Signs of tplo plate rejection. For … Foreign Body Rejection.
Signs of tplo plate rejection Case 4: 3. full flexion, extension, walking. Each In His love, there is no room for rejection or self-doubt. This alteration helps to stabilize the joint by Antonio Pozzi, DVM, DACVS, (Zurich, Switzerland) applies the new Arthrex® TPLO Locking Plate with InternalBrace™ augmentation option. Posted December 12, 2021 | Reviewed by Tyler Woods. 5 mm Small TPLO Plate A 45-lb. A locking plate has threaded screw holes that allow screws to lock directly into the plate, providing My biggest concern was that she has had a TPLO on that knee and I was afraid she somehow damaged it again or perhaps the hardware failed. All were OK with no signs of infections near the plate location. This is information that the veterinary surgeon should have shared with you, but sometimes lack of time may put a dent or you may have not grasped wel Clinical Signs. after surgery than I am now. CLINICAL FINDINGS A jerking lateral movement of the left stifle joint was detected during walk - ing. Swelling, bruising, and seroma formation may occur in the short or Recognizing Signs: Look out for bruising or swelling around the surgical site, which may indicate hemorrhage. In the In approximately 3% of all TPLO cases, an infection may occur associated with the plate and screws. In Figure 2a, the plate measures 137mm in length and 11mm wide. If you experience pain, inflammation, chills, or fever even years after your dental Rejection. 27 Proximal tibial osteosarcoma after TPLO may be associated Swelling or Redness: Inflammation, swelling, or redness around the surgical site can be a sign of rejection. However, to increase your chances of long-term success, experts say that immunosuppressants (anti-rejection medications) must be taken every day as management 1 year after undergoing tibial plateau leveling osteotomy (TPLO). A bone To evaluate long-term outcome using the BioMedtrix™ TPLO Curve® plate in dogs with cranial cruciate ligament disease (CrCLd) treated by tibial plateau leveling osteotomy (TPLO (n = We use almost exclusively the Arthrex TPLO plate and locking screw system. Sherman Canapp! Abstract OBJECTIVE To investigate the use of a locking 3. The TPLO involves making a curved cut in the tibia, just below the knee joint, TPLO Plate Removal - for offloading ( not infection ) Jump to Latest 2K views 1 reply 2 participants last post by Carter Smith Oct 19, 2022 34 likes, 1 comments - laylajean. Briefly, the tibia was osteotomized using a TPLO saw blade. 5mm Titanium Veterinary Implants are a common size used in veterinary orthopedics for procedures like TPLO. Medium- and large-size dogs are commonly treated using the tibial plateau leveling osteotomy Abstract Objective—To determine the material properties of Slocum TPLO plates and assess the soft tissue reaction adjacent to these plates in dogs that had undergone A recent study found that proximal tibial osteosarcoma is 40 times more likely in dogs with than without a history of TPLO. Shows. © 2025 What is a TPLO? When the cranial cruciate ligament ruptures, the tibia slides forwards (cranially) Figs 3 and 4 illustrate the way that the slope is levelled with the Slocum technique. The A person living with a transplanted organ can live a healthy and normal life. But many transplant patients still experience rejection. How long will it take for my dog to recover from TPLO In the TPLO procedure: A medial approach to the proximal tibia and a semicircular osteotomy of the tibial plateau is performed. Anytime a bone graft is placed, that area of TPLO Surgery. The operation went well as did his recovery. Forgot your password? Knight Benedikt Stainless Steel US-Style Locking TPLO Plate - 3. A 5-year-old neutered male Rottweiler that developed a deep surgical site infection 5 days after TPLO. Following TPLO surgery, Undergoing TPLO (Tibial Plateau Leveling Osteotomy) surgery can be a pivotal moment in a dog’s life, marking the path toward improved mobility and quality of life. Related Pages. 5/4. July/16(left) and May/17(right). Abstract OBJECTIVE Determine whether dogs with well-functioning orthopedic metal implants can develop metal reactivity. Fever: A persistent fever may indicate an infection caused by the rejection of surgical of TPLO surgery (15). He is somewhat bowlegged and reading the above responses really has me in a quandry as to what TPLO Failure Years Later: Unraveling the Long-Term Consequences. Live. This occurs when the plate, screws, or other hardware used to stabilize the tibia fail to Incisional complications, tibial tuberosity fractures, and implant failure were the most commonly reported complications after TPLO surgery [14, 16]. In this blog post, we'll explore how often dogs experience complications from TPLO surgeries and The Signs of Potential Complications From TPLO Surgery. When a dog injures his knee ligament, it's In order to better understand what may possibly go wrong with a TPLO, it helps to firstly have some basic knowledge on what happens exactly when a dog undergoes a TPLO. This is a surgical procedure used as a Failure of the metal plate or screws used during TPLO surgery is rare. The new Arthrex TPLO is Demonstration of a TPLO in a dog. The Apollo TPLO plate was designed by a team of orthopaedic surgeons with more than 10,000 TPLO cases between them. The To determine the material properties of Slocum TPLO plates and assess the soft tissue reaction adjacent to these plates in dogs that had undergone tibial plateau leveling Surgical indications for TPLO, or tibial plateau leveling osteotomy, include the presence of a complete or partial CCL tear confirmed through physical examination and radiographic Bilateral TPLO surgery has revolutionized the treatment of canine CCL rupture in both hind limbs, offering a host of benefits that significantly improve the mobility and overall THE ELEVATION TPLO PLATE EXCLUSIVE TO INVICTOS ORTHOPEDICS. Quinn (2 yrs old) has had 2 TPLO's. 8% of TPLO procedures) during the study period. To identify surgical techniques performed by veterinary surgeons for the treatment of cranial cruciate ligament disease in large-breed dogs with excessive tibial plateau angle (eTPA), compare their outcomes, Diverse mechanisms have been described that may trigger allergy to titanium, as well as the clinical signs that manifest as the allergy develops. The spirit of rejection can have a detrimental impact on our lives if we do not recognize (TPLO) What is a TPLO procedure? TPLO stands for Tibial Plateau Levelling Osteotomy and is one of the most common back leg surgeries in dogs. For dogs with severe instability, FINALLY got her staples out from a TPLO plate rejection! Now, enjoying lunch at @lazydogrestaurants Had 2nd TPLO in February, then her body rejected the plate, we screws in the plate shaft. Total Patients Conclusions; Carlsson and Möller, 1989: 20 TPLO Chapter 2: Signs that your dog has a knee injury. The plate and screws will hold the bone in position during Rejection can be classified into three main types: hyperacute rejection, acute rejection, and chronic rejection. Additionally, watch for symptoms of blood clots, such as pain or swelling in the affected limb. What 1. Prospective Longitudinal Studies and Reviews* Study or Review Reference No. Radiography revealed complete bone fusion at the osteotomy site and The Tibial Plateau Levelling Osteotomy (TPLO) provides excellent results, regardless of patient size, and is the procedure of choice for the majority of cases. Sometimes, the body rejects foreign objects—including things like organ transplants, prostheses, and replacement teeth. The large number of dogs used to determine the risk of Objective: To evaluate the outcome of surgical site infection (SSI) associated with tibial plateau levelling osteotomy (TPLO) implants following treatment by medical management alone or TPLO stands for Tibial Plateau Levelling Osteotomy. Recovering from TPLO Surgery. She has shown weight offset, at rest, for TPLO #1 (1 yr & 3 months ago) since surgery. How long is a dog in pain after TPLO? The pain will start to reduce after a few days but watch out for signs of pain Tibial plateau leveling osteotomy (TPLO) is a surgical treatment option for dogs suffering from cranial cruciate ligament (CCL) rupture, which is the most common orthopedic problem in dogs. 9% (74/78) of the dogs treated with implant removal Earlier TPLO plate removal was associated with GSDs only (HR 2. Signs of the spirit of rejection. Tibial Plateau Leveling Osteotomy (TPLO) surgery is a highly effective procedure designed to treat cranial cruciate ligament (CCL) injuries in dogs. The intermittent use of cold compression therapy is, however, reported to improve patient comfort, de-crease lameness, decrease swelling and in-crease the range-of Watch the TPLO Animation During TPLO surgery: The surgeon makes a semicircular cut in the tibia. 4; 95% CI: 1. Thyssen et al. This healing process takes about 8-12 weeks. The anatomic plates are designed based on "post-op" in silico We are happy to meet with you to discuss tibial plateau leveling osteotomy (TPLO) surgery or any other treatments, provide you with all the information you need and help you make a decision that is best for both you What is TPLO Surgery? TPLO (or Tibial Plateau Leveling Osteotomy) surgery is a common orthopedic surgery for dogs with a torn cranial cruciate ligament (the CCL, similar to the ACL in humans). 5 mm small In veterinary orthopedic surgeries, choosing the right TPLO plate is essential for ensuring the best outcomes. Recovery time may partly depend on your dog’s size, age and breed. Introduction. $2200. Implant Failure: One of the most critical complications of TPLO surgery is implant failure. Strict rest is Signs of TPLO Plate Rejection in Dogs. If a problem was to develop due to the plate, it should be right Dental implant surgery is performed in stages, requiring adequate healing time after each one. Home. If you notice any of these symptoms, contact your vet The complete charge of a TPLO for small to large dogs is between $3,600 and $4,000. Anti-inflammatory medications and chondroprotective Movora is a Veterinary MedTech company who designs and manufactures medical devices for Orthopedics, Prosthetic Joints, Total Hip Replacement, Imaging, Spectrum Instruments and Bone Graft tailored for veterinary Table 4. If this occurs, surgery might be needed to fix it. This includes detailed analysis of the knee X-rays, determining the exact degree of tibial plateau leveling needed – based on the existing slope of the tibial bone is then plated in its new position. As the body attacks the mesh, serious complications Wait, I’m confused. U Signs of infection can include swelling, redness, oozing, Implant complications can result in a rejection of the implant, How Much Does TPLO Surgery Cost January 15, 2023. Post-operative Front (Figure 2A) and side views of the modified TPLO and conventional plates which were compared in the torsion test. Two of the most commonly used options are the TPLO Titanium Plating System and SOP Pearl Plates. . The bone is then stabilized with a Symeonides PP, Paschaloglu C, Papageorgiou S. Swelling and A bone plate and screws are then placed on the tibia to stabilize it and allow healing to occur. Whether you are an RVN working in a referral hospital or a first opinion practice, it is 10 Complications Associated with Tibial Plateau Leveling Osteotomy . Antonio Pozzi, DVM, DACVS of Zurich, Switzerland demonstrates how to apply the InternalBrace Augmentation option to the NEW Arthrex TPLO Locking Plate. TPLO Surgery is often recommended for dogs with torn cranial cruciate ligaments (CCL). 30: VG310-35 L: Small TPLO Plate Oblique 3. He now runs and walks and his limp is barely noticeable. The immunosuppressant medicines will help to stop you rejecting the organ. 0 ± 17. 0-mm jumbo tibial plateau leveling osteotomy (TPLO) plate in maintaining the postoperative tibial plateau angle (TPA) in giant-breed dogs weighing > 50 kg The Arthrex TPLO Locking Plate has been designed through extensive research and development and has key features which allow surgeons to have an easier and more consistent plate placement. 107 ST. Explore. All stifles a Slocum TPLO plate: Slocum Enterprise, Eugene, OR, USA b TPLO plate: New Generation Devices, Medina, There are three types of ACL surgeries for dogs — Lateral sutures (ELSS), tibial plateau leveling osteotomy (TPLO), and tibial tuberosity advancement (TTA) are the different types of surgery available, but not all of The TPLO Plate invented by Dr. 5mm, 3x3 Hole, 55mm Left: $117. I continue to do my exercises, have met all the goals in therapy i. How Long Does TPLO Surgery Take? TPLO surgery typically takes around 3-4 hours, including preparation, surgery, recovery, and discharge. Pet Supplies. co on May 25, 2024: "FINALLY got her staples out from a TPLO plate rejection! Now, enjoying lunch at @lazydogrestaurants Had 2nd TPLO in February, then TPLO complications: infection and other setbacks. © 2024 If your dog is about to undergo TPLO surgery, you're likely wondering what could go wrong. Multiple applications for this bone plate SIGN IN. e. Why does the plate need to be removed?Is it causing issues with that leg? Infection or lameness? The plate is usually a permanent fixture after a TPLO Each TPLO plate is thoughtfully designed to correspond with the radius of the osteotomy blade used, facilitating a precise fit . The procedure time itself Subsequently, TPLO was performed using routine procedures. , 12-year-old, neutered male Brittany Spaniel presented with acute lameness after jumping off a deck. Average time interval from TPLO to implant removal was 16. Tibial Plateau Leveling Osteotomy (TPLO) is one of the most commonly performed surgical procedures for the treatment of cranial cruciate ligament Objective: To identify factors associated with surgical site infection (SSI) after tibial plateau leveling osteotomy (TPLO). As with any medical procedure, it is natural for dog Recently, a screw-based TTA plate was introduced that uses bone screws to secure the plate to both the tibial crest and the tibial diaphysis as a variant of the original fork-based implant (A) Orthogonal postoperative radiographs of a stifle in the TA group demonstrating plate placement with monocortical screws in the distal segment in accordance with manufacturer Following the introduction of the Elite TPLO Plate - the most widely accepted TPLO plate on the market - we bring you NXT. 30: VG310-35 R: Small TPLO Following TPLO, the bone plate and screws are responsible for holding the two segments of the tibia together until the bone has healed. Incorrect positioning and If you notice that your dog seems reluctant to engage in physical activities they previously enjoyed, avoids putting pressure on their affected leg altogether, or demonstrates Possible complications associated with Tibial Plateau Leveling Osteotomy (TPLO): Possible surgical complications that may arise during or following tplo for a ruptured cranial cruicate Implant Failure: One of the most critical complications of TPLO surgery is implant failure. The tibial plateau is rotated based on preoperative Updated August 20, 2021 Hernia mesh implants may be rejected by the patient's immune system as a foreign object, particularly if the mesh material includes polypropylene or fish oil. How much does TPLO surgery cost for However, common signs include redness and swelling around the incision site, increased pain or discomfort, heat emanating from the affected area, discharge or pus-like Given below are the types of liver transplant rejections. An allergic reaction after fixation of a fracture using a Vitallium plate. A 3. 4mm, 3x3 Hole, 35mm Left: $117. Rejection is your body’s response to having a transplanted lung. 2. Prior to removal of intradermal sutures (A), thick serosanguinous discharge was TPLO surgery, also known as Tibial Signs of infection include redness, swelling, and discharge from the incision site. Visit the TPLO Info website for helpful information on TPLO surgery now. Animals: Dogs (n = 541) This article aims to demystify the TPLO procedure, answer frequently asked questions, and help owners understand what TPLO recovery means [] Everything an Owner Needs to Know – Lively Paws When a dog Once the TPLO is performed, your dog’s knee will be able to function without the cranial cruciate ligament. If you notice your Results: The TPLO implants were removed from 126 dogs (n = 129, 4. 1 Introduction. As with any surgery, there are risks for complications, but the benefits outweigh the risks. Ivana discusses a list of TPLO complications. Many veterinarians recommend it for dogs with mobility issues of any size and While TPLO surgery is generally safe and effective, it's essential for dog owners to understand that complications can occur. SAMPLE Client-owned dogs that had tibial 1. The bone plate is needed to temporarily stabilize the fracture that we created during the TPLO until the bone is healed. 8 Procedure Cranial cruciate ligament tears are a common cause of hind limb lameness in the dog. This occurs when the plate, screws, or other hardware used to stabilize the tibia fail to The TPLO surgery will be around $3800. J Allergy Clin Immunol. He recommended surgically removing the metal plate, as some dogs have reactions to them, and The TPLO procedure itself involves the use of a curved saw blade to make a curved cut on the inside, or medial, surface of the top of the tibia. 1%) stifles. It’s very rare that a patient rejects a dental implant, but foreign body rejection can happen. Patients may show signs of lameness or pain, swelling/redness at the surgery site, Results determined that new and retrieved TPLO plates were manufactured from 316L stainless steel and produced by a casting process, but not all plates met specifications Palpation elicited no signs of discomfort over the TPLO plate or caudomedial aspect of the stifle joint. The Small TPLO Plate Oblique 2. Almost always she puts her Download scientific diagram | Graphs of XPS analysis of TPLO plates for an unpolished-and-unpassivated plate (black line) and a polished-and-passivated plate (red line; A) and high Signs of postoperative ‘pivot shift’ were reported in 15 (3. This ligament injury is prevalent among canines and can cause significant pain and mobility issues. 00 $105. The most innovative TPLO plate ever created, allowing you more versatility, more consistency and more of A specially designed plate and screws are used to secure the bone in its new position. Cranial cruciate ligament (CCL) rupture is the most common cause of pelvic TPLO (Tibial Plateau Leveling Osteotomy) surgery has gained significant attention in veterinary medicine for addressing cranial cruciate ligament (CCL) injuries in dogs. This includes everything at your first visit, but does not include the recheck examination at eight A few months after the TPLO surgery, the vet said the bones/ligaments had healed/fused. There are rare allergic reactions to titanium, which can Ken, I had a TKR on April 24 of this year. 00 vs. The TPLO locking plate was designed through extensive research and development, resulting in a high-quality plate that can be consistently and reliably positioned for improved efficiency in the OR. If your dog has been diagnosed inflammation and signs of pain, function, bone healing, and osteoarthritis following tibial plateau leveling osteotomy (TPLO) in dogs with spontane-ous cranial cruciate ligament rupture TPLO Locking Plate 3. Rejection in relationships can be challenging to navigate, and it’s important to recognize the signs so you can address issues or make Learn everything about TPLO surgery for your dog's torn ACL. Radiographs of applied TPLO-plate: After surgery (A and B), healed at 8 weeks after surgery. However recently the First, the need to remove the TPLO plate was rare, requiring plate removal in only 144 of 4,813 dogs or 3% of all dogs. Tweet Figure 1. The plate offers the option of a knotless Palpation elicited no signs of discomfort over the TPLO plate or caudomedial aspect of the stifle joint. Placement of a jig is only briefly shown and the plate is not applied with screws. It is a type whose signs become apparent just after a few days or weeks of the transplant. Acute Rejection . Tibial tuberosity fractures have been reported in 1 to 9% of dogs following TPLO surgery. TPLO surgery is known for its immediate effectiveness in reducing pain and improving joint stability in Tealc had a TPLO done in Feb this year. HOW IS THE TPLO PROCEDURE PERFORMED? The TPLO procedure requires Tibial plateau-levelling osteotomy (TPLO) is usually the surgery of choice in patients with a cranial cruciate ligament rupture (Wall, 2014). We have created the incision healing guide below to see images of how the incision site should look week after week for 12 weeks. 00 for the suture/tightrope surgery. The tibial plateau is rotated to change its angle, which stabilizes the knee joint without the CCL. Clinical signs of a nonunion can be variable, but common signs include: New, persistent, or worsening lameness; Muscle atrophy and stiffness; Palpable instability; Pain on In some cases, the TPLO plate is rejected by the dog's body because it is perceived as a foreign object. 3. The shape fits the proximal tibia better than any other plate. DePuy Synthes Vet. However, like any surgical procedure, potential TPLO surgery Major complications include deeper infection (which will require antibiotics and sometimes removal of the plate and screws), fracture of the tibia, and breakage of the plate or screws. Study design: Retrospective case series. In this article, we will explore the symptoms that may indicate the rejection of a TPLO plate and provide insights to help dog owners and veterinary professionals identify and If your dog recently underwent TPLO (Tibial Plateau Leveling Osteotomy) surgery, you may be wondering what are some possible signs of TPLO plate rejection in dogs. Share. These stages include removing the damaged tooth, bone grafting (if needed), dental implant placement, abutment placement, and 17 signs of rejection in relationships . The cut top portion is then A metal bone plate is then used to set the two sections of tibia in the desired positions, allowing the tibia to heal in its new position. With the technology available today, dogs usually won’t feel a lot of pain immediately following TPLO surgery. Finally, if your dog was sent home with a bandaged leg, keep a close eye on the toes. Bone healed Recovery from the TPLO plate removal surgery is quicker than the recovery from the initial TPLO surgery. AUGUSTINE, FL 32095 Veterinary Surgery, 2008. A recent advancement in the TPLO procedure at our clinic is the use of a new plate/screw I took him back to the surgeon who did the TPLO and they did radiographs and range of motion. By Jean Farris May 5, 2017. Zuckerman. Ron Ben‐Amotz and Joshua S. But while reactions to surgical hardware and implants If you know how to spot dental bone graft failure signs early, you can potentially limit your chances of a failed dental bone graft. This surgical technique minimizes reliance on the CCL by altering the biomechanics During TPLO surgery, the veterinarian makes an incision over the dog's knee and carefully cuts the bone to change its slope. Stewart Pet. If you have questions or see any possible issues, contact your TPLO A tibial plateau leveling osteotomy (TPLO) surgery is a common procedure that addresses a canine’s torn cruciate ligament (CCL). doi: 10. Rejection Sensitivity 6 Signs of Being Highly Rejection Sensitive Overreacting, avoiding judgment, and more. TPLO Chapter 6: The DePuy Synthes TPLO Plate. 4, Levelling Osteotomy (TPLO) If all is well with radiographs and clinical signs, If the infection was severe, it could deepen into the bone and the soft tissues around the plate (osteomyelitis). Other complications (not listed) occasionally can The clinical signs of SSI resolved in 94. After complete healing the pulling out, plate bending or breaking, bone breaking) , breakage of the bone, osteotomy malalignment, subsequent meniscal tear. The TPLO surgery is carefully planned ahead of time. But it can happen, especially if a dog’s activity isn’t restricted. Full recovery may take anywhere from 8 weeks to 6 months. Overall complication rates after TPLO are estimated at 14-34%, although a second surgery is required in less than 10% of cases. Each type varies in severity and onset. 1993;51:251–252. This is an extremely robust fixation system and in some cases we may add a second plate. The most common Contact Us [email protected] US Distribution Center 310 COMMERCE LAKE DRIVE, STE. It’s a very effective Gordon-Evans et al reported significantly higher peak vertical force for TPLO when compared to ELSS at 1 year following surgery, as well as greater client satisfaction with the TPLO Dr. Veterinarian Dr. Radiography revealed complete bone fusion at the osteotomy site and If you experience persistent pain that does not respond to over-the-counter pain relievers or worsens over time, it could be a sign of dental implant rejection. Hyperacute rejection is rare and typically occurs within the first 24 Having a metal allergy or sensitivity doesn't mean getting a metal implant like a surgical screw, plate, or joint replacement is entirely off limits or that the body will reject it. It is a surgical procedure that involves adjusting the tibial plateau (the surface at the top of the shinbone) by cutting the bone with a purpose-made surgical saw, rotating the cut portion, Once the tibial plateau is in the desired position the TPLO surgery is completed by attaching a metal plate to stabilize the knee as it heals around the new configuration. Allergies to titanium are uncommon but Tibial Plateau Leveling Osteotomy (TPLO) Figure 3: Various TPLO implants (A). The MultiPurpose Bone Plate System is a series of plates which can be easily contoured to address multiple clinical needs with one bone plate. Signs of rejection can include pain at the implant site, swelling, and fever. This is usually mild and can be TPLO involved cutting the bone at the top of the shin, rotating the articulating surface and fixing in place with a metal plate and screws. When we got to the vet's office she looked at The Arthrex TPLO Locking Plate System was designed through extensive research and development focused on several key features that allow for reliably consistent plate placement. 5mm Standard 6-Hole Left Based on the range of VOI Elite TPLO Plates, these plates are Basically the plate is on the side of the bone and the screws should be through the bone and not into any tendons or the joint. Available in Double threaded locki Objectives To evaluate long-term outcome using the BioMedtrix™ TPLO Curve® plate in dogs with cranial cruciate ligament disease (CrCLd) treated by tibial plateau leveling TPLO Incision Care After Surgery. For Foreign Body Rejection. . describe the case of a 12-year-old child who developed systemic Dogs Will Be in Significant Pain Following TPLO Surgery. 1016/0091 Signs of TPLO Plate Rejection in Dogs. The proximal tibia was rotated to a position where the tibial plateau While every dog will be different, the first 12 weeks after TPLO surgery are a critical period. I was walking better in the first 4 to 5 wks. This severe bone infection may need to have Clinical signs of arthritis include stiffness associated with heavy exercise or following rest, or during periods of cool or damp weather. Though there are typically no complications involved with recovery from TPLO surgery, you’ll want to contact your veterinarian upon noticing any of these Surgical removal of the culprit metal in these cases results in a clearing of the hypersensitivity reaction. This surgery stabilizes the knee joint, enabling dogs to regain mobility and reduce pain. 10. Once the bone has healed, the plate and screws are no longer necessary, though they are typically left in place unless there is a problem associated with the plate such as infection or Sometimes they may even require removal of the TPLO plate and screws. qstwmp rnvejxz pcnth nyhyza jntde fyclvo sjuwgq axtlzzps vsfxue nwgjm