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They can be something as simple as just feeling better or saving money

The ceramides are classified based on the structure of their polar headgroup (sphingosine S, dihydrosphingosine dS, phytosphingosine P and 6-hydroxysphingosine H) and a substitution of their acyl chain (non-substituted N, -hydroxylated A, -esterified EO or -hydroxylated O) (Supplementary Fig

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This problem was largely overcome by justifying to patients and repeating the question