3605ad699dae6143de3d3e7a9963d4dc pmc_10854799.pdf 248a917fa49c828294d026420970075c4fd0b4c5 pmc_10854799.pdf ea4e69b96fc8634bcf9978051c6737771ce06e9c3f34e57eef813fd265dd8b54 pmc_10854799.pdf Title: Management of Cutaneous Squamous Cell Carcinoma of the Scalp: The Role of Imaging and Therapeutic Approaches Subject: Cutaneous squamous cell carcinoma (cSCC) is the second most common subtype of skin cancer. The scalp is one of the most frequently affected locations and is associated with a higher rate of complications, compared to other locations. In addition, it has a characteristic thickness and anatomical structure that may influence both growth pattern and treatment of primary cSCC; while clinical peripheral margins may be easily achieved during the surgery, vertical excision of the tumor is limited by the skull. Despite having a unique anatomy, current guidelines do not contemplate specific recommendations for scalp cSCC, which leads to inconsistent decision-making in multidisciplinary committees when discussing tumors with high risk factors or with close margins. This article provides specific recommendations for the management of patients with scalp cSCC, based on current evidence, as well as those aspects in which evidence is lacking, pointing out possible future lines of research. Topics addressed include epidemiology, clinical presentation and diagnosis, imaging techniques, surgical and radiation treatments, systemic therapy for advanced cases, and follow-up. The primary focus of this review is on management of primary cSCC of the scalp with localized disease, although where relevant, some points about recurrent cSCCs or advanced disease cases are also discussed. Keywords: squamous cell carcinoma; cutaneous squamous cell carcinoma; scalp; head and neck; treatment; management; surgery; margins; recurrence; imaging Author: Júlia Verdaguer-Faja, Agustí Toll, Aram Boada, Álvaro Guerra-Amor, Carla Ferrándiz-Pulido and Ane Jaka Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Sun Feb 4 08:44:56 2024 CET ModDate: Sun Feb 4 08:57:28 2024 CET Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 24 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 17131473 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- RFRMYN+VnURWPalladioL-Bold Type 1 Custom yes yes yes 10 0 BBAXXJ+VnURWPalladioL Type 1 Custom yes yes yes 16 0 ZZRELB+URWPalladioL-Bold Type 1 Custom yes yes yes 21 0 VFPZCG+URWPalladioL-Roma Type 1 Custom yes yes yes 27 0 BKLQBH+URWPalladioL-Ital Type 1 Custom yes yes yes 32 0 LCJEVJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 49 0 CCGMBL+CMSY10 Type 1 Builtin yes yes yes 66 0 GPJOEJ+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 77 0 GPJOFK+PalatinoLinotype CID TrueType Identity-H yes yes yes 80 0 GPJOFL+PalatinoLinotype TrueType WinAnsi yes yes no 86 0 GPJOFN+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 89 0 GPJONL+PalatinoLinotype TrueType MacRoman yes yes no 92 0 GPJOEJ+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 102 0 GPJOFK+PalatinoLinotype CID TrueType Identity-H yes yes yes 105 0 GPJOFL+PalatinoLinotype TrueType WinAnsi yes yes no 111 0 GPJOFN+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 114 0 GPJONL+PalatinoLinotype TrueType MacRoman yes yes no 117 0 GPJOEJ+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 125 0 GPJOFK+PalatinoLinotype CID TrueType Identity-H yes yes yes 128 0 GPJOFL+PalatinoLinotype TrueType WinAnsi yes yes no 134 0 GPJOFN+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 137 0 GPJONL+PalatinoLinotype TrueType MacRoman yes yes no 140 0 GPJOEJ+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 151 0 GPJOFK+PalatinoLinotype CID TrueType Identity-H yes yes yes 154 0 GPJOFL+PalatinoLinotype TrueType WinAnsi yes yes no 160 0 GPJOFN+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 163 0 GPJONL+PalatinoLinotype TrueType MacRoman yes yes no 166 0 GPJOEJ+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 176 0 GPJOFK+PalatinoLinotype CID TrueType Identity-H yes yes yes 179 0 GPJOFL+PalatinoLinotype TrueType WinAnsi yes yes no 185 0 GPJOFN+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 188 0 GPJONL+PalatinoLinotype TrueType MacRoman yes yes no 191 0 WAVIOZ+wasy7 Type 1 Builtin yes yes yes 201 0 QHMYDZ+wasy8 Type 1 Builtin yes yes yes 209 0 GPJOEJ+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 229 0 GPJOFK+PalatinoLinotype CID TrueType Identity-H yes yes yes 232 0 GPJOFL+PalatinoLinotype TrueType WinAnsi yes yes no 238 0 GPJOFN+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 241 0 GPJONL+PalatinoLinotype TrueType MacRoman yes yes no 244 0 GPJOEJ+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 267 0 GPJOFK+PalatinoLinotype CID TrueType Identity-H yes yes yes 270 0 GPJOFL+PalatinoLinotype TrueType WinAnsi yes yes no 276 0 GPJOFN+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 279 0 GPJONL+PalatinoLinotype TrueType MacRoman yes yes no 282 0 GPJOEJ+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 290 0 GPJOFL+PalatinoLinotype TrueType WinAnsi yes yes no 293 0 GPJOFN+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 296 0 GPJOEJ+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 308 0 GPJOFL+PalatinoLinotype TrueType WinAnsi yes yes no 311 0 GPJOFN+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 314 0 GPJOEJ+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 326 0 GPJOFL+PalatinoLinotype TrueType WinAnsi yes yes no 329 0 GPJOFN+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 332 0 LDHCMG+VnURWPalladioL-Italic Type 1 Custom yes yes yes 351 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2024-06-06 02:43:30 CEST RepresentationInformation: pmc_10854799.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2024-05-31 06:26:45 CEST Size: 17131473 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 979 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Children: Item: Title: Cutaneous Squamous Cell Carcinoma Destination: subsection.1.1 Item: Title: Staging System in Cutaneous Squamous Cell Carcinoma Destination: subsection.1.2 Item: Title: Cutaneous Squamous Cell Carcinoma of the Scalp Destination: section.2 Children: Item: Title: The Scalp: A Special Location Destination: subsection.2.1 Item: Title: Scalp Anatomy Destination: subsection.2.2 Item: Title: Clinical Presentation and Diagnosis Destination: subsection.2.3 Item: Title: Clinical and Pathological Risk Factors in Scalp cSCCs Destination: subsection.2.4 Item: Title: Surgical Treatment Destination: section.3 Children: Item: Title: Surgery of the Scalp: Some Initial Considerations Destination: subsection.3.1 Item: Title: Curettage and Electrodesiccation Destination: subsection.3.2 Item: Title: Excision with Postoperative Margin Assessment Destination: subsection.3.3 Item: Title: Histological Margins Destination: subsection.3.4 Item: Title: Mohs Micrographic Surgery or Excision with Complete Circumferential Peripheral and Deep Margin Assessment Destination: subsection.3.5 Item: Title: Reconstructive Approaches on the Scalp Destination: subsection.3.6 Item: Title: Management of Locoregional Disease Destination: section.4 Children: Item: Title: Management of Patients with Satellitosis or In-Transit Metastases Destination: subsection.4.1 Item: Title: Management of Patients with Clinically Detected Lymph Nodes Destination: subsection.4.2 Item: Title: Management of Patients without Clinically Detected Lymph Nodes Destination: subsection.4.3 Item: Title: Non-Surgical Treatment Destination: section.5 Children: Item: Title: Radiation Therapy Destination: subsection.5.1 Item: Title: Systemic Treatment Destination: subsection.5.2 Children: Item: Title: Immunotherapy with Checkpoint Inhibitors Destination: subsubsection.5.2.1 Item: Title: EGFR Inhibitors Destination: subsubsection.5.2.2 Item: Title: Conventional Chemotherapy Destination: subsubsection.5.2.3 Item: Title: Imaging Approach Destination: section.6 Children: Item: Title: The Role of Imaging in Diagnosis and Staging Destination: subsection.6.1 Item: Title: Follow-Up Destination: subsection.6.2 Item: Title: Algorithms for the Management and Treatment of Primary Scalp cSCC with Localized Disease Destination: section.7 Children: Item: Title: Proposed Algorithm for the Initial Management of Primary cSCC of the Scalp Destination: subsection.7.1 Item: Title: Proposed Algorithm for the Management of Histological Margins and Other Histological Features Destination: subsection.7.2 Item: Title: Proposed Algorithm for the Follow-Up of cSCC of the Scalp Destination: subsection.7.3 Item: Title: Conclusions and Future Directions Destination: section.8 Item: Title: References Destination: section.9 Info: Title: Management of Cutaneous Squamous Cell Carcinoma of the Scalp: The Role of Imaging and Therapeutic Approaches Author: Júlia Verdaguer-Faja, Agustí Toll, Aram Boada, Álvaro Guerra-Amor, Carla Ferrándiz-Pulido and Ane Jaka Subject: Cutaneous squamous cell carcinoma (cSCC) is the second most common subtype of skin cancer. The scalp is one of the most frequently affected locations and is associated with a higher rate of complications, compared to other locations. In addition, it has a characteristic thickness and anatomical structure that may influence both growth pattern and treatment of primary cSCC; while clinical peripheral margins may be easily achieved during the surgery, vertical excision of the tumor is limited by the skull. Despite having a unique anatomy, current guidelines do not contemplate specific recommendations for scalp cSCC, which leads to inconsistent decision-making in multidisciplinary committees when discussing tumors with high risk factors or with close margins. This article provides specific recommendations for the management of patients with scalp cSCC, based on current evidence, as well as those aspects in which evidence is lacking, pointing out possible future lines of research. Topics addressed include epidemiology, clinical presentation and diagnosis, imaging techniques, surgical and radiation treatments, systemic therapy for advanced cases, and follow-up. The primary focus of this review is on management of primary cSCC of the scalp with localized disease, although where relevant, some points about recurrent cSCCs or advanced disease cases are also discussed. Keywords: squamous cell carcinoma; cutaneous squamous cell carcinoma; scalp; head and neck; treatment; management; surgery; margins; recurrence; imaging Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Sun Feb 04 08:44:56 CET 2024 ModDate: Sun Feb 04 08:57:28 CET 2024 ID: 0x45840f0e3aa9e05d2b4e39aba9f581c0, 0x45840f0e3aa9e05d2b4e39aba9f581c0 Filters: FilterPipeline: FlateDecode Fonts: Type1: Font: BaseFont: BBAXXJ+VnURWPalladioL FontSubset: true FirstChar: 129 LastChar: 226 FontDescriptor: FontName: BBAXXJ+VnURWPalladioL Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: BKLQBH+URWPalladioL-Ital FontSubset: true FirstChar: 2 LastChar: 216 FontDescriptor: FontName: BKLQBH+URWPalladioL-Ital Flags: Symbolic FontBBox: -170, -305, 1010, 941 FontFile: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: QHMYDZ+wasy8 FontSubset: true FirstChar: 35 LastChar: 35 FontDescriptor: FontName: QHMYDZ+wasy8 Flags: Symbolic FontBBox: -23, -1667, 1827, 755 FontFile: true ToUnicode: true Font: BaseFont: CCGMBL+CMSY10 FontSubset: true FirstChar: 2 LastChar: 21 FontDescriptor: FontName: CCGMBL+CMSY10 Flags: Symbolic FontBBox: -29, -960, 1116, 775 FontFile: true ToUnicode: true Font: BaseFont: ZZRELB+URWPalladioL-Bold FontSubset: true FirstChar: 3 LastChar: 122 FontDescriptor: FontName: ZZRELB+URWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: WAVIOZ+wasy7 FontSubset: true FirstChar: 35 LastChar: 35 FontDescriptor: FontName: WAVIOZ+wasy7 Flags: Symbolic FontBBox: -17, -1667, 1912, 756 FontFile: true ToUnicode: true Font: BaseFont: RFRMYN+VnURWPalladioL-Bold FontSubset: true FirstChar: 129 LastChar: 243 FontDescriptor: FontName: RFRMYN+VnURWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: VFPZCG+URWPalladioL-Roma FontSubset: true FirstChar: 2 LastChar: 252 FontDescriptor: FontName: VFPZCG+URWPalladioL-Roma Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: LDHCMG+VnURWPalladioL-Italic FontSubset: true FirstChar: 161 LastChar: 226 FontDescriptor: FontName: LDHCMG+VnURWPalladioL-Italic Flags: Symbolic FontBBox: -170, -305, 1010, 941 FontFile: true EncodingDictionary: Differences: true ToUnicode: true Pages: Page: Sequence: 1 Annotations: Annotation: Subtype: Link Rect: 34, 281, 152, 290 Annotation: Subtype: Link Rect: 34, 271, 87, 278 Annotation: Subtype: Link Rect: 34, 164, 96, 186 Annotation: Subtype: Link Rect: 125, 90, 154, 99 Annotation: Subtype: Link Rect: 34, 78, 149, 87 Annotation: Subtype: Link Rect: 34, 756, 152, 792 Annotation: Subtype: Link Rect: 515, 756, 560, 792 Annotation: Subtype: Link Rect: 141, 660, 152, 674 Annotation: Subtype: Link Rect: 287, 660, 298, 674 Annotation: Subtype: Link Rect: 532, 660, 543, 674 Annotation: Subtype: Link Rect: 115, 648, 126, 661 Annotation: Subtype: Link Rect: 110, 17, 261, 28 Annotation: Subtype: Link Rect: 410, 17, 560, 28 Annotation: Subtype: Link Rect: 34, 378, 87, 397 Page: Sequence: 2 Annotations: Annotation: Subtype: Link Rect: 297, 689, 304, 698 ActionDest: 339 Annotation: Subtype: Link Rect: 386, 677, 393, 686 ActionDest: 339 Annotation: Subtype: Link Rect: 396, 677, 403, 686 ActionDest: 339 Annotation: Subtype: Link Rect: 339, 664, 346, 673 ActionDest: 339 Annotation: Subtype: Link Rect: 320, 639, 327, 648 ActionDest: 339 Annotation: Subtype: Link Rect: 328, 639, 334, 648 ActionDest: 339 Annotation: Subtype: Link Rect: 335, 639, 342, 648 ActionDest: 339 Annotation: Subtype: Link Rect: 345, 639, 357, 648 ActionDest: 342 Annotation: Subtype: Link Rect: 512, 627, 519, 636 ActionDest: 339 Annotation: Subtype: Link Rect: 519, 627, 526, 636 ActionDest: 339 Annotation: Subtype: Link Rect: 527, 626, 534, 636 ActionDest: 339 Annotation: Subtype: Link Rect: 534, 626, 541, 636 ActionDest: 342 Annotation: Subtype: Link Rect: 544, 627, 556, 636 ActionDest: 342 Annotation: Subtype: Link Rect: 215, 601, 222, 610 ActionDest: 339 Annotation: Subtype: Link Rect: 222, 602, 234, 610 ActionDest: 342 Annotation: Subtype: Link Rect: 235, 601, 247, 610 ActionDest: 342 Annotation: Subtype: Link Rect: 247, 601, 259, 610 ActionDest: 342 Annotation: Subtype: Link Rect: 262, 601, 274, 610 ActionDest: 342 Annotation: Subtype: Link Rect: 471, 589, 478, 598 ActionDest: 339 Annotation: Subtype: Link Rect: 478, 589, 490, 598 ActionDest: 342 Annotation: Subtype: Link Rect: 188, 564, 200, 573 ActionDest: 342 Annotation: Subtype: Link Rect: 201, 564, 213, 573 ActionDest: 342 Annotation: Subtype: Link Rect: 479, 564, 486, 573 ActionDest: 339 Annotation: Subtype: Link Rect: 486, 564, 498, 573 ActionDest: 342 Annotation: Subtype: Link Rect: 499, 564, 511, 573 ActionDest: 342 Annotation: Subtype: Link Rect: 514, 564, 525, 573 ActionDest: 342 Annotation: Subtype: Link Rect: 298, 488, 305, 497 ActionDest: 339 Annotation: Subtype: Link Rect: 305, 488, 312, 497 ActionDest: 339 Annotation: Subtype: Link Rect: 313, 488, 320, 497 ActionDest: 342 Annotation: Subtype: Link Rect: 320, 488, 332, 497 ActionDest: 342 Annotation: Subtype: Link Rect: 335, 488, 347, 497 ActionDest: 342 Annotation: Subtype: Link Rect: 468, 463, 475, 472 ActionDest: 342 Annotation: Subtype: Link Rect: 476, 463, 488, 472 ActionDest: 342 Annotation: Subtype: Link Rect: 488, 463, 500, 472 ActionDest: 342 Annotation: Subtype: Link Rect: 501, 463, 513, 472 ActionDest: 342 Annotation: Subtype: Link Rect: 513, 463, 525, 472 ActionDest: 342 Annotation: Subtype: Link Rect: 526, 463, 538, 472 ActionDest: 342 Annotation: Subtype: Link Rect: 521, 375, 528, 384 ActionDest: 342 Annotation: Subtype: Link Rect: 529, 375, 541, 384 ActionDest: 342 Annotation: Subtype: Link Rect: 544, 375, 556, 384 ActionDest: 342 Annotation: Subtype: Link Rect: 298, 350, 310, 359 ActionDest: 342 Annotation: Subtype: Link Rect: 305, 338, 312, 347 ActionDest: 339 Annotation: Subtype: Link Rect: 313, 337, 319, 347 ActionDest: 342 Annotation: Subtype: Link Rect: 320, 338, 332, 347 ActionDest: 342 Annotation: Subtype: Link Rect: 332, 337, 344, 347 ActionDest: 342 Annotation: Subtype: Link Rect: 347, 337, 359, 347 ActionDest: 342 Annotation: Subtype: Link Rect: 331, 312, 343, 321 ActionDest: 342 Annotation: Subtype: Link Rect: 505, 261, 512, 270 ActionDest: 339 Annotation: Subtype: Link Rect: 512, 261, 519, 270 ActionDest: 339 Annotation: Subtype: Link Rect: 519, 261, 526, 270 ActionDest: 342 Annotation: Subtype: Link Rect: 526, 261, 533, 270 ActionDest: 342 Annotation: Subtype: Link Rect: 533, 261, 544, 270 ActionDest: 342 Annotation: Subtype: Link Rect: 544, 261, 556, 270 ActionDest: 342 Annotation: Subtype: Link Rect: 207, 236, 214, 245 ActionDest: 339 Annotation: Subtype: Link Rect: 214, 236, 221, 245 ActionDest: 342 Annotation: Subtype: Link Rect: 221, 236, 232, 245 ActionDest: 342 Annotation: Subtype: Link Rect: 223, 211, 230, 220 ActionDest: 339 Annotation: Subtype: Link Rect: 230, 211, 237, 220 ActionDest: 339 Annotation: Subtype: Link Rect: 237, 211, 249, 220 ActionDest: 342 Annotation: Subtype: Link Rect: 252, 211, 264, 220 ActionDest: 342 Annotation: Subtype: Link Rect: 265, 211, 277, 220 ActionDest: 342 Annotation: Subtype: Link Rect: 201, 198, 208, 207 ActionDest: 339 Annotation: Subtype: Link Rect: 208, 198, 220, 207 ActionDest: 342 Annotation: Subtype: Link Rect: 336, 173, 343, 182 ActionDest: 339 Annotation: Subtype: Link Rect: 343, 173, 355, 182 ActionDest: 342 Annotation: Subtype: Link Rect: 356, 173, 368, 182 ActionDest: 345 Annotation: Subtype: Link Rect: 341, 148, 353, 157 ActionDest: 342 Annotation: Subtype: Link Rect: 353, 148, 365, 157 ActionDest: 345 Annotation: Subtype: Link Rect: 366, 148, 378, 157 ActionDest: 345 Annotation: Subtype: Link Rect: 199, 135, 211, 145 ActionDest: 345 Annotation: Subtype: Link Rect: 211, 135, 223, 145 ActionDest: 345 Annotation: Subtype: Link Rect: 224, 135, 236, 145 ActionDest: 345 Annotation: Subtype: Link Rect: 433, 135, 445, 145 ActionDest: 345 Annotation: Subtype: Link Rect: 445, 135, 457, 145 ActionDest: 345 Page: Sequence: 3 Annotations: Annotation: Subtype: Link Rect: 374, 716, 381, 728 ActionDest: 71 Annotation: Subtype: Link Rect: 206, 630, 218, 639 ActionDest: 342 Annotation: Subtype: Link Rect: 218, 630, 230, 639 ActionDest: 345 Annotation: Subtype: Link Rect: 231, 630, 243, 639 ActionDest: 345 Annotation: Subtype: Link Rect: 332, 385, 344, 395 ActionDest: 342 Annotation: Subtype: Link Rect: 344, 385, 356, 395 ActionDest: 345 Annotation: Subtype: Link Rect: 222, 360, 234, 369 ActionDest: 342 Annotation: Subtype: Link Rect: 235, 360, 247, 369 ActionDest: 345 Annotation: Subtype: Link Rect: 522, 323, 534, 332 ActionDest: 345 Annotation: Subtype: Link Rect: 522, 310, 534, 319 ActionDest: 345 Page: Sequence: 4 Annotations: Annotation: Subtype: Link Rect: 228, 716, 235, 728 ActionDest: 96 Annotation: Subtype: Link Rect: 255, 716, 262, 728 ActionDest: 96 Annotation: Subtype: Link Rect: 269, 718, 276, 727 ActionDest: 339 Annotation: Subtype: Link Rect: 277, 718, 284, 727 ActionDest: 342 Annotation: Subtype: Link Rect: 284, 718, 291, 727 ActionDest: 342 Annotation: Subtype: Link Rect: 292, 718, 304, 727 ActionDest: 342 Annotation: Subtype: Link Rect: 304, 718, 316, 727 ActionDest: 345 Annotation: Subtype: Link Rect: 317, 718, 329, 727 ActionDest: 345 Annotation: Subtype: Link Rect: 265, 128, 272, 140 ActionDest: 145 Annotation: Subtype: Link Rect: 293, 128, 300, 140 ActionDest: 145 Annotation: Subtype: Link Rect: 307, 130, 314, 139 ActionDest: 339 Annotation: Subtype: Link Rect: 315, 130, 322, 139 ActionDest: 342 Annotation: Subtype: Link Rect: 323, 130, 334, 139 ActionDest: 345 Annotation: Subtype: Link Rect: 233, 92, 245, 102 ActionDest: 342 Annotation: Subtype: Link Rect: 544, 67, 556, 76 ActionDest: 345 Page: Sequence: 5 Annotations: Annotation: Subtype: Link Rect: 278, 167, 285, 176 ActionDest: 339 Annotation: Subtype: Link Rect: 285, 167, 297, 176 ActionDest: 342 Annotation: Subtype: Link Rect: 298, 167, 310, 176 ActionDest: 345 Annotation: Subtype: Link Rect: 310, 167, 322, 176 ActionDest: 345 Annotation: Subtype: Link Rect: 530, 130, 537, 139 ActionDest: 339 Annotation: Subtype: Link Rect: 199, 114, 206, 126 ActionDest: 223 Annotation: Subtype: Link Rect: 439, 114, 454, 126 ActionDest: 255 Page: Sequence: 6 Annotations: Annotation: Subtype: Link Rect: 381, 690, 388, 699 ActionDest: 339 Annotation: Subtype: Link Rect: 389, 690, 396, 699 ActionDest: 339 Annotation: Subtype: Link Rect: 396, 690, 403, 699 ActionDest: 342 Annotation: Subtype: Link Rect: 403, 690, 415, 699 ActionDest: 342 Annotation: Subtype: Link Rect: 416, 690, 428, 699 ActionDest: 342 Annotation: Subtype: Link Rect: 428, 690, 440, 699 ActionDest: 345 Annotation: Subtype: Link Rect: 441, 690, 453, 699 ActionDest: 345 Annotation: Subtype: Link Rect: 453, 690, 465, 699 ActionDest: 345 Annotation: Subtype: Link Rect: 304, 627, 311, 636 ActionDest: 342 Annotation: Subtype: Link Rect: 311, 628, 323, 636 ActionDest: 342 Annotation: Subtype: Link Rect: 324, 628, 336, 636 ActionDest: 345 Annotation: Subtype: Link Rect: 339, 628, 351, 636 ActionDest: 345 Annotation: Subtype: Link Rect: 483, 615, 490, 624 ActionDest: 198 Annotation: Subtype: Link Rect: 435, 529, 441, 535 ActionDest: 339 Annotation: Subtype: Link Rect: 440, 529, 446, 535 ActionDest: 339 Annotation: Subtype: Link Rect: 446, 528, 451, 535 ActionDest: 342 Annotation: Subtype: Link Rect: 451, 529, 460, 535 ActionDest: 342 Annotation: Subtype: Link Rect: 460, 528, 468, 535 ActionDest: 342 Annotation: Subtype: Link Rect: 468, 528, 477, 535 ActionDest: 342 Annotation: Subtype: Link Rect: 477, 529, 486, 535 ActionDest: 342 Annotation: Subtype: Link Rect: 487, 528, 496, 535 ActionDest: 342 Annotation: Subtype: Link Rect: 496, 528, 505, 535 ActionDest: 345 Annotation: Subtype: Link Rect: 435, 420, 441, 427 ActionDest: 339 Annotation: Subtype: Link Rect: 440, 420, 446, 427 ActionDest: 339 Annotation: Subtype: Link Rect: 446, 420, 451, 427 ActionDest: 342 Annotation: Subtype: Link Rect: 451, 420, 460, 427 ActionDest: 342 Annotation: Subtype: Link Rect: 461, 420, 470, 427 ActionDest: 342 Annotation: Subtype: Link Rect: 470, 420, 479, 427 ActionDest: 342 Annotation: Subtype: Link Rect: 480, 420, 489, 427 ActionDest: 342 Annotation: Subtype: Link Rect: 489, 420, 498, 427 ActionDest: 345 Annotation: Subtype: Link Rect: 498, 420, 507, 427 ActionDest: 345 Annotation: Subtype: Link Rect: 507, 420, 516, 427 ActionDest: 345 Annotation: Subtype: Link Rect: 515, 420, 524, 427 ActionDest: 345 Annotation: Subtype: Link Rect: 524, 420, 533, 427 ActionDest: 345 Annotation: Subtype: Link Rect: 534, 420, 543, 427 ActionDest: 345 Annotation: Subtype: Link Rect: 352, 115, 362, 123 ActionDest: 345 Annotation: Subtype: Link Rect: 219, 105, 225, 113 ActionDest: 339 Annotation: Subtype: Link Rect: 225, 106, 231, 113 ActionDest: 339 Annotation: Subtype: Link Rect: 231, 105, 241, 113 ActionDest: 345 Page: Sequence: 7 Annotations: Annotation: Subtype: Link Rect: 497, 715, 504, 724 ActionDest: 339 Annotation: Subtype: Link Rect: 504, 715, 511, 724 ActionDest: 339 Annotation: Subtype: Link Rect: 511, 715, 522, 724 ActionDest: 342 Annotation: Subtype: Link Rect: 522, 715, 533, 724 ActionDest: 345 Annotation: Subtype: Link Rect: 534, 715, 545, 724 ActionDest: 345 Annotation: Subtype: Link Rect: 545, 715, 556, 724 ActionDest: 345 Annotation: Subtype: Link Rect: 366, 690, 372, 699 ActionDest: 339 Annotation: Subtype: Link Rect: 373, 690, 384, 699 ActionDest: 342 Annotation: Subtype: Link Rect: 384, 690, 395, 699 ActionDest: 345 Annotation: Subtype: Link Rect: 395, 690, 407, 699 ActionDest: 345 Annotation: Subtype: Link Rect: 189, 665, 195, 674 ActionDest: 206 Annotation: Subtype: Link Rect: 462, 611, 468, 618 ActionDest: 339 Annotation: Subtype: Link Rect: 468, 611, 478, 618 ActionDest: 342 Annotation: Subtype: Link Rect: 462, 498, 468, 506 ActionDest: 339 Annotation: Subtype: Link Rect: 468, 498, 478, 506 ActionDest: 345 Annotation: Subtype: Link Rect: 478, 498, 488, 506 ActionDest: 345 Annotation: Subtype: Link Rect: 488, 498, 497, 506 ActionDest: 345 Annotation: Subtype: Link Rect: 497, 498, 507, 506 ActionDest: 345 Annotation: Subtype: Link Rect: 507, 498, 517, 506 ActionDest: 345 Annotation: Subtype: Link Rect: 462, 355, 472, 363 ActionDest: 345 Annotation: Subtype: Link Rect: 472, 355, 482, 363 ActionDest: 345 Annotation: Subtype: Link Rect: 482, 355, 492, 363 ActionDest: 345 Annotation: Subtype: Link Rect: 492, 355, 501, 363 ActionDest: 345 Annotation: Subtype: Link Rect: 462, 280, 472, 288 ActionDest: 345 Annotation: Subtype: Link Rect: 474, 280, 484, 288 ActionDest: 348 Annotation: Subtype: Link Rect: 506, 171, 518, 180 ActionDest: 345 Annotation: Subtype: Link Rect: 519, 171, 530, 180 ActionDest: 348 Annotation: Subtype: Link Rect: 310, 131, 317, 143 ActionDest: 71 Annotation: Subtype: Link Rect: 310, 96, 322, 105 ActionDest: 345 Annotation: Subtype: Link Rect: 238, 70, 250, 80 ActionDest: 345 Annotation: Subtype: Link Rect: 251, 70, 263, 80 ActionDest: 348 Page: Sequence: 8 Annotations: Annotation: Subtype: Link Rect: 364, 718, 376, 727 ActionDest: 348 Annotation: Subtype: Link Rect: 352, 668, 364, 677 ActionDest: 345 Annotation: Subtype: Link Rect: 502, 555, 509, 564 ActionDest: 339 Annotation: Subtype: Link Rect: 509, 555, 521, 564 ActionDest: 342 Annotation: Subtype: Link Rect: 522, 555, 534, 564 ActionDest: 345 Annotation: Subtype: Link Rect: 534, 555, 546, 564 ActionDest: 345 Annotation: Subtype: Link Rect: 289, 517, 296, 526 ActionDest: 339 Annotation: Subtype: Link Rect: 296, 517, 308, 526 ActionDest: 342 Annotation: Subtype: Link Rect: 267, 404, 274, 413 ActionDest: 339 Annotation: Subtype: Link Rect: 275, 404, 287, 413 ActionDest: 342 Annotation: Subtype: Link Rect: 287, 404, 299, 413 ActionDest: 345 Annotation: Subtype: Link Rect: 299, 404, 311, 413 ActionDest: 345 Annotation: Subtype: Link Rect: 382, 379, 389, 388 ActionDest: 339 Annotation: Subtype: Link Rect: 390, 379, 402, 388 ActionDest: 342 Annotation: Subtype: Link Rect: 402, 379, 414, 388 ActionDest: 342 Annotation: Subtype: Link Rect: 415, 379, 427, 388 ActionDest: 342 Annotation: Subtype: Link Rect: 427, 379, 439, 388 ActionDest: 342 Annotation: Subtype: Link Rect: 440, 379, 452, 388 ActionDest: 342 Annotation: Subtype: Link Rect: 452, 379, 464, 388 ActionDest: 342 Annotation: Subtype: Link Rect: 465, 379, 477, 388 ActionDest: 342 Annotation: Subtype: Link Rect: 477, 379, 489, 388 ActionDest: 345 Annotation: Subtype: Link Rect: 490, 379, 502, 388 ActionDest: 348 Annotation: Subtype: Link Rect: 434, 366, 441, 375 ActionDest: 339 Annotation: Subtype: Link Rect: 441, 366, 453, 375 ActionDest: 342 Annotation: Subtype: Link Rect: 454, 366, 466, 375 ActionDest: 342 Annotation: Subtype: Link Rect: 193, 354, 205, 363 ActionDest: 345 Annotation: Subtype: Link Rect: 206, 354, 218, 363 ActionDest: 345 Annotation: Subtype: Link Rect: 347, 328, 359, 338 ActionDest: 345 Annotation: Subtype: Link Rect: 451, 291, 463, 300 ActionDest: 345 Annotation: Subtype: Link Rect: 464, 291, 476, 300 ActionDest: 348 Annotation: Subtype: Link Rect: 476, 291, 488, 300 ActionDest: 348 Annotation: Subtype: Link Rect: 426, 241, 433, 250 ActionDest: 339 Annotation: Subtype: Link Rect: 433, 241, 445, 250 ActionDest: 342 Annotation: Subtype: Link Rect: 446, 241, 458, 250 ActionDest: 345 Annotation: Subtype: Link Rect: 458, 241, 470, 250 ActionDest: 345 Annotation: Subtype: Link Rect: 471, 241, 483, 250 ActionDest: 348 Annotation: Subtype: Link Rect: 423, 228, 430, 237 ActionDest: 339 Annotation: Subtype: Link Rect: 431, 228, 443, 237 ActionDest: 345 Annotation: Subtype: Link Rect: 443, 228, 455, 237 ActionDest: 345 Annotation: Subtype: Link Rect: 283, 203, 290, 212 ActionDest: 339 Annotation: Subtype: Link Rect: 290, 203, 302, 212 ActionDest: 342 Annotation: Subtype: Link Rect: 353, 153, 360, 162 ActionDest: 339 Annotation: Subtype: Link Rect: 410, 115, 422, 124 ActionDest: 345 Annotation: Subtype: Link Rect: 241, 90, 252, 99 ActionDest: 345 Page: Sequence: 9 Annotations: Annotation: Subtype: Link Rect: 304, 656, 311, 665 ActionDest: 339 Annotation: Subtype: Link Rect: 311, 655, 323, 665 ActionDest: 342 Annotation: Subtype: Link Rect: 324, 655, 336, 665 ActionDest: 345 Annotation: Subtype: Link Rect: 336, 655, 348, 665 ActionDest: 345 Annotation: Subtype: Link Rect: 349, 655, 361, 665 ActionDest: 345 Annotation: Subtype: Link Rect: 361, 655, 373, 665 ActionDest: 348 Annotation: Subtype: Link Rect: 374, 655, 386, 665 ActionDest: 348 Annotation: Subtype: Link Rect: 219, 618, 231, 627 ActionDest: 345 Annotation: Subtype: Link Rect: 232, 618, 244, 627 ActionDest: 345 Annotation: Subtype: Link Rect: 244, 618, 256, 627 ActionDest: 345 Annotation: Subtype: Link Rect: 357, 605, 369, 614 ActionDest: 345 Annotation: Subtype: Link Rect: 338, 555, 350, 564 ActionDest: 345 Annotation: Subtype: Link Rect: 367, 505, 379, 514 ActionDest: 345 Annotation: Subtype: Link Rect: 256, 477, 263, 489 ActionDest: 255 Annotation: Subtype: Link Rect: 210, 467, 222, 476 ActionDest: 345 Annotation: Subtype: Link Rect: 222, 467, 234, 476 ActionDest: 345 Annotation: Subtype: Link Rect: 521, 429, 533, 438 ActionDest: 345 Annotation: Subtype: Link Rect: 533, 429, 545, 438 ActionDest: 348 Annotation: Subtype: Link Rect: 545, 429, 556, 438 ActionDest: 348 Annotation: Subtype: Link Rect: 494, 354, 505, 363 ActionDest: 342 Annotation: Subtype: Link Rect: 506, 354, 517, 363 ActionDest: 348 Annotation: Subtype: Link Rect: 520, 354, 531, 363 ActionDest: 348 Annotation: Subtype: Link Rect: 491, 286, 503, 295 ActionDest: 345 Annotation: Subtype: Link Rect: 503, 286, 515, 295 ActionDest: 348 Annotation: Subtype: Link Rect: 516, 286, 528, 295 ActionDest: 348 Annotation: Subtype: Link Rect: 375, 261, 387, 270 ActionDest: 342 Annotation: Subtype: Link Rect: 388, 261, 400, 270 ActionDest: 345 Annotation: Subtype: Link Rect: 400, 261, 412, 270 ActionDest: 345 Annotation: Subtype: Link Rect: 288, 223, 300, 232 ActionDest: 345 Annotation: Subtype: Link Rect: 300, 223, 312, 232 ActionDest: 345 Annotation: Subtype: Link Rect: 368, 211, 380, 220 ActionDest: 345 Annotation: Subtype: Link Rect: 380, 211, 392, 220 ActionDest: 345 Annotation: Subtype: Link Rect: 437, 186, 449, 195 ActionDest: 345 Annotation: Subtype: Link Rect: 449, 186, 461, 195 ActionDest: 348 Annotation: Subtype: Link Rect: 469, 173, 476, 182 ActionDest: 339 Annotation: Subtype: Link Rect: 476, 173, 488, 182 ActionDest: 342 Annotation: Subtype: Link Rect: 489, 173, 501, 182 ActionDest: 345 Annotation: Subtype: Link Rect: 501, 173, 513, 182 ActionDest: 345 Annotation: Subtype: Link Rect: 513, 173, 525, 182 ActionDest: 345 Annotation: Subtype: Link Rect: 526, 173, 538, 182 ActionDest: 348 Annotation: Subtype: Link Rect: 316, 136, 328, 145 ActionDest: 345 Annotation: Subtype: Link Rect: 329, 136, 341, 145 ActionDest: 345 Annotation: Subtype: Link Rect: 341, 136, 353, 145 ActionDest: 348 Annotation: Subtype: Link Rect: 501, 123, 513, 132 ActionDest: 345 Annotation: Subtype: Link Rect: 534, 68, 546, 77 ActionDest: 345 Page: Sequence: 10 Annotations: Annotation: Subtype: Link Rect: 544, 718, 556, 727 ActionDest: 345 Annotation: Subtype: Link Rect: 344, 620, 356, 629 ActionDest: 345 Annotation: Subtype: Link Rect: 356, 620, 368, 629 ActionDest: 348 Annotation: Subtype: Link Rect: 295, 594, 307, 604 ActionDest: 345 Annotation: Subtype: Link Rect: 485, 544, 497, 553 ActionDest: 348 Annotation: Subtype: Link Rect: 428, 494, 435, 503 ActionDest: 339 Annotation: Subtype: Link Rect: 450, 456, 462, 466 ActionDest: 345 Annotation: Subtype: Link Rect: 456, 431, 468, 440 ActionDest: 345 Annotation: Subtype: Link Rect: 469, 431, 481, 440 ActionDest: 345 Annotation: Subtype: Link Rect: 481, 431, 493, 440 ActionDest: 348 Annotation: Subtype: Link Rect: 496, 431, 508, 440 ActionDest: 348 Annotation: Subtype: Link Rect: 524, 419, 531, 428 ActionDest: 339 Annotation: Subtype: Link Rect: 531, 419, 543, 428 ActionDest: 345 Annotation: Subtype: Link Rect: 544, 419, 556, 428 ActionDest: 348 Annotation: Subtype: Link Rect: 544, 369, 556, 378 ActionDest: 345 Annotation: Subtype: Link Rect: 349, 331, 361, 340 ActionDest: 348 Annotation: Subtype: Link Rect: 494, 318, 506, 327 ActionDest: 348 Annotation: Subtype: Link Rect: 543, 293, 555, 302 ActionDest: 348 Annotation: Subtype: Link Rect: 482, 281, 494, 290 ActionDest: 348 Annotation: Subtype: Link Rect: 543, 281, 555, 290 ActionDest: 348 Annotation: Subtype: Link Rect: 258, 243, 270, 252 ActionDest: 345 Annotation: Subtype: Link Rect: 270, 243, 282, 252 ActionDest: 345 Annotation: Subtype: Link Rect: 283, 243, 295, 252 ActionDest: 345 Annotation: Subtype: Link Rect: 544, 218, 556, 227 ActionDest: 345 Annotation: Subtype: Link Rect: 456, 193, 468, 202 ActionDest: 348 Annotation: Subtype: Link Rect: 392, 168, 404, 177 ActionDest: 348 Annotation: Subtype: Link Rect: 404, 168, 416, 177 ActionDest: 348 Annotation: Subtype: Link Rect: 519, 155, 531, 164 ActionDest: 348 Page: Sequence: 11 Annotations: Annotation: Subtype: Link Rect: 494, 743, 506, 752 ActionDest: 342 Annotation: Subtype: Link Rect: 506, 743, 518, 752 ActionDest: 345 Annotation: Subtype: Link Rect: 470, 718, 482, 727 ActionDest: 345 Annotation: Subtype: Link Rect: 482, 718, 494, 727 ActionDest: 345 Annotation: Subtype: Link Rect: 495, 718, 507, 727 ActionDest: 357 Annotation: Subtype: Link Rect: 422, 681, 434, 690 ActionDest: 345 Annotation: Subtype: Link Rect: 356, 643, 363, 652 ActionDest: 339 Annotation: Subtype: Link Rect: 363, 643, 375, 652 ActionDest: 342 Annotation: Subtype: Link Rect: 376, 643, 388, 652 ActionDest: 345 Annotation: Subtype: Link Rect: 388, 643, 400, 652 ActionDest: 345 Annotation: Subtype: Link Rect: 407, 593, 419, 602 ActionDest: 348 Annotation: Subtype: Link Rect: 481, 504, 493, 513 ActionDest: 357 Annotation: Subtype: Link Rect: 347, 491, 359, 500 ActionDest: 357 Annotation: Subtype: Link Rect: 359, 491, 371, 500 ActionDest: 357 Annotation: Subtype: Link Rect: 317, 479, 329, 488 ActionDest: 357 Annotation: Subtype: Link Rect: 330, 479, 342, 488 ActionDest: 357 Annotation: Subtype: Link Rect: 344, 479, 356, 488 ActionDest: 357 Annotation: Subtype: Link Rect: 403, 466, 415, 475 ActionDest: 357 Annotation: Subtype: Link Rect: 196, 428, 208, 437 ActionDest: 357 Annotation: Subtype: Link Rect: 483, 416, 495, 425 ActionDest: 357 Annotation: Subtype: Link Rect: 496, 416, 508, 425 ActionDest: 357 Annotation: Subtype: Link Rect: 327, 401, 334, 413 ActionDest: 223 Annotation: Subtype: Link Rect: 341, 403, 353, 412 ActionDest: 357 Annotation: Subtype: Link Rect: 460, 165, 467, 173 ActionDest: 339 Annotation: Subtype: Link Rect: 468, 164, 480, 173 ActionDest: 345 Annotation: Subtype: Link Rect: 480, 164, 492, 173 ActionDest: 345 Annotation: Subtype: Link Rect: 437, 139, 449, 148 ActionDest: 357 Annotation: Subtype: Link Rect: 449, 139, 461, 148 ActionDest: 357 Annotation: Subtype: Link Rect: 369, 127, 381, 136 ActionDest: 357 Page: Sequence: 12 Annotations: Annotation: Subtype: Link Rect: 283, 678, 295, 687 ActionDest: 357 Annotation: Subtype: Link Rect: 296, 678, 308, 687 ActionDest: 357 Annotation: Subtype: Link Rect: 355, 640, 367, 649 ActionDest: 357 Annotation: Subtype: Link Rect: 262, 577, 274, 586 ActionDest: 357 Annotation: Subtype: Link Rect: 275, 577, 287, 586 ActionDest: 357 Annotation: Subtype: Link Rect: 269, 527, 281, 536 ActionDest: 357 Annotation: Subtype: Link Rect: 282, 527, 293, 536 ActionDest: 357 Annotation: Subtype: Link Rect: 482, 439, 494, 448 ActionDest: 357 Annotation: Subtype: Link Rect: 256, 426, 268, 435 ActionDest: 357 Annotation: Subtype: Link Rect: 310, 414, 322, 423 ActionDest: 357 Annotation: Subtype: Link Rect: 284, 376, 296, 385 ActionDest: 357 Annotation: Subtype: Link Rect: 297, 376, 309, 385 ActionDest: 357 Annotation: Subtype: Link Rect: 509, 288, 521, 297 ActionDest: 357 Annotation: Subtype: Link Rect: 521, 288, 533, 297 ActionDest: 357 Annotation: Subtype: Link Rect: 544, 276, 556, 285 ActionDest: 357 Annotation: Subtype: Link Rect: 230, 238, 247, 247 ActionDest: 357 Page: Sequence: 13 Annotations: Annotation: Subtype: Link Rect: 361, 706, 373, 715 ActionDest: 342 Annotation: Subtype: Link Rect: 374, 706, 391, 715 ActionDest: 357 Annotation: Subtype: Link Rect: 269, 681, 281, 690 ActionDest: 342 Annotation: Subtype: Link Rect: 282, 681, 299, 690 ActionDest: 357 Annotation: Subtype: Link Rect: 189, 668, 206, 677 ActionDest: 360 Annotation: Subtype: Link Rect: 256, 630, 273, 639 ActionDest: 360 Annotation: Subtype: Link Rect: 368, 593, 385, 602 ActionDest: 360 Annotation: Subtype: Link Rect: 374, 492, 391, 501 ActionDest: 360 Annotation: Subtype: Link Rect: 208, 455, 225, 464 ActionDest: 360 Annotation: Subtype: Link Rect: 226, 455, 243, 464 ActionDest: 360 Annotation: Subtype: Link Rect: 323, 430, 340, 439 ActionDest: 360 Annotation: Subtype: Link Rect: 341, 430, 358, 439 ActionDest: 360 Annotation: Subtype: Link Rect: 274, 405, 291, 414 ActionDest: 360 Annotation: Subtype: Link Rect: 352, 379, 369, 388 ActionDest: 360 Annotation: Subtype: Link Rect: 369, 379, 386, 388 ActionDest: 360 Annotation: Subtype: Link Rect: 244, 264, 261, 273 ActionDest: 360 Annotation: Subtype: Link Rect: 261, 239, 273, 248 ActionDest: 345 Annotation: Subtype: Link Rect: 274, 239, 291, 248 ActionDest: 360 Annotation: Subtype: Link Rect: 294, 239, 310, 248 ActionDest: 360 Annotation: Subtype: Link Rect: 539, 201, 556, 211 ActionDest: 360 Annotation: Subtype: Link Rect: 210, 101, 222, 110 ActionDest: 357 Annotation: Subtype: Link Rect: 193, 76, 200, 85 ActionDest: 339 Page: Sequence: 14 Annotations: Annotation: Subtype: Link Rect: 519, 703, 536, 712 ActionDest: 360 Annotation: Subtype: Link Rect: 539, 703, 556, 712 ActionDest: 363 Annotation: Subtype: Link Rect: 539, 590, 556, 599 ActionDest: 363 Annotation: Subtype: Link Rect: 373, 488, 385, 497 ActionDest: 342 Annotation: Subtype: Link Rect: 522, 475, 538, 484 ActionDest: 363 Annotation: Subtype: Link Rect: 539, 475, 556, 484 ActionDest: 363 Annotation: Subtype: Link Rect: 266, 450, 278, 459 ActionDest: 342 Annotation: Subtype: Link Rect: 341, 438, 358, 447 ActionDest: 363 Annotation: Subtype: Link Rect: 272, 425, 289, 434 ActionDest: 363 Annotation: Subtype: Link Rect: 352, 400, 369, 409 ActionDest: 363 Annotation: Subtype: Link Rect: 477, 362, 484, 371 ActionDest: 339 Annotation: Subtype: Link Rect: 485, 362, 491, 371 ActionDest: 342 Annotation: Subtype: Link Rect: 518, 299, 535, 309 ActionDest: 363 Annotation: Subtype: Link Rect: 538, 299, 555, 309 ActionDest: 363 Annotation: Subtype: Link Rect: 477, 287, 494, 296 ActionDest: 363 Annotation: Subtype: Link Rect: 336, 249, 353, 258 ActionDest: 363 Annotation: Subtype: Link Rect: 424, 199, 431, 208 ActionDest: 342 Annotation: Subtype: Link Rect: 354, 174, 361, 183 ActionDest: 342 Annotation: Subtype: Link Rect: 492, 124, 509, 133 ActionDest: 363 Annotation: Subtype: Link Rect: 519, 74, 536, 83 ActionDest: 363 Annotation: Subtype: Link Rect: 539, 74, 556, 83 ActionDest: 363 Page: Sequence: 15 Annotations: Annotation: Subtype: Link Rect: 549, 655, 556, 665 ActionDest: 342 Annotation: Subtype: Link Rect: 217, 567, 224, 576 ActionDest: 339 Annotation: Subtype: Link Rect: 225, 567, 232, 576 ActionDest: 342 Annotation: Subtype: Link Rect: 232, 567, 249, 576 ActionDest: 363 Annotation: Subtype: Link Rect: 390, 530, 397, 539 ActionDest: 342 Annotation: Subtype: Link Rect: 363, 392, 380, 401 ActionDest: 363 Annotation: Subtype: Link Rect: 549, 329, 556, 338 ActionDest: 342 Annotation: Subtype: Link Rect: 409, 227, 416, 239 ActionDest: 261 Annotation: Subtype: Link Rect: 199, 202, 206, 214 ActionDest: 261 Annotation: Subtype: Link Rect: 549, 141, 556, 153 ActionDest: 300 Annotation: Subtype: Link Rect: 363, 90, 375, 102 ActionDest: 300 Page: Sequence: 16 Page: Sequence: 17 Page: Sequence: 18 Annotations: Annotation: Subtype: Link Rect: 59, 235, 96, 245 Annotation: Subtype: Link Rect: 212, 212, 250, 222 Annotation: Subtype: Link Rect: 509, 188, 547, 199 Annotation: Subtype: Link Rect: 412, 165, 449, 176 Annotation: Subtype: Link Rect: 464, 142, 501, 153 Annotation: Subtype: Link Rect: 59, 120, 96, 130 Annotation: Subtype: Link Rect: 56, 85, 355, 96 Page: Sequence: 19 Annotations: Annotation: Subtype: Link Rect: 59, 730, 96, 741 Annotation: Subtype: Link Rect: 246, 696, 283, 706 Annotation: Subtype: Link Rect: 59, 661, 96, 671 Annotation: Subtype: Link Rect: 228, 638, 266, 648 Annotation: Subtype: Link Rect: 113, 604, 150, 614 Annotation: Subtype: Link Rect: 156, 604, 192, 614 Annotation: Subtype: Link Rect: 346, 580, 383, 591 Annotation: Subtype: Link Rect: 373, 557, 410, 568 Annotation: Subtype: Link Rect: 59, 523, 96, 533 Annotation: Subtype: Link Rect: 102, 523, 138, 533 Annotation: Subtype: Link Rect: 154, 488, 191, 499 Annotation: Subtype: Link Rect: 330, 465, 368, 476 Annotation: Subtype: Link Rect: 135, 443, 173, 453 Annotation: Subtype: Link Rect: 109, 420, 146, 430 Annotation: Subtype: Link Rect: 409, 396, 446, 407 Annotation: Subtype: Link Rect: 520, 373, 557, 384 Annotation: Subtype: Link Rect: 446, 350, 483, 361 Annotation: Subtype: Link Rect: 483, 327, 521, 338 Annotation: Subtype: Link Rect: 235, 292, 273, 303 Annotation: Subtype: Link Rect: 215, 269, 252, 280 Annotation: Subtype: Link Rect: 300, 224, 337, 234 Annotation: Subtype: Link Rect: 175, 190, 212, 200 Annotation: Subtype: Link Rect: 279, 154, 316, 165 Annotation: Subtype: Link Rect: 59, 109, 96, 119 Annotation: Subtype: Link Rect: 241, 86, 278, 96 Annotation: Subtype: Link Rect: 448, 74, 486, 85 Annotation: Subtype: Link Rect: 492, 74, 528, 85 Page: Sequence: 20 Annotations: Annotation: Subtype: Link Rect: 108, 719, 146, 729 Annotation: Subtype: Link Rect: 321, 696, 359, 706 Annotation: Subtype: Link Rect: 105, 673, 142, 683 Annotation: Subtype: Link Rect: 148, 673, 184, 683 Annotation: Subtype: Link Rect: 327, 649, 364, 660 Annotation: Subtype: Link Rect: 117, 615, 155, 625 Annotation: Subtype: Link Rect: 161, 615, 197, 625 Annotation: Subtype: Link Rect: 348, 580, 385, 591 Annotation: Subtype: Link Rect: 264, 546, 302, 556 Annotation: Subtype: Link Rect: 112, 523, 150, 533 Annotation: Subtype: Link Rect: 328, 500, 366, 510 Annotation: Subtype: Link Rect: 395, 476, 433, 487 Annotation: Subtype: Link Rect: 59, 443, 96, 453 Annotation: Subtype: Link Rect: 376, 419, 414, 430 Annotation: Subtype: Link Rect: 59, 374, 96, 384 Annotation: Subtype: Link Rect: 511, 351, 548, 361 Annotation: Subtype: Link Rect: 490, 327, 527, 338 Annotation: Subtype: Link Rect: 343, 304, 381, 315 Annotation: Subtype: Link Rect: 371, 269, 408, 280 Annotation: Subtype: Link Rect: 118, 224, 155, 234 Annotation: Subtype: Link Rect: 161, 224, 197, 234 Annotation: Subtype: Link Rect: 284, 189, 321, 200 Annotation: Subtype: Link Rect: 469, 143, 507, 154 Annotation: Subtype: Link Rect: 309, 108, 347, 119 Annotation: Subtype: Link Rect: 353, 108, 389, 119 Annotation: Subtype: Link Rect: 267, 74, 305, 85 Page: Sequence: 21 Annotations: Annotation: Subtype: Link Rect: 504, 730, 541, 741 Annotation: Subtype: Link Rect: 331, 706, 369, 718 Annotation: Subtype: Link Rect: 113, 684, 150, 694 Annotation: Subtype: Link Rect: 370, 661, 407, 671 Annotation: Subtype: Link Rect: 256, 614, 293, 625 Annotation: Subtype: Link Rect: 300, 614, 336, 625 Annotation: Subtype: Link Rect: 59, 581, 96, 591 Annotation: Subtype: Link Rect: 131, 558, 168, 568 Annotation: Subtype: Link Rect: 263, 534, 301, 545 Annotation: Subtype: Link Rect: 467, 488, 505, 499 Annotation: Subtype: Link Rect: 479, 465, 517, 476 Annotation: Subtype: Link Rect: 370, 442, 408, 453 Annotation: Subtype: Link Rect: 186, 407, 223, 418 Annotation: Subtype: Link Rect: 477, 373, 515, 384 Annotation: Subtype: Link Rect: 412, 350, 450, 361 Annotation: Subtype: Link Rect: 507, 315, 544, 326 Annotation: Subtype: Link Rect: 338, 292, 376, 303 Annotation: Subtype: Link Rect: 140, 270, 177, 280 Annotation: Subtype: Link Rect: 194, 236, 231, 246 Annotation: Subtype: Link Rect: 340, 212, 377, 223 Annotation: Subtype: Link Rect: 144, 190, 182, 200 Annotation: Subtype: Link Rect: 297, 143, 334, 154 Annotation: Subtype: Link Rect: 341, 143, 377, 154 Annotation: Subtype: Link Rect: 377, 97, 415, 108 Annotation: Subtype: Link Rect: 421, 97, 457, 108 Annotation: Subtype: Link Rect: 452, 74, 489, 85 Annotation: Subtype: Link Rect: 496, 74, 532, 85 Page: Sequence: 22 Annotations: Annotation: Subtype: Link Rect: 59, 730, 96, 741 Annotation: Subtype: Link Rect: 328, 695, 366, 706 Annotation: Subtype: Link Rect: 372, 695, 408, 706 Annotation: Subtype: Link Rect: 380, 672, 417, 683 Annotation: Subtype: Link Rect: 117, 627, 155, 637 Annotation: Subtype: Link Rect: 184, 592, 221, 602 Annotation: Subtype: Link Rect: 149, 558, 186, 568 Annotation: Subtype: Link Rect: 192, 558, 228, 568 Annotation: Subtype: Link Rect: 189, 522, 227, 533 Annotation: Subtype: Link Rect: 233, 522, 269, 533 Annotation: Subtype: Link Rect: 311, 488, 349, 499 Annotation: Subtype: Link Rect: 409, 465, 446, 476 Annotation: Subtype: Link Rect: 452, 465, 488, 476 Annotation: Subtype: Link Rect: 513, 431, 551, 441 Annotation: Subtype: Link Rect: 338, 396, 376, 407 Annotation: Subtype: Link Rect: 59, 362, 96, 372 Annotation: Subtype: Link Rect: 374, 327, 411, 338 Annotation: Subtype: Link Rect: 288, 292, 326, 303 Annotation: Subtype: Link Rect: 193, 258, 230, 269 Annotation: Subtype: Link Rect: 236, 258, 272, 269 Annotation: Subtype: Link Rect: 193, 223, 230, 234 Annotation: Subtype: Link Rect: 237, 223, 273, 234 Annotation: Subtype: Link Rect: 106, 190, 144, 200 Annotation: Subtype: Link Rect: 326, 166, 363, 177 Annotation: Subtype: Link Rect: 268, 143, 306, 154 Annotation: Subtype: Link Rect: 519, 120, 557, 131 Annotation: Subtype: Link Rect: 59, 109, 95, 119 Annotation: Subtype: Link Rect: 333, 85, 370, 96 Annotation: Subtype: Link Rect: 376, 85, 412, 96 Page: Sequence: 23 Annotations: Annotation: Subtype: Link Rect: 299, 730, 336, 741 Annotation: Subtype: Link Rect: 357, 706, 394, 718 Annotation: Subtype: Link Rect: 248, 661, 285, 671 Annotation: Subtype: Link Rect: 59, 627, 96, 637 Annotation: Subtype: Link Rect: 519, 591, 557, 602 Annotation: Subtype: Link Rect: 59, 581, 95, 591 Annotation: Subtype: Link Rect: 127, 546, 164, 556 Annotation: Subtype: Link Rect: 170, 546, 206, 556 Annotation: Subtype: Link Rect: 386, 511, 423, 522 Annotation: Subtype: Link Rect: 430, 511, 466, 522 Annotation: Subtype: Link Rect: 86, 477, 124, 487 Annotation: Subtype: Link Rect: 130, 477, 166, 487 Annotation: Subtype: Link Rect: 520, 442, 557, 453 Annotation: Subtype: Link Rect: 59, 431, 95, 441 Annotation: Subtype: Link Rect: 95, 385, 133, 395 Annotation: Subtype: Link Rect: 139, 385, 175, 395 Annotation: Subtype: Link Rect: 59, 339, 96, 349 Annotation: Subtype: Link Rect: 102, 339, 138, 349 Annotation: Subtype: Link Rect: 113, 293, 150, 303 Annotation: Subtype: Link Rect: 59, 247, 96, 257 Annotation: Subtype: Link Rect: 341, 212, 379, 223 Annotation: Subtype: Link Rect: 59, 167, 96, 177 Annotation: Subtype: Link Rect: 102, 167, 138, 177 Annotation: Subtype: Link Rect: 332, 131, 370, 142 Annotation: Subtype: Link Rect: 376, 131, 412, 142 Annotation: Subtype: Link Rect: 218, 97, 256, 108 Annotation: Subtype: Link Rect: 262, 97, 298, 108 Page: Sequence: 24 Annotations: Annotation: Subtype: Link Rect: 271, 719, 309, 729 Annotation: Subtype: Link Rect: 315, 719, 351, 729 Annotation: Subtype: Link Rect: 321, 695, 358, 706 Annotation: Subtype: Link Rect: 364, 695, 400, 706 Annotation: Subtype: Link Rect: 255, 673, 292, 683 Annotation: Subtype: Link Rect: 488, 649, 525, 660 Annotation: Subtype: Link Rect: 135, 604, 173, 614 Annotation: Subtype: Link Rect: 135, 569, 173, 579 Annotation: Subtype: Link Rect: 338, 545, 375, 556 Annotation: Subtype: Link Rect: 149, 500, 186, 510 Annotation: Subtype: Link Rect: 385, 476, 422, 487 Annotation: Subtype: Link Rect: 429, 476, 465, 487 Annotation: Subtype: Link Rect: 519, 453, 557, 464 Annotation: Subtype: Link Rect: 59, 443, 95, 453 Annotation: Subtype: Link Rect: 179, 408, 216, 418 Annotation: Subtype: Link Rect: 223, 408, 259, 418 Annotation: Subtype: Link Rect: 452, 384, 490, 395 Annotation: Subtype: Link Rect: 496, 384, 532, 395 Annotation: Subtype: Link Rect: 519, 361, 557, 372 Annotation: Subtype: Link Rect: 59, 351, 95, 361 Annotation: Subtype: Link Rect: 59, 316, 96, 326 Annotation: Subtype: Link Rect: 262, 293, 300, 303 Checksum: 4fccf6fd Type: CRC32 Checksum: 3605ad699dae6143de3d3e7a9963d4dc Type: MD5 Checksum: 248a917fa49c828294d026420970075c4fd0b4c5 Type: SHA-1 Checksum: ea4e69b96fc8634bcf9978051c6737771ce06e9c3f34e57eef813fd265dd8b54 Type: SHA-256