Case Reports. AJR Am J Roentgenol. Search 205,922,991 papers from all fields of science. CONCLUSION. The articular muscle was visualized in 80% (74/92), ranging from 1- to 8-mm anteroposterior thickness. It fills the gap between the posterior part of the quadriceps tendon insertion and the retropatellar cartilage covering the proximal pole of the patellar base [ 3 ]. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Scola F, Anterior suprapatellar fat pad impingement syndrome. The quadriceps (suprapatellar) fat pad (QFP) is an extrasynovial structure bordered anteriorly by the quadriceps tendon and posteriorly by the suprapatellar recess of the knee joint [ 1 ]. Of the 11 quadriceps fat pads with mass effect on the suprapatellar recess, 91% (10/11) had signal intensity greater than fat (9/11 were intermediate signal and 1/11 were fluid signal). This would have to be proven with histologic or pathologic evaluation, which was not available in this study. 10. 2018;17(3):195-202. Tsavalas N & Karantanas A. Suprapatellar Fat-Pad Mass Effect: MRI Findings and Correlation With Anterior Knee Pain. am zdemir M, Ekin E, Sari K, Yalnkaya E, Kazc Z. The average anteroposterior measurement of the quadriceps fat pad from the 92 knees was 7.5 mm (range, 412.2 mm). The presence of medial synovial plica was recorded and was considered abnormal if greater than 2 mm thick or elongated between the patellar and femoral articulation. MR images were retrospectively reviewed by two fellowship-trained radiologists (experience, 8 and 9 years) with an opinion rendered by consensus. In summary, mass effect of the quadriceps fat pad on the suprapatellar recess on MRI has a prevalence of 12% and is significantly associated with intermediate or fluid signal intensity of the quadriceps fat pad and anterior knee pain. Anterior suprapatellar fat pad impingement syndrome, anterior suprapatellar fat pad impingement syndrome, Fat pad impingement syndromes of the knee. In addition, impingement of the Hoffa fat pad, also known as Hoffa's disease, is characterized in the acute stage by an edematous and hemorrhagic-appearing infrapatellar fat pad often with mass effect [4]. You can also filter price, timings, airports and more to find the best route to Istanbul that suits your needs. The cause of the quadriceps fat pad abnormalities in this study is unknown. 3. 1A, 1B, 1C). The imaging findings are edema and convex posterior surface of the anterior suprapatellar fat pad. The quadriceps or suprapatellar fat pad is a normal fat pad, positioned between the distal quadriceps tendon anteriorly and the suprapatellar recess posteriorly. This technique is designed to tilt the patellar so the top half of the knee cap moves towards the thigh bone, with the lower half subsequently moving further away from the shin bone, reducing compression of the patella on the fat pad. This information was recorded without knowledge of the clinical history. The relationship between quadriceps fat pad syndrome and patellofemoral morphology: a case-control study. Jarraya M, Diaz L, Roemer F, Arndt W, Goud A, Guermazi A. MRI Findings Consistent with Peripatellar Fat Pad Impingement: How Much Related to Patellofemoral Maltracking? anterior suprapatellar fat pad impingement syndrome, Fat pad impingement syndromes of the knee, Anterior suprapatellar fat pad impingement syndrome. MRI reports were reviewed for meniscal and ligament abnormalities. Check for errors and try again. a pilot study. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. The term 'quadriceps fat-pad impingement' has been used to describe an inflammatory process within the anterior suprapatellar fat, manifested on MRI as high T2 signal, low T1 signal and mass effect on the quadriceps tendon. The town of Dalaman is located in the coastal plain, whereas the rest of the district - towards Fethiye district on . The anterior femoral sulcus angle was 117.8 (range, 100.5137.1). After a direct blow to the kneecap, the fat pad might end up becoming impinged between the kneecap and the distal thigh bone. The quadriceps (suprapatellar) fat pad (QFP) is an extrasynovial structure with a triangular shape and is one of the fat pads located in the anterior knee . Clinical data were reviewed for findings of anterior knee pain in the history and at physical examination. There were no significant associations between quadriceps fat pad mass effect and chondromalacia of the trochlea (2 = 4.3879, p = 0.3561), medial facet (2 = 4.9683, p = 0.2906), or lateral facet (2 = 3.9645, p = 0.4108). Fat Pad Impingement. It is the smallest fat pad and triangular-shaped with average size of 8 2 mm in men and 7 2 mm in women [ 3 ]. Enlargement of the quadriceps fat pad on MRI has a prevalence of 12% and is significantly associated with intermediate or fluid signal intensity of the quadriceps fat pad and anterior knee pain. There is no significant correlation with patellofemoral maltracking 8. The quadriceps fat pad lies above the patella in the anterior knee. It fills the gap between the quadriceps tendon, the * Benedikt J. Schwaiger bschwaiger@gmx.com 1 Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry Street, Suite 350, San . data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAKAAAAB4CAYAAAB1ovlvAAAAAXNSR0IArs4c6QAAAnpJREFUeF7t17Fpw1AARdFv7WJN4EVcawrPJZeeR3u4kiGQkCYJaXxBHLUSPHT/AaHTvu . A medial plica was identified in 43% (40/92) and was considered abnormally thick (> 2 mm) or elongated in 3% (3/92) with no significant association with quadriceps fat pad mass effect (2 = 0.7966, p = 0.6714). Borja M, Jose J, Vecchione D, Clifford P, Lesniak B. Prefemoral Fat Pad Impingement Syndrome: Identification and Diagnosis. Suprapatellar Fat-Pad Mass Effect: MRI Findings and Correlation With Anterior Knee Pain, Review. 2. Quadriceps and anterior hip stretching is found to improve IFP restriction symptoms . Because of the small number of patients with anterior knee pain and quadriceps fat pad enlargement, no conclusions can be drawn from these clinical data. Do Patients Really Have Pain with Quadriceps Fat Pad Edema? In addition, the maximal anteroposterior thickness of the quadriceps fat pad was measured and recorded. ADVERTISEMENT: Supporters see fewer/no ads. Synovitis was considered present in 11% (10/92) and absent in 89% (82/92). Bend your elbow at a right angle. The relationship between quadriceps fat pad syndrome and patellofemoral morphology: a case-control study Authors Yavuz Yuksel 1 , Tarkan Ergun 1 , Ebru Torun 1 , Melih Unal 2 , Lena Sonnow 3 , Ozkan Kose 4 Affiliations 1 Department of Radiology, Faculty of Medicine, Alaaddin Keykubat University, Alanya, Turkey. Check for errors and try again. 2013;200(3):W291-W296. Prefemoral fat pad impingement syndrome, also known as supratrochlear / posterior suprapatellar fat pad impingement syndrome, is one of the fat pad impingement syndromes of the knee, specifically involving the prefemoral fat pad. 2016;100(1):78. It has been shown that at high knee flexion angles, patellofemoral contact is at the proximal patellar pole [10] and the suprapatellar fat pad articulates with the trochlea [5]. These synovial-lined surfaces articulate with the trochlea during knee flexion; this process increases congruency of the extensor mechanism [5]. It gets stuck between the femoral condyle and the patella. Guide: Limbs and Spine MRCS Revision Guide: Limbs and Spine Mazyar Kanani, PhD, FRCS (CTh) Fellow in Congenital Cardiac Surgery, Children's Hospital, Pittsburgh, Pennsylvania, USA. However, quadriceps fat pad enlargement was not significantly associated with medial collateral ligament abnormality on MR images. Imaging Key Wrist Ligaments: What the Surgeon Needs the Radiologist to Know, Original Research. Anterior suprapatellar (quadriceps) fat pad impingement syndrome is a controversial cause of anterior knee pain although anterior suprapatellar fat pad edema may often, and possibly more commonly, be incidental 1,2 . MRI of the Thumb: Anatomy and Spectrum of Findings in Asymptomatic Volunteers, Review. When inflamed, the infrapatellar fat pad can be pinched between the patella and the femur, or the femur and tibia. One reviewer then retrospectively evaluated the referring physician's notes for clinical indicators of anterior or patellofemoral knee pain as determined by history and physical examination. Patella Hypermobility - the patella may have a large amount of movement which can impinge the fat pad. An additional anterior knee structure, the articular muscle, is found deep relative to the quadriceps muscle, is present in all individuals, and is routinely visualized on MR images [9]. One final theory of quadriceps fat pad enlargement is that of a primary or intrinsic cause. This injury affects at least one ligament that connects the fibula and tibia bones being sprained. Loss of Council on Sports Medicine and Fitness eccentric quadriceps strength in the postopera- (Table 3.1) is most commonly used and quite use- tive phase of anterior cruciate ligament . A fat pad apron extends from the retropatellar fat pad to compartmentalize the bursa partially. The quadriceps tendon showed normal appearance in 60% (55/92), tendinosis in 40% (37/92), partial-thickness tear in 0% (0/92), and full-thickness tear in 0% (0/92). A high-riding patella, a short distance between the patellar ligament and the lateral trochlear facet, and an increased distance from the tibial tubercle to the trochlear groove are associated with superolateral Hoffa fat pad edema at MR imaging. Edema and convex posterior surface of the quadriceps (anterior suprapatellar) fat pad. The suprapatellar recess, an extension of the knee joint, does not possess a capsule. Differential Diagnosis List Consecutive patients who had undergone MRI of the knee in April 2002 were identified. In addition, predominant quadriceps fat pad signal intensity was characterized as fat intensity, intermediate intensity (equal to muscle or hyaline cartilage), or fluid intensity on proton densityweighted fat-saturation MR images. However, we found no association between quadriceps fat pad enlargement and patellar length, patellar tendon length, patellar articular length, and femoral sulcus angle. 1. The femoral sulcus angle (angle of the anterior trochlear groove) was measured on the axial sequence at a space approximately 10 mm above the distal femur. 1 To our knowledge, there are no reports of quadriceps fat pad edema as shown on sonography. Compression of the ulnar nerve as it passes the inner aspect of the elbow (figure 10) often due to a direct impact or. There were no other statistically significant associations between anterior knee pain at physical examination or by history and other data. In addition, 100% (5/5) of patients with quadriceps fat pad mass effect and anterior knee pain had fat pad signal intensity greater than fat and equal to muscle or hyaline cartilage on proton densityweighted images with fat saturation. It fills the gap between the posterior part of the quadriceps tendon insertion and the retropatellar cartilage covering the proximal pole of the patellar base [ 3 ]. Infrapatellar fat pad (aka Hoffa's fat pad): A fluid filled sack that sits below the patella, and can be felt on either side of the patellar tendon (the patellar tendon connects the patella to the tibia). Hyperintense Signal Alteration in the Suprapatellar Fat Pad on MRI is Associated with Degeneration of the Patellofemoral Joint over 48 months: Data from the Osteoarthritis Initiative. Abnormalities of the infrapatellar fat pad have also been described [4]. Link to video demonstrating this. a convex border)and quadriceps tendon1-4. Increased signal intensity of the suprapatellar fat pad, with a convex posterior border and mass effect over the suprapatellar joint recess. AJR Am J Roentgenol. The patellar tendon length and patellar articular cartilage sagittal length were also measured. Pathology Prefemoral fat pad impingement is caused either by: prominent suprapatellar osteophyte, with the edema usually in the superior aspect close to the midline patellar tendon-lateral femoral condyle friction syndrome, with the edema, usually occurs in the inferolateral aspect of the fat pad secondary to lateral patellar dynamic subluxation The knee is a complex synovial joint that can be affected by a range of pathologies: ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Three normal fat pads are located about the anterior knee: the quadriceps (anterior suprapatellar), the prefemoral (posterior suprapatellar or supratrochlear), and Hoffa (infrapatellar) fat pads [46]. Patellar and trochlear chondromalacia was graded from 0 to 4 (0, normal; 1, signal abnormality without defect; 2, defect < 50% of cartilage thickness; 3, defect > 50% of thickness; 4, full-thickness defect) [8]. After we excluded patients with prior knee ligament reconstruction, prior extensor mechanism repair, or evidence on MRI of prior knee surgery, the study group consisted of 92 knee MR images from 84 patients. In this setting, sagittal MR images best . The finding of quadriceps fat pad mass effect on the suprapatellar recess was significantly associated with anterior knee pain at physical examination. Skeletal Radiol. The term 'quadriceps fat-pad impingement' has been used to describe an inflammatory process within the anterior suprapatellar fat, . Tsavalas N & Karantanas A. Suprapatellar Fat-Pad Mass Effect: MRI Findings and Correlation With Anterior Knee Pain. Search. Series: Medical Radiology Title: Imaging of Orthopedic Sports Injuries Edition: 2nd ed. They found that this abnormality represented injury or inflammation of the infrapatellar plica (or ligamentum mucosum) and can be a potential cause for knee pain or hemarthrosis [7]. A 32-year-old man was referred to a radiology department for intermittent anterior knee pain and swelling for approximately 6 months. OBJECTIVE. If you happen to have a more severe, direct impact on your kneecap, the fat pad can become impinged (pinched). Yavuz Yuksel Department of Radiology, Faculty of Medicine, Alaaddin Keykubat University, Alanya, Turkey. Repeat this process 1 - 3 times depending on the amount of support required. Suprapatellar fat pad edema may be analogous to Hoffa's disease, is rare, and may be a cause of anterior knee pain, however, this finding is not infrequent and its precise association with symptoms remains unclear. With regard to the trochlea of the femur, 66% (61/92) were normal; 8% (7/92) showed grade 1 chondromalacia; 10% (9/92), grade 2; 4% (4/92), grade 3; and 12% (11/92) showed grade 4 chondromalacia on MRI. 7. Reference article, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-77665. MRCS Revision. Prepatellar edema was present in 98% (90/92) of patients (Fig. Quadriceps fat pad syndrome is a diagnosis of exclusion which must be considered in a highly active patient with persistent anterior knee pain and without evidence of trauma or internal joint derangement. Quadriceps fat pad mass effect on the suprapatellar recess was associated with quadriceps fat pad signal intensity (2 = 7.19, p = 0.0274). ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. KNEE FAT PAD IMPINGEMENT MRI APPEARANCE MRI OF FAT PAD IMPINGEMENT AROUND THE KNEE There are four fat pads around the knee that can become impinged and can be symptomatic. ADVERTISEMENT: Supporters see fewer/no ads. Imaging findings and symptoms need to be present for diagnosis. In the absence of anterior knee pain, quadriceps fat pad edema diagnosis cannot be made based solely on MRI findings 2,10. The finding that anterior knee pain at physical examination was significantly associated with quadriceps fat pad enlargement and medial collateral ligament abnormality may suggest a potential biomechanical cause if indeed these two processes are related. 11. Suprapatellar fat pad impingement as an unusual cause of knee pain. 195 (6): 1367-73. . Dec/2022: Grey goos vodka Umfangreicher Kaufratgeber Die besten Grey goos vodka Beste Angebote Testsieger Direkt weiterlese. Each of the MR images was prospectively interpreted, and the findings were reported by one of six musculoskeletal fellowship-trained radiologists as part of their daily clinical assignment. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Anterior knee pain revealed by history or at physical examination was not associated with this finding in our study population. 2006;35(5):269-274. fall from a height or due to a collision in contact sports) with severe elbow pain, loss of function, swelling, deformity and often associated with one or more fractures. 2017;30(7):639-46. . (2018) Magnetic resonance in medical sciences : MRMS : an official journal of Japan Society of Magnetic Resonance in Medicine. Case study, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-52863. Institutional review board approval was obtained before the initiation of this investigation. In the second manuver, keeping the hip flexed, flex the knee and adduct the knee accross the body of the patient, again looking for pain in the the posterior/buttocks region. Prefemoral fat pad impingement is caused either by: Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. In addition, no association was found between thickness of the articular muscle and quadriceps fat pad enlargement. In our practice, we noted that the quadriceps fat pad may show enlargement or mass effect on the adjacent suprapatellar recess. The pre-femoral fat pad or the posterior suprapatellar fat pad is located anterior to the distal femur and superior to the trochlea, separated from the quadriceps fat pad by the suprapatellar bursa. The imaging findings are edema and convex posterior surface of the anterior suprapatellar fat pad. The average size of the quadriceps fat pad having mass effect was 8.1 mm (range, 7.412.2 mm), which was significantly different from the average size of 6.9 mm (range, 410.5 mm) without mass effect (p = 0.0006). Retrospective review of MRI reports showed medial meniscus abnormalities in 51% (47/92) (equivocal tear in 1/92 and definite tear in 46/92), lateral meniscus abnormalities in 29% (27/92) (equivocal tear in 3/92 and definite tear in 24/92), and no significant association with quadriceps fat pad mass effect (2 = 1.1416, p = 0.5651 and 2 = 1.5917, p = 0.4512, respectively). A recent study reported an association with patellofemoral joint degeneration 9. The quadriceps (suprapatellar) fat pad (QFP) is an extrasynovial structure with a triangular shape and is one of the fat pads located in the anterior knee . The chi-square and Student's t tests were used to determine significant associations. Skeletal Radiol. -. Enter the email address you signed up with and we'll email you a reset link. Of those quadriceps fat pads with fat signal, the average size was 7.0 mm. One reviewer who did not prospectively interpret the MR images reviewed the MRI reports retrospectively and recorded information concerning the meniscus (no tear, equivocal tear, definite tear), anterior cruciate ligament (normal, partial-thickness tear, full-thickness tear), posterior cruciate ligament (normal, abnormal), and medial and lateral collateral ligaments (normal, abnormal). 3. On further review of the patients with anterior knee pain found at physical examination and quadriceps fat pad enlargement seen on MR images, we attempted to find a common underlying factor such as a patient's body habitus or occupation, especially given bilateral involvement in one patient. Anterior knee pain at physical examination was associated with quadriceps fat pad mass effect (2 = 8.76, p = 0.0031), medial collateral ligament abnormality (2 = 4.83, p = 0.0031), and history of anterior knee pain ( 2 = 22.76, p < 0.0001). Ninety-two consecutive knee MRI examinations from 84 patients were retrospectively reviewed by two musculoskeletal radiologists for quadriceps fat pad enlargement and signal intensity. Authors Brian Van Le 1 , Srinivasan Harish Affiliation 1 Department of Radiology, McMaster University, Ontario, Canada. 4. Insights into imaging. Incidentally, we found a similar abnormality in 8% (7/92) of our patients (Fig. K Distance: 472 kms. In addition, one patient had intraarticular corticosteroid injection followed by three Synvisc injections (hylan G-F 20, Wyeth-Ayerst Pharmaceuticals), and another had an intraarticular injection of some unknown medication. Magnetic resonance imaging of impingement and friction syndromes around the knee. 1. Faour M, Ramkumar PN, Yakubek G, Khlopas A, Chughtai M et al. With regard to measurements of anatomic structures, the average patellar length was 41.2 mm (range, 32.851.4 mm), the average patellar articular length was 30.6 mm (range, 21.537.9 mm), and the average patellar tendon length was 45.7 mm (range, 30.460.9 mm). Draghi F, Ferrozzi G, Urciuoli L, Bortolotto C, Bianchi S. Hoffa's fat pad abnormalities, knee pain and magnetic resonance imaging in daily practice. The presence of the articular muscle was recorded, and maximal anteroposterior thickness, if present, was measured. Enlargement of the quadriceps fat pad on MRI has a prevalence of 12% and is significantly associated with intermediate or fluid signal intensity of the quadriceps fat pad and anterior knee pain. These treatments include exercise therapy to reduce the forces on the fat pads, leg stretching to relieve tightness, and taping or bracing the knee. Ultrasonography-Guided Injection for Quadriceps Fat Pad Edema: Preliminary Report of a Six-Month Clinical and Radiological Follow-Up. Bend your wrist slowly towards you, and then slowly release. Discover cheap flights from Mula Dalaman to Istanbul with the Opodo search engine. Imran Khan, Tanweer Ashraf, Asif Saifuddin. WHICH FOUR FAT PADS WHAT IS THE MRI APPEARANCE OF NORMAL KNEE FAT PADS WHAT DOES NORMAL FAT PAD LOOK LIKE MRI NORMAL KNEE FAT PADS Dynamic quad exercises can be prescribed to treat this. RESULTS. 2. Jarraya M, Diaz LE, Roemer FW, Arndt WF, Goud AR, Guermazi A. MRI Findings Consistent with Peripatellar Fat Pad Impingement: How Much Related to Patellofemoral Maltracking?. J Knee Surg. Case study, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-53598. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Ibrahim D, Bell D, El-Feky M, Prefemoral fat pad impingement syndrome. Flores D, Meja Gmez C, Pathria M. Layered Approach to the Anterior Knee: Normal Anatomy and Disorders Associated with Anterior Knee Pain. The anterior suprapatellar fat pad shows edema with increased signal intensity with a slightly convex posterior surface. In the first manuver, keeping the leg straight, flex the hip up to 90 degrees, looking for pain in the posterior/buttocks region. A patient has right shoulder pain. The term "quadriceps fat pad edema" has been used to describe an inflammatory process within the suprapatellar fat, manifested on magnetic resonance imaging (MRI) as high T2 signal, low T2 signal, and mass effect on the quadriceps tendon. The purpose of this investigation was to characterize the MRI appearance of the quadriceps fat pad and to correlate these findings with other knee abnormalities, anatomic measurements of the extensor mechanism, and findings in the patient's history and at physical examination. 2012;2012(dec09 1):bcr2012007643-bcr2012007643. Patients present with anterior knee pain exacerbated by hyperextension. The patellar tendon showed normal appearance in 67% (62/92), tendinosis in 32% (29/92), partial-thickness tear in 1% (1/92), and full-thickness tear in 0% (0/92). 17 (3): 195-202. Skeletal Radiol. A ankle syndesmosis injury is a severe form of ankle sprain that also causes damage to other ligaments that support the ankle . Figure 1 2018;38(7):2069-101. Our results show that this subjective assessment is useful because of a significant association between mass effect and measured anteroposterior thickness. No significant relationship was found between quadriceps fat pad signal intensity and patient age (p = 0.45). With regard to the lateral facet of the patella, 40.2% (37/92) were normal; 28.3% (26/92) showed grade 1 chondromalacia; 9.8% (9/92), grade 2; 5.4% (5/92), grade 3; and 16.3% (15/92) showed grade 4 chondromalacia on MRI. Magn Reson Med Sci. 2009 Jul;28 (7):959-62. doi: 10.7863/jum.2009.28.7.959. Check for errors and try again. Presence or absence of prepatellar edema (fluid signal on proton densityweighted MR images) was noted. Unable to process the form. Since the fat pad is one of the most sensitive areas within the knee, it is thought to be quite painful. Because this injury involves ligaments located above the ankle joint it is sometimes called a high ankle sprain. 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