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<p class=MsoNormal><b><span style='font-family:Arial'>Cardiomyopathy</span></b></p>
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<p class=MsoNormal><span style='color:red'>Cardiomyopathy</span> <br>
<a href="index.html">Home</a></p>
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<p class=MsoNormal><i><span style='font-size:11.0pt;font-family:Arial'>This
doctor gave a guy six months to live.</span></i><span style='font-size:11.0pt'>
<br>
</span><i><span style='font-size:11.0pt;font-family:Arial'>The guy couldn't
pay his bill.</span></i><span style='font-size:11.0pt'> <br>
</span><i><span style='font-size:11.0pt;font-family:Arial'>The doctor gave
him another six months.</span></i><span style='font-size:11.0pt'> <br>
</span><span style='font-size:11.0pt;font-family:Arial'>(Henny Youngman)</span><span
style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> Dave was 51,
intelligent and cheerful. He had brought his entire family to see me
over the years. This time his wife brought him.</span><span
style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "So what's
up?" I asked them. They looked awfully serious that morning.</span><span
style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "Dave has been
to the doctor, and to a cardiologist," said his wife Sandra. "He
has been diagnosed with dilated cardiomyopathy."</span><span
style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> If you looked
carefully, you could see that she was near tears.</span><span
style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> Dave nodded his
head.</span><span style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "It doesn't
look so good," Dave said.</span><span style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "How bad is
it?" I asked.</span><span style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "The
specialists said I have two years to live, unless I get a heart transplant,
and there is even doubt about that."</span><span style='font-size:11.0pt'>
<o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> He looked at his
wife, and then down, and then at me.</span><span style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "Anything we
can do?" Dave asked quietly.</span><span style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> There it was again:
that question, that single question that makes the difference between passive
surrender and active resistance.</span><span style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "What have the
doctors offered besides a transplant?" I asked.</span><span
style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "They said
there is no other treatment," Dave answered.</span><span
style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "It sounds
like you have little alternative but to try some alternatives," I
said. "There is in fact literature supporting the use of diet,
vitamin E, vitamin C, a substance called coenzyme Q-10, and the essential
fatty acids linoleic and linolenic acid. Want to hear about them?"</span><span
style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> They sure did.</span><span
style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "Dave, the
first thing you have to do is lose weight," I said.</span><span
style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> He looked at me
with a childlike, "Do I hafta?"</span><span style='font-size:11.0pt'>
<o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> But Dave said,
"I know. I've let myself go for the last five years at least. What's
the best way to do it?"</span><span style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "What do you
think?" I responded.</span><span style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "Exercise,
right?"</span><span style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "Sure." Everybody
knows it; it's just that not everybody does it.</span><span style='font-size:
11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "What exercise
is best for me?" asked Dave.</span><span style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "The one you
will actually do," I answered. It is a stock reply, but a true
one. "What do you like to do?"</span><span style='font-size:
11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "Well,
walking. Don't do it much, because I have a desk job. But I like
walking."</span><span style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> I waited.</span><span
style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "I could walk
on my lunch hour," Dave said presently. "Weekends, too. Sandra
will walk with me."</span><span style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> Sandra nodded
vigorously.</span><span style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "What else
should I do?" said Dave.</span><span style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "Vegetable
juice fasting: a week on, and a week off. Repeat until you've lost 30
pounds at least. Do you own a juicer?"</span><span style='font-size:
11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "Yes,"
smiled Dave. "But we haven't been using it."</span><span
style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "Well then,
dust it off and start today," I said. "You will also need to
supply the heart with the special nutrients it prefers, specifically the
fatty acids. Linolenic acid is found in fish, leafy green veggies, and
flaxseed oil. Linoleic acid is found in oils in general. Lecithin
contains both."</span><span style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "How do you
pronounce that word again?" said Sandra.</span><span style='font-size:
11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "Lecithin?
Remember it this way: 'You are less-a-thin than you used-to-a-be.'"</span><span
style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> They both laughed
politely at such low humor.</span><span style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> I continued,
"There is about half a gram of linolenic acid in a tablespoon of
lecithin granules. There's eight times as much linoleic acid. Try
to have three to five tablespoons a day. Most people work up to that
amount gradually."</span><span style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "How do you
take it?" asked Sandra. Dave pursed his mouth, bracing himself for
the worst.</span><span style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "Stir it into
yogurt, or juice. It won't dissolve in liquids, but just drift around. Down
it quickly, and follow with something you like to eat. It doesn't taste
bad, but it's not everybody's first choice, either. It is by far the
cheapest source of the essential fatty acids. Your heart preferentially
burns them for fuel. It is analogous to 'high-test' premium gas for a
car."</span><span style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "You keep
saying 'fatty acids.' Isn't lecithin high in fat?" said Sarah.</span><span
style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "It is if you
ate nothing else. But even five tablespoons a day is 24 grams of fat, or
about 30% of the Recommended Daily Value. On a vegetable juice diet, you
will have no other source of fat, so you need it here. For that matter,
lecithin is a lipotrophic compound, and may help mobilize and get rid of fat
buildups in the body. That part is controversial, but the heart's need
for the fatty acids is beyond question."</span><span style='font-size:
11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "What about
vitamins?" Dave asked.</span><span style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "Little doubt
about those, either. In animals, vitamin E deficiency will cause heart
conditions much like cardiomyopathy. Vitamin E seems to help the heart
do more work on less fuel and oxygen. 'E' increases your heart's stroke
volume, that is, the amount of blood pumped per beat. Stronger, more
regular heartbeats are essential for you, Dave."</span><span
style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "No
argument!" Dave replied. "How much?"</span><span
style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "Working up
gradually to somewhere between 1,000 and 2,000 IU a day is what I've
read. Be sure the vitamin E is the natural, d-alpha tocopherol
type. 'Mixed Natural Tocopherols' on the label would be better
still."</span><span style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> Sandra dutifully
wrote all of this down on a notepad.</span><span style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> I went on. "Vitamin
C is needed for all connective tissue. Deficiency, really severe vitamin
C deficiency like scurvy, results in profound connective tissue and muscle
damage. I'd also recommend calcium and magnesium, as orotates, aspartates or
citrates for best absorption. Hans Neiper, MD, one of <st1:place w:st="on">Europe</st1:place>'s
finest cardiologists, uses those extensively. You could and probably
should double the RDA of both."</span><span style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "That is a lot
of stuff to be taking, along with the juicing and the lecithin," Dave
said.</span><span style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "Don't worry,
there's more," I said with a cheesy grin. "Coenzyme Q-10
has shown promise in conditions like yours. It is a bit pricey, but
worth it under the circumstances."</span><span style='font-size:11.0pt'>
<o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "How much of
that will I need?" said Dave.</span><span style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "Hard to
say. Physicians use between 100 and 400 milligrams a day. It
certainly will not hurt you if you take the high end of that, so get a
bottle, read the dosage information on the label, and take as much as you can
afford to."</span><span style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "He
can't afford not to," Sandra said, as if on cue. "We'll do all
of it. Won't you, Dave."</span><span style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "Yep,"
Dave said.</span><span style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> And he did. We
talked a few times over the next two months, and each time Dave felt better
and better.</span><span style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "I lost over
30 pounds," Dave said. "I'm increased my walking to over two
miles every day. I can handle 5 or 6 cups of juice easy, sometimes
eight. And I'm taking all those pills you told me about."</span><span
style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "Vitamins,
Dave. They are all non-prescription nutritional supplements."</span><span
style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "Vitamins,
right. Sure, who cares! I feel great!"</span><span
style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "What have the
doctors said?" I asked.</span><span style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "They said
I've gotten no worse, so keep doing whatever I'm doing."</span><span
style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "That'll
certainly do for starters," I replied.</span><span style='font-size:
11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> In healing, there
are levels of achievement. We always hope for cure, fast and
unconditional. We can be well pleased with improvement, even if gradual and
partial. And any progress is good. Keeping a serious disease from
getting any worse is success. Slowing a rate of decline is well worth
doing. Improving length of life is a victory, and failing that, better
quality of life is still desirable. You try for the best, and see what you
get.</span><span style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> Dave and I talked
again some months later.</span><span style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> "Just have
been to the cardiologist!" said Dave. "I'm symptom free! They
"know" I have dilated cardiomyopathy, but they can't find a single
symptom of it. I have no pain at all. This is wonderful!"</span><span
style='font-size:11.0pt'> <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'> Sure was. And
after five years, he was still symptom-free.</span><span style='font-size:
11.0pt'> <o:p></o:p></span></p>
<p><b style='mso-bidi-font-weight:normal'><span style='font-size:10.0pt;
font-family:Arial'>Copyright C 2005, 1999 and prior years Andrew W. Saul.</span>
<o:p></o:p></b></p>
<p><b style='mso-bidi-font-weight:normal'><span style='font-size:11.0pt;
font-family:Arial'>MORE ON COENZYME Q10<o:p></o:p></span></b></p>
<p><span style='font-size:11.0pt;font-family:Arial'>By now, coenzyme Q10
(coQ10 or umbiquinone) should probably be accepted as a vitamin. Many other
vitamins are coenzymes. CoQ10 is found in small quantities in foods. A person
with cardiomyopathy may have a bigger requirement because of the illness. It
has been established that heart muscle greatly benefits from coQ10
supplementation, resulting in improvement in cases of congestive heart
failure and even cardiomyopathy. Because coQ10 is so absolutely vital to
muscle cells, involved with growth control, cellular energy production, and
other essential life functions, it warrants special consideration for persons
with cardiomyopathy. The research cited below is promising, but not unequivocal.
In my opinion, it would have been more conclusive if higher doses were
employed. <b style='mso-bidi-font-weight:normal'>I submit that 300–600
mg of coQ10 per day would be a minimum effective dose.</b> The limiting
factors will be either cost and/or medical disapproval. As there are no
harmful side effects with coQ10, much higher doses are worth a serious
therapeutic trial.<o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'>FOR FURTHER <st1:City
w:st="on"><st1:place w:st="on">READING</st1:place></st1:City>:<o:p></o:p></span></p>
<p><b style='mso-bidi-font-weight:normal'><span style='font-size:11.0pt;
font-family:Arial'>Mol Aspects Med. 1997;18 Suppl:S145-51. Treatment of
hypertrophic cardiomyopathy with coenzyme Q10. Langsjoen PH, Langsjoen A,
Willis R, Folkers K. Langsjoen Clinic, Tyler, TX 75701, USA. </span></b><i
style='mso-bidi-font-style:normal'><span style='font-size:11.0pt;font-family:
Arial'>“Seven patients with HCM, six non-obstructive and one
obstructive, were treated with an average of 200 mg/day of CoQ10 with mean
treatment whole blood CoQ10 level of 2.9 micrograms/ml. Echocardiograms were
obtained in all seven patients at baseline and again 3 or more months
post-treatment. All patients noted improvement in symptoms of fatigue and
dyspnea with no side effects noted. The mean interventricular septal
thickness improved significantly from 1.51 +/- 0.17 cm to 1.14 +/- 0.13 cm, a
24% reduction (P < 0.002). The mean posterior wall thickness improved
significantly from 1.37 +/- 0.13 cm to 1.01 +/- 0.15 cm, a 26% reduction (P
< 0.005). Mitral valve inflow slope by pulsed wave Doppler (EF slope)
showed a non-significant trend towards improvement, 1.55 +/- 0.49 m/sec2 to
2.58 +/- 1.18 m/sec2 (P < 0.08). The one patient with subaortic
obstruction showed an improvement in resting pressure gradient after CoQ10
treatment (70 mmHg to 30 mmHg).”<o:p></o:p></span></i></p>
<p><b style='mso-bidi-font-weight:normal'><span style='font-size:11.0pt;
font-family:Arial'>Pediatr Cardiol. 2005 Jul-Aug;26(4):361-6. The effect of
coenzyme Q10 on idiopathic chronic dilated cardiomyopathy in children. Soongswang
J, Sangtawesin C, Durongpisitkul K, Laohaprasitiporn D, Nana A, Punlee K,
Kangkagate C. </span></b><i style='mso-bidi-font-style:normal'><span
style='font-size:11.0pt;font-family:Arial'>“A total of 15 patients with
idiopathic chronic DCM were included, with the median age of 4.4 years
(range, 0.6-16.3). Presenting symptoms were congestive heart failure in 12 cases
(80%), cardiogenic shock in 2 cases (13.3%), and cardiac arrhythmia in 1 case
(6.7%). . . CoQ10 was given at a dosage of 3.1 ? 0.6 mg/kg/day for 9 months
as a supplementation to a fixed amount of conventional antifailure drugs
throughout the study. At follow-up periods of 1, 3, 6, and 9 months, NYHA
functional class was significantly improved, as was CT ratio and QRS duration
at 3 and 9 months follow-up with CoQ10 when compared to the baseline and
post-discontinuation of CoQ10 at 9 months (range, 4.8-10.8).” <o:p></o:p></span></i></p>
<p><b style='mso-bidi-font-weight:normal'><span style='font-size:11.0pt;
font-family:Arial'>Clin Nutr. 2005 Jun;24(3):331-8. Potential role of
ubiquinone (coenzyme Q10) in pediatric cardiomyopathy. Bhagavan HN, Chopra
RK. </span></b><i style='mso-bidi-font-style:normal'><span style='font-size:
11.0pt;font-family:Arial'>“About 40% of children who present with
symptomatic cardiomyopathy are reported to receive a heart transplant or die
within the first two years of life. In spite of some of the advances in the
management of PCM, the data shows that the time to transplantation or death
has not improved during the past 35 years. Coenzyme Q10 is a vitamin-like
nutrient that has a fundamental role in mitochondrial function, especially as
it relates to the production of energy (ATP) and also as an antioxidant.
Based upon the biochemical rationale and a large body of data on patients
with adult cardiomyopathy, heart failure, and mitochondrial diseases with
heart involvement, a role for coenzyme Q10 therapy in PCM patients is
indicated, and preliminary results are promising. Additional studies on the
potential usefulness of coenzyme Q10 supplementation as an adjunct to
conventional therapy in PCM, particularly in children with dilated cardiomyopathy,
are therefore warranted.”<o:p></o:p></span></i></p>
<p><span style='font-size:11.0pt;font-family:Arial'>SEE ALSO:<o:p></o:p></span></p>
<p><b style='mso-bidi-font-weight:normal'><span style='font-size:10.0pt;
font-family:Arial'>(</span></b><b style='mso-bidi-font-weight:normal'><span
style='font-size:11.0pt;font-family:Arial'>Note: PMID numbers, included below,
enable you to quickly find the study using MEDLINE/Pub Med</span></b><span
style='font-size:11.0pt;font-family:Arial'> <a
href="http://www.ncbi.nlm.nih.gov/sites/entrez">http://www.ncbi.nlm.nih.gov/sites/entrez</a>
)<o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'>Therapy with coenzyme Q10
of patients in heart failure who are eligible or ineligible for a transplant.
[Biochem Biophys Res Commun. 1992] PMID:1731784 <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'>Coenzyme Q10 and
cardiovascular disease: a review. [J Cardiovasc Nurs. 2002] PMID:12597259<o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'>Effect of coenzyme Q10
therapy in patients with congestive heart failure: a long-term multicenter
randomized study. [Clin Investig. 1993] PMID:8241697<o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'>Clinical aspects of
coenzyme Q10: an update. [Curr Opin Clin Nutr Metab Care. 2005] PMID:16205466<o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'>Usefulness of coenzyme
Q10 in clinical cardiology: a long-term study. [Mol Aspects Med. 1994]
PMID:7752828 <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'>Isolated diastolic
dysfunction of the myocardium and its response to CoQ10 treatment. [Clin
Investig. 1993] PMID:8241699<o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'>Coenzyme Q10 in dilated
cardiomyopathy. [Int J Tissue React. 1990] PMID:2276896<o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:Arial'>The clinical and
hemodynamic effects of coenzyme Q10 in congestive cardiomyopathy. [Am J Ther.
1997] PMID:10423594<o:p></o:p></span></p>
<p><b style='mso-bidi-font-weight:normal'><span style='font-size:10.0pt;
font-family:Arial'><o:p> </o:p></span></b></p>
<p><b style='mso-bidi-font-weight:normal'><span style='font-size:10.0pt;
font-family:Arial'>Andrew Saul is the <span class=grame>author of the books <i>FIRE</i></span><i>
YOUR DOCTOR!</i> How <i>to be Independently Healthy </i>(reader reviews at<i>
</i><a href="http://www.doctoryourself.com/review.html">http://www.doctoryourself.com/review.html</a>
) and <i>DOCTOR YOURSELF: Natural Healing that Works.</i> (reviewed at <a
href="http://www.doctoryourself.com/saulbooks.html">http://www.doctoryourself.com/saulbooks.html</a>
) </span><o:p></o:p></b></p>
<p><b style='mso-bidi-font-weight:normal'><span style='font-size:10.0pt;
font-family:Arial'>For ordering information, <a
href="http://www.doctoryourself.com/order.html">Click Here</a></span> .<o:p></o:p></b></p>
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