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Chegodaev DA, Pavlova PA. High lactic acid levels in the brain contribute to the generation of focal slowing on the electroencephalogram. Front Neurol 2024; 15:1393274. [PMID: 38694777 PMCID: PMC11061411 DOI: 10.3389/fneur.2024.1393274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/09/2024] [Indexed: 05/04/2024] Open
Abstract
Focal slowing on the EEG is often associated with structural pathology of the brain. Despite the clinical significance of focal slowing, the actual electrochemical mechanisms underlying this EEG phenomenon are still poorly understood. This paper briefly reviews the role of lactate in the pathogenesis of brain disorders that are primarily related to focal EEG slowing. An attempt is made to trace the hypothetical link between this EEG pattern and focal cerebral tissue lactacidosis.
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Affiliation(s)
- Dmitry Alexandrovich Chegodaev
- Laboratory for Brain and Neurocognitive Development, Ural Institute of Humanities, Ural Federal University named after the First President of Russia B. N. Yeltsin, Yekaterinburg, Russia
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Insulin-Like Growth Factor-1 Promotes Synaptogenesis Signaling, a Major Dysregulated Pathway in Malformation of Cortical Development, in a Rat Model. Mol Neurobiol 2023; 60:3299-3310. [PMID: 36847937 DOI: 10.1007/s12035-023-03256-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 02/07/2023] [Indexed: 03/01/2023]
Abstract
Malformation of cortical development (MCD) is one of the main causes of intractable epilepsy in childhood. We explored a treatment based on molecular changes using an infant rat model of methylazoxymethanol (MAM)-induced MCD established by injecting MAM at gestational day 15. The offspring were sacrificed on postnatal day (P) 15 for proteomic analysis, which revealed significant downregulation in the synaptogenesis signaling pathway in the cortex of MCD rats. Recombinant human insulin-growth factor-1 (rhIGF-1) was injected from P12 to P14 twice daily and the effect of IGF1 on N-methyl-D-aspartate (NMDA)-induced spasms (15 mg/kg of NMDA, i.p.) was tested; the onset of P15 single spasm was significantly delayed (p = 0.002) and the number of spasms decreased (p < 0.001) in rhIGF1-pretreated rats (n = 17) compared to those in VEH-treated rats (n = 18). Electroencephalographic monitoring during spasms showed significantly reduced spectral entropy and event-related spectral dynamics of fast oscillation in rhIGF-1 treated rats. Magnetic resonance spectroscopy of the retrosplenial cortex showed decreased glutathione (GSH) (p = 0.039) and significant developmental changes in GSH, phosphocreatine (PCr), and total creatine (tCr) (p = 0.023, 0.042, 0.015, respectively) after rhIGF1 pretreatment. rhIGF1 pretreatment significantly upregulated expression of cortical synaptic proteins such as PSD95, AMPAR1, AMPAR4, NMDAR1, and NMDAR2A (p < 0.05). Thus, early rhIGF-1 treatment could promote synaptic protein expression, which was significantly downregulated by prenatal MAM exposure, and effectively suppress NMDA-induced spasms. Early IGF1 treatment should be further investigated as a therapeutic strategy in infants with MCD-related epilepsy.
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Barrit S, Park EH, Rotenberg A, Kaye H, Pearl PL, Madsen JR. Single-stage resection of bottom-of-a-sulcus dysplasia involving eloquent cortex using navigated transcranial magnetic stimulation and intraoperative modalities. Childs Nerv Syst 2022; 38:1365-1370. [PMID: 35449311 DOI: 10.1007/s00381-022-05532-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/13/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Focal cortical dysplasia (FCD) is a common etiology of refractory epilepsy, particularly in children. Surgical management is potentially curative, but poses the challenge of distinguishing the border between ictogenic regions of dysplasia and functionally critical brain tissue. Bottom-of-a-sulcus dysplasia (BOSD) amplifies this challenge, due to difficulties in physiologic mapping of the deep tissue. METHODS We report a one-stage resection of a dysplasia-associated seizure focus abutting and involving the hand and face primary motor cortex. In doing so, we describe our surgical planning integrating neuronavigated transcranial magnetic stimulation (nTMS) for functional motor mapping, combined with intraoperative ultrasonography, intracranial electroencephalography, and magnetic resonance imaging (MRI). A 5-year-old girl with intractable focal epilepsy was referred to our comprehensive epilepsy program. Despite attentive pharmacotherapy, she experienced status epilepticus and up to 70 seizures per day, accompanied by multiple side effects from her antiseizure medication. A right frontal BOSD in close proximity to the hand motor area of the precentral gyrus was identified on MRI. Postoperatively, she is seizure-free for over 1 year with no hand deficit. CONCLUSION Although technically complex, single-stage resection taking advantage of comprehensive surgical planning with optimized fusion of functional mapping and intraoperative modalities merits consideration given the invasiveness of a two-stage approach for limited added value. Integrated pre-surgical nTMS allowed for mapping of eloquent cortex without invasive electrocortical stimulation.
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Affiliation(s)
- Sami Barrit
- Service de Neurochirurgie, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, B, 1070, Brussels, Belgium. .,Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.
| | - Eun-Hyoung Park
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Alexander Rotenberg
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Harper Kaye
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Phillip L Pearl
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Joseph R Madsen
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
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Whitehead MT, Bluml S. Proton and Multinuclear Spectroscopy of the Pediatric Brain. Magn Reson Imaging Clin N Am 2021; 29:543-555. [PMID: 34717844 DOI: 10.1016/j.mric.2021.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Magnetic resonance spectroscopy (MRS) is a valuable adjunct to structural brain imaging. State-of-the-art MRS has benefited greatly from recent technical advancements. Neurometabolic alterations in pediatric brain diseases have implications for diagnosis, prognosis, and therapy. Herein, the authors discuss MRS technical considerations and applications in the setting of various pediatric disease processes including tumors, metabolic diseases, hypoxic/ischemic encephalopathy/stroke, epilepsy, demyelinating disease, and infection.
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Affiliation(s)
- Matthew T Whitehead
- Department of Radiology, Children's National Hospital, 111 Michigan Avenue NW, Washington, DC 20010, USA; Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA; The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
| | - Stefan Bluml
- Department of Radiology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, 450 Sunset Boulevard, Los Angeles, CA 90027, USA; Rudi Schulte Research Institute, Santa Barbara, CA, USA
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Gong T, Liu Y, Chen Y, Lin L, Lin Y, Wang G. Focal corticarl dysplasia in epilepsy is associated with GABA increase. Neuroimage Clin 2021; 31:102763. [PMID: 34280836 PMCID: PMC8313738 DOI: 10.1016/j.nicl.2021.102763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 07/08/2021] [Accepted: 07/10/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Focal cortical dysplasia (FCD) is a major cause of drug-resistant epilepsy; however the underlying epileptogenic mechanisms of FCD metabolism in epilepsy patients remain unclear. The aim of this study is to detect alterations of γ-aminobutyric acid (GABA), glutathione (GSH), and the composite of glutamate and glutamine (Glx) in MRI-typical and neuropathologically confirmed FCD-associated epilepsy using Hadamard Encoding and Reconstruction of Mega-Edited Spectroscopy (HERMES). MATERIALS AND METHODS Fourteen epileptic patients suspected to be caused by FCD and 14 healthy controls were enrolled prospectively in this study; all subjects underwent a 3 T MRI scan, including 3D T1 weighted imaging and HERMES. The GABA signal detected by HERMES also contains signals from macromolecules and homocarnosine, so it is referred as GABA+. Signals of GABA+, GSH and Glx detected by HERMES from tumor foci, contralateral cerebral regions, and healthy controls were quantified using Gannet. Fitting errors and signal to noise ratios (SNRs) of GABA + signals were also recorded. Differences of GABA+, GSH, Glx, fitting error and SNR of GABA + among three groups were analyzed using linear mixed effects models. RESULTS Twelve FCD-associated epilepsy patients (7 females, aged 21.9 ± 9.3 years) and 12 matched healthy controls (7 females, aged 22.8 ± 9.8 years) were finally enrolled in this study. ANOVA results indicated that GABA levels were significantly increased in FCD foci compared with contralateral regions (p = 0.008) and with healthy controls (p = 0.003), while no difference was found in GSH and Glx levels. No difference of fitting errors or SNR of GABA + was found among FCD foci, contralateral regions and healthy controls. CONCLUSIONS Increased GABA levels were found in FCD foci that indicated GABA may play a central role in the pathophysiology of FCD patients with epilepsy.
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Affiliation(s)
- Tao Gong
- Department of Radiology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China; MSunSoft Health Group, Shandong, China
| | - Yubo Liu
- Department of Radiology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China
| | - Yufan Chen
- Department of Radiology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China
| | | | - Youting Lin
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China.
| | - Guangbin Wang
- Department of Radiology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China.
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Quantitative 1H-MRS reveals metabolic difference between subcategories of malformations of cortical development. Neuroradiology 2021; 63:1539-1548. [PMID: 33758963 DOI: 10.1007/s00234-021-02694-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 03/16/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE To figure out the spectra features of malformations of cortical development (MCDs) and the differences between MCDs subcategories. METHODS Twenty patients and 18 controls were studied. The patients included two subcategories: disorders of migration (DOM) and postmigration (DOPM). Spectra of patients were acquired from both the lesion and the normal-appearing contralateral side (NACS), and they were compared to those of the controls obtained from the frontal lobe. RESULTS Compared to the controls, a decreased NAA (P = 0.002) was identified in MCDs. After dividing the MCDs into the DOM and DOPM, we found that NAA reduction was only notable in the DOM (P = 0.007). Moreover, Ins and Cr of the DOPM were higher than those of the controls (P = 0.017 and 0.013) and the DOM (P = 0.027 and 0.001). Compared to the NACS, a decreased NAA (P = 0.042) and an increased Ins (P = 0.039) were identified in the lesion of MCDs. After dividing the MCDs into the DOM and DOPM, we found no significant differences in the DOM, but Ins, Cr, and Glx of the lesion were higher than those of the NACS (P = 0.007, 0.005 and 0.047) in the DOPM. In addition, we found that Cr and Glx correlated positively to the seizure frequency (P = 0.003 and 0.016). CONCLUSION Decreased NAA was the prominent abnormality confirmed in MCDs. Spectra of different MCDs subcategories were different: the DOM was characterized by decreased NAA, while the DOPM was characterized by increased Ins.
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Castello MA, Gleeson JG. Insight into developmental mechanisms of global and focal migration disorders of cortical development. Curr Opin Neurobiol 2020; 66:77-84. [PMID: 33099181 DOI: 10.1016/j.conb.2020.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 12/20/2022]
Abstract
Cortical development involves neurogenesis followed by migration, maturation, and myelination of immature neurons. Disruptions in these processes can cause malformations of cortical development (MCD). Radial glia (RG) are the stem cells of the brain, both generating neurons and providing the scaffold upon which immature neurons radially migrate. Germline mutations in genes required for cell migration, or cell-cell contact, often lead to global MCDs. Somatic mutations in RG in genes involved in homeostatic function, like mTOR signaling, often lead to focal MCDs. Two different mutations occurring in the same patient can combine in ways we are just beginning to understand. Our growing knowledge about MCD suggests mTOR inhibitors may have expanded utility in treatment-resistant epilepsy, while imaging techniques can better delineate the type and extent of these lesions.
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Affiliation(s)
- Michael A Castello
- Department of Neurosciences, Division of Child Neurology, University of California San Diego, San Diego, CA, USA
| | - Joseph G Gleeson
- Department of Neurosciences, Rady Children's Institute for Genomic Medicine, University of California San Diego, San Diego, CA, USA.
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Sone D, Ikegaya N, Takahashi A, Sumida K, Ota M, Saito T, Kimura Y, Matsuda H, Sato N. Noninvasive detection of focal brain hyperthermia related to continuous epileptic activities using proton MR spectroscopy. Epilepsy Res 2017; 138:1-4. [DOI: 10.1016/j.eplepsyres.2017.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 09/03/2017] [Accepted: 10/01/2017] [Indexed: 10/18/2022]
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Carlesimo GA, Daniele A, Lombardi MG, Lacidogna G, La Cara A, Fadda L, Caltagirone C. Accelerated Long-Term Forgetting Limited to the Recollection Component of Recognition Memory in a Temporal Lobe Epileptic Patient. Neurocase 2017; 23:278-286. [PMID: 29070006 DOI: 10.1080/13554794.2017.1390141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Accelerated long-term forgetting (ALF) is a frequent finding in patients with temporal lobe epilepsy (TLE). Here we report the case of a TLE patient who complained of marked difficulties in remembering personal events and information even though repeated neuropsychological assessments had failed to detect any deficit on common laboratory memory tests. The patient underwent an experimental investigation that involved estimating recollection and familiarity processes in the performance on verbal and visual recognition tests, over intervals ranging from 10 minutes to 7 days. Results showed accelerated forgetting confined to the recollection component only, which was particularly evident in the verbal test.
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Affiliation(s)
- Giovanni Augusto Carlesimo
- a Department of Systems Medicine , "Tor Vergata" University , Rome , Italy.,b Unit of Clinical and Behavioural Neurology, IRCCS Santa Lucia Foundation , Rome , Italy
| | - Antonio Daniele
- c Centre for Neuropsychological research , Institute of Neurology- Catholic University , Rome , Italy
| | | | - Giordano Lacidogna
- c Centre for Neuropsychological research , Institute of Neurology- Catholic University , Rome , Italy
| | - Alfredo La Cara
- d Neurophysiopathology Unit , Tivoli hospital , Tivoli , Italy
| | - Lucia Fadda
- a Department of Systems Medicine , "Tor Vergata" University , Rome , Italy.,b Unit of Clinical and Behavioural Neurology, IRCCS Santa Lucia Foundation , Rome , Italy
| | - Carlo Caltagirone
- a Department of Systems Medicine , "Tor Vergata" University , Rome , Italy.,b Unit of Clinical and Behavioural Neurology, IRCCS Santa Lucia Foundation , Rome , Italy
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Zimatore DS, Trentadue M, Castellaro M, Ferlisi M, Piovan E, Calabrese M. A case of epilepsy in multiple sclerosis: Three-dimensional double inversion recovery sequences revealed cortical dysplasia. Neuroradiol J 2017; 30:352-355. [PMID: 28379049 DOI: 10.1177/1971400917697732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In epileptic patients with multiple sclerosis (MS), cortical lesions have been suggested to cause seizures. In brain magnetic resonance imaging (MRI), double inversion recovery (DIR) sequences are generally used to evaluate MS cortical disease burden. We present the case of a woman, diagnosed with MS, suffering from drug-resistant partial seizures initially attributed to MS. The patient underwent many MRI exams, but only by means of high-resolution three-dimensional DIR sequences was a focal cortical dysplasia discovered. The MRI findings and FDG-PET/CT supported the diagnosis. This case recommends the use of DIR sequences both in patients with suspect epileptogenic lesions not detected with routine MRI protocols and in epileptic patient with MS, before ascribing seizures to MS.
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Affiliation(s)
- Domenico S Zimatore
- 1 Neuroradiology, Department of Diagnostics and Pathology, Azienda Ospedaliera Universitaria Integrata Verona, Italy
| | - Mirko Trentadue
- 1 Neuroradiology, Department of Diagnostics and Pathology, Azienda Ospedaliera Universitaria Integrata Verona, Italy
| | - Marco Castellaro
- 2 Department of Information Engineering, University of Padova, Italy
| | - Monica Ferlisi
- 3 Division of Neurology; Azienda Ospedaliera Universitaria Integrata Verona, Italy
| | - Enrico Piovan
- 1 Neuroradiology, Department of Diagnostics and Pathology, Azienda Ospedaliera Universitaria Integrata Verona, Italy
| | - Massimiliano Calabrese
- 4 Neurology Section, Department of Neurological and Movement Sciences, University of Verona, Italy
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Aitouche Y, Gibbs SA, Gilbert G, Boucher O, Bouthillier A, Nguyen DK. Proton MR Spectroscopy in Patients with Nonlesional Insular Cortex Epilepsy Confirmed by Invasive EEG Recordings. J Neuroimaging 2017; 27:517-523. [PMID: 28318128 DOI: 10.1111/jon.12436] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 02/10/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Recent studies suggest that a nonnegligible proportion of drug-resistant epilepsy surgery candidates have an epileptogenic zone that involves the insula. We aimed to examine the value of proton magnetic resonance spectroscopy (1 H-MRS) in identifying patients with insular cortex epilepsy. METHODS Patients with possible nonlesional drug-refractory insular epilepsy underwent a voxel-based 1 H-MRS study prior to an intracranial electroencephalographic (EEG) study. Patients were then divided into two groups based on invasive EEG findings: the insular group with evidence of insular seizures and the noninsular group with no evidence of insular seizures. Sixteen age-matched healthy controls were also scanned for normative data. RESULTS Twenty-two epileptic patients were recruited, 12 with insular seizures and 10 with extra-insular seizures. Ipsilateral and contralateral insular N-acetyl-aspartate concentrations ([NAA]) and NAA/Cr ratios were found to be similar in both patient groups. No significant differences in [NAA] or NAA/Cr ratios were found between the insular group, noninsular group, and healthy controls. [NAA] and NAA/Cr asymmetry indices correctly lateralized the seizure focus in only 16.7% and 0% of patients, respectively. CONCLUSIONS Our preliminary findings suggest that 1 H-MRS fares poorly in identifying patients with nonlesional insular epilepsy.
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Affiliation(s)
| | - Steve A Gibbs
- Department of Neurosciences, Université de Montréal, Canada.,Division of Neurology, Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Canada
| | - Guillaume Gilbert
- MR Clinical Science, Philips Healthcare, Canada.,Department of Radiology, CHUM Notre-Dame, Université de Montréal, Canada
| | | | - Alain Bouthillier
- Division of Neurosurgery, CHUM Notre-Dame, Université de Montréal, Canada
| | - Dang Khoa Nguyen
- Department of Neurosciences, Université de Montréal, Canada.,Division of Neurology, CHUM Notre-Dame, Université de Montréal, Canada
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