55734e459dc65bcd4a42edcdd3c01cd9 animals_a2021v11n7p2081.pdf 0692557369a6120b6f2e7b9b04a7e136b033b35a animals_a2021v11n7p2081.pdf 0b00c524801eecad08039f169185f6362ec5411d758c5fa3889d41e30ac3dfac animals_a2021v11n7p2081.pdf Title: Cardiorespiratory, Sedative and Antinociceptive Effects of a Medetomidine Constant Rate Infusion with Morphine, Ketamine or Both Subject: Standing surgery under sedation reduces anesthetic-related mortality in horses. Medetomidine, alone and combined with morphine in a constant rate infusion (CRI), has been described for standing surgery but their cardiorespiratory, sedative and antinociceptive effects have never been compared. The addition of ketamine could improve analgesia in these procedures with minimal cardiorespiratory consequences. The objectives were to compare the cardiorespiratory effects, quality of sedation, antinociception and ataxia produced by administration of a medetomidine-based CRI with morphine, ketamine or both, in standing horses. A prospective, blind, randomized crossover, experimental design with six healthy adult horses was performed, in which four treatments were administered to all horses with at least two weeks of washout period: medetomidine (M); medetomidine and ketamine (MK); medetomidine and morphine (MMo); and medetomidine, morphine and ketamine (MMoK). Dosages were the same in all treatment groups: medetomidine at 5 g/kg bwt followed by 5 g/kg bwt/h, ketamine at 0.4 mg/kg/h and morphine at 50 g/kg bwt, followed by morphine 30 g/kg bwt/h. Drug infusions were maintained for 120 min. Cardiorespiratory variables, sedation degree and antinociceptive effects were evaluated during the procedure. All combinations produced similar sedation and antinociceptive effects and no clinically relevant alterations in cardiorespiratory variables occurred. Medetomidine CRI combined with morphine, ketamine or both are suitable and safe protocols for standing sedation in horses and the addition of morphine and/or ketamine did not cause any negative effect but no improving effect on sedation and antinociception was detected. Keywords: horse; alpha-2-agonist; opioids; mechanical stimulus Author: Lucas Troya-Portillo, Javier López-Sanromán, María Villalba-Orero and Isabel Santiago-Llorente Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Tue Jul 13 08:18:06 2021 CEST ModDate: Tue Jul 13 10:38:26 2021 CEST Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 12 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 611917 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- DUFXDP+VnURWPalladioL Type 1 Custom yes yes no 10 0 ZZJXSH+EURM10 Type 1 Builtin yes yes no 15 0 SFZWBX+URWPalladioL-Ital Type 1 Custom yes yes no 19 0 EGGJEU+URWPalladioL-Bold Type 1 Custom yes yes no 24 0 VTGQKI+URWPalladioL-Roma Type 1 Custom yes yes no 28 0 PRJKGQ+VnURWPalladioL-Bold Type 1 Custom yes yes no 32 0 SZMRXJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 40 0 MCBCCI+SourceSansRoman-Regular Type 1C Custom yes yes no 62 0 MCBCCM+SourceSansRoman.613wght Type 1C Custom yes yes no 66 0 MCBCCO+SourceSansRoman-Bold Type 1C Custom yes yes no 70 0 GQWIGS+CMSY10 Type 1 Builtin yes yes no 82 0 BCDEEE+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 106 0 BCDFEE+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 110 0 BCDGEE+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 114 0 Jhove (Rel. 1.22.1, 2019-04-17) Date: 2022-03-10 03:01:59 CET RepresentationInformation: animals_a2021v11n7p2081.pdf ReportingModule: PDF-hul, Rel. 1.12.1 (2019-04-17) LastModified: 2022-03-07 12:03:50 CET Size: 611917 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 349 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7b69c6ba Item: Title: Materials and Methods Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@46daef40 Children: Item: Title: Study Design Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@12f41634 Item: Title: Animals Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@13c27452 Item: Title: Sedation Protocols Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@262b2c86 Item: Title: Experimental Procedure Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@371a67ec Item: Title: Cardiorespiratory Monitoring Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@5ed828d Item: Title: Sedation Assessment Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@50d0686 Item: Title: Antinociceptive Effect Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7a3d45bd Item: Title: Data Analysis Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1e7c7811 Item: Title: Results Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@77ec78b9 Children: Item: Title: Cardiovascular and Respiratory Variables Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1a3869f4 Item: Title: Sedative Effects Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@a38d7a3 Item: Title: Antinociceptive Effect Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@77f99a05 Item: Title: Discussion Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@63440df3 Item: Title: Conclusions Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@3aeaafa6 Item: Title: References Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@76a3e297 Info: Title: Cardiorespiratory, Sedative and Antinociceptive Effects of a Medetomidine Constant Rate Infusion with Morphine, Ketamine or Both Author: Lucas Troya-Portillo, Javier López-Sanromán, María Villalba-Orero and Isabel Santiago-Llorente Subject: Standing surgery under sedation reduces anesthetic-related mortality in horses. Medetomidine, alone and combined with morphine in a constant rate infusion (CRI), has been described for standing surgery but their cardiorespiratory, sedative and antinociceptive effects have never been compared. The addition of ketamine could improve analgesia in these procedures with minimal cardiorespiratory consequences. The objectives were to compare the cardiorespiratory effects, quality of sedation, antinociception and ataxia produced by administration of a medetomidine-based CRI with morphine, ketamine or both, in standing horses. A prospective, blind, randomized crossover, experimental design with six healthy adult horses was performed, in which four treatments were administered to all horses with at least two weeks of washout period: medetomidine (M); medetomidine and ketamine (MK); medetomidine and morphine (MMo); and medetomidine, morphine and ketamine (MMoK). Dosages were the same in all treatment groups: medetomidine at 5 g/kg bwt followed by 5 g/kg bwt/h, ketamine at 0.4 mg/kg/h and morphine at 50 g/kg bwt, followed by morphine 30 g/kg bwt/h. Drug infusions were maintained for 120 min. Cardiorespiratory variables, sedation degree and antinociceptive effects were evaluated during the procedure. All combinations produced similar sedation and antinociceptive effects and no clinically relevant alterations in cardiorespiratory variables occurred. Medetomidine CRI combined with morphine, ketamine or both are suitable and safe protocols for standing sedation in horses and the addition of morphine and/or ketamine did not cause any negative effect but no improving effect on sedation and antinociception was detected. Keywords: horse; alpha-2-agonist; opioids; mechanical stimulus Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Tue Jul 13 08:18:06 CEST 2021 ModDate: Tue Jul 13 10:38:26 CEST 2021 ID: 0xcb79a4d2263d9d8b53b40381f776c132, 0xcb79a4d2263d9d8b53b40381f776c132 Filters: FilterPipeline: FlateDecode Fonts: Type1: Font: BaseFont: PRJKGQ+VnURWPalladioL-Bold FontSubset: true FirstChar: 161 LastChar: 226 FontDescriptor: FontName: PRJKGQ+VnURWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: GQWIGS+CMSY10 FontSubset: true FirstChar: 0 LastChar: 21 FontDescriptor: FontName: GQWIGS+CMSY10 Flags: Symbolic FontBBox: -29, -960, 1116, 775 FontFile: true Font: BaseFont: SFZWBX+URWPalladioL-Ital FontSubset: true FirstChar: 46 LastChar: 122 FontDescriptor: FontName: SFZWBX+URWPalladioL-Ital Flags: Symbolic FontBBox: -170, -305, 1010, 941 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: EGGJEU+URWPalladioL-Bold FontSubset: true FirstChar: 3 LastChar: 122 FontDescriptor: FontName: EGGJEU+URWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: DUFXDP+VnURWPalladioL FontSubset: true FirstChar: 161 LastChar: 226 FontDescriptor: FontName: DUFXDP+VnURWPalladioL Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: VTGQKI+URWPalladioL-Roma FontSubset: true FirstChar: 2 LastChar: 252 FontDescriptor: FontName: VTGQKI+URWPalladioL-Roma Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: ZZJXSH+EURM10 FontSubset: true FirstChar: 11 LastChar: 22 FontDescriptor: FontName: ZZJXSH+EURM10 Flags: Symbolic FontBBox: -32, -243, 1060, 720 FontFile: true Pages: Page: Sequence: 1 Annotations: Annotation: Subtype: Link Rect: 35, 759, 165, 795 Annotation: Subtype: Link Rect: 515, 759, 560, 795 Annotation: Subtype: Link Rect: 140, 643, 151, 656 Annotation: Subtype: Link Rect: 274, 643, 285, 656 Annotation: Subtype: Link Rect: 126, 346, 154, 355 Annotation: Subtype: Link Rect: 35, 334, 127, 343 Annotation: Subtype: Link Rect: 35, 162, 97, 184 Annotation: Subtype: Link Rect: 153, 89, 154, 98 Annotation: Subtype: Link Rect: 35, 77, 147, 86 Annotation: Subtype: Link Rect: 116, 17, 251, 28 Annotation: Subtype: Link Rect: 407, 17, 558, 28 Annotation: Subtype: Link Rect: 35, 446, 87, 465 Page: Sequence: 2 Annotations: Annotation: Subtype: Link Rect: 207, 709, 214, 718 ActionDest: 126 Annotation: Subtype: Link Rect: 214, 709, 221, 718 ActionDest: 126 Annotation: Subtype: Link Rect: 454, 683, 461, 692 ActionDest: 126 Annotation: Subtype: Link Rect: 464, 683, 471, 692 ActionDest: 126 Annotation: Subtype: Link Rect: 249, 658, 256, 667 ActionDest: 126 Annotation: Subtype: Link Rect: 256, 658, 263, 667 ActionDest: 126 Annotation: Subtype: Link Rect: 539, 621, 546, 630 ActionDest: 126 Annotation: Subtype: Link Rect: 480, 595, 487, 605 ActionDest: 126 Annotation: Subtype: Link Rect: 274, 558, 286, 567 ActionDest: 126 Annotation: Subtype: Link Rect: 207, 533, 219, 542 ActionDest: 126 Annotation: Subtype: Link Rect: 220, 533, 232, 542 ActionDest: 126 Annotation: Subtype: Link Rect: 214, 508, 226, 517 ActionDest: 126 Annotation: Subtype: Link Rect: 228, 482, 240, 492 ActionDest: 126 Annotation: Subtype: Link Rect: 243, 482, 255, 492 ActionDest: 129 Annotation: Subtype: Link Rect: 531, 457, 543, 466 ActionDest: 129 Annotation: Subtype: Link Rect: 544, 457, 556, 466 ActionDest: 129 Annotation: Subtype: Link Rect: 198, 420, 210, 429 ActionDest: 129 Annotation: Subtype: Link Rect: 211, 420, 223, 429 ActionDest: 129 Annotation: Subtype: Link Rect: 328, 382, 340, 391 ActionDest: 129 Annotation: Subtype: Link Rect: 343, 382, 355, 391 ActionDest: 129 Annotation: Subtype: Link Rect: 488, 370, 500, 379 ActionDest: 129 Annotation: Subtype: Link Rect: 544, 344, 556, 353 ActionDest: 129 Page: Sequence: 3 Annotations: Annotation: Subtype: Link Rect: 226, 644, 233, 656 ActionDest: 86 Page: Sequence: 4 Annotations: Annotation: Subtype: Link Rect: 521, 622, 533, 631 ActionDest: 129 Annotation: Subtype: Link Rect: 518, 358, 530, 367 ActionDest: 129 Annotation: Subtype: Link Rect: 531, 358, 543, 367 ActionDest: 129 Annotation: Subtype: Link Rect: 374, 320, 385, 329 ActionDest: 129 Annotation: Subtype: Link Rect: 445, 295, 457, 304 ActionDest: 129 Annotation: Subtype: Link Rect: 457, 295, 469, 304 ActionDest: 129 Annotation: Subtype: Link Rect: 259, 182, 271, 191 ActionDest: 129 Annotation: Subtype: Link Rect: 274, 182, 286, 191 ActionDest: 129 Page: Sequence: 5 Annotations: Annotation: Subtype: Link Rect: 253, 480, 260, 492 ActionDest: 95 Annotation: Subtype: Link Rect: 196, 355, 203, 367 ActionDest: 95 Annotation: Subtype: Link Rect: 280, 254, 287, 266 ActionDest: 98 Page: Sequence: 6 Page: Sequence: 7 Annotations: Annotation: Subtype: Link Rect: 298, 428, 305, 440 ActionDest: 98 Page: Sequence: 8 Annotations: Annotation: Subtype: Link Rect: 206, 735, 218, 744 ActionDest: 126 Annotation: Subtype: Link Rect: 218, 735, 230, 744 ActionDest: 126 Annotation: Subtype: Link Rect: 230, 735, 242, 744 ActionDest: 129 Annotation: Subtype: Link Rect: 243, 735, 255, 744 ActionDest: 129 Annotation: Subtype: Link Rect: 315, 647, 326, 656 ActionDest: 129 Annotation: Subtype: Link Rect: 330, 647, 342, 656 ActionDest: 129 Annotation: Subtype: Link Rect: 286, 609, 298, 618 ActionDest: 126 Annotation: Subtype: Link Rect: 294, 584, 306, 593 ActionDest: 129 Annotation: Subtype: Link Rect: 456, 559, 463, 568 ActionDest: 126 Annotation: Subtype: Link Rect: 463, 559, 475, 568 ActionDest: 126 Annotation: Subtype: Link Rect: 476, 559, 488, 568 ActionDest: 129 Annotation: Subtype: Link Rect: 285, 547, 297, 556 ActionDest: 126 Annotation: Subtype: Link Rect: 469, 471, 481, 480 ActionDest: 129 Annotation: Subtype: Link Rect: 516, 446, 528, 455 ActionDest: 129 Annotation: Subtype: Link Rect: 220, 383, 232, 392 ActionDest: 129 Annotation: Subtype: Link Rect: 544, 358, 556, 367 ActionDest: 129 Annotation: Subtype: Link Rect: 336, 321, 348, 330 ActionDest: 126 Annotation: Subtype: Link Rect: 348, 320, 360, 330 ActionDest: 129 Annotation: Subtype: Link Rect: 509, 308, 520, 317 ActionDest: 129 Annotation: Subtype: Link Rect: 521, 308, 533, 317 ActionDest: 129 Annotation: Subtype: Link Rect: 196, 233, 208, 242 ActionDest: 129 Annotation: Subtype: Link Rect: 209, 233, 221, 242 ActionDest: 129 Annotation: Subtype: Link Rect: 221, 233, 233, 242 ActionDest: 129 Annotation: Subtype: Link Rect: 234, 233, 246, 242 ActionDest: 133 Annotation: Subtype: Link Rect: 344, 220, 356, 229 ActionDest: 129 Annotation: Subtype: Link Rect: 339, 182, 351, 192 ActionDest: 133 Annotation: Subtype: Link Rect: 362, 170, 374, 179 ActionDest: 133 Annotation: Subtype: Link Rect: 211, 70, 223, 79 ActionDest: 133 Annotation: Subtype: Link Rect: 226, 69, 238, 79 ActionDest: 133 Page: Sequence: 9 Annotations: Annotation: Subtype: Link Rect: 406, 710, 418, 719 ActionDest: 133 Annotation: Subtype: Link Rect: 419, 710, 431, 719 ActionDest: 133 Annotation: Subtype: Link Rect: 434, 710, 446, 719 ActionDest: 133 Annotation: Subtype: Link Rect: 191, 685, 203, 694 ActionDest: 133 Annotation: Subtype: Link Rect: 203, 685, 215, 694 ActionDest: 133 Annotation: Subtype: Link Rect: 426, 672, 438, 681 ActionDest: 133 Annotation: Subtype: Link Rect: 439, 672, 451, 681 ActionDest: 133 Annotation: Subtype: Link Rect: 493, 634, 505, 643 ActionDest: 133 Annotation: Subtype: Link Rect: 207, 584, 214, 593 ActionDest: 126 Annotation: Subtype: Link Rect: 215, 584, 227, 593 ActionDest: 129 Annotation: Subtype: Link Rect: 227, 584, 239, 593 ActionDest: 133 Annotation: Subtype: Link Rect: 240, 584, 251, 593 ActionDest: 133 Annotation: Subtype: Link Rect: 350, 534, 362, 543 ActionDest: 129 Annotation: Subtype: Link Rect: 363, 534, 375, 543 ActionDest: 133 Annotation: Subtype: Link Rect: 481, 521, 493, 530 ActionDest: 133 Annotation: Subtype: Link Rect: 388, 509, 400, 518 ActionDest: 129 Annotation: Subtype: Link Rect: 365, 484, 377, 493 ActionDest: 133 Annotation: Subtype: Link Rect: 378, 484, 390, 493 ActionDest: 133 Annotation: Subtype: Link Rect: 325, 383, 337, 392 ActionDest: 129 Annotation: Subtype: Link Rect: 338, 383, 350, 392 ActionDest: 129 Annotation: Subtype: Link Rect: 529, 371, 541, 380 ActionDest: 133 Annotation: Subtype: Link Rect: 485, 346, 497, 355 ActionDest: 129 Annotation: Subtype: Link Rect: 399, 258, 411, 267 ActionDest: 129 Annotation: Subtype: Link Rect: 411, 258, 423, 267 ActionDest: 129 Annotation: Subtype: Link Rect: 424, 258, 436, 267 ActionDest: 133 Annotation: Subtype: Link Rect: 544, 245, 556, 254 ActionDest: 133 Annotation: Subtype: Link Rect: 193, 220, 204, 229 ActionDest: 133 Annotation: Subtype: Link Rect: 209, 195, 221, 204 ActionDest: 133 Page: Sequence: 10 Annotations: Annotation: Subtype: Link Rect: 424, 732, 560, 743 Annotation: Subtype: Link Rect: 166, 720, 263, 731 Annotation: Subtype: Link Rect: 468, 424, 505, 435 Annotation: Subtype: Link Rect: 192, 401, 230, 412 Annotation: Subtype: Link Rect: 99, 379, 137, 389 Annotation: Subtype: Link Rect: 351, 355, 388, 366 Annotation: Subtype: Link Rect: 394, 355, 430, 366 Annotation: Subtype: Link Rect: 59, 333, 97, 343 Annotation: Subtype: Link Rect: 103, 333, 139, 343 Annotation: Subtype: Link Rect: 352, 309, 389, 320 Annotation: Subtype: Link Rect: 396, 309, 432, 320 Annotation: Subtype: Link Rect: 131, 275, 169, 285 Annotation: Subtype: Link Rect: 59, 229, 97, 239 Annotation: Subtype: Link Rect: 514, 182, 551, 193 Annotation: Subtype: Link Rect: 223, 136, 259, 147 Annotation: Subtype: Link Rect: 320, 114, 357, 124 Annotation: Subtype: Link Rect: 363, 114, 399, 124 Annotation: Subtype: Link Rect: 158, 91, 194, 101 Annotation: Subtype: Link Rect: 183, 67, 221, 78 Page: Sequence: 11 Annotations: Annotation: Subtype: Link Rect: 290, 721, 328, 732 Annotation: Subtype: Link Rect: 59, 687, 97, 697 Annotation: Subtype: Link Rect: 136, 653, 173, 663 Annotation: Subtype: Link Rect: 425, 629, 463, 640 Annotation: Subtype: Link Rect: 324, 594, 362, 605 Annotation: Subtype: Link Rect: 167, 571, 205, 582 Annotation: Subtype: Link Rect: 422, 548, 459, 559 Annotation: Subtype: Link Rect: 332, 525, 369, 536 Annotation: Subtype: Link Rect: 376, 525, 412, 536 Annotation: Subtype: Link Rect: 414, 502, 452, 513 Annotation: Subtype: Link Rect: 410, 479, 447, 490 Annotation: Subtype: Link Rect: 167, 457, 205, 467 Annotation: Subtype: Link Rect: 238, 433, 275, 444 Annotation: Subtype: Link Rect: 59, 411, 97, 421 Annotation: Subtype: Link Rect: 59, 388, 97, 398 Annotation: Subtype: Link Rect: 103, 388, 139, 398 Annotation: Subtype: Link Rect: 297, 364, 333, 375 Annotation: Subtype: Link Rect: 139, 342, 176, 352 Annotation: Subtype: Link Rect: 59, 319, 97, 329 Annotation: Subtype: Link Rect: 212, 295, 248, 306 Annotation: Subtype: Link Rect: 155, 261, 193, 272 Annotation: Subtype: Link Rect: 199, 261, 235, 272 Annotation: Subtype: Link Rect: 95, 227, 133, 237 Annotation: Subtype: Link Rect: 139, 227, 175, 237 Annotation: Subtype: Link Rect: 362, 180, 400, 191 Annotation: Subtype: Link Rect: 406, 180, 442, 191 Annotation: Subtype: Link Rect: 329, 157, 367, 168 Annotation: Subtype: Link Rect: 255, 134, 292, 145 Annotation: Subtype: Link Rect: 59, 100, 97, 111 Annotation: Subtype: Link Rect: 109, 66, 146, 76 Page: Sequence: 12 Annotations: Annotation: Subtype: Link Rect: 139, 710, 176, 720 Annotation: Subtype: Link Rect: 82, 676, 119, 686 Annotation: Subtype: Link Rect: 497, 652, 535, 663 Annotation: Subtype: Link Rect: 158, 629, 196, 640 Annotation: Subtype: Link Rect: 202, 629, 238, 640 Annotation: Subtype: Link Rect: 136, 607, 173, 617 Annotation: Subtype: Link Rect: 59, 572, 97, 582 Annotation: Subtype: Link Rect: 103, 572, 139, 582 Annotation: Subtype: Link Rect: 450, 548, 487, 559 Annotation: Subtype: Link Rect: 493, 548, 528, 559 Annotation: Subtype: Link Rect: 308, 525, 345, 536 Annotation: Subtype: Link Rect: 351, 525, 387, 536 Annotation: Subtype: Link Rect: 149, 491, 187, 502 Annotation: Subtype: Link Rect: 460, 468, 497, 479 Annotation: Subtype: Link Rect: 503, 468, 540, 479 Annotation: Subtype: Link Rect: 230, 445, 267, 456 Annotation: Subtype: Link Rect: 274, 445, 310, 456 Annotation: Subtype: Link Rect: 319, 422, 356, 433 Annotation: Subtype: Link Rect: 362, 422, 398, 433 Annotation: Subtype: Link Rect: 99, 400, 137, 410 Annotation: Subtype: Link Rect: 519, 376, 557, 387 Annotation: Subtype: Link Rect: 59, 365, 95, 375 Annotation: Subtype: Link Rect: 163, 330, 200, 341 Annotation: Subtype: Link Rect: 207, 330, 243, 341 Annotation: Subtype: Link Rect: 303, 307, 340, 318 Annotation: Subtype: Link Rect: 420, 295, 457, 306 Annotation: Subtype: Link Rect: 464, 272, 502, 283 Annotation: Subtype: Link Rect: 149, 238, 186, 249 Annotation: Subtype: Link Rect: 219, 203, 257, 214 Annotation: Subtype: Link Rect: 263, 203, 299, 214 Annotation: Subtype: Link Rect: 460, 180, 497, 191 Annotation: Subtype: Link Rect: 504, 180, 540, 191 Annotation: Subtype: Link Rect: 407, 157, 444, 168 Annotation: Subtype: Link Rect: 451, 157, 487, 168 Annotation: Subtype: Link Rect: 503, 146, 540, 157 Annotation: Subtype: Link Rect: 158, 111, 196, 122 Annotation: Subtype: Link Rect: 118, 89, 155, 99 Annotation: Subtype: Link Rect: 131, 66, 169, 76 Checksum: 4894025b Type: CRC32 Checksum: 55734e459dc65bcd4a42edcdd3c01cd9 Type: MD5 Checksum: 0692557369a6120b6f2e7b9b04a7e136b033b35a Type: SHA-1