The leoopd si lgalepcrhyn,oei and a 1010/ doog y.ob

eftrA eth ffcu is ,ited hte ellcs dna utsise asdlti to eth uffc lliw neoinuct mnnigsuco TPA (&PT-DPA;Agt,) tub no hrsfe oldbo lilw be eedlivrde to ca“le”r wtah llwi eb an mntgcliaaucu nutoam fo DPA dna hotre msioaeebltt. APD in=e)(nAsode is lftesi a xopry fo moinpncosut adn isrvde doltvsioiaan of atrersie! tuoilnvo(E is )s!mrta nIgsaciern oPnDdniAee/As in a c“laol rnmoenvtnie” is a gnlisa ot teh ydbo hatt a otl of copumitsnon si uocrcrgni ;hrete h,tsu tesrraei adn teoaieslrr larnyulat tlieda ot eenicrsa odlbo lofw atres dan sp“eew aya”w etaiolcbm otyrpscu.bd

ta BMI 15 nto ylon sha hse enrve hda a eoipdr utb she erven ahd a e.mal

I ilke siht uoqtsien esubcae ti ersimnd me hatt asiemrxen tnhki bctojes nca xetsi in 2 isden.nomsi

Tnkha oyu MBNE orf hte hihg tqluaiy uptse.cri It sakme esteh amxse sssret feer dna baonyejel.

tihs entoqusi aemsk me tnaw ot ate an e cloi eciook nda oeph i bleed tuo

The naoudedl munel na(d aecatcnpir sosearpte liek )CNHTIPSRYYMO is eth esti rehwe pccntaeria esyzenm “eedesipopd(”)tsna eecalv grael ytidolpspepe oitn lsealrm ibst itee=.rdip(te)dptieis,dpsp tI is at hte RHUBS DBERRO ehwer eth lssletma sdkni fo tsepiedp ppspeept(id,ties)itrdide are roekbn ndwo into iterh noami icsa,d ichwh fylnial nac eb nr-orsatteodpc with +Na iotn het lesnitnati elc.l

I hntik atoub it ihst :ywa

• tocahms idca nuedtaers adn sone“p pu” oeirpsnt htu(otiw csfciipe agcee;av)l
• acaprincte syezmne enth vcalee daduneert ipedeytlppso tnio lesamlr ib;st
• hsurb redrob nymeesz nylflai aekbr wond tnstiie sdetiepp noti seablbobar ioamn icad.s

eThse dnski fo eiouqssnt rea aelylr radh sbueeca eI'v rnvee sene mleaef vptercdeiuro rstcusteru l.ri c:

tsaM cllse utdaeagr,len cprduigon nesiatmhi wihhc tttarsac s.oipeihsnlo ehT yaelr atesg of na icrgella niatcroe si tams clel ,ddaieetm ubt eth eatl tages giiunl(dcn usucm iudron)tpco si mdtaeedi by s.iinlhopeso

tanPeti sha aSipn faiidb caucotl cwihh si a lurean uetb ftcdee ulif(era fo unofis of the rsroeunep)o. lsceemStoro era eth prta fo each sotemi ni a abetrreetv rbomey ivgign reis ot ebno or teorh klealset i.eutss eniSc a tpar of tshi 'sienttap npisa baifdi elunidcd cbsaeen"s of issonpu srpos"ec hent a mscoroetel asw levoi.dvn wnnigoK thta lurnea buet stdcefe rae na seuis wiht ounsfi hsodul be gnouhe ot get to teh rhgit n.esraw

fI hte orncootdh lfieda ot vepoled tehn the nirtee NSC dwulo ton evldope sa teh tnodhrcoo cnieuds ofmortina fo luaren alp.et

If het lnerau tebu ildaef to doelpve htne teh ehwlo SCN wdluo tno hvae eedd.oelvp

Ylok sca si eranlvrite ot shti ie.ptant

hneW rlneua ctesr lecl it hsa diereffnt tuoecoms in ffereidnt iest.ssu aurlieF fo lurean ecrts to mgietar ni reath nac seacu onoasiTsirpnt of etarg slvse,es trTalyeog of F,atlol or nsrtPietse tursnuc srteraoi.su rileuaF fo ealurn escsrt ot mitager in GI can ecusa Hrupicgnsrhs sadiees (tglniaecon agmlo.)noce recTerah lolisCn rmeSdnyo acn ocucr newh unrlae ertcs llces ifla to rigaetm otin t1s lhpgeanyra ra.hc ulareN utbe stedfce sha inontgh to od wtih urafeil fo anrlue rsect onaiigmtr .gtohuh

vyoEeern hwo otg shti inetquos tgihr si a .cop ༼⌐༽■͟ل■

Uera lyCec oedsrriDs g&;t loIsdtea veeres emaapimenhorym t;(g& 0001; e..i, on rthoe eesevr ibtloaemc tscsdrinbaeu

iOtrnnihe almserasrbctnyaa ycedfeinci tg;& som(t mnoomc uare lceyc )sid. tcorio cmcaiadaradeu/iii, nmriapmaeoyemh

cOnirag Aidaseimc t&;g mieaoenHrm,amyp nai-naogp scs,aoidi isstkeo (frmo ymgcoaplehiy)

-iiuedMcnmha ocACa-ly eohyddsaengre fyicinedec g;t& pnroam,eymHmaie ctetoopihky ligyoyecahpm (snee in xβi-naoodti irsdsedro, ETCPEX nyhkeorrddueotao)plsy

ervLi fdouticynsn ;gt& mmaerpyn,maioHe TsLF deemss up, ledro t.p

Setnt rsmbohoist vs ernssieost-. tSnte mssohorbit is an auect niooslucc fo a oyrrcaon ryetar ,tnset cwhih fneot uesltrs in eutca nrroyoac eo.yrsmnd Can be pdretenve yb uadl entalaipttle rheatyp ro trluugdg-nie ts.tnse e-ssnoeRtsi si eht udrlaag wnirgrano fo the tnest umlen ude to nalntiomie nptolfarro,iei snutgielr in nilanga .ymssmtop

Adgnneor ivnIysitsinte Soymnerd - eceDtf ni eanorgdn epteorrc tinurlegs ni ana-pmopelgnrrai eeamfl 6Y,(X4 D.S)D unFngiintoc eetsts csesau cdrsnieae eottreensost at e,rpbytu chwih si netcdover to eonsrtge pheayl,priler vnigig mealef rdcsoayne lusxae ieracctstshacir elfem(a telxaner at)li.engai kLca fo agorendn reoprtce cuontnfi sdela ot tsanbe ro nastc illxayar nda ipbcu irah. ttnasiPe veha aunymtrerdi iga,van tbu urtues adn inalofalp uestb t.aesnb

rnnegAdo yiestsiinnvti ernsdoym si eth ranwse tbu oyu tgimh hvae nrcosdeeid ailrMnelü einaesgs siykaoM(-arekt-Ryn sKeser-rüuHta .eymrodsn)

Mraileunl sgisneea lwil aevh almonr moehrno eelslv dna aym stenrpe as °1 oremnehara (due to a clak fo terueni peeelndotvm) in melfsea wiht ylful veddpleeo °2 sauxle ciscraaerthistc uo(litafnnc a)r.seivo irHa eptelnvdmoe is lmoarn sa wl.el naiPsett oasl eavh mrolan .theihg

eemSs eikl stih uoesniqt ddi ont vieg us umch ot udintiihssg seseidb etihgh adn nrntea seagt 1 bclpariaiy/lxu iahr.

ehT otsm dicert tha,p dan stmo elikly ,thap rfo basert ccaner to smtaaietsze ot eht vetbraer rae hte ceaoltisnrt isnve. hiTs wsa no na earelir ENBM ttes as el.lw straBe cecanr lliw suace xdim,e tcliy dna atlbcis soelsni neco in eb.no

nO an aruldntaee eont; I aifllny aemc pu wthi a dnctee ayw to eeremrbm liytc sv. atisbcl crscnea ni !enbo

IkYedn adn rdoYhtI scuea ltcYI

rpsatote &;tg tasatebl g&t; atsibcl

owT strbesa g;&t otw ytsep fo sseioln t&;g B seatr sesuac B tho

owT ugnls &;tg wot speyt of slneois edi(degnpn no yetp fo glnu )crcena

alelm-lcsl lgnu ;g&t malsl" tsbl"as

sn-anmoll llce ;> lcity

bdesalu-"drotn rbaeska.r..e sdaceu by giozinin i,iaortnad dnciglniu amagm arsy dan yX-sr"a. .vs U"V airtndaio sscuae wto cssasle of NAD sno:lsei tubcaynlcoe iindimyepr dmsrie CPDs(, rugiFe )1 nad -46 pcsrhootuotpd -(46 P,sP Fueirg 2.")

iaab.nratstmmgca/a-aoaclc-drioinnia/thg-/w:s/eu4-pfpmhane-sotti.m-tserwinriaw-ecmpand4de3egpn/

ihsT iteuoqsn si ervy kysane, ubt ni seecnse hsti si hawts .engppnhai

The naaldicect melrvoa fo het HPT agsnld dnirug octiodtmhyeyr ⇒ ↓ HPT

PHT lniaym-:onr-l :neob ↑ vlaomre fo ⁺²Ca nda optahhPe mfro ineb on-- i:nkysed ↑ ²C⁺a irbrotpnsoae dna ↓ ⁻₄P³O irarns b↑oetp--o onsvornice of ,25 viamondxrHyyti D ot ,512 ioyaitrmnxdyHv D liCiat(ocrl - eicatv )omfr avi ↑ ytiaticv of -1a srxoyeylHad cncieifeyd

errheofTe a ↓ HTP udolw aeld o:t

⇒ ↑ ⁻³PO₄ ⇒ ↓ ²aC⁺ ⇒ ↓ 51,2 Hiridaytvymnxo D

eTh etoqnusi is nsyeka u(cmh kile het tser of ihts me)xa ascubee oeeosmn ohw tsni fognuisc ylelar rahd ro ni a rsuh imgth ckip the pntioo C eerwh ohaethpp si ↑ and HTP is ↓ UBT ↓ 25 rmtahxodyviniy D

hiTs si rwong as lyno 1,25 hyotydixaimvnr D dwulo eb eaecdsdr,e the srnoescivon brfeeo this rae noed by eth ksin tiulsn(gh) nda evrli.

I rleayl sihw etyh ludwo tops ngikam teh noueitqss noisungfc PRLYEU ofr eth skea fo kmnaig mthe nunso.gifc nIts it hugnoe that we vaeh ot nwko tihs cirluoduis uoantm of aoitnoi,frmn ithwout vihang htme nteonialtynil nakmig ti rdaher yb iptgonin yuo ot 1 awersn ccoeih but aginnghc a ntiume ieltda to ekma uyo rsawne wgnor. rO ugsni a domrna sas eoartumnnecl for a edesais to oadvi gmkian ti oto semlip GNS(P = peotaielr"rfvi )NG"

aMke a ntnpetu uearsq htwi a sscro fo B +B nda B 0B; +B rsrtpensee 50% nitcnouf wilhe 0B psstnerree %0 lun)l( nfic.uotn oS in tshi acse, eht dhubasn dwoul aehv a B 0B neegpoty ewlih eth fewi hsa a B +B pegnytoe.

srosC fo hetes owt illw suretl ni hte gowollnfi tpe;gyones ,BB 0B,B +,BB B0+B BB = 0%10 ni,oucnft +BB = %57 fu,oncitn BB0 = 50% iuonfnc,t B+B0 = 2%5 fnnuicto

So hte rwsnea liwl be 1 ni 4 evha a %25 fnnotiuc ngvie eth nygoee.tsp

hTe way I htghout autob it asw a eilttl remo .ipcmiiltss We seu onn ivceteels btae esrlcobk e..g( loorlrP)pnoa fro teh nmterteta fo eltsiesan o.tmrre erTfehoer a atbe nsaogit uldwo ahve eht ppseotoi t,feefc aka auecs or enhacne e.trrmo

"aseatlarrnP evhea f)lit( usrcco undrig hgrti nrclvurtaei htpypohrrey i.(e. renetm)ganle or yerv rryeal eseevr tlef ralait menlne.tr"eag RV yrohyrpthep acn be enes os saiyle eecausb eth VR is at the rrenaiot sefrcua of eht e.tcsh

In hist pttaein odblo omrf LA ot VL saseredec in osuart,nati os ti si giong rw.heoesme moFr eth O2 sta. we nac dudeec three si ropbylba a SVD d(aienesrc RV uersrpes ulodw aesuc RVH nda etpsaanrarl hv.)eae rmuorFrt,he eth vtigneet is liyelk ngicrbsdie aoegttryl of lltfoa ue(dacs yb esurernrotpaoi emceitlapdns of eht nifnribduaul ms.ptue) In Tet slsp,le RV oufltow is oot toerctusbd dna itepnta gtse saoiyscn dan ;gLRt& nhgntisu uStasq eicnsaer SVR, ceergdsnai &tgL;R sutnnhgi, upingtt rome odlob uthhorg aounpymrl cictiru dan virengiel cs.isoayn

tujs wtdnea to dda ttah sonstuieq ahtt ask amlsl litsdae keil ihts akme em ntaw ot ravce my lyeeblas uot

erP mhPtaao: alyer iihrnteed scaes of eliehsmr'Az ndimeeta are aoidesatsc whit iunsmotta in innrsenl-n,-ieipep1eli/r2s as llwe as Dsnw'o red.mosyn wDosn' lwoud be eud to an axter ohomsmeorc 21, hchiw esrrica eht egen ofr mlayiod urporsrce rpetnio (AP)P. atxrE PPA si ednotvcer ot at-beA lamidoy adn stih orfms exltarrecuall erntucii le,qspua a reptoninm frautee fo hme.'zAreisl

tamntIopr ot ton ucfeons mAioyld A tropnie e(on fo hte sarewn ceoihcs) twih doilmAy rourcpser et.nirop ioetpDsnoi fo AA iydaoml si rmoe dssaectoia hwti hncocir lyaiafrtnmmo tse,sta lcinnamgay, dna mlalaFii etdnenaMiarer ereFv. -aBe2t gbcunriloiolm is oneahrt yloimda ctnososia:ai discosy-staesaildai tpsiedso( ni tnj)iso

plAprnatye erthe si a pcoeeyltlm aepserat slnpia rodc lerexf ewhre crtedi npliee itmlotuains elsad to na .rioentec ihsT eerxlf yonl seedn an natcit acr in 2-SS4, os sa nglo as tsih egoirn si tno iejd,nru an retcoine nac itlls uco.rc e,wHorve thwi iaocsrnentt at C8, tneh eth ocsiehcpnyg inercote erflex nctano ruc,co as siht iersuqre gsneidcnde efsbir fomr hte t.corex

ehT apeintt has loss fo pani adn eeeattmrupr on eht hgtir isde of sih ea.cf tnnasSeoi of teh fcea si p,lriitasael os eht sesui mstu eb no eth tisptn'ae tghri e,dsi wichh we nac oimfcrn by nwgknio htat onntsisea fo eth oydb si r,rlcolatatane dan eh ash stol lfte iedds anip dna tremeraeptu fo eth .bydo

iaPn dna ptereerumat ensiatons of eht ybod si atpr fo het tclioahmnaspi tra,ct hchiw alasyw rsnu ellyltaar tgouhhr hte r.tbaimsen ishT nca be eoirnmdcf yb ereimbrmegn htat saetniosn to the acef saol unsr erlaltyla rgtouhh het r.tmsenbai o,S we cna crionfm sith is a hgtir dside rlleaat sbramtine esi.us

heT osls fo gag lrxefe dna asyisarlp of het oavlc sdocr myipl iimnmatper fo ailarcn vresen IX nad X, hbot fo hwcih illzoace ot hte mealdl.u hTeer,erfo het aswenr is gtrhi tlelsaoorrda medal.ul

yheT ytipxleilc ettas htta eth neptait ash enbe tknaig exssce fo ihs ioteryeolhnxv i.eocnmatid Lvortenhxiyeo si eht ognusexoe frmo of T4. rTfeeh,eor eerf T4 tmsu be le.etvdea T4 si cdnveotre ot T3 at osmt aererhiplp e,itusss os T3 lwil saol eb e.veltdea auBecse hte bydo sha emor tdryioh nhrmoeo than e,edned ssle SHT wlil be md,ae nda eht rhodtyi lwil be sesl ,aitcve iknatg up ELSS en.dioi

Frxole uoirtdmgi odupnufsr si sesrlnoiepb ofr nefxiol fo PDI. aeiMdl tepacs fo eht sleumc ihhw(c lefexs eth h4t dna 5th d)igit is lpeduips by hte lraun eenrv ,C8( 1.T) ehT etaarll acpset iwh(hc fexels the 2nd adn d3r dg)tii is rdiventaen yb teh midena revne iefalylcsicp het onriaret tssurosineoe rhcbna ,8C( .)1T So the steouqni is regiiscndb a cainroltea namdaggi the eenvr ppsylu ot the IPD exlorf fo eth n2d tidig xdien( f)e.irng hTsi si ansiyg the dmieal veern is bgeni daeagmd 8C( adn T1; oelrw krunt .r)soto

imbcrLaslu ,(s2d1/tn dne;ima h/r43d,t )nrlau ear a grupo of ecsslmu tath lfxe at the CPM nto,ji dna eendtx IPP nda IPD j.stnoi

Cudlo reeembmr as xlf'eor tdgrmuiio durpunfos si lfyodounpr ong'l seinc ntnodse tinsre no DIPs. eapdrmoC to loerxf giomirdtu suiiafelrscip heswo dnteno sapwr aourdn sfpuuonr'd ieflapcisrlyu btu seritsn on P.PIs

eeBucsa oyu rea isenup, etesr’h needirasc olperda gingo abck ot oruy reath no( ndee ot rwko satinag ,vtiaygr royu dbool sni’t lgoionp in royu sgle as cumh .)rheeit sA a tsreu,l ANP si ceerdset ude to RA tehstcr, dgienla ot iuseirsd nda a nriotdceu fo doobl evouml.

Aurnaln pcneaasr si an nmroaalb artooint fo eth tevlrna tnrcaeapci dbu. tI ceincrsle het 2nd tpra of eth odmuuedn klie a ignr dna rorswna the uelnm of the mneduduo. If teh ainraepcct ngir is hittg gouhne ot orawnr het meunl ue,hnog it aldse ot ivom.gtni eTh biiluso igmotniv pleismi teh oucostbnrit is dilsta to het uaAplml fo a.retV

rOhte wessnra

rPclyio oensists -tg&; NONuiiblos tjreiloecp tingovmi, i-aedophlesv smas ni pigrcsaeti rgeoni

Ealspogeah tsreaai ;-> uldwo eb nno iisbluo sa .lewl ulsylau nseotnea pentesr whti roodgnl,i koche nda mvoti iwht TIFSR egifed,n shit oby is 3 rys ldo os ti si ei.ulklny

ialyirB eriasta -;gt& -vortrFieoaliebibt rdtteuscnoi fo haxteictpera ilbe cdu,t desal ot .asltiehcsso lyUausl rbnwone iwth jid,aenuc dkra niure dan ahicolc sosotl aucesbe lbei kcaedb p.u

If BMEN ksas uatob a ikd ihtw siuouspics rahs duner ihs seno + /guhiedmaeelbdrhdt ni lcas,s ahtt kds'i ufgnifh guel

The sesedia eerh si octfesru oshsaihsbtaepp eey.dfnccii In t,i IV rglelocy or urofsetc e’osndt ehpl ucebaes tboh eentr het encnoeoliegugss hwytpaa elowb trceofus athppha.soiebs oGtsaeacl no eht htoer adnh rtsene aobev it. I d’ont tnhik uyo yllrae ndee to wonk sthi ot socheo the ercrtco srewan scnie eth aiclnlci priuect fo ngtfais yogcipmaheyl hatt si dotcerrce w/ emos srto fo guras htat anc etren hte onessicgongeule phaywat losuhd celu uyo tino hte githr wse.nra

orneAht ayw ot ihktn utoba htsi si hastw teh osselc gesta ot istmsoi csuabee rghti oerfbe M o(smtis)i oyu eedn to aehv cittimo csliync dsezsheyti,n nad thta uoldw be 2G

1G t-g-&; S &-g-;t G2 -t&-;g M

acArl iitlgensuo is omts onmocm ytpe fo aenmolam ni aAcfnir cimsnarAe nda is no eht lmpsa or so.les I suseg het plaitcy hnktngii of echts and bakc un(s d)poseex is a leitlt fieeftndr in shit ep?yt ngoAm lla gompdrs;iaehc oesnlaamm coruc the tyarjoim fo itme no hte blsmi 3%(~6 rlweo adn %9~1 rupe;p) nrtuk si .27.%~. So bdaes no atth and mhi eigbn fo afAricn esdtcne we can ooecsh .lsmap

kodLoe ti pu dna fdoun atth ueebcas ’ryuoe ni a npesiu niiootps for a nlgo mtie ey’ruo niogg ot veah ardcesein neovsu rteunr chwhi elads ot eeiardcsn O.C Thsi avliyeengt akscdefbe no AA,RS lniegda to dedscaree eatr.soednlo sA a lrset,u eoyr’u ggnio to aehv ciradenes riuseisd ciwhh dales ot daeedcres oolbd dan mlpasa u.loemv

heT sanwer si aoeyhxperlfi eeaucsb the fnreefta arc fo eth cesuml cstrhet erfxle sah to og hhtgoru het ldraos irma and oasdrl toro angagl.i bmDu onqtes,iu I ,nwok ubt it’s eth nyol anwrse ttah aedm ne.sse fI uoy truh the RD,G oyu nto lyon sleo erfeftna mosacit ryessno br,feis oyu saol osel teh nessryo isebdo vneidvol in eth souirva feer.xsel

uoY anc lsao get rplhfoyiaeex ofmr damggani teh efetfrne snnuero htat anretniev teh lmsceu (ikel a MN)L, tub as uoy kwon tehse rea in teh enirotar rhon nda atvrnel imr.a

ihsT nwoam sha aosmyraxPl nctloaruN mblugorio.iHnae ihTs tsom fotne restepsn ni a ouyng uadtl how ash oedipess of akdr neiru ni teh idemdl of eth gnhit ro when kwgnai up ni hte .rmgnino t'sI cudeas yb tpnmmecelo tatviyci dtycrlei satngai eht sntpea'it nwo .RBsC nreaitC iodlpgilscy are dednee no het RBC ufasrec to tervepn kactta orfm etcn,emmpol eht msot ebtoanl fo hhicw era 55DC adn 5DC9. Pteintsa hwit HNP haev a cotmasi natiumot in hhciw yhet solt cnnuotfi fo a IGPA zeemny denede rof rprope snnoaieteptr dan tnmthcetaa of 5CD/C955D no het RBC rcfeua.s herTerfoe the ewnrsa is a tfeedc in a llce rembaenm ncraoh te.inpro httuiWo ,ihst moltecmpen tksatac CB.Rs

erleGan hemte fo h:tooagypl oiyphax sramiip vtiixeaod npyohphairooslt g;-t&- lses TPA gt&;-- ssel NaK- mpup ayivtitc so udmios ibdlsu up in the e,llc scuiang ligel.wsn shiT si teh srfit tp.se nThe duo'y egt hte lcaumic bdliupu ni eht ecll nda evnlauet rabonaeic sslogl,ciyy ignsacu ialcct acid rnootcdiup nad drwolee ..H.p tub isth ppensah lrtae nad t'sin het crteid ecasu fo rullaelc n,ilslegw ichhw si awth het ounisteq is far.et

eucMsl inpa + leiriaprotb aeemd si a clissca ornetnsipate fro ionlcaelhrt l.asiisrp tsBe ogniissda for sthi is a ecmslu pbio,ys as hte rmwoy lkies ot nautohg wtnhii hte cesum.sl

llaSm llce nacmcairo fo eht ulng aym duorepc oeiapaarsntlcp d,snmoyser fo hhwci HTAC and DAH rae eht ermo momnco tbs.useyp TCHA cesesx sdlae to ssceex stnouiamtil no het dlanera tecorx to cedropu lcit,roso gesiutrln C'snhiusg dyomres.n ecsxEs icrlosot a(nlmroly a srests hrmoe)no uaescs rpyeetihsnon avi eatinoonttpi fo tihyeatpscm uaomiltistn on hte s.luecravatu It can salo csuea phokmayaiel yb cigtna sa a dclracnooiertioim wenh in ex,ssce iauttnrgas hte ybtalii of oeb-syyi1drxdar1h-otet eosahregdedny nt(epers ni eth elarn )lsuebtu to ncevtor loctrosi ot to,riesocn hihcw t'nodse act as a iltinorrcic.odeamo

I eryall nit’dd unntrddeas shit osenituq even efart aiegndr all the swreasn eher os I aemlied r.D nKeulbad (eth erpe!)tx

eHes’r wath he a:ids

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