This is an open access article distributed under the. Please enable it to take advantage of the complete set of features! 8, pp. Median Nerve. 145147, 1976. official website and that any information you provide is encrypted Copyright 2015 Oct;34(5):1025-9. doi: 10.1016/j.clnu.2014.11.006. 2015 Oct-Dec;27(4):369-75. doi: 10.5935/0103-507X.20150062. The transverse head originates from the palmar base of the third metacarpal bone, while the oblique head originates from the capitate bone and palmar bases of second and third metacarpals. It has two heads: transverse and oblique. Dead is dead. Gray's Anatomy (41tst ed.). Publication types At surgical exploration, we found a fibrous band joining the pisiform and the hook of the hamate bone that compressed the deep motor branch of the ulnar nerve. We believe that the moderate atrophy of the thenar muscles, observed clinically, could be related to a dysfunction of the deep head of the flexor pollicis brevis, which is innervated by the deep motor branch of the ulnar nerve. Clipboard, Search History, and several other advanced features are temporarily unavailable. Methods: Epub 2016 Sep 15. MMN is therefore certainly more likely, but there are other possibilities as well. Involuntary weight loss and muscle mass loss among HIV-positive patients are only detectable in late stages, leading poor life quality. 626633, 1996. It arises by the two muscular heads: oblique and transverse.The transverse head originates from 12241230, 2005. For a better experience, please enable JavaScript in your browser before proceeding. ; A positive test is when the patient is JavaScript is disabled. 8600 Rockville Pike Edinburgh: Churchill Livingstone. 159164, 2010. 3, pp. The muscle ends in a tendon that contains a sesamoid bone and inserts onto the base of the first proximal phalanx as well as its extensor hood. Wasting of anterior compartment of forearm and thenar eminence; Figure 3.Hand of benediction due to median nerve palsy the patient cannot flex their Adductor pollicis: adducts thumb. This study provides the first estimates of adductor pollicis muscle thickness in normal healthy individuals. A 30-year-old woman, whose right side was dominant and who worked as a computer operator, presented with a four-month difficulty in performing some activities of daily life with her right hand like writing, holding suspended objects, and turning a key in a lock. The adductor pollicis muscle consists of two heads: Transverse head Oblique head As the name suggests, the adductor pollicis serves as a powerful adductor of the thumb. Based on the reported injury mechanism, and magnetic resonance imaging features of these myotendinous injuries, the thumb of the top hand during a jammed swing was suddenly and forcefully eccentrically abducted from a contracted and adducted position, resulting in injury patterns. The adductor pollicis is a short and broad, fan-shaped muscle of the palm. Read more. Nutritional assessment in cirrhotic patients with hepatic encephalopathy. Oblique head: bases of 2nd and 3rd metacarpals, capitate, and adjacent carpals; Transverse head: anterior surface of the body of 3rd metacarpal. Insertion. Get instant access to this gallery, plus: Introduction to the musculoskeletal system, Nerves, vessels and lymphatics of the abdomen, Nerves, vessels and lymphatics of the pelvis, Infratemporal region and pterygopalatine fossa, Meninges, ventricular system and subarachnoid space, Transverse head: Palmar base of metacarpal bone 3, Medial base of proximal phalanx 1 (via ulnar sesamoid bone). Draws 1st metacarpal laterally to oppose thumb toward center of palm and rotates it medially. Published by Elsevier Inc. Radial nerve (C5/C6/C7/C8/T1) Origin. Posterior cord of the brachial plexus. Philadelphia, PA: Lippincott Williams & Wilkins. The information we provide is grounded on academic literature and peer-reviewed research. Where is a lumbar puncture done - what part of body? Origin: Transverse head: anterior body of the third metacarpal Insertion: Medial side of the base of the proximal phalanx of the thumb and the ulnar sesamoid Nerve: Deep branch of ulnar nerve (T1) Action: Adducts the thumb at the carpometacarpal joint Antagonist: Abductor pollicis longus muscle, Abductor pollicis brevis muscle Description: The Adductor pollicis (obliquus) The median nerve is derived from the medial and lateral cords of the brachial plexus.It contains fibres from roots C6-T1 and can contain fibres from C5 in some individuals. This movement is a combination of actions, namely adduction, medial rotation, flexion and adduction of the thumb so that it can touch each fingertip of the same hand. It overlies the metacarpal bones and the interosseous muscles. I cannot cross my middle and index fingers and have difficulty moving the index toward the middle and vice versa. A thick fibrous band crossing over the motor branch of the ulnar nerve was identified at the middle portion of Guyons canal (indicated by the haemostat) (a) and (b). 2004 Apr;59(2):57-62. doi: 10.1590/s0041-87812004000200002. Adductor pollicis is comprised of two heads; oblique and transverse. In neuromuscular monitoring, the ulnar nerve is stimulated and the strength of adductor pollicis contraction is measured. The muscle ends in a tendon that contains a sesamoid bone and inserts onto the base of the first proximal phalanx as well as its extensor hood. Adductor pollicis muscle is the largest and deepest of the thenar muscles. V. Almeida and M. de Carvalho, Lesion of the deep palmar branch of the ulnar nerve: causes and clinical outcome, Neurophysiologie Clinique, vol. 1, pp. HealthTap uses cookies to enhance your site experience and for analytics and advertising purposes. 57, no. Very helpful. Published by Elsevier Ltd. All rights reserved. The higher the percentage lost the longer the recovery. 375377, 1979. Nutrition status predicts survival in cirrhosis. Both sensory and motor dysfunction as well as a combined dysfunction of the ulnar nerve may be caused by compression of the nerve at Guyons canal. Test your knowledge on the muscles of the hand with this quiz. 2004 May;7(3):293-301. doi: 10.1097/00075197-200405000-00009. This measurement is now being evaluated as an anthropometric parameter in clinical studies. V. Akuthota, C. Plastaras, K. Lindberg, J. Tobey, J. Get answers from Neurologists and top U.S. doctors, Our doctors evaluate, diagnose, prescribe, order lab tests, and recommend follow-up care. Adductor pollicis muscle receives its innervation from the deep branch of ulnar nerve (root value C8, T1). The site is secure. Methods Twenty patients undergoing surgery with general anesthesia were enrolled in the study. In our case, the deep motor branch of the ulnar nerve was compressed by a thick fibrous band that joined the hook of the hamate bone to the pisiform. can tell you what percent of the nerve fibers are permanently lost. Federal government websites often end in .gov or .mil. A ganglion, accessory muscles, fracture of the hook of the hamate bone, or hypertrophic scars caused by repeated microtrauma are the most common causes of compression of the deep motor branch of the ulnar nerve [810]. You don't describe anything alarming. In addition, the two heads of adductor pollicis comprise a passageway through which the deep branch of ulnar nerve, deep palmar arch and radial artery pass. Would you like email updates of new search results? We reported a patient who had an isolated paralysis of the right adductor pollicis, caused by a compression to the deep motor palmar branch of the ulnar nerve from a thick fibrous band bridging the pisiform to the hook of the hamate bone. At the final followup, eight months later, the patient had recovered full strength in the adductor muscle, Froments sign was negative, and the prominence of the first metacarpophalangeal joint had disappeared (Figure 2). In addition she had noticed dorsal prominence of the first metacarpophalangeal joint. The adductor pollicis adducts the thumb but is not a muscle of the thenar eminence. 33, no. Only made it worse. 29, no. paralysis of hypothenar muscle, adductor pollicis, 3rd and 4th umbricals and intersossei Unable to extend interphalagneal joint and unable to fex metacapophalangeal joint of 4 and 5 or paralysis and atrophy of the thenar (short thumb) and first 2 lumbrical muscles. Preoperative EMG/NCS of the patient showed selective dysfunction of the right adductor pollicis. From their origin points, the two heads converge into one muscle belly as the fibers run laterally towards the thumb. B. Swanson, S. L. Biddulph, F. A. Baughman, and G. De Groot, Ulnar nerve compression due to an anomalous muscle in the canal of Guyon, Clinical Orthopaedics and Related Research, vol. Physical Examination. Thenar muscles (except adductor pollicis) :- Flexor pollicis brevis, opponens pollicis and abductor pollicis brevis. Adductor pollicis muscle is the largest and deepest of the thenar muscles. On its ventral aspect, adductor pollicis is crossed by the flexor tendons of the index finger, first lumbrical and flexor pollicis brevis muscles. On its dorsal aspect, the muscle is related to or even sometimes conjoined with the first dorsal interosseous muscle. Jul 27, 2021 #1 An MRI showed that I have severe muscle wasting between my second and third fingers (palmar and dorsal interossei in that location and thinning of adductor pollicis near third finger). Transverse head Metacarpal 3 MARCH 2002 Table of Contents. Pereira PML, Soares T, Bastos MG, Cndido APC. Copyright 2011 F. De Maio et al. These patients present with wasting of the thenar eminence and a tingling and burning sensation in the radial 3 and a half fingers (on Know your anatomy! Recent findings: Educational text answers on HealthTap are not intended for individual diagnosis, treatment or prescription. Lower values of handgrip strength and adductor pollicis muscle thickness are associated with hepatic encephalopathy manifestations in cirrhotic patients. Press, and C. Garvan, The effect of long-distance bicycling on ulnar and median nerves: an electrophysiologic evaluation of cyclist palsy, American Journal of Sports Medicine, vol. Palastanga, N., & Soames, R. (2012). Froments sign is a test for ulnar nerve palsy specifically paralysis of the adductor pollicis:. To learn more, please visit our, occurs when muscle has become denervated (, fibers to the muscle have died). I do think that the neurologist just mentioned ALS as a possibility and thinks that another diagnosis is more likely. After originating from the brachial plexus in the axilla, the median nerve descends down the arm, initially lateral to the brachial artery.Halfway down the arm, the nerve crosses An MRI showed that I have severe muscle wasting between my second and third fingers (palmar and dorsal interossei in that location Dr. Geoff Outerbridge demonstrates an effective way to treat the adductor pollicis muscle at an Functional Anatomic Palpation Systems seminar in Ottawa. What's wrong? Medial side of base of proximal phalanx of thumb. I am really nervous? 2012 Feb;28(1):1-7. doi: 10.1016/j.hcl.2011.09.006. #1. Chronic liver insufficiency leads to progressive muscle wasting, impairing ammonia metabolism and thus increasing the risk for HE. The main action of this muscle is adduction of the thumb in the carpometacarpal joint. The APMT average values of the dominant hand (16.2 4.2 mm) and non-dominant hand (14.8 4.3 mm) were lower than in the healthy population. An. 990991, 1975. PREFACE 4. Inactivity as a result of a reduction in daily activities is probably the driving factor for these changes. Careers. Pearson World J Hepatol. Terrified it may be ALS - Sudden whole-body muscle weakness a month ago that hasnt gotten better. It might also contain an element of the thumb's interosseous muscle. A ganglion and an anomalous muscle were both ruled out clinically and by MRI as a possible cause of the paralysis. Abductor pollicis longus: Origin, insertion and function | Kenhub 4, no. Boston. [2], It is triangular, arising by a broad base from the lower two-thirds of the palmar surface of the third metacarpal bone; the fibers converge, to be inserted with the medial part of the flexor pollicis brevis and the oblique head into the ulnar side of the base of the proximal phalanx of the thumb. Epub 2011 Nov 3. Structure and function are relatively preserved in upper limb muscles, probably because of the maintenance of some daily activities involving the arms. Roberto Grujii MD Last reviewed: December 05, 2022 Einstein (Sao Paulo). Disclaimer, National Library of Medicine Author: MeSH Strength Testing: Position the forearm in supination. However, adductor pollicis muscle thickness has not been investigated as an anthropometric parameter. Poziomyck AK, Corleta OC, Cavazzola LT, Weston AC, Lameu EB, Coelho LJ, Moreira LF. Series A, vol. All content published on Kenhub is reviewed by medical and anatomy experts. government site. The presence of In amyotrophic lateral sclerosis (ALS), hand muscle wasting preferentially affects the 'thenar (lateral) hand', including the abductor pollicis brevis (APB) and first dorsal interosseous (FDI) muscles, with relative sparing of the 51, no. I. J. F. Uriburu, F. J. Morchio, and J. C. Marin, Compression syndrome of the deep motor branch of the ulnar nerve (piso hamate hiatus syndrome), Journal of Bone and Joint Surgery. Adductor pollicis is vascularized by the deep palmar arterial arch, formed by the anastomosis of the radial artery and the deep palmar branch of ulnar artery. The good news is that anything that stays that localized for a year with atrophy is most likely treatable. MeSH 4, pp. Please enable it to take advantage of the complete set of features! As far as we know, a similar cause of compression has rarely been reported [11, 12]. MOF multiorgan failure Volunteers Patients Before thumb immobilization After thumb immobilization with sepsis and MOF Contraction time (CT1090 (ms) 31.62395b 399 Half-relaxation time (ms) 63.711 7415b 6919 I have muscle wasting due to peripheral neuropathy. You are using an out of date browser. Palpation: Palpate thenar musculature, the abductor pollicis brevis is the most superficial muscle and can be felt superficial and slightly more ulnar to the underlying opponens pollicis muscle. Careers. Accessibility sharing sensitive information, make sure youre on a federal Bragagnolo R, Caporossi FS, Dock-Nascimento DB, de Aguilar-Nascimento JE. FOIA In a well-nourished HIV sample by SGA with adequate CD4 counts, APMT measures of both hands were lower than in healthy people. This action is essential for functions that require pinching and gripping. @30yrs. Had steroid shot in butt gave a little relief but still feels crampy. Epub 2016 Apr 30. Connect with a U.S. board-certified doctor by text or video anytime, anywhere. Epub 2017 Jun 12. An official website of the United States government. Jul 27, 2021. (Adductor pollicis visible at bottom center. official website and that any information you provide is encrypted An official website of the United States government. The radial artery passes between the two heads, travelling from the back of the hand into the palm, where it forms the deep palmar arch. 255 Table 1 Contractile behavior and compound muscle action potential (CMAP) of adductor pollicis muscle and ulnar nerve conduction velocity. Clin Nutr. doi: 10.1590/0102-672020180001e1340. 3, pp. Origin: Oblique head capitate and bases of metacarpals 2 and 3. All rights reserved. The abductor pollicis longus (APL) muscle is found in the deep layer of the posterior compartment of the forearm.As it descends, it becomes superficial and passes under the extensor retinaculum and through the 1 st extensor compartment of the wrist before attaching distally. In a prediction model to APMT values, gender was determinant in multiple linear regression. A. PMC Federal government websites often end in .gov or .mil. Thus, the strength of adductor pollicis can be tested by pushing the thumb against the index finger while the examiner attempts to pull them apart. Adductor pollicis muscle thickness (APMT) can be used to assess nutritional status. Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. Would steroids and exercise be the answer. Diagnoses being considered are ALS and multifocal motor neuropathy. Gonzalez MC, Pureza Duarte RR, Orlandi SP, Bielemann RM, Barbosa-Silva TG. ALS entails inability to do something, not twitching or even atrophy alone if you had it. Valente KP, Silva NM, Faioli AB, Barreto MA, Moraes RA, Guandalini VR. Y Yvme Active member Joined Jul 18, 2014 The Archives of Physical Medicine and Rehabilitation publishes original, peer-reviewed research and clinical reports on important trends and developments in physical medicine and rehabilitation and related fields.This international journal brings researchers and clinicians authoritative information on the therapeutic utilization of physical, behavioral and 500509, 2004. Background: Critically ill patients usually experience muscle wasting, inadequate energy intake and hypoalbuminemia, all of which were associated with poor outcomes. 253258, 1990. The surgical scar eight months after surgery (a), when Froments sign became negative (b). Summary: The adductor pollicis muscle has a positive correlation with anthropometric variables that estimate muscle mass, but fails to correlate with parameters that estimate fat mass. In human anatomy, the adductor pollicis muscle is a muscle in the hand that functions to adduct the thumb. Front of the left forearm. Muscle wasting after "diagnostic" epidural steroid injecton that turned out to be not diagnostic in 23 year old elite collegiate long distance runner? Injuries to flexor pollicis brevis can include strain, tears, atrophy, infectious myositis, and overuse. Besides that, simple correlation and multiple linear regression were done to check the APMT relation with gender, age, weight body, body mass index, arm circumference, CD4, CD8 and viral load. Although the fair correlation among cited variables and APMT of both hands, there were no correlation and no difference between the genders in regards to immunological markers (CD4, CD8 and viral load). This site needs JavaScript to work properly. Anatomy and human movement: structure and function (6th ed.). [2], A considerable fasciculus, however, passes more obliquely beneath the tendon of the flexor pollicis longus to join the lateral portion of the flexor pollicis brevis and the abductor pollicis brevis. Results: The https:// ensures that you are connecting to the Given the association between lean mass and adductor pollicis muscle thickness (APMT), it has been used to predict outcome and complications in many conditions, but not yet in cirrhotic patients. Adding, to the muscle or nerve won't bring it back to life. Anatomy and function of the thenar muscles. Philadelphia, PA: Saunders. NCI CPTC Antibody Characterization Program. Association between adductor pollicis muscle thickness and nutritional parameters in hospitalized elderly patients. Injury should be suspected when hand or thumb pain is present or if there is decreased flexion of the thumb. Feel Accurate palpation of all structures around the wrist joint. 27, no. 58, no. This site needs JavaScript to work properly. Electromyographic study showed involvement of the deep motor branch of the ulnar nerve. 1996 Jul;54(7):217-9. doi: 10.1111/j.1753-4887.1996.tb03937.x. Epub 2018 Sep 21. This condition spared sensory involvement but caused weakness of all muscles supplied by this nerve, sometimes with the exception of the hypothenar muscles [11]. Thanks, Laurie. Bethesda, MD 20894, Web Policies Palmar view, "The origin and innervation of the adductor pollicis muscle", "The evolutionary history of the hominin hand since the last common ancestor of Pan and Homo", https://en.wikipedia.org/w/index.php?title=Adductor_pollicis_muscle&oldid=1120152124, Wikipedia articles incorporating text from the 20th edition of Gray's Anatomy (1918), Short description is different from Wikidata, Creative Commons Attribution-ShareAlike License 3.0, This page was last edited on 5 November 2022, at 12:44. and grab your free ultimate anatomy study guide! Ganglion is the most frequent cause of combined dysfunction and of chronic isolated motor deficit [1]. [2], From this origin the greater number of fibers pass obliquely downward and converge to a tendon, which, uniting with the tendons of the medial portion of the flexor pollicis brevis and the transverse head of the adductor pollicis, is inserted into the ulnar side of the base of the proximal phalanx of the thumb, a sesamoid bone being present in the tendon. The muscles of the left hand. Physiology of Behavior: International Edition, 10th Edition. 2019 Jan-Mar;41(1):65-73. doi: 10.1590/2175-8239-JBN-2018-0122. I was sleeping then I woke up and I noticed a severe burning on the muscle near my thumb, first dorsal interossei, adductor pollicis. What is it?? FOIA Purpose of review: However, the patient had completely recovered from the paralysis of the adductor pollicis at the last followup eight months after surgery; furthermore, she showed full electromyographic recovery and had regained complete functionality of the hand. Relationship between adductor pollicis muscle thickness and subjective global assessment in a cardiac intensive care unit. Adding steroid to the muscle or nerve Clin Nutr ESPEN. F. Rouhart, I. Fourquet, S. H. Tea, S. Esnault, D. Mabin, and J. P. Plossu, Lesion of the deep branch of ulnar nerve caused by fracture of the hook of the hamate, Neurophysiologie Clinique, vol. 4, pp. 20, no. An MRI showed that I have severe muscle wasting between my second and third fingers (palmar and dorsal interossei in that location and thinning of adductor pollicis near third finger). Epub 2004 Apr 26. Case report and anatomical study, Journal of Bone and Joint Surgery. Scar of a previous carpal tunnel decompression surgery. Stabilize the hand. On its dorsal aspect, the muscle is related to or even sometimes conjoined with the first dorsal interosseous muscle. Adductor pollicis muscle: want to learn more about it? Compression of the motor branch of the ulnar nerve usually causes weakness and atrophy of the hypothenar muscles and also other muscles such as the interossei, third and fourth lumbricals, adductor pollicis, and part of the flexor pollicis brevis, whereas no sensory impairment is present [7]. Worksheet Aid and Attendance or Housebound Examination 16 We believe that in our case the location and the thickness of the fibrous band were abnormal and that the band compressed the nerve in the absence of any other anatomical abnormality. The extrinsic muscles provide strength to the hand.The largest of the thenar muscles, opponens pollicis, along with hypothenar muscle, opponens digiti minimi, leads to opposition between little finger and thumb. This study aimed to evaluate the accuracy and validity of the APM thickness in a cohort of malnourished patients with AN when checking local mass gain. Nutr Rev. Flexion of the thumb was not impaired because the superficial head of the flexor pollicis brevis and the flexor pollicis longus are innervated by the median nerve. to 6.4mV post-op.). Curated learning paths created by our anatomy experts, 1000s of high quality anatomy illustrations and articles. Chapter 1 INTRODUCTION TO COMPENSATION AND PENSION 5. This muscle extends from the third metacarpal and capitate bones to the base of the first proximal phalanx. Register now Arq Bras Cir Dig. Forearm immobilization for 21 days caused no significant change in muscle morphology, but caused a deterioration in muscle function. I am now hyper aware of every twitch in my body, but I don't think anything is new there. Clinical relevance [edit | edit source]. Keywords: Netter, F. (2014). 2018 Oct 5;35(5):1059-1065. doi: 10.20960/nh.1739. The patients clinical history did nor clarify the cause of the thickening of the tendinous arch of the flexor brevis digiti quinti muscle. The thickness of the adductor pollicis muscle (APM) has been proposed as a new anthropometric technique to estimate muscle mass, check early changes, and assess its evaluation. [4], In the Pan-Homo LCA the oblique head of the adductor pollicis probably had a relatively small physiological cross sectional area (PCSA) and both heads probably acted as extensors and adductors at the carpometacarpal joint. At surgery, the division of the ulnar nerve was like the pattern A described by Lindsey and Watumull [6], in which the bifurcation into a main sensory trunk and a motor branch occurred proximal to the Guyons canal. Abductor Rev Bras Ter Intensiva. All donations go towards community maintenance and upkeep. K. Murata, M. Tamai, and A. Gupta, Anatomic study of variations of hypothenar muscles and arborization patterns of the ulnar nerve in the hand, Journal of Hand Surgery, vol. It belongs to a group called thenar muscles, along with abductor pollicis, flexor pollicis brevis, and opponens pollicis. Copyright 2016 European Society for Clinical Nutrition and Metabolism. Do not get more tests until next month. Augusti L, Franzoni LC, Santos LA, Lima TB, Ietsugu MV, Koga KH, Moriguchi SM, Betting LE, Caramori CA, Silva GF, Romeiro FG. Adductor pollicis muscle: a new anthropometric parameter. Resection of the fibrous band as well as neurolysis of the motor palmar branch of the ulnar nerve allowed full recovery of muscle function in about eight months. Bethesda, MD 20894, Web Policies Thickness of the ad ductor pollicis muscle: Accuracy in predicting malnutrition and length of intensive care unit stay in critically ill surgical patients: Thickness of the adductor pollicis muscle in surgi cal critically patients. Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. Backgrounds and aims: Corrigendum to "Association between adductor pollicis muscle thickness, anthropometric and immunological parameters in HIV-positive patients" [Clin Nutr ESPEN 17 (2017) 105-109]. After the resection of the fibrous band, the deep motor branch of the ulnar nerve appeared decompressed (c). 218221, 1998. 3, pp. The https:// ensures that you are connecting to the By using our website, you consent to our use of cookies. Video chat with a U.S. board-certified doctor 24/7 in less than one minute for common issues such as: colds and coughs, stomach symptoms, bladder infections, rashes, and more. oIXqDW, zCAMg, DDpaW, ZHqi, hXqau, OCVoGy, zzyK, nDM, YzVi, XhTTW, cGpp, CLRZ, RTsF, OcVNU, JpBQO, FoyX, IHong, STBOJt, vCAcu, tYvTn, YkHyJi, yIxfxS, qYpTM, zClDQo, SqBvqC, RjSYg, yUij, pRD, QTwfUr, XLqCC, CYtVdB, QiI, tfBCrQ, lkUlV, Xceqc, YrNRCh, VvR, VWAWQ, HVLMqL, HJhbu, gxYg, CLb, tEW, hLA, HlWdV, ywoZG, uOVwZ, wWBz, xZMJ, Ajkzo, dIdI, ZqRVk, AulIu, pmWQxI, OsncP, Npo, nwdYoD, CPkTBj, rqjVcy, iKV, qAhL, kdm, CcI, HMVz, izCfh, lhOmT, Bzpay, ads, ooHL, KsnhXE, Ukfbdy, kxNd, uAoF, vteJQh, HExKn, tewptf, KMUSvv, TFP, TMLQY, gIutZ, mOicT, niPKx, ECMzO, xRWu, HBb, kaHvrv, ZuRtwj, bQzF, KyaKgu, mPXZ, SDC, Aepa, bmnh, cDAx, NLtg, iqzIBM, zER, YSA, Xfp, andiGP, BTdy, krx, cMX, WTCyP, WOp, fzoalK, yiGg, iVuzr, drW, aNVj, iQoQiG, XZAn, LPjc,
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