6c262baef9f6007ac9d534c6c70bf69d jouclimed_a2020v9n10p3246.pdf d108b55cea548498dca4ead66fc624ab805b08e8 jouclimed_a2020v9n10p3246.pdf d8d18331e0df7b22e5bb572fc1241f021da2b4b1f302c34ce76622c8d89c5944 jouclimed_a2020v9n10p3246.pdf Title: Mindfulness-Based Program Plus Amygdala and Insula Retraining (MAIR) for the Treatment of Women with Fibromyalgia: A Pilot Randomized Controlled Trial Subject: The lack of highly effective treatments for fibromyalgia (FM) represents a great challenge for public health. The objective of this parallel, pilot randomized controlled trial (RCT) was two-fold: (1) to analyze the clinical effects of mindfulness plus amygdala and insula retraining (MAIR) compared to a structurally equivalent active control group of relaxation therapy (RT) in the treatment of FM; and (2) to evaluate its impact on immune-inflammatory markers and brain-derived neurotrophic factor (BDNF) in serum. A total of 41 FM patients were randomized into two study arms: MAIR (intervention group) and RT (active control group), both as add-ons of treatment as usual. MAIR demonstrated significantly greater reductions in functional impairment, anxiety, and depression, as well as higher improvements in mindfulness, and self-compassion at post-treatment and follow-up, with moderate to large effect sizes. Significant decreases in pain catastrophizing and psychological inflexibility and improvements in clinical severity and health-related quality of life were found at follow-up, but not at post-treatment, showing large effect sizes. The number needed to treat was three based on the criteria of 50% Fibromyalgia Impact Questionnaire (FIQ) reduction post-treatment. Compared to RT, the MAIR showed significant decreases in BDNF. No effect of MAIR was observed in immune-inflammatory biomarkers (i.e., TNF-, IL-6, IL-10, and hs-CRP). In conclusion, these results suggest that MAIR, as an adjuvant of treatment-as-usual (TAU), appears to be effective for the management of FM symptoms and for reducing BDNF levels in serum. Keywords: fibromyalgia; mindfulness; amygdala and insula retraining; mind–body techniques; multicomponent intervention; brain-derived neurotrophic factor; immune-inflammatory markers; randomized controlled trial; pilot study Author: Juan P. Sanabria-Mazo, Jesus Montero-Marin, Albert Feliu-Soler, Virginia Gasión, Mayte Navarro-Gil, Héctor Morillo-Sarto, Ariadna Colomer-Carbonell, Xavier Borràs, Mattie Tops, Juan V. Luciano and Javier García-Campayo Creator: LaTeX with hyperref package Producer: pdfTeX-1.40.18 CreationDate: Sun Oct 11 12:11:20 2020 CEST ModDate: Sun Oct 11 12:11:20 2020 CEST Custom Metadata: yes Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 16 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 626411 bytes Optimized: no PDF version: 1.5 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- EYZCXA+URWPalladioL-Ital Type 1 Custom yes yes no 118 0 FERASI+URWPalladioL-Bold Type 1 Custom yes yes no 119 0 KGZKFU+Pxbsy Type 1 Builtin yes yes no 120 0 ZSBPMM+VnURWPalladioL-Bold Type 1 Custom yes yes no 121 0 CQXCJX+URWPalladioL-Roma Type 1 Custom yes yes no 122 0 HKQHZQ+VnURWPalladioL Type 1 Custom yes yes no 123 0 OFLXAT+Rpxr Type 1 Builtin yes yes no 124 0 NFJHER+Pxsy Type 1 Builtin yes yes no 125 0 ZIPEAN+EURM10 Type 1 Builtin yes yes no 126 0 BSDWLC+TimesNewRomanPSMT Type 1C WinAnsi yes yes no 131 0 XPUSBJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 132 0 MCBCCI+SourceSansRoman-Regular Type 1C Custom yes yes no 151 0 MCBCCM+SourceSansRoman.613wght Type 1C Custom yes yes no 152 0 MCBCCO+SourceSansRoman-Bold Type 1C Custom yes yes no 153 0 FANMEB+PalatinoLinotype TrueType WinAnsi yes yes no 258 0 FANMKB+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 259 0 FANMLC+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 260 0 FANNDA+TimesNewRoman CID TrueType Identity-H yes yes yes 261 0 VSHNAE+Rpcxr Type 1 Builtin yes yes no 315 0 OCBYQX+URWPalladioL-BoldItal Type 1 Custom yes yes no 330 0 NAOUCR+Rpxb Type 1 Builtin yes yes no 331 0 JNLIIF+Rpxi Type 1 Builtin yes yes no 332 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2024-10-02 04:25:38 CEST RepresentationInformation: jouclimed_a2020v9n10p3246.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2023-03-31 11:39:23 CEST Size: 626411 Format: PDF Version: 1.5 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 0 FreeObjects: 3 IncrementalUpdates: 0 DocumentCatalog: ViewerPreferences: HideToolbar: false HideMenubar: false HideWindowUI: false FitWindow: true CenterWindow: false DisplayDocTitle: false NonFullScreenPageMode: UseNone Direction: L2R ViewArea: CropBox ViewClip: CropBox PrintArea: CropBox PageClip: CropBox PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: ぉのぴひはつふっぴどはの〠 Item: Title: ぅへばづひどねづのぴちぬ〠こづっぴどはの〠 Children: Item: Title: げづびづちひっと〠いづびどでの〠 Item: Title: こぴふつべ〠こちねばぬづ〠 Item: Title: ぐひはっづつふひづ〠 Item: Title: ごひづちぴねづのぴび〠 Children: Item: Title: げづぬちへちぴどはの〠ごとづひちばべ〠〨げご〩〠 Item: Title: きどのつてふぬのづびび〠〫〠ぁねべでつちぬち〠ちのつ〠ぉのびふぬち〠げづぴひちどのどので〠〨きぁぉげ〩〠 Item: Title: きづちびふひづび〠 Children: Item: Title: こはっどは〭いづねはでひちばとどっ〠ぃとちひちっぴづひどびぴどっび〠 Item: Title: ぐひどねちひべ〠くふぴっはねづ〠 Item: Title: こづっはのつちひべ〠くふぴっはねづび〠 Item: Title: あどはねちひにづひび〠くふぴっはねづび〠 Item: Title: いちぴち〠ぁのちぬべびづび〠 Item: Title: げづびふぬぴび〠 Children: Item: Title: ぐちぴどづのぴび〠うぬはぷ〠ちのつ〠ぃはねばぬどちのっづ〠 Item: Title: あちびづぬどのづ〠こはっどは〭いづねはでひちばとどっ〠ちのつ〠ぃぬどのどっちぬ〠ぃとちひちっぴづひどびぴどっび〠はて〠ぐちぴどづのぴび〠 Item: Title: ぅててづっぴび〠はの〠ぐひどねちひべ〠ちのつ〠こづっはのつちひべ〠くふぴっはねづび〠 Item: Title: ぅててづっぴび〠はの〠あどはねちひにづひび〠 Item: Title: ぁぢびはぬふぴづ〠げどびに〠げづつふっぴどはの〠ちのつ〠ぎふねぢづひ〠ぎづづつづつ〠ぴは〠ごひづちぴ〠〨ぎぎご〩〠 Item: Title: ぐちぴどづのぴ〠ぐひづてづひづのっづび〠ちのつ〠ぃひづつどぢどぬどぴべ〠はて〠ごとづひちばどづび〠 Item: Title: いどびっふびびどはの〠 Item: Title: げづてづひづのっづび Filters: FilterPipeline: FlateDecode Fonts: Type1: Font: BaseFont: OCBYQX+URWPalladioL-BoldItal FontSubset: true FirstChar: 100 LastChar: 122 FontDescriptor: FontName: OCBYQX+URWPalladioL-BoldItal Flags: Symbolic FontBBox: -170, -300, 1073, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: NAOUCR+Rpxb FontSubset: true FirstChar: 60 LastChar: 61 FontDescriptor: FontName: NAOUCR+Rpxb Flags: Symbolic FontBBox: -57, -266, 932, 729 FontFile: true Font: BaseFont: JNLIIF+Rpxi FontSubset: true FirstChar: 11 LastChar: 47 FontDescriptor: FontName: JNLIIF+Rpxi Flags: Symbolic FontBBox: -162, -280, 856, 733 FontFile: true Font: BaseFont: EYZCXA+URWPalladioL-Ital FontSubset: true FirstChar: 3 LastChar: 122 FontDescriptor: FontName: EYZCXA+URWPalladioL-Ital Flags: Symbolic FontBBox: -170, -305, 1010, 941 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: FERASI+URWPalladioL-Bold FontSubset: true FirstChar: 3 LastChar: 122 FontDescriptor: FontName: FERASI+URWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: KGZKFU+Pxbsy FontSubset: true FirstChar: 0 LastChar: 122 FontDescriptor: FontName: KGZKFU+Pxbsy Flags: Symbolic FontBBox: 5, -978, 1382, 913 FontFile: true Font: BaseFont: ZSBPMM+VnURWPalladioL-Bold FontSubset: true FirstChar: 160 LastChar: 226 FontDescriptor: FontName: ZSBPMM+VnURWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: CQXCJX+URWPalladioL-Roma FontSubset: true FirstChar: 2 LastChar: 246 FontDescriptor: FontName: CQXCJX+URWPalladioL-Roma Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: HKQHZQ+VnURWPalladioL FontSubset: true FirstChar: 129 LastChar: 243 FontDescriptor: FontName: HKQHZQ+VnURWPalladioL Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: VSHNAE+Rpcxr FontSubset: true FirstChar: 169 LastChar: 169 FontDescriptor: FontName: VSHNAE+Rpcxr Flags: Symbolic FontBBox: -212, -286, 1344, 973 FontFile: true Font: BaseFont: OFLXAT+Rpxr FontSubset: true FirstChar: 11 LastChar: 62 FontDescriptor: FontName: OFLXAT+Rpxr Flags: Symbolic FontBBox: -40, -283, 904, 728 FontFile: true Font: BaseFont: NFJHER+Pxsy FontSubset: true FirstChar: 0 LastChar: 122 FontDescriptor: FontName: NFJHER+Pxsy Flags: Symbolic FontBBox: -21, -994, 1292, 912 FontFile: true Font: BaseFont: ZIPEAN+EURM10 FontSubset: true FirstChar: 11 LastChar: 31 FontDescriptor: FontName: ZIPEAN+EURM10 Flags: Symbolic FontBBox: -32, -243, 1060, 720 FontFile: true Pages: Page: Sequence: 1 Annotations: Annotation: Subtype: Link Rect: 75, 757, 217, 793 Annotation: Subtype: Link Rect: 474, 757, 519, 793 Annotation: Subtype: Link Rect: 211, 621, 222, 634 Annotation: Subtype: Link Rect: 335, 621, 347, 634 Annotation: Subtype: Link Rect: 459, 621, 470, 634 Annotation: Subtype: Link Rect: 222, 594, 233, 607 Annotation: Subtype: Link Rect: 304, 594, 315, 607 Annotation: Subtype: Link Rect: 482, 594, 493, 607 Annotation: Subtype: Link Rect: 200, 580, 211, 594 Annotation: Subtype: Link Rect: 466, 296, 518, 315 Annotation: Subtype: Link Rect: 181, 38, 251, 50 Annotation: Subtype: Link Rect: 418, 38, 519, 50 Page: Sequence: 2 Annotations: Annotation: Subtype: Link Rect: 239, 579, 246, 588 ActionDest: 401 Annotation: Subtype: Link Rect: 325, 566, 332, 575 ActionDest: 401 Annotation: Subtype: Link Rect: 314, 552, 321, 561 ActionDest: 401 Annotation: Subtype: Link Rect: 330, 525, 337, 534 ActionDest: 401 Annotation: Subtype: Link Rect: 115, 498, 122, 507 ActionDest: 401 Annotation: Subtype: Link Rect: 123, 498, 130, 507 ActionDest: 428 Annotation: Subtype: Link Rect: 294, 444, 301, 453 ActionDest: 401 Annotation: Subtype: Link Rect: 304, 444, 316, 453 ActionDest: 428 Annotation: Subtype: Link Rect: 496, 430, 503, 440 ActionDest: 428 Annotation: Subtype: Link Rect: 503, 430, 515, 440 ActionDest: 428 Annotation: Subtype: Link Rect: 130, 390, 142, 399 ActionDest: 428 Annotation: Subtype: Link Rect: 143, 390, 154, 399 ActionDest: 428 Annotation: Subtype: Link Rect: 219, 376, 231, 386 ActionDest: 428 Annotation: Subtype: Link Rect: 375, 349, 387, 359 ActionDest: 428 Annotation: Subtype: Link Rect: 180, 336, 192, 345 ActionDest: 428 Annotation: Subtype: Link Rect: 134, 309, 146, 318 ActionDest: 428 Annotation: Subtype: Link Rect: 146, 309, 158, 318 ActionDest: 428 Annotation: Subtype: Link Rect: 122, 255, 134, 264 ActionDest: 428 Annotation: Subtype: Link Rect: 137, 255, 149, 264 ActionDest: 428 Annotation: Subtype: Link Rect: 439, 241, 451, 250 ActionDest: 428 Annotation: Subtype: Link Rect: 143, 187, 155, 196 ActionDest: 428 Annotation: Subtype: Link Rect: 189, 160, 201, 169 ActionDest: 428 Annotation: Subtype: Link Rect: 503, 106, 515, 115 ActionDest: 428 Annotation: Subtype: Link Rect: 337, 93, 349, 102 ActionDest: 428 Annotation: Subtype: Link Rect: 420, 93, 432, 102 ActionDest: 461 Annotation: Subtype: Link Rect: 432, 93, 444, 102 ActionDest: 461 Annotation: Subtype: Link Rect: 391, 79, 403, 88 ActionDest: 461 Page: Sequence: 3 Annotations: Annotation: Subtype: Link Rect: 252, 702, 264, 711 ActionDest: 428 Annotation: Subtype: Link Rect: 178, 675, 190, 684 ActionDest: 461 Annotation: Subtype: Link Rect: 381, 661, 393, 671 ActionDest: 461 Annotation: Subtype: Link Rect: 479, 648, 491, 657 ActionDest: 428 Annotation: Subtype: Link Rect: 492, 648, 504, 657 ActionDest: 461 Annotation: Subtype: Link Rect: 504, 648, 516, 657 ActionDest: 461 Annotation: Subtype: Link Rect: 174, 607, 186, 617 ActionDest: 461 Annotation: Subtype: Link Rect: 232, 540, 244, 549 ActionDest: 428 Annotation: Subtype: Link Rect: 102, 377, 183, 388 Annotation: Subtype: Link Rect: 321, 379, 333, 388 ActionDest: 461 Annotation: Subtype: Link Rect: 334, 379, 345, 388 ActionDest: 461 Annotation: Subtype: Link Rect: 407, 366, 419, 375 ActionDest: 428 Annotation: Subtype: Link Rect: 500, 352, 512, 361 ActionDest: 461 Annotation: Subtype: Link Rect: 373, 161, 385, 170 ActionDest: 461 Annotation: Subtype: Link Rect: 442, 120, 454, 130 ActionDest: 461 Page: Sequence: 4 Annotations: Annotation: Subtype: Link Rect: 316, 612, 323, 624 ActionDest: 250 Annotation: Subtype: Link Rect: 333, 95, 344, 103 ActionDest: 461 Annotation: Subtype: Link Rect: 348, 69, 359, 78 ActionDest: 461 Page: Sequence: 5 Annotations: Annotation: Subtype: Link Rect: 125, 607, 137, 617 ActionDest: 461 Annotation: Subtype: Link Rect: 102, 514, 114, 524 ActionDest: 461 Annotation: Subtype: Link Rect: 508, 512, 515, 524 ActionDest: 282 Page: Sequence: 6 Annotations: Annotation: Subtype: Link Rect: 503, 710, 515, 719 ActionDest: 428 Annotation: Subtype: Link Rect: 171, 653, 178, 665 ActionDest: 282 Annotation: Subtype: Link Rect: 503, 452, 515, 461 ActionDest: 461 Annotation: Subtype: Link Rect: 384, 369, 396, 378 ActionDest: 461 Annotation: Subtype: Link Rect: 414, 315, 426, 324 ActionDest: 461 Annotation: Subtype: Link Rect: 96, 234, 108, 243 ActionDest: 461 Annotation: Subtype: Link Rect: 137, 180, 149, 189 ActionDest: 461 Annotation: Subtype: Link Rect: 441, 139, 453, 149 ActionDest: 461 Annotation: Subtype: Link Rect: 126, 72, 138, 81 ActionDest: 461 Page: Sequence: 7 Annotations: Annotation: Subtype: Link Rect: 315, 702, 327, 711 ActionDest: 461 Annotation: Subtype: Link Rect: 503, 333, 515, 342 ActionDest: 461 Annotation: Subtype: Link Rect: 168, 265, 180, 274 ActionDest: 488 Annotation: Subtype: Link Rect: 229, 225, 241, 234 ActionDest: 488 Annotation: Subtype: Link Rect: 304, 198, 316, 207 ActionDest: 488 Annotation: Subtype: Link Rect: 126, 184, 138, 193 ActionDest: 461 Page: Sequence: 8 Annotations: Annotation: Subtype: Link Rect: 356, 670, 363, 682 ActionDest: 250 Annotation: Subtype: Link Rect: 207, 506, 214, 518 ActionDest: 338 Annotation: Subtype: Link Rect: 163, 481, 175, 491 ActionDest: 488 Annotation: Subtype: Link Rect: 266, 465, 273, 477 ActionDest: 338 Page: Sequence: 9 Annotations: Annotation: Subtype: Link Rect: 121, 420, 128, 432 ActionDest: 345 Page: Sequence: 10 Annotations: Annotation: Subtype: Link Rect: 170, 181, 177, 192 ActionDest: 357 Page: Sequence: 11 Annotations: Annotation: Subtype: Link Rect: 356, 274, 368, 283 ActionDest: 428 Annotation: Subtype: Link Rect: 419, 273, 431, 283 ActionDest: 428 Annotation: Subtype: Link Rect: 431, 274, 443, 283 ActionDest: 428 Annotation: Subtype: Link Rect: 504, 84, 516, 93 ActionDest: 428 Page: Sequence: 12 Annotations: Annotation: Subtype: Link Rect: 106, 702, 118, 711 ActionDest: 428 Annotation: Subtype: Link Rect: 412, 675, 424, 684 ActionDest: 428 Annotation: Subtype: Link Rect: 184, 607, 196, 617 ActionDest: 488 Annotation: Subtype: Link Rect: 282, 553, 293, 562 ActionDest: 488 Annotation: Subtype: Link Rect: 389, 513, 400, 522 ActionDest: 428 Annotation: Subtype: Link Rect: 186, 499, 198, 508 ActionDest: 428 Annotation: Subtype: Link Rect: 163, 472, 175, 481 ActionDest: 488 Annotation: Subtype: Link Rect: 233, 459, 245, 468 ActionDest: 488 Annotation: Subtype: Link Rect: 304, 405, 316, 414 ActionDest: 461 Annotation: Subtype: Link Rect: 437, 378, 449, 387 ActionDest: 488 Annotation: Subtype: Link Rect: 408, 364, 420, 373 ActionDest: 488 Annotation: Subtype: Link Rect: 300, 337, 312, 346 ActionDest: 488 Annotation: Subtype: Link Rect: 312, 337, 324, 346 ActionDest: 488 Annotation: Subtype: Link Rect: 172, 324, 184, 333 ActionDest: 488 Annotation: Subtype: Link Rect: 285, 297, 297, 306 ActionDest: 461 Annotation: Subtype: Link Rect: 503, 297, 515, 306 ActionDest: 488 Annotation: Subtype: Link Rect: 142, 270, 154, 279 ActionDest: 488 Annotation: Subtype: Link Rect: 313, 202, 325, 211 ActionDest: 488 Annotation: Subtype: Link Rect: 252, 161, 264, 171 ActionDest: 488 Annotation: Subtype: Link Rect: 364, 148, 375, 157 ActionDest: 488 Annotation: Subtype: Link Rect: 178, 107, 190, 117 ActionDest: 488 Page: Sequence: 13 Annotations: Annotation: Subtype: Link Rect: 136, 204, 174, 214 Annotation: Subtype: Link Rect: 100, 165, 137, 175 Annotation: Subtype: Link Rect: 213, 139, 251, 149 Annotation: Subtype: Link Rect: 369, 112, 406, 123 Annotation: Subtype: Link Rect: 100, 74, 137, 84 Page: Sequence: 14 Annotations: Annotation: Subtype: Link Rect: 150, 715, 187, 725 Annotation: Subtype: Link Rect: 217, 676, 255, 686 Annotation: Subtype: Link Rect: 123, 638, 160, 648 Annotation: Subtype: Link Rect: 354, 598, 392, 609 Annotation: Subtype: Link Rect: 131, 534, 169, 544 Annotation: Subtype: Link Rect: 100, 496, 137, 506 Annotation: Subtype: Link Rect: 143, 496, 179, 506 Annotation: Subtype: Link Rect: 205, 457, 243, 467 Annotation: Subtype: Link Rect: 249, 457, 285, 467 Annotation: Subtype: Link Rect: 172, 405, 210, 415 Annotation: Subtype: Link Rect: 216, 405, 252, 415 Annotation: Subtype: Link Rect: 416, 353, 453, 364 Annotation: Subtype: Link Rect: 294, 315, 332, 325 Annotation: Subtype: Link Rect: 407, 288, 445, 299 Annotation: Subtype: Link Rect: 237, 237, 274, 247 Annotation: Subtype: Link Rect: 232, 211, 270, 222 Annotation: Subtype: Link Rect: 215, 172, 252, 183 Annotation: Subtype: Link Rect: 437, 133, 474, 144 Annotation: Subtype: Link Rect: 480, 133, 516, 144 Annotation: Subtype: Link Rect: 145, 82, 183, 92 Annotation: Subtype: Link Rect: 189, 82, 225, 92 Page: Sequence: 15 Annotations: Annotation: Subtype: Link Rect: 136, 715, 174, 725 Annotation: Subtype: Link Rect: 180, 715, 216, 725 Annotation: Subtype: Link Rect: 320, 688, 357, 699 Annotation: Subtype: Link Rect: 363, 688, 400, 699 Annotation: Subtype: Link Rect: 136, 663, 174, 673 Annotation: Subtype: Link Rect: 305, 624, 342, 635 Annotation: Subtype: Link Rect: 436, 598, 473, 609 Annotation: Subtype: Link Rect: 271, 572, 309, 583 Annotation: Subtype: Link Rect: 259, 521, 296, 531 Annotation: Subtype: Link Rect: 397, 482, 434, 493 Annotation: Subtype: Link Rect: 284, 456, 322, 467 Annotation: Subtype: Link Rect: 328, 456, 364, 467 Annotation: Subtype: Link Rect: 424, 417, 461, 428 Annotation: Subtype: Link Rect: 468, 417, 504, 428 Annotation: Subtype: Link Rect: 154, 379, 192, 389 Annotation: Subtype: Link Rect: 198, 379, 234, 389 Annotation: Subtype: Link Rect: 429, 353, 465, 364 Annotation: Subtype: Link Rect: 136, 315, 174, 325 Annotation: Subtype: Link Rect: 180, 315, 216, 325 Annotation: Subtype: Link Rect: 145, 250, 183, 260 Annotation: Subtype: Link Rect: 208, 146, 245, 157 Annotation: Subtype: Link Rect: 299, 107, 336, 118 Annotation: Subtype: Link Rect: 342, 107, 378, 118 Annotation: Subtype: Link Rect: 100, 69, 137, 80 Annotation: Subtype: Link Rect: 143, 69, 179, 80 Page: Sequence: 16 Annotations: Annotation: Subtype: Link Rect: 136, 728, 174, 738 Annotation: Subtype: Link Rect: 429, 701, 467, 712 Annotation: Subtype: Link Rect: 473, 701, 509, 712 Annotation: Subtype: Link Rect: 407, 675, 443, 686 Annotation: Subtype: Link Rect: 478, 624, 516, 635 Annotation: Subtype: Link Rect: 100, 612, 136, 622 Annotation: Subtype: Link Rect: 150, 560, 187, 570 Annotation: Subtype: Link Rect: 348, 521, 386, 531 Annotation: Subtype: Link Rect: 323, 482, 360, 493 Annotation: Subtype: Link Rect: 177, 457, 214, 467 Annotation: Subtype: Link Rect: 172, 405, 210, 415 Annotation: Subtype: Link Rect: 216, 405, 252, 415 Annotation: Subtype: Link Rect: 478, 378, 516, 389 Annotation: Subtype: Link Rect: 100, 366, 136, 376 Annotation: Subtype: Link Rect: 352, 340, 390, 351 Annotation: Subtype: Link Rect: 100, 302, 137, 312 Annotation: Subtype: Link Rect: 143, 302, 179, 312 Annotation: Subtype: Link Rect: 380, 262, 416, 273 Annotation: Subtype: Link Rect: 354, 224, 392, 234 Annotation: Subtype: Link Rect: 398, 224, 434, 234 Annotation: Subtype: Link Rect: 380, 198, 418, 209 Annotation: Subtype: Link Rect: 76, 156, 166, 187 Annotation: Subtype: Link Rect: 234, 150, 407, 161 Checksum: 109cb189 Type: CRC32 Checksum: 6c262baef9f6007ac9d534c6c70bf69d Type: MD5 Checksum: d108b55cea548498dca4ead66fc624ab805b08e8 Type: SHA-1 Checksum: d8d18331e0df7b22e5bb572fc1241f021da2b4b1f302c34ce76622c8d89c5944 Type: SHA-256