ࡱ>  q` 0\bjbjqPqP .V::\6666666JyyyyV{Jj|b[G$kbdddddd$Mhj6[[66z66bb66| mZsuyP0h,b0 6$@R JJJd/J.JJJJJJJ666666  Small-Bowel Obstruction  HYPERLINK "http://progps1.emedicine.com/gps/redline.gps?docid=374962"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/images/redline-large.gif" \* MERGEFORMATINET  HYPERLINK "http://progps1.emedicine.com/gps/medlinesearch.gps?docid=374962" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/images/btnMedline.gif" \* MERGEFORMATINET  This article uses template:  HYPERLINK "http://progps1.emedicine.com/gps/booktemplates.gps?action=view&templateid=15" \t "_blank" RADIOLOGY Author Information Author:Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP, Chairman of Medical Imaging, Professor of Radiology, NGHA, King Fahad National Guard Hospital,  HYPERLINK "http://www.ngha.med.sa/ngha/" \t "_blank" King Abdulaziz Medical City, Riyadh, Saudi Arabia. Ali Nawaz Khanis a member of the following medical societies:  HYPERLINK "http://www.aium.org/" \t "_blank" American Institute of Ultrasound in Medicine,  HYPERLINK "http://www.rsna.org/" \t "_blank" Radiological Society of North America,  HYPERLINK "http://www.rcplondon.ac.uk/" \t "_blank" Royal College of Physicians,  HYPERLINK "http://www.rcpsus.com/" \t "_blank" Royal College of Physicians and Surgeons of the United States,  HYPERLINK "http://www.rcr.ac.uk/" \t "_blank" Royal College of Radiologists, and  HYPERLINK "http://www.rcseng.ac.uk/" \t "_blank" Royal College of Surgeons of England. Coauthor(s): Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute; John MT Howat, MB, BCh, MD, FRCS, Consultant General and Colorectal Surgeon, North Manchester General Hospital, UK Editors:Eric P Weinberg, MD, Associate Professor, Department of Radiology, University of Rochester Medical Center, Strong Memorial Hospital; Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand; Spencer B Gay, MD, Professor of Radiology, Director of Body Computed Tomography, Department of Radiology, University of Virginia Health Sciences Center; Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute; Eugene C Lin, MD, Consulting Staff, Department of Radiology, Virginia Mason Medical Center.  Synonyms, Key Words, and Related Terms SBO, mechanical ileus, mechanical small bowel obstruction, ileus, bezoar, foreign body obstruction, food bolus obstruction, bowel wall lesional obstruction, bowel stricture, volvulus, hernia, bowel adhesion  Introduction Background In parts of Europe, the term ileus is applied both to a mechanical obstruction and atony of the bowel related to abdominal surgery or peritonitis. However, in most English-speaking countries, the term obstruction is used for a mechanical blockage arising from a structural abnormality that presents a physical barrier to the progression of gut contents. The term ileus is reserved for the paralytic or functional variety of obstruction. Mechanical small-bowel obstruction (SBO) can be classified by cause into 3 main groups: (1) intraluminal (eg, foreign bodies, bezoars, food bolus), (2) obstruction resulting from lesions in the bowel wall (eg, tumors, Crohn disease), and (3) extrinsic (eg, adhesions, hernias, volvulus). Pathophysiology In the mechanical form of SBO, the proximal gut is distended by swallowed gas and fluid that arises from gastric, small-bowel, pancreatic, and biliary secretions. Fluid sequestered within the small bowel is drawn from the circulating blood volume and interstitial spaces, and copious vomiting exacerbates fluid loss and electrolytic depletion. The resultant hypovolemia may be fatal. Prolonged obstruction may result in compromise of the venous blood in the affected segment of bowel and in edema, localized tissue anoxia with ischemia, necrosis, perforation leading to peritonitis, and death. Septicemia may occur in patients as a result of extensive aerobic and anaerobic proliferation in the lumen. The bowel beyond the obstruction collapses and empties. In general, the higher the level of obstruction, the less the distention and the more rapid the onset of vomiting. Conversely, in patients with distal SBO, central abdominal distention may be marked, and vomiting is usually a late feature because the bowel takes time to fill. Colicky pain is most marked in patients with a distal obstruction. Hypotension and tachycardia suggest fluid depletion, and tenderness and leukocytosis suggest strangulation. In the early stages, bowel sounds are usually high pitched and occur in frequent runs as the bowel contracts to try and overcome the obstruction. A silent tender abdomen suggests perforation or peritonitis and is a late sign. The etiologies of SBO Intraluminal causes are relatively unusual. Swallowed foreign bodies may be involved, though usually, a foreign body that has passed the pylorus passes through the remainder of the small bowel without difficulty unless the small bowel is already compromised by postoperative adhesions. Bezoars are possible factors. Parasites such as Ascaris lumbricoides may be found. Gallstones may occur with a cholecystenteric fistula. A food bolus may occur, with indigestible vegetable material impacted in the terminal ileum. Patients usually will have undergone gastric outlet surgery. Inspissated meconium resulting in obstruction of the distal ileum may be seen with cystic fibrosis in patients of any age. Regarding intramural causes, obstruction resulting from lesions in the wall of the small bowel is relatively infrequent. Neonatal atresias and strictures may be causes. Thickening of the bowel wall with luminal compromise may be seen, as in patients with Crohn disease. This thickening may occur with recurrent episodes of partial or incomplete obstruction. Small-bowel tuberculosis is not uncommon in certain parts of the world. Strictures may occur following the ulceration induced by potassium tablets, nonsteroidal anti-inflammatory agents, and therapeutic irradiation for bladder or cervical cancer. An intramural hematoma may occur in trauma or in patients receiving higher doses of anticoagulant agents than are necessary. Lipomatas, leiomyomatas, and carcinoid tumors rarely result in obstruction, but these have been reported in association with small-bowel lymphoma and the rare adenocarcinoma. Secondary tumors, notably gastric and colonic carcinomas, ovarian cancers, and malignant melanomas, may occasionally compromise the lumen of the small bowel. Any polypoid mucosal or submucosal lesion may form the head of an intussusception, which in turn can result in SBO. Intussusception in children younger than 2 years is a common abdominal emergency and usually idiopathic, although Meckel diverticulum, polyps, duplication cysts, and Henoch-Schnlein purpura have been implicated. Extramural causes may be the most common. Adhesions related to previous surgery or peritonitis are frequently implicated. Adhesive bands occur between loops of bowel and the wound and operative site. These adhesions can obstruct the small bowel by causing acute angulation and kinking, often many years after the initial procedure is performed. Congenital intraperitoneal bands may result in obstruction. Congenital malrotation results in a short mesenteric attachment, and the entire midgut may undergo torsion or volvulus, which leads not only to obstruction but also rapid progression to ischemia and death. Hernias may cause SBO. A loop of small bowel may enter any form of hernia and become obstructed because of the narrow neck of the hernia, which compromises the caliber of the bowel from without. Most frequently, hernia-induced obstruction may occur as a complication of femoral, indirect inguinal, or umbilical hernias. Such obstruction is a recognized complication of incisional and epigastric hernias and of the rare spigelian hernia. Clearly, development of the obstruction is related to the width of the neck of the hernia, which to some degree reflects the nature of the boundaries of the hernial defect. Obstructions resulting from a femoral hernia are particularly unwieldy. Initially, the venous return of the bowel is compromised, leading to congestion and edema, which progresses to localized tissue anoxia with frank ischemia; necrosis; and, in some patients, perforation. The site of the obstruction is at the neck of the hernial sac, but any dead bowel is usually within the sac, which contains transudate; this sac is often tender. In large, multiloculated umbilical and incisional hernias, obstruction and its sequelae may arise in a single locus if the neck is sufficiently tight. A Richter hernia occurs when only part of the circumference of the small bowel is trapped at the hernial neck (usually femoral). This type of hernia may not result in a complete obstruction and is easy to overlook, particularly in patients with obesity, until perforation has occurred. Obstruction occasionally results from incarceration of a loop of small bowel through congenital defects in the mesentery or omentum. Other so-called internal hernias may arise as a result of various degrees of malrotation occurring during fetal development. The most common are right and left paraduodenal hernias. Obstruction due to an internal hernia is clinically indistinguishable from obstruction due to postoperative adhesions. In some patients, the etiology of SBO may be multifactorial. For example, metastases to the small bowel can directly invade the bowel wall, causing luminal compromise. Obstruction may be the result of extrinsic compression or kinking of the bowel when it adheres to the primary tumor or a metastatic deposit. Frequency United States The frequency in the United States is the same as that found internationally. International Approximately 20% of patients admitted to the hospital with an acute abdomen have an intestinal obstruction; SBO is responsible for 80% of these cases. Some causes of SBO (eg, A lumbricoides, tuberculosis) are more common in developing countries. Mortality/Morbidity Mortality and morbidity rates of SBO depend on the etiology and the patient's age at presentation. For example, in SBO due to intussusception in infants, the prognosis is favorable because reduction and relief of the obstruction are possible by using a gas enema under radiologic guidance. On the contrary, the prognosis in an obese elderly woman with an obstruction due to a femoral hernia is poor, particularly if diagnosis is delayed and if the SBO is associated with protracted vomiting, fluid depletion, or intercurrent illnesses. Strangulation with ischemia of the bowel by an adhesion or a  HYPERLINK "http://www.medscape.com/resource/hernia" hernia is an emergency, and any delay in surgery beyond the time required to resuscitate and optimize the patient's status is associated with an increase in mortality rates, which are as high as 25% when the delay exceeds 36 hours. Leukocytosis, a slight amylasemia, and a tender silent abdomen may be signs of ischemia or a perforated small bowel. These are of grave prognostic significance. Early surgery is essential. Race No racial predilection exists. Sex Age Although SBO may occur in patients of any age, certain etiologies are more common in particular age groups. Common causes of SBO Age GroupIntraluminal CausesIntramural CausesExtramural Causes (Extrinsic Compression)Neonates and infants <24 moMeconium ileus, milk curd obstruction, foreign bodiesCongenital atresias, stenoses, and diaphragms; duplication cysts; intussusception; Henoch-Schnlein purpuraInguinal hernia, congenial bands, midgut volvulus, postoperative adhesionsChildren and young adultsForeign bodies, A lumbricoidesCrohn disease, tuberculosis, benign neoplasms, primary and secondary malignant neoplasmsInguinal hernia, congenital and postoperative adhesions, midgut volvulus, complications of appendicitisElderly personsForeign bodies, gallstones, food bolusCrohn disease, tuberculosis, primary and secondary neoplasia, potassium strictures, radiation strictures, complications of surgical anastomosisPostoperative adhesions; femoral, inguinal, umbilical, or incisional hernia; colonic and ovarian neoplasia; adhesion to an inflammatory process (eg, appendicitis or diverticulitis Anatomy The distal part of the duodenum (jejunum, ileum, colon proximal to the splenic flexure) develops from the embryologic midgut. A normal small bowel is approximately 3-6 m in length, although the exact length is often difficult to assess because the small bowel can become considerably elongated or foreshortened in life. In most individuals, the jejunal loops lie in the left hypochondrium, and the ileum lies in the pelvic midline. The terminal ileum is the narrowest part of the small bowel, and peristalsis may be weaker in this segment than more proximally. The valvulae conniventes are more prominent in the jejunum than in the ileum. The intramural width of the small bowel may be measured by using findings of the gas-filled lumen on plain abdominal radiographs. An intramural width of 3 cm is considered abnormal and may indicate obstruction or ileus. This measurement is reduced to 2.5 cm on CT scans. In most healthy adults, the small bowel contains little gas, and only 1 or 2 nondistended gas-filled loops may be seen in the small bowel. However, in the supine position, the duodenum cannot maintain an efficient water trap, and air may pass into the jejunum from the stomach. This is a common observation in patients undergoing intravenous urography who are supine during the procedure. In young children, gas-filled small-bowel loops are common normal findings; however, distention of these loops by gas or fluid should be regarded as abnormal. The depiction of the small bowel on sonograms is improved when the small bowel is filled with water. A water-filled small bowel may occur normally, particularly after meals or the ingestion of a large volume of fluid. Sonography shows fluid-filled tubes lined by an echogenic mucosa that is thrown into folds or valvulae. These folds may lend a ribbed appearance to the inner wall of the bowel. The normal bowel wall is 3-5 mm thick, and normal loops of bowel are yielding and easily deformed during examination. The configuration of the loops may be altered as a result of peristalsis and distention with fluid and air. Progressive pathologic distention makes the bowel more tubular, with a loss of sharp angles between consecutive loops. Clinical Details Patients with a mechanical SBO usually present with abdominal pain, vomiting, absolute constipation, and varying degrees of abdominal distention. Signs of peritonitis suggest perforation of the bowel as a result of ischemia and are indistinguishable from peritonitis resulting from other causes of perforated intra-abdominal viscus. In patients with a simple obstruction with no associated vascular compromise, pain tends to be colicky and initially mild, but it progressively increases, both in frequency and in severity. The pain may be continuous or interspersed with pain-free periods. The patient often assumes a knee-chest position, or he or she may roll around. Patients with peritonitis tend to lie still because movement exacerbates the pain. Vomiting is an early sign in proximal or high SBO. However, if the obstruction is in the distal small bowel, vomiting may be delayed. Initially, the vomitus contains gastric juice, which is soon followed by bile, and finally, the vomitus contains stale small bowel content; this is often is termed feculent. Hypovolemia and electrolyte depletion may occur rapidly unless the patient receives intravenous replacements. The degree and distribution of abdominal distention may reflect the level of the obstruction. With a proximal or high obstruction, distention may be minimal. On the contrary, central abdominal distention tends to be marked in patients with a distal obstruction. No definitive signs distinguish a strangulated obstruction from a simple obstruction; however, certain clinical and laboratory features may suggest strangulation (see  HYPERLINK "http://progps1.emedicine.com/gps/topiccontrol.gps?docid=374962" \l "IntroductionPathophysiology#IntroductionPathophysiology" Pathophysiology). Examine the groin in all patients with SBO to exclude an inguinal or femoral hernia. Femoral hernias are easy to overlook in patients with obesity. Note scars from previous laparotomy. Blood and mucous may be passed, and an abdominal mass is occasionally palpated in children in whom SBO is secondary to intussusception. In children with intussusception, colicky pain is a classic finding. The episodes of pain starting suddenly, last several minutes then fade, with the patient's condition appearing close to normal between episodes. Vomiting is uncommon. Constipation is a typical finding, although a mixture of blood and mucus may be passed as the so-called red current jelly, which is said to be pathognomonic for intussusception. Occasionally, an abdominal mass is palpable. Preferred Examination Certain radiologic investigations can be used to confirm the diagnosis and level of an SBO but not its etiology, whereas others are aimed at determining the cause. Conventional plain radiography is the investigation of choice in patients in whom SBO is suspected. This study should always be performed first. The unique capabilities of CT make it an important diagnostic tool when a specific clinical answer is sought. Studies have shown the superiority of CT scans in revealing not only the site of the obstruction but also its cause. CT scans may demonstrate signs of ischemia. At present, the relative value of performing conventional small bowel contrast enema study versus CT scans in a known or suspected SBO remains underdetermined. Small-bowel enema is preferable to CT when the obstruction is intermittent or incomplete, and it may be of particular value under these circumstances if the plain radiographic findings are normal. Although ultrasonography has no specific role in the diagnosis of an acute SBO, the technique is widely used in the investigation of acute abdominal pain. The radiologist must be aware of the sonographic appearances of SBO. Sonograms help not only in the diagnosis of an obstruction but also in defining the cause. Importantly, the sonographic findings differentiate an adynamic ileus from a mechanical obstruction by depicting peristalsis. Ultrasonography has particular advantages in the diagnosis of neonatal SBO. Radionuclide-labeled white blood cell scanning has no specific role in the diagnosis of acute SBO. However, the technique is sensitive and specific in the diagnosis of some of the causes of chronic and incomplete obstruction, such as Crohn disease. Similarly, a specific diagnosis of a carcinoid of the gastrointestinal tract associated with an incomplete obstruction may be achieved by performing imaging with a radionuclide-labeled somatostatin analog. Recently, the diagnosis of SBO has been achieved by using MRI with T1-weighted sequences combined with antiperistaltic agents and retrograde insufflation. Similar results have been achieved by using subsecond rapid acquisition with relaxation enhancement (RARE) imaging for the delineation of bowel obstruction. Virtual small-bowel imaging is theoretically possible with a spiral CT scanner, but note that any digital imaging technique enables virtual-reality processing. Limitations of Techniques The sensitivity of plain radiographic findings in the diagnosis of SBO is approximately 50-66%. When little or no gas is present in the small bowel, a diagnosis of SBO may be overlooked, especially if the condition is proximal. Avoid performing barium studies in patients with suspected perforations or complete SBO. CT scans have poor sensitivity for low-grade, partial, or incomplete obstruction. Although sonographic findings may suggest a diagnosis and etiology of SBO, the exact sensitivity of sonography is not known. In addition, bowel gas and obesity poses problems, and the technique remains operator dependent. Radionuclide findings do not help with a specific diagnosis in bowel obstruction. MRI is expensive and not universally available. The extent to which MRI will be used clinically in the future depends not only on the availability of an appropriate scanner but also on overall sensitivity of the procedure compared to time-honored simple methods such as plain radiography. The sensitivity of MRI has yet to be established. The requirement for nasogastric intubation and enteroclysis prior to CT or MRI for virtual small-bowel imaging makes virtual imaging invasive and time consuming.  Differentials  HYPERLINK "http://progps1.emedicine.com/gps/differentiallink.gps?docid=364581" Carcinoid, Gastrointestinal  HYPERLINK "http://progps1.emedicine.com/gps/differentiallink.gps?docid=367666" Crohn Disease  HYPERLINK "http://progps1.emedicine.com/gps/differentiallink.gps?docid=409870" Intussusception, Child  HYPERLINK "http://progps1.emedicine.com/gps/differentiallink.gps?docid=410644" Meckel Diverticulum  HYPERLINK "http://progps1.emedicine.com/gps/differentiallink.gps?docid=410845" Meconium Ileus  HYPERLINK "http://progps1.emedicine.com/gps/differentiallink.gps?docid=411249" Midgut Volvulus  HYPERLINK "http://progps1.emedicine.com/gps/differentiallink.gps?docid=350175" Myocardial Infarct, Acute  HYPERLINK "http://progps1.emedicine.com/gps/differentiallink.gps?docid=404450" Ovary, Malignant Tumors  HYPERLINK "http://progps1.emedicine.com/gps/differentiallink.gps?docid=376015" Tuberculosis, Gastrointestinal Gastrointestinal amyloid Other Problems to be Considered The differential diagnosis of SBO per se is usually straightforward and involves the diagnosis of the cause of the obstruction, which may be elusive. Many medical disorders can cause a symptom complex similar to that seen in patients with SBO, although other disorders often do not cause pain. Distention, vomiting, and constipation may be seen in patients with myocardial infarction, intracranial pathology, diabetic ketoacidosis, hyperthyroidism, uremia, and hypokalemia, among others. Tricyclic antidepressants, atropine, and comparable agents may cause similar symptoms, as may peritonitis of any cause in patients of any age. However, the pain is usually different in nature. Enterocolitis in a neonate may present a particular problem. Perhaps the greatest problem arises in the immediate postoperative period following any abdominal surgery, in which it is difficult to determine whether the failure of gastrointestinal tract function to return to normal is merely the atony frequently seen after surgery or a supervening mechanical obstruction.  Radiograph Findings Plain radiography The following radiologic features may be of assistance in making a diagnosis of SBO: In complete obstruction, loops of small bowel distend within 3-5 hours. Bowel larger than 3 cm in diameter is often associated with obstruction. Usually, gas and fluid may be present in the distended small bowel loops, and gas and fluid levels may be present at the same or different levels in the abdominal cavity. In the past, some suggested that gas and fluid levels at different heights indicated a mechanical obstruction, whereas gas and fluid levels at the same height more likely indicated an adynamic ileus. However, these levels are no longer considered to be reliable signs. Often, a discrepancy exists between the size of the loop of bowel proximal to the obstruction and the size of the loop of bowel distal to the obstruction, which is usually empty or of normal caliber. In long-standing obstruction, small-bowel dilatation may mimic a dilated colon. To differentiate large bowel from small bowel, an attempt should be made to identify the cecum, which is usually normal in caliber in the early stages of SBO. However, with time, the colon may empty completely and become difficult to depict. When distended, loops of small bowel are usually positioned in the center of the abdomen. With a proximal jejunal obstruction, a gas-fluid level usually exists in the stomach unless the patient has vomited recently. Occasionally, 1 or 2 loops of distended small bowel may be seen in the left upper quadrant. The more distal the obstruction, the more numerous the gas-fluid levels. At different heights, the levels reveal a stepladder appearance. With the patient in the supine position, fluid-filled loops of small bowel lie posteriorly, and gas-filled loops rise anteriorly and superiorly. With the patient erect, gas-filled loops are observed in the upper part of the abdomen. Grossly distended fluid-filled loops, particularly of the mid and distal small bowel, may appear as elongated soft-tissue masses. Valvulae conniventes are usually closely spaced and should be within 1-4 mm of each other, but this distance increases with small-bowel distention. A stretch sign may appear as a result of the erect valvulae conniventes encircling the bowel lumen. Even when distended, the valvulae conniventes in the jejunum are usually preserved; however, in a distended terminal ileum, they flatten and the bowel often appears tubelike. An increase in peristaltic activity can give rise to the string-of-beads sign in which the beads represent gas trapped within the valvulae conniventes. In some patients, the outer border of the bowel is delineated by mesenteric fat, allowing the differentiation of fluid-filled small-bowel loops and distention due to ascites. The small bowel may become massively dilated if the obstruction is chronic. An associated thickening of the intestinal wall often occurs such that the distance between gas shadows in the small-bowel lumen increases. Less common radiologic signs are seen in specific circumstances and are described as follows: Most (75%) closed-loop obstructions are caused by adhesions. A closed-loop obstruction occurs when a loop of bowel is not decompressed by the caudal passage of gas and fluid. This obstruction may be associated with a U-shaped distended loop of small bowel. This loop may be fixed and does not change in position over time. An increasing amount of fluid is incarcerated within the closed loop, and the coffee bean sign (a gas-filled loop) or a pseudotumor (fluid-filled loop) may be seen. Gallstone ileus is characterized by the presence of a calcified intraluminal stone (often in the terminal ileum), radiologic signs of an SBO above the ileus, and gas in the biliary tree as a result of the cholecystoduodenal fistula. In children with an intussusception, plain abdominal radiographs may show a soft-tissue mass at the head of the intussusception. Usually, no gas is seen in the colon immediately proximal to the site of obstruction because the intussusceptum occupied the entire lumen. Occasionally, the right lower quadrant is effaced, and no bowel gas is seen in the region. The intussusceptum may form a large, convex, soft-tissue mass in the region of the ascending or transverse colon, and the large bowel immediately distal to the intussusception is dilated and filled with gas. Radiologic signs of an SBO may be seen above the intussusception. Intramural gas secondary to ischemia may eventually appear in an obstruction of any etiology. This is a poor prognostic sign. Conventional barium follow-through examination and enteroclysis Controversy exists around the type of contrast medium to be used in patients with suspected SBO. The use of water-soluble contrast material, ionic or nonionic, has limitations because it is diluted by the intestinal fluid. As a result, the diagnosis of both the obstruction and the site of obstruction is difficult. A barium suspension should be used only if no features of peritonism are present. One or all of the following radiologic features may assist in the diagnosis: A delay in transit time on conventional follow-through examination of greater than 12 hours is suggestive of an organic obstruction. A snakehead appearance may be observed due to the bulbous appearance of the bowel proximal to the site of an obstruction. The finding results from the attempts of peristaltic activity to overcome the obstruction. Abrupt changes may occur in the caliber of the small bowel at the site of the obstruction, with a dilated contrast-filled small bowel located proximally to the obstruction and a collapsed bowel located distally. The beak sign may be detected at the site of the obstruction as barium trickles through a narrow lumen. Fixation and kinking of the bowel may be demonstrated clearly. Stretched mucosal folds or valvulae conniventes may be apparent. SBO has been subdivided into 3 groups on the basis of enteroclysis findings, as follows: A low-grade or incomplete obstruction in which flow of contrast agent through the obstruction is sufficient to define the mucosal folds distal to the obstruction well A high-grade obstruction in which stasis occurs and transit of the contrast material is delayed. Dilution of the contrast material by intestinal fluid and the passage of minimal contrast material through the obstruction mean that no details may be defined. A complete SBO in which no contrast agent passes the obstructed segment during the 3-24 hours after the start of the examination Barium enema study Barium enema has a limited role in patients with SBO. Although examining patients with an ileocecal intussusception or other causes of ileocecal obstruction is possible by using oral contrast material, barium enema study more quickly performed in these patients. Barium enema examination is particularly useful if a distal colonic obstruction cannot be excluded by using plain abdominal radiograph findings. In children with intussusception, barium enema study is not only diagnostic but also possibly therapeutic as well. Degree of Confidence Plain radiography remains the most useful noninvasive procedure in the radiographic diagnosis of SBO despite its limited sensitivity of 50-66%. When plain radiographic findings are combined with the clinical history and the results of physical and laboratory examinations, SBO can usually be diagnosed with confidence. False Positives/Negatives Differentiating an adynamic ileus from SBO may be particularly difficult, especially in the immediate postoperative period. Eventually, most intestinal obstructions may lead to an adynamic ileus, (especially when strangulation is present). This finding is associated with perforation and peritonitis. Under these circumstances, gas may appear in the small bowel proximal to the obstruction or may be retained in the atonic colon, leading to diagnostic confusion. Little or no gas in the small bowel may lead to a false-negative diagnosis. Differentiating a proximal obstruction, a Richter hernia, a gallstone ileus, or a volvulus of the midgut is notably difficult because all of these conditions are demonstrated as a relatively gasless abdomen on plain radiographs. The radiographic features of gallstone ileus are not consistent; not all stones are radiopaque, and not all choledochoenteric fistulas allow reflux of air into the biliary tree. Gallstone ileus is one condition that causes accumulation of fluid rather than gas within the obstructed bowel; therefore, gallstone ileus should always be considered in the differential diagnosis of SBO accompanied by a relatively gasless abdomen. In large-bowel obstruction, small-bowel dilatation may occur if the ileocecal valve is patent; this is a potential cause of confusion.  CT SCAN Findings CT scanning is recommended when the clinical and initial plain radiographic findings are indeterminate or when strangulation is suspected. CT scans clearly demonstrate abnormalities of the bowel wall, the mesentery, the mesenteric vessels, and the peritoneum. CT should be performed with intravenous contrast enhancement. Intraluminal contrast material may not be necessary because fluid and gas accumulating in the bowel may be sufficient. However, the oral administration of a 1-2% barium sulphate suspension or a 2% water-soluble contrast agent 30-120 minutes before scanning may be useful for accurately locating the site and degree of obstruction. The diagnosis of obstruction is based on the identification of a dilated proximal loop and a collapsed distal loop of small bowel. A bowel diameter in excess of 2.5 cm is regarded as abnormal, but this criterion is insufficient to differentiate mechanical obstruction from an adynamic ileus. The feces sign is an uncommon but reliable sign of a mechanical obstruction. The feces sign occurs when feces intermingle with gas and are observed proximal to the obstruction. The level of obstruction may be determined by identifying the transition from dilated to collapsed loops of bowel. The degree of collapse and the amount of residual content in the distal bowel beyond the obstruction are useful to note. The passage of contrast material into the distant collapsed segment indicates that the obstruction is partial or incomplete. CT scans usually do not help in identifying an adhesive band. The diagnosis of adhesions is based on the abruptly changing caliber of the small-bowel lumen in the absence of radiologic evidence of another obstructive cause. Adhesions most frequently involve the terminal ileum, usually in association with the undersurface of an abdominal scar, the site of previous surgical intervention, or an inflammatory focus. CT findings in a closed-loop obstruction depend on the length, the degree of distention, and the intra-abdominal orientation of the closed loop. Findings may include a U- or C-shaped loop of small bowel and a radial configuration of the mesentery with stretched vessels converging on the site of a torsion. Tightly twisted mesentery is occasionally depicted as the whirl sign. At the site of the obstruction, collapsed loops are round, oval, or triangular. On longitudinal imaging, the beak sign appears as a fusiform tapering at the site of the obstruction. CT features of strangulation may include evidence of SBO as outlined above, a circumferential thickening of the bowel wall with a high attenuation, the target sign, and congestion or hemorrhage in the mesentery attached to the closed loop. A serrated beak may be seen at the site of obstruction. Edema in the mesentery attached to the involved segment may result in a hazy appearance with diffuse engorgement, and the mesenteric vasculature may take an unusual course. After the intravenous administration of contrast material, the bowel wall may show delayed, poor, or no enhancement. In advanced cases, pneumatosis intestinalis may develop. A large amount of ascites may be present. CT findings of malrotation include the distribution of the small bowel to the right side of the abdomen and of the colon to the left side. Abnormal orientation of the superior mesenteric vessels and aplasia of the uncinate process of the pancreas may be seen. If a volvulus occurs, its radiologic appearance is similar to that of any closed-loop obstruction. CT is useful in the diagnosis of external hernia at unusual sites, particularly in patients with obesity. The technique can demonstrate visceral hernial contents and complications such as vascular compromise. The diagnosis of an internal hernia is always based on radiologic findings, and CT is useful in depicting the precise site and type of hernia and its contents. CT features of a paraduodenal hernia include the following: A cluster of small bowel anterior and lateral to the pancreas A saclike mass of small-bowel loops Encapsulation of the small-bowel loops A mass effect on the posterior wall of the stomach Caudal displacement of the duodenal-jejunal junction Stretching and/or engorgement of the mesenteric vessels, which may be displaced to the left or right of the aorta or the inferior vena cava, respectively Less common CT findings include the following: An established SBO, caudal or dorsal displacement of the transverse colon, and medial displacement of the ascending or descending colon may be present. Similar features may be seen with the uncommon transmesenteric hernia, together with the additional finding of a deficiency in the omental fat overlying the herniated small bowel. Any of the less-common causes of SBO can be demonstrated on CT scans, and many of them have specific radiologic features. In patients with Crohn disease, narrowing of the small-bowel lumen and mural thickening are well depicted. In the acute phase, the small bowel shows mural stratification and often has a target-like or double-halo appearance. With intravenous contrast enhancement, inflamed mucosa and serosa show marked enhancement, and the intensity of the enhancement is well correlated with the activity of disease. In chronic disease, mural stratification disappears and the diseased bowel has a typically uniform attenuation. Fat deposition in the bowel wall indicates inactive disease. On CT scans, the appearances of intussusception depend on the severity and duration of the condition. On cross-sectional imaging, the intussusception may appear as a target, with alternating layers of low and high attenuation, or it may be seen as a sausage-shaped or reniform mass. When SBO is secondary to bowel adhering to an inflamed mass in appendicitis or diverticular disease, CT findings may help in making the diagnosis. CT scans can demonstrate appendicitis and its complications, such as an inflammatory mass, abscess, or peritonitis. In diverticular disease, mural thickening may be demonstrated clearly together with edema of the mesentery and the complications of paracolic and pelvic abscess and peritonitis. In radiation enteropathy, CT scans demonstrate the features of SBO, as well as abnormalities of an irradiated segment of small bowel, which lies within the pelvis in most instances. Mural thickening, luminal narrowing, and mesenteric fibrosis occur. In intestinal tuberculosis, CT scans may demonstrate only slight asymmetric mural thickening if the inflammation is mild, but with gross disease, the bowel wall is thickened and an inflammatory mass is demonstrated. This mass has a heterogeneous appearance. Large regional lymph nodes with low-attenuation centers may also be demonstrated. In gallstone ileus, CT scans may demonstrate the gallstone and gas within the shrunken gallbladder or biliary tree, in addition to the SBO. The CT appearances of an intramural hematoma are nonspecific and depend on the age of the hematoma. Soon after hemorrhage occurs, the attenuation is low; however, as time passes, its attenuation increases. Once lysis of the clot begins, the attenuation again decreases. It may also be centripetal, which gives rise to the ring sign with a crescent of high attenuation. If a bezoar is the cause of SBO, CT may demonstrate the bezoar as a mass in the obstructed segment of bowel. The bezoar may be outlined by fluid in the proximally dilated small bowel, and the mass may be mottled owing to air trapped within it. Malignancy involving the small bowel may have a variety of CT appearances. Though rare, adenocarcinoma may be seen, particularly in the duodenum and proximal jejunum. The tumor is usually detected only at an advanced stage, and in patients with SBO, the mass may be seen as mural thickening with luminal compromise in a transitional zone between dilated and collapsed bowel. Primary non-Hodgkin small bowel lymphoma rarely causes obstruction; however, nodal lymphoma may arise in the mesentery and invade the small bowel by means of direct infiltration to cause SBO. A mesenteric mass invading, kinking, or compressing the small bowel may be seen on CT scans. SBO is a major complication of a carcinoid tumor, one largely due to the desmoplastic reaction that may occur in the mesentery. Therefore, mural thickening and retraction of bowel loops around a segment of mesentery may occur. Metastatic nodular masses may be present. Peritoneal carcinomatosis may be recognized by the demonstration of omental masses kinking or compromising the small bowel, resulting in SBO. In all malignant tumors causing SBO, CT scans are useful in depicting local extent of the disease and the presence of distant metastases, when appropriate. With the advent of multisection CT, CT angiography may provide a future alternative to angiography for assessing intestinal ischemia. Degree of Confidence The reported sensitivity of CT scanning in the detection of SBO is 78-100% in high-grade or complete obstruction. If the obstruction is partial or intermittent, the accuracy is low. False Positives/Negatives If the entire small bowel is distended, a barium enema study should be performed to exclude a large-bowel obstruction and a patent ileocecal valve. A distended loop of small bowel may migrate from its expected anatomic location; therefore, determining the site of obstruction on the basis of a transitional zone alone may be misleading. Carcinoid tumors, intestinal tuberculosis, and desmoid tumors all may have CT features similar to those of peritoneal carcinomatosis. Although the presence of ascites suggests a strangulated obstruction, intra-abdominal fluid may occur in less complicated forms of obstruction. Feces in the small bowel can mimic the mottled appearance of a bezoar if stasis above a complete blockage is severe.  Mri Findings Although MRI is applicable to imaging of the small bowel, the plethora of contrast media and techniques available indicates that its role is not yet fully established, and further clinical trials are required. The technique has been used to evaluate chronic mesenteric ischemia. However, to the authors' knowledge, no human studies have been performed in patients with acute ischemia and strangulation. Results of animal studies suggest that a lack of enhancement after the intravenous injection of contrast material may be a useful early sign of acute ischemia. Because MRI can be used to demonstrate vessels, quantitate blood flow, assess oxygenation, and depict associated morphologic changes, it may become the modality of choice in detecting acute ischemia in the future. Therefore, MRI will have a role in the assessment of SBO associated with strangulation. Recently, SBO has been diagnosed by using T1-weighted MRI sequences combined with antiperistaltic agents and retrograde insufflation. Subsecond RARE imaging may produce similar results. Degree of Confidence Clinical experience with MRI in the diagnosis of acute small-bowel disease is limited, and its use in this capacity depends on the availability of suitable equipment. False Positives/Negatives  Ultrasound Findings Ultrasonography may demonstrate the features and causes of SBO, and it is of particular value in looking at the dynamics of the small bowel. In patients with SBO, sonogram may clearly demonstrate loops of distended bowel. The loops have a rounded contour and are not deformed by the pressure of adjacent bowel loops. The loss of definition and prominence of the valvulae conniventes are demonstrated. Sonograms can help predict the level of SBO accurately by helping locate the dilated loops and analyze the fold patterns. Unlike other radiologic techniques, ultrasonography may be used to assess peristalsis. Close to the site of an obstruction, the distended bowel loses its muscular activity, whereas more proximally, peristaltic activity may be marked in cases of acute obstruction. These features help to differentiate a mechanical obstruction from the adynamic ileus of the postoperative state or peritonitis. Occasionally, the cause of an SBO can be identified directly. Gallstones, foreign bodies, and mural thickening from inflammatory or neoplastic disease may be revealed. A bezoar may appear as an echogenic intraluminal mass. If a bezoar contains air or is surrounded by fluid, it may cast an acoustic shadow. Sonographic appearances of intussusception are specific and a target, atypical target, or doughnut appearance on the transverse section of the bowel may be seen as a complex mass of concentric rings of alternating hypoechoic and hyperechoic layers surrounding a highly reflective center. The head of the intussusception may be visible within a dilated loop of small bowel, and left-right inversion of the superior mesenteric vessels may be evident. The presence of free peritoneal fluid is a less-specific sonographic finding. Certain sonographic appearances have been proposed as predictors of the irreducibility of an intussusception. These appearances include a large amount of fluid within the intussusceptum and the presence of a doughnut-like appearance with a thick echo-poor rim. Color-flow Doppler images depict the viability of the bowel; therefore, the absence of flow suggests necrosis. This finding has been linked to the success rate of hydrostatic reduction of intussusception. When blood flow is present, the success rate is in excess of 90%, but the rate decreases to only 30% when no blood flow is demonstrated. The sonographic diagnosis of midgut malrotation is based on the inversion of the relationship of the superior mesenteric artery and vein. However, this finding is not sensitive or specific for this diagnosis. A hyperpulsatile superior mesenteric artery and a thickened and highly reflective small-bowel wall suggest volvulus. With gallstone ileus, the classic triad of a calcified gallstone in an ectopic position, gas in the biliary tree, and SBO may be demonstrated. Regarding intestinal ascariasis, individual worms may appear as hypoechoic longitudinal tubular structures with echogenic walls. If the alimentary tract of the worm is empty, the worm may appear as an echogenic line. If its alimentary tract is distended, the worm can appear as parallel hypoechoic bands. On transverse sections, the worm appears as a target sign with an echogenic body wall and a central dot representing its gut. Prolonged scanning may demonstrate movement of the worm. A tangle of worms mixed with feces, and gas may appear as a complex intraluminal mass. With a small-bowel lymphoma, eccentric mural thickening by lymphomatous infiltrate and aneurysmal dilatation of the bowel lumen and mesenteric lymphadenopathy may produce a so-called sandwich sign, which distinguishes lymphoma from Crohn disease. A lymphomatous infiltrate is usually anechoic, but hemorrhage and clot may give rise to echogenic areas. Anechoic deposits may mimic duplication cysts. In patients with jejunoileal atresia and meconium ileus, sonography may demonstrate dilated loops of bowel containing gas and fluid proximal to an atretic segment. Peristalsis may be reduced or increased. In meconium ileus, multiple loops of bowel are filled with highly echogenic material. Degree of Confidence SBO is well depicted on sonograms because intraluminal fluid is a natural contrast medium. Numerous studies have shown the value and effectiveness of sonography in the diagnosis of SBO, but its exact sensitivity remains uncertain. In patients with intussusception, the sensitivity is 95-100% with a positive predictive value of 100%. Because sonographic findings in patients with malrotation are nonspecific, barium examination remains the preferred study in patients in whom malrotation is suspected. False Positives/Negatives When intraluminal air is associated with SBO, the air may obscure the sonographer's field of view. However, by paying attention to detail and by using graded compression, an examination of all regions of the abdomen is possible. Scanning in the coronal plane through the flank may also be of value. The variation that may occur in peristalsis in patients with SBO may cause confusion. Occasionally, differentiating an ileus from an obstruction is difficult, particularly if peristalsis is reduced or absent in the bowel immediately proximal to an obstruction. Fluid trapped within an intussuscepted mesentery can mimic duplication cysts or hematomas. The target appearance of small bowel referred to above is not specific and may occur in a multitude of inflammatory and neoplastic disorders. Vessel inversion can be found in patients with normal gut anatomy, and documented malrotations have occurred with normally related superior mesenteric vessels.  Nuclear Medicine Findings Radionuclide scanning has no specific role in the diagnosis of SBO, with an exception for white blood cell scanning for the detection and localization of intra-abdominal inflammatory disease that may result in obstruction. Scanning for technetium-99m hexamethylpropyleneamine oxime (HMPOA) uptake is useful for demonstrating disease activity in patients with Crohn disease. Degree of Confidence 99mTc HMPOA granuloscintigraphy has been shown to have a sensitivity of 79% and a specificity of 98%. False Positives/Negatives 99mTc HMPOA uptake is not specific for Crohn disease, and activity may be observed with other causes of inflammation or infection.  Angiography Findings Superior mesenteric angiography has been used in the diagnosis of internal herniation, intussusception, volvulus, malrotation, and adhesions. Findings are of particular importance when vascular compromise is associated. Degree of Confidence Although angiography is a sensitive method for demonstrating vascular occlusion, it is invasive, and its role is limited in patients who are ill, particularly because alternative and less invasive techniques are available. Color Doppler imaging and CT angiography may provide the information by alternative means. False Positives/Negatives  Intervention Many patients with SBO respond to an initial trial of decompression of the stomach and small bowel by fasting and nasogastric aspiration, with intravenous fluid and electrolyte replacement. This treatment is particularly useful in patients in whom the etiology of the SBO is believed to be postoperative adhesions; in these patients, the obstruction is often only partial or incomplete. This treatment should be abandoned if clinical improvement does not occur fairly rapidly, as judged by the bowel sounds, the diminution of the nasogastric aspirate, the passage of flatus, and the resolution of any distention. Surgery is mandatory in these patients. The role of radiologic interventions in the management of SBO is limited and confined to the management of intussusception. Most institutions choose to perform an air-contrast enema in the evaluation and treatment of intussusception. A barium enema reduction is an alternate choice. One may also choose to perform the reduction under sonographic guidance as opposed to fluoroscopic guidance. Regardless of the technique, reduction of intussusception has a high success rate with minimal risks. The overall success rate is 80-90% with a complication rate of around 1%. Intestinal perforation in the gravest complication, but the most common complication is a recurrence of the intussusception in the next 72 hours. A recurrent intussusception can be reduced again with an air enema. The most important consideration in deciding to perform the air enema reduction is to ensure that a pediatric surgeon has examined the child and is readily available because of the risk of perforation or unsuccessful air enema reduction. In either case, the child will need to be transported the operating room. The child should be clinically stable with adequate intravenous access. Contraindications to air reduction include evidence of free air on abdominal radiographs or signs of peritonitis on physical examination. A prolonged process increases the likelihood of ischemia, which decreases the rate of successful reduction and increases the likelihood of a perforation. A commercial kit is available for performing air reduction (Shiels intussusception air reduction system). A tape plug and rubber disk around the enema tip helps to create a tight seal. A tight seal is the key to a successful reduction. A generous amount of athletic grade tape is necessary. The buttocks are used to create an adequate seal. If air leaks from the rectum, the procedure must be terminated and the enema tip reinserted. Alternatively, manual squeezing of the buttocks may help in minimizing the air leak. The pressure in the colon should be monitored throughout the examination, and the pressure should not exceed 120 mm Hg. The child is not sedated for the examination because crying increases the intra-abdominal pressure and aids the reduction. The intussusception mass is visualized, and thus, direct observation of the reduction can be achieved under fluoroscopic guidance. Complete reduction is confirmed with reflux of air into the small bowel. As an alternative, barium enema may be used for the reduction of intussusception. The barium bag should be elevated no more than 3 feet above the rectum to limit the colonic pressure. This leads to the rule of 3s, which states that only 3 attempts be made and that 3 minutes of rest should be allowed between each attempt. Medical/Legal Pitfalls The most serious consequences of an SBO are strangulation with ischemia, necrosis, perforation, peritonitis, and death. The prevalence of strangulated SBO is 5-42% of all patients. Expeditiously investigate clinical suspected strangulation because a delay may be lethal. The use of barium suspensions for enteroclysis or retrograde examination may cause inspissation of the small bowel and convert a partial obstruction to a complete obstruction. Therefore, if CT is available, CT scans should be obtained as an alternative to conventional contrast-enhanced studies. The presence of a closed-loop obstruction and features of ischemia can be missed, even on CT scans; therefore, if an obvious discrepancy exists between CT and clinical findings in patients with obstruction, urgent surgery is mandatory. See also the Medscape topic  HYPERLINK "http://www.medscape.com/resource/medical-malpractice" Medical Malpractice and Legal Issues. Special Concerns  Test Questions Question 1: HYPERLINK "http://progps1.emedicine.com/gps/questions.gps?docid=375099&action=edit"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/edit-white.gif" \* MERGEFORMATINET  Which of the following statements regarding small-bowel obstruction is true? A.Inspissated meconium resulting in obstruction of the proximal ileum may be seen with cystic fibrosis in patients of any age.B.Intussusception in children younger than 2 years is an uncommon abdominal emergency.C.Congenital malrotation results in a long mesenteric attachment.D.Approximately 80% of patients admitted to the hospital with an acute abdomen have an intestinal obstruction.E.Vomiting is an unusual feature of intestinal obstruction in children with intussusception.The correct answer is E: In children with intussusception, colicky pain is a classic finding. The episodes of pain start suddenly, last several minutes, then fade, with the patient's condition appearing close to normal between episodes. Vomiting is uncommon. Inspissated meconium resulting in obstruction of the distal ileum may be seen with cystic fibrosis in patients of any age. Intussusception in children younger than 2 years is a common abdominal emergency and usually idiopathic, although Meckel diverticulum, polyps, duplication cysts, and Henoch-Schnlein purpura have been implicated. Congenital malrotation results in a short mesenteric attachment, and the entire midgut may undergo torsion or volvulus, which leads not only to obstruction but also rapid progression to ischemia and death. Approximately 20% of patients admitted to the hospital with an acute abdomen have an intestinal obstruction; small-bowel obstruction is responsible for 80% of these cases.  Question 2: HYPERLINK "http://progps1.emedicine.com/gps/questions.gps?docid=375100&action=edit"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/edit-white.gif" \* MERGEFORMATINET  Which of the following statements regarding imaging in patients with small-bowel obstruction (SBO) is true? A.CT has high sensitivity for low-grade small-bowel obstructions.B.Ultrasonography is of no value in the diagnosis of SBO.C.Most closed-loop SBOs are caused by adhesions, and as such, they may be depicted as a U- or C-shaped, dilated loop of bowel on CT scans.D.On plain radiographs, gas-fluid levels at different heights reliably indicate mechanical obstruction, and gas-fluid levels at the same level reliably indicate an adynamic ileus.E.The absence of air in the bile ducts, nondepiction of an extrahepatic gallstone, and the absence of air-distended loops of small bowel exclude the diagnosis of gallstone ileus.The correct answer is C: Most (75%) closed-loop obstructions are caused by adhesions. Radiologic features depicted on plain radiographs include the coffee bean or pseudotumor signs. Features depicted on CT scans include the presence of a U- or C-shaped, dilated loop of bowel and a beak or whirl sign. The reported sensitivity of CT scanning in the detection of SBO is 78-100% in high-grade or complete obstruction. If the obstruction is partial or intermittent, the accuracy is low. Numerous studies have shown the value and effectiveness of sonography in the diagnosis of SBO, but its exact sensitivity remains uncertain. In the past, some suggested that gas and fluid levels at different heights indicated a mechanical obstruction, whereas gas and fluid levels at the same height more likely indicated an adynamic ileus. However, these levels are no longer considered to be reliable signs. The radiographic features of gallstone ileus are not consistent; not all stones are radiopaque, and not all choledochoentericfistulas allow reflux of air into the biliary tree.  Question 1 (T/F): HYPERLINK "http://progps1.emedicine.com/gps/questions.gps?docid=375101&action=edit"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/edit-white.gif" \* MERGEFORMATINET  The reported prevalence of strangulated small-bowel obstruction is 2-3%. The correct answer is False: The reported prevalence of strangulated small-bowel obstruction is 5-42%. The most serious consequences of a small-bowel obstruction are strangulation with ischemia, necrosis, perforation, peritonitis, and death. Expeditiously investigate clinical suspected strangulation because a delay may be lethal.  Question 2 (T/F): HYPERLINK "http://progps1.emedicine.com/gps/questions.gps?docid=375102&action=edit"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/edit-white.gif" \* MERGEFORMATINET  Leukocytosis and slight amylasemia, with a tender silent abdomen, are grave prognostic signs of ischemia or a perforated small bowel. The correct answer is True: Strangulation with ischemia of the bowel by an adhesion or a hernia is an emergency, and any delay in surgery beyond that required to resuscitate and optimize the patient`s status is associated with an increase in the mortality rate. This rate increases to as high as 25% when the delay exceeds 36 hours. Leukocytosis and a slight amylasemia, with a tender silent abdomen, may be signs of ischemia or a perforated small bowel. These are of grave prognostic significance. Early surgery is essential.  Question 3 (T/F): HYPERLINK "http://progps1.emedicine.com/gps/questions.gps?docid=375103&action=edit"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/edit-white.gif" \* MERGEFORMATINET  The sensitivity of plain radiographs in the diagnosis of small-bowel obstruction is only 10% when little or no gas is present within the small bowel. The correct answer is False: The sensitivity of plain radiographs in the diagnosis of small-bowel obstruction is approximately 50-66%. When little or no gas is present in the small bowel, a diagnosis of small-bowel obstruction may be overlooked, especially if it is proximal.  Question 4 (T/F): HYPERLINK "http://progps1.emedicine.com/gps/questions.gps?docid=375104&action=edit"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/edit-white.gif" \* MERGEFORMATINET  With the widespread availability of CT, plain abdominal radiography currently has a limited role in the diagnosis of small-bowel obstruction. The correct answer is False: Plain radiography remains the most useful noninvasive procedure in the radiographic diagnosis of small-bowel obstruction despite its limited sensitivity of 50-66%. When plain radiographic findings are combined with the clinical history and the results of physical and laboratory examinations, small-bowel obstruction can usually be diagnosed with confidence.   Further Reading  Multimedia Media file 1:Small-bowel obstruction. Plain abdominal radiograph in a 6-year-old boy who presented with vomiting and acute pain in the right iliac fossa. The loops of the small bowel are dilated, and this is associated with small calcific nodules in the right iliac fossa. These findings are suggestive of appendicoliths. At laparotomy, an appendiceal mass was found; this caused the small-bowel obstruction.  HYPERLINK "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5322.jpg" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5322tn.jpg" \* MERGEFORMATINET  Media type: X-RAY Media file 2:Small-bowel obstruction. Plain abdominal radiograph in a 9-year-old patient with a past history of appendicitis complicated by peritonitis who presented with abdominal pain and vomiting. The clinical diagnosis was small-bowel obstruction due to adhesions. Radiograph shows markedly distended loops of small bowel with effacement of the valvulae in the mid abdomen. The child recovered with conservative treatment.  HYPERLINK "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5323.jpg" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5323tn.jpg" \* MERGEFORMATINET  Media type: X-RAY Media file 3:Small-bowel obstruction. Lateral decubitus radiograph of a newborn who presented with features of bowel obstruction. Radiograph shows markedly distended loops of small bowel (same patient as in Image 4).  HYPERLINK "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5324.jpg" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5324tn.jpg" \* MERGEFORMATINET  Media type: X-RAY Media file 4:Small-bowel obstruction. Plain abdominal radiograph of the abdomen in a newborn after 10 days of conservative treatment (same patient as in Image 3). Radiograph shows only mild dilatation of the loops of the small bowel. Note the fine grainy calcification in the right iliac fossa. Meconium peritonitis (arrow), caused the small-bowel obstruction, was diagnosed.  HYPERLINK "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5325.jpg" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5325tn.jpg" \* MERGEFORMATINET  Media type: X-RAY Media file 5:Small-bowel obstruction. An erect plain abdominal radiograph in a 4-year-old patient from a region in which roundworms are known to be endemic. Radiograph shows multiple dilated loops of the small bowel with air-fluid levels and tangled roundworms (arrow).  HYPERLINK "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5326.jpg" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5326tn.jpg" \* MERGEFORMATINET  Media type: X-RAY Media file 6:Small-bowel obstruction. Plain abdominal radiograph of the abdomen in a 55-year-old woman presenting with features of intestinal obstruction shows dilated loops of the small bowel associated with thickened edematous valvulae conniventes and a strangulated left inguinal hernia (arrow).  HYPERLINK "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5327.jpg" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5327tn.jpg" \* MERGEFORMATINET  Media type: X-RAY Media file 7:Small-bowel obstruction. Plain abdominal radiograph of the abdomen in a 72-year-old man with a history of intermittent abdominal pain over several years that settled spontaneously. On this occasion, his pain was more severe. Abdominal radiograph shows dilated loops of small bowel, but note the concentration of several loops of small bowel in the right hypochondrium; this is suggestive of malrotation. At surgery, a midgut volvulus due to malrotation was found. The patients age is unusual for those presenting with a midgut volvulus.  HYPERLINK "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5328.jpg" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5328tn.jpg" \* MERGEFORMATINET  Media type: X-RAY Media file 8:Small-bowel obstruction. Upper GI barium series in a 32-year-old man with a history of intermittent small-bowel volvulus, which lasted several years and settled spontaneously. Barium study shows the jejunal loops in the right hypochondrium; this finding is suggestive of bowel malrotation.  HYPERLINK "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5329.jpg" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5329tn.jpg" \* MERGEFORMATINET  Media type: X-RAY Media file 9:Small-bowel obstruction. Erect plain abdominal radiograph of the abdomen in a 72-year-old woman shows markedly distended jejunal loops with air-fluid levels. Note the air overlying the liver and a large laminated gallstone in the right iliac fossa (arrow). The features are those of a gallstone ileus.  HYPERLINK "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5330.jpg" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5330tn.jpg" \* MERGEFORMATINET  Media type: X-RAY Media file 10:Small-bowel obstruction. Plain abdominal radiograph of the abdomen in 52-year-old woman presenting with features of small-bowel obstruction. At laparotomy, a cecal volvulus was found to be the cause of the obstruction. Note that the cecum occupies the mid abdomen and that the cecal pole is directed laterally.  HYPERLINK "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5331.jpg" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5331tn.jpg" \* MERGEFORMATINET  Media type: X-RAY Media file 11:Small-bowel obstruction. Plain abdominal radiograph of the abdomen in a 36-year-old man shows features of mid small-bowel obstruction due to a paraumbilical hernia (arrow).  HYPERLINK "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5332.jpg" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5332tn.jpg" \* MERGEFORMATINET  Media type: X-RAY Media file 12:Small-bowel obstruction. Upper GI barium study performed through a nasogastric tube in a patient with clinical features of bowel obstruction but a gasless abdomen on plain abdominal radiograph. Barium study shows a fistulous communication between the gallbladder fossa and the duodenum and mark dilatation of the jejunum associated with stretched mucosal folds. At laparotomy, a gallstone ileus was confirmed.  HYPERLINK "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5333.jpg" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5333tn.jpg" \* MERGEFORMATINET  Media type: X-RAY Media file 13:Small-bowel obstruction. Erect plain abdominal radiograph of the abdomen in a 69-year-old woman presenting with features of small-bowel obstruction. Radiograph shows air in the biliary tree, a string-of-beads sign (arrows), and a faint opacity in the right lower pelvis suggestive of a gallstone (not depicted well) (same patient as in Images 14-15).  HYPERLINK "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5334.jpg" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5334tn.jpg" \* MERGEFORMATINET  Media type: X-RAY Media file 14:Small-bowel obstruction. Upper GI barium series performed via a nasogastric tube in a 69-year-old woman presenting with features of small bowel obstruction. Image shows reflux of barium into the biliary tree and the gallbladder fossa (same patient as in Images 13-15). Note the mild dilatation of the duodenum.  HYPERLINK "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5335.jpg" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5335tn.jpg" \* MERGEFORMATINET  Media type: X-RAY Media file 15:Small-bowel obstruction. Follow-up barium study in the small bowel in a 69-year-old woman presenting with features of small-bowel obstruction (same patient as in Images 13-14). Image shows the small bowel as being obstructed by a large laminated gallstone (arrow).  HYPERLINK "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5336.jpg" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5336tn.jpg" \* MERGEFORMATINET  Media type: X-RAY Media file 16:Small-bowel obstruction. Water-soluble contrast upper GI examination in a patient with clinical features of small-bowel obstruction and a history of surgery for large bowel cancer. Contrast-enhanced study shows dilated loops of small bowel with stretching of the mucosal folds and a narrowed segment ending in a beak (arrow). At surgery, a small-bowel obstruction from extrinsic compression was found to be the result of mesenteric metastases.  HYPERLINK "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5337.jpg" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5337tn.jpg" \* MERGEFORMATINET  Media type: X-RAY Media file 17:Small-bowel obstruction. Plain abdominal radiograph of the abdomen in a 53-year-old woman with Crohn disease who presented with features of small bowel obstruction. Radiograph shows a long stricture of the terminal ileum.  HYPERLINK "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5338.jpg" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5338tn.jpg" \* MERGEFORMATINET  Media type: X-RAY Media file 18:Small-bowel obstruction. Upper GI barium series in a patient with features of intermittent small-bowel obstruction. Multiple strictures and polypoid filling defects are noted in the proximal small bowel due to deposits of non-Hodgkin lymphoma.  HYPERLINK "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5339.jpg" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5339tn.jpg" \* MERGEFORMATINET  Media type: X-RAY Media file 19:Small-bowel obstruction. Plain abdominal radiograph of the abdomen in a 47-year-old man presenting with features of small-bowel obstruction. Radiograph shows markedly dilated loops of small bowel in the central and upper abdomen with little air seen in the colon (same patient as in Images 20-21).  HYPERLINK "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5340.jpg" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5340tn.jpg" \* MERGEFORMATINET  Media type: X-RAY Media file 20:Small-bowel obstruction. Erect plain abdominal radiograph of the abdomen in a 47-year-old man presenting with features of small bowel obstruction. Image shows multiple fluid levels in the small bowel (same patient as in Images 19-21).  HYPERLINK "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5341.jpg" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5341tn.jpg" \* MERGEFORMATINET  Media type: X-RAY Media file 21:Small-bowel obstruction. Postevacuation image from part of a double-contrast barium enema study in a 47-year-old man presenting with features of small-bowel obstruction. Image shows a coiled-spring appearance in the region of the cecum suggestive of an intussusception (same patient as in Images 19-20). At laparotomy, an ileocecal intussusception was found in association with a carcinoid tumor of the terminal ileum.  HYPERLINK "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5342.jpg" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5342tn.jpg" \* MERGEFORMATINET  Media type: X-RAY Media file 22:Small-bowel obstruction. Erect abdominal image obtained as part of a double-contrast barium enema study shows multiple fluid levels in the centrally placed small bowel (same patient as in Image 23).  HYPERLINK "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5343.jpg" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5343tn.jpg" \* MERGEFORMATINET  Media type: X-RAY Media file 23:Small-bowel obstruction. View of the terminal ileum shows a stricture and shouldering of the terminal ileum due to an adenocarcinoma (same patient as in Image 22).  HYPERLINK "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5344.jpg" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5344tn.jpg" \* MERGEFORMATINET  Media type: X-RAY Media file 24:Small-bowel obstruction. Supine abdominal radiograph in a 57-year-old man presenting with colicky abdominal pain and vomiting shows multiple dilated loops of small bowel in the central abdomen and a suggestion of a mass in the right hypochondrium (same patient as in Image 25).  HYPERLINK "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5345.jpg" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5345tn.jpg" \* MERGEFORMATINET  Media type: X-RAY Media file 25:Small-bowel obstruction. Postevacuation image from part of a barium enema study in a 57-year-old man presenting with colicky abdominal pain and vomiting. Image shows a coiled-spring appearance at the hepatic flexure of the colon typical of an intussusception (same patient as in Image 24). At laparotomy, an ileocolic intussusception was found; this was secondary to a carcinoid tumor of the terminal ileum.  HYPERLINK "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5346.jpg" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5346tn.jpg" \* MERGEFORMATINET  Media type: X-RAY Media file 26:Small-bowel obstruction. Sonogram of the right iliac fossa in a 2-year-old child presenting with abdominal pain shows a bowel mass demonstrated as the pseudokidney sign (same patient as in Image 27).  HYPERLINK "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5347.jpg" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5347tn.jpg" \* MERGEFORMATINET  Media type: Image Media file 27:Small-bowel obstruction. Part of a barium enema study in a 2-year-old child presenting with abdominal pain shows a polypoid filling defect within the ascending colon (same patient as in Image 26). The filling defect was constant on all images. At laparotomy, a chronic ileocolic intussusception was found.  HYPERLINK "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5348.jpg" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5348tn.jpg" \* MERGEFORMATINET  Media type: X-RAY Media file 28:Small-bowel obstruction. Abdominal sonogram in a 16-year-old male adolescent with cystic fibrosis who presented with intermittent colicky epigastric pain of 6 weeks duration. Scan shows a complex mass of concentric rings of alternating hypoechoic and hyperechoic layers surrounding a highly reflective center. The mass was located in the epigastrium (same patient as in Image 29).  HYPERLINK "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5349.jpg" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5349tn.jpg" \* MERGEFORMATINET  Media type: Image Media file 29:Small-bowel obstruction. Nonenhanced CT scan of the abdomen in a 16-year-old male adolescent with cystic fibrosis who presented with intermittent colicky epigastric pain of 6 weeks duration. Scan shows a complex mass of concentric rings of alternating low- and high-attenuating layers surrounding a very high attenuation center due to intraluminal Gastrografin (same patient as in Image 28). At laparotomy, a chronic jejunojejunal intussusception was found.  HYPERLINK "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5350.jpg" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5350tn.jpg" \* MERGEFORMATINET  Media type: CT Media file 30:Small-bowel obstruction. A 36-year-old woman with Gardner syndrome presented with features of small-bowel obstruction. Axial contrast-enhanced CT scan through the midabdomen shows an extrinsic mass compressing a loop of small bowel. At laparotomy, a desmoid tumor of the mesentery was found; this caused the small-bowel obstruction.  HYPERLINK "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5351.jpg" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5351tn.jpg" \* MERGEFORMATINET  Media type: CT Media file 31:Small-bowel obstruction. Supine abdominal radiograph in a 47-year-old man who presented with intermittent abdominal pain and weight loss of 3 months duration. Radiograph shows mildly dilated loops of small bowel. Note the air in the transverse colon; this can be traced to the rectum (same patient as in Image 32).  HYPERLINK "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5352.jpg" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5352tn.jpg" \* MERGEFORMATINET  Media type: X-RAY Media file 32:Small-bowel obstruction. Contrast-enhanced axial CT scan through the midabdomen shows a marked mural thickening associated with mucosal irregularity at the hepatic flexure of the colon. At laparotomy, a carcinoma was found; this involved the ascending colon and hepatic flexure.  HYPERLINK "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5353.jpg" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5353tn.jpg" \* MERGEFORMATINET  Media type: CT Media file 33:Small-bowel obstruction. A 67-year-old man presented with features of small-bowel obstruction. Plain abdominal radiograph demonstrates gasless findings (same patient as in Image 34).  HYPERLINK "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5354.jpg" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5354tn.jpg" \* MERGEFORMATINET  Media type: X-RAY Media file 34:Small bowel obstruction. Nonenhanced CT scan at the level of the umbilicus in a 67-year-old man who presented with features of small bowel obstruction. Scan shows dilated loops of fluid-filled small bowel with a small amount of air (same patient as in Images 33-35). Note the collapsed right colon and beak-shaped transition of the small bowel (arrow).  HYPERLINK "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5355.jpg" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5355tn.jpg" \* MERGEFORMATINET  Media type: CT Media file 35:Small-bowel obstruction. Nonenhanced transaxial CT scan at the level of the umbilicus in a 67-year-old man who presented with features of small bowel obstruction. Scan shows a dilated loop of air-fluidfilled small bowel leading into an incarcerated umbilical hernia (same patient as in Images 33-34).  HYPERLINK "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5356.jpg" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5356tn.jpg" \* MERGEFORMATINET  Media type: CT Media file 36:Small-bowel obstruction. Enhanced axial CT scan of the mid abdomen in a 67-year-old woman. Scan shows a dilated loop of small bowel with a beak-shaped cutoff (same patient as in Image 37).  HYPERLINK "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5357.jpg" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5357tn.jpg" \* MERGEFORMATINET  Media type: CT Media file 37:Small-bowel obstruction. Enhanced axial CT scan at the level of the pelvic brim in a 67-year-old woman. Scan shows a gallstone obstructing the small bowel (same patient as in Image 36).  HYPERLINK "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5358.jpg" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5358tn.jpg" \* MERGEFORMATINET  Media type: CT Media file 38:Small-bowel obstruction. A 63-year-old woman presented with features of recurrent attacks of small bowel obstruction. Barium follow-through study shows mucosal edema and stricturing of the terminal ileum and the cecum (same patient as in Images 39-40).  HYPERLINK "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5359.jpg" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5359tn.jpg" \* MERGEFORMATINET  Media type: X-RAY Media file 39:Small-bowel obstruction. Enhanced axial CT scan at the level of the right iliac fossa in a 63-year-old woman who presented with features of recurrent attacks of small bowel obstruction. Scan shows transmural thickening of the terminal ileum associated with mucosal irregularity (same patient as in Images 38-40).  HYPERLINK "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5360.jpg" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5360tn.jpg" \* MERGEFORMATINET  Media type: CT Media file 40:Small-bowel obstruction. Technetium-99m hexamethylpropyleneamine oxime (HMPAO)labeled white blood cell scan in a 63-year-old woman who presented with features of recurrent attacks of small-bowel obstruction. Scan shows active uptake of the radionuclide in the terminal ileum and the cecum/ascending colon indicative of an active inflammatory process (same patient as in Images 38-39). The patient was treated for active Crohn disease.  HYPERLINK "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5361.jpg" \t "_blank"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5361tn.jpg" \* MERGEFORMATINET  Media type: Image  REFERENCES HYPERLINK "http://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&add=1"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/images/add.gif" \* MERGEFORMATINET  HYPERLINK "http://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&reorder=1"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/images/btnReorder.gif" \* MERGEFORMATINET   HYPERLINK "http://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&refid=36069&action=edit"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/edit-white.gif" \* MERGEFORMATINET  HYPERLINK "javascript:if%20(confirm('This%20will%20delete%20this%20reference.%20Are%20you%20sure%20you%20wish%20to%20do%20this?'))%20window.location.href='bibliographymaint.gps?docid=374962&action=delete&delete=1&refid=36069'"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/delete-white.gif" \* MERGEFORMATINET Berrocal T, Lamas M, Gutieerrez J, et al.Congenital anomalies of the small intestine, colon, and rectum.Radiographics.Sep-Oct1999;19(5):1219-36. HYPERLINK "http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&dopt=Citation&list_uids=10489177" [Medline].  HYPERLINK "http://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&refid=36070&action=edit"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/edit-white.gif" \* MERGEFORMATINET  HYPERLINK "javascript:if%20(confirm('This%20will%20delete%20this%20reference.%20Are%20you%20sure%20you%20wish%20to%20do%20this?'))%20window.location.href='bibliographymaint.gps?docid=374962&action=delete&delete=1&refid=36070'"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/delete-white.gif" \* MERGEFORMATINET Boudiaf M, Soyer P, Terem C, et al.CT evaluation of small bowel obstruction.RadioGraphics.May-Jun2001;21(3):613-24. HYPERLINK "http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&dopt=Citation&list_uids=11353110" [Medline].  HYPERLINK "http://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&refid=36071&action=edit"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/edit-white.gif" \* MERGEFORMATINET  HYPERLINK "javascript:if%20(confirm('This%20will%20delete%20this%20reference.%20Are%20you%20sure%20you%20wish%20to%20do%20this?'))%20window.location.href='bibliographymaint.gps?docid=374962&action=delete&delete=1&refid=36071'"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/delete-white.gif" \* MERGEFORMATINET Burkill G, Bell J, Healy J.Small bowel obstruction: the role of computed tomography in its diagnosis and management with reference to other imaging modalities.Eur Radiol.2001;11(8):1405-22. HYPERLINK "http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&dopt=Citation&list_uids=11519550" [Medline].  HYPERLINK "http://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&refid=36072&action=edit"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/edit-white.gif" \* MERGEFORMATINET  HYPERLINK "javascript:if%20(confirm('This%20will%20delete%20this%20reference.%20Are%20you%20sure%20you%20wish%20to%20do%20this?'))%20window.location.href='bibliographymaint.gps?docid=374962&action=delete&delete=1&refid=36072'"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/delete-white.gif" \* MERGEFORMATINET Burkill GJ, Bell JR, Healy JC.The utility of computed tomography in acute small bowel obstruction.Clin Radiol.May2001;56(5):350-9. HYPERLINK "http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&dopt=Citation&list_uids=11384132" [Medline].  HYPERLINK "http://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&refid=36073&action=edit"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/edit-white.gif" \* MERGEFORMATINET  HYPERLINK "javascript:if%20(confirm('This%20will%20delete%20this%20reference.%20Are%20you%20sure%20you%20wish%20to%20do%20this?'))%20window.location.href='bibliographymaint.gps?docid=374962&action=delete&delete=1&refid=36073'"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/delete-white.gif" \* MERGEFORMATINET Calvo AM, Erce R, Montón S, et al.[Cavernous haemangioma of the small bowel: an uncommon cause of intestinal obstruction].An Sist Sanit Navar.Sep-Dec2003;26(3):437-40. HYPERLINK "http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&dopt=Citation&list_uids=14716374" [Medline].  HYPERLINK "http://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&refid=36074&action=edit"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/edit-white.gif" \* MERGEFORMATINET  HYPERLINK "javascript:if%20(confirm('This%20will%20delete%20this%20reference.%20Are%20you%20sure%20you%20wish%20to%20do%20this?'))%20window.location.href='bibliographymaint.gps?docid=374962&action=delete&delete=1&refid=36074'"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/delete-white.gif" \* MERGEFORMATINET Chen SC, Chang KJ, Lee PH, et al.Oral urografin in postoperative small bowel obstruction.World J Surg.Oct1999;23(10):1051-4. HYPERLINK "http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&dopt=Citation&list_uids=10512946" [Medline].  HYPERLINK "http://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&refid=36075&action=edit"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/edit-white.gif" \* MERGEFORMATINET  HYPERLINK "javascript:if%20(confirm('This%20will%20delete%20this%20reference.%20Are%20you%20sure%20you%20wish%20to%20do%20this?'))%20window.location.href='bibliographymaint.gps?docid=374962&action=delete&delete=1&refid=36075'"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/delete-white.gif" \* MERGEFORMATINET Chou CK, Mak CW, Huang MC, et al.Differentiation of obstructive from non-obstructive small bowel dilatation on CT.Eur J Radiol.Sep2000;35(3):213-20. HYPERLINK "http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&dopt=Citation&list_uids=11000564" [Medline].  HYPERLINK "http://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&refid=36076&action=edit"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/edit-white.gif" \* MERGEFORMATINET  HYPERLINK "javascript:if%20(confirm('This%20will%20delete%20this%20reference.%20Are%20you%20sure%20you%20wish%20to%20do%20this?'))%20window.location.href='bibliographymaint.gps?docid=374962&action=delete&delete=1&refid=36076'"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/delete-white.gif" \* MERGEFORMATINET Delabrousse E, Bartholomot B, Sohm O, et al.Gallstone ileus: CT findings.Eur Radiol.2000;10(6):938-40. HYPERLINK "http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&dopt=Citation&list_uids=10879707" [Medline].  HYPERLINK "http://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&refid=36077&action=edit"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/edit-white.gif" \* MERGEFORMATINET  HYPERLINK "javascript:if%20(confirm('This%20will%20delete%20this%20reference.%20Are%20you%20sure%20you%20wish%20to%20do%20this?'))%20window.location.href='bibliographymaint.gps?docid=374962&action=delete&delete=1&refid=36077'"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/delete-white.gif" \* MERGEFORMATINET Delabrousse E, Brunelle S, Saguet O, et al.Small bowel obstruction secondary to phytobezoar CT findings.Clin Imaging.Jan-Feb2001;25(1):44-6. HYPERLINK "http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&dopt=Citation&list_uids=11435039" [Medline].  HYPERLINK "http://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&refid=36078&action=edit"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/edit-white.gif" \* MERGEFORMATINET  HYPERLINK "javascript:if%20(confirm('This%20will%20delete%20this%20reference.%20Are%20you%20sure%20you%20wish%20to%20do%20this?'))%20window.location.href='bibliographymaint.gps?docid=374962&action=delete&delete=1&refid=36078'"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/delete-white.gif" \* MERGEFORMATINET DiSantis DJ, Ralls PW, Balfe DM, et al.The patient with suspected small bowel obstruction: imaging strategies. American College of Radiology. ACR Appropriateness Criteria.Radiology.Jun2000;215(suppl):121-4. HYPERLINK "http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&dopt=Citation&list_uids=11037416" [Medline].  HYPERLINK "http://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&refid=36079&action=edit"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/edit-white.gif" \* MERGEFORMATINET  HYPERLINK "javascript:if%20(confirm('This%20will%20delete%20this%20reference.%20Are%20you%20sure%20you%20wish%20to%20do%20this?'))%20window.location.href='bibliographymaint.gps?docid=374962&action=delete&delete=1&refid=36079'"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/delete-white.gif" \* MERGEFORMATINET Furukawa A, Yamasaki M, Furuichi K, et al.Helical CT in the diagnosis of small bowel obstruction.Radiographics.Mar-Apr2001;21(2):341-55. HYPERLINK "http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&dopt=Citation&list_uids=11259698" [Medline].  HYPERLINK "http://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&refid=36080&action=edit"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/edit-white.gif" \* MERGEFORMATINET  HYPERLINK "javascript:if%20(confirm('This%20will%20delete%20this%20reference.%20Are%20you%20sure%20you%20wish%20to%20do%20this?'))%20window.location.href='bibliographymaint.gps?docid=374962&action=delete&delete=1&refid=36080'"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/delete-white.gif" \* MERGEFORMATINET Gollub MJ, DeCorato D, Schwartz LH.MR enteroclysis: evaluation of small-bowel obstruction in a patient with pseudomyxoma peritonei.AJR Am J Roentgenol.Mar2000;174(3):688-90. HYPERLINK "http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&dopt=Citation&list_uids=10701610" [Medline].  HYPERLINK "http://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&refid=36081&action=edit"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/edit-white.gif" \* MERGEFORMATINET  HYPERLINK "javascript:if%20(confirm('This%20will%20delete%20this%20reference.%20Are%20you%20sure%20you%20wish%20to%20do%20this?'))%20window.location.href='bibliographymaint.gps?docid=374962&action=delete&delete=1&refid=36081'"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/delete-white.gif" \* MERGEFORMATINET Jabra AA, Eng J, Zaleski CG, et al.CT of small-bowel obstruction in children: sensitivity and specificity.AJR Am J Roentgenol.Aug2001;177(2):431-6. HYPERLINK "http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&dopt=Citation&list_uids=11461877" [Medline].  HYPERLINK "http://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&refid=36082&action=edit"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/edit-white.gif" \* MERGEFORMATINET  HYPERLINK "javascript:if%20(confirm('This%20will%20delete%20this%20reference.%20Are%20you%20sure%20you%20wish%20to%20do%20this?'))%20window.location.href='bibliographymaint.gps?docid=374962&action=delete&delete=1&refid=36082'"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/delete-white.gif" \* MERGEFORMATINET Lappas JC, Reyes BL, Maglinte DD.Abdominal radiography findings in small-bowel obstruction: relevance to triage for additional diagnostic imaging.AJR Am J Roentgenol.Jan2001;176(1):167-74. HYPERLINK "http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&dopt=Citation&list_uids=11133561" [Medline].  HYPERLINK "http://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&refid=36083&action=edit"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/edit-white.gif" \* MERGEFORMATINET  HYPERLINK "javascript:if%20(confirm('This%20will%20delete%20this%20reference.%20Are%20you%20sure%20you%20wish%20to%20do%20this?'))%20window.location.href='bibliographymaint.gps?docid=374962&action=delete&delete=1&refid=36083'"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/delete-white.gif" \* MERGEFORMATINET Regan F, Beall DP, Bohlman ME, et al.Fast MR imaging and the detection of small-bowel obstruction.AJR Am J Roentgenol.Jun1998;170(6):1465-9. HYPERLINK "http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&dopt=Citation&list_uids=9609154" [Medline].  HYPERLINK "http://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&refid=36084&action=edit"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/edit-white.gif" \* MERGEFORMATINET  HYPERLINK "javascript:if%20(confirm('This%20will%20delete%20this%20reference.%20Are%20you%20sure%20you%20wish%20to%20do%20this?'))%20window.location.href='bibliographymaint.gps?docid=374962&action=delete&delete=1&refid=36084'"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/delete-white.gif" \* MERGEFORMATINET Rhodes AI, Shorvon PJ.Recent advances in small-bowel imaging: a review.Curr Opin Gastroenterol.Mar2001;17(2):132-139. HYPERLINK "http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&dopt=Citation&list_uids=11224668" [Medline].  HYPERLINK "http://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&refid=36085&action=edit"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/edit-white.gif" \* MERGEFORMATINET  HYPERLINK "javascript:if%20(confirm('This%20will%20delete%20this%20reference.%20Are%20you%20sure%20you%20wish%20to%20do%20this?'))%20window.location.href='bibliographymaint.gps?docid=374962&action=delete&delete=1&refid=36085'"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/delete-white.gif" \* MERGEFORMATINET Suri S, Gupta S, Sudhakar PJ, et al.Comparative evaluation of plain films, ultrasound and CT in the diagnosis of intestinal obstruction.Acta Radiol.Jul1999;40(4):422-8. HYPERLINK "http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&dopt=Citation&list_uids=10394872" [Medline].  HYPERLINK "http://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&refid=36086&action=edit"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/edit-white.gif" \* MERGEFORMATINET  HYPERLINK "javascript:if%20(confirm('This%20will%20delete%20this%20reference.%20Are%20you%20sure%20you%20wish%20to%20do%20this?'))%20window.location.href='bibliographymaint.gps?docid=374962&action=delete&delete=1&refid=36086'"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/delete-white.gif" \* MERGEFORMATINET Umschaden HW, Szolar D, Gasser J, et al.Small-bowel disease: comparison of MR enteroclysis images with conventional enteroclysis and surgical findings.Radiology.Jun2000;215(3):717-25. HYPERLINK "http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&dopt=Citation&list_uids=10831690" [Medline].  HYPERLINK "http://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&refid=36087&action=edit"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/edit-white.gif" \* MERGEFORMATINET  HYPERLINK "javascript:if%20(confirm('This%20will%20delete%20this%20reference.%20Are%20you%20sure%20you%20wish%20to%20do%20this?'))%20window.location.href='bibliographymaint.gps?docid=374962&action=delete&delete=1&refid=36087'"  INCLUDEPICTURE "http://progps1.emedicine.com/gps/delete-white.gif" \* MERGEFORMATINET Zalcman M, Sy M, Donckier V, et al.Helical CT signs in the diagnosis of intestinal ischemia in small-bowel obstruction.AJR Am J Roentgenol.Dec2000;175(6):1601-7. HYPERLINK "http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&dopt=Citation&list_uids=11090385" [Medline].  Acknowledgments  HYPERLINK "javascript:AL_get(this,%20'jour',%20'Pediatr%20Emerg%20Care.');" Pediatr Emerg Care. 2008 Feb;24(2):99-101. HYPERLINK "http://www.ncbi.nlm.nih.gov/entrez/utils/fref.fcgi?PrId=3159&itool=AbstractPlus-def&uid=18277846&db=pubmed&url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?an=00006565-200802000-00007" \t "_blank"  INCLUDEPICTURE "http://www.ncbi.nlm.nih.gov/corehtml/query/egifs/http:--www.lwwonline.com-pt-pt-core-template-journal-lwwgateway-images-pmlogo.gif" \* MERGEFORMATINET   HYPERLINK "javascript:PopUpMenu2_Set(Menu18277846);" \t "_self" Links Child with small bowel obstruction and perforation secondary to ileal bezoar.  HYPERLINK "http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Quintana%20JF%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1" Quintana JF,  HYPERLINK "http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Walker%20RN%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1" Walker RN,  HYPERLINK "http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22McGeehan%20A%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1" McGeehan A. Geisinger Medical Center, Danville, PA 17822, USA. Bezoars are a rare cause of intestinal obstruction, but morbidity and mortality of late diagnosis and complication are high. Generally, bezoars remain in the region of the stomach; however, infrequently, they will pass to the small bowel. The clinical diagnosis of bezoar is challenging, and initial radiographs are frequently nondiagnostic. Early recognition of this entity on plain film or by computed tomography is important to prevent late complications. In addition, bezoar formation can indicate underlying psychiatric disorder that requires evaluation and therapy. We present a child with classic radiographic trichobezoar that had passed to the distal ileum and resulted in subsequent perforation. PMID: 18277846 [PubMed - in process]  HYPERLINK "javascript:AL_get(this,%20'jour',%20'Scand%20J%20Gastroenterol.');" Scand J Gastroenterol. 2008 Mar;43(3):382-3. HYPERLINK "http://www.ncbi.nlm.nih.gov/entrez/utils/fref.fcgi?PrId=3079&itool=AbstractPlus-def&uid=18266180&db=pubmed&url=http://www.informaworld.com/openurl?genre=article&doi=10.1080/00365520701698843&magic=pubmed||1B69BA326FFE69C3F0A8F227DF8201D0" \t "_blank"  INCLUDEPICTURE "http://www.ncbi.nlm.nih.gov/corehtml/query/egifs/http:--www.tandf.co.uk-journals-images-informaworld-informaworldbutton.jpg" \* MERGEFORMATINET   HYPERLINK "javascript:PopUpMenu2_Set(Menu18266180);" \t "_self" Links Small-bowel obstruction due to bilharziasis.  HYPERLINK "http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Hanaei%20AA%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1" Hanaei AA,  HYPERLINK "http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Hefny%20AF%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1" Hefny AF,  HYPERLINK "http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Teraifi%20HE%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1" Teraifi HE,  HYPERLINK "http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Zidan%20FM%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1" Zidan FM. Department of Surgery, Al Ain Hospital, Al Ain, United Arab Emirates. PMID: 18266180 [PubMed - in process]  HYPERLINK "javascript:AL_get(this,%20'jour',%20'Pediatr%20Radiol.');" Pediatr Radiol. 2008 Feb 7 [Epub ahead of print] HYPERLINK "http://www.ncbi.nlm.nih.gov/entrez/utils/fref.fcgi?PrId=3055&itool=AbstractPlus-def&uid=18256816&db=pubmed&url=http://dx.doi.org/10.1007/s00247-008-0754-8" \t "_blank"  INCLUDEPICTURE "http://www.ncbi.nlm.nih.gov/corehtml/query/egifs/http:--production.springer.de-OnlineResources-Logos-springerlink.gif" \* MERGEFORMATINET   HYPERLINK "javascript:PopUpMenu2_Set(Menu18256816);" \t "_self" Links Fluoroscopic and CT enteroclysis in children: initial experience, technical feasibility, and utility.  HYPERLINK "http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Brown%20S%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1" Brown S,  HYPERLINK "http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Applegate%20KE%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1" Applegate KE,  HYPERLINK "http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Sandrasegaran%20K%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1" Sandrasegaran K,  HYPERLINK "http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Jennings%20SG%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1" Jennings SG,  HYPERLINK "http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Garrett%20J%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1" Garrett J,  HYPERLINK "http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Skantharajah%20A%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1" Skantharajah A,  HYPERLINK "http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Maglinte%20DT%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1" Maglinte DT. Indiana University School of Medicine, Indianapolis, IN, USA. BACKGROUND: Partial small-bowel obstruction can be difficult to diagnose on clinical examination. These obstructions might not be detected on routine abdominal/pelvic CT. OBJECTIVE: To evaluate the feasibility, safety, and techniques of fluoroscopic enteroclysis (FE) and CT enteroclysis (CTE), and to review their indications and findings in children. MATERIALS AND METHODS: We retrospectively reviewed all enteroclysis studies in children younger than 18 years performed between January 2002 and March 2007. We correlated the results with other abdominal imaging and surgical and pathological findings. RESULTS: The review revealed 112 FE and 74 CTE studies performed in 175 children (mean age 14 years, range 3-18 years). FE and CTE studies were performed most commonly for evaluation of known Crohn disease (FE 38%, CTE 29%) and abdominal pain (FE 26%, CTE 26%). One FE study was terminated because of patient anxiety, and one CTE study was terminated because of patient discomfort. No complications of FE or CTE were reported. The findings were normal in 54% of the FE studies and 46% of the CTE studies. The most common small bowel diagnoses were Crohn disease (FE 34%, CTE 28%) and partial small bowel obstruction (FE 3%, CTE 10%). Two FE studies (2%) and 14 CTE studies (19%) showed abnormalities outside the small bowel. In 54 patients with inflammatory bowel disease, 11 FE studies and 25 CTE studies showed additional bowel abnormalities. Overall, 14 and 21 patients had surgery as a result of the findings of FE and CTE, respectively. CONCLUSION: FE and CTE are safe, feasible, and accurate in depicting small-bowel pathology in children. These techniques can be particularly useful in children with Crohn disease involving the small bowel. PMID: 18256816 [PubMed - as supplied by publisher]  HYPERLINK "javascript:AL_get(this,%20'jour',%20'Am%20J%20Gastroenterol.');" Am J Gastroenterol. 2007 Dec 12 [Epub ahead of print] HYPERLINK "http://www.ncbi.nlm.nih.gov/entrez/utils/fref.fcgi?PrId=3046&itool=AbstractPlus-def&uid=18076735&db=pubmed&url=http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=0002-9270&date=2007&volume=&issue=&spage=" \t "_blank"  INCLUDEPICTURE "http://www.ncbi.nlm.nih.gov/corehtml/query/egifs/http:--www.blackwell-synergy.com-templates-jsp-_synergy-images-synergy_linkout.gif" \* MERGEFORMATINET   HYPERLINK "javascript:PopUpMenu2_Set(Menu18076735);" \t "_self" Links Gastrointestinal Manifestations of Amyloidosis.  HYPERLINK "http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Ebert%20EC%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1" Ebert EC,  HYPERLINK "http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Nagar%20M%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1" Nagar M. Department of Medicine, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA. Amyloidosis is characterized by extracellular deposition of abnormal protein. There are six types: primary, secondary, hemodialysis-related, hereditary, senile, and localized. Primary (AL) amyloidosis is associated with monoclonal light chains in serum and/or urine with 15% of patients having multiple myeloma. Secondary (AA) amyloidosis is associated with inflammatory, infectious, and neoplastic diseases. The presentation is protean, including macroglossia, a dilated and atonic esophagus, gastric polyps or enlarged folds, and luminal narrowing or ulceration of the colon. Amyloid deposition in the gastrointestinal (GI) tract is greatest in the small intestine. The symptoms include diarrhea, steatorrhea, or constipation. Pseudo-obstruction carries a particularly grave prognosis, often not responding to promotility agents. Hepatic involvement is common, but the clinical manifestations are usually mild with hepatomegaly and an elevated alkaline phosphatase level. Biopsies to diagnose amyloidosis can be taken from the fat, kidney, intestine, or bone marrow. The safety of liver biopsies is controversial. With Congo Red stain, amyloid appears red in normal light and apple-green in polarized light. Treatment for AL amyloidosis is chemotherapy and stem cell transplantation; treatment for AA amyloidosis is control of the underlying disease. Amyloidosis should be considered in patients with proteinuria, cardiomyopathy, hepatomegaly (with mildly abnormal liver tests), peripheral and autonomic neuropathy, weight loss, and GI symptoms. PMID: 18076735 [PubMed - as supplied by publisher] efg% & '    * + 3 _ Կ᳠wg[gghiKB*OJQJphhiKB*CJOJQJaJph hiK0J5CJOJQJ\aJ.jhiK5B*CJOJQJU\aJph%hiK5B*CJOJQJ\aJphhiKB*CJ0aJ0phjhiKB*UphhiKB*phjhiKB*UphjhiKB*UphhiKB*ph hiK0JhHj!  + ,.U$&3>$ & Fdd[$\$gdiKgdiKHgdiKgdiKgdiKgdiKgdHj\ ) * l m ! # $ Y Z u v x y   8 9 ? @ r s 5V7Udw,-.Tۺۺۺۺۺۺۥ۝hiKB*ph(j0hiKB*CJOJQJUaJph%hiK5B*CJOJQJ\aJphhiK0JCJOJQJaJhiKB*CJOJQJaJph(jhiKB*CJOJQJUaJph9TU$%&23>#$(<4.=.>.L....X/g//// 2 2?2@2F2G2333 4 4444ƺƺƘƺuƺƺhiK0JCJOJQJaJ(jhiKB*CJOJQJUaJphhiKB*CJOJQJaJph#hiK0JIB*CJOJQJaJphhiKB*CJaJphhiKB*ph(jhiKB*CJOJQJUaJphhiKB*CJOJQJaJphhiKB*OJQJph&LDKy )!!="#=#m$$y%=&0'&(( & Fdd[$\$gdiK & Fdd[$\$gdiK & Fdd[$\$gdiK(),*K++,,4.>.L...//133 4444444 $$Ifa$HgdiKgdiKgdiK & Fdd[$\$gdiK & Fdd[$\$gdiK4444#kdh$$If\o W! @@@@(ffffffff0634abp(ffffffff $$Ifa$44455#61666o8p8q8x8y8A A!AaGbGGGGG K K!KoTTT=Y>Y?YLYMYNYYYYYYY ZԹԹԘԘԹԹuԹiԘԘhiKB*OJQJph(jhiKB*CJOJQJUaJphhiK0JCJOJQJaJ(jhiKB*CJOJQJUaJphhiKB*CJaJphhiKB*ph%hiK6B*CJOJQJ]aJphhiKB*CJOJQJaJphhiKCJaJ%hiK5B*CJOJQJ\aJph)4 5A555562666Wkd$$If\o W!0634ab$If 667+77o8]WWWW$IfkdO$$If\o W!0634abo8p8q8y8:,>A!AoB]VQLLLQLHgdiKgdiKgdiKkd$$If\o W!0634aboBDFEFG@I K!KKWLfMNPRoTTUVVHWX=Y?YMY\]7]`gdiKgdiKgdiKHgdiK ZZZZZZnZoZZZZZZZZZZZ?[@[N[O[P[Q[[[[[[[\\\\ \!\q\r\\\\\\\\\]6]7]UaVaWaaabakaŹͤŘhiKB*OJQJph(jk hiKB*CJOJQJUaJphhiKB*CJaJphhiKB*phhiKB*CJOJQJaJphhiK0JCJOJQJaJ(jhiKB*CJOJQJUaJph6`UaWabaka~aabcdd+ffgbgghh[ikkLl$mm & Fdd[$\$gdiKgdiKgdiKgdiKHgdiKka|a[n\nMss{{%}9}:}y~~~ƃǃȃσЃكu@YZ678;<Eauv678¶¶ܡ•¶¶܀•¶¶k(j? hiKB*CJOJQJUaJph(j hiKB*CJOJQJUaJphhiKB*OJQJph(j hiKB*CJOJQJUaJphhiKB*CJaJphhiKB*ph#hiK0JIB*CJOJQJaJphhiKB*CJOJQJaJph%hiK5B*CJOJQJ\aJph*mkoUprMssuhuuvwxBxxxyz{{%}:}y~~gdiK & Fdd[$\$gdiK & Fdd[$\$gdiKHgdiK & Fdd[$\$gdiK?ƃȃЃكބg?Iy'>}ʓ4Δ & Fdd[$\$gdiK & Fdd[$\$gdiKgdiKgdiKgdiKHgdiKΔJŖ!ۛ֜+*kĤSu@Z6gdiK & Fdd[$\$gdiK & Fdd[$\$gdiK & Fdd[$\$gdiKHgdiK68<Eyav79DMۯY)ŹT"EZPj#HgdiKgdiKgdiKgdiK89CDMEYZPij#$%56?0IJM()*+78ϨϨ~(j hiKB*CJOJQJUaJph(jw hiKB*CJOJQJUaJph"hiKB*CJH*OJQJaJph(j hiKB*CJOJQJUaJphhiKB*CJaJphhiKB*OJQJphhiKB*phhiKB*CJOJQJaJph,#%6?0J)+8Bx & Fdd[$\$gdiKHgdiKgdiKgdiKgdiKDUWf%svLKkd2$$If0!634a$IfgdiKgdiKgdiKHgdiK & Fdd[$\$gdiK ABDTUVWefrs ŹŘooWDW%hiK5B*CJOJQJ\aJph.jhiK5B*CJOJQJU\aJph,jhiK0JJB*CJOJQJUaJph#hiK0JJB*CJOJQJaJphhiKB*OJQJph(j hiKB*CJOJQJUaJphhiKB*CJaJphhiKB*phhiK0JCJOJQJaJhiKB*CJOJQJaJph(jhiKB*CJOJQJUaJph !"#LM`ay012>?йyggT%hiK5B*CJOJQJ\aJph#hiK0JJB*CJOJQJaJph(jghiKB*CJOJQJUaJph%hiK5B*CJOJQJ\aJphhiKCJaJhiKB*CJOJQJaJph,jhiK0JJB*CJOJQJUaJph.jhiK5B*CJOJQJU\aJph.jKhiK5B*CJOJQJU\aJphLMPaKkd$$If0!634a$IfKkd$$If0!634a`ae02^aa\\WW\gdiKHgdiKKkd$$If0!634a$IfKkd$$If0!634a 78=>jk !pqrй|gUU#hiK0JJB*CJOJQJaJph(j+hiKB*CJOJQJUaJph%hiK5B*CJOJQJ\aJph#hiK0JIB*CJOJQJaJphhiKCJaJhiKB*CJOJQJaJph,jhiK0JJB*CJOJQJUaJph.jhiK5B*CJOJQJU\aJph.jhiK5B*CJOJQJU\aJphajaKkdg$$If0!634aKkd$$If0!634a$Ifjkn !$aKkdI$$If0!634a$IfKkd$$If0!634adf+ 57gdiKHgdiKKkd$$If0!634ar-23defxy%&ԼԥoZHH#hiK0JJB*CJOJQJaJph(jhiKB*CJOJQJUaJph%hiK5B*CJOJQJ\aJph%hiK5B*CJOJQJ\aJphhiKB*CJOJQJaJph,jhiK0JJB*CJOJQJUaJph.jhiK5B*CJOJQJU\aJph.jhiK5B*CJOJQJU\aJph%hiK5B*CJOJQJ\aJph&'(),-.йn\\I1.jhiK5B*CJOJQJU\aJph%hiK5B*CJOJQJ\aJph#hiK0JJB*CJOJQJaJph(jIhiKB*CJOJQJUaJph%hiK5B* CJOJQJ\aJph%hiK5B*CJOJQJ\aJphhiKB*CJOJQJaJph,jhiK0JJB*CJOJQJUaJph.jhiK5B*CJOJQJU\aJph.jbhiK5B*CJOJQJU\aJph 6;<567IJttaI.jhiK5B*CJOJQJU\aJph%hiK5B*CJOJQJ\aJph#hiK0JJB*CJOJQJaJph(jhiKB*CJOJQJUaJph%hiK5B*CJOJQJ\aJph%hiK5B*CJOJQJ\aJphhiKB*CJOJQJaJph,jhiK0JJB*CJOJQJUaJph.jhiK5B*CJOJQJU\aJph#$%&01>?234۾۾yddO?OhiKB*CJOJQJaJph(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJph hiK0JK5CJOJQJ\aJ%hiK5B*CJOJQJ\aJph(j"hiKB*CJOJQJUaJphhiKB*OJQJphhiKB*ph(j"hiKB*CJOJQJUaJphhiKB*CJOJQJaJph(jg!hiKB*CJOJQJUaJph$&1MMIOiRlUX[_b2e'hCknqtxe{~ & F dd[$\$gdiKgdiKgdiKlmnJKLMNOZcpq<=>}h}(j6hiKB*CJOJQJUaJphhiKB*CJOJQJaJph hiK0JK5CJOJQJ\aJ%hiK5B*CJOJQJ\aJphhiKB*CJOJQJaJph(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJph(jG#hiKB*CJOJQJUaJph *3@A}h}(jXhiKB*CJOJQJUaJphhiKB*CJOJQJaJph hiK0JK5CJOJQJ\aJ%hiK5B*CJOJQJ\aJphhiKB*CJOJQJaJph(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJph(jHhiKB*CJOJQJUaJph :;<XYZ}h}(jyhiKB*CJOJQJUaJphhiKB*CJOJQJaJph hiK0JK5CJOJQJ\aJ%hiK5B*CJOJQJ\aJphhiKB*CJOJQJaJph(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJph(jihiKB*CJOJQJUaJph ~ H I J    & ' }h}(jKhiKB*CJOJQJUaJphhiKB*CJOJQJaJph hiK0JK5CJOJQJ\aJ%hiK5B*CJOJQJ\aJphhiKB*CJOJQJaJph(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJph(jԎhiKB*CJOJQJUaJph ' ( ) * + 6 ? M N       b c d e f g r {   6 7 8    }h}(jhiKB*CJOJQJUaJphhiKB*CJOJQJaJph hiK0JK5CJOJQJ\aJ%hiK5B*CJOJQJ\aJphhiKB*CJOJQJaJph(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJph(j&hiKB*CJOJQJUaJph $-;<=>?9:;}h}(jjhiKB*CJOJQJUaJphhiKB*CJOJQJaJph hiK0JK5CJOJQJ\aJ%hiK5B*CJOJQJ\aJphhiKB*CJOJQJaJph(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJph(j hiKB*CJOJQJUaJph '0>?uvwSTUVWXclz{ab}h}(jhiKB*CJOJQJUaJphhiKB*CJOJQJaJph hiK0JK5CJOJQJ\aJ%hiK5B*CJOJQJ\aJphhiKB*CJOJQJaJph(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJph(j hiKB*CJOJQJUaJph bcdefqzDEF"#$%&'2;IJ'()}h}(jmBhiKB*CJOJQJUaJphhiKB*CJOJQJaJph hiK0JK5CJOJQJ\aJ%hiK5B*CJOJQJ\aJphhiKB*CJOJQJaJph(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJph(j -hiKB*CJOJQJUaJph   ,- !"%&OPQ- . }h}(j)jhiKB*CJOJQJUaJphhiKB*CJOJQJaJph hiK0JK5CJOJQJ\aJ%hiK5B*CJOJQJ\aJphhiKB*CJOJQJaJph(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJph(j+WhiKB*CJOJQJUaJph . / 0 1 2 = F T U ?!@!A!!!!""" "!"""-"6"D"E"###O$P$Q$$$}h}(jhiKB*CJOJQJUaJphhiKB*CJOJQJaJph hiK0JK5CJOJQJ\aJ%hiK5B*CJOJQJ\aJphhiKB*CJOJQJaJph(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJph(j~hiKB*CJOJQJUaJph $$$$$$$$$%%%&&&&&&&&&&&&&\']'^'''':(;(}h}(jպhiKB*CJOJQJUaJphhiKB*CJOJQJaJph hiK0JK5CJOJQJ\aJ%hiK5B*CJOJQJ\aJphhiKB*CJOJQJaJph(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJph(j hiKB*CJOJQJUaJph ;(<(=(>(?(J(S(a(b(w)x)y))))U*V*W*X*Y*Z*e*n*|*}*,,,|,},~,,,}h}(jhiKB*CJOJQJUaJphhiKB*CJOJQJaJph hiK0JK5CJOJQJ\aJ%hiK5B*CJOJQJ\aJphhiKB*CJOJQJaJph(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJph ,,,,,- ------I.J.K...........00000000}h}(jRhiKB*CJOJQJUaJphhiKB*CJOJQJaJph hiK0JK5CJOJQJ\aJ%hiK5B*CJOJQJ\aJphhiKB*CJOJQJaJph(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJph 000001111222333y3z3{3|3}3~33333k5l5m5555I6J6}h}(j<hiKB*CJOJQJUaJphhiKB*CJOJQJaJph hiK0JK5CJOJQJ\aJ%hiK5B*CJOJQJ\aJphhiKB*CJOJQJaJph(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJph(j$hiKB*CJOJQJUaJph J6K6L6M6N6Y6_6m6n6777"8#8$88888888888999`:a:b:::}h}(jdhiKB*CJOJQJUaJphhiKB*CJOJQJaJph hiK0JK5CJOJQJ\aJ%hiK5B*CJOJQJ\aJphhiKB*CJOJQJaJph(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJph(jMhiKB*CJOJQJUaJph :::::::::<<<|<}<~<<<<<<<=======5>6>7>>>}h}(jhiKB*CJOJQJUaJphhiKB*CJOJQJaJph hiK0JK5CJOJQJ\aJ%hiK5B*CJOJQJ\aJphhiKB*CJOJQJaJph(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJph(jyhiKB*CJOJQJUaJph >>>>>>>>>3@4@5@@@@AAAAAA!A'A5A6AcBdBeBBBBACBC}h}(jhiKB*CJOJQJUaJphhiKB*CJOJQJaJph hiK0JK5CJOJQJ\aJ%hiK5B*CJOJQJ\aJphhiKB*CJOJQJaJph(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJph(jǦhiKB*CJOJQJUaJph BCCCDCECFCQCWCeCfC"D#D$DDDDEEEEEEEE$E%EEEEFFGFHFFF}h}(jhiKB*CJOJQJUaJphhiKB*CJOJQJaJph hiK0JK5CJOJQJ\aJ%hiK5B*CJOJQJ\aJphhiKB*CJOJQJaJph(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJph FFFFFFFFFGGGEHFHGHHHHHHHHHHHJJJJJJJJ}h}(jhiKB*CJOJQJUaJphhiKB*CJOJQJaJph hiK0JK5CJOJQJ\aJ%hiK5B*CJOJQJ\aJphhiKB*CJOJQJaJph(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJph(jBhiKB*CJOJQJUaJph JJJJJ KKKKLLL9M:M;MMMMMMMMMMMM}hSKhiKB*ph(jlhiKB*CJOJQJUaJph(j_NhiKB*CJOJQJUaJphhiKB*CJOJQJaJph hiK0JK5CJOJQJ\aJ%hiK5B*CJOJQJ\aJphhiKB*CJOJQJaJph(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJph(j6hiKB*CJOJQJUaJphMM.N/N0NNNNNNNNNNNDOEOFOGOHOIOJOKOOOO P P޼󰙄oXo-hiKhiKB*CJOJQJaJmHphsH(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJph-hiKhiKB*CJOJQJaJmHphsHhiKB*OJQJphjnhiKB*UphjlhiKB*UphhiKB*phjhiKB*UphhiKB*phjhiKB*Uph P PPPPPPPPNQOQPQQQRQ|QQQQQ[R\ReRfRjRkRRRR֓~n[nnMnnhiK0JCJOJQJaJ%hiK6B*CJOJQJ]aJphhiKB*CJOJQJaJph(jrhiKB*CJOJQJUaJph-hiKhiKB*CJOJQJaJmHphsH-hiKhiKB*CJOJQJaJmHphsH(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJph(jphiKB*CJOJQJUaJphR+S,S-S.S/S0S1STTTnToTpTqTrTTTTT^U_UhUiUmUnUUUU.V/V0V1V2VڰڋڰxjUڰ(jxhiKB*CJOJQJUaJphhiK0JCJOJQJaJ%hiK6B*CJOJQJ]aJph(jvhiKB*CJOJQJUaJphhiKB*CJOJQJaJph(jhiKB*CJOJQJUaJph(jthiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJphhiKB*CJOJQJaJph!2V3V4VWWWqWrWsWtWuWX X6X7XXXXXXX#Y$Y%YzY{Y|Y}Y~YYYdZeZfZZZŵŠŵjŵ(j|hiKB*CJOJQJUaJphhiK0JCJOJQJaJ%hiK6B*CJOJQJ]aJph(jzhiKB*CJOJQJUaJphhiKB*CJOJQJaJph(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJphhiKB*CJOJQJaJph#ZZZZ%[0[H[I[[[[[[[[5\6\7\\\\\\\\v]w]x]]]yybMyyb(jshiKB*CJOJQJUaJph-hiKhiKB*CJOJQJaJmHphsH-hiKhiKB*CJOJQJaJmHphsHhiK0JCJOJQJaJ%hiK6B*CJOJQJ]aJphhiKB*CJOJQJaJph(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJph(j|~hiKB*CJOJQJUaJph]]]]]P^c^^^^^^^__m_n_o________```aayiTi(jQhiKB*CJOJQJUaJphhiKB*CJOJQJaJphhiK0JCJOJQJaJ%hiK6B*CJOJQJ]aJphhiKB*CJOJQJaJph-hiKhiKB*CJOJQJaJmHphsH(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJph(jZhiKB*CJOJQJUaJpha a a afaraaabb b bbbybzb{bbbbbbbbcccdddddddրkրV(jhiKB*CJOJQJUaJph(j/hiKB*CJOJQJUaJphhiKB*CJOJQJaJphhiK0JCJOJQJaJ%hiK6B*CJOJQJ]aJphhiKB*CJOJQJaJph(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJph(j8hiKB*CJOJQJUaJph!ddd$e%e.e/e3e4eeeeeeeeeeefff7g8g9g:g;ggggghh#h$h(h)hhhhhhڷڷ}jڷ%hiK6B*CJOJQJ]aJph(jhiKB*CJOJQJUaJph(j hiKB*CJOJQJUaJphhiKB*CJOJQJaJph(jhiKB*CJOJQJUaJphhiK0JCJOJQJaJ(jhiKB*CJOJQJUaJphhiKB*CJOJQJaJph)hhhhhhiii,j-j.j/j0jjjjj5k6k?k@kDkEkkkkllll l l l֡֌yk֡V(jɓhiKB*CJOJQJUaJphhiK0JCJOJQJaJ%hiK6B*CJOJQJ]aJph(jґhiKB*CJOJQJUaJphhiKB*CJOJQJaJphhiKB*CJOJQJaJph(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJph! llllHmImJmKmLmmnn nnnnnnn o oocodoeofogohoioMpNpOpppŵŠŵjŵ(jhiKB*CJOJQJUaJphhiK0JCJOJQJaJ%hiK6B*CJOJQJ]aJph(jhiKB*CJOJQJUaJphhiKB*CJOJQJaJph(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJphhiKB*CJOJQJaJph!pppp qq7q8qqqqqqq$r%r&r{r|r}r~rrrresfsgssssssGtZtրkրV(jlhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJphhiKB*CJOJQJaJphhiK0JCJOJQJaJ%hiK6B*CJOJQJ]aJphhiKB*CJOJQJaJph(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJph!Ztttutttttttaubucuuuuuuuuvvvvvvvvkw~www x xxxxxxxxxxڷڷ}jڷ%hiK6B*CJOJQJ]aJph(jJhiKB*CJOJQJUaJph(jchiKB*CJOJQJUaJphhiKB*CJOJQJaJph(jhiKB*CJOJQJUaJphhiK0JCJOJQJaJ(jhiKB*CJOJQJUaJphhiKB*CJOJQJaJph)xxxxxxyyyzz z!z"zzzzzW{X{a{b{f{g{{{{'|(|)|*|+|,|-|֡֌yk֡V(jhiKB*CJOJQJUaJphhiK0JCJOJQJaJ%hiK6B*CJOJQJ]aJph(j(hiKB*CJOJQJUaJphhiKB*CJOJQJaJphhiKB*CJOJQJaJph(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJph(jAhiKB*CJOJQJUaJph!-|}}}j}k}l}m}n}}}}~r~s~|~}~~~~~~BCDEFGH,-.ŵŠŵjŵ(jhiKB*CJOJQJUaJphhiK0JCJOJQJaJ%hiK6B*CJOJQJ]aJph(jhiKB*CJOJQJUaJphhiKB*CJOJQJaJph(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJphhiKB*CJOJQJaJph!ҀwxGHIJKLM123#րkրV(j°hiKB*CJOJQJUaJph(jۮhiKB*CJOJQJUaJphhiKB*CJOJQJaJphhiK0JCJOJQJaJ%hiK6B*CJOJQJ]aJphhiKB*CJOJQJaJph(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJph!#;<()*ijk†ÆĆņƆ_hopqƈLjڷڷ}jڷ%hiK6B*CJOJQJ]aJph(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJphhiKB*CJOJQJaJph(jhiKB*CJOJQJUaJphhiK0JCJOJQJaJ(jhiKB*CJOJQJUaJphhiKB*CJOJQJaJph)LjȈɈʈˈ̈     '(12567F֡֌ykVNhiKB*ph(juhiKB*CJOJQJUaJphhiK0JCJOJQJaJ%hiK6B*CJOJQJ]aJph(j~hiKB*CJOJQJUaJphhiKB*CJOJQJaJphhiKB*CJOJQJaJph(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJph(jhiKB*CJOJQJUaJph57GHIyn :tߙa*h^gdHj^gdHj^gdHj^gdHj^gdHjgdHjgdiKgdiK & F dd[$\$gdiKFGIJËċhijklmnoʎˎ֎׎َڎklvwtͺǛבvvvhHj0J5\jhHjUhHj hHj0JjhHj0JUjhHj0JUjhHjB*UphhHjB*phjhHjB*Uph hHj0JjhHj0JU hHj0J hHj0JjhHj0JU hiK0JhiKB*OJQJph+t|•Õĕ  :;  ʗ˗ӗԗ֗חhiqrнʞڔ}}}}hHj0J5\jhHjU hHj0JjhHj0JUj0hHj0JUjwhHjB*UphhHjB*phjhHjB*Uph hHj0JjhHj0JU hHj0J hHj0JjhHj0JUhHjhiKhHjB*ph1șߙ'(78YZab!")*,-ɞʞٞڞܞݞнʞڔ}}}}hHj0J5\jhHjU hHj0JjhHj0JUjhHj0JUjhHjB*UphhHjB*phjhHjB*Uph hHj0JjhHj0JU hHj0J hHj0JjhHj0JUhHjhiKhHjB*ph1qr{|~EFTUWX'(GPtu©é֩ש"#Ͽ}Ƀ hHj0JjhHj0JUjhHj0JUjhHjB*UphhHjB*phjhHjB*Uph hHj0JjhHj0JU hHj0J hHj0JjhHj0JUhiKhHjB*phhHj0J5\hHjjhHjU1hAt"([\^gdHj^gdHj^gdHjgdHj^gdHj^gdHj .7\hiKhHjB*phhHj0J5\hHjjhHjU,1h/ =!"#$% Ddv,f   c BAredline-largebUsD^I51Dn)sD^I5PNG  IHDR* PLTE ffXhtRNSKFbKGDaf} cmPPJCmp0712OmIDAT(m E}`nPULPCHTb`_O<` `ee Cwz1JCq!2BHKsUaۼ!yoOCG3eGRTnܷvFWIENDB`!Dde`   c <AbtnMedlinebmr9ISnAr9PNG  IHDRK*CPLTE̙ff^zbKGDH cmPPJCmp0712OmIDAT(ύ C@;_!?|  !g~J%^/hZUf$'*MXD4JcpIENDB`o$$If!vh55= #v#v= :V 6,5534o$$If!vh55= #v#v= :V 6,5534o$$If!vh55= #v#v= :V 6,5534o$$If!vh55= #v#v= :V 6,5534o$$If!vh55= #v#v= :V 6,5534Dd <\  3 S" ((Dd `  c <Aedit-whiteb3eb^ڍ/: 1Sneb^ڍ/: 1PNG  IHDR#niPLTEss wotRNSSbKGDhQ cmPPJCmp0712OmcIDAT(m P.`X]H3L"{ A 1i,B^Qٝ>J%^/hZUf$'*MXD4JcpIENDB`o$$If!vh55= #v#v= :V 6,5534o$$If!vh55= #v#v= :V 6,5534o$$If!vh55= #v#v= :V 6,5534o$$If!vh55= #v#v= :V 6,5534o$$If!vh55= #v#v= :V 6,5534Dd <\  3 S" ((Dd `  c <Aedit-whiteb3eb^ڍ/: 1neb^ڍ/: 1PNG  IHDR#niPLTEss wotRNSSbKGDhQ cmPPJCmp0712OmcIDAT(m P.`X]H3L"{ A 1i,B^Qٝ>J%^/hZUf$'*MXD4JcpIENDB`Dd <\  3 S" ((Dd `  c <Aedit-whiteb3eb^ڍ/: 1neb^ڍ/: 1PNG  IHDR#niPLTEss wotRNSSbKGDhQ cmPPJCmp0712OmcIDAT(m P.`X]H3L"{ A 1i,B^Qٝ>J%^/hZUf$'*MXD4JcpIENDB`Dd <\  3 S" ((Dd `  c <Aedit-whiteb3eb^ڍ/: 15neb^ڍ/: 1PNG  IHDR#niPLTEss wotRNSSbKGDhQ cmPPJCmp0712OmcIDAT(m P.`X]H3L"{ A 1i,B^Qٝ>J%^/hZUf$'*MXD4JcpIENDB`Dd <\  3 S" ((Dd `   c <Aedit-whiteb3eb^ڍ/: 1neb^ڍ/: 1PNG  IHDR#niPLTEss wotRNSSbKGDhQ cmPPJCmp0712OmcIDAT(m P.`X]H3L"{ A 1i,B^Qٝ>J%^/hZUf$'*MXD4JcpIENDB`Dd <\ ! 3 S" ((Dd!<P " 3 3"((Dd!<P # 3 3"((Ddn $ c A *8336139-374962-5322tnClick to view original fileRZ~$}A-I#FZ~$}A-IJFIFC    $.' ",#(7),01444'9=82<.342C  2!!22222222222222222222222222222222222222222222222222" }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?V1pxZ8P;>oʀ:]v+Y$|ʞɈ=;VkY@\MhA?Ld3c*~GQ *MpB^ K*`%V #۶"{Q-+溅@>J,@mѴ/ 9: p t\0V(zW1>1+kty.7Ҁ8#i w}V(a8b wi0 ^qI4 Όa9ff;[5i܊כxҪA)G>rLDeBmKUFia@{oQ@ %%f~°ZҶmǨ4.%Þ=+cimDgDktT(ɠIӕ@i] k.W-erǠճE2N-+.]v+ŀzxOUգ`mp9 GD,Pg8S ̎ᶓЁҵTɑ&ָH~Q@5ù[IbVL*3cF~jյEN= ^SAs`Qb+%A C׶:PMod۞HpPClS޴L4ztJd! =+:eSHqYbt'1u5ZgvQ瞃ꭵ.&HEOp>%ҭkiUDihAdof)|1]jiS㎔ks Ad2:sVF,85I d]JUFj3Z+ި5BwdTٔf>UZ7(oQ@ W JkB Yִ}(^ݷ`5jpр60+b l5 r]ېAʷ$1^ޭ.nj5jJȤ\֕QO̡3Ӯ1".yӡ*C؃\3p5ZfY񓃜rχr€97z+:mڷ Yy{礓spE9r$89$b295^ }Š&ʞ?*X&NigZҲm۳ʸP>M;iFj 68I&(lDIހʰ2,)20@IK DB swc9Bas%de$u; ֘Qa#%B^3^b+bMXn$bw6Jah[^eR6.r3\ޣ`}&0<@[JBI 'nF1礝Y}6&F|W5q($VoWc)50y~EŠeO^+zW(~N7lskpdsV|6mS)rp}]M[j["Y@GbhQM0'u!8 2ci $E U$ICw Oc̴oilhA4h8f APM:Tn1u+z}=+2& nPY% 3w-籮[m\ i\hk7'\ s1XŵJi~%Q/(TPT@"᫥ѤW{ִ&0N=yN[RIw.!RMBG'mzlP&ю$ HQ xݎ$34k.Qw@T)p΀^,- đ&;NW&vgV#f\f}ʃy n8T\ VzN0 RAPG@Ucw=nBy͌:HgVNV 1#ܱ %+6 ɀsr 8&(2Ovc%wNYj1-lpGJ1ր!nN4h)>R\dE\Vz㹪\23(օϔ(e"-Q@  Pcpj2h"hgDd3 % c A *8336139-374962-5323tnClick to view original fileRiϪ 'hsֳr6 GE^6F=Ϫ 'hsֳr6 GJFIFC    $.' ",#(7),01444'9=82<.342C  2!!22222222222222222222222222222222222222222222222222" }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?2S2uѽ\HԖOrwo*l"?w\ՠbC?u:l28y|MjEIysSz΋Jk(!*5Ěѳ@%R[XrEZ GjnP5_(M]D,ք,xHm#vr~q}kbHqҪ7.2#$(]ff\\v= sד%~YBGsoUdՀbB`'oA1N&(ZطZJ@_<XfP!JƉ`]v̀׽u0sV k:Z\cJTwYVVR}=jrNXӲ|OR(T2xQ89gJPtZsy9)0{UmFHTb\z|I& 5eW*p}frT1Th1$u0l</tynaaXi2G9bnjq>\˵maxmolgk)mV@<G$έ[k[&1[ztp\;ܲsI.EۂEswB(Uǩ/Ā>N]qsɴCJ&dDt5Ē##us@vW'!"E?8cЊ,#$3G\h𭝸ѤYpz]nY)Ɲh &m ǭqع* zWkEV`FW4GVry /8%x%Us Y,C0s]݇ٴX K]2{J%TeaEfnˑ[M}unLpz>XGq@)\Nxu)VmʑgI֢& ? (RTq(ZeO@20*`V,VOΰ\?iZ]'%Ξ ʵ]ѭLwR((#ͻڤea:V oZm}b^+!?hu{8{Vo594o P1ʂ@|/u.A\z,|6,lye2n< "usJH$rA$j4]˸KxiOq"DރT+9@|Ԥ@;WŨqU5pcT\s@EFJd}dդ*uO+ӣ-"sv1ewY&@Ƌ=>_ -FҽnbU6X֍rJP%( )JHF0s'k82qYL~\Ὡcz:q#cǭTC9Kr6U9nr}Isqkc,s"8'5OrsӃ]۲۞$xذJ1iѐvWHnq'nj/y6 z7 6f#:Y +|xG"8sPѹ#Vsph%E4Cz԰kEuP$*` l~ϵQEښ } h2MK!oqO_j$mo14Q@HT<XE_`q4I׮f]'sVȓr0z\:} ^Ygs>^٦"DV(w13@>rt[]50[9YZ6'b㜟ԥqy}%Öc\uoffCJ{3=hO3QKIJ(]! ;Pñ~~]Jѵ-HwH73J;2 Z"lAF͞>OHl 3@סY s\&uTz E,.| *0=ThXS򝤃lT(q65R[ׄKnY~e_ʰ-2+6U N%r$i8a*M[Eh".kW,_+b=^iY` C @ēVvN*iN#@<~P}-%8 P+}u+X;pzÝ4OxϞP5urq->f֒9KibeN:~sK\rjݴt+&y# { z|A|6bI.0YI*nlzl-IOB~qL$5i. @ er01U%~Uj-~ \ 3B{#2T38;cx͠pH@}jcYUdN*$Zs@x?̺ɮ Zw6Xr m65PiwQ~{MSVbB1E,JP5[Pn{Jx"N׫i0Q=;טx6Cj}^C)E$c>ѭ"d cޞH]PX/j- @s! B}FHI6q$Sҳg͂|JO$JvfYjƃ:s\k{$s.GN]{uȠ" jSDD 3Ϩ ޶:QMxh ֮(sީz~P1ylw;^GI ,j3k, 3&:خ'x^>*?mN7<>(ܷSy5nh!gu<ǏS]-ᭃ4{/To53q:G^O9lwsIk[+c'=|K }Zb=kZ:)?k)4L4jkicJ;Q*!%c@hi2+?j鋗A>hLsdu4b$S'@X帠ɭ":w Jdv1G$=x v`f.3hXx~QȦBMnlަGN} bj]4ŸA(Η%qZ÷9GՅG-v7/4j\^*֦) YRLNM,vY8duQ@{s 74,$z`w-)t u:}BƱ5[eLg@\L=+y k#gr&X+(QNQ@ IKLP(Eg҃P5i:rEg5tv*PIg( =Ei7)u͸F`=kXI((a Rl4Q@ ڊ(CDdo ' c A *8336139-374962-5325tnClick to view original fileREWͧ u! YFWͧ uJFIFC    $.' ",#(7),01444'9=82<.342C  2!!22222222222222222222222222222222222222222222222222" }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?z))hR|ckr?$2+=Nh5}( 91{%"EPFJL'@``"&6!JVC!Y²C#kg![jhU󸑊ź%%Aǹ[O0? $.>&NWzki(h~"PW!W>A MF툘F=cԷx˹&?wF]J Aqfh0isM4QERJQ@TJAqf;dzmAPisAor%'^C,=~=ɤ@g?,yP[Nv`P*y; # oXA*@\HԱg`Ah@q@ad,Tv/մQT$\N}g9{ Y˃Z/@fY"lǥ:K˂1u痃cHϥgQJ qҒ iKE%Q@())2€6ImKO:I8F'դӭT{SXam^_>~-HLJ  >֭ ,cVmcZ@ 2ACVΟFn.[#8[|ۃ?Mc[(Ĭ<<2#+^IN_Q9nU;TiWVNHB# 1<+(YġҀ"/,AH>L:ހzQERJ(v zUG5r?:I,!V,HKX="Y~T1WIkm&,Z_l[*~jq~p በddҶ4+ѧF'FO5een7VϮ( ,`+{סjSqZHt Qʏʷ/b0+[>G ۈtJA[>'лǜy\z (6doª0[WPҲ&r(*iRQE-(iE8V9LfXɮOgFF.GҺ{&w#' H-C>յl1񪖖c,OPZXE`rV0qLM4@5w2mcַ08Ӭv=+Z "c:5v˞3ْKg#5RA:V^(Q֭n z"P#S2qP\noL y$b2ѤV UVT-ҙsc3PIB YUasڳWƶ.b嗑\!CQ!7(@W3pِCNjC4L=iƚzE%*H 9Mba.1]%@,ϡ8d{R$AtȐ04whi`׊5x2+ cUU[P-rdڱ/!!cIk*3tH%{b8JS1 {F8]rL °5+2ņA+ @/zn'v`·5XDHW1s2ee -BAZ&˺B+?4zӍ4(ii)E-(ӅZkkӤ W$`zN(FҢ ^ Evv~hPb_}?U`#t#:v9pi8 OPw[0"5 B1 ˀ28(ỊzR,r+Wo#8^ eGn8nˈp皍N겅uÆcSbPh&g!=*RsMM-!h(Z)--- W,. °ýsɽ,d7dxgPsg%+pƒ ozZCڊNPEQ@ *{f(Ez/Էu p DrHfh\>uc /٘XƊ(!n0&ފ(Ϻ( ~f<2}ETכ3阢ShE%Q@Dd ( c A *8336139-374962-5326tnClick to view original fileR/'^R`ULiF/'^R`UJFIFC    $.' ",#(7),01444'9=82<.342C  2!!22222222222222222222222222222222222222222222222222" }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?KH)h>BivRPQKF(f(Sj_MT$Mr2 u RaqYb-U}+# $r"j>UOG鑊)\5Fd kEcMg ֛Rx*EFS`wsVҥgGg)L p9=+gXדY36mqE#y7B mj(- ' J5:JpAh+N-=QAa*[35r+nV£}T; m6zsCbaẑ7W$k.Xy7.XmbxOq޺+J.l|sUygiʣ n9Lr uWprA e̴ϲCL550fpAh:3%9 Q"$Hہֵ-UTɭ;d25M]դ ed\+H<:[0mtEL֦KPO={Lr? 4 1ي ֳ"Ӄvs"Pvpʥr>Z< p9QAY>#kd\ ڀ8ytF$ Ҩ\XC Uڄ\8FLDW;uWup[VۖQze>`-Uģa#֫P  w*\kZ&+s\$@3vS>#|; [\ ۛگůG}y!;NRi2@gٔt67ܪ3!O5we>@=h-&D^UKss7W]9}\s@uQ-&p@T^?3J[k~K%,kgĽ3Ҁ$׮l1e_ˏzoGmfZI3@.DJN+.{ ՌHp1'hF;MFhx\UjO#$z2;@^2:WU*hsޡp+tj:(iHSq@c񌚹 MC:'ZkYm @%َ⹯SӼ@$+`jʺd2uM-,.IV..K d]=ռl!F +گiD $=AhF1}+qkvo,b>}k͕FhZa]ܰ"..2kо` Pvx'4ȤN_1b3QP- !g `Xe" gFae}Em=tOk4Z&@lu-LsD;{fK(km/Oww)d@I\NI\ z:V)N_]F" _ZON={jі+^y 𒋔 N$oC@{)^H[Ꙡ \5 ;9\Sh- O+ 17ܪ!OSU{]N 8ϥlE +1ښ- E r_ ҟ c ɠɒ }N+nEG`@KWC]2}H@UPyyq*lŜ*znf V. v;姺YnhOt+m/d9b.7Ƹ\^]oYo}Mhga.oK[[%=XMv4ihznY)p=k 9_/Q]:Io5jynuK&u%i9 a.'k S_sX,ۺf!lleVw Ï+VNZc1u(Uً(c+~\ 9˃󚂤棠jªX:=ty<I h޺a Eq-MBd`f7PN Ss*SR, ի{B3FG4pSRHjj(22MhP/U\ 9Às@] eݾZi:Y7Mcj.Juyt߅yֻh'I&!cTThފ(kkLԌ8R4\ {@H#u=h-Zj%9:fZV1Q@wQE5o CyRX( a_Eq棷+޼T3Q@QE%-PDd ) c A*8336139-374962-5327tnClick to view original file RŎ%ߦ@zFŎ%ߦJFIFC    $.' ",#(7),01444'9=82<.342C  2!!22222222222222222222222222222222222222222222222222" }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?߃z5N0Xg8>tkxe]`?y"&yU_nyj@Shi0 Ԝ}g Vՙf{VX8sր@ 5~ьUI#;s]["m@7Uqޢ?4.r*M#TrMb6(#0{cMz@<dphYyyRN*Y88$Hh2=2+5Dsڶn 2*!P<RIoU 5w~3f&~Uq"EPi]39cJ}멷q p1V@9c3Hv:$68^9<;X kKB)aji@}@+(Py51S˂Iz⫏0ߚɰr*$_dWb۵]d\Lwlnd+G!W6v f\T^FT djq\4@@5i: “plJt岖Tdd0?giR8eݦAtBct&5ceNFYNzf4c]U=kfU1kz;@U Z#.i $w=+R?Pٌ|VF*2aSձҀ9GbPFgW/4ĺVxW}`pW<%Nzg5NG2[X>M:8C0bl[rz } P 26-;Xd "@=@@O3'(0=柧P]2>,C8&URDNya[wHtnYWh%\Ƴdi֖qcVnG6=eN$P "㎦FOAۙ[g^iDcin F$\wxmɽ-oFO$weim[|` vNYpeƐc%P :H2.讦k(n \ 6ruPenjӷFAɨkq" ez# #Xv|ux nOθҜIh\*lVqX^icۆRA"Ak/]<0O'ހ1I 1ֶvFy@CLՁi֖Z@F( iV#֖I 3VlHUcJcs@6zGxkT*6&ϴ mrzXr/ٺB<ڬj؟֤ർy<UܳSZ㝵[`W5%ժmEn@'܁N e]@2&!(څElZ<ȀEV@=89략olQ'2hf^ #kN r䌂qM$}h’/!t:r^r'X-==+Ӵ3@ͷ<"9i"ag;q@ՙN `8no'rX07qTmb!\19Ҁ;;~. zs& ޘN;~k6׿zV`1Oo$Q@ڌsTȆ[r$0ñx'u@c(=}h899=vinM04!Fzeo@Z[WG<6»BA4a8V!c{&pea)-ֆj^9䫱`}"R@,/5Nf(㊀0b@5ώw9WdG]m@6q)Ӟ,g횎H5`bx$ux%'8 Y>pA>Nq3S2%jukw ~&"3,U'o^{ug1]"l^{I$1Żf8]VB;4Pg!G`2y:& I0.q]nAVWm]IAӹp>ܐZѕA05j>|J&#~4\ۋ?^3޹ ZU?vp>$*yG\޵J;9{j %cOF A:C*{ $UUoܧ< fVݏj&_VbZu1@\҉2}}b!s5tBcj(-*>_KrU,P?>j^4@ 2y$ \>"+FkkPQzAX n@ed`qL@1ҊoH/AXInؠL)$ =5" 20OOA^{᫴Ӯ@:1[i&gO%NjҊɹE~A==pθ޳cvt).'lA_I#lKSߨ JiB1V"նr,?<ںR1wp(үZ`93^nXsQG"ڈoRE~j:1Vua2GQڹVber36 1>hJՔ3c^.yPU nTtXPkg"#E ^omȣ$]&{$sdd_ӦCV,.;E1ƞ9;%@;a*9iaӡ6h8>`_+ 'ǒU\ G zILe{`K A䉵rIkbBp k`O~8׭uW_1gݱ`G5\4#w7 @XrV |fpk<;ms~Sc h㑏Ǐz)$`|V' zgxE.#F7 2rWPsHٕ!XZֿ}[eZ_F{gVO>b~Q>ZK pMU$ɠ ϔV}R$cQE . ( ?xt$@#RTMPIPդV!4Q@ +&np(x6M@QEiiI5˃Gga3H\Վw]NjTH PWv -rZ=ԍ8c(wDd*dd * c A*8336139-374962-5328tnClick to view original file!RylA*7xE lUFMlA*7xE lJFIFC    $.' ",#(7),01444'9=82<.342C  2!!22222222222222222222222222222222222222222222222222" }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?{-Q]mmG ͡VfTWe;5UnI5_E.Hd^i!/e퐜X/HkiQW}k|15ms^ VMw4-ݤw! m"FĿ*+K$`M>x%M E!\azWVq1`1gpY|y2Ԓ$;gpQ'YaVQ Y([ S I3* y6VXsЎ1@j!7b&hfI6dgG @"]>]Q@tQ֊*S)PWv(ϵQPK1]a<})rsҀ0R;+z:i4Pj1=qZQT!d]ZA8Ƞ @槹KvI9=kfB&wgm8 ZkwF=Y$P.5wpAwMgłh״i.d|åv+'I9QWx/!w^5O"6,֬6ԊԼĠ]ˑ?{&Wnoh6ı'&1 Ph64U$]Qp UO 5l} ZupH@0MXӵO2pzWY.-Հ#)K6y^GsmphT SI:>8 ɻ^P6 c_&Nӊν՚Xf9bdWv]6K c4T2 g!F)PI湘 æynIp9f(-U"_ܙ6oPvVAs޺4)DyHyW9iq[~,9?bUyZ74'pl-'`ͅf8WFu%34ʻL>€:2EӢ؉8r4aF̏ι}#Tk)#S]~\]YYp 塍"-cCR]$$48RSj h峚 Hߢ+o IoV}.C`d 8CKKczNxCO8A& {~y+$-w %ePea9\f9.FkkP $,Q[z@b´'^{ ͈|Վ23@Q@bcGkGm*VU;@Z@ M Z:KB=ɭxn꺓hINV"ŕOPxH] Srgb4_Hʣ5Y4VA(9-,4* >Pޕz˘E}(uuuX@wH+/Qm+)$cֵG$WV5H3@.uA 5ᘫ"* ڔ+`BԃYV'Tx^G.", K.;ǮyR±\ ջb)A` &1'$$ PV.&}d!u$x qrB⪬jYX)M~5my`pyҹlrF \2}t6@9f̒K(9. x5q2y $VLjqǚwE Q@֧VUu@qҳW PH?]sQF, 0;NHI<(7R1:fAcx& 4 r?Ҁ9@)'8]1Cp$*+NY%nz'kJ&M6zV 6ƠgtROȱ+6w`*:~պqn]Ý@?Z-t觱#9=;5E(ahbG,z$NѩZ[J{]m{=#}VdI42Hb\s`+R{$Pc8'#[VgUT䞕qچ^8gž ށҐ(QH9h_zu1NGJx<v+ 5i1$s@pOk.dV`c>뉷]޺m+} _tğľ#n| *T|eyS.$7+ɲA\!'&h!nIS4GY88yJҫm'۱dDܤ֯]Ew3O\E$GڍNZH>a5%({Tuq4 <֖pQSWmׁvVw[";PXLg5M!rJnӻ|O{[\Fp; c%CzͻWGy.T=hf}zZҙ_zs|~HnIx<4J⭴ҹ>s>CZiz6@%5V"P\uVY˾x@΀7ү ր&yt>VI$*$nncY1WBcY-b HmS<-rTkwKpRU":QPnV9ہR^H#5N93YN0i[jTw7ڀ "4_)jIłlڝ<9ch\̏ o__gx+=yw$OsJN9j7ϞH(^Lb 0|§ڹ:?6U5ZZs@DyOL.Gj^>W皭w#`~Ui2>Xv' {vHNhYJ* XshbRI?q`gZ-e-WhnKX/- eݽeYX`: . 2@`F~j)a6٬2-\ KdnhFa,o^Q_+?cnw# m&Z9Kh1M_e ¸jm w:׸XczsXԗfj v4h&jXTUn5GعU0yt#__zZ{xceN՝ۋkFd;2 iٚ9Owgw 1B}*h,JS-Ć~AU9Ϩ3VDg#ǽHhI=+{KɌZܒO* DoK&yTldO=T'L]+(FjY$PX WMa%pnޔJ{vS7R[}s1q`%z\Z4EsZƁ#[,*2=ꎩEAXb-xI]{?ZiiҦ+ <+knҀ1ygEkq&L1I'&;OŚuhmy9ֲ,q zpNr=j)}Ú;4@ Pb=%K9]ׂ hT9}R]>F2vAOC(U"#?˸;:dCeڻd5Z4ev': si۴h@F#<%,6W;̣RO2L~OuJ6{TPaq=l0[Y^bg<ڴ--09P3@WKf,;Gn~ cۻԚ>8ty, OZ;kvbGМּG"DV3TeT ?xz濆?1rƹS}*_(,ExcѸe$;PE%!QJ_Mc6d(I#ҨӔuzP\Hf@:ך&b[V=;F3z{<1kniPŨڵʪݸ&ӮX$(0=Sڍ*ot+Ę經Lt2"F& e=&_CǵP#sʈ`|1IG#o$Fn @Yc ~g@qϡ?Gi5qknW@SȺ1*)sF/mgkk+Uj"T'hi{\mu!A*pEfAq4LStt`:5+ $݌qQΒ4 #}c>ԷoVH`*tʴilbI6à :γmSJV3yr)؃ȫpژceL4YINq\4lZRɮ ?fLF4 9x5ٷ^mR- bS^IHR+}kO[V&O(jg(XY`U [Hnu E_zY!C.%C6NG5 0b8٠M 'k,Tbu U Eq幗H({>bsҀ1'"UxjZCm7~GެS*F6''-dUwRbKrf%H?trH7(ܼPm0(!T*)$vDz{z QM?.N?*bDDZGifd@ u>fqGK@*E;UQIX 7!-@T =kj$qҼP3.(mWUmuO W#3մ|.mS=eZ yNwss]\[D, ROր74(O`+<z{nC]6+eKPws^saIlB=qڀ8r=i14*zzU?P]5J4!=<sM@38Aҥ1]HǍ_4yXwrK!U(rXO5=d c[+"qnVtn\bq@ 6T*!֧Eu~p/?ҺGu}xi:?5+R_gt5jJҶrh@sQyc7 &H0crszs׊B(s` n'VڋP}CQMK1bFMaMc!3[+:_^Dsf̹MPN˖U;)HC{֓DY("ks5Kjr:wk@dh@va+˦+ɊGjrMENiƛ h5zJ zd r{מo:8IH4-UsEUHvʾ} ZEikoDyn/ +0 Dm|ϱǑs8 ̈>f 5VR=@a5 ϚvYZ]"YM"rqK4̄@ӭHdm*ޣoYKx$u:%Z{Y[r]bbG$8Rd\.s(,8T%@mzn<&]mg3+u SjFȠ9(ӦQҊps@8t2Ck0X-"ѰZ.4ߝGF9Lw j10ӣ)R~&_2uMFh>K떟{9v?Q=C^0٩sNTJ>f2*7ɭ7Fk24c'ҭi#9sJc5kaG5"[!aGA@ <%qj('TU'9V9o^<1s%(v;Ԃ9Vx&(0S8":6)!B.~Q@PWlQEN]Q@ *EgLʲg()K)ӣF PlD1iSE,1;riX׊( bsE0A+g8p*[ءSk&w6#1@-Euj% ]kb0:̶dhēm_.72H75s2d0D,\|j40Y>[a+#NWT|Q[i\j:Ƨ p9kطWx#=VCI.#kdҳϏLnc,yiC5ċ^M$$z{PZܘnd<F{8 Jyi!:bVSk6`J ө6a e.tpIm݈䌘 ˾b\qPђNZ$ w5ITϧ5,eۏJF70}_vF Q$簭tMČީF\@Q6V˨l Ofc9gTbSҀ5gW\gJ͕4O5 n~i S {"Úc Em䃵cyEW]/^*jGX& @ⵤe]c mj.h7PL@9Y 9iLj}(jwR]hl Nh)cLd4UJÊޮȕVN( QN[UGjZ<vSGSBT'͓Ҁ$UJNKPp>ܤg{pKlg :PF RcRqܚZ,[OֵdGj1sҚc㚽rFIhT c4HȣA Lr0j(ɣθ$ *_!hB̉φ3H '6IX8U >.bE2=2:ֱ7(=:9Jrm,f;ufayLAO]&ڿv9sߵmZ| VD,dgn޵5'͸NsVnnfR4B4pLԭ#("EI,';QTB'0֮|n=*̪8 @EĜbH@ͫ iמhUel sUS,i6 ZXw5YU{@#AScj=`3PҀoF]Lp*޵Z,qsPu  RYs;֍֤ʶ#p$&븊Gґ]Q 2kz&f "_Z͙1b;8@ H9Fry*cJOBJ W(`< D Flj1$;bL($I SwCEzhvZmHi$ǖ>nq[sq @&9&镥Tc=!Vf<-{N4r}g>Rn ;qk&C уY|Xz[h:ݪᶍ$w =L _+JFs=}jX- 2'=bKA amX3w4RZ닉W5le`c9h˅ g$^zV.&mnFʡ7b)N_nk>V{(^{w!qסuo1 s@ n,Ǡ9*KyH8leg9򓃴zդ#qtM,c)^O0bMtIBYbn@ qU>jV#c}hQcrwnfrO+h =%REI@B 9Ȯ!-|Y#lEy턥@BH:[ufZBT\c>}A$Ĭ.èREr-l*3N+aJ]Ñ@Ion Aw c֭ 6=ꔹo(ɸcZb'AT EX,t,s3sʀ+M,z k5=긐qK% ],dR 8WLO(TSPUյTo/ⰵ.c#̏ ҺIeV>5jW ?P)Dw ei%bƲn#q84Wx-ɲ].C `Xƌ ?Jy $@5͸pֶ`k|+uy&44߶G3UǽFҀ8I# rA;uPpLsهQY3hҠ-h{tHVzh$$lQT%@bXHbOiFmAa1@ՏyǑ@ j5 h5mYw|ֱ<#@?`O1f5km2'ֳl@ Pd@YxROO`q'V\UL+w?P::pkPECEm[I ʚYxU`sEu4xJKϱ~K@Kn#( mZlSGz Նdֶ4GZ6zn}kK%zd$`"Y4`+.82O-nzUyf߅9VM<3YtO z6{4Dn+ I X;}ji[]4vtz:Kl1ujF$v[e S +5}k }z_+@Ƀc`vֵŧ:UҝNR<ңh@C.Bq >XƦ q ZlSv [8w0TqֲMQBZb&ch{a#̐zfmcQ2PqsThHٕx>:_WwVT.o (p:T,DWy֟#3E۩'Int뒹fPqMq{jh ֮aX~4j`v 0)= r9[qm3nM k:xl~\d ˖UaSUBOz aG=EcCbonk QZ۸„tZqMFSdQ@ UE[?0u:d\KZO2\EsP*ֶd $4$1֪E 7JhP>SWR5vzʊt=Rw,M{&jq-~ըlk}|mߴ9iWK$ nK\I*Z4ESibkkGC!,_:R?ÚlM`APHKGQOv)OZoZ 8#ڹ'֭Q|PUڅYvҹhGCcں^ 'n-di kbQr7K+C#+LJQJ3(S `欢,Y72G'o);#sڹeo!GJ-,tGu<mH Ϋh+2.xlS` Ak!*GJ먊F WEzׄd-5ׇ,TmTBA_J-4҆q$H`il}n:VI&L .G9 ֑Ϻ:תx,)hl| )8ɾDoJ)VSa@KbTj 8'@wjs5FdcN*&6xSsz5X]9aW90h(qy#;I+ZrjOYgFRA"{' 5p685Faǥjyr{,QNxb^s,Om5_3rݸ*X#2; ̄9UHjwp] U aNOn_KUYfnk sDSIoq nj,ʼn ##l%,Cr ok)l?v%Q1xc pX.3ړsV.Iؐ3ޫN(ђ8ZV\|Kϵt:UK"(@vjb4p]`#¨LcpB3@<{+ҷC< Ms`.vUć4U; (dݳQ[n1[mڀ7c@kA 0>lGJܵ"ckB8Terr@]ms>^sZD6M:Zp&km< zNjDGJaDT֛wG+Gzƀ!͝4|g5_[k捣VGoUPIy<ޓ|~]4%% @ :UK+b &ܹ4J+Q y>84_I}20V=u'v@jRNOq[S)mr0(fؠZH⧼rfO€2n?h8\.fb65ĀeP pq1Qv1ph6];a IWҺ[VxJq]>x 5[J  촵@ EdQ|ҖC+  2I@{w]ZB\ cڀ!m]"{ 9((4m\B W7>|fN: guB#w65 B3Z؞PZcVL[As[jz@CqMk遑{U하H;pׄ5%"K@uM5 hW-MHSKn,v@ E#0^E7p7quQ@y զ ̹+ &_&C9YXnG}^J[.EGpA%`[328*#s8{I9z ؿҡݭn~+=󉤴<.AB@Ea,8f_Z/,; ^@ntVFف^PN[ǻ?J҆΄?8lA(-k>̜j>(,@MVeMwJ`*W@Y?$nN5!hH('"VY ֊ԟJIgα'Z,ج-f%{)+n}7kSU/4=뙼@02EUL:֭nq\K+cO&=ߎ[} yg/Rz:]oQʀ/iS\5 kVꭊ «.S+LdO%~Vv4=PCU:Q5ʴS)Av ~5?Zc%8j m?mL{Tq( Ě#v*ܺ{G5^~j~͚L[uv׆y$9oz |4cȌRIgX\W= L=؎mݫ5Ar9}>YrlBb4Wg4Sr }(Fbe!vutp03]X4Q@%2Dvjp `{E1Q E~-G^P%~P7-C%Q@^Gv Q@v2EKH}NR#\Ed߉R=(9}Rc$Q@ I#4QE^DdKg// . c A*8336139-374962-5332tnClick to view original file%R`C4̴ e5eI=<PF4C4̴ e5eI=JFIFC    $.' ",#(7),01444'9=82<.342C  2!!22222222222222222222222222222222222222222222222222" }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?4CtlZRzY^mzA,XW_c:F[RO֯,ˎ+9$h`J 885A%NI ;)sUM¨7Z/Uy>dd/pCβ[P4h3ҫ|Ak$/\mnyv 2" PdֲXazu:ȿ)4JH=jp$Kf9\k֢Pb*#^>Ur3WFzPޙxvks\>+bnj۹&y1ךGZT`bX_l=cy7Ӟ~xb8bX@7njkȢ!s]Kq֨je &w 36qR2k]ԭ!Xk(FbnyWqGx4FV +[f98/(QҀ/]HЪ 6Io9[DG}&rA PǑYB&m /P*8`2Er1XQ x+ީK$qӛ]E+f+fMtq5f+zKf۸A7RRy5f \ҲVh*ay6G*Mm8^D. ⠚(7r; &&CtY$ n4cg c#W/-vL#h\zͼ FufZyUG{}k4R2̓R稩㻌#cEo>1MXiAȨR: F}1QH9. +KYN p#&4CMrpĞ3ph>گ]IYs@_ɬ5eok"GCYܺT~|OjRPx@+ոe ySؠ 0Q?j5Fҟ@~!p54s(<@Ze͂#VlIc5os('ڶD,zL[J\sdb |ı'Mҳ <%̓Ҳb+}#Ym' qQNkF9YHcQ@i5ed8 @枏Q'|TY6)™N*rjjE8@clqY0, 6 185Iw9Hdʼn8+jG$ncJl4i &*ϛ8i51|dVI?֫iݑH=j G"Om9dʟΖ|&dlF5ŭykkmS3|€:ǃLsU`D2SE0 >8$H(k(:1.4Mw1Q~<>&y(aӳ˩1@T@ˎsXVy8U3EukEȂq^^ A UxVA HfҀOl2< "^h?ªAoA|!B(sC]4O}}41I@_`<9qoKOʺ+ki@q@xcZ*c'Ey9Z85e(_zYsާBOJw1{1n@([-̢"i 3TM Ӗ;NHűvps0H ߶M@yWR?h M Uk﷟δV-8 ¸+#YF+C[}Y@ۍr6z U\\Mm#e8|7;eEQ\91GBhym &C9sZdmbjj^@ҹQ[xFE'#ju0, vq\ .9aڌ d$Pzr yRɎحk+z="̣\.N2yHGw팇W7~z'L'n簬r,l'Jn'(t5 quЍ@[o<ᶠVmpr}+&dbB "/d7OiӼ"۰( Iyf$K&1@x'PSƷ$)-~ߍ2O"Dž;N?vAGz;jw !Sju) O=J[B m_Θ$D"{5Bb$x '@K~Jb08`+2 P+YYfOG&ݼ9RW0ēed@~C˵F)5mmb(SmU+Gm >i?CdOaZ,$EPʴcV]]=:Eb@"-H9\}*!^¤aGRG6 1h qW4~DLcN z@xT<;g~dQ4W~3oz]Xmۇp?:bMsXL@X̐ʱnGijA+m(9=!H66 =kF["iJ=F)tRO=FISɘ?@'v?{ڣy-br`1Wt6S=k5H @v巒A, Z;n +[#u8%lqZv nϵtPRґ;Ejpd+weOr+T8׭j1J:4rg O\*ɮ_Gԯ)f잲H PP\}A6F*r(;i.vW++q":8koM[YEտC`0r m֮~$LMeu.fe ֯DMhikSq]ְu 9qZP ڪ١dX+.qVA'O`kR#ݽD+(>]O/7;NP|ߏGctȴ+}jO1!>R]*8\UVo4N3LN@P$cƝnwzTFA `s\o.0*ӓR7,5~+$fh3XLdg/Q4ycy/-B^m^=KoQYHj͑Nk"Eŭk?*wQ\b #&Š(@ɬѱ2s@v1QWS5 mWcC\{6p>hur]!l$Upst'fel2xzӑ'IJݠ ө'wSŢ?Ѡ֊)v?^OVB>utV0JɊ cr&Gm+&ڬ& ͊U2}={ɽ=V{Šn',w|gΊp@YsS`:8q@%G`3VL"GjH瑚*t#KLEYH/hjuAP?A]Dh/>$z!mzU !}}赍fcq96< #@:^`:`0O@e;k^ǵC'1wpG,K&o&( *%@n oN21} t2됳rǕ JyVC0 &tl?Ί7 G}P1NX*Ȁw 8`zRq7sʚ΂ܻ# WnՈcq' H*'k^Hr:V{p(0I X:|Xq%8QG@ .R8E!|'WvCG!P܀TdP)6'$u;OOά<΍ u#*܃vCU 8e c=v}hfNUp*u"'jE]7 ^\q[$@R$V˅")H䍦 3R,ؤ#T$Tx;Kނec?*`H*++2GV'a8iא?Ó4a=*8~U#rpFjeȠ vkQb-ՃtNLjHrqڲ')$GҲnd(&SR2CuSo)6b(-]ߝPsf>]IRFypZ-VP(Tv8+H%TvpirPv@UD#u/Uht>'Z߂yVhoTϮ(2:1Yڅ2 V3ީ^BB峟J&M.,0+N$0+6D$;`+~UZKN,nhyUXFFFk95pP iGzϸ >[#Ԋ48kNEEV:)PH|!sk!wA谆`[kQ յqZBU[P1Z =mu(tiitʓґ SM?O7:gtctSCDcgyu#LPW{S W+3$f$GjԋNUX(X!& 8ۃS(=hbY@>b$qU/GjWhA#ڀ0'=9D'ҷ=جʰ\U~Vk*0+gB)fcRkĚ%Q>FrUAbG(?-ZWl J~y 77ZmMvv3U m@:sI6OpzM&[ *"> +0\*(Sb =+O&*?$wqgw HQOr*RGJc 0 [的\VLjQXsGӊa#Oq@2["p*($ ذ Ayb8$qֹm0=B>3n}y֋VA' ŁT !'sjK(qJ|[zVj=D+3o I\MD,EbnJ0y]YH5}>"@857PqVAއxTFF!OZdQn󐣵s*[+RKkFO{PZ|#ߧZrBaD޵jj4T~X3prjhͼd}-%sTlX0>S@:vH蠶ci1\eN;Q1!Ǡk9QLKV6 nTI|=kq skb8QS*kChr5gp*B楀 @1#;aSb1h59ǵG*U9┠*N( @Lh:ʴ]^>€2U&0pɭ 7M R"^>fA]Z܌VNd\(ola|R oʻmCOٸ)@nede+DrGZ'q2u^CEtzP8l`(p1J,p*XNu"`Hi&"C.;UZ4= \Ԫ@L0)MM  hfmj'=@]jⵊY) 8 .9EV'#9]VGC@ sQHr=ߍ WD0ߚ& 9ʊp⫂F*O3 @/"Ro :5$GJLPQ6O15V* <[+ 952_fF9hq޴l!JUf!@ `H]2\_JM6uz.vd#8XI}kp֜2/%~Ym=)$j9_0ҤޑD`?Bק#ڀ'2Zn5QriLFZeigVcm@v}MZlwO`j #tK.H>(5wcax7Zg,vz֯ArIx gJz5֗ղz>Cأw裩-G gjjrO{Pp1zccxvOznA>N}b}MU ֣iҀ.$uT7EenN:dDrϒi\dJS.B6csC@KTOqRp֡7@QͶE8.9犥Z<__[I+ȝM.h݁O?MzH HVFVΙ{U_-ЎUYy=.yIހ[ Z@O|Rf5,.)T^k*s^:Tf\V"e[5+5f0755P˸7 {qRyo^k:˒٦>܊ۖ$3ªu@'5ˮ.ēHXyh[0${Tڐܜ+DZ5]]`5S[ cݽ5F!Z#v-MX]C ~`rhz;g3U. QLڰ UI?7@ O1cx9g@HY1*i֙PIS YK܀9!OQ@'?&SmuP/c[6 Q@rTzd:QE[:N77czu z( wZsןZ5g$Bx*ݵel̬[@3޳4 \!;WX!P9޴b')Bۗzm83ր e۝+JJy#X z#7c\f[Ā籠5O7`ڴ-nFTiAF(,+s֘Ӥs[6bmCЕ f9DڭEN*ape#|H9{B0+N+%aC@v]w%wltdu=S>ŷpy #ִbfdˆڵbC'nZHEPl*dA{G&rzVjWfA#a&9R簫&6TcҢ(oqjrG](h¿qRI"'(y+R`UO [MtG ?Dxt65rQmE^Fi5qZtJ듟oJvRPɑ[U R [:`fsRAv9Q~u\Gm=#%I#jMOyF[^G^6b.j]T+bsJ".~AЊc6"ˆ4 թ 1Km;⧁NzӖ ?E) <$YP)Ow!OQ@H滿/ =Z ?zˀ=S×xGk{]C(`r">ZCkBŠ̈hBpEX:SG>1Ua,UUrǥ6zrGִr#\M ѾL}}j?6ﺡ{ PyysAqsˈOz_5ZlQ.ry4-IcF>KdTI=kF968 dB  7 1H}z@@gi`=*cff Zhj@'vs@33qɨ`E5z ${z@AX uGV+;B[u 0֍| h˒+.. ѷRZطaɭ(.}+9®yZX$N*vdژMY^FXڀmY.c#oZsTJ*zQH$Isǒ%AD_+4{o58S7DOեy;#J TyJ1;[f$8E>Y!c&@!7]@Wp+fyn'z*z[~Ӗks ʡ=wnI}+v|$b,ERAHVm*>(صk>#$(HABx^+RӈbTw~K.A~-HI }@WvB=f<@+kO|Yy#?6>>$1xC#o'Oՙ\mNHON~9GiP>xPn8qvt2w9]AVSa$69ɩV?6y f.Tm"=)6:Y-jn3wLMg fE 8'n\l y7F #"-Udh 2մ lSsV}R<@8;lς}0ؿ(h'&8W'g T?h>qA`@@5~<;6dmvsImף1?<rlzqZj1D.O>CuhI`QT\ жAx zU|NY(P*@^ PѐaUUFjae bAwlBG<`L3Cݿ.:yl/6cl;lTK/ ' )sfSU{{Go*K> y] 0F`O;WG m l `$&=hjA#YaS1ƣ(- R8tn1֠WL& ,)ʦ Z`%ebFkqdecQ\I`2HjW{R:&E Q/ 7֬n6 &|y/} >X4Q@z"$eڏWr2=_%JW^ԩh%[`OJ#TP|}h/NRNvprh#6$z%p.Q@@ކAQEA \m<Ϟ;PlpV H1EdDdNDD 2 c A*8336139-374962-5336tnClick to view original file)Rf_X%WU;.IBM-F:_X%WU;.IJFIFC    $.' ",#(7),01444'9=82<.342C  2!!22222222222222222222222222222222222222222222222222" }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?Zp'4Q@'͚zgr@Z g#U. 3Ҁ:hytIT22;#)z)ݜPZ=(՘8 YsTXȉ\`V|?iYFrMr>cG=(Ӧ, 6:+S%Gi]A .OpXYFve(w7NVPw@-US#Z1'p^y5G PUHVגOYWrJ=삸=?Vqō _ZY>!JٷcvrPI~%Nkkv p:/ֱ5_W14qSTsƸr$4xcIgM^ n=(}EH$Ek<tQhI׊V\NdHqײ˒qO ԧ2[[,Iv9}+bdqNrxh'+":?=XAHnn+uv~f9'րź1$Q`Dd ހ/0ŶNjc[Ug`dc(h@̬zkJe%P84ؠX>f [/֣H%s?]i'jڵ,|+j1DstyL02ҜeM@P\nA / Ex)qAJg橵]H9@(){ъZQRF*X4b>*QQ IGA:n;8] 7ֻt$@|Owgh&3:eGNխ$8`?S޳mІS+ s@J2pz֙d$XЧ's}MOiV\9ῥl[itT ,t\Em >Q-2(r*ukfs[ZbO221@1l7oANynOQ@,B*Pyxn9r2XZZkټH< p(zչ-FrS= Њmh;-J=..fmϮu C f&}[WSˤk% :њXcxDfU I] ¨@t*Zn4ˍU[ԏz+Pg˻9JE٠ZdJyY;Aְ_n]ͤ`}hIl,;3Tbc`0jU m$kC@2!—ިѰ@c, ͹=0*=U.q@$rzcP) GOIGaOUV7 <ܴENT[SZ/ٙb,'tמXq+é6т(4 6;=#P7均j"+ݴVbA(]KJ@WFha(3y!7 P{c1r5Ħ њB'o8T;1ҳueޒyxi`u==>F%o0֣LAI/yjpS@xfHX3kcC{xQtۗ< \[KT)=ž*nII{fQ6^TO;>Ւ YZ.:8P-xVn# ڴ$T>N0kB@)=]21N"*Gj@ Zkjcd, +J H-з\P p0=*k9M)>3xQz؏2ű灁@y0 weFy7n#'Q²#-:@UZFԺlex+/"f 95ԉ*A[Qq=Rh0ۉ8ȠN:Ec=Ey[IAS׎)-: h/4D",{uKl01OH*hTyȠ DC=j{T2Kul),B8ϭTy* ~bp@${V:,jB)e EdjV^rnde0jk!ǒ` mFT]n\`vi&F{:V!V"}[ހ-[vmVj 3<$/iYA h2 v8q98"En2F=+Z>#fKk#}+)a8e^rA*'WQEs:lsb|T +nOֺP9( t +QZl8<aO7y!'VY; ;#4]$I 99nN3 Q޷\gǺ@{!vhM^|*ɿjh+w$9%.[޵lOKrOjaF]5 ,bS>լ$?B;P+N mf TZ.9m*QKtA&I\f\AP0SQP_(?ZfA\֊K(io8)q/5ĐH%,PP$5 Wm'\܋_V [߼p2+H3րw.fVJ$%$F$R=0$I7g҃.Â3kF?,PNv w>јVLN[\qNF2Z)JA{U/XV(Z=9y=jݩ!hr`ߺn'U5 e<[d٠$E"8NG@Pk#S`ztVjsҸYS OZ1 AEd\1EVM򢓌Idn'Jmں7mPFDQDZ95`:Ȥ`e~m}+`XXɾ@܌RJKހ"hNا>EzWD? v;NG{V95[4؜󊰲zS0:r`Ze,xbgی[R8sZKMXrN2OLn8#5NKE!Td \P}CP6 e݋d/Ѡ GEq: ۛYJY[ x'Ml>H9м Tɫj nC@/C⼽uSۦf=oS7@ek"+WU;JWh]ǧ֔z=)6089*A#9B4m"jdSdPų#'҉5vA+y(͊c QyQ =e*-_>o0)$UA㩠 ^_?B'.ZҌƝ7(s@J1ҺIz nLPiu&fH~\޵_Ie<08!%1P)Š(H5iTPc์ pG5j1rP*(Ue[4M,/P8x) ֌S|(ǥFR+|Ɗ(cpsP9sEՆIHi T?Vx0; ( +daC`P::(90 dSh92O_ΆܮQEپDd 3 c A*8336139-374962-5337tnClick to view original file*Rk HfBFk HfJFIFC    $.' ",#(7),01444'9=82<.342C  2!!22222222222222222222222222222222222222222222222222" }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?kP7z׆EPY͸m^z/ŹM_- mbglU*鯀OZ/݌Nހ(5* cJzҞOZW*[Ov8{LkcW_#$4l$kJr}jسa5i4běy9íbE# 3 5hsG{ -fVz=@U T*q*@Q@ "(N?c\W/«G8j-6;Gy>a5 ޸i&-#S@[qǥbǗ)%ϥk@ qVn:-d,ܚQ9a%JesUS/h-2{}͍HVi̇Z hqO]}Ga@ 9#twy4BVZ#?9@mHS¬\$6zVczPomܮpd4,ɝ[I i4 ('2#nQ>EPpX[0F:Phj*+/Qp jb+Rs^{ .K |Ig#d@{H@9O=jCր:8%Z95MZ{ $K)bIcT^7(:teL< {Ⱥ⾋4i@87wdqɯ\Bª; ~1ҘT$QrI 葐Yj%\FA& rJe :sހ6$0Ocҹ~mh'-̹5}ysҦ֝"7JEAz&l1[)9|; q9@N9u¡*y>xC#{_Gjl׺kX)wmFBOP/)j Cjh^b#Pֶ7\?4bEh;]g2&e''U^Gc=V+A\<qًkp@'A8قzVd2lNvTwb2}֝glgOQ߽]XDj3Ҁ0u(wS^yujdZ-r[; siKU{@iw-tjɾӮ'WhF1}+ѭژT9Zǚe@T\ʐGM8Ry.à*YZ!wtlYi`0ibxat-ѿ8_Pr5=Ct{zPe  ܳ 6\S=pXҀ:[n[\}Tq2@Oq㲙;tA C$xMu@=Gjuc8`mV #&qT |Y;rBȮ#[H|"1kw[Q}kR⽲[)P1.afI+^s^i8`EqZؒ[GSWvJNZ99]Jj6W\$=Xs5ZDHA5ēOhWeE91]pXnK#s]TpyC(GcͼEQ"ejd`0sw`` {U23Izؿ s(qқA4dzօ [X}&ەz!N=mZ+}s<[r|zl IUT6/ 種0gf$ayz碙su^ӧnQnn\!W6 .clgsLݷdQF-$0]Dv`θ^Z_48;-ņyQthݎ{Pj'?+yigv#9lۙ @E0W=7E.gahycaݍ+5-Iٙ4NZNzұځANII0=*NtL4JklUeт`NpJt={PLXza Sȫ]o~srn f5yC6޹y.h>J4PD1z~jJ@*ޮmu _iuRGj,;(t+@crIlcWfM_Ni.FIޫOz(䵑Q*ҸBȹ-q@{@pF~cT 94}]+ЃW<)Aȥ `&4Ec-Y7+gbsZcnkJ޻]r|ݏ ' hc&h Ni5-I 9T^G[Wz[hrX{Ī$q]q)#|=2;Vޯ$9gB!=9$yif@ ϭɠfIȃnY+Y$`r@Ṽhs\ȓ;j$B\1x+ZQJ{ 7%k[P 5]0=tX<<}=>4@ʼn{7˚xp;)dm!Mh>G5b,5PUՄh[!4 梙.OE]܊؊t1MP["|ǭZ,UYP߿ v}v`x;=h!ĝNJ56Cmv([úKv2n2+ZwڬN(9»soP}u=(2sR(sKPDd 4 c A*8336139-374962-5338tnClick to view original file+RV:eBAK\ PoWFV:eBAK\ PJFIFC    $.' ",#(7),01444'9=82<.342C  2!!22222222222222222222222222222222222222222222222222" }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?liFd>3ӵo=(@rj(x&…ZPс@ĻRa2 #SlA 2A[6 <ȟ Z礸KylH>yy4zPֹWW?W|M1жq޸<>I :䓰;GJ.yaρhY8XpYWۭWCh6 렌sȨ %RJ||PPݐd%zR9j* 5hs] qu$dQb:KfX~oJЎk)sK~v {-ڹlo:ŻԚ DހO`(]lUh`G[5 B˟N{B֝& [0r{i"SY:<脪7E=O)- e\'KR235ZG98.n k>ay{YC}Kp[aeQ2 \yNXf'q Vxc  f Qz èdhZf 8aM0F;GV\uEٛh8@w\܀z/A]k(<3! /IϥL\H02=jhT.O/";_'Nʉ}\.\yI{f\wP7ρ&e8/ CG67qPӘikp5}1Vt8 ). LgA4)<$^ 1ץ:# ɠV9[(c Eo5q+=7ɗt(x&Q>`x>\k;7 9 *p+OG}p;e\(:2eBRZђ99'֪W, zaI|Mx+%|rIZ Kݶgހ+MsVPy#!gDÒh.#wVnnpǸ5OY&rqҠf>V5@ &Ji(^2xop=-Yր3D9%OzZ/șcϲ)}ݏG1Ҁ'{cJDH. *bӹ f/{#eU {t?Z+;ӬX&`$n8w)*ZE>~YI޴C(2Θkm$"䌌zf8i)g( |\`eJsGGiZu6#-4զә0gZ*ųsJRV3ZI %(6O4*Y!i0()!S9Hjڵ gZ&Xq[[Jb s,HQ+Z8]F\vhؐ8ZА;sZ_ٱ6qU6';~YM%\U%[^q(EpG*ysbRWUh z$$7t^CʥUQ :QO^+͛OszY ku6Ղ촁- `;W?nܿvZ`rxf`Gz|N+/ن2,boTh` cCZEcL(29XW" ; c2ISV+*XWCeր/$-" >$0͸ XBqoYىBSj಍d9-ҵİ\`*(*3Ҩ\;tX6qZC\s<{*Օ;n?/A@C2x" HTW#'1 pOҹ;Xk,z̷d&#@z}iȭ5wG\. z[6ZDsi-+b@:P8QqP1G8D觇R9U.2sMP"C~4 ъLBz}7Ojľ%L|I*Wl\A41d'[3H%dk9'i^*cjd BWR@5v3تp¥U&?6b`05!y #ڹ;sý{(Y.e$c5 Ryzo<5wnz nXxܓT|ƀ=bm$cTtۏ2yj KJlo8 BZ6^I5ٰ'JfmaVfP^KSsa[Oؚ€5PP=45P3#jElc4wQY@nնtbEާw ?fLVp4y "ct x$x; 8˓y5,ls_Ozy@Vlր;ys7gvlc'dI{{\G:ۣ|Wݛ $S52,s@.I-O+5Xh?6cW+yc(Mu;G+гMgxLjK5N@*7kp mtt Zj JAj\c'4&PKzVD7EF3IstU2^DqAy #X2J9apP59CEhH ckq΀/\\SQUFkS4 )=s@L,6‡@+*liNLnnxҢqbǨ񓕲W1'WNWk[fʒ [P25W=zӘ ;5KeȮN̅IEyezDso!'O*FVUzwPaTvtK (?\4߻^co4E%@W Qkv#*0(`N$n=ꤗ2?;sZ:<Й7BYYbqހ)<ǖ'OsSx)9Ni+L+@ "ARH$ `c@ ,}i2i(٧qB$RfܡT@9f=:8V9G {UWMTjڀk:t\1@Vn#xjъ>b(z{<`WҺGx6eVa]8zբJ,: nuq囊Jf Cb\ۤ3ڳ淒7VHcUe?MD1ːa>=,X ú8((DEO 犈Zf)ЊJU@ jLi[7}5*sު:9 {WQ M`@E@a\wz5/#eUN޷jN@% kT77 5ڀp-އUQ3޻k@AODq׫5۾{ l-$X"Ei?Z#ܞ 3!_O!5Ĥ\94Ӑlѷ>Fn7sjUɣ8ʎkG]0cLez0a<*L)Vs*C=ߖN3Eơ#/2MLx8Y.m$T=)W=$#b_DIIxP>QYwV̘8ar@[$6ɠBEHyj/-MFһ Rt+Z Ii1JE%{uľ\j r9^cJCǽ\bӵeUbv= ~nkBGހ;emP̒NjX`X}hSi&Niɲ@GZMr(jGXGR[BlGo0*CT[[aE!䄆=rH -XIV'V8V@PKۈctQUS\#,_nqo?erDc@7 I" p }űg9ڌ1#uqWDgYH`s@&!ָ/XH'5aT1Vt4Ěm9O  v(P8@kͤIf.#'Ҹ?]N6nnb݂m{V*LiׯpMFb>o€5ͿyۜOq%P9SA]Eh?Ԯq@/$RGl*k d++sү]d8 wF3p(҂7ƻSj!13{ `q'\7 ꒩5ZSXI"HUQ( :{Ոa8BtesR*`$\<`("·pH\Kp0{+-A!#=+ Z,hTǗTlI8fF!:`ӥ8u"6 Ҧγ6aր0ۂi97&;[F3U⢾mE5m+RZYXڶ41N߼ӥdp%krQ,\a ( !qX ȴ.5h! ll]tEC*^ebP Yrtwڨ`85nqΝ umRX{_;505_&7l Pd.CHdqG>=U?v%J(_K!jBIPU&Uo:ֲ/"(y gs`$ąLu4f ]Rx < ?εn4# HQFjޛu|֖:P%}ۘD}?P#p+e_8ހ1M4{PE|ڢ9z5"z([\ipcu`x"OJաUeVppxkONiP봑@s c /Lr r`3`b}j$H;Ivw</!cְɯ^i"f BrMl{)ca+ 0@2F 8_:_)H\5!Y2Ҵ8-܅%_Ƴmͳ ghܩPUK緶93y$L7++*{WAr&&e!AU#%gooZc\Z8mxX\Λv#=b2J}]\|'ך v5v|"|ɬ,O4zNn}(V}m<dG݆s) ,g8'.k:.jg95ikNs TxB9a 4OYȼ`vc9ݨF6sב,2oR tV%qPm(B;8 UxT1\Ƨw{r$Vv?l7ӟ.0h²*m5iW$ Qֺ8AUwZU5ub©*?JayK9\y)8</4ڈ[˻T! T'c+U_nXMSS^ך{6mRg8WJ0nXF#ҹ[Gq;A< 7" !LhR8g&qץP@16[9V hV?tԖ495%3Z6i%XqOU{SGZA #F(ypr{T'PDd 6 c A*8336139-374962-5340tnClick to view original file-RiZdӃ\hG~FiZdӃ\hGJFIFC    $.' ",#(7),01444'9=82<.342C  2!!22222222222222222222222222222222222222222222222222" }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?k2~+YǵJ*\a؃7PA2|s[)^56Z<u6!d@b^\k1d2wdk7(Z^KpE$u(u>PA:T/4}ŏ=oخARkW \k쏵1ZSHIҀ6 2 RnE`RۻDŽr3Y ,1'cܰ$={[=gpHEy%-WgV!C㏔VlĤ/V+29>t[sk/Ǿ\[C^Z,K"+ HjwM1/!nh 1)>;VչmX^2j5瘿7Z&KJI4Vlw(+[# `s]Uu`Zj*dgmgxFNMuoXwrM [i<ICQܝcۥ.BS5>U\qjtV I_)%~MD4Jwh[%zL8NqUIe! rsW޲mҮPLc u aoʼn8ROq c.T>gɠ ;+Ɔ7z: 2yk%T}]cfI  Ao ߔR;~bC+Զ,eWX֖'ݖ (+[ѬnUb1}qW3tluGQ*[]bAHsZ969UIsߥnƜ?lhdȮsmZI:[V5sXvNJӊNml2 QQ") Ǿ|?_+?(֧m3ޫX#Y9r{hD$GP5C!UPH#$tF-cg?N}ametMS6N]6AcP-@9m߼$BA`<شcTukR` +PZuc5rWIpj SBp8 %N=МsLl5*h;Vd5p>c̖@A't`\ 3\Ƞ L)j(Z|cBkVɻPCnx1ZͷlZ6 vFj9i㹧%-+^GHO'&,/Njw-,@Z^ U7a[XlEG#C^::AiN>oSa<3ьZ3\vt*з򂭳zo?N/.@+y"&1\|p_8]s+n#3*Sd| ހijPLt8R@8Uy2TwA5S 3۩x"ZwRu汮$bqE#}(5PTl[Jq[RGj AbH hˏq[]޻Te+v,JZ4یG"i<~uJ5[m ;K}qN%c[ۑ8yq7jki4UhJxϠ5Ѻc5Z.m${ A=H*­F~zD[&u˞A 8-BLsU-Z-Gm$@\g8R-)e΃wZڻ @ 5qpkzx"l*kQ@ dpkJrؠ Kdf"풶(ӗqQ]1 q] #&)Y`gT\y)UpYgg۟\탗mXy<lHj,I9 d3T-O+ۊF6|x@9$+2nCqW-[x_ V 46w[Ki!}vPZZ,b/[tkEY%r{CTdSYfPC+.UאEy xF+լz[p k"CkFٮKT]ƀ1f;&&96kVPV.j8v2+b @ɮE$t Tx CB펧xT?1A04J ghFxm+ q@\o6IOep`.GĜ~tռ'Ok'#`Iv$Rր))Rg֪\;Q<1<5q>rsހ.I?tiqr:\˒sH]+r8؍}BPFD*rq\ B=IoZc'θ ApO{ޒw#1]%<)\01/v$yQğQ,$#nh%=82xW܄*x""TK+cZ󬠾UeL?5ɳrj[!딌mF  V 3U#+g֫\Gcր-enk.bI tTRj7y&zrig Y XY^A#Iu<1:8~fw?Oigb^ٱ]9t(YXxs7S֯_9'5B ($)Rvzm)23q@8Rh9Z9fd`vڊK ITrO&=P}Y `4%qOk'y2 ZumN(Z\AEPفDd 7 c A*8336139-374962-5341tnClick to view original file.RwAA\ D0No<,_̓FWwAA\ D0No<,JFIFC    $.' ",#(7),01444'9=82<.342C  2!!22222222222222222222222222222222222222222222222222" }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?<=.U=53rc^X?upJ!wmS2OH$քvpKTnǁuO& YB(4!%G#үb88^̜^ٯG51o;W"٦O,zVޑHրFy@3k՘+P$%\Tn=:"3q@3ީ}jI =I7/M58TF{sMݸNi 7qciy@N ) d,hpXҺMWm!RJn©j 3Y0d tD<&MmCqӏZ-FHɠy,%h!{UkF@-lsp1V%2EqڳP?ZcH`*|1PGzl2-@.:bX2eyeh99o$(TooPR0w݊(5b0{}sZvr(=+nNsrp+nL@rxS[[rqYtI=+ 3qڀy!vgl\5X`W= - VpZH".sV3k"g=( EV)A:F3EBP{SmP@0 r>z)dPWl{b"i69=8fC׊촱 irLX<8~GZ˶fLqC{P8CYWf|k&@#Cn՞*ݻ`+r B(ɮvY\Ҁ%ԯr6bY|T~$+$GҦJHڦ7q@ofvz{J85R7==ƀm2*EjC*Mzw(BchIQO~zUuݰZV3ր0>"*dUWrM"U\d*X2avpye;@E 4PEX?0§5a~0MdD!fl@nbqVc ˌз@D NMA;``Vtd`?:F~8#.!,$i=F ZK#ԑhl}[ԎK [g+Bhq.5ufHލzVc硠 4tޠ'K#17nZuE4Tj1Rɠ H0aL]S֭"4!hv8InV;D*SEa1´Rak.y QGjӵ -XC:WI:6zçQ39@:n(b1,Iiؘ/sx儏UڇW7yiEq($ ~ˁkFɼf$rrpk2o bOЂ8 3E9(dŜY"CEanK l-3-@uVUs@,+zԜ{TQ!#fP9h)X1RZ~N!Mr:ՌRUH⫵.X;Fۆ )KlMsWfVrk*OW @,ZĽ99N1Klp:殗ulFErwaI"0OZ*ISE% 0+ fV!{k}N+L0CVco+Ph4\mz۵9*QEQEѫE4Dx%&rՊc <»\u=+"X@hA8k+ҵHkS*Fz 8%)~a].2J"EPKQJ~hh4QLEQE!њCW ̸<."E5P7>#<ןDy8*AzM1.Ƹ-QveF!bؑdP~*#`G7T(WƯHRj( Hi\њ(4.{E-.hBhk7Q@pkcGBXsZHH(0jo485GLJKvTMH"ޮ[Z8ɠ ,|{<,8e?Ρ؞:΄ IHv x8@* QŠ驿%s|Rb9WJAh8;=UU5BF0:f I^U17=̍#B}(o (9F'`;!O.G|tM?PS s󸼀ʬhĉŴ4n,/W8}*( xdn =:£KN~5Zb}jzP@eRGSC[`*?FG#te71]5q}95PF{eU4QnJ۵ۑh1BckP,K8ҹ33+ėǬ=#Q*z&{P<{%f#ֶ,DH=SGCck[O ?tu86RE,TqK]B*8 UP3#")ܔlҳZ.7o9bo˵s[\`cUtMuȳFB}SPD̠Ҁ9V"͌j5ժmi]HQ!.P1JmnBϱ@ytt`H& WEcoL;R Tʺ\ 6CW5FD"ǞN ~וVNdB8pxZ:mui&UA^UN\K\Mj|8#N3c;PPO$pr+<<%09H c9q׳"z]c`}C?#mK p$c\l):(>kߤHq1%(5՘ mV@}F%U ̔x`;#EL~tKI*u̡n@'ҀNH̄:@ w> p>aS\ɉR2P+W6i6]PwEDv tsR\-cub"G!2 WAU!O-D@6aB'{56gSJҼ k>"[Dm-'@G;jY&g)ա!xR8<4HckJ@RqK;R@X֬<{B$C1aePsZ$_{V;آgr&=*(nd+h;]JUPY<$}pVpP3ր#[]jep:F8XMbW?J$RMn.BN:{"<p>.nf+;J{$ߏZҪj?ۖǶ}Rgmv m$GiFK*~@)e "A  /xQ]eo'jWu--X3=ѷSv1iB#8sֵPJ}n ՈcP>nր:F֯o|(jWYpJDڹkORh~QK|``:~\:j4gr{ҽj9/xm5m.Y"Tn;[؊Z)YXr }Mp`GjŶ_\ yǚ%*{yR& HM9A4Y֝2:*rYpBwgՁj..Y$<pVt *-g oEso%c0J#2<6;IF#E)ob>*ꗒ;[]ԯ!Kku}d"geiAmګG*7[ah.Ĉcf8Nx>ec(!b HԳT$F] 7[9"K>\v>J8X>!t{6v$ {p^>rn W:OoAI2E>Ok¼|"98'9[q^%wƪߦ?y5NHҺj8➐r8 СI2+n)U̓ӭZ1%G@\;SjxhL7qҬEpp~5g#J]}t P.TjYEE7q@ě$յRO5E>nkNѱh!y Z\9nqh9%*f ;{GG (\#U"\͌)jU͂RKyexָonuMĒZϮ+~30T)- Kڀ9]AB'+ I8 [Em@(4bv;(ݼ*)yk0?E>',0因I$R K&T}E]_;zEm&QC>ފ(YaBT> >d fHq9ο#rGڦTzQE-7ZID#kVKV8`>袀1$%]6d/:(GT&FHٵDd 9 c A*8336139-374962-5343tnClick to view original file0R%zQ]9['MF%zQ]9['MJFIFC    $.' ",#(7),01444'9=82<.342C  2!!22222222222222222222222222222222222222222222222222" }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?Ƴ? ض{Gj-n(F3i 8 \٩u"J6*' :V=LCҀ3Z[`*Q|)B f*kI{U;P+hxAT^ LdF;@#Ӓ(B*`W1i2c5tI9of-.%$JɴuV7̪{W;|g8ٷzUr*H>}Ttn=EPi5c]=5nU\Ll:@ ȴ`Hq@TvV<"X\ve0IV[C U&*䞴m ^|%$QAVb%PO7̪@V#+N2d- 5;hx5q)~S$ڲ06q5ė rC+"]nLHQXs@t"i1 G5uBpͷh ͢(f&Q] ^{ʓ,&eg'ֽn9\ݜtfmC=@j;TwY0Py?s p=?t}kԵ餔CG߈ ս.{G͓5喺Mxxv.eas܂ENbf\r ڀ3$+*\bϠ:؅rݻPfӉCF+DFG ƿ$)e~G!7#=+lVRJ5FyX@;M˂;Wu]A9͎mu7ֹ_S,HA'ӥbqʠÚwWcj3@ EPKJU@5iCtQիwp,}lͭdr0Dvz_1eI9%0+WOypw9Yd@] #?tNݐx"I$mf.60PN<} gmBRO~ 6V̩ dio ⩹3T~BUhc~`܈=cU8hI'V/X&؁ּJij\o9^ 4rZ>ڱ4{>э.u̐qޏ(|qVfLVͭg^4DTsfW34oaǽtAFW.yK"9>yLQՠ."΢9ۀAYY[jV`AN2kIҥ{΀;9-*ªFp+U1+ФG{WKcz%± ~# YgPE'+||W槖bp?*κf`Xd9+Qkz\֣Y ?d<{g«J lmP~gIݜR@*8k1vu!4Ȫ@jV7z + P(qPV\WqaWzCjok=3@1oEgn0߼ߴ8k;;WtHdkGweDˉ6F N?{-B@۰J.㙌DkKgM=)BOXlXvsMROk y|RK8H\r{Pij!HchRVD"$rA;2$k 7՝Zw>@zqZ6a@UrkĘw/$fBdQ5=R4-˸'?Zk½32r*1@SŃýҡ$trTg@/RX2 =똙@wڜ Y8+B6F9 QEmZHheb?,qہ A(T]}e4'cUlcx+00"mQHO\ t0kNX HMKOF+vxSLI#UX|ݖ+@]Ҁ~ 3rAY_ !# @فhd,h$H ExlVWϦZu_Np̡=tW<d/'ֲRYL)ϥivR%;WzբWAA*μ1"`I*Ypyc1Y՞YDڊI׍w{x΀NNhgMP(q]fk ?)Y_znj&(.Ey\LX1Zh{n(;V Ksp\xTڮbz( 4lx XNmfsEhˎMEU& {Ep*[YF•#^c)EE֊()Dd : c A*8336139-374962-5344tnClick to view original file1R+ĪQ8ݩFĪQ8ݩJFIFC    $.' ",#(7),01444'9=82<.342C  2!!22222222222222222222222222222222222222222222222222" }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ? 5B*j6Suj4;7 )6q4~Uմ_ʒ.![UtU &^Hn&H$# nKrDFAw :YS Zޒn:y֯kus̐H3 f.5)%b@e?o*[IaaSppB8ѵ'cp홯I強lbcT*lS/$,XdR|$Зs+FA=J-g]ɦ\ĭ#B0s^rwI_^B5n 8=yR&Y u)nʻ`{9Ŏ;]]D CpH_3M͜L{ϴ6[Du;ڥBu sO*^]̟_Q@GfA  3^Ȓď)kW' +[C֏v-B۹q@z,-{5NA A$ѩW?oaN+(Oj_ uC+\s^ê݋[9fsSYCn8\zDcUE*+=8ke4uPO{N| ೓Oh05^E-.zmO&Fl™Pm$ր/Fa GvRb})Jѩf8\γ3Vs OP<fM3@2 _">9BCuވPvʩ{y ހ6=y/70 ,c? $H1Sþ{-(>׼/>HCKnFKcksUnmhC+ GQ@F I 2H'/Xc&WÞ&s\3>fK=9rj?ZcE @#SHXh.y0^栺E!wd޴඙m01@U\kvWme :һux;S͇<=XGHw zWu13,gJ,!wdunI"i0ۙd7>֮ cdk7 zzϺ?*caJ@b9k\Ⱥ{ у= װ-P TlȦg^ZZɼ''Үi5-:KJE{Vu]HC}*TbH'^68BEG5f!A= ?˸VWlnJe%w(5(A79nje+%m KM@cNrjHO@%;Ji?E41ecm4P)\@#!FqTZX ݵ{V7#;o^=QH+m).NqZ>nrhqX;…#[ҩ[TuȔzT.15\z \)S@M9i@P&)߽H9 G4m \g3Oi$h8H4dUy&\Ef=Ig *qU;iٟa@bğW.&ojW|O^;jk2;U8,g26jΝ=t $$2N:zM!eFFRVEq>2Яt*#o~S ]1#gj>Ă)zz:UpFE^{VuSjXb!Xkӭi(FMXCp{N}FS{=7A%IB+1T 7RU9;AF|M . zA㊼1\ž`֯ũ+ @fARVC %W4}~2Ҳ,I>CY'iYNnXր;2 L4i"9d⺨.T PъyΊT*X5aFh @nЯمl:nSI9C4ghYc,iW9QwB!qÀqP]IJ1ր<$#X@˪jM!rkwvIo7t ޲؅7"gًKE@PEC6q] U(mT:J'Yoc6}€]j)9<1zUrb@~eHVl OQگEm>_fqZˋ1Y@n#B;`zu (؀ KcylvH?@!EJm֫.X7 Ť ttS: hZYJrrjm/^[;-8t˺-_V`NmBRxb>E讬 k^{=I( Ҵ/ΪJb'pxR+p52洜݉Uy |VZc&G"2 s@+:085ڼ9d6ap=OS@EU[嘬Cp2M\N4,2[J;' tg]uś4}dnqz֢ZZ >h)(Z2WA^fl|@5>$TePE#A(` z\ǥuzIl$ۚ'zx*9m`Jp}(yNsڀ3͑kּ +A=Gy IY'ڄhR8h(/Q’P,Xq^Cm#"1},#=uq*C#ڀ=-u%v69H εxGvF c;Fr+qX>#uM&`z?t{x\`)m:RAU]1[AoNH@uUt[2bÀOj(JZg84,l5Yǝ"鞕w4P[]2G} [WPj|rTp'=(dQlɼzY(Ȅdu>!jdFMq÷֟}bv-@8ܽ5œ Nȯj?e]s$Q 죯_uJtS[C&5xS7i,uQ'N\FtBHan0ߕkPtQZc,V}\ m4RM-Dd ; c A *8336139-374962-5345tnClick to view original file2R |Urvx췲hqm [F|Urvx췲hqm [JFIFC    $.' ",#(7),01444'9=82<.342C  2!!22222222222222222222222222222222222222222222222222" }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?4˒ OjQ\&q{;PH*P (8 Pt:YWZEۡ X}Qf8ӷj7H2:P(1ہ868hWhժڵLj16o'Ҩ穭+.qYzI=kf玴.㚍cҮHU+؇Mg]JW7{+>ߕj^I['L(* 4V]Yvt稢1m$3] P9_C\ռH2Mo2xJe[Qk&b]+ 7Jc0&ƬzTkyN=jRQ5kyXa{PtWKlbw]"D P*@CjF 䚮ApmQb8S"0#8|?fhu/ iM=1VX[jv<g2;&ʹ89]5不p3wX$xW=zu 8;ix5+aN#g\JȜ(1E7QmӌE`_lYdWu,$PmH2,v@t6~c}ec1PaeF>TR-oҡʀE_!e  eM+Ӛ 4e8+˟z?Th-REћ^}EG&qxœSGf8)ր -U5 *(䚣+m1m-G qǔ1$ "CPM=84 czq(rO5_J V+ Ɂb)#j,XkYE$FiFsW8>SE, 7SJ(N.ANҙ6PQ@5pFr}k^Ќ(b)6Zvs ~RQEhA[ 5(QEcr)b$QEYUP38y߽tO,>p(%d.w#n(>`}V'7[XetˏIP_]w}cY[k>MFG*ד~Q@0WA.Q`R znw/4 "M`t#wO1szx7 s@+ FY|of$w8Gx+15 {h ?U>;Rf>Gqs4 6nGU{ j"]% 9_pz`5-f{`?u7'˹FAil-QWךEQf7+Yy3Ҁ9(c81~ѹXρz(qך^ok)Y5Pq@a2mČ6 -wnTO{P^"VpǦid\7H5Ic5mEt9@Nhi!SҳfCmz%X`FqXQX;~mq1 WQB8c?W$P<4FTQ!acyi{ ÁU]n#˅ 8T4H/-b+g# ,a'h?\) άi^f2Kq]68YI<䓪zHҹK`ۘI1m$e"1!ܜps?񼴍2ܠ85{;s֒ŠMz`մInCr"eFuFq9WV`*dm2 G۟J,+fk2kqw`/zVu"+T*ǑT/n[8F@ڴ<"P( 1 lY\TXHyI[q@d'/O*G\gy$N6^yqīEՉ420ٍJ`qޤo('X?QګGHp@57<{R]E!|LO΀97GtX](XA9hIU<h޼#ڳN^`;UgPAA,=N(l842񤷒U[{Su[u!0_oZ%lbX] 4f#8=v#Ȣ"+2P9FAȊo]N`WRv21tZuȫ qǧaIcEesˏ\̿gF̥3 uiw!{8䒣y2;tH4] v뜖=*:%=eDݝǎ __#1me sX dbH#;n:0=R_,+>5I>VͰ 47NT(sh.\iހ,$J]zVಎՌm\@ri{Sq 0}?}u9)W$~@~eK$r&q ׸z%ڦفEC+UkUeI2ר?w $qG{JZ+:2e9*hmO3qy"++CXFs[wlL2G8( $wbܲ]n8=*7\ߐbʎ+1mX2Z$sJ-ހ"#VV8}VF,k.K\6 $F82|! 1,sX~q$dЀcc)s\Ef9 ڀ+RPHѻmps+[Mi&ex`nFP$Z+VB1gS lX_ZT3nbDKwhRMpW*@'מs [b;3=ĥܒhm=BN ޝLHF84$i$d#"ѦQҫHm##Ņܝ ~הVlq 2YvOqs-;J9#fcb4P2J͟΀@u+⹋2MѴB nEBϰg($}vo-Uap=hM!n/[WOY؍Λ\63I1]T r(4Pr t#FOnF~cP3<ߚUe`Ʒ# 1ǰ GVQKOq[Ļ9 LQIqkÌqQ;Nzh|% fd,܎}}2y]p=)ӅO@Ca XgWvZbK3dv13]fp @M-p5DXeG'l^~Br)+#q@eՊz !89m-sW^ $svj0fvJ O@n:Q@ \y^5ɭ xfl6 eYolq@@ ;S.qv ]{tD^EC'a=ub`gֳoR5hc#~sҀ+ټ0F HJEهZad%cԁMs$2fu)3. ڇPRxv4$;ֽޝnlD\H=rc$*ս vZ` JOWSc|h.b'<ǿm@?1wqx z/*Z<$'k6FLVp9t;ܹ ϵS{@8Ǡx囊OY\Q+/q@Sz(KjŻn2~c4itیV|+sWbw\PYa1]6]Wv.@58Ƞ 哎+{9}Bs9AAi#@Rp{PX6*Frx3ihEx[ˉn3;z&uӮ ddzW?|եm.m*q$9g7yۂÎ: =e1(0Է{i zMMJ}2bNc'ĀIoذEVQpW"tbZG'Ho a=(ݩT~gw{V7,j}23V((5oaǏJWZz֊ ;AgP[G-GIң--%Gk K}R6U"`8go]kVYN!x6"paXZi6&OpFyOozX?_Vyz3@G5;ŒW`;\V7ʖo6b ;m?ѭoPHgYĚՂ孜{n##ހ8YGEv-zᆏ#Ф4P ZK5<':ɻקirK'?ּNbpJuEJ,De@(EܺnPi<#5 $B"n!բL3.ٱGAuip8#^Y#rH>S}/Wc8I2=}0)zVfT7pT pN8kNX"'XՑH\|lbSn3?Z"F+ʼmK('+'8>ʔۼdnsys(t+}Svy+ [p *D[#;=X[PlZ0T0;ۚB7lP宣&⹝r`ēQh F>붑cej3zW-{O/u ,X]:e9׼!٥[۩%c0NO_>P0 6$`rx,-\`7N⺝5 Q@M@idmeyѴQ*{g7 r@y(/Lյ/ j>e),^Zkqgwe$ ?j(f6ݵe;zQ@6#}$b*_f02~v袀=Qy9EuͧY c=sE_+ z#<ї_}EP)I$NI9(hٶDd  = c A"*8336139-374962-5347tnClick to view original file4R}yFz&oF}yFz&oJFIFppC    $.' ",#(7),01444'9=82<.342C  2!!22222222222222222222222222222222222222222222222222" }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?sC~&}l}) 4u8Twpi3ҘG4dq֦K(*`Z>y^ŧkv"epBx0g_Go5gPMۼLUСTܚWҏ/]kPD;E?A]~jm It?y'8۴d~u>>e:%L u6x(MLv&aԯ' E1E#G'֟^'=G_ւiN1M8c}($p(=h=h8<>R 烜Q@֑<ӈ)@ {1K>.~3>`r) rQ=T˵#MH<i:TI>~Bp^x#٥Ugɞ;cӧZt"\x6a09=(|_*;>_H=d]iIFܑϧ?/QI2, 8FfToc>xsE$p`-epF'I;皭$|n׺Ir&kz, T Q^'4[z4>^~`$'ޡ#zR>:ʃCaҀzi>㑟~ 1aE; ( ޠI:iN9@ c'\dU?6%V1JȪyތr:Pi SޱydXFbyaxX}68ztP<'."9#D$W] h Bpnjqzii&Y2vc^uJaqʣg5OmJsG<'$k Hd^_A:%$2K 7g=5}I6muzqN!Yv8=Zco+lL>OK6U?}c݇t9xvBM91 hmMw@όvךKIZv|vYfRu=}jsA) `@ig,ng*]DcA=I끎+Ls@%1?1ZxWtczj6:#E>9MBJXd烊񏉞+t[gڨdQ~y2^,pY;YE K0 RL.An5)`~=sw:*@8XfS$~a2[V;_ZjsA2.LI[xQ C.Grp]e¼%Q}kkO0m넍5 T_;1k&[y-;eI$zvּSXXjkJeTl4ڷ)r= ^JLqXWbPִ܉r\U2zI}|W^H7vx<@ 3xpx61@ ')uq(wct.{})ys@fv{O]9ȌbF0XV]IMA~H_챼Gq絕$̃.iq~^rHŸۜ~#ă*<=BZKحe]P}sP[(#Ybfnf&,Oo$DLЌ<.hI,OJO]á9&f6rIv%̍LX.h 9 +75izr07K,~Ih`͎xT;`6  f>M4Þ~R|{Q@H9 BOJR02:w$h޴s8qhڏq}ip9u0O@3 JsjD z@ SOǯ4@8* gP(L,ŦMW||R'dʜG8Q(hKGwj L@B"@ry<{;ǹMpd~tW'zHIqӛ'@;ZKBS@M'<8OjCbA'€Eprz@\uz1)'֚N1g9 p)3c8@SqIRd44$֓9(3qHʸcfr~0}HϮi>}(^"DŽeϮ3Py Nz3hp7'ZiAsP,e[RZmFHDd!Fz(59#Q[#h^QcNMg%I'4)7J>&y9K$G#@yN}qJx=釮3:PƊnpsQ@ Dd*!dd > c A#*8336139-374962-5348tnClick to view original file5R 'd^FNUL$F'd^FNUJFIFC    $.' ",#(7),01444'9=82<.342C  2!!22222222222222222222222222222222222222222222222222" }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?ZQFە wFu` $Mw n (U^9'ڼxI42L>Y$S0~N7Om˕ "u)ڹ?|CUs0 hzw^e=Gcc9ӿ C>UO?t-"<2 Q ԚۯEgt4hIw @;UW5]n]#'ӅO䨜Jb^f#^Zk4F.[h8h >j(4uu@ՊpHn^}wlaCPl?Ǩ<##)ب4doRH'+ב@1HE69VRiZy3A-BwUj&]!c*'W\וC2ilWOaϿP'U).IO${SKu1cv8I-ۘw~$ǝ6lɚ4{׀ !Y*|Ci:?ؾR1cX#@Jly8|% *| só!e#ˇuWiUAb^{[HcU*( =j@hAҜ)Rϭ?4QFis@VK4$;OjښP 70 ?Rs[N_0X 578+78(`#dJEpZ?p-mGTWw4k$nd09P0EJzcd(Rax8|de##:S s/uԛb?vvP&'\dz(x#&dWF20a\{Eo]: HX@~H4Ԛ`K!4ր:55Jѱ&ȆA@XUXcU @U t niڣ\S(dbUQI\ϊ|L-/;A[:)7X4/+4E+:`PX"El^5mH=Rav@|Wf k/[u|I+`71 3|ז2iV[̄W<@cjQ95W[ҧcpGRs@]N*;^ ^DGo,c gүb`ڽJbմ{~ x< ,bφzY.4?ǸGG4QEq?jWb,n5̞]^k|a.2ƀ#7G4DT"KNJFb:f:12zϵcGvWSMi˞OxL@(^ 2wu'59;>'Yȣсd޵tۀ$}XÃ6!g5*r:}k] k VǥmXȰfj[@;lҹ/eEks+}b!zG!@$RqZI/ 8^!EmW!_V4ա0N{Ur[,Tu\#lǓOKƑ1etn{U6%qKd'S5KbhPy.QGbsZvpIjY|`(+Dl.dd @Lӵ(d)\Յ{5nTq@.42+7– }Ʊ{ki 6IZT2zA^uH}qҸhtlq^=\-OJ}OE};P{iF6=QU70FүXA2m@[=봆&o*p1@֭҅s96[\J[Mew}yRlK(kr`b]Vإen5 gwr*a ;Pao+<25iW#~T l ~w?WZZEgnġUF- o EvTQ@Q%*b)Ұ.`!jhִ/A <ktPk&Z q_ƼK"f++ #=y4Z־Zu#,גou6}ؾLsm l:. f9&F+ӯTR02|υ_ƶdkyU$@1@2XآM9ڵu].k|*tU>&ΥPP;*ZֻԪ%) }kݝE6z;-&F{Ƈ-JIy&ÔgNA5hRVHVһȥXf,,GZӊPg ~tw%pY-4;Of8KySCC@KgnBL7S=n]\EokA's>d@UM~xaE{y3^%On;^cusBj4P(ͧ"xY|SmsOʷ'(ixdu*H*F5Uok{D)JUq7א:{s@J✋N+J,hE mB2ջcqtiPo1X1'>t囉UXt Hru+6w3>꺍g\C^&bKxSQᑥ(&[E[28f۟,85F+} PBvgMW S!8G$a6`zT_g29 [PkPjU2@, v W" M֛vK5|e(iHQ+#-]2+4"% V]z?EPE!98[CZ}k-K,2GF jn|+9u{sEpj'|qװ*0:KN 능6sn@w;M󲽰*R:$Fӊ ip2p:W^ &+ J+òZo59j 7C'hk$e8RɅ@hʇq 3$go% ],Zgڇfu :E} nJbe}+t>ϧDv =s~ي_/G h( (*ȫhx@ !! sʋ$n0!Ey yo8@&oCװ)|S/pA?Z|sM &c[Εڇqe_kojsKosJ G8Vi .sOqH< \Pϵ--!weëP)qoven֍ia|ڶȤQt6{R `]طjEQE) 4QLcDn(,Fyx[5*EH)GPZ6J(K((((((z#(EٻDdr ? c A$*8336139-374962-5349tnClick to view original file6R4+>ϸx/;V<F4+>ϸx/;JFIFC    $.' ",#(7),01444'9=82<.342C  2!!22222222222222222222222222222222222222222222222222q" }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?.Zۓ p$;8z䎜 NCKo<"[#sqڀ2dZnkj]wne㙟$eciH=: J3@ ԹҊp)3f7,?zWQ@K_u$r.v>ҭ ti4bs#55b++x8皹gwuH\]4׭1,7 IP|> UpIKi4kΣӚ+ vֺ7^FO)pAub&Bp#ow˜h|C.oH-n\cZh Ui"cӥyg(=AP} g)(ȣ=3F}Q@fTItUqc?F 1sVEM>Iր,[X, |GFBBB?5a$d)%TzQcX?-.~VcձֳQ'WF*r<|36ZF>E\6jӥUKځE(eţT YecBJkY#8b(veu\O.A`W=ԏ 'WWa{(@߁\2$'I(igq]ޛ+t|ԏZՓRu K12l-p28\αu J2 ~ڔir;\?8le~:5vQ1 ~h^0NGJ]N b7`NK<+cL&1$lHGּźGO?kK%v!VcC-ᩴ[p1a?^x15,UԐ5Ni?\Q@ E/|@{@ Vo0ߟ֡E2)⦿mײ]DmVO=]D- ǦG5 i Px_ajo;Z6YX9)&{tC+*Qؑڀ:t>rs[Vm\sByFBQ~GКhi#I")gb3L2+1ˑހ4:"UÉCkSB ?΂VA`S t# z&uKCCеI 1@W"P1osPsso0bFOE{·WnxY#WY' HUZF.H1 n] iu$@??f٬fd,Nvd_|WE.cZѷ"(+HkRM+P.WҀ'Ӯ" _&yivvIx"w .O>n$MTvFHxz_ZR)sv+xs#G2##.[)-x8uyLwgrYU-M l;\IFh ($SUcH4N-Ďܰ2iZmOepm/b'oR;݋3<}M'֎\FHQ4i\")$뫰4ӢD̋&Dj#?JӢh?.l5iek{ KwWZH1- ~o \^$<,E86g|+~u w%8ݓ@k$&`([ic$iن?!]3,loϷjyb)3 O //n5+bn ~+;Ί8)G_恈R9k-.L1 ~R>[|M0y(>! 1}tQ {{h~O9:X7i̐M$e?*O3:˰}Iֵme >s ;K<:m9 Vt#p] >?] 6 uH85Gayii}"TsMrR=r9Au)<,lJ[y@*#J | 5f }5ye\'8Ǚ$|۷\u:»@׎u6O1OO?O,lGO iw6%E,qϯ=h*+5: ?Gיr!J\S4(!-I@ eWQUDWӁ@s 0#<SÏ ǚo:!5@> J9e$7 ;59kj H93YOY:6l$ *n*LĜ5LTt()v( bWFN {i!DɓL ˒+)#Lo2 A ٕs#/SѥsNN~{ u5'fndTU8c{T̮$* !v0Zvk-ҤǑ߮?*d'%T -u{XxERڝ$Z]sA4x$ ʧI~qLU`R+s@c8R3O*,cSpqHozfrKן`3*7nJyPG\qsg>$UnM.\n uV(>}6irFz35"{T`|ĎKlހ%OB 7\UpA,D}xVXϖH=0Jd@5V&Y_?L!X4s.9P6:9O@)?6?Jgު:nzwECpOhN?sASPE0!(YTv(OS?pP/OƞןP?~Q@T( }jAE3֊(ٿDd @ c A%*8336139-374962-5350tnClick to view original file7R >=ϐQNF >=ϐQJFIFC    $.' ",#(7),01444'9=82<.342C  2!!22222222222222222222222222222222222222222222222222" }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?lza3(<~vI*B7o@ M.}88“sK)pjz[ rndGf/J4 x[+񭈼rN%?Q p99(r! vzmm5Ďv5x{J)>*6d$1@y+GSҢykGtIQ$1m{ l=hTg`սxZȓ,2@H@:sF1B94tN@i@Z1Kړix&:ю( c)qmiFjOM<7Jn;QjHy"AcjstA۱qFIxc0iLTC>}ݞ;x8䅠=tK \@?,Oe<˫;m2dUWLnM_[HϡZG)$O跆_]LM(JeleIYj_"wI};VĠxLKh<1;y5 Dܰ { 0&29k.]8}'Ҁ,hLmz[PD`~`sI ZlA^-pq@|t!^6,e;Jȭ.?J\lSosH h>= z’A22NC A/)U>guƪ،D]Jկ-ޠDѹRsЏQ^d8޼ĺ_ص cDdS:Ls@ Kڔa|_''ڛڀ4?3^"m 4S4o/bH\l`rxEgH:_mޛnG=۟V{%y$ct 47oV_#ҼĶ ((~[66 :sZbFU kA h^5iH*ylm\I t#*&(|/礒p $XRhw/i3Z<ҽ%9W8а$RhE?C$jSig;Mq!%[8.xڥղ;Im\ Uĸ*bo%wr9\쑼R)WSѝ<p8!?k}Z Y"UnB(9xa$}#s@~smM.`&ڋؠgϷOǥWhm Z^up s/(^yEGi?@Y_YIpDʽ\)+٢"k; a[KC$'auM q  ]DzލYKv"FιAl5),d"08=i֞M&daă&oOoF+v,6݆?clo8e Ҳf𮞱 1rI,涐oIP'#M.H O'FEoWX~1W&f\:m>kE0&Oΰ7b={/S@5UӶ1`9GLV [j&S;ɼ:xmvqq S\O'|:c'@8j #@> :H(Ts}h7OMx!p"<ރmjc퍞(T-Fj9#+ M߄?z4VIn>''gX3=@I2%@H\pCE{a%[2I%Cq R })BoFx4 M=m^.<S >VR؃ٷq|C+؝>soV/}##٘I9&(7cxǨmzU[p;I Y`|µ 9 4SZʹ~0ǎҮ@C(@!T=Zt4y{81`–R<` r[ɷЬ;z|V`͹3zkp#E@F8)&ܘkYhLơ<Q4/[1¿qñ;5zKvb!Xd04\Yj̾@8!ǥK0(0Ҩda8}BяZ]ϓ7OINi E?`3]M4)Znq@ygj/wP8=*Zjxzdfc?ߪuh` TfE8Dd88 A c A&*8336139-374962-5351tnClick to view original file8R:mF XXdFmF XXJFIFC    $.' ",#(7),01444'9=82<.342C  2!!22222222222222222222222222222222222222222222222222" }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?"m5#m7m.J)hM.u(B{~bK6:rNRkF8ĢI; }fc1WVv9$ZUs7q@.t8.v ^{NibhC+!A׫H@P@ fRdmЃ@%vGH\=&! 4_6y'?<ՙb^1OdOa[1_$VZ7 :bbK̑;t eJ{)RAPP($NEzHz(œ)A4퍱bB{Jmi$,Hzs,q)~+ش_h#nMy~\w0Hn%zW!X1oj{ipB$b'ֺH;#:GUheuا矧]"5Ҏ@=@ 0y=J"73g_/jH`Qn=]!a>c+ {uḻc3WO%%8=s@  7_w꿈 <#[Eb>N: j%\` ⹟Y[鬷i#78lnkc+p<'?4< {vu,/ Y>[>WUu +,G"цqJ|3v@?I"}+m O.&,m1#L-^@q!*8)3 ~G?9C_La{SCy0Ҁ*QA(oz!K@QZي{ݏg٪a;s]G-y9WދXMt!c<^jx~5#iVIXhڅfcykfU !*ޱ(qTnm T' tz .!JɌ't{q?F9G+Iq$I:"]9'_3R03@% vUpI,Tlֲtkn3 aZV(EH$G֡䳟Ɋg`vmceE€}9c5k?AƣY5"u_iCQB% Pc ychՎ|_bɯ2'^A+zK%Fe?2j<+FrZMRA r9]*޵0ݾ9~SC M} D$jo^]vVRU'\ {{jwM L#I69N apLRx]FW{C+><֒a'@# mX,1$KERʠnn`4PSKHz(݉Oo[ '޸C;>+RG } V^ljo$aq8?J!a5zƣ=dtq! G_^9ю*AI^?/ФwkCC>dק[@$j\ދ"`,"mȊK`o'd*GKal,*xo"?0hއڀ+-bW'9"%."V]85xD慚)cPmĞ:(䲞 =Fݗ:P9Dc)~ {yUc9q^}ؠ$}hc8GתfZ}O:H(NPՊ Ӑb ;YBL}~q@Ssz/1r4?stAOq7W-o}fۦ"E=ht[(t>$yin*ĽD u:i'~!MUC,YsZM:adLJMBJMLE~ofH>zcNT;T "jk^}_bXT.{uZhq@vb< ir0dmԺ׈eTrE "C=L$;/еGi6TɯJEKt a,OS\#;c3:m4R'vf9i u= Uax %2E p zlQ,P,cs+-IVG>]?zUR&W8r+e*isaVq*րQf ڋ^Ck(]A'Ğ$6ٶ|p=MNh+! Z]"P~Z@Ln3(E6)h W,&FUtoY5gI1zXG#ƙ\iMaЎʃ܍ꧡG[<E;|9>`In`9R'*=s^IR} J!5;z֥Y2g> Ut;FxOp$iz@]^2F|ۨnhV:ƊIe_-kod0 ґz`5quSvQPqZot;"+.Y˼JPUN3@?JKX.h_=f95:1^vE$G%cliǺ qb?0 bymŎ\Nɰ;c9s{5ӗWsh/>u,qJ*٤?g<3@͙ĚQ@Pb@t*[ۙ-܄Q M2Mh_aIu ZQF)hFٱdRǿBcbaUPH9}kIgvB]t}||GfZႫ> ID*i3)riʪICv7q\A~"-XmnkLx3N zГܠ^cm눡ґݎMVׅqR;4ڃZ(;W'[, [<9漚/mDLxE@nٖ9$1U2ppEr) @ly|uDA1vF@HR>-r(g9?ƹKƷJHT\MNvT`XڟsNvƌA{[73??P0ebYļj 2j(ڋ*K0#z d5Zb@(GwZ*X1 1b\Ίl|X4 Er2nsጎ-ż_pqnՕz3@ E&h--'Ҋ Чx#*awleoT ~hhok2tғj,^FhDOl_S#뫖Xn vm0$'Pzӌ71_[%OXۨ@fwl?&U'̿N?Y;7PjVj;¾3hYe_~BM&]o{rN}-My6-_A,vBaPEs9 ( J(ɐ@ZPEPEPIEv=h L84Q@'rh((Dd B c A'*8336139-374962-5352tnClick to view original file9Rtzj2vzFtzj2vJFIFC    $.' ",#(7),01444'9=82<.342C  2!!22222222222222222222222222222222222222222222222222" }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?4S]$0MW4mo06d 1[ $sO G5XPijmX:Յ1@mKomVw*@!r xHfD#7Z9z[0sF9pT2z]5Mo `\a4I8+:S@]@ZHnn}*M Hsвdga('%V]a]7JJcO_Z$r[ִ-Jҷ."] j V"!'s@e 0 fŃ8P@qW8yyI=885. }eu'@D#\(9= RT32~hrV>*+?L#VW!8bKiI-ą*+k>z+GivM. Z <a FXQ LP\qRl-Ȭq/5|8C˞@cSeMhGs/\Hr[4Ŷ@kбU܇p $(bpu!D<$<UY!\q(mVռz99ԕ<oh'uug$>5䀶Nh:IuWHB/ 5sL7'p9 fNj",g>~fYqF miQܿ+ <֓E8%+66dz5I" fTe/bv$TMۦ ?Fڹ>aހ9F٤ ޢ+ 4h8Lko+C>̅if/1(Qo#Cc$jMYUkBvIH$"3g'Ojd*wUg5f`1.{lU5Dc EbbO~ Zu ==j 1UK9[~A-W$Dw+290x5UB~Vː8#Gk1k3yb^@ܕ {զ8 I Ze9R*X\Nҫ [F@YZޚ *5ɤIJW Ҁ3]MkJ\dkRDQ3Ԏkb&MKT P8>WS҄$(;hLfgI2A=rs޵m[Yy[ǼґUF?Jz.Qdf Qi` 6[gbұfsSyLiʰ#DѶOG;y)pO_Z|"6QkN<q2G>lҒk-g$Z$*ܖL1]t">_tV!>a2J1522r sHɾݐ2znȪjI!vḊD! II*9p2y8lH@A69YŎ°"vۃ[V|~T m`沔$r@ $f8jv>{pZw h6II$p237Eb^{Qܱ,ӴjHx$d 0H(еH-DO5g#uЎLa0H9 +7 Fe=+F \ DFp8ۛ{gә8ğ+v^>= i4 vh]Y+)tݻ05eh/ʽh;N[P^;)U zb[q"9G* xb0s5~u#FϷq\Y5]2r95f H/Hg<Ѐ. \`Nz֔nm> Xϊӷ\YjԶ9PhЈWy^8 6m!tcRJjalN1]$VpÒ vsGjkw(+q-rWgťy1ƀ3"1G zT9ydAՁ݆ gnGzĘA\dUrXFq uB@ޮ[#!IP6] (5Z 67`'+ 2nmj@&' +Nk5+ն$azWk2ۓt60Dڞ%$Igcy%H}S8jEb^Mf'jSh;p m¹zer]=ރ Hh ]F*JgV!vE5u #  e ީzUę Bn鞕jYvfĸF X;z-X1d;کM[K'#jp:ncZ:H[XG0MdNEvZ%e\q-#j-#vy2d*ݽiN'i{P5$GJЂ MZ iIʧy\H2o'L\ĬZSsOKyM#/L$P$EuL":tPS me sn2YVN6=qZqF:A(Z싂?'\iȓYs[9$:o k{ P6GZ_`b&*s@$ɮS2J<+V`~xsop=)+j$L֙&">gC֭K@A;.I8kS&GU&71󭥌H2H'T/c!0?Of\VMGܱ{΀8RBf+VDҵxw.r`ɒ+ti, \?X$Syo ;8@aY$9+"@@K !eIhYù7ۅsnEsL)H >vcuO5c_^~{j&8"i>Sun1=1ea)PV+rT⣒ɦ@⧐mj89vi#ր(MFͻ*E3p>_ X0gB64O)?ͧ8u[isjp_Q&y$̣T(G4 (f#-7,MU浭otҡZr ?h, )N7xxQڒby[lkOj܌(vZk2(T4v{aX`z#O$eGZVԁ,Q#B6_5 t6aGUʮF_׽UN`swf9Q F҆D?20Һ[Y4IFqT^ vKBf܀9\w=;.概{ 2Hވ֔1eIG~`sZ%I& ,Ԑ1@\ :g1LojO w7^3Ќ1F~_g_H!><].{k[L7Rw'߭{[$LuVqF <0HS:4@%BzZ}g1EO0RȼfPmbku1bO(x(:3@ 8|J<(Q5: PlS@t|򱏾s]e {S1>+@B<Wf7. A@˩;(V_/:Q[VԶ;b| L2[֎<;sֵRXݎ 8|w@ ط5vn*AS6̣Wx<N?*tzƥOuu#ںmtu]?.FȭYkXnED`A9xƐ_jcxdt-h[Ff^bopd]_JkPa5mfۘ]̖紼AkO. U ~Y8sI{ȮCpF89(kRzw!^fh4`dOW F#[o鉧^ \Z\2=ƀ9)7d=APhAE'4?^k,)5AayDU#(kytD2_zӶfD'-OOրQ3"GQȵۃz$cy_OMIƯiXL`N pq:;TSڻ#XѣfX@[%i\ Y89>hc0ho]V$]?e =ε_<Һ@(8 QW5FM#ZҸ+㠠Þֵ[h°fbI tCoV[,3ȉCW4kSRח4T2\)`Sitp>j>302Mc+\fs`Wp֨OG$=R)-k:{-%Ws5-dž@M`nOuO;NJ۠ڹ _ODW<@w 5CY76\&z5$T7 i浬mv9$PJw"7p6ç~TV֊;@  >3{@l-T'kdHTAڦI8+@^[OS2(aV>1x ?jCVS~uˌ]hlE*r8zӋDPڶQ"0x5 7Rqj ƥ@Zu5Ե-IWCeBzf*Jۀ1J'9A&EQfUy9A4?ӭ-'c3OATZӯU+o<#''kGI[JR+=<3-Qm-Hc,o gB#F{qX*ҭ}Zdut/ 8]|+Rbv"7.cX`&Alz LnH1\IZG±n-+4O_O[2c'ZۛI%1#Q^Nѵ?QEk or>.69õy]h"Jʇt84$_&l\zydh p\k=Ԏl ir^hbC-M:/ics=eB$ F={JF31{ln~E%PK\RT0爪BZ?ң>7x(ր4luy~q\^Z]dṙ#?JA'趟Ğ?,SD;[?К<1$rmڈ?Zr 82KHu zWcyVyRw`2LRX^@\ïU斈#?tHBK!dXF&MOg20ֺٟ̊dfvϨ'T] N6\x^L\ېm)5\kc- רeYv]޿g)Ub4GfP&D3@P\O}EE6wխy8ԈCLh똾f)|1&dU.D2aח1y0\VN (Ǩ2ZF&)E)fM2FxQŠY$y S1@ LPqEYwr`yc#=~aECG4is@\n i}~U)/$>6wK5$~Q H(T2(sXpuH`O`"a۩J-a*} ɟ\>@?*I$Z|n P)@e/&A J5+iLt~y})gMkJ #\£RV)Tu9 ?m~P;fbzzr3ILL@h/z>O MA'9-@Ar\h (ɣ4Q@4g(43Fh n7QE&(Lњ(4f(P#8<EP)Dd[44 D c A)*8336139-374962-5354tnClick to view original file;R+s|$|0..J?^ Fs|$|0..J?^JFIFC    $.' ",#(7),01444'9=82<.342C  2!!22222222222222222222222222222222222222222222222222" }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?W V*0+: iBs@"\ո⡇۸ZrRiA 8I1ɠNԅp3VE$"@JsҵmP8s(X,WeMoܴPc5 *;r t/Z y3`>Z6PEI8Ɖ8*}FeB/cYKqϷJ(HOZ#C3'f{L7y*R3fd1nbBr855Tc>}e *w @ C$LS'Jݹ ؁~C#%Hހ0&R*ƺ GDϽc[c`oIOm-0d Ԏ<Gpszԁ8P[峜֔6⢶Pm8h-7x k \K{PGb˦y,*øö"Z,P7ϭjh$v&C e^H'| L1YLi>f%,9Jv2}v9b=*̊1'v I-u~Oұ5;lu(1#\ 1ljgygkWWyӌVLo|g"B^)c2CҨbi+g`;rb[A>8 kS,8@AlA@A<[gwN WCon6j 1J΍v'[g<9rB;'+rq1"OJmvM)DpVH5U|2qZQFWGJ,% \u;cl -#W589=V/+~O!QkM6+s8YҀ8B!>Js!Z@dcOZb# ."G|53dz&( cZVHnHA @l8EmN0QIwu AZtHcF{31`TvRNO=(z!A&E,wlOzͷ] 9 7n$HٰttcOSXDҬ/9(PU0+ǭUǭc`$r0#ү"Rm@h>pqGȽ}ϥtwde" OP jlb۔bWDA0aWsmǁ]Únv3cb|P3yj̭]SAVUvc|Ǒ]4o=sUnJ8Ng3@e/"׷s~7j9/yv@ylɀz+G3Bxg$uZ;|@ d.+2О˻5Cª[}h%gd5^NC%Q) AQR:rH 2{Pps+B-SSьdԃA tfv?i¸-=L*(ڵ #?ҜM>{7G€14.3wp?Tdٔ%u?4}+NM`u56ɱT OۗPF:P{KJ8 -ƾT&Y0?R@sVR]*8eD2nVSOBakooۡU=h_mtD26UAk:趢<קjCKL(ڊig5M ހ+N1}+F=`ms^*r,ԙ@j $'I@cNFy.d?3_ƭ-c0 CisWUT>ݏC`iY%3좻 #{(??VO&[@򿢊4PBTdֲj<|95|H,1d=ʀ:|%*-693U|_(9 zS nn$,I5rD1 uZǏu-B[XXl$Ջiw[Xj!5 J@#9UVm8%?hw{"/-ld|O.Aa,F5^xVd@?Im}J .T O€=+\5GYsU|YbUŘx.GYW"0ij\[G')1EG()mn 52Vu8m!Zƻmdgtd||!kz A8V5dr'М}kмIac!cC@M5o>^#L% Ƞq0GC^}C-rzh:,[h;zg?ҞۀchIWu\v @y |BXc!f<'_!ǖ-2?5~Ŵ/tT3G ~58W?w kO@ ̓8@:WI \ko9zmj),}z{(ag *>}aBj̷uZM'ZMj+eaet2_6$Ƈ"D{{)}Wހ-k^iZ"=;ƍ|Rm!`2knV2وq@Ipasg᫙Z13zM+XUoGq@() rܕU_P=^>i -ckI#ڭI7Xn<Թ_HāYhZU$fSoƊP-?~+ q\G9pWSm4212+1?J$P+wo- 6{H#**_㨝-JXZB<O43hpeH-4^ =;\u1N>iT3/n8=,c"Nѓw v펴9ۜ皮^=IsW;7_-k=EnY\[X3$dhm5)dON$] w㯯5a}{J冘gdSʨH9ϵax+/nKc(FG(PtlV}xcA< ǺV${'=NJO O&slwTrw vLvڗd?vx2Ld`~q{_L߼hHQS;~_@ Ԝ uIO'BP6:椌lT8CFfɘfy*zFKi}e@e7r?r558 ʻr?zסkVZwā4gإu m윆QZ]Ro6waRxN]I]DXpݎGu 'cI@h (˕X` kt& FzJŵZPf^hqqHHB€:pyj;-yj6fj}{.v:0$@nkUfn½ׇ-Cz# I#ST~6͊IٕoQ^ቖoY*Tb5@{z~ZkT|:v"Ǎ8dc9>`eY%B"cWjohI+5`EGMyա T;`۽jAx ,%aa]I%*S,e0u#GڬYCgG !?-u]6HpC⼡W oҽy]TQsx㉯t<˟Bh<;2A q  Ͻrk,^<%ؘItµI(sOZ!ȹnѫcy4gڋGd b;Go\c!!gTԧncՙ!c?tQEUҜTv>Ppz{z1J(N?wH7-N#q֩Uʀ=ⵖoXx@u>52kKm;F-Uk.KiHt#:ǿF{RF917|hn/]A \fJi<8ֹ ߵ=)5ٙP =(C"mm[G$W0ebA3[)"Yvc@ci@~Oh3+|##ewzs֯ 20qҀ-֬B$$޽2]N;@tȑ۸zI5K%^_N]#ukp>qqi$HY[I[K[eBp- mٗSp$$ yހ:TXAaӿUbՃ0Wh1L@"x>h>`J6>3EW:u6 8gWl[EH n:zVF8&3K\zqAv)qP/CSFsVmf*VH8 mu AW;V~'Ӄ*7ĠY ZYʔjcV@@k7|RQқom}|Op:8RxȏɋŠ?_ӟʀ 4b!/% pZ_AORhH{P9Th5-x9?֯Hm,Iq௟@fqZ2ijq]&][ 3ʟPlS!()u$]ϵ2<2?y>8 (C>y6aUp;g-ė2fr@|?:zөۼAORh?®ŧ9Q%ËxMo?^,f CK(+dJlәNB᳒ĒXMJgMtq楒is%( w&%^;ҩɨb-xr5yc= *kd*.\z ctďSȯIKXzP Rm9-O2ק8(GĈ]NA^ƀ33Ex9>b+p:}EQ'Cj`*(S U,TdLόQ1Xa1ӻVU :Zh@)zA<@)uNX65iȩ r p1j9,8thV,w]PLҬPS ?9=@^WP zq.䏌Swm&Eykwz|ZZAw@63$va_swYWP;Qʁ52:`P&j fUVv0I( LD*"2OP;FErrր:93A[N=5.}9TfԄ- vFΎ"2>x -Q}3=muZPLBCTu)2iӀsH3JdA(nM_eL$p~Jѣb9i!Uhx4R(S䌱֢)U8p)aaqܬ鹛!"bxu5i{+4 m1mY't޴n<9QKm/L!V I'v_SXW|F&o*;ks {S/|;Oh2!~]GfBXVqvL|si~"&=un@7!dwy ]D}rс3湫Rw*<Q[mۗݫI1՛x%[i4?ZYZN2~fe &\c8 MWKY' 5vKG}k0a\=Ie]dk0#4}#1bR4L 12QK;g6eD1y$|cX׼Ds&-e$qpWp1xT#,0"{6юZ2yOZֿ$>F<= u 4oB?Jl Z<[%ȻB)9Q-̯vڀ c()A BFYMtO-~dlu?\Y>½* GOCXXbl"}MMN \*Fs:GœPSRI `sdVH9yVI*,<{sq}kAmdw5Pt!"lʱ5G\Mr(q׭gkQ["ahޭ]_8xObO 0]~UZȃA6Rr%ίh+ 7[njs]./-45>";T(ldt\ҡ𶮣NIm­# Q$.3қR zokBZ.2(@GUk=5cѐ@qY)wXۃWXXI}syYi/K {fnJlBS;^$$dV5&~JlWisIw`yf]{+ԭdy,,9ً&N7޾WQ5Ŝ1B׊$Id-Z(Tg$_EC@4Q@:Eдԡ9CBH#r+Aвe;=Ezu%IgʨW91^nxt#{-. )bp_Vѡ_0n!^26կ[D Ir=ԓIk˼ҧ%+# ջ Ham)%?@p#\,q!.Os]UDwqqE^Y~EmxaTV9<]𓒤 sCwY# QH5]i+oc CX|ƹ;CRFkt;X[XbW syr<5sb#r{VՖemUzQ_tq{5 ;zlK }}hYbx±V\+4"2AO½A,Wͯm̡@;}X >$-pW ivі.gWOxoTvqWhN]4JΑ2[huj7yK$ۍz\MR;? LO,pQvC]- Yr=y_u{?V%@#Yi m٨XlSIhKIK@ =Z4#ƚ-ϔ(߅zޟ퀼ݳ~ La\AnFUr>c84١]\0y?>i11<^*~_o믵[O,n6wHYF<Տ(GCҀ<2KP4d 8#ڻ;]b0VTR5躟-Y84 ?zc7z/mpf(=O O_{KDmy;)ڀWƂ85\|ޛ\Me `3_B9 @ 7Q7\DX>afq)c3+ͼI ߆.6?gr^c+EcxMvgtOo(n^)QdT*FC)?,n )ƆG~ t5InV,1*z~:Z#h,{x] 'od窩 omQmc"DNn9jYl1ȸz_r(OUl4W9'_UW{]t`m=S K{nQs,)g8`ñ?GNl$h%w ]TkYU]׺N9eSn/} R>o!;ISW'gusM$|Z-myJ\t|9lƗK#FIqVtL㞇8' 99JkffDxYIzwN[ŢW,{@# wl`kw὆ۍH3E=xcvS@ ,OJ)>ybO>zJEXHpw~\~IQIi$\-4qfsؐ3q73F-vJݾԢ] tbfMDX0IOIڀ&|/S)n]2v(-&(-44z)' *.)s@vêu\}+w!guHe(OR?¼5Jp (jZ~X 2+ 8#^hpadݟ\bČ9+*#!nIkoVKG犭i]8}k8h?;*hh_,4K 112dR#u^&}޿y)8TO s^;8Idz]j3S4.$*U -j"A7S%&)1- 1B/$a#g8Z*bP"D/.VOͻێ87 <{2I#9zZvx4K@ 3Iړ?4fڔPɐpʌ 0l^sHُUZCր,,юI;Z5PRv4ḱdhd}UR }giBҤPqji%y%m;9c4'3M ;P;~4($9ʝy'e4U'(lDd@SS G c A,*8336139-374962-5357tnClick to view original file>Rnj0JFBj0JFIFC    $.' ",#(7),01444'9=82<.342C  2!!22222222222222222222222222222222222222222222222222" }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?|ҪJGNSъJ\fOHFڊX@ {Z0wҮy<8pNs ]T^?Y:sEq&na9^^}qP8;5e,$4B(Yc +¯}Nk2H rul= Vr08 B9@=5nHbtboC:`0=:3&Jq݇T@U E#9VA紸$K \T8Ͻ.809'OcAP8?΀#h Cb[# IZlQ=,@V5U ID##8\Zdv0"fm4sYQm:1>ScӴՍ" ~_j)K;_a@EbG<ڡӒ7$CSm#o=ZNPd,?Mh9E+r;tԭD/߁SD=)+vIR]I@f!wފv1ҊZDcx^a>Lm%;N~g,T ""bʈ^Fa=h -#E%ST%O='eak+P{[k|!(29h4_ Le\O{4zJ$sT]?*L1(RzuRݻa+€"vN{bq;@!c`##ޣڸ?ߑX( cL`nɨmybF OJwe%Hd&?{Q uziAiZ,prŸQ]Y(ʒ,(f1N'Ո-ZG'144S㜃@z{6oNX9vw.м caIo G"1]c);P4rD18)>#+yL =9˙$nmf!gfZ)dE][IKJrqR -jyeG^Fд mҌzjz7 )dJ믠 y +OSH%EtI Z}{C~[G;CezÂiO )AV5.1xc+4קeS\ٕ&`rT0}P#4M)/,"VU>r~K#}FQxNt0 (wGe\iܜ+B Vz͝a~F6J E,6H=C^wzڤ'MPP|/O{Q%{SqPf ^.ѼuM3X_- QW"8Ҵ'ay`zP|Oi|I%y£ r?pL0 skgo=X ʼϭrVK"Xcʇ,/-г3(;xj̞vFw?1=Mki7-^?.Gs0R4+N>X+o3rõtfkڕ?4|خe9>(YV4 (@&Š#ajK" Zٓ ұH't$hec%(I(m$BϬ[@9(o"jxynBq2K?'t^`Ya(t:UIޮ:}(4=UY:BCp33ǸE5Y/G*c2ݶ i%HP4%մWrN >>E]'^xx99ҽۀ=+uyJ;4,*ɆBGx8-4xRrڽ,2nq5xy`AIʶWWO{p<6s0ֽ(c;ǭt*HH²޸}t64++[:|,ֆ.a$(mRQe~bGV#\ɪ4Hp(I%IJb㞦^%Y1y4Kr *-SGSM͔GRrY|Y[/b=jƙڼ{.I=u=/Px&I%J<3&}l..nH?ʸ?V5ǩpm< f8foPg/O%EǛ>NWlĕg$ }mf :nxZ2%@yx'|՝t LNKgk>0/ DyhO!8zEZ\I(j\JG.řO&@֊R( oc$TMNwDW%~ Ai%2pp}s bgZNCHT`dӳZxXd`k{NXmò\SA;:ءU4& ˌuSӵ8ٓ'lq\ƶ]6mܓ@x 2&en|n$,\8nl۴4Mf,s˰b8$aj[7N_W}-/ZB,1{ 1טi04nGV-Ԋе].i$p|ISV 0 p֍3O[=(yoq x.ö`7|u;攖U٩o-!3UePָW[;"ʣ _KsATsM9${{POF?:8 ړ(h\Q@ l`3OJmt/nF~U9#eϨ"  "Z#Bȡ ֣;2/?@^s J^(L "QJ4ܦ#uYz+f~IUϭwSTu$t$`V]mY%˟p0ֳ!b鸜QV][kZk'Q hշb:2Y%}͎kdTƯFUzAjvf.7X7~'XbxVmх{c\{ڄpS,IVt9g(@ EI͝q'oH~t+1©'ڥhDXaߕD§Oz<n!PSanHNc|>EVgs?Px5͌Pѭ?ԛwSLњ-j͡=04 ;BxqkQZc] ҆ PvR??t~)oU!qMf]w˥[O0"Oe@?Bmm$RHqKtyG(I/9HE}¦FkvQ)6$J0͂LO_[ixEU_MjfٔP ӁghKy\O'Df׋4O!(0qq [e(?AxZ.e%ľŘS"nRgby=M4UmߧoG?cٮSj !-hG Z3] ԐV5xQT][ŃL.M-?]\Ief&]* st5/rO)PX[Xb/ߛgQk4Ҽp 8( ( ;QEQ@ ފ((Z;QEQE-%PH((((١DdR>? H c A-*8336139-374962-5358tnClick to view original file?Rc61$ Fwc61$ JFIFC    $.' ",#(7),01444'9=82<.342C  2!!22222222222222222222222222222222222222222222222222" }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?l=9w/c4ͼrqNt~4F(:x'ǽ5"F*(3E]6329`.%r6\@fS$֓MXՄҷP]Y\ xtȠ NH?4UEWa5ī1@(ҭ.b͎PE@t\_NKYQG8+/@ ьwNԞݩGcOjLPdT9KҊaP@M#BMR+\HIّ@BJB~m:玦#KSey=ecʜ]|~d#'zVhϓ^6?`Ee4TR3ջF>2[Yk!tdB(h6O\RG{ <8ⳍt:/#,KdAkƢ$s"O^݂3D\[FTztIBMɠ _KrͰaܶ^ Ш!/v#U&cހ=nŶ%') |.x >9U-'^ih,w{=疍qƇ!c3@.>(رnJxRQ7:;eʕ$}j/"$Ҁ o8p)0J1q4- ]\>xMր):TUIt2ʒ.3桒&0T%NA#x>HbYxofE>Oƭ\jG)09}:esE<E_|s}q9@rbNtm[##;lxAoMVF@<*MG,c_ >jI j}k gbx K;tpȌ|%IU-VBKCYO] +A8,Ge/T($`hBNTԤ8>%3,qtt[pT:}еB*`qGJˁH;tkyEð»NislnUc%=h*L1cQtUKdj۫㠠 H]8cTA9'ݎY& $SLnAck_IUV>f\d$Vn.}5ͯ׏ǀnt>d81hqZڎ-Q#Ms 9RcZcӦCg +uF:yC$C"0::{5!c9 _JcZa.<r20F3kWOk@~yw&-C݅m .pyYiv{ |I+zڀ?`2LUQo Jg%9uyd;h$(I,܃jVsA5=ppnpj[td/Lu"Xbv=+kH3jڴo rO-`OM1ϰ?Snv23r1޸DEw0ss g4meMNFz~4PƏy[ڲ~c'x=F櫖ua6>\ܶ_%.x^Phe[=y7c~M#j@&+y/WM@1:+ʴ}MO@mY<)"js=t:?Z2c56-;U)]1b S֖{>}rgF\}cu#4rD9#LW-;TUլF{cTEp+ݨHĜza*QFn-UGsui<q\ZLnk0)O<0b%p:h\'\,p)?SZ\ B2rjVX,ܗl1o%ɃvR>}h rɸȻ|$=Z5..-hMgPlDpHmo˵}!1+ҥZ&㟇[&DM$D¼N^D0k-@)F67a}wťT=%$}kƼU6哷/ nF3ҽHaPS -k{InFV5OUaӥr=iu+B1 SK*F{_WC~-.O{ig٭b8u>4鶚^cs9.ǩ5~X#3(}(FT E<6[NFC!1=q@R?CCV<@k@1+:ohGS>, ּFnй$Us"Ӣ04z 5+۶$qYqI1RrO^(_jA]mܛ  d=isVc*2x$VqҸJDU$QSWo GkdSV~Ёn.@$=vP?¡PD +\wMr<ɸn8G:ٶ ^#o6y|zb!C#9."IHr^HMPyNTvITokh;2cX3-VP!!mkk3(3=Б@[5NG qE;#N--!*#9*HM㔂sV~G L)VV޷t.+*(6U L:9"pxw<̨bjմo"lNhڀ=c~"]J);I/j oƺ[;V%cXh\SÂ+t72C9vIPdޅ8<iqހPcFiF=hsMHs* [VDyEy31Sd\ wPVd~[kSBj)o.$䁎(r&hR.O sn%?2Ҵ!=h#D6aypieWTY8ֱ.\@Ha]\F3vgҀ5>P}95R[3̆}OCU{uk-k8 skgH&dĤd{4 fVrIbC'lyr)$8ҩF5v 7sWj?JӲo"i-uaҀ#-P54K@}*f ]fMt*p+HGҵebg+{ke}qI2UF?1^ٯh{&+v􋋜@ 852(#W{OZ_[0?K QW`h<+t_rg=QR#7\^|p"ޗ ώz?.{ hIY$ I+N]}ģRBTnǸ9V-t'N$VleH:s@cmE5;aBrq\nڻ_i.ӷןZW h#Z \j֨>kƏ r (jhH8e4_Z @d\nS:ޗ$*vW0ˉUvN)"Z5<0 m$*]¹[L^m0gI%ez^w{V7s?5= #?99ĺ^eogL@Oқb$oiIU*91=>kڞ! +V "\ʩP9oj<1wc$~<:VM#1iP lW[,Ĺ!!q\^ū^$2 >1lO!-Ȯ=zuY4S}UGקJZ8`BnaSݳ^==+)#RiV0nB!8@PW68pJdwvxluw]{iNF8復j7@ѵ=YYG@d'GJ^&J}#ڼi3&p6^zU`yWm\fbmgZȄh-jyYxHf۴g#s$զi\&8nPĭdd  CT^:l|$+rUdEvR0rҀ=cVKDeN6WfV{חZ}V#Y$eYDr4ZOp6?qGOr*>!ڣo[i걄XzV~K ᜂcv_q@ Xu0,Mʜ遚yxr涱s HÜY%ĩjĜ۸L[fPI\MsH@ \+朶:=0+?Z;{@pkVrԄ1s֝͢ t)4ݯ,.ReZ/|^ eܜ{ A&Q)N9#!0:Q@jEcަ#fn&9ԊM\UZ!ǽs{uǁ]$G\yFoPgTIN= IMᚮ>xJۏA riddIǞGR(UFVjx/SNԊܐI]LU g@z 5Vyڽ;UJBy7B==>U 38 zPŏJlHte`pAVk@(:4C9O0ί$R2tIvm@@Y5ŪWks2,,q/n)j5ןLջ1VrI c 5xk7zg=뵚С2Xps^_ijګVndA8~IL#U:!YGr|]|Z,7&D{\%&SCD~Eݎ;dPA*LWB4}k*2x$7),yrBSj2y#~qƀ0r}Zc,YvZnjsK0E=n%V/"vҀ2no4}TN圓Ԛ5%s'PT1zUr纜9h׼[nY0=b+{WζW̳[Ѹq]֓]GG@Gl_~*@?65'Z+q2a cE~~# "/"GPڄ0Mßٺ\GNtS, gP6\q֬UenV֫J֬-惧eX8U0Ӗ}Vy&DFT ׯZ)= q#>^Z[^͚dq]c kl[OzѰ]%´N~#ju`eHv۳Qخ=Nv2/!D{u-y嚺q1">Q\N&gTf(YAVWd soS=袀4--I4Q@~͒9km, ( $VUqSFފ(5LM J( Cu$RdX-s23EWy9SVWTA=ZT:=멇E^Hl`?J_xN__FJZZ4II.ZB3YMߑ$7RHMW,tTsVukFed &xUy&fR#ʘ$#7m+{Eyg`q[-6Q8magc@5/™^MuV#vh4읦 YV׷I%<+z}TѴǗ⧽}²<[oJ JڥoQG&y1]Oy:jVJ$"`!=v(դݍ3p>ӅɥRwt;s[i=uRQ \bh3M?^ЮewE3%V#p}ygD,jTN}Vy#:֝5$``WY{c6C+C(y)0keC1^iZUpqs@hx )(ӺANEbsQ.DXSKR&X}{fkf:4}0 d=€8?Cq$K }_ exF:m=^ffi-؅3; -P7ڋR8$t )vUPr1^ڍ"* Y5 j%X9rpڴ51[:Ku= Vl+vHc Vhյ8H7=yL:lU!ì Tfǘ00^q@Yx~qG ^$tw& +!xWD Gy=Υ}\e mQ\>/ɜk]&ǒG=WBed"irGA]%cFy_Pd/eN;4ۤwinM{ۼvͱ9p:f4[;'~K^>5dgb>U'S4ly B.xQTV&r M6|1#20AzwoM(1nrZWum!J߇)w$'$xZ5m eH>q\h63H}{wԦBc{}ҼI60z(̵.;vMn`} b{N[:cF{Thԫ)EPjOyj2U]?-1w܊qր:-!ӭos^VK&m7p/h_[)`(Y'ҧf.Q#2q~G=oŞS幁1:?| = +(b;MᓞA+O}&mlz@=y&]Xv fnE|nrŵQCzXź-d:ޙ kRē%O`H_ i|Zz3Y č$$ot֚z\F EՏG]r'.} w9Pٴ?:.ݲ`pIJPθ;sqvavB-ބIbE#GirDckD$F^`J-~Ғ՗ b>𦺺֐c!&P{ok+؁ݜOz0X 7lze#IBEvToOtBx_ýp/n~lA0y!q{H2ָ[tOgI;\#)\FQ33`&n?A@sr F`7x;̾&Km㍣=볻:śA$x~`=ePao'O@{ǘ ǵsƳnZЪrڠ'5Ohz¼8l̀$۵fi.g Fg7'בf8ۖg-#Jm&HL v8]udXJWNڹaunR{x|v|;||kܷiٶ%u~-%A} ۉnbf8u> /CEc;l3HO 8,EEjguG`% ̺&^T&BwJN[$#L9 @qFaC Oʸ yq'@9'=Iyyjҥ,z[`Y0CQMfj{)d➮H%d9%*P$F8LE0Gjl捡#5U]BlILZ(xKdY'p? W? |in?:}Zdr8iTI1}= /|eV_[€=O߆|VE*HVUQdK ;#l153[[xHq-Íw ^m|YIJO &ߋ^?^j݈c>?K a$m)xH:x&m=lZy76r9+۟ʀ{gۋ}Z嬤M }+u &$ZRx.|Px[r@mָR VwZ8T|YCzG/I{AT=9B>7T]mg è=i|駒I}c?Jj(Z- u}s\ye(PᘜF6v1*$~6Uy[HOJ|#r;*Wߚž3|<v`= Ω\~!eER2ckeֵY[w;i ycmvqUy5^XKPc '~qs-˗ѺJZzyF˹o撀IKޒ QEQKEQEhNAÀѫcQ@́,R!~uf7+>"pQ#19& TJKlwiq{Q[~ ށtB)>h!V(vCsȕ"|W&b*! ?FR^i @=+K|\j!`W>|2®\1?%ǣf{O x^);bX(dlz5jȍqK8_1 k85?a W챣Ukoě_V_a Uzu5?.73=yt:c5 zeI&˛pc8ɨ.nr6}aPPOI)(J){@J3@ )3QIȢ)њ~iCsL3@o&Vhu8*}ko\H"5 ."P}x&qJ$`rGҀ&9!dU44aA\]mKs rI壺9蠞OS-;~p #GӁ@cT'FwڵhZ]F"X秡Nz[ A$-}IZ|$#̷:*B=pay׊ȎF}pr321ڄ7NюONG#<Y럺A Y Uh _KdF$Mmp<5țÄ{qhZؗ@2W޹v q$MjTq#9ǧZ:Cv~lW :st{,d]~a^CQi85U~=(+^#,#WY W* ָiRtZ Po<{w<(*`m^ݺ KFOi ;A<ެXBknF}޾ߙrSVyc G'sz󐨠:_Ɛ,ۘO֙wPs5i)A0}s1曓sO#zׁ8zɀ{Ҏ)"e2L]=6c#k$Y3׽^dgg?a=J-XS9p8ށ* g-y뎞=Ǎmt6 (XbO֭}2 TSuzV7y\s:DhYT-U 9]vA)U`~Oʹobm(c.uҝ" 6ysYIltS%$#@r֛4'㠨qPI;[s? gF|!XY8^whU/]M&JOAZzfzGÛ,&0ۻYkEȣjT1׊N˅eWO1N^x l&|qRtpƌ-｟Gm/S$[8L^q>&8Ck1H=YWuGlbyY:̪I sU`Qw]:F;b[tԱQloAs cqz[V&{6.9PϡaGF%Tq2IYyjI$²VeA9+|3xVVGSjC6<{D֯:6nqT^}x(X+^֙siAXŚ2 q+tY_hpns6;xd\*ysS~x8N9ӝ8= eJnTi'`Y9<'5<[خ@*)(@1$V3SVܞ'[GTGQwr=kSOȾ[Pg=:dB{5f:M\#zny>yC`qSF~pzZ/BǶxR<5Ƈ%^=9#pOX!!`XC㧭vf?[˿.n埭rb)b km*9d*ЕT$هo%f8 |_Ǣǽ0s}1ר4a6į\q&~[ۡ/{i.:@+tؑ>a#'eJ]unc(U%JI4i2W.rqՒu 9@>g6w= ԃ9Z*q>KE|V%KU3)t澵h q܊&݌1U cJJKC)F⻗'4;@*y&&Vм}f z-o_cMZbc,?( czLq&IPsMf2>[ C[H (6l(,}@\Ӂz;;uDYCI=n-f$)pv)x˭|$ZMZۤ/;2'@y)n|^n{.$𥜀6dq\M2~M?6s߰MӯncfxFujIvO@;^R<>Toiζrsa vgajvf)X=3q:=pA tv7(ATR:3Rܶ6Q:Z35h=>٩u `JNkʯ$G X'LzEY&)$Ȫz('ex3K̛<?h N^& BpGHϵ?hثZA\u"QVn9B#y]V$q'5. t}ǎ)]ul˧F~+X'0̍ 0ErT*~h0غXx?98SOxie1  9y=?,\EK|ʤO>G̷1qӘ(r.x$`((&G 9FjEqml+_sBAcJKYN扃u3ҳz{R~.\2/L89xu'vTdiG%(C=*Umz#rgiUS<|闓Ht|;B '{3Iy3J}h( z5"xHxB!& NGRs׫[Ff6>c''R^SYZ;r#Po,y9OUvV|.Vľb{Wڼd:y%;ы Xxzvŏ .rf9`#u_EF}O:Z :6cr.x$޸=9;4#qUpAF\Dr A=:TRMfmRqg T#J;S;O4^g1z 2xzqJ=hSb횐s)LlW#bolSHϥNHX:ΒKy-鴅;iGMڧ3,NUp ֣d22br?R0ʔv>8E}'^'Ȍpd(A֚=;O ?%<+E7#ÓwehGB[]7-q.=+>1i3JhVd3/+=kӭ. ¬#y>!d䃑L>De< 积L^⦪QI:mTFܓ)oO }P5Nv?ҙ4B=z{g)rEbb ;H+ p{էq 9ݜZ o&sҚJO<~N+'11Knizʱr dž٭Fл`##'Tˈ=ݧ-n`V`i֪lVF̞ Z#pr? {Ϩ|t PF013? FE7֭ɋ-8X`Q7!SǾ:ZUiXTp#5M43*ʍ6&Lu$ &^*46%,OW Qތ9RpqsqiҨ+jzùh %<ui2O{ +[G l'yr^q_0;"Jp˖ uubԬp݇=}:m c`'9#ӏڽ$csFZScu~Aqs2*pqߕRIa-򓒽9'V|321tF#ۭvvIqs,$7g-A;{cҳܜqUo v#sq@zHQq@<Ҍڢ M<sOj &)G5CqHҙRKGZJW$xoۭ49J jt,Id'; +/NˈG-EzJQf'M<s 潛GhUrpq*POsTNJ ]V̕' az׏q'C021ױq?UWsmirzzk^Qv*ӰPbzuɃ m]9ʺ5-&{Pœ!?u̼ҽŶm>^nߙRe8@$:W*UbI)ʕMѝR85 QNj"JAiz"ҚxLllL>֙QrDG4>أԈ(c46vU~=ax'lE,LcDtӃVQ|B3S$g?*2h[]!U'dMkĪ0uxsPX.˔N8ۈՈ2~G$K|mMסRgOEX뫈DqFFWvpk]\yp8#_s?^g]-;>Xzs B&N:^atO_/US(1݌%T+5UOonGT>%T+5UPNG  IHDRK*CPLTE̙ff^zbKGDH cmPPJCmp0712OmIDAT(ύa0 $G4^`0@"O(¾QhGyk\4d4]( &yv=F.; k`. Xv\QZZfilTsHLΖR'c9\Jm JKMQnA@lXbOtk/_8*>iX yH@#LIENDB`Dd ` O c <Aedit-whiteFb3eb^ڍ/: 1?qneb^ڍ/: 1PNG  IHDR#niPLTEss wotRNSSbKGDhQ cmPPJCmp0712OmcIDAT(m P.`X]H3L"{ A 1i,B^Qٝ>J%^/hZUf$'*MXD4JcpIENDB`Ddd P c @A3delete-whiteGb?xҴ&snxҴPNG  IHDR-pPLTEss wtRNSbKGDo cmPPJCmp0712OmnIDAT(υ PW H( wJ1PޏG NH .]HIENDB`Dd ` Q c <Aedit-whiteHb3eb^ڍ/: 1uneb^ڍ/: 1PNG  IHDR#niPLTEss wotRNSSbKGDhQ cmPPJCmp0712OmcIDAT(m P.`X]H3L"{ A 1i,B^Qٝ>J%^/hZUf$'*MXD4JcpIENDB`Ddd R c @A3delete-whiteIb?xҴwnxҴPNG  IHDR-pPLTEss wtRNSbKGDo cmPPJCmp0712OmnIDAT(υ PW H( wJ1PޏG NH .]HIENDB`Dd ` S c <Aedit-whiteJb3eb^ڍ/: 1xneb^ڍ/: 1PNG  IHDR#niPLTEss wotRNSSbKGDhQ cmPPJCmp0712OmcIDAT(m P.`X]H3L"{ A 1i,B^Qٝ>J%^/hZUf$'*MXD4JcpIENDB`Ddd T c @A3delete-whiteKb?xҴznxҴPNG  IHDR-pPLTEss wtRNSbKGDo cmPPJCmp0712OmnIDAT(υ PW H( wJ1PޏG NH .]HIENDB`Dd ` U c <Aedit-whiteLb3eb^ڍ/: 1|neb^ڍ/: 1PNG  IHDR#niPLTEss wotRNSSbKGDhQ cmPPJCmp0712OmcIDAT(m P.`X]H3L"{ A 1i,B^Qٝ>J%^/hZUf$'*MXD4JcpIENDB`Ddd V c @A3delete-whiteMb?xҴ~nxҴPNG  IHDR-pPLTEss wtRNSbKGDo cmPPJCmp0712OmnIDAT(υ PW H( wJ1PޏG NH .]HIENDB`Dd ` W c <Aedit-whiteNb3eb^ڍ/: 1neb^ڍ/: 1PNG  IHDR#niPLTEss wotRNSSbKGDhQ cmPPJCmp0712OmcIDAT(m P.`X]H3L"{ A 1i,B^Qٝ>J%^/hZUf$'*MXD4JcpIENDB`Ddd X c @A3delete-whiteOb?xҴnxҴPNG  IHDR-pPLTEss wtRNSbKGDo cmPPJCmp0712OmnIDAT(υ PW H( wJ1PޏG NH .]HIENDB`Dd ` Y c <Aedit-whitePb3eb^ڍ/: 1neb^ڍ/: 1PNG  IHDR#niPLTEss wotRNSSbKGDhQ cmPPJCmp0712OmcIDAT(m P.`X]H3L"{ A 1i,B^Qٝ>J%^/hZUf$'*MXD4JcpIENDB`Ddd Z c @A3delete-whiteQb?xҴ|nxҴPNG  IHDR-pPLTEss wtRNSbKGDo cmPPJCmp0712OmnIDAT(υ PW H( wJ1PޏG NH .]HIENDB`Dd ` [ c <Aedit-whiteRb3eb^ڍ/: 1sneb^ڍ/: 1PNG  IHDR#niPLTEss wotRNSSbKGDhQ cmPPJCmp0712OmcIDAT(m P.`X]H3L"{ A 1i,B^Qٝ>J%^/hZUf$'*MXD4JcpIENDB`Ddd \ c @A3delete-whiteSb?xҴZnxҴPNG  IHDR-pPLTEss wtRNSbKGDo cmPPJCmp0712OmnIDAT(υ PW H( wJ1PޏG NH .]HIENDB`Dd ` ] c <Aedit-whiteTb3eb^ڍ/: 1Qneb^ڍ/: 1PNG  IHDR#niPLTEss wotRNSSbKGDhQ cmPPJCmp0712OmcIDAT(m P.`X]H3L"{ A 1i,B^Qٝ>J%^/hZUf$'*MXD4JcpIENDB`Ddd ^ c @A3delete-whiteUb?xҴ8nxҴPNG  IHDR-pPLTEss wtRNSbKGDo cmPPJCmp0712OmnIDAT(υ PW H( wJ1PޏG NH .]HIENDB`Dd ` _ c <Aedit-whiteVb3eb^ڍ/: 1/neb^ڍ/: 1PNG  IHDR#niPLTEss wotRNSSbKGDhQ cmPPJCmp0712OmcIDAT(m P.`X]H3L"{ A 1i,B^Qٝ>J%^/hZUf$'*MXD4JcpIENDB`Ddd ` c @A3delete-whiteWb?xҴnxҴPNG  IHDR-pPLTEss wtRNSbKGDo cmPPJCmp0712OmnIDAT(υ PW H( wJ1PޏG NH .]HIENDB`Dd ` a c <Aedit-whiteXb3eb^ڍ/: 1 neb^ڍ/: 1PNG  IHDR#niPLTEss wotRNSSbKGDhQ cmPPJCmp0712OmcIDAT(m P.`X]H3L"{ A 1i,B^Qٝ>J%^/hZUf$'*MXD4JcpIENDB`Dd8d b c @A3delete-whiteYb?xҴnxҴPNG  IHDR-pPLTEss wtRNSbKGDo cmPPJCmp0712OmnIDAT(υ PW H( wJ1PޏG NH .]HIENDB`Ddz8` c c <Aedit-whiteZb3eb^ڍ/: 1neb^ڍ/: 1PNG  IHDR#niPLTEss wotRNSSbKGDhQ cmPPJCmp0712OmcIDAT(m P.`X]H3L"{ A 1i,B^Qٝ>J%^/hZUf$'*MXD4JcpIENDB`Dd8d d c @A3delete-white[b?xҴҙnxҴPNG  IHDR-pPLTEss wtRNSbKGDo cmPPJCmp0712OmnIDAT(υ PW H( wJ1PޏG NH .]HIENDB`Ddz8` e c <Aedit-white\b3eb^ڍ/: 1ɛneb^ڍ/: 1PNG  IHDR#niPLTEss wotRNSSbKGDhQ cmPPJCmp0712OmcIDAT(m P.`X]H3L"{ A 1i,B^Qٝ>J%^/hZUf$'*MXD4JcpIENDB`Dd8d f c @A3delete-white]b?xҴnxҴPNG  IHDR-pPLTEss wtRNSbKGDo cmPPJCmp0712OmnIDAT(υ PW H( wJ1PޏG NH .]HIENDB`Ddz8` g c <Aedit-white^b3eb^ڍ/: 1neb^ڍ/: 1PNG  IHDR#niPLTEss wotRNSSbKGDhQ cmPPJCmp0712OmcIDAT(m P.`X]H3L"{ A 1i,B^Qٝ>J%^/hZUf$'*MXD4JcpIENDB`Dd8d h c @A3delete-white_b?xҴnxҴPNG  IHDR-pPLTEss wtRNSbKGDo cmPPJCmp0712OmnIDAT(υ PW H( wJ1PޏG NH .]HIENDB`Ddz8` i c <Aedit-white`b3eb^ڍ/: 1neb^ڍ/: 1PNG  IHDR#niPLTEss wotRNSSbKGDhQ cmPPJCmp0712OmcIDAT(m P.`X]H3L"{ A 1i,B^Qٝ>J%^/hZUf$'*MXD4JcpIENDB`Dd8d j c @A3delete-whiteab?xҴlnxҴPNG  IHDR-pPLTEss wtRNSbKGDo cmPPJCmp0712OmnIDAT(υ PW H( wJ1PޏG NH .]HIENDB`Ddz8` k c <Aedit-whitebb3eb^ڍ/: 1cneb^ڍ/: 1PNG  IHDR#niPLTEss wotRNSSbKGDhQ cmPPJCmp0712OmcIDAT(m P.`X]H3L"{ A 1i,B^Qٝ>J%^/hZUf$'*MXD4JcpIENDB`Dd8d l c @A3delete-whitecb?xҴJnxҴPNG  IHDR-pPLTEss wtRNSbKGDo cmPPJCmp0712OmnIDAT(υ PW H( wJ1PޏG NH .]HIENDB`Ddz8` m c <Aedit-whitedb3eb^ڍ/: 1Aneb^ڍ/: 1PNG  IHDR#niPLTEss wotRNSSbKGDhQ cmPPJCmp0712OmcIDAT(m P.`X]H3L"{ A 1i,B^Qٝ>J%^/hZUf$'*MXD4JcpIENDB`Dd8d n c @A3delete-whiteeb?xҴ(nxҴPNG  IHDR-pPLTEss wtRNSbKGDo cmPPJCmp0712OmnIDAT(υ PW H( wJ1PޏG NH .]HIENDB`Ddz8` o c <Aedit-whitefb3eb^ڍ/: 1neb^ڍ/: 1PNG  IHDR#niPLTEss wotRNSSbKGDhQ cmPPJCmp0712OmcIDAT(m P.`X]H3L"{ A 1i,B^Qٝ>J%^/hZUf$'*MXD4JcpIENDB`Dd8d p c @A3delete-whitegb?xҴnxҴPNG  IHDR-pPLTEss wtRNSbKGDo cmPPJCmp0712OmnIDAT(υ PW H( wJ1PޏG NH .]HIENDB`Ddz8` q c <Aedit-whitehb3eb^ڍ/: 1neb^ڍ/: 1PNG  IHDR#niPLTEss wotRNSSbKGDhQ cmPPJCmp0712OmcIDAT(m P.`X]H3L"{ A 1i,B^Qٝ>J%^/hZUf$'*MXD4JcpIENDB`Dd8d r c @A3delete-whiteib?xҴnxҴPNG  IHDR-pPLTEss wtRNSbKGDo cmPPJCmp0712OmnIDAT(υ PW H( wJ1PޏG NH .]HIENDB`Ddz8` s c <Aedit-whitejb3eb^ڍ/: 1۶neb^ڍ/: 1PNG  IHDR#niPLTEss wotRNSSbKGDhQ cmPPJCmp0712OmcIDAT(m P.`X]H3L"{ A 1i,B^Qٝ>J%^/hZUf$'*MXD4JcpIENDB`Dd8d t c @A3delete-whitekb?xҴ¸nxҴPNG  IHDR-pPLTEss wtRNSbKGDo cmPPJCmp0712OmnIDAT(υ PW H( wJ1PޏG NH .]HIENDB`Dd<P u 3 3"((l DdYz  c VA &--wwwClick here to readmb7 |S_r! Un |S_r!PNG  IHDR3FPLTE[[[dddjjjvvvwxw{{{#v&x/{,zN=Z,^)mqd a.i7v;WJ]TbNdPyGt"|*z1:=EKhHLL5EHSRYDFGJhk{͕uٍ}ĭuׄӆوՌ؍הړځ鐝ǜܬĮϥޥ߭ӫݳűӣftRNSebKGDH cmPPJCmp0712HsIDATHK͖s5oK+SɈ ~fTMHDK hݓ"1bIsV ^lKsMO{xܙs_. p6[{O폝*ZG~v?-6E(]j:wUD1A꾈Qƛ fڏ-X{3zk|v}uwGly5SYh1tUD4, fE72q$Y&hhuީ.^|?z9Z- irJ T!iPcVY8ٺEV(Rhm267B%9@Hߌ)rkP{N^ҁ`Ao Ut'TuUAekRagB7Bi@3 :Z%i:y{֛~i]4U$:&l00E&'t&Ľ"^+6lU,YL4Ԣ@5p]{_35N=?:V>eC15r@5eMw4(&zFXm aY2αca@ ߻޿Z*Ą*Va @#( \Ia2$)KBS~B֠+945(M\6 Wx=>}9'KBr\Qc@c {s&SH@48[勑z C\>7333{y}eqNFu) Qf\6ebe0 .< ꪵR0!˗6U,t&k\U]Ƃ5֬\Ln{^xl !'FyeC4ƉScs(UkThe BI3J@0};1߿?9,;acS,֤I0.QVFr`5VCX WOt|aan;Ak2!AdВSKJj +Dx b%yOa piy0LS K5Ƌ$VRXm7Ɋ&Ft $0Bc<ۉaLjvuM,',  *bi–U-Q,ɏqXY:z ٜKl /uj(Io,F/Di'|8ݛ}JaHRSghݛX7|ו';j͝S\4)uIENDB`aDd,  c :ANormalFax01C"R<!-- var Menu18277846 = [ ["UseLocalConfig", "jsmenu3Config", "", ""], ["LinkOut", "window.top.location='/sites/entrez?Cmd=ShowLinkOut&Db=pubmed&TermToSearch=18277846&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1' ", "", ""] ] -->JavaScript1.2nb!X󆡑NBZnX󆡑NBPNG  IHDRfsRGB@}0PLTE{bIDATE!0Eq^uM&VUp\ &C|)"3.8̴(6 jPtsʄ&)NU- \^w& ^eyƾ_c|_^9IENDB`Dd[Wz  c VA &--wwwClick here to readoRrM^`n aJEe+%AFJZrrCQF7fqcǛ8hnstLT,V mv+E{I.eih\֥ @xﱔ贆(!.(XӴv.ZYDM#"sc `ȉE_|8^NޖVV4%4ҎXAD!$RZC@Ud4x5^0``326QsLI\~^Uσ\YcZY%Ɛ_Mv1п5 +ۇ/YӃsYE/ ):^6XGSuR҆UEx-[D%ZW~?K᛹s)V1}dז84rDQ!"CuY:2] $E Pn>ڵh]+k;vQ 4<hj6%q#pjz))Z?W6F` '(䍍aUcҴՕ.iW/{vzRNޅ{ruD8b*5kjwMaYqہd6ˑ(**v!T;*j?nok5uE},%F{-7շ;Y2cӹ 6 3 8]޽F3UH|=sݏ ɶ]``NYG!s.fĝq!1G f!)6ԅT (*︛Lb" +p#}C8d,&ކe{Hks!UUXA2HłyפY@{EMF U3njτM |`hld$2x8>[v{4s}SJavaScript1.2pb!X󆡑NBtnX󆡑NBPNG  IHDRfsRGB@}0PLTE{bIDATE!0Eq^uM&VUp\ &C|)"3.8̴(6 jPtsʄ&)NU- \^w& ^eyƾ_c|_^9IENDB`Ddp^  c dA&--productionClick here to readqbw_^ME"nnw_^ME"nPNG  IHDRjPLTE*?*?*_*_U*_*_**U****U****U****U*ߪ***U**UUUUUUUUUUU?U?UU?U?U_U_UU_U_UUUUUUUUUUUUUUUUUUUߪUUUUUUUU??U??__U__UUUUߪUUU??U??__U__UUUUߪUUU??U??__U__UԟԟUԟԟԿԿUԿԿUߪUUU??U??__U__UUUUߪU3fUUUUߪU**U****U***?*?U𠠤wbKGDH cmPPJCmp0712HsnIDATHKV;8u&n @t: 4 tX@_B{EIY`vm٢b}_=>([3~h8,sn8}sWz_*ȠBUG8oQ}rG}:yMm)zv+bSZ z%X'Pgˤ PMު|{;I19hhd̠8H[u63ij,|[yAy2]~&K)b63)j' z3'Cqp Ԋk*ZtK\N|bWEʇ-\HxA,SJ|KQB"P| .IS~h΋D} @'= :u$PT/lM$*'Wp L8ЫAP!l DJn%$X~0F! 3Z|vAIIXu @W&~:iw}&Oš[7B@ luԟ~G9! V@+ S3buΛSo/3er9]]MNMc / gCE)ғ%|TQ/T5Zt_};U1}yG}7"8>ݑ² f&_ 2)wofy]UIѕJ+d>3s*Vvn\?gvz8TU\wnͬUuevIENDB`aDd,  c :ANormalFax01C"R<!-- var Menu18256816 = [ ["UseLocalConfig", "jsmenu3Config", "", ""], ["LinkOut", "window.top.location='/sites/entrez?Cmd=ShowLinkOut&Db=pubmed&TermToSearch=18256816&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1' ", "", ""] ] -->JavaScript1.2rb!X󆡑NBnX󆡑NBPNG  IHDRfsRGB@}0PLTE{bIDATE!0Eq^uM&VUp\ &C|)"3.8̴(6 jPtsʄ&)NU- \^w& ^eyƾ_c|_^9IENDB`Ddzz  c VA &--wwwClick here to readsbDfN̂n  'nfN̂n PNG  IHDR#qT7PLTE@@@bRppp3!프3331.U@öm䙙$1)C<(tf7+z @00)( GAmb_J}gD9̾m,'J1{8(XJjXvk1!@3;1B)L<ƽ독t<.qtjM;dWUIy~phbKGDHgIFg>U cmPPJCmp0712Hs IDATXG͘kW@)T7E\=t* J"Z8 glBt<;쒮]A38M8cǝAOr߉^mu yqlW043(.9[P S $"^X v s'eLT&]Ē9d% q)iN3VX eu-sI,0325d`$ CʨHPK, }os@ -a,T Nz^EfHB]x{r(94LSs5cHɱ` JW\,៪L\jaЂy`VCP2}F r&&YoQRT5*6tu$%%X4n{kWFtJ-:ux\0aH/z/h}#m`xXV('Դtۓiz @4V0$gH`FE2Edq\gjpˮR_k`QO降dcEo3㣀,MMyus̸Rԝ\0t ;}ǥɝavP}f#e,ڣ 2+X+l+y^0|D)EcsblʩXTyС4i&`2r[M:Z3B SWO˔eۗvDCMHg<xv|[5~TnUpS-uOa)}LMcYD#]/80Ҧ\pRJ" MSs B&XՔyRL۰ai>9msR8R94:ۑIyLTX^n1зEu<?Q?2n;6N6L+DN|up}OSrt4nIENDB`aDd,  c :ANormalFax01C"R<!-- var Menu18076735 = [ ["UseLocalConfig", "jsmenu3Config", "", ""], ["LinkOut", "window.top.location='/sites/entrez?Cmd=ShowLinkOut&Db=pubmed&TermToSearch=18076735&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1' ", "", ""] ] -->JavaScript1.2tb!X󆡑NB9nX󆡑NBPNG  IHDRfsRGB@}0PLTE{bIDATE!0Eq^uM&VUp\ &C|)"3.8̴(6 jPtsʄ&)NU- \^w& ^eyƾ_c|_^9IENDB`L@@@ NormalCJ_HaJmH sH tH Z@Z iK Heading 1$<@&5CJ KH OJQJ\^JaJ N`"N Hj Heading 2dd@&[$\$5CJ$\aJ$V@V iK Heading 3$<@&5CJOJQJ\^JaJJ@J iK Heading 4$<@&5CJ\aJDA@D Default Paragraph FontRi@R  Table Normal4 l4a (k(No Listo Hjti4U`4 Hj Hyperlink >*ph:o: Hjfeatured_linkouts&o!& Hjlinkbar@o2@ Hj affiliationdd[$\$:oB: Hjabstractdd[$\$2oR2 Hjpmiddd[$\$DV`aD iKFollowedHyperlink >*phor iKapptitleedd$d%d&d'd-DM NffOffPffQff[$\$B* CJ$OJQJ^JaJ$ph3o iKapplogoedd$d%d&d'd-DM NffOffPffQff[$\$B* CJ$OJQJ^JaJ$ph3LoL iK aleftcelldd[$\$CJOJQJaJVoV iKbuttondd[$\$5B*CJOJQJ\aJph>o> iKcodedd[$\$ OJQJ^JPoP iKdocroleinheritdd[$\$ B*phPoP iK docrolepsn!dd$dNff[$\$hoh iKdocrolepsninherit!dd$dNff[$\$ B*phLoL iKerrorbox!dd-DM f[$\$VoV iK formfield dd[$\$B*CJOJQJaJphfof iKformfieldlabel!dd[$\$5B*CJOJQJ\aJphvo"v iKformfieldlabelrequired"dd[$\$5B*CJOJQJ\aJphTo2T iKhelp!#dd-DM [$\$CJOJQJaJ^oB^ iKhnav!$dd-DM [$\$B*CJOJQJaJphoR iK hnavbordere%dd$d%d&d'd-DM NffOffPffQff[$\$CJaJfobf iKleftcell!&dd-DM [$\$B*CJOJQJaJphVorV iKlisterdropping'dd[$\$CJOJQJaJbob iK majorheading(dd[$\$5B*CJOJQJ\aJph33XoX iK minorheading)dd[$\$5CJOJQJ\aJToT iK navnormblack*dd[$\$B*CJaJphXoX iKnormalerrormessage+dd[$\$ B*phfof iKnormalnotificationmessage,dd[$\$ B*phZoZ iKnotificationbox!-dd-DM ̙[$\$JoJ iK processitem.dd[$\$ B*phffpop iKprocessitemcurrent!/dd-DM [$\$5B*\ph^o^ iK pagesubtitle0dd[$\$5B* OJQJ\^Jph3non iK pagetitle!1dd-DM [$\$5B*CJOJQJ\aJphdo"d iKthsmall!2dd-D@M ff[$\$B*CJOJQJaJpho2 iK teensyborderT3dd$d%d&d'dNffOffPffQff[$\$loBl iKuserhome!4dd-DM [$\$5B*CJOJQJ\aJphoR iK userlogine5dd$d%d&d'd-DM NffOffPffQff[$\$B*CJOJQJaJphbobb iKuserpage!6dd-DM [$\$5CJOJQJ\aJxorx iKuserpageactive!7dd-DM [$\$5B* CJOJQJ\aJph3LoL iK todolinks8dd[$\$CJOJQJaJo iKsplitbare9dd$d%d&d'd-DM NffOffPffQff[$\$CJaJxox iKwfcellnotpossible!:dd-D M [$\$B*CJOJQJaJphror iKwfcellpossible!;dd-DM [$\$B*CJOJQJaJphnon iK wflabelsmall!<dd-DM [$\$B*CJOJQJaJphNoN iKwfchartheading=dd[$\$CJaJhoh iK wfchartdone!>dd-DM [$\$5CJOJQJ\aJnon iKwfchartpending!?dd-DM [$\$5CJOJQJ\aJnon iKxxxwfcellpossible2@dd$d&dNP[$\$tot iKxxxwfcellnotpossible2Add$d&dNP[$\$jo"j iKxxxwflabelsmall2Bdd$d&dNP[$\$<o2< iKxxxxxxCdd[$\$6]FoBF iK fontlargerDdd[$\$CJaJHoRH iK fontsmallerEdd[$\$CJaJJobJ iKmidgray!Fdd-DM [$\$LorL iK imagecaptionGdd[$\$ B*phffB^`B iK Normal (Web)Hdd[$\$.X`. iKEmphasis6]*W`* iKStrong5\8o8 iK imagecaption1phff\V+, . U $ & 3 >  $ LDKy)==my=0& !,"K##$$4&>&L&&&'')++ ,,,,,,,,,, -A----.2..../+//o0p0q0y02,69!9o:<F=>?@A C!CCWDfEFHJoLLMNNHOP=Q?QMQTU7UXUYWYbYkY~YYZ[\\+^^_b__``[accLd$eekgUhjMkkmhmmnopBpppqrss%u:uyvvx?{{{{{|g~~?Iy'>}ʋ4ΌJŎ!ۓ֔+*kĜSu@Z68<Eyav79DMۧY)űT"EZPj#%6?ʾ0JͿϿۿ)+8BxDUWf%svLMP`ae02^ajkn !$df+ 57$&1EEIGiJlMPSWZ2]'`Ccfilpesvy|57GHIyn :tߑa*hAt"([^0000000000H0. 0. 0(0& H03 H03 (0& H0 H0 H0 H0  0  0  0  0  0  0  0  0  0  0  0  0  0  0  0  0  0  0  0  0  0  0  0y  0y  0y  0y  0y  0y  0y  0y  0y  0 (0& 804&H0>&804&H0&(0& H0'H0'(0& H0+(0& (0& H0,H0,0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0,0,0,0,0, 0,0,0,0,0, 0,(0& H0q0H0q0H0q0(0& H09H09H09H09H09H09H09(0& H0 CH0 CH0 CH0 CH0 CH0 CH0 C(0& H0oLH0oLH0oLH0oLH0oLH0oL0oL00?Q0?Q(0?QH0UH0U0U0(0WYH0bYH0bY 0bY 0bY 0bY 0bY 0bY 0bY 0bY 0bY 0bY 0 bY 0 bY 0 bY 0 bY 0 bY 0bY 0bYH0bY 0bY 0bY 0bY 0bYH0bYH0bYH0bY 0bY 0bY 0bY 0bY 0bY 0bYH0bY 0bY 0bY 0bYH0bYH0bY(0WYH0%u(0WYH0yvH0yvH0yv0yv0(0{H0{H0{ 0{ 0{ 0{ 0{ 0{ 0{ 0{ 0{ 0{ 0 { 0{ 0{ 0{ 0{ 0{ 0{H0{ 0{ 0{ 0J{ 0J{ 0J{ 0J{ 0J{ 0J{ 0J{ 0J{ 0J{ 0{ 0{ 0{ 0{ 0{H0{(0{H0u(0{H0@0@0(08H0<H0<(08H0a(0800(09H0DH0DH0DH0DH0DH0DH0DH0DH0DH0DH0D(09H0E(09H0PH0P0P0(0%H06(0%H0(0%H00000(0ϿH0ۿ(0ϿH0(0Ͽ00H0+H0+H0+H0+H0+(0+ 0 0 0H0(0+0D00WH0W0W0W0W 0W0W0W 0W0W0W 0W0W0W 0W0W0W H0WH0W0W0WH0W0W0W0W 0W0W0W 0W0W0W 0W0W0W 0W0W0W H0WH0W0W0WH0WH0W0W0WH0WH0W0W0WH0WH0W0W0WH0WH0W0W0W0000&0&0 0E 0E 0E 0E 0E 0E 0E 0E 0E 0 E 0 E 0 E 0 E 0 E 0E 0E 0E 0E 0E@0@000000000000000000000000000+, . U $ & 3 >  $ LDKy)==my=0& !,"K##$$4&>&L&&&'')++ ,,,,,,,,,, -A----.2..../+//o0p0q0y02,69!9o:<F=>?@A C!CCWDfEFHJoLLMNNHOP=Q?QMQU7UXUYWYbYkY~YYZ[\\+^^_b__``[accLd$eekgUhjMkkmhmmnopBpppqrss%u:uyvvx?{{{{{|g~~?Iy'>}ʋ4ΌJŎ!ۓ֔+*kĜSu@Z68<Eyav79DMۧY)űT"EZPj#%6?ʾ0JͿϿۿ)+8BxDUWf%svLMP`ae02^ajkn !$df+ 57$&1EEIGiJlMPSWZ2]'`Ccfilpesvy|57Gyn :tߑa*hAt"([^K0 谋K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0 K0 K0K0 K0 K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0K0@0~@0~@0~@0~@0~@0~@0~@0~@0~@0~@0~@0~@0~@0~@0~@0~@0~@0~@0~@0~@0~@0~@0~@0~@0~@0~@0~@0~@0~@0~@0~@0~@0~@0~@0~@0~@0~@0~@0~@0~@0~@0~@0~@0~@0~@0~@0~K0K0K0K0K0K0@0o@0o@0o@0o@0o@0z@0z@0z@0z@0z@0z@0@0@0@0@0@0 0J T4 Zka8 r&' b. $;(,0J6:>BCFJM PR2VZ]adh lpZtx-|#LjFt\      !"#%&'(*(446o8oB`mΔ6#Lajh\$)\ef%& )l #Yux8?r *?*F*a???MQQQQ RRRnRRRRRR?SNSPSSSSTT TqTTTTTAr!">pqx%'(,-I23mJLM=:;XY~I&()bde7=>:      v   S U V acdE"$%(!P-/0@ OP]: < = x!!!U"W"X"$|$}$$$$%I&J&&&&((((((*++y+{+|+l---I.K.L./"0#00001`2a22224|4}4444556666664888999d:::A;C;D;#<<<====F>G>>>>?E@F@@@@BBBBBBD9E:EEEEE.F/FFFFFFFDGFGGGJGGG H HHHHHNIPIQII[JeJjJJJ+K-K.K0KLLnLpLqLL^MhMmMMM.N0N1N3NOOqOsOtO6PPPP#Q$QzQ|Q}QQdReRRRRHSSSS5T6TTTTTvUwUUUUVVVWmWnWWWWWXXY Y YYZ ZZyZzZZZZZ[[\\\\$].]3]]]]]]]^^7_9_:__`#`(```````aa,b.b/bb5c?cDcccddd dddHeJeKeffff g gcgegfghgMhNhhhh7iiii$j%j{j}j~jjekfkkkktllllambmmmmmnnnnno pppppppppqqr r!rrWsasfsss't)t*t,tuujulumuurv|vvvvBwDwEwGw,x-xxxxywyyyyyGzIzJzLz1{2{{{{;||||(})}}}}}i~j~~~~opƀȀɀˀ   '1IÃhjknʆֆنkvÍ : ʏӏ֏hqߑ'7Ya!),ɖٖܖq{~ETW't¡֡"\XCXCXXXXXXXXXXXXXXXXXXXXXCXCXCXCXCXCXCXCXCXCXCXCXCXCXCXCXCXCXCXCXCXCXCXCXCXCXCXCXCXCXCXCXCXCXCXCXCXCXCXCXCXCXCXCXCXCXCXCXCXCXXCXCXXCXCXXCXCXXCXCXXCXCXXCXCXXCXCXXCXCXXCXCXXCXCXXCXCXXCXCXXCXCXXCXCXXCXCXXCXCXXCXCXXCXCXXXCXXXXXXCXXXXXXXCXXXXXXXXXXCXXX8@0(  B S  ?SynonymsKeyWordsandRelatedTerms IntroductionIntroductionBackgroundIntroductionPathophysiologytargetAIntroductionFrequency!IntroductionFrequencyUnitedStates"IntroductionFrequencyInternationalIntroductionMortalityMorbidityIntroductionRaceIntroductionSexIntroductionAgeIntroductionAnatomyIntroductionClinicalDetails IntroductionPreferredExamination#IntroductionLimitationsofTechniques Differentials(DifferentialsOtherProblemstobeConsidered RadiographRadiographFindingsRadiographDegreeofConfidence!RadiographFalsePositivesNegativesCTSCANCTSCANFindingsCTSCANDegreeofConfidenceCTSCANFalsePositivesNegativesMri MriFindingsMriDegreeofConfidenceMriFalsePositivesNegatives UltrasoundUltrasoundFindingsUltrasoundDegreeofConfidence!UltrasoundFalsePositivesNegativesNuclearMedicineNuclearMedicineFindings!NuclearMedicineDegreeofConfidence&NuclearMedicineFalsePositivesNegatives AngiographyAngiographyFindingsAngiographyDegreeofConfidence"AngiographyFalsePositivesNegatives Intervention InterventionMedicalLegalPitfallsInterventionSpecialConcerns TestQuestionsFurtherReading Multimedia #pictures #picture1Multimediamedia1 #picture2Multimediamedia2 #picture3Multimediamedia3 #picture4Multimediamedia4 #picture5Multimediamedia5 #picture6Multimediamedia6 #picture7Multimediamedia7 #picture8Multimediamedia8 #picture9Multimediamedia9 #picture10Multimediamedia10 #picture11Multimediamedia11 #picture12Multimediamedia12 #picture13Multimediamedia13 #picture14Multimediamedia14 #picture15Multimediamedia15 #picture16Multimediamedia16 #picture17Multimediamedia17 #picture18Multimediamedia18 #picture19Multimediamedia19 #picture20Multimediamedia20 #picture21Multimediamedia21 #picture22Multimediamedia22 #picture23Multimediamedia23 #picture24Multimediamedia24 #picture25Multimediamedia25 #picture26Multimediamedia26 #picture27Multimediamedia27 #picture28Multimediamedia28 #picture29Multimediamedia29 #picture30Multimediamedia30 #picture31Multimediamedia31 #picture32Multimediamedia32 #picture33Multimediamedia33 #picture34Multimediamedia34 #picture35Multimediamedia35 #picture36Multimediamedia36 #picture37Multimediamedia37 #picture38Multimediamedia38 #picture39Multimediamedia39 #picture40Multimediamedia40 references bibliographyAcknowledgments. & 3  $ 4&>&&'+ ,,q09 CoL?QUWYbY%uyv{{u@8<a9DEP%60Ͽۿ+DW&&11cc33  ??{{--0 0 l l zz;;FF66S S n"n" % %&&))++_._.00225566'9'9W;W;==>>@@CCEE7^      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~. & 3  4&>&&'+ ,,q09 CoL?QUWYbY%uyv{{u@8<a9DEP%60Ͽۿ+DW&&11cc33  ??{{--0 0 l l zz;;FF66S S n"n" % %&&))++_._.00225566'9'9W;W;==>>@@CCEE7^;&L[| &, &l&&,&l&&l&,&&̤p &p & p &p &̠p &Lp & p &p & p &p &Lp &p & p &̚p &Lp & p &p &p &̝p &Lp & p &p &Lp &̟p &C&$C&C&$I&dI&I&I&$J&dJ&$O&dO&M&L&L&G&dM&dH&p &p & p &Lp &p &p & p &Lp J >&>&a&a&FFKssx++..66RR Y YYeeexy*2=QQ_cҥ զզ^      !"#'$%&()*+,-0./123456789:P K&K&n&n&IMMvzz##++..66RRYYYeeex1<C]aff צצ^    !"#%&'$()*+,-/0.123456789: 9/*urn:schemas-microsoft-com:office:smarttagsState:(*urn:schemas-microsoft-com:office:smarttagsStreet80*urn:schemas-microsoft-com:office:smarttagsCity;)*urn:schemas-microsoft-com:office:smarttagsaddressB4*urn:schemas-microsoft-com:office:smarttagscountry-region=7*urn:schemas-microsoft-com:office:smarttags PlaceType=;*urn:schemas-microsoft-com:office:smarttags PlaceName96*urn:schemas-microsoft-com:office:smarttagsplace>*urn:schemas-microsoft-com:office:smarttags PostalCode ` ;;;;76646460/60/60)(60)(6060/6;76;;760/464;7760/40//646/6/=BHKMPmse j  [ ` P \ ^ `  (/0<hx)*2$y& =L#x &#!*!m!w!!!!!""##$)$q$}$,%:%T'V'Z'f'1(@((()))+5+@+J+,, ----L-T-V-^-----------%.1.2.7.....+/0/^/g/////0%0L0N0`0n000001111222233U4a4^5g57767?7d7l7f:l:<<<<F=Q=@@/A>AQA`ABBBB)C3CGGH"H=HEHFHKHIIIIJJJ K$K0K^KgK!N,N|NNPPPPQQRRoR~RRRRR@SHSISNSSSSSUUVVWWW(WWWY YYY[[[[]]^^[acadaoa"b*b+b6blbtbubbbccccc0e:e=gHgugzggggghh8hJhihxhhh7iEiii\jkjjjjjkkm m7mAm]pepfpqpppts}s~ssssttvvvvGwOwPwUw3x9xxxy yyyyyyyzzPzUzzz{{}(}}}|Waև6A08EO '")čӍ֎ێ%4p|+78=/5bhxכ Ϝݜݟڠ!/8;+-6̨fpƫ̫ 0?ET,7ϮݮR`ñԱٱ isIJͲ&dzгδڴ"1{3>?FKSTY[e1:Raָ6Ao{ ռ:RSX־qv/9;JLTVaJU0?xjyvv[fO^epqyRXYe #+JV]i,6y {+7CMqz # drw'[c9F^iyem BG7<ch&  ^l+0BQx/=K!X!""p##########%%Z'b'''''' ())*%*q*|*++;,E,,,, ---7-C-P-Q-`-//Z/d/h/o/C3M33366O9Z9[9e9????AAFC^C_CdC:D?DDDRI|IIIrLyL}LLLLLLuO|OPPP PRR%S)S*S0SUUV VSVWVXV]V^VcV2Y;YnYrY \#\\\\\;_F_J_U_Y_]_r_w_____0b;b?bGbKbQbbbbbLeTeceheffhh iikkkkkk/l;lep8>^ruX'Y'ddiillqz8;XZ?=cF^"#7))++0\166;;>==@ARI|IIILL&P)P:S=SUUPVRVqVtV|YY\\__bb ff(i+ikkdlhloorruuxx-|0|~~rvy 9t*gá֡!^333333333333333333333333333333333333333333333333333333333333333& N$$, --2../TU__-kMkǐ֔Ĝ7)DUsvMP^akn!$$EIGIiJPP%SSPVWtYZ\2]_'`bCcefiiGllkopresuvxy||_57^^ 81Jx:1 p #RBQ#K::qN`r8FGk7|r{(^`CJOJQJo(^`CJOJQJo(opp^p`CJOJQJo(@ @ ^@ `CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(PP^P`CJOJQJo(^`CJOJQJo(^`CJOJQJo(opp^p`CJOJQJo(@ @ ^@ `CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(PP^P`CJOJQJo(^`CJOJQJo(^`CJOJQJo(opp^p`CJOJQJo(@ @ ^@ `CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(PP^P`CJOJQJo(^`.^`.pp^p`.@ @ ^@ `.^`.^`.^`.^`.PP^P`.^`CJOJQJo(^`CJOJQJo(opp^p`CJOJQJo(@ @ ^@ `CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(PP^P`CJOJQJo(^`CJOJQJo(^`CJOJQJo(opp^p`CJOJQJo(@ @ ^@ `CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(PP^P`CJOJQJo(^`CJOJQJo(^`CJOJQJo(opp^p`CJOJQJo(@ @ ^@ `CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(PP^P`CJOJQJo(^`CJOJQJo(^`CJOJQJo(opp^p`CJOJQJo(@ @ ^@ `CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(PP^P`CJOJQJo(^`CJOJQJo(^`CJOJQJo(opp^p`CJOJQJo(@ @ ^@ `CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(PP^P`CJOJQJo( Q#::r{:1 1N`FGk # $! F2De|f4 $vHbM _"yq G~% LbM ENf8S=%<7 +X9n\p-ptK!X//wh2bM e|f4rOR4kY&6 +<7q989^;4 GzwyGptK$vH!X//PI +ptK\yROwivrOR$ShT$ShT98Lp]!x5ewivNfk EX9nF2Dwiv8S=%zw~%_"y9^;\yLp]iKHjR,,,,,, -A----.2..../+//o0p0svLMP`a^ajkn !$^@TU UU\p@UnknownGz Times New Roman5Symbol3& z Arial7&  Verdana?5 z Courier New;Wingdings"qhj¦¦"?ml ?ml !242KX)?Hj2Small-Bowel Obstruction xpxp0         Oh+'0|  8 D P\dlt Small-Bowel Obstruction xpNormalxp1Microsoft Office Word@L@ʛu@ع[u?ml՜.+,D՜.+,H hp|    Small-Bowel Obstruction Titlep 8@ _PID_HLINKSA(Khttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Nagar%20M%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1z|http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Ebert%20EC%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1U*)javascript:PopUpMenu2_Set(Menu18076735);/5http://www.ncbi.nlm.nih.gov/entrez/utils/fref.fcgi?PrId=3046&itool=AbstractPlus-def&uid=18076735&db=pubmed&url=http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=0002-9270&date=2007&volume=&issue=&spage=aV8javascript:AL_get(this, 'jour', 'Am J Gastroenterol.');Zhttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Maglinte%20DT%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1KThttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Skantharajah%20A%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1p,http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Garrett%20J%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1T http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Jennings%20SG%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1Jhttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Sandrasegaran%20K%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1pehttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Applegate%20KE%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1Nhttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Brown%20S%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1U$)javascript:PopUpMenu2_Set(Menu18256816);?:http://www.ncbi.nlm.nih.gov/entrez/utils/fref.fcgi?PrId=3055&itool=AbstractPlus-def&uid=18256816&db=pubmed&url=http://dx.doi.org/10.1007/s00247-008-0754-83W4javascript:AL_get(this, 'jour', 'Pediatr Radiol.');}jhttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Zidan%20FM%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Teraifi%20HE%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1}bhttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Hefny%20AF%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1;dhttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Hanaei%20AA%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1\()javascript:PopUpMenu2_Set(Menu18266180);]http://www.ncbi.nlm.nih.gov/entrez/utils/fref.fcgi?PrId=3079&itool=AbstractPlus-def&uid=18266180&db=pubmed&url=http://www.informaworld.com/openurl?genre=article&doi=10.1080/00365520701698843&magic=pubmed||1B69BA326FFE69C3F0A8F227DF8201D0<G;javascript:AL_get(this, 'jour', 'Scand J Gastroenterol.');BIhttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22McGeehan%20A%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1)fhttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Walker%20RN%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1]http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Quintana%20JF%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1Q&)javascript:PopUpMenu2_Set(Menu18277846);CFhttp://www.ncbi.nlm.nih.gov/entrez/utils/fref.fcgi?PrId=3159&itool=AbstractPlus-def&uid=18277846&db=pubmed&url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?an=00006565-200802000-00007lX8javascript:AL_get(this, 'jour', 'Pediatr Emerg Care.');xfhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&dopt=Citation&list_uids=11090385 ]|javascript:if (confirm('This will delete this reference. Are you sure you wish to do this?'))%20window.location.href='bibliographymaint.gps?docid=374962&action=delete&delete=1&refid=36087'klv\http://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&refid=36087&action=editpsfhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&dopt=Citation&list_uids=10831690]mjavascript:if (confirm('This will delete this reference. Are you sure you wish to do this?'))%20window.location.href='bibliographymaint.gps?docid=374962&action=delete&delete=1&refid=36086'jlg\http://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&refid=36086&action=editpdfhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&dopt=Citation&list_uids=10394872 ]^javascript:if (confirm('This will delete this reference. Are you sure you wish to do this?'))%20window.location.href='bibliographymaint.gps?docid=374962&action=delete&delete=1&refid=36085'ilX\http://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&refid=36085&action=editpUfhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&dopt=Citation&list_uids=11224668 ]Ojavascript:if (confirm('This will delete this reference. Are you sure you wish to do this?'))%20window.location.href='bibliographymaint.gps?docid=374962&action=delete&delete=1&refid=36084'hlI\http://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&refid=36084&action=edit}Fehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&dopt=Citation&list_uids=9609154 ]@javascript:if (confirm('This will delete this reference. Are you sure you wish to do this?'))%20window.location.href='bibliographymaint.gps?docid=374962&action=delete&delete=1&refid=36083'ol:\http://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&refid=36083&action=editt7fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&dopt=Citation&list_uids=11133561 ]1javascript:if (confirm('This will delete this reference. Are you sure you wish to do this?'))%20window.location.href='bibliographymaint.gps?docid=374962&action=delete&delete=1&refid=36082'nl+\http://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&refid=36082&action=editr(fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&dopt=Citation&list_uids=11461877]"javascript:if (confirm('This will delete this reference. Are you sure you wish to do this?'))%20window.location.href='bibliographymaint.gps?docid=374962&action=delete&delete=1&refid=36081'ml\http://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&refid=36081&action=editwfhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&dopt=Citation&list_uids=10701610]javascript:if (confirm('This will delete this reference. Are you sure you wish to do this?'))%20window.location.href='bibliographymaint.gps?docid=374962&action=delete&delete=1&refid=36080'll \http://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&refid=36080&action=editr fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&dopt=Citation&list_uids=11259698Rjavascript:if (confirm('This will delete this reference. Are you sure you wish to do this?'))%20window.location.href='bibliographymaint.gps?docid=374962&action=delete&delete=1&refid=36079'ec\http://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&refid=36079&action=editvfhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&dopt=Citation&list_uids=11037416Rjavascript:if (confirm('This will delete this reference. Are you sure you wish to do this?'))%20window.location.href='bibliographymaint.gps?docid=374962&action=delete&delete=1&refid=36078'dc\http://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&refid=36078&action=editrfhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&dopt=Citation&list_uids=11435039 Rjavascript:if (confirm('This will delete this reference. Are you sure you wish to do this?'))%20window.location.href='bibliographymaint.gps?docid=374962&action=delete&delete=1&refid=36077'kc\http://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&refid=36077&action=editqfhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&dopt=Citation&list_uids=10879707Rjavascript:if (confirm('This will delete this reference. Are you sure you wish to do this?'))%20window.location.href='bibliographymaint.gps?docid=374962&action=delete&delete=1&refid=36076'jc\http://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&refid=36076&action=editvfhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&dopt=Citation&list_uids=11000564 Rjavascript:if (confirm('This will delete this reference. Are you sure you wish to do this?'))%20window.location.href='bibliographymaint.gps?docid=374962&action=delete&delete=1&refid=36075'ic\http://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&refid=36075&action=editsfhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&dopt=Citation&list_uids=10512946 Rjavascript:if (confirm('This will delete this reference. Are you sure you wish to do this?'))%20window.location.href='bibliographymaint.gps?docid=374962&action=delete&delete=1&refid=36074'hc\http://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&refid=36074&action=editvfhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&dopt=Citation&list_uids=14716374 Rjavascript:if (confirm('This will delete this reference. Are you sure you wish to do this?'))%20window.location.href='bibliographymaint.gps?docid=374962&action=delete&delete=1&refid=36073'oc\http://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&refid=36073&action=edittfhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&dopt=Citation&list_uids=11384132 Rjavascript:if (confirm('This will delete this reference. Are you sure you wish to do this?'))%20window.location.href='bibliographymaint.gps?docid=374962&action=delete&delete=1&refid=36072'nc\http://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&refid=36072&action=edityfhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&dopt=Citation&list_uids=11519550Rjavascript:if (confirm('This will delete this reference. Are you sure you wish to do this?'))%20window.location.href='bibliographymaint.gps?docid=374962&action=delete&delete=1&refid=36071'mc\http://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&refid=36071&action=editqfhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&dopt=Citation&list_uids=11353110R}javascript:if (confirm('This will delete this reference. Are you sure you wish to do this?'))%20window.location.href='bibliographymaint.gps?docid=374962&action=delete&delete=1&refid=36070'lcw\http://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&refid=36070&action=editztfhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&dopt=Citation&list_uids=10489177Snjavascript:if (confirm('This will delete this reference. Are you sure you wish to do this?'))%20window.location.href='bibliographymaint.gps?docid=374962&action=delete&delete=1&refid=36069'ebh\http://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&refid=36069&action=editRbNhttp://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&reorder=1 D\Jhttp://progps1.emedicine.com/gps/bibliographymaint.gps?docid=374962&add=1QVMhttp://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5361.jpgPPMhttp://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5360.jpgYJMhttp://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5359.jpgXDMhttp://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5358.jpgW>Mhttp://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5357.jpgV8Mhttp://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5356.jpgU2Mhttp://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5355.jpgT,Mhttp://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5354.jpgS&Mhttp://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5353.jpgR Mhttp://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5352.jpgQMhttp://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5351.jpgPMhttp://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5350.jpgYMhttp://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5349.jpgXMhttp://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5348.jpgWMhttp://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5347.jpgVMhttp://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5346.jpgUMhttp://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5345.jpgTMhttp://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5344.jpgSMhttp://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5343.jpgRMhttp://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5342.jpgQMhttp://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5341.jpgPMhttp://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5340.jpgYMhttp://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5339.jpgXMhttp://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5338.jpgWMhttp://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5337.jpgVMhttp://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5336.jpgUMhttp://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5335.jpgTMhttp://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5334.jpgSMhttp://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5333.jpgRMhttp://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5332.jpgQMhttp://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5331.jpgPMhttp://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5330.jpgYMhttp://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5329.jpgXMhttp://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5328.jpgWMhttp://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5327.jpgVMhttp://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5326.jpgU~Mhttp://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5325.jpgTxMhttp://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5324.jpgSrMhttp://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5323.jpgRlMhttp://progps1.emedicine.com/gps/articleimages/336139/336139-374962-5322.jpg>yfHhttp://progps1.emedicine.com/gps/questions.gps?docid=375104&action=edit9y`Hhttp://progps1.emedicine.com/gps/questions.gps?docid=375103&action=edit8yZHhttp://progps1.emedicine.com/gps/questions.gps?docid=375102&action=edit;yTHhttp://progps1.emedicine.com/gps/questions.gps?docid=375101&action=edit:yNHhttp://progps1.emedicine.com/gps/questions.gps?docid=375100&action=edit2pHHhttp://progps1.emedicine.com/gps/questions.gps?docid=375099&action=editSXE5http://www.medscape.com/resource/medical-malpractice#wBChttp://progps1.emedicine.com/gps/differentiallink.gps?docid=376015"q?Chttp://progps1.emedicine.com/gps/differentiallink.gps?docid=404450#t<Chttp://progps1.emedicine.com/gps/differentiallink.gps?docid=350175&9Chttp://progps1.emedicine.com/gps/differentiallink.gps?docid=411249'y6Chttp://progps1.emedicine.com/gps/differentiallink.gps?docid=410845'v3Chttp://progps1.emedicine.com/gps/differentiallink.gps?docid=410644-}0Chttp://progps1.emedicine.com/gps/differentiallink.gps?docid=409870%s-Chttp://progps1.emedicine.com/gps/differentiallink.gps?docid=367666(w*Chttp://progps1.emedicine.com/gps/differentiallink.gps?docid=364581^\'?http://progps1.emedicine.com/gps/topiccontrol.gps?docid=3749628IntroductionPathophysiology#IntroductionPathophysiology1$(http://www.medscape.com/resource/herniaS!http://www.rcseng.ac.uk/ http://www.rcr.ac.uk/=2http://www.rcpsus.com/fhhttp://www.rcplondon.ac.uk/JDhttp://www.rsna.org/\Lhttp://www.aium.org/http://www.ngha.med.sa/ngha/X Mhttp://progps1.emedicine.com/gps/booktemplates.gps?action=view&templateid=1566@http://progps1.emedicine.com/gps/medlinesearch.gps?docid=374962GV:http://progps1.emedicine.com/gps/redline.gps?docid=374962  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~Root Entry F@wsuData ,V1Table$OWordDocument.VSummaryInformation(DocumentSummaryInformation8CompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q