6523ab826e767b5f6ff126ff6677dca0 pmc_35206128.pdf deef3e6b172262f69ce4a60dbee6a6a6bf0b7023 pmc_35206128.pdf 86439aa17de0465b2f1f7983b7561d09343157b9c1b6eef6ac7a4bb4903737a0 pmc_35206128.pdf Title: Oral Health-Related Quality of Life Changes in Patients with Dentofacial Deformities Class II and III after Orthognathic Surgery: A Systematic Review and Meta-Analysis Subject: Our aim was to assess the impact of combined orthodontic–surgical treatment on patients’ oral health-related quality of life (OHRQoL) according to type of dentofacial deformities, by synthesizing the available evidence. Methods: Search was conducted in the PubMed, Embase/MEDLINE, Scopus, and Cochrane databases. The eligibility criteria were studies that measured OHRQoL before–after orthognathic surgery, with results disaggregated by Class II and III. Two researchers independently performed the selection process, data extraction, and methodological quality assessment. Meta-analysis of the standard mean differences (SMD) was performed using random effect models. Results: The search identified 1047 references. Thirteen studies met the inclusion criteria, and four were included in the meta-analysis. The SMD of OHRQL global score showed large improvement 4–7 months after surgery in Class II and III patients (2.09, 95% CI 0.68 to 3.49 and 1.96, 95% CI 1.22 to 2.70, respectively). The sensitivity analyses, excluding studies with weak methodological quality, showed that Class III patients’ improvement in functional limitation was significantly higher than in Class II patients (SMD 0.57, 95% CI 0.12–1.02). Conclusions: There is not enough evidence to support differences between Class II and III patients in the OHRQoL impact after orthognathic surgery, but findings suggest lower improvement of some domains in Class II patients. Keywords: oral health-related quality of life; orthognathic surgery; dentofacial deformity Author: Valentina Duarte, Carlos Zaror, Julio Villanueva, Matías Andreo, Matías Dallaserra, Josefina Salazar, Àngels Pont and Montse Ferrer Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Wed Feb 16 08:54:10 2022 CET ModDate: Wed Feb 16 08:56:55 2022 CET Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 24 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 6772338 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- KWFMFA+VnURWPalladioL Type 1 Custom yes yes no 10 0 XRAAQV+URWPalladioL-Bold Type 1 Custom yes yes no 15 0 NECBUF+URWPalladioL-Roma Type 1 Custom yes yes no 20 0 FIVMQV+URWPalladioL-Ital Type 1 Custom yes yes no 24 0 FWNTIM+VnURWPalladioL-Bold Type 1 Custom yes yes no 28 0 MCBCCI+SourceSansRoman-Regular Type 1C Custom yes yes no 36 0 MCBCCM+SourceSansRoman.613wght Type 1C Custom yes yes no 40 0 MCBCCO+SourceSansRoman-Bold Type 1C Custom yes yes no 44 0 LWQXII+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 56 0 IRWHZX+TimesNewRomanPSMT Type 1C WinAnsi yes yes no 59 0 CZNUER+CMEX10 Type 1 Builtin yes yes no 87 0 GIGFZE+CMR10 Type 1 Builtin yes yes no 91 0 NAPVSJ+CMSY10 Type 1 Builtin yes yes no 95 0 KEFLLF+TimesNewRoman,Bold CID TrueType Identity-H yes yes yes 150 0 KEFKHE+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 156 0 KEFKHF+TimesNewRoman CID TrueType Identity-H yes yes yes 159 0 KEFKHH+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 165 0 KEFKII+PalatinoLinotype CID TrueType Identity-H yes yes yes 168 0 KEFKIJ+PalatinoLinotype TrueType WinAnsi yes yes no 174 0 KEFLLE+TimesNewRoman,Italic TrueType WinAnsi yes yes no 177 0 KEFLLF+TimesNewRoman,Bold CID TrueType Identity-H yes yes yes 190 0 KEFKHE+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 196 0 KEFKHF+TimesNewRoman CID TrueType Identity-H yes yes yes 199 0 KEFKHH+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 205 0 KEFKII+PalatinoLinotype CID TrueType Identity-H yes yes yes 208 0 KEFKIJ+PalatinoLinotype TrueType WinAnsi yes yes no 214 0 KEFLLE+TimesNewRoman,Italic TrueType WinAnsi yes yes no 217 0 KEFLLF+TimesNewRoman,Bold CID TrueType Identity-H yes yes yes 233 0 KEFKHF+TimesNewRoman CID TrueType Identity-H yes yes yes 239 0 KEFKIJ+PalatinoLinotype TrueType WinAnsi yes yes no 245 0 KEFLLE+TimesNewRoman,Italic TrueType WinAnsi yes yes no 248 0 KEFLLF+TimesNewRoman,Bold CID TrueType Identity-H yes yes yes 265 0 KEFKHE+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 271 0 KEFKHF+TimesNewRoman CID TrueType Identity-H yes yes yes 274 0 KEFKIJ+PalatinoLinotype TrueType WinAnsi yes yes no 280 0 KEFLLE+TimesNewRoman,Italic TrueType WinAnsi yes yes no 283 0 KEFLLF+TimesNewRoman,Bold CID TrueType Identity-H yes yes yes 298 0 KEFKHE+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 304 0 KEFKHF+TimesNewRoman CID TrueType Identity-H yes yes yes 307 0 KEFKIJ+PalatinoLinotype TrueType WinAnsi yes yes no 313 0 KEFLLE+TimesNewRoman,Italic TrueType WinAnsi yes yes no 316 0 KEFLLF+TimesNewRoman,Bold CID TrueType Identity-H yes yes yes 334 0 KEFKHE+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 340 0 KEFKHF+TimesNewRoman CID TrueType Identity-H yes yes yes 343 0 KEFKHH+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 349 0 KEFKII+PalatinoLinotype CID TrueType Identity-H yes yes yes 352 0 KEFKIJ+PalatinoLinotype TrueType WinAnsi yes yes no 358 0 KEFLLE+TimesNewRoman,Italic TrueType WinAnsi yes yes no 361 0 KEFLLF+TimesNewRoman,Bold CID TrueType Identity-H yes yes yes 379 0 KEFKHE+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 385 0 KEFKHF+TimesNewRoman CID TrueType Identity-H yes yes yes 388 0 KEFKIJ+PalatinoLinotype TrueType WinAnsi yes yes no 394 0 KEFLLE+TimesNewRoman,Italic TrueType WinAnsi yes yes no 397 0 PMDKUN+SFRB0800 Type 1 Custom yes yes no 414 0 QHMYDZ+wasy8 Type 1 Builtin yes yes no 419 0 Jhove (Rel. 1.22.1, 2019-04-17) Date: 2022-03-17 02:30:50 CET RepresentationInformation: pmc_35206128.pdf ReportingModule: PDF-hul, Rel. 1.12.1 (2019-04-17) LastModified: 2022-02-27 18:34:26 CET Size: 6772338 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 675 FreeObjects: 5 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7b69c6ba Item: Title: Material and Methods Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@46daef40 Children: Item: Title: Protocol and Registration Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@12f41634 Item: Title: Elegibility Criteria Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@13c27452 Item: Title: Information Sources and Search Strategy Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@262b2c86 Item: Title: Selections Process Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@371a67ec Item: Title: Data Collection Process Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@5ed828d Item: Title: Data Items Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@50d0686 Item: Title: Study of Methodological Quality Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7a3d45bd Item: Title: Effect Measures and Synthesis Methods Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1e7c7811 Item: Title: Certainty Assessment Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@77ec78b9 Item: Title: Results Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1a3869f4 Children: Item: Title: Study Selection Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@a38d7a3 Item: Title: Study Characteristics Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@77f99a05 Item: Title: Risk of Bias within Studies Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@63440df3 Item: Title: Results of Individual Studies Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@3aeaafa6 Item: Title: Synthesis of Results Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@76a3e297 Children: Item: Title: OHRQL Changes in Class II and Class III Patients Measured with Global Scores of OQLQ and OHIP-14 Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@4d3167f4 Item: Title: OHRQL Changes in Class II and Class III Patients in OHIP-14 Domains Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@ed9d034 Item: Title: Sensivity Analysis Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@6121c9d6 Item: Title: Reporting Bias Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@87f383f Item: Title: Certainty of Evidence Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@4eb7f003 Item: Title: Discussion Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@eafc191 Children: Item: Title: Main Findings Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@612fc6eb Item: Title: Strengths and Limitations Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1060b431 Item: Title: Implications for Practice and Research Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@612679d6 Item: Title: Conclusions Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@11758f2a Item: Title: References Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@e720b71 Info: Title: Oral Health-Related Quality of Life Changes in Patients with Dentofacial Deformities Class II and III after Orthognathic Surgery: A Systematic Review and Meta-Analysis Author: Valentina Duarte, Carlos Zaror, Julio Villanueva, Matías Andreo, Matías Dallaserra, Josefina Salazar, Àngels Pont and Montse Ferrer Subject: Our aim was to assess the impact of combined orthodontic surgical treatment on patients’ oral health-related quality of life (OHRQoL) according to type of dentofacial deformities, by synthesizing the available evidence. Methods: Search was conducted in the PubMed, Embase/MEDLINE, Scopus, and Cochrane databases. The eligibility criteria were studies that measured OHRQoL before after orthognathic surgery, with results disaggregated by Class II and III. Two researchers independently performed the selection process, data extraction, and methodological quality assessment. Meta-analysis of the standard mean differences (SMD) was performed using random effect models. Results: The search identified 1047 references. Thirteen studies met the inclusion criteria, and four were included in the meta-analysis. The SMD of OHRQL global score showed large improvement 4 7 months after surgery in Class II and III patients (2.09, 95% CI 0.68 to 3.49 and 1.96, 95% CI 1.22 to 2.70, respectively). The sensitivity analyses, excluding studies with weak methodological quality, showed that Class III patients’ improvement in functional limitation was significantly higher than in Class II patients (SMD 0.57, 95% CI 0.12 1.02). Conclusions: There is not enough evidence to support differences between Class II and III patients in the OHRQoL impact after orthognathic surgery, but findings suggest lower improvement of some domains in Class II patients. Keywords: oral health-related quality of life; orthognathic surgery; dentofacial deformity Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Wed Feb 16 08:54:10 CET 2022 ModDate: Wed Feb 16 08:56:55 CET 2022 ID: 0xd8e6a4f81cc7340a1299cac63021a6eb, 0xd8e6a4f81cc7340a1299cac63021a6eb Filters: FilterPipeline: FlateDecode Fonts: Type1: Font: BaseFont: QHMYDZ+wasy8 FontSubset: true FirstChar: 35 LastChar: 35 FontDescriptor: FontName: QHMYDZ+wasy8 Flags: Symbolic FontBBox: -23, -1667, 1827, 755 FontFile: true Font: BaseFont: NECBUF+URWPalladioL-Roma FontSubset: true FirstChar: 2 LastChar: 246 FontDescriptor: FontName: NECBUF+URWPalladioL-Roma Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: CZNUER+CMEX10 FontSubset: true FirstChar: 113 LastChar: 113 FontDescriptor: FontName: CZNUER+CMEX10 Flags: Symbolic FontBBox: -24, -2960, 1454, 772 FontFile: true Font: BaseFont: FIVMQV+URWPalladioL-Ital FontSubset: true FirstChar: 39 LastChar: 121 FontDescriptor: FontName: FIVMQV+URWPalladioL-Ital Flags: Symbolic FontBBox: -170, -305, 1010, 941 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: KWFMFA+VnURWPalladioL FontSubset: true FirstChar: 128 LastChar: 243 FontDescriptor: FontName: KWFMFA+VnURWPalladioL Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: GIGFZE+CMR10 FontSubset: true FirstChar: 40 LastChar: 61 FontDescriptor: FontName: GIGFZE+CMR10 Flags: Symbolic FontBBox: -40, -250, 1009, 750 FontFile: true Font: BaseFont: FWNTIM+VnURWPalladioL-Bold FontSubset: true FirstChar: 128 LastChar: 189 FontDescriptor: FontName: FWNTIM+VnURWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: PMDKUN+SFRB0800 FontSubset: true FirstChar: 155 LastChar: 155 FontDescriptor: FontName: PMDKUN+SFRB0800 Flags: Symbolic FontBBox: -218, -350, 1639, 949 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: XRAAQV+URWPalladioL-Bold FontSubset: true FirstChar: 2 LastChar: 122 FontDescriptor: FontName: XRAAQV+URWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: NAPVSJ+CMSY10 FontSubset: true FirstChar: 0 LastChar: 8 FontDescriptor: FontName: NAPVSJ+CMSY10 Flags: Symbolic FontBBox: -29, -960, 1116, 775 FontFile: true Pages: Page: Sequence: 1 Annotations: Annotation: Subtype: Link Rect: 54, 323, 152, 332 Annotation: Subtype: Link Rect: 34, 311, 82, 320 Annotation: Subtype: Link Rect: 34, 164, 96, 186 Annotation: Subtype: Link Rect: 126, 90, 154, 99 Annotation: Subtype: Link Rect: 34, 78, 147, 87 Annotation: Subtype: Link Rect: 34, 756, 180, 792 Annotation: Subtype: Link Rect: 515, 756, 560, 792 Annotation: Subtype: Link Rect: 139, 642, 150, 655 Annotation: Subtype: Link Rect: 230, 642, 241, 655 Annotation: Subtype: Link Rect: 338, 642, 349, 655 Annotation: Subtype: Link Rect: 526, 642, 537, 655 Annotation: Subtype: Link Rect: 112, 629, 124, 643 Annotation: Subtype: Link Rect: 520, 82, 527, 91 ActionDest: 430 Annotation: Subtype: Link Rect: 528, 82, 535, 91 ActionDest: 430 Annotation: Subtype: Link Rect: 201, 17, 346, 28 Annotation: Subtype: Link Rect: 416, 17, 560, 28 Annotation: Subtype: Link Rect: 34, 444, 86, 463 Page: Sequence: 2 Annotations: Annotation: Subtype: Link Rect: 368, 736, 375, 744 ActionDest: 430 Annotation: Subtype: Link Rect: 376, 735, 383, 744 ActionDest: 430 Annotation: Subtype: Link Rect: 228, 698, 235, 707 ActionDest: 430 Annotation: Subtype: Link Rect: 443, 673, 450, 682 ActionDest: 430 Annotation: Subtype: Link Rect: 453, 673, 460, 682 ActionDest: 430 Annotation: Subtype: Link Rect: 430, 635, 437, 644 ActionDest: 430 Annotation: Subtype: Link Rect: 440, 635, 452, 644 ActionDest: 430 Annotation: Subtype: Link Rect: 529, 623, 541, 631 ActionDest: 430 Annotation: Subtype: Link Rect: 544, 623, 556, 631 ActionDest: 433 Annotation: Subtype: Link Rect: 328, 585, 340, 594 ActionDest: 433 Annotation: Subtype: Link Rect: 341, 585, 353, 594 ActionDest: 433 Annotation: Subtype: Link Rect: 353, 585, 365, 594 ActionDest: 433 Annotation: Subtype: Link Rect: 318, 572, 330, 581 ActionDest: 433 Annotation: Subtype: Link Rect: 255, 509, 267, 519 ActionDest: 433 Annotation: Subtype: Link Rect: 267, 509, 279, 519 ActionDest: 433 Annotation: Subtype: Link Rect: 206, 497, 218, 506 ActionDest: 433 Annotation: Subtype: Link Rect: 221, 497, 233, 506 ActionDest: 433 Annotation: Subtype: Link Rect: 429, 472, 441, 481 ActionDest: 433 Annotation: Subtype: Link Rect: 442, 472, 454, 481 ActionDest: 433 Annotation: Subtype: Link Rect: 457, 472, 469, 481 ActionDest: 433 Annotation: Subtype: Link Rect: 347, 370, 359, 379 ActionDest: 433 Annotation: Subtype: Link Rect: 218, 345, 230, 354 ActionDest: 433 Annotation: Subtype: Link Rect: 281, 317, 416, 329 Page: Sequence: 3 Annotations: Annotation: Subtype: Link Rect: 394, 579, 486, 591 Annotation: Subtype: Link Rect: 355, 267, 367, 276 ActionDest: 433 Annotation: Subtype: Link Rect: 367, 267, 379, 276 ActionDest: 433 Annotation: Subtype: Link Rect: 352, 217, 364, 226 ActionDest: 433 Annotation: Subtype: Link Rect: 463, 78, 475, 87 ActionDest: 433 Page: Sequence: 4 Annotations: Annotation: Subtype: Link Rect: 183, 674, 195, 683 ActionDest: 433 Annotation: Subtype: Link Rect: 421, 524, 433, 533 ActionDest: 433 Annotation: Subtype: Link Rect: 544, 448, 556, 457 ActionDest: 433 Annotation: Subtype: Link Rect: 538, 433, 560, 445 Annotation: Subtype: Link Rect: 165, 420, 310, 432 Annotation: Subtype: Link Rect: 387, 243, 395, 255 ActionDest: 99 Annotation: Subtype: Link Rect: 432, 118, 439, 130 ActionDest: 119 Annotation: Subtype: Link Rect: 412, 95, 424, 104 ActionDest: 433 Annotation: Subtype: Link Rect: 543, 83, 555, 92 ActionDest: 433 Annotation: Subtype: Link Rect: 544, 70, 556, 79 ActionDest: 433 Page: Sequence: 5 Annotations: Annotation: Subtype: Link Rect: 285, 710, 297, 719 ActionDest: 433 Annotation: Subtype: Link Rect: 297, 710, 309, 719 ActionDest: 433 Annotation: Subtype: Link Rect: 310, 710, 322, 719 ActionDest: 433 Annotation: Subtype: Link Rect: 322, 710, 334, 719 ActionDest: 433 Annotation: Subtype: Link Rect: 337, 710, 349, 719 ActionDest: 436 Annotation: Subtype: Link Rect: 349, 698, 361, 707 ActionDest: 433 Annotation: Subtype: Link Rect: 271, 685, 283, 694 ActionDest: 433 Annotation: Subtype: Link Rect: 283, 685, 295, 694 ActionDest: 436 Annotation: Subtype: Link Rect: 519, 685, 531, 694 ActionDest: 433 Annotation: Subtype: Link Rect: 531, 685, 543, 694 ActionDest: 433 Annotation: Subtype: Link Rect: 544, 685, 556, 694 ActionDest: 436 Page: Sequence: 6 Page: Sequence: 7 Page: Sequence: 8 Page: Sequence: 9 Page: Sequence: 10 Page: Sequence: 11 Annotations: Annotation: Subtype: Link Rect: 518, 724, 530, 733 ActionDest: 433 Annotation: Subtype: Link Rect: 530, 724, 542, 733 ActionDest: 433 Annotation: Subtype: Link Rect: 531, 711, 543, 720 ActionDest: 433 Annotation: Subtype: Link Rect: 543, 711, 555, 720 ActionDest: 436 Annotation: Subtype: Link Rect: 363, 698, 375, 708 ActionDest: 436 Annotation: Subtype: Link Rect: 249, 686, 261, 695 ActionDest: 433 Annotation: Subtype: Link Rect: 261, 686, 273, 695 ActionDest: 433 Annotation: Subtype: Link Rect: 274, 686, 286, 695 ActionDest: 436 Annotation: Subtype: Link Rect: 468, 686, 480, 695 ActionDest: 436 Annotation: Subtype: Link Rect: 218, 645, 226, 657 ActionDest: 129 Annotation: Subtype: Link Rect: 203, 636, 215, 645 ActionDest: 433 Annotation: Subtype: Link Rect: 215, 635, 227, 645 ActionDest: 433 Annotation: Subtype: Link Rect: 228, 635, 240, 645 ActionDest: 433 Annotation: Subtype: Link Rect: 240, 635, 252, 645 ActionDest: 433 Annotation: Subtype: Link Rect: 253, 635, 265, 645 ActionDest: 436 Annotation: Subtype: Link Rect: 242, 623, 254, 632 ActionDest: 433 Annotation: Subtype: Link Rect: 255, 623, 267, 632 ActionDest: 433 Annotation: Subtype: Link Rect: 267, 623, 279, 632 ActionDest: 433 Annotation: Subtype: Link Rect: 280, 623, 292, 632 ActionDest: 433 Annotation: Subtype: Link Rect: 295, 623, 306, 632 ActionDest: 436 Annotation: Subtype: Link Rect: 307, 623, 319, 632 ActionDest: 436 Annotation: Subtype: Link Rect: 544, 434, 556, 443 ActionDest: 433 Annotation: Subtype: Link Rect: 216, 397, 228, 406 ActionDest: 433 Annotation: Subtype: Link Rect: 228, 397, 240, 406 ActionDest: 433 Annotation: Subtype: Link Rect: 241, 397, 253, 406 ActionDest: 436 Annotation: Subtype: Link Rect: 344, 384, 356, 393 ActionDest: 433 Annotation: Subtype: Link Rect: 356, 384, 368, 393 ActionDest: 433 Annotation: Subtype: Link Rect: 369, 384, 380, 393 ActionDest: 433 Annotation: Subtype: Link Rect: 381, 384, 393, 393 ActionDest: 433 Annotation: Subtype: Link Rect: 501, 372, 513, 381 ActionDest: 433 Annotation: Subtype: Link Rect: 514, 372, 526, 381 ActionDest: 433 Annotation: Subtype: Link Rect: 235, 359, 247, 368 ActionDest: 433 Annotation: Subtype: Link Rect: 458, 334, 470, 343 ActionDest: 433 Annotation: Subtype: Link Rect: 471, 334, 483, 343 ActionDest: 433 Annotation: Subtype: Link Rect: 483, 334, 495, 343 ActionDest: 436 Annotation: Subtype: Link Rect: 255, 321, 267, 330 ActionDest: 436 Annotation: Subtype: Link Rect: 343, 321, 355, 330 ActionDest: 433 Annotation: Subtype: Link Rect: 508, 309, 520, 318 ActionDest: 436 Annotation: Subtype: Link Rect: 193, 296, 205, 305 ActionDest: 433 Annotation: Subtype: Link Rect: 217, 284, 228, 293 ActionDest: 433 Annotation: Subtype: Link Rect: 229, 284, 241, 293 ActionDest: 436 Annotation: Subtype: Link Rect: 329, 284, 341, 293 ActionDest: 433 Annotation: Subtype: Link Rect: 296, 271, 308, 280 ActionDest: 433 Annotation: Subtype: Link Rect: 420, 145, 432, 154 ActionDest: 433 Annotation: Subtype: Link Rect: 433, 145, 445, 154 ActionDest: 433 Annotation: Subtype: Link Rect: 522, 145, 534, 154 ActionDest: 433 Annotation: Subtype: Link Rect: 316, 133, 328, 142 ActionDest: 433 Page: Sequence: 12 Annotations: Annotation: Subtype: Link Rect: 217, 168, 224, 180 ActionDest: 140 Page: Sequence: 13 Annotations: Annotation: Subtype: Link Rect: 216, 360, 223, 372 ActionDest: 255 Annotation: Subtype: Link Rect: 517, 284, 524, 296 ActionDest: 324 Page: Sequence: 14 Page: Sequence: 15 Page: Sequence: 16 Annotations: Annotation: Subtype: Link Rect: 217, 267, 225, 279 ActionDest: 369 Annotation: Subtype: Link Rect: 354, 257, 366, 266 ActionDest: 433 Annotation: Subtype: Link Rect: 366, 257, 378, 266 ActionDest: 433 Page: Sequence: 17 Page: Sequence: 18 Annotations: Annotation: Subtype: Link Rect: 256, 707, 263, 719 ActionDest: 411 Page: Sequence: 19 Page: Sequence: 20 Annotations: Annotation: Subtype: Link Rect: 180, 459, 192, 468 ActionDest: 433 Annotation: Subtype: Link Rect: 193, 459, 205, 468 ActionDest: 433 Annotation: Subtype: Link Rect: 205, 459, 217, 468 ActionDest: 433 Annotation: Subtype: Link Rect: 456, 434, 468, 443 ActionDest: 436 Annotation: Subtype: Link Rect: 305, 384, 317, 393 ActionDest: 433 Annotation: Subtype: Link Rect: 320, 384, 332, 393 ActionDest: 433 Annotation: Subtype: Link Rect: 359, 358, 371, 367 ActionDest: 433 Annotation: Subtype: Link Rect: 237, 321, 249, 330 ActionDest: 433 Annotation: Subtype: Link Rect: 461, 296, 473, 305 ActionDest: 433 Annotation: Subtype: Link Rect: 474, 296, 486, 305 ActionDest: 433 Annotation: Subtype: Link Rect: 364, 258, 376, 267 ActionDest: 433 Page: Sequence: 21 Annotations: Annotation: Subtype: Link Rect: 436, 712, 448, 721 ActionDest: 433 Annotation: Subtype: Link Rect: 448, 712, 460, 721 ActionDest: 436 Annotation: Subtype: Link Rect: 461, 712, 473, 721 ActionDest: 436 Annotation: Subtype: Link Rect: 353, 649, 364, 659 ActionDest: 433 Annotation: Subtype: Link Rect: 311, 612, 323, 621 ActionDest: 433 Annotation: Subtype: Link Rect: 218, 574, 230, 583 ActionDest: 433 Annotation: Subtype: Link Rect: 230, 574, 242, 583 ActionDest: 433 Annotation: Subtype: Link Rect: 243, 574, 255, 583 ActionDest: 433 Annotation: Subtype: Link Rect: 255, 574, 267, 583 ActionDest: 436 Annotation: Subtype: Link Rect: 261, 512, 273, 521 ActionDest: 436 Annotation: Subtype: Link Rect: 301, 499, 313, 508 ActionDest: 436 Annotation: Subtype: Link Rect: 330, 486, 342, 495 ActionDest: 436 Annotation: Subtype: Link Rect: 343, 486, 355, 495 ActionDest: 436 Annotation: Subtype: Link Rect: 462, 411, 474, 420 ActionDest: 433 Page: Sequence: 22 Annotations: Annotation: Subtype: Link Rect: 536, 698, 560, 710 Annotation: Subtype: Link Rect: 165, 686, 379, 697 Annotation: Subtype: Link Rect: 261, 318, 299, 329 Annotation: Subtype: Link Rect: 305, 318, 341, 329 Annotation: Subtype: Link Rect: 261, 295, 299, 306 Annotation: Subtype: Link Rect: 305, 295, 341, 306 Annotation: Subtype: Link Rect: 104, 273, 141, 283 Annotation: Subtype: Link Rect: 147, 273, 183, 283 Annotation: Subtype: Link Rect: 520, 226, 557, 237 Annotation: Subtype: Link Rect: 204, 191, 242, 202 Annotation: Subtype: Link Rect: 520, 180, 557, 191 Annotation: Subtype: Link Rect: 442, 157, 479, 168 Annotation: Subtype: Link Rect: 516, 134, 553, 145 Annotation: Subtype: Link Rect: 511, 111, 549, 122 Annotation: Subtype: Link Rect: 319, 88, 357, 99 Annotation: Subtype: Link Rect: 214, 65, 252, 76 Annotation: Subtype: Link Rect: 258, 65, 294, 76 Page: Sequence: 23 Annotations: Annotation: Subtype: Link Rect: 300, 724, 338, 735 Annotation: Subtype: Link Rect: 344, 724, 380, 735 Annotation: Subtype: Link Rect: 322, 701, 360, 712 Annotation: Subtype: Link Rect: 108, 667, 146, 677 Annotation: Subtype: Link Rect: 152, 667, 188, 677 Annotation: Subtype: Link Rect: 240, 643, 277, 654 Annotation: Subtype: Link Rect: 322, 620, 359, 631 Annotation: Subtype: Link Rect: 145, 597, 182, 608 Annotation: Subtype: Link Rect: 187, 563, 224, 573 Annotation: Subtype: Link Rect: 520, 539, 557, 550 Annotation: Subtype: Link Rect: 59, 506, 96, 516 Annotation: Subtype: Link Rect: 109, 471, 146, 481 Annotation: Subtype: Link Rect: 152, 471, 188, 481 Annotation: Subtype: Link Rect: 286, 448, 324, 458 Annotation: Subtype: Link Rect: 330, 448, 366, 458 Annotation: Subtype: Link Rect: 364, 424, 401, 435 Annotation: Subtype: Link Rect: 408, 424, 444, 435 Annotation: Subtype: Link Rect: 469, 390, 506, 401 Annotation: Subtype: Link Rect: 59, 333, 96, 343 Annotation: Subtype: Link Rect: 443, 309, 481, 320 Annotation: Subtype: Link Rect: 502, 275, 539, 286 Annotation: Subtype: Link Rect: 218, 240, 256, 251 Annotation: Subtype: Link Rect: 311, 206, 348, 217 Annotation: Subtype: Link Rect: 372, 183, 410, 194 Annotation: Subtype: Link Rect: 333, 160, 370, 171 Annotation: Subtype: Link Rect: 376, 160, 412, 171 Annotation: Subtype: Link Rect: 104, 126, 141, 136 Annotation: Subtype: Link Rect: 147, 126, 183, 136 Annotation: Subtype: Link Rect: 148, 91, 186, 102 Annotation: Subtype: Link Rect: 192, 91, 228, 102 Page: Sequence: 24 Annotations: Annotation: Subtype: Link Rect: 174, 712, 212, 723 Annotation: Subtype: Link Rect: 378, 689, 415, 700 Annotation: Subtype: Link Rect: 390, 666, 427, 677 Annotation: Subtype: Link Rect: 433, 666, 469, 677 Annotation: Subtype: Link Rect: 59, 632, 96, 642 Annotation: Subtype: Link Rect: 288, 608, 325, 619 Annotation: Subtype: Link Rect: 506, 585, 543, 596 Annotation: Subtype: Link Rect: 520, 562, 557, 573 Annotation: Subtype: Link Rect: 259, 539, 297, 550 Annotation: Subtype: Link Rect: 260, 516, 297, 527 Annotation: Subtype: Link Rect: 113, 494, 150, 504 Checksum: d2a9b62f Type: CRC32 Checksum: 6523ab826e767b5f6ff126ff6677dca0 Type: MD5 Checksum: deef3e6b172262f69ce4a60dbee6a6a6bf0b7023 Type: SHA-1