Clot dissolution to optimize body preparation for the continuous flow perfused cadaver model

Clot dissolution to optimize body preparation for the continuous flow perfused cadaver model | 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 Clot dissolution to optimize body preparation for the continuous flow perfused cadaver model Philippe Pharand, Anna Nayouf, Josefina Maranzano This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7040941/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract The Continuous Flow Perfused Cadaver Model (CFPCM) is employed to ensure the highest degree of realism for vascular surgeon trainees. To prepare the CFPCM, the blood is drained from the body, then a pre-fixation solution is injected to clean the vessels and to dissolve clots. The preparation of CFPCM is often suboptimal when clots remain in the vessels, hindering the smooth running of the surgical anatomy workshops. Our goal was to optimize the preparation of the cadaver by using an innovative pre-fixation solution to increase clot dissolution. METHODS. We used a convenience sample of 10 cadavers, evenly split in 2 groups according to the pre-fixation solution used (Solution 1: Proflow; Solution 2: PI3N1). We evaluated the efficacy of the pre-fixation solution across groups by comparing qualitative and quantitative variables of clots that remained in the bodies after their preparation. We also assessed the correlation between some of the clots variables and anatomical variables measured in our sample. RESULTS. The data did not reveal any statistically significant differences between the groups in any of the variables measured. However, a significant association was identified between the circumference of the thoracic aorta and the total clot weight in that segment (p = 0.038). The abdominal aorta and the left atrium exhibited the highest prevalence of total obstruction by clots, and the left atrium the highest clot weight. CONCLUSIONS. Different chemical pre-fixation solutions do not change the qualitative or quantitative characteristics of clots found in cadavers used in surgical workshops. surgical anatomy workshops continuous flow perfused cadaver model pre-fixation solution post-mortem clots cadaver preparation vessel obstruction Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Introduction The Anatomy Laboratory of the University of Québec at Trois-Rivières (UQTR) offers a wide range of services to undergraduate and graduate health students (e.g., gross anatomy classes, advanced dissection classes, and surgical training). Surgical anatomy workshops (SAW) are essential for the development of new trainees, and it is the only way for surgeons to have access to near-patient training [1]. Furthermore, the cadaver sessions ranked highest among SAW, meaning that trainees benefited most from their laboratory learning experience [2]. Therefore, the development of continuous flow perfused cadaver models (CFPCM) has been prominent since the 2000s [3–6]. At the UQTR anatomy laboratory, our CFPCM is powered by the VIVO I (LifeEngine Technologies Inc, Montreal, Qc) system that provides an artificial cardiac pulse and arterial and venous pressures [7]. For a CFPCM to work successfully, the heart, arterial and venous systems must be properly cleaned to be as free as possible of blood aggregates, which have been originally classified as: pre-mortem thrombi (PMTs), or post-mortem clots (PMCs). PMCs are classically described as non-adherent to the vessel wall, soft with a glossy gelatinous finish, and a dark-red to black or yellow-red colour [8, 9]. PMTs are adherent to the wall vessels, firm with a granular surface, and pale tan to dark red [8]. Regardless of their time of formation (before death and even potentially contributing to it, as would be the case of a PMT) or after death, such as PMCs (therefore just a post-mortem phenomenon not contributing to death), the preparation of the body in anatomy laboratories has the same approach [8]. (NOTE: in our Methods, Results, and Discussion sections we refer to all types of blood aggregates as clots because we did not attempt a pre- vs post-mortem classification given that all samples were collected after embalming with a fixative solution, which may affect the macroscopic characteristics of the aggregates, precluding such a classification). The first step in preparing the body in an anatomy laboratory is to drain the blood, from the vessels, along with the clots that move with the liquid blood. The second step is to inject a pre-fixation solution under pressure to help lubricate and more thoroughly clean the blood vessels, so the remaining clots are removed. The cadaver is then embalmed with a fixative solution to prevent tissue decomposition. In our laboratory, we use a saturated salt solution (SSS) as the fixative agent in bodies that will be used as a CFPCM [10]. Ideally, after the pre-fixation process, the vascular system should be free of any obstructions, so the fixative may be distributed to all organs and tissues. However, we have encountered problems with the use of our CFPCM: 1- surgeons and other trainees (e.g., interventional radiology and vascular surgery) found that some of their procedures were impossible to perform due to intravascular clots, 2- clots entered the VIVO I system and clogged its filter, considerably increasing the time of the SAW, 3- clots increased the vascular system's pressure causing microvascular ruptures, extravasation of perfusion liquid and damaging the valuable CFPCM. Despite efforts to remove or dislodge intravascular clots before (i.e., during pre-fixation), and during surgical workshops (e.g., by extracting the clots with hemostat clamps), it is currently almost impossible to obtain a cadaver with a completely clear vascular system within the laboratory’s setting. To date, no studies have sought to optimize the CFPCM for the presence of intravascular clots. The extant literature has explored thrombi and clot dissolution quality as a secondary outcome, albeit with no explicit intention to directly impact the optimization of the CFPCM [11]. Exploration of an alternative pre-fixation solution may offer a viable solution to this problem. We know that the standard pre-fixation solution is incapable of adequately dissolving, lubricating, and cleaning the vasculature. Consequently, we sought to explore a pre-fixation solution comprising distinct chemical ingredients from our standard solution, and we hypothesize that this alternative solution may more thoroughly clean the vascular system. Therefore, the objective of this study is to systematically compare the quantity and quality of clots present in bodies treated with a pre-fixation solution alternative (PI3N1: Trinity Fluids, LLC, MI, USA) to the standard solution utilized in our laboratory (Proflow: The Dodge Company, Inc., Billerica, MA). Materials and Methods Research type and population This research is an experimental study with a convenience sample of 10 cadavers from the body donation program of the UQTR anatomy laboratory. Five cases were assigned to be prefixed with solution 1 (Proflow) which is a dimethyl-sulfoxide, propylene glycol, trisodium EDTA, and sodium borate-based solution, and five cases were assigned to be prefixed with solution 2 (PI3N1) which is a methanol, formaldehyde and ethylene-based solution. We excluded cases who had been prescribed thrombolytic drugs prior to death and non-spontaneous deaths (donors who received medical assisted death). The donors of our program provided their consent on body donation and sharing of medical information for teaching and/or research purposes before dying. Broad permission for the use of the body in education and/or research was acquired as part of the consent process, this included consent around images. All other figures were sourced from the scientific image and illustration software BioRender. The demographic characteristics of the body donors are presented in Table 1 . Table 1. Demographic data. BMI = body mass index; F = female; M = male; COD = cause of death; FS = fixation solution; PFS = pre-fixation solution; FD = fixation delay; EDD = extraction/dissection delay; SSS = saturated salt solution; COPD = chronic obstructive pulmonary disease; PVD = peripheral vascular disease; PE = pulmonary embolism; MSC = metastatic sigmoid colon Fixation protocol At the UQTR anatomy laboratory, cadaver donations are accepted within 48 hours from the time of death. The 10 bodies’ vascular systems were cleaned and lubricated with one of two vascular pre-fixative solutions (Group 1 Proflow: N = 5, Group 2 PI3N1: N = 5). Then a fixative SSS was pumped into the cadaver. At the UQTR laboratory, a SSS is preferred for SAWs due to its lifelike properties, low degradation rate, good image quality, low cost, and ease of use [12, 13]. The preparation of the bodies entailed cannulation in the right carotid and jugular veins, to drain blood from the jugular vein, and to connect the carotid artery to a pump (Duotronic III, Hygeco International Products, RRID:SCR_027129) for injection of the pre-fixative solution with a pressure of 12 pounds per square inch (PSI). The standard volume of the pre-fixative solution injected in cadavers with a body mass index (BMI) between 20 and 28 was 4 liters. Then an average of 22.1 liters of SSS was pumped into the cadaver at 6–7 PSI (Table 1 ). Finally, the cadavers were placed in the refrigerator for a total of 6 weeks, which is the minimum wait-period to ensure fixation of tissues by the SSS. Extraction of the heart and aorta To access the intravascular and intracardiac clots that we aimed to qualify and quantify, we conducted a consistent dissection and extraction protocol of the heart with the aorta. After thoracotomy and pericardiotomy, the first part of the dissection was mediastinal, and the goal was to free the heart from all pulmonary and systemic vessels. The heart and major arteries of the aortic arch (i.e., brachiocephalic trunk, left carotid artery, and left subclavian artery) were immediately dissected and ligated, followed by the dissection of the thoracic aorta to the aortic hiatus. The inferior and superior vena cava, pulmonary arteries (left and right trunks), right and left pulmonary veins were then dissected and ligated to free the heart and aorta from the mediastinal cavity. Then, after median and chevron laparotomy, the second part of the procedure consisted in dissecting the abdominal aorta. The Kosher maneuver was performed to reach the retroperitoneal space, where the abdominal aorta and the common iliac artery bifurcation are located. The abdominal aorta was then dissected up to the diaphragmatic pillars, and down to the proximal portions of the left and right common iliac arteries and finally ligated for proper harvest. Mid-proximal ligation of the celiac trunk, superior and inferior mesenteric arteries, right and left renal arteries, and the phrenic, the suprarenal, the lumbar and gonadic arteries were also performed. Finally, the aorta was extracted from the mediastinal and abdominal cavity simultaneously. Variables of interest Demographic data were collected and compared across the two groups: 1- age, 2- sex, and 3- BMI. Variables related to the fixation of body donors were also collected: 1- fixation delay (FD): time interval between the moment of death and the injection of the fixative solution expressed in hours, 2- the quantity of fixative fluid used expressed in liters, and 3- the extraction/dissection delay (EDD): time delay until we performed the extraction and dissection of the heart and aorta, once the six-week wait period for complete fixation had elapsed. We also collected the following anatomical variables: 1- the length of the ascending aorta to the left subclavian ostium (i.e., upper aorta = ascending aorta + aortic arc), 2- the length from the left subclavian artery to the celiac trunk (i.e., thoracic aorta), and 3- the length from the celiac trunk to the iliac artery bifurcation (i.e., abdominal aorta). The sum of the 3 segments was also recorded. We also measured: 4- the diameter of the right atrium: from the point where the superior vena cava arrives to the beginning of the inferior vena cava and 5- the diameter of the left atrium: between the superior and inferior pulmonary veins, from one side to the other (see Fig. 1 ). Subsequently, we performed incisions in the ventricles (see Fig. 2 ) to measure: 6- the width of the interventricular septum, at the point preceding its convergence with the pulmonary trunk’s wall, 7- the apex of the heart, at the point where the myocardial muscle was the widest and closest to the edge of the left ventricle, and 8- the diameter of the right and left ventricular cavities together at the level where the interventricular septum was previously measured, from one cavity's end to the other (see Fig. 1 ). Then we performed incisions of each segment of the aorta (upper, thoracic, and abdominal aorta) to measure 9- the circumference of the upper aorta, taken between the left carotid and left subclavian artery 10- the circumference of the thoracic aorta, taken just above the coeliac artery’s ostium, and 11- the circumference of the abdominal aorta, taken at the level of the inferior mesenteric artery’s ostium. For each segment, 12- the presence or absence of a calcification-like crust on the vessel wall was recorded. Finally, we measured: 13- the weight of the heart on a scale after removal of all the clots and the separation from aorta (Ohaus Valors1000, Data Weighing Systems Inc., IL). The lengths, widths and circumferences of the segments and cavities were measured using a catheter. Once the catheter was positioned on the segment, a bulldog clamp was used to secure the catheter in place, thereby providing stability. A second bulldog clamp was then employed to facilitate the measurement. Subsequently, the catheter was superimposed on a plastic, non-extensible ruler, and the measurement was recorded. The catheter was selected for its lack of flexibility and tendency to retain its shape when used on curved surfaces. Each anatomical variable was evaluated on six occasions by two researchers (three measurements by rater that generated a mean value by rater) to assess the inter-rater variability. Furthermore, we kept all anatomical specimens to repeat the measurements at a later timepoint to assess intra-rater variability. We also recorded the following variables pertaining to the clots removed from each segment of the aorta and heart cavities: 1- presence/absence of clots, 2- countable/uncountable clots (uncountable clots were the friable aggregates that disintegrated into multiple and small fractions upon touch, hence we were not able to count them), 3- number of clots (when they were countable), 4- clot consistency (mixed, soft or hard) (see Fig. 3 ), 5- vessel's lumen obstruction (none, partial, or total), 6- attached/unattached to the vessel wall and 6- weight of clots in grams. Statistical analysis Qualitative variables were assessed across groups (group 1: proflow vs. group 2: PI3N1) using Chi square and Fisher's exact test. Quantitative variables were assessed across groups using either an independent-sample t-test (when normally distributed) or Mann-Whitney test when not normally distributed. Finally, we used a general linear model to relate the weight of the clot of each segment with the length and circumference of the said segment as predictors. For the weight of the clots in the heart cavities, we used the diameter of the cavity as predictor for the atriums, and the diameter of the cavity and septum width as predictors for the ventricles. The inter- and intra-rater variability was evaluated using an intraclass coefficient (ICC), a two-way mixed-effects model, mean of k raters (k = 2), and an absolute agreement for intra-rater reliability and a consistency agreement for inter-rater reliability [14]. The interval utilized for the assessment of reliability was as follows: <0.5 (poor), 0.5-0.749 (moderate), 0.75–0.899 (good), and ≥0.9 (excellent). The statistical analysis was conducted using the 29th edition of the Statistical Package for the Social Sciences (SPSS). Results Demographical characteristics There was no significant difference in BMI (20.7 ±4.5 vs. 23.1 ±2.5; t = 1.0, p = 0.3), in age (80.6 ±10.3 vs. 82.2 ±8.0 years; t = 0.3, p = 0.8), nor in the ratio of females to males (X 2 = 1.7, p = 0.5) between groups. Finally, there was no significant difference regarding cause of death between the groups (COD) (X 2 = 4.1, p = 0.5). Fixation variables There was no statistically significant difference in FD between the two groups (37.3 ±23.6 vs. 27.4 ±14.4 hours; t = 0.8, p = 0.4). The EDD was different between groups, but it did not reach statistical significance (264.0 ±338.6 vs. 72.0 ±67.9 hours; U = 0.2, p = 0.2). Finally, the amount of fixative injected (liters of SSS) was also not statistically different between groups (21.6 ±3.6 vs 22.6 ±3.1 liters; U = 15.0, p = 0.7). Anatomical variables There were no statistically significant differences when comparing the groups for lengths of the upper aorta (12.3 ±1.9 vs. 10.2 ±1.6 cm; t = 1.9, p = 0.1), the thoracic aorta (25.5 ±2.5 vs. 22.9 ±3.0 cm; t = 1.5, p = 0.2), and the abdominal aorta (13.9 ±1.2 vs. 14.5 ±0.9 cm; t = 1.5, p = 0.2). Same for the sum of lengths of the aorta, the result showed no significant differences (51.7 ±5.0 vs. 47.6 ±3.5 cm; t = 1.5, p = 0.2). The mean circumference of the upper aorta was higher in the Group Proflow (7.0 ±0.4 cm) than in the Group PI3N1 (6.3 ±0.7 cm), although this result was not statistically significant (t = 1.94, p = 0.1). Furthermore, there were no statistically significant differences regarding the circumferences of the thoracic aorta (5.9 ±1.0 vs. 5.6 ±0.9 cm; t = 0.4, p = 0.7) nor the abdominal aorta (4.7 ±0.9 vs. 4.2 ±0.6 cm; t = 1, p = 0.4). Regarding the diameters of the atrium, we found no statistically significant differences between the two groups (left atrium: 5.5 ±1.1 vs. 5.6 ±1.0 cm; t = 0.1, p = 0.9; right atrium: 4.7 ±1.3 vs. 5.2 ±1.0 cm; t = 0.8, p = 0.5). The diameter of the left and right ventricles did not show any statistical significance when comparing both groups (9.3 ±2.1 vs. 8.5 ±1.4 cm; t = 0.7, p = 0.5), nor the width of the septum (1.7 ±0.5 vs. 1.5 ±0.3 cm; U = 5.5, p = 0.4), nor the width of the apex (1.3 ±0.2 vs. 1.2 ±0.3 cm; U = 13.0, p = 1.0). We did not find a significant difference in the presence of calcification-like crust for any of the segments evaluated across groups (p-values = 1.0). By segment the presence of a calcification-like crust was as follows: in the upper and thoracic aorta 7 out of 10 cases were positive, in the abdominal aorta 9 out of 10 cases were positive, and in the heart cavities there were no positive cases. Finally, the weight of heart was not significantly different across groups either (399.0 ±123.7 vs. 373.2 ±79.3 g; t = 1.5, p = 0.2). Presence of clots Regarding the presence of clots, there was no statistically significant differences between the groups (p-values = 1.0). Specifically, the results by segment were as follows: the upper aorta: X 2 = 0.0, p = 1.0, the thoracic aorta: X 2 = 0.5, p = 1.0, the left atrium: X 2 = 1.1, p = 1.0, the right atrium: X 2 = 0.0, p = 1.0, the left ventricle: X 2 = 0.0, p = 1.0, and the right ventricle: X 2 = 1.1, p = 1.0 (see Fig. 4 ). The abdominal aorta presented clots in every sample for both groups. The distribution of clots among the different segments was as follows: in the upper aorta, 8 out of 10 cases were positive; in the thoracic aorta, 7 out of 10 cases were positive; in the abdominal aorta, 10 out of 10 cases were positive; in the left atrium, 9 out of 10 cases were positive; in the right atrium, 8 out of 10 cases were positive; in the left ventricle, 8 out of 10 cases were positive, and in the right ventricle, 9 out of 10 cases were positive (see Fig. 6 ). Countable clots A comparison of both groups revealed no statistically significant differences (p-values > 0.1). By segment the results were: upper aorta: X 2 = 1.1, p = 1.0; thoracic aorta: X 2 = 0.2, p = 1.0, abdominal aorta: X 2 = 0.5, p = 1.0, left atrium: X 2 = 0.1, p = 1.0), right atrium: X 2 = 4.8, p = 0.1, left ventricle: X 2 = 0.0, p = 1.0), and right ventricle: X 2 = 0.9, p = 0.5 (see Fig. 4 ). The distribution of cases showing countable and uncountable clots by segment was as follows: in the upper aorta 7 out of 8 cases were countable, in the thoracic aorta 3 out of 7 cases were countable, in the abdominal aorta 3 out of 10 were countable, in the left atrium 4 out of 9 cases were countable, in the right atrium 5 out of 8 cases were countable, in the left ventricle 4 out of 8 were countable, and in the right ventricle 6 out of 9 were countable (see Fig. 6 ). Number of clots We consider the number of clots (when countable) and used 3 categories of comparison: 1, 2 or 3 clots. No statistically significant differences were observed between the groups regarding the number of clots present in the segments (p-values > 0.3). The results by segment and cavity were as follows: upper aorta: X 2 = 0.9, p = 1.0, thoracic aorta: X 2 = 3.0, p = 0.3, left atrium: X 2 = 1.3, p = 1.0, left ventricle: X 2 = 1.3, p = 1.0, and right ventricle: X 2 = 0.6, p = 1.0 (see Fig. 5 ). The abdominal aorta and the right atrium only showed one clot, precluding the statistical testing. When assessing the number of clots by segment, the results were as follows: in the upper aorta, among the 7 cases with documented clots, 6 cases exhibited 1 clot, while 1 case presented 2 distinct clots. In the thoracic aorta, 2 cases exhibited 1 clot, while one case presented with 3 clots. The abdominal aorta exhibited a uniform pattern, with all 3 cases having 1 clot. In the left atrium, 3 cases exhibited 1 clot, while one case had 2 clots. The right atrium exhibited a uniform distribution of 1 clot in all 5 cases. In the left ventricle, 3 cases exhibited 1 clot, while one case had 2 clots. Finally, in the right ventricle, all five cases exhibited 1 clot, while one case had 2 distinct clots (see Fig. 7 ). Clot consistency The consistency of the clots was evaluated as a hole per segment regardless of the number found, as we considered the consistency to be the same for all clots found per case per segment. No statistically significant differences were identified when comparing groups for clot consistency (p-values > 0.4). The results by segment and cavity were as follows: in the upper aorta: X 2 = 3.0, p = 0.7, in the thoracic aorta: X 2 = 2.1, p = 1.0, in the abdominal aorta: X 2 = 2.7, p = 0.7, in the left atrium: X 2 = 1.4, p = 0.4, in the right atrium: X 2 = 2.8, p = 0.7, in the left ventricle: X 2 = 1.1, p = 1.0, and in the right ventricle: X 2 = 1.9, p = 0.7 (see Fig. 5 ). The proportions for clot consistency by segment per case were as follows: in the upper aorta 2 (cases) had hard consistency, 2 soft consistency, and 4 mixed consistency; in the thoracic aorta, 1 had hard consistency, 1 soft consistency, and 5 had mixed consistency. In the abdominal aorta, 1 had hard consistency, 2 soft consistency, and 7 mixed consistency. In the left atrium, 1 had soft consistency, and 8 mixed consistency. In the right atrium, 2 were hard, 2 soft, and 4 as mixed. In the left ventricle, 1 had hard consistency, and 7 were mixed. In the right ventricle, 4 had hard consistency, 1 was soft, and 4 were mixed (see Fig. 7 ). Clots attached to the vessel wall The results revealed no statistically significant differences between the groups regarding the attachment of the clots to the vessel walls (p-values > 0.4). By segment and cavity, the results were as follows: in the thoracic aorta: X 2 = 0.9, p = 1.0, in the abdominal aorta: X 2 = 0.4, p = 1.0, in the left atrium: X 2 = 1.4, p = 0.4, in the right atrium: X 2 = 1.1, p = 1.0, in the left ventricle: X 2 = 1.1, p = 1.0 and in the right ventricle: X 2 = 0.9, p = 1.0 (see Fig. 4 ). All upper aorta specimens had no attached clots to the vessel. The overall distribution by segment was: no attached clots in the upper aorta, 1 attached clot out of 7 (cases) in the thoracic aorta, 5 out of 10 attached clots in the abdominal aorta, 1 out of 9 attached clots in the left atrium, 1 out of 8 attached clots in the right atrium, 1 out of 8 attached clots in the left ventricle and 1 out of 9 attached clots in the right ventricle (see Fig. 6 ). Obstruction of the vessel lumen The obstruction of the lumen of the vessels by the clots did not demonstrate any statistically significant differences between the groups (p-values > 0.5). By segment and cavity the results were as follows: upper aorta: X 2 = 0.4, p = 1.0, the thoracic aorta: X 2 = 2.1, p = 0.7, the abdominal aorta: X 2 = 1.4, p = 1.0, the left atrium: X 2 = 1.1, p = 1.0, the right atrium: X 2 = 2.3, p = 0.5), the left ventricle: X 2 = 2.1, p = 0.7), and the right ventricle: X 2 = 1.5, p = 1.0) (see Fig. 5 ). The overall results by segment were as follows: in the upper aorta, 4/10 cases showed no obstruction, 4/10 cases had partial obstruction, and 2/10 cases had total obstruction. In the thoracic aorta, 4/10 had no obstruction, 4/10 had partial obstruction, and 2/10 cases had total obstruction. In the abdominal aorta, 1/10 case had no obstruction, 3/10 cases had partial obstruction, and 6/10 total obstruction. In the left atrium, 1 case had no obstruction and 9/10 cases had total obstruction. In the right atrium, 5/10 cases had no obstruction, 2/10 cases had partial obstruction, and 3/10 cases total obstruction. In the left ventricle, 4/10 cases had no obstruction, 4/10 cases had partial obstruction, and 2/10 cases total. In the right ventricle, 1 case had no obstruction and 9/10 cases had partial obstruction (see Fig. 7 ). Clot weight The weight of the clots was not statistically significant different between the groups (p-values > 0.1). The weights by segment were as follows: in the upper aorta 9.8 ±11.3 vs. 7.8 ±7.7 g, t = 0.3, p = 0.8; in the thoracic aorta 8.4 ±15.0 vs. 19.4 ±24.6 g; U = 17.5, p = 0.3; in the abdominal aorta 4.4 ±1.9 vs. 5.4 ±4.7 g; U = 11.5, p = 0.8; in the left atrium 45.0 ±26.6 vs. 19.0 ±23.3 g; t = 1.7, p = 0.1; in the right atrium, 22.0 ±39.8 vs. 8.2 ±9.5 g; U = 11.0, p = 0.8; in the left ventricle 8.2 ±10.3 vs. 4.4 ±5.5 g; t = 0.7, p = 0.5 and in the right ventricle, 8.4 ±5.1 vs. 4.0 ±3.2 g; t = 1.6, p = 0.1 (see Fig. 8 ). The overall results by segment were: in the upper aorta 8.8 ± 3.1 g; in the thoracic aorta 13.9 ± 6.4 g; in the abdominal aorta 4.9 ± 1.1 g; in the left atrium 32 ±7.9 g; in the right atrium 15.1 ±9.1 g; in the left ventricle 6.3 ±2.6 g; and in the right ventricle, a mean of 6.2 ±1.4 g (see Fig. 8 ). Relation between calcification-like crust and clot attachment to the vessel wall In the segments that showed calcification-like crusts, we explored the relationship with the attachment of clots to the vessel wall. Given that there were no statistical differences between groups in relation to attachment of the clots to the wall of the vessels nor the calcification-like crust, we analysed all 10 cases to see if there was a significant association between the attachment and calcification of the vessel wall of the thoracic aorta or the abdominal aorta. The results were not statistically significant for these segments (X 2 = 0.2, p = 1.0; X 2 = 1.1, p = 1.0 respectively). The upper aorta did not show any attached clot and the heart cavities did not show any calcification. Relation between clot consistency and attachment to the vessel wall We also assessed the association between clot consistency and attachment to the vessel wall. No statistically significant results were observed between these two variables at each aortic segment, nor in the heart cavities (the thoracic aorta X 2 = 1.5, p = 1.0, the abdominal aorta X 2 = 0.5, p = 1.0, the left atrium X 2 = 0.1, p = 1.0, the right atrium X 2 = 1.4, p = 1.0, the left ventricle X 2 = 0.2, p = 1.0, and the right ventricle X 2 = 2.0, p = 1.0). The upper aorta did not show any clot attached to the wall. Relation between clot consistency and obstruction of the vessel lumen We assessed the association between clot consistency and obstruction of the vessel. We found no significant associations between these two variables (the upper aorta X 2 = 6.70, p = 0.09, the thoracic aorta X 2 = 3.3, p = 1.0, the abdominal aorta X 2 = 2.8, p = 0.9, the right atrium X 2 = 4.3, p = 0.6, and the left ventricle X 2 = 1.4, p = 1.0). In all 10 cases, the left atrium only showed total obstructions and the right ventricle only showed partial obstructions so no comparisons were made. Relation between countable clots and consistency We did not find a statistically significant association between these two variables (the upper aorta X 2 = 2.8, p = 0.5, the thoracic aorta X 2 = 2.0, p = 1.0, the abdominal aorta X 2 = 4.6, p = 1.0, the left atrium X 2 = 0.9, p = 1.0, the right atrium X 2 = 3.8, p = 0.3, the left ventricle X 2 = 1.1, p = 1.0, and the right ventricle X 2 = 4.0, p = 0.2). Association between the weight of the clots and the anatomical variables by segment In the upper aorta, circumference and length accounted for 46% of the total clot weight in the segment, yet these results did not demonstrate a significant association with either circumference (p = 0.8) or length (p = 0.2) within this segment. In the thoracic aorta, circumference and length accounted for 57% of the total clot weight in the segment and a significant association was observed between circumference and clot weight (p = 0.04), while no significant association was found for length (p = 0.5). In the abdominal aorta, circumference and length accounted for 26% of the total clot weight and these results did not show a significant association with either circumference (p = 0.2) nor length (p = 0.6). In the left atrium, cavity diameter accounted for 30% of the total clot weight, with no statistical association (p = 0.1). In the right atrium, the cavity diameter accounted for 24% of the total clot weight with no statistical association (p = 0.2). Within the left ventricle, the diameter of both ventricles and the septum accounted for 43% of the total clot weight with no significant association for the diameter (p = 0.1) or the septum (p = 0.2). In the right ventricle, the diameter of both ventricles, the septum, and the apex accounted for 14% of the total clot weight in the segment with no significant associations with the diameter (p = 0.7), the septum (p = 0.6), nor the apex (p = 0.7). Inter-intra rater reliability The inter-rater ICC estimations (average measures) were greater than 0.995 [0.988-1.000]. These estimates can be considered to indicate an "good" level of reliability. Moreover, the intra-rater estimations (average measures) were greater than 0.999 [0.995-1.000], indicating an "excellent" level of reliability [14]. Discussion Demographical characteristics The study found no statistically significant differences between the groups in terms of BMI, age, or sex. This is important because sex differences in coagulation have been documented [15]. Nonetheless, the impact of these variations on the outcomes of the study appears to be negligible, as the observed differences are predominantly attributed to platelet aggregation in vivo rather than erythrocyte aggregation, as evidenced in post-mortem clot analysis [9]. The COD did not show any statistical differences either, with most cases dying of non-acute pathologies that entail an agonal period before the moment of death (e.g. pneumonia and different types of cancers). Interestingly, the association between non-acute COD has been documented to be linked to the formation of PMCs, particularly in the heart [16] such as the clots found in both groups of our study. Fixation variables There were no statistically significant differences between the groups in terms of fixation variables, so they were not considered as confounding factors in our study. We observed that there was a longer EDD in group 1 (though not statistically significant). However, we did not observe any qualitative difference in the characteristics of the bodies dissected after a longer EDD (see anatomical variables section below). This suggests that once the bodies are fully fixed, there does not seem to be an over fixation phenomenon changing the characteristics of the tissues or the clots. Anatomical variables The analysis of the anatomical variables revealed no statistically significant differences between the groups. These findings indicate that a comparison between the two groups could be made without the need of normalization to the anatomical variables. It is noteworthy that post-mortem decomposition of tissue, particularly the muscle fibers of the vessel wall, may lead to size variations [17, 18]. However, it has also been reported that despite the potential effects of the fixation solution on cadaver tissue, vessel dimensions may not differ between cases with or without fixation [19]. In our study, we did not detect any anatomical differences across groups. Moreover, we did not find any difference in calcification-like crust in the different segments of the aorta, with most cases exhibiting calcifications, particularly in the abdominal segment (90% of cases). Our small sample size is a limitation regarding the potential detection of anatomical significant differences across groups. However, a power analysis using our anatomical measurements showed that a sample size of 736 subjects would have been required to potentially reach statistical significance, which is unfeasible in the context of our human anatomy laboratory (and probably most anatomy laboratories), which receives an average of 75 to 100 bodies per year for all teaching and research activities. Consequently, it would be important to record gross anatomical variables on regular basis using standardized measurement practices, such as the ones used in our study. This would allow anatomy laboratories to create databases that could serve as a normative reference when researchers are interested in experiments regarding the heart and vascular system. Finally, we reviewed imaging studies [20–23] and validity of post-mortem arterial measurements [18, 24] to attempt to assess the anatomical variability of our sample in relation to other populations, but the absence of large post-mortem imaging with comparable anatomical variables recorded during dissection, and the limited medical record information of our small sample precludes any inference regarding how representative our measures are in relation to the general population [18, 25, 26]. Presence/absence of clots We found no significant disparities in the incidence of clot across the study groups. The abdominal aorta demonstrated a consistent presence of clots in all ten cases, with six cases of them exhibiting total vessel obstruction. Given that the pre-fixation solution (and subsequently the fixation solution) is injected into the carotid artery towards the aortic arch, the solution can either go towards the aortic valve or downstream towards the thoracic, and the abdominal aorta, down to the common iliac bifurcation. The aortic size is decreased in the distal portion in comparison to the proximal portion of the aorta, so we speculate that the injected solutions displaced the clots towards the iliac bifurcation leading to a greater accumulation in the abdominal aorta. Additionally, all heart cavities had clots in 80 to 90% of cases. This finding can be attributed to post-mortem alterations such as: the cessation of blood circulation with the aggregation of erythrocytes and platelets due to the onset of livor mortis, which goes along with a concomitant decrease in the pH of the extracellular environment favoring platelet aggregation and preventing disaggregation through fibrinolysis [26, 27]. Finally, we think that the cardiac valves remain mostly closed during the perfusion of the solutions, precluding to properly empty the heart chambers. Moreover, the hollow pockets created by the muscular walls could facilitate blood aggregation and coagulation, with clots remaining enclosed within the chambers. These phenomena combined may contribute to the high prevalence of PMCs in the heart cavities. Countable clots No statistically significant differences were observed between the groups with respect to the presence of countable or uncountable clots. This variable relates to the to the consistency of the clots, since soft clots, being more friable, may disintegrate under manipulation, making them uncountable. Conversely, hard and mixed clots typically exhibit firmness and maintain their structural integrity during manipulation, being countable. As previously mentioned, the ventricle and the atriums function as hollow pockets that trap blood during the occurrence of livor mortis, so the presence of countable clots within the heart chambers would be expected. In our sample more than half of the clots (56%) were countable in the heart chambers. Number of clots No statistically significant differences were observed between the groups regarding number of clots identified in the segments. The majority of cases with countable clots (84%) exhibited a single clot. This finding may be attributed to the fact that the majority of the heart cavities act as hollow pockets, as previously mentioned. The same phenomenon could occur in the upper aorta where the clots could form and accumulate under the pressure of the perfused solutions (12 PSI with the pre-fixative and 6 PSI with the fixative) that would clump the clots against a closed aortic valve. Conversely, in the thoracic and abdominal aorta, the perfusion solution might push the blood and clots distally, towards the iliac bifurcation, making most of the clots in the thoracic and the abdominal aorta uncountable and of a mixed consistency. Further research using a design that changes the pressures of perfusion (i.e., group with high pressure of perfusion vs. group with low pressure of perfusion) [3] could increase our understanding in the number of clots found, but this was beyond the scope of our current work. Clot consistency per segment No statistically significant differences were observed in the consistency of clots across groups. However, the majority of clots in all segments were of mixed consistency (66%). This phenomenon can be explained by the process of sedimentation, which is associated with the rate of aggregation of cadaveric blood. The stasis of the circulation and the post-mortem changes induces the aggregation of erythrocytes, platelets, and fibrin strands as the blood sediments [26, 28]. Our hypothesis is that the blood aggregates after the initiation of the sedimentation process, resulting in a mixture of different consistencies. The coagulation of cadaveric blood has been described to occur in two ways: fast or slow [9]. The fast coagulation is characterized by the absence of sedimentation. Conversely, the onset of sedimentation before aggregation of the blood elements indicates slow coagulation, with clots likely becoming of mixed consistency, as seen in this experiment. This observation is further supported by a histologic study, which described the macroscopic characteristics of PMCs as red cruor (aggregated erythrocytes, analogous to our hard clots), chicken fat (aggregated platelets and fibrin strands, analogous to our soft clots), or a mixture of both (representing our mixed clots) [8]. Finally, we must consider that the pre-fixative and fixative solutions dehydrate and solidify the clots during the delay of the fixation process [29]. Once a clot is formed in a vessel segment, the water contained in the blood constituents is absorbed by the tissue as the fixative induces an osmotic shift. As a result, clots are dehydrated by the solutions [12] and if they remain partially not sedimented, this would result in the formation of mixed clots, or hard clots, which combined represent 85% of all clots in our study. Future studies should prioritize elucidating the impact of clotting speeds and the sedimentation of blood, as well as microscopic characteristics of clots of different consistency (all of which were beyond the scope of our study). This will contribute to a more profound comprehension of macroscopic findings. Clot attached to the vessel wall We did not find significant differences in the attachment of clots to the vessel wall. Most of the clots were unattached (83%), and most of the attached clots (50%) were in the abdominal aorta, which also exhibited the most prevalent calcification-like crusts. Interestingly, our observations from the dissection revealed that the majority of clots attached to the vessel wall were attached to the calcification-like crust portion. Since attachment to the vessel wall is characteristic of pre-mortem thrombi, one potential explanation would be that these clots start developing pre-mortem [9]. Alternatively, it is also possible that the high perfusion pressure pushes the blood and the clots towards the common iliac bifurcation, resulting in their adhesion to the calcification-like crusts of the abdominal aorta. This phenomenon is coherent with the high prevalence of obstruction observed in that segment (60% of cases with total obstruction and 30% with partial obstruction). Our study did not aim to assess the histology of the clots. However, future studies assessing the microscopy of the clots would clarify the nature of those attached as either PMCs or PMT. Obstruction of the vessel lumen The study revealed no statistically significant differences between the groups. As mention before, there was a high prevalence of obstruction in some segments, with the abdominal aorta exhibiting total obstructions in 90% of the cases. This finding aligns with the hypothesis that the perfusion pressure exerts a force on the clots, displacing them towards the common iliac bifurcation, where there is a constricted space that facilitates clogging, accumulation of clots, and obstruction of the segment. Furthermore, 90% of the cases showed total obstruction of the left atrium, and also 90% of the cases showed partial obstruction of the right ventricle. This pattern of accumulation of clots could be in part explained by the injection of the pre-fixative and fixative solutions in the systemic circulation, through the carotid artery. If the mitral valve (left atrioventricular valve) remains totally or partially closed, the left atrium would be unreachable. If the blood was pushed through an open mitral valve, the smaller caliber of the pulmonary veins, could restrict the continuous flow of the solution towards the lungs and the clots would accumulate in the left atrium. The systemic circulation perfusion would also explain the high prevalence of obstruction of the right ventricle. Clot weight No statistically significant differences were identified when comparing groups in terms of clot weight, with the left atrium being the segment that had the highest clot weight. This is coherent with the perfusion happening via the systemic circulation, as explained above. It has been established that the development of PMCs in the heart is associated with "common" or natural deaths [16]. This phenomenon has been observed predominantly in the elderly, where a prolonged interval separates injury from death (agony period). In the anatomy laboratory, the majority of body donors are of advanced age and have experienced a natural death, so a high prevalence of PMCs in the heart is to be expected. Relation between calcification-like crust and clot attachment to the vessel wall The investigation revealed no significant association between the attachment of clots and the presence of a calcified-like crust in all the segments. The abdominal aorta was the only segment with a higher prevalence of attached clots to the calcification-like crust, but all the other segments had a very low prevalence of attached clots or no attachment at all. This observation is in line with the descriptions of PMCs in the existing literature [8, 9, 28, 30], as it confirms that PMCs (as opposed to PMTs) are not adherent. Relation between clot consistency, attachment to the vessel wall and obstruction of the vessel lumen The association between the clot consistency and attachment to the vessel wall was not significant, neither was the association between clot consistency and vessel obstruction. The majority of the clots found were mixed, and given their features of fragility and dehydration, it was anticipated that they would exhibit a lack of adherence to the vessel wall, thereby resulting in an absence of association between the variables. Regarding the lack of association with obstruction, we were not expecting this result, given that 85% of clots had a mixed/hard consistency and also the majority of segments (71%) exhibit some obstruction. Future studies in a larger sample size are needed to clarify the relationship between these two variables. Relation between countability and consistency of clots There was no statistically significant associations between these variables. However, a majority of the clots found were either mixed or hard (85%) and also most of them were countable (54%). This finding aligns with the idea that the harder the consistency of the clot, the easier it is to be countable. This would be due to the tendency of friable clots to disintegrate under physical manipulation, while harder clots tend to maintain their structural integrity. Association between the weight of the clots and the anatomical variables by segment The findings of the linear regression analysis indicated a statistically significant correlation between the circumference of the thoracic aorta and the clot weight measured within the segment. The aorta's circumference was found to be a predictor of 57% of the total clot weight observed in the thoracic aorta. This phenomenon can be attributed, at least in part, to the anatomical characteristics of the thoracic aorta, which, on average, constitutes the largest portion of the aorta. Consequently, a substantial presence of clots could be detected in this region during the dissection process. However, no significant associations were observed in the other segments. Limits of our study The main limitation of our study is the small sample size. However, a power analysis based on our current data regarding the number of bodies necessary to detect certain differences across variables puts the sample size in the hundreds, making the study design non feasible within a reasonable timeframe (i.e., it would take several years to collect all the bodies). We believe that the results of this study are still very instructive, since they show no differences in cadavers vascular clots regardless of the pre-fixation solution used, and if a difference was to be detected by using hundreds of bodies, that would be signalling a small magnitude of the difference. Conclusion Different chemical pre-fixation solutions commercially available to anatomy laboratories do not change the qualitative or quantitative characteristics of clots found in cadavers used in surgical workshops. Future research exploring either alternative pre-fixative solutions (i.e., chemically different than the two used in our study), or mechanical means (i.e., pre-fixation thrombectomy and cardiac massage during perfusion), or changing the injection pressures of the solutions, could help reduce the number of clots and therefore produce better cadaver models suitable of a continuous flow free from obstructions. Declarations All authors have taken steps to ensure that they have no affiliations with or involvement in any organization or entity with any financial or non-financial interest in the subject matter or materials discussed in this manuscript. The University's Ethics Subcommittee on Anatomical Teaching and Research (Certificate No23-09) has kindly provided ethics approval for this manuscript. We would like to confirm that this study was carried out in accordance with the ethical principles established in the 1964 Declaration of Helsinki. The pictures in this manuscript were taken by the authors with the permission of the body donor consent process. Funding Declarations We are grateful for the partial financial support we received from NovaScience, which is affiliated with the Quebec government ( https://www.quebec.ca/entreprises-et-travailleurs-autonomes/aide-financiere/recherche-innovation/programme-novascience ). This grant supported the corresponding author with a full 2-year salary, allowing them to dedicate themselves fully to this project for the benefit of our institution. Author Contribution All authors reviewed the manuscript. P.P. wrote the original draft, developped the project's protocol, collected the data, analyzed the data, prepared all the content (figures and table) of this manuscript and edited the manuscript. A.N. developped the project's protocol, collected the data and edited the manuscript. J.M. developped the project's protocol, analyzed the data and edited the manuscript. Acknowledgement The authors sincerely thank those who donated their bodies to science so that anatomical research could be performed. Results from such research can potentially increase mankind's overall knowledge that can then improve patient care. Therefore, these donors and their families deserve our highest gratitude. We would also like to express our gratitude to the anatomy laboratory staff of the University (Johanne Pellerin, Marie-Eve Lemire, Sophie Plante, Sonia Gauthier, and Kevin Désaulniers, MSc.) for their invaluable contributions to the success of this project. Finally, we would like to express our sincere gratitude to the LifeEngine team (Catherine Forest-Nault, PhD., Aymeric Guy, PhD., Hugo Jobidon-Lavergne, MSc.) for their invaluable insights and guidance, which have enriched our work and contributed to our professional growth. References Holland, J.P., et al., Cadaveric hands-on training for surgical specialties: is this back to the future for surgical skills development? J Surg Educ, 2011. 68 (2): p. 110-6. Lewis, C.E., et al., A novel cadaver-based educational program in general surgery training. J Surg Educ, 2012. 69 (6): p. 693-8. Bellier, A., et al., Development of cadaver perfusion models for surgical training: an experimental study. Surg Radiol Anat, 2019. 41 (10): p. 1217-1224. Chevallier, C., et al., Postmortem circulation: a new model for testing endovascular devices and training clinicians in their use. Clin Anat, 2014. 27 (4): p. 556-62. Garrett, H.E., Jr., A human cadaveric circulation model. 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Mao, S.S., et al., Normal thoracic aorta diameter on cardiac computed tomography in healthy asymptomatic adults: impact of age and gender. Academic radiology, 2008. 15 (7): p. 827-834. Pham, M.H., et al., Normal values of aortic dimensions assessed by multidetector computed tomography in the Copenhagen General Population Study. European Heart Journal-Cardiovascular Imaging, 2019. 20 (8): p. 939-948. Schoeman, M., et al., The validity of arterial measurements in a South African embalmed body population. Surg Radiol Anat, 2018. 40 (1): p. 39-43. Balta, J.Y., et al., A comparison of embalming fluids on the structures and properties of tissue in human cadavers. Anat Histol Embryol, 2019. 48 (1): p. 64-73. Jackowski, C., et al., Postmortem imaging of blood and its characteristics using MSCT and MRI. Int J Legal Med, 2006. 120 (4): p. 233-40. Thomsen, H., H.J. Kaatsch, and B. Krisch, How and why does the platelet count in postmortem blood change during the early postmortem interval? Forensic Sci Int, 1999. 101 (3): p. 185-94. Hansma, P., et al., Agonal Thrombi at Autopsy. Am J Forensic Med Pathol, 2015. 36 (3): p. 141-4. Tobin, C.E., A method for removing intravascular clots from embalmed human specimens. Proc Soc Exp Biol Med, 1970. 135 (2): p. 263-6. Tiu, R.E., et al., Agonal Thrombus at Necropsy-A Third Category of Blood Coagulation in Domestic Carnivores. Life (Basel), 2023. 13 (9). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted 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-7040941","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":484886711,"identity":"093bd3a5-6bf7-4e2e-a625-ae364eea65fa","order_by":0,"name":"Philippe Pharand","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAklEQVRIiWNgGAWjYBAC+xmMjQcSwEweMMnYT0iLwQ3GBlQtMxsYGBvwa2FgOMCArGXDAUJabjc3HHi4444cg3Tvwc8VNXdkN99I3v64gsFOHqdf5hxsOJB45pkxg8y5ZMkzx54Zb7uRVth4hiHZEJdVBhKJQC1thxMbJHIMJBvYDiduu5Fj2NjAcACn62Ba6oFajH82/DucuHkGRIs9IS0JDBI5ZpKNQOs2SEC0JOLXcuaZYZvMGTPLxr7DxjPOPCuc2WCQnIxbS/rDhz933JHnl+4xvtnw7bBsf3vyho8NFXa2uLSAATA2GdgkkMwBI7wApIUBVcsoGAWjYBSMAgQAAOaVaavosQJkAAAAAElFTkSuQmCC","orcid":"","institution":"Université du Québec à Trois-Rivières","correspondingAuthor":true,"prefix":"","firstName":"Philippe","middleName":"","lastName":"Pharand","suffix":""},{"id":484886712,"identity":"6163b903-7d25-4701-8158-3f1882e71e28","order_by":1,"name":"Anna Nayouf","email":"","orcid":"","institution":"Université du Québec à Trois-Rivières","correspondingAuthor":false,"prefix":"","firstName":"Anna","middleName":"","lastName":"Nayouf","suffix":""},{"id":484886713,"identity":"dacb9f36-a586-4147-a5be-da7424e44c25","order_by":2,"name":"Josefina Maranzano","email":"","orcid":"","institution":"Université du Québec à Trois-Rivières","correspondingAuthor":false,"prefix":"","firstName":"Josefina","middleName":"","lastName":"Maranzano","suffix":""}],"badges":[],"createdAt":"2025-07-03 19:08:04","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7040941/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7040941/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":86786587,"identity":"3d9c3900-c9b1-4ce6-a124-017f9c001c6a","added_by":"auto","created_at":"2025-07-15 14:11:57","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":463400,"visible":true,"origin":"","legend":"\u003cp\u003eThe different segments and measurements of the heart and the aorta. The dotted lines on the heart represent the diameters measured for the right ventricle (RV), the left ventricle (LV), the left (LA) and right atrium (RA); The full lines on the heart represents the width measurements collected for the interventricular septum (IVS) and the myocardial apex; The wide dotted lines on the aorta separate the 3 segments of the aorta: the upper aorta (UA), the thoracic aorta (TA) and the abdominal aorta (AA); The narrow dotted lines on the aorta represent the level at which the circumferences for the aorta were collected; Finally, the full line on the aorta represents the length measured for the aorta (Adapted from BioRender)\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7040941/v1/ed89ae695f8739cf94708ef4.png"},{"id":86787288,"identity":"5b0933eb-5f3e-4f68-9c3f-dbd680892cfe","added_by":"auto","created_at":"2025-07-15 14:19:57","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":333948,"visible":true,"origin":"","legend":"\u003cp\u003eIllustration of incisions (black arrows) made to the heart cavities to remove clots (Adapted from BioRender)\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7040941/v1/b7c522538e4861956e017391.png"},{"id":86788518,"identity":"49ee7e0d-56d6-4e2f-ad8f-1f9f0f6b0d65","added_by":"auto","created_at":"2025-07-15 14:27:57","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1289291,"visible":true,"origin":"","legend":"\u003cp\u003eExample of different clot consistencies found in the anatomy laboratory’s sample: a) Mixed clots b) Soft clots c) Hard clots\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7040941/v1/fe712cb54eaccd9e9aa0d882.png"},{"id":86786599,"identity":"cb827a3e-8a4c-4bd5-a03f-33903350a08e","added_by":"auto","created_at":"2025-07-15 14:11:57","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":163013,"visible":true,"origin":"","legend":"\u003cp\u003eQualitative results for the presence of clots, the countable clots and the clots attached to the vessel wall per group and segment\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7040941/v1/b9b48ceaa8db14e5f8ccc1f6.png"},{"id":86786593,"identity":"c3005b92-ef0f-4b23-877a-723e2fbf3bc7","added_by":"auto","created_at":"2025-07-15 14:11:57","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":168213,"visible":true,"origin":"","legend":"\u003cp\u003eQualitative results for the number of clots, the clot consistency and the obstruction of the vessel lumen per group and segment\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-7040941/v1/cee3c88c06256c2d082de5c6.png"},{"id":86786597,"identity":"dad96fc0-4b33-4d0e-a9e9-838806d8be39","added_by":"auto","created_at":"2025-07-15 14:11:57","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":92875,"visible":true,"origin":"","legend":"\u003cp\u003eQualitative results for the presence of clots, the countable clots and the clots attached to the vessel wall per segment\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-7040941/v1/068097425d25047e8b405a02.png"},{"id":86787292,"identity":"0f04363c-56f8-41e3-9d47-cc3aa7165dd5","added_by":"auto","created_at":"2025-07-15 14:19:57","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":101633,"visible":true,"origin":"","legend":"\u003cp\u003eQualitative results for the number of clots, the clot consistency and the obstruction of the vessel lumen per segment\u003c/p\u003e","description":"","filename":"7.png","url":"https://assets-eu.researchsquare.com/files/rs-7040941/v1/04f455238b6560078fee55dc.png"},{"id":86786601,"identity":"9d539371-61e8-450e-a237-34703f2783b9","added_by":"auto","created_at":"2025-07-15 14:11:57","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":78585,"visible":true,"origin":"","legend":"\u003cp\u003eQuantitative results for the clot weight per group and segment, also per segment\u003c/p\u003e","description":"","filename":"8.png","url":"https://assets-eu.researchsquare.com/files/rs-7040941/v1/5b2a3f13a2ea0b783db1073f.png"},{"id":88880551,"identity":"667ed778-31ca-4249-bb14-0df584eb07ec","added_by":"auto","created_at":"2025-08-12 11:02:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3846101,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7040941/v1/c4ee5628-a7a3-436a-acc9-a257c4b5093e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clot dissolution to optimize body preparation for the continuous flow perfused cadaver model","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe Anatomy Laboratory of the University of Qu\u0026eacute;bec at Trois-Rivi\u0026egrave;res (UQTR) offers a wide range of services to undergraduate and graduate health students (e.g., gross anatomy classes, advanced dissection classes, and surgical training). Surgical anatomy workshops (SAW) are essential for the development of new trainees, and it is the only way for surgeons to have access to near-patient training [1]. Furthermore, the cadaver sessions ranked highest among SAW, meaning that trainees benefited most from their laboratory learning experience [2]. Therefore, the development of continuous flow perfused cadaver models (CFPCM) has been prominent since the 2000s [3\u0026ndash;6]. At the UQTR anatomy laboratory, our CFPCM is powered by the VIVO I (LifeEngine Technologies Inc, Montreal, Qc) system that provides an artificial cardiac pulse and arterial and venous pressures [7].\u003c/p\u003e\u003cp\u003eFor a CFPCM to work successfully, the heart, arterial and venous systems must be properly cleaned to be as free as possible of blood aggregates, which have been originally classified as: pre-mortem thrombi (PMTs), or post-mortem clots (PMCs). PMCs are classically described as non-adherent to the vessel wall, soft with a glossy gelatinous finish, and a dark-red to black or yellow-red colour [8, 9]. PMTs are adherent to the wall vessels, firm with a granular surface, and pale tan to dark red [8]. Regardless of their time of formation (before death and even potentially contributing to it, as would be the case of a PMT) or after death, such as PMCs (therefore just a post-mortem phenomenon not contributing to death), the preparation of the body in anatomy laboratories has the same approach [8]. (NOTE: in our Methods, Results, and Discussion sections we refer to all types of blood aggregates as clots because we did not attempt a pre- vs post-mortem classification given that all samples were collected after embalming with a fixative solution, which may affect the macroscopic characteristics of the aggregates, precluding such a classification).\u003c/p\u003e\u003cp\u003eThe first step in preparing the body in an anatomy laboratory is to drain the blood, from the vessels, along with the clots that move with the liquid blood. The second step is to inject a pre-fixation solution under pressure to help lubricate and more thoroughly clean the blood vessels, so the remaining clots are removed. The cadaver is then embalmed with a fixative solution to prevent tissue decomposition. In our laboratory, we use a saturated salt solution (SSS) as the fixative agent in bodies that will be used as a CFPCM [10]. Ideally, after the pre-fixation process, the vascular system should be free of any obstructions, so the fixative may be distributed to all organs and tissues. However, we have encountered problems with the use of our CFPCM: 1- surgeons and other trainees (e.g., interventional radiology and vascular surgery) found that some of their procedures were impossible to perform due to intravascular clots, 2- clots entered the VIVO I system and clogged its filter, considerably increasing the time of the SAW, 3- clots increased the vascular system's pressure causing microvascular ruptures, extravasation of perfusion liquid and damaging the valuable CFPCM. Despite efforts to remove or dislodge intravascular clots before (i.e., during pre-fixation), and during surgical workshops (e.g., by extracting the clots with hemostat clamps), it is currently almost impossible to obtain a cadaver with a completely clear vascular system within the laboratory\u0026rsquo;s setting.\u003c/p\u003e\u003cp\u003eTo date, no studies have sought to optimize the CFPCM for the presence of intravascular clots. The extant literature has explored thrombi and clot dissolution quality as a secondary outcome, albeit with no explicit intention to directly impact the optimization of the CFPCM [11]. Exploration of an alternative pre-fixation solution may offer a viable solution to this problem. We know that the standard pre-fixation solution is incapable of adequately dissolving, lubricating, and cleaning the vasculature. Consequently, we sought to explore a pre-fixation solution comprising distinct chemical ingredients from our standard solution, and we hypothesize that this alternative solution may more thoroughly clean the vascular system. Therefore, the objective of this study is to systematically compare the quantity and quality of clots present in bodies treated with a pre-fixation solution alternative (PI3N1: Trinity Fluids, LLC, MI, USA) to the standard solution utilized in our laboratory (Proflow: The Dodge Company, Inc., Billerica, MA).\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cem\u003eResearch type and population\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThis research is an experimental study with a convenience sample of 10 cadavers from the body donation program of the UQTR anatomy laboratory. Five cases were assigned to be prefixed with solution 1 (Proflow) which is a dimethyl-sulfoxide, propylene glycol, trisodium EDTA, and sodium borate-based solution, and five cases were assigned to be prefixed with solution 2 (PI3N1) which is a methanol, formaldehyde and ethylene-based solution. We excluded cases who had been prescribed thrombolytic drugs prior to death and non-spontaneous deaths (donors who received medical assisted death). The donors of our program provided their consent on body donation and sharing of medical information for teaching and/or research purposes before dying. Broad permission for the use of the body in education and/or research was acquired as part of the consent process, this included consent around images. All other figures were sourced from the scientific image and illustration software BioRender. The demographic characteristics of the body donors are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eTable 1. Demographic data. BMI\u0026thinsp;=\u0026thinsp;body mass index; F\u0026thinsp;=\u0026thinsp;female; M\u0026thinsp;=\u0026thinsp;male; COD\u0026thinsp;=\u0026thinsp;cause of death; FS\u0026thinsp;=\u0026thinsp;fixation solution; PFS\u0026thinsp;=\u0026thinsp;pre-fixation solution; FD\u0026thinsp;=\u0026thinsp;fixation delay; EDD\u0026thinsp;=\u0026thinsp;extraction/dissection delay; SSS\u0026thinsp;=\u0026thinsp;saturated salt solution; COPD\u0026thinsp;=\u0026thinsp;chronic obstructive pulmonary disease; PVD\u0026thinsp;=\u0026thinsp;peripheral vascular disease; PE\u0026thinsp;=\u0026thinsp;pulmonary embolism; MSC\u0026thinsp;=\u0026thinsp;metastatic sigmoid colon\u003c/p\u003e\n\u003cp\u003e\u003cimg 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8+u1eCgt5dxjjz3S9D67P1q3AwH48Ic/nBYVs9SwXSOFNxGVqsEQGLyqD9j7dNXYXltU5+mnny6s57f++usn42Bci+4beRDt2WKLLdIhbcbDmGmDxBgVj0jFM0VS3JORsZAh6kkXLAQm6kjvgphw6s6JoBogap0Surf33nunczvvvHPxkY98ZOSFr+oEAoF0SL+82Nn26KOPLg444IC0FhFSokFjPRLRYFHUo446Km3F7z5j6lyrYcNuGBvHbpjiy/bss88+6bnyb6C/7u2MavF7vxa4OZuJjL1529bGrxMxIFHIzCDFPoGQU1z9lW2ELg0ypYi6KYYxd4xfhAT5EJLlrGO8iIiII8KznDyiYqqcc7FSobEjBo76zogJiRr0SoGHwbMotJURDZ5FFkYFg4gYGWCmZaK1JjrD6Pg0e8b0PemUL60gkRHpdZ/Wj/Ev7pc3rSKD0Zw34E24WbrlwXPGgedZhE0Zii5lTAfkUBic7OoGbBIGbiKpxhpNs0pom6CPpt3SV/o5LuhX2Ab6EV0ddIYO0xV6pBHjf3aDfvqcRH8G4bmxANsHP/jBxWfHhzTJA/0s2wzn2Q36SucNkkdM5MXBBka+5WXYc9gXjST2hZ1xfRVAkthbXeC6m+cTTCrgk0ynJpujoNcRknJYri9oK72Mhz0NGF4KFezeJ+cuymFtAQNXEVBKa3EghIOiagH5n3IaxCpEq9tnJjIyLRgARtE7KatPERpOywDbMIKu0TXjnLQwQAih/xk4406QW/kOQ2t5bc/0Oa0xbRPlcPJMYFznA8bVmz7ZhbbTSqdNe6UTdIn+0B3waVyJsVhsRIzLoo9d0x82Q9oHbQbbQP/ZAun1O/Lif3ku52XYc+TZdcqpKjIyCsgGHR5FRka9rkp4X5XvrHwvG2yTU9Pq0YrGfrHKUSoRI9WdMNteNjLPWRqcKV3B3IO9NyksZWC6s+1lo/x0HYiiGFzlt7xUpdAiBaIkogCj7GUzExgfrQJbUJutoo+YUTJanQKPC/VDDpAex3yA1lVbe9kwOnSE/AsfiwaRJfVPlqJFaN0W14hQiQhJqwPomciAetEy1p1HJtU7/Qmy2hSkb669bAxMJt/GOpEp6fUpn3Q/nKjfoqymr6onZQOR90F4DnvF3owjn54rPd5H76XFubBBzkkDW6W8w7b5lBYkwD2iMyLD7pVemCmtM8Ezp9nLpm3wGWRZ/fU1SjUp5trLRteS6LuymU0+6YAoo6gEHarbD2oMkVuROdEnjd1B0AF5G2cvm1o212MIjTm45pprUiEL1Y9i5EJpZyIkBJejNGWVsqsgBsp7hL203FVsG5iNkAj/2TfGWAejt/VX+s3wWPWvClRFSDg1rYLYznqNNdZIA18ZOi2HcZEJSXXwXtErY32UKyfMAF1++eVp6rbQKNkzQO+qq656vnvLirr0hmFgODhJA5P1rzMqSI1rjDEix1qDwttNYRRCQvf16x9zzDGJJJNF99j6wJgitkleLrjggqQHDLQxAsYNiZDNZBAnJSTKzLgL6VG2nqH8DAxH3BEoa+YYf8AuqAsLEDrYROTvkksuSQ0Uxl0+OB4tefU0DjIh6S/mIiR8L5kR1SYbM4G8G9NDf+nCuA1djRjPUBejkBn+xkrebA97we8NYhJCUnmXDUMhJCaRCpFyjsv4ZwKFtYIoJ2AgVWyzbN48Q8tIzAYRCQUfqDLUNBuQJUsSWyfDjBUbOVkVUKWW0UbIbRhESYQprUkQxpxjy2gPnBZCa3E4ym9w76qrrpoG7yKOiAhjYtAysotEbrXVVmnfEdcy9pynFleErOml1W532mmnYv/990/7BFmJ13WcfZcgrRo2bIrDUt8GXO+3334p/5yycQjI/1577ZX+k38OGumoGggbwy8tdOTggw9OtoiuX3rppWmclgaSBgiiyEapB+PwEElkhvPYZJNNiu222y6lVZ1ElCQjA+jnQQcdlGYPzgZd0VtvvXUamFteH2UmnzLY3YvMa8ggtmWwKcPgfewQEjXox6ZBLWNIGEcJpoxVjTHQytaKQDp0Hyh0z+c8VZbBpMiPEKqZIkJJrmcgtE50ISEFWoLCpAoag3NOK5MhwNItFCbqohXpOVpYZpxobelyKROaUaHyPdsAH5EmDsHMFfPjwTMJgvdIn2u1gF0vH1im/6VHZKgLpCWjWSAIplmSW9ErDpH8c26mXZpxJLpITp03fVHEIcila7TGLaMN7qObnuMakYl11103kRwyj/x3DdLrYFsYQjbAp3VpEA+RFmk3i0q+DDhWVmUDXSWUm8O7vMNaFyItyhkxcs7/SAtC5ROJEQWgw+yJmRy+G5Ol/NuK8GZ0D6Jo/JZuV76KTxBdd1hygS6LDgJCLkrqevfxKRoffIqIIp8CInf8nageX8O38H18pcaOPcIQeNESzxad8QzvBuddIxrjfe7V/VgVahvUqkBmYmeTQKUoSGErXQrg+YiD/xSY73ZsPOyww9L20wpY5SElWo2Muu4k22hHa0rERWgVaVHQ9mbREmUsPMfUMa1Oe7kceeSRqX96XDBCDKM57IiTVqgIkpaTPAjzEgiGjNMRShee1ooyXY2TkSbXIGZauxkLC4gosm2Q8WC3ht9kCSEhw7oeBp2w+zg7cg1kKHQ04B6ROw6WY+fgu4SwJRoM9CM2f0T4kRQ6Jl+mppumySCbsVfXSsLKzrvZHYZd48GYHC1HdcCmKEM2h2HXtSxNoo0iWLpWY9qpxofIb9i2jAzkwSZ+RxxxRCIg/AO5FsFECHSX8HPIBvvAV+kG1Gg3s9G+X9EIcY8GLX+o25cc8o+nn356itSRW76FHCM1yAof6buNVC2kiahoqPBHrhVVcW8vCEnVwAARCIYnxmgwPvpu9YebI86Ian1oIVJu41i0HDFERkNUQpeJloqwqvsZc+xTnxuj7fmiGIhPtB6Fsx3epZIIyjjQ5WHePsNDeHTZMEQciHdJH4Gy8p8oj3OMmcV3jDEhWNIvrFvVmJOMfoGRIRMiG4NdoNGdRi6jxTJIWsm3I2Rr8P+A57uOrnWx+0CXML0xgI9xZRCDVOnCpfMaAGzCokWLku4MhqergjL0bkbcNHBkULSWnipD71VvziMrPpUrSCMboJtHA8UussYGxf8ZGXwRgkrfyRLfJtrJv/FjW265ZSIJyIfr+CwRVORCVANxjyU0yCk5QzT4PF29uj1FFpFnz+Z7DCvQBYN48H/Oe67GvHtFVkRedUHSNz5zXH84G3pDSBQOIqKQkRNgEEQahG0ZYQWtEhWYwjUGgvEVWYnzCl9ftOcwZggHg+5Znu/w26cWowInBMgCksP4GIg0DjgB6TfuxYBc4VkLDBnwJh1avtIpjVq6+sCtJ0DIkChEyDXeXyUbzegPouuTsRE2HQaGiiP0/2BkktFwkDGD1sqRkTI8nxOlJ8hJlyBPYZiNu9BIYFTpbvwnwnPGGWekaKZysP0BslAHvDPGzNlfSYPjwAMPTBEZjsGhHG27sOeee6ZFxNgS5+m7xoU5BVqpbJd0swsZGQH6Sqf5pOiu1KA2ZpLMOKfhwF/5z2dMcCBjbIK1fcgmn+i86/g2vsX4MZFTNsHEE9eLfoiM0H/nNOqN1dILoUHND0mP+/hP8lwVaiEkDISMyOQkMzOGATHA1PRrRdgZVBZnryBjdLDCCqMrLQxxeWAbp+56FaMwpdU9EGlnbBwqOM67J4jROBCy1a8trcLKuoWMgxGmFRmRTsYz+voNbnMtxyBdCJQQm5BbxsIE48MIIddkpgzdAgwIx6i7wHgjxKIMi2fRgVh4LOQ85B60zrXkyZ3xEIORmLYhrdIsXYwhe2DBJXpJf0RI9WtrpNgcTqjbf5N0s44C6WFLGHdRUHVkDImyBWn1P8Puf+v26KZhc6TTDArOxWJgNqqk/8awVWngM/qP0FNyxZ+GT/VJvnzyIeHvHHwegk5H+BQk2bWii7E6tfuQDA1m13oHv+M65/lQ9sJYLCTEubgeXOco25BpUQshYRyEeDjRqkKQFFmIyhQi4z70qYHCEekQNVHAKoLBdvhPhVgBDyGIwTmuN3qZ8VbZDIMxGsLAwl+xvglCIg+eg1kaLOQ+pGQcEALjR3T3eFa0rBggZANzNbhWCNd2/sasCO8aQ+K9Wleu1YKSxoyFB2Rj4403Tt+NeeJ8EQz9uMKoSC+HqJuCbOmSjMgb4qvrQmRuvfXWS88gk4gLPdFl6RryZTyTmR9dXIEW8aK7dIJ+QhhqQKbOPffcZHvomPMc/jTT4GeDliT7oCzZnTL8ls4yOVQv0sTQa1ipR91OnIEDyRIVZZMyMoC/oKNkiPzTafqKfPB59MH5kJmQIwRCZDCW37j55psT2eA/jQGxW7oxKHxMNMrJKjtBdzzjtNNOS3ZEV6LuGpFJ5Nr0duMy+VRybAznoPxPisrXIVEgwjruEUngbBnTiF7MBgVMuRmQwXVIKLL+Lo7ZdZRdxWgx+q2LA5tzTiUxRJRbwXoeYsRQGYshMiJCoXI8V0V4r/CXilGZWlkKXZeKSiAIuoAYaq2uQXindyM5gxEUXTxBbDzHLB/MUihMC09ahdk4BYbWOS0qZSj9ZhEoV++QdiRrsPUaYTrdUnUZ4EkgPwy30LVjPkCIlMyoA7LSBDheMkkeREO8n2yqczJB7ugMUkKeyJlyd52IIllH6OmiexgShoicaUCQT5/6kHWDeEZTYFDpJtmV/mFQ5vLhOg0CdkDao3XGQCsXeuxaEQh5EpWwlo4yGgakbpJ1SKRZ48X73KduPAPpkBbpRBJBWh0cQiAGwoZdkrcgncphHLB/6ll55HVI+oXZ1iHRAOYDyCf54Vf4APKhnum3/4wR8VtjglyaBh8RDbO4fIq6G/PhOeSND1LehiJEFyOb4ZMf1VCmQ6KLfI/rzMAjw+qKrpFz/tKzdT8O+iT+UN7GWYek8r1stMgUEiWRYM5bQUcf+GzQ2ptrLxsFhi0yxoyJAmEIVIgC8Z/DeYWgomVRYVNaBoPx4LR9x+wUMIfuGZ6vX8xvo5ZVgEGonuG+mYyFQUBGNA/by4aQOBhK6SYIDC8DxKCqcGUmlIaoyLvzzik3zkF5EkDpkU5pLEPFIzQI4CjEsQkoM+x5kr1smoCuCS1UjktYc9T0qYu29rIhQ2SZQWCwyDg5InPkCuggR0kmXENmy9fQD88I1XeO7vjfMWhY6oa8zLWXDbIkTxy4dOsmYeiioUOHGHd65tMh3wzwbA4+jDOSP44zJDvKUCODrkqPLjXpkRb20sGeKE/2xjXALrqfjQl7Ra91S9P1qMdRMe1eNm1D3Yoey/c0e9n0EQiGhq/G8+BeNnSdzJNpfoBskX/lxP7TA/LHHyArIhp8hO4/fpevYdvcx6fwk2yDd/oPkaZzZI+doIdkl87wjeRKdIb/dj/f5H38NBvofs+WFrLvnjIEC/gk4yJH3cumckLicRQOFJzfEjqKko1CSAIU3eG5CiUKI94dKBeSypAe15fT45yKQGICwlH6oBkJU35VxmCBlzEbIQl4DwLk3Z43WCaRdu+JcnRNXOecY1h5jkpICDljTcBnSucoQJakb5DVlyGtoxISSscwyRdDzdHO1KqdCcpWy5NyjtLaFSUwfVQaKSVjSBnnig60SUgCZDlktiy3ZTAy6oi8RyQBnAs5Kn+fTb7rxCiERBpDH+L3MD2AUcomMCkhmS098R/Eb5/Dylc6pVf9qKdJMA0h8W7yLG100OckUT82hbNiD4bVyWyok5BIF3vCaSJ+nLJG6jhQRhq/6idIZVWYjZCUZcx3iLINeUMYdLtIn/xpeJj2Hgj9Lus/kLuQ1zJCVgN8rHvL51wT54fJdGASQlK5BZJwCY3EDmamKjA0Wh6cT7lQfC8fZRCoYUTA77LhYsgpJwPFQSFjg8+aBN4TaR5WJuU0+z/K0HeH79OUJ2eNODFggxGWcSENxr2IMEwLoW3z6jkm/ZXmvWt9jguhSQN/5W8uUFSGSdedrjP50boQ9tRf2nWQZbI0m8Ml664hM2WU5cinZ4TcdRWRVumcSw9GKZtpMVt64r/4Pz6HwX/SOikZmQaiNIigxpcxeVrWliCYBPKH4NMd9rML0MCVHk7fOlTGTYiSjwt1w7YYq8XJNoWyjJXlKX77ny9BDtSlKC97VkZcO4i4fxCD5+jQ4Dm/lYlnV41uW6GWoKCREcvwmm89TSShKxDq0wqhnPr7hgnpOIh+c4Rkmtk/+s4tZqeMpQtzF2nS2hoHWjEIDaIxSn+lOtaai24zLR+RJS0VUTqL0GVkzGdoBBhjYJyNqKAW9iQOG+ivxpsxDyYP0OM2IXJg3Q2OU/7YB90X7OAkkDe2hQ2dpLFUF9SbMV+mwZvyPtMYrL4gE5IhwAo5XN01nO64XQddgxCbrgmOlsOVHw4/Dt04FJay6vZwPeXzXSgQXGPmj+iDFhCWLBRH4Tlv144L4VQRG++VLi16ZMIzI9QofQxlGJJIB/JRhv+lTd+p0D+DqOUg/SJc4JkxDgEQEV1PIkcGfCEo7mV8dMloYWVkzEeIitA9XePGIBjjYhxARJXoBf0J+K5rRUs8IiAcvMaDaDLokmU3RRImJTZVwcq4umItVGcMkfyJCrMtbB3bU4Y8sQvyCCIi8qYcXC8Swd7Jq9W02yZcATZMmbNZ7PqwqEefUMtuv5NCXyaHQXj09bUJFVs+5oLIA8c3bJZNE9BPahxJKF8ZnLJlthkT44A4ZlO3dI0wNOqV873pppuSs9cKMP2YUlu6mOHRKqCMzlFUo67DoWtp6f4YNu6HYusKoTSOMkxdpdwiI2YSeZ6wry4cfckIhqWRGQTkkJEzZY2c6Hc1/ds5z0Vm3OcZul0sNiW8yjjKi+/C0kK3yIbniZLodnKvMTXy51mIkDwxTsP65JEi7xVqb2qWzXyGcjeWg+w23cKjG2SYvRmUz76APpBHZB65GAUaEXTCmDdjoThj41CM96LvV111VdJd9WGxNgMm2QXLI/hfI0Gd0Vdrp7A5bIC00B16yBaOYjvZoCpn2bAbdF6aogtDJJbNYMeMidQ1Rd7IHhvDzrFFoiohE+7RkENWOHz5Y2OcQ07GXf5hGBAjdtuzZxuP10fwh/I2ziybHCFZAEAIGCwKiEXHiH7Gw4A+DhhZYYBEKoQBGSYKbYdS/8c8dFO//B8tBAYLYfCccSFN0iAKhRQAsiTKoXXDQGp16RuNSAwjauM4Qi4sq0UnDQihbhcEQv4ogmeaRslwCE1Lv9/Kw0Aw57QSGSjdRtFqipYicpaRMd9A5+gR0lAewI0YcIxW8DSV0/gSszHYAZ9I+4477pj0DamnI3QRCQp7gNTRYY2CiEQ2DQ1oZEm0MyBN7JSlG3TDi+giFrqaNLY1yKzToyGEHLE/fouwIEoRFVI+yIryy6gemZAsADBAjEO568lMJjNEKJeWg2gAZRX5wGYZFlELCmnVTgq7++67J0W3TDZjBhQaWYhukVHBQEgXZS+P0WH0kCED0IRY9Y1Gq8+7GQ8tCZEJrVrRKO9nhDwLuWE0kArfERQjvF0bM5D8r4XnvD2Q9thjj7T/iL5miEGGunJEnjIy5hPoHb2nO9EQ0OgQMTSmSutfQwDJYDcQEKSEfnDSbIQogk1AkXljFzRkQGOC/rAH0f3RNOLdGmBlaJjIl13W5UcjjL3RuGEbbHiIjGmsibBYVAzpkj/XgcaOCCmCllE9MiFZAGBYEIBy+JRyUjTnrOSn+4QiIi1aSgxVzMShqEbgIyqHHnpoWmEyjA1iwpCN26fKAEpTGMKA5zAkDF5522tpEZ1hIK0oKiyMdCBHrmEkGMMAQuEAeXF4jyP6yb1HNxNDG2NrQJk4pM+RkTGfQMfoeNkegN/R0KAjdCXsBl0K8sJO2JfLHj0XX3xxWmE6Zra5xzNCt9vAMHsH8iQP5XxKo/PRCJF+URINFV1T9nCxeqnygnjmuPYuYzRkQrIAIAJB4bQIytBasEpf7JqqdRQIwwKiIxRc1MJmTCIqBsUBYkI5y1GOUeDZulg8Vz9uwG+tl0WLFiWSYZxLhEu1TszVF7XR9YIkadkIryJY+qxB2hmOMB5+l8+Vf0N8Bhgf6UBYql53ICOjbdAVEVD6pRsDQicc5d/0NMhJ/CdyyJbYBNQQRBGXmGlHVz0zbE4bkD9p1qgJRF4iH4O/I59sUXTX2IaAfdS9K6IE8iZfo46JyBgPmZAsAHDwwpIMSTh34HB1xyAmBpbqGvE/cmJAV5AOA7kMINUtwkF7lu4QCEWdayG7YdD1IhRqIDNQdv23+mf1ba+11lppEKuojGucv+SSS4qDDz447ap6zDHHpIF2WjJIBCPhGQiUgbfyYRBbbGQmrQ75YXQY0mEwlkQfc5mgZWTMFyAjohx0PRopdIVeGJdFZ0Q82AA655M+0SswBktUlaPmnNkD0cr4TwNF1HHatY4mhWgnW2aMGsijtMuffBpfRv8jb+yDAe/OIyfGllx99dXJ5hjMatG86LJhG0RSo4sqo1rkWTYVgaB3dZaNMKX6M1WWMdInHNAF4rBpIAfsOVoK6hrJcL1navHIn+9CmgwaIARaFQa/imAMYrZZNpQcQaDkCBFS4d3GfXi+9xvr4rtWj3S6R9cNA4h8GHiKJDknjVp9wrDGwxiYJwyLqKgXn8rCec/1jGERELMGEKMtttgiGdtBeEeeZVMd8iyb6cBujjvLhu4g8oi/KCOnTZbZATrovGgkh4xY0BcNF3WkrHSPuocDp3vGZdA1g1mRGRHMUdNC76ucZSN97LFxHrqVNC7CrsiPNLN1bI68yb/0Oyd/DiCX0mMvJLKhnA20V85m70SX8DTIs2xeiExIKkKXCQkFJPAICQPM6FA2rR4GxPXGiXCwlIwhoYg+OXCOHinQUtAyoDiMh5aFaX/Cm9FdMojZCEmM2WAYEQ6GgVHwbgLMKPrOEGrdaJExMIgCA+l/rTzvjgGpDA+igZCI4nguIyTd8Uzf5UW+lE0ZDIQZBBxj7Iw7iExIqkUmJNNhEkKinNkrUQKDWN1LL+g5W+F/OuR5Dl0XdFOjg9z7X4PB4Tybx/7ozqWLxqeN6rCrJiR0mp6TKWXDb3GK8sN2+U+62QC2z6f/5Fs+/B8NomgMgciJSMtmm21WGXnIhOSFyF02CwSctBX9RATMtzceZPPNN08GhEOPSIG+VErJ6Pik3AyF367RMvJbaDfm4+tamRRm8iAZyA2jhAB5r4NBi0FohJrjOvLII9NaKgcccEBx++23J2PD+AWk1z2Rfkf5meUDeSmDcbBuiXeZ3ZORMV9B9tkDjtiUdxGT0Iuy7vhe/s0+AN1E6B2exfmwJYiKqcDDoqVNQhR0ww03TITEfiqR/sFDOuM7O8F+yKNILHsn72DmH4LjmcqsbSDS8qZxxBabNSgyrLtNOtVnVfBcttdRNzIhWUAQMRB+tIHZJptsksZjGC2vhTAuKCsiYY2QwSjDOKD8SI10aZnMNDJflMMgVgPNREgMetVNJNSKsFQBBglBsn132wY1I6NuIBNkXYRzWnDgoqxWPI4uj7YhqiPKKcoxk10ZBQa4s532vNLNU5W9mRTWT7Imkwj3iSeemDbTswo3EmIBTAu9xUrW8j1N3kF+dcNZPE6kuk5kQrKAQLB0kwhTUlaGSFgyWj3jwHOEcqMFMQ20tkRwGLKZlF0rTEiT0TPV11oIjISWTVVAQryjrcF4GRlNA5EQTp9Wj0J3ohu2C4iuG8c0JMK9um10601iK6uEaI/VskVp2ECNSekTMdGg0lgzZVk3mgiKMS+GXEwL/oJ9NgVaJLsuZEKyQDGNgsK09w/DqM9ETtp8f0bGfEMX7UFX0JW86TIxicBSC2ZHsoMi1RpQkUZd6gimcTkxWyhW0RbpQVKMdzRWU0TFYZyfLjfdPc4bBOw64z/8Nn5Uw1PXuC6i2267LT2vDmRCkpGRkZGR0XGYmmwsi0H+ASQDRJkRjY997GPFySefnCYbGJxvzx6f7tOtc/PNN6dub0sp+G7cz2GHHZaiKgcddFDqAtIddOmllybiccIJJyQSBCIkok1mNtbVdZMJSUZGRkZGRsehq8RsSrMRyzBGBDHRraRLyXRnM8Z0bxsvaIsQ5w1eFumwl4+IikkBnieaYlCsZfMd1mbxLpMejMGJ8XQiMrqtRE0QnDqQCUlGRkZGRkbHYZyIRediRmQZSImuG9OHRUscxgc5EBXdMCIbBsKahWMMiokEZkWJehiL4rfxeaZ/G6ti4Uko73juHZ5lkc06kAlJRkZGRkZGDxDRkIBIRyzNADFt2XUiHz79RiL8Z/0ms4XMzNlyyy0TgQHRDyQGLOOw5557piiIZRbsGxbwDEddyIQkIyMjIyOj4xAZQTzK64EgHAaaIh+IhwgK8hEEJRb+85/7HnjggeeXyze2xIBW9wZhia1DrO900UUXpQiKHZ1jM0Gr8+r2EVWpA5mQZGRkZGRkdBwWe0NKYk8hs22M/UAikA1rj9hew3lEw2wbXSwGriIUFqyzh4/Bq5dffnlaCBIZcb2xJFb7RWQQljvvvDN1y1g001pPEXXxPlGVmVbmnhaZkGRkZGRkZHQctvxABEQ3AMkw9mPrrbdOW1ggGKbm6pIRxTAWxO7sBrUaCOs6m5Ja0BI5MV7E4ngWszN4FTkRJfEezxUpMb1Y1w4gI7E9SnmmT5XIhCQjIyMjI6PjEB1BNsx6+cu//MsU/UAYbAHgUwTFRodmyiAgyIaVtJEPs25ENgxcNX7EOBERFItLWq3XcxEYkRBkwzPXXXfdRHB0z+gWsq6Jd1o+vy5kQpKRkZGRkdEDGNthp2FdNKb3WmHXTBoREQey4rcBqrpfrN7qXAxE9RtRcS2UZ+PEar0GuFpgDQGK67xLlw1yg/jUhUxIMjIyMjIyegAkw27K1hepctuM2YCIIDGm/7797W9ffLYeZEKSkZGRkZHRE+hWsfeXRcqaABLkXfZAq3PKL2RCkpGRkZGR0SMgCXWTgzK8yzvrRiYkGRkZGRkZGa0jE5KMjIyMjIyM1pEJyTyCwUddQxfTVAXma77aRFtlOh/qUh6yTGb0HSMREv1HpgvVjZiyZK5z32DEsylS0t8GvNdUrbbePwz6HKVJfcaOkfMB8hKymjE9YspiG3ofOttHmxOQfkdfdSx0aSHqU8gfOznfoF7xhnHGnvzer1n1nLTaMrK33nprWjDFam51AOmx3K3V4CziYofC8iZCXYZ521a1k3ZlpBKabK0oO/PSbQttepbR0F0pO6sHWt3PKG0L8dQlP01BWVtq2Y6ZFM4KiX3PU5uIPTYse03nX/e61z2/b0bd8G57fVgi27v/8A//cPE//QF5/OlPf5rKzwJW9h751a9+tfjf7oOzoj/f/e5303e70LapT2W7PehI479xHOxsIH/s43PPPZfsI7/XpN+YC9PkV95inZQddthh5JVdRyIkd911V1qudvPNN0/GuA5w6n/zN39TfPvb3y7+5E/+pDeGXvFpXX3+859PZWQJXqSgybQrO0Jtd0YG3Tz1tsuOECsb+yPYP8EqgIwN+alKoduAsubEnnjiibRwkJUMbUyVMRmQd7Jru/PXv/71xTLLLJNkdwSzNDW8m9G0d8cb3/jG4k1velM638S7q4KFrTSGnnzyyaRfys9+Jn3RMYTKKqCPPvpoSrNVQxGqPtXBpOCsv//97xdf+cpXkr9761vfms7Ph7yL/PDl3/zmN4uVV1555PVLRiIkdvvTyt1+++0Xn6kHNg16+umn0xbJ1tLvE+yc+I1vfCPtF/DSl7508dnmwLAy6pYMVn5dAaFk8CkbojkfoFVjS24t6ve9732Lz2ZMir/7u79LDonsWvCpSXAIf/VXf5XsTV/lU0Pus5/9bGqI2Aitb0Do77nnnkRI6lyWvIvQYLP5ndVPrcI6n8D2y9tf/MVfjExIOjmotY8MUReJo620e28cXUGkxWdfut9GQTlfGdOjzXL07jj6jr7mIdI9H+pgXITs1WUfdX9q6IveD3bl+S+GSdTx/kn8YW2ERCa1PHyOg4UolPMduU4zMjJmQjjljGrB915wwQXF7rvvnno3jjjiiBSNDHz1q18tPvaxjxUPPfRQZ8q/ckKi/1f3xS677FKceOKJxY9+9KPF/2QMAoPU32tQmoF92KrvzjU1sA8Io358IbZf/OIX6Zz3//KXv0zdE8ZMSF/bYyWk4Tvf+U4qo4A0SWOk0xiVYWyfXPpf/upqjYyDct1H+TZZ5+OCITNGKeSjafzzP/9zkk9dLMrNb/iXf/mX1GVhUKS0xRg3ZelaLUOy4bpxy1eLUr041JH3TmK41bEuqQceeCB1SRtE2wUZLENeQ4+iDOmMwbLKcaayc59yV75dhzKXVvU4CHZEXsNfsX1sTWwq1zfIK7nTDXrCCScUe+65ZxqI/+Uvfzn9bwjG/fffn8b3GcPTFVROSAz601/07ne/Ow1YUrEZw6HP1LiTffbZJ41Evvnmm4vzzjuvOProo9MgtSbA0H7yk58s7rjjjrSl9aWXXpr6NY372HbbbYuVVlqpWGGFFYpNNtmkePDBBxff1Two0n777VdsueWWxTbbbJPGcDCSJ510Utr06f3vf3/xgQ98oDjnnHOSAxkER6A1cO+993bCGdANxmD//fdPrRfk3bbgZrN1DcqZnBqnMG7EswqQxdNOO6247777iquvvjqVmb5pJFp9X3/99Wmcm5YgWVa/rrvwwguLRx55pDj00EOLq666auyB3hwRedlss82Kfffdtzj88MOTYTcIcVQYcCpt5I9u77rrrkm31X9XgExccsklxXvf+95igw02SHlGNG644YZkD6699tr0OahXnNopp5yS9JJ8dBmIljzstttuqcEcUMfG3pEv8m2g89e//vV0Ldmhj7fddlvv/Bjf8oY3vCENKP3zP//zNIbP7MuYAcr2kEEDuZ3rCkGuRSvMMjHF00jbPrLLpkBozIox5dCUL8YACTBTx+8mgDV/7nOfS/XFoXM+ZgwhKjvuuGMy9gcccEAS6piF0DS02ESPlMvll1+eFI2xNILbIL4rr7yyOPfcc9MI/ZgyXgZjJCz57LPPptZAV2RyySWXfH6q60c/+tGUL/lQ/sApaLmVW6ecqvII5+qTMXHEd/lzj4Oz8RzwfTDK5b9ymcSz4t3Om8KngbHFFlukaaXgWY4myhL5MKV9nXXWScQd+ZRGBJoMbLXVVonUrbrqqilN6lk0R8Nou+22K9Zff/20GVlEVUYFQ/3a1742Te82YHTvvfdOz0csopWtnJwD5V2uGxDVQUaWXnrp5AwNnHVNlJsyjjpxzrPkzbM8O+rUb9/rKG/lKz8XXXRRcfHFF6eB2vSF06Jzylt5alGXYZrxm9/85pSmccu2aZhoYOCoNT+CVEv3448/nggH24Z4alDLK/LFHtJR5SOq1SfwLWbxkF35ZAPNYlNfyKOol8Gm6jDsQxdQCyFRAHUoznwEoaEkjF8YIWE2RxPgECnhww8/nAw8QTbjYNllly3WWGONZNQJLZJpamQbMLVRetZee+3kGGKtFw58tdVWK5ZbbrmUtiWWWOJ3iJyWDaelbBkXJJmB7wKkJRaFUg/Sz3AI719zzTXJQZx99tmJhDGQHJk6OuussxIJ09K+/fbbk0HVbXHLLbek374jkpzLZZddVhx//PGpu0DU4Jhjjnm+hS8krfWLBN19990pXI2ccrjOnXrqqak1iZz61HJmzEUsPPvMM89MUbNwyHVBXYuQiX4oM3VODnx/6qmnUlnRG/IqokeGdTGJTAi5i/CJotG1cRH1Y4o3eTPFX2RGa1r//Omnn57KFekQtVNffutC+uEPf5jK87HHHktOQHoRf/KMXLhH3YryuE59eKZ69J86QLy9T2vdelBVh9fpBXkQESAznk8OyRB5QJbpjTSLnA7C+hl9WFQOqZbW8gxI5Wp2DzKmbjV65IWt09WnHsgPMtnHNWoC6lLd0Q31SGflnYzKJ+LpdxfQnbjhAgXjyTgJEzLywsxGRTvfBCii7hjCybgymKafEVxEhZIKzWpBMM5tQDoYEo5JepQXI8FwSCdnxJhzHINTNykc52QqtNaua5sq27kQxF3rn8M3CBy50ophKMmBlj3npLtCaFlLTR4NSENO/I5+YXkTXUFqOBlO0/oGHKOQvOgGgobA6C/XTSdsK7KgRcyxK0fOTxn7L/qZGTQEiGOVDsTP/9YoqrsbBwER/aIbH/rQh1LeOE0ExDR7pMoaSfKujpXPRhttlNIteqK7huyQj0mAcIkkIkQclPQ457e6kxZkgeEXUVDeHDwCaV2Qd77znYnYW40TAZAWJEX5q28O/4orrkg66B6tdnWlHtUtMsRpktuqddAzN91000RajTlAWJE875cPaaFzxl4Ma2T2qfE5mFbdaeRZ2dKlgw8+OOmhCBEZ0iD40pe+VKy44oqpDvoI8kqG2Hk2MPJP/0V+RPDovLruAjIhaRla6ww7BUAMRAGQgqbA0CAcDKN+Ro6QQQpw6AySrhGtjDbBmHOGWjrCqwEGhWJpgZbXr+FEGRjsn+MQKXFdV5QPOAREggzojjjqqKNSBEh/r/pQL4whh8g4IiLKgZMTJYjWNtIm/+SJg+RQRI0YV2RSS5cjDUdnYTcO22JaDi1Av4EsiijopovuHM+SRtcx0CI6DBnZqNMhyQ9SduCBBybCLO9mC2i9as3uvPPOKZIgXcqOYyenuj9FG6xrcv7556d7JyVO6kiXBBJmPIqxPtJksT+tTrohgqXrRZ2pPwZf11G0yh1B8pFCDRAEQBhdd5jz0bWD7IhCIR+cpuil/KmPqqFOyYbyUq7kjnMmK2QHERbBoUvI3nxANEiQeTLE5n7wgx9MhFF0UsNAXa+11lrJdog6sjF9g7TfdNNNiahr3IjcyZu1Xsgxcr/KKqukg853AbUQEkLOKFAy3zNmRpSV1htnythrITcFToXBExX5+Mc/nsgQAY4BbMgKQ9skSRoGTo8zRqAoEGMdRoKD5TBi7Eg4SIaHA2PchdN9OjiLLkC9q39OSb0jAchE9P06yAVHJi/Igd8GqiGv+sTl1X90DbHhwLXA3Yug+IzneV84ReWCTChD13GYPuMehtq7XOuItOi+UZacO8frOs+qC/KEFGvpcRAGHzKeiCZSxbGL8Og+MtYhIk2iDQibgcwGQhsXQH7GhbJVnrpQkQ96EuUi7xG5I38hj8iD86B+wwFC6Lu6pGPIh2sRF3UpoqKLFIkizwik6BbSWUc3LnnxXulif5BTMiBvZkoasIqIOB+L1klL6Jj74ug6lLsjEHVHP0SpkG72hVzJo7FzGj6I4rDuqi5DvepyI5N0SCRIpFhdyisZVad0hkyr7y6gFikSdpR5rToGLGNmKB8tdocWUziNpsD4UErCy7Ew9sJ7zmlBOLQEOaS2QLm02rR+RTh0RQjDY/2AVFGoWOkwwuuIitasWUtaAxzX6quvPvK+CnWDUxe5Ue8cWhhLRIE8SL968Z0DVC+MI+drPAdiJd+u54g5Z9drVXuu+zlypNI7vM85B0fHOBm7wIGre+XCsXiue+IZnq+1xViLoggBew+H6ryuinBQVUOZMKbXXXdditxx5MqBMZVPM9PkWzo5ciRNWWrZ64ZynvGVN/+Pi3JdcFIB5amclKkIFmcuPciaMhEpcc7gwSg75COchEYHuSbLusK0zs1yEXmRP++jiyImyjbIdtWQP7LkEMJHiBGv+I9usUe6wDgyEUpjEMgH+HS4tstQhiHTQRzZNSSPHUFW6RhCqIGgXtUVoijCiIT2CUgwHTGrS+TroIMOSrPQyqt4iwKxiaKtXSGUtaSCcBIAlUkRMbSM3wWDxPAwQISe828aDGMs18zYSIv9WRAVZIkR13JHUNoCB8MphEGXTmXHcER3B+Mi7XE9QuxTK4jicUgiC0hLF3bWlH71LQ8MPWcW5+VTXjhS+UUe/BZFER3S9aQ85JkTM04EURPFEtZneDmwcIjqUD0jE0Ly7nPO+AtGmFNULmYVqHdpkg4kxX3KmD5Lh2dqKZMNRpoBj//rgLr1XoQYeRLNkwZRD2kzjggZc54zd1761bsuE4N55cPYDoZ3HJAfdSHSgnQoc0BMpAuh46x9F7HyfGlUdgw9uVM26kcjzbM4QNcrw4033jg5Q07fb1034NOMHLMgdNlxJJxLHVA20hBjlsiP/MorJ62eRaZ037iWzCK5oqbKR17kSZ7lsatAZKWZHtEN3Wa+s31kCKlF/tSbQdCIrbFK8kR2yFSfgJDQZXpO58mq72U7juzT4UkGe9eFyvey8TiVGKEihkSFM3xzIZgqFsfY9Ala8Fpy1siQ31GgrCgKxQbCMWkkggPmqBmHiBSMCgZWfTE4hFgaGBoGVB06Vw51jgr54wSFy6NvfRIwdohtGDzPVVZRzs5TwCi7MJaRF5BH58khpSyH0ceF1jEnyLAJeU4K6ZZOaZEf6S2fD2enHqRZXpwXmfDd+5UFpyF/YWzUVThNz3C/6xge9amekTLv9Sz/ibT43/OVk+9BSjzDp9/e69nSqCzjudOEfEUaOHKyG90CZUR9SkO8T93LF7lwDqQTEfE77A8oD+kbRqpF00SIkBwyWob8eq+8erZn+PT8OC8tQXClhT6rR9cqX+eUl3N++1+5uSfSH44h6j/qyG/fpcN7ZoIIFVJp4KzGwziQNvIjXdKg/KRP2uQvZNO5KA/3yJ90c+yulT7Xkblx4T0iNN5lLEcdkHbviTqTVulXzmH7og4in+ROfUf+64CGiMiURgICOp+g4cQnabSQzVFQeYQkBFhrDasUJamrMvsOZcXAC5M6wnk2DfXDuUkDQxNGhQEPw9MmpEcLFdMPtu+38gt5K5cdgyO6UD4nj/LiP/d0AVH3dCScEcR5Tpfj8r9P9cBhhF4pF+d8p2/q0OEa+VdGysY5v313zvXqlrH1Hi0n7/Q873HOp/e7z3f3+S6dfmv9++1ZyrVORH1Kp/cGEZWHSL9DGqNMfI/z7h1GRuZClId3KkPlBeRHnj1bWYccSpd68CkNIbfS6Hrlr7z87z9l6dnOlevfe+K37/JfF+iF9JEp5RS2WnlJu7TGuSiPKAu/5T/kxe+uQtrKdRY2LWSlXAeRT/kq5z+jfnRXgjIyMjIyMjIWDDIhycjIyMjIyGgdmZBkZGRkZGRktI5MSDIyMjIyMjJaRyYkGRkZGRkZGa0jE5KMjIyMeYCY/pyR0VdkQpJRK+arkczGP6MrIIuOrkxnz8iYFCMREoIec/DrhHngfZ7zrYysNdAGlJ31CsrrGbQNchNrhHQpXdMi8jOf8tQmlKN1L+pcb2MmeKdDnfYVIY9tlF8VkH5pn2StmL4j5G8+2hJ54hPHIcojrdRqXxCHFVRj9cOqYTEa+wxYdMeS1rEMeF9gD4sbb7wxpZsTttpfU1B2Vty0Wqvys3unlQfbRAhh7AlhQSKLmlnlsc9Q1lZ7tMIihbPCZ9/z1CY0QKwUavMyskt/mpJd77Z1g2XSY5G3vsHCXnTMirOxD46VU/sCdoL+WKUbrOa8UPRJ3dlmhd0O+xjRrr6DbskX2Eds1FW6RyIkd911V9oXYtNNN03GuA6oHDt0IiWxZXqfYOl4u+TaD8TKf00qlcq3gZf9GJARy/S2rdQMDVLGUDI2HLf9OMjPOIy5awgHaklkqzjaS6ZPDqBr0Cqm88rTaqH2UkFImjDK3m1fFls+2C/H0vVks08OQQsUObbhIf1SfpZz74uOIfiWrX/sscdSmm1+qdE7H5zyXBAZsdeU7VLsNBxbF0ya97iv7bqXDlEv24bYY8v+QKMuHT/yXjY2VVq0aFFtgqIQZcC+EvNhL5u6ymkYlJ39QL70pS+ljbwYpSbfPxOkwcZhiJKdS7HkLqRrGijrwb1s+p6nNhGy++ijj6ZGiL1smipP7y7vZUNG+wZ5QPiVX+xl0yd5lH6NFLszg71sFoo+yTsyiYzby6YKu+1+zy2j/Fsj0e+4rvxfleXuud/61rdS3uzRU+leNuWEx/eqD8CW5wuG5bGuI943+Nn2Maw+h13XpyPyMPiZj8mOwOD3Jo4yhv3fhyPSXsbgNV0+Ir1lDF4zX49hGHbdOAebO3jOBo4ahhpS8X/YZjsa2ylbwGHwvmmOSTESAxiHOWFgWuof+9jHiuOOOy61jjMWJkJuqmTeXYD8xJExP5Drsj0sdF2qM/+GQZx44onFqaee+vyYDhCVPOuss5KvFh2sY/zUJPmqNCSBjBhHceWVV6a+o7vvvrs44IAD0rmM30IfuVCdvkODmgZhO2zhLuN2fK8T6uwnP/lJepfQ9TPPPPO84Boo++CDD6at4W3H3UVg/QYlDg6ENIZGXoQMjfmoGjO1AqQjxvNofdAD25gHtEQeeuih4mtf+9riM92EcR0GapOJLgwyVG7siW32GVP1Dj4feOCBVKa24Y/zugGeeOKJNP5NV7BW4rgD8kMP1dXTTz/9O3U5KqTXgPfzzz8/pYfu07uuwBgotoie0/mA/D/++ONpfMdM+s/huY+8dB26tgw/UKeDYAPZCpGEqBt51qXnv74SJgOddQexV+FL2KcbbrghjTVaZ511Ujd/7H7cNiolJEZ7MxzrrrtuUr6PfOQjyUDrH2QQMn4Dla88TjnllGL33XdPBjNg1P+ZZ55Z7LvvvsnA2ga7TjCWJ598crHrrrsWBx54YLHPPvukGVWU89prr03XUNJzzz03pa1L0G8u3VdcccULFEq5KUOG1GBF2403BengwK+55ppUv3SiPB2T8Xeu6/rAaXKiX/jCF1o3xlpx5M/gR7py7LHHFk899VQiCOedd16SYbLpPIePNFx22WVpXBe4hiyPSwJsV0/2DzvssOKqq64qbrrppmL77bcv7r///sVXzA1pvPfee1O9I6h0DVHuSvc04nbPPfcUl1xySXH88cenMuSIyaj6ZweQ0gsvvDA5sgCZQETuuOOOVD/XX399atR0EdKqDqTVDEj+iEMG9eI//ooMGVgddcN+fOITn0j5m6Ybok2YCWgGWXlaMd1B1tkgeTOwtiuoVCsM8jOiduWVV07fjRo2UIxBHmzBLnRwlMrokUceSUIREJ0gLCIndU9DZKAp61prrVWcc845xcEHH1ysttpqqd60DLQMl1pqqTQC3NRdkYguQdqw+3IERLqRAQZkk002SbOOmjb+6tVMK8bvVa961eKzv4GpfQi7gV6TQH3NRBCGnZ/p3EzPCEg/IieqEMZ4kmeN8q65oPWuobPssssWm2++eZJRz6QnCIOZbeuvv346bxaUweVawVqG6623XhooueSSS6YW4TiQb8bcTBb377TTTqlukZtyJKFMdAbzajqzNJJVA97ZQ4Qprpu2bKYFkkffDz/88FROWtF0CBEVUTDrxUwykRC2KuA/v5XH2muvnRw7Rx8Rqi5BebNl7MRyyy2X/JE8Il5Ih+iaiRTyGuvRiPjIj+varqNpIO2RfnZQPYnektl3vOMdiSQjXRpxXcCLPv5rLP4+I7B8lfdnf/Zni88Mh9ahymYUgCLK/IorrlgsvfTS6dxsIMwEgdHu25oAWpRCe+985ztf0CKeCYREi0OLj6AoH+XGyCIlr371q5OSMISjANt1HwOq/EaFViDCwXEjQQzNMssskxySwU4UmSGXHvU47uJFnonMcMyDznlacBhab8guEhxGUVjfu8x2YmCqXqyOEedotDoQokFIj3SpE2XGaAeEwK+++uqUVk7ztNNOS+fV2c0335zuUyd33nlncfnllxff/OY303sYzgsuuCC18hhJ73Wd2T4cpOdeeumlqWvBaH3vdq3okS5T10fr8Lrrrkv3SQM51DrW6r/tttuKW265Jc1wk2YtqVgfIe4TlSJjyl53nnvIiHKOVqg8ILjSyQYYS6b1yX4MI4ecu2s9F1EfBGOpBa7VTic4dS1Z+iZqQfecZ2DpiwiVtMi3qbDkWR6kMWxTgJNCtNmbYfLJHj355JOJ3CBEyo2eqRMRhNtvvz39rzyUl0iKT2RO2WqJc9yerSzdazaRdKoz+dIVxb5Kt359hAoRVN/K9rWvfW1ympGfQR1kN8kjHVUu48CzllhiiSRL5JHOrLLKKim6hISsscYaSW7YJXnk0IFPIAvKfIUVVkh1ztYj2uPabvkmJ54fU1+rBJlj18iw+pRnMqQ+NF7IkXKlt+pJecoP2XCva42zkL6qQS/IhDpQz1WDDKor8sHHiLiLbPm03pf8iYLp2pHPKqFc5Y1vIZujoLamo8pUEIwbY5HxQhB+Tp/DEjblRBkllUhROIS6++4pmNafw7sQB4LKOHEeG2+8cTKW+ugZ47q7j8YFZSu3ThkSzkFelCFHrdtESL9pSJtjEMra2hcMEQPgGg4XiVXuQTLUBZLFMBrLgRQisMgGJxEtOQaF03K/Fp77GBxkkvE1LZljQXZ0Z4jG7bzzzkkvOfPo/xe2FWlQngiTNMY7GHNOH9nm0JEjDoshM02XEyLLWqLKn74vv/zyyQFwzCJCzlsrYxLIr+iE9GvF61KUNvnVxSgPG264YXL+ZJRz2XHHHVNeGF3dEMqvHLYeFXQEARWl0W3EsG+xxRaJ4Oii4MCkI+pM2XovYqKOOWvlQ5+Ukf+UoevplT58U3URG06ZM0dC1Y88kg1l6B7vIh9VQiOSLfJ+ZIi8IbMRFUU66JWjDHWNNJFn4OSVk/NdAx0RxUGeTj/99ERA2V1yzUcpcxE4Az/JEGImH5YpQNCCuPcRQaLCHtEPcqjOyRQ7Kf+DRL0t1EJIKJ2WmpYPtj0ua18IUEYUhaGi/IytVp3vFAFJaRKctoMxlwZGETnae++9k0G8+OKLO9dlMwhOR7lxiNtuu20KNWPoDE/TmKk1xSAoT/XP6ShvBlALVEtUaJ9jQui1WnQ7WSiQM9VKe9e73pVa60EOOQKtDy1Lc/0ZGFG3iGy5DrFEHIxdYFxFIfx2r3rm6JAjxIGh5pCQmCCqDDlyRB48A3EmI+SBEyM3fsuXtEiHiIz3+JRe7xp0aqNAOXkugiEC5NknnXRSGiPCmW600UYpksTxS4uxAKDMjHuwSqSBjO5BssYFIy7tbBgyhOCqE8RA3tSHiAfyoax81xIVzVEPjL/0qwflKc3qRbmzj56L7Kt7kRGy652Io/ciQMZ4iB4hLnVAupAqY/44ZoRvzTXXTGUriqNckZNy9IrtcoScy7vf8tc1KE9Ei2zutddeiVwi3eRZ/ZAdQw3oG1lBStSPe0S7HJPIThegXthEB90nU2RMvYlo0WERjFF6MJpALYREv5TWg4pmQCheF5lzmyAQjC1nwAlooTI8DDunQnhmcmp1gHIyOgwfcGiUklHaYYcdkkBT0C5hsHxECaJ7hJG1jDZnwCA1DXUbpBOiW4Ljci7SxBnptxc65pSEbhECrWPOTkSk3KIJgx959xzP859zDt/Vl3vc7zmeSwdjVheCo/WnzNzvt0/l5Vrn49kMsu4ZUQGGCyEho8gqQq1bSGs/0qHs3cv4+Q6TyjI94EDIorIS7WBXnBNl0IKXR/3gxouwPSI3GkTSK43bbbddcijI1LiIetKKtJKrQ9mAvDrkWzqDcCEfUbZkQD14Thyudx7pRE6Uk+uVlWgKx2kgrncircpXNILjqBrSxmmpd6RTFEya5Esk6MMf/nCyUew4OxWQXvkku5EP6SOrXQNdIBPyesghh6SooUYKOZYHdYGMyKcyR7xcyyYjaGyjZ/QRbAndVn90kByttNJKxZZbbpmiQ6JaXdqqpVJComKFl/V9ah1o+QmRac0IC2f8FpQYOyUgWrdaPyIjBIMCUHBGrglwVFp0HBGlBI6d81NvlJZAM/BdAiOhnByMi/TpKlCmxkQoY617LdkmIV0ICAfF8IkgaHnp5mDopNUBHLpWsjrgDJQ7w27cgfUD3Ke7hCNDZgaJvfOMiveFc0AqOTJdK8Zy6K4RKXr3u9+dysozGSNGmHGSFmSJvpJJ0RKO1/s8173+94m0kgkEBVExkNS4Atd6TsiS797l/qgfjm9ccNIiRrfeemtq0XkPGdXKkw5dis7TGU5SfXP40ockuR7Rc37Y+JS5EPLFsKu7gHOe7ZPeKDOkRx0rI8RN9ItDUwbKRV2pI3aSznP6IhDIlXoX1VF35BVJ8QwHJzlqH/y4kD7jU0ToEDayKFoAyKuoDf3fbLPNUrnrWhZBcY6uyav7w9HVlc5poJyVoTpQR+Re+dM9UUf6qbHFYeu23G233dKhMSZPiNqoY/m6BgSRjiLlyC6brjzkXaTPhIbYMqELqHRQKwFmSLWuXc/AEQAhW4URfdIzgQFnZDgWAtQnjDOolWFmZBl4LU0khMFUvoypMK2yojiOuZ4HDKbnMWjjEgdG0kEwhZwJLafISEZdcmZIybgh2ToHtXKSypysKEfPZxA5MX3vypCRZ0yqVLjZBrVyNlpW8s1BcljqmlPioJxDGjhH0TChf61TDg0hZSw8UznTHY6XbChDkBf1S044yGi9cRDkBInlVEQRPFfXi/cySrqDXCd6wDkytogLJ4M4SRt542iUV5DUcJ7eST4YcTLLmdFXckF2yaA0IACu9Qx1413S6l73DdaFspltUKvr5ZE9EXlVVsaMeBfZVN7IkfLUrSLfrqcPnL160iWhfAffHQ0D6RyUT+mi1/LuP2VBJ5QxJ+bd9ESala080heySO6UtfJ3v/u8m3xwEqI97osuMKROGap36ZVWkS33KV8yENGmQbCb5JHsq/txII8RUSKL0iEv6lW3kbqLvUjYLflmK8iA+lR+ZFOUSp6kfVyEPVQ+ZK1qKFPlot7kUznpzpUHA0npEBnio3Rlkh+EkP1Q/uStatsVQGrJKdmqY1ArPZQX9UJ+Qv6dlz86NKgTVUG5yhsdGZWojryXjYebgz8bCBYBZQyAghIGFexQCLOBUWRAGGGGsk/QMirvZTMbFLkywtgJCWFRTs4zWAyUsvMfofHfXFDxDAtSMRdxHIR3aeF4T9noOcfJqDfGaiaDOBPkJ8YzMDSMbJVQfsqRQinDIG4IgzKUXumeS+7GBQegu4CxEv4tQ54ZPmlQl1Gn0sBRS6s0c1LhuJWz6xiOAKMvD/RGvhAb+iWfDs9xjzJweE48S74923vUnzLgHMG1nJBrpJ8h1g3if20TzyBz3uX9fnu/+0Imvdt5eXSdd0mT93m/vLlm8LvnRNrL4OQMTCW7HMIgvCP0RVnKj8Mz452RDuUlna6Vvniv88P0CBHSOuacBp2h53i+Z0tzyJhyj/SE41Ie6sjht/Is67JyiPrx6X/PZS/9lr7QL+e9w2/3ek78NwzIN1KJNIw7zsS7yAiZjXRHOqVdmSlr+ZcOeY6ydp1r3Ou3spkEytL4Oe9AKOuCuvEu9RjpV850TX7lvayDyt75QbtYJRBeU6yj0T6foJuVTzLLjWyOgkotNaXD9DB/h9acTy0ClZ/xG1A8CqFFSAnCaCsj3xGa+G8UMjItvIOSDiqd31qOHFddCjkNGEBpI19lYygv0j0KCa4a6lFapEkdRvTGZzg0aQ7DD8q2bAjB/1oV4ezkxfP89g7w6Zne5X+Ow7PDgZAxEQ/PCni/1p7rADnx3bs4HPe4V5riudLmM57tGu/1W97CuMf7vW/Y93LaxwGd8H7vkk7PA2mkK2yOfLoGyLM0KXPnvXsSPXKP9Lu/LGNRtupDWqIefZc+6XCN+6PcPMc9UaZRxiEbZf2S3/jtGeX/qoZ3yYdyUpZlmZRW6Y468586lH7pcl6e3V/Wv65CWpW3PEU+5UF+1MGgDsrjMLuYUR+atdYZGRmdgdahbg4zD8xG4ZwyMjIy2kImJBkZCxTROtS/roWs9ZuRkZHRFjIhycjISIjQfEZGRkYbyIQkIyMjIyMjo3VkQpKRkZGRkZHROjIhyciYAAaEZmRkZGRUh5EJSRP9y6Zi9bkfW/pNFWsD8e6YztYFqEtp6lq6pkWUdVt1Pd9ATtrSnTbfXRWk39FX26nszfCSh4WGso2cbwi5HAcjLYxmeWYLKJkaaCGcOgSfQFpEy2FxHwsV9QkWRrMKoOWGzd+3qE5TIMwWRovVKi0sZ/GiNkFGrGth0SYL5Fgt1GqTFibqq+EEcmphNAt5WV/CwmgWi8oYH0yP9SvIrmXuya4VgZuQ3Xi3FU4t3GdRNotTkc0+Rb+skWGVU0vQW3zKwnIWAOuLjnFYbILl56XZCrwWWpvvCPmzMJoVcWNTxmnkL+5ru+6lw/otFgq10KnVf0ddFHMkQmLvAgLjwYSljgwTTIaJwbc7ad/2DrCHz5133plWe7QAD2fcFJQdJ0m4LRLFsDf5/tlgWWlLoFsW2SJ5dclPE6Aq5JPBR7LUM0WzmmPG+FCeHKpl9m1PYdEqKzQ3RUi82/L4GlsWizP1eRqH0AY0RuiYhhz90pCzQm1fdEw66U9sfGhVz7YbU00g5M/2CxptZE/99U3+hkH6LTJnFWS20j5Io67UOhIhsTW+fSQ233zzxGbrAENv6XikxB4bGGOfIEJigyrbdouQNKlUyu65555LERpCLRLRhQgJ0UKSGEv7Y9gToi75aQqMiOW+tUitbGnPGCSr70akLWglIqyWzya74ZCaKM+IznCG9thhc/rkEKSV7tsvRyubftn/hhPoCxAqNsHS97D22msngrIQ9In8cdp2qLZ/VUQR5kPeRUg0MkRJVllllWoJib1sMLlFixbV1vLWyue47CvR571sbOWMkDQdIbEfCKNEsG101YUICdESTmbwddkQyq5EbiaFstaiZ0Cjy6bveWoTylOEIvaysUFbU+Xp3dFlI7JARvsGeaBjjz76aNIvXV59kkfpNwzgvvvuS791eS8UfZJ3ZNJ+L7oL2e2qyYh3lBFlWz7vnXW8VxSZT7JHz6iEZKQRJ5i4A7yojiOeHe/pK+oup2EHxHvbeP9Mh9ZPF9M1zRF5gPmSpzYPUI5xwLDr6jgg3ulz2DVdP8BnG+VXxRHp7Wv6pzkg8h3HsOumOURgzj333OKMM85I5CfOa8BefPHFaZiBCG/5niqOyNu4+M2dc2Ac9iRzunj0G+28887F5z//+bHur5qpZbSHqMv5VqfyE0fG/ECuy/aw0HWprvzrjtS7IQqoW8iu3nohdKXceOONacyWXfyvvvrqFKWqGpPk60Uft+f4HJABCZ5rW3uzDb785S+nEKJBOkKhTz75ZBrTYNDYXDAw8wc/+EHxmte8Ju2+WCV+9rOfFc8++2zqn9alUjWMlVC573znO1Pf4CiQFmkSrtatoeyMAzHQThrH2VvEFuIE0M6bym8c6HMWMjXTwbiIKHvnpUf61EvsNjsOdG8YdKf+R5GB2WDcxnXXXZdmMBn0jIELQRq7Y9B1Oe0B1wqJ3nHHHamv2jiFYPCTwqBBSq6fVBfZXEDSEfNbb701tVKkm4y4v2mQ01tuuSWlh04oE3JoTxv6K/R/++23J8OlvsmhMTNkky4bNa+LRXcVWSAfyp+u+894EIN9PW9U2HFYS8771M8w6A69/vrr06c0K0P1bUCg897NfhjjI81kzmD8Bx98MOmG8nYYc1GGvP3whz9McjMon5Fvh/wZ4+ad4+SNQZbmq666qrjhhhtSGNv9nMEkLchhkG/yaKdh+xJNAl3yxgnSDbvhgnFp9957b8q7sonzAfbBYP5HHnkkyRC7M4luuZfPUB4mBTQFMqJu2BD1yn7ec889SaZD9usGHfRekxEM/K8K8kTu6ekHPvCBJG9kTz7JCp/+wQ9+sPinf/qn4jOf+UwaPzWu35gL/KG8ve51r0uyOQqms8wDIFAGh6277rrFHnvs8fwULhXfJhQ6g3Daaaclg9wVMI6UnBOg1MiMymNcOYQmQGAYSk6WsF555ZVp+jAgSxdddFFi0xR30Jg3CYbx2muvTQ7vE5/4RHHZZZel86JxiAqF1hqIwXFgcJy8KE95Oeecc4oHHnigltbITECIOEaGe9VVV01GQhkjak1D+Zx55plprMZ6662XjKFyZJyk59RTT00tKf34HLTyYqAZZiTgtttuS06KY95vv/1S2SNVDz/8cJJhA5c5x3333Te1xqpqdSk7RNTYMoYVYZJmdXvNNdek/HBk8hcEhEwjFMb4IEzyMW69yzf7hfB4n4aCfPs9Ksid8kG0lJU0IlHTkuIqobFx9tlnF+edd17KI3Ba5JZdUG6XXnppIiwBBEb9kyFjb5BVjQLl1QcgwZdffnnKdxBi8s0GIgbkBxHrK/hiQYHwKQiB3+pHd41ZMOQbOaanGkpdQKVaoXUi85TP+AGs2gjbUVqRdYLTN2hNy61rCvPiF784lZWyM7DJrI3111+/sVlGjOPXv/715NCt/6K1wsFzOhTSrIfjjz++2G677X6nhdQUKAxZ2nHHHYvDDjsszSQwWCqiSpRr+eWXT05V2st1LJKy6aabpsHG5JDDbHKaLjLOcWqxMA5mEUhrpMF5hHkUZ6luEIMyEB7nA/4fJuOcMqdusDhipFxWXnnlNAhSSwbpVOerr756KidppMv6mDlVugOmlGtwiDYgd/Kh/P1vHQWtLgeCzeBPC+Xi/aIYZpGstdZaaRYeh45oavWJwNKb973vfUlGOU73kBkD6pQ50qKcxwX9BAQNUfNMZYLsgLIv1x1ZLdcHAo30023lgrSV1yhSX5z+bCAjdYKjigG9saYOPeKklKvIONLiXABxEUmQfrZVfchnH9bkUf5mdWlkqV8yLD/khvyQe3ob5KyPQEj4FIc60pBQx/QAAXOe39HIJL+j2qC6UXmERCax5vPPP784+eST03fhr7aBDYZx6RKizBwcAyVn0Bi+JqA1qY5AyE4LgfEXludITznllERIGCRpbQNalpy5UeiYPoNBpjgFiqZug+0zilo7QNmUI7Il7Vo+CBYH2hS8n8Hn8PWOqmdTwxkGhOrCCy9M0YSDDz44dY0ZgIb8aXHKiyiFVrVr6dShhx6aIhlap56HbC1atCi1bnVLnXXWWSlCoYVXdnwiGOSL0w5Im0gJkuF9ygepAOXLgGkJe7fyU250SH0w4g6OSDk7GDn/yZ97RavCcU8K75U+BPQjH/lIIiAIldk4ypDT3HvvvVNkx3sd6lt3wnHHHZfKyQj/FVdcMcn2uPB++ULAdFH57dnKd/vtty+23XbbVN6iNiIndEUET1SHbJp9h5zpIuMYyKhnKRdpU98f+9jHUqSK7suLdHOYe+65Z3oWfRQJIgt1NKjkSWhf3fkO6p1Djpa0ei5HutWJRhOZO+GEE5IsWKdqnO6stkBmlClySAeQKLZPPZ900kkpEqvRM+piXl2H7jANMXlSb2wQICB8jbrVoIi6bxO1xA0prhUDtbSE/az0WjfLnwvB/rpQ6GUQBo6DQb3ggguS42LImgJFZOQYUK1oyootM/YcHofJADOGmHUbUEZBIoQb1eV73/veVG7SxsCrVwZFazNawlHXuukYGQ6D4y23YOsGR73VVlul6M5NN92UWtnG60g3Z6W8GXaOltNCmBgM0Qr5pkMcBefFQXC26klkSz6QiN133z0RCI6PgdVKp3eMLqhfDkY5IUdlMETep8wGHbbWorJmzMBzo9uHjnPI0jNYnjFGAtGtomtK1Obwww9PZWXRRE7cO5ErMkouN9lkk+TIOReyiyRwKLqOHe6dhIiqA0QCuUI2lNNee+2Vuoi8i50zeN9yBcop6gJBQeJFmhBp3U3KV3mSS89T3yI+upUQRlEd9Y1QizKrS99d7175qotMh32MT5E0dScaRDaRY/oVQEwRQ3ll3+W9yjEQdYEOqSsETOSHvQg92mCDDVIDTX7oxajjHroMUR+RbqRclI6uy5d8yjsZVq9kqwuohZAwfELBGD6jQKCnbSnNVyBqjB6B0dLluDD3pqBFrJ4MhuP0REa0bkUhOBtGR6iZoeLU2oRWmJYyQ61bS5ooE2KiHH1y3oxJGYz7PvvsU6y22mqJkHAUTUGaORNOUT+8rhJRJ90ZjKPfujV1RW2xxRapW8I4LOnUleZezl3rVD6QG06YE5NPRkZ9kSEHfTPO4aCDDkpGFxghOlkma2X4D3Ea/C8iINLgGUgIwkRejj766EQKlftgYwMB8izEJNIwKUI/RHJEERC6K664IkWLpE+XgnJFCjhPkSLnEYDTTz+9OPLII5NRPvHEExPJGxfeT6Y8Tx2KZtEJZUFnlDeSh3yRR44NWWHwkYly9A6ZUI7IqDFiCJ7rdSspY6RJt6n6QFg4faTS2AbPQH7qRhAS3WK77LJLygdyq0zJX4DsakSJiriOk4/rugp1aeA+sqi7USNFVJJN0f0nkqBrV/3q3oyxdH2FLinTfemHBiUijQSTNw1RDSPRT8SsK1u1VE5IVHoItUwzlhSXIrYJaQrH1TVIE8dK4RGTJlsa3suxGICsvrSMtOqcj/5g5zlORrMtSAsFQmyNGtcq5hT07XN+WjlaaZwDh+43xxhOFcnT7SMPIZ9NAJHQ9667hPE+8MADU0SEc5QHJE8YVT6kN1puHJbR7/KiLlwrL0EUlQeCIS/IhP84RSTF84KAAN3TSnePKErA+6TDecTGQEaRF3CvyJL0+E95OkRNyKly1nInu/TKfwFGnjHkQLWgp4E0cnzGCknHRz/60VT/0ibCxLGIKoiIaOFKv1lVDg5d99cOO+yQymcSQhJ2Q7kihnRTeXqe/0KW5J+TBsRDubkn5DDsomeRR3WmvtSr3wiLsg1nYTA5mUBuOEd15P11IdIW+ZH2NdZYIzVGEDINF446gNRz2Frbu+22W7IZHHobg7VHBXllB4yBQqw1bNSTskf8EELjkTQMlHWXJkCMC/KmDhH5XXfdNeXZd/mmlyKN8u63Ro4y6AIqJSQYv9AjRk/5jUwnBPqu2nRmwChQfkeXoMxiHEeExhmopsAAKRPdANJCGZEiLQmhcVNVtfQ4yWmdy6SQRq2vSy65JLVmjE3S+uUUjA1QbrqcKCBypcvLoj9k0fWmuZqlo2VqIOdgt0Wd4Lw4VDNrGGyhb4QiBjia/cGZcjqiU4A8IBXyI5TKcEqzLieRHnWCmCkXTlA5IP5kSETgmGOOSS0hhC2g20NUSTkqjyA8iEMM/GWEYyaNsvMfp8RoIX0O7wuiA8qU/HJEIjrGFGh5qgfRvmmBWCEZ8o5kcBryxaiqd/lB+JAptobjRESUq3LSxSfdHPskkUf3KuuIgASUgbKQd/WD7HqXKCNnLaLCuSlL9weBoWtIiusRl+gqjS4QdY5gIT7spusQMfJQJ6IefQKHJu3GspBXxE4a5U+Eij0lmwbtKnvyKb/S31WQDw0uxFUDTBSIvIhy0QG6qu7Uj/IuR4T6BnnVeCFT9H6dddZJEWJ5kk+NIpFZY7EQ366g0nVIVKT+Kv3MHAEBNsiMgxvFyTIwBEILocpC0gfMoAh7UnSGt+q+WGxaK5gBYURHgRaJ/EqLUD2H75iEkDAmnJ37ld+oUC5an4yllifD7f3SxtgwpMLInOQkZcZRiRIw2o5JoP4Ycq0xhkP9kUWtSYpF+TgH4XtGnLNgMCmfuiC/ZJPyjVM/M8HzGWEtR85jLjDodEF41L3KmUNFIhg+Za2FyYlrOTPq0s5QyrN7OVPP0ZJBwtynnshzRLY8DzgwBKRMINWdvHMiHDySyYkoL7qmTOmptGj5kgcGTJlqnStfaWHkXK8177yWJb0SyeG8pRWJcYxKYNWt9Lh+0AlwjBoz/uPwlTuCxK54r/Pshm4ZJICzkTb/kRukShm5nuyQlTKQBXmQp0H5lB/yK8/yJx3Knyy5Tz2pB+Wi7L2TDsqD8S3kLORWOkW6tEq9h/zSefovTZyDZ/juGv+rf9fSPfVLNoZB/pWL90yyDom8sB9Rv96pTMiB72RJ/skG+ZUv8uhQxupO2ZLfSRqeyrOpdUjojHKUB3Up3XRC/uSdrVLv5F5aOO86wf5GI4WcVgVlGXmNQ15C/n2yCTPJVBXgD+VNuZKtUTDyXjYebhDbbPCoaFEwJCqcko7qYEVV9OUxLBSwKkgLB0WhpEVFVC1osZfNNttsM7JSKi/popAERJqkLYRmHKh4LUjKNRdxLMO7GRXlUm7dKCutJWl0fhLBda+WOJJKuRnYSVCuv4ByYuCBY3RIpzJ0HSIlzdIgH8qUo6qi3jkA0QWOw1iO2eD90i89SL1ypheRjjiv1S9PgchrOb2cgetd6zl+QxgW75FX9yAGw+C5nKRrXVOOogBZ8AzPVF7e4x7l7x7lqNwdUS8+5ZMsOT/Tu2cCoqGbh+wOjpPwXId8S5u0SBeHEvWs7r1b/SOJ0uO/kAvnpGmYXnGmxj/oQx90hpFv74fIt9+ht8paWSkn75JGaVOu0uGcT/9HWUqHNHkOe+m3tPsfojw923eI/4YBwTTmBKHUeBgXkU/v8k7pV67kS96kFaIeXBd5lt8o47huXHiGCKZyEDlsCvItT1E38hU2L2S/bmjIikJpRGhgzScYO8onaUCQzVFQaYkTKMZWC0HLQaugiUqdC9JAWSg9Q1E28m1CeVF+6WIwfXeuSXBk6kwaylBGiBVCWSeLHgXl+ouDYwgoN2mNevXpeul2HeIgH23Uu/qM9GiFS0s5HdInbQx8Ga4ZTK9nqCv5UiZkxhH145z/ZyMEnkkvtcgGyQg4J1qiPEN33eN8yGmUfdSLc/6Tj9nePQmUn/eoY2Un3b6DdHm/9zrvO7heGjkV56VtEr2KfMtTOd9lvfXOKKdIY5Sr81FuPv3vOb5HvpSzOotngO9R976X/6sD5fqVH2kjj9IWZQpxvpxn98lz+bq+QL5Dl8CnuijLfkazyKWekZGRkZGR0ToyIcnIyMjIyMhoHZmQZGRkZGRkZLSOTEgyMjIyMjIyWkcmJBkZGRkZGRmto1OExHSrjMnRxfKbr3WaZbV6tFWm86Eu5SHLZEbfMRIhiSlqdcO0upju1kdIe0wNbBqmr5lW2Nb7hyGmCTpiaup8gLwo5y6VdZ8R0y8Hpz43Ae/23phK3EdE2fVVx0KXFqI+tSn7dUO+xvXnIy+MZtEvO2paxIajqRoSb4EfyxVb0tcKnH2CJaAt120VTusiWHSnKah0Kz5agMxKjRahsWhTmyAjRMsKklZhtPCUlSgtotRnkFOrK1qJ2HoFVqe0qFTGZGCI6bzNBMmuRf2akl0O0IKCVnm1UqdVd0Nu+wLySMdirx+rusaCeX2Ahq70WhhP2Vvh1+JrCyHaQ/5sF/H000+nFWOt3Fu3/Hl2Hf57EAi+FbItjGkV4lEXRhuJkNgvwkqA9gGpy/hyqiqHI7f2/ihLcncJVmq1bTWDYHGdpgmJlXQ5fks9c/5Nvn8YQrEQJStxcjaUDiFpQiHqgrK2uqZl4C28ZS8MBjRjfJAPhITs2nqf7CKtTchuvNvmhlbLtIy+pbvrdghVgzwidFbFpF/Kr65GYx1ASPgUK3SD7R3Uf5/qYBKE/Fmin9Mmf30kxMMg/QgJvbL1gh26KyUkNlTi7GzNTNjrAKbvHZZytq9H3yIkCIllcu2oKELSZIRC2dl3hlJr6XGSXYmQ2AyNwtn3wtLcdclPU9CqESERDVPP9pVhUPtuRNoCwyVKYYM8smvpc7LbRHl6N7IssmhladtV9M0hkEeRZcuPM/r2Jorl6PsAhIpNEGEGu9IulAgJ+ePvRAdtmxBOu468zybXdci8FXxFHumWfZ0qJSS6bLQkFi1a9PzeClUDU+a47CtR9V42TSD2skHaOKq6ymkYlB3DSrC1kkRpmnz/MISQI5l2gRWOtJdN2+maFsoa6xcxtGS2vWz6nqc2oTxFRmMvGy3kpsrTu3V3MJqiimQUqjbOdUIe7AEWe9m8+93v7pU8Sj9Cct9996Xf9rJZKPok7xpsGrLR3QZVyp93lFEu2/J/VZe5Z4va6dq2R8+ohGTkQa3BuL2ojiOe3XfUXU7DDggC0Mb7hx3S4XMQg9f17Yg8QFfKus8HKMc4YNh1dRwQ7yynYdi1XT0G0w7DruvqAZHuwLDr5uMB5bqLY9i1kxyeZWzRfvvtV+y1114pilb+X1cpIogQ8R3l/6Y9JsVId07K2LR6Tj311NQ/nLHwEHJTJeMP1PHMUeHdcWTMD+S6bA8LXZfqyr/I41NPPZXGpxiXc+6556YoeuCxxx4rLrjgghTZR17qwLj5etHHf43F32eE0bK2SB9nW3tdCMccc0xiZauttlrxute9bvE/M8O27gZBvuY1r0k7o/YJBvBgnO985ztT3+Bs0Eeqz/zWW29N3+2OHKxS6IyA3HHHHal/0UC7UXbS/MUvfpH64u3kqvxGhRHuBPO6665LbFl9Oee9xkmcfPLJqS6FsyeZmqZ740c/+lEasOiYBgaAPfDAA+mZ+vyVFdJ76aWXFg899FAKD9o+/NWvfvXzdeD3nXfeWZx33nlp7IfQ6LTTC5WPUL96aXrwtUHBxgqRD3lWRz//+c/ToGFdnuqRbCkbZeQ/ZaZuw0DZ6t016prcKi8DdNuCNJJ1sksXBmFMyaOPPprqWX7Jo/q1k688qFvn2Sl1Ij/6r6+44oo0IF8ejVXwfOOtyvjHf/zHJFfszaB8skePPPJIGkNHzhhzhntYGmcCWVHm119/fXH++eencpfuGEBbBaSTPMo3OZgUZOYzn/lMcfHFF6dP+uRc2T4FyJpyMaCWvZnL5s0G9atrV3kYZ1Y3lBebwP7KFz2JuuDn6MoTTzyRumQddYJNYrdDJqqCemMr7NxtDId8CAwgJ8qYTigDuqcrXZfKNJGNYeAP5Y3vJ5ujoNoULMbf//3fJyeHHSmAtgdYdg0cIiU33evII49MnwFjdbDWa6+9Nk0rrVshCAyjyyhLF8Pm4PSQQ4OLOb5rrrmm1Zk73s1oUSIGHqSdI0JQkCVOiKIFceIM9GNyRhTCvWZCtZmPacHwk4sgwAYLq7/jjz8+GRTGNpweuBYpc+0KK6yQ+usZW8RsnXXWSXW87777prLpKuTPIb0GvBszQUbZmPvvv79Ya621ijXXXDMRLgRFXu+5555EMozpQta/8pWvjG2HEJgXv/jF6ZkcFl04++yzk36OCiQJmTEmjuE3nko6uwgNIYNLDdJG3Ngls8noT0ADCsG98cYbkwNdbrnlUhn1BQjobbfdlmyGWaPkyhhJUC9Io09LT1RJEJoGeWUD2Ad6QJaRE6SbrWffyaQxh9CVCFXlhAQrMzDVSO93vOMdyaFmQvK7IBxmFXCiHAgQCi1FM2YYhJe85CXpfF3wPgNwt9xyy+LQQw9NawAYWEhQzdRh6P23zDLLpJZDm46cUdSSoVDSAkZymyKO1G222WYp7Vr6EVFCsAxW5KyM3ueEKWpXlG9SkAt5l0/roGjdcLgcr1kqyie6STkXZUcXGVjOA3Hx3RRRawv5LvpQDud2CZy6mSRa/5wIUiL/MWhOC12+ES56ZaAgg4u8kePVV189kQkEdVwoa+VHTzyH/CHoSI+ypaucG2htIhwMPnDe0sjRcw4ixdJB/sihViz9R7RB+kQTOU2NOmTRsz3X4bt31gVOa+ONNy4OOuig9Cna61wZbPvDDz+cWtnshXIpE5augxypE/Uo4i/t8uS8yIg623DDDZMtmSbq0zbIFx/iIE/ypz5FdMmbBtp73vOeVH8acNNGjatC5YSEQ6VkEQaiQAon44VQJrEYDiPm0JKlLEgcZtvEImLYM8ckksVRMZKMp7VUtK6ly7m11157oi6bKsE5lEkaYyntEQ5UbuWQNWPjnHRrUXNiZnANhu37hnBoDKZPBgfpZ1TMUuH0zLpwji4iKKYnB8oORKROa5AhLkfqugTODykxy+/BBx9MhMTBwIr4bLfddqmVKx+iKGRA2eiN1uJF/IWtGd9JQC88T3kqa/pw++23F1tssUWKLh133HHFlVdemaJMogeiKLrUhOM5AhEddlEZI4SIJCIjyiB64l5do+rqxBNPLE4//fTUShf1OvPMM5Md0PV0ww03VB5WL4MNYLOROvmkOzHzA6ILS8RId81pp53Wu/GBGsoIozJl3xzInzyJtuqqOuuss1IUJRo+fYZGJN0he2wA0nvZZZcVH/nIR4o99tgjdc9ddNFFqV67gEqlW38iQ4h9alXLvILoc4i8LigTrXmtOg5Gq0OrS3npc+NEGb46wZkxcD4pn+4irWX1BxRV98gtt9ySjjpbZ5OAY5V+aWfMOZxh45zky2hzTkIraJKWcpcg32RDROOUU05JerfLLrskcoZMciKMkOgBxxYyNQzq3j3IGmPdRZhafdJJJyV92WGHHVI0TyRBVITTFgXbbbfdij333DM5fnk98MAD0xRS92211Vapm2oSIhrypWvIAH1O2/s1GKTHKpQ77bRTispw4ttvv30iRK5HRhBg12pxK2Plre5ERUVxkKhVV101EX+/Xac+1YkDkUa6opFSJ5kOfeKs6RMb5Z0B9kD5isrtuuuuyV5deOGFiXD1BcqXnUCorr766hQdUb4IorzTI/ljK5DLPoNfYQfIkzyJJKrTD3/4w4mo77777sn/0C8BhC6gUkJCYFUkYRUOOuSQQ1JLQksluiUyfgPCQgEikoSQ3Hzzzal1K8xMSRivpsBxGZfAuMegWEaQkdcdwkBFaLptDJaLyFIMXJTmQYigkMkNNtgghSsRlD6DQyM7uta00j/60Y+myACHB3RPHWr9CPVbm2I2qFfyJirWNYhKIMLyoCWnO4GuMKgIgG44UYRPfOITqbUe55GCI444IkUrYNLWPD1VrhpYDPgBBxyQFh8T6VDG9EWUUfQAIuIo3RxBRPVcTz4dCA55Veau152GfNBB+XStiA/CgyQav+W79zYB5YeURMMkgNjSPREnkThlEoMy+wJkVVRr2223TXaDLsmPaKt6Vp9ssvJGtHSD9hUaLIcddliSWaQcQde1K7KIKPM79ESUlPx1AZUSEpWpFaEVevnllye2KVSqBUF4M14IhhZbF37mOAiQcRLCwwwCY9gUOCWGKJySdzM+jCmjz6m33WUjTRj+YMRNCJahV3bgf1EQTsE9/qN0EUFokujVgSgH9SGiJcQe42aAQeXYdG9oIZVbPwywcglwJhb1Y5C11rsG+WRENWjI4M4775y6DzV+DGrVilWnDK4xT1rtog0xI8bYIQNbybHW/biIsna/cnZARH6VZ0QtvBuQReWJHEd5+/Qs9+laU1+cOZ3zH73zbM4C0UFCPEPdac2zFcPIdh0gM2BBKwh54aSlia2iX9KDUPVprIW64afYXHUhP8aMaAj6jVjSK3lTH10ZWzEuyJo8IeVXXXVVIuRHH3102mstbIX/NTjpU1e6sSslJBimEB/yIXSuBSfEKUzWtjPrGrSGGE6hZ47UgDcD9iiBaIQQYhi4uqEVxsBrKURoH6nU6kQspSUGsLWJ2BdHWqP7iGEU9dAXHAZU6FufPEOupalf/pJLLknlKR8zdV/0Bcij7gCHMhkGrW7OmB6GsVHPnDISYjEk4xKUDce6//77J33tGjg70QT93vr1yaXIAn3RejXN2VgMXcWcu5Y7537TTTel6IjzQcomaRQpKzKn3KK1zNiTJS1ousGpmW3iGms90F/dZt5pQKvzonLuFzUhv2SVg5d2csp2kk3OgqPQeuU0RUtFRpqqG3pFn8gEx42MmCbOsZE1MkWOTKnWTSWNTUzVrRLyYbad+th8881TPckr34XImmIuOqSOykS/T0DGEXVyqLvGQf7LUS+RuJgo0JVGWm3rkAS0agzcHMWZYaeERQsB8+4TYhqmFs5cLQYtIuVJECiCvGrRciLAuTJCRkQzrqOwdMrFeDKO0eUyKrQMKJ5IiHsJpzz4lDbGVtomaS1wnlWsQ6LMkA9lQg4jDM45iIAYICxaANKpHCI/rkGMGU/nXD8NpEPfvjJreh0SdcVpyAeZoV8c22Ce5N8YC84i5FHLVssP8WWIkF91yxFyglqPbUC6OG1pFskqg2NUr7E/k/yLuiIe6pa+qQfRBvVrTAf9EQ2TP/LHuWsZDpM/JEaEjZwP/i+kr0y8i/zTRXInTUiesvUe71MfGl7qgb3TN08OyWhEPdhAzs917guyqA4RLHmnc9JB/10n7777bya5ZTfJo+eUB3VPAnoWXRfKD+TBc6WHnEiLdCNJZDCiqpNCvSJB8l43uWF3yZo0G7sjn+rYb9/Jku8GgDahE3WtQ9IF8IfypgFINkfByHvZeLgBW+OA8SBsoiOjOAEtDq3bPu9ls8022yQDNReUC+Un8HEAYxdVEs52FKWIVi+jMS5x9B7v9a5gys7pNoIgJ+PCMyygZK8QhoYxnhSRRp/S4pDeOB+/y9fGb/nw/1xEcVRwAEbjc+4GhDWJyFsZ5XqbDe4LmYsy60JIWgTCbBOya/xLGVHfIDIi3RykPPgPEDSH8yET7mF/kEdOZqZ8ck4GNnJGg85QWXmfd/numRyx5/sd7/d/XEPWXON9fjsgro28uAakD6QxMHjtXBApi71skNBp4N0hG2V9kg95dN535S0PkY9poF5FYTzbOIc6EWmXl2FRe/+5plwfdUJD1gwfhDYivPMFZozySSIzZHMU1Er/KCW2HYKd8VtQZArhk3IElFUouvIr/1cXGALvKxtA3ymlo3y+LUQalYnPkKk4X5axOOfTIQ9VkZG2EXkrH86NAmWk/HySPd+7jnLe2BLRoNCJqF91q1VblgmQP+cnzaf3RHn5VNbg+c5F+Ud6fEpjvM/vuMa5eIYjEDpWRuSrDXiv9EVZQuQ30iRf0lzOR18QaZ9pCIHzg/WR0Rzq93YZGRkZGRkZGXMgE5KMjIyMjIyM1pEJSUZGRkZGRkbryIQkIyMjIyMjo3VkQpKRkZGRkZHROjpFSGK6W8ZkUH5dK8P5WqdZVqtHW2U6H+pSHrJMZvQdIxGSmApWN0y3iilzfYMykva2ppd6r3UYujRlTZlIk2OmaXZ9RNRznh5YDaI8TZltGt7tvW28uyqELPbVdkp/HAsN6kzd9Vn+ZkIsLRDTxUfBSAujWWLa4i1rrrnm84tlVQ3z3GNnS3tSNL0C5rSwffNDDz2UFnay9kEsiNQElJ2lqS1ZbUVSi+xY3KhNEEKiZWlt9WpZeisfWnioywh1KCtR+ZyytrKoxbTUs6WZLcBVRvn6udRrVGUtP2fwuTM9o5wOGPw9F0Z5x7TQ0CG7Fs+zmqnF8ywa2AS82yrCFmS0SmaslFrOd9dBHumY8mMzLUA1zEaX637w+7C6LV9TJ6wLIr2x95AVUgf1qUmU636cvE9SXpy1urOAGNljH6GchlExmO5yegafN2oahz1z8HPYf4CMxNYW66+//sgLo41MSKwEaMnpOgmJ/V04chnoIyG55557koOyeFOThEDZ2R/D8suWnSbYXSAkYO8O9YqQWN69LvlpCpyYvTzsQ6SeLQvedZLVZTBcVoF+5plnnt9mAiEZwSxNDQ7Bu+3J4t2WuC4b1T6A7jP6VommX8pPo24Y5Cv0MjDsXGC2/6oCQkJ/rNDtXZbpb6r+Z8Kk+R73PrJv2wJbsyDE6g8mzXv5/cO+j5s+mO2eYf85B6JdVqHllzbZZJNqCYml4y3vvMMOO6T9HcbN1Chg6FWMw/LHlnLuEywdT6k23XTTtKQ4ll9HOQ1C9TGs6ufLX/5y2qMEKWqqlTkM0sTQ+ESSGEuG0n4glspuolzqQJS1peMRdHuvBEn3X1/z1RaUGaNMdu3cyyBzSHSn7vKMd4veiS5Ytt7mat6pUdT1uozyIY90TPmJLik/hGQw/a4H5+N7YFhey9fXBe9AqKTXztTeZel4BCXy1zTKZTPO+8ctL9dz2qIIX/rSl5K/s2UKTCJ/5XTPhXHSOCnkjd1/6qmn0sZ+lROSSfayGRdCp08//XRqdfZxLxuhN3vZCOU3DaG/2MsmBLsLsJeNaAJCUvfGWU3Bhlif/vSnEyGx0VvGdLAPkx1WRfZs1tYkRO9iLxsy2keI8NhbCeG3EV/fgNCLLnOUG2644eKzCwOiCOw2MjzJ5rVdhuCCoR726OnEXjYBnGdUtjUNK2sb4+SzasS7u1R+5TR1KV3TIvIyn/LUJtosT++Mo69os/yqwHyog2kg33WMOfRMZGf//fcv9tlnn+Lxxx9/QRkbu3Xfffel8Tt1dPF7/7h1Wgsh0ad51FFHpa4XWzxfeOGFaXv8jN9AJdkGe7bxFK4xVqGN8QllIdIH6JgG4wrlTKA00jKoPEK+tpEfFVWlZ1x4ry5PdV+GLgrn1bf/Rk0fg6J1PPi8+Qh1Lq8GoUK5S1KXjwPKZfcP//APKSQe8jKu0aV76sV9dHVSp+EZjL7Woi4islqHA6oCytcOyFGOBnCLjs8E0UL1MtO4lVHQtD7OZFOdLw+olS6/owuxb6ATuiOXWGKJ1FV+0UUXFV/5ylcW/1ukbr4LLrggjd/qCl708V9j8fcZIfTC6I0SUlJ5+o50Ieh2sfWwMQ0GNeovnA365pEZo+1f8YpXLD7bDwi9UVzdTaNMXxMmPvXUU5OA6Ps1NRYo9m233Vacf/75qbzMmJmr3ADhE/rWjaD8RgUDdO655xZHHHFEcfXVV6d3q2tdP4woBk1gOcsYBT4OOAXvMNjWMSl0+ygvSqV7jDwZCHbjjTcWRx99dEo3mRN2L0+hk4eDDz64OP3001P+/Ja3adJCuTkW0/XGGXwtJK2L4JxzzkkzsqT1ZS97WXre/fffn8LWr3zlK0eqP2TkmmuuSa2et7zlLWncUl/B6XGCZNdsg0EgFTfddFNyfPTFIPuXv/zlxUte8pLihhtuSHWqXK+99tpEHujMnXfeWTzwwAOpnG6//fb0qbwHdQk5MLCQvRmUCaTHYHVyp5+fAdc18vrXvz4Z+VFAJj/3uc+lGXDyoPvbWBkyWBXYTfJoYK60TQLlpyzVA7ttwLZutLvuuiulXTlJt7FhwM4bs/b5z38+1Q/9ZMPI77hQzsbB0I+6unURJzbiyiuvTHITA0iB7fSf+mVX6CTIE5shz+Xrq4R0sdvkiT2rCggUu+K573//+5N9YMfNwlTG6pkekR3dKY6o26rAH8qbweJkcxRUHiGRAMaAAdh8882LD3/4wylSYgBZxm9A8Qif1v4ll1ySDGqAcWS4KMc0W6ePCgrBiOy2226prvRlMs6MDQep7gjTvffemwxPG9A6ZTApzb777psMGOeD+JKrRYsWpUic8KTBpgF5oxSrrLJKititscYayZCOOqirDnBEBh4zdGeeeWZKDwPJwaqHURWXbHAADMo0rdM+4IknnkiEXz2qQ0aV7iCmiL1ZeauvvnoicmZ1aUDRKeNC1ltvvWSAGWiRinGgYaFukAqflj2gAxdffPHI0Rb3klMNM/bQM9VZlyIkdIs80jNLLpBBBME4KY7MmDR65XcAAULOkP+VVlopySBy0tVIuPpj19gD+Q2QC+MW77777kS8InqCgCGyCOk40dcugT3RWEFKHH47+Bj2nS0KYtyVCFDlhCRaO5goR4F1dzU82SZC0TlHLSgKTRkMAqXkWnl1kzhCqEVqIJmpWVpGjD2HybBz6KIiDDul5BjaAOZusJ4R+KuttlqKQgX7R0Q4HecZ0nJ4mcM2SNLMJ+sbcExtRxPkRd1arwaBEi0B0QFlL20cAwMpeOkTAUNcHn744eKkk05KhF/+5Zeh5QREsuicKEIZHMsZZ5yRQrMMLmjtn3zyycXll1+e/udc6Ol1111XnH322cUVV1yR9JjeMlyI02WXXZbKVvTsjjvuKI499thEWMkFo40gctSeU+5OqQKic5yhWWzqkByoR2lBSugPmSXD6tt5rUFOVGvX9Yj1KJHGQZAhz1A36kwEggNTFzfffHNx3nnnpXJU7hzy8ccfnxoUSIdGmZY3x6auRR20wMmAA8kSnVS+SIt6EAFUrupInbk/nL8WrbKoEmyA97E7ykgazXg0O0Ljkq6JDnjvs88+u/iuItko9kGekUIySB4j0ts1aNhpBNKzsnyK3iKw0q2OEU122AQFn/JEbrrisEcFv6IeHXTUhBF1iYD4Lmqx3HLLJXvDz9Td8B0VlRMSTo2xwrgpLwPHWGa8EAScApimRykoNifDsBESRIETqhOEliJqOfhOcAkwY+M7RSSoEcLUsmhDMaVBOF0UgZGQLkaSsYi0IXSUrNytRNHkjdOWdg6CUiIybYLRQ6Q22mij5NRuvfXW5AjkSyuevogArLDCCikydemllybnqmWji8gUSc7Jc3QbcSZa7qJb5ZC9MQvICyeNYHJ2HJtzHKM65iw5T90brhd54YwQAI4XCSCnjBjH6b3kk55LN4eJtHDCultFAKqWkQ984ANppP5HPvKRYuedd05kST0joY4jjzyy2HLLLZMeLb300iltylfZiWogTORlktlv9IIekp9bbrklkXLRDqQRgUPyPBdJ892sK/WhzsiqRgcSpVtWuSkbdSaCo/zki1wjH96B9OkqUT/yoy7IPnkg4+SkSpAbdU032CARSDKBYHDc3s0mIFAIiDwBOSO/0nziiSem6JQp8JOQvqYQRFCdgjzqAlSmnLO0sxnkWNmbtSSf6izu6RvUIXLlk2ySW7K59957p4i48Z1kD8HuAionJBwcoym0yoDot9U6KLdcM37jlBhvrS5OVd8yB8CBakEzgk06f86O0xIN4egZHso7iDYISRnGTMBWW22VPoGhjLUkGMVhkDd51EpquzUg8sApfehDH0oOVSvZGBJyQE84eC3kICCMZIyQ19o3al4XBUeBnLiXsTHfvxxV03L1DE6PI99ll12SwxYRY6CQE6TEe5E0cocE0WFGTBqkVRo/+tGPFssvv3wiLZyy+zh5B4Ou5bnFFls8n64qoV6NE0I85IkhRaAQpcMPP7w47rjjUteI8wiS9Fii4KyzzkrpOvDAA1MkatKuLc5I1AVx8D7lT085YeVFhzkxz+fYEEMRD4drlK10hGN3HaInzfTNPc4hH8gUeUYQXE+uwy5wkFVDFISuizLSKbIgYkJu2CdpIAODeu+3Q3rJi3uMuegyIs1BLsiyCKEGC70z3k290CmNQwRFvbIdVUemmoC8yh8yK0JMX9Q1O4CE7LHHHuk8mznqtNy6UTkhKUPLgBFjJCc1BvMZBEaomUHD1A1S1DLS+sNkm2TlFE9rR4tIPyMjE6Qo+oW1FoaRlKbASRo5vu666z4/+FE5adlxQlpsw8qM8+VAOQWt1C6AkefgjN3hwE477bTnR7vLk3Na/TvttFPSI/kWGUCmOGiOQr7olpa5Fne0XgPyrO5cq7wcInAIhXLS0lefnikqps4dnunZWokMNccUrXvOkhNFPqQNwfF890cXUpVyyzGQS+W17bbbpogrORT94KyVi7V/kDrEC7HXtSDqo1GkawoB061THqs1KuRZ/uglw4340Q/OSmREuSgvka0ofzoU5wbLwn30SvqQHM93PcKhvkSzEBgEyvM5EXlzDzmoGtKj7uQDWSdbylr6HdIkjc4hK84BR6dVLb2nnHJKIl6IMafeVURdxCf5pgvXX399inCxI4g/O4NgiYCRGxE2EcK+AeE66KCDit13373YYIMNEulEuExOMdEEwRVVZhfajhoHKvUuBFfL3ycwhgRZmJzSZfwWlIKRYew5BgYJRJSUof+aBEPCOHGSgCgxPgwno89xIU5tgZMx4h8wft0OjIfZKsgcgyrULfzMQWttGssEPrVGlS2n2QVE/XICSIkWijzSE//ptjE+gsHUQiMf8irfDKTWN2et31+3hGjHYNcoY8MA6T5VLhyIqIcIjHJwv5awuqenoJ45VuSNkxHdZKwNsjaWAVFBBpS9Zylr+h46XzWQAenVjQBIh3rkRJUXAkJfGFfnESpOVASF00SedJtw7JMQpdBT6XDQkYCycCAOCLHuD7LpHCMveuDeqOsoW6QtBrXTLZ8iZtIpIiatEfGTJ/Irv3U0BpAcUS5OGJQl8kWmlKWIFBIqfcqSvKhz5BjhkjfdUWyDNMp7lxHkCtZZZ500JuuQQw5JkUd5MEDarDxjgbbbbrsUQRD1U5d9g3FWxxxzTJqJaNamPMkLnwPqU9eNBh7Z7gIqnfaLgBhYZ5pchCwpn2lHDNxc4Py01BnCcNB9wTjTfik9Q8+xUHrOiBEwcBMhEDJkhBgtihCtktmg7IVfw5GMAwaRMXUfw+59DKpPLQX1QnkZzHGNYhXTfhk/jodD5hS1dKNVz8kKFYsucEDSr/ylW9ky6urGoTXP2E8Ljlw6GOlxpv2CsuAs3Y8wSI/DdyRB+v0OAqbMlL3uFHk0yNU5xka+OQvywznQU/IjgsCRqkMOgkHSBWCWCiPE2dHNkFP58T9j7bsxEFrDuhI8HxnwHBEo8q38pYN8sgmeFdG1SaaGq1/yTnaluQxpYhPoCxJEN9Sr7i5p0qpFusgBR2MmC9shjf5DUjlRhlh0Y1B+kRf/u2dQPoXptZCVu3fKG+LLCXs+QuYeZYDAkz91C6IpyoeOq2stUJEvz6JXMd5CVMF96tBYGf95PhkQ4SHj6pNjlIZhoJ/eQX5cOw48Xx5EzpBW0R8OinwpK8RedEDZGe/mGgRRnhEZ39WL5xi349y4UI/KgMzWEQUC/gu5JyvqwnvoCjl3kHu+SuRA2SOY0qPO1M0kcj0K6Be7LU3kpUqoE3mhUw7PL8sQG6oMnJuErM8F/lDewraNgkqXjvcoRlFrjXHQ8mdIZXqUDBN8AsPx9Y2Ras0yzMLHBHw2KCfGDokgNFpYyivKiIGJlpRnlVtlM0HFM9oc8FzEcRAMgi41LJmTjXRQUmlxniEed+yFfHJuHCADoCU1CRA4ihv9uJ6rzBhvZciAOyedHIvycr3yY1jkQ/78ds+0UCZkXJkg2+NAWqVNmYcxAPXtHHmQXyRR3jhpxop80EHnvFf+I++e4X4HeZHPqEPXIEHIB+PEyXi2a51TbsrLu/2njpWXT89S5kilZzIqrkdenFfWrkEolK80zSX7wyBKwPGT3WFROM/2DmlUDspImUinspQm5+VHmnx3vf9DLpQZ2R4EIiQKgKgNOkP14DnySm48I8rMeWWrXJx3TjlxfM4pB+VJVjg155Rz+VnyJf3OR72B69Wr3yEXszkNjQmDnjlOEbNxIZ+ImfTQF2nxLumILpvIu/RKm9+ukT+/1Yn7RrFVg/BeUTfPE6moAyETiHukNaIC/iMrUc5xXtmrT3IzTHaqgIaSrhV+UvRvPkHUjU/CA8jmKKh8LxuPU4mEvFy5o2ChEJI6MA0hqQtkoQpC0jVMQ0gyfhdzEZI6MRsh6QumJSRtowlC0lVkQvJCVN4pSaiihTAOGcnIyMjIyMhYuKh+lFRGRkZGRkZGxpjIhCQjIyMjIyOjdWRCkpGRkZGRkdE6MiHJyMjIyMjIaB2ZkGRkTIARJqdlZDSKLJMZfUfnCIlZOo4+ou10d9EgSVNf63M29FlOM34X86Eu+5qHrEvzQ/6GYdx8jURIPLSJKbwWY/KecRfg6gIi3RYPagMWW/LuKhb+qgrkJtLUxzqdCZGf+ZSnNhFl2Ybsxrv7XJd9z4N6n282YlT0ve5mgzodd6G8kRZGs3+GxVvsb2D1vjog4RZIslCMBZIsgWxxta5D8VnFzxLKFlmyPLcF4az+1xSsCGnhOqvkWk3TIjtdKTt7yFjW2tLa6pX89LU1oK4RTys+WkzLyqSWmrZSZcb4UJ4MsZVfLZ5n6wKL51kxs27Euy0bb2Exy2oPLlvfB7CbFkW0jQD9Un5WHe2LjrFdbEJsfLjSSistCH0ifxw2+2gBMf7O4nzO9x3yoCFqoVP6ZVM/W2KMgpEJiZUU7bVA2OtAKBbnRbGsf9+EYaoCliK2wiwyZeVOhKRJQqDsEBKroiIkBLttQsIgEi0bwyFqCIl9X+oitE0BIbH8N0JimW2r4jKg88GQtAFGmewiJGTXaqlkt4ny9G5kiOGMPT+gL3VJx+g+p2bvI3bTZnxWPu0LEBJLtGvQyc8KK6ywYPSJ/HHYVvhGiGO/nPmQd4TE/ki2rbAHVqWExNLxhN5245aFrwMMvQ2WVE5sZtQXQiJCYuM3hGCzzTZLq9Q2TUiQOaTIJn3hJNtEEBIkTZ0iSeq1760fZW3PEhu3xdLxfSdZbYLe25hPBBZhtZ09B9UEvFsDiHyyN2QU+uQQ5EGExwZ3Sy21VNoAr0/yiJAgUDZHZDMsHV9Xo7drUHectt3KbZUSTrtK+VOmyhhE7QefXf6vSog+0is+iU6Pum3ISITEzp5aMXbYrBMU6+mnn0572dS1u2JdsAum0NvWW2+dQvlNA2G0+yijrvy6AiRT61fLra97hQzChmPq28Z3QswZ0wGZfuyxx1ILv+m9WJAh8omM2OG2j0D67a2E8NsxvG9AoGIvmw022GDx2YUBhNh+L7rZ69qDjH5pIItSDyI2FRTtrRqGEGho2KOn0r1scJZJWJtQva3LKYtdFueCd2BqTY6/qAqR9knKqQq0/f5hKNdnl9I1LSJPjozpUZaTptHmu6uCtMtHX3Usyr/PdTAp6pQ/Daebb765OPbYY4vDDz+8OP/889NO3wEN6LPPPjs1BuqI6MvTuDJZy7RfIVeM9/LLL0/s14Ad4amM30DlI2vf+ta3hoZX/S/iIbpgvELd8D6tRDuG6lMHwmRXW60vYUUDjg3mbBO6SoSmI41lYbct+kzpc/7RRx9N4cOqjLbWXFdARqKeGBnfA8bwaKmQJaHhp556Kn2vq+u1LqhD3aJPPPFEitaGXmjoaPCQXXmNfJFp9X3//fenKAibNE13Ibn5wQ9+kHTWmBNjNqKRRfacc6gD56VPtFcLGDgCdSPtAWllBzzLfdFF7f7ydXWDrssX2Ri0R8pd2qRzmC1ip4z/YCv6gF/84hdD0yqfMQ4Q1Be5Mli4ryBD9MBEC10mdERdgfzSDbvUk+uu4EUf/zUWf58RDBrlGSWkpAAeeOCB4o477ije+c53FhtuuGHxqle9KhGSuYw4QVE4Rtu/4hWvWHy2HyDIBECe55r6q9+Og7/kkkuSoyQs0c1D6a+77rri2muvTQN7dXWM4vwomtCcbgTlNyoYU4LqXn25BmsuscQSyYgff/zxxT333JMUU3eQZwurjwMkwsAmMuCYFN5/0UUXpa6SBx98MMmH7ilO6KqrrkoyZ1CiwYllcBKuJ5dkyzgf5Wrcz6QQ5uRoPEMa2ob+Ws7vsssuS+mir8Z9kSk7b5MnjtzAOYbId/XelS4KaeLwyNewmS4cOXti/I46vO+++1Le6NFtt92W7kc4RGM5VOHvW2+9tXjmmWfSAHOG1+BBXYaeUYZWpP/I02zySQeV2U033VQ88sgjidzcdddd6V46QUduvPHGlK6Xv/zlqUEmDcYaGfQuX+674YYbkty4R70hAfSPTNI7zzn33HOTvI4a5mY31btBwRp/44Asf/KTn0w6hPApM+UkH2zCpZdeWlx88cUpn0L+r3zlKxffWaRrpRdhcShDeR8XiBiSrIzr6tYlI+SDXTX2K/RWOesyUV/qyTgctlyd+I+dVrbqxyDUqkGmlLO6p59VAYEmX+rMTEByz/aRO3qvAYpskWPjV8hajCepCvyhvCk7sjkKKo+QyDRFJbjrrLNO6ptSGF1qUXYBKgiJuOaaa5KzDXDexuxgshSk7nJDPLBkRlL/MwLBYSGgq622WrHrrrumQUnqsGyMmgSjyXEss8wyaWC1tDD2nI8BxAwFRyXtZWj5cdRaf4giQ4QARoRlvoCMKBPkDBk2roUcXX/99ek/LW4tPg2K97znPWng4yBx6zLIo/FlK664YrHqqqsmw00ezPzj0MmpAxEnA+qbk2EI11hjjUT4lU9ENCYFh+sZ3mE2CNvGwdFV3zltjoBTNo7LeAhGXsubc+AEhcdPPvnkFBUBsqvOkLH45DzpZRPgbOnRtttuW6y99tqJ/CHwIN3ydcghh6SZEmWZkT5Ej0Mz7ofsuW/aMq4L7BuSRQ84SVBXphsjuGRKJIGcqE/yJl/qAzlpMmJVBei9uotgAMgjGUSyyCq77vcowYKmUCkhwXQNYnEgJieeeGKx1157JSeQ8UJouWoNaMHphsCUOV4jkxERrbwmwHiqN5EQ0QcKqTXHoK677rrJuWHZGPywQVFNgMIgIwym9GDzyAYlUn7Si5hEyDvAGfifg+KctcI5J8RkvoHDY4A4DWXFEGnpMbrKgGFFKMmW730bNG4WhugEIr/pppsmcqV+RSCuvPLK5HAMKH/f+96XZIND0X9OrzbeeONEZqZt4brfexATLWnGHBHm4MgfnSarQUi0TNUFMqwO1Akig0yJOiA27nO9egFOQx3KQxPwPmSOXq288sqpBa2h5LDcw6mnnpoiO2SH3ATkWxk7b9Ai2dMliAh3EeqOnVB3YSeQDCSKr1LeGirqySGCgGzSIfamnPe+IEiGbjU28L3vfW+SNZEivxETeUdCEZQuoFJCQvllVKWbkcNwqGRjSYT0Mn4LCsBALb/88om1azkJO2t5KD9GadDB1gEkY4sttkjG5ZRTTknvFSlheB1hnDgwBrcNMPIMghaOFpjfurIYGQ6XY3IMY/kckZaPkLTwsu9tRXrqBCKJ0IomHHfccSlyIJpAlpSRRsI555xTHHjggak7h2HqC1ZfffVi/fXXT+k3LVTLPRwpEiLKKBqLnHCoyLzp95wJUn3hhRcmJ1OF/JIxBlz3oa4OxMPUb2Vflj8O+7zzziuuuOKK5yNyogmIFNuoKxEpIc/IpDoCz1CXw2S5DtCpCKezPQgSnVFWe+65Z7HvvvumaJPBj+XIogiqPNNB6UeodDfHGJ4uYtBOqAPEg23R7XXCCSckGyGqxgaqH3rEZvRJX8pgu3XDs/P0RRSOHCIjIvO6d5ESEa4uoFJCwqESUo5Wv5SQEFamBZEJyQuhf5IiE3wOUjcXg8rQasUryzBSdYIR0VJDjBhyzooAB0RstCSELxGBtiGaxKggUaCM4hgGiuY/Dgvx089PSecbEFzypNuCQTX+Z5tttkl1Rta05tdaa63k0K13wCj1BbpeDjjggOKkk05KdYlUiX5wJLvvvntqxdMhMwkQT0ZXPs8666xiueWWS8TgtNNOq2TgpfeLFtIHzvrII49Mxp7di/9BeqRBdISTM0aC3IJ6IL+6SqVXXZR1ayZZrgPhnOmGRsnSSy+d0iytPnfcccfUnaPsyl3LcV/kiYxJd1NEahJIXzmNogLKHaEUWVMP7AuSIuKDCIuq3nLLLZ0mWjOBXWfvRLhESXzXMGELdcOJHIr+IMldiZhWSki0qBmJaK0BB+t8lwW1LVAOg9AYTX3KBrwJKzooRxNlxgjpIxVePuqoo1J9idboxwZKqxVX7j9uC1orCAZjXo5yKKdhZSXC5B4hcmNhOGiOQct5voEs0TutXQZGGJ0uhgH23VobjK9ugyCiXYeB1lqySKQlqJEP+SOz0cLTlad7WN5iNpUIhfEyhx56aLHVVlulqAZZmBbKUmtZd6sG15JLLvkC2YvvHJ3uGmnm3JQ15404umaTTTZJxMR4MQ2RNsFWG0tBp0xCKEPa5YPDKpNYERHRkZi9ZBwKoub6rkK5l+tKFIhvQuSRXvqBmJEheUOC1RPb3DebQc6MD2LfRbYQkYgGCRYIGpBh3XQaxSJjXUClhER4mCEkoFGBDIoCGHf093wHgYlpdAys8iEsuiIYX/+5pglg/+oMEVJX6pGS6oJzMEZC3m1CK1PoXYuFERdCFkrmhKVdHrTSgOzpJ+WEtJYZGZ/yIW9diPRUDbKCRNI3ZRJASJzzH6eBpHGAWk2Mcdeh3hAPM4johGgEY4p4ISPGj2i966rhUHVByKeZRYg1R4Nku2fasHuUJYI+SEK8UxmTRQ4AKRIWd45Oiz5y3u51DYeHKOmKivsCCIJrm4AyNZNGeYlkm+EjIqDMDfY0k8ZsDLZBVMh5g1k5MI0YxI88IVwI2jgz/JoGHVF/UdZkhhxp5IgCsx+ctHPKgs0zVohdZg/7BDIp7brdTKQVVRRNRD7CPqgrBDQmLXQBlRIS0P9IyUzD/OhHP5qUk+I1NUizD+AUKDqhZ6C0nPbff//Ut6w1z8CKSFASxqpOUED98AyLsT4MuL5GLSDnOC0tTY6hLSBoyorSKB/dSFo3CIayQji0zBibaLFJu7I1WE+3ISOrzI0t6Ep4siqQEZEszppsiSgAA6ys1B2HzHlz7Jwlo9s2yRwF8qDlikzoetEVxZbsvPPO6TwSIk+6TrTQ99hjj2RoHaIojLGBlrodONBJgYxoKdNVz+aYgwAbe8Ehx4BQ/5mmjECTU0afg0CgyKv6QWDUiXxsueWWSd/kVYvWd3WmhVs3EHyyg2B4N71B2v1G+I3PkRYbq3LMdM019E3oX/6MWxJF0VWIaHURbIG8Sq+6UF/kh2+iM+yDLip1xf5x5ldffXWKqKofXZ59gjzKK3suiufwnWwFkCz13CU7MPJeNpzj9ttvv/jM7FD5FI/CKhSzGkZplVJUxtJAMS31PkF/MOOvW2Cu8JciV0Za9ZSdQJT7YrVaKIn/lN8oZcdhMyCMoojLOPCuaKV5Xygto8nBS98kDFo+DZgSKkR8jI2ZBFEm0Q0I0sQoxn/SjjxJu/woX78poHLmKJSjupm2tUO2RWxiL5u2Ib/yqL7IkTKQd+UfLfqAc3FN2Ti1CZEEU3jJLvJbhvSqW/mTF/WtDh3yK2/+d5AHxMU1rg2CqixmskGclDFTnBMZnQ3SEGWp7EJPvIMMei/ZUr6uRTCkx3X+I4NlOXWd885x5J7lPgd9cw0bMBei29V4AFGMcUCnpEs5h2yIMnk/OSdbyo6++V/+pVnaXONe9eD3pI5NPcXS8cbd1AFplnb5VdbSq66cZ/vUIZlSr5FPdepa5+uKqorm6k5BsvUuzCeIUPNJyCrZHAWVR0hAZQvxYWVaMHVVZl9B8RhPrVQGi2JQbgcF0EKJ/5ooO+/wTlEZ6ZI+YAzDOLUJ71cW0heHdEmntDOYWpvOMajKUGsuHC5D6R4t6GnJSBehDBhNZSCPHB4oH3l3Pg5yRSe7QkbmgjyoT3Ws64VdkVcgnyG3zrsmZIIsyKvzVdmgclmW9SR01nlpkD5RFC1SthDI8KCcxnn15bfnud41njcKGZkW3u19yko5+u4cPXFOHoJoSF+QPuXpd8jdpGSkKShnaZUn9RB2wHm2Qt5DJyKf6lA9VCE7GaOhFkKSkZGRkZGRkTEOMiHJyMjIyMjIaB2ZkGRkZGRkZGS0jkxIMjIyMjIyMlpHJiQZGRkZGRkZrSMTkoyMCWBqYEZGl5BlMqPvGImQxPS2JtDku6qGtMd0vqbh3XF0BVEeptZ1KV3TQl7kqa26nm8IuW1DRrxTPfa5LtssvyoQ5d/X9E+LvsvfTAjdGgcjL4xmNT8bLVlApg6Y622nYMsUW1GxjwujWQnUqn7mtVtQqCkoO6tFWoTGioKWB7bYUpsgjETLwmjKxaJoNnWrS36agrK2yqP6tkaBHXX7nqc2YQ0PsmuhOQuj2deJ7jTR2vduC1NZjNHCaG95y1uel9u+wHoaVoC1/4qVRi0DbqGyYc5dvrrm9DksC6NZph7sEM929akOJgX5s6idDf0sjBYrCc+HvMubhdEs+sYfjbow2kiE5M4770zLA1sa2Ep3dQi1Fqelkj3fksR9W6rX3iCWy7fSpIWPGNUmlF/1cZKWx+b8LfCDzFmBsC1IU+TdLpPq1bLmlmyvS36aQJS1FRyffvrptHgSI9I2+esrlCfDZXsJq/mSXcQ1CEmdchLv1tCyQrRFsN7whjekd1phtS8yym7SMeVHv5QfBz+YfvmFLuVLmqQfgfryl7+cztl6JAjJKGntYr5GQciffXSs8G0Bv9jSog75i3KCusvKuyzqh2zRrw022KD6lVq9JDIV3+s6+gqC5Ig8DOarjiPeA+X3t3kE4nc5TeXzfTsCg+fKv/Mx+hHwfVB3oHxt1Uc8f/Bz8HvXj8G0BsrnZjvf5hHpgabrv+2jDL/rtpF1PHOmI+D7YJ3OhZG7bDC5nXbaKe2zUAe0PG1khC3ai6WvXTZCjpZWbjJCoezsByL0rJWn/LrSZfPd73431an6nA9dNlp0umzscGoJanvZaOFVhcGxKaHUjpngeveB6ILvyn+w68M5sgJdiepIjy4bEVhRURHGpmTEu0XvbJqndRo2ZwST2BnIg5YoedTltOyyy1Yqj3UjumweeuihJJ8bbbRRiqIuBOhuE537yle+krpsll566SR7Vcpf6LzPwa4w55S/c7PZl0kgb/SKT9KNOOo+ZiMREtu921zPbrR1gmLJgL7QPhISfWY219Nl0zSEbe0yyqjbnLAr0I1kXJAt2OfavKwv+NnPfpbGPBgrZDfhqkAV1aMdVX23wZduIc7S50yIHZDtJyI0akxBbAcfe3YAgkK/PHvcTdjqhI0hY3M9aW4SyJDN9dgbDr2PMA6GPKp7/fV9AwIVm+sJ7y8kIMTG/iEk426KOgqQO/Ktgax7Ofa5AufYCeVuv6eqYUyovNk0sNIuGwZsBN4yNZp6T11oM/3eO254rG5EeXQtXdMi8lR1q4JhQEJuvfXW4qqrrnp+bMWZZ55Z3HzzzWnsyjDYcfX+++9PDQcRTPdpeQ1GQRggu9tyYF1CyEkbMhLvrboum0ToVxvlVwVCl/pcB5MiZK+OvGs43XXXXcXVV19dnHfeecW5555b/OAHP1j8b5Ei+meddVYaVFtHRH8SmZx/c40yMhoA8lAH7NZrO3Rbv6+wwgopAmMX0htuuCEZl2GwQ6yWD8IiCqLbY6211vqdHVgNNFtttdWKlVdeefGZjIyM+QqERIR03XXXTRFREXQRUmBfzGx68sknU5SkK8iEJCOjQ9Dfy4ggIcaoGBPEoOgeYkB0gYl+XH/99cUFF1yQQqLGjOgmREq0gG688cbis5/9bOq6ufjii4vjjz+++PjHP54+ERuGSTj10ksvTdPyXHfFFVekbkd9+aeeemqKyrj+sssuS8eRRx5Z3HHHHSmCk5GR0W2IuGjcaNCYHYuQ6JYRCXGIjoigsi9sTleiU5mQZGR0ECIwEe40HXbJJZdMY0s+/elPFw8++GAiFMZdXHTRRakLxhRCQGT0S/sPUXGdKZX6qBkfhihIjNaSw/ennnoq/adVhbB4N2LkfQyY5yIsxlxkZGR0GwarGndmrSQwloQNMVbKmC1kxIB8Yw5FTtmALiATkoyMjiIIiU8ExWwE5MOYEYPELML3wQ9+MEVPGBjEQVQFgdHicf61r31tWgNmk002KdZee+1koFznPwZLF497dPtoKb3qVa9K9xtgZ4CpyIvByAZLunamcSwZGRndQnQra6CYMGIGlijqlVdemaKdIq4GQ2toaLh0AZmQZGR0CIxITOONGTL6exkUEQ6EQZ+vGSFrrrlmGsHuOgTEfQ7REuTCM7R+jCXxiYC4NqYB+nSt6IdrfGewHH47/BeHe8PIZWRkdB8aEJZeMHPVonPsgEYKW6JhYoq9z9xlk5GR8TsQWjVLxmwYhkTXy4knnpiMxt57752iFqbxHXXUUWmMhzEfjI6uFkTFFEqfDuM9PMvB4PjPdwQHGfH/Y489Vtxyyy2plWR6tunD/vdMg2tN9xeZca3vC2WNiIyMvsPaVMaDnXPOOWnm3nHHHZe2GFh99dWL3XbbLY0tMdV+qaWWSgSlC8iEJCOjI0AabAGgi2SZZZZJi4VZenm99dYrDjnkkNSN4th1111Tf7BoiN8iGVo97hOeNZjN/QbAvu51r0sL0jFOSEssL45g2KLBc5CdzTbbLK1ToCtHd5C0mELsHEKiJeW787puMjIyugvdvBoV9Jm+63rVLUv/X//616fvoqy6fEVO/O4CRl6pVeto++23X3xmZujfZkhjoB3jxVjqv4oBNjPB7AGD7Czs1ceF0bQuLYz2spe9bPHZ5mCgksGKGG8dC+xMAqLFKVpLg7McdbW+rkMEQd9rrNRaFZQXouCI37pJYlpvQJRCGnSfIB9gcTS/XY88RNdPkAfdNX6LevhkoJCLiJYI5Xqfw3gUuouoOKJLyPfo+vGMqoAsxcJopiw3CZEoESeb6/V14T7deWZVIZJdWvBuVCC8sTAaB7mQwE+a6WbQue7XqkCP2Qm2hN76Tc/pPR0GtkHUNLp2q+6OtVAon6RxVOnCaKNCxi2ycvbZZ6epgrfffnuaBWBRJ4Yv44UgEAyijdqQGUsIOwhpU6FxgsqZxbL9poBqlZdbwcL8Wt6cUpuwfcGwmR7kTpqHyRjn7HrK4VC2XR2YySBw9gaVOmz4hnCUyQj4jeT7H1lwmNLnWmQ4vmsdGXPiMAaE0fHdfzFexHOcc58tD5Asv33XgPDdufjuuirJyKhQt5wW4mJqM5kFBEu3lc0t6ZLfoN7NFtKY4rBFewYXihsHZD82saMnZiRFGkSenNPlhYCTL/8xxvTJvWZI+d8zApyFtNF/jbHQOd1tZL1pSI+GTeiHMuMs2fSZ7JEypXtd1alhUM7qT77K5B/UlfInY31agn8QbAmdZwvClvgeZAQQlGjsVE1GJsWLPm6BgjlAqQjnXC1viskoGJG/++67p1BQtPCcY+RmA6NDEBTeXNGUroGjE0UyeKhc6bOBYWcArCehb89siGjtcEx2gBwVIlOexQkpv1GhdXraaaelfkbO/p577knGRzSDoNqPwBgGpEQdjjs9jHLrhuDMHJNCROL0009PaUR0lY/l6JGNM844I+1IrZWri6IM5XrsscemcRKuQfh0Ybz61a9efMX4UD4ImvLp267UXQQSwW6Q3WEyr86uvfbaRIbI60033ZTsA+dhxgCn6Lu1VDgRcqFBRHYZYXWPCLBfg/KLOHCoQbhmAoPtWmu3WKDO+6yAaZyPyIqp2JdccknKA8J32223Fdddd13x8MMPJ/In4otQnX/++ckmSqPzSJNdwnWdkUnP1tfvfbrIRgG7SR7dLxw/CaL8NB5FqTho5YYo0X0LaJF1eheg19arkVfjEDi+SYAgaBDJc91RKgSELLG56gxpZDei7tlfK5qy5+wEHa8TfCa7TWY0DuYT+EN5Y5NHtbeVNnUYDAuxWA2SgkUYiJOeVFjnOxgwBopxEm61CJZjUsMyDhgh0QX1xbAceOCBxfve977Uz6guo5XXdlQBGWYgTXM95ZRTUngTcXKeXOkLxfajdRxgqJ3fa6+9kuPaYYcdkmLUbWQyqoN6R0gYNyvX2rxSQ4cTEy0RkbAqrXE2/ne9aIVoGCfpvLEyjOK0Mozc0FMtT9OobYaG5NrYzvORnWiVGjC4//77J11CWvznesQLsaZXoJHmXnLs2Rwy5yii0iQQIzolsqQLRZ6ULduAoPiuMVAGXUKsICINXQcSZQCnQeH77LNPSreB3UA+rLujC0+jg23MaBaVEhLGH4OmWCDsSAAwvziX8UIoM8RN3x5iggRorY0THZkUyCLig0RqjTGODKdIjeiNEDMnr/9P/SEwbUD5MIqWPNfSdIScOZSXKFyEXQPKVP8lB8bgI38iPz4z+gEyqm5FyC688MJUxzHdWT0iK2YSiBDamG2VVVZJMiEiElES8v3e9743kYVpELpqEDF5Qjw4MTobU6Tpj/TG4MHY7NI56V111VXTc+RFtCcGG9J90D3maBKiKxoddIMuiTiJPIpuarkjHvKltTsI18t7X6BO2AONZHaNnZU3QBxF2ERM1EsmJM2jts5grdcIReXoyMygDFp7QrtaVCeccEIKGzYBxj6iM5RPK5Rx0eWjlSkdyy+/fGqxtamcyiiMvZYjYiScyrBLFyc1SEbA/+GEdDsysowumczoD0RA7DSuC0S0w5gRTlsUYo899khdIa7RlYckaLWLhiELBkmedNJJSWamJSQB0QJL8osoGKxvGqWoQlkO2T4bl+kGiTFPnJ1o3oc//OEUqtc1oMFGTgMzyXJdECGwSi+CL0KLjEgPm61BaQyJvEnvsHQ1nd5pwdaRA/KgjpAtXdGGClgczMBqEdhpxhtlTI7aCAklxLq1ZrW4M4aDQ2UArC+x7777JsPbRnlprTk4ekRFOFz/sb5jg+60NDn1NsHwGYgmkqP7ZhwgMlqyHFZGf6DO1bd1E0Q8dAUb9nb55Zcn57L11lsnpy9iYqyTsQHkV1eDMR1bbLFF2r8H0TdWpAog6LqHjjjiiOJjH/tYcmrIhvcGOPQdd9wxRWyMCUPw6bnGx3LLLZdmLBogK42IU5mUNAlps1O0stFNI53SxR6JOPlPN6n/B8dn9Rnyw77pRhMlQS7N8DSWRXeaMtAg6xPZmg+ojZBwAML9umsiJJYxHIQea8fMRSTaGCgpOqKVwPgLIftkYCmt8LeWnGvagjLShy0dWsMiOzG9tewIQOsnBjoCgy/8zPDk7pp+gaPXdSicjgQgHXTE/jycKYLKeSIcxl4ZC+FAoJGXAw44IEVLNJCMDZgGIWeiCRpaxqjosgDySd7iGgRDpEYXDRIsYuy/kEljW4yHQQIcgbi/KUdIHxAs5aOMDWCl72zAtttum8Zf+V9kR/kDUhXpi/TGZx8gjwa7s3HGzKkTdcqm6L5SFgiLMWhRXxnNoBZCoj9XxVLW+TZyuGpwnIyVMuM4KXbTrSWOHYFknNQZ5bTviZVBd9ppp6S0WnVVzpMfF0bEC9kLs5rKaVaQyI2xLkLKyjC6lQwcNPJfKyd+u48DyRGSfoGT0Gq3g3G0WEUkOEh1alAp0kyPdOPo/wctXgSWQzEeQN1Pa4tCznyWB3Fy0HTXQEgEikMTYSR/GmXGMSEwrtH1EffqTuL0I3ICnuEddLIJGDtmcCfioTtMtw3iocykU/eUOrBwnq5cA0Dvvvvu56NNkWeffYCGCTtiHxc+yrIU5MQYtf322y9FqEXXlIFocW5MN4taCIlKp3wGDeXumpnBCDFeFJ0h1cUVhqlJMDwiNFqaYbSREgTFiHSDSZES59oAssawG/vB8SAYQuIiSgw8422wGucTkRFG3XdgVJRxEzOXMqoH8qG7wBiRq666Ks1E4TiMBxJN5CB1fajfnXfeOV1rLIAoiS4czlI0YtTFmYYBEaKfSA9yYxZPEGBROzLHgfm0xoXoDbJktpoxJiACCZw5mfUfQqLbydgt9/qPrCLO5LxuGKRLrzRE6L8oE5stT9Z2QTakj8OW3yBMQC/9ZiOcK5O0rkJ0RD5EfZQ1uyJyKpqmPsiNQdCicBH9ymgOla/UCpQNITG9cpwR2Fo6C2mlVkWvteXQ0mccEINJwp9ai/o+J1mplYKqM45bv3wZ0sgogfSNkzb3amFpKXIiHMgkkD4GTzpCXJUTgoTA+c+ntJO3uF56yaC8OXyvIvoklFvHSq0LFcYuzbRSq/pWt3SE81O3Wu/qHuHkBH26RjcD3XNNXO8/cuD8sLrn9EddqTV0FTyTrNEHskXeEArvcM510i6tIZPSKp2h53TePc6V75Nu/7lvUB+HQeQIAUK4plmpNcpR+iK9bIKyljZplTbXRN4jTzFYdJKIgjw3tVIrG6Ku5E9+In/yDM6pT2mRJ591AsmtY6XWLqD1lVoDKhK7JLQZM4OwKyMtFNGIUPKmQSkZk2HGT3o4ckcbaQPpY9i1GrVsHBGtYcg5m+hqYsiFmPUPSzPIl/+qICNNg1NjPBcqyJz6VMe6akTwou6dRwrJg/PREAgnQ16cJxtV1D0d8SwH8hP6QL6kw3lpIKvSKooXNlCaQk7dS07Bp/t9ep7rXeN5w/SxTijPIEpRtvIS+XRe+uRDeZbzpLz97joQD7aWbKgjtjfICMgju+FcW/ZuIaO2Qa0ZGRnTwbgerV8tuoyMjIz5jkxIMjI6CN1CBuaa6hrTES0CpmvDGAX/C4kK95oVEb91jwnfm67tvOvN4tDfH8/1n2cZJ+C3dSji2e4Xghfa9k4zVnwK1WdkZGTUiUxIMjI6CATC2IbYeA05scCXNTUsovfJT34yLXNtkKfNLI1hsjaHJfItHGbRLXutOG9VUAMUDQD2n/sMArUHkO/2V0F8zDzwDP2+CApig6yYIom8ZGRkZNSJTEgyMjoI/fcx0C2Wvte/b2qm2RzW4dDPbQlsfd36vkGfvkXjYhaB2SgGi4qyiJSIqFgMyuwUkRBjVIwLMFPC/iyeIwKjqyje4XpjcjIyMjLqRCYkGRkdhAGCyAASggwYiGc6qz1SEAgzAQzM22ijjYpddtklEQyDJRER15k6ipwY1Ol+5MOMEuNSzGBDWhYtWvT8AOEYhGkgpUF9ltM2cPGOO+5IUZqY3ZSRkZFRFzIhycjoKIzjsHaFaIXulpgiagaEtX506Zg2aMq3MR4xRRbMzHEgFTHFETnxPF0wnmevEsQmZvKItPg0ldN9FsMSnTHF2fiUjIyMjDqRCUlGRgchUiEaogtFd4vBp2bbWMjJwlwWqtOlYpM3hASQEms6GIRq3x4EA2kxHgXpEEWx6+0tt9xSXHvttc+vDIyAuNfmYq5z/oknnkj3irpYG0QkJSMjI6NOZEKSkdFBiIIgD1tttVVaQdMCbLpnrEaKJIhe2HDOBmhWldQNY38Ue6dYF8LS/+uvv37qjrFdv+uME7Gvi91mXWenWqugeq6lsnXbWJjKf8ap2IvF+BH3trG/UkZGxsJCJiQZGR0FYmGvEeTASocICkIiaiJigaTYd8OYEQs8WaXTIFfEw3cr9loS23gQg2MNlLVMtm37RVg8QzcOYuIdSI1rkRDvs3+RVRa9sw+LXmVkZPQbmZBkZHQUulOM5YhDN06ZGIiixIqSDr8dro3P+O6ImTie43CPc76Xr4v7PDuen5GRkVE3MiHJyMjIyMjIaB2ZkGRkZGRkZGS0jkxIMjIyMjIyMlpHJiQZGRMgLxSW0TVkmczoO0YiJDH4rW4YsNfEe+qC9BsU2AYMQvR+n10BuYkBkl1K17QoD/zMmB7KsS3ZbfPdVaHveSgPpl5oiHpry2/UCXmSv3Hwe79m1XPS6k996lNp+WjrGtS166eEW3XS0tamMtp/o0+wSZnNyEynfOlLX5pWvGwKys6+Jd/4xjfSkuHWj2jy/cOAjBCt73//+8V3v/vdVJ9//Md/nFYGnRYhsm3M/lDWFhqzKJl6tkZIFXnqOyatE0bL6rEWfzN92ZTjWG22bsS7v/3tb6d3myIdcjsK2pTDAGdmSwD22bRt5WdxvLbSNG6ZaIBakfjxxx9P91gD51e/+tXIddBnkD87cn/9619PU/XtXQV9zXu57s3cs0Aj2Vx99dXTMgKjYCRCcuedd6bdQldaaaUkPHWAof/bv/3bJKAWamIc+gTlc9dddyWDYOGqpgmJpcQ5fvubKLsuEBJAlCgdg0/p6pKfpsABWNn02WefTfVs/Y5MSCYHo0x2LU1vXRRGOTb9qxverQGENNMbZB765BDII1L113/918Ub3/jGREoQkr6AvUdAvva1ryWbYR2cpuq/bXDadtG2m7d9pNSffM+HvFsu4Hvf+15aMdoijpUSEhESZMEqj4zxXOzXI+Oa8vfZQLG0VBwWddKa7hNs866VZ8dUC1BRqlHyPS2Ur7JTP7aMJ9QW02qqlTkM0sTQ2D/FPiwiN5Y7J5ScdxPlUgeirDnQz33uc6meV1lllUSyRpXzjN9CmSEFCIGdiBFpi79FC7nO8ox3M5paqCJ4ZNQ7yW3X6zLKRx6QEeX3tre9LS3zL4rdB1mUB40pWyI89NBDKc1WCo79lfqQh0kR8he7aiOSFjWEquQvyjCe5XecK/9XPl8FPAvZ0mgTuaPTlRKSu+++u/jJT36StjKvEyqHU1cxKqhPQEi08rbZZpsUym8aohBf/OIXk2H90z/908Vn2wdjyeDrRnrrW9+6+Gy/gfWrbzvw6qLLmA724kHwyK4usCaBDNmzRwOIjPYRIqM2QBStE2HoGxD6e+65JznEDTfccPHZhQGE+Atf+EKKDGpIzicILsibVaJHJSQjjSANBjUqXGuDLjuKau2MinHf0zW0mf54d5fKL9KD8XcpXdNCfmA+5alNhJy0UZ5tvrsqRNr7moewD32ug0kR+a4j73yvhtN2221XbLrppsUnP/nJF3SZI0M253zggQdq6eKfxO5XPqVFOPuaa64pTj311OKss84qTjrppNQCaRvCgLFFe5dAEAhOpM/RRh+qNETXQ0DapKft8SgB6dA/PpgeaZ5L+JVvm91YwxB171DOQXS6COUntN6WLKjbsn6USWH5fFkGpJm8VKVPg/UVZeHZ3uF8vMt/kSaQXukp1/HgfQHXNCELYXPK8F7n/DcTZpJX+XGfoy05GRXSONN4Nvlw9B268UXPDBQWnb7iiitS1x6oH+Meb7jhhnRdVd010+JFH/81Fn+fEUIvjJHNumYDAX300UdTpldcccU0W8a9ujJ0wczVlWGLdQO0DC6zsVhVMNr3vPPOKy6//PIUbrfDqf67KmGGkG4t3U0G9IwCQvHkk08Wl112WepD1eem/HRx2CxtnDIw80PoWzdCDM4bBRRP+dx6663Fgw8+mOrZ4FMGUhj1tNNOSwPOhNNf/vKXL75rdCCoBm4ZsDjNFvY//vGPE9E9++yzU9ee8QbSw+EI9yu/F7/4xb/zDkZHGVO8Z555Jv1v7Mc0YIy1Ln7/939/4l1w1b0xP2RSC0VXpcFt8qQOuwRpJRvkweDkqtP385//PI3G91yb/w2Czt57771JRnVLqkd91HREvV9//fWpH/6JJ55IY5fIr1CxOjf7TT+2PNjN2BigMjzbwGu6Npd8eq/6kpannnoq6Y3dlDnom2++ubjpppuSHpKvxx57rDj99NPTdfJEr8iv88rQNWT34YcfLm655Zb0DOO/dCHdeOONyZbErIu5wG6SR/mzEeIoYJPZxKuuuiqVP5uobMx20ZAkk9KoLMuQZ61qNst76SG9M7ZQXVx44YVJ35TnqHaIrfFcTrHubl0+it6xI+rMb7Yt5IK9Iuv8lvTT8TqhF4HdJss2uqwK8sW2s0/GcPzBH/xBsptkUdckWaYboMwdxvNUCTIsb+SdbI6CyiMkFBwrUxgqlJApnLYYGGPDOKkYYysYBYaqCyAAKotiMwpGI+tDNeLf7ybwrW99KykmZbCNPQOJOTMQlBS7RpSUGaPZBsgSQ8lYrLXWWomAXHTRRek/hpCB8b8ZE4P40pe+lAZlI9Oc/XXXXZfG27QNdf+mN70p1bPuTTPLONXDDjss6c9sqLr1Rj9ng7QaaG7afxgWaag6HTOBc1TnW2yxRbHmmmsmG6PhwnHcd999qew233zzJJ/IPHJj3BuCsdNOOyXSYCxTOQoxCTguZJSh3WCDDZKOqC9GlwPWKFFWyoXucATq0uw7DofTv+OOO4oTTzwx2SWOXNrIpQG1yJTrOQp6WRc0EJAGZEMDCimh30g/W2QXaTLhXFmn3EfPEEezCemVvAEyHf8ZL2DWSBeh3Nkz5M9xySWXJBkK0EGRBA2EpuS7DvC36gJBJYt+0wd5Jq90xABofpHcteWfB1EpIZExAk7RtKyPO+64ZATMQx6n1V4lGAgDvTbeeONi++23T4ZVa6IrwFxFVLT4okVioKQR802AYGqVebfBRy972ctSK5ShZPwZJ4JLmNsSWlEOcmWWF8fD0HNIHDml05Jk1AcJk9aq7kKtUy0ATkPLkPHsAqLulTWHpOXCWBqgyLkxjsi0PMgbJ6GuRAI4Xo6RU5QfLS2tOq0g5cKhiQxooXPm7mNkrZXjPlA+rhHR5AiFsZE19yBy3uM+0QXEjy6TAcTQ/+7zf92G2/vkjUM08A8xQuQ5UGXz3HPPJbKw7rrrJmfoPAJCRhDt9dZbL9mAaQl11Jfp3t7jUE/qghxqTdNjrdCVV1456TG55ZzZRM6Ag1Af1157bSrviIj5P0iq++sk/+pQeWy55ZbFokWLkt4rX2TTrDGRbQRe2ZWjvfJP94xHUKYIFhni5DUK2FXpl/e27P1sIKci4yussEKx4447JltiMDP5AbaQPsinOpmWwLYJdcwfA72h3waMk0Xyh2j6HwFVf2xGF1B5hIRhNdOEERG+o6RGf7cFgqW7iNFnVDncNtMzEziJ6NOjGKN2+0yLcDAcEQXkfLRAsWoHB8bJKTO/2wAjz5iHkeMQok6ln4wNSxtlky//u9YnQ6+FMFdUoAmEIxclkSaGESH1+dGPfjSFzoXzzz333EQAkClrAmmVnnzyySna4396ph9YVOD8889PhEKD4BOf+ERx//33F2eeeWZx5JFHpkiDZ2oRa+nffvvtKcqA1Ajfe7ZzWv1XXnllaj1effXVyeG654ILLkhpcA+ipOtC2shPndCIIAMHHHBAypeuX46ec1ReBx10UHH00Ucnp+4cp4jcSfNee+2VyobzRLqnQdQX400n6CmZ9L4ga2VyhiwhLNEV5BoOXxSUrouWuB4RCXkMUuNZdQExR+LpEbLORkZ3PGeMzEa3Mb0J+C6vIricGVvqt3J3jrMnI6KXbEjXoEzlVVRAPqMbz2/dZ+qUXVlmmWVSXuqsg6aA9CIj6jzWEdPQ0P3JbogOsRFdGOcJlRMSDgBTpnSYsn5Vhk7ltwHKHgqPxWuRaPl3BYRe2jilYKpNOksK6FA2hFTfIgPD6DMqFJVx0q2D0LUBxi/YvvEs6jPqkEFXXmVHEOAAEJCQAWXtIIvDrm8D0sFpMQyM5aGHHpq6A7RkOAnkniMVLdGy0frnbP2PhMUifAwsx4doaIVr+XHWO++8c3Lertttt93SMxkoYxm0Bv23xhprpPIRcudkOCvlu/baa6f3KUPRAO/z3btjnSBEilOrE6IiRx11VIrWGbtw4IEHprRr/CBaygsx23///Z/vNth9992LffbZJ5Gz/fbbr7jtttsq0ysEBylDHjwbCRrUDb/pj0gNg6+VCnRrq622St2jGh/GXUiX8gfyULdshj7QD0RXealroO9az+o1xt8E6A495NSCaInkshWIlgkM2267bbIXyr2LCDsgosjWsX0Ir7F7IojyJv/yN6wLuE+QR6TX2C9+Rb2Qwz322CM1XOgIOeSnu9JIr5SQYGNaTlpRxh4cc8wxyWhoubXdTYL1izoYp0GBKGMXwPhoETHwSByFbqq7BkQe9txzz1QuWrqMIwVF3BzWnpEu4e+mxrXMhDCUupCMB1J2jEsYWN/LUM/RleMgn/KnNef6tsG4c/IIxtZbb526pJZddtnktBAD6eT8tUw5fYRVq1Wo+eCDD05dF4hGEBP55STjfofrtY7850Bu5F05ajy4xjs4F+WjTH3X8td61FJ0vXL0bL+VIWfrWu+tM5onTepdN4bx9yJDSJLoh+4iunP44YcXZ5xxRrreGDGEQZp22WWXNHiRPiHUnO80CFmjq7ot1JdWp/KP/4I4K2fX6Cbm5Dm4KDv/qW8DQkWi2MuQ3cHn1Ak2UfnpziYb0kZ2dDXtvffeKZ0aKoNAaDluNl5XGbiPrCkP5BUha6sROhfILRkh07qnlLeGjnE1yKOpsr4jLOxGXyGCh2jxyQZKX3rppUmX1JkuT3rB1qsvZdEFVCr1BBoT069ISbW09NcRdgLcBgiU1gzF51SjT11LsgtgcLFWgkIxOCFOoil4p75iLWx1xKAst9xyyehTSCRFeiLE2xawe85Fmhg7LUtGngHXEuCsGX7Q/aWela3Bd/JltVhdIRFi7wKCZHDunL2WqvwgfsqfHtEn16gnRsO4Dd0qWq7yT75dy3Ewqoi/wz26rDyDbKlH5eCc7zE4leFVXv4TWfEeREUaXOdez3CNclf+Ip7KnNNn9Oock6M8GFTdU8qCAUVGOVKhZxET5WcchGgPZ8NhivYpD2TPeAllO20jhM1Q1srF+znsiBo5x74oI2WnnFyrXrXCkT7lSAZ9aggg+6JYZDMcn3ewB+qpLtALETmDN6VZWpUluaFnzgHHRe/JgAidtHNwbGnUO1sqCiS6gOCQHYTWfWSpayBD1uMwhkd+jNlS/gbLI7wikiJyIgbGnSGRfQQ9QHj33XffRNZ1aWrE8MdRL/TdQHHnmiDAo6DSVFA+hoGyMZiEF0nBQmW+DYRzCmXTUiKE0toFMOwcjVYsA9Y0GEAGKULgZixwVlptIltG0mv9GMSGWLYBBlQfpzQxeJwNR6oFxpBHqzMUjTPWR6/ODeTikBgdeZUPTqAL4MSUKWepxRZADpxDEskEQog0IoocG+fMETD8HLRrOQzOEOFyD7KgHj1X/fmuPDzLNfrNDQJVVsYJ+a1LRDTGocylw/t8+k1GlbNnibAof//Tsboijhy+ehUNkU6tV2UhakdvOEvn2Brps/S4/EW+HIifbqkYJzEp5FNZKnf5D3By8i9dZBE51NLm9Mkn++c/9a3MECiQHt1KQubh+JAVdeTwvQ7IhzQiFXT/pptuSrolfdItxC9/onX0B7FTjnQI+SBHbKixTAbDkjez83SLcfKIIXnqIpA9umK8CL+A3JMVjRTEUQOGg9YNR476CkSefojmIeXIlfyVIyFItagWG+T6LmDkvWwIsfDjXKBwWijhABh/A8oYzbmAcWPaWkAKrwowFpSEQVXoshuh8CrBKMozhs2YjALGS7lSaIaXQXVM0rJgQGLp+HEMr/Jh7JWNMF4Ip3SpR4ZSuDxag+NAWTNgDBqFmLQrilGPLiNMnoxRLAbDdwaFMw5nKVLiejKnrpWvaziTiAZNA61XM2G8jxOfBFH3HKryZhg4OmUmvZwD0uw/eiQ6RTbcE61QRl/+RUrIt2uUj3xyeu5FTBAKz/VdWXKeyolBUsfKK+o4IiKe5TqH8vJ835Wp53Hyzsc5904KpAnBIru648pQTupWmcu7d6tDDRxpkF7/SzOdZm+kyfXKwCFtsV7GIDhlZJfhJqMzQfmpE3UD8qwOlLd3c3TKyDvoievUjfSQQWmKCIr0uNd18qP8kUDPkh+H/1xTdiAzgXNFGITeEdS5EDYxojLK2LukwbOUK1tAv+i/cleOQVRDtqRX3uSZDfFcdeNZZGtUyL8B0p6JUNYJNkQ9yHvkgS7QLVBPrgFlX3eUh+6KAIooaczPJyC5fJJBwmRzFFROSMAjCTWFZAQdo6AOQhLZI3y++6wDkxASYAygnL5J0jgpIfF+SkjxysonLeoPxiUiAc+ogpDMVod+x/8Q5Ve+B+SR8XFMiyoICUTdg/RG+Q+ejzxE2v1fzkeUQfmca9wXnw716Rrf43r/KxuOJ64PxDU+A/Es53xWgdkISRmciPRxduV3S7+8xflIm2vdQ35nciyjEhKIsolnD9ZXvBt8Oh+RD7/jP3Cto4zBa6BcpzNhXEIS74j0ltOhHKVbmZXPD6YLyv+7J8pkMF9zoUlCMlve20AmJC/E9NZ5CFSyFhbHPCoZqQvSEkLXtvANA4MTTiI+m4R3MuSDBls6GKVJyUiVkJYol8Hy8TvKsFx+5XtAPvzfJZTTXS7/wfPxPVD+DlEGZfjtfNzve5RB+XqfZQfvdxzhXMrn4rr4bBKcO3sy+G75Kp+PT+l1flC2J0W5DIbVl/Px3f9BRqD8X1w7iMFrHHXAe+L9g+mIdA+ej3vKRxnSqh4Gz3cN5bR3Pa0LEfVIfEZGRkZGRkbGGMiEJCMjIyMjI6N1ZEKSkZGRkZGR0ToyIcnIyMjIyMhoHZmQZGRkZGRkZLSOTEjmEYZNzWsbXUxTFZiv+WoTbZXpfKhLecgymdF3jERITI9qYvqnKXpNvKcumC7X1gqwys67fXYF5MaiSRbQGmehpK5DGUd5Z0wPsqE8p12wbhJ4t/e28e6qEPLo6CPoUddsV1NoU/brhnyN689HWhjN3hUW/orti+uA+e8WSOLELF9uZcU+wVLlllK29LAVDWNRsSag7KzuaIEkKydaYKrJ9w9DzPG3KqJF26z8aNXKWB2yr1DWVtu0CB6yZc+LvuepTTBYVkC1D4oVPi2ISHabaO17twUfLY5mtU4rk5LbPkUayKNViJUf/bLAVl02ug4ob/pj8USwVL2F7sapg7A1fYL8acBa4deCoFYZtuVK/NfHPAWkH9Gy6JtVjG0yWelKrTYjsv6/vS8sY11HYVEsy1hbtte+E5xqn4CQOFZcccW0/Hqs3tgEwihZGY9RtVR/FwiJMkAyCaZlzjmbuuSnCYQRIaP2AlHP9snJhGQyhOFilO0rYtlxhJ5DqhvxboTZfiwIs0YQ2RzBJHYGSFWsNku/lJ9VsvuiYxZUQ6Bs7gf29ZmUkHax3maTJxEE20AgY7ZuQCZh2ny0JcPeGXIn4vWd73wnbSmwzjrrVL90PMXdaaedkkOpAww9h2qzJ0voVrV0fFMQQbJ5n90TLSneJCFglFS8ZXo5/i44yVAKS8erUxs82RKgT623YVDWolGWjrefyQc+8IGUp6oNwGxGZS6DE0YBytfNdL6MUa6pEvSeQ7V0PNldfvnlk+w29W6NoFg6noxCE++uAupKHhAqmwsy+jZgrMtG1wGNKQTKRoSw2Wabpf1y+lIH00DdiY6w2/ydXYZhPuQd2ecPBTJEvSolJHZ9tVnUqHvZTAqVY9dZu0X2kZAI42+77bap5dw0Jt3Lpm4wlgTTPiFz7RXSF9ih+dOf/nQiJO973/sWn+0eRKgGlx9HlDmy2ZYljxYq8tUEyC6HOtdeNnWgHF0IQtI3IFUIMqM/yl42XQMCZS8bqHsvm64h9rKx03oQkvkC3YjyVvleNk0ytr6zw76nv0pEWficT+VSzlfVYJxFJG1Lbzv3MuymeuONNxYf+chH0nglm5INQp/taaedVuy3337J0ZeB8H/iE59I280Pg/EUZ555ZnHQQQelaGVT6IJs9Fk++65b0t/3PEyLuvJvZ2Y244wzzkj6D6LWhx56aLH55pun4/DDD09R7KoxSZ7ytN+MjA5B3+ub3vSmRCbOPvvsFDEMfO973yuuvvrqNN7C9vvDRuaLzukyFNE0FgPJePLJJ5NhMmhOlFM//TDYENOg6NhiPiMjo9/Q/WmcyrPPPpt0mm6LXIjumjxivKFB5bqPuoBMSDIyOgbGgqEwViUG++lnF7XQ1WKshe4YLR7dYa7z6QCkxAwg91x33XXFKaec8rxBEmURhfHpnJDqgw8+mAagITgvf/nLEymKLh0D7kRjPLuJwaYZGRnVgT5riLAHyAniYYzhDjvsUGyyySapm8iAWg2RLiATkoyMjkGo03gKAy1FQ4RYkQszlhiYV7ziFcmwGLN0ySWXpAHnvp9//vmpNWSgoHEiDsRDNw4CY9yLLpuHH344TeXfa6+9igsvvDA947DDDksDSxkuY0di5oP3Gwd0+umnF/fff//iFGZkZPQBbAFboYHBBrAJphgvscQSKXqqkfK2t70tLVXRBWRCkpHRMRhU+rKXvaxYYYUVkgERobDGjHU6RE6QBaPYRTSEYMEUQmNKtILc4xkiJabSOgzYNKhYSwjhMcVVy2nNNddMY1IQkccffzz9x4CZRv7QQw8VX/3qV59fF0Jod9i4lYyMjG6C3jrKYB9AhFVjhk1hT7qATEgyMjoIBsKaEsaTmIGgW8XCV8KrCIIWT7R+4nCPc8DoOOe388iJwzgRERBkRteQ9TeQFa2mIBv+t/gbsiOku++++xbHH398sdZaa6VnZmRk9APsAFvhCCISsJ4S22BRwK4gE5KMjI4BGbBYmKiFabCiHciCqYHGi/z0pz9NURJkQ5eMqau6agxkZWT8JxTrOeB6U0P977vuH6TGp99Ct0gIcuI9IiHGkQjxmo77pS99KY0x0XXTpzUuMjIWOtgONsJSBexCwLpVBs6b7t6V7hrIhCQjo0MQlXjuuecSyUAqrN643XbbFe9///tT6BUhie6T6As2HsRYDwTFwFdERCTDcwyARTZEWBihWGMEcUFEjBv5/Oc/nwyTVYYRFPd77mqrrZbScMghhxQPPPBA6u7pkvHKyMiYHUFGNC6igQIaPAiK6GiX9hAaeaVWxmuUhdE8jhHTYpNhS5kznDFqfzbo09JnbUXPvi6Mts0226T+/6bRxYXRyIIBmWZqGL9g8NR8AKdtISrTaxGFKoEweL6BqJw/WXIOGBVExG/ndb8gKK5lVIRk3eM60Q/X6JpxTXTrICK6bkwFvv3229PKnquvvnq6370RQYnZNsaSOIeMGIuC3FQNg3URozYXRjOAuK8L9xlf9NnPfra3C6OJyumWJL8LdWE0DQ8rlFcNEU3665Pes1l0mI9mN4xLq4uQaBzxSeMsjPaij/8ai7/PCKFaRmoUR4d53XPPPcngcURabjI9Sj+VgjPIBokxk6BPIFhIm1VmR61gjkMr1pRKRhmTZSCVAWcwbJ2JmUC4kBLjApTfqIh56WZUIFTWujAw0nOwa3u2UJhwSuOOIeBAyQQZcEwK8kemGF7K5FnSIs+PPfZYEv6YtloGUqxMLfyjy4LTnVYBKbdyUkciEFUCcY/xHQhHjAEJQsGg+M81fiMd6sU5/+nmcZ/v5Wvk2+84T+ZM+2UEHc551+C9viMiynWURsUkQJLUkTwYIzMIdcjpqkPXkSdpk1ZdURox5MAhjfJLr6zhQi9910XFIA/mgSwhXezNXPKJ2EmDd0YXmfLmSOkOPaJP5MI1ZNU18kWnlDndVpbS7xw5QtqRTPlxvXrxHPeNArrpOWys9WmmARvGbis39kn9l8FGiaixF9IskkZupoG60SWoHJsgheREg0I+1YM8BMiasmS31EcdBLwM5Sk90kDPqoa6IfdkKWTVQUbpSZ35I0vypit41HEqlRISTNeeBJyYVpfr9UETbgP0FMhsWGiEhGBQxLPOOispOYH0HAZW/scxLpMSEobVWhXqjYJqqYpsaGl5nv8oL+Mjb3PV4SCqIiQM4C233JJIiWiUMjamwnnTUW1sKL0MGgUMyJPZIgy97+RLa5iTnxR1EhIgF4FRvo8LesoQMriiEiKY0zqVaTAXIWFPdEtxkOTV9GV1zHlYzVZ+yL9ILuemfm+++eZEUpUTYuB/4WkOqIxxCAnZueCCC1JrnvyZPi2qS9/I2GWXXZbSpTzps4YZ++daA5Ldd95556U0iQJzBvTNebpP3+39ce655yZCMmq0oypCoixsE0JPyIfWLUcZzkQDRdnLF5ugXvw3rQ40SUjki72QT7PKkER1EzYTsVTHbAmfhZjXiboJyaCdmMZujItJCEmlTR6KoVXCUDB0KtQnxq//OuN3QREYQp82arN63gYbbDB1S2dUENCVVlqpOProo4u99947TTVFJAnTHXfckf63DPmHP/zh32ktNQXyxHgrl5NPPjkREQQE2UGSLLO+4YYbphYn8hOQB9EdBMJO1RwVg6pFupCBSFkcyUZm4Ri7DI4PudCd86EPfSg1dhBjdeuwId/WW2+ddglHsjg3jp0h3GqrrYr1118/TXEmR9PA80Sj6Kp06IK0E7oGBJmMNWIY31VWWSXJJQdLDqVL+skoh2dMDrjWvewksiSdnBPn3zSQfd1XuvHMqGLPY9M7UH4IlzFNBx54YIq6uQfZ6ws0rJW17RGsw6OcNWogvrMPyO8IoxkyKkalhEQFau1ocXACWl2cGCFwPuN3EeF4LXitKgZWi4rxawKMKwP0jne8IxkYzglTZzgZJF1uxhoIe7fVilY+HCeyxGBrkUkrIqectCYREf2wsYU3kDtEmMEMR8LoYO0LGdEtxLkgJ022miaBFqw6s+Ish7nsssum6cjkQAvTYm+67cgHUi9fHMqVV15Z3HrrrUkmkJZxo3uDIIf0lR44RGbIGJ2hs8rSd+8hmwizdCAuzgmRIyr064orrkh5cQ5ZicgNuXauru6x2SACJEIrrZw2gkXvg8j5jVQhs+qE7rHvkfY+ANkzpgFRFDEjQyEXIkPsnvEO6iHGbmU0h0qlXmVrXQurXnrppWlkP8YpJEfpMoaD4HOaWnZaHAxDU2BAGVlO3XsZHQZd6FxUZNddd03hYPXZFqlknBkNaWUwGQ277HIKDD6jqZWqJY0MB5AQC4AJy1577bWJ7CEkHEdGf2D2z0477ZTk0Jool19+eWrwkAHRO10NFnfTHWImgUiYAfiijMcdd1xx1FFHpTEoSMM00OBykDeRNu/aYostEqH3Pf4HTtw4EqTDuBM2kI5xgLvttluSZ5ES3eFlh15+RtOwQBYdQ+R0f4kU0DHnIMgW0DNOW4SyT/pEBpBxNlfZi1AhWbreyJFuMvKDpEe+M5pDpYSEYK699tppC34sX38cJ1vuh8x4IThUDpfjtGqm8LLvTUMkwUEZRRIYIukw6l1XCRJgUF+bQIiQDouFCSmDdBqUKY3Sp184wHgK7+sGU84MEGLcVHdYxvTgyDkR+26cdNJJKdJhLNH111+fIhS6G0888cTUXaMbBFlBOsnEsccem7pWEIJzzjknkdkqgMCLgJCrHXfcMX2nH2Ug9fSZs0OW2UKy6jrRyEWLFqUISoxX8F/bkC57nIgoIfGitiKSg2mTXoPwlfEoEx26CF2A8iCqZsyPcTE2rrzmmmvSuCTjTDRgyF9Gc6g8LiiMp49RK8AgNSTFegbDBqtl/DZCwXkKg2pxtFFWQt8cujpjgDjwQPSdR+uoDWgRG5+kVbbqqqsmciISB8jve9/73tT6dB1ooTImziHIwubKWkjfuYx+gBxyjg4O0J47Qu4iDxyGsSLGqtlO3RRs5IOzQQA0gkT4RDGM4zALZhqQH9EMBES3BZmiLxoU/nOE89bC5szJpXRokbvX4XpRH2N4RFt0i0ZUJN7RRpcNW00/pAs0ToL4B+ESRUDs2SjdZsrVuT5BpE3ETPqRMHaP7SU/utPYY2URM88ymkPl034pIoViMOzB4Z7NN988OZK5sNBm2QBDe9NNN6XWiLIadc2WQejy0XIZd5YNuJdhZxQZew5en7wQuNYdJ0959bmOm7YqZtl4vxaxDd44GqP/yaS0mOlg4J33yLet9b1PS0d+yJFZFiIr+o3XWWedqQfnSk+ds2wWGpDL2WbZGFul1UpHkArdBZyHSMgNN9yQIiVICB1EWhBoA7LJLoev60E9Gb+hS7IMznTUWTaivTfeeGNKq/fQVZAuszZ0T5NB3Td0WvcrWTH+ie7Ih1k3CIoxGkGgHSI/oirGMcgrMu0cGZsLVc2yYePZI/qCQInWSrcZNbpwlLPZRKI6iJ9opLyLqEj7pJDXpmbZsBtmNRpbRJbMcmJH2A3dNQgJuVKOzrGFdaLuWTZtgj+UN/o4ag9JpYQkBIvQMhDYJ6Ee1UEuNEKi9aflwbAxcIwUBZhkkOE0hES9aRUwLBRRq0B/N6MkMiJP4xKtQBWERPqUE4VlIAk42dKC85/IjbQz/Fo6DLwylBf/MTBaqwZDTpqGMjIhqRazERL1SO7Iof+VuXoWYUAsnWcrnOfMnGfcNYCc10Wn69F5+jWIUQkJcivq5jrk3DO9X/roiveTSUc0vqRNmpwjh/SdbpIZeaFznkOm5VtDjjy7Rh7JeZOERD7YEWktL2Yl39JK/9gn6bJwJZ1iF+RHZGdShN9ogpDII3mSfvKg/OXBpzyQF+WoTpTlNPkaBZmQvBCVrtRK4TBmoXQCTMkGWySzYSGu1EoZHZQREZhUAVT8pCu1EgHkI9IA0kR5QV1Oki7P1TrV6mNoJl2p1XMQEmmK34x3ECdy57dDHuTF9f7X+nGfT/9XAQ6grpVaFyLmWqlVfapD9e5Qr2Qy6hnivDr23fXkwncy4fph0T1ESDQXuZ3LGUY6wLtCJ7wn3hfv8Nt7pcd15TS51+F/5+O+kN24133D0jyIqlZqnendzjmkOfIR5Rp6Nw1EXppaqTVkZlA2oi6jPiDqpE5oyOp61KDSKJ1PEJQYd6XW8eLvc0AFamVoEWCY45CRhQqKoBWEtYdSNI0wQAxOwG8tJUdb6QqE0Yj0aMX4Lb36eeN3GA/nlSlD6buyndZo9hG63awvY0ZInxF1qE7Vt7qO886Vz5MBdsj3OO9zFMc+FyIdg7pafp9PBzn17rhOushg3Buy6tNzy7LrGs+oIs3jYKZ3S6+8SX/kjc757JtehcyU81Cuy6iPcp1kNIfKJZ4ghyPIyMhoD/RQBMD004yMjIyuo1kKnpGRMSv01xtTYTAmIiE8rhvUd6Ftfc66OIzNMa7L+AfXQgxOjt8ilMYqRAjap25FXWhC1xDjBtwjfOy3Lindp94HQtwGO7o3npWRkZFRNSqfZTMNFtqg1ioxzaDWOlHFoNauoa5BrfTMmhpWxqUHZluYlWHAnxlrUcfW2oh3G8uCoBicaSyEtWQsZy7cbKCcKaUGTeujth+MZyEbZifpUjAb6aqrrkrjvtyne0c6fPc+4WxrNBinoE/YzATvdW9VmGuWTZ0YZ5ZNV1HVoNa2gHQ3Nai1a8iDWl+IHCHJyOgIKC0y61hvvfXSjCERCSuSGuTNaRtIy3kiCIiFiIZB1KZhIi+uQRxMQUWcdKEiFQiIwXPWBDKdFHExENu9yI3BuZyB5xmEZnCkAcnIDpKA0DCeIjCISkZGRkbVyIQkI6MjMMBOlADhMKVSZMN3hEDUS9eJmShWJ0VGDFo1MA+hQBIMJrcooXUWLExoDIlZA+7TAhWJQHKsdIvYiAy43/RU57VkvF9LTUtbt471JRAk3TXW1zCoUYs2IyMjo2pkQpKR0REIWTtENeKI0f6+Ixc+zWAzvsNS6QiL38L2xnkgFwiEbhfRDtcjJrpYdJ0JoSIwfiMbCEb5nd4Xnw7PtMCXd+iyzYPVMzIy6kImJBkZHYHxNrpikAlEIDZnM24jziEVxnDoerF2hkW49D9bohxxsNGbZdTB+AhdLKIjFgYT9bBjrtVNERLLhHu2d4iAxJoxoi9+e6dlta0NdNlll6X1iHQFeU8Mis3IyMioCnlQa0XIg1qHIw9qHR3GixgrglQYT2JMh4XCdNkstdRSaaVZYzlEMJANBMOCQ8iFLhf7q1hUENEgh8iK38aE6KbxqRvIYcyIbiH3eZ9Pz/YO3ULy5d3Gkjje/e53p3tsVuiZ0ywVPog8qHU65EGt/UUe1PpC5AhJRkZHwMkjErEfC+PsOydtlVubyGkcWOxMdw3SEMQdCbakua0aEA8khYNFKnS3IE9Ih91N/Y+0IizegcgE6fGf63z3POTEe4Ps+H9U45KRkZExDjIhycjoCGIMiSPGjjhERMBsGa1JJMRGcW95y1vS+TJc4x6I++MA40mMGwnEfzF2xHef8b18TUZGRkadyIQkI6MnQBpELXbYYYcU6SgveZ2RkZHRd2RCkpHRI+iKMWW3HOXIyMjImA/IhCQjIyMjIyOjdXSKkFhnIWNydLH85mudZlmtHm2V6XyoS3nIMpnRd4xESGLQW93o+y7B+vTloQ14r5kUbb1/GMiN2R+6F+bTeAd5kafcbVIN6Dy5bWO6vHerxzbeXRWUXZ91LNK/EPVpPsjfTCCPjnEGxP/er1n1nLTaxl7PPvtssckmm6Q1GOqAirEQlHVI7N1h3YQ+wb4gn//859MaEPYHMRuiqZkJyk652c/EXHZTRLuycJX1JawxYBEvU0nJT19nbFAVCmbdjC9+8Yupni1IZkXUjPGhPBljsmsBN1OdDdq11H3diHfbVNDicKY9V7mmTFOg+3TsK1/5SlpHxlpRVvHti46ZzcUm2AYB1lhjjQWhTyF/9op6+umniyWXXDJNzx/BHXce8qBxbIkCtn/VVVdN6yWNgpEIiZ0/H3roobSAku3R6wDFsogKtrzxxhunCuoTEJI77rgjretgfYcmCYGyswCZxdkssKPs2iYkYRAtisboI0qMflPGhljXYZSVtUUCbWBnHxjkLxOSyUHfyS7jZdl7xLWpvXK820q0Nhq0ZosF46BPToE80jGr7NIvC+vV1WisAwgJAmoVYvpqnZsmCGkXQP5+/OMfp9WZre1j/R+oU/7qsotQfjayhSjb/2rzzTevlpBYMprSLlq0KL2gDmh5UiqHVSEZpj4BIbHV+0YbbZRWnGxyAzJlh2lrJVl9s6lW5mwgmEQrtq3XeiOUfXfeHICVMT/3uc+lel555ZUTSR9BjTKGgFFmWx5//PFEpK0US3abKE/vtsKpyKLoiAgeubVibh8grfKgFSo6qzHEdtbVaKwDQfDtRg0f/OAHk41YCPqk7thHdluPgEUR65C/IAmDZRrnoeryRkj0qtiWQiCjUkJy9913p2VgP/ShDy0+Uw9Ujn0zVAym3ycgJBzvtttumyIkTeO5555L3QhW1lR+XQFjqfUjHOmYD7Dc+Kc//elESOy8mzEdRNAeffTRJLscapNAhhhN9mbYQnN9gK7uz372s2m3ZxGGvgEBueeee9L3DTfcMH0uFCDEX/jCFxIZrntrlqYh6ilvVpselZCMNKgVZxmVQf3/27uXVqmOLQ7gPQ6IH8WJwUFwIiJGDToSog5EjSgYjPEFZiDiEzEPiW8zCOYhRgxkpCIIjhT8DH6LfIDLr3LXTd2m+5x+7O7d+5z1h83ps/uxq9bzX6tq18bu+qcLVAuUpsxtLoVxrrOI0Pa2RleuG8eiIOSxaO2aFvrSpq5XGkKebfh+XLfLuux6H7Q7bGC1YZa6k3etzbp69Wp53IQqZF25l5MtxbCGZRbXn0Snjdz2a87SCOfbb78tTLcuGVqwZg3Kn3/+WQ4j5sTqwmoMNLNEyjOxktCGPa8GH5J7kY2///675F1P7PY0b9B/VbV79+6VWYlFkUdjT/s1XeGx5sjIJ598Um5jUtq20NN7SomEgrEpLX700Uf//ea/WG1P+1VJssLfGh2PdLcIyLSLR7+vXbu2HKNimqf9ui5C+f79+9IHC6wwae1isPTnKaLjtCfQ1NN+PRXzjz/+6N2/f79MT1lvwIZev37du3v3bmH6ZMj+tN8cJrj+kydPej/99FOZGojvTQMEfNKn/RqVIO3mjdl4LVN37+gHGyAr8+uvXr0qh2mFDx8+lF1a3d3js+bd3Z2gZM+vPLWW7qPvXcFyT/sVUK2RME2mn+amLSgmP+dNKVsHQv/6Tv+mCZ0nZ0HZuhSLVi2irDHO037Jme74ivVi1rtZRO43X7x4UfSkCkw/1hixVdPQ+sRm4m5FC7ztuMtWtZkejSYt6hUj/Zb3Rn1y77RP++Xf2sr2+EbowG9qm4TF1vW1RiQ5ccL7rt0v31Eg1vgtaxpm9bRf8qQzSdiaO7oWf1UN7ty5U/TFF+nGZ9mTB1iSAbvRv1lgVk/7RTD0Q7ywzs3v8wk2QsamKtky27cwX06eRHdLobWn/VKwOVirhOvpGolVENEYjy4XvBm3eaXEPwu6gDNwFEYjKElajnlAImCYCA0nlfgQE3rijIIrHf7888+FlLYBwZrNCFraKLA/fvy4GDvGbw5aIhJEEDz2CBZg6wenlwD00/ckuLZAnmR+8eLFkjBrsAHjA/1AaiU4QUQA8b/kJSnS1dOnT0ty5lsWxDknOSNgKw0I2ps3b/43UKFjZODdu3clYYo7grmBk88KhIgqckA2gq6kO+3dJ2yMzOmJ3JGd77//vtglf3358mXxGSSH7bE57Zaw+TpSdPv27d6DBw9KsqBTeqNT8Bn6o3d9mweCzJCrhfG//vprGRTqw/PnzwsJRhT4DjIV8D2DMATG5/lV9GMRIUFLwsgenwLt1SfxAnE0aGFDXtOlXMZXVfiR5i6BzuQT66L4jYPNyi/uLBPnDc7kbXa3KBWSxigRZ+WAkWSBMXPUYM6YJqckDA6Z6JVAYGTIWNxhsHnz5vIIeQv85gGOJrAKQPQkWTNYutq2bVvv7NmzpeKFXLbllEZQRm1uHzt+/Hh5HD4iwpa2bt3aO3PmTG/v3r1l0axRToxmEBn92LlzZ+/kyZNlcZUA1GbSloTccaTtiB5SBeQeZEPQWLNmTUmugqcRDF0g9TH6dpCD/vvrXn97ogQZC0jKqigSYxAx+pX0/L52IHSCdSwqp+sIUPzXgu16nlkCkqCcA8lX9UnSd67p207jd9mAuzDsVcFvEDfkABnZsmVLOS/wSpT6JuYYHfInd+3p6zRAho04XXv79u1F7kbY2ubuNrphf9pJV3v27CkjT6BP1VOf+f333wuhBL9loKYP2uuveLDcerum4E6PdevW9Q4ePFhkKIbzNzGafLV5/fr1JTGTaYAds8v9+/f3du/eXRbyL3JM114jde0M2Ton5n711VcltvADfXSIdXSI7BoMsamuQS6mX7Ed0WKvSAgf13f/03f/ms820RghEcAiiGFnXmPRwAlBovCe8xHcVjskEDKRDExJmPbiDALVPID4IBxGQ7du3SqroTdu3FjOY88cmCNj24y4DZCRJC4AkouELTHErZrax96ci3v5QVnf9/RFQvA5DtlWPwLa5Wm9An9USSQAgWPDhg0lQAgkpkgl4y+++KIkPWQVcUVGBH+jf0nM4TU90lMA8YpRu+9cv369BFejYAEWEWVzEs+NGzd6P/74Y7GDR48elfK2qTEVCG0wAmabPqst2qjtpsNc4/z586VaoMyNsDQJSV3M+PLLL3vPnj0rCVSSJB+2cfTo0dInt7sjaPQsqd+8ebP02WuymfbuN3IW5Pkr0qWi4C+dOK8tkQQc5IT8Icrx3qZNm3off/xxkTuSKCGwR++BGKnq4FrzAFvUfhUnlVE+hVDRuYoouyI3/oV0RtzWRmRftUo1J763qKAzfa2nXpBXuhFP9EUf+CRyrn/e91c85gtdBJJlUKP/Bi30aDDB1/kGf3LUZLNNzNTqdZ4gwrkYM4U770j8S+RUmMhKAJtnJYKTCuSur7SsJC14RqITqJTAjTIl/DagHSEfo3d2pGIAzgmczguc9Tqn+B6oPkhqyJbg0yYECTJXTlV9UCWxzgZpEtRjpKmP586dK8lfMv7hhx9KxUIVRQITLAN0RpfRX0A+HEaBEqHELiAjcUbiEpCKkYSoTcgeomQEKcmorLBFtzarPtC/aSEEBDHxXUTad1VfVKA+++yzEuCbBJKG8JANeTiQAevSTH3R+eXLl3tff/11SZAIybFjx8rO0qoRRv+SP5LQBNjSX3/9VX5Pdc4+C/rfH9fIhV1am0Fn9IgwHjp0qJD9hw8fFlIYZCQwz9jIf0D1SOwx1cUuxGlgUwH9qatMvssX6UKlSkV80VHLNoijKV0EjD8iu/53PuIg6HvXQId8VGzRL3Ymlu/YsaN36tSp3qeffloImbhQD+TaxEwICaUzViMTBhubqQl03uOUlJ34R1aM3ijFlvl2qZUw5gWjZ4kH4fjmm28KATHPChzTyF25W1KK4NUWOJNRpzUVZBWQDPSDww1aeGvE7ntKlEbWbYNPaKcRiwB/7dq1EvCiahJATJxTeTDtJKmqWBhVs5tBQbIOuGSiSiJBS+qmGUw70CsioQ1BZPikEWFUkyQnCcY1VJVMfQheziMzfgsxkOwREGRGBctnpq1E1CAfh6rClStXCtGQxH/55ZdiD9p24cKF3unTp8vI1lon5/UZQfEewmXdhuDcBPSXPD///PNCwPQX2aj9g0wFfHJSWeBXZE2/pncOHDhQ2mVNCV30k5J5Qvyht8OHDxc7QDrZgPP0z14hqjkB/UWsTXeQAfK1yIm79o2A9ooN+mKwwo7pgj71219yqMl/F6CvBpeqIG755TcnTpwoU28GKOK5PX/oPdaZLAIaIySUyOFqVqkEJgBySDBC9Z6RTT2SW80gL2ycs5OVANv0CHMpWPAnUCNE+/btK0YqYcWaAG0yt2ykLKgOcup5wAiTg3Eco3WjshiRqRoIlOwNBBEkWECRkCUwpWcBhw3qcwTZNhA+YhpBu0yTsAGBgXy9D+7moBsE1YZ7bENCkwToQ78C+qnsqm8BSVHFwGJY1/Pa1Iv1N4iOpE1WMVJ08EvXR1YEafPNfps8VUWMtlQIgoSY+tEm9luXw5sCeUgYRu1GcUeOHClkVFXJOcmTTUjwCJ72sQtEWl8QOcRB3wTjaRC+qlJEJyo2+k1OodOaWEjupkCtzdIW7/m+zxuV0qnX9BH2GNeYN0GhO8lJ5YbukUvn6Fq/tC8qi0E6tN175BDTZGG7i4iwb+0Gti/GmXYzHUqvqq1iHnvnYz4jtiDhXYOBpPUxpmMNHpASMYfNAl2r1onvZLMIaOy2X58xxyzgW1zHGSmWUgWyCKCEZFQxiHH6rtGsACPYdQkCs5HZOLf9CraC6m+//VYSiSAleIXDjAMJW5AWFMZhuwKIIG6e0d0C2kTP1hBcunSp3NGifRKTkvy4jimZ+X224JgEgoPbj5XnlYbZmaSD2AqeyswCh/UDHItMrZh3bclYBULSV743GjXaJqdJIYCpPgjYQYJGBfKkHYgG8sdWBEJtd85aCAFfIjNtoq/sSj9cFxkzuvEZukFajEwdSCWCE0mBD9Lpd999V9Z2SBoO+wHRZyxk5dt8VEWG7amQITOqANae2F9I4EYEJC2yFOR8R9WJ3ZnC0A9kadxkKjYgC3TSvw5Be8iBDfIxBMR8vkc0IM5xOzeyijBrIxt99OhRqSixE3FHVU21IoJxwLodvifeLGef+ks/ZEYOUeZ2ffPwKo2IGrKs8mHRMp0hwtYymepiqz7jf7YjoZO7UasqAz0jjfQrjtZTJsMgbrJH+hc/xoE+me4yXUu+7EO1VBv5bdiXypkqmfUHDjbDjumFPsR1JFdlZVwgtLO+7ZceTI+yU37BttmVCpp+uJPGQm96EVfIIqZT9VtldRZkiw27hjY1SXrIkq2zB7pja+y1rl6KlXzOuUlyznIQt/SNTbHNUTDys2z8uBXVg8B5GLYgRwgSGgPVYUnBeU6KYZvLGpYwBQ+f9RnsrUtgvBxXlSEW8S4Houf0gonAFNWRSYyD4o2QGd9SxLEfUUUQlAUGBqoNSvOcUqLXTueNCscpXfqeJGEEKNAYdU0CJXtt0UfJTpu1kY0IEhIr+SmFg/6wN2RFGyQ73/Fa0hF0RiWNgyABSHYSsJX44wC5Muoka+RBu01l+i0+pq18SGJGMtkHP+JjdCCoIEKSuN+RUOlEQOP0dQLTX3Jgl/qL5Phtgwcy9Zp+fUeCMXr0W+QnSPFX32effJYOyd/36cP12IQpM5+jEzY8buD2XcSH7UoUNeiNXMI+JW96JTt9p3ttcl4/XB+cl4R8X3vIU/v6Qd4xLblUMiRLciELMqMH8uGr+u96dILYuJ6BlXaRm8957TNsx//OO6cPvkeWdETf2uQ1edQJZBgQJESdfpHtccDGkE3y0y4yYmf6KwYgG/ooWbJRfWCv+kkn2q/tDu9PErv8HpLru+6imgXYu77Qi7aLFeSOCLm+a/MHMUU/fJbd8QdJfRRiOAn4kXVeYpIB30oCu5KTEDy2OQoaISScnkFzVAHWwaHCOL1H6c5R+jCsNkICIX6y8noSh4ZJCUnAtelRkGwKfrMJQrIcahkGBp1rCtMQkmhXYFibvY73+BUM0s1S7wWGyWfQtWvE+/2fBbbi3FK/OSqWIiQ19NU1+gmPtoTt9rfHd/rP1xiVkEDIyG/Vfe0/D/FXLIT4PzCsPaN+rsY0hARc0xFtrRHtGdZXh9ejtHMY5kFIINra36dhiM/PEklI/h+NrCFhyIgGNo9RGsHVikREBO+lyMhqBTmFrGZt/EvBtZskI/NELcPAoHOLgGjXoPbV5+r36GWYbpZ6LzDsWjXiM/URqF8H+Hz/+UGfaxL6Oaj6oi3OD2rPoPOTwu/Eb9W/2X/eoU11go/zcQzDqJ9rEq5Tt7VGfzvq/+N79fuLjLrdo7S5K/1aSWiEkCQSiUQikUhMgyQkiUQikUgkWkcSkkQikUgkEq0jCUkikUgkEonWkYQkkUgkEolE60hCsoIQt7MtEhaxTU1gpfarTbQl05WgS31Im0x0HSMRErc/LXdrYRNwi57NmRZlG9txQD7a3Vbbyc7t1YskO3ajTXQ66HbNrkJf2tT1SkPczstO5g3Xdl122lWE7LrqY+FLq9GfIm+0YfuzBnsclzeMtDGa7XZta71nz56yic0soPE2+LELpGd62CTJzoxdgP1VbLGs7bt27SrbJ8eGVfMApdtZ0AZkdhW0BX3bskNGmJadLcnFxj+227Z7ZpfBTm33bNtpO4baLtvGf4nJIBDbet0GSnZTtYkS253HaF8isKGgDQ3t3Gn3V+hSpYE92lzL4xLETfKz625X9tCwj4mYYGM3bfZAQruqdkkHk4Lt25jPYzps7R4bR07a9/jeIugewffsLJujecaUR0yMgpEIydu3b8vzLWwpbEfEWYAQBXaHjdUoqytGiRDYhphj2ZaYk82z7WTHiQUiQdbmdIsiO1ueI7F0irjNyn7mBbJGNm0XTu/IZ9f71Cb4CtslTz5vi+55yTP8Rszp6ihVH/iYRxLwMfKb52BoWmg/fdvCHmyguVr8ie2zPXGb7hxdyXnLQd88VgBn8IDLeKTDchiJkEi0DGYewmKgK0UpiURi8ZExJ5FoHnwK0fcolVGnE0ciJIlEIpFIJBKzRN5lk0gkEolEonUkIUkkEolEItE6kpAkEolEIpFoHUlIEolEIpFItI4kJIlEIpFIJFpHEpJEIpFIJBIto9f7D0dqwishE84IAAAAAElFTkSuQmCC\" width=\"548\" height=\"359\"\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eFixation protocol\u003c/em\u003e\u003c/p\u003e\u003cp\u003eAt the UQTR anatomy laboratory, cadaver donations are accepted within 48 hours from the time of death. The 10 bodies\u0026rsquo; vascular systems were cleaned and lubricated with one of two vascular pre-fixative solutions (Group 1 Proflow: N\u0026thinsp;=\u0026thinsp;5, Group 2 PI3N1: N\u0026thinsp;=\u0026thinsp;5). Then a fixative SSS was pumped into the cadaver. At the UQTR laboratory, a SSS is preferred for SAWs due to its lifelike properties, low degradation rate, good image quality, low cost, and ease of use [12, 13]. The preparation of the bodies entailed cannulation in the right carotid and jugular veins, to drain blood from the jugular vein, and to connect the carotid artery to a pump (Duotronic III, Hygeco International Products, RRID:SCR_027129) for injection of the pre-fixative solution with a pressure of 12 pounds per square inch (PSI). The standard volume of the pre-fixative solution injected in cadavers with a body mass index (BMI) between 20 and 28 was 4 liters. Then an average of 22.1 liters of SSS was pumped into the cadaver at 6\u0026ndash;7 PSI (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Finally, the cadavers were placed in the refrigerator for a total of 6 weeks, which is the minimum wait-period to ensure fixation of tissues by the SSS.\u003c/p\u003e\u003cp\u003e\u003cem\u003eExtraction of the heart and aorta\u003c/em\u003e\u003c/p\u003e\u003cp\u003eTo access the intravascular and intracardiac clots that we aimed to qualify and quantify, we conducted a consistent dissection and extraction protocol of the heart with the aorta. After thoracotomy and pericardiotomy, the first part of the dissection was mediastinal, and the goal was to free the heart from all pulmonary and systemic vessels. The heart and major arteries of the aortic arch (i.e., brachiocephalic trunk, left carotid artery, and left subclavian artery) were immediately dissected and ligated, followed by the dissection of the thoracic aorta to the aortic hiatus. The inferior and superior vena cava, pulmonary arteries (left and right trunks), right and left pulmonary veins were then dissected and ligated to free the heart and aorta from the mediastinal cavity. Then, after median and chevron laparotomy, the second part of the procedure consisted in dissecting the abdominal aorta. The Kosher maneuver was performed to reach the retroperitoneal space, where the abdominal aorta and the common iliac artery bifurcation are located. The abdominal aorta was then dissected up to the diaphragmatic pillars, and down to the proximal portions of the left and right common iliac arteries and finally ligated for proper harvest. Mid-proximal ligation of the celiac trunk, superior and inferior mesenteric arteries, right and left renal arteries, and the phrenic, the suprarenal, the lumbar and gonadic arteries were also performed. Finally, the aorta was extracted from the mediastinal and abdominal cavity simultaneously.\u003c/p\u003e\u003cp\u003e\u003cem\u003eVariables of interest\u003c/em\u003e\u003c/p\u003e\u003cp\u003eDemographic data were collected and compared across the two groups: 1- age, 2- sex, and 3- BMI. Variables related to the fixation of body donors were also collected: 1- fixation delay (FD): time interval between the moment of death and the injection of the fixative solution expressed in hours, 2- the quantity of fixative fluid used expressed in liters, and 3- the extraction/dissection delay (EDD): time delay until we performed the extraction and dissection of the heart and aorta, once the six-week wait period for complete fixation had elapsed.\u003c/p\u003e\u003cp\u003eWe also collected the following anatomical variables: 1- the length of the ascending aorta to the left subclavian ostium (i.e., upper aorta\u0026thinsp;=\u0026thinsp;ascending aorta\u0026thinsp;+\u0026thinsp;aortic arc), 2- the length from the left subclavian artery to the celiac trunk (i.e., thoracic aorta), and 3- the length from the celiac trunk to the iliac artery bifurcation (i.e., abdominal aorta). The sum of the 3 segments was also recorded. We also measured: 4- the diameter of the right atrium: from the point where the superior vena cava arrives to the beginning of the inferior vena cava and 5- the diameter of the left atrium: between the superior and inferior pulmonary veins, from one side to the other (see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Subsequently, we performed incisions in the ventricles (see Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) to measure: 6- the width of the interventricular septum, at the point preceding its convergence with the pulmonary trunk\u0026rsquo;s wall, 7- the apex of the heart, at the point where the myocardial muscle was the widest and closest to the edge of the left ventricle, and 8- the diameter of the right and left ventricular cavities together at the level where the interventricular septum was previously measured, from one cavity's end to the other (see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Then we performed incisions of each segment of the aorta (upper, thoracic, and abdominal aorta) to measure 9- the circumference of the upper aorta, taken between the left carotid and left subclavian artery 10- the circumference of the thoracic aorta, taken just above the coeliac artery\u0026rsquo;s ostium, and 11- the circumference of the abdominal aorta, taken at the level of the inferior mesenteric artery\u0026rsquo;s ostium. For each segment, 12- the presence or absence of a calcification-like crust on the vessel wall was recorded. Finally, we measured: 13- the weight of the heart on a scale after removal of all the clots and the separation from aorta (Ohaus Valors1000, Data Weighing Systems Inc., IL).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe lengths, widths and circumferences of the segments and cavities were measured using a catheter. Once the catheter was positioned on the segment, a bulldog clamp was used to secure the catheter in place, thereby providing stability. A second bulldog clamp was then employed to facilitate the measurement. Subsequently, the catheter was superimposed on a plastic, non-extensible ruler, and the measurement was recorded. The catheter was selected for its lack of flexibility and tendency to retain its shape when used on curved surfaces. Each anatomical variable was evaluated on six occasions by two researchers (three measurements by rater that generated a mean value by rater) to assess the inter-rater variability. Furthermore, we kept all anatomical specimens to repeat the measurements at a later timepoint to assess intra-rater variability.\u003c/p\u003e\u003cp\u003eWe also recorded the following variables pertaining to the clots removed from each segment of the aorta and heart cavities: 1- presence/absence of clots, 2- countable/uncountable clots (uncountable clots were the friable aggregates that disintegrated into multiple and small fractions upon touch, hence we were not able to count them), 3- number of clots (when they were countable), 4- clot consistency (mixed, soft or hard) (see Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), 5- vessel's lumen obstruction (none, partial, or total), 6- attached/unattached to the vessel wall and 6- weight of clots in grams.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eQualitative variables were assessed across groups (group 1: proflow vs. group 2: PI3N1) using Chi square and Fisher's exact test. Quantitative variables were assessed across groups using either an independent-sample t-test (when normally distributed) or Mann-Whitney test when not normally distributed. Finally, we used a general linear model to relate the weight of the clot of each segment with the length and circumference of the said segment as predictors. For the weight of the clots in the heart cavities, we used the diameter of the cavity as predictor for the atriums, and the diameter of the cavity and septum width as predictors for the ventricles. The inter- and intra-rater variability was evaluated using an intraclass coefficient (ICC), a two-way mixed-effects model, mean of k raters (k\u0026thinsp;=\u0026thinsp;2), and an absolute agreement for intra-rater reliability and a consistency agreement for inter-rater reliability [14]. The interval utilized for the assessment of reliability was as follows: \u0026lt;0.5 (poor), 0.5-0.749 (moderate), 0.75\u0026ndash;0.899 (good), and \u0026ge;0.9 (excellent). The statistical analysis was conducted using the 29th edition of the Statistical Package for the Social Sciences (SPSS).\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cem\u003eDemographical characteristics\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThere was no significant difference in BMI (20.7 \u0026plusmn;4.5 vs. 23.1 \u0026plusmn;2.5; t\u0026thinsp;=\u0026thinsp;1.0, p\u0026thinsp;=\u0026thinsp;0.3), in age (80.6 \u0026plusmn;10.3 vs. 82.2 \u0026plusmn;8.0 years; t\u0026thinsp;=\u0026thinsp;0.3, p\u0026thinsp;=\u0026thinsp;0.8), nor in the ratio of females to males (X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;1.7, p\u0026thinsp;=\u0026thinsp;0.5) between groups. Finally, there was no significant difference regarding cause of death between the groups (COD) (X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;4.1, p\u0026thinsp;=\u0026thinsp;0.5).\u003c/p\u003e\u003cp\u003e\u003cem\u003eFixation variables\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThere was no statistically significant difference in FD between the two groups (37.3 \u0026plusmn;23.6 vs. 27.4 \u0026plusmn;14.4 hours; t\u0026thinsp;=\u0026thinsp;0.8, p\u0026thinsp;=\u0026thinsp;0.4). The EDD was different between groups, but it did not reach statistical significance (264.0 \u0026plusmn;338.6 vs. 72.0 \u0026plusmn;67.9 hours; U\u0026thinsp;=\u0026thinsp;0.2, p\u0026thinsp;=\u0026thinsp;0.2). Finally, the amount of fixative injected (liters of SSS) was also not statistically different between groups (21.6 \u0026plusmn;3.6 vs 22.6 \u0026plusmn;3.1 liters; U\u0026thinsp;=\u0026thinsp;15.0, p\u0026thinsp;=\u0026thinsp;0.7).\u003c/p\u003e\u003cp\u003e\u003cem\u003eAnatomical variables\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThere were no statistically significant differences when comparing the groups for lengths of the upper aorta (12.3 \u0026plusmn;1.9 vs. 10.2 \u0026plusmn;1.6 cm; t\u0026thinsp;=\u0026thinsp;1.9, p\u0026thinsp;=\u0026thinsp;0.1), the thoracic aorta (25.5 \u0026plusmn;2.5 vs. 22.9 \u0026plusmn;3.0 cm; t\u0026thinsp;=\u0026thinsp;1.5, p\u0026thinsp;=\u0026thinsp;0.2), and the abdominal aorta (13.9 \u0026plusmn;1.2 vs. 14.5 \u0026plusmn;0.9 cm; t\u0026thinsp;=\u0026thinsp;1.5, p\u0026thinsp;=\u0026thinsp;0.2). Same for the sum of lengths of the aorta, the result showed no significant differences (51.7 \u0026plusmn;5.0 vs. 47.6 \u0026plusmn;3.5 cm; t\u0026thinsp;=\u0026thinsp;1.5, p\u0026thinsp;=\u0026thinsp;0.2). The mean circumference of the upper aorta was higher in the Group Proflow (7.0 \u0026plusmn;0.4 cm) than in the Group PI3N1 (6.3 \u0026plusmn;0.7 cm), although this result was not statistically significant (t\u0026thinsp;=\u0026thinsp;1.94, p\u0026thinsp;=\u0026thinsp;0.1). Furthermore, there were no statistically significant differences regarding the circumferences of the thoracic aorta (5.9 \u0026plusmn;1.0 vs. 5.6 \u0026plusmn;0.9 cm; t\u0026thinsp;=\u0026thinsp;0.4, p\u0026thinsp;=\u0026thinsp;0.7) nor the abdominal aorta (4.7 \u0026plusmn;0.9 vs. 4.2 \u0026plusmn;0.6 cm; t\u0026thinsp;=\u0026thinsp;1, p\u0026thinsp;=\u0026thinsp;0.4). Regarding the diameters of the atrium, we found no statistically significant differences between the two groups (left atrium: 5.5 \u0026plusmn;1.1 vs. 5.6 \u0026plusmn;1.0 cm; t\u0026thinsp;=\u0026thinsp;0.1, p\u0026thinsp;=\u0026thinsp;0.9; right atrium: 4.7 \u0026plusmn;1.3 vs. 5.2 \u0026plusmn;1.0 cm; t\u0026thinsp;=\u0026thinsp;0.8, p\u0026thinsp;=\u0026thinsp;0.5). The diameter of the left and right ventricles did not show any statistical significance when comparing both groups (9.3 \u0026plusmn;2.1 vs. 8.5 \u0026plusmn;1.4 cm; t\u0026thinsp;=\u0026thinsp;0.7, p\u0026thinsp;=\u0026thinsp;0.5), nor the width of the septum (1.7 \u0026plusmn;0.5 vs. 1.5 \u0026plusmn;0.3 cm; U\u0026thinsp;=\u0026thinsp;5.5, p\u0026thinsp;=\u0026thinsp;0.4), nor the width of the apex (1.3 \u0026plusmn;0.2 vs. 1.2 \u0026plusmn;0.3 cm; U\u0026thinsp;=\u0026thinsp;13.0, p\u0026thinsp;=\u0026thinsp;1.0). We did not find a significant difference in the presence of calcification-like crust for any of the segments evaluated across groups (p-values\u0026thinsp;=\u0026thinsp;1.0). By segment the presence of a calcification-like crust was as follows: in the upper and thoracic aorta 7 out of 10 cases were positive, in the abdominal aorta 9 out of 10 cases were positive, and in the heart cavities there were no positive cases. Finally, the weight of heart was not significantly different across groups either (399.0 \u0026plusmn;123.7 vs. 373.2 \u0026plusmn;79.3 g; t\u0026thinsp;=\u0026thinsp;1.5, p\u0026thinsp;=\u0026thinsp;0.2).\u003c/p\u003e\u003cp\u003e\u003cem\u003ePresence of clots\u003c/em\u003e\u003c/p\u003e\u003cp\u003eRegarding the presence of clots, there was no statistically significant differences between the groups (p-values\u0026thinsp;=\u0026thinsp;1.0). Specifically, the results by segment were as follows: the upper aorta: X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.0, p\u0026thinsp;=\u0026thinsp;1.0, the thoracic aorta: X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.5, p\u0026thinsp;=\u0026thinsp;1.0, the left atrium: X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;1.1, p\u0026thinsp;=\u0026thinsp;1.0, the right atrium: X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.0, p\u0026thinsp;=\u0026thinsp;1.0, the left ventricle: X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.0, p\u0026thinsp;=\u0026thinsp;1.0, and the right ventricle: X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;1.1, p\u0026thinsp;=\u0026thinsp;1.0 (see Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The abdominal aorta presented clots in every sample for both groups. The distribution of clots among the different segments was as follows: in the upper aorta, 8 out of 10 cases were positive; in the thoracic aorta, 7 out of 10 cases were positive; in the abdominal aorta, 10 out of 10 cases were positive; in the left atrium, 9 out of 10 cases were positive; in the right atrium, 8 out of 10 cases were positive; in the left ventricle, 8 out of 10 cases were positive, and in the right ventricle, 9 out of 10 cases were positive (see Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eCountable clots\u003c/em\u003e\u003c/p\u003e\u003cp\u003eA comparison of both groups revealed no statistically significant differences (p-values\u0026thinsp;\u0026gt;\u0026thinsp;0.1). By segment the results were: upper aorta: X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;1.1, p\u0026thinsp;=\u0026thinsp;1.0; thoracic aorta: X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.2, p\u0026thinsp;=\u0026thinsp;1.0, abdominal aorta: X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.5, p\u0026thinsp;=\u0026thinsp;1.0, left atrium: X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.1, p\u0026thinsp;=\u0026thinsp;1.0), right atrium: X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;4.8, p\u0026thinsp;=\u0026thinsp;0.1, left ventricle: X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.0, p\u0026thinsp;=\u0026thinsp;1.0), and right ventricle: X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.9, p\u0026thinsp;=\u0026thinsp;0.5 (see Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The distribution of cases showing countable and uncountable clots by segment was as follows: in the upper aorta 7 out of 8 cases were countable, in the thoracic aorta 3 out of 7 cases were countable, in the abdominal aorta 3 out of 10 were countable, in the left atrium 4 out of 9 cases were countable, in the right atrium 5 out of 8 cases were countable, in the left ventricle 4 out of 8 were countable, and in the right ventricle 6 out of 9 were countable (see Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cem\u003eNumber of clots\u003c/em\u003e\u003c/p\u003e\u003cp\u003eWe consider the number of clots (when countable) and used 3 categories of comparison: 1, 2 or 3 clots. No statistically significant differences were observed between the groups regarding the number of clots present in the segments (p-values\u0026thinsp;\u0026gt;\u0026thinsp;0.3). The results by segment and cavity were as follows: upper aorta: X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.9, p\u0026thinsp;=\u0026thinsp;1.0, thoracic aorta: X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;3.0, p\u0026thinsp;=\u0026thinsp;0.3, left atrium: X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;1.3, p\u0026thinsp;=\u0026thinsp;1.0, left ventricle: X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;1.3, p\u0026thinsp;=\u0026thinsp;1.0, and right ventricle: X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.6, p\u0026thinsp;=\u0026thinsp;1.0 (see Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). The abdominal aorta and the right atrium only showed one clot, precluding the statistical testing. When assessing the number of clots by segment, the results were as follows: in the upper aorta, among the 7 cases with documented clots, 6 cases exhibited 1 clot, while 1 case presented 2 distinct clots. In the thoracic aorta, 2 cases exhibited 1 clot, while one case presented with 3 clots. The abdominal aorta exhibited a uniform pattern, with all 3 cases having 1 clot. In the left atrium, 3 cases exhibited 1 clot, while one case had 2 clots. The right atrium exhibited a uniform distribution of 1 clot in all 5 cases. In the left ventricle, 3 cases exhibited 1 clot, while one case had 2 clots. Finally, in the right ventricle, all five cases exhibited 1 clot, while one case had 2 distinct clots (see Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eClot consistency\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe consistency of the clots was evaluated as a hole per segment regardless of the number found, as we considered the consistency to be the same for all clots found per case per segment. No statistically significant differences were identified when comparing groups for clot consistency (p-values\u0026thinsp;\u0026gt;\u0026thinsp;0.4). The results by segment and cavity were as follows: in the upper aorta: X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;3.0, p\u0026thinsp;=\u0026thinsp;0.7, in the thoracic aorta: X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;2.1, p\u0026thinsp;=\u0026thinsp;1.0, in the abdominal aorta: X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;2.7, p\u0026thinsp;=\u0026thinsp;0.7, in the left atrium: X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;1.4, p\u0026thinsp;=\u0026thinsp;0.4, in the right atrium: X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;2.8, p\u0026thinsp;=\u0026thinsp;0.7, in the left ventricle: X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;1.1, p\u0026thinsp;=\u0026thinsp;1.0, and in the right ventricle: X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;1.9, p\u0026thinsp;=\u0026thinsp;0.7 (see Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). The proportions for clot consistency by segment per case were as follows: in the upper aorta 2 (cases) had hard consistency, 2 soft consistency, and 4 mixed consistency; in the thoracic aorta, 1 had hard consistency, 1 soft consistency, and 5 had mixed consistency. In the abdominal aorta, 1 had hard consistency, 2 soft consistency, and 7 mixed consistency. In the left atrium, 1 had soft consistency, and 8 mixed consistency. In the right atrium, 2 were hard, 2 soft, and 4 as mixed. In the left ventricle, 1 had hard consistency, and 7 were mixed. In the right ventricle, 4 had hard consistency, 1 was soft, and 4 were mixed (see Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cem\u003eClots attached to the vessel wall\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe results revealed no statistically significant differences between the groups regarding the attachment of the clots to the vessel walls (p-values\u0026thinsp;\u0026gt;\u0026thinsp;0.4). By segment and cavity, the results were as follows: in the thoracic aorta: X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.9, p\u0026thinsp;=\u0026thinsp;1.0, in the abdominal aorta: X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.4, p\u0026thinsp;=\u0026thinsp;1.0, in the left atrium: X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;1.4, p\u0026thinsp;=\u0026thinsp;0.4, in the right atrium: X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;1.1, p\u0026thinsp;=\u0026thinsp;1.0, in the left ventricle: X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;1.1, p\u0026thinsp;=\u0026thinsp;1.0 and in the right ventricle: X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.9, p\u0026thinsp;=\u0026thinsp;1.0 (see Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). All upper aorta specimens had no attached clots to the vessel. The overall distribution by segment was: no attached clots in the upper aorta, 1 attached clot out of 7 (cases) in the thoracic aorta, 5 out of 10 attached clots in the abdominal aorta, 1 out of 9 attached clots in the left atrium, 1 out of 8 attached clots in the right atrium, 1 out of 8 attached clots in the left ventricle and 1 out of 9 attached clots in the right ventricle (see Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eObstruction of the vessel lumen\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe obstruction of the lumen of the vessels by the clots did not demonstrate any statistically significant differences between the groups (p-values\u0026thinsp;\u0026gt;\u0026thinsp;0.5). By segment and cavity the results were as follows: upper aorta: X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.4, p\u0026thinsp;=\u0026thinsp;1.0, the thoracic aorta: X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;2.1, p\u0026thinsp;=\u0026thinsp;0.7, the abdominal aorta: X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;1.4, p\u0026thinsp;=\u0026thinsp;1.0, the left atrium: X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;1.1, p\u0026thinsp;=\u0026thinsp;1.0, the right atrium: X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;2.3, p\u0026thinsp;=\u0026thinsp;0.5), the left ventricle: X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;2.1, p\u0026thinsp;=\u0026thinsp;0.7), and the right ventricle: X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;1.5, p\u0026thinsp;=\u0026thinsp;1.0) (see Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). The overall results by segment were as follows: in the upper aorta, 4/10 cases showed no obstruction, 4/10 cases had partial obstruction, and 2/10 cases had total obstruction. In the thoracic aorta, 4/10 had no obstruction, 4/10 had partial obstruction, and 2/10 cases had total obstruction. In the abdominal aorta, 1/10 case had no obstruction, 3/10 cases had partial obstruction, and 6/10 total obstruction. In the left atrium, 1 case had no obstruction and 9/10 cases had total obstruction. In the right atrium, 5/10 cases had no obstruction, 2/10 cases had partial obstruction, and 3/10 cases total obstruction. In the left ventricle, 4/10 cases had no obstruction, 4/10 cases had partial obstruction, and 2/10 cases total. In the right ventricle, 1 case had no obstruction and 9/10 cases had partial obstruction (see Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eClot weight\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe weight of the clots was not statistically significant different between the groups (p-values\u0026thinsp;\u0026gt;\u0026thinsp;0.1). The weights by segment were as follows: in the upper aorta 9.8 \u0026plusmn;11.3 vs. 7.8 \u0026plusmn;7.7 g, t\u0026thinsp;=\u0026thinsp;0.3, p\u0026thinsp;=\u0026thinsp;0.8; in the thoracic aorta 8.4 \u0026plusmn;15.0 vs. 19.4 \u0026plusmn;24.6 g; U\u0026thinsp;=\u0026thinsp;17.5, p\u0026thinsp;=\u0026thinsp;0.3; in the abdominal aorta 4.4 \u0026plusmn;1.9 vs. 5.4 \u0026plusmn;4.7 g; U\u0026thinsp;=\u0026thinsp;11.5, p\u0026thinsp;=\u0026thinsp;0.8; in the left atrium 45.0 \u0026plusmn;26.6 vs. 19.0 \u0026plusmn;23.3 g; t\u0026thinsp;=\u0026thinsp;1.7, p\u0026thinsp;=\u0026thinsp;0.1; in the right atrium, 22.0 \u0026plusmn;39.8 vs. 8.2 \u0026plusmn;9.5 g; U\u0026thinsp;=\u0026thinsp;11.0, p\u0026thinsp;=\u0026thinsp;0.8; in the left ventricle 8.2 \u0026plusmn;10.3 vs. 4.4 \u0026plusmn;5.5 g; t\u0026thinsp;=\u0026thinsp;0.7, p\u0026thinsp;=\u0026thinsp;0.5 and in the right ventricle, 8.4 \u0026plusmn;5.1 vs. 4.0 \u0026plusmn;3.2 g; t\u0026thinsp;=\u0026thinsp;1.6, p\u0026thinsp;=\u0026thinsp;0.1 (see Fig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003e). The overall results by segment were: in the upper aorta 8.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1 g; in the thoracic aorta 13.9\u0026thinsp;\u0026plusmn;\u0026thinsp;6.4 g; in the abdominal aorta 4.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1 g; in the left atrium 32 \u0026plusmn;7.9 g; in the right atrium 15.1 \u0026plusmn;9.1 g; in the left ventricle 6.3 \u0026plusmn;2.6 g; and in the right ventricle, a mean of 6.2 \u0026plusmn;1.4 g (see Fig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eRelation between calcification-like crust and clot attachment to the vessel wall\u003c/em\u003e\u003c/p\u003e\u003cp\u003eIn the segments that showed calcification-like crusts, we explored the relationship with the attachment of clots to the vessel wall. Given that there were no statistical differences between groups in relation to attachment of the clots to the wall of the vessels nor the calcification-like crust, we analysed all 10 cases to see if there was a significant association between the attachment and calcification of the vessel wall of the thoracic aorta or the abdominal aorta. The results were not statistically significant for these segments (X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.2, p\u0026thinsp;=\u0026thinsp;1.0; X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;1.1, p\u0026thinsp;=\u0026thinsp;1.0 respectively). The upper aorta did not show any attached clot and the heart cavities did not show any calcification.\u003c/p\u003e\u003cp\u003e\u003cem\u003eRelation between clot consistency and attachment to the vessel wall\u003c/em\u003e\u003c/p\u003e\u003cp\u003eWe also assessed the association between clot consistency and attachment to the vessel wall. No statistically significant results were observed between these two variables at each aortic segment, nor in the heart cavities (the thoracic aorta X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;1.5, p\u0026thinsp;=\u0026thinsp;1.0, the abdominal aorta X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.5, p\u0026thinsp;=\u0026thinsp;1.0, the left atrium X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.1, p\u0026thinsp;=\u0026thinsp;1.0, the right atrium X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;1.4, p\u0026thinsp;=\u0026thinsp;1.0, the left ventricle X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.2, p\u0026thinsp;=\u0026thinsp;1.0, and the right ventricle X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;2.0, p\u0026thinsp;=\u0026thinsp;1.0). The upper aorta did not show any clot attached to the wall.\u003c/p\u003e\u003cp\u003e\u003cem\u003eRelation between clot consistency and obstruction of the vessel lumen\u003c/em\u003e\u003c/p\u003e\u003cp\u003eWe assessed the association between clot consistency and obstruction of the vessel. We found no significant associations between these two variables (the upper aorta X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;6.70, p\u0026thinsp;=\u0026thinsp;0.09, the thoracic aorta X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;3.3, p\u0026thinsp;=\u0026thinsp;1.0, the abdominal aorta X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;2.8, p\u0026thinsp;=\u0026thinsp;0.9, the right atrium X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;4.3, p\u0026thinsp;=\u0026thinsp;0.6, and the left ventricle X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;1.4, p\u0026thinsp;=\u0026thinsp;1.0). In all 10 cases, the left atrium only showed total obstructions and the right ventricle only showed partial obstructions so no comparisons were made.\u003c/p\u003e\u003cp\u003e\u003cem\u003eRelation between countable clots and consistency\u003c/em\u003e\u003c/p\u003e\u003cp\u003eWe did not find a statistically significant association between these two variables (the upper aorta X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;2.8, p\u0026thinsp;=\u0026thinsp;0.5, the thoracic aorta X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;2.0, p\u0026thinsp;=\u0026thinsp;1.0, the abdominal aorta X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;4.6, p\u0026thinsp;=\u0026thinsp;1.0, the left atrium X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.9, p\u0026thinsp;=\u0026thinsp;1.0, the right atrium X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;3.8, p\u0026thinsp;=\u0026thinsp;0.3, the left ventricle X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;1.1, p\u0026thinsp;=\u0026thinsp;1.0, and the right ventricle X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;4.0, p\u0026thinsp;=\u0026thinsp;0.2).\u003c/p\u003e\u003cp\u003e\u003cem\u003eAssociation between the weight of the clots and the anatomical variables by segment\u003c/em\u003e\u003c/p\u003e\u003cp\u003eIn the upper aorta, circumference and length accounted for 46% of the total clot weight in the segment, yet these results did not demonstrate a significant association with either circumference (p\u0026thinsp;=\u0026thinsp;0.8) or length (p\u0026thinsp;=\u0026thinsp;0.2) within this segment. In the thoracic aorta, circumference and length accounted for 57% of the total clot weight in the segment and a significant association was observed between circumference and clot weight (p\u0026thinsp;=\u0026thinsp;0.04), while no significant association was found for length (p\u0026thinsp;=\u0026thinsp;0.5). In the abdominal aorta, circumference and length accounted for 26% of the total clot weight and these results did not show a significant association with either circumference (p\u0026thinsp;=\u0026thinsp;0.2) nor length (p\u0026thinsp;=\u0026thinsp;0.6). In the left atrium, cavity diameter accounted for 30% of the total clot weight, with no statistical association (p\u0026thinsp;=\u0026thinsp;0.1). In the right atrium, the cavity diameter accounted for 24% of the total clot weight with no statistical association (p\u0026thinsp;=\u0026thinsp;0.2). Within the left ventricle, the diameter of both ventricles and the septum accounted for 43% of the total clot weight with no significant association for the diameter (p\u0026thinsp;=\u0026thinsp;0.1) or the septum (p\u0026thinsp;=\u0026thinsp;0.2). In the right ventricle, the diameter of both ventricles, the septum, and the apex accounted for 14% of the total clot weight in the segment with no significant associations with the diameter (p\u0026thinsp;=\u0026thinsp;0.7), the septum (p\u0026thinsp;=\u0026thinsp;0.6), nor the apex (p\u0026thinsp;=\u0026thinsp;0.7).\u003c/p\u003e\u003cp\u003e\u003cem\u003eInter-intra rater reliability\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe inter-rater ICC estimations (average measures) were greater than 0.995 [0.988-1.000]. These estimates can be considered to indicate an \"good\" level of reliability. Moreover, the intra-rater estimations (average measures) were greater than 0.999 [0.995-1.000], indicating an \"excellent\" level of reliability [14].\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cem\u003eDemographical characteristics\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe study found no statistically significant differences between the groups in terms of BMI, age, or sex. This is important because sex differences in coagulation have been documented [15]. Nonetheless, the impact of these variations on the outcomes of the study appears to be negligible, as the observed differences are predominantly attributed to platelet aggregation in vivo rather than erythrocyte aggregation, as evidenced in post-mortem clot analysis [9]. The COD did not show any statistical differences either, with most cases dying of non-acute pathologies that entail an agonal period before the moment of death (e.g. pneumonia and different types of cancers). Interestingly, the association between non-acute COD has been documented to be linked to the formation of PMCs, particularly in the heart [16] such as the clots found in both groups of our study.\u003c/p\u003e\u003cp\u003e\u003cem\u003eFixation variables\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThere were no statistically significant differences between the groups in terms of fixation variables, so they were not considered as confounding factors in our study. We observed that there was a longer EDD in group 1 (though not statistically significant). However, we did not observe any qualitative difference in the characteristics of the bodies dissected after a longer EDD (see anatomical variables section below). This suggests that once the bodies are fully fixed, there does not seem to be an over fixation phenomenon changing the characteristics of the tissues or the clots.\u003c/p\u003e\u003cp\u003e\u003cem\u003eAnatomical variables\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe analysis of the anatomical variables revealed no statistically significant differences between the groups. These findings indicate that a comparison between the two groups could be made without the need of normalization to the anatomical variables. It is noteworthy that post-mortem decomposition of tissue, particularly the muscle fibers of the vessel wall, may lead to size variations [17, 18]. However, it has also been reported that despite the potential effects of the fixation solution on cadaver tissue, vessel dimensions may not differ between cases with or without fixation [19]. In our study, we did not detect any anatomical differences across groups. Moreover, we did not find any difference in calcification-like crust in the different segments of the aorta, with most cases exhibiting calcifications, particularly in the abdominal segment (90% of cases).\u003c/p\u003e\u003cp\u003eOur small sample size is a limitation regarding the potential detection of anatomical significant differences across groups. However, a power analysis using our anatomical measurements showed that a sample size of 736 subjects would have been required to potentially reach statistical significance, which is unfeasible in the context of our human anatomy laboratory (and probably most anatomy laboratories), which receives an average of 75 to 100 bodies per year for all teaching and research activities. Consequently, it would be important to record gross anatomical variables on regular basis using standardized measurement practices, such as the ones used in our study. This would allow anatomy laboratories to create databases that could serve as a normative reference when researchers are interested in experiments regarding the heart and vascular system. Finally, we reviewed imaging studies [20\u0026ndash;23] and validity of post-mortem arterial measurements [18, 24] to attempt to assess the anatomical variability of our sample in relation to other populations, but the absence of large post-mortem imaging with comparable anatomical variables recorded during dissection, and the limited medical record information of our small sample precludes any inference regarding how representative our measures are in relation to the general population [18, 25, 26].\u003c/p\u003e\u003cp\u003e\u003cem\u003ePresence/absence of clots\u003c/em\u003e\u003c/p\u003e\u003cp\u003eWe found no significant disparities in the incidence of clot across the study groups. The abdominal aorta demonstrated a consistent presence of clots in all ten cases, with six cases of them exhibiting total vessel obstruction. Given that the pre-fixation solution (and subsequently the fixation solution) is injected into the carotid artery towards the aortic arch, the solution can either go towards the aortic valve or downstream towards the thoracic, and the abdominal aorta, down to the common iliac bifurcation. The aortic size is decreased in the distal portion in comparison to the proximal portion of the aorta, so we speculate that the injected solutions displaced the clots towards the iliac bifurcation leading to a greater accumulation in the abdominal aorta. Additionally, all heart cavities had clots in 80 to 90% of cases. This finding can be attributed to post-mortem alterations such as: the cessation of blood circulation with the aggregation of erythrocytes and platelets due to the onset of livor mortis, which goes along with a concomitant decrease in the pH of the extracellular environment favoring platelet aggregation and preventing disaggregation through fibrinolysis [26, 27]. Finally, we think that the cardiac valves remain mostly closed during the perfusion of the solutions, precluding to properly empty the heart chambers. Moreover, the hollow pockets created by the muscular walls could facilitate blood aggregation and coagulation, with clots remaining enclosed within the chambers. These phenomena combined may contribute to the high prevalence of PMCs in the heart cavities.\u003c/p\u003e\u003cp\u003e\u003cem\u003eCountable clots\u003c/em\u003e\u003c/p\u003e\u003cp\u003eNo statistically significant differences were observed between the groups with respect to the presence of countable or uncountable clots. This variable relates to the to the consistency of the clots, since soft clots, being more friable, may disintegrate under manipulation, making them uncountable. Conversely, hard and mixed clots typically exhibit firmness and maintain their structural integrity during manipulation, being countable. As previously mentioned, the ventricle and the atriums function as hollow pockets that trap blood during the occurrence of livor mortis, so the presence of countable clots within the heart chambers would be expected. In our sample more than half of the clots (56%) were countable in the heart chambers.\u003c/p\u003e\u003cp\u003e\u003cem\u003eNumber of clots\u003c/em\u003e\u003c/p\u003e\u003cp\u003eNo statistically significant differences were observed between the groups regarding number of clots identified in the segments. The majority of cases with countable clots (84%) exhibited a single clot. This finding may be attributed to the fact that the majority of the heart cavities act as hollow pockets, as previously mentioned. The same phenomenon could occur in the upper aorta where the clots could form and accumulate under the pressure of the perfused solutions (12 PSI with the pre-fixative and 6 PSI with the fixative) that would clump the clots against a closed aortic valve. Conversely, in the thoracic and abdominal aorta, the perfusion solution might push the blood and clots distally, towards the iliac bifurcation, making most of the clots in the thoracic and the abdominal aorta uncountable and of a mixed consistency. Further research using a design that changes the pressures of perfusion (i.e., group with high pressure of perfusion vs. group with low pressure of perfusion) [3] could increase our understanding in the number of clots found, but this was beyond the scope of our current work.\u003c/p\u003e\u003cp\u003e\u003cem\u003eClot consistency per segment\u003c/em\u003e\u003c/p\u003e\u003cp\u003eNo statistically significant differences were observed in the consistency of clots across groups. However, the majority of clots in all segments were of mixed consistency (66%). This phenomenon can be explained by the process of sedimentation, which is associated with the rate of aggregation of cadaveric blood. The stasis of the circulation and the post-mortem changes induces the aggregation of erythrocytes, platelets, and fibrin strands as the blood sediments [26, 28]. Our hypothesis is that the blood aggregates after the initiation of the sedimentation process, resulting in a mixture of different consistencies.\u003c/p\u003e\u003cp\u003eThe coagulation of cadaveric blood has been described to occur in two ways: fast or slow [9]. The fast coagulation is characterized by the absence of sedimentation. Conversely, the onset of sedimentation before aggregation of the blood elements indicates slow coagulation, with clots likely becoming of mixed consistency, as seen in this experiment. This observation is further supported by a histologic study, which described the macroscopic characteristics of PMCs as red cruor (aggregated erythrocytes, analogous to our hard clots), chicken fat (aggregated platelets and fibrin strands, analogous to our soft clots), or a mixture of both (representing our mixed clots) [8].\u003c/p\u003e\u003cp\u003eFinally, we must consider that the pre-fixative and fixative solutions dehydrate and solidify the clots during the delay of the fixation process [29]. Once a clot is formed in a vessel segment, the water contained in the blood constituents is absorbed by the tissue as the fixative induces an osmotic shift. As a result, clots are dehydrated by the solutions [12] and if they remain partially not sedimented, this would result in the formation of mixed clots, or hard clots, which combined represent 85% of all clots in our study.\u003c/p\u003e\u003cp\u003eFuture studies should prioritize elucidating the impact of clotting speeds and the sedimentation of blood, as well as microscopic characteristics of clots of different consistency (all of which were beyond the scope of our study). This will contribute to a more profound comprehension of macroscopic findings.\u003c/p\u003e\u003cp\u003e\u003cem\u003eClot attached to the vessel wall\u003c/em\u003e\u003c/p\u003e\u003cp\u003eWe did not find significant differences in the attachment of clots to the vessel wall. Most of the clots were unattached (83%), and most of the attached clots (50%) were in the abdominal aorta, which also exhibited the most prevalent calcification-like crusts. Interestingly, our observations from the dissection revealed that the majority of clots attached to the vessel wall were attached to the calcification-like crust portion. Since attachment to the vessel wall is characteristic of pre-mortem thrombi, one potential explanation would be that these clots start developing pre-mortem [9]. Alternatively, it is also possible that the high perfusion pressure pushes the blood and the clots towards the common iliac bifurcation, resulting in their adhesion to the calcification-like crusts of the abdominal aorta. This phenomenon is coherent with the high prevalence of obstruction observed in that segment (60% of cases with total obstruction and 30% with partial obstruction).\u003c/p\u003e\u003cp\u003eOur study did not aim to assess the histology of the clots. However, future studies assessing the microscopy of the clots would clarify the nature of those attached as either PMCs or PMT.\u003c/p\u003e\u003cp\u003e\u003cem\u003eObstruction of the vessel lumen\u003c/em\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe study revealed no statistically significant differences between the groups. As mention before, there was a high prevalence of obstruction in some segments, with the abdominal aorta exhibiting total obstructions in 90% of the cases. This finding aligns with the hypothesis that the perfusion pressure exerts a force on the clots, displacing them towards the common iliac bifurcation, where there is a constricted space that facilitates clogging, accumulation of clots, and obstruction of the segment. Furthermore, 90% of the cases showed total obstruction of the left atrium, and also 90% of the cases showed partial obstruction of the right ventricle. This pattern of accumulation of clots could be in part explained by the injection of the pre-fixative and fixative solutions in the systemic circulation, through the carotid artery. If the mitral valve (left atrioventricular valve) remains totally or partially closed, the left atrium would be unreachable. If the blood was pushed through an open mitral valve, the smaller caliber of the pulmonary veins, could restrict the continuous flow of the solution towards the lungs and the clots would accumulate in the left atrium. The systemic circulation perfusion would also explain the high prevalence of obstruction of the right ventricle.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eClot weight\u003c/em\u003e\u003c/p\u003e\u003cp\u003eNo statistically significant differences were identified when comparing groups in terms of clot weight, with the left atrium being the segment that had the highest clot weight. This is coherent with the perfusion happening via the systemic circulation, as explained above. It has been established that the development of PMCs in the heart is associated with \"common\" or natural deaths [16]. This phenomenon has been observed predominantly in the elderly, where a prolonged interval separates injury from death (agony period). In the anatomy laboratory, the majority of body donors are of advanced age and have experienced a natural death, so a high prevalence of PMCs in the heart is to be expected.\u003c/p\u003e\u003cp\u003e\u003cem\u003eRelation between calcification-like crust and clot attachment to the vessel wall\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe investigation revealed no significant association between the attachment of clots and the presence of a calcified-like crust in all the segments. The abdominal aorta was the only segment with a higher prevalence of attached clots to the calcification-like crust, but all the other segments had a very low prevalence of attached clots or no attachment at all. This observation is in line with the descriptions of PMCs in the existing literature [8, 9, 28, 30], as it confirms that PMCs (as opposed to PMTs) are not adherent.\u003c/p\u003e\u003cp\u003e\u003cem\u003eRelation between clot consistency, attachment to the vessel wall and obstruction of the vessel lumen\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe association between the clot consistency and attachment to the vessel wall was not significant, neither was the association between clot consistency and vessel obstruction. The majority of the clots found were mixed, and given their features of fragility and dehydration, it was anticipated that they would exhibit a lack of adherence to the vessel wall, thereby resulting in an absence of association between the variables. Regarding the lack of association with obstruction, we were not expecting this result, given that 85% of clots had a mixed/hard consistency and also the majority of segments (71%) exhibit some obstruction. Future studies in a larger sample size are needed to clarify the relationship between these two variables.\u003c/p\u003e\u003cp\u003e\u003cem\u003eRelation between countability and consistency of clots\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThere was no statistically significant associations between these variables. However, a majority of the clots found were either mixed or hard (85%) and also most of them were countable (54%). This finding aligns with the idea that the harder the consistency of the clot, the easier it is to be countable. This would be due to the tendency of friable clots to disintegrate under physical manipulation, while harder clots tend to maintain their structural integrity.\u003c/p\u003e\u003cp\u003e\u003cem\u003eAssociation between the weight of the clots and the anatomical variables by segment\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe findings of the linear regression analysis indicated a statistically significant correlation between the circumference of the thoracic aorta and the clot weight measured within the segment. The aorta's circumference was found to be a predictor of 57% of the total clot weight observed in the thoracic aorta. This phenomenon can be attributed, at least in part, to the anatomical characteristics of the thoracic aorta, which, on average, constitutes the largest portion of the aorta. Consequently, a substantial presence of clots could be detected in this region during the dissection process. However, no significant associations were observed in the other segments.\u003c/p\u003e\u003cp\u003e\u003cem\u003eLimits of our study\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe main limitation of our study is the small sample size. However, a power analysis based on our current data regarding the number of bodies necessary to detect certain differences across variables puts the sample size in the hundreds, making the study design non feasible within a reasonable timeframe (i.e., it would take several years to collect all the bodies). We believe that the results of this study are still very instructive, since they show no differences in cadavers vascular clots regardless of the pre-fixation solution used, and if a difference was to be detected by using hundreds of bodies, that would be signalling a small magnitude of the difference.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eDifferent chemical pre-fixation solutions commercially available to anatomy laboratories do not change the qualitative or quantitative characteristics of clots found in cadavers used in surgical workshops. Future research exploring either alternative pre-fixative solutions (i.e., chemically different than the two used in our study), or mechanical means (i.e., pre-fixation thrombectomy and cardiac massage during perfusion), or changing the injection pressures of the solutions, could help reduce the number of clots and therefore produce better cadaver models suitable of a continuous flow free from obstructions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAll authors have taken steps to ensure that they have no affiliations with or involvement in any organization or entity with any financial or non-financial interest in the subject matter or materials discussed in this manuscript. The University's Ethics Subcommittee on Anatomical Teaching and Research (Certificate No23-09) has kindly provided ethics approval for this manuscript. We would like to confirm that this study was carried out in accordance with the ethical principles established in the 1964 Declaration of Helsinki. The pictures in this manuscript were taken by the authors with the permission of the body donor consent process.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding Declarations\u003c/h2\u003e\u003cp\u003eWe are grateful for the partial financial support we received from NovaScience, which is affiliated with the Quebec government (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.quebec.ca/entreprises-et-travailleurs-autonomes/aide-financiere/recherche-innovation/programme-novascience\u003c/span\u003e\u003cspan address=\"https://www.quebec.ca/entreprises-et-travailleurs-autonomes/aide-financiere/recherche-innovation/programme-novascience\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). This grant supported the corresponding author with a full 2-year salary, allowing them to dedicate themselves fully to this project for the benefit of our institution.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors reviewed the manuscript. P.P. wrote the original draft, developped the project's protocol, collected the data, analyzed the data, prepared all the content (figures and table) of this manuscript and edited the manuscript. A.N. developped the project's protocol, collected the data and edited the manuscript. J.M. developped the project's protocol, analyzed the data and edited the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors sincerely thank those who donated their bodies to science so that anatomical research could be performed. Results from such research can potentially increase mankind's overall knowledge that can then improve patient care. Therefore, these donors and their families deserve our highest gratitude. We would also like to express our gratitude to the anatomy laboratory staff of the University (Johanne Pellerin, Marie-Eve Lemire, Sophie Plante, Sonia Gauthier, and Kevin D\u0026eacute;saulniers, MSc.) for their invaluable contributions to the success of this project. Finally, we would like to express our sincere gratitude to the LifeEngine team (Catherine Forest-Nault, PhD., Aymeric Guy, PhD., Hugo Jobidon-Lavergne, MSc.) for their invaluable insights and guidance, which have enriched our work and contributed to our professional growth.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHolland, J.P., et al., \u003cem\u003eCadaveric hands-on training for surgical specialties: is this back to the future for surgical skills development?\u003c/em\u003e J Surg Educ, 2011. \u003cstrong\u003e68\u003c/strong\u003e(2): p. 110-6.\u003c/li\u003e\n\u003cli\u003eLewis, C.E., et al., \u003cem\u003eA novel cadaver-based educational program in general surgery training.\u003c/em\u003e J Surg Educ, 2012. \u003cstrong\u003e69\u003c/strong\u003e(6): p. 693-8.\u003c/li\u003e\n\u003cli\u003eBellier, A., et al., \u003cem\u003eDevelopment of cadaver perfusion models for surgical training: an experimental study.\u003c/em\u003e Surg Radiol Anat, 2019. \u003cstrong\u003e41\u003c/strong\u003e(10): p. 1217-1224.\u003c/li\u003e\n\u003cli\u003eChevallier, C., et al., \u003cem\u003ePostmortem circulation: a new model for testing endovascular devices and training clinicians in their use.\u003c/em\u003e Clin Anat, 2014. \u003cstrong\u003e27\u003c/strong\u003e(4): p. 556-62.\u003c/li\u003e\n\u003cli\u003eGarrett, H.E., Jr., \u003cem\u003eA human cadaveric circulation model.\u003c/em\u003e J Vasc Surg, 2001. \u003cstrong\u003e33\u003c/strong\u003e(5): p. 1128-30.\u003c/li\u003e\n\u003cli\u003eSarkar, A., et al., \u003cem\u003eContinuous Flow Perfused Cadaver Model for Endovascular Training, Research, and Development.\u003c/em\u003e Ann Vasc Surg, 2018. \u003cstrong\u003e48\u003c/strong\u003e: p. 174-181.\u003c/li\u003e\n\u003cli\u003eRifahi, A., et al., \u003cem\u003eA cadaveric perfused model with antegrade arteriovenous pulsatile circulation: a new tool for teaching endovascular skills.\u003c/em\u003e Can J Surg, 2022. \u003cstrong\u003e65\u003c/strong\u003e(4): p. 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Kogan, \u003cem\u003eAn improved low-formaldehyde embalming fluid to preserve cadavers for anatomy teaching.\u003c/em\u003e J Anat, 1998. \u003cstrong\u003e192 ( Pt 3)\u003c/strong\u003e(Pt 3): p. 443-6.\u003c/li\u003e\n\u003cli\u003eBellier, A., et al., \u003cem\u003eTechniques of cadaver perfusion for surgical training: a systematic review.\u003c/em\u003e Surgical and Radiologic Anatomy, 2018. \u003cstrong\u003e40\u003c/strong\u003e: p. 439-448.\u003c/li\u003e\n\u003cli\u003eHayashi, S., et al., \u003cem\u003eSaturated salt solution method: a useful cadaver embalming for surgical skills training.\u003c/em\u003e Medicine (Baltimore), 2014. \u003cstrong\u003e93\u003c/strong\u003e(27): p. e196.\u003c/li\u003e\n\u003cli\u003eHayashi, S., et al., \u003cem\u003eHistory and future of human cadaver preservation for surgical training: from formalin to saturated salt solution method.\u003c/em\u003e Anat Sci Int, 2016. \u003cstrong\u003e91\u003c/strong\u003e(1): p. 1-7.\u003c/li\u003e\n\u003cli\u003eKoo, T.K. and M.Y. Li, \u003cem\u003eA Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research.\u003c/em\u003e J Chiropr Med, 2016. \u003cstrong\u003e15\u003c/strong\u003e(2): p. 155-63.\u003c/li\u003e\n\u003cli\u003eColeman, J.R., et al., \u003cem\u003eFemale platelets have distinct functional activity compared with male platelets: Implications in transfusion practice and treatment of trauma-induced coagulopathy.\u003c/em\u003e J Trauma Acute Care Surg, 2019. \u003cstrong\u003e87\u003c/strong\u003e(5): p. 1052-1060.\u003c/li\u003e\n\u003cli\u003eSenanayake, K., I. Amerasinghe, and J. Warnasekara, \u003cem\u003ePostmortem clots (PMC) of the heart; is it merely an artifact or a predictor of cause of death?\u003c/em\u003e Ceylon Medical Journal, 2022. \u003cstrong\u003e67\u003c/strong\u003e(3).\u003c/li\u003e\n\u003cli\u003eTakahashi, N., et al., \u003cem\u003eChanges in aortic shape and diameters after death: comparison of early postmortem computed tomography with antemortem computed tomography.\u003c/em\u003e Forensic Sci Int, 2013. \u003cstrong\u003e225\u003c/strong\u003e(1-3): p. 27-31.\u003c/li\u003e\n\u003cli\u003eHyodoh, H., et al., \u003cem\u003eVascular measurement changes observed using postmortem computed tomography.\u003c/em\u003e Jpn J Radiol, 2012. \u003cstrong\u003e30\u003c/strong\u003e(10): p. 840-5.\u003c/li\u003e\n\u003cli\u003eBalta, J.Y., et al., \u003cem\u003eHuman preservation techniques in anatomy: A 21st century medical education perspective.\u003c/em\u003e Clinical Anatomy, 2015. \u003cstrong\u003e28\u003c/strong\u003e(6): p. 725-734.\u003c/li\u003e\n\u003cli\u003eNevsky, G., et al., \u003cem\u003eSex-specific normalized reference values of heart and great vessel dimensions in cardiac CT angiography.\u003c/em\u003e American Journal of Roentgenology, 2011. \u003cstrong\u003e196\u003c/strong\u003e(4): p. 788-794.\u003c/li\u003e\n\u003cli\u003eLin, F.Y., et al., \u003cem\u003eAssessment of the thoracic aorta by multidetector computed tomography: age-and sex-specific reference values in adults without evident cardiovascular disease.\u003c/em\u003e Journal of cardiovascular computed tomography, 2008. \u003cstrong\u003e2\u003c/strong\u003e(5): p. 298-308.\u003c/li\u003e\n\u003cli\u003eMao, S.S., et al., \u003cem\u003eNormal thoracic aorta diameter on cardiac computed tomography in healthy asymptomatic adults: impact of age and gender.\u003c/em\u003e Academic radiology, 2008. \u003cstrong\u003e15\u003c/strong\u003e(7): p. 827-834.\u003c/li\u003e\n\u003cli\u003ePham, M.H., et al., \u003cem\u003eNormal values of aortic dimensions assessed by multidetector computed tomography in the Copenhagen General Population Study.\u003c/em\u003e European Heart Journal-Cardiovascular Imaging, 2019. \u003cstrong\u003e20\u003c/strong\u003e(8): p. 939-948.\u003c/li\u003e\n\u003cli\u003eSchoeman, M., et al., \u003cem\u003eThe validity of arterial measurements in a South African embalmed body population.\u003c/em\u003e Surg Radiol Anat, 2018. \u003cstrong\u003e40\u003c/strong\u003e(1): p. 39-43.\u003c/li\u003e\n\u003cli\u003eBalta, J.Y., et al., \u003cem\u003eA comparison of embalming fluids on the structures and properties of tissue in human cadavers.\u003c/em\u003e Anat Histol Embryol, 2019. \u003cstrong\u003e48\u003c/strong\u003e(1): p. 64-73.\u003c/li\u003e\n\u003cli\u003eJackowski, C., et al., \u003cem\u003ePostmortem imaging of blood and its characteristics using MSCT and MRI.\u003c/em\u003e Int J Legal Med, 2006. \u003cstrong\u003e120\u003c/strong\u003e(4): p. 233-40.\u003c/li\u003e\n\u003cli\u003eThomsen, H., H.J. Kaatsch, and B. Krisch, \u003cem\u003eHow and why does the platelet count in postmortem blood change during the early postmortem interval?\u003c/em\u003e Forensic Sci Int, 1999. \u003cstrong\u003e101\u003c/strong\u003e(3): p. 185-94.\u003c/li\u003e\n\u003cli\u003eHansma, P., et al., \u003cem\u003eAgonal Thrombi at Autopsy.\u003c/em\u003e Am J Forensic Med Pathol, 2015. \u003cstrong\u003e36\u003c/strong\u003e(3): p. 141-4.\u003c/li\u003e\n\u003cli\u003eTobin, C.E., \u003cem\u003eA method for removing intravascular clots from embalmed human specimens.\u003c/em\u003e Proc Soc Exp Biol Med, 1970. \u003cstrong\u003e135\u003c/strong\u003e(2): p. 263-6.\u003c/li\u003e\n\u003cli\u003eTiu, R.E., et al., \u003cem\u003eAgonal Thrombus at Necropsy-A Third Category of Blood Coagulation in Domestic Carnivores.\u003c/em\u003e Life (Basel), 2023. \u003cstrong\u003e13\u003c/strong\u003e(9).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"surgical anatomy workshops, continuous flow perfused cadaver model, pre-fixation solution, post-mortem clots, cadaver preparation, vessel obstruction","lastPublishedDoi":"10.21203/rs.3.rs-7040941/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7040941/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe Continuous Flow Perfused Cadaver Model (CFPCM) is employed to ensure the highest degree of realism for vascular surgeon trainees. To prepare the CFPCM, the blood is drained from the body, then a pre-fixation solution is injected to clean the vessels and to dissolve clots. The preparation of CFPCM is often suboptimal when clots remain in the vessels, hindering the smooth running of the surgical anatomy workshops. Our goal was to optimize the preparation of the cadaver by using an innovative pre-fixation solution to increase clot dissolution. METHODS. We used a convenience sample of 10 cadavers, evenly split in 2 groups according to the pre-fixation solution used (Solution 1: Proflow; Solution 2: PI3N1). We evaluated the efficacy of the pre-fixation solution across groups by comparing qualitative and quantitative variables of clots that remained in the bodies after their preparation. We also assessed the correlation between some of the clots variables and anatomical variables measured in our sample. RESULTS. The data did not reveal any statistically significant differences between the groups in any of the variables measured. However, a significant association was identified between the circumference of the thoracic aorta and the total clot weight in that segment (p\u0026thinsp;=\u0026thinsp;0.038). The abdominal aorta and the left atrium exhibited the highest prevalence of total obstruction by clots, and the left atrium the highest clot weight. CONCLUSIONS. Different chemical pre-fixation solutions do not change the qualitative or quantitative characteristics of clots found in cadavers used in surgical workshops.\u003c/p\u003e","manuscriptTitle":"Clot dissolution to optimize body preparation for the continuous flow perfused cadaver model","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-15 14:11:51","doi":"10.21203/rs.3.rs-7040941/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c3d379cf-9063-4e9c-bb88-e52780878e56","owner":[],"postedDate":"July 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-12T10:53:46+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-15 14:11:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7040941","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7040941","identity":"rs-7040941","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}