ࡱ> n}vQ,brPNG  IHDRsRGB pHYs+yIDATx^ݽe>Nnɦ wH 6OQПE,tҒ@HHBzO6nk |lrܹ3yO?9< b@du=[2Zw`o=/V!Mg]sO*B!>o|c˖-2(/.}{i#kَk/@[˞;mlc+7K(Zh?TN<˶=Iۘw (ӧ蛾.G,A3! ~ l-Ɩ #Z.<3)l{]Ģkiݲɗ珚|ΫreANZ[knްy uo/&M4k,,7cw 7)2M*,@F\^#.;g}x*-oXRx5tN%Gu+@{jMB)?L pG862eHsWq%l#pƅv"t5~R."%eQ!lzQD6 Ip\I,I5w{kOBt e;*! 78k8ͯE-g_$"|3zZtC0' 9Tt[wܚK |K^CJ |Erʏ.td}r@,l2\&VK1qr+dy*A{ʼnco?tBMDx?>cx%PIVR(^]C/sg~%]55e4|8k'eC"N t,EH—;6@lW$z?~Ήg%G"G<w<ܩ}\M%)< %8$Q)d[\ĉO;4&*X,Jmqp?0c&1Z߱g͛]xxD .+>* ߽X>AzrvXHT1L<R[53 YY ҊGWMXVHH'X &#HIQe[.5\u-Zvp}{ADӽ_+GUu_&dӄ1EmϺ#}SF>n)gUAF$9(unPO5<>Bڷ9jrK*lj)C&O3̣_[{v&?q$\Gpt,ߜ"*>_҉5 u{-~m%Gx 7{عK|ۄ8^t` L\_H: *}w,ކi%.!MQ$!7 o#hɫO=ğ3 yc'/a1Pq"ʝ{& cVzۨ~Ŷ4<31w':;;|os'N'7L쳯3#أIbXIGZC9׊j'oj۵sg2n۝c>8I4&fQ'\xΆ w<ޑL i+I}ϯkxtkvtVw=r"zRm3)'Ӊߙ+5|7_[vӖfm@`FS1ɂLE&7ލo{} $cSbI:z7=T)jH sFd(c$?DDPiʜk_CڃN4p$ 66oƟ3gĶ0΁-u8OxJ+Wb!~2~˪LǻS;aP]メx-?ɥ=w'ǜO)e4Wqo-f3moPWi N1Sk n r$fsfP;ܳ%˗IE&%(`5g=(k;IbD!,5З |wz@bU5C^ziٲe555MMMP` >E]E ۿvgOBH6TIdno[D\RC UijGAw`3'vh߼yKDzE2|#d/is+_wVVV5##4ᦛnz\̕!!nkVwnڳ"Ipfdk׽ڿ!0|mNjsmIGg΀ 6F~<.CL%%+2Z)ixA(EՐhZ̟ۧRP, c弿lF6>c~AL$>LRj(HABZ*gѿL>i!DLB ofg@r `o}[s ǁ\'Gu:l jEU2-1j,zwumZ!Sgw ECa/:&ٍW?}rh~Q 9S=;hsն=9JEbȉ0JQH+D=BPr؍*/\|n]Q7_XUœZݒV w`QozO7_?,Hּ|6 2F=۝,\As) }azsP݂^PH,љnU R(ƓSaTMq EB?Q6`hDmGױ{y4Ơ8'POȼ!V UX h۳\h֦Rզж%] B`@$ī"'Im[/Jp,aۀ{gw#BF  7$ Hs( iyC4sO}m!JHe4MWGQs?7xi?/-(.g䎩X_],z%c1Mۈ=ݺ<8U0ݶ;\\rUkH8V⹂^ԋE3_Lwmt9~Ɏ6sѱa: 6~e~Z]] #k _rumu^ǒP%+@ ج\F g[;ú](zBoR9U;GfD*v]_  uIc`%#pP| |5ְF4~2SQP}؄,*9)HFsz07ӴfM(u=ɺ3_}ŕr?㻸|3?ÙoB!Ouj)tAJ5 EBYP/`!=pR]"#g Y^\s` +8m@`;D(e-[P+VU~\_|=8Dp}Q{U&FWWT%)c>ɔ'/5HO:^%V%_1ڇ2MC@^Ӱ;aT#G2U9N2$UJwaQ Iu hSE}D8\ ,Y|MܑF?uʭ/A4؟ E ! ?qcXvi~ uj|>G~ܑ%YQO|5Lyrd*_+>>)CWL\@"!%Wh®(alPF2oW#=r& QNvcxp{ϼGmT^QCJk"tZ63O?3zh[O ~A~Fi<bu$l7Wkјеa톼iT*<z9/+M\pOa17G$QK7.> Yz) Jzb*HvMACVIk)\Dh 7z o; vj![$b+_^IDl]/ P.Q3rM( ?&@#8@QP "LlR_9?HQ%I^GlS tΙ#!Syi/22uiɉdXS@!ؚ]=I;eIE3S ZĶlI1qJ؀ TpHi9C' /ӡ X$ ` Ԛ[%U7}\nww±ٱE- ;5ǓEщhrwa|"Z;XƺqBܲ|d?:g%xHPH0&?WxԦNA2uXrD g6PP]5_5;(fAT-]emU;J)Go2 Z=xT0]@Ϸ=[l 9Qkރ)8O"A`sP.08ޣ/ jB oY6$_="nE؟kt;GNɬq _y3X'7q_5gTsBBp]udpQbB H˪[{z3)X lklD5IC噜OFideaX+åXnjT8\|NDe4C,_, dV͂aLmC`Q #|oZ/n+' wl4"$N H [T62W,z}|>bEb:Q(g %t;Vl*hnl.z8,ȓH/`qB<PEe8Ui5xk{hu4;VizsyK@FfweR&f-}YUGwg<_thUNoNLOwÞ.GEA{ ǣM`xŎ ijy 5s$뢵bMCKZsv+pĕxL:U,D%,Uj$Lht~aDu2D묪gl3*æU*oHV1pu*MG7d~d]ۜ#f-O9̘zh۴iӆ >jl{CMCk\n4oںu0-}xg|淶=& )"iV!ūW?}w3#$DT'^;׺\i˜[#o_,zmm']lM4}]/2LF~<|\`HJDl U?^ۥ^_aw.o~9S4ni"'Ne-Ny/Kڧrz'JfSF̝I@zT_|c=F CEEGt1L,8U?Қ]Mן}n ?Q؝l6J9á6؋|?[*u#ǜAA VˡS[86:VJ!Av$;4[}uE6fmu,ٱhX6~϶B&28Q*\FT) Y%d[UU[&"_mMz.ܓ4읇LoYg(a(&x^6i!EXÎwIN_==m=]m]ݝ=la(!xЭY,asj-kk_O0JtE; j\ր7iGs(6 L4#YpX(#fN)!䅺 Q5r풥=;8<$=Xp!=U_ࢊmw\}CVD'͝Wc ($'>?<2c'N$ qzV_SkhݳFkV/Jj _3Ҫ?XD#bP Ԑj>;^8۷L +SdnYd|# cwȴ.%ݗ>ۆ4׷g+7LT=M;[x}λpjl1VzZI^/ӤQySn/ƹ4L+(|bۻwoa>u>ߗ|6Cr@.O k/2‘yTe9Gp Np!8 YY=@;H{ᛪs[?k?_1ed_nM8jΜn-ě}f+ ]}NHȺ&H*/G՛چ\u)c>m8C ^AK1sk=7b3l- ?k隵߽obq*1}m3TmS.w˾ Zo1ׯ1DURPjV]G%*/Km$9vr.\X4?|i\#qB}y.भqHBӞ^ڴ k,`,Ix&Ds-I/mdn@l^ [Յf=Om5j@Gj>9D\čQuDSU1m6k9Fp"B ЛzJRdEoڒN'}5LX,f6:mWD70= (76Q/qhT,l x{z|SU,m AD|턉~Ņ3F)G( ޶PԀ` D6N"/6>K7qOؙ;דּQuuy`(B %2%7UE&)(%P^&vxpmlRA@H oe~T)MNf(wțVc)= ZdM)7@l1w-^O](ZiFI:3ʕ8br2%.l[<"I~4`$2ٶCS3:kl}UЉ!ԙ#65Չhok;QMaѸ\ї@e^-TBV`.wѬDDL"ACT6h"yFH\3G J}Pd.%tNnt [lxjycdtQk_;GuM4!@9o:+*ފ[}Ed ^"-2Uv! m<6GiU௒.sPW8-=rXW`zJ>$FG̏ Z"ot ckH o!t[j(S րΌ[ | _m<=LJc_;czcH|Tq)Ճ "=â]xrOؗ_-' 糥,:ʩ`UZ^v%vPPD"#r!,fAiԥB ΍#W >HڢhD_,sv;yݦQ v Ē|lW}a% p ^pmF?"RxgD3x급!"'v [~(rE`vkkOk ۈ7SB);7WHd:ûz^щFh񏉨WԑrŇER-ex6bb6OΒPD:J *,k o|PB znM?d)G%$@)!'xpo+r=h $mZ{QKIe wT9u\a'^}VFAeFw:rh"= *75ߨT\l>$Ma:%|;Fk+RM#MZc5~Fׄ*bU S VĂ5y=twZ-;:{O&XM(磲K%r`gM+"l}P4p{jgua3a{8=:*<3}볣" *{'cU=vi"$B)Ev 壵Z-c26Ni' .1t 1!\,lZ'I+zqd<ʡ>̂:P8Lm} ?k`o_P1?!)!5k#b@mҞG(%xfg՝sF)(Ee'-}>wi`|hH_ڊgZt{D\%>,XWP촟O@:24̋[r l~ƫC(7,E{KbB{۽|ǯyo;) ݮugWS3aJ yB}k[gSqg4q׮Ό-.H4~ܠD@&1ƹ9kdm͠ )㇅ $$ |% ?vstD$Tr0D!LX`\- oNZ RFBooܪ«dB@BC ]Z#9-I!wi]DPEwz4o:΄m}h߽~|N]xTxpA@exU7twnܹ[nBdz=%cŷ>3΍_Uo!{X{7|柅vBeYAjzhS>e[ֳ6Y-ՌY0C DcT#-ɮe7 g .>vԸQ>-PMty0eOrzШX ϡV5EFUQq>}|]ӵenȪBqf#Idd4UrCZhm]*=]ZQEv%~_1wv緪HU AT=;0CB@j{`_ІRD GD;X6'Rwl;k+fϙpI-=miU+x~z@4⮒uq. ƕRpJEQ_;M>H$0?_,{ͧ !w))]8Xby</,+V )r 6vŒb+7 6֪clQJeTA"ȕ) Aq4XC̪~mhm,BX ߻P++pb 6\a hYE4%,1k_"`s} XԬΆl(@*jcNq3>{xb._JJ*T(M#ҊCTt-jd-V;ykFM/,<'WWaA1p7jʦi ?O<\)8@@ 4(O7u]B)K_ޮT ٭YQz7y3v_=+ EE :Yi,dXTp.+adU "ԂO7{yK*eDS=rG<1#DM5*6Ⱥs3+:d6>v&ko5I!KIB],>9x|6 C!HMvnzNh!5h\Z-f5Yt"~%/&zCA ~gu$te}ШEAIɱ\UzuPC;ְ&ro)!#jGLmJ8sbqd})Ŵ龆A^r"%p+W1-xUM8,a2 N-R}qy5͘}~mص+ {*\cdDOGUK^ \K'8&:{>zF.T4XDjE@ɦP&Yxd^%'*8qnR;קWӗM_P\2^_=Xm_nrN[0ժx QעMU{c _y?*WN=h'p#c̋-[~[zj΢sz+zH#\›o?7\e) P -~РW(|=.yd*rؓ\w6'uV)`}V2~Iz0ĈXp2~鯟WF Ԃ-i-kI{Xř^;cS*jF6Y+G4itߟ];:ږn_EN YpRV/;w W!#64hb1Vڙ+o~rmaN1}KM^ 0łN3^GqwxXhGVOr%%k|E<'ȏBx_e1\P'!2y|^38XWgÕ r0ÑGZ(FI@9-4繅n@Ḫq^05ITj#CFkB7a{.ܪ@Q5+ҚvrDF[,`e?6&8`."tp递A1KuecÊCE-M.<p6TTzB^xᐑУsdԂD< UBn*KN2ٲP@m=Dmq'~IAHRnЉ. `.[(Z1%)^#?)t_Ӛ_o8.}=}L2IH npQ$p 4 2P (ӒF.U̙K>/{C2*pLD_(-}5%LBNOUGMϏzIl.VOQXqdK} 5Oi/u nV92=|Ѭ>R=)bg_[ jD bCsWz͉թ -^Gt|lѺ[C}I(WB",meԬY ^sĦH!Dⅉ#~!DhΧ{‰LR1d3û$T%eW=tӦKG.zOqGT#?Hz44V@Y5z @m2j'ߋiecY acJɷd3th_~XPVlmf #>BBضHQ6j ` fB Cz0rcU# Ǟ{WkX7IGpN{ӡW~.>K)bN7z&wb#ཁq?G*>#~p~nP0|ڇCq4BqSU/4p^BO #PTnc`05O ew O_,ly$_~zYC=w",CpC³Huw>& Pɏ=U l ZfEU?>0Tf4{!PHx Y;;H7 C䞏IB.t&DH)b/`b_BLiղ/WOQN;FꕛԲDY"$i`H!h8Jc燲m1(L[,ߑG*C< ^BU,2OX1*Ln?Ϯ΀_C1VʲJJ +xDЃi*~Q'򨻝xh1?O;LÍD8ڹd4ܻWSzD2ɶw#'e:@PXNBݽ io {4qXt[u0/*w:=z " y Cо6Փzu70*Ix v[lgdgIY{f۽8zov\.RE9Ì`„w 2&d>af~5)#w+CX  E ǿ8aq`_(7 әpPuNfTǯϔR=n;{ :XrE_=;2Wj-Pq4A'ɛ~5(D_h?S@BYf=wwmSITP܄)z7H\T&G٨*!>WNHʞ+gPՅ>0j@c!ذ.(\.@:q[8o''Z2a, UippR"_t(|'k1+3J h#5m9j֤) O,]صՏ=hؿ|=S̔٧3!ZOLɀ $(ﲛ.Q_~yǾbL O ӠYiFw#ORlwf[bO~ct= iЌkNC)S^uc˜a4`(""cf|&S(~(ck5quW6m"ñJ`7&~n#Bzde2u8PBRs*7cI _ujXsT(]W3.8:7J{>ol =RCthQ.ht}8֎ߝk3FCF-!4TqSo/,Xv3 nQCY㿽?i9/gu}[9 (<:!%.=[ p ],,A ƂWȌd1.ťw5+b4}d4xæ51gT2tUdb2]k- O ~eb$wֳ.eټꨆ΅i!!g \'&?|Hg\jOOqSHQSN}Q fE@Zl6cZR"ETտPRGv\ Z=V$X.B-:g۫5K(,gL2'hFG㯌Ty8 1QL/'\jֱ{ Ȇ:m=lຐL0#';4]m4\2Q?d.Lv1RFc|nqgyۂ71)p;9hyp%MBe-Zm% ߪ m9"vDcSFWst qa! ')GL8J?䲳1HgS4/Za[LSIC_9t)$BB$&5dxT832 XIF6,Iƾ8d5,,`ADF2[YLt$.~2kp#x g|06e6vOyUc'-<^cc#62&=cOvꠔyr7OSoGv9#&Q̎!kkIhAi-4gz+ nRpOtZt+ "A~-{}OI| :1md-鏸ckO1rr}UyW{%X>m2;Q"gуw1 hpỸeXa%|&-n+ t! Id4_&v%J&ggf ;i Qޅ"9dR61U1窏=K0t⨫ ؝q4F m8gs4N2Rhj-ء6:ui/C g.HHig߆\:0P<|b(CTzunږO&ERa('\bҞFjYcX ,bb _ӳٲJCU0}g/t  Į¾1=ܸ 0?\Ya׸- 2}-L؋w,ʉAP"ܓ/:u$[D(?Z_@/[i{[O<ړ +KxApD|hlCE/ Ќ`0:ndDQ҆p'kxXG~rETnp|QsޘM}1W h7m]Q {,[.< [:)!Dkvv>gdf&"dԠۋEm=F܌`x]w f;+1;|zw}ݤhT9FiSMmtj:(D{AW*RߪrT0;4\P{:O?u1[ua61Ԋ/FQ$鲛)[+\z7]Ps\ Inݗ;ԋτ<K"0%cB (cq~9섲dY~ёaezF_O/U'kʁ<Ǝe(oPy:6S `I+K'&W؝Lwxlw9@uEHHZɗ, p$I[=_M_6hNY3U%{pdqsC ׁ y3VfAg7Xd'c!5ԙ`9t Þ+ei&Wu/ $#N݁D -c me0FCIrkmL( t}‡/V<`l㻵{+ͪ(F8`q6a{=OY8LYSOPqO|sYlCڍ ;3'2{2lJblqL_AZfOhD6Wp2E Ald,"Iq&r,~av,`&1{0'gWd1xɴ~Y#X 償eiAY)E)K⽀JAFiޔlsH q&k([d7-@=)jg900b:-r9vi*:&?5Gj}򥢠 {^fay #`XT{g,"iiq +~Y M^$ ^ve4h61b3Í TEwZ2;:7&">`Nun /CWNu}+^|(hE6LhGKա8Sc;4sSS')uY P@,m+uHu,3%"hyyY\U&̙^%Hh#7/5? ( UBF)~EXݸeىwf01vbS88N#'3Q D=5,4 rЌݙLҔUphobcqvlsp!L10Mi ǰϮ\|G_.xWV'J@G!\E1YMҔ.{X1R 7m-vxT^^S &@*m?xLPm Xcm: =.X!CtDyTZ>٫݇"|! Ѐa.gqps0)iL3#%[4ll3\Lľ}1ӯ83s&;ag?;\=TXmY0>rhX ap.N5Xޝ[1#]]SwTr(bF& þjEjZ,_`uq<n]S*QvPE_ NiY|dˋow}e7VˏV򳗗S9Z& 4m7 p}?t-A}>?swiϖ=چ@gB t6}An!M0I!+ Dlu 33:0p}|We8%N7 ,B01{BFVT4G]: d?{n/LXiWJbO9t6 [V//)3'- KeEG؇C¼6hJ{GL3i^޾ 9$0Gccȅ|/atY,Y1z6[Y?(`c|"h|@b)X3B!2"ThNX1(O@ڎ#uw:inVw8F=uuP26"gU>b]SR :Cy@O 'e 6;)s>mb#<1 ]ΪHsLީN0 !YD,$/CDDS)3vgF>pz̢`f0" "I@zt "sTqKgߕc #0Մom.YvŏU_N8$mƒ0,nw5x G8W'VGq$4@c^7jl8.߮sE.g aL*~AE.8 A j.9w{$&/(x'g|'J]EMmp 6o_A+ 9;i婛㸙)*@lDZOfLչc6.98.mY@iax_(Ԅm6^ekgJ9wPeoɛTSM36,Yl@lw%`[,G\ >(. cO~oQCPQ)E!-ah'>Ga Ņ(n@lw\yˈQj-3M̌*R@Go*c۹jA&e`tl L Bs:{ny`inZx`op}Gtx;V!n"\~gӉL _t89# +u=^ҭӹ90 QYJWEvȱsg8B6<~Gj;\-{=CbaG!zh|%JA!S76lX?OH`5ՓƤ 3-ȠKd"rVi,`0@*s8 @L%;hcp&Di7{Zx^_7?p e1E>هBv|:JT0"'>p=Go Ւ:S:00sRQ$L;iSSv :FE cabP 2A~53*b9?Z1#ǼLdOzx X{!-£~ZXIǫ=O}3*gpB RSe$:E{[m#B߅L(yK lNv: !\Y%;h^HXJr/H-5o拘 \L|GD׳=?{$tEwMA{鏌cLNsyiW>VD7QvNsJ c_^k 흤qY.cpE ~K  {@Q ǝp A~np9 zll}G@$XO!M0+|1l8d8)69,vִe 4Nh`ܱ=`f4Z=;K-=ΞgO=焢I6e>pCog(gه>RPH ´6?3;4#0l'N58QYA{{,{s P2AC2D ୣ bQ_+Rޞfӄ(=Z9ls1IAGM ("Z AѥN! bYk`HR W.isJ~_b2Qgu2k*?M7bhF9ڊ7YG YF:ٗ51.֞na"FS8Z ڰ8 NȚNy#AQp% 7fxLԄ \enZQQnMGU'OS//~l`\׸2qVCkW91Z,X| Sk̎T6?5ˢmv6ozǟ0;^E Z#{+LֆGd 1_SDfc o rX ?"rdH> u-ɡ?5%%g;[%;WjEc Kdoe`h+e 'bC4 #tiSOGvU<C>k4t#W}zis/e  Ia+hRm R+XfX?4؊ڽyE%:+@#Q{ŗ߀_3EV3^uP8zͣg\̇|?$;υWF:˿i^cUE(eI yb ~ A74|"&UyО02µAsr]Gowš1p,+_\=H0qsB"j0H:J@A=MQ{0kr,(8 4;]wHM(Vęy(8zX7WGnXg\^BfɨbFK1OFF d3 g!FFҔӬbҍeG?<J>33٫Z{wv/O[P뿟co)Adz%(P;n:i^QE5t hS޵W x:XUnq@6u𨈆ŌnXRaxXcy3,ٶO=pLU& /tVaZP 'xw>3H?Zd  4l A=5nOO^Tt9-K7x!iw| Q=P^Oh]h+xc;C]a~ tgHOtIO3>xb= IQH; gK$K2_.%>ysS&,oMRI0Mb?:nθ̽D,kC빾kHA !٥Ԓ BM.0%;^F%ަzD}/'hdЛ(#;2^/]4scS_ct)i(GKhR\ &JYœ~1M2T"* D{IB1'+f{>w@&{WƘձ'ܠnbHeqb0L%zEJ/|'6]SVXB0=kX=i@hdԷ X )D(Yp tu2t̢xT#$Ea29=3 ̡2AF0~Irt[HfaL;쐜^d:VI@w9A~ ^<ߢ'KZb37FoC4,,xTWVA(l3pW] ag0V t`F1pp !ėC47;p ;` !Q}/:'CaE]\1`uǢIRNi1b_醕d&>bR$Ǧ!-) NBi+|@_Ga!nRҧ~ uItq ؀6?=,YN>F@ D"!#sy5Eh/9!7Q×mL 5"!O o2p3 ?N އzxjP&pnjuXދTƪDQվLfnKJOd]P&+$+H,$F)'95ȣS5MÐGU*ZD E!@F(AA`fUUo1zu~bo>pζ=a-h*1Z(F=j }b}~Ő(;J Ǐ3Ȇ€s@b1 c55}%8joF)k9,R"zSқ۩}'G">:0 &qpA6&fį%Bd`g@^q~eve]@LYM.i2Y.XT  < C`ѧW{ȵ[BBde>ty1'_<]QEPmrhHҍE›aX g"Y})_" DQK`k-*]yڴBjEM?_rpqQ_f@14X\R^~vn,ؚq al)qTq$sA!AZa2!c4;sC!+AO,j=; . 6 U1TCvcG~UM',dЙByŏ=^ @%*^5jRuo |3l\BWwE3<`v=% T$1ȨŸB9cn-~xg$cPk.6Ak /Ʈ0OQ C`8yu~yR{F ?~M*xx8 3"}:+$p,OU@ ݕJư(CG2@̅@_E!3f;n_݉}`IA1(pVTd&r-A&$ʊD*HPL0㠚fa`XXuD lKY73@@6*t3JV~?4,Ü7ptqAe3 1%JEY! <|6htH  /P V;<2-t^/99RtB =ݝ.&@cԯ#&gG-hMY lU@R1IG@]ebs&`Y*TbĀ9p2iXB‰tg2"fIL¸ Th*_5&l@41Ǿ3aLx }D[ ]z0x 9"G_B ϲ高/:cಇ^wETe ( R00 "!f+H#1Tag*]kO83$W<8Y!n[pTMVِ7h Eȣ]ѣVL* ԇYmWr|mœ 80M{.E¡H( @_ UuW0ycPf 8C?u(Gu?S̵ÚIkWk/y|XPH bcCUYNj8Eqy4ThAG)PW &bD1S'1C}<^ǃ`7`˲ۗg)W t 5<`QTcޟ3 h"KH;#`Pڐ󶁼D2J>xp~S  )m澿~Fz`1r 7W6Ir3;Ev%MSԼp4AƆ#R 'LBZDND5y:BPMq+*()'|&՛ΐ06쮘Kn)/qlLArx( q($v+*jUUdvЛB C[iUF0t:wqظ>*TrUҞ)!ůX;d;s߱d $ O F.zNɬJ*X G:Ύ^2<3:Nqd˼BryF%m1m#"$$K k?BJ`pxK&5Ra-x]v{ i6S: U紥hEUZQ5|$27PآD]BlO<#$IC<Up"V|WNeChL=t<۳l吥\0а땔lMGōAZTG4` 8Mc,(MC@1lh^t$.،W0vTO-\5ռTgqfXb!@ {R37rBo?ы{I4U*-,Q-`)"B{%uPˮsōR P쫙=X._H2uF̀b[-4x.0R)Dt{©(薎ђ8[qP]r@߀Q&RSGH@> uFv*" BmR@vP\NRyβu&"_=/E/e(=2Z9;V1|Ԡ >SY@*MjB=d`ؘAL7) OJiWX%T[e,]Ds5 f^&~[:bH{^l̨iJ0lp^ ̝Vݲ;, fKiuuġTH腄8]== 1%"Aa:{anp' J*xJ aV1X{R=DxA]`4* $9$d,C$<bzk>k} ,(ĊaO<% 2%4٨vӽ7RzEtWD)6H]Cp0k$hҗDC v4m&6 %0~ _%aE/^g?λyK2DÄ䜏&aED37r?g8:.7$.R]!|`\Х`0"Ȳ<[4|!^`0q1Z(/E2.^mVx-dZ/%`c0TgYH&lA,57zs Q8w89;3aJ{@ԕ4,$ ?F[-}Lj2_[3~tBMjiŚc^/{#څ5 j9-W9r{h'(e]xx#{G0/BgΜ?g"(I5Ђ 1*j!QHe' gĝ!x#Eit2 Ns}W{+<],:c.إA]{[zG#%̯}AGpv faxi*\#?T :GZ?;s:ŷܡ>OEpho/D`ڝV%BUx}uR9SLsYus?_t:~or4jޟ9 (ʗ#pGw+01:FP?>j\r?SݼH|(!HTtL(H@RNuivCg zqDfEDCx8-ohboܿAʜ:N 8 q: 04"_?"I[þzlJ>}jww 4(hظ ""NK@ H3Q(h #o!*4 eCޢH 9d; p=˾S"ӟ$N xeiJ c}n4$~wHνOT Ъ6 @"68ňc!^Q&2`bMD n9/NmCuN3y^FS#`6M`a*Nl;(Ҹ?p ώ-]1_bܩٓ^'NIqjXyĀҰla߫8\Ow@ygrѱd]\I,ҩ}%!+b yKjnSש|G&s 1Ohc`b@E@>DcG0|a0> HJ_E3~ "`SJI´ja^5B4-t4+3W,Yi+"~KH|:gcJ2x8({)A TVZ045 ~?`{`]!%+39/kC&#M0Z.*MJOU쨠Hϩz#DZHR~s?G׋* yiMZ@e/cG$l7f|9Pρx)uD)r=}GvPeOt@)drfQR$qa~(fz ^Bt [tPϋ~Kr$sZug19:!rih?7톈ɠeC9)V.sזU DCWp ",gؕ~k]DtHfn|j) ^ Z.=s%y욹'_:7ݝ U#ς"s?j拖6EN^K:n[LJ w>>(!]5R_L5 >KnAy`Xq<"F%q BB &N/[ɫ/D)=j ջt4 bkj ,1DH]QvgUcFh"m Ru`&7z?HiD}n#Ͷf7Ns8Pv灧aFd47b '{}q?ާhdres 8PA@gL3-~U@jw[2H{<.1r(18aTWNz0ݻiA*SeYˑ(M?82P8hw>AH@Qta1'`sPG j> Y>Zol%08/?S)sD()!;ʟH" ??5="64 l@,JRxeԒ]5!RD5 )4mu*bÜt(n̕eE`t$~PͲTA6=P|xب K;;9tHǡu1+};0>IENDB`Fsц-OJFIFKK.Handmade Software, Inc. Image Alchemy v1.11     $.' ",#(7),01444'9=82<.342  2!!22222222222222222222222222222222222222222222222222\!  }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyzw!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?(*q$e6%v8$fJ,o>o>W* ֫jSD)Yl4w˺7I.07#91ABXy˪~|VM]G=oe},y-0")R<9'~H'R @gqtr?PLg9W=Yusm9HOI*9MVk&f?7vzL"+FRP-A$W 3[x bÜ ~ѭdՍxu[I,,CD>FEtF\ަS/QT@V??'wG%lQ@Q@Q@dUM "#Dz:h60ShH(Q@ KH&Wki|}çAɨ]pGW `==\>!KJwFyZTmH7<ϔS~'bqWa J }IOLԴ:{R4,JG#f-6qV2]wp%ߗCJ`3ִYc4u2ZިI\|?gMܻXEo=ś1-w #H\(x/fTN6F̤zKWbk2x{Shxtma.3hz|1i$ؓ5hHW#6ggWDfX;d2UCq=6VffԞsؾq.UmN UH7SnMW\Mү/~HPOxfÖQ^H^:y,essaϩ'=gú}Dgy(KEdqh|I5i+ҝZټq 7MqWfuWo;Cs!1NOY-κQz}OCuOs8yIzz鷯}~\XԽʎŖ55, \g.Ar\G++ub*eQ]M%v7v }^T0\~[+؄w#OHW_ qi՜<\ȶA,%H9A4\%˯y{W9M`? ~hAjeP1C#_MY$8kQZ&B:h2X/Y\x0?umwlul,>`^ן/MOJGԯG7Zd^[J5NZH5{?ypr~g0+ZYZݢ;J?qx%zܾhz\_K{@?.ףW.Y$Կ褪8NUfl3jP{#4P VV]Nb z2k5FO-adF\h!X,k dGJ#-W=9Q"KwGz=j펧qsno @%$#oQ({JI"k..HT`t [6?ayoy֜4"Cg֤4kI x±;gZSM7Da!-3aHX ^^W/9o-s}.%nȋgfNӥ]JKAʮ1yv(.-N(nmLVt-HcJhlwy}@$a<U-V??'wG%1P\i.?ѵ{FzHJ3wLޠvd#g9\{%e\?ٿ&,߬@|hݾa%0*τCnN=Znub*@?[Is=GcD<dHΞyaXa.-)qtgSb&0*F<GE~Iɏyf?J<+wPDƧ@c1k7jGȽԡW_TC^ܣ˃x_>61F #e?:!9Կ褪8渰\d`GYj宄FBFfhaxPLb7#)r}8ES9_j\Iwc>>2Jcڹg;ЎK;v iq oupG~"yo}u 꺓p.d,}S¯sf拝J;ٱQptdQ}KF\~Օݬ$]Kci? $ IJ2_kc[ *R3aX( lQ@s.A.׺{-Q7̻ FTDB+t(G/]!4Fv^Ⱥ|icq#Ư:ATmrR(T)UūEGR2V i SÐٹI%g'(?p."n ~?i? Uꎣ,h4 WǦw'W<6;ЌbS1$3~gV)$#_E&ވ=[= &JO3vE5Կ褪8BvY1ڧk8}apԟٜnj\d|Isgm.3k%XxnJ줕>k{z}[2X`>Vefg OztvZBZF2 CV7]]L@OJb6+'ZHJJ] Y\##,*K\γ:Zx\.>zC&q;\9[hcE}6~Ft2խOcOo Ew7qJqӎ^L22A«jOguqn,*;:?Oh<8W%֭:$Uo,乏Voj,H߄Q~}:k ӹ!L5r-F?N(]Wq%fH?95%^oz@+Go7s.#oξ: _py3|fc!b}21kǻ;fԿ褪8P>]Ο'9FAF,*{Lv2O/]Vr#+Or[2um`LVo_C*1|'޹$lPtN4,gDϴ @Ditd)7ԟe^&e3.cdoիjzjsJXM40) 󑪟[;Vt9ez`yiCyKYzI|b2^kNqM".;H==ڌWsp>|sz7H?c!%ԠAT֣qp:`wI |G%_F?h3Eߟo5{Mr^-K+ I7V)$gp{r2G=FE_m>8Eeݎ6({  ~ӄ~rE+RJUeJDz|Rj77npgnwK7^(ZRo`‹-bzEʼqz:_2UQGBJWJϸ3QEJksgZ[?,Ѕ]aX( \u;m.Kp,v '\sNm@Tg0x`nZ3 ANIc Y#fKP֯-kzJ1|gRQi ռC27fH~1Oλ/ ̑A{#]{[^cVQXJN_RUm; ǃi^$bqJm.3 F~4=QEY຾{Qշ"߫G؅s0/#AHj;~vkG{/8g͜:'û,lJh\'$`gڼR_k1dZ0LI7љeܱ _ 5\$ykr$I s|fITcf9i 7̶:siy>y܀+E'%"o/-WkCըTϖhx6mj׷TW5+]_NMJ220AGb W%Ry'fupX~CFZ’or& ۟E'{scΆۉ6sutm5$epc=~m%)AtL5׈zeGTI$e|sIu1,# w($:ǠilcƑm&\T؞ [_nlcy~~]߅tяvD4tfvu&G8,= 4Shy5(T0OM985+YK=.dk!@sgJ`]o[w6Vv(q& m,v-S91* >]1~D'AZR_%6T+*Oo٣?ok/d]LFD{31eWaGa댚w8b-R9'D2:#$fn8'U΍eҢH%ʪ6D+>j޾~Gc侳6̭ixm̈́l2;e=r?'Z[][\6th'TģkC#ס]Bܧi%4+4w<$~WcQB#WYZG6.ͣ>&mkwP0FR;Ө0{t sPBy*K;p,(ɭZ*Mʥ oNT'O "o=%P1ncH;R;$P$b <8540*BIE8-Y:iDSG]r9b_M,ɪhՂ$1Ǡ^kh=,&"5}:V")[Xl|=7OCuO0lΚ!-NM'WHȪ[܉e^VU?2 DCHD6xNMj!P3F*{m7]ś+^E-QmA? 8]F}:aPMnćpbg :cѬɆ5ĉ.ћ{OJnakEVjFekk}?#hnݷkEsL$R)WF}:{xZ'%27\#ޱ.R1^kGk%pgsX2*q{#=S[Ԯ3? p`kR"𥥷%7kaRȡ=w4nO]Y }k\#iEI+Hn9QWh[삱Qƃ'wG%1.צUHr?za:m+Gba'i>vSUhP6W#Ӛ3ɟ1_U^W>;1һn-ݦܥ_,H?w/#Ykv]t~&AoW×l5ٜ}a1 J0z$O֮d^6#L\ޔ<7}W[msFw!tgjn(W/RƭokweT^F --B?c<?N#F%f:8zunj隕 oxBࣧN~ WOd9Vgh;% rYFw@T7ho"0Ǩ.,r!I2GxyjIaZ^ F}}gnmV&` 1#$z8F6j$d C[3[ˢ4%ބIkOLte Q ȥ?wu9*6Ϋ]]_6k#^bC> GP3דҶ7hiv^(=W#_@\|V61F+dxK3η]v@": IL'i|^Fw/4 [9m18ت{%.CfssŬmn!ъj.2xrtV(ZX@`:~9#CNӭAon/#wf=tMݞ{Zݒ6J7Wd٪dH,OQԫPkuGM4E,^r١?޳)9{7b< H]<%]ʝ|ldtep+6]f}:mj>90H;yi'sҼZN^3HkI[^ōJO 0@WB>᷋{QdF7~\yv 3+UyjprZGA?=]_~&p,I'ᣍe?YEja9u3ɉȟW?5?<~'fƦE<cZVߌ4F̸ؓKG ({ סņ]^,$.Wyɠ|?<>:ZG7xL]E|)NcF+Ds.#KDZK]F@'>S÷cS-o6T=Q Aw`>YCq =F(ocWog/nd?~mu.Ì`0 8*gIn9nءwy^H ]22~8Aau(mB`EOalg9yTUO{:{h\lodҮ$A$hdLV~T;@$(8@"lSz)1]1@TKğjT!c78$Gu7Syߏ- P:‡~9yQ{6߆bgQ ܹD?ȋ?5`c G=WVC&' ʒ3#SOJآ9y)@LW@yr+MykrGzn?Rvlle@:=M2M[yIK7$)bTzsRi>c'6.Z"5k`w-C/իm" ل~r¥>~/)N鶳B UQ^XNmq$r\to#|џq{I~gx_Qxñ. ,Ӹ"*"{dljҫG\15(k+ڤ#ܒg6?;[U'@9eCJL*s^R_G#_C_ũZRd6W0yU?6B*F};:*~ qtڄb46MqU)EoJ(`$iEAZ=ؼCiX9ǛJWtz& GK'O&BTsXSGcB0Ȁg'5gD&>N" (N:,yͼs{t]R;k(nl ɏPHF+MM9%{Js+';&77`=tMiǖ)wq6Ѷ\6.gk:2֊[}SЏJZT{knm IdB< W&&oSٝ农ni|wn2Mtec ;dV??'wG%lQ@!֫aXqktɾեYu25dޚ<|{~A ҕEvhW+>z) E?2㬵nI/3L k>aVښ'3F?R Ȋ1)P /Ɋ./o]³ $*#$6ٍ; j/sMW_-D$1P!v.?c_TGCEDP+JZݟ5Q:Y$cO F'Q ijHspUgrduTڸOCuO, ({qn$oL5$؅A(\!xGR6U n#ۜv;VkkIN{/:8Zt|Ikc:bGb;p*d&r家Zm!QOoʢ r:ȡ6S=%S]SE%wPEPEPEPEPE]@P^-%?NV咵Ø+=vLvsɯW#3-vP¸}OCuOQ@Q@Q@Q@Q@V??'wG%lQ@p:].$+l;D̫h^"{W Kz_1ê_Di8TQܒ@Zfkaoqyr *fJ MkG4BL`K1GRi qo+ITaWv.JԶHBu-N%@Ԇ;R9YYA#9fgԿ褠⳵ jPKټIAm+>O i_,o[Jd~xW $}ğҿY'$?f'I7?-O?@ټIAm+>O i_,SnލqӤQԿf'I7?-O?T)|I0Դ/q ;d$T۳P4\7?-O?GټIAm+G<^$ $N-9=ew Q$$,~tnQ ?9(b+9f쪢LՍ QZ:*h;G}OY~ɣw,)$gSjͣߧ2ڹFV(,jYsUG$JE[#O Ee!xpB(4{ϘոrV4:N+^ۧ#SCzۧ7F $ww%Ċ?@+H51QVy\>!KJ+?.]?5 ()k s&|R4w~C,;\TWQXs,`t=(gIJn-dȵ^9k?5fYX`1hJ+/<=d/I!'KVv:)^ǍroU|?"ޕ^q4k6(6v|%7)DcG*@H h|9j.tm6s-Ov?5ů^+& ;$٭} : @}y!#ں~ :?_GI?s\/x.8^EK, Tbܢ`qfu\+(-IzN+bϧ;5t7Hў;SI{w9BAG^ hU3fB}OCuOV?\k@P-}oqYom;z?XR+Ind1)wl:)Ef[ :@F(?:hS3 (f=3Ů3"(گ-ϽCӽ$dnh>3ޖy1@Jտ~ð/Z?݂Fi:7(0 ʪE+h_me`:Ƭm+ 3z@lг_=G :lг_=G :lг_=T5CZ5 [jIy=Ml]I9kp[[ {H<1bAZQ-ɜxoRYm&XMʏm?˺iڣ̿o=SwG2z2SSҮluє'<һ85;{xEZ69qrl=CiTp kW:톗 7^k)5RśIJakƋm6b]M1 _VuΨ~ZlRű_WZ?oY8fWZ?oYfWZm;S/oNey#-.~Fa?\k@P,FqYEeA=W[+ xSSݔ{0EI!kzƒ>d=fN~-16h9B&s[ZlS($9 =?з7Z(,>'SI~VLO}?Wgng'uUq\U_ȷל_ ( ( ( ( ( ( O hbۉ|-u 1<`|>GGǟ5=8FS\{0||kJ&15<Т<j9)>N+}eZ}Rҭce-Ҹ [eRiV6Z0 xPã2 > ʪE+h@Q@UOd]GQz*^ $ wu bH 7n81';ֵPEPEPEPX)rlR3Rht<C/W453#๶ǟ5 fzXZeR&+uS?҆m3r񂢺kN#6?ʀPBW3)c=w?ɈN}MhwSQDeO_ ӠAEPrMOI"J#`“ ( ( uFTHJȠi]fLfcT&e`e9$M>Y6{pҵZ8cvDѼL`FAE.bm O+D!ʍki'cj/kiGtPKH 0OOpGbAF$lslO6]Qt˦mEl|W1 V =Bq2ҔyF=<*^x@IHEy?sϸƫa^/,p]/Muɹ#"3; =< .#Eb2X6Y''o[6U>ğޖMZЁsw$HRZW * +zWy '+8*0(\)JLҜyoMvѱeqgV[6خZIBrBXOm 䢳PQw85mnk~}J{qt1~L=2->%SLt^,$d|n8uAEtQ-Aơr-aL~5@%ޝ[%s|3UVU ;l~4oZfaEPE6 E{|tq&t;Tp?ѰH~(e<1>?o Ǿi;6si,w|L Efo$Qw4[i9Z3.qik큂}OѴ&=P[Ԣ}IO+#bj1~2 麅Q;unXG͟lkG-_*pJѢMwHгUɠi6:RInIXh#2 bX<\l碂ki-b?,}IrBjQ\V_uk!`"OZ"ӎ~ʫݰ88 ŏ@TUݎL¯Χ[~,T"cU@UUSi& }筇r4 C,:}]_L5kb7*uVyEPE.Q@=4>iFӦCBמzSz6óƖF9^A#4 6{Ñ׬tgF5i8IhUONަ5 64Q<@#`8^WdIhMbf%&XgGV/WԘ4Ǟ5CC&Ie?/f}3"9aZl;{8F"%U.4q 譏 ʪE+h@rX.ߙjeӃWC^fUo>|egA`a[ [O[o^r1N.w%/%}A5@Hl-?6{.ZkC (ͣ_A}?_Ey$ɟAFAjtˍ:M b <C h?",~_W??՝UgPEPX)rlQ@EKj\ٕXqL+-3[#Fs~Gm9F=HEKat9!cu==WU6Fh:ri[n-~5R ?֥7$Ԍpjԟ{~Ұq Ԛ"D:cS:#kTdd5GTҾl|w/(O ʪE+h@pe ;aZ/\) vX& \zC㻫%Z^h|S{,f  zW<+3

I?OWTnϫ7^ٴ_B]_\|H!\?54 |=4ect-tM=OY-˙J?NTI6WسQEq؎ K(S/3AQU *Q.IR;\IMkHfѬ@^^HcC߁MXP}bMAEW܎8+E_+~ʟE7ON'𫕪VGըM )V?\k@PE>4XĪch_ꊟ q}2j&Z>,aZMqBӂ&UjtZfRcK9mYGQ=Zo2k#푃vH=i>[?'5?7oJ8[4Y[{xdsV(r) ( EmdXkY JˑC+t]KܿW4ePw*w#ҮRՔSt[3-4İJ$v Z?03(pQ*$,Qv``z 9lsCtil$_dtUӮnbܟ@5&B,-mT{(Ut\ZHR٤b2YT{ /Rr슾 [9?WMd)sItEM_o43U$^ѥ$s&jc3u-@i]̪ 4g4$$T*v.%7'%sO% ( O hb( z^j3op^%edrw]LLӟYoԚʡ9==ҡdORIR4Nk];YikE rpzOY {PXG-DH&^{~ꚲG% D+Wce|JQt i.#1?:nxyÿ#ʪE+n|EP?X!)2yB+Œ]ɜsH5=Ɉmsj<^(U~\"g$ڄs)V;[Ǡ52Ҟ χzx XRxfj~8B.R8cSs v)wxa5۞TmB?#w;Z^E3}%k#/ԯ~m 'EiAx^únK瑾yg>kZKEWޅ_4譏 ( (ȹwր6(~%\G-?6yXk:ƦԛBgFC u(tDL,Qұƒ:`iXUT*lVoF3$|yg>jh)x8Wlb\0oeE#b;?"ҜodZb-KQEW4v69}.-SUqsz7q\U_ȷל_ϑ4h|`m>KƣvHb>?O(FIIqkt༲L-Qdq{6ºxv$ؒK4$Iu55c\zZ&ִo4GЄMSVf|Egl=>SsyGpq8JO;V;OfzyzSixZr+,Y'JZ馽s?->ࢬŠ(+?.]?5 (<n|Wڏok=/龱䊱~Vx#!?᎙u)W)e gzJJا#3˂|N闀|+۷BG[O>W>LLֶGTj(zRvAu%@Bjbzr^GǍroU|?"ޕ^q>XѢ (Ԃ/#k[ ''N;nB0&EtC8*;3H䭣7qOז?Zg$[ˎ:VKkhfwq47_uj.zv0Q@Q@cE˿EPKuc^f?-C$Ք>+Q+<5AQcӌqFeHP?&?0ʗvw/&=ɟ5bX[ZqұH̹8"Ưy5AT7?qx&UW-_+S($8.OehPwgh W2M\KfL{IuAklyDq=׎ 4sp9Wrvni$.;f*{q7񮃠YO/4T`W$N4>OV>TXPQLw[ &um!U9$+<1'(oySb9^~zzڛ|yA'آ>|((S"CZآ (c}e?j6;N"{T mSc5ͷMCGY M=4xT8sR:TѮlp2tFG8gi&cBUuGmQc՝[htHO؆=kbFsj 2PY[ fu,sk>ׇhIՍ{~&P O'} djfeOJG8# %O ֐zmO/-OQ>4((S"CZآ (e9w?-nJFֱ]=c5H͓*]i0ZDLp̤}JJPjMEQG$ /,9+4Jq\U_ȷל_ (n̟0n]!l`pq+ЪOafU$nX?Z%m#6[WWp`=?Gu^=ٕtesAye2@3Ak e6+A~wgvܖ*)f #(l,DRؠ ֗q܏U=kB>jRkkv̷221գǚ=`ӯ4KsnaI?:]'g`Q@V,aԬ%QQÜ€(` j?AWP1@ ?5_@|'ow%zt$rG.cU` j?AWP1@ ?5_@ƫ(? cUtdm_U*}tV;;HmE kr@PP\%~!cl-JC0UD`hP1X=CFi!(ޮsYv>I ==7'G.0>uSGR?_TQH(_cd) O@s]vY^PM M)߆PA?JClQQrz}^KK؄WVU9WCS=A$2dRj]Dq#V=Kl:U#|:M=tm`"~I"º[ ^V?-ݤ7*?Fdo]oƫWQTrQ@Q@Q@Q@Q@Q@W+w3Zx\]Cl.D? r9PTҝ.] ׏.O$7Qo1-ռ$v4pTm\s٭jZW'O=W~/f63̣,Qq˖.]}4-?F?l|'':?,m[wm-)P{#ӭ'k)dr{خk*c'jtk+RzT#ۮ7Цy|kkh|=~(8((((((+|cKi7oqn-~G.89czD{nyqCgo\ԼزuxXmn7I#̣t?Z+|M]2%NbQhb))%%щ6u02?ΚB~>B{Vc[ aǣ'񨩱d%1`Nl+$}!&Bѫh-"aEQPEPEPEPEPEPEP\ǍiVi;$Q W&x&6##_V"#6G/;4X`6(9{;2 ,2x'+joK)bb,i\7@;N;g.($ ]tH;v1 p~;)c]c RW6\X>[3!F2j[k7j\xRP F8Gl+|vך<4UسE=.B9Fn5ifZmt eCB+T|~F\ ( ( ( ( ( ( ( ( Im-:"hn$ SH]$UEّR<ѱX==oŤ*vd ҼUԟW2SGv9ap#d7%Ǡu:2޴b1.F2\g9Y$UcXšb)d'癘T/#g Xd^92 ",qhQ@ pEPEPEPEPEPEPEPEPExFusCkz1*FN`3,gԛl̩!\ @g8qt_[u X( YJN[Q Gw*R4H!fa/{1)ҚZ/C( ( ( ( ( ( ( ( ( (N5ܚ5q{]w<:tHgnuKuPݍd\w$zF7H~ ( ( ( ( ( ( ( ( &&kmF3H.9ҖBddf>N#KDXQ*(¨z 4栶HK}BmsCypol222x flm62t4|K߻#*~^O}]n~t( %3 =p3^hzdD,r9坏v'iu9qչ_Š(((((((()U= ֶOs$0E0ȀŒd4 UJ[P,~鸁d#hF#P>T((((C(   $Photo Editor Photo MSPhotoEd.30@Microsoft Photo Editor 3.0 Photo/ 0DArialngsRomantt} 0DTimes New Romantt} 0 DWingdingsRomantt} 0 C0.  @n?" dd@  @@`` LT<    !"#'J(,-./0123456789:;<=CDEFGHIJKLMNOPQRS?b$}vQ,br$R$ц-Os <AA 3PP@PPTf ʚ;4,1ʚ;g4BdBdD 0ppp@ <4dddd@k 0t|g48d8d 0\p@ pp <4BdBd@l 0t0___PPT10 f___PPT9H@ (?r+1/30/06 HD. Ikossi, Stanford Vascular SurgeryO  =&7Brachiocephalic Vessel Reconstruction: Chapter 91, Rutherford s Vascular Surgery*S&&(* D@Danagra Georgia Ikossi, MD Stanford Surgery Resident, R3 1/30/06A&: BackgroundAortography: 1/3 of pts have significant lesions of the vessels of arms or head Small fraction of these are SAT (supra-aortic trunks) lesions Critical territory: cerebral hemispheres, ocular, vertebrobasilar, upper extremity and cardiac vascular beds. Z$ /Anatomy $Diseases of the Supra-Aortic Trunks%%(Atherosclerotic disease Inflammation Takayasu s Arteritis Radiation Dissection Aneurysm Thoracic outlet syndrome (SCA only) Congenital lesionsB%ZZKZ%K 3Atherosclerotic Disease of the Supra-Aortic Trunks44(50-61yo mean age (younger than other occlusive atherosclerotic lesions) Smoking Hypertension Diabetes CAD concomitant Radiation !3Atherosclerotic Disease of the Supra-Aortic Trunks44(Severe disease 75% stenosis ulcerated plaque thrombus in lumen Multivessel disease: may be  spillover from aortic arch disease into vessel ostia Single vessel disease: most commonly left subclavian BZ0ZZ0,@ B; Symptoms: SAT occlusive disease!!(Multivessel disease vertebrobasilar ischemia from low flow Single vessel disease upper extremity emboli Proximal subclavian disease subclavian-vertebral steal Innominate disease steal from carotid to subclavian@>$  " SAT Aneurysms:Complications: thrombosis, embolus, compression of surrounding structures, rupture Traditionally syphilitic in origin (rare now) Innominate and common carotid aneurysms or dissections Extension of dilation of proximal ascending aorta or thoracoabdominal aorta Takayasu s Arteritis @PaPPa# SAT AneurysmsSubclavian Artery Aneurysms 2% of all peripheral aneurysms Middle or distal 1/3 of vessel Extrathoracic: post-stenotic dilation, TOS Intrathoracic: atherosclerotic, cystic medial necrosis, Marfan s, infection (TB, syphillis)\PPPP]  + )Traumatic AneurysmsFalse aneurysms Short segment dissections Secondary to deceleration injury Mid-subclavian pseudoaneurysms from penetrating iatrogenic injuryZ* Aneurysms Kommerell s diverticulum: diverticulum at origin of anomalous artery off the arch (usually RSA) Takayasu s Arteritis: 3 vessel disease, proximal, inflammation, initially occlusive, later aneurysmal.:IS>    DiagnosisPhysical examination: Bilateral brachial cuff pressures Auscultation for bruits Palpate pulses carotid, superficial temporal and upper extremity Duplex of arch (screening tool) Digital Subtraction Angiography MRI, CT AngioBZ|ZPZ|P DiagnosisRoutine preoperative studies may include: TEE (evaluate aorta, r/o embolic source) CT of head (r/o recent infarct) Coronary angiogram (r/o CAD)&*f*f>?% Indications for Reconstruction(pSymptomatic TIAs: occular, hemispheric or vertebrobasilar (emboli or low-flow) Upper extremity ischemia Limb threateneing ischemia (occlusive disease or emboli) Steal syndrome L SCA occlusion: vertebral L SCA Innominate occlusion: R CCA & vertebral R SCA LSCA or IA occlusion: LIMA/RIMA ipsilateral SCA  Z]ZHZZZZ ]HC   >5  Indications for Reconstruction(Asymptomatic Severe stenotic lesions >75% Aneurysmal lesions (>4cm in RSA) EXCEPT: active Takayasu s Developmental Anolamies Esophageal or tracheal compression from abnormal RSA (usually aneurismal if symptomatic) Preparation for difficult stentgraft of the aorta [Y 2! [Y2,v t  Disease Treatment`Direct transthoracic reconstruction Remote cervical reconstruction Endovascular reconstruction M Direct ReconstructionComplete or partial (upper) median sternotomy Complete sternotomy required if aorta particularly calcified or if L SCA involved Partial sternotomy better tolerated>#  H 8Direct Reconstruction Endarterectomy best in isolated middle or distal IA lesions often lesions are continuous with aortic arch atherosclerosis and involve the ostea of other arteries off the arch challenging endarterectomy resulting thin walled artery possible flap dissection ZSR 9Direct ReconstructionBypass of IA lesion to proximal ascending aorta (borrowed from Mattox et al.) Less technically demanding than edarterectomy Partial occlusion clamp used (Lemole-Strong Clamp) 9mm-10mm graft used For multiple limbs, tailor them, handsewn*P0>o  F: Direct ReconstructionMProximal left subclavian lesions are challenging Very posterior structure (possibly easier through thoracotomy) Ligate and divide innominate vein to provide exposure via sternotomy Aberrant subclavian vessels (stenosis or aneurysm) can be resected and replaced via transposition to the common carotid and ligation of the origin ~11 >c 4 ;!Direct ReconstructionTransthoracic repair is safe and durable 0-14% mortality 94% 5 year and 88% 10 year graft patency 80% stroke-free at 10 years :)V)V s Cervical ReconstructionRecommended approach for Single lesions of the common carotid or subclavian Patients with contraindications to transthoracic approach (even multiple vessel disease) Patients with contraindication to endovascular approach B p b?"Cervical ReconstructionShort, transverse cervical incision above the clavicle Dissection between two heads of SCM Subclavian transposed to carotid Carotid transposed to subclavian  Z@#Cervical ReconstructionMust preserve vertebral and IMA Alternative: carotid-subclavian bypass Alternative: extra-anatomic bypass, retropharyngeal Use prosthetic for best longterm results  A$Cervical ReconstructionAll manner of cervical reconstruction patients Relief of symptoms ~ 100% Long term patency (10 years) 82% Stroke-free survival (10 years) 84% :/_/_Endovascular RepairAccess: Brachial artery femoral artery Cutdown during CEA Prevent embolization: retrograde approach with surgical control of neck vessels. Do not treat arteritis. Atherosclerosis and inflammatory lesions are acceptable. BZ4ZZ4,( 1Endovascular RepairStents: conflicting evidence, commonly used in SCA do not use in occluded vessels (high early re-thrombosis rate) do not use in post-vertebral SCA, thoracic outlet will crush metal framework 6  B%Endovascular RepairPrimary success rate 73-100% Complication rate 0-10% Nearly no mortality Long term durability likely inferior to surgical treatment Recurrence rate, clinically significant 16% in 4 years Summary A variety of approaches exist for the reconstruction of lesions of the supra-aortic trunks. Choice of technique and approach is based on: Patient characteristics (life expectancy, cardiac reserve, etc.) Lesion number and location Surgeon preference and experience *History: treatmentSyphilitic aneurysms of SCA 1950s endarterectomy for atherosclerotic disease of IA 1960s SCA-CA bypass, SCA-CA transposition 1994 extra-anatomic revascularization 1980s angioplasty 1990-2000s stenting/stentgraftingP  HistoryEarly 1800, first description Early 1900, Takayasu s arteritis 1960s subclavian steal syndrome described mZm/ $% & ' ( + ,-./07<=>CDEFGP   0` ̙33` ` ff3333f` 333MMM` f` f` 3>?" dd@,|?" dd@   " @ ` n?" dd@   @@``PR    @ ` ` p>> .&@ (    6Ӓ "`  T Click to edit Master title style! !$  0֒ "  RClick to edit Master text styles Second level Third level Fourth level Fifth level!     S  0ݒ "``  b*0   0D "`   d* 0   0| "`   d* 0   HA ?jJ?"P  T  <C޽h @ ? 80___PPT10.TR 8ACS INSTRUCTOR COURSE SLIDES 0 p*(  p p 0 P    X*  p 0̘     Z* d p c $ ?PP0   p 0 @0  RClick to edit Master text styles Second level Third level Fourth level Fifth level!     S p 6D _P   X*  p 6 _   Z* H p 0޽h ? 3380___PPT10.9% t(  t t 0j# P   # X*  t 0o#    # Z*  t 6@q# _P  # X*  t 6v# _  # Z* H t 0޽h ? 3380___PPT10.9%0a? x  0  $(  r  S Y   r  S 8T `    b  <C޽h @ ?"` 33r j ___PPT10J .5%)`+D ' = @B Di ' = @BA?%,( < +O%,( < +D ' =%(DH ' =%(D6' =A@BB BB0B%(D' =-g6B fade*<3<*D' =1:Bhidden*o3>+B#style.visibility<*%(D6' =A@BB BB0B%(D' =-g6B fade*<3<*D' =1:Bhidden*o3>+B#style.visibility<*%(D6' =A@BB BB0B%(D' =-g6B fade*<3<*9D' =1:Bhidden*o3>+B#style.visibility<*9%(D6' =A@BB BB0B%(D' =-g6B fade*<3<*9AD' =1:Bhidden*o3>+B#style.visibility<*9A%(+p+0+0 ++0+0 +  0 l*(  lx l c $|w`   r l S 0  H l 0޽h ? ___PPT10i.8%7+D=' = @B +!  0 p'Ip7(  x  c $2`   l   G ,$D 0@    C      BCDE<FvAOO8008 X @8@0PX @X0hH00xXP`8@Ph(px8`h0X0@P8HXx@PH(Phx (0 (8<@                          `"6 ? @ "   6C"?m"   6C"?$`w"   6C"?"  6A C"?+"  6>C"?"f@ `  D`    BCDE<FvOO8008 X @8@0PX @X0hH00xXP`8@Ph(px8`h0X0@P8HXx@PH(Phx (0 (8<@                          `"6 ?` "  6C"?"  6C"?"  6C"? "  6A C"?XEw"  6>C"?b9  BP8Pc 9 @Normal0   B<c i  @Bovine0@ @   E@   &  BCDE<FvOO8008 X @8@0PX @X0hH00xXP`8@Ph(px8`h0X0@P8HXx@PH(Phx (0 (8<@                          `"6 ?@ p " ' 6C"?  " ( 6C"?D  " ) 6C"?  " * 6A C"? 01 [" + 6>C"?B  " 3 6C"?w " 4 6C"?   5 B0B ( ULeft Vertebral off aorta 00@  p0  F i0 " > <PPC"?] " ? <WPPC"?0" @ <PPC"?  8  BCDE<FvOO8008 X @8@0PX @X0hH00xXP`8@Ph(px8`h0X0@P8HXx@PH(Phx (0 (8<@                          `"6 ?P " 9 0C"?" : 0C"?pw" ; 0C"? B <xH&  VAberrant Right Subclavian 0 I S L   H  0޽h ? ___PPT10.>%/+M6Db' = @B D' = @BA?%,( < +O%,( < +DT' =%(%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*G%(+  0 00(  0x 0 c $`   x 0 c $`  H 0 0޽h ? ___PPT10i.7%PC+D=' = @B +  0 40(  4x 4 c $"`   x 4 c $#U  H 4 0޽h ? ___PPT10i.7%ph+D=' = @B +   0 0(  x  c $L3`   x  c $$4  H  0޽h ? ___PPT10i.H%X+D=' = @B +   0 80(  8x 8 c $G`   x 8 c $H  H 8 0޽h ? ___PPT10i.7%)r+D=' = @B +   0 *(  x  c $V`   r  S W  H  0޽h ? ___PPT10i.N%@5+D=' = @B +   0 *(  x  c $h`   r  S iPp   H  0޽h ? ___PPT10i.N%e5+D=' = @B +   0 P0(  x  c $(`   x  c $p  H  0޽h ? ___PPT10i.\%0/+D=' = @B +  0 p0(  x  c $``   x  c $8  H  0޽h ? ___PPT10i.\%`+D=' = @B +  0 <0(  <x < c $`   x < c $<  H < 0޽h ? ___PPT10i.7%pNx+D=' = @B +  0 @0(  @x @ c $`   x @ c $  H @ 0޽h ? ___PPT10i.7%j{+D=' = @B +  0 D0(  Dx D c $`   x D c $`  H D 0޽h ? ___PPT10i.7%<€+D=' = @B +0  0  H0(  Hx H c $t`   x H c $L  H H 0޽h ? 80___PPT10.7%‰0  0 0L0(  Lx L c $`   x L c $  H L 0޽h ? 80___PPT10.7%80  0 @P0(  Px P c $`   x P c $  H P 0޽h ? 80___PPT10.7%t$  0 @$(  r  S `   r  S   H  0޽h ? 80___PPT10.k%/  0 P~(  r  S `   r  S l`   R  C *Af066004 LH  0޽h ? ___PPT10i.l%xb+D=' = @B +$  0  $(   r   S `   r   S   H   0޽h ? 80___PPT10.n%p]$  0 ($(  (r ( S  `    r ( S     H ( 0޽h ? 80___PPT10.o%\   0 PTF(  Tx T c $ `     T c $    "p`PpH T 0޽h ? ___PPT10i.7%(ǚ+D=' = @B +$  0 ,$(  ,r , S ' `    r , S h( P    H , 0޽h ? 80___PPT10.p%P B:$  0 4$(  4r 4 S <8 `    r 4 S 9    H 4 0޽h ? 80___PPT10.v%P`v$  0 <$(  <r < S XF `    r < S 0G p   H < 0޽h ? 80___PPT10.w%PEy(0  0 `X0(  Xx X c $dL `    x X c $(M 0   H X 0޽h ? 80___PPT10.7%Р$  0 $(  r  S ,Y `    r  S Z    H  0޽h ? 80___PPT10.f%p\$  0  H$(  Hr H S a `    r H S b    H H 0޽h ? 80___PPT10.y%`>0  0 p\0(  \x \ c $j `    x \ c $Xk    H \ 0޽h ? 80___PPT10.7%c  0  *(  x  c $x `    r  S | P0   H  0޽h ? ___PPT10i.;%K+D=' = @B +  0  *(   x  c $$ `    r  S      H  0޽h ? ___PPT10i.5%1+D=' = @B + 0 rj|(  |X | C pP    j | S 0 p@0    atherosclerotic oculsive disease of the vessels supplying the head and arms is found in nearly 1/3 of all patients undergoing aortography, though only a small fraction of these lesions are in the supra aortic trunks. These lesions are of interest because they affect precious territory, including the cerebral hemispheres, occular and vertebrobasilar territories, the upper extremities and cardiac vessels. Pf :H | 0޽h ? 3380___PPT10.9%7  0 (  X  C pP     S p@0    H  0޽h ? 3380___PPT10.9%@ 0 RJ(  X  C pP    J  S  p@0    TThe first description of supra aortic trunck occlusive signs and symptoms was in the early 1800, followed in the early 1900 by the description of an inflammatory process leading to  pulseless disease now known as takayasu s arteritis. In the 1960s, th anatomy of subclavian steal was described. t&    H  0޽h ? 3380___PPT10.:%[,  0 0<(  X  C pP      S \ p@0    >Surgery for supraaortic occlusive disease began as treatment for syphilitic aneurysms of the subclavian artery, initially by ligation o the innominate with poor results, eventually by resection of the aneurysms and replacement bypass grafting 75 years later, in 1965. In the 50s, endarterectomy for atherosclerotic disease of the innominate artery was first successfully performed and shortly therafter in the 1960s, subclavian to carotid bypasss and subclavian  carotid artery transposition was perfrmed. More recently, extra-anatomic, retropharyngeal bypass has been described and endovascular techniques, including angioplasty, stenting of lesions, and stent-grafting of traumatic pseudoaneurysms has been performed. These procedures will be further reviewed as we progress.  F  $ 5    $QH  0޽h ? 3380___PPT10.<%F$ 0 LD (  X  C pP    D   S | p@0     The definition of the supraaortic trunks includes the innominate, subclavian and carotids before the bifurcation. Anomalies include only one great vessel or as many as 6 trunks coming off the transverse aorta. The most common anomaly is the bovine arch where there is one trunk for the innominate and left carotid. In 6% of people, the left vertebral artery arises from between the left common carotid and left subclavian artery. Also, the right subclavian can take off the aorta separately and the carotids can come off a common trunk called the truncus bicarotidus or, very rarely, the subclavians can come off a common trunk. The relationship of the subclavian to the esophagus and the trachea can also be anomalous, and, particularly with the right subclavian, if compressing the esophagus can cause dysphasia lusoria or if compressing the trachea, causes a chronic cough. Of note, in these cases the right reccurent laryngeal nerve is not recurrent at all and takes a direct course to the trachea, laying right on the common carotid artery. Other fascinating anatomic anomalies include a right sided aortic arch which is usually found in conjunction with other cardiac anomalies but rarely can be found alone. In this radiograph I found on the internet, there is a right sided aortic arch and an abberent left subclavian artery. There is also an aneurysm of the aorta known as Kommerell s diverticulum which is a congenital dilation of the wall of the aorta :    t  [  8 Z 3Z  :  :H  0޽h ? 3380___PPT10.@%Lrr 0 (  X  C pP   "  S "p@0  " Onto diseases of the supra-aortic trunks. The most common diseases are atherosclerotic which cause an equal number of occlusive and embolic symptoms. Occlusive lesions from inflammation due to takayau s aryteritis or those due to radiation are far less common. The carotids and subclavians are also subject to dissection and aneurysmal dilation. The more distal subclavians can be affected by thoracic outlet syndrome with permanent focal changes. Congenital abnormalities account for less than 20% of lesions. b  C $  H  0޽h ? 3380___PPT10.E%0 0 \T(  X  C pP   "T  S  )"p@0  " Atherosclerotic diseases of the aortic trunk generally occur at a younger age than atherosclerotic diseases of other body regions, particularly in those with single vessel supra aortic trunk disease. There may be a more even distribution between the sexes than in other body regions. However, the risk factors are similar, including smoking, hypertension and diabetes, and not unexpectedly, concomitant coronary artery disease is common. Radiation performed for the treatment of cancers, such as breast and hodgkin s, accelerates the formation of atherosclerotic lesions in a dose dependent fashion.  UH  0޽h ? 3380___PPT10.F%@U 0 @8(  X  C pP   "8  S  p@0  " xSevere atherosclerotic disease of the supra-aortic trunks is defined as a 75% stenosis, a deep ulcerated plaque or thrombus in the lumen. Based on a 282 patient series, 40% of cases had multivessel disease and these are often due to spill over of aortic arch disease into the vessel ostea. Of those that were single vessel disease, it was most commonly the left subclavian. >Ne  H  0޽h ? 3380___PPT10.I%@U| 0 e] (  X  C pP   "]  S $>"p@0  " UIf there is multivessel disease, patients experience vertebrobasilar ischemia from low flow. If it is single vessel disease, the symptoms are generally embolic in origin. Steal syndrome is characteristically from the vertbral to the subclavian in proximal subclavian disease, and from the carotid to the subclavian in innominate disease.    &   H  0޽h ? 3380___PPT10.R%`RX 0 0h(  X  C pP   "  S HL"p@0  " jAneurysms of the supra aortic trunks can cause present because of thrombosis, embolus, compression of surrounding structures or from rupture. They were historically described in the setting of syphillis, but now this is very rare, and the majority are associated with aneurysmal dilatation of the aorta, either thoracoabdminal or ascending aorta and the ostea of the vessels are usually involved, making them harder to repair surgically. Less commonly, they are associated with takayasu s arteritis. b B !  H  0޽h ? 3380___PPT10.S%6V 0 @f(  X  C pP   "  S ,\"p@0  " hSubclavian artery aneurysms are far more common, accounting for about 2% of all peripheral aneurysms. Usually it is the middle or distal 1/3 of the vessel. Those that are extrathoracic are usually distal to the takeoff of the vertebral and are related to repetetive trauma from thoracic outlet syndrome and post-stenotic dilation of the vessel. The more proximal, intrathoracic aneurysms are related to atherosclerosis but can also be due to infection, cystic medial necrosis and marfan s [cycstic medial necrosis is focal degeneration of the elastic tissue and the muscle in the media, with the presence of mucoid material in the media. It is more frequent after 40 years of age and is twice as common in males than in females.]  G 0- gotH  0޽h ? 3380___PPT10.T%`5k" 0 `2(  X  C pP   "  S da"p@0  " 4Traumatic pseudoaneurysms or short segment dissections can be caused by deceleration injury and by penetrating iatrogenic injury secondary to misadventures during attempted placement of a central venous catheter in the subclavian vein. ,  H  0޽h ? 3380___PPT10.\% } 0 (  X  C pP   "  S y"p@0  " Other interesting aneurysmal disease includes the kommerell s diverticulum which is basically a focal, congenital aneurysmal dilation of the aorta where an anomalous right subclavian artery comes off. Takayasu s arteritis is an inflammatory condition affecting women more likely than men and most commonly in the second and third decades of life. Initially, the lesions are hypertrophic and occlusive, issues are not embolic -- symptoms are due to low flow. Later in the disease, the affected areas can become aneurysmal and then emboli are possible. Takayasu s can be compared to giant cell arteritis which affects an older population and more commonly affects the distal subclavian than the supra aortic trunks.    ( 0    }   H  H  0޽h ? 3380___PPT10.^%V/ 0 x(  X  C pP   "x  S "p@0  " Diagnosis of the described lesions begins with physical examination, including cuff pressures, palpation of pulses and listening for bruits. Some centers perform duplex of the arch but because of the air and bone in the vicinity, this is challenging and not commonly used as a screening tool. Angiography with late view to look for steal filling vessels retrograde is still the standard. Gadollinium enhanced MRI and CT Angio are now becoming more used. , H  0޽h ? 3380___PPT10.`%#G& 0 6(  X  C pP   "  S "p@0  " 8Once you ve diagnosed any one of the aforementioned lesions, Other imaging and studies that may be useful before deciding to operate include a transesophageal echocardiogram to evaluate the extent of calcification of the aorta and rule out an embolic source other than the supra-aortic trunk issues. A CT of the head to ensure that there are no recent infacts that would be negatively affected by reperfusion after intervention and finally a coronary angiogram as the concomitant CAD is as high as 40%. ,H  0޽h ? 3380___PPT10.a%p4  0 qi(  X  C pP   "i  S x"p@0  " Indications for revascularization of occlusive supra aortic trunk lesions include embolic or low-flow related transient ischemic attacks. Also, upper extremity ischemia from occlusive disease or emboli. Steal syndrome occurs when the first portion of the subclavianis occluded and the distal pressure drops below that of the vertebrobasilar junction, reversing the direction of flow, siphoning blood from the brain to the left arm! This can also occur when the IA is occluded and the common carotid and vertebral artery flow is reversed to supply the right arm. Coronary steal can also occur and result in myocardial ischemia when there is IMA CABG and there is disease of the IA or the SCA. , :gH  0޽h ? 3380___PPT10.b%P^   0 > 6 (  X  C pP   "6  S "p@0  " In order to prevent the development of complications, severe asymptomatic lesions, greater than 75% stenosis, and any incidentally found aneurysmal lesion should be repaired. The exception is active takayasu s arteritis in which case no surgery should be preformed in the asymptomatic patient. Elevated ESR and constitutional symptoms are suggestive and steroid therapy helps. An abberrant right subclavian artery can become symptomatic with dysphagia lusoria or chronic cough if it becomes aneurysmal and compresses the esophagus or trachea. If it is <4cm in diameter, observe it with serial imaging. Finally, I was surprised to read that the subclavial artery or common carotid will be transposed to preserve vertebral and left uper extremity flow while extending the proximal neck for deployment of an endograft for endovascular repair of a thoracic aortic aneurysm. d 4    $   LG 9H  0޽h ? 3380___PPT10.c%al~r  0 0 (   X   C pP   "   S "p@0  " The direct, transthoracic approach is perfommed through a median sternotomy or parital, upper median sternotomy. The partial sternotomy is better tolerated from a respiratory and post-op pain standpoint but does not give adequate access for L subclavian arterial repair or in the patient with a very calcified aorta where you re looking for a soft spot to cross clamp.      l uH   0޽h ? 3380___PPT10.j%0" 0 bZ`(  X  C pP   "Z  S "p@0  " Endarterectomy for atherosclerotic disease is best reserved for isolated middle or distal innominate lesions. Unfortunately many lesions are proximal and continuous with the arch plaque, interdigitating into the ostea of other vessels off the arch, creating a very challenging situation for endarterectomy and leaving a thin wall and edges of plaque that can serve as a lead point for a dissection. HL XY_H  0޽h ? 3380___PPT10.l%u 0 p((  X  C pP   "  S l#p@0  " *Now this borrowed image is from a trauma text, for lack of a good vascular image I could pilfer, so what is depicted here is oversewing of the origin of the IA and replacement with a graft anterior to the brachiocephalic vein. More commonly a bypass is performed as it is more feasible than endarteectomy. A partial occlusion clamp can be used nad a 9-10mm graft is required. If multiple limbs are used, they recommend tailoring them, handsewn, rather than trying to use commercial grafts. Once the reconstruciton is done, they recommend flipping the thymus between the graft and sternum. (T-berg when clamp removed to prevent embolizing air) } FG )X8u H  0޽h ? 3380___PPT10.m%lU  0 $e(  $X $ C pP   # $ S $"p@0  # gThe authors note that the anterior approach to the left subclavian vein can be challenging and that it may require the division of the innominate vein to provide exposure. Alternatively a cervical approach or posterolateral thoracotomy can be useful. P8 E @ H $ 0޽h ? 3380___PPT10.n%pJ" 0 0(  0X 0 C pP   " 0 S #p@0  " For a cervical reconstruction the incision is made just above the clavicle and the dissection is carried out between the two heads of the SCM. The omohyoid muscle is divided and the jugular and vagus are reflected laterally. The common carotid is mobilized circumfrentially and reflected medially. On the left the thoracic duct will be identified, ligated and divided. On the right unnamed lymphatic channels will be ligated and divided. Vertebral vein is tied off and divided and the subclavian artery can then be controlled, taking care not to injure the vertebral artery which comes off posteriorly. After systemic heparinization, the artery of interest is transected and re-implanted. This can be subclavian to carotid or vice versa. ':L>= _ F H 0 0޽h ? 3380___PPT10.u%(S# 0 B:8(  8X 8 C pP   #: 8 S %#p@0  # In the event that transposition is not technically feasible, bypass between the same vessels can be performed. Bypass is generlly performed more distal along the subclavian in a retro-scaleneposition. Finally, if the only target vessel is on the contralateral side, a retropharyngeal extra-anatomic bypass can be performed. The long term patency rates for the extra-anatomic bypases are not high, therefor they must be avoided when possible. In all of the above surgeries, prostetic patency is far better than vein graft. y!  1 OE "H 8 0޽h ? 3380___PPT10.v%  0 yq@ (  @X @ C pP   #q @ S 8#p@0  # The new wave of endovascular therapy has not spared the branches of the aortic arch. For atherosclerotic or inflammatory arteriopathies, angioplasty can be performed. Access can be from brachial or femoral percutaneous access or during a cutdown on the carotid for endarterectomy. Also, to prevent embolization, the procedure can be done retrograde while the vessels are under surgical control. bzG  WH @ 0޽h ? 3380___PPT10.x% rQ 0 }D(  DX D C pP   #} D S h[LK?%y/=/$&h HUV"H[f4X@DzX:}޹ݛ]h-Szcsb#:!n@֮}q? Hv})[ſr[r7O;]\-~;ag&6޾d_~ߩw|,M,Od ~6K.Z3;՟t5~!z %w5~~p>w:|!ף߿ -+9]c]^ƄA^pH_\@x~tb%KA]/.苠/  o oз@}?}=A?#ЏA?觠 /A]A[Е߁~ AW t-τ1t诠At V mAAC@CAw$^yh t7h,hxDսɠ) &SAM$̟w-2w<1_?7wz+E^ϓ+ܜܑT?_l 7G Ozɓ U{0GW=>d!ӬVɰJ%!D6X3fd ^j.$EѠiDe\YWw*M3(Dش/)@0<|q-TDشb($;77e$TEÝ8OΥX1l3ih~]@!IQ V9j%9;F<_pyw4@7͏̯|`. ߱cME gFhAE6(m/{Ь<ƞ;QwУmDh0c15v&GJa]ʢ;(N ;U:UkocݮWqTј9݊^k[}N1.׎gYYzvxo't~ǫWO/,#Xz-'WO_~YW&R&0e':mNÛ6 -\iNܭ*N$uC,oNqRx!pK EMNUL+] >ҊKcJk|q\br;ZE9ytxw_;g& aTm>צ?!ѩ5f9 鲤i8\V".i,]H! 84H=p)晎cok9 MdKxsϫ4VTs$MV6]V*lL&e^p7We2:rd(y/_BXi7eg:Qi;*bؔ-ki<7vo"#*] 7c?JLq??60GLT:v>"TZQg}9͐1vhQ=`SM"5א@vݞZwc/o x"/vNXXpe ۱! +F$sa"zT6:`b̰o# މC{D dLdU7*XBhצ7^uAh8ZڦPK/P^ z̀s ̽Е71W\Ef_Mb_!W>jBMLJIɱ 㮈,>!ue"n9 C}/x6kB($'Xϼu@SItB;3~)L*peΙ8h+ HRU+uWj𷵊ˤ`9nn =fjsB[8/9Y?wS+ Z;suA[6֯tvaCmJOGe65eѐ.iIM-F?b {rz1i $pnq19|9ÝdEF+s9|;yqoƔW?ƨ^kl - ȸ9i+&_t6KwRޘ&{½Ұvc :Im%-C_[ٹC^|R kg-c̬ lڸq׫ZbyEOYkNzli y`՟s-ǐkmZ*aw$GCꁨޏZ[{0𾬪2!p FHlY$h[V;7N=sc=qS1~L =ZOn1Vw'im[ۭ5rXYsEN~sn9K(O|r9rߊQoXXho޾޼l<UGFϜSZz3pOBl4qڧ7!"ýgy6p_bJp8u1qZ`%f> +ζiMngsd-IΡa[*'K\͕_ϼz36n}VtWp1`vܝ)^k_W|TѢܖb2G*۹i}g=ߵaX@}vC/.*3GЭ,Eo45GX7%/j8yl€Pd''{_谡4i{vls=jY -j{6/cR*U_S"E<#6)V^,?/\A};th\ qJ#VIqC̅nL۱ݻ_EcE!q8HsN: &YKA^/O yM6ּ~ ҋÇ(\ch[{\o Yp8|#}Q_$Gp)4C)CɪGWg/>Q'(|5l/%mb(mlqӾu}$}+o";[Z 6t}s˭lFcB13daaaV,K>wue t8ң?~A1!hSʬt3/i=W&.)ckP%L/b{kmhڧy':y[?`Uj~U(*Ahrh!F̸$>6O<[}mk/Fj̑/r7_6@uBqgsKZZeX`g=؎ !oMo-[+bS71#SpӍcR]G.6q([袇,JM/k1Gwpl*e"tBY-ׇ'&pyi8כ\wb3DZ1ε>Y@T.J+􈕖$k`yck޸*3 OC/xg ڴS)Fh!GHEc.U Yd< Wm MjoN>2ܡ. !|dfXtc\lL|tL. VOadON6Ot>[ivhI*JfuCP-(3:zf= j"|=°{4?QLRleԏf ;[ۅL ل 'U z}c0ys)΁^6RE>j^g.9RS뵃ʘףDlՒ={xxbܷ_ӧ/>Mšޘ+ZFjK==yjע'"O@.:q7<[Tv"y'~c!!tsZE'Vkt?5bL ,ܜg[ MͼhpԢ3ݲϪ>MDOtm[dr6ɵ|Kܞ G?rg@:FN}YK䈍N/xk65KCL5kMaiNT0?k 4|K*e1Y3#-/MM6O4|NSEn?-q_iGlGZ `$]*sVgiGҹH!)i2Rloɸ1%{zb*i=G˖F>﹓EQC tOag873-VqmA6PX,i٘ޘc#l8ŖHfƫʻ|;aͺ-/;m.Pxbd*90P[kUv h+ܱoV=`1$>ƾvn-z h<=i\o9$Iۥ.=bLAhCk,EV?lMPZGUEA1H=&te.ynUwgov#ɓ4w~M O#'l gЭגe*6_ؘdBCA>$  ɖQ-ـfxЏɳ+['?l ki9ڼPN2BVʧD}erwpo%sԩcǎR_l:[pn2BIÅ ~g2(A൷sG5ڢ+Qt:fDmO8f4kPLBWAK&3i-W\m( BVՀTJjI*kQ0dU;>W+hZj;z1dCϖ)9ho"WK!r˯L: yW W ? / oI3mcv)Ʋ^gג JmC"ruxmPs$J-W=eOօH|!y %LL ڶ~,Th^YItPgtZL7guf8hZR[l2ɊIKeN-fS Md:1?Y}Tsȏ[[T#r1ʥ!TB:v!b[9IyB8&{~e+>lCaZ+6P@wNTZgex*g•j{$ 뱈U…wdH<ʐ2k{4']t{0'܀tY/}M# >͔Q#0W}|XwwxMt#*>Wi5SNm>u:"W.cVHkIAcKmks5P)uuP -Q^ +hy-ϗVt79G-ItQ7YF<+5;ݑ=βnO^ɗ(oIcfq.&fb[+L$V]Mk8rM?]#.[tÁ 9dBݛ\bm;Jm\!N@Be&(HoagZnC\m{zJj\iMTI7-/O'çJܩ1޴`p.cgkr%8#vLyH܅# .x> hE>Gҥ.:ٿg"QTyxW țc-*eǔhHS}}=% 5 5<(؜eK!6&OYD|1\#ِ "^Ă#+sRCjm dX! Z3!ghXj=رĞRb40}y/6?P!֟l45v'y(PӅlXA3D2窦4"0YЕ.go,g6@Å;ƪ~gMWAGkMiZMޜ01[0do@E< 05OGr K誋)DsՐSܕ4z) *u[doOԡM tWSg+.5 %ָIZ5^b#H(ٲnmQa/p|2z $!)~se, &NsH{}2Ԓ*ݺw0ώؖS:$Mu24xy [Nk<;_Jes#.[zE(%h? "_D%$QfMynp[˱j^.$-k>)"H$Kh[8s`╽԰K6CG_(MST,jgwpD?Dgr险̨a!,/pyo:~6?}+/gWIW]e^fW<9Wsi4GC!d+gVZp,2K| i,Ms,="Ky{RPY1G9<;ȍ\L2tmf-S;qxD1Ͳ?_/yl5gα/3㳧qyqA&5ǒMQ^}(7)ڒ4lG\eNcdqxl3P[QT(d$3X>uz&fa?fD<-m_\0)dS)~jK tTtH0Eϖiy_Tq߅oGݞrJ lݏG@":vs>Q Q1ʓHYT*[61#e$cc[1lOYꋥ@AI+sY#*Z5}i@rByH+FI%ܭ7'nuDVbk{c#NkNsSt&-Hb1ֵDPoХXLK("PStE_=fD_Oecd9Nprւկ|,<샫.\g QStEtH7v4.nj.,K9Ѫw! f456)&i|Q۫yU9 w={Xe<lŅ7C}|!Ν $(ƭ@W& jֳ3Թվi?q3bĹȯ]ZywpԪm(ȣҰYcRCgbH,(δ^A4ZƦ}m.l;N|# }otj1'[$phޜ\ =}e-GݑVkS>v~ʢpQ8sm9UUkzr~EhO6>^pMt*CW(ƍ41ll[i Q}qu;w \rY&?@_c3ڪXUl(Hs{ȸPPg޻$ le4"ld29;вw_F5s?Yws5Oi}ή{=jqǗeۗӂ07󧹶B.BdxB|n\ 1>rP};pR)hl C^V /E6#w\c_}SXxx~-G㷰lZTI6wm:01H+--v{Z8fIti,R63m¿\X_:J!(K(}:yܼa&$7c$DdGسtCG%].:O7)17NW=X0˭h8<4@YY4N}şkĺ< 8^`hK؍c|q~ص2g)PY%4E"[nn@#qD~( Ϻq<=T٤4;8SVDM+Q :r1O,:~+_D ޺`+T} 0!sd\;ad`C#[wsMŮ7.{EF f(}MopT̲#TO=(l!hj㛓CޣnkKHM#!vXWE]#F/΄-z%;c]Yusj[XNsi81~rw5^ƀꇃ;Kj61sfZ.&C:x NFDwi+,2|[96ZXl~-`^;xRV+p$ˏ#.;&lLh3NNSEؘ~uK<{˽dOb(y^,Q2OYa8bJ~0XR"|C7/{%s3_IjQ# {3+ ^[p#ha|cFH작~E|ζ5OrG3]G0ibSJyQO]$*#߱kLANc0<Ds˻1}6]w--@cH/LW*,r7&;*H-)OU ?"д,eBvAm;`:e0r%C~T=2}ꦻ#?~=Jޝ\;6gQ=f Qp=53pPG:% %fE0Y?~{ĸ^)vklUD^PG2YAmaAtWv!% ^FѫY>C}].S5={Rgng|Dbk{U)5лVZ+zu}cARۚ?sy0_Q|a_{P!Y_e!’ű&dmoyb=G7oўisiKO1 %g4RB.!H4 @L)yC6+vc9w^ 5왎km8׆pdcHbw5Dl ēҸkʶiK5?ዩ/9 (:1T*I觃~Gm,H5GdAb i(r)_T.%:}ʻg$-G7rV(ŋIgV|SxXXBKo&U*h]nEA^ƾ,^A!*"F&ci?8T;'amI2Fv^7`LӉ$bgX)P߮7TJ3TΜM]mcW G.I< )VvlY%EŽH]HO_C_-K)q3%"?Hu2" [ag2q`[2 K^Ŝć5lIv ?Lym,pnl [Z~t|ge27Fx~p=QTҝW&ۣ +v,s?ay6^5r${{;{F>CH2;N7SRLә8;Sf;v{=;^%eXu_ =bv{Pvo4+S:G#n 6Wȏ鲯wi8{^)#ufzs=Jhfҍ7OBEV dvhT䴖eVRi2tJ֔ZV8.1_ap=L=X˷;@wjqOM qwycG)3!ϰ|{2{Ӵ] . ]i;KDThEo9XS_l{kK]R1ѢOD{k$=PIJqw'(^,u-3W(}OpkRЦwp+J]P l }K/'*<:Oz{QyqLPO?EU[5O _g2^Vs4W{a2W26{AtLu2nB>=mNW}9> 8[`vaKpI7@wZtS8?-if['UÁ>Y7rѥx})%-]}+k_?O.fj.ј w{Ρ<\\ivvS*J"ӔMPX_5%2g6`c[i_$[jnenԮ[Ωh3(_`oH/u'o %a}X=g{|NBEn|uMϳdll hl.L-ix6ζ2Yd<;`5h?pwH^g|r`r=[XV}ODGYTM9v-{&KxywJ!9dKP׺ K'ltJv-s階bnP|=IQ0n{ks=hCTYڒ |E A3g31h ]?] C{+u|qfr0sݼl}ysJwϩsЙt&Vm߽<#h\x")NSn#~uF&j%teW")q *X1; Y4FD#Pn H<^{J'zAėzȩrkT-k3? Rw2-i-n@WCMYnvj*걷ܒ҆ MT|w>s?MxZԙ[9f J,=Ig2{cǎ8pL)V444ן8qѣG9~xccc[[^TKfv5oKGGɓ'q=(={v?9C6bKa]u-e+sBxaWMݿFmrsJHd:uxBm/؁l9"n$\ͲqLƪ#/)+b "][￮ֽ&Ly,:<Z fQC q%O#Ԅ;|0/͔ 5(5'Mxf9Oވj( .iq[.̓<T=.M @ y7p=[ ܹp|[rU#mJQM02iF*ڹ98]Zol{݌l"O[j[j8l%wZH{Ed(LX^9?| (!7eo1"paɩ^am9y;)ܒ,]/3n.ܔyns܇5dq^;Z[ #ƺD, Ju,pҫsDWʴ%T;Rj&bfKyHe ν2;u1[?1%{k\!s\8<9 ok'}fJ4fQp޻PU;<<.ki$žfuHdU)!6;V# %kB޹sG>WǺ14%1IleΥhD[cPmkK&ْ{SW)~Ufe;O!ـQVJAYom-&hBT2-*ysS<|r8`1,Cr79<އ=)؍w3<39Sp̄WQgQ++km[|k<i69̰%|rS~7px_m *HAeDv6Q !Tt<0~"y,N(}V:]V9wfK㕗^~޳l-}Vn aP[x$Im'ۓLoܶ}BrԸ#3hXvFȉ9HyԀ/&8+- E,(̇l♆:~!Q jA:5)W1m\Uv?rw| 3}—`mh˪ SV"8\{0ྴԈ#9yt`);=쐌-)מz&[qM1W&-]tm?[u :~l)I7+Α'?On7 (L\qr^3y  Ao:0н +y]EGǛIQ:=N~_Z-}f/Me$;bp۳0p.-)yK'*jrZo~ⳟVRr&֬Y1oNk$aK\ԘFvL^8!XՍ/*=v׺HZ>n=9Ki{m5&;[O64mU7~nFGi$hŖ" 64E0ܹk3Dט|;<̝;W_+k.DDI+CDd @1D=p%l7N# d6QG( EC7HʆU *-0FAC|; \e$ڿ&h!HsEPX= 0aZ# r;"ۈIkBH閣Q^E~k >t5 ?AfsQ(ǜu$61-,PN_2DDZ$jWߌg2ԓn=B"j{2qiKe͓i-/PQ¤C[= pEmE bH3Hnw&oix73v. o,P=T3MFO!"EՁu @C]N;6^¨4sl^:/rpETdx{ K@DaM \3"c 6,4sX0B|M^7% ҂rD]cGTHc "&)T(U>ž[Q Cݼno_s|.2 koymDطeś/ rCyxyW̸iątco&'$)1y@Mğ8#(?De!\^WF0/ x.G ??+\-Ksפ :UoνU"6XԖ˺$9?ɅOIhac|R XJ& nl.bis U&#[ICMž-'D\5pg_cv聃OLm%eӹWwƥڅ^L|N ;RHyy/E&b3fL Dd| e~8i 5@PE Ms{oT P\0a %EL*** T_;4DL<g.Xj8OG&Qe+*Ǽ1V1/+5UMeeH3t~>ヅ-(:&qV~dǡ7OZ9K}2ߘ})ɰ~1Ĵj58;6'TG F8V1֘z3Q3tǿMIqAB\@8%JtvkxfZ<4ED76f$-̨Hfk2+MɌPgtAQmt ةaXJaҒ>!vN2y?xӇSdC}8Q>q_p? ' S'?zA:Vif ɌZd: fMIK0hZ,p|:>5ԗF)VaWK3bZk,M0{>n<齅זy.A*1eJg3ԪgAe걯gmTٶky6dÃq31iݟ0J1ins2Zܬ2΄SXIE/|v\݃A~{O.1nB$,;i,p#-b| E!n#ʰ${1:dU-z5`.OĴng9y&L!/*Ww{9`!!B1۲\+".e32}XH$>ABǒ4$S$םqя2cy(!ƓJ#X3rt^Bg4 oG%|@>EgM|QFL;Z1$gAu8DJ6a9`Uf܌5#~`Y߸瓪稲%m@b_gdG_xg͚s l sY4c\qȳ=j5܏,Q[/a=Ho.;2sgFO6Ӿ5&M&#qlE˵ 6j C'ƂJ,Z!X An'o۵Xݠ6; x=DXp[:.5" F(te3q%). A3U#^\0UtP5fC)V?p4yP" BbB.@-}KH=íLfH 6:5 ;;e_>޴Xrq$wNT?Ң̢fOKʜ0)9f=ˏ<u?-X?Ń&6M@[eV9+›gQ-ƐO5Ґ,<vvu'D'GyM[WB#%ψiUZ)yIF\YRpN@A'fҩySI.wfj~($VL?3Lc ߙh!4!8s#oRpTP I41_mfG_Q Oí#8ΡDPZ˥!ۏV~J&ynEioִ6/t E 'SaZ|@;8qȌ3b LudpnO<`Gi}Oz0؀E w{HXcgdd1MZT>]e6~l٤0!q6S*/ D/6WӦ0'1g死̆INsăI.2g؜wEyJKsv[2!iU#>?iƲ%Fu q{E([i*O7Фa-aFkV~{W[믫 _w<5uW/\ܿԍG>|2:|dač^6Ng7x7'MDTJ0sG&sN; !*W,f<]U2Hy' og5dsAZsQ;%;‰ aZY+'fII3iwAbj憉I ~ɱÛ0.[ Ŭ+`Y=VH/0Qx3>ݸ&/&R6]QSwՓG}wCGv]|aa-ǚ="⥶:$m^sm 2v i'u893x`s=C]aZl!,ʀ7 d6Nf>p3fE֘Z]N5C UG4~̤p$&rY6Cq ̲~ ACk5ݫ%qliɠ쒛:5ffT 8eLKLWseÕ˶1j5\4fXt|, X^D OϳkC۬IHſec^nXuv +5(iBw0ڜ㣣 IIOf d'dR )QЂݦ&9$X,/W5&TTsЀ[5ksٖEdzYRЊ?aLxEvy: +)N%`(:g; sur{N-> 䚨1j 1m7 ,- _Ga rǸ+Fct.(PQl]4faqM2{Ô3WrAL54QQ',(=+'8d>LS DbSotP}7ДLJu|+4wcPL3 7A'k+`CAk|hN3fD_7 \PMIaDz0DL8e)=Ir:nm~m=^RFɧ?NV==( NNKlT4Ai?V$ *ѵFɲ1/X,\RARGHY}F66*E9/^EVNh5 zrbA)$CG,0 ̙y)R ~,i-%k#۝!61 u7e^爰QI7JmH&VVR2_3M_ΜNxNl"cY\MO3>];bd؃SB?M%fJa*-+2<׾,bQ( l_YU7'EzEe*؀Ȇ%kMD?1)O*+? w|Fh\C3JьF8ZNhw*c$6sT2Krˢ<./LSyr6  ƫ> Պ!y)}|w}s{ `"PӡjY.ILK19B=zX$ _J$[g|jr>3 ^f)74ϴ15ۛI!;>8-zbݚ)m#uk)/B,E'}rI]%p+AL,-&Z=q_d˿=b -nkTzB>qֿڹ.ڤ EU1YBɈQcjg) *+Ƅn&pzjU" XN=9M9Ո`,So3tIDZGB!NUʋu'ue?ӯ>uP좢ys+*Nto-?i>Z0ޖ~̶LƷmZZtiZ.BPh.4*25ӖIMsRPrb #bJZO =~lwx|0m|V1Q%Bg1B!{wᾭs4|[ 1w̑+1 *yk.]:ޠVU !5s!uzNT7y?3G1dӆU"6RBCT`4Vjً;vTF h5k^}woV0ڳ_%^rRͰ{9~'Ԗ@{CE*?4IcC7Ƕ8鄸DDn,G@I:jO]Wf.]7ef~|_G6ฉLy%2l%1R '} w`cÔvG=IW@Xvy`)A/)5ز1}(($\ ظ kmL# e=w` YUW/u9E[J7j{ٖ3/=ÌJ[:bvj60kޔu/>6S:ʝ̚ 7Neku%x^JN*s'JMÿ}Sߎr]e!u[B#LJ=B TUD&63J#0 ,B cQ9CBqǏz&fjAfui;S7?9P*XIqgD*nk6&a4t h&S8t^-jaevt(lEpTfX.Ê{U}[?ƪQ[O87b-=a~&@.zIOe/Dp0٘$~uS`G ExFrtUMV> "{kعĕ]Mv4c/YGfN\Y.U ٺ4JF,EaB>5x=}f^>tn_ā9<9Lt8+QgWwlhC1?-7ћOY@C_妫H, ~ʹcTqwoJu%2P1j/еkF\̸ m$nٰ4w;Z4Ok=1z!0 < <R'2`pݗnA9ė+أT$ʹ ~YWi_fG9v]>Վ}γF4%Ǽi$8373:zx fK)qfg"R\_!y?.9/&)n'ZdZL?ַu/{{>K dN3=&".7=zbHYU:?"ݵ;dmԥ@VyVqd*cXVXZZDm䅐_FTSvd5#MaouZP"l4P<}օZ6̷:npi|4/Km&ɭ={ĉ]w}v|U#&ȡ/.[HDi72HVJ "~̥kJLqTr~) F?Ny>`3XbA!N60>6wʽ^_\>l 9BS+kQ5@vҚcS/)H&5Af(Qw-r Wi;_Iꙧ_޶cqٳzװUiTg3r.Ǜ\`֊-z¡N3S#&wʯݻućWtmҸ{kܻ\.bq,=0$1enݕA, #"Ȉb(%7F16*6faBd$AA]%///ێ~A6ŽE2%7T?צʬ<؆Џ.*¿кe@h07"+8Fip)ޏ>%8?>=Fޓ4Slg.slKU928&a$#SREIQ;Tb@WYG:9!p ﮭ* `vޙeY_ODTW"u4&gĿu߈ ]hr ?ЇU>wPĒQ._EUνc~S %wq8ˁ%C8幕͸{=:؉ܡGt_,C])F?[l[w(bIVosիƏZ콞51F+Ge\a݁s+"J.EZ=aן=/)5TT/;sFXb0iܰ9 ;tTImU.T4I.S@>Oժ*Orť珜&S}kʿK^ړ-(׽&džl]xY鍾}=9 CWZ#S!oAp$;~."dFx38$(3*z#׿BT?nuȕ__ټ+S~^k  W8 O^yN0i8*xr.ħׯm>u~>X^SWG@{Nz%+C\AN;zdGY!enf-WRK2]Ec'-VWyju0RmM#O:H|jM_c*~:X:Ηji3 f|ܥmܳLVG[&A$TV) W4^{^L|Ywe*HTYuZ5W_NXSh0sl}cĩƙIqZ#H  Z"t`d$~жWkг󐙣8zkW*nG xs8LBwA #y $K~·2~ >k 55&.\enXUKx'zs5 5`@&rZTڴV`Qb͞{py2qnțdKmU ޸v5}IzFJGOq u[zLyaܤVw-hά}ٔCoϞOaT#i2rwc*,nb0LdU6a=Vg49{{8 8'D͌]4FS8c@鷴A˷B= 6ZW.Ec1o aƺ<%s6\$@wSB1<j}Cu5qIȖs\h 1í9o)ƍ*é7 Xww޽g5k#A^ spjC ùvb$nq>7Fۣ;PSSǖlac8Ӯ%|O5T(1]gϵF]as9̹3o/A?{u#Wr^{,Hˇ2/kCqnWJ =! ~nʈQ̩aF L|O~qh;@#H6PP.?[w &.(Z TՔϷ>ƍ(suu!9 ` =<)Ѱ FÒzZB[.K>ϜeثuaHU^`Uz?()\Jv(d $2s$8ut -8wF^‘t/, HEʢ"qvOCLa$R3sԎJ |O{ S:`%Uz llZttWSe6RGW'lyǒ5@I:#p6P~Juwx/ %8D~n1n)paWZH]bχiDR|58!V4T|t/X&cN%`aֺoHF9a|Lp@X=ָ tYTﴠ}v`?充+~,GXr{3#¶D'im/D8[xǺشEQx-s?w72.،=Vwٗa" Z>µ=^ i^z@]k, \8px3s/S _vL+ cv ?Pp<@Jx_oռ 86iԓE+5U R[ƾJŹFWQC<\V--b^ WI՝.%]/4c-_]h\SΚ xF0JӝŽSKP /^HG]\;LI{-#wƤDu= gY̹)FȾг=C?d[?A*8&yN9 ,HX9Cle@ؠG+*F +A01$FlLb 6'7 Dn>)3-A[t9Akoz6]J;w%%ff ~s)o"yYEh7Be[24­M:hQ"7/1S>|4-&Օdf6.bPۆx0aƤȞ=YF2d5Њm13ڿ8d-'9-P??ʙk8IT҅ICx8|: Re! {yYzOX .`[B3p1&CPÇ P5K;vx|~_-HHTx7'8{ۏɊ\gtJ~/ɚK肇]#ڸRCŘ0`}5p}Az%DCkV-M؍{ef+7A~ g߱cO82}ʕ~zz!A.-0CT,RQ!M~h$3!m]C,Ztq}ikTe8dߑy`@@񜫨mo0 FA'~;ֱyVCMSZ筁̋ ݟbݨ(8s{wxqG.6P4Z|+x-`t:9-O?QQ>vR|C- f(>_~[l!}k+;v/^xTF5T4IQ0} D͍3,iT{ڭ5J|ܑmW$pEϱXbJ*LJmZ&Zrhw"t|i>`Zx ^ԢX!Z*Z_e;Xd g6bR, \+8h ue&)+;ىZ<_2Z2JpɳS_Շu7wѠ{|dkf+\.jQƿ.]O[,=6]N]8cܒAZ.]~''<޵ʯMMȇ;k F/ :\f iO-ՖYS'9T†뚦4Cbl((bDyi#N>FCHvɪ7/C~ݍGskCLŒڳx0Ĵ0Enp3} w_bi0X*b:B޳f_w#~ԂQ~TV 8'':Xz(dKLj%9Sd= &dئ_**R`#DJWعCMۣ ~2쀕xFhhL~ʤ:%kuj>-H۫4 d-ܠ_9&DV![:~r_cQ>Z@qz^2X2완ArBGjLDz("+' FUsc{j7<#p#h*&ަO-:ł8s6g&lGEgFh g᛾80Wup0|4 zVVQbyR&8!OnfZ1XlbLg_?' hs cϧ^p!%GgA b%L1gKHy++1ٔS sh͍i&D (@]wWf^D=OsT`yERdE5"L4O8gKa_/N};| s՞çƅ'm_1bT#^ ޭ(@Mb?#vn믿ԓOKX~@w>H0'COd:'g;iBg 5fq t/~i$'k4c2㻯E֏q E@*ed.EOc Spդ%E^ xTalJVFf8PY -Y .IUG1dH1M;3&?e A40q07QTe`u@={vG=zo-YaLc<>6LkdT4Xpc[/]$W.&f{.L lyFIH+ 6 Ap㖿~ `ح g%&{0d0o[ڄ(`o  Nr)Oo~/"!i+,?N/۲~lSXuQșm(zy8 蠾caO^8pEu,:yԔc&n>s<4̨8GG zõK-d0f m@Hf-=wn (v p)m?U'pr<}7;Ʈm3+!ckuDɋID1$o.Vt GWػ[wn*Sqd7֬50I:Sӏ1sb"FW0+nԎYqQ"7GaU vdaϞX"4،Q=ݩj*LQh3-Zs65EE[,d[2gm()ڳ뗇(Y ?T4or'?OYL{\t>ݡ WQ l ۹G^E'` ׯ\6ˤ bі.fuJKA .w-.]=.A T!ހt|GF9xc^1)`I?Hl?:e]؈}L>30:]c L kBsT3̙Pӧ. β@CC'VF0u% h )A!¤oM6i7{ڦQ%䝷e5rw6߹nͨho 4c7z+UZcy/)`ِ4A' b`"n8QkH`Zrk_5늄 7Z˴ڱ_ōpjr{"܌e_Ts9# {^`)@@S$./?#2:@R]ɋԁVKb[{#J \^WY,W`bzX5k>5Qsol+ G12tҷm/y7u"Ўx)b5PcOY=9/lHCSip*Vx*;gЂǷ>&`'bS֞`#c EU?=3Os bTdL -4Cn9@S&wVUrL5 z:EO]h8_ z̫XsØs lWQng~tfQqb[P@m)R֫\M7%^EoqoVGDϚQjs,LY8i׈uŭ}Z#֑>nӯ~_ږ+}=@eEg5 YX&=RٺkK?_:aqkftO"mͰ[^TԲIɣ?#eEeqJ%ՎX]S}]]@8|6x`C3$d -z5˭ӕsPJ}`I3fshl9zpZL+ݗSp[qW:v[hQA"H϶1 h"[M7SHR:Rko>s=MgĨd':j݆)`ֿ)qEabQ'6X*1jBQPDw!HwM?Rnjh;dMu-X@kAaQ֑Rw_L,h^5':iJk(b칋.O5 J0x,LYO&HT 겪'gd|K~vh4kavPAih [s~9f yxo_l A6!VS${A]VH[j)yBJjijsSV>}Ay{j/}E(XSpJvfc!)"(]q i7ȑPDa~Ow[_ݔGS*Z{F, jͭ+⻥3/qkF WDne1gGx+߂ 0V9ڼ r|rh0 ,}`/v~ZdQ}U+4P[/Yɬ7'B0732AyztBO2O9ǭ^QW1CPGQ)Iy$//; gf ᙚPs`)0)8F%*bRΒn%ke'cd׊ER\7NSRc0V 0Mڵ4 z`yEIa$܌moH 濹廟m{ނSވNܢc4H[ig]|_:Ģ4l?fC('1/еX2/&:=ұ>'q&G}5dt_L%1R4n|>5e3ˏM8aߒfcz6,J2'vS{]](9ƾ4@v4F9m?R̉};UYMlOq$'27Ta 싮um(}d;YBmaGFwAjTi #ߟETÜ*R!9dȺoS6?.2VL)ֲu٘[Zwޚs ;sSDiOes1];- sj/o,QL;R2#s(:֖M#^!$:8 C؂v6Y1SQϼ}Ox5=6w okm Z}8f?e5AZzD)C~8p=lۺs@ɽ>HѴdndkdCgKkk"k՛HwJ0WqtRsp{ W[e?Jo!GZ21Ar$JF"P'H6ޒOF K}7[i)Ć,7 F vGTrJǶ[ bj2chChhf2BӶv`7Κ'V2۸ yvQŜMߚe[+R a 4pFRSR.0b_VVϋ™X|,QPCs 06Q#Ι LbUJAЋ$wmʘ _CLvIƷ`Nܲ:tmx˸rsodF,: JV!Z%Kl*LXgBnle*ҽL dwy$ Kd),hr74r8ze묠X*7LEc aImټ[p";@;mAz LϜjl=@(V6 j":)z&}]9nOO/߳f <"Hrqu`k%.{2jd_nKB? ߴmOIYJ ARbP-NhqX0` &,eެ~UjDA vb]ez4YQ9İ"t ޷w?I~G~{CDV=N/+!m"32eOk8L>T8{upU}VAf.aZ늀4d>P5=Qwls4u,4=6~o=[nҿi[İLl)7^:A@;U}X]Ο`E~ l."Fq?(3LyhuƵAKqxU # {s.( *ڼIaUhaBa敠iK :CKLvбAUdՠ9+6_^h~t:|FhLdaN/tk@5^,_*K=ux0Î%eRJT]7f?&.h?cG'QxUZsyxH矦uedg^ltB ގ]`Ym*rULɥ[D 0j`.#a*?0L\42vǬ%izl]<][|cOJ-vPG;/K2(b6WRTR,Xch#?& !0zC2\Wc%.?Fϑ{h07FJ ]J0y)NdEc!l9WMى)2gًCkCzbVU 2;tDcBٛ} y1`RrI´B#L*@LTG{DrdyoaE<{qO±_<_xpBu&2|?D $K#iGHANbQ(` (fޘ)?Brak)%d@cX"%wAU+uyU}ȟ #ݹO;umq{#thGH7ڢ7ƪj )$иGF5-UҊf/(ƠMjoxD&CQP[W(ؓxP}wf8NKɡexШP7T#_A4"xLMJ`OZ[*$tj¥"0TT)ZX%ӷMr?{龵 osGBpcs%pxR䉳ڹ)}DɌ?; }7'_L_ꞗpqJ ;H| v",.Ŕ̡)f;G$rL|Z)%:.ѪG"^?*`p*Jއ.r޿HE2 !j܍ҝퟸax@{Yz릂m 逅τRa.ӊZ^I]!f.Ĥ{P$fjx^لUkiGu͍Ξ`GwnoO+.oFbEBmD oU#l\:0/l:F&1ˮQ;}-$+1BPYYMOĘdIAAw0oSч ne"ёc4BH0lUvt Ԉd);B m|H`WhC٫KsQl͚ B?- QUt O)A /"/{kF-/<4h@*PA(y!n(. ګG"裢¬+5I2 e넉 EU#.+59g죃\Y\T{cvEy`qPasz YLMvtc9ISfO%;5ymv䟾xI 1%Zr:vGΰ<5[;?6v.xvimTHUH*fؿ4_T薪(:XQǪ{z W<(}8Տϝ]oj/S(uK-lU[Vm岵 9 yVT'Tu v wBCdOYEȝ>)~-Cm oTӒpЈck]ExjpjT /xh\cJNTBM%['oLSo'YJ\-ږF'+y 50Z /fIbj/v SãsI &4AS_XNͦC椪%Z 6/v[(i7Et[jfF-ѿ4gT|qXIv\-Fg 8HwAB!_^j2iiQMΰ`I3_m zI`.yuYe~6BCƤGP'XYڳ1K@_EJׅ. Shêp[W#Fe:^ö(\HYIM.ut*jDotV_9;/|'e^*YНtm@K!c'fxɦeYm4Ph`9wW'H0aŃ`oʅR~Q*@&Ћ nx2pp k,/zKR!2fc[AڎVy # ,\f.%qVx0=o=1S􁉋~RJm'cϓMS@W) Z^@mXDh婏DbqQQ*ڏҎcp4V2-DSؒ}ȋ R4&*aJ ]ؘ}{s䢰UṻLc &<"hw*~?{"p`Sa ьfԾB&D󊰹ÔO)Զ lT˦r%LH+K< VڸO] 4ѐD [Bͧkz? Կ,e*"B&iM$?>4*(K46mq.}S+M,;v07.cj ړA5s,t"Xꢄtև|YM;H^9 qsuGԱn-\T^eާLPQ0Wߏ 3 z8f#6WĞN %iÒw/Vp2x!SӵbxucU)}K{6ɔ)K=i+770.B" %(.ivG}klFmJlZIؔ:sbs7ub/׭=9 JQ aϖo݊^fP>_1~KŰae/hխTk JLsаRpLf?>+ݰ %Ƚϼ5,O|b;?p$0}1&}ɺEP[^}T_ %:lkP@A) *0 Gn}{ox#T&/I4XʏVTd)T/(20T:yee iV*J҄O۪v t0F֜}Ηg~!^'nt/Oc寯J{t\; *:wpiqoA OM_+cx$J; Y`lJf}R0?P1H6!2m=NBV\3!+]5zb= ݙ{OOtG>HqwsK%Sh(vV`/Y68^ثпj)M81kQy6՘]mqش!uf Yu atU_DWZ9߽&𮾥kY*m`]:bѫd%2-]Zky8<%0mI6P ۏLq tLĽ12-Ô_ײm2x[4fYBerK \)ݞKayb*zTD1é%g<2tK+hk'ˀqXĔKGaY(!]5 L23*0U5q#w=d9K#ŢEo )w^?1"[ z1]W,PEbZEcnzg?-mͲłN5fyĴ1 jF/4E&;;qEJgT_P .6V Z% k^CE9%¢?#+jsQh_Tnzq<cD%HhSוr2qV.fWԱ*,)y5T =]#\sQu^]z\_ntcY."&x#ՈD9 ~>[BX7K駐LcwܟgeDSr/S{ kͤbpRdt;9'n?,aFZjYc\1w:ԁ5C<2,1Kך/]--Ǔ=D{{;:(CZD"mmmAc5\΄y OrUⲎ2Ztڭ z.67Z*JD+/˪\@WbJe!1Mسmߧ;ױB]q[-YZ )l.ŒKw̟8q/gmv VUʞ$0_E-IHd3 NZ(x1S^@orMZam9{"& ׻ UAaHTe+T0Xs\m@S OM "/nL6+Xo ]% Kvjj>b3Ͼf$bp4ۄC&Sa`œ=OL?ݮe1D&)9C[WW_ U 6_3 ׇro/et%' ư sJ:#;+uki^,E#צ,[k;`+^o5R2̱DQD fyA 9 )omaįsbڶ g9`{`k2.`)B,LN[ fH#Pso@r[Tjpr;\J2N,x#79\.P3a!r opR.$ap1`䋖^l,Ȧ@Ōݞ]V d'\5cy/ǮCiټFUeV}tf7.J6y*mz21M fj~=lZ2ܕu2h3jT^ ` %'l]_f(sYw?P ^wa&;tƗ鬩 W:,]1S#. I7s]\ORp돋-UzY4$~$|HCq^YE6 m"4LBR֒A _ZTɔfu;emJ;" L-$Zt yci]IQIݠ/h rV ;>79x@FTh ţ"l𙇙I.prpEPpJw.׻8Z#'4|NB2]oI84\<uO4ݔ'sE:tcCmā .c3:e`Ҹnb}皥ݶtw^~iZ2~!Q$K0$F%up?&}#@;%]sI xEUv.»ay9;e9IoqsKnIzq-0ف~l[96o)B!y̝OyӧZͩ8FbgUWe+{MKk}~QMO(emPyw aQY1FaFK'ysmX$) :MSGFIuݖȰ)0iÈ],trCP:q {r%i`kôsKR})9?r<]IW Ϲt[Ip8eMˠOл¯pv4YXgQdX}7*iEIϸ\0[ipK{5Qw4=feX gA²@p>RXM;dTfyCCF|KVVGUSuz"PgdȈӍˍxgdp>0]@;KaNЮא)c\.''|'|= $`pӝd>4ָ [<_k]os>nPϜ9+/GYqRMjuf,TM4&J\T }#1#*6C*0EO H4=r|ؘ ?b_2OC-0N5Ç_HG65WEIdJ`S{>z6g0\tir(iW`^b^$7Nҝ{M `́̿ȁ@ʌML_ܺl?y\d6'Swsnh$-Z&+$_Qs_¤t?JHq ?wS,,K )BJ!*g/v8#ha#x;դeE R=`O ,2:)L>VLsC5Z_!=Z=`@Q\I#+\9y _rP.h0f_{9ߕT&{?iq`8\dHZ/:0?q^k\ʾg\ )a'C&?ϗY5UddHm#fcZXoizV$)7p6iO6%L PgϜy&d )99g}t8N]_'Xrdpg)W:U1WNRŽNzB_4%6|/sri@ xf]s2Av'\^?1E|sG1I՝r\LKtr dVZ<\0F5-8b6^H6y k5A%`&o 6p'_N֢Cz2&桷!-# vhSsj QkepB~ŰBXʜGy,L[v CkR5K)һ.t\1\&Y_ɿ@W@,zݯ8튋\}kO74*[9EMwRT+A},M p{QRXK[j#}>җP*-;hqX ˑ`mH]g9wp˨R'iKΜH b|.+JIEeǤ߿oREuNw![Y={1_ u=26`Qg?4tPyV@bJŞy \VC+1^Vƴ@n.QqN-=I Q1Xu\*;)Sg_x>lU tnh} AQL)ҍdHd߉D B㯒[ĺ| ;1X" h j9rz/dp,mMq'7ʵ1h)H} {IttNid۟>l-w"ws?JNXHorəs{?Q8Dl3w U~1* dt)y:hpzYq[~0#N9/9->`TeghY:0u%[]{üvp@wKӑ¹{4f- =IQKT37~zY#28%1OL0w˵6C/sDK@Vi*YmzVҚZwѢC-__Z{#QKP%T [ #)ٵ[Q%nX :JNOмL5粮y9ѼRȉgքpOBB6E.a'EltV*()ɾߦgʓ |=}/h;gZ k*uAy̯:~oy[ZV™MIqY|$~ޙdẕd澼W3_vxzՔ|ec?eWG~Neχy IDY͢x/m5-kMMZ)܎sOU8.v+oG%쐇ye`o\+&)vLN>B˛iaZz?Y/*K>F ~V5Kj.Vͥ,%OVvزoeK³ԲMwܰ`}dDc(?Lд|+3(-9Io_((rE7{ KèD&õ487KuV#D\Syw_]-|Bq7]H(UӯUѹhucwB+;fN x'r[bY|}xqFk;JӯWxorܔCrū, ' {50FQՍ5x:!͆hqlcG}k[%[JN̏ȥL ՊZ ߳:G4C 򽓠`c=vϤ¥}/[  >ڭɑyUdЦ i!% 2woGxY52O;05ZsbU݊"Ɋ|zk5I\ztsbl k*׭@˻>1 Vfw:R4f^n0/ DS. {o,9,u޶ynLjPEֵKѸ~ߎKE/5*̉YKR@3A?ON WTRjE2S\%Ջ=ٍɔd2dyd~2}Lk.9rԂFw C2L E2޾P"~GPd3H]a]^+Y)86)Xl4q:О}zRƀ3A\"_vhSRG~_ВeRۘ+l1GV00Fg.ɔvkA2 w 8cr?<ݟo]q'>Ұ)?R%īt<W͘av"ʯcb֤"\mz,| cQg=Ľ( gh4+PctV } xTǕn$vL2qe22f2K&L<;ēf 0`0[ݭ^Ԓ؂weqX{߽*-1lW_%5N:uc::>`# v:uuP_}LgSC.[Y3awNgX:_xf3p~L:-MyҭKns ?/ +*VO~qþ1F 5raXcAg]$JL]+yuN7Y۳Νi5LEaZcL q7{UWEcrGN'Wh!-@[),[贽ʣ}۟#kѥ#/'*V㭍g{(sדidҝ F߶z򢓇tJ=H?X}K٘gm߲QqFpqA ٣od8,k3܃p~ԭfaa2܉߽ڒ@LP/V#`[Qgὣg׌/f-@H ư tҮ􃻕{۵(U4iOqX?CDyԚWMcd 2z?{" ;@a`XvY5ℤPH5~?= 瞷*js0Q']1h7mN[Q2-g_h $=Ȥ9ᢧ=y XȨ TaG[_cvǾn޽~Ep/YCܭa[Ue(~c;bIIJ|m|cVr[~D^@VR@=c=IS/8[kYY_uG-,v<+l0+β!%2Y=YaqaN̯g;80udѱMR0p?{-S[]O̯l?z5[6aq! 6Ap,i h7i+h]y=r+ʏߨo &gSl͞ /Ah ڇ4af%TK>Agw|>G2kZ" 1;c=^ tzv,q}Ѝ>TȦEn/gN/1.n+4xy#qwXֲʫL3wa3fQT#.&X! n5h9n>n,8X< B"irOxu-(ɡsC5jd䗙Kpǒ+v*'Bj88I;N 4Oɜ9l(`+J_ qD4r ,oCss3Y;;ZZ/Rh2/M +YӘIZiʫ9fm׼jt;)Z.Jbb )RTb`by⌗Ƚ >盿h:NnjֶƋZZkE|D)5Anȯ΋d )pr\ݶX1Rkܴf}CEƟYbhwg4|l\׃]F .pdę8;bWW7H4440^B%٭vڣ,X Y&"FbNyld@ uƍӛ6gr/.bD^^N>5.y}MfdHCBݶVS{} +wȤu[a_iOD/:ejbqV9OrD#OH:twutOd왆k|bܴQ>3&5$Knl.}::愨Տ.h9ûtn&<"4*LN0?9MYC?;h+7pB]Nc~ɍ@JRiiS\H KvKq4߫M E=M¨;Xx҂;i).rz>5ߏ[@ΜP]>(<*0HF;y,ۜWڍT\*2COEos9{ G Ѡ=]\[%8''T4;i툂lR3\/dEJ:r:X5vWL ɝ[(#lǎ3C֥9 /aH` ~9=%ȟ<h[[?96; "<z<a2#Cq:[X_\ {EgvCXkiޤsx3bRZy3:Pٝ!?;vo#rbG[42s%]8q'14/  ]ℷ\h ˡ}VQ]Q-ZMc9˿ʈ؝s|ڨZX8-(`!sXxW5TdHͭ ZCG`yVxN*SܓOZ1D2hup&a$@XΒ͟Y]hsprfο P2XIR:Ӥ ؕ2CB2rЇʺ,eQ"i=Փ7@,ƜG-y|#okVa uM⚚䁔8'p+61s9{T{9%2Uv3xrxٳge#%L;UX` ;ŊݫWg2V0ːBLÑ oulTMfUT e-[{;&.&س-:<԰Dwn }蛚8>Lo>+oz!;ėpLJ50-O^ >IVUӒ'&a&t#ݐ_xLݟ;g Ə;Sr 9ŝӏq6rN.5 ~t*4wk3d"N}Rh^8M\ Rnتalj gIijE+/I*w԰jk9yCd",~ŮpTjʪ,љw2K>a)몛Fgb[k W\wVi9% eʈ@J*) 1;YC!]f2.s}xzmyda<ؑʰ|gSfǢ!zY :.q\ޡ>%dӦǿei+/~Fx8Š5p/S>LtMװ9RhRn|U:7n7/n)\u 2,E ǼUԃȷ́ VER^ ϟ 'Ȁ;νDqnVuqT\޸Otg@0,avߕk@9@!o2a\'ʾ\tmYX)audpV W&7KMæ.kIE -k=]SWGO9^\JFM.7,1k%my 9.T1x6()ө{QG"-2Ԑ%|lUڻLDYěYa,*%xLR-gZΫ4UuKZiK AeR,m"˺pj ]Ҵ3|X'kUD<~8ӜNG)2}xǴ~hYV>\~|se.}h0ylG[j : NӗqxR%S*/.NM{(I* (aa:r=ͫId]+{G2QSz%5hϐlo0q+3BoaT>5Wr/iNu͜ZQ움#NX\q}hQ!ud](씊Sn{ͯSpUSpCR!f/:Ex©d* ey-љYxe˔hɬsdK,Cm&^#Fk57~)K3,;i 9nmތbE#i0.YW۟}[z޲Wи1;Ʌ3|k |y%ْL32]eUȽaN;HU*TGGѵ:XBI:׫I uրMJIƃEuR՘Vx\T>9g _z|Fye`Uނn!0B'3"TrCq8l1Tf|5r(Pa6Ubf >#Xƹ̞Uïʘl͘ {;~_Q{$8xl+t9\Q|wX"cHPe,,`N{I a/>Jfͤww](#pBܝRe±52ewf'LqyQ(e{֦Ɔ-gZζiHt6m{-SXщj˚ĒFkiT aa53x-aqa4pP^D칔[q̇{ c)M<9t~E{o`&={+iҹE5`AZp͖v[1ƝU޻m<+dteUZ_z#tIud;¬]`w;?H]ﾓ >YIǺ䨖dt\{ 8B)*j`!9/Qth !/(S: JaR%fJ΋si ÙuoȋwON~a*6f? f}dQ&a1!j}Ѐ92:8V!tAݙuYz6pEŘhh~?Wpg%>_<2-(44wkx ﲙq:^0H!kOn7W>x:dHϓ j'a/q?pQ~4 r wV7K GªM~Dtaj-Ϣ {[ǂ9=n*L7N8HfOu/\K5#nfd0OɁ.e ːi%S*^BkK~. K +V$6j( 6}"vh뻨׾#Ҥiܒ&8^KR\TᄬVAyjC>艒GJI![b(}B4vJeSiE?^"mV e$Vqu I:VqJ7vS[ *XH*H#jxf5pa: Q! ߴe6@/ZP|}6ūѫ=LiR}d2fkS! ybâ+.QY''<I= ;ǨPg%_f>ASZ4uI""ʈ+EABcvaIq^RrobWih:Op֓ydկZ7,,= PσY:w[9v$Ա6UYΏzE֭U2)AX`um4:VJ{۰( FVz.5Vym P*MrRS'-ȃ;g9/X'>Nø+ّ{l CQ,A_N#WU)KsQRܝSL}wm;p:t-ϯ|e4=EVԅ*-ɌdiosБSEyE$")2+4XCrotR*cN*.+ptӳ;"v]ԑ+Nt5c%CZ|i*x#dNrYqvM"ѵ{K'NeSߚl(qB5u0]xh_}:FVb |7s5ςwODW>̇?(M2"jj12d˜&ۼQuu0Uw[ _S$|w`@4.SWoj~~Uz_> N6֞ݸޣN;^:W4auE^9ȔV57G)0uL5Z`?14 L C䙥B$^FE'_%&-+?Cx26ʛx;Kqj^zeڿGo2~9V-sy{v玭d\!Ң|4~!)cGo .xȸ]d'RUUūlQ*e,ED³ugwZYPK` mGs߼Myz&׭YqI?v~6o}%2Y4 o=NqA=:y~Ch^{Mj[C~Ms])CV8bVĝbV:2 ^M>2GAܽ AznꔼP}tn{?yJvT'sk))?`/gc2ܿ_gT爫wݖT${¼z2nu12f֊$SJ5CfƸEs)V`̝xfVñvZ O$%L8o{Е'#][7?`ŭ`}͒9ڀTlf` oT Nyq724w4cKQS^;jSI?|xMҨnX!22^x3s Rx̪W~/[/?4lQFVrIݽ^__FCީݺM'S$deȄ*+^*H˜8ݎ$vi:m2tW46!VbҤ^0m:pf~wmo_$%wI9Bݹ!I}CHF M55:ņP6BEŐG?-dg4AZsdq_;Ʉo64/L?tÄG xM;oS'9nj}/\~@]v.:?ݻ~9zt礴 #O.FUKpW&Feɒd K͔&?9OGxp;m/z,L8ᢘTSB7DoZ*ԭelM~1Lo=nb!|ᛮ ֨4E{XVà%rHF:ƼwkvnY7XJɘ;5T$Vs0/9?)mUS=@Wʏ5U}qGJ]T[9NVlJfA,X`%eoĶ?T L&,5fQb߼i={;}0]~T{>mNW6aujnUsN1nU8qk 518 h]:톻՟f0)z[j dU3ܔIYչ=q7$OZ a1d"iF"2hi2_U1:Mzp8̆@bD5ə;1 =yW/q.<!nk-M6L~2 q3Ixh`(]t[A)Q>Ld=fBJ8/e/k IvH zkFbBf6ܟ3,9~!wd-[u){P mtHom҆U97+<$c?ZBsE<&rr?&C7Q*9w)4{~/qd7 +d_y P1#BKl?6b-q??k|Ijxah_5tǝ5 m xnI,1!ᔋ)Xjs1 # OUωV>""2,&<$"9)HyaޒښȀ?b_?>Uy:ѕ4ݵoo 2$khO~I-Z5R\wv^8_]nrۃ֟?nc)=H|}F:ē,!%#rnzexܠI DNw 'M?|{og}d{dFeΪ.IqNG;WB}MÉ9F _&%lZq3]n*yL+!{#\G$wɝxܵ9v𻗥{_UoUx(gdVpg)y2⚒{dAYbd~ >9O!OfVЍK\Xew.m$?$%K-Ev8gӶhbTW^ħ}sa늃]2,Ȅȿȿ^]f ӌ UVW;.ƙpo> Ł<&A=;"Kb֗S~&Z3TugY $8/.{z[mKl:-r2x7_$^*|$/tEe@Y,&x盋V]%V/$T}β;o]Rs]bҤheYm Z4h7okgF2fsތ3IF_ݹǂk-h_dO%;ӾE{X&aKj!?)Vs%ri{^ɟ7;W״yY! ,:s r# oY  I_d?y쨴Wk\ڲbgfTZQdX]v'

uѫ>hdC31j){w߄sśIX|Ÿ..RB 2u[\S YxΕ(s;X- p0w&tQ [-8q&&ʴ+n%*>CN5xDi `xw&E7G,Y*Q"G}2ݜr&VnAE`#N EbPq,veF3\>LF 44ޥx-D(57zG&i* ` Fgd $Yѵ*+X ֹt`kX^QT ^*q8)=Jfϟ9o{kxQSFˣ mmm|]_[[[#秢lR)N ~>SbdrI)P@hFPi*WM] Lաhtܓw˸N>r]4ZwtG&.=FJf:@K;LAyYVf2)>#~ܹ,5 y0%L5ʙe_OyTˤ|~1l(Tv})H-Srwd'~DC8'̉bN) k/da_L2Ah\Oƛz[E)bk]q^5g!ur87`9=fgg'sx@;'vqjʾ;vast-]:q;a1S8ġwɂӖy>Z1sA@ߋ/JpG-gbN!%ş<F!ޱ咽)$Ĥwk3Yq9\!g[fX3Ew+^V9qGΦ< iUx=yQspNvytqX{s Lt>S|<7'ID'4}0qԸ|-+,WX{~sY |dS3O2QSb,Nf[}̨O+= '\=Q)\,64߬:󜞑Klp9%)e\;|xBЊ930bW4%,Ycdv#aؘ#ai`ʄ(w)Sg5(X}$KE3hׂG֣Tx3_*p71C:%-9aFħB"kcPɇX\.e%f4Q^ ;?q,t\xg1{8AŁ ??aC=V~8bRTRj .tV$֝UoaHnEti9H [ ww²cw;>YyO>o$?l6ur @N*Tb@CX2fV /Q<ͦ=ضh0mK/D Z b$*/;7O9u>BG׽g0KPUY]G1Oh+'00U hp  (4 T ` lxTBrachiocephalic Vessel Reconstruction: Chapter 91, Rutherfords Vascular SurgeryDanagra Georgia Ikossi LeCardiac PhysiologyJason T. Lee, MD14Microsoft PowerPoint@pQH@q5%@0I9 GSg  )'    """)))UUUMMMBBB999|PP3f333f3333f3ffffff3f̙3ff333f333333333f33333333f33f3ff3f3f3f3333f33̙33333f333333f3333f3ffffff3f33ff3f3f3f3fff3ffffffffff3ffff̙fff3fffff3fff333f3f3ff3ff33f̙̙3̙ff̙̙̙3f̙3f333f3333f3ffffff3f̙3f3f3f333f3333f3ffffff3f̙3f3ffffffffff!___www4'A x(xKʦ """)))UUUMMMBBB999|PP3f3333f333ff3fffff3f3f̙f3333f3333333333f3333333f3f33ff3f3f3f3333f3333333f3̙33333f333ff3ffffff3f33f3ff3f3f3ffff3fffffffff3fffffff3f̙ffff3ff333f3ff33fff33f3ff̙3f3f3333f333ff3fffff̙̙3̙f̙̙̙3f̙3f3f3333f333ff3fffff3f3f̙3ffffffffff!___www_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<_____________________________________________________________________________________________________________________________________________________________________<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<_________________________________________________________________________________________________________________________________________________________________<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<__<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<__<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<____<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<___<<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<__<___<_<_<___<_<_<___<_<_<___<_<_<___<_<_<___<_<_<___<_<_<___<_<_<___<_<_<___<_<_<___<_<_<___<_<_<___<_<_<___<_<_<___<_<_<___<_<_<___<_<_<___<_<_<___<_<_<___<_<<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<____<_<_<___<_<_<___<_<_<___<_<_<___<_<_<___<_<_<___<_<_<___<_<_<___<_<_<___<_<_<___<_<_<___<_<_<___<_<_<___<_<_<___<_<_<___<_<_<___<_<_<___<_<_<___<_<_<___<_<_<<<<_<_<_<<<_<_<_<<<_<_<_<<<_<_<_<<<_<_<_<<<_<_<_<<<_<_<_<<<_<_<_<<<_<_<_<<<_<_<_<<<_<_<_<<<_<_<_<<<_<_<_<<<_<_<_<<<_<_<_<<<_<_<_<<<_<_<_<<<_<_<_<<<_<_<_<<<_<_<__<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<<_<<<_<_<_<<<_<_<_<<<_<_<_<<<_<_<_<<<_<_<_<<<_<_<_<<<_<_<_<<<_<_<_<<<_<_<_<<<_<_<_<<<_<_<_<<<_<_<_<<<_<_<_<<<_<_<_<<<_<_<_<<<_<_<_<<<_<_<_<<<_<_<_<<<_<_<_<<<_<__<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<__<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<<_<<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<_<՜.+,0p     On-screen Show UCSF/SFIC  $ArialTimes New Roman WingdingsACS INSTRUCTOR COURSE SLIDES!Microsoft Photo Editor 3.0 PhotoSBrachiocephalic Vessel Reconstruction: Chapter 91, Rutherfords Vascular Surgery BackgroundAnatomy%Diseases of the Supra-Aortic Trunks4Atherosclerotic Disease of the Supra-Aortic Trunks4Atherosclerotic Disease of the Supra-Aortic Trunks!Symptoms: SAT occlusive diseaseSAT AneurysmsSAT AneurysmsTraumatic Aneurysms Aneurysms Diagnosis DiagnosisIndications for ReconstructionIndications for ReconstructionDisease TreatmentDirect ReconstructionDirect ReconstructionDirect ReconstructionDirect ReconstructionDirect ReconstructionCervical ReconstructionCervical ReconstructionCervical ReconstructionCervical ReconstructionEndovascular RepairEndovascular RepairEndovascular RepairSummaryHistory: treatmentHistory  Fonts UsedDesign TemplateEmbedded OLE Servers Slide Titles(_0Jason T. Lee, MDJason T. Lee, MD  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~Root EntrydO)PicturesCurrent UserSummaryInformation(`UPowerPoint Document(DocumentSummaryInformation8