2024 What is cushing

Apr 17, 2015 · Cushing’s syndrome is a rare disorder resulting from prolonged exposure to excess glucocorticoids. Early diagnosis and treatment of Cushing’s syndrome is associated with a decrease in morbidity and mortality. Clinical presentation can be highly variable, and establishing the diagnosis can often be difficult. Surgery (resection of the ... . Rooms for rent dollar500 a month near me

What is Cushing’s disease? “Cushing’s disease is a rare but serious condition that is caused by a pituitary tumour," a specialist from the University of California, Los Angeles (UCLA) pituitary team tells Yahoo Canada. " The gland releases excessive adrenocorticotropic hormones and cortisol into the blood over a long period of time.Cushing’s triad usually occurs in the late stages of acute head injury. This reflex is usually a normal homeostatic response of the body to prevent brain ischemia. But, unfortunately, this triad is a late indication of increased intracranial pressure. Moreover, this triad also suggests that brainstem herniation is possible.Feb 22, 2022 · Cushing’s disease is a condition in which the body produces too much cortisol. Learn about symptoms and treatment. Cushing's disease (also known as Cushing’s syndrome) is a condition in which the adrenal glands overproduce certain hormones. The medical term for this disease is hyperadrenocorticism. Literally translated, “hyper” means over-active, “adreno” means adrenal gland, and “corticism” refers to the outer part (cortex) of the adrenal gland. Cushing’s disease, also called hyperadrenocorticism, is a condition caused by having too much cortisol. Cortisol is a hormone found in all mammals that’s responsible for helping the body deal with stress, control blood pressure, and metabolize sugar. When a cat, dog, or human has Cushing’s disease, the excess cortisol in their body then ...Cushing syndrome can cause a range of symptoms. 1,2 The symptoms might also be similar to those of other conditions. 3. Physically, someone with Cushing syndrome might have: Overweight or obesity above the waist but thin arms and legs; A round, red face, sometimes referred to as a moon face; A fat lump between the shoulders, sometimes called a ...Jul 4, 2023 · Hypercortisolism refers to the clinical state resulting from excess tissue exposure to cortisol and/or other glucocorticoids. When such exposure is sustained, it results in the development of Cushing syndrome (CS), which is a distinctive constellation of clinical signs and symptoms resulting from chronic exposure to excess cortisol, either ... For all causes, the incidence of Cushing’s syndrome is 3-8 times higher in women than men and most commonly affects individuals 20-50 years of age. Iatrogenic Cushing’s syndrome is the most common type and is caused by administration of corticosteroids such as prednisone in non-physiologic doses. Exogenous steroids suppress the adrenal ...Cushing's disease (hyperadrenocorticism) is a serious health condition in dogs that occurs when the adrenal glands overproduce cortisol (cortisone) in the animal's body. Excess cortisol can put a dog at risk of several serious conditions and illnesses, from kidney damage to diabetes, and can be life-threatening.Cushing’s disease is a specific form of Cushing’s syndrome. People with Cushing’s disease have high levels of cortisol because they have a non-cancerous (benign) tumor in the pituitary gland. The tumor releases adrenocorticotropin hormone (ACTH), which causes the adrenal glands to produce excessive cortisol.Price Range: $$. Royal Canin gastrointestinal diet is a low-fat (maximum 9.4% of dry matter) dog food with over 22% protein by dry matter. This product includes digestible proteins and prebiotic fiber to assist digestion. It comes in a 1.5-pound container.Cushing’s horses today have a better prognosis than ever before, and with proper treatment and management they can enjoy long and productive lives. In recent studies, McFarlane has found that PPID begins when hypothalamic neurons degenerate and produce less dopamine, the substance that restrains pituitary secretion.Apr 17, 2015 · Cushing’s syndrome is a rare disorder resulting from prolonged exposure to excess glucocorticoids. Early diagnosis and treatment of Cushing’s syndrome is associated with a decrease in morbidity and mortality. Clinical presentation can be highly variable, and establishing the diagnosis can often be difficult. Surgery (resection of the ... Cushing’s disease—also known as hypercortisolism and hyperadrenocorticism—is a serious disease that typically affects middle-aged and senior dogs. It can be serious if left untreated. Here’s what you need to know about Cushing’s disease in dogs—from types and symptoms to treatment and care.Cushing syndrome, first described by Harvey in 1912, refers to signs and symptoms caused by excess free plasma glucocorticoids. Excess glucocorticoids can arise from increased endogenous production or prolonged exposure to exogenous use of glucocorticoid products. While endogenous Cushing syndrome is a rare disease, iatrogenic (drug-related or ...Cushing's syndrome is a disorder caused by the body’s exposure to an excess of the hormone cortisol. Cortisol affects all tissues and organs in the body. These effects together are known as Cushing's syndrome. Cushing’s syndrome can be caused by overuse of cortisol medication, as seen in the treatment of chronic asthma or rheumatoid ...Mar 20, 2023 · The Cushing reflex (vasopressor response, Cushing reaction, Cushing effect, and Cushing phenomenon) is a physiological nervous system response to acute elevations of intracranial pressure (ICP), resulting in Cushing’s triad of widened pulse pressure (increasing systolic, decreasing diastolic), bradycardia, and irregular respirations. What are the most important facts to know about Cushing syndrome? Cushing syndrome is a set of symptoms that result from high cortisol levels. Cushing syndrome has many causes, most commonly glucocorticoid medication use. When Cushing syndrome is caused by an ACTH-producing pituitary tumor, it is called Cushing disease.Cushing reflex (also referred to as the vasopressor response, the Cushing effect, the Cushing reaction, the Cushing phenomenon, the Cushing response, or Cushing's Law) is a physiological nervous system response to increased intracranial pressure (ICP) that results in Cushing's triad of increased blood pressure, irregular breathing, and ...Price Range: $$. Royal Canin gastrointestinal diet is a low-fat (maximum 9.4% of dry matter) dog food with over 22% protein by dry matter. This product includes digestible proteins and prebiotic fiber to assist digestion. It comes in a 1.5-pound container.Hypercortisolism refers to the clinical state resulting from excess tissue exposure to cortisol and/or other glucocorticoids. When such exposure is sustained, it results in the development of Cushing syndrome (CS), which is a distinctive constellation of clinical signs and symptoms resulting from chronic exposure to excess cortisol, either ...Cushing’s disease (otherwise known as hyperadrenocorticism) is an overproduction of cortisol in the body. The endocrine system is the system in the body that produces and regulates hormones, such as cortisol. Cortisol is important and critical for many functions in the body, such as responding to stress, modulating the immune system or ...Cushing's syndrome is a disorder caused by the body’s exposure to an excess of the hormone cortisol. Cortisol affects all tissues and organs in the body. These effects together are known as Cushing's syndrome. Cushing’s syndrome can be caused by overuse of cortisol medication, as seen in the treatment of chronic asthma or rheumatoid ... Cushing ( Meskwaki: Koshineki, [4] Iowa-Oto: Amína P^óp^oye Chína, meaning: "Soft-seat town" [5]) is a city in Payne County, Oklahoma, United States. The population was 7,826 at the time of the 2010 census, a decline of 6.5% since 8,371 in 2000. [6] Cushing was established after the Land Run of 1891 by William "Billy Rae" Little.Cushing’s disease in dogs is caused by one of three things: A tumor on the pituitary gland at the base of the brain (this gland is responsible for telling the adrenal glands to secrete cortisol).Price Range: $$. Royal Canin gastrointestinal diet is a low-fat (maximum 9.4% of dry matter) dog food with over 22% protein by dry matter. This product includes digestible proteins and prebiotic fiber to assist digestion. It comes in a 1.5-pound container.May 13, 2021 · Cushing syndrome is a disorder that occurs when your body has a higher than normal level of the hormone cortisol. This hormone is made in the adrenal glands. Too much cortisol can be due to various problems. One such problem is a tumor on one of the adrenal glands. Adrenal tumors release cortisol. Equine Cushing’s disease is one of the most common diseases of horses greater than 15 years of age. The clinical signs are associated with abnormally elevated hormone concentrations in the blood and along with other hormones, cortisol, plays an important role in this disease. This syndrome is better defined as Equine Pituitary Pars Intermedia ...Cushing reflex (also referred to as the vasopressor response, the Cushing effect, the Cushing reaction, the Cushing phenomenon, the Cushing response, or Cushing's Law) is a physiological nervous system response to increased intracranial pressure (ICP) that results in Cushing's triad of increased blood pressure, irregular breathing, and ...May 22, 2019 · Cushing’s disease in dogs is caused by one of three things: A tumor on the pituitary gland at the base of the brain (this gland is responsible for telling the adrenal glands to secrete cortisol). The most common cause of Cushing syndrome is taking too much glucocorticoid or corticosteroid medicine. This form of Cushing syndrome is called exogenous Cushing syndrome. Prednisone, dexamethasone, and prednisolone are examples of this type of medicine. Glucocorticoids mimic the action of the body's natural hormone cortisol.Cushing’s disease affects your cat’s adrenal glands. If your cat develops this condition, his adrenal glands will produce more of the hormone cortisol than his body needs. While cortisol is an integral part of overall health, too much can lead to serious illness and even death. Mar 3, 2022 · Cushing’s disease in dogs is brought about by an excess of circulating cortisol hormone. This causes functional tumors to form on a dog’s adrenal or pituitary glands. There are three different types of canine Cushing’s disease: pituitary-based, adrenal-based and iatrogenic. Chronic and slowly progressive, each type presents the same ... In most cases, Cushing's disease begins as subtle changes in behaviour and appearance. The most obvious sign is the lack of a topline. The hair coat may be thin or coarse, and there may be evidence of delayed shedding. Horses with Cushing's disease are usually lethargic. Their appetite and energy levels decrease.Cushing’s disease is a condition in which the body produces too much cortisol. Learn about symptoms and treatment.Cushing's disease is one cause of Cushing's syndrome characterised by increased secretion of adrenocorticotropic hormone (ACTH) from the anterior pituitary (secondary hypercortisolism ). This is most often as a result of a pituitary adenoma (specifically pituitary basophilism) or due to excess production of hypothalamus CRH ( corticotropin ... Usually, the test is done overnight, but it can also be done over 2 days. There are two doses you can take for the test: low dose and high dose. The low-dose test helps you find out if you have ... What causes Cushing's syndrome and Cushing's disease? Some people with Cushing's syndrome have a benign tumour in part of the brain. This tumour tells the adrenal glands to release cortisol. This condition is known as Cushing's disease. Cushing's syndrome can also be caused by: a tumour of the adrenal gland; overgrowth of the adrenal glands The following may contain Chewy links. PetMD is operated by Chewy. Cushing’s disease develops when a dog’s body produces too much of a steroid hormone called cortisol. . Chronically high levels of cortisol in the body leads to recurrent infections, skin problems, a pot-bellied appearance, and increased appetite, thirst, and urinatiMay 13, 2021 · This is called ectopic Cushing syndrome. Ectopic means that something is occurring in an abnormal place in the body. Ectopic Cushing syndrome is caused by tumors that release ACTH. Tumors that can, in rare cases, release ACTH include: Benign carcinoid tumors of the lung. Islet cell tumors of the pancreas. Medullary carcinoma of the thyroid. Jul 1, 2008 · Cushing’s syndrome (hyperadrenocorticism) occurs when the adrenal gland produces too much cortisol. While cortisol is an essential hormone, elevated levels lead to illness. There are several possible causes to this disease, including a tumor in the pituitary gland or the outer layer of the adrenal gland. Equine Cushing’s Disease is more commonly known as Pituitary Pars Intermedia Dysfunction (PPID). It involves the overproduction of certain pituitary hormones and is the most common endocrine disease of older horses and ponies. PPID occurs in all breeds and both genders, with increasing age as the only proven risk factor.Jul 1, 2008 · Cushing’s syndrome (hyperadrenocorticism) occurs when the adrenal gland produces too much cortisol. While cortisol is an essential hormone, elevated levels lead to illness. There are several possible causes to this disease, including a tumor in the pituitary gland or the outer layer of the adrenal gland. Diagnosing Cushing’s Syndrome. Your doctor will run a series of tests to measure your cortisol levels and determine the source of the excess hormone (pituitary, adrenal, or an ectopic tumor). Tests include saliva, blood, urine, and imaging. Diagnosing Cushing’s syndrome can be difficult and take time because many of the symptoms can be ...What is Cushing’s disease? “Cushing’s disease is a rare but serious condition that is caused by a pituitary tumour," a specialist from the University of California, Los Angeles (UCLA) pituitary team tells Yahoo Canada. " The gland releases excessive adrenocorticotropic hormones and cortisol into the blood over a long period of time.Cushing's syndrome is a condition caused by having too much of a hormone called cortisol in your body. It can be serious if it's not treated. Who gets it and why. Cushing's syndrome is uncommon. It mostly affects people who have been taking steroid medicine, especially steroid tablets, for a long time. Steroids contain a synthetic version of ...Jul 9, 2007 · The Cushing reflex helps save brain tissues during periods of poor perfusion. Unfortunately, it s a late sign of increasing intracranial pressure and indicates that brainstem herniation is imminent. Cushing's syndrome is a collection of signs and symptoms due to prolonged exposure to glucocorticoids such as cortisol. Signs and symptoms may include high blood pressure, abdominal obesity but with thin arms and legs, reddish stretch marks, a round red face due to facial plethora, a fat lump between the shoulders, weak muscles, weak bones, acne, and fragile skin that heals poorly. Cushing is a city in Nacogdoches County, Texas, United States. The population was 612 at the 2010 census. Geography. Cushing is located at (31.813492, –94.840288 ...Cushing's disease (hyperadrenocorticism) is a serious health condition in dogs that occurs when the adrenal glands overproduce cortisol (cortisone) in the animal's body. Excess cortisol can put a dog at risk of several serious conditions and illnesses, from kidney damage to diabetes, and can be life-threatening.Feb 22, 2022 · Cushing’s disease is a condition in which the body produces too much cortisol. Learn about symptoms and treatment. Cushing's syndrome is a disorder caused by the body’s exposure to an excess of the hormone cortisol. Cortisol affects all tissues and organs in the body. These effects together are known as Cushing's syndrome. Cushing’s syndrome can be caused by overuse of cortisol medication, as seen in the treatment of chronic asthma or rheumatoid ... What causes Cushing's syndrome and Cushing's disease? Some people with Cushing's syndrome have a benign tumour in part of the brain. This tumour tells the adrenal glands to release cortisol. This condition is known as Cushing's disease. Cushing's syndrome can also be caused by: a tumour of the adrenal gland; overgrowth of the adrenal glands Jun 15, 2021 · Cushing's disease (hyperadrenocorticism) is a serious health condition in which the adrenal glands overproduce cortisol (cortisone) in the body. Excess cortisol can put a dog at risk of several serious conditions and illnesses, from kidney damage to diabetes, and can be life-threatening. Cushing syndrome can cause a range of symptoms. 1,2 The symptoms might also be similar to those of other conditions. 3. Physically, someone with Cushing syndrome might have: Overweight or obesity above the waist but thin arms and legs; A round, red face, sometimes referred to as a moon face; A fat lump between the shoulders, sometimes called a ...For all causes, the incidence of Cushing’s syndrome is 3-8 times higher in women than men and most commonly affects individuals 20-50 years of age. Iatrogenic Cushing’s syndrome is the most common type and is caused by administration of corticosteroids such as prednisone in non-physiologic doses. Exogenous steroids suppress the adrenal ...Cushing is a city in Payne County, Oklahoma, United States. The population was 8,371 at the 2000 census. The city was established after the Land Run of 1891 by Billy Rae Little. It was named for Marshall Cushing, private secretary to U.S. Postmaster General John Wanamaker. An oil boom that began in 1912 led to the city's development as a ... Equine Cushing’s Disease is more commonly known as Pituitary Pars Intermedia Dysfunction (PPID). It involves the overproduction of certain pituitary hormones and is the most common endocrine disease of older horses and ponies. PPID occurs in all breeds and both genders, with increasing age as the only proven risk factor.Cushing's syndrome is a collection of signs and symptoms due to prolonged exposure to glucocorticoids such as cortisol. Signs and symptoms may include high blood pressure, abdominal obesity but with thin arms and legs, reddish stretch marks, a round red face due to facial plethora, a fat lump between the shoulders, weak muscles, weak bones, acne, and fragile skin that heals poorly. Cushing syndrome happens when the body has too much of the hormone cortisol for a long time. This can result from the body making too much cortisol, or from taking medicines called glucocorticoids, which affect the body the same way as cortisol.Cushing’s disease, also called hyperadrenocorticism, is a condition caused by having too much cortisol. Cortisol is a hormone found in all mammals that’s responsible for helping the body deal with stress, control blood pressure, and metabolize sugar. When a cat, dog, or human has Cushing’s disease, the excess cortisol in their body then ...Cushing's syndrome is a condition caused by having too much of a hormone called cortisol in your body. It can be serious if it's not treated. Who gets it and why. Cushing's syndrome is uncommon. It mostly affects people who have been taking steroid medicine, especially steroid tablets, for a long time. Steroids contain a synthetic version of ... May 22, 2019 · Cushing’s disease in dogs is caused by one of three things: A tumor on the pituitary gland at the base of the brain (this gland is responsible for telling the adrenal glands to secrete cortisol). Feb 2, 2023 · Cushing’s disease is a condition of excessive production of the hormone cortisol due to a benign tumor of the pituitary gland. Common symptoms include high blood pressure, high blood sugar, fatigue, and body fat accumulation to the face, neck, and abdomen. The wide variety of symptoms and gradual changes in appearance often lead to delayed ... Aug 22, 2018 · Cushing’s syndrome is a hormonal condition that occurs when a person’s cortisol levels are too high. It can have severe and wide-ranging effects on the body. It often results from using ... May 13, 2021 · This is called ectopic Cushing syndrome. Ectopic means that something is occurring in an abnormal place in the body. Ectopic Cushing syndrome is caused by tumors that release ACTH. Tumors that can, in rare cases, release ACTH include: Benign carcinoid tumors of the lung. Islet cell tumors of the pancreas. Medullary carcinoma of the thyroid. Cushing’s disease is a condition in which the body produces too much cortisol. Learn about symptoms and treatment.Nov 9, 2021 · Cushing’s disease is an endocrine disorder of middle-aged and older dogs. It’s the result of the overproduction of cortisol by the adrenal glands located on each kidney. Normally, your dog responds to stress by producing something called ACTH (adrenocorticotropic hormone). Cushing's disease is one cause of Cushing's syndrome characterised by increased secretion of adrenocorticotropic hormone (ACTH) from the anterior pituitary (secondary hypercortisolism ). This is most often as a result of a pituitary adenoma (specifically pituitary basophilism) or due to excess production of hypothalamus CRH ( corticotropin ... Cushing is a city in Payne County, Oklahoma, United States. The population was 8,371 at the 2000 census. The city was established after the Land Run of 1891 by Billy Rae Little. It was named for Marshall Cushing, private secretary to U.S. Postmaster General John Wanamaker. An oil boom that began in 1912 led to the city's development as a ... Cushing's syndrome is a hormonal disorder caused by high levels of the hormone cortisol in your body. It’s also known as hypercortisolism. Cortisol comes from your adrenal glands, which sit on...Cushing syndrome, also known as hypercortisolism, is a condition in which your body overproduces a hormone called cortisol. Cortisol helps to regulate a variety of processes in the body. These processes include: Controlling blood sugar levels. Regulating metabolism. Aug 9, 2021 · Cushing syndrome can also be due to endogenous causes; approximately 70% of Cushing syndrome is the result of Cushing disease. Cushing disease occurs when excess adrenocorticotropin hormone (ACTH) production from a benign pituitary tumor (adenoma) causes the adrenal glands to produce excessive amounts of cortisol. Apr 17, 2015 · Cushing’s syndrome is a rare disorder resulting from prolonged exposure to excess glucocorticoids. Early diagnosis and treatment of Cushing’s syndrome is associated with a decrease in morbidity and mortality. Clinical presentation can be highly variable, and establishing the diagnosis can often be difficult. Surgery (resection of the ... Jun 9, 2022 · What is Cushing’s disease? “Cushing’s disease is a rare but serious condition that is caused by a pituitary tumour," a specialist from the University of California, Los Angeles (UCLA) pituitary team tells Yahoo Canada. " The gland releases excessive adrenocorticotropic hormones and cortisol into the blood over a long period of time. Cushing’s syndrome (CS) is a rare problem caused when the adrenal gland (s) makes too much of a hormone called cortisol. CS is most often due to a tumor or mass found in the pituitary gland, but can also be caused by tumors in the adrenal glands themselves. People with Cushing's syndrome may see their face get round ("moon face"), they gain ... Cushing syndrome can cause a range of symptoms. 1,2 The symptoms might also be similar to those of other conditions. 3. Physically, someone with Cushing syndrome might have: Overweight or obesity above the waist but thin arms and legs; A round, red face, sometimes referred to as a moon face; A fat lump between the shoulders, sometimes called a ...Aug 9, 2021 · Cushing syndrome can also be due to endogenous causes; approximately 70% of Cushing syndrome is the result of Cushing disease. Cushing disease occurs when excess adrenocorticotropin hormone (ACTH) production from a benign pituitary tumor (adenoma) causes the adrenal glands to produce excessive amounts of cortisol. The Cushing reflex helps save brain tissues during periods of poor perfusion. Unfortunately, it s a late sign of increasing intracranial pressure and indicates that brainstem herniation is imminent.Cushing syndrome is a disorder that occurs when your body has a higher than normal level of the hormone cortisol. This hormone is made in the adrenal glands. Too much cortisol can be due to various problems. One such problem is a tumor on one of the adrenal glands. Adrenal tumors release cortisol.Dec 8, 2022 · In most cases, Cushing's disease begins as subtle changes in behaviour and appearance. The most obvious sign is the lack of a topline. The hair coat may be thin or coarse, and there may be evidence of delayed shedding. Horses with Cushing's disease are usually lethargic. Their appetite and energy levels decrease. Welcome to Cushing Academy, a private, coed day and boarding high school with a postgraduate option, located an hour from Boston in Ashburnham, Massachusetts.

Cushing ( Meskwaki: Koshineki, [4] Iowa-Oto: Amína P^óp^oye Chína, meaning: "Soft-seat town" [5]) is a city in Payne County, Oklahoma, United States. The population was 7,826 at the time of the 2010 census, a decline of 6.5% since 8,371 in 2000. [6] Cushing was established after the Land Run of 1891 by William "Billy Rae" Little.. Count in lookerandampsauandampved2ahukewiukr_m4ph ahwklgofhfbjdl8qfnoecamqagandampusgaovvaw1ov1hpjdnrh as6mos lnc

Cushing is a city in Nacogdoches County, Texas, United States. The population was 612 at the 2010 census. Geography. Cushing is located at (31.813492, –94.840288 ... Cushing's disease results when the body produces too much of a hormone called cortisol. Cortisol is produced and stored by the adrenals, two small glands that sit on top of the kidneys. Dogs, cats ...Cushing’s disease is a condition in which the body produces too much cortisol. Learn about symptoms and treatment.Nov 9, 2021 · Cushing’s disease is an endocrine disorder of middle-aged and older dogs. It’s the result of the overproduction of cortisol by the adrenal glands located on each kidney. Normally, your dog responds to stress by producing something called ACTH (adrenocorticotropic hormone). Cushing syndrome happens when the body has too much of the hormone cortisol for a long time. This can result from the body making too much cortisol, or from taking medicines called glucocorticoids, which affect the body the same way as cortisol.Cushing's disease is a metabolic disorder caused by long-term exposure to an excess of the hormone cortisol in the body ( stress hormone). This disorder is caused by an excess of adrenocorticotropic hormone released by the pituitary gland. Cushing’s disease is an uncommon variant of Cushing’s syndrome.Cushing’s Triad case: Secondary head injury. It’s a nice winter afternoon (Midwest winter – that is – a balmy 37°F) and a group of teenagers are playing a recreational game of ice hockey ...Cushing’s disease is a condition in which the body produces too much cortisol. Learn about symptoms and treatment.Cushing syndrome is a disorder that occurs when your body has a higher than normal level of the hormone cortisol. This hormone is normally made in the adrenal glands. Exogenous means caused by something outside the body. Exogenous Cushing syndrome occurs when a person takes man-made (synthetic) glucocorticoid medicines to treat a disease.Cushing's disease is one cause of Cushing's syndrome characterised by increased secretion of adrenocorticotropic hormone (ACTH) from the anterior pituitary (secondary hypercortisolism ). This is most often as a result of a pituitary adenoma (specifically pituitary basophilism) or due to excess production of hypothalamus CRH ( corticotropin ...39 School StreetAshburnham, MA 01430. Founded in 1865, Cushing is an independent, college preparatory school for girls and boys in grades 9 through 12 and post-graduate. Cushing Academy exists for students and develops curious, creative, and confident learners and leaders. Our beautiful 162-acre campus is located in Ashburnham, Massachusetts ....

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