numbers of individual microbes than I had.

 

#5. 25 Hydroxy Vitamin D:

My last blood test for 25 Hydroxy Vitamin D was in 6/2020. At that time, my blood level was 89 ng/mL. and I was taking 5,000 IU of Vitamin D3 daily. I have reduced that dosage to every other day, and I’ll have another test shortly. As a cancer patient, I want to keep my Vitamin D level between 60-80 ng/mL.

 

Bottom Line

A robust immune system is our internal armed forces to fight the fight. My ultimate goal is to make my immune system as robust as I can. The 5 important tools I described will guide me along my path and document my success. They also will confirm that I am remaining where I want to be.

I firmly believe that my cancer journey has been as successful as it has because I have significantly improved my immune system along the way. You may find that my 5 Important Tools will help you monitor your journey to a stronger and more responsive immune system.

 

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6906406/

[2] https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0200728

[3] https://www.frontiersin.org/articles/10.3389/fmicb.2016.00455/full

[4] https://articles.mercola.com/sites/articles/archive/2020/12/11/do-vitamin-d-supplements-help-prevent-respiratory-tract-infections.aspx?ui=baff764f733a1f4f602b56b0683839cc74ea77293ab586e40b1b7b0b93d42111&cid_source=dnl&cid_medium=email&cid_content=art1HL&cid=20201211&mid=DM744365&rid=1032114513

[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3166406/

[6] https://health.ucsd.edu/news/releases/pages/2018-06-15-greater-levels-of-vitamin-d-associated-with-decreased-risk-of-breast-cancer.aspx

[7] https://www.mdpi.com/2072-6643/12/4/1140

[8] https://www.mdpi.com/2072-6643/12/5/1248

 

 

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Cancer & Carnivore Diet
– My Experiment –

Dr. Al Danenberg ● Nutritional Periodontist

January 6, 2020

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Cancer & Carnivore Diet

I am making a major change in my diet. As with my entire unconventional cancer journey, I continue to experiment and think “outside of the box”. My current research is suggesting that there are potential benefits to replacing my Paleo-type diet with the Carnivore Diet in my Daily Cancer Protocols. While there is no peer-reviewed published trials which I could find where the Carnivore Diet has been designed to treat cancer patients, there are anecdotal reports and case studies that are impressive. The Carnivore Diet is similar to a ketogenic diet but with all fruits, vegetables, nuts and seeds removed.

A ketogenic diet reduces carbohydrates and increases healthy fats to a level where the body’s metabolism shifts away from burning carbs to burning fat and ketones for energy. The Carnivore Diet requires eating only wild-caught and pastured animals from nose-to-tail. Since the Carnivore Diet completely eliminates all plants, it importantly avoids the abundance of antinutrients (i.e. lectins and oxalates) found in plants.

 

Lectins

Lectins are proteins, which plants produce to defend themselves against animals trying to eat them. Lectins will cause digestive upset, particularly when eaten raw. These proteins are found in roots, stems, leaves, and especially in the seeds of many plants.

After we eat lectins, they bind to the sugar portions of our intestinal wall where they interfere with digestion and nutrient uptake. However, after edible seeds are cooked using moist heat, some of the damaging effects of many lectins may be reduced. Yet, the danger of lectins is real.[1]

 

Oxalates

Oxalates, which are tiny molecules found in a variety of seeds, nuts and many vegetables, will bind minerals like calcium and form crystals. Oxalates also can cause kidney stones and are responsible for a wide variety of other health problems related to inflammation, autoimmunity, mitochondrial dysfunction, mineral balance, connective tissue integrity, urinary tract issues and poor gut function.

Sally K. Norton wrote an excellent article about the health hazards of oxalates.[2] Medical research also has shown that oxalates promote the transformation of normal breast cells into highly malignant and undifferentiated tumors.[3] Specifically, oxalates have been shown to damage mitochondria.[4] And mitochondrial dysfunction is a primary component in the development of cancer.[5]

 

My Research

In 2016, a case study was published of a 60-year old patient who had a malignant myoepithelial tumor of the soft palate. The patient refused conventional chemotherapy and radiation treatment. Instead, the patient started a paleolithic-ketogenic (paleo/keto) diet in December 2014. For the first six months, the patient followed a strict meat and fat only diet (Carnivore Diet). From July 2015 on, she was allowed to eat small amounts of vegetables less than two times a week. Surprisingly, the cancer progression was halted as evidenced by imaging follow-up. After 20 months and the conclusion of the case report, the patient had no symptoms or side effects from the originally diagnosed cancer.[6]

During my research, I also came upon another cancer patient. Andrew Scarborough was diagnosed with an aggressive and incurable brain tumor (Grade 3 Anaplastic Astrocytoma) at the age of 27. He elected to treat his cancer with a strict paleo/keto diet, which he modified into a strict Carnivore Diet. Two years after his diagnosis, his cancer was in remission. And his protocol and results are being studied by Hammersford Hospital in Australia.[7]

In a 2018 review of medical papers, the authors found a ketogenic diet reduced the production and growth of most cancer tumors. However, in some isolated types of cancer, a ketogenic diet apparently supported the growth of tumor cells.[8]

Mark Sisson[9] and Chris Kresser[10], two people for whom I have great respect, recently wrote about the pros and cons of the Carnivore Diet.

If you google “Carnivore Diet”, you’ll find many anecdotal reports on the Internet describing the benefits of this lifestyle change. For more in-depth discussions of the medical benefits of the Carnivore Diet, I recommend Dr. Paul Saladino’s website (https://carnivoremd.com/the-carnivore-diet-start-here/). He is an MD who highly recommends and personally follows a strict Carnivore Diet.

 

My Experiment

So, I am connecting some of the medical dots that I am researching. I believe the benefits of a Carnivore Diet will assist my body’s challenge to heal from IgA Kappa Light Chain Multiple Myeloma. As you may recall, my original prognosis at the time of my diagnosis in September 2018 was that I could be dead by the end of 2018. I’ve surprised a lot of people!

Let me be very clear though. I am not recommending that cancer patients should be on the Carnivore Diet. I will experiment with it and will describe below exactly what I will be doing for my personal use. Again, there is no published proof that what I am including in my 10 Unconventional Cancer Protocols is going to treat my cancer or anyone’s cancer. But all my research has proven to me that what you eat and what you eliminate from your diet are vital for overall health.

 

Potential Benefits of Carnivore Diet

  1. Restricts calories and mimics fasting: Protein is filling, so you eat less. Eating less reduces caloric intake. Reducing caloric intake will decrease insulin production, insulin-like growth factor, and growth hormone. Fasting (which restricts caloric intake for a period of time) triggers autophagy where old cells die and damaged cells repair. The end result is reduced inflammation as well as reduced symptoms of chronic and autoimmune diseases.
  2. Provides low residue in gut: This diet is basically protein and fat – all of which are absorbed in the upper part of the gut. So, there is little leftover residue to irritate or inflame the lower portions of the gut. Less residue in the lower gut reduces diarrhea, bloating, gas, and abdominal pain while helping prevent inflammatory bowel disease and irritable bowel syndrome. Also, the Carnivore Diet avoids oxalates and lectins that could be damaging to the body.
  3. Alters the gut microbiome: A healthy gut microbiome is vital for optimum immune health and reduction of inflammatory diseases.[11] However, altering the gut microbiome may have positive as well as negative effects.[12] Microbial diversity and homeostasis are key to a healthy microbiome.
  4. Supplies pre-digested nutrients: Eating an animal from nose-to-tail provides all the nutrients that support that animal’s health. The nutrients that are consumed by the animal are present in their muscles, fat, cartilage and collagenous parts, and their organs. Eating wild caught or pastured animals from nose-to-tail provides us with all these nutrients, which may be in sufficient quantity and quality for us to thrive.[13]
  5. Creates ketones: A Carnivore Diet will put the body into a state of ketosis. Ketosis will shift the body to burning fat or ketones for energy instead of burning glucose. Cancer cells cannot utilize ketones, but our remaining healthy cells can. As I mentioned above, cancer patients might have significant results from being in a state of ketosis even though there are no controlled, long-term human studies to support this.[14]

 

My Updated Unconventional Cancer Protocol

I’m going to tweak my 10 Unconventional Cancer Protocols by replacing my current diet program with the Carnivore Diet along with a few of my modifications. I will follow this eating program for at least 1-2 months to see how my biomarkers react and how I feel. This experiment may become the way I will eat forever going forward. It should be no surprise to you that my ultimate decision maker or breaker will be how I feel. Of course, I will continue with my other integrated cancer protocols daily.

I’ll eat when I’m hungry and drink when I’m thirsty. Although I purchase most of my pastured and wild-caught animal products from neighborhood grocers and local farmers’ markets, I purchase what I can’t find from White Oak Pastures[15] in Georgia or VitalChoice[16] in Washington.

 

My Carnivore Diet

  • Intermittent fasting, which is part of my current diet – probably easier to do on a Carnivore Diet because proteins and fats are more satiating
  • Pastured animal meats and their healthy fats (including organs like pork and chicken liver, sweetbreads, skin, cartilage and collagenous parts)
  • Wild caught seafood – especially sardines, salmon, shrimp, mussels, and salmon roe
  • Butter or ghee from grass-fed and pastured cattle
  • Raw cheeses
  • Pastured chicken eggs
  • Homemade bone broth
  • Spices, sea salt, and herbs for flavor
  • One cup of organic coffee with raw heavy cream in the morning
  • Freeze-dried Organ Complex[17] and Freeze-Dried Bone Marrow[18] (supplied by Enviromedica from grass-fed cattle in New Zealand)

My Daily Cancer Protocols

  1. To support my gut: I take 2 caps of Megasporebiotic, 2 caps of HU58, 2 caps of RestorFlora, 8 caps of MegaIgG2000, and 1 scoop of MegaPrebiotic mixed with 1 scoop of MegaMucosa in cold water (all products from Microbiome Labs). I also take 2 caps of TerraFlora (from Enviromedica).
  2. To support my bone: I take 6 caps of OsteoVegan (from NuMedica), 4 caps of Megaquinone K2-7 (from Microbiome Labs), and 25,000 IU of Vitamin D3 (from Nutrigold).
  3. To assist killing cancer cells: I take 6 caps of Salvestrol Platinum 2000 (from Salvestrol).
  4. To support my immune system: I take 3 herbal liquid extracts from MediHerb: 5.0 ml of Echinacea Premium 1:2; 2.5 ml of Korean Ginseng 1:2; and 5.0 ml of Astragalus 1:2. Also from MediHerb, I add 5.0 ml of Marshmallow Root 1:5 Glycetract to the 3 herbal liquid extracts for mucous membrane support and as a “sweetener” for the other 3 “bitter” elixirs.
  5. To help repair my mitochondria: I use PEMF (Pulsed Electromagnetic Field) Therapy using the PureWave full-body mat[19] first thing in the morning for 8-minutes at setting “Vital – 10”, afternoon session for 8-minutes at setting “Basis – 10”, in early evening for 8-minutes at setting “Relax – 4”, and at bedtime for 24-minutes at setting “Relax – 1”.
  6. To control pain: I take 600-800mg of ibuprofen only when necessary.
  7. To target specific proteins involved in my cancer, I take 2 human-derived monoclonal antibody immunotherapies: XGEVA injections attack a protein that causes my bones to weaken and inactivates this protein. Darzalex infusions attack a specific protein on the surface of malignant plasma cells and kills them. Along with the Darzalex, I am given premeds (Tylenol, Benadryl, and Decadron) just before the infusion to limit any side effects.
  8. To help prevent colds and flu: I use a Bee Propolis Mouth Spray 4 times a day if I feel any “scratchiness” in my throat (from Beekeeper’s Naturals).
  9. To strengthen my body: Based on the condition of my skeleton, I perform appropriate upper body and lower body exercises several days a week at home. It’s essential for me to avoid any “twisting” motions because of my risk for additional pathological fractures. Also, I walk about one mile outside a few days a week. As my body strengthens, I’ll incorporate a more challenging routine.

That’s it for now. I started the Carnivore Diet on January 1, 2020. My Unconventional Cancer Journey is taking a turn to more experimentation, which is my New Year’s Resolution. This is how I roll.

Up until now, I have had success maintaining my quality of life. Maybe my bone marrow cancer will go into remission, or maybe I can cure this malignancy. Who knows? Certainly, conventional oncologists don’t know. By checking my cancer biomarkers as I progress with the Carnivore Diet, I will know for sure. I’m prepared for all outcomes.

 

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6603809/

[2] https://pdfs.semanticscholar.org/5875/48f7a3e96e9173be688689d5e0b013791a07.pdf

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4618885/

[4] https://www.sciencedirect.com/science/article/pii/S2213231717307565

[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4950268/

[6] http://pubs.sciepub.com/ajmcr/4/8/8/

[7] https://www.openfuture.biz/expertise/AndrewScarborough.html

[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5842847/

[9] https://www.marksdailyapple.com/the-carnivore-diet-pros-cons-and-suggestions/

[10] https://chriskresser.com/the-carnivore-diet-is-it-really-healthy/

[11] https://www.ncbi.nlm.nih.gov/pubmed/23618829

[12] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3957428/

[13] https://carnivoremd.com/what-to-eat-on-a-carnivore-diet-your-carnivore-diet-meal-plan/

[14] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5450454/

[15] https://www.whiteoakpastures.com/

[16] https://www.vitalchoice.com/

[17] https://shop.enviromedica.com/pastured-organ-complex

[18] https://shop.enviromedica.com/pastured-bone-marrow

[19] https://www.purewavenow.com/product/pemf-home-system/

 

 

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