text:
Page 1
This?? review?? has?? been?? accepted?? as?? a?? thesis?? together?? with?? 3?? previously?? published??
papers?? by?? University?? of?? Aarhus?? 28th?? October?? 2010?? and?? defended?? on?? 10th?? December??
Tutor(s):?? Kjeld?? Soballe,?? Brian?? Elmengaard,?? Troels?? T.?? Andreassen,?? Joan?? E.?? Bechtold.??
?? ??
Official?? opponents:?? Erik?? Fink?? Eriksen,?? Benny?? Dahl,?? Ivan?? Hvid.??
?? ??
Correspondence:?? Department?? of?? Orthopaedics,?? Aarhus?? University?? Hospital,?? Tage??
Hansens?? Gade?? 2,?? 8000?? Aarhus,?? Denmark.??
?? ??
E-‐mail:?? firstname.lastname@example.com??
Dan?? Med?? Bull?? 2011;58(9):B4317??
Daugaard?? H,?? Elmengaard?? B,?? Andreassen?? TT,?? Lamberg?? A,?? Bechtold??
JE,?? Soballe?? K.?? Systemic?? intermittent?? parathyroid?? hormone?? treat-‐
ment?? improves?? new?? bone?? of?? press-‐fit?? inserted?? implants?? in?? cancel-‐
lous?? bone.?? Acta?? Orthopaedica.?? Accepted?? for?? publication.??
Daugaard?? H,?? Elmengaard?? B,?? Andreassen?? TT,?? Lamberg?? A?? Bechtold??
JE,?? Soballe?? K.?? Parathyroid?? hormone?? treatment?? increases?? fixation??
of?? orthopaedic?? implants?? with?? gap?? healing.?? A?? biomechanical?? and??
histomorphometric?? canine?? study?? of?? porous?? coated?? titanium?? alloy??
implants?? in?? cancellous?? bone.?? Calcif?? Tissue?? Int.?? 2011?? Apr;88(4):294-‐
303.?? Epub?? 2011?? Jan?? 21.??
Daugaard?? H,?? Elmengaard?? B,?? Andreassen?? TT,?? Baas?? J,?? Bechtold?? JE,??
Soballe?? K.?? The?? combined?? effect?? of?? parathyroid?? hormone?? treat-‐
ment?? and?? bone?? graft?? on?? implant?? fixation.?? J?? Bone?? Joint?? Surg?? Br.??
2011?? Jan;93(1):131-‐9.??
Total?? hip?? replacement?? restores?? the?? mobility?? and?? quality?? of?? life?? in??
an?? individual?? with?? a?? painful?? and?? deformed?? hip?? joint?? (1).?? ??
History?? of?? total?? hip?? arthroplasty??
Over?? the?? past?? centuries?? the?? advances?? in?? hip?? joint?? surgery?? has??
evolved?? from?? the?? earliest?? resection?? arthroplasties?? through?? inter-‐
positional?? membrane?? techniques?? to?? the?? successful?? total?? hip?? ar-‐
throplasty?? (THA)?? as?? known?? today?? in?? which?? the?? entire?? joint?? is?? re-‐
placed?? (2,?? 3).?? ??
?? The?? first?? salvage?? procedure?? of?? a?? degenerated?? painful?? hip?? joint??
was?? the?? removal?? of?? the?? affected?? femoral?? and?? acetabular?? bone?? by??
White?? in?? 1821.?? Later,?? in?? 1826?? Barton?? treated?? an?? ankylosed?? hip??
with?? a?? trochanteric?? osteotomy?? creating?? a?? false?? joint?? (a?? pseudoar-‐
throsis).?? Although?? immediate?? relief?? was?? apparent?? long-‐term?? out-‐
come?? was?? unpredictable.?? ??
?? Further?? need?? for?? improvement?? in?? mobility?? introduced?? from??
1830s?? and?? onwards?? strategies?? of?? interposing?? membranes?? be-‐
tween?? the?? femoral?? head?? and?? the?? acetabulum?? (wood,?? rubber,?? wax,??
gold?? foil,?? pig?? bladders).?? In?? the?? early?? 1900s?? the?? use?? of?? the?? individu-‐
als?? own?? peri-‐implant?? soft?? tissues?? (fascia?? lata,?? muscle?? etc.)?? became??
popular.?? However,?? failure?? occurred?? due?? to?? insufficiency?? in??
strength?? withstanding?? the?? stresses?? of?? weight?? bearing?? and?? intraar-‐
ticular?? pressure.?? In?? 1932?? Smith?? Petersen?? introduced?? the?? synthetic??
interpostitional?? arthroplasty?? with?? a?? mould?? prosthesis?? (4).?? A?? cup??
was?? fitted?? on?? the?? existing?? femoral?? head?? articulating?? with?? both??
joint?? surfaces?? as?? a?? synovial/cartilage-‐like?? layer?? "guiding?? nature's??
repair".?? The?? moulded?? cups?? were?? of?? celluloid?? (Bakelite)?? or?? glass??
(Pyrex),?? but?? sensitive?? to?? material?? fracture.?? These?? cups?? were?? fol-‐
lowed?? by?? Vitallium?? (Co-‐Cr-‐Mo)?? when?? Venable?? in?? 1937?? set?? the??
standard?? in?? material?? properties?? of?? implants.?? The?? same?? year?? the??
Aufranc?? cup?? was?? introduced?? as?? a?? further?? anatomic?? design.?? These??
mould?? interpositional?? arthroplasties?? provided?? the?? first?? predictable??
results?? in?? hip?? joint?? surgery.??
?? The?? earliest?? recorded?? attempt?? of?? the?? total?? hip?? arthroplasty??
(THA)?? was?? replacement?? of?? one?? half?? of?? the?? hip?? joint?? with?? a?? femoral??
head?? prosthesis?? (hemiarthroplasty).?? In?? 1891?? Glück?? used?? a?? femoral??
head?? of?? ivory?? and?? in?? 1919?? Delbet?? a?? rubber?? femoral?? prosthesis.??
However,?? until?? the?? progress?? in?? metallurgy?? in?? the?? 1940´s?? the?? THA??
procedures?? were?? rare?? and?? unpopular?? compared?? to?? mould?? arthro-‐
plasties.?? In?? 1946?? the?? Judet?? brothers?? introduced?? a?? short-‐stem??
femoral?? prosthesis?? of?? Co-‐Cr?? alloy?? and?? others?? adapted?? the?? implant??
design?? (Thompson?? 1951).?? These?? and?? subsequent?? short-‐stem??
implants?? were?? however?? subject?? to?? high?? shear?? stress?? and?? resulted??
in?? early?? loosening?? and?? failure.?? Longer?? stems?? that?? provided?? less??
stress?? concentration?? gradually?? replaced?? short-‐stem?? designs.?? In??
1942?? the?? Moore?? prosthesis?? was?? introduced.?? The?? original?? prosthe-‐
sis?? was?? a?? femoral?? head?? replacement?? with?? a?? large?? fixed?? head?? of??
Vitallium,?? which?? was?? secured?? to?? the?? resected?? end?? of?? the?? femoral??
shaft.?? Long-‐term?? success?? was?? however?? not?? achieved?? until?? 1950??
when?? Moore?? inserted?? the?? femoral?? replacement?? within?? the?? medul-‐
lary?? canal?? and?? with?? only?? partial?? resection?? of?? the?? femoral?? neck.?? This??
technique?? is?? a?? fundamental?? of?? today's?? THA?? in?? which?? weight-‐
The?? influence?? of?? Parathyroid?? hormone?? treatment?? on??
implant?? fixation??
Henrik?? Daugaard??
Page 2
bearing?? forces?? are?? transferred?? to?? the?? femur?? through?? an?? intrame-‐
dullary?? stem?? (5).?? In?? 1952?? Moore?? refined?? the?? implant?? featuring?? a??
proximally?? fenestrated?? stem?? to?? allow?? bone?? ingrowth.?? The?? modern??
artificial?? joint?? of?? today?? owes?? much?? to?? the?? work?? of?? Sir?? Charnley,??
who?? replaced?? both?? the?? acetabulum?? and?? the?? femoral?? head?? in?? a??
total?? hip?? replacement.?? Although?? Wiles?? in?? 1938?? and?? McKee?? in?? 1951??
described?? the?? first?? attempts?? of?? THA,?? the?? introduction?? of?? Low??
Friction?? Arthroplasty?? by?? Sir?? Charnley?? far?? surpassed?? these?? by?? the??
1970s.?? Charnley´s?? original?? design?? in?? 1960?? (6)?? consisted?? of?? three??
parts?? with?? synovial?? fluid?? ?? lubrication:?? 1)?? a?? metal?? femoral?? compo-‐
nent?? of?? stainless?? steel?? (a?? long?? femur?? stem)?? with?? a?? non-‐modular??
artificial?? femoral?? head?? articulating?? with?? 2)?? an?? artificial?? acetabular??
component?? (cup),?? with?? both?? components?? fixed?? to?? the?? bone?? using??
3)?? poly(methylmethacrylate)?? (PMMA)?? (cement)?? as?? a?? bone?? filler.??
The?? cup?? was?? originally?? of?? Teflon?? (polytetrafluorothylene,?? PTFE)??
which?? caused?? significant?? wear?? debris?? and?? bone?? resorption?? (osteol-‐
ysis).?? It?? was?? replaced?? in?? 1962?? with?? Ultra?? High?? Molecular?? Weight??
Polyethylene?? (UHMWPE),?? a?? Co-‐Cr?? alloy?? stem,?? and?? an?? articulating??
small?? head?? reducing?? wear.?? The?? Charnley?? prosthesis?? showed?? in??
general?? good?? mid-‐term?? results.?? Ten?? years?? after?? the?? introduction??
some?? implants?? showed?? mechanical?? loosing?? due?? to?? osteolysis?? and??
this?? was?? suspected?? to?? be?? caused?? by?? cement?? particles?? (7,?? 8).?? Under??
this?? impression?? implants?? inserted?? without?? cement?? prospered?? in??
the?? 1980s?? and?? were?? further?? refined?? with?? roughened?? implant??
surfaces?? facilitating?? bone?? ingrowth.??
Present?? total?? hip?? arthroplasty??
Current?? standard?? THA?? consists?? of??
a?? femoral?? stem?? of?? titanium?? or?? cobalt-‐chromium?? (Co-‐Cr)??
alloy?? with?? insertion?? in?? interference?? fit?? or?? with?? PMMA?? as??
means?? of?? fixation??
connected?? to?? a?? modular?? femoral?? head?? of?? Co-‐Cr?? alloy?? or??
ceramic?? and?? ??
articulating?? with?? an?? acetabular?? liner?? of?? UHMWPE?? or?? ce-‐
ramic.?? The?? articulation?? may?? be?? cemented?? into?? the?? ace-‐
tabulum?? or?? fitted?? into??
an?? acetabular?? cup?? of?? titanium,?? Co-‐Cr?? alloy?? or?? tantalum??
and?? press-‐fit?? secured?? in?? the?? acetabulum.??
?? The?? long-‐term?? survival?? of?? hip?? implants?? depends?? on?? how?? well??
the?? implant?? becomes?? fixed?? from?? the?? outset?? of?? the?? procedure.?? Two??
methods?? are?? now?? routinely?? used?? to?? attain?? initial?? implant?? fixation:??
1)?? cementing?? the?? implant?? in?? the?? bone?? using?? polymethylmethacry-‐
late?? (PMMA),?? 2)?? press-‐fitting?? the?? implant?? into?? the?? prepared?? bone??
site?? with?? subsequent?? bone?? ingrowth?? into?? the?? implant?? porosity.?? ??
?? In?? Denmark,?? of?? the?? 7473?? primary?? hip?? arthroplasties?? per-‐
formed?? in?? year?? 2008?? 59.1%?? were?? non-‐cemented,?? 17.9%?? hybrids??
(one?? prosthetic?? component?? cemented,?? the?? other?? uncemented),??
and?? 22.9%?? cemented?? (9).?? Of?? the?? 534?? cup?? revisions?? performed?? in??
2008?? 83?? %?? were?? uncemented?? and?? 73?? %?? in?? the?? 486?? femur?? stem??
revisions?? (9).?? ??
?? For?? young?? more?? active?? patients,?? non-‐cemented?? implants?? are??
preferable.?? Reports?? from?? the?? Norwegian?? Arthroplasty?? Register??
(10)?? and?? other?? studies?? (11)?? show?? better?? survival?? of?? non-‐cemented??
as?? to?? cemented?? femur?? stems?? in?? patients?? younger?? than?? 60?? years??
old.?? In?? general?? uncemented?? femoral?? components?? have?? high?? mid-‐
term?? results?? (11,?? 12),?? but?? higher?? failure?? rate?? has?? been?? reported?? of??
the?? cementless?? acetabular?? cups?? compared?? to?? the?? femoral?? stem,??
with?? acetabular?? components?? having?? less?? bone?? ingrowth?? (10,?? 12,??
13).?? ??
?? The?? functional?? life?? of?? a?? prosthetic?? total?? joint?? is?? influenced?? by??
a?? large?? number?? of?? factors?? (14),?? among?? others??
Patient?? related??
Technical?? aspects?? ??
host?? bone?? quality?? and?? pathology??
load?? conditions??
patient?? activity??
underlying?? disease??
surgical?? technique??
geometry?? and?? design??
elastic?? modulus??
corrosion?? resistance??
surface?? texture??
success?? rate,?? but?? outcome?? differs?? depending?? on?? subgroup?? evalu-‐
ated.?? The?? ten-‐year?? implant?? survival?? rate?? for?? patients?? over?? 75?? years??
is?? 95%,?? but?? only?? 88%?? for?? patients?? under?? 50?? years?? of?? age?? according??
to?? the?? Danish?? Hip?? Arthroplasty?? Registry?? (9).?? ??
?? Among?? the?? risk?? factors,?? age?? less?? than?? 60?? years?? old?? is?? still?? a??
strong?? predictor?? of?? long-‐term?? implant?? failure?? (14)?? and?? for?? younger??
patients?? the?? risk?? of?? implant?? failure?? is?? still?? unsatisfactorily?? high.?? ??
?? The?? overall?? objective?? of?? this?? thesis?? is?? to?? improve?? the?? long-‐
term?? survival?? of?? a?? prosthetic?? total?? joint?? by?? improving?? the?? initial??
implant?? integration?? into?? bone.?? ??
?? It?? seems?? relevant?? to?? enhance?? the?? initial?? fixation?? by?? adjuvant??
therapy.?? ??
The?? typical?? total?? hip?? replacement?? enjoys?? in?? general?? a?? high??
Implant?? composition??
?? The?? goal?? of?? an?? orthopaedic?? implant?? material?? is?? to?? obtain??
long-‐term?? implant?? fixation?? and?? implant?? material?? properties?? com-‐
parable?? with?? the?? bone?? environment.?? Bone?? is?? viscoelastic?? and??
anisotropic?? (15,?? 16)?? and?? the?? bone?? bed?? varies?? in?? which?? a?? prosthesis??
is?? inserted.?? The?? femur?? component?? of?? the?? THA?? is?? primarily?? fixed?? in??
the?? proximal?? femur?? in?? a?? bone?? environment?? abundant?? in?? cancel-‐
lous?? bone.?? The?? acetabular?? cup?? is?? inserted?? in?? the?? cancellous?? or??
subchondral?? bone?? of?? the?? acetabulum.??
Metals?? used?? for?? uncemented?? implants?? include??
titanium?? (Ti)?? as?? commercially?? pure?? titanium?? (CPTi)?? or?? ti-‐
tanium?? alloy,?? predominantly?? Ti-‐6AL-‐4V,??
cobolt-‐chromium?? (Co-‐Cr)?? alloys,?? most?? widespread?? Co-‐
stainless?? steel,?? or??
Metals?? differ?? in?? properties?? and?? biocompatibility.?? Implants?? made?? of??
Co-‐Cr?? alloys?? are?? harder,?? more?? wear?? resistant,?? and?? with?? lower??
biocompatibility?? than?? Ti?? alloys?? (3,?? 17).?? Ti?? alloys?? have?? superior??
mechanical?? and?? corrosive?? properties?? than?? CPTi,?? but?? CPTi?? has??
relatively?? higher?? ductility?? and?? biocompatibility?? (18).?? Whereas?? the??
elastic?? modulus?? of?? Co-‐Cr?? alloys?? (210-‐253?? GPa)?? considerably?? ex-‐
ceeds?? that?? of?? cortical?? bone?? (15-‐40?? GPa),?? the?? modulus?? of?? Ti?? alloys??
(116GPa)?? and?? CPTi?? (110?? GPa)?? are?? closer?? and?? thereby?? provide?? less??
non-‐physiological?? bone?? remodelling?? (stress?? shielding)?? (3).?? In?? gen-‐
eral,?? the?? Ti?? alloys?? are?? used?? as?? stem?? and?? cup?? in?? the?? THA?? compo-‐
nents?? of?? uncemented?? prosthesis,?? the?? CPTi?? in?? some?? as?? coatings,??
and?? Co-‐Cr?? alloys?? in?? the?? THA?? articulation.?? Only?? short-‐term?? success??
Page 3
has?? been?? achieved?? using?? stainless?? steel?? in?? uncemented?? hip?? ar-‐
throplasty?? (19).?? ??
Implant?? surface??
The?? surfaces?? used?? for?? uncemented?? implants?? include??
a?? smooth?? surface?? or??
a?? roughened?? surface.?? ?? The?? roughness?? is?? achieved?? by??
a?? porous?? coat.?? The?? porosity?? may?? consist?? of??
i. plasma?? spraying?? heated?? Ti-‐alloy??
powder?? on?? to?? the?? implant?? surface,??
ii. beads?? sintered?? to?? the?? implant?? sur-‐
iii. diffusion?? bonding?? of?? Ti?? wires?? mould-‐
ed?? into?? a?? fibre?? mesh,?? or??
iv. trabecular?? metal?? structure??
Uncemented?? implants?? with?? a?? smooth?? surface?? on?? the?? entire?? com-‐
ponent?? have?? a?? high?? failure?? rate?? and?? are?? abandoned?? (10).?? To?? help??
achieve?? adequate?? initial?? fixation?? without?? the?? use?? of?? cemented??
implants?? porosity?? provides?? a?? rough?? surface?? that?? secures?? the?? initial??
stability?? at?? the?? time?? of?? insertion,?? and?? a?? structure?? for?? subsequent??
bone?? ingrowth?? for?? secondary?? fixation.?? Comparative?? studies?? on??
porous?? coats?? are?? limited?? (20,?? 21).?? The?? optimum?? pore?? size?? for??
facilitating?? bone?? ingrowth?? is?? controversial.?? Openings?? of?? 50?? μm?? and??
400?? μm?? in?? diameter?? have?? been?? shown?? to?? provide?? good?? bone??
ingrowth?? and?? fixation?? strength?? (22).?? Acetabulum?? components??
often?? have?? a?? porous?? coat.?? Femoral?? components?? have?? either?? a??
porous?? coat?? along?? the?? whole?? length,?? or?? a?? proximal?? porous?? coating??
with?? the?? distal?? portion?? of?? the?? implant?? being?? gritblasted?? or?? smooth.?? ??
?? The?? implants?? used?? in?? this?? PhD?? thesis?? are?? Ti-‐alloy?? with?? a?? po-‐
rous?? coat?? of?? plasma?? spray?? and?? inserted?? non-‐cemented?? in?? bone.??
Peri-‐implant?? endosseous?? healing??
?? The?? insertion?? of?? a?? prosthesis?? induces?? a?? bone?? injury.?? Subse-‐
quent?? bone?? repair?? is?? required?? in?? order?? to?? integrate?? the?? implant??
into?? the?? bone.?? A?? few?? retrieval?? studies?? show?? that?? some?? well-‐
functioning?? acetabular?? and?? femoral?? stems?? may?? become?? fixed?? by??
fibrous?? tissue?? instead?? of?? bone?? ingrowth?? (5,?? 23).?? During?? load?? of?? a??
prosthesis?? wear?? of?? the?? components?? occur.?? This?? may?? induce?? wear??
osteolysis?? and?? implant?? loosening.?? By?? stimulating?? bone?? ingrowth?? to??
the?? implant?? surface?? a?? seal?? of?? tightly-‐bonded?? bone?? on?? the?? implant??
inhibits?? peri-‐implant?? migration?? of?? wear?? particles?? (24).?? ??
?? Ideal?? conditions?? for?? peri-‐implant?? bone?? healing?? require?? func-‐
tional?? stability?? at?? insertion.?? A?? modest?? bone-‐implant?? motion?? im-‐
pairs?? the?? process?? of?? bone?? growth?? while?? a?? more?? extensive?? motion??
(>150?? µm)?? induces?? a?? fibrous?? encapsulation?? (25)?? with?? a?? layer?? of??
reactive?? bone?? on?? the?? fibrous?? membrane?? (26).?? Inserting?? the??
uncemented?? prosthesis?? in?? press-‐fit?? with?? surrounding?? bone?? pro-‐
vides?? a?? primary?? fixation,?? while?? secondary?? fixation?? is?? acquired?? by??
subsequent?? bone-‐integration.?? ??
?? The?? osseointegration?? of?? an?? implant?? is?? a?? time?? related?? process??
in?? which?? the?? initial?? regeneration?? of?? new?? bone?? is?? followed?? by?? life-‐
long?? bone?? remodelling.?? The?? definition?? of?? osseointegration?? varies??
with?? the?? observer's?? perspective?? and?? evaluation?? options.?? Clinically,??
osseointegration?? is?? defined?? as?? the?? asymptomatic?? rigid?? fixation?? of??
alloplastic?? material?? maintained?? in?? bone?? over?? time?? during?? func-‐
tional?? loading?? (27).?? In?? clinical?? implant?? studies?? the?? degree?? of?? rigid??
fixation?? can?? be?? evaluated?? by?? radio-‐stereometric-‐analysis?? (RSA)??
(28).?? However,?? on?? the?? daily?? basis?? the?? clinician?? is?? faced?? with?? the??
challenge?? of?? identifying?? successful?? osseointegration?? by?? an?? x-‐ray??
image?? in?? which?? the?? implant?? may?? seem?? in?? direct?? contact?? with?? bone??
at?? the?? feasible?? macroscopic?? resolution?? level?? (29).?? The?? original??
definition?? by?? Brånemark?? (30)?? and?? Albrektsson?? (31)?? provides?? the??
histology?? of?? implant?? anchorage?? on?? the?? light?? microscopy?? level?? and??
defines?? osseointegration?? as?? direct?? connection?? of?? osseous?? tissue?? to??
the?? implant?? surface?? without?? intervening?? (connective)?? tissue.?? At??
the?? level?? of?? transmission?? electron?? microscopy?? ultrastructural??
investigations?? have?? challenged?? the?? light?? microscope?? perception?? of??
bone?? in?? continuum?? with?? the?? implant?? revealing?? an?? intervening??
amorphous?? matrix?? between?? bone?? and?? implant?? interface?? (27).?? ??
?? A?? number?? of?? factors?? can?? be?? defined?? in?? describing?? the?? bone??
formative?? process.??
?? Osteogenesis?? is?? the?? process?? of?? bone?? formation?? in?? which?? new??
bone?? is?? laid?? down?? by?? osteoblasts.?? ??
?? Osteoinduction?? and?? osteoconduction?? are?? prerequisites?? for??
osseointegration.?? ??
?? Osteoinduction?? is?? the?? process?? by?? which?? osteogenesis?? is?? in-‐
duced?? (32).?? It?? describes?? the?? recruitment?? of?? perivascular?? primitive??
undifferentiated?? pluripotent?? mesenchymal?? cells,?? and?? the?? stimula-‐
tion?? of?? these?? cells?? to?? develop?? into?? osteoprogenitor?? cells?? and?? oste-‐
oblasts.?? Inductive?? agents?? induce?? heterotopic?? osteogenesis?? (33),??
that?? is,?? ?? stimulate?? bone?? formation?? extraskeletally?? by?? recruitment??
of?? mesenchymal?? cells?? without?? the?? presence?? of?? osteogenic?? and??
osteoconductive?? substances.?? However,?? in?? an?? orthotopic?? bone?? site??
differentiation?? between?? bone?? induction?? and?? conduction?? may?? be??
more?? vague.?? Of?? osteoinductive?? agents?? bone?? morphogenetic?? pro-‐
teins?? BMP-‐7?? (OP-‐1),?? BMP-‐2?? as?? well?? as?? TGF-‐β?? induce?? bone?? growth??
?? Osteoconduction?? describes?? the?? process?? by?? which?? bone?? grows??
on?? a?? surface.?? It?? is?? characterised?? by?? an?? initial?? invasion?? of?? fibro-‐
vascular?? tissue?? along?? the?? surface?? followed?? by?? new?? bone?? for-‐
mation.?? It?? includes?? the?? recruitment?? and?? migration?? of?? differentiat-‐
ed?? cells?? through?? the?? residue?? of?? the?? peri-‐implant?? blood?? clot?? placing??
differentiated?? osteogenic?? cells?? at?? the?? surface.?? An?? osteoconductive??
surface?? permits?? bone?? growth?? (32).?? Bone?? grafts?? are?? osteoconduc-‐
tive.?? Implant?? materials?? of?? high?? conductive?? biocompatibility?? are?? the??
titanium?? compounds,?? CPTi?? better?? than?? and?? Ti-‐alloy?? (35),?? whereas??
copper?? and?? silver?? show?? less.?? ??
?? Rasping?? and?? reaming?? damage?? trabeculae?? during?? implant?? site??
preparation.?? In?? this?? respect?? fracture?? healing?? and?? peri-‐implant??
healing?? exhibit?? many?? similarities.?? However?? the?? presence?? of?? an??
implant?? induces?? an?? additional?? mode?? of?? healing?? (36)?? in?? an?? envi-‐
ronment?? characterised?? by?? intramembranous?? ossification.?? ??
?? The?? osseointegration?? process?? is?? triggered?? by?? trauma?? from??
the?? implantation?? procedure?? and?? by?? the?? implant.?? In?? implants?? of??
adequate?? stability?? the?? integration?? process?? opens?? with?? the?? for-‐
mation?? of?? a?? hematoma,?? then?? a?? reactive?? phase?? of?? inflammation??
and?? granulation?? tissue,?? followed?? by?? a?? reparative?? phase?? of?? woven??
bone?? formation,?? which?? is?? later?? remodelled.??
Hematoma.?? Preparing?? the?? bone?? site?? causes?? bleeding?? in??
the?? peri-‐implant?? space.?? The?? coagulation?? pathway?? is?? acti-‐
vated.?? The?? blood?? clot?? acts?? as?? physical?? barrier?? to?? further??
bleeding?? and?? a?? provisional?? scaffold?? for?? cell?? migration.??
Platelets?? adhere,?? become?? activated,?? degranulate?? and?? re-‐
lease?? multiple?? growth?? factors?? (platelet-‐derived?? growth??
factor?? (PDGF),?? transforming?? growth?? factor?? beta?? (TGF-‐b)),??
cytokines?? and?? vasoactive?? substances?? (serotonin,?? hista-‐
mine).?? These?? chemotactic?? and?? mitogenic?? factors?? play?? an??
important?? role?? in?? accelerating?? the?? subsequent?? bone?? re-‐
generative?? cascade?? in?? which?? inflammatory,?? endothelial,??
Page 4
mesenchymal,?? and?? bone?? cells?? are?? recruited,?? migrate,??
and?? proliferate?? (34,?? 37-‐39).??
Reactive?? phase.?? The?? hematoma?? is?? gradually?? transformed??
into?? granulation?? tissue?? by?? angiogenesis?? and?? fibroplasia??
accompanied?? by?? an?? inflammatory?? response.?? Neutrophil??
leucocyt?? infiltration?? is?? followed?? by?? influx?? of?? monocytes??
influenced?? by?? PDGF?? (37)?? and?? thrombin?? (40).?? Monocytes??
differentiate?? into?? macrophages?? for?? phagocytosis?? of??
wound?? debris.?? The?? initial?? ischemia?? and?? anaerobe?? me-‐
tabolism?? leads?? to?? local?? acidity?? which?? in?? itself?? also?? is??
chemotactic?? to?? endothelial?? and?? mesenchymal?? cells?? (41).??
New?? blood?? vessels?? are?? initiated.?? Bone?? conduction?? and??
formation?? depends?? on?? an?? adequate?? blood?? supply.?? Influ-‐
enced?? by?? both?? PDFG?? and?? TGF-‐b?? fibroblasts?? migrate?? and??
proliferate?? forming?? a?? loosely?? woven?? connective?? tissue??
supporting?? vascular?? growth?? of?? cells?? (42,?? 43).?? ??
Reparative?? phase.?? Osteogenesis?? relies?? on?? previous?? oste-‐
oinduction,?? since?? pre-‐existing?? preosteo-‐
blasts/osteoblasts?? only?? contribute?? minimally?? in?? the?? new??
bone?? formation?? (44,?? 45).?? Surface?? osteoinduction?? is?? con-‐
sidered?? essential,?? although?? at?? the?? same?? time?? as?? a?? repar-‐
ative?? reaction?? the?? damaged?? bone?? surfaces?? at?? the?? pre-‐
pared?? site?? provide?? the?? osteogenic?? cells?? that?? lay?? down??
new?? bone?? matrix?? on?? the?? old?? bone.?? Undifferentiated?? cells??
are?? recruited?? to?? form?? osteoprogenitor?? cells?? (46)?? and?? de-‐
velop?? into?? bone?? forming?? cells.?? This?? is?? affected?? by?? the??
growth?? factor?? bone?? morphogenetic?? proteins?? (BMP-‐2??
and?? BMP-‐7),?? which?? are?? the?? only?? known?? osseoinductive??
agents?? and?? are?? released?? in?? response?? to?? the?? trauma?? of??
implant?? insertion?? (33,?? 34,?? 47).?? PDGF?? modulates?? the?? pro-‐
liferation?? of?? osteoblasts?? (48,?? 49).?? The?? growth?? factors?? re-‐
leased?? from?? platelets?? and?? injured?? bone?? tissue?? stimulates??
synthesis?? of?? additional?? factors?? by?? the?? osteoblasts,??
thereby?? maintaining?? the?? healing?? process?? (34).?? Osteo-‐
blasts?? lay?? down?? woven?? bone?? as?? osteoid?? containing??
mainly?? collagen?? type?? I?? with?? subsequent?? mineralization??
and?? woven?? bone?? formation.??
At?? the?? implant?? interface?? the?? initial?? hemorrhagia?? leads?? to?? a?? coating??
of?? the?? surface?? with?? plasma?? proteins?? (50).?? An?? implant?? surface,??
which?? is?? microtextured,?? improves?? the?? osteoconductive?? activity??
(51-‐54).?? Differentiating?? osteogenic?? cells?? initiate?? bone?? deposition.??
Collagen?? is?? synthesized?? onto?? and?? mineralized?? to?? produce?? morpho-‐
logically?? identifiable?? bone?? matrix.?? However,?? an?? amorphous?? matrix??
layer?? (20-‐50?? to?? 500?? nm?? thick)?? can?? be?? visualized?? directly?? on?? the??
titanium?? implant?? surface?? (27,?? 55).?? This?? amorphous?? layer?? has?? been??
associated?? with?? both?? mineralised?? (56)?? and?? non-‐mineralised?? tissue??
(27)?? in?? which?? the?? innermost?? 20-‐40?? nm?? seem?? not?? to?? contain?? colla-‐
gen?? and?? the?? outermost?? have?? randomly?? arranged?? filaments.?? Non-‐
collagen-‐proteins?? have?? been?? identified?? as?? osteopontin,?? bone??
sialoprotein,?? proteoglycans?? and?? glucosaminoglycans?? (57,?? 58).??
With?? titanium?? alloy?? implants?? similar?? zones?? of?? the?? amorphous??
matrix?? of?? varying?? magnitude?? are?? described?? showing?? an?? organiza-‐
tion?? at?? the?? implant?? interface?? divergent?? from?? that?? of?? the?? surround-‐
ing?? bone?? (59).?? The?? amorphous?? layer?? has?? in?? in?? vitro?? studies?? been??
associated?? with?? osteoblast?? activity,?? but?? not?? confirmed?? in?? vivo?? (27).??
The?? effect?? on?? implant?? fixation?? has?? been?? questioned.??
Remodelling?? phase.?? Bone?? remodelling?? reflects?? the?? func-‐
tional?? adaptation?? of?? the?? bone?? structure?? and?? starts?? with??
osteoclastic?? resorption.?? At?? the?? light?? microscopy?? level?? di-‐
rect?? bone?? contact,?? osteogenesis?? and?? bone?? resoption?? oc-‐
cur?? simultaneously?? (60).?? Basic?? multicellular?? units?? (BMU)??
resorb?? woven?? bone?? and?? lay?? down?? new?? lamellar?? bone?? at??
the?? presented?? resorbed?? surface.?? Resorption?? and?? deposi-‐
tion?? are?? coupled?? in?? space?? and?? time.?? The?? resorption-‐
formation?? frequency?? of?? the?? BMU?? is?? increased?? initially??
(44,?? 45).?? Osteogenic?? cells?? are?? derived?? from?? the?? endoste-‐
al?? trabecular?? surfaces?? and?? mesenchymal?? osteoprogeni-‐
tor?? cells?? in?? marrow?? influenced?? by?? BMP?? release?? during??
resorption?? (34),?? while?? circulating?? mononuclear?? precur-‐
sors?? supply?? osteoclasts.?? ??
Osseointegration?? is?? characterised?? by?? the?? direct?? connection?? be-‐
tween?? bone?? and?? implant?? surface.?? However,?? histologically,?? total??
bone?? contact?? does?? not?? occur.?? Levels?? of?? ingrowth?? into?? porous??
coatings?? vary?? considerably,?? ranging?? from?? 10-‐40%?? in?? intramedul-‐
lary?? in?? vivo?? models?? (61-‐63)?? and?? 10-‐65%?? in?? clinically?? retrieved??
specimens?? (64-‐66).??
?? This?? thesis?? evaluates?? the?? effect?? of?? adjuvant?? parathyroid??
hormone?? on?? the?? bone?? formation?? at?? an?? implant?? and?? in?? conse-‐
quence?? implant?? fixation.?? The?? implant?? fixation?? is?? evaluated?? by?? both??
osseointegration?? and?? mechanical?? fixation.?? Given?? the?? studies?? are??
experimental,?? in?? this?? case,?? determination?? of?? osseointegration?? by??
light?? microscopy?? is?? feasible.??
?? Joint?? replacement?? can?? present?? with?? difficult?? bone?? defects.?? In??
the?? primary?? arthroplasty,?? loss?? of?? bone?? stock?? may?? be?? evident?? as??
arthritic?? cysts.?? In?? the?? revision?? setting,?? bone?? loss?? may?? be?? caused?? by??
osteolysis?? with?? cavitary?? defects,?? by?? peri-‐implant?? osteopenia?? or??
during?? implant?? change?? at?? the?? revision?? surgery.?? At?? revision?? initial??
implant?? fixation?? can?? be?? achieved?? on?? the?? femoral?? side?? by?? using?? a??
long?? stem.?? The?? stem?? may?? be?? uncemented?? passing?? the?? fixation??
from?? the?? proximal?? defective?? bone?? to?? the?? more?? distal?? viable?? bone,??
or?? it?? can?? be?? cemented?? as?? often?? used?? in?? older?? patients.?? On?? the??
acetabular?? side?? revision?? is?? often?? more?? challenging?? with?? the?? need??
of?? metal?? augmentations?? and?? highly?? trabecular?? or?? custom?? made??
cups?? with?? supplemental?? screw?? fixation.?? Changing?? a?? prosthetic??
component?? and?? the?? fixation?? method?? both?? intend?? to?? secure?? fixa-‐
tion,?? however?? bone?? grafting?? is?? often?? needed?? for?? supplemental??
implant?? stability.?? Impacting?? morsellised?? bone?? graft?? around?? the??
implant?? in?? these?? situations?? is?? a?? well-‐established?? method?? for?? opti-‐
mizing?? the?? initial?? implant?? stability.?? Restoring?? bone?? with?? bone?? graft??
is?? therefore?? often?? used?? in?? younger?? patients?? or?? in?? patients?? with??
large?? defects.?? ??
History?? of?? bone?? graft??
?? Bone?? grafting?? did?? not?? become?? an?? applicable?? and?? sustainable??
technique?? until?? the?? late?? 1970´s.?? Hasting?? described?? in?? 1975?? the?? use??
of?? bone?? graft?? for?? acetabular?? reconstruction?? of?? protrusio?? acetabuli??
(67).?? In?? 1984?? Sloof?? introduced?? morsellised?? impacted?? bone?? grafting??
for?? cemented?? acetabular?? revisions?? (68).?? ?? On?? the?? femoral?? side?? in??
1985?? the?? Exeter?? group?? introduced?? bone?? grafting?? without?? cement??
in?? which?? morsellised?? allograft?? was?? impacted?? around?? the?? stem?? (68).??
However,?? success?? was?? limited?? due?? to?? high?? subsidence?? and?? in?? 1987??
the?? group?? introduced?? the?? cemented?? bone?? graft?? technique?? in??
which?? the?? stem-‐cement-‐graft-‐bone?? construction?? provides?? the??
initial?? fixation?? (69).?? ??
Page 5
Present?? bone?? grafting??
?? The?? effect?? of?? bone?? grafting?? on?? implant?? outcome?? and?? survival??
is?? hard?? to?? establish.?? In?? the?? revision?? setting?? an?? even?? larger?? number??
of?? factors?? influence?? the?? functional?? life?? of?? a?? prosthetic?? total?? joint??
compared?? to?? the?? primary?? arthroplasty.?? Clinically?? the?? evaluation??
may?? be?? by?? RSA?? on?? subsidence,?? by?? x-‐ray,?? patient?? evaluation?? scores??
and?? the?? need?? for?? re-‐revision.?? Grafted?? revised?? femur?? stems?? have??
been?? described?? with?? subsidence?? in?? 48%?? of?? the?? cases.?? In?? other??
series,?? ≥?? 5?? mm?? subsidence?? was?? seen?? in?? 20%?? of?? cases,?? and?? ≥?? 10?? mm??
in?? 4%?? (69).?? Admissible?? mid-‐?? and?? long-‐term?? results?? on?? the?? acetabu-‐
lar?? side?? show?? a?? survival?? rate?? of?? 94%?? at?? 11.8?? years?? (70)?? but?? less?? on??
the?? femur?? side?? (71,?? 72).?? The?? outcome?? of?? a?? revision?? arthroplasty?? is??
considerably?? worse?? than?? after?? a?? primary?? arthroplasty.?? In?? Den-‐
mark,?? the?? 10-‐year?? survival?? for?? the?? first?? revision?? of?? total?? hip?? re-‐
placement?? is?? 80%?? and?? for?? second?? revisions?? 70%?? (9).?? Although?? both??
the?? cemented?? and?? uncemented?? grafting?? techniques?? are?? used?? to??
day,?? no?? definite?? reports?? are?? available?? on?? which?? technique?? provides??
best?? outcome?? (71).?? ??
Objective?? of?? bone?? grafting??
?? The?? primary?? aim?? of?? bone?? grafting?? in?? total?? joint?? replacement?? is??
to?? give?? structural?? support?? of?? the?? prosthesis.?? Secondary,?? restoring??
bone?? loss?? is?? considered.?? In?? the?? ideal?? situation?? of?? bone?? grafting??
bone?? chips?? are?? impacted?? and?? fill?? the?? bone?? defects?? around?? the??
prosthesis?? with?? a?? secure?? fit?? of?? the?? implant.?? During?? remodelling,??
the?? graft?? must?? maintain?? its?? volume?? and?? shape,?? not?? only?? during?? the??
initial?? weight-‐bearing?? by?? the?? patient,?? but?? also?? during?? the?? entire??
remodelling?? period,?? which?? involves?? osteoclastic?? resorption?? of?? the??
graft?? and?? simultaneous?? osteoblastic?? cancellous?? new?? bone?? for-‐
Graft?? biology??
?? Bone?? graft?? material?? may?? be?? characterised?? according?? to?? donor??
site.?? Autograft?? is?? graft?? harvested?? from?? the?? same?? individual,?? allo-‐
graft?? from?? another?? genetically?? different?? individual,?? and?? xenograft??
from?? a?? different?? species.?? Autograft?? is?? considered?? the?? golden??
standard,?? but?? sufficient?? amount?? is?? often?? hard?? to?? harvest?? and??
frequently?? involves?? donor?? site?? morbidity.?? Allograft?? has?? been?? used??
as?? a?? successful?? alternative.?? Immunogenicity?? may?? be?? reduced?? by??
modifications?? as?? freezing,?? drying,?? irradiation,?? rinsing,?? chemomodi-‐
fication?? (73).??
?? Bone?? graft?? material?? can?? be?? characterised?? in?? bone?? types?? by??
structure?? and?? histology?? as?? cortical,?? cancellous,?? corticocancellous,??
or?? osteochondral.?? Cortical?? and?? corticocancellous?? struts?? have?? been??
used?? to?? reconstruct?? uncontained?? bone?? defects,?? while?? morsellised??
graft?? may?? impact?? more?? closed?? defects.?? Morsellised?? graft?? is?? most??
often?? applied.??
?? Morsellised?? graft?? is?? a?? structure?? of?? bone?? fractures?? exposing??
the?? bone?? matrix?? to?? the?? surrounding?? tissues?? without?? a?? protective??
linning?? cell?? and?? osteoid?? layer.?? Bone?? graft?? material?? induces?? bone??
(osteoinduction)?? by?? releasing?? growth?? factors?? (BMP)?? during?? resorp-‐
tion?? and?? thereby?? stimulating?? local?? bone?? formation.?? Bone?? graft?? also??
performs?? as?? a?? scaffold?? for?? new?? bone?? formation?? (osteoconduction).??
The?? bone?? formation?? within?? mechanically?? stable?? grafts?? has?? been??
described?? as?? an?? intramembranous?? ossification?? (74,?? 75).?? The?? pro-‐
cess?? by?? which?? graft?? is?? replaced?? with?? new?? bone?? over?? time?? has?? been??
described?? as?? creeping?? substitution?? (74).?? ??
?? Although?? bone?? graft?? is?? non-‐structural?? and?? particulate?? in??
nature,?? implant?? stability?? can?? be?? achieved?? with?? the?? impaction.??
After?? impaction?? the?? graft?? material?? recoils?? (76)?? and?? at?? the?? same??
time?? the?? mechanical?? loading?? causes?? graft?? interlocking?? movement??
(77).?? This?? adds?? to?? initial?? stability?? of?? the?? implant.?? Bigger?? size?? bone??
chips?? increase?? stability?? of?? uncemented?? cups?? (78).?? The?? morsellised??
and?? impacted?? graft?? can?? still?? be?? regarded?? as?? a?? porous?? structure?? and??
ingrowth?? of?? vessels?? is?? thought?? not?? to?? be?? impaired?? (79).?? Even?? after??
a?? fairly?? firm?? experimental?? impaction,?? 35%?? of?? graft?? volume?? still??
consists?? of?? non-‐osseous?? material?? for?? the?? fibro?? vascular?? tissue?? to??
penetrate?? (80).??
?? On?? the?? basis?? of?? radiographs?? that?? show?? increased?? radiograph-‐
ic?? density?? and?? load-‐oriented?? trabecular?? orientation,?? it?? is?? thought??
that?? most?? of?? the?? graft?? volume?? remodels?? into?? trabecular?? living??
bone?? (69).?? Histological?? studies?? in?? humans?? of?? biopsied?? or?? retrieved??
morsellised?? impacted?? grafts?? reveal?? mixed?? areas?? of?? remodelled??
bone?? and?? necrotic?? graft?? bone?? (81-‐87).?? ?? Up?? to?? 4?? years?? after?? grafting??
old?? bone?? is?? still?? visible?? (81,?? 83-‐85).?? Varying?? ingrowth?? of?? new?? bone??
into?? the?? bone?? graft?? has?? been?? shown.?? In?? a?? human?? retrieval?? study?? of??
grafted?? uncemented?? cups?? vascular?? penetration?? of?? 4?? mm?? is?? seen?? at??
18?? and?? 53?? months?? (83).?? Bone?? graft?? may?? remain?? encapsulated?? in??
fibrous?? tissue?? within?? the?? host?? bone?? many?? years?? after?? transplanta-‐
tion?? (87).?? Ingrowth?? into?? the?? morsellised?? impacted?? graft?? may?? be??
delayed?? or?? limited?? due?? to?? the?? impaction?? alone.?? Bone?? growth?? into?? a??
bone?? conduction?? chamber?? was?? reduced?? at?? 6?? weeks,?? but?? not?? at?? 12??
weeks?? compared?? to?? structural?? grafts?? (88).?? Bone?? graft?? size?? per?? se??
may?? not?? be?? an?? advantage?? in?? implant?? fixation.?? The?? relative?? area?? of??
surface?? per?? volume?? influences?? the?? degree?? of?? osteoconduction.??
However?? with?? the?? increased?? degrees?? of?? graft?? density?? impaction??
can?? in?? reverse?? reduce?? osteoconduction?? and?? this?? can?? be?? explained??
by?? the?? impacted?? graft?? acting?? as?? a?? hindrance?? for?? ingrowth?? of?? tissue??
(89)?? Mechanical?? load?? increases?? remodelling?? and?? new?? bone?? for-‐
mation?? of?? morsellised?? impacted?? cancellous?? bone?? grafts.?? In?? the??
bone?? conduction?? chamber?? model?? both?? formation?? and?? resorption??
of?? the?? graft?? were?? increased?? (90).?? ??
PTH?? and?? calcium?? homeostasis??
?? Parathyroid?? hormone?? (PTH)?? is?? the?? hormone?? naturally?? secret-‐
ed?? by?? the?? parathyroid?? gland.?? The?? genuine?? hormone?? is?? a?? chain?? of??
84?? amino?? acids?? (PTH(1-‐84)).?? It?? is?? the?? major?? regulator?? of?? bone??
metabolism?? and?? maintains?? homeostasis?? of?? the?? calcium?? ion?? in??
extracellular?? fluids?? within?? physiological?? limits?? (91).?? Secretion?? of??
PTH?? is?? controlled?? by?? serum?? calcium?? through?? negative?? feedback.??
PTH?? acts?? on?? bone,?? kidney,?? and?? gastrointestinal?? tract?? (91).?? In?? bone,??
calcium?? is?? liberated?? through?? a?? process?? of?? enhanced?? bone?? resorp-‐
tion?? by?? osteoclasts.?? The?? osteoclasts?? do?? not?? have?? PTH?? receptors??
and?? are?? indirectly?? activated?? by?? PTH.?? PTH?? activates?? the?? osteoblast??
PTH/PTHrP-‐receptor?? that?? stimulates?? its?? expression?? of?? RANKL.??
RANKL?? activates?? the?? RANK-‐receptor?? on?? the?? osteoclast?? precursors??
causing?? the?? cells?? to?? differentiate?? and?? resorb?? bone.?? In?? the?? kidney,??
PTH?? increases?? the?? active?? re-‐absorption?? of?? calcium?? from?? the?? distal??
tubules.?? In?? the?? intestine?? PTH?? enhances?? the?? absorption?? of?? calcium??
indirectly?? by?? activating?? the?? vitamin?? D?? precursor?? in?? the?? kidney,??
which?? then?? as?? activated?? 1.25-‐dihydroxy?? vitamin?? D?? exerts?? it?? calci-‐
um?? absorbing?? action?? in?? the?? intestine.?? ??
PTH?? shows?? dual?? action?? on?? bone?? (the?? PTH?? paradox)?? (92-‐95).?? The??
skeletal?? effect?? depends?? on?? administration:??
physiological:?? calcium?? homeostasis??
continuous:?? bone?? resorption?? (katabolic)??
intermittent:?? bone?? formation?? (anabolic)??
History?? of?? PTH?? treatment??
?? PTH?? improves?? skeletal?? mass?? when?? administered?? pulsative.??
The?? osteogenic?? potency?? of?? PTH?? has?? been?? known?? since?? the?? late??


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Category Archives: Personalized Gifts
What can keep drinks hot for days and cold for days? My 2 favorite Thermoses! (Product Review)
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The Perfect Personalized Cutting Board – tips on what to engrave for the perfect wedding gift
Whether your friends are professional chefs or are creating a kitchen from nothing, a personalized bamboo cutting board is the perfect wedding gift! There are so many ways that you can make this wedding gift creative and unique, showing your … Continue reading
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Personalized Wholesale Agate – Laser engraved with your text, logo or design
When restocking your rock shop with wholesale agate, consider having it customized – laser engraved with your shop logo, town slogan, location images (like skiing, moose, etc) Lazer Designs is proud to introduce wholesale priced laser engraved agate – hand … Continue reading
My favorite BBQ set – great utensils, long reach handles, good case (Product Review)
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Best Friends Picture Frames – 3 Ideas to create your own custom best friends picture frame!
Best Friend's are precious – and a gift! When we have cherished memories of times with our best friends, we want to preserve those memories – in our minds, and also by using photos of the good times together. The … Continue reading
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New movie Divergent gives personalized Buck Nobleman knives from LazerDesigns
What do you get a movie star to celebrate an exciting new role? A custom engraved Buck Nobleman knife is the answer! Lazer Designs is excited to be part of celebrating the launch of Divergent, the new film adaptation of … Continue reading
Hidden Lanyard on Leatherman Wave
Did you know…there is a hidden lanyard hook on the Leatherman Wave? Learn how to access this little known tool at Instructables.com The Leatherman Wave is one of Leatherman's classic, large tools. You may have given a personalized Leatherman Wave … Continue reading
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subset: commoncrawl


text:
I am trying to update my item and tried 5 times, after submitting it redirects me to the item edit page again. Anyone else having this problem
some weeks ago I've got the same troubles with my older items (http://codecanyon.net/forums/thread/troubles-with-updating-my-files/28125)
did you reported your issue to support?
and – I'm unable to update my items too – hmmm?
Hi buddy, I think devs were working on some changes… I am able to update now… just updated my item
The devs, just yesterday, deployed a rather massive update to our accounts system. If done correctly, none of you will be able to tell the difference. Anyhow, @5thSenseLabs, I'm assuming that this update fixed the update issue that you were having.
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text:
Watch Video Segments (195)
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The Emmy-winning actor reflects on his career, discusses his…0:11:07
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The New York Times Op-Ed columnist discusses his new book, "The…0:26:36Air Date 5/19/15
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text:
Scales, technique, tunes, improvisation techniques,finger picking,flat picking
I've been playing music since I was 14 years old. I studied classical guitar at State University in Buffalo, NY. and also studied guitar at the Berklee College of Music in Boston. I love just about every style of music. I mostly play Celtic, Bluegrass, American traditional, jazz, and classical. I also love to improvise. My goal is to get my students results so they feel that they are really making progress. I do this by incorporating practice exercises, ear training and some music theory. Music theory and reading music can be intimidating for beginning students. So I like to get you playing first and add theory a little at a time so you can better understand it through experience and it makes learning more fun. *** Studio Equipment *** The studio has a piano, acoustic ...
I began to teach guitar at 16 years of age. I have taught students from 7 to 60 years old in a wide variety of styles. From age 12 to 21 I took private guitar lessons regularly. Now I have a lesson every once in a while. I studied jazz guitar primarily with Randy Vincent, one of the San Francisco Bay Area's greatest guitar players. Aside from teaching lessons as a job, I have played guitar in many concerts and continue to do so. Before moving to San Francisco, I gained a lot of experience and valuable education with guitar. I played in the jazz bands in Junior High and High School. I went to four years of a week long summer jazz camp called jazz camp west where I took classes, played open mics and had fun with many musicians, making some good friends. I hold BA degrees in Music ...
I have been involved in music all of my life. As a child I played trumpet in band and sang in school and church choirs. My favorite movies were musicals and they still are my favorite. Music was my major in college, which included singing, dancing, acting and playing musical instruments. I like all types of music. As a school teacher, I taught 3rd. grade through high school, everything from band and choir to musical theater. I also taught private students, of all ages, piano, guitar, voice and most of the wind instruments. *** Lesson Details *** My students can expect to learn the basics of music theory, such as melody, harmony, key signature and rhythm. I want my students to have fun by learning the kind of music they like best while learning to appreciate the kind of music that ...
Notation and chord instruction. I can teach Beatles, The Eagles and other classic rock songs. Chords and charts. I will teach you how to write your own chart and write your own songs.
Acoustic and electric. Sorry I do not teach mariachi songs.
I have been teaching instrumental music since 1994. I have taught school district bands and private instruction. I earned a Bachelor's of Music at Sacramento State College in 1989 extensive single subject instrumental music K-12 teaching credential. i am a flute player in the bay area and performed weddings and church functions. I have performed musical productions with the Stapelton School of the Arts. Lessons are assigned one a week, However twice a week is an option. A minimum of four lessons per month are required for success on the instrument. My students are allowed one make up per month. I specialize in teaching beginning lessons on PIANO, GUITAR & FLUTE in downtown Novato. I have twenty years experience and currently teach at Our Lady of Loretto church after ...
Experienced guitarist of 12+ years looking to teach students of all ages toward levels they've only dreamt about! I base my lessons purely off my students best interests, and building a strong foundation rooted in self expression and emotion. I specialize primarily in classic/hard rock, blues and heavy metal. I hope to not only help guide my student's physical playing styles but also boost their singularity as a musician through their playing.
Hi there my name is Downey and I am a working musician based in Sonoma County. My primary instrument is electric guitar and i've been playing now for over 12 years. I specialize in mostly Classic/Hard rock styled music and I am mostly self taught. I want to teach students how to really find their voice through the guitar and work their way up to becoming the musician they've always dreamt of being! I believe anyone has the potential to be great as long as they are committed, driven and having fun doing it! The band I am currently playing with is called Vintage Suns and you can check out our website at www.vintagesuns.com I'm excited to start meeting new up and coming guitar players, and start teaching some key points I've come across in my own musical endeavors. I look forward to ...
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text:
Cricbuzz Cricket Scores & News
10,000,000 - 50,000,000 downloadsAdd this app to your lists
+ By Cricbuzz.com
Check out a number of interesting IPL features like the Historical Timelines, a Teams section to follow your favourite team, Venues, Squads, Preview, Photos and much more.
- The No. 1 Cricket App on Google Play.
- Most highly rated Sports App on Google Play
- Complete coverage of all International cricket, ICC World Cup, ICC World T20, IPL, Champions League T20, Big Bash and other major cricket tournaments. Tons of domestic cricket coverage too.
- If you would like to follow cricket in Indian Languages (Hindi, Tamil, Kannada, Telugu, Marathi and Bengali are currently supported), please check out our new App "Cricbuzz - In Indian Languages".
Top Features:
Live cricket score updates and ball by ball text commentary that helps you visualize the action.
Match Timelines and Twitter Timelines in the Commentary page (Match Center)
Match alerts via push notification service - so that you don't miss THE moment
Latest cricket news and editorials - to keep you posted on the latest happenings.
Current Matches page - To help you follow all live matches in one place.
Upcoming matches - what's up for tomorrow, next week, next month?
Series Home - Complete coverage of any major series/tournament in one place.
Results of recent matches - in case you want to look at the scorecard of a game that you recently missed.
Series Stats and Overall Records - for the ones obsessed with numbers
Photos - because a picture is worth a thousand words and all that.
Differential sized Widgets - Bringing the game onto your home-screen.
Player profiles - Cricket is all about the players - runs, wickets and everything else.
Player and Team Rankings for ODIs, Tests, and T20Is.
Points tables for all major tournaments - Which team is at the top and who will get knocked out?
Share the score - Give score updates via sms/email or share the scores of Facebook/Twitter.
Cricket On Twitter: Follow your favorite cricketers and commentators on Twitter.
Tags: cricbuzz, crickbuzz, cricbuzz cricket scores and news, cricket score widgets, cricbuzz.com, google cricket player, crick news, cricket score widget, www.cricbuzz.com, sms cricket updates.
New in 3.0.8
- On some devices with screens of lower resolution, scorecard and menu icons were not visible in the previous update, we have resolved it.
- UI enhancements and other critical bug fixes.
New in 3.0.7
- Choose your default landing page from Settings - Regular Cricbuzz Homepage with the grey theme or the Special IPL edition with the white theme.
- Solved the App Freeze issue on some handsets.
- Fixed several bugs and crashes.
(54 stars)
very nice
(54 stars)
Mast h saata laganea kea lea
(54 stars)
The ads on this app are irritating, and end up getting you registered for something your not even interested in and you also end up being charged for it. Small ad in the side u understand but full page ad nonsense. Once you finally get rid of the ads then the information and updates are quick but the ads spoil the whole fun of following the game
(54 stars)
My friends are use this site and I just saw this site ,then I am very excited with this app,most impotent new that this app are very simple for use of every people,,
(54 stars)
(54 stars)
(54 stars)


text:
Rubinius Tab Sweep
Ola Bini has written a couple of posts that touch on Rubinius and the other Ruby implementations. The first talks about the new weekly meeting of implementors, saying "[I]t's a huge deal. This will make the lives of all Ruby implementations much easier, and the meeting yesterday actually accomplished some very nice things." I hope we'll see this yield more Ruby Implementor Summits and the like.
Ola also wrote about the RbYAML Project for the Google Summer of Code. As the RubyCentral organizer for the GSoC, I'm really excited that we have nine great looking projects (including RbYAML) that will really help the whole Ruby community.
Vladimir Sizikov wrote about the RubySpecs Project (an outgrowth of the Rubinius project). This one also tied into GSoC, we've got two students working on separate projects to improve spec coverage.
Charlie Nutter provided a good perspective on the various implementations. I'm not sure I agree with everything he says, but he's a smaart guy and I don't really want to bet against him either. Here' the obligatory Rubinius quote:
Rubinius is, and always has been, a great project and a great idea. I talk with Evan and Brian and all the others on a daily basis, I contribute specs whenever I find gaps or fix bugs in JRuby, and I secretly harbor a desire to implement a JRuby/JVM backend for the Rubinius kernel. I'm sure we'll see great things from Rubinius in the future.
Nikos Dimitrakopoulos provided some coverage of Ruby implementation performance. Rubinius doesn't look to good, but the standard caveat still applies … they're still focusing on completeness not performance.
Luis Lavena posted some surprising performance numbers for Rubinius. I think this is the first time I've ever seen Rubinius win a "shootout" with the Ruby 1.8.6. It might be a micro-benchmark, but I think som congratulations are in order.
-- -pate http://on-ruby.blogspot.com
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|My Humble Little Game Collection
|May 28, 2015
|New Linux Based OS Brings Internet of Things Closer to Reality
|May 27, 2015
|Non-Linux FOSS: All the Bitcoin, None of the Bloat
|May 26, 2015
|Dr Hjkl on the Command Line
|May 21, 2015
|Initializing and Managing Services in Linux: Past, Present and Future
|May 20, 2015
|Goodbye, Pi. Hello, C.H.I.P.
|May 18, 2015
- My Humble Little Game Collection
- New Linux Based OS Brings Internet of Things Closer to Reality
- Initializing and Managing Services in Linux: Past, Present and Future
- Dr Hjkl on the Command Line
- Using Hiera with Puppet
- Non-Linux FOSS: All the Bitcoin, None of the Bloat
- Gartner Dubs DivvyCloud Cool Cloud Management Vendor
- Infinite BusyBox with systemd
- Goodbye, Pi. Hello, C.H.I.P.
- It's Easier to Ask Forgiveness...


text:
All across the nation, colleges are reporting a record number of applications received for the Class of 2015.
Harvard College, in Cambridge, Mass., reported a 15 percent increase in overall applicants from last year, to nearly 35,000 for roughly 2,200 acceptance slots.
At Syracuse University, in Syracuse, N.Y., the admissions office has received more than 25,270 applications, setting a school record with a 13 percent increase from last year.
And at Stanford University, the school received over 34,000 applications to fill its 1,700 slots for the incoming freshmen class.
Alan Krueger, an economics professor at Princeton University and the U.S. Assistant Secretary of the Treasury for Economic Policy, said multiple factors are contributing to this increase.
"The job market is still quite weak, and it's not unusual when the job market is weak for students to stay in school longer or additional students to seek higher education," Krueger said. "There's also been a trend taking place where the more recent cohorts are larger - just because of the echo of the baby boom. You have an increase in the number of students who are college-age."
In Westport, Conn., Staples High School saw this year's senior class rise to a record number of 471 students, up from 386 students in the class of 2010.
"Another important factor is the Common Application form, which has made it less costly to apply to a larger number of schools," he added.
Addressing the increase from the schools' point of view, Eric Hoover, senior writer for The Chronicle of Higher Education, noted that the technology allows for colleges to recruit more heavily online.
"As recruitment has gone digital, the Web has reduced the cost and the hassles of the traditional recruit outreach," said Hoover. "It's making it easier for the colleges to reach out to students all over the country and the world."
One of the highest increases occurred at Columbia University, in New York City, whose applicant pool rose by 32 percent from last year, totaling 34,587 applications. Columbia attributes its membership in the Common Application as one of the key factors to this year's rise.
The Common Application, an online program that allows students to use one application form to apply to multiple colleges, reported they had processed a new record of more than 2.3 million applications as of March 15. The application system expects that its 414 member colleges will receive another 64,000 applications before the end of the academic year.
"There were about 20 percent more kids using our system this year, and there were 20 percent more applications submitted this year," Rob Killion, executive director of the Common Application, told ABCNews.com.
"Ten years ago, students were applying to five schools, and this year it will be 10 schools," Kelly Herrington, director of college counseling at University Prep, in Seattle, told ABCNews.com. Prior to working at the private high school in Seattle, Herrington served as an associate director of admissions and director of international admissions at Union College, in Schenectady, N.Y.
"If you broaden your pool of applications, you have more students to choose from and more in the mix - then you can be more strategic about enrolling a class that is, quote, 'better' by a number of measures," Hoover told ABCNews.com.


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ROCKINGHAM — Construction projects are popping up all over town — and especially along U.S. 74 Business.
In January, Fidelity Bank will move to a new site at 532 E. Broad St., formerly the Rockingham Fish Camp, after spending years at its East Washington Street location in downtown Rockingham.
Senior Vice President Wiley Mabe said in May that the bank has outgrown the downtown location. Davie Construction of Clemmons is currently on-site building the new bank.
FastMed, an urgent-care clinic, will soon be a part of a small retail center in front of Lowe's Home Improvement on Broad Street. Developers have not yet announced a completion date.
Zaxby's Restaurant, a much-anticipated eatery coming to Rockingham on U.S. 74 Business in front of the Aldi supermarket, is due to open on Sept. 22. Crews with Dimension Construction have worked tirelessly over the last two months to have the new restaurant ready to open by the tentative date. The restaurant will be able to seat 90 people.
Another of Aldi's new neighbors will be Fountain Pointe Apartments on Clemmer Road. The 39-unit complex is set to be finished and apartments ready to lease by April 2015. Blue 22 Development and Connelly Development N.C. have been working in a joint effort on the project.
Griffin Toyota Scion, also on U.S. 74 Business between Rockingham and Hamlet, is in the process of expanding and remodeling its showroom, restrooms and service department. Hawks Construction of Rockingham is in charge of building, and the project is set to be complete by mid-December.
A new housing development known as Savannah Place is taking shape on Brooklyn Lane off of Roberdel Road in Rockingham. Whitley Construction Company is building the homes, and the development includes two phases, the second of which will take place on adjacent Lawson Lane.
Another project due to be finished by the first of next year is the Villager Deli and Discovery Place Kids assembly area across the street from the nonprofit children's museum. Oakboro-based Carpenter Construction is in charge of construction on the former Steele building.
Rockingham City Manager Monty Crump called it a "demonstration project" that will "serve as an example to hopefully induce further similar redevelopment in downtown Rockingham."
The fourth Family Dollar store in Richmond County will soon be finished on the corner of Airport Road and Entwistle Street in the East Rockingham community. Family Dollar spokesperson Bryn Winburn said the new store is set to open at the end of the year and will hire eight to 10 people.
"The city is pleased development interests in our community have increased over the last year or so," City Planner John Massey about the projects taking place in Rockingham. "The new construction projects provide a positive impact on the local economy with jobs and tax base. We're hopeful this trend will continue."
Reach reporter Matt Harrelson at 910-817-2675.


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The MCAT
The MCAT
Taking the MCAT
All medical school applicants must take the Medical College Admission Test (MCAT) to be considered for medical school. The MCAT is offered numerous times per year between January - September. Students are recommended to take the MCAT when they've completed the majority of the pre-med course work and have ample time to study, review and take practice tests. The MCAT is a timed computerized exam that covers physical sciences (physics and general chemistry), verbal reasoning and biological sciences (biology and organic chemistry). Each section is worth 15 points with a composite total of 45.
The following website https://www.aamc.org/students/applying/mcat has helpful information regarding how to register, how to prepare and also offers one FREE practice test. You may also purchase previous MCATs for practice.
The University of Louisville School of Medicine Office for Minority and Rural Affairs offers a FREE MCAT-DAT Review Summer Workshop for eligible students. Please contact Ms. Katie Leslie, Program Coordinator Sr. at 502-852-8109 or firstname.lastname@example.com for more information.
In addition to the FREE MCAT-DAT Review Summer Workshop offered at U of L, please consider Kaplan, Exam Krackers, Princeton Review, etc.
The Program Advisor will discuss when the best time is to take the MCAT and will offer suggestions on how to prepare for it.
MCAT Preparation for 2014 MCAT Takers
If you are applying for the entering 2015 class, the last test date for the 2014 MCAT is January 23, 2015. Our program provides MCAT preparation for its students, as program funds are available.
Per approval, students may register for the on-line Kaplan Classroom Anywhere. Which includes Kaplan materials, AAMC and Kaplan practice tests, a live and interactive three hour class on-line and access to On Demand pre-recorded classes if you happen to miss a live class. This on-line arrangement allows you to prepare for the MCAT anywhere and anytime of the day. It gives you the convenience of bringing the classroom to you. This course is available to you on behalf of the program, as program funds are available.
Keep in mind that a library of MCAT materials is also available in the program office; Princeton Review, Kaplan and Exam Krackers if you'd like to check some out. Our graduates and medical student mentors are encouraged to donate their MCAT materials to the program or to one of the current students.
Please note: This complimentary service will continue to be offered as program funds are available. If funding decreases or discontinues, students will be notified.
Assured Admission Candidates Taking The MCAT
Assured admission candidates are allowed to take the MCAT the year they want to matriculate versus the year before. For example, students applying for the entering 2014 medical school class who may not be prepared to take the MCAT this summer (by Sept.12), may take the MCAT between January - early April 2014 for assured admission consideration. Test scores must be in before/by May 15, 2015.
If a student took the MCAT this summer and needed to retake it in January - early April, that would be allowed for assured admission consideration; however, most medical schools do not accept the January 2015 MCAT for the 2015 admissions cycle. You would need to check with each individual medical school of interest to see if there is an exception. Keep that in mind when deciding when to take the MCAT and whether or not to apply exclusively to U of L School of Medicine.
The required minimum composite score for an assured admission candidate is 27with nothing below an 8 in each category. If you do not meet that criteria, you have a choice to either retake the MCAT if it's within the time frame, withdraw your application or allow your applicant file to be submitted to the general applicant pool for consideration by the medical school admissions committee. Keep in mind that usually by mid-March the class is full and most remaining applicants are being considered for the wait list or may be denied. Please note: The writing sample has been removed as of the 2013 MCAT.


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Price of non-subsidised cooking gas (LPG) was Tuesday hiked by Rs 16.50 per cylinder and that of jet fuel by over half-a-percent after international oil prices surged due to the ongoing Iraq crisis. The increase in rates of non-subsidised LPG and ATF accompanies the Rs 1.69 a litre hike in petrol and 50 paisa a litre in diesel announced yesterday.
The price of non-subsidised LPG, which customers buy after using up their quota of 12 subsidised cylinders, was raised by Rs 16.50 per 14.2-kg cylinder, the first hike in six months.
Each non-subsidised 14.2-kg cooking gas cylinder will now cost Rs 922.50 in Delhi, up from Rs 906, according to Indian Oil Corp (IOC), the nation's largest oil firm. Non-subsidised LPG rates were last month cut by Rs 23.50 per cylinder. A subsidised LPG cylinder in Delhi costs Rs 414.
Today's hike breaks the declining trend that started in February with a Rs 107 cut in rates to Rs 1,134 per cylinder. It was followed by a Rs 53.5 per cylinder reduction in March to Rs 1,080.50, by Rs 100 to Rs 980.50 in April, by Rs 52 in May and by Rs 23.50 cut last month. IOC said losses on LPG have risen to Rs 449 per subsidised cylinder from Rs 432.71 in the previous month. The loss was Rs 762.50 in January.
Separately, the price of jet fuel or aviation turbine fuel (ATF), at Delhi was increased by Rs 413.78 per kilolitre (kl), or 0.6%, to Rs 70,161.76 per kl. The increase follows three straight monthly reduction, the last one of Rs 1,285.89 per kl, or 1.81%, which came into effect on June 1. In Mumbai, jet fuel costs Rs 72,411.21 per kl as against Rs 71,940.36 per kl previously, IOC said. The rates vary because of differences in local sales tax or VAT.
Jet fuel constitutes over 40% of an airline's operating costs and the price hike will increase the financial burden of cash-strapped carriers. No immediate comments were available from airlines on the impact of the price increase on passenger fares.
The three fuel retailers -- IOC, Hindustan Petroleum Corp and Bharat Petroleum Corp -- revise jet fuel and non-subsidised LPG prices on the first of every month, based on the average international prices in the preceding month.
READ: Petrol price hiked by Rs 1.69/litre, diesel by Rs 0.50
Petrol price was today hiked by a steep Rs 1.69 per litre and diesel by 50 paise a litre as the crisis in Iraq spooked international oil and currency markets. The hike, effective midnight tonight, excludes local sales tax or VAT and the actual increase will be higher, varying from city to city. Petrol in Delhi will cost Rs 73.58 per litre, up Rs 2.02 from Rs 71.56 at present. Diesel rates will go up by 56 paise to Rs 57.84 per litre. "Due to geo-political unrest in the Middle East, there has been significant increase in international oil prices during the past two weeks. The international prices of gasoline (petrol) have increased by more than USD 4 per barrel, and the rupee-US dollar exchange rate has also deteriorated. The combined impact of both these factors has warranted an increase in petrol prices by Rs 1.69 per litre, excluding state levies," Indian Oil Corp, the nation's largest oil firm, said. Read more


text:
Methicillin-resistant Staphylococcus aureus infections in the U.S. decreased by nearly 30% from 2005 to 2011, while the rate of hospital-acquired MRSA infections saw a 54% decline, CDC officials reported. Another study showed exposure to agricultural operations that use swine manure was associated with MRSA community-acquired infections. The studies appear in JAMA Internal Medicine.
View Full Article in:Reuters · HealthDay News
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Property Details
4 Bedroom, 3.5 Bath, 2 Living rooms, Mountain Views
This home is a one story, +2,500sqft house in one of the best areas in Palm Desert and school districts. It is located on a cul-de-sac street in non-gated community and has a beautifully matured landscaped yard with a west facing pool/spa and outdoor misters. The home layout is an open floor plan and holds 4 bedrooms, 3 full bathrooms, large kitchen, dining area, family room, living room, utility room with a new washer/dryer, and a three car garage. The first Guest bedroom has a new queen size memory foam mattress, full size dresser, two night stands, mid-size walk-in closet, and private restroom/shower. The other 2 bedrooms have new queen size beds and share a bathroom in a Jack and Jill style layout; both have pillow top mattresses, full size dressers and closets. The master bedroom & bathroom include a large walk-in closet, big shower and Jacuzzi tub; with views of the pool and mountains. It also has a new California King-size bed, full size dresser, 2 night stands, and is directly accessible to the pool. The kitchen has all the necessary amenities to live and cook comfortably; including blender, Keurig coffee maker, toaster, knife block, pots/pans, baking dishes, fridge, stove, oven, microwave and dishwasher. It also includes all the necessary glassware, dishes, cooking utensils, and silverware necessary to accommodate a house full of people. The formal dining area includes an oversized table and can seat 7 comfortably. The family room shares a gas fireplace with the kitchen, has a 55' TV, new large leather sofa, love seat, and oversized recliner. Next to the dining room is the living room which is a lowered floor and has a new sofa and love seat next to a large window facing the front of the home. The backyard has three outdoor poolside lounge chairs and includes a glass top table with seating for 6. The common areas of the home and master bedroom have cathedral/vaulted ceilings. Included with the home is cable TV, internet, and active home security system.
Recent Review
Great home!
About the Owner
I am currently a Construction Management Professional and specialize in Industrial Process Facility Equipment Installation.
7 Reviews
5 based on 7 traveler reviews
Great home!
Perfect spot!
Beautiful home!
Wonderful January Vacation !!!
Perfect family house!
Spring Break Family & Music hide awaySpring Break Family & Music hide away
The house is on a culd-a-sac so the kids brought razor scooters, and bikes. The Marriott Desert Springs was close enough to bike to, so going out to eat was a breeze. The house is centrally located to all desert activities.
The last 5 days we spent with two other couples, sent the kids back home. The house has 4 bedrooms, all with queen beds so there was plenty of room for 8 adults. The beds are heavenly and brand new. All the furniture was brand new and modern. The carpet and floors were new. The 3 bathrooms were all clean and well maintained. Plenty of closet space, we did not pack lightly. Brand new washer and dryer.
The kitchen had ample storage and was stocked with all the appliances and kitchen tools a chef might need. There coffee pot was a Keurig so K-cups are used, a starter selection was left for us. Fridge had condiments on our arrival.
Several of the yearly activities in the desert offer shuttle service, this house was conveniently located near the Marriott Desert Springs shuttle stop. The local street fair was close, the kids had fun dancing to the local musicians, adults had fun shopping for jewelry and organic foods.
We would definitely rent this home again, the kids are already to go back. The owner was easy to work with and was able to make sure all of our needs were met during our stay. He was over accommodating when we left an IPAD behind, he FedEx'd immediately.
From the Owner
"This property is in a great location on a quiet cul-de-sac, just minutes from El Paseo (Shopping and Restaurants), great golf courses, and centrally located in the Desert Valley. Its in a great neighborhood and has excellent views of the Mountains with a sunny exposed west facing back yard."
Activity and Interests
Nearby the property include; casinos, live music, McCullum Theatre, El Paseo, Great restaurants, Golf Courses, Tennis, and other misc events during the winter season...
Palm Desert City Lic. #14-00040534
Rental rates
|Rate Period
|Weekend Night
|Monthly *
2014/15 May Seasonal
Apr 28 2015 - Jun 1 2015
3 night minimum stay
Summer Specials
Jun 2 2015 - Sep 30 2015
3 night minimum stay
2015/16 Seasonal Specials
Oct 1 2015 - Apr 5 2016
3 night minimum stay
Coachella/Stagecoach 2016
Apr 6 2016 - Apr 25 2016
5 night minimum stay
* Approximate monthly rate. Actual rate will depend on the days of the month you stay.
Payment is usually accepted in the quoted currency (USD) unless the currency and the amount is specifically agreed in advance with the owner / advertiser.
Additional information about rental rates
- Refundable damage deposit $350.00
- Property Damage Protection $99.00
- Gas - Heating Pool / Spa $30.00 + Tax
- Cleaning Fee' $300.00
- Tax Rate 9.0%
GREAT SUMMER SPECIALS - Please Call or Email...
$305 - 705.00 Cleaning/Utility Fee' For The AC Units &
All Pool n Jacuzzi Utilities - Just Depends How long Our Guests Stay...
Cancellation Policy
- 12
- Available
- 12
- Unavailable
- 12
- Today
Property Type
- house
- Adventure
- Away From It All
- Family
- Historic
- Romantic
- Spa
- Sports & Activities
- Tourist Attractions
- Air Conditioning ...
- Clothes Dryer
- Fireplace
- Garage
- Hair Dryer
- Heating
- Internet
- Iron & Board
- Linens Provided
- Living Room
- Parking
- Towels Provided
- Washing Machine
- Coffee Maker
- Dishes & Utensils
- Dishwasher
- Kitchen ...
- Microwave
- Oven
- Pantry Items
- Refrigerator
- Stove
- Toaster
- Dining ...
- Dining Area
- Music Library
- Satellite / Cable ...
- Stereo ...
- Television ...
Pool / Spa
- Heated Pool
- Hot Tub
- Private Pool
Onsite Services
- Concierge
- Massage
- Private Chef
- Staff
- Events Allowed
- children welcome
- limited accessibility
- non smoking only
Location Type
- Mountain View
- arboretum
- botanical garden
- churches
- cinemas
- festivals
- health/beauty spa
- library
- live theater
- museums
- playground
- recreation center
- restaurants
- synagogues
- theme parks
- water parks
- winery tours
- zoo
Leisure Activities
- antiquing
- bird watching
- eco tourism
- gambling casinos
- horseback riding
- miniature golf
- outlet shopping
- photography
- scenic drives
- shopping
- shuffleboard
- sight seeing
- walking
- wildlife viewing
Local Services & Businesses
- ATM/bank
- Babysitter
- fitness center
- groceries
- hospital
- laundromat
- massage therapist
- medical services
Sports & Adventure Activities
- cycling
- equestrian events
- golf
- golf privileges optional
- hiking
- hot air ballooning
- hunting
- hunting big game
- hunting small game
- mountain biking
- mountain climbing
- rock climbing
- roller blading
- swimming
- tennis
Floor Area
- 2507 sq. ft.
- 3 Bathrooms
- Bathroom 1 - toilet, tub, shower, jetted tub
- Bathroom 2 - toilet, combination tub/shower
- Bathroom 3 - toilet, shower
- 4 Bedrooms, Sleeps 9
- Bedroom 1 - 1 king
- Bedroom 2 - 1 queen
- Bedroom 3 - 1 queen
- Bedroom 4 - 1 queen
- 4 Bedrooms, Sleeps 8, Beds for 8
- Bicycles
- Deck / Patio
- Golf
- Lawn / Garden
- Tennis
- Guests provide their own meals


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blinkbox is available on PC, Mac, mobile, tablets, Chromecast, consoles, smart TVs, set‑top boxes and Blu‑ray players.
What to Expect When You're Expecting author Heidi Murkoff has even more mama wisdom for you — and this time around, she's focusing on helping the pregnant set. Made with baby bumps in mind, this system of six ten-minute mix-and-match workouts are perfect for every stage of pregnancy. Fitting fitness into every day of your nine months has never been easier!
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Q. "What type of faucets can I use in the bathroom?"
A. The two most commonly used bathroom sink (lavatory) faucets are the 4-inch centerset and the widespread.
Q. "What is a centerset?"
A. It is a lavatory set that is 4" center to center from handle to handle.
Q. "What is a widespread faucet?"
A. A widespread faucet includes three separate parts that measure from 8 to 16 inches from center to center.
Q. "What is a mini-widespread (4 inch centerset)?"
A. It is similar to a widespread but with a 4 inch center to center instead of 8 or 16 inches.
Q. "I'm hearing a lot about lead-free these days. What does that have to do with plumbing products and how does the new lead-free legislation affect me?"
A. Basically, the laws implemented Jan. 1st, 2014 require plumbing products that come in contact with drinking water to be essentially lead free (less than 0.25% weighted average). For further information about how the law determines what is lead free, rules regarding which plumbing products must be lead free, and who these laws will affect, please visit our LEAD FREE Plumbing Information page.
We hope that we have helped you on this page with bathroom faucets,
and thank you for helping to make PlumbingSupply.com® the most famous Internet plumbing supplier.
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The median home value in Palisades Park, NJ is $490,800.
This is
higher than
the county median home value of $396,800.
The national median home value is $170,100.
The average price of homes sold in Palisades Park, NJ is $490,800.
Approximately 29.66% of Palisades Park homes are owned,
compared to 63.53% rented, while
6.81% are vacant.
Palisades Park real estate listings include condos, townhomes, and single family homes for sale.
Commercial properties are also available.
If you see a property you're interested in, contact a Palisades Park real estate agent to arrange a tour today!
Learn more about Palisades Park Real Estate.
Easy access to malls and NYC from this single family home. Fenced in yard, 2 full baths and 4 bedrooms make this a great home if you need more space. Close to schools, houses of worship, and a beautiful block too.
Real Living Five Corners
300 Heathcote Road
Scarsdale, NY 10583
Email Us | Visit our Real Estate Website


text:
From Our Editors
The Pure Skin's experienced owner and aesthetician, Renata Martins, specializes in Brazilian-style waxing but takes pride in her ability to restore radiance in a variety of ways. Have your pores prettified during The Pure Skin facial, a 60-minute customized treatment that cleanses, tones, steams, and exfoliates, finished with a relaxing neck and shoulder massage ($85), or use this Groupon toward a more intensive 75-minute Ultrasonic Beautifying Facial geared to improve the appearance and health of mature skin ($115). Limb paddles are pampered during soothing and exfoliating hand and foot treatments, both of which include hydrating masks and luxurious massages ($35/hand, $45/foot). Unwanted hairs can be weeded from nearly any bodily zone with Renata's prided waxing treatments ($10?$65). The Pure Spa uses a combination of hard and soft waxes depending on the treatment area, ensuring proper precision and minimal discomfort.


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Crossing the gulf and things you forgot to bring aboard
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Re: Crossing the gulf and things you forgot to bring aboard
Originally Posted by
"We were on our last tank of water and it was full, we had just switched. "
If I may suggest, when you have at least two tanks of anything, the safest way to use them is to use only 1/2 of the first tank, then switch to #2. Now you use #2 up, but you've still got half of the first tank in reserve--instead of having one tank empty and zero reserve.
There are lots of oil platforms and other often unlit obstructions in parts of the Gulf, so you may want the night watch to keep especially alert, and of course to use sunglasses during the day in order to improve night vision.
Excellent suggesiton about switching water tanks. We had 3. (port, starboard, aft).
We had 2 radars, one at nav station and one at helm, so night navigation was fairly safe and always had two people in cockpit during night shifts, always used sunglasses during the day.
All went well, except for this small water incident. We could have refilled water near holbox next day but decided just to go home as quick as we could.
The hunter handled the fairly rough weather pretty well, was fast with the proper reefs and was very dry inside. I quite enjoyed "on-the-fly" main reefing (main is roller) and I'm quite happy with the performance compromise for the ease of handling. Was comfortable overall, if not for that water issue caused by human error.
Guero - Enjoy the little things!
Current boat: Hunter 410 2002 (Illusion) - Current Location: Marina Paraiso, Yucalpeten, Mexico.
Sold: 1975 Aloha 34 (Serenity)
Sold: 1982 Catalina 25 (Polaris)
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HOUSTON Two teachers, a principal and a superintendent were charged Monday in connection with a videotaped beating at a Houston charter school.
Sheri Lynn Davis, a 40-year-old former teacher at Jamie s House Charter School, is facing charges of injury to a child for her role in the incident.
Investigators said Davis backed 13-year-old Isaiah Reagins into a corner in a classroom and repeatedly punched and kicked him on April 29. Another student filmed the incident with a cell phone camera.
I think this is validation for Isaiah and his mother and the other kids, that there s been a cover-up all along, attorney Brant Stogner said.
Authorities said Davis snapped after Reagins reportedly laughed at a mentally challenged girl who was dancing.
In the video, Davis is seen beating Reagins for nearly a minute as laughter and applause are heard in the background.
Reagins mother said he suffered a black eye and other bruises in the attack.
Reagins mother filed a complaint with the Harris County Sheriff s Office on May 20, and an investigation was launched.
Davis was fired and publicly apologized for the attack.
But she was not alone. In addition to Davis, three other Jamie s House coworkers were charged in the incident Monday.
Teacher Gabriel Hahn Moseley, who was in the room at the time of the beating, is facing charges of failure to report abuse. He was also fired in the wake of the investigation.
School Principal David Jones and Superintendent Ollie Williams Hilliard were also charged with failure to report abuse.
Harris County Sheriff s Office Spokesperson Christina Garza said investigators hope to send a strong message with the charges.
The message that we want to send to people, regardless of where they work or who they are, is to report any type of incident -- especially one involving a student or child being beat or kicked or struck. Failure to do so is a crime, Garza said.
A spokesperson for Jamie s House said both Jones and Hilliard were shocked by the charges against them charges they believe are without merit.
Jones, Hilliard and Moseley could all face up to a year in jail if convicted.
Davis could face two to 10 years in prison.
All four have since bonded out as of Tuesday morning.


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|Half Baths
|Property type
|Minimum Stay
Ultimate Family Compound
5,000 Sq. Ft. Home on 56.6 Private Acres
2 acre pond with great bass fishing & skating in winter
Heated indoor pool (with child alert alarm)
Many trails throughout for hiking, snowmobile/quad riding, or cross country skiing
Central heat and air conditioning system
Large great room with Rumford stone fireplace/lower family room with stone fireplace
6 1/2 bathrooms(5 with heated floors)/ laundry room with 2 washers and dryers
2 Refrigerators and ovens in kitchen
2 Cedar decks overlooking pond
Auto start generator
Close to Lake Taghkanic and town of Hudson(antiques)
Less than an hour from Ski Mountains-Windham, Hunter, Jiminy Peak and Catamount
Family room has ping pong table, pool table and air hockey.
Our group rented this house for a week of relaxation and chamber-music making. We have been doing this for 10+ years, and arguably this is one of the best houses! It was clean and neat, the facilities were perfect, home was comfortable, and the grounds were gorgeous. The caretaker was very helpful as well.
Halfway through this vacation, our group decided that we would love to return. Highly recommended!
We stayed here to attend a rehearsal dinner and wedding in Hudson and Germantown the first weekend of September. There were several different families - some with kids, some not. There were 15 of us in total including young kids and babysitters. The house is so large that everyone had their own private space but then we could all commune for coffee in the morning and snacks and wine at the end of the day. Also even though some of the kids were up early, people sleeping were undisturbed because we were all spread out. The house is in a beautiful hidden grove and we saw wildlife coming and going every time we went out. It is decorated like a lodge and the furniture is very comfortable, beds were clean and had nice sheets and plenty of towels and linens in the laundry room. We all wished we could have stayed longer and had more time to sit on the deck and enjoy the view and use the grill. (FYI if you stay a while, there is more than enough room for food as there are two full size refrigerators.) Several of our friends were planning return trips either for retreats or for team building sessions. Although I did not use the pool, some of us did and enjoyed that very much. The pool is bigger than it appears in the picture. It's a lovely house and we all would definitely stay there again. There is good communication from the owners before and during the stay and I received my security deposit back within the time promised.
One note: You do need to bring your own pack and play or crib if you have very young children.
My friends and I (15 people in our early-mid 30s) rented this house for a weekend trip. After doing all the research, trying to find the perfect place for such a big group of adults, I was very excited to find this beautiful house. As the organizer, I made sure to arrive first and couldn't believe that the house was even more amazing in person than it seemed online. We enjoyed the property, the fire pit and enormous fireplace, the bbq grill and the giant open kitchen. All 15 of use were very comfortable with room to spare and we are already planning our return next year, the only difference being that we will stay for more nights.
Really great property. The grounds were green and ample. Small basketball court in the back. Indoor pool was refreshing as it was a really hot weekend. Would absolutely stay there again. Thanks!
Michelle C. MI, NJ, VT, MA for Remarkable Reunion & Family Birthday Celebration
Unbelievably beautiful and large, yet, charming rental property! Remote, but 20 minutes to cute towns (i.e. Hudson, Red Hook), conveniently located 45 minutes south of Albany airport, 2 1/2 hours-NJ & 3 1/2 hr.-VT. Estate is perfect for any occasion and is even more gorgeous & functional than pictures! Layout well thought out by owners! Home very clean, well-maintained & cozy! Setting is intimate & inspiring allowing for your vacation to be a relaxing retreat or action packed location (summer or winter!) Our Labor Day family reunion weekend was both because property is more incredible than we even imagined!
Layout quite spacious, large kitchen & table, great room and upper decks! Long upper deck could fit 3 tables & extra chairs if needed/rented. Owners thought of everything for extended family fun including tree spotlights for fire pit by lake! My family ages 3-77 enjoyed every minute with so much to do from large indoor swimming pool with alarm, air hockey, ping pong or pool table & big screen TVs! Outdoor fun: basketball court, fishing, rowboat, lawn games & hiking trails. Surprised fire pit area was not bugy at all! Dad's/Grandpa's birthday highlight, 2- mile mountain bike ride right on property w/ family who brought bikes! 14 slept in house, easily, w/ so many bathrooms! Some stayed at Red Hook/B&B or one 10-min. away from this Elizaville, NY area. 24 family members from 4 states wanted to spend time hanging out, playing games & not cooking dinner. Big chef's kitchen, convenient sizeable propane grill on lower deck area & kitchen well equipped w/ dishes, platters and utensils made entertaining easy! But what made it even more enjoyable was using JandJgourmet, an outstanding caterer & pricing based on quality & quantity from Red Hook 20 min. away! House was ideal for our active, competitive family! We'll cherish our memories created at your special vacation property! Weekend ended up being amazing & had power despite Irene storm in area week before! Glad to know has almost whole house generator, but happy not needed! Eddie, caretaker, is attentive.Thanks for your help & responses for me to plan a flawless family celebration! We hope to be back!
Highly recommend property: Family Celebrations, Reunions, Any Season for Group Getaway. *Great for all ages, as long as, can climb stairs up one level. Even had a child gate at top of stairs.
Twelve members of our family spent Presidents' weekend here last year and enjoyed it so much we had to come back this year with more. The house is amazing. It has a chef's kitchen that we totally needed since so many of us like to cook. Our group will include 4 generations this year ranging in age from infant to 83, including my adult children. Everyone had a great time last year and are looking forward to it again this year. The surroundings are so secluded and peaceful yet skiing and snowboarding is only about 30-40 minutes away. We hightly recommend it for family reunions.
Lake Taghkanic ~ fishing, hiking , canoeing, beach
Hudson, Red hook, Rhinebeck- Antiques and Restaurants
Less than an hour away:
Hyde Park and Culinary Institute
Skiing~Windham, Hunter, Jiminy Peak, Catamount


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To lose weight, achieving a healthy source of weight loss motivation is necessary. Read More »
Home » Tag Archives: self-development
Tag Archives: self-development
Book Review: A Princess and Her Garden: A Fable of Awakening and Arrival by Patricia R. Adson
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Book Review: Engaging Your Power: Using Your Divine Energy to Have the Life You Want by Mary Ann Robbat
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Joe Slattermill Central, WY
Joe Slattermill Central, WY
Lynne D. Green Detroit, MI Understanding Race Project – University of Michigan That's what we hear in America and I haven't seen any evidence of it yet!!!!
Matthew Duris Fresno, CA Race has no basis in biology I hope it's OK that I did a number of them, each one encapsulates a bite-sized chunk of the construct of the human mind that is race. Much like other constructs of the human mind, such as time and money, race both mesmerizes and beguiles […]