Transvaginal Ultrasonographic Characteristics of Different Types of Residual Pregnancy Tissue in Patients with Incomplete Medication Abortion

Transvaginal Ultrasonographic Characteristics of Different Types of Residual Pregnancy Tissue in Patients with Incomplete Medication Abortion | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Transvaginal Ultrasonographic Characteristics of Different Types of Residual Pregnancy Tissue in Patients with Incomplete Medication Abortion Zhiyue Li, Mingcui Chen, Dan Lu, Qin Lu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8957197/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 28 Apr, 2026 Read the published version in Archives of Gynecology and Obstetrics → Version 1 posted 9 You are reading this latest preprint version Abstract Objective This retrospective study aimed to investigate the transvaginal ultrasound (TVUS) characteristics of different pathological types of retained products of conception (RPOC)—chorionic-decidual versus non-chorionic-decidual—following incomplete medication abortion, to provide an imaging basis for individualized clinical management. Methods A total of 300 patients with incomplete medication abortion treated at Kunshan Traditional Chinese Medicine Hospital between January 2023 and June 2025 were enrolled. Based on histopathological examination, patients were categorized into a chorionic-decidual group (n = 214) and a non-chorionic-decidual group (n = 86). All patients underwent TVUS examination, which assessed uterine volume, residual tissue morphology (mass-like vs. patchy), echogenicity pattern (hyperechoic, hypoechoic, mixed), local blood flow distribution (graded by the Alder classification), and hemodynamic parameters (pulsatility index, PI; resistance index, RI). Differences in sonographic features between the two groups were statistically compared. Results The proportion of patients with increased uterine volume was significantly higher in the chorionic-decidual group than in the non-chorionic-decidual group (33.18% vs. 8.14%, P = 0.003). Residual tissue in the chorionic-decidual group predominantly presented as mass-like (80.84%), whereas in the non-chorionic-decidual group, it was mainly patchy (87.21%), with a significant intergroup difference (P < 0.001). Echogenicity in the chorionic-decidual group was primarily hypoechoic (28.97%) or mixed (55.61%), while the non-chorionic-decidual group showed predominantly hyperechoic signals (74.42%) (P < 0.001). Residual tissue in the chorionic-decidual group demonstrated significantly richer blood flow (Alder grades II-III: 89.72% vs. 10.47%, P < 0.001) and lower hemodynamic indices (PI: 0.87 ± 0.14 vs. 1.49 ± 0.20; RI: 0.62 ± 0.08 vs. 0.75 ± 0.12; both P < 0.001) compared to the non-chorionic-decidual group. Conclusions Chorionic-decidual RPOC is characterized on TVUS by vascular, mass-like lesions with hypoechoic/mixed echogenicity and low-resistance blood flow. In contrast, non-chorionic-decidual RPOC typically appears as avascular, patchy, hyperechoic foci with high-resistance flow. These distinct sonographic patterns allow for non-invasive preoperative differentiation of RPOC type, facilitating risk stratification for more personalized and precise patient care. incomplete medication abortion retained products of conception transvaginal ultrasound Doppler ultrasonography hemodynamics 1. Introduction Medical abortion, involving the use of pharmaceutical agents such as mifepristone and misoprostol, has become a cornerstone in the provision of safe and effective voluntary termination of early pregnancy[1]. Its widespread adoption is largely attributable to several distinct advantages over surgical evacuation. These benefits include enhanced patient privacy and autonomy, the convenience of a non-invasive administration, the avoidance of surgical risks such as uterine perforation and cervical trauma, and a generally lower incidence of short-term complications[2, 3]. As a result, more and more women see it as a private and empowering choice. Despite its efficacy and safety profile, medical abortion presents significant clinical challenges. A principal complication is the incomplete expulsion of products of conception (POC), a condition pathologically defined as retained products of conception (RPOC)[4, 5]. This occurs when embryonic or placental tissues are not fully eliminated from the uterine cavity, serving as a nidus for subsequent morbidity[6]. The most prevalent clinical manifestation is the persistence of irregular or heavy vaginal bleeding beyond seven days post-procedure[7]. If left unaddressed, RPOC can predispose patients to serious sequelae, including endometritis, the formation of intrauterine adhesions (Asherman’s syndrome), and pelvic inflammatory disease. These conditions cause immediate discomfort and pose a significant long-term threat to female reproductive health, potentially leading to secondary infertility or adverse outcomes in future pregnancies, as underscored by prior research[8–10]. The clinical management of incomplete medical abortion is primarily bifurcated into two approaches: surgical intervention, namely uterine curettage, and conservative pharmacological treatment with uterotonic agents like misoprostol[11]. The selection between these strategies is critically contingent upon the nature and volume of the retained tissue. For instance, cases with minimal, avascular remnants may resolve successfully with medication, avoiding the risks of surgery[12]. In contrast, cases involving extensive or vascularized tissue often necessitate prompt surgical intervention to control bleeding and prevent infection[13]. Therefore, the pre-therapeutic accurate identification and characterization of RPOC, specifically its size, vascularity, and composition, is paramount for formulating a scientific, individualized, and rational treatment plan. An erroneous assessment could lead to the inappropriate application of curettage, with its attendant risks, or the failure of medical management, prolonging the patient's condition[14, 15]. A significant diagnostic gap persists in current clinical practice. While transvaginal ultrasound (TVUS) is the first-line imaging modality for post-abortion assessment, conventional B-ultrasound and color Doppler sonography often lack the specificity to reliably differentiate between simple necrotic tissue, actively adhering placental remnants, and highly vascularized tissue that may indicate arteriovenous malformation[16, 17]. This diagnostic ambiguity creates a dilemma for clinicians, complicating the selection of the optimal management strategy and potentially leading to suboptimal patient outcomes[18]. It is within this critical gap that our research is situated. This study aims to conduct a systematic and detailed analysis of the TVUS characteristics associated with different pathological types of RPOC following medical abortion. We will investigate a comprehensive set of sonographic parameters, including but not limited to volume changes of the uterus, specific morphological patterns of the intrauterine content, ultrasound signal characteristics of post-abortion residual tissue, blood flow distribution and hemodynamic ultrasound parameters of post-abortion residual tissue. By elucidating the sonographic signatures that correlate with histopathological findings, this research seeks to establish a more reliable TVUS diagnostic framework. The ultimate objective is to facilitate the refined application of TVUS in clinical decision-making, thereby guiding physicians towards the most appropriate and effective treatment for each patient and improving overall reproductive health outcomes. 2. Materials and Methods 2.1 Clinical data This retrospective study selected 300 patients with incomplete medical abortion who were treated at Traditional Chinese Medicine Hospital of Kunshan from January 2023 to June 2025. Based on pathological examination results, patients were categorized into chorionic decidua group (n = 214) and non-chorionic decidua group (n = 86) according to the type of retained tissue. The inclusion criteria for subject selection were as follows: (1) confirmed normal intrauterine pregnancy; (2) history of regular menstruation with amenorrhea duration ≤ 49 days; (3) voluntary choice of medical abortion and presence of irregular vaginal bleeding for ≥ 7 days post-abortion; (4) complete medical records; (5) normal cognitive and communication abilities. The exclusion criteria were as follows: (1) patients with reproductive tract inflammatory diseases or tumors; (2) bleeding due to traumatic factors in the reproductive tract; (3) comorbid untreated underlying diseases; (4) comorbid hematological system diseases; (5) patients with mental or cognitive impairments. The study received approval from the institutional review boards of the participating institution and was performed in line with the Declaration of Helsinki. Informed consent was secured from each patient before investigations, treatment, and participation. 2.2 Implementation of medical abortion Before the therapy, the methods, side effects and precautions of the treatment regimen were completely elucidated to the patients, and the informed permission of the patients was gained. All patients underwent medical abortion following this specific protocol: On Day 1, 50 mg of mifepristone was administered orally at 10:00 PM. On Day 2, 50 mg of mifepristone was administered orally at both 10:00 AM and 10:00 PM. On Day 3, patients maintained a fasting state for 1 hour before and after medication administration; at 8:00 AM, 600 µg of misoprostol was administered orally. Patients were then observed in the outpatient clinic until the gestational sac was successfully expelled. 2.3 Transvaginal ultrasound examination and evaluation Transvaginal ultrasound examination was performed if patients experienced irregular vaginal bleeding 14 days after medical abortion. A GE Voluson E8 color Doppler ultrasound diagnostic system (USA) was used. Patients were instructed to empty their bladders before the examination. In the lithotomy position, a vaginal probe (RIC5-9-D, frequency 4.0–9.0 MHz) covered with a disposable condom and coated with ultrasound coupling gel was gently inserted into the vagina. Routine examination assessed uterine volume and residual tissue morphology, observing the characteristics of the ultrasound signals. The mode was switched to color Doppler to examine local blood flow distribution in the residual tissue. The Alder grading standard was used to classify local blood flow distribution, with grades II and III indicating abundant residual blood flow. After the ultrasound signal stabilized, hemodynamic parameters including the pulsatility index (PI) and resistance index (RI) of the residual blood flow were measured and recorded. Each parameter was measured three times, and the average value was taken. After the ultrasound examination, uterine curettage was performed, and the extracted residual tissue was sent for pathological examination. 2.4 Main outcome measures (1) Collection of medical record data, including patient age, BMI, and amenorrhea duration. (2) Analysis of uterine volume changes and post-abortion residual tissue: Statistical analysis of differences in uterine volume changes and residual tissue morphology (patchy vs. mass-like) between the two groups. Morphology was judged based on the shape and echogenicity features: mass-like was defined if hyperechoic foci showed high aggregation, layered intensity, and clear boundaries; patchy was defined if the echoes appeared thin and scattered. (3) Analysis of ultrasound signal characteristics of post-abortion residual tissue: Statistical analysis of the composition ratios of different ultrasound signal types (hyperechoic, hypoechoic, mixed echogenicity) between the two groups. (4) Comparison of post-abortion residual tissue blood flow distribution between the two groups. (5) Comparison of hemodynamic ultrasound parameters (PI and RI) between the two groups. 2.5 Statistical analysis Data were analyzed using SPSS 26.0 statistical software. Measurement data are expressed as (mean ± standard deviation), and intergroup comparisons were performed using the independent samples t-test. Count data are expressed as n (%), and intergroup comparisons were performed using the chi-square test. P -value < 0.05 was considered statistically significant. 3. Results 3.1 Comparison of general data between the two groups Based on histopathological examination of the residual tissue, among all 300 patients with incomplete medical abortion, 214 (71.33%) had chorionic decidua type residual tissue and 86 (28.67%) had non-chorionic decidua type residual tissue. No statistically significant differences were found in age, BMI, or amenorrhea duration between the two groups ( P > 0.05), as shown in Table 1 . 3.2 Comparison of uterine and residual tissue ultrasound morphology between the two groups The proportion of patients with increased uterine volume was significantly higher in the chorionic decidua group than in the non-chorionic decidua group. Furthermore, the post-abortion residual tissue in the chorionic decidua group was predominantly mass-like, whereas in the non-chorionic decidua group, it was mainly patchy. The differences in uterine volume and residual tissue morphology between the two groups were statistically significant ( P < 0.05), as indicated in Table 2 . Table 2 Comparison of uterine and residual tissue ultrasound morphology between chorionic decidua group and non-chorionic decidua group [n (%)] Ultrasound morphology Chorionic decidua Non-chorionic decidua P value Uterine volume 0.003 Normal 143(66.82) 79(91.86) Increased 71(33.18) 7(8.14) Residual tissue morphology < 0.001 Patchy 41(19.16) 75(87.21) Mass-like 173(80.84) 11(12.79) 3.3 Comparison of ultrasound signal characteristics of residual tissue between the two groups There was a statistically significant difference in the distribution of ultrasound signal types of the post-abortion residual tissue between the two groups ( P < 0.001). The ultrasound signals in the chorionic decidua group were primarily hypoechoic and mixed echogenicity, while those in the non-chorionic decidua group were predominantly hyperechoic, as shown in Table 3 . Table 3 Comparison of ultrasound signal characteristics of residual tissue between chorionic decidua group and non-chorionic decidua group [n (%)] Ultrasound signal Chorionic decidua Non-chorionic decidua P value Hyperechoic 33(15.42) 64(74.42) < 0.001 Hypoechoic 62(28.97) 8(9.30) Mixed Echogenicity 119(55.61) 14(16.28) 3.4 Comparison of post-abortion residual tissue blood flow distribution between the two groups The local blood flow Alder grades of the post-abortion residual tissue in the chorionic decidua group were primarily grades II and III, whereas in the non-chorionic decidua group, they were mainly grades 0 and I. The proportion of patients with abundant residual blood flow (grades II and III) in the chorionic decidua group was significantly higher than that in the non-chorionic decidua group ( P < 0.001), as shown in Table 4 . Table 4 Comparison of post-abortion residual tissue blood flow distribution between chorionic decidua group and non-chorionic decidua group [n (%)] Blood flow distribution Chorionic decidua Non-chorionic decidua P value Alder Grade 0 4(1.87) 35(40.70) Alder Grade I 18(8.41) 42(48.84) Alder Grade II 83(38.79) 5(5.81) Alder Grade III 109(50.93) 4(4.65) Abundant blood flow (II + III) 192(89.72) 9(10.47) < 0.001 3.5 Comparison of hemodynamic ultrasound parameters of residual tissue between the two groups The PI and RI values of the post-abortion residual tissue blood flow in the chorionic decidua group were significantly lower than those in the non-chorionic decidua group, and the differences were statistically significant ( P < 0.001), as shown in Table 5 . Table 5 Comparison of hemodynamic ultrasound parameters of residual tissue between chorionic decidua group and non-chorionic decidua group (± s) Hemodynamic ultrasound parameters Chorionic decidua Non-chorionic decidua P value PI 0.87 ± 0.14 1.49 ± 0.20 < 0.001 RI 0.62 ± 0.08 0.75 ± 0.12 < 0.001 4. Discussion The findings of this study provide a comprehensive sonographic profile that effectively distinguishes between chorionic-decidual and non-chorionic-decidual RPOC following medical abortion. The observed differential characteristics in morphology, echogenicity, vascularity, and hemodynamics are not merely descriptive but are rooted in the distinct pathophysiological states of these retained tissues. These results advance the clinical application of TVUS from a tool for simply detecting the presence of RPOC to a more sophisticated modality for predicting its biological nature, thereby directly addressing the critical need for non-invasive, pre-treatment risk stratification. The fundamental divergence in ultrasound morphology—mass-like versus patch-like appearance—correlates directly with the inherent biological properties of the retained tissue[19]. Chorionic-decidual residuals, comprising viable trophoblast cells and embryonic tissue remnants, maintain proliferative and invasive potential. This biological activity likely promotes the formation of a discrete, organized three-dimensional structure, which manifests sonographically as a well-defined mass or nodule within the endometrial cavity[20]. The concurrent finding of a significantly larger residual volume and associated uterine enlargement in this group further supports this notion of continued growth or expansion. In contrast, non-chorionic-decidual residuals consist primarily of degenerated and necrotic decidual tissue without active trophoblastic elements. This composition lacks the architectural drive for mass formation, instead presenting as disorganized, irregular material lining the endometrial cavity, consistent with the observed patch-like or linear hyperechoic patterns. This morphological distinction is of paramount clinical importance, as a discrete mass may pose a higher risk of causing persistent bleeding, infection, or acting as a nidus for future placental abnormalities[21]. The echogenic patterns offer another layer of discriminatory power. The predominance of hypoechoic or mixed echogenicity in chorionic-decidual residuals can be attributed to the cellular, vascular, and potentially edematous nature of viable trophoblastic tissue. The mixed echo pattern may reflect areas of hemorrhage, necrosis within an otherwise active tissue, or early calcification[22]. Conversely, the strong hyperechoic signature of non-chorionic-decidual residuals is classic for acellular, fibrotic, or degenerating tissue with multiple acoustic interfaces, similar to the appearance of retained blood clots or necrotic debris[23]. This clear dichotomy in echogenicity provides a rapid, initial visual clue for the sonographer during the diagnostic evaluation. Perhaps the most compelling and physiologically insightful findings pertain to vascularity and hemodynamics. The higher blood flow grades (e.g., Adler score) and visually richer vascular distribution within chorionic-decidual residuals, as demonstrated by color Doppler, are a direct sonographic correlate of biological viability. Trophoblast cells are inherently angiogenic, capable of invading maternal spiral arteries and establishing a low-resistance blood supply to support gestation[24, 25]. When these cells persist as RPOC, this angiogenic activity continues, resulting in the detectable vascular network observed in our study. This aligns with the histological expectation of active tissue requiring perfusion. The hemodynamic parameters quantified by pulsed Doppler provide quantitative validation. The significantly lower Pulsatility Index (PI) and Resistance Index (RI) values in the chorionic-decidual group are indicative of low-impedance blood flow, characteristic of newly formed, trophoblast-modified vessels lacking a muscular coat[26]. This hemodynamic profile mirrors that of an early gestational sac and underscores the persistent, pregnancy-like vascular physiology of this high-risk RPOC type. In stark contrast, the non-chorionic-decidual residuals exhibited higher PI and RI values, signaling high-resistance blood flow. This finding is pathophysiologically coherent. Degenerated, necrotic tissue does not stimulate angiogenesis; instead, its vascular supply is likely derived from adjacent, normal endometrial vessels or represents stagnant flow within thrombosing vessels at the periphery of the necrotic material. The high resistance reflects the absence of a metabolically demanding tissue bed and likely progressive thrombosis within the supplying vessels[27]. Our results corroborate the work of researchers who also identified distinct hemodynamic patterns in RPOC, strengthening the evidence base for this application of Doppler ultrasound[28]. The clinical implications of these differential sonographic features are substantial. Accurately identifying a chorionic-decidual (high-risk) RPOC via TVUS prior to any intervention would strongly support proceeding directly to uterine curettage. This approach ensures definitive removal of biologically active tissue, which is less likely to respond to repeated pharmacological intervention and poses a greater risk of complications like hemorrhage or sepsis[29]. Conversely, confidently diagnosing a non-chorionic-decidual (low-risk) RPOC would justify a trial of conservative or pharmacological management, such as a repeated dose of misoprostol or expectant management[30]. This strategy spares a large cohort of patients the risks, pain, and anxiety associated with an unnecessary surgical procedure, along with its potential long-term reproductive consequences[31]. Thus, this sonographic stratification framework empowers clinicians to personalize treatment, moving away from a one-size-fits-all approach. This study has several limitations. First, the sample size, while adequate for establishing significant differences, warrants validation in larger, multi-center cohorts to ensure generalizability across diverse populations and operator expertise. Second, the sonographic assessment, though performed systematically, has an inherent subjective component, particularly in grading echogenicity and blood flow subjectively. The development of a standardized scoring system or the integration of quantitative ultrasound techniques (e.g., shear-wave elastography, 3D power Doppler indices) could enhance objectivity in future research. Third, our classification was ultimately based on post-procedure histopathology. While this is the accepted standard, it creates a diagnostic pathway dependency where ultrasound guides the treatment that then provides the definitive diagnosis. Prospective studies where TVUS predictions are tested against the outcome of initial conservative management could provide even stronger evidence. 5. Conclusion In summary, this study delineates clear and pathophysiologically rational differences in the TVUS characteristics of RPOC types after medical abortion. Chorionic-decidual residuals present as vascular, hypoechoic masses with low-resistance flow, while non-chorionic-decidual residuals appear as avascular, hyperechoic patches with high-resistance flow. By integrating these morphological and hemodynamic features, TVUS emerges as a powerful, real-time tool for pre-treatment risk assessment. We recommend its routine and systematic use in the evaluation of incomplete medical abortion to guide a more rational, patient-centered, and effective treatment selection process, ultimately optimizing clinical outcomes and patient satisfaction. Declarations Ethics approval and consent to participate The study protocol was approved by the Ethics Committee of Traditional Chinese Medicine Hospital of Kunshan (ethical review: KZYYJH2024-SB052-26). All subjects provided informed consent prior to their inclusion in the study. All the procedures performed in this study were in accordance with the principles of the Declaration of Helsinki. Consent for publication Not applicable. Availability of data and materials Data that supports the findings of this study are within the article. Further data is available from the corresponding author upon reasonable request. Conflicts of interest The author declares no competing interests. Funding This work was supported from the Youth Scientific Funds of Traditional Chinese Medicine Hospital of Kunshan (No. 2024QNJJ01). Authors’ contributions Zhiyue Li (co-first author 1): conceptualization, methodology, software, investigation, formal analysis, writing-original draft. Mingcui Chen (co-first author 2): visualization, software, validation, writing-review & editing. Dan Lu (co-corresponding author 2): conceptualization, supervision, project administration, funding acquisition. Qin Lu (co-corresponding author 1): conceptualization, supervision, project administration, funding acquisition. Zhiyue Li # and Mingcui Chen # contributed equally to this work. All authors have read and agreed to the published version of the manuscript. Acknowledgments The author would like to acknowledge and thank all faculty members and patients who volunteered to participate in this study. References Grossman A, Prata N, Williams N, Ganatra B, Lavelanet A, Läser L, Asmani C, Elamin H, Ouedraogo L, Rahman MM et al : Availability of medical abortion medicines in eight countries: a descriptive analysis of key findings and opportunities . Reprod Health 2023, 20 (SUPPL 1):11. Zorila GL, Capitanescu RG, Dragusin RC, Istrate-Ofiteru AM, Bernad E, Dobie M, Bernad S, Craina M, Ceausu I, Marinas MC et al : Uterine Perforation as a Complication of the Intrauterine Procedures Causing Omentum Incarceration: A Review . Diagnostics 2023, 13 (2):16. 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Cite Share Download PDF Status: Published Journal Publication published 28 Apr, 2026 Read the published version in Archives of Gynecology and Obstetrics → Version 1 posted Editorial decision: Revision requested 14 Mar, 2026 Reviews received at journal 11 Mar, 2026 Reviewers agreed at journal 08 Mar, 2026 Reviews received at journal 08 Mar, 2026 Reviewers agreed at journal 04 Mar, 2026 Reviewers invited by journal 02 Mar, 2026 Editor assigned by journal 01 Mar, 2026 Submission checks completed at journal 26 Feb, 2026 First submitted to journal 24 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8957197","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":600641106,"identity":"ce123935-0cf8-43c3-b7f6-06b6c11d90df","order_by":0,"name":"Zhiyue Li","email":"","orcid":"","institution":"Traditional Chinese Medicine Hospital of Kunshan","correspondingAuthor":false,"prefix":"","firstName":"Zhiyue","middleName":"","lastName":"Li","suffix":""},{"id":600641107,"identity":"99206320-6c9a-4b5a-9875-dabe14263802","order_by":1,"name":"Mingcui Chen","email":"","orcid":"","institution":"Yangcheng Lake People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mingcui","middleName":"","lastName":"Chen","suffix":""},{"id":600641108,"identity":"eb69c4f1-9565-4245-beaa-b2bf5e6d70e0","order_by":2,"name":"Dan Lu","email":"","orcid":"","institution":"Northern Jiangsu People’s Hospital Affiliated to Yangzhou University","correspondingAuthor":false,"prefix":"","firstName":"Dan","middleName":"","lastName":"Lu","suffix":""},{"id":600641109,"identity":"e81852c1-3a13-4aaf-8a80-d4510970c019","order_by":3,"name":"Qin Lu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvklEQVRIiWNgGAWjYPACCR429sbGhx+IUcsDoSxk+HgONxtLkKClwkZOIr1NgIcYLfbsx59J/mwDOkzyYRuDBIOdnG4DIVt4cswkJM4AtUgntj0oYEg2NjtASAtQsYRBBVhLu4EEw4HEbYS1sD+TSDAAOewg0HnEaWEwkzgAskWCkVgtZ3KMLRtAfuFJBAayARF+YW8//vDmz7Y6e3kg4+GHCjs5glqAgAUpAg0IKwcBZqKSySgYBaNgFIxgAAAuEjXhjSDpiAAAAABJRU5ErkJggg==","orcid":"","institution":"Traditional Chinese Medicine Hospital of Kunshan","correspondingAuthor":true,"prefix":"","firstName":"Qin","middleName":"","lastName":"Lu","suffix":""}],"badges":[],"createdAt":"2026-02-24 12:08:54","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8957197/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8957197/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00404-026-08420-4","type":"published","date":"2026-04-28T15:57:49+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":108437684,"identity":"87dbcd11-7dec-4cd2-95ba-c8296f146f84","added_by":"auto","created_at":"2026-05-04 16:02:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":333412,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8957197/v1/078af049-5ad2-41cd-8542-68aaa80152f3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Transvaginal Ultrasonographic Characteristics of Different Types of Residual Pregnancy Tissue in Patients with Incomplete Medication Abortion","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eMedical abortion, involving the use of pharmaceutical agents such as mifepristone and misoprostol, has become a cornerstone in the provision of safe and effective voluntary termination of early pregnancy[1]. Its widespread adoption is largely attributable to several distinct advantages over surgical evacuation. These benefits include enhanced patient privacy and autonomy, the convenience of a non-invasive administration, the avoidance of surgical risks such as uterine perforation and cervical trauma, and a generally lower incidence of short-term complications[2, 3]. As a result, more and more women see it as a private and empowering choice.\u003c/p\u003e \u003cp\u003eDespite its efficacy and safety profile, medical abortion presents significant clinical challenges. A principal complication is the incomplete expulsion of products of conception (POC), a condition pathologically defined as retained products of conception (RPOC)[4, 5]. This occurs when embryonic or placental tissues are not fully eliminated from the uterine cavity, serving as a nidus for subsequent morbidity[6]. The most prevalent clinical manifestation is the persistence of irregular or heavy vaginal bleeding beyond seven days post-procedure[7]. If left unaddressed, RPOC can predispose patients to serious sequelae, including endometritis, the formation of intrauterine adhesions (Asherman\u0026rsquo;s syndrome), and pelvic inflammatory disease. These conditions cause immediate discomfort and pose a significant long-term threat to female reproductive health, potentially leading to secondary infertility or adverse outcomes in future pregnancies, as underscored by prior research[8\u0026ndash;10].\u003c/p\u003e \u003cp\u003eThe clinical management of incomplete medical abortion is primarily bifurcated into two approaches: surgical intervention, namely uterine curettage, and conservative pharmacological treatment with uterotonic agents like misoprostol[11]. The selection between these strategies is critically contingent upon the nature and volume of the retained tissue. For instance, cases with minimal, avascular remnants may resolve successfully with medication, avoiding the risks of surgery[12]. In contrast, cases involving extensive or vascularized tissue often necessitate prompt surgical intervention to control bleeding and prevent infection[13]. Therefore, the pre-therapeutic accurate identification and characterization of RPOC, specifically its size, vascularity, and composition, is paramount for formulating a scientific, individualized, and rational treatment plan. An erroneous assessment could lead to the inappropriate application of curettage, with its attendant risks, or the failure of medical management, prolonging the patient's condition[14, 15].\u003c/p\u003e \u003cp\u003eA significant diagnostic gap persists in current clinical practice. While transvaginal ultrasound (TVUS) is the first-line imaging modality for post-abortion assessment, conventional B-ultrasound and color Doppler sonography often lack the specificity to reliably differentiate between simple necrotic tissue, actively adhering placental remnants, and highly vascularized tissue that may indicate arteriovenous malformation[16, 17]. This diagnostic ambiguity creates a dilemma for clinicians, complicating the selection of the optimal management strategy and potentially leading to suboptimal patient outcomes[18]. It is within this critical gap that our research is situated.\u003c/p\u003e \u003cp\u003eThis study aims to conduct a systematic and detailed analysis of the TVUS characteristics associated with different pathological types of RPOC following medical abortion. We will investigate a comprehensive set of sonographic parameters, including but not limited to volume changes of the uterus, specific morphological patterns of the intrauterine content, ultrasound signal characteristics of post-abortion residual tissue, blood flow distribution and hemodynamic ultrasound parameters of post-abortion residual tissue. By elucidating the sonographic signatures that correlate with histopathological findings, this research seeks to establish a more reliable TVUS diagnostic framework. The ultimate objective is to facilitate the refined application of TVUS in clinical decision-making, thereby guiding physicians towards the most appropriate and effective treatment for each patient and improving overall reproductive health outcomes.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Clinical data\u003c/h2\u003e \u003cp\u003eThis retrospective study selected 300 patients with incomplete medical abortion who were treated at Traditional Chinese Medicine Hospital of Kunshan from January 2023 to June 2025. Based on pathological examination results, patients were categorized into chorionic decidua group (n\u0026thinsp;=\u0026thinsp;214) and non-chorionic decidua group (n\u0026thinsp;=\u0026thinsp;86) according to the type of retained tissue. The inclusion criteria for subject selection were as follows: (1) confirmed normal intrauterine pregnancy; (2) history of regular menstruation with amenorrhea duration\u0026thinsp;\u0026le;\u0026thinsp;49 days; (3) voluntary choice of medical abortion and presence of irregular vaginal bleeding for \u0026ge;\u0026thinsp;7 days post-abortion; (4) complete medical records; (5) normal cognitive and communication abilities. The exclusion criteria were as follows: (1) patients with reproductive tract inflammatory diseases or tumors; (2) bleeding due to traumatic factors in the reproductive tract; (3) comorbid untreated underlying diseases; (4) comorbid hematological system diseases; (5) patients with mental or cognitive impairments. The study received approval from the institutional review boards of the participating institution and was performed in line with the Declaration of Helsinki. Informed consent was secured from each patient before investigations, treatment, and participation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Implementation of medical abortion\u003c/h2\u003e \u003cp\u003eBefore the therapy, the methods, side effects and precautions of the treatment regimen were completely elucidated to the patients, and the informed permission of the patients was gained. All patients underwent medical abortion following this specific protocol: On Day 1, 50 mg of mifepristone was administered orally at 10:00 PM. On Day 2, 50 mg of mifepristone was administered orally at both 10:00 AM and 10:00 PM. On Day 3, patients maintained a fasting state for 1 hour before and after medication administration; at 8:00 AM, 600 \u0026micro;g of misoprostol was administered orally. Patients were then observed in the outpatient clinic until the gestational sac was successfully expelled.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Transvaginal ultrasound examination and evaluation\u003c/h2\u003e \u003cp\u003eTransvaginal ultrasound examination was performed if patients experienced irregular vaginal bleeding 14 days after medical abortion. A GE Voluson E8 color Doppler ultrasound diagnostic system (USA) was used. Patients were instructed to empty their bladders before the examination. In the lithotomy position, a vaginal probe (RIC5-9-D, frequency 4.0\u0026ndash;9.0 MHz) covered with a disposable condom and coated with ultrasound coupling gel was gently inserted into the vagina. Routine examination assessed uterine volume and residual tissue morphology, observing the characteristics of the ultrasound signals. The mode was switched to color Doppler to examine local blood flow distribution in the residual tissue. The Alder grading standard was used to classify local blood flow distribution, with grades II and III indicating abundant residual blood flow. After the ultrasound signal stabilized, hemodynamic parameters including the pulsatility index (PI) and resistance index (RI) of the residual blood flow were measured and recorded. Each parameter was measured three times, and the average value was taken. After the ultrasound examination, uterine curettage was performed, and the extracted residual tissue was sent for pathological examination.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Main outcome measures\u003c/h2\u003e \u003cp\u003e(1) Collection of medical record data, including patient age, BMI, and amenorrhea duration.\u003c/p\u003e \u003cp\u003e(2) Analysis of uterine volume changes and post-abortion residual tissue: Statistical analysis of differences in uterine volume changes and residual tissue morphology (patchy vs. mass-like) between the two groups. Morphology was judged based on the shape and echogenicity features: mass-like was defined if hyperechoic foci showed high aggregation, layered intensity, and clear boundaries; patchy was defined if the echoes appeared thin and scattered.\u003c/p\u003e \u003cp\u003e(3) Analysis of ultrasound signal characteristics of post-abortion residual tissue: Statistical analysis of the composition ratios of different ultrasound signal types (hyperechoic, hypoechoic, mixed echogenicity) between the two groups.\u003c/p\u003e \u003cp\u003e(4) Comparison of post-abortion residual tissue blood flow distribution between the two groups.\u003c/p\u003e \u003cp\u003e(5) Comparison of hemodynamic ultrasound parameters (PI and RI) between the two groups.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Statistical analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using SPSS 26.0 statistical software. Measurement data are expressed as (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation), and intergroup comparisons were performed using the independent samples t-test. Count data are expressed as n (%), and intergroup comparisons were performed using the chi-square test. \u003cem\u003eP\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n \u003ch2\u003e3.1 Comparison of general data between the two groups\u003c/h2\u003e\n \u003cp\u003eBased on histopathological examination of the residual tissue, among all 300 patients with incomplete medical abortion, 214 (71.33%) had chorionic decidua type residual tissue and 86 (28.67%) had non-chorionic decidua type residual tissue. No statistically significant differences were found in age, BMI, or amenorrhea duration between the two groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05), as shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n \u003cp\u003e\u003cimg 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6h2Dy6D5oNERIYoOIUbqKOucF5FmJBGcPn36lB9EaQNyxzNBzvWTQdQ3xs8YGTckkDJWljFFRhE7C0reRR9WMjwMsIWPRYJjR4wtMmruIADSINkwddVOZJHBVXZzg3nKMDAeZI5BNX+0uVoGOVE2jC24eGsYRWRRvdW01Xv5pLEIQMrl4SXS/mq6evfSr7POOglx0G9EFDk3Rha3SA/DhRyPPfbYpacUXsaqsfItsIytOagsMqxuZTDW2goT72Ay/vjjl/NCPgbQnGVQ6RveMHPIXEZIjSuSZC7rozFD7ukvRhXBl5ehRWyQx+222y6R1UkmmSSZa+qtF+BoTDgqeNzNX3nNS3VV89ANyANdQIcg7rCSxnyiR4wHUkt+ecCVTZeKIwP6YKzNAfoI6dd/OkW59JjyBDrOghFpUZ/8sLS4QKgQO7jBQr3mmXLIMwJG7+W+a4/6/EKUsnNAjMg9OZ9vvvnKj+Z5xM0r+iynq16RGLKA9GuXsmGhjGr7ETWk0bw2B+0GqAvRs7Aj32RPHnJC/s07BB92nfYjQgAAEABJREFUFlqe6fdq/RYTSD+SZ3GmfvpX/eZ0Touswzk/u9Kp8HefA/Kubt/0qJMskV/9y2lqr2Tc4p5OMq/VS+faAaJjpLe4I0tFUSTzyEKE3YUdPecKD9hpl8UEO6FP2qQMMlgUwzqp1ClO0EfzTp/IBDlWLnzoSvOBzEpbL1gYwh/OMFA//YCkmosWhYg3nasOY6FPFszsiHmtXHqBPtF2ujnbIHNSfL2gfCQ+lw//XD4Z5Dwwr+S16NJWO3vKN+bqgjE9T0/Iz64rl60hW9pKD5sn7JeyIrQcgR5PrCkKnh8eBoSJhwexay5UCKO0iKaJ4b5eQN5NVEaQgFLeyApl35ECyojUa0/tOxOJ94ahYaRzPMXGeGi/VX1+zyghi54pDoTLBDQxTULvrbBdKVXXHKRFAuVTF8WLdFkZF0VRbusi5spDAnkBct7aq/rk9dW09LXxnilLxJpSQHaKokiMJJJg3ChNbaUIpdcunn6Eg9G1oEBYvBeP7LgKymaYjKPn2qB8ihlZ0VfxylE+/PRN+d43NyBr+gPnovjJSCifcqyWcd111yUyx0CRN8EiR30WDdIqQ9+Ms3vvlEPxM/ieyadxoKSVYWHCwyoN7540OTBqyJQx5vlmtBh9RAC5ZORz2pZcGQXGwBw1Z3PevkMXRPneFdnglbeTJI8FIaMmrqlAHi2AGHXkEEGzuGgqT46Dm/4hEd7BiFHSXvPP4tGi0WJKHMKCLBhHXjB56gXyyLBpD/ylIWsMIY9d1lMIsff6Lo2y1YfMqU8Z8pvjsEBCPPNsiUfyjZH2ZOJIRvXH/EJilOtqbPXJc73A24fg9evXryG679AxsliDScPLoTfe57Ekg3DMugL2SLZxGZq04X+kx3ynOzNJEIl4IDTKyzrZ+2pA3njBa3WcdpAr44Q4FUWR1KE8OkAZ2qfsvJjxrl6Anz5U+2pc9B/ZqpfHPLIYIEP6kdPQLTDJz/Awn5F84ybYhbNAMabmKQJJ9qv56FLEjTzlsqpX89xCC/Gn13Mc/ajP+bm5V/bCYoxOIaMcSiPKS6Z4x+Gc08It68z8Ll/pTvIII+202II7PZ7TyGu3g8zySuf3zb0ae7JSFEX562F2bvWpKUcYAmtXgZ1HXOl++FbrNDZ0I7kzz8QZGzYkpyWn0uineIFe1mf3TQXlS2ce5PJhQc5y+Y6BSQO7XBa8ySjbQh69z+NBD+R7MkrfKE+aCC1HoMcTa4JHETAuSBQDQyBbDlVqOFpQLy8jYLIxVowDhci4ea/eenla+86ENAnlp2xdRxSQECQwT56cnlJi3HhixOf37XllwCh0E1q5DIx7hoOh5hH1vrUB2UMEKRWeRYYHLvqK7PFMGRd9zXXwbMBQn5vafsvpG7uqx+q+tnwKU5+Vz+A3lr/ee94Y+ZEP3ippkBnyxSPiWVA2TxVZy8HOgP7wTkjTnKBs3kfevlwOzyYP1Ihk14LHeWXeJTsDCExz6qxNo6/azRjUxlWfyb7zhAw7TyPPF8JQTVPvXjp9tOjlXYWxYxX10o7onTYyyEgamSNfvFM8XRk/hsvcR3iaKk9blMFAI76uZJgRNDcQPYtFx0HImLKMFznIdfHuIo3qo+vIhcWhvuY0iAcdYJ4oo7XBYqIoitJTm9rwn0U8nZP7lItCQHxDgERl2c9xI7pyfDjeYN5X0yLRxkv/xVfjWnrP0ygPu+LanICgGB/tquqg2rzaZj7lMXM1XsaVDIg3tvpTm7epZ/LFqSJfU/U3VUY1DrkVODLoBzqoGl9775mupXOd5fYskGMyzwvrualAj8O8tv12FOWjh13bEugI+gXejZVjYa4vSDinA7mqbVNjeavv83joU/V9e91biGhXUfzkmMnlWhCbcy3ByxjTldXguE4uM67DI9DjibXVvm1xE4FS5LWyuhseivpvKEUxhNRK0X29kJWm+ngMrbR59VzrpW/LO55bnkKKwHEL3oDGyrNKRvyklY8HLfcp57E6pSAQwfyuI64IsLoQMNvOiJwrYt+W+hgOiyWkEoFgQGyV8urxSlAkyC0ccj3aISBYbakfAVI+UogM1JZPUWfln+NGdCVntuscV+C94qWyzW/ckLecX70MtjrIWg4tHUflaD8Sl8tw5e0gz7m+eldeG2TOcQRza4kllqiXbITvzC+himG9TMi+M6dkmbfa0RfjXS9t9R0PPgNukcdbZJsfiaumae69ceB9Q9SNFfxs8dbiZxzIZlPl6oez2Npn18h5aLstMHUGnBeTtxLZzOWQWwsReY1TDmRZGu1BDsg7/ZPjjaf4tgReOPqGTGpHLks/Eb8RyUtOTwfDp0q0cpxyGXHkLb9rzlVf6WHk3xjlPMoTzEP15vetufJoKtvumzJzGU31vyiK8ic2yYd0OU/tFckyruxHHjNX/RJHdo253RaEtJrfolv51XfVezIhvqn6q+mburfgc1SMt9gC19xvKr04CwbHOCxGefftyNBpyLb30jQVyAIdzqNfTZfHoDltqOard5/L8mFivXi2lM1y7MrxO4GntyiGJa/18ta+y+OhzNq49ng2T+n02sVp7iPnRHPrUZajU9XArjY3f29M1+OJNeNii9YREOTRKplxzoNNIeX7elf5vHf2yZk69/WCrX+Kj9LldWIQKTFbZYh9vTyte/dTLl/vChSUrXHG7qeY//9L+frAwVayyYGoUdoUY07FEOYzqxR4ft+WK2VRxdWZT4rE9qn6rIDdO+enHgbZVaD8XVsSbH/bHlc28uQsJa8iLwcFwIvqYw8eq1yuNvE0Nkep5zz1rspHJi3aeMxyGh45sjcij2VOX3tFFvUFoWJIefgR16p3Vpy+80waQ7ir0wLDkZDaMht7VqZjBEg7eSc35MkHnTyvjeXznqGBNa+VNsPUe8FcyIrcc1OBLPDS22ZFLqpplaEs73hKGGfGDTEmZ9orThpp3VeDsbCFb/ydTxQnLbzcy+PZfXOCsWC0yBVibV4hxoi+c7LK4Fnk9Sd3nquBXqguIJB8fXK23C4OcmjhbC7Y5q/dfbCda3z9co5x036Ew8d8yIejJNrI40k/wEighxwJqLalpfcWNdpvvpE5dZt3Fux26MQ1p0y7Vha05MsiIOeBm/GnTxHv/L45V3JsLGBhwZnzaJPjNnBraZm5jHxF4CwA6VXt1HcYWMRbZNaTI/PCWVwySBfnsvI1yy9MEH9nhy2wzEFxZIvcI9nG1jMPtjFVBp2uPWTSc21Ays1PCzfzuzZeHfmdBY3+WDh6R05ry3Xci6OG/NPrdI60QrUszznAyXx1zKwoiuSInONtdHVO09TVB5SOKDinrX05rTGw2KArvWODi6Ioj8h5Fur12XttzTrAMz2hL47Wea4NdljIvR1Rnl/xxii3R1n66f2IAtttHB15qs1j3o8o/4jiLc7pFPOS/Of09BPcyXF+N6Kr75Xommqgn0aUrzfHd3tiTSgp5kzOCDfSlAeVokM+PDt35IyUCeVZQHwoD/c58D6ZjCaZ81aUCAJm1WwSVQXfxJKPkrFNJJ4x9dENb5r8I1odMiZIoLJMAts4uT/Krhe0CanxdbazlH4lQL3SUrjaj8DCR7t4NXk/EUEeA14ddSFP0joXSnFJ7yMXBCnjAi8Yu5qY6hAsUPRXnAWLdwJlRwHCXtk8E3YMrO7FMzTIPSIAH8YemWBkBXXnMbRAkacaGHTGJI8DI+BXLRAH6YwbA8UIeXZMAba+KtdW2Fr88DbbzpSG0kRG3FOwrvK4Nz65Pd7XBh9cwdx4IDryOdfNSJG3nB4W8NU/hj6/r70qC5lGDsgcRe6oAQNZzefsOkLqF1jIgSNIjjwhdHYHlIuAmRM8F67e5b5YCJABBIc3AibO65JbBM/YWDTIBx9jzBgoIwfjpjwkzu4J8u/cJnlWHhlQtzSwV1/OW73yBOqPseGtJz9kVJnG2dgiG0VRlD+TSbaRDbIsD5m1bS5tURRJuxAdOPIuwg7uZMDHYRajDI8tUaQEIa22J9/z8pInHy26yqNOmDGOykU2GRqGx8dQxgF+POO8pMpCQASY2FWp4mjRqwwLFF5w6RFEH2aaX7ULekdFzGMfGblXn3rNRzKHYHoPQ0dNjKdgbBy7UqbxNB6u6hPMKWNNLvLc974atAXxIJs+jLLj5IM842RhZG6bM++8805SnvGXn+zAz4ey5hNPpfzkwhxE3oyPD4bJvA8TlUV2zHdzE/bKyoGeNlf0w5yj4xwPgoExstg13yw09QkmyJ0+2gVQX+4nGdI+ZeexUbb5Bq9cN12qbTz22o9k0i/kUf+RPGVUA1mURzkWSvQdXc0eqdMHekiv4zs+poQtjI2ZwDHEsZO9vuqAuY/tyDPdrU/mkHqzvYOZPpBRbS2KovwZUKTcQkD9+q9+88sYme/mKFth7vjAzjhYrNhBMU/0x3yzkKTb7UBaYMLbXNKG2kAWHMOUn86yI0PWyYLxy+nZDvfGXHvcC5wI+mnuwtp4GVPz2I4PuZTOfLNzY4Hu1zDoRvIojl21uDEOnulj85qMaJe+GF8f04qvDRZURVEk46MvAt2iPHONvoEnMgt3dimXoY8wIOfSs4ecS+Yw20Vfsn3a4d6YkO+cP1/JuX4o39zI7/XReOfy4eu4mDmvbfpozOkk35uRVfac/iM76s1lsWHKp09c8/u4Nh+BUZqftGumpEQZjyzElCWh5ZnyziRDcikDXhA/C4VMM1yIlZUuZat3rrx2lJWfrnK8gHCZnMqg0AivYwbSC7aDGAOeEKtwitM9z4S2UbqMs7T1Ai8VI4PEMEKEXBsoyazg6+XzTj5KzcSkZGzN8TozyAy4Z79QwqBLb5XtXBjFRoHzkCC4Jp8VbFEU5W+c6oeJijiI4zHjFTWpfQjKkHtmqCgJBJlBg716ECvKG34mt7KRT2SXkoeZCUup6K8yKTQTmieSYmOolUXR+/ki9xQhrw3FhnAjm94bW2OtPfoPc4SWl0O8MihNpAvhVBelrW/SM7JkhndPep4tytqWoDHg6cweH/G1QTrlGz+KnWwxmMpnDKUnQ8qVRn3GAqFgxMRXAwWOJFCgjIl+GS/kjTFi9KRHrhh4hJS8WSQhVRZaZFs+HxYZN+8YYsSb10h+5RhLZwYRESSBQWNstIECVof3xg9m7uEpv8C4kifGzu4MA+5nuBgYWDPK5h2ja9zIbL3tf+mQegaRcUAUySF5YATIkXoscLWZfCMo5NvcZLSc9SYLFp22qpEXcmIeaJMxZmzJq3tjyuDIY77pT22wWIIDgkGeyabzzuat+S09mYQDvUJeyL5x9zFonvvkAnnm8dK/LLvy0zvao830lXd0CE82OdQ+73LQT33glTL+xkt5sJEfQTdO5heDzrCSfe2R1zMMkWpEyDhJy6vKmFvQWGgxurnOfDVO0iLU5NhcRjr13fgYP3KuHPfkkc7h9UL4kDkkiE4ydupHruBDT9AP5AS5RlQ4JbopzAkAABAASURBVJBbuJpn5FxbjD3ZQMxhgIDSWQiY/lms6AMdh/xY+JHDoigSmUbQ5DWWjjPAEqbK9s7izniYU+YPoqtc/ScTAnJp3hhP2NsRlb82FEWRyBp9oK/mn19oIk/GwyJMXrKiXLoE6dFHcs2+kB3lGiPnc/XLQs7i0lwxr7XNGOe06qOXi6JIFufO4tO79IJxg5H65bVQJDdwVJ42GBsEjZzTPTCiL5FZc5K32UJJ381POph+0s7aQIbpNBirXzAvyQr54wyAibrZFHOI7suEj9NH3/THeJErnn06g47Td3VqK1vKlhgb7dV26dVHNxfFT0c39IGO4MElG/pvXqtLWbVBenJPZ9OnbJe+GzfjpH/wM8ctRLQN5uTNuNKJeIn2w53O0B5znA7HL4wrJ4n5QI9V20Be2QFOG6RaHnJNp7LHbA45JS/y+oUZbWALtR2vgRV5szDRF+1ik1zxKHNGG8kfHsJm0B3VdvSk+47qS7cn1gQYoWMgTUhXAkwx2BZC8igYCsXkRTqtFJEok5ZBQyIATEETQgJGkRNe25uUAMUgDYNHgNUlINrIujhkhsJizAiuSdWYwZZeMKnUQ3iVJ7hnrLRVmqYCZcAAU4ImHjwYMIbVZGLAcv6iKMp/1IVCtmBAokxyk5tBk05+9cNR3xhMpBCp8o5hYJRM0IyD9CYxgqAMEx2BgS/CT/nATZzAIKpbHAOmfp5VZJpysqpWJiy0gTdePsZH+ygCSo0i955SRAJy/3kMEAdeFPH6tsACCyReAHkYZ+3PY0OxW80rU53aRcEiGN5RpNrBsCuvNigfseHRMZa8+gwAHHJacqUM5SuTIqa45M1p8rUoivIfGWG4kAKK2hjAGMnjuUVipWcELK7Ua2zIOjksiiIxYuTQuBk/cQxxHjfvyE1RFMlcQZ7ha66ok7EtiiJRyNJqu/IQH3ULZMwCQD6YUeg8x7BjZIuiKD2X+kxZk2tGQ97awDgiMxZQ+sMjxJiTFeSZDBlTc1tfedSMnQUKeUZ64WnOw58egLE8jKe+kytyYG5pr/aYP/LVtsczeTR2dIM2GQ+EUB1F8ZOBLoqiJGvmPnzUYaGBuBTFT2mQb7iIs1DN+kQdRVEk/WZQczuKokj6rG3SVENRFOU/xKM8Y2VsGEkkIqcjF9qN9JkvyC29R9chQWSAXMuPIHMIkE/vjBUPZt5hymXmqwUynWd+G1Nz3dwsiqL8x6DINpnTV/gilcpWrvTqUxbd1L9///IfMTIvybR5qXzxCKK5qix5lcurKw5JUqb26h8iZjFTFEWSxu9UWzjkuUzm9F1ebdJveZWJPJBp7SXj4skeIq296udJJYvykwk6DeEXb56ZK7l8aWqDcYW7ecFe2bXgoPGsLOSsKIpEVhFKpF1bjEO/fv0aPhZVjl0HhB8mvJt0nbmjTnMVLvKSRQ4i7+Wjd+kO9SNnFsF0pfmT6ydDxtNigm5A9DgqkHz6D/mzILBQtpBB6MiahW72uquvNhRFkcy5nA5mWafxyNNN5F3btB2u7DVSmssy/2FGP6ibTJuLtXPJO3JPzixiYANPtox+yuW557Rhr8kKYm9Bl+Nrr8aXI46uQ9yVR660xa4IG2NctJ3MmGN+rtc8MRb5nf4WRZHIjHEwf+lQJNiiCRYWAsas2gY6zCK6Wj7ZIYfKUD78cIqiKNLkk0+ezCf6Ex7wtFCCB96ATGsXvF3NGbpRGd6RAeR/zDHHrDYj7puBQLcn1s3oYyQJBLoVAowWhUvx8q7zNvFOCLaUGTjGrOt1KloUCAQCgcDwCFik0GsWBXQazyh9JiDLdjGQ9uFzxptAoPshEMS6+41Zl22xlbPGWT3z7rmP0HIEeE9smdt1sJ3OEy7w1Dq+wTvOU9zykiNHIBAIBAKdj4CdBzrMcQ7XHOwMOFrkeAIvame07NNPP008zjz7Yac6A/HeV0cQ69435h3SY9vyPKkKt73oLKAjKZ4jtAwB243OF1ug2K51FMkxDWe9bS3CtnabsGU1ROpAIBAIBDoPAceSHOnjtabPnON19MKxBg4Ex8Y6ozWOhzhm4UiF457O0/tljs6oO+roPQgEse49Y91RPS3LdZaNx9rZLGcenVn2MVMZGX9ahIDzu87WUv7ItcAgMEB+6SRIdYvgjMSBQCAwkhHwgbQjHz4WpM98/+D7JYTbtzlF8dO3CB3dTN9kOCON0Dujrh0+mu3oeqP83oVAEOveNd7R20AgEAgEeiEC0eVAIBAIBDoHgSDWnYNz1BIIBAKBQCAQCAQCgUAg0MMRaDWx7uG4RPcCgUAgEAgEAoFAIBAIBAKBFiEQxLpFcEXiQCAQ6EYIRFMDgUAgEAgEAoFORSCIdafCHZUFAoFAIBAIBAKBQCCQEYhrT0MgiHVPG9HoTyAQCAQCgUAgEAgEAoHASEEgiPVIgT0q7UgEouxAIBAIBAKBQCAQCARGBgJBrEcG6lFnIBAIBAKBQG9GIPoeCAQCPRSBINY9dGCjW4FAIBAIBAKBQCAQCAQCnYtAzyHWnYtb1BYIBAKBQCAQCAQCgUAgEAgMg0AQ62HgiIdAIBAIBDoOgSg5EAgEAoFAoGcjEMS6Z49v9C4QCAQCgUAgEAgEAoHmIhDp2ohAEOs2AhjZA4FAIBAIBAKBQCAQCAQCAQgEsYZChECgIxGIsgOBQCAQCAQCgUCgVyAQxLpXDHN0MhAIBAKBQCAQaByBiAkEAoH2QSCIdfvgGKUEAoFAIBAIBAKBQCAQCPRyBIJYd5gARMGBQCAQCAQCgUAgEAgEAr0JgSDWvWm0o6+BQCAQCFQRiPtAIBAIBAKBdkUgiHW7whmFBQKBQCAQCAQCgUAgEAi0FwLdrZwg1t1txKK9gUAgEAgEAoFAIBAIBAJdEoEg1l1yWKJRgUBHIhBlBwKBQCAQCAQCgUBHIBDEuiNQjTIDgUAgEAgEAoFAoPUIRM5AoJsiEMS6mw5cNDsQCAQCgUAgEAgEAoFAoGshEMS6a41HR7Ymyg4EAoFAIBAIBAKBQCAQ6EAEglh3ILhRdCAQCAQCgUBLEIi0gUAgEAh0bwSCWHfv8YvWBwKBQCAQCAQCgUAgEAh0FgIjqCeI9QgAiuhAIBAIBAKBQCAQCAQCgUCgOQgEsW4OSpEmEAgEOhKBKDsQCAQCgUAgEOgRCASx7hHDGJ0IBAKBQCAQCAQCgY5DoP1KPuCAA1JzwzfffNN+FUdJnYJAEOtOgTkqCQQCgUAgEAgEAoFAIKWFFlqo2WHUUUcNyLoZAkGsu9mA9aTmRl8CgUAgEAgEAoHehsBSSy2VmhuCWHc/6Qhi3f3GLFocCAQCgUAg0DkIRC2BQCAQCLQIgSDWLYIrEgcCgUAgEAgEAoFAIBAIBAL1Eeh8Yl2/HfE2EAgEAoFAIBAIBAKBQCAQ6NYIBLHu1sMXjQ8EAoGOQCDKDAQCgUAgEAgEWoNArybWn332WbrlllvKjwh23XXX9MUXX7QGw2blefrpp9Nvf/vbtOGGG6aO+m+bbbZJv/rVr5K62rOON998M5122mlprrnmSvfcc097Fp1eeOGFNOOMM6a///3v6dtvv61b9ltvvZXOOOOMEr+77rqrbpp42TYEvvvuu3THHXeUPwG19NJLp1//+tdp4MCB6ZNPPmlbwS3Mffzxx6cpp5wy9cRxJuOTTz55euihhxpF5YMPPihlfe65505nn312o+kaizj11FPTxBNPnG677bbGknTr9+T0kUceSRtssEFaZ5110vvvv9+t+9Ocxv/vf/9Ll19+eTIvBw0a1JDl9ttvT9NOO206/fTTG9619Qa+//nPf9Jmm22W/vjHP6Y33nijVUX6iTjjtPnmm6dRRhk5NOPee+9NM800Uzr55JNb1Ye2ZGLL4HjJJZek77//vi1FNZW31XFfffVVuvHGG9PgwYPT119/3epyImN9BEaOxNdvS6e//fTTTxNy/dhjjzVK6tqrUZNOOmmiZFZdddX2KnK4clZYYYW00047JXUNF9nKFz/++GP68MMP0/3335+ef/75VpbSeDYkYNttt00LL7xwauzrZ/U/+OCD6bnnnmu8oIhpEwLPPPNMOvjgg9Of/vSndOmll6Y111yzJHhvv/12m8ptKvNHH32UGL9qmt/97ndpxx13TNNMM031dbvdP/7448lCrd0KbEFBZHznnXcuF7/VbMiLBaZ3iPXHH3+cHn30UY8tDvPMM0/iJJhuuulanLc7ZED86IMnn3wyff755y1u8lNPPdVqstjiytopA3ngLEFUEdZcbN++fdP222+fLMLyu7ZekUDzEilkG1tbHmJpUX7nnXe2togW5dNWOgxhzBmnnnrqxLbMN998+VWnXe++++5k4bPYYos1atc6rTF1KhpzzDHTggsuWNr0k046KVVxq5M8XrUQgV5NrKeYYorUv3//0kPWQtxanBzZ5QX4wx/+0OK8zc2w/PLLpx122KFdiXVRFGmOOeYof3PTZGxuW5qbbqKJJko87X7XszHPxuyzz14S746of5h29uIHhgBhQWgnmGCCktzykvGIdRQsN998c6o1vPPPP38pw9rREfXuv//+qSMXC021mYxbNNhVqqYbNGhQevHFF8tXM888c1p55ZVTa/9DrHfZZZfUt2/f1hbRpfPRARYov/nNb1rVzqOOOqrbEWtjueyyy6Y+ffoM02dzc7vttmtXYj3GGGOUuna22WYbpq6WPowzzjiJbWX3Wpq3NelffvnldNFFFw1DEKeaaqq09dZbp3nnnbc1RbY6j7YceuihyZhNNtlkrS6nuRl5xa+//vrmJm9IN95446U///nPidPKjnBDRNy0GYFeTawzeo15SnN8XAOBnowAbw9PHm9g7icjziAhMvlde17/+9//pn/84x8devyqtr2IvFD7fmQ+w/3oo48epgmjjTbaMM/x0D4IOF50ww03tE9hI7GUqHp4BM4555z0yiuvDB8xEt6st956JZm3SG6s+h9++CFVg51haeu9876pYMfr3XffbSpJo3GcKH/729/SkUcemeiiRhNGRIsQ6PHEmsDaXnWu0blDytWZYQJci5Qz1rbAbOHYmq0SDWmr8TxtL7300jBHSMTzPNludvbvgQceSILtO8dOCK4tTGXloB3q0q5bb721PB9d3eKU97XXXkvK/PLLL0tvC++iVaYyczm23l5//fUkrppfPE/kww8/XJ67VI906hXXWNAXWGiTc9X6A8va9Cb0fffdl6STXjuqaTw7QgIvaWCgHzmNbccnnngiDRkyJL8qr+qHlTz69N5776VcvzOH3gtwkcF2qWMF3sGmurWljTnO1bM8TQX4vPPOOyn3Tbk5GFPtg6v69Y8XVB9fffXVhmK1mdzJ5yhNrtd2q2Mt3gvqkYmng4x6R7a8g5/xshWMAJMV8fqoz9KMKCjLGMoHU+XkPMog75Sz9+7hDeOcJl+1W58ee+yxZE7JM3jw4NLrrA8wy2mVpS5yN3ZoAAAQAElEQVT9USaMyLJ4snTMMceUc4Mx1C7xyocjzGArrWDcyYl6lWdMqvHiyBDsyZYxcV4cntqkXPJ/4IEHJnNG+fCQT/nSmRfCs88+W5779742GHNptFfQdvi5zyEf4YAPHL139EQb9E292uBZfzbeeONEz2iztFW5Vb9xIG9kqzG9JZ2gTOMgvfq9U7Z6lQ8zMqgNgnGArXSC/OoQpy1wUr+4HGBgnhtTWMBOHTneeU0yajyMBYyMGfzJhHTeyWtOaJN3Ar1lXtAR6oGPvOqrxUX62qD9sDbHySX5M3/00T0vIiy0Rf0Wd8ogI0OGDCnP9eu39itLXL2gvKpOVo6xJpdwF2+eeCaH5m+1HPHGSf/Vl7GqpjFXtAPOMFCGduY0yiC/joeIy+9d5TWfyIzy6Q5jIU7I2MJI+6StjqE0zQ1kiJyoBwbkp15ecqEd6pQ+y0JOC2/6xNgpS7/Ihn5KI57skm39Nl7qI39nn312eY4apvpDbuQzN81HekEZOZAJMgaf22+/vTxiqH05HlZklMxop3tplQW7nK7e1S6fNjqWWS/eO/1aY4010i9/+cvymIgdLN96kX1e7rHGGqs8T2/cpW9LgBs5gguZ1+9aPBZYYIGyivPOO6/UReVD/GkTAj2eWJsUhx9+ePr3v/9dKs499tijPHpAWf+E3E9/GTvbIT7+2XLLLdNf//rX5MzWT7GpPJfJMP/rX/8qSeRZZ52Vtthii/KjPpPSebKbbroprbvuuuVZ6osvvrj8AMQEokDPP//8ZCW777775iLLbSsfVvBYUTjOtirTdiWFJaEJ7VymYyTq9hHhPvvsU56F1V5pKALGwjGQlVZaKVUnDqV72GGHpauuuqrs/5577pm22mqrRHHJWy/Awgcxxx13XEnU1XvllVcm9VTTm6gHHXRQeZbMNpw2Oq8FD+lcfYymzfp37rnnprXWWivBmKGkFE1m53rFySNQZvA99thjy/ovvPDCdMUVVzR4NylM+DoHvNtuu8lSfmSnDv3XDoZNxKtDia6tcX2gsKUnA96LbywgrvIZE+PqrJ5/Kct4UdzIqr76wAcG8NIeW/0MoDEnL7boKEhjwDMgLyMm/yGHHFIq0OxF1SZGQj0wg4NytFk45ZRTkjbB0JEi5SursT7An4yoW99haOwPOOCAhuMQxhoBQDjUx7AxfDCulmu8zBnkZP3110/Ghyy7X2655cqz/cZTHgRJ+5Fn8kv2N91006SfsFGnto099tiJfDKQ5hqZ3HvvvcuP0twrS2CsYX3NNdeUZcBC35Eo45xlSJoTTjihNLLq0zblMy6MGYPluBGSmfvICOqHMbruuuuS+aHd6q0N5P+yyy4rP3b2vQTDa94PGjQowcC2vHkoH+MPd+NlsY087bfffslxLQZUm7SfcWXokQ44wEV+AdEw5vQD3aH82nGRTkCm9MtRF3JoTL2HI30xYMCA8iM340YfSsNLZayk0x4fM+k7Iw9r9Wm/vkhjHPQhzyWyBQdX9cMYUaED5TUudiVguuqqqybP5oP+GGdzxzgqW17Y+ihRnLTmC7xsV/NIVrGRpxq0n4ybn2ROG+VXDplT/uijj54EY2HcvVMG3ZbzkVtyQ182NrcGD11M7rXXXqV+V48+wsW81FfjBkffLOg3nQ47dQkI2hFHHJGUQ7/Ai/7IY6G91157bfnNg7HQljPPPLNczMqPNNIV6qU76ULvBfPUHFCe8uEGP8/iBPKgbXAiX2ydcZG/JUEb4ABj406u9NWio7YcbfT9j/aussoq5cfqFiE5HR0LEzsK9IQ5CUt6Uhrk0HxyTApm+rj66quX34FY2DhSSBfQl+aSea/P+m6MlCEYczJnnDM+m2yySakzsl4iR/QHXQ538r377ruXxybwCPgrqzaYx2SJ3Dg+WRufn7WVvVOmozKCjywdXXHMybl5dmDJJZfMWVp9hSXc9JV+ozuNV22B6iWX7EBtXDy3HIFRWp6le+VwfpfSNUkoAYaCAbNyq/YEAV9g6MrNhz8mHmJrlScNZYQMUsgIFsVPiVhpDhw4MFGCtsxtnZtcvDzOiCKVFIQtoVlnnbVBMSpToDAZwgEDBpQfHCnTvSsyoix5feDHGJuwDCzC6xdGGCjlMBbTTz99aTS01bscKDqrbKRb/7Wd0UXwcprqlVK36qbgEFTpKWJn7uCY0yILcKIoKQK/eEA5wCPjRpkyMIwlJaK9+sRoU2IUzDLLLFN+QJHLpbTgIg1vXq5/zjnnbPi62plDStqvR+R8PlQxxnDJ71yRc2QHDoyfM3eUIwUsvl5AJChUSphyN0bqowCNM6Xr4zB1kRtGE6Fn6IwPBc9IkA8EAyb6wRtK0es7jwaDWj2GtMQSSyQY5Tb94he/KH8xBRlEkIytsbCIobhPPPHE8svunL72SqmSZ/WQe6TYfCA/SKjyKHNpfODjFysoXjIO42p5jifA2NlJxk5AQBgSfdYmCyAyiljo/6KLLpr020KmKIokrfGH3V/+8pfyWwAf90gDP3UimshqtW7Gn1waO2OIMDE8iJjx8Gs1CCdyrjxjRtaNDTmGIzkTpx8bbbRRUoYzqsZZvfotj/FpjMCZh+pXlvmtXpiYB/pqjsiv7TPMMEP5KzaMGr0i/fjjj18upsVrExlAyBH+tddeu8TK1qx4gVz9/ve/T8r429DtWuQDwRBXG8iROuAHixwPa7pBPnKH6JExxBrJzuSGbFrQL7LIIuXiDfFyJvyKoQtankKLCuQTaSHTxoyecoaUfCNmFkq+h0CyGWjHiegQBGeWWWZJdIHFhHEkfz6eQnB4GuXVVoTIOI477riJ/jTO3klvIZP7VXulj/75z38mY0PXab/xpXf0zdjzBsKdPpLGL9/QA+Y3cmmOqJOMkl+Y1dbjGZ76TSfTibBE9NSByNKfq622WqJ7zCXjhqzJiwSaN/379y8/PIQhnI2JnQJp6Cv6FImEs4U7OYGr+KIoEt2pf8bFuxzoXPN7gw02SPoOc/2hT40/3a+tcDJPxHMimAe5jOZer7766nKxZN6wcwgqPcUe1pYBJ44E7TMP4JzTkQlziOzQRcaDnkIGLf7YBLqJvqez6B62QT/oEbqZrmUjOKG8m3DCCZN5XTuX6WhjxFbAB87GDcbGjX7o169fold48pWjLjiRT6SUjqvtn2f2gsywg84ve9dYIN/siHEi7+aQBYM+wpNeqZfXAobjhb7JAZban59d6RO4IvC+u6CDlUuO6IrastUHV3lq4+K55Qj0aGJt4lJWfpbJZC6KIjHgDIXJV4XLpEQuEA0k2EQmaNK4UiIMIcNl8k0yySSJsFKUDD8FZ1IwjNIgXYyUSelZuZS68gTeCcpEXT7YQo6RFl4PeREVxonCoECVscRQ4sVgM+Cu2TOgPRQ9w6/sHHigeDwocu0qiqL0kCJ+2pXTVa+UhhU6JYe8iUMokYOqskBYvGccET/kwIRn1BEoSoYyGjBgQNJHbWRoGTntktezfqgjB0rUIsbHSYiL97BWvzH0LMBLve5zgG+1jd5TYMbFeBZFUW6/6WOtwpU2B4ae5xb2cFOXFb1yYCedco1LURSJ7BgznhieZCt/izfjJR1FJt7YIgAIjTJg5loNFHl+1h/thhNlTVkqp/9Qo8yAGHNkKKevXskjA6uNFK2ykBdeQobE4oIRqOZp6t74kS9jARMLKuUwQgy0X/PwEQ3DZ1wo6r59+5ZF6qdx0SbjW76s+QMjMqG/1ShyxCOMFJkf4tRpPpBtdemjtlnY+oUEdZNfbUXy5Wks8NKTVwaFMUWSlNdYev1AzJEqYymdj6D9FBpM86LA3PQhmPbAXvv0T3vlaU6AqfFGmPWHLCm3Xl746a+2VOPViUAaM/rIvEIQlEsPIl3mg/msndJot4D00W/yIxnIGfkmd+RB2Yif+YI8I355zpgr5A4J9XOa5o82InScBYi2ePLA8wl7bVeueU8/u1qokHHeeKSw2rd8b9FlvrrSjd7rL3ngVECYvKsXkF/zVHu0xVyj5y0gGnM+6Ju+k0F54aNPsKMr2BEBznSCdmVZodeLokgIDlmA86qrrlqeD2arjIUFsLGgT5Vn3pIF9eY+0IWwFp/fmSuwou/1B5b6Q+da+GgznIuiSOZQUfxE0OU3D1xbEtRNLsldURRJm7Qbga8tR5uMJ93FU855YZeIvUCQzZvFF1880RXaTV5giwjDrk+fPoluEAc7ckwH5fGurc88hY/25Djl0FH0MB2hLAsUdpjsWqiTdzibc8bPmNJjxpgss8nkJJdZvTqeYqHalP6opjefLejZR4SdXSQv3lfTVe9hRO/BMAeLEDo4P7vy0us/+WdP4TzmmGOWP6EI42qZ7skvfCzmPbc2RL6fEOjRxBrBKYqinKw/dbd1fwkbcl0r8ITRBOXdlqYlpSM1FJCJXc1nslPKvDMmQzWupfc87PJQzK7NCRQDjzOCR+k3lkd/eWEYoRwoBwSDUhNPWVO2jZVR7z1vv1W5+imCemla8o73g5JhJClpnqwR5Vev+o1PVqJIAUPIOI0oP48T5cXwVNMyjsqg+KrvW3OPaCM4lGy9/AgYuayVL2kRGkoUIfLc1oDEMLAwRtS0zRgyuEgNwwWT1tRjnujHdtttl7KcOX5goYrYtKbMah6eK+OtbF4jHkyLlmqa2nvGli7gUWOQERoLZYbYLgKZoXsYWHOhNn9XezZmvPtklnzWax+vsTT6XY1HOIyFBSfSUY1rr3sEU1l0MKLgvhp4Q+kb+gjZMpaCBdMCQ3chjUc1ffUegbZDJn0OSDodTC6qadvjHsm12Mt1ufLKWnCYq2QJwaOzzauW1KlccthUPniwK3Q7km9etaSOaloeV7ti5ozFr4U8OaimqXdvkYkgWtixETy17J425fQW0WTLGDhymN+35Up+6JJ6NgnhJ9/i21JHS/OyMxal+muOwa8peW1p+Y7+KZsDzG6bRSz92dJyIn3LEOjRxNqqmAegrQqfd5MnDumshReJQLoohtq4pp5577JBqKZj2BAmK2331biW3uu/ScroNDcvQ9PctLwiVtm1wZYfvGBfe+RmRGW3NP2IyrO44FVD9HgGbM2OKA/8ne1EjmyT6oczua7NMUQIOQ8MDKp1IYJFUZTbjNX3jd83HkPeyB2vRL1U6kaY6o09zyD5kr9e3pa+I6fKQwzc6zuCaZsfEeJ95CFrabk5vXIdh6iVMwulWqKX8zT3ynOL/PuHmyxStNVOC8LcWBna43wnQqavzusiYjxsji7w7jKSiIFxaqycrvKeR9U48do31u+mdCCPNFnqqL7mxYmrehrDzZEKHslaOTH/G8vjvZ2X2jyeHecQ396B/NjdUEc18Dwag9bWZ87TUU3pUDYMwTI3jbuFZWvrs0hwBMRxIYtonmDX5pSH3Fo8cD4gs+TOoqCaV1nSINfV9629Z3PpxHp8wOKQ/DYlX62tt6l82sRz70gI0utI3ALCaAAAEABJREFUUC0OTeUfUZxFqSN6jumQNVc77CPKF/FtQ6BHE2teNMrGoX0TN0NlxY5wicvvmroiRLaGbNXVpjNJTcrGCE5t+vzMm2UlaUtZGfk9Iqx9iIjVbH7fmisiSZFQ4gxjLgPx03/GNL/L13z8g0dTO/L72ivFiGzyElXjKGtbxrbt9I/SrSV3tsz0u5ov3ztW4d6HcBYG7tsSbNvz3joHzivBOI+oPMp8wIAB5e9383j3798/OZdn2855tRHltz3J88Tbajxz+twfyi6/a+3VuFqYOdpUrwzySH60AcmrprErYLdFmur71t4bc/OLR56hNE/sXjg24BgW4sVotaZ8JAQZ4H3k3cplqI/sNXcO53y1V2cQbf06c63NvNHO8/pQszZtfmboedyQauSax43H0ViYU0gLz1OeSzlfV70aMztvzsfWkjK6wjERizFp6nkP7XyIM+c7oo/aYN5yYljA1dZhMSfe4lkfqvFkxrne6rvqvUW0I4OOmlTf01FNyUA1bUvu7XiZj+Smmo/31q6OYwfeI5uIlvvmBvjTXXRuLUHnjbXgcw7dcRH6zTGbXF9z68jpyDkvNTuyyy67lL+9rn5jkdM0daWT6Unea98R0JdsTjWP+YXoOhZSfd/aezaXTmQPa8ugY8iX8amNa+6zvOSw1t41lt8iyHg41mKBYlFPz3FMNZanpe/NXe1i/xxB5AyzsIJ/tSwE3/jRt9X3cd86BHo0sXZeCQFk+AgYI0whIEkIBwOJ+ORQhbD6jgIwuZXDsIiTluIjoM6P8Zx5Xw3S5JDf52ekZsCAAeW/HsbzhpyIQ4AZN+fIKH3v5HWthvwu5xOX3+XriiuuWH7kYrI6I67/yjeZKURKWL5qoHgQIsoZcVZ+DtIhZZ7hIa2zr85kIxKMkQ+TTFKGVhxy7vyXs2sUCY+4owEWK8rLbXUvGC9nDhkeW4zqEpBI8cipZwsd5+6koZTF28K13adMz+4ZKySMwlc/o6Yc8cpyXxuQVtukPFbawWDDkEemmlY9nvPVveCoBZLpoxJ4eycNPCkuZ6W9s/BhOHg8tUf7YClOHwX3grYiCe6VhQgwno154ClTilq/ndnMZbnywiOGzgwqT1BmDp6bCvpkPKWXzr0+GDdzCrFmqBA29Zlzxsi9PuqLfEVRlB+k8tCYj8ZJmTlIw9jB0jlMxsd8Y3Bh66Mf+FXTyyPkd+r0XA2wZvy026KbDCH+SIaPXI2/NlfzVO+Loih/p9b48fg5l20ukXdy70MwZ6urW9vya1P16j4HbTJ/zKOcLse5eifU64/4HOrFeyevkNPlq3fIKnmgbywwEBzjZMHvoz7G2ILXOJgXxlc+ZWizdD6QtZD2XhCXr/nes+C5GmrfWVRrszSuvNAWKY4xFEWRpBfEC2TAgtdRFr/CxENH/rRNuxAq6XKANZzJgP65N1c4BMwxupG8kcecp/aqXbXvcpvyVXy+z1c2Sf3mrQUc/egIhw9DtZdOs1XPBui3uSavPK4WGe7rlU0nIqnmlw/VyLdxdKwQWTO+FhHekXflmU+5LGWTfe9zEFcvsAPK1X5kUptgzsbAxrU6h8QrR7mOUOkXO2PsfHhnDNhX5UonL4+4b0LMKe/krV7dV4N49bDR3nuuXu1OkSF2GwfI8fLA27EcXvKcJ8dXn70TvKsNFp9sIhvXWJqcRzy7YkGlXuPuuydOCMcV7XxJk9Pnq901NpJuycEHn47l5GdXnMViiuNAf+FsB81RKWMD/1ymK0cX+SEjniO0DYEeTawJKwGlcClYHwna4kdIeJgoVr++QaicD6V0KCMfelA4tk4QKwbDF8S+0mZ4kR+rXis/RJKCoFQoBgSDQPOSUFSGh9KgJCkN9WTFIq9fVGDckR/1HX/88cnKkaeP8tMmZ+4YL+SY0bFlTfkr2xa5e+d2TVRKgoEwYZ210z8T0aT1MQ/jz3PBuyZ/bUCGKGWGzPa4bVRnwJTJAFNIFBfyaOsSOXOOi1Lh7SuKojwLq1yrZAsEfaDUeGotQuQzNnD38ZC0yB5vEyKoTh+6UBbakvHO9TsDLg/iS2FYQCA4xtXHkBTHBRdckNShv8pGZh3j4AliPCwuECrl1AaGCUn3xbhfNRCcu/VLAeTJWBgHHhtGhOfUdp4FhbIoKL8wAEtyZ5HinPfgwYNTVozSOZMLR22VTh22pZE03jKYK19a9TG+ZEW9yoMTb4f4ekGZjDQihJRaXDrmIC3Zg6e+ap/2Gw/eVuOb+yJtbUBsKWwyTq7JYP+hXn3HI4yfe+32s5UWVYw64wsnGDLsxobMGH8LLYbNYsEcQm7MQTKsbh42RFXbkCT4mmdIhLEg40i2j9vk8y5fzRnyx1DDWzu0C/kiJ+aY7VFECg4WueTJ0Q51NxYskMgWuWYYczq/UICgOxaS3+kvGTRvGTT1IFHizZ+iKJKdEYTc3HSMRpwxMXbGxS9L0B+86mRDfDUggeYPXWHsyAn9Ri/ok3FWBrJCto2F/Mid8vTXfNM+CwZyaTzJELw5DvwiDf0JP22lA8kVWYKZuUUmLCAtYGFv0aQt5qz5CXf60fhpg/qMH/nWHoHuJTPGzdibB2Qd6RBP5vSBzBhn5A6xRlbpTmTZwl0f7PzR+/LZWUR8zGdziEzQv57pagtD8cgHOaMD5asN6tQncgYD/dFn4wt7OtIxMuNGz9DJ5pQ0dlHNY7rZL5OYBxYs2kI/qst8INvOLFvoKI/egRUbkeWHbWJ3tIUDQV5lkkvYk03fvNi1M0bq0jdX3mo6Srn6Se7ML1jC13h5R2eQHWVXA/l3blcatpR9pN/YWvaCTqMD1G9hRrbMbWUj0sbVnFameekDO/Kr7+rUZ/WyIUVRJHZTn7QPfuRH3hzoQfnsKpIz8mds2F7jldOrm6zSg2SfjLEd2sme0D3aqS4yqUxOARibJ/QM3aeOXHe+6rs5Q6dIm9/Xu5rbbJvdHvOGjJgr5JcOhScZVXc1vzbSv2ShqWBuwJWtM9Yw4xwiO+Sdw6JaLllFxs2R6vu4bx0CPZpYg4QhYIxMKOSKMjH5kE1KiZAyGJQRr5mJS8khixS0yaUcgmjyI9PIN+XPICPE4ilmihaRYHgoWEEcBUHJmMAILg8FQ4iwm+B+V9ik5AFAfn2Nb4LJ653JpM2IALKhbr9xaWVrEjLS3vG6aJ8VKyMsP6XHcEmLrDP8jBTlKr5eoPAYd796AicTFG4UvfKRP/kocYoZAUWu4IM4IYbieeXVTYHBU/0MK9IsHg4mvrZR0nD1njFUPyzVz8ipHwlTP+ImHaOPEPFSUZYIjrNqvJkIpW1GChppQfApd6TeOTaGxkJAObUB+TIOCAYlSSZ4IRAB59OMF7ng3WAIeLIpSGOqLGTfwoWBobApLYoTTjwm0ghwUh75QwIoPOSB0UEsGFfjKy2lJ69FFGWrfxYpOV6a2qB88unjKG0lS4wcJZu9QJQ5I0TWyQWZpZQp7dry8jOjar4wWuaMe3nVIY2zroy08UFqtIERMZ7kXzpkzbP35InHlJE2Tt5Lk2UYQWDMjBtcyIE+wYrMFEVR/uYvDPURPtrBKDMq5of+0AXGQF8tkmFgzpAtBpXR9B7+Y445piKaDORO36qJkDPygTjl94g1WSe39BDyBjvx+q4/CJ52abu+mxM8TEgbvQJzGJsnPFDyVoN5xNOM0CO7jrfQb/BA2ORVrrLIrqNA6uChgg/ibD6TWXMMbuYyD2uuRx6LXGP23nvvlb9BztFgDkhT1YF24xAGOsvcoYd41mBBh5kvZMPcNA6elSHQP+SdHNKL5ji5ECdYMJAjC3+yS4aNFx2jffQnfUQGja08AvyNl3lDX9Dp3tMX0uZ8yjAXLTzF1wakiSxVdbL2k1PY0Vd2y7TTuBlz/Te29ACiSy+RRWNg4WPMsk6mt+hauFp4sRMINvmXHnmDoV0pc8X4GnvtNO50Lv0JDzrXItyOg3jP+gs/NsSYq0tfeIfJCPmgR+lLcmpuyFsNxkU8+0VPwVMftJmNMQ/IFGcB+2vxYH6TU4SxOp7K1S6yBzsEWzuMVR4j/WU3zC1Xeke+HMiWPpi/Fg/0AtvhnbroYGkt5ukSOpeuM07aqi56P78j13QsHUSuYUKnm0fKNpbKqw1sEN1m4VcbV33GBzjktId98axMO8EwZKe0Rd3VfC29N0fIjjrgDxtzrloObMXBDmbVuLhvHQI9nlgjHogaJWMVSAFko0fZeFcNjHX1mZczQ8sLQqmJVx4jl+N4qUwGcTkwWuIZpPzOlQE1icVRPhQTEkDJIWK5feKlrwZ1Unr5HYViglJM+R3PjRW8/EXx08/BURTiTZ6swMXXC4ghUsm4KJ9RUC9jm8vN+bzXb8qUUqFwc5wrEkFhq5siZii8FxgE73OAg/fGDAGUnmJE3Chm9XsvjaBs79Stjer2DENx0hgDJFow3t4xKjBjsDzXBgYREaPEGT8LA8ZW4IFiyBn/3G5Xi7bquCHkyEHGEMkkW0VRDFMdPLTN+MC2KIryH54gs1XDbrGEOBoPCzQECpkYprA6DzBhQMmEfAgBY5+TMsTaXw3a3JSMkA+eN+2WD8GsptcuxgypMV/EIdvmTPaIwAeplEabjFdVhpULD+0kD3YiEBLygBjlcngqpa0GuFefLXSVb3wQPnM6G2ztNB9zen1prnGBHXKojTnIS8fkZ1d4WBznOshrzidOv2FJT5DLnM5VHELoPgcGXrnVQJYdSclpXMk7uXKfA7lRZn52pROUZSFmgeMdjBh5uy7icrDgz/MZrhZ7Oc4CnJzJnwOSmO/zVZ5qP8kA+cjlwBDZQcrIDI9qjnPN5eSrBbz32mqxTJeSdWNL/sUJdK55qlwy4p1AFuke+ehgZVTnnjTVkOvNV/0xJvnZFUbmnfsc6DHlkmc7BPSmOPgbv2odZIvOMN+VRe/RbeS9KIpEH8qbg7ic3/xGoMRx/tAxOY4e4Qggg+RUveSLnCCE0slXDXmuiasGxN58MifJjXkO36r+UJ8FB12uTAvZeuVJZ04ggdLpM9KZ6zM+3udAhnOcK3tFZslVURSpVj/DUjqhT58+iXzBwBjov/rF6RN5zPW4Ivuu1UD/SV8bYGgBZHFjYVkbn5/ZqFwePUd2YVit2/xSd87TmivcjJG6yD18cI5qWRY69IL5Un3fI+5HUid6PLEeSbhGtd0YAR4kW+hFUZQ/1YiUIeiULq8Cgsx4dUYXnbPjzXAVOqPOpurIbXFtKl3EBQItRSDLt6vQ0vyRPhDoCgggrxY2dgq6shxrm50OR8TsAFYXoV0Bx+7chiDW3Xn0ou0dggBvki1zniSeFluCVvu8R85I84Z1SMU1hdqCdd7PtqKtSOdnm/KC1GRv10db+rfddltyJtH2pPOdtlcp53atKArrlQg4SuHDSMfmHAVwrtoxvV4JRnS62yPAS8zj7mx3V9SRjiQh1fS5BYDdvG4PehfqQBDrLhbFwxQAABAASURBVDQY0ZSugYDjC4582JazTeesa79+/ZLtR8dDbJl3RkuRWedpbfPaEucldgylM+qurcPZWB/s2MJ0xtZWtfOHXdFo1LY9nrs+Agi1I0aOFTiq5RyrM6Zdv+XRwq6HwMhvkWNHjkayFV1RR7IlUHKszk6s+wjth0AQ6/bDMkrqIQg4c+nMng/KkGveagoon2/srG76gId3nKc8h7aeuWtt253Ls7DI7XB1ttR50daWGfkCgYyABSyZysF3JL5pyfFxDQS6GwJIte8DuqKOdKbbdybhqe4YqQpi3TG49qhSozOBQCAQCAQCgUAgEAgEAiNGIIj1iDGKFIFAIBAIBAJdG4FoXSAQCAQCXQKBINZdYhiiEYFAIBAIBAKBQCAQCAQC3R2Bxol1d+9ZtD8QCAQCgUAgEAgEAoFAIBDoRASCWHci2FFVIBAItC8CUVogEAgEAoFAINCVEAhi3ZVGI9oSCAQCgUAgEAgEAj0JgehLL0MgiHUvG/DobiAQCAQCgUAgEAgEAoFAxyAQxLpjcI1SOxKBKDsQCAQCgUAgEAgEAoEuiEC7EOtvv/02+ednI3wSOHwSGMQ8CBkIGQgZCBkIGQgZaB8Z6ILcuckmtQuxvuCCC5J/wSfCBIHDBIFBzIOQgZCBkIGQgZCBkIH2kYEmWWwXjGwXYt05/YpaAoFAIBAIBAKBQCAQCAQCga6LQLsQ65VWWik9+uijEQKDkIGQgd4tAzH+Mf4hAyEDIQPtKgNdl0LXb1m7EOsJJ5ww9evXL0JgEDIQMhAyEDIQMhAyEDLQhWWgXzdrW3362nXftgux7rrdi5YFAoFAIBAIBAKBQCAQCAQCnYNAEOvOwTlq6dEIROcCgUAgEAgEAoFAIBBIKYh1SEEgEAgEAoFAINDTEYj+BQKBQKcgEMS6U2COSgKBQCAQCAQCgUAgEAgEejoCQaxbP8KRMxAIBAKBQCAQCAQCgUAgEGhAIIh1AxRxEwgEAoFAT0Mg+hMIBAKBQCDQmQgEse5MtKOuQCAQCAQCgUAgEAgEAoH/R6CH3QWx7mEDGt0JBAKBQCAQCAQCgUAgEBg5CASxHjm4R62BQEciEGUHAoFAIBAIBAKBwEhAIIj1SAA9qgwEAoFAIBAIBHo3AtH7QKBnIhDEumeOa/QqEAgEAoFAIBAIBAKBQKCTEeg0Yv3NN9+k999/P7333nsN4bPPPuvk7vbs6qJ3Iw+BH374IX3++efpgw8+KOXb9Ysvvkjeu4q75ppr0rzzzpvOO++8dm/oueeem+abb7705ZdftlvZ77zzTppmmmnSCSec0C5lwuTwww9Piy22WHr55ZfbXOajjz6aJpxwwnTHHXfULevDDz9Mf//739PCCy+cXnrppbppuuLLH3/8MdGNWVd+/PHHybtqW7/66qtSznKaTz75pBrdaffk+84770zLLLNMGjRoULvXa2z79OmTjHV7FW6O/OUvf0kHH3xwYpfaWq7yTj/99LTSSiulF154oa3Fpaeffjr169cvwbVeYV9//XU666yzyvqeffbZekl63bv//e9/w8wH88L8N086Agz10YtTTTVVu+rcjmhrlNn5CHQasX7mmWfSjjvumOaYY47Ut2/ftNpqq6Urrrii7PF3332XXn/99XZRcmWB8ScQ6EQEEOfLLrss7brrrmmHHXZIf/vb39Luu++ejj322HTmmWemI488siRKr7zySnrsscc6pGXmFHIz6qijtlv5Y445Zlp55ZXTTDPN1C5lItMI0ltvvdUu5SHV9Mikk05at7yM95tvvlk3vqu+pA+vvPLK9Kc//SlNPfXUJWl96qmnhmnuAw88kNZbb7007bTTpr/+9a8dslgbpsJGHhAMpP6hhx5KCF8jyaqvW3RvbI1xnz59WpSvqcTmyAILLJBmmWWWNMoobTeB5Oy5555LL774YlPVNjtu/PHHT7///e+TvtfLZB49//zz7ULi65XfHd8dcMABaa655irHdJtttklbbbVVOT/23HPPknC3d584CV999dXSWdjeZUd53R+BtmuVZmJA6E899dRylc0Ldsghh6R11lmnzD1kyJB06aWXluSjfBF/AoFuhMDJJ5+cTjrppDTPPPOUJPqCCy4oSfWSSy6Z/vnPfybk45e//GVaYokl2sWQ14Nm0UUXLT1wv/jFL+pFt+odMnPiiSeWRr5VBdRk4lFfcMEFa962/tFiwsIFQapXivFYaKGF6kV16Xejjz56WmuttUqy/Mc//rH01vKucj7khvP6n3/++SX5sgOy5ZZb5qhOvU488cTJmNLpHVGxseWdnW666dqteHPE4hdhH2200dpc7qyzzprMvzYX9HMBvKCHHXZY+s1vfvPzm2EvMDH+w77t3U+77LJL+t3vflfyi3/961+JDubIu+qqq9LRRx/d7uBwNtBn4403XruXHQV2BQTa1oZOI9aaOcYYY6QpppgijT322GmCCSZIRVEkWzW2EHlgpIkQCHQnBB555JFkkdi/f//SczjJJJOUzR9rrLFKRY90f/rpp+W7+BMINBcBXlXe6kUWWSRtvfXWyY6IxZtjB7kMpBYxnGyyyfKruAYCvRIB84IX2YKjKIpk/sw444yJc4COTvFfINCJCHQqsa7Xr2OOOab07l1++eXlNg6S/f3336f7778/8dYg4laGF198cfr222/Lc6y22FdYYYUyzW677VZul2644Yblls9NN92U+vXrVxJ4q9Z6dca7QKA9EHDu1fEPRxJWXHHFxNNYW+6vf/3r8kxx9f1HH31Uyvz000+fEPLqFrKz2OTbDk/fvn3TgAEDyjOXzrLKx0vJEy4N0iWd90gXD5djKeoyhx577LG00UYbpcknnzzNPffcpVdd+drtaAEvpy1ni1pXRM48y/lvu+228jiCbVXvBNv9PKTaYKvauVJnQsXVCxYV22+/fdI24eabbx4mmYX1P/7xj7J96reLlT2z+uzoiLnNY8kzyBulb/pJZ/CWnnHGGQ1lqo+nSl2wv/7668u4d999t9QnvJU8fl7eeOONyVGKcccdNx133HFeleclHeeRRv/omZFpmB1V4Fk1Bsb46quvLs/tl42t88d5bMeQZptttqT/sBgyZEiZEgb77bdfiTVcNtlkk5J4GJ8RnTWG64UXXpiWWmqpUreSd8c/yFJZ+NA/ZMNZY2OF4MAtx2uXReZvf/vb9Ktf/So54yzeGMt30UUXle265ZZbyqMvZPvxxx9PZ599drlAdTRmaBXl/44SbbHFFuURJf086KCDku8BRNqedxRgjTXWSNdee20yfubnMccckxyx0Z7//Oc/ae2110577713aU/kMy8uueSStOyyy5bzxXy47777GsUalhbUyNuUU05ZnnlWTg7OyA8aNCjNP//8yW7VmmuumZ588snyrLw2OMqhnXTAdEO98eazIzXaeM4556Q//OEPKc9FZTozzIvNU8omVmX+z3/+cxpnnHHKvsIGnnnRdcopp8ienDeWf+aZZy7713+oI8D81pYyQTf/88Ybb5T2nz4siqLsDaJtXMlb+aLyx7E5+poDJM99MkYH9enTJ9GP5IScym8Xgcy9/fbblVL+/9Y3Lo7wmK9IPvkgY/SNuqSEtfExJ8mNcOCBB5Y6R3yEnoPAKCO7K4yYQAE6h73++usnChcpdm5qyJAhaZVVVkl77bVXIugE9r///W9JNu6+++5yy/TQQw9NgwcPLs+zUrCUydJLL12ecx3Z/Yv6ey4CZJHcMWqMXWM9XXfddYeJ8iEd4kYZ+/joqKOOKuORTGSXUkdA77rrrkTW11prrdIoM9YUO7KJjDvm0Hco+WY0vTdXKG+FmUM77bRTQjAQVYTqiCOOSPvvv39CStX18MMPl+U7s8noLrfcciURd3SFkVcOcuIqWNj6GNBHmObnY0OJuzlp/oqvDdql7wyNj9CQp9dee60hGRLhiIOPGm+//faSCD344IMJ4dBXxMbCYtNNNy3n+6qrrproB/3RB2RD/blA7R4wYEBCApXneBlDJh65sSCobtkjUfoiPgfE3Tuk44knnii//cjjk9N09pXx57Wm0xxh0LZ6bYAjAocw3HvvvemKK65IrogXHBAuZ4GNNxlErBE6x2lsmdcr0zvjBBdjSGbJFk85og9raQTygPjBncdQWmOPtDtSJB62cEX8Nttss1KujRsSpF3avPrqqycEXNnG2HxQvkDOkU4ESjkIJgK78847l0eu1Ce9fpqfbAPbwSZYCIgnW+ZdlnELNSSWU8bCAAG22PJx2kcffaTaYYL+kAkk3liQU2XkRO4t+tgiCwX16svAgQPLM7nO/CP1joZp57777lsutI2VODu6yszlwd9xBmNGL5i33uV4x83IRX62M3zdddeVjqr8zry64YYbknap02LAIj1jkNN116txmGGGGcpFjD7o42mnnVYuOMiGd9VAHjkHzCk6V9xKK61U6st///vfiV4lMwg1fUN3+ZiUwy/rWHlyQMDpxnw0hL4xtxxPyWnIA3lEtHEdH3Jro5DTxLVnIDBKV+sGhUEZUSyUybbbbpt41BgGHiYr/Nlnnz1RHjza/fr1K70ovFmULkNOmAXKuqv1L9rTcxDI8oX4IArN7RlSgNT5tYo555yzJBfyWigiMJtvvnl5dpZSP/744xMDzvDb8kem1bf88ssnnjpk0ZxQJo+JcpAHBpQ3luFAtHjgeBmV55cLnD+m/C0KEHfziMJHGtTHy8fwy6tMQT5zkhdcWxhn5CMbJmmqgSEXeGWk11fEL6dRD281I8P4MXZICeIgMDj660Mzfea55vXkUXLkZvHFF088Qrk8xEh9yLq+0RPV+sYcc8ykHTm9qzSuOdAbjB9yg4xoD89pjh9ZV15NBNECzkKGfqxtC3KMvDpvShYs3nivLT4shJyD7j/UUwkzY8ubauyNOVJbW15+5m1GLHih1Q/DPfbYozz6BNOcjkxJA1MeZyTRAg6hQLbtbvD+GTsLIHKKFNpRkUebefkQbmOoDB7yXL6r8UeYLbDIBNnQXzbD/LFToQ0TTTRR6fkmc0gP8i6fcUXavVeeoB1IpvnIYymvnVBtlF6aaoAVWwQ76c1TOy05DTzNYwtjcs1BpH5tZKPMWc/mpPnFcaS/2m7OcjLlslwtmBFlCyTxMPThqjihKIoEU/c52G0R8rPdCx/yGb977rmn9GAbFwvUnKY7X+FjHO1M0J/6ajfEAsg8qO0bEk432DngvBBv0W+e0TnmCLzJgLHCQcgynVWPWFtI0pnyKUswT8i0e4E+UY65wHlAR1vsItjiI/QcBLocsaaUGFrKhceNEeFpY2gZ9Aw9j0lR/LTl456CEnJ8XLsAAj28CQieLlLomWR7HlEgrzkNYsIT7JkhRuT6DvVCexaQZkaAcc1GUH4Gn7xnD4m0OfBC8doxwLYmvafwEQfGRpx3ggWqq6Bc18YCYq0N1UWEXw3hQayXx7EFJKZq9HmA+LObAAAQAElEQVQCc1peQ+Xts88+5a+pmOsMJG8zwsKIMU45va1TOiDjnt/nK2+oXx1qrL6crqmrowVIOQ+g/iKjdFJTeTorzuLJB+BwQcRsf1fr5vHU9yrGyBtCgFzntEVRpDzW1fHP8bVXxp8HEEkoiqI8v2oBwuNHrtLP/ymzKP5fJ3OSiCJvxlnbPAvIKNnmAfScg7Els/XkWhpjbD4g1Z4FC0akGTHyLChDcD+iPpp/jjOpsyiK8gNjxw8tSs3PVPMfuVY/EiaqKIrk2b2g334pZIMNNijlmh1zvENfHcUg39pkUSs9QoakI82eawMPqvT6neOq9eV3TV3pFOOHdJIFZdE19EFT+bpDHI+ysUeC7ezQIziDXTg6ryh+kslqXxBhi0xzhWdZnPnjyJw4upUMGDO/zuMdXWRspW1NsMtInzh6pY12LewC3Xrrra0pLvJ0YQS6HLG2GjTZTXrKgCISbDFSfF0Yy2haL0MAOUDknOPj/Wms+4gNmW4sPr8n8+6RaNccGNWiGN445Pjaa55DCFi1XsZC2qJoflnS14ZaosnY5LZX0+o38ldtQzXee21ltMzxHBCM3FZlVPO4R/Rca4P3vKTKrY1r7rOjCDyc2223XfnzoNVFRHPL6Kh0iKLfQefxYoydDbWoy/XpN4JoPPK7THyLonljjlj4sDwHxt8YGd9qucpHSMW5byrIy+uXPYPSGnOhKJrXLnkEZSHqrp6F3Ef3rQnyKK9e/2AqvhpgTi4tFqrvq/dkEXHOMu3KnmkrzNQn5Dzua+vPcepTHj2T37X06siaxSJCx4uOWLe0jK6anueXvFrsWexkrL0zZxprNwwsDnmMzRsY0z3SG1tHdBy9sRPmSJ1Fn7jWBuPuaFFuo3YK7Ehry4x8XROBLkesKR5bNz6ucZYPbJSbc2/OOHmOEAh0FQRs8zJ4tuFda9tFkfLCUtS1cbXPSDpDwKNVjSP/tq6bq9gZdAbC2U7b+LksZEAcL05+15IrQ4QM2TZn7HNe2+LO9+bnfEUkHOHSjvyuerX1zfPueEomXUg7Y2YHwBEBRxB4o3I+nlPbqfm5etVnW+22XKvvq/e8TvBkRL2v4uOZ9xx5dTTGs/a4jsxg3Kr1OyLhrDwvKE9tjnMcjifTeOR35M6YOzaT3zV19ZvrxjcH2+EWdo5HGJcs49pkh8XZ4abKE0duEEc7kci4d0ikwNvsubnB0Q9jVx1jbSJr+t/ccqrpeNrJhaMauT/q4ME0f6tp3ds5gTubpF/eVYPykCUfQ5J/ceQIQXNmHAF0XtqRDGRLvOMlzoy7rw2cSurjaYZZbXxRFOWvbKmDbIuHc56j2kg/OQ4iqLNeOfJ1t6CPfo7RmJCzlrbf8TJ61YeocKJzlGHcjJcPh+k8mIkX11gwz8wVZ/ilMUeMg3tB++yC+YUf89I7+sfxJvcReg4CHUCsGweHMNkOoQh92JSVgByerRqdk7OKJJy2dXhMnCX1gY3JQ7ilpQAFeU0uZWYlSGl4Vj5lLk2EQKAjEEAMyCkjimRn40jWGU7nKRFmW4480RQ0I6ktFC9DyyBSsLaeleeXEJBHc8DZWGcl83ELW8zSI6LmgnLIuWd18thS8AyCdAyGecFzjHDxViGg3pkjgvmjHGVon6tnJFXZSK6yGGXeXH3i5fFhI6+O/iAm8lSDM4wImTqldf7X4lg7He2yBc6w+WAMhsrkUUMgLK59L6EtziPy0tIBgwYNShYZ6lEvDLTTs28uHDfw1b0jA7k+OKsPxkiNvtvOp2t8CMr4SWt8GEbnLrWTAeT1R7LE11s8qLejgnoZYnJUrUMbnTGGL0dEjrNlDRvHRCxA6Efb3M7OO5MvHQJnTI27ZzstMKRT6c0lllii/C1g56EFZ5/tFDqqwDPoAy0LRUdS4K5+MmyceKWVoXz3yoQt0ktu/KoIuVYffHkUnS+WXn5yWF1EaZ9tfvFk0LNtdLsIzvYjP+rhufdhq2NH0sBMvfDzLJ17464swXxwZEo6ixH/yA4ZdXxA/5zvN/b1joKwT74vcNyAAwjWFsP6S57gbmyU5wNR534t2Bx9spBUF7JmceTbCbJtnovTXqS72l5j4giB88LaRj59rJfrI5eO1cCOrNBB8NU3cs/DbweILbTI9R2CIw7moZ0PdXbHQCf5JQ/99b0AWWxpP+gZ3mg42a3JZXBwwAw+5MkYkRlY06NkmNyTWTpXvY6v0Wk+qLXosvAkY+SIrnGUy4KdDNs9MJccE+JgkD9Cz0Gg04i1ie6jEitnyt3HHgSL8FJUFKuPhqzqeIwoTgSB8qIsGE3KhRKlpChLv2KgXMqLEFPc8loBMtKEHiHhieg5QxY96WoIUJQIDMXr2wCKEhFB1BhYC0JED+FDPCwUKVQfajHElDCCSpkjjwypj5P8lNzgwYMTw8xr5Yp4IhmIKNmHBeNsAcpQ+tiLoTfXkAMfuSEcjLl3FLr8yjGv1O+cNCPvgx/G2MeI7uVBwJBQ88lcNR/FI1Y+puOZ49XUjtpgLvJ8atfGG29c/moPbAQfUTFC5rK2a4s5jzT5FRCEBiFk0BAJGCMDfvIKIWPwEG6LD/PdL1AwjK4MrvoYOLjl+ugTRM4CZscdd0w8UoiotvDiO4PKY4uswcd4wFMdxlK9tX3sqGd9JjtwtjjSH0Y91wcnHybyXud3DLtFme1lpJgc6Qs5sPDxwSGsvFOej0rpUDLpI1LEDaHL5eUrIm/MnW/3gSk5Riyc3+YoMU4WOWSEfEjHi0j2yCni6mNAi0YLAufYYW/BhRCSceUjis7JGkN1W8Btt9125b91oFxjbnFnF4Nu54VXpsWU+WN8PFsA2O3UDnNGHxEc9TnqY6GL6FgMsyc8zGyI88ewUqfy5dN2bakGWNplIaMWhhYyZIisaQu5tij0U5x5bsPYwscihT7wixPq0G/zy8JHfu1TL3JuvCwyjbW5QX6NmwW8+pRj0a3f5Jgd1XZjTOb1E9bS0Uf6YOzgLC2Z9q47Bos6esLPUFoo0b/GujV9oevoSBjm/L5PwVEQd3rGbgg8nYnGUcjgwIEDy19YMs+MG8yNDx5Dpxlr5dA5ZAZ/McfYCDrbXDV/fcie641rz0Cg04i1n7myWmZkGW/EmOIpiiJRkBQQBUP4KDofFvACUD5W6QyfVT4DixhQVFboyuU1UC5lpA4TgREy4aw2GceeMVzRi66IAOOLrCECyDXPlAUkLx2Fqs0Mvvc8wgwbooAAIDICo8BA8vD65Q1pGVWEh2EsiiIxmggM2Xc1R5SN2JoT5J2HjxcGCabwEVZebuQF0eAVY/wReHOLN9cWP4KbyzBnkH8LUgQKuUai1YV8ImS8NMgLQqJMcbXBfEW6bNub70gMUoAgMSjikQV6QLvN5/322y+pQ1n0APLG0yYOGaEfxCEGPFXapy2IjPKMA68ow4v8qE/f6QnlqQ/ZRyoYRni7h417iw9t0WZeUKQWLu7lV3dnBOSYUUcIP/roo8Srj2BV60aujF31HeJpbI0hXYjs5nwIIK89+eGhM6Y88eRGHX5dA4mulpfvYYO8coDYWaSHlcujDS/jQK4RaPiqh2whEMrQVmOBiJNtCwYePIsXY0melcGDbizlsbAju9pHBqTz3kdlFlz6SL4tMLLMWMCyBWSbnJkz5qSyeRj9lB+PsLaxF+RemcgwIqsdFqZIONJaFMOfAS+KovxtbfZJegTJQhlZ10Zzz1z2i1a8lbAw38luURTlP4xGHjmDyJZFiEUo+SVn5FmfYQ2joiiSPvNSq8/CA/6OqpB39ZnTdIV5hlizl8rVBvMTcbQwNWcQRoRe2zLWMOhOgTwNGjQosfN0KqyMdWv6YEeFzFbnt0UTJ4Sx4OGHs10FY2YBxCli7IwT+TduvN3wNpfodrtjdr04EOUxvs5XazeZwHksNI1fY+2O990TgU4j1t0Tnmh1IBAIBAKBQCAQCAQCgUAg0DwEglg3D6dI1SMQiE4EAoFAIBAIBAKBQCDQcQgEse44bKPkQCAQCAQCgUCgZQhE6kAgEOjWCASx7tbDF40PBAKBQCAQCAQCgUAgEOgqCPQGYt1VsI52BAKBQCAQCAQCgUAgEAj0YASCWPfgwY2uBQKBQHdBINoZCAQCgUAg0BMQCGLdE0Yx+hAIBAKBQCAQCAQCgUBHIhBlNwuBINbNgikSBQKBQCAQCAQCgUAgEAgEAk0jEMS6aXwiNhDoSASi7EAgEAgEAoFAIBDoQQgEse5BgxldCQQCgUAgEAgE2heBKC0QCARagkAQ65agFWkDgUAgEAgEAoFAIBAIBAKBRhBoF2L92WefpZdffjlCMzEIrEJWQgZCBkIGQgZCBkIGQgZGLAON8Ncu+7pdiPXll1+eZphhhgiBQchAyEDIQM+QgRjHGMeQgZCBLiEDXZZBN9KwdiHWCy+8cDrnnHMiBAYhAyEDIQMhAyEDIQMhAyED7SYDjfDXlFLXjGkXYj399NOnddddN0JgEDIQMhAyEDIQMhAyEDIQMtBuMtA16XPjrWoXYt148RETCAQC3QmBaGsgEAgEAoFAIBAItB6BINatxy5yBgKBQCAQCAQCgUDnIhC1BQJdGoEg1l16eKJxgUAgEAgEAoFAIBAIBALdBYEg1t1lpDqynVF2IBAIBAKBQCAQCAQCgUCbEQhi3WYIo4BAIBAIBAKBjkYgyg8EAoFAoDsgEMS6O4xStDEQCAQCgUAgEAgEAoFAoCsjULYtiHUJQ/wJBAKBQCAQCAQCgUAgEAgE2oZAEOu24Re5A4FAoCMRiLIDgUAgEAgEAoFuhEAQ6240WNHUQCAQCAQCgUAgEOhaCERrAoEqAkGsq2jEfSAQCAQCgUAgEAgEAoFAINBKBIJYtxK4yNaRCETZgUAgEAgEAoFAIBAIdD8Eglh3vzGLFgcCgUAgEAiMbASi/kAgEAgE6iAwUon1Z599llZZZZX05Zdf1mlavAoEuj4C3377bTrzzDPTfPPNl8YZZ5z05z//Ob344ovDNPz7779PL7/8ctptt93ScsstN0xcYw9ff/112mCDDdL444+fxhtvvDTRRBOlCy+8MP34448NWX744Yf0zjvvpH/84x/lPJp11lnTvffe2xCfb/73v/8l7czP9a7m4GabbZaWXXbZetEN7/773/+mv/3tb2nqqadOv/rVr9Kxxx6bvvrqq4b4Rx55JI0++uhlm7VbgMsSSyxRYtCQMG5GiMB3332XbrnllrT88sunCSecMC200ELpzjvvHC7fBx98kM4666z0hz/8oZSH4RLUvHjhhReSsZ533nnTPPPMk84555xhdLDy9t9//1KmZ5tttlK2br/99qQ9NUWljz76aJi8tfGeyenFF1+cFl100fT66697NcLw/vvvp3XWWSftvPPOw6T95ptvyj5uueWWaZ999klffPHFMPHx0PsQeO+999KOO+5YyuvSSy+drrjiikROmkKCHv3000/Ttdded9a2cAAAEABJREFUm7baaqs055xzpl133TV98sknZTY6+7jjjkuTTDJJqcsmmGCCMj7ruqeffjqtv/76pR6cdNJJ0yGHHJLeeuutMm/8CQRGKrFmDG699dZ05ZVXGokIgUC3QwDhQG4RkX333TfddNNNybXaEaT1ueeeS9dcc01CMqpxjd0/+OCDqW/fvunggw9Ohx56aDrxxBPTUkstlYqiKLMgOTfffHNJvh966KG0ww47pLvuuistuOCCZXz1z7/+9a/0xhtvVF8Nc490I3BCU+1DYs4999zSCJ100knp97//fdppp53KehWonEsuuSTtsssuZZu1W1h77bUT0j/FFFNIFqGZCJAZRJrht4Bh7DfeeOPhcj///PPp7rvvTq+88spwcbUvhgwZkpDSxRZbrBw35OHAAw8siXkmI2eccUZ65pln0r///e/01FNPpY022igdcMABST215Rnv//znP7Wvh3m2qETeP/zww2HeN/ZAtq+//vp0zz33DDdfLBKfeOKJsu0cM42VEe97BwIWgQMGDCgXWDfccEPaa6+90tZbb10S5qYQePPNNxOdfcopp6RFFlkkXX311aWMc2TIhySTNeXRYUcddVTaZJNN0phjjlk6Ek477bRkYUoPen/EEUeUTgY6Uv4IvRuBkUaskZHBgweXXj4rTJ6P3j0U0fvuiABPIq8ar+L2229fks533313mK6MO+64pddxyimnHOZ9Yw+IOK/3SiutVBoJxAo55T3JeR5++OG05557Jh4aSn3xxRcvvdo5viVXdSFSk002WZPZeNFXXXXVhNytvPLKZdvGGGOMxLsoY1EU6a9//Ws66KCDSi+QdgsINcI/1lhjSdbNQ+c1f+yxxy4XLuQArq52DGpbAFve4Nr39Z6R5meffTb98Y9/LEnCwgsvnNZYY41kwZSJucXib37zmzT55JOXRfCUa0se5/JlM/98/vnnJeHgEWxmlmRB8dhjj6UZZphhuCy//OUvS8/3XHPNNVxcvOh9CNx4440Jod58881L/de/f/+0zDLLpJNPPjk1xSkOP/zwcqFoUUm3TjPNNOkXv/hFA4AWkb/+9a/L3Tk6zOJyxhlnLOMt7MxFC1R6cODAgeWujt26evOzzBR/ehUCo4ys3l533XWlB27dddctvS08dPXawtPGkCMltlxyIMwICC/L8ccfn2aZZZY0/fTTp/322y81x5PBePCi5fIYHPXzOOZ3yIZ3EQKBxhCYe+65y6MP4m0TUqy77767x1YH2+XHHHNMuV3vmrcnc4GeBw0alJAfyr1Pnz45qlVX3hdHQKrEvV5B6jHHchwP5Oyzz55WW2218tVoo41WeqbLh8ofu1IWAJVXcdsMBPoO3bGwKJPUbgAPmi1nz60NSEhRFMmCKJfBe03mXn311fKVMeWJvv/++8tnXmvpyVv5ogV/tNfOhjKbk+3jjz9O5g+yY/u9OXkiTe9F4LLLLit3NeaYY44GEBBrx50c12h4WbmxM2f3kGe7MbnkHNh7772T3cfaBWW/fv2So22jjjpqWSpCPv/886dRRhmlYUexjBiZf6LukYrAKCOjdts3ti5twVCgDPRtt91WbrFU28ND5syq7RkrSFs3PCDOUyHWBProo49OlDFiblsGEaHMbSdWy6q95+GTl8Facskl01/+8pcyiffKt/Uz88wzl+/iTyDQGAJFUSRyaqHo/DSl7txqY+mb8x5B561TLo/KAgsskBz7yDL90ksvlcenJp544rTddtuVBJuit1h0dtDW+5NPPplysK1p/uRnHkHzSHkXXHBBec6WB7Aofjpm0lgbi+KneGcazQ+enMMOO6yx5OX7s88+OzF6k//s/Sxfxp9mIVAUP+GNIGyxxRYJ8W3rAgVBNu5VssATR27yMSB10bkDBgxIJ5xwQrLwcmTEjoYt9CxHrp7Jo/sc6HNlOcohD+9eUfzUl6Y6Tt7Vtccee6Rpp522qaQRFwgkPIL8/e53vytJbYaE7Dg//dprr+VXDVeyz75zApBPOzbTTTddeQyEw0JCfGKqqaZKFrWnn356uXPiKBP5FI93INHuc5CHniPv+V1cey8CnU6sKVxnQX2MZQIgrxSvj1t4p6tDgQw4v4c0+ACKwue5fvzxx8tkti5tg1s5Oq9tlcrbPHjw4NIIlYma+MOTYhvfBEQ+JDW5kA51Kte7CL0egSYB4Em0ULRdjoAMHLo12NQ2ZJOFDY20bX7ppZeWOzk+TOS5c9YPgRkanWzlU/LSHXnkkYlHGBHfdtttE0PjaNWpp56acjDfnLPOz+edd175oY154hjI6quvrthmB/POdijjYsfJ3K2X2W6SeekYQ734eNc8BHiZyZNxpANr9WTzSvkp1XrrrZeQjosuuqg8l0p2jZ8PThEGqXyYinxYuNGPfYd6zoviJ2J8++23N8gVebrjjjvKj8Xc58DDPWTIkHTfffc17GYot6ng/Lhz1XZFLCSbShtxgQAEnGemY+hHz9VAnujI6jv3dmbIp90XHx/aof773/9eHh2hqzjalIdII96OSHEA2kXh/FNGbUDwLX4558Ycc8za6HjuhQh0OrHmjeNdtoXuFwOQkRVXXLEkBLZnqmPgTCYijuzm95Q9wffsoy0TATn3CwUCb/V+++2XpJNmRGHDDTdMCLQPdZT1wAMPlF8BOxc6orwRHwhAgDfWliHvho8IbaMjFeLaEngNnYXlFXa8ydEknkX3FqU8Nbwq5B455oVElrUBwc9hzTXXLLc087MP0YqiSMixX4cwz1rSTvXaHWJ0EDIfVvJS1pbBM+59Wz34teX2tme7Ej6ysmPneIaFUWsxWGuttdI222yTyKojdgg2WaXvOC2Ua7Hlo0kfztKnxtfOCflCHrIcudpxRMLd52BbHAH3cVcuU7lNBbKNjPuVqKbSRVxTCPSuOF5ni/t6vfY+LxSr8Zxmnh1/smDksKNjHe8gs/SVeIFetENk7kkrnsdbXA6Oo3LukVu7fvl9XHs3Ap1OrHmHfViw6aabJt5lwZYywk2RV4fDeU4emn/+85/JB2FWl5T+BhtsUCZDMBh2k8QHODmYDDwfZaIR/LF1Y2I5s/r2228nBoTxQLZHkDWiA4EGBMghskuGLfx8nNsQ2cYbSt8HZLyLjRXlfLSFquMCjaWpvvczU84Q8txYhAqOs/BAOneIWFXT195bEPuJQWSPx8ZWaG0annTHCRio2rh4bj4CRVGUutIHVHYp7Fg0P/ewKckIx4OxsThCCDgTLJZmmmmmMrHzpfSyDyKdQ6UbL7/88mTRViYYwZ+PPvqo/LDVz/8ph2z55QQLLe1H6qtFcGhwbPgY1wdj0nOW+KUGbWQH7EZW88R9IOBDVvL86KOPDgMGx112OAwT0cQD4kyHIcq1yRwLsYAk12S1Gm+Ry3FgHgVnqCLTu+87lVjbnjn//PPLXwzg/WCQBaTZLyoQ3KrStep0TMSq0gdSVoa82oyAYaOkbff4uT7E3DvPfst3yJAhHkcYTAYfblnd8vRZdZpIMkYIBFqKAHlyZq+5njrl25Uht7zRnmuDeEbEB7pFUSTkw9Eli9Sc1txS9xJLLJFfNXn1033Oz5pTOfjNYiTGsRNXBZhXtcbE+xx4Oh3r8uso+Z2rXSYfCS3XzN/tlidC0wjQh/B2lrPplMPG2jInQ/mtRWB2PPhpRLLqN3yVLw1CSwcWRZF4BcmUXx5BPMSPKNhpIVu+Ycmy5TgQko08Z/1Nrmzlk1s62EfojjbJg/zrJ3Jvh4WMjajeiO9dCJBXhBaXyMfkIOAXZRxnos88kzH61T3dbOHGgeC9d4L54TidOM+1AT/g4MhOAnnxDg4G3IQMk+d6xLy2rHju+Qh0GrEmdLZSnOdzLpOgZnizcDLOfgbHuWpEwUdSPNs8YwyAM6QUPdIsnuLlreY1k88XwrYjbXHbnjfBeDyc1c511bv6eMfPpWmfbdd6aeJdIFCLgG1FH1shkIikZ2fzeIEzech5kBvKGDlxze9dnd1DKiwwPVPYvMfKQ2xt/1P6PMni/ZqN41O28e2yUOa8NLbgbb9773ePc1D+oEGDyp89884v4PCq2/mpBj85hVA5LoBs6RMPvD6pl6dUf51RNJ95x805v2WdiZp0Au+k8njxPUdoGQJkxE+JOWtPLjwbR3oTSa2UVv4qgt07MiZU44zDwIEDk59nzO/tfPgmYLfddktkzAemCHuOX2GFFcrfATa+FnvO1CPjFls+oiVDOZB9/3BRfnblXa7KlXsfhSPHPkantxEdR6Ycc0KQeP2ky4GHkOxI6x+KqRIeJMg80vbarfnch7j2DgT+9Kc/JXrPsTT6yk/emSeOOdnFg4LFmuMc5IWTzjMO4dsF88pHtxwVdlh4wL33TQrCLl6Zjogg0MoTzEvfPDiGh2fQv97hLuaMNBF6LwKjdFbXeZp5pQk05eua6/YxDk+2ieEXDXxgw6gwIiYHL7azoEi2rWXxiIcv3HlFeFR4SHjaeMBNEB8REHRfmCPXtQYn1+2qHkSIUucN9C5CIDAiBHgpkFhKnPHnWUNyLQJ57XJ+8u1fK/TRLVLqN1ddc7yteOQE4fEO6bF7YgHq1ze8s/CzvekeyVAHuUWyzAlyj+AiQLzbSG0OjjbxtuRnpNncUVZTAVlDpB0bkc7xFh/6aJdjCY5o+RUUXiPxOSA+DI3t/ObUk/PF9f8RQDbJhYW+8aM7OQz8a4PG9/9TpuRIj3PQPlx15AIxyPFIsQ9gEWzvLOCU50NDus6vKOUFm3iBt5iTg5w6u09f2zlEYJDjLEeuzu/7uMt9DllOldVYQFjo+Lxoayxd7Xv2Aek2R8ilvtSmiefeg4AFoX/5lpzTwfST+eB4Z0aBnqKn6WbvkHHHTznhpDM/6FFHSMWbK8rwjtPOzqAFoWOj4v2SkkUpne17BR9B0sF4CidhUfz0oa+0ETICvevaacQaMbD9wjj7IMZWTYba5OBxtmq0SrTitFXtN4H9HA4jTditLAcPHlz+vi+ywuvhXCAjwUviIxwTQXnKRqoZIyR7RJ4Nq9LqilT+CIFAUwiQK95lZ/yctbOws/jLCjjnJY8Isu1KcovMIDU5Hokm8/kdgk6WfaVul4bCr5KpoigS0orwWDySf7Kej4rwDpLlxoLjGbblc/35ygBdccUV+TFpt3nHG+SlbXmeT+dzETSkzz+QgMyLzwEp9FEwYmaHKb+Pa/MRgJtf5KDzjLF//Q0ZMO61pfjFAr9gQLdK279//4YkZMcvISAGXloQ8cZxNiAFVT0sXrA7QkYRCDKIgNjF4O3z0XljcpXf82wrpxp8/0KmLeq8R74tBuhdz7XB4hHp9s1LNY4X23tziXfQvKvGx33vQ8AOHnJMFjgC6B6ympFwNNQvzpAp7zgkzAO7bWTJrgmCTZ+L910XuUScEWiLSkdIxAmrrrpq4iTBLXitBQs9ulNbpInQuxHoNGLNc2X72Zax7RbevlOTGOkAABAASURBVAy9e+/E5UD4fW3OY41AMzQMeFEUpcEnwMpUhquyeQnl806wQuUZZ2jEeVcNDI4JYnvT0RIGpRof94HAiBDgoSCz5A9ZIKe1ecg3+ZNOcF9NR37lRUjl9aw8gYGQ3/tqKIqi/JfzlCedPEXRNk+JurQj11MURdJWffROO/I8VafzhrnN4quBkarOxWpc3DcPAWMKZ2MM98bwNGbS5CBfroGcKYPu9M5YSmesxXlXLyhDPmmVb+zrpWvuO/XrQ5aXoiiStnhXr4yiKJI2krFqvHZoUzVU4+O+dyJATsgrWc0ylpHwTiiK/9eP5IjskSNyVs1DVum9XF7tPKHb5KsN6qiWk+uPa+9DoNOIdWugdbb6qquuSjxjPq5x3pNXzZERZ/JGJMS82CYcD129+v06iTocJ/HbqUh8vXTxLhAIBAKBQCAQCARahEAkDgR6JQJdmlg7M+rstDOdvhq3xe3qWIlV5ohGzLlpxLmxdM7G2jp1DMU57RER9cbKifeBQCAQCAQCgUAgEAgEAoFAlybWvM0+uuJx9oEUUu2MoW3K9hg6ZwGdEfWzPI1ts7ZHPe1WRhQUCAQCgUAgEAgEAoFAINBlEejSxLrLohYNCwQCgUAgEKiLQLwMBAKBQKA3IxDEujePfvQ9EAgEAoFAIBAIBAKB3oVAh/Y2iHWHwhuFBwKBQCAQCAQCgUAgEAj0FgSCWPeWkY5+BgIdiUCUHQgEAoFAIBAIBAIpiHUIQSAQCAQCgUAgEAj0eASig4FAZyAQxLozUI46AoFAIBAIBAKBQCAQCAR6PAJBrHv8EHdkB6PsQCAQCAQCgUAgEAgEAoGMQBDrjERcA4FAIBAIBHoeAtGjQCAQCAQ6EYEg1p0IdlQVCAQCgUAgEAgEAoFAINBzEWgNse65aETPAoFAIBAIBAKBQCAQCAQCgVYiEMS6lcBFtkAgEOjKCETbAoFAIBAIBAKBzkcgiHXnYx41BgKBQCAQCAQCgUBvRyD63yMRCGLdI4c1OhUIBAKBQCAQCAQCgUAg0NkIBLHubMSjvo5EIMoOBAKBQCAQCAQCgUBgpCEQxHqkQR8VBwKBQCAQCPQ+BKLHgUAg0JMRCGLdk0c3+hYIBAKBQCAQCAQCgUAg0GkI9Ahi3WloRUWBQCAQCAQCgUAgEAgEAoFAIwgEsW4EmHgdCAQCgUA7IhBFBQKBQCAQCPQCBIJY94JBji4GAoFAIBAIBAKBQCDQNAIR2x4IBLFuDxSjjEAgEAgEAoFAIBAIBAKBXo9AEOuKCHzyySfp2WefTa+//nrlbetvn3vuudZnjpw9AoHoRCAQCAQCgUAgEAj0HgQ6jVg/8MAD6dBDD00HHHDAMOGggw5KZ599dnr88cfTd999VyL/xRdfpIcffjgdeeSR6fDDD0/PP/98+b7eH2mPPvrohjJfeumldOqppzY8q+/cc89Nn332Wb3sDe/+97//pcGDB6e11lqrbE9DRCtvPv3003Tccce1KvfHH3+cLrzwwgSbq666Kn3zzTetKicydQ4C//nPf9Kxxx5byty1116bjH21Zs8XX3xxOvjgg9MJJ5yQ3njjjWr0CO/vv//+dMUVV6SvvvpqmLSvvvpqOuSQQ8p6yfkFF1yQvv/++2HSNOfhgw8+SJdcckkyd5qT3gJ00KBBDfUef/zx6Z133hku6+eff57uuOOOch5I/+GHHw6XJl40jcBbb73VoM/OO++8ujjnEujCU045pdSd+V1TV3qF7NKXxxxzzDDjT444BshrU2WMKI7M3n777enqq68eUdL01FNPpSOOOKJBrsi0cNRRRzXkJav0ufdnn312ev/99xvi4qbVCHT7jIOH2m6yc8YZZzQ5R3JHzZXLLrusQdZwiCrPoM/OOuusMv78889P9XQXvvLkk0+mqnzm8uPauxHoNGI9xRRTpNlnnz2deOKJ6corr0yzzDJLWmihhdJUU02V7rrrrrT++usngm44Rh999DT55JOXRnmvvfYqDQsjIK423HDDDWm33XZL//73v9Nss82W+vTpk379618nZGTgwIEJ+fBembV5q89jjjlmmm+++dIzzzxTfd3q+0ceeSTNO++8Lc7/ww8/lIsMhm2mmWZKu+++e7rnnntaXE5k6BwEkIGddtopPfbYY+maa65Jm222WTlmyHRuwWmnnZYQbmnI6vbbb5/efffdHN3kFYlVJuL75ZdfDpMW0bpiKOG2+BIsDodJ8PODOIbi58dhLg899FA688wz01ZbbdVs2WdMTjrppKRcgayPM844qfrfK6+8krbeeuuSVBdFkaaZZppkjlXTxH3TCFiAbbPNNunOO+9MxmnvvfdOf/nLX9J7771XNyNZ2HPPPdODDz5YN7768qOPPioXZWSRjBkfulMauva2225L++yzT9pll128ajSQa7t89RIMGTKklJENNtggWfTVS5PfIeDmCZJPpnI4/fTTy/5Lx+GgTZw0gr6aT+Ii9F4EEGBOuGmnnbZcHP71r39Nb775ZpOAvPbaa+nkk08u5ZOssbGjjTZaQx5yhkMg7Nttt10y977++uuGeI66m2++Oe28886lvm+IiJtAYCgCnUasp5566rTSSiul3/zmN2miiSZKiyyySFpqqaVKQs0zS7FvuummCTlAgqeccso06aSTpl/96lclwX7xxReHNnf4/yn+CSecMC222GJpueWWSxNPPHFafPHFy/uxxx47bbLJJmnuuedOY4wxxvCZK2/GGmushPxXXrX+dmhOhnDhhRceetey/0cZZZS06KKLlgZ0zTXXTNNNN91wnsqWlRipOxIBHmMeW+T03nvvLeXw0ksvTYiJehHM6aefviSvdiF4RhAf3kDxIwrrrbdeOQ9q0zEcyCyPMJIhbL755mnUUUetTVp6yGtJeU40zzzzpFVWWSWZQxZ1+X1TV7tJjJk6BX0fb7zxGrJom4WyOYf8I9hLLrlkMh8bEsXNCBHgLPjb3/6WzjnnnIQ0M+LwrudFtsC7++67U9X4N1YBbx2HBdLA0bHjjjum1VdfvdSd8vziF78odfOCCy6YiqLwqtHAo46Y10vQt2/f9Kc//SkhPBwF9dLkd8pZfvnlS6eCPuawwAILJHNAOvMGybETaKGJQPFei4vQOxGwyGfj1xq600zWcAlHOenZphB54YUXEodIlrOLLroo0dPy2F0Uh3gjz7///e9LDvL222+LLsO4446bvMcteK7Ll/EnEPgZgU4j1j/XV1dRI8NINI8EL01O68qYICe3D91OrFXOthcR6smHerelbe9g8iEuAsP17bffph9//DExAvfdd1852cQJiDSvizb897//TUjP+OOPXx7jsDq2zWSV+/TTTycG0DtEhudSWfKLl78oinJLX1redn30PkLXQsBRhw033DDNPPPMpVwXRVFuZSM3PIJaS7ZXXXXVhngLJQtL8i6+sUDWECrGwmK0ms484CmUxvEN7SiKoqyjmq4590XRsny8k+adNuQ+FkXRUJU5sN9++5WL1H333bf0UhfF/8c3JIybJhEwtnb0fve735XjWhRFudgmO7U6ErG1kENC6ZwmCx4aSa7sEv79738vd/eKYvjxKYqirHdo8jb9XxRFs/IjNYgKB0dRFGXdCJIdx6WXXrosgzNmhhlmKOM4X375y1+2alewLCz+9AgE7HKzo2RHh4qiSHZIbrzxxoQ3eFcbzBeOATtobHVR/CRvOZ2yqjrdzrGd9arzQNqiGDafdxECAQh0OrFWaTVY7SGmiCuBnnHGGavR5ZER3i6ryOp5OpPD2SdbmcNkaMcHHhJedh5J292MHYLM22OFK2jzgAED0q233pqyV9AWKO8cL6D0VtE77LBD+te//lWeNbSFaesdwfbuH//4R1IG757mqwepRmJsSWUCIy5C10HA4olsVlvUp0+fxJthx8X7THQQTtuNzgDuuuuupVyLbyw4NuL4xp///OfhkpB98QceeGDpEbRNyfOC7A6XuJ1fkHnzwmJh2223TQxYtQrPiLcFIaO3//77l2nIdDVd3DeNAOI411xzlQuTnJJOsaM155xz5lfl9aabbkrk7Le//W353NQfuslZ/379+pXeYTJE73BqNJVvZMTxqJOzTGgQIf0n5/StReVhhx02MpoWdXYBBOhUC0Q7zZNMMklDi8wbZ/EbO9ZJdtjetddeO2255ZbJrgdnSC7AXHJPz3Jg+P7LmX5OEu8jdCoC3bKykUKsbSX/8Y9/TEgJb8TGG29cHg855phjEo9FFUnGxFY14WbQc5wJxZBkApPft9eVobH1YzvIduk666xTbmXbhvSeV86HlbahEOgVV1yxYTudF5o3xVa4SY9s8SoiG4677LHHHsnRlkcffbTchleO892OEFh9uyLa3uu7s7vt1a8op2MRIJe+JeBpzDXZeic3trSNrUVTvY9hcnpnaO1gIBXVc385HqFHahFYHm3nVx0ZsDiVJh+9ML8EH1Y6m+tecMQIMZe2pUE5ziSqXxvJ8+WXX95QjLliV4eHBw76bhH5z3/+MwW5boCpVTcW6RNMMEFyBCIXYBzpRkc56Jv8vrGrsUI6HLHjxJhsssmShT6Cikg0li+/5+UmQzn4YAw5yc+uV1xxRU7e6qvdO0erllhiieHKsE3PZphLbMlwCeJFr0CADuV08k1VtcOIMdJNzqvv8/38889fnq22wLRz7HhR7QeInHicWvSb3XK2Wpm5jLgGAk0hMFKItXOdzshZOfqKnVfOCtJZv9rG8lA4q+wsE+UvntLlGUPOPbd3MCEZEGfAEWrGRzvUw4uM7POiuDrX7WOfPOmsfBnAPNkZQsRaeobMvW1PK2zvpptuuqR85Bz5Vo/zYgyGIyLOeCHv6o7QtRFATBBcJJrXOreWnPgWwO4E2afE3ef42qsdHHJjO7I2zrMzsOKcxR84cGD50a9zzXZw7AA5g2tu5YAEI7bl89CdFV5nHktltTSQYVvyyuTNQaIRM3NGWRa/FpWOyPjWwS8Bmbt+waH2CIP0EZqHAL3i4z5Elu6Qix60W2HXripv4hoLTzzxRLmjYuFufBAHOyjkw0KpsXz5vaN5WY5ckVwfsrrPwYIwp2/t1TY+D7Vvb2rLgIHjLPQoUkRH1qaJ556PgJ0Ljii7O7W9pZfE1b73bFHJ8WEOkB26dNCgQcncEC+YY76fcWTEdyscaQi2uAiBwIgQGCnEutooBJTQ8rIRcsJcjXfv4xcEFtmkvH2w0Ldv37ofdUnflmCy2lrlDeFVri0LybdKHjJkSOmB433klUaOpeXpFq99niP0DgQsinzE59gQ8lmv13YleOH8Ig5ZRsRr05Env4xg23Hw4MFp8NCANNsF4Q2vZyz8+swWW2yReF/qxdfW0V7PZNwxAotKuzi5XHM637vyOjovyxPvOULLEKCT/DKIHTqLKbkt5jkaLP55rMmJXzFAwC3skQRppK0NdkGq36UYH9+NGKPatCP1QAz2AAAQAElEQVTjGSnSB86GPn36DNcERMd3J0iP7w8sKIdLFC+6NQLNabzFpF2a6i8wyUevcj5wTnhuKvBuO7LGoWUOVNPaPV9mmWXKI1McFo7yVePjPhBoDIGRTqw1zIrThzo8uEizd7XBUQvHPpzZJOBWmSZWbbq2PlPaK6ywQuJ1URfvYbVMP33GI2cbiaeOV5n3zq+eSGdxYKvJfYTegYDjDhZjiKat8BH12o5EUdT/8CXLv5+PImMCL7BjHjzd9Y5TmD/mAxksimJE1bdrPIJjzvDKKxhh45mGiWeBgRIYQc8RWoaARZiP+HzPwYsrt4WcRZRdAzIi+FaDF/u6664rv+dwL201cAAgCdWFEL2rXGNUTTuy7i0OLDDnmGOO4Y4GVttE5vv165fIf/V93PcOBCy8OCkch6qSa7vf4shHc5DgGPPdQtZhtXnE4x/0XG1cPAcC9RDoEsQaWTA5GGPnMus11Je5jn7w3PDM8NIVRceQCKtYHxuqkyfQP6KQ2+SXQmxPbrTRRslk4zXiTc/xPN39+/fPj13kGs3oSASuv/768icRl1122cTzwcPo5/ScAaxXr49cea+dlRZP7hEnhIcs+cCxGnglbV3yhvPEyFMN5o+v23keeSOrcW29tyWv7MbKsfB0zhupl8Z84fmszhk/ockAmjfSRGg+ApwIFm0+ombg5TQeFi+OQVTlBLnm4V133XUT/ZU9dkgqmZPXsTukvLqtbTfELsOss84qSacF/bAbU1uhtvJYj6g9dkrsguhTbRnx3DsQ8L2BhRjnQ+4x5xZHXd45tIisJ2c5vXi62DG9/K72Sqf71Z3a9/EcCNRDoNOIte095IGh1hDPPC6UKO+cD6wQWb/FK47CdBTDrx14tlr0ERSvCs8Nz4v3vgz36wk8fVat3rnaClV2zq9OH20x7la0nqtBPp4hE0g7ecN9TMko+U1e5UnvK3rnsfyUGENm+18wcZEpk1leaQVkyRY9Q8igeYdo6J92q5dnyfERXsmXX35ZkgjdBAEfDpIFMoP4Wmg5h+qIBFkVx/PGi8gA+AcvkAYfMiLhumlnxG/4Gn+LOiS1GngUKX47NkVRJFvfiCpvJXn1e8fKdkypKIrkar7k4B8ZIZf52RxwdEDd5I8c+liH7JFX7wXHnXhyEGfP/jEmXh1nfcmsRa7+OKObvYbqYtTMDQbL0RfzQxo/FaecCM1DwG4YObFYonPIlmA3zc6An2ysygnibYzhLM69s/wWccZArc67+yjaOXxkhNzacXMUr+rUQFrFWbTRreREft97KDcHO3h+7zo/uzpzLa08Fpd0Pp2HSHsv0Hf0uQ+6PZfh5z+OtpAnZP/nV4nuZBvskJApOt6vLflo08Izp4tr70KAE8vOMR2KCzh/7+ofVstOCL8SYmFKz9Fx3vvmxXchZJu+9oMCdCz06E9OCs4+Rzt9N2NucJyIz4FDhI4k53S6a46La+9GoNOItXNMvFl+hxQZsNJ0fonAI7QICM+fLRwkljBT0r5iNwkoaL80gISvttpq5ajZGmewKWcGwC8W+ADHR5Aml49zfKHuAxv5kXFGHxkqC6j88XN6znfLY/I5v4fA2NrXJh8IMRC+gLeyNTmREMbPhzTqcP7bNn+l2OSn+Uw6ZfiSHSHxr4Xpi5U1peCXFBgxXnjExH21jLjvmgj4kJXHkFz5mDYHCyxjiVjb1eB5o/B9KEZ5Ix4Iau6VtMiBc9X5XfVqS1MZCJb3jho5a2suICfKQjqQcvEWjuZYY8FCj0GS1rwcOHBgYnwQdAbJe4HHU/uzQZFGH8wfV4tJhE066XPQP4bIx0EIoXmE0OX4uI4YASTU7pfvS7Jc5SujjzjXlkLekAILsBxnAUaHGY/8zm4bPYOM0EX0K+dBjueQIK8ILjmj24y5eIuqxuQqv6cjpaXXEXE6n36mqzkUxDkWZBcmL9q8y4FDxe5kfnY1b/xCEo+8Dza134JBX8RH6L0IkOM11lij/JdenZNGiDkSMiIcauYMGbIgxTXIJp3JOWCRWU1vJ4hzDI8wP8idOZDLc0XK/QQf54GyxeMv4iL0bASa07tOI9YEn4ftlltuSbXBb1QjCDwuGs2AU+Q5nV/o4IURx0OCpLon+DlNvlK2Pv7Kz64IiPwmEM9MPSOPLPulEukFxsGkcp8DDyPDgij4ybH8Hnm3TbTyyisn5WhbDgxUTudqwrrmwLPH4ORnP63HmOb8ce26CPhwyjZ9Hrt8NYaUsZYjwf7FRXF+GcNvp1Lw4nJAIni7Lbbyu+oVieBR4bn23s5OlnHnah0fcUZWXEuDealtOZhruQzzzDxUt3eMkl0caf2KhEVkJvviczDXeBN5uP3qD499jotr8xBAnI0FrGuDXbN6pZAfv/hCD+V4Z5AtmDgM8jukFuH1nkf7D3/4Q44qrwg6h0CuF2Egt2VkC/5YMFoc5HIswixCFaEO+ps+9VwNHBC+c6m+c29Xh97lkLBg0+7Wyr3yIvQcBOhIu4KcbdWFpR6y+97Tn5wQnFlkEu/g7LNYky4Hiz1zQxo/t8vpkePylROEI04agVySzxwf196NQKcR65ENsy0dRsSX8iZOa9pjJeyXGUw2V551nm7GzJa5jxpbU27kCQR6LwLR80AgEAgEAoFAoOcg0GuIte1qXhfborzGrRlCXkjb3Lwwtn94p/1mMVLt2bnA1pQbeQKBQCAQCAQCgUCgiyIQzQoEWoBAryHWLcCkyaS+uHeO25lBwZakc41NZorIQCAQCAQCgUAgEAgEAoEej0AQ6x4/xF2yg9GoQCAQCAQCgUAgEAgEehwCQax73JBGhwKBQCAQCATajkCUEAgEAoFAyxEIYt1yzCJHIBAIBAKBQCAQCAQCgUAgMBwCnUqsh6s9XgQCgUAgEAgEAoFAIBAIBAI9BIEg1j1kIKMbgUAg0C4IRCGBQCAQCAQCgUCrEQhi3WroImMgEAgEAoFAIBAIBAKdjUDU15URCGLdlUcn2hYIBAKBQCAQCAQCgUAg0G0QCGLdbYYqGtqRCETZgUAgEAgEAoFAIBAItBWBINZtRTDyBwKBQCAQCAQCHY9A1BAIBALdAIEg1t1gkKKJgUAgEAgEAoFAIBAIBAJdH4HeTay7/vhECwOBQCAQCAQCgUAgEAgEugkCQay7yUBFMwOBQKB3IhC9DgQCgUAgEOg+CASx7j5jFS0NBAKBQCAQCAQCgUCgqyEQ7akgEMS6AkbcBgKBQCAQCAQCgUAgEAgEAq1FIIh1a5GLfIFARyIQZQcCgUAgEAgEAoFAt0MgiHW3G7JocCAQCAQCgUAgMPIRiBYEAoHA8AgEsR4ek3gTCAQCgUAgEAgEAoFAIBAItBiBINYthqwjM0TZgUAgEAgEAoFAIBAIBALdFYEg1t115KLdgUAgEAiMDASizkAgEAgEAoFGEQhi3Sg0EREIBAKBQCAQCAQCgUAg0N0QGJntDWLdgeh/9NFH6aabbkpnn312+vjjjzuwpvpFf/XVV+nmm29OZ511VqfX/9xzz6XDDjssffDBB/Ub10lvX3nllTRo0KD00EMPdVKNUU0gEAgEAoFAIBAI9FYERjqx3mOPPXos9o899ljafffdS2L9+eefd3o/b7jhhnTwwQeXxPLTTz/t1Ppfe+21st+ffPJJp9ZbreyFF15IF110Udp3333TM888U43qsPuTTjopDRgwYJjyv/nmm3TllVempZdeOi222GLpmmuuGSa+9kH6q666Ki2zzDLpt7/9bRo4cGB66623apOlhx9+OM0///xlGum22Wab9O233w6XrrkvjjzyyLTllls2kvyn1xaIBx54YFpwwQXL/mjnTzHD/7WoOuWUU9Jyyy2XNthgg/Tqq68OnyjeNImAheFGG21UjvGmm26aXn/99eHSX3fddWnFFVcsx+T4448fLr72BVnaeeedS9lZdNFF05lnnpm++OKLhmTfffddUubKK69c1nvssccOE9+QsAU39957b9p4443TO++802SuK664ImnTQgstlI477rjh6n333XfTDjvsULZriSWWSKeffnqT5UVk70CA3l188cXTOuusk5599tkRdprTa7fddivliO6kmwcPHtyQ78UXX0xbb711mm+++UqdfeGFFyaOqpzA/SWXXNKgo88444xh4nO6uPZOBEYqsaZETz755HTHHXf0SPT79++fGCeGamR0cJVVVklLLrlkm8hWc9r9448/pksvvTS99NJLDcmRwqeffjpNN910De86+2ammWZKu+66a+qMRQUMEN0dd9wxIfTVvl5++eXpqKOOSoceemgi77vsskuilOWppsv3FPzhhx+eGIp55pmnzLfVVlsNQ0p++OGHdP7556epppoqTT/99GVYYYUV0mijjZaLabgyOghaw4uaG+247777EuPw/PPP18T+/+P3339fkiP9ROQsFldbbbWEkCsjp9S2Bx54oCTU1157bbm4lGbaaafNSeLaDATefvvttNlmm5Vju8gii6TLLrssrb322g05YW7haPGOhCKZAtJsrBoSVm68X3fddUs5ufXWW9MFF1yQ7Ogcc8wxSXmSXn/99QmZNmYIBVndc889k/EWXw3qM9bVd7X3FmPah1w3tvBTt0Wa/qy++uppsskmS+aS51yeRTp9Os4446Q777yzXBCcdtpp6YgjjshJ4trLECDP5J39Oe+889JiQx0XFmZPPfVUk0jQh4888kg5t+jPueaaKwkyKdMilr7CTc4999xEh7qSU2nMm4svvricO+q1ODVfEG7xEXo3AiONWH/22WeJYDLClHcIZPcVxDfffDNRLrxJ3bcXbWv5q0O9sYgPIlwtCRlBqFdaaaXUr1+/NNtss6Utttii9OYjTtW0+X7IkCElnnvttVfpkUMcbr/99lQ1Fk8++WSaZZZZSo88oyIsv/zyqSiKXEyzr9qBWI8ow2OPPZaWXXbZZKGgbbzw+oNcVcf+nnvuSYwdEoiUWSBMNNFEIyo+4msQsOtjXiG1FmabbLJJMgY5mQXcdtttlyzCZphhhlK29t9//4RsXn311TnZMFc7N2RnvfXWS+OOO26acsop0+abb56QXl48Ydttt03iZ5555iQcdNBB6YqhnmREPBOLYQpt4gGR1ocmkpRRX375ZZpiiinSqaeemrbffvvSW80jrb1lgqF/Hn300fTGG2+kvffeu2y7Rfv6669fEuyh0fF/L0QA8TU3OFCmnnrqciE655xzlscQm+IUnAPkmt4UkOIJJ5ywRPDxxx9P9Nkaa6yRxhprrIRgW+zdf//95eLyww8/LJ0JZM/8oQPNQ8SbjJaFxJ9ejcBII9Y8DtNMM025lWJyUPa1I2E7ZtCgQYkHhcAyGvvtt1+y2mQAGBBKmOcOgcn5TQpxPB5ITS5bHmTg7LPPTs4A88rstNNOpVHJeV3fe++9ktDk/OpmIMQp24LAVqnzyzn/E088UXolGTtnmnkmeVjkckY5tQAAEABJREFUEWyB2qZV5t133+1VGRiql19+OR199NGlQdGm6nYv48rbY+I60nD77beX+Rr7Y7WNzPBiSY/0SksZHHLIIUk5tue9e/DBB8tnhjsbbFhZfavnlFNOKY2YfhgLXi35GTZ9cGQBVkiWs+Tarn+wUp4+GSt15QCzffbZJzkCxFjncbMVTQ4cM1CXPsDWNedt7lUfjLu2NkYwmltWc9LxiN94442Jx7hPnz7DZLnrrrvS+++/X3pDsjfZ1iN8jPswiX9+WGqppVLfvn1/fkoJwaD0887H119/nfRLnZR5HuOGDC28YVhmnHHG0nvTVNZJJpkkbbjhhg1JeBXXXHPNZHFMFkSQM/N03nnnLb3bo48+utcRWoHA3HPPnSaddNIyZ1EUadRRRy23utPP/5m/5g/Z+PlVuUNFTsyz/K56RabpCMeRzDlxdKFFH0+wBRZ5HX/88UWVYdZZZ01jjz124uEzt8uXzfxjscmJYm40lWWMMcZI+qt90o0yyihp4oknLrfhPQvjjTde6Wk/4YQTkjlA5hDvVVddVXSEXogA3cWGLrzwwg29R4jtorDFDS8rN2zSiSeemByVRLDlr0Qnsm+X5ZZbbinlTBwdO8ccc6QxxxwzDR48OLGJ5os4YfbZZy93hvGA2vLER+hdCIwUYk2h2yK2nWzLxZkoRJtByPAjsAwHzxcvhnseDUR7t912S7zcDDoFjBjKLy9DY9JYadqmRmCcyVOHgGzyAPK6UdzIjXf/x97940iRQ2EALyeTMhkjQiQEIRlIJBBBRAQCIZAg24gzsCLkAmSgCSBF4gBwB1JuQEDABZZfSW/kbfrPDNPdA10fkre6XLbL/vz83ufnV7PInPqMAHKIIIjXcs97Y5F57iM4ccvIA6OhPxb3+/fvB6RQ+vDTu+NYXRvqGAsShHTxRiKWtegRbh6nK1eujHGSiJL3I6zq3rt3b4yvpSx4FhEbi9yzecn7bRx4Fhll/VKOUZKnr45c5SFTCBx8hQAg8Qiz/tnBw8iVQTVeHoBnz54N5gm51o9z586N4S6MO6/s06dPB/189+7d8PLly7Hv3iXB3VjFszHknou79AwONhC8CDxcFBsvFu8ukq/McRKSINbYeHlweTOOU+80ZcgYORSPN9sOuaGAeTbqGaz29vbGzd08Jcz7WGXrKqzl/Pnz4y0iD3ubGRtLx+Pm+aSkR2O8y+oJ3UHc5C1KPDezZYybDFmb6pl3xqW1Ngg5MM/m3Vx6nnR8BGxKWmsD7KwNOsEmtlogB0gyfVp55J4HjeGvvP7KqyeO3jq0NsyNOaQjySTnA5m01qse0ut0hG71vspfdaVT6VxhTMayrDy5kpRRj75xNC+UTZ6EvNCH//50rtD5r1+/HkOheCs9T5oWAmT8y5cv48kdHVujtxH8/v37LyF59ZyzQ112nCf6n58nNux8PXcSwt6+ePFiPEFR7uDgYPxOhHOEXbcObOyqDjJOb1uT1k/l5zpNBM6EWDtqIXyXL18eP6DxIRTC9+3bt6NZQCIcJSNYFgoC7iiUJ5ZHktdP/CFDg7DaharMU4PI8pCoR0EjIPKvXbs2iDtWXtuPHz8ej4wQAfHA6r99+3awcBA6HhTvQxx4SRg23kQ7V3lIrB2vBYgs2s26Ijk8ioyYNhH4hw8fjkQDUWVsEFnPeNYdt+qb99k0fPr0aYw7t/gteKTn+vXrg6MnHx7pr7qz6fPnz+N4GMtbt26NH194r3IMmzAFBN69hODB0G/JCYJNBONqnMZgI0HR8BDdvn17PG6GLfLMs8Xoes4oUyyw0Q6yh3RrV0LOjVXyAR9PJxIuhhKRFudGyVFW2vfBFq+zD+BswrSxKtloGS+sGHP9dXqwqt5pniMgxmC8MJhti1zBvlf8rbXR+0i2rYNhxT/ybq1IivIc2zyaJ5soxAsxYjA8N24yV8nmlGzVPYKirPAVhM3mxjyqe5KEkNt8ITbGqK6wEMbn5s2bg3XgmXViLmGlTNLJELh///7w4qeRf/PmzXgEDXctmEdyZZ3KI0sw5q1rrSnyS0Je6RibHnPCOUB29vf3x7J0hI2zzWy1SQfZsLbWBmEiJUeuToXoJ78rcSqQbetC38sLPb5gxX/YBh/kOoV06tevfeuL/uRccPrH42i993pmRfN5vEMIkDGbPd+Z9MOii8guktvn12+y73sgJ9GcIWwEe4EsK2ONcBzduXNn/EYHf2AnbVo992Gtd1tn1op1hzPgIDapyiRNG4GtE2vECXHkVRF3SekiVITUMeTsdBBUZSrfztHCoWQrr7/yxvK6IuKSkAO7T4vCu5Xt65dBkS8Jd0CIlXfP882zziOO5MmTEH9khBev7x/PomNT/bRAlUU0qr/eZzFWX3iohZboq+SjCDGp2rYLRqoYDuEZPqCwiHsPlfYrIajeWwRM/qzSkbcqGTMPpH7bnBgjAufdlJBQEuEqxrGqrXqO9DP62qo8RhcZNmeV5wo/15oDv4+TbHJ4j328UuX791Xeuq42PkgjRU0e5rVL1ublyyv58HtRElMqts8X6uZltpyNInJkY+JqThAOslrp1atX4zF+3ZMp6w95sfEkZ7Ptrrq30UKcra3eq+jUQ1+cXphHG1gnP05snNasajfPf0VA+JqTBRtRXlqEVSnhNpwDnvvTlsLTPKc7eh2gbJ9s9pxmIcVIs004kqEM/SUEi8w5PTJv2rcJo0uQ3ZIjV/oS8fC7EgeA9a4P2tPucRMvNQeGk48LFy6MHzBaZ1Vfu/StdUcHcQRwVNTzXKeDAG7Q2vwNZGttdF4MS/6RT/aXEw1nYD+quBAjDi8bSTqYnpXnOZvIVgunstFzKmlzS245lVqb3yd1p5Eyyq0Ta95kRErctGNs3hKC2Vpby9fdlC3vodjcPlH2DM6qKbfrRE6qnMXLCFHufX49P+1Vfy3svq9+G4O2kSJedEZNGIa8RYm3hzFa9Px38xlfnkjhN4j7o0ePhkVEctE77OhnPQjaUt6xnetpkyNkbfDEu246IbLmyobm+fPng+QDQzLkuNrcUt6z3hMeZqcz5qq1xUoYURG3jjwtIygMAPIKRxuV44wb+UaatK/fkmNVJym8Na6L2vEOG2HzKaxgthyPep/ndMm6178+P7+Ph4ANGO80MmmukUs1nZDxZAvp4KSgn2xebJSEQSkzm8wD4sxTJwROGJjNHz3jBEp5JxzkVww9B4B5o394kvVFmWWJrkQ4nGYIayNbdJhwL2FmvqVYVt+GHpFRl+6pdS1sz1/UIes2BU4RORl4G8nisjbzbPcQoOc5G2zm+9HRv/Jn9VBfpn4rJySRrNPJ8p0KO83h4LIO6gTGppJsK8Nh5+THJo9+d3ooXMqJbWuLdbq6SbuPwNaJtaM9IQOUul2fxJDzCouj5s0+DezaFipRi0RbfvPSWADulyWeWjtUC6Uvxwvn2LXPW8dv/TVmHsBqz8JGbOyieaJ8nCM8YpWi0D/EzvFYtbWOqzYZxrt3747x1Ccl1frA684IGpf7Sq21Mbyk7k9z5SFVv+LX/d5kMh/kFhGoxKvfWjvylsCM0e+VP8KNCJGp1uYrYRsR4R6OuoVxDEv+ITsMgzAfG8ElRY8e2dRo12az+q4u0qw94zgqPPODh9BfkfANAxLXP9YHBKhfP4ibzanTmr5sfp8MAesOwRZyUTWd6jgdsMGhuzgthN8oV2X6q5A468PcmxdhU2JI5SG+ymoTMdemdhAKm2kbJM9XJe3yppPJkq2SKfdkbFUbnvvrDvpCd7inJ9UlY97hTxCKtRZmJjRNmaTpIEDf+2jRxouNr5GTB2sE0a28ZVc6TDij9aXcx48fx78KwjPtpFnoIgcgjzW9rIz26XabOjacg4Xzzm/Pk6aNwNaINUNN+TmqpPgpdkpb4gnhtWV47QKFDChfMU+UqXtTJc9vyb2rVPmEXXwgY4GgWgi844gNZYxcKy+pX/W8w70jd0bGUagyPDaIkDhCREo5dVw9V0eS557XyL1U967Ky6tyde8okzH0FzQcJfFSMn6MnJ03LJAfxLs8St5hHNrrEwKOVDOEvKL6rr53+a0fju0RPZ4rz3i55Xuub9p277er9pEk/aFklBNfhiQrq1/KSO7le5/6dfWMEXRM5qMpbWgbzpSjD5KUUd9VPVdtuLpX3nMYGKN7z/okTl174riROxjxeCnrt/p9+dP+Rmh45ngMK5Fn8fdi/4UUicejoIU5GY9+2EA6fvfxqD6YCx5gc+Ye3rwkSA/jIN84KHxjgDkvIhyVN58+ZhTfj7ioD6dK6ipf99YEg1R9rqvwEKSFF5SnXX/FYiPS3gNHHlEx/OaMx0jfrC3llOHJ8S6bQvOmv55b75sMy/HuXUqwNq/WGgzd0w9IhBjjGqt88mAd050+UObpJQfKeOZkwty7t8Exr+bU/Eg+rEUueN+UkdSzoRamZ105XbT+yZK2KrmflTd6tmSqrsKlEH8ea/H3+i1u2zcc3qdPxlpr271NuDjXIivkjS4WlqLf6tHJvI6euU86MwTO5MXsp5MbfwqSzNBHwjLo5tI3wpyQbTKjDNnt5UxoHPmxGTQITgd2jA0hp+rIw0/ImjLy2U9t4waSUK1ad8okTReBrRFrwuv4jmFGqCjRgt3xCmJAgBkIR4eOCxEkRARRtjCQXcfvDIzFw2CLxUNM3CMslLZdpDhEpAYB0Cbj4PgbOfEuxobhEC/s/TzpiKy/KKEsciqumKeWAZDP+BweHo7/xzseOyEsxkDR27EyhGKQecflI8z+QggPuPa9T5x0vQ+J9pGej82QFTtjccfKI1UWOuXAGPFeivPm+aFE6h3eU4mS4WnSdxjqO0KHgDFglI52Ye/EAL7qttYGscnGpB+MJZwYNs8dA0sIl5AQsZyMrNhK88IgUzywMT71xI0bnzhcxtAHqjD0Dkdv8nnjhSIg3bCBIYVlLrWrPffiS9VzBI4YGBvlqG990gf9Ix9whZmNnDLwMk9+bzuJYybzZE2fkBofw5QnDmY+zPVBDYXvyN/YzZ9yTnXIMRxbawPZhZljSnNAtpB58anG5lift7GSuXe0WffIrzlSdlmyThzJI1XKIf8MlnVCfvRLsq4ZImU895W9EANrwRUZFF5g06NM0moEGG3r3nG0zRtdYl1bO8JBtGCzax1xIpgP4WM26J5VIhvIMT0kD/EWF2/tkS9zZA3ytiHYNkW+8/AeckKnKOc0TH0xqSVHrtamNed3Jfpa2WWJDrQuOEKUI/tOZ4Q9kX3jJbfkxnMJefHRM5nzzYly1pTNOr2gTNK0EOB4YMfwAFen31evXh3YmkKC/NNJbAbnHkeecCKhjWyZNcIRUuXpPPaKXJF3suaPK6jDU82u+T6FPVTPOrGBLNJd7eQ6XQS2RqztFv2lCaQBgeaFKdjdI2cULSOCICCByJu/WkD58qBQxoghYXaUzvi01sa/tcyoaJNw89xYZK5ImCmwPBcAAAXQSURBVONCO1KeOgvMBwm8wEgMjwcy6Z0IKONvkTA0+uAoUlwfb57+6qtFa3fqd+Wpz1ghw9qVr3/eJ6bR+OTrtzHy4CGN3u+egdAvfUVU9vb2Bt5DnksfgImJNBZ4MIxlXL2nkraN29+r1g+eUn1yzygZG0ONeGnPR37KIXbGpL7jW/3h0YSntsX3wsQ8+A0PBlxbFJBjNMTNb15zRrje7TjX3GkHSTQenmvYihlHgD1D5m0wfO3vSM4mxe5fHKVjaG3wALtHSG2m1JtNsIIBI20zYJ6QWcTVJmW2/LrvnbzwGPbtwtpfl+FZMd+Ff5Wh+JEo/SVTvMXkxhyQd4l8I0U2Vu6VF6ONCMFYSArZ16aPzmwsFyWbjZJn5SuZH3JQ9/pqnh2DyiMPNq1Ivj5U0n9jVEYix8iPTbE2yIawF8+SjoeAubQ2kFU6yMbFptupRLVgTVhHyAUibG7Uq+euSIQ5dELiXqIP/CUY+o4OQmatMZ5mc0xPkg+EnTxYz+pJ5HuRXFW+daxsn/y1EXqbHpZPF+mDvrkn+/SkusZqrZBHusVzCQ7sB/1o7GwKfPTf86RpIkDXk53W2sDhQP8fHBwcgUHfIr/sBvvG1rKH7DN5JON9eRXZTZs4Nru1Nv6pPTqYTaLX2Cc2nPzSdeRZvaQgAIGtEWvEkwBS/gTWzk8HJMLNWHtWyRGgI8+65322GOreFbl0raRMtScmGTlB9LQvH+mqsn4zOnXvitC01gaLTPwoI6Jcr9yVq4RQaBdpqDx1imQ8ePBgqHyGa/Z9SIf6jkiRZXVtPvpFakxw482GGWOLYM0aUO1IFAd8GSVKhkFjrAoDcbTqa8fOnqJgsJFOZLj668q4atMGRz+0aQ54h4xdXz1nkJF0bQpvQIDVl4xJnnLaQcaQXGURR/mSUwLlJc+QdsfH7iXEwPzAEQ4IvnrzEqz0lUzBWB11jXVe+XXmIbiw6dv0XvJPnpGAXp6U88z87+/vj/9zAvgY82wqHOFfsmWuESvv0NZpkjXDW1NtkEMeS3Muz3yZz9l+GVPJl3LqwcH60z/yLT/pZAgIK7L2kUd6yPq0sapWrFlrBbHw0ZR1WM/qygtNniqcQr6TtzpZQG5tiKsu2ar3Wf+r5Ep7x0nWqzFwMCjvfdY0OXZPZugTMkPGnLyRm9b+/w2CNeIZGbSe9F39pGkjwP7Q+ew9At2jwQ7I50xjg+gz8sPpQqfNs6Xshjpk0RphR2st4Afy6TYcpLX/y2j/7vyeJgJbI9bThDejXicCQmEc+fHcU5LrbDttBYEgEASCQBAIAjuHwNYHFGK9dcjzwt9FgFeCp8GR8O+2kXpBIAgEgSAQBIJAENgUAiHWm0I27QaBXUUg4woCQSAIBIEgEATmIhBiPReWZAaBIBAEgkAQCAJ/KwLpdxA4KwRCrM8K+bw3CASBIBAEgkAQCAJBYKcQCLHeqenc5GDSdhAIAkEgCASBIBAEgsAyBEKsl6GTZ0EgCASBIPD3IJCeBoEgEATOGIEQ6zOegLw+CASBIBAEgkAQCAJBYDcQWEWsd2OUGUUQCAJBIAgEgSAQBIJAENgwAiHWGwY4zQeBILBpBNJ+EAgCQSAIBIE/A4EQ6z9jHtKLIBAEgkAQCAJBYFcRyLgmg8BaiPWHDx+GS5cuJQWDyEBkIDIQGYgMRAYiA5GBtcnA38bI10Ksf/z4MXz9+jUpGGxTBvKuyFtkIDIQGYgMRAZ2XAYmSawvXrw4PHnyJCkYRAYiA5GByEBk4EgGYhfDDSIDp5WBSRLrGzduDIeHh0nBIDIQGYgMRAYiA5GByEBkYG0yMElivc1B511BIAgEgSAQBIJAEAgCQeBPRGAtMdZ/4sDSpyAQBILAGSGQ1waBIBAEgsBEEQixnujEZ9hBIAgEgSAQBILAVBHIuDeFQIj1ppBNu0EgCASBIBAEgkAQCAKTQiDEelLTncFuEoG0HQSCQBAIAkEgCEwbgf8AAAD//0RPfPoAAAAGSURBVAMAvSMWbtXj/BgAAAAASUVORK5CYII=\"\u003e\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"char\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003e3.2 Comparison of uterine and residual tissue ultrasound morphology between the two groups\u003c/h2\u003e\n \u003cp\u003eThe proportion of patients with increased uterine volume was significantly higher in the chorionic decidua group than in the non-chorionic decidua group. Furthermore, the post-abortion residual tissue in the chorionic decidua group was predominantly mass-like, whereas in the non-chorionic decidua group, it was mainly patchy. The differences in uterine volume and residual tissue morphology between the two groups were statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), as indicated in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of uterine and residual tissue ultrasound morphology between chorionic decidua group and non-chorionic decidua group [n (%)]\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eUltrasound morphology\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eChorionic decidua\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNon-chorionic decidua\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUterine volume\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e143(66.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e79(91.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIncreased\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e71(33.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7(8.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eResidual tissue morphology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePatchy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e41(19.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e75(87.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMass-like\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e173(80.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11(12.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003e3.3 Comparison of ultrasound signal characteristics of residual tissue between the two groups\u003c/h2\u003e\n \u003cp\u003eThere was a statistically significant difference in the distribution of ultrasound signal types of the post-abortion residual tissue between the two groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The ultrasound signals in the chorionic decidua group were primarily hypoechoic and mixed echogenicity, while those in the non-chorionic decidua group were predominantly hyperechoic, as shown in Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of ultrasound signal characteristics of residual tissue between chorionic decidua group and non-chorionic decidua group [n (%)]\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eUltrasound signal\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eChorionic decidua\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNon-chorionic decidua\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHyperechoic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33(15.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e64(74.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"3\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHypoechoic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e62(28.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8(9.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMixed Echogenicity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e119(55.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14(16.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003e3.4 Comparison of post-abortion residual tissue blood flow distribution between the two groups\u003c/h2\u003e\n \u003cp\u003eThe local blood flow Alder grades of the post-abortion residual tissue in the chorionic decidua group were primarily grades II and III, whereas in the non-chorionic decidua group, they were mainly grades 0 and I. The proportion of patients with abundant residual blood flow (grades II and III) in the chorionic decidua group was significantly higher than that in the non-chorionic decidua group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), as shown in Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of post-abortion residual tissue blood flow distribution between chorionic decidua group and non-chorionic decidua group [n (%)]\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBlood flow distribution\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eChorionic decidua\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNon-chorionic decidua\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAlder Grade 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4(1.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35(40.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAlder Grade I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18(8.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e42(48.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAlder Grade II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e83(38.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5(5.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAlder Grade III\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e109(50.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4(4.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAbundant blood flow (II\u0026thinsp;+\u0026thinsp;III)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e192(89.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9(10.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003e3.5 Comparison of hemodynamic ultrasound parameters of residual tissue between the two groups\u003c/h2\u003e\n \u003cp\u003eThe PI and RI values of the post-abortion residual tissue blood flow in the chorionic decidua group were significantly lower than those in the non-chorionic decidua group, and the differences were statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), as shown in Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of hemodynamic ultrasound parameters of residual tissue between chorionic decidua group and non-chorionic decidua group (\u0026plusmn;\u0026thinsp;s)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHemodynamic ultrasound parameters\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eChorionic decidua\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNon-chorionic decidua\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.62\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe findings of this study provide a comprehensive sonographic profile that effectively distinguishes between chorionic-decidual and non-chorionic-decidual RPOC following medical abortion. The observed differential characteristics in morphology, echogenicity, vascularity, and hemodynamics are not merely descriptive but are rooted in the distinct pathophysiological states of these retained tissues. These results advance the clinical application of TVUS from a tool for simply detecting the presence of RPOC to a more sophisticated modality for predicting its biological nature, thereby directly addressing the critical need for non-invasive, pre-treatment risk stratification.\u003c/p\u003e \u003cp\u003eThe fundamental divergence in ultrasound morphology\u0026mdash;mass-like versus patch-like appearance\u0026mdash;correlates directly with the inherent biological properties of the retained tissue[19]. Chorionic-decidual residuals, comprising viable trophoblast cells and embryonic tissue remnants, maintain proliferative and invasive potential. This biological activity likely promotes the formation of a discrete, organized three-dimensional structure, which manifests sonographically as a well-defined mass or nodule within the endometrial cavity[20]. The concurrent finding of a significantly larger residual volume and associated uterine enlargement in this group further supports this notion of continued growth or expansion. In contrast, non-chorionic-decidual residuals consist primarily of degenerated and necrotic decidual tissue without active trophoblastic elements. This composition lacks the architectural drive for mass formation, instead presenting as disorganized, irregular material lining the endometrial cavity, consistent with the observed patch-like or linear hyperechoic patterns. This morphological distinction is of paramount clinical importance, as a discrete mass may pose a higher risk of causing persistent bleeding, infection, or acting as a nidus for future placental abnormalities[21].\u003c/p\u003e \u003cp\u003eThe echogenic patterns offer another layer of discriminatory power. The predominance of hypoechoic or mixed echogenicity in chorionic-decidual residuals can be attributed to the cellular, vascular, and potentially edematous nature of viable trophoblastic tissue. The mixed echo pattern may reflect areas of hemorrhage, necrosis within an otherwise active tissue, or early calcification[22]. Conversely, the strong hyperechoic signature of non-chorionic-decidual residuals is classic for acellular, fibrotic, or degenerating tissue with multiple acoustic interfaces, similar to the appearance of retained blood clots or necrotic debris[23]. This clear dichotomy in echogenicity provides a rapid, initial visual clue for the sonographer during the diagnostic evaluation.\u003c/p\u003e \u003cp\u003ePerhaps the most compelling and physiologically insightful findings pertain to vascularity and hemodynamics. The higher blood flow grades (e.g., Adler score) and visually richer vascular distribution within chorionic-decidual residuals, as demonstrated by color Doppler, are a direct sonographic correlate of biological viability. Trophoblast cells are inherently angiogenic, capable of invading maternal spiral arteries and establishing a low-resistance blood supply to support gestation[24, 25]. When these cells persist as RPOC, this angiogenic activity continues, resulting in the detectable vascular network observed in our study. This aligns with the histological expectation of active tissue requiring perfusion. The hemodynamic parameters quantified by pulsed Doppler provide quantitative validation. The significantly lower Pulsatility Index (PI) and Resistance Index (RI) values in the chorionic-decidual group are indicative of low-impedance blood flow, characteristic of newly formed, trophoblast-modified vessels lacking a muscular coat[26]. This hemodynamic profile mirrors that of an early gestational sac and underscores the persistent, pregnancy-like vascular physiology of this high-risk RPOC type.\u003c/p\u003e \u003cp\u003eIn stark contrast, the non-chorionic-decidual residuals exhibited higher PI and RI values, signaling high-resistance blood flow. This finding is pathophysiologically coherent. Degenerated, necrotic tissue does not stimulate angiogenesis; instead, its vascular supply is likely derived from adjacent, normal endometrial vessels or represents stagnant flow within thrombosing vessels at the periphery of the necrotic material. The high resistance reflects the absence of a metabolically demanding tissue bed and likely progressive thrombosis within the supplying vessels[27]. Our results corroborate the work of researchers who also identified distinct hemodynamic patterns in RPOC, strengthening the evidence base for this application of Doppler ultrasound[28].\u003c/p\u003e \u003cp\u003eThe clinical implications of these differential sonographic features are substantial. Accurately identifying a chorionic-decidual (high-risk) RPOC via TVUS prior to any intervention would strongly support proceeding directly to uterine curettage. This approach ensures definitive removal of biologically active tissue, which is less likely to respond to repeated pharmacological intervention and poses a greater risk of complications like hemorrhage or sepsis[29]. Conversely, confidently diagnosing a non-chorionic-decidual (low-risk) RPOC would justify a trial of conservative or pharmacological management, such as a repeated dose of misoprostol or expectant management[30]. This strategy spares a large cohort of patients the risks, pain, and anxiety associated with an unnecessary surgical procedure, along with its potential long-term reproductive consequences[31]. Thus, this sonographic stratification framework empowers clinicians to personalize treatment, moving away from a one-size-fits-all approach.\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, the sample size, while adequate for establishing significant differences, warrants validation in larger, multi-center cohorts to ensure generalizability across diverse populations and operator expertise. Second, the sonographic assessment, though performed systematically, has an inherent subjective component, particularly in grading echogenicity and blood flow subjectively. The development of a standardized scoring system or the integration of quantitative ultrasound techniques (e.g., shear-wave elastography, 3D power Doppler indices) could enhance objectivity in future research. Third, our classification was ultimately based on post-procedure histopathology. While this is the accepted standard, it creates a diagnostic pathway dependency where ultrasound guides the treatment that then provides the definitive diagnosis. Prospective studies where TVUS predictions are tested against the outcome of initial conservative management could provide even stronger evidence.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eIn summary, this study delineates clear and pathophysiologically rational differences in the TVUS characteristics of RPOC types after medical abortion. Chorionic-decidual residuals present as vascular, hypoechoic masses with low-resistance flow, while non-chorionic-decidual residuals appear as avascular, hyperechoic patches with high-resistance flow. By integrating these morphological and hemodynamic features, TVUS emerges as a powerful, real-time tool for pre-treatment risk assessment. We recommend its routine and systematic use in the evaluation of incomplete medical abortion to guide a more rational, patient-centered, and effective treatment selection process, ultimately optimizing clinical outcomes and patient satisfaction.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study\u0026nbsp;protocol was approved by the Ethics Committee of Traditional Chinese Medicine Hospital of Kunshan (ethical review: KZYYJH2024-SB052-26). All subjects provided informed consent prior to their inclusion in the study. All the procedures performed in this study were in accordance with the principles of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData that supports the findings of this study are within the article. Further data is available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author declares no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported from the Youth Scientific Funds of Traditional Chinese Medicine Hospital of Kunshan (No. 2024QNJJ01).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eZhiyue Li (co-first author 1): conceptualization, methodology, software, investigation, formal analysis, writing-original draft. Mingcui Chen (co-first author 2): visualization, software, validation, writing-review \u0026amp; editing. Dan Lu (co-corresponding author 2): conceptualization, supervision, project administration, funding acquisition. Qin Lu (co-corresponding author 1): conceptualization, supervision, project administration, funding acquisition. Zhiyue Li\u003csup\u003e#\u003c/sup\u003e and Mingcui Chen\u003csup\u003e\u0026nbsp;#\u003c/sup\u003e contributed equally to this work. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author would like to acknowledge and thank all faculty members and patients who volunteered to participate in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eGrossman A, Prata N, Williams N, Ganatra B, Lavelanet A, L\u0026auml;ser L, Asmani C, Elamin H, Ouedraogo L, Rahman MM\u003cem\u003e\u0026nbsp;et al\u003c/em\u003e: \u003cstrong\u003eAvailability of medical abortion medicines in eight countries: a descriptive analysis of key findings and opportunities\u003c/strong\u003e. \u003cem\u003eReprod Health\u0026nbsp;\u003c/em\u003e2023, \u003cstrong\u003e20\u003c/strong\u003e(SUPPL 1):11.\u003c/li\u003e\n \u003cli\u003eZorila GL, Capitanescu RG, Dragusin RC, Istrate-Ofiteru AM, Bernad E, Dobie M, Bernad S, Craina M, Ceausu I, Marinas MC\u003cem\u003e\u0026nbsp;et al\u003c/em\u003e: \u003cstrong\u003eUterine Perforation as a Complication of the Intrauterine Procedures Causing Omentum Incarceration: A Review\u003c/strong\u003e. \u003cem\u003eDiagnostics\u0026nbsp;\u003c/em\u003e2023, \u003cstrong\u003e13\u003c/strong\u003e(2):16.\u003c/li\u003e\n \u003cli\u003eDickinson JE, Doherty DA: \u003cstrong\u003eMaternal complications associated with second trimester medical abortion using mifepristone priming and subsequent misoprostol\u003c/strong\u003e. \u003cem\u003eContraception\u0026nbsp;\u003c/em\u003e2023, \u003cstrong\u003e125\u003c/strong\u003e:5.\u003c/li\u003e\n \u003cli\u003ePateisky P, Mikula F, Adamovic M, Neum\u0026uuml;ller J, Chalubinski K, Falcone V, Springer S: \u003cstrong\u003eEvaluation of the Management and Outcome of Patients with Retained Products of Conception after Gestational Week 23+0: A Retrospective Cohort Study\u003c/strong\u003e. \u003cem\u003eJ Clin Med\u0026nbsp;\u003c/em\u003e2024, \u003cstrong\u003e13\u003c/strong\u003e(15):11.\u003c/li\u003e\n \u003cli\u003eSundararajan S, Roy S, Polanski LT: \u003cstrong\u003eThe accuracy of ultrasound scan in diagnosing retained products of conception: a systematic review and meta-analysis\u003c/strong\u003e. \u003cem\u003eAm J Obstet Gynecol\u0026nbsp;\u003c/em\u003e2024, \u003cstrong\u003e230\u003c/strong\u003e(5):23.\u003c/li\u003e\n \u003cli\u003eTzur Y, Shperling RB, Inbar TG, Bar-On S, Gil Y, Levin I, Cohen A: \u003cstrong\u003eExpectant vs Medical Management for Retained Products of Conception After Medical Termination of Pregnancy: A Randomized Controlled Study\u003c/strong\u003e. \u003cem\u003eObstet Gynecol Surv\u0026nbsp;\u003c/em\u003e2022, \u003cstrong\u003e77\u003c/strong\u003e(11):662-663.\u003c/li\u003e\n \u003cli\u003eCohen N, Kedem HI, Levy C, Lavie O, Zilberlicht A: \u003cstrong\u003eRisk factors for procedural interventions for retained products, after failed treatment with misoprostol or mifepristone and misoprostol for first trimester pregnancy loss - 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A multicenter clinical trial\u003c/strong\u003e. \u003cem\u003eTaiwan J Obstet Gynecol\u0026nbsp;\u003c/em\u003e2024, \u003cstrong\u003e63\u003c/strong\u003e(2):214-219.\u003c/li\u003e\n \u003cli\u003eSuzuki D, Lan KC, Takashima Y: \u003cstrong\u003eUsing human pluripotent stem cells to dissect trophoblast development\u003c/strong\u003e. \u003cem\u003eCurr Opin Genet Dev\u0026nbsp;\u003c/em\u003e2023, \u003cstrong\u003e83\u003c/strong\u003e:7.\u003c/li\u003e\n \u003cli\u003eWang JQ, Zhou XB, Han TL, Zhang H: \u003cstrong\u003eEpigenetic signatures of trophoblast lineage and their biological functions\u003c/strong\u003e. \u003cem\u003eCells Dev\u0026nbsp;\u003c/em\u003e2024, \u003cstrong\u003e179\u003c/strong\u003e:14.\u003c/li\u003e\n \u003cli\u003eKassir E, Hernandez-Andrade EA, Sibai BM, Papanna R, Soto-Torres EE, Coselli JO, Mehl ST, Gerulewicz-Vannini D, Zamorano AS, Blackwell SC\u003cem\u003e\u0026nbsp;et al\u003c/em\u003e: \u003cstrong\u003ePostpartum Uterine Artery Doppler Indices when Leaving the Placenta In Situ for Placenta Accreta Spectrum\u003c/strong\u003e. \u003cem\u003eAmerican Journal of Perinatology\u0026nbsp;\u003c/em\u003e2025, \u003cstrong\u003e42\u003c/strong\u003e(15):1998-2005.\u003c/li\u003e\n \u003cli\u003eLorenz J: \u003cstrong\u003eUltrasound Diagnosis of Pregnancy Residues\u003c/strong\u003e. \u003cem\u003eGeburtshilfe Frauenheilkd\u0026nbsp;\u003c/em\u003e2024, \u003cstrong\u003e84\u003c/strong\u003e(11):1.\u003c/li\u003e\n \u003cli\u003eBarral PA, Ghelfi J, Bravetti M, Willoteaux S, Agostini A, Janot K, Legendre G, Torre A, Midulla M, Thouveny F\u003cem\u003e\u0026nbsp;et al\u003c/em\u003e: \u003cstrong\u003eAppropriateness of treatments for postpartum and post-abortion uterine vascular anomalies\u003c/strong\u003e. \u003cem\u003eEur J Obstet Gynecol Reprod Biol\u0026nbsp;\u003c/em\u003e2025, \u003cstrong\u003e308\u003c/strong\u003e:132-142.\u003c/li\u003e\n \u003cli\u003eLin FF, Chen ZB, Tao H, Ren XY, Ma PY, Lash GE, Shuai HL, Li P: \u003cstrong\u003eSonographic Findings of Vascular Signals for Retained Products of Conception in Women Following First-Trimester Termination of Pregnancy\u003c/strong\u003e. \u003cem\u003eJ Obstet Gynaecol Can\u0026nbsp;\u003c/em\u003e2024, \u003cstrong\u003e46\u003c/strong\u003e(3):7.\u003c/li\u003e\n \u003cli\u003eCohen A, Gutman-Ido E, Karavani G, Albeck A, Rosenbloom JI, Shushan A, Chill HH: \u003cstrong\u003eThe association between history of retained placenta and success rate of misoprostol treatment for early pregnancy failure\u003c/strong\u003e. \u003cem\u003eBMC Womens Health\u0026nbsp;\u003c/em\u003e2023, \u003cstrong\u003e23\u003c/strong\u003e(1):6.\u003c/li\u003e\n \u003cli\u003eKoenig LR, Raymond EG, Upadhyay UD, Frye LJ, Kaneshiro B, Boraas CM, Oldenburg CE, Glidden DV: \u003cstrong\u003eEffectiveness and safety of medication abortion with vs without screening ultrasonography or pelvic examination\u003c/strong\u003e. \u003cem\u003eAm J Obstet Gynecol\u0026nbsp;\u003c/em\u003e2025, \u003cstrong\u003e233\u003c/strong\u003e(5):453e451-453e416.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"archives-of-gynecology-and-obstetrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"arch","sideBox":"Learn more about [Archives of Gynecology and Obstetrics](https://www.springer.com/journal/404)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/arch/default.aspx","title":"Archives of Gynecology and Obstetrics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"incomplete medication abortion, retained products of conception, transvaginal ultrasound, Doppler ultrasonography, hemodynamics","lastPublishedDoi":"10.21203/rs.3.rs-8957197/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8957197/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eObjective\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis retrospective study aimed to investigate the transvaginal ultrasound (TVUS) characteristics of different pathological types of retained products of conception (RPOC)\u0026mdash;chorionic-decidual versus non-chorionic-decidual\u0026mdash;following incomplete medication abortion, to provide an imaging basis for individualized clinical management.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA total of 300 patients with incomplete medication abortion treated at Kunshan Traditional Chinese Medicine Hospital between January 2023 and June 2025 were enrolled. Based on histopathological examination, patients were categorized into a chorionic-decidual group (n\u0026thinsp;=\u0026thinsp;214) and a non-chorionic-decidual group (n\u0026thinsp;=\u0026thinsp;86). All patients underwent TVUS examination, which assessed uterine volume, residual tissue morphology (mass-like vs. patchy), echogenicity pattern (hyperechoic, hypoechoic, mixed), local blood flow distribution (graded by the Alder classification), and hemodynamic parameters (pulsatility index, PI; resistance index, RI). Differences in sonographic features between the two groups were statistically compared.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe proportion of patients with increased uterine volume was significantly higher in the chorionic-decidual group than in the non-chorionic-decidual group (33.18% vs. 8.14%, P\u0026thinsp;=\u0026thinsp;0.003). Residual tissue in the chorionic-decidual group predominantly presented as mass-like (80.84%), whereas in the non-chorionic-decidual group, it was mainly patchy (87.21%), with a significant intergroup difference (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Echogenicity in the chorionic-decidual group was primarily hypoechoic (28.97%) or mixed (55.61%), while the non-chorionic-decidual group showed predominantly hyperechoic signals (74.42%) (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Residual tissue in the chorionic-decidual group demonstrated significantly richer blood flow (Alder grades II-III: 89.72% vs. 10.47%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and lower hemodynamic indices (PI: 0.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14 vs. 1.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20; RI: 0.62\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08 vs. 0.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12; both P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) compared to the non-chorionic-decidual group.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e\u003c/p\u003e \u003cp\u003eChorionic-decidual RPOC is characterized on TVUS by vascular, mass-like lesions with hypoechoic/mixed echogenicity and low-resistance blood flow. In contrast, non-chorionic-decidual RPOC typically appears as avascular, patchy, hyperechoic foci with high-resistance flow. These distinct sonographic patterns allow for non-invasive preoperative differentiation of RPOC type, facilitating risk stratification for more personalized and precise patient care.\u003c/p\u003e","manuscriptTitle":"Transvaginal Ultrasonographic Characteristics of Different Types of Residual Pregnancy Tissue in Patients with Incomplete Medication Abortion","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-05 15:31:09","doi":"10.21203/rs.3.rs-8957197/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-14T18:43:33+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-11T15:11:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"107451301938563535547493936911270615552","date":"2026-03-08T19:35:12+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-08T08:02:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"56748733193777826637052003187924830404","date":"2026-03-04T12:52:48+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-02T11:29:12+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-01T11:40:03+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-26T05:52:59+00:00","index":"","fulltext":""},{"type":"submitted","content":"Archives of Gynecology and Obstetrics","date":"2026-02-24T12:00:54+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"archives-of-gynecology-and-obstetrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"arch","sideBox":"Learn more about [Archives of Gynecology and Obstetrics](https://www.springer.com/journal/404)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/arch/default.aspx","title":"Archives of Gynecology and Obstetrics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"dffa3b3a-ea48-42ab-bca4-edc788a0cef2","owner":[],"postedDate":"March 5th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-05-04T16:00:59+00:00","versionOfRecord":{"articleIdentity":"rs-8957197","link":"https://doi.org/10.1007/s00404-026-08420-4","journal":{"identity":"archives-of-gynecology-and-obstetrics","isVorOnly":false,"title":"Archives of Gynecology and Obstetrics"},"publishedOn":"2026-04-28 15:57:49","publishedOnDateReadable":"April 28th, 2026"},"versionCreatedAt":"2026-03-05 15:31:09","video":"","vorDoi":"10.1007/s00404-026-08420-4","vorDoiUrl":"https://doi.org/10.1007/s00404-026-08420-4","workflowStages":[]},"version":"v1","identity":"rs-8957197","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8957197","identity":"rs-8957197","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}