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Rampazo ÉP, Bellew JW, Pinfildi CE, Guerra RLS, Liebano RE. Low-Level Laser Therapy and Electrotherapy for Neck Pain: "Clinical Practice Guideline for Physical Therapy Assessment and Treatment in Patients with Nonspecific Neck Pain," Bier JD, Scholten-Peeters WGM, Staal JB, et al. Phys Ther. 2018;98:162-171. Phys Ther 2019; 99:118-119. [PMID: 30476228 DOI: 10.1093/ptj/pzy120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/21/2018] [Indexed: 11/14/2022]
Affiliation(s)
| | - James W Bellew
- Krannert School of Physical Therapy, University of Indianapolis, Indianapolis, Indiana
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Alayat MS, Elsoudany AM, Ali ME. Efficacy of Multiwave Locked System Laser on Pain and Function in Patients with Chronic Neck Pain: A Randomized Placebo-Controlled Trial. Photomed Laser Surg 2018; 35:450-455. [PMID: 28783464 DOI: 10.1089/pho.2017.4292] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Multiwave locked system (MLS) laser therapy utilizes the synchronized emission of an 808 nm continuous laser and a 905 nm pulsed laser. It is postulated that MLS enables greater penetration and therapeutic benefit than single-wavelength low-level laser therapy (LLLT). OBJECTIVE The aim of this research was to evaluate the efficacies of MLS laser therapy and the 830 nm laser in the treatment of patients with chronic neck pain (CNP). MATERIALS AND METHODS Seventy-five patients with CNP (mean age 46.28 ± 5.89, weight 83.78 ± 5.65 kg, height 1.72 ± 4.96 m, and duration of illness of 5.98 ± 1.44 months). They were randomized into three groups. Group I received MLS laser therapy and exercises, Group II received LLLT and exercises, and Group III received placebo laser therapy plus exercises (PL + EX). Neck pain levels and neck function were measured using the visual analogue scale (VAS) and neck disability index (NDI), respectively. RESULTS Both VAS and NDI were significantly reduced post-treatment for all treatment groups. After 6 weeks of treatment, MLS plus exercise showed a significantly greater decrease in pain and disability scores {Δ VAS (6.68) and Δ NDI (39.84)} compared to both LLLT plus exercise group {Δ VAS (5.72) and Δ NDI (37.88)} and PL + EX {Δ VAS (4.84) and Δ NDI (36.68)}. CONCLUSIONS MLS laser therapy in conjunction with exercises decreased pain and increased functional activity following 6 months of therapy. MLS laser therapy in combination with exercises is a more effective therapy for CNP compared to exercise plus LLLT or exercise alone.
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Affiliation(s)
| | | | - Mohamed Ebrahim Ali
- 2 Department of Physical Therapy for Musculoskeletal Disorders, Faculty of Physical Therapy, Cairo University , Giza, Egypt .,3 Physical Therapy, Faculty of Applied Medical Science, Umm Al-Qura University , Mecca, Saudi Arabia
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Chow R. Misleading negative conclusions on the efficacy of low-level laser therapy (LLLT) for neck pain. Spine J 2016; 16:1631. [PMID: 27916333 DOI: 10.1016/j.spinee.2016.02.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 02/15/2016] [Indexed: 02/03/2023]
Affiliation(s)
- Roberta Chow
- Brain and Mind Centre, The University of Sydney, 94 Mallett St, Camperdown, NSW 2050, Australia
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Low-level laser therapy in the treatment of recurrent aphthous ulcers: a systematic review. ScientificWorldJournal 2015; 2015:150412. [PMID: 25879049 PMCID: PMC4386290 DOI: 10.1155/2015/150412] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 10/31/2014] [Indexed: 11/23/2022] Open
Abstract
Recurrent aphthous ulcers (RAUs) are the most common lesion found in the oral cavity. There is no definitive cure for RAUs and current treatments are aimed at minimizing symptoms. Since low-level laser therapy (LLLT) modulates inflammatory responses, and promotes pain reduction and cellular biostimulation, LLLT can be suggested as an alternative treatment for RAUs. The literature concerning the potential of LLLT in the treatment of RAUs was evaluated. A systematic literature review identified 22 publications, of which only 2 studies were adopted. The eligibility criteria consisted of randomized controlled trials (RCTs). Both RCTs achieved significant results concerning LLLT and pain-level reductions and reduced healing times. Despite the variance in irradiation conditions applied in both studies, very similar wavelengths were adopted. There is accordingly strong evidence that wavelength plays an important role in RAU treatment. Taking into account the different parameters applied by selected RCTs, it is not possible to suggest that a specific protocol should be used. However, in light of the significant results found in both studies, LLLT can be suggested as an alternative for RAU treatment. Additional RCTs should be performed in order to reach a clinical protocol and better understand the application of LLLT in RAU treatment.
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Law D, McDonough S, Bleakley C, Baxter GD, Tumilty S. Laser acupuncture for treating musculoskeletal pain: a systematic review with meta-analysis. J Acupunct Meridian Stud 2014; 8:2-16. [PMID: 25660439 DOI: 10.1016/j.jams.2014.06.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 06/18/2014] [Accepted: 06/25/2014] [Indexed: 11/28/2022] Open
Abstract
Laser acupuncture has been studied extensively over several decades to establish evidence-based clinical practice. This systematic review aims to evaluate the effects of laser acupuncture on pain and functional outcomes when it is used to treat musculoskeletal disorders and to update existing evidence with data from recent randomized controlled trials (RCTs). A computer-based literature search of the databases MEDLINE, AMED, EMBASE, CINAHL, SPORTSDiscus, Cochrane Library, PubMed, Current Contents Connect, Web of Science, and SCOPUS was used to identify RCTs comparing between laser acupuncture and control interventions. A meta-analysis was performed by calculating the standardized mean differences and 95% confidence intervals, to evaluate the effect of laser acupuncture on pain and functional outcomes. Included studies were assessed in terms of their methodological quality and appropriateness of laser parameters. Forty-nine RCTs met the inclusion criteria. Two-thirds (31/49) of these studies reported positive effects, were of high methodological quality, and reported the dosage adequately. Negative or inconclusive studies commonly failed to demonstrate these features. For all diagnostic subgroups, positive effects for both pain and functional outcomes were more consistently seen at long-term follow-up rather than immediately after treatment. Moderate-quality evidence supports the effectiveness of laser acupuncture in managing musculoskeletal pain when applied in an appropriate treatment dosage; however, the positive effects are seen only at long-term follow-up and not immediately after the cessation of treatment.
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Affiliation(s)
- Dina Law
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand.
| | - Suzanne McDonough
- Centre for Health, Activity and Rehabilitation Technologies, University of Ulster, Londonderry, UK
| | - Chris Bleakley
- Centre for Health, Activity and Rehabilitation Technologies, University of Ulster, Londonderry, UK
| | - George David Baxter
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Steve Tumilty
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Bjordal JM, Chow RT, Lopes-Martins RAB, Johnson MI. Methodological shortcomings make conclusion highly sensitive to relevant changes in review protocol. Rheumatol Int 2014; 34:1181-3. [PMID: 24402005 DOI: 10.1007/s00296-013-2940-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 12/27/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Jan M Bjordal
- Physiotherapy Research Group, Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, 5018, Bergen, Norway,
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Is low-level laser therapy in relieving neck pain effective? Systematic review and meta-analysis. Rheumatol Int 2013; 33:2493-501. [PMID: 23579335 DOI: 10.1007/s00296-013-2742-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 03/22/2013] [Indexed: 10/27/2022]
Abstract
The aim of this study is to determine the efficacy of low-level laser therapy (LLLT) in reducing acute and chronic neck pain as measured by the visual analog scale (VAS). A systematic search of nine electronic databases was conducted to identify original articles. For study selection, two reviewers independently assessed titles, abstracts, and full text for eligibility. Methodological quality was assessed using the Detsky scale. Data were analyzed using random-effects model in the presence of heterogeneity and fixed-effect model in its absence. Heterogeneity was assessed using Cochran's Q statistic and quantifying I (2). Risk ratios (RR) with 95 % confidence intervals (CI) were reported. Eight randomized controlled trials involving 443 patients met the strict inclusion criteria. Inter-rater reliability for study selection was 92.8 % (95 % CIs 80.9-100 %) and for methodological quality assessment was 83.9 % (95 % CIs 19.4-96.8 %). Five trials included patients with cervical myofascial pain syndrome (CMPS), and three trials included different patient populations. A meta-analysis of five CMPS trials revealed a mean improvement of VAS score of 10.54 with LLLT (95 % CI 0.37-20.71; Heterogeneity I (2 )= 65 %, P = 0.02). This systematic review provides inconclusive evidence because of significant between-study heterogeneity and potential risk of bias. The benefit seen in the use of LLLT, although statistically significant, does not constitute the threshold of minimally important clinical difference.
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Leaver AM, Refshauge KM, Maher CG, McAuley JH. Conservative interventions provide short-term relief for non-specific neck pain: a systematic review. J Physiother 2010; 56:73-85. [PMID: 20482474 DOI: 10.1016/s1836-9553(10)70037-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
QUESTION Which interventions for non-specific neck pain are effective in reducing pain or disability? DESIGN Systematic review with meta-analysis of randomised controlled trials. PARTICIPANTS Adults with non-specific neck pain. INTERVENTION All interventions for neck pain that were evaluated in trials with a placebo, minimal- or no-intervention control. OUTCOME MEASURES Pain and disability outcomes (0-100 scale) at the conclusion of a course of treatment (short term), and in the medium (3 to 9 months) and long (> 9 months) term. RESULTS 33 trials were identified. The interventions with significant short-term effects on pain were manipulation (MD -22, 95% CI -32 to -11), multimodal intervention (MD -21, 95% CI -34 to -7), specific exercise (MD -12, 95% CI -22 to -2), combination orphenadrine/paracetamol (MD -17, 95% CI -32 to -2), and manual therapy (MD -12, 95% CI -16 to -7). There was a significant short-term effect on disability for acupuncture (MD -8, 95% CI -13 to -2) and manual therapy (MD -6, 95% CI -11 to -2). Treatment with laser therapy resulted in better pain outcomes at medium-term follow-up but not at short-term follow-up. No other intervention demonstrated medium- or long-term effects. CONCLUSION Some conservative interventions for neck pain are effective in the short term. Few interventions that have been investigated have shown longer term effects that are better than placebo or minimal intervention.
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Affiliation(s)
- Andrew M Leaver
- Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia.
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Tumilty S, Munn J, McDonough S, Hurley DA, Basford JR, Baxter GD. Low level laser treatment of tendinopathy: a systematic review with meta-analysis. Photomed Laser Surg 2010; 28:3-16. [PMID: 19708800 DOI: 10.1089/pho.2008.2470] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To assess the clinical effectiveness of Low Level Laser Therapy (LLLT) in the treatment of tendinopathy. Secondary objectives were to determine the relevance of irradiation parameters to outcomes, and the validity of current dosage recommendations for the treatment of tendinopathy. BACKGROUND LLLT is proposed as a possible treatment for tendon injuries. However, the clinical effectiveness of this modality remains controversial, with limited agreement on the most efficacious dosage and parameter choices. METHOD The following databases were searched from inception to 1(st) August 2008: MEDLINE, PubMed, CINAHL, AMED, EMBASE, All EBM reviews, PEDro (Physiotherapy Evidence Database), SCOPUS. Controlled clinical trials evaluating LLLT as a primary intervention for any tendinopathy were included in the review. Methodological quality was classified as: high (> or =6 out of 10 on the PEDro scale) or low (<6) to grade the strength of evidence. Accuracy and clinical appropriateness of treatment parameters were assessed using established recommendations and guidelines. RESULTS Twenty-five controlled clinical trials met the inclusion criteria. There were conflicting findings from multiple trials: 12 showed positive effects and 13 were inconclusive or showed no effect. Dosages used in the 12 positive studies would support the existence of an effective dosage window that closely resembled current recommended guidelines. In two instances where pooling of data was possible, LLLT showed a positive effect size; in studies of lateral epicondylitis that scored > or =6 on the PEDro scale, participants' grip strength was 9.59 kg higher than that of the control group; for participants with Achilles tendinopathy, the effect was 13.6 mm less pain on a 100 mm visual analogue scale. CONCLUSION LLLT can potentially be effective in treating tendinopathy when recommended dosages are used. The 12 positive studies provide strong evidence that positive outcomes are associated with the use of current dosage recommendations for the treatment of tendinopathy.
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Affiliation(s)
- Steve Tumilty
- Centre for Physiotherapy Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand.
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Chow RT, Johnson MI, Lopes-Martins RAB, Bjordal JM. Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials. Lancet 2009; 374:1897-908. [PMID: 19913903 DOI: 10.1016/s0140-6736(09)61522-1] [Citation(s) in RCA: 336] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Neck pain is a common and costly condition for which pharmacological management has limited evidence of efficacy and side-effects. Low-level laser therapy (LLLT) is a relatively uncommon, non-invasive treatment for neck pain, in which non-thermal laser irradiation is applied to sites of pain. We did a systematic review and meta-analysis of randomised controlled trials to assess the efficacy of LLLT in neck pain. METHODS We searched computerised databases comparing efficacy of LLLT using any wavelength with placebo or with active control in acute or chronic neck pain. Effect size for the primary outcome, pain intensity, was defined as a pooled estimate of mean difference in change in mm on 100 mm visual analogue scale. FINDINGS We identified 16 randomised controlled trials including a total of 820 patients. In acute neck pain, results of two trials showed a relative risk (RR) of 1.69 (95% CI 1.22-2.33) for pain improvement of LLLT versus placebo. Five trials of chronic neck pain reporting categorical data showed an RR for pain improvement of 4.05 (2.74-5.98) of LLLT. Patients in 11 trials reporting changes in visual analogue scale had pain intensity reduced by 19.86 mm (10.04-29.68). Seven trials provided follow-up data for 1-22 weeks after completion of treatment, with short-term pain relief persisting in the medium term with a reduction of 22.07 mm (17.42-26.72). Side-effects from LLLT were mild and not different from those of placebo. INTERPRETATION We show that LLLT reduces pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain. FUNDING None.
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Affiliation(s)
- Roberta T Chow
- Nerve Research Foundation, Brain and Mind Research Institute, University of Sydney, Sydney, NSW, Australia.
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Tumilty S, Munn J, Abbott JH, McDonough S, Hurley DA, Baxter GD. Laser Therapy in the Treatment of Achilles Tendinopathy: A Pilot Study. Photomed Laser Surg 2008; 26:25-30. [DOI: 10.1089/pho.2007.2126] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Steve Tumilty
- School of Physiotherapy, Centre for Physiotherapy Research, University of Otago, Dunedin, New Zealand
| | - Joanne Munn
- School of Physiotherapy, Centre for Physiotherapy Research, University of Otago, Dunedin, New Zealand
| | - J. Haxby Abbott
- School of Physiotherapy, Centre for Physiotherapy Research, University of Otago, Dunedin, New Zealand
| | | | | | - G. David Baxter
- School of Physiotherapy, Centre for Physiotherapy Research, University of Otago, Dunedin, New Zealand
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Chow RT, David MA, Armati PJ. 830 nm laser irradiation induces varicosity formation, reduces mitochondrial membrane potential and blocks fast axonal flow in small and medium diameter rat dorsal root ganglion neurons: implications for the analgesic effects of 830 nm laser. J Peripher Nerv Syst 2007; 12:28-39. [PMID: 17374099 DOI: 10.1111/j.1529-8027.2007.00114.x] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report the formation of 830 nm (cw) laser-induced, reversible axonal varicosities, using immunostaining with beta-tubulin, in small and medium diameter, TRPV-1 positive, cultured rat DRG neurons. Laser also induced a progressive and statistically significant decrease (p<0.005) in MMP in mitochondria in and between static axonal varicosities. In cell bodies of the neuron, the decrease in MMP was also statistically significant (p<0.05), but the decrease occurred more slowly. Importantly we also report for the first time that 830 nm (cw) laser blocked fast axonal flow, imaged in real time using confocal laser microscopy and JC-1 as mitotracker. Control neurons in parallel cultures remained unaffected with no varicosity formation and no change in MMP. Mitochondrial movement was continuous and measured along the axons at a rate of 0.8 microm/s (range 0.5-2 microm/s), consistent with fast axonal flow. Photoacceptors in the mitochondrial membrane absorb laser and mediate the transduction of laser energy into electrochemical changes, initiating a secondary cascade of intracellular events. In neurons, this results in a decrease in MMP with a concurrent decrease in available ATP required for nerve function, including maintenance of microtubules and molecular motors, dyneins and kinesins, responsible for fast axonal flow. Laser-induced neural blockade is a consequence of such changes and provide a mechanism for a neural basis of laser-induced pain relief. The repeated application of laser in a clinical setting modulates nociception and reduces pain. The application of laser therapy for chronic pain may provide a non-drug alternative for the management of chronic pain.
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Affiliation(s)
- Roberta T Chow
- Castle Hill Medical Centre, Discipline of Medicine, The University of Sydney, Sydney, Australia.
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Chow RT, Heller GZ, Barnsley L. The effect of 300 mW, 830 nm laser on chronic neck pain: A double-blind, randomized, placebo-controlled study. Pain 2006; 124:201-10. [PMID: 16806710 DOI: 10.1016/j.pain.2006.05.018] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2005] [Revised: 03/23/2006] [Accepted: 05/17/2006] [Indexed: 11/15/2022]
Abstract
A randomized, double-blind, placebo-controlled study of low-level laser therapy (LLLT) in 90 subjects with chronic neck pain was conducted with the aim of determining the efficacy of 300 mW, 830 nm laser in the management of chronic neck pain. Subjects were randomized to receive a course of 14 treatments over 7 weeks with either active or sham laser to tender areas in the neck. The primary outcome measure was change in a 10 cm Visual Analogue Scale (VAS) for pain. Secondary outcome measures included Short-Form 36 Quality-of-Life questionnaire (SF-36), Northwick Park Neck Pain Questionnaire (NPNQ), Neck Pain and Disability Scale (NPAD), the McGill Pain Questionnaire (MPQ) and Self-Assessed Improvement (SAI) in pain measured by VAS. Measurements were taken at baseline, at the end of 7 weeks' treatment and 12 weeks from baseline. The mean VAS pain scores improved by 2.7 in the treated group and worsened by 0.3 in the control group (difference 3.0, 95% CI 3.8-2.1). Significant improvements were seen in the active group compared to placebo for SF-36-Physical Score (SF36 PCS), NPNQ, NPAD, MPQVAS and SAI. The results of the SF-36 - Mental Score (SF36 MCS) and other MPQ component scores (afferent and sensory) did not differ significantly between the two groups. Low-level laser therapy (LLLT), at the parameters used in this study, was efficacious in providing pain relief for patients with chronic neck pain over a period of 3 months.
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Affiliation(s)
- Roberta T Chow
- Castle Hill Medical Centre, 269-271 Old Northern Road, Castle Hill, NSW 2154, Australia.
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