a4ff4f9d510b887a94896f70e2ebd9ab 253292.pdf 0f71784ba43cebc0b5b08a68279a2ce0ad337b4e 253292.pdf 103f752096e3a99cec77a97f1639a3dc2199095c1fcd41fc07ac73cb56730b71 253292.pdf Title: Impact of Lymphocyte and Neutrophil Counts on Mortality Risk in Severe Community-Acquired Pneumonia with or without Septic Shock Subject: Background: Community-acquired pneumonia (CAP) is a frequent cause of death worldwide. As recently described, CAP shows different biological endotypes. Improving characterization of these endotypes is needed to optimize individualized treatment of this disease. The potential value of the leukogram to assist prognosis in severe CAP has not been previously addressed. Methods: A cohort of 710 patients with CAP admitted to the intensive care units (ICUs) at Hospital of Mataró and Parc Taulí Hospital of Sabadell was retrospectively analyzed. Patients were split in those with septic shock (n = 304) and those with no septic shock (n = 406). A single blood sample was drawn from all the patients at the time of admission to the emergency room. ICU mortality was the main outcome. Results: Multivariate analysis demonstrated that lymphopenia <675 cells/mm3 or <501 cells/mm3 translated into 2.32- and 3.76-fold risk of mortality in patients with or without septic shock, respectively. In turn, neutrophil counts were associated with prognosis just in the group of patients with septic shock, where neutrophils <8850 cells/mm3 translated into 3.6-fold risk of mortality. Conclusion: lymphopenia is a preserved risk factor for mortality across the different clinical presentations of severe CAP (sCAP), while failing to expand circulating neutrophils counts beyond the upper limit of normality represents an incremental immunological failure observed just in those patients with the most severe form of CAP, septic shock.50pt Keywords: community-acquired pneumonia; mortality risk; leukocyte subclasses counts; neutrophils; lymphocytes Author: Estel Güell, Marta Martín-Fernandez, Mari C. De la Torre, Elisabet Palomera, Mateu Serra, Rafael Martinez, Manel Solsona, Gloria Miró, Jordi Vallès, Samuel Fernández, Edgar Cortés, Vanessa Ferrer, Marc Morales, Juan C. Yébenes, Jordi Almirall and Jesús F. Bermejo-Martin Creator: LaTeX with hyperref package Producer: pdfTeX-1.40.18 CreationDate: Mon May 27 13:19:47 2019 CEST ModDate: Mon May 27 13:19:47 2019 CEST Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 10 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 1272851 bytes Optimized: no PDF version: 1.5 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- IKEIRT+URWPalladioL-Ital Type 1 Custom yes yes no 81 0 PQZCQS+URWPalladioL-Bold Type 1 Custom yes yes no 82 0 CUAJJQ+Pxbsy Type 1 Builtin yes yes no 83 0 NRWICF+VnURWPalladioL-Bold Type 1 Custom yes yes no 84 0 QANTWC+URWPalladioL-Roma Type 1 Custom yes yes no 85 0 HKBJPQ+VnURWPalladioL Type 1 Custom yes yes no 86 0 OFLXAT+Rpxr Type 1 Builtin yes yes no 87 0 CIPNNK+Pxsy Type 1 Builtin yes yes no 88 0 BSDWLC+TimesNewRomanPSMT Type 1C WinAnsi yes yes no 93 0 XPUSBJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 94 0 MCBCCI+SourceSansRoman-Regular Type 1C Custom yes yes no 113 0 MCBCCM+SourceSansRoman.613wght Type 1C Custom yes yes no 114 0 MCBCCO+SourceSansRoman-Bold Type 1C Custom yes yes no 115 0 GIGFZE+CMR10 Type 1 Builtin yes yes no 196 0 VBUOPI+Pxex Type 1 Builtin yes yes no 197 0 QLBIEB+URWPalladioL-BoldItal Type 1 Custom yes yes no 207 0 VUPETJ+Rpxb Type 1 Builtin yes yes no 208 0 ABCDEE+Palatino Linotype TrueType WinAnsi yes yes no 213 0 ABCDEE+Palatino Linotype,Italic TrueType WinAnsi yes yes no 214 0 ABCDEE+Palatino Linotype,Bold TrueType WinAnsi yes yes no 215 0 ABCDEE+Palatino Linotype CID TrueType Identity-H yes yes yes 216 0 Times New Roman TrueType WinAnsi no no no 217 0 ABCDEE+Palatino Linotype,BoldItalic TrueType WinAnsi yes yes no 218 0 Arial,Bold TrueType WinAnsi no no no 232 0 Arial TrueType WinAnsi no no no 233 0 ABCDEE+Calibri,Italic TrueType WinAnsi yes yes no 234 0 ABCDEE+Calibri TrueType WinAnsi yes yes no 235 0 JLZORU+EURM10 Type 1 Builtin yes yes no 263 0 ABCDEE+Palatino Linotype TrueType WinAnsi yes yes no 270 0 ABCDEE+Palatino Linotype,Italic TrueType WinAnsi yes yes no 271 0 ABCDEE+Palatino Linotype,Bold TrueType WinAnsi yes yes no 272 0 ABCDEE+Palatino Linotype CID TrueType Identity-H yes yes yes 273 0 Times New Roman TrueType WinAnsi no no no 274 0 ABCDEE+Palatino Linotype,BoldItalic TrueType WinAnsi yes yes no 275 0 Arial,Bold TrueType WinAnsi no no no 289 0 Arial TrueType WinAnsi no no no 290 0 ABCDEE+Calibri,Italic TrueType WinAnsi yes yes no 291 0 ABCDEE+Calibri TrueType WinAnsi yes yes no 292 0 VSHNAE+Rpcxr Type 1 Builtin yes yes no 401 0 Jhove (Rel. 1.22.1, 2019-04-17) Date: 2022-12-17 02:30:45 CET RepresentationInformation: 253292.pdf ReportingModule: PDF-hul, Rel. 1.12.1 (2019-04-17) LastModified: 2022-12-16 13:19:24 CET Size: 1272851 Format: PDF Version: 1.5 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 0 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: ViewerPreferences: HideToolbar: false HideMenubar: false HideWindowUI: false FitWindow: true CenterWindow: false DisplayDocTitle: false NonFullScreenPageMode: UseNone Direction: L2R ViewArea: CropBox ViewClip: CropBox PrintArea: CropBox PageClip: CropBox PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: ぉのぴひはつふっぴどはのぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸲ Item: Title: きちぴづひどちぬびぜ〴ぜ〰ちのつぜ〴ぜ〰きづぴとはつびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮ㄩ‾㸊⡜㌷㙜㌷㝜〰こぴふつべぜ〴ぜ〰いづびどでのぜ〴ぜ〰ちのつぜ〴ぜ〰ぐちぴどづのぴぜ〴ぜ〰こづぬづっぴどはのぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㈩‾㸊⡜㌷㙜㌷㝜〰ぅぴとどっびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㌩‾㸊⡜㌷㙜㌷㝜〰がづふにはっべぴづぜ〴ぜ〰けふちのぴどてどっちぴどはのぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㐩‾㸊⡜㌷㙜㌷㝜〰きちどのぜ〴ぜ〰くふぴっはねづぜ〴ぜ〰きづちびふひづびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㔩‾㸊⡜㌷㙜㌷㝜〰くぴとづひぜ〴ぜ〰こぴふつべぜ〴ぜ〰ざちひどちぢぬづびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㘩‾㸊⡜㌷㙜㌷㝜〰こぴちぴどびぴどっちぬぜ〴ぜ〰ぁのちぬべびどびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸳ Children: Item: Title: こぴふつべぜ〴ぜ〰いづびどでのぜ〴ぜ〰ちのつぜ〴ぜ〰ぐちぴどづのぴぜ〴ぜ〰こづぬづっぴどはのぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㈩‾㸊⡜㌷㙜㌷㝜〰ぅぴとどっびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㌩‾㸊⡜㌷㙜㌷㝜〰がづふにはっべぴづぜ〴ぜ〰けふちのぴどてどっちぴどはのぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㐩‾㸊⡜㌷㙜㌷㝜〰きちどのぜ〴ぜ〰くふぴっはねづぜ〴ぜ〰きづちびふひづびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㔩‾㸊⡜㌷㙜㌷㝜〰くぴとづひぜ〴ぜ〰こぴふつべぜ〴ぜ〰ざちひどちぢぬづびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㘩‾㸊⡜㌷㙜㌷㝜〰こぴちぴどびぴどっちぬぜ〴ぜ〰ぁのちぬべびどびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸳ Item: Title: ぅぴとどっびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㌩‾㸊⡜㌷㙜㌷㝜〰がづふにはっべぴづぜ〴ぜ〰けふちのぴどてどっちぴどはのぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㐩‾㸊⡜㌷㙜㌷㝜〰きちどのぜ〴ぜ〰くふぴっはねづぜ〴ぜ〰きづちびふひづびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㔩‾㸊⡜㌷㙜㌷㝜〰くぴとづひぜ〴ぜ〰こぴふつべぜ〴ぜ〰ざちひどちぢぬづびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㘩‾㸊⡜㌷㙜㌷㝜〰こぴちぴどびぴどっちぬぜ〴ぜ〰ぁのちぬべびどびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸳ Item: Title: がづふにはっべぴづぜ〴ぜ〰けふちのぴどてどっちぴどはのぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㐩‾㸊⡜㌷㙜㌷㝜〰きちどのぜ〴ぜ〰くふぴっはねづぜ〴ぜ〰きづちびふひづびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㔩‾㸊⡜㌷㙜㌷㝜〰くぴとづひぜ〴ぜ〰こぴふつべぜ〴ぜ〰ざちひどちぢぬづびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㘩‾㸊⡜㌷㙜㌷㝜〰こぴちぴどびぴどっちぬぜ〴ぜ〰ぁのちぬべびどびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸳ Item: Title: きちどのぜ〴ぜ〰くふぴっはねづぜ〴ぜ〰きづちびふひづびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㔩‾㸊⡜㌷㙜㌷㝜〰くぴとづひぜ〴ぜ〰こぴふつべぜ〴ぜ〰ざちひどちぢぬづびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㘩‾㸊⡜㌷㙜㌷㝜〰こぴちぴどびぴどっちぬぜ〴ぜ〰ぁのちぬべびどびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸳ Item: Title: くぴとづひぜ〴ぜ〰こぴふつべぜ〴ぜ〰ざちひどちぢぬづびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㘩‾㸊⡜㌷㙜㌷㝜〰こぴちぴどびぴどっちぬぜ〴ぜ〰ぁのちぬべびどびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸳ Item: Title: こぴちぴどびぴどっちぬぜ〴ぜ〰ぁのちぬべびどびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸳ Item: Title: げづびふぬぴびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㌮ㄩ‾㸊⡜㌷㙜㌷㝜〰ぐちぴどづのぴぜ〴ぜ〰ぃとちひちっぴづひどびぴどっびぜ〴ぜ〰ぜ〵ぜ〰ごちぢぬづぜ〴ぜ〰〱ぜ〵ㅜ〰ぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㌮㈩‾㸊⡜㌷㙜㌷㝜〰ぁのちぬべびどびぜ〴ぜ〰はてぜ〴ぜ〰きはひぴちぬどぴべぜ〴ぜ〰げどびにぜ〴ぜ〰どのぜ〴ぜ〰ぴとづぜ〴ぜ〰ぇひはふばぜ〴ぜ〰はてぜ〴ぜ〰ぐちぴどづのぴびぜ〴ぜ〰ぷどぴとぜ〴ぜ〰びぃぁぐぜ〴ぜ〰ちのつぜ〴ぜ〰こづばぴどっぜ〴ぜ〰ことはっにぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㌮㌩‾㸊⡜㌷㙜㌷㝜〰ぁのちぬべびどびぜ〴ぜ〰はてぜ〴ぜ〰きはひぴちぬどぴべぜ〴ぜ〰げどびにぜ〴ぜ〰どのぜ〴ぜ〰ぴとづぜ〴ぜ〰ぇひはふばぜ〴ぜ〰はてぜ〴ぜ〰ぐちぴどづのぴびぜ〴ぜ〰ぷどぴとぜ〴ぜ〰びぃぁぐぜ〴ぜ〰ちのつぜ〴ぜ〰ぎはぜ〴ぜ〰こづばぴどっぜ〴ぜ〰ことはっにぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸴ Children: Item: Title: ぐちぴどづのぴぜ〴ぜ〰ぃとちひちっぴづひどびぴどっびぜ〴ぜ〰ぜ〵ぜ〰ごちぢぬづぜ〴ぜ〰〱ぜ〵ㅜ〰ぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㌮㈩‾㸊⡜㌷㙜㌷㝜〰ぁのちぬべびどびぜ〴ぜ〰はてぜ〴ぜ〰きはひぴちぬどぴべぜ〴ぜ〰げどびにぜ〴ぜ〰どのぜ〴ぜ〰ぴとづぜ〴ぜ〰ぇひはふばぜ〴ぜ〰はてぜ〴ぜ〰ぐちぴどづのぴびぜ〴ぜ〰ぷどぴとぜ〴ぜ〰びぃぁぐぜ〴ぜ〰ちのつぜ〴ぜ〰こづばぴどっぜ〴ぜ〰ことはっにぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㌮㌩‾㸊⡜㌷㙜㌷㝜〰ぁのちぬべびどびぜ〴ぜ〰はてぜ〴ぜ〰きはひぴちぬどぴべぜ〴ぜ〰げどびにぜ〴ぜ〰どのぜ〴ぜ〰ぴとづぜ〴ぜ〰ぇひはふばぜ〴ぜ〰はてぜ〴ぜ〰ぐちぴどづのぴびぜ〴ぜ〰ぷどぴとぜ〴ぜ〰びぃぁぐぜ〴ぜ〰ちのつぜ〴ぜ〰ぎはぜ〴ぜ〰こづばぴどっぜ〴ぜ〰ことはっにぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸴ Item: Title: ぁのちぬべびどびぜ〴ぜ〰はてぜ〴ぜ〰きはひぴちぬどぴべぜ〴ぜ〰げどびにぜ〴ぜ〰どのぜ〴ぜ〰ぴとづぜ〴ぜ〰ぇひはふばぜ〴ぜ〰はてぜ〴ぜ〰ぐちぴどづのぴびぜ〴ぜ〰ぷどぴとぜ〴ぜ〰びぃぁぐぜ〴ぜ〰ちのつぜ〴ぜ〰こづばぴどっぜ〴ぜ〰ことはっにぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㌮㌩‾㸊⡜㌷㙜㌷㝜〰ぁのちぬべびどびぜ〴ぜ〰はてぜ〴ぜ〰きはひぴちぬどぴべぜ〴ぜ〰げどびにぜ〴ぜ〰どのぜ〴ぜ〰ぴとづぜ〴ぜ〰ぇひはふばぜ〴ぜ〰はてぜ〴ぜ〰ぐちぴどづのぴびぜ〴ぜ〰ぷどぴとぜ〴ぜ〰びぃぁぐぜ〴ぜ〰ちのつぜ〴ぜ〰ぎはぜ〴ぜ〰こづばぴどっぜ〴ぜ〰ことはっにぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸴ Item: Title: ぁのちぬべびどびぜ〴ぜ〰はてぜ〴ぜ〰きはひぴちぬどぴべぜ〴ぜ〰げどびにぜ〴ぜ〰どのぜ〴ぜ〰ぴとづぜ〴ぜ〰ぇひはふばぜ〴ぜ〰はてぜ〴ぜ〰ぐちぴどづのぴびぜ〴ぜ〰ぷどぴとぜ〴ぜ〰びぃぁぐぜ〴ぜ〰ちのつぜ〴ぜ〰ぎはぜ〴ぜ〰こづばぴどっぜ〴ぜ〰ことはっにぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸴ Item: Title: いどびっふびびどはのぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸵ Item: Title: ぃはのっぬふびどはのびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸵ Item: Title: げづてづひづのっづび Filters: FilterPipeline: FlateDecode Fonts: Type1: Font: BaseFont: GIGFZE+CMR10 FontSubset: true FirstChar: 40 LastChar: 61 FontDescriptor: FontName: GIGFZE+CMR10 Flags: Symbolic FontBBox: -40, -250, 1009, 750 FontFile: true Font: BaseFont: VBUOPI+Pxex FontSubset: true FirstChar: 113 LastChar: 113 FontDescriptor: FontName: VBUOPI+Pxex Flags: Symbolic FontBBox: -5, -3116, 1694, 792 FontFile: true Font: BaseFont: JLZORU+EURM10 FontSubset: true FirstChar: 31 LastChar: 31 FontDescriptor: FontName: JLZORU+EURM10 Flags: Symbolic FontBBox: -32, -243, 1060, 720 FontFile: true Font: BaseFont: QLBIEB+URWPalladioL-BoldItal FontSubset: true FirstChar: 110 LastChar: 112 FontDescriptor: FontName: QLBIEB+URWPalladioL-BoldItal Flags: Symbolic FontBBox: -170, -300, 1073, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: VUPETJ+Rpxb FontSubset: true FirstChar: 61 LastChar: 61 FontDescriptor: FontName: VUPETJ+Rpxb Flags: Symbolic FontBBox: -57, -266, 932, 729 FontFile: true Font: BaseFont: IKEIRT+URWPalladioL-Ital FontSubset: true FirstChar: 2 LastChar: 121 FontDescriptor: FontName: IKEIRT+URWPalladioL-Ital Flags: Symbolic FontBBox: -170, -305, 1010, 941 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: VSHNAE+Rpcxr FontSubset: true FirstChar: 169 LastChar: 169 FontDescriptor: FontName: VSHNAE+Rpcxr Flags: Symbolic FontBBox: -212, -286, 1344, 973 FontFile: true Font: BaseFont: PQZCQS+URWPalladioL-Bold FontSubset: true FirstChar: 3 LastChar: 252 FontDescriptor: FontName: PQZCQS+URWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: CUAJJQ+Pxbsy FontSubset: true FirstChar: 121 LastChar: 122 FontDescriptor: FontName: CUAJJQ+Pxbsy Flags: Symbolic FontBBox: 5, -978, 1382, 913 FontFile: true Font: BaseFont: NRWICF+VnURWPalladioL-Bold FontSubset: true FirstChar: 161 LastChar: 243 FontDescriptor: FontName: NRWICF+VnURWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: QANTWC+URWPalladioL-Roma FontSubset: true FirstChar: 2 LastChar: 252 FontDescriptor: FontName: QANTWC+URWPalladioL-Roma Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: HKBJPQ+VnURWPalladioL FontSubset: true FirstChar: 129 LastChar: 226 FontDescriptor: FontName: HKBJPQ+VnURWPalladioL Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: OFLXAT+Rpxr FontSubset: true FirstChar: 11 LastChar: 62 FontDescriptor: FontName: OFLXAT+Rpxr Flags: Symbolic FontBBox: -40, -283, 904, 728 FontFile: true Font: BaseFont: CIPNNK+Pxsy FontSubset: true FirstChar: 0 LastChar: 122 FontDescriptor: FontName: CIPNNK+Pxsy Flags: Symbolic FontBBox: -21, -994, 1292, 912 FontFile: true Pages: Page: Sequence: 1 Annotations: Annotation: Subtype: Link Rect: 75, 757, 217, 793 Annotation: Subtype: Link Rect: 474, 757, 519, 793 Annotation: Subtype: Link Rect: 495, 641, 506, 654 Annotation: Subtype: Link Rect: 166, 599, 177, 613 Annotation: Subtype: Link Rect: 466, 339, 518, 358 Annotation: Subtype: Link Rect: 177, 38, 247, 50 Annotation: Subtype: Link Rect: 418, 38, 519, 50 Page: Sequence: 2 Annotations: Annotation: Subtype: Link Rect: 243, 632, 250, 641 ActionDest: 345 Annotation: Subtype: Link Rect: 253, 631, 260, 641 ActionDest: 345 Annotation: Subtype: Link Rect: 104, 605, 111, 614 ActionDest: 345 Annotation: Subtype: Link Rect: 112, 604, 119, 614 ActionDest: 345 Annotation: Subtype: Link Rect: 303, 591, 310, 600 ActionDest: 375 Annotation: Subtype: Link Rect: 310, 591, 317, 600 ActionDest: 375 Annotation: Subtype: Link Rect: 99, 550, 106, 560 ActionDest: 375 Annotation: Subtype: Link Rect: 106, 550, 113, 560 ActionDest: 375 Annotation: Subtype: Link Rect: 376, 483, 388, 492 ActionDest: 375 Annotation: Subtype: Link Rect: 245, 469, 257, 479 ActionDest: 375 Annotation: Subtype: Link Rect: 90, 442, 102, 452 ActionDest: 375 Annotation: Subtype: Link Rect: 286, 429, 298, 438 ActionDest: 375 Annotation: Subtype: Link Rect: 503, 388, 515, 397 ActionDest: 375 Annotation: Subtype: Link Rect: 132, 361, 144, 370 ActionDest: 375 Annotation: Subtype: Link Rect: 144, 361, 156, 370 ActionDest: 375 Annotation: Subtype: Link Rect: 345, 334, 357, 343 ActionDest: 375 Annotation: Subtype: Link Rect: 190, 307, 202, 316 ActionDest: 375 Annotation: Subtype: Link Rect: 448, 294, 460, 303 ActionDest: 375 Annotation: Subtype: Link Rect: 297, 253, 309, 262 ActionDest: 375 Annotation: Subtype: Link Rect: 217, 159, 229, 168 ActionDest: 375 Annotation: Subtype: Link Rect: 230, 159, 242, 168 ActionDest: 375 Annotation: Subtype: Link Rect: 503, 145, 515, 154 ActionDest: 398 Annotation: Subtype: Link Rect: 386, 118, 398, 127 ActionDest: 398 Page: Sequence: 3 Annotations: Annotation: Subtype: Link Rect: 114, 487, 126, 497 ActionDest: 398 Annotation: Subtype: Link Rect: 166, 157, 178, 166 ActionDest: 398 Page: Sequence: 4 Annotations: Annotation: Subtype: Link Rect: 297, 551, 309, 560 ActionDest: 398 Annotation: Subtype: Link Rect: 214, 352, 221, 365 ActionDest: 204 Annotation: Subtype: Link Rect: 347, 196, 354, 208 ActionDest: 204 Annotation: Subtype: Link Rect: 472, 155, 479, 167 ActionDest: 204 Annotation: Subtype: Link Rect: 498, 155, 505, 167 ActionDest: 260 Page: Sequence: 5 Page: Sequence: 6 Annotations: Annotation: Subtype: Link Rect: 218, 531, 225, 543 ActionDest: 260 Annotation: Subtype: Link Rect: 413, 218, 420, 230 ActionDest: 260 Page: Sequence: 7 Annotations: Annotation: Subtype: Link Rect: 124, 632, 136, 641 ActionDest: 398 Annotation: Subtype: Link Rect: 263, 605, 275, 614 ActionDest: 375 Annotation: Subtype: Link Rect: 107, 551, 119, 560 ActionDest: 375 Annotation: Subtype: Link Rect: 291, 524, 303, 533 ActionDest: 375 Annotation: Subtype: Link Rect: 181, 308, 193, 317 ActionDest: 398 Annotation: Subtype: Link Rect: 290, 240, 302, 250 ActionDest: 398 Annotation: Subtype: Link Rect: 188, 200, 200, 209 ActionDest: 398 Annotation: Subtype: Link Rect: 503, 173, 515, 182 ActionDest: 398 Annotation: Subtype: Link Rect: 396, 119, 408, 128 ActionDest: 398 Annotation: Subtype: Link Rect: 408, 119, 420, 128 ActionDest: 398 Page: Sequence: 8 Annotations: Annotation: Subtype: Link Rect: 432, 661, 444, 671 ActionDest: 398 Annotation: Subtype: Link Rect: 395, 594, 407, 603 ActionDest: 398 Annotation: Subtype: Link Rect: 100, 249, 137, 259 Annotation: Subtype: Link Rect: 220, 211, 257, 221 Annotation: Subtype: Link Rect: 264, 211, 300, 221 Annotation: Subtype: Link Rect: 206, 172, 243, 182 Annotation: Subtype: Link Rect: 479, 145, 516, 156 Annotation: Subtype: Link Rect: 100, 133, 136, 143 Annotation: Subtype: Link Rect: 100, 94, 137, 105 Page: Sequence: 9 Annotations: Annotation: Subtype: Link Rect: 203, 715, 240, 725 Annotation: Subtype: Link Rect: 298, 675, 335, 686 Annotation: Subtype: Link Rect: 479, 637, 516, 648 Annotation: Subtype: Link Rect: 100, 625, 136, 635 Annotation: Subtype: Link Rect: 232, 572, 270, 583 Annotation: Subtype: Link Rect: 395, 546, 432, 557 Annotation: Subtype: Link Rect: 438, 546, 475, 557 Annotation: Subtype: Link Rect: 460, 508, 498, 519 Annotation: Subtype: Link Rect: 353, 469, 390, 480 Annotation: Subtype: Link Rect: 136, 431, 173, 441 Annotation: Subtype: Link Rect: 296, 391, 334, 402 Annotation: Subtype: Link Rect: 338, 366, 375, 376 Annotation: Subtype: Link Rect: 382, 366, 418, 376 Annotation: Subtype: Link Rect: 230, 340, 267, 351 Annotation: Subtype: Link Rect: 131, 302, 169, 312 Annotation: Subtype: Link Rect: 175, 302, 211, 312 Annotation: Subtype: Link Rect: 463, 249, 501, 260 Annotation: Subtype: Link Rect: 478, 224, 516, 234 Annotation: Subtype: Link Rect: 100, 212, 136, 222 Annotation: Subtype: Link Rect: 438, 172, 476, 183 Annotation: Subtype: Link Rect: 379, 133, 416, 144 Annotation: Subtype: Link Rect: 184, 95, 222, 105 Annotation: Subtype: Link Rect: 228, 95, 264, 105 Page: Sequence: 10 Annotations: Annotation: Subtype: Link Rect: 258, 714, 296, 725 Annotation: Subtype: Link Rect: 100, 663, 137, 673 Annotation: Subtype: Link Rect: 143, 663, 179, 673 Annotation: Subtype: Link Rect: 203, 625, 240, 635 Annotation: Subtype: Link Rect: 247, 625, 283, 635 Annotation: Subtype: Link Rect: 100, 586, 137, 596 Annotation: Subtype: Link Rect: 177, 534, 214, 544 Annotation: Subtype: Link Rect: 291, 508, 328, 519 Annotation: Subtype: Link Rect: 191, 483, 229, 493 Annotation: Subtype: Link Rect: 235, 483, 271, 493 Annotation: Subtype: Link Rect: 370, 404, 407, 415 Annotation: Subtype: Link Rect: 479, 366, 516, 376 Annotation: Subtype: Link Rect: 438, 340, 475, 351 Annotation: Subtype: Link Rect: 481, 340, 516, 351 Annotation: Subtype: Link Rect: 285, 301, 322, 312 Annotation: Subtype: Link Rect: 328, 301, 365, 312 Annotation: Subtype: Link Rect: 273, 249, 310, 260 Annotation: Subtype: Link Rect: 76, 207, 166, 238 Annotation: Subtype: Link Rect: 234, 202, 407, 213 Checksum: 71fa294c Type: CRC32 Checksum: a4ff4f9d510b887a94896f70e2ebd9ab Type: MD5 Checksum: 0f71784ba43cebc0b5b08a68279a2ce0ad337b4e Type: SHA-1