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Archive for the ‘Acupuncture in USA’ Category

Reporting Error Revealed in Knee Pain Acupuncture Study, Catastrophe Avoided

June 2016 | by Jonathan Gilbert

http://thegilbertclinic.com/reporting-error-revealed-in-knee-pain-acupuncture-study

On October 1st, 2014, the prestigious Journal of the American Medical Association (JAMA) published a study entitled “Acupuncture for Chronic Knee Pain: A Randomized Clinical Trial”[1]. It was a major study whose results stated that neither acupuncture nor laser acupuncture was useful to patients aged 50 and older with moderate-to-severe knee pain. Enter Dr. Arthur Fan…

In March of 2016 Dr. Fan and associates published a reevaluation of this study. It found serious flaws in its methodology and analysis. Not only that, but when properly evaluated, it appears that the study actually showed significant improvement in patients undergoing acupuncture and laser acupuncture in the clinical trial.

Dr. Fan is a consultant and long term researcher in Traditional Chinese Medicine who has been published in many of the world’s foremost medical journals. He has received numerous awards and commendations including a letter of thanks from the President himself. And thanks to him a grave reporting error was averted and an catastrophe avoided.

What is of interest to this writer is how such a mistake could have been made by one of the most respected, peer reviewed, medical publications in the world? I leave that, along with the link to Dr. Fan’s paper, “Acupuncture is Effective for Chronic Knee Pain: A Reanalysis of the Australian Acupuncture Trial”[2] to your discerning minds. Be well. ♥

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46 reviews of McLean Center for Complementary and Alternative Medicine, about Dr.Arthur Yin Fan, from http://www.bookfresh.com
Simply Amazing
3/2/2016
Deborah L. says: Dr. Fan is simply amazing. Regular PT failed my daughter and both. Dr. Fan far exceeded expectations. Love the atmosphere in the office
Thankful
12/30/2015
Kay S. says: Dr Fan is a super amazing Acupuncturist.. His Chinese Herbs have helped to save my life.. Dr Fan’s acupuncture opened up my meridian to the point where I even got pregnant. I had a healthy baby girl. Dr Arthur Fan knows exactly what he is doing when it comes to treating his patients with Acupuncture . He not only listens , but he treats his patients according to their diagnosis w his super excellent Chinese Herbs💗
PERFECT
11/28/2015
Gwen D. says: Dr. Fan is wonderful. He listens and is very patient and understanding of your issues. I highly recommend him.
Amazing
10/19/2015
Abdou Y. says: I have just started a treatment for a knee pain that has been threatening my ability to work out. Just after 2 visits to Dr. Fan’s center, I can only say that I feel way better than before as I don’t feel anymore about 70% of the pain. I can’t wait for the next sessions as I now hope for a complete healing. I was skeptical at first since I was stranger to acupuncture but not I can say it works.
Excellent
9/1/2015
Lynn D. says: I saw Dr. Fan yesterday for the first time and already feel like I have some improvement in my mood and stress level. Wonderful.
Doctor who cares
8/26/2015
Kasandra M. says: I just started seeing Dr Fan and I appreciate that he is looking at finding the cause of medical issues rather than masking symptoms. I have seen countless doctors and this one finally gives me hope. I have started feeling some relief with my various conditions and I know I have a long road ahead but Dr Fan is very kind, explains things and really targets where the issues are. I am so happy to have found him.
Great insight
7/24/2015
Barbara B. says: Dr. Fan listens more than most conventional doctors and is more attuned with what is going on with your health. His treatments are specialized and individualized to you. He has addressed specific concerns ranging from back discomfort, swollen joints, headaches, and colds, to helping to guide you to an overall sense of quiet and calm. Regardless of what ails you, a cupping session is a must.
Dr Fan Is Amazing
7/3/2015
Yuuna K. says: Dr. Fan is an outstanding doctor. He is trained in both western medicine as well as Chinese traditional medicine. He brings years of experience practicing both disciplines. He is amazing with acupuncture, diagnosis, and treatment suggestions. My body responded very positively to his acupuncture treatment. I would recommend him to other patients considering Chinese Traditional Medicine.
Post-Stroke Dystonia
6/9/2015
Sameer Y. says: I have an odd condition, and Dr. Fan is handling it with patience and success.
Excellent Doctor
4/7/2015
Robin S. says: I am fortunate to have found Dr. Fan who has helped me with a variety of issues: poison ivy, arthritis and allergies among them. His medical expertise is evident as he explains what is happening in the body and how acupuncture can support healing. His knowledge is balanced with kindness and compassion supported by an office environment that provides positive energy. I highly recommend Dr. Fan, particularly if other approaches to a problem have not brought relief.
Incredible!
4/6/2015
Eileen W. says: I was diagnosed with dystonia which affects my neck movement ability. Specialists such as neurologists, rehabilitation doctors suggest Botox injections which has side affect and not a long term solution. I had acupuncture in nearby NYC area and not much improvement. I found Dr. Fan and had great improvement under his treatment. And Dr. Fan is extremely kind and patient. Many thanks to Dr. Fan! Eileen
Very Helpful
4/6/2015
Gwen D. says: Dr. Fan amazes me with his ability to help me with multiple things. I have seen him in the past on other issues, and he has helped me greatly. I tend to be very stressed out and when I am with Dr. Fan, I feel my anxiety level drop. He is kind, understanding and extremely knowledgeable. Dr. Fan his assistant, Sarah, are excellent.
Very astute in diagnosis and treatment
2/8/2015
Scott B. says: I daresay, Dr. Fan has added years to my life. Very early in my chronic lymphocytic leukemia Dr. Fan intervened with a combination of herbs and acupuncture that has kept my cell counts stabilized since 2009–and at a juncture where it is too early for western medicine to intervene. From my vantage, Dr. Fan is most astute for both his skills of diagnosis and week-by-week treatment. Incidentally, for anyone with an interest, I recommend the book “Between Heaven and Earth: A Guide to Chinese Medicine,” by Beinfield and Korngold.
Magical Doctor
1/23/2015
Deborah L. says: I have been going to Dr. Fan now for years when I have a medical issue I’m confident he can treat. When I experienced back issues years ago, I saw a orthopedic doctor, tried a chiropractor, physical therapy and pain medication. It was then I decided to give acupuncture a try. How fortunate that I found Dr. Fan. A very informed physician who was gentle and caring. After only a few treatments which included cupping, I was cured. To this day years later, I have not had any back issues. He is now treating me for acid reflux. I so recommend his treatment – just amazing.
Alternative medicine treatment for hypertension,insomnia and others
11/26/2014
May T. says: Dr Fan treated my hypertension and a myriad of other aches and pains. His knowledge of western and Chinese medicine blends a wholistic approach in his treatment. He is patient and gentle as a doctor. Determined to avoid getting on medication to treat hypertension, I started a diet and exercise regime but only to limited results. Only after I began accupuncture did my blood pressure begin to normalize. My husband also sees him for insomnia which has helped.
Dr. Fan has done wonders!
11/2/2014
Al P. says: Dr. Fan has done wonders for both my wife and me. My wife had lingering multiple small blood clots in her lower leg area. Her vascular surgeon had told she needed to be on blood thinners for the rest of her life. Plus, she would have to wait for the clots to reobsorb back into her blood. Inside two weeks of treatment from Dr. Fan, the clots were gone. After my knee replacement the swelling was not going down. I was told that at my age it would take a much longer time frame. Three weeks of visits to Dr. Fan the swelling was completely reversed. We both whole heartedly recommend Dr. Fan.
Larry A
9/12/2014
Larry A. says: I believe I am very fortunate to have found Dr. Fan. I could not be happier and I am a severe critic, so I believe Dr. Fan is tops. Dr. Fan took his time to explain the procedures before they happened and made sure I understood the message he was telling me. Thank you Dr. Fan
Feeling much better
9/4/2014
Phannee W. says: Having been a patient of Dr. Fan for a while, I am very grateful that he has cured most of my ailments and I would highly recommend him to other patients for acupuncture treatment..
Great Service and Very good doctor
9/2/2014
Maryam Z. says: I have really bad leg pain and I went to see Dr. Fan and explained him my situation. He took great interest in my leg pain and overall health issues and gave me a treatment plan which will help me to deal with my pain until its treated completely. He was not interested in money aspect of my treatment but was more keen to find a cure for my leg pain. I am very happy with his treatment strategy and after 3 sessions, I already to start feeling better.
Great!
8/13/2014
Gwen D. says: Dr. Fan is a wonderful doctor. He is interested in his patients, listens carefully to your issue, and proceeds with the treatment. I have seen Dr. Fan before and he was concerned about the symptoms I had experienced previously; making sure that was cleared up. His assistant is also very committed to the patients and practice. The office has a lovely peaceful aura, I felt good just walking in.
Good oriental medicine and doctor
7/23/2014
Eric T. says: I had went to see Dr. Fan because of pain and numbness in my hands, elbow, and wrist. The doctor at urgent care could not do anything but give my anti-inflammatory. But after seeing Dr. Fan and being treated with acupuncture and medicine he gave me, the symptoms have lighted and is decreasing daily. I would recommend that people with issues that most western medical doctors cannot treat to at least pay Dr. Fan a visit to see if anything can be done.
Five Star
4/27/2014
Al P. says: Both my wife and I have been seeing Dr. Fan for almost a year. He has been able to allow me to delay a total knee replacement for almost a year. And I am certain he will allow me to delay the operation until I am in a better position to have the operation on my terms. He also, in one treatment cleared my Carole tunnel node that was sticking out over an inch and stop the pain entirely. Dr. Fan has saved me from a repetitive operation on my wrist.
Professional and curteous
4/25/2014
Dr. Jerome W. says: Just started, so far everything is fine. I will have more to say when I an further into my treatment.
Made huge difference!
4/23/2014
Takeo Y. says: I had a great experience with Dr. Fan. Aggravated shoulder pain due to lifting heavy stuff on top of the old pain I had been suffering for a while was removed mostly after 3 sessions of acupuncture and cuppings. Will definitely go back to seek for his treatment if the needs arises.
Excited to finally experience alternative medicine
4/22/2014
Carmela & Brent B. says: For me and my husband, it was all positive energy and results. I can’t wait to complete the recommended treatment (2 times a week for 4 weeks), I know Dr. Fan will make a difference! My husband was satisfied after his first time treatment yesterday (4/21/14). After his 40 mins session, he felt like he slept for days and no pain all day.
Always awesome
2/7/2014
Diane H. says: Dr. Fan is wonderful. He has helped me overcome a paralyzed leg (skiing accident), increased the mobility of a surgically repaired shoulder, relieved migraines, and relieved vertigo induced by a concussion. He’s amazing!
Highly recommended!
1/16/2014
Meschelle L. says: I have been seeing Dr. Fan regularly for about 8 months. Acupuncture and Chinese herbs were new to me and I have greatly appreciated Dr. Fan’s knowledge, skills, and approach/demeanor. He and his office team are highly professional and organized as well. Dr. Fan has helped me tremendously with both benzodiazepine withdrawal and rheumatoid arthritis. I plan to make acupuncture and Chinese herbs a regular accompaniment to my healthcare from now on.
Outstanding
12/19/2013
Caron D. says: Dr. Fan has been successfully treating me for something western medicine hasn’t been able to achieve. He is very knowledgable, gentle, thorough and runs a very sanitary and organized office. I highly recommend Dr. Fan.
Outstanding !!!!
10/20/2013
Phil S. says: My wife and I have been going to Dr. Fan for years off and on for various treatments, proof is in the treatment when the pain associated with the condition, goes away. Dr. Fan is extremely helpful and knowledgeable about how to treat a problem. Very compassionate and takes the time to explain the his treatment plan.
Great Experience
10/19/2013
Gwen D. says: This was my first visit, I too was impressed with Dr. Fan’s compassion, understanding and patience with me. Both Dr. Fan and his assistant were wonderful. I am so glad that my friend recommended him.
The best doctor of Chinese medicine in the DC areas
10/9/2013
Jane C. says: I had shingles and the pain was awful. After a brief antivirus treatment my primary doctor at Kaiser Permanente could only give me strong pain killers (generic Percocet) to dull the pain. I was warned that the pain could last for months. So I turned to Dr. Fan for help. Within a week, my pain was gone under Dr. Fan’s care. I am very grateful to Dr. Fan!
Professional and attentive
9/25/2013
Dianna P. says: I have seen Dr. Fan only once so far, but can report that my experience was very good. I had acupuncture and felt better afterwards. I will continue to see him as I believe in the holistic approach to staying well.
More than accupuncture…
9/3/2013
Bill S. says: I have been seeing Dr. Fan for amost 2 years. The accupuncture has helped in so many ways. But, Dr. Fan will talk to you and get to know you. He has recommended teas, herbs and lifestyle changes that have been so benefitial to me. He is a wonderful wholistic healer. WRS
Chinese Medicine works
7/21/2013
Ruth B. says: Dr. Fan’s thoughtful analysis of our conditions each week help us with everything from swollen ankles to allergies to getting greater function in a hip replacement area to blood abnormalities. He and his office staff are pleasant, welcoming, and reassuring.
Dr. Fan is the best!
6/8/2013
Karen D. says: I feel very fortunate to have met Dr. Fan; he is very knowledgeable and skilled in his art. I sought Dr. Fan’s care for what a previous doctor diagnosed as facial nerve damage. Dr. Fan assessed the situation as chronic inflammation, and I have had a remarkable reversal. I couldn’t be more pleased with my transformation, and I highly recommend Dr. Fan. His staff is awesome too; thank you so much, Dr. Fan!
A Real Treasure
4/17/2013
George L. says: I have been a patient of Dr. Fan’s for some time now, and consider him to be a real treasure. Based on the effectiveness of his treatment, he is obviously a master acupuncturist and herbalist. He takes care to explain the nature of the treatment and to answer any questions related to it. I can wholeheartedly recommend Dr. Fan to anyone interested in acupuncture.
Great, compassionate doctor
3/30/2013
Anastasia C. says: Dr. Fan understood my problem and approached it with the utmost care. I’m very appreciative of the wonderful experience being his patient has been.
Mike B says:
3/5/2013
Michael B. says: I have seen Dr. Fan but one time, received accupuncture and something new to me, cupping. The cupping seems to have made my lower back pain, that I have been experiencing 24/7 for about four months, disappear. I have no fantasies about this being a forever thing, but I am optimistic that future visits will have nothing but positive effects on the many trouble spots of my body. Thank you Dr, Fan!
Keeps me balanced
3/1/2013
Jan Y. says: Dr. Fan keeps me balanced and when I have congestion he opens up my sinuses. Doesn’t matter what I go in for, he always seems to have a solution.
Great Dr of alternative medicine
12/22/2012
Sarah T. says: Sarah T. says: Dr Fan is very professional and extreamly knowledgeable about alternative and conventional medicine. He takes time to fully interview me each time I see him, regarding my symptoms and progress. Dr Fan fully understands herbal medicines and I trust his recommendations. I am seeing some success for my balance issues and expect to see additional progress. Thank you Dr Fan.
Thank You Dr. Fan !!
12/3/2012
William S. says: Both I and my wife have been seeing Dr. Fan for most of 2012. We are thoroughly satisfied with Dr. Fan’s kindness, awareness and manner in which he works with us. We could not think of a better environment in which to receive this kind of help. I have recommended Dr. Fan to others and, they are very well satisfied as well. Thank you Dr. Fan!!!
Richard & Arlene
10/16/2012
Arlene R. says: Dr. Fan was recommended to us and my husband went first. Richard came home relieved of his pain so he than he took me in to see Dr. Fan. I been having back and hip pain for 20 years and now after 3 sessions I can sleep on my right hip with no pain. The best customer service to both of us, he gives us great advice on health care. I don’t know why I waited so long to see him!! I highly recommend Dr. Fan and my husband and I always feel very relaxed while getting our treatment together and we love the music that just soothes our whole being!!!
Great !
5/29/2012
Bill S. says: WRS – I am a new patient. I have seen Dr. Fan twice. My initial evaluation was very informative. Dr. Fan discussed alternatives and diet. My first few days were much better. On the second visit, I was complaining of back pain. When I wakled to my car after the accupuncture treatment I realized… “hey!! no more pain!!”. I recommend McLean Center for Complementary & Alternative Medicine and Dr. Yin Fan.
THE BEST DOCTOR IN ALEXANDRIA
4/17/2012
Simara C. says: I have severe back pain and I have to say that everytime I come to see Dr. Fan, he really takes care of me and makes the pain go away. I usually get spasms where sometimes I can’t even move and/or walk straight. He is always concerned, he gives very good advice and is extremely skilled and helpful. His technique is amazing and I never feel whenever he puts the needles in. The cupping is also amazing- which most of the time are done by his great assisstant, April. Dr. Fan along with April give the best customer service and the best treatment. His office is very pleasant, always clean and organized and I always feel very relaxed while I’m getting my treatment with the chinese music he has in every patient room. I feel very lucky to be his patient and I plan to keep going to him as long as I need to.
Wonderful!
3/19/2012
Susan G. says: I am very happy to have found Dr. Fan over a year ago. He is very patient, gentle and understanding and uses his knowledge to help with various issues, like neck and back pain. His assistant is also kind and skilled.
Sarah & Scott
2/8/2012
Sarah L. says: I was very impressed at Dr. Fan’s level of organization and ability to handle multiple clients. He conducted a thorough interview of both my husband and myself and provided treatment. Dr. Fan was very knowledgeable and the things he suggested made sense. He and his assistant are very compassionate and thoughtful individuals and we feel fortunate to have found him.

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|http://blogs.poz.com/mikebarr/2014/12/bmj_editors_hit_and.html
BMJ Editors Hit–and Hit Hard–Over Careless Interpretation of Acupuncture for Chronic Knee Pain Study (JAMA 10/1/2014)

Let’s start with the conclusion, lest I lose you between here and the end.

Acupuncture is more likely to provide relief for chronic knee pain due to osteoarthritisthan any other modality. Pooled studies (a meta analysis) that compared physical interventions for chronic knee pain showed the following “effect sizes:”

(Electro-) Acupuncture: ES of 0.89
Warm baths: ES 0.65
Exercise: ES 0.55

To put this in perspective, the “Minimum Clinically Important Difference” or minimally significant Effect Size, according to patients suffering from chronic knee pain, is 0.39. And the Effect Size threshold the UK’s National Institute for Health and Care Excellence (NICE) uses to determine reimbursement is 0.50.

Call them acupuncture activists. And really brainy ones.

When an Australian group published (in October 1st JAMA) an impressively large (N=282, but there were 4 groups) clinical trial of 12 weeks of acupuncture for chronic (moderate to severe) knee pain in persons 50 years and older, they concluded no difference between the sham control and actual acupuncture. Editors of the premier acupuncture journal in the world (the BMJ group’s Acupuncture In Medicine), however, cried foul. And lamented the lost opportunity to help millions of chronic knee pain suffers. There were determined to set the record straight.

Their protest and clarification letter to JAMA was summarily rejected.

But guess what? They just happen to have their own journal. (Take that, AMA.) And not one of the enumerable, embarrassing American titles. As noted above, we’re talking The British Medical Journal (Even if the quality of the studies AIM publishes sometimes causes a cringe here and there, the White and his staff are doing the best with what they have to work with.) And so AIM editor and British Medical Acupuncture Society chief Mike Cummings proceeded to publish their quibbles today for inclusion, I imagine, in the January 2015 print edition, and set about to educate folks about how to consider clinically relevant results.

For expediency’s sake, I will extract the key arguments from their brilliantly prepared letter today. Then over the next week or so I will work on paraphrasing and whittling it down.

1. BACKGROUND OF THE CLINICAL PROBLEM. Patients with OA knee pain are suffering the commonest cause of pain and disability in older people. More than half have inadequate pain relief.2 They face a choice between ineffective paracetamol, non-steroidal drugs that can harm the heart, (kidneys) and gastrointestinal tract, gels that scarcely work, physiotherapy, opioids that cause dependency and lose effectiveness, arthroscopic washouts that do nothing or surgery.3 They deserve a fuller, more considered answer to their question: “Is it worth trying acupuncture?”

2. NIFTY DESIGN OF TRIAL. The neat part of the Zelen design that Hinman et al used was that the control group, who were not given acupuncture, were not even aware that their pain scores were used in a trial of acupuncture so disappointment could not influence their scores, as was claimed for other studies. This ‘no acupuncture’ group was compared with acupuncture (manual) and with sham laser (and with real laser, which is not considered here, to keep things simple).

3. WHERE THE ANALYSIS BEGINS TO STUMBLE. The problems started with the trialists’ choice of the threshold minimum clinically important difference (MCID) to estimate sample size. They chose a value based on one chosen by six self-styled ‘expert’ physicians,4 namely a 35% fall in baseline pain score (1.8/sample mean baseline 5.1). This is equivalent to an effect size (ES) of 0.6, calculated using their assumed baseline SD of 30 (the actual SD was 21, giving a higher threshold ES of 0.86). A different figure for MCID was generated by 192 patients with OA, who registered improvement scores as well as changes in pain.5 This showed a more modest MCID, equivalent to an ES of 0.39 (shown in figure 1). The National Institute for Health and Care Excellence (NICE) did not regard any value for MCID as valid6 and chose a generic value of 0.5 (see figure 1). Hinman et al chose a high threshold and also failed to discuss the effect that alternative threshold MCID values would have on the interpretation of their findings. We also note that the MCID for any treatment should be chosen to take account of acceptability, safety and cost-effectiveness,7 which would argue for a lower threshold for acupuncture for knee pain.

4. THE OLD “BETA ERROR” BUGABOO: SHORT ON STATISTICAL POWER. Hinman et alapplied this ‘clinically important’ difference to a ‘clinically irrelevant’ comparison–acupuncture versus sham laser. Sham laser is not an available therapy. The only reason for comparing acupuncture with sham would be to estimate the effects of the needles themselves, but this is already well known from the Cochrane review8 and an individual patient data meta-analysis (figure 1).9 It is known that the effect of needles alone is small, and so is unlikely to be identifiable reliably with sample sizes of less than about 800.10 The sample size in the study by Hinman et al (n=70) clearly appears to be inadequate for the question, according to the existing evidence, and not best use of resources. The resulting ES of acupuncture against sham that was actually found by Hinman is similar to that shown by the best evidence8 (see figure 1), although the wide CI means the data can only be of any importance when they are included in a meta-analysis in the future.

5. WHO DECIDES WHAT TREATMENT EFFECT IS MEANINGFUL? Hinman et al found that, after 12 weeks, knee pain was significantly reduced by acupuncture compared with no acupuncture control, with an ES of 0.6 (data from their table 2; see figure 1). The difference did not quite meet the MCID they had postulated–although the estimated ES is the same size as the MCID–but it more than meets the MCID chosen by patients themselves (ES 0.39) and that selected by NICE (ES 0.5). In interpreting this result, the secondary outcomes should also have been brought into thoughtful consideration: there were significant differences in favour of acupuncture for six out of eight secondary outcomes (see eTable 5 in their paper) and the response rate, which is the most patient-orientated measure of success,7 was 76% in the acupuncture group compared with 32% in the no acupuncture control group.

6. TO MAKE MATTERS WORSE, THE AUSTRALIANS STUDIED THE LEAST EFFECTIVE ACUPUNCTURE TECHNIQUE. Hinman et al did not apply optimal acupuncture. Use of electroacupuncture has been shown superior to manual stimulation for knee pain in 2010.8

A couple of weeks ago, I also came across a study of “needle-less” acupuncture, also for chronic knee pain of the OA variety. Basically it involved warming the knee with these stick on cones of burning mugwort–sort of like (very carefully) burning incense around your knee cap. That too showed clinical effectiveness, although now I am prompted to dig up the original study and see if we can fit that “effect size” into our acupuncture, warm baths, exercise line-up above. Stay tuned.

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Dr. Arthur Yin Fan’ s two articles

GLOBAL VIEWS
Nevada: the first state that fully legalized acupuncture and Chinese medicine in the Unites States — In memory of Arthur Steinberg, Yee Kung Lok and Jim Joyce who made it happen
January 19, 2015 | Arthur Yin Fan (doi: 10.1016/S2095-4964(15)60158-3)
ABSTRACT | FULL TEXT | PDF
Title: The earliest acupuncture school of the United States incubated in a Tai Chi Center in Los Angeles
Authors: Arthur Yin Fan
Abstract | Full text | PDF

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Cervical dystonia case

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https://www.youtube.com/my_videos?o=U

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