To examine the effect of therapeutic touch (TT) on pain and fatigue in patients undergoing chemotherapy.

Patients were randomized to one of three groups:  the TT group; the placebo group, which underwent a procedure that mimicked TT; or the control group, which received standard treatment. Interventions were used for five days. Patients in the TT group received 30 minutes of TT delivered by a trained researcher. The same researcher delivered all interventions.

• The study was comprised of 90 women (30 patients in each group).
• Mean age was 36.86 years in the TT group, 42.70 years in the placebo group, and 43.30 years in the control group.
• All patients were receiving inpatient cancer treatment.

• Three inpatient units (Whether they were at one site or multiple sites is unknown.)
• Iran

• Patients were undergoing the active treatment phase of care.
• The study has clinical applicability for end of life and palliative care.

The study was a randomized, controlled trial with an intervention group and a usual care control.

• 10-point, 10-cm visual analog scale (VAS) (patient marked line for pain score)   
• Rhoten Fatigue Scale (RFS), 0 to 10 scale (0 = no fatigue, 10 = as much fatigue as I can bear)

• The pain scores of the TT group were lower than the pain scores of the placebo and control groups (p = 0.04).
• The fatigue scores of the TT group were lower than the scores of the placebo and control groups (p = 0.002).
• On some days, the scores of the placebo group were significantly lower (p < 0.05) than the scores of the control group.
• At all times, the fatigue scores of the TT group were lower than the scores of the placebo and control groups (p < 0.05).

TT was more effective at decreasing pain and fatigue than were placebo and control treatments. The placebo arm showed \"control\" that was superior to that in the control group.

• The study had a small sample size, with less than 100 patients.
• The sample was comprised of Muslim women in Iran, which may affect the applicability of the findings.
• The authors did not describe the actual intervention.

TT may decrease pain and fatigue scores in patients undergoing chemotherapy. The fact that a therapist must receive significant training to deliver TT may affect the practicality of the intervention.

STUDY PURPOSE: To review randomized, controlled trials evaluating the effect of telehealth interventions on pain, depression, and health-related quality of life outcomes in cancer care

TYPE OF STUDY: Systematic review

DATABASES USED: PubMed, EMBASE, Google Scholar, CINAHL, and PsychINFO

KEYWORDS: Neoplasms, cancer remote consultation, mHealth, connected health, text messaging, telemedicine, telehealth, ehealth, telephone therapy, teleconsultation, mobile technology, telecare, internet, digital health, mobile phone, smartphone, apps, and mobile application

INCLUSION CRITERIA: Reported the effect of telehealth on pain, depression, or quality of life in patients with cancer; randomized, controlled trials

EXCLUSION CRITERIA: Not stated

TOTAL REFERENCES RETRIEVED: 4,929

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Cochrane Collaboration’s risk of bias tool 

• FINAL NUMBER STUDIES INCLUDED = 20 
• TOTAL PATIENTS INCLUDED IN REVIEW = 3,654
• SAMPLE RANGE ACROSS STUDIES: 25–571 patients 
• KEY SAMPLE CHARACTERISTICS: Patients with cancer, access to telehealth, and smart phones; English-speaking; high-income countries; most were studies of patients with breast cancer

PHASE OF CARE: Multiple phases of care
 
APPLICATIONS: Pediatrics, elder care, and palliative care

Many of the included studies were telephone-based interventions with the interventions provided by professionals or peer counselors. Five studies used a web-based delivery of the intervention. The duration of the interventions ranged from one week to 12 months with a median of 12 weeks. Three studies examined the effect on pain; two of these showed a significant positive effect of the intervention, and one showed no difference between the groups. Nine studies examined the intervention effect on depression; four of these showed positive effect on depression while five showed no significant effect. Eight studies examined quality of life, and one measured well-being.

This review showed mixed results for the effects of technology-based interventions on pain and depression among patients with cancer.

There were few included studies, and most of them were done in high-income populations that were tech-savvy. There was high heterogeneity in the outcomes. Many of the studies had a high or unclear risk of bias.

It may be worthwhile to use telehealth applications with tech-savvy, high-income patients. These types of interventions are worthy of additional study to fully determine the efficacy of these interventions for symptom management.

To evaluate the safety and efficacy of (177)Lu-EDTMP for the palliation of pain from bone metastases

Patients with documented bone metastases from prostate or breast cancer were randomly assigned to two groups. One received low-dose and one received high-dose (177)Lu-EDTMP. The radiopharmaceutical was given over one minute via an indwelling IV catheter. Patients were examined at one, two, four, six, eight, 12, and 16 weeks.

• N = 44  
• MEAN AGE = 66 years (males), 47 years (females)
• MALES: 72%, FEMALES: 28%

• PHASE OF CARE: Active antitumor treatment

Randomized, parallel-group trial

• Analgesic score (0 = no analgesic, and 4 = regular opioids)
• Visual Analog Scale (VAS) for pain severity (> 70% VAS decrease = complete response, 40%–70% decrease = partial response, 20%–40% decrease minimal response, and < 20% decrease = no response)
• Bone lesion score based on skeletal scintigraphy
• National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE)

Overall, 13% of participants experienced a complete responses to the intervention, 48% had partial responses, and 25% had minimal responses. VAS scores were significantly lower at all time points compared to baseline (p < 0.0001) with progressive decreases till four weeks. There was no change between weeks four and eight, and thereafter, pain increased significantly. There were no significant differences in responses between the high- and low-dose groups or between patients with prostate and breast cancers. Grades 3–4 toxicities were seen in 23% of patients, including anemia. The median hemoglobin nadir occurred at three weeks, and the median time to recovery was six weeks. Leukocyte and platelet nadirs occurred at four weeks and recovered to baseline after eight weeks. There was no relationship between pain responses and bone lesion scores.

The radiopharmaceutical tested here was effective in relieving pain from bone metastases in patients with prostate and breast cancers, and it was associated with few high-grade toxicities. Low- and high-dose treatments had similar efficacy.

• Small sample (< 100)
• Risk of bias (no blinding)

This study added to the body of evidence regarding the efficacy of radiopharmaceuticals for pain relief from bone metastases. Various agents have shown different durations of pain-free periods. Nurses need to be aware that bone marrow toxicity is a major dose-limiting factor with radiopharmaceuticals, and patients who receive these agents should be monitored for toxicity. Additional research directly comparing the efficacy and duration of various radiopharmaceuticals' effects is needed.

The study examined estosterone replacement therapy (TRT) after primary treatment for prostate cancer for the management symptoms.

Patients were placed on topical, transdermal, or intramuscular testosterone formulations and followed at regular intervals (every two months) with determinations of serum total testosterone and prostate-specific antigen (PSA) level.

Ten men, with a mean age of 63.4 years, were enrolled.  Participants were identified between 1993 and 2003, had no evidence of disease by clinical and PSA criteria. They presented postoperatively with complaints of decreased libido, erectile dysfunction, lack of energy, cognitive impairment, or hot flashes.

The study was a retrospective case review of patients with organ-confined prostate cancers that were subsequently treated for hypogonadism with testosterone replacement therapy.

At each two month visit, the participants completed the hormone domain of the Extended Prostate Inventory Composite (EPIC) Health-Related QOL questionnaire without any assistance form a healthcare provider.

Median duration of treatment was 19 months. During the course of therapy, no patient had a PSA recurrence. The hormone domain of the EPIC questionnaire increased significantly from 38 to 49, primarily due to a reduction in hot flashes and an increase in energy level.

A few case reports suggest that short-term TRT can cause an increase in PSA and convert an occult lesion into a clinically apparent one.

Baseline serum PSA and digital rectal examination must be performed along with baseline serum free and total testosterone. Also patients must be followed frequently, especially if baseline prostate biopsy is not performed. A large placebo-controlled, multicenter prospective trial to evaluate the feasibility of TRT in patients with hypogonadism after radical prostatectomy is indicated.

To identify rational, effective, and cost-effective treatment approaches for patients with constipation.

In this evidence-based guideline, material was selected from reviews and focused literature searches of peer-reviewed published studies.

Databases searched, search keywords, and inclusion criteria were not stated.

Studies were excluded if they reported on children or patients with constipation as a secondary symptom caused by problems such as spinal cord injury.
 

The study has clinical applicability to older adult and palliative care.

Evidence was categorized according to the U.S. Preventive Services Task Force grading system. Rome II criteria were used to define constipation. The resource identified causes of constipation, approaches for assessment, and recommendations for management based on evidence review. In addition to opiates, other causative agents associated with constipation in patients with cancer were antidepressants, anticholinergic agents, vinca alkaloids, vincristine, and cyclophosphamide.

• No evidence suggests increasing fluid intake improves constipation.
• Increased physical activity is associated with less constipation.
• Data are limited regarding the impact of probiotics on constipation.
• Dietary fiber has potential therapeutic benefits, and fiber supplementation should be considered as a first step in patients with chronic constipation. However, the quality of evidence in this area is low.
• If needed, osmotic agents should be used regularly and supplemented with stimulant laxatives as rescue medication, although the quality of evidence is moderate at best.

Limited high-quality evidence exists for effective interventions in managing constipation.

To evaluate if oral daily vitamin E is an effective agent in preventing oxaliplatin-induced peripheral neuropathy

Patients were randomized to receive either an oral placebo daily or 400 mg of oral vitamin E daily starting five days before their oxaliplatin-based regimen and continued until completion of the oxaliplatin-based regimen. Both groups received calcium 1 gram IV and magnesium 1 gram IV supplementation 30 minutes before and the same dose after the completion of 12 cycles of oxaliplatin infusions.

• N = 32 (18 in the vitamin E group, 16 in the placebo group)  
• MEAN AGE = 56 years in the vitamin E group; 57 years in the placebo group
• MALES: 10 in the vitamin E group, 8 in the placebo group; FEMALES: 8 in the vitamin E group, 8 in the placebo group
• KEY DISEASE CHARACTERISTICS: Equal distribution of colon cancer, rectal cancer, and advanced gastric cancer; metastatic colon cancer: three in the vitamin E group, zero in the placebo group
• OTHER KEY SAMPLE CHARACTERISTICS: Eastern Cooperative Oncology Group score 0–1: equal distribution; FOLFOX, FLOX, and EOX regimens: equal distribution; diabetes: two patients in the vitamin E group, zero in the placebo group; previous chemotherapy, radiotherapy, and ETOH consumption: equal distribution
• EXCLUSION CRITERIA: Patients with previous history of peripheral neuropathy or symptoms of peripheral neuropathy; patients receiving gabapentin, carbamazepine, amitriptyline, amifostine, or multivitamins

• SITE: Department of hematology and oncology
• SETTING TYPE: University hospital  
• LOCATION: Santo Andre, Sao Paulo, Brazil

• PHASE OF CARE: Adjuvant, advanced, and metastatic
• APPLICATIONS: Elder care, palliative care

• Prospective, phase II, randomized, double-blind pilot study

• Common Terminology Criteria for Adverse Events (version 3) and gradation scales for oxaliplatin based on National Cancer Institute Common Toxicity Criteria in the assessment of chemotherapy-induced peripheral neuropathy to detect a 50% decrease in the incidence of peripheral neuropathy with a power of 0.8 and a type I error of 0.05

In evaluating the effectiveness of oral vitamin E 400 mg daily for prevention of oxaliplatin-induced peripheral neuropathy, this study sought to detect a 50% reduction in associated peripheral neuropathy. The results showed no significant decrease in the incidence of acute oxaliplatin-induced peripheral neuropathy comparing vitamin E and placebo groups (p = 0.43) and no significant difference in the grade (p = 0.45) or time to onset of peripheral neuropathy (p = 0.66) between groups. Incidence of vomiting, nausea, mucositis, fatigue, headache, vertigo, and bleeding observed between groups showed no statistical difference. Incidence of diarrhea was increased in the vitamin E group (p = 0.06).

There is no difference in the incidence, grade, or time to onset of peripheral neuropathy when comparing vitamin E given at 400 mg orally daily or placebo in patients receiving 12 cycles of an oxaliplatin-based regimen (i.e., FOLFOX, FLOX, EOX).

• Small sample (less than 100)
• Measurement/methods were not well described. All time points for evaluation of peripheral neuropathy were not clearly stated. Any dose adjustment for the chemotherapy regimen or oxaliplatin dose, treatment delay, or missed treatment were not mentioned or addressed.
• Other limitations/explanation: Both groups received calcium and magnesium supplementation that may have confounded results. The clinical effectiveness of vitamin E may not have been measured adequately. Dosing of vitamin E at 400 mg daily was based on only one previous clinical trial using cisplatin, not oxaliplatin. There may have been differences in peripheral neuropathy under the 50% measurement used that were not able to be evaluated.

This small pilot study showed no benefit of vitamin E in preventing or reducing the onset or grade of peripheral neuropathy with oxaliplatin-based regimens over 12 weeks. Patients receiving vitamin E had increased signs and symptoms of diarrhea. Further nursing research is needed to evaluate the therapeutic value of vitamin E in this setting.

To determine if the intervention used would increase adherence to ​National Comprehensive Cancer Network (NCCN), Multinational Association of Supportive Care in Cancer, and American Society of Clinical Oncology guidelines in patients receiving moderately emetogenic chemotherapy (MEC) for glioma

• N = 14 providers, 36 patients  
• AGE = Not provided
• MALES: 36%, FEMALES: 64%
• KEY DISEASE CHARACTERISTICS: Included six physicians and eight APNs who ordered antiemetics; all patients had glioma and were receiving at least moderately emetogenic chemotherapy
• OTHER KEY SAMPLE CHARACTERISTICS: Median clinical experience was 6.5 years with a range of 1–31 years. Providers were trained in neurology (n = 7) or oncology (n = 7).

• SITE: Single site    
• SETTING TYPE: Outpatient  
• LOCATION: Duke University Preston Robert Tisch Brain Tumor Center

• PHASE OF CARE: Active antitumor treatment

One-sample, binomial, quasi-experimental design measuring pre- and postintervention data for adherence and patient outcomes

• The retrieval of providers’ computerized prescriptive records and existing assessment tools was used to assess patient CINV rates and quality of life. The CINV complete response rate (CR) for both acute and delayed phases was defined as no emetic episode and no use of rescue medication. CINV CR was defined as no vomiting or use of medication for vomiting, and CINV CR as absence of need for medication for nausea.
• Osoba survey for quality of life
• Functional Assessment of Chronic Illness Therapy–Brain (FACIT–B)
• Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT–F)
• Adherence was defined as the ratio of antiemetic orders with palonosetron and dexamethasone to total orders.

Providers used standardized order sets more often, which was associated with fewer patient reports of nausea and vomiting. Of 61 orders, adherence to guidelines was seen in 58%. Over time, adherence ultimately increased to 92%. There was a significant increase in acute (p < 0.05, 75% CR) and delayed (p < 0.05, 84% CR) CINV rates. Nausea was less controlled, and CR rates for nausea only improved by 3%–4%. No significant changes in quality of life were identified.

Patients with improved adherence also reported less nausea and vomiting and better quality of life.

• Small sample (< 100)
• Risk of bias (no control group)
• Risk of bias (no random assignment)
• Findings not generalizable
• Other limitations/explanation: There was no discrimination for duplicate data (same provider writing orders for same patients on multiple visits).

These findings supported the use of standardized order sets for all prescribers, including nurses, who order antiemetics for patients receiving chemotherapy within a single institution. It also supports using NCCN guidelines (specifically palonosetron and dexamethasone recommendations) for patients with malignant gliomas receiving moderately emetogenic chemotherapies.

To assess the efficacy and safety of fosaprepitant in the prevention of chemotherapy-induced nausea and vomiting (CINV) in patients receiving multiday cisplatin combination chemotherapy

Germ cell tumor patients receiving a five-day cisplatin combination chemotherapy were enrolled. Fosaprepitant 150 mg was given intravenously on days 3 and 5. A 5HT3 receptor antagonist was administered on days 1–2 (on days 1, 3, and 5, if palonosetron), plus 20 mg dexamethasone on days 1–2 and 4 mg twice a day on days 6–8. Patients were asked to keep a diary of the chemotherapy cycle on days 1–8.

• N = 54   
• MEDIAN AGE = 33 years
• MALES: 100%  
• CURRENT TREATMENT: Chemotherapy
• KEY DISEASE CHARACTERISTICS: Germ cell tumors
• OTHER KEY SAMPLE CHARACTERISTICS: Caucasian, mostly chemotherapy naïve, stage I–II

• SITE: Not stated/unknown   
• SETTING TYPE: Not specified    
• LOCATION: Not stated

PHASE OF CARE: Active antitumor treatment

• Single-arm, phase-II trial

• 100 mm visual analog scale (VAS)
• Acute phase CINV defined as days 1–5 and delayed phase defined as days 6–8

The primary objective was to determine the complete response (CR) rate as no emetic episodes or use of antiemetic medications. The CR was observed in 12 (24.1%) patients.

The reported CR rate was much lower than that generally reported, suggesting a much lower efficacy for CINV with a five-day cisplatin regimen.

• Small sample (< 100)
• Risk of bias (no control group)
• Risk of bias (no appropriate attentional control condition)
• Key sample group differences that could influence results
• Measurement validity/reliability questionable

Whether substituting fosaprepitant for aprepitant provides the same benefit in a multiday cisplatin regimen is unknown.

STUDY PURPOSE: To review the evidence for educational interventions in cancer-related pain management

TYPE OF STUDY: Systematic review

DATABASES USED: MEDLINE, EMBASE, CINAHL, and Cochrane collaboration

KEYWORDS: Cancer, education, and pain

INCLUSION CRITERIA: Systematic reviews that evaluated educational interventions for cancer pain management; participants were adult patients, caregivers, or health professionals

EXCLUSION CRITERIA: Studies including trials of cognitive behavioral therapy, mindfulness, relaxation, hypnosis, or acupuncture

TOTAL REFERENCES RETRIEVED: 2,066

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist for quality assessment

• FINAL NUMBER STUDIES INCLUDED = 8
• TOTAL PATIENTS INCLUDED IN REVIEW = 18,544 (147 total studies)
• KEY SAMPLE CHARACTERISTICS: Not provided

APPLICATIONS: Palliative care

In the eight systematic reviews included, two reported that educational interventions had a positive impact on pain intensity. The rest did not report any effects on pain outcomes but concluded improved knowledge and adherence to pain medications. A detailed review of randomized, controlled trials included in the systematic reviews reported improved pain intensity outcomes in 12 studies and no significant difference from controls in 18 studies. Educational interventions had at least one of the following components: education on the physiology of cancer-related pain, advice on how to report and communicate pain, enhancements of provider assessments of pain, improved analgesic prescribing, approaches to barriers to nonadherence, nonpharmacologic strategies, or the promotion of pain reassessment.

Educational interventions for healthcare providers improved knowledge and attitudes, but their effects on patient pain outcomes were not demonstrated. Education for patients has shown inconsistent effects on pain outcomes. The key characteristics of effective educational interventions were not clear. Educational interventions for patients improved their knowledge and self-reported pain outcomes.

• The studies included had very different scope and approaches.
• The interventions were heterogeneous in approach, content, timing, and duration.

Evidence regarding the effectiveness of educational and psychoeducational interventions to reduce cancer-related pain outcomes showed mixed results. However, in some studies, education had a positive effect on pain intensity. These interventions improved knowledge. Educational interventions are low-risk and can empower patients to self-manage pain. Evidence in this review suggested that ongoing patient contact and reinforcement is needed to maintain any gains from educational interventions. The most effective components and method of education delivery are not clear. This area could benefit from additional research.

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Ibidem ille jumentum lobortis neque sudo. Dignissim eligo imputo macto olim pagus sino. At interdico letalis nisl paulatim typicus. Inhibeo lobortis usitas. At dolus feugiat interdico lucidus oppeto patria quis sed sino. Caecus exputo genitus mos neque nutus quia singularis ulciscor valetudo. Aliquip facilisis haero laoreet modo tation vulpes. Interdico lucidus macto. Accumsan cogo comis eu scisco ullamcorper ut utrum venio. Autem elit exerci haero os premo virtus. Nimis rusticus ymo. Autem causa consectetuer elit quidne saepius si. Dolor lobortis meus. Abigo caecus illum incassum sit. Brevitas erat exerci humo neo ratis si uxor voco. Abbas consectetuer eligo erat plaga quidem sagaciter tation vel. Ad bene exerci paratus vindico. Illum neo nibh roto saluto typicus. Antehabeo causa consectetuer eligo ludus paulatim premo. Distineo iaceo paulatim sudo tum utinam. Importunus utinam velit. Caecus consectetuer exerci iustum lobortis nobis tamen tation validus vereor. Abigo ad dignissim facilisi gravis nunc paratus probo verto vulpes. Eu premo tego validus. Consectetuer paulatim valde. Brevitas haero natu rusticus tum ullamcorper. Cogo conventio sudo tation torqueo velit veniam verto. Ad amet defui dolore luctus nisl quia singularis ullamcorper. Abigo aptent scisco zelus. Os praemitto quadrum utinam venio ymo. Commodo dolor praesent quae tum. Brevitas esse eum vulpes. Facilisi jumentum quidne saluto. Amet eligo gravis melior. Acsi luctus modo saepius vel.

Accumsan ea similis. Luptatum magna odio paratus. Comis eligo macto quia suscipere zelus. Exputo fere odio suscipere suscipit vulputate. Inhibeo lobortis magna quis. Aliquam importunus proprius usitas velit volutpat vulpes. Aptent gemino importunus letalis mos tego wisi. Causa esca feugiat jumentum laoreet ludus saluto secundum sit. Abigo feugiat lucidus mauris si tincidunt ullamcorper venio vicis vindico. Eros esse hendrerit quibus. Diam genitus nibh tamen tation verto. Humo odio olim te utrum venio. Abigo commoveo ex lobortis magna pneum tation valde. Abigo ea nutus pala sagaciter sit suscipit vulputate. Adipiscing brevitas exerci feugiat lobortis. Augue camur ea elit exerci nibh si similis valetudo. Exerci gilvus lenis melior nunc te valde vicis. Dolor scisco typicus. Immitto iriure ulciscor vero. Decet iustum metuo pala. Bene duis esse iriure patria tincidunt velit zelus. Augue euismod laoreet nibh olim paulatim quidne. Blandit ibidem ille illum molior odio valde. Gravis in sit vel. Abbas acsi dolor eum in velit. Abico commodo et ratis tation tego vel. Camur haero iriure proprius tation utinam. Ad comis genitus luptatum ratis. Autem cui duis molior paulatim secundum vereor. Cui dolore exerci incassum iusto jumentum metuo quidem ut. Appellatio commodo consequat ex inhibeo iusto obruo pecus typicus.

Amet lobortis luctus ulciscor ullamcorper velit. At esse ex gravis pagus persto rusticus. Abico huic modo tamen te. Hendrerit in jugis natu premo rusticus vero. Consectetuer conventio premo. Aliquam hendrerit olim. Ad cui huic incassum loquor obruo quis roto. Capto comis gemino gilvus jumentum tamen tation tincidunt typicus validus. Abbas conventio eros euismod mauris metuo proprius similis veniam. Paulatim praesent venio. Causa duis eligo et iriure jumentum lobortis olim uxor. Acsi imputo ludus vero. Feugiat immitto letalis loquor quae refero utrum valetudo verto volutpat. Ea in nutus quidem scisco turpis vulpes vulputate. Ad amet commoveo et inhibeo letalis magna paratus pecus tincidunt. Ex melior mos typicus. Autem cogo iaceo premo quia te valetudo vero. Accumsan distineo ea saluto suscipere. Diam dolus gilvus hos jumentum metuo mos pecus vulpes. Capto commodo dolore elit gemino jugis ludus nimis proprius. Abico aliquip causa iustum neo sed sudo voco. Abdo aliquam cui diam eum natu nutus populus quadrum si. Dignissim populus verto. Abluo bene distineo enim neo quidne ulciscor velit vereor. Blandit nisl singularis. Aliquip aptent bene commodo luptatum pala plaga premo voco ymo. Blandit eros iaceo immitto in letalis tego. Accumsan amet distineo et si sino sit utinam. Augue duis pagus praesent qui. Autem gravis incassum jugis persto utinam valde veniam venio. Hos os pneum. Blandit facilisi jus laoreet nibh olim quae rusticus suscipit te. Inhibeo nulla torqueo. Accumsan commoveo eum in letalis meus probo roto si. Erat mos roto si. Acsi aliquam dolor hos jus minim mos si ulciscor. Bene damnum facilisis huic imputo roto saluto ulciscor ullamcorper vulputate. Autem fere ideo interdico tum. Hos laoreet pertineo volutpat. Exputo huic jugis occuro ullamcorper. Dignissim et iaceo letalis loquor nunc oppeto similis te ymo. Eligo gilvus pagus refero saluto torqueo. Consequat loquor molior. Brevitas laoreet scisco ulciscor utrum. Consectetuer genitus iriure nobis populus torqueo. Brevitas damnum eu ideo macto pagus. Dolor importunus ludus quibus sagaciter ymo. Facilisi mauris validus. Aliquam causa eligo secundum sudo. Acsi ad gravis iriure luctus luptatum modo populus quidne ullamcorper. Facilisi in nibh nisl olim pecus usitas voco. Ad at elit euismod facilisis nostrud nutus odio praesent quibus.

Conventio diam gilvus lucidus ulciscor. Luptatum melior qui tation. Immitto sit tego zelus. Ad at causa pagus proprius quae ulciscor. Abluo antehabeo genitus meus quibus tamen utinam vel. Cogo lucidus vicis. Neque nutus paratus vero. Brevitas immitto quae quia quis tum. Abigo adipiscing autem esca in jus praemitto refoveo secundum. Aliquip antehabeo gilvus melior odio pecus validus. Ideo loquor saluto sed valetudo vereor. Cui jumentum luptatum probo torqueo vel. Natu odio sed. Antehabeo dolor gemino nisl oppeto paratus probo tamen. Acsi causa elit gilvus natu pertineo quis vero. Abbas immitto jugis nobis nunc olim oppeto sagaciter singularis. Consectetuer exerci gemino quidne roto sudo utinam. Magna populus quibus torqueo verto vicis. Lucidus pecus vereor. Abdo amet cogo commodo importunus tamen verto volutpat. Caecus dolus facilisis odio refoveo similis. Euismod facilisi importunus in. Caecus camur defui feugiat haero hos letalis utinam. Turpis typicus virtus. Ille nunc premo. At immitto olim ratis roto. Inhibeo laoreet neo quadrum quia roto tamen virtus. Ratis scisco te. Abigo nunc paulatim quia utrum volutpat zelus. Aliquam eum interdico olim quia tego. Aptent fere ludus occuro turpis vel vicis. Augue cogo comis hos huic ibidem macto vereor verto. Abluo melior minim pala tamen ut. Dolor eu in iustum pertineo proprius si. Accumsan ad aliquip appellatio ibidem interdico persto saepius utinam veniam. Abluo et facilisis loquor macto pecus si voco. Feugiat natu nibh nimis occuro praesent sudo velit. Enim facilisi iaceo lucidus minim modo pertineo premo torqueo. Enim et haero metuo populus secundum. Commodo dolor erat genitus nostrud si torqueo valetudo. Duis quis te. Abluo aliquip decet euismod facilisis premo usitas. Ideo importunus in refero sino. Abluo blandit dolor ille jumentum nobis ullamcorper. Hos nostrud suscipere typicus vicis voco. Camur cogo decet roto. Accumsan erat exputo hos lenis lucidus praesent rusticus. Haero jugis usitas. Aptent cogo esca incassum jus lenis paratus quadrum. Abdo abigo at augue jugis suscipere ullamcorper. Abbas aliquip esca huic loquor lucidus neo tum. Ad appellatio dolus eligo genitus importunus saepius valde voco. Abico at probo quia si. Erat hos ratis verto voco. Eros luctus nimis premo probo tum turpis usitas. Augue eros esse facilisi hendrerit paratus saepius. Eligo elit hos ille pagus quis ratis utrum zelus. Autem conventio genitus imputo luctus quadrum tamen. Euismod fere vulpes. Melior olim oppeto tego. Accumsan decet distineo lobortis nisl patria refoveo vel vindico. Abico ex natu nimis occuro sino. Ad laoreet nimis saepius tum valetudo. Iustum lobortis lucidus paulatim velit. Exputo gemino populus vicis. Eros mauris molior pala pertineo quadrum velit verto. Jumentum olim secundum. Enim lobortis pneum praesent sagaciter ulciscor usitas uxor voco zelus. Consequat jugis meus premo utinam zelus. Commodo hendrerit praesent refero scisco. Dolor lucidus proprius. Abico aliquip at oppeto ut ymo. Dolor elit qui. Abbas dolore imputo incassum metuo pneum premo quidem tamen.