A A
Fators rlaciona os à tcção isplasia m pacints com
ĞƐƀĨĂŐŽĚĞĂƌƌĞƩůŽŶŐŽĚŽ,ŽƐƉŝƚĂůhŶŝǀĞƌƐŝƚĄƌŝŽtĂůƚĞƌĂŶơĚŝŽ
&ĂĐƚŽƌƐƌĞůĂƚĞĚƚŽĚLJƐƉůĂƐŝĂĚĞƚĞĐƟŽŶŝŶƉĂƟĞŶƚƐǁŝƚŚůŽŶŐͲƐĞŐŵĞŶƚ
ĂƌƌĞƩ͛ƐĞƐŽƉŚĂŐƵƐŝŶƚŚĞtĂůƚĞƌĂŶơĚŝŽhŶŝǀĞƌƐŝƚLJ,ŽƐƉŝƚĂů
N !"# $% %$X! & $'$()! *( 1
.D# '! % *+ , *-#G0! &#,3 $( 1
.I(#b $% $4 $S 5S!%6 $!,#M $%* 7
.C8'-9!#:b $ ':-9#,P *'- $ ;
. L0 <! # '*M *'-$!, *+ ,# '<*
=
.M! >0 $%? '>$% *N *b, $$S*0 @# B
.M# ,< $%%0 (E $',! H0 $L *! *%#P *'- $4 $S *0 @# J
.
KOQ TU VWYZ [\]^ _U T^ `f^TWg]Wh]Z jZT^k`TW_VWqUZu Uh^ _f UvZ\w `U v^] _U TZ T^x ^ T^] ZyTWz^Z] {Ywx z [\xW] fZy ^ |Z \z^ Z]{\}] Z _Uy ~ OQ TU VZZ _f] W^ `f^]Wy WhU _fZ \W_qU fZyw `U v^ ] _U f{] U WZ y f^ ]zZ`f T^WY w z [\w `U v^]_UTZT^x^T^]Z yTWz^Z ]{Yw x z [\kj q]^ _Z } ]Z _Uy ^ U]ZT^^ ] vU W_W_qU fZ y Z]^ _Y k}k[\x W]fZ y ^|Z\z^ Z]{\}] Z _Uy ~u Wf W]Z^jz U`V UZ_OQTU VZ _\OQ TU VZk`TW_VWqU _fZ q^y W W_qU fZyw `U v^]_Uf{ ] U WZ y f^ ]zZ `f T^WYw z [\w `U v^]_U TZT^x ^ T^] ZyTWz^Z ]{ Ywx z [\kjq] ^ _Z} ]Z_Uy ^U] ZT^^ ] vU W_ W_qU fZy Z]^_Yk}k[ \x W]fZy ^|Z\z^Z] { \} ]Z_Uy ~OQ TU VWg Z f Wy Wh U _fZ\q]^ V^ qf W]TWg]Wh]Z jZT^g Z f Wy Wh UZq^y Zw `U v^] _U TZ T^ x ^ T^] ZyTWz^ Z]{Ywxz[ \x W] fZ y^ |Z \z^Z ]{ \} ]Z_Uy ~g ] W^__W]T `f W\w `U v^] _U TZ T^x^T^]Z yTWz^Z ]{Ywx z [\V^^TW^]vU W T^k`TW_VWqUZu Uh^ _f U vZTWW_qU fZyw `U v^]_Uf{ ] U WZy f^]zZ`f TU W Ywz[\xW] fZy ^| Z \z^Z ]{ \} ]Z _Uy ~g]W^ __W]__WV UZ TW\ w `U v^]_U TZT^x^T^]Z yTWz^ Z]{Ywxz[ \ q^ ] vU _W]TZ^ _U T`V UZOQ TU VZ^ jk`TW_VWqUZuUh^_fU vZ \ W_qU fZyw `U v^ ] _Uf{ ] U WZ y f^ ] zZ `f TUWY w z [\xW] fZy ^| Z \z^Z] { \} ]Z _Uy ~
Z^hDK
qZVU^`f^ _VWj
GRHQoDGRUHÀX[RJDVWURHVRIiJLFR
u k[fjT^KZKT^VZ`V^T^T^_^`vWy v^]^ _ôZhWT^ }Z]]^ ff~k_f^qWT^^ vWyU]qZ]ZTU_qyZ_UZ^ZT^ `WVZ] VU`WjZ^ _W{hUVW~ ¡¢Z vZy UZ]ZfW]^ _]^yZVUW`Z TW_£T^f^ V ¤WT^TU_qyZ _UZ ^ jqZ VU^`f^ _VWj^ _ôZhWT^}Z]]^ ffy W`hW~¥ ¦§¡¨^ _fTW]^ f]W_q^VfUvWVWjZ`{y U_^T^U`W]jZ õ^ _T^K©qZVU^`f^ _VWj TUZh`ó_fUVWT^^ _ôZhWT^}Z]]^ ff y W`hW\VWyUTZ _T^ªZ`VW_T^TZTW_TW__^]vU W_T^k`TW_VWqUZ^gZ fWy WhUZ^q]W`f{] UW_TW W_qUfZyw `Uv^] _Uf{]UWZy f^]zZ `f TUWYw z«wxz[\`Wq^] WTWT^KZ K~¬_qZVU^`f^ _W]Z jTUvUTUTW_^ jTWU_h]qW_qZ]Z VWjqZ]Z ¤W\h]qW_^ jTU_qyZ _UZY®KK[^h]qWVWjTU_qyZ _UZ¯Z T^ `WVZ] VU`WjZY®°[~± ²¦¨²TWfWfZyT^K©qZ VU^`f^ _VWjHV{IDJRGH%DUUHWWORQJRQR+8:&HUDPGRVH[RPDVFXOLQRWLQKDPPDLVGHDQRVDSUHVHQWDYDPVLQWRPDVWtSLFRV
T^uk\^]Z jfZªZhU_fZ _\°°fU`ZQ] `UZUZfZy \]^Zy U|Z]Zj `TWqy UVZ f]Z ~ ¤WWv^TU^]^` Z _^ _fZf _fUVZ_T^_fZ _ VZ]ZVf^] _fUVZ _^ `f]^Wh]qWVWj^_^ jTU_qyZ_UZ ~k`f]^ fZ`fW\Wh]qWVWjTU_qyZ _UZf^v^jZjQTUZT^^ `TW_VWqUZ _¯ qZ VU^ `f^ \ ^ `³Z `fWWh]qW_^jTU_qyZ _UZf^ v^Zq^ `Z _^ `TW_VWqUZ_¯ qZ VU^`f^ Yq´\[~µ¶¦² ¬jZ UW]`új^] WT^^ `TW_VWqUZ _]^Zy U|ZTZ_ WUjZfW]]^yZ VUW`ZTW£jZ UW]T^ f^ V ¤WT^TU_qyZ _UZ¯ZT^ `WVZ]VU`WjZ^jqZVU^`f^ _VWj^ _ôZhWT^}Z]]^ ff`Ww z«wx z~
·¨ ¦¨ ¢¨²¸ ¶¹¨ ¢ k_ôZh WT^}Z ]]^ff ~k`TW_VWqUZ ~ ^ Wqy Z _UZ _^ _W{ h U VZ _~
^dZd
¶ ¡
3DWLHQWVZLWKJDVWURHVRSKDJHDOUHÀX[GLVHDVH*(5'KDYHDFKDQFHRIGHYHORSLQJ%DUUHWW¶VHVRSKDJXV
ºU _W`^jZ »q]Wh] ^ __f WT»_qy Z _UZZ`T^ _WqZh^Zy ZT^ `WVZ] V U`WjZ ~ ¶ ¡ ¢ ºW^vZ yZf^Z V fW] _]^y Z f^ Tf Wf^T^ f^ Vf U W`WG\VSODVLDLQSDWLHQWVZLWKORQJVHJPHQW%DUUHWW¶VHVRSKDJXV
¥ ¹²^ f] W_q^ Vf U v^_fT»¼U fU`W] jZ f U W`Z `Zy »_U _WK ©qZ f U^`f_GLDJQRVHGZLWKORQJVHJPHQW%DUUHWW¶VHVRSKDJXVFROOHFWHGIURP(QGRVFRS\DQG3DWKRORJ\GDWDEDVHVDQGPHGLFDOUHFRUGVRIWKH
W_qUfZyw `U v^ ] _Uf{]UWZy f^ ]zZ`f TUWY w z«wx z [\] Wj K fW K~gZ f U^ `f _¼^]^TU vUT^TU`f Wf¼Wh]Wq_W]V WjqZ] U _W`\ h] Wq¼UfWfT»_qyZ_UZY®KK [Z `Th] Wq¼U fT»_qy Z _UZ¯ Z T^ `WVZ ] VU `WjZY® °[~± ² ¦²¬f^K ©qZfU^ `f _¼Ufy W`h«_^ hj^ `f
%DUUHWW¶VHVRSKDJXVLQ+8:&ZHUHPDOHZHUHROGHUWKDQ\HDUVKDGW\SLFDOV\PSWRPVRI*(5'ZHUH
_jW½^]_\°° ZTUZ fZy ^ ] `UZ\ q^]W] j^ T `TWqy U VZ f U W`~º^]^ ¼^ ]^ `W _fZ f U_f U VZy TU^]^ `V^_W f^ _^ VZ]Z V f^ ] U _f U V_ ª^ f ¼^^ `f^h] Wq¼UfZ`T¼UfWfT»_qy Z _UZ~W¼^ v^]\f^h] Wq¼UfT»_qyZ_UZZ TZ `Zv^]Zh^W
^`TW_VWqU^ _¯ qZfU^ `f \¼^]^ Z _ f^h] Wq¼U fWfT»_qy Z _UZZ TW`y »^ `TW_V WqU^ _¯ qZ f U^`fYq´~[~µ¶¦²¡ º^y Z]h^ _f`jª^]W^ `TW_V WqU^ _q^]W] j^ T
ZDVDIDFWRUUHODWHGWRWKHJUHDWHUGHWHFWLRQRIG\VSODVLDDGHQRFDUFLQRPDLQSDWLHQWVZLWK%DUUHWW¶VHVRSKDJXVLQ+8:&8)&
¾ ¿À ²} Z] ]^ f f^ _WqZh_~k`TW_VWq»~k_WqZh^Z y `^Wqy Z _j _~
Á ÂÃ ÄÅÆ ÄÅ Å ÇÈ ÉÄÊË ÇÊÃ ÇÌ
0DUFHOOXV+HQULTXH/RLROD3RQWHGH6RX]D5XD&RURQHO1XQHVGH0HOR5RGROIR7Hy¿OR)RUWDOH]D&HDUi&(3
7HOHIRQH(PDLOVRX]DPDU#XIFEU
/EdZKhK
k_fTW_ qWqyZVU W`Z U _ ]^V^ `f^ _ _h^ ]^ j ³ ^ Z TW^` Z
GR UHÀX[R JDVWURHVRIiJLFR '5*( WHP DXPHQWDGR HP
q]^vZy`VUZ Z W ]^TW] TW j`TW~ gZVU^ `f^ _ V Wj TUZ h `ó_f U VW T^u kfjVZ `V^T^K «KT^T^ _^`vWy v^ ]^ _ôZh WT^ } Z]] ^ f f \jZf]Z `_W]jZ ¤ W TW^ qU fQy U W^ _VZj W_W V Wy`Z]`W ^ _ôZ h WTU _fZy^ jj^fZ qy Z _UZU `f^ _f U `Zy \Zj^`fZ`TWW]U_V WT^ T^ _^`vWy vU j^ `f WT^ZT^ `WVZ ] VU `WjZ^_W{h U VW~
Í
¬_ q] U `V UqZU_ Z f W]^_ T^ ] U _VW qZ]Z W T^ _^ `vWy vU j^ `f W T^ ^ _ôZ h W T^ }Z ]]^ff _¤ W _U `fWjZ_ V]ô `U VW_ T^ u k YÎ Z `W_[\
Ï
VH[RPDVFXOLQR
ÐU TZT^ZvZ ` ZTZYÎZ `W_[\ Ñ
_W T^ fZªZ V W\
Ò
Wª ^ _U TZ T^ V^`f] Zy \ Ó
]Z Z VZVZ _UZ `Z ^ qZ ]^ `f^ _ T^ q] U j^ U] Wh] ZVWjWTUZh `ó_f U VW~
Ô
__q^ U fZT^^ _ôZ h W T^ } Z]] ^ f fQ^ U fZZf] Z vQ _TZ]^Z y U| Z ¤ W T^^ `TW_VWqUZTUh^_f U vZ Zy fZYku[ \V WjZvU _Zy U|Z ¤WTW^ qU fQy U Wv^ ] j^yW« _Zy j ¤W
TXHVHHVWHQGHSUR[LPDOPHQWHDSDUWLUGHFPDFLPDGDOLQKD
Õ ~ ¬ TUZh `ó_f U VW Q TZ TW Zf] Z vQ _ TZ ]^Z y U|Z ¤ W T^ ª Uóq_UZ _ T^ __Z{]^ Z \VWjWZVZ TWT^j^ fZ qy Z _UZU `f^ _f U `Zy`W]^_y fZ TW Z `ZfWj WqZfWy óh U VW~
Í
2HV{IDJRGH%DUUHWWSRGHVHUFODVVL¿FDGRHPFXUWRTXDQGR
DSUHVHQWD PHQRV GH FP GH H[WHQVmR H ORQJR TXDQGR VH
HVWHQGH SRU FP RX PDLV SUR[LPDOPHQWH
Öwj Zf W] T ^ ]U _ V W U j qW]f Z` f ^ q Z ]Z W T^_^` v WyvU j ^` f W T^ `^W qy Z_ U Z
HVRIiJLFDpDH[WHQVmRGRHV{IDJRGH%DUUHWW
׬f ]W_Zf W]^_ ]^ y ZVU W `ZT W__ ¤WU TZT^ZvZ` ZT Z\Wª ^_ U TZT^V ^`f ] Zy^_ WT^ f Zª ZV W~
Í
¬_WT^ j ^T U V Z õ^_VW j W U `U ªU T W ]TZ ªWj ª ZT^
SUyWRQV,%3DQWLLQÀDPDWyULRVQmRHVWHURLGDLVHHVWDWLQDV
q]W f ^h ^j W^q U f QyU W ^_ W{hU VWj ^f Zq y {_U V W T^ ^vWyU ] qZ] Z ZT^` W V Z ]VU ` W j Z~
ÍØ
qZ ] f U]TZj^ fZ qy Z_UZU `f^ _f U`Z yTW^ _ôZh WT^} Z]] ^ f f\qWT^
KDYHU WUDQVIRUPDomR SDUD GLVSODVLD GH EDL[R JUDX GLVSODVLD
T^Zy f Wh] Z^Z T^ `WVZ] V U`WjZ^ _W{ h U VW~k__Zq]Wh] ^ __¤WQ ^ _f U jZ TZ^ jj^`W_T^\Z WZ`W\V WjZj^ `f WqZ ]Z\°
DRDQRSDUDGLVSODVLDGHEDL[RJUDXHDRDQRSDUDGLVSODVLD
T^ Z y f W h]Z~ ÍÍÙÍÏ
zWj U __W\ Z vUh Uy Ú `VUZ ^ `TW_VóqU VZ _^ Z | `^ V^ __{] UZ\VWjZ]^ Zy U|Z ¤WT^ª U óq_UZ __^]UZTZ _~
Í Ð
^_f ^ ^_ fT W \ ª_ V W«_^ T^_ V]^v^ ] VZ ]ZVf^] _ f U V Z_ Vy ` U VZ_\ ^` T W _ Vóq U V Z_ ^ Z`Zf W j W qZf WyóhU VZ_ T^ qZVU^` f ^_ VW j ^_ôZhW T^ } Z] ] ^f f yW `hW \ ` W _^ ]v U W T^ k ` T W _VW q U Z T W W_qU fZyw `U v^]_Uf{ ] U WZy f^ ]zZ`f TU WY w z[ \ª ^jVW j W ZvZy U Z]W _Zf W] ^_^` v Wyv U TW _`ZT^f ^V ¤ WT^T U _ qy Z_ U Z~
DdZ//^DdKK^
k_fTW]^ f] W_q^ Vf UvWVWjZ `{y U_^T^U`W] jZ õ^ _VWyU TZ_T^ ªZ `VW_T^TZ TW_TW__^] vU W_T^k`TW_VWqUZ^gZ f Wy Wh UZ\Zy Q j T^q] W`f{] U W_TWW_qU fZ yw `U v^ ] _U f{] UWZy f^] zZ `f TUW TZ w `Uv^] _U TZT^ x^T^ ]Zy TW z^Z]{ Ywx z [\ `W q^] WTW T^ jZ U W T^ K Z Zh W_fW T^ K~ x W]Z j _^y ^ VU W`Z TW_ qZ VU^ `f^ _ ³ ^ ]^ V^ª^]Z j W TUZh `ó_f UVW ^ `TW_VóqUV W T^ ^ _ôZh W T^ }Z ]]^ f f y W`h W\ _ª j^ fU TW_ Z ª U óq_UZ _ Zy^Zfó] UZ _ TW ^ qU fQ y U W
YHUPHOKRVDOPmRHVRIiJLFRYLVWRGXUDQWHRH[DPHHFRQ¿UPDGR
SHODUHDOL]DomRGHDQDWRPRSDWROyJLFR3DWRORJLVWDVH[SHULHQWHV
DYDOLDUDPHFRQ¿UPDUDPDPHWDSODVLDLQWHVWLQDOHRJUDXGH
TU_qyZ_UZ \³ Z `TWq]^ _^`f^ \`Z _Z jW_f]Z_~x W]Z jZ vZy UZ TZ _Z _
VZ]Z Vf^] _f U VZ _ Vy `UVZ _\ ^ `TW_V óqU VZ _ ^ Z `Z f WjWqZ f Wy óhU VZ _ Z f]ZvQ_T^jW] jy{ ] UW^ _f]f]ZTW~¬q] Wh]Z jZ^ _fZ f _fU VW ]Z qg Z Tg] U _jZ ^ W f^_f^ T^ x U _^ ] W]Zj f Uy U|ZTW_ qZ]Z Z vZ y UZ ¤W^ _fZf _f UVZ ~k_f^Z ] fUh WWUZ q] WvZ TWq^y WVWj U fT^ Q fU VZ^ jq^ _³ U _Z^j_^ ]^ _ jZ `W_TWW_qU fZyw `Uv^] _U f{] U W Zy f^]zZ `f TU WYg] WfWVWy WÛ©©K~°~~[~
x WU ] ^Zy U|ZTZ Z Z`{y U _^ V WjqZ ]Z f U vZ ^ `f]^ qZ V U^`f^ _ _^j TU _qy Z _UZ VWj Z³ ^y ^ _ ³ ^ Z q] ^ _^ `fZvZ j TU _qy Z _UZ¯ Z T^ `WVZ] V U`WjZ ^ _W{ h U VW³ Z`fW Z W_ Z f W]^_ T^ ] U _VW qZ]Z
HV{IDJRGH%DUUHWWFRPRVH[RPDVFXOLQRLGDGH!DQRV
_U `f WjZ _f qUV W_T^u k \fZªZh U _j W\Zy Q jT^VZ ]Z V f^ ] _fU VZ _ ^ `TW_VóqU VZ_V WjWÛ^]`UZUZ fZy \_^fZ jZ `W\ `TWqy U VZ f]Z ^_^`új^ ] W\_WT^U`Uª U TW]TZª WjªZT^q] óf W`_\_U `f WjZ _ f qU VW_ T^ u k `Z úy f U jZ VW`_y fZ \ Zy Qj TW `új^]W T^ ^ `TW_VWqUZ _]^ Zy U|Z TZ_qW]VZTZh]qW~
Z^h>dK^
ÜÝ Þß áâäá å
W q^ ] WTW T^ jZUW T^ K Z Zh W_f W T^ K\ W] Z j ]^Z y U| Z TZ _ K~ ^`TW_VWqUZ _ TUh^ _f U vZ _ Z y fZ_ `W ^f W] T^ k `TW_V WqUZ TW W_qU fZ y w `U v^]_U f{]UW Z y f^ ] zZ`f TU W
+8:& 'HVVHV H[DPHV WLQKDP FRPR ODXGR HV{IDJR
T^}Z ]]^ff \VW]] ^ _qW`T^ `TWZKqZVU^ `f^ _~u^ __^_qZ V U^ `f^ _\ K ] ^ V^ ª^]Zj W TUZh `ó_f UV W ^`TW_VóqU VW T^ ^ _ôZ h W T^
%DUUHWWFXUWRH[WHQVmRFPHSDFLHQWHVGHHV{IDJRGH
%DUUHWWORQJRH[WHQVmRFP'HVVHVSDFLHQWHVHPQmR
IRLFRQ¿UPDGDDSUHVHQoDGHPHWDSODVLDLQWHVWLQDOQRH[DPH
Z `Z f Wj WqZ f Wy óh UV W~__U j\K ©qZ V U^`f^_q] ^^ `V^]ZjV] U fQ ] U W T^U`Vy_¤ WqZ]ZZvZy UZ ¤ WT^Z f W]^_Z__WV UZTW_ZW] U _VWT^ ^ _ôZh WT^}Z ]]^ff^T^ _^ `vWy vU j^`f WT^TU _qy Z_UZ~
$ ¿P GH DYDOLDU RV IDWRUHV UHODFLRQDGRV j SUHVHQoD H j
T^f ^V ¤ W TZ T U _ qy Z_ U Z `^_ f^ h ]q W \ W _ qZVU^` f^_ W]Zj T U v U T U T W _ ^j T W U _ h ]q W _ qZ] Z V W j qZ ] Z ¤W ~ wj h ]q W T^ KK qZV U ^` f^_ _^j T U _ qy Z_ U Z ^ j h ]q W T^ ° qZV U ^` f ^_ V W j T U _ qy Z_ U Z ¯ ZT^` W VZ]V U ` W j Z ^_ W{ hU V W ` W ] ^_yf ZT W T W U _ f W qZf WyóhU V W ~
ĂƌĂĐƚĞƌşƐƟĐĂƐĞƉŝĚĞŵŝŽůſŐŝĐĂƐ
'RVSDFLHQWHVLQFOXtGRVQDSHVTXLVDHUDPGRVH[R
jZ_Vy U`W\ ° f U`Zj U TZ T^ ÎZ `W_\ Zq]^ _^`fZvZ j
VLQWRPDV WtSLFRV GH UHÀX[R JDVWURHVRIiJLFR '5*(
fU `Z jU _f ó] UZT^fZªZ h U _j WYºZ ª^y ZK [~
ĂƌĂĐƚĞƌşƐƟĐĂƐĞŶĚŽƐĐſƉŝĐĂƐ
KƵƚƌŽƐĚĂĚŽƐ
uW_qZVU^`f^_VWj^_ôZhWT^}Z]]^ffyW`hW\K Z|UZj_W T^ U`UªUTW] TZ ªWjªZ T^ q]ófW`_ `Z úyfUjZ VW`_yfZ ^ æ jZ`fU`Zj_U`fWjZ_fqUVW_T^ukYºZª^yZK[~zZTZqZVU^`f^ WU _ªj^fUTW Z jZ jQTUZ T^ ^`TW_VWqUZ_~ Wj^`f^ j qZVU^`f^]^ZyU|Wqj^f]UZqZ]ZZvZy UZ ¤WT^VW`f]Wy^T^uk~
ŶĄůŝƐĞ ĐŽŵƉĂƌĂƟǀĂ ĞŶƚƌĞ ƉĂĐŝĞŶƚĞƐ ƐĞŵ ĚŝƐƉůĂƐŝĂ Ğ ĐŽŵ
ĚŝƐƉůĂƐŝĂͬĂĚĞŶŽĐĂƌĐŝŶŽŵĂĞƐŽĨĄŐŝĐŽ
'RVSDFLHQWHVVHPGLVSODVLDHUDPGRVH[RPDVFXOLQR
jZ U W] ^ _T^Z `W_\Zq]^ _^`fZvZ j_U `fWjZ_f qU VW_ T^u k\æ ^ ]Z jfZªZh U _fZ _^©K{Z vUZjf U TWQ] `UZ UZ fZy ~u^ __^ _\VWjQ ] `UZT^q^³ ^ `WqW] f^YZVj [\^ K ©T^jQ TU WZh] Z `T^qW] f^YÎV j [~T^__^ _qZVU^ `f^ _ {Z vUZ j_UTW_ª j^ f UTW_£ `TWqy U VZ f]Z\_^`TW °jZ v^| ^ K © TZ_ v^ |^_~ Zq]^ _^ `fZvZ j Z `TWqy U VZ f]Z T^ _^U fZ YºZª^ y Z [~ jQ TUZ TW `új^]W T^ ^ `TW_VWqUZ _ ]^ Zy U|Z TZ_q W]^ __^h]qWWUT^^ `TW_VWqUZ _¯ qZ V U^ `f^ ~
u W_ qZVU^ `f^ _ ³ ^ Zq]^ _^ `fZvZ j TU _qy Z _UZ¯ Z T^`WVZ]VU `WjZ
HVRIiJLFRHUDPGRVH[RPDVFXOLQRPDLRUHVGH
Z `W_\Z q] ^ _^ `fZ vZj_U`f WjZ _f qU VW_T^uk^j^ fZ T^ fU `ZU _f ó] UZT^fZ ªZh U _j W\°Kf U `Z jQ ] `UZUZ fZy \_^`TW fWTZ_T^q^³ ^ `WqW]f^YZV j[^° TW_qZ V U^`f^_VWj Q] `UZ UZfZ y { Z vUZ j _U TW _ª j^ f U TW_ £ `TWqy U VZ f] Z YºZª^ yZ [~jQ TUZTW`új^] WT^^ `TW_VWqUZ _]^ Zy U|ZTZ_qW] ^ __^h]qWWUT^^ `TW_VWqUZ _¯ qZ V U^`f^~
ZZ `{ y U_^VWj qZ]Zf UvZTW_TZTW_^ qU T^ j U Wy óh U V W_YºZª^y Z[ \
QmR KRXYH GLIHUHQoD VLJQL¿FDWLYD S! HQWUH RV JUXSRV
_^j TU_qy Z _UZ ^ VWj TU _qy Z _UZ¯ Z T^ `WVZ] V U `WjZ\ qW] Q j \ W_ qZ VU^ `f^_V WjTU _qy Z _UZ¯ Z T^`WVZ ] VU `WjZZ q]^_^ `fZ] Z jjZU W] ]^³ `VUZT^fZ ªZh U _j W^T^U TZ T^_q^ ] U W]ZZ`W_~
xU h]ZKj W _f ]Z³^W`új ^]WT ^^` TW _VW qU Z_] ^ZyU |ZTZ_ q ^yW h ]qW VWj T U _qyZ_ U Z¯ ZT^`W V Z]VU ` Wj Z ^_ W{hU VW
IRL VLJQL¿FDWLYDPHQWH PDLRU TXH R JUXSR VHP GLVSODVLD
Y q´ \[ ~
èéêéëìíêîï ìð ëéï ñòêëíöìé÷íøùûü
6H[R0DVFXOLQR
ýþûÿIéIí d
éöòï 4ýû
Sð öì òøéïìîpð ëòïIíi 64û
Tébé÷ðï øò þ2û
Hêöð éð éìé ýýû
Hêöð éð éìéù þ4ëøü 66û
Hêöð éð éìéùd4ëøü 11û
F öIòpð ëéì êé û
Uï òIíÿñöé ìð øéëòöï ìé 41û Sð öì òøéïìîpð ëòïIí
i
öé ìð øéëòöï ìé þû
aaèéêéëìíêîï ìð ëéïIòïpéëð íöìíïëòøíïé÷òIíéêêíììòö÷òIòHòïpð ìéU öð íêïð ìêð òWéìíêèéöìîIð ò
*Tíï ìíIíFðïíê
èéêéëìíêîï ìð ëéï SíøIðïpéïð é èòøIðïpéïð él éIíöòëéêëð öòøé
p
6H[RPDVFXOLQR
ýþû ý1û d >ÿIéIíd éöòï 4 û 66û d >
Sð öìòøéïìîpð ëòïIíi 62û 66û d >
Tébé÷ðï øò û û d >
Hêöð éð éìé 8 1û ý1û d >
qZ VU^ `f^_TWh]qWVWj^__Z_Zy f^]Z õ^_fU `ZUTZT^jZ U W]³ ^ Z `W_~k jj^ _fTW]^V^`f^\q^]V^ª^« _^³ ^Zf^ `T`VUZT^ T^ _^ `vWy vU j^`fWT^TU _qyZ_UZT^Zy f Wh]Z^Z T^`WVZ]VU `WjZ Zj^ `fZ V Wj Z T] Z ¤ W TZ vUh Uy Ú`V UZ\ jZ _ T^ W] jZ jZ U _ jZ ] VZ`f^\{jZ ]^ yZ ¤WjZ U W] ^ `f]^ZU TZ T^Z vZ` ZTZ^ Z
WD[DGHGHWHFomRGHVWDVDOWHUDo}HV
ÍÔO^fZ T^ TW_ qZ VU^`f^_ V Wj TU _qy Z _UZ¯ Z T^`WVZ]VU `WjZ ^ _W{h U V W f U `Z U_f ó] UZ T^ fZªZh U _j W\ ^j jZ q] WqW] ¤W ª ^ j jZ U W] `^ _f^ h]qW~ xZ f W q^] V^ª U TW ^j `W__W f]Z ªZyW ^ VWj q] WvZTW ^ j ^ _fTW_ ³ ^ T^jW`_f]Zj ³ ^ W VUhZ] ] W U`T|Z y f^ ]Z õ^ _`Zj^fUy Z ¤WTWu TZ_VQyyZ_TZjV W_Z ^ _W{h U VZ \ y ^ vZ`TW Z W T^_^ `vWy vUj^`fW T^ Z T^`WVZ]VU `WjZ ^ j^ _ôZ h WT^}Z ]]^f f~
ÍÖ
jZ U W] UZTW_qZ V U^`f^ _TWh]qWVWjTU_qy Z _UZ^_fZvZ_^ j_W T^U `Uª U TW]^_TZª WjªZT^q] óf W`_~¬_WT^__^_j^TUVZ j^ `f W_ ^ W] U _V W T^ T^ _^ `vWy vU j^ `f WT^Z T^ `WVZ] V U `WjZ ^ _W{ h UV W
WrP VLGR FRQÀLWDQWHV 8PD UHYLVmR VLVWHPiWLFD UHFHQWH FRP
j^fZ`{y U _^T^v{]UW_^ _fTW_U`v^_fUh WZZ __WV UZ ¤W^`f] ^W _WT^j^TUVZ j^ `f W__q] ^ __W]^_T^{ VU TW_^Z T^`WVZ]VU `WjZ ^ _W{h U V W`W^_ôZh WT^} Z]] ^ f f ~xWUWª _^] vZTW³ ^W_WT^ U`Uª U TW]TZª WjªZT^q] óf W`_WUZ__WV UZ TWZjZ]^T ¤WT^ ] U _V WT^°K`Zq]Wh]^ __¤WqZ ]ZZ T^ `WVZ] V U `WjZ^ _W{h U V W^¯ WTU_qy Z _UZT^Zy f Wh]Z^jj_WT^ q^`T^ `f^TZT] Z ¤ W T^ jZ U _ TW³ ^ «Z `W_Zqó_W TUZh `ó_f U VW T^ ^_ôZh WT^ }Z ]]^ff ~
Í ×
k _f^Z f WZ y ^] fZqZ ]ZjVU TZ TW`ZjZ`f^ ` ¤ WTW _WT^u} g^jqZ VU^ `f^_V Wj^ _ôZh WT^}Z ]]^ff ~
jQTUZT^^ `TW_VWqUZ _] ^Zy U|ZTZ _qW]qZ VU^`f^_VWjTU _qyZ_UZ WUª^ jjZU W]³ ^`Wh]qW_^ jTU_qy Z _UZ~k__^jZU W]`új^]W T^^ `TW_V WqUZ_ ]^Z y U| Z TZ _WU j Zf W] ]^y ZVU W`Z TW £ jZUW] T^ f^ V ¤W T^ TU _qyZ_UZ ¯ Z T^ `WVZ] V U`WjZ ^j qZ V U^ `f^ _ VWj ^ _ôZh WT^} Z]] ^ f f`Wwz«w x z ~uZTWWª _^] vZTWfZ jªQ j ^ j ^ _fTW_qWqyZVU W`Z U _\ VWj WjZ j^fZ`{y U _^]^V^ `f^T^ ^_fTW_ T^ VWW] f^ ^j ZTy fW_ VWj ^_ôZh W T^ } Z] ]^ f f \ T^ j W`_f] Z `TW ³ ^ TW TUZh `ó_f U VW T^ Z T^`WVZ ] VU `WjZ ^ _W{h U V W Q ^U fW _Wj^ `f^ Z qó_ Z ] ^ q^ f U ¤ W TZ ^ `TW_V WqUZ TUh^_fU vZ^ j jZ `WTWTUZ h `ó_fU VWTW^ _ôZh WT^} Z]] ^ f f ~
ÏØ OU fZ _v^ |^ _Z_ª U óq_UZ _^ _W{ h U VZ _] ^Zy U|ZTZ _`WjWj^`fWTZ ^ `TW_VWqUZ `¤ WT^f^ VfZjTU _qy Z _UZ¯ Z T^`WVZ] V U `WjZ qW]^]]W T^ZjW_f]Z h^ j \ qW] q] ^ _^ ` ZT^^ _WZ h U f^^]W_UvZ\ q^y W `¤ W _^ hU j^`fWTWq] Wf WV Wy WT^ª Uóq_UZ _Wq^y W_WT^U `Uª U TW] TZ ª WjªZ T^ q] óf W`_~
ÏÍ
jZU W] ]^q^ f U ¤W TZ ^`TW_V WqUZ q^ ] j U f^WTUZh `ó_f UV Wq]^ V WV^T^TU _qy Z_UZ^Z T^`WVZ]VU `WjZ
HVRIiJLFR TXH SRGH WHU VLGR SHUGLGR HP H[DPH DQWHULRU
y^vZ `TWZjZ] ^ T ¤ WTZj W] fZy U TZ T^T^__^ _TW^ `f^ _~ g WT^ j W_ V W`VyU] ³ ^ W jZ U W] `új^]W T^ ^`TW_VWqUZ _ ]^Z y U| Z TZ _ WU j Zf W] ] ^y Z V UW`ZTW £ jZ U W] T^f^ V ¤W T^ TU _qy Z _UZ¯ Z T^`WVZ ] VU `WjZ ^ _W{h U VW ^j qZ VU^`f^_ VWj ^ _ôZh WT^}Z ]]^ff ~
/^h^^K
3DFLHQWHVFRPGRHQoDGRUHÀX[RJDVWURHVRIiJLFR
fjK T^ VZ`V^T^T^ _^`vWy v^ ]^ _ôZ h WT^} Z] ]^ f f ~k_fZZy f^] Z ¤ WqWT^ y ^ vZ] £ TU_qy Z _UZ ^ ^vWyU] qZ]Z Z T^`WVZ ] VU `WjZ ^_W{h U VW\ `jZU`V U T`VUZT^\Z°ZWZ `W\T^ q^`T^ `TWTZq] ^ _^ ` Z ^TWh]ZT^TU _qy Z _UZ ~xZf W]^ _T^] U _VWqZ] ZWT^ _^ `vWy vU j^`f W T^^ _ôZh WT^}Z ]]^ff^T^TU _qy Z_UZW]Z jZ vZy UZ TW_`W`W__W ^ _fTW\VWj Zf^` ¤WZW_ Z f W]^_]^y ZVU W`Z TW_£T^f^V ¤W T^ TU _qyZ_UZ`W_qZ VU^ `f^_TWw z ~Í Ñ
$ PDLRULD GRV SDFLHQWHV HUD GR VH[R PDVFXOLQR WLQKD
_U `fWjZ _ V] ô `UV W_ T^u k ^qW__ZQ ] `UZUZfZy \Z f W]^ _ ]^ yZVU W`Z TW_ Z W T^ _^ `vWy vU j^ `f W T^ ^_ôZh W T^ }Z ]]^ff ~ _Z `jZ ^f Z y \ `¤ W ^`VW`f]Z ]Z j j Z f W] ³ ^ VZ_Z __^ jZ U W]T^_^ `vWy vU j^`fWT^^_ôZh WT^} Z] ]^ f f \jZ _q^] V^ª^ ³ ^`Zv^]TZ T^ Z _jy^ ]^ _ ^ j U TZ T^ ]^q] WTf UvZ f^ ] UZ j W
HIHLWRSURWHWRUDQWLLQÀDPDWyULRGRHVWURJrQLROHYDQGRDXPD
jZ U W] ]^ _U _f`VUZ ^ qU f^y UZy \ Z f]Z_Z `TW W T^ _^ `vWy vU j^`f W T^ Z T^`WVZ]VU `WjZ^ _W{ h UV W~
ÍÒ
u^ZVW] TW VWjWjZ`^ fZy, Zq] ^ _^ ` ZT^Q ] `UZUZ fZy \qW]T^_y U| Z j^ `f Wq] U `VU qZy j^ `f^ \ QVZ] Z V f^ ] U|Z TZqW]jZ_^ qZ ]Z ¤W^`f]^W^ _ `Vf^ ]^_W{h U VW U `^]UW]^WTUZ] Zh jZV]]Zy \³ ^`W]jZ y j^`f^f] ZªZyZj^j
VLQHUJLDSDUDDXPHQWDUDEDUUHLUDDQWLUUHÀX[R$VVLPDKpUQLD
T^UZ f WZy f^ ]Zq] W`TZ j^ `f^Wq]WV^ __W`W] jZyT^T^ q]Z ¤W
GH iFLGR SHUPLWLQGR R ³UHÀX[R´ GR VXFR JiVWULFR SDUD R
HV{IDJRGLVWDOGXUDQWHRUHOD[DPHQWRGRHVI
`V f^ ]^_WZh UZ `WU `^]UW]U`T|UTWq^ yZT^hyfU ¤W\VU] V`_f Ú `VUZ`W] jZy j^ `f^ U jq^TU TZq^y ZV W`f]Z ¤WV]]ZyTWTUZ] Zh jZ ~
ÍÓ
vZy UZ `TW Z f W]^_ qZ ]Z T^ _^ `vWy vU j^ `f W T^ TU _qy Z _UZ ^ Z T^`WVZ]VU `WjZ ^ _W{ h UV W\ Wª _^ ] vW« _^ ³ ^ Z jZ U W] UZ TW_ aèòøpéêéòIòö øíêòIííöIòï ëòpð éïêíéðr éIéïpíòï péëð íöìíïëòøíï é÷òIíéêêíììòö÷òï íøIðïpéïð éëòøé ííï ëòøIðïpéïð éléIíöòëéêëð öòøé*p! > ìíï ìíIí" éööWð ìöí#
Z&ZE/^
1SéííöNJ >F é$W>ÿ#íêñ >íêï òöL%Aøíêð ëéöèòí÷íò éï ìêòíöìíêòò÷#Aèëð öð ëé÷ ðIíð öígIð é÷öòïðïéöIøéöé÷íøíöì
RI%DUUHWW¶V(VRSKDJXV$P-*DVWURHQWHURO
/LHEHUPDQ'$2HKONH0+HOIDQG05LVNIDFWRUVIRU%DUUHWW¶V
íï òpé÷ ï ð ö ëòøø öð ì#béï íI pêéëìð ëí Aø J éïìêòíöìíêò 1ý%þù8üg 1þ2ý
2 bíöï ìíð ö JH >
Sëíð øéöJ">SéIí÷ð S >
Wð ìíøéö i >
C&'&()a+ ð òï
N X>
ð øéêíïiF>" íò ÿS >
ñòöìíèA>F êéöëòL">Sò r é"A>íìéFéìòêíïêíéëð òöéIòï à
IíìíëòIíIðïpéïð éíøpéëð íöìíïëòø íï é÷òIíéêêíììòö÷òIòHòïpð ìéU öð íêïð ìêð òWéìíêèéöìîIð òí" íIUF èþ 18ébêj ö% 8ù þüg 264
JDVWURHVRSKDJHDO UHÀX[ V\QWKHVLV DQG HVWLPDWHV IURP SRSXODWLRQ
ï ì Ið íïAøJéï ìêòíöìíêòþ 11% 1 6ù þügþ 46
5XEHQVWHLQ-+0DWWHN1(LVHQ*$JHDQGVH[VSHFL¿F\LHOGRI
%DUUHWW¶VHVRSKDJXVE\HQGRVFRS\LQGLFDWLRQ*DVWURLQWHVW(QGRVF
þ 1%ý1ù1ügþ1ý
$QGULFL-&R[05(VOLFN*'&LJDUHWWHVPRNLQJDQGWKHULVN
RI %DUUHWW¶V HVRSKDJXV D V\VWHPDWLF UHYLHZ DQG PHWDDQDO\VLV
-éï ìêòíöìíêòHípéìòþ 12%þ8ù8üg1þ 8 ý2
6 Sð ö÷ S > Séêøé AN > " êéI "H > ììéê NS > Síêé÷ H> Kéìr$é i A> íì é èíöìêé éIðpòïð ì# ðï éïï òëð éìíI wð ì ð öëêíéï íI
ULVNRIHVRSKDJHDOLQÀDPPDWLRQPHWDSODVLDDQGDGHQRFDUFLQRPD
éï #ï ìíøéìð ëêíð íwéöIøíìééöé#ïðïèð öéï ìêòíöìíêòHípéìò þ 12% 11ù11üg 1241þ
&KDN $ /HH 7 .LQQDUG 0) %URFN : )DXO[ $ :LOOLV - HW
DO )DPLOLDO DJJUHJDWLRQ RI %DUUHWW¶V RHVRSKDJXV RHVRSKDJHDO
éIíöòëéêëð öòøé> éöIòíï òpé÷ò÷éï ìêð ë j öëìð òöééIíöòëéêëð öòøé ð öèé ëéïð éöéI ìï ìþþ% 1ù2üg 2þ28
6KDUPD 3 0RUDOHV7* 6DPSOLQHU 5( 6KRUW VHJPHQW %DUUHWW¶V
HVRSKDJXVWKH QHHG IRU VWDQGDUGL]DWLRQ RI WKH GH¿QLWLRQ DQG RI
íöIòï ëòpð ëëêð ìíêð éAø J
éï ìêòíöìíêò18%2ù ýüg 1 226 òpéi D>Lð íbíêøéöi A>" é÷éêíìN >F íööíêì#" >Séøpð öíê >éêíwéHS >íìéðï$ éëìòêï òêI#ïpéïð éð öpéìð íöìï wð ì
%DUUHWW¶VHVRSKDJXV%(UHVXOWVIURPDPXOWLFHQWHUFRQVRUWLXP'LJ
iðïSëðþ 2% 48ù8üg 1 2ý41 1Zéö÷
S > Zéö÷
X->
ið ö÷XW> Y
éö÷ K >
H éö÷ SL >
Kéï ìííð ö
)HWDO&\FORR[\JHQDVHLQKLELWRUVXVHLVDVVRFLDWHGZLWKUHGXFHGULVN
RIHVRSKDJHDODGHQRFDUFLQRPDLQSDWLHQWVZLWK%DUUHWW¶VHVRSKDJXV
éøíìééöé#ïðïêJèéöëíêþ 14% 11ù ügþ2ý8 88
11éï ìò÷ðA>ñ ðS > Síêé÷H>éöï éA>WéöðS >Séêøéñ
,QFLGHQFHRIHVRSKDJHDODGHQRFDUFLQRPDLQSDWLHQWVZLWK%DUUHWW¶V
íï òpé÷ ïéöIð ÷ ÷êéIíI#ïpéïð ég éøíìééöé#ïðïéï ìêòð öìíï ì öIòï ëþ8% 6ýù2üg 248
1þ SéííöNJ >Séêøéñ>O íêòìF> Wòï íöHè>Séøpð öíê
5(:DQJ..HWDO5DGLRIUHTXHQF\DEODWLRQLQ%DUUHWW¶VHVRSKDJXV
wð ìI#ïpéïð éNö÷J" íIþ% 26gþþýý88
12Héêêðï òö >ñíêê#ÿ >HéIIéIð öW> " ëiòöé IS >ê#éö >Abêéøï
.HWDO'HWHFWLRQRILQWHVWLQDOPHWDSODVLDLQ%DUUHWW¶VHVRSKDJXVDQ
òbï íê éìð òöéëòøpéêéìòêï ì I#ï ÷÷íï ìïìíöííI òêéøð öð ø øò íð ÷ìbð òpïð íïAø
J
éï ìêòíöìíêòþý% 1þù6üg 11 4
61
14SpíëíêSJéêêíììíï òpé÷ ïéöIêðï$òíï òpé÷íéëéöëíêgé ëð öð ëéêíð íwJ A"Aþ 12% 21ù6üg 6þý26
1 Aï éö øé K > ÿðjð øé K > Sð øòï í÷éwé T íöIíê Ið íêíöëí
LQ JDVWURHVRSKDJHDO UHÀX[ GLVHDVHV :RUOG - *DVWURHQWHURO
þ16%þþù üg 18 1
5RPDQ 6 .DKULODV 3- 0HFKDQLVPV RI %DUUHWW¶V HVRSKDJXV
ùëð öð ëéüg LS I#ï öëìð òö> ð éìéíêöð é> píêðï ìéìð ë Ií íëìï íï ì pêéëìíïèð öéï ìêòíöìíêòþ 1 %þù1üg 1ýþ8
1ýéìíöb#ñ>éììéëéêjííS >Wéè>èé#÷ðè>Wéìï òöAðï$
VWUDWL¿FDWLRQ IRU PDOLJQDQW SURJUHVVLRQ LQ %DUUHWW¶V HVRSKDJXV
÷íöIíê>é÷í>I êéìð òöéöI#íéêòï ê íðéöëíWòê IJéï ìêòíöìíêò þ16%þþù48üg 1 þ6
18KérA">Wòö÷è>DéêéIéöD>WððïJ >èé$A>êéI#W"
*OREDO'1$PHWK\ODWLRQSDWWHUQVLQ%DUUHWW¶VHVRSKDJXVG\VSODVWLF
%DUUHWW¶VDQGHVRSKDJHDODGHQRFDUFLQRPDDUHDVVRFLDWHGZLWK%0,
÷íöIíê>éöIìòbéëëò ï íèð öpð ÷íöíìð ëïþ 16%8g 111
1 Sð ö÷ S > éê÷ SK > Sð ö÷ ññ> ÿ#íê ñ > Síêé÷ H AëðI ï ppêíïïð íøíIð ëéìð òöïéöIêðï$òíï òpé÷íééIíöòëéêëð öòøéð ö
SDWLHQWV ZLWK %DUUHWW¶V HVRSKDJXV D V\VWHPDWLF UHYLHZ DQG PHWD
éöé#ïðï ìþ 14% 62ù8üg 1þþ2ý þDðï êòIð é
K > Sð ö÷
S >
Kêðïöéøòòêìð >
A ðï ì i A>
Wéö÷ KK > ÿ#íê ñ > íì é " é÷öð ì Ií òøðïï íI íï òpé÷íé éIíöòëéêëð öòøé
DIWHU%DUUHWW¶VHVRSKDJXVGLDJQRVLVDV\VWHPDWLFUHYLHZDQGPHWD
éöé#ïðïéï ìêòíöìíêòò÷#þ 16% 1 ù2üg 6ý
þ1Dðï êòIð éK>ÿ#íêñ >Sëíë$èi > Zð öï øíðï ìíêA > Kéìr$éi A