ࡱ>  '` bjbjLULU |.?.?ƙ2/ttttt,:$h`'RttRR'tt<Rj!ttRat `+|yR0,|f||lRRRRRRR''RRRRRRRK^RE^R Nelson's syndrome Nelson's syndromeis the rapid enlargement of a HYPERLINK "http://en.wikipedia.org/wiki/Pituitary_adenoma" pituitary adenomathat occurs after the removal of both HYPERLINK "http://en.wikipedia.org/wiki/Adrenal_gland" \o "Adrenal gland" adrenal glands Pathophysiology: Removal of both adrenal glands, or HYPERLINK "http://en.wiktionary.org/wiki/bilateral" \o "wiktionary:bilateral" bilateral HYPERLINK "http://en.wikipedia.org/wiki/Adrenalectomy" adrenalectomy, is an HYPERLINK "http://en.wikipedia.org/wiki/Surgery" \o "Surgery" operationfor HYPERLINK "http://en.wikipedia.org/wiki/Cushing%27s_syndrome" Cushing's syndrome. Removal of both adrenals eliminates production of HYPERLINK "http://en.wikipedia.org/wiki/Cortisol" cortisol, and the lack of cortisol's HYPERLINK "http://en.wikipedia.org/wiki/Negative_feedback" negative feedbackcan allow any preexisting pituitary adenoma to grow unchecked. Continued growth can cause HYPERLINK "http://en.wikipedia.org/wiki/Mass_effect_(medicine)" \o "Mass effect (medicine)" mass effectsdue to physical compression of brain tissue, along with increased production of HYPERLINK "http://en.wikipedia.org/wiki/Adrenocorticotrophic_hormone" \o "Adrenocorticotrophic hormone" adrenocorticotrophic hormone(ACTH) and HYPERLINK "http://en.wikipedia.org/wiki/Melanocyte_stimulating_hormone" \o "Melanocyte stimulating hormone" melanocyte stimulating hormone(MSH). Clinical Presentation: The common HYPERLINK "http://en.wikipedia.org/wiki/Signs" signsand HYPERLINK "http://en.wikipedia.org/wiki/Symptoms" \o "Symptoms" symptomsinclude HYPERLINK "http://en.wikipedia.org/wiki/Muscle_weakness" muscle weaknessand skin HYPERLINK "http://en.wikipedia.org/wiki/Hyperpigmentation" hyperpigmentationdue to excess MSH. Nelson's syndrome is now rare because bilateral adrenalectomy is now only used in extreme circumstances. Management: Pituitary surgery is performed in some cases. The risk can also be minimized by pituitary irradiation. Kallmann syndrome Kallmann syndromeis a HYPERLINK "http://en.wikipedia.org/wiki/Hypogonadism" hypogonadism(decreased functioning of the glands that produce sex hormones) caused by a deficiency of HYPERLINK "http://en.wikipedia.org/wiki/Gonadotropin-releasing_hormone" gonadotropin-releasing hormone(GnRH), which is created by the HYPERLINK "http://en.wikipedia.org/wiki/Hypothalamus" hypothalamus. Kallmann syndrome is also called HYPERLINK "http://en.wikipedia.org/wiki/Hypothalamus" \o "Hypothalamus" hypothalamic HYPERLINK "http://en.wikipedia.org/wiki/Hypogonadism" hypogonadism,familial hypogonadism with HYPERLINK "http://en.wikipedia.org/wiki/Anosmia" anosmia, and HYPERLINK "http://en.wikipedia.org/wiki/Hypogonadotropic_hypogonadism" \o "Hypogonadotropic hypogonadism" hypogonadotropic hypogonadism, reflecting its disease mechanism. Kallmann syndrome is a form of tertiary hypogonadism, reflecting that the primary cause of the defect in sex-hormone production lies within the hypothalamus rather than a defect of the pituitary (secondary hypogonadism), testes or ovaries (primary hypogonadism). Kallmann syndrome was described in 1944 by HYPERLINK "http://en.wikipedia.org/wiki/Franz_Josef_Kallmann" Franz Josef Kallmann, a HYPERLINK "http://en.wikipedia.org/wiki/Germany" \o "Germany" German- HYPERLINK "http://en.wikipedia.org/wiki/United_States" \o "United States" American HYPERLINK "http://en.wikipedia.org/wiki/Geneticist" geneticist.However, others, such as the Spanish doctor HYPERLINK "http://en.wikipedia.org/w/index.php?title=Aureliano_Maestre_de_San_Juan&action=edit&redlink=1" \o "Aureliano Maestre de San Juan (page does not exist)" Aureliano Maestre de San Juanin 1856, had noticed a correlation between HYPERLINK "http://en.wikipedia.org/wiki/Anosmia" anosmiaand hypogonadism. Clinical Features: Kallmann syndrome's characteristics:  HYPERLINK "http://en.wikipedia.org/wiki/Hypogonadotropic_hypogonadism" \o "Hypogonadotropic hypogonadism" Hypogonadotropic hypogonadism(a lack of the HYPERLINK "http://en.wikipedia.org/wiki/Pituitary_gland" \o "Pituitary gland" pituitary hormones HYPERLINK "http://en.wikipedia.org/wiki/Luteinizing_hormone" \o "Luteinizing hormone" LHand HYPERLINK "http://en.wikipedia.org/wiki/FSH" FSH) Congenital (present from birth) HYPERLINK "http://en.wikipedia.org/wiki/Anosmia" anosmia(complete inability to smell) or hyposmia (decreased ability to smell) Normal stature It can occasionally be associated with optic problems, such as HYPERLINK "http://en.wikipedia.org/wiki/Colour_blindness" \o "Colour blindness" colour blindnessor optic atrophy, nerve deafness, HYPERLINK "http://en.wikipedia.org/wiki/Cleft_palate" \o "Cleft palate" cleft palate, HYPERLINK "http://en.wikipedia.org/wiki/Cryptorchidism" cryptorchidism, HYPERLINK "http://en.wikipedia.org/wiki/Renal_agenesis" renal agenesis, and HYPERLINK "http://en.wikipedia.org/w/index.php?title=Mirror_movement_disorder&action=edit&redlink=1" \o "Mirror movement disorder (page does not exist)" mirror movement disorder. However, it is not clear how, if at all, these other problems have the same cause as the hypogonadism and anosmia. Males present with delayed puberty and may have HYPERLINK "http://en.wikipedia.org/wiki/Micropenis" micropenis(although congenital micropenis is not present in most male KS cases). Females present with delayed puberty (i.e., HYPERLINK "http://en.wikipedia.org/wiki/Primary_amenorrhea" \o "Primary amenorrhea" primary amenorrhea) and lack of HYPERLINK "http://en.wikipedia.org/wiki/Secondary_sex_characteristic" \o "Secondary sex characteristic" secondary sex characteristics, such as HYPERLINK "http://en.wikipedia.org/wiki/Thelarche" \o "Thelarche" breast development. A fraction of cases may present with post-pubertal onset, which results in a phenotypically normal penis in men with subsequent testicular atrophy and loss of some secondary sex traits. These men generally present with sexual impairment and low libido. In women, late-onset Kallmann Syndrome can result in HYPERLINK "http://en.wikipedia.org/wiki/Secondary_amenorrhea" \o "Secondary amenorrhea" secondary amenorrhea. HYPERLINK "http://en.wikipedia.org/wiki/Anosmia" Anosmiamay or may not be present in these individuals. Physical findings associated with hypogonadism include eunuchoidal skeletal proportions. A low ratio, less than 1:1 in adults, of the upper body segment (crown to pubis) to the lower body segment (pubis to heels) is present only in patients with classic Kallmann syndrome or idiopathic hypogonadotropic hypogonadism. Similarly, an arm span greater than height by more than 5 cm is observed only in patients with congenital Kallmann syndrome or idiopathic hypogonadotropic hypogonadism. Height for age is normal in these patients, distinguishing them during adolescence from individuals with constitutional delay in growth and development because adolescents in the latter group tend to be short for chronological age. Absence of terminal facial hair and decreased body hair is observed in men with Kallmann syndrome or who have congenital idiopathic hypogonadotropic hypogonadism. Men with adult-onset idiopathic hypogonadotropic hypogonadism may report decreased shaving frequency. In addition, lack of temporal hair recession (male-type baldness) is noted in men with Kallmann syndrome or idiopathic hypogonadotropic hypogonadism. High-pitched voice is present only in men with Kallmann syndrome or congenital idiopathic hypogonadotropic hypogonadism. Lack of breast development is observed in women with Kallmann syndrome or congenital idiopathic hypogonadotropic hypogonadism. Women with long-standing hypothalamic amenorrhea may experience a decrease in breast size. Gynecomastia is observed only rarely in men with classic Kallmann syndrome or idiopathic hypogonadotropic hypogonadism at the time of diagnosis, but it may occur as an adverse effect of androgen replacement therapy in these patients. Muscle mass is decreased, muscle strength is diminished, and fat is distributed over the hips and chest, particularly in men with Kallmann syndrome or congenital idiopathic hypogonadotropic hypogonadism. Axillary and pubic terminal hair may be scantly present in these patients (with the exception of patients with X-linked idiopathic hypogonadotropic hypogonadism and AHC) because of circulating adrenal androgens. Males with Kallmann syndrome or congenital idiopathic hypogonadotropic hypogonadism lack terminal hair growth along the midline towards the umbilicus. Men with Kallmann syndrome or congenital idiopathic hypogonadotropic hypogonadism have prepubertal testes (<4 mL) and lack scrotal pigmentation. Some patients (previously known as fertile eunuchs) experience some testicular growth in association with partial GnRH deficiency. Testicular volumes in patients with adult-onset idiopathic hypogonadotropic hypogonadism are either within the normal range or mildly decreased (10-15 mL). Cryptorchidism is present in a minority of men with classic Kallmann syndrome or idiopathic hypogonadotropic hypogonadism. Males with classic Kallmann syndrome or idiopathic hypogonadotropic hypogonadism have small penises (<8 cm long in adults). In addition, prostate size is decreased, particularly in men with classic Kallmann syndrome or idiopathic hypogonadotropic hypogonadism. In women, the vaginal mucosa has a deep red color because of the lack of squamous epithelial differentiation. All patients with Kallmann syndrome by definition have anosmia or severe hyposmia. Formal smell testing can be carried out by administering the Smell Identification Test (SIT, Sensonics, Haddon Heights, NJ), which is a standardized, multiple choice test that includes 40 scratch-and-sniff panels, each with 4 possible answers. Alternatively, the sense of smell can be evaluated by using serial dilutions of multiple odorants such as dimethyl sulfide, menthone, acetic acid, exaltolide, amyl acetate, cineole, and pm-carbinol (Olfacto Laboratories, El Cerrito, Calif), according to the protocol of Rosen and Rogol. A small percentage of patients with Kallmann syndrome experience color blindness, as assessed by Ishihara plate testing. In addition, sensorineural hearing loss has been reported in some Kallmann syndrome patients. Some patients with X-linked Kallmann syndrome and a contiguous gene syndrome may have ichthyosis. Cleft lip, cleft palate, or high (arched) palate has been reported in 6-22% of patients with Kallmann syndrome. Short metacarpals and pes cavus also have been reported in a minority of Kallmann syndrome patients. Cardiovascular findings are present in some patients with Kallmann syndrome who have congenital heart disease (including ASD, VSD, Ebstein anomaly, transposition of the great vessels, right aortic arch, atrioventricular block, right bundle-branch block, and WPW syndrome). A detailed discussion of these findings is beyond the scope of this review. Neuropsychiatric findings that exist in a minority of patients with Kallmann syndrome or idiopathic hypogonadotropic hypogonadism include abnormal eye movements (including gaze-evoked horizontal nystagmus, abnormal pursuit, and saccades), synkinesia (mirror movements of the opposite upper extremity), paraplegia, cerebellar ataxia, and learning disability (secondary to mental retardation). Synkinesia has been reported only in X-linked Kallmann syndrome patients. Conditions associated with primary adrenocortical insufficiency are present in males with X-linked idiopathic hypogonadotropic hypogonadism and AHC. A detailed discussion of these conditions is beyond the scope of this review. Early-onset obesity is present in patients with idiopathic hypogonadotropic hypogonadism and mutations of either the leptin gene or the leptin receptor gene Sheehan's syndrome Sheehan syndrome, also known aspostpartum hypopituitarismorpostpartum pituitary necrosis, is HYPERLINK "http://en.wikipedia.org/wiki/Hypopituitarism" hypopituitarism(decreased functioning of the HYPERLINK "http://en.wikipedia.org/wiki/Pituitary_gland" pituitary gland), caused by HYPERLINK "http://en.wikipedia.org/wiki/Necrosis" necrosisdue to HYPERLINK "http://en.wikipedia.org/wiki/Hemorrhage" \o "Hemorrhage" blood lossand HYPERLINK "http://en.wikipedia.org/wiki/Hypovolemic_shock" \o "Hypovolemic shock" hypovolemic shockduring and after HYPERLINK "http://en.wikipedia.org/wiki/Childbirth" childbirth. Causes: It is a rare complication of HYPERLINK "http://en.wikipedia.org/wiki/Pregnancy" pregnancy, usually occurring after excessive blood loss. The presence of HYPERLINK "http://en.wikipedia.org/wiki/Disseminated_intravascular_coagulation" disseminated intravascular coagulation(i.e., in HYPERLINK "http://en.wikipedia.org/wiki/Amniotic_fluid_embolism" amniotic fluid embolismor HYPERLINK "http://en.wikipedia.org/wiki/HELLP_syndrome" HELLP syndrome) also appears to be a factor in its development. Symptoms: Most common initial symptoms of Sheehan's syndrome are HYPERLINK "http://en.wikipedia.org/wiki/Agalactorrhea" \o "Agalactorrhea" agalactorrhea(absence of lactation) and/or difficulties with lactation.Many women also report HYPERLINK "http://en.wikipedia.org/wiki/Amenorrhea" \o "Amenorrhea" amenorrheaor HYPERLINK "http://en.wikipedia.org/wiki/Oligomenorrhea" oligomenorrheaafter delivery. In some cases, a woman with Sheehan syndrome might be relatively asymptomatic, and the diagnosis is not made until years later, with features of HYPERLINK "http://en.wikipedia.org/wiki/Hypopituitarism" hypopituitarism.Such features include secondary y HYPERLINK "http://en.wikipedia.org/wiki/Hypothyroidism" hypothyroidismwith tiredness, HYPERLINK "http://en.wikipedia.org/wiki/Cold_sensitivity" \o "Cold sensitivity" intolerance to cold, HYPERLINK "http://en.wikipedia.org/wiki/Constipation" constipation, HYPERLINK "http://en.wikipedia.org/wiki/Weight_gain" weight gain, HYPERLINK "http://en.wikipedia.org/wiki/Alopecia" \o "Alopecia" hair lossand slowed thinking, as well as HYPERLINK "http://en.wikipedia.org/wiki/Bradycardia" \o "Bradycardia" a slowed heart rateand HYPERLINK "http://en.wikipedia.org/wiki/Hypotension" \o "Hypotension" low blood pressure. Another such feature is secondary HYPERLINK "http://en.wikipedia.org/wiki/Adrenal_insufficiency" adrenal insufficiency, which, in the rather chronic case is similar to HYPERLINK "http://en.wikipedia.org/wiki/Addison%27s_disease" Addison's diseasewith symptoms including HYPERLINK "http://en.wikipedia.org/wiki/Fatigue_(medical)" \o "Fatigue (medical)" fatigue, HYPERLINK "http://en.wikipedia.org/wiki/Weight_loss" \l "Unintentional_weight_loss" weight loss, HYPERLINK "http://en.wikipedia.org/wiki/Hypoglycemia" hypoglycemia(low blood sugar levels), HYPERLINK "http://en.wikipedia.org/wiki/Anemia" anemiaand HYPERLINK "http://en.wikipedia.org/wiki/Hyponatremia" hyponatremia(low sodium levels). Such a woman may, however, become acutely exacerbated when her body is stressed by, for example, a severe infection or surgery years after her delivery, a condition equivalent with an HYPERLINK "http://en.wikipedia.org/wiki/Addisonian_crisis" \o "Addisonian crisis" Addisonian crisis. HYPERLINK "http://en.wikipedia.org/wiki/Gonadotropin" Gonadotropindeficiency will often cause HYPERLINK "http://en.wikipedia.org/wiki/Amenorrhea" \o "Amenorrhea" amenorrhea, HYPERLINK "http://en.wikipedia.org/wiki/Oligomenorrhea" oligomenorrhea,  HYPERLINK "http://en.wikipedia.org/wiki/Hot_flashes" \o "Hot flashes" hot flashes, or HYPERLINK "http://en.wikipedia.org/wiki/Decreased_libido" \o "Decreased libido" decreased libido. HYPERLINK "http://en.wikipedia.org/wiki/Sheehan's_syndrome" \l "cite_note-schrager-0" [1]Growth hormone deficiency causes many vague symptoms including fatigue and decreased muscle mass. Uncommonly, Sheehan syndrome may also appear acutely after delivery, mainly by HYPERLINK "http://en.wikipedia.org/wiki/Hyponatremia" hyponatremia. There are several possible mechanisms by which hypopituitarism can result in hyponatremia, including decreased free-water clearance by hypothyroidism, direct HYPERLINK "http://en.wikipedia.org/wiki/Syndrome_of_inappropriate_antidiuretic_hormone_hypersecretion" \o "Syndrome of inappropriate antidiuretic hormone hypersecretion" syndrome of inappropriate antidiuretic hormone (ADH) hypersecretion, decreased free-water clearance by glucocorticoid deficiency (independent of ADH).The potassium level inthese situations is normal, because adrenal production of aldosterone is not dependent on the pituitary. There have also been cases with acute hypoglycemia. Pathophysiology: Hypertrophy and hyperplasia of HYPERLINK "http://en.wikipedia.org/wiki/Lactotrophs" \o "Lactotrophs" lactotrophsduring pregnancy results in the enlargement of the HYPERLINK "http://en.wikipedia.org/wiki/Anterior_pituitary" anterior pituitary, without a corresponding increase in blood supply. Secondly, the anterior pituitary is supplied by a low pressure HYPERLINK "http://en.wikipedia.org/wiki/Portal_venous_system" portal venous system. These vulnerabilities, when affected by major HYPERLINK "http://en.wikipedia.org/wiki/Hemorrhage" \o "Hemorrhage" hemorrhageor hypotension during the peripartum period, can result in HYPERLINK "http://en.wikipedia.org/wiki/Ischaemia" \o "Ischaemia" ischaemiaof the affected pituitary regions leading to HYPERLINK "http://en.wikipedia.org/wiki/Necrosis" necrosis. The HYPERLINK "http://en.wikipedia.org/wiki/Posterior_pituitary" posterior pituitaryis usually not affected due to its direct arterial supply. Empty sella syndrome Empty sella syndrome is a condition in which the pituitary gland shrinks or becomes flattened. Causes, incidence, and risk factors: The pituitary gland is a small gland located at the base of the brain. It sits in a saddle-like compartment in the skull called the "sella turcica," which in Latin means "Turkish saddle." When the pituitary gland shrinks or becomes flattened, it cannot be seen on HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003335/" MRIscans, giving the appearance of an "empty sella." This is referred to as empty sella syndrome. The pituitary makes several hormones that control the other glands in the body, including the: Adrenal glands Ovaries Testicles  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000689/" Thyroid Primary empty sella syndrome occurs when a hole in the membrane covering the pituitary gland allows fluid in, which presses on the pituitary. Secondary empty sella syndrome occurs when the sella is empty because the pituitary gland has been damaged by: A tumor Radiation therapy Surgery Empty sella syndrome may be seen in a condition called pseudotumor cerebri. This is a condition seen most commonly in obese women. Symptoms Often, there are no symptoms or loss of pituitary function. Patients with empty sella syndrome may have symptoms caused by a partial or complete loss of pituitary gland function. For more information, see HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000343/" hypopituitarism. Symptoms include: Erectile dysfunction ( HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003164/" impotence) Headaches Irregular or HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003149/" absent menstruation Low sexual desire ( HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A001952/" low libido)  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A001515/" Nipple discharge Signs and tests: Primary empty sella syndrome is most often discovered during HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003786/" radiological imaging of the brain. Pituitary function is usually normal. The health care provider may test pituitary gland function to make sure that the gland is working normally. Sometimes tests for high pressure in the brain will be done, such as: Examination of the retina by an ophthalmologist Lumbar puncture ( HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003428/" spinal tap) The hormone prolactin is a little high in a small percentage of patients, which may interfere with the normal function of the testicles or ovaries. Prognosis: Primary empty sella syndrome does not cause health problems, and it does not affect life expectancy. Complications: Complications of primary empty sella syndrome include mild hyperprolactinemia. Complications of secondary empty sella syndrome are related to the cause of pituitary gland disease or to the effects of too little pituitary hormone. Forbes-Albright syndrome Forbes-Albright syndrome is characterized bypituitary tumor in a patient without acromegaly, which secretes excessive amounts of prolactin (PRL) and produces persistent lactation.A pituitary adenoma which secretes PROLACTIN, leading to HYPERPROLACTINEMIA. Clinical manifestations include AMENORRHEA; GALACTORRHEA; IMPOTENCE; HEADACHE; visual disturbances; and CEREBROSPINAL FLUID RHINORRHEA. Symptoms of Forbes-Albright syndrome: The list of signs and symptoms mentioned in various sources for HYPERLINK "http://www.wrongdiagnosis.com/f/forbes_albright_syndrome/intro.htm" Forbes-Albright syndromeincludes the 14 symptoms listed below: Increased prolactin secretion Enlarged pituitary gland  HYPERLINK "http://www.wrongdiagnosis.com/sym/galactorrhea.htm" Galactorrhea  HYPERLINK "http://www.wrongdiagnosis.com/medical/absence_of_menstruation.htm" Absence of menstruation  HYPERLINK "http://www.wrongdiagnosis.com/sym/ovary_symptoms.htm" Lack of ovulation  HYPERLINK "http://www.wrongdiagnosis.com/sym/hair_symptoms.htm" Altered pattern of body hair in females  HYPERLINK "http://www.wrongdiagnosis.com/sym/decreased_libido.htm" Decreased libido Female obesity  HYPERLINK "http://www.wrongdiagnosis.com/sym/oily_skin.htm" Oily skin  HYPERLINK "http://www.wrongdiagnosis.com/sym/breast_swelling.htm" Enlarged male breasts Milk-secreting male breasts  HYPERLINK "http://www.wrongdiagnosis.com/sym/impotence.htm" Impotence  HYPERLINK "http://www.wrongdiagnosis.com/sym/sperm_symptoms.htm" Decreased sperm Low level of gonadotropins Complications list for Forbes-Albright syndrome: The list of complications that have been mentioned in various sources for Forbes- HYPERLINK "http://wrongdiagnosis.pubs.righthealth.com/topic/McCune%E2%80%93Albright%20syndrome?as=clink&ac=1437&afc=2168586466&p=" \o "McCuneAlbright syndrome" \t "_blank" Albright HYPERLINK "http://wrongdiagnosis.pubs.righthealth.com/topic/Syndromes?as=clink&ac=1437&afc=2168586466&p=" \o "Syndromes" \t "_blank" syndromeincludes:  HYPERLINK "http://www.wrongdiagnosis.com/d/dyspareunia/intro.htm" Dyspareunia  HYPERLINK "http://www.wrongdiagnosis.com/o/optic_nerve_disorder/intro.htm" Optic nerve disorder  HYPERLINK "http://www.wrongdiagnosis.com/g/gynecomastia/intro.htm" Gynaecomastia  HYPERLINK "http://www.wrongdiagnosis.com/f/female_infertility/intro.htm" Female infertility  HYPERLINK "http://www.wrongdiagnosis.com/symptom/amenorrhoea.htm" Amenorrhoea  HYPERLINK "http://www.wrongdiagnosis.com/g/galactorrhoea_hyperprolactinaemia/intro.htm" Galactorrhoea-Hyperprolactinaemia  HYPERLINK "http://www.wrongdiagnosis.com/p/pituitary_cancer/intro.htm" Pituitary tumour Diagnosis: The diagnosis is often one of exclusion found during the workup of delayed puberty. The presence of anosmia with delayed puberty should suggest Kallmann syndrome. Pathophysiology: Under normal conditions, GnRH travels from the hypothalamus to the HYPERLINK "http://en.wikipedia.org/wiki/Pituitary_gland" pituitary glandvia the HYPERLINK "http://en.wikipedia.org/wiki/Hypophyseal_portal_system" hypophyseal portal system, where it triggers production and release of HYPERLINK "http://en.wikipedia.org/wiki/Gonadotropin" \o "Gonadotropin" gonadotropins( HYPERLINK "http://en.wikipedia.org/wiki/Luteinizing_hormone" \o "Luteinizing hormone" LHand HYPERLINK "http://en.wikipedia.org/wiki/Follicle_stimulating_hormone" \o "Follicle stimulating hormone" FSH) from the HYPERLINK "http://en.wikipedia.org/wiki/Gonadotrope" \o "Gonadotrope" gonadotropes. When GnRH is low, the pituitary does not create the normal amount of gonadotropins. The gonadotropins normally increase the production of HYPERLINK "http://en.wikipedia.org/wiki/Sex_steroid" \o "Sex steroid" gonadal steroids; so, when they are low, these steroids will be low as well. Kallmann syndrome In Kallmann syndrome, the GnRH neurons do not migrate properly from the HYPERLINK "http://en.wikipedia.org/wiki/Olfactory_placode" \o "Olfactory placode" olfactory placodeto the hypothalamus during development. The olfactory bulbs also fail to form or have hypoplasia, leading to anosmia or hyposmia. Management: Treatment is directed at restoring the deficient hormones HYPERLINK "http://en.wikipedia.org/wiki/Hormone_therapy" hormone therapy(HT). Males are administered HYPERLINK "http://en.wikipedia.org/wiki/Human_chorionic_gonadotropin" human chorionic gonadotropin(hCG) or HYPERLINK "http://en.wikipedia.org/wiki/Testosterone" testosterone. Females are treated with HYPERLINK "http://en.wikipedia.org/wiki/Estrogen" estrogenand HYPERLINK "http://en.wikipedia.org/wiki/Progestin" \o "Progestin" progestins. Klinefelter syndrome Klinefelter syndrome,47, XXY,orXXY syndromeis a condition in which human males have an extra X chromosome. While females have an XX chromosomal makeup, and males an XY, affected individuals have at least two HYPERLINK "http://en.wikipedia.org/wiki/X_chromosome" \o "X chromosome" X chromosomesand at least one HYPERLINK "http://en.wikipedia.org/wiki/Y_chromosome" Y chromosome. Because of the HYPERLINK "http://en.wikipedia.org/wiki/Trisomy" \o "Trisomy" extra chromosome, individuals with the condition are usually referred to as "XXY Males", or "47, XXY Males". In humans, Klinefelter syndrome is the most common sex chromosome disorder in malesand the second most common condition caused by the presence of extra chromosomes. The condition exists in roughly 1 out of every 1,000 males. One in every 500 males has an extra X chromosome but does not have the syndrome.Other mammals also have the XXY syndrome, including mice. The principal effects are development of small HYPERLINK "http://en.wikipedia.org/wiki/Testicle" \o "Testicle" testiclesand reduced HYPERLINK "http://en.wikipedia.org/wiki/Fertility" fertility. A variety of other physical and behavioral differences and problems are common, though severity varies and many boys and men with the condition have few detectable symptoms. Signs and symptoms  INCLUDEPICTURE "http://wormix.com/files/2011/01/wpid-klinefelter-syndrome-inheritedsv.jpg" \* MERGEFORMATINET  Affected males are almost always effectively HYPERLINK "http://en.wikipedia.org/wiki/Infertility" \o "Infertility" infertile, although advanced reproductive assistance is sometimes possible.Some degree of language learning impairment may be present,and neuropsychological testing often reveals deficits in HYPERLINK "http://en.wikipedia.org/wiki/Executive_functions" executive functions.In adults, possible characteristics vary widely and include little to no signs of affectedness, a HYPERLINK "http://en.wiktionary.org/wiki/lanky" \o "wikt:lanky" lanky, youthful build and facial appearance, or a rounded body type with some degree of HYPERLINK "http://en.wikipedia.org/wiki/Gynecomastia" gynecomastia(increased breast tissue).Gynecomastia is present to some extent in about a third of affected individuals, a slightly higher percentage than in the XY population. About 10% of XXY males have HYPERLINK "http://en.wikipedia.org/wiki/Gynecomastia" gynecomastianoticeable enough that they may choose to have cosmetic surgery. The term HYPERLINK "http://en.wikipedia.org/wiki/Hypogonadism" hypogonadismin XXY symptoms is often misinterpreted to mean "small testicles" or "small penis". In fact, it means decreased testicular hormone/endocrine function. Because of this (primary) hypogonadism, individuals will often have a low serum HYPERLINK "http://en.wikipedia.org/wiki/Testosterone" testosteronelevel but high serum HYPERLINK "http://en.wikipedia.org/wiki/Follicle-stimulating_hormone" follicle-stimulating hormone(FSH) and HYPERLINK "http://en.wikipedia.org/wiki/Luteinizing_hormone" luteinizing hormone(LH) levels.Despite this misunderstanding of the term, however, it is true that XXY men also have HYPERLINK "http://en.wikipedia.org/wiki/Microorchidism" microorchidism(i.e. small testicles). The more severe end of the HYPERLINK "http://en.wikipedia.org/wiki/Spectrum" spectrumof symptom expression is also associated with an increased risk of HYPERLINK "http://en.wikipedia.org/wiki/Germ_cell_tumor" \o "Germ cell tumor" germ cell tumors, HYPERLINK "http://en.wikipedia.org/wiki/Male_breast_cancer" male breast cancer,and HYPERLINK "http://en.wikipedia.org/wiki/Osteoporosis" osteoporosis,risks shared to varying degrees with females. Additionally, medical literature shows some individual case studies of Klinefelter syndrome coexisting with other disorders, such as HYPERLINK "http://en.wikipedia.org/wiki/Pulmonary_disease" \o "Pulmonary disease" pulmonary disease, HYPERLINK "http://en.wikipedia.org/wiki/Varicose_vein" \o "Varicose vein" varicose veins, HYPERLINK "http://en.wikipedia.org/wiki/Diabetes_mellitus" diabetes mellitus, and HYPERLINK "http://en.wikipedia.org/wiki/Rheumatoid_arthritis" rheumatoid arthritis, but possible correlations between Klinefelter and these other conditions are not well characterized or understood.[ HYPERLINK "http://en.wikipedia.org/wiki/Wikipedia:Citation_needed" \o "Wikipedia:Citation needed" citation needed] In contrast to these potentially increased risks, it is currently thought that rare HYPERLINK "http://en.wikipedia.org/wiki/Sex_linked" \o "Sex linked" X-linked recessiveconditions occur less frequently in XXY males than in normal XY males, since these conditions are transmitted by genes on the X chromosome, and people with two X chromosomes are typically only HYPERLINK "http://en.wikipedia.org/wiki/Genetic_carrier" \o "Genetic carrier" carriersrather than affected by these X-linked recessive conditions. There are many variances within the XXY population, just as in the most common HYPERLINK "http://en.wikipedia.org/wiki/46,XY" \o "46,XY" 46, XYpopulation. While it is possible to characterise 47, XXY males with certain body types, that in itself should not be the method of identification as to whether or not someone has 47,XXY. The only reliable method of identification is HYPERLINK "http://en.wikipedia.org/wiki/Karyotype" karyotypetesting. Diagnosis: A HYPERLINK "http://en.wikipedia.org/wiki/Karyotype" karyotypeis used to confirm the diagnosis. In this procedure, a small blood sample is drawn. HYPERLINK "http://en.wikipedia.org/wiki/White_blood_cell" \o "White blood cell" White blood cellsare then separated from the sample, mixed with HYPERLINK "http://en.wikipedia.org/wiki/Growth_medium" \o "Growth medium" tissue culture medium, incubated, and checked for chromosomal abnormalities, such as an extra X chromosome. Diagnosis can also be made prenatally via HYPERLINK "http://en.wikipedia.org/wiki/Chorionic_villus_sampling" chorionic villus samplingor HYPERLINK "http://en.wikipedia.org/wiki/Amniocentesis" amniocentesis, tests in which fetal tissue is extracted and the fetal HYPERLINK "http://en.wikipedia.org/wiki/DNA" DNAis examined for genetic abnormalities. A 2002 literature review of elective HYPERLINK "http://en.wikipedia.org/wiki/Abortion" abortionrates found that approximately 50% of pregnancies in the United States with a diagnosis of Klinefelter syndrome were terminated. Cause: The extra X chromosome is retained because of a HYPERLINK "http://en.wikipedia.org/wiki/Nondisjunction" nondisjunctionevent during HYPERLINK "http://en.wikipedia.org/wiki/Meiosis_I" \o "Meiosis I" meiosis I(gametogenesis). Nondisjunction occurs with when homologous chromosomes, in the case the X and Y sex chromosomes, fail to separate, producing a sperm with an X and a Y chromosome. Fertilizing a normal (X) egg produces an XXY offspring. The XXY chromosome arrangement is one of the most common genetic variations from the XY HYPERLINK "http://en.wikipedia.org/wiki/Karyotype" karyotype, occurring in about 1 in 500 live male births. Another mechanism for retaining the extra X chromosome is through a nondisjunction event during HYPERLINK "http://en.wikipedia.org/wiki/Meiosis_II" \o "Meiosis II" meiosis IIin the female. Nondisjunction will occur when sister chromatids on the sex chromosome, in this case an X and an X, fail to separate. An XX egg is produced which, when fertilized with a Y sperm, yields XXY offspring. In HYPERLINK "http://en.wikipedia.org/wiki/Mammal" \o "Mammal" mammalswith more than one X chromosome, the HYPERLINK "http://en.wikipedia.org/wiki/Gene" \o "Gene" geneson all but one X chromosome are not expressed; this is known as HYPERLINK "http://en.wikipedia.org/wiki/X_inactivation" \o "X inactivation" X inactivation. This happens in XXY males as well as normal XX females.However, in XXY males, a few genes located in the HYPERLINK "http://en.wikipedia.org/wiki/Pseudoautosomal_region" \o "Pseudoautosomal region" pseudoautosomal regionsof their X chromosomes, have corresponding genes on their Y chromosome and are capable of being expressed.These HYPERLINK "http://en.wikipedia.org/wiki/Triploid" \o "Triploid" triploidgenes in XXY males may be responsible for symptoms associated with Klinefelter syndrome.[ HYPERLINK "http://en.wikipedia.org/wiki/Wikipedia:Citation_needed" \o "Wikipedia:Citation needed" citation needed] Polycystic ovary syndrome Polycystic ovary syndrome(PCOS) is one of the most common female HYPERLINK "http://en.wikipedia.org/wiki/Endocrine" \o "Endocrine" endocrinedisorders affecting approximately 5%-10% of women of reproductive age (1245 years old) and is thought to be one of the leading causes of HYPERLINK "http://en.wikipedia.org/wiki/Female_subfertility" \o "Female subfertility" female subfertility. The principal features are obesity, HYPERLINK "http://en.wikipedia.org/wiki/Anovulation" anovulation(resulting in irregular HYPERLINK "http://en.wikipedia.org/wiki/Menstruation" menstruation) or HYPERLINK "http://en.wikipedia.org/wiki/Amenorrhea" \o "Amenorrhea" amenorrhea, HYPERLINK "http://en.wikipedia.org/wiki/Acne" acne, and excessive amounts or effects of HYPERLINK "http://en.wikipedia.org/wiki/Androgen" \o "Androgen" androgenic(masculinizing) hormones. The symptoms and severity of the syndrome vary greatly among women. While the causes are unknown, HYPERLINK "http://en.wikipedia.org/wiki/Insulin_resistance" insulin resistance, HYPERLINK "http://en.wikipedia.org/wiki/Diabetes" \o "Diabetes" diabetes, and HYPERLINK "http://en.wikipedia.org/wiki/Obesity" obesityare all strongly correlated with PCOS Other names for this syndrome include polycystic ovarian syndrome (alsoPCOS), polycystic ovary disease (PCOD),functional ovarian hyperandrogenism,Stein-Leventhal syndrome(original name, not used in modern literature),ovarian hyperthecosisandsclerocystic ovary syndrome. igns and symptoms Common symptoms of PCOS include: Menstrual disorders - mostly HYPERLINK "http://en.wikipedia.org/wiki/Oligomenorrhea" oligomenorrheaor HYPERLINK "http://en.wikipedia.org/wiki/Amenorrhea" \o "Amenorrhea" amenorrheabut other types of menstrual disorders may also occur.  HYPERLINK "http://en.wikipedia.org/wiki/Infertility" Infertility, generally resulting from chronic HYPERLINK "http://en.wikipedia.org/wiki/Anovulation" anovulation(lack of ovulation).  HYPERLINK "http://en.wikipedia.org/wiki/Hirsutism" Hirsutism symptoms of HYPERLINK "http://en.wikipedia.org/wiki/Hyperandrogenism" hyperandrogenism, such as acne or HYPERLINK "http://en.wikipedia.org/wiki/Hypermenorrhea" \o "Hypermenorrhea" hypermenorrheaApproximately three-fourths of patients with PCOS (by the diagnostic criteria of NIH/NICHD 1990) have evidence of hyperandrogenemia.  HYPERLINK "http://en.wikipedia.org/wiki/Metabolic_syndrome" Metabolic syndrome, characterised by HYPERLINK "http://en.wikipedia.org/wiki/Central_obesity" \o "Central obesity" central obesity, insulin resistance and other symptoms. PCOS can present in any age during the reproductive years. Due to its often vague presentation it can take years to reach a diagnosis. Serum HYPERLINK "http://en.wikipedia.org/wiki/Insulin" insulin, HYPERLINK "http://en.wikipedia.org/wiki/Insulin_resistance" insulin resistanceand HYPERLINK "http://en.wikipedia.org/wiki/Homocysteine" homocysteinelevels are significantly higher in subjects having PCOS. Diagnosis: Not all women with PCOS have polycystic ovaries (PCO), nor do all women with ovarian cysts have PCOS; although a HYPERLINK "http://en.wikipedia.org/wiki/Pelvic_ultrasound" \o "Pelvic ultrasound" pelvic ultrasoundis a major diagnostic tool, it is not the only one. The diagnosis is straightforward using the Rotterdam criteria, even when the syndrome is associated with a wide range of symptoms. Standard diagnostic assessments: History-taking, specifically for menstrual pattern, obesity, hirsutism, and the absence of breast development. A HYPERLINK "http://en.wikipedia.org/wiki/Clinical_prediction_rule" clinical prediction rulefound that these four questions can diagnose PCOS with a HYPERLINK "http://en.wikipedia.org/wiki/Sensitivity_(tests)" \o "Sensitivity (tests)" sensitivityof 77.1% (95% HYPERLINK "http://en.wikipedia.org/wiki/Confidence_interval" confidence interval[CI] 62.7%88.0%) and a HYPERLINK "http://en.wikipedia.org/wiki/Specificity_(tests)" \o "Specificity (tests)" specificityof 93.8% (95% CI 82.8%98.7%).  HYPERLINK "http://en.wikipedia.org/wiki/Gynecologic_ultrasonography" Gynecologic ultrasonography, specifically looking for small HYPERLINK "http://en.wikipedia.org/wiki/Ovarian_follicles" \o "Ovarian follicles" ovarian follicles. These are believed to be the result of disturbed ovarian function with failed ovulation, reflected by the infrequent or absent menstruation that is typical of the condition. In normal HYPERLINK "http://en.wikipedia.org/wiki/Menstrual_cycle" menstrual cycle, one egg is released from a dominant follicle - essentially a cyst that bursts to release the egg. After ovulation the follicle remnant is transformed into a HYPERLINK "http://en.wikipedia.org/wiki/Progesterone" progesteroneproducing HYPERLINK "http://en.wikipedia.org/wiki/Corpus_luteum" corpus luteum, which shrinks and disappears after approximately 1214 days. In PCOS, there is a so called "follicular arrest", i.e., several follicles develop to a size of 57mm, but not further. No single follicle reach the preovulatory size (16mm or more). According to the Rotterdam criteria, 12 or more small follicles should be seen in an ovary on ultrasound examination. The follicles may be oriented in the periphery, giving the appearance of a 'string of pearls'. The numerous follicles contribute to the increased size of the ovaries, that is, 1.5 to 3 times larger than normal.  HYPERLINK "http://en.wikipedia.org/wiki/Laparoscopic_surgery" \o "Laparoscopic surgery" Laparoscopicexamination may reveal a thickened, smooth, pearl-white outer surface of the ovary. (This would usually be an incidental finding if laparoscopy were performed for some other reason, as it would not be routine to examine the ovaries in this way to confirm a diagnosis of PCOS). Serum (blood) levels of HYPERLINK "http://en.wikipedia.org/wiki/Androgen" \o "Androgen" androgens(male hormones), including HYPERLINK "http://en.wikipedia.org/wiki/Androstenedione" androstenedione, HYPERLINK "http://en.wikipedia.org/wiki/Testosterone" testosteroneand HYPERLINK "http://en.wikipedia.org/wiki/Dehydroepiandrosterone_sulfate" Dehydroepiandrosterone sulfatemay be elevated.The free testosterone level is thought to be the best measure,with ~60% of PCOS patients demonstrating supranormal levels.The HYPERLINK "http://en.wikipedia.org/wiki/Free_androgen_index" Free androgen indexof the ratio of testosterone to HYPERLINK "http://en.wikipedia.org/wiki/Sex_hormone-binding_globulin" sex hormone-binding globulin(SHBG) is high, is meant to be a predictor of free testosterone, but is a poor parameter for this and is no better than testosterone alone as a marker for PCOS, HYPERLINK "http://en.wikipedia.org/wiki/Polycystic_ovary_syndrome" \l "cite_note-pmid1296589-13"  possibly because FAI is correlated with the degree of obesity. Some other blood tests are suggestive but not diagnostic. The ratio of LH ( HYPERLINK "http://en.wikipedia.org/wiki/Luteinizing_hormone" Luteinizing hormone) to FSH ( HYPERLINK "http://en.wikipedia.org/wiki/Follicle_stimulating_hormone" \o "Follicle stimulating hormone" Follicle stimulating hormone) is greater than 1:1, as tested on Day 3 of the menstrual cycle. The pattern is not very specific and was present in less than 50% in one study. There are often low levels of HYPERLINK "http://en.wikipedia.org/wiki/Sex_hormone_binding_globulin" \o "Sex hormone binding globulin" sex hormone binding globulin, particularly among obese women. Fasting insulin level or GTT with insulin levels (also called IGTT). Elevated insulin levels have been helpful to predict response to medication and may indicate women who will need higher dosages of metformin or the use of a second medication to significantly lower insulin levels. Elevated HYPERLINK "http://en.wikipedia.org/wiki/Blood_sugar" blood sugarand insulin values do not predict who responds to an insulin-lowering medication, low-glycemic diet, and exercise. Many women with normal levels may benefit from combination therapy. A hypoglycemic response in which the two-hour insulin level is higher and the blood sugar lower than fasting is consistent with insulin resistance. A mathematical derivation known as the HOMAI, calculated from the fasting values in glucose and insulin concentrations, allows a direct and moderately accurate measure of insulin sensitivity (glucose-level x insulin-level/22.5).  HYPERLINK "http://en.wikipedia.org/wiki/Glucose_tolerance_test" \o "Glucose tolerance test" Glucose tolerance testing(GTT) instead of fasting glucose can increase diagnosis of increased glucose tolerance and frank diabetes among patients with PCOS according to a prospective controlled trial.While fasting glucose levels may remain within normal limits, oral glucose tests revealed that up to 38% of asymptomatic women with PCOS (versus 8.5% in the general population) actually had impaired glucose tolerance, 7.5% of those with frank diabetes according to ADA guidelines. Pathogenesis: Polycystic ovaries develop when the ovaries are stimulated to produce excessive amounts of male hormones (androgens), particularly testosterone, either through the release of excessive HYPERLINK "http://en.wikipedia.org/wiki/Luteinizing_hormone" luteinizing hormone(LH) by the anterior pituitary gland or through high levels of insulin in the blood (hyperinsulinaemia) in women whose ovaries are sensitive to this stimulus. The syndrome acquired its most widely used name due to the common sign on ultrasound examination of multiple (poly) ovarian HYPERLINK "http://en.wikipedia.org/wiki/Cyst" \o "Cyst" cysts. These "cysts" are actually immature follicles, not cysts ("polyfollicular ovary syndrome" would have been a more accurate name). The follicles have developed from primordial follicles, but the development has stopped ("arrested") at an early antral stage due to the disturbed ovarian function. The follicles may be oriented along the ovarian periphery, appearing as a 'string of pearls' on ultrasound examination. The condition was first described in 1935 by Dr. Stein and Dr. Leventhal, hence its original name of Stein-Leventhal syndrome. A majority of patients with PCOS have insulin resistance and/or are obese. Their elevated insulin levels contribute to or cause the abnormalities seen in the hypothalamic-pituitary-ovarian axis that lead to PCOS. PCOS is characterized by a complex set of symptoms, and the cause cannot be determined for all patients. In many cases it is characterised by a complex positive feedback loop of insulin resistance and hyperandrogensim. In most cases it can not be determined which (if any) of those two should be regarded causative. Experimental treatment with either antiandrogens or insulin sensitizing agents improves both hyperandrogenism and insulin resistance. PCOS is also likely to have a genetic predisposition, and further research into this possibility is taking place. A few specific genetic defects are known accounting only for a small fraction of cases, the rest may be due to the combination of several factors. Adipose tissue possesses aromatase, an enzyme that converts androstenedione to estrone and testosterone to estradiol. The excess of adipose tissue in obese patients creates the paradox of having both excess androgens (which are responsible for hirsutism and virilization) and estrogens (which inhibits FSH via negative feedback). HYPERLINK "http://en.wikipedia.org/wiki/Polycystic_ovary_syndrome" \l "cite_note-17" [18] Hyperinsulinemia increases HYPERLINK "http://en.wikipedia.org/wiki/GnRH" \o "GnRH" GnRHpulse frequency, LH over FSH dominance, increased ovarian androgen production, decreased follicular maturation, and decreased HYPERLINK "http://en.wikipedia.org/wiki/SHBG" \o "SHBG" SHBGbinding; all these steps contribute to the development of PCOS. Insulin resistance is a common finding among patients of normal weight as well as those overweight patients. PCOS may be associated with chronic inflammation, with several investigators correlating inflammatory mediators with anovulation and other PCOS symptoms. HYPERLINK "http://en.wikipedia.org/wiki/Polycystic_ovary_syndrome" \l "cite_note-18" [19] HYPERLINK "http://en.wikipedia.org/wiki/Polycystic_ovary_syndrome" \l "cite_note-19" [20] One study in the United Kingdom concluded that the risk of PCOS development was shown to be higher in lesbian women than in heterosexuals.It should be noted however that all the participants in this study were referred after infertility was discovered or highly suspected and conclusion made is purely conjecture. Until further studies have been conducted and the research collaborated there is no assumption that female homosexuality will increase the occurrence of PCOS. It has previously been suggested that the excessive androgen production in PCOS could be caused by a decreased serum level of HYPERLINK "http://en.wikipedia.org/wiki/IGFBP-1" \o "IGFBP-1" IGFBP-1, in turn increasing the level of free HYPERLINK "http://en.wikipedia.org/wiki/IGF-I" \o "IGF-I" IGF-Iwhich stimulates ovarian androgen production., but recent data concludes this mechanism to be unlikely. Management: Medical treatment of PCOS is tailored to the patient's goals. Broadly, these may be considered under four categories: Lowering of insulin levels Restoration of fertility Treatment of HYPERLINK "http://en.wikipedia.org/wiki/Hirsutism" hirsutismor acne Restoration of regular menstruation, and prevention of endometrial hyperplasia and endometrial cancer Prognosis: Women with PCOS are at risk for the following: Endometrial HYPERLINK "http://en.wikipedia.org/wiki/Hyperplasia" hyperplasiaand HYPERLINK "http://en.wikipedia.org/wiki/Endometrial_cancer" endometrial cancer(cancer of the uterine lining) are possible, due to overaccumulation of uterine lining, and also lack of HYPERLINK "http://en.wikipedia.org/wiki/Progesterone" progesteroneresulting in prolonged stimulation of uterine cells by estrogen. It is not clear if this risk is directly due to the syndrome or from the associated obesity, HYPERLINK "http://en.wikipedia.org/wiki/Hyperinsulinemia" hyperinsulinemia, and HYPERLINK "http://en.wikipedia.org/wiki/Hyperandrogenism" hyperandrogenism  HYPERLINK "http://en.wikipedia.org/wiki/Insulin_resistance" Insulin resistance/ HYPERLINK "http://en.wikipedia.org/wiki/Diabetes_mellitus_type_2" \o "Diabetes mellitus type 2" Type II diabetes. A review published in 2010 concluded that women with PCOS had an elevated prevalence of insulin resistance and type II diabetes, also when controlling for HYPERLINK "http://en.wikipedia.org/wiki/Body_mass_index" body mass index(BMI).  HYPERLINK "http://en.wikipedia.org/wiki/High_blood_pressure" \o "High blood pressure" High blood pressure  HYPERLINK "http://en.wikipedia.org/wiki/Depression_(mood)" \o "Depression (mood)" Depression/Depression with HYPERLINK "http://en.wikipedia.org/wiki/Anxiety" Anxiety  HYPERLINK "http://en.wikipedia.org/wiki/Dyslipidemia" Dyslipidemia- disorders of lipid metabolism cholesterol and triglycerides. PCOS patients show decreased removal of HYPERLINK "http://en.wikipedia.org/wiki/Atherosclerosis" atherosclerosis-inducing remnants, seemingly independent on insulin resistance/Type II diabetes.  HYPERLINK "http://en.wikipedia.org/wiki/Cardiovascular_disease" Cardiovascular disease  HYPERLINK "http://en.wikipedia.org/wiki/Stroke" \o "Stroke" Strokes  HYPERLINK "http://en.wikipedia.org/wiki/Weight_gain" Weight gain  HYPERLINK "http://en.wikipedia.org/wiki/Miscarriage" Miscarriage  HYPERLINK "http://en.wikipedia.org/wiki/Acanthosis_nigricans" Acanthosis nigricans(patches of darkened skin under the arms, in the groin area, on the back of the neck)  HYPERLINK "http://en.wikipedia.org/wiki/Autoimmune_thyroiditis" Autoimmune thyroiditis Cushing's syndrome Cushing's syndromeis a hormone disorder caused by high levels of HYPERLINK "http://en.wikipedia.org/wiki/Cortisol" cortisolin the blood. This can be caused by taking HYPERLINK "http://en.wikipedia.org/wiki/Glucocorticoid" glucocorticoiddrugs, or by tumors that produce cortisol or HYPERLINK "http://en.wikipedia.org/wiki/Adrenocorticotropic_hormone" adrenocorticotropic hormone(ACTH) or CRH.  HYPERLINK "http://en.wikipedia.org/wiki/Cushing%27s_disease" Cushing's diseaserefers to one specific cause of the syndrome, a tumor ( HYPERLINK "http://en.wikipedia.org/wiki/Adenoma" adenoma) in the HYPERLINK "http://en.wikipedia.org/wiki/Pituitary_gland" pituitary glandthat produces large amounts of HYPERLINK "http://en.wikipedia.org/wiki/ACTH" \o "ACTH" ACTH, which in turn elevates cortisol. It is the most common cause of Cushing's syndrome, responsible for 70% of cases HYPERLINK "http://en.wikipedia.org/wiki/Cushing's_syndrome" \l "cite_note-1"  This pathology was described by HYPERLINK "http://en.wikipedia.org/wiki/Harvey_Cushing" \o "Harvey Cushing" Harvey Cushingin 1932.The syndrome is also called Itsenko-Cushing syndrome,hyperadrenocorticismorhypercorticism) Cushing's syndrome is not confined to humans and is also a relatively common condition in domestic HYPERLINK "http://en.wikipedia.org/wiki/Dogs" \o "Dogs" dogsand HYPERLINK "http://en.wikipedia.org/wiki/Horses" \o "Horses" horses. Signs and symptoms: Symptoms include rapid HYPERLINK "http://en.wikipedia.org/wiki/Obesity" \o "Obesity" weight gain, particularly of the trunk and face with sparing of the limbs ( HYPERLINK "http://en.wikipedia.org/wiki/Central_obesity" \o "Central obesity" central obesity). A common sign is the growth of fat pads along the collar bone and on the back of the neck (buffalo hump) and a round face often referred to as a " HYPERLINK "http://en.wikipedia.org/wiki/Moon_face" moon face". Other symptoms include HYPERLINK "http://en.wikipedia.org/wiki/Hyperhidrosis" hyperhidrosis(excess sweating), HYPERLINK "http://en.wikipedia.org/wiki/Telangiectasia" telangiectasia(dilation of capillaries), thinning of the skin (which causes easy bruising and dryness, particularly the hands) and other mucous membranes, purple or red HYPERLINK "http://en.wikipedia.org/wiki/Striae" \o "Striae" striae(the weight gain in Cushing's syndrome stretches the skin, which is thin and weakened, causing it to hemorrhage) on the trunk, buttocks, arms, legs or breasts, proximal muscle weakness (hips, shoulders), and HYPERLINK "http://en.wikipedia.org/wiki/Hirsutism" hirsutism(facial male-pattern hair growth), HYPERLINK "http://en.wikipedia.org/wiki/Baldness" baldnessand/or cause hair to become extremely dry and brittle. In rare cases, Cushing's can cause HYPERLINK "http://en.wikipedia.org/wiki/Hypercalcemia" \o "Hypercalcemia" hypercalcemia, which can lead to skin necrosis. The excess cortisol may also affect other endocrine systems and cause, for example, HYPERLINK "http://en.wikipedia.org/wiki/Insomnia" insomnia, inhibited HYPERLINK "http://en.wikipedia.org/wiki/Aromatase" aromatase, reduced HYPERLINK "http://en.wikipedia.org/wiki/Libido" libido, HYPERLINK "http://en.wikipedia.org/wiki/Impotence" \o "Impotence" impotence, HYPERLINK "http://en.wikipedia.org/wiki/Amenorrhoea" amenorrhoea/ HYPERLINK "http://en.wikipedia.org/wiki/Oligomenorrhea" oligomenorrheaand HYPERLINK "http://en.wikipedia.org/wiki/Infertility" infertilitydue to elevations in HYPERLINK "http://en.wikipedia.org/wiki/Androgens" \o "Androgens" androgens. Patients frequently suffer various psychological disturbances, ranging from HYPERLINK "http://en.wikipedia.org/wiki/Euphoria_(emotion)" \o "Euphoria (emotion)" euphoriato HYPERLINK "http://en.wikipedia.org/wiki/Psychosis" psychosis. HYPERLINK "http://en.wikipedia.org/wiki/Clinical_depression" \o "Clinical depression" Depressionand HYPERLINK "http://en.wikipedia.org/wiki/Anxiety" anxietyare also common. Other striking and distressing skin changes that may appear in Cushing's syndrome include facial acne, susceptibility to superficial HYPERLINK "http://en.wikipedia.org/wiki/Dermatophyte" dermatophyteand HYPERLINK "http://en.wikipedia.org/wiki/Malassezia" malasseziainfections, and the characteristic purplish, atrophic striae on the abdomen.:500 Other signs include HYPERLINK "http://en.wikipedia.org/wiki/Polyuria" polyuria(and accompanying HYPERLINK "http://en.wikipedia.org/wiki/Polydipsia" polydipsia), persistent HYPERLINK "http://en.wikipedia.org/wiki/Hypertension" hypertension(due to cortisol's enhancement of HYPERLINK "http://en.wikipedia.org/wiki/Epinephrine" epinephrine's vasoconstrictive effect) and HYPERLINK "http://en.wikipedia.org/wiki/Insulin_resistance" insulin resistance(especially common in HYPERLINK "http://en.wikipedia.org/wiki/Ectopic" \o "Ectopic" ectopicACTH production), leading to HYPERLINK "http://en.wikipedia.org/wiki/Hyperglycemia" hyperglycemia(high HYPERLINK "http://en.wikipedia.org/wiki/Blood_sugar" blood sugar) and insulin resistance which can lead to HYPERLINK "http://en.wikipedia.org/wiki/Diabetes_mellitus" diabetes mellitus. Insulin resistance is accompanied by skin changes such as HYPERLINK "http://en.wikipedia.org/wiki/Acanthosis_nigricans" acanthosis nigricansin the HYPERLINK "http://en.wikipedia.org/wiki/Axilla" axillaand around the neck, as well as skin tags in the axilla. Untreated Cushing's syndrome can lead to HYPERLINK "http://en.wikipedia.org/wiki/Heart_disease" heart diseaseand increased HYPERLINK "http://en.wikipedia.org/wiki/Death" \o "Death" mortality. Cushing's syndrome due to excess HYPERLINK "http://en.wikipedia.org/wiki/ACTH" \o "ACTH" ACTHmay also result in HYPERLINK "http://en.wikipedia.org/wiki/Hyperpigmentation" hyperpigmentation,This is due to Melanocyte-Stimulating Hormone production as a byproduct of ACTH synthesis from Pro-opiomelanocortin (POMC). Cortisol can also exhibit HYPERLINK "http://en.wikipedia.org/wiki/Mineralcorticoid" \o "Mineralcorticoid" mineralcorticoidactivity in high concentrations, worsening the hypertension and leading to HYPERLINK "http://en.wikipedia.org/wiki/Hypokalemia" hypokalemia(common in ectopic ACTH secretion). Furthermore, HYPERLINK "http://en.wikipedia.org/wiki/Gastrointestinal" \o "Gastrointestinal" gastrointestinaldisturbances, opportunistic infections and impaired wound healing (cortisol is a stress hormone, so it depresses the immune and inflammatory responses). HYPERLINK "http://en.wikipedia.org/wiki/Osteoporosis" Osteoporosisis also an issue in Cushing's syndrome since, as mentioned before, cortisol evokes a stress-like response. Consequently, the body's maintenance of bone (and other tissues) becomes secondary to maintenance of the false stress response. Additionally, Cushing's may cause sore and aching joints, particularly in the hip, shoulders, and lower back.  INCLUDEPICTURE "http://www.pharmacy-and-drugs.com/illnessessimages/cushings_syndrome1.jpg" \* MERGEFORMATINET   INCLUDEPICTURE "http://1.bp.blogspot.com/_XRpaqbDtwK4/Sfy_VyxrSLI/AAAAAAAAAvM/k-D2uULRqkE/s320/cushings-syndrome.jpg" \* MERGEFORMATINET  Cause: There are several possible causes of Cushing's syndrome. Exogenous vs. endogenous Hormones that come from outside the body are called exogenous; hormones that come from within the body are called endogenous. The most common cause of Cushing's syndrome isexogenousadministration of HYPERLINK "http://en.wikipedia.org/wiki/Glucocorticoid" \o "Glucocorticoid" glucocorticoidsprescribed by a health care practitioner to treat other diseases (called HYPERLINK "http://en.wikipedia.org/wiki/Iatrogenesis" \o "Iatrogenesis" iatrogenicCushing's syndrome). This can be an effect of steroid treatment of a variety of disorders such as HYPERLINK "http://en.wikipedia.org/wiki/Asthma" asthmaand HYPERLINK "http://en.wikipedia.org/wiki/Rheumatoid_arthritis" rheumatoid arthritis, or in HYPERLINK "http://en.wikipedia.org/wiki/Immunosuppression" immunosuppressionafter an organ transplant. Administration of synthetic ACTH is also possible, but ACTH is less often prescribed due to cost and lesser utility. Although rare, Cushing's syndrome can also be due to the use of medroxyprogesterone. EndogenousCushing's syndrome results from some derangement of the body's own system of secreting cortisol. Normally, HYPERLINK "http://en.wikipedia.org/wiki/ACTH" \o "ACTH" ACTHis released from the HYPERLINK "http://en.wikipedia.org/wiki/Pituitary_gland" pituitary glandwhen necessary to stimulate the release of cortisol from the HYPERLINK "http://en.wikipedia.org/wiki/Adrenal_gland" \o "Adrenal gland" adrenal glands.  INCLUDEPICTURE "http://www.nature.com/eye/journal/v20/n6/images/6701956f4.jpg" \* MERGEFORMATINET  (Exogenous Cushings syndrome) Inpituitary Cushing's, a benign pituitary adenoma secretes ACTH. This is also known asCushing's diseaseand is responsible for 70% of endogenous Cushing's syndrome. Inadrenal Cushing's, excess cortisol is produced by adrenal gland tumors, hyperplastic adrenal glands, or adrenal glands with nodular adrenal hyperplasia. Finally, tumors outside the normal pituitary-adrenal system can produce ACTH that affects the adrenal glands. This final etiology is calledectopicor HYPERLINK "http://en.wikipedia.org/wiki/Paraneoplasia" \o "Paraneoplasia" paraneoplasticCushing's syndromeand is seen in diseases like HYPERLINK "http://en.wikipedia.org/wiki/Small_cell_carcinoma" \o "Small cell carcinoma" small cell HYPERLINK "http://en.wikipedia.org/wiki/Lung_cancer" lung cancer. Pseudo-cushing's syndrome Elevated levels of total cortisol can also be due to estrogen found in oral contraceptive pills that contain a mixture of estrogen and progesterone. Estrogen can cause an increase of HYPERLINK "http://en.wikipedia.org/wiki/Transcortin" \o "Transcortin" cortisol-binding globulinand thereby cause the total cortisol level to be elevated. However, the total free cortisol, which is the active hormone in the body, as measured by a 24 hour urine collection for urinary free cortisol, is normal. Pathophysiology: The HYPERLINK "http://en.wikipedia.org/wiki/Hypothalamus" hypothalamusis in the brain and the HYPERLINK "http://en.wikipedia.org/wiki/Pituitary_gland" pituitary glandsits just below it. The paraventricular nucleus (PVN) of the hypothalamus releases HYPERLINK "http://en.wikipedia.org/wiki/Corticotropin-releasing_hormone" corticotropin-releasing hormone(CRH), which stimulates the pituitary gland to release adrenocorticotropin ( HYPERLINK "http://en.wikipedia.org/wiki/ACTH" \o "ACTH" ACTH). ACTH travels via the blood to the adrenal gland, where it stimulates the release of HYPERLINK "http://en.wikipedia.org/wiki/Cortisol" cortisol. Cortisol is secreted by the cortex of the HYPERLINK "http://en.wikipedia.org/wiki/Adrenal_gland" adrenal glandfrom a region called the HYPERLINK "http://en.wikipedia.org/wiki/Zona_fasciculata" zona fasciculatain response to ACTH. Elevated levels of cortisol exert HYPERLINK "http://en.wikipedia.org/wiki/Negative_feedback" negative feedbackon the pituitary, which decreases the amount of ACTH released from the pituitary gland. Strictly,Cushing's syndromerefers to excess cortisol of any etiology. One of the causes of Cushing's syndrome is a cortisol secreting adenoma in the cortex of the adrenal gland. The adenoma causes cortisol levels in the blood to be very high, and negative feedback on the pituitary from the high cortisol levels causes ACTH levels to be very low.Cushing's diseaserefers only to hypercortisolism secondary to excess production of ACTH from a corticotrophic HYPERLINK "http://en.wikipedia.org/wiki/Pituitary_adenoma" pituitary adenoma. This causes the blood ACTH levels to be elevated along with cortisol from the adrenal gland. The ACTH levels remain high because a tumor causes the pituitary to be unresponsive to negative feedback from high cortisol levels. Cushing's Syndrome was also the first autoimmune disease identified in humans. Diagnosis: When Cushing's syndrome is suspected, either a HYPERLINK "http://en.wikipedia.org/wiki/Dexamethasone_suppression_test" dexamethasone suppression test(administration of dexamethasone and frequent determination of cortisol and ACTH level), or a 24-hour urinary measurement for cortisol offer equal detection rates. Dexamethasone is a HYPERLINK "http://en.wikipedia.org/wiki/Glucocorticoid" glucocorticoidand simulates the effects of cortisol, including HYPERLINK "http://en.wikipedia.org/wiki/Negative_feedback" negative feedbackon the HYPERLINK "http://en.wikipedia.org/wiki/Pituitary_gland" pituitary gland. When dexamethasone is administered and a blood sample is tested, high cortisol would be indicative of Cushing's syndrome because there is an ectopic source of cortisol or ACTH (e.g.: adrenal adenoma) that is not inhibited by the dexamethasone. A novel approach, recently cleared by the US FDA, is sampling cortisol in HYPERLINK "http://en.wikipedia.org/wiki/Saliva" salivaover 24 hours, which may be equally sensitive, as late night levels of salivary cortisol are high in Cushingoid patients. Other pituitary hormone levels may need to be ascertained. Performing a HYPERLINK "http://en.wikipedia.org/wiki/Physical_examination" physical examinationto determine any HYPERLINK "http://en.wikipedia.org/wiki/Visual_field" visual fielddefect may be necessary if a pituitary lesion is suspected, which may compress the HYPERLINK "http://en.wikipedia.org/wiki/Optic_chiasm" optic chiasmcausing typical HYPERLINK "http://en.wikipedia.org/wiki/Bitemporal_hemianopia" \o "Bitemporal hemianopia" bitemporal hemianopia. When any of these tests are positive, HYPERLINK "http://en.wikipedia.org/wiki/CT_scan" \o "CT scan" CT scanningof the adrenal gland and HYPERLINK "http://en.wikipedia.org/wiki/MRI" \o "MRI" MRIof the HYPERLINK "http://en.wikipedia.org/wiki/Pituitary_gland" pituitary glandare performed to detect the presence of any adrenal or pituitary HYPERLINK "http://en.wikipedia.org/wiki/Adenoma" \o "Adenoma" adenomasor HYPERLINK "http://en.wikipedia.org/wiki/Incidentaloma" \o "Incidentaloma" incidentalomas(the incidental discovery of harmless lesions). HYPERLINK "http://en.wikipedia.org/wiki/Scintigraphy" Scintigraphyof the adrenal gland with HYPERLINK "http://en.wikipedia.org/w/index.php?title=Iodocholesterol_scan&action=edit&redlink=1" \o "Iodocholesterol scan (page does not exist)" iodocholesterol scanis occasionally necessary. Very rarely, determining the ACTH levels in various veins in the body by venous catheterization, working towards the pituitary ( HYPERLINK "http://en.wikipedia.org/w/index.php?title=Petrosal_sinus_sampling&action=edit&redlink=1" \o "Petrosal sinus sampling (page does not exist)" petrosal sinus sampling) is necessary. Mnemonic C-Central obesity,Cervical fat pads,Collagen fibre weakness,Comedones (acne) U- Urinary free cortisol and glucose increase S- HYPERLINK "http://en.wikipedia.org/wiki/Striae" \o "Striae" Striae, Suppressed immunity H- Hypercortisolism, Hypertension, Hyperglycaemia, Hirsutism I- Iatrogenic (Increased administration of corticosteroids) N- Noniatrogenic (Neoplasms) G- Glucose intolerance, Growth retardation Wolfram syndrome Wolfram syndrome also called DIDMOAD (DiabetesInsipidus,DiabetesMellitus,OpticAtrophy, andDeafness), is a rare HYPERLINK "http://en.wikipedia.org/wiki/Genetic_disorder" genetic disorder, causing HYPERLINK "http://en.wikipedia.org/wiki/Diabetes_mellitus" diabetes mellitus, HYPERLINK "http://en.wikipedia.org/wiki/Optic_atrophy" optic atrophy, and HYPERLINK "http://en.wikipedia.org/wiki/Deaf" \o "Deaf" deafnessas well as various other possible disorders. Causes: It is thought to be caused by both a malfunction of the HYPERLINK "http://en.wikipedia.org/wiki/Mitochondria" \o "Mitochondria" mitochondriaand of HYPERLINK "http://en.wikipedia.org/wiki/Myelin" \o "Myelin" myelination, the latter in effect similar to HYPERLINK "http://en.wikipedia.org/wiki/Multiple_sclerosis" multiple sclerosis. It may have autosomal recessive or dominant or mitochondrial inheritance depending on the genes involved. Three genetic forms have been described: Wolfram Syndrome 1 (WFS1), Wolfram Syndrome 2 (WFS2) HYPERLINK "http://en.wikipedia.org/wiki/Wolfram_syndrome" \l "cite_note-4" [5]and a possible mitochondrial syndrome. WFS1 The HYPERLINK "http://en.wikipedia.org/wiki/WFS1" WFS1or wolframin geneprovides instructions for making the wolframin protein. The WFS1 gene is active in cells throughout the body, with strong activity in the heart, brain, lungs, inner ear, and pancreas. The pancreas provides enzymes that help digest food, and it also produces the hormone insulin. Insulin controls how much glucose (a type of sugar) is passed from the blood into cells for conversion to energy. Other disorders - caused by mutations in the WFS1 gene Mutations in the WFS1 gene cause Wolfram syndrome, which is also known by the acronym DIDMOAD. This syndrome is characterised by childhood-onset diabetes mellitus (DM), which results from the improper control of glucose due to the lack of insulin; a gradual loss of vision caused by optic atrophy (OA), in which the nerve that connects the eye to the brain wastes away; and deafness (D). This syndrome can sometimes cause diabetes insipidus (DI), a condition in which the kidneys cannot conserve water. Other complications that affect the bladder and nervous system may also occur. Syndrome of Inappropriate Antidiuretic Hormone Secretion Introduction The serum sodium concentration is regulated by the balance of water intake, renal filtration and reabsorption of sodium, and antidiuretic hormone (ADH) mediated water conservation by the collecting duct. Water balance is normally mediated by thirst, the secretion of antidiuretic hormone (also known as vasopressin), the feedback mechanisms of the renin-angiotensin-aldosterone system, and renal handling of filtered sodium and water. Disorders in any one of these components of sodium balance can result in hyponatremia. HYPERLINK "javascript:showcontent('active','references');"  ADH is secreted by supraoptic and paraventricular nuclei in the hypothalamus and transmitted via the neuronal axons to the posterior pituitary where it is secreted. HYPERLINK "javascript:showcontent('active','references');" It is released when a decrease in the effective circulatory volume is sensed by vascular baroreceptors primarily located in the large arterial vessels. The key action of ADH in the kidney is to trigger the insertion of aquaporin-2 into the principal cells of the collecting duct. Aquaporins' selective permeability allows water reabsorption and consequently urine concentration. HYPERLINK "javascript:showcontent('active','references');"  The syndrome of inappropriate antidiuretic hormone secretion (SIADH) was initially described by Leaf and Mamby. They demonstrated a direct relationship between excessive vasopressin and fall in serum sodium concentration without any change in urine osmolality or flow rate. HYPERLINK "javascript:showcontent('active','references');"  Pathophysiology: The key to the pathophysiology, signs, symptoms, and treatment of SIADH is to understand that the HYPERLINK "http://emedicine.medscape.com/article/767624-overview" hyponatremiais a result of excess water and not a serum sodium deficiency. SIADH consists of hyponatremia, inappropriately elevated urine osmolality (>200 mOsm/kg), excessive urine sodium (UNa >30 mEq/L), and decreased serum osmolality. These findings occur in the absence of diuretic therapy; in the presence of euvolemia without edema; in the setting of otherwise normal cardiac, renal, adrenal, hepatic, and thyroid function; and in absence of factors known to stimulate ADH secretion such as severe pain, hypotension, and stress. In SIADH, the inappropriately elevated level of vasopressin enhances the reabsorption of water, thus concentrating the urine. It is the excess free water absorption that causes hyponatremia. Two scenarios can occur in which vasopressin secretion will be not be correlated with the serum osmolality. First, a decrease in the effective circulatory volume may be falsely sensed by the large arterial baroreceptors in conditions such as HYPERLINK "http://emedicine.medscape.com/article/185856-overview" cirrhosis, HYPERLINK "http://emedicine.medscape.com/article/244631-overview" nephrotic syndrome, and HYPERLINK "http://emedicine.medscape.com/article/757999-overview" congestive heart failure. In these cases, the stimulus for ADH secretion overrides osmotic signals, which are conveying a hypoosmotic state. ADH secretion ensues despite hypoosmolality resulting in hyponatremia. HYPERLINK "javascript:showcontent('active','references');" In contrast to patients with SIADH, these patients appear hypervolemic. Second, inappropriate ADH secretion occurs when there is dysregulation of cells secreting vasopressin or in the feedback mechanisms responsible for its release. A variety of ADH-secreting tumors both inside and outside the pituitary have been associated with SIADH, as well as certain CNS disorders, pulmonary disorders, and medications (see HYPERLINK "http://emedicine.medscape.com/article/768380-diagnosis" \l "Differentials" Differentials). A distinction should be made between the SIADH and the clinical syndrome of euvolemic hyponatremia. A mutation of the ADH receptor can make it more responsive to ADH and can result in the same clinical picture of hyponatremia, concentrated urine output, and decreased serum osmolality but with normal ADH secretion. Clinical Findings: In general, increased ADH causes water retention and extracellular fluid volume expansionwithout HYPERLINK "http://en.wikipedia.org/wiki/Edema" edemaor HYPERLINK "http://en.wikipedia.org/wiki/Hypertension" hypertension, owing to HYPERLINK "http://en.wikipedia.org/wiki/Natriuresis" natriuresis(the excretion of sodium by the kidneys). The water retention and sodium loss both cause hyponatremia, which is a key feature in SIADH. Hyponatremia and concentrated urine (UOsm>300 mOsm) are seen, as well asno signs ofedema or HYPERLINK "http://en.wikipedia.org/wiki/Dehydration" dehydration. When hyponatremia is severe (sodium <120 mOsm), or acute in onset, symptoms of HYPERLINK "http://en.wikipedia.org/wiki/Cerebral_edema" cerebral edemabecome prominent (irritability, confusion, seizures, and coma). Diagnosis: Laboratory findings in diagnosis of SIADH include-  HYPERLINK "http://en.wikipedia.org/wiki/Hyponatremia" Hyponatremia<135 mEq/L, and POsm<270 mOsm/kg. Hyponatremia is often treated pharmaceutically through the use of HYPERLINK "http://en.wikipedia.org/wiki/Vasopressin_receptor_antagonist" \o "Vasopressin receptor antagonist" vasopressin receptor antagonists, which include the phase III drug HYPERLINK "http://en.wikipedia.org/wiki/Lixivaptan" lixivaptan. Other findings include- Urine sodium concentration >20 mEq/L (inappropriate natriuresis). Urine sodium concentration may be normal reflecting dietary intake. Maintained hypervolemia Suppression of renin-angiotensin system No equal concentration of atrial natriuretic peptide Low HYPERLINK "http://en.wikipedia.org/wiki/Blood_urea_nitrogen" blood urea nitrogen(BUN) Normal serum HYPERLINK "http://en.wikipedia.org/wiki/Creatinine" creatinine Low HYPERLINK "http://en.wikipedia.org/wiki/Uric_acid" uric acid Low HYPERLINK "http://en.wikipedia.org/wiki/Albumin" albumin Normal Acid-Base, K+ balance Normal Adrenal, Thyroid function Causes: Some common causes of SIADH include:  HYPERLINK "http://en.wikipedia.org/wiki/Meningitis" Meningitis Head injury  HYPERLINK "http://en.wikipedia.org/wiki/Subarachnoid_hemorrhage" Subarachnoid hemorrhage  HYPERLINK "http://en.wikipedia.org/wiki/Cancer" \o "Cancer" Cancers  HYPERLINK "http://en.wikipedia.org/wiki/Lung_cancer" Lung cancer(especially small-cell lung cancer, as well as other small-cell malignancies of other organs)  HYPERLINK "http://en.wikipedia.org/wiki/Infection" \o "Infection" Infections  HYPERLINK "http://en.wikipedia.org/wiki/Brain" Brain HYPERLINK "http://en.wikipedia.org/wiki/Abscess" abscess  HYPERLINK "http://en.wikipedia.org/wiki/Pneumonia" Pneumonia  HYPERLINK "http://en.wikipedia.org/wiki/Lung_abscess" Lung abscess  HYPERLINK "http://en.wikipedia.org/wiki/Medication" \o "Medication" Drugs  HYPERLINK "http://en.wikipedia.org/wiki/Chlorpropamide" Chlorpropamide  HYPERLINK "http://en.wikipedia.org/wiki/Clofibrate" Clofibrate  HYPERLINK "http://en.wikipedia.org/wiki/Phenothiazine" Phenothiazine  HYPERLINK "http://en.wikipedia.org/wiki/Cyclophosphamide" Cyclophosphamide  HYPERLINK "http://en.wikipedia.org/wiki/Carbamazepine" Carbamazepine  HYPERLINK "http://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitor" \o "Selective serotonin reuptake inhibitor" Selective serotonin reuptake inhibitors(SSRIs, a class of antidepressants)  HYPERLINK "http://en.wikipedia.org/wiki/Methylenedioxymethamphetamine" \o "Methylenedioxymethamphetamine" Methylenedioxymethamphetamine(MDMA, commonly called Ecstasy. SIADH due to taking ecstasy was cited as a factor in the death of HYPERLINK "http://en.wikipedia.org/wiki/Leah_Betts" Leah Betts)  HYPERLINK "http://en.wikipedia.org/wiki/Oxytocin" Oxytocin  HYPERLINK "http://en.wikipedia.org/wiki/Vincristine" Vincristine  HYPERLINK "http://en.wikipedia.org/wiki/Hypothyroidism" Hypothyroidism Management: Management of SIADH includes: Treating underlying causes when possible. Long-term HYPERLINK "http://en.wikipedia.org/wiki/Fluid_restriction" \o "Fluid restriction" fluid restrictionof 1,2001,800 mL/day HYPERLINK "http://en.wikipedia.org/wiki/Syndrome_of_inappropriate_antidiuretic_hormone_hypersecretion" \l "cite_note-1" [2]to increase serum sodium.  HYPERLINK "http://en.wikipedia.org/wiki/Intravenous" \o "Intravenous" Intravenous HYPERLINK "http://en.wikipedia.org/wiki/Saline_(medicine)" \o "Saline (medicine)" saline- For very symptomatic patients (severe confusion, convulsions, or coma) hypertonic saline (5%) 200-300 ml IV in 3-4 h should be given. Drugs Conn Syndrome Introduction: Conn syndrome is characterized by increased aldosterone secretion from the adrenal glands, suppressed plasma renin activity (PRA), hypertension, and hypokalemia. It was first described in 1955 by JW Conn in a patient who, as in the image below, had an aldosterone-producing adenoma (ie, Conn syndrome). Later, many other cases of adrenal hyperplasia with increased aldosterone secretion were described, and now the term primary hyperaldosteronism is used to describe Conn syndrome and other etiologies of primary hypersecretion of aldosterone (eg, adrenal hyperplasia). Currently, primary hyperaldosteronism, especially Conn syndrome, seems to be the most common form of secondary hypertension. Primary HYPERLINK "http://en.wikipedia.org/wiki/Hyperaldosteronism" hyperaldosteronismhas many causes, including adrenal HYPERLINK "http://en.wikipedia.org/wiki/Hyperplasia" hyperplasiaand adrenal HYPERLINK "http://en.wikipedia.org/wiki/Carcinoma" carcinoma.When it occurs due to a solitary aldosterone-secreting HYPERLINK "http://en.wikipedia.org/wiki/Adrenal_adenoma" adrenal adenoma(a type of benign tumor), it is known asConn's syndrome. In practice, however, the terms are often used interchangeably, regardless of the underlying physiology. Conn's syndrome is anAldosterone-Producing Adenoma(APA). Causes: The syndrome is due to: bilateral idiopathic adrenal hyperplasia 70% unilateral idiopathic adrenal hyperplasia 20%  HYPERLINK "http://en.wikipedia.org/wiki/Aldosterone" aldosterone-secreting HYPERLINK "http://en.wikipedia.org/wiki/Adrenal_adenoma" adrenal adenoma(benign tumor, < 5%) rare forms, including disorders of the HYPERLINK "http://en.wikipedia.org/wiki/Renin-angiotensin_system" renin-angiotensin system Signs, symptoms and findings: Aldosterone enhances exchange of sodium for potassium in the kidney so increased aldosteronism will lead to HYPERLINK "http://en.wikipedia.org/wiki/Hypernatremia" hypernatremiaand HYPERLINK "http://en.wikipedia.org/wiki/Hypokalemia" hypokalemia. Once the potassium has been significantly reduced by aldosterone, a sodium/hydrogen pump in the HYPERLINK "http://en.wikipedia.org/wiki/Nephron" nephronbecomes more active leading to increased excretion of hydrogen ions and further exacerbating the HYPERLINK "http://en.wikipedia.org/wiki/Hypernatremia" hypernatremia. The hydrogen ions that are exchanged for sodium are generated by HYPERLINK "http://en.wikipedia.org/wiki/Carbonic_anhydrase" carbonic anhydrasein the renal tubule epithelium causing increased production of HYPERLINK "http://en.wikipedia.org/wiki/Bicarbonate" bicarbonate. The increased bicarbonate and the excreted hydrogen combine to generate a HYPERLINK "http://en.wikipedia.org/wiki/Metabolic_alkalosis" metabolic alkalosis. The high HYPERLINK "http://en.wikipedia.org/wiki/PH" pHof the blood makes HYPERLINK "http://en.wikipedia.org/wiki/Calcium_in_biology" \o "Calcium in biology" calciumless available to the tissues and causes symptoms of HYPERLINK "http://en.wikipedia.org/wiki/Hypocalcemia" \o "Hypocalcemia" hypocalcemia(low calcium levels). The sodium retention leads to plasma volume expansion and elevated blood pressure. The increased blood pressure will lead to increased HYPERLINK "http://en.wikipedia.org/wiki/Glomerular_filtration_rate" \o "Glomerular filtration rate" glomerular filtration rateand cause a decrease in HYPERLINK "http://en.wikipedia.org/wiki/Renin" reninrelease from the granular cells of the HYPERLINK "http://en.wikipedia.org/wiki/Juxtaglomerular_apparatus" juxtaglomerular apparatusin the kidney. If there is a primary hyperaldosteronism the decreased renin (and subsequent decreased HYPERLINK "http://en.wikipedia.org/wiki/Angiotensin_II" \o "Angiotensin II" angiotensin II) will not lead to a decrease in aldosterone levels (a very helpful clinical tool in diagnosis of primary hyperaldosteronism). Aside from high blood pressure manifestations of HYPERLINK "http://en.wikipedia.org/wiki/Myalgia" \o "Myalgia" muscle cramps(due to hyperexcitability of neurons secondary to hypocalcemia), HYPERLINK "http://en.wikipedia.org/wiki/Muscle_weakness" muscle weakness(due to hypoexcitability of skeletal muscles secondary to hypokalemia), and HYPERLINK "http://en.wikipedia.org/wiki/Headache" \o "Headache" headaches(due to hypokalemia or high blood pressure) may be seen. Secondary hyperaldosteronism is often related to decreased HYPERLINK "http://en.wikipedia.org/wiki/Cardiac_output" cardiac outputwhich is associated with elevated renin levels. Diagnosis: Measuring aldosterone alone is not considered adequate to diagnose primary hyperaldosteronism. Rather, both HYPERLINK "http://en.wikipedia.org/wiki/Renin" reninand aldosterone are measured, and theratiois diagnostic. Usually, renin levels are suppressed, leading to a very low renin-aldosterone ratio (<0.0005). This test is confounded by antihypertensive drugs, which have to be stopped up to 6 weeks. If plasma levels of renin and aldosterone suggest hyperaldosteronism, HYPERLINK "http://en.wikipedia.org/wiki/Computed_axial_tomography" \o "Computed axial tomography" CT scanningcan confirm the presence of an adrenal adenoma. If the clinical presentation primarily involves hypertension and elevated levels of catecholamines, CT or MRI scanning can confirm a tumor on the adrenal medulla, typically an aldosteronoma. Hyperaldosteronism can be mimicked by HYPERLINK "http://en.wikipedia.org/wiki/Liddle_syndrome" \o "Liddle syndrome" Liddle syndrome, and by ingestion of HYPERLINK "http://en.wikipedia.org/wiki/Licorice" \o "Licorice" licoriceand other foods containing HYPERLINK "http://en.wikipedia.org/wiki/Glycyrrhizin" glycyrrhizin. In one case report, hypertension and HYPERLINK "http://en.wikipedia.org/wiki/Quadriparesis" \o "Quadriparesis" quadriparesisresulted from HYPERLINK "http://en.wikipedia.org/wiki/Substance_intoxication" \o "Substance intoxication" intoxicationwith a non-alcoholic HYPERLINK "http://en.wikipedia.org/wiki/Pastis" pastis(an HYPERLINK "http://en.wikipedia.org/wiki/Anise" anise-flavored HYPERLINK "http://en.wikipedia.org/wiki/Aperitif" \o "Aperitif" aperitifcontaining HYPERLINK "http://en.wikipedia.org/wiki/Glycyrrhizinic_acid" \o "Glycyrrhizinic acid" glycyrrhizinic acid). Shy-Drager syndrome Also called as Neurologic orthostatic hypotension; Shy-McGee-Drager syndrome; Parkinson's plus syndrome; MSA-P; MSA-C, Multiple system atrophy Multiple system atrophy (MSA) is a rare condition that causes symptoms similar to HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000755/" Parkinson's disease. However, patients with MSA have more widespread damage to the part of the nervous system that controls important functions such as heart rate, blood pressure, and sweating. Causes, incidence, and risk factors: The cause is unknown. MSA develops gradually and is most often diagnosed in men older than 60. Symptoms: MSA damages the nervous system, which can cause the following symptoms: Changes in facial expression "Mask" appearance to face May be unable to close mouth Reduced ability to show facial expressions Staring  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000733/" Difficulty chewingor swallowing (occasionally) Disrupted sleep patterns (especially during rapid eye movement (REM) sleep late at night)  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003093/" Dizzinessor HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003092/" faintingwhen standing up or after standing still Frequent falls  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003164/" Impotence Loss of control over bowels or bladder Loss of fine motor skills  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003115/" Difficulty eating Difficulty with any activity that requires small movements Writing that is small and hard to read Loss of sweating in any part of the body Mild decline in mental function (may occur)  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003198/" Movement difficulties  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003093/" Loss of balance Shuffling  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003199/" Walking pattern (gait) changes  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003178/" Muscle achesand pains (myalgia)  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003193/" Muscle rigidity Difficulty bending arms or legs Stiffness Nausea and problems with digestion Posture difficulties: may be unstable, stooped, or slumped over Slow movements Difficulty beginning to walk or starting any voluntary movement Freezing of movement when the movement is stopped, unable to start moving again Small steps followed by the need to run to keep balance Tremors May become severe enough to interfere with activities May be worse when tired, excited, or stressed May occur at rest or at any time May occur with any action, such as holding a cup or other eating utensils Finger-thumb rubbing (pill rolling tremor) Vision changes, decreased or HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003029/" blurred vision Voice and speech changes Difficulty speaking Monotone Slow speaking Voice is low volume Other symptoms that may occur with this disease:  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003205/" Confusion  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000739/" Dementia  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003213/" Depression Sleep-related breathing difficulties, especially HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000811/" sleep apneaor a blockage in the air passage that leads to a harsh vibrating sound Signs and tests: The health care provider may perform the following:  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003398/" Blood pressuremeasurement, lying and standing Eye examination Nerve and muscle (neuromuscular) examination There are no specific tests to confirm this disease. A neurologist can make the diagnosis based on: History of symptoms Findings during a physical examination Ruling out other causes of symptoms Testing to help confirm the diagnosis may include:  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003791/" MRI of head Plasma HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003561/" norepinephrinelevels Urine examination for norepinephrine breakdown products ( HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003613/" urine catecholamines) Prognosis: The outcome is poor. Loss of mental and physical functions slowly get worse. . Early death is likely. The typical survival time from the time of diagnosis is 7 to 9 years. Complications: Progressive loss of ability to walk or care for self Difficulty performing daily activities Injuries from falls/fainting Side effects of medications Milk-alkali syndrome Milk-alkali syndrome is an acquired condition in which there are high levels of calcium ( HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000365/" hypercalcemia) and a shift in the body's acid/base balance towards alkaline (metabolic HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A001183/" alkalosis). Causes, incidence, and risk factors: Milk-alkali syndrome is caused by excessive consumption of milk (which is high in calcium) and certain antacids, especially HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000035/" calcium carbonateor HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000538/" sodium bicarbonate(baking soda), over a long period of time. Calcium deposits in the kidneys and in other tissues can occur in milk-alkali syndrome. Consumption of excessive amounts of vitamin D, which is usually added to milk bought at the supermarket, can worsen this condition. In the past, milk-alkali syndrome was often a side effect of treating HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000206/" peptic ulcerdisease with antacids containing calcium. It is rarely seen today, because newer, better medications are available for treating ulcers. A more common scenario today is when someone takes too much HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000035/" calcium carbonatein an attempt to prevent osteoporosis. This syndrome has been reported in persons who take as little as 2 grams of calcium per day. Symptoms: The condition usually has no symptoms (asymptomatic). When symptoms do occur, they are often related to complications, such as kidney problems. Symptoms include: Back, middle of the body, and loin pain (related to kidney stones) Excessive urination Fatigue Nausea Other problems that can result from kidney failure Signs and tests: Calcium deposits within the tissue of the kidney (nephrocalcinosis) may be seen on: X-rays Computed tomography ( HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003330/" CT scans) Ultrasound Other tests used to make a diagnosis: Electrolyte levels Kidney function blood tests  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003855/" Blood gas  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003477/" Blood calciumlevel Treatment Treatment involves reducing or eliminating milk and other forms of calcium such as in antacids. If severe kidney failure has occurred, the damage may be permanent. Expectations (prognosis) This condition is often reversible if kidney function remains normal. Severe prolonged cases may lead to permanent kidney failure requiring dialysis. Complications The most common complications include: Calcium deposits in tissues (calcinosis) Kidney failure Kidney stones KearnsSayre syndrome KearnsSayre syndrome(abbreviatedKSS) also known asoculocraniosomatic diseaseorOculocraniosomatic neuromuscular disease with ragged red fibersis a HYPERLINK "http://en.wikipedia.org/wiki/Mitochondrial_myopathy" mitochondrial myopathywith a typical onset before 20 years of age. KSS is a more severe syndromic variant of HYPERLINK "http://en.wikipedia.org/wiki/Chronic_progressive_external_ophthalmoplegia" chronic progressive external ophthalmoplegia(abbreviated CPEO), a syndrome that is characterized by isolated involvement of the muscles controlling eyelid movement (levator palpebrae, orbicularis oculi), and those controlling eye movement (extra-ocular muscles). This results in ptosis and ophthalmoplegia respectively. KSS involves a triad of the already described CPEO, as well as bilateral pigmentary retinopathy, and HYPERLINK "http://en.wikipedia.org/wiki/Heart_block" \o "Heart block" cardiac conduction abnormalities. Other areas of involvement can include HYPERLINK "http://en.wikipedia.org/wiki/Cerebellar_ataxia" cerebellar ataxia, proximal muscle weakness, HYPERLINK "http://en.wikipedia.org/wiki/Deafness" \o "Deafness" deafness, HYPERLINK "http://en.wikipedia.org/wiki/Diabetes_mellitus" diabetes mellitus, HYPERLINK "http://en.wikipedia.org/wiki/Growth_hormone_deficiency" growth hormone deficiency, HYPERLINK "http://en.wikipedia.org/wiki/Hypoparathyroidism" hypoparathyroidism, or other HYPERLINK "http://en.wikipedia.org/wiki/Endocrinopathy" \o "Endocrinopathy" endocrinopathies. In both of these diseases, muscle involvement may begin unilateral but always develops into a bilateral deficit, and the course is progressive. Signs and Symptoms: Individuals with KSS present initially in a similar way to those with typical CPEO. Onset is in the first and second decades of life. The first symptom of this disease is a unilateral HYPERLINK "http://en.wikipedia.org/wiki/Ptosis" ptosis, or difficulty opening the eyelids, that gradually progresses to a bilateral ptosis. As the ptosis worsens, the individual commonly extends their neck, elevating their chin in an attempt to prevent the eyelids from occluding the visual axis. Along with the insidious development of ptosis, eye movements eventually become limited causing a person to rely more on turning the head side to side or up and down to view objects in the peripheral HYPERLINK "http://en.wikipedia.org/wiki/Visual_field" visual field.Pigmentary retinopathy:KSS results in a pigmentation of the HYPERLINK "http://en.wikipedia.org/wiki/Retina" retina, primarily in the posterior HYPERLINK "http://en.wikipedia.org/wiki/Fundus_(eye)" \o "Fundus (eye)" fundus. The appearance is described as a "salt-and-pepper" appearance. There is diffuse depigmentation of the HYPERLINK "http://en.wikipedia.org/wiki/Retinal_pigment_epithelium" retinal pigment epitheliumwith the greatest effect occurring at the HYPERLINK "http://en.wikipedia.org/wiki/Macula" \o "Macula" macula. This is in contrast to HYPERLINK "http://en.wikipedia.org/wiki/Retinitis_pigmentosa" retinitis pigmentosawhere the pigmentation is peripheral. The appearance of the retina in KSS is similar to that seen in HYPERLINK "http://en.wikipedia.org/wiki/Myotonic_dystrophy" myotonic dystrophytype 1 (abbreviated DM1). Modest night-blindness can be seen in patients with KSS. Visual acuity loss is usually mild and only occurs in 40-50% of patients. Cardiac conduction abnormalities:most often occurs years after the development of ptosis and ophthalmoplegia.  HYPERLINK "http://en.wikipedia.org/wiki/AV_block" \o "AV block" Atrioventricular(abbreviated "AV") blockis the most common cardiac conduction deficit. This often progresses to a HYPERLINK "http://en.wikipedia.org/wiki/Third_degree_heart_block" \o "Third degree heart block" Third-degree atrioventricular block, which is a complete blockage of the electrical conduction from the atrium to the ventrical. Symptoms of heart block include HYPERLINK "http://en.wikipedia.org/wiki/Syncope_(medicine)" \o "Syncope (medicine)" syncope, HYPERLINK "http://en.wikipedia.org/wiki/Exercise_intolerance" exercise intolerance, and HYPERLINK "http://en.wikipedia.org/wiki/Bradycardia" bradycardia.Other:As characterized in Kearns' original publication in 1965 and in later publications, inconsistent features of KSS that may occur are weakness of facial, pharyngeal, trunk, and extremity muscles, HYPERLINK "http://en.wikipedia.org/wiki/Hearing_impairment" \o "Hearing impairment" hearing loss, small stature, electroencephalographic changes, HYPERLINK "http://en.wikipedia.org/wiki/Cerebellar_ataxia" cerebellar ataxiaand elevated levels of HYPERLINK "http://en.wikipedia.org/wiki/Cerebrospinal_fluid" cerebrospinal fluidprotein. Genetics: KSS is the result of deletions in mitochondrial DNA (mtDNA) that cause a particular phenotype. mtDNA is transmitted exclusively from the mother's ovum.Mitochondrial DNA is composed of 37 HYPERLINK "http://en.wikipedia.org/wiki/Genes" \o "Genes" genesfound in the single circular HYPERLINK "http://en.wikipedia.org/wiki/Chromosome" chromosomemeasuring 16,569 HYPERLINK "http://en.wikipedia.org/wiki/Base_pairs" \o "Base pairs" base pairsin length. Among these, 13 genes encode proteins of the HYPERLINK "http://en.wikipedia.org/wiki/Electron_transport_chain" electron transport chain(abbreviated "ETC"), 22 encode HYPERLINK "http://en.wikipedia.org/wiki/Transfer_RNA" transfer RNA(tRNA), and two encode the large and small subunits that form HYPERLINK "http://en.wikipedia.org/wiki/Ribosomal_RNA" ribosomal RNA(rRNA). The 13 proteins involved in the ETC of the mitochondrion are necessary for HYPERLINK "http://en.wikipedia.org/wiki/Oxidative_phosphorylation" oxidative phosphorylation. Mutations in these proteins results in impaired energy production by mitochondria. This cellular energy deficit manifests most readily in tissues that rely heavily upon aerobic metabolism such as the brain, skeletal and cardiac muscles, sensory organs, and kidneys. This is one factor involved in the presentation of mitochondrial diseases. There are other factors involved in the manifestation of a mitochondrial disease besides the size and location of a mutation. Mitochondria replicate during each cell division during gestation and throughout life. Because the mutation in mitochondrial disease most often occurs early in gestation in these diseases and only occurs in one parent mitochondria, only those mitochondria in the mutated lineage are defective. This results in an uneven distribution of dysfunctional mitochondria within each cell, and among different tissues of the body. This describes the term HYPERLINK "http://en.wikipedia.org/wiki/Heteroplasmic" \o "Heteroplasmic" heteroplasmicwhich is characteristic of mitochondrial diseases including KSS. The distribution of mutated mtDNA in each cell, tissue, and organ, is dependent on when and where the mutation occurs. This may explain why two patients with an identical mutation in mtDNA can present with entirely different phenotypes and in turn different syndromes. A publication in 1992 by Fischel-Ghodsian et al. identified the same 4,977-bp deletion in mtDNA in two patients presenting with two entirely different diseases. One of the patients had characteristic KSS, while the other patient had a very different disease known as HYPERLINK "http://en.wikipedia.org/wiki/Pearson_marrow_pancreas_syndrome" \o "Pearson marrow pancreas syndrome" Pearson marrow pancreas syndrome.Complicating the matter, in some cases Pearson's syndrome has been shown to progress into KSS later in life PraderWilli syndrome PraderWilli syndrome(abbreviatedPWS) is a rare HYPERLINK "http://en.wikipedia.org/wiki/Genetic_disorder" genetic disorderin which seven genes (or some subset thereof) on HYPERLINK "http://en.wikipedia.org/wiki/Chromosome_15_(human)" \o "Chromosome 15 (human)" chromosome 15 (q 11-13)are deleted or unexpressed ( HYPERLINK "http://en.wikipedia.org/wiki/Chromosome_15q_partial_deletion" chromosome 15q partial deletion) on the paternal chromosome. The incidence of PWS is between 1 in 25,000 and 1 in 10,000 live births. The paternal origin of the genetic material that is affected in the syndrome is important because the particular region of chromosome 15 involved is subject to parent of origin HYPERLINK "http://en.wikipedia.org/wiki/Genomic_Imprinting" \o "Genomic Imprinting" imprinting, meaning that for a number of genes in this region only one copy of the gene is expressed while the other is silenced through imprinting. For the genes affected in PWS it is the paternal copy that is usually expressed, while the maternal copy is silenced. This means that while most people have a single working copy of these genes, people with PWS have no working copy. PWS has the sister syndrome HYPERLINK "http://en.wikipedia.org/wiki/Angelman_syndrome" Angelman syndromein which maternally derived genetic material is affected in the same genetic region. Clinical features and signs: In utero: Reduced fetal movement Frequent abnormal fetal position Occasional HYPERLINK "http://en.wikipedia.org/wiki/Polyhydramnios" polyhydramnios(excessive amniotic fluid) At birth: Often HYPERLINK "http://en.wikipedia.org/wiki/Breech_birth" \o "Breech birth" breechor HYPERLINK "http://en.wikipedia.org/wiki/Caesarean" \o "Caesarean" caesareanbirths  HYPERLINK "http://en.wikipedia.org/wiki/Lethargy" \o "Lethargy" Lethargy  HYPERLINK "http://en.wikipedia.org/wiki/Hypotonia" Hypotonia Feeding difficulties (due to poor muscle tone affecting HYPERLINK "http://en.wikipedia.org/wiki/Sucking_reflex" \o "Sucking reflex" sucking reflex) Difficulties establishing respiration  HYPERLINK "http://en.wikipedia.org/wiki/Hypogonadism" Hypogonadism Infancy:  HYPERLINK "http://en.wikipedia.org/wiki/Failure_to_thrive" Failure to thrive(continued feeding difficulties) Delayed milestones/intellectual delay  HYPERLINK "http://en.wikipedia.org/wiki/Hypersomnia" \o "Hypersomnia" Excessive sleeping  HYPERLINK "http://en.wikipedia.org/wiki/Strabismus" Strabismus  HYPERLINK "http://en.wikipedia.org/wiki/Scoliosis" Scoliosis(often not detected at birth) Childhood:  HYPERLINK "http://en.wikipedia.org/wiki/Speech_delay" Speech delay Poor physical coordination  HYPERLINK "http://en.wikipedia.org/wiki/Polyphagia" \o "Polyphagia" Hyperphagia(over-eating) from age 2 8 years. Note change from feeding difficulties in infancy  HYPERLINK "http://en.wikipedia.org/w/index.php?title=Excessive_weight_gain&action=edit&redlink=1" \o "Excessive weight gain (page does not exist)" Excessive weight gain  HYPERLINK "http://en.wikipedia.org/wiki/Sleep_disorders" \o "Sleep disorders" Sleep disorders  HYPERLINK "http://en.wikipedia.org/wiki/Scoliosis" Scoliosis Adolescence: Delayed puberty Short stature  HYPERLINK "http://en.wikipedia.org/wiki/Obesity" Obesity Extreme flexibility Adulthood: Infertility (males and females)  HYPERLINK "http://en.wikipedia.org/wiki/Hypogonadism" Hypogonadism Sparse pubic hair Obesity Hypotonia Learning disabilities/borderline intellectual functioning (but some cases of average intelligence) Prone to HYPERLINK "http://en.wikipedia.org/wiki/Diabetes_mellitus" diabetes mellitus Extreme flexibility General physical appearance (adults) Prominent nasal bridge Small hands and feet with tapering of fingers Soft skin, which is easily bruised Excess fat, especially in the central portion of the body High, narrow forehead Almond-shaped eyes with thin, down-turned lids Light skin and hair relative to other family members Lack of complete sexual development Frequent HYPERLINK "http://en.wikipedia.org/wiki/Skin_picking" \o "Skin picking" skin picking  HYPERLINK "http://en.wikipedia.org/wiki/Stretch_marks" \o "Stretch marks" Striae Delayed motor development Behavioral: PraderWilli syndrome is also frequently associated with an extreme and insatiable appetite, often resulting in HYPERLINK "http://en.wikipedia.org/wiki/Morbid_obesity" \o "Morbid obesity" morbid obesity. There is currently no consensus as to the cause for this particular symptom, although genetic abnormalities in chromosome 15 disrupt the normal functioning of the hypothalamus. HYPERLINK "http://en.wikipedia.org/wiki/Prader%E2%80%93Willi_syndrome" \l "cite_note-pmid9391886-2" [3]Given that the hypothalamus regulates many basic processes, including appetite, there may well be a link. However, no organic defect of the hypothalamus has been discovered on post mortem investigation. HYPERLINK "http://en.wikipedia.org/wiki/Prader%E2%80%93Willi_syndrome" \l "cite_note-pmid9391886-2" [3] PraderWilli syndrome patients have high HYPERLINK "http://en.wikipedia.org/wiki/Ghrelin" ghrelinlevels, which are thought to directly contribute to the increased appetite, hyperphagia, and obesity seen in this syndrome. Cassidy states the need for a clear delineation of behavioural expectations, the reinforcement of behavioural limits and the establishment of regular routines.[21] The main mental health difficulties experienced by people with PWS include compulsive behaviour (usually manifested in skin-picking) and anxiety. HYPERLINK "http://en.wikipedia.org/wiki/Prader%E2%80%93Willi_syndrome" \l "cite_note-Udwin-3" [4] HYPERLINK "http://en.wikipedia.org/wiki/Prader%E2%80%93Willi_syndrome" \l "cite_note-6" [7]Psychiatric symptoms, for example, hallucinations, paranoia and depression have been described in some cases HYPERLINK "http://en.wikipedia.org/wiki/Prader%E2%80%93Willi_syndrome" \l "cite_note-Udwin-3" [4]and affect approximately 510% of young adults. HYPERLINK "http://en.wikipedia.org/wiki/Prader%E2%80%93Willi_syndrome" \l "cite_note-pmid9391886-2" [3]Psychiatric and behavioural problems are the most common cause of hospitalization.  INCLUDEPICTURE "http://upload.wikimedia.org/wikipedia/commons/0/00/Pws.jpg" \* MERGEFORMATINET  Laurence-Moon-Biedl-BardetSyndrome Also called as Laurence-Moon-Biedl syndromeandLaurence-Moon-Biedl-Bardet, BardetBiedl syndromeis a HYPERLINK "http://en.wikipedia.org/wiki/Ciliopathy" \o "Ciliopathy" ciliopathic HYPERLINK "http://en.wikipedia.org/wiki/Human" human HYPERLINK "http://en.wikipedia.org/wiki/Genetic_disorder" genetic disorderthat produces HYPERLINK "http://en.wikipedia.org/wiki/Pleiotropy" \o "Pleiotropy" many effectsand affects many body systems. It is characterized principally by HYPERLINK "http://en.wikipedia.org/wiki/Obesity" obesity, HYPERLINK "http://en.wikipedia.org/wiki/Retinitis_pigmentosa" retinitis pigmentosa, HYPERLINK "http://en.wikipedia.org/wiki/Polydactyly" polydactyly, HYPERLINK "http://en.wikipedia.org/wiki/Mental_retardation" mental retardation, HYPERLINK "http://en.wikipedia.org/wiki/Hypogonadism" hypogonadism, and HYPERLINK "http://en.wikipedia.org/wiki/Renal_failure" renal failurein some cases Summary of the syndrome: "BardetBiedl syndrome is a HYPERLINK "http://en.wikipedia.org/wiki/Pleiotropic" \o "Pleiotropic" pleiotropicdisorder with variable HYPERLINK "http://en.wikipedia.org/wiki/Expressivity" expressivityand a wide range of clinical variability observed both within and between families. The main clinical features are rodcone dystrophy, with childhood-onset visual loss preceded by night blindness; postaxial HYPERLINK "http://en.wikipedia.org/wiki/Polydactyly" polydactyly; HYPERLINK "http://en.wikipedia.org/wiki/Truncal_obesity" \o "Truncal obesity" truncal obesitythat manifests during infancy and remains problematic throughout adulthood; specific learning difficulties; male HYPERLINK "http://en.wikipedia.org/wiki/Hypogenitalism" \o "Hypogenitalism" hypogenitalismand complex female HYPERLINK "http://en.wikipedia.org/wiki/Genitourinary" \o "Genitourinary" genitourinarymalformations; and HYPERLINK "http://en.wikipedia.org/wiki/Renal" \o "Renal" renaldysfunction, a major cause of morbidity and mortality. There is a wide range of secondary features that are sometimes associated with BBS"including Speech disorder/delay  HYPERLINK "http://en.wikipedia.org/wiki/Strabismus" Strabismus/ HYPERLINK "http://en.wikipedia.org/wiki/Cataracts" \o "Cataracts" cataracts/ HYPERLINK "http://en.wikipedia.org/wiki/Astigmatism" astigmatism " HYPERLINK "http://en.wikipedia.org/wiki/Brachydactyly" Brachydactyly/ HYPERLINK "http://en.wikipedia.org/wiki/Syndactyly" syndactylyof both the hands and feet is common, as is partial syndactyl (most usually between the second and third toes)" "Developmental delay: Many children with BBS are delayed in reaching major developmental milestones including gross motor skills, fine motor skills, and psychosocial skills (interactive play/ability to recognize social cues)"  HYPERLINK "http://en.wikipedia.org/wiki/Polyuria" Polyuria/ HYPERLINK "http://en.wikipedia.org/wiki/Polydipsia" polydipsia(nephrogenic diabetes insipidus)  HYPERLINK "http://en.wikipedia.org/wiki/Ataxia" Ataxia/poor coordination/imbalance Mild HYPERLINK "http://en.wikipedia.org/wiki/Hypertonia" hypertonia(especially lower limbs)  HYPERLINK "http://en.wikipedia.org/wiki/Diabetes_mellitus" Diabetes mellitus Dental crowding/ HYPERLINK "http://en.wikipedia.org/wiki/Hypodontia" hypodontia/small dental roots; high-arched palate  HYPERLINK "http://en.wikipedia.org/wiki/Cardiovascular" \o "Cardiovascular" Cardiovascularanomalies  HYPERLINK "http://en.wikipedia.org/wiki/Hepatic" \o "Hepatic" Hepaticinvolvement  HYPERLINK "http://en.wikipedia.org/wiki/Anosmia" Anosmia Auditory deficiencies  HYPERLINK "http://en.wikipedia.org/wiki/Hirschsprung_disease" \o "Hirschsprung disease" Hirschsprung disease Pathophysiology: The detailed biochemical mechanism that leads to BBS is still unclear. At this moment, twelve genes that are responsible for the disease when mutated, have been cloned.[ HYPERLINK "http://en.wikipedia.org/wiki/Wikipedia:Citation_needed" \o "Wikipedia:Citation needed" citation needed] The gene products encoded by theseBBSgenes, called BBS proteins, are located in the HYPERLINK "http://en.wikipedia.org/wiki/Basal_body" basal bodyand HYPERLINK "http://en.wikipedia.org/wiki/Cilia" \o "Cilia" ciliaof the HYPERLINK "http://en.wikipedia.org/wiki/Cell_(biology)" \o "Cell (biology)" cell. Using the round worm HYPERLINK "http://en.wikipedia.org/wiki/Caenorhabditis_elegans" \o "Caenorhabditis elegans" C. elegansas a model system, biologists found that BBS proteins are involved in a process called HYPERLINK "http://en.wikipedia.org/wiki/Intraflagellar_transport" Intraflagellar transport(IFT), a bi-directional transportation activity within the cilia along the long axis of the ciliary shaft that is essential for the formation and maintenance of cilia.Recent biochemical analysis of human BBS proteins revealed that BBS proteins are assembled into a multiple protein complex, called "BBSome". BBSome is proposed to be responsible for transporting intracellular vesicles to the base of the cilia and to play an important role in the ciliary function. Since abnormalities of cilia are known to be related to a wide range of disease symptoms including those commonly seen in BBS patients, it is now widely accepted that mutated BBS genes affect normal cilia functions, which, in turns, causes BBS.[ HYPERLINK "http://en.wikipedia.org/wiki/Wikipedia:Citation_needed" \o "Wikipedia:Citation needed" citation needed] Genes involved include:  HYPERLINK "http://en.wikipedia.org/wiki/BBsome" BBsome: HYPERLINK "http://en.wikipedia.org/wiki/BBS1" BBS1, HYPERLINK "http://en.wikipedia.org/wiki/BBS2" BBS2, HYPERLINK "http://en.wikipedia.org/wiki/BBS4" BBS4, HYPERLINK "http://en.wikipedia.org/wiki/BBS5" BBS5, HYPERLINK "http://en.wikipedia.org/wiki/BBS7" BBS7, HYPERLINK "http://en.wikipedia.org/wiki/TTC8" TTC8/BBS8, HYPERLINK "http://en.wikipedia.org/wiki/BBS9" BBS9  HYPERLINK "http://en.wikipedia.org/wiki/Chaperone_(protein)" \o "Chaperone (protein)" chaperone: HYPERLINK "http://en.wikipedia.org/wiki/BBS6" \o "BBS6" BBS6, HYPERLINK "http://en.wikipedia.org/wiki/BBS10" BBS10, HYPERLINK "http://en.wikipedia.org/wiki/BBS12" BBS12 Other: HYPERLINK "http://en.wikipedia.org/wiki/ARL6" ARL6/BBS3, HYPERLINK "http://en.wikipedia.org/wiki/TRIM32" TRIM32/BBS11  HYPERLINK "http://wrongdiagnosis.pubs.righthealth.com/topic/Waterhouse%E2%80%93Friderichsen%20syndrome?as=clink&ac=1437&afc=2168586466&p=" \o "WaterhouseFriderichsen syndrome" \t "_blank" Waterhouse-Friderichsen HYPERLINK "http://wrongdiagnosis.pubs.righthealth.com/topic/Syndromes?as=clink&ac=1437&afc=2168586466&p=" \o "Syndromes" \t "_blank" syndrome It is a malignant form of cerebrospinal meningitis Multiple species of bacteria can be associated with the condition: Meningococcusis another term for the HYPERLINK "http://en.wikipedia.org/wiki/Bacteria" \o "Bacteria" bacterialspecies HYPERLINK "http://en.wikipedia.org/wiki/Neisseria_meningitidis" Neisseria meningitidis, blood infection with which usually underlies WFS. While many infectious agents can infect the adrenals, an acute, selective infection is usually Meningococcus. WFS can also be caused by HYPERLINK "http://en.wikipedia.org/wiki/Streptococcus_pneumoniae" Streptococcus pneumoniaeinfections, a common bacterial pathogen typically associated with meningitis in the adult and elderly population.  HYPERLINK "http://en.wikipedia.org/wiki/Mycobacterium_tuberculosis" Mycobacterium tuberculosiscould also cause WFS. Tubercular invasion of the adrenal glands could cause hemorrhagic destruction of the glands and cause mineralocorticoid deficiency.  HYPERLINK "http://en.wikipedia.org/wiki/Staphylococcus_aureus" Staphylococcus aureushas recently also been implicated in HYPERLINK "http://en.wikipedia.org/wiki/Pediatrics" \o "Pediatrics" pediatricWFS. It can also be associated with HYPERLINK "http://en.wikipedia.org/wiki/Haemophilus_influenzae" Haemophilus influenzae.  HYPERLINK "http://en.wikipedia.org/wiki/Cytomegalovirus" Cytomegaloviruscan cause adrenal insufficiency,especially in the immunocompromised. The list of HYPERLINK "http://wrongdiagnosis.pubs.righthealth.com/topic/Medical%20signs?as=clink&ac=1437&afc=2168586466&p=" \o "Medical signs" \t "_blank" signsand symptomsmentioned in various sourcesincludes the 10 symptoms listed below:  HYPERLINK "http://www.wrongdiagnosis.com/sym/fever.htm" Fever  HYPERLINK "http://www.wrongdiagnosis.com/sym/collapse.htm" Collapse  HYPERLINK "http://www.wrongdiagnosis.com/sym/coma.htm" Coma  HYPERLINK "http://www.wrongdiagnosis.com/sym/cyanosis.htm" Cyanosis Petechiae on the skin  HYPERLINK "http://www.wrongdiagnosis.com/sym/confusion.htm" Confusion  HYPERLINK "http://www.wrongdiagnosis.com/sym/altered_mental_status.htm" Altered mental status  HYPERLINK "http://www.wrongdiagnosis.com/sym/photophobia.htm" Photophobia  HYPERLINK "http://www.wrongdiagnosis.com/sym/seizures.htm" Seizures  HYPERLINK "http://www.wrongdiagnosis.com/sym/papilloedema.htm" Papilloedema Complications and sequelae of Waterhouse-Friderichsen syndrome from the Diseases Database include:  HYPERLINK "http://www.wrongdiagnosis.com/medical/adrenal_cortex_insufficiency.htm" Adrenal cortex insufficiency The infection leads to massive HYPERLINK "http://en.wikipedia.org/wiki/Hemorrhage" \o "Hemorrhage" hemorrhageinto one or (usually) both adrenal glands. HYPERLINK "http://en.wikipedia.org/wiki/Waterhouse%E2%80%93Friderichsen_syndrome" \l "cite_note-Robbins_2005-0" [1]It is characterized by overwhelming bacterial infection HYPERLINK "http://en.wikipedia.org/wiki/Meningococcemia" \o "Meningococcemia" meningococcemia, HYPERLINK "http://en.wikipedia.org/wiki/Hypotension" \o "Hypotension" low blood pressureand HYPERLINK "http://en.wikipedia.org/wiki/Shock_(circulatory)" \o "Shock (circulatory)" shock, HYPERLINK "http://en.wikipedia.org/wiki/Disseminated_intravascular_coagulation" disseminated intravascular coagulation(DIC) with widespread HYPERLINK "http://en.wikipedia.org/wiki/Purpura" purpura, and rapidly developing HYPERLINK "http://en.wikipedia.org/wiki/Adrenal_insufficiency" \o "Adrenal insufficiency" adrenocortical insufficiency. Von Graefe's sign Von Graefe's sign(lid lag sign) is the immobility or lagging of the upper HYPERLINK "http://en.wikipedia.org/wiki/Eyelid" eyelidon downward rotation of the HYPERLINK "http://en.wikipedia.org/wiki/Human_eye" \o "Human eye" eye, indicating HYPERLINK "http://en.wikipedia.org/wiki/Exophthalmos" \o "Exophthalmos" exophthalmic HYPERLINK "http://en.wikipedia.org/wiki/Goitre" \o "Goitre" goiter  INCLUDEPICTURE "http://www.thyroidmanager.org/Chapter12/figures/figure4.jpg" \* MERGEFORMATINET  Joffroy's sign Joffroy's signis a HYPERLINK "http://en.wikipedia.org/wiki/Medical_sign" \o "Medical sign" clinical signin which there is a lack of wrinkling of the forehead when a patient looks up with the head bent forwards. It occurs in patients with HYPERLINK "http://en.wikipedia.org/wiki/Exophthalmos" exophthalmosin HYPERLINK "http://en.wikipedia.org/wiki/Graves_disease" \o "Graves disease" Graves disease. Stellwag's sign Stellwag's signis a sign of infrequent or incomplete HYPERLINK "http://en.wikipedia.org/wiki/Blinking" \o "Blinking" blinkingassociated with HYPERLINK "http://en.wikipedia.org/wiki/Exophthalmos" exophthalmosor HYPERLINK "http://en.wikipedia.org/wiki/Graves_orbitopathy" \o "Graves orbitopathy" Graves orbitopathy. It is accompanied by HYPERLINK "http://en.wikipedia.org/wiki/Dalrymple%27s_sign" Dalrymple's sign, which is a retraction of the upper HYPERLINK "http://en.wikipedia.org/wiki/Eyelid" \o "Eyelid" eyelidsresulting in an apparent widening of the HYPERLINK "http://en.wikipedia.org/wiki/Palpebral" \o "Palpebral" palpebralopening. Dalrymple's sign Dalrymple's signis a widened HYPERLINK "http://en.wikipedia.org/wiki/Palpebral" \o "Palpebral" palpebral(eyelid) opening, or eyelid spasm, seen in HYPERLINK "http://en.wikipedia.org/wiki/Thyrotoxicosis" \o "Thyrotoxicosis" thyrotoxicosis(as seen in HYPERLINK "http://en.wikipedia.org/wiki/Graves%27_disease" Graves' disease, HYPERLINK "http://en.wikipedia.org/wiki/Exophthalmos" \o "Exophthalmos" exophthalmic HYPERLINK "http://en.wikipedia.org/wiki/Goitre" Goitreand other hyperthyroid conditions), causing abnormal wideness of the HYPERLINK "http://en.wikipedia.org/wiki/Palpebral_fissure" palpebral fissure. As a result of the retraction of the upper eyelid, the white of the HYPERLINK "http://en.wikipedia.org/wiki/Sclera" sclerais visible at the upper margin of the HYPERLINK "http://en.wikipedia.org/wiki/Cornea" corneain direct outward stare.  INCLUDEPICTURE "http://www.thyroidmanager.org/Chapter12/figures/figure2.jpg" \* MERGEFORMATINET  Chvostek sign TheChvostek sign(alsoWeiss sign) is one of the HYPERLINK "http://en.wikipedia.org/wiki/Sign_(medicine)" \o "Sign (medicine)" signsof HYPERLINK "http://en.wikipedia.org/wiki/Tetany_(medical_sign)" \o "Tetany (medical sign)" tetanyseen in HYPERLINK "http://en.wikipedia.org/wiki/Hypocalcemia" \o "Hypocalcemia" hypocalcemia. It refers to an abnormal reaction to the stimulation of the HYPERLINK "http://en.wikipedia.org/wiki/Facial_nerve" facial nerve. When the HYPERLINK "http://en.wikipedia.org/wiki/Facial_nerve" facial nerveis tapped at the angle of the jaw (i.e. HYPERLINK "http://en.wikipedia.org/wiki/Masseter_muscle" masseter muscle), the facial muscles on the same side of the face will contract momentarily (typically a twitch of the nose or lips) because of HYPERLINK "http://en.wikipedia.org/wiki/Hypocalcemia" \o "Hypocalcemia" hypocalcemia(ie from hypoparathyroidism, pseudohypoparathyroidism, hypovitaminosis D) with resultant hyperexcitability of nerves. Though classically described in HYPERLINK "http://en.wikipedia.org/wiki/Hypocalcemia" \o "Hypocalcemia" hypocalcemia, this sign may also be encountered in HYPERLINK "http://en.wikipedia.org/wiki/Respiratory_alkalosis" respiratory alkalosis, such as that seen in HYPERLINK "http://en.wikipedia.org/wiki/Hyperventilation" hyperventilation, which actually causes decreased serum Ca2+with a normal calcium level due to a shift of Ca2+from the blood to HYPERLINK "http://en.wikipedia.org/wiki/Albumin" albuminwhich has become more negative in the alkalotic state. Chvostek's sign may also be present in hypomagnesemia, frequently seen in alcoholics, persons with diarrhea, patients taking aminoglycosides or diuretics, because hypomagnesemia can cause hypocalcemia. Magnesium is a cofactor for Adenylate Cyclase. The reaction that Adenylate Cyclase catalyzes is the conversion of ATP to 3',5'-cyclic AMP. The 3',5'-cyclic AMP (cAMP) is required for Parathyroid hormone activation.  INCLUDEPICTURE "http://www.wrongdiagnosis.com/bookimages/14/4721.1.png" \* MERGEFORMATINET  Type 1a Pseudohypoparathyroidism is clinically manifest by bone resorption with blunting of the fourth and fifth HYPERLINK "http://en.wikipedia.org/wiki/Metacarpal" \o "Metacarpal" knucklesof the hand, most notable when the HYPERLINK "http://en.wikipedia.org/wiki/Dorsum" dorsumof the hand is viewed in HYPERLINK "http://en.wikipedia.org/wiki/Flexion" \o "Flexion" flexedposition. This presentation is known as 'knuckle knuckle dimple dimple' sign. This is as opposed to HYPERLINK "http://en.wikipedia.org/wiki/Turner_syndrome" Turner syndromewhich is characterized by blunting of only the fourth knuckle, and Down's syndrome, which is associated with a hypoplastic middle phalynx. Trousseau sign Trousseau signis the name of two distinct phenomena observed in clinical medicine. Both are attributed to HYPERLINK "http://en.wikipedia.org/wiki/Armand_Trousseau" Armand Trousseau:  HYPERLINK "http://en.wikipedia.org/wiki/Trousseau_sign_of_latent_tetany" Trousseau sign of latent tetany  HYPERLINK "http://en.wikipedia.org/wiki/Trousseau_sign_of_malignancy" Trousseau sign of malignancy Trousseau sign of latent tetany is a HYPERLINK "http://en.wikipedia.org/wiki/Medical_sign" medical signobserved in patients with low HYPERLINK "http://en.wikipedia.org/wiki/Calcium" calcium. HYPERLINK "http://en.wikipedia.org/wiki/Trousseau_sign_of_latent_tetany" \l "cite_note-0" [1]This sign may become positive before other gross manifestations of HYPERLINK "http://en.wikipedia.org/wiki/Hypocalcemia" \o "Hypocalcemia" hypocalcemiasuch as HYPERLINK "http://en.wikipedia.org/wiki/Hyperreflexia" hyperreflexiaand HYPERLINK "http://en.wikipedia.org/wiki/Tetany" tetany, but is generally believed to be more sensitive (94%) than the HYPERLINK "http://en.wikipedia.org/wiki/Chvostek_sign" Chvostek sign(29%) for hypocalcemia. To elicit the sign, a HYPERLINK "http://en.wikipedia.org/wiki/Blood_pressure_cuff" \o "Blood pressure cuff" blood pressure cuffis placed around the arm and inflated to a pressure greater than the HYPERLINK "http://en.wikipedia.org/wiki/Systolic_blood_pressure" \o "Systolic blood pressure" systolic blood pressureand held in place for 3 minutes. This will occlude the HYPERLINK "http://en.wikipedia.org/wiki/Brachial_artery" brachial artery. In the absence of blood flow, the patient's hypocalcemia and subsequent neuromuscular irritability will induce spasm of the muscles of the hand and forearm. The wrist and HYPERLINK "http://en.wikipedia.org/wiki/Metacarpophalangeal_joint" \o "Metacarpophalangeal joint" metacarpophalangeal jointsflex, the HYPERLINK "http://en.wikipedia.org/wiki/Distal_interphalangeal_joint" \o "Distal interphalangeal joint" DIPand HYPERLINK "http://en.wikipedia.org/wiki/Proximal_interphalangeal_joint" \o "Proximal interphalangeal joint" PIPjoints extend, and the fingers HYPERLINK "http://en.wikipedia.org/wiki/Adduction" \o "Adduction" adduct. The sign is also known asmain d'accoucheur( HYPERLINK "http://en.wikipedia.org/wiki/French_language" \o "French language" Frenchfor "hand of the HYPERLINK "http://en.wikipedia.org/wiki/Obstetrician" \o "Obstetrician" obstetrician") because it supposedly resembles the position of an obstetrician's hand in delivering a baby. TheTrousseau sign of malignancyis a HYPERLINK "http://en.wikipedia.org/wiki/Medical_sign" medical signfound in certain HYPERLINK "http://en.wikipedia.org/wiki/Cancer" \o "Cancer" cancersthat is associated with HYPERLINK "http://en.wikipedia.org/wiki/Venous_thrombosis" venous thrombosis HYPERLINK "http://en.wikipedia.org/wiki/Trousseau_sign_of_malignancy" \l "cite_note-0" [1]and HYPERLINK "http://en.wikipedia.org/wiki/Coagulation" \o "Coagulation" hypercoagulability. It is also referred to asTrousseau syndrome HYPERLINK "http://en.wikipedia.org/wiki/Trousseau_sign_of_malignancy" \l "cite_note-1" [2]and is distinct from the HYPERLINK "http://en.wikipedia.org/wiki/Trousseau_sign_of_latent_tetany" Trousseau sign of latent tetany. BC     % & ' J K 6 7 @ A F G   ) * f g x y 2 3 ? @   $ % Žhh[5hh[5 hh[hh[0J>*B*phjhh[U hh[hh[5CJ J ' qxKL_m!h!L""# d`gddgd [\deno/0ghtu9:[\UVbc./Lhh[5CJ hhxhh[0J>*B*phjhh[U hh[hh[5hh[5JLM=>DEFG  /078LU]^_ op;<novw _`pqhh[5hh[5hh[0J>*B*ph hh[jhh[UQ'(679:st$%=>$%{|0 1 666666(7)7c7d7s7t777777777ž hh[hh[5CJ hhhh[hh[0J>*B*ph hh[jhh[UK#|%%&'()*++, ---./0-12_315666666dgdx d`gd66E9M9J;T;FJ#JQKKbMMMMMMMNoNNPOLPPPPPQ d`gddgd7 8!8)8*81828w8x888888888997989B9C9E9K9L9M9j9k9999999<:=:c:d:n:o:::::::; ;;;J;K;R;S;T;;;;;;;9<:<<<<<<<<<<<<<{=|=== hhxhh[5hh[5hh[0J>*B*phjhh[U hh[O========$>%>3>4>E>F>>>>>>>>>>>>>-?.?9?:?*B*phVCC)C*CCCLDMD^D_DaDbDDDDDDD E EEEEERESEaEbEcEdEeEEEEEEEFF!F"F#F$F{F|FFFFF3G4GkGlGxGyGzG{GHHHH I IIIJJJ!J"J#JBJCJJJļhh[5hh[5 hhx hh[hx hh[hh[0J>*B*phjhh[UJJJJJJ K KKKKKKKKKKKLL]L^LhLiLLLLLLL"M#MVMWM_M`MfMgMMMMMMMMMNoNNNNOOOOOOPPQQQQSSSSSSTTbTcTlT߾hh[5hh[5hh[5CJ hxh[ hhx hh[jhh[Uhh[0J>*B*phHQQRR0R8RRRSSToTyTTSUUUVWGWwWWuXXXXCYYdgd d`gdlTmTTTTTTTTTEUFUPUQUSUTUUUUUUUUUUVJVKVlVmVWWWWWWuXXXXXXXYYYY Z[[[[[[7\8\P\Q\\\\\\\]]P]Q]h]i]j]ǽhh[5CJ hh[5CJ hh[hh[5hh[5hh[0J>*B*ph hh[jhh[UFYYY[[[y\\\]j]]-^^^^:_V___`A`a:bbbSccdgd d`gdj]k]]]]]]]^^+^,^-^.^r^s^^^^^^^^^^^"_#_8_9_V_W___________``A```AaBaJaKaLaMaaaaaaaa,b-b8b9b:b;bbbbbbbbbbbbb>c?cQcRcSchh[5 hh[hh[0J>*B*ph hh[jhh[URScTccccccccd!d"d#d$dldmd}d~ddddd-eeeeeeeeeeff5f6fdfefffffffgggg g!ggggggggggg|h}hhhhhii&inioiiiǽhhI{5CJ hhI{hh[5hh[5hh[0J>*B*ph hh[jhh[UJc#ddd-e>eii&iXjdjmlnlln6pqq6r7rRvry$~*3dgd d`gdiiiXjcjdjjjjjjjk kPkQkmknkwkxkkkkkkk l lllll_l`ljlklnlllWmXmmmmmmmmmnn n nnnYnZnjnkn4p5pepfppppppppppŻߴߴ hhxhh[5CJ hhI{5CJ hh[5hhI{5 hh[jhh[Uhh[0J>*B*phGppqq2r5r7rdrerrrrrospsssss't(titjtotptttttu uuuvvvvPvQv[v\vvvvvwwwwwwww-x.xJxKxVxWxxxxxyyHyIyWyXypyqyyyyyyy hhxhxhh[0J>*B*ph hhCjhhCU hh[jhh[ULyzz_z`zpzqzsztzzzzzzz{{{{2{3{{{||,|-|/|0|{|||||||||||||"}#}7}8}}}~~!~"~x~y~~~~~yz܁݁hx0J>*B*phhxhh[0J>*B*phjhh[U hh[O34=>()tu QRklpq !$%rs12389:jk†ÆUVĈň%&klvwS hhxhh[0J>*B*phjhh[U hh[hhI{5hh[5N3:ƈP-.OD*5śS<t۱ d`gddgdSTBC jk78@A-opIJݏޏ !:;rsƻƻƻƻƥƻƻƻƻ hhI{hhC0J>*B*phjhhCU hhChhC5CJ h5CJ hh[0J>*B*ph hh[jhh[UAʐːՐ֐ِؐ 45vw=>PQSTْؒ.MNOlm DE{|:;DETUhhI{5hhC5 hh[hhC0J>*B*ph hhCjhhCUN֗חMN]^GHOPRS()*345 śWXFGRSbcΝϝ&'23SThhI{5hhC5 hhxhhC0J>*B*ph hhCjhhCUN؞ٞ,->?45DE)*56no|}%&TU CDPQVWRSǧȧ,-ΨϨ134rs hhxhx hhChhC0J>*B*phjhhCUS67UVܫݫ#$Z[fgٱڱܱMNSTXYѻһ ʼ˼ϼмnosu˾̾оѾ*+jkrshhI{5hhC5hx hhxhhC0J>*B*ph hhCjhhCUM۱ܱsH~ҾGSSEa Sdgd d`gdsEFGQRS ?@IJ67BCHI<=IJ%&67=>yzABRS+,;<CDEFhhI{5hhC5 hhxhhC0J>*B*phjhhCU hhCO$%WX_`abLM\] IJQRST23<=pqøøjhh5U hh5hhI{5CJ h hhxhhC0J>*B*phjhhCU hhCEAr ,o? d`gdxdgd d`gdqyzdeNOVW_` }~=>LMRSWX]^]^SThhI{5hh55hx hh5jhh5Uhh50J>*B*phPT CDRS-.45;<EFjkOP]^  TU^_aij-.9:;<uv'hxhh50J>*B*phjhh5U hh5V'(12#$&'~bcUV./;<_`,-lmtu hhx hh5hh50J>*B*phjhh5UU%&QR23:;lmst-.ijst():;$%56JK[\-.:; j@hh5Uhh50J>*B*phjhh5U hh5P fgPQWX]^ gh GH jvhh5Uhxhh50J>*B*phhhI{5hh55 hhh} hh5jhh5Ujjhhh}UA +,QR`a01<=?YXYrsIJKZ[\`a ^_QRVWܺܳܺhhI{5 hhxhh55hh50J>*B*phjhh5U hh5hh5CJaJhhI{CJaJ hhI{C?YK\} )      `e;rJdgd d`gddgdQR_`yz<=NOtu12{|?@RS &'abqrOP\] hhmhhI{5hh55 hhI{hh50J>*B*phjhh5U hh5L dez{  BCFGOP&'+,wx]^ )    ¸hhhI{5CJhhI{5CJ hh55 hhmh5 hh5jhh5Uhh50J>*B*phF U V             8 9 F G L M            H I U V ^ _             3478^_`eijhhh}5CJ hhI{hhh}5hmhhI{5hhh}5 hh5hhh}0J>*B*phjhhh}U hhh}C  GI+-689HIJ   OPbcij`!a!!!!!####{#|###########$$>$?$J$K$3%4%j%k%v%w%hhh}0J>*B*phhhI{5hhh}5jhhh}U hhh}R9J !##S&^&&6(N((()I)))=*~*****,+8++dgd d`gdw%%%&&&&S&\&]&^&&&&&&&='>'''''''(()(3(4(M)N)))))))))))))1*2*;*<*A*B*t*u*|*}*******+ +*+++8+9+{+|+++++++++++,, ,!,,,hhI{5hhh}5hhh}0J>*B*phjhhh}U hhh}R++,,G---.h...C//X0112Y2e2223 5555,57dgd d`gd,,,,,,,--- - - -=->-E-F-G-H-|-}-----------......W.X.f.g.h.i.............0/1/A/B/C/D/|/}///// 0 02030X0Y00000F1G1|1}111111111hhh}0J>*B*phjhhh}U hhh}X11122 2 222H2I2W2X2Y2c2d2e222 3 333435333333344"4#4$4%4x4y444555*5+5,577)8*8<8=8a8b888Ⱦhh[0J>*B*phjhh[U hh[ h5hh[5hh[5CJ h5CJ hhI{5hhh}5hhh}0J>*B*phjhhh}U hhh}88888888888*9+9e9f9u9v9T:U:V:W:]:^:_::: ; ;;;#;$;^;_;n;o;;;;; < < <'<(<)<<<<<<<<<==$=%=======%>&>^>_>l>m>>>>>??B?C?hhI{5hh[5 hhmh[hm hh[jhh[Uhh[0J>*B*phL7:U:V:W:_:w:::; <)<{ADF8GCG$HHJ+N,N-NANN1PVPPdgd d`gdC?y?z?????@@%@&@1@2@_@`@b@c@w@x@@@@@ A AVAWAcAdABBgBhBBBBBBBBBBBACBC[C\CCCDD D!DDDEEE EbEcEEEEEEE=F>FGFHFFFFFGG8GAGBGCGGGhhI{5hh[5hh[0J>*B*phjhh[U hh[RGGGGG"H#H$I%IIIIIJJJJ K K"K#KdKeKmKnKKKKKKKKKCLDLQLRLaLbLLLLLLLMMMM"M#MSMTMYMZMdMeMMMMMMMNN'N(N*N+N,N-N@Nɿhh[5CJ hhmhmh[ hhI{hh[0J>*B*phjhh[U hh[G@NANPNNN"O#OmOnOOO1PTPUPVPPPPPQQQQQQeRfRRRRRRR S SSSMSNSSSSSSS0T1TBTCTTTFUGU\U]U^U_UUUUUUUVV/V0V1V2V|V}VVVVVŽŽhhI{5hh[5hh[0J>*B*phjhh[U hh[ hhI{hhI{5CJ JPPQ$Q>Q[QQQ ReR>SMSSSSDTTTTT^UUU1VVVW&W d`gddgdVVVVVYYYYYYdZeZZZZZZZ[[[[[[\[][g[h[[[[[[[:\I\J\K\\\\\\\.^/^y^z^^^^^^^^^*_+_u_v______D`Q`R`S````Ⱦhh5CJ hm5CJ hhI{5hh[5hh[0J>*B*phjhh[U hh[H&WIWWWW(X`XhXXXX7YbYYYZZZ3ZdZZ[i[:\K\\\ ]dgd d`gd ]8]]]]].^^^__D`S```````TbUbzbcdffggdgd d`gd`WaXaaaaaaaFbGbPbQbSbTbUbxbybzbbb9c:cKcLcPcQcccccdd@eAeMeNeffVfWfhfifffff3h4hChDhEhhhii i ilimiiiiiiijjjjkk h5CJ h5hhI{5hh5 hhmhhh0J>*B*phjhhU hhGggggh3h4hEhhh ii=iPilii$j.jjjkkkkkkkldgd d`gdkllllllmm^m_mmmmm^o_ooooooo.p/p@pAp]p^pppppppppppppAqBq[q\q^q_qqqqqqq r rrrrrrrrryszsssssnuou仳hh5hh5 hhmhh0J>*B*phjhhU hhhh5CJ hh5CJ Flrr~~<=S!LڑrߒZݓ dgd d`gdouuuuuuu$v%v+v,vIvJvvvvvwwIwJwdwewwwwwwwww/x0xDxExxxxxxxyy z z zLzMzuzvzzz#{${G{H{{{||$|%|'|(|g|h|||}|||||||}}}}}}'~(~d~ hh hhmhh0J>*B*phjhhU hhRd~e~v~w~~~~~~~~~~~JKUVhi78PQqr/0=>ׂ؂ц҆߆:;͉Ή=S޽hh5CJ hhmhh5hh5 hhhh0J>*B*phjhhUJŠҊӊabyzqr|} JK\]ΏϏЏ܏)*cdrs9:CDLMΑϑّؑ`aopВђݒޒߒh hhhh5 hhhh0J>*B*phjhhUO%&78ȓɓۓܓݓޓ !UV_`”ÔϔД23>?*+@ABCٖږCDKLalėŗїҗcd67 hhjhhUhh0J>*B*phhh5jhh5UPєBMalӗZȘ2Uԙ  d`gd - /ˢ0T(e_Jdgd d`gdۚܚ   }~˛̛ڛۛÝĝ)*-.XYFG  wxסءۡܡ  rsvwˢ̢,-./0Tcߵ hhhh5CJ jw5hhmUhh5hh5 h5 hhjhhUhh0J>*B*phDc @AFGHI<=opwxz{ϥХҥӥ  VWijlm&'(DEƨhh5hh5hh0J>*B*phjhhU hh hhOƨǨ    \]lmީߩ,-;<PQ56?@ABxyάϬЬѬefڮۮ :;ABdehmhh0J>*B*ph hhjhhUV!"WXbcٰڰ45<=JK}~  Ȳɲ,-<=˳ֳ̳׳ܳݳ'(uvz{|}UV hhmhh5hh5hh0J>*B*ph hhjhhUNJ?~ ҺqrݽS˿Ydgd d`gd{|߸  <=CDFGvw{|~#$&'VW[\^_˺̺кѺҺӺ*+4578qrvwyz#$()01bchh0J>*B*phjhhU hhXcijrs12<=KLҽӽ۽ܽݽyzžƾϾо())*BC  23xyддЪߜߜ hhm hhhh5CJ #hh0J5>*B*CJ phhh5CJ jhh5CJ U hhjhhUhh0J>*B*ph=ABQR67IJRSWXYZKLabcd:;GH?@./hh0J>*B*ph hhm hhjhhUUcI  btQRSTUV d`gddgd d`gd/23lm*+01  "#UV]^wxSTJKWYǼǼǼǼǼǼǼ hhQhh[0J>*B*phjhh[U hh[hh5CJ h5CJ hhjhhUhh0J>*B*phA ,-vw  DEQRVW>?GHYZ  #$abrs  MNWXabstҸ hhhhhQ0J>*B*phhh5CJ hh[joVhhQUjhhQU hhQH [\jkxy!RSYZ67hiopMNOPRSVdŻhh_0J>*B*phjhh_U hh_hh5CJ h<*Z5CJ hhjhh<*ZU hhQhhQ0J>*B*phjhhQU*B*ph hh_jhh_USyzQRb  hiOP\]|}^_  =>DEǼǼǼǼǼǼǼǼǼǼǼǼǼǼǼǼǼǼǼhh$0J>*B*phjhh$U hh$hh5CJ hhhh_0J>*B*phjhh_U hh_DTUhi'(`aXYMNQRWX./56ef&'DELMfg`hm hh$hh$0J>*B*phjhh$UV`astef hh$hh$0J>*B*phjhh$Uz+p ,p -p .p 1h/R 4 5 6 7 :px/ =!"#$% @Dd  c rAL?wpid-klinefelter-syndrome-inheritedsvR?j24.{m:J Ez?DF|?j24.{m:J EzJFIF;CREATOR: gd-jpeg v1.0 (using IJG JPEG v62), quality = 85 C  !"$"$CT@" }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?.(((;Cg z;lyO>QX6 | }~/}mj_"Ocx Ykr7:ے2z x8Ȯ4WI&]N+Yc:dWk^e_mIK:Pο=b[~QEQKI@Q@RQKE%Q@RQEQEQEQEQEQEQEQEQEQEyk:m?bu=9n-$HF 6 SWZHwV7z.,R˜\X Ix+'ֳS$^m|-bBӡ7<樗79zڏË,M0ֺ:d /9GtR_&oa'~--[v:WUq>`cD[XXЮ~X}AVO[}>EPWZŽw݅ݜPΞ{qƫ?.JSͤ]yݑ}C?*hn8ﮋO-.o}$# MGYct](To(|m9 :( ( ( (6yjsm-bi%oah#^?1[˹`'t?X-.=λm o/Euj:OOUXninl9rvz/7󯥙0A?u^YP؛?DZj%.XT#%o^R]gNk#yH}zvfy|-R-ݫHTOZϫ,ɻnԔJMJc.¶6ȷ:}A$6_ުsb.>RTUrˬ_mU1oW91/Jo&^[_yd-,x\C};?٠`Z>eYqűfEtb?+`n+_Qj7Ŀ"D 吸J]3G \3jkbXL8}^ou]^=^<-Cy#\+cu_uUާ=a:4;(1,pa3Z+#>Oy{y7A5/Wh_ 7˹gC?{Y((((((-/X;$qQt]J){i̊UǀUwi8&5}F}KUGn]&;FL mp|v=jiז%Eʯ|+-|I +(:wƋ߻&')s" b>~ gK}]eRo1Q^%WV6}Ri*,g]0~WSϫS,;]BtpX*DM 6J+c>pVԷ-.N$7{ !3\]z5H=߱wfC&Ѹ}+w><_L6jrŧH>ym©(;|]ǮxvK)Tg׷Zآ̬Te]\['٤&奕]fUۏQ]IM~T:䵿 4=߼m|&3T抗tE]JFџmWzG Mu{{ȟk5[xo#2SdWqh|_5^+W3JgGT5m_Lbj7Z #u?g?߭j5XKX37ik.huzgwsqZni|2GV4}i,v,[+ q-j_ omhvV6`hğ+ >Zx::O}ŧ"[>YQU8uI'T0+)WK2qҰ-"kIumo+{47fM 1Qh m/uN9E""@\ ox}([[BfvF} *vϳ͎Wdn V(h(((((ִ̽--rRIU['׵A=+Zޟ#VXͳq^w .ؒimDS"+[ ~ooks6Kug[XC帆W'+.GK@$H^l<8|ȟ|{UJ%-~[tgc\(-\g>.f@hQosޟ5"cnY>LGrh 5;h ]KlV\`:օNmSY:VXGҩ6{qڟI'ŪZ$խfBٔeːjǁOmg&gF=]t$:F7$f?x*xm;7JnhOކ;Wo?6O?5/QZzʱ+&D޹!7V|+=ti֖0isۘamL\ 9( szZG1OMڢHW*9ԗ,ΐzc^\G y͵/kw|p;~ְn.&gݳ|WW=ZYLܬnjw)}}{y ɐ6XdE3 s2Z_M"|j\Z9)sw=Ò*="kuj^O6k 򥞣U3{ׅK l}?M֕uƾԴUm8WgZ^Y24)Ǒ7ΟzokY_POON6]g_/IsnƊ+|we/'t i/ڣ6F~Sk;+/Jl%hm./bYRI3zJ+jJOϵ_CK4PE}l**ɌJ"46,ZEfM+n Ԏ{P*(d%7I#uܬ((((((myY`t.ⶼ l7W+ k/ iĖRUN m/ܭemb5UU6/wQt)}[&U;ZѴXնSn!m-"zbT}!yEvvbkMd?6ձeteSS=/0i?o߽T8LjZ{qV:Eu~Yᖬ|Sfɂ00S /|=#s"2ud9*H2:׿)&|*(vf~{f -Y-' #K>eG61~^o;n$s߇[9o_M Zk%fq!uBeIYlCgws,ehM3x;WΘ񢷈-5&do/oPUW v'iw6ZAcf3+FF/M,Si:}ŝE&DU4/S<`ha[wpBbEUE^tk–F*`U`b, V}{JMJG٤ "HA*O>EPEPEPEPEPEPQ^7ど7_g}y"xzx٦-0WgA4>[ojz|>XewG1M9Fhi.[[Hm'DY}T4h^XGa?-ـf]~z%x? ۽SvP*Vq4hv3Ơiq_ A|?PGEsxSPqO A|?PGEsxSPqO A|?P= May?`?bo#JEq3Rxĺ ׌~k% m"zV|AϧAjm_o*v>(F_ ✂yMFkrlO.4{]6KwofVmf7%m}QꏽwE=begeZwu\'گ1o5e_Rk~E]mDtQeO"WR_Ii2n_ӯލ~o.ߺՁ?M>;OvRA=sW/4uǁ[5?>SCP)UF#qWѓ74i]/# [lSG]Ǟp_Z6oW]kWz`w`37}ҧχ-4ԁ%|P"o!dޢ((((((C'W֒hԼ n&Q0fڑ֬^[Ֆ }-wo^q ˭bSTkiX2/d%FϙxMu=~Sֵ-PukZƑ39Y`R4.Z||I?V0Jna+bU/Z_Ϭ__6vz Qu/Zq1gIBE!Vom_-S PmXwrnkUmͻ2|Ցt_WZLkev^s$[W3i֜]գnePhM4+}gJ(Βc%Fnh,~)nM߉{fI+F_6>??a|f?vey=c3RcƌU~b[Qk:LGYIn?5zNJhQTSӍٮw*HǮ*_[}h;w[3 QE-Q@Q@Q@Q@Q@Q@d,u =`3A/1[݀h.mu͖է e\x;|CkZ]ޗA>Sq3j]Ry-ne_46S#hqfžTy"Ҷ"3}0tjoo-vvZ <^E'b9s|/≵:j6k呙O@O'oWֵI-t[RC8_:oy}V[̓S;kivZ\XYz" * ޸l2]?|#}x_S为+YŬe 0J}ty5KF3"ωWeM⢵&u mkNE3| =$jEΟ{c?$0{l7߂1fH,uYcKxtYzڏ .|'ᶞ⹏[4;⺹^=5/d4}?O^vs煬߉hc+.Z2:DǽX%oy6/zon<_ۉ;ݟ>"S`?;WOc/ŝUޭ[OZ}WI2jk"kxpէmsi3 Tep򥮓Sj4Uka眒+6_7Cȏeї7޶e5-ΔZM'j줟 .Ẓ͇~V=}+bS5; 7M'$N,~ZNwmRvzt_YMvcfEp3q^'%qr;XMƳ-\5'@Xӊg_ Vo yf-üFpn+ټ ծRH]XE4]7] ^_]gOc[i6+t[CoH"*zZ( ( ( ( ( (8mwzWR{tʓDH}AnnnopsP+e㻤"ï\ v(WSS]^#Ӵ-[;U]˚i4Ityu m<0"8j{^z/Y]j7-HTHɏ_ʀ1ie$uz\:nc42(%'5Ý+Si?o_'irsb;/W\+?Uw-sc{kieڧ{+[VƥH#}N~j–ZIoUw ԚKVokk_L.5_bu-1T+OZЋO[ku/w%-WN ^H<)-C`Z<'a{~{WٽWS̤[ ;]"_>_q*õegM ;dy<)wm/ju{̞!q5_hK#ji B$ݜq:z6䫍&uBᙤNrZlb+HRe ,ʀѳq6gj {qy)~Q߭y.]OZ]+2̯p;pͷjaR]Y$r~`#MwS@~zBwgsBZڢFm /Ҁ<¾#'Np]Q( dmPsWl$WeO-[[`UeaO@$w_)  ~!!V/X~&ɕNIEn SǒmminU=-BM[iZHۙTVV>?̲#+Aڂ?ul}% m4fӴ9Újv]s'R67&>{hZ--~颏w &+}>"}Ɲq+B^-g-?ɳkЩ/TyԢ2$d~b㕙y7I5k-tUN?wc6k <5fYsb]rWfWۺi*KkKJ3+2+ZrmVTWIhZc5z EiS\xVn[o5zYTe/u8Wr{UJOGr+7Sj7jv_̚'cpfs>bܞWkԴ|ExYvw$(;Piխ12gh!kV9[ݓFk/mm>ݍ7>?Ԭ|5x=k8q%K߆ߑEWyAEPEQEQEQEQEQEFSm.R I% ۡh޹;){x5 rTlw/`Zi_j6$څfje_,^SxW/:?6M,DZOyDoj-nsvZC\c&Rs@EPvj_m/'6`Y7w8tzLE}wx'Ci RIoY4Ēy,mݕZer1y3օ~wZúiiVj^?0GiV V}2V&O]4o#Y<\4ٯbVԵ[oam;ūW>Oh8-xc)v<ĺ¬TCnY%uv 'U+OonÂxsUK użlLe:eHꋾ4{fɿu1 u_4[k/\z~tL\v%jO^ Y{\+jވ%ˇf%g uHn5m'.|@l^~ʿ2#1}sΗֵ'Kcº1t\p`1*mpk?Z.{m{GWPeN}0k|/oeO|-4;'m v8vZ,KsҊѯ21d:~O/Q^Q@ EPEPEPEPEPEP*M]JOP5ڥrs5y̍n*'??Ҽ ΑOy᭙sP- : ]v #Ԛ ޖp^>czcf9W敭} ZNip:m݆ *V:}-_vOjtY"hr3|57eyV/[ |GBحG}[xkէ1^BFwdKelw~ΗޭQXhsz2\hWmwZ'yυ>jXG:>ɏ5z+OJ0ywZoɺ/!~*5Ui֫aP~#ͥF%es6^~Xb~!wTNm|ȾIڱ![wNJk+.n`L=,sZ= v/eڸ[)^۟2߻?[1*RrwbE-Q"QEQEQEQEQEQEQEsMKQm5Rs:66沭kim X;"[y5{%|?TUG$Mv[VE%1^4ҭ>3}?ʽxf?7j~' k٫ˣ?=sX|fյ++ﱶkoҬ1PUO8uMkusg ڎ\O|ͥ ZM4o\˴](Smvڼ/e"mOZO(a֣B޴z|]v/_R0-ږB1\G a!>^ A/׋mDemcmp:ib,|FxvSQ%Ϊ?Y-lu ZeRYb١`v2y_#G?//6>G7洽e寥$'k-)_.xioZYisYu F Fa^ExtIV:sXZ/s+I委aO]~{c / :-ݶ܂A"ɮƊ(Z( ( ( ( ( ( J((((((/>~'w^3 ._&^7<4-v?07|H-R}xז|8s_Ey-x3Ś\BwV5\mo%SxIWqJuBJ|?/k˫Ri˲;OWVou+mmvydpj&E njfI-8!ڐv?k7N{QήkTɹB2;^_C }^QBU@)Q[EPEPEPEQEQEQEQEQEQEQEQEQEQEQEr? w\Unf/6}K|?ʸxʹ׋W=_~L嬷Y_vz+zV ?^ /We垭Ҵ˶0Vg̺k;}%foų]m\T[Xmٿij;$VҺ\è|؏Lbkǖ}KQEjbQEQEQE-Q@Q@Q@Q@Q@Q@ EPEPEPEPQEQEA[Սųcd?yFCtmtזEOjڬt831=\^֧YU~0ڿzISa^޿t}*rVk>gP٬>(c_䪿ٮPV+(?ܲ¿VlU jkOҷ[5e^vjܞg*yN[{H8Q~bT|QEQEQEQEQEQEQEQEQEQE%Q@Q@Q@Q@Q@Q@p>>6w=x{uޚ't_W.2] +ҷ\ayqo٤Y;+GWVY xmG NɇR݈jpE-suGG5Ki!F]$[\JExifII* ACD Systems Digital ImagingACD Systems Digital Imaging"   ("&#/#&)*---!141+4(,-+  @+$+@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@!1AQa"2q#BR3bSrt%7s46DV!1"AQ2a#q3 ?ㆿ|Q+[!fژFʿ@#.7$v~tBK'|C;.^lz'6[xUZ ƕZ}*<́8C>___*"pQߩI52^"7rq4YQ^P鞻ҪitIu (c⑺^"km69!i%uٷ?RpwC =虥u3# o,@r79j޼aQOZݼ)/|ڵqO ſ`ǖ}Z[Y'IK T)XiI ݱ=h%/x!+gx(a!ǹ?+8 c;3r9Q\ڥq5jfL򢳈%y eT&ӛO@I1w 4>3 u5G87ц"45B Ϯjqj.qFoٍ/.@;i.FI*܁ Vm-E3#m{ѡ8\qO,|Eqx~Andp̪"`Ҥ5ԸFϼKtkVk?wn)O)RCǞjv1kVڦDQn[RvGBʽN:kx;-;X/T]Ĝ(Rpa\ԦK j\K{G l .K~=vJ29GZonтsrсmPT5X۴ך̐Ɵ3Zt֝a];(=~#ޔTK 5Uϒ%CDL&:@:UkƢ^G_Bտsg)I+t"A鷅xe]ev qyS.=NOV|EKi!hBM:uS(;.1KeɅG)qj\By緺9nbp: SY-ܔc` 7$p͌EeLI̊y[wZxLJN73gF=k|XR5]_N,!0`)A9ǩ$i^I$,܌2N9Hڅ+"yD"f;P=)+|նuZKh3[))uG\9w-6 )fh۸#8?\Ǩ4!<$f:x_W+}{hmn l}eʩ6u6ǥgEmr$ƒ'1e'ށŲ%ֲIJ?ƫ{<[iq rO'uޝ .bG{Y,GDRO,}p{w|Ib0RBԱ?/ׯҫ HEG2-IacQ>f~>:}[ wv;rȤ#Ѭ5ߤ[P唏9=w.t6m=bOq~Bi@T IXSRmFvfpӳt/.qW彵s,|Z\6u$⃃looc_!k/ o'.z=}9i=jyAfo@NߕR0q:dbH~%6d'Q |KQ<&q݁rKn%Ms0BI)'6 v'R_p~F&hm de8Uisg;ሁ~Z-텧(a̕h wn&qcsp%΀$I`'c64U5k]wO#Sy0#`H$m%;3_x&[[G8;zeѴZ~b@9=?&ah𫌻Dዻ)rTo 8p jYsl&jāZ@;Z8Kgih`}to.%P@9̞7;x-c#5:(*G9 H$)s[̙L[]mّ|j4#E2{גGŰ_Xrz櫮$kԕfbrW|VWlu-j֑>fX"3riM X`-biB8YO?O?t?>v>!;6k31 YL~uoZ|&$odLaN*,ja& 2A?( w>UV:ӿSC4Pd߭_"F<Nu8.(ɪ} " U"uTu褀p0oz9*S4G<҈Vɔ4Ic0=OaXݺChXI29ϟ7@H@A-HVWL,LYVv,dߨk:,W 8ڵkw$hmeW'nrhDՉ9Irr1oOz4]kNҴWCۨ@g9j[̭H gDर-q:7BG8ĕ˝JijST;sabܡgYmvj%!f,̭zՃh"1~Fʜ Qj{GK/i bFW~Hcw9꣱9SLZg$I$@_OotNϓB횦x/,%H |Xvڏǹu!WVп:}Ρfe2zoNJ.GD 0**erL˔lF>]#uslվ$_tw,`jWͤwҜS9/x+_)+R^[ĀG?q4wA/д]IjR~&)y!I`֭{?|V\*(A9Jk+w'Tp:T4ix|Z ^Q9B@-#.htUEZwOsP۾4ўڤvvNUZi-/ Fl>9T&Y%j"Pߘ A ip(\ljRp6h+``7Oڴ姐ȇ8]Cĝ.hcm 1jYtL|y2gz2yA⁞;mB l$:|l2sZ\OC!LtnyBL_=i%Uhv ےOݷVڋ]c|L&#6Y3mK",Z)iD) w7(>U -Ɲp- yL @vOFU_CŭF}WTi"1=;R];xmM2!TgcI4WDz>̮c yGl,#_WՐ\ƅ c_M``6Qh\MFn2 ںsJt84(`sirnW?GCҦXi9s]ufesPoJ}54y[HT~ުMU".nf{hy`j˲te.FzqYi<;dR4V@۹>A( *EB Zg=fB3;͵Vw|U\( Ԗe8K`XYc5/Bj>_J%X9Si5VfC( ιquDӦrY1'ryOP}i1"ͦB!Gk m;i9@ c#9S$ɴKkϳR\u Tc<ܜ{^!˷9JR M' M nCΗ գ׭Zdrrh-hbx/>^Z؀ 'o>3-Y#XIAO[4]"TuSP+$L#>j^ɳ;˃tϱưm%F[Fi%ݎMux; Pxv(&E "9PzUi,*XB(ҭ]=wP}k )n4o1d`Pk_\5}2 k~VbxdN_$91hkTDOd ı.QW5 ]#ݩtGl7V~lg6cY4Dp~%}iK%V_ _cSlFJ{yd HF53:m!՝RL '5/V3(~Sʤ|ް-Ű9$7)vhĎ_&+f+4D\>ZP@"1b>K+V13أ泭I[k_:׵^KB :Im!_~Qd֮ LjF'"g@3Hoga1"0MX9.9+2L AjM1e^L̜bX``V6Ha2&1f< AҡYO*cnɦp;jsG cƹT_eϮx ZQzR/p@=4x _BO&A->p[}0Oa3gN'ǁ8Q#!ĝV2cTΗi&yc8#V\Dgߕ.2,}m$Zx75~is0F z}}[~;5cs(%HUp35VΏn-{RTr+F'QqAS_X,,(:cH"pw'Unxi\)oޒĨog{dA0~#ERf CiG3*o 3 YS*pYpܸp '.{ dQ hռH kݒ.4 կIѴ" elXCaI \1c񮕧^#$|!i&2 ɬD=yYMr<(n{e@0+tIi&b SL7u`wVc\BDCZ;Vf?{'#*|5e;csx")7fjey7=i9#;귁a@GQHIp@1~R:J*3~R(v, t@cqhT`1?T^#QɅsBNƞ$!Uk+L$&m_/剼iœSޘ} l[|I$/(}Eo-(>$^)W8_2$;)]C69#Iׂ0C GV\QڱenFQS&p*Z8F$>L7K~U$c ԚFH<OÎQT7_Ԇ(XCQ#ٕ W*}Lp2!O\Q ҴJǑ#븪Uہ/!(72n-8[NΠez8S:k]Kk&W,0S_ 1B)ζFM7^ 25v(A%1L,20b:{R/q^$m$D3\$C]Q24J6yszx*4ٷVAc/-)Z2Ƕ 2=WH6B=OҖ?:^ĝ; ś]`j'jDy$gE(pIiƾثmmG,|d{F2$"Х}$9uqN?s*l ̀Tc^4r?֮`$ |IY NxaUVQ䉻 R&T ցT;>\fĩe WŨ_Y-yī7ZEZX; ǖ'Ҭ?&}^Rp!2{T[dCq_S* #4ȷ'ZXb\VvPY-n.~QLdzҝx?KKB1aޱ+X"ԌNF % k$e h;|Xm71T~e65\v&5_iڄN\kHJބoiI6ڒu[p+3vc'}wQ;ZA fd`[oSo i7zHH,@QxTJ4%ˈ|UZI,]#ë+(mLrcN\+ZqrcQ:^P"7ArSĞ!K O)uӒ{`8ԸH@,.oªzN(b6͂A 꺎wWR s0=Hkxx%hYS/km{k7Y sNxdV/c ]R HʌO+ɓD6vCH9\Q|Ctx\taX&.]o^I-uY4kgGqp&J[Gr7n8=+!rr:o]:QF>~X$0̹e)"u;HtVstL_*t; YjVP3 87QK\slKړ/7 Dyzh \hM}I!Ɍ#ힴV4&kc>B6:W'A4ϭG!'R+Kj$έ$~ ZQ'%2U0[dɿ(-?AZ6a%ȴk;F#6ڥAotnX2e5i5gE;sޛ*DWXHnɼ1Ͻ7`+r6䐩 qje41RB(N^G#ҶyA%sBC'oФu#aӥF⻕|8AҖ7R]chP|ۯzZUKT,AYQ(^aݿґ6foK|L~ .絾剙أ5,|el5%'n !p#3czE+ݧ\"Jw ˷-Tk?eR1^צN v^,_QIڌ`t0pާ+2rFz-I<; [洕&+F4?2Js)tpde "ʍWv+'A&rCn57^r.e nAfAq*'%lI\G pZiqpojV~/SReXQ礛/CXcVGlIjt &܉vz&kD5t!=E-1ye4puG>I a $E-2z;Q[^m?b0~BJzPd9Iք:bOQ$^?B2% ?^ 5XZQ hITҼ; 7 h}}> fa;hP9}|žK,Nooi(F$~D4`. YP.A,tzEW`"5J+(ʬF~X҇żG#.vʶ[O6, v#ʞO~t5-?ҭG47:?1y[1?o_$vv ^Ճ)$UM2[I"$&RGEEȿOC[ -$o%(;D ංYUTsS~ɿ_𩧠,?HDdVAz  VA$m .?cushings-syndromeR%HQBԛM/R5QHjFGQBԛM/R5QJFIF                 @" H!1A"Qaq2B#Rbr $3CDS4/!1A"Qa2qBR ? KvL%) #B6[+jXJID&nH II56` FߑQ4, TP)5~2gGMA6L@Ux.' (X=cH"%Ev)61pPQ*g"\deV]l4iv0LbEyeHlB Eu$RR4y#4J"Zb[g+\!EPZ. LVDܵ*di [yfxBPD%n$iMj˼)$NJ/vNTRGNId*1>J*Um:D-R0 i9R&b?館V6mn*yXNp/yjEJDҏAXj))3j*4dzFm dp,lCh)b9JE@cBU)t$(yu\/GWowț2D:$+! ؋K+"2H"MbJ@Icn+\)p2@1za D)BBf YGP̟(l=bRU ,ArjZ?(;<\DMey:tS$iYcM}J fjȽy!!I *q&*x>`ݠ]^8>t(5HP Y׸|B<_Wćz|_X4Z4ω(,ğ~0jRNMy4q"0ȡ٘5+͔UDfUVz 63.pR}PV`2*Fq_^Q n4u jXKp,"O5ӇR|WV<򝅸ryqZ<,Ly@IzP*6twH/2T;@wSx O!`6r)`M|FV|) :ϞQ.J`GG[,38*~_)zs$dI Ryy$xTxDAJ["E*Q]H-U%G )Y>]ZO-Lqb6$r-J3ĥ URiT'y)̥oe+hҦHIK%AJzoB$f5= :0pbH͗ѳi!`G*@ YH?gY“pE}ˣOY6$#6I@]zEM,ȞNDKMr)XQF[X-j>jgLn1b)' _8SFvHe);-p :P O +:̩by&-$R.!T P J?w%!UI R ?Wr#}v%"X|fZp(2)S9 `k O qD?\4tAeddP'F0{%MORKr'V^]f 2RfppMbʼ&6BnJl鳮rB,KB1ʗ4wA!h:IKUm(5t^g\vUj(9#uS Xe.P(^جG+텛)\J`I+Q%H4-g;Hڒ&܁IN$R$ fr q~@cJPt$rWҰtٷQ^Np`&:\o }B$0F`^ ܖ 1F& ъ)jj cQZ’5 )#*5ˤ~{ݪ, 1 )=SҬ\a%XISSH^Wq)w A\ *$g5[xju7DM p棠e8` %gj:4SG {rhrՠ*.KPQP6 $O:$eduᒖZ~P^%XOU\e0Y!DG|DzHu~uR['R9 C@ ܓ1ɜ)¸5_xsY5CReZDAcm.Zlj^"\r,%\c-㗷6}\gc{:b[ r_D-XR#J#%0`-jB}RJrD?/V&SObeeէes2jiW9<#by8dMTTrJF2@})>C:0[+tKC1E@Щ[1LiũBqS:R$H]rrZ%GJ'&yqxڭ2ׄ ei‰i%R@$̘h f7۞̷J3@KLs%Mj\RRAi^jvċ$$e(%S2i ߖTLwRW*cV-E&_ySH8@%CwgJ[pR^(8-\ԆQ^B,å%9aC 1`: 5DaY *@ J'RDڀ5sv7aJ,8A쓔E$w G6\RmA,g Xf+d%dKNK᧓GΩYd}a%AsƁ.ـC>Q)%bTFmfJ.tvrF`DȕكY.BEwq9Q'iȎeйׁ3wbK )svf#@eS6;f3 xg|S_=bb1*Df pjB1ƃa 컱 H;HX墴D^[BTVJ()%E8P BpR -LJV-;gЋC/$( "XfN41Qr"ȱKRJt)8B +KzDZ'jP@fC K{Q0=K+M +%)AJ @ p !ߓEZ&KP %K$Mxe`i/Y2cK[@A"g|$t5X%#$y 8~p[ YȷX!NaAf#8 8dƉ2,(#4Jw4\~!y-Sl`}9Aǩl}bQIӂ|TɆo.p6p$d@;*2Z|ANi%u/;drP1K-3%%) w%]O_R_ t?}oֆ)>CnΦxg;}}ži%_1'v:Y .bJÄ,WW=cM!Aʅ2` Rj2:*#]2bx/JDN+8O5::hHr6}rɀ%5X":e\ˀ`sGA]#"y&ˋMj-af?x)ܸ<}{;ONLbHe!F3LbjoYFɤ>FE ily. nNmFNI̟(Yfi\&JChp `ϐLG#Q!!/%U45?h9G0Y5>ۯ#ڦS'g1*zX1b5?:y} ݻ>ߋ,L8?eGV(d%ط_3N:56G>ǣ[8?gb6%ķEK ?GǠ]YLRYAmjԎǨ6}?ڷq~M4DrbGR'XfZl鄡dȖy! N~LVI=MJQjԟש=sL8\+TMT(ԓa!5>Q"r/yc)$)B|JID+2'!RK-0NPBp1au9ALSM5L$*Bës5>%kbbEEM ȜEV 'F6{1*b93Swȸ.#\K(>Lq5ڮ5TYJ^bIvqMRajW0oMR[էtUdMBK8dWz)RTѴE/ɻd*bN$+'r$(}ڀ,(c,,1X>};a+^} ˦Z+[&}|20>$8%KY3g} - ԰`)Vo*IiwRƤ(HU$N$d\T oKcb0hYaӂzZ,VbͿNh}ZBJmvk=~9T]2#a1ZItהU=u>RR $ΐiL9"͗xK-PO!.Ґ|]#e*>|6 Ly  8zM *wԎ@i_v^+al_,ģ1*i? #lxN=hmCW#zxh;AͨjzvpfeD~5m"\I%isLҒhV &1YNUye=L9~(3~M#UdU~"=l# 5j'u Nz@kHsRř:X#ܒ5Q3rS9j%FENß>bhY3&tQEOτE؜#jŪI L)L3=54M4˜]8R ZNjH|b9_ZiVuƜGN\bQ=S?!'RTexawhh 9z86Is4":ڪffѦbhbA=lH_GtklyOv -@HPů״.`N `C F+݀mYj-co)V8vG%I;U;=:la3w IKHReDM(+V`HRĚT4l;imTJP Ov*Tg`RÒpWCS$wy. I>07!ayqzė%ʲ$Ռ*\7TzyPRȳ |dm'fCj"Hdx d򍖹HЇR5˘|5"f. >\a"ȁZCp|U@[%Udg%Qr>95UIegCO rD gW槡*:QfJu"-o8 :GԥN-'Y</Fާ},^15y6cIt-I$Ӥ$(EZ.S^ !ϱ(j R[>/&^!Ug ̟gŕZ[ (3@gabBENQIW6\TlV@YP8S5=y@psxH;`P"JLF)΢tkt=;E,Y""ļd,,hyD`#-*)x64=81h@~R Jеo)2.xGR}|x5̚ (T7Xv% b#}Ȅ2),l\YTle?{Z^._pT.#xJj T0taĘ(* ^*txҫ^wCLz ' n*KS:H18SFV283Ğ,5"Y\blaO@Z5ᯙfZG 4WH6I&Δ=B*%zuS/^@v[B5aٽ~1)(p l*!U`4ĥ#tb Pp+\TS=)Xxs嗬[5j iWewCY $$@~yeH;&6jwSBp9Wؕԡҡ=+S:Y/ %){'dK˧ӔS[W(}*VM-ځ0PI0-yL`kr;%Υ)@-jSţuZD2UT{ݒ!XXlD',NP#V5fSV`Yf# A8`vUF=٭\ULOO߄Hv%ϼ2'XS` K0m#qgstK$Hj~JhFRGhm#>FSR$w, -F[ y ˁLrɵsR"؛J]-BIYh;K 635C枑tb i|M4e#T.At&mJ [9}%rwQ?xcm8CƄnOy31e?+˔eyZGZWj95Ā(78јҥ0zδΧqtAN> G`@|IvLg$^6|nT4ISDτ+@K NT5afQ$MzYa8 n)Կ8 jRfSҺ|Þf+K5gnПJ& #mYO1'9*(aYm˗ְJEnXPJAS*|e]`X"4LcR7*nD Ā_#k OX`C~!1@#wf nI  4E@FۜJev u@ #˞t@gX@65 T-2]AkjBx f2 "ǧط?#V!4vDvH-5*![> zFR6Ecg M @csAI} 布FƱDNDStZVpL?a0ĥ9 &ZĤw,S<BhCR73hRRb Aj_XSS8|AOHgA#WibġQTm7IȚ(Aī :ya4{-7W%Lz;]mvO, 51"Y:TrE$ag%a!MNeDUcRRMA''Zל~xbz\C5Ű*Z,RD8IG2фB)VYLeS5 }R:qljs{OclCaPPÝ3SE=Ї8Ovk= *a}sI'-yD; 1jf~h%Y')4oc{ !+ZTp-RxϬbTj7Vs"_cQ|ױ%Q=aeYQ\VrNea`otH7,:@sXTt{R#>Xt ycJ7=WLq,^B,l]Pemu 6ϬL)H^ZC ~DejOK,=,ڎQ)x#lm!JB4=Lg0 .ۼ#EV'0]zvzLhHثS&viBzqhgB2jB^ FyLƟP<'F~h7Ȥe}QepL((כ7K6֕C_vP($p1)e2JJRqaS$%LG4o6WoݥRb@rP(#B>4:/ T!`' )$@>Yv9![IP@$SS{0j@ iI198=D$>** Y*Į. GEV{-*o,$g$ x\WwʞP-<6HiU ]vBR͝-+ 9>M# 8ԁFꞔ| ǦXߣa)ֆ0ڞԤI4vgZghRI[9(*c$d|5! %DV{5E!KRAFk}Z&-I9SxH?H7_lɞ٤JUsPR0%:wRƹ.'YL$LJ* "TsfeaJtEiW׏8m~Kҹb{@WvO8؅hwٿeJn0(K'4l}ȹDv!%)!, $Z*-f^<4jpvcM*&1TuD2ϻR@dob2XQƋmsfsaLj+O2W/)ݮЫ2X\+XNSݐuҍ+8l.!jX+bc N-ޯ z=+RY.(K@\SeZR5Ƶ !VZ~m>Ms6R'حH)&[B2j'ķ%c;^7I _9MGqe?+e+ -M3+*`4M&*JT#tb.Rw*Ar) I$L2Y3!Ԋp/l8MNM5"IHi чO@oHl8Ha_*rv>krF%9]UT(?JJ%5jE[t*rXBcIYJKR7[>({U/:8 }r9)F/lrPY<ɆKS/F֪a% |Cl҄jpI;prhyMB9o-KyO_ bt4ݨdX,%uǔ9%FWOLR1y}*򀷥BRN|!+M@P9>]ASPǜ/ڶYYI* 1UB'4xz@)zD0ށ6T ܙQ\Q#j`v$M݊6(:X JrhCg"3ᐴ.bd1&*TRga™E rT(fUF&˒RI*&08W26dąn Z\8b"Ͼ>bmnt*r&[JBhD7Y@'/]zaԨ׎ H841m|qasȨ 2-0sڅ#*iAI"&$q:q~vs% (֙3z>vw~xHbEZT]I9cC8ic'75r]A$$]:gI`$$I"`MXha` o+2fwJ&n%( T褧51֛-2U X%!ɏP&EfPG@Yn5IJKe$'B4җh*QLً+1cݮŤ%rhvJoG' THb yR~ \iI._*ޣ?XC>ЉRRxz4~ JҀG%@vhIU/O:it/mhCrFn CH;xmL<,aI +N &p]2ʐm7&X# HQX;;P#ع*B9 Ꮙ#'P7q 3\D5<1ʅ"<,rZ$|2uU ?(5,ݹ(QWV%MK&'k2ՂSFΰ t[%;2*Hb KFD xgPDA#~j)\fOFUEz܌TLip32krFN%ne _sB$7fh91R C#Nz'ox=Ixc26a*m3cɈ=)FuBĦd[]+Y7KB#dnʔi J@~rBRٮ鞐 XOXi"*jD{$kA]cb!o.*"bp*,X8RHTB&hzܬޑe4EJtVk."K\O xTkj<|\'Sg`h?2C&b.~zFfD39UDg }X*jmhW.YWE(!JT7=3J-3R e SkmJQ8Q.xxJx; \38 YohϘd S 6୎2ڰZ7%텾Pܝb_]9)wlQCioɵ&_S|t 46(Ӡ ~dtL%ka92M2\VD!9l[;$%$a/a`2oީLe8,x@H`Ի,'̤ɉ*ef;>[#<2`jlĹʂi kYI f)Yd-1 !u%ZF&/9U=RN, Tu;1Lb[frZ *4&vIYS5h_3ٌŵC& Iavt(\J~1e0K BER@KHBhI?fU.JbWNѭv!1r E2UFWv3d>n_Z})>\ Q7{K'ꖅL0ŷw5%SXY3#i7zkq4:5MJ\@Fm ej"q- $`nO>Rx͖?dR<g#I?:*r0mWH:}j(¦." ALj7-=!9v3>cBɴ.+6sML2DdKBa%JUj ʚjgBIYȂ+ &Dd$\ז8N ]Algҁ (' P@LrxsGkѵ7XY$sbDB鄐"\$ωə :UW-(*Z +SFi5l5Uj%kkT@R]JBAf/tGc6YAnfT̒#CᖔAZwQH+X)HVh$k k,[hf% ߳QĦZ(QF ५逩WS6ʙD\|[79ysY ٨BH^?͠ ᚆ\I$! ;Ui\\i)6+blRgU:d[rcv?,%dO4F{~DuGVdZQT4q`=m6ufMvi^knrT_y^#D;\0¡VӛKlEgH\rII @xt >P|LD)S, +y3% 9$=2LRWvL0LKfl)6PfօR8V$ `ZBE.Y8,:N;1JUR-D8,, qsH yҁPE.T > @39:%r/})&LMq;Hd yd>Mt3fTF5I\ r˨sI_go -r~M'2" sm`,shH%K* +*ֲIA ZٞӢkfHD N:hc_ip%3 pȖ(ĩacԔRz{Ӯ(J@ #ρq~2muV0.XBɋ*XZU$Bʈz%̇ZoJ_*ḕm0BU3% 1cU@ppxp_ ZpBTv`%u+>%&/5 Q8A5!je@N6)Bfq,I TԡT5SD۱e WL'to =)zhtAkIBTX!m+$'/˞Yf\#OC:Rr3)`c# }y-wD!IQ/d%R2z+T3J R]{Ӈ8ל!uɗ u U~d*8Ju7xHPrĤ~ IXFi oo,8\Ɇ,%b` (B(!dY TAv-p_ LQ٦ Ym$gj^R0`: ) bKԾYP*'Ix㹫DÎkīFwjIZƒIAe5H(-Lb)XBMZEqdjWw_bdx8gmB%ː͛,aLK 2̙'aOt3e-@ I!*$(wlqW w "ً2t Z) MS1 R64 zx8r^[&-JiJ+ݡᚥMdn)Yp&U)!+ϽUgfRe Z)TZgKwbfm3R:P55&sU3XeTR,) %gPv\;3F9㺷_eDj &335nb-K>5f  "ڭ2RU]i%8Q9-\^9dž6\ .7uSruBao$^KjBB$s`$45z&FQl= Wbq\aBdFGX_LF\6a<4i~oKD#ʸЃA)HA :gKmb\xNgIkm`k ]m}eUF?KQ}8 Yڢ蘦 + 5y 0'kS֨5sXbEmnNe{hmV?ѷ%/Eb鋪l0ocWaz}`" Z6ǵUM iE% ֝MMKz7S?͟o[W}bu 2cs=_ov-_Ϳ=eD5d7Boو /ǺAfセ%+BVϟn11-P-G!@50 vzcAnJ% 3u晘YRK*DZ=kSerO^YSڱ@M;k3vjC..( k4r3ߩ>zkExU^vzuUg\N#Gx쮟7Sl:,t _9/iE^c}n/ii= uԄ gJv!P~WOĭdVꍮ?OfV׻K,`0Z_v=z.k ]~ c[gk:MYUߕ, `{ysd,2bzjP7ms&KzxC'^ ZZ"Hcl{mlGݟ`D$ljڷ>fۚo:CGݕ[^VQGî3d# e@Zķ.n$o̭ru6/4٨ЭElof%7Lsd9wPOVPv;]̉էZh67MC~vKDX{l;kMnk8cLѕ%:rJSO*}4=ֵDcg}bm $"/dnv,cZ< ԭu :?sSmV@EtT滳i`?Z{\sǾ\9oYP22C2C1]tZ-ؘJ|PY_W1/[fpǪ͟IwyB-̒"hM'9\tø3GH= :tF=Ki.$+1iϐXV'2=n,۴UN>&pw,uηzK'96Z[Hc?Ki4-A%mO!omۗ!UeؙoF%ͶW){bxm1rgهa ؙ&=6?_46,İgߔ '{ `jɪZ5q>j#lBuiaB9ܭ{s궁eo9E ) -Bkm]ހa.nmvg.e.k7x6bf._U#lKY$ݫ]>>+1qƓ$ߜѯ"*ԍ]e=;%¦G6޸}@û+vӎ]MR~Vq$2l.~o9kUs9\IK~zvz>bC4;ic+쯻A\VJIGSݭjwNΧ\vYMDcyپ]k59ѫs˫m<󗕤ӆmx=1f}bS0ˁu Em>\}'/$IIn|UwRs:)(:\mwmwXvYֳa ;a-? B^xU9>{IV3rzPŷ߳y 9'{כm|Δwk]KY?7%$0 Photoshop 3.08BIM8BIM%F &Vڰw8BIM}}8BIM&?8BIM 8BIM8BIM 8BIM 8BIM' 8BIMH/fflff/ff2Z5-8BIMp8BIM@@8BIM8BIMIw 6701956f4wwnullboundsObjcRct1Top longLeftlongBtomlongRghtlongwslicesVlLsObjcslicesliceIDlonggroupIDlongoriginenum ESliceOrigin autoGeneratedTypeenum ESliceTypeImg boundsObjcRct1Top longLeftlongBtomlongRghtlongwurlTEXTnullTEXTMsgeTEXTaltTagTEXTcellTextIsHTMLboolcellTextTEXT horzAlignenumESliceHorzAligndefault vertAlignenumESliceVertAligndefault bgColorTypeenumESliceBGColorTypeNone topOutsetlong leftOutsetlong bottomOutsetlong rightOutsetlong8BIM8BIM X JFIFHH Adobe_CMAdobed            X"?   3!1AQa"q2B#$Rb34rC%Scs5&DTdE£t6UeuF'Vfv7GWgw5!1AQaq"2B#R3$brCScs4%&5DTdEU6teuFVfv'7GWgw ?0FL5FbﯿX2lֺL`䵺z8zmNz?5ɣs!]AYV\xNgIkm`k ]m}eUF?KQ}8 Yڢ蘦 + 5y 0'kS֨5sXbEmnNe{hmV?ѷ%/Eb鋪l0ocWaz}`" Z6ǵUM iE% ֝MMKz7S?͟o[W}bu 2cs=_ov-_Ϳ=eD5d7Boو /ǺAfセ%+BVϟn11-P-G!@50 vzcAnJ% 3u晘YRK*DZ=kSerO^YSڱ@M;k3vjC..( k4r3ߩ>zkExU^vzuUg\N#Gx쮟7Sl:,t _9/iE^c}n/ii= uԄ gJv!P~WOĭdVꍮ?OfV׻K,`0Z_v=z.k ]~ c[gk:MYUߕ, `{ysd,2bzjP7ms&KzxC'^ ZZ"Hcl{mlGݟ`D$ljڷ>fۚo:CGݕ[^VQGî3d# e@Zķ.n$o̭ru6/4٨ЭElof%7Lsd9wPOVPv;]̉էZh67MC~vKDX{l;kMnk8cLѕ%:rJSO*}4=ֵDcg}bm $"/dnv,cZ< ԭu :?sSmV@EtT滳i`?Z{\sǾ\9oYP22C2C1]tZ-ؘJ|PY_W1/[fpǪ͟IwyB-̒"hM'9\tø3GH= :tF=Ki.$+1iϐXV'2=n,۴UN>&pw,uηzK'96Z[Hc?Ki4-A%mO!omۗ!UeؙoF%ͶW){bxm1rgهa ؙ&=6?_46,İgߔ '{ `jɪZ5q>j#lBuiaB9ܭ{s궁eo9E ) -Bkm]ހa.nmvg.e.k7x6bf._U#lKY$ݫ]>>+1qƓ$ߜѯ"*ԍ]e=;%¦G6޸}@û+vӎ]MR~Vq$2l.~o9kUs9\IK~zvz>bC4;ic+쯻A\VJIGSݭjwNΧ\vYMDcyپ]k59ѫs˫m<󗕤ӆmx=1f}bS0ˁu Em>\}'/$IIn|UwRs:)(:\mwmwXvYֳa ;a-? B^xU9>{IV3rzPŷ߳y 9'{כm|Δwk]KY?7%$0 8BIM!UAdobe PhotoshopAdobe Photoshop 7.08BIMHhttp://ns.adobe.com/xap/1.0/ adobe:docid:photoshop:9d177d7d-4c15-11da-9328-d5446feb6bda XICC_PROFILE HLinomntrRGB XYZ  1acspMSFTIEC sRGB-HP cprtP3desclwtptbkptrXYZgXYZ,bXYZ@dmndTpdmddvuedLview$lumimeas $tech0 rTRC< gTRC< bTRC< textCopyright (c) 1998 Hewlett-Packard CompanydescsRGB IEC61966-2.1sRGB IEC61966-2.1XYZ QXYZ XYZ o8XYZ bXYZ $descIEC http://www.iec.chIEC http://www.iec.chdesc.IEC 61966-2.1 Default RGB colour space - sRGB.IEC 61966-2.1 Default RGB colour space - sRGBdesc,Reference Viewing Condition in IEC61966-2.1,Reference Viewing Condition in IEC61966-2.1view_. \XYZ L VPWmeassig CRT curv #(-27;@EJOTY^chmrw| %+28>ELRY`gnu| &/8AKT]gqz !-8COZfr~ -;HUcq~ +:IXgw'7HYj{+=Oat 2FZn  % : O d y  ' = T j " 9 Q i  * C \ u & @ Z t .Id %A^z &Ca~1Om&Ed#Cc'Ij4Vx&IlAe@e Ek*Qw;c*R{Gp@j>i  A l !!H!u!!!"'"U"""# #8#f###$$M$|$$% %8%h%%%&'&W&&&''I'z''( (?(q(())8)k))**5*h**++6+i++,,9,n,,- -A-v--..L.../$/Z///050l0011J1112*2c223 3F3334+4e4455M555676r667$7`7788P8899B999:6:t::;-;k;;<' >`>>?!?a??@#@d@@A)AjAAB0BrBBC:C}CDDGDDEEUEEF"FgFFG5G{GHHKHHIIcIIJ7J}JK KSKKL*LrLMMJMMN%NnNOOIOOP'PqPQQPQQR1R|RSS_SSTBTTU(UuUVV\VVWDWWX/X}XYYiYZZVZZ[E[[\5\\]']x]^^l^__a_``W``aOaabIbbcCccd@dde=eef=ffg=ggh?hhiCiijHjjkOkklWlmm`mnnknooxop+ppq:qqrKrss]sttptu(uuv>vvwVwxxnxy*yyzFz{{c{|!||}A}~~b~#G k͂0WGrׇ;iΉ3dʋ0cʍ1fΏ6n֑?zM _ɖ4 uL$h՛BdҞ@iءG&vVǥ8nRĩ7u\ЭD-u`ֲK³8%yhYѹJº;.! zpg_XQKFAǿ=ȼ:ɹ8ʷ6˶5̵5͵6ζ7ϸ9к<Ѿ?DINU\dlvۀ܊ݖޢ)߯6DScs 2F[p(@Xr4Pm8Ww)KmAdobed@w/     u!"1A2# QBa$3Rqb%C&4r 5'S6DTsEF7Gc(UVWdte)8fu*9:HIJXYZghijvwxyzm!1"AQ2aqB#Rb3 $Cr4%ScD&5T6Ed' sFtUeuV7)(GWf8vgwHXhx9IYiy*:JZjz ?XGIe'?M=uUzBLק7~.~ptS?ցIz57' p~٭3=TJM:O~yӛz5?ǭB?c^/a?gV`h{oR aaO}R=6GN *oA{$͸ZNԠ4]dq{{zyniQ:FkS \>ڏm?^'OziYG噂/g}*-rIO)I?W:ҧ~_'sz-ѹ:;.㤢ۻ;뺨#%shWΡEE)3*zeıUP>̟^dk&-?~ε;?rUyc%Ij+PLM,$!k?_fk 5T>U/T* wyztjɜܐI[[ԢT _FoQdK` d\G յUH'z?`K]7%m3PUGUKjU:mLSEY9*HC9ٻ[M2'kp>-J(FM yL:+hwE+4LReO㤭zHj:Ċ9d3W!Tr7iDLHZd+wStkX^ksBքAVZuyƞr?+^㽿ubo?SBxFkUE'ߍZuW;SX-[=ֺj_˫| qOcSV<ͬ}`T#PO}mӃ qմ ?N-O\r?On(iOONX F sqak~->mL >[{?Jžcu[}5nYhgH|W b;EpA#xgY=n8=C ‚ NGZƝ; nAcONU:s/co餏?k?[P @UF:q9%>y{bQǏ^FOŹ$~.EͽZԒ+ղAlpO~CE ?uzޥ[(37-76ԑ][Ob= 2)椏4._v]ќxF9EkJPսonPn~ؽ[w~/#f斚z4yT本J#fdT8'W_/Zuh])L̩ޞij%JZyY &) Պ Oaᫎ Ӆ>γn9[I?rX^{ Đ:g_Ox%H=YI\yu?Sb8QFSЍm6qj4+^JW}D r ~WqouZՕWW^}Ex6+{&>jG#,cϨMOቹW_߿ִ5п8؀.Eyj=Iˡ j)?QocoϺֆjzߒZzVoScG\_O_P6$~.?}ꠚ=hT֢:1?P;:iիD^}IJ{齈^~nG>€:TO-)#n q^Hx> 8RFϫN+~ sk~G<jj?N"ME:%)zfgvoueDSew!EU?`nTW-ETh'AHH&nH Aऀ;<hֆO )Uu(էP?ĺJ7]š9 錒\=1y`7ov4GT SXG^SR2gZQc_QٹK8>|?}Dzp}:y6؎n=yz IG_OzM]4{N.?<-}ѩy"58t<|\'u &#fPBM_$-WGz-}Q}5< ɉD4A4F O5M:i0\-ŭn.M@k^?>P1Ӥ0M`8RI7`S"ӴQO{Wl=:E 'I|I8yqY|[]#&}I4? R?8~rMsJqQuj4^6B '``h7Fyf񸬦RlN2W49,R2DFW}=,Jk>~]T ӭQzgz|u=tnlvfo fjg p9-4/1H(W|]c;Q\ H9=J\f9#'=[G[/.m͕QI tD#PG80DDO,q!6gb%л>t8'F2tw۽JlSKJiCҾG(~~5>](Ԕ"$D_]mY~Fh=DU[A8#T<ɠ>'N PgQ.lTXpO>PQ~ޣ<`%lnHcQoǽOS SֽDx6\rԏisǭRu HGPH&}?ߙV׻EE -asn4">\WPS=8uN*oa$ ?ЗI5B87Es#{_.Lms9qb^u2:kf~@Z?ށi_[V5OS"~{+^9UOM)`x+NO-n-nOǎ= S2:{ہ,-?xi9'ϯ2SMeAU>Y^{sKEh1Ǫ֐g12[\Kmݽhiw-T L4*塦.y‹QYdDҧI|%?C* G$C0kHiH6xI֟fg f"`I$ QO2?v8J(rGiuJ@ó]Fr8~O sAA9 W+,2ĥÏf]^WGĀ˂24!;-UWJdj jܚ*LVֿ~OBx:-wp28?h*>q*DONTJ o2W!jYj/'VhWOíwbᅤl7ܴm+3̲;jJlMTTDYm"߬"+pĀAH= H-ggkJ~bysUzGכ:j$='4*ETpBQ 6 ~ljxӭ':,ʠ/<?N=ҵ QO`ּTBjpAyIO~$_hN?>20Ề\GنE="ig߼#o%y*?'}TDU^܏>PA6#UP `^Cçx8bo}-pmTd秨b<`?\l\i(-mW"<K[ W_u45%Qװ6ۻ ln 2T]p-ɸG&? #Q4:F.vў5 ˪l;9~qvn-wzkPfep[NiaD *mrOak(gqqc$uCq4jFpiv}QPGG a(U0Q`1n-pnR F2F ((+Aub lQDZ݄r ׻0$5[$0|RǧBQErx]j!tjCR{Kj^U$&TŎ<:ӺnĉqyF X@<ƕ OˏCX]}56ٹb<6jUz*r8)A)" 6c,5E)1D^HI:O8|`MټNjVnöUd6O s$Uad4bH^wy1%kpiW4?>kDq%٥@$WlMS'R3`+@tң}u$do>~ۍCPo^j$q?Q2#p/rAo>SFzc齅blA7YH$Pyupz-sqpnO{SL)ՕW&+ma"8>ض:kh9E' "q.@.l-~}]iJ,_lp)mC` *Ga[}'Ӫ1aCI3P=MxS6q˯/νݚ폖!A$U2U;2-͐ЉXk㣦KQe b vї`kz\3*5x:+`64)_CG=H#Q>cC7tSW>gf'H:tcdUK Wq嫝`*ON,fHxc6Q[I vA<˫[4.J2iJ .Ws8cج*mǹve>J!5F{##OSF ,=X}#JyK*h 0G:wuoUmQvEt%4汳?Сq*3FBIEmuAe'0mb{cC\槅ssw~tm}F%`!= ȲKS@%rO4l09@ ڸ6he|| 7~mgW0j5?tL+7֭]jA(}5\)icH^V'ͧv̔Ht? p?>G-؝Q1zO^SB)LCg ;?cp@ ?َS ?:G}I>D?0/ѓ}?jpN:B\{OȽױ+x@"ߍ?7?T O6GOPkqsG7^9Z !lGίtZ9F. .~[zi7o<U?^E ]N69?ER}ZJW^ +@T# 蟉Տ!F`28M{cf&!y%WƸArS۱$T5 ??W>ۻ!}$sY Kj$/YEXjmI&~Matkm^gˡUw E+Tϓlv>,~xkj&yUbrJ,@{]$SwytmD!Z澼851qIPK fKOd-6xfsO/\. 22z=,0#4UIfA4 C,KO/Er%Ph_P||MnM䶼4r;k1Cv?J6"J̲ŒZSKk{η6\შ5G@QI#eCytb/AoXƥ^K|Q16,-o63S@ }:n&݇{kI"ƛ{{(POB?>GNEÂ8ͭ߫$ϯJ-+:8E [UN:`F?gS1v $^6~=؃S֊\Q$Maao~Opz",y?7(A4`"x{1$@<ט=:P1.}{/#]m%:y+kX1Xt#pBF;EgL 'zvp-lai._^&3ZS=|껗ݯ[b[C5 :MO'+O4UbFBjtHSYA4`F-@>U ;]S\B7#PtӢ)YAiiƼ~P=z3^=:ok4R [|?"+^?Hްb14xYj)&%ZDZRJ7{g""0f:)0:|5nIwUll1*n0>iF}İ$%W:Ov[G> Y#1YpJSx"ɮ䍧bR{KuZ}_Ean7 VZcca 2]LhHBdF Շ*A!{enN;ScڛU;6i)!N'q\]A'5Ӵy7V`@nv67ZXQh|ɡSAIzx#1=nZ ؋[ sk>uW׈"F"~q'4|uy-rx ؏t,kիcC\\O?[4%r<]D^O?O~xC X7P$n_v,|ֈ C= X3owgXO F)6/>F##'}/:;dzꗍuRU@HHM׏zS4Q`(ZI7e6~OotrbSS(8<϶+UJcVR )Jׅ:tV?MoP yubJZtBݟhaI>Ptwz_"̹A)K_ a0'v:BWϏCSmL폡tᦒ*HS7(rG{n#}w*^h6XR{G ׇ:6IEt$2 Z )o @,g䤋ǧ.˦OMnÒX9'yrJ"fiPr qC--juv֣:lv!jLOfоޟFYi)dI؈:u|hQʉ:ŽrK[ܼ(8spfu(}xu\6:UI_zW*S$FWXsˍ #gFUȧ@-W̔ 8iGab=6ObP(+`dsP~r*>I8uH\1 pY([$UzI'/6?O߁`OWPOp $ި5app3Gr&#x [ZGxӭjv(l~KI`A+CЕsFNQS }_>Bb-kq?gνl^]vbNӛsb=5T)֝W۔{tWKxt4-;u4V6U  OW7RRZ.!5]t F郲wEj7]tJUTE2,"UF'O {q%hzh4r~kyYOS?oEGF;Dm]2oﯗ>g[w7ͶtO1 9W}D?GfEkޢ8xt\!ߪb6mDZ%Jjax{?n쭥5nȡl5Vi1XR_%&BhƩ abAp$QArMK{4gVH6N?z&Նyuo? cڸb.G᲋R}mZLN;n%~\nx7RR_~=N߫%~ tF'$)c`@77<3 )quqBgX%O7{I˫SQ3.ȡ7}EISBp}^FGNF>{*TRX=W?O;C9qǶ- '[QJ~Φ7?Ks*bI:⃏@˭o8y)ym%dFzDܴJpFKRcSN{O/!u|}|{[fk{'r bn<쭥dajXjXx^\=Y}1Ҵ ԛ{klvJW\)LSGl. 4p .74wO #)M~Tn4Wƕ88I`XoJ8Gz93 {D }.XDַc~H>u#MrO:ϸ ?Z9uU_LCȔf@F1P,>b_\WSkH$T|J/Kx gN`wj;.QYLCQ9 &v>I\y /ϲ9WL 3gˣ[X ,2iAT]n\F~=+SRNmqHͭ G\.Էe^ꜚJts @(3ν0V|_5Pew[MWtTQGA:[Z)+b@{\,-/kq򬀂Ӱ?US{h;gq`F:5}G)7ͯ?%GGB?n$ue:䟡$oK{1SbMhA7Sɿ y@=xd.Gd7_6> "[? WN}6`$^ZL)߀ )^?ڵp&~E-=4O^$B|EVW^ڨiVvI#[zR#ƬZy Aٞ?V3і͸͵wVt)D~u5emg8zVSll#CYAĕPz9[V*KFCeb*hF0sڤr7o϶l%ʃ:rݼ3۫0>?uI)i'jRfFk{DB;Lңo cjT7u EŎ|n"hfe)Y>?1RWWO,u#\j&A f_Wf묯Y^!Z7D$Lz]/>b$jx,.Eɖ +^m;h ( >*TCUPl U=,Ta2T8iO-+&/bIjIbfEm5>Jkxe|)#FOErLfa JHaET"*) vGnkmm ȶ詤E uf{TY Ƀ} @bؘxfAeS-R̶,M#r@:LJoz7 cerShQ^p-NMӓ{4 Jׯxm{/ ~8<7YROC 0XL?MXt'dyyn}Ho$wߟ?.Oŭ)_4=C ߀x |:WTe )^[(ٖtpRf=nߍ-6JNW$_p)϶e绒t kӜ7?xј͑bdNj{uEjaHETP_ɠ;5A?.llߦ5Οm)ǝw"N{G=>>[NZ̬q@2t0Z+Fib oIeRNm~=Ʒ|O , QԳͨvGni%$M%T(y*O-TZƧGpFbԠWc4_oa&o}ѹ22L` :mw3ES.XҹwSBIʀi'<N4\_~}@síR:OMC{}UxUP;<{@$%8I7}%jO^!i_Q fX^?[q6W ׅ4Ā>=*zLIb(N1D, [4$izɩ(ہozPH:wV>DtQcmVߛo׏ׂ GRw"?߈V:sudX jk@8Te ERCߛq}׀9?.[Hi6>}~O{$-h:ڒ 鮰pk(Vz?ۊ*kZcuHWne]: mwV8;U` xx+0Y嫥dqyd WJUI}' @C}s~ɷmaAh1GE)sN6di<lu2!%<r~ާYC3 gF48Ɣ4g!SQRxiiy٬"dJ=O:?n_FkEs o)~y:SJePΤ]gJ7x O ͹ɹ2j?*]jv˴*p; IrA6)bhO SBy ny~[ǽ>?Rk[5o+o$RCΝxZPQa~<'P{mdQ׀+|"7z.,YmՙSyyäݓ" ^sxd%Y5+=$@R7-qr;DUiƧ$g}%>U5f@\}P+gퟐ]ogM]sI6Tg&!>JSbPoam!BÍ=xJ|[Dզ#!`Xo8 -2G㚚PzI4Td$I=1LqVSO/Z|]lP.s%ډ  Xo]n,7k!U%LȚ/*Ыm*d\ B\u&+WkI6WkLE;CߦDVJ?H>v]HPXVNoS=?z{Pz ^S֚):t ,CDY%C;8hMi"@ʷ( 0+Lq?O+.t;swQFc%LDhJ !q<9'[V. ;즳Ĥ)ՂhW&3TԲ!#J[m(:4w#կĕ>ODy;6 'eVnGmldXتeVTd6ѴIY,2,oDZduixEg;{a %ljz:ݽ=r?Ur5TȄ< gB{{{dq/=s`i.{/n.\IZH ? Ou6 /onP+Ou|DWR)RޟXA\5P4׋(7_8BҵBp8 [.-oOV94 >˨yi&ǂ~?t;GV-Sa! B@ ~H) z.@$l,9ҿ^AJׁ^oz8o|bܛm'<`+A?OxTkO?Z‡z[ l|Z7N읯rQmgA2>5C!\ݎZ ^:ARB,H=FNya`(ƦKV/CYs&.LRd-+G7<=gOntwo ElPgB,yUavM?Z,ZR3($e-|ćO`mfآL`g҃f#N&%+c[j|67d}~;P=}=浖[50՞_MiiqBғM^*;^+Pep) Zz"HĪ^H"IV3V \tQ[p'p:>V'nx!m.7 CG5 I"9bxЪ:dvGKEů,mn?PN M&u"MMՔq&Eok[R׷yu׺Bo>IϨ+skۀyֲIX"[݈MiJ8Nq6‹09A/"]+twA?lio-KM )>^L-R+L">{NHcn/z{KXZ[B~};B@Tu&ZӬ`[ŭE)֨"=L`'>ݪA.A N<:>xO)MGhU:בWν%}^Ms-V->rok IuM)瞴?~wwv~e|?av7auFj'4[`xٸz}UJ*;\ݹM/r`4&Y-dluS$y=)kl%c3|[Zu6yX%o'˘6lfxtp?1MۡL7z̓- ҇Iƽ--:Bx%kϩ~s$`Pn܄H(ıjzuJf *k`ڦo | z${I}2=gwGRZ>&mx"E],/$eYX|T [ٽ㷵^zL}o<;mHi˪}ژtvG4{x?ݑBѼT 4qUwvP[iLȒ08Q7fo tdqٔ_&ʭZ흜!0-AL?#i$a#X>r3-1^֞U8WM-6HlQБNN?|7I8垲$0moJ˫M:2Mtf,I'$iZP__h=GNϨ H#ݞJ^%WH+orX_͉6_Iၧ瞶ԌJNڞi$\>nmͽ/ϡ2jW˧HPZ@<e~}Զj}[VEOS8X{=Esu(+pGTPgu9: l/'ݰ$TuԄK?UE@[`(Xi}Ћӏ~H5Rqu`]{x`Uht䒿K^~{W0T >s/hjdW.erHKm|UMt2 ,Oښ&dJtsZO֋[+4L[c ~iUtqTZWq($0G=KvrmE2q"/B>}.YR@YhO9%tHϯO~oǴXkQp?}/ܒ9cJ q8GN <jzнU K 싩<Ⱥ@moe1M+SWc:.~C\GH#KwH6O$ZVGgkm`[ufUj zg8es$^<~?jI⺩z:YTv6$_Mb6_D)=&$HHGz` vOkJ/P]M^:A$cNVn>U*jЂOjߎY+ִ=;@OӟM׀>WJNVC{K?_ǽ(>{Ci^Emn>["Ӭ>>>ROJmU]U=:YJIޚK{mLu+ Y0dTb򰉍NƲ|sq)UPYAj~fr=ֿ<~hJ}~:JLAoi0LSPm hY]rܨ!RD< aBJ(\[Y1-: TS:g.]YdS|2?؋hYht?Nxu9"vaFAE*IvYnG|.}IH\Fkʝ}ӛfNζmηYՑx-`j4ǟoIehw(nY Fs&ݿۃ"?|1bZd]LsSN=X cAJ&X2cRUG$~~;OTgˇgE3 Dx?U;E#G]KA$'f" %٘Oc`U/R|Σ-oR 88Tl흶VmI; UjjZ(v;p릥Z7 ߸(T\(cYsIkf>^@iR*\(j q{O[bZ1XvBӯx&GrQ䤑W{9;$+'*<~Ί7QaRHV G?c%:q=v ]ή+7aoZ@Z@X6{^[[K_C hg jCz @:$͇ͭ1P8u`WoQmAK}~4?u4*sn-ž`/* BRN}86? [z8RHzj(t:k^*Oԓ}ؐTTzu GY}C#ǽ / /9e*Ke\ \q3_?3Cyv/^ |=MN%?1xnMQTRb[K`ZyO _ǯ*1_2"=>3'YM5TZ4E_sσXcd=5Z8hӰ(L m]#m-*Wn[R8otџFrϲ9oF)h?`ב.+]PSAw~|٪KvFÆ!67lQBhv(Qa!&KZ}tv3N+AO?nZAķu?n+] }Bʍ$ 9c`,9Ϻݴ3V\pC-s©(?e=?.:ZJ#O>GxVeᙋ#Uآ2kPo)c}ˤ>j2MW@|%m%^եXD7 +Q{4e8P6ݬd,7']}ȯzO+DHiZ]4GF@OϿ]d U$f`Z-pY#Ve\ +XM4.G$)LJ3-*nmd4К/Cr̅qRk域|ZNϣ{frm ܆ߓ;+L&K[<_"R"3" ذ6Y/d oч|?gMls_7U8q3}:j=ʫM4X̢RU_)ܜRM,kjn߬.J:;V`|3Ec* `HO#S+`Mj8 {rM׏S*zUG:?l}o'uuPn$SX=@aߏׯcQB)Pyouk$/rr~SoPjg֩nKv(Z-?fQyѿKW8?C7{Q(״+!PH}:J@{lxCUS_PA"?oOp9cŮl7_ލO1O\^$=:B!W_@ [āJ zq1ȱ~yߊ[:#jgPt\WTU^czN"<h&ٻN3~:,t+kSnzmŏX*.C %/)41Rx'B:3~~}|~/,;sF쭷&j<> dⷭ* ƨBWUֲݬ6a[i"|k{}HOK :'? rxg*IE[djXƬC]R"YBnmk[/tH܅uexFHd5V$?1"6UeSKWEb0~'yjJfFiBdSd+/~>YίWze@TTUL}S;HJ-EvsGOVQBO][uf*i(֖8Z1(+-[  -nm#w2deiQBpWf˟bCc19|MzYjei6}EmCG T.7vSp,-v$WhO+B]`2Q܌hk@?qgGQAAa% ڗI,I,M>֖Xх8<>y5|yCo{^ QQv BXY-s~ڤ [YX5r'"<B_>|Gg{O~~!u1 &Wy9[~N(L`)k}@,,A}E5׸ ^ (/+xۑ@xLϧ>}>ſ?=Ђ|׃Vϩ<~rGTsނ4L{vmL/K ha~y*8x\̓G.@zSW7IcV}˕x/$v="De#d)#~} Mܷ*<ߥ }ᅲ?,*Z=,Ej~'eAI(?G#H8؞.>Rȓ.I<PS|A^+@(1w^$=Q,Sddz׻=MTHYhd(= 㲉V UD()pO(kNy)UIUUmbhݗ^6-O ^$}"RkN n˲Y#k5+iurߐ7وRzHPWg\2 QGi"E%@IӞm*rXjˠC!ו8 d:}DU6ꣃRry:֑J?#uo}/ͼ;~ 4x̲ŸQ>SF@ǷowMtY]R58I*J_<:]j×Wr?ը?H=#qΟT\OF&*3x㣑Ġ~?>n8 gCC$Q)FG@&kO.Ջm]ߵ75;sۊ:CdvgB*c*j?F [_Z)$Oi8tx&$l< >O~MڼTJS+kIXO/{mC3ӪP].O<xZPA'ի]D`*mS{2}tX~j?EڊOfoSaoo57}zԺIku&$t ׸Gבp,oeuPAbT/t,E@ XXR]QL8~ޝ~9r,~K}=~"5ui@lJ?׿_c~~_u8}fgHQ(i%NU:ގ*#t\3IRGuC|{ JTOM7&6NQDzn:Lh'_.6xkOZʽU~0.| ?!v+!JU1@0TqK ſ W~t4` T(?2Eiֻ'-&91X\ hXt@FTXe25D@i#[hƬTkֽr_L31SxWޗ} ~릆IrX(7@ՈT,ַ^ \RzIf9#pdaOaIVjIKcz5f,SMJ@ Ys]m cҘhE5qHNBcQLhT7rxw5jզ <=N49:"t_s[ nBFZS}<ӇJSP~J|w!iuJJD&AWd9UԇF_j gF>m?rxc8swݻ{ @7F7򯊓qÐfУXT$R#eo6gu Ղ}k:tsmaVF$餁z͛v^A1D1uO%*:0V]\4`G܃խG%"yPׇ.h/m)J5}okqڐ^ H ljzuĆ\Zn _ot$Pu-SOQ[H+p6_ީP[UV:4@O1^\}&BiO&s˃q?B[=l.ߟ_5> #RWp zacsaq{a`,NTbx!bhkԸ}4uKIIKI Q5ELb( و I{F[5R;z?Wɭc3xNBlVĉ#1IV᳕*/*2[DdK}3dh=GM=#^Fv5UJ>gimjX85IitbTUaoA()XЊP[UDB` Xx?إWU )9|H?20hH&e0?[~=bd>baN,p7HjIfb TK FUlDI=?>]CISPHOש*)!P%G,p@ټ2TLJHA N=%49gR336k'HZcVMWJgrEO]*i X$`y=7"=ҙ!L5@1xJ H) r"iYucftpa{k Tyee%/瞞$:j$2¨Ul] zY?ک!aZRoT,>?z rXj*B,r2B}9I(x-{\{@U_'Jg}Fؠ!51Bmk0 @ex6q"W b! ?J|,qI!Āf^]M4 `Jx PyY u՘Tfug$.}(Gp<_ItZ=@%bNF+;ԫrm콗SR6ǂxc2K,jB\\`??oUk3 *è7>&=ϸvF~%+tjUbpFc_F=I4N{e9|{rc~4%OLG{ul.`CZ9:̺MϘu_:vᮙhg4Fbiʒk]VJ"H#Ɔ\/Bc7_իS|^IǞ~y?Q}i ˧1Ї m<<ӓG -΋o隙! ?V9i8۷f:Lۀb?IHc^HI տoOxW 6G#}TJWJ-źUgNk.3)bi,t"<m<0DZY@Ağzr%!rpO5ru6ՒHvHVFJY,XT<,2ȄS+s8`&;(4V>mR}A|tk@"z)ۿ{bSY$Ia2*x=챚@f3ԩrN÷=Zo`Xt+ILi )$7ٕ/bm?j#fzx1ҕ4<)Ɵl:A6EbjX@Lj$DT= gְIU+_z)DCᰋ$q#A.t3Za`Ӑ.9o2րzEG]G#>ytNO$}5?cSY:ŽGGH>Yj?3vJUzAh| m{pP+몾_ׇ dc?觭]7(,$5, ȵ̑(SӤ+nCEz--NQh!` $ƢT_=w,]=mVpQ[i?6BH Q:SP2 4Wq֝/W/_C)@.CAfo13"T֞/~]X^ꨓN(J}*)?`nPA.xg@G}yr6Kwxf낤iaz~?^}WtҰZc=FokrG xzBN3N r.~/v?3E:?NƸ}oHR5 }?[x??+FWǡ1JqNGsÏVU ;mͧjTj{zJXE4Rc%u i{=k5̠B50< #:)kaN9JxQBΌ)$a-!A>kJ%ŧJ|хZZzAN#Q$W*niu<_gEt>At>yæጅ!6@%C(XHaڠ9(@'yjd3bO4b=_ˢtyޛK2 J0N,g^%vDOA?Y@ Pcs:YM&T ZI#Yb \OND`[k]CR;eXe%T/%cBBN~_4xuR$<:i/,Fژ[\[=å+pD۷p?gI(Fh̺YFAAI٧4,0ƹ4>Θ] +}ePW@{Nm4AU>x'FV꽄*|˟Ҧ(uFW$ y{ۏӌ JEsW+jc" 2k30s #?R==%YcR5bWӝ]56E$Q II,u_ex|a'oJu'XooffFU${ЯXϦ'4xSttQ3; 7@ = z5BE`ˢ;esN[ǧЌbPTHX'}[`@IRk=]ۃt>_W>Q2G3dRSQZyg["wOX(y*y %hoCʗ}4LMKFxx>:ykM"A!8a>?mzy#?M\i qԃϥ)Kisw zjb>_"nބ_ Mcůנ}]qVi8^ @> i,jӬy+l᲻;YM19<}Kh'y b ' >̋**O^A#3*fK9/}.Y娡کi~ ?j$d芧+@5-cx|fe8GS&\)sr$Oz}14z t SU6 2-?w~ X :E oqom"Ja/kP|ǗIM?lt~F:T1I3Uc$XL+iE}b,LPPӻĚ("|{Dо3~Ηڥu8R@IE T2}~GdF%)c^:겅cgaо RllzSHmt+^p _. :Q;"BS+]'v&`i`?_=jHk)_Mm 4Ll<u6(7hЛ~{Wo"QK FO^K[ t2F&V$eXo$b=$^E>2 ?8AfPimN2BJ9#S/Gz},) @AL|UD%7i^mzZhLBH% i,vzDfP4ǤyYEh~_1OH$&I 8%t@lx#W U:V4J X]hG3TȦH$TZF!qOϤ3ˮ癪Hyh,J['ߓJ*먨a_|ezd.M=zIHF(ILJJo#`8H"?^r.4ZgH?W]v u4{i & z;ˢg%JTҮJX  K A4e-꠯~(؀⃈F8G亵4%j8aN?>I*iҦji*"kSKQKOcPA΄NxʮWA{ofIoP|fJ=}?#+M51܍Fo 6ˤ-ߋyOǺU!Qo rozFe=K(T U%w*nF%ާ>G4MV+q|n$J?tQ:JԢe3"8a_u6Zʐ²;T=jA&8:CcJ$rЀMc{bت`=FpM:H .*rRcO-O; 'I {)xq,j[^EKx`EOj+=2Q<:-E]lZ&2ZYO!5BA OdXEj15SJ T`/k ٥Hj V:/TŃI]u4]jꤝQ8 Hs b{?o]VV?鮻eK"C|jseԭc;Xfu_jbH*hFPO@)psr]T&pǗtUơ O.:Xj|e]@ԅOp,%i!(j;?>ТI 4V&Q(p &_Zm>iSz;jjpf$j$3o(Ķ6<OjcX kK<ǎg~|G'O}Tv</ca[؏= 2q" a44?Nzہ>cm ZEGMsY(}RWn0WVʙ7}WqZcmc\[A^Eu?V8l5+T *t^u}<_7P8'ӣH`D2ST7ʄJi@[8 V>5|1&fpNE>Y-q{7\{nW-ԉN=^M{{T"3tpiM)4>tgU;2:bK70}lol4+:ݼ#YOъJy"U:rBU9!~xD#vRiA§Gvx5?"|~˨ε C2:H>}OIhk\z_<8ES֤ΒoG,w2yE OG`E'ϧR#sSkI"Ҵ`J+Uui<I ˋo!Zv?.Jp?G:Y1Ts5,2:)(Tc\}=tGqn?Bn 8D ,ypږ4fV@nxل"M xc?H$cM.ܸG)hC<iJ٦0vUd@3opP8ecp>sc\${-] fE1V: `  *?*PQ̟SUkL9_Iup9zM1хi쨭8T9UȈNc7FǨOhCZ(J D~ B3T;D,`IԬ E|n?"XEY ᧗J'iX[Rl_V%8M-e<)χw'd OUL$u4BfKk,ʄ %13gë<2I ;փP8"8@y\2NΩTѼ+vk KƼ.vٕH (r WʠC^}Hj4-iffvfT*YщscoMM 48He2sE;1z>Ş&OK_3[ȇɿ5ݱƟ!?F$3M?_} {~. |8T-e.>a>~JKG 525ȿٿ{Jͤi:}ꡕhO:|eWu֔1ܙתom!QIUv#쀨Qԙ[6aZGVfx*cU0dFYJADcez Ҹ7Bx:j=:!GO#:^Zg矠{,M4`?EFH+8NDҼ-jCՔY~~M%,OK"us,JLn420>N`%Չi b~ҾbXʳ0pGxd_Hr׭@c2^/RaG˯<-*$dRWRg&/:Hխgbx]];Z/crT#T\pfeȿxQ)e6E)Zo #GRӹ⑥@dyi/Zī\XSQ{E~T?/?ˢʠ+/C5R< USSHT C{s-++2tj `kmw`a^(MS2Z&@w)?|N<.E2G42#*GFԤt2Ջ# =BE(<̺^POSX!|οۆ0t~8 }EÇ+П}TmxU]?X!Z\ >SpϤjM7>jcA\gat*s}!I$ZJ)멚ID4,Ӆ?#Z'}HbN$ȿ$d=txhW\ٴ7X&$C R?]ÒB A<:YYVǂ4O'80MWURȱQSehUSIYY*UhZ@ğz8fPOZ=*ahLBGCӵqXѼ14,FD0/.C=JW5f%+N"?/=QU:JYՃRB Hת3ůtp4/W ́^HxJ jpM33T.P}}-N@^]:F챳hcHgƦXcP,"F$h#Up/]@J8_@@ ˁ4;W3hM:F}LTă&Wl /‘S'8EDzi;|RLL}RmA^`REI>oS1 .ZBEVJ*X*Z^DAK28]_h53Zzʐ<6gM:^KU,"i)$3C]c,GP#HoeM^S49IEMˇΚ)5xBJR(m"pVff 0$ g]ME>GlVIYKiF[iɷ#}Ex|5@UAT^UAP^28&xJiHQͨز-Ok..J'p. }>}''1h`#_YdTIT0  oci7>Lzr*>Y;⚂~1,T8cEa(8.t {T!PU~0GgδE݅j\kSt1ULh &hb-f:lG=XJR ]&6Z?^}S礍v Y !vu5UIl hA^]3,!<#D<BLe*376qa2O?,.5MJTz䕺&|\{~IkvAaG:qDB[CE&Z/?۠*sBjIHWԺƃk5Lq>{8נHޠ7{/OK<\q϶ӐsS_P[_Dc$xj]e%fL Ey+WK-cYa#&@~T\gW2`*cTR 5 #hUPE}?ԝ IZMp D[:(n-Q?gq fXUu ISͯn,?B)DkAz@azRtOlUjxkjN>ߟJ;KN9Fp<%B ar~9:{rM?g>ޓ<3I$>hH_dHց eBM'laQ(Fj9ϩR9|/ ! nmP N3}NGYaM0tfHDFxƑ~ ׅ .Gϥ> FFCg̩v%8 jL1?/.$t}SHjaKN[Ȍz#P{r'(jğ!zEu`jפGvdyG%kF$;*rm$i ?>=P4WB@r{TkVNGwVa*`qԗiS/>)Xx;ؼḿ=BLq%DoGqejɑ@7ϴQ?ہx7pTAƐ>;_f 5u=CX$i,c@ȚX{S16c9>mH ^}PQEmWV9gv]73jc;t'Z58dp)ЊV1$ OOS-TS @Õ+ , o)&B̮1"*p|(LLdZNSEBkvf& :sҮˤ[qp1>1 R"O uy 9: ѲT_}Hj=jIꑍ'h2&)NBo:c%:E?OvƬ:O5>}.I']P6e\YoŽ/8ΕiW:kJL#I1yYj;JQ)"+#4*`HטX? Ҁ xצ;J(eT *]仏O蜩^*)7%IpWzXGJy'Z(-1YDpAF58td`?O8w BD^1d?^l-Ga@PY/Jő\=4eZy42H1fYmcGR[rMWO8S> Ǧ~_[!jG<+jX$ij4Ř V`yQ'Eg1H(\WxD,K"Į88=]nD2Pނ]Iݳ#Oj]|m1Ĉ”E_͋QG^Ҿ5K;s %tq*i#Jau@-U+ӹb t'8S2$@kJp> q\ _"=OEr&0*x Ek <) gHI+wF5~5czR"UO-f63TV=؏4/S]l%dM&N~/D}}9#z ^ ң==/ͿƞߞlOMӷQꖯH :"|r[dTݽtbJ=E\#˧UV>.6(U ZVR]}%K#(!C)+~A }uӚ~d|FƅbՃ)_DdrK;Y'\a59GI;L<]9TѠ* mLZ%coo O>:aVgX?_^fri|qVY%eH!E#n,> 6O0Bi,+%ecq$:A@ Gub5^衤ҳlWRC>JTd+YM$Yp<^xXxA2:0IU\Wˡx59 +!@1Br$9hE _/eʖ'Y,Ȟ䢏UtD؟fALț+ⶣZ|?gA{nY/3?$oe&Ǵ:埳$Z<25O=ݚ)ZIaiIo\f>o=*\Xϫ!FZ)jz 񚂖IgZB T TkeH/(<hפrSE>\zAmȋrT)jhjEN'$B਌SJjx# WI?IfddiZKҜK{FNW4R>g'E۶+`4$,!#HT(`ZB $W5$E-x՞)M5gOݭQ+s¶YSTMWN.G'O)Ҳ`+O1}$3!R~}s~Z9Li4B'>q/9'<R.}>ݿ;:7o뼾vUC_JYV =kTRM?2zUMuz䪵'Sc玈W]UT#PTTRކ"4w3- ֟өI}4p=xe)iT8#Ewi%2@ydbq. g>)Zppw 43璲54U-jک*3ռTCMOE([ 4~QW=3CKYJ'H#P j5>|~Ϋ7eW<W*&E\7?o7TdMMĨ5kkNI$aFOδVg URҌdy9![GP̭b9>ɝA(R*hJ4fzªSBQZpmj3$ |>8Ⴆ5FPFr?ٶyҟX%/7}OBIBˢ&6XTp!@eb$[&u T \zN+uj,i"ӫQ#,jŬoo3Ƶ/j)砧v5fUë2oAtrtq`V *=|իR_.'f&&d eBB4atzT+zaQc*"SĨ?̣y$V" (nJh 1.TI" +Ȏ ?`ĊC"#Q!<Ϸ8O[˪EYjW+Tjj1vيHE5OuhΪG"<8UI5 '2/Xjs-q["BsezF2TVi1(Da#T868*Z`҇CH#+!$WǨ[7Q嚷h~ڒJhBTԦQ)a2?pr&xىp<)U`e>t8>;˱I-D2EyQQ44̠ g`A Uř@ \>*'~އqc6`TM.:FuI` Iʕƫ_%DfS_ϡ5h`P"^'c褂9Y F)|hѾ>bB_|sx,?!>Gi㧎BEicN+W[@d8^uMbOq" >-`JarA߶M#?\[SAϐb~7ߘϧOƊC=6d@@4HF_>ؽ`5'TES:3nծ>4nʺ@?F-YipTOqVA>gB>_I\-xUt6qd"Q\L1t1u5^:jHc 54(uhWM^8T*"2o]Hi譢w1Y1Y5M  D%E =Q >*y[)`.̕YGikI XMDZ}>ܹ9 i};+!"N9j꩔5DiᑒKgJƁ!ig`PkpU:[ڿ(zHe}nu8`,ii C~޼Pt^7t⧊hђ;Շ B^@Yc c(}+*VOώxtMCp,b*3[9Y7)V} Y*&,J(_z)#j7j|SDula`-E ؕe3nWn[jy'-JUHiuL[H 3ߞmof+E|z)WErGn K5@y99< \ƒBq¸ꤹ1Xu#4Ă5/woP)upu]9 {w Z_si+y=w6EſW 8' +NRI~>@ rWcApԪdכx#H% B4e噁û/׺U?.ZSP?.{hTMC5 |f 6Ye|cH?R=: ֕?=JÍ+P>Dҟ=) 5 ҞticIY4d5哟2|(V"ZM(=@%-=lTrShԑ}2)};~BYB0q}+Z.28}ќwy ;_XWNB;ص#T*nڸWt:=yBmV/SG=^H*<1QQ#OY-3B!fĉ i#$WWGğnW% h)tdv`gZjVIU"Ķ$[WJxU3O_[T0p8j&G5MJV 6f$UK2\E)WӌJZ 32T@!1pgceǴJ/.r)P^̞]#TU-AU) uFHBn,ډ_W$4*b/Fg$uI'Q#Y!Iՙ$t걽Ǵ⧇J.UIEuS{*횦BkujUJ*X FVR+bT7_+bZȺB #gˡsqSN*uUD vX@,.( WѼbT}]ύM=Bʯ*5=DB05\ۀ #:gEw([)zmwT^eg8B@nGmlx:vpk9ǟP8/۸)OOpfn{h7?Bj$'m#@ \5ŏjjP(!4Z3܀=#dZ2gVZܑ`~h?o1sr7e]1izr+)h)CW*zsEL#G4m5ҬK\CP{jPZPq#U:ZJ~~ϐcI13RT-5=BEXm;:ueTAV(PpcJ38*64"VBXޖ2ST[|(:Bϧt+u`X8g6rH<1-DRd+̞-6!NJR??j4 OxwHgO8@ \[ϷYjg̮044eU-=f*B@4`(<LV?DMOϠ]+90ij*ֱT9DWQ'h!g)Ÿ>8leCf 7OCM$rmژ+q7D4<ʸS\xtB6P.GI?1jB¢Ij)$Hʠ,0$Ub5{)>ڍq8>_%=;I`#O83[&C,1x{gA%jh Wz)$W>==>ޔ[-P*zzf_$8TPUs_eGCb[Q*G-Up__CՃ`Ug GQc%E.%fU2gx0PuO{}S/1>4!M4 }}iҒ.ѓ),iGQ-\4a'(YI,JZQb$>DS\4U*BDT8ˏv(դPDT<׼M uQ9s8,22H(N}XIhIz@2 IsŽSÁ-(,}$Րjx嚗 #(Fus~mpWIdQTb(C+fa$$iIF~76KUtEq.h:)è}KIz'8:5 I}ǣ+Q^cj?\w'lNdj+ ie 19i ޖ*:]E$(?I%:DO- W)ALJfem!ل=l S4[P1CAN0?%dyVITK'XCɨ3YDGfU'P&Pxk@`~Gz <~}!گ|kt9|fvqZd@mnC-$hENxASFJx 47@UEk]Km?s{]IWB9h)EG 9J% K*eDdPTϨUl}{ o;0"h)WhU+vO5 !꒲@nrmݚUjiO% 5PA2V' P.Oʚݻ{2}YU2#_SKܸ9uZY}}9 -ȢWkôpTpe2xM&gRk8B&?8c:xܢTf@򴅤Cn9~NhYWC1OYo:8RQbBo>" :K#`"?EVB:]NH%$%VB_B b/I3pU?-8c֌j,kL`U7/MJ. Ӷ2F"fɭ=դN)HK 5j"4k?A Eb1*?:7$4Ҥێ?oGkoIc3<"q" 'i7ӫLT.',%ҕ?.^3wS4ҟIӭªAokE!g2HC@PWcro7FX"ZU"K+;%AFa@J}l}")҂~}.ORChAM9FD3g`r $)x{_dUN1A#1p FSY WW 9`?,}FEA=W,]{3xg}H'.1ܸdMlS`Nriת6\RG^F~ٽx?{H7MdՊSUA)[焣>ث+_SyUIQN}sIRUR4k, <{ܲQ<:xEdڻ.0GG@:0o8Dr UQ $HH-?kte3P,Ix!iˤV,  I{ j+KLx/?ˣ6msʢxPx@=[FLjd]avzV$ht)8xmY2Y )IB4-4QFUg}?*#*?t%JO:ފJEBdcRFPi7FDpFEEzY Te~(*hiX#41b:AX:en/څIc氶FO3z* ]QV2#J}[ܺ+>׻9 (PiQ^6q31Uʁz%Y Jw>f| CZ~މmASE溒I ȑF.K; thHVF}|æ1S]3*#]L,tCaѤYTT/D.~]+gV:)@:Wt> w3bU9VǍ; }ub"e*OjB_1dǤV7I>=F( d/V1 #TH)Ou)$N4Njkԅf@Vg>^ϣ ^:HIi1p^;,꾴y<7Y@gJS=+H4O>!ϨuR :䐳KqPK-!'Һ 1[yM}̚x>YTÅOXN͵Cb[c{٬PN+jj#?Oez|%C2GQ7BK+u+~çz<he'ܙ/OQ]|zaf'_y[-{85ZӭD}?ȅl] mLLa]Hф扫Ue˅Tէ=ZRduf D* B7V 9?mi% 0|}tոt_R)",B@v<KjQ}54'S:jxfyjOUHI&Ć XXT V\rQ8n|,h[D|>l=3Q r@&`^Y,3|W K=$RjݣuLjc.,/i W:\-}3JyGo,!5hE`{ HiTEvjUXJ]$=?>h(Q^krC>#5^ȟqԺ!d/P ܢjQsǴ۩{dj־/.\%E\ihH2ĺku$K2 AW4G!ԭWo"ݪC"V>&:0̄jZِS EE?*UPP-n g+#H#nf 9k?dR柷"iE[w!U XZYЬ zY-͇聣"/ IS $?i3HRʦ@YdPG玟 uz$6vIhe0K Fd{) S鵿Md@Ъ5 ֟Y)sPÇ?>|6sSWO]u#SS<.aVϴf,Tc p8?h7U5؛ڛph`LLCղ$,*B?b-o Qp{?,uiOWQERGZ:X\$h*p9 }?]|cXB૭8R 6hH҂2jm- j !dcӠcv*[F,e DSPp qT4υ}?꒰&Hs?$o& 06tjQVSħ +6{ [gH gS28WN#yWW_?BSz qS믎]ɹ 1H%^osR>Q@%" ~56s~ޏ`k[D/"NX46Xw)3rH+V+%0F*|@qFjԆO *<TUx M" Z̄aF?+Xa![UH2K}+TP((hc%Vh$Sm'=TY,f8~ђ3 d}>eLx=E_UEMyȫ\|ST^5v&YuϟR$``9ȯB_"ˢF|ne $mo΀kKmFf+֝} щ]5j2?E4#yUT<~?ѵp Oѥe>9:i ׇoObϥg4d+lRkg_,w6ư ?zua'ŜJx|{6,2*j%ՖJڄ4Ç 5]FSOz&%G U~%&Oٰڂ~ox~]T*(c|@汏S{D$A"ruk5XX0G48'tNRz+`T"FFYy3׽6h%*?g:Q+j5W>yRCR"jd W] X[?&6 @W㴔Ө'Ϡ'%dijpihd:ى>Uc+dBtփ&cSovtsJ\J$zR角OhH ~C^RH\]]W+,Y9K執vnoYko hQmP?`@~W+!d^*eJL:ϖ% R2Z=ġIR1u2Ҫ@|ʽۣc(jym6P8rxim/lo%JSљ$̣ĢVp=Tu|Un楂*&ԑ#?E vSGa o:CL|HB쯚3R}"&"/@{ vliŒttx]ܫ4?g[SZ\? Ar^ӍTq{<}%3qqzHŏ/SW4FEF==Z117D'ՀoIKHJ7dnArܬAui= 9/hnP ,MJ{8p 0<^D$-ar ?oϵ(U|W\:i֠!SZ~Tʚg,䮩@n/j6{ʭԌ‚")\֟UsNΞf]uU["PZK1TdcVڃhaЈ5,j+W>5}w`Jk:?gU٘$i:0"cvRKqX{/sŠ] TR:clǵjc!C5 #$m Ug_͍۠MzNr/4ET:&(YFY:L5/-h5RݵĴeQzp$M.tȭY{ -#Pzzt3veeត͂:X!vF]O"ߏK$ډ oGhGCn+<0Tx&$hk DE@#k~}*BĐ\_}Ow3|E#}0UfRdJPNr-dzdBju3G{%?g5LI*.N-:=])"oQmTiy^3- "f2#T2Nx k@=S+::᎑=̡PC;Ri)ܒS<oM.^ƀWqv̖;u8FhnzbH(aëL㊆A{+k IAcG4^}Y, )_h=)5LRH! *6>dfȦ?/}+v੓!$#},"M#HRnިY1a%U- HgȯlSR[R㡜u_I.6a*5 _Lk eҔ ԠElIٽ}iI "N W(VvR2YmXq$$(*PB2XH9K]ioqՈ=tQo^Ȳ21r)Apʅ[Ae_g(k Ҝ?/W#-O4Ěz$H xťŀV `K澟oR"*Msǡc x*o!b ?&5XH9:RJSC hѩQ>]-3G6F2C+iEŭʪQ^?QE?>>2Dj.i!# Al&/Szt+:z1ufxĀ"32HcJE2n UTN=iUr?Md)YY*'HeS\aH}blͽHJ>J|Xzt6^8!eZBgI69*P~S[ . iAL;Aϯy~}4d)z%iDI$F}jcB9%ouXTz 7DIgJ*0iXGY_Qu$.Eނkh{B<4i8iXĭIk7{XC_|I ~~L٬H~S*1~{6Rԓ0?âYd CQ+O[NEcp.j+Q-rGZ4+4aw1jLz@y0L)uN"ŸWwrЛ`\)#tHAFPu#ͥIlFqӨ]Np|ٖ%C?zWeL <0RĸWdOw Cm CONzxNc>!{CC#Q{&2JKj'Bu*'H ~]MMOB3 .̣J-*H76k b VzFIkMI %ds4l䶗 J?T{1=.~_oE :GA1tjHYIQK l9WXqFʘϧGڊM>^n%X08u^ /6qoAy4l*M1_?.4$EQ~-ceHTl؎tҋ|_FKQ}SM-TD2Y[KJv`j8=.m*ʠ4RK j`-I>$ډ @tZQ䑵P61ew_M}_hY5#KmwjQ->yj&r XN"=^ʿl>~CBN̖c$i`}K] 6vqi'<>V *>.wIbsDc]b5@l}.(i_J dod u1"d 6̼?Ol-@}"eF_?ou` 'FFܹĊJx4K^7.TMwyS08iFX~>|=:} ~7'M}q=axR|t] *QS}"9mXK2)+K3RMT}J$9u"^ oY {k[JaIXRKI*SG<$FK/4 ZTj%N2Ț.x4]MҢIR԰<(&%e (-A.#\iӑ yM<N|ߝYSb39?+;7fX]j*`?*WyzחwSJ??-X5lLOG4)`XIh95X[~eF Wը>_J"ʇ?mM\f `SϣX3ϣE<kD1V$ŎNtuI>\N>@HRI:1gZHِ^H%P&C *g\iա,+ЏC-4mI q>+2cjSb $9IAne 3OڑB?*])9iϤC H$A#oބQ(9"w=TϢyf}@b u4Z骃DևJ^ϠSTVQU@tJJ!*̳$ߪ)hpŽܻҘQ9E V\g~]mۻwomZdp|w;F"5VZڪITA7܈. &.?03u `v \uLm|\s,[ Yk24M,WAzZHD}ӤqOOv )FSPOoCu\tO]/Uj;'>ݕ%?ៗe02jΪ[ytfe&%gJRe*+bYj`r[G>zKЊ)+{լizZx 5STB$QG,r{k#tKC[*|cӏ[V'^M7-:UڴOKDk.JcpH }ᵅd2DWOR)ic/kӯȚ=);A?GA5L;57?Z6*ױG>̡"S/WFW%܃%Z~} yh#R(a]FO#P>Sa_hhBIƐ}8NgU,f?,m"_TX}EK}+ђe5qYNGamyzsX;`Vd}FU!6#IL1cYwh. t@>gX4*Z-@hUZgf|gmK?5ݰ4QjwUT~Dt=YXNM8S˨Vj mTv#hnu] ^,=M7PҟˇSthk=Hk(}IU }7#+Y@Q%ǣ EIQl:㦧 ZHIϲYM5/Bj>r9YY*R @I*nϴ:tP짙} qݷfI :,,sd}\u }=}W^\nNFq3BHWFPAڠR4d $Rp;JjY".M rM}tgPu#Oץį ??*Rh񥝐*ODYrP|?NIiP5|OIc!ERu&xdgע J?:)\ E!.u7b[w(.I g|qd }=H%dW*RPj6\rB$`Xo֞]"6)F?Kn[w[oE>]շ댻eIM^܍Jkp`)#͈Qws"K#~R?F~ўߤ9LԳŢ:B,)c*͈>rf*VcυCQSO)Nm)p(*Pf#A@{XrlO@R4<tIgy*ɒkL1zy.T{\_}m^jO\y[0SzS^]mo&ָJ}fY[ԹڝTQ>w'lVMFw5?o+H_ ti Cm_Q{pxßDNGE>+'_etKDҵ1,tX6^?@="!kC\uE4TaJW>=(8u\1VTG*TO+Aa! U;0`7vE8SH#,"t:A 蒩  (VdUnx ~olsj?)='M|=ME-dx*dPOUP9 +bU}Wg2D zkpQ^8D&SA_+6L|G u/^ƩD `f 4)T&R} E.[!rh?_u Ⱦ5k">E_. ̉2w@GV(i6sO Re$sK,1⩫Xb"*-p c窝.7OuYdPT,FXLo(#ϩIJf^P\tŸr+xiH,ȏI::HU>ηR4j7yc a*DˬIԤOl@?>*9n>tEGt=m%.q4cZ-mdwU@ba",kc/C&@|f5鱺{[}0OiC/P_ʃ?ˠ/NT(7}- ժOڑE εlYtt(_o[()jKɎw`\I[:OrJBk{rۇQPz91iBҺ_ Ӫꊹh)0vh7*o@MGV[@qO BlŸ Gӣ)#=>h,e(ւhKV)xʱrlO>p8Ҫ~`4*²VZ_^ #+ڡARI!2=;PD$ұipUi:2!ZMZ*LH9hsTXՖIZiBy$Hkѕ=b?QӉH'# @5 +\w'{AݽY L/3SjwoUF& Ύ="藟aCr}2(LFQРqT:n{i5ĆWpHSMMRcI<h[G*G<5/p1O:۹1GTuIJঅ?ǰlTSJcqLg”pk^?WM+S64TI)6'?JW!@q?o瞀NTXqPU?9ZX9`"9 *$h$CNwRtU}ٟ-C "խ[s-F695c15?x揑%\J,vOsf1 (7VG>\0InS:JI5|?Cx^].pP=]<ߦxPtnmG,S9h )k!~OlYyI3ytM;#{O@&Iu ˫ 6cWPz(YBI \}iL:EbRTREG>Σ*MZA?OAeZ6֒ %5}=IZPЊSN:GEpz9]m7KK8=`䩃?)IC˅&f94d4SXxߕ7ٷEڠHKLrxI!u9P;?%<΋[,Œe|Oef`ngy\I3^I'nI:Vi_?BQ@FctM AU7jb}/iX@\Ɓ|br+臻7eO.,/p~>^k%G㈌>& U}E5=K̡V4P!i,ޮOYN8jc8Ch SxJH0d li^-q3p6$2@ ?;{5|鏗Yzl#M,jXeb%VtCl-ԳB5Oq?.Gpn\N7'_Q".=L;3 iny{\7t[T5~ލkuKdsa6Ñ"kA(@>.c6550cFNvoyՅ8A"jLL:˸Uӓk{ gJtg(h ¬uS(memh|Tz:Su`bF?xٳ;GIJ >> I5u=C dg@l9[=Ɲ.F>6P-"5L>>IKGE5^7+Nj)i֎*yՒIg.=M`8c'|ьQId94t%bfH61ZxFcI"h2$[,I4+= 4TBfJh0t'1UTX0:VM*! +?Ojo?,UJI,PMNgFX Y#9i%j?n=/YOꨧO Ӣ$''4~R@CQ$3#*qW򃖯zޚ Z\^v%\jY֋i׬2[⩧G;vnl.֡V9b3B:=Ɖ?tM&O/l&j|}?穕oquXx'4 ר@O[2%KY*jh)&]pUB9ᕕ7j )VPI++i>~?Z?GO1[UWq*E%FԸ-Uv-1R.C{k-A-q!l{mż?80Ag^v C#+Eyմ8#=,}Iq7C+j$tc\1%#Ȣi]-h{#tmq/責|ނn,:LLe4!.Hb4Q>\f<ҵՠ:H#^?o[vT~tD{1^9S_gI'' O^6ޕUsKT )E<1fPHG +Q@}j8^}Ԉ&ђ;=Hchvݫ\OfXo(<+xirO G\~&HnmFP1!G^&mI*QB"cSqD8 /U(okh?M@e8.(>`?oY|UU}}2%ۍY>A,i7Ah#, N~XȍߚpΡJgW?3GfǜiQdUs#GڐBKBԥ): w芯**VUrS $cE4 Cނ24 2)>}%ֿ뼲m۰ehrŤj( ދWj{$i E0QZM2zsÌS9f$\6&#j}uXuCsrk،1Q?3_ϢSS/pgcZZݻJ _y-A{zzj-\ 'w|Unt;仕6+&=#~i`(Uxԫ V!Qnu[P^SWVzl$Xefϧ} 5,1G#e@ ,ͤJEBe<6*V Ğ֥kin,5$6aJਘ# c AA7E> m#Xb8z}) zzM%dS_PdׯjxJ}*6UWjk_?˨_Qݮ?/z!>@\nE"~<ߑQ?ˢCGNoߵ1ЃRj:e֕q zhv)R<= F\>BSd(!H ACs<_g^Y&Φ=k߽%~5o݋9 +6vTK0BArJS ׍"̷= >DzשiWpR+@b˥QOAIE G1S^-a F:Ghh{&. |$jDK,.rx n_E4 F2F=sJ!+J֜<:u? $VUANXH4~o/Bd#N&e qgn׫5=  "M\d˪8#{k2ӝ3$ʀ fЇQGCk_/>@^(2މJ^yeuK<&vck9܌S'̏F~~gK(ثM1(t> 4ZGA뙜J.K>`^wpO̚ NNlY"iouC4XIG` Nodzݮg )ORr[oP9_4DxuXJ^~e(ksgvPp~'pQYyh3 4nzEB?QB)^]mz^ݳIWIc1QK }R$0 8%vXi8'3OGku!6cA_wofRzs vS "KdDԮ4ԌA{ )"Rp" sbg, GN+sRc*7XE4+22 y^`JJWc)F Gρz N)VHDkr0DkOZYV7!Y& G$_YP$~TF1Ry!w:Aj/N}-$XL2GFF)(D_uBo 7o@"_SU$#%*R&t< DZͽH? 0 ?-E FE8ՁnèSSUS6ұS;4^BtW>!j}?s1b!/LdLbU Bki i[[{A@ _ˤw,豥kOO= P@f 9ZtXM0J颜>|z ^LǏ*Ǡ vard(QL3mRK]])()HՅgk I4;g9?AKgJ#Z?:u_aKEML6?0t9AQ}2zرQȑY8ņ O$YS ~1mTZȑ*[ \|Mz*_?lgk'`&ޫLn$*>F]>$ԃГͮc5">ڊu^!gZaM^ U7X쎸vQCP?b@cUˈzn8䡝Ps)_$K\?G 3+ 34pVTrA1 ?jzU, yQUU)@ktܲ %u_OщQڿzmdgY}xە!Ew{R4?ڟm .\TZ?Տ|+Y};`ou=3_Az]~?Ss&mojjEXi^ͫRP ۔"^@G?$z# SQf [W۬_6*)41TA#;c%wr\D=Zub{'YK1Jg!)r8,E^BmGP.6ыi>a2I*)>G- Z#jir=:yۨk/K;XgVadJ57˦PY SÇж~APS=^:PZ7a^ 0 5Hv`&J3B׵@`59= Ʀ_hP,TpK"jyccNЖm$%-{G_G1P 0Џݫo-KZ [ H*: j-bMk MTԌrP`3=%,TUA]Ƃ  }I*qQ>g1V\5HUo "p>_ yj(5S'> 4e8BW^3Beh2¦@QĞ=`/ɱhCJǣjb 8zpEwg=[T+ԲW1E S8F>^{r pp>>f:cRG kO_Li10JZ5r"j!s!ԤJߟڅ](0 }^)閊x䠆!#)W*秨 X7kyeN~J@@}A{m/hd|ӥC"ׂ~{j=]E֣~}Q:YPnA#-(%=m =I'/Y[0^ܵ%HGQ(Ր.4 oV<ɌgoOKtЬ^9:#}{{1j*钹!KU*$tѧ,ʈH۱ѐE r-mB1qvT&wbuO5;k{CM]S8.R-,#i_u񧹺X'Q3Jt>c3sTciIc)ULA,~`uWTid]KԟlG4?J\iyz-a,QC41=43M;$$o]&+'kq4TغwEVDYVK"DsB0"$A( T}u'_N]E+U~MQ-J@R8^c$ @2)fӨ$i!?*c=VFIg.csnCDz: C z2(|\ckьIFS^YlOT}F&v,nW\ҾU(}sjR}eAuiJMNBE5-3,{'mGm UBp?/>|_QQŅ01¾]iCA\}0-6BERTS45bӤ=maL!A✖%3 p?;OeSY 5.٫Arqp}9+qAP|'(?˭x:gw5~.ZQ-3FI%hĞFr {!q\~yWS="FѤA- ttUQaY/9T&5VRRzyt'cJU)'Pg!#21(+q6<#IiSWDϏFIx?wR8ղfBǙHX%?}rkm{^?Q?ܷyƢT~nG唚~Hw:Iؒ}1{P@ڂz-8/pOOm?QHOwiQ(΢ XǷ@#Q''\S1OZǃNO?dӷzj=Nwnעc3SPy(rFԨ[PifIe@Tki,i#/*8xO2)ǪY/)l%M~δ>7b^@H|ny! *7vۮ6‘+lS})Sa`@8чd^h y)PAcč$ۂ%X J̒DJ\pY|ISKS@R7G heĥF0jPUjƕ?gBEEMIȔ.$(7WMAF0܂5 (k>i"iDyβf, }1J Rz6Y etN yhV]L^*&vԣ@}=k#nbF>g@jz(/VrαLD,LX*OI6{7n1UˇsHFc:[n@dVIdS W?ˣ(YT5SuK!ԮUà9|<KUWvVP~h({yia_p%j+Q6:AQf45TfeTiXİE@'XӨy ϠV aL epH rsy[h OҞY qT[.X=-?`,m>{lEڿ\vMؙke}8GbikN[}l6/RILHӉ㏷Q2]Igu~!QZ 1§ٻck 3 Ax*qt C jOW9BH76`*O>gQgwi$5IWAåK [,M>nT{O&_DTj(Z(C^QLbUg*$OZcrF_^(OzϻX%,VRXU#b[+OTGjR̔ȏ\OU#:ʟ!O/[3qӮ=ZH[)#g0rqnvRDqkz6rگr,n#`go/2*54Iyo|O~LJ5SVI]]-FS'PJ,doS,VŸDPu3+3I=HRL5ik R8tG_˦I:>|ŝ{_SoμL7YbpDo3nVdz{OEPBAR-.GáRꙌjƌنgG#1"ֿ!pDQq96 bsj#JFlWWk`PO^mf+{/fDoS6FO$LaSh ۘxgI5/RW.ߙm<&??C&ݞ֞g&Ulh"40-"3~Oˀd,rE[P0"=)Yq ur'ڙ|,X*{FXCQ/0ʹ}u NȻ/pl<ݔ/_J6HxtQ< 0HU1{ q}9e]lkwld>&v-1{-FBl%--~:Ae#jNZ8Y=[JHя= hXiDR̮umɬdS?ϣ(7x>3ՕUc%8 $ [y%OO\H`GG&U2 $1*rVU kdUԵ~^-ꩪ#OO8:)ᨏCk$,A {lΥQVZI<㇗AF)j M-FJ ^xjmLS"k~_g>Ί/7U Yh@7垓W5%t#Z6D冕cqFÇ,F['H>C7Vw.Slո*YJxu5J[_#D~)]"q褦 n5٦/KE5zՃ.Vn=M:{J,7SZlT0}FQYijh] 2-OSL477cq^xB2(Q3\,Q&@A=N)tTYJZ 6Btea5%tSLE>ך9R8tVzJlt$AK&#XE*~pmf-jW`rҵoRjO rQJåq-*&h뙪m\{6'<_ljbըơSV$xEh,Yf$ض~=+32S0_tS;{SmRbeo)&GX[Mh O7Dw3xPՍ.@uoHO;$;t_ DM =cmEG+$C%P'jw_윟˨_z7XA֚?._0ޣ'Ngd>\R|[=%$,x}aZ0GWD$ lI} Pnϵu>c7tI%n8#X%^Px-6 ۆ }q}@TkuY JbqP@A$)Ϯ,b5 5Q@+3o3qNqqOe(?5" c/+k^ڒ% iWKVѩ1N˥xv*.5>e:1/?CǴgisCI/F{TVoka$.ȱ HRoGl8'=*wȍDj1aQMEĘܒ6cA OٯK`vcE~>_?nWlWCFmGANLvujDElUYJ雮~n|DA^!kL砟5;zT]R*R2=+Az ]wjw>zcMM_"&$1n ٍ308瞤E*u5 OPk[8gUx8 I"g2>w,q܌NQؙkaoO狟ǵ$c=s嫼֭?N3݂ 8,cI}[O!' EY<KX~[oJ֦p Fur~K_5êLo!+=-S1R FD5T @}N4I3æ&K]kvgnнMPImvLZic~Q, aHdxtOWD2Kk/qxS|q[+W1ݽU,2z75$h׺ILޚ^i+PxB9'I`WɁ|˥6I۰F`>&ߟO-=%lvܩ+Khk?!.g+MdSdJYY)0ghnU{NG1C|~P= B5Rwn>/'n{޽uvy_{Q2Xܨ4H 5ЖܻiL2D™`}K?S.HS)ֻWHakGެ4BB{no! ^ljhhL4rX}^303%qk&A?gz-ܑܤ|Ն@厽U7M".J0I2͈v`OOm5#0N'uvN=vSrQN0?#G_ _?~?ף8o>nO~<[O>O<}e~O{?K}W?_{>ou_~>&˪)ˇ/kݟ[qU:V3}?߇?<8oz+>5~g~|7_i?ϫ~/y*~}/uOO^}l{cW_ݴ?'v?ߧ_iacn_[p/V_ZRnŷ-RV???tx?T'l_ /?}K۷p_FgaN_)xoSS~r?'ٞ%^? |^UN?ׇˣEoO~[1ٿ~]AMxi?x|ON?տ}}E>?W8]&jrs;AO{,nOb8'H//<~êG?b -Ïzf(8|#P?[}G3-/xtf[ږpd>ЋfqOˏBݟwdz:`Vjcg.;Ǐz:7Z_/~>=~S^śuc':3Dw.oҿś/E6/7~.=k%yd#=?MG\?w'x|?ݳ:#[,?% ?ϝrS6+ܾ3s] v_x#?b`쉿O?M-#КƟzڻ{8?w_Z0.o7OcH>=C~'^?˪FwoO_wx?mDGÇ:'pU>]lW|,_OGsi?˪oK{9j>zZA_N^ã(!yq?NOW7WTOzdp?gz_ Dd0*j  c FA?PwsFile:Pws.jpgR: GP#G+.G_ 5F GP#G+.G_JFIFC     C     k !1A"Qa2q #B$RW%38Ubr456DEScdsuv&CVet7TF#1!QA2a"Bq ?@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@}]Ss J'h~bWZl'BV$Nl Ư$?`rW[0?t-:G܀ْg>p=eZl)X ?QQOQLMQ==2RSQfXRBfdB<:{R_x(鑃]t6F [%2̒OD/Lêm>!Bte~Hx ޴v>CxjtB=2}4=|=5@%h{~b-3MpBzm`u_#lmlC h{!|)LC⾞8T}c-},=nQzGabFąY>ܻjuBM&=Йʞ)ٍD14ףɐ[NR:LRKL- X۹9x~/UCO_+qk!+ϲ ~>_](I[?pka+CH>%Z?Kp_}K~⼧vW=,3*pj}go },={GJL(S#_Kp_=S{(AX_Kp^{ ,HV{%pů5o=$HվCJl'Z]7Mjku$\,e`*=&YpigГ4+ـv弜̖"=*h5-Z~y}u~B`˭]R>HKu)Z Kp!o8JUI*70FaW kq`u| 5޻mXZ*tbm~<>%S 7S"$Т]Z d'kOb@ Fʗ*-ˍDmG[q |OZ",cL:>4uc|AQ"pQsr#z )C\lRIH z\HcSgA'Sar/邼u}h+Jԭc)/Bwی>֞{+˷HMF /h+6/xeiH"R@gKMw4+9@A-n8A,Rn@Y~{GT v%M$[?꿼qW1lqU9cҨ6Q< $+5<( 5YQ`Ww6;mx)2~48╡)ܓ&7$JJ_7bj\|2A>0Y i-%0o%)WtM%ͮzKͥi؋;nX @0*  w&zn;6i~`U4rz0ϗR$v@]Mߥ!YW S .kBRP T17S% NDMH_ZUT"*<SXq7u& |Ts{ZNɸG#ok_h kb&AZOx[=M5]IH `ם*Q<=[H2q)kCQf^Դ"FjPu()VҔLĥd @3qIM.]nYN(Zn~8 ĝ2+/t{3)#\qc_-K1 $J;mbUm*ℝ=Z8&fuJ77QQ7^e*%ec!nӌ%CIB8('zWb)b}pl %q|u3InrLιws;&R&[g'baD 9t45#h H<7u-!itX[kz`>%]L ߔ w:h%/`Jq)r;MLu;/"` 4O<=@ -X ^+ߓܠWЭ#cV|0M>cc6n#@A0VH|pTVč5}$Xcj9>0 sYJH/ŹErbni-.2qTzYaY } Vz4cbޙt]esMcOQwFiy yBp'zآMU^(Q7J !3qp֢mI'oXb d.V|оA/V[870\~Z c,lry.a֭V֠Hfi$ny *u/dCoBtڏ`G@ 98.Ȁ  RQ^aM7")m|Tc8&$0T:(c1S9xbI ;~@:4s;OP?GasOĎw Oצ->%};DLIIД#.q}2O-T$8n=;Csb8eN&h6M;1f^ g_qd:N8޴#@@6+%T4Rlԥ%Yt弲)%,TVַ89gʼ_,m+!הћIw N\դ:;sHh)>y!-B'NSnj#чeԁU}To)r7@dhM 2ISN%ݙX)iDz&ΟeN5.7 ?$q_#L>_t`iٜ=b*s`DF- ĹRwZ"5.}䲃dڿ 't$\Zǜ?^`UY7W8oGRS]Ѣ!XNQԹp )ޭq;WDŽŧN׸1˧4A4@Ӥqx(k 9$ߜk0m8.6;n|s2s*uuM!%&=    w`Xqiu)=uP.2XN_RTڈnepF6iXZEH˥°T}94 qքa6Kx#t%v%J"/iQW1jJ\um?z`8 WtwZss ʖ﹂ l3Aː]KJ$%{Kw-ҡ'KLS4Cqn<k2!jbz0_zmo,RI֤T@@@  =Ҵ/Y"^^m6rl0ΒnLOŋny+8q9o#d}4VohɢAjaN!*@`@q$Y܉]ù8>ہ@c@F9[? 8䢀$򉸺m)$ug{~MEL< "Ķ~Wզ1k(}4>++䌳cP`^il9iOL2]\brX!6l/h gU^E ,H<9Ay$jXlUfq@aMwLŴ&[Kv(i›{B3xBbbZY$m!Jmm#ʺ]Nyu9rI~<`)JȾ?$nPui"FԴRѵPÈ-uS`/E@}τY:;JwW-ti\g+jزv"pY7cxXAMc1Rڜ CZ`B r$ LLNS淪0;^:Of%z\ K!\ٷ cqe VW[#߄Ts{ZNF[+m$]ʵt j BM<[S]TP;B:D\˴Ss Ln\ ' јS';Iw(     >E*lA18^NwA sB઱һ8# Lͬ\rPzx]՗xVJlLʖ@ a)Vi?qߍ0멝R2N+OK5 T1lݗAI'A<崄0B2U\B+* ]J#ֲNJ$B!0pG*bKhJ`F\T6eҥvQJ% @^){=0̦^e+P,RdA[23,|#߂2Z)6@oK.,l6l.T`$ lt(vφn'ꮶmq~Qu9o6oxi!xZ5>BԖ*ҍۄw\ ױ.zWHi6= @@@@@̊ޕK((Lc67@Үd/ߌ"زou:xzAkO2\$^o +NqԦ|0D3'pL%BNĞ@@rcs&ŸG #ьa7Ғ]D;p۫Q3=%2Z}*ǑӀ   &,;   XNI):,slMȳ|r;Î3YRGBZH=)X=qF*%kSo,4 pϭ:_ mb᎙Y@Uf&S׺So'ē0R”lƘu^M"g+c4A>j|ct< !4LK֨v\/!O! 71TĸSj_XDl72IT< 2@{r4++@'=4ب3I6RG97M hσm߾&:xH_8?x-X6A<`ٓ$jzam EFܻ9[?Ե5MaDKu9eF`6# AQēhN9;0\t܄'     12_;,IR X>>L^ָo܎<#" +'THQ G;o)XZ#}noٰ1ϸ%t_u>HBo|Tzvq6@<MMyYi)-JW Qrkmpzu#+mTʁE)##lNzf9 AE*Ķ(qN=q雈fl"]7QI&=  @@@@@*2)9ոB| ga]^. \x0lc@*{N2Lu;.$LE?ƟghM Z*ʸR.`r㉧Յ)O.ɜZǹ5YuScf"       ,oCh%cYR3nG#+=py($cUÔṫ<`oĴR Մ=rބH͔y*R,xz#,4ît,l*a2RJ{>HŵO3`%[&"<@!/+{bjr N$,P,.m[_#nNn-zlHvi V~x~(6Ru bR$¼' )՛CxUDoX*J]:-~Ii@N$6ta&tO8XD|b4î3+HUumymss0$[G*V[l831ATiZ7xώ*gKnhbyGǓ0@`}ௐA@h ))6"  HȹY1 Z_@7uH4t Fn҆ Q8[mqNļ;Y$~$ixP5X-/n[-\&gq ?$is&7y@@@@@@@ "i82 :"Y/G胡{Mtf.ZۙPO_ㄚdP@iHt/Dw?X.:ǿ\5O7.]rM4,Klsrwp} !(Q=֋28I4ɠ|bZFs:LcȨ7Wߴqa_ |+oґQv` 6հ{!ҙi{ qj Y3?Ƨ8iIa|JZ l _riurߔM}N:TRz]q3o%aqEI'ڦHԒV$SZ%&@/Si,iH 2iH?0q'UvnX֬ͭ#٬"]Y h|#:.84~ejc´$p@ҡ{Y$du2P_4'4A&#ܦ:ݗ,H]wtc/Ujg4oě ouS|b-Բ Wq'fXGA},o؞?*GVx)GkIVʊV YEA@@}PGI} hc93|8zshFnL$ھ굇3u;U#č?ΆQ<[9;ҲGZ4[p@>&;/q:V.,D@TCl}6کqRK7cqoHC^Ij{h%'SRߐD_Roho1KXecTP:#R{d?59w**i ?576PgƘ_uˠO2JT8¿peJc֦IaRZzwԭN1_7D^KUbBЗ:X!-!P7۔<n-RzxOje; *$mxxH[nUą% UEî*#M2 B %G&":5V {@H86e3M)$k^CRq"}0 4:pyߚBxXU]#D (Vai0"tїuqMr*㽯D Z!68a< ( ;JxzzihҒN9IrN妕2ˁD҅'e¡$Y Z@L c3(ʑXS4(l X;>K%[)С*N+LN9@1] IkVߑ02 ڍ4˩KEq'Dt}B.(#_k@!:v=N ],%E) >ǎSelwFn)ꊎM}b:+fm$ixU0ZN9o5F-\͞XZqc_gRԣohًrz6O~GHb,`{JH@y̫k5}6> C0`    bK2 %7/A)!N血e$6@dJ(kqrÌ-HZ{@gCZp4^: gmwym3b)ThlSޚaX:53&*WW9z?W6HʙL]bOe:)t' Ҿ"ȉUױj)!GV$zq)eġ3O rT5$$޲]ċ{T%] LyGV/gu&Wa00yyJ; TK Qj.K8"D鞕Zno( +.C{|f{v1ubyS9k9 G*՘PZvtʤ=EXR@;î3R-TWb<{ Ieü.^Cax^q {n3$- me*P"Xlk: ;o~$ߏz# M'H˯F3Q~#G6Tv%gč?i޹S]d$ū$wfmIZڭț,K6 iԴv=ѧ|8ܩi=U a.'ut#2:..,{Sj)-{@HK@KuZKő#J8eӅ(U[c8vMI)i`!*;\ZA➥JQ +6*uvyR܏s8y߫+>\5ujF@XiPkE/ Xc5d'^;qos^צpMGڲ.~ `ꄨN 9M19|e6ԃ_m3+M$5գWx/Jrf! q^,[m-M$k)9UtF4Y qRI "CZM.<=Jlj쓼v{7[A E ,܀8 Gd- H!oA$ 9QMe VH8OPLoR}iP#k @F^IBݠ l>YM`19I卷 5?bnU4VLgq9l6QX x hOC6^.۾<]ץn T7&lNļs+K4$ix!b̮c9WBHUw%-6ۏ-g+d !A:{eRn)gP|vY^h6Ld&\'OGRU)={}cs,˖ X4ܰ$ms:ma¥@|    =Rt`m 0m=u\WI@%N̶l#cӢm?־x>Tմ:a2\t"̅sIJp^jAuZyFJٸ{d~yή]<_Jt;Pkɺe$Z8ώTµ%H(#GrDyӓ= @]coK⤰T@J πd$UZ~e\.r en9DFruFyܪ9T+lZ!zC-7\af'!WeZ*)!$@,IeܓQJT@@@@ª3+LYJ{ kwcLo/T-/ ,'܏1ͮd-=8˩;r _s2NV D:9&QI6].ꦟq T5cGuk/Ы AHݥ1oRoS7jm{Aԏ,&L:m6D=0sb^˹6C6oMc#{PM 8kӆ8u .#, 9mҞzR&jp: ԑUDW!@ĺ Nel8GXw-]G A[ }fHi[Qi싈:lsbJ]zpkZ%SgC՞P2irJ$Ԡ-vi.i>f~1,fޘ]ŚN*'NeRǿx;MV*SSuKoe ͢JJ{Z)c R6߻qx|gJ#O8s},sn~m:rU(Ҥ$Pe|w]A?Rϭu5t'Sd ");tݏȘŌ%*Z`sU&c0:JM_I*-ڐg|bՕL%n1Pq /X (XGZ󛔣*l04q.;(oHkㅤi_)vA=WhLn˹*R%[HEr)/%-̲lwP6놷byy-T((۳]? jT;o˹kxa닟ߍf_>% 3,%%CZ;@xGe8CmΩE.\1"8T*S(&awnpDJ\;**m}c}qc@o{߯Q" Tv.(ǚ8ZQ㑅m Gg6mWr;0Ugvzi/8J=ˎ<;î M&D[r#ަ&jOsB܎Tȱ\,,vnd3,PR؃{V9MVx!( @s<׵ǍG]JU l@ <X3'e5J4;R,riĐVi6m|tG(ifW-),!+o=]OUN8}GmjyODzq։M=Nn"JHWLvPhW̾8c=ď3$jN%iPHc,wū<[70mL;֝j]:okZCҞxّQ wS$^@VK6;$);CZId^#6R\"l:&T :u>|هaI:OX15JxM)WNWZ\UOfi!.IHEmWiGYV`4Y.6 /ҦX3XԘ0ϦVKUw#/[-nw kO9<h)1dж䴊T)l  ,ש]iksyOJT4+ZpZ0X,xA^ae%= +>rCѝvQ:Q߀؎Zޙ~fMM&J.W. MlT.Mm)1lmahffE ]Y Mzʸ(([x ^eɖAWFw[QcUOKK7G.)B K %^iPx:L༺KR;0:{kXZ|mt{1#Le3he+}3 K(#.dA3C !,ƮO/z=]MSR;p    c^'ͪ[}Qqn⍶?,ga`0,i [-Sh a?IHS2ҿYJʡ Kpl{7qrdƀu6 Jg\q!eҒl.mxq$LұVR<@%W*#a 2ugψJµ)UI멤)ZMƻM0pKMqQ7&-.ROJnjiy( ŹqsRKQqOk2{u!䩩V %Hդ$'dtԵ\RͱpKu@1n ,[q_4EGo1fK);tw:mZԋ-M؞]WMrTRwsK=X ÿ1潯FTrLAAOxѵY\ҫ=;,zfꊸ:#;wvS)B;`8]T6(4y77ԫq7iJԤYrNZMjakI'ajF>$eqαJ \q"۩wNz-9yXmMڢsDu<)%}{U\ S} 㧼 ;V1fO1'0_iNlm&/&IbE3L`1ji¬G@c 5E?rg@Dʺֹ kHjDmh&(n0U:lk P@L݄ oQCu]ZVI7ޟ-%$$3fB”;@413.4qPk҉j`]|6:el %|VTnkh;ON)s*PF7dS1/>tTڎ@(ҷԄa90k3K:_IKhHǎ ÉlYեpNO,nHx@3ֶҭD`)H ",a吭w2l"p4t% s9tvcfR;*M/plm+$"ZXb^S7Wč?1uE$k)dcU")#P* +*.\yWBTRG|W%SAQ14֓4m$'IF*aHTx( <82 yoqkpge*bbU҄MGFhMukA77 |5Z?u6 w1\sqjosSm&o֩ DKqbpjS([m)EˤU > - iIQ{.2}t9a2J` 0T$w*H,٤2.uY@v)v@@<.0Ɣciָ/2g tM4amm$J*H ENWS?}*ч|vGnD@U_U gg`$ÒV~XI j)IZAАG9Mşj[U-sǙX!*uYc#MlAj^M͸lc:>9-FThu$%?'>8çp`Ď)3lK}—V@l'~ƚ܅Q꡹'T6ƶ%sILLL˶4&RX{ś_7Z2)AҴ,(7u IM*uɱ10X m*|wߟ-Ɯxz1E>ZRVum̀ߵҡbRmˈgw$4+9N&Y-$5#b}%}H:Յ>Ut'xɭ]Гa7S'HO_OaBJ[4Xx 7H<'l8_N=q=,eA5i6я5z1]Z˧q{aqzmmtS-XQ,̘R7;n`3`VM4LJ: Oq0zԀ@ SͲ [h"3n):u& DUL .mqz)hJ6Km-,ĂE*7 ߌiD)"0oRg@`Ž!EmTÄ/X)@8$&P@Qx:)JwVUX\JhVeIAvkIyEBeo3`s'^ӪU~ڸڝoiWqN ɵ6ex%-Ჟ_`)kaqNtR}H9XQ{ Q;f*$mln^!10$aufqmQԹ娨Z R ġ¬USbvyobjku)5 '2f:[([䒘8W*e!-, peR]@ r^nUo%=Rt(bd+)*Vyay&hӳIqw՚$S,ƴWfnC{Ga!D#tm0ei\P#.{5X⠀   9KAT\A-K#H$mrc*S)bIܤ M[@SUhT aǟ.ۑ@WGBy))j4^.Tj-ڙn>x|ѾC z}Im/+˔eo"{͉LUz绲c:m#\ROZӁ:EFM1U,PKE.ZFsugksM0,.w#{|yqĴ(˖ZY\&8˭'#$ʑ'R[[HF% -RK߯P> WwFevTSn3.(ǚ9t Wo4'@B`DO%TQc 4LKHp{q;J*҄@/0sIӂlG Hj'qJK Ȱ7[iW0iƓF>}uKV]A[HW!# KT%7iIQ"}miզNqnVU ϜnipUJmJSǔf: MqB2{L ))^~s2 v OdgXpOV哤ѷv)IS@ 7mZs|,HT-,GS/)EaOč$jA[.`+]OM(&zjkqHlN jINJ8 e-7I;I)l")i[(U˳$=F%EGUͭiROts3Xe,h]m' j;!H( SKq>ǓUZUOTpi͛1Ia-6VI8_5IJM)OgISCTw6bʬlVO sM 4)%eS,6J&@뫽)4|`]'>j-LTB ҽ8e_LFyU}T'Ғ M-a*Xlt| 2RVQ,gV<.:ǫY۬VP"I3W5ǁ{6zMN2o9d\؛^c:n9B܊i}igTBl mHd+-K [k^2r]h\K̗\HUMk𿈒Yt%+qj *G_jtܖaִSax)c:ф3&&[J^[m߸w:ϨLoQjQ!d$Oxc3M;;]4PRNέo ډnBmR sw~4y&R , d&<"X +'H7&$$k O|[~!K 1.]5ov%>3rU36ˌF Pnw;f7[+nDŽ7Q?(T>x$"]e P;7[/J/M@MpI xr77h @HAZJ)ہ8RwkNS jPJ{W5M`8e֠ RݘR^u:R^Qs+R{s" @0 LèTJv +2l[96.:Fu-K%FyTſ-*⑾q닌"šMI)PElǏ=)J@^SenT6֔)\_knՁ0y2:p%0\z0ϗNȀ  < <Ө&/7i$\ؑxDV6ݸYdEGTM<}. jy~sWD}Y$5 ~H:jVVp] 2Z}Ǚ\jV)tn1^ yXTcܖ8!* r2NF~ekiwe]f<řXKs̸5'Hķk&,QA0CRūY:\T%6uU4ʶW2Bu l~3?#FV#/*+Yv&2)oqo)6*Digx7] ۜVfkn%.um68M-Rʣ)RujYq9G*YI =)Jt 4Cc)4W8 rEz(sF2#DF^9V%x7ˌq/RHzTR;ƷR5 ^")zι`2^dx)yH7e Qk'x )Kui;wAOs\p:xA}Ҥ$ePW"ܬt$ h;r\AIjwb@#2yҞ7r6f%CJkWLaOķ;mE&}TʊuH˕Ug?v嶄)AE‡mUטUQ^[(A h; ¸q%]ԎD.O!1tzS5UAmC}6&2O\\4Z x"mW8.Qہ@WGBy))iP$[`6Z]eXή7B$-.7{C"<[JvMf'7*@a?)q k"Okn{cʖJXi^B)wu#(?S (o)XvkatԴw~qSn@+6JL EEmz)sĸ77vS'TxMժtj%@jPxTޠl~1cL:>}>Ns{]5_`Cqē>7Uզ+JNրP+`4唹D8R0sjtYb-k6̲:\S.I6 AIqgN_(hCw*(QqLQMS m슠1W$-^ 0 /׽k?:F_HHw/gO/T36U<Wn݄7եVe` }zEt P<*^"qIp+-k-`1?/" Hs,'KqWgTlRloIf-+ \J4)\20ZҦحu5PBuYhh>oa&b-EC2!`RFm 'mgm)V&PS`PDݕLm*чeӲ;r O3??% 81MRi7U2h$7/)zŶ:vwT0{͏΀4t~XmTzϢ,ͫ@k-zٹ:4&gVbR;A '9%i t YI%!ǂR8`20;xV&@B&%Ua7%VTܭiJY Em@\0 N!FvJzOR)HqӪw Vt'he>[{N]ij`܆ 'I0Ln,o&ѩqÏ>]:" *33RR0so;RZ4 GRy'Kɶӧn?,y^ţ\ݷRx ZiRqx ) -˫špsxfY<@:|h҅M@.4Zd]ة@=Rҥ$p$ SDY!*SU2\(2U%U!Qԛ wD%a[B市eI[4î38E~&]i-Dr1)\H":`Zw0FH0/{ g\G=NmV#a_ӢR4Gqr8@ԾtJ. \@DVy )0=dx2X7u XE۫ҵ$ajN:%TD(HfTBw78r2\ ;%#0Ye"'&w$ Ξ2-4ee#RRv8fq %B -D#YQƛz-<8=q}2#JN4 C=:neӧLw$lfM>7 yz%Y9èɎUYZI۾ܐ-x2MH]NļH%n܍3gWIZN<-\5fRZdzL%JJl)ME]M֍ ]>`Loq4jJrf]2nUaANp\K ;^Jցq߱Q$`/< i) `3ZH;A8ݕJW!F1I~5kY!<,wDpЬ%$oV@n.y6A FUǣ0˧Tv@UQPfJJ@p6BI@zJN' ,Eלok_bH<lj5ю[Y* I-aT&Vuڬx aW'yA]`*nnZV|1ҷb<Ė~-@ 5s㫆ZfPۡCB2juM-*f˩&eThhd]0VcqNr.Im($@"̥ʁdޟy!(~O&N6zU#J:_WVm~v*>)bø3+8YfJ5f%sW=](dMsXt|hcvێ&dp+&1es5Լfʶn>,}; /3.M T6ZO,m:-BLrIY;۾ =b>AEvv9I–-pzlYIF-XUh)EJ)'aw.0MiAV۾fN'! j˛/i6Ah yM79}>Yu `\{[^US78APցR֎ @۾mH] RRG~ *>nWUH@BYLSꜚH]m7dƙRĎ eDn=Y+>qźGnLko0@;>k✻q&UzUEݲ},V]/ERƨxHo18yRIP<#6{xYrȃ)\z0 tGn@U_U ggz#1',P$[@huۆ߱}nAgPyv߬U ѝM~q}rVU-d;ckeψ1"Vfhoe=ɀjkn[ҳttyfʔey@{Ëbem@{o+NZmnb::^au&;v0< ؙ6^A ɔ,K |P}BS}XNc0 sIp3ayŏO G9 Q9.s4ہ>ŇߩT咁{vy)n Τ)Aэ1뛔V|sg01bDQpM(eZ2bwzʭVny_$|""nᐻ($3ZwZ&֯u+WLjvϗT/ zӏ@mS*ifA\ee*K%ˤ:ifajȰb,m?>*uYڦgSΫ$kR* fQO:fXXqlRn!ӎBV7%Ҫ#}ҡaoYI)F3v6;ASWqÏ>]: *33RR0@{.$ᴁݿ倜:8MIM>psp| p1.h$ Wfխ*)! `*N-kQTM:obR:f4~hZ/$7%Cn EkJMRD͈nhiN})+ x@)KTokt+>iYgƶ{,C]ġDKg szqU1Ǫ;ÍR%jN&%-I>bmsrwcU5LK4v&s|Q@XVlɘTj{ zI#m#A@oaLC%S`L]R [4'1%ANc$@K}f%zRdY}ƒ1a )&uA4~sg@fT.}ߴ0Zm& :0{'쇄g?tF?ba ]a ֌&:5}i@ IHP8H7Vnl 0($w HDM'ŭ"mbLZˌK( jE#Y..q^rRX0m{ XCy͌l,uMͼuRysܘM9xH G> Swɿ΍vo";Č6;F-T#`/4&znANҲ!r )nK@B x KbXyX7"]b=2TGeM!tb8mRhTjD\qQsMcoݟO8O -b-ɕ~Hj9Ԧ>hu%?,euNWG8[R6u uyFRVf&a)^Io3Z+S6鐓7hF :$nw&4f   $#U:cczUX* ~9'mTx qgN  < @@'ပ6qC<6`$ߘ#, [5UVޘNޮ`J'.}ߦ_KEuIln_l  =s1.I6yB6FX}S> %siiK=DTB…f5_Iߘ0 ;b Ϳ۱Ug:?ge7^4ì,U>ruFT@@ˬԟ/!}$,w;[Ω Km{K4Ŗ&ぼ@/zRިmB_,o̯->bYDTKli4پ'r`RaI K [76)n,juPs#9+ )'$߼zq#>:@;SF|784R[Fp9[1hƥGsy'߀2&aO%Os 5B0rҘi8| Ԩs'ɑgŠΛ rJm@Wܹ4Ss@k K=@ c} R&falJP|fs386UK c|q9e4 ؏AkZ6Xm)/KF#QwM(EJ%D&*>@@@@I=NY:3k9s\URԢ8{oW9t?IH@90.sOy[lu!}SGmL&Zgq!TNtH\"L twq`c*\f (!GMGx]On2Zdn޷ F#/t+.zI4%Co!}5饴yu9QV7"x&OdHn)(8]ORo83V"I&Y aYAWNI|QdmT=EP@@CSvd=$7M*KՖĿ/ T\iR2/SZc*R4dLߑ\Xi߲rASf@$ nj-66}&YX ebÖQtP0s%JؗQW|m?sQ1@@JU>Mto~sI?qР6ٱ7buw`18Vk*w0+ Ap .H$5˕6J[PC'NVֶ )`)Ǫ'82>Z}iͽZ4mW@@@@@[.8nq҄ά:<5,J&2ʊ|8.ہ@WGBy))ITʴJ/@zY^`fL0?>\)#M8;MD͘me0ZS&run\Z0`%Y%Z_[HZBFv*gfe%U[9XW9Mj"=;N_eK)Px/$J*m)`[q=송fcm,p ? ,Լ10m7(~hώ{T=EP@@@ WRy<=Ϙ?9; J̶,spgNNUZc?5WkM hHiGRpێ9V_5Y~x-J)kuֱUB0>jvי$GND@@JU>Mto~sQ?2O\?W3hūÆɂ^QҳmF%;eܘ|֎bޑbqIV䝽 ' $[_pcxRѹy'aQNH *m!j'pF:!@@@@@oPSxv'SuLJmi6 [8^ ښ "qƃOp@U_U ggdje io2 i$seM.a06Q(B0 [⩤jEvb;vvఒ  xF CH[#?hώgT=EP@@@@@@@JU>Mto~s}ByF_k*ڍV5+]8c"W .Io~0sZ**U{bZwk,Ϊ[gruFT@@@@@@@DO0* vm``smxQ@Ecmek=#yVb~V`5^6=@9e(o-=Ju\ bg5qyKJMJ^фac@@@@@wԸByg')7j^c9Dtj MzSr{MFYjRF`x 7zE{7zE{7zE{7zE{7zE{7zE{7zE{7zE{7zE힉ط@s' 7<{7zE{7zE{7zE{7zE{7zE{7zE{7zE=3Nf@e3`{^{@ގY݇#.[x\q\. :ڍ;+ߥ֩6~Z[S%ԥ@RJIxof=:6Jbne}\ju؝)H6(mJf`꼝ѤaNq;Z:ph^{ܐ1TZ[Զ]_$q;ⴎu^wd=nSS :%uN釸x5^ GYjCO5F1JUlUɞsk+#Mv;d=Y9݂/f]SS+ak3;Mb-#'[MLZoɞE/i9F>(9wj#SDn4ښ R֐ S7g1\w1ӗKHeHQI{/ܧ5)X-ɶp.]MwxΚV+%}˗`_:4xf.ԍY20oѦ e{lR2Є~|=h}A 'Q7mVIu_G$=5t)5*5iS,ž7)U,sꔜØ/B{K_w8-u"FOU{]x2NMrpNW}Se82uxP@C6"&]L,,Wr-k|wQTw/]Bgg$KS)* (;XmZEJ>%DN>˨jaЗ,{J \X_O5Ê:L%'k.UDSj]V1 DZ nm;62$7駘Xb:kb].BZ >kCi"8oU[夻,&%*1aGPYîLK.KSV0Cg O˴Y*sZmJ>U]~9C4ƴML&`(Y yl"o/[ۉ7 @F jfU:`\wb76eb6sH;Q]5e4|?1%IRONJt^ }اPCR76i` ЂYrcT;?R*$& vS 9kSH)S$41ݘ-@9z,?8/NݐD6n}23LejI6",h۪ 'z1fPV_8UKLF.ЄXₙ>@6Q0C/-O{oB>x*Os꪿ogԧDPCR/B*ͨGwNv\IC R8gV1xz]@9> T'ܩ1c'36(l9Wn .mfAXǀn=Pm~H鲜J6ߐRÅ uNO4ڮx L\f-S.ukTU]vէuʥ`>OҩS fhY6K $)ZϒIvJ$ѴXiSU7BZrIwy]]NAw7<r䫮q=ZΤ<03x׬-,j$ G՘Jq A`˵9J { jT \H$ܤl`piRܾD%[8X=ow 02+PH =@<`ǣ ku%RC\אUj9ZѾaR`hX3%Gw&J+fLq@/C2@W,q<.iKC_^ ~4cK.@JBV7?0 F1pXS~0Iڳ죮mdjEZ33*搤-(@7<3ՇE˾~0nVb2MgKvuv}C~^V$%wWWsbz`m5+^^M<&RNb/b.3!W;!6]52TM͠M&R\) ́sj(a.L4[U>^sL:M9s} 9kLTb*@gjrbf"IYҠo 5Vd Rm0WZ [E6b3Z,+MNļ]ʯ!\&B# *MP-s.cum/Q%/1! Y]@#i mzMBM)0PU0mq$.HMU uĹV+b.:II˺SW\:Dvh ~o2MӨA{XWX0R;.kl䦆AQ+Ok]e "ׂ, Z%1ZAE!V!%2RN)513N7NONBM,L-qf-MDh8a/MWSl)IfqXܸ;^0&9+TLu'$|?Ig[{׷LIMZ$R%B-LA :kk#9kҴT$˪ yRc% 9mgx*HK)kܹ4͠JLar-~xu L-3T'&JTPEi>bưkLF 2_rc֗m.u3煈> ӎ7̴RT x}9/-.,<.dSDP :99WK.=9J mIAґ(y+E(JT<#JM`-A>3)&|j%掠,8AVk)lJEץ7ۙCU+,P% mo83K&] {Pls,;Z7?!ׂ,&2p$ x ND9S@JA !jn-%PN4IvU䫹Me(X+s!0T7UEqƔ9BٵWӂg%ki4!i%5k؍sPA Ɇq>jfu".ƙ7(ZʘX|-D7D>$KSp"ru%NXxh }ۛr< ԭ5EI19RLv pVHpO*6%TlQ@?nyI& mމcL U>I`dpEam>ܺe Դ)@ܑm '~FrZT:ujYVogԍ(Ep2S̿Bm66U=Ѹ!#=A~0z E{`#ۤܵFj猣ܿb`0ץeޥdnm#OPD9nbWh`*.҈$Lx eR VB6t=6)üHc,;ޖ 0u5JmE*F42qDI" YSSZ*3J J?xӧ'&Ҥ0@pv4uhqJBӄߗd6~e UQ^J@\Cы^ J7.ˁGAV%j\qۨ<`ƳJ`ǘ:\Bu'x 9ߩ><Ϙ= W#*8^e!(H$ SR$/4PNq'`0tI8-1#>.Ba~*)ҧ(QQ7D¾{HyUY64כ|ЮPMN7g&f`i*ayl)ַ?}mf,yJqr46rz\[SI;^cN`SuUJs+C/,)aSh!ZoapT&J[.#@6i,1B[rJ뗽fT8$8Ad7 6i@l3#St&O ԕg 7oj魂0Cu8 >}[7JH=Yeg0lpʕ<7$ KSkYl}Se3H t!JYc H-E@\ eڮ͉=):ZnF^X V L˦I|ʾh 0gb4-L;\&YQ'cY⹶YRX(mhJU1md L97B]ekQTP 1azU 95+'eܪzljq{z8ώu0čAuD%`-;SjiN * a<̈ʍ%WfrV12RAk`G2 ~a4^U+.B.k;6ԗKz|]?\.4ؓ{n҈zit8o1CԼjV)|!ɉ)Ŧtm9ÊSBWA[TRHI%Bǟ8yt[ѮHO ]&/)IR ,8GV$ 0\9Je7(<Հ7azR #__o =VFxv2HK_p7k>]&4Hyu8{A $C]aj䤨d~ JdJYG.prLͦhy|x<qVfr݅ UAgMm?;*-8T "x)1uMxfQ=0Ptm0X;W\cg}D8@&*e2IqA IN@یώTgLW{GǣՖs)aJ]9o2IdeiX $ q͞sqXJ9RΉ^Jqd\88WE:oI?DdNs97f}Sb1ԛKtnWj.4̾X#Q1ˢ'HDgeޚuvq '}[ΉYJ[TDBKmԲu\G9%fBJ J~Ҩ򸝊oR4 +HT' y^~Yԭ`W @"EFr/߀SnZ%{NSvì͓E)vg0A>۬% y,^(B/5[Xy|eUN2t#ʇZ]5 i v!|ܘRT6]9ŎjSu\㟗Ԥ'qZ4ǭ-~'v)BM9ݢLREzqr$hXI`ZƇ5ڎwG*g?Wv ߄u[O9 $k;@-/xԛ@썣o9,KIiHz-:432un4ŽmĪWrA/ֱep`C§0R EO_̺┵Jb0‘.w@>R!q$R%$TH#k^sg }u)[dj mxl;%&C"g+;GSAX- ( T3 >vLCw"384[P Lzg#zX :;,+3δS_Jc{yގ3:oRfNi>Tq6#qUb\\sjA&IV6:}& ?bjh Fyh_XviC(8~*$e٪]ëE[*벮)TR ;7OfX!5I@>X C2N[cV_*1up]m6?e~FxϵmqZZ=jV#6O2dg(rnwҙ]Y]m0 **sK &⃄(x)0j 1NdL=N-m o9$&uƀnb|TV!)ajJ$&adZݭ0H[T/*0B č*t1jK7p8|q?eb R$Èx]bu4(4x ٙgz[ǒqplA?ߺ\'ť8E||ߴfμɮ[)L%EMH*t䍤Ե_lx.$Τ2;'`.#^ QTWk4~ 8]*™rOWQCS&V!Acv*^]rfޟuęwv 6+kى2lv(_Sy$$˽be[M΅X\[]1B@ 6v)nbҼt6R|÷vMBV~)%#ܪaڒPI **fFd_g bfLg[jU:m&:YIm].npr=q-gfqzZcoEOfQʺ摥Mcە8rG1ML:*ۓ+ Iҫ|cW+0TYZlϓ`L.yJNc@|ϡE(R-rOLwwsKHZAMv"N_ 1[)mnS}wFՔb$ 6{rT'ҧT2}XnM YTn%V C'C[)Eon7&כ7L2[79aJiIJ^)jJ#rO:Dckx"`RZ^})W:MkD)UfQ  Ps.i%Lje) cnqgرrv^In9ҹtȪ!*Bf'l$i\gĝla,Lvw]ϐwT,eɌ-2WJJ8YP;'T.b^䓨IeN$Ǖ4frBuMJVzc=ON$*R K)ҮJ c>pw38aĭ M޵ 7KPQ+#x ~vԔ:7AN6nnmN] !¾4+KxA"]ښG4+>-q2+dw^UHb K-}x|Y߮16:C)t, [}J1Efm*` )Wq}'ٷK>DܢTj"aQYwQtOH?5>RJO s}K4W׊pT)^ɣe4pJK6BV` 9Ohp6;nK2{`կ>Yto2G.pjt%e*9+I%!7DDYר5ë a6Q?*,JՃ]#WyS%7_ %ayŪ͠O&}FsR ȳ }7N7xLOiǥE:]i JEqU+/bx08ɡ\La*Zs\N(MVRJl40 JcS*WhNY +%LTҎ@Ex(~uM#w$ ժ= gRˮku95̀"b\*5hK] 8QhT*ӏ _DoJlB{Itv K`@XLV" -m `E=bҝ[H#E8IHN H)i| reqe??%NOyL+55Mi$jg ZJV6RE!=罥X =iK\aZmRI? r1|wUf%f\20|[sjcbǫթ O[#^18ĊZD fQ*RHHT,֨i%) 8 aS-)24{I$pז0V*Y7.b%ihC(aG~)~jIQR6:T1&%ʲMpM*,3zYJ]P#+]iגJ:w1<#ц-sۈR@Eui|C&9HNBT=Ūf.Ueǧ.ɗJJlO)#LB3a3N%@I8gHѕ(Ƨg 6Ϗ)=,'f\BH`͇BU$JӉ \Ŕy@2ܢ@K-Hpvv`0;Req[7-irs{(WrOUh.:WN3L(V)C8$pT /*gq*̪ Cu b~H]9i2yIәk,rҺdRTΕO=I`_ ;軀p2o4?8z7 qu>-Rv.%.+q:kb Dٟ=r,qˌdUB痍Ujo+JV4q\wy\NYъ4nu>1zIJupz2-c ֩xjQOI7g`VxWVkK4Ha@h eRn~XQހ*Iت瘀hON!%mcaqĻl fÁeW@y*-!l^jExv%Gxq'瀕rnjM˖_n_bDQXCi%Gd8LGGa9,5b ZEu$S/=/24xօmr2Ml)s5T,MiCWEE3&үٜvrS +!)R.9@Y[dku)>+9SC7N^߃_tax)%Q?0vࠦpe,dpwKb2Բ *lI`nSE:0Mv̒\i;e$ JjaAP7PO+@OcOfHW%9i,q0&RMaFC9TU\s[-t4Nm"Uٙᙞ)BT؄{|~uYʾP^reBT yso7ÌshmSe*ͤR +P\M8 qKgF/ccǕ&<|A:vmZMNRkTTҕ,)Pfe<@' j.mr-` %uQkKM˺U}("Dz.Y*:2 ,-f)ShyE<54ë,N 2Yq%*pӐ[. juP U/cPzb͡Fja 3u[d+ɗxC)cw7]@S*I^8tqNi_fN 6["@M>p 3t٩M*8 '%$l0f)vm IހMqSEΡuϊ\Q@1$FZB.N X!Di0̅1fԔRcZddE;倔2ՙĘ&KiֲC@)u;Шț=P}G7,-*N+tˊ "2jJjyZL-*t*R[mI*iu,6_!)HIژOc@obi$6!)XtMV;)Uń|D爹"x@2Զ(9u xϗPJ) (Q=HEmYRjJ$y?$KIy3m-p&l I6ZwiT5$5$A ˩Xdz>^^0BXN7;p0SvVdsQeskuUDīI~MJ {{mfùv&*GԘM?)xI aZr. RQk_:bEˉJ9.ft7czߊ # BT<&>;êkSh4*iۓ-$lFb<]V1Vm3 JP]P|`>e#8yɾcRPTcD-]}.&yd^98)S2ꔅnB70m TVx Q4h(n؎+$̫!BC;%I'&cPMԟ56&NeRMTv'O?rW02K!*sX#\Iԝ Eͷ`vY2+F$O;{ʆ:o\/QYRչPu`0 292kU+|,t1% M>MrV*x~\^]b9BkNpH%\hvz~sd3+1ģU,gS)m%EE|,y,l1tf’$osp1>J` 6QܛBU} ^ ԛRDkYX#e8RͼBKWR8U)#cHl{:JS[߂U%̎Ԛl>[.YVik%rշ*t Na짪NԺkN'P7C+gIsWLTXǕ#LTUIeXPM8^ +$Um'pOt($:]iGJpDfwߧӦNV҅pqU0Z֮ЀnyYrstjC3kԆ\ V@'Lʯ 9SM/\om{ Ss w˺+<9@SnXH'a6+UT912%䀽&L3. ynRf!1Fd4:0#B"])goQ:z&n%GwTFJfZ]&m"Zin- K $y7>%%4%|䓿uܱJDS|oݒS`'Z>s!( .~w%K*pE͒02nU隔pu+u@H7/:WU^qz]I߄u;BBARdDIYOۇv e\;Z"YjA;]űM,DM {+tD&`$)ݬC,y o 2jA ўgi;'O"DU;BxP*ur96&UgP6Oq޶ؑI'EˬgSHBC%H]eXO\BzmoaF^5BqRu+LF%)ؠl"*w+N&^v7!\肧, KEDBlhJ{dlfr{=Zˌ-E nP Rk;A BBo=^++^bfZSF&7əA u>t)Âg. $ k0W:/ba"n?@Da{JqP@>$SRʚ䲦YJn$!6}GU7ZThmZS2uz uT 9\R5< Øq)i&^aI%{RۇpW%GvZCZa:iԭI7I..I׀m*q=2T\U0BiBJ[(Mp>0ҕ6zeo=Ka+_TNTt`75\17&GVtx[XIa8%)B@ 0ꘑH!ŸtkAVMN[,O)oHɹw}FzD`kXp1"̛!th $ib=6E!yscKiʪJO+D=ԙdP5fzX;AKޯznS))PQ&R!AOɼn%hGu'1~i[4kAM2ҧ+&X!X/U^ fazSω 9AU~oyx1ϩ5Mp-i)OP9Wl4"[R2q C,|w+ID"`-S5o%+U,[~(twq,MqR_oc AUiZ_)ja@Z ; 8N1fƢy r1.%dY*7(ԣ$|Ξ Z3ECͅ8_W8rBA8ܕT8QޒUf TwKe+ I)CS/+qyGH6w !J%,c[a.2I|kih@W 2jP' JkM3Dlnkw CF^r m..7A0% PYGYqIy?7i;u:.; P {yZ̸a:L*iRQe#u&9n%Jtʯ6blY}86\QH/o7A:ĄJn+ĭ1o*/{PZFw5\]ċD[nQ:.B/}),#i7ب 8Y;6_>;êiJ" n͙u3m$::\b3knfyxDҫm)&mox ڭD8<u))7/H.Ԓ7߻ɹ=W60 VfY-4!Z}+Ī=I6>0C]zS;5N&p2`-b[%JWa悟OEɸ86ʶEFS-Nm&䂞bGËTR*۵4Pnn ժeRI&j6E2`&fŠxpt,7Mh+# ւ&Q{@M:R ()d_ MyE@z;/_W_iyB=8+6vs.SHu6xzҚ]M UeĔh`[p7({u̬bi; wǕ"j2+Rnc Y7}0ՅIZBJIGrN.S@H4"  ijpn hNmn}[3 )Me\ul,ψgctȸ+eF]JēʰI]nM#"e)o݈).^GF.+eh}3*pAfTPP`KCmnjiRKb䓴3&N!`AZ5+6% ;`|a0 .{G918aizs=)ty|/JHD\~CLzzI)ILg]bGFU;.RR\˨WVBD\zq/ZSEe]Tρ, ĺmRbYP 7kL2Rn[j v Sy8!ܩJ(FM὇y0C2=5ɶѫx@3ʺ\2DAX`,3gK;hu>/?:WJ9*PudMA7JT=hgOm<z^zUU-7f~gaœeDy@zeũr_1l%X\.Ր%$M$ˢO,(5s2MMA0DwS8BQ=(:\|@$52M-3i[j HIM8X읢;ENL:k)#'YԩObejn]IU+e)I繎Wnf3C )K! 6q,>_Ux]O>;êN7C7v$)ro%qlt#M>aD^M^{N#B JEbxiPzo :ZУsaI)Z@*bbB}eX) RH 3W=\ $ j&aJFj8BI.$@RBR-. L:>!VUj\Rcww BsaZ5ףli%+'ћq sV \:D阞l4܁n6JԷ:{/QRn&[:W{^>R)9eAqӨyKBk>^UFfu2$B{jJ֥VIQ,(ȵVCoQue&ݑ^0iH'C+e]!0sFY*M~-.vB큵GS/TK̎}k!`J-F?ɡ++eeiFV sHn>ռN- ~ D[hJ)F} -1N'Ԣ3g'fUrn)*0hgC,^4 î)Re'fuo!i *ūfm&]$AM,ЩF5^ɎEoڪJ#nDt1K86h%R V KeRPD̤KXYI >lyg>hAJGX\4Mao=2s *7Lgb @Jޑ, s+!#g]RG w0IaU\)4$vD@-&w4*R)(͐)DPۺaUV<ܛJNJUu+ TYRHB0M®/3 -֔CYcv4Ӡa*jUeI$nSIN=8 5frg6I2oqN^deYK(}ґMXSvǵI9bL~,$Y]FS :jrKIlY4悓"+SG$uU)3 Lɂ5$Z%tE8%PR9 54L{pZx-[k[H<%r* yyYQn n-b4L:Ny{ߖguK8%RZp&U6>yO &q' I\8*2uInP{mk+d09QiCо^TUi6Ǭ&.N,jT0RHo,x9$+/h imVYrox!E"{6X)waS1JSux"@Z֝BtPOTĎV$?4&4 $OJft%KXRBa9#Xn7M uRMh Iۉ%N(, APDԜ8wBʊAYZTܜ;Jj<λ"tN19-˗ʼfJ(q,꒤C 򸝎oQl$RjsE$M4Z-^ %x`5:*OB0B8\x@zj!ja@o`\c7RR,sB@<;@11J8Tu$+| 58ʳ$CO6+<;vR 2=ޘ|i_e;x8Ck'~`PBJ/h jtʔ16ZK?et).e(րnkI´3O׳({4cXL*mJ.LvTi U.Sq+AR{ 7e1@M/ T.0Re 5 KH`q Y̤8ʒ-)[OM*>0.x%s JU(6m)ZdBW,m!gb)$ZSpZ Ѥ˭vt v`%|l39b>vyJ#ؗƞ<"Q3KNƭWe8glO{luWZYJ4c Lm@uEU"RT4߁F`)0˪Q^ݕ " xb31B]IN2 Mv@U(RI S3KˉNO"ej.6H;C2jDΒn\sBLWp#6Z(XRN2*2Tլ[>ge#LI,l/_q6(4!iAM1|0JU%? ڒWZIG*jlR K& ,f8&6(hz)4ܻSB\V鵄/Q$t}쓬u.)CV~Ht`I,36KͤlE8!4j5e[XbzZIyO6BԓĎqQētr:؅^n+Ii S BU掲\=>:EajT&9uA=O+@I"yK->O}rtqD=)^M!EԤn>+&M"yukLBU "fq&^VeRNuL(y %`kЧhR^\ ޥ'1&Zᖘ~̇^Y(=`^zb]җBu4it{EOQ,S2JY)0<6⶷.1|96Y 6ؗmHHq"<*Hiyou ގ7Ql $.kϚ,˵$+Xod ; 㫏̺Go%R*{|Qϟu ]'7az@F"NNWN^Zǻ떣- PثٕlP犄ԽI@3ӌ)+RbN/]qJXN X0fs ɸmp)\n0cϯןu2RlU֤nwiKc.޷W~7EH 6 q=8+i!ErOJ%x~_sխ$| bp2./9u q)IFA %M4,hIPZ 6U7#ʅc )d aCmˆ+cMPOHuH(lK)꬧(Ru ۛi^z:ѧ(_Tfu]q#PP),0/p{ 3kX ;wsVMIL 8zxS p'!7-KpUie'Ym!꜍t`6R4@_K}Wt^%7_K=W:-ea@*3C,ka/J4ۉrwN8|x?rVUo&KOL-fVnz:.}-?vM~WlJt6> i-x Ivgs}͉/ߒRS[mej"|.Vݴir`_I؞"4ɂiF/E5wpU}oz._uh@J]}PV^_3ZOW{k +&}o~H"ZX2^Ju}|Mi=]%"nA'uT,4_/'$nNֽ/Te-!"l#@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@xDd**Z  c 6A?figure4RʀEqښ7_ VFEqښ7_ JFIFHHC    $ &%# #"(-90(*6+"#2D26;=@@@&0FKE>J9?@=C  =)#)==================================================&&">!1AQ"a2q#BR3br$CS4Dc$!1AQa"2q ?2K&t>*@$\ W* DK$d0.\HLa@&jI̱&ݥ~yB.Z@6*!IHe !*u׺Y(iǍ\IuZsũѐIqt\KKR;1X 5/o7߶_1F1|L'.Up?6tIWqLl1-hÓLd1#!9bBICɅw~h 4[܈:c_==tEd;02%Eֶ'Ӑju Hpa9wmYwCMU,IW6;Ĝ_1#B ̨} 7c&L@C/YaQ>&1#s=F+ga =jFxfE \W iT֬'b&E3D)`@rb5_Ƙm~,s}5YSFNY>@PytyU$ #_̈H1SNE6a,M&;mYTv5MhUz<l@JFD]>M;I@\,d+ E >c1DC;H@,n(w))U-e*_[tַr7 T*/{#QR^AM|ƒbKW ԕyO<ǃD#t$>#_!I'x40aA$ ,|J@|'y7'y+y ԗ%*KJ[Tn&yDT7n|F ).1^<^cpwC2uUc#[~f\AC}iӿsz g%&Ptr( ES?Q֣dV 9\g^vWlm=bG)܏㏘ :TϞb L`ÙÑq6briqg|ecYUuY:Δ8LM*ѶU1Rv7)}X G>>(-A4,*݇'i w|yF0}6 2+f,ҿ=.Cjq̟MeL|ƦEX _3.NJ̣Ez2~-%l 鿭{]{ѕ:dۃȘ=FNjSe5go'ٴ7ޓ0#.8Q,JOΆVIՍ~: U\"nUX {f<2&eċ8im[Ir1WmY<ܬi )şU_ov*i=,**xx-EqTBrd?zʺ2i޶("ep ^ѸLn$}{?X:N6o2%H2`u ]7R(lH"|p~#3{G #}s84ͨ",֫"ѴCJL'.,';+ {[lvƬF2rie +}m$-$er]P $7\I rI%_hI%WHRT3CJ6VG1;D=2r#:6d!mgޘO'p;LmSGrNv%?#ruDbAA LϘ*B@eu$XYKՂ΀rTi=:Rh#i%suR|` pvxB7[LʰdU$xeI:ebUV)xUVm漎˘bvol1ٌ6\`6٤ڸS;c`21(MEA&XlU&4N6m^ɫ8E+d;'@b=#XPOcps"a[q LY5lLT>NQTbC)6Yns3u:=*Stӣmw#곫.WӪO18qn/6flj**Z# 07NrV\8N8gVUpJMu 2Rv*1D9x8/( Pćj7M:΄l4P3s9Nr3D]M؏؏U F 4c[eŅq_O*BKgCx q2̌Y8sG s+'hY`!~"٫`!X_eAxYа#(NQF2kHv45o2XYS]a}☶|/AIF5ZiCa jZ'PvX,0o"d,H08HT@l!lvt6|HɧȐ$%,"J$O 6xCi*@wUxHMKX$JxH\KWHJ`9#~ Yë޶ȉRqbV&]\txzi,s9W~įq/NC^hM̭_90h?N`ɖ5d<Ñ% {+, &~`8>=\V&,LuUڴJ)wVnpQ^vyfDNEǵۇ42TCxs-TA6~dZ W t$5@0AZZu9dŔ@ tJj4~Qs>wAIcw7C7^xzQn> dCM_ѝN?_={A}L*.Iאȸ1.@JۥP +F# ʨRL': bNOdDP+UBi¨krm*N? \u:(Cx-AyrLدb^uRen犆sP;(nPT 󴲤m&U2TZT1C+fjB1Á^V D3uAUq[QM(CDQy46cf ,](KB("}MPH5/c+yb]$ RUI.e@$%T/m.V˺#Ľ&pq`.clFeatV6\.G<~<[ &/'Ǽͨ9R"-YDJPDT'-{$ X>O;}BCi}7`.m̎tߴOLښ|D=6-@c _uxV< qdkD#!Is i"5L3.dĘ^FLIh\V3Ukb!|ҟ\ e97X #(TI P-ñju>LiFNۙ^p(.*OWfE3gLzY5ҞU=X, FZ˃]U[_сzXVm^D$,s xVɽj% Up+Ҫdl?vD|@/3x" Zcuj=:szrA8.߷x.L ȥ~!7L4f`e` uQnɐ8cp[g?z2r)UP 0^ِ1#`E"7O4!k쇧Vl,Rc3VLٵ_g=4Pz165ܽW4I}.,0(:nw߃/[lGTp~$حvLhɺjTҧVNB@dZAy׮L_-wnd^i믉F,6ycÏqLQ/kÔZRڌtF񋐮 ꊫ!ǜ ~+#\|{yǃOY' 騴a \BgԔ}3Aj{]2 tuÙhu`MmO)kc@ 2}􃐲 `ķwM,c'Z% Ke%Uo)p @4T-Fb=!]Y>eQhL{$TN@>E oMW=$Xx! JYJ̻ 2It`d!^Ѝ0$s)̚m u.B|dnxOc0E;Ɍχ9k\+P34~ &95!` u{ߴCGywWu=#uT :<]xžH+b]?`IYbGJYtI)9_<؎,)!nΑ|ٜ0/펩;[Hcs ;/J_)7L#S{@7cLXt;?5uԭu'sK!vDҸ['V,WR6LE Bw܊qW yF\y"5>H)ȝ"3u#;0,/&Lwrkqwƽ)Y:Gpʻ7.c.wu/qGe ؼ{W+*)􃋳tߩōWI7'3Lգ7+ܸ h9qˎ~_i><)1-erQq.p$-u 1:l+HvkF,N$haWьn2ǔiSNONعfk߂"gg uDaQ eǑ&i%R7Ǫߘ[iz"P聴ṱ H.Ԟ3K nOYeܹB>8&+!aG_vr$r 9Y cqjXs|8_J"LI1ѪڡbCuVJ\:S.0ŝf>&P>$Mef3*'cB?NVC?F|vvH]  33CY3/J}#śqd" .(hXa Zy?;>\x1hՎ=Cdg&L_MЫuQmRy~XgRMrN ɐF|)2,=1oNF Ab(JkInhJ8Xª1|=R+fG|=nˋ?pŶLG)`?Ƣd<>OAnaϓ,L sWH3Q~`ұt:Pl/Bq|?h6#aTX 4UR&0}UQs`˘6Ew7'@ucЋt|T"Aյ~&I$WS N"yIĺŁRd®W&po~aȪt75oS a 'Ȣdža{Au ,62NM|JFn ]b:as@0` Ɛx"?C!A K-ԒI1l;$4j02gUk:Z$fUJYrIBJ'yl{FC."MX C U%yJ ;CBAh2s'S-wԲ f=:|}2fB d:8fC^a_G3);fRÎ<62gkc#G1TUTr(Ō { }9"VUu[o3h-+mr4Jv2j0Fk_b4lvy"LW7{ 6LڴP\ wW^M8Ly^6 9a}g\gS7kQ9K= 2||(:xc&Cf`E 0O[!ؓHSۇ. cu Y&Wt ^6CJ_px @Lcae JC"dxk2@eWw\8y'tGN2 L4f\ͫ.oPaqc#90/\֝EP 8*5z vmM}  p;19>02fLc87z{{N}W?P>JM f .?i8.ЦXzvVkR}6u9#J&vW8Q) ,iE-:BK_h=C!lc #mGhAGǰIOb+u>ҽe?ٸr•&Lt5&Ez_`4L!niLs@RYG#3c|4 B*IEU2ť}ǔp NRު)I?Oh9@d7SļN1)"EWd <F`:Y~2#X2L=2 9;8רɅYw#:%}8*"FfymiT_"g}D֣K.=\S͈}-1"0?oxv7YRHYZN6Sm 3dI$%JW$@bI(I$'2/T.\ 4J21.W\%ǙAiȂrr95fm>ȣtR|1TNaf x: c{aׯʬ>@NØORu;Ԁ5A#hy'oQr4<^/Mr(<8(3a2)_Ĺ:N@o (ŷq%YFvd,t-| 16?q2͘l)W=W*}{a@=f^ =@/m!p|BP/i)̤^R{4i"y65Zۓv#XQvLlYܚ5MCmA^bij;F)o̚W$5@J5̓sc-~`.>;7PI(׸z&;ebukIҨ~L#eOј&;r͹|M#mҙP!ﴴ\tY隘d26W|lG\4%ibnVmȈ =%4eӗu>yHC1EnXzoˇ* Nk~ \6߃'Au9==p["Ȇ3 L8lqbՄ/1H^q/It[NF8 /:pۑq:zV[W}[tyd$|ǯұ2*DV,mP?`=*"TI?]/P{fhP\ڂ#z>63_UTjݞDN%OCPk|2tcMAg3f.,ľU5vƄ6njV V-L*ZnNSW]vi%ճvu YGX1uM8~L^f$;ZSyin_i癫{hyzL@Bef5[ ||Yŷi5rykbun4.@Xܛ h|;|j.(% DЁޏ|ɇ'DJcE? k|ڨMByx,tI%-dmyM\ ubm6e1όjنӍ]?U"fLue=GN@Sz6c®JйCzQǢB9H oZCN2. 1>ir>g1w5*+j?bLGSڿY9:/prw 2':7HVjv8 ݛٖ$7. =l6ݏ0czdJ7pePNnJ+R;Jɀ01 l6,֚{u*@8~l V-:7- mϡUG{E%HRqZ+oruc/0 %O؍6e`o2p{ٱik }߰ @P(-B# $@\l^)JaDȁOd|RDIU=.II$ %Kw$l I^ ˨^2eTWxDn4vH?[dl*p/_сGpk hETT6?ҧJ4/Lnl(} nk~t `bU_/y??ǟ Y:ec_~o"r}s؋UE2LcN1MWaj[N&kfu|n_ޟx [&6 ԫY$^gMMD&Q8Ru o3 4{宵zcs+bHs(9c, \f#@(W1x:m}VZ f?vBE+]ɍEuNFĀe;f8ϧp 5:e&0H Y? b_QFd͉NC-L.xC'M0[0#d9ENCeE5{8Adˣ'xQ{9\{;EM^uGRz bEmƥq;\ɋUuv:?[+e/x }usA|~)Qlzb6?)o8L(j.N3O6D_+e%r:'M Cxu]]g鱵& ~Oa>A݇Faf,!C~{͏ma;lּb DXX\z$&PCW:skgiB P:ؖGU@oh[[}b$ޛ}.6{媦z';1Q YR60'שPg:W?{1P۪dֲa(+ )fl*NOѵQcV8mdݍY:f@kp@EN4?Ik_bϓ^;(:4ii躊O':p܉o:Ϊ#0(rfuO=+o"LW>_Gʷۊ+#,j\7ھc U~&vKKnѪ@KwcEvP tcP2UA͑u(B QUP-h&;;Js>Q^Bx0Gߑe %܋tryOƃ*Mz(Lm$cO;?S/?E"^#⟥s=j5# T* S1,̠BG W‚F7{G&O{CUsjq~Cz= Gߤn%W㹂a̼J̃i &}}+v'O^}}GP2颸7Pp7Ypx[Y14$٭r 92LMM2i񶴥@ 7ڸ2oU%@(T}Xn$KXqnБ1JAsOPerA>#EhAhoyuAy3D=*j:Tb teKNkmMf8E'K%0;]1%I:j 8ZCh:/;z:skc3(Jw$J.98ҧ["<}K>%?1͍3;`DIEn*SdnpC'Z9z\X"I#?v<$P[)|zQ428QGdrqױU~yUISJfSȭ%sפ/GlN[W /#K~Y}n~Id Sjq4 `X ,[qK)q-na2ZY 嵭Hs26wmḍsuVlMT8( "/Ge77>+oJ/o/dUFZ5.y?2П}\.FA&MXِ)0 >dG/NT6ptau1N.NMЊ 7mNP"~>6?.Ǚt$iQR'^K׺?s#:UVޟt2|.et|kvgM3IqaLrX,7T o@=3j')֙T#'k^ v (ny"eACIW[^ЪŞ>\!p*bM"GCu >lk݄gqӐϐx3qȸ{ #:Lzj^ze8z&akG?`fːlB5P_hsd5yu9#(U,v$0aF_t0҃y"̃3c-}l§)Ǭo?Mz01]N[m W_7+!p\+g:ߧeΠtl}^n;ܙF>(e>L93cɋ3a!_2c9&ni8W?\ּ?6&}Lw]v, [2HIlM87onei(0`̺lwS(u)M lAhy5la8 5![r6ٔ5FhW:* 3˱xUj-Lx4& ꪬF"PLʯ6ɕ-/nؚ J&gF Bz=diQr8dv75]"Cڣ#"ZrI11aB@_2P&>#QT09Vy(x\5`)ɩN&5;ٮV>Ͱ#ܱήϧ׻ơrj ZƄU7[~[!E@N|pLaKb>|ʙ=$nj`Ʉ: 3GMxh츗60.P-` ;нtc\Gո;Ebt-ǚEv.kZ5WnaޡDjQ9C̠[o@ALlu\XT1z(Jj KUJ]HǴľAR%xKrT \(xmsraGsx10>J_O`}:: =ȝ ( Gq9dzx ;3yu-,5|:Bmטu:_R b?9KLWiSө l 7]jي59;\S 9NR{ 9Ƞ}MNGRU#K9=?Iҿ݇N+'RWJ4=چnVqQwfJ'M~&U5;ˈ؃"ۑm\{QT(U* pzAJ(ī?R5QBtl74ȄƟ}3hjpa`91mj!.g`˳k޼Klg.|ELVN2mC9tнGPr`BE%dӲc j7Ƣ&l/.,vUyLkTwb,X[3SVɈ`2 emJ5LӶTƬ,}&w`DMՖKC۳~ ZϋS?0[锱a2EUo[yl ަ.ܳf>6W,0jCəG+uǑ^("Xr%UƼ Z+2wc-&5+hVUR{*T ̊Ny!#/OI, "g^:K~OOӻ8,٧ n Ӆo/'>wﯢMX+~,DŽy:q=Ebx \ `V5&m*U;nF Ğ=GKJQ0k-Fri،c/l!M<ճKuO3cRۼ}C&~푏6]vͼS9|~ OqsGW#5goyލV;Bu*O:e(2ݧO=22ua3n1 ./ቇS)Mq@@8"\eLݏ>l=Ca2ig2I:l$F տU!_{Ge!\hѨ/\gPq()OPY\5^өZIR>EoS:Qٵ_2sVN_gɤ +hեWzmSt׌?)ٍ%e\YW%\bj`]+cyHZF5bp}C&aG&S翱(zs͓38:[QS͛{_kqj3}OOLza[bwTɔSy Jn7D BBs:t}Aҩ|hqގuu.|bKIƿ9!}e@b;B>UN#r1d|yϾu'm( &Ld:L1AlX9ߘjѶ]~@Q=MJoAHh5ʪ+VB~&A2jb!S1ؘ$\EՏ(ƞAqp8%Ok=cv [#jM5d6xFvc ucpT4xR;*JjFԽy(PV~GRJl $ohA:{ՁJ} =cW,t5k!CZlYʌ7ߴʙRxqt&0~[x?Q2/ON\vxT ".8@@/N"Ó&:jQj6< 0M c8t4dE raJe2+|gRG PWExF~BzJrK'DZwav3cj澟 ۸qPyE9.NjWNֱrzeWtu蔾,e]Os`aˀ\kjUCiƆ3Y~kɧjzb]:V;P͜i(YZc s oOMk:|Tv-X6k8ly3/l87kXt"Xb1 0A,Vʉud+Ki@rO`Zdgҿ\ e$;9<̽}?E_B4T'k3 1d˙S|`~_]WC􌭑7^FY}8X:qg!sD31 NxaOY.ـX&b/AYPy#(f~ \W9=8zf=>: Z+~NWmU5cUh~6jH 0%f_P)ac` c֞Mګ^|FcmbY r)wV?x܊[zSEȣpbd8]2qʠEE\b]j|Ab@#$t4VCUC'uaԞ>U#}/I`Pr!,Q >7cJŘAVK:u(QR|7!eT"yJ1t@9(^ee͍a7Bw*-g}O0 lE̟m0G[#zbcśRMJѩ@_qGbŕ=,$MV s(!P;/S 巳\@vcfU%bqzf/`y#4iwYzyXwjLJq,HI40⺎Z49瞙3t,Bm4G`'r;PGue'L~dSff}RG;OqCJdr:|#"yz\Odң0>ZO{䎗6Gǵ 6{<1N,ˑcyߛ]QOxK`3bq~o4`'+3PNBMM*8 a},>="0e6ۼX:6YNr l(&+_^E4 ӼxG+>V,}&GcY-DQH8I PUZϪ^cbY2rM2_A}MJS@"t/12.x"wC5/QAW _f1ȻtUS_ˡ]#xQ:vx!q۱ߺP_=ژ8Qcz{`heFHG3MR+hZH v04A`IW%,+zό6u9qږCkpcxI =Ɏɀr6dLWh>yBxIn$6*A(D\y]NoXgL~U1ߧLuXbuӪ?ԃeA~{'&7掹qVq*טxNVux/z{^tt9۸3Z7}\C/50gXq: qRܬ00 |#}Ɠs>3ί.@C?3)3'&G/Μ@WbhCW>Eצ,Z S=e4H境cǯM]J_ ./LQnf"@ncc\bvVF=;uΒmt"VLdTEd}J|dFN2{Ę::jlf&D&C! 7;ʕ=X?n#/bqR[bQv'Uc jQ%P>yP1#Ly 8"*XlDk+Cخǣ6U2@(6&uU/o[Ә똱"X1Zm4mv5`lJC0"U!LyY>vZ R~1eٷֽOr{\p۸rS/jҗ7UsK'QvoVB5(ĬY|V:+LjeFMjy+rcZaP^I<зR5T8Ʌay ?ۑ NǴV3cFT`o`?#ьVSbX]+-j0S㠿2=?lx4{ a7|wkIŰh| -`l` !) ilq0AhL` ZSsqt͝'hSLpyz}?FO|c>5P8X'TQ"ݍ=WO?OBI:>fm_/!txNv;SP@M9.CMK70*v"o[o">2-_-ےߧn$,nn@~2 _[skSf8M]j bz=CV:cצ{LgNj+f~g܊ LXUD] .K^{JbLisHj3;g̨n`t3wZW}OS}ʹTŏԦ"@,y15`'Aɨ^MLu=?X"Nn\*N]T,kbf7-5^wG,qA Lv}2tOYof&ڛ* V #[vPpG$48?t8{!{6%t5Nv<01,}BRƕ*jLqAjb l6 0q32rV2Ej`BNiE >|ȹ}W ],y%@\(4Yl@zJ^ L=f!lگF#-@I?mX5Ģj l5Qjn}"To}ܘMmG)xPZ[A$j@ ̹HX⦇4(qYNԟXOȞoUTo{^m)-{mgs zy2nI,#I7T#3m| NlKc{fuF?9rڝkҹ;@A"d6+_ ,R:8i36zI &EiMq4w#]<IBLX[߸=* &TkCZa\cS 5ͿwL@a zs "`#5P<,jnnaIKE[wCxrXa;5G3.= vN#Cn|OG;Q*rG[..qcz;1N}~VN5K9ŋl9Njv׼a+m8źZv=ۼϪי&]Mgciu a2k̺8/aJ:w}Nۿ;AAV 58x1:.ǮTcZ@Q6|̸j1 ҏMC`|L*=\I=#ٜM׿VY5pjd|i@ X:W09Bc + 2i "8VPXҥ||CQ!bmdFO],k"QZU,f8ecTŏ"pfY <C*=pDy;@9~aH._qjvhÕUl(x4%Z1AW@xp6$6ۛ&6%H#.V`ILvrzh-dAfYH=5o?2l6}6aerIb b|@,ۓJGZ6- byeĊW4uER~uMj@G(d I7h_2$8Tz7QwBK@M9bl ~v4'U ӤJ{Dj sRm0X-` 4*g!{01b0YԧȥcVxqdE2;\ Pۏ QuBGP{]_r`\hkf,- dڋ1cHmv/F!SSZe@ rdQ z(6mGqğ1y"e9C8#?ۙZI#onŌQ-haPN-%/!U$`#)Hs&&@#HI#~l/ WA$Ǣ" Xhzu}W{;LN6bɍd 7Xےccב4XB^K(4cV5W܉@IXTb"zr!7V6!vuQ N:}kLV\gO]]*MF>)#2?=:A@nO&LވULa-h +5z@F_RD*0`{!:N%< G=+:Qƫ51 6,dQIZv1Ur;B;m,xInĐ m@Yz0-Q҉Ue"T3 >"r*ҠQ&YoIv"T@CPX#Q1W]ms1xFF5\xCYlx9;/=ۿ!s% Adu()B|?Y/o58͉7,@2 B)ɣkj<H! hEU bbh%o֤$fUsQ fMWɀ rm\hU` 'Dډ iryS.#,/ j^Xaɕl1#{M"3ԕxj2.鍔QǝAHa561%z@j:GzԻ:cVd#Mz$&1X!! Տ`E 56#ۃhu15VLErY"N*I)>'W`f,L[bn;IN )Au '$"y>b}Upv&C @һGT1w&7U&; GU"Gwj1w,H E4RLHĚSaj8f&4&1@PY6#FPxƙ6~lF\`{#-^KUHoKZ)%ӵL@V!A8AFZ̄{hƽ ?[ZX$ 1iV[)%5HMG%}*[$DQ%"Dӱit#8˪KoU9R2eE,u=%m-1͡7߈n EPF?15T>e5FXz Jߴ4Oq&[ )xg%#SsF4B80%[0FaK>QD_~ /WjeQfSUez~e8[E0io~7U:niU(;B)T $譑PN4ejRa!|~䙫 oJGoqA1!Nkdr/9G}Hƃc[vIVKŤ7(8ӽ@IH{Klvll"G $6="U4;F @M]VxD c$˔ۉ{ }I$6s1asK]PHT@ S7HXf+Vx&ʼ^@j)qn۰d.P  RyKq ~YnRBɖJj?*r0v ̬ds VM|!Uن*O%"zo3}N[VMSɯ7ujn2~a-՗!S_-5̄YYH\VheoQB*p;Ʀ(˶(H= h` @I R4=ulWym'+ݥo{KUh6,Wcbsj/QԬrwcI 5*U aHaYt;4Ylby*&@:$?CQ ibAdq'+WF')=DppT5+ŏvcdFɸoɨx{L] @"Rc&oT wȌYT3I 2j"4m`HǦ66OAUb.V\T~`k{ۼY1ga7R*XĤ 5 33hއn":xbAN(JQ$n) >VbMm޶UOȁYȋ@\|f(V1ǷpK(xhs|ƴN0v &=ly1Nҳ*"~`KX$E]7J JTmLM77؀ Hqb@5GZ:1 =;FP6 ĆķrM hX1`">ix-kxAT/cU0,(}+IaHh]о ,VĢݻ6+-Sf- ;x B~iU8"ɸn#V5+Q 0W̄ Z`QcD{qh ߿Ϥt*509,0"szyP*;f;jceb.%e^&U/sV!@(#51W1f 0  -#SqS•̵i_Ixj(<hUA5 2YaSm"(&Ř3QR$QW6CȻpo೾M_sUDђPUhE9AդPOHDY/ FVJwhU}UD mn;V;e+{K|ddv=+?qv3mD B 56ak1gU$i-OmÒ hW4EaLTFR8Ou60XiPƪ,7$ Nq ڂM(|15RiR1av9'[ȩlAxr@`L@qm"Ǻ ECyAMs)YG?XQ4LVCdQH ͽ( x@ $Bv5f^EZQߓ$llmd"/2U,c-1ѓM6 _Bknw=) cPOk00 6;$i!{\а̍ME}Sո%aB {Ju?'%Ԣ}ds {CFXY\rI04PtTw(s|s)B,40+έqA!1d#BFn]Ē2ol9JGmHszrQdC`7p;NRLj 2Ϸe`T$QTD` 1\A@Ɏкto;,^)^5daA awB#)0ZmE6j@״WJ &q<6B+P]X2>KSJSw'X jaXsVa2(dGDcXRpc3H?Ry&]XvGYW0pjBV>$V$ﳼ&͚sgP-[9E}>ab}`6Q@'ݟ1 l8۷x0]$:'Ya@2Vay;WU&|Jü7T_=KP* ̽`(_i:r V(m hs3xQ x PP -N߬n(Y &Tt}z ӰClhq ܤقhභ¶0+{Zut 4GRY; S{. @-ĺ/i0`_p80y"$A}MVN- Wڊ. I1TNl$B lL$Rߘ/J DR;*1xnx5Î$Tl*x=5c RZWSk-lT|9fB'ՔjPhii]V,8Bϕ! 6紬m7}߈Vpj206c \UI(70t@4-0Hf0 u{A$y Mҳ*a"]|%P+* Dur [I8&VkdRx:MjLjWJPT#+6 CZ{΅`V8jϝ p{F5 Th(f[#zFfa{}62'K+@DyRv+5+mFzS`V!cqNoۼ?J 1Y}O#hc}ĭ{'O#Z$K7mgABIT,Kaf,ӌ n_0ɋ 1PG7#1L1D]mO'!,~6~8_8cRAvBŔmQWi6@I 2k@a9SB$stԑO4xC mtIX܅j *PĀ$]xS i /"D^"E ~'jR! su`sos&`Tn-1 Q9\5) N5,?=befӖ]0T}o͈UK88. =Gc CcyTmx",9X2nbQaQ9Ӈt+!KD)+4YdT Α7o=Bjn.:GfUIG5A䫂U\6;*}]fɤm̵:'8}BZvm(ڀS͂(r{o(-؋WhՉe[_P`]7qRal!r9bjMḧjsF0Ok̠Nl 0 & ejVWYv)7l2M[d_*|IZf6Os xZlW?/c(9& H%EMBdӏ+)UpҲ>Q98ڳu,-x75#u :y$\%ZBoy1 @XfT!ve)[W@ a`PO4"V ;CA(%U?-jG$>L,C%/hxMh+ ob-1-hbB vF hazV,|FNj ?h2~{cKvTVRHSđbo`  5Es2"mmDbVU'x0 |@ K 7 }͝m&o8` ]ҠPQ{=*Bа}HF6~&h&֨or<$U T H1:iy>&lGɣVlifzS޻\0*A+['&3hzO65WHV[K$6 ɾ3pB>Y.ϣ3NTަ{H,'cvw=EP F.;^$]L'z'L7xۥ*8&!n 7y}n͸Ub^SPǾRHD-ER}LUG1cKIAFS0}@vBpQB{D4#Z*4vI * dk4Mo *&#f\F4'ee}'p!aaU ) M>ac個y* 6?r$^< Fr noY-{} :x'bu1+DJ+"5 iaD,BXmBt~dD%lJaza*jCa-HLƄ@.06I\7ƀ$/2Ґ $CJqI%~ $ هiDdup  LA28 \? figure2ImageRh[{mpKk[Յh+Fh[{mpKk[ՅJFIFHHC    $ &%# #"(-90(*6+"#2D26;=@@@&0FKE>J9?@=C  =)#)==================================================&"9!1AQ"a2q#BR3b$r4C!!1AQ2aq ? nv#iTUAgzOst)qҫEU@G2J#hc9 饋MCa84$m (`}̕7!N* (\HOH؀K|]Kk+DRÆJ]9ƪT_c_HJ&S u E^xa&nKIƻ7ĕW"͕UFݡj5 f#[b5̑wgN`"`:x lXtMtO}YY!qQ."M1le{m( E:H (W}@g~d>w'@-{}$čy5<{@l;q%q%Awɓĭ1J,j;,|wܞ>5\)b$ԢvPM6%8)ScpO ʰbFc@c ۚr@ @j5)]C(s,۝N?MCx0n66R {4@ȱB ȋAg}-QKWQzwSbNRQ|̨ 3*y(p)r-ԕ> Fo%t>x k>NBBY1LR*Xc\=do,\="@fYd6r]HXc\㛄|ɡ-\&qoGțEr3><+p.*/'=_)whj7:u'yDK-:yу' 75@؁ESH>w><@1C=Džud`fA` ;YlbbSS0wX*ULp=Z;t'WEr(Pa^3_ #Y,*fJ '~P%N '>2)T ߉sh,XX*0AeѬp<};\>ӆCdIfaha!>$Z7{qRʵ,FE -MI^[ {}l`nug(\!I ᥉ K}HԦgn#@s A(B@"zGj2u ]N\v'6O< O berzGyځ#;Іck!K2/Q[P^!sn`Lo{Kت&܏JAF{Z#"Wfh@ ;h66 7^EErQ}J ǂOhszDzL+#&z棢y1Ut#PJɎSt]NY~7T.]4ko0!_>2iFO&FY1jzϹժha̠W6ośC=$UʧWhbu1:vLLSTy|82LRKf70.>)p6p)Gc[Έ]haeii<P 0(d2%3h H2,оL.4Ĩ6}&*O@~T0}Pm>N$V_0QFǍio00 . Jf>\ {>5Qt#8hnF1W bopK- >: ڤ@旼2_Q厝T!q{Q Ӳĕ/b`.hU%O"CU 6ǘp(DUrCv ˅s Ċ$[ŔҬc쬰!èW< a{ uvKEbE$R(N FdNw7HD Aa CGY̕sZjx,2ުb(x`JXzTT!N$w!SK W%Mp 7J; dDYՔ)Grik-[J!hltf9Vҟ(ط4a ŔW⠋o|+hZcR3ExL@j=& /Rb4Ve۸,ф|6Aʊ8:/iga󴷧PmbLx֚+3q9`mg3|`bgZ>cMf2C`%\F3  s( 8Vpr%bPy1P=+X_>]-w]/RH3{a:=21q;YhØ!ɂ-@DHBq\X5:\ Ђ,̵@h<8KqaP_f,  NH |4mBETnblQT:G K'y  zPOR,-K.1Ð B ` /K^I( ״CWw2o{P5rDX;dipdsȖDy=[Ё({ Xkw.Ɓ .;)a}T!4ߏ" :P8mANi`jLjE* dUH,s*P!i%e)$2Eč$6#C &[ U7d]@pT),SɭrWs# &2KQDôZQ'vCsR >QNud B`~))xF}`P},+3bE2!W5caW{9YI l-2kهEV͏.Lz2su}MT{FBĈ7kI`}ಹ"2taH=98:5Ɂ$Ԋ6(<;C!iؔwƈ?3C @ G@;j1UsPMSlG iwLȌ*JP 5@ MA#`kdc}$-`;DrZ0*e\o"z9)JZTw~&n]eR 'Qy\7C/T:7 o0EiTWTȧ2,8}wqJb<G`֟UJu<FPƵi#WzUp+m#us.AvɋbW5ǁJ0/uk+X9H#h3{K.`ѵ +"X}'M oFU܊X67>d5̩_I7ڊu@V^; ?P$kKbQ{v" Ba&YAY6Lf*,8,HkGveŤFiA!P'CaT}OT/gbNJu [ y\RzC1'a+lA$ A3%?yStf; lJoh=&՟5r"/0SzKZH& H+^bZm7Qg9! zhUex޷7pM !]_?Dž"R5l9Kb.S1%vy6u9Q*J9:@iqLa_#49oQL6Yz M |AΠˎp/Ϸ:zƔJbʺIn7,ȤRQq?5|N؉ʋȽh ?o*BbԜ9ʍv3Tqe 8ԒRPz'Sѳbqtۛ0>?c+2tõ|.N?2.oBqwGGr'Ԣ滉8E_ '\ PN4[*Cv,peTAhhk5`]F͸% B5HٿA_~ =b=VSs'h|nVf60ߒ|Dq3>*=.ǴϖHw$a+6 -4h<%!A;)C[Jm{D*د@b?)K,%0v>':Eט|?* Wq0M"imCmW&PO B}CaCfS?05}eaoS_aWI/|MїJw90+)7ug?e5 0 Q@wˏB죒!y3f@s^&?_-+)Lk4%ϓ(6?xq4aV5~y+`*n򟙘S`O_6\Cqz>=ϼs\!Rк>,WlO1tQFF60eέh6Ga=>t=QUy_BwlP(l'n4\=:0H_{xI @;fF2@Poߪ_N~RBbeWaE bv;?V2z =L.L9͏U; @EiR,Ey)[CLER ynຜg(ZV<5a]|4g@u$y4#cGMu;[k,NIXIuT^aX%I3 pQ/6F &j mT,Mcx}pO=ډxtfWaeF3;Z1PhlX8GQ Ѐ &؛QfJAhy_'7ﺯ@l?̽)KTSWbl=]Շ1X |ƠC|9'Wtj<j۱U" ,p8Y}9w|ō$TW WDjぽĺςw֪X4L~QՎʞG˜i aWb r'4gS!Ս$'vWaV 0ѧWQ."G mśر)'ո'j,"3̕ox?yNLzT &?0uc6F5Zo=WSc|xݶ!u$x>BŀJa)92T8?MdY=AF<]2Z>WFn1-cSc_akφ ]:aÅ1A.뀅 ݆O!H@7}mpg 81L{RIzr쁂u{d-:lN6db}*roU$DMەalGsD44Pu(0C09^)2ra?QTVu68/Q]Ggϓ($3\ӥ-S-;c0NOH_8YfP!B,Xﰍ`!:2* F6NIcW{NpWNi\ c t͍P'Jw4|xQ4q^mV S2f!=0EǗXt7ި)Udͽ@;Af KAE{D/"+:_1k$ [ZYkm+ +nUFW'J\uH!Xzăڌ'Υ!gdV Ry9JZj|]3SӮp1qEx.De|xԑM3Wgośu}&fԌ8*c[k6ʄ*RתǛ.2*eOs|8f yiP cUzNdI"[hF7 ,|U9bsCvS,^TQ6s# -O8׵U>Cv#,,Q\+D~JӪ@d]@Uyau(p}EPoDs=SEҥce.bͿqH'kB1 >_5 ]ʌ{'u㸁 FK|Z\&TzvPc)rXEs1;Ч lG8ǙѬpzqT!xfEnf[xW[1cӹwy# Í7bP.~}/r"zL@hi? SvYtP<*ahh;s)SՈEV U.`8@>`Jp)I  &, laRH,v@Ǎ>"\݅?R0եB#_],Z Ldr9<OW*Ԥ'V]jXoUGig}=읿0N0 Gc1.dtP4 XN6o%eU `&Oe:o6%TBloհT7b/pVZc|*mp6񲄊 GP'{R=`~I IцGH;]1$ <ŕƑ\=Y,Hib\luP^J&Ԧ$ lޥy =ԥ qud ,qan{ %Ju3MVC+!#0V {fMJMLS*׸1߰p|]7a#lT wX؃ڎ\C!ܯ:&(Ͱ fB# ˊ 5?.B1q/]Y8P};Za[ !:l:[:Z5is.@W7H\C8FHكXpY:УHPĝ yYЛdT$b #]3ԒtU{.ucaN&F*`j!I 4U )QKgVMs@]r47:je㹐IJ 6 }˄}T;07a !l/"tU(P2zFm*acfgMJhoG^7z``@eX =Ftm̮LJ ȢDl j$m\pK* yx:ٕW0VΒT:2j"H_И!fd$UV;BW!RU EhޏZ-[MXZ1&o61Q&,PP}g2G B`TpV ,y5U̺7#"k #K7{ ǯƧM0#"o(B /$ _Z۲f%/'/V?X|=J:rst?C֡]'S&7|p&J>yKhkuqd\ c~vw>V*(ܒx.?^R{ct΢wc{ #&FoUUN|1ڨi|o5X8q@WgPu8Ƒwe2bQRO|aۼ1 ځ6(Viɮc0rOf~&6hˠȨ{=i:V̺BAGV]f(I߃ 7EqvE}|;#xyR,ڱ=5p5{R~8}I'|B/X˻~LIUʓeGKaQs0lž oatҼW?ĝYX;űumA_1 +k؏̨`T^0Y>ln>5`Wi|[Xm}f$)h #ϟ~c ڢ=W]>&}[ՅbYJ\cl75ʺlL 148?V%:Dd-xgA2ky3 :VΘzCaշ>T>5Ԧ]ƧPm]K ?2LXaZIOU!(!fnZµ#2vVPk6KGܝcj=q݊vedEz2iK3YS9Щ>;tʤ,|Lj j[?);*1Roឲ?>I{G9&D_ex"vLQXq Ӄ!>$a]X2~ѶZļ\YTk1U i}3/Zոf-/LɩDh31܈]Zq0B]hLĞE-ZkKs/ޟCduJP}7Gvm/P+eʛ2V4'A@O7Q=Iz_ O?G@X5@?u:1ǟ^g]|AnU?[WҧsG#m0׶~R)j }C<>Pɐ^`\f"G&n 6îo>=}s?v fM|Zo˾|K,t}?ABݚˮ|]t)O"~fn]֝ۛ\{y;6M\]H _o&9olc86'b[c}xTm;G՝cOcٓ*$'Ѻnz,i,>ulihG&7M[لg9mXik_0~`X.T܋vB|•T @6+4¶qQLΤsBu{DWQĸƳ"iDl I =|G:~fMǙNv2WRvG0nפltSē:OTc,Ǟ&f,N56ueLV!@ر R iD[:miޛk׿3ѱB9KN~'UJ'Xr#վ;5 P#O!г=zcXKҰ:d6+0jW2VUvX8@h3||ÑuX'P3] nxOᮄeE 1ɞ^gZh9s,>^9%?ct&l =@3:ljSs/>r|STwы)?,c*ًڪ1<H!N9%. @WV}.Ev'@NCН'D0fK.\wéh>a!PV26Cq\~k=4;(wL +vU=5 u ,RٱE&ROx,uU@똎rlb͵W~=]#>Cu.kc'p<ƭik-,0Qe :y>sL̬˟! RVO}{'OH`(w"*19I1}u{ 1%P0tqpsϢ]Pcɘ>̣*A*x Ua#izs~XłO>|fۊ7u8JE;z|+'@JWhM櫮gsl;8:qIJm'q{S.$ j*!êε=|fm|C9QN]0s/9To̾bxj&ۘ>(N3|ŵ)X?1^ɐf,g~+С9+]H>0*aU4*=GtFJ'h t5^pl!e`'4;py̥ F*fl#mgOhRFT׿a`Z5SI,H'@6ti3zKQj:zbTi* +exT`(I,tf}V =Ҩ%M X:&dS. k(鳌\=6Pv$vKn8Va4VU\1y^\iE82ߴ7 ɩބw}d(IVE+S+S$%'İAY@a-ӏ \sf|{{G:]W|2tB9+:WK:^dOL|=#9=>× DP*Ubw[ `AHm5Ez|svsTj3ġ>c]_LQcd̻cIV:ODq2PVFq+ޥj8k:Ǽ)FJk6Ca ePƧGZI$!oĞu;YePA+kc%I"l;$ Jm 'YVKXH!`*3GzhGReP(l@c aRZ)'1|Mc,s[yj;sQC">".]@YTb--H3tå7P(陕4f xX<(s8B lyO_+`0US:I$MXlW)Gqfs-r h *Lz8=bɑ0&,ZM@#ᜁb{B J5uq*R0.QpJ(bۉ ¡h-΍q*Newd1@Wosɏ`̸}tC:K}9fLI?y8ΙcC(ڽ>)^0omԑ7G<}^3GIҰ}##˭U@}3?WN06K4*83eÓaSae]JoQ׉L6|MI5E|?lA5a؎f_QdKv&^ea *7=4raTacu(HK>-.є^[3 `ct4*MbYAogN{ _'$ƺn*ĐCӖ]nUޓ>L> lxV`N,T7(B@;{7 q (Oq:0~sJ&6vb](M$$PJӒO4.gN&N)gZr1 Qlhr&Fͮ @N=,91΋E#z?BmCZ&_L: qb?WP1I>ȏtt Bkgɒfq6O=p_7B|ϕO&n_Nv~XNpa%A.{p|&d}tEE)!0t4W>5#&*EN 5n<:&ÏBR hɍn >E&a"8iwm#myd]&.0N%p9M̢3$ J `KJ&S{p9 0ig<&<dǘ}GZ䏹)|RY:{GzW,(קyGZaW8kM\hv*i/dԺJF4ޭ;0`6>dHRbl1)#N""Q8 4-ЫGHAuQҁE|y yILz)k/XwJj'ǏKbM?]0=[rt2,J[G64L}$cR&:,4Z0tb8tk>a5X"ya.SH_1}LV芡:Dw{3+i:Ala է Ap: [LIG?7i0xW= SĬq}$Q,lnP2ҵogˊE\̣Ki6_&>fZY2'];ɫ¸ ;D`i?[n'U6adb\>]}FI6#[wKΑ8E]7_xJNR1D Эn?LPŽߙSS313jԻ6 T!>NxХd (_;!()I:GS+7Dzx9Lxm#&g NUeBd$amc!TllNN05obVSk@_]*\A ;-, WGqP"X#=500 0Ś#nA3# stѦV^*2O}&!pl/5j{41yBj7{IڸTn.zugGc ~=^c}=&iAJe!QYk]96(b6'`?2l7ߘM`б  ,eƊ{TMS.h*Ų 4=.[`]nvn@MR񩲢ClBQv;@M~j,$;kRNn7PqfRXǘkQ\mCIc2VH˥c nDS"i%[ďKK-Kg3ԗkYI :O{aZ>~p|!r@~ %M'0P$* Y;S)2ITl @Ӓ@h2zg$cgaӖGk}1`b8X.cmB]J*6E ([$`ʥj[oI5 T t26 Rļ#Ǒ&4pbҊ?h@ 6dqx@i*`9)ehv@o8b eUk[Ր I̲ur;˪+7Y JTlK m{C0A#[+pƪ{|h:)XؓLoA"S#KvUd(x#ygkcDΧ̺ @fKr1X<YL+c.bV>4 md2ŰGp,.Ą("Wl*YTV+9k(:$Z{IL;+'|}>JFĵǛ>R#e,7KxNRm8°,,(9<Ո5Ȯ`󂼥E͆cCIiz؂='2zk1UT5!FC*QE1LG|>"o%d!4d5q5U11ƚJ̼Y?hd#JvkEF?5jkɐ0l UXoaZ@ܤפ~ y0 -M 5E缲;j<@B,!oI`#FW% x5޼:]ឪ.sEQ^m͊eل *F5q+ٽ< jRhNN ?8%Gd9f6扨++/įJ\`/'yٸieBvb~X tW]-Mu*#Z5bjJs:>-iv"n L1ɫ:L\"8,vδ?5Om1qf5v.qx!=/NV>b.MŚ+^Xr0Mb=;?OPJs1AJtw_U[)#!2+ȋ)6ߘeݿ.\$q)ՒvW1Xeq^MII^ /~ 63`+MrmɅcu ;1bC%}ԍ/] 楔@9_@ \_'}BP7PO'}@QMoƖ',cKL)b88VV2?_T#TÑ!IYy_b8FԂ{L(*9h;'&J^Mp.&˽tL$v)EoEEW 'k*l +l *uj@# 2 LKyRG'irJ ;vS`g^ElqLNLi%o 7d v٘zH pNn~}6]U E &+;ONzX]_Cc ^}FzAO5\bwŲcxkƛq6ov,`ܒ&a_0}/>pl'S|-m\Th0 Lj}AdҒk3#Rˋ:C>K .bCk?Myp5 T 7vTCnK Zڌs;,z/@p|Ld 3_amlO<@0bĤ=]Ag7a}>-Rrmtu_ɟ-`R^bG(l<6z?& gj2_lΓyz.[qs{p6ŇGд8 ώIAYR2@s.:ˀ Q/Jop,[ƺNɏ'L\!DŅjg$SOuaHy;Kcmik,Hm,kh,ȅ|A ʹS:>x"3]^ \o9jWWbNk,t:X?mYY=I1` 4CP_EVE<%szWqD@*9![ib?t [T] &-bѬ &2Om=?o J ;  Ȑ^Κv62 0_Ž;p;pS;b4Hv2R%hyeGn#[|EzeqqW:E\CX} W0-F4P(h\nE_DoSZ`u*ڍ=XC 0zkxsYvʾ3XR؈k=r0"t^nw%y3C[$34:!'נjRE0#xO:+Tw\BCmb6|,U\z|à5N!oF|ˮH}M6vlJc7$" qĮNS q`H-heb|K-w4;D}%6K֊,O0*}%]6/5BTimaEk97`!3^9; S*VbhBXJdSDvǍh'x ~:`=C}0mo{ר]K,I0.PV؊_K-QNLݖ8ipQMJe%:j[?56@e;O6cu (ID@ErnFItG"/Wmĺg& )ehN`q5rch>T0G<}jPhC7osJAa_"15xAo4 FTcDĽޛ"56;@3{70+CivbCm.EdƢm"3w0HmHPDd^T  c 0A ?4721b芉[E$An|芉[E$PNG  IHDR.:#gAMA7tEXtSoftwareAdobe ImageReadyqe<PLTE jcgZSVzswJCFPu{)%&ӽƭaW[ƳiH?Bx,|g]aۓ登̹¼®rrfkLlꉵtקlA;=QHKنxlqB501mxۚ[|VMQ0,-r835=8:yRy夾㠢l䄮fƖҰȉ3.0Ւޮ;68oruӐbղz|ؿ^bcW ~jlnģPRTz=GDߎ,62[\^Q^[ŻLMOxdkk~AMJ0=9Ϳ'0,# !276}F_|=Y7@>C>@zѡߟv}|w" ᑰx` IDATxliYe)~E!*N\Eux1 6AV EvUE3"\e![g{mX9Z yz17XiifH7R2^Fm)ݻjO{νfc'IQE\>}~!/DKC?f+sAFζlH[C?'ri!-eD_ߜ-dOnJD_ U_kdAfx {2#ɲ-DH~=}wfiT9AD}xs#O'}'|TvÃ>Hߝ;;.v=<=CdߑpZߥt?|h:>xeȞpH?勾'U]LKcxgo^8aɿk~q¿4><BYA8@--!“?u|q[M)MX!rS><'N{"¬t@88[JskÁ}}Oj>9B"B@A\;#'}g)tRþON=#i\ہAty.<o×>^hOѻQT}^#K$ΞzvԅY"}?~`O.;;w.WUwwyt`dtk}=ǎ#}_=0ygV߿w@c oه7 ׎:r쓎޹; tr(ãC?#`x {jzrIίo޻sGN}xrx̿Acp72Nf>]Zu=_.:շmz֝tA{ g9q0g'z2,Ͷ<]P~޽;͌SgHNp~eKgRPVj͛9fAD8(`;ar``P!f$^S, xB x/yR Oŧ~˰BɆ"0ζ@Ia3K! C" ^S}H)P , '!f(-^t<m";)A& + rֽ$dk dl1K f(5qn3/!/;.Ri>/N6 F7ґ;AFr΁E8mKyA&xn&x64Pl!`8t`u?aȡCa8}(1L0̔'0Ly66~2SypA?y`\gCW ґFpHH?c%]eu$݂ԁ3'rEݤ Hdr+!Iu{ |mKómmmtJ֖0616j6Yul|¿FmNF( ަommsMpֆ&Jm2A'8Ձ6zաѶ)6ckmTh+ X絫CG-5?EƶU4:QCɶdMlʝmqh76㴫ˀo;#"$~O!*EoLׄڴXUgm[4Pl[[V(j36+) lNXqq3t`'a.sK@FAFIm_FHz "MhQhUdk8aXuk~3۸PirHfS܋P:ӑ94*/"E7&چL֞6N 6SӆI ODtxsaxǵJ84/)ts|34!&wQ&r94 &W#8{UŘ/FA}RA4p"D/ Hj]ȇ!pa8DxC!p0"[?yur|;>1+yrc_Npc_tes{OyLc/uu##{;V?kt{g?{WMz4w]lr7 ;;{{ŋZ\xO;;#}/X1iر@8vs:hoK;bYoNXر=zED=v>$.u[,̮.-xknSilD['⃱wҁ~rb9&--𸫽K3'Wa0o0W50x蠯nwM+ʕ\|ȣj{(>n# ϱG@10tGuT K}DcϜ鋟^ 51P̥wN_^;;ퟂ=~̧-}'S/ww}׋A[xcǎ]lG/^<Rs DG FT| (lc0w*2sy=~Ab{ˠ"R:/=hu}g`4Rr+sG:mA:ΏǶK:gp:#"O> |P:@Gw\~]{o885u>Z ]+';@pO|9nPZ/_vYvpA~( (it#l?r9B#}?"G?XI ~ߕH`>jۉWݣG>ڭHc}Eu;5-˿z3^<}t* ~u?~g`x!*0_ r>h.0A 8c,Pj;-'~sco {{Ot3@I^3(8zBhT ߹mT\nWW]"Dbvڽ)9}t -c!ݗ.|;rr t ]Gb tY<CA0>Z8#_y:zԔBpʥ/#>OprDվw->ݾ>`V{2pj pzl { A"~`Lw C|Νg.uA^瑣 S@;v Б{tl:rܧ?Jex=X|W|n#_kl \2k1~eP?~д5N~/_ \}]0.kp5e6umx܌1~%5]M+?g;/h? د:su3]Ј~tr~G^=߼00s/uuupz ?!Ca8Dx!p0"a>jWϜ(dꅌ3>y/Btgynv'# E|.ߏ4|-ȪU[wwm('gGA 4$>_Pm "cSF4xeZ} /A(0*q v <(t@ vg~u|̩50]è:1 aOt84;:J8;@ p.-P~B me4  l]2wb.:)H6c ӁП , Gq[VaG1TqԘ̰DԊ0&5(NL28~TAO{ &l0ΐr $DI# 8!n }w"NKZ|wd! Cp)9% Op4AFpgAWFω/5I6X,t0;בd 0N;mls6N*P71JN), `nO;$CAC, B+ [6Պy 94P_f#dǥ:)ZTc/B%=!ªD U} r::d5_CF!:oΚ9)MR:ޟb: pY#A:urk>w Xׁ#uSQ~HVf:$*z;*BnDmYZjZdސ~ߦUzEQ!E*@<8"ۑ(p4=1mܳ[vH}1J`ÄIܦb/B5wFpy"v^T,[8f}'DSyL78O |S.voE t}"c[HkbArr2;dvrF*]~rK^+5,F籼L ":p@ 3-b^gʵ(Y(mż%[n,T6.՚-7l_!"0/K qD*Z@}jAkXM =qɳ$C7 4P"D|XY7p@8R=\ 3@Y.vJh B '۱^ܕ3qY}!ݫ/_U(lNESB;D.k*Z[0_6߁֙ Z}"AA}e8S IKwP'0AAϩ1 s)rBظjY`m^N9U8sM_+cGJg'[6K;PPV%ײ\K 70Fc<"B(Qy'P[eL ψ'S)RcamYͻ)*hJc\8/#j"#I1a+J(T,H8vl) Lᖻ>pwcj̑pSL oz^SPeO2] D륙M_١RZ/+ JeJng6&+m_0Upr S,Ҥ0ƸjFtר\XS29/KpRkLp8c5rb .%,gsl6i0Լ7Srz7 v^w$8j8yLRdΫY +LZI4aV,]--lzb 卡嵚Yi<[G~M8;Fሊ {QVᜧȤ5L&`ĩvjsXG*:UN<q|,fB{cHDrD.Qa 8 qQQ` yL;B<!<܇ tBcuTT/3pSrPbsWS<BL4BoHzIVj؁UI*k5-?&]Jݾ^ȶJkwV͋obY˷B NF9°9 "cuXL*9BDŧQ#a 1mh:XwrLӜU˃ kX\Q) ܄n5h#)ðP펈(SNdTL$a%/,!*8Ş*5;L4jT+к-fDoF!ɪ^_MbgoSפŹԼ6ד-eKyP΍T0 2 x8cAu Vs?S=aK59i i\EBu=˰қ'5 ʸ'Rd##sUD](@(zEg<!̛$ :&/P$" +"O\X{@mRXIDC,~Twt@H/j\2Yjiͮhz$[47zMJ%)$6bluǣl-{&"*?d!(OQ6p±:8FˁRD0DDl#|R.+f`z$Ͱ僕OՕL:$K=@J%Ț9]HʓYSg@b8¯ոyp~W!!2)P|!\3aTQf X™8Gu'|V+GB@# B锊:Q&7 *f[Ȣ^XF~4BN 3jX"(5R04iBW덩 Tǘ ݶn) U뒚+ CNӶ}mndn6.R{$; \}y\ZEi jnd(UZ`կHaP> i8(NBpM KI/@{*W< Cqjod9FpPڄߎ,r @Ap+ba<ȲF^U059^r(,:xƈ*IRj,7p!LS2ljo+u=E׋> =` ZedXH'=sCPg枅2;~Cm-R>k6]lO1.E]olJRc6}!a3Ǵ1Up.Ѵcbg~ GO S}{b oarD-gx> |wƼ,=7[58T.B^e#i8r"TlJM_)U'P8;F{y/Ֆ;PϢy<_X.&g[Bd H=+AEkemHܳrmrHYチ\S7D_)\9Yͨ~6Mk2Y{U![8k/ɛ+0"Ggh ʍzO~{++srPiΙ҂]68*1e[֒-I1]c_u^:DkRy9Oy9mڭ|qV4+VHW f]]Z|/gleiq9ܓ_OyBߋӇ:{.j6{tq( 9Ǎ8s{ݦ3QwP4 -==eIY|ؚG k뗋BV[޼.vnaF N5JCWnqXZc*4 F1 Y(qd8i9L8Hs r$2P3ۢb1!6aFhcr,VӜ&E:]-6\VZ[#k,n6n[o]ɷVnݜ})0ƚǞ&\oqc@}` €3J)GV#urN0v0mquJcCQŜD>8(Sw;Q""DQGQFkJ(oHřumMYtRFҖ![ڬOW,_(,kbvCt6­{O[7e*5(kRD#*2I!Vp&^"b4r i1<[crIcD(jIȽ*SKC1)Oy@:LjU΀7w aocG"k/Dz:x]2MjcG;Up&`U$%c,L&<A@^j/a7&@+(<' 1*BʹAh͎IiqN/M56;so6yZ*"F1tX1!\3Iˆ$L1"]q7pM*(i?KXJ 2dDFZ1~n$֙ǘz{#>JL(KL [!N_\ G4$Bϵ:&f((*fϜ'$n__jeYIV4hۛZkפfҜdi"Ex=i2IjV'TKr䨒G p)'uyY~uU3CܖpKBJ0O`0Sn=ʲ8!K '==C'U^as[Q8@@&4t6ݣ 1E< LtН(2a,t 8QZ4I@F '8"1Ub1΁~X8FNj c o;SW lC)Z]XYo*6\ط,<0{o/[sa(,Oq| g"%@<WAZchAcf+RõaEf .#4S֒ 3E'^x&PpM Pyփ jÅ.1z1 L}װ !癯jw%IrTjf3hS@rRe]+-!|7fs**Zk!;תU[}?=ƍ~Ԟȿ17KWcz;q"\ͶeYZ)Ib:zj/K[&0n{ןSg^|{G(3_,,&k.C %j0SDt~Vf7BWt} p}C!%R_WW/e 5}%;">|JgfjDqŁQU}hX Y[S_KNRAR}~.zQ(bYk@8y-Ju߇e}Zzadfia߃1k !%6>a>Oq#16j'gL r^lAUHD1`u @t,,E1NjuG,B  (Zbhs(l'C <a͖}u-di meq\}iZAՃ1H;.m{\, 7ob(0f3$FxwXM0M,c3@(´輄 2 q6C)[ oqp3d!g+h I$8rg &#4*\TS~" Bϰj֭St4A`.:)ι`M90 SB}L֨ 3q[E8{fr?;mYVk5ݥ+E8WԎ6Yxo8lW keÕ#s4zF"$MMޡaTO jt9'Rd߇0M1ѐ'p:S`UID +Nmzgd|v,)תhܙ$E~23^,,LnO_뇲#ٛso@ S  z~Kxд*2'9 SjC=Mc@w 5ȥ6p4Є0Hp'Ae(LZn0 aµNcд\ n$85} GhحGL ybJww ;0L9~żE2[uEvC:TID*J3$-sGbvrRmYi![ Jq9]+ݗ 7&JxKaJIUApaՂ1Wnj͚sK.WA3is< aGFβi,1&Ϩ< x8EXW@DID3'KÁ /E'T104^&&onOz&#K[bZLzuC:7"Z(Vs^Hkkzuecr62>^(dwZ߈N Q cF"H˨<;Iad @8IuGdQwbb@HșPS AQku7D 0#p*j2Dv&D8J ,X F@ )˜i&xנx읖J6,̔%ѳWsSx핵MVpllR5=sōӂy61!ܹi5 ."Nu|\Ayi꙰cR6‰qipjF& T PNc*KY~ T@ gmFph[$&2 $¬ɜR."tFS&V@pmp0d+:ྒྷo"EZ ѧ. ׸0Ͱ}"+^Awޯ*j\I[763}va-;ɸ^hQd3ל?&\ LU4yus@4.^!δE&:"l&a|jLM 8WMaqP d165{sdp,ܟw=& ἆ&ǘIrԗ7pE%+g' ?V\1&‚h3vLOe{mEDgCTR//֗[͖>$Dq5vsj:#?KBSyIݍ<D1wļ$p3~B p'#E۫: fs`۫LvDpz'8>O}\ !HsY#/+ -z&As p hzD*-HWjٰ3\Z.ԠU{6Z@)ts$ts)+/Ȟ/x$#/M #厳L$6S.EvsE"{G|9Bpor+j^E%ь(CssJV6XZֆV-\OgY]Ui@fӯeb~Y&>oH6霴'iz6K%ҽ[ٙ֊]\ Y)Ke-񢾼cmr^k?\HY"D@ ߼Yj].o {֡ ]J-3-GoX(L׫c~hji;7nU*~PqJɖ}~ &_zY'O%K7ӽjeWTgҝRve5;Ra%#b ,g|m|yqeS^*fkO7oZ@&~xXٷbQ7bUWI18^f/ӸDƢFG$b"ץ"[EhGRke}6^-z0}XʏH9}u^sj˶쬲$m- - v }`1DS'p:}ZBhH#ĶB3Bsڤo>gL28V|s=) qCA,(]G(kx,4L \$|"檳8ՍfkC7Z7j5`/糅e8lRYmĶf %6IdeU6Wk.maHVZGjfmQ>7ɺuU$V5Q :tQʝVsUK)r"QM4 2oԈLF!5*u'pVqO"Z) On ρa9ʧ<s7sjpM8H̀kMƚF;Jrshp[{;R\I!_ցu_$t"֛x<2DV_ɷ業tOԣϗ37!D %6 <+t s&9e9v+n h4q W-Pq:I] c+%X:yGoyVexZΐc^yX0VA2 99\ o4`CX&D^_@xoѴ»S)BM5Eyt\iY_h=͒g>tbXjhggAkز62[6=-i#܂* tйGnˠra+g428*1p`HQ.5r 44ܴ B( s-&Pp&~3Q*dt 7h6T)#EXAO9f;aisFx[7nWJ-3JYG-m SUC=杉/vIVn΁J BK4-nlrFsy넻zL* :az9܋+2u*2Hv)̈́F7"nr?rJOqbS8Ypc`RSoS8p6F@n#x"w>'zp_IqK twq Pe"IڮT^x-mͰ?Y}WMV'۰kjvypOԑcFm~H]'KE\nWts i ?fer.,$aput'mJVf_ڀryk}ggdmݞ^֟J 체R#?C2ɫ*^`-vk\*q5*BanTaT A'q.)*y&[:<{9!Hq+6sI/U3x*3J0r +0 =I2Dc₣J '& kF(!¤Fst^nBp6 QQ.@O5Y {Q,؋. Zz L~≣ʰa5LH UBnD:¯˾Ŧ،-Wӡ;t%lf.Mmf$_hnJY[ޥ_9D[S/ tKkdsrx* sy&RFHdvM ^Rv;g ZBoa9IVD]IƠ Z1Mj0Nt$B&r2.ު֔VǏ¦֐Mo*? Īux# N waYUgZY̘@+ٮ{5'mG^+좝J*@B}FS}JFM2&G~.PN0j7@at.WĘP9&62QsxRNQ.*B8V! @9c5j0.3~ʊkp޻q4F$Қ$$u[@"cYJ;K*mYpX%*'D^') O9n*8 r)_:o&qYުС6տ~=W1rJ*N-c [%I8wVIDR^.n25z>iVїy!D(b{ssC '~$5oF!NdBA!xaNDfn0a/am6yH"L$vsɋKbW6 '*^ $;xKA~`4GEdY-\~"n(09dRbp7$&)=MP-IĜ{=`PHb't3 `CF2aœJ!*Osb0g\@T jqgISۇ@C~Q37v[\A|V<;;:uHINŰa3?utx2@m1| }_ Ÿa>"?0Dož b-4D9?&T^JLdt*l23;fGX@8bs"Z"->s*ol[ R 6y!DhEapCYV< GN=Ԟylz䉖ތ82:a{ńɆʯ[Cʰ/+ꊞy6"i]я!=fϳJı.u)S !X:- UɉC{&,$ߣx(YpsndDa@)=.Z5xCUfaYI y~^ e|/$\V4 !.- ZJ#% Jé+)4OHI&pqQfM+/ ?rSE3}@o],l!<'s%0}eqg7?#BqͤfN-s=.7`Sp*™ T}UqC!>[͑ySu)Қ($F?[KI# DYg ;_O88=ZMД4ˣ4 5e\הTSgة\5"?GWꔔ˾k2nLq4*/k( mS_|Y ?@WS[\=IP(+= Jr %5)2ݯ*%,S߁0Ǻ#JR4|C=LCD"k21Kh~ZY~5Q @xh,mB(^)]%)ʎ>" i>E2a-V쀨OIS\-.z'1?hq_j}F淀]sߛj9w<a<Ҳ @ ۸um{R_؂PKBͩԬm!~,w[zGNEqnN$:tOC3GjhB=RnP,5 =Gu_GQfCz.7YCnrFÄSn3np~9b!UBCI➋_vjW3JG!R횊#ʳw^:/L-/Gόy)ٻ Q+'!,WY+Eer5QmeB0*iwJ[_#C\Ү:IV}0:(Q߭*-:ܓNŲg$Qp&iXK<߰$ѕR?BKlȲ̺Gr|^:;~Љ.&wN9楤n r6̱uE&FfRgq b?ӽ)!OK"˜#MZZT)E1uLK \0Y"M_PCHbNqg!5IBT¬#kr%6i锄rHTAvLL0ɯy7M-g$I"IeQA%JO% 84ĕ q@G/N7u(gRF\ 0Ff]ep,ۋ>_j4X!}Ŏ(C'DmM}c>7{F\bM?Y,h" 0LE[R/{Æ#"ìC8 %yMi8`HIJ( GsSJ\g sGϰu =yw*J}v?yr<hu=Y@# l kVFfɌ~M? #.QG4P6v),-óMwkGqldD @B '$ =Z,ehz١SGf`KL`|#Ԟ0ݾ›ua}}ykud3@+d(@0aSK$6Daբ\C$8O ) x7锏b.Og4@|{3jYL"y3&^Mbދ߄Prwc0ח"$KwswjȠ\FdI;$R'J f #r-Φ_nbFرZ9]BHW.i]La9S}RΩoUM0{Yځw Bpc,WsDd6 qض hl8PCqR~ϝO(?Fv㞥OU\ 9mbbP*J'ǟ(rId."^D?B~ +q搾([&)O㥈TBGل0Յ!iX߇0@xm5mM^" T-Wk6!qcܟ a<kYfpe i5B!"  G&B8?艤/d}Ap8:0| S::Uv۳>R\ꃶ83`Fղ&vOȈ)тBXÈ{㝓9Da2$=G7A>ŀxLucOiӸ*84BZ1bs dB55iI7Q.vTT p](WH@RXKfjc)aeVSf%?d4¡}=a GQm[ZIٓi7(N8C YY#'R糆H㧻p{`5j7:xaR쐈qO'(1rHRq*VMK[%4AyϾLjgb ߰[~aL T#&1I N0BjP&iN4닊"ʘ1G>Sy<1W&,*ޥ╳s' 3D"' LxR}_㚠*G[:~ Aњ!w-D5;V(O0z[f6?`$eP{zkײO%^ZbvsX$z+/j)XZbRxvNf\ߊP>'2ɹ"A<8M悓RF\ L F"WJ WғxDLH/dXA@g%R4ZMJZ`5R<7__ckI(}g Y1 un @\M)vч"/j\^B>tO(xڏb*pa|<ݍ~K`xfḙۯCP>X}B@\tg{lGpNѢ#Fv&VOnѫS%*N$'KOȉiO."}F..9[h##n!ؤxeUg }s~"0uGn 3_9 pK({wȎNn|*CfENa2#˒^}u#T+o0L5:!vn[o{Jonr ib! RU~PG7(.NzG 0ꚿ %XB~w0oegi1=iDX(ۿiGnz;|dEhoZAc2l3I8ҁ| %oEC8 }F(IG63pres-}T>P1`e˽$~voJRf7ܸ3ܟ]fz}}} = k OGn gӏd6:0zӝ2D'q{Y gTϭoff歗lbC-9OOpp礒^=PM^o11nC)}9S^.9=789#:cOyHw!J*.)>ʴzͷO DG%/,iq `A`B!%rѦGvKY1HmȲM{ kCQ(b?>[} uҿ!9[J</x#;V7^*˦va3l*7 el8 |&V>EN5aj/7fmo{3֭{0xulv8q BֈNQ(DSԩ=²\q :E0DzJtԯXJc!lDi,=: Fl=box3-n3ybmhjYϾC쑿Ш>u~)>mOwq ASޱv^B^V aއ_n=Cl'T2$ H]6iU.?1FߦNTq8/d %#lߋ>|Irp'oҹbkm?_ecvi.qtqіiΖQw{BY 8ȖGՇԎ隣^;ds#\n^0bnU:jSY>sL3y{li/YS&GiΤ0ĔVX0*w9tOh謹5#^ՖrH+5|F%Bj:`n -bҤ46MT'LYmaw_6Ǩ-±*G'g@D{m U'~_$GZv" sR뼹!o4<=+c %5Z~рt?V.Pn(VؼmYp~R&xXKUWc )TZmۢ䚜\F^vN?GIimynCwC) !# ;1Χ@@D1z=YCg__:y"(^ABE7|R.=L@EyȦknnvRhJAO֗xC6jWu;`^:YҨaAo_YtRq+Ȥ b "IbbJ.3/^.dʣTeQWihF/oOJQ5|DyOCvϢa`FF!!X2W[lO&Ơ8]G ̓Yf $ !>FQ iep UbKQvjYo펰''':ubt[z\eD-qJ}< TTZP'ӫ)F֩N "*=lQ*"׺j1b!E!@P燩N97@/هMb(%+"J![]sKKÝ} Ah'>{(u+5j^|GG Z'v5Zk/Ot%dQ>T#C7TDЯKI]&xS:n1k*x^k\ d +DxO1sOf)_<b`'_-;-:-7Og>{8^kC׬As|jaoOeVq$j 8xU,@8l:"f.$O[C;p{c`]|P<ҰvyikF-I!3}x*$@u ahѦôZo/ȯʢu 9weMg,u]0w Vk7kgZh8|Q۲!!\Xh4v|u\θ}T`%ܶVTT3 &9cձ0XXؘ>bٴ %5D}{vrJ(AaŃ5qkE 7S}Y{ڽx3Ҟ@ԁZRDA赣F{+/4񽙈50ðwccu=>,MUUW?~~\ŕn ⦵%=3$?xUΞ;2YWo-YLdg~-R5a7یz j;rm- 5}SIOIGFI*6v֊KcSC ǒr`x7ClMkUI;+=*`M8!r`j58^on\("#uٺE=[n4C,Hc}2+VBvݘLQ1b.Adv7ӻ^u@ՌYQ4}`m٠UI<Ռ/E˫+AE` A+lFo#fAuEJi *b>;0m! H ua>X5Q5x29bbĺloDeAQF~eAn 7mCv&srpZT!UI7p6+[ ð>!Ѐe'_R?0~h)hgFY@9 5[bx}^9/?@dzl=¾@/ؙAdP P- @s@2^_r V3r`gaq iʦ.ӧM;|48ُC'NG_#kMVEwf +W;-6hM]mLy^0Twٰ΅Z#|ƝGˎ8^=pG.] h ]_w:Y1XAlakmc*Wx=6  LS ߣf{̊@ʪ2oL׺[{Ӊ(*!.H7BZrw%|®."PIË>%. ""Y^16fs7#fD 4lFq B EyA>8X'PcY}Ҋƅ E._k؁Bjۻm!6l-8z/ZQzmЊL&C1)PեuM/N 57;X\K4*f<3%l, \~~ki==]&Q h,Y _Ϝ,Zʿyt^HzLuQtQ`Z}vU]iǜ}}*0Jda A8Kֹ>% ٍttշzXl[֠l;e wnGWcϨ7pmR'tʚ`پP dvsK!{cպ0v69 V1TC0xzd}\h9yL#oOVHQ׌'v_I2k2!׋2^7[PX (G}F}6bEHuf>ֵ-\uW>sggdKZT_Vd@ڹQ299z,i33ׁqP +@g(bi%O'.ˉڵ(_E@A10ovyAX:5 +7 dh0TwxᶅԆWO Aܛ*2L %3֌`A@ &SP ҁ%KZ7NǪSQ1[ {jaȿi|Zk&S֕FgジF3F vs|?r^/F+v3 İwbn7,,oM bEFPajZ|*[w`73<>,!4ԿQdz1rzR Χ<8='yd2U}Y,x|Z(ԥ2}oʊ_a{h}(ՙo=w>Hp^dk̚,Yo b$] v;ĵEߟmzQj4&/y-ef?nn4_kOζl_Ү\7I14kIb*B!ͨݩʄv]p Q:9%# ;ٴmWM]VkLk6w&.!YBʴ2lo#pK6:}àZت76`nPGbh/\d{.>5Oۯ$uvOmJEN?rW%uJ,RU qp4~I&/_~z" m#f`oFp3dw^ fPV$O[^~9xT%X>W'"j56]_Ev;sSKd٬ R{67Ż`M&K Ru; Ռu+lU-Ũ37q;5w&_Ɲ7 xj=Udi)_P ^w*` s x)|ƒc%%uuqccV {[eαul޾^_X2 AFzYU՚w\XX`ȕ}/h=~˰;`)ddw?Ѕ)d~co^NUQRTܨHX)x"ϽCH #!AكjeVe\H# +`ʱc ΅cNn,8~jfIK-(Fmp\X l34p[t[qYBNAsVkK;V[d4Py [lso8ּCAbrPd2+ &jӊ"pN`>ctCwr`5C%>4bEbAdmp㝲֗̐=B\G~f;/8v|auH|۱ ZMqpqd4^9\0MNl* mp ‡cnui0ߠ"/вϷ~k3 Z{y؈(~]򊫵vsyi#c^dѲ "K',z&|vF212ϹzW5SI~$Ri}}X93dlݵބmXIl>Nm }`B`d®͕݀\Q1EmvQU^sZ6!(<40,I L/ıW%grn%E!}aϜ=?5W۬kGe(5Uc}}1)/ :}y=n0];I"~1_2gѪ  Z̶f5yUv˪`eQ[7VW55a VwnzdqyyoŵZxq9ynnq}S˯>]d~9y~E獹c֛|6 L~糂ZŅ ;:P]47߮M?oi;?M5vw 7??-WW#[#=#h(%FE#J=/7 y7qug~D{DAaسE'&سՈ=/gUë{sxqϋ㋛G_iitg!;@3v ;@;c;@3v ;@~j_hLj_` djJ4IENDB`@@@ NormalCJ_HaJmH sH tH R@R [ Heading 1dd@&[$\$5CJ0KH$\aJ0\@\ [ Heading 2$<@& 56CJOJQJ\]^JaJV@V [ Heading 3$<@&5CJOJQJ\^JaJDA@D Default Paragraph FontRi@R  Table Normal4 l4a (k@(No List8O8 [apple-style-spanBOB [apple-converted-space4U@4 [ Hyperlink >*ph.O!. [ mw-headlineB^@2B [ Normal (Web)dd[$\$.OA. [ editsection"OQ" [title4Ob4 [smalldd[$\$$Oq$ [k_word$O$ [source  'q x KL_mhL| !"##$ %%%&'(-)*_+1-.......E1M1J3T3>B#BQCCbEEEEEEEFoFFPGLHHHHHIIJJ0J8JJJKKLoLyLLSMMMNOGOwOOuPPPPCQQQQSSSyTTTUjUU-VVVV:WVWWWXAXY:ZZZS[[#\\\-]>]aa&aXbdbmdnddf6hii6j7jRnrq$v*xyy{3~:~ƀP-.OD*5œS<t۩ܩsH~ҶGSɺSĻEa SAr ,o?YK\} )`e;r    J 9J S^6 N   !I!!!="~""""",#8###$$G%%%&h&&&C''X())*Y*e***+ ----,-/2U2V2W2_2w2223 4)4{9<>8?C?$@@B+F,F-FAFF1HVHHHI$I>I[III JeJ>KMKKKKDLLLLL^MMM1NNNO&OIOOOO(P`PhPPPP7QbQQQRRR3RdRRSiS:TKTTT U8UUUUU.VVVWWDXSXXXXXXXTZUZzZ[\^^_____`3`4`E``` aa=aPalaa$b.bbbcccccccdjjvv<=S!LډrߊZ݋ ьBMalӏZȐ2Uԑ - /˚0T(e_J?~ ҲqrݵS˷ѼYcI  btQRSTUVd2QRb00000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000 0 00000'q x KL_mhL| !"##$ %%%&'(-)*_+1-....E1M1J3T3>B#BQCCbEEFoFFPGLHHHHHIIJJ0J8JJJKKLoLyLLSMMMNOGOwOOuPPPPCQQQQSSyTTTUjUU-VVVV:WVWWWXAX:ZZZS[[#\\\-]>]aa&aXbdbmdnddf6hii6jRnrq$v*xyy{3~:~ƀP-.OD*5œS<t۩sH~ҶGSɺSĻEa SAr,o?YK\} )`e;r   J 9J S^6 N   !I!!!="~""""",#8###$$G%%%&h&&&C''X())*Y*e***+ ---,-/2W2_2w2223 4)4{9<>8?C?$@@B-FF1HVHHHI$I>I[III JeJ>KMKKKKDLLLLL^MMM1NNNO&OIOOOO(P`PhPPPP7QbQQQRRR3RdRRSiS:TKTTT U8UUUUU.VVVWWDXSXXXXXUZzZ[\^^_____`3`E``` aa=aPalaa$b.bbbccccccdjvv<=S!LډrߊZ݋ ьBMalӏZȐ2Uԑ - /˚0T(e_J?~ ҲqrS˷ѼYcI  tQRSd2QRb00@0@0@0@0@0@000@0@0@0@0 0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0000 @00304ǀ@0@0@0@0@0@0@0@0@0@000000000000000000000000000000000000000000000000000000000000000@000a000000@00a0@0~@0~@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@000a@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0f @0f 0000@0P@0P@0P@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@000@0(@0(@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@00 0@0@0@0@0@0@0G@0G@0@0@0@0@0@0@0@0@0@0@0R@0R@0R@0R@0R@0R@0R@0R@0R@0R@0R@0R@0R@0R@0R@0R@0R@0R@0R@0R@0R@0R@0R@0R@0R@0R@0R@0R@0R@0R@0R@0R@0R@0R@0R@0R@0R@0R@0R@0R@0R@0R@0R@0R@0@0@0@0 @0 @0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000@0{ 00000000@0@0000000000000000000000000000000000000000000000000000000000000000000000"0@00@00@00@00@0!u=@0!u=@0!u=@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@000000@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@000{0@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@00@0!u=@0!u=01010101010@0@0001010 0000010101@00@00@00@00 0 L7=CJlTj]ScipySsqT'  w%,18C?G@NV`koud~cƨc/`     !"$&'(*+,.135678;<=>@ABDEFHIJK#6QYc3۱?+7P&W ]gl JV #%)-/0249:?CGBJ6@F )fx2?$ [dn/gt 9 [    U b . L = D F /7o;nv _p'69s$=${0(/c/s///// 0)010w00000171B1j1111<2c2n2222333339444444{5555$636E6666666-797<7~77778 8S8f88889T9f999995:A:D:|::::::;);;L<^<a<<<< ===R=a=d====>!>#>{>>3?k?x?@@ ABBBBB CCCCCD]DhDDDD"EVE_EfEEEGGGHIIKKKLbLlLLLLLEMPMSMMMMJNlNOOOS7TPTTTTUPUhUjUUUUV+V-VrVVVVVV"W8WVWWWWWWXAYJYLYYYY,Z8Z:ZZZZZZZ>[Q[S[[[[[!\#\l\}\]]]]^5^d^^^^__ ______|```naaabbbcPcmcwcccc ddd_djdWeeeeeffYfjfehhhhhhi2j4jdjjjokkk'lilolllmmnn[nnnoooo-pJpVpppqHqWqqqqr_rprsrrrrssst,t/t{tttttt"u7uuv!vxvvvwwwyxxxyyyy3z=zzzz({t{{ |Q|k|p|||| }$}r}}}j~~~~U%kvSB j7@oI݇ :rʈՈ؈ 4v=PS؊l D{:DT֏M]GOR WFRbΕ&2Sؖ,>4D)5n|%T CPVRǟ,Π12Uܣ#ZfMSXѳ ʴϴnst˶ж*jrֹܹ ?I6BH<I%6=yʾݾ߾AR+;E$W_aL\ IQS2<pydNV_ }=LRW]]S CR-4;EjO] T^i-9;u'1#&~bU.;_,lt%Q2:ls-is(:$5J[-: fPW] gG Q`0<Xr` ^QVQ_y<Nt1{R &aqO\dz BFO&+w]U8FLHU^ 37i G H  +,67 Obi`{>J3jv=( 3 M!!!!!!!1";"A"t"|""#*#8#{######$ $$$$$%% %=%E%G%|%%%%%%&&&W&f&h&&&&&&&0'A'C'|''' (2(X(((F)|))))))* **H*W** ++4++++,",$,x,,/)0<0a000000*1e1u12 33#3^3n333 444445$5555%6^6l6667B7y7778%818_8b8w888 9V9c9:g::::::A;[;;< <<==b=====>G>>>????$AAABB C"CdCmCCCCCCDQDaDDDDEE"ESEYEdEEEEF'F"GmGGIIIeJJJJ KKMKKKK0LBLLFM\M^MMMMN/N1N|NNNNNQQQdRRRRSSS\SgSSSSTTT.VyVVVVV*WuWWWYYYYFZPZZ9[K[P[[[\@]M]^V^h^`a alaaaabbdde^eee^gggg.h@h]hhhhhhhAi[i^iiii jjykkknmmmm$n+nInnnoIodooooo/pDpppp rLrurr#sGsst$t'tgt|ttttuuu'vdvvvvvvwwwxJxUxhxxxx7yPyqyyyy/z=zzzz~~~:́҂ayq| J\)cr9CLΉ؉`oЊ݊%7ȋۋ݋ U_Œό2>*@BَCKďяc6ے}˓ړÕ)-XF wיۙ rv˚,. @FH<owzϝҝ VilDƠ  \lޡ,;P5?AxΤФeڦ:Ad!Wb٨4<J} Ȫ,<˫֫ܫ'uzU{߰ <CFv{~#&V[^˲вҲ*47qvy#(0bir1<Kҵ۵yŶ϶()B 2xAQ6IɼϼѼRWYKac:G?.2l*0 "U]wSJWX,v DQV>GY #ar MW [jx RY6hoMOMT^,9E}p0F^PX2JSx y hO\|^ =DTh'`XMQW.5e&DLf`seXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXCXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXCCXXXXXXXXCXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXCXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXCXXXXXXXXXXXXXXXXXCXXXXXXXXXXXCXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX Introduction0101IntroductionBackground0104IntroductionPathophysiology   9J   9J% (Xe ht ' < @ V b n z / ? @ L q y ? K i u x E 07=I_gov`f6$;EKY1=FQ -=>J-5aqr~=E]mnz*2Uefr(89E; C f v w !!!%!d!l!!!!!!"$"4"5"A"G"R"^"`"""?#O#P#\######## $ $$.$6$N$^$_$k$$$%%%%i%q%%%%%%%>&G&?'G'Q'Y'h'r'''''''''( (z((((((!)+)))))))))<*D*****++++++",+,N,X,,,,,--T-b-----O._.`.l....../d/s/!0-0003344555368 8;);M<W<<<S=a=l?x?????@@@ A.AJCJoJzJ{JJKKKKMMOOPPQQ/QAQdQiQFRPRvRRTTTTXX-Z8ZZZ[[\!\w\}\\\]"]-]<]W][]^'^^^____7`D`J`W```aa)a1a@aDaaa,b6bCbJbNbVbacmcocrc`djdndydddfflm%m1mnnnnSo_oIqWqsstt\uguvvwwxxyy4z=z\|b| ~~~~"0 skz Ո  ;D#,͕2v|R^:EǤФƥM^HN3<_hůү!(1KZ^ez Ƴ @Iϼ߼&6z()2qyx\$,szDR.4<EP]U^.1W&,EO()5ms$s)@KU%5Kh W S[5=*R`FOrzYa5=KZ$3Vv%ow&6es |"@MQyYf=ER\eopzxZ_js.<>G.:I+4! *   ` l |    ] z ] g l { FPvQV9HYhO[|+4Q](2PY)4YguCP ,J~) 3 m p       !.!4!5!@!!!X&f&&&&&1'A'}''5(:((())* *.+0+X-c-----(.3.G.I.....-/;/?/J/L/N/y//*0<0001102;2 3334)444z44444$5\5g555_6l667W9c99r:::B;Q;;;;;<<B<M<<<)=:=S=_=====Q>\>>>*?/?M?X???????-@2@`@q@@@@AA"AB(BvBBBBBCDDQDEEE"F1F7F~FFNNVVWW|WWYYw``ccJd\dedyddeIeReee^fefffofqf|f}ffffffBgLg/h9hhhii jjkkllllllmmm+nnnnn:pDpppqqqrMr]r1sAsssttevov,w1wVw[wyy@zDzzz~~>CHX=CDISYZ_KS߇drω؉ъ݊3>ŏяܒ /56;DOs~ >Jqv ŝϝ )/05 ]dڡ;GP!b~t{=C=IS`(ɷ8B ;G[cr~V] K !EQ !mNWYabmt\jYV^hpNT 3D4BMYw5@HO >DUWcs2IL'l(**X2c2;W<RRacmceesywy |׏T@?Mͱӱrs ˾T4@;@w~CH?N  ()**1+4+w2222 3"333>>WWjkMr^rVw[w3cƪȪy{+433333333333333333333333333333333333333333333333333333333()RRўўMM2234rs67٩ک\\EFCDVV`a<<IJ?@^_I I --880011T2V2*F,FXXSZTZjjqqwwρρʚʚ˚˚-.00  |}[[ssC( h^`OJQJo(hHhpp^p`OJQJ^Jo(hHoh@ @ ^@ `OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHhPP^P`OJQJ^Jo(hHoh  ^ `OJQJo(hHC(         [ ,~k3@mT\R8CBVU@O];o1 D"jR:oVi("gubNYEu}s63?qYEubb[0D  0 uZ LLY+VY+}X : LLE^SQF B{bb[uY!Y!tb! ."v4Y9"V#L7K)O/*637_*guN+o.+E^;o1HM<n4}oL56L72z9bN :-:8Vi1<K|a=r[A1<1^AD`$qD :SQF,~k Px8HM1<0D  0 HkMoL5mNT\R`RHS<n4r.TBV}XtWv4Y}XiZuZ[bN Dbb['Y]k].P^i("Z7^t^;o1 D1b7_*8Vi} j0*http://en.wikipedia.org/wiki/Exophthalmos t;'http://en.wikipedia.org/wiki/Human_eye  v8$http://en.wikipedia.org/wiki/Eyelid e53http://en.wikipedia.org/wiki/Adrenal_insufficiency B 2%http://en.wikipedia.org/wiki/Purpura #r/Dhttp://en.wikipedia.org/wiki/Disseminated_intravascular_coagulation r ,1http://en.wikipedia.org/wiki/Shock_(circulatory) Z))http://en.wikipedia.org/wiki/Hypotension R&-http://en.wikipedia.org/wiki/Meningococcemia Da#Fhttp://en.wikipedia.org/wiki/Waterhouse%E2%80%93Friderichsen_syndromecite_note-Robbins_2005-0,g (http://en.wikipedia.org/wiki/Hemorrhage WBGhttp://www.wrongdiagnosis.com/medical/adrenal_cortex_insufficiency.htm gd3http://www.wrongdiagnosis.com/sym/papilloedema.htm g/http://www.wrongdiagnosis.com/sym/seizures.htm DT2http://www.wrongdiagnosis.com/sym/photophobia.htm <http://www.wrongdiagnosis.com/sym/altered_mental_status.htm  +0http://www.wrongdiagnosis.com/sym/confusion.htm iv /http://www.wrongdiagnosis.com/sym/cyanosis.htm co+http://www.wrongdiagnosis.com/sym/coma.htm pw/http://www.wrongdiagnosis.com/sym/collapse.htm =>,http://www.wrongdiagnosis.com/sym/fever.htm T[bhttp://wrongdiagnosis.pubs.righthealth.com/topic/Medical signs?as=clink&ac=1437&afc=2168586466&p= T-http://en.wikipedia.org/wiki/Cytomegalovirus 4http://en.wikipedia.org/wiki/Haemophilus_influenzae ${(http://en.wikipedia.org/wiki/Pediatrics >@3http://en.wikipedia.org/wiki/Staphylococcus_aureus f8http://en.wikipedia.org/wiki/Mycobacterium_tuberculosis g 6http://en.wikipedia.org/wiki/Streptococcus_pneumoniae  |4http://en.wikipedia.org/wiki/Neisseria_meningitidis R&http://en.wikipedia.org/wiki/Bacteria  K^http://wrongdiagnosis.pubs.righthealth.com/topic/Syndromes?as=clink&ac=1437&afc=2168586466&p= R }http://wrongdiagnosis.pubs.righthealth.com/topic/Waterhouse%E2%80%93Friderichsen syndrome?as=clink&ac=1437&afc=2168586466&p= *1$http://en.wikipedia.org/wiki/TRIM32 G"http://en.wikipedia.org/wiki/ARL6 f<#http://en.wikipedia.org/wiki/BBS12 f>#http://en.wikipedia.org/wiki/BBS10 W"http://en.wikipedia.org/wiki/BBS6 z1http://en.wikipedia.org/wiki/Chaperone_(protein) W"http://en.wikipedia.org/wiki/BBS9 A"http://en.wikipedia.org/wiki/TTC8 W"http://en.wikipedia.org/wiki/BBS7 W"http://en.wikipedia.org/wiki/BBS5 W"http://en.wikipedia.org/wiki/BBS4 W"http://en.wikipedia.org/wiki/BBS2 W"http://en.wikipedia.org/wiki/BBS1 8c$http://en.wikipedia.org/wiki/BBsome b@7http://en.wikipedia.org/wiki/Wikipedia:Citation_needed \$6http://en.wikipedia.org/wiki/Intraflagellar_transport +F4http://en.wikipedia.org/wiki/Caenorhabditis_elegans vT,http://en.wikipedia.org/wiki/Cell_(biology) 5q#http://en.wikipedia.org/wiki/Cilia d(http://en.wikipedia.org/wiki/Basal_body b@7http://en.wikipedia.org/wiki/Wikipedia:Citation_needed S)2http://en.wikipedia.org/wiki/Hirschsprung_disease A%http://en.wikipedia.org/wiki/Anosmia X%http://en.wikipedia.org/wiki/Hepatic 1v,http://en.wikipedia.org/wiki/Cardiovascular 8d(http://en.wikipedia.org/wiki/Hypodontia $K/http://en.wikipedia.org/wiki/Diabetes_mellitus 3s(http://en.wikipedia.org/wiki/Hypertonia 9v$http://en.wikipedia.org/wiki/Ataxia 9~(http://en.wikipedia.org/wiki/Polydipsia Q&http://en.wikipedia.org/wiki/Polyuria 2{(http://en.wikipedia.org/wiki/Syndactyly $s~+http://en.wikipedia.org/wiki/Brachydactyly E{)http://en.wikipedia.org/wiki/Astigmatism  jx'http://en.wikipedia.org/wiki/Cataracts $zu(http://en.wikipedia.org/wiki/Strabismus 1or#http://en.wikipedia.org/wiki/Renal 8fo+http://en.wikipedia.org/wiki/Genitourinary 'el,http://en.wikipedia.org/wiki/Hypogenitalism r i-http://en.wikipedia.org/wiki/Truncal_obesity Zf)http://en.wikipedia.org/wiki/Polydactyly Lc*http://en.wikipedia.org/wiki/Expressivity B`)http://en.wikipedia.org/wiki/Pleiotropic p]+http://en.wikipedia.org/wiki/Renal_failure DZ*http://en.wikipedia.org/wiki/Hypogonadism 4YW0http://en.wikipedia.org/wiki/Mental_retardation ZT)http://en.wikipedia.org/wiki/Polydactyly cQ2http://en.wikipedia.org/wiki/Retinitis_pigmentosa PN%http://en.wikipedia.org/wiki/Obesity +gK(http://en.wikipedia.org/wiki/Pleiotropy aH.http://en.wikipedia.org/wiki/Genetic_disorder !tE#http://en.wikipedia.org/wiki/Human 1vB(http://en.wikipedia.org/wiki/Ciliopathy =:<;http://en.wikipedia.org/wiki/Prader%E2%80%93Willi_syndromecite_note-pmid9391886-2F9;http://en.wikipedia.org/wiki/Prader%E2%80%93Willi_syndromecite_note-Udwin-3*$6;http://en.wikipedia.org/wiki/Prader%E2%80%93Willi_syndrome cite_note-6F3;http://en.wikipedia.org/wiki/Prader%E2%80%93Willi_syndromecite_note-Udwin-3Q0%http://en.wikipedia.org/wiki/Ghrelin =:-;http://en.wikipedia.org/wiki/Prader%E2%80%93Willi_syndromecite_note-pmid9391886-2=:*;http://en.wikipedia.org/wiki/Prader%E2%80%93Willi_syndromecite_note-pmid9391886-2?S',http://en.wikipedia.org/wiki/Morbid_obesity n$+http://en.wikipedia.org/wiki/Stretch_marks J6!*http://en.wikipedia.org/wiki/Skin_picking $K/http://en.wikipedia.org/wiki/Diabetes_mellitus D*http://en.wikipedia.org/wiki/Hypogonadism P%http://en.wikipedia.org/wiki/Obesity <j'http://en.wikipedia.org/wiki/Scoliosis s -http://en.wikipedia.org/wiki/Sleep_disorders }wVhttp://en.wikipedia.org/w/index.php?title=Excessive_weight_gain&action=edit&redlink=1 ,{ (http://en.wikipedia.org/wiki/Polyphagia @1 *http://en.wikipedia.org/wiki/Speech_delay <j'http://en.wikipedia.org/wiki/Scoliosis $z(http://en.wikipedia.org/wiki/Strabismus ^)http://en.wikipedia.org/wiki/Hypersomnia  O/http://en.wikipedia.org/wiki/Failure_to_thrive D*http://en.wikipedia.org/wiki/Hypogonadism p,http://en.wikipedia.org/wiki/Sucking_reflex %|'http://en.wikipedia.org/wiki/Hypotonia J&http://en.wikipedia.org/wiki/Lethargy 4s'http://en.wikipedia.org/wiki/Caesarean Z9*http://en.wikipedia.org/wiki/Breech_birth ,o,http://en.wikipedia.org/wiki/Polyhydramnios ?\/http://en.wikipedia.org/wiki/Angelman_syndrome r0http://en.wikipedia.org/wiki/Genomic_Imprinting d=http://en.wikipedia.org/wiki/Chromosome_15q_partial_deletion R3http://en.wikipedia.org/wiki/Chromosome_15_(human) a.http://en.wikipedia.org/wiki/Genetic_disorder V*>http://en.wikipedia.org/wiki/Pearson_marrow_pancreas_syndrome ,n+http://en.wikipedia.org/wiki/Heteroplasmic k7http://en.wikipedia.org/wiki/Oxidative_phosphorylation  n+http://en.wikipedia.org/wiki/Ribosomal_RNA O-*http://en.wikipedia.org/wiki/Transfer_RNA Y6http://en.wikipedia.org/wiki/Electron_transport_chain (B(http://en.wikipedia.org/wiki/Base_pairs 2}(http://en.wikipedia.org/wiki/Chromosome 5e#http://en.wikipedia.org/wiki/Genes f1http://en.wikipedia.org/wiki/Cerebrospinal_fluid 'S/http://en.wikipedia.org/wiki/Cerebellar_ataxia k0http://en.wikipedia.org/wiki/Hearing_impairment [)http://en.wikipedia.org/wiki/Bradycardia ^62http://en.wikipedia.org/wiki/Exercise_intolerance  0http://en.wikipedia.org/wiki/Syncope_(medicine) r6http://en.wikipedia.org/wiki/Third_degree_heart_block N.&http://en.wikipedia.org/wiki/AV_block  N0http://en.wikipedia.org/wiki/Myotonic_dystrophy c2http://en.wikipedia.org/wiki/Retinitis_pigmentosa !}$http://en.wikipedia.org/wiki/Macula :`8http://en.wikipedia.org/wiki/Retinal_pigment_epithelium =*http://en.wikipedia.org/wiki/Fundus_(eye) 9w$http://en.wikipedia.org/wiki/Retina F!*http://en.wikipedia.org/wiki/Visual_field 2i$http://en.wikipedia.org/wiki/Ptosis ,r,http://en.wikipedia.org/wiki/Endocrinopathy 9p0http://en.wikipedia.org/wiki/Hypoparathyroidism /}7http://en.wikipedia.org/wiki/Growth_hormone_deficiency $K/http://en.wikipedia.org/wiki/Diabetes_mellitus S&http://en.wikipedia.org/wiki/Deafness 'S|/http://en.wikipedia.org/wiki/Cerebellar_ataxia ry)http://en.wikipedia.org/wiki/Heart_block V8vJhttp://en.wikipedia.org/wiki/Chronic_progressive_external_ophthalmoplegia `s4http://en.wikipedia.org/wiki/Mitochondrial_myopathy -p=http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003477/ #m=http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003855/ -j=http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003330/ Ug5http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000035/ *d=http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000206/  Ua5http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000538/ U^5http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000035/ ,[=http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A001183/ (X=http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000365/ +U=http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003613/ *R=http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003561/ (O=http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003791/ %L=http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003398/ 'I=http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000811/ /F=http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003213/  C=http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000739/ )@=http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003205/ '==http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003029/ ,:=http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003193/ '7=http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003178/ &4=http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003199/ -1=http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003093/ '.=http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003198/ *+=http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003115/ +(=http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003164/ ,%=http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003092/ -"=http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003093/ *=http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000733/ ,=http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000755/ _;1http://en.wikipedia.org/wiki/Glycyrrhizinic_acid C&http://en.wikipedia.org/wiki/Aperitif (r#http://en.wikipedia.org/wiki/Anise  u$http://en.wikipedia.org/wiki/Pastis l 4http://en.wikipedia.org/wiki/Substance_intoxication   +http://en.wikipedia.org/wiki/Quadriparesis Z *http://en.wikipedia.org/wiki/Glycyrrhizin Z&http://en.wikipedia.org/wiki/Licorice _3-http://en.wikipedia.org/wiki/Liddle_syndrome )c7http://en.wikipedia.org/wiki/Computed_axial_tomography 9m#http://en.wikipedia.org/wiki/Renin  j,http://en.wikipedia.org/wiki/Cardiac_output W&http://en.wikipedia.org/wiki/Headache M*-http://en.wikipedia.org/wiki/Muscle_weakness I%http://en.wikipedia.org/wiki/Myalgia g,http://en.wikipedia.org/wiki/Angiotensin_II e7http://en.wikipedia.org/wiki/Juxtaglomerular_apparatus 9m#http://en.wikipedia.org/wiki/Renin D8http://en.wikipedia.org/wiki/Glomerular_filtration_rate L*http://en.wikipedia.org/wiki/Hypocalcemia @0http://en.wikipedia.org/wiki/Calcium_in_biology 5o http://en.wikipedia.org/wiki/PH c 1http://en.wikipedia.org/wiki/Metabolic_alkalosis E)http://en.wikipedia.org/wiki/Bicarbonate 7A0http://en.wikipedia.org/wiki/Carbonic_anhydrase ?j+http://en.wikipedia.org/wiki/Hypernatremia W%http://en.wikipedia.org/wiki/Nephron N )http://en.wikipedia.org/wiki/Hypokalemia ?j+http://en.wikipedia.org/wiki/Hypernatremia 26http://en.wikipedia.org/wiki/Renin-angiotensin_system m-http://en.wikipedia.org/wiki/Adrenal_adenoma ^)http://en.wikipedia.org/wiki/Aldosterone m-http://en.wikipedia.org/wiki/Adrenal_adenoma 4i'http://en.wikipedia.org/wiki/Carcinoma Q )http://en.wikipedia.org/wiki/Hyperplasia <m0http://en.wikipedia.org/wiki/Hyperaldosteronism p/http://en.wikipedia.org/wiki/Saline_(medicine) D)http://en.wikipedia.org/wiki/Intravenous st[http://en.wikipedia.org/wiki/Syndrome_of_inappropriate_antidiuretic_hormone_hypersecretion cite_note-1 /http://en.wikipedia.org/wiki/Fluid_restriction 9r,http://en.wikipedia.org/wiki/Hypothyroidism L )http://en.wikipedia.org/wiki/Vincristine Z&http://en.wikipedia.org/wiki/Oxytocin .\(http://en.wikipedia.org/wiki/Leah_Betts 7n;http://en.wikipedia.org/wiki/Methylenedioxymethamphetamine =\Dhttp://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitor ?g+http://en.wikipedia.org/wiki/Carbamazepine G .http://en.wikipedia.org/wiki/Cyclophosphamide :`+http://en.wikipedia.org/wiki/Phenothiazine <|(http://en.wikipedia.org/wiki/Clofibrate %i,http://en.wikipedia.org/wiki/Chlorpropamide 1n(http://en.wikipedia.org/wiki/Medication P0}*http://en.wikipedia.org/wiki/Lung_abscess (hz'http://en.wikipedia.org/wiki/Pneumonia Gw%http://en.wikipedia.org/wiki/Abscess .rt#http://en.wikipedia.org/wiki/Brain %tq'http://en.wikipedia.org/wiki/Infection O2n)http://en.wikipedia.org/wiki/Lung_cancer 7wk$http://en.wikipedia.org/wiki/Cancer [;h5http://en.wikipedia.org/wiki/Subarachnoid_hemorrhage *re(http://en.wikipedia.org/wiki/Meningitis Eb%http://en.wikipedia.org/wiki/Albumin ,[_'http://en.wikipedia.org/wiki/Uric_acid &m\(http://en.wikipedia.org/wiki/Creatinine j+Y1http://en.wikipedia.org/wiki/Blood_urea_nitrogen  lV(http://en.wikipedia.org/wiki/Lixivaptan e>S=http://en.wikipedia.org/wiki/Vasopressin_receptor_antagonist ]P*http://en.wikipedia.org/wiki/Hyponatremia +[M,http://en.wikipedia.org/wiki/Cerebral_edema @J)http://en.wikipedia.org/wiki/Dehydration _G)http://en.wikipedia.org/wiki/Natriuresis Z D*http://en.wikipedia.org/wiki/Hypertension <~A#http://en.wikipedia.org/wiki/Edema )*>7http://emedicine.medscape.com/article/768380-diagnosisDifferentials*k;/javascript:showcontent('active','references'); UN86http://emedicine.medscape.com/article/757999-overview YH56http://emedicine.medscape.com/article/244631-overview ]M26http://emedicine.medscape.com/article/185856-overview ^O/6http://emedicine.medscape.com/article/767624-overview *k,/javascript:showcontent('active','references'); *k)/javascript:showcontent('active','references'); *k&/javascript:showcontent('active','references'); *k#/javascript:showcontent('active','references'); S "http://en.wikipedia.org/wiki/WFS1 2".http://en.wikipedia.org/wiki/Wolfram_syndrome cite_note-4?D0http://en.wikipedia.org/wiki/Multiple_sclerosis  ~$http://en.wikipedia.org/wiki/Myelin G*http://en.wikipedia.org/wiki/Mitochondria P"http://en.wikipedia.org/wiki/Deaf }+http://en.wikipedia.org/wiki/Optic_atrophy $K /http://en.wikipedia.org/wiki/Diabetes_mellitus a.http://en.wikipedia.org/wiki/Genetic_disorder ($http://en.wikipedia.org/wiki/Striae +2Xhttp://en.wikipedia.org/w/index.php?title=Petrosal_sinus_sampling&action=edit&redlink=1 O'Uhttp://en.wikipedia.org/w/index.php?title=Iodocholesterol_scan&action=edit&redlink=1 S*http://en.wikipedia.org/wiki/Scintigraphy "p+http://en.wikipedia.org/wiki/Incidentaloma R%http://en.wikipedia.org/wiki/Adenoma r-http://en.wikipedia.org/wiki/Pituitary_gland G!http://en.wikipedia.org/wiki/MRI S.%http://en.wikipedia.org/wiki/CT_scan 5F3http://en.wikipedia.org/wiki/Bitemporal_hemianopia z*http://en.wikipedia.org/wiki/Optic_chiasm F!*http://en.wikipedia.org/wiki/Visual_field D!2http://en.wikipedia.org/wiki/Physical_examination =v$http://en.wikipedia.org/wiki/Saliva r-http://en.wikipedia.org/wiki/Pituitary_gland ?@/http://en.wikipedia.org/wiki/Negative_feedback -s,http://en.wikipedia.org/wiki/Glucocorticoid 8s<http://en.wikipedia.org/wiki/Dexamethasone_suppression_test `/http://en.wikipedia.org/wiki/Pituitary_adenoma ?@/http://en.wikipedia.org/wiki/Negative_feedback S-.http://en.wikipedia.org/wiki/Zona_fasciculata l+http://en.wikipedia.org/wiki/Adrenal_gland ]&http://en.wikipedia.org/wiki/Cortisol V "http://en.wikipedia.org/wiki/ACTH <=http://en.wikipedia.org/wiki/Corticotropin-releasing_hormone r-http://en.wikipedia.org/wiki/Pituitary_gland J*http://en.wikipedia.org/wiki/Hypothalamus Q )http://en.wikipedia.org/wiki/Transcortin O2)http://en.wikipedia.org/wiki/Lung_cancer u02http://en.wikipedia.org/wiki/Small_cell_carcinoma (b+http://en.wikipedia.org/wiki/Paraneoplasia l+http://en.wikipedia.org/wiki/Adrenal_gland r-http://en.wikipedia.org/wiki/Pituitary_gland V "http://en.wikipedia.org/wiki/ACTH >p/http://en.wikipedia.org/wiki/Immunosuppression Q=2http://en.wikipedia.org/wiki/Rheumatoid_arthritis .g$http://en.wikipedia.org/wiki/Asthma \*http://en.wikipedia.org/wiki/Iatrogenesis -s,http://en.wikipedia.org/wiki/Glucocorticoid R*http://en.wikipedia.org/wiki/Osteoporosis ^.http://en.wikipedia.org/wiki/Gastrointestinal N )http://en.wikipedia.org/wiki/Hypokalemia O~.http://en.wikipedia.org/wiki/Mineralcorticoid 4y{/http://en.wikipedia.org/wiki/Hyperpigmentation V x"http://en.wikipedia.org/wiki/ACTH $ru#http://en.wikipedia.org/wiki/Death qr+http://en.wikipedia.org/wiki/Heart_disease !{o$http://en.wikipedia.org/wiki/Axilla Q$l2http://en.wikipedia.org/wiki/Acanthosis_nigricans $Ki/http://en.wikipedia.org/wiki/Diabetes_mellitus }f)http://en.wikipedia.org/wiki/Blood_sugar ;vc+http://en.wikipedia.org/wiki/Hyperglycemia P`%http://en.wikipedia.org/wiki/Ectopic w]0http://en.wikipedia.org/wiki/Insulin_resistance GZ)http://en.wikipedia.org/wiki/Epinephrine Z W*http://en.wikipedia.org/wiki/Hypertension 9~T(http://en.wikipedia.org/wiki/Polydipsia QQ&http://en.wikipedia.org/wiki/Polyuria <aN(http://en.wikipedia.org/wiki/Malassezia @K*http://en.wikipedia.org/wiki/Dermatophyte FH%http://en.wikipedia.org/wiki/Anxiety U!E1http://en.wikipedia.org/wiki/Clinical_depression #~B'http://en.wikipedia.org/wiki/Psychosis e^?0http://en.wikipedia.org/wiki/Euphoria_(emotion)  c<'http://en.wikipedia.org/wiki/Androgens R9)http://en.wikipedia.org/wiki/Infertility 'k6,http://en.wikipedia.org/wiki/Oligomenorrhea I3)http://en.wikipedia.org/wiki/Amenorrhoea 1y0'http://en.wikipedia.org/wiki/Impotence 5u-$http://en.wikipedia.org/wiki/Libido -t*'http://en.wikipedia.org/wiki/Aromatase Z'&http://en.wikipedia.org/wiki/Insomnia *{$+http://en.wikipedia.org/wiki/Hypercalcemia U !&http://en.wikipedia.org/wiki/Baldness (t'http://en.wikipedia.org/wiki/Hirsutism ($http://en.wikipedia.org/wiki/Striae 4k,http://en.wikipedia.org/wiki/Telangiectasia #n+http://en.wikipedia.org/wiki/Hyperhidrosis 1F'http://en.wikipedia.org/wiki/Moon_face -http://en.wikipedia.org/wiki/Central_obesity P %http://en.wikipedia.org/wiki/Obesity )` $http://en.wikipedia.org/wiki/Horses Z"http://en.wikipedia.org/wiki/Dogs "L,http://en.wikipedia.org/wiki/Harvey_Cushing K0http://en.wikipedia.org/wiki/Cushing's_syndrome cite_note-1V "http://en.wikipedia.org/wiki/ACTH r-http://en.wikipedia.org/wiki/Pituitary_gland R%http://en.wikipedia.org/wiki/Adenoma tS1http://en.wikipedia.org/wiki/Cushing%27s_disease b9http://en.wikipedia.org/wiki/Adrenocorticotropic_hormone -s,http://en.wikipedia.org/wiki/Glucocorticoid ]&http://en.wikipedia.org/wiki/Cortisol  L4http://en.wikipedia.org/wiki/Autoimmune_thyroiditis Q$2http://en.wikipedia.org/wiki/Acanthosis_nigricans C)http://en.wikipedia.org/wiki/Miscarriage M9)http://en.wikipedia.org/wiki/Weight_gain .u$http://en.wikipedia.org/wiki/Stroke 5V4http://en.wikipedia.org/wiki/Cardiovascular_disease K -http://en.wikipedia.org/wiki/Atherosclerosis Y*http://en.wikipedia.org/wiki/Dyslipidemia F%http://en.wikipedia.org/wiki/Anxiety u/http://en.wikipedia.org/wiki/Depression_(mood) I1http://en.wikipedia.org/wiki/High_blood_pressure i!-http://en.wikipedia.org/wiki/Body_mass_index g6http://en.wikipedia.org/wiki/Diabetes_mellitus_type_2 w0http://en.wikipedia.org/wiki/Insulin_resistance O.http://en.wikipedia.org/wiki/Hyperandrogenism \ .http://en.wikipedia.org/wiki/Hyperinsulinemia Y *http://en.wikipedia.org/wiki/Progesterone j0http://en.wikipedia.org/wiki/Endometrial_cancer Q )http://en.wikipedia.org/wiki/Hyperplasia (t'http://en.wikipedia.org/wiki/Hirsutism y#http://en.wikipedia.org/wiki/IGF-I Q%http://en.wikipedia.org/wiki/IGFBP-1 Kk7http://en.wikipedia.org/wiki/Polycystic_ovary_syndrome cite_note-19Kj7http://en.wikipedia.org/wiki/Polycystic_ovary_syndrome cite_note-18]"http://en.wikipedia.org/wiki/SHBG [ "http://en.wikipedia.org/wiki/GnRH Ke7http://en.wikipedia.org/wiki/Polycystic_ovary_syndrome cite_note-17L"http://en.wikipedia.org/wiki/Cyst l1http://en.wikipedia.org/wiki/Luteinizing_hormone $a4http://en.wikipedia.org/wiki/Glucose_tolerance_test })http://en.wikipedia.org/wiki/Blood_sugar b:http://en.wikipedia.org/wiki/Sex_hormone_binding_globulin E:http://en.wikipedia.org/wiki/Follicle_stimulating_hormone l1http://en.wikipedia.org/wiki/Luteinizing_hormone Vy7http://en.wikipedia.org/wiki/Polycystic_ovary_syndromecite_note-pmid1296589-13:http://en.wikipedia.org/wiki/Sex_hormone-binding_globulin y#|1http://en.wikipedia.org/wiki/Free_androgen_index )Ry<http://en.wikipedia.org/wiki/Dehydroepiandrosterone_sulfate ]v*http://en.wikipedia.org/wiki/Testosterone ]s-http://en.wikipedia.org/wiki/Androstenedione Np&http://en.wikipedia.org/wiki/Androgen N;m2http://en.wikipedia.org/wiki/Laparoscopic_surgery 4Yj+http://en.wikipedia.org/wiki/Corpus_luteum Y g*http://en.wikipedia.org/wiki/Progesterone zd-http://en.wikipedia.org/wiki/Menstrual_cycle  ja/http://en.wikipedia.org/wiki/Ovarian_follicles r^9http://en.wikipedia.org/wiki/Gynecologic_ultrasonography | [1http://en.wikipedia.org/wiki/Specificity_(tests) ]3X1http://en.wikipedia.org/wiki/Confidence_interval ~U1http://en.wikipedia.org/wiki/Sensitivity_(tests) u.R6http://en.wikipedia.org/wiki/Clinical_prediction_rule $IO/http://en.wikipedia.org/wiki/Pelvic_ultrasound QL*http://en.wikipedia.org/wiki/Homocysteine wI0http://en.wikipedia.org/wiki/Insulin_resistance GF%http://en.wikipedia.org/wiki/Insulin C-http://en.wikipedia.org/wiki/Central_obesity i@0http://en.wikipedia.org/wiki/Metabolic_syndrome 0h=,http://en.wikipedia.org/wiki/Hypermenorrhea O:.http://en.wikipedia.org/wiki/Hyperandrogenism (t7'http://en.wikipedia.org/wiki/Hirsutism Z4)http://en.wikipedia.org/wiki/Anovulation R1)http://en.wikipedia.org/wiki/Infertility ,c.(http://en.wikipedia.org/wiki/Amenorrhea 'k+,http://en.wikipedia.org/wiki/Oligomenorrhea P(%http://en.wikipedia.org/wiki/Obesity J%&http://en.wikipedia.org/wiki/Diabetes w"0http://en.wikipedia.org/wiki/Insulin_resistance N&http://en.wikipedia.org/wiki/Androgen V"http://en.wikipedia.org/wiki/Acne ,c(http://en.wikipedia.org/wiki/Amenorrhea Y*http://en.wikipedia.org/wiki/Menstruation Z)http://en.wikipedia.org/wiki/Anovulation L?1http://en.wikipedia.org/wiki/Female_subfertility (q 'http://en.wikipedia.org/wiki/Endocrine b@ 7http://en.wikipedia.org/wiki/Wikipedia:Citation_needed X&http://en.wikipedia.org/wiki/Triploid s4http://en.wikipedia.org/wiki/Pseudoautosomal_region v,http://en.wikipedia.org/wiki/X_inactivation P"http://en.wikipedia.org/wiki/Gene 9~$http://en.wikipedia.org/wiki/Mammal  r(http://en.wikipedia.org/wiki/Meiosis_II )u'http://en.wikipedia.org/wiki/Karyotype  r'http://en.wikipedia.org/wiki/Meiosis_I 2i,http://en.wikipedia.org/wiki/Nondisjunction L &http://en.wikipedia.org/wiki/Abortion [!http://en.wikipedia.org/wiki/DNA 0n+http://en.wikipedia.org/wiki/Amniocentesis X7http://en.wikipedia.org/wiki/Chorionic_villus_sampling $]+http://en.wikipedia.org/wiki/Growth_medium O.http://en.wikipedia.org/wiki/White_blood_cell )u'http://en.wikipedia.org/wiki/Karyotype )u'http://en.wikipedia.org/wiki/Karyotype {~#http://en.wikipedia.org/wiki/46,XY u -http://en.wikipedia.org/wiki/Genetic_carrier  s(http://en.wikipedia.org/wiki/Sex_linked b@7http://en.wikipedia.org/wiki/Wikipedia:Citation_needed Q=2http://en.wikipedia.org/wiki/Rheumatoid_arthritis $K/http://en.wikipedia.org/wiki/Diabetes_mellitus (_+http://en.wikipedia.org/wiki/Varicose_vein g/http://en.wikipedia.org/wiki/Pulmonary_disease R*http://en.wikipedia.org/wiki/Osteoporosis N0http://en.wikipedia.org/wiki/Male_breast_cancer w7-http://en.wikipedia.org/wiki/Germ_cell_tumor T&http://en.wikipedia.org/wiki/Spectrum "s,http://en.wikipedia.org/wiki/Microorchidism l1http://en.wikipedia.org/wiki/Luteinizing_hormone Ea:http://en.wikipedia.org/wiki/Follicle-stimulating_hormone ]*http://en.wikipedia.org/wiki/Testosterone D*http://en.wikipedia.org/wiki/Hypogonadism S*http://en.wikipedia.org/wiki/Gynecomastia S*http://en.wikipedia.org/wiki/Gynecomastia ;$http://en.wiktionary.org/wiki/lanky b1http://en.wikipedia.org/wiki/Executive_functions R)http://en.wikipedia.org/wiki/Infertility <r'http://en.wikipedia.org/wiki/Fertility G&http://en.wikipedia.org/wiki/Testicle Y%http://en.wikipedia.org/wiki/Trisomy m*http://en.wikipedia.org/wiki/Y_chromosome m*http://en.wikipedia.org/wiki/X_chromosome :'http://en.wikipedia.org/wiki/Progestin S}&http://en.wikipedia.org/wiki/Estrogen ]z*http://en.wikipedia.org/wiki/Testosterone ^w:http://en.wikipedia.org/wiki/Human_chorionic_gonadotropin lt-http://en.wikipedia.org/wiki/Hormone_therapy  xq/http://en.wikipedia.org/wiki/Olfactory_placode ` n)http://en.wikipedia.org/wiki/Sex_steroid V k)http://en.wikipedia.org/wiki/Gonadotrope Eh:http://en.wikipedia.org/wiki/Follicle_stimulating_hormone le1http://en.wikipedia.org/wiki/Luteinizing_hormone Vb*http://en.wikipedia.org/wiki/Gonadotropin [_7http://en.wikipedia.org/wiki/Hypophyseal_portal_system r\-http://en.wikipedia.org/wiki/Pituitary_gland -_Y;http://www.wrongdiagnosis.com/p/pituitary_cancer/intro.htm <TVLhttp://www.wrongdiagnosis.com/g/galactorrhoea_hyperprolactinaemia/intro.htm Q]S6http://www.wrongdiagnosis.com/symptom/amenorrhoea.htm yP=http://www.wrongdiagnosis.com/f/female_infertility/intro.htm :mM7http://www.wrongdiagnosis.com/g/gynecomastia/intro.htm .pJ?http://www.wrongdiagnosis.com/o/optic_nerve_disorder/intro.htm KG6http://www.wrongdiagnosis.com/d/dyspareunia/intro.htm  KD^http://wrongdiagnosis.pubs.righthealth.com/topic/Syndromes?as=clink&ac=1437&afc=2168586466&p= QAuhttp://wrongdiagnosis.pubs.righthealth.com/topic/McCune%E2%80%93Albright syndrome?as=clink&ac=1437&afc=2168586466&p= )>5http://www.wrongdiagnosis.com/sym/sperm_symptoms.htm 9:;0http://www.wrongdiagnosis.com/sym/impotence.htm aM86http://www.wrongdiagnosis.com/sym/breast_swelling.htm 450http://www.wrongdiagnosis.com/sym/oily_skin.htm rB27http://www.wrongdiagnosis.com/sym/decreased_libido.htm */4http://www.wrongdiagnosis.com/sym/hair_symptoms.htm /,5http://www.wrongdiagnosis.com/sym/ovary_symptoms.htm ln)Bhttp://www.wrongdiagnosis.com/medical/absence_of_menstruation.htm }n&3http://www.wrongdiagnosis.com/sym/galactorrhea.htm ^#Chttp://www.wrongdiagnosis.com/f/forbes_albright_syndrome/intro.htm " =http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003428/ /=http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003786/ .=http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A001515/ %=http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A001952/ &=http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003149/ +=http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003164/ .=http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000343/  ^ 5http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000689/ (=http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003335/ v1http://en.wikipedia.org/wiki/Posterior_pituitary Q&http://en.wikipedia.org/wiki/Necrosis "x'http://en.wikipedia.org/wiki/Ischaemia ,g(http://en.wikipedia.org/wiki/Hemorrhage }?2http://en.wikipedia.org/wiki/Portal_venous_system )R0http://en.wikipedia.org/wiki/Anterior_pituitary S)http://en.wikipedia.org/wiki/Lactotrophs 1O[http://en.wikipedia.org/wiki/Syndrome_of_inappropriate_antidiuretic_hormone_hypersecretion ]*http://en.wikipedia.org/wiki/Hyponatremia #q0http://en.wikipedia.org/wiki/Sheehan's_syndromecite_note-schrager-0y.http://en.wikipedia.org/wiki/Decreased_libido )http://en.wikipedia.org/wiki/Hot_flashes 'k,http://en.wikipedia.org/wiki/Oligomenorrhea ,c(http://en.wikipedia.org/wiki/Amenorrhea V*http://en.wikipedia.org/wiki/Gonadotropin 3K/http://en.wikipedia.org/wiki/Addisonian_crisis ]*http://en.wikipedia.org/wiki/Hyponatremia 6r$http://en.wikipedia.org/wiki/Anemia A*http://en.wikipedia.org/wiki/Hypoglycemia w)http://en.wikipedia.org/wiki/Weight_lossUnintentional_weight_lossc/http://en.wikipedia.org/wiki/Fatigue_(medical) eU1http://en.wikipedia.org/wiki/Addison%27s_disease e3http://en.wikipedia.org/wiki/Adrenal_insufficiency Z)http://en.wikipedia.org/wiki/Hypotension [)http://en.wikipedia.org/wiki/Bradycardia J&http://en.wikipedia.org/wiki/Alopecia M9)http://en.wikipedia.org/wiki/Weight_gain H *http://en.wikipedia.org/wiki/Constipation J/.http://en.wikipedia.org/wiki/Cold_sensitivity 9r,http://en.wikipedia.org/wiki/Hypothyroidism J-http://en.wikipedia.org/wiki/Hypopituitarism 'k,http://en.wikipedia.org/wiki/Oligomenorrhea ,c(http://en.wikipedia.org/wiki/Amenorrhea %q+http://en.wikipedia.org/wiki/Agalactorrhea i,http://en.wikipedia.org/wiki/HELLP_syndrome I5http://en.wikipedia.org/wiki/Amniotic_fluid_embolism #rDhttp://en.wikipedia.org/wiki/Disseminated_intravascular_coagulation "s'http://en.wikipedia.org/wiki/Pregnancy !l(http://en.wikipedia.org/wiki/Childbirth d/http://en.wikipedia.org/wiki/Hypovolemic_shock ,g(http://en.wikipedia.org/wiki/Hemorrhage Q&http://en.wikipedia.org/wiki/Necrosis r-http://en.wikipedia.org/wiki/Pituitary_gland J-http://en.wikipedia.org/wiki/Hypopituitarism A%http://en.wikipedia.org/wiki/Anosmia o~2http://en.wikipedia.org/wiki/Secondary_amenorrhea +i{'http://en.wikipedia.org/wiki/Thelarche M x:http://en.wikipedia.org/wiki/Secondary_sex_characteristic bu0http://en.wikipedia.org/wiki/Primary_amenorrhea 0rr(http://en.wikipedia.org/wiki/Micropenis g6oYhttp://en.wikipedia.org/w/index.php?title=Mirror_movement_disorder&action=edit&redlink=1 gl,http://en.wikipedia.org/wiki/Renal_agenesis ;|i,http://en.wikipedia.org/wiki/Cryptorchidism `f*http://en.wikipedia.org/wiki/Cleft_palate M%c.http://en.wikipedia.org/wiki/Colour_blindness A`%http://en.wikipedia.org/wiki/Anosmia F]!http://en.wikipedia.org/wiki/FSH lZ1http://en.wikipedia.org/wiki/Luteinizing_hormone rW-http://en.wikipedia.org/wiki/Pituitary_gland %[T;http://en.wikipedia.org/wiki/Hypogonadotropic_hypogonadism AQ%http://en.wikipedia.org/wiki/Anosmia TLN^http://en.wikipedia.org/w/index.php?title=Aureliano_Maestre_de_San_Juan&action=edit&redlink=1 5rK(http://en.wikipedia.org/wiki/Geneticist <JH+http://en.wikipedia.org/wiki/United_States SE%http://en.wikipedia.org/wiki/Germany OB2http://en.wikipedia.org/wiki/Franz_Josef_Kallmann %[?;http://en.wikipedia.org/wiki/Hypogonadotropic_hypogonadism A<%http://en.wikipedia.org/wiki/Anosmia D9*http://en.wikipedia.org/wiki/Hypogonadism J6*http://en.wikipedia.org/wiki/Hypothalamus J3*http://en.wikipedia.org/wiki/Hypothalamus <0<http://en.wikipedia.org/wiki/Gonadotropin-releasing_hormone D-*http://en.wikipedia.org/wiki/Hypogonadism 4y*/http://en.wikipedia.org/wiki/Hyperpigmentation M*'-http://en.wikipedia.org/wiki/Muscle_weakness S$&http://en.wikipedia.org/wiki/Symptoms 2x!#http://en.wikipedia.org/wiki/Signs 7d<http://en.wikipedia.org/wiki/Melanocyte_stimulating_hormone F-:http://en.wikipedia.org/wiki/Adrenocorticotrophic_hormone 4http://en.wikipedia.org/wiki/Mass_effect_(medicine) ?@/http://en.wikipedia.org/wiki/Negative_feedback ]&http://en.wikipedia.org/wiki/Cortisol yB2http://en.wikipedia.org/wiki/Cushing%27s_syndrome U %http://en.wikipedia.org/wiki/Surgery ){ +http://en.wikipedia.org/wiki/Adrenalectomy u=(http://en.wiktionary.org/wiki/bilateral l+http://en.wikipedia.org/wiki/Adrenal_gland `/http://en.wikipedia.org/wiki/Pituitary_adenoma   !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./02345678:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~Root Entry F j Data M1TableWordDocument|SummaryInformation(1DocumentSummaryInformation89CompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q