Thousands of Kiwi couples will have their baby plans dashed this year as they discover they can’t conceive naturally.
Holding their child and watching them grow up will become a dream out of reach for one in four women who try – unless they choose to get assistance.
Infertility is defined as not conceiving after 12 months of trying.


Research on acupuncture in people with breast cancer and other types of cancer

Research on acupuncture in people with breast cancer and other types of cancer
Much research is being done on how acupuncture can help relieve some of the symptoms of cancer and side effects of cancer treatment. Acupuncture has been shown to help relieve fatigue, hot flashes, nausea, vomiting, and pain.
The most thorough study of acupuncture in breast cancer patients was published in Journal of the American Medical Association in 2000. In the study, 104 women undergoing high-dose chemotherapy were given traditional anti-nausea medication. In addition to taking the medication, the women were randomly chosen to receive 5 days of electroacupuncture (acupuncture in which needles are stimulated with a mild electrical current), acupuncture without an electrical current, or no acupuncture. The women who had acupuncture had significantly fewer nausea episodes than those who didn’t.
Another study, completed at Duke University and published in 2002, compared the use of acupuncture to the use of Zofran (chemical name: ondansetron), an anti-nausea medication, before breast cancer surgery to reduce the nausea that can occur after surgery. The acupuncture treatment was found to work better than Zofran at controlling nausea.
In a French study published in 2003, acupuncture was examined in the treatment of cancer-related pain. Patients treated with acupuncture had a 36% reduction in pain after 2 months of acupuncture treatments, compared with a 2% reduction in pain in the patients receiving a placebo type of acupuncture.
In one very preliminary 2004 study at Memorial Sloan-Kettering Cancer Center, acupuncture was shown to reduce post-chemotherapy fatigue by 31% in people with various types of cancer. In 2005, another preliminary study of breast cancer patients in Sweden showed that acupuncture reduced hot flashes by half. While doctors find these results encouraging, they are still very early results and require further study.

Acupuncture for Back Pain

Nearly 8 out of every 10 people will have low back pain at some point in life. Back pain is one of the top reasons people seek medical treatment. It is also the No. 1 reported reason for seeking acupuncture. The good news is chronic low back pain is one of the conditions that research suggests acupuncture may be an effective tool for treating.
One recent review of 22 acupuncture studies showed that it provided short-term relief from chronic back pain. It also showed there was greater improvement in pain for people who got acupuncture compared to those who received a “sham” treatment. Other studies have found, though, that sham acupuncture can be as effective as actual acupuncture. Those studies also found that, compared to standard treatment, both actual acupuncture and sham acupuncture are more effective.
Guidelines from the American Pain Society and American College of Physicians say doctors should consider acupuncture as an alternative therapy for patients with chronic low-back pain that’s not helped by conventional treatment.
How Acupuncture Appears to Help Back Pain
Acupuncture began in China more than 2,500 years ago. It involves inserting thin needles at certain points on the body. According to traditional Chinese medicine, the body has more than 2,000 of these points. They are connected by pathways or meridians, which create a flow of energy called Qi (pronounced “chee”). Stimulating these points is said to correct the imbalance of qi and improve the flow of energy. Practitioners believe that this helps relieve pain and improve health.

What’s that Ringing? Tinnitus and How TCM Can Help

Have you ever had an inexplicable ringing in your ears, but don’t know why or how to get rid of it? You may have a condition called Tinnitus, and there is a wide array of causes. Exposure to sudden, loud music or explosive noises can cause Tinnitus, a nerve disorder that involves a consistent ringing sound in a person’s ears. At its worse, Tinnitus can lead to deafness. Tinnitus affects one in 10 people, and can range from mild to chronic. While it is a common problem for veterans and the elderly, other common causes include whiplash or even dental work. While it is a difficult phenomenon for Western and East Asian medicine doctors to treat, tinnitus is not incurable.
In Chinese medicine, chronic Tinnitus is believed to be caused by kidney weakness, according to Pacific College of Oriental Medicine Faculty Member Dr. Mohammed Javaherian. Acupuncture is recommended and treatments will focus most likely on the kidney meridians, as well as on points along the liver and gallbladder meridians to help strengthen the root of the problem.
Tinnitus is linked to nerve and touch sensitivity. For some people, clenching one’s jaws or applying pressure to the neck can bring on or reduce tinnitus episodes. Acupuncture patients with this disorder will have a high response rate to the nerve’s natural response to pressure and the disorder’s sensitivity to certain points. The practice of acupuncture is based on the stimulation of certain points on the body, as well as meridians and channels. Stimulating specific points (which are determined based on the patient’s unique case) can rebalance the qi (one’s life force) and alleviate the source of the problem. It is integral in traditional Chinese medicine to treat the origin of an ailment as well as the symptoms, and TCM has several theories as to what causes tinnitus.
For example, in more temporary cases of Tinnitus, high emotional strain or sudden anger can lead to a ringing in the ears. Also, diet can have an effect. Practitioners of TCM believe that excessive greasy foods or irregular eating can lead to Phlegm (a TCM term that commonly refers to a retention in body fluid), which prevents the rising of clear qi to the head (resulting in the “phantom noise” associated with tinnitus). Overworking or excessive physical strain can lead to a nerve disturbance, causing tinnitus. Lastly, trauma is a common cause of the ringing noise associated with this disorder.

What’s that Ringing? Tinnitus and How TCM Can Help

Acupuncture may reduce high blood pressure


Acupuncture may reduce high blood pressure
Published Friday 21 August 2015
By Catharine Paddock PhD

A new study suggests that a form of acupuncture may benefit patients with high blood pressure and lower their risk of stroke and heart disease.

Electroacupuncture is a form of acupuncture that applies low-intensity electrical pulses through needles inserted at specific points on the body.
Image credit: Chris Nugent/UCI
The single-blind trial, conducted at the University of California-Irvine (UCI), is the first scientific confirmation that the ancient Chinese medical technique is beneficial for patients with mild to moderate hypertension.
In the journal Medical Acupuncture, the team describes finding how electroacupuncture can lower blood pressure for up to 6 weeks in patients with hypertension.
Electroacupuncture is a form of acupuncture that applies low-intensity electrical pulses through needles inserted at specific points on the body.
The researchers say their findings suggest that with regular use, electroacupuncture could help people manage their blood pressure and reduce their risk of heart disease and stroke in the longer term.

Senior author John Longhurst, a cardiologist and UCI professor of medicine, says the clinical study comes after nearly 10 years of bench research into the effect of acupuncture on high blood pressure. He adds:
“By using Western scientific rigor to validate an ancient Eastern therapy, we feel we have integrated Chinese and Western medicine and provided a beneficial guideline for treating a disease that affects millions in the US.”
70% of treated patients experienced noticeable drop in blood pressure
According to the Centers for Disease Control and Prevention (CDC), there are about 70 million American adults (29%) with high blood pressure – only about half of whom have the condition under control.
Fast facts about acupuncture
Acupuncture is a traditional Chinese medicine that has been in use for over 3,000 years
It uses thin needles to stimulate one or more out of hundreds of specific points on the body
US regulators approved acupuncture needles for use by licensed practitioners in 1996.
Learn more about acupuncture
High blood pressure costs the US some $46 billion a year. This figure covers health care services, medications and absence from work.

For their study, Prof. Longhurst and colleagues recruited 65 patients with hypertension who were not taking any drugs to treat their condition. Each patient was randomly assigned to one of two groups.
Both groups were treated with electroacupuncture, except that one group (the treatment group) had it applied to both sides of the inner wrists and slightly below each knee (acupoints thought to reduce blood pressure), and the other group had it applied to other acupoints along the forearm and lower leg (the control group).
The trial was a single-blind trial. That means the practitioners giving the treatment knew which patients were in the treatment group and which were in the control group, but the patients did not.
The results showed that 70% of the 33 patients in the treatment group experienced a noticeable drop in blood pressure. On average, the reduction was 6-8 mm/Hg for systolic blood pressure and 4 mm/Hg for diastolic blood pressure.
Systolic (when the heart contracts) is the higher, and diastolic (when the heart rests between beats) is the lower number in blood pressure readings.
The researchers say these improvements persisted for 6 weeks after treatment.

Treatment also followed by other beneficial changes
The treatment group also showed significant drops – 41% on average – in blood concentration of norepinephrine (also called noradrenaline), a hormone that constricts blood vessels and increases blood pressure and blood sugar.
The treatment group also showed a 67% drop in renin – an enzyme released in the kidneys that helps control blood pressure – and a 22% drop in a hormone that regulates electrolytes (aldosterone).
There were no significant blood pressure changes in the 32 patients in the control group.
Prof. Longhurst notes that while the reductions in blood pressure seen in the treatment group were not large – most ranged between 4 mm/Hg and 13 mm/Hg – they were clinically significant and suggest the treatment could be especially useful for people in their 60s and older with high systolic blood pressure. He concludes:

Because electroacupuncture decreases both peak and average systolic blood pressure over 24 hours, this therapy may decrease the risk for stroke, peripheral artery disease, heart failure and myocardial infarction in hypertensive patients.”
Medical News Today also recently learned about a study published in the journal Endocrinology that suggests acupuncture acts in a similar way to psychiatric drugs when used to treat chronic stress. Researchers from Georgetown University Medical Center in Washington, DC, came to this conclusion after running controlled experiments with rats.

Menopause-related hot flashes and night sweats can last for years

Menopause-related hot flashes and night sweats can last for years

How long do hot flashes last? It used to be said that menopause-related hot flashes fade away after six to 24 months. But for many women, hot flashes and night sweats often last seven years and may go on for 11 years or more.
The hormonal roller coaster that comes with the end of a woman’s childbearing years can trigger a range of hot flash symptoms. Up to 80% of women going through menopause experience hot flashes. Hot flashes, also known as vasomotor symptoms, are often described as a sudden sensation of heat in the chest, face, and head followed by flushing, perspiration, and sometimes chills. When a hot flash occurs during sleep, it can be accompanied by a drenching sweat. Such night sweats make it difficult to get a good night’s rest.The estimates of the duration of these symptoms come from the Study of Women’s Health Across the Nation (SWAN), a long-term study of women of different races and ethnicities who are in the menopausal transition. They were published in JAMA Internal Medicine.
“The data from this study confirm what many women already know firsthand. Hot flashes can go on for years and take a toll on a woman’s health and well-being,” says Dr. JoAnn Manson, professor of women’s health at Harvard Medical School and professor of epidemiology at Harvard School of Public Health.
The SWAN researchers found that some women are more likely to deal with long-term hot flashes than others. Women who had their first hot flashes before their menstrual periods ended had hot flashes for an average of nine to 10 years. When hot flashes didn’t start until after the last menstrual period, the average duration was only about three and a half years. But even on the short end of the spectrum, that’s a long time to deal with hot flashes and night sweats.
Women in the SWAN study who experienced hot flashes for a longer time tended to be current or former smokers, overweight, stressed, depressed, or anxious. Ethnicity also played a role. African American women reported the longest duration of hot flashes (averaging more than 11 years), while Japanese and Chinese women had hot flashes for about half that time.
The “reality check” the SWAN study provides on hot flashes should encourage women to seek solutions. If hot flashes and night sweats are really bothering you, don’t put up with them. Talk with your doctor about treatment options.
The most effective hot flashes treatment is estrogen-based hormone therapy, though it comes with several downsides. “While hormone therapy is very effective at relieving hot flashes, longer-term treatment carries an increased risk for breast cancer, and women at older ages have higher risks of stroke, blood clots, and other health problems. So it’s important that women explore a full range of treatment options — especially women likely to have persistent hot flashes,” advises Dr. Manson.
Several non-hormonal medications can also provide r hot flashes treatment and relief from night sweats. These include some types of antidepressants, some drugs commonly prescribed for nerve pain, and some high blood pressure medications. As with any medication, it’s best to opt for the lowest dose that effectively relieves your symptoms, and to take it for the shortest amount of time possible.
For some women, self-help measures can help ease hot flashes. These include deep-breathing exercises when a hot flash starts; dressing in layers; lowering the thermostat; staying away from caffeine, alcohol, hot beverages, and spicy foods; stress reduction techniques like meditation and mindfulness; and doing your best to stay cool in general.

How Acupuncture Can Relieve Pain and Improve Sleep, Digestion and Emotional Well-being

Acupuncture is a 3,000-year-old healing technique of Traditional Chinese Medicine. In 1997, the U.S. National Institutes of Health (NIH) documented and publicized acupuncture’s safety and efficacy for treating a wide range of conditions. Acupuncture is now covered by many insurance policies and is used most broadly to relieve pain.
How does acupuncture work?
Acupuncture improves the body’s functions and promotes the natural self-healing process by stimulating specific anatomic sites–commonly referred to as acupuncture points, or acupoints. The most common method used to stimulate acupoints is the insertion of fine, sterile needles into the skin. Pressure, heat, or electrical stimulation may further enhance the effects. Other acupoint stimulation techniques include: manual massage, moxibustion or heat therapy, cupping, and the application of topical herbal medicines and linaments.
Traditional Chinese Medicine is based on an ancient philosophy that describes the universe, and the body, in terms of two opposing forces: yin and yang. When these forces are in balance, the body is healthy. Energy, called “qi” (pronounced “chee”) flows along specific pathways, called meridians, throughout the body. This constant flow of energy keeps the yin and yang forces balanced. However, if the flow of energy gets blocked, like water getting stuck behind a dam, the disruption can lead to pain, lack of function, or illness. Acupuncture therapy can release blocked qi in the body and stimulate function, evoking the body’s natural healing response through various physiological systems. Modern research has demonstrated acupuncture’s effects on the nervous system, endocrine and immune systems, cardiovascular system, and digestive system. By stimulating the body’s various systems, acupuncture can help to resolve pain, and improve sleep, digestive function, and sense of well-being.

What happens during an acupuncture treatment?
First, your acupuncturist will ask about your health history. Then, he or she will examine your tongue’s shape, color, and coating, feel your pulse, and possibly perform some additional physical examinations depending on your individual health needs. Using these unique assessment tools, the acupuncturist will be able to recommend a proper treatment plan to address your particular condition. To begin the acupuncture treatment, you lay comfortably on a treatment table while precise acupoints are stimulated on various areas of your body. Most people feel no or minimal discomfort as the fine needles are gently placed. The needles are usually retained between five and 30 minutes. During and after treatments, people report that they feel very relaxed.
How many treatments will I need?
The frequency and number of treatments differ from person to person. Some people experience dramatic relief in the first treatment. For complex or long-standing chronic conditions, one to two treatments per week for several months may be recommended. For acute problems, usually fewer visits are required, usually eight to ten visits in total. An individualized treatment plan that includes the expected number of treatments will be discussed during your initial visitWhat conditions are commonly treated by acupuncture?
Hundreds of clinical studies on the benefits of acupuncture show that it successfully treats conditions ranging from musculoskeletal problems (back pain, neck pain, and others) to nausea, migraine headache, anxiety, depression, insomnia, and infertility.

Case-controlled clinical studies have shown that acupuncture has been an effective treatment for the following diseases, symptoms or conditions:
Allergic rhinitis (including hay fever)
Biliary colic
Depression (including depressive neurosis and depression following stroke)
Dysentery, acute bacillary
Dysmenorrhoea, primary
Epigastralgia, acute (in peptic ulcer, acute and chronic gastritis, and gastrospasm)
Facial pain (including craniomandibular disorders)
Hypertension, essential
Hypotension, primary
Induction of labor
Knee pain
Low back pain
Malposition of fetus, correction
Morning sickness
Nausea and vomiting
Neck pain
Pain in dentistry (including dental pain and temporomandibular dysfunction)
Periarthritis of shoulder
Postoperative pain
Renal colic
Rheumatoid arthritis
Tennis elbow
The following diseases, symptoms or conditions have limited but probable evidence to support the therapeutic use of acupuncture:
Abdominal pain (in acute gastroenteritis or due to gastrointestinal spasm)
Acne vulgaris
Alcohol dependence and detoxification
Bell’s palsy
Bronchial asthma
Cancer pain
Cardiac neurosis
Cholecystitis, chronic, with acute exacerbation
Competition stress syndrome
Craniocerebral injury, closed
Diabetes mellitus, non-insulin-dependent
Epidemic haemorrhagic fever
Epistaxis, simple (without generalized or local disease)
Eye pain due to subconjunctival injection
Female infertility
Facial spasm
Female urethral syndrome
Fibromyalgia and fasciitis
Gastrokinetic disturbance
Gouty arthritis
Hepatitis B virus carrier status
Herpes zoster (human (alpha) herpesvirus 3)
InsomniaLabour pain
Lactation, deficiency
Male sexual dysfunction, non-organic
Ménière disease
Neuralgia, post-herpetic
Opium, cocaine and heroin dependence
Pain due to endoscopic examination
Pain in thromboangiitis obliterans
Polycystic ovary syndrome (Stein-Leventhal syndrome)
Post-extubation in children
Postoperative convalescence
Premenstrual syndrome
Prostatitis, chronic
Radicular and pseudoradicular pain syndrome
Raynaud syndrome, primary
Recurrent lower urinary-tract infection
Reflex sympathetic dystrophy
Retention of urine, traumatic
Sialism, drug-induced (excessive salivation)
Sjögren syndrome
Sore throat (including tonsillitis)
Spine pain, acute
Stiff neck
Temporomandibular joint dysfunction
Tietze syndrome
Tobacco dependence.


Acupuncture Reverses Facial Paralysis And Enhances Drug Therapy

Acupuncture is effective for the treatment of facial paralysis and improves patient outcomes for patients taking medications.
Hospital researchers find acupuncture effective for the treatment of facial paralysis. Across multiple hospital investigations, researchers document effective acupuncture protocols that yield significant positive patient outcomes for facial paralysis patients. In addition, acupuncture, infrared therapy, and moxibustion demonstrate the ability to significantly improve positive patient outcome rates for patients taking pharmaceutical medications.

Acupuncture and infrared heat therapy are effective for the treatment of facial paralysis. Researchers from the Third People’s Hospital in Chongqing determined that combining acupuncture and infrared heat therapy with conventional facial paralysis medications improves the rate of positive patient outcomes for the the treatment of this condition. Facial paralysis is a disorder in which the facial muscles are dysfunctional, causing immobility, and it may occur in any age demographic. In the Third People’s Hospital investigation, facial paralysis patients who received supplementary infrared heat therapy and acupuncture reported a 91.67% total treatment effective rate while those in the control group reported a 60.42% total treatment effective rate. The addition of acupuncture and infrared therapy increased the effectiveness by 31.25%.
The study involved 96 patients with facial paralysis. Onset was within 6 days of treatment. Of the 96 patients, there were 46 males and 50 females. Patient ages ranged from 46 to 65 years old. The patients were randomly divided into 2 groups: the treatment group and the control group with 48 patients in each group. The control group was given conventional facial paralysis medications: vitamins, hormones, brain glycosides, carnosine and antiviral drugs. The treatment group underwent acupuncture therapy and infrared heat therapy in addition to receiving the same conventional medications as the control group. The total treatment duration was 2 weeks.
For acupuncture, the principles for the treatment of facial paralysis focused on restoring nerve function via improving local blood circulation, eliminating edema, and reducing facial nerve inflammation. The selection of acupoints for facial paralysis treatment largely involves the Yangming and Taiyang meridians. The acupoints include: Zusanli, Hegu, Fengchi, Yifeng, Taiyang, Jiache, Dicang, Zanzhu, and Xiaguan. The Zusanli and Hegu acupoints improve qi and blood circulation and eliminate excess wind (feng). The Fengchi, Yifeng and Taiyang acupoints eliminate wind (feng) and pernicious influences (Xie). The Jiache, Dicang, Zanzhu and Xiaguan acupoints are selected based on the symptoms presented by the individual patient.
Infrared heat therapy utilizes the red spectrum of visible light, which has photochemical effects including: activating catalase in cell mitochondria, increasing glycogen concentration, strengthening cell metabolism, improving adenosine triphosphate decomposition, and protein generation. These processes culminate in accelerated cell synthesis and regeneration, improved local blood microcirculation to the skin and nerves in the affected area, as well as improved metabolism and overall immunity. The net effect on the afflicted facial region is the reduction of nerve tissue inflammation therapy alleviating paralysis.

Standard acupuncture was administered on these acupoints once daily for 14 consecutive days. Infrared therapy was administered using the Carnation33 high power infrared light therapy device with a 640 nm wavelength (+/- 10 nm). The unit was manufactured by the Shenzhen Universal Gate Science and Technology Co. The affected site of paralysis received infrared heat from a distance of 30 to 35 cm and skin surface temperature was maintained at 40 degrees Celsius, or the highest temperature within the patient’s tolerance zone. The infrared heat therapy therapy was conducted for 20 minutes at a time, 2 times daily, for 14 consecutive days.


Acupuncture Painkilling Relief For Shingles Found

Acupuncture relieves pain due to shingles, reduces the need for painkillers, speeds the healing of herpes zoster lesions, and reduces the incidence of postherpetic neuralgia (PHN). Tianjing University of Traditional Chinese Medicine researchers combined acupuncture with standard drug therapy. Patients receiving both drug therapy and acupuncture in a combined treatment protocol had superior patient outcomes compared with patients using only drug therapy.

Three month follow-up examinations determined that the incident rate of postherpetic neuralgia plummeted to 3.33% in the group receiving acupuncture plus drug therapy. The group receiving only drug therapy had a PHN incident rate of 30%. The addition of acupuncture to the treatment protocol decreased the PHN rate by 26.67%.
The VAS (Visual Analogue Scale) scores in the acupuncture plus drugs group were significantly better. The addition of acupuncture to drug therapy decreased pain levels, patients required less painkillers, and herpetic lesions healed faster. The researchers conclude that the combination of acupuncture plus drug therapy is safe and effective for the treatment of acute herpes zoster (shingles).
The study design was as follows. A total of 78 patients were randomly distributed into a control group and a treatment group, each consisting of 39 cases. The control group received drug therapy. The treatment group received acupuncture plus the same drug therapy administered to the control group. All patients were diagnosed with acute herpes zoster between June 2014 and December 2015.
The statistical breakdown for each randomized group was as follows. The average age in the treatment group was 54.21 (±24.07) years. The average course of disease in the treatment group was 2.46 (±0.84) days. The average age in the control group was 54.72 (±24.16) years. The average course of disease was 2.41 (±0.89) days. There were no significant statistical differences in terms of age, gender, and course of disease relevant to patient outcome measures.
Patients from both groups consumed 0.5 g of oral famciclovir tablets (3 times per day, for 7 consecutive days), as well as 1–2 tablets of oral tramadol (3 times per day, for 10–12 consecutive days). Famciclovir is a guanosine analogue antiviral drug used for the treatment of herpes zoster. Tyring et al. note, “Oral famciclovir . . . is an effective and well-tolerated therapy for herpes zoster that decreases the duration of the disease’s most debilitating complication, postherpetic neuralgia.” Tramadol is an opioid pain reliever used to treat moderate to severe pain. In addition, the patients received a neurotropin injection, once per day, for 10–12 days. Neurotropin is a drug made from inoculated, inflamed rabbit skin that is used for the treatment of neuropathic pain. The treatment group received acupuncture in addition to the aforementioned drug therapy.

Patients receiving acupuncture plus herbs had a significantly faster recovery rate. Eradication of the herpes zoster lesions was faster for patients receiving acupuncture plus herbs than for patients taking acyclovir. Acupuncture plus herbs had a faster effective action for the relief of pain. In addition, the acupuncture plus herbs group had a 17.14% greater total effective rate than the drug therapy group.
The Hubei Medicine College researchers employed the use of a surround acupuncture procedure. Placement of acupuncture needles surrounded the areas of the herpes zoster lesions. The needles were separated from each other by 2 – 5 cm. Jiaji acupoints were added at corresponding levels of lesion presentations. Total needle retention time was 30 minutes per acupuncture session. The herbal formula administered to all patients in the form of a decoction included the following Chinese medicinal herbs。

Research indicates that acupuncture is an effective means of alleviating herpes zoster pain. Acupuncture contributes to faster healing times. The combination therapy of drugs plus acupuncture demonstrates clinically superior patient outcomes to patients receiving only drug therapy. Based on the evidence, patients are best served with an integrated treatment protocol of acupuncture, herbal medicine, and drug therapy.


Acupuncture plus Chinese Herbal Medicine for Irritable Bowel Syndrome with Diarrhea: A Systematic Review and Meta-Analysis

To the best of our knowledge, this is the rst systematic review
and meta-analysis of acupuncture combined with CHM
in treating IBS-D. e results indicate that the combined
method is suggestive of an eective and safe therapy, which
may serve as a promising method to treat IBS-D in practical
application. However, the included studies of this meta-
analysis are associated with poor methodological quality and
heterogeneity in diagnostic and evaluation criteria, as well as
in interventions of acupuncture and CHM; consequently, fur-
ther rigorously designed, multicenter, and large-scale clinical
RCTs are required to overcome the limitations of the current
study and to enhance the strength of evidence.

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