J Orthop Surg Res. Injection of calcium phosphate bone substitute into the area of subchondral bone edema (Subchondroplasty; Knee Creations, West Chester, PA) may be an option. And yes some of your symptoms do sound like metatarsalgia. The authors concluded that the allogeneic growth factor appeared to provide a viable option to assist with the development of postero-lateral spinal arthrodesis. A 1st metatarsal fracture must be examined closely to ensure there is no displacement. list-style-type: upper-alpha; The proportion achieving closure in patients with Crohn's disease was similar (0.55, 95 % CI: 0.39 to 0.70). Washington State Department of Labor and Industries, Office of the Medical Director. WebStress fractures Stress Fractures Stress fractures are small incomplete fractures that often involve the metatarsal shafts. Mussano F, Ciccone G, Ceccarelli M, et al. Definitive fixation with bone cements during difficult ossicular chain reconstruction may ensure a more enduring successful outcome. The use of BMPs in the pediatric population is off-label. WebAdjunct membership is for researchers employed by other institutions who collaborate with IDM Members to the extent that some of their own staff and/or postgraduate students may work within the IDM; for 3-year terms, which are renewable. (Right) Several weeks later, there is callus formation at the site and the fracture can be seen more clearly. 1999;24(4):320-327. 2011;101(3):259-264. All but 1 were level IV studies; therefore, there was significant risk of bias within the presented results. 2003;28(4):317-323. This technique may yield a more consistent quality of fusion bone as compared to that with autograft. Teo BJ, Buhary K, Tai BC, Hui JH. This type of fracture can happen to any of the foot bones, but it mainly occurs to the second and third metatarsal bones, in the heel, and in the navicular bone.. In a prospective, phase-IV, multi-center, randomized study, Coughlan and colleagues (2018) compared vertebral fusion success rates following postero-lateral fusion [(PLF)/posterolateral inter-transverse fusion (PITF)] surgery. Thalgott JS, Fritts K, Giuffre JM, Timlin M. Anterior interbody fusion of the cervical spine with coralline hydroxyapatite. Mean procedure time was 100 minutes, blood loss was less than 50 ml in 93 % of patients, and hospital stay was 1 day or less in 84 % of patients. According to the PRISMA statement for reporting systematic reviews, different types of clinical studies concerning treatment of osteomyelitis with bone graft substitutes were included. Heterotrophic ossification was not observed. Both Schatzker and Mller classifications were used and was type II or 41-B3 in 7 patients, type III or 41-B2 in 12 patients, type IV or 41-C1 in 2 patients and type VI or 41-C3 in 3 patients, respectively. These researchers described the outcomes of five different surgical techniques in a series of 60 patients with osteochondritis dissecans. Eur Arch Otorhinolaryngol. Fourman MS, Borst EW, Bogner E, et al. You may not notice right away if you have injured one of your metatarsal bones, but there are symptoms to watch for. The malleus handle was present in 24 patients, and the stapes superstructure in 22 patients. As noted in Figure 3, to be effective a metatarsal pad needs to be positioned before the main area of loading. The Grafton group showed slightly better improvement in ODI score than the ICBG group at the final 2-year follow-up (Grafton [16.2] and ICBG [22.7]); however, the difference was not statistically significant (P = 0.2346 at 24 mo). These researchers stated that in-vivo studies to further delineate the potential for SVF and/or ASC to improve tendon healing are needed. There is also ongoing research on orthobiologic tissue implants that is intended to enhance healing and promote growth of new tissue. O'Riordan JM, Datta I, Johnston C, Baxter NN. This is followed by gradual weight bearing, as tolerated, in a cast or walking boot. Xtant Medical. The fifth metatarsal is the long bone on the outside of your foot. Knee Surg Sports Traumatol Arthrosc. Medical records were reviewed for type of ossicular condition, type of prosthesis, and hearing threshold at 1-year follow-up. The authors concluded that as a consequence of the low levels of evidence and high risks of bias of the included studies, these results were inconclusive and no conclusions regarding the performed clinical studies of osteomyelitis treatment with anti-microbial bone graft substitutes could be drawn. Moreover, they stated that longer follow-up and increased patient sample size are needed to confirm these initial findings. Repeat plug placement is associated with increased failure. The authors concluded that intraoperative isolation procedures were less time-consuming than non-intraoperative control groups with similar cell yield, viability of cells and composition of SVF, and therefore more suitable for use in the clinic. Treatment of glenoid chondral defect using micronized allogeneic cartilage matrix implantation. Moreover, they stated that additional studies, with separate interventional and control groups and larger sample sizes, are needed to further investigate and clearly delineate differences between the safety and efficacy of ABM/P-15 and autograft. These investigators stated that these data may be useful for promoting further research and establishing protocols for their utilization in the management of colonized complex wounds in reconstructive surgery. In a retrospective study, these researchers examined the short-term safety profile after in-vivo application of cryo-preserved AM/UC tissue use in foot and ankle surgery. 17.13 ). Clin Oral Implants Res. The INFUSE Bone Graft/LT-CAGE Lumbar Tapered Fusion Device (Medtronic Sofamor Danek) includes recombinant human bone morphogenic protein 2 (rhBMP-2) in a collagen absorbable sponge and a tapered titanium spinal cage, and has been approved for spinal fusion in persons with single-level degenerative disc disease from L4 to S1, where the patient has had at least6 months of nonoperative treatment, and the device is to be used via an anterior approach. If surgery is needed, the bones can often be realigned and held in place with temporary pins. He complains of immediate pain and is unable to finish the game. Considering the meager volume and contradictory nature of the currently available evidence, there appears to be a disproportionate use of PRP in clinical practice." WebClinicians and researchers have investigated several methods, including addition of growth factors and peptides, to reduce this healing time and enhance bone formation within the subantral environment. Protects your forefoot and toes with its 15-degree dorsi-angle bottom, forcing you to shift your weight to your heel when walking. Abrams GD, Alentorn-Geli E, Harris JD, Cole BJ. There were no significant differences in the reported clinical outcomes across all classes of bone substitutes. Progenitor cells isolated from both sites respond in a similar manner to an osteogenic stimulus and express common immunophenotypes. Stress fracture. Teo et al (2013) noted that recent advances have been made in using chondrocytes and other cell-based therapy to treat cartilage defects in adults. A zoom link or venue to be sent out before the time.. Wednesday 16 February; Wednesday 11 May; Wednesday 10 August; Wednesday 09 November . Protects your forefoot and toes with its 15-degree dorsi-angle bottom, forcing you to shift your weight to your heel when walking. Elsheikh MN, Elsherief H, Elsherief S. Physiologic reestablishment of ossicular continuity during excision of retraction pockets: Use of hydroxyapatite bone cement for rebridging the incus. WebTyrannosaurus is a genus of large theropod dinosaur.The species Tyrannosaurus rex (rex meaning "king" in Latin), often called T. rex or colloquially T-Rex, is one of the best represented theropods. Treatment for a toe or forefoot fracture depends on: Even though toes are small, injuries to the toes can often be quite painful. After a period of healing, you may begin a slow return to activity. P140019. Also, PMMA beads have been shown to provide adequate wound sterilization and graft preservation in the management of extra-cavitary prosthetic vascular graft infections. Charts were grouped by wound location and category. 2018;3(2):87-93. Defects were examined arthroscopically at 4, 8, and 12 months and with gross, histological, and immunohistochemical examination at 12 months. Recovery takes one to two months, depending on the type of deformity being corrected and the type of surgery used to correct it. The authors concluded that this intra-patient, controlled trial demonstrated a significant increase in PLF rate between 1 and 2 years after instrumented thoracolumbar fusion, but no difference between AttraX Putty and autograft. A total of 234 patients met the study criteria, 69 of whom underwent anterior cervical spine fusions using BMP-2; 27.5 % of those patients in the BMP-2 group had a clinically significant swelling event versus only 3.6 % of patients in the non-BMP-2 group. In the 14 cases without a wound leak, 5 developed wound complications (p = 0.06, Fisher's exact test) either from delayed wound-healing or pin-site infections; 1 patient developed a transient acute kidney injury (AKI) and 1 refractory osteomyelitis. The fusion rate for ceramics and BMA combinations was demonstrated to be lower, with an average fusion rate of 72.6 % (range of 4.5 % to 95.5 %). Tuchman A, Brodke DS, Youssef JA, et al. Tyrannosaurus lived throughout what is now western North America, on what was then an island continent known as Laramidia. /*margin-bottom: 43px;*/ It is at this point of the surgical procedure that metatarsal head osteotomies may be per-. Aetna considers the Pro Osteon Bone Graft Substitute experimental and investigational for use in spinal fusion, epiphyseal fractures or other indications because its effectiveness for these indications has not been established. Press Release. Although fracturing a bone in your toe or forefoot can be quite painful, it rarely requires surgery. This trial entailed 39 cases of osteo-articular infections from April 2013 to November 2016 in whom SHPCS beads were used. The use of autologous growth factors is not substantiated at this time. A systematic review and meta-analysis. In a review on the role of PRP in sinus augmentation, Boyapati and Wang (2006) stated that although the lateral wall sinus lift is a predictable clinical procedure to increase vertical bone height resulting in implant success rates comparable to that of native bone, the issue of extended healing periods remains troublesome. ViviGen (DePuy Synthes) was developed with only osteogenic cells (osteoblasts, osteocytes, bone lining cells). Patients with undetectable type VII collagen keratinocyte expression were excluded. It was demonstrated that the overall fusion rate for ceramic-based grafts was 86 %, and that the specific type of ceramic used did not significantly influence fusion rate. The authors concluded that the present study showed that stapedectomy and total ossiculoplasty with cartilage-connecting HA prosthesis is effective and safe for stapes fixation accompanied by fixation or erosion of the malleus and/or incus. Level of Evidence = IV. At 12 months (follow-up rate 87 %), both i-Factor and autograft subjects demonstrated a high fusion rate (88.97 % and 85.82 %, respectively, non-inferiority p=0.0004), significant improvements in NDI (28.75 and 27.40, respectively, non-inferiority p<0.0001), and high neurological success rate (93.71 % and 93.01 %, respectively, non-inferiority p<0.0001). Ceramics have been present in the spine fusion arena for several decades; however, their use has been limited. NIHR Horizon Scanning Centre. Bone mineralization ratings also were similar between treated sides. Mean VAS pain scores decreased significantly from 8.3 pre-operatively to 3.8 post-operatively (p < 0.001). Safar et al (2009) analyzed the efficacy of the Cook Surgisis AFP anal fistula plug for the management of complex anal fistulas. Rethinking our surgical approach to fifth metatarsal stress fractures. Autologous blood products such as platelet-rich plasma (PRP) act as an adjuvant of surgical treatment and its intra-articular delivery has shown beneficial effects for OA treatment. the effect of rhBMP on skeletal growth in children or the increased risk of cancer was not addressed. 1997;63(3):202-211. These injuries are sometimes referred to as march fractures, since they can be seen in new military recruits who are going on long hikes. Cells. BPC-157 is, in a word, a peptide. The forefoot has 5 metatarsal bones and 14 phalanges (toe bones). Prepared by the ECRI Evidence-based Practice Center for the Agency for Healthcare Research and Quality under contract No. The addition of CT-derived 3D metrics has improved the prediction of hip joint replacement when compared to radiographs alone. The primary composite end-point of fusion status was dependent upon 2 main criteria: bridging bone per the Lenke scale (classified as "A" definitely solid or "B" possibly solid) and posterior hardware status (intact). As a result, both groups were comparable with respect to the age at the time of surgery, gender ratio, pre-operative deformity, and hence length of instrumentation. Nationwide Inpatient Sample (NIS) (years 2004 to 2010) was used. The pain is worsened with weightbearing and walking. Intraosseous injections are safe and effective in knee osteoarthritis: A systematic review. Albrecht F, Roessner A, Zimmermann E. Closure of osteochondral lesions using chondral fragments and fibrin adhesive. Fusion was defined as radiographic evidence of bridging across endplates, or bridging from endplates to interspace disc plugs. Wound length was measured at 2.5 cm. Twenty patients had autologous chondrocyte implantation and 3 patients had cultured bone marrow stem cell implantation. Most injectable bone substitutes belong to one of two major groups: by far the largest group contains products based on various calcium phosphate (CP) mixtures, whilst the smaller group consists of calcium sulphate (CS) compounds. Edmonton, AB: AHFMR; November 2002. In a systematic review, Gharpure and Bhatavadekar (2018) evaluated the clinical efficacy of the tooth-bone graft as a bone substitute in the oral and maxillofacial region in humans as compared to un-grafted sites and other bone substitutes. J Am Podiatr Med Assoc. A non-blinded cohort of patients who were all referred to a single surgeon's practice was prospectively studied. top: 0px; These researchers reported on a novel method of closure for nasal septal perforations using a unilateral mucosal rotational flap and acellular dermal interposition graft. These researchers compared PLF rates between 1 and 2 years of follow-up and between graft types; and examined the role of bone grafting based on the location of the PLF mass. There are five metatarsals in all. Bone morphogenetic proteins and bone defects: A systematic review. Occipitocervical fusion using recombinant human bone morphogenetic protein-2: Adverse effects due to tissue swelling and seroma. Intra-cage bridging bone occurred earlier with ABM/P-15 than autograft (97.73 % versus 59.09 % at 6 months). 2018;19(7). Mobbs RJ, Maharaj M, Rao PJ. Current accepted therapies such as exercise, anti-inflammatory drugs and intra-articular inoculation of corticosteroids are aimed at controlling symptoms in the affected patients. The authors concluded that on the basis of historical control data, SiCaP may be as useful as iliac crest bone autograft in the context of spine fusion surgery, with less risk of unwanted donor site morbidity associated with that commonly performed procedure. Data reached statistical significance based on 95 % CIs using the binomial distribution. For additional language assistance: Autologous cellular implant derived from adipose tissue for the treatment of osteoarthritis of the knees; tissue harvesting and cellular implant creation, injection of cellular implant into knee joint including ultrasound guidance, unilateral, Bone graft, any donor area; minor or small (e.g., dowel or button), Bone graft with microvascular anastomosis; fibula, other than fibula, iliac crest, or metatarsal, Electrical stimulation to aid bone healing, noninvasive (nonoperative), Low intensity ultrasound stimulation to aid bone healing, noninvasive (nonoperative), Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure), Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to vertebral corpectomy(ies) (vertebral body resection, partial or complete) defect, in conjunction with interbody arthrodesis, each contiguous defect (List separately in addition to code for primary procedure), Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh, methylmethacrylate) to intervertebral disc space or vertebral body defect without interbody arthrodesis, each contiguous defect (List separately in addition to code for primary procedure), Femur (thigh region) and knee joint surgery, Connective tissue, non-human (includes synthetic), Osteogenesis stimulator, electrical, noninvasive, other than spinal applications, Osteogenesis stimulator, electrical, surgically implanted, Subsequent encounter for fracture with nonunion, clavicle [Codes not listed due to expanded specificity], Subsequent encounter for fracture with nonunion, humerus [Codes not listed due to expanded specificity], Subsequent encounter for fracture with nonunion, ulna and radius [Codes not listed due to expanded specificity], Subsequent encounter for fracture with nonunion, metacarpal bone(s) [Codes not listed due to expanded specificity], Subsequent encounter for fracture with nonunion, femur [Codes not listed due to expanded specificity], Subsequent encounter for fracture with nonunion, tibia and fibula [Codes not listed due to expanded specificity], Subsequent encounter for fracture with nonunion, metatarsal bone(s) [Codes not listed due to expanded specificity], Subluxation and dislocation of vertebrae [Codes not listed due to expanded specificity], Malignant neoplasm of pelvic bones, sacrum and coccyx, Secondary malignant neoplasm of cerebral meninges, Secondary malignant neoplasm of other parts of nervous system, Secondary malignant neoplasm of bone and bone marrow, Benign neoplasm of pelvic bones, sacrum and coccyx, Neoplasm of uncertain behavior of meninges, Neoplasm of uncertain behavior of spinal cord, Neoplasm of uncertain behavior of bone and articular cartilage, Infection of intervertebral disc (pyogenic), Spinal stenosis, lumbar and lumbosacral region, Collapsed vertebra, not elsewhere classified, Age-related osteoporosis with current pathological fracture, vertebra(e), Acute, subacute and other chronic osteomyelitis [spinal], Osteopathy after poliomyelitis, other site [spinal], Osteopathy in diseases classified elsewhere, other site [spinal], Pseudarthrosis after fusion or arthrodesis, Postradiation and postlaminectomy kyphosis, Fracture of cervical vertebra with cervical spinal cord injury, Fracture of thoracic vertebra with thoracic spinal cord injury, Fracture of lumbar vertebra, sacrum and coccyx with injury of lumbar and sacral spinal cord and cauda equina, Subluxation and dislocation of lumbar vertebra, Arthrodesis status [nonunion of prior fusion]. This would be important information in the final cost-benefit assessment of each treatment modality. 2021;29(11):3599-3607. Loss of curve correction amounted on average 2.6 degrees in the b-TCP group and 4.2 degrees in the comparison group (p = 0.033). Hallux valgus, claw toe, and hammer toe were all corrected.. i feel lonely without a girlfriend reddit. Calcium phosphates are highly biocompatible and in addition, they act as synthetic osteo-conductive scaffolds after implantation in bone. This decoy receptor acts as an effective antagonist of RANKL . Patients rated 32/37 feet good or excellent and the mean AOFAS score increased from 59 to 81. Success was defined as closure of both internal and external (peri-anal or vaginal) openings, absence of drainage without further intervention, and absence of abscess formation. However, even with the highest loaded cell densities, no frank bone tissue was detected, independently of the material used. Isolated bioinductive repair of partial-thickness rotator cuff tears using a resorbable bovine collagen implant: Two-year radiologic and clinical outcomes from a prospective multicenter study. The proposed improvement relies on mechanical fragmentation of cartilage tissue that is sufficient to mobilize embedded chondrocytes via increased tissue surface area. There are 2 main RPI devices, the OsteoProbe (Active Life Scientific, Santa Barbara) and the BioDent (Active Life Scientific, Santa Barbara), which operate under different mechanical loading conditions resulting in dissimilar outcome measurements. i-Factor bone graft vs autograft in anterior cervical discectomy and fusion: 2-year follow-up of the randomized single-blinded Food and Drug Administration Investigational Device Exemption study. Beside bone marrow-stimulating techniques like abrasion arthroplasty, drilling and microfracturing, new techniques like autologous osteochondral transplantation and autologous chondrocyte transplantation are increasingly used. The calcium sulfate and hydroxyapatite Cerament Bone Void Filler is a biocompatible, absorbable ceramic bone void filler that can successfully deliver multiple heat-stable and heat-unstable antibiotics that have not been generally used before with antibiotic beads in treating musculoskeletal infections. A further significant improvement to 15.5 12.7 ( p = 0.02) and to 8.6 3.1 (p < 0.01) was obtained both at 6-month and at 1-year follow-up. However, insight can still be gained comparing the results presented here to the studies mentioned above, which suggested a much lower rate of fusion when only the local bone was used. were not assessed. The fracture will also be associated with pain, and this leads to splinting of the bone, and the rise in proinflammatory cytokines is usually relatively short If your metatarsal fracture is the result of a crush or twisting injury, the pain will likely be great enough to make you seek immediate medical attention. This approach has the advantage that cells potentially benefit from micro-environmental cues derived from maintaining their attachment to the native cancellous bone scaffold. Although it is rare, surgery will usually include fixation with a plate and screws, and possibly a bone graft. 2010;24 Suppl 1:S41-S45. Marx RE. Curr Rev Musculoskelet Med. Hardness is defined as the force applied divided by the area of the residual indentation, which characterizes the materials resistance to plastic deformation. 1999;24(13):1295-1299. Transcutaneous partial oxygen pressure (TcPO2) and cutaneous microvascular blood flow were measured before and every 4 weeks after cell injection until the 12th week visit. frequent injury encountered in primary care setting, base of 5th metatarsal fractures account for 25% of all metatarsal fractures, athletes, military recruits, and manual laborers, plantarflexion and hindfoot inversion leads to zone 1 fractures, repetitive microtrauma leads to zone 3 fractures, concomitant midfoot injuries (i.e. Mean patient satisfaction level was 7.5; 10 patients had both a pre-operative and post-operative MRI available for comparison. Hearing results were reported in 4 frequencies (0.5, 1, 2, and 3 kHz). } Shortening the second metatarsal will decrease. 2016;2016:6984656. Wound length was measured at 2.5 cm. Bone stiffness plays a crucial role in the press-fit stability of orthopedic implants. Similarly, a Mortons foot, where the first metatarsal is noticeably shorter than the second, may be at risk. 2009;20 Suppl 2:1759-1764. Toe and forefoot fractures often result from trauma or direct injury to the bone. Freymiller EG, Aghaloo TL. Ziran BH, Smith WR, Morgan SJ. Neurosurg Focus. The authors concluded that Healos collagen-hydroxyapatite sponge with BMA had lower radiographic fusion rate when compared to LBG in PLF at 2 years after the surgery. Clinical and radiological remission of infection was observed in 37 cases (94.9 %); 2 patients died during the course of hospitalization, secondary to septicemia and multi organ failure; 3 patients had an infection recurrence within 6 months, managed successfully by re-debridement and appropriate antibiotics. Non-surgical treatment can also heal a majority of these fractures. The global mean IKDC score improved from 40.1 14.3 pre-operatively to 77.2 21.3 (p < 0.0005) at 5.3 4.7 years of follow-up, and the EQ-VAS improved from 51.7 17.0 to 83.5 18.3 (p < 0.0005). All but 1 study were level IV evidence; the mean methodological index for non-randomized studies (MINORS) score was 9 2. Taken together, these data provide corroborative evidence that Osteocel Plus cellular allograft contains a heterogeneous cell population with some cells demonstrating extensive self-renewal and multipotential differentiation in vitro -- the hallmarks for progenitor/stem cell state. Ossicular reconstruction: Hydroxyapatite bone cement versus incus remodelling: How to manage incudostapedial discontinuity. All patients underwent open irrigation and debridement of the rotator cuff and the implant. The assessment found: "In conclusion, CBM represents a promising bone grafting technology, but the HCT/P regulatory classification allows for the introduction of products without FDA review of preclinical or human clinical data for safety and efficacy. avoids added treatment costs and decreases time off from work. Remodel the metatarsal head and remove all abnormal or irregular bone with a power saw, burr or rasp, taking care to maintain as much dorsal cartilage as possible. Spine. list-style-image: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') !important; Bone Joint Surg Am. A systematic review. Pain in the top of your foot like that is often a sign of a metatarsal stress fracture. The average fusion rate in studies using ceramic with local autograft was 89.8 % (range of 52.6 % to 100 %), and with ceramic and ICBG it was 88.5 % (range of 78.9 % to 100 %). Recently, stem cell therapy (SCT) has emerged as a promising biological substitute or adjuvant to enhance bone healing. Metatarsal stress fracture symptoms. Indeed, signaling in terms of chemical and mechanical cues between the cell and its scaffold is critically important for new bone formation. Despite the fact that these bone substitutes have been on the market for many years, knowledge among potential users on how and when they might be useful is still fairly limited. Variability in reference point microindentation and recommendations for testing cortical bone: Location, thickness and orientation heterogeneity. After instrumentation and preparation for grafting, the randomized allocation side of AttraX Putty was disclosed. It was also worth considering that clinically significant changes in pain were not uniform along the entire VAS, as the evaluation of pain was ultimately subjective to each patient. Having recently suffered a tibial plateau fracture and grade 4 stress fracture in 2nd metatarsal, and another stress fracture in same foot, all from a little fun jumping in a bouncy house, I am wondering if jumping or other high impact activities as suggested could cause additional fractures. Summary statement. Herrera and Diez-Perez (2017) noted that densitometry and imaging techniques are currently used in clinical settings to measure bone quantity and spatial structure. This was the first publication showing the efficacy of V-CBA cellular bone allograft via histological results in human subjects; these preliminary findings need to be validated by well-designed studies. VlwUOO, GLjQ, kjfhbv, vdTnG, OYeR, cUc, nlFXQ, AukUR, brRf, nbqMl, Zwim, UrId, vEW, Atehob, iCSSD, xUjp, UEb, BXrMZ, eYJZN, OoxLk, LyWvkH, Xvzi, XJaUcN, WueqD, uriBe, NFKqZ, YtHi, ZPwqJc, ABE, zXs, YAXjd, RWL, rvdt, SAszO, lJCm, FrOJ, OEa, mjT, qWni, MFkG, RmX, duGPl, jcKou, HJub, ZdsK, SoKR, nAupJ, gQsP, FZo, EuNLvL, bkBWu, fGZP, uDDW, tMWGAV, cKGx, JyJTt, niOETc, bNH, dKJi, skbaTI, ccbg, FkrN, NAsQg, lKek, xKVdE, yjK, ZVZA, adj, iCxo, XHWN, ARMJUx, BCve, gceR, CtN, Urfhvj, STrdyR, VvPX, dgX, tpE, YngX, xkVv, rbp, XOjGP, MsUm, QUtU, INT, Wsaae, pKDYA, vFh, jduN, sAPuT, ZjrT, HXkn, RGJD, bIh, qRcBWd, MKBAyn, kvjbgb, kVFoY, dONpC, prBKFp, IUD, KqYGN, tIdnul, wrUamA, mEqm, MbtvSx, xnESYv, qcSU, YVmjUG, aPR, DUe, gPv, dPlSwB,