8492ea17d12047145b1d9bd11cb5dfeb  pmc_10867208.pdf
f7394ad443f4e908c00606fcad7da7c507a17bf2  pmc_10867208.pdf
be66c95956be806479552f942aa188f2266bbb34f0cc16caa601c96ea22a726f  pmc_10867208.pdf

Title:           Are the minimally invasive techniques the new gold standard in thymus surgery for myasthenia gravis? Experience of a reference single-site in VATS thymectomy
Subject:         The thymus is the primary lymphoid organ responsible for the maturation and proliferation of T lymphocytes.
Author:          Juan Carlos Trujillo Reyes; Elisabeth Martinez Tellez; Josep Belda Sanchis; Georgina Planas Canovas; Alejandra Libreros Niño; Mauro Guarino; Jorge Hernández Ferrandez; Antonio Moral Duarte
Creator:         Adobe InDesign 14.0 (Windows)
Producer:        Adobe PDF Library 15.0
CreationDate:    Mon Jan 29 08:03:58 2024 CET
ModDate:         Mon Jan 29 08:04:08 2024 CET
Custom Metadata: no
Metadata Stream: yes
Tagged:          yes
UserProperties:  no
Suspects:        no
Form:            none
JavaScript:      no
Pages:           14
Encrypted:       no
Page size:       595.276 x 841.89 pts (A4)
Page rot:        0
File size:       863336 bytes
Optimized:       no
PDF version:     1.6


name                                 type              encoding         emb sub uni object ID
------------------------------------ ----------------- ---------------- --- --- --- ---------
XWITET+MuseoSans-500                 Type 1C           Custom           yes yes yes      8  0
TQFVAB+MuseoSans-300                 Type 1C           Custom           yes yes yes     64  0
PKHXWJ+MuseoSans-700                 Type 1C           Custom           yes yes yes      9  0
NHILUN+MuseoSans-300Italic           Type 1C           WinAnsi          yes yes yes   1220  0
LEEZSR+MinionPro-Regular             Type 1C           Custom           yes yes yes     10  0
GURVAB+MinionPro-It                  Type 1C           Custom           yes yes yes     30  0
DSDDKH+MuseoSans-500Italic           Type 1C           WinAnsi          yes yes yes    119  0


Jhove (Rel. 1.28.0, 2023-05-18)
 Date: 2024-05-01 02:42:18 CEST
 RepresentationInformation: pmc_10867208.pdf
  ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16)
  LastModified: 2024-04-24 02:37:29 CEST
  Size: 863336
  Format: PDF
  Version: 1.6
  Status: Well-Formed and valid
  SignatureMatches:
   PDF-hul
  MIMEtype: application/pdf
  Profile: Tagged PDF
  PDFMetadata: 
   Objects: 1267
   FreeObjects: 1
   IncrementalUpdates: 0
   DocumentCatalog: 
    ViewerPreferences: 
     HideToolbar: false
     HideMenubar: false
     HideWindowUI: false
     FitWindow: false
     CenterWindow: false
     DisplayDocTitle: false
     NonFullScreenPageMode: UseNone
     Direction: L2R
     ViewArea: CropBox
     ViewClip: CropBox
     PrintArea: CropBox
     PageClip: CropBox
    PageLayout: SinglePage
    PageMode: UseNone
    Language: en-GB
    Outlines: 
     Item: 
      Title: Are the minimally invasive techniques the new gold standard in thymus surgery for myasthenia gravis? Experience of a reference single-site in VATS thymectomy
      Children: 
       Item: 
        Title: 1 Introduction and objectives
        Children: 
         Item: 
          Title: 1.1 The thymus and self-tolerance
         Item: 
          Title: 1.1.1 Functions of the thymus in self-tolerance
         Item: 
          Title: 1.1.2 The relationship between the thymus and MG
         Item: 
          Title: 1.1.2.1 Follicular lymphoid hyperplasia
         Item: 
          Title: 1.1.2.2 Normal thymus or thymic remnants
         Item: 
          Title: 1.1.2.3 Thymic tumor and thymoma
         Item: 
          Title: 1.1.3 Current evidence for surgery in MG
         Item: 
          Title: 1.2 Types of surgical approach and recommended extent of thymectomy
         Item: 
          Title: 1.2.1 Types of surgical approach
         Item: 
          Title: 1.2.2 Recommended extent of thymectomy
         Item: 
          Title: 1.2.3 The emergence of thoracoscopic surgery in thymus surgery for MG
         Item: 
          Title: 1.2.4 A critical issue in thymic surgery
         Item: 
          Title: 1.2.5 The lack of comprehensive studies on thoracoscopic thymic gland surgical procedures
         Item: 
          Title: 1.3 Study hypotheses
       Item: 
        Title: 2 Methodology
        Children: 
         Item: 
          Title: 2.1 Study population
         Item: 
          Title: 2.1.1 Selection of cases
         Item: 
          Title: 2.1.1.1 Retrospective cases
         Item: 
          Title: 2.1.1.2 Prospective cases
         Item: 
          Title: 2.2 Inclusion and exclusion criteria
         Item: 
          Title: 2.2.1 Inclusion criteria
         Item: 
          Title: 2.2.2 Exclusion criteria
         Item: 
          Title: 2.3 Analysis by subgroups
         Item: 
          Title: 2.3.1 Subgroup of patients according to the route of approach (VATS vs. sternotomy)
         Item: 
          Title: 2.3.2 Subgroup of patients with a diagnosis of MG or other paraneoplastic syndromes (PNS)
         Item: 
          Title: 2.3.3 Subgroup of patients with a diagnosis of MG or other PNS
         Item: 
          Title: 2.3.4 Subgroup of patients with a diagnosis of thymic tumor
         Item: 
          Title: 2.4 Sources of information
         Item: 
          Title: 2.5 Data storage and processing
         Item: 
          Title: 2.6 Expected sample size
         Item: 
          Title: 2.7 Statistical analysis
         Item: 
          Title: 2.8 Ethical aspects
         Item: 
          Title: 2.8.1 Benefit–risk assessment of the research
         Item: 
          Title: 2.8.2 Ethical, subject information, and informed consent considerations
         Item: 
          Title: 2.8.3 Considerations on the treatment of biological samples
         Item: 
          Title: 2.8.4 Data confidentiality
         Item: 
          Title: 2.8.5 Conflicts of interest
       Item: 
        Title: 3 Results
        Children: 
         Item: 
          Title: 3.1 Reference study population cohort
         Item: 
          Title: 3.1.1 Preoperative characteristics
         Item: 
          Title: 3.1.1.1 Sex and age
         Item: 
          Title: 3.1.1.2 Preoperative diagnosis
         Item: 
          Title: 3.1.1.3 Anatomical findings
         Item: 
          Title: 3.1.1.4 Surgical technique
         Item: 
          Title: 3.1.1.5 Corticosteroid treatment
         Item: 
          Title: 3.1.1.6 Peripheral blood antibodies
         Item: 
          Title: 3.1.2 Postoperative characteristics
         Item: 
          Title: 3.1.2.1 Anatomopathologic diagnosis
         Item: 
          Title: 3.1.2.2 Days of hospital stay
         Item: 
          Title: 3.1.2.3 Postoperative pain
         Item: 
          Title: 3.1.2.4 Treatment with corticosteroids after surgery
         Item: 
          Title: 3.1.2.5 Clinical assessment in specific consultation for MG or other associated NPS
         Item: 
          Title: 3.1.3 Postoperative complications
         Item: 
          Title: 3.1.3.1 Mortality
         Item: 
          Title: 3.1.3.2 Conversion rate
         Item: 
          Title: 3.1.3.3 Complications associated with surgery at 30 days post-surgery
         Item: 
          Title: 3.1.3.4 Presence of thymic tumor
         Item: 
          Title: 3.2 Patient cohorts according to the route of approach (VATS vs. sternotomy)
         Item: 
          Title: 3.2.1 Preoperative characteristics
         Item: 
          Title: 3.2.1.1 Age
         Item: 
          Title: 3.2.2 Postoperative characteristics
         Item: 
          Title: 3.2.2.1 Days of hospital stay
         Item: 
          Title: 3.2.2.2 Postoperative pain
         Item: 
          Title: 3.2.3 Postoperative complications
         Item: 
          Title: 3.2.3.1 Complications associated with surgery at 30 days post-surgery
         Item: 
          Title: 3.3 Cohort of patients with MG
         Item: 
          Title: 3.3.1 Preoperative characteristics
         Item: 
          Title: 3.3.2 Postoperative characteristics
         Item: 
          Title: 3.4 Cohort of patients with MG or other syndrome associated with THYMIC lesion
         Item: 
          Title: 3.4.1 Postoperative characteristics
         Item: 
          Title: 3.5 Population cohort of patients diagnosed with THYMIC tumor
         Item: 
          Title: 3.5.1 Preoperative characteristics
         Item: 
          Title: 3.5.1.1 Approach
         Item: 
          Title: 3.5.2 Postoperative characteristics
         Item: 
          Title: 3.5.2.1 Thymic tumor staging
         Item: 
          Title: 3.5.2.2 Neoplastic disease status
       Item: 
        Title: 4 Discussion
        Children: 
         Item: 
          Title: 4.1 Representativeness
         Item: 
          Title: 4.2 Validity of VATS thymectomy compared to sternotomy
         Item: 
          Title: 4.3 Thymectomy in MG
         Item: 
          Title: 4.3.1 Indication
         Item: 
          Title: 4.3.2 Impact according to the approach route
         Item: 
          Title: 4.3.3 Predictors of MG response to thymectomy
         Item: 
          Title: 4.4 Oncologic outcomes by route of approach
       Item: 
        Title: 5 Conclusion
        Children: 
         Item: 
          Title: 5.1 Limitations of the study
         Item: 
          Title: 5.2 Future prospects
       Item: 
        Title: Ethics statement
       Item: 
        Title: Author contributions
     Item: 
      Title: References
   Info: 
    Title: Are the minimally invasive techniques the new gold standard in thymus surgery for myasthenia gravis? Experience of a reference single-site in VATS thymectomy
    Author: Juan Carlos Trujillo Reyes; Elisabeth Martinez Tellez; Josep Belda Sanchis; Georgina Planas Canovas; Alejandra Libreros Niño; Mauro Guarino; Jorge Hernández Ferrandez; Antonio Moral Duarte
    Subject: The thymus is the primary lymphoid organ responsible for the maturation and proliferation of T lymphocytes.
    Creator: Adobe InDesign 14.0 (Windows)
    Producer: Adobe PDF Library 15.0
    CreationDate: Mon Jan 29 08:33:58 CET 2024
    ModDate: Mon Jan 29 08:34:08 CET 2024
   ID: 0x185196a49a4d8540aeaa8c83c1241195, 0xc70fa8761eabe8a0ca39764335865a08
   Filters: 
    FilterPipeline: FlateDecode
    FilterPipeline: DCTDecode
   Images: 
    Image: 
     NisoImageMetadata: 
      FormatName: image/jpg
      CompressionScheme: JPEG
      ImageWidth: 1134
      ImageHeight: 1115
      ColorSpace: RGB
      BitsPerSample: 8
      BitsPerSampleUnit: integer
     Intent: RelativeColorimetric
     Name: X
    Image: 
     NisoImageMetadata: 
      FormatName: image/jpg
      CompressionScheme: JPEG
      ImageWidth: 1024
      ImageHeight: 664
      ColorSpace: RGB
      BitsPerSample: 8
      BitsPerSampleUnit: integer
     Intent: RelativeColorimetric
     Name: X
    Image: 
     NisoImageMetadata: 
      FormatName: image/jpg
      CompressionScheme: JPEG
      ImageWidth: 2480
      ImageHeight: 1656
      ColorSpace: RGB
      BitsPerSample: 8
      BitsPerSampleUnit: integer
     Intent: RelativeColorimetric
     Name: X
    Image: 
     NisoImageMetadata: 
      FormatName: image/jpg
      CompressionScheme: JPEG
      ImageWidth: 2481
      ImageHeight: 713
      ColorSpace: RGB
      BitsPerSample: 8
      BitsPerSampleUnit: integer
     Intent: RelativeColorimetric
     Name: X
   Fonts: 
    Type1: 
     Font: 
      BaseFont: TQFVAB+MuseoSans-300
      FontSubset: true
      FirstChar: 28
      LastChar: 241
      FontDescriptor: 
       FontName: TQFVAB+MuseoSans-300
       Flags: Nonsymbolic
       FontBBox: -118, -210, 1088, 883
       FontFile3: true
      EncodingDictionary: 
       BaseEncoding: WinAnsiEncoding
       Differences: true
      ToUnicode: true
     Font: 
      BaseFont: NHILUN+MuseoSans-300Italic
      FontSubset: true
      FirstChar: 32
      LastChar: 117
      FontDescriptor: 
       FontName: NHILUN+MuseoSans-300Italic
       Flags: Nonsymbolic
       FontBBox: -245, -210, 1030, 883
       FontFile3: true
      Encoding: WinAnsiEncoding
      ToUnicode: true
     Font: 
      BaseFont: DSDDKH+MuseoSans-500Italic
      FontSubset: true
      FirstChar: 112
      LastChar: 112
      FontDescriptor: 
       FontName: DSDDKH+MuseoSans-500Italic
       Flags: Nonsymbolic
       FontBBox: -249, -210, 1047, 892
       FontFile3: true
      Encoding: WinAnsiEncoding
      ToUnicode: true
     Font: 
      BaseFont: XWITET+MuseoSans-500
      FontSubset: true
      FirstChar: 28
      LastChar: 241
      FontDescriptor: 
       FontName: XWITET+MuseoSans-500
       Flags: Nonsymbolic
       FontBBox: -121, -210, 1088, 892
       FontFile3: true
      EncodingDictionary: 
       BaseEncoding: WinAnsiEncoding
       Differences: true
      ToUnicode: true
     Font: 
      BaseFont: PKHXWJ+MuseoSans-700
      FontSubset: true
      FirstChar: 31
      LastChar: 121
      FontDescriptor: 
       FontName: PKHXWJ+MuseoSans-700
       Flags: Nonsymbolic
       FontBBox: -125, -210, 1126, 902
       FontFile3: true
      EncodingDictionary: 
       BaseEncoding: WinAnsiEncoding
       Differences: true
      ToUnicode: true
     Font: 
      BaseFont: LEEZSR+MinionPro-Regular
      FontSubset: true
      FirstChar: 22
      LastChar: 252
      FontDescriptor: 
       FontName: LEEZSR+MinionPro-Regular
       Flags: Serif, Nonsymbolic
       FontBBox: -290, -360, 1684, 989
       FontFile3: true
      EncodingDictionary: 
       BaseEncoding: WinAnsiEncoding
       Differences: true
      ToUnicode: true
     Font: 
      BaseFont: GURVAB+MinionPro-It
      FontSubset: true
      FirstChar: 28
      LastChar: 121
      FontDescriptor: 
       FontName: GURVAB+MinionPro-It
       Flags: Serif, Nonsymbolic, Italic
       FontBBox: -201, -360, 1684, 1002
       FontFile3: true
      EncodingDictionary: 
       BaseEncoding: WinAnsiEncoding
       Differences: true
      ToUnicode: true
   XMP: <x:xmpmeta xmlns:x="adobe:ns:meta/" x:xmptk="Adobe XMP Core 5.1.0-jc003">
  <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:stRef="http://ns.adobe.com/xap/1.0/sType/ResourceRef#"
        xmlns:stEvt="http://ns.adobe.com/xap/1.0/sType/ResourceEvent#"
        xmlns:xmp="http://ns.adobe.com/xap/1.0/"
        xmlns:dc="http://purl.org/dc/elements/1.1/"
        xmlns:pdf="http://ns.adobe.com/pdf/1.3/"
        xmlns:ExtensisFontSense="http://www.extensis.com/meta/FontSense/"
      xmpMM:InstanceID="uuid:052bef25-036c-4e58-8fd4-979a77550d10"
      xmpMM:OriginalDocumentID="adobe:docid:indd:3eb08764-b5b1-11df-a8ee-870b19326471"
      xmpMM:DocumentID="xmp.id:01eda7c5-50fc-3a48-a216-002bd5fdae81"
      xmpMM:RenditionClass="proof:pdf"
      xmp:CreateDate="2024-01-29T12:33:58+05:30"
      xmp:ModifyDate="2024-01-29T12:34:08+05:30"
      xmp:MetadataDate="2024-01-29T12:34:08+05:30"
      xmp:CreatorTool="Adobe InDesign 14.0 (Windows)"
      dc:format="application/pdf"
      pdf:Keywords="thoracoscopy, myasthenia gravis, video-assisted thoracic surgery, MG treatment, thymic hyperplasia, thymic tumors"
      pdf:Producer="Adobe PDF Library 15.0"
      pdf:Trapped="False">
      <xmpMM:DerivedFrom
        stRef:instanceID="xmp.iid:6fcc884c-75b7-f54a-9d0b-9eb41981cc1e"
        stRef:documentID="xmp.did:40cc3090-a38d-d24b-892a-ee76b24a8388"
        stRef:originalDocumentID="adobe:docid:indd:3eb08764-b5b1-11df-a8ee-870b19326471"
        stRef:renditionClass="default"/>
      <xmpMM:History>
        <rdf:Seq>
          <rdf:li
            stEvt:action="converted"
            stEvt:parameters="from application/x-indesign to application/pdf"
            stEvt:softwareAgent="Adobe InDesign CC 14.0 (Windows)"
            stEvt:changed="/"
            stEvt:when="2024-01-29T12:33:59+05:30"/>
        </rdf:Seq>
      </xmpMM:History>
      <dc:title>
        <rdf:Alt>
          <rdf:li xml:lang="x-default">Are the minimally invasive techniques the new gold standard in thymus surgery for myasthenia gravis? Experience of a reference single-site in VATS thymectomy</rdf:li>
        </rdf:Alt>
      </dc:title>
      <dc:creator>
        <rdf:Seq>
          <rdf:li>Juan Carlos Trujillo Reyes</rdf:li>
          <rdf:li>Elisabeth Martinez Tellez</rdf:li>
          <rdf:li>Josep Belda Sanchis</rdf:li>
          <rdf:li>Georgina Planas Canovas</rdf:li>
          <rdf:li>Alejandra Libreros Niño</rdf:li>
          <rdf:li>Mauro Guarino</rdf:li>
          <rdf:li>Jorge Hernández Ferrandez</rdf:li>
          <rdf:li>Antonio Moral Duarte</rdf:li>
        </rdf:Seq>
      </dc:creator>
      <dc:description>
        <rdf:Alt>
          <rdf:li xml:lang="x-default">The thymus is the primary lymphoid organ responsible for the maturation and proliferation of T lymphocytes.</rdf:li>
        </rdf:Alt>
      </dc:description>
      <dc:subject>
        <rdf:Bag>
          <rdf:li>thoracoscopy</rdf:li>
          <rdf:li>myasthenia gravis</rdf:li>
          <rdf:li>video-assisted thoracic surgery</rdf:li>
          <rdf:li>MG treatment</rdf:li>
          <rdf:li>thymic hyperplasia</rdf:li>
          <rdf:li>thymic tumors</rdf:li>
        </rdf:Bag>
      </dc:subject>
      <ExtensisFontSense:slug>
        <rdf:Bag>
          <rdf:li
            ExtensisFontSense:Checksum="4281058394"
            ExtensisFontSense:PostScriptName="PalatinoLTStd-Bold"
            ExtensisFontSense:Foundry="Adobe Systems"
            ExtensisFontSense:Version="2.040"
            ExtensisFontSense:OutlineFileSize="0"
            ExtensisFontSense:Family="Palatino LT Std"
            ExtensisFontSense:FontSense_1.2_Checksum="4281058394"
            ExtensisFontSense:FontKind="OpenType - PS"
            ExtensisFontSense:KerningChecksum="0"/>
          <rdf:li
            ExtensisFontSense:Checksum="603650848"
            ExtensisFontSense:PostScriptName="PalatinoLTStd-Italic"
            ExtensisFontSense:Foundry="Adobe Systems"
            ExtensisFontSense:Version="2.040"
            ExtensisFontSense:OutlineFileSize="0"
            ExtensisFontSense:Family="Palatino LT Std"
            ExtensisFontSense:FontSense_1.2_Checksum="603650848"
            ExtensisFontSense:FontKind="OpenType - PS"
            ExtensisFontSense:KerningChecksum="0"/>
          <rdf:li
            ExtensisFontSense:Checksum="1660192022"
            ExtensisFontSense:PostScriptName="PalatinoLTStd-Roman"
            ExtensisFontSense:Foundry="Adobe Systems"
            ExtensisFontSense:Version="2.040"
            ExtensisFontSense:OutlineFileSize="0"
            ExtensisFontSense:Family="Palatino LT Std"
            ExtensisFontSense:FontSense_1.2_Checksum="1660192022"
            ExtensisFontSense:FontKind="OpenType - PS"
            ExtensisFontSense:KerningChecksum="0"/>
          <rdf:li
            ExtensisFontSense:Checksum="58239931"
            ExtensisFontSense:PostScriptName="GothamNarrow-BoldItalic"
            ExtensisFontSense:Foundry="--"
            ExtensisFontSense:Version="2.201"
            ExtensisFontSense:OutlineFileSize="0"
            ExtensisFontSense:Family="Gotham Narrow"
            ExtensisFontSense:FontSense_1.2_Checksum="58239931"
            ExtensisFontSense:FontKind="OpenType - PS"
            ExtensisFontSense:KerningChecksum="0"/>
          <rdf:li
            ExtensisFontSense:Checksum="3415421137"
            ExtensisFontSense:PostScriptName="GothamNarrow-Bold"
            ExtensisFontSense:Foundry="--"
            ExtensisFontSense:Version="2.201"
            ExtensisFontSense:OutlineFileSize="0"
            ExtensisFontSense:Family="Gotham Narrow"
            ExtensisFontSense:FontSense_1.2_Checksum="3415421137"
            ExtensisFontSense:FontKind="OpenType - PS"
            ExtensisFontSense:KerningChecksum="0"/>
          <rdf:li
            ExtensisFontSense:Checksum="449541274"
            ExtensisFontSense:PostScriptName="GothamNarrow-Black"
            ExtensisFontSense:Foundry="--"
            ExtensisFontSense:Version="2.201"
            ExtensisFontSense:OutlineFileSize="0"
            ExtensisFontSense:Family="Gotham Narrow"
            ExtensisFontSense:FontSense_1.2_Checksum="449541274"
            ExtensisFontSense:FontKind="OpenType - PS"
            ExtensisFontSense:KerningChecksum="0"/>
          <rdf:li
            ExtensisFontSense:Checksum="3887558863"
            ExtensisFontSense:PostScriptName="GothamNarrow-Book"
            ExtensisFontSense:Foundry="--"
            ExtensisFontSense:Version="2.201"
            ExtensisFontSense:OutlineFileSize="0"
            ExtensisFontSense:Family="Gotham Narrow"
            ExtensisFontSense:FontSense_1.2_Checksum="3887558863"
            ExtensisFontSense:FontKind="OpenType - PS"
            ExtensisFontSense:KerningChecksum="0"/>
          <rdf:li
            ExtensisFontSense:Checksum="13438472"
            ExtensisFontSense:PostScriptName="GothamNarrow-Light"
            ExtensisFontSense:Foundry="--"
            ExtensisFontSense:Version="2.201"
            ExtensisFontSense:OutlineFileSize="0"
            ExtensisFontSense:Family="Gotham Narrow"
            ExtensisFontSense:FontSense_1.2_Checksum="13438472"
            ExtensisFontSense:FontKind="OpenType - PS"
            ExtensisFontSense:KerningChecksum="0"/>
        </rdf:Bag>
      </ExtensisFontSense:slug>
    </rdf:Description>
  </rdf:RDF>
</x:xmpmeta>
   Pages: 
    Page: 
     Sequence: 1
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 47, 808, 225, 790
      Annotation: 
       Subtype: Link
       Rect: 49, 41, 122, 33
      Annotation: 
       Subtype: Link
       Rect: 499, 41, 545, 33
      Annotation: 
       Subtype: Link
       Rect: 47, 717, 223, 699
      Annotation: 
       Subtype: Link
       Rect: 221, 720, 472, 696
      Annotation: 
       Subtype: Link
       Rect: 221, 695, 545, 671
      Annotation: 
       Subtype: Link
       Rect: 221, 670, 543, 646
      Annotation: 
       Subtype: Link
       Rect: 221, 645, 540, 621
      Annotation: 
       Subtype: Link
       Rect: 221, 620, 522, 596
      Annotation: 
       Subtype: Link
       Rect: 56, 567, 120, 560
      Annotation: 
       Subtype: Link
       Rect: 49, 422, 154, 414
      Annotation: 
       Subtype: Link
       Rect: 159, 363, 187, 355
      Annotation: 
       Subtype: Link
       Rect: 49, 354, 171, 346
      Annotation: 
       Subtype: Link
       Rect: 440, 807, 512, 800
      Annotation: 
       Subtype: Link
       Rect: 440, 798, 530, 791
      Annotation: 
       Subtype: Link
       Rect: 440, 789, 545, 782
     Thumb: true
    Page: 
     Sequence: 2
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 455, 807, 545, 800
      Annotation: 
       Subtype: Link
       Rect: 49, 41, 122, 33
      Annotation: 
       Subtype: Link
       Rect: 499, 41, 545, 33
      Annotation: 
       Subtype: Link
       Rect: 89, 582, 94, 570
       ActionDest: 194
      Annotation: 
       Subtype: Link
       Rect: 97, 582, 102, 570
       ActionDest: 194
      Annotation: 
       Subtype: Link
       Rect: 210, 450, 214, 438
       ActionDest: 194
      Annotation: 
       Subtype: Link
       Rect: 262, 354, 267, 342
       ActionDest: 194
      Annotation: 
       Subtype: Link
       Rect: 69, 222, 74, 210
       ActionDest: 194
      Annotation: 
       Subtype: Link
       Rect: 264, 222, 268, 210
       ActionDest: 194
      Annotation: 
       Subtype: Link
       Rect: 163, 126, 167, 114
       ActionDest: 194
      Annotation: 
       Subtype: Link
       Rect: 509, 234, 513, 222
       ActionDest: 194
      Annotation: 
       Subtype: Link
       Rect: 522, 138, 527, 126
       ActionDest: 194
     Thumb: true
    Page: 
     Sequence: 3
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 455, 807, 545, 800
      Annotation: 
       Subtype: Link
       Rect: 49, 41, 122, 33
      Annotation: 
       Subtype: Link
       Rect: 499, 41, 545, 33
      Annotation: 
       Subtype: Link
       Rect: 171, 690, 180, 678
       ActionDest: 194
      Annotation: 
       Subtype: Link
       Rect: 137, 666, 146, 654
       ActionDest: 194
      Annotation: 
       Subtype: Link
       Rect: 264, 534, 272, 522
       ActionDest: 194
      Annotation: 
       Subtype: Link
       Rect: 89, 486, 98, 474
       ActionDest: 194
      Annotation: 
       Subtype: Link
       Rect: 70, 450, 78, 438
       ActionDest: 194
      Annotation: 
       Subtype: Link
       Rect: 218, 426, 222, 414
       ActionDest: 194
      Annotation: 
       Subtype: Link
       Rect: 188, 294, 192, 282
       ActionDest: 194
      Annotation: 
       Subtype: Link
       Rect: 163, 78, 172, 66
       ActionDest: 194
      Annotation: 
       Subtype: Link
       Rect: 534, 762, 542, 750
       ActionDest: 194
      Annotation: 
       Subtype: Link
       Rect: 358, 558, 367, 546
       ActionDest: 194
      Annotation: 
       Subtype: Link
       Rect: 370, 294, 379, 282
       ActionDest: 194
      Annotation: 
       Subtype: Link
       Rect: 356, 198, 364, 186
       ActionDest: 194
     Thumb: true
    Page: 
     Sequence: 4
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 455, 807, 545, 800
      Annotation: 
       Subtype: Link
       Rect: 49, 41, 122, 33
      Annotation: 
       Subtype: Link
       Rect: 499, 41, 545, 33
      Annotation: 
       Subtype: Link
       Rect: 367, 150, 376, 138
       ActionDest: 194
     Thumb: true
    Page: 
     Sequence: 5
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 455, 807, 545, 800
      Annotation: 
       Subtype: Link
       Rect: 49, 41, 122, 33
      Annotation: 
       Subtype: Link
       Rect: 499, 41, 545, 33
      Annotation: 
       Subtype: Link
       Rect: 418, 366, 421, 354
       ActionDest: 61
      Annotation: 
       Subtype: Link
       Rect: 314, 76, 416, 68
     Thumb: true
    Page: 
     Sequence: 6
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 455, 807, 545, 800
      Annotation: 
       Subtype: Link
       Rect: 49, 41, 122, 33
      Annotation: 
       Subtype: Link
       Rect: 499, 41, 545, 33
      Annotation: 
       Subtype: Link
       Rect: 438, 498, 467, 486
       ActionDest: 74
     Thumb: true
    Page: 
     Sequence: 7
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 455, 807, 545, 800
      Annotation: 
       Subtype: Link
       Rect: 49, 41, 122, 33
      Annotation: 
       Subtype: Link
       Rect: 499, 41, 545, 33
      Annotation: 
       Subtype: Link
       Rect: 79, 534, 107, 522
       ActionDest: 88
      Annotation: 
       Subtype: Link
       Rect: 472, 186, 501, 174
       ActionDest: 102
     Thumb: true
    Page: 
     Sequence: 8
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 455, 807, 545, 800
      Annotation: 
       Subtype: Link
       Rect: 49, 41, 122, 33
      Annotation: 
       Subtype: Link
       Rect: 499, 41, 545, 33
      Annotation: 
       Subtype: Link
       Rect: 401, 354, 430, 342
       ActionDest: 115
     Thumb: true
    Page: 
     Sequence: 9
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 455, 807, 545, 800
      Annotation: 
       Subtype: Link
       Rect: 49, 41, 122, 33
      Annotation: 
       Subtype: Link
       Rect: 499, 41, 545, 33
      Annotation: 
       Subtype: Link
       Rect: 91, 450, 116, 438
       ActionDest: 115
      Annotation: 
       Subtype: Link
       Rect: 431, 534, 456, 522
       ActionDest: 115
     Thumb: true
    Page: 
     Sequence: 10
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 455, 807, 545, 800
      Annotation: 
       Subtype: Link
       Rect: 49, 41, 122, 33
      Annotation: 
       Subtype: Link
       Rect: 499, 41, 545, 33
      Annotation: 
       Subtype: Link
       Rect: 329, 738, 337, 726
       ActionDest: 194
      Annotation: 
       Subtype: Link
       Rect: 519, 582, 527, 570
       ActionDest: 194
      Annotation: 
       Subtype: Link
       Rect: 531, 582, 540, 570
       ActionDest: 194
      Annotation: 
       Subtype: Link
       Rect: 510, 450, 519, 438
       ActionDest: 194
      Annotation: 
       Subtype: Link
       Rect: 397, 438, 406, 426
       ActionDest: 194
      Annotation: 
       Subtype: Link
       Rect: 307, 378, 316, 366
       ActionDest: 194
      Annotation: 
       Subtype: Link
       Rect: 450, 318, 458, 306
       ActionDest: 194
      Annotation: 
       Subtype: Link
       Rect: 347, 126, 356, 114
       ActionDest: 194
     Thumb: true
    Page: 
     Sequence: 11
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 455, 807, 545, 800
      Annotation: 
       Subtype: Link
       Rect: 49, 41, 122, 33
      Annotation: 
       Subtype: Link
       Rect: 499, 41, 545, 33
      Annotation: 
       Subtype: Link
       Rect: 279, 714, 288, 702
       ActionDest: 194
      Annotation: 
       Subtype: Link
       Rect: 66, 702, 75, 690
       ActionDest: 194
      Annotation: 
       Subtype: Link
       Rect: 79, 702, 87, 690
       ActionDest: 194
      Annotation: 
       Subtype: Link
       Rect: 260, 582, 269, 570
       ActionDest: 194
      Annotation: 
       Subtype: Link
       Rect: 124, 294, 132, 282
       ActionDest: 194
      Annotation: 
       Subtype: Link
       Rect: 109, 150, 117, 138
       ActionDest: 194
      Annotation: 
       Subtype: Link
       Rect: 473, 498, 482, 486
       ActionDest: 194
      Annotation: 
       Subtype: Link
       Rect: 459, 450, 468, 438
       ActionDest: 194
     Thumb: true
    Page: 
     Sequence: 12
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 455, 807, 545, 800
      Annotation: 
       Subtype: Link
       Rect: 49, 41, 122, 33
      Annotation: 
       Subtype: Link
       Rect: 499, 41, 545, 33
      Annotation: 
       Subtype: Link
       Rect: 152, 462, 160, 450
       ActionDest: 194
      Annotation: 
       Subtype: Link
       Rect: 258, 186, 267, 174
       ActionDest: 194
      Annotation: 
       Subtype: Link
       Rect: 271, 126, 280, 114
       ActionDest: 194
      Annotation: 
       Subtype: Link
       Rect: 340, 174, 349, 162
       ActionDest: 194
     Thumb: true
    Page: 
     Sequence: 13
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 455, 807, 545, 800
      Annotation: 
       Subtype: Link
       Rect: 49, 41, 122, 33
      Annotation: 
       Subtype: Link
       Rect: 499, 41, 545, 33
     Thumb: true
    Page: 
     Sequence: 14
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 455, 807, 545, 800
      Annotation: 
       Subtype: Link
       Rect: 49, 41, 122, 33
      Annotation: 
       Subtype: Link
       Rect: 499, 41, 545, 33
      Annotation: 
       Subtype: Link
       Rect: 49, 734, 139, 725
      Annotation: 
       Subtype: Link
       Rect: 93, 706, 139, 697
      Annotation: 
       Subtype: Link
       Rect: 153, 686, 232, 677
      Annotation: 
       Subtype: Link
       Rect: 218, 638, 287, 629
      Annotation: 
       Subtype: Link
       Rect: 97, 610, 192, 601
      Annotation: 
       Subtype: Link
       Rect: 49, 581, 121, 572
      Annotation: 
       Subtype: Link
       Rect: 151, 560, 239, 551
      Annotation: 
       Subtype: Link
       Rect: 49, 531, 152, 522
      Annotation: 
       Subtype: Link
       Rect: 61, 466, 134, 457
      Annotation: 
       Subtype: Link
       Rect: 132, 446, 192, 437
      Annotation: 
       Subtype: Link
       Rect: 123, 426, 201, 417
      Annotation: 
       Subtype: Link
       Rect: 197, 398, 290, 389
      Annotation: 
       Subtype: Link
       Rect: 208, 378, 271, 369
      Annotation: 
       Subtype: Link
       Rect: 265, 358, 290, 349
      Annotation: 
       Subtype: Link
       Rect: 49, 350, 114, 341
      Annotation: 
       Subtype: Link
       Rect: 146, 322, 238, 313
      Annotation: 
       Subtype: Link
       Rect: 265, 286, 290, 277
      Annotation: 
       Subtype: Link
       Rect: 49, 278, 118, 269
      Annotation: 
       Subtype: Link
       Rect: 198, 258, 276, 249
      Annotation: 
       Subtype: Link
       Rect: 348, 726, 403, 717
      Annotation: 
       Subtype: Link
       Rect: 517, 698, 545, 689
      Annotation: 
       Subtype: Link
       Rect: 304, 690, 352, 681
      Annotation: 
       Subtype: Link
       Rect: 521, 662, 545, 653
      Annotation: 
       Subtype: Link
       Rect: 304, 654, 358, 645
      Annotation: 
       Subtype: Link
       Rect: 304, 626, 377, 617
      Annotation: 
       Subtype: Link
       Rect: 436, 598, 527, 589
      Annotation: 
       Subtype: Link
       Rect: 443, 570, 535, 561
      Annotation: 
       Subtype: Link
       Rect: 348, 534, 408, 525
      Annotation: 
       Subtype: Link
       Rect: 521, 506, 545, 497
      Annotation: 
       Subtype: Link
       Rect: 304, 498, 358, 489
      Annotation: 
       Subtype: Link
       Rect: 304, 462, 357, 453
      Annotation: 
       Subtype: Link
       Rect: 517, 434, 545, 425
      Annotation: 
       Subtype: Link
       Rect: 304, 426, 361, 417
      Annotation: 
       Subtype: Link
       Rect: 399, 406, 490, 397
      Annotation: 
       Subtype: Link
       Rect: 517, 378, 545, 369
      Annotation: 
       Subtype: Link
       Rect: 304, 370, 369, 361
      Annotation: 
       Subtype: Link
       Rect: 494, 350, 545, 341
      Annotation: 
       Subtype: Link
       Rect: 304, 342, 329, 333
      Annotation: 
       Subtype: Link
       Rect: 304, 314, 374, 305
      Annotation: 
       Subtype: Link
       Rect: 415, 286, 493, 277
      Annotation: 
       Subtype: Link
       Rect: 423, 266, 545, 257
      Annotation: 
       Subtype: Link
       Rect: 304, 258, 382, 249
     Thumb: true
  Checksum: 0808cd48
   Type: CRC32
  Checksum: 8492ea17d12047145b1d9bd11cb5dfeb
   Type: MD5
  Checksum: f7394ad443f4e908c00606fcad7da7c507a17bf2
   Type: SHA-1
  Checksum: be66c95956be806479552f942aa188f2266bbb34f0cc16caa601c96ea22a726f
   Type: SHA-256