96762ac20a957a4c3698cdea806e0141  324034.pdf
f8772246be0299b366124397111982a7a83bfead  324034.pdf
4657b7a821adb4ea91610ad73ebab661a50b4d178d2a631f0f215de334b2ee3a  324034.pdf

Title:           Integrative clinical, hormonal, and molecular data associate with invasiveness in acromegaly: REMAH study
Subject:         DOI: 10.1093/ejendo/lvae045; European Journal of Endocrinology, 190, 6, 2024-5-3.; Abstract:  Introduction: Growth hormone (GH)-secreting pituitary tumors (GHomas) are the most common acromegaly cause. At diagnosis, most of them are macroadenomas, and up to 56% display cavernous sinus invasion. Biomarker assessment associated with tumor growth and invasion is important to optimize their management. Objectives: The study aims to identify clinical/hormonal/molecular biomarkers associated with tumor size and invasiveness in GHomas and to analyze the influence of pre-treatment with somatostatin analogs (SSAs) or dopamine agonists (DAs) in key molecular biomarker expression. Methods: Clinical/analytical/radiological variables were evaluated in 192 patients from the REMAH study (ambispective multicenter post-surgery study of the Spanish Society of Endocrinology and Nutrition). The expression of somatostatin/ghrelin/dopamine system components and key pituitary/proliferation markers was eval
Keywords:        pituitary tumor; curation; combined molecular and clinical biomarkers; transsphenoidal surgery; REMAH study
Author:          Miguel Sampedro-Nuñez
Creator:         Servigistics Arbortext Advanced Print Publisher 11.1.4546/W-x64
Producer:        PDFlib+PDI 9.0.7p3 (C++/Win64); modified using iTextSharp.LGPLv2.Core 3.7.4.0
CreationDate:    Wed Jun  5 04:12:55 2024 CEST
ModDate:         Wed Jan 14 09:19:01 2026 CET
Custom Metadata: yes
Metadata Stream: yes
Tagged:          yes
UserProperties:  no
Suspects:        no
Form:            AcroForm
JavaScript:      no
Pages:           13
Encrypted:       no
Page size:       595.276 x 782.362 pts
Page rot:        0
File size:       1141420 bytes
Optimized:       no
PDF version:     1.6


name                                 type              encoding         emb sub uni object ID
------------------------------------ ----------------- ---------------- --- --- --- ---------
SKJJWW+UniversLTStd-Bold             Type 1C           Custom           yes yes yes     40  0
IGBOIC+UniversLTStd-Cn               Type 1C           Custom           yes yes yes     36  0
WNQLEB+UniversLTStd-CnObl            Type 1C           Custom           yes yes yes   1730  0
QGPKQT+UniversLTStd-BoldCn           Type 1C           Custom           yes yes yes     35  0
ILGJOM+ArialMT                       TrueType          WinAnsi          yes yes no       1  0
NQBKBM+UniversLTStd-Obl              Type 1C           Custom           yes yes yes     37  0
GRNPFF+UniversLTStd                  Type 1C           Custom           yes yes yes     38  0
OHGDKI+SourceSansPro-Regular         Type 1C           Custom           yes yes yes     39  0
GHRCHU+UniversLTStd-Light            Type 1C           Custom           yes yes yes     41  0
CMNJUW+UniversLTStd-LightObl         Type 1C           Custom           yes yes yes     42  0
WILIVQ+STIXGeneral-Regular           Type 1C           Custom           yes yes yes     43  0
ZBRDQL+UniversLTStd-Black            Type 1C           Custom           yes yes yes     44  0
CNBIJC+SabonLTStd-Roman              Type 1C           Custom           yes yes yes     45  0
IKCMGU+SabonLTStd-Bold               Type 1C           Custom           yes yes yes     46  0
GQJPLG+SabonLTStd-Italic             Type 1C           Custom           yes yes yes     54  0
MYOQMC+SabonLTStd-BoldItalic         Type 1C           Custom           yes yes yes     55  0


Jhove (Rel. 1.28.0, 2023-05-18)
 Date: 2026-01-15 04:13:31 CET
 RepresentationInformation: 324034.pdf
  ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16)
  LastModified: 2026-01-14 09:22:29 CET
  Size: 1141420
  Format: PDF
  Version: 1.6
  Status: Well-Formed, but not valid
  SignatureMatches:
   PDF-hul
  ErrorMessage: Invalid indirect destination - referenced object 'corFM3' cannot be found
   ID: PDF-HUL-149
  ErrorMessage: Invalid indirect destination - referenced object 'corFM1' cannot be found
   ID: PDF-HUL-149
  ErrorMessage: Invalid indirect destination - referenced object 'corFM2' cannot be found
   ID: PDF-HUL-149
  ErrorMessage: edu.harvard.hul.ois.jhove.module.pdf.PdfInvalidException: Invalid indirect destination - referenced object 'corFM1' cannot be found
   ID: PDF-HUL-122
   Offset: 1029904
  ErrorMessage: edu.harvard.hul.ois.jhove.module.pdf.PdfInvalidException: Invalid indirect destination - referenced object 'corFM3' cannot be found
   ID: PDF-HUL-122
   Offset: 1029904
  ErrorMessage: edu.harvard.hul.ois.jhove.module.pdf.PdfInvalidException: Invalid indirect destination - referenced object 'corFM2' cannot be found
   ID: PDF-HUL-122
   Offset: 1029904
  MIMEtype: application/pdf
  Profile: Tagged PDF
  PDFMetadata: 
   Objects: 1784
   FreeObjects: 1
   IncrementalUpdates: 0
   DocumentCatalog: 
    ViewerPreferences: 
     HideToolbar: false
     HideMenubar: false
     HideWindowUI: false
     FitWindow: false
     CenterWindow: false
     DisplayDocTitle: true
     NonFullScreenPageMode: UseNone
     Direction: L2R
     ViewArea: CropBox
     ViewClip: CropBox
     PrintArea: CropBox
     PageClip: CropBox
    PageLayout: OneColumn
    PageMode: UseOutlines
    Language: en
    Outlines: 
     Item: 
      Title: Integrative clinical, hormonal, and molecular data associate with invasiveness in acromegaly: REMAH study
      Destination: head1
      Children: 
       Item: 
        Title: Introduction
        Destination: seclvae045-s0
       Item: 
        Title: Methods
        Destination: seclvae045-s1
        Children: 
         Item: 
          Title: Patients and tumor sample processing
          Destination: seclvae045-s1.1
         Item: 
          Title: Immuno-histochemical analysis
          Destination: seclvae045-s1.2
         Item: 
          Title: RNA isolation, reverse transcription, and qPCR
          Destination: seclvae045-s1.3
         Item: 
          Title: Statistical analysis
          Destination: seclvae045-s1.4
       Item: 
        Title: Results
        Destination: seclvae045-s2
        Children: 
         Item: 
          Title: Patient population
          Destination: seclvae045-s2.1
         Item: 
          Title: Relationships between clinical, hormonal, and radiological findings
          Destination: seclvae045-s2.2
         Item: 
          Title: Correlation of clinical/hormonal data with molecular findings
          Destination: seclvae045-s2.3
         Item: 
          Title: Combination of clinical, analytical, radiological, and molecular features enhances characterization of tumor size and invasiveness in GHomas
          Destination: seclvae045-s2.4
         Item: 
          Title: Pre-surgical treatment with agonists in GHomas
          Destination: seclvae045-s2.5
       Item: 
        Title: Discussion
        Destination: seclvae045-s3
       Item: 
        Title: Acknowledgments
        Destination: acknow
       Item: 
        Title: Supplementary material
        Destination: seclvae045-s5
       Item: 
        Title: Funding
        Destination: seclvae045-s6
       Item: 
        Title: Authors’ contributions
        Destination: seclvae045-s7
       Item: 
        Title: Data availability
        Destination: seclvae045-s8
       Item: 
        Title: Appendix
        Destination: apnd
        Children: 
         Item: 
          Title: REMAH investigators
          Destination: apndlvae045-s4
       Item: 
        Title: References
        Destination: reflist
   Info: 
    Title: Integrative clinical, hormonal, and molecular data associate with invasiveness in acromegaly: REMAH study
    Author: Miguel Sampedro-Nuñez
    Subject: DOI: 10.1093/ejendo/lvae045; European Journal of Endocrinology, 190, 6, 2024-5-3.; Abstract:  Introduction: Growth hormone (GH)-secreting pituitary tumors (GHomas) are the most common acromegaly cause. At diagnosis, most of them are macroadenomas, and up to 56% display cavernous sinus invasion. Biomarker assessment associated with tumor growth and invasion is important to optimize their management. Objectives: The study aims to identify clinical/hormonal/molecular biomarkers associated with tumor size and invasiveness in GHomas and to analyze the influence of pre-treatment with somatostatin analogs (SSAs) or dopamine agonists (DAs) in key molecular biomarker expression. Methods: Clinical/analytical/radiological variables were evaluated in 192 patients from the REMAH study (ambispective multicenter post-surgery study of the Spanish Society of Endocrinology and Nutrition). The expression of somatostatin/ghrelin/dopamine system components and key pituitary/proliferation markers was eval
    Keywords: pituitary tumor; curation; combined molecular and clinical biomarkers; transsphenoidal surgery; REMAH study
    Creator: Servigistics Arbortext Advanced Print Publisher 11.1.4546/W-x64
    Producer: PDFlib+PDI 9.0.7p3 (C++/Win64); modified using iTextSharp.LGPLv2.Core 3.7.4.0
    CreationDate: Wed Jun 05 04:42:55 CEST 2024
    ModDate: Wed Jan 14 09:19:01 CET 2026
   ID: 0x4636df7a97d3b3e5c30fef9035b319e0, 0xf0111327354362627a041807576266f1
   Filters: 
    FilterPipeline: FlateDecode
    FilterPipeline: DCTDecode
   Images: 
    Image: 
     NisoImageMetadata: 
      FormatName: image/jpg
      CompressionScheme: JPEG
      ImageWidth: 204
      ImageHeight: 153
      BitsPerSample: 8
      BitsPerSampleUnit: integer
    Image: 
     NisoImageMetadata: 
      FormatName: image/jpg
      CompressionScheme: JPEG
      ImageWidth: 1262
      ImageHeight: 791
      BitsPerSample: 8
      BitsPerSampleUnit: integer
    Image: 
     NisoImageMetadata: 
      FormatName: image/jpg
      CompressionScheme: JPEG
      ImageWidth: 1328
      ImageHeight: 922
      ColorSpace: RGB
      BitsPerSample: 8
      BitsPerSampleUnit: integer
    Image: 
     NisoImageMetadata: 
      FormatName: image/jpg
      CompressionScheme: JPEG
      ImageWidth: 1295
      ImageHeight: 1622
      ColorSpace: RGB
      BitsPerSample: 8
      BitsPerSampleUnit: integer
    Image: 
     NisoImageMetadata: 
      FormatName: image/jpg
      CompressionScheme: JPEG
      ImageWidth: 1328
      ImageHeight: 794
      ColorSpace: RGB
      BitsPerSample: 8
      BitsPerSampleUnit: integer
   Fonts: 
    Type1: 
     Font: 
      BaseFont: WNQLEB+UniversLTStd-CnObl
      FontSubset: true
      FirstChar: 1
      LastChar: 17
      FontDescriptor: 
       FontName: WNQLEB+UniversLTStd-CnObl
       Flags: Nonsymbolic, Italic
       FontBBox: -172, -270, 1064, 989
       FontFile3: true
      EncodingDictionary: 
       BaseEncoding: WinAnsiEncoding
       Differences: true
      ToUnicode: true
     Font: 
      BaseFont: QGPKQT+UniversLTStd-BoldCn
      FontSubset: true
      FirstChar: 1
      LastChar: 23
      FontDescriptor: 
       FontName: QGPKQT+UniversLTStd-BoldCn
       Flags: Nonsymbolic, ForceBold
       FontBBox: -83, -250, 1000, 969
       FontFile3: true
      EncodingDictionary: 
       BaseEncoding: WinAnsiEncoding
       Differences: true
      ToUnicode: true
     Font: 
      BaseFont: IGBOIC+UniversLTStd-Cn
      FontSubset: true
      FirstChar: 1
      LastChar: 73
      FontDescriptor: 
       FontName: IGBOIC+UniversLTStd-Cn
       Flags: Nonsymbolic
       FontBBox: -166, -250, 1000, 989
       FontFile3: true
      EncodingDictionary: 
       BaseEncoding: WinAnsiEncoding
       Differences: true
      ToUnicode: true
     Font: 
      BaseFont: NQBKBM+UniversLTStd-Obl
      FontSubset: true
      FirstChar: 1
      LastChar: 19
      FontDescriptor: 
       FontName: NQBKBM+UniversLTStd-Obl
       Flags: Nonsymbolic, Italic
       FontBBox: -174, -272, 1145, 947
       FontFile3: true
      EncodingDictionary: 
       BaseEncoding: WinAnsiEncoding
       Differences: true
      ToUnicode: true
     Font: 
      BaseFont: GRNPFF+UniversLTStd
      FontSubset: true
      FirstChar: 1
      LastChar: 48
      FontDescriptor: 
       FontName: GRNPFF+UniversLTStd
       Flags: Nonsymbolic
       FontBBox: -168, -250, 992, 947
       FontFile3: true
      EncodingDictionary: 
       BaseEncoding: WinAnsiEncoding
       Differences: true
      ToUnicode: true
     Font: 
      BaseFont: OHGDKI+SourceSansPro-Regular
      FontSubset: true
      FirstChar: 1
      LastChar: 1
      FontDescriptor: 
       FontName: OHGDKI+SourceSansPro-Regular
       Flags: Nonsymbolic
       FontBBox: -192, -323, 1160, 952
       FontFile3: true
      EncodingDictionary: 
       BaseEncoding: WinAnsiEncoding
       Differences: true
      ToUnicode: true
     Font: 
      BaseFont: SKJJWW+UniversLTStd-Bold
      FontSubset: true
      FirstChar: 1
      LastChar: 75
      FontDescriptor: 
       FontName: SKJJWW+UniversLTStd-Bold
       Flags: Nonsymbolic, ForceBold
       FontBBox: -167, -250, 995, 938
       FontFile3: true
      EncodingDictionary: 
       BaseEncoding: WinAnsiEncoding
       Differences: true
      ToUnicode: true
     Font: 
      BaseFont: GHRCHU+UniversLTStd-Light
      FontSubset: true
      FirstChar: 1
      LastChar: 68
      FontDescriptor: 
       FontName: GHRCHU+UniversLTStd-Light
       Flags: Nonsymbolic
       FontBBox: -151, -250, 1000, 957
       FontFile3: true
      EncodingDictionary: 
       BaseEncoding: WinAnsiEncoding
       Differences: true
      ToUnicode: true
     Font: 
      BaseFont: CMNJUW+UniversLTStd-LightObl
      FontSubset: true
      FirstChar: 1
      LastChar: 19
      FontDescriptor: 
       FontName: CMNJUW+UniversLTStd-LightObl
       Flags: Nonsymbolic, Italic
       FontBBox: -151, -274, 1144, 957
       FontFile3: true
      EncodingDictionary: 
       BaseEncoding: WinAnsiEncoding
       Differences: true
      ToUnicode: true
     Font: 
      BaseFont: WILIVQ+STIXGeneral-Regular
      FontSubset: true
      FirstChar: 1
      LastChar: 7
      FontDescriptor: 
       FontName: WILIVQ+STIXGeneral-Regular
       Flags: Nonsymbolic
       FontBBox: -995, -455, 2000, 1055
       FontFile3: true
      EncodingDictionary: 
       BaseEncoding: WinAnsiEncoding
       Differences: true
      ToUnicode: true
     Font: 
      BaseFont: ZBRDQL+UniversLTStd-Black
      FontSubset: true
      FirstChar: 1
      LastChar: 8
      FontDescriptor: 
       FontName: ZBRDQL+UniversLTStd-Black
       Flags: Nonsymbolic, ForceBold
       FontBBox: -153, -250, 992, 986
       FontFile3: true
      EncodingDictionary: 
       BaseEncoding: WinAnsiEncoding
       Differences: true
      ToUnicode: true
     Font: 
      BaseFont: CNBIJC+SabonLTStd-Roman
      FontSubset: true
      FirstChar: 1
      LastChar: 99
      FontDescriptor: 
       FontName: CNBIJC+SabonLTStd-Roman
       Flags: Nonsymbolic
       FontBBox: -165, -228, 1000, 944
       FontFile3: true
      EncodingDictionary: 
       BaseEncoding: WinAnsiEncoding
       Differences: true
      ToUnicode: true
     Font: 
      BaseFont: IKCMGU+SabonLTStd-Bold
      FontSubset: true
      FirstChar: 1
      LastChar: 48
      FontDescriptor: 
       FontName: IKCMGU+SabonLTStd-Bold
       Flags: Nonsymbolic, ForceBold
       FontBBox: -163, -228, 1000, 968
       FontFile3: true
      EncodingDictionary: 
       BaseEncoding: WinAnsiEncoding
       Differences: true
      ToUnicode: true
     Font: 
      BaseFont: GQJPLG+SabonLTStd-Italic
      FontSubset: true
      FirstChar: 1
      LastChar: 57
      FontDescriptor: 
       FontName: GQJPLG+SabonLTStd-Italic
       Flags: Nonsymbolic, Italic
       FontBBox: -146, -228, 1059, 927
       FontFile3: true
      EncodingDictionary: 
       BaseEncoding: WinAnsiEncoding
       Differences: true
      ToUnicode: true
     Font: 
      BaseFont: MYOQMC+SabonLTStd-BoldItalic
      FontSubset: true
      FirstChar: 1
      LastChar: 1
      FontDescriptor: 
       FontName: MYOQMC+SabonLTStd-BoldItalic
       Flags: Nonsymbolic, Italic, ForceBold
       FontBBox: -147, -238, 1080, 955
       FontFile3: true
      EncodingDictionary: 
       BaseEncoding: WinAnsiEncoding
       Differences: true
      ToUnicode: true
    TrueType: 
     Font: 
      BaseFont: ILGJOM+ArialMT
      FontSubset: true
      FirstChar: 32
      LastChar: 121
      FontDescriptor: 
       FontName: ILGJOM+ArialMT
       Flags: Nonsymbolic
       FontBBox: -664, -324, 2000, 1039
       FontFile2: true
      Encoding: WinAnsiEncoding
   XMP: <x:xmpmeta xmlns:x="adobe:ns:meta/" x:xmptk="Adobe XMP Core 5.4-c006 80.159825, 2016/09/16-03:31:08        ">
   <rdf:RDF xmlns:rdf="http://www.w3.org/1999/02/22-rdf-syntax-ns#">
      <rdf:Description rdf:about="" xmlns:xmpMM="http://ns.adobe.com/xap/1.0/mm/" xmlns:xmpRights="http://ns.adobe.com/xap/1.0/rights/" xmlns:pdf="http://ns.adobe.com/pdf/1.3/" xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:prism="http://prismstandard.org/namespaces/basic/2.0/" xmlns:xmp="http://ns.adobe.com/xap/1.0/" xmlns:pdfx="http://ns.adobe.com/pdfx/1.3/" xmlns:pdfuaid="http://www.aiim.org/pdfua/ns/id/" xmlns:pdfaExtension="http://www.aiim.org/pdfa/ns/extension/" xmlns:pdfaSchema="http://www.aiim.org/pdfa/ns/schema#" xmlns:pdfaProperty="http://www.aiim.org/pdfa/ns/property#">
         <xmpMM:InstanceID>uuid:fe22d8bf-b7bf-40a2-82cf-5798331388fa</xmpMM:InstanceID>
         <xmpMM:DocumentID>uuid:BC0EC4CB-3CE3-C942-D0F9-62944547F7D5</xmpMM:DocumentID>
         <xmpRights:Marked>True</xmpRights:Marked>
         <pdf:Keywords>pituitary tumor; curation; combined molecular and clinical biomarkers; transsphenoidal surgery; REMAH study</pdf:Keywords>
         <pdf:Producer>PDFlib+PDI 9.0.7p3 (C++/Win64); modified using iTextSharp.LGPLv2.Core 3.7.4.0</pdf:Producer>
         <dc:format>application/pdf</dc:format>
         <dc:identifier>10.1093/ejendo/lvae045</dc:identifier>
         <dc:lang>en</dc:lang>
         <dc:publisher>
            <rdf:Bag>
               <rdf:li>Oxford University Press</rdf:li>
            </rdf:Bag>
         </dc:publisher>
         <dc:title>
            <rdf:Alt>
               <rdf:li xml:lang="x-default">Integrative clinical, hormonal, and molecular data associate with invasiveness in acromegaly: REMAH study</rdf:li>
            </rdf:Alt>
         </dc:title>
         <dc:creator>
            <rdf:Seq>
               <rdf:li>Miguel Sampedro-Nuñez</rdf:li>
               <rdf:li>Aura Dulcinea Herrera-Martínez</rdf:li>
               <rdf:li>Alejandro Ibáñez-Costa</rdf:li>
               <rdf:li>Esther Rivero-Cortés</rdf:li>
               <rdf:li>Eva Venegas</rdf:li>
               <rdf:li>Mercedes Robledo</rdf:li>
               <rdf:li>Rebeca Martínez-Hernández</rdf:li>
               <rdf:li>Araceli García-Martínez</rdf:li>
               <rdf:li>Joan Gil</rdf:li>
               <rdf:li>Mireia Jordà</rdf:li>
               <rdf:li>Judith López-Fernández</rdf:li>
               <rdf:li>Inmaculada Gavilán</rdf:li>
               <rdf:li>Silvia Maraver</rdf:li>
               <rdf:li>Montserrat Marqués-Pamies</rdf:li>
               <rdf:li>Rosa Cámara</rdf:li>
               <rdf:li>Carmen Fajardo-Montañana</rdf:li>
               <rdf:li>Elena Valassi</rdf:li>
               <rdf:li>Elena Dios</rdf:li>
               <rdf:li>Anna Aulinas</rdf:li>
               <rdf:li>Betina Biagetti</rdf:li>
               <rdf:li>Cristina Álvarez Escola</rdf:li>
               <rdf:li>Marta Araujo-Castro</rdf:li>
               <rdf:li>Concepción Blanco</rdf:li>
               <rdf:li>de Miguel Paz</rdf:li>
               <rdf:li>Rocío Villar-Taibo</rdf:li>
               <rdf:li>Clara V. Álvarez</rdf:li>
               <rdf:li>Sonia Gaztambide</rdf:li>
               <rdf:li>Susan M. Webb</rdf:li>
               <rdf:li>Luis Castaño</rdf:li>
               <rdf:li>Ignacio Bernabéu</rdf:li>
               <rdf:li>Antonio Picó</rdf:li>
               <rdf:li>María-Ángeles Gálvez</rdf:li>
               <rdf:li>Alfonso Soto-Moreno</rdf:li>
               <rdf:li>Manel Puig-Domingo</rdf:li>
               <rdf:li>Justo P. Castaño</rdf:li>
               <rdf:li>Mónica Marazuela</rdf:li>
               <rdf:li>Raúl M. Luque</rdf:li>
            </rdf:Seq>
         </dc:creator>
         <dc:description>
            <rdf:Alt>
               <rdf:li xml:lang="x-default">DOI: 10.1093/ejendo/lvae045; European Journal of Endocrinology, 190, 6, 2024-5-3.; Abstract:  Introduction: Growth hormone (GH)-secreting pituitary tumors (GHomas) are the most common acromegaly cause. At diagnosis, most of them are macroadenomas, and up to 56% display cavernous sinus invasion. Biomarker assessment associated with tumor growth and invasion is important to optimize their management. Objectives: The study aims to identify clinical/hormonal/molecular biomarkers associated with tumor size and invasiveness in GHomas and to analyze the influence of pre-treatment with somatostatin analogs (SSAs) or dopamine agonists (DAs) in key molecular biomarker expression. Methods: Clinical/analytical/radiological variables were evaluated in 192 patients from the REMAH study (ambispective multicenter post-surgery study of the Spanish Society of Endocrinology and Nutrition). The expression of somatostatin/ghrelin/dopamine system components and key pituitary/proliferation markers was eval</rdf:li>
            </rdf:Alt>
         </dc:description>
         <dc:rights>
            <rdf:Alt>
               <rdf:li xml:lang="x-default">© The Author(s) 2024. Published by Oxford University Press on behalf of European Society of Endocrinology.</rdf:li>
            </rdf:Alt>
         </dc:rights>
         <dc:subject>
            <rdf:Bag>
               <rdf:li>pituitary tumor</rdf:li>
               <rdf:li>curation</rdf:li>
               <rdf:li>combined molecular and clinical biomarkers</rdf:li>
               <rdf:li>transsphenoidal surgery</rdf:li>
               <rdf:li>REMAH study</rdf:li>
            </rdf:Bag>
         </dc:subject>
         <prism:aggregationType>Journal</prism:aggregationType>
         <prism:publicationName>European Journal of Endocrinology</prism:publicationName>
         <prism:copyright>© The Author(s) 2024. Published by Oxford University Press on behalf of European Society of Endocrinology.</prism:copyright>
         <prism:issn>0804-4643</prism:issn>
         <prism:elssn>1479-683X</prism:elssn>
         <prism:volume>190</prism:volume>
         <prism:number>6</prism:number>
         <prism:issueName />
         <prism:startingPage>421</prism:startingPage>
         <prism:endingPage>433</prism:endingPage>
         <prism:doi>10.1093/ejendo/lvae045</prism:doi>
         <prism:url>https://doi.org/10.1093/ejendo/lvae045</prism:url>
         <xmp:CreateDate>2024-06-05T07:42:55+05:30</xmp:CreateDate>
         <xmp:ModifyDate>2026-01-14T08:19:01+00:00</xmp:ModifyDate>
         <xmp:CreatorTool>Servigistics Arbortext Advanced Print Publisher 11.1.4546/W-x64</xmp:CreatorTool>
         <xmp:MetadataDate>2026-01-14T08:19:01+00:00</xmp:MetadataDate>
         <pdfx:EPSprocessor>PStill version 1.84.42</pdfx:EPSprocessor>
         <pdfuaid:part>1</pdfuaid:part>
         <pdfaExtension:schemas>
            <rdf:Bag>
               <rdf:li rdf:parseType="Resource">
                  <pdfaSchema:schema>PDF/UA Universal Accessibility Schema</pdfaSchema:schema>
                  <pdfaSchema:namespaceURI>http://www.aiim.org/pdfua/ns/id/</pdfaSchema:namespaceURI>
                  <pdfaSchema:prefix>pdfuaid</pdfaSchema:prefix>
                  <pdfaSchema:property>
                     <rdf:Seq>
                        <rdf:li rdf:parseType="Resource">
                           <pdfaProperty:name>part</pdfaProperty:name>
                           <pdfaProperty:valueType>Integer</pdfaProperty:valueType>
                           <pdfaProperty:category>internal</pdfaProperty:category>
                           <pdfaProperty:description>Indicates, which part of ISO 14289 standard is followed</pdfaProperty:description>
                        </rdf:li>
                     </rdf:Seq>
                  </pdfaSchema:property>
               </rdf:li>
            </rdf:Bag>
         </pdfaExtension:schemas>
      </rdf:Description>
   </rdf:RDF>
</x:xmpmeta>
   Pages: 
    Page: 
     Sequence: 1
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 181, 626, 186, 637
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 188, 626, 193, 637
       Flags: Print
       Destination: null
      Annotation: 
       Subtype: Link
       Rect: 364, 626, 369, 637
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 371, 626, 376, 637
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 378, 626, 383, 637
       Flags: Print
       Destination: null
      Annotation: 
       Subtype: Link
       Rect: 383, 623, 393, 633
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 520, 626, 525, 637
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 527, 626, 532, 637
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 534, 626, 538, 637
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 541, 626, 545, 637
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 548, 626, 552, 637
       Flags: Print
       Destination: null
      Annotation: 
       Subtype: Link
       Rect: 159, 611, 164, 622
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 166, 611, 170, 622
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 244, 611, 248, 622
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 352, 611, 356, 622
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 356, 608, 366, 618
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 520, 611, 524, 622
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 174, 596, 178, 607
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 228, 596, 237, 607
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 309, 596, 318, 607
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 450, 596, 460, 607
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 154, 581, 163, 592
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 245, 581, 254, 592
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 409, 581, 418, 592
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 418, 579, 428, 588
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 504, 581, 513, 592
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 197, 566, 207, 577
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 282, 566, 291, 577
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 352, 566, 361, 577
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 437, 566, 446, 577
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 530, 566, 539, 577
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 170, 551, 179, 562
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 292, 551, 301, 562
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 301, 549, 311, 558
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 417, 551, 426, 562
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 506, 551, 515, 562
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 144, 536, 153, 547
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 242, 536, 251, 547
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 353, 536, 363, 547
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 363, 533, 372, 543
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 461, 536, 470, 547
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 543, 536, 552, 547
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 142, 521, 151, 532
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 224, 521, 234, 532
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 236, 521, 245, 532
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 247, 521, 256, 532
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 377, 521, 382, 532
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 384, 521, 388, 532
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 508, 521, 512, 532
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 161, 506, 171, 517
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 265, 506, 269, 517
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 272, 506, 276, 517
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 278, 506, 283, 517
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 285, 506, 290, 517
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 298, 506, 303, 517
       Flags: Print
       Destination: null
      Annotation: 
       Subtype: Link
       Rect: 303, 504, 313, 513
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 415, 506, 420, 517
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 428, 506, 433, 517
       Flags: Print
       Destination: null
      Annotation: 
       Subtype: Link
       Rect: 433, 504, 443, 513
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 146, 491, 150, 502
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 152, 491, 157, 502
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 159, 491, 164, 502
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 166, 491, 171, 502
       Flags: Print
       Destination: 1024
      Annotation: 
       Subtype: Link
       Rect: 179, 491, 184, 502
       Flags: Print
       Destination: null
      Annotation: 
       Subtype: Link
       Rect: 387, 491, 392, 502
       Flags: Print
       Destination: null
      Annotation: 
       Subtype: Link
       Rect: 392, 488, 402, 498
       Flags: Print
    Page: 
     Sequence: 2
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 408, 717, 468, 725
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 62, 699, 176, 707
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 475, 699, 517, 707
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 192, 268, 195, 277
       Flags: Print
       Destination: 83
      Annotation: 
       Subtype: Link
       Rect: 202, 222, 206, 231
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 249, 198, 253, 208
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 243, 164, 252, 173
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 281, 152, 285, 161
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 419, 307, 423, 316
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 425, 307, 429, 316
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 468, 296, 472, 305
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 474, 296, 477, 305
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 348, 261, 366, 271
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 480, 204, 487, 213
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 476, 169, 484, 179
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 485, 169, 493, 179
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 317, 146, 324, 156
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 453, 66, 547, 73
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 42, 56, 101, 64
       Flags: Print
    Page: 
     Sequence: 3
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 94, 712, 101, 722
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 174, 657, 191, 667
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 107, 624, 115, 634
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 117, 624, 124, 634
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 101, 536, 109, 546
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 283, 250, 291, 259
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 337, 411, 371, 420
       Flags: Print
       Destination: 51
      Annotation: 
       Subtype: Link
       Rect: 390, 411, 395, 420
       Flags: Print
       Destination: 56
      Annotation: 
       Subtype: Link
       Rect: 400, 393, 403, 403
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 312, 312, 346, 321
       Flags: Print
       Destination: 51
      Annotation: 
       Subtype: Link
       Rect: 365, 312, 370, 321
       Flags: Print
       Destination: 56
    Page: 
     Sequence: 4
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 275, 372, 283, 381
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 278, 162, 285, 171
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 504, 405, 512, 414
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 439, 383, 446, 392
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 539, 361, 547, 370
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 509, 258, 544, 267
       Flags: Print
    Page: 
     Sequence: 5
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 274, 635, 281, 645
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 283, 635, 291, 645
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 129, 525, 136, 535
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 517, 590, 552, 599
       Flags: Print
       Destination: 51
      Annotation: 
       Subtype: Link
       Rect: 329, 579, 334, 588
       Flags: Print
       Destination: 56
      Annotation: 
       Subtype: Link
       Rect: 506, 465, 547, 474
       Flags: Print
       Destination: 59
      Annotation: 
       Subtype: Link
       Rect: 391, 443, 456, 452
       Flags: Print
       Destination: 59
      Annotation: 
       Subtype: Link
       Rect: 341, 410, 403, 419
       Flags: Print
       Destination: 59
      Annotation: 
       Subtype: Link
       Rect: 312, 377, 384, 386
       Flags: Print
       Destination: 59
    Page: 
     Sequence: 6
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 90, 338, 119, 347
       Flags: Print
       Destination: 56
      Annotation: 
       Subtype: Link
       Rect: 151, 316, 185, 325
       Flags: Print
       Destination: 51
      Annotation: 
       Subtype: Link
       Rect: 208, 316, 213, 325
       Flags: Print
       Destination: 56
      Annotation: 
       Subtype: Link
       Rect: 222, 305, 252, 314
       Flags: Print
       Destination: 65
      Annotation: 
       Subtype: Link
       Rect: 145, 180, 184, 189
       Flags: Print
       Destination: 68
      Annotation: 
       Subtype: Link
       Rect: 45, 158, 84, 167
       Flags: Print
       Destination: 68
      Annotation: 
       Subtype: Link
       Rect: 240, 147, 283, 156
       Flags: Print
       Destination: 68
      Annotation: 
       Subtype: Link
       Rect: 352, 530, 384, 539
       Flags: Print
       Destination: 72
      Annotation: 
       Subtype: Link
       Rect: 353, 519, 387, 528
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 395, 475, 426, 484
       Flags: Print
       Destination: 76
      Annotation: 
       Subtype: Link
       Rect: 349, 464, 379, 473
       Flags: Print
       Destination: 76
      Annotation: 
       Subtype: Link
       Rect: 303, 343, 338, 352
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 425, 310, 493, 319
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 369, 255, 404, 264
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 306, 180, 344, 189
       Flags: Print
       Destination: 76
      Annotation: 
       Subtype: Link
       Rect: 358, 125, 396, 134
       Flags: Print
       Destination: 76
    Page: 
     Sequence: 7
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 274, 250, 291, 259
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 233, 228, 241, 237
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 243, 228, 250, 237
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 165, 206, 173, 215
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 117, 162, 121, 171
       Flags: Print
       Destination: 83
      Annotation: 
       Subtype: Link
       Rect: 123, 162, 140, 171
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 356, 305, 364, 314
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 366, 305, 383, 314
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 541, 261, 548, 270
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 426, 151, 430, 160
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 432, 151, 440, 160
       Flags: Print
       Destination: 90
      Annotation: 
       Subtype: Link
       Rect: 442, 151, 450, 160
       Flags: Print
       Destination: 90
      Annotation: 
       Subtype: Link
       Rect: 365, 107, 373, 116
       Flags: Print
       Destination: 90
      Annotation: 
       Subtype: Link
       Rect: 375, 107, 383, 116
       Flags: Print
       Destination: 90
      Annotation: 
       Subtype: Link
       Rect: 385, 107, 393, 116
       Flags: Print
       Destination: 90
      Annotation: 
       Subtype: Link
       Rect: 427, 85, 435, 94
       Flags: Print
       Destination: 90
      Annotation: 
       Subtype: Link
       Rect: 437, 85, 445, 94
       Flags: Print
       Destination: 90
      Annotation: 
       Subtype: Link
       Rect: 481, 63, 489, 72
       Flags: Print
       Destination: 90
      Annotation: 
       Subtype: Link
       Rect: 377, 41, 385, 50
       Flags: Print
       Destination: 90
    Page: 
     Sequence: 8
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 69, 63, 76, 72
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 78, 63, 86, 72
       Flags: Print
       Destination: 90
      Annotation: 
       Subtype: Link
       Rect: 87, 63, 95, 72
       Flags: Print
       Destination: 90
      Annotation: 
       Subtype: Link
       Rect: 278, 52, 285, 61
       Flags: Print
       Destination: 90
      Annotation: 
       Subtype: Link
       Rect: 403, 41, 410, 50
       Flags: Print
       Destination: 90
    Page: 
     Sequence: 9
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 190, 261, 197, 270
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 234, 195, 242, 204
       Flags: Print
       Destination: 90
      Annotation: 
       Subtype: Link
       Rect: 118, 162, 126, 171
       Flags: Print
       Destination: 90
      Annotation: 
       Subtype: Link
       Rect: 265, 129, 273, 138
       Flags: Print
       Destination: 90
      Annotation: 
       Subtype: Link
       Rect: 426, 261, 434, 270
       Flags: Print
       Destination: 90
      Annotation: 
       Subtype: Link
       Rect: 371, 195, 389, 204
       Flags: Print
       Destination: 90
      Annotation: 
       Subtype: Link
       Rect: 450, 96, 467, 105
       Flags: Print
       Destination: 90
      Annotation: 
       Subtype: Link
       Rect: 481, 41, 489, 50
       Flags: Print
       Destination: 87
    Page: 
     Sequence: 10
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 199, 690, 206, 700
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 208, 690, 216, 700
       Flags: Print
       Destination: 90
      Annotation: 
       Subtype: Link
       Rect: 217, 690, 225, 700
       Flags: Print
       Destination: 90
      Annotation: 
       Subtype: Link
       Rect: 142, 679, 149, 689
       Flags: Print
       Destination: 90
      Annotation: 
       Subtype: Link
       Rect: 268, 668, 285, 678
       Flags: Print
       Destination: 90
      Annotation: 
       Subtype: Link
       Rect: 226, 657, 234, 667
       Flags: Print
       Destination: 87
      Annotation: 
       Subtype: Link
       Rect: 236, 657, 243, 667
       Flags: Print
       Destination: 90
      Annotation: 
       Subtype: Link
       Rect: 245, 657, 252, 667
       Flags: Print
       Destination: 90
      Annotation: 
       Subtype: Link
       Rect: 254, 657, 262, 667
       Flags: Print
       Destination: 90
      Annotation: 
       Subtype: Link
       Rect: 268, 547, 285, 557
       Flags: Print
       Destination: 90
      Annotation: 
       Subtype: Link
       Rect: 77, 514, 85, 524
       Flags: Print
       Destination: 90
      Annotation: 
       Subtype: Link
       Rect: 197, 470, 205, 480
       Flags: Print
       Destination: 90
      Annotation: 
       Subtype: Link
       Rect: 239, 338, 247, 348
       Flags: Print
       Destination: 90
      Annotation: 
       Subtype: Link
       Rect: 248, 338, 256, 348
       Flags: Print
       Destination: 90
      Annotation: 
       Subtype: Link
       Rect: 303, 703, 399, 712
       Flags: Print
    Page: 
     Sequence: 11
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 309, 47, 313, 55
       Flags: Print
       Destination: 31
    Page: 
     Sequence: 12
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 224, 710, 285, 718
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 56, 700, 166, 708
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 42, 690, 46, 698
       Flags: Print
       Destination: 31
      Annotation: 
       Subtype: Link
       Rect: 224, 650, 285, 658
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 56, 640, 117, 648
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 42, 630, 46, 638
       Flags: Print
       Destination: 31
      Annotation: 
       Subtype: Link
       Rect: 147, 620, 282, 628
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 42, 610, 46, 618
       Flags: Print
       Destination: 31
      Annotation: 
       Subtype: Link
       Rect: 160, 580, 285, 588
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 56, 570, 81, 578
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 42, 560, 46, 568
       Flags: Print
       Destination: 31
      Annotation: 
       Subtype: Link
       Rect: 139, 519, 285, 527
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 56, 509, 85, 517
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 42, 499, 46, 507
       Flags: Print
       Destination: 31
      Annotation: 
       Subtype: Link
       Rect: 176, 479, 285, 487
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 56, 469, 81, 477
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 42, 459, 46, 467
       Flags: Print
       Destination: 31
      Annotation: 
       Subtype: Link
       Rect: 145, 439, 272, 447
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 42, 429, 46, 437
       Flags: Print
       Destination: 31
      Annotation: 
       Subtype: Link
       Rect: 224, 409, 285, 417
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 56, 399, 121, 407
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 42, 389, 46, 397
       Flags: Print
       Destination: 31
      Annotation: 
       Subtype: Link
       Rect: 235, 379, 285, 387
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 56, 369, 135, 377
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 42, 359, 51, 367
       Flags: Print
       Destination: 31
      Annotation: 
       Subtype: Link
       Rect: 143, 328, 284, 337
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 42, 319, 51, 327
       Flags: Print
       Destination: 31
      Annotation: 
       Subtype: Link
       Rect: 131, 288, 264, 296
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 42, 278, 51, 286
       Flags: Print
       Destination: 31
      Annotation: 
       Subtype: Link
       Rect: 262, 258, 285, 266
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 56, 248, 184, 256
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 42, 238, 51, 246
       Flags: Print
       Destination: 31
      Annotation: 
       Subtype: Link
       Rect: 204, 198, 285, 206
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 56, 188, 125, 196
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 42, 178, 51, 186
       Flags: Print
       Destination: 31
      Annotation: 
       Subtype: Link
       Rect: 135, 148, 261, 156
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 42, 138, 51, 146
       Flags: Print
       Destination: 31
      Annotation: 
       Subtype: Link
       Rect: 135, 117, 285, 126
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 42, 108, 51, 115
       Flags: Print
       Destination: 51
      Annotation: 
       Subtype: Link
       Rect: 249, 97, 285, 105
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 56, 87, 169, 95
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 42, 77, 51, 85
       Flags: Print
       Destination: 51
      Annotation: 
       Subtype: Link
       Rect: 56, 57, 227, 65
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 42, 47, 51, 55
       Flags: Print
       Destination: 51
      Annotation: 
       Subtype: Link
       Rect: 360, 710, 515, 718
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 303, 700, 312, 708
       Flags: Print
       Destination: 51
      Annotation: 
       Subtype: Link
       Rect: 350, 670, 498, 678
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 303, 660, 312, 668
       Flags: Print
       Destination: 51
      Annotation: 
       Subtype: Link
       Rect: 438, 640, 547, 648
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 318, 630, 367, 638
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 303, 620, 312, 628
       Flags: Print
       Destination: 51
      Annotation: 
       Subtype: Link
       Rect: 485, 600, 547, 608
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 318, 590, 411, 598
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 303, 580, 312, 588
       Flags: Print
       Destination: 51
      Annotation: 
       Subtype: Link
       Rect: 485, 550, 547, 558
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 318, 540, 415, 547
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 303, 530, 312, 538
       Flags: Print
       Destination: 56
      Annotation: 
       Subtype: Link
       Rect: 465, 499, 547, 507
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 318, 489, 421, 497
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 303, 479, 312, 487
       Flags: Print
       Destination: 56
      Annotation: 
       Subtype: Link
       Rect: 394, 459, 545, 467
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 303, 449, 312, 457
       Flags: Print
       Destination: 59
      Annotation: 
       Subtype: Link
       Rect: 303, 419, 312, 427
       Flags: Print
       Destination: 59
      Annotation: 
       Subtype: Link
       Rect: 440, 399, 547, 407
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 318, 389, 387, 397
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 303, 379, 312, 387
       Flags: Print
       Destination: 68
      Annotation: 
       Subtype: Link
       Rect: 485, 359, 547, 367
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 318, 349, 378, 357
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 303, 339, 312, 347
       Flags: Print
       Destination: 68
      Annotation: 
       Subtype: Link
       Rect: 418, 319, 544, 327
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 303, 309, 312, 317
       Flags: Print
       Destination: 68
      Annotation: 
       Subtype: Link
       Rect: 351, 278, 484, 286
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 303, 268, 312, 276
       Flags: Print
       Destination: 68
      Annotation: 
       Subtype: Link
       Rect: 318, 238, 500, 246
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 303, 228, 312, 236
       Flags: Print
       Destination: 68
      Annotation: 
       Subtype: Link
       Rect: 388, 208, 535, 216
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 303, 198, 312, 206
       Flags: Print
       Destination: 68
      Annotation: 
       Subtype: Link
       Rect: 461, 168, 547, 176
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 318, 158, 385, 166
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 303, 148, 312, 156
       Flags: Print
       Destination: 68
      Annotation: 
       Subtype: Link
       Rect: 447, 118, 547, 126
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 318, 108, 340, 115
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 303, 98, 312, 106
       Flags: Print
       Destination: 68
      Annotation: 
       Subtype: Link
       Rect: 426, 77, 547, 85
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 318, 67, 342, 75
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 303, 57, 312, 65
       Flags: Print
       Destination: 68
    Page: 
     Sequence: 13
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 254, 720, 291, 728
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 62, 710, 150, 718
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 48, 700, 57, 708
       Flags: Print
       Destination: 68
      Annotation: 
       Subtype: Link
       Rect: 268, 680, 291, 688
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 62, 670, 189, 678
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 48, 660, 57, 668
       Flags: Print
       Destination: 68
      Annotation: 
       Subtype: Link
       Rect: 128, 620, 227, 628
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 48, 610, 57, 618
       Flags: Print
       Destination: 68
      Annotation: 
       Subtype: Link
       Rect: 230, 580, 291, 588
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 62, 570, 127, 578
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 48, 560, 57, 568
       Flags: Print
       Destination: 68
      Annotation: 
       Subtype: Link
       Rect: 145, 520, 291, 528
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 62, 510, 91, 518
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 48, 500, 57, 508
       Flags: Print
       Destination: 68
      Annotation: 
       Subtype: Link
       Rect: 105, 460, 241, 468
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 48, 450, 57, 458
       Flags: Print
       Destination: 68
      Annotation: 
       Subtype: Link
       Rect: 209, 420, 291, 428
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 62, 410, 152, 418
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 48, 400, 57, 408
       Flags: Print
       Destination: 68
      Annotation: 
       Subtype: Link
       Rect: 121, 370, 275, 378
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 48, 360, 57, 368
       Flags: Print
       Destination: 68
      Annotation: 
       Subtype: Link
       Rect: 211, 320, 291, 328
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 62, 310, 106, 318
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 48, 300, 57, 308
       Flags: Print
       Destination: 68
      Annotation: 
       Subtype: Link
       Rect: 62, 270, 194, 278
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 48, 260, 57, 268
       Flags: Print
       Destination: 72
      Annotation: 
       Subtype: Link
       Rect: 209, 220, 291, 228
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 62, 210, 113, 218
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 48, 200, 57, 208
       Flags: Print
       Destination: 72
      Annotation: 
       Subtype: Link
       Rect: 181, 150, 291, 158
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 62, 140, 80, 148
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 48, 130, 57, 138
       Flags: Print
       Destination: 72
      Annotation: 
       Subtype: Link
       Rect: 241, 110, 291, 118
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 62, 100, 171, 108
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 48, 90, 57, 98
       Flags: Print
       Destination: 76
      Annotation: 
       Subtype: Link
       Rect: 146, 60, 281, 68
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 309, 720, 318, 728
       Flags: Print
       Destination: 76
      Annotation: 
       Subtype: Link
       Rect: 428, 700, 552, 708
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 309, 690, 318, 698
       Flags: Print
       Destination: 76
      Annotation: 
       Subtype: Link
       Rect: 398, 670, 548, 678
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 309, 660, 318, 668
       Flags: Print
       Destination: 76
      Annotation: 
       Subtype: Link
       Rect: 529, 640, 552, 648
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 323, 630, 458, 638
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 309, 620, 318, 628
       Flags: Print
       Destination: 76
      Annotation: 
       Subtype: Link
       Rect: 502, 600, 552, 608
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 323, 590, 422, 598
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 309, 580, 318, 588
       Flags: Print
       Destination: 76
      Annotation: 
       Subtype: Link
       Rect: 426, 550, 552, 558
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 323, 540, 372, 548
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 309, 530, 318, 538
       Flags: Print
       Destination: 76
      Annotation: 
       Subtype: Link
       Rect: 411, 490, 539, 498
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 309, 480, 318, 488
       Flags: Print
       Destination: 80
      Annotation: 
       Subtype: Link
       Rect: 366, 460, 501, 468
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 309, 450, 318, 458
       Flags: Print
       Destination: 80
      Annotation: 
       Subtype: Link
       Rect: 398, 420, 526, 428
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 309, 410, 318, 418
       Flags: Print
       Destination: 80
      Annotation: 
       Subtype: Link
       Rect: 421, 370, 549, 378
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 309, 360, 318, 368
       Flags: Print
       Destination: 80
      Annotation: 
       Subtype: Link
       Rect: 323, 330, 451, 338
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 309, 320, 318, 328
       Flags: Print
       Destination: 80
      Annotation: 
       Subtype: Link
       Rect: 382, 290, 537, 298
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 309, 280, 318, 288
       Flags: Print
       Destination: 80
      Annotation: 
       Subtype: Link
       Rect: 425, 260, 552, 268
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 309, 250, 318, 258
       Flags: Print
       Destination: 80
      Annotation: 
       Subtype: Link
       Rect: 376, 210, 504, 218
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 309, 200, 318, 208
       Flags: Print
       Destination: 80
      Annotation: 
       Subtype: Link
       Rect: 529, 180, 552, 188
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 323, 170, 418, 178
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 309, 160, 318, 168
       Flags: Print
       Destination: 80
      Annotation: 
       Subtype: Link
       Rect: 471, 130, 552, 138
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 323, 120, 398, 128
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 309, 110, 318, 118
       Flags: Print
       Destination: 80
      Annotation: 
       Subtype: Link
       Rect: 398, 90, 509, 98
       Flags: Print
      Annotation: 
       Subtype: Link
       Rect: 309, 80, 318, 88
       Flags: Print
       Destination: 80
      Annotation: 
       Subtype: Link
       Rect: 378, 60, 504, 68
       Flags: Print
  Checksum: 6a4a90fc
   Type: CRC32
  Checksum: 96762ac20a957a4c3698cdea806e0141
   Type: MD5
  Checksum: f8772246be0299b366124397111982a7a83bfead
   Type: SHA-1
  Checksum: 4657b7a821adb4ea91610ad73ebab661a50b4d178d2a631f0f215de334b2ee3a
   Type: SHA-256