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Severe mucosal)Tj 0 -1.4444 TD 0 Tc 0.1037 Tw (involvement however, can lead to significant)Tj 0 -1.4443 TD 0 Tw (complications including blindness. )Tj 1.3997 -1.4444 TD 0.0194 Tw (There is only one previously reported case)Tj -1.3997 -1.4444 TD 0.1328 Tw (of lamotrigine induced TEN in the Australian)Tj 0 -1.4443 TD 0 Tw (literature,)Tj 4.0501 0 0 4.5002 249.6554 372.6524 Tm (5)Tj 8.1003 0 0 9.0003 254.9886 369.4643 Tm 0.1024 Tw (however, many general practition-)Tj -4.8788 -1.4443 TD 0.0833 Tc 0.3982 Tw (ers provide care for patients taking)Tj 0 -1.4444 TD 0.0656 Tc 0.0732 Tw (lamotrigine. We present these cases to)Tj 0 -1.4443 TD 0 Tc 0.0427 Tw (remind readers of the potential for life threat-)Tj 0 -1.4444 TD 0.0047 Tc 0.1341 Tw (ening adverse cutaneous reactions resulting)Tj 0 -1.4443 TD 0 Tc 0 Tw (from treatment with lamotrigine. )Tj 1.3999 -1.4444 TD 0.0937 Tw (The risk of severe cutaneous side effects)Tj -1.3999 -1.4444 TD 0.0054 Tc 0.1334 Tw (from lamotrigine can be minimised by com-)Tj 0 -1.4443 TD 0.0833 Tc 0.0952 Tw (mencing at a low dose, avoiding rapid)Tj 0 -1.4444 TD 0 Tc 0.1053 Tw (increases in dosage and reducing the use of)Tj 0 -1.4443 TD 0 Tw (concomitant sodium valproate.)Tj ET /Cs5 CS 0.929 0.137 0.165 SC 0 J 0 j 1 w 10 M []0 d 1 i 215.467 204.453 m 379.883 204.453 l S BT /F1 1 Tf 8.0803 0 0 9.5003 239.6801 213.459 Tm /Cs5 cs 0.929 0.137 0.165 sc 0.0051 Tc (Summary of important points)Tj /F7 1 Tf 8.1003 0 0 9.0003 215.4693 187.4582 Tm /Cs9 cs 1 scn 0.0356 Tc 0.1032 Tw [()-864.1(TEN is a potentially fatal adverse cuta-)]TJ 1.3997 -1.4443 TD 0.0152 Tc 0.1236 Tw (neous drug reaction )Tj 10.7226 0 TD -0.007 Tc (usually developing)Tj -10.7226 -1.4444 TD -0.0224 Tc 0 Tw (during the first 8 weeks of treatment.)Tj -1.3997 -1.4443 TD -0.0168 Tc 0.0441 Tw [()-916.5(Concomitant therapy with sodium valproate)]TJ 1.3997 -1.4444 TD 0 Tw (increases the risk of developing TEN.)Tj -1.3997 -1.4443 TD 0 Tc 0.0171 Tw [()-899.7(The risk can be minimised by starting with)]TJ 1.3997 -1.4444 TD 0.0568 Tw (a low dose and slow dose titration, partic-)Tj T* 0 Tw (ularly in patients taking valproate.)Tj 20.6475 70.7779 TD (Conflict of interest: none declared.)Tj /F4 1 Tf 9.3503 0 0 11.0004 394.0583 712.4739 Tm [(Refer)-16.8(ences)]TJ /F2 1 Tf 7.2002 0 0 8.0003 394.0583 700.1374 Tm 0.0495 Tc 0.0881 Tw [(1)44.5(.)-1119(Chaffin JJ, Davis SM. Suspected lamotrigine)]TJ 1.9685 -1.25 TD 0.0847 Tc 0.1106 Tw (induced toxic epidermal necrolysis. Ann)Tj T* 0.0051 Tc 0 Tw (Pharmacother 1997;31:720723.)Tj -1.9685 -1.25 TD 0.0273 Tc 0.1103 Tw [(2)22.3(.)-1141.2(Yalcin B, Karaduman A. Stevens-Johnson syn-)]TJ 1.9685 -1.25 TD 0.0625 Tc 0.0751 Tw (drome associated with concomitant use of)Tj T* 0.0823 Tc 0.0553 Tw (lamotrigine and valproic acid. J Am Acad)Tj T* 0.0051 Tc 0 Tw (Dermatol 2000;43:898899.)Tj -1.9685 -1.25 TD 0.0847 Tc 0.4016 Tw [(3)79.7(.)-1083.8(Schlienger RG, Shapiro LE, Shear NH.)]TJ 1.9685 -1.25 TD 0.0108 Tc 0.1268 Tw (Lamotrigine induced severe cutaneous adverse)Tj T* 0.0051 Tc 0 Tw (reactions. Epilepsia 1998;39\(Suppl 7\):S22S26.)Tj -1.9685 -1.25 TD 0.0145 Tw [(4.)-1163(Rzany B, Correia O, Kelly JP, Naldi L, Auquier A,)]TJ 1.9685 -1.25 TD 0.1243 Tw (Stern R. Risk of Stevens-Johnson and toxic epi-)Tj T* 0.0847 Tc 0.2303 Tw (dermal necrolysis during first weeks of)Tj T* 0.0546 Tc 0.083 Tw (antiepileptic therapy: a case control study.)Tj T* 0.0051 Tc 0 Tw (Lancet 1999;353:21902194.)Tj -1.9685 -1.25 TD 0.0488 Tc 0.0888 Tw [(5)43.8(.)-1119.7(Sullivan JR, Watson A. Lamotrigine induced)]TJ 1.9685 -1.25 TD 0.0259 Tc 0.1117 Tw (toxic epidermal necrolysis treated with intra-)Tj T* 0.0846 Tc 0.7384 Tw (venous cyclosporin: a discussion of)Tj T* 0.013 Tc 0.1246 Tw (pathogenesis and immunosuppressive manage-)Tj T* 0.0051 Tc 0 Tw (ment. Australas J Dermatol 1996;37:208212.)Tj /F8 1 Tf 8.0003 0 0 8.0003 29.3774 57.5676 Tm 0.0002 Tc (830)Tj /F3 1 Tf 1.9551 0 TD 0 Tc ()Tj /F2 1 Tf 7.0002 0 0 7.0002 53.1091 57.5676 Tm (Reprinted from Australian Family Physician Vol. 33, No. 10, October 2004)Tj /F4 1 Tf 8.1003 0 0 9.0003 29.3774 774.8469 Tm 0.0278 Tw (Clinical practice: )Tj /F2 1 Tf 8.3132 0 TD 0.0264 Tw (Toxic epidermal necrolysis caused by lamotrigine)Tj ET q 0.03 810.503 595.02 -779.026 re W n /Cs9 CS 1 SCN -14.14 767.982 m 609.501 767.982 l -14.14 73.468 m 609.501 73.468 l S Q 392.523 457.271 14.09 -20.451 re f BT /F1 1 Tf 8.1003 0 0 9.0003 411.3179 450.685 Tm 0 Tw (Correspondence)Tj /F7 1 Tf 0 -1.3333 TD (Email: m.sladden@doctors.org.uk)Tj ET /Cs5 cs 0.925 0.553 0.306 sc 557.484 497.978 m 557.484 494.382 553.221 491.462 547.968 491.462 c 542.716 491.462 538.453 494.382 538.453 497.978 c 538.453 501.574 542.716 504.493 547.968 504.493 c 553.221 504.493 557.484 501.574 557.484 497.978 c f* BT /F1 1 Tf 5.4002 0 0 6.0002 542.8593 496.0675 Tm /Cs9 cs 1 scn -0.0001 Tc (AFP)Tj /F4 1 Tf 7.2002 0 0 8.0003 36.8817 424.9532 Tm 0.0054 Tc 0.028 Tw (Figure 1. Severe oral mucositis in a patient)Tj 0 -1.1875 TD (with TEN)Tj 0 -17.1636 TD (Figure 2. Large bullae in TEN demonstrating)Tj 0 -1.1875 TD (positive Nikolskys sign)Tj 0 -20.427 TD (Figure 3. Confluent bullae with large areas of)Tj 0 -1.1875 TD (epidermal shedding)Tj ET /Cs10 cs 0 scn 36.881 538.194 165.676 -105.634 re f q 36.881 538.194 165.676 -105.634 re W n q 168.8367 0 0 112.7558 36.1312 426.4202 cm /Im5 Do Q Q 36.881 391.379 165.676 -105.634 re f q 36.881 391.379 165.676 -105.634 re W n q 168.8367 0 0 109.5157 36.1412 284.0554 cm /Im6 Do Q Q 36.881 243.974 165.676 -131.144 re f q 36.881 243.974 165.676 -131.144 re W n q 167.0061 0 0 131.9604 36.594 112.4697 cm /Im7 Do Q Q /Cs5 cs 0.929 0.137 0.165 sc 428.984 249.244 134.705 -153.095 re f q 398.013 226.373 25.921 17.761 re W n 409.383 243.748 m 412.116 243.791 414.179 243.561 416.073 242.808 c 416.384 242.756 416.695 242.703 417.007 242.651 c 417.007 242.599 417.007 242.547 417.007 242.495 c 417.214 242.442 417.422 242.39 417.629 242.338 c 417.629 242.286 417.629 242.234 417.629 242.181 c 417.888 242.129 418.148 242.077 418.407 242.025 c 418.459 241.92 418.511 241.816 418.562 241.712 c 418.77 241.659 418.977 241.607 419.185 241.555 c 419.237 241.451 419.289 241.346 419.34 241.242 c 419.444 241.242 419.548 241.242 419.652 241.242 c 419.703 241.137 419.755 241.033 419.807 240.929 c 419.911 240.929 420.015 240.929 420.118 240.929 c 420.274 240.72 420.43 240.511 420.585 240.302 c 420.689 240.302 420.793 240.302 420.896 240.302 c 421.052 240.093 421.208 239.884 421.363 239.676 c 421.415 239.676 421.467 239.676 421.519 239.676 c 421.519 239.571 421.519 239.467 421.519 239.362 c 421.726 239.206 421.934 239.049 422.141 238.893 c 422.193 238.684 422.245 238.475 422.297 238.266 c 422.4 238.214 422.504 238.162 422.608 238.11 c 422.66 237.849 422.712 237.588 422.764 237.327 c 422.815 237.327 422.867 237.327 422.919 237.327 c 422.919 237.222 422.919 237.118 422.919 237.013 c 422.971 237.013 423.023 237.013 423.075 237.013 c 423.075 236.805 423.075 236.596 423.075 236.387 c 423.127 236.387 423.178 236.387 423.23 236.387 c 423.55 235.306 422.92 232.828 422.608 232.315 c 422.504 232.263 422.4 232.211 422.297 232.158 c 422.245 231.95 422.193 231.741 422.141 231.532 c 421.934 231.375 421.726 231.219 421.519 231.062 c 421.519 230.958 421.519 230.853 421.519 230.749 c 421.311 230.592 421.104 230.436 420.896 230.279 c 420.896 230.227 420.896 230.175 420.896 230.122 c 419.152 228.855 417.277 227.873 414.984 227.146 c 414.725 227.146 414.465 227.146 414.206 227.146 c 413.345 226.886 412.453 226.833 411.25 226.833 c 410.212 226.833 409.175 226.833 408.138 226.833 c 408.138 226.885 408.138 226.937 408.138 226.99 c 407.671 227.042 407.204 227.094 406.737 227.146 c 406.737 227.199 406.737 227.251 406.737 227.303 c 406.53 227.303 406.322 227.303 406.115 227.303 c 406.115 227.356 406.115 227.408 406.115 227.46 c 405.804 227.512 405.493 227.564 405.181 227.617 c 405.181 227.669 405.181 227.721 405.181 227.773 c 404.922 227.825 404.663 227.878 404.403 227.93 c 404.403 227.982 404.403 228.034 404.403 228.087 c 404.196 228.139 403.989 228.191 403.781 228.243 c 403.781 228.295 403.781 228.348 403.781 228.4 c 403.574 228.452 403.366 228.504 403.159 228.556 c 403.107 228.661 403.055 228.765 403.003 228.87 c 402.899 228.87 402.796 228.87 402.692 228.87 c 402.692 228.922 402.692 228.974 402.692 229.026 c 402.536 229.078 402.381 229.131 402.225 229.183 c 402.173 229.287 402.121 229.392 402.07 229.496 c 401.966 229.496 401.862 229.496 401.758 229.496 c 401.551 229.757 401.343 230.018 401.136 230.279 c 400.825 230.54 400.514 230.801 400.203 231.062 c 399.412 232.185 398.372 234.274 398.957 236.23 c 398.957 236.491 398.957 236.752 398.957 237.013 c 399.009 237.013 399.06 237.013 399.112 237.013 c 399.112 237.17 399.112 237.327 399.112 237.483 c 399.164 237.483 399.216 237.483 399.268 237.483 c 399.32 237.692 399.372 237.901 399.423 238.11 c 399.475 238.11 399.527 238.11 399.579 238.11 c 399.579 238.214 399.579 238.318 399.579 238.423 c 399.683 238.475 399.787 238.527 399.89 238.579 c 399.89 238.684 399.89 238.788 399.89 238.893 c 399.994 238.945 400.099 238.997 400.203 239.049 c 400.203 239.154 400.203 239.258 400.203 239.362 c 400.409 239.519 400.617 239.676 400.825 239.832 c 401.136 240.198 401.447 240.563 401.758 240.929 c 401.862 240.929 401.966 240.929 402.07 240.929 c 402.121 241.033 402.173 241.137 402.225 241.242 c 402.381 241.294 402.536 241.346 402.692 241.398 c 402.692 241.451 402.692 241.503 402.692 241.555 c 402.796 241.555 402.899 241.555 403.003 241.555 c 403.055 241.659 403.107 241.764 403.159 241.868 c 403.366 241.92 403.574 241.973 403.781 242.025 c 403.781 242.077 403.781 242.129 403.781 242.181 c 403.989 242.234 404.196 242.286 404.403 242.338 c 404.403 242.39 404.403 242.442 404.403 242.495 c 404.663 242.547 404.922 242.599 405.181 242.651 c 405.181 242.703 405.181 242.756 405.181 242.808 c 405.337 242.808 405.493 242.808 405.648 242.808 c 405.648 242.86 405.648 242.912 405.648 242.964 c 406.893 243.225 408.138 243.487 409.383 243.748 c W* n q 26.0009 0 0 17.7606 398.0134 226.3735 cm /Im8 Do Q Q q 398.433 196.802 25.681 17.761 re W n 416.72 213.394 m 416.72 213.289 416.72 213.185 416.72 213.08 c 417.59 213.007 418.128 212.477 418.742 212.141 c 418.95 212.088 419.157 212.036 419.365 211.984 c 419.417 211.88 419.469 211.775 419.52 211.671 c 419.624 211.671 419.728 211.671 419.832 211.671 c 419.832 211.619 419.832 211.566 419.832 211.514 c 420.108 211.317 420.015 211.412 420.298 211.514 c 420.35 211.358 420.402 211.201 420.454 211.044 c 420.817 210.783 421.18 210.522 421.543 210.261 c 421.543 210.157 421.543 210.053 421.543 209.948 c 421.751 209.792 421.958 209.635 422.166 209.478 c 422.166 209.374 422.166 209.269 422.166 209.165 c 422.269 209.113 422.373 209.061 422.477 209.008 c 422.529 208.8 422.58 208.591 422.632 208.382 c 422.788 208.278 422.944 208.173 423.099 208.069 c 423.099 207.964 423.099 207.86 423.099 207.756 c 423.151 207.756 423.203 207.756 423.255 207.756 c 423.307 207.495 423.358 207.234 423.41 206.973 c 423.358 206.973 423.307 206.973 423.255 206.973 c 423.255 206.92 423.255 206.868 423.255 206.816 c 423.307 206.816 423.358 206.816 423.41 206.816 c 423.41 206.503 423.41 206.189 423.41 205.876 c 423.462 205.876 423.514 205.876 423.566 205.876 c 423.775 205.155 423.019 202.801 422.788 202.431 c 422.684 202.379 422.58 202.326 422.477 202.274 c 422.477 202.17 422.477 202.065 422.477 201.961 c 422.373 201.909 422.269 201.857 422.166 201.804 c 422.166 201.7 422.166 201.596 422.166 201.491 c 422.01 201.387 421.854 201.282 421.699 201.178 c 421.388 200.813 421.076 200.447 420.765 200.082 c 420.661 200.082 420.558 200.082 420.454 200.082 c 420.35 199.925 420.247 199.768 420.143 199.612 c 420.039 199.612 419.935 199.612 419.832 199.612 c 419.78 199.507 419.728 199.403 419.676 199.299 c 419.469 199.246 419.261 199.194 419.054 199.142 c 419.002 199.038 418.95 198.933 418.898 198.829 c 418.691 198.777 418.483 198.724 418.276 198.672 c 418.276 198.62 418.276 198.568 418.276 198.516 c 418.172 198.516 418.068 198.516 417.965 198.516 c 417.965 198.463 417.965 198.411 417.965 198.359 c 417.705 198.307 417.446 198.255 417.187 198.202 c 417.187 198.15 417.187 198.098 417.187 198.046 c 416.875 197.994 416.564 197.941 416.253 197.889 c 416.253 197.837 416.253 197.785 416.253 197.733 c 415.838 197.68 415.423 197.628 415.008 197.576 c 415.008 197.524 415.008 197.472 415.008 197.419 c 414.749 197.419 414.49 197.419 414.23 197.419 c 414.23 197.367 414.23 197.315 414.23 197.263 c 412.986 197.263 411.741 197.263 410.496 197.263 c 407.394 197.262 405.368 197.943 403.494 199.142 c 403.287 199.194 403.079 199.246 402.872 199.299 c 402.82 199.403 402.768 199.507 402.716 199.612 c 402.613 199.612 402.509 199.612 402.405 199.612 c 402.301 199.768 402.198 199.925 402.094 200.082 c 401.99 200.082 401.887 200.082 401.783 200.082 c 401.472 200.447 401.16 200.813 400.849 201.178 c 400.694 201.282 400.537 201.387 400.383 201.491 c 400.383 201.596 400.383 201.7 400.383 201.804 c 400.278 201.857 400.174 201.909 400.07 201.961 c 400.07 202.065 400.07 202.17 400.07 202.274 c 399.968 202.326 399.863 202.379 399.759 202.431 c 399.759 202.535 399.759 202.64 399.759 202.744 c 399.707 202.744 399.655 202.744 399.603 202.744 c 399.603 202.848 399.603 202.953 399.603 203.057 c 399.552 203.057 399.5 203.057 399.448 203.057 c 399.448 203.214 399.448 203.371 399.448 203.527 c 399.396 203.527 399.344 203.527 399.292 203.527 c 399.292 203.684 399.292 203.84 399.292 203.997 c 399.24 203.997 399.189 203.997 399.137 203.997 c 399.137 204.206 399.137 204.415 399.137 204.623 c 398.683 206.07 399.231 207.59 399.759 208.539 c 399.759 208.643 399.759 208.747 399.759 208.852 c 399.863 208.904 399.968 208.956 400.07 209.008 c 400.07 209.113 400.07 209.217 400.07 209.322 c 400.227 209.426 400.383 209.531 400.537 209.635 c 400.537 209.739 400.537 209.844 400.537 209.948 c 400.642 210 400.746 210.053 400.849 210.105 c 401.16 210.47 401.472 210.836 401.783 211.201 c 401.887 211.201 401.99 211.201 402.094 211.201 c 402.198 211.358 402.301 211.514 402.405 211.671 c 402.509 211.671 402.613 211.671 402.716 211.671 c 402.768 211.775 402.82 211.88 402.872 211.984 c 403.079 212.036 403.287 212.088 403.494 212.141 c 403.546 212.245 403.598 212.35 403.65 212.454 c 403.754 212.454 403.857 212.454 403.961 212.454 c 403.961 212.506 403.961 212.558 403.961 212.611 c 404.065 212.611 404.169 212.611 404.272 212.611 c 404.272 212.663 404.272 212.715 404.272 212.767 c 404.428 212.767 404.584 212.767 404.739 212.767 c 404.739 212.819 404.739 212.872 404.739 212.924 c 404.843 212.924 404.947 212.924 405.05 212.924 c 405.05 212.976 405.05 213.028 405.05 213.08 c 405.206 213.08 405.361 213.08 405.517 213.08 c 405.517 213.133 405.517 213.185 405.517 213.237 c 405.621 213.237 405.725 213.237 405.828 213.237 c 405.828 213.289 405.828 213.341 405.828 213.394 c 406.036 213.394 406.243 213.394 406.451 213.394 c 406.451 213.446 406.451 213.498 406.451 213.55 c 406.606 213.55 406.762 213.55 406.917 213.55 c 406.917 213.602 406.917 213.655 406.917 213.707 c 407.125 213.707 407.332 213.707 407.54 213.707 c 407.54 213.759 407.54 213.811 407.54 213.863 c 408.214 213.916 408.888 213.968 409.562 214.02 c 409.562 214.072 409.562 214.124 409.562 214.177 c 411.118 214.124 412.674 214.072 414.23 214.02 c 414.23 213.968 414.23 213.916 414.23 213.863 c 414.386 213.863 414.541 213.863 414.697 213.863 c 414.697 213.811 414.697 213.759 414.697 213.707 c 414.853 213.707 415.008 213.707 415.164 213.707 c 415.164 213.655 415.164 213.602 415.164 213.55 c 415.319 213.55 415.475 213.55 415.631 213.55 c 415.631 213.498 415.631 213.446 415.631 213.394 c 416.133 213.217 416.351 213.354 416.72 213.394 c W* n q 26.0009 0 0 17.7606 398.4334 196.8025 cm /Im9 Do Q Q q 398.193 137.611 25.921 18.001 re W n 409.251 155.225 m 413.194 155.286 415.767 155.008 418.276 153.658 c 418.587 153.554 418.898 153.45 419.209 153.345 c 419.261 153.241 419.313 153.136 419.365 153.032 c 419.572 152.98 419.78 152.928 419.987 152.875 c 420.091 152.719 420.195 152.562 420.298 152.406 c 420.402 152.406 420.506 152.406 420.61 152.406 c 420.973 151.988 421.336 151.57 421.699 151.153 c 421.854 151.048 422.01 150.944 422.166 150.84 c 422.166 150.735 422.166 150.631 422.166 150.526 c 422.321 150.422 422.477 150.317 422.632 150.213 c 422.632 150.109 422.632 150.004 422.632 149.9 c 422.684 149.9 422.736 149.9 422.788 149.9 c 422.892 149.587 422.995 149.273 423.099 148.96 c 423.151 148.96 423.203 148.96 423.255 148.96 c 423.255 148.804 423.255 148.647 423.255 148.49 c 423.307 148.49 423.358 148.49 423.41 148.49 c 423.41 148.282 423.41 148.073 423.41 147.864 c 423.462 147.864 423.514 147.864 423.566 147.864 c 423.758 147.21 423.543 145.931 423.41 145.515 c 423.358 145.149 423.307 144.784 423.255 144.419 c 423.203 144.419 423.151 144.419 423.099 144.419 c 423.099 144.314 423.099 144.21 423.099 144.105 c 423.047 144.105 422.995 144.105 422.944 144.105 c 422.84 143.792 422.736 143.479 422.632 143.166 c 422.477 143.061 422.321 142.957 422.166 142.852 c 422.166 142.748 422.166 142.644 422.166 142.539 c 421.803 142.226 421.439 141.913 421.076 141.6 c 420.921 141.391 420.765 141.182 420.61 140.973 c 420.506 140.973 420.402 140.973 420.298 140.973 c 420.195 140.817 420.091 140.66 419.987 140.503 c 419.78 140.451 419.572 140.399 419.365 140.347 c 419.313 140.242 419.261 140.138 419.209 140.033 c 419.002 139.981 418.794 139.929 418.587 139.877 c 418.587 139.825 418.587 139.772 418.587 139.72 c 418.276 139.616 417.965 139.511 417.653 139.407 c 417.653 139.355 417.653 139.303 417.653 139.25 c 417.498 139.25 417.342 139.25 417.187 139.25 c 417.187 139.198 417.187 139.146 417.187 139.094 c 417.031 139.094 416.875 139.094 416.72 139.094 c 416.72 139.042 416.72 138.989 416.72 138.937 c 416.564 138.937 416.409 138.937 416.253 138.937 c 416.253 138.885 416.253 138.833 416.253 138.781 c 416.097 138.781 415.942 138.781 415.786 138.781 c 415.786 138.728 415.786 138.676 415.786 138.624 c 415.319 138.572 414.853 138.52 414.386 138.467 c 414.386 138.415 414.386 138.363 414.386 138.311 c 414.023 138.311 413.66 138.311 413.297 138.311 c 413.297 138.258 413.297 138.206 413.297 138.154 c 412.579 137.952 409.762 138.163 409.251 138.311 c 408.629 138.363 408.006 138.415 407.384 138.467 c 407.384 138.52 407.384 138.572 407.384 138.624 c 407.021 138.676 406.658 138.728 406.295 138.781 c 406.295 138.833 406.295 138.885 406.295 138.937 c 405.984 138.989 405.673 139.042 405.361 139.094 c 405.361 139.146 405.361 139.198 405.361 139.25 c 405.102 139.303 404.843 139.355 404.584 139.407 c 404.584 139.459 404.584 139.511 404.584 139.564 c 404.376 139.616 404.169 139.668 403.961 139.72 c 403.961 139.772 403.961 139.825 403.961 139.877 c 403.754 139.929 403.546 139.981 403.339 140.033 c 403.287 140.138 403.235 140.242 403.183 140.347 c 403.079 140.347 402.976 140.347 402.872 140.347 c 402.872 140.399 402.872 140.451 402.872 140.503 c 402.716 140.555 402.561 140.608 402.405 140.66 c 402.353 140.764 402.301 140.869 402.25 140.973 c 402.146 140.973 402.042 140.973 401.938 140.973 c 401.679 141.286 401.42 141.6 401.16 141.913 c 400.901 142.122 400.642 142.33 400.383 142.539 c 399.592 143.662 398.552 145.752 399.137 147.707 c 399.137 147.968 399.137 148.229 399.137 148.49 c 399.189 148.49 399.24 148.49 399.292 148.49 c 399.292 148.647 399.292 148.804 399.292 148.96 c 399.344 148.96 399.396 148.96 399.448 148.96 c 399.448 149.065 399.448 149.169 399.448 149.273 c 399.5 149.273 399.552 149.273 399.603 149.273 c 399.655 149.482 399.707 149.691 399.759 149.9 c 399.863 149.952 399.968 150.004 400.07 150.056 c 400.07 150.161 400.07 150.265 400.07 150.37 c 400.174 150.422 400.278 150.474 400.383 150.526 c 400.383 150.631 400.383 150.735 400.383 150.84 c 400.746 151.153 401.109 151.466 401.472 151.779 c 401.627 151.988 401.783 152.197 401.938 152.406 c 402.042 152.406 402.146 152.406 402.25 152.406 c 402.301 152.51 402.353 152.614 402.405 152.719 c 402.561 152.771 402.716 152.823 402.872 152.875 c 402.872 152.928 402.872 152.98 402.872 153.032 c 402.976 153.032 403.079 153.032 403.183 153.032 c 403.235 153.136 403.287 153.241 403.339 153.345 c 403.65 153.45 403.961 153.554 404.272 153.658 c 404.272 153.711 404.272 153.763 404.272 153.815 c 404.376 153.815 404.48 153.815 404.584 153.815 c 404.584 153.867 404.584 153.92 404.584 153.972 c 404.739 153.972 404.895 153.972 405.05 153.972 c 405.05 154.024 405.05 154.076 405.05 154.128 c 405.154 154.128 405.258 154.128 405.361 154.128 c 405.361 154.181 405.361 154.233 405.361 154.285 c 405.517 154.285 405.673 154.285 405.828 154.285 c 405.828 154.337 405.828 154.389 405.828 154.442 c 405.984 154.442 406.139 154.442 406.295 154.442 c 406.295 154.494 406.295 154.546 406.295 154.598 c 406.658 154.65 407.021 154.703 407.384 154.755 c 407.384 154.807 407.384 154.859 407.384 154.911 c 407.643 154.911 407.903 154.911 408.162 154.911 c 408.162 154.964 408.162 155.016 408.162 155.068 c 408.525 155.068 408.888 155.068 409.251 155.068 c 409.251 155.12 409.251 155.172 409.251 155.225 c W* n q 26.0009 0 0 18.0006 398.1934 137.6105 cm /Im10 Do Q Q q 398.193 108.37 25.921 17.761 re W n 409.562 125.744 m 413.648 125.809 416.616 125.265 419.054 123.708 c 419.261 123.655 419.469 123.603 419.676 123.551 c 419.728 123.447 419.78 123.342 419.832 123.238 c 419.935 123.238 420.039 123.238 420.143 123.238 c 420.247 123.081 420.35 122.925 420.454 122.768 c 420.558 122.768 420.661 122.768 420.765 122.768 c 421.076 122.403 421.388 122.037 421.699 121.672 c 421.802 121.619 421.906 121.567 422.01 121.515 c 422.678 120.576 423.204 119.46 423.566 118.226 c 423.739 117.635 423.523 116.545 423.41 116.19 c 423.307 115.668 423.203 115.146 423.099 114.624 c 423.047 114.624 422.995 114.624 422.944 114.624 c 422.892 114.415 422.84 114.207 422.788 113.998 c 422.684 113.946 422.58 113.893 422.477 113.841 c 422.477 113.737 422.477 113.632 422.477 113.528 c 422.321 113.424 422.166 113.319 422.01 113.215 c 422.01 113.11 422.01 113.006 422.01 112.902 c 421.699 112.641 421.388 112.379 421.076 112.118 c 420.973 111.962 420.869 111.805 420.765 111.649 c 420.661 111.649 420.558 111.649 420.454 111.649 c 420.35 111.492 420.247 111.335 420.143 111.179 c 420.039 111.179 419.935 111.179 419.832 111.179 c 419.78 111.074 419.728 110.97 419.676 110.866 c 419.469 110.813 419.261 110.761 419.054 110.709 c 419.002 110.605 418.95 110.5 418.898 110.396 c 418.794 110.396 418.691 110.396 418.587 110.396 c 418.587 110.344 418.587 110.291 418.587 110.239 c 418.483 110.239 418.379 110.239 418.276 110.239 c 418.276 110.187 418.276 110.135 418.276 110.083 c 418.12 110.083 417.965 110.083 417.809 110.083 c 417.809 110.03 417.809 109.978 417.809 109.926 c 417.705 109.926 417.601 109.926 417.498 109.926 c 417.498 109.874 417.498 109.822 417.498 109.769 c 417.238 109.717 416.979 109.665 416.72 109.613 c 416.72 109.561 416.72 109.508 416.72 109.456 c 416.512 109.456 416.305 109.456 416.097 109.456 c 416.097 109.404 416.097 109.352 416.097 109.3 c 415.942 109.3 415.786 109.3 415.631 109.3 c 415.631 109.247 415.631 109.195 415.631 109.143 c 415.371 109.143 415.112 109.143 414.853 109.143 c 414.853 109.091 414.853 109.038 414.853 108.986 c 414.593 108.986 414.334 108.986 414.075 108.986 c 414.075 108.934 414.075 108.882 414.075 108.83 c 412.986 108.83 411.896 108.83 410.807 108.83 c 407.528 108.83 405.483 109.441 403.494 110.709 c 403.287 110.761 403.079 110.813 402.872 110.866 c 402.82 110.97 402.768 111.074 402.716 111.179 c 402.613 111.179 402.509 111.179 402.405 111.179 c 402.301 111.335 402.198 111.492 402.094 111.649 c 401.99 111.649 401.887 111.649 401.783 111.649 c 401.575 111.91 401.368 112.171 401.16 112.432 c 400.901 112.64 400.642 112.849 400.383 113.058 c 400.383 113.163 400.383 113.267 400.383 113.371 c 400.278 113.424 400.174 113.476 400.07 113.528 c 400.018 113.685 399.968 113.841 399.915 113.998 c 399.863 113.998 399.811 113.998 399.759 113.998 c 399.433 114.521 398.652 117.123 398.981 118.226 c 399.24 118.957 399.5 119.688 399.759 120.419 c 399.811 120.419 399.863 120.419 399.915 120.419 c 399.968 120.575 400.018 120.732 400.07 120.889 c 400.174 120.941 400.278 120.993 400.383 121.045 c 400.383 121.15 400.383 121.254 400.383 121.358 c 400.694 121.619 401.005 121.881 401.316 122.142 c 401.472 122.35 401.627 122.559 401.783 122.768 c 401.887 122.768 401.99 122.768 402.094 122.768 c 402.198 122.925 402.301 123.081 402.405 123.238 c 402.509 123.238 402.613 123.238 402.716 123.238 c 402.768 123.342 402.82 123.447 402.872 123.551 c 403.079 123.603 403.287 123.655 403.494 123.708 c 403.546 123.812 403.598 123.916 403.65 124.021 c 403.754 124.021 403.857 124.021 403.961 124.021 c 403.961 124.073 403.961 124.125 403.961 124.177 c 404.065 124.177 404.169 124.177 404.272 124.177 c 404.272 124.23 404.272 124.282 404.272 124.334 c 404.428 124.334 404.584 124.334 404.739 124.334 c 404.739 124.386 404.739 124.438 404.739 124.491 c 404.843 124.491 404.947 124.491 405.05 124.491 c 405.05 124.543 405.05 124.595 405.05 124.647 c 405.206 124.647 405.361 124.647 405.517 124.647 c 405.517 124.7 405.517 124.752 405.517 124.804 c 405.621 124.804 405.725 124.804 405.828 124.804 c 405.828 124.856 405.828 124.908 405.828 124.96 c 406.036 124.96 406.243 124.96 406.451 124.96 c 406.451 125.013 406.451 125.065 406.451 125.117 c 406.606 125.117 406.762 125.117 406.917 125.117 c 406.917 125.169 406.917 125.222 406.917 125.274 c 407.177 125.274 407.436 125.274 407.695 125.274 c 407.695 125.326 407.695 125.378 407.695 125.43 c 407.955 125.43 408.214 125.43 408.473 125.43 c 408.473 125.483 408.473 125.535 408.473 125.587 c 408.836 125.587 409.199 125.587 409.562 125.587 c 409.562 125.639 409.562 125.691 409.562 125.744 c W* n q 26.0009 0 0 17.7606 398.1934 108.3695 cm /Im11 Do Q Q q 397.443 167.321 25.441 17.761 re W n 408.333 184.696 m 412.819 184.768 415.649 184.111 418.29 182.346 c 418.394 182.346 418.498 182.346 418.602 182.346 c 418.654 182.242 418.705 182.138 418.757 182.033 c 418.861 182.033 418.965 182.033 419.068 182.033 c 419.224 181.824 419.38 181.616 419.535 181.407 c 419.639 181.407 419.743 181.407 419.846 181.407 c 419.898 181.302 419.95 181.198 420.002 181.094 c 420.209 180.937 420.417 180.78 420.624 180.624 c 420.624 180.519 420.624 180.415 420.624 180.31 c 420.78 180.206 420.936 180.102 421.091 179.997 c 421.091 179.893 421.091 179.788 421.091 179.684 c 421.195 179.632 421.299 179.58 421.402 179.527 c 421.454 179.319 421.506 179.11 421.558 178.901 c 421.61 178.901 421.662 178.901 421.714 178.901 c 421.765 178.692 421.817 178.483 421.869 178.275 c 421.921 178.275 421.973 178.275 422.025 178.275 c 422.025 178.066 422.025 177.857 422.025 177.648 c 422.077 177.648 422.128 177.648 422.18 177.648 c 422.421 176.918 422.426 175.244 422.18 174.516 c 422.128 174.516 422.077 174.516 422.025 174.516 c 422.025 174.307 422.025 174.098 422.025 173.889 c 421.973 173.889 421.921 173.889 421.869 173.889 c 421.817 173.681 421.765 173.472 421.714 173.263 c 421.662 173.263 421.61 173.263 421.558 173.263 c 421.506 173.054 421.454 172.845 421.402 172.637 c 421.299 172.584 421.195 172.532 421.091 172.48 c 421.091 172.376 421.091 172.271 421.091 172.167 c 420.936 172.062 420.78 171.958 420.624 171.854 c 420.624 171.749 420.624 171.645 420.624 171.54 c 420.417 171.384 420.209 171.227 420.002 171.07 c 419.95 170.966 419.898 170.862 419.846 170.757 c 419.743 170.757 419.639 170.757 419.535 170.757 c 419.38 170.548 419.224 170.34 419.068 170.131 c 418.965 170.131 418.861 170.131 418.757 170.131 c 418.705 170.026 418.654 169.922 418.602 169.818 c 418.446 169.765 418.29 169.713 418.135 169.661 c 418.135 169.609 418.135 169.557 418.135 169.504 c 417.824 169.4 417.513 169.296 417.201 169.191 c 417.201 169.139 417.201 169.087 417.201 169.035 c 416.89 168.93 416.579 168.826 416.268 168.721 c 416.268 168.669 416.268 168.617 416.268 168.565 c 415.957 168.513 415.645 168.46 415.334 168.408 c 413.645 167.747 412.318 167.625 409.888 167.625 c 408.696 167.677 407.503 167.728 406.31 167.782 c 406.31 167.834 406.31 167.886 406.31 167.937 c 406.102 167.937 405.895 167.937 405.687 167.937 c 405.687 167.99 405.687 168.043 405.687 168.095 c 405.532 168.095 405.376 168.095 405.221 168.095 c 405.221 168.146 405.221 168.199 405.221 168.252 c 405.065 168.252 404.909 168.252 404.754 168.252 c 404.754 168.304 404.754 168.356 404.754 168.408 c 404.598 168.408 404.443 168.408 404.287 168.408 c 404.287 168.46 404.287 168.513 404.287 168.565 c 404.131 168.565 403.976 168.565 403.82 168.565 c 403.82 168.617 403.82 168.669 403.82 168.721 c 403.509 168.826 403.198 168.93 402.887 169.035 c 402.887 169.087 402.887 169.139 402.887 169.191 c 402.783 169.191 402.679 169.191 402.576 169.191 c 402.576 169.243 402.576 169.296 402.576 169.348 c 402.368 169.4 402.161 169.452 401.953 169.504 c 401.953 169.557 401.953 169.609 401.953 169.661 c 401.798 169.713 401.642 169.765 401.486 169.818 c 401.435 169.922 401.383 170.026 401.331 170.131 c 401.227 170.131 401.123 170.131 401.02 170.131 c 400.864 170.34 400.708 170.548 400.553 170.757 c 400.449 170.757 400.345 170.757 400.242 170.757 c 400.19 170.862 400.138 170.966 400.086 171.07 c 399.826 171.279 399.566 171.488 399.307 171.697 c 399.307 171.801 399.307 171.906 399.307 172.01 c 399.203 172.062 399.1 172.115 398.996 172.167 c 398.996 172.271 398.996 172.376 398.996 172.48 c 398.892 172.532 398.788 172.584 398.685 172.637 c 398.581 172.95 398.477 173.263 398.374 173.576 c 398.322 173.576 398.27 173.576 398.218 173.576 c 398.218 173.681 398.218 173.785 398.218 173.889 c 398.166 173.889 398.114 173.889 398.062 173.889 c 398.062 174.046 398.062 174.203 398.062 174.359 c 398.011 174.359 397.959 174.359 397.907 174.359 c 397.907 174.62 397.907 174.881 397.907 175.142 c 397.855 175.142 397.803 175.142 397.751 175.142 c 397.751 175.769 397.751 176.395 397.751 177.022 c 397.803 177.022 397.855 177.022 397.907 177.022 c 397.907 177.283 397.907 177.544 397.907 177.805 c 397.959 177.805 398.011 177.805 398.062 177.805 c 398.062 177.961 398.062 178.118 398.062 178.275 c 398.114 178.275 398.166 178.275 398.218 178.275 c 398.218 178.379 398.218 178.483 398.218 178.588 c 398.27 178.588 398.322 178.588 398.374 178.588 c 398.374 178.744 398.374 178.901 398.374 179.058 c 398.477 179.11 398.581 179.162 398.685 179.214 c 398.685 179.319 398.685 179.423 398.685 179.527 c 398.788 179.58 398.892 179.632 398.996 179.684 c 398.996 179.788 398.996 179.893 398.996 179.997 c 399.1 180.049 399.203 180.102 399.307 180.154 c 399.307 180.258 399.307 180.363 399.307 180.467 c 399.566 180.676 399.826 180.885 400.086 181.094 c 400.138 181.198 400.19 181.302 400.242 181.407 c 400.345 181.407 400.449 181.407 400.553 181.407 c 400.708 181.616 400.864 181.824 401.02 182.033 c 401.123 182.033 401.227 182.033 401.331 182.033 c 401.383 182.138 401.435 182.242 401.486 182.346 c 402.42 182.816 403.354 183.286 404.287 183.756 c 404.443 183.756 404.598 183.756 404.754 183.756 c 404.754 183.808 404.754 183.86 404.754 183.913 c 404.909 183.913 405.065 183.913 405.221 183.913 c 405.221 183.965 405.221 184.017 405.221 184.069 c 405.376 184.069 405.532 184.069 405.687 184.069 c 405.687 184.121 405.687 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