����JFIFXX�����    $.' ",#(7),01444'9=82<.342  2!!22222222222222222222222222222222222222222222222222����"��4�� ���,�PG"Z_�4�˷����kjز�Z�,F+��_z�,�© �����zh6�٨�ic�fu���#ډb���_�N�?��wQ���5-�~�I���8����TK<5o�Iv-�����k�_U_�����~b�M��d����Ӝ�U�Hh��?]��E�w��Q���k�{��_}qFW7HTՑ��Y��F�?_�'ϔ��_�Ջt��=||I ��6�έ"�����D���/[�k�9���Y�8ds|\���Ҿp6�Ҵ���]��.����6�z<�v��@]�i%��$j��~�g��J>��no����pM[me�i$[����s�o�ᘨ�˸ nɜG-�ĨU�ycP�3.DB�li�;��hj���x7Z^�N�h������N3u{�:j�x�힞��#M&��jL P@_���� P��&��o8������9�����@Sz6�t7#O�ߋ �s}Yf�T���lmr����Z)'N��k�۞p����w\�Tȯ?�8`�O��i{wﭹW�[�r�� ��Q4F�׊���3m&L�=��h3����z~��#�\�l :�F,j@�� ʱ�wQT����8�"kJO���6�֚l����}���R�>ډK���]��y����&����p�}b��;N�1�m�r$�|��7�>e�@B�TM*-iH��g�D�)� E�m�|�ؘbҗ�a��Ҿ����t4���o���G��*oCN�rP���Q��@z,|?W[0�����:�n,jWiE��W��$~/�hp\��?��{(�0���+�Y8rΟ�+����>S-S����VN;�}�s?.����� w�9��˟<���Mq4�Wv'��{)0�1mB��V����W[�����8�/<� �%���wT^�5���b��)iM� pg�N�&ݝ��VO~�q���u���9� ����!��J27����$O-���! �:�%H��� ـ����y�ΠM=t{!S�� oK8������t<����è:a������[�����ա�H���~��w��Qz`�po�^ ����Q��n� �,uu�C�$ ^���,������8�#��:�6��e�|~���!�3�3.�\0��q��o�4`.|� ����y�Q�`~;�d�ׯ,��O�Zw�������`73�v�܋�<���Ȏ�� ـ4k��5�K�a�u�=9Yd��$>x�A�&�� j0� ���vF��� Y�|�y��� ~�6�@c��1vOp�Ig����4��l�OD���L����� R���c���j�_�uX6��3?nk��Wy�f;^*B� ��@�~a�`��Eu������+���6�L��.ü>��}y���}_�O�6�͐�:�YrG�X��kG�����l^w���~㒶sy��Iu�!� W ��X��N�7BV��O��!X�2����wvG�R�f�T#�����t�/?���%8�^�W�aT��G�cL�M���I��(J����1~�8�?aT ���]����AS�E��(��*E}� 2��#I/�׍qz��^t�̔���b�Yz4x���t�){ OH��+(E��A&�N�������XT��o��"�XC��'���)}�J�z�p� ��~5�}�^����+�6����w��c��Q�|Lp�d�H��}�(�.|����k��c4^�"�����Z?ȕ ��a<�L�!039C� �Eu�C�F�Ew�ç ;�n?�*o���B�8�bʝ���'#Rqf���M}7����]����s2tcS{�\icTx;�\��7K���P���ʇ Z O-��~��c>"��?�������P��E��O�8��@�8��G��Q�g�a�Վ���󁶠�䧘��_%#r�>�1�z�a��eb��qcPѵ��n���#L��� =��׀t� L�7�`��V���A{�C:�g���e@�w1 Xp3�c3�ġ����p��M"'-�@n4���fG��B3�DJ�8[Jo�ߐ���gK)ƛ��$���� ���8�3�����+���� �����6�ʻ���� ���S�kI�*KZlT _`���?��K����QK�d����B`�s}�>���`��*�>��,*@J�d�oF*����弝��O}�k��s��]��y�ߘ��c1G�V���<=�7��7����6�q�PT��tXԀ�!9*4�4Tހ3XΛex�46���Y��D ����� �BdemDa����\�_l,��G�/���֌7���Y�](�xTt^%�GE�����4�}bT���ڹ�����;Y)���B�Q��u��>J/J �⮶.�XԄ��j�ݳ�+E��d ��r�5�_D�1 ��o�� �B�x�΢�#���<��W�����8���R6�@g�M�.��� dr�D��>(otU��@x=��~v���2� ӣ�d�oBd��3�eO�6�㣷�����ݜ6��6Y��Qz`��S��{���\P�~z m5{J/L��1������<�e�ͅPu�b�]�ϔ���'������f�b� Zpw��c`"��i���BD@:)ִ�:�]��hv�E�w���T�l��P���"Ju�}��وV J��G6��. J/�Qgl߭�e�����@�z�Zev2u�)]կ�����7x���s�M�-<ɯ�c��r�v�����@��$�ޮ}lk���a���'����>x��O\�ZFu>�����ck#��&:��`�$�ai�>2Δ����l���oF[h��lE�ܺ�Πk:)���`�� $[6�����9�����kOw�\|���8}������ބ:��񶐕��I�A1/�=�2[�,�!��.}gN#�u����b��� ~��݊��}34q����d�E��Lc��$��"�[q�U�硬g^��%B �z���r�pJ�ru%v\h1Y�ne`ǥ:g���pQM~�^�Xi� ��`S�:V29.�P���V�?B�k�� AEvw%�_�9C�Q����wKekPؠ�\�;Io d�{ ߞo�c1eP����\� `����E=���@K<�Y���eڼ�J���w����{av�F�'�M�@/J��+9p���|]�����Iw &`��8���&M�hg��[�{��Xj��%��Ӓ�$��(����ʹN���<>�I���RY���K2�NPlL�ɀ)��&e����B+ь����( � �JTx���_?EZ� }@ 6�U���뙢ط�z��dWI�n` D����噥�[��uV��"�G&Ú����2g�}&m��?ċ�"����Om#��������� ��{�ON��"S�X��Ne��ysQ���@Fn��Vg���dX�~nj�]J�<�K]:��FW��b�������62�=��5f����JKw��bf�X�55��~J �%^����:�-�QIE��P��v�nZum� z � ~ə ���� ���ة����;�f��\v���g�8�1��f24;�V���ǔ�)����9���1\��c��v�/'Ƞ�w�������$�4�R-��t���� e�6�/�ġ �̕Ecy�J���u�B���<�W�ַ~�w[B1L۲�-JS΂�{���΃������A��20�c#��@ 0!1@AP"#2Q`$3V�%45a6�FRUq��� ����^7ׅ,$n�������+��F�`��2X'��0vM��p�L=������5��8������u�p~���.�`r�����\���O��,ư�0oS ��_�M�����l���4�kv\JSd���x���SW�<��Ae�IX����������$I���w�:S���y���›R��9�Q[���,�5�;�@]�%���u�@ *ro�lbI �� ��+���%m:�͇ZV�����u�̉����θau<�fc�.����{�4Ա� �Q����*�Sm��8\ujqs]{kN���)qO�y�_*dJ�b�7���yQqI&9�ԌK!�M}�R�;������S�T���1���i[U�ɵz�]��U)V�S6���3$K{�ߊ<�(� E]Զ[ǼENg�����'�\?#)Dkf��J���o��v���'�%ƞ�&K�u�!��b�35LX�Ϸ��63$K�a�;�9>,R��W��3�3� d�JeTYE.Mϧ��-�o�j3+y��y^�c�������VO�9NV\nd�1 ��!͕_)a�v;����թ�M�lWR1��)El��P;��yوÏ�u 3�k�5Pr6<�⒲l�!˞*��u־�n�!�l:����UNW ��%��Chx8vL'��X�@��*��)���̮��ˍ��� ���D-M�+J�U�kvK����+�x8��cY������?�Ԡ��~3mo��|�u@[XeY�C�\Kp�x8�oC�C�&����N�~3-H���� ��MX�s�u<`���~"WL��$8ξ��3���a�)|:@�m�\���^�`�@ҷ)�5p+��6���p�%i)P M���ngc�����#0Aruz���RL+xSS?���ʮ}()#�t��mˇ!��0}}y����<�e� �-ή�Ԩ��X������ MF���ԙ~l L.3���}�V뽺�v�����멬��Nl�)�2����^�Iq��a��M��qG��T�����c3#������3U�Ǎ���}��לS�|qa��ڃ�+���-��2�f����/��bz��ڐ�� �ݼ[2�ç����k�X�2�* �Z�d���J�G����M*9W���s{��w���T��x��y,�in�O�v��]���n����P�$�JB@=4�OTI�n��e�22a\����q�d���%�$��(���:���: /*�K[PR�fr\nڙdN���F�n�$�4�[�� U�zƶ����� �mʋ���,�ao�u 3�z� �x��Kn����\[��VFmbE;�_U��&V�Gg�]L�۪&#n%�$ɯ�dG���D�TI=�%+AB�Ru#��b4�1�»x�cs�YzڙJG��f��Il��d�eF'T� iA��T���uC�$����Y��H?����[!G`}���ͪ� �纤Hv\������j�Ex�K���!���OiƸ�Yj�+u-<���'q����uN�*�r\��+�]���<�wOZ.fp�ێ��,-*)V?j-kÊ#�`�r��dV����(�ݽBk�����G�ƛk�QmUڗe��Z���f}|����8�8��a���i��3'J�����~G_�^���d�8w������ R�`(�~�.��u���l�s+g�bv���W���lGc}��u���afE~1�Ue������Z�0�8�=e�� f@/�jqEKQQ�J��oN��J���W5~M>$6�Lt�;$ʳ{���^��6�{����v6���ķܰg�V�cnn �~z�x�«�,2�u�?cE+Ș�H؎�%�Za�)���X>uW�Tz�Nyo����s���FQƤ��$��*�&�LLXL)�1�" L��eO��ɟ�9=���:t��Z���c��Ž���Y?�ӭV�wv�~,Y��r�ۗ�|�y��GaF�����C�����.�+� ���v1���fήJ�����]�S��T��B��n5sW}y�$��~z�'�c ��8 ��� ,! �p��VN�S��N�N�q��y8z˱�A��4��*��'������2n<�s���^ǧ˭P�Jޮɏ�U�G�L�J�*#��<�V��t7�8����TĜ>��i}K%,���)[��z�21z ?�N�i�n1?T�I�R#��m-�����������������1����lA�`��fT5+��ܐ�c�q՝��ʐ��,���3�f2U�եmab��#ŠdQ�y>\��)�SLY����w#��.���ʑ�f��� ,"+�w�~�N�'�c�O�3F�������N<���)j��&��,-� �љ���֊�_�zS���TǦ����w�>��?�������n��U仆�V���e�����0���$�C�d���rP �m�׈e�Xm�Vu� �L��.�bֹ��� �[Դaզ���*��\y�8�Է:�Ez\�0�Kq�C b��̘��cө���Q��=0Y��s�N��S.���3.���O�o:���#���v7�[#߫ ��5�܎�L���Er4���9n��COWlG�^��0k�%<���ZB���aB_���������'=��{i�v�l�$�uC���mƎҝ{�c㱼�y]���W�i ��ߧc��m�H� m�"�"�����;Y�ߝ�Z�Ǔ�����:S#��|}�y�,/k�Ld� TA�(�AI$+I3��;Y*���Z��}|��ӧO��d�v��..#:n��f>�>���ȶI�TX��� 8��y����"d�R�|�)0���=���n4��6ⲑ�+��r<�O�܂~zh�z����7ܓ�HH�Ga롏���nCo�>������a ���~]���R���̲c?�6(�q�;5%� |�uj�~z8R=X��I�V=�|{v�Gj\gc��q����z�؋%M�ߍ����1y��#��@f^���^�>N�����#x#۹��6�Y~�?�dfPO��{��P�4��V��u1E1J �*|���%���JN��`eWu�zk M6���q t[�� ��g�G���v��WIG��u_ft����5�j�"�Y�:T��ɐ���*�;� e5���4����q$C��2d�}���� _S�L#m�Yp��O�.�C�;��c����Hi#֩%+) �Ӎ��ƲV���SYź��g |���tj��3�8���r|���V��1#;.SQ�A[���S������#���`n�+���$��$I �P\[�@�s��(�ED�z���P��])8�G#��0B��[ى��X�II�q<��9�~[Z멜�Z�⊔IWU&A>�P~�#��dp<�?����7���c��'~���5 ��+$���lx@�M�dm��n<=e�dyX��?{�|Aef ,|n3�<~z�ƃ�uۧ�����P��Y,�ӥQ�*g�#먙R�\���;T��i,��[9Qi歉����c>]9�� ��"�c��P�� �Md?٥��If�ت�u��k��/����F��9�c*9��Ǎ:�ØF���z�n*�@|I�ށ9����N3{'��[�'ͬ�Ҳ4��#}��!�V� Fu��,�,mTIk���v C�7v���B�6k�T9��1�*l� '~��ƞF��lU��'�M ����][ΩũJ_�{�i�I�n��$���L�� j��O�dx�����kza۪��#�E��Cl����x˘�o�����V���ɞ�ljr��)�/,�߬h�L��#��^��L�ф�,íMƁe�̩�NB�L�����iL����q�}��(��q��6IçJ$�W�E$��:������=#����(�K�B����zђ <��K(�N�۫K�w��^O{!����)�H���>x�������lx�?>Պ�+�>�W���,Ly!_�D���Ō�l���Q�!�[ �S����J��1��Ɛ�Y}��b,+�Lo�x�ɓ)����=�y�oh�@�꥟/��I��ѭ=��P�y9��� �ۍYӘ�e+�p�Jnϱ?V\SO%�(�t� ���=?MR�[Ș�����d�/ ��n�l��B�7j� ��!�;ӥ�/�[-���A�>�dN�sLj ��,ɪv��=1c�.SQ�O3�U���ƀ�ܽ�E����������̻��9G�ϷD�7(�}��Ävӌ\�y�_0[w ���<΍>����a_��[0+�L��F.�޺��f�>oN�T����q;���y\��bՃ��y�jH�<|q-eɏ�_?_9+P���Hp$�����[ux�K w�Mw��N�ی'$Y2�=��q���KB��P��~������Yul:�[<����F1�2�O���5=d����]Y�sw:���Ϯ���E��j,_Q��X��z`H1,#II ��d�wr��P˂@�ZJV����y$�\y�{}��^~���[:N����ߌ�U�������O��d�����ؾe��${p>G��3c���Ė�lʌ�� ת��[��`ϱ�-W����dg�I��ig2��� ��}s ��ؤ(%#sS@���~���3�X�nRG�~\jc3�v��ӍL��M[JB�T��s3}��j�Nʖ��W����;7��ç?=X�F=-�=����q�ߚ���#���='�c��7���ڑW�I(O+=:uxq�������������e2�zi+�kuG�R��������0�&e�n���iT^J����~\jy���p'dtG��s����O��3����9* �b#Ɋ�� p������[Bws�T�>d4�ۧs���nv�n���U���_�~,�v����ƜJ1��s�� �QIz��)�(lv8M���U=�;����56��G���s#�K���MP�=��LvyGd��}�VwWBF�'�à �?MH�U�g2�� ����!�p�7Q��j��ڴ����=��j�u��� Jn�A s���uM������e��Ɔ�Ҕ�!)'��8Ϣ�ٔ��ޝ(��Vp���צ֖d=�IC�J�Ǡ{q������kԭ�߸���i��@K����u�|�p=..�*+����x�����z[Aqġ#s2a�Ɗ���RR�)*HRsi�~�a &f��M��P����-K�L@��Z��Xy�'x�{}��Zm+���:�)�) IJ�-i�u���� ���ܒH��'�L(7�y�GӜq���� j��� 6ߌg1�g�o���,kر���tY�?W,���p���e���f�OQS��!K�۟cҒA�|ս�j�>��=⬒��˧L[�� �߿2JaB~R��u�:��Q�] �0H~���]�7��Ƽ�I���(}��cq '�ήET���q�?f�ab���ӥvr� �)o��-Q��_'����ᴎo��K������;��V���o��%���~OK ����*��b�f:���-ťIR��`B�5!RB@���ï�� �u �̯e\�_U�_������� g�ES��3�������QT��a����x����U<~�c?�*�#]�MW,[8O�a�x��]�1bC|踤�P��lw5V%�)�{t�<��d��5���0i�XSU��m:��Z�┵�i�"��1�^B�-��P�hJ��&)O��*�D��c�W��vM��)����}���P��ܗ-q����\mmζZ-l@�}��a��E�6��F�@��&Sg@���ݚ�M����� ȹ 4����#p�\H����dYDo�H���"��\��..R�B�H�z_�/5˘����6��KhJR��P�mƶi�m���3�,#c�co��q�a)*Pt����R�m�k�7x�D�E�\Y�閣_X�<���~�)���c[[�BP����6�Yq���S��0����%_����;��Àv�~�| VS؇ ��'O0��F0��\���U�-�d@�����7�SJ*z��3n��y��P����O���������m�~�P�3|Y��ʉr#�C�<�G~�.,! ���bqx���h~0=��!ǫ�jy����l�O,�[B��~��|9��ٱ����Xly�#�i�B��g%�S��������tˋ���e���ې��\[d�t)��.+u�|1 ������#�~Oj����hS�%��i.�~X���I�H�m��0n���c�1uE�q��cF�RF�o���7� �O�ꮧ� ���ۛ{��ʛi5�rw?׌#Qn�TW��~?y$��m\�\o����%W� ?=>S�N@�� �Ʈ���R����N�)�r"C�:��:����� �����#��qb��Y�. �6[��2K����2u�Ǧ�HYR��Q�MV��� �G�$��Q+.>�����nNH��q�^��� ����q��mM��V��D�+�-�#*�U�̒ ���p욳��u:�������IB���m���PV@O���r[b= �� ��1U�E��_Nm�yKbN�O���U�}�the�`�|6֮P>�\2�P�V���I�D�i�P�O;�9�r�mAHG�W�S]��J*�_�G��+kP�2����Ka�Z���H�'K�x�W�MZ%�O�YD�Rc+o��?�q��Ghm��d�S�oh�\�D�|:W������UA�Qc yT�q������~^�H��/��#p�CZ���T�I�1�ӏT����4��"�ČZ�����}��`w�#�*,ʹ�� ��0�i��課�Om�*�da��^gJ݅{���l�e9uF#T�ֲ��̲�ٞC"�q���ߍ ոޑ�o#�XZTp����@ o�8��(jd��xw�]�,f���`~�|,s��^����f�1���t��|��m�򸄭/ctr��5s��7�9Q�4�H1꠲BB@l9@���C�����+�wp�xu�£Yc�9��?`@#�o�mH�s2��)�=��2�.�l����jg�9$�Y�S�%*L������R�Y������7Z���,*=�䷘$�������arm�o�ϰ���UW.|�r�uf����IGw�t����Zwo��~5 ��YյhO+=8fF�)�W�7�L9lM�̘·Y���֘YLf�큹�pRF���99.A �"wz��=E\Z���'a� 2��Ǚ�#;�'}�G���*��l��^"q��+2FQ� hj��kŦ��${���ޮ-�T�٭cf�|�3#~�RJ����t��$b�(R��(����r���dx� >U b�&9,>���%E\� Ά�e�$��'�q't��*�א���ެ�b��-|d���SB�O�O��$�R+�H�)�܎�K��1m`;�J�2�Y~9��O�g8=vqD`K[�F)k�[���1m޼c��n���]s�k�z$@��)!I �x՝"v��9=�ZA=`Ɠi �:�E��)`7��vI��}d�YI�_ �o�:ob���o ���3Q��&D&�2=�� �Ά��;>�h����y.*ⅥS������Ӭ�+q&����j|UƧ����}���J0��WW< ۋS�)jQR�j���Ư��rN)�Gű�4Ѷ(�S)Ǣ�8��i��W52���No˓� ۍ%�5brOn�L�;�n��\G����=�^U�dI���8$�&���h��'���+�(������cȁ߫k�l��S^���cƗjԌE�ꭔ��gF���Ȓ��@���}O���*;e�v�WV���YJ\�]X'5��ղ�k�F��b 6R�o՜m��i N�i����>J����?��lPm�U��}>_Z&�KK��q�r��I�D�Չ~�q�3fL�:S�e>���E���-G���{L�6p�e,8��������QI��h��a�Xa��U�A'���ʂ���s�+טIjP�-��y�8ۈZ?J$��W�P� ��R�s�]��|�l(�ԓ��sƊi��o(��S0��Y� 8�T97.�����WiL��c�~�dxc�E|�2!�X�K�Ƙਫ਼�$((�6�~|d9u+�qd�^3�89��Y�6L�.I�����?���iI�q���9�)O/뚅����O���X��X�V��ZF[�یgQ�L��K1���RҖr@v�#��X�l��F���Нy�S�8�7�kF!A��sM���^rkp�jP�DyS$N���q��nxҍ!U�f�!eh�i�2�m���`�Y�I�9r�6� �TF���C}/�y�^���Η���5d�'��9A-��J��>{�_l+�`��A���[�'��յ�ϛ#w:݅�%��X�}�&�PSt�Q�"�-��\縵�/����$Ɨh�Xb�*�y��BS����;W�ջ_mc�����vt?2}1�;qS�d�d~u:2k5�2�R�~�z+|HE!)�Ǟl��7`��0�<�,�2*���Hl-��x�^����'_TV�gZA�'j� ^�2Ϊ��N7t�����?w�� �x1��f��Iz�C-Ȗ��K�^q�;���-W�DvT�7��8�Z�������� hK�(P:��Q- �8�n�Z���܃e貾�<�1�YT<�,�����"�6{/ �?�͟��|1�:�#g��W�>$����d��J��d�B��=��jf[��%rE^��il:��B���x���Sּ�1հ��,�=��*�7 fcG��#q� �eh?��2�7�����,�!7x��6�n�LC�4x��},Geǝ�tC.��vS �F�43��zz\��;QYC,6����~;RYS/6���|2���5���v��T��i����������mlv��������&� �nRh^ejR�LG�f���? �ۉҬܦƩ��|��Ȱ����>3����!v��i�ʯ�>�v��オ�X3e���_1z�Kȗ\<������!�8���V��]��?b�k41�Re��T�q��mz��TiOʦ�Z��Xq���L������q"+���2ۨ��8}�&N7XU7Ap�d�X��~�׿��&4e�o�F��� �H����O���č�c�� 懴�6���͉��+)��v;j��ݷ�� �UV�� i��� j���Y9GdÒJ1��詞�����V?h��l����l�cGs�ځ�������y�Ac�����\V3�? �� ܙg�>qH�S,�E�W�[�㺨�uch�⍸�O�}���a��>�q�6�n6����N6�q������N ! 1AQaq�0@����"2BRb�#Pr���3C`��Scst���$4D���%Td�� ?���N����a��3��m���C���w��������xA�m�q�m���m������$����4n淿t'��C"w��zU=D�\R+w�p+Y�T�&�պ@��ƃ��3ޯ?�Aﶂ��aŘ���@-�����Q�=���9D��ռ�ѻ@��M�V��P��܅�G5�f�Y<�u=,EC)�<�Fy'�"�&�չ�X~f��l�KԆV��?�� �W�N����=(� �;���{�r����ٌ�Y���h{�١������jW����P���Tc�����X�K�r��}���w�R��%��?���E��m�� �Y�q|����\lEE4���r���}�lsI�Y������f�$�=�d�yO����p�����yBj8jU�o�/�S��?�U��*������ˍ�0������u�q�m [�?f����a�� )Q�>����6#������� ?����0UQ����,IX���(6ڵ[�DI�MNލ�c&���υ�j\��X�R|,4��� j������T�hA�e��^���d���b<����n�� �즇�=!���3�^�`j�h�ȓr��jẕ�c�,ٞX����-����a�ﶔ���#�$��]w�O��Ӫ�1y%��L�Y<�wg#�ǝ�̗`�x�xa�t�w��»1���o7o5��>�m뭛C���Uƃߜ}�C���y1Xνm�F8�jI���]����H���ۺиE@I�i;r�8ӭ����V�F�Շ| ��&?�3|x�B�MuS�Ge�=Ӕ�#BE5G�����Y!z��_e��q�р/W>|-�Ci߇�t�1ޯќd�R3�u��g�=0 5��[?�#͏��q�cf���H��{ ?u�=?�?ǯ���}Z��z���hmΔ�BFTW�����<�q�(v� ��!��z���iW]*�J�V�z��gX֧A�q�&��/w���u�gYӘa���; �i=����g:��?2�dž6�ى�k�4�>�Pxs����}������G�9��3 ���)gG�R<>r h�$��'nc�h�P��Bj��J�ҧH� -��N1���N��?��~��}-q!=��_2hc�M��l�vY%UE�@|�v����M2�.Y[|y�"Eï��K�ZF,�ɯ?,q�?v�M 80jx�"�;�9vk�����+ ֧�� �ȺU��?�%�vcV��mA�6��Qg^M����A}�3�nl� QRN�l8�kkn�'�����(��M�7m9و�q���%ޟ���*h$Zk"��$�9��: �?U8�Sl��,,|ɒ��xH(ѷ����Gn�/Q�4�P��G�%��Ա8�N��!� �&�7�;���eKM7�4��9R/%����l�c>�x;������>��C�:�����t��h?aKX�bhe�ᜋ^�$�Iհ �hr7%F$�E��Fd���t��5���+�(M6�t����Ü�UU|zW�=a�Ts�Tg������dqP�Q����b'�m���1{|Y����X�N��b �P~��F^F:����k6�"�j!�� �I�r�`��1&�-$�Bevk:y���#yw��I0��x��=D�4��tU���P�ZH��ڠ底taP��6����b>�xa����Q�#� WeF��ŮNj�p�J* mQ�N����*I�-*�ȩ�F�g�3 �5��V�ʊ�ɮ�a��5F���O@{���NX��?����H�]3��1�Ri_u��������ѕ�� ����0��� F��~��:60�p�͈�S��qX#a�5>���`�o&+�<2�D����: �������ڝ�$�nP���*)�N�|y�Ej�F�5ټ�e���ihy�Z �>���k�bH�a�v��h�-#���!�Po=@k̆IEN��@��}Ll?j�O������߭�ʞ���Q|A07x���wt!xf���I2?Z��<ץ�T���cU�j��]��陎Ltl �}5�ϓ��$�,��O�mˊ�;�@O��jE��j(�ا,��LX���LO���Ц�90�O �.����a��nA���7������j4 ��W��_ٓ���zW�jcB������y՗+EM�)d���N�g6�y1_x��p�$Lv:��9�"z��p���ʙ$��^��JԼ*�ϭ����o���=x�Lj�6�J��u82�A�H�3$�ٕ@�=Vv�]�'�qEz�;I˼��)��=��ɯ���x �/�W(V���p�����$ �m�������u�����񶤑Oqˎ�T����r��㠚x�sr�GC��byp�G��1ߠ�w e�8�$⿄����/�M{*}��W�]˷.�CK\�ުx���/$�WPw���r� |i���&�}�{�X� �>��$-��l���?-z���g����lΆ���(F���h�vS*���b���߲ڡn,|)mrH[���a�3�ר�[1��3o_�U�3�TC�$��(�=�)0�kgP���� ��u�^=��4 �WYCҸ:��vQ�ר�X�à��tk�m,�t*��^�,�}D*� �"(�I��9R����>`�`��[~Q]�#af��i6l��8���6�:,s�s�N6�j"�A4���IuQ��6E,�GnH��zS�HO�uk�5$�I�4��ؤ�Q9�@��C����wp�BGv[]�u�Ov���0I4���\��y�����Q�Ѹ��~>Z��8�T��a��q�ޣ;z��a���/��S��I:�ܫ_�|������>=Z����8:�S��U�I�J��"IY���8%b8���H��:�QO�6�;7�I�S��J��ҌAά3��>c���E+&jf$eC+�z�;��V����� �r���ʺ������my�e���aQ�f&��6�ND��.:��NT�vm�<- u���ǝ\MvZY�N�NT��-A�>jr!S��n�O 1�3�Ns�%�3D@���`������ܟ 1�^c<���� �a�ɽ�̲�Xë#�w�|y�cW�=�9I*H8�p�^(4���՗�k��arOcW�tO�\�ƍR��8����'�K���I�Q�����?5�>[�}��yU�ײ -h��=��% q�ThG�2�)���"ו3]�!kB��*p�FDl�A���,�eEi�H�f�Ps�����5�H:�Փ~�H�0Dت�D�I����h�F3�������c��2���E��9�H��5�zԑ�ʚ�i�X�=:m�xg�hd(�v����׊�9iS��O��d@0ڽ���:�p�5�h-��t�&���X�q�ӕ,��ie�|���7A�2���O%P��E��htj��Y1��w�Ѓ!����  ���� ࢽ��My�7�\�a�@�ţ�J �4�Ȼ�F�@o�̒?4�wx��)��]�P��~�����u�����5�����7X ��9��^ܩ�U;Iꭆ 5 �������eK2�7(�{|��Y׎ �V��\"���Z�1� Z�����}��(�Ǝ"�1S���_�vE30>���p;� ΝD��%x�W�?W?v����o�^V�i�d��r[��/&>�~`�9Wh��y�;���R��� ;;ɮT��?����r$�g1�K����A��C��c��K��l:�'��3 c�ﳯ*"t8�~l��)���m��+U,z��`(�>yJ�?����h>��]��v��ЍG*�{`��;y]��I�T� ;c��NU�fo¾h���/$���|NS���1�S�"�H��V���T���4��uhǜ�]�v;���5�͠x��'C\�SBpl���h}�N����� A�Bx���%��ޭ�l��/����T��w�ʽ]D�=����K���ž�r㻠l4�S�O?=�k �M:� ��c�C�a�#ha���)�ѐxc�s���gP�iG��{+���x���Q���I= �� z��ԫ+ �8"�k�ñ�j=|����c ��y��CF��/��*9ж�h{ �?4�o� ��k�m�Q�N�x��;�Y��4膚�a�w?�6�>e]�����Q�r�:����g�,i"�����ԩA�*M�<�G��b�if��l^M��5� �Ҩ�{����6J��ZJ�����P�*�����Y���ݛu�_4�9�I8�7���������,^ToR���m4�H��?�N�S�ѕw��/S��甍�@�9H�S�T��t�ƻ���ʒU��*{Xs�@����f�����֒Li�K{H�w^���������Ϥm�tq���s� ���ք��f:��o~s��g�r��ט� �S�ѱC�e]�x���a��) ���(b-$(�j>�7q�B?ӕ�F��hV25r[7 Y� }L�R��}����*sg+��x�r�2�U=�*'WS��ZDW]�WǞ�<��叓���{�$�9Ou4��y�90-�1�'*D`�c�^o?(�9��u���ݐ��'PI&� f�Jݮ�������:wS����jfP1F:X �H�9dԯ���˝[�_54 �}*;@�ܨ�� ð�yn�T���?�ןd�#���4rG�ͨ��H�1�|-#���Mr�S3��G�3�����)�.᧏3v�z֑��r����$G"�`j �1t��x0<Ɔ�Wh6�y�6��,œ�Ga��gA����y��b��)��h�D��ß�_�m��ü �gG;��e�v��ݝ�nQ� ��C����-�*��o���y�a��M��I�>�<���]obD��"�:���G�A��-\%LT�8���c�)��+y76���o�Q�#*{�(F�⽕�y����=���rW�\p���۩�c���A���^e6��K������ʐ�cVf5$�'->���ՉN"���F�"�UQ@�f��Gb~��#�&�M=��8�ט�JNu9��D��[̤�s�o�~������ G��9T�tW^g5y$b��Y'��س�Ǵ�=��U-2 #�MC�t(�i� �lj�@Q 5�̣i�*�O����s�x�K�f��}\��M{E�V�{�υ��Ƈ�����);�H����I��fe�Lȣr�2��>��W�I�Ȃ6������i��k�� �5�YOxȺ����>��Y�f5'��|��H+��98pj�n�.O�y�������jY��~��i�w'������l�;�s�2��Y��:'lg�ꥴ)o#'Sa�a�K��Z� �m��}�`169�n���"���x��I ��*+� }F<��cГ���F�P�������ֹ*�PqX�x۩��,� ��N�� �4<-����%����:��7����W���u�`����� $�?�I��&����o��o��`v�>��P��"��l���4��5'�Z�gE���8���?��[�X�7(��.Q�-��*���ތL@̲����v��.5���[��=�t\+�CNܛ��,g�SQnH����}*F�G16���&:�t��4ُ"A��̣��$�b �|����#rs��a�����T�� ]�<�j��BS�('$�ɻ� �wP;�/�n��?�ݜ��x�F��yUn�~mL*-�������Xf�wd^�a�}��f�,=t�׵i�.2/wpN�Ep8�OР���•��R�FJ� 55TZ��T �ɭ�<��]��/�0�r�@�f��V��V����Nz�G��^���7hZi����k��3�,kN�e|�vg�1{9]_i��X5y7� 8e]�U����'�-2,���e"����]ot�I��Y_��n�(JҼ��1�O ]bXc���Nu�No��pS���Q_���_�?i�~�x h5d'�(qw52] ��'ޤ�q��o1�R!���`ywy�A4u���h<קy���\[~�4�\ X�Wt/� 6�����n�F�a8��f���z �3$�t(���q��q�x��^�XWeN'p<-v�!�{�(>ӽDP7��ո0�y)�e$ٕv�Ih'Q�EA�m*�H��RI��=:��� ���4牢) �%_iN�ݧ�l]� �Nt���G��H�L��� ɱ�g<���1V�,�J~�ٹ�"K��Q�� 9�HS�9�?@��k����r�;we݁�]I�!{ �@�G�[�"��`���J:�n]�{�cA�E����V��ʆ���#��U9�6����j�#Y�m\��q�e4h�B�7��C�������d<�?J����1g:ٳ���=Y���D�p�ц� ׈ǔ��1�]26؜oS�'��9�V�FVu�P�h�9�xc�oq�X��p�o�5��Ա5$�9W�V(�[Ak�aY錎qf;�'�[�|���b�6�Ck��)��#a#a˙��8���=äh�4��2��C��4tm^ �n'c���]GQ$[Wҿ��i���vN�{Fu ��1�gx��1┷���N�m��{j-,��x�� Ūm�ЧS�[�s���Gna���䑴�� x�p 8<������97�Q���ϴ�v�aϚG��Rt�Һ׈�f^\r��WH�JU�7Z���y)�vg=����n��4�_)y��D'y�6�]�c�5̪�\� �PF�k����&�c;��cq�$~T�7j ���nç]�<�g ":�to�t}�159�<�/�8������m�b�K#g'I'.W�����6��I/��>v��\�MN��g���m�A�yQL�4u�Lj�j9��#44�t��l^�}L����n��R��!��t��±]��r��h6ٍ>�yҏ�N��fU�� ���� Fm@�8}�/u��jb9������he:A�y�ծw��GpΧh�5����l}�3p468��)U��d��c����;Us/�֔�YX�1�O2��uq�s��`hwg�r~�{ R��mhN��؎*q 42�*th��>�#���E����#��Hv�O����q�}�����6�e��\�,Wk�#���X��b>��p}�դ��3���T5��†��6��[��@�P�y*n��|'f�֧>�lư΂�̺����SU�'*�q�p�_S�����M�� '��c�6�����m�� ySʨ;M��r���Ƌ�m�Kxo,���Gm�P��A�G�:��i��w�9�}M(�^�V��$ǒ�ѽ�9���|���� �a����J�SQ�a���r�B;����}���ٻ֢�2�%U���c�#�g���N�a�ݕ�'�v�[�OY'��3L�3�;,p�]@�S��{ls��X�'���c�jw�k'a�.��}�}&�� �dP�*�bK=ɍ!����;3n�gΊU�ߴmt�'*{,=SzfD� A��ko~�G�aoq�_mi}#�m�������P�Xhύ����mxǍ�΂���巿zf��Q���c���|kc�����?���W��Y�$���_Lv����l߶��c���`?����l�j�ݲˏ!V��6����U�Ђ(A���4y)H���p�Z_�x��>���e��R��$�/�`^'3qˏ�-&Q�=?��CFVR �D�fV�9��{�8g�������n�h�(P"��6�[�D���< E�����~0<@�`�G�6����Hг�cc�� �c�K.5��D��d�B���`?�XQ��2��ٿyqo&+�1^� DW�0�ꊩ���G�#��Q�nL3��c���������/��x ��1�1[y�x�პCW��C�c�UĨ80�m�e�4.{�m��u���I=��f�����0QRls9���f���������9���~f�����Ǩ��a�"@�8���ȁ�Q����#c�ic������G��$���G���r/$W�(��W���V�"��m�7�[m�A�m����bo��D� j����۳� l���^�k�h׽����� ��#� iXn�v��eT�k�a�^Y�4�BN��ĕ��0 !01@Q"2AaPq3BR������?���@4�Q�����T3,���㺠�W�[=JK�Ϟ���2�r^7��vc�:�9 �E�ߴ�w�S#d���Ix��u��:��Hp��9E!�� V 2;73|F��9Y���*ʬ�F��D����u&���y؟��^EA��A��(ɩ���^��GV:ݜDy�`��Jr29ܾ�㝉��[���E;Fzx��YG��U�e�Y�C���� ����v-tx����I�sם�Ę�q��Eb�+P\ :>�i�C'�;�����k|z�رn�y]�#ǿb��Q��������w�����(�r|ӹs��[�D��2v-%��@;�8<a���[\o[ϧw��I!��*0�krs)�[�J9^��ʜ��p1)� "��/_>��o��<1����A�E�y^�C��`�x1'ܣn�p��s`l���fQ��):�l����b>�Me�jH^?�kl3(�z:���1ŠK&?Q�~�{�ٺ�h�y���/�[��V�|6��}�KbX����mn[-��7�5q�94�������dm���c^���h� X��5��<�eޘ>G���-�}�دB�ޟ� ��|�rt�M��V+�]�c?�-#ڛ��^ǂ}���Lkr���O��u�>�-D�ry� D?:ޞ�U��ǜ�7�V��?瓮�"�#���r��չģVR;�n���/_� ؉v�ݶe5d�b9��/O��009�G���5n�W����JpA�*�r9�>�1��.[t���s�F���nQ� V 77R�]�ɫ8����_0<՜�IF�u(v��4��F�k�3��E)��N:��yڮe��P�`�1}�$WS��J�SQ�N�j�ٺ��޵�#l���ј(�5=��5�lǏmoW�v-�1����v,W�mn��߀$x�<����v�j(����c]��@#��1������Ǔ���o'��u+����;G�#�޸��v-lη��/(`i⣍Pm^���ԯ̾9Z��F��������n��1��� ��]�[��)�'������:�֪�W��FC����� �B9،!?���]��V��A�Վ�M��b�w��G F>_DȬ0¤�#�QR�[V��kz���m�w�"��9ZG�7'[��=�Q����j8R?�zf�\a�=��O�U����*oB�A�|G���2�54 �p��.w7� �� ��&������ξxGHp� B%��$g�����t�Џ򤵍z���HN�u�Я�-�'4��0��;_��3 !01"@AQa2Pq#3BR������?��ʩca��en��^��8���<�u#��m*08r��y�N"�<�Ѳ0��@\�p��� �����Kv�D��J8�Fҽ� �f�Y��-m�ybX�NP����}�!*8t(�OqѢ��Q�wW�K��ZD��Δ^e��!� ��B�K��p~�����e*l}z#9ң�k���q#�Ft�o��S�R����-�w�!�S���Ӥß|M�l޶V��!eˈ�8Y���c�ЮM2��tk���� ������J�fS����Ö*i/2�����n]�k�\���|4yX�8��U�P.���Ы[���l��@"�t�<������5�lF���vU�����W��W��;�b�cД^6[#7@vU�xgZv��F�6��Q,K�v��� �+Ъ��n��Ǣ��Ft���8��0��c�@�!�Zq s�v�t�;#](B��-�nῃ~���3g������5�J�%���O������n�kB�ĺ�.r��+���#�N$?�q�/�s�6��p��a����a��J/��M�8��6�ܰ"�*������ɗud"\w���aT(����[��F��U՛����RT�b���n�*��6���O��SJ�.�ij<�v�MT��R\c��5l�sZB>F��<7�;EA��{��E���Ö��1U/�#��d1�a�n.1ě����0�ʾR�h��|�R��Ao�3�m3 ��%�� ���28Q� ��y��φ���H�To�7�lW>����#i`�q���c����a��� �m,B�-j����݋�'mR1Ήt�>��V��p���s�0IbI�C.���1R�ea�����]H�6����������4B>��o��](��$B���m�����a�!=��?�B� K�Ǿ+�Ծ"�n���K��*��+��[T#�{E�J�S����Q�����s�5�:�U�\wĐ�f�3����܆&�)����I���Ԇw��E T�lrTf6Q|R�h:��[K�� �z��c֧�G�C��%\��_�a�84��HcO�bi��ؖV��7H �)*ģK~Xhչ0��4?�0��� �E<���}3���#���u�?�� ��|g�S�6ꊤ�|�I#Hڛ� �ա��w�X��9��7���Ŀ%�SL��y6č��|�F�a 8���b��$�sק�h���b9RAu7�˨p�Č�_\*w��묦��F ����4D~�f����|(�"m���NK��i�S�>�$d7SlA��/�²����SL��|6N�}���S�˯���g��]6��; �#�.��<���q'Q�1|KQ$�����񛩶"�$r�b:���N8�w@��8$�� �AjfG|~�9F ���Y��ʺ��Bwؒ������M:I岎�G��`s�YV5����6��A �b:�W���G�q%l�����F��H���7�������Fsv7��k�� 403WebShell
403Webshell
Server IP : 104.21.45.146  /  Your IP : 172.69.214.218
Web Server : Apache/2.4.52 (Ubuntu)
System : Linux ip-172-31-19-221 6.8.0-1029-aws #31~22.04.1-Ubuntu SMP Thu Apr 24 21:16:18 UTC 2025 x86_64
User : www-data ( 33)
PHP Version : 8.1.28
Disable Function : NONE
MySQL : OFF  |  cURL : ON  |  WGET : ON  |  Perl : ON  |  Python : OFF  |  Sudo : ON  |  Pkexec : ON
Directory :  /efsdata/scitechnol.com/httpdocs/submission/uploads/

Upload File :
current_dir [ Writeable ] document_root [ Writeable ]

 

Command :


[ Back ]     

Current File : /efsdata/scitechnol.com/httpdocs/submission/uploads/197-0-Manuscript-2012-11-25.doc
��ࡱ�>��	�����������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������y�	����bjbj��	4�{�{Lv,���������FFFFF����ZZZ8��^<Z�<���������G;I;I;I;I;I;I;$Z>�Ajm;�F�����m;FF���f<�#�#�#��F�F�G;�#�G;�#�#r+T,�����@����
������"6�+3;|<0�<�+�vA�#(vA,vAF,����#�����m;m;�#����<������������������������������������������������������������������������vA���������� :	Dual Time Point PET imaging in head and neck squamous cell carcinoma
Sanaz Harirchian MD, Department of Otolaryngology - Head & Neck Surgery, University of Medicine and Dentistry of New Jersey  � New Jersey Medical School
Nasrin Ghesani MD, Department of Nuclear Medicine, University of Medicine and Dentistry of New Jersey � New Jersey Medical School
Erik G Cohen, MD, Assistant Professor, Department of Otolaryngology - Head & Neck Surgery, University of Medicine and Dentistry of New Jersey  � New Jersey Medical School
Institution: University of Medicine and Dentistry of New Jersey � New Jersey Medical School, Newark New Jersey USA

No financial support or disclosures
No source of financial funding 
Conflict of interest: none
Corresponding author:
Sanaz Harirchian, MD
90 Bergen Street
Suite 8100
Newark, NJ 07103
 HYPERLINK "mailto:coheneg@umdnj.edu" harirs02@gmail.com
tel: 9739724588
fax: 9739723767
Presented as oral presentation, Academy of Otolaryngology � Head & Neck Surgery, September 14, 2011, San Francisco, CA 
This article is original and not considered for publication elsewhere. All authors have participated in the conception and design of the work, in the analysis of data, and in writing/supervision of manuscript. 
word count: 3262










Abstract: 
Objective: 
Dual time point 18F-fluorodeoxyglucose -positron emission tomography (DTP-PET) is a technique which may detect malignancy more accurately than standard PET/CT imaging. Our main objective was to perform a pilot study to evaluate the characteristics of DTP-PET in primary head and neck squamous cell carcinomas (HNSCC) and lymph node metastases. 
Study design: case series
Setting: University hospital tertiary care center 
Subjects and Methods: 
35 patients with previously untreated HNSCC underwent preoperative PET/CT at two time points (mean 41 minute time difference) from 2007-2010. Mean and maximum standardized uptake values (SUV) were measured for the primary lesion and cervical lymph node metastases at both times points and change in SUV over time was calculated. An SUV increase of 10% was used as the threshold for positivity.
Results:
30 of 35 primary tumors (86%) were positive by DTP-PET with an average increase in maximum SUV of 28%. 16 of 21 lymph node metastases (76%) were positive by DTP-PET with an average increase in maximum SUV of 35%. Change in mean SUV did not correlate as well with the presence of tumor. 
Conclusion:
86% of primary tumors and 76% of cervical lymph node metastases showed an increase in maximum SUV over time. These findings justify further study of DTP-PET as a method of detecting tumor in initial staging and restaging of HNSCC after treatment to improve the accuracy of standard PET/CT. 
Keywords: PET/CT, dual time point PET, PET, head and neck squamous cell carcinoma 




















Introduction:
Computed Tomography with intravenous contrast (CT) of the neck and chest are frequently used in the initial staging and restaging of head and neck squamous cell carcinoma (HNSCC). Whole body 18F-Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) and, more recently, concurrent FDG-PET/CT have been added to CT imaging to improve the accuracy of initial radiologic staging, restaging after definitive treatment, and post-treatment surveillance of malignancies.1,2 Recent studies have reported the superiority of PET/CT in detecting occult cervical lymph nodes3 and distant metastases4-6 over CT scan in the initial staging of HNSCC.  PET/CT is also frequently used in the restaging of HNSCC after definitive radiation therapy or chemoradiation, with reported high negative predictive value (NPV).  However, its lower specificity and positive predictive value (PPV) have been problematic and one of the major limitations of FDG-PET. 
Fluorine-18-fluoro-2-deoxy-D-glucose (18FDG) is a glucose analog. It is not tumor specific and can accumulate in benign inflammatory lesions.7 This results in the potential for difficulty in differentiating malignant from benign lesions, and can lead to false positives and decreased positive predictive value.8 This limitation of FDG-PET is most evident in reimaging after definitive radiation or chemoradiation as well as in the preoperative evaluation of cervical lymph node metastases. One postoperative series noted a specificity of 64% for detecting recurrent disease at the primary site and  77% for cervical lymph node metastases.9 While a negative PET is reliable in ruling out residual neck disease, a positive PET has been less useful.10,11  Tan et al reported restaging PET scans performed 8-12 weeks after definitive chemoradiation for HNSCC had a PPV of only 15% for cervical lymph node metastases.10   False positive scans can result in overtreatment of the cervical lymph nodes.  In addition, false positive or equivocal scans may require re-biopsy of the primary tumor site after radiation or chemoradiation therapy and causes uncertainty in patient�s disease status. 
Dual time point 18F-fluorodeoxyglucose -positron emission tomography (DTP-PET) is a technique which may detect malignancy more accurately than standard PET/CT imaging. DTP-PET involves imaging at two time points following one single administration of 18F-FDG, and is posited to better differentiate benign from malignant lesions based on the pattern of FDG uptake over time. It is based on the premise that the standard uptake value (SUV) of malignant lesions increases over time, while that of normal tissue or inflammatory lesions remain unchanged or decrease.12  While this imaging technique has been studied in several malignancies, including lung, bone, abdomen, and mediastinum, its use in the head and neck has not been well studied.13-19  An SUV increase of 10% in DTP-PET has also been used as the threshold for positivity in various studies.17,19,20 DTP-PET evaluation in the head and neck has been limited. 
Our main objective was to perform a pilot study to describe the characteristics of DTP-PET in previously untreated primary HNSCC and cervical lymph node metastases, determine optimal methodology for measure DTP-PET in HNSCC, and to determine if DTP-PET should be further studied for clinical use in HNSCC. 
Materials and Methods:
We performed an Institutional Review Board approved retrospective review of all PET/CT scans performed between 1/1/07 to 1/1/11. We included all patients with previously untreated known HNSCC who had preoperative PET/CT imaging and subsequently underwent surgical resection as definitive treatment at our institution. All patients had biopsy-confirmed squamous cell carcinoma of the upper aerodigestive tract.  Patients with squamous cell carcinomas of the head and neck in other sites, such as the sinonasal tract and skin, were excluded. 
Thirty five patients, 27 men and 8 women, with a mean age of 62 (range 47-83 years) were included in this study.  The primary sites of tumor were oral cavity in 29 patients (3 buccal, 9 oral tongue, 9 floor of mouth, 3 gingiva, 2 hard palate, and 3 unknown due to multisite involvement), larynx in 4 patients, and base of tongue in 2 patients. 
All patients underwent resection of the primary site, while 32 patients (91%) underwent unilateral or bilateral selective or modified radical neck dissections. 22 patients (63%) had pathologically positive nodes. We reviewed PET/CT scans of all primary tumors and pathologically confirmed cervical lymph node metastases.  16 PET/CT scans were suggestive of cervical lymph node metastases, with 6 false negatives. 
There was no change in the standard PET/CT imaging protocol. All patients were asked to fast for at least 6 hours before FDG-PET imaging. Imaging was performed with a Discovery PET-CT scanner (GE Healthcare, United Kingdom).  Blood glucose levels were checked prior to 18F-FDG injection, and were less than 200 in each patient.  Skull base to mid- thigh PET/CT images (time point 1) were acquired approximately 60 minutes after intravenous injection of 15 mCi of 18F-FDG. Delayed PET-CT images of the head and neck, from vertex to the thoracic inlet with thinner cuts through the head and neck region (time point 2) were obtained at a mean of 41 minutes (range 39-49 min) after the initial scan.  The 2 time point image acquisition was part of the standard PET/CT protocol, not done specifically for DTP-PET imaging.  However, the time difference between the 2 scans allows for dual time point analysis. 
Early and delayed PET images were reviewed on a computer monitor in the axial, sagittal, and coronal planes with maximum-intensity projection images. An experienced nuclear medicine physician (NG) evaluated the 18F-FDG uptake at the primary site and regional lymph nodes. No distant metastases were present in any patients included in the study. The PET images were correlated with the CT images for correct anatomic correlation. All CTs were performed with the injection of intravenous iodinated contrast.
Using the Mimvista 4.2.2 software (MIM Software Inc., Cleveland, Ohio), a region of interest (ROI) was drawn around the entire 18F-FDG avid lesion, including the largest area of radioactivity (Figure 1). The ROI encapsulated the entire tumor in the largest axis.  Semiquantitative analysis was then performed using the standardized uptake value (SUV), which was calculated using the following formula:  SUV = tissue concentration (MBq/g)/[injected dose (Mbq)/body weight (g)]. The mean and maximum SUV (SUVmax and SUVmean) of the ROI was calculated by the software.  The change in FDG uptake over both time points was calculated as the % � SUV using the following formula: % � SUV = (SUVdelayed   SUVearly)/SUVearly X 100. 
ROIs were also drawn over an uninvolved tonsil and trapezius muscle as possible benign controls, and maximum and mean SUVs were calculated. Tonsils in close proximity or involved by the tumor were excluded from analysis.  An SUV increase e" 10% was considered positive by DTP-PET, indicating malignancy. These results were compared with histopathologic data from surgical resection.
Results:
	35 patients with squamous cell carcinoma of the oral cavity, oropharynx or larynx were included in the study. Primary tumors ranged in size on preoperative imaging from 1.5 to 6.6 cm (mean 3.3 cm). 16 patients had preoperative PET-CT scans which were considered positive for regional lymph node metastases due to lymph nodes e" 1 cm in size which were FDG avid (SUV > 2.5). Cervical lymph nodes smaller than 1 cm in size or with SUV < 2.5 were considered either likely reactive or borderline, and were considered negative. 
	Delayed FDG PET-CT images of the head and neck (time point 2) were obtained at a mean of 41 minutes after the early scan, ranging from 39 to 49 minutes.  The early SUVmax of the known primary tumor ranged from 1.5 to 38.0 (mean 14.2 � 7.6) (Table 1). 34 (97%) of primary tumors had an early SUVmax e" 2.5. Delayed SUVmax of primary tumors ranged from 4.3 to 45.5 (mean 17.8 � 9.7). This was a statistically significant increase using the Student s paired t-test, with a p value of 0.001.  100% of primary tumors had a delayed SUVmax of e" 2.5. 30 of 35 primary tumors (86%) were positive by DTP-PET, with an average SUVmax increase of 27.9% � 36.8 (range -15 to 265%) (Table 2, Figure 2).  
	SUVmean did not correlate as well with the presence of tumor.  The early SUVmean of the primary tumor ranged from 1.2 to 16.5 (mean 8.9 � 4.2), while the delayed SUVmean ranged from 2.5 to 23.5 (mean 10.4 � 5.3) (Table 1). However, only 20 scans (57%) were positive by DTP-PET, with a 43% false negative rate (Table 2).  
	While 16 patients had cervical LN metastases and preoperative PET-CTs which were suspicious for regional lymph node metastases, a total of 21 lymph nodes were used for analysis due to multiple FDG-avid lymph nodes in 3 patients. Early SUVmax of cervical lymph nodes ranged from 2.9 to 22.6 (mean 8.5 � 5.1), while delayed SUVmax ranged from 3.1 to 30.9 (mean 10.9 � 6.9) (Table 1).  This was a statistically significant increase using the Student�s paired t-test, with a p value of 0.001.  16 of 21 (76%) metastatic lymph nodes were positive by DTP-PET using SUVmax (Table 2, Figure 3). Overall % � SUVmax ranged from with a -36 to 284% (mean 35.0% � 53.4). Interestingly, two of the four metastastic lymph nodes which were falsely negative by DTP also had primary tumor falsely negative by DTP. 13 out of 21 (62%) of metastatic lymph nodes were positive by DTP-PET using SUVmean. 6 patients (17%) had pathologic evidence of lymph node metastases on neck dissection that was missed on PET-CT.
	Mean and maximum SUVs were also measured for uninvolved tonsil and trapezius. Tonsils in close proximity or involved by the tumor were excluded from analysis, yielding 29 tonsil measurements.  Early SUVmax ranged from 1.5 to 5.4 (mean 3.2 � 1.2); and delayed SUVmax ranged from 1.6 to 6.4, (mean 3.4 � 1.4) (Table 1). This was not a statistically significant increase using the Student�s paired t-test, with a p value of 0.10.  15 out of 29 (52%) were positive by DTP-PET using SUVmax versus 24% using SUVmean (Table 2, Figure 4). The trapezius muscle had an early SUVmax ranging from 0.55 to 1.51(mean 0.9 � 0.2); and delayed SUVmax from 0.54 to 1.63 (mean 0.9 � 0.3). Average increase in SUVmax for trapezius was 3%.   9 out of 34 (26%) of trapezius SUVmax measurements were positive by DTP-PET (Figure 5).  
Discussion
While FDG-PET is routinely utilized in the staging and restaging of head and neck malignancies, its clinical application is limited by its lower specificity and positive predictive value due to 18F-FDG uptake by inflammatory lesions.  While traditionally, a single time point SUV of > 2.5 is used as the threshold for malignancy, inflammatory lesions may also have elevated SUVs.17 Equivocal or falsely positive PET/CT scans may result in both patient and physician uncertainty regarding disease status.  This often necessitates biopsies, repeat imaging, and/or surgery.  
DTP-PET, which involves imaging at two different time points after one injection of 18F-FDG, has emerged as a technique to more accurately differentiate inflammatory processes from malignancy.  DTP-PET is based on differences in SUV patterns between benign and malignant lesions. Zhuang et al�s in vivo study demonstrated an SUV increase of 59 -198% in all malignant cell lines over 60 minutes versus a decrease in 7 out of 8 mononuclear cell lines.12 This differential 18F-FDG uptake pattern has been attributed to intracellular trapping of 18F-FDG in tumor cells.18,21 Hexokinase mediates the phosphorylation of intracellular 18F-FDG, while glucose-6-phosphatase dephosphorylates 18F-FDG-6-phosphate, allowing exit from the cell. It has been demonstrated that tumor cells have low levels of glucose-6-phosphatase, resulting in intracellular trapping of 18F-FDG and an increase in SUV over time.21,22  Studies have confirmed significantly higher SUVs on delayed scans in malignant lesions of the breast, bone, lung, esophagus, gallbladder, and lung.13-17,19,20,23
Several studies have demonstrated the advantages of DTP-PET, illustrating the improved accuracy, positive predictive value and specificity in detecting tumor compared with single time point PET. 18,19,20,23 In the detection of mediastinal nodal metastases from lung primary tumors, DTP-PET improved the specificity from 62.9% using standard PET to 91.4% using DTP-PET at a 2 hour interval.18 Chan et al reported 13 out 133 (10%) malignant lesions undetected on early PET alone, were detected using DTP-PET at a 2.5 hour interval.13 Other studies have refuted the benefit of DTP-PET. Yen reported no improvement in accuracy in the detection of nasopharyngeal carcinoma at the primary site and in locoregional lymph node metastases.24
While the SUV of benign lesions theoretically decreases or remains unchanged over time, some studies have also documented an SUV increase in benign lesions using DTP-PET. This false positivity in benign lesions may be explained by inflammatory uptake.  Jones et al demonstrated that SUV in activated neutrophils continued to increase at 100 minutes,25 while Deichel et al reported SUV increase in activated monocytes and macrophages at 3 hours.26 Even though benign lesions may be positive by DTP-PET, their average SUVs on early and delayed images have been reported to be significantly lower than those of malignant lesions (2.67 to 2.96 in benign lesions versus 6.02 to 7.80 in malignant lesions; 1.98 to 2.01 versus 5.73 to 7.27).13,17 The mean % � SUV in benign lesions is also lower than in malignant lesions (7 versus 18%).19  To address this issue, studies using a threshold of SUV e"2.5 and % � SUV e" 10 have demonstrated improved specificity, sensitivity and PPV than either criteria alone.17 In addition, different tumor types may have different patterns of SUV change due to different levels of glucose-6-phosphatase and hexokinase. Chan et al reported that benign and malignant lung lesions were positive by DTP-PET, while benign abdominal lesions did not have a significant change in SUV.13 Therefore, DTP-PET needs to be evaluated in different tumor types to determine optimal parameters for its use.  In addition, DTP-PET may better differentiate malignant tumors from non-neoplastic lesions than malignant tumors from benign tumors. 
There is no standard time interval between scans. Although the most common interscan interval is 2 hours, studies have used intervals between 30 minutes and 3 hours.27,28 Yamada et al reported that 18F-FDG uptake peaked 1 hour post-FDG injection.27 Wong et al reported a study of tumor kinetics demonstrating a 13% � SUV in head and neck tumors between 1-2 hours.29 While there is no established optimal time interval for DTP-PET, it has been suggested that a longer time interval may improve the accuracy of DTP-PET.
	In our study, delayed FDG PET-CT images of the head and neck (time point 2) were obtained at a mean of 41 minutes after the initial scan, ranging from 39 to 49 minutes.  Our interscan interval was short compared with other studies, which usually ranges from 1 to 2.5 hours. This is because the 2 time point image acquisition was part of the standard PET/CT protocol, not done specifically for DTP-PET imaging.  The time difference between the 2 scans allowed for dual time point analysis. 
Our study of 35 patients demonstrated a mean increase in SUVmax of 28%, and 86% of primary tumors demonstrated a % SUVmax increase of e" 10%.  The average of SUVmax for all primary tumors at time point 1 was 14.2 which increased to 17.8 at time point 2. This was statistically significant using the Student s paired t-test, with a p value of 0.001.  SUVmax also increased in cervical lymph node metastases, with a mean increase of 35%. 76% of cervical lymph node metastases were positive by DTP-PET using SUVmax. The average of SUVmax for all cervical LN metastases at time point 1 was 8.53 which increased to 10.9 at time point 2. This was statistically significant using the Student�s paired t-test, with a p value of 0.001. 
5 of 35 primary tumors (14%) were falsely negative by DTP-PET, with a 9.5% increase to 14.6% SUVmax decrease.  Of these 5 tumors, 2 also had falsely negatively cervical lymph node metastases by DTP-PET.  This may indicate a difference in the biochemical properties of these tumors, such as normal or increased levels of glucose-6-phosphatase, preventing the trapping of FDG in the primary tumor and lymph node metastases. Another falsely negative primary tumor was less than 1 centimeter in size. PET imaging is thought to be less reliable for imaging small lesions, which may explain this false negative scan. The 4th primary tumor had a 9.5% SUV increase, which was below the 10% threshold for positivity. 
The average SUVmax of uninvolved tonsils increased from 3.2 to 3.4, which was not statistically significant using the Student�s paired t-test, with a p value of 0.10.  52% were falsely positive by DTP-PET. The average SUVmax increase was 14%, which was lower than the average increase for primary tumors and cervical LN. The SUV increase in tonsils may be explained by the presence of chronic inflammation.  While many benign tonsils were positive by DTP-PET, it was less frequent than with known tumors and cervical LN and the SUVmax was significantly lower than that of known tumors.  Combining this with the criterion of early SUV e"2.5 would decrease this false positive rate to 31%. The SUVmax of the trapezius muscle remained unchanged at 0.9, and 35% were falsely positive by DTP-PET.  The average SUVmax increase for trapezius was 2.8%. Combining this with the criterion of SUV e"2.5 would decrease this false positive rate to 0%.
The false positivity of benign tonsil and trapezius may also be explained by the short interscan time interval (mean 41 minutes). Wong et al�s study demonstrated differences in early and delayed SUV when taken 29 versus 97 minutes apart.29 SUV of primary tumors at 90 minutes have been significant higher than those from 45 minutes, while inflammatory lesions continued to decrease over time.17 While the SUV of tumor cells continue to increase 130-500 minutes after 18F-FDG injection, it is believed that the SUV of inflammatory lesions will eventually stabilize or decrease.30 This is thought to be due to the low glucose-6-phosphatase activity in tumor cells and increased glucose uptake through glucose-transporter proteins. Subsequently, it has been suggested that a longer time interval may improve the accuracy of DTP-PET. Further studies utilizing DTP-PET at different time points is needed to determine the optimal time parameters for maximal accuracy. 
	The measurement DTP-PET using SUVmean was much less reliable than SUVmax. One potential reason for this is the technical limitation of the software used to measure SUV in a ROI.  The software used in this study is only capable of drawing a circular ROI, while most tumors are irregular in shape.  This results in either including some surrounding non-tumor tissue in the ROI to encompass the entire tumor, or excluding some tumor tissue to avoid including any surrounding non-tumor tissue. This is also true of tumors with areas of necrosis, which are generally non-FDG avid.  This can drastically alter the calculated mean SUV, and renders this measurement unreliable for comparison.  SUVmax, on the other hand, indicates the maximum SUV of any pixel within the ROI, and is therefore not affected by the inclusion of surrounding non-tumor tissue, provided it is not FDG-avid, making its measurement reliable and fast.  It is possible that more sophisticated software that allows for creating a 3-dimensional ROI that conforms to the irregular borders of the tumor may make SUVmean a more accurate measurement. 
Conclusion
This pilot study demonstrated that 86% of primary tumors and 76% of cervical LN metastases were positive by DTP-PET using SUVmax. These findings justify further study of DTP-PET as a method of detecting tumor in initial staging and restaging of HNSCC after treatment to improve the accuracy of standard PET/CT.  Measurement of SUVmax was more reliable than SUVmean using current software. Uninvolved tonsil tissue and trapezius muscle are much less commonly positive by DTP-PET, consistent with the proposed mechanism of FDG accumulation in malignant cells over time. However, the role of this measurement as a negative control is unclear.  
Acknowledgement:
Drs Harirchian, Ghesani, and Cohen had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Ghesani, Cohen. Acquisition of data: Harirchian. Analysis and interpretation of data: Harirchian, Ghesani, Cohen. Drafting of the manuscript: Harirchian. Critical revision of the manuscript for important intellectual content: Ghesani, Cohen. Statistical analysis: Harirchian, Cohen. Administrative, technical, and material support: Ghesani, Cohen. Study supervision: Ghesani, Cohen. No financial support, disclosures, or conflicts of interest.  


References:
Gregoire V, Lefebvre JL, Licitra L, et al. Squamous cell carcinoma of the head and neck: EHNS-ESMO-ESTRO clinical practice guideline for diagnosis, treatment, and follow-up. Ann Oncol 2010; 21 (5): 184-6 
Zimmer LA, Branstetter BF, Nayak JV, et al. Current use of 18F-Flurodeoxyglucose positron Emission tomography and combined positron emission tomography and computed tomography in squamous cell carcinoma of the head and neck. Laryngoscope 2005; 115(11): 2029-34
Myers LL, Wax MK, Habi H et al. Positron emission tomography in the evaluation of the N0 neck. Laryngoscope 1998; 108: 232-36 
Wax MK, Myers LL, Gabalski EC, et al. Positron emission tomography in the evaluation of synchronous lung lesions in patients with untreated head and neck cancer. Arch Otolaryngol Head Neck Surg 2002; 128(6): 703-7
Teknos TN, Rosenthal EL, Lee D et al. Positron emission tomography in the evaluation of stage III and IV head and neck cancer. Head Neck 2011; 23: 1056-60
Subramaniam RM, Truong M, Peller P, et al. Fluorodeoxyglucose-Positron-Emission Tomography Imaging of Head and Neck Squamous cell Cancer.  AJNR 2010; 31: 598-604
Kubota R, Yamada S, Kubota K et al. Intratumoral distribution of fluorine-18-fluorodeoxyglucose in vivo: high accumulation in macrophages and granulation tissues studies by microautoradiography. J Nucl Med 1992; 33: 1972-80
Hustinx R, Smith RJ, Benard F et al. Duak time point fluorine-18-flurodeoxyglucose positron emission tomography: a potential method to differentiate malignancy from inflammation and normal tissue in the head and neck. Eur J Nucl Med 26: 1345-48 
Fishbein NJ, Aassar S, Caputo G et al. Clinical utility of positron emission tomography with 18-F-Fluorodeoxyglucose in detecting residual/recurrent squamous cell carcinoma of the head and neck. AJNR 1998; 19: 1189-96
Tan A, Adelstein DJ, Rybicki LA. Ability of positron emission tomography to detect residual neck node disease in patients with head and neck squamous cell carcinoma after definitive chemoradiotherapy. Arch Otolaryngol Head Neck Surg 2007; 133: 435-40
Ong SC, Schoder H, Lee NY et al.  Clinical utility of 18F-FDG PET/CT in assessing the neck after concurrent chemoradiotherapy for locoregional advanced head and neck cancer. J Nucl Med 2008; 49(4): 532-40 
Zhuang H et al. Dual time point 18F-FDG PET imaging for differentiating malignant from inflammatory processes. Journ Nuc Med 2011; 42(9): 1412-17
Chan W, Ramsay S, Szeto E et al. Dual time point 18F-FDG-PET/CT imaging in the assessment of suspected malignancy. Jour med Imaging Rad Onc 2011; 55: 379-90
Mavi A, Basu S, Cermik T et al. Potential of dual time point FDG-PET imaging in differentiating malignant from benign pleural disease. Mol Imaging Biol 2009; 11: 369-78
Suga K, Kawakami Y, Hiyama A et al. Dual-time point 18F-FDG PET/CT scan for differentiation between 18F-FDG-avid non-small cell lung cancer and benign lesions. Ann Nucl Med 2009; 23: 437-35
Nishiyama Y, Yamamoto Y, Fukunaga K et al. Dual-time point 18F-FDG PET for the evaluation of gallbladder carcinoma. J Nucl Med 2006; 47:633-38
Lan X, Zhang Y, Wu Z, Jia Q, et al. The value of dual time point 18F-FDG PET imaging for the differentiation between malignant and benign lesions. Clin Rad,DE�
�
�
�
�
	%67]^pq�������ʾ��ʗ��x�plp^L�=h�t�hW:�CJOJQJaJ#jh.90JCJOJQJUaJh6�0JCJOJQJaJh.9jh.9U$h�t�h�M�CJOJQJaJmHsHh}N�CJOJQJaJh6�CJOJQJaJh�t�hWK�CJOJQJaJhWK�CJOJQJaJh�M�CJOJQJaJh�t�h�M�CJOJQJaJh�t�h$u�CJOJQJaJh�<*CJOJQJaJh$u�CJOJQJaJE�`	
~

�
�
�
�
	%6r��
����������������������������������	d�gdHm$$a$gda<$a$gdH�	
��������



���ǻ���rbRB3h�t�h�&:CJOJQJaJh�t�h�&:>*CJOJQJaJh�h�{15�CJOJQJaJh�t�h05�CJOJQJaJh�D�5�CJOJQJaJh�t�hH>*CJOJQJaJh�M�>*CJOJQJaJh�t�h�M�>*CJOJQJaJhN7ha<CJOJQJaJh�}:CJOJQJaJhN7CJOJQJaJha<ha<CJOJQJaJha<h�M�CJOJQJaJha<hW:�CJOJQJaJ�����

h���V_~��	
����������������������������	d�gdHm$
!
G
c
m
hu������,46UV_agz}������൥������zkzkz�_P_��Dh�'�CJOJQJaJh�t�h�(�CJOJQJaJh�&�CJOJQJaJh�t�h�GKCJOJQJaJh�GKCJOJQJaJh�t�hb[lCJOJQJaJh�t�h�&:>*CJOJQJaJh�t�h"4>*CJOJQJaJh�t�h�{1>*CJOJQJaJh�t�h-)CJOJQJaJhr�CJOJQJaJh�t�h�&:CJOJQJaJh�t�h�&:CJH*OJQJaJ����,1~��������!"��������ֺ�֢֮��tgWH9h�t�hfKYCJOJQJaJh�t�h�G�CJOJQJaJh�t�h�&:5�CJOJQJaJh�D�5�CJOJQJaJh@*Qh�D�CJOJQJaJh@*Qh�D�CJOJQJaJh@*Qh�D�>*CJOJQJaJh�CJOJQJaJh�i�CJOJQJaJh�t�h�&:>*CJOJQJaJh�'�CJOJQJaJh�t�h�&:CJOJQJaJh�&�CJOJQJaJh�t�h-)CJOJQJaJ
"�o9 P m"�#d%�(�*�.�1�1����������������������
��d�`��gdq�m$
��d�`��gd��m$
��d�`��gd�;�m$
��d�`��gdHm$	d�gdHm$��������WXopr=COSVXf����������������җ��y�j�[�[L��h�t�hCJOJQJaJh�t�hk�CJOJQJaJh�t�h,OJCJOJQJaJh�t�h�2CJOJQJaJh�t�h9
ECJOJQJaJh�t�h{j�CJH*OJQJaJh�<*CJOJQJaJh�t�h$^CJH*OJQJaJh�t�h4B�CJOJQJaJh�t�hfKYCJH*OJQJaJh�t�hfKYCJOJQJaJh�t�h^8�CJOJQJaJ��Z[��
 #'23NQW[������պ���~o`TEoE6oh�t�hVgCJOJQJaJh�t�h�z�CJOJQJaJhOj�CJOJQJaJh�t�h�-
CJOJQJaJh�t�h*"oCJOJQJaJh�t�hKJCJOJQJaJh�t�h�s*CJOJQJaJh�t�hCJOJQJaJh�t�h�	JCJOJQJaJh^YMCJOJQJaJh�t�h3�CJOJQJaJh�t�hfKYCJH*OJQJaJh�t�hfKYCJOJQJaJh�UNCJOJQJaJ[���$KLem��������$(16���ĵĥ���xhxYJY�Y;J;�h�t�h9
ECJOJQJaJh�t�h�:CJOJQJaJh�t�h�jICJOJQJaJh�t�h�bCJH*OJQJaJh�t�h�`�CJOJQJaJh�t�hv6�CJOJQJaJh�t�hw/�CJOJQJaJh�t�h�K/CJH*OJQJaJh�t�h*"oCJOJQJaJh�t�h�h�CJOJQJaJh�t�h�
�CJOJQJaJh�t�h}^+CJOJQJaJh�t�hVgCJOJQJaJ6G]_no����jl�� ;C���ô����z���j[L=Lh*�hQ/�CJOJQJaJh*�h�d�CJOJQJaJh*�h��CJOJQJaJh�4hfKY5�CJOJQJaJh�t�h�:CJOJQJaJhPCJOJQJaJh�t�hfKYCJH*OJQJaJh�t�hfKYCJOJQJaJh�t�h�E�CJOJQJaJh�t�h*"oCJOJQJaJh�t�hSs�CJH*OJQJaJh�t�hSs�CJOJQJaJh�t�hH�CJOJQJaJCDU]^|�����������������SXY�������ʺ����sdsdsdsUs�Esh�t�hfKYCJH*OJQJaJh�t�hz~5CJOJQJaJh�t�h�:CJOJQJaJh�t�hfKYCJOJQJaJh
CJOJQJaJh�'FCJOJQJaJh�4h�F5�CJOJQJaJh�4h�d�5�CJOJQJaJh*�h��CJH*OJQJaJh!5�CJOJQJaJh*�hk9iCJOJQJaJh*�h�d�CJOJQJaJh0�CJOJQJaJYZ���9Bdy����8 9 P ^ _ ` � ���ɽ�埐��rcSD�D5h�t�hyz�CJOJQJaJh�t�hn4$CJOJQJaJh�t�hu<5�CJOJQJaJh�t�hu0�CJOJQJaJh�t�hPO~CJOJQJaJh�t�hk9iCJOJQJaJh�t�h�]�CJOJQJaJh�t�h�QzCJOJQJaJh�t�h�:CJOJQJaJh�r�CJOJQJaJh8q�CJOJQJaJh�t�hfKYCJH*OJQJaJh�t�hfKYCJOJQJaJh!w�CJOJQJaJ� � � � � � � � � � � !
!!(!+!B![!}!�!�!�!�!�!�!"������ĵ��ė����y��j[�jLh�t�h{,CJOJQJaJh�t�h�s�CJOJQJaJh�t�hkCJOJQJaJh�t�hVJ%CJOJQJaJh�t�h�iCJOJQJaJh�t�h�!�CJOJQJaJh�t�hvFCJOJQJaJh�t�h��CJOJQJaJh�t�h�
�CJOJQJaJh�t�hr�CJOJQJaJh�t�hn4$CJOJQJaJh�t�hk9iCJOJQJaJ"!"/"?"C"V"l"m"x"z"�"�"�"�"�"�"�"�"�"�"#�#�#�#�#����ӵ����y��y�yjyj[LyL�h�t�h�C�CJOJQJaJh�t�h�CJOJQJaJh�t�h��CJOJQJaJh�t�hk9iCJOJQJaJh�t�h�ZCJOJQJaJh�t�hdH�CJOJQJaJh�t�hr�CJOJQJaJh�t�h��CJOJQJaJh�t�h�>�CJOJQJaJh�t�hT;FCJOJQJaJh�t�h{,CJOJQJaJh�t�h9_CJOJQJaJ�#�#�#�#�#�#�#�#$$$$5$F$f$r$x$�$�$�$%���ĵ����y�j�[LyL=y=h�t�h�aCJOJQJaJh�t�h
�CJOJQJaJh�t�h�$�CJOJQJaJh�t�h�=(CJOJQJaJh�t�hk9iCJOJQJaJh�t�h�K�CJOJQJaJh�t�h=W�CJOJQJaJh�t�h7XVCJOJQJaJh�t�hvEyCJOJQJaJh�t�h`?�CJOJQJaJh�t�h�ZCJOJQJaJh�t�hh�CJOJQJaJh�t�h�>CJOJQJaJ%%%4%?%c%d%�%�%�%�%�%&&#&C&D&E&q&s&�&�&�&�&������ĸ������|��m]N�?�h�t�h�)]CJOJQJaJh�t�h�@�CJOJQJaJh�t�h�6�CJH*OJQJaJh�t�h�6�CJOJQJaJh�t�hOCJOJQJaJh�t�ht>�CJOJQJaJh�t�hDW�CJOJQJaJh�t�hQJQCJOJQJaJhSH�CJOJQJaJh�t�h,%
CJOJQJaJh��hQJQCJOJQJaJh�t�hk9iCJOJQJaJh�t�h�u�CJOJQJaJ�&�&�&�&''/'3'5'7'<'f'�'�'�'(((((N(j(�(�(�(�(�(�(�(�(�(�(����߱��ТГ��Є�uiuZuZuZuZuZh�t�h��CJOJQJaJh
	?CJOJQJaJh�t�hI~�CJOJQJaJh�t�hg]CJOJQJaJh�t�h2"CJOJQJaJh�t�hk9iCJOJQJaJh�t�hk9iCJH*OJQJaJh�t�hDW�CJOJQJaJh�t�hX�CJOJQJaJh�t�hNE?CJOJQJaJ"h�t�hk9ihk9iCJOJQJaJ�(�(5)�)�)�)�)�)�)G*�*�*�*+	+++���ĵĥĖ�{l]N?0h�t�h�e�CJOJQJaJh�t�hI~�CJOJQJaJh�t�h�H�CJOJQJaJh�t�h*�CJOJQJaJh�t�h1dCJOJQJaJh(�CJOJQJaJh�t�h$�CJOJQJaJh�t�h�: CJOJQJaJh�t�h�;kCJH*OJQJaJh�t�h�:CJOJQJaJh�t�h�;kCJOJQJaJh�t�h�U�CJOJQJaJh�t�h(DCJOJQJaJh�t�hQJQCJOJQJaJ+-+.+0+1+K+g+i+|+�+�+�+�+�+�+z,{,�,���ĵ����x�i�ZK<-h�t�hL>XCJOJQJaJh�t�h��CJOJQJaJh�t�h�>5CJOJQJaJh�t�hMc�CJOJQJaJh�t�h[|CJOJQJaJh�t�h1M�CJOJQJaJh�t�h� CJOJQJaJh�t�hy�CJH*OJQJaJh�t�hy�CJOJQJaJh�t�h98�CJOJQJaJh�t�h3q�CJOJQJaJh�t�h�H�CJOJQJaJh�t�hI~�CJOJQJaJh�t�h!?4CJOJQJaJ�,�,�,�,�,�,�,---..J.Z.\.f.t.�.�.�.�.�.�./��������񴥴���whwhwhYJh�t�h~'dCJOJQJaJh�t�h$�CJOJQJaJh�t�hb)�CJOJQJaJh�t�hb)�CJH*OJQJaJh�t�h�]tCJOJQJaJh�t�h�4CJOJQJaJh�t�h�6�CJOJQJaJh�t�h�=CJOJQJaJh�t�hI~�CJOJQJaJh�t�h�
�CJH*OJQJaJh�t�h�
�CJOJQJaJh�t�hz$�CJOJQJaJ/*/8/>/P/�/0j0�0�0�01�1�1�1�1�1�1�1�����ĵ�����yl\M>/h�t�h+MCJOJQJaJh�t�hF:CJOJQJaJh�t�h�U�CJOJQJaJh�]/hG0|5�CJOJQJaJh�]/5�CJOJQJaJhq�h�]/CJOJQJaJh�t�hEm
CJOJQJaJh�t�heN&CJOJQJaJh�t�h�rYCJOJQJaJh�t�h66CJOJQJaJh�t�hZm�CJOJQJaJh�t�ht#�CJOJQJaJh�t�hI~�CJOJQJaJh�t�h^{�CJOJQJaJ�12*2M2N2l2�2�2�2�2�2�2�2�2�24*4�4���ĵ����yj[yjyL=h�t�hUECCJOJQJaJh�t�h4EZCJOJQJaJh�t�h�^�CJOJQJaJh�t�h�:�CJOJQJaJh�t�h�
wCJOJQJaJh�t�h�8�CJOJQJaJh�t�hD�CJOJQJaJh�t�hZm�CJOJQJaJh�t�hHeCJOJQJaJh�t�h\"YCJOJQJaJh�t�hkdbCJOJQJaJh�t�h�]�CJOJQJaJh�t�hF:CJOJQJaJ�4�5�5�5�5�6�6�6�6�6�6�6�6�6�6�6�6�6�6�6�67����Ĵ�⥖▊{�o�`Q{Bh�t�hi:3CJOJQJaJh�t�h�,CJOJQJaJh�t�h�>CJOJQJaJhVg0CJOJQJaJh�t�h�Z�CJOJQJaJh�+RCJOJQJaJh�t�hCCJOJQJaJh�t�h�*�CJOJQJaJh�t�h��CJH*OJQJaJh�t�h��CJOJQJaJh�t�hF:CJOJQJaJh�t�h�:�CJOJQJaJh�t�hUj�CJOJQJaJ�1�5�:�;�@�C�C!FJJ'M5T�W�Y�]Y`f�in)n�p�p��������������������
��d�`��gd�um$
��d�`��gd�m$
��d�`��gd�3�m$
��d�`��gdiCVm$
��d�`��gdHm$	d�gd�1(m$	d�gdHm$788&8,8T8�8�8�8�8�8�8�8~9�9�9�9�9::���Ѳ�����ym^N^B3Bh�t�hkCJOJQJaJh6ECJOJQJaJh�t�h�:�CJH*OJQJaJh�t�h�:�CJOJQJaJh�}�CJOJQJaJh�t�hsBCJOJQJaJh�t�h�r/CJOJQJaJh�^�CJOJQJaJh�t�h�:�CJOJQJaJh�t�hm(|CJOJQJaJh�t�hXKfCJH*OJQJaJh�t�hXKfCJOJQJaJh�t�hi:3CJOJQJaJh�t�hi:3CJH*OJQJaJ::@:C:P:T:V:W:X:\:q:y:�:�:�:�:�:�:�:�:�������墓�uf�WH9h�t�h�:�CJOJQJaJh�t�h)�CJOJQJaJh�t�h�{%CJOJQJaJh�t�h�I CJOJQJaJh�t�hc �CJOJQJaJh�t�h[eDCJOJQJaJh�t�h�kCJOJQJaJh�t�h�>CJOJQJaJhU]�CJOJQJaJh�t�h(CJOJQJaJh�fCJOJQJaJh(CJH*OJQJaJh(CJOJQJaJh�t�h�u�CJOJQJaJ�:�:�:�:�:�:�:;;;;;;;.;2;D;J;L;S;U;Y;[;\;];��ο���������vfv���Z�ZN�h.OoCJOJQJaJh�j�CJOJQJaJh�t�hYcCJH*OJQJaJh�t�hYcCJOJQJaJhU]�CJOJQJaJh�t�h�:�CJOJQJaJh�t�h�^JCJOJQJaJh�t�h:TdCJH*OJQJaJh�t�h:TdCJOJQJaJh�t�h�>UCJOJQJaJ"h�t�h�:�h�:�CJOJQJaJh�t�h�:�CJH*OJQJaJ];e;f;h;x;~;�;�;�;�;�;�;�;�;�;�;�;�;�;�;���Ǹ������p�apRC4h�t�h�>nCJOJQJaJh�t�h�K�CJOJQJaJh�t�h)�CJOJQJaJh�t�h�8�CJOJQJaJh�t�hrn�CJOJQJaJh�t�h��CJOJQJaJh�t�h`�CJOJQJaJh�t�hc �CJOJQJaJh�v�CJOJQJaJh�t�h�:�CJOJQJaJh.OoCJOJQJaJh�t�hYcCJOJQJaJh�t�h|O�CJOJQJaJh�t�h2f�CJOJQJaJ�;�;�;�;�;9<N<Y<|<�<�<�<�<�<�<�<�<�<����⵩⚋|l|]N?3hb�CJOJQJaJh�t�h<�CJOJQJaJh�t�h�sBCJOJQJaJh�t�h!@CJOJQJaJh�t�hERCCJH*OJQJaJh�t�hERCCJOJQJaJh�t�hC�CJOJQJaJh�t�hw�CJOJQJaJhH[yCJOJQJaJh�t�hy�CJOJQJaJh�t�h�/bCJOJQJaJh�t�h�cUCJOJQJaJh�t�h�>nCJOJQJaJh�t�h	V�CJOJQJaJ�<�<�<�<�<==!=(=,=.=4=7=>=?=G=H=J=K=�=�=�=�=�=���ʻ���������~o�ocWHWHh�t�h�CJOJQJaJh�&�CJOJQJaJh�PiCJOJQJaJh�t�hy�CJOJQJaJh�t�h2f�CJOJQJaJh�t�hLUBCJOJQJaJh�t�hY
�CJOJQJaJh�t�hS/^CJH*OJQJaJh�t�hS/^CJOJQJaJh�t�h�sBCJOJQJaJhb�CJOJQJaJh�t�h<�CJOJQJaJh�J&CJOJQJaJ�=�=�=�=>>>(>*>.>L>R>l>�>�>�>�>�>�>�>���ƺ���~o_oPA5AP5Ah�0xCJOJQJaJh�t�h�sBCJOJQJaJh�t�hRCJOJQJaJh�t�h�ICJH*OJQJaJh�t�h�ICJOJQJaJh�t�h�w�CJOJQJaJh�t�hy�CJOJQJaJh�t�h�C�CJOJQJaJh�t�h2f�CJOJQJaJhg�CJOJQJaJh�t�h�1(CJH*OJQJaJh�t�h�1(CJOJQJaJh�1(CJOJQJaJh�t�h��CJOJQJaJ�>�>v?�?�?�?�?#@)@-@7@;@=@�@�@�@�@�@=A���Ǹ���{l]lQB3h�t�h�V*CJOJQJaJh�t�h�H�CJOJQJaJhEv9CJOJQJaJh�t�h�:CJOJQJaJh�t�h�U�CJOJQJaJh�t�h�+wCJOJQJaJh�t�h^X
CJH*OJQJaJh�t�h��CJOJQJaJh�t�h^X
CJOJQJaJh�t�h�-GCJOJQJaJh�t�h�CJOJQJaJh�t�h�kYCJOJQJaJh�t�h�w�CJOJQJaJh0V�CJOJQJaJ=AUAnAoApAxA{A�A�A�A�A�A�A�A�A�A�A�A�A�A�A�A�A�A�A�A�A������Ӵӥ���{�l\l�l�Pl�P�h�6ECJOJQJaJh�t�h>[:CJH*OJQJaJh�t�h>[:CJOJQJaJh�@�CJOJQJaJh�t�h�s�CJOJQJaJh�t�hcJ_CJOJQJaJh�t�h��CJOJQJaJh�t�h�:CJOJQJaJh�t�h�eTCJH*OJQJaJh�t�h�eTCJOJQJaJh�t�h�V*CJOJQJaJh�t�hhZ
CJOJQJaJ�A�A�A�A�AZBjBmB�B�B�B�B�B�B�B�B�B�B�B�B�B�B���ǻǬ����u�u��f�WGWh�t�h�Y�CJH*OJQJaJh�t�h�Y�CJOJQJaJh�t�h�C�CJOJQJaJho�CJH*OJQJaJho�CJOJQJaJh�t�h��CJOJQJaJh�t�h�:CJOJQJaJh�t�h�y�CJOJQJaJh�G�CJOJQJaJh�6ECJOJQJaJh�t�h>[:CJOJQJaJh�t�hg�CJOJQJaJh�t�h2f�CJOJQJaJ�BCCCCCC$C'C9C;CCCECICJCKCLCcCfCC�C�C�C�C�C�C�C�������ô�����ӥ����qaqRCqh�t�h�PCJOJQJaJh�t�hu�CJOJQJaJh�t�h�!�CJH*OJQJaJh�t�h�!�CJOJQJaJh�|CJOJQJaJh�O�CJH*OJQJaJh�O�CJOJQJaJh�t�h�!�CJOJQJaJh�t�h�-�CJOJQJaJh�t�h�Y�CJH*OJQJaJh�t�h�Y�CJOJQJaJh�t�hcJ_CJOJQJaJh�t�h�?iCJOJQJaJ�C�C�C�C�D�D�DAE_EaEbEcEoEwExE�E F!FtFuFwF|F�F�F�F�F���²�£���ymyay�£���R�Ch�t�h�%CJOJQJaJh�t�h�:CJOJQJaJh�SzCJOJQJaJh�=�CJOJQJaJh�t�h��CJOJQJaJh�/ CJOJQJaJh�t�hu�CJOJQJaJh�t�hDACJOJQJaJh�t�hDACJH*OJQJaJh�t�hubCJOJQJaJh�?DhKQ�5�CJOJQJaJh�t�hKQ�5�CJOJQJaJh�t�hF:CJOJQJaJ�FG
GG9GPG�G�G�G�G�G�G�G�G�G�G�G$H?H���ĸ�����|m]mN>N/h�t�hZI�CJOJQJaJh�t�h'LCJH*OJQJaJh�t�h'LCJOJQJaJh�t�h�=CJH*OJQJaJh�t�h�=CJOJQJaJh�t�h�2CJOJQJaJh�t�hB �CJOJQJaJh�t�h�2�CJOJQJaJh�t�hA_CJOJQJaJh[oCJOJQJaJh�t�hyp�CJOJQJaJh�t�hokCJOJQJaJh�t�h<2CJOJQJaJh�t�hK|�CJOJQJaJ?HAHUHVHXH[H\H�H�H�H�H�H�H�H�HxIzII�I����࢓���t�eVFV7h�t�hrj�CJOJQJaJh�t�h�[`CJH*OJQJaJh�t�h�[`CJOJQJaJh�t�hnI�CJOJQJaJh�t�hu<CJH*OJQJaJh�t�h�|6CJOJQJaJh�t�hu<CJOJQJaJh�t�h�z�CJOJQJaJh�t�h�|6CJH*OJQJaJh�t�h�urCJH*OJQJaJh�t�h�urCJOJQJaJh�t�hZI�CJOJQJaJh�t�hZI�CJH*OJQJaJ�I�I�I�I�I�I�IJJ;J=JIJJJ�J
KKKIK�������|m^N?0h�t�h�T�CJOJQJaJh�t�h�>�CJOJQJaJh�t�h�4�CJH*OJQJaJh�t�h�4�CJOJQJaJh�t�h�{�CJOJQJaJh�t�h�
CJOJQJaJh�t�h�
DCJH*OJQJaJh�q�CJH*OJQJaJh�q�CJOJQJaJh�t�h�
DCJOJQJaJh�t�hEv�CJOJQJaJh�t�hrj�CJH*OJQJaJh�t�hrj�CJOJQJaJh�t�hd	tCJOJQJaJIKZKbK�K�K�K�K�K�K�K�K�K�K�K�K�K-L5LCLDLGLZL[L]L^L����ӵⵦ����{�l�l]�]lM>h�t�h&CCJOJQJaJh�t�h&CCJH*OJQJaJh�t�h�o�CJOJQJaJh�t�h�\�CJOJQJaJh:pCJOJQJaJh�t�h��CJOJQJaJh�t�h�<YCJH*OJQJaJh�t�h�<YCJOJQJaJh�t�h�6CJOJQJaJh�t�h�^�CJOJQJaJh�t�h�T�CJOJQJaJh�t�h��CJOJQJaJh�t�h��CJOJQJaJ^L�L$M&M'M-MGMUM]M^MbMhMiM�M�M�M�M�MN#N�N���ô���������xi�ZK<h�t�h�X�CJOJQJaJh�t�h^cCJOJQJaJh�t�h3�CJOJQJaJh�t�h�NCJOJQJaJh�t�h�x�CJOJQJaJh�t�h�WpCJOJQJaJh�t�h��CJOJQJaJh�t�h��CJOJQJaJh�t�h�-oCJOJQJaJh�t�h�T�CJOJQJaJh�t�h�O�CJH*OJQJaJh�t�h`"�CJOJQJaJh�t�h�>�CJOJQJaJ�N�N�N�N�N�NLOeO�OP
PPPvP�P�P�P�P�P���������ueV�VFV7h�t�h27CJOJQJaJh�t�h�s�CJH*OJQJaJh�t�h�`OCJOJQJaJh�t�hB.}CJH*OJQJaJh�t�hbNCJH*OJQJaJh�t�h�DCJOJQJaJh�t�h��CJOJQJaJh�t�hbNCJOJQJaJh�t�h�>zCJOJQJaJh�t�h�%�CJH*OJQJaJh�t�h�%�CJOJQJaJh�t�h�X�CJOJQJaJh�t�h3+�CJH*OJQJaJ�PQRRR�R�R�R<S>S?S�S�S�S�ST4T5TATgT�T����ô�����z�nz�_PAh�t�hmp�CJOJQJaJh�t�h�G<CJOJQJaJh�t�h�5CJOJQJaJh`2UCJOJQJaJhQbQCJOJQJaJh�t�h��CJOJQJaJh�t�hbNCJH*OJQJaJh�t�h��CJOJQJaJh�t�hbNCJOJQJaJh�t�h�|CJOJQJaJh�t�h�o�CJH*OJQJaJh�t�h`pCJOJQJaJh�t�h<VCJOJQJaJ�T�T�T�T�T�T�TU+U-U.U8ULUMUZU[U\UfUVnVrV�V����ԵԦ����xi�Zi�iJ;h�t�h]�CJOJQJaJh�t�h�f�CJH*OJQJaJh�t�hL�CJOJQJaJh�t�h7�CJOJQJaJh�t�h]CJOJQJaJh�t�h8&CJOJQJaJh�t�h��CJH*OJQJaJh�t�h�gnCJOJQJaJh�t�h�(zCJH*OJQJaJh�t�h�?DCJOJQJaJh�t�h�(zCJOJQJaJh�t�hmp�CJOJQJaJh�eCJH*OJQJaJ�V�V,W�W�W}X�X�X�X�X�X�X�X�X�X&YBYnYoY�Y�Y�Y�Y�Y�Y�Y�Y���ĵ���������v�vjvjv^R�C�h�t�h��CJOJQJaJh�CJOJQJaJhFkuCJOJQJaJho#CJOJQJaJh�t�h�2CJOJQJaJh�NdCJOJQJaJh4^�CJOJQJaJh�2CJOJQJaJhs&CJOJQJaJh�t�ho1CJOJQJaJh�t�h�[�CJOJQJaJh�t�hbsCJOJQJaJh�t�hKT�CJOJQJaJh�t�h�C0CJOJQJaJ�Y�Y�YZZZZVZfZlZ�Z�Z�Z�Z�Z�Z�ZH[P[�[\\\\!\'\9\���ŶԪ��Ŏr�r�f�Z�Z�J��h�t�hO^�CJH*OJQJaJhiCVCJOJQJaJhsECJOJQJaJh47�CJH*OJQJaJh�t�h47�CJOJQJaJh47�CJOJQJaJh�t�h>Y�CJH*OJQJaJh�Q�CJOJQJaJh�t�h��CJOJQJaJh�t�hO^�CJOJQJaJh�CJOJQJaJh�t�ho1CJOJQJaJh�t�ho1CJH*OJQJaJ9\<\F\S\m\p\r\�\�\�\�\�\�\�\�\�\�\�\]
]]"]i]�]�]�]���Ǹ���񩙍~q�eq�Y�Y�e�Jh�t�h#tSCJOJQJaJhc>�CJOJQJaJhiCVCJOJQJaJh�-LCJH*OJQJaJh�t�h�-LCJOJQJaJh�-LCJOJQJaJh�t�hdaeCJH*OJQJaJh�t�hdaeCJOJQJaJh�t�h�|vCJOJQJaJh��CJOJQJaJh�t�hO^�CJOJQJaJh�t�h��CJOJQJaJh�t�hF�CJOJQJaJ�]�]�]�]�]�]�]�]�]^
^=^H^R^]^_^8_:_B_G_I_S_]_a_b_�_�_�_�_�_W`�������������񖇖�x�x�i]M]hq5�hq5�CJH*OJQJaJhq5�CJOJQJaJh�t�hq5�CJOJQJaJh�t�h�v�CJOJQJaJh�t�h��CJOJQJaJh8CJOJQJaJhiCVCJOJQJaJh�KqCJH*OJQJaJh�KqCJOJQJaJh�t�h�f%CJOJQJaJh�-LCJOJQJaJh�t�h#tSCJOJQJaJh�t�h�p�CJOJQJaJW`X`Y`]`e`h`k`{`�`aa
aa'a3a6a9a�a"bXb�b����ӷӫǟӐӄueYJ>Jh�9zCJOJQJaJh�t�hQ)CJOJQJaJh[l�CJOJQJaJh�t�h�C�CJH*OJQJaJh�t�h�C�CJOJQJaJh�C�CJOJQJaJh�t�hGHCJOJQJaJh];QCJOJQJaJh\vCJOJQJaJh�t�hA �CJH*OJQJaJh.sCJOJQJaJh�t�hA �CJOJQJaJh�t�h��CJOJQJaJh�t�h��CJOJQJaJ�b�b�b�b�bc*cBcpc�c�c�c
dddd$d�d�d�d�d������败�����~n~_PDh	y;CJOJQJaJh�t�h�6�CJOJQJaJh�t�hGHCJOJQJaJh�t�hn
�CJH*OJQJaJh�t�hn
�CJOJQJaJh�CJOJQJaJh�a�CJOJQJaJh�t�h!?MCJOJQJaJh�t�hQ)CJOJQJaJh�o�CJOJQJaJh0i�CJOJQJaJh*+�CJH*OJQJaJh*+�CJOJQJaJhz~KCJOJQJaJ�deeJefff6fSf�f�f�fOg�g�g�g�g�g�g���ƺ����~qeYLY@3@h`D`CJH*OJQJaJh`D`CJOJQJaJh�OICJH*OJQJaJh�OICJOJQJaJh��CJOJQJaJhBZ�CJH*OJQJaJh�cCJOJQJaJhs�CJOJQJaJh�K�CJOJQJaJh�G�CJOJQJaJh�CJOJQJaJh�CJOJQJaJh�t�h!?MCJOJQJaJh	y;CJOJQJaJh�t�h	y;CJH*OJQJaJh�t�h	y;CJOJQJaJ�gBhDhEh�h�h�h�h?i�i�i�i�ijjwjxj�j�jwlzl�m�mnn(n��������z�z�n�n�z�z�_Oh�t�h�/�5�CJOJQJaJh�h�CJOJQJaJh�CJOJQJaJh�t�h�CJH*OJQJaJh�t�h�CJOJQJaJhnQh�CJOJQJaJh|N�CJOJQJaJh�t�h�1�CJOJQJaJhaN�CJOJQJaJh��CJOJQJaJh�OICJOJQJaJhj
�CJH*OJQJaJhj
�CJOJQJaJ(n)n.n:nLnNnbncndnhn�n�n�n`oposovowo�o�o�opjpnp�p�p�p�p���¶�˜�‰y��y��y�j[j�Kh}@h}@5�CJOJQJaJh�t�h!?MCJOJQJaJh�t�h�pCJOJQJaJh�t�h-)CJH*OJQJaJh�t�h-)CJOJQJaJh�t�h#h�CJOJQJaJh�t�h�/�CJOJQJaJho�CJOJQJaJh�t�h�[hCJOJQJaJh�t�h�JOCJOJQJaJh�t�h(`CJOJQJaJh�?Dh�/�5�CJOJQJaJ�p�p�plq�q�q�q�q�q�q�q�q�q�qrr rhrvrxr�r�r�r�r�r�r�r�rsBsCsDsEsFs���ƶ�����ƶ�ơ�ƶ�ơ��ƶ�ƶo�cWhMR�CJOJQJaJh}@CJOJQJaJh�mB*CJOJQJaJph)%&h9�B*CJOJQJaJph)%&"h�fmB*CJOJQJ]�aJph)%&(h}@h}@B*CJOJQJ]�aJph)%&h�fmB*CJOJQJaJph)%&+h}@h}@6�B*CJOJQJ]�aJph)%&h}@B*CJOJQJaJph)%&%h}@h}@B*CJOJQJaJph)%&!�pDsEsFsRst$u�uyvw�w�x�yfza{/|�|^}~�~T���^����������������������������
&Fd�gdH	d�gdHm$d��7$8$H$gd}@FsQsRsvs}st	t.tItZt\tuu�u�u�u�uEvdv�vw*w=w�w�wxxyx�xpy~y�yNzSzezfz����д��ФддИддИдЉддЉy�jh�t�h�K/CJOJQJaJhSuhVL<6�CJOJQJaJh�t�hVL<CJOJQJaJh�4�CJOJQJaJh�t�h�`!CJH*OJQJaJhSuh�`!6�CJOJQJaJhe3�CJOJQJaJh�t�h�`!CJOJQJaJh�?Dh�`!5�CJOJQJaJh�t�h�`!5�CJOJQJaJ#fz�z�z/{N{U{X{`{a{||.|�|�|4}L}�}�}�~�~9C]v������������ô���whXhXhXhXhXhLhXJhXUh�Q�CJOJQJaJh'?Oh�`!6�CJOJQJaJh�t�h�`!CJOJQJaJh�t�h�D�CJOJQJaJhSuh�D�6�CJOJQJaJh�t�h�bCJOJQJaJh�t�h�N%CJOJQJaJh�t�h(:CJOJQJaJh�t�h1=)CJOJQJaJhSuhSs�6�CJOJQJaJh�t�h�4cCJOJQJaJh�t�hSs�CJOJQJaJ 2008; 63: 756-64
Demura Y, Tsuchida T, Ishizaki T et al. 18F-FDG accumulation with PET for differentiation between benign and malignant lesions in the thorax. Journ Nuc Med 2003; 44(4): 540-48
Tian R, Su M, Tian Y et al. Dual-time point PET/CT with F-18 FDG for the differentiation of malignant and benign bone lesions. Skelet Rad 2008; 38: 451-58 
Shum W, Hsieh T, Yeh J et al. Clinical usefulness of dual-time FDG PET-CT in assessment of esophageal squamous cell carcinoma. Eur J Radiol 2011; 
Gallagher BM, Fowler JS, Gutterson NI et al. Metabolic trapping as a principle of radiopharmaceutical design: some factors responsible for the biodistribution of [18F] 2-deoxy-2-fluoro-D-glucose. J Nucl Med 1978; 19: 1154-61
Nelson CA, Wang JQ, Leav I, et al. The interaction among glucose transport, hexokinase, and glucose-6-phosphatase with respect to 3H-2-deoxyglucose retention in murine tumor models. Nucl Med Biol. 1996; 23: 533-41
Suga K, Kawakami Y, Hiyama A, et al. Differentiation of FDG-avid loco-regional recurrent and compromised benign lesions after surgery for breast cancer with dual-time point F-18-fluorodeoxy-glucose PET/CT scan. Ann Nucl Med 2009; 23: 399-407
Yen T, Chang Y, Chan S, et al. Are dual-phase 18F-FDG PET scans necessary in nasopharyngeal carcinoma to assess the primary tumour and loco-regional nodes? Euro Jour Nucl Med Molec Imaging 2005; 32(5): 541-47
Jones HA, Cadwallader KA, White JF, et al. Dissociation between respiratory burst activity and deoxyglucose uptake in human neutrophil granulocytes: implications for interpretation of F-18 FDG PET images. J Nucl Med 2002; 43: 652-7
Deichen JT, Prante O, Gack M, et al. Uptake of F-18 fluorodeoxyglucose in human monocyte-macrophages in vitro. Euro J Nucle Med 2003; 30: 267-73 
Yamada S, Kubota K, Kubota R et al. High accumulation of fluorine-18-flurodeoxyglucose in turpentine-induced inflammatory lesions. J Nucl Med 1995; 36: 1301-06
Ma SY, See LC, Lai CH et al. Delayed 18F-FDG PET for detection of paraaortic lymph node metastases in cervical cancer patients. J Nucl Med 2003; 44: 1775-83
Wong C, Noujaim D, Fu H, et al. Time sensitivity: a parameter reflecting tumor metabolic kinetics by variable dual-time F-18 FDG PET imaging. Mol Imaging Biol 2009; 11: 283-90
Hamberg LM, Hunter GJ, Alpert NM et al. The dose uptake ratio as an index of glucose metabolism: useful parameter or oversimplification? J Nucl Med 1994; 35: 1308-12






Figure legends: 
Figure 1:  Early and delayed PET images were reviewed on a computer monitor in the axial, sagittal, and 	coronal planes. CT images were used for anatomic correlation.  A region of interest (black arrow) 	was drawn around the entire 18F-FDG avid lesion. Mean and maximum SUVs were then measured. 
Figure 2: SUVmax over time for primary tumor
Figure 3: SUVmax over time for cervical lymph node metastases
Figure 4: SUVmax over time for tonsil
Figure 5: SUVmax over time for trapezius 

















 PAGE   \* MERGEFORMAT 19




��A�K����(�����������T�U������������{���������óã�Ҕ��t�eVJV:h'?Oh�` 6�CJOJQJaJh�Q�CJOJQJaJh�t�h�` CJOJQJaJh�t�h�`wCJOJQJaJh'?Ohrj�6�CJOJQJaJh�t�hrj�CJH*OJQJaJh�t�hrj�CJOJQJaJh'?Oh�q�6�CJOJQJaJh�t�h�q�CJH*OJQJaJh�t�h�q�CJOJQJaJh�t�h�|6CJOJQJaJh'?Oh�`!6�CJOJQJaJh�t�h�`!CJOJQJaJ�����k�S����"��x�y�z�{�|�}�~������"�H�r�s�t�u�v�w���������������������������d�gdTwgdMR�d�gd�
&Fd�gdH������6�V�k�����8�B�S�h�v�����h�r�s����������⳧������x��iYiJih�t�h
�CJOJQJaJhN�h�(z6�CJOJQJaJh�t�h�(zCJOJQJaJhN�hA6�CJOJQJaJh�t�hACJOJQJaJhN�h�X�6�CJOJQJaJh�Q�CJOJQJaJh�t�h�X�CJOJQJaJh'?Oh`"�6�CJOJQJaJh�t�h`"�CJH*OJQJaJh�t�h`"�CJOJQJaJh�t�h�` CJOJQJaJ��������"�;�������[�e�w�x�z�~�����w������Ŷ������ui�\L=h[[hMR�CJOJQJaJh[[hMR�>*CJOJQJaJhMR�>*CJOJQJaJh�CJOJQJaJhfwACJOJQJaJh;k6�CJOJQJaJh;kCJOJQJaJh� CJOJQJaJhm'�h�f�6�CJOJQJaJh�t�h�f�CJOJQJaJh�CJOJQJaJhN�h� 6�CJOJQJaJh�t�h� CJH*OJQJaJh�t�h� CJOJQJaJw�y�������������/�2�U�X�r�t�{�|�~���������������������������������������ଠ�����������q�m��h.9jh�t�UmHnHuh�mHnHuh�t�jh�t�Uh�:^jh�:^Uh��CJOJQJaJh�CJOJQJaJh[[hMR�CJH*OJQJaJhTwCJOJQJaJhMR�CJOJQJaJh[[hMR�CJOJQJaJh[[hMR�CJH*OJQJaJ!w�x�y�z�{�}�~����������������������������������������$a$	d��gd�t�d�gd�21�h:pKA"��/ ��=!��"��#��$��%�������j���������666666666vvvvvvvvv666666>666666666666666666666666666�6666666666�666666666666hH66666666666666666666666666666666666666666666666666666666666666666�62���� 0@P`p������2(�� 0@P`p������ 0@P`p������ 0@P`p������ 0@P`p������ 0@P`p������ 0@P`p��8X�V~ OJPJQJ_HmH	nH	sH	tH	J`�JNormald��CJ_HaJmH	sH	tH	DA`�DDefault Paragraph FontRi@�R
0Table Normal�4�
l4�a�(k �(
0No List@�@�@�G� List Paragraph	^��m$R�@R	*"o0Balloon Textd��CJOJQJ^JaJN�o�N*"o0Balloon Text CharCJOJQJ^JaJT�o�"T�M�Medium Grid 21CJPJ_HaJmH	sH	tH	L�`�2L�M�
No SpacingCJPJ_HaJmH	sH	tH	6U`�A6�M�0	Hyperlink>*B*ph�>R>�t�0Headerd���H�$.��a.�t�0Header Char> @r>�t�0Footerd���H�$.���.�t�0Footer Charx�@��x�k��
Table Grid7:V�0������d��PJ<�o�<}@superscript1CJEHaJPK!����[Content_Types].xml���N�0E�H���-J��@%�ǎǢ|�ș$�ز�U��L�TB� l,�3��;�r��Ø��J��B+$�G]��7O٭V��<a���(7��I��R�{�pgL�=��r���8�5v&����uQ�뉑8��C����X=��$␴�?6N�JC������F�B.ʹ'�.�+���Y�T���^e5�5�� ��ð�_�g -�;�����Yl�ݎ��|6^�N��`�?���[��PK!�֧�6_rels/.rels���j�0���}Q��%v/��C/�}�(h"���O�
����=������ ����C?�h�v=��Ʌ��%[xp��{۵_�Pѣ<�1�H�0���O�R�Bd���JE�4b$��q_����6L�R�7`������0̞O��,�En7�Li�b��/�S���e��е�����PK!ky���theme/theme/themeManager.xml�M
� @�}�w��7c�(Eb�ˮ��C�AǠҟ����7��՛K
Y,�
�e�.���|,���H�,l����xɴ��I�sQ}#Ր���� ֵ+�!�,�^�$j=�GW��)�E�+&
8���PK!0�C)��theme/theme/theme1.xml�YOo�6��w toc'vu�ر�-M�n�i���P�@�I}��úa��m�a[�إ�4�:lЯ�GR��X^�6؊�>$�������!)O�^�r�C$�y@�����/�yH*��񄴽)�޵��߻��UDb�`}"�qۋ�Jח���X^�)I`n�E���p)���li�V[]�1M<������O�P��6r�=���z�gb�Ig��u��S�eb��O������R�D۫����qu	�g��Z����o~ٺlAp�lx�pT0���+[}`j���zA��V�2�F���i�@�q�v�֬5\|��ʜ̭N��le�X�ds���jcs���7���f����
��W��+�Ն�7����`���g�Ș��J���j|��h(�K��D-����
dX��iJ�؇(��x$(��:��;�˹!�I_�T��S1�����?E��?�����?ZBΪm���U/������?�~����xY���'���y5�g&΋/����ɋ�>���G�M�Ge���D�����3Vq%'#q�����$�8��K�����)f�w9:ĵ��
x}r�x����w���r�:\TZaG�*�y8I�j�bR��c|XŻ�ǿ�I
u3KG�nD1�NIB�s���
��R��u���K>V�.EL+M2�#'�f��i~�V��vl�{u8��z��H�
�*���:�(W�☕
~��J�T�e\O*�tHG��HY��}KN�P�*ݾ˦���TѼ�9/#��A7�qZ��$*c?���qU��n��w�N��%��O��i�4=3��N���)cbJ
u�V�4����(Tn���
7��_?���m-ٛ�{U���B�w�<w���_���$�#��[Ի�8{���(�/�$Ϫ0h݋�F۴��®{L�)#7�i�%�=A�:s�$�),��Qg20pp��f
\}DU4�p
M{��DB��%J������+{�l�C���]��=��5
2F��hsF+��Y��\Ɉ�n�ì��:3���E�[��6�9����`��&45Z!��*��5k8�`Fmw��-��"�d>�z��n���ʜ"Z��x��J�Z��p;�������{/�<�P;��,)''K�Q�k5���q��pN��8�K�Gb�e���
�S��d�̛�\17	�p�a�>��SR!���

3��K4'+�r�zQ
TT��I����Ivt]K�c⫲�K#�v�5+�|��D������~��O@%\w���_�nN[�L��9K���q��g�V�h��n
R!�y+��U�n�;�*&�/H�r��T�	�>��>\
�t��=.Tġ
���S; Z�~�!����P��9gi���C�ڧ!�#	B��,��;�X=ۻ,I�2UW�V�9$l�k���=A��j���;�{�A�P79�|s*Y�����;�̠�[�MC�ۿ�hf��]o��{oY=1k�yV��V���5E8�Vk+֜���\8���0X4D)�!!��?*|f�v�
u���"�x��A�@T_������q��6�4)kڬu�V�7��t�'��%;���i�9s�9�x���,��ڎ-45x�d���8?�ǘ�d�/Y|t��&LIL�J`�& �-G�t�/��PK!
ѐ��'theme/theme/_rels/themeManager.xml.rels��M
�0���wooӺ�&݈Э���5
6?$Q��
�,.�a��i����c2�1h�:�q��m��@RN��;d�`��o7�g�K(M&$R(.1�r'J��ЊT���8��V�"��AȻ�H�u}��|�$�b{��P����8�g/]�QAsم(����#��L�[������PK-!����[Content_Types].xmlPK-!�֧�60_rels/.relsPK-!ky���theme/theme/themeManager.xmlPK-!0�C)���theme/theme/theme1.xmlPK-!
ѐ��'�	theme/theme/_rels/themeManager.xml.relsPK]�
<?xml version="1.0" encoding="UTF-8" standalone="yes"?>
<a:clrMap xmlns:a="http://schemas.openxmlformats.org/drawingml/2006/main" bg1="lt1" tx1="dk1" bg2="lt2" tx2="dk2" accent1="accent1" accent2="accent2" accent3="accent3" accent4="accent4" accent5="accent5" accent6="accent6" hlink="hlink" folHlink="folHlink"/>yv����	+++.�
���[6CY� "�#%�&�(+�,/�1�47:�:];�;�<�=�>=A�A�B�C�F?H�IIK^L�N�P�T�V�Y9\�]W`�b�d�g(n�pFsfz������w���@BDEGHIJKLMNOPQRSTUVWYZ[\]^_`abcdefghijklmnopqrstuvxy������1�p�w���ACFXw��6]pyvX���$'.!�����L�#����@�����������0�(	�
��B
�S����	?�EJKU�������	 $ru[i#1��CL#,/�"�"�#$�$�$�$�$�$�$�$�$�%�%�%�%�%�%''�)�)s*y*�*�*]+c+�+�+,	,K,R,�,�,0.6.�.�.t/z/�/�/�/0�0�0�1�1*202333$3\3b3�3�3�3�344�7�7�7�7�;�;z=�=?
?�CDcFlF�G�GHH<HBH�HI�I�I�I�I�J�JGMMMNNKOQO�O�O_PeP;QDQnQrQ�T�T�T�TVW\W�X�X�Y�YRZXZpZwZ�[�[�[�[�[�[h\o\�\�\�\�\�\�\�\]J]Q]p]z]�]�]�]�]4^<^M^T^�^�^___!_``�`�`,a7aBaFa[aaa�abbb!b3b�b�bEcYc]cacxcc�c�c�c�cRdUdXd\dndvd{d�dOeXe]ede�eff!f,f0fCfFfKfRf�f�f�f�f�f�fgg�g�g�g�g�g�g+h.h@hDhHhLhPhVh�h�h�h�h�h�h�hi�i�i�i�i�i�ij!j6j9jLjOj�j�j�j�j�j�j�jkqkvkwkzk�k�k�k�kll@lCl�l�l�l�l�l�lQm`m�m�m�m�mYn]nyn}n�n�nPoTo�o�oppppFpQp�p�pqq$q+q0q6q:q>qXqjq�q�q;r?r�r�r�r�r�rs�s�s�s�s�s�s.t2tNtNt�u�u�u�u�uv#v)vLvNvOvQvRvTvUvWvXvwvzv	$ru����������$�$�8�8�B�BUDXD�U�U�\]ii6j9jnWnFoJo�o�oMtOtLvNvOvQvRvTvUvWvXvwvzv33333333333333333NtNtLvXvtvzv6o)pw2\�����������8pw2\���������bvBpw2\���������7~�Gpw2\��������������^��`���o()������^��`���.��p�L�^�p`�L�.��@���^�@`���.�����^�`���.����L�^��`�L�.������^��`���.������^��`���.��P�L�^�P`�L�.�����^��`���o()������^��`���.��p�L�^�p`�L�.��@���^�@`���.�����^�`���.����L�^��`�L�.������^��`���.������^��`���.��P�L�^�P`�L�.�����^��`���o()������^��`���.��p�L�^�p`�L�.��@���^�@`���.�����^�`���.����L�^��`�L�.������^��`���.������^��`���.��P�L�^�P`�L�.�����^��`���o()������^��`���.��p�L�^�p`�L�.��@���^�@`���.�����^�`���.����L�^��`�L�.������^��`���.������^��`���.��P�L�^�P`�L�.6o)7~�G��8bvB��������������������																																				���sBvF��*�4D�`E*�-�2�:mR�9nQ]j."Y6� I"_P�=~�
,%
�-
�F
(M
^X
hZ
Em
�\-N8a<5/"+R�W�r
A��DMm[o�?&�e��2�BsEk�3M.n9�\0]�f�pC�6�@[|8(:'L�IcS.s(�U}727<Vj�u;<2+M�N�U�b�.�1��a}c��5J:}@YcSubxKJ0�]�.�BPFK�
G � �/ �: �I �` �`!2"�2"KA"�I"�f"#+&#B0#o#n4$�`$�%�)%VJ%�N%Ya%�f%�{%8&�J&eN&�i&s&�|&�1(@:(�=(�l(�
)Q)�)-)1=)&D)Q)o*�<*�V*�s*(+}^+�,{,�),=<,�I,�c-�.�K/�O/�]/�n/�r/�0�C0hW0Vg0o1zx1�{1�2+2;p2�3i:3"4� 4!?4�p4�>5z~5�666�S6ke6�|67N79M7IJ8�j8�r8.9Ev9�&:>[:�}:	y;u<�,<�G<VL<Sl<u<�=�=�=D\=�>�B>-M>�t>
	?;?N+?NE?!@m(@�N@DA�*A^AfwALUBcBBiB�sB&CUECERC�D�
D(D�?D�?D[eDjmD9
E6E�6E�FF�'FT;F�uF\G�-GH�HGH�<H�<H�SH�oH�II$I�OI�^I�jIkJ�	J�<J,OJ�^JTlJ�K�KX1K�GKz~K�-L�8LSL�wL!?M^YMbN�AN�NN�UNO,!O�2O'?O�JO.VO�`O�P�4PVqP@*Q];QQJQQbQ%R�+R�1S#tSVLT[WT�eTsT�	UwU`2U�>U]U�cU[%ViCV7XV�W
,W�XL>XTY\"Y�<YfKY�kY�rY�Z4EZ�yZ�&[[[�a[�|[�)]g]$^S/^�3^	8^�:^�r^A_9_cJ_(``D`�[`�aub�/bkdb�c�c*c�4c�Jc5[cZ\c^c\ded1d~'d,d�Nd:Td�adeHedae	f�8f�@fXKfnfZgVgbg�|gI,h�<h#Kh�[h�ik9i�?i�Piokk;k�k�k�;k�l�.l�6lb[l�m�fm�im�kmP2n�>n�gn*"o�-o>o.Oo�p�p`p:p�Wp�q�Kq�urbsxFsd	t�]t^ftFku\vZ4v�|v�
wTw�+wb\w�`w�rwCx�x�0x#7x}]x`px�yvEyH[y1z�(z�9z�>z�Qz�SzdVz�{W{�|�|�|�%|m(|G0|�v|�+}B.}Fc}PO~�U~F:q�yI|]�SH��D�%I��h�Y
�����*� |��}�j
�w����)��:�u���Mc��s��}�N�x�m'�>Y�#h�8q��I��^�o��w�3��(��@�A��C�2f�Dj��r�!w��;�1M��Q��0��D��Q��z���(>�C�P��d��e��i�yp����3��v��*+��8��C���rn��y�&"�z$�(1��>��N��u���`"�RA��C��h��&��:�s���(��
��*��:�}J�/^�Wa��4��G��J��K�0�Qf�(��,��/��s�o�OW��o��o��]�^{��\��_�Ic�Uj�c>��>�O^��k�u�3+�}N��O��T�0V�Z`�\��-�_���
����!��Q�P	�(���:Q�z���,��D��t��h���BF��G�	V�g��-�S��Y�I~�dH��g�/i��s��H�O5�68�D���4B��&��2�^8��]��m���pv�u0��L��t�Ev��g��'��W���t#�7��E��H�=W�Zn����8��U�Da�Oj�Ss��~�|N�KT�Zm�e3�W:��U�hs��u�!��"�nI�df����&�L�xS��{������K!��A��0�
S�b��p��t��6�s=�;n��z�k��K��U��}�H��C��Q�mp��
������^��a�q�1$�ZI��T�h��s���F�*���`��k���a"�3�KQ��3�BZ��h�9����M�$u����5��^�
d�n��n�$	�:��$�/�<��E�l[�o�~p�8�v6��<��>��@��X�K|���c ������*�z=��V��f�[l��!�U]���}@��1�{J��^�uK��W��\�)��;��&�y�_����%��C�MR��s��q��!��@��O�\�Ut���D�h�z�98��S��^�r��x�~*���@>�0i�s��/�`?�FE�|O��h���6�;�*�q5��`�+��-��2��T�%a��r��K��&�B'���WK�IM��=��>��^�E`�8+�t>��v���X�c)�L-�HR��o�yz���U�
����=�B ��I��M�47��C��K��U�q��q�u����6�aN��T��d���Q/��A��G��G�=N����O�n��v��2��H�DW��b�����3�n
����G��i�t����$�b)��2�A �r�����8�{j��D���y��z�0E�I��T��0�^v��,��8�_j�w/��j��Z-�^6�7��4��C��|���@��"��q��#�!5�'T��Z����4�^(�3q�+��[������
�����6����/��A�2F��H�rj��o�Ps���	�4^�LvNv�@�NtNtNtNt�d%d&d'u(u)y*y+y/y0y@yA�D�E�G�H�N�O�P�jyv�@�.�0�d@�4�l@�8�t@�>��@�P��@�V��@�Z��@�b�d��@��@��Unknown������������G��*�Ax�	�Times New Roman5��Symbol3.��*�Cx�	�Arial7.���@	�CalibriG=��
	���j�MS Mincho-�3� fg5.��.�[`�)�TahomaA���$B�Cambria Math"1���h`�c���d<����d<�!�������0vvJ�Q���HX	�	$P����������������������I$I2!xx����Sanaz HarirchianSanaz Harirchian����Oh��+'��00
px��	��
��
 (�Sanaz HarirchianNormalSanaz Harirchian7Microsoft Office Word@��G@("/�
�@�k��
���d����՜.��+,��D��՜.��+,��4�hp��������
���Microsoft�<vTitle� 8@_PID_HLINKS�Al,mailto:coheneg@umdnj.edu	

 !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������Root Entry��������	�F@����
��1Table��������������AWordDocument	��������4SummaryInformation(�����DocumentSummaryInformation8�������������MsoDataStore��������`����
�@����
�LI�V5���W�OE��SR�OS�BQ==2��������`����
�@����
�Item
���������Properties������������UCompObj����
r����������������������������	����������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������<b:Sources SelectedStyle="\APA.XSL" StyleName="APA" xmlns:b="http://schemas.openxmlformats.org/officeDocument/2006/bibliography" xmlns="http://schemas.openxmlformats.org/officeDocument/2006/bibliography"></b:Sources>
<?xml version="1.0" encoding="UTF-8" standalone="no"?>
<ds:datastoreItem ds:itemID="{7FD58C2C-EA5C-435B-84D2-2491E4E4AB05}" xmlns:ds="http://schemas.openxmlformats.org/officeDocument/2006/customXml"><ds:schemaRefs><ds:schemaRef ds:uri="http://schemas.openxmlformats.org/officeDocument/2006/bibliography"/></ds:schemaRefs></ds:datastoreItem>��
����	�F Microsoft Word 97-2003 Document
MSWordDocWord.Document.8�9�q

Youez - 2016 - github.com/yon3zu
LinuXploit