Itsenko-Cushing tus kab mob. Cov kab mob ntawm endocrine system

Cov txheej txheem:

Itsenko-Cushing tus kab mob. Cov kab mob ntawm endocrine system
Itsenko-Cushing tus kab mob. Cov kab mob ntawm endocrine system
Anonim

Itsenko-Cushing tus kab mob tsim tawm vim yog thawj qhov txhab ntawm qia thiab subcortical formations. Lub adrenal cortex thiab pituitary caj pas tau maj mam suav nrog hauv cov txheej txheem pathological. Tus kab mob no feem ntau cuam tshuam rau poj niam lub cev thaum muaj hnub nyoog nruab nrab.

keeb kwm me ntsis

Thawj zaug, cov kab mob tau piav qhia los ntawm Lavxias tus kws tshawb fawb hauv thaj chaw ntawm neuropathology N. M. Itsenko hauv xyoo 1924. Nws yog nws leej twg tau mloog rau qhov tseeb tias thaum xub thawj lub diencephalon cuam tshuam, thiab dhau sijhawm, tag nrho cov kab mob endocrine, nrog rau lub caj pas pituitary, koom nrog cov txheej txheem pathological. Yim xyoo tom qab, xyoo 1932, American neurosurgeon Cushing zoo ib yam piav txog cov tsos mob ntawm tus kab mob. Tus kws tshawb fawb tau txuas cov basophilic adenoma ntawm lub caj pas anterior pituitary nrog qhov tshwm sim ntawm tus kab mob.

Cas thiab tsos mob

Ntau zaus nws tsis tuaj yeem txheeb xyuas qhov ua rau tus kabmob. Qee lub sij hawm tus kab mob no cuam tshuam nrog cov xwm txheej xws li kev puas siab puas ntsws lossis mob hlwb, ntau yam kab mob (arachnoencephalitis, meningitis, encephalitis), cev xeeb tub thiab yug me nyuam, qog pituitary, intoxication ntawm lub cev, menopause. Qee cov kws tshaj lij ntseeg tias cov xwm txheej no tsuas yog nrog cov txheej txheem pathological thiab tsis ua lub luag haujlwm tseem ceeb hauv nws qhov tshwm sim. Lwm tus hais tias cov xwm txheej no tsuas yog ua rau cov kab mob pathology xwb, thaum lwm tus cim lawv ua tus kab mob tseem ceeb.

itsenko-cushing tus kab mob, cov tsos mob
itsenko-cushing tus kab mob, cov tsos mob

Nws nyuaj heev los kuaj pom tus kab mob Itsenko-Cushing. Cov tsos mob tshwm sim maj mam. Tus kab mob tuaj yeem ua rau txo qis ntawm qhov rhiab heev ntawm receptors rau dopamine thiab serotonin hauv nruab nrab paj hlwb. Cov kab mob no, zoo li lwm yam kab mob ntawm cov kab mob endocrine, ua rau cov npe ntawm lwm yam teeb meem: arterial hypertension, rog rog, osteoporosis, ntshav qab zib mellitus. Tsis tas li ntawd, kev ua haujlwm ntawm zes qe menyuam tuaj yeem ua haujlwm tsis zoo, thiab qee zaum hypertrichosis tshwm sim.

Thaum Itsenko-Cushing tus kab mob tshwm sim, cov tsos mob tshwm sim. Cov yam ntxwv tseem ceeb suav nrog:

  • hloov pauv hauv neurons;
  • gonadal atrophy;
  • atherosclerotic hloov pauv hauv cov hlab plawv;
  • fatty siab.

Kev tshawb fawb ntawm daim tawv nqaij qhia tias thinning thiab ncab vim qhov poob ntawm collagen thiab elastic fibers.

Tib neeg cov kab mob endocrine txuas ncaj qha nrog lwm lub cev. Nws cov pathologies cuam tshuam rau cov xwm txheej ntawm tus neeg mob. Kev loj hlob zuj zus ntawm tus kab mob yog nrog los ntawm cov neeg mob tsis txaus siab ntawm kev qaug zog, apathy, discoloration ntawm lub ntsej muag, tsis muaj zog, kev coj khaub ncaws tsis xwm yeem, mob hauv caj dab thiab nraub qaum. Sprains tsim nyob rau saum npoo ntawm cov qog mammary, plab thiab lub xub pwg nyom. Qhov no yog li cas Itsenko-Cushing tus kab mob tshwm sim nws tus kheej.

Tus kab mob no nyuaj, cov ntshav hauv lub cev tuaj yeem tshwm sim. Ib tus kws kho mob qhov kev kuaj xyuas kuj tseem tuaj yeem pom cov kev xaiv hauv cheeb tsam ntawm cov rog ntawm lub ntsej muag, caj dab, plab, hauv siab, daim tawv nqaij qhov txhab nrog boils. Cov txiv neej feem ntau ntsib cov plaub hau poob, thiab cov poj niam feem ntau ntsib cov plaub hau ntawm lub ntsej muag. Hauv ib lub lis piam, Itsenko-Cushing tus kab mob tuaj yeem hloov kho tus neeg zoo heev. Tus kab mob (daim duab hauv qab no) ua rau hnyav nce sai.

Cushing tus kab mob
Cushing tus kab mob

Kev faib tawm

Hauv cov tshuaj, nws yog txoj cai los faib cov kab mob no raws li nws cov chav kawm thiab daim ntawv. Daim ntawv tuaj yeem yog lub teeb, nruab nrab thiab hnyav. Kev nthuav qhia ntawm cov tsos mob yog tus yam ntxwv ntawm ib daim ntawv me me ntawm Itsenko-Cushing tus kab mob. Cov kab mob hauv qhov no yuav tsis cuam tshuam rau kev coj khaub ncaws ntau. Nrog rau daim ntawv nruab nrab, tag nrho cov tsos mob tau qhia meej meej, thiab qhov mob hnyav kuj tseem nrog cov teeb meem, uas suav nrog kev puas siab puas ntsws, cov leeg tsis muaj zog, lub raum kub siab, cov leeg nqaij atrophy.

Cov kab mob no ntawm cov kab mob endocrine tuaj yeem ua rau mob hnyav lossis nce ntxiv. Hauv thawj kis, cov kab mob pathology maj mam, hauv qhov thib ob - sai sai, ntau lub hlis.

cuam tshuam rau pob txha thiab kab mob plawv

Tus kab mob no feem ntau nrog pob txha thiab pob txha deformities uas ua rau mob ntev thiab mob hnyav. Qee zaum cov pob txha zoo li no tuaj yeem dhau mus yam tsis muaj qhov mob tshwm sim. Xws li cov kev hloov hauv lub cev pob txha yog tshwm sim los ntawm osteoporosis. Feem ntau, nws yog ib qho ntawm cov tsos mob tseem ceeb ntawm Itsenko-Cushing tus kab mob. Tus kab mob no ua rau tsis muaj thyrocalcitonin.

Yog tias tus kab mob cuam tshuam rau tus neeg mob thaum ntxov, ces tus kws kho mob endocrinologist yuav tsum ua tib zoo saib xyuas qhov tseeb tias qhov sib txawv ntawm pob txha thiab kev loj hlob qeeb tuaj yeem ua tau.

pediatric endocrinologist
pediatric endocrinologist

Itsenko-Cushing tus kab mob ua rau kev hloov kho rau kev ua haujlwm ntawm cov hlab plawv. Yog li, qhov feem ntau tshwm sim yog kev nthuav dav ntawm ciam teb ntawm lub plawv, tachycardia, systolic yws. Txhim kho arterial hypertension thiab nrog rau mob pyelonephritis, electrolyte cuam tshuam, theem nrab aldosteronism. Kev mob plawv tsis ua haujlwm tuaj yeem tshwm sim los ntawm cov kab mob metabolic thiab arterial hypertension. Lwm yam teeb meem xws li sab laug ventricular hypertrophy, coronary insufficiency, electrolyte-steroid cardiopathy tshwm sim los ntawm potassium deficiency.

Cov kab mob ua pa thiab digestive

Tib neeg endocrine system sib koom tes nrog lwm yam kabmob, yog li cov kab mob uas tshwm sim hauv nws cuam tshuam rau lub xeev ntawm tag nrho cov kabmob. Nws tuaj yeem kuaj mob ntsws, mob ntsws thiab mob ntsws. Yog vim li cas rau lawv txoj kev loj hlob yog ib tug txo nyob rau hauv lub reactivity ntawm lub cev thiab cov teeb meem txuam nrog impaired carbohydrate metabolism.

Itsenko-Cushing tus kab mob provokes qhov tshwm sim ntawm cov kab mob ntawm lub plab zom mov. Qhov no yog mob gastritis, nquag mob nyob rau hauv cheeb tsam epigastric, kub siab. Qee zaum muaj gastroduodenal ulcers los yog gastric los ntshav. Cholesterolsterifying, galactose-fixing, hluavtaws thiab antitoxic zog ntawm lub siab yog impaired.

YEndocrine system thiab raum

Nyob rau theem ntawm endocrine system, txiv neej muaj kev sib deev impotence, mus txog impotence. Cov poj niam raug kev txom nyem los ntawm kev coj khaub ncaws tsis zoo, txo libido thiab kev loj hlob ntawm amenorrhea. Tsis tas li ntawd, atrophy ntawm cov qog mammary, zes qe menyuam thiab uterus feem ntau pom. Kev txo qis hauv kev tso tawm ntawm cov tshuaj hormones gonadotropic thiab kev loj hlob hormone ua rau qeeb hauv kev sib deev thiab kev loj hlob raug ntes hauv menyuam yaus.

Qhov tseem ceeb tsis muaj zog ntawm lub cev tiv thaiv kab mob kuj hais txog qhov tshwm sim ntawm Itsenko-Cushing tus kab mob. Tus kab mob kuj muaj kev cuam tshuam tsis zoo rau kev ua haujlwm ntawm ob lub raum, tshwj xeeb, nws txo qhov ceev ntawm lawv cov ntshav khiav, thiab pom qhov txo qis hauv glomerular pom. Muaj teeb meem nrog rau cov zis: urolithiasis thiab pyelonephritis.

Psyche thiab neuromuscular system

tib neeg endocrine system
tib neeg endocrine system

Cov kab mob pathology tuaj yeem ua rau qee qhov mob hlwb. Tus neeg mob tas li raug mob los ntawm qhov mob thiab amyotrophic syndromes, uas yog tshwm sim los ntawm corticosteroid intoxication. Stem-cerebellar thiab pyramidal syndromes tsis tshua muaj. Lawv tsim los ntawm intracranial hypertension thiab arterial hypertension. Nrog pyramidal syndrome, central paresis ntawm VII thiab XII khub ntawm cranial qab haus huv thiab tendon hyperreflexia tshwm sim. Stem-cerebellar syndrome ua rau pathological reflexes, ob tog tsis muaj zog ntawm VI khub ntawm cov hlab ntsha ntawm pob txha taub hau, kev tsis sib haum xeeb, ataxia.

Cov tsos mob ntawm cov kab mob endocrine, suav nrog Itsenko-Cushing's kab mob, yog tus cwj pwm los ntawm kev puas siab puas ntsws. Ntawm cov kev puas siab puas ntsws, cov kws paub txog cov hauv qab no: hypochondriacal-senestopathic, epileptiform, astheno-adynamic thiab neurasthenic syndromes. Cov neeg mob ua rau qeeb qeeb, qaug zog, tsis muaj kev txawj ntse, ceev ceev thiab nco, thiab kev xav tua tus kheej yuav tshwm sim.

Cov ntaub ntawv kuaj thiab kuaj X-ray

Cov tsos mob tseem ceeb ntawm cov kab mob endocrine tau lees paub los ntawm kev kuaj thiab X-ray. Kev kuaj ntshav yuav qhia tau tias muaj cov kab mob pathology yog tias kuaj pom lymphocytopenia, neutrophil leukocytosis, erythrocytosis, eosinopenia, hyperhemoglobinemia. Cov tsos mob ntawm Itsenko-Cushing nyob rau theem ntawm kev loj hlob ntawm tus kab mob tuaj yeem nrog hypokalemia, hyperchloremia, hypoalbuminemia, hypercholesterolemia. Thaum kuaj zis, tus kws kho mob tuaj yeem kuaj pom cov granular thiab hyaline casts, qe ntshav liab, thiab cov protein. Muaj qhov nce hauv cov ntsiab lus ntawm renin, cortisol thiab ACTH hauv cov ntshav plasma.

Cov txiaj ntsig ntawm craniogram tuaj yeem pom orthoshorosis ntawm cov pob txha cranial thiab mob pob txha loj. X-ray kuaj ntawm cov qog adrenal yog ua los ntawm pneumosuprarenography. Cov txheej txheem no qhia txog adrenal hyperplasia ntawm lub tomogram. Cov kab mob ntawm cov qog adrenal kuj tau kuaj xyuas los ntawm echography thiab radioisotope imaging, uas muab cov ntaub ntawv qhia ntau ntxiv.

Kev kuaj mob thiab kuaj mob

Differential diagnosis of Itsenko-Cushing's disease thiab Cushing's syndrome yog ua los ntawm kev sim nrog dexamethasone thiab metopyrone. Thaum nruab hnub ua ntej noj metopirone, cov zis tau sau los ntawm tus neeg mob txhawm rau txiav txim siab cov ntsiab lus ntawm 17-OKS. Tom qab ntawd, rau ob hnub, txhua 2 teev, metapiron tau noj ntawm qhov ncauj. Nws muaj peev xwm xaiv los thaiv cov enzyme 11-P (hydroxylase) hauv adrenal cortex. Raws li qhov tshwm sim, biosynthesis ntawm corticosterone, aldosterone thiab cortisol yog maj mam ua tsis taus. Kev txo qis hauv qib cortisol hauv cov ntshav ua rau muaj kev nce ntxiv hauv ACTH. Kev noj cov tshuaj metopirone ua rau lub cev hypothalamic-pituitary, ua rau muaj kev tso zis ntau ntxiv ntawm 17-OCS.

Itsenko-Cushing tus kab mob tuaj yeem kuaj tau raws li kev kuaj mob. Lub xub ntiag ntawm tus kab mob yog qhia los ntawm localization ntawm rog, atrophic pob tw, nyias ceg, striae ntawm reddish-liab xim nyob rau ntawm daim tawv nqaij ntawm cov qog mammary, ncej puab, plab, xub pwg nyom, siab diastolic thiab systolic ntshav siab. Yuav siv lwm txoj hau kev ntxiv.

Sib txawv ntawm lwm yam pathologies

Hauv tshuaj, tus kab mob thiab Itsenko-Cushing's syndrome yog qhov txawv. Cov tom kawg tuaj yeem tshwm sim los ntawm kev ua haujlwm hormonal ntawm cov qog ntawm adrenal cortex. Muaj ib tug predisposition rau nws tshwm sim nyob rau hauv cov neeg raug kev txom nyem los ntawm lub xub ntiag ntawm malignant neoplasms. Itsenko-Cushing's syndrome, qhov kev kuaj mob uas yog qhov tseem ceeb hauv lub sijhawm thaum ntxov, yooj yim dua li tus kab mob.

Nws tseem ceeb heev kom paub qhov txawv ntawm Itsenko-Cushing tus kab mob los ntawm kev rog lossis kev coj khaub ncaws tsis zoo, uas yog tshwm sim los ntawm lwm yam ua rau. Yuav kom kuaj tau qhov tseeb, nws yog ib qho tsim nyog yuav tsum ua tib zoo ua txhua txoj kev tshawb fawb.

kab mob ntawm endocrine system
kab mob ntawm endocrine system

Cov kab mob Itsenko-Cushing zoo ib yam li cov txheej txheem ntawm glucosteroma. Qhov sib txawv ntawm ib tus kab mob thiab lwm qhov tuaj yeem tsim los siv kev kuaj X-ray. Glycosteroma tshwm sim sai dua, thiab pob txha pob txha nrog nws tsis meej.

Tsis tas li, tus kab mob no zoo ib yam li hypothalamic syndrome. Tab sis qhov tsim ntawm tus mob no feem ntau yog ua ntej los ntawm kev rog. Pathology feem ntau cuam tshuam rau cov tub ntxhais hluas. Tus kws kho mob endocrinologist yuav tsum tau saib xyuas tag nrho cov nuances ntawm ob kab mob kom tsis txhob ua yuam kev hauv kev kuaj mob. Cov chav kawm ntawm hypothalamic syndrome yog tus cwj pwm los ntawm kev ua kom nrawm ntawm kev sib deev thiab kev loj hlob ntawm lub cev, muaj cov kab txaij liab liab ntawm daim tawv nqaij, nce thiab hloov pauv ntawm cov zes qe menyuam.

Qhov sib txawv tseem ceeb ntawm kev rog, uas yog nrog los ntawm kev coj khaub ncaws tsis xwm yeem thiab ntshav siab, thiab Itsenko-Cushing tus kab mob yog cov tawv nqaij ib txwm muaj xim thiab cov qib tshuaj hormones.

Huab cua

Yog tias tus neeg mob tau kuaj pom tus kab mob Itsenko-Cushing, kev kho mob yuav tsum tau pib tam sim ntawd, vim tias tsis muaj nws qhov kev cia siab rau yav tom ntej yog qhov tsis zoo. Feem ntau cov teeb meem (lub raum tsis ua hauj lwm, cerebral hemorrhage, pneumonia, phlegmon, sepsis, erysipelas) uas tshwm sim nrog ib tug mob hnyav yuav ua rau tuag taus. Cov neeg mob tau txo lub peev xwm ua haujlwm, kev ua si lub cev ntau dhau yog contraindicated rau lawv. Nrog rau tus kab mob me me lossis maj mam nce mus rau nruab nrab, qhov kev tsis taus ntawm pawg III tau tsim rau cov neeg mob. Ob daim ntawv no tso cai rau tus neeg mob ua haujlwm uas tsis tas yuav tsum muaj kev mob hlwb lossis lub cev muaj zog. Cov kab mob hnyav yog qhov ua rau muaj kev tsis taus ntawm pawg II. Cov teeb meem sib txuam ua rau muaj kev tsis taus ntawm pawg I.

Kev kho mob

Thaum kho tus kab mob Itsenko-Cushing, nws yog ib qho tsim nyog los ua kom cov metabolism hauv kev cuam tshuam, tso tawm ntawm ACTH corticosteroids, hypothalamic hloov. Cov txheej txheem tseem ceeb yog cov chaw taws teeb irradiation, kev kho mob thiab kev phais. Cov kws tshaj lij pom zoo kom irradiation rau mob me me.

cov cim qhia ntawm cov kab mob endocrine
cov cim qhia ntawm cov kab mob endocrine

Kev kho Proton thiab gamma kho tau zoo dua. Lawv raug tshuaj nyob rau hauv cov ntaub ntawv uas ib tug pituitary qog kuaj pom radiographically. Kev kho hluav taws xob tuaj yeem ua tau raws li kev cog qoob loo 90Y lossis 198A thiab stereotaxically hauv thaj tsam ntawm adenohypophysis. Txhawm rau txo qhov cuam tshuam ntawm cov duab hluav taws xob ntawm lub hauv nruab nrab paj hlwb thiab tiv thaiv baldness, leukopoiesis stimulants, vitamins C thiab B, thiab anabolic steroids tau sau.

Ua tiav qhov kev kho mob kom zoo raws li qhov tshwm sim ntawm kev kho hluav taws xob tuaj yeem kwv yees li rau lub hlis. Cov kev hloov hauv qab no tau pom: lub cev qhov hnyav thiab kev coj khaub ncaws hauv cov poj niam yog normalized, ntshav siab thiab hyperglycemia raug txo kom zoo, trophic hloov ntawm daim tawv nqaij raug txo, thiab cov pob txha pob txha muaj zog. Txawm hais tias muaj kev kho mob kom tiav, kev tso zis ntawm 17-OCS tseem nyob rau hauv cov neeg mob feem ntau.

Drug therapy

Kev kho mob nrog tshuaj yog siv rau ntau theem ntawm tus kab mob. Lub hom phiaj tseem ceeb yog los thaiv kev ua haujlwm ntawm lub caj pas pituitary. Ntawm cov tshuaj feem ntau tsom tshwj xeeb rau qhov no, parlodel (zoo tshaj plaws), deseryl, peritol, reserpine tuaj yeem paub qhov txawv. Qhov kev txiav txim ntawm parlodel yog tsom los ua kom muaj kev nkag siab zoo rau corticosteroids ntawm hypothalamic-pituitary system los ntawm kev txhawb nqa ntawm dopamine qauv hauv nruab nrab paj hlwb. Raws li qhov tshwm sim, qhov tso tawm ntawm cortisol thiab ACTH txo qis nrog kev maj mam normalization ntawm lawv cov atherosclerosis txhua hnub. Kev siv lwm yam tshuaj yog ua ke nrog txoj kev kho mob.

Yog tias tsis muaj kev kho mob tsis tu ncua ntawm kev kho mob nrog parlodel, tom qab ntawd cov tshuaj tau sau tseg uas nws qhov kev txiav txim yog txhawm rau thaiv kev ua haujlwm ntawm adrenal cortex (trilostane, aminoglutethimide, metopyrone, chloditan). Chloditan ua rau degeneration ntawm cov hlwb ntawm thaj chaw reticular thiab fascicular, atrophy, inhibits qhov tso tawm ntawm androgens thiab glucocorticoids, xaiv cuam tshuam rau adrenal cortex. Tus nqi txhua hnub ntawm cov tshuaj yog nyob ntawm qhov chaw ntawm tus kab mob thiab nyob ntawm tus mob ntawm tus neeg mob. Txhawm rau kom ua tiav cov txiaj ntsig ntawm adrenal cortex thiab hypothalamic-pituitary system tib lub sijhawm, cov tshuaj tau ua ke nrog kev kho X-ray.

Kev sib xyaw ua ke yog siv los kho tus kab mob nruab nrab. Ntawm no, Chloditan yog ua ke nrog hluav taws xob thiab unilateral adrenalectomy. Nyob rau hauv daim ntawv hnyav ntawm Itsenko-Cushing tus kab mob, tib lub tswv yim tau ua raws. Ua ntej kev ua haujlwm, tus neeg mob tau sau cov tshuaj uas nws qhov kev txiav txim yog txhawm rau thaiv cov haujlwm ntawm adrenal cortex. Cov txheej txheem no txhim kho tus neeg mob lub sijhawm tom qab phais.

Ob sab tag nrho adrenalectomy yog siv rau kev mob hnyav heev. Nyob rau tib lub sijhawm, autotransplantation ntawm ntu ntawm adrenal cortex rau hauv cov ntaub so ntswg subcutaneous kuj tau ua. Cov txheej txheem no yuav pab txhawb kev ua siab ntev rau qhov tsis muaj corticosteroids hauv lub cev.

Lwm yam kev kho mob

Cov tsos mob ntawm cov kab mob endocrine
Cov tsos mob ntawm cov kab mob endocrine

Pituitary stalk transection, electrocoagulation, hypophysectomy yog ua nyob rau hauv lub xub ntiag ntawm ib tug qog pituitary uas ua rau lub qhov muag pom kev. Tom qab ob tog adrenalectomy, kev loj hlob ntawm Nelson's syndrome yog ua tau. Cov tsos mob ntawm tus kab mob no yog qog pituitary, tawv nqaij pigmentation, mob adrenal tsis txaus. Txhawm rau zam qhov teeb meem tsis zoo no, tus neeg mob tau txais kev kho kom zoo, uas sib txuas nrog kev siv ACTH secretion blockers thiab corticosteroids.

Yog tias Itsenko-Cushing's tus kab mob yog nrog los ntawm theem nrab aldosteronism, cov tsos mob uas yog convulsions, arterial hypertension, electrolyte cuam tshuam thiab cov leeg nqaij tsis muaj zog heev, ces tus neeg mob yuav tau txais cov tshuaj uas normalize electrolyte metabolism. Ntawm cov feem ntau siv yog spironolactone.

Anabolic steroids, kalyditrin, yog tshuaj rau pob txha. Nyob rau hauv rooj plaub uas cov poj niam muaj kev xav tias amenorrhea, cyclic kev sib deev hormone kho yog ua.

ntsuas kev tiv thaiv

Kev tiv thaiv kab mob ntawm cov kab mob endocrine, tshwj xeeb yog Itsenko-Cushing's kab mob, muaj nyob rau hauv kev soj ntsuam kev noj zaub mov kom raug, noj zaub mov los ntawm tus kws kho mob, txwv tsis pub lub cev tawm dag zog thiab kev ntxhov siab. Txhawm rau txhawm rau txheeb xyuas qhov teeb meem hauv lub sijhawm thiab pib daws nws kom zoo, koj yuav tsum tau kuaj xyuas tag nrho ib ntus. Cov kab mob tsis tshua muaj xws li Itsenko-Cushing's kab mob yog qhov txaus ntshai heev rau kev noj qab haus huv, thiab pib kho sai dua, tus neeg mob yuav rov qab mus rau lub neej li qub.

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