Kyphosis in children

Treatment of kyphosis in children

Kyphosis in children occurs most often between the ages of 13 and 19 years. In this time interval active growth of the spine is observed, and the muscular corset of the back often does not have time to increase and maintain the axis of the spinal column in the correct position.

From the age of 12 to 17, there is a high likelihood of the occurrence of Scheerman-Mau disease, which is characterized not only by increased concavity in the thoracic spine but also by the wedge deformation of several vertebrae.

Kyphosis in a child often develops in school years due to improper planting at the school desk

A good time for correcting the curvature of the spinal column is 10-15 years, when the bone structure of the spinal axis is still represented by a cartilaginous tissue, which is flexible and elastic, so it undergoes displacement. After 25 years, the vertebrae consist exclusively of bone tissue, and the vertebral axis becomes practically immobile.

Anatomical features of pathological infantile kyphosis

In a child over 12 years old, the spine has 4 natural bends: 2 kyphosis and 2 lordosis. If you look at it in the lateral plane, the axis of the spinal column will resemble the letter "S".In the cervical and lumbar regions, the bend is forward, and in the thoracic and sacral - back.

In the thoracic region there is a "big kyphosis", the curvature of which normally reaches 30-40 degrees."Small" kyphosis is localized in the area of ​​the sacral region. Its angle of curvature is about 15-20 degrees.

This constructive feature of the spinal column is biomechanically optimal. It provides an ideal "absorption" of the damping load during running, jumping, walking. If bends did not exist, then any physical impact would quickly lead to the destruction of the spinal column.

photo of the kyphosis of a girl 10 years old Pathological kyphosis in children leads to a disproportionate shift in the center of gravity of the trunk. In this case, the following features are observed:
  • Stomach protruded forward;
  • Slight lumbar lordosis displaced;
  • Body pressure falls on the lower limbs.

Methods of treatment

Treatment of excessive convexity of the thoracic spine posteriorly is carried out at the initial stages by medical gymnastics, maintenance of correct posture and physiotherapy.

Special gymnastics for kyphosis in children under 18 years old is held for 6 months. It must be done every other day, but regularly. It is practically meaningless to do exercises less than 3 times a week. Of course, training for kyphosis does not belong to a series of simple and take from 40 minutes to 1 hour. The minimal result from the procedures can be expected no earlier than 2-3 months.

In kyphosis in children, gymnastic exercises include 5 important blocks:

  1. Initial exercises should be aimed at strengthening the muscles of the back and chest. When doing the workout, it is necessary to distribute the load so that at least 2 parts of the entire time of the exercise is spent on strengthening the back muscles;
  2. In children with poor posture, the muscles of the buttocks are almost always relaxed. The second stage of training for the treatment of kyphosis is their strengthening. At each training, such exercises should be taken about 10% of the time;
  3. In the curvature of the thoracic region, it is necessary to relax the musculature of the neck and lower back. For a relaxing gymnastics, take 3-5 minutes;
  4. Creation of elasticity for pectoral muscles. When the posture is violated, children are strictly forbidden to "pump" the pectoral muscles, since it will pull the spinal column forward. The muscular skeleton of the chest, on the contrary, must be stretched. Highlight this type of exercises in each lesson for about 2-3 minutes;
  5. Breathing exercises in each lesson should be given about 5 minutes. They promote the expansion of the chest and increase the vital capacity of the lungs. There are special breathing exercises for children that can correct serious deformations of the ribs and breasts that appear with Sheyerman-Mau disease and hyperkypophysis.

The choice of types of gymnastics and its duration is determined in each case by an orthopedic traumatologist or a vertebrologist. What kind of gymnastics is contraindicated in kyphosis in children:

  1. Exercises with weights dumbbells, weights, weights with a weight of more than 3 kg for girls and 5 kg for boys. Other types of gymnastics with weights less than these values ​​are performed only in the prone position;
  2. It is advisable not to apply the sports load associated with jumping in the treatment of enhanced curvature. Against her background, Shmorl's hernias can form, which lead to a "flattening" of the vertebrae.

The correct selection of furniture

Children spend a lot of time at the computer or TV.Long sitting adversely affect the spine, so it is important to choose the right furniture and chairs.

  • The chair should be with a headrest and armrests. When sitting on it, the child's back should not be too round or too concave, as otherwise the stoop will only become worse. When sitting on a chair, do not feed the body forward. You need to sit, leaning back in your chair;
  • Monitor is better to install on a table, which is located at a height at the level of the armrests of the chair. It should be borne in mind that the child's legs should be on the floor;
  • Orthopedists-traumatologists recommend for kyphosis in children an even and hard mattress for sleeping. Only in the presence of pain in the back against the background of kyphosis, you can reduce the stiffness of the mattress.
  • Pillow width is selected according to the size of the shoulder girdle. It should ideally repeat the cervical bend of the spine, but do not put pressure on it.

Thus, kyphosis in children is a complex pathology that, over time, without qualified treatment will lead to serious complications. It can not be cured independently. Even a qualified doctor will not be able to save him from the disease without the help of a child. Prepare for daily long work for several years to get the perfect posture.

SpinaZdorov.ru

Note to parents: kyphosis of the spine in adolescents

Very often, seeing a gaggle of teenagers walking in the crowd, one can notice among them one or two children who differ from other peers by higher growth, and, as a rule, these guys or girlsvery much slouching, trying to seem less.

I myself, at 12-13 years old, wanted to grow above my mother, whose height is only 156 cm. And, I must say, "my prayers" were heard - being one of the youngest in my class, in a couple of years I was already onphysical education one of the first among girls, and to the graduating class stretched out so that not only caught up with her mother, but also overgrew it almost 20 cm. Of course, next to the smaller boys did not want to look like a "dildo", involuntarily had to stoop,to refuse shoes with heels, do not do high hairstyles on school discats. Teachers and parents constantly said: "Lena, you're a slender, pretty girl, straighten shoulders - because stoop does not go to anyone."But I graduated from high school with a certain complex about my growth( the blessing at the institute was that almost all my friends were also quite tall, besides, in those years, beauty contests were actively held - podiums were girls and taller, and my complex is gone).

Now my son graduates from high school and he also suffers from his high growth( he grew very fast and quickly in the past one or two or two previous years, and now his height is 190 cm), but the worst thing is that his back and neck often hurts.

What is kyphosis of the spine?

The word kyphosis comes from the Greek kyphosis and means literally "hunchback".That is, kyphosis of the spine is a disease, meaning the presence of curvature of the spine with bulge back( unlike lordosis, which means concavity).It should be noted that you should not immediately frighten the terms kyphosis and lordosis, as soon as you hear them in the doctor's office - after all, a normal healthy spine and should not be perfectly straight. In a standing position, he must necessarily have bends in the right places. Another thing is that the angle of deflection at the problem points from the axis of the spine, exceeding the norm, just says that there is one or another stage of the disease.

As a rule, with the kyphosis of the spine, the thoracic region is subject to curvature, but in rare cases, there is also kyphosis of the cervical spine, and kyphosis of the lumbar region. Curvature develops when one or more vertebrae of the area are affected: this may be a consequence of a spinal injury, after a severe infectious disease( for example, poliomyelitis, which can lead to paralysis of the back muscles), infantile cerebral palsy and other diseases. There are other, more rare, reasons for the development of kyphosis, for example, due to a spinal tumor, radiotherapy, etc.

But, as a rule, teenagers are diagnosed with the so-called functional kyphosis of the spine( better known to us as usual stoop), which arises due to incorrect posture, long non-physiological sitting at the table or, as in my case, connected with psychological aspects( complex due to non-for high growth)

Kifoz spine - treatment

Because our children spend a lot of time not only for school and home lessons, but also sitting at the computer - the posture spoils almost everyone, not only for tall children.

If you have complaints about excruciating pains in the back or neck, decreased sensitivity and numbness of the limbs, heart and lung disorders, your child, after a manual examination, will definitely be given an x-ray of the spine( sometimes can be directed to magnetic resonance imaging).But, in any case, the examination should be done by a qualified specialist, a doctor - it is not necessary to trust the health of your child with manual therapists who advertise their services in newspapers with free ads. Of course, when the son complained of frequent pain several years ago, we went to the polyclinic and, like many teenagers, the surgeon discovered signs of juvenile scoliosis and kyphosis( good not in severe form).The son on the recommendation of the doctor went to LFK and massage in the same polyclinic, and also signed up for swimming. But the lessons of basketball and volleyball, despite the high growth of his son, the doctor categorically advised him not to aggravate the state of affairs with the spine.

Some children are prescribed wearing special corsets to correct posture( my daughter's daughter wore one of the variations of such a corset, they are now in the specialized departments of large pharmacies now a lot, the main thing is to choose the right one for you).

Keep track of the correct posture of your children, find opportunities to write them in sports sections( although this is sometimes very costly for the parent wallet).It is important to properly strengthen the muscles of the back in the period of active growth of the child, do not give excessive load and do not let things slide. If you do not do this - in the future you can easily get a disability.

fb.ru

Note: CT provides an opportunity to identify pathological changes in bone tissue, and MRI allows you to determine the presence of structural changes and give an objective assessment of the processes occurring in the spinal cord and nerve roots.

Treatment of kyphosis in children

Conservative treatment methods include:

  • manual therapy;
  • wearing supporting corsets of various designs;
  • LFK.

Unfortunately, with some forms of kyphosis, it is not possible to do without surgical treatment.

Postural( sedimentary) kyphosis, which is very typical for adolescence, almost always accompanies hyperlordosis - a pathological bending of the spine anteriorly in the lumbar region. To eliminate this violation, it is advisable for a child to sleep on an even hard surface and hang more often on a horizontal bar, "stretching" his back. To improve posture and strengthen the back muscles during the period of active growth and reconstruction of the musculoskeletal system, a complex of exercise therapy was developed. It is advisable for a young patient to attend group sessions, where the correctness of the exercises will be followed by an experienced specialist.

In the treatment of congenital kyphosis for the elimination of pathology or the stopping of its progression, in most cases an operation is indicated.

Surgical correction is also the only method for treating post-traumatic spine pathology. Operative intervention in kyphosis involves the stabilization of the spinal column in the correct position by means of metal( titanium) rods and screws.

A set of exercises recommended for kyphosis in children

Note: will need a tourniquet and a gymnastic stick to perform therapeutic exercises.

Basic exercises for kyphosis:

  1. As a warm-up you need to take your hands back so that the gymnastic stick is between the trunk and elbows. Shoulders align to achieve the most even posture. In this situation, walk quietly around the room for 10 minutes.
  2. Align the shoulders, tilt at an angle of 90 °( so that the trunk at the extreme point is parallel to the floor surface).The head and pelvic area should remain immobile. Repeat 20-30 times, making sure that your breathing is even.
  3. Holding one hand behind the bar, you do not have to swing to hang on it until the first weak pains appear.
  4. Run 20-40 slopes with the straight body in the sides, making sure that the abdominal area is tightened. Jerk should be avoided!

A complex of effective exercises for kyphosis of the thoracic spine is presented in the video review:

If the kyphosis causes periodic painful sensations, it is possible to take analgesics and non-steroidal anti-inflammatory drugs as prescribed by the doctor. As an analgesic, acetaminophen is often recommended.

Manual therapy involves a warm-up of the patient back area. Procedures should be conducted only by an experienced manual technician with solid experience in working with children.

Note: with manual intervention often causes pain in a certain area. This is an indication that a group of muscles and ligaments have begun to work, that is, manipulations have a positive effect.

In some cases, a child in the treatment of kyphosis has a fairly long time to wear a special orthopedic construction - a corset. This auxiliary therapeutic device helps to minimize or completely prevent pain, and also to support the back, shoulders and chin in a physiologically correct position. Corsets can stop the progression of pathology. Selection of the design and determination of the duration of its wearing is the task of the attending physician. In difficult cases, patients are shown not to remove the corset most of the day( up to 20 hours).

Prevention of kyphosis

Measures to prevent acquired kyphosis involve the elimination of possible causes of pathology. The child needs to lead an active lifestyle, and spend as little time as possible in front of a computer or television. The height of the desk, as well as the chair, should correspond to the height. Since children are actively growing, regular workplace correction is required. With short-sightedness, they need to wear glasses or lenses to constantly not bend forward.

If the child begins to stoop, embarrassed by his height, he may need to consult a child psychologist.

Konev Alexander, the therapist

33 views in total, 1 views today

okeydoc.ru

Kyphosis in 11-month-old baby |Forum about the spine

  1. Marianna Newborn

    When examined at an orthopedist in an 11-month-old baby, signs of kyphosis-round back, protrusion of the vertebrae in the lower spine, round ribs are revealed. Is there any hope that the defect can be eliminated given early diagnosis? What could advise and what exercises to do at home?
  2. Gregory Newbie

    Dear Marina. First of all, it is necessary to determine the degree of deformation for which to perform the radiography of the spine, depending on the results, the tactics of treatment from corset treatment up to the operation of
  3. may also vary. Marianna The novice

    The pictures are taken. The lower part of the spine has a significant deviation from the center to the right,child and constantly sits with a bias in this direction. The muscles of the body are weak. The orthopedist said that he does not see the pathology inherent in the pictures, but the kyphosis is pronounced, suggested that either the child was put in early, or there was a mechanical trauma, but the latter did not seem to be. In addition, the child has rickets, which could well be one of the reasons for the development of kyphosis. Our doctor said that it is undesirable to put on a corset, otherwise the muscles will be completely reflected and the child can become a cripple. The doctor recommended manual therapy, good massage, gymnastics and swimming. Are these measures sufficient?
  4. Gregory Novice

    Recommendations are correct, but with severe deformity, corset treatment is indicated, of course, not as monotherapy, but in the structure of complex treatment. Also it is necessary to seem to the neuropathologist for exception of a pathology from nervous system, tk.the difference in muscle tone can also give a similar picture.
  5. Marianna Newcomer we made a computer test that revealed a child's lag in psychomotor development and revealed elevated intracranial pressure. Diuretics

  6. was prescribed Gregory Newbie

    Basically, the neurologist's recommendations are tactically correct, in order to speak more accurately you need to see the patient and preferably write in fulldoctors' conclusions, test data and prescription drugs, and if you talk about the deformation of the spine, then follow the recommendations, but if you do not put itI highly recommend turning to corset therapy, and even better, come to us in St. Petersburg, where you can hospitalize a baby in a profile hospital. SPbNTSER them. Albrecht is a federal government institution that is engaged in the rehabilitation of patients with pathology of the musculoskeletal system
  7. Albrecht, is it on Bestuzhevskaya?

MedHouse.ru

Kyphosis

In mild cases, kyphosis may not cause symptoms.

Reasons for

The spine( vertebral column) consists of bones( vertebrae), which are connected by dense, fibrous ligaments. The spine consists of 7 cervical( cervical) vertebrae, 12 thoracic vertebrae vertebrae( thoracic) and 5 lumbar vertebrae. Lumbar vertebrae - the largest, they retain most of the body weight. The sacrum, consisting of 5 intergrown vertebrae, is located below the lumbar vertebrae. The last three small vertebrae, also fused together, form the coccyx.

The causes of kyphosis vary in the types of this disease.

Kinds of kyphosis in children and adolescents

Postural kyphosis( sedimentary kyphosis) .This form of kyphosis is mainly found in adolescents. The development of postural kyphosis usually occurs slowly. It is more typical for girls than for boys. Poor posture or stoop may cause stretching of the vertebral ligaments and formation of inappropriate spine bones( vertebrae).Postural kyphosis is often accompanied by an excessively concave bend( hyperlordosis) in the lower( lumbar) section of the spine. Hyperlordosis is a way of compensating the body for an excessively curved bend in the upper part of the spine.

Kifoz Sheyermann .Like the postural kyphosis, Sheyerman kyphosis usually develops in adolescents aged 10-15 years, while the bones are in the process of growth. This kyphosis is also called Sheyerman-Mau disease, it is twice as common in boys as in girls. In Scheuerman-Mau disease, the vertebrae are deformed in such a way that they look like x-ray images, which are wedge-shaped, rather than triangular. On the affected vertebrae, the Schmorl hernia may also develop. These hernias appear as a result of pushing the cushion( disk) located between the vertebrae, into the bone in the lower and upper parts of the vertebra.

The cause of Sheyerman kyphosis is not known, but it is usually hereditary. Some patients suffering from this form of kyphosis also develop scoliosis - deformation of the spine, which causes lateral bending. Adults with whom Sheyermann-Mau's disease developed as a child may experience increasing pain with age.

Congenital kyphosis .Congenital malformation of the spine, which forms during the development of the fetus, causes kyphosis in some infants. A few vertebrae may form or the bones may form incorrectly. This form of kyphosis can be aggravated by the growth of the child. Kyphosis is the most common cause of paralysis of the lower body( paraplegia) after trauma and infection.

Causes in adults

Diseases that can cause curvature of the spine in adults, leading to kyphosis, include:

  • Osteoporosis is a disease associated with decreased bone density, often leading to vertebral fractures, which causes compression of the spine and development of kyphosis;
  • Degenerative arthritis of the spine .which can cause destruction of bones and discs of the spine;
  • Ankylosing spondylitis( Bechterew's disease) .inflammatory arthritis, affecting the spine and nearby joints;
  • Disorders from connective tissue .such as Marfan syndrome, which affect the ability of the connective tissue to keep the joints in the correct position;
  • Tuberculosis and other spinal infections that can lead to joint destruction;
  • Cancer or benign tumors of .which affect the bones of the spine and cause a change in their position;
  • Spina Bifida is a congenital defect. That part of the spine in which it is located is not completely formed, it causes damage to the spinal cord and vertebrae;
  • Conditions causing paralysis of .for example, cortical paralysis and poliomyelitis, as well as those conditions that result in reduced flexibility of the spine bones.

Risk Factors

Some groups of people have a high risk of developing kyphosis:

  • Adolescent girls with abnormal posture are at increased risk of developing postural kyphosis.
  • Boys aged 10-15 years are at increased risk of developing Sheyerman kyphosis.
  • Elderly people with osteoporosis are at increased risk for vertebral fracture, which can lead to kyphosis.
  • Patients with connective tissue disorders, such as Marfan syndrome, are also at high risk.

When to Call a Doctor

Since kyphosis often does not show any signs and symptoms, it can go unnoticed before passing a standard physical examination or a scoliosis test at school. Some patients notice pain, curvature of the shoulders or hump in the upper back.

Contact your doctor to have your child undergo a physical examination if you notice signs of kyphosis. If you develop any signs or symptoms, take a physical examination to find out if you need further examination.

Although rare, kyphosis can lead to serious health problems, for example, physical malformation, shortness of breath or damage to internal organs. You should see a doctor if you are experiencing any signs or symptoms of kyphosis.

Diagnosis and diagnosis of

The doctor will record the medical history and conduct a physical examination. Inspection may include:

Tilt test forward .The doctor will ask you to lean forward, watching your spine from the side. With kyphosis, the curvature of the upper back can become more prominent in this position. With postural kyphosis, the defects are corrected themselves when you lie on your back.

Neurological function test .Although the neurologic changes accompanying kyphosis are rare, the physician can check for their presence, paying attention to weakness, changes in sensitivity or paralysis below the kyphosis site.

Visualization of the spine .The doctor may order a radiographic examination to confirm the presence of kyphosis, to determine the degree of curvature and to detect deformity of the vertebrae, which helps determine the appearance of kyphosis. For example, the appearance of the wedge-shaped vertebrae or other characteristics seen on X-rays help to distinguish between postural kyphosis and Kheifa Sheyerman. In adults, x-rays can reveal arthritic changes in the spine, which can lead to increased pain. If the doctor suspects the presence of a tumor or infection, he can recommend conducting an MRI of the spine.

Investigation of lung function .The physician can also perform respiratory function tests to assess breathing problems caused by kyphosis.

Complications of

Kyphosis can cause the following complications:

  • Adolescents may develop a violation of the proportions of the trunk due to a curved back.
  • Deformation. The hump on the back can become noticeable over time.
  • Back pain. In some cases, the curvature of the spine can cause pain and aggravation that aggravates pain.
  • Difficulty breathing. In severe cases, kyphosis can lead to the fact that the ribs will press on the lungs, preventing breathing.
  • Neurological signs and symptoms. Although in rare cases, it can be weakness or paralysis of the legs, as a result of squeezing the vertebral nerves.

Treatment of

Treatment of kyphosis depends on the cause of the disease and the signs and symptoms present.

Less severe cases of

In these cases less aggressive treatments are used:

  • Postural kyphosis .This kind of kyphosis does not progress, and the condition can improve on its own. The exercises to strengthen the muscles of the back, exercises for proper posture and sleep on a hard surface can help. Painkillers can help reduce discomfort if exercise and physiotherapy are not effective enough.
  • Structural kyphosis .For kyphosis caused by spine pathology, treatment usually depends on age and sex, the severity of the symptoms and the magnitude of the bend of the spine. With Sheyerman kyphosis, only the observation of the progression of curvature may be recommended if the patient does not show symptoms. Anti-inflammatory drugs can help relieve pain. General strengthening physical exercises and physiotherapy can help alleviate the symptoms.
  • Osteoporosis kyphosis .Multiple compression fractures in patients with low bone density can lead to abnormal spinal curvature. In the absence of pain or other symptoms, the treatment of kyphosis is not necessary. But the doctor can recommend the treatment of osteoporosis to prevent fractures and worsening of kyphosis.

More serious cases of

More serious cases of kyphosis require more aggressive treatment. The main methods are wearing a corset and, as an extreme case, an operation. The earlier treatment is begun in children and adolescents, the more effective it will be for curing deformity.

When to wear a corset

If a teenager is still growing and suffers from moderate or severe kyphosis, the doctor may recommend a corset. Wearing a corset can prevent further progression of the curvature and even provide some correction.

There are several varieties of corsets for children suffering from kyphosis. A doctor can help you choose the most effective corset for your child.

Those children who wear corsets usually have only a few restrictions and can participate in most activities. Although at first you can feel uncomfortable and even strange in the corset, it must be worn according to the prescription, so that the treatment is effective. After the process of bone growth, the child can remove the corset according to the doctor's prescription.

There are different types of corsets for the treatment of kyphosis in adults, these can be postural simulators or hard corsets. The purpose of wearing a corset in adults is to relieve pain.

When an operation is needed

The operation on the spine carries many risks, so the doctor can recommend surgery only if you or your child have the following:

  • severe curvature of the spine, which can not be cured by other methods;
  • continuing to progress kyphosis;
  • debilitating pain, not amenable to drug treatment;
  • presence of neurological disorders, for example, paralysis;
  • kyphosis associated with a tumor or infection;
  • surgery can be recommended for a baby with congenital kyphosis for straightening the spine.

The operation consists in implanting a metal structure( screws, hooks) into the spine, which allows to align the spine on special rods. After the operation, corsets, gypsum, etc. are not used.

The period of hospitalization for one operation is about 10 days. Such operations are also shown in scoliosis.posttraumatic and postoperative curvature of the spine. Non-operated spinal curvatures are accompanied by respiratory failure, displacement of internal organs, problems in pregnancy.

The standard classical surgery for kyphosis and scoliosis is the operation of French surgeons Cotrel and Dubusset. This method was first used in Ukraine in 1999 as far back as 1999.Now the International Center for Neurosurgery has introduced a new, more effective, modification of these operations, developed by the Korean surgeon Sook and American Lenka. The first such operations were carried out by us in December 2006.The International Center for Neurosurgery uses imported designs of American manufacture, which are considered the best in the world( CD HORIZON( M 10, M8), LEGACY -( Medtronic) USA).

Adaptation and support of

During growth, adolescents encounter physical and emotional changes in the body. Wearing a corset or having a noticeable deformation of the spine can complicate this already difficult period.

Ensure that your child has close-minded people, including a caring family, friends or even a professional counselor, if necessary, to whom he can seek help and advice.

Synonyms of the disease: Sheyerman's disease - Mau, Shoerman's disease - Mau, Shoerman's disease - Mau, Sheyerman's disease - Mao, Shoerman's disease - Mao, Shorman's disease - Mao, hump, hunchback.

leshim-sami.ru

Plexitis of the shoulder joint medication treatment

Plexitis of the shoulder joint medication treatmentTreatment Of Joints

Plexitis of the shoulder joint Plexitis of the shoulder joint develops as a result of complete or partial inflammation of the nerves of the brachial plexus. With prolonged flow can lead to loss...

Read More
Plexitis of the shoulder joint

Plexitis of the shoulder jointTreatment Of Joints

Treatment of shoulder plexitis by the body Acute pain in the shoulder joint, covering the entire adjacent area from the scapula to the clavicle along the entire length of the limb, partial or c...

Read More
Periarthrosis of the shoulder joint treatment

Periarthrosis of the shoulder joint treatmentTreatment Of Joints

Periarthrosis of the shoulder joint Shoulder-bladder periarthrosis or periarthritis( PLP) is a whole group of diseases of the periarticular tissues of the shoulder joint, which have very simila...

Read More