hogeiylnoxmeboD ahs a hirgeh aKp htan ngexoomilahyb and uhst wlil tacpce ngerhdoy osni oerm iyralde. shiT si ttirnampo ni the lbiytia to ""ryarc CO2 as het niam mcaeshmin fo C2O nprorastt is yllactau oocsnrevni of CO2 to -COH3 (2CO + H2O t-&;g C3-HO + H)+, tshu diobenlhmgyaxeo seiarcr het H+ wilhe H3O-C is sdnpttearor ni het apslma ot the .nsugl abnbleonmgiChraomia is acltyaul olyn obtau 02% fo the C2O prratntos adn 2CO isdledsvo as O2C is 01%; ttnorrpas as H-3CO is doanur 07% of eth 2OC r.aspntotr

Heer is hetnaor aiegm fo teh csoreps.

hAonetr omttpniar setcpa fo het repssco ot eakt onet fo that yeht keil to sak obaut si teh ocelidhr sti.fh doilrehC osvem eht iposotpe rinidoetc sa OH-3C ni eth RBC. Thus ta tuissse wehre ew aer iaenntggre 3CHO- frmo O2C adn eedn to ppmu it uot of teh ell,c ierldcoh eomvs onti eht tAlecl. the leoavil heewr we edne ot pupm -3HOC bkca into teh RCB ot untr ti otin 2OC, hordelci vseom tou of the lec.l

erOht srwesna:

• P3,BG2 will idnb and asibliztes edhgiyeonoxlamb aikgnm it ssel atdrtctae ot xoney,g gsnihift eth eabgmiholn soatniiiosds ceurv tgrhi.
• eilynehaDgxobom hsa a ehrhgi acipcyat ot omrf hebblangcimanormoai
• bxmloenayDehgio sah a erighh KpA anht magebynhxlooi iths( si yhw ti nac actepc hergnydo nios emro aedi)rly
• iCopntemtio rof diibgnn esti is not a rmajo semchamin ofr hte iyablti ot rcayr 2CO sa stmo OC2 is r"iercad" by envcroosni to 3C-HO
• iNitrc odeix nngbdii si otn a niecmmsha of C2O aryr.c

rtsFi equnstoi : yhTe ltel us sti a oyhlpmtcyic eiaelkmu

ocndeS eutoqsni : pgerhDnceii ehhwter it is a B llce ro T le.lc

hTe esllc aehv no crfsuae obund gI M gI, G ro cscloimtpay hsaicn for esteh oesbaniidt , btu vhea a regadrenar eeng m(etgesn nmeangi ievtca ) for eht T llce eptReorc . oS eht seCll rea T eClls

hrdiT uinqteos : oNw htta ew owkn htat ythe rae T Clels , ew nawt ot oknw ethhrwe ethy rae CD4 or DC 8 tpeioivs

Teh lelcs in teh lcclanii ivengtet kacl thob DC4 and CD 8 ( edboul teavnige ) roAcdcgni ot ohw T elcsl lanrlymo dveopel - hTey tsrat fo sa igben dbueol tgieevan ( .ei tno eprxenssgi D4C ro DC 8) ni eth rbaapuscusl oegnir adn eegyrslrisvop obecme
- sviieotp rof tboh CD 4 dna DC 8 in eth rcetox
- adn yvluntelae cearuqi the CRT adn DC3 by eht eitm eyth teg to het aueldml

hTsee cllse fehroeret mstu T plymoetych mteoyhsytc clodaleis ot teh rxceot

eHer is ym ak:te a ntiruacverl ltpsae etecdf ni afnniyc wlsalo fro tefl ot grhti nsgutihn of doblo ni het e.crltviesn hisT uscsea an scrdneiea reessurp in teh hitrg crevnelit e(ud to roem ldboo gnbei uhpeds itno i)t dan a ddcrseeae esprsuer in teh ftle nleiervct. cuBesea heret is rome obdol in hte prolamyun olirccianut form eth nsuht, I htikn the elft rtilaa epurssre wdluo soal eb enairsedc in na eryal SDV.

OS ehnw yuo rreipa teh VSD, the tefl neltecirv errupess llwi eb ridansece perocadm ot nweh het nhstu asw prstnee i(t si on rongle glniso obdl,o) hte rtigh renltevic reepssur llwi eb edacdseer t(i is on ognrle gentigt obodl omrf eth ushtn,) nad teh eftl tilaar essrrupe ilwl be adeedercs ete(rh si on reolng dveooalr of het onylrmpua sytesm nrtreguin ot het flte r)ti.uam

02FA02 982p

isTh man iyellk sah icidteab tnarhyupoe nda utsh wodlu ahev nuciaorpthe pai.n utcNrahieop inap is rddeisceb sa a bnnriug naip sa mapoderc to het hroet idksn of apn.i

Here era eoms fersdfiecen etebewn eintoecvipoc and hioepnctaru inap.

eHre is a hrtca of iporstcesrd esdu orf napuroichte v oeneitcvipoc anip.

rH,ee we twna to knwo ignload esod whchi is eaulq ot eht vuloem of ribouitsnidt x rgatte nnccttnooriae ni smap.la

oS oru gndaoil deos = /g1k1L8. x 0m1g = 1gk1.m/g8

hSe is a g5k5 eorpns so g8/1.kg1m x 55gk = 5.959 gm ichwh oixpsetaarmp to 0g1m00 lotta inadglo .eosd

armtInpot rmhPa uoEtansiq ot mebRmree

Teh ntsedciipor sotpin ot aatcrcniep fnyiuiniescfc deu to eseotraathr at(f in het ,lotos eyklli deu ot nnscifeiuyicf fo pcateiranc lasp)ie and elsucm irefb in hte soolt hwh(ic nostip ot tnmelpioce rtinpeo sedint,igo kyilel ued to ceiunicisynff of eaictpancr sto.psree)a

rue,rtFh he sah no eidifeccyn in oahredacrybt apnsbritoo sa edecndvei by eht yxoseDl- tets cwh(ih eicsdinat na ctatni oaucsm rfo pbansiroot nda dseo ont eerqriu sgetiedvi sz,yneem A020F2 3p7)3; nda he ahs on nmlaibseatoir on sbiyop fo teh teinn.site

sTuh, the pmairyr ssiue si acanectirp finucycneifis dan eeuonsnptpimtla of acpeianrtc nzymees is somt lfeuhpl.

mnatotrpI cspaets of taeolivl (s)ag saiehcet:stn 2AF2(00 4p9:5)

• AMC uinm(mim lveolara tnnronotacie)c: sielyltsaen eht 0E5D ofr dahenli ,sanitsehect stih is eht iumminm nocrientontac of heiceasttn ahtt aucses a peosrsne in %50 fo netaitsp
• OLW CAM nmesa GHIH cyopnet - mero optnet dgusr uwold eahv a worel inmumim anutom ededne ot eb npseret in het lloieav ni rdeor to etrxe rthei tc.ffee
• WLO AMC si aeelrtd ot HHIG iipld lbusytiilo g(iehrh laoi/sg inaotrpti ncieic)oftef - omer pildi lsbeolu etsagn dnet ot be roem tnopet seuabec of eihrt aedisncer itlibay to scsor the BBB
• CsAM aer iievddat ie(.. eno ags at 5.1 CAM = otw essga at .075 treih siretcpeev C)MAs
• loaB/sogd potiianrt cfinecotfei: na esonirsxpe of ;ityllouibs esiathentsc wiht a wlo odobl asg iitrantop cntefeifoci vhae a diapr sfooest/fent
• e..i SLES pasalm suloelub iactsehnte = TSERAF ffeott/onsse
• Tish is sbecaeu essl pamsal uelslob tnaegs iwll lf"li pu" erith ammixmu mtnoua ni eth odbol esoerrriv ckuriqe and hsut era hedspu nodw rhtei oinottcenanrc tearindg tino the nirab icqerku; ie.. etyh kylicqu aatresut eth odbol dan llwi evmo no to gitncfeaf teh bainr ekqcrui
• CAM and oobgld/sa ntairipto efniietofcc laos nted ot eb ivleysrne atedler -- rhgehi MAC = rlowe s/doalogb aptintoir fcnietiecof dna cevi r;esva htsu namy fo eht emor nttepo taeshneistc haev a elnorg tmie for stoeeofsn/tf

;RTL:D Even htiw pyTe I ro II ranle atburlu ciissdao the giimsemnesaoan ofrm nilmetuga is ont diipearm and suht si the mina oseruc of o.mamian

Heer si ym ek:ta sdaBe no hre htorsiy dan asuedrme palams eau,vls thsi rigl leikly ash neo of eth owl" t"iuopssam leran ltbaruu edai,csso heiret pyeT I or eTpy II (ese htsi ctrha rfo esrnoaing saebd on aseudrem veausl or stih eaimg fro nuf ullorcfo enlra buruatl aossciid and 2A0F20 p)935

nhTe, we rea ldto htta she sha a cetfde ni nm"nies"sgeoi.aam In eht alrne t,lubsue imaomna is adenegert ni tow ryimarp aw:sy via tedirc rinoscnvoe of eitnlguma ot maainmo ni the xolrmaip ueublt cwihh is neht crsetdee tnoi teh ,elubtu ro by HN3 bingnimoc twih hiwt +H ni eth ltcnoieclg uteslub iwh(ch I sesgu hyte rae cigendrnsoi a tereaspa ioanegmesisnma wtapyah eevn gthuho tis all nkdai el?taer).d eSe isth raimdga or tsih aidargm

snuiAsmg uro gilr hsa ypeT I aerln rbatulu oscsi,dia eehtr illw be ecsedreda iatllyiaiavb of orydehgn snio ni eth renla tulbeus to eboimnc hitw N.3H uhsT, eth irpramy cseruo fo aomanim dnoctopuri ni tihs enaiptt will eb ueimgtnal whhi(c si eht ojmar reoucs fo asiagminmeosen ni a amnlor pnsreo asnwya)y.

rFhuetr onanregis - eyTp I is iedramip ncteireos of grdhyneo ions into het en,lmu so hetre illw be sles nydhgero sion baveilaal. hSe eillyk hsa ptye I ubeasec iths is rayriimpl deaettr tihw mispustao ratitec bho(t to erffub nda ot vrenetp rnela stenso hhicw aer a nocmom mpinati)ocolc. vEen if ehs dah yepT II eth endseiacr ietexocrn fo bbacir luwdo soal efurbf omer H+ velnagi less rof mnmeiiongaasse ni hte 3+H/NH tcnmbaniooi no.sihfa

lrCnr,itayo Teyp 4 lnaer ltuarbu cdiiosas yi)harkmlpec(e tsuersl in esrdedeca shsynseti fo mominaa ni eht oliapxmr ubluset, iwhhc ew know ehs sdeo not heav sceabue fo erh olw ssaom.itup

0A2F02 p 126 has yrlae efalt letnemov.edp ereH aer the aaoexisnltpn rfo eht assrw:en

• hTe oosinrbtlttpysochay estedami yrlae notipilatnam ni teh sftri ekwe and itsh si newh hGC otcineesr singb.e erFuh,tr it morsf ynnotutltecc ihtw eht hypraotslboottc ofmr het blopthartos.
• ehT bimiarlna idcs otw( e)ayrls si esptnre ngduir kewe o,wt and oatlsrgauint ccsoru urignd eewk 3 adn 3 gemr slyaer era eht opu.cdtr
• hTe nlarue eubt si nto llfyu dfremo linut day 21 ubt the aunrle lepat is foermd on yad 81 2(2F0A0 )04p9
• heT erymob si NTO tnrtaseis ot gstorteean ree,h urnlea ebut eestcdf cna ruocc fi teh berym si espoxed to seroangtet ni eekw 3. lrEeira htna hsti teh ybmreo si ni na "lla ro tihg"nno estag and dthae of teh erbymo si more lkleiy to urcco if eth ybmreo is xpedsoe.
• heT esiomst ormf acnjaedt to teh lrneau ogvoer prori ot moctsrleeo itmrngiao.

,asBylalci enve iohutwt gnowkni lla the cxaet sayd of o,mpdnveeelt ostm swsnera anc be dteeialmin eabds no hivgan hte stenev ni eth rcteornic dorer ro vhngia an roetncicr epatcs baotu eveeopnldmt .ie.( teh prtoctyhoisysntbaol rfmso cnutrrcneo thwi teh sobrtaotyp,coht 3 egmr asrlye aer ertepns treaf atarl,ogtnuis teh mobeyr is enver rylut nstestiar ot erngeottas ftera mln,taotpiina eth romltcoese sfrom fmor stsmoei os eostism heav to moec i)r.fts

eHre si a eenargl wivvreeo of eht ftsri theer wkese fo eevnedtmpol aetrf tirlifzieanto.

Heer si rontahe eno fi that snd'eto do it orf ay.

I fleediinyt did otn nowk h,its ubt plertnaypa mngioks nac sewron RDEG deu to tyencend fo iieoncnt to saceu niaxelrota fo hte rwleo apehesagol pstrn.echi omiSkgn is aslo dlneik ot csamtho cursle due ot ieercntfreen tiwh isgtarc masuco and acid opc.nuoridt utsJ dont' moesk ksd.i Dto'n od rsudg. Syat in ochosl errfveo klie emd ssdu.ttne

tmuoilBs onitx stac iva oaertesps that lvaece SAENR dan tvrepen cncolyheietla lresaee ta eth unurroscelmau onicnjut A2(02F0 )2.p13 ,suhT it edos otn tieclrdy tffeac eht atroinpt-sspyc umcels .lecl If you add lantxree ,haecollciyten you ulwod tslil aveh a lltypemeco aromln nser.ospe ihsT ltieimnesa lla utb wot sean.wsr

heT end tlape ttinpeola P)P(E dolwu be etfdecfa yb mosutilb oixtn sebceua hte nde eaptl ilteatonp is eht gceanh ni eoatlgv tath rcsocu ta eth oisnppsatytc lmuecs rootm letdapen erfat na toianc iotetnpla in eth rotom reonun aonx irggrets leaeser of yamn leteclnahoiyc cise.vsel laroNl,my an nctioa ttniloeap in eth ootrm onenur lwli ucaes lnxuif of iuclmca atth aldse ot sfuino fo hcA csliseve gqeuir(rin ARSEN) dan ssiotc,xoye lgieensar eglra qseattnuii of hAc ntio teh seapsny whchi cna tnhe bndi dan eirggrt an PEP in het .lmuesc tWih olibmt,su nsfiou fo eht chA eessilvc is ntidiiehb so lsse hcA si daresele nda het PPE si udt.ebln yltN,oba hte vaotgel si eth mesa sa the EmPP wichh is eht vgeotal afetr omarnd nrreccueco fo Ahc eseelar ese( ebwol.)

A eniuairmt ned tlape tiolenatp (EP)Pm is eht govlate ceaghn atht csuocr ewnh eon vecsiel fo cyalhconeitle is .ldeersae seeTh urocc odlmrny.a PEPm loudw ont be atecdfef by iuobmlst xnoit cesuabe it si eht uepdrco fo odnamr uofsni fo a eecvsli ichhw cdluo itlsl roccu eftar odnaiatsiitmrn of obtilmus o.nitx

rHee si na aimge nneirdigm hte cefeeindrf wbeeent PEP nad PEPm.