ࡱ                >  	               ^          `          ]    q`               J   bjbjqPqP                   .T  : : P                                                                                                                                             ,     $         v>  h  @      @      @      @      @      @      @      @      =     =      =      =      =      =      =  $   ?  h  FB     =  E                         @                      @      @      @      @      =                          @              @      0>                       @          @            @      =                                                                    @      =                      6  i9                                                                         <      @      4     @                  I:             =      F>  0   v>      e:    6C        L   6C  8   <                                                                              6C                    <    @      @            @      @                                      @      @      @      =      =                                                                           @      @      @      v>      @      @      @      @                            	                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             H y p e r a k t i v n    m o o v    m c h  Y  N a   r o z d  l   o d   i n k o n t i n e n c e ,   k t e r    j e   i   v d n  m   m e d i  l n  m   t  m a t e m ,   m o~e   b  t   h y p e r a k t i v n    m o o v    m c h  Y  ( O A B ,   O v e r A c t i v e   B l a d d e r )   o n e m o c n n  m   v z d  l e n  m   i   m n o h a   l  k a Yom ,   k t e Y   s e   u r o l o g i i   i   u r o g y n e k o l o g i i   p Y m o   n e v n u j  .   P r o t o   d i a g n  z a   t  t o   c h o r o b y   n e b  v    a s t o   s t a n o v e n a   v a s   ( j e - l i   v ob e c   s t a n o v e n a )   a   p a c i e n t y ,   p Ye s t o ~e   j e   v  s o u a s n o s t i   l  b a   d o s t u p n  ,   t o t o   n e p Y j e m n    o n e m o c n n    z b y t e n   t r  p  .   Z d r a v    l o v k   d o k  ~e   n a   u r i t o u   d o b u   n u c e n    n a   m o e n    p Ye k o n a t   a   k   v y p r  z d n n    m o o v  h o   m c h  Ye   d o j d e   a ~  v  s i t u a c i ,   k d y   j e   k  t o m u   z e   s o c i  l n  h o   h l e d i s k a   v h o d n    p Y l e ~i t o s t .   P o k u d   v aa k   d o c h  z    k  n e c h t n  m u   u n i k u   m o i ,   h o v o Y m e   o   i n k o n t i n e n c i .   T e n t o   n e j e n   z d r a v o t n  ,   a l e   i   s o c i  l n    p r o b l  m   j e   z n  m ,   p o p s  n ,   r o z d l e n   d o   k a t e g o r i    ( i n k o n t i n e n c e   s t r e s o v  ,   u r g e n t n  ,   p a r a d o x n    a   r e f l e x n  ) ,   l  e n   a   m n o h d y   v y l  e n .   J e   n a   n j   p a m a t o v  n o   p Yi   a n a m n e s t i c k  m   p o h o v o r u .   K l a d n o u   o d p o v d    n a   o t  z k u :   U d r ~ t e   m o ?   d a l a   p  t r  n    p o   p o t  ~ c h   k o n  .   M n o z    p a c i e n t i   a   p a c i e n t k y   m o   s i c e   u d r ~ ,   a l e   z a   j a k o u   c e n u !   V z d  v a j    s e   s p o l e e n s k  h o   ~i v o t a   c e s t o v  n  ,   s e x   p r o   n   z n a m e n    d a l a   t r a u m a t i z u j  c    z  ~i t e k ,   p r a c o v n    v  k o n n o s t   k l e s  ,   o b t  ~n   s e   s o u s t Ye d  ,   n a s t  v a j    p r o b l  m y   v  z a m s t n  n  . . .   N e j d e   o   p s y c h i c k y   n e m o c n  .   M a j    h y p e r a k t i v n    m o o v    m c h  Y.   A   j e   j i c h   m n o h o .   O d h a d u j e   s e ,   ~e   v   E v r o p   t r p    s y n d r o m e m   h y p e r a k t i v n  h o   m o o v  h o   m c h  Ye   5 0   a ~  6 0   m i l i o n o  l i d  .   V  U S A   a   E v r o p   p o s t i h u j e   a s i   j e d n o h o   z e   ae s t i   d o s p l  c h   v e   v k u   n a d   4 0   l e t   a   j e h o   v  s k y t   s  v k e m   s t o u p  .     V  s k y t   s y n d r o m u   h y p e r a k t i v n  h o   m o o v  h o   m c h  Ye   v   e v r o p s k  c h   z e m  c h   Z e m 	 	   P r o c e n t o   l i d    s  O A B 	 	 P o e t   l i d    s   O A B  F r a n c i e   	 	 1 2   %   	 	 	 2 , 8 9   m i l i o n o N m e c k o   	 	 1 8   %   	 	 	 6 , 4 6   m i l i o n o I t  l i e   	 	 	 1 2   %   	 	 	 3 , 2 8   m i l i o n o `p a n l s k o   	 	 2 2   %   	 	 	 3 , 6 0   m i l i o n o `v  d s k o 	 	 1 9   %   	 	 	 0 , 8 1   m i l i o n o V e l k    B r i t a n i e   	 1 9   %   	 	 	 5 , 1 5   m i l i o n o  P Ye s t o ~e   s e   p Y z n a k y   h y p e r a k t i v n  h o   m o o v  h o   m c h  Ye   v y s k y t u j    s e   s t e j n o u   f r e k v e n c    u   ~e n   i   m u ~o,   b  v    t a t o   p o r u c h a   a s t j i   d i a g n o s t i k o v  n a   a   l  e n a   u   ~e n .     D i a g n o s t i k a   p o d l e   p Y z n a k o H y p e r a k t i v n    m o o v    m c h  Y  j e   c h o r o b o u ,   k t e r    j e   v e l m i   a s t o   n e r o z p o z n  n a   a   n e l  e n a .   P o d l e   p r oz k u m o  n e n    d i a g n o s t i k o v  n o   a s i   4 0   %   p Y p a d o.    P o d e z Ye n    n a   O A B   b y   m l y   v z b u d i t   n  s l e d u j  c    s y m p t o m y :  N  h l    a   n u t k a v    p o t Ye b a   m o i t ,   k t e r o u   n e l z e   p Ye k o n a t .   N a z  v    s e   u r g e n c e   a   j e   k l  o v  m   p Y z n a k e m   h y p e r a k t i v n  h o   m o o v  h o   m c h  Ye .    F r e k v e n t n    m o e n  :   p o s t i ~e n    p o c i eu j e   n u t n o s t   m o i t   v e l m i   a s t o ,   n e j m  n   o s m k r  t   d e n n .  P o t Ye b a   m o i t   v  n o c i      n y k t u r i e .  U r g e n t n    i n k o n t i n e n c e ,   k d y   d o j d e   k    n i k u   m o i   p Yi   p o c i t u   u r g e n c e   a   n e d o s t a t k u   a s u   d o j  t   n a   t o a l e t u .  N e m o c n    v   p r om r u   e k a j    s  v y h l e d  n  m   p o m o c i   ae s t   a ~  d v a n  c t   m s  c o  o d   z a  t k u   p Y z n a k o,   a s t o   p r o t o ,   ~e   s e   s t y d    o   t o m t o   p r o b l  m u   h o v o Yi t .   P o d n t e m   p r o   v y h l e d  n    p o m o c i   j e   a ~  z h o r ae n    p Y z n a k o,   p o r u c h y   s p  n k u   n e b o   z n e p o k o j e n  ,   ~e   b y   s e   m o h l o   j e d n a t   o   v  ~n    o n e m o c n n  .   M n o h o   p a c i e n t o  s i   v y t v o Y   m e c h a n i s m y ,   j e j i c h ~  p o m o c    u v e d e n    p Y z n a k y   z v l  d a j  .   M  n   p i j  ,   c h o d    n a   t o a l e t u   d Y v e   n e ~  c  t    p o t Ye b u ,   v y h  b a j    s e   m  s t om   v z d  l e n  m   o d   t o a l e t .     P Y i n y   o n e m o c n n     H y p e r a k t i v n    m o o v    m c h  Y  j e   z p os o b e n   h y p e r a k t i v i t o u   n e b o   h y p e r s e n z i t i v i t o u   m o o v  h o   m c h  Ye ,   k   p o c i t om   n u c e n    n a   m o e n    d o c h  z    i   p Yi   t a k o v    n  p l n i   m o o v  h o   m c h  Ye ,   k t e r    u   z d r a v  c h   o s o b   n e v y v o l  v    p o c i t   n u c e n    n a   m o e n  .   U r i t o u   r o l i   p Yi t o m   h r a j    m u s k a r i n o v    r e c e p t o r y   s v a l o v i n y .    A k o l i   j e   p Y i n a   t o h o t o   o n e m o c n n    n e z n  m  ,   e x i s t u j    s t a v y ,   k d y   s e   O A B   v y s k y t u j e   a s t j i .   J e d n    s e   n a p Y k l a d   o :  O n e m o c n n    d o l n  c h   m o o v  c h   c e s t   a   o k o l    ( i n f e k c e ,   a t r o f i e ,   b e n i g n    h y p e r t r o f i e   p r o s t a t y ,   p r o l a p s   d l o h y ,   n  d o r y   m o o v  h o   m c h  Ye      z e j m  n a   t r i g o n a )    K o n k r e m e n t y   v  m o o v  m   m c h  Yi                                                                 $  &  4  6  8      N	  `	  f	  r	   
  
  2
  >
  P  j                         >  B  x  z  |  ~          
  b  d  n  p  |  ~              ϡ  hYM hR  h3* hR 5>* h3* hR 5>*]hR hR 5hv  hR  h,  h[!  hH  hX  hUt  	hv 5	h[! 5	h 5	hj3 5	h/ 5hD hD 5CJ aJ hD h/ 5CJ aJ h6= 5CJ aJ  4   6  8  N  P  ~      
  d        `        "  $  Z  t                                                                                                                                                                                                                                                                                                                                 
& F	 gdz    gdz 	  7$ 8$ H$ gdR    gdR    gd~A    gdYM     J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 0  2  6  :  <  @  V  \  ^  `  r  v  x  |                              $  Z      b  p                             H  J      (  >  Ŀ        	hS 5	h 5	h_  5hc+ hz  h  	hz 5hH$ hz  h,  hz  hp
 hz 5hR  hYM hR J      B  |!  ^"  #  #  R0  0  h1  1  >2  @2  :3  <3  r3  6  6  6  (7                                                                                                                                                                                                                                                                                    
& F
 gdz    gdYM 	  7$ 8$ H$ gd*    gdp
    h^hgd_    
& F gdp
   
& F gd_     gdUt    gdR    gdz  >  @  B  F                 z!  |!  ^"  "  "  #   0  R0  0  0  (1  81  B1  L1  \1  f1  1  1  1  <2  83  :3  <3  J3  ^3  p3  r3  3  3  3  3  3  3  3  3  4  \4  n4  p4  4  4  4  4  4  4  5  (5  ,5  j5  5  5  ʼhd  h"+  hp;  hqEE  hg]*  hz hp; 5hz hB 5h* CJ OJ QJ ^J aJ  hS hp
  hp
  Uh  h_   hr~c  h  hS  hS hS  	hUt 5hR hUt 5 <S t a v y   p o   c h i r u r g i c k  m   v  k o n u   n a   p r o s t a t  O n e m o c n n    C N S   ( i k t u s ,   n  d o r y ,   r o z t r o u ae n    s k l e r  z a ,   P a r k i n s o n o v a   c h o r o b a )  S t a v y   p o   c h i r u r g i c k  c h   a   g y n e k o l o g i c k  c h   o p e r a c  c h   v  m a l    p  n v i  E m o n    l a b i l i t a ,    z k o s t n o s t ,   d e p r e s e    D e g e n e r a t i v n    o n e m o c n n    m o o v  h o   m c h  Ye   v  s o u v i s l o s t i   s e   s t  r n u t  m   V  l i t e r a t u Ye   j e   m o ~n    n a l  z t   i   s y n o n y m a   O A B :   U r g e n t n    s y n d r o m ,   n e s t a b i l n    ( d r  ~d i v  )   m o o v    m c h  Y,   h y p e r a k t i v i t a   d e t r u s o r u .   S o u a s n    m o ~n o s t i   t e r a p i e    P a c i e n t i   s e   s y n d r o m e m   h y p e r a k t i v n  h o   m o o v  h o   m c h  Ye   a s t o   v y ~a d u j    d l o u h o d o b o u   l  b u .   S m y s l e m   t e r a p i e   j e   o d s t r a n n    p Y z n a k o  c h o r o b y   t a k ,   a b y   p Yi t o m   n e d o c h  z e l o   k  v  s k y t u   n e ~ d o u c  c h    i n k o.   L  b u   j e   d ol e ~i t    u p r a v i t   p o d l e   i n d i v i d u  l n  c h   p o t Ye b   t a k ,   a b y   b y l   p a c i e n t   s c h o p e n   v y k o n  v a t   b ~n    a   n e z b y t n    a k t i v i t y ,   n a p Y k l a d    a s t n i t   s e   j e d n  n  ,   c e s t o v a t   n e b o   n a k u p o v a t   b e z   n  h l    p o t Ye b y   m o i t .     K   z  k l a d n    t e r a p i    h y p e r a k t i v n  h o   m o o v  h o   m c h  Ye   p a t Y :  z m n a   ~i v o t n  h o   s t y l u  t r  n i n k   m o o v  h o   m c h  Ye  a n t i m u s k a r i n o v    ( a n t i c h o l i n e r g n  )   l  i v a  c h i r u r g i c k    Ye ae n    e v .   e l e k t r o s t i m u l a c e   Z m n a   ~i v o t n  h o   s t y l u  C  l e m   l  b y   j e   o d s t r a n i t   n e s p r  v n    n  v y k y   p Y j m u   t e k u t i n   a   r e ~i m u   m o e n  .   M n o h o   p a c i e n t o  t o t i ~  o m e z u j e   p Y j e m   t e k u t i n ,    m ~  s i   m o~e   z p os o b i t   Ya d u   z d r a v o t n  c h   p r o b l  m o.   M e z i   d o p o r u e n    o p a t Ye n    p a t Y   o m e z e n    p Y j m u   d r  ~d i v  c h   p o t r a v i n   a   n  p o j o,   n a p Y k l a d   p i t    k  v y   a   e r n  h o   a j e ,   a l k o h o l u   a   u r i t  c h   p o k r m o.  T r  n i n k   m o o v  h o   m c h  Ye  L i d    s   O A B    m a p u j     t o a l e t y   v  p r o s t Ye d  ,   v e   k t e r  m   s e   p o h y b u j  .   S n a ~   s e   v ~d y   v d t ,   k d e   j e   n e j b l i ~a ,   a   n e v z d a l u j    s e   o d   n  .    P r e v e n t i v n    p a k   v y p r a z d Hu j    m o o v    m c h  Y,   k d y k o l i v   j e   m o ~n o s t   j  t   n a   t o a l e t u ,   c o ~  m o~e   m  t   n e g a t i v n    d o p a d ,   n e b o e  s i   m o o v    m c h  Y  z v y k n e   u d r ~o v a t   m e n a   m n o ~s t v    m o e .    C  l e m   t r  n i n k u   j e   s n  ~i t   p o t Ye b u   m o i t   n a   k a ~d    3   a ~  4   h o d i n y .   T a t o   t e c h n i k a   p o m  h    p a c i e n t om   k   t o m u ,   a b y   s e   n a u i l i   z m  r n i t   p o c i t   n u c e n    n a  m o e n  .   T r  n i n k   s e   p r o v  d    t a k ,   ~e   p a c i e n t i   s i   s a m i   s t a n o v    c  l   l  b y   a   p o s t u p n   p r o d l u ~u j    a s   m e z i   n  v at v a m i   t o a l e t y .    A n t i c h o l i n e r g n    l  i v a  F a r m a k o t e r a p i e   m    v  s o u a s n o s t i   v  l  b   O A B   n e j v t a   v  z n a m .   P o u ~ v a j    s e   b l o k  t o r y   m u s k a r i n o v  c h   r e c e p t o r o.   V z h l e d e m   k  t o m u ,   ~e   m u s k a r i n o v    r e c e p t o r y   s e   k r o m   m o o v  h o   m c h  Ye   v y s k y t u j    i   v e   s l i n n  c h   ~l  z  c h ,   g a s t r o i n t e s t i n  l n  m   t r a k t u ,   s r d c i ,   n e r v o v  m   s y s t  m u   a   o  c h ,   m o h o u   t y t o   l  k y   z p os o b i t   n  s l e d u j  c    n e ~ d o u c     i n k y :  s u c h o   v   s t e c h  z  c p a  r o z m a z a n    v i d n   t a c h y k a r d i e  p o t  ~e   s e   s o u s t Ye d n  m  T y t o   n e ~ d o u c     i n k y   n k d y   m o h o u   v  s t   a ~  k  p Ye r u ae n    t e r a p i e .   P r o t o   j e   v h o d n    v o l i t   p Y p r a v e k ,   k t e r    m    s e l e k t i v n     i n k y   p o u z e   n a   r e c e p t o r y   v e   s v a l o v i n   m o o v  h o   m c h  Ye .  N e j v  c e   u ~ v a n  m i   p Y p r a v k y   v  s o u a s n    d o b   j s o u :   s o l i f e n a c i n ,   o x y b u t i n i n ,   t o l t e r o d i n ,   t r o s p i u m   a   p r o p i v e r i n ,   z  n i c h ~  n e j s e l e k t i v n j i    i n k u j e   s o l i f e n a c i n   ( V e s i c a r e ) .  Z  d a l a c h   l  k o,   k t e r    m a j    s v    m  s t o   v  t e r a p i i i   O A B ,   j e   n u t n    j m e n o v a t   a n t i d e p r e s i v a   ( z e j m  n a   i m i p r a m i n   a   d o s u l e p i n ) ,   u   ~e n   v  p o s t m e n o p a u z e   l z e   v y u ~ t   i    i n k o  l o k  l n    e s t r o g e n n    t e r a p i e .     D a l a   l  e b n    m e t o d y  C h i r u r g i c k    l  b a   s e   u ~ v    s e   a ~  v   p Y p a d e c h ,   k d y   j i n    t e r a p i e   s e l h a l a .   E x i s t u j    d v a   p Y s t u p y .   P r v n  m   z  n i c h   j e   a p l i k a c e   b o t u l o t o x i n u   d o   m o o v  h o   m c h  Ye ,   k d e   b o t u l o t o x i n   b l o k u j e   k o n t r a k c i   s v a l o v i n y ,   d r u h  m   p a k   z v t ae n    m o o v  h o   m c h  Ye   p o m o c    s t Ye v n  h o   s e g m e n t u .  M  l o   p o u ~ v a n o u   m e t o d o u   j e   e l e k t r o s t i m u l a c e   p o m o c    v a g i n  l n  c h   e l e k t r o d ,   a l e   p Yi   p o u ~i t    n i ~a   f r e k v e n c e   p r o u d u ,   n e ~  j e   o b v y k l    v  t e r a p i i   i n k o n t i n e n c e   s t r e s o v  .   D o c .   M U D r .   R o m a n   Z a c h o v a l ,   P h . D .  U r o l o g i c k    k l i n i k a   F a k u l t n    n e m o c n i c e   K r  l o v s k    V i n o h r a d y ,   P r a h a                                                                                                                                                                                                                                                                                                         5  5  5  5  5  26  B6  6  6  6  6  6  (7  Z7  7  7  7  7  7  7  *8  8  8  8  9  "9  49  d9  v9  x9  z9  9  :  :  &:  .:  p:  :  :  :  D;  F;  j;  =  =  =  =  $=  6=  &?  T?  ?  ?  ?  @  @  (@  ,@  ,B  BB  DB  VB  nB  pB  C  C  DC  м谸ܬܬܬ  hiqS  hk  h8C hk 5hv  hv hH 5h_   h  hz   h8C  h8C hz  5hv  hC  hp;  hH  hqEE  hB  hd  hg]*  h"+ B(7  Z7  7  7  7  *8  :  :  =  &?  T?  A  A  
B  ,B  DB  rB  C  E  F  F  F  H  J                                                                                                                                                                                                                                                                                                gd_   
& F gd8C    gd8C    gdk    gdv    gdH    gdYM   
& F
 gdz   
& F
 gdH  DC  XC  C  E  E  HF  LF  ZF  jF  F  F  F  F  F  F  F  F  F  G  $G  ,G  .G  G  G  G   H  H  LH  bH  dH  ~H  H  H  H  H  H  ^I  hI  I  I  I  I  J  J  J  J  ž賯                                                                                                           h_  h_   h&  h_   h_ hv  h_ hbM  h_ hC  h_ hv 5h_ h_ 5h_ hm.! 5hv  h  hv  hm.!  hv  hk  h_ -J  J  VJ  J  J                                                                                                                                                                                                                                                                                                                                                                                                                                                                               h^hgdm.!    gd_  , 1h. A!"#$%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   D  @ D           N o r m  l n        CJ _HaJ mHsHtH                  J A  J          S t a n d a r d n    p  s m o   o d s t a v c e     Z i  Z          N o r m  l n    t a b u l k a      4 
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  0                     
  0                    
  0                    
  0                       0                        0                        0                        0                        0                        0                        0                        0                       0                       0                      0                      0                      0                        0                        0                        0                        0                        0                        0                        0                        0                        0                        0                        0                                          2  Q  p                  :  q    K	  l	  	          /                &  '  a  w            ,  E  o  v                  -  .  C  R      0                       0                       0                       0                       0                       0                       0                     0                       0                       0                       0                       0                       0                       0                       0                       0                       0                   ي 00         4         @   0                   @   0                   @   0                   @  0                   @  0                   @  0                   @  0                   ۊ 00         .             0                   ۊ 00         /         ۊ 00         /         ي 00         /          00         ,         ۊ 00         /         ۊ 0 0                        0                       0                       0                   ۊ 0 0                   ي 0 0                   ي 0 0                   ي 0 0                   ي 0 0                    0 0                   ۊ 0 0                   ۊ 0 0                   ي 0 0                   ي 0 0                   ۊ 030                  @   0                   @   0                   @   0                       0                       0                      0                       0                       0                       0                      0                       0                       0                       0                       0                      0                        >  5  DC  J           &   (        (7  J  J        '   )      J                                                   A  M              u  ~                  v                _  r             (  +  5                      f  v    
  R                                                                                             1  2  P  Q  o  p                          9  :  p  q      J	  K	  k	  l	  	  	              .  /              V  W                  %  '  `  a  v  w                  +  ,  D  E  n  o  u  v                                  o  p  ,  .  B  C  J  K          N  R                                                                                                                                       a        R                      R      }e|.2P &Z bc$$ H~ 1b(` 	?u '!?*@ k@ QP [<^Ҡw 
2jg ]P l\g 1}&E               h        h h^h`OJ  PJ  QJ  ^J  o(  -              h        8 8^8`OJ QJ ^J o( h    H   o              h         ^`OJ QJ o( h    H                h        	 	^	`OJ QJ o( h    H                h         ^`OJ QJ ^J o( h    H   o              h        x x^x`OJ QJ o( h    H                h        H H^H`OJ QJ o( h    H                h         ^`OJ QJ ^J o( h    H   o              h         ^`OJ QJ o( h    H                             ^`OJ  PJ  QJ  ^J  o(  -                         ^`OJ QJ ^J o( h    H   o                        p p^p`OJ QJ o( h    H                          @ @^@`OJ QJ o( h    H                           ^`OJ QJ ^J o( h    H   o                         ^`OJ QJ o( h    H                           ^`OJ QJ o( h    H                           ^`OJ QJ ^J o( h    H   o                        P P^P`OJ QJ o( h    H                h         ^`OJ QJ o( h    H                h         ^`OJ QJ ^J o( h    H   o              h        p p^p`OJ QJ o( h    H                h        @ @^@`OJ QJ o( h    H                h         ^`OJ QJ ^J o( h    H   o              h         ^`OJ QJ o( h    H                h         ^`OJ QJ o( h    H                h         ^`OJ QJ ^J o( h    H   o              h        P P^P`OJ QJ o( h    H                h        8 8^8`OJ QJ o( h    H                h         ^`OJ QJ ^J o( h    H   o              h        	 	^	`OJ QJ o( h    H                h         ^`OJ QJ o( h    H                h        x x^x`OJ QJ ^J o( h    H   o              h        H H^H`OJ QJ o( h    H                h         ^`OJ QJ o( h    H                h         ^`OJ QJ ^J o( h    H   o              h         ^`OJ QJ o( h    H                 h         ^`OJ  PJ  QJ  ^J  o(  -              h         ^`OJ QJ ^J o( h    H   o              h        p p^p`OJ QJ o( h    H                h        @ @^@`OJ QJ o( h    H                h         ^`OJ QJ ^J o( h    H   o              h         ^`OJ QJ o( h    H                h         ^`OJ QJ o( h    H                h         ^`OJ QJ ^J o( h    H   o              h        P P^P`OJ QJ o( h    H                 h         ^`OJ  PJ  QJ  ^J  o(  -              h         ^`OJ QJ ^J o( h    H   o              h        p p^p`OJ QJ o( h    H                h        @ @^@`OJ QJ o( h    H                h         ^`OJ QJ ^J o( h    H   o              h         ^`OJ QJ o( h    H                h         ^`OJ QJ o( h    H                h         ^`OJ QJ ^J o( h    H   o              h        P P^P`OJ QJ o( h    H                  h         ^`OJ  PJ  QJ  ^J  o(  -                         ^`OJ QJ ^J o( h    H   o                        p p^p`OJ QJ o( h    H                          @ @^@`OJ QJ o( h    H                           ^`OJ QJ ^J o( h    H   o                         ^`OJ QJ o( h    H                           ^`OJ QJ o( h    H                           ^`OJ QJ ^J o( h    H   o                        P P^P`OJ QJ o( h    H                          h ^h`OJ QJ o( h    H                           ^`OJ QJ ^J o( h    H   o                        p p^p`OJ QJ o( h    H                          @ @^@`OJ QJ o( h    H                           ^`OJ QJ ^J o( h    H   o                         ^`OJ QJ o( h    H                           ^`OJ QJ o( h    H                           ^`OJ QJ ^J o( h    H   o                        P P^P`OJ QJ o( h    H                h         ^`OJ QJ o( h    H                h         ^`OJ QJ ^J o( h    H   o              h        p p^p`OJ QJ o( h    H                h        @ @^@`OJ QJ o( h    H                h         ^`OJ QJ ^J o( h    H   o              h         ^`OJ QJ o( h    H                h         ^`OJ QJ o( h    H                h         ^`OJ QJ ^J o( h    H   o              h        P P^P`OJ QJ o( h    H                h        8 8^8`OJ QJ o( h    H                h         ^`OJ QJ ^J o( h    H   o              h        	 	^	`OJ QJ o( h    H                h         ^`OJ QJ o( h    H                h        x x^x`OJ QJ ^J o( h    H   o              h        H H^H`OJ QJ o( h    H                h         ^`OJ QJ o( h    H                h         ^`OJ QJ ^J o( h    H   o              h         ^`OJ QJ o( h    H                 h         ^`OJ  PJ  QJ  ^J  o(  -              h         ^`OJ QJ ^J o( h    H   o              h        p p^p`OJ QJ o( h    H                h        @ @^@`OJ QJ o( h    H                h         ^`OJ QJ ^J o( h    H   o              h         ^`OJ QJ o( h    H                h         ^`OJ QJ o( h    H                h         ^`OJ QJ ^J o( h    H   o              h        P P^P`OJ QJ o( h    H      k@ Q            1}            &            }e|            	?            '!?            [<^            bc            
2j            H~ 1            ]P l                                         N1         N1                             N1         N1         N1         (                             N1        h                g   gi  z  k d v m 6
 _ R <$ kZ f  _  m.! [! H$ }n$ :' -' 3* g]* cY+ ^+ c+ , , -{. j3 Q6 N: p; 6= #@ `B 8C lD qEE {F =G bM >O Y3R S iqS <V X YZ \ o_ r~c g zj k 'k Mk (m kn %r Ut z ,n & 0 D2 * 9  } B K YM * + D   ~A T "|  S G v F X v  aa ap . X v w } H Tj "+ D H p
 C ` 0 / @          7:                   @                  P  P      P  
    P      P       P  0        U n k n o w n                                   G z                  T i m e s   N e w   R o m a n   5                       S y m b o l   3& z                  A r i a l   5& z a               T a h o m a   ?5 	z                  C o u r i e r   N e w   ;                                W i n g d i n g s   "  1       qKqK}       [       1     [      1       !                                                                                                                                                                                                                                                                                                                            4    d      C  C                                                                       2Q                              HX    	 ?    zj     2                        H M c h  Y  f u n g u j e   j a k o   s v a l o v    v a k ,   u   z d r a v  c h   j e d i n c o  p o j m e   a ~  6 0 0   m l   m o i        H a n a   K r  s n i a n o v  
 R e n    B u Yi                     8                            	  
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