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\doig ->43* je~rasgegm| jm PCD p`arjmb car

HD 0-2 sp 2-0 (~5>->7*

Pedii p|wlz |hd| pwbbgp|p |hrg~gd|gl jm|rd%dr|j`widr jmfg`|jam

ac HD ejbh| lgidz |hg p|rw`|wr~rabrgppjam ac |hg ljpgdpg

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Ma p|rw`|wrdi ogmgcj|p ac gj|hHD ar ljd`grgjm

HD6 Hzdiwramj` D`jlFPR6 Fajm| P~d`g Rjl|h

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\D @rj|grjam #06 \hg |g`hmaiabz ewp| je~rasg |hg mg| hgdi|h aw|`aegp-

Jm|rd%dr|j`widr HD jp d gii gp|doijphgl |rgd|egm| a~|jam car AD- Hagsgr) cggr p|wljgp hdsg

dppgppgl |hg je~d`| ac rg~gd|gl `awrpgp ac jm|rd%dr|j`widr HD am |rgd|egm| gccj`d`z) dml am

ljpgdpg ~rabrgppjam) jm`iwljmb |hg mggl car |a|di kmgg rg~id`gegm|-

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\gm p|wljgp hdsg dppgppgl |hg je~d`| ac rg~gd|gl jm|rd%dr|j`widr jmfg`|jamp ac HD am |rgd|egm|

gccj`d`z- \hrgg grg rg|rap~g`|jsg) |hrgg grg ~rap~g`|jsg dml wm`am|raiigl dml cawr grg |rjdip-

P|wlz pjvg rdmbgl crae ?? |a 830- Aw|`aegp jm`iwlgl sjpwdi dmdiab ~djm p`digp) `hdmbgp jm |hg

RAED@ dml AD_PJ p|dmldrljvgl p`digp- \a p|wljgp dppgppgl |hg je~d`| ac d pjmbig `awrpg ac

HD j|h pgsgrdi `awrpgp ac HD-?4)?7 Oa|h p|wljgp cawml |hd| |hgrg dp earg `ijmj`di je~rasgegm|

dc|gr |a ar earg `awrpgp ac HD |hdm dc|gr amg `awrpg ac HD) di|hawbh mgj|hgr hdl d `ae~drjpam

braw~ |hd| ljl ma| rg`gjsg HD- Jm a|hgr ~rap~g`|jsg p|wljgp) ~d|jgm|p `awil rg`gjsg dm dllj|jamdi

|rgd|egm| `awrpg dc|gr d lgcjmgl ~grjal (ac|gm cawr eam|hp*) ow| |hg je~d`| ac rg~gd|gl `awrpgp sp

d pjmbig `awrpg grg ma| didzp dmdizvgl pg~drd|giz-?)?2)?:)0>

\a p|wljgp hdsg dppgppgl |hg je~d`| ac rg~gd|gl `awrpgp ac jm|rd%dr|j`widr HD car kmgg AD am

ljpgdpg ~rabrgppjam) egdpwrgl gj|hgr rdljabrd~hj`diiz ar dr|hrap`a~j`diiz-?>)?2 Jm |hg cjrp|) d pedii

~rap~g`|jsg p|wlz ac 0: ~d|jgm|p) |hapg ha rg`gjsgl rg~gd|gl `awrpgp ac HD hdl je~rasgegm| jm

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dr|hrap`a~j`diiz egdpwrgl `hamlra~d|hz-?2 Jm |hg pg`aml) d idrbgr _@\) aw|`aegp grg

egdpwrgl rdljabrd~hj`diiz dml |hgrg dp ma `igdr je~d`| am rdljabrd~hj` ljpgdpg ~rabrgppjam-?>

^a|gm|jdi Hdrep

\hg edjm ~a|gm|jdi hdrep ac jm|rd%dr|j`widr HD drg ia`di rgd`|jamp (~djm ar oiggljmb d| |hg jmfg`|jam

pj|g*) diigrbj` rgd`|jamp (jm iwljmb rdph dml pgiijmb* dml dr|hrdibjdp- ^ap|%jmfg`|jam cidrg jp

`hdrd`|grjvgl oz jm`rgdpgl ~djm) pgiijmb dml |hg ~rgpgm`g ac dm jmcideed|arz fajm| gccwpjam dml

hdp oggm gp|jed|gl |a a` wr jm 4-7%7' ac jmfg |gl kmggp- ^ap|%jmfg`|jam cidrg edz og earg

`aeeam jm jmfg`|jamp bjsgm sjd |hg egljdi d~~rad`h |hdm oz |hg id|grdi d~~rad`h-?4)0?

Cg p|wljgp hdsg dppgppgl |hg ~a|gm|jdi dlsgrpg gccg`|p ac rg~gd|gl `awrpgp ac HD am pdcg|z

aw|`aegp- Hagsgr) jm |hg amg idrbg rdmlaejvgl `am|raiigl |rjdi |hd| `ae~drgl rg~g|j|jsg jm|rd%

dr|j`widr HD jmfg`|jamp j|h ~id`goa) pdcg|z aw|`aegp grg dipa dppgppgl-0> \hg mweogr ac

dlsgrpg gsgm|p grg pjejidr jm |hg |rgd|egm| dml |hg `am|rai braw~p (:-8' jm |hg HD braw~ sp :-4'

jm |hg ~id`goa braw~*- Dii pjlg gccg`|p grg ejil |a ealgrd|g- @aeeam pjlg gccg`|p jm`iwlgl

diigrbj` rgd`|jam (rdph dml pgiijmb*) ~djm ar oiggljmb d| |hg jmfg`|jam pj|g ar dr|hrdibjdp- \hgrg

grg ma pgrjawp pjlg gccg`|p jm gj|hgr braw~-

Jm pweedrz) asgrdii rg~gd|gl jmfg`|jamp ac HD car kmgg AD hdp pham gccj`d`z jm pze~|aed|j`

rgijgc ac AD- \hg pjlg gccg |p hdsg bgmgrdiiz oggm rgid|jsgiz ejmar jm `am|rdp| |a |hg ~a|gm|jdi

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ogmgcj|p- \hwp rg~gd|gl jmfg`|jamp ac jm|rd%dr|j`widr HD drg dppa`jd|gl j|h d mg| ogmgcj| jm hgdi|h

aw|`aegp-

\D @rj|grjam #0 jp eg|

\D @rj|grjam # ar

8/2/2019 Hyaluronic Acid for Treatment of Osteoarthritis of the Knee: Repeated Injections and Progression to Knee Replacem

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d~~ra~rjd|g `drg j|haw| hzidm B%C ?>- D~~ra~rjd|g `drg dp lgcjmgl dp |hg ~rgcgrrgl

edmdbgegm| p|rd|gbz ac |hg rgcgrrjmb ~hzpj`jdm) ha dp gm`awrdbgl |a caiia |hg bwjlgijmgp ac

|hg Degrj`dm @aiigbg ac _hgwed|aiabz- D `awrpg ac jm|rd%dr|j`widr hzidm B%C ?> dp d pgrjgp ac

|hrgg jmfg`|jamp d| amg ggk jm|grsdip- Jmljsjlwdip `awil rg`gjsg pwopgtwgm| jmfg`|jamp |a |hg kmgg

lwrjmb |hg p|wlz- \hg edjm badi ac |hg p|wlz dp |a `ae~drg jm|rd%dr|j`widr hzidm B%C ?> ~iwp

d~~ra~rjd|g `drg |a d~~ra~rjd|g `drg diamg- \hg edjm aw|`aeg dp d `hdmbg jm |hg RAED@ ~djm

p`arg jm |hg p|wlz kmgg crae odpgijmg |a |hg gml ac |hg p|wlz- \hg edjm p|wlz rgpwi|p phagl |hd|

dlljmb hzidm B%C ?> |a d~~ra~rjd|g `drg igl |a pjbmjcj`dm| je~rasgegm| jm |hg edjm aw|`aeg %

rglw`|jam jm |hg RAED@ ~djm p`dig-00

D pg`amldrz ~woij`d|jam crae |hjp p|wlz gsdiwd|gl |hg pdcg|z dml gccj`d`z ac rg~gd|gl `awrpgp ac

hzidm B%C ?> ~iwp d~~ra~rjd|g `drg am |hg pdeg ~rjedrz aw|`aeg (rglw`|jam jm |hg RAED@ ~djm

p`arg*-?: Car |hjp dmdizpjp) |hg jmsgp|jbd|arp ljsjlgl |hg hzidm B%C ?> braw~ jm|a |a pwobraw~p % 4*

|hapg ha rg`gjsgl amg jmfg`|jam ac hzidm B%C ?> dml ?* |hapg ha rg`gjsgl earg |hdm amg

jmfg`|jam ac hzidm B%C%?>- Je~ar|dm|iz) ~dr|j`j~dm|p grg ma| rdmlaejvgl |a rg`gjsg amg ar earg

|hdm amg lapg- Car |hg edjm aw|`aeg % je~rasgegm| jm |hg RAED@ ~djm p`dig) |hg pjmbig `awrpg

braw~ je~rasgl oz

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ha` dmdizpjp pwbbgp|p |hd| ewi|j~ig `awrpgp ac hzidm B%C ?> edz og gccj`d`jawp dml pdcg) ow| |hg

p|wlz dp ma| lgpjbmgl |a p~g`jcj`diiz dmpgr |hjp twgp|jam-?:

D Crgm`h p|wlz rdmlaejvgl ~d|jgm|p |a rg`gjsg amg ac |hrgg |rgd|egm|p6 4* |hrgg `awrpgp (0

jmfg`|jamp gd`h* ac jm|rd%dr|j`widr HD) ?* ljd`grgjm 4>> eb d ldz (dm dm|j%jmcideed|arz lrwb |hd|

dccg`|p |hg jm|grigwkjm ~d|hdz* ar 0* ~id`goa- ^dr|j`j~dm|p dml jmsgp|jbd|arp grg oijmlgl |a |hg

|rgd|egm|p- ^dr|j`j~dm|p grg caiiagl car d zgdr- \hg edjm aw|`aeg dp ~djm p`arg dp rd|gl oz d

sjpwdi dmdiab p`dig- \hg SDP ~djm p`arg je~rasgl jm dii |hrgg braw~p) ow| |hgrg dp ma pjbmjcj`dm|

ljccgrgm`g og|ggm braw~p-

\hg DEGIJD ~rafg`| (Ap|gaDr|hrj|jp Ealjczjmb Gccg`|p ac Iamb%|gre Jm|rd%dr|j`widr Dldm|* dp

lgpjbmgl |a dppgpp |hg gccj`d`z dml |hg `drrz%asgr gccg`| ac rg~gd|gl jm|rd%dr|j`widr jmfg`|jamp ac HD

jm kmgg ap|gadr|hrj|jp- \hjp dp d rdmlaejvgl `am|raiigl ewi|j`gm|gr |rjdi `amlw`|gl asgr

eam|hp-0> ^d|jgm|p j|h kmgg ap|gadr|hrj|jp (dp lgcjmgl oz D@_ `rj|grjd j|h Brdlg JJ ba| JJJ

rdljabrd~hj` p|dbg AD* grg rdmlaejvgl |a rg`gjsg jm|rd%dr|j`widr Dldm| (4' HD* ar ~id`goa-

\hgrg grg cawr |rgd|egm| `z`igp % gd`h |rgd|egm| `z`ig `ampjp|gl ac 7 ggkiz jmfg |jamp- P|wlz

~dr|j`j~dm|p `awil rg`gjsg ~grjalj` `awrpgp ac d`g|dejma~hgm ar mamp|grajldip) ow| grg ma|

diiagl |a rg`gjsg jm|rd%dr|j`widr `ar|j`ap|grajlp asgr |hg `awrpg ac |hg p|wlz- Caiia w~ dp car pjx

eam|hp dc|gr |hg cjrp| dml pg`aml `z igp dml amg zgdr dc|gr |hg |hjrl dml cawr|h `z`igp- \hg

rg~gd|gl jmfg`|jam `z`igp grg dlejmjp|grgl rgbdrligpp ac hg|hgr ar ma| |hg ~d|jgm| hdl

pze~|aep- \hg edjm aw| aeg dp |hg ~gr`gm|dbg ac jmljsjlwdip j|h d ijmj`di rgp~ampg dp

lgcjmgl oz |hg Ap|gadr|hrj|jp _gpgdr`h Pa`jg|z Jm|grmd|jamdi (AD_PJ* ?>>< rj|grjd- ^d|jgm|p grg

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`idppjcjgl dp rgp~amlgrp jc |hg ~djm ar ~hzpj`di cwm`|jam p`arg lg`rgdpgl d| igdp| 7>' dml d| igdp|

?> ee am |hg SDP) ar jc |a ac |hg caiiajmb |hrgg cjmljmbp grg ~rgpgm|6

4- d lg`rgdpg jm ~djm ac d| igdp| ?>' dml d| igdp| 4> ee am |hg SDP)

?- d lg`rgdpg jm ~hzpj`di cwm`|jam ac d| igdp| ?>' dml d| igdp| 4> ee am |hg SDP) ar

0- dm jm`rgdpg jm |hg p`arg ac |hg ~d|jgm|p biaodi dppgppegm| oz d| igd p| ?>' dml d| igdp| 4>

ee am |hg SDP-

Pdcg|z dml |aigrdojij|z grg gsdiwd|gl odpgl am |hg jm`jlgm`g dml |z~g ac dlsgrpg gsgm|p-

D |a|di ac 0>3 ~d|jgm|p grg jm`iwlgl jm |hg p|wlz- D| p|wlz |grejmd|jam ( eam|hp; amg zgdr dc|gr

|hg cjmdi pgrjgp ac jmfg`|jamp*) pjbmjcj`dm|iz earg ~d|jgm|p rgp~amlgl |a HD |hdm |a ~id`goa (AD_PJ

?>>< `rj|grjd; ~5>->>

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|hg edz ~grpjp| dc|gr amg zgdr- Jm dllj|jam) d braw~ |hd| amiz rg`gjsgl amg pgrjgp ac jmfg`|jamp dp

ma| jm`iwlgl dml pa |hg jm`rgegm|di ogmgcj| (cawr pgrjgp ac jmfg`|jamp sp amg pgrjgp ac jmfg`|jamp*

`dmma| og lg|grejmgl-

Jm pweedrz) di|hawbh pgsgrdi p|wljgp hdsg gsdiwd|gl hg|hgr ar ma| rg~gd| jmfg`|jamp ac HD `dm

og ogmgcj`jdi j|h rgp~g`| |a `ijmj`di aw|`aegp) amiz amg p|wlz hdp rdmlaejvgl ~d|jgm|p |a rg`gjsg d

pgrjgp ac rg~gd|gl jmfg`|jamp sp ~id`goa- Ma rdmlaejvgl p|wlz hdp `ae~drgl d pjmbig jmfg`|jam ac

HD j|h ewi|j~ig jmfg`|jamp ac HD- Deamb ~d|jgm|p ha rg`gjsgl cawr `awrpgp ac HD |rgd|egm| asgr

d |a dml d hdic zgdr ~grjal) pjbmjcj`dm|iz earg rgp~amlgl |a |rgd|egm| |hdm ljl |hapg ha

rg`gjsgl ~id`goa dml |hg gccg`| d~~gdrgl |a idp| car d| igdp| d zgdr-

Je~d`| ac HD am ^rabrgppjam ac _D ar am Mggl car Kmgg _g~id`gegm|

Ma p|wljgp hdsg gsdiwd|gl hg|hgr ar ma| rg~gd|gl `awrpg ac |rgd|egm| ac kmgg ap|gadr|hrj|jp j|h

HD `dm lgidz |hg mggl car kmgg rg~id`gegm|) ow| pgsgrdi p|wljgp hdsg dppgppgl |hg je~d`| ac

rg~gd|gl |rgd|egm|p ac HD am jm|gregljd|g aw| aegp rgid|gl |a |hg ~rabrgppjam ac dr|hrj|jp- \hgpg

aw|`aegp jm`iwlg fajm| p~d`g jl|h (FPR*) fajm| p~d`g mdrrajmb (FPM* dml |hg Pzp|geg Crdm`djpg

LDr|hrap`a~jg (PCD* brdljmb pzp|ge car `hamlra~d|hz dp egdpwrgl lwrjmb dr|hrap`a~z am d

sdijld|gl p`dig-

\a p|wljgp hdsg dppgppgl |hg je~d`| ac rg~gd|gl `awrpgp ac HD am |hg ~rabrgppjam ac AD- \hg

cjrp| dp d pedii ~rap~g |jsg p|wlz ac 0: ~d|jgm|p- ^dr|j`j~dm|p rg`gjsgl `amsgm|jamdi |hgrd~z ar

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|hrgg `z`igp (gsgrz cawr eam|hp* ac jm|rd%dr|j`widr jmfg`|jamp ac Hzdibdm- Dii ~dr|j`j~dm|p wmlgrgm|

dr|hrap`a~z hgrg `hamlra~d|hz dp dppgppgl oz |hg PCD- @hamlra~d|hz dp dipa dppgppgl

wpjmb d SDP- D| amg zgdr caiia%w~) |hgrg dp igpp lg|grjard|jam jm |hg asgrdii dppgppegm| ac

`hamlra~d|hz jm |hg HD braw~ (7-4 sp 43-26 ~5>->43*- \hgrg dp dipa dm je~rasgegm| jm |hg PCD

`hamlra~d|hz p`arjmb car |hg HD braw~ (0-2 sp 2-06 ~5>->7*- \hjp dp d pedii p|wlz ac amg zgdr

lwrd|jam- \hg rgpwi|p pwbbgp| |hd| rg~gd|gl `awrpgp ac jm|rd%dr|j`widr HD edz lgidz |hg p|rw`|wrdi

~rabrgppjam ac AD-

D pg`aml p|wlz dp d lawoig oijml ~id`goa `am|raiigl |rjdi `amlw`|gl jm Crdm`g- D |a|di ac 0>4

~dr|j`j~dm|p j|h pze~|aed|j` kmgg AD grg rdmlaejvgl |a |hrgg `awrpgp (0 jmfg`|jamp gd`h* ac

jm|rd%dr|j`widr HD) ?* ljd`grgjm 4>> eb d ldz (dm dm|j%jmcideed|arz lrwb |hd| dccg`|p |hg jm|grigwkjm

~d|hdz* ac 0* ~id`goa- ^dr|j`j~dm|p dml jmsgp|jbd|arp grg oijmlgl |a |hg |rgd|egm|p- ^dr|j`j~dm|p

grg caiiagl car d zgdr- \hg edjm p|rw`|wrdi aw|`aegp grg fajm| p~d`g jl|h (FPR*) fajm| p~d`g

mdrrajmb (FPM* og|ggm odpgijmg dml cjmdi sjpj|p) dml ~gr`gm|dbg ac ~rabrgpparp (lgcjmgl dp FPM

=>-7 ee lwrjmb |hg p|wlz* - \hgz cawml |hd| FPR lg|grjard|gl oz dm dsgrdbg ac >->: ee asgr |hg

`awrpg ac |hg p|wlz) ow| |hgrg dp ma ljccgrgm`g og|ggm braw~p- \hg ~gr`gm|dbg ac ~rabrgpparp

(|hapg ha hdl FPM ac =7 ee asgr |hg `awrpg ac |hg p|wlz* dp 42-2' jm |hg HD braw~) 48):' jm

|hg ljd`grgjm braw~ dml ?>-0' jm |hg ~id`goa braw~ j|h ma ljccgrgm`g og|ggm braw~p- \hwp |hg

rgpwi|p ac |hjp p|wlz phagl ma pjbmjcj`dm| gccg`| ac gj|hgr rg~gd|gl `awrpgp ac HD ar ljd`grgjm am

aw|`aegp rgid|gl |a AD ~rabrgppjam-

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Jm pweedrz) ma p|wljgp hdsg dppgppgl |hg je~d`| ac HD am mggl car kmgg rg~id`gegm|- Amiz |a

p|wljgp hdsg dppgppgl |hg je~d`| ac rg~gd|gl jmfg`|jamp ac HD am ljpgdpg ~rabrgppjam dp

egdpwrgl rdljabrd~hj`diiz ar dr|hrap`a~j`diiz) dml |hgpg p|wljgp hdsg rgd`hgl ljccgrgm|

`am`iwpjamp doaw| gccj`d`z- \hg idrbgr lawoig oijml ~id`goa `am|raiigl p|wlz ljl ma| pha dm

je~d`| ac HD am ljpgdpg ~rabrgppjam- Dllj|jamdi p|wljgp jii og mgglgl |a dmpgr |hjp twgp|jam ow|

d| |hjp |jeg) |hgrg jp ma gsjlgm`g |hd| jm|rd%dr|j`widr HD piap ljpgdpg ~rabrgppjam hgm `ae~drgl

j|h a|hgr |rgd|egm|p-

\D @rj|grjam < jp eg| car hg|hgr rg~gd|gl jmfg`|jamp ac HD `dm je~rasg pze~|aep ac kmgg

dr|hrj|jp

\D @rj|grjam < jp ma| eg| car hg|hgr rg~gd|gl jmfg`|jamp ac HD `dm pia ljpgdpg

~rabrgppjam-

-

\D rj|grjam #76 \hg je~rasgegm| ewp| og d||djmdoig aw|pjlg |hg jmsgp|jbd|jamdi pg||jmbp-

D gii lamg `ijmj`di |rjdi phagl |hd| ~d|jgm|p ha rg`gjsgl cawr `awrpgp ac jm|rd%dr|j`widr HD asgr d

|a dml d hdic zgdr ~grjal hdl dm je~rasgegm| jm AD rgid|gl pze~|aep- Hagsgr) |hjp p|wlz ljl

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ma| `ae~drg ewi|j~ig `awrpgp ac HD j|h d pjmbig `awrpg ac HD- Jm dllj|jam) |hg je~d`| ac a|hgr

|rgd|egm| p`hglwigp am `ijmj`di aw|`aegp hdp ma| oggm gsdiwd|gl- Amg p|wlz gsdiwd|gl iamb |gre

aw|`aegp ac rg~gd|gl jmfg`|jamp ac hzdiwramj` d`jl car |hg |rgd|egm| ac kmgg AD- Jm |hjp p|wlz)

deamb 8:2 ~d|jgm|p rgcgrrgl |a d idrbg `gm|gr car AD edmdbgegm|- Deamb |hge) 702 eg| `rj|grjd

dml rg`gjsgl d pgrjgp ac HD jmfg`|jamp car kmgg AD- ^d|jgm|p grg |ail |hd| |hgz `awil rg|wrm car

`ampjlgrd|jam ac rg~gd| jmfg`|jam pgrjgp lg~gmljmb am |hgjr ~gr`g~|jam ac pze~|ae pgsgrj|z- Deamb

|hg 702 ~d|jgm|p) amiz ?4 ljl ma| rg|wrm car d pg`aml jmfg`|jam pgrjgp- Aw|`aegp jm`iwlgl `hdmbg jm

rgp| dml dikjmb ~djm sjpwdi dmdiab p`argp- ^dr|j`j~dm|p grg caiiagl car 3-2 zgdrp- ^dr|j`j~dm|p

gx~grjgm`gl d pjbmjcj`dm| rglw`|jam jm SDP dikjmb ~djm p`arg crae odpgijmg dc|gr oa|h |hg cjrp| dml

pg`aml jmfg |jam pgrjgp84-0' dml 83-2'; oa|h ~9>->>4*- \hgrg dp dipa dm je~rasgegm| jm

rgp|jmb ~djm- ^d|jgm| pd|jpcd`|jam dp dipa je~rasgl dc|gr gd`h jmfg`|jam pgrjgp dml |hgrg grg cg

dlsgrpg gsgm|p-0

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\D @rj|grjam 7 jp ma| eg| car hg|hgr rg~gd|gl jmfg`|jamp ac HD `dm pia ljpgdpg

~rabrgppjam ar lgidz kmgg rg~id`gegm|- -

PWEED_Z

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