Guest guest Posted June 26, 2005 Report Share Posted June 26, 2005 You might want to familiarize yourselves w/ Marnae Naesers¹s work. She was a classmate of mine who created very successful studies of the effect of acup post CVA. The most important conclusion they reached is that acupuncture is most effective if there is little damage to the PVWA ( peri ventricular white matter) this can be seen and assessed on the SM and SM +1 slice of a CT scan. If there is total scarring to this area then acupuncture will not be effective. I will try to see if she has a web site to refer you to. There research, as I recall was done at the VA hospital in Boston. from personal experience: as in Parkinson's, I have gotten the best results from scalp acupuncture. One case: stroke 4 yrs ago in a young African American. He still smoked. His life goal was to be able to hold a pencil so he could become a draftsman and work for an architect. We created parameters for assessing progress: first he couldn't grasp the pencil. Then for 10 seconds, 30 seconds: 45; 60, 2 minutes and then indefinitely. This was over 15 years ago: I don¹t remember the exact points, but I know I used the motor control area on the scalp. Cara > Hi All, & Steve, > > I have left instructions with my family that, should I be unable to > communicate my wishes in the the aftermath of a serious CVA, stroke > or coma, I am to receive intensive acupuncture therapy in addition to > conventional therapy. > > Steve wrote: >> > ... several studies ... indicated that acupuncture has some efficacy in >> > post-stroke recovery. I saw one study that indicated acupuncture is >> > only helpful for dysphagia, but others that seemed to show improved >> > motor function. I'd suggest you google " post stroke recovery >> > acupuncture " . You'll get a lot of hits on that search. Steve > > Google threw up the following: > > Stroke Rehabilitation Forum: Questions answered by Stuart A. Rubin, > M.D., Board Certified in Pain Management and Physical Medicine and > Rehabilitation: post stroke recovery and acupuncture Forum: The Stroke > Rehabilitation Forum Topic: Stroke Treatment post stroke > recovery and acupuncture: > > Q: Has anyone had any experience using acupuncture in addition to > rehabilitation? My mother's physical therapists see nothing adverse in > trying this to help my mother's impaired right arm. > > A: Acupuncture has not been shown to be helpful to improve motor > function. It has been shown to be helpful for dysphagia. It can also > reduce pain which secondarily can improve function. Good Luck, SR > MD " > > Dr. Rubin is correct that evidence for the value of AP in motor DysFx > after stroke is conflicting; some RTCs and most meta-analyses found > little or no effect. However, other studies found positive effects. > > For example, Dr Rubin wrote on April 11, 2005 but the following > reference will not be published until August 2005: > > Lo YL, Cui SL, Fook-Chong S. Neurosci Lett. 2005 Aug 12;384(1- > 2):145-9. The effect of acupuncture on motor cortex excitability and > plasticity. National Neuroscience Institute, Singapore General Hospital, > Department of NeurologyOutram Road, Singapore 169608, Singapore. > Acupuncture has been used extensively in facilitating motor recovery > after stroke. Its mechanism of action remains uncertain. In this sham- > controlled study, we demonstrate for the first time that acupuncture HAS > A REAL AND ENDURING EFFECT on motor cortex functional changes, > in terms of cortical excitability and output mapping using transcranial > magnetic stimulation. PMID: 15913891 [PubMed - in process] > > Dr. Rubin also may have missed this one: > > Alexander DN, Cen S, Sullivan KJ, Bhavnani G, Ma X, Azen SP. Effects > of acupuncture treatment on poststroke motor recovery and physical > function: a pilot study. Neurorehabil Neural Repair. 2004 > Dec;18(4):259-67. ASAP study group. Daniel Freeman Memorial > Hospital, Inglewood, CA, USA. This pilot study obtained preliminary > data on the effects of acupuncture treatment combined with a standard > inpatient stroke rehabilitation program on poststroke motor recovery and > physical function. Thirty-two patients with acute stroke were recruited > and randomized to 1 of 2 treatment arms: standard rehabilitation > (control group) or a combination of acupuncture and standard > rehabilitation (acupuncture group). Baseline and discharge > assessments were obtained on motor recovery as measured by the > Fugl-Meyer (FM) Assessment and on physical function as measured by > the Functional Independence Measure (FIM). Comparisons were made > between the acupuncture and control group in total FM and FIM as well > as for each subscale of the FM and FIM. No differences between > treatment groups were found in the total FM or the total FIM. However, > statistically significant benefit due to acupuncture was observed for the > FM lower extremity motor function subscale (P = 0.01) and the > tub/shower transfer mobility subscale of the FIM (P = 0.03). Marginally > significant benefit due to acupuncture was noted for the toilet transfer > mobility subscale of the FIM (P = 0.09). The effectiveness of > acupuncture as an adjunct to standard poststroke rehabilitation > programs may be demonstrated when more specific measures of stroke > motor recovery and physical function are used. Publication Types: > Clinical Trial Randomized Controlled Trial PMID: 15537996 [PubMed - > indexed for MEDLINE] > > See also: > > Moon SK, Whang YK, Park SU, Ko CN, Kim YS, Bae HS, Cho KH. > Antispastic effect of electroacupuncture and moxibustion in stroke > patients. Am J Chin Med. 2003;31(3):467-74. Department of > Cardiovascular and Neurologic Diseases, College of Oriental Medicine, > Kyung-Hee University, Seoul, Korea. m919k523 Spasticity > is a frequently observed motor impairment that develops after stroke. > The objective of this study was to evaluate the efficacy of > electroacupuncture (EA) and moxibustion (Mox) on spasticity due to > stroke. The subjects consisted of 35 stroke patients with elbow > spasticity whose mean duration of stroke was 2.97 months. Fifteen > patients were randomized to the EA group, ten to Mox, and ten to > control. Every other day, 30 minutes of electrical stimulation with a > frequency of 50 Hz was given through four needles on the Ch'u-Ch'ih- > San-Li (LI-11-LI-10) and Wai-Kuan-Ho-Ku (TB-5-LI-4) points of the > paretic side. Direct Mox was applied to Ch'u-Ch'ih (LI-11), San-Li (LI- > 10), Wai-Kuan (TB-5) and Ho-Ku (LI-4) points 3 times/day every other > day. The control group was given only the routine acupuncture therapy > for stroke and range of motion (ROM) exercise, which were also applied > to the EA and Mox groups. The efficacy of treatment was measured > before, immediately, 1 hour, 3 hours, 1 day, 5 days, 10 days and 15 > days after the start of treatment using a modified Ashworth scale (MAS). > In the EA group, spasticity was significantly reduced immediately, 1 hour > and 3 hours after treatment (p < 0.05). Reductions were significant on > the 5th day and thereafter (p < 0.05). In the Mox group, there was no > significant change in the MAS scores after the first treatment. In the Mox > and control group, there was no significant change in MAS scores. This > study suggests that EA can temporarily reduce spasticity due to stroke, > and if applied repeatedly it can maintain reduced spasticity. Publication > Types: Clinical Trial Randomized Controlled Trial PMID: 12943177 > [PubMed - indexed for MEDLINE] > > > Wang SJ, Omori N, Li F, Jin G, Hamakawa Y, Sato K, Nagano I, Shoji > M, Abe K. Functional improvement by electro-acupuncture after > transient middle cerebral artery occlusion in rats. Neurol Res. 2003 > Jul;25(5):516-21. Department of Neurology, Graduate School of > Medicine and Dentistry, Okayama University, 2-5-1 Shikatacho, > Okayama 700-8558, Japan. Functional recovery by the application of > electro-acupuncture (EA) on different acupoints was investigated using > a transient middle cerebral artery occlusion (MCAO) model in rat. > Acupoints were Baihui (D20) plus Renzhong (D26) (MCAO + D group), > and Hanyan (G4), Xuanlu (G5), Xuanli (G6), plus Qubin (G7) (MCAP + > G group). Animals with EA treatment showed significant functional > improvements from 12 days after the reperfusion against those without > EA treatment. Among EA treated groups, MCAO + G showed a more > significant recovery than MCAO + D. Infarct volume revealed the > significant reduction in the EA treated groups especially in MCAO + G at > 30 days. Immunohistochemical study showed a remarkable induction of > vascular endothelial growth factor (VEGF) in astrocytes of the peri- > infarct area at 30 days, more in EA treated groups than in groups > treated with MCAO alone. These results suggest that the acupoints > applied in this study are effective for the functional recovery, and an > enhanced expression of VEGF may play a certain role in recovery > process after stroke. PMID: 12866201 [PubMed - indexed for > MEDLINE] > > Sze FK, Wong E, Or KK, Lau J, Woo J. Does acupuncture improve > motor recovery after stroke? A meta-analysis of randomized controlled > trials. Stroke. 2002 Nov;33(11):2604-19. Department of Medicine and > Geriatrics, Shatin Hospital, N.T. Hong Kong. fkhsze > BACKGROUND AND PURPOSE: Acupuncture may be a promising > treatment for poststroke paralysis. We conducted a meta-analysis, > assessing the efficacy of acupuncture with and without stroke > rehabilitation. METHODS: We identified randomized trials comparing > acupuncture with no acupuncture within 6 months of stroke by searching > MEDLINE, CINAHL, EMBASE, Cochrane Library, and Chinese medical > literature databases. Two reviewers independently extracted data on > study characteristics, patient characteristics, and impairment and > disability outcomes. The outcome measures were internationally > recognized or nationally approved. The fixed- and random-effects > models were used to combine effect size and odds ratio across studies. > RESULTS: Fourteen trials with 1213 patients met all the inclusion > criteria. For the comparison of acupuncture with no acupuncture in > addition to stroke rehabilitation, the pooled random-effects estimates of > the change in motor impairment and disability were 0.06 (95% CI, -0.12 > to 0.24) and 0.49 (95% CI, 0.03 to 0.96), respectively, with heterogeneity > in disability measures (P=0.05, chi(2) test). For the comparison of real > with sham acupuncture, the pooled random-effects estimate of the > change in disability was 0.07 (95% CI, -0.34 to 0.48). For the > comparison of acupuncture with no acupuncture without stroke > rehabilitation, the pooled random-effects estimate of the change in > motor impairment was 0.46 (95% CI, -0.20 to 1.12), and the pooled > random-effects odds ratio for disability was 12.5 (95% CI, 4.3 to 36.2), > with no statistically significant heterogeneity (P=0.97 and P=0.12, > respectively, chi(2) test), but the study quality was poor. > CONCLUSIONS: This meta-analysis suggests that with stroke > rehabilitation, acupuncture has no additional effect on motor recovery > but has a small positive effect on disability, which may be due to a true > placebo effect and varied study quality. The efficacy of acupuncture > without stroke rehabilitation remains uncertain, mainly because of the > poor quality of such studies. Publication Types: Meta-Analysis PMID: > 12411650 [PubMed - indexed for MEDLINE] > > Hopwood V & Lewith GT. Does Acupuncture Help Stroke Patients > Become More Independent? Journal of Alternative and Complementary > Medicine Feb 2005, Vol. 11, No. 1: 175-177 Val Hopwood, F.C.S.P., > Ph.D. Complementary Medicine Research Unit, Aldermoor Health > Centre, Southampton, UK. George T. Lewith, D.M., F.R.C.P. > Complementary Medicine Research Unit, Aldermoor Health Centre, > Southampton, UK. This short speculative report describes the outcome > of three studies looking at the effect of acupuncture on stroke recovery > and the subsequent place of residence of the subjects entered. It is not > a systematic review and does not endeavor to provide comprehensive > data on the effect of acupuncture on poststroke recovery. Our > observations demonstrate that patients may be more likely to remain > independent and in their own homes one year post stroke if they receive > acupuncture. This conclusion is supported by our study and two > previous trials. It may be that acupuncture improves poststroke > perception, thereby enhancing independence. > > Pei J, Sun L, Chen R, Zhu T, Qian Y, Yuan D. The effect of electro- > acupuncture on motor function recovery in patients with acute cerebral > infarction: a randomly controlled trial. J Tradit Chin Med. 2001 > Dec;21(4):270-2. Longhua Hospital, Shanghai University of Traditional > , Shanghai 200032. The aim of this study is to > investigate the effect of electro-acupuncture treatment in acute phase of > cerebral infarction on the motor functions. In this randomly controlled > trial, 86 patients were allocated to two groups, the experimental group > given clinical and electro-acupuncture treatments for a period of 4 > weeks, and the control group given clinical treatment plus active and/or > passive functional exercise. The result showed that the level of > impairment and disability in both groups were improvement according to > the Chinese Stroke Scale, Brunnstrom-Fugl-Meyer score, and Barthel > Index throughout the study and 3 months after. The motor functions and > the activities of daily living (ADL) were improved significantly in the > electro-acupuncture group as compared with the control group (P < > 0.05). Also, the results showed greater reduction of neurological deficit > in the electro-acupuncture group than in the control group. > CONCLUSION: Early acupuncture treatment for acute stroke patients > may improve motor functions, and consequently the activities of daily > living. Publication Types: ClinicaTrial Randomized Controlled Trial > PMID: 12014128 [PubMed - indexed for MEDLINE] > > Best regards, > > > Tel: (H): +353-(0) or (M): +353-(0) > > > > > Ireland. > Tel: (W): +353-(0) or (M): +353-(0) > > > > " Man who says it can't be done should not interrupt man doing it " - > Chinese Proverb > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 27, 2005 Report Share Posted June 27, 2005 Hi All, & Steve, I have left instructions with my family that, should I be unable to communicate my wishes in the the aftermath of a serious CVA, stroke or coma, I am to receive intensive acupuncture therapy in addition to conventional therapy. Steve wrote: > ... several studies ... indicated that acupuncture has some efficacy in > post-stroke recovery. I saw one study that indicated acupuncture is > only helpful for dysphagia, but others that seemed to show improved > motor function. I'd suggest you google " post stroke recovery > acupuncture " . You'll get a lot of hits on that search. Steve Google threw up the following: Stroke Rehabilitation Forum: Questions answered by Stuart A. Rubin, M.D., Board Certified in Pain Management and Physical Medicine and Rehabilitation: post stroke recovery and acupuncture Forum: The Stroke Rehabilitation Forum Topic: Stroke Treatment post stroke recovery and acupuncture: Q: Has anyone had any experience using acupuncture in addition to rehabilitation? My mother's physical therapists see nothing adverse in trying this to help my mother's impaired right arm. A: Acupuncture has not been shown to be helpful to improve motor function. It has been shown to be helpful for dysphagia. It can also reduce pain which secondarily can improve function. Good Luck, SR MD " Dr. Rubin is correct that evidence for the value of AP in motor DysFx after stroke is conflicting; some RTCs and most meta-analyses found little or no effect. However, other studies found positive effects. For example, Dr Rubin wrote on April 11, 2005 but the following reference will not be published until August 2005: Lo YL, Cui SL, Fook-Chong S. Neurosci Lett. 2005 Aug 12;384(1- 2):145-9. The effect of acupuncture on motor cortex excitability and plasticity. National Neuroscience Institute, Singapore General Hospital, Department of NeurologyOutram Road, Singapore 169608, Singapore. Acupuncture has been used extensively in facilitating motor recovery after stroke. Its mechanism of action remains uncertain. In this sham- controlled study, we demonstrate for the first time that acupuncture HAS A REAL AND ENDURING EFFECT on motor cortex functional changes, in terms of cortical excitability and output mapping using transcranial magnetic stimulation. PMID: 15913891 [PubMed - in process] Dr. Rubin also may have missed this one: Alexander DN, Cen S, Sullivan KJ, Bhavnani G, Ma X, Azen SP. Effects of acupuncture treatment on poststroke motor recovery and physical function: a pilot study. Neurorehabil Neural Repair. 2004 Dec;18(4):259-67. ASAP study group. Daniel Freeman Memorial Hospital, Inglewood, CA, USA. This pilot study obtained preliminary data on the effects of acupuncture treatment combined with a standard inpatient stroke rehabilitation program on poststroke motor recovery and physical function. Thirty-two patients with acute stroke were recruited and randomized to 1 of 2 treatment arms: standard rehabilitation (control group) or a combination of acupuncture and standard rehabilitation (acupuncture group). Baseline and discharge assessments were obtained on motor recovery as measured by the Fugl-Meyer (FM) Assessment and on physical function as measured by the Functional Independence Measure (FIM). Comparisons were made between the acupuncture and control group in total FM and FIM as well as for each subscale of the FM and FIM. No differences between treatment groups were found in the total FM or the total FIM. However, statistically significant benefit due to acupuncture was observed for the FM lower extremity motor function subscale (P = 0.01) and the tub/shower transfer mobility subscale of the FIM (P = 0.03). Marginally significant benefit due to acupuncture was noted for the toilet transfer mobility subscale of the FIM (P = 0.09). The effectiveness of acupuncture as an adjunct to standard poststroke rehabilitation programs may be demonstrated when more specific measures of stroke motor recovery and physical function are used. Publication Types: Clinical Trial Randomized Controlled Trial PMID: 15537996 [PubMed - indexed for MEDLINE] See also: Moon SK, Whang YK, Park SU, Ko CN, Kim YS, Bae HS, Cho KH. Antispastic effect of electroacupuncture and moxibustion in stroke patients. Am J Chin Med. 2003;31(3):467-74. Department of Cardiovascular and Neurologic Diseases, College of Oriental Medicine, Kyung-Hee University, Seoul, Korea. m919k523 Spasticity is a frequently observed motor impairment that develops after stroke. The objective of this study was to evaluate the efficacy of electroacupuncture (EA) and moxibustion (Mox) on spasticity due to stroke. The subjects consisted of 35 stroke patients with elbow spasticity whose mean duration of stroke was 2.97 months. Fifteen patients were randomized to the EA group, ten to Mox, and ten to control. Every other day, 30 minutes of electrical stimulation with a frequency of 50 Hz was given through four needles on the Ch'u-Ch'ih- San-Li (LI-11-LI-10) and Wai-Kuan-Ho-Ku (TB-5-LI-4) points of the paretic side. Direct Mox was applied to Ch'u-Ch'ih (LI-11), San-Li (LI- 10), Wai-Kuan (TB-5) and Ho-Ku (LI-4) points 3 times/day every other day. The control group was given only the routine acupuncture therapy for stroke and range of motion (ROM) exercise, which were also applied to the EA and Mox groups. The efficacy of treatment was measured before, immediately, 1 hour, 3 hours, 1 day, 5 days, 10 days and 15 days after the start of treatment using a modified Ashworth scale (MAS). In the EA group, spasticity was significantly reduced immediately, 1 hour and 3 hours after treatment (p < 0.05). Reductions were significant on the 5th day and thereafter (p < 0.05). In the Mox group, there was no significant change in the MAS scores after the first treatment. In the Mox and control group, there was no significant change in MAS scores. This study suggests that EA can temporarily reduce spasticity due to stroke, and if applied repeatedly it can maintain reduced spasticity. Publication Types: Clinical Trial Randomized Controlled Trial PMID: 12943177 [PubMed - indexed for MEDLINE] Wang SJ, Omori N, Li F, Jin G, Hamakawa Y, Sato K, Nagano I, Shoji M, Abe K. Functional improvement by electro-acupuncture after transient middle cerebral artery occlusion in rats. Neurol Res. 2003 Jul;25(5):516-21. Department of Neurology, Graduate School of Medicine and Dentistry, Okayama University, 2-5-1 Shikatacho, Okayama 700-8558, Japan. Functional recovery by the application of electro-acupuncture (EA) on different acupoints was investigated using a transient middle cerebral artery occlusion (MCAO) model in rat. Acupoints were Baihui (D20) plus Renzhong (D26) (MCAO + D group), and Hanyan (G4), Xuanlu (G5), Xuanli (G6), plus Qubin (G7) (MCAP + G group). Animals with EA treatment showed significant functional improvements from 12 days after the reperfusion against those without EA treatment. Among EA treated groups, MCAO + G showed a more significant recovery than MCAO + D. Infarct volume revealed the significant reduction in the EA treated groups especially in MCAO + G at 30 days. Immunohistochemical study showed a remarkable induction of vascular endothelial growth factor (VEGF) in astrocytes of the peri- infarct area at 30 days, more in EA treated groups than in groups treated with MCAO alone. These results suggest that the acupoints applied in this study are effective for the functional recovery, and an enhanced expression of VEGF may play a certain role in recovery process after stroke. PMID: 12866201 [PubMed - indexed for MEDLINE] Sze FK, Wong E, Or KK, Lau J, Woo J. Does acupuncture improve motor recovery after stroke? A meta-analysis of randomized controlled trials. Stroke. 2002 Nov;33(11):2604-19. Department of Medicine and Geriatrics, Shatin Hospital, N.T. Hong Kong. fkhsze BACKGROUND AND PURPOSE: Acupuncture may be a promising treatment for poststroke paralysis. We conducted a meta-analysis, assessing the efficacy of acupuncture with and without stroke rehabilitation. METHODS: We identified randomized trials comparing acupuncture with no acupuncture within 6 months of stroke by searching MEDLINE, CINAHL, EMBASE, Cochrane Library, and Chinese medical literature databases. Two reviewers independently extracted data on study characteristics, patient characteristics, and impairment and disability outcomes. The outcome measures were internationally recognized or nationally approved. The fixed- and random-effects models were used to combine effect size and odds ratio across studies. RESULTS: Fourteen trials with 1213 patients met all the inclusion criteria. For the comparison of acupuncture with no acupuncture in addition to stroke rehabilitation, the pooled random-effects estimates of the change in motor impairment and disability were 0.06 (95% CI, -0.12 to 0.24) and 0.49 (95% CI, 0.03 to 0.96), respectively, with heterogeneity in disability measures (P=0.05, chi(2) test). For the comparison of real with sham acupuncture, the pooled random-effects estimate of the change in disability was 0.07 (95% CI, -0.34 to 0.48). For the comparison of acupuncture with no acupuncture without stroke rehabilitation, the pooled random-effects estimate of the change in motor impairment was 0.46 (95% CI, -0.20 to 1.12), and the pooled random-effects odds ratio for disability was 12.5 (95% CI, 4.3 to 36.2), with no statistically significant heterogeneity (P=0.97 and P=0.12, respectively, chi(2) test), but the study quality was poor. CONCLUSIONS: This meta-analysis suggests that with stroke rehabilitation, acupuncture has no additional effect on motor recovery but has a small positive effect on disability, which may be due to a true placebo effect and varied study quality. The efficacy of acupuncture without stroke rehabilitation remains uncertain, mainly because of the poor quality of such studies. Publication Types: Meta-Analysis PMID: 12411650 [PubMed - indexed for MEDLINE] Hopwood V & Lewith GT. Does Acupuncture Help Stroke Patients Become More Independent? Journal of Alternative and Complementary Medicine Feb 2005, Vol. 11, No. 1: 175-177 Val Hopwood, F.C.S.P., Ph.D. Complementary Medicine Research Unit, Aldermoor Health Centre, Southampton, UK. George T. Lewith, D.M., F.R.C.P. Complementary Medicine Research Unit, Aldermoor Health Centre, Southampton, UK. This short speculative report describes the outcome of three studies looking at the effect of acupuncture on stroke recovery and the subsequent place of residence of the subjects entered. It is not a systematic review and does not endeavor to provide comprehensive data on the effect of acupuncture on poststroke recovery. Our observations demonstrate that patients may be more likely to remain independent and in their own homes one year post stroke if they receive acupuncture. This conclusion is supported by our study and two previous trials. It may be that acupuncture improves poststroke perception, thereby enhancing independence. Pei J, Sun L, Chen R, Zhu T, Qian Y, Yuan D. The effect of electro- acupuncture on motor function recovery in patients with acute cerebral infarction: a randomly controlled trial. J Tradit Chin Med. 2001 Dec;21(4):270-2. Longhua Hospital, Shanghai University of Traditional , Shanghai 200032. The aim of this study is to investigate the effect of electro-acupuncture treatment in acute phase of cerebral infarction on the motor functions. In this randomly controlled trial, 86 patients were allocated to two groups, the experimental group given clinical and electro-acupuncture treatments for a period of 4 weeks, and the control group given clinical treatment plus active and/or passive functional exercise. The result showed that the level of impairment and disability in both groups were improvement according to the Chinese Stroke Scale, Brunnstrom-Fugl-Meyer score, and Barthel Index throughout the study and 3 months after. The motor functions and the activities of daily living (ADL) were improved significantly in the electro-acupuncture group as compared with the control group (P < 0.05). Also, the results showed greater reduction of neurological deficit in the electro-acupuncture group than in the control group. CONCLUSION: Early acupuncture treatment for acute stroke patients may improve motor functions, and consequently the activities of daily living. Publication Types: ClinicaTrial Randomized Controlled Trial PMID: 12014128 [PubMed - indexed for MEDLINE] Best regards, Tel: (H): +353-(0) or (M): +353-(0) Ireland. Tel: (W): +353-(0) or (M): +353-(0) " Man who says it can't be done should not interrupt man doing it " - Chinese Proverb Quote Link to comment Share on other sites More sharing options...
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