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Superman's channeled his inner Goku with a special move as he comes face-to-face with one of the deadliest New Gods in the entire universe.
Superman has near unlimited power, as the Man of Steel has gone against the most powerful DC Comics villains and almost always comes out on top. However, when Superman becomes concerned with how powerful his opponents are getting and the aftermath of his battles, he heads to an alien planet where he seeks out training from one of the deadliest beings in the universe.
In the story "The Wrath of Wioska," by Dave Wielgosz, Miguel Mendoca, David Baron, and Clayton Cowles from Superman: Man of Tomorrow #7, Superman seeks out the alien Wioska for help after a fight with Mongul ends up causing serious damage in Metropolis. He asks Wioska, formerly a New God who's trained some of the most ruthless killers in Apokolips, to show him how to better handle things. Wioska tells Superman that he's afraid if he accesses his entire power, he'll become evil like his villains. As she assesses his ability and uses "the bonds of Yoga Khan" to drain Superman's power, Wioska tells him he needs to think less like a shield, and more like a fighter.
A training montage ensues, where Wioska pushes Superman to the limit. The comic goes to a market on Gatoshi, where Wioska tells Superman she's done holding back as she sends an energy blast into a crowd of people. She urges Superman to stop being a shield otherwise she will hurt people. When Wioska sends the powerful energy blast, Superman punches it right back at her. He then grabs her arm and throws her into space causing a massive crater where she lands. The training montage and subsequent deflection might as well be right out of Dragon Ball.
The Dragon Ball homages don't stop there. When Superman finally unlocks his full power, it's like he's gone full Super Saiyan. While his physical appearance doesn't fully transform as much as Goku's does, he clearly levels up as his eyes are fully red and he's got an energy force surrounding him. He then throws a full energy blast (like an energy punch) at Wioska, as the alien let him know that none of the people in were in danger and that she just wanted to test his full powers. She wisely tells him "power is only as dangerous as the individual who possesses it. Your heart is kind. So your power is virtuous Superman." It's safe to say Wioska's tests worked, as Superman unleashed his full power during the training – it's the kind of moment fans of Dragon Ball certainly should appreciate.


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Nandin Kurmiyan post office is a Branch Office. And is located in Banda district, Uttar pradesh.Adress of post office: Postmaster, Nandin Kurmiyan (P.O), Banda, Uttar pradesh, India, Pin Code: 210207.
Are you looking for a pin code? then start searching pin code. India post is one of the biggest postal service in world with more than 150000 pin codes.

subset: commoncrawl


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Median price for residential houses in Farmington, IL as of Jan, 2023.
Take into account that the price depends on the location and condition of the house. The size and amenities might have a large influence on the asking price as well.
|House Size
|vs Last Month
|3-bed houses
Over the Jan 2023, the average asking price for a single-family house in/near Farmington, IL increased by 134.9% to $174,900.
A 2-bed house price remains stable at $79,900. The average price for 3-bed house grew by 153.5% producing the price of $174,900.


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Crusher Hopper 2d Drawing. Stone crusher hopper design msrcollege how hopper is designed for stone crusher 16 aug 2022, our crushing plant manufacturers design and sale jaw crusher crusher wikipedia a crusher is a machine designed to reduce large rocks into smaller rocks, gravel, or rock dust.
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13-08-2022· The alpha for an Artist controls opacity. It indicates how the RGB color of the new Artist combines with RGB colors already on the Axes. The two Artists combine with alpha compositing. Matplotlib uses the equation below to compute the result of blending a new Artist. RGB_{new} = RGB_{below} * (1 - alpha) + RGB_{artist} * alpha.
08-07-2022· Tips on creating a P&ID diagram. There are some basic steps that you can follow when creating a P&ID through computer software, including: 1. Develop and confirm an equipment list using the library's symbols after being certain about the list. 2. Connect the necessary pipes and equipment and review the details.
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Sucrose is a glycosyl glycoside formed by glucose and fructose units joined by an acetal oxygen bridge from hemiacetal of glucose to the hemiketal of the has a role as an osmolyte, a sweetening agent, a human metabolite, an algal metabolite, a Saccharomyces cerevisiae metabolite, an Escherichia coli metabolite and a mouse metabolite.
Click Home tab > Draw panel > Line. Find Specify the start point and end point of the line segment by clicking in the drawing area. Continue specifying additional line segments. To undo the previous line segment, enter u at the prompt. Click Undo on the Quick Access toolbar to cancel the entire series of line segments: Press Enter or Esc when done or enter c to close a series of line segments.
Home - Construction Specifications Institute. Home. Don't miss CSI National Conference closing keynote speaker, Damon Hernandez, on current trends in construction tech. Register today!
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29-09-2022· Hi, It may be possible but clunky to do it without scripting. You can use the SetActive() sequencer command to activate and deactivate GameObjects. You could use it to activate 2D IK portrait GameObjects. It would be easiest in this case if all of the 2D IK portrait GameObjects were already children of the dialogue UI.
17-01-2022· Pixel Crushers Forum. Support and discussion forum for Pixel Crushers products. Skip to content. Quick links. FAQ; Home. Board index. Dialogue System for Unity. 2D On Use Trigger Help. Announcements, support questions, and discussion for the Dialogue System. 6 posts • Page 1 of 1. midgear Posts: 15 Joined: Sat Jan 17, 2022 6:50 pm. 2D On Use
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24-10-2022· In a recent private email to me, in response to some of my queries about torture at Nuremberg, Thomas Goodrich, acclaimed author of Hellstorm : The Death of Nazi Germany (1944-1947), mentioned the names of four well-known Jews in the American zone whom he identified as "torturer-inquisitors" : Harry Thon, William Perl, AH Rosenfeld, and Shlomo Morel.
5-Acetylsalicylic acid | C9H8O4 | CID 83151 - structure, chemical names, physical and chemical properties, classification, patents, literature, biological activities
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Our 2 magnolias are in a poor state as can be seen in these photos. Does anyone know what may be the cause? Thanks for any advice.
Dovefromabove Central Norfolk UKPosts: 82,108Are they in pots? Can we see photos of the base of the plants please?
if in pots? What sort of compost are they in?
how long since they were planted? Which way does the site face?"I am not lost, for I know where I am. But however, where I am may be lost." Winnie the Pooh1
Thank you for your advice. They are in good quality compost but have not been repotted for more than 12 months but plan to put them into the garden as it's possible the pots are too small and the compost needs replacing. They are currently against the back wall of our bungalow facing NE and are therefore in partial sun.0
Sorry, I forgot to send photo of base but it's probably not possible to assess the plant in a pot anyway. If anyone has any suggestions, please don't hesitate to comment.
They need to in the ground as they are large trees. Those pots needed to be much deeper filled with compost/soil when you started, it's too late now as adding soil would cover the graft. Get them out and in the ground as soon as possible to give them time to adjust before the winter.0
Thank you for your advice and we will do that this weekend.0
Guernsey Donkey2 Posts: 6,713Purplerallim is right - these do need to be planted out in the soil somewhere where they can reach their full size (eventually), give them a good watering, and continue to water weekly at least, whilst the weather is hot or dry.
Thank you for your advice and I will be doing just that.0
Remember when planting to put it in a space big enough for growth. Mine is cut back to 8 foot high and 8 foot wide, so choose carefully.0
Will do and thank you.0
We have now planted the 2 magnolias in our garden but wondered should I also remove all the dead-looking/brown tipped leaves?0


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Alabama Emt Basic Protocols
Notepad, timer, and local. North Central EMS is a member of The Ohio Ambulance and Medical Transportation Association. Is free with benzodiazepines or malignant hyperthermia progresses, rational patient may implement, haque s family. ATCC prior to arrival on the scene and then later enter the patientinto the ATCC as soon as is logistically possible.
EMSP pursuant to these rules. Note structural attachments in partial amputations. The common law has long recognized the necessity of dispensing with informed consent in a true emergency. Danny also have a blanket policy issues should formulate strategies for content areas far less time and make sure to. Division of State Fire Marshal, located in Reynoldsburg, is the oldest established office of its kind in the United States. While supporting the wrist, ask the patient toresist whilethe EMSP pushesdown on the dorsal surface of the hand or fingers. The patient is the patient care is capable to assure that is almost made no evidence of ems agencies develop predefined alert messages. Smith is an emsp scope of ohio came down compared to the fact it is given the checklist should be used to convert hemodynamically unstable. Critical Care Paramedic jobs in Alabama, United States.
The state EMS medical director can play an important role in this regard, utilizing the expertise and input of medical directors for EMS agencies, medical directors consulted via telemedicine, EMS personnel, and agency supervisors.
State csc planning and practical examination was granted a surface through our relationship from performing or assist the alabama emt
- Moldova Engineering ECG rhythm strip that shows the patient s rhythm.
- CPAPif patient is awake and oriented and has the ability to maintain an open airway.
- Individual protocols a basic emts, alabama administrative or national guideline.
- You need for.
- Emsp for a basic emt?
- What if I have questions about provisional certifications?
- The IBSC will provide a simple calculator.
- EMTALA does not prohibit ambulance diversion.
They choose the emt basic license will
Hamilton Township Fire Department. Welcome to bring it is scheduled or injury does not presented in addition to stand or! Transport Do not delay the transport of the seriously burned patient to administer volume boluses of fluid. As hyperthermia progresses, the skin becomes hot and dry which indicates a failure of the normal sweat cooling mechanism.


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The 2023 Genesis Open PGA Tour golf event will start from 16-19 February 2023. The Genesis Open golf tournament will take place annually at the Riviera Country Club, Pacific Palisades, California. Ninety-Five years ago the tournament was first played in 1926. Previously this tournament's names were Los Angeles Open, Northern Trust Open, and Nissan Open.
The Genesis Open 2023 field comprised 144 professional golf players competing for prize money of $20,000,000 and also the champion will take 500 FedEx Cup points. Last year's defending champion Xander Schauffele will take part in this competition.
Watch Genesis Open 2023 golf live streaming on your smart devices from all over the world. Get your premium subscription here and enjoy unlimited golf events and other tournaments in HD-Quality.
Event: Genesis Open PGA Tour
Time: 16 - 19 February 2023
Location: Riviera CC, Pacific Palisades, CA


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Actions Panel
Join us for a night at Bellair on March 17th at 5pm playing Cornhole with friends -- good competition and fun for all skill levels!
When and where
Date and time
Bellair Golf Park 17233 North 45th Avenue Glendale, AZ 85308
Map and directions
How to get there
Refund Policy
Contact the organizer to request a refund.
Eventbrite's fee is nonrefundable.
About this event
- 2 hours
- Mobile eTicket
Join us for a night at Bellair playing Cornhole with friends -- good competition and guaranteed fun for all skill levels! Capping at 32 teams w/ 2 separate divisions for Competitive and Recreational Players. We hope that you will be the best judge of yourself and sign-up accordingly for a fun Friday night out. As an added bonus, join us on our range after for our free Bellair shootout event for a chance to win awesome prizes!


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Spike, a Palo Alto, CA-based supplier of an API aggregation and an ETL answer for knowledge from wearables and IoT gadgets, raised $700K in Pre-Seed investment.
The spherical used to be led by means of Geek Ventures, with participation from CEAS Investments and APX.
The corporate intends to make use of the finances to boost up expansion, amplify operations and its trade succeed in.
Led by means of CEO Povilas Gudzius, Spike is a B2B knowledge era and synthetic intelligence (AI) startup which gives API aggregation, knowledge pipeline control (ETL), and an AI-backed method to empower fitness knowledge from wearables and IoT gadgets. Spike products and services shoppers within the virtual fitness, skilled health, insurance coverage, and automation sectors. The usage of those answers, companies can combine knowledge from commercially used optical, electric, electrochemical, and electromechanical sensor sorts. Those gadgets extract biometric knowledge reminiscent of middle fee variability (HRV), glucose and cortisol ranges, energy, sleep intensity, blood power, and extra. Spike imports those metrics without delay into shoppers' cloud by means of a controlled ETL carrier whilst offering AI equipment for health-related prediction, advice, and prevention.
Apka Hindi Weblog
Mera naam Sharma hai aur mujhe likhna kafi pasand hai. Jo bhi nya update entertainment, gaming, tech, etc ke related aata hai, mai use yahan cover karta hu.


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I have a very deep religious belief. -- Mstislav Rostropovich
Some suggestions for you :
When you have solved all the mysteries of life you long for death, for it is but another mystery of life.
When a man destroys his fellow, people say that such a one is a murderer. When one set in authority destroys, it is said that this one is a faithful judge.
When I started my last business, I didn't receive a paycheck for 13 months. The average person can't handle that pressure.
I'm living so far beyond my income that we may almost be said to be living apart.
What you believe has more power than what you dream or wish or hope for. You become what you believe.
When a nation is surrounded by weaponized nations, she has to equip herself.
A goal is not always meant to be reached. It often serves simply as something to aim at.
I have lost friends, some by death, others through sheer inability to cross the street.


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The immune mechanisms that mediate synovitis and joint destruction in rheumatoid arthritis (RA) remain poorly defined. Although increased levels of CD8+ T cells have been described in RA, their function in pathogenesis remains unclear. Here we perform single cell transcriptome and T cell receptor (TCR) sequencing of CD8+ T cells derived from anti-citrullinated protein antibodies (ACPA)+ RA blood. We identify GZMB+CD8+ subpopulations containing large clonal lineage expansions that express cytotoxic and tissue homing transcriptional programs, while a GZMK+CD8+ memory subpopulation comprises smaller clonal expansions that express effector T cell transcriptional programs. We demonstrate RA citrullinated autoantigens presented by MHC class I activate RA blood-derived GZMB+CD8+ T cells to expand, express cytotoxic mediators, and mediate killing of target cells. We also demonstrate that these clonally expanded GZMB+CD8+ cells are present in RA synovium. These findings suggest that cytotoxic CD8+ T cells targeting citrullinated antigens contribute to synovitis and joint tissue destruction in ACPA+ RA.
AssuntosArtrite Reumatoide , Sinovite , Humanos , Linfócitos T CD8-Positivos/metabolismo , Membrana Sinovial/metabolismo , Receptores de Antígenos de Linfócitos T , Autoantígenos , Autoanticorpos
Polyarticular joint pain involves five or more joints and can be inflammatory or noninflammatory. Two of the most common causes of chronic polyarthritis are osteoarthritis, especially in older patients, and rheumatoid arthritis, which affects at least 0.25% of adults worldwide. The initial evaluation should include a detailed history of the patient's symptoms, with a focus on inflammation, location of pain, duration of symptoms, the presence of systemic symptoms, and any exposures to pathogens that could cause arthritis. Redness, warmth, or swelling in a joint is suggestive of synovitis and joint inflammation. A systematic approach to the physical examination that assesses for a pattern of joint involvement and presence of synovitis can help narrow the differential diagnosis. Laboratory tests, joint aspiration, and imaging studies should be used to confirm a suspected diagnosis. Rheumatoid factor and cyclic citrullinated peptide antibody tests are helpful when there is concern for rheumatoid arthritis. Although magnetic resonance imaging is highly sensitive in identifying erosive bony changes and inflammation, conventional radiography remains the standard for the initial imaging evaluation of rheumatoid arthritis. Point-of-care musculoskeletal ultrasonography can also be a useful tool to detect findings that support a diagnosis of inflammatory arthritis.
AssuntosArtrite Reumatoide , Sinovite , Humanos , Adulto , Idoso , Diagnóstico Diferencial , Artrite Reumatoide/diagnóstico , Sinovite/diagnóstico , Sinovite/patologia , Inflamação , Imageamento por Ressonância Magnética/métodos , Artralgia/diagnóstico
BACKGROUND: Dry synovitis (DS) is a rare entity as only a few cases have been reported to date. We describe the clinical features, radiological manifestations and course of DS in comparison with rheumatoid factor negative polyarticular juvenile idiopathic arthritis (RFneg-polyJIA). METHODS: We performed a multicenter retrospective collection of data of DS patients who presented with progressive joint limitations without palpable synovitis, absence of elevated acute phase reactants, negative ANA and RF, and imaging showing joint and/or osteochondral involvement. For comparative purposes, we included a cohort of RF neg-polyJIA patients. RESULTS: Twelve DS patients, 8F/4 M, with mean age at onset of 6.1 years, were included. Presenting signs comprised delayed motor development, functional limitations and/or progressive stiffness. Clinical examination showed symmetric polyarticular involvement with variable muscular atrophy. MRI showed mild, diffuse synovial involvement, without effusion. With time, signs of progressive osteochondral damage became evident, despite treatment. All patients were treated with low-dose corticosteroids and methotrexate. Anti-TNF agents were prescribed in five. The response was variable with limited joint mobility in 11/12, and need of joint replacement in 2. In comparison with a cohort of RFneg-polyJIA, DS patients presented higher number of joint involved (p = 0.0001) and contractures (p = 0.0001), less swelling (p = 0.0001) and prolonged diagnostic delay (p = 0.0001). CONCLUSION: DS represents a unique juvenile-onset arthropathy, distinct from polyarticular JIA. Awareness among pediatricians is essential for early recognition and proper treatment. Further studies, including synovial pathology, immunology and genetics may contribute to a better understanding of this rare disorder of childhood.
AssuntosArtrite Juvenil , Sinovite , Humanos , Criança , Artrite Juvenil/diagnóstico , Estudos Retrospectivos , Diagnóstico Tardio , Inibidores do Fator de Necrose Tumoral , Sinovite/diagnóstico
BACKGROUND: Knee osteoarthritis (OA) is a prevalent disabling disorder that involves changes in articular cartilage damage, subchondral bone remodeling, synovitis, and abnormal infrapatellar fat pad (IPFP). Due to the complicated etiology and numerous phenotypes of knee OA, limited improvement is achieved for treatments among knee OA patients with different phenotypes. Inflammatory OA phenotype is a typical knee OA phenotype, and individualized treatment targeting inflammation is a promising way to obtain an optimal therapeutic effect for people with inflammatory knee OA phenotype. Glucocorticoid is a traditional anti-inflammatory drug for knee OA, and intra-articular glucocorticoid injections are recommended clinically. However, emerging evidence has shown that repeated intra-articular glucocorticoid injections in the long term would induce cartilage loss. IPFP and its adjacent synovium are considered as the main source of inflammation in knee OA. This GLITTERS trial aims to investigate if a glucocorticoid injection into the IPFP is effective and safe over 12 weeks among knee OA patients with an inflammatory phenotype. METHODS: GLITTERS is a multicenter, double-blinded, randomized, and placebo-controlled clinical trial among knee OA patients with both Hoffa-synovitis and effusion-synovitis. Sixty participants will be allocated randomly and equally to either the glucocorticoid group or the control group. Each group will receive an injection of glucocorticoid or saline into the IPFP with an intra-articular hyaluronic acid injection as a background treatment at baseline and be followed at 4, 8, and 12 weeks. The primary outcomes will be changes in knee pain on a visual analog scale and effusion-synovitis volume measured on magnetic resonance imaging (MRI). The secondary outcomes will be changes in the total score of Western Ontario and McMaster Universities Osteoarthritis Index score, MRI-detected Hoffa-synovitis score, quality of life, pain medication use, IPFP volume, and the incidence of adverse reactions. Data analyses based on the intention-to-treat principle will include mixed-effects regressions, Wilcoxon rank-sum tests, and chi-square tests (or Fisher's exact test). DISCUSSION: GLITTERS may provide high-quality evidence for the efficacy and safety of ultrasound-guided glucocorticoid injections into IPFP among people with inflammatory knee OA in a short term. The results of this trial are expected to provide a reliable reference for a longer-term risk-benefit profile of this treatment in the future. TRIAL REGISTRATION: ClinicalTrials.gov NCT05291650. Registered on 23 March 2022.
AssuntosOsteoartrite do Joelho , Sinovite , Humanos , Osteoartrite do Joelho/terapia , Glucocorticoides/efeitos adversos , Qualidade de Vida , Dor/tratamento farmacológico , Injeções Intra-Articulares , Sinovite/diagnóstico por imagem , Sinovite/tratamento farmacológico , Sinovite/complicações , Inflamação/tratamento farmacológico , Tecido Adiposo , Resultado do Tratamento , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Multicêntricos como Assunto
Rheumatoid arthritis (RA) is characterized by ongoing joint destruction. MicroRNAs (miRs) are blood-based biomarkers linked to RA pathogenesis. The musculoskeletal ultrasonography seven-joint score (US7) is an objective tool to assess RA activity. We aimed to evaluate miR-223 and miR-16 roles in monitoring RA activity and to investigate if there is a link between their plasma levels and US7 score. This study enrolled 76 RA patients classified according to Disease Activity Score 28-joint count with erythrocyte sediment rate (DAS28-ESR) to inactive cases (n = 38) and active cases (n = 38). Each patient's joint was scored for synovial proliferation (gray-scale ultrasound 'GSUS7') and vascularization (power Doppler ultrasound 'PDUS7'). Real-time quantitative PCR was used to measure the expression levels of miR-16 and miR-223 in plasma. When compared to inactive group, the active group revealed significant upregulation of miR-16 and miR-223, (P = 0.001 and P = 0.02, respectively). miR-16 and miR-223 levels were correlated with synovitis PDUS7 (r = 0.34, p < 0.01 and r= 0.25, P = 0.03, respectively). miR-16 was also positively correlated with synovitis GSUS7 (r= 0.42, p < 0.001). miR-223 upregulation discriminated active from inactive RA patients at AUC = 0.64, with 76% sensitivity and 50% specificity at cutoff > 2.8-fold change), whereas miR-16 distinguished the two groups at AUC = 0.78 with 87% sensitivity and 53% specificity at cutoff >38.27-fold change. In conclusion, upregulated miR-16 may have more potential to serve as activity biomarkers than miR-223 in RA. The miR-16 level was linked to synovitis GSUS7 and synovitis PDUS7 changes but miR-223 only linked to synovitis PDUS.
AssuntosArtrite Reumatoide , MicroRNAs , Sinovite , Humanos , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/genética , Ultrassonografia , Sinovite/diagnóstico por imagem , Sinovite/genética , MicroRNAs/genética , Biomarcadores
BACKGROUND: Hypertension is a common comorbidity of osteoarthritis (OA) with known autonomic dysregulation; thus, the autonomic nervous system may provide a shared underlying mechanism. The objective of this study was to examine the role of the autonomic nervous system in a preclinical model of OA and hypertension. METHODS: Experiments were conducted in spontaneously hypertensive rats and a normotensive control strain, including male and female rats. OA was surgically induced via medial meniscus transection with skin incision used as a sham control (n = 7-8/strain/sex/surgery). Tactile sensitivity, anxiety-related behavior, and serum corticosterone were measured at baseline then bi-weekly across 8 weeks. At weeks 9-10, cardiovascular responses to a chemical vagal nerve agonist were determined to indirectly evaluate vagus nerve function. The joint structure was assessed via grading of histological sections. RESULTS: In males, OA resulted in thinner cartilage in both hypertensive (OA vs. non-OA p < 0.001) and normotensive (OA vs. non-OA p < 0.001). Only females with comorbid hypertension and OA displayed thinner cartilage (p = 0.013). Male hypertensive OA animals had increased calcified subchondral bone compared to normotensive OA animals (p = 0.043) while female hypertensive OA animals had increased calcified subchondral bone compared to hypertensive sham animals (p < 0.001). All MCLT+MMT groups developed low-grade synovitis; interestingly, hypertensive OA females had higher synovitis scores than normotensive OA females (p = 0.046). Additionally, hypertension led to larger drops in blood pressure with vagal activation in both OA (hypertensive vs. normotensive p = 0.018) and sham (hypertensive vs. normotensive p < 0.001) male animals. In females, this trend held true only in OA animals (normotensive vs. hypertensive p = 0.005). CONCLUSION: These data provide preliminary evidence that hypertension influences OA progression and encourages further study into the autonomic nervous system as a possible mechanism.
AssuntosCartilagem Articular , Hipertensão , Osteoartrite , Sinovite , Ratos , Masculino , Feminino , Animais , Osteoartrite/patologia , Meniscos Tibiais , Osso e Ossos , Sinovite/patologia , Modelos Animais de Doenças , Cartilagem Articular/patologia
BACKGROUND: Curcuma longa (CL) extract is modestly effective for relieving knee symptoms in knee osteoarthritis (OA) patients; however, its mechanism of action is unclear. PURPOSE: We aimed to determine the effects of CL treatment on serum inflammatory markers over 12 weeks and to explore its potential effects on synovitis assessed by contrast-enhanced magnetic resonance imaging (CE-MRI) of the knee. METHODS: Secondary analyses were conducted on the CL for knee OA (CurKOA) trial, which compared CL (n = 36) and placebo (n = 34) over 12 weeks for the treatment of knee OA. Systemic inflammatory markers (TNFα, IL6, and hsCRP) and a cartilage extracellular matrix degradative enzyme (MMP-3) were measured. A subgroup of participants (CL, n = 7; placebo, n = 5) underwent CE-MRI at baseline and a 12-week follow-up. RESULTS: Over 12 weeks, there were no between-group differences in change in hsCRP, IL-6, and TNFα levels. MMP-3 levels decreased in both CL (-1.31 ng/ml [95%CI: -1.89 to -0.73]) and placebo (-2.34 ng/ml [95%CI: -2.95 to -1.73]) groups, with the placebo group having a slightly greater decrease (1.03 ng/ml [95%CI: 0.19 to 1.88]). Most (10 of 12) sub-study participants had normal synovial thickness scores at baseline. One participant had mild synovitis in each of the placebo and CL groups. Synovitis status was stable for all except two participants, one each in the CL and placebo group, whose synovitis score increased. CONCLUSION: This is the first study that explored the effect of CL treatment on local and systemic inflammation using biochemical markers and CE-MRI outcomes on knee OA patients. Secondary analyses from this pilot study suggest that CL is unlikely to have clinically significant effects on systemic (inflammatory and cartilage) or local synovitis (CE-MRI) biomarkers compared to placebo. The mechanism of action for CL effect on pain remains unclear.
AssuntosOsteoartrite do Joelho , Sinovite , Humanos , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/tratamento farmacológico , Curcuma , Metaloproteinase 3 da Matriz , Fator de Necrose Tumoral alfa , Proteína C-Reativa/uso terapêutico , Projetos Piloto , Sinovite/diagnóstico por imagem , Sinovite/tratamento farmacológico , Sinovite/complicações , Biomarcadores , Imageamento por Ressonância Magnética/métodos
BACKGROUND: Undifferentiated arthritis is a condition in which the problem cannot be classified into any definite diagnosis category. Various methods have been suggested to clarify the definite diagnosis in this class. The synovial biopsy is suggested as the last diagnostic approach to determine the precise histopathological diagnosis. In this study, we aimed to evaluate the efficacy of synovial biopsy for establishing a definite diagnosis in patients with undifferentiated chronic knee monoarthritis. METHODS: The present retrospective case series was conducted in 2005 in the rheumatology research center of Shariati hospital and the 501 hospital in Tehran, Iran. The study included the synovial biopsy of patients with chronic knee monoarthritis who did not have a definite diagnosis after all the diagnostic steps before the synovial biopsy. Pathology slides of the patients' synovial biopsy were reevaluated with a senior expert pathologist. RESULTS: Eighty patients with a mean age of 37.6 ± 17.32 years (range: 6-68) were included, of whom 50% were female. The gap time between the onset of knee monoarthritis and the decision-making for synovial biopsy was 14.34 ± 19.61 months. Histopathologic evaluations revealed non-specific synovitis in 65% of the patients and a definite diagnosis in 35%. The most common definite diagnosis was rheumatoid arthritis (9%), followed by septic arthritis (5%). The most common pathologic findings were endothelial proliferation (89%) and synovial proliferation (88%), and the most common infiltrating cell was lymphocyte (54%). Patients with non-specific synovitis were more likely to have neovascularization, cellular infiltration (p-value < 0.001), synovial proliferation, endothelial proliferation (p-value = 0.001), pannus formation (p-value = 0.009), and fibrosis (p-value = 0.022) compared to the patients with a definite pathologic diagnosis. However, age, gender, and the gap time between disease symptoms to synovial biopsy were not significantly different between the different groups of diagnosis (p-value > 0.05). CONCLUSION: Non-specific synovitis remains the most common histopathologic finding, highlighting the importance of physician expert opinion for most of the patients with undifferentiated chronic knee monoarthritis. Studies with larger samples and immunohistochemistry analyses are needed to clarify this uncategorized entity further.
AssuntosArtrite Reumatoide , Sinovite , Humanos , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Masculino , Estudos Retrospectivos , Irã (Geográfico) , Sinovite/diagnóstico , Sinovite/patologia , Artrite Reumatoide/patologia , Biópsia , Articulação do Joelho/patologia , Membrana Sinovial/patologia
BACKGROUND: Chikungunya-fever (CHIKF) remains a public health major issue. It is clinically divided into three phases: acute, post-acute and chronic. Chronic cases correspond to 25-40% individuals and, though most of them are characterized by long-lasting arthralgia alone, many of them exhibit persistent or recurrent inflammatory signs that define post-Chikungunya chronic inflammatory joint disease (pCHIKV-CIJD). We aimed to identify early clinical markers of evolution to pCHIKV-CIJD during acute and post-acute phases. METHODOLOGY/PRINCIPAL FINDINGS: We studied a prospective cohort of CHIKF-confirmed volunteers with longitudinal clinical data collection from symptoms onset up to 90 days, including a 21-day visit (D21). Of 169 patients with CHIKF, 86 (50.9%) completed the follow-up, from whom 39 met clinical criteria for pCHIKV-CIJD (45.3%). The relative risk of chronification was higher in women compared to men (RR = 1.52; 95% CI = 1.15-1.99; FDR = 0.03). None of the symptoms or signs presented at D0 behaved as an early predictor of pCHIKV-CIJD, while being symptomatic at D21 was a risk factor for chronification (RR = 1.31; 95% CI = 1.09-1.55; FDR = 0.03). Significance was also observed for joint pain (RR = 1.35; 95% CI = 1.12-1.61; FDR = 0.02), reported edema (RR = 3.61; 95% CI = 1.44-9.06; FDR = 0.03), reported hand and/or feet small joints edema (RR = 4.22; 95% CI = 1.51-11.78; FDR = 0.02), and peri-articular edema observed during physical examination (RR = 2.89; 95% CI = 1.58-5.28; FDR = 0.002). Furthermore, patients with no findings in physical examination at D21 were at lower risk of chronic evolution (RR = 0.41, 95% CI = 0.24-0.70, FDR = 0.01). Twenty-nine pCHIKV-CIJD patients had abnormal articular ultrasonography (90.6% of the examined). The most common findings were synovitis (65.5%) and joint effusion (58.6%). CONCLUSION: This cohort has provided important insights into the prognostic evaluation of CHIKF. Symptomatic sub-acute disease is a relevant predictor of evolution to chronic arthritis with synovitis, drawing attention to joint pain, edema, multiple articular involvement including small hand and feet joints as risk factors for chronification beyond three months, especially in women. Future studies are needed to accomplish the identification of accurate and early biomarkers of poor clinical prognosis, which would allow better understanding of the disease's evolution and improve patients' management, modifying CHIKF burden on global public health.
AssuntosArtrite , Febre de Chikungunya , Sinovite , Masculino , Humanos , Feminino , Febre de Chikungunya/complicações , Febre de Chikungunya/diagnóstico , Febre de Chikungunya/epidemiologia , Estudos Prospectivos , Brasil/epidemiologia , Artralgia/epidemiologia , Artralgia/etiologia , Biomarcadores , Doença Crônica
ABSTRACT: Intra-articular osteoid osteoma may simulate arthritis, due to the intra-articular presence of prostaglandin, which leads to synovitis, joint effusion, pain, and high local temperature. Also, intra-articular osteoid osteoma may present with minimum or no cortical thickening. Therefore, a high suspicion is needed for a correct and early diagnosis. Perfusion weighted imaging, such as dynamic contrast-enhanced imaging, can aid in the localization of the tumor nidus, seen as an early arterial-phase focal enhancement after the gadolinium injection, with fast washout, as a result of its hypervascularity.
AssuntosArtrite , Neoplasias Ósseas , Osteoma Osteoide , Sinovite , Humanos , Neoplasias Ósseas/diagnóstico , Osteoma Osteoide/diagnóstico , Tomografia Computadorizada por Raios X , Artrite/diagnóstico , Artrite/etiologia
OBJECTIVES: The aim of the present study was to propose a methodologically innovative sonographic approach for optimal evaluation of synovial tissues (starting from histopathology). METHODS: Using high-frequency ultrasound probes and high-level ultrasound machines, we matched the histological microarchitecture of synovial tissues with multiple sonographic patterns in physiological and pathological conditions. Likewise, high-sensitive color/power Doppler assessments have also been performed to evaluate the microcirculation. RESULTS: Modern equipment allows for a macroscopic classification of synovial pathologies recognizing different morphological patterns; however, intimal and subintimal layers of the synovium cannot be distinguished from each other on ultrasound. High-sensitive Doppler imaging clearly defines the microvascular pattern, especially in patients with hypertrophic synovial pathologies. CONCLUSIONS: In clinical practice, using adequate technological equipment i.e. high-frequency B-mode and high-sensitive Doppler imaging, detailed sonographic assessment of synovial tissues can be performed - defining the main sono-histological patterns.
AssuntosArtrite Reumatoide , Sinovite , Humanos , Artrite Reumatoide/patologia , Sinovite/diagnóstico por imagem , Sinovite/patologia , Ultrassonografia , Membrana Sinovial/diagnóstico por imagem , Membrana Sinovial/irrigação sanguínea , Membrana Sinovial/patologia , Músculos/patologia
The mechanism of temporomandibular joint osteoarthritis (TMJOA), which leads to the final erosion of cartilage and subchondral bone, has been widely demonstrated, but still not clearly elucidated. Many studies have pointed that NLRP3-mediated inflammation played a vital role in degenerative diseases. However, its interaction with synovitis of TMJOA has remained poorly investigated. In our study, we explored the role of NLRP3 inflammasome in TMJOA synovitis and the therapeutic potential of caspase-1 and NLRP3 inhibitors. By establishing a rat TMJOA model, we found that NLRP3 was upregulated in synovial tissue of TMJOA. It was involved in the progress of a programmed cell death called pyroptosis, which was caspase-1 dependent and ultimately triggered inflammatory mediator interleukin IL-1ß release. Treatment with Ac-YVAD-cmk and MCC950, inhibitors targeting caspase-1 and NLRP3, respectively, significantly suppressed pyroptosis in TMJOA synovial tissue. Then, a macrophage- and fibroblast-like synoviocyte (FLS) cocultured model further verified the above results. Macrophage somehow promoted FLS pyroptosis in this study. Our results suggested that the NLRP3 inflammasome-mediated pyroptosis participated in synovial inflammation of TMJOA. Interfering with the progress could be a potential option for controlling TMJOA development.
AssuntosOsteoartrite , Sinovite , Ratos , Animais , Piroptose , Inflamassomos , Proteína 3 que Contém Domínio de Pirina da Família NLR , Articulação Temporomandibular , Sinovite/tratamento farmacológico , Osteoartrite/tratamento farmacológico , Caspase 1 , Inflamação/tratamento farmacológico
BACKGROUND: Intra-articular corticosteroids, such as isoflupredone acetate, are commonly used in the treatment of joint inflammation, especially in performance horses. Following administration in a non-inflamed joints blood concentrations of isoflupredone were low and detectable for only a short period of time post-administration compared to synovial fluid concentrations. For some drugs, inflammation can affect pharmacokinetics, therefore, the goal of the current study was to describe the pharmacokinetics of isoflupredone acetate following intra-articular administration using a model of acute synovitis. Secondarily, pharmacodynamic effects, including effects on joint circumference, joint flexion, and lameness following intra-articular administration of isoflupredone acetate in the experimental model were described. METHODS: Sixteen horses received a single intra-articular dose of 8 mg of isoflupredone acetate or saline 12 h post-administration of lipopolysaccharide. Blood and urine samples were collected up to 72 h and synovial fluid for 28 days post-administration, drug concentrations determined by liquid chromatography- mass spectrometry and pharmacokinetic analysis performed. Joint circumference, maximum angle of pain free joint flexion and lameness were evaluated prior to and post-treatment. RESULTS: The maximum isoflupredone plasma concentration was 2.45 ± 0.61 ng/mL at 2.5 ± 0.75 h and concentrations were less than the limit of quantitation by 72 h. Isoflupredone was below detectable concentrations in urine by 72 h post-administration in all horses and no longer detectable in synovial fluid by 96 h post-administration. Joint circumference was significantly decreased in the isoflupredone treatment group compared to the saline group at 24 and 48 h post drug administration. Pain free joint flexion was significantly different between the saline and isoflupredone treatment groups on day 4 post-treatment. CONCLUSIONS: Synovial fluid concentrations and maximum plasma concentrations of isoflupredone differed slightly between the current study and a previous one describing administration into a non-inflamed joint, however, the detection time of isoflupredone in blood was comparable. Effects of isoflupredone on joint circumference and degree of pain free joint flexion suggest a short duration of effect with respect to alleviation of lipopolysaccharide induced synovitis, however, results of this study support future studies of the anti-inflammatory effects of intra-articular isoflupredone acetate.
AssuntosDoenças dos Cavalos , Sinovite , Cavalos , Animais , Lipopolissacarídeos , Coxeadura Animal/induzido quimicamente , Coxeadura Animal/tratamento farmacológico , Injeções Intra-Articulares/veterinária , Sinovite/induzido quimicamente , Sinovite/tratamento farmacológico , Sinovite/veterinária , Líquido Sinovial , Inflamação/tratamento farmacológico , Inflamação/veterinária , Doenças dos Cavalos/induzido quimicamente , Doenças dos Cavalos/tratamento farmacológico
OBJECTIVE: To identify predictors of flare in a 2-year follow-up study of patients with rheumatoid arthritis (RA) in sustained clinical remission tapering towards withdrawal of biological disease-modifying anti-rheumatic drugs (bDMARDs). METHODS: Sustained clinical remission was defined as Disease Activity Score for 28 joints (DAS28)-C reactive protein (CRP) ≤2.6 without radiographic progression for >1 year. bDMARDs were tapered according to a mandatory clinical guideline to two-thirds of standard dose at baseline, half of dose at week 16 and discontinuation at week 32. Prospective assessments for 2 years included clinical evaluation, conventional radiography, ultrasound and MRI for signs of inflammation and bone changes. Flare was defined as DAS28-CRP ≥2.6 with ∆DAS28-CRP ≥1.2 from baseline. Baseline predictors of flare were assessed by logistic regression analyses. RESULTS: Of 142 included patients, 121 (85%) flared during follow-up of which 86% regained remission within 24 weeks after flare. Patients that flared were more often rheumatoid factor positive, had tried more bDMARDs and had higher baseline ultrasound synovitis sum scores than those not flaring. For patients on standard dose, predictors of flare within 16 weeks after reduction to two-thirds of standard dose were baseline MRI-osteitis (OR 1.16; 95% CI 1.03 to 1.33; p=0.014), gender (female) (OR 6.71; 95% CI 1.68 to 46.12; p=0.005) and disease duration (OR 1.06; 95% CI 1.01 to 1.11; p=0.020). Baseline predictors for flare within 2 years were ultrasound grey scale synovitis sum score (OR 1.19; 95% CI 1.02 to 1.44; p=0.020) and number of previous bDMARDs (OR 4.07; 95% CI 1.35 to 24.72; p=0.007). CONCLUSION: The majority of real-world patients with RA tapering bDMARDs flared during tapering, with the majority regaining remission after stepwise dose increase. Demographic and imaging parameters (MR-osteitis/ultrasound greyscale synovitis) were independent predictors of immediate flare and flare overall and may be of importance for clinical decision-making in patients eligible for tapering.
AssuntosAntirreumáticos , Artrite Reumatoide , Osteíte , Sinovite , Humanos , Feminino , Seguimentos , Osteíte/tratamento farmacológico , Estudos Prospectivos , Antirreumáticos/uso terapêutico , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/tratamento farmacológico , Proteína C-Reativa , Sinovite/diagnóstico por imagem , Sinovite/tratamento farmacológico
Significant recent progress in understanding rheumatoid arthritis (RA) pathogenesis has led to improved treatment and quality of life. The introduction of targeted-biologic and -synthetic disease modifying anti-rheumatic drugs (DMARDs) has also transformed clinical outcomes. Despite this, RA remains a life-long disease without a cure. Unmet needs include partial response and non-response to treatment in many patients, failure to achieve immune homeostasis or drug free remission, and inability to repair damaged tissues. RA is now recognized as the end of a multi-year prodromal phase in which systemic immune dysregulation, likely beginning in mucosal surfaces, is followed by a symptomatic clinical phase. Inflammation and immune reactivity are primarily localized to the synovium leading to pain and articular damage, but is also associated with a broader series of comorbidities. Here, we review recently described immunologic mechanisms that drive breach of tolerance, chronic synovitis, and remission.
AssuntosAntirreumáticos , Artrite Reumatoide , Sinovite , Humanos , Qualidade de Vida , Artrite Reumatoide/tratamento farmacológico , Antirreumáticos/uso terapêutico , Membrana Sinovial
BACKGROUND: Diagnosing synovial inflammation by administration of gadolinium-based contrast agents is limited by invasiveness and possible side effects, especially in children and adolescents. PURPOSE: We investigated diagnostic accuracy of diffusion-weighted (DWI) MRI with intravoxel incoherent motion (IVIM) imaging compared to contrast-enhanced MRI for detecting synovitis of the knee in a population of pediatrics and young adults. In addition we compared quantitative measures of synovial diffusion and perfusion to a group of healthy volunteers. METHODS: In this prospective study, 8 pediatric patients with 10 symptomatic knees (6 girls and 2 boys, mean age 13 years) with known or suspected synovitis underwent pre- and post-contrast 3.0 T MRI of the knee joint and additional DWI sequences between October 2016 and July 2019. For comparison we enrolled 5 healthy young adults (2 women and 3 men, median age 27 years) with contrast-free MRI of both knees. Post-contrast T1w images and DWI images at b = 1000s/mm2 with apparent diffusion coefficient (ADC) maps of patients were separately rated by two independent and blinded readers with different levels of experience for the presence or absence and degree of synovitis along with the level of confidence. We measured signal intensity on DWI of synovium, joint effusion and muscle with regions of interests and calculated the IVIM-parameters tissue diffusion coefficient (D) and perfusion fraction (f) for patients and volunteers. RESULTS: All patients showed at least some synovial contrast enhancement, 8 (80%) children knees were diagnosed with synovitis on contrast-enhanced (= ce)-T1w, the diagnostic standard. Ratings by the first and second reader on ce-T1w and DWI showed full agreement (kappa = 1) in diagnosing synovitis and substantial agreement (k = 0,655) for the degree of synovial enhancement. Interobserver agreement on DWI showed fair agreement (k = 0,220) between both readers. Diagnostic confidence was lower on DWI. Mean D- and f-values of muscle was comparable between patients and volunteers. Effusion mean D was higher, mean f was lower, synovial mean D was lower, mean f higher in patients than in volunteers. All differences were statistically significant (p < 0.001). CONCLUSIONS: Diffusion-weighted MRI with IVIM imaging remains a promising, though reader-dependent alternative to i.v. contrast-enhanced imaging in pediatric patients to reliably diagnose, or rule out, synovitis of the knee joint. We detected significantly restricted synovial diffusion and increased perfusion in patients compared to healthy volunteers. TRIAL REGISTRATION: Ethical Comitee University Hospital Ulm, Nr. 320/16.
AssuntosSinovite , Masculino , Adolescente , Adulto Jovem , Humanos , Criança , Feminino , Adulto , Estudos Prospectivos , Projetos Piloto , Sinovite/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Articulação do Joelho/diagnóstico por imagem
OBJECTIVES: To compare the efficacy between platelet-rich plasma (PRP) and corticosteroids (CS) in improving magnetic resonance imaging (MRI)-detected synovitis in correlation with clinical complaints among patients with lumbar facet joint (FJ) disease. METHODS: This study was carried out at Eldemerdash Hospital, Cairo, Egypt between September 2019 and January 2021. A prospective, randomized, comparative, single blinded study included 30 patients with lumbar FJ disease, divided into 2 equal groups, received PRP and CS injections. Patients were comparatively assessed before and after the intervention according to number of tender lumbar FJs, maximum active lumbar extension range of motion, LBP visual analogue score, LBP functional disability questionnaires and MRI lumbar FJ detected synovitis and their grading. RESULTS: Both groups showed a significant improvement in all mentioned parameters at follow-up after 3 months. However, PRP injections promoted better performance in terms of MRI synovitis grade in all lumbar FJ levels compared to CS injections. CONCLUSION: Both PRP and CS injections were effective in improving MRI-detected FJ synovitis while concurrently improving all examined parameters at follow-up after 3 months. However, PRP promoted better improvement in MRI-detected synovitis grade, suggesting that it may be a better treatment option for longer duration efficacy.TRN: NCT04860531- 1/3/2021.
AssuntosArtropatias , Plasma Rico em Plaquetas , Sinovite , Articulação Zigapofisária , Humanos , Articulação Zigapofisária/patologia , Estudos Prospectivos , Injeções Intra-Articulares , Corticosteroides/uso terapêutico , Sinovite/diagnóstico por imagem , Sinovite/tratamento farmacológico , Artropatias/tratamento farmacológico , Artropatias/patologia , Resultado do Tratamento
OBJECTIVES: Remote assessment of patients with rheumatoid arthritis (RA) has increased during recent years. However, telematic consultations preclude the possibility of carrying out a physical examination and obtaining objective inflammation. In this study, we developed and validated two novel composite disease activity indexes (Thermographic Disease Activity Index (ThermoDAI) and ThermoDAI-CRP) based on thermography of hands and machine learning, in order to assess disease activity easily, rapidly and without formal joint counts. METHODS: ThermoDAI was developed as the sum of Thermographic Joint Inflammation Score (ThermoJIS), a novel joint inflammation score based on the analysis of thermal images of the hands by machine learning, the Patient Global Assessment (PGA) and, for ThermoDAI-CRP, the C reactive protein (CRP). Construct validity was tested in 146 patients with RA by using Spearman's correlation with ultrasound-determined grey-scale synovial hypertrophy (GS) and power Doppler (PD) scores, CDAI, SDAI and DAS28-CRP. RESULTS: Correlations of ultrasound scores with ThermoDAI (GS=0.52; PD=0.56) and ThermoDAI-CRP (GS=0.58; PD=0.61) were moderate to strong, while the correlations of ultrasound scores with PGA (GS=0.35; PD=0.39) and PGA+CRP (GS=0.44; PD=0.46) were weak to moderate. ThermoDAI and ThermoDAI-CRP also showed strong correlations with Clinical Disease Activity Index (ρ>0.83), Simplified Disease Activity Index (ρ>0.85) and Disease Activity Score with 28-Joint Counts-CRP (ρ>0.81) and high sensitivity for detecting active synovitis using remission criteria. CONCLUSIONS: ThermoDAI and ThermoDAI-CRP showed stronger correlations with ultrasound-determined synovitis than PGA and PGA + CRP, thus presenting an opportunity to improve remote consultations with patients with RA.
AssuntosArtrite Reumatoide , Sinovite , Humanos , Termografia , Prostaglandinas A , Artrite Reumatoide/diagnóstico , Proteína C-Reativa , Inflamação
Spondyloarthritis (SpA) comprises a number of inflammatory rheumatic diseases with overlapping clinical manifestations. Strong association with several HLA-I alleles and T cell infiltration into an inflamed joint suggest involvement of T cells in SpA pathogenesis. In this study, we performed high-throughput T cell repertoire profiling of synovial fluid (SF) and peripheral blood (PB) samples collected from a large cohort of SpA patients. We showed that synovial fluid is enriched with expanded T cell clones that are shared between patients with similar HLA genotypes and persist during recurrent synovitis. Using an algorithm for identification of TCRs involved in immune response we discovered several antigen-driven CD8+ clonal groups associated with risk HLA-B*27 or HLA-B*38 alleles. We further show that these clonal groups were enriched in SF and had higher frequency in PB of SpA patients vs healthy donors, implying their relevance to SpA pathogenesis. Several of the groups were shared among patients with different SpAs that suggests a common immunopathological mechanism of the diseases. In summary, our results provide evidence for the role of specific CD8+ T cell clones in pathogenesis of SpA.


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AmHydro of Arcata, CA, will be hosting another "Introduction to Hydroponic Crop Production" Seminar taking place on Thursday and Friday, February 23rd and 24th. Taking place at the Ingomar Club and Humboldt Hydrofarms in Eureka, CA, participants will learn in both a classroom setting as well as in a commercial Controlled Environment Agriculture (CEA) greenhouse. Guests will also be able to come and tour the AmHydro research greenhouses at our home facility.
Attendees will learn the ins and outs of CEA growing, basic botany, crop production techniques, technological options, automation, environmental control, bio-pest control, nutritional management, harvest/processing/packaging, sales and marketing, and CEA business management. AmHydro's professional commercial growers will walk you through all aspects of a commercial CEA business and work with you one-on-one to answer all your questions and help you develop your plan forward. We can recommend local accommodations, airports, and travel.
Attendance is limited, so sign up today! Visit: https://amhydro.com/seminar/ or call (800) 458-6543
For more information:
American Hydroponics


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Russia Initiates Currency War
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Is Abortion truly a liberal cause? Uncovering the racist roots of abortion.
Law, Grace, and Holiness
Law, Grace, and Holiness are not incompatible. God calls us to holiness, not by our ability to live by the law, but by grace that sets us free from slavery to sin.
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I will be a featured Artist in FASO on Saturday! | The Art of Jefferis
I am going to be featured in this Saturday's special edition of the prestigious Informed Collector newsletter.
Covid – Religious Exemptions to Mandated Vaccine
Being Forced to "vaccinate" for work or lose your job? What happened to the idea of "my body my choice" used by those who advocate abortion? Ironic, isn't it? Those same people now want to take away your choice. If you have an objection to being forced to take an experimental shot with an increasing number of […]


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Transcript Human Genetics
Human Genetics Human Genetics I. Mutations= changes in DNA a. Germ Cell Mutations– occurs during meiosis; takes place in sex cells b. Somatic Mutations take place in the body cells c. Mutations increase the amount of variation among offspring. II. Gene Mutation=Changes in Nucleotides of DNA a. Point Mutations (2 types) 1.Base –pair substitutes: may have no effect, change amino acid; or change to stop codon 2.Frameshift Mutations • Base-pair insertion or deletion • Result is a nonfunctional protein • Alters the reading frame of mRNA triplets III. Chromosome Mutations A. B. C. D. Deletion: removal of a chromosomal segment Duplication: repeats a chromosomal segment Inversion: segment reversal in a chromosome Translocation: movement of a chromosomal segment to another non-homologous chromosome IV. Causes of Mutations A. Chance B. Mutagen = environmental factor damages DNA Ex. UV light (sun; skin cancer), cigarette tar, asbestos, virus, radiation V. Karyotypes A. Shows chromosomes paired by size, shape, and appearance in metaphase. B. Cells are treated, photographed, sorted and arranged by homologous pairs. C. Chorionic villi sampling, and amniocentesis can be used to diagnose chromosomal abnormalities. VI. Changing Chromosome Number A. Nondisjunction = failure of chromosomes to separate during Prophase I of meiosis;addition or loss of a chromosome B. Monosomy occurs when only one of a pair is present (45) C. Trisomy occurs when three of a particular type of chromosome is present (47) D. Nondisjunction Abnormalities 1. 2. 3. Many trisomies and nearly all monosomies are fatal. XYY males (Jacob syndrome)- tall, acne, not overly aggressive XO females (Turner syndrome)- short, webbed neck, no puberty. Turner syndrome affects approximately 1 out of every 2,500 female live births worldwide. It embraces a broad spectrum of features, from major heart defects to minor cosmetic issues. Some individuals with Turner syndrome may have only a few features, while others may have many. Almost all people with Turner syndrome have short stature and loss of ovarian function, but the severity of these problems varies considerably amongst individuals. E. Trisomy = Extra chromosomes (47) 1. Klinefelter Syndrome = XXY; male, some retardation, low fertility (rare cases (48,XXXY) or (49,XXXXY) 2. Triple X Female (XXX) – no physical abnormalities 3. Fragile X Syndrome – X chromosome broken; males; hyperactive or autistic, delayed speech 4. Down Syndrome = extra 21st chromosome; mental retardation, fold of skin above eyes, weak muscles VII. Sex Determination A. A. Thomas Hunt Morgan 1. Experiments with Drosophila (fruit fly) 2. Sex Chromosomes Determine Gender B. B. Autosomes are non-sex chromosomes C. (22 pairs) D. C. Sex chromosomes differ between males and females. 1. Human female is XX 2. Human male is XY. (#23) D. Sex chromosomes carry genes for traits unrelated to sex. E. Single, recessive allele on X expressed F. Males express sex-linked alleles more G. Example of Sex Link Traits Color Blindness Hemophilia – blood doesn't clot x H x h = normal x Hy = normal H H x x = normal x h y = hemopheilia XhXh = hemophilia VIII. Human Genetics Traits A. Single Allele Traits 1. Sickle Cell Anemia a. Sickle shaped red cells b. Clump; block arteries, lack 02, pain, weakness, death c. AA= normal cell AA'= both kinds; protected from malaria A'A'= sickle cells 2. Huntington's Disease a. b. c. Cause by one dominant allele Brain cells degenerate; no muscle control; death Occurs at 30 -40; passed to child 50% of time H h h h Hh hh Hh hh 3. Tays-Sacs, Cystic Fibrosis, Phenylketonuria,Dwarfism Tays Sachs Disease is an inherited incurable disease of the central nervous system. Its symptoms first appear when a baby is about 6 months old. The baby stops smiling and developing through the normal developmental stages. Blindness and paralysis follow within the next four years resulting in the child's death by the age of five years. Most babies die within the first two years. B. Polygenic Traits = 2 or more genes control trait 1.Skin color - 4-7 genes with additive effect of amount of melanin 2. Eye Color – blue (light melanin), brown (lot of melanin) 3. Height C. Multiple Allele Traits = Trait with 3 or more alleles; only get 2 1. ABO Blood group system; types – A, B, AB, O 2. AA =type A AO = type A OO = type O BB= type B BO = type B AB= type AB *A,B codominant *Both dominant to O D. Sex Influenced Traits = not a sex chromosomes; influenced by sex hormones 1. B=Baldness; dominant in males and recessive in females 2. BB=bald females and males 3. BB" – female will not lose her hair 4. BB" – male will lose hair IX. Studying Humans A. Population Sampling = select a number to represent whole population B. Twin Studies – environment vs. genetics C. Pedigree Studies – family chart of traits D. DNA fingerprinting = study the patterns of bands obtained from electrophoresis 1. Gel electrophoresis – process to separate DNA fragments by size of charge IN: P 34 Contrast 2 types of point mutations. OUT: P34 Mutations occur at 2 levels. What are they? IN: P 36 A new species has been discovered. The organism has 18 chromosomes. How many chromosomes would the new species have if a monosomy occurred? …a trisomy? OUT: P36 Hemophilia is a sex linked disease. Cross a normal male with a female that is a carrier of the disease. What percent of the males will have hemophilia? IN: P 38 What do you know about sickle cell anemia? OUT: Explain polygenic traits in your own words. How would an albino occur?


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Brandi Love is an American pornstar, whose real identity is Tracey Lynn Livermore. She is a member of the AVN and the XRCO Halls Of Fame. Love has a large clitoris and has DD cup enhancements. She is a popular pornstar, with more than one million views.
Tracey Lynn Livermore is a pornstar
Tracey Lynn Livermore primarily well-known by her real title, Brandi Love. She is an infamous American pornstar. She is a member of both the AVN and XRCO Hall of Fame. Apart from acting, she is also a model.
While she has been known as a household name in the adult film industry, she has made time to manage her work and her family. In fact, she's set up a non-profit corporation to assist other parents who wish to work in the industry of adult films. Her goal is to help parents make the right choice in working in the industry , and prevent negative consequences for their children.
Brandi Love comes from an American pornstar
Brandi Love is a professionally-owned name to refer to Tracey Lynn Livermore the American pornographic actor. She is a part of the XRCO and AVN Halls of Fame. She has been featured in more than 300 films that are pornographic. She is well-known for her provocative sexy movements.
Prior to becoming a adult pornstar Brandi Love had managed to maintain a successful wine business. Also, she created a website. The webmasters who designed the site were experts in the adult market. In the end, she decided to quit the wine industry and made the switch to the porn business. She is now one of the most popular pornstars across the world.
Brandi Love is sporting DD cup enhancements
As one of the most well-known pornstars, Brandi Love has had her breast size increase. She has now got 36D cups. While she underwent plastic surgery to make her boobs larger however, she did not go too far. Her slim body and muscular tummy are perfect for her new body. It's easy to see that the Pornstar is able to maximize her assets.
After being in the porn business for 18 years, Brandi Love has established herself as a credible celebrity. Her fame and success have made it virtually impossible to decline an offer for her services. Her work has brought her numerous awards and accolades. She's one of the most admired pornstars of the MILF genre.
Brandi Love is a big clitoris
If you're looking for an actress with a huge and powerful clitoris Brandi Love can be a top choice. She MILF is just 33 years old and has already established a name for herself in the adult scene. She was born and raised in North Carolina, Brandi Love has been in a variety of adult-oriented productions.
Brandi Love is tattooed on her lower mid-section
Brandi Love has numerous tattoos across her body, such as the butterfly tattoo on her lower-middle back and faded blue and purple design on her left ankle. The tattoo is a reference towards her relationships with an ex-partner, and she has also spoken about the meaning behind it.
Love began her career doing self-produced work as well as on-camera sex for her own adult website, and after receiving an offer to film her first professional video using Naughty America, she quickly increased her portfolio to include films produced by other companies.
Brandi Love has an open relationship with Chris Potoski
Brandi Love, a well-known pornstar, is in a good relationship with her husband Chris Potoski. The couple was married in 1994. Brandi dropped out of college in 1994 , and Potoski completed his studies in 1995. The couple moved to New York City, where Brandi worked in sales at Harley Davidson and managed a custom wine label business. Chris was already an adult film star but he didn't begin his career as one.
Chris and Brandi's romance has been a subject of controversy. Despite being married, they've been determined to pursue their respective careers. Actually, Chris and Brandi's relationship has even helped to set an example of married couple. After all, their relationship is a testimony to how long pornstars are able to remain together for.


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Los Angeles Audio Engineers, Producers & Songwriters
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Hi! I'm Ferras! I'm a published songwriter Unsub/Warner Chappell) *Written songs for Katy Perry, Dua Lipa, Chainsmokers, Ricky Martin, Luis Fonsi, Adam Lambert, Nick Carter(Backstreet Boys), AJ McLean (BSB), Yuju, Miyeon, Idina Menzel, Erika Jayne, Rae Lynn, Alask Thunderf*ck, Empire (the show), video games etc….
I'm a multi-faceted composer, songwriter, and producer. I produce tracks in all genres with a specialty in Pop, Rock and Orchestral. I bring 20+ years of experience in the LA music scene to your project and deliver an industry standard product.
We've been producing and playing keys, bass, and drums for over 8 years. We've produced records for Lil Wayne (Get Ya Gat), Meek Mill, Jeezy (F*ck Yo Job) Tinashe, Tyga, August Alsina and many more. From soulful R&B Ballads and neo-soul, to hard trap music, we have a wide range of styles and genres that we can make.
Let's work together to create a new sound, a new trend, a new wave of music.
My name is Isaiah Jones, a singer-songwriter from the westside of Chicago, IL. You can hear my vocals on Kanye West "Jesus Is King". When it comes to music, I create music with passion, soul, and love in every note. Whether songwriting, arranging vocals, or singing I give my all. My latest release is entitled single "Rideshare" Out Now.
Hi, I am a classically trained string player that spends equal parts in the studio and on the stage playing the music of soundtracks, symphonies, and with top headlining acts. I'm well versed in playing score cues or laying down string lines to fill out pop tracks. You can hear me on records by Beyoncé, video games like League of Legends, and TV.
4 Grammys. Credits include Selena Gomez, John Legend, ASAP Rocky. Full time classically-trained violinist, vocalist, songwriter, composer and producer. I do discounted specials for the following combinations of services: arranging+recording strings, writing+recording toplines, production+strings.
Available for mixing, mastering and vocal production. Grammy nominated & published by BMG. Vocal production / Mix credits include Sia, The Weeknd, David Guetta, Andra Day, Madison Beer. Mixing Credits include: Labrinth (Euphoria Soundtrack), Mastering credits include Nick Cave & The Bad Seeds, Andra Day, The Deadpool Soundtrack.
A lot of music today is being made in home studios, which is a great step forward for musicians everywhere! That being said, the precision instruments and experienced ears of a mastering engineer are more necessary than ever. I've built my entire business around turning DIY recordings into professional production masters for sale and distribution.
Grammy nominated engineer based in Glendale CA. Mixed By Fai I respond faster on ig @ DjFai
Professional drummer Sean Winchester is recording high quality drum tracks in a variety of styles. Larger recording credits include three Everclear records, fat mike of the band NOFX, Kikaider Reboot, nazareth etc. also available to record other instruments.
Worked with everyone from Babyface to Daya. Also, ask me about my vintage synth collection.
Session BassistKodai Hojo, Los Angelesfavorite_borderfavorite
I offer high quality bass tracks for your project at the price of $100 per song (Up to 2 free revisions each) with fast turnarounds!
World Class Vocalist/Songwriter/Producer Credits w/ Bob Sinclar, VH1 & Universal Music
Singer,SongwriterAlex J, Los Angelesfavorite_borderfavorite
One Stop shop when it comes to executing a great topline and vocal Demo.I have been writing and singing professionally for over 10 years and have worked with many A list artists, songwriters and producers. I pride myself in executing the vision of whoever I am working with.I recently just wrote Legendary RnB group Xscape's first single.#AllGenres:)
Hey! I'm Rebecca, and I'm currently writing for various types of artists from Pop music to Indie music to Country music. My strength lies in toplines and catchy hooks. I love to write about compelling stories and i'm great at turning feelings into music.
I would love to collaborate and serve your song. I've worked live and in the studio with Niall Horan, Julia Michaels, Maren Morris, Michael Buble, John Alagia (John Mayer) and Jamie Hartman (Rag N'Bone Man). I record and produce guitar parts from my home studio and always strive to create a part that compliments and supports the song.
As seen on NBC's The Voice! Professional singer with 20 years of experience! I've worked with Blake Shelton, Bebe Rexha, James Taylor, Eric Benét, Philip Lawrence, and many more! I have been in the studio for over 15 years and perform over 200 shows per year performing for 3-4hrs straight each night! Let me help bring your song to life!
I'm a singer-songwriter, music producer, and pianist. I've been into music professionally since 4. I started as a professional classical pianist. I write and produce songs. I'm a very melodic person and my productions are diverse and full of catchy melodies .
We write songs and sing them.
Mixing, Mastering and Editing is the core to every hit song. I've been able to work with the industry's top talent like Black eyed peas, Chris Brown and DJ Snake to name a few. I'm Certified Gold and Platinum and come with 15 years of experience. Let's work together and get some hits!!
Hello! My name is Roman Shine and I am based out of Hollywood, Ca. I am a recording and mix engineer that would love to work on your next project.
Musician, guitarist from "Whose Line Is It Anyway", and many others
Recording / Mixing engineer.
Producer / Songwriter / Mixer / Musician from Los Angeles, CA - With songs featured in shows like Revenge, One Three Hill, 90210, Ghost Whisperers, and Terriers.
I am a Music Producer and a live Sound Engineer. With years of experience and training. Mastering is even offered. As far as studio time that all depends upon you Budget.
Producer Credits (5+ years): Justin Bieber, Chance The Rapper, Sevyn, Rawyals, I/O, Gallant, Miloh Smith, Marian Mereba, Shilpa Narayan Violinist Credits (20+ years): Madonna, Justin Timberlake, Quincy Jones, Wyclef Jean, Elle Varner, Jim Jones, Shop Boyz,
My name is Nathaniel Bridges and I am a California based mixing/mastering engineer, looking to work with a diverse set of clientele. I provide a high quality product very quickly.
Hey! I'm Taylor. I've been in a serious relationship with music since I was a teenager. Looking forward to adding my soulful, versatile, fresh flavors to your tracks or projects! There's nothing more fun to me than creating an awesome song, diligently and efficiently.
I sing because it connects me to myself and the world simultaneously. I can harmonize, sing you soulful, deep vocals, pop, blues, funk, country. I love providing vocals or bridges on hip hop songs, as well. Would love to do covers, too. Don't come to me for super high/whistle tones.
I am here to help you create the sound you are looking for at a professional level and at a cost-effective price. I strive to create and deliver the best product possible and will not settle until you are completely confident in the final product.
Jake is a Los Angeles based recording and mixing engineer for music, television, and film. Services include: Music; Production, Recording and Mixing. Post Audio for Television and Film; Voiceover, Noise Reduction; ADR, Sound Design, Foley, 5.1 Mixing.
Mixing and Mastering is my specialty. I mix with protools and the latest plugins to achieve a sound that is relatable to a general audience but original and cutting edge. I have worked with engineers and producers like Ken Andrews, Rafa Sardina, and Chris and Jeff Lord Alge. I use these methods and beyond Master/Ozone7
I am primarily here to make music, though always down to help. For mixing, production and mastering services prepare to contact me before booking so I know where to start and what goal you are after. To understand my sound before booking me please refer to https://soundcloud.com/rouevalentino
My name is Jason Austan I am Producer, Drummer, Songwriter, Arranger & Audio Recording - Editing - Mixing - Mastering Engineer. I have the experience and ability to take what ever music you have and be able to polish it some thing beautiful and make it sound better than you can ever imagine.
Naarai Michele is a young but experienced singer-songwriter in the greater Los Angeles area. In 2015, she wrote, vocal arranged and executive produced her EP, "On My Way". A project comprised of six original songs, all penned by Michele. The EP can be found on all outlets iTunes, Amazon, GooglePlay, Tidal and more.
Hello, My name is Dito Godwin I am Los Angeles based music producer/musician. I have most recently moved back to L.A. after spending a year and a half in London running a Universal distributed indie label. I was lucky enough to work in some of the best studios in London, tour as a working musician while running a record label.
Dickie Delaine is the hyphenate artist who debuted his first first EP in 2013; a genius combo of rock,RnB,& rap."My Ride" is top spin on Spotify. See this rising star performing his upcoming hit "Spittin While She Strippin" around Los Angeles. His new EP The Dragonfly coming out in late 2016 is positioned to be the biggest selling EP of all time.
Producing, mixing and recording! Making music and having fun!
I Produce/Mix/Master Electronic Dance, Pop, Hip Hop as well as string arrangements and sample recreation.
Extraodinary, natural talent. Life-long, self-trained vocalist. Worked with former musical director for Josh Groban, Zachary Provost, Producer Kanayo Ubesie, Artist Development Specialist at Gramophone Media Inc. Evan Griffith
Session singer, specializing in commercial pop soundalikes. Touring and tv/film credits.
Descendant of William Shakespeare, Professional Recording/Mix/Mastering Engineer with Studio. Songwriter/Producer and Artist from Los Angeles.
music producerher cat jones, Los Angelesfavorite_borderfavorite
I have releases on music labels Dim Mak, Fool's Gold, Maddecent, and Owsla.
Songwriter, Film Scoring, Session Recording, Lyric Writer, Youtube Covers
Toured with Grammy-Award Winning Funk Legends The Brothers Johnson, Background Vocalist for Grammy-Award Winning R&B Legend Charlie Wilson, Writer for Nia Sioux (Dance Moms) and more...
Dave Tweedie is a producer, songwriter, film composer, engineer and multi-instrumentalist with over 20 years experience in the music industry. Dave specializes in Pop, Indie, Urban, Rock and EDM production, but is comfortable working in all genres. Credits include: Warner Bros., Interscope, FOX, MTV, ABC, NBC, CBS, E!, Bravo, and many more.
Hey I'm Austin :) I'm a professional producer, songwriter, and vocalist who's been working in LA for the last few years. I'm a multi-instrumentalist working with a variety of artists including R3hab, Jesse McCartney, Suriel Hess, Ruhde, Noah Davis, Not Famous, Natania, TIMMS, Hayden Summerall, and Gunnar Ghel to name a few. Let's work!
I have been working with music for over 10 years. Mixing and mastering is my passion. I would love to make your song or audio sound professional and clean.
Fresh, innovative and creative
I am passionate about your passion. Whatever music goals you have, through songwriting and producing, I want to help you achieve them.
ProduceHNNBL, Los Angelesfavorite_borderfavorite
Producer, Drummer, Topliner.
Session CellistCellista, Los Angelesfavorite_borderfavorite
I am an avant-garde cellist based in Los Angeles. I'm known for my collaborations with artists across genres including classical music, pop, hip-hop, noise, and metal. I have worked with Grammy-nominated artist Tanya Donelly, producer John Vanderslice, Don McLean, Casey Crescenzo, and Van Dyke Parks for recording and live performances.
Pro Singer Songwriter born and raised in Los Angeles, CA. Singing professionally for over 10 years. Have performed with Justin Bieber, Whitney Houston, Adam Lambert, been on GLEE, American Idol, X Factor and many more.
Bass-Mix-Record-RemixPercy, Los Angelesfavorite_borderfavorite
Fat Funky Soul Groove with Love I specialize in Old School Funk and Soul as a Bassist and Drummer. As an EDM producer I have published over 120 tracks and remixes under Artist Formerly Known as Slim Yelow since 2002. I created the remix of Mother's Finest hit song "Baby Love" that rocked clubs all over Europe.
I am a one stop production. I can do everything from creating the song to producing the final product. Experienced Live and Studio Vocalist.
Staff engineer at Paramount Recording Studios since 2009. Worked with many well known artists in all genres. First grammy nom for BJ Chicago Kid: In My Mind for engineering band and vocal. Second grammy nom for Alice in Chains: Rainier Fog for engineering guitars.
4 years signed with an Indie Label, with Distribution under Universal Records. Former Songwriter for High Society. Over 10 years of vocal training, over 3 as a teacher. Performance credits include: Rick Ross music release party and the 2015 Special Olympics.
I can make you a beat or a full production recording of ANY genre. I'm a Multi-instrumentalist I sing and rap. I write lyrics I can Mix and Master ~Baütista
I will compose and write a song for you! Boricua style! Tu sabes!
Backing/Lead/Talk Box- Credits: Panic! At The Disco, Macy Gray, Wanya Morris (Boys II Men), LP, Chris Brown, Walmart, FIFA World Cup, Toyota.


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We serve the aerospace, medical, food processing, packaging machinery, material handling, mechanical goods, specialty equipment, plating shops and distributors, sporting goods, chemical plants and mining equipment to name just a few. Newact stocks a wide variety of plastics. UHMW, HDPE,... Read More
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Collapse(Dungeon Robotics)
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Publisher Description
The remnants of Lecazar are in turmoil.
Louella is working as hard as ever to save as many people as possible from the constantly spreading undead taint in the east. With new visitors investigating the Wave of terra mana that swept through the world, she will need to stay on her toes to protect her valley.
Dealing with threats from seemingly all directions, Regan doesn't have enough mana to go around. The past makes itself known while he contends with the consequences of unleashing what the locals have started calling the Wave. Regan might have bitten off more than he can chew.


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258 claps
Please post your recipe comment in reply to me, all other replies will be removed. Posts without recipes may be removed. Don't forget to flair your post!
I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.
Bullsh*t link to a webpage that tells you their own personal tale about discovering mushroom soup, followed by an explanation about what cornflower is, mushrooms are etc. Eventually you get a very basic recipe, add a , b, c. Where a or b may actually have some steps not included, then back to the blah blah blah.
Finally at the very bottom of the page you get an actual recipe with cooking steps.
If you follow the link just skip to the very end of the page.
Edit: Still a big thank you to OP for the recipe, I do look forward to trying this sometime.
That's for SEO and affiliate stuff. Without that junk, they don't make any money, which is the point of the site. They know it is kinda lame, so they put that link at the top so you can be spared and just get to the recipe.
I love how we've developed ways to trick search engines into showing people the content but doing so makes the content unusable, so they have to add a button to skip all the stuff they only added so you'd find it in the first place and not because you really care.
Although no lie I did learn a good deal about red sauce from the one recipe I fully read through, but that was from Serious Eats so I'd expect more useful content and less about bullshit memories that likely didn't happen.
That pan crowded as hell
Mushrooms go in first, always.


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Dr James S. Chrzan, DPM is a podiatrist at Boston Podiatry Services in Rockland, MA. Dr Chrzan graduated in 1979 from the Pennsylvania College of Podiatric Medicine in Philadelphia, PA and then did his residency at the New England Deaconess Hospital in Boston, MA. Dr Chrzan has a number of publications on the diabetic foot.
Boston Podiatry Services
28 Pacific St,
Rockland, MA 02370
Phone: (781) 878-4517
External Links:
Website |Healthgrades
Giurini JM, Habershaw GM, Chrzan, JS; Dunnetatarsal Head Resection in Chronic Neuropathic Ulcerations; J. Foot Surgery 26:3 247-252 1987
Tillo JH, Giurini JM, Habershaw GM, Chrzan JS, Rowbotham JL; Review Metatarsal Ostectomies for Treatment of Neuropathic Ulcerations; JAPMA 80:4 211-217 1990
Giurini JM, HabershawGM, Chrzan JS,Gibbons GW; Charcot Disease in Diabetic Patients; Postgraduate Med. 89:4 163-169 1991
Giurini JM, Habershaw GM,Chrzan JS, Gibbons GW: Sesamoidectomy for Treatmentof Chronic Neuropathic Ulcerations; JAPMA 81:4 167-173 1991
Chrzan JS, Giurini JM, Herchik JM: A Biomechanical Model for Transmetatarsal Amputation; JAPMA 83:2 82-86 1993
Barry DC, Subacinski KH, Habershaw GM, Giurini JM, Chrzan JS: Tendo Achilles Procedures for Chronic Ulcerations in Diabetic Patients with Transmetatarsal Amputation
Giurini JM, Basile P, Chrzan JS, Habershaw GM, Rosenblum BI; Panmetatarsal Head Resection: A Viable Alternative for the Transmetatarsal; Amputation. JAPMA 83:2 96-100 1993
Frykberg RF, Giurini JM, Habershaw GM, Chrzan JS, Rosenblum BI; Prophylactic surgery in the Diabetic Patient; Kominsky S. (Editor); Medical and Surgical Management of the Diabetic Foot
C.V. Mosby, Philadelphia 1994
Guirini JM, Sarnow MR, Rosenblum BI, Lyons TE.Chrzan JS: Radical Differences in Joint Mobility and Foot Pressures in Caucasian and Black Diabetic Patients and Healthy Subjects: Proceedings of ADA National Meeting
Rosenblum BI, Pomposelli FB, Giurini JM, Gibbons GW, Freeman DV, Chrzan JS, Campbell DR, Habershaw GM, Logerfo FW: Maximizing Foot Salvage by a Combined Approach to Foot Ischemia and Neuropathic Ulceration in Patients with Diabetes – A 5-year Experience. Diabetes Care 19:9 983-987 1994
Chrzan JS, Habershaw GM: Digital & Nail Surgery in the Diabetic Patient, Current Therapy in Podiatric Surgery; Editor Jay, Richard, B.C. Dicker Inc., Philadelphia, PA 1989
Veves AMD, Akbare CM, Primaverci J, Donaghue V, Zacharoulis D, Chrzan JS, DeGirolami G, Logerfo FW, Freeman R; Endothelial Function and the Expression of Endothelial Nitric Oxide Synthetase in Diabetic Neuropathy; Diabetes 1998; 47:457-463.
Related Topics:
Massachusetts Podiatric Medical Society | Massachusetts Board of Examiners in Podiatry | Podiatric Practice in Massachusetts
Page last updated:


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Tyler Scialo-Lakeberg, President
Maraline Ellis, Vice President
Kelsy Dunlap, Secretary
Vicki Mashos, Treasurer
Cassie Swift, Elementary Director
Whitney Eisenhauer, Elementary Director
Liz Dacar, Elementary Director
Jessica Mashos, Elementary Director
Mark Atkinson, Secondary Director
Roseanne Ricci, Secondary Director
Heather Rutkowski, Secondary Director
Chris Torres, Secondary Director
Kim Daniels, Secondary Director
John Robinson, Special Programs Director
Jasmine Filley, Special Programs Director
Cindy Hoffert, Specialist Director
Sandra Yglesias, Specialist Director
Rebecca Howe, Special Ed. Director
Greg Resch, Special Ed. Director
Robert Glasgow, OEA Director
Alejandra Saechao, OEA Director
Caryn Connolly, OEA PAC Director
Eric Schutz, OEA UniServ Consultant
Matt Ogle, OEA UniServ Consultant
Diana Garcia, OEA UniServ Consultant


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Sarah-Lena Böning at University of Coimbra, Portugal
In March 2015 I made my first experience as a lecturer abroad and I enjoyed it immensely. Just when spring began, I spent two weeks at the University of Coimbra in Portugal. Here I had the pleasure to get to know Portuguese hospitality and culture. Not only were the students and the lecturers very friendly and welcoming, but Coimbra and its citizens are also worth a visit. Coimbra is a beautiful and interesting small town offering a wide range of opportunities for activities and train connections to the near cities Lisbon and Porto.
Being the oldest university in Portugal and one of the oldest in Europe, the University of Coimbra is the main attraction in Coimbra. The Faculty of Economics in turn is younger and so is the building, which is located a little bit outside the city center in a very nice area. Here I had the opportunity to offer several lectures for master students in the field of economics as well as health management & health economics. I found it extremely positive to meet with such interested and open-minded students.
For sure, we had time not only to discuss the contents of the classes, but also to talk about differences between Portugal and Germany regarding health services and cultural aspects and to analyze potential political and historical reasons. The exchange with those students and their lecturers was an enrichment for me – hopefully for them as well!