L'eau et les liquides de dialyse dans le traitement de l'insuffisance rénale chronique terminale

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(1)L’eau et les liquides de dialyse dans le traitement de l’insuffisance rénale chronique terminale Edouard Kunegel. To cite this version: Edouard Kunegel. L’eau et les liquides de dialyse dans le traitement de l’insuffisance rénale chronique terminale. Sciences pharmaceutiques. 2013. �hal-01733202�. HAL Id: hal-01733202 https://hal.univ-lorraine.fr/hal-01733202 Submitted on 14 Mar 2018. HAL is a multi-disciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers.. L’archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d’enseignement et de recherche français ou étrangers, des laboratoires publics ou privés..

(2) AVERTISSEMENT. Ce document est le fruit d'un long travail approuvé par le jury de soutenance et mis à disposition de l'ensemble de la communauté universitaire élargie. Il est soumis à la propriété intellectuelle de l'auteur. Ceci implique une obligation de citation et de référencement lors de l’utilisation de ce document. D'autre part, toute contrefaçon, plagiat, reproduction encourt une poursuite pénale.. illicite. Contact : ddoc-thesesexercice-contact@univ-lorraine.fr. LIENS. Code de la Propriété Intellectuelle. articles L 122. 4 Code de la Propriété Intellectuelle. articles L 335.2- L 335.10 http://www.cfcopies.com/V2/leg/leg_droi.php http://www.culture.gouv.fr/culture/infos-pratiques/droits/protection.htm.

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(57) SERMENT DES ApOTHICAIRES. --.Je j ure, en présence des maUres de la Faculté, des conseillers de l'ordre des pharmaciens et de mes condiscip les :. D' honorer ceux. qui m 'ont instruit dans les préceptes de mon art et de leur témoigner ma reconnaissance en restant fidè le à leur enseignement.. D 'exercer, dans l' intérêt de la santé publique, ma profession avec conscience et de respecter non seulement la légis lation en v igueur, mais aussi les règles de l' honneur, de la probité et du désintéressement.. De. ne jamais oublier ma responsabil ité et mes devoirs envers le ma lade et sa dignité humaine ; en aucun cas, je ne consent ira i à utiliser mes connaissances et mon état pour corrompre les mœurs et favoriser des actes criminels.. Que les hommes m 'accordent leur estime si je suis fidèle à mes promesses.. Que je sois couvert d'opprobre et méprisé de mes confrères si j'y manque.. --.--. . . .

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(300) j ) E9);E ;g)DE AC)DBH) C2); )E 9g)NA+C2);&) )DE E=HEa BH) 9g=; &BH2)CE .=C&) () :=()DE2) )E () ECL29dk . EC2&8KD82;(a. j =HE) &1=D) )DE A=DD2%9) E;E BHg)99) ;) Dg)DE AD L+C+) 2:A=DD2%9) o )E :,:) ); &) &Da )99) ;) 9g)DEA)HE,EC)BH)AC=L2D=2C):);Edk . )C9H&8a . . .

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(306) *:) D2*&9)a ACE2C () D)D ;=:%C)HD)D )NA+C2);&)D();+A1C)&E=:2)D&;2;)Da&=::);E)H;))N&)99);E)E=9+C;&) 9DHAAC)DD2=;(gH;C)2; )E=%D)CL)BH)9:=CEAC%2;+A1C)&E=:2);g)DEAD2::+(2E)d. C"&) D)D )NA+C2);&)Da 29 )DE 9=CD AACH +L2();E BH) 9)D C)2;D ;g+E2);E BHg2;(2C)&E):);E 2;(2DA);D%9)D 9L2))EBH)9)HCDHAA9+;&)+E2EA=DD2%9)d )H9)DEC=2D:+E1=()D()EC2E):);EaH7=HC(g1H2aDg=..C);EHAE2);E2;DH..2D;EC+;9&1C=;2BH)s

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(311)

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(313) 3.

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(318) 9 :)DHC));L2C=;&:()9=;0A=HC&:()9C0))Ea&:(g+A2DD)HCuvdDECH&EHC))DE);C=%+) (gH;)&ADH9).2%C)HD)92DD)uvd 9&=HA)D02EE9)a&1BH)C)2;AC+D);E)()HNP=;)Db9gH;)A+C2A1+C2BH)aA"9)c9&=CE2&9)a)E9gHEC) &);EC9)aA9HD.=;&+)aAOC:2(9)c9:+(H992C)u vd :+(H992C))DE)99)n:,:)(2L2D+));()HNC+02=;DaH;)C+02=;)NE)C;).2D;EDH2E)H&=CE)N)EH;) C+02=;2;E)C;)aBH2D)AC=9=;0)AC9AA299)d. +#TA/1 2,33%-,C4,1%,2%,#4$3C4,1%,/3$-*-#%04I#*-+ 14*-, /$1%3J1-%3KWLB. <I<I< ; ) C)2; 1H:2; D) &=:A=D) (g);L2C=; a 2992=; (gH;2E+D DECH&EHC=.=;&E2=;;)99)D )N&C+EC2&)Dc 9)D ;+A1C=;Dd1&H;()D;+A1C=;D)DE.=;&E2=;;)92;(+A);(::);E()DHEC)D;+A1C=;Dd

(319) 9D=;E&=::) . .

(320) C>9) (g+9%=C)C 9gHC2;) ACE2C (H A9D: D;0H2;a A=HC 9g+L&H)C (;D 9)D L=2)D HC2;2C)Dd 1BH);+A1C=;D)&=:A=D)(gH;09=:+CH9))E(gH;EH%)C+;9d )09=:+CH9)D2EH+(;D9)&=CE)NC+;9a)DE);.2EH;DODE*:)&=:A9)N)()&A2992C)D09=:+CH92C)D &=;E);H (;D H;) );L)9=AA)c 9 &ADH9) () =M:;d ;EC) 9 &ADH9) )E 9) C+D)H () &A2992C)D &2C&H9)9gH9EC.29ECE09=:+CH92C)BH2Dg+&=H9)L)CD99H:2*C)(HEH%)C+;9d. +#UA$ +3%23%-,*2314341M4,#*-+ 14*KXL. ;C+DH:+a9)09=:+CH9)A=DD*()H;A>9)LD&H92C)cCE+C2=9)..+C);E)BH2D)(2DD=&2));H;C+D)H ()&A2992C)DAH2DC)DD=CE);H;)CE+C2=9))..+C);E)b)EH;A>9)HC2;2C)&=::H;2BH;EL)&9)EH%) &=;E=HC;+AC=N2:9uvd )EH%H9)a=HEH%)HC2;2.*C)a.2D;EDH2E)H09=:+CH9)a)DE&=;DE2EH+(gH;)D)H9)&=H&1)(g+A2E1+92H: A=9C2D+DgAAHO;EDHC9:):%C;)%D9)(H&>E+A+C2EH%H92C)d 1BH)EH%H9))DEDH%(2L2D+);c n. n n n. . H;EH%)AC=N2:9a&=;DE2EH+()c o H;) ACE2) &=;E=HC;+) (7&);E) H 09=:+CH9) )E (=;E 9) AC&=HCD )DE AC99*9) 9 DHC.&)C+;9)a o H;)ACE2)(C=2E)aj3565"7kaBH2A+;*EC));AC=.=;()HCaA)CA);(2&H92C):);E 9 DHC.&)(HC)2;a H;);D)() );9+b H;EH%)&=;E=HC;+(2DE9b H;EH%)&=99)&E)HCc o H;EH%)&=99)&E)HC&=CE2&9C)92+(2C)&E):);E 9g;D)() );9+a o H; EH%) &=99)&E)HC :+(H992C) BH2 &=;.9H) L)& 9)D HEC)D EH%)D :+(H992C)Da A=HC %=HE2C () 9C0)D &;HN &=99)&E)HCD BH2 Dg=HLC);E H ;2L)H () 9 AA299) )E &1):2;);E9gHC2;)(+.2;2E2L)(;D9)D&92&)Dd. .

(321) +#VA$ +*2314341M4,, /$1-,KYL. <I<J< 1)P9g1=::)9)(+%2ED;0H2;C+;9)DE() :l:2;lC)2;dA)C.HD2=;()D()HNC)2;DC)AC+D);E) (H (+%2E &C(2BH) H C)A=Dd )H9):);E () &) (+%2E A9D:E2BH) C+;9 )DE .29EC+ AC 9)D .9=&&H9HD09=:+CH92C)Duvuvd. 7D7E7D7 ) C)2; )DE C2&1):);E LD&H9C2D+ )E &g)DE H ;2L)H ()D &A2992C)D 09=:+CH92C)D BH) Dg)..)&EH) 9gH9EC.29ECE2=;D;0H2;)d2D%2);L;E&)D:2&C=DECH&EHC)Da9gCE*C)C+;9)AC2;&2A9)L2);EA+;+EC)C H;2L)H(H129)C+;9)ED)C:2.2)C);A9HD2)HCDA)E2E)DCE*C)D2;E)C9=%2C)DaBH2 9)HCE=HCa.=C:);E ()DCE+C2=9)D..+C);E)DA+;+EC;E(;D9)D09=:+CH9)Dd LD&H9C2DE2=; (gH; ;+A1C=; )DE (=;& DDHC+) AC H;) CE+C2=9) ..+C);E)a BH2 A+;*EC) (;D 9 &ADH9)()=M:;HA>9)LD&H92C)d)EE)CE+C2=9)D)DH%(2L2D));&A2992C)D.=C:;E9)09=:+CH9)a )E 29D Dg;DE=:=D);E A=HC .=C:)C 9gCE+C2=9) )..+C);E)d )EE) ()C;2*C) D) C:2.2) ); H; C+D)H 2:A=CE;E()&A2992C)Dc9)D&A2992C)DA+C2EH%H92C)DaBH2);E=HC);E9)DEH%)D&=;E=HC;+DAC=N2:HN )E(2DEHNd. 7D7E7E7 )D C+D)HN () &A2992C)D A+C2EH%H92C)D D) C)0C=HA);E ); ()D L)2;H9)D &=CE2&9)D AC=.=;()Da BH2 D) &=;;)&E);ED=2EDHC9)DL)2;)DA+C2A1+C2BH)D+E=29+)DaD=2EDHC9)DL)2;)D&=CE2&9)D2;E)C9=%H92C)Dd)D L)2;)D+E=29+)DD)7)EE);E(;D9)DL)2;)D2;E)C9=%H92C)DBH2a 9)HCE=HCa(C2;);E9)DL)2;)DCBH+)D); AC=.=;()HCsH;2L)H:+(H992C))NE)C;)td. . .

(322) )DL)2;)DCBH+)DD)C)0C=HA);E);H;)D)H9)L)2;)C+;9)BH2%=HE2E)99)HDD2H;2L)H(H129)u v uvd. +#WA %14*3%-,1 ,*A**1/1 2,3RU\4 %31%041/-22-%3Q?R 2,#F+%,43KWL. 3 )C)2;)DEH;=C0;):H9E2.=;&E2=;;)9d

(323) 9A9HD2)HCDC>9)Dc n. n. n. 9g+AHCE2=;(HD;0)E9g)N&C+E2=;HC2;2C)c o )N&C+E2=;();=:%C)HNAC=(H2ED()&E%=92D:)s+92:2;E2=;()D(+&1)ED);(=0*;)Dta o )N&C+E2=; () N+;=%2=E2BH)D s(+E=N2.2&E2=; )E +92:2;E2=; ()D (+&1)ED )N=0*;)Da &=::)()D:+(2&:);EDta o C>9) (g1=:+=DED2)c AC 9) :2;E2); ()D L=9H:)D () .9H2() )E (H :2;E2); ()D +BH292%C)Dc1O(C=n+9)&EC=9OE2BH))E&2(=n%D2BH)()9g=C0;2D:)b ()D.=;&E2=;D);(=&C2;)Dc o DO;E1*D)(g+COE1C=A=5+E2;)c 09O&=AC=E+2;) DO;E1+E2D+) AC 9g+A2E1+92H: LD&H92C) ()D &A2992C)D A+C2EH%H92C)DC+;HNst)EAC9).=2)staBH2DE2:H9)9AC=92.+CE2=;)E 9(2..+C);E2E2=;()D+COE1C=%9DE)Da o DO;E1*D)()C+;2;)c 1=C:=;) BH2 ACE2&2A) 9 C+0H9E2=; ()D L=9H:)D )NEC&)99H92C)D )E () 9 AC)DD2=; CE+C2)99) sA9&) 2:A=CE;E) (;D 9) DODE*:) C+;2;)n;02=E);D2;)n 9(=DE+C=;)ta 9C+;2;))DE.=C:+)H;2L)H()DCE+C2=9)D..+C);E)Duva o .=;&E2=;D (g1O(C=NO9E2=; () 9 n1O(C=NO &1=9+&9&2.+C=9a ); an(21O(C=NO &1=9+&9&2.+C=9a.=C:)&E2L)()9L2E:2;)b =;&E2=;D():+E%=92D:))E()&E%=92D:)c o .=;&E2=; () ;+=09H&=0+;*D) 7HDBHg ); &D () 7)J;)a D=HD 9) &=;EC>9) () 9g2;DH92;))E()D&E+&1=9:2;)Duvd. )C)2;)DEH;=C0;)ACE2&H92*C):);E.C029)a&CEC*DA)C.HD+(H.2E()D.=;&E2=;().29ECE2=;d

(324) 9)DE (=;&9gH;()DAC):2)CDsL)&9).=2)t ,EC))NA=D+():;2*C)2:A=CE;E)HNN+;=%2=E2BH)DAC+D);ED (;D9)D;0dgHEC)ACEa9)DN+;=%2=E2BH)DA)HL);E,EC):);+D .=C:)C()D:+E%=92E)DE=N2BH)D 9=CD () 9)HC +92:2;E2=;a =H AC+&2A2E)C 9=CD () 9g&2(2.2&E2=; ()D HC2;)Da )E (2:2;H)C 2;D2 AC=0C)DD2L):);ED)D&A&2E+D.=;&E2=;;)99)Duvd . .

(325) 2

(326) . 3. 2. g

(327) ;DH..2D;&) C+;9) 1C=;2BH) s

(328) t )DE H;) (+0C(E2=; AC=0C)DD2L) )E 2CC+L)CD2%9) ()D .=;&E2=;D C+;9)DaD)&=;(2C)D ()D9+D2=;D(HAC);&1O:)C+;9d )99)n&2%=HE2E H;)C+E);E2=;()AC=(H2ED()(+0C(E2=;(H:+E%=92D:)s(2:2;HE2=;()9g)N&C+E2=;t )E H;)9E+CE2=;()D.=;&E2=;D);(=&C2;)D)EEH%H92C)Dd 9DD2BH):);Ea=;(+.2;2EH;AE2);E&=::)+E;E2;DH..2D;EC+;9&1C=;2BH)Dg29D=H..C)(g2;DH..2D;&) C+;9)()AH2DA9HD()EC=2D:=2D&=;D+&HE2.Duvd

(329) 9 .HE AC+L);2Ca (+A2DE)Ca EC2E)C )E &&=:A0;)C H 9=;0 &=HCD 9)D A=AH9E2=;D C2DBH)a .2; () AC+D)CL)CH:N2:H:9)HCD.=;&E2=;DC+;9)Dd ) (+&92; () 9 .=;&E2=; C+;9) +L=9H) 2;+L2E%9):);Ea ); 9g%D);&) () AC2D) ); &1C0) AC+&=&)a L)CD 9g2;DH..2D;&) C+;9) E)C:2;9)a BH2 ;+&)DD2E) 9) C)&=HCD 9g+AHCE2=; )NECnC+;9) =H 9 EC;DA9;EE2=;C+;9)d. +#XA%343%-,,3-+%04M4,#1""-,1 ,*KWL. )A);(;Ea9g

(330) ;)Dg2;DE99)BH)D29gEE)2;E)C+;9))DE%29E+C9)d;D)H9C)2;)DE&A%9)(gDDHC)C9 E=E92E+()D.=;&E2=;D(g+AHCE2=;dg)DEA=HCBH=2H;AE2);EEC;DA9;E+A=DD*()&9DD2BH):);EEC=2D C)2;Dc()HNC)2;DEC=A12+D2;)..2&&)D)E9)0C)..=;aBH2DHAA=CE) 9H2D)H99)D.=;&E2=;DC+;9)Duvd. 3

(331)

(332) 6 2 ; C;&)a AC*D () ()HN :2992=;D () A)CD=;;)D D=H..C);E (g2;DH..2D;&) C+;9) &1C=;2BH)d

(333) 9 )DE &)A);(;E EC*D (2..2&29) (g+E%92C H; %29; )N&E BH;E 9 AC+L9);&) () 9 :9(2) (;D 9) AODa ); C2D=; () 9g%D);&) () C)02DEC) ;E2=;9d E 9 :9(2) C+;9) +E;E D29);&2)HD)a D AC+L9);&) )E D=; 2;&2();&)C)DE);E9C0):);ED=HDn+L9H+)Dd ) C+D)H

(334) s+D)H A2(+:2=9=02) )E

(335) ;.=C:E2=; ); +A1C=9=02)t )DE2:)a (gAC*D H;) +EH() :);+) ); DHC (+ACE):);ED C;'2Da BH) 9) DE() E)C:2;9 () 9 :9(2) E=H&1) AE2);EDa(=;ED)C2);EEC2E+DAC(29OD))E9)C)DE)AC0C)..)C+;9)d)HNE2)CD()DAE2);ED D)C2);E()D1=::)Dduv 2 9g=; &=;D2(*C) 9)D E)&1;2BH)D () DHAA9+;&) )N2DE;E)D s=HEC) 9 0C)..) o &12..C)D () tc 9g1+:=(29OD) &=;L);E2=;;)99) &=;&)C;)C2E ()D AE2);EDb a ()D

(336) H DE() E)C:2;9 HE292D)C2);E9(29OD)A+C2E=;+9)sE=HDEOA)D&=;.=;(HDt)Ea()DAE2);EDD)C2);E&=;&)C;+DAC . .

(337) 9g1+:=.29ECE2=; )E 9g1+:=(2.29ECE2=;d )D &12..C)D D=H920;);E 9g2:A=CE;&) ()D E)&1;2BH)D (g1+:=(29OD)u vd A=AH9E2=;()AE2);EDEE)2;ED(g2;DH..2D;&)C+;9)&1C=;2BH)()LC2E);&=C)H0:);E)CL)&c9) L2)2992DD):);E () 9 A=AH9E2=;a 9g:+92=CE2=; (H DH2L2 )E () 9 AC2D) ); &1C0) ()D AE2);ED EC;DA9;E+D )E (29OD+Da 2;D2 BH) 9gH0:);EE2=; () 9 AC+L9);&) (H (2%*E) )E () 9g1OA)CE);D2=; s()HN&HD)D:7)HC)D()9g2;DH..2D;&)C+;9)td. 3

(338)

(339) 6 2 :7=C2E+ ()D

(340) (+&=H9) (gH;) ;+A1C=AE12) &1C=;2BH)a BH2 AC=0C)DD) 9=;0 E)C:) L)CD 9g2;DH..2D;&)C+;9)E)C:2;9)d

(341) 9A)HEDg02C();+A1C=AE12)Dc n. n. n. . LD&H92C)Ds;+A1C=AE12)DLD&H92C)Dtc o ;+A1C=;02=D&9+C=D)c (H) H;)1OA)CE);D2=;CE+C2)99);&2);;)a o DE+;=D)CE+C2)99)9=&92D+)(;D9)DC)2;Dc (H) H;)A9BH)(gE1+C=:)&&=:A0;+)(gH;)1OA)CE);D2=;b 09=:+CH92C)Ds09=:+CH9=AE12)DAC2:2E2L)Dtc o :9(2)DHE=n2::H;)Dc (2%*E)a :O9=D)a 9HAHDe 2;E)CDE2E2)99)Ds;+A1C=AE12)D2;E)CDE2E2)99)Dtc o L)&C)2;D1C:=;2)HNc E=N2BH)DcD)9D()92E12H:aA9=:%a&2DA9E2;)a %2=9=02BH)c1OA)CHC2&+:2)a1OA=892+:2)a1OA)C&9&+:2)a 1+C+(2E2C)cA=9O8ODE=D)a&2(=D)EH%H92C)a(C+A;=&OE=D)a o L)&C)2;D(2D1C:=;2)HNuvd. .

(342) 3

(343) 2. +#YA ,%,,RPQP2+*%21 ,*2%,%3%*2KQUL. gAC*D9g+EH()C+92D+));AC9)C+D)H

(344) =;C):CBH)BH)AC*D()9:=2E2+()D&D(g

(345) =;E(+%HE+ACH;);+A1C=AE12)(2%+E2BH)sa t=H1OA)CE);D2L)std. +#QPA ,%,,RPQP1 /13%,"-,3%-,4274/3%,33*+*%1 ,*BKQUL. AC):2*C);=:92)A1OD2=AE1=9=02BH)AAC2DD;E9=CD(gH;);+A1C=AE12))DE9gH0:);EE2=;() 9 AC)DD2=; &A2992C) 2;ECn09=:+CH92C)a (H) H; (+%2E D;0H2; C+;9 +9)L+d )D ;=:92)D D=;E D)&=;(2C)D 9LD=(29EE2=;()9gCE+C2=9)..+C);E))E 9LD=&=;DEC2&E2=;()9gCE+C2=9))..+C);E) 09=:+CH92C)dg)DE &)DE()BHgAAC4EC9:2&C=n9%H:2;HC2)s;=C:=n9%H:2;HC2):0l1td C99*9):);E &)DEC=H%9)D1+:=(O;:2BH)DaLD)AC=(H2C)H;)(2:2;HE2=;()9A)C:+%292E+()D &A2992C)D 09=:+CH92C)Da AC +A2DD2DD):);E () 9)HC :):%C;) %D9)a )E H; C+:+;0):);E () 9 DECH&EHC)()&)99)n&2sC+(H&E2=;(H;=:%C)()D&1C0)D:):%C;2C)D;+0E2L)Dtdg1OA)C09O&+:2)L %=HE2C H;) 1OA)CEC=A12) () 9 :EC2&) )NEC&)99H92C) AC DHC&E2LE2=; ()D &)99H9)D :+D;029)Dd )EE):=(2.2&E2=;(H:+D;02H:%=HE2C H;)09=:+CH9=D&9+C=D)uvd. . .

(346) )D&)99H9)D:+D;029)D&=;DE2EH);EH;E2DDHc9):+D;02H:aE2DDH2;E)CDE2E2)9BH2);E=HC)9)C+D)H() &A2992C)D ;DE=:=D+D (H 09=:+CH9)d )D &)99H9)D :+D;029)D D=;E ()D .2%C=%9DE)D HN AC=AC2+E+D :&C=A102BH)D)ED+&C+EC2&)Ds*K"KAC=DE09;(2;)Da&=990*;)td99)DA)C:)EE);E2;D2():2;E);2C)E ()C);=HL)9)C9DECH&EHC)09=:+CH92C)dC9)HCDAC=AC2+E+D&=;EC&E29)Da)99)DC+0H9);E9).9HND;0H2; ()D&A2992C)Duvd g1OA)CE);D2=;%=HE2CaBH;E )99)a H;);+A1C=;02=D&9+C=D)d. +#QQA %23-1%04-++4,47, /$1-/3$%2% 3%0423$8/13,2%5KQWL. g2;DH..2D;&) C+;9) )DE H;) :9(2) 2;D2(2)HD) )E D29);&2)HD)a +L=9H;E DHC A9HD2)HCD ;;+)Dd ) AC):2)C :CBH)HC jAC+&=&)ka E+:=20;;E () 9 D=H..C;&) C+;9)a )DE 9 :2&C=9%H:2;HC2)d :9(2) +L=9H) AC=0C)DD2L):);E L)CD H;) :&C=AC=E+2;HC2)a (H) &1)P 9) (2%+E2BH) ()D 1OA)C09O&+:2)D C+A+E2E2=;a H;)1OA)CE);D2=;CE+C2)99))EH;)(OD92A2(+:2)&=;&=:2E;E)d +&)::);Ea H; .&E)HC 0+;+E2BH) +E+ :2D ); +L2();&)c H;) 2;&E2LE2=; (H 0*;) &=(;E A=HC 9 8992&C+2;) s);PO:) A1C) (H DODE*:) 8992&C+2;)n82;2;)t ); D)C2E C)DA=;D%9)d ) &)EE) :;2*C)a 9 8992&C+2;) ;) A=HCC2E A9HD AC=(H2C) 9)D 82;2;)D s&=;;H)D A=HC 9)HCD )..)ED LD=(29EE)HCD )E ;E2E1C=:%=E2BH)Dtd ;E):AD;=C:9a9)DODE*:)8992&C+2;)n82;2;))DE&E2L+AC+:EHC+:);EH&=HCD(H(2%*E)(;D9) %HE () AC=E+0)C 9) C)2; ()D C2DBH)D () 9g1OA)C09O&+:2)d =; 2;&E2LE2=; 0+;+E2BH) &&+9+C)C2E 9g+L=9HE2=;()9:9(2)C+;9)uvd. 3

(347)

(348) 6

(349)

(350) 2 g

(351) )DE H;) :9(2) AC=0C)DD2L) )E D29);&2)HD) (=;E 9) (20;=DE2& 9=;0E):AD +E+ )N&9HD2L):);E %2=9=02BH)d )9=;9E2=;92(;)O =H;(E2=;n2(;)O2D)D)HE&=:)DH92EO

(352) ;2E2E2L)s

(353) taA=HC ,EC)BH92.2+(g2;DH..2D;EC+;9a29.HEAC+D);E)C()D;=:92)DDECH&EHC)99)D=H.=;&E2=;;)99)D(HC)2;a :,:)A=HCH;(+%2E().29ECE2=;09=:+CH92C)s tDHA+C2)HC :l:;la:a=HL=2CH; 2;.+C2)HC :l:;la:A);(;EA9HD()EC=2D:=2Duvd. . .

(354) *4QA*22%"%3%-,

(355) F

(356) IRPPRJ*+*%1 ,*$1-,%043*2 5 1%3 *M . <#$ &),4,<,54 Y3V3,4VcOie3lZ <#$c 9(2)C+;9)w <#$d

(357) 9+0*C) <#$e

(358) :=(+C+) <#$f

(359) D+L*C) <#$g

(360) E)C:2;9) =H(29OD) X"56*671"i^02*6!"0548"856!N77"*17"5$1/"J3527$*185*"H0*52/80*185*"T*#7"!" 7=3"\UH)$0785*"H/"82=785*"H120/*"60253)2/2(*48"6/N$)2(53)*"28)*672/2(*48"6KV\dW V][WK )9=; g s0);&) ;E2=;9) (g&&C+(2EE2=; )E (g+L9HE2=; ); D;E+ta ;&2);;) %C;&1) () 9 HE)HE=C2E+();E+s ta29;gOA9HDBH)DE()D(g

(361) c *4RA*22%"%3%-,IRPPRJ*+*%1 ,*$1-,%043*2 5 1%3 *M . <#$ <#$c <#$d <#$e <#$f. &),4,<,54 9(2)C+;9)w

(362) :=(+C+)

(363) D+L*C)

(364) E)C:2;9). Y3V3,4VcOie3lZ =H EC2E):);E () DHAA9+;&) w"56*671"i^02*6!"0548"856!N77"*17"5$1/"J3527$*185*"H0*52/80*185*"T*#7" !" 7=3" \UH )$0785*"H /"82=785*"H 120/*"6 0253)2/2(*48"6 /N$)2(53)*" 28 )*672/2(*48"6Kuvauv. g(+.2;2E9g

(365) &=::)+E;EH;)A)CD2DE;&)(gH;);=:92)()D:CBH)HCDD;0H2;DA);(;E A9HD () EC=2D :=2Da BH)9 BH) D=2E 9) a )E )DE 2;(2D&HE%9) ); &D () 2;.+C2)HC :l:;la:uvd )AH2D 9)D (+.2;2E2=;D () 9g

(366) () 9g )E (H

(367) a (E;E E=HE)D 9)D ()HN () a H;) AAC+&2E2=; A9HD C+&);E) +E+ +E%92) ); c 9 &9DD2.2&E2=;

(368) s2(;)O 2D)D)

(369) :AC=L2;0. 9=%9 HE&=:)Dtd )EE) ()C;2*C) AC);( ); &=:AE) H;) ACE ;=; ;+0920)%9) () 9g+L9HE2=; () 9 .=;&E2=;C+;9)c9)(20;=DE2&&92;2BH)a2;D2BH)9gsE2=9%H:2;HC2)lC+E2;2;HC2)td *4SA*22%"%3%-,

(370) ?M/12 583*B?RPPU. ,*45;<,! , %<$ C8$:<$4;,54 2#,$*253&:?2,:$ ?<:$;32#,$; :4;824<&

(371) 4!544? . . Y3V3,4VcOie3lZ n n n n . . 2 ?3,4?:,$YO3*V*Z n .

(372) )DC)&=::;(E2=;D&EH)99)D()9 A=HC9&9DD2.2&E2=;)E9AC2D));&1C0);)C)A=D);EBH) DHC()HN2;(2&E)HCDc9) )E9AC=E+2;HC2)d ; C+DH:+a A=HC &1&H;) () &)D &9DD2.2&E2=;Da 29 )DE +E%92E BH) A=HC H; 2;.+C2)HC :l:;la:a 9) AE2);E )DE &=;D2(+C+ &=::) 2;DH..2D;E C+;9 &1C=;2BH)a L)& =H D;D :CBH)HC (gEE)2;E) C+;9)d E A=HC H; DHA+C2)HCa 29 )DE ;+&)DD2C) () AC);(C) ); &=:AE) 9g+EE AE1=9=02BH)(HAE2);Ed )9=;9)DC)&=::;(E2=;D()9=&2+E+();+A1C=9=02)()7;L2)Ca29)DE;+&)DD2C)()&9DD)CH; AE2);E(29OD+);DE()sD;DDE()ta)E);.=;&E2=;(H (gH;AE2);EEC;DA9;E+C+;9caa aad. 3

(373)

(374)

(375) 2 ) :)DHC)9g+L9HE2=;()9.=;&E2=;C+;9))E2;(2C)&E):);E9);=:%C)();+A1C=;DBH2C)DE);E .=;&E2=;;)9DdH.2E()D&=:A9)N2E+)E()D=;&=JEa29.99H(+L)9=AA)C()DE)&1;2BH)D(g)DE2:E2=; ()9:)DHC)(H uvd. 3<3 6

(376)

(377)

(378) 5 j&92C;&)C+;9)(gH;)DH%DE;&))DE9)L=9H:)()D+CH:E=E9):);E+AHC+()&)EE)DH%DE;&)9=CD ()D=;ADD0)AC9)C)2;dg)DE9D=::)()D&92C;&)DAC.29ECE2=;09=:+CH92C))EACD+&C+E2=; EH%H92C)d99))DE)NAC2:+));:AC:2;duv &92C;&)()&)EE)DH%DE;&))DE+09)H D2&)EE)DH%DE;&);g)DEADD+&C+E+)a;2C+%D=C%+) (;D9)DEH%H9)Dd)(+%2E.29EC+)DE9=CD+09H(+%2E)N&C+E+dkgAC*DuvaA0)d j&92C;&)(gH;)DH%DE;&)C)AC+D);E)9)L=9H:)L2CEH)9()D;0=H()A9D:E=E9):);E+AHC+() &)EE)DH%DE;&)ACH;2E+()E):ADdg)DEH;L=9H:)E1+=C2BH)kgAC*DuvaA0) d. )C+DH9EE()&)EE)&92C;&))DE;=C:92D+);+E;ECAA=CE+ a:sDHC.&)&=CA=C)99):=O);;) (gH;(H9E)taA)C:)EE;E2;D29&=:AC2D=;A=HC()DDH7)ED()A=2(D)E()E299)(2..+C);EDd. 3=3

(379) 6 65 =::H;+:);E =; D) D)CE () 9 &C+E2;2;) A=HC 9g)DE2:E2=; (H a &C 29 Dg02E (gH; AC=(H2E () &E%=92D:) () 9 &C+E2;) :HD&H92C) +92:2;+ )DD);E2)99):);E AC L=2) C+;9) )E () &=;&);ECE2=; &=;DE;E)(gH;7=HC 9gHEC)uvuvd

(380) 9)N2DE)()HN0C;()D:+E1=()DA=HC=%E);2C9&92C;&) 9&C+E2;)c n n. C)&H)29()DHC2;)D()D1)HC)D)E(=D0)()9&C+E2;2;)b )DE2:E2=; ACE2C()9&C+E2;2;+:2)L2(2..+C);E)D.=C:H9)Dd. ;ACE2BH)a9)C)&H)29HC2;2C))DE(2..2&29)dg)DEA=HCBH=29:+E1=()9A9HDHE292D+))DE9g)DE2:E2=; (H AC9gAA92&E2=;().=C:H9)Dd. <J<I<

(381) ; A9HD A=AH92C) ()D .=C:H9)D (g)DE2:E2=; () 9 &C+E2;)a (E;E () a A)C:)E (g)DE2:)C 9 &92C;&)()9&C+E2;)AC9:)DHC)()9&C+E2;2;+:2)c . cL9)HC;=C:9)(H &1)PH;(H9E)7)H;))DE():l:2;la:()DHC.&)&=CA=C)99)duv. . . .

(382) . . :"J

(383) h\H]^)">/N)200"I

(384) h\H[_)">/'"00". . .=C:H9)()=&8&C=.E)E H9Es ta;)AC);;E);&=:AE)BH)9&C+E2;2;+:2)a9)A=2(Da9g"0))E9) D)N)a(=2E2(+9):);E,EC)&=CC20+)AC9DHC.&)&=CA=C)99):=O);;)sa:td . . :"J

(385) h\H]^)">/N)200"I