756ecc2bb7e85ae1f520b6c677e2cc74 fcaf437.pdf f65096f740038f4f98b621650e02337ecb10708c fcaf437.pdf 1b1395489646396e70a35e288afbe94039dc098dd7761ccb92d3f483b1ec30c2 fcaf437.pdf Title: Sleep-related changes in astrocytic biomarkers are modulated by APOE ε4 genotype in cognitively unimpaired adults Subject: DOI: 10.1093/braincomms/fcaf437; Brain Communications, 7, 6, 2025-11-07.; Abstract: Astrocytes are key regulators of sleep and neuroinflammatory responses. However, the relationship between objective sleep parameters and astrocytic fluid biomarkers in cognitively unimpaired individuals remains unclear. We examined how sleep architecture relates to astrocytic, neuroaxonal and Alzheimer’s disease-related fluid biomarkers in cognitively unimpaired adults and whether age, sex and APOE ε4 moderate these associations. This cross-sectional study included 51 cognitively unimpaired participants from the Sant Pau Initiative on Neurodegeneration cohort. One-night in-lab polysomnography was used to quantify sleep architecture, fragmentation, slow-wave activity and respiratory parameters. CSF biomarkers included glial fibrillary acidic protein (GFAP), chitinase-like-3 protein 1 (YKL-40), Aβ42, Aβ40, pTau181 and tTau; plasma biomarkers included GFAP and neurofilament light chain (NfL). Association Keywords: astrocytes; Alzheimer’s disease-related proteins; polysomnography; apolipoprotein ε4; cognitively unimpaired individual Author: Nuole Zhu 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: Tue Nov 18 11:48:15 2025 CET ModDate: Thu Dec 4 12:41:36 2025 CET Custom Metadata: yes Metadata Stream: yes Tagged: yes UserProperties: no Suspects: no Form: AcroForm JavaScript: no Pages: 16 Encrypted: no Page size: 612.283 x 790.866 pts Page rot: 0 File size: 1475168 bytes Optimized: no PDF version: 1.6 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- GOFPNW+TimesNewRomanPS-BoldMT CID TrueType Identity-H yes yes yes 78 0 VBCXFA+TimesNewRomanPSMT CID TrueType Identity-H yes yes yes 43 0 WVTALK+TimesNewRomanPS-ItalicMT CID TrueType Identity-H yes yes yes 60 0 KTJSVD+GillSansMTStd-Medium Type 1C Custom yes yes yes 44 0 CVJIDW+GillSansMTStd-Bold Type 1C Custom yes yes yes 41 0 PKLYEF+GillSansMTStd-BoldItalic Type 1C Custom yes yes yes 59 0 EGIVLW+SabonLTStd-Roman Type 1C Custom yes yes yes 42 0 PRGGQL+SabonLTStd-Italic Type 1C Custom yes yes yes 51 0 OEJMGX+STIXGeneral-Regular Type 1C Custom yes yes yes 55 0 WSUMCK+ArialMT TrueType WinAnsi yes yes no 1 0 UWWKIV+GillSansMT Type 1 Custom yes yes no 1451 0 UIFIOL+GillSansMTStd-MediumItalic Type 1C Custom yes yes yes 45 0 ZOXVZR+STIXGeneral-Bold Type 1C Custom yes yes yes 64 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2025-12-05 04:26:26 CET RepresentationInformation: fcaf437.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2025-12-04 12:45:08 CET Size: 1475168 Format: PDF Version: 1.6 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf Profile: Tagged PDF PDFMetadata: Objects: 1504 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: Sleep-related changes in astrocytic biomarkers are modulated by APOE ε4 genotype in cognitively unimpaired adults Destination: head1 Children: Item: Title: Introduction Destination: secfcaf437-s1 Item: Title: Materials and methods Destination: secfcaf437-s2 Children: Item: Title: Ethics approval and consent to participate Destination: secfcaf437-s2.1 Item: Title: Participants and study design Destination: secfcaf437-s2.2 Item: Title: Polysomnography Destination: secfcaf437-s2.3 Item: Title: Blood and CSF collection and analysis Destination: secfcaf437-s2.4 Item: Title: APOE status determination Destination: secfcaf437-s2.5 Item: Title: Statistical analyses Destination: secfcaf437-s2.6 Item: Title: Results Destination: secfcaf437-s3 Children: Item: Title: Participants characteristics Destination: secfcaf437-s3.1 Item: Title: Bivariate associations between sleep parameters and fluid biomarkers Destination: secfcaf437-s3.2 Item: Title: Multivariate associations between sleep parameters and astrocytic-neuroaxonal fluid biomarkers Destination: secfcaf437-s3.3 Item: Title: Multivariate associations between sleep parameters and CSF Alzheimer’s disease-related proteins Destination: secfcaf437-s3.4 Item: Title: Moderating effects of APOE ε4, age and sex on the associations between sleep parameters and fluid biomarkers Destination: secfcaf437-s3.5 Item: Title: Discussion Destination: secfcaf437-s4 Children: Item: Title: Strengths and limitations Destination: secfcaf437-s4.1 Item: Title: Conclusion Destination: secfcaf437-s5 Item: Title: Supplementary material Destination: secfcaf437-s6 Item: Title: Acknowledgements Destination: acknow Item: Title: Funding Destination: secfcaf437-s7 Item: Title: Competing interests Destination: secfcaf437-s8 Item: Title: Data availability Destination: secfcaf437-s9 Item: Title: References Destination: reflist Info: Title: Sleep-related changes in astrocytic biomarkers are modulated by APOE ε4 genotype in cognitively unimpaired adults Author: Nuole Zhu Subject: DOI: 10.1093/braincomms/fcaf437; Brain Communications, 7, 6, 2025-11-07.; Abstract: Astrocytes are key regulators of sleep and neuroinflammatory responses. However, the relationship between objective sleep parameters and astrocytic fluid biomarkers in cognitively unimpaired individuals remains unclear. We examined how sleep architecture relates to astrocytic, neuroaxonal and Alzheimer’s disease-related fluid biomarkers in cognitively unimpaired adults and whether age, sex and APOE ε4 moderate these associations. This cross-sectional study included 51 cognitively unimpaired participants from the Sant Pau Initiative on Neurodegeneration cohort. One-night in-lab polysomnography was used to quantify sleep architecture, fragmentation, slow-wave activity and respiratory parameters. CSF biomarkers included glial fibrillary acidic protein (GFAP), chitinase-like-3 protein 1 (YKL-40), Aβ42, Aβ40, pTau181 and tTau; plasma biomarkers included GFAP and neurofilament light chain (NfL). Association Keywords: astrocytes; Alzheimer’s disease-related proteins; polysomnography; apolipoprotein ε4; cognitively unimpaired individual 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: Tue Nov 18 12:18:15 CET 2025 ModDate: Thu Dec 04 12:41:36 CET 2025 ID: 0x97a43b134708284cc7fb340ad05ded7a, 0xcf6478143dbd8749a55be287cdd50c50 Filters: FilterPipeline: FlateDecode FilterPipeline: DCTDecode Images: Image: NisoImageMetadata: FormatName: image/jpg CompressionScheme: JPEG ImageWidth: 933 ImageHeight: 933 ColorSpace: RGB BitsPerSample: 8 BitsPerSampleUnit: integer Image: NisoImageMetadata: FormatName: image/jpg CompressionScheme: JPEG ImageWidth: 1286 ImageHeight: 1029 ColorSpace: RGB BitsPerSample: 8 BitsPerSampleUnit: integer Image: NisoImageMetadata: FormatName: image/jpg CompressionScheme: JPEG ImageWidth: 1066 ImageHeight: 1280 ColorSpace: RGB BitsPerSample: 8 BitsPerSampleUnit: integer Image: NisoImageMetadata: FormatName: image/jpg CompressionScheme: JPEG ImageWidth: 1727 ImageHeight: 1017 ColorSpace: RGB BitsPerSample: 8 BitsPerSampleUnit: integer Image: NisoImageMetadata: FormatName: image/jpg CompressionScheme: JPEG ImageWidth: 1066 ImageHeight: 1338 ColorSpace: RGB BitsPerSample: 8 BitsPerSampleUnit: integer Fonts: Type0: Font: BaseFont: VBCXFA+TimesNewRomanPSMT Encoding: Identity-H ToUnicode: true Font: BaseFont: WVTALK+TimesNewRomanPS-ItalicMT Encoding: Identity-H ToUnicode: true Font: BaseFont: GOFPNW+TimesNewRomanPS-BoldMT Encoding: Identity-H ToUnicode: true Type1: Font: BaseFont: ZOXVZR+STIXGeneral-Bold FontSubset: true FirstChar: 1 LastChar: 1 FontDescriptor: FontName: ZOXVZR+STIXGeneral-Bold Flags: Nonsymbolic, ForceBold FontBBox: -1030, -455, 2000, 1055 FontFile3: true EncodingDictionary: BaseEncoding: WinAnsiEncoding Differences: true ToUnicode: true Font: BaseFont: PRGGQL+SabonLTStd-Italic FontSubset: true FirstChar: 1 LastChar: 42 FontDescriptor: FontName: PRGGQL+SabonLTStd-Italic Flags: Nonsymbolic, Italic FontBBox: -146, -228, 1059, 927 FontFile3: true EncodingDictionary: BaseEncoding: WinAnsiEncoding Differences: true ToUnicode: true Font: BaseFont: OEJMGX+STIXGeneral-Regular FontSubset: true FirstChar: 1 LastChar: 9 FontDescriptor: FontName: OEJMGX+STIXGeneral-Regular Flags: Nonsymbolic FontBBox: -995, -455, 2000, 1055 FontFile3: true EncodingDictionary: BaseEncoding: WinAnsiEncoding Differences: true ToUnicode: true Font: BaseFont: CVJIDW+GillSansMTStd-Bold FontSubset: true FirstChar: 1 LastChar: 70 FontDescriptor: FontName: CVJIDW+GillSansMTStd-Bold Flags: Nonsymbolic, ForceBold FontBBox: -177, -237, 1167, 957 FontFile3: true EncodingDictionary: BaseEncoding: WinAnsiEncoding Differences: true ToUnicode: true Font: BaseFont: EGIVLW+SabonLTStd-Roman FontSubset: true FirstChar: 1 LastChar: 98 FontDescriptor: FontName: EGIVLW+SabonLTStd-Roman Flags: Nonsymbolic FontBBox: -165, -228, 1000, 944 FontFile3: true EncodingDictionary: BaseEncoding: WinAnsiEncoding Differences: true ToUnicode: true Font: BaseFont: PKLYEF+GillSansMTStd-BoldItalic FontSubset: true FirstChar: 1 LastChar: 8 FontDescriptor: FontName: PKLYEF+GillSansMTStd-BoldItalic Flags: Nonsymbolic, Italic, ForceBold FontBBox: -190, -237, 1074, 959 FontFile3: true EncodingDictionary: BaseEncoding: WinAnsiEncoding Differences: true ToUnicode: true Font: BaseFont: KTJSVD+GillSansMTStd-Medium FontSubset: true FirstChar: 2 LastChar: 77 FontDescriptor: FontName: KTJSVD+GillSansMTStd-Medium Flags: Nonsymbolic FontBBox: -162, -234, 1041, 931 FontFile3: true EncodingDictionary: BaseEncoding: WinAnsiEncoding Differences: true ToUnicode: true Font: BaseFont: UIFIOL+GillSansMTStd-MediumItalic FontSubset: true FirstChar: 1 LastChar: 12 FontDescriptor: FontName: UIFIOL+GillSansMTStd-MediumItalic Flags: Nonsymbolic, Italic FontBBox: -201, -233, 1009, 931 FontFile3: true EncodingDictionary: BaseEncoding: WinAnsiEncoding Differences: true ToUnicode: true TrueType: Font: BaseFont: WSUMCK+ArialMT FontSubset: true FirstChar: 32 LastChar: 121 FontDescriptor: FontName: WSUMCK+ArialMT Flags: Nonsymbolic FontBBox: -664, -324, 2000, 1039 FontFile2: true Encoding: WinAnsiEncoding CIDFontType2: Font: BaseFont: GOFPNW+TimesNewRomanPS-BoldMT CIDSystemInfo: Registry: Adobe Registry: Identity Supplement: 0 FontDescriptor: FontName: GOFPNW+TimesNewRomanPS-BoldMT Flags: Nonsymbolic, ForceBold FontBBox: -558, -328, 2000, 1056 FontFile2: true Font: BaseFont: VBCXFA+TimesNewRomanPSMT CIDSystemInfo: Registry: Adobe Registry: Identity Supplement: 0 FontDescriptor: FontName: VBCXFA+TimesNewRomanPSMT Flags: Nonsymbolic FontBBox: -568, -307, 2046, 1040 FontFile2: true Font: BaseFont: WVTALK+TimesNewRomanPS-ItalicMT CIDSystemInfo: Registry: Adobe Registry: Identity Supplement: 0 FontDescriptor: FontName: WVTALK+TimesNewRomanPS-ItalicMT Flags: Nonsymbolic, Italic FontBBox: -498, -307, 1333, 1023 FontFile2: true XMP: uuid:04d83ccf-c99b-49ad-ac6f-1be80192d33b uuid:F3381BF3-EA87-0916-ADC0-847AD47A44D0 True astrocytes; Alzheimer’s disease-related proteins; polysomnography; apolipoprotein ε4; cognitively unimpaired individual PDFlib+PDI 9.0.7p3 (C++/Win64); modified using iTextSharp.LGPLv2.Core 3.7.4.0 application/pdf 10.1093/braincomms/fcaf437 en Oxford University Press Sleep-related changes in astrocytic biomarkers are modulated by APOE ε4 genotype in cognitively unimpaired adults Nuole Zhu Miren Altuna Javier Arranz Íñigo Rodriguez-Baz Maria Belén Sanchez-Saudinós Laura Videla Sílvia Valldeneu Mireia Carrera-Vega Sergio Romero Juan Fortea Alberto Lleó Sandra Giménez Daniel Alcolea DOI: 10.1093/braincomms/fcaf437; Brain Communications, 7, 6, 2025-11-07.; Abstract: Astrocytes are key regulators of sleep and neuroinflammatory responses. However, the relationship between objective sleep parameters and astrocytic fluid biomarkers in cognitively unimpaired individuals remains unclear. We examined how sleep architecture relates to astrocytic, neuroaxonal and Alzheimer’s disease-related fluid biomarkers in cognitively unimpaired adults and whether age, sex and APOE ε4 moderate these associations. This cross-sectional study included 51 cognitively unimpaired participants from the Sant Pau Initiative on Neurodegeneration cohort. One-night in-lab polysomnography was used to quantify sleep architecture, fragmentation, slow-wave activity and respiratory parameters. CSF biomarkers included glial fibrillary acidic protein (GFAP), chitinase-like-3 protein 1 (YKL-40), Aβ42, Aβ40, pTau181 and tTau; plasma biomarkers included GFAP and neurofilament light chain (NfL). Association © The Author(s) 2025. Published by Oxford University Press on behalf of the Guarantors of Brain. astrocytes Alzheimer’s disease-related proteins polysomnography apolipoprotein ε4 cognitively unimpaired individual Journal Brain Communications © The Author(s) 2025. Published by Oxford University Press on behalf of the Guarantors of Brain. 2632-1297 7 6 1 16 10.1093/braincomms/fcaf437 https://doi.org/10.1093/braincomms/fcaf437 2025-11-18T16:18:15+05:30 2025-12-04T11:41:36+00:00 Servigistics Arbortext Advanced Print Publisher 11.1.4546/W-x64 2025-12-04T11:41:36+00:00 PStill version 1.84.42 1 PDF/UA Universal Accessibility Schema http://www.aiim.org/pdfua/ns/id/ pdfuaid part Integer internal Indicates, which part of ISO 14289 standard is followed Pages: Page: Sequence: 1 Annotations: Annotation: Subtype: Link Rect: 56, 557, 66, 567 Flags: Print Annotation: Subtype: Link Rect: 129, 561, 134, 573 Flags: Print Destination: 858 Annotation: Subtype: Link Rect: 137, 561, 142, 573 Flags: Print Destination: 858 Annotation: Subtype: Link Rect: 144, 561, 149, 573 Flags: Print Destination: 858 Annotation: Subtype: Link Rect: 153, 557, 162, 567 Flags: Print Annotation: Subtype: Link Rect: 240, 561, 245, 573 Flags: Print Destination: 858 Annotation: Subtype: Link Rect: 248, 561, 252, 573 Flags: Print Destination: 858 Annotation: Subtype: Link Rect: 334, 561, 339, 573 Flags: Print Destination: 858 Annotation: Subtype: Link Rect: 341, 561, 346, 573 Flags: Print Destination: 858 Annotation: Subtype: Link Rect: 467, 561, 472, 573 Flags: Print Destination: 858 Annotation: Subtype: Link Rect: 474, 561, 479, 573 Flags: Print Destination: 858 Annotation: Subtype: Link Rect: 231, 547, 236, 559 Flags: Print Destination: 858 Annotation: Subtype: Link Rect: 239, 547, 244, 559 Flags: Print Destination: 858 Annotation: Subtype: Link Rect: 321, 547, 326, 559 Flags: Print Destination: 858 Annotation: Subtype: Link Rect: 329, 547, 334, 559 Flags: Print Destination: 858 Annotation: Subtype: Link Rect: 336, 547, 341, 559 Flags: Print Destination: 858 Annotation: Subtype: Link Rect: 437, 547, 442, 559 Flags: Print Destination: 858 Annotation: Subtype: Link Rect: 444, 547, 449, 559 Flags: Print Destination: 858 Annotation: Subtype: Link Rect: 175, 533, 180, 545 Flags: Print Destination: 858 Annotation: Subtype: Link Rect: 272, 533, 277, 545 Flags: Print Destination: 858 Annotation: Subtype: Link Rect: 281, 529, 291, 539 Flags: Print Annotation: Subtype: Link Rect: 360, 533, 365, 545 Flags: Print Destination: 858 Annotation: Subtype: Link Rect: 367, 533, 372, 545 Flags: Print Destination: 858 Annotation: Subtype: Link Rect: 374, 533, 379, 545 Flags: Print Destination: 858 Annotation: Subtype: Link Rect: 458, 533, 463, 545 Flags: Print Destination: 858 Annotation: Subtype: Link Rect: 465, 533, 470, 545 Flags: Print Destination: 858 Annotation: Subtype: Link Rect: 472, 533, 477, 545 Flags: Print Destination: 858 Annotation: Subtype: Link Rect: 56, 515, 66, 525 Flags: Print Annotation: Subtype: Link Rect: 160, 519, 165, 531 Flags: Print Destination: 858 Annotation: Subtype: Link Rect: 168, 519, 173, 531 Flags: Print Destination: 858 Annotation: Subtype: Link Rect: 175, 519, 180, 531 Flags: Print Destination: 37 Annotation: Subtype: Link Rect: 207, 515, 217, 525 Flags: Print Annotation: Subtype: Link Rect: 299, 519, 304, 531 Flags: Print Destination: 858 Annotation: Subtype: Link Rect: 306, 519, 311, 531 Flags: Print Destination: 858 Annotation: Subtype: Link Rect: 56, 180, 70, 189 Flags: Print Destination: 858 Annotation: Subtype: Link Rect: 56, 169, 70, 178 Flags: Print Destination: 858 Annotation: Subtype: Link Rect: 56, 158, 70, 167 Flags: Print Destination: 858 Annotation: Subtype: Link Rect: 56, 147, 70, 156 Flags: Print Destination: 858 Annotation: Subtype: Link Rect: 56, 136, 70, 145 Flags: Print Destination: 858 Annotation: Subtype: Link Rect: 56, 125, 70, 134 Flags: Print Destination: 858 Annotation: Subtype: Link Rect: 56, 114, 70, 123 Flags: Print Destination: 858 Annotation: Subtype: Link Rect: 346, 49, 467, 55 Flags: Print Annotation: Subtype: Link Rect: 56, 750, 206, 759 Flags: Print Page: Sequence: 2 Annotations: Annotation: Subtype: Link Rect: 47, 719, 61, 728 Flags: Print Destination: 858 Annotation: Subtype: Link Rect: 78, 633, 161, 642 Flags: Print Annotation: Subtype: Link Rect: 78, 558, 164, 567 Flags: Print Page: Sequence: 3 Annotations: Annotation: Subtype: Link Rect: 137, 655, 148, 664 Flags: Print Destination: 92 Annotation: Subtype: Link Rect: 98, 606, 102, 615 Flags: Print Destination: 92 Annotation: Subtype: Link Rect: 104, 606, 107, 615 Flags: Print Destination: 92 Annotation: Subtype: Link Rect: 109, 606, 123, 615 Flags: Print Destination: 92 Annotation: Subtype: Link Rect: 83, 543, 93, 552 Flags: Print Destination: 92 Annotation: Subtype: Link Rect: 125, 493, 139, 502 Flags: Print Destination: 92 Annotation: Subtype: Link Rect: 262, 442, 266, 452 Flags: Print Destination: 92 Annotation: Subtype: Link Rect: 267, 442, 285, 452 Flags: Print Destination: 92 Annotation: Subtype: Link Rect: 271, 392, 274, 402 Flags: Print Destination: 92 Annotation: Subtype: Link Rect: 276, 392, 284, 402 Flags: Print Destination: 92 Annotation: Subtype: Link Rect: 77, 344, 81, 354 Flags: Print Destination: 92 Annotation: Subtype: Link Rect: 83, 344, 87, 354 Flags: Print Destination: 92 Annotation: Subtype: Link Rect: 89, 344, 97, 354 Flags: Print Destination: 92 Annotation: Subtype: Link Rect: 99, 344, 106, 354 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 207, 320, 211, 330 Flags: Print Destination: 92 Annotation: Subtype: Link Rect: 213, 320, 221, 330 Flags: Print Destination: 92 Annotation: Subtype: Link Rect: 223, 320, 231, 330 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 127, 284, 145, 294 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 79, 236, 87, 246 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 89, 236, 97, 246 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 203, 212, 211, 222 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 244, 140, 262, 150 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 90, 104, 98, 114 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 206, 56, 214, 66 Flags: Print Destination: 92 Annotation: Subtype: Link Rect: 216, 56, 234, 66 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 446, 692, 454, 702 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 456, 692, 464, 702 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 466, 692, 474, 702 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 425, 608, 443, 618 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 556, 584, 564, 594 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 366, 536, 374, 546 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 376, 536, 384, 546 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 391, 476, 409, 486 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 411, 428, 428, 438 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 465, 392, 473, 402 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 449, 284, 452, 294 Flags: Print Destination: 92 Annotation: Subtype: Link Rect: 454, 284, 462, 294 Flags: Print Destination: 92 Annotation: Subtype: Link Rect: 464, 284, 472, 294 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 474, 284, 482, 294 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 454, 260, 462, 270 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 464, 260, 472, 270 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 413, 188, 417, 198 Flags: Print Destination: 92 Annotation: Subtype: Link Rect: 419, 188, 423, 198 Flags: Print Destination: 92 Annotation: Subtype: Link Rect: 381, 152, 389, 162 Flags: Print Destination: 92 Annotation: Subtype: Link Rect: 391, 152, 399, 162 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 401, 152, 409, 162 Flags: Print Destination: 95 Page: Sequence: 4 Annotations: Annotation: Subtype: Link Rect: 85, 248, 93, 258 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 60, 104, 68, 114 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 128, 80, 136, 90 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 114, 68, 122, 78 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 349, 620, 357, 630 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 408, 572, 416, 582 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 418, 572, 426, 582 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 434, 488, 442, 498 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 444, 488, 452, 498 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 517, 404, 525, 414 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 441, 272, 449, 282 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 517, 212, 525, 222 Flags: Print Destination: 98 Annotation: Subtype: Link Rect: 377, 116, 385, 126 Flags: Print Destination: 98 Page: Sequence: 5 Annotations: Annotation: Subtype: Link Rect: 276, 716, 284, 726 Flags: Print Destination: 98 Annotation: Subtype: Link Rect: 282, 668, 289, 678 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 267, 572, 275, 582 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 276, 572, 284, 582 Flags: Print Destination: 98 Annotation: Subtype: Link Rect: 104, 536, 112, 546 Flags: Print Destination: 98 Annotation: Subtype: Link Rect: 230, 404, 238, 414 Flags: Print Destination: 98 Annotation: Subtype: Link Rect: 320, 148, 351, 157 Flags: Print Destination: 61 Page: Sequence: 6 Annotations: Annotation: Subtype: Link Rect: 314, 424, 409, 433 Flags: Print Annotation: Subtype: Link Rect: 348, 400, 444, 409 Flags: Print Annotation: Subtype: Link Rect: 314, 376, 409, 385 Flags: Print Annotation: Subtype: Link Rect: 411, 364, 506, 373 Flags: Print Annotation: Subtype: Link Rect: 340, 280, 433, 289 Flags: Print Annotation: Subtype: Link Rect: 450, 124, 473, 133 Flags: Print Destination: 67 Page: Sequence: 7 Annotations: Annotation: Subtype: Link Rect: 520, 64, 545, 73 Flags: Print Destination: 71 Annotation: Subtype: Link Rect: 383, 52, 414, 61 Flags: Print Destination: 75 Page: Sequence: 8 Annotations: Annotation: Subtype: Link Rect: 133, 52, 163, 61 Flags: Print Destination: 71 Annotation: Subtype: Link Rect: 504, 88, 533, 97 Flags: Print Destination: 71 Page: Sequence: 9 Annotations: Annotation: Subtype: Link Rect: 148, 506, 178, 515 Flags: Print Destination: 71 Annotation: Subtype: Link Rect: 147, 446, 178, 455 Flags: Print Destination: 71 Annotation: Subtype: Link Rect: 268, 398, 300, 407 Flags: Print Destination: 71 Annotation: Subtype: Link Rect: 56, 386, 83, 395 Flags: Print Destination: 71 Annotation: Subtype: Link Rect: 153, 374, 211, 383 Flags: Print Destination: 71 Annotation: Subtype: Link Rect: 256, 350, 294, 359 Flags: Print Destination: 75 Annotation: Subtype: Link Rect: 268, 160, 300, 169 Flags: Print Destination: 79 Annotation: Subtype: Link Rect: 56, 148, 80, 157 Flags: Print Destination: 79 Annotation: Subtype: Link Rect: 197, 88, 255, 97 Flags: Print Destination: 79 Annotation: Subtype: Link Rect: 239, 52, 270, 61 Flags: Print Destination: 82 Annotation: Subtype: Link Rect: 411, 619, 436, 629 Flags: Print Destination: 86 Annotation: Subtype: Link Rect: 444, 619, 477, 629 Flags: Print Destination: 89 Annotation: Subtype: Link Rect: 533, 475, 564, 485 Flags: Print Destination: 86 Annotation: Subtype: Link Rect: 320, 463, 343, 473 Flags: Print Destination: 86 Annotation: Subtype: Link Rect: 357, 403, 413, 413 Flags: Print Destination: 86 Annotation: Subtype: Link Rect: 342, 307, 435, 317 Flags: Print Annotation: Subtype: Link Rect: 454, 307, 460, 317 Flags: Print Annotation: Subtype: Link Rect: 465, 307, 558, 317 Flags: Print Annotation: Subtype: Link Rect: 449, 235, 558, 245 Flags: Print Annotation: Subtype: Link Rect: 503, 211, 564, 221 Flags: Print Annotation: Subtype: Link Rect: 320, 199, 351, 209 Flags: Print Page: Sequence: 10 Page: Sequence: 11 Annotations: Annotation: Subtype: Link Rect: 232, 452, 240, 462 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 151, 380, 159, 390 Flags: Print Destination: 92 Annotation: Subtype: Link Rect: 161, 380, 179, 390 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 181, 380, 189, 390 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 99, 332, 107, 342 Flags: Print Destination: 98 Annotation: Subtype: Link Rect: 109, 332, 117, 342 Flags: Print Destination: 98 Annotation: Subtype: Link Rect: 280, 272, 284, 282 Flags: Print Destination: 92 Annotation: Subtype: Link Rect: 286, 272, 290, 282 Flags: Print Destination: 92 Annotation: Subtype: Link Rect: 292, 272, 300, 282 Flags: Print Destination: 98 Annotation: Subtype: Link Rect: 240, 128, 247, 138 Flags: Print Destination: 98 Annotation: Subtype: Link Rect: 249, 128, 257, 138 Flags: Print Destination: 98 Annotation: Subtype: Link Rect: 226, 92, 234, 102 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 236, 92, 243, 102 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 391, 680, 399, 690 Flags: Print Destination: 98 Annotation: Subtype: Link Rect: 550, 632, 558, 642 Flags: Print Destination: 98 Annotation: Subtype: Link Rect: 437, 584, 448, 594 Flags: Print Destination: 92 Annotation: Subtype: Link Rect: 356, 524, 360, 534 Flags: Print Destination: 92 Annotation: Subtype: Link Rect: 362, 524, 366, 534 Flags: Print Destination: 92 Annotation: Subtype: Link Rect: 453, 500, 457, 510 Flags: Print Destination: 92 Annotation: Subtype: Link Rect: 556, 344, 564, 354 Flags: Print Destination: 98 Annotation: Subtype: Link Rect: 502, 308, 510, 318 Flags: Print Destination: 98 Annotation: Subtype: Link Rect: 360, 272, 368, 282 Flags: Print Destination: 98 Annotation: Subtype: Link Rect: 385, 164, 393, 174 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 395, 164, 403, 174 Flags: Print Destination: 98 Annotation: Subtype: Link Rect: 523, 128, 531, 138 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 533, 128, 541, 138 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 542, 128, 550, 138 Flags: Print Destination: 98 Annotation: Subtype: Link Rect: 467, 92, 475, 102 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 477, 92, 485, 102 Flags: Print Destination: 98 Annotation: Subtype: Link Rect: 435, 80, 442, 90 Flags: Print Destination: 95 Page: Sequence: 12 Page: Sequence: 13 Annotations: Annotation: Subtype: Link Rect: 254, 582, 262, 592 Flags: Print Destination: 98 Annotation: Subtype: Link Rect: 183, 534, 191, 544 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 193, 534, 201, 544 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 203, 534, 221, 544 Flags: Print Destination: 98 Annotation: Subtype: Link Rect: 286, 308, 290, 318 Flags: Print Destination: 92 Annotation: Subtype: Link Rect: 292, 308, 300, 318 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 266, 248, 270, 258 Flags: Print Destination: 92 Annotation: Subtype: Link Rect: 272, 248, 280, 258 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 282, 248, 290, 258 Flags: Print Destination: 95 Annotation: Subtype: Link Rect: 292, 248, 300, 258 Flags: Print Destination: 98 Annotation: Subtype: Link Rect: 472, 346, 564, 355 Flags: Print Page: Sequence: 14 Annotations: Annotation: Subtype: Link Rect: 47, 52, 137, 61 Flags: Print Annotation: Subtype: Link Rect: 311, 604, 316, 612 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 311, 574, 316, 582 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 311, 534, 316, 542 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 311, 494, 316, 502 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 311, 464, 316, 472 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 311, 434, 316, 442 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 311, 404, 316, 412 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 311, 374, 316, 381 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 311, 343, 316, 351 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 311, 323, 320, 331 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 311, 293, 320, 301 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 311, 253, 320, 261 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 311, 223, 320, 231 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 311, 183, 320, 191 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 311, 153, 320, 161 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 311, 123, 320, 131 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 311, 92, 320, 100 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 311, 72, 320, 80 Flags: Print Destination: 48 Page: Sequence: 15 Annotations: Annotation: Subtype: Link Rect: 56, 725, 65, 733 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 56, 695, 65, 703 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 56, 665, 65, 673 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 56, 645, 65, 653 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 56, 605, 65, 613 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 56, 585, 65, 593 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 56, 555, 65, 563 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 56, 524, 65, 532 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 56, 494, 65, 502 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 56, 464, 65, 472 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 56, 424, 65, 432 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 56, 394, 65, 402 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 56, 364, 65, 372 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 56, 334, 65, 342 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 56, 304, 65, 312 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 56, 263, 65, 271 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 56, 233, 65, 241 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 56, 203, 65, 211 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 56, 173, 65, 181 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 56, 143, 65, 151 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 56, 113, 65, 121 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 56, 73, 65, 81 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 320, 725, 329, 733 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 320, 705, 329, 713 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 320, 675, 329, 683 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 320, 655, 329, 663 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 320, 625, 329, 633 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 320, 595, 329, 603 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 320, 565, 329, 573 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 320, 535, 329, 543 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 320, 504, 329, 512 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 320, 474, 329, 482 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 320, 434, 329, 442 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 320, 404, 329, 412 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 320, 374, 329, 382 Flags: Print Destination: 48 Annotation: Subtype: Link Rect: 320, 334, 329, 342 Flags: Print Destination: 52 Annotation: Subtype: Link Rect: 320, 294, 329, 302 Flags: Print Destination: 52 Annotation: Subtype: Link Rect: 320, 263, 329, 271 Flags: Print Destination: 52 Annotation: Subtype: Link Rect: 320, 223, 329, 231 Flags: Print Destination: 52 Annotation: Subtype: Link Rect: 320, 203, 329, 211 Flags: Print Destination: 52 Annotation: Subtype: Link Rect: 320, 173, 329, 181 Flags: Print Destination: 52 Annotation: Subtype: Link Rect: 320, 133, 329, 141 Flags: Print Destination: 52 Annotation: Subtype: Link Rect: 320, 113, 329, 121 Flags: Print Destination: 52 Annotation: Subtype: Link Rect: 320, 73, 329, 81 Flags: Print Destination: 52 Page: Sequence: 16 Annotations: Annotation: Subtype: Link Rect: 47, 725, 56, 733 Flags: Print Destination: 52 Annotation: Subtype: Link Rect: 47, 695, 56, 703 Flags: Print Destination: 52 Annotation: Subtype: Link Rect: 47, 665, 56, 673 Flags: Print Destination: 56 Annotation: Subtype: Link Rect: 47, 625, 56, 633 Flags: Print Destination: 56 Annotation: Subtype: Link Rect: 47, 595, 56, 603 Flags: Print Destination: 56 Annotation: Subtype: Link Rect: 47, 555, 56, 563 Flags: Print Destination: 56 Annotation: Subtype: Link Rect: 47, 514, 56, 522 Flags: Print Destination: 82 Annotation: Subtype: Link Rect: 47, 474, 56, 482 Flags: Print Destination: 82 Annotation: Subtype: Link Rect: 47, 444, 56, 452 Flags: Print Destination: 82 Annotation: Subtype: Link Rect: 47, 414, 56, 422 Flags: Print Destination: 82 Annotation: Subtype: Link Rect: 47, 384, 56, 392 Flags: Print Destination: 82 Annotation: Subtype: Link Rect: 311, 725, 320, 733 Flags: Print Destination: 82 Annotation: Subtype: Link Rect: 311, 685, 320, 693 Flags: Print Destination: 82 Annotation: Subtype: Link Rect: 311, 655, 320, 663 Flags: Print Destination: 82 Annotation: Subtype: Link Rect: 311, 625, 320, 633 Flags: Print Destination: 82 Annotation: Subtype: Link Rect: 311, 585, 320, 593 Flags: Print Destination: 82 Annotation: Subtype: Link Rect: 311, 555, 320, 563 Flags: Print Destination: 82 Annotation: Subtype: Link Rect: 311, 514, 320, 522 Flags: Print Destination: 82 Annotation: Subtype: Link Rect: 311, 474, 320, 482 Flags: Print Destination: 89 Annotation: Subtype: Link Rect: 311, 444, 320, 452 Flags: Print Destination: 89 Annotation: Subtype: Link Rect: 311, 414, 320, 422 Flags: Print Destination: 89 Annotation: Subtype: Link Rect: 311, 384, 320, 392 Flags: Print Destination: 89 Checksum: d3d59282 Type: CRC32 Checksum: 756ecc2bb7e85ae1f520b6c677e2cc74 Type: MD5 Checksum: f65096f740038f4f98b621650e02337ecb10708c Type: SHA-1 Checksum: 1b1395489646396e70a35e288afbe94039dc098dd7761ccb92d3f483b1ec30c2 Type: SHA-256