NUTRITION AND BIOCHEMISTRY-FEBRUARY 2024
⏩SECTION – A (NUTRITION) ⏪
⏩1.Elaborate on:(1×15 = 15)
🔸1.Define BMR and explain the factors affecting BMR in detail.
BMR stands for Basal Metabolic Rate. It’s the amount of energy your body needs to maintain basic physiological functions while at rest. Several factors influence BMR:
⏩II. Write notes on:(4×5 = 20)
🔸1.Anthropometric measurement.
Anthropometric measurement refers to the systematic measurement of the size, shape, and composition of the human body. It involves taking various physical measurements to assess different aspects of an individual’s body composition and proportions. Some common anthropometric measurements include:
1.Height
Measured using a stadiometer, height provides information about an individual’s linear growth and can be used to calculate other measurements such as body mass index (BMI).
2.Weight
Measured using a scale, weight provides information about an individual’s mass and is often used in conjunction with height to calculate BMI.
3.Body Mass Index (BMI)
Calculated by dividing a person’s weight (in kilograms) by the square of their height (in meters), BMI is used as a screening tool to assess whether a person has a healthy weight for their height.
4.Waist Circumference
Measured at the narrowest part of the waist, waist circumference provides information about abdominal obesity and is a risk factor for various health conditions such as cardiovascular disease and type 2 diabetes.
5.Hip Circumference
Measured at the widest part of the hips, hip circumference provides information about body shape and fat distribution, with higher ratios of waist to hip circumference indicating higher risks of certain health conditions.
6.Skinfold Thickness
Measured using calipers, skinfold thickness provides information about subcutaneous fat levels at various sites on the body, allowing for the estimation of body fat percentage.
7.Body Composition
Determined using techniques such as dual-energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA), or underwater weighing, body composition analysis provides information about the proportion of fat, muscle, bone, and other tissues in the body.
Anthropometric measurements are widely used in fields such as nutrition, fitness, medicine, and ergonomics to assess growth, monitor health status, evaluate nutritional status, design ergonomic products, and track changes in body composition over time.
🔸2.Anaemia.
Anemia is a condition characterized by a deficiency of red blood cells or hemoglobin in the blood, leading to reduced oxygen-carrying capacity. Hemoglobin is a protein in red blood cells that binds to oxygen in the lungs and carries it to tissues throughout the body. When the hemoglobin level is low, tissues and organs may not receive enough oxygen to function properly, resulting in symptoms such as fatigue, weakness, pale skin, shortness of breath, dizziness, and headaches.
There are several types of anemia, each with different causes:
1.Iron-deficiency anemia
This is the most common type of anemia and occurs when the body doesn’t have enough iron to produce hemoglobin. Causes include inadequate dietary intake of iron, blood loss (from menstruation, gastrointestinal bleeding, or other sources), and poor absorption of iron.
2.Vitamin deficiency anemias
Deficiencies in vitamins such as vitamin B12 and folate can impair the production of red blood cells. This type of anemia may result from poor dietary intake, malabsorption disorders, or certain medical conditions.
3.Anemia of chronic disease
Chronic inflammatory conditions such as autoimmune disorders, chronic infections, and certain cancers can interfere with the body’s ability to produce red blood cells or utilize iron effectively.
4.Hemolytic anemias
In hemolytic anemias, red blood cells are destroyed faster than they can be produced. Causes include autoimmune disorders, inherited conditions such as sickle cell disease or thalassemia, infections, medications, and toxins.
5.Aplastic anemia
This rare but serious condition occurs when the bone marrow fails to produce enough red blood cells, white blood cells, and platelets. Causes may include autoimmune disorders, infections, exposure to toxins, and certain medications.
Treatment for anemia depends on the underlying cause and severity of the condition. It may include dietary changes, iron or vitamin supplements, medications to stimulate red blood cell production, blood transfusions, or other interventions aimed at addressing the specific cause of the anemia. Regular monitoring and follow-up with a healthcare provider are important for managing anemia effectively.
🔸3.ICDS.
The Integrated Child Development Services (ICDS) program in India is a comprehensive initiative aimed at addressing the health, nutrition, and development needs of children under six years of age, as well as pregnant and lactating mothers. Here’s a detailed overview of the ICDS program:
1.Objectives
Improve the nutritional and health status of children in the early years of life.
Enhance the cognitive, social, and emotional development of young children.
Reduce the incidence of maternal and child mortality and morbidity.
Empower women through training and employment opportunities.
Promote community participation in planning and implementing services.
2.Components
a.Supplementary Nutrition
Provision of supplementary nutrition to children under six years of age and pregnant and lactating mothers to address malnutrition and promote healthy growth and development.
b.Healthcare and Immunization
Provision of basic healthcare services including immunization, growth monitoring, antenatal and postnatal care, and treatment of common illnesses through Anganwadi centers.
c.Preschool Education
Provision of early childhood care and education (ECCE) to promote school readiness and enhance cognitive, social, and emotional development in young children.
d.Nutrition and Health Education
Imparting knowledge and awareness about nutrition, health, hygiene, and child care practices to mothers and caregivers through counseling, demonstrations, and community-based activities.
e.Referral Services
Identification and referral of children and women in need of specialized medical care, nutrition support, or other services to appropriate healthcare facilities.
f.Supplementary Services
Provision of services such as growth monitoring, supplementary nutrition, and health check-ups to children in underserved areas through mobile vans and outreach programs.
3.Delivery Mechanism
The ICDS program is delivered through a network of Anganwadi centers, which serve as the primary service delivery points at the grassroots level.
Anganwadi workers (AWWs) and Anganwadi helpers (AWHs) are frontline workers responsible for delivering ICDS services in their respective communities.
The program operates under the supervision of the Ministry of Women and Child Development at the central level and state-level departments at the state and district levels.
4.Coverage and Reach
The ICDS program covers rural, urban, and tribal areas across all states and union territories in India.
As of 2020, there were over 1.4 million Anganwadi centers and around 13 lakh Anganwadi workers and helpers serving approximately 8 crore beneficiaries.
5.Challenges and Future Directions
Challenges include inadequate infrastructure, funding constraints, shortage of trained manpower, and gaps in service delivery, particularly in remote and underserved areas.
Efforts are underway to strengthen the ICDS program through increased investment, capacity building, technology integration, and community engagement to improve its effectiveness and reach.
🔸4.Functions of fats.
⏩III. Short answers on: (5×2 = 10)
🔸1.Define Malnutrition.
Malnutrition refers to a condition in which there is an imbalance between the nutrients a person consumes and the nutrients their body needs for proper growth, development, and function. It can manifest as undernutrition, overnutrition, or micronutrient deficiencies.
1.Undernutrition
This occurs when a person does not consume enough calories, protein, vitamins, or minerals to meet their body’s needs. Undernutrition can result in stunted growth, weight loss, weakened immune function, and impaired cognitive development. It is often associated with poverty, food insecurity, inadequate access to nutritious foods, and underlying health conditions.
2.Overnutrition
This occurs when a person consumes an excess of calories, often from foods high in fat, sugar, and refined carbohydrates, leading to obesity and related health problems such as type 2 diabetes, cardiovascular disease, and certain cancers. Overnutrition is increasingly prevalent worldwide, particularly in urban areas and among populations with easy access to energy-dense, nutrient-poor foods.
🔸2.Give any four examples of supplementary foods for an infant.
four examples of supplementary foods suitable for infants:
1.Iron-Fortified Infant Cereal
Iron-fortified rice cereal, oat cereal, or other grain-based infant cereals are often recommended as one of the first complementary foods introduced to infants around six months of age. These cereals provide essential nutrients, including iron, which is important for the baby’s growth and development.
2.Pureed Fruits and Vegetables
Pureed fruits and vegetables, such as apples, bananas, sweet potatoes, carrots, and peas, are nutritious options for introducing new flavors and textures to an infant’s diet. These foods are rich in vitamins, minerals, and fiber, and they can be easily prepared at home or purchased commercially.
3.Mashed or Pureed Protein Foods
Soft-cooked and mashed or pureed protein-rich foods, such as cooked and pureed meats (chicken, turkey, beef), fish, tofu, legumes (lentils, chickpeas), or well-cooked eggs, are important sources of essential amino acids and iron for infants transitioning to solid foods.
4.Yogurt or Cottage Cheese
Plain, unsweetened yogurt or cottage cheese can be introduced to infants around six months of age as sources of protein, calcium, and probiotics (in yogurt). These dairy products can be served plain or mixed with pureed fruits for added flavor and nutrition.
🔸3.List down the signs and symptoms of Beri-beri.
Beri-beri is a disease caused by a deficiency of thiamine (vitamin B1) and is often associated with diets high in refined carbohydrates, such as polished rice. There are two main types of beri-beri: wet beri-beri, which affects the cardiovascular system, and dry beri-beri, which affects the nervous system. Here are the signs and symptoms associated with each type:
1.Wet Beri-Beri (Cardiovascular Beri-Beri)
Rapid heart rate (tachycardia)
Enlarged heart (cardiomegaly)
Shortness of breath (dyspnea)
Swelling of the legs, feet, and/or abdomen (edema)
Difficulty breathing when lying down (orthopnea)
Fatigue and weakness
Elevated blood pressure
2.Dry Beri-Beri (Nervous System Beri-Beri)
Peripheral neuropathy: Tingling, numbness, and burning sensation in the hands and feet.
Muscle weakness and wasting, particularly in the lower extremities.
Difficulty walking (ataxia) and loss of coordination.
Paralysis of the lower extremities (in severe cases).
Wernicke-Korsakoff syndrome: In chronic cases of thiamine deficiency, individuals may develop neurological symptoms such as confusion, memory loss, and psychosis.
🔸4.Give the classification of Carbohydrates.
Carbohydrates are classified into several categories based on their chemical structure and properties. The main classifications of carbohydrates include:
1.Monosaccharides
Monosaccharides are the simplest form of carbohydrates, consisting of single sugar molecules. They cannot be broken down into smaller sugars through hydrolysis. Examples include glucose, fructose, and galactose.
2.Disaccharides
Disaccharides are composed of two monosaccharide units linked together by glycosidic bonds. They are formed by the condensation reaction between two monosaccharides, resulting in the elimination of a water molecule. Examples include sucrose (glucose + fructose), lactose (glucose + galactose), and maltose (glucose + glucose).
3.Oligosaccharides
Oligosaccharides consist of 3 to 10 monosaccharide units linked together by glycosidic bonds. They are found in certain foods and serve as dietary fibers or components of complex carbohydrates. Examples include raffinose and stachyose found in legumes.
4.Polysaccharides
Polysaccharides are complex carbohydrates composed of long chains of monosaccharide units linked together by glycosidic bonds. They serve as energy storage molecules or structural components in plants and animals. Examples include:
Starch: A polysaccharide found in plants, composed of glucose units linked together in amylose and amylopectin molecules. Starch serves as a storage form of energy in plants.
Glycogen: A polysaccharide found in animals, composed of glucose units linked together in highly branched chains. Glycogen serves as a storage form of energy in the liver and muscles.
Cellulose: A polysaccharide found in the cell walls of plants, composed of glucose units linked together in linear chains. Cellulose provides structural support and is a major component of dietary fiber.
Chitin: A polysaccharide found in the exoskeletons of arthropods and the cell walls of fungi, composed of N-acetylglucosamine units linked together in linear chains. Chitin provides structural support and protection.
🔸5.List down the food sources of Vitamin C.
Vitamin C, also known as ascorbic acid, is a water-soluble vitamin that acts as an antioxidant and plays a crucial role in various physiological processes, including collagen synthesis, immune function, wound healing, and iron absorption. Here are some common food sources of vitamin C:
1.Citrus Fruits
Citrus fruits are well-known for their high vitamin C content. Examples include oranges, lemons, limes, grapefruits, and tangerines.
2.Berries
Berries such as strawberries, raspberries, blueberries, and blackberries are rich sources of vitamin C.
3.Kiwi
Kiwi fruit is exceptionally high in vitamin C, providing more than the recommended daily intake in a single serving.
4.Tropical Fruits
Tropical fruits like papaya, mango, pineapple, and guava are good sources of vitamin C.
5.Bell Peppers
Bell peppers, particularly red and yellow varieties, contain high levels of vitamin C. Green peppers also contain vitamin C, although in slightly lower amounts.
6.Broccoli
Broccoli is a cruciferous vegetable that provides a significant amount of vitamin C along with other nutrients.
7.Brussels Sprouts
Brussels sprouts are another cruciferous vegetable that is rich in vitamin C.
8.Tomatoes
Tomatoes are a good source of vitamin C, especially when consumed in their raw form.
9.Leafy Greens
Some leafy greens, such as spinach and kale, contain moderate amounts of vitamin C.
10.Potatoes
Potatoes, particularly sweet potatoes and red potatoes, are sources of vitamin C when consumed with the skin.
11.Melons
Melons like cantaloupe and honeydew contain vitamin C, albeit in smaller amounts compared to other fruits.
12.Paprika
Paprika, a spice made from ground dried peppers, is a surprisingly rich source of vitamin C.
⏩SECTION – B (BIOCHEMISTRY)⏪
⏩1.Elaborate on:(1×15 = 15)
🔸1.What is the normal fasting, post Prandial and random blood glucose level?Add in detail about hormonal regulation of blood glucose level.
blood glucose levels and the hormonal regulation of blood glucose:
Fasting Blood Glucose
Typically measured after 8-12 hours of fasting, the normal fasting blood glucose level is usually between 70 and 100 milligrams per deciliter (mg/dL) or 3.9 to 5.6 millimoles per liter (mmol/L). This level can vary slightly depending on the laboratory and individual circumstances.
Postprandial (After Meal) Blood Glucose
This refers to blood glucose levels measured 1-2 hours after eating a meal. In non-diabetic individuals, postprandial blood glucose levels typically rise but should remain below 140 mg/dL (7.8 mmol/L) two hours after eating.
Random Blood Glucose
A random blood glucose test can be taken at any time of the day, regardless of when the person last ate. In non-diabetic individuals, random blood glucose levels should generally be below 125 mg/dL (6.9 mmol/L).
Several hormones play crucial roles in regulating blood glucose levels, ensuring that they remain within a narrow range to meet the body’s energy needs:
Insulin
Produced by beta cells in the pancreas, insulin is released in response to rising blood glucose levels after a meal. Insulin promotes the uptake of glucose by cells, where it is used for energy or stored as glycogen (in the liver and muscles) or fat. Insulin also inhibits the breakdown of glycogen and promotes the synthesis of proteins and fats.
Glucagon
Produced by alpha cells in the pancreas, glucagon is released in response to low blood glucose levels (such as during fasting or between meals). Glucagon stimulates the breakdown of glycogen in the liver (glycogenolysis) and the synthesis of glucose from non-carbohydrate sources (gluconeogenesis), thereby increasing blood glucose levels.
Cortisol
Produced by the adrenal glands, cortisol is a stress hormone that helps regulate blood glucose levels during times of stress or fasting. Cortisol promotes gluconeogenesis (the synthesis of glucose from amino acids, glycerol, and lactate) and inhibits glucose uptake by cells, helping to maintain blood glucose levels.
Epinephrine (Adrenaline)
Produced by the adrenal glands and released during the “fight or flight” response, epinephrine stimulates glycogenolysis and gluconeogenesis, leading to an increase in blood glucose levels to provide energy for immediate use during stressful situations.
Other Hormones
Other hormones, such as growth hormone, thyroid hormones, and incretins (e.g., glucagon-like peptide-1), also play roles in regulating blood glucose levels by influencing insulin secretion, insulin sensitivity, and glucose metabolism.
Together, these hormones work in concert to maintain blood glucose homeostasis, ensuring that cells receive a steady supply of energy while preventing hyperglycemia (high blood sugar) or hypoglycemia (low blood sugar), both of which can have adverse health effects. Dysregulation of blood glucose levels, as seen in diabetes mellitus and other metabolic disorders, can lead to serious complications if left untreated.
⏩II. Write notes on:(1×5 = 5)
🔸1.Add note on cardiac functional enzymes.
Cardiac functional enzymes are essential proteins found within the myocardium (heart muscle) that are involved in various biochemical processes critical for the proper functioning of the heart. These enzymes play key roles in energy metabolism, muscle contraction, cellular signaling, and maintaining the structural integrity of cardiac tissue. The measurement of cardiac enzymes in the blood is an important diagnostic tool used to assess cardiac health and detect abnormalities, particularly in the context of acute coronary syndromes such as myocardial infarction (heart attack).
Here’s an in-depth look at some of the most important cardiac functional enzymes and their functions:
1 Creatine Kinase (CK)
Creatine kinase, also known as creatine phosphokinase (CPK), is an enzyme that catalyzes the conversion of creatine and adenosine diphosphate (ADP) into phosphocreatine and adenosine triphosphate (ATP).
ATP is the primary energy source for cardiac muscle contraction, and phosphocreatine serves as a rapid reserve of energy that can be used to regenerate ATP during periods of high energy demand, such as during muscle contraction.
CK is found in high concentrations within cardiac muscle cells, making it a useful marker of myocardial injury when detected in the blood.
2.Lactate Dehydrogenase (LDH)
Lactate dehydrogenase is an enzyme involved in anaerobic metabolism, specifically in the conversion of lactate to pyruvate.
During periods of increased energy demand or decreased oxygen supply (such as during ischemia), cardiac muscle cells may switch to anaerobic metabolism, leading to the production of lactate.
Elevated levels of LDH in the blood may indicate tissue damage or ischemia, including damage to cardiac muscle cells.
3.Troponins
Troponins are regulatory proteins that play a central role in the contraction of cardiac muscle fibers.
Cardiac troponins, particularly troponin T and troponin I, are highly specific markers of myocardial injury.
During myocardial infarction (heart attack), the integrity of cardiac muscle cells is compromised, leading to the release of troponins into the bloodstream.
Elevated levels of troponins in the blood are indicative of myocardial damage and are used to diagnose acute myocardial infarction.
4.Aspartate Aminotransferase (AST)
Aspartate aminotransferase is an enzyme found in various tissues, including the heart, liver, and skeletal muscle.
AST catalyzes the transfer of an amino group from aspartate to alpha-ketoglutarate, producing oxaloacetate and glutamate.
Elevated levels of AST in the blood may indicate tissue damage or injury, although AST is less specific for cardiac injury compared to troponins.
Measurement of cardiac enzymes, particularly troponins, is routinely performed in the diagnosis and management of acute coronary syndromes, including myocardial infarction. Elevated levels of these enzymes provide valuable information about the extent of myocardial damage and help guide appropriate treatment strategies. Monitoring changes in cardiac enzyme levels over time can also aid in evaluating the effectiveness of treatment and predicting outcomes for individuals with heart conditions.
⏩III. Short answers on:(5 x2 = 10)
🔸1.Bitot spots.
Bitot spots are small, white, foamy patches that appear on the conjunctiva (the membrane that lines the inside of the eyelids and covers the white part of the eye) due to a deficiency of vitamin A. These spots are typically triangular or irregular in shape and are most commonly found in the temporal or nasal region of the eye.
Bitot spots are a clinical sign of vitamin A deficiency, which is a common nutritional deficiency, especially in developing countries where access to a diverse diet is limited. Vitamin A is essential for maintaining healthy vision, skin, and immune function. A deficiency of vitamin A can lead to a range of ocular and systemic manifestations, including:
1.Night blindness
The earliest sign of vitamin A deficiency is often difficulty seeing in low light conditions, known as night blindness.
2.Xerophthalmia
Bitot spots are a characteristic sign of xerophthalmia, a condition characterized by dryness of the conjunctiva and cornea due to inadequate tear production. In severe cases, xerophthalmia can progress to corneal ulceration, scarring, and blindness.
3.Impaired immune function
Vitamin A plays a critical role in maintaining the integrity of the epithelial barriers in the respiratory, gastrointestinal, and genitourinary tracts. A deficiency of vitamin A can compromise immune function and increase susceptibility to infections, particularly respiratory and diarrheal illnesses.
Treatment of vitamin A deficiency typically involves supplementation with vitamin A, either orally or through intramuscular injections, along with addressing dietary deficiencies and promoting dietary diversity. In areas where vitamin A deficiency is endemic, supplementation programs and public health interventions aimed at improving nutrition, promoting breastfeeding, and fortifying food with vitamin A can help prevent and control deficiency-related complications. Early detection and intervention are essential to prevent irreversible damage to vision and other health consequences associated with vitamin A deficiency.
🔸2.Essential and Non-essential Amino acids.
Amino acids are the building blocks of proteins and are essential for various physiological processes in the body. They can be categorized into two main groups: essential amino acids and non-essential amino acids.
Essential Amino Acids
Essential amino acids are amino acids that cannot be synthesized by the body and must be obtained from the diet. There are nine essential amino acids:
These amino acids are essential for protein synthesis, as well as for various other functions in the body, including enzyme activity, hormone synthesis, and neurotransmitter production. Since the body cannot produce these amino acids on its own, they must be obtained through dietary sources such as meat, fish, poultry, eggs, dairy products, legumes, nuts, and seeds.
Non-essential Amino Acids
Non-essential amino acids are amino acids that the body can synthesize on its own from other amino acids and metabolic intermediates. There are eleven non-essential amino acids:
While these amino acids are considered non-essential because the body can produce them, their synthesis may become limited under certain conditions, such as during illness or stress. In such cases, non-essential amino acids may need to be obtained from dietary sources or supplements to meet the body’s needs.
Both essential and non-essential amino acids are important for overall health and well-being, and ensuring an adequate intake of all amino acids through a balanced diet is essential for supporting protein synthesis, maintaining muscle mass, promoting tissue repair, and supporting various physiological functions in the body.
🔸3.Name four specialised proteins.
Specialized proteins are proteins that perform specific functions in the body beyond their role as structural components or sources of energy. Here are four examples of specialized proteins:
1.Hemoglobin
Hemoglobin is a protein found in red blood cells that is responsible for transporting oxygen from the lungs to tissues throughout the body and carrying carbon dioxide back to the lungs for exhalation. It consists of four globin protein subunits, each containing a heme group with an iron atom that binds to oxygen molecules.
2.Antibodies (Immunoglobulins)
Antibodies are proteins produced by the immune system in response to foreign substances (antigens) such as bacteria, viruses, and toxins. They play a critical role in the immune response by recognizing and binding to specific antigens, thereby neutralizing or marking them for destruction by other immune cells.
3.Enzymes
Enzymes are specialized proteins that catalyze biochemical reactions in the body by lowering the activation energy required for the reaction to occur. Each enzyme is specific to a particular substrate and catalyzes a specific chemical reaction. Examples of enzymes include amylase (which breaks down carbohydrates), lipase (which breaks down fats), and proteases (which break down proteins).
4.Collagen
Collagen is the most abundant protein in the body and is a major component of connective tissues such as tendons, ligaments, skin, and bones. It provides structural support, strength, and elasticity to tissues and helps maintain the integrity of the extracellular matrix. Collagen molecules form long fibrils that give tissues their strength and resilience.
🔸4.Define pH. What is normal blood pH?
pH, or “potential of hydrogen,” is a measure of the acidity or alkalinity of a solution. It is defined as the negative logarithm of the concentration of hydrogen ions ([H+]) in a solution. The pH scale ranges from 0 to 14, with 7 being considered neutral. Solutions with a pH below 7 are acidic, while solutions with a pH above 7 are alkaline (or basic).
Mathematically, the pH of a solution is calculated using the formula:
[ \text{pH} = -\log_{10}[\text{H}^+] ]
Where [H+] represents the concentration of hydrogen ions in moles per liter (M).
The pH scale is logarithmic, meaning that each whole number change in pH represents a tenfold change in acidity or alkalinity. For example, a solution with a pH of 5 is ten times more acidic than a solution with a pH of 6.
Normal Blood pH
The normal pH range of arterial blood in humans is approximately 7.35 to 7.45. Arterial blood pH is tightly regulated within this narrow range by the body’s homeostatic mechanisms to maintain optimal physiological function. Deviations from this normal range can have significant health implications and may indicate underlying metabolic or respiratory disorders.
🔸5.Atherosclerosis.
Atherosclerosis is a progressive and chronic disease characterized by the buildup of plaque (composed of cholesterol, fatty substances, calcium, cellular waste, and fibrin) within the walls of arteries. This buildup narrows and stiffens the arteries, leading to reduced blood flow to vital organs and tissues. Atherosclerosis is a major cause of cardiovascular diseases, including coronary artery disease (leading to heart attacks), peripheral artery disease, and stroke.
The development of atherosclerosis typically begins with endothelial dysfunction, which occurs when the endothelial cells lining the arteries become damaged or dysfunctional due to factors such as high blood pressure, smoking, high cholesterol levels, diabetes, inflammation, or oxidative stress. Endothelial dysfunction allows low-density lipoprotein (LDL) cholesterol to penetrate the arterial wall and become oxidized, triggering an inflammatory response and the recruitment of immune cells, particularly macrophages.
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