Decreased cerebral glucose metabolism in patients with brain tumors: an effect of corticosteroids

Michael J. FulhamNeuroimaging Branch, National Institute of Neurological Disorders and Stroke, and Department of Diagnostic Radiology, Clinical Center, National Institutes of Health, Bethesda, Maryland

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Arturo BrunettiNeuroimaging Branch, National Institute of Neurological Disorders and Stroke, and Department of Diagnostic Radiology, Clinical Center, National Institutes of Health, Bethesda, Maryland

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Luigi AlojNeuroimaging Branch, National Institute of Neurological Disorders and Stroke, and Department of Diagnostic Radiology, Clinical Center, National Institutes of Health, Bethesda, Maryland

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Ramesh RamanNeuroimaging Branch, National Institute of Neurological Disorders and Stroke, and Department of Diagnostic Radiology, Clinical Center, National Institutes of Health, Bethesda, Maryland

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Andrew J. DwyerNeuroimaging Branch, National Institute of Neurological Disorders and Stroke, and Department of Diagnostic Radiology, Clinical Center, National Institutes of Health, Bethesda, Maryland

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Giovanni Di ChiroNeuroimaging Branch, National Institute of Neurological Disorders and Stroke, and Department of Diagnostic Radiology, Clinical Center, National Institutes of Health, Bethesda, Maryland

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✓ The authors measured cerebral glucose metabolism (CMRglu) using [18F]fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) in patients with brain tumors to evaluate the effect of exogenous corticosteroids (in this instance, dexamethasone) on glucose metabolism. Fifty-six FDG-PET studies obtained in 45 patients with unilateral supratentorial brain tumors were analyzed. Patients with brain tumors were divided into three groups: 1) patients with cushingoid symptoms, who had been treated with combinations of radiotherapy and chemotherapy taking oral dexamethasone; 2) patients not taking dexamethasone but treated with radiotherapy; and 3) patients not taking dexamethasone who had not been treated with radiotherapy. Serial FDG-PET scans were obtained in eight of the cushingoid patients. Glucose metabolism was measured in the contralateral cerebral and ipsilateral cerebellar hemispheres in patients and compared to measurements taken from 19 normal volunteers. The authors found that in the cushingoid brain tumor patients there was a marked reduction in CMRglu compared to normal volunteers and other brain tumor patients (Kruskal—Wallis test; p 0.001). In the majority of patients who had serial FDG-PET scans, there was a decline in glucose metabolism over time and in one patient, in whom dexamethasone was reduced in dosage, there was a subsequent increase in CMRglu. The authors conclude that there is a generalized reduction in CMRglu in brain tumor patients taking dexamethasone compared to other brain tumor patients and normal volunteers, and that this effect is independent of radiotherapy, concurrent anticonvulsant medication, and transhemispheric functional disconnection (transhemispheric diaschisis).

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  • 1.

    Ahima RS, & Harlan RE: Charting of type II glucocorticoid receptor-like immunoreactivity in the rat central nervous system. Neuroscience 39:579604, 1990 Ahima RS, Harlan RE: Charting of type II glucocorticoid receptor-like immunoreactivity in the rat central nervous system. Neuroscience 39:579–604, 1990

    • Search Google Scholar
    • Export Citation
  • 2.

    Andrews RJ: Transhemispheric diaschisis. A review and comment. Stroke 22:943949, 1991 Andrews RJ: Transhemispheric diaschisis. A review and comment. Stroke 22:943–949, 1991

    • Search Google Scholar
    • Export Citation
  • 3.

    Andrews RJ, , Bringas JR, & Alonzo G, et al: Corpus callosotomy effects on cerebral blood flow and evoked potentials (transcallosal diaschisis). Neurosci Letts 154:912, 1993 Andrews RJ, Bringas JR, Alonzo G, et al: Corpus callosotomy effects on cerebral blood flow and evoked potentials (transcallosal diaschisis). Neurosci Letts 154:9–12, 1993

    • Search Google Scholar
    • Export Citation
  • 4.

    Aquilonius SM, & Eckernas SA: A Colour Atlas of the Human Brain. New York: Raven Press, 1980 Aquilonius SM, Eckernas SA: A Colour Atlas of the Human Brain. New York: Raven Press, 1980

    • Search Google Scholar
    • Export Citation
  • 5.

    Baron JC, , Bousser MG, & Comar D, et al: “Crossed cerebellar diaschisis” in human supratentorial brain infarction. Ann Neurol 8:128, 1980 (Abstract) Baron JC, Bousser MG, Comar D, et al: “Crossed cerebellar diaschisis” in human supratentorial brain infarction. Ann Neurol 8:128, 1980 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 6.

    Beaney RP, , Brooks DJ, & Leenders KL, et al: Blood flow and oxygen utilisation in the contralateral cerebral cortex of patients with untreated intracranial tumours as studied by positron emission tomography with observation of the effect of decompressive surgery. J Neurol Neurosurg Psychiatry 48:310319, 1985 Beaney RP, Brooks DJ, Leenders KL, et al: Blood flow and oxygen utilisation in the contralateral cerebral cortex of patients with untreated intracranial tumours as studied by positron emission tomography with observation of the effect of decompressive surgery. J Neurol Neurosurg Psychiatry 48:310–319, 1985

    • Search Google Scholar
    • Export Citation
  • 7.

    Bentson J, , Reza M, & Winter J, et al: Steroids and apparent cerebral atrophy on computed tomography scans. J Comput Assist Tomogr 2:1623, 1978 Bentson J, Reza M, Winter J, et al: Steroids and apparent cerebral atrophy on computed tomography scans. J Comput Assist Tomogr 2:16–23, 1978

    • Search Google Scholar
    • Export Citation
  • 8.

    Birnbaum MJ, , Haspel HC, & Rosen OM: Cloning and characterization of a cDNA encoding the rat brain glucose-transporter protein. Proc Natl Acad Sci (USA) 83:57845788, 1986 Birnbaum MJ, Haspel HC, Rosen OM: Cloning and characterization of a cDNA encoding the rat brain glucose-transporter protein. Proc Natl Acad Sci (USA) 83:5784–5788, 1986

    • Search Google Scholar
    • Export Citation
  • 9.

    Brooks RA: Alternative formula for glucose utilization using labeled deoxyglucose. J Nucl Med 23:538539, 1982 Brooks RA: Alternative formula for glucose utilization using labeled deoxyglucose. J Nucl Med 23:538–539, 1982

    • Search Google Scholar
    • Export Citation
  • 10.

    Carlstedt-Duke J, & Gustafsson JA: The molecular mechanism of glucocorticoid action, in Ludecke DK, , Chrousos GP, & Tolis G (eds): ACTH, Cushing's Syndrome and Other Hypercortisolemic States. New York: Raven Press, 1990, pp 714 Carlstedt-Duke J, Gustafsson JA: The molecular mechanism of glucocorticoid action, in Ludecke DK, Chrousos GP, Tolis G (eds): ACTH, Cushing's Syndrome and Other Hypercortisolemic States. New York: Raven Press, 1990, pp 7–14

    • Search Google Scholar
    • Export Citation
  • 11.

    Carroll BJ: Psychiatric disorders and steroids, in Usdin E, , Hamburg DA, & Barchas JD (eds): Neuroregulators and Psychiatric Disorders. New York: Oxford University Press, 1977, pp 276283 Carroll BJ: Psychiatric disorders and steroids, in Usdin E, Hamburg DA, Barchas JD (eds): Neuroregulators and Psychiatric Disorders. New York: Oxford University Press, 1977, pp 276–283

    • Search Google Scholar
    • Export Citation
  • 12.

    Cohen SI: Cushing's syndrome: a psychiatric study of 29 patients. Br J Psychiatry 136:120124, 1980 Cohen SI: Cushing's syndrome: a psychiatric study of 29 patients. Br J Psychiatry 136:120–124, 1980

    • Search Google Scholar
    • Export Citation
  • 13.

    Conover WJ: Practical Nonparametric Statistics, ed 2. New York: Wiley, 1980, pp 229237 Conover WJ: Practical Nonparametric Statistics, ed 2. New York: Wiley, 1980, pp 229–237

    • Search Google Scholar
    • Export Citation
  • 14.

    Crane PD, , Braun LD, & Cornford EM, et al: Dose dependent reduction of glucose utilization by pentobarbital in rat brain. Stroke 9:1218, 1978 Crane PD, Braun LD, Cornford EM, et al: Dose dependent reduction of glucose utilization by pentobarbital in rat brain. Stroke 9:12–18, 1978

    • Search Google Scholar
    • Export Citation
  • 15.

    Dauth GW, , Gilman S, & Frey KA, et al: Basal ganglia glucose utilization after recent precentral ablation in the monkey. Ann Neurol 17:431438, 1985 Dauth GW, Gilman S, Frey KA, et al: Basal ganglia glucose utilization after recent precentral ablation in the monkey. Ann Neurol 17:431–438, 1985

    • Search Google Scholar
    • Export Citation
  • 16.

    De la Paz RL, , Patronas NJ, & Brooks RA, et al: Positron emission tomographic study of suppression of gray-matter glucose utilization by brain tumors. AJNR 4:826829, 1983 De la Paz RL, Patronas NJ, Brooks RA, et al: Positron emission tomographic study of suppression of gray-matter glucose utilization by brain tumors. AJNR 4:826–829, 1983

    • Search Google Scholar
    • Export Citation
  • 17.

    Fulham MJ, , Brooks RA, & Hallett M, et al: Cerebellar diaschisis revisited: pontine hypometabolism and dentate sparing. Neurology 42:22672273, 1992 Fulham MJ, Brooks RA, Hallett M, et al: Cerebellar diaschisis revisited: pontine hypometabolism and dentate sparing. Neurology 42:2267–2273, 1992

    • Search Google Scholar
    • Export Citation
  • 18.

    Fulham MJ, , Brunetti A, & Nieman L, et al: Decreased cerebral glucose metabolism in patients with Cushing disease: a PET-FDG study. J Nucl Med 33:834, 1992 (Abstract) Fulham MJ, Brunetti A, Nieman L, et al: Decreased cerebral glucose metabolism in patients with Cushing disease: a PET-FDG study. J Nucl Med 33:834, 1992 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 19.

    Fulham MJ, , Melisi JM, & Nishimiya J, et al: Neuroimaging of juvenile pilocytic astrocytomas: an enigma. Radiology 189:221225, 1993 Fulham MJ, Melisi JM, Nishimiya J, et al: Neuroimaging of juvenile pilocytic astrocytomas: an enigma. Radiology 189:221–225, 1993

    • Search Google Scholar
    • Export Citation
  • 20.

    Ginsberg MD, , Castella Y, & Dietrich WD, et al: Acute thrombotic infarction suppresses metabolic activation of ipsilateral somatosensory cortex: evidence for functional diaschisis. J Cereb Blood Flow Metab 9:329341, 1989 Ginsberg MD, Castella Y, Dietrich WD, et al: Acute thrombotic infarction suppresses metabolic activation of ipsilateral somatosensory cortex: evidence for functional diaschisis. J Cereb Blood Flow Metab 9:329–341, 1989

    • Search Google Scholar
    • Export Citation
  • 21.

    Ginsberg MD, , Reivich M, & Giandomenico A, et al: Local glucose utilization in acute focal cerebral ischemia: Local dysmetabolism and diaschisis. Neurology 27:10421048, 1977 Ginsberg MD, Reivich M, Giandomenico A, et al: Local glucose utilization in acute focal cerebral ischemia: Local dysmetabolism and diaschisis. Neurology 27:1042–1048, 1977

    • Search Google Scholar
    • Export Citation
  • 22.

    Heinz ER, , Martinez J, & Haenggeli A: Reversibility of cerebral atrophy in anorexia nervosa and Cushing's syndrome. J Comput Assist Tomogr 1:415418, 1977 Heinz ER, Martinez J, Haenggeli A: Reversibility of cerebral atrophy in anorexia nervosa and Cushing's syndrome. J Comput Assist Tomogr 1:415–418, 1977

    • Search Google Scholar
    • Export Citation
  • 23.

    Horner HC, , Packan DR, & Sapolsky RM: Glucocorticoids inhibit glucose transport in cultured hippocampal neurons and glia. Neuroendocrinology 52:5764, 1990 Horner HC, Packan DR, Sapolsky RM: Glucocorticoids inhibit glucose transport in cultured hippocampal neurons and glia. Neuroendocrinology 52:57–64, 1990

    • Search Google Scholar
    • Export Citation
  • 24.

    Jarden JO, , Dhawan V, & Moeller JR, et al: The time course of steroid action on blood-to-brain and blood-to-tumor transport of 82Rb: a positron emission tomographic study. Ann Neurol 25:239245, 1989 Jarden JO, Dhawan V, Moeller JR, et al: The time course of steroid action on blood-to-brain and blood-to-tumor transport of 82Rb: a positron emission tomographic study. Ann Neurol 25:239–245, 1989

    • Search Google Scholar
    • Export Citation
  • 25.

    Jeffcoate WJ, , Silverstone JT, & Edwards CRW, et al: Psychiatric manifestations of Cushing's syndrome: response to lowering of plasma cortisol. Q J Med 48:465472, 1979 Jeffcoate WJ, Silverstone JT, Edwards CRW, et al: Psychiatric manifestations of Cushing's syndrome: response to lowering of plasma cortisol. Q J Med 48:465–472, 1979

    • Search Google Scholar
    • Export Citation
  • 26.

    Kadekaro M, , Ito M, & Gross PM: Local cerebral glucose utilization is increased in acutely adrenalectomized rats. Neuroendocrinology 47:329334, 1988 Kadekaro M, Ito M, Gross PM: Local cerebral glucose utilization is increased in acutely adrenalectomized rats. Neuroendocrinology 47:329–334, 1988

    • Search Google Scholar
    • Export Citation
  • 27.

    Kataoka K, , Hayakawa T, & Yamada K, et al: Neuronal network disturbance after focal ischemia in rats. Stroke 20:12261235, 1989 Kataoka K, Hayakawa T, Yamada K, et al: Neuronal network disturbance after focal ischemia in rats. Stroke 20:1226–1235, 1989

    • Search Google Scholar
    • Export Citation
  • 28.

    Leenders KL, , Beaney RP, & Brooks DJ, et al: Dexamethasone treatment of brain tumor patients. Effects on regional cerebral blood flow, blood volume, and oxygen utilization. Neurology 35:16101616, 1985 Leenders KL, Beaney RP, Brooks DJ, et al: Dexamethasone treatment of brain tumor patients. Effects on regional cerebral blood flow, blood volume, and oxygen utilization. Neurology 35:1610–1616, 1985

    • Search Google Scholar
    • Export Citation
  • 29.

    McEwen BS, , de Kloet ER, & Rostene W: Adrenal steroid receptors and actions in the nervous system. Physiol Rev 66:11211188, 1986 McEwen BS, de Kloet ER, Rostene W: Adrenal steroid receptors and actions in the nervous system. Physiol Rev 66:1121–1188, 1986

    • Search Google Scholar
    • Export Citation
  • 30.

    Meyer JS, , Hata T, & Imai A: Clinical and experimental studies of diaschisis, in Wood JH (ed): Cerebral Blood Flow. Physiologic and Clinical Aspects. New York: McGraw-Hill, 1987, pp 481502 Meyer JS, Hata T, Imai A: Clinical and experimental studies of diaschisis, in Wood JH (ed): Cerebral Blood Flow. Physiologic and Clinical Aspects. New York: McGraw-Hill, 1987, pp 481–502

    • Search Google Scholar
    • Export Citation
  • 31.

    Momose KJ, , Kjellber RN, & Kliman B: High incidence of cortical atrophy of the cerebral and cerebellar hemispheres in Cushing's disease. Radiology 99:341348, 1971 Momose KJ, Kjellber RN, Kliman B: High incidence of cortical atrophy of the cerebral and cerebellar hemispheres in Cushing's disease. Radiology 99:341–348, 1971

    • Search Google Scholar
    • Export Citation
  • 32.

    Mueckler M, , Caruso C, & Baldwin SA, et al: Sequence and structure of a human glucose transporter. Science 229:941945, 1985 Mueckler M, Caruso C, Baldwin SA, et al: Sequence and structure of a human glucose transporter. Science 229:941–945, 1985

    • Search Google Scholar
    • Export Citation
  • 33.

    Munck A: Glucocorticoid inhibition of glucose uptake by peripheral tissues: old and new evidence, molecular mechanisms, and physiological significance. Perspect Biol Med 14:265289, 1971 Munck A: Glucocorticoid inhibition of glucose uptake by peripheral tissues: old and new evidence, molecular mechanisms, and physiological significance. Perspect Biol Med 14:265–289, 1971

    • Search Google Scholar
    • Export Citation
  • 34.

    Okuno T, , Ito M, & Konishi Y, et al: Cerebral atrophy following ACTH therapy. J Comput Assist Tomogr 4:2023, 1980 Okuno T, Ito M, Konishi Y, et al: Cerebral atrophy following ACTH therapy. J Comput Assist Tomogr 4:20–23, 1980

    • Search Google Scholar
    • Export Citation
  • 35.

    Olgemöller B, , Schön J, & Wieland OH: Endothelial plasma membrane is a glucocorticoid-regulated barrier for the uptake of glucose into the cell. Mol Cell Endocrinol 43:165171, 1985 Olgemöller B, Schön J, Wieland OH: Endothelial plasma membrane is a glucocorticoid-regulated barrier for the uptake of glucose into the cell. Mol Cell Endocrinol 43:165–171, 1985

    • Search Google Scholar
    • Export Citation
  • 36.

    Packan DR, & Sapolsky RM: Glucocorticoid endangerment of the hippocampus: tissue, steroid and receptor specificity. Neuroendocrinology 51:613618, 1990 Packan DR, Sapolsky RM: Glucocorticoid endangerment of the hippocampus: tissue, steroid and receptor specificity. Neuroendocrinology 51:613–618, 1990

    • Search Google Scholar
    • Export Citation
  • 37.

    Patronas NJ, , Di Chiro G, & Smith BH: Depressed cerebellar glucose metabolism in supratentorial tumors. Brain Res 291:93101, 1984 Patronas NJ, Di Chiro G, Smith BH: Depressed cerebellar glucose metabolism in supratentorial tumors. Brain Res 291:93–101, 1984

    • Search Google Scholar
    • Export Citation
  • 38.

    Pessin JE, & Bell GI: Mammalian facilitative glucose transporter family: structure and molecular regulation. Annu Rev Physiol 54:911930, 1992 Pessin JE, Bell GI: Mammalian facilitative glucose transporter family: structure and molecular regulation. Annu Rev Physiol 54:911–930, 1992

    • Search Google Scholar
    • Export Citation
  • 39.

    Phelps ME, , Huang SC, & Hoffman EJ, et al: Tomographic measurement of local cerebral glucose metabolic rate in humans with [18F]2-fluoro-2-deoxy-d-glucose: validation of method. Ann Neurol 6:371388, 1979 Phelps ME, Huang SC, Hoffman EJ, et al: Tomographic measurement of local cerebral glucose metabolic rate in humans with [18F]2-fluoro-2-deoxy-d-glucose: validation of method. Ann Neurol 6:371–388, 1979

    • Search Google Scholar
    • Export Citation
  • 40.

    Reivich M, , Alavi A, & Wolf AP: Glucose metabolic rate kinetic model parameter determination in humans: the lumped constants and rate constants for [18F]fluorodeoxyglucose and [11C]deoxyglucose. J Cereb Blood Flow Metab 5:179192, 1985 Reivich M, Alavi A, Wolf AP: Glucose metabolic rate kinetic model parameter determination in humans: the lumped constants and rate constants for [18F]fluorodeoxyglucose and [11C]deoxyglucose. J Cereb Blood Flow Metab 5:179–192, 1985

    • Search Google Scholar
    • Export Citation
  • 41.

    Sapolsky RM, , Uno H, & Rebert CS, et al: Hippocampal damage associated with prolonged glucocorticoid exposure in primates. J Neurosci 10:28972902, 1990 Sapolsky RM, Uno H, Rebert CS, et al: Hippocampal damage associated with prolonged glucocorticoid exposure in primates. J Neurosci 10:2897–2902, 1990

    • Search Google Scholar
    • Export Citation
  • 42.

    Sokoloff L: Relation between physiological function and energy metabolism in the central nervous system. J Neurochem 29:1326, 1977 Sokoloff L: Relation between physiological function and energy metabolism in the central nervous system. J Neurochem 29:13–26, 1977

    • Search Google Scholar
    • Export Citation
  • 43.

    Sokoloff L, , Reivich M, & Kennedy C, et al: The (14C)-deoxyglucose method for the measurement of local cerebral glucose utilization: theory procedure and normal values in the conscious and anesthetized albino rat. J Neurochem 28:897916, 1977 Sokoloff L, Reivich M, Kennedy C, et al: The (14C)-deoxyglucose method for the measurement of local cerebral glucose utilization: theory procedure and normal values in the conscious and anesthetized albino rat. J Neurochem 28:897–916, 1977

    • Search Google Scholar
    • Export Citation
  • 44.

    Theodore WH, , Bairamian D, & Newmark ME, et al: Effect of phenytoin on human cerebral glucose metabolism. J Cereb Blood Flow Metab 6:315320, 1986 Theodore WH, Bairamian D, Newmark ME, et al: Effect of phenytoin on human cerebral glucose metabolism. J Cereb Blood Flow Metab 6:315–320, 1986

    • Search Google Scholar
    • Export Citation
  • 45.

    Theodore WH, , Bromfield E, & Onorati L: The effect of carbamazepine on cerebral glucose metabolism. Ann Neurol 25:516520, 1989 Theodore WH, Bromfield E, Onorati L: The effect of carbamazepine on cerebral glucose metabolism. Ann Neurol 25:516–520, 1989

    • Search Google Scholar
    • Export Citation
  • 46.

    Theodore WH, , DiChiro G, & Margolin R, et al: Barbiturates reduce human cerebral glucose metabolism. Neurology 36:6064, 1986 Theodore WH, DiChiro G, Margolin R, et al: Barbiturates reduce human cerebral glucose metabolism. Neurology 36:60–64, 1986

    • Search Google Scholar
    • Export Citation
  • 47.

    von Monakow C: Neue Gesichtspunkte in der Frage nach der Lokalisation im Grosshirn. Wiesbaden: JF Bergman, 1910, pp 121 von Monakow C: Neue Gesichtspunkte in der Frage nach der Lokalisation im Grosshirn. Wiesbaden: JF Bergman, 1910, pp 1–21

    • Search Google Scholar
    • Export Citation
  • 48.

    West JR: The concept of diaschisis: a reply to Markowitsch and Pritzel. Behav Biol 22:413416, 1978 West JR: The concept of diaschisis: a reply to Markowitsch and Pritzel. Behav Biol 22:413–416, 1978

    • Search Google Scholar
    • Export Citation
  • 49.

    Wise R, , Gibbs J, & Frackowiak R, et al: No evidence for transhemispheric diaschisis after human cerebral infarction. Stroke 17:853861, 1986 Wise R, Gibbs J, Frackowiak R, et al: No evidence for transhemispheric diaschisis after human cerebral infarction. Stroke 17:853–861, 1986

    • Search Google Scholar
    • Export Citation
  • 50.

    Yamaguchi T, , Kunimoto M, & Pappata S, et al: Effects of unilateral lesion of the nucleus basalis of Meynert on brain glucose utilization in callosotomized baboons: a PET study. J Cereb Blood Flow Metab 10:618623, 1990 Yamaguchi T, Kunimoto M, Pappata S, et al: Effects of unilateral lesion of the nucleus basalis of Meynert on brain glucose utilization in callosotomized baboons: a PET study. J Cereb Blood Flow Metab 10:618–623, 1990

    • Search Google Scholar
    • Export Citation
  • 51.

    Zülch KJ: Brain Tumors. Their Biology and Pathology. Berlin: Springer-Verlag, 1986, pp 125 Zülch KJ: Brain Tumors. Their Biology and Pathology. Berlin: Springer-Verlag, 1986, pp 1–25

    • Search Google Scholar
    • Export Citation

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