hWta retwh em fof ni hsit uqiesotn is teh shpaer l"ecls ithw little matlcoysp htta rae cetwi teh zeis fo .hys"mcoytpel I hhtguo llm"sa llec ac"macniro antnco eb ahtt .ibg

ehreT rae niaectr tnssiaiuot ni ichhw oyu tdno' dene ot yiontf snatrep atubo ynnghtia wnhe ngteatri a dilSsI--hcT ear one fo m.het The rosaen gienb hatt endaeurtt TIsS ilwl ueasc rmeo sadrep sa ewll sa can adel ot DIP

LPIRSEO IROSPLE PISERLO
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hiTs si LYILATLRE eht emas otohp tehy esdu to sibedcer teh yeolrd--a4 yob twhi udfifes rolitcac srsionec from BMEN 8.1 aCn enosoem xenlapi sht'wa oggni on here

heWil teh miltfeie rsik ni eth ernegal inlpoopatu si sjtu wbole 1%, ti si %6.5 in feerdts-ireg vasetelri of saetpint nad it ssrei ot emro naht %04 ni zngomotcioy wtisn of efefcadt lpoee.p ganAliynz islscac teidsus fo het iegctsen of oaipneishzcrh enod as yaelr sa in ,30s91 reiFshc dnclocseu htat a rancocenocd taer ofr scoshsipy of utoba 05% ni gtozyiomcon tinws sseme to eb a tsiaelcri siteatme, ihwch si ntsiginfaiylc hrghie htna atht ni cziodygti nswit fo tubao 9%–011 (/rn9iccgl./t/.oCm/mpe2c643nP3vfi#ah5in6sler.bM)

can mnoseeo eiaxpln wyh ti yssa he sah an 'ai'tntc PTH nii.rantco.s.nctoe ti to tel us wnko atth the PTH nrotaietonccn si a reults of pl ?dtoynagoah wa'sth shi ?dx tknh!sa

hisT is viraceet cthyiaeoplmy aer,v ichwh is due to hhig tduetali or lugn .dsiseae aSO2 si ol,w dan PEO si dincrse.ea

rhnotAe ywa to oahrpacp the uienotsq is oioglnk at eth odlob mesar. tsI' yrtept rmoanl (no ageaosyktr,mcye on encdsiare rebumn of lptaltee,s no ro,ds hnnigto ue,bl ec.t) A obldo rsmae fmor a DOPC tiapent lilw eb .aromnl stJu an arndceies ebnumr fo RsCB deu ot hte rdaeinsce POE ndigael to receadsin .bgH

cililnaC esu of inpK-grsa dcreiusit:

• nrsiaeHylmdtosoper
• +K doelneipt
• FH
• hptecai cisetsa o)tloscoir(paenn
• prghncoeein DI el(idaoi)rm
• dnreiagontna

g,hAit kid if m'i hte olny noe ubt i dah NO eaid wtha the g to icaelro isvsonecnro were so eher :seog

rPe 1g of

teobarhCy:dra 4 acl neo: tPri 4 cla Fa t: 9 lca

ehT orme oyu kwno...

I ihtnk tshi si eia,basB tadmnretist yb het oniR[b fo] odIesx ckT.i

751P, A2190F

Wnhe uorey' no gLno sInld,a icngdraoc to noj,Gal yu'oer NGIGO to get a ctki iebt fi uyor egsl aer eosexpd. sTih ilgr asw nrogkwi as a l.gaiurfde hTe osexid ckit si tevain ot eht EN A.SU ilheW we yypaltlic scdsaeaoti teh ealetms rscso iwth seibaab, teehr si asol na riytnathoritcre rign ofm.r This lgir lsao dha a n,pmlesetcyo hiwch iscenasre eht skir fo svreee sised.ea

Tihs daly ahd rtremep eretumrap eurutpr fo neem.smbar heS had a tlnaeig tarct tf,nionice whihc is a skri oartfc rof .RPMOP

Fmro tat:nde pUoayM of the nosgiarcsmmiro atht oolnicze eht elowr enligta trtca hvae eht aypitacc to rdpuoce pih,oeaoshpplss cihhw anc ieasumltt eth cunoorpidt fo idgonnlasprtas and rhybeet aled ot the onste fo erniute n.acctrisootn nI dtidia,on eht ohss't eumnim psoreesn ot alabecrit iiasvnon fo hte ecerxivodn a/odrn etafl mbemrsaen easld to eht nptidoocur fo lulpetim iytmmaflnroa oresmtdai htat anc acues alicdozle gkeewinan of eht altef asrnmbmee dna tlseru ni .MPRPO

AF 1092 gP 373
cci hron istastgri asoculm initamnoalfm anildge to tryhoap

ihsT owldu stju eb the amlron nrspsoee of rou esiydkn to nhew we nto'd rknid ewtar ungeho ka(a sjtu a.lnmo)r

iaxrPoml utlbeu is csontioi aeusbec ew ear oebrsanribg TBHO Na+ adn O.H2

uMalac senda is htonyiopc baeuces it is esngsni teh tdlias lncvoouedt elutbu -- het omst IUTLDE ptar fo teh eornhn.p meemerbR the nnorctuterecru ghnxceae tymsse - tchik gesanncid ilmb is nsgiol alCN nu(ier gtse lsse cetratdeconn as it ndea)ss.c

euarlydlM lnoctilcge uctd is hecpinroyt bueesca we ear sebogrranib lal eht weatr mnagik teh eirnu eorm .erdtcaocennt

Cluod emsoneo xinapel wyh htis cheico si hte best rswaen? I segtlrdgu nbewtee A dan D, adn kcipde A ,anilylf ihchw si crias"taen aeuntidcloa ellve nad ripdove "slca.upotbini

I aws cudfsoen tenweeb aphAl- cSuennyil nad au.T ih sT tienatp sha ssakniopnr iseadess dan uths we odwlu ese Alahp lninsyc.ue

uaT si eesn ni intseapt wtih Picks easde,si kaa anoelrprFtotmo tdamenei NAD ihserazmel iss.eead ap ge 4.50 AF 2018

ttPrey seru htsi si a ecas of leoenLalg.i The caft atht ti ndi'td ohsw pu on etcruul btu a gylhhi" aepc"ldsziei mmiedu ni( itsgnhhid ffdereub oalhcacr )sayte edeyild neiaerg-mavtg odrs tpu ogllLneaie no my ad.arr hTe dcheahae nad rdy oguhc osal line pu ithw it tbu the rsmeldcioa twhre me off sneci I gttuohh yeht wree tredeta thwi fouqouonrloinle. t Bu eth ckyhest odive for lsdromiaec liuencds nLelaigoel as a gaettr os ti ekwdor tu.o

eetcyLouk dieohsan yd,cfecneii a tcdfee ni igtinnre .FL1A loptiseuhNr are ueabln to rhedea adn grimate to ieintnofc es,tis adetnis cglcuanuitam ni b.dolo Tish xlpsniea eth aeebnsc fo speiohlnrtu at intneofic esits nda tldeaeev hoenptrsilu in .blood

Seid ent:o shPoey is a agert erfe eoesrurc twih ykecsit-helk smieag ot lpeh merebrme icidismecueeifonmn dna mro.e toN at all pso,renosd utjs bemsudlt opun it nrgidu eitaeddcd and ksdheco ti s'itn eorm yewlid nkonw tboua./scn/el/moohm/imgopsohty:.uypt

aWht ouldw a uuerprt of hte ainalolpf ebut olok klei then? erpdCaom to olranm peias.lgl.

Tihs elalry sonuds kile si't ergdscbiin plorAt m,yersdno tbu Atrlop oerymnds si e-Xidnkl ATMOIN!DN Wath si gongi no r?ehe sI iths a i?eatksm owH to pxenali liagnlc it Xlidk-ne EVSE?IRCES

trlApo tmnouotydMi eSnar ni pyet VI gloecanl ;t-g& itghnnin dna isitpntlg of lgmaruelro bnetames beemrn.ma oMts mmyclono -dkielXn dna.tiomn Eey psreolmb ge(, eihoprnt,aty tirerano ico)ntuesln, oiitsohgp,umrnleerl nalosneruseir fs;deenas ant’c“ ,ese an’ct ee,p an’tc rhea a e-”be.e—ebsa “M”ekvEawt rapecnaepa due ot arlerguir ignncthiek of MGB

hte loeAesontrd saw CEISNAEDR in hte ansrew

Tihs hsa to do thiw the lhitramog fo aniettgr hks.co eciptS a( etyp of ersbdti)ivtui oshkc sa llew sa phlvoycoime oskch ear ardtete itwh VI idluf neuasitcrtosi 2(0F20A p3)01. lstailodyrC dsfilu ear ies-lfrint hoec,ci dna anlorm asinel 0(,.%9 oision)ct si -teirslfni yciacseifllp ni csesa of cokhs.

%5 esredtox ni awrte dan 40.%5 lnisea si cnpohrteyi adn not fuselu he.re

%5 xrotedse aolen is coiitosn ni eth bga but gcpiliylloyoahs ntp.ioochy tI is rome nofte evgni for diulf nrtmpaeelce tfrae evrees etyndahrdo.i

45.%0 anelis nyol is thcponiyo dna tno lusuef eerh.

3% aslnie si iponecyhtr dna not ulufse .eher

• erHe is a thcra fo eth fdlui ucteriaistons for the niefdtfer nsidk fo khcos
• ereH is a ahctr of hte effnrdeit ndkis of VI lososintu and in lagnere henw to esu meth
• Heer si etonhar ahctr of IV oosulnsti and usse aecus I keli tracsh
• And eher is an gaeim inhwsgo in ranelge henw ot vige nomrla lniaes %(90. eals)in

layomakeHip is tnofe rmof tridsceui TCEE(PX eth K npgaris seidctuir on the eiccolltgn uutb,le STEA nSrti,ocnl[paoeo neprol,enee ri,ieolAmd htrhtimrzrlaTedecn,odroe]H )iaeayi a ricisutde cantgi no het CTD sacuse hol.kyamapei

Ohrte sopo:tin inioendlC aapl(h ,orcb)elk Liplirsoni Atriio-,Ci(En)hb Moorellotp tbae( ocb,elk)r itmerneTare K( pagsrni )uedciit.r

oT wols aiebctid pnrahhyotep, yuo nca gvie na AEC botnihiir i(.e,. )opiillnrsi or an A.BR ihTs dwluo to icrseenad itiadnol fo eht fernefte rteieroal and pvnrtee hte foetnlatririyph njyiru secadu yb bidieact erh.pnthapyo

A wfe of the nisht taht nptio to dauhoetirm ttrshriai roev hte retoh snewsra:

• oYrunge age of tones dna fmelae - ithruedamo irtirhtsa is na meamtniuuo aesesdi and anc tsuh pesetnr ni uoeygrn seflaem wsereha rtohtoraitises si omfr eawr nad aetr os ti si ylulsau roled daliivsdinu (0F220A 664p rof roitrtstiaohse sv irmhutdaoe)
• anpgrSi fo teh ltadsi ietraaepgnhlynl toijns DP(I are sedrpa ni irtudhaemo iirhtt)rsa adn belatrali - ni teh rothe diderrsos terhe si not ssceyaeilrn liiyttecvse for teh PPI dan PCM, adn tyhe duwol otn eracslneiys be ribltaela i(e.. outg si otn eirescanlys ailbaeltr) sheawr dirmtohaue irashtirt is albatreil
• uPsann onrmfiaot - het omniforta fo aorlund nespnasu si acerccisihtart fo oumeirathd tirrtshia vero ethro irdsrodes (ecplesilay ocne gtou is emldaitnie het cenreeps fo doleusn ptinso smot to uomaritehd sirarih)tt
• LSE ouwdl be eiklly be dsiaeocsat twhi oterh sisoaedtca mtposysm 04)p7(
• sloA eth raihtitsr ni ulups is cleennivetso rfo inotj teyp
• mSolerdcera seod tno conlommy peersnt whit rhtaiitsr or tnoij ainp 7(43p)

hTe eky fro tihs ngebi isesgtncid ymrasune si atth st'i a ddeiewn itocar .rcah ol,sA t'shere vneenu pussel s(iihn"mdied uelpss ni eth flet urppe etixy"tmr)e nmegani atth dlboo is ont npaissg fmor hte raoitc ahrc ot hte tefl lancasiuvb ryrate i'st( ton ssgnpia hte roctai ra.)hc

eHer is ym aket: a trnearvcuil tlepsa deetcf in yncaifn oslwla fro left to rhtig hntgusin fo dolob ni hte irts.lecnve ihsT cuseas an eredscnai suprerse ni the gihrt tlcnreevi ue(d to ermo odlbo gbnie sdephu inot t)i dna a aercsdede uesserrp ni teh tlef c.veelrnti Bceusae ethre si moer odlob ni the ypuramnlo oinrctaucli mofr the ns,hut I nhtki eth etfl alairt resrsupe woldu aols eb snaericde ni an yelra .DVS

OS ehnw yuo areipr het S,VD het etfl cnrlvtiee rusepsre wlil be ierenacsd damcrope to wehn het uhstn saw prsenet ti( si on enolrg ionsgl olo),bd het tgrih teilncvre repursse lliw eb eaddecers (ti si on roleng ntetggi oobdl omfr het u,s)tnh nad teh eftl aaltri erssepur will be dsearceed tre(he si on olgenr ovrodela of het orumpalny mstesy tnrigenur to eht telf a.tmi)ur

0A022F 8p29

hsTi nustoeqi is kaigsn athw tfel inmnotda cciaulotrni mna.es I sesoppu ti tsanw su to fneri ahtt hte PDA si pyupsglin teh ahgarpmid acuefsr nda VA odn.e

tI si nugfisnoc to em sueeabc rylnomal het tRhig nrialamg trarye sipesplu het irpidtaagmcha orerbd tae(uc ignr)ma of the ra.the mI' ont erus ahtt it cnhesag ni etfl inadmotn cn.ircioulta tumrheorFer it odulw ont hcnbar off eth DP,A ghlhaotu aybme tapsr fo ti rea sudlppei by hte DPA

lsoA eth AV done si lsueppdi by hte liAetvoicunrrart doanl ryrate, hwcih anc be a abrchn off of teh LCA or eth u XtLbC otn layrel het APD

p3P9gmt7cwbnMvli/5tls9ww3ithnni././/C/:ahe.ps/r.1cmco

os oinsfgnuc ioeqstun rfo me ubt eht npoti si to ownk het osecru fo tfel oaimnndt uirntciclao ot hte PDA

dsaBe on teh siyroth tmuip(nnosoc fo grela atsmoun fo oaoclhl nad aetlvede remus apmye/alisleas hitw ycachlp)imaeo, tish man likeyl ahs cateu tiaatspreinc (02F02A .)9p73 enO fo teh raojm ipmnccslaooit is oettidgaunosi fo t,iussse such as tawh is seen in teh meg.ia