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The last person to die on New Year's Eve before the clock strikes twelve is doomed to take the reins of Death's chariot and work tirelessly collecting fresh souls for the next year. So says the legend that drives The Phantom Carriage (Körkarlen), directed by the father of Swedish cinema, Victor Sjöström (The Wind), about an alcoholic, abusive ne'er-do-well (Sjöström himself) who is shown the error of his ways and the pure-of-heart Salvation Army sister who believes in his redemption. Based on a novel by Nobel Prize winner Selma Lagerlöf, this extraordinarily rich and innovative silent classic (which inspired Ingmar Bergman to make movies) is a Dickensian ghost story and a deeply moving morality tale, as well as a showcase for groundbreaking special effects.
SPECIAL EDITION FEATURES • New digital transfer, restored in collaboration with the Archival Film Collections of the Swedish Film Institute • Two scores, one by acclaimed Swedish composer Matti Bye and the other by the experimental duo KTL • Audio commentary featuring film historian Casper Tybjerg • Interview with Ingmar Bergman excerpted from the 1981 documentary Victor Sjöström: A Portrait, by Gösta Werner • The Bergman Connection, an original visual essay by film historian and Bergman scholar Peter Cowie on The Phantom Carriage's influence on Bergman • New and improved English subtitle translation • PLUS: A booklet featuring an essay by screenwriter and filmmaker Paul Mayersberg • More!
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And they think there is no God. Such wonderful design like the human brain just happens to be.
"The FOOL said in their heart that there is no God."
"aww cram it, churchy"
To see a photo of the prototype chip, click below:
When I saw the title of the article, I thought it was about the iPhone.
Tech Europe covers Europe's technology leaders, their companies, and the people and industries that support them — and their ideas. The blog is edited by Ben Rooney, with contributions from The Wall Street Journal and Dow Jones Newswires.

subset: commoncrawl


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Tracy Gordon cherishes her time with her younger daughter, Lexi, who is in the final stages of Tay-Sachs disease.
- Filed Under
A new Bossier City nonprofit will bring comfort and hope to the family of a terminally ill Keithville toddler this week.
Pay it Forward Networking is making sure the world will remember Lexi Gordon. Lexi, 2, suffers from Tay-Sachs disease, an incurable genetic illness. The organization, founded in September, helps fulfill wishes for children with disabilities, special needs and serious illnesses. This afternoon volunteers and donors will deliver a special surprise to Lexi's home.
Thursday, Bossier City Mayor Lo Walker will proclaim March 30, 2014 Lexi Gordon Day. Lexi's birthday is ...


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- Age / Gender:
- n/a, Male
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- Location not disclosed
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- 9/16/07
- All Stats >
User Statshot
- Community Stats
Level 4 Blank Slate
Normal Whistle
Ranked as Civilian
Contact Info / Websites
Favorite Movies
COGS OF WAR 2 Rated 4.4110 Stars So many questions, so few answers. Comedy - Parody Kanzeni Marin Nitsuite Rated 4.2095 Stars All About Maryn...and Rabbit-san Comedy - Original B Cause of U (in Halo 2) Rated 4.1866 Stars A musical parody of Because of You by Kelly Clarkson about the horrors of Halo 2! Comedy - Parody WAV Fiesta Rated 2.8363 Stars Random .wav files; random animation Action
Favorite Games
Mad World Differences Rated 4.1768 Stars Spot the differences in this mad mad world. Puzzles - Difference The Pick of Destiny 2 Rated 4.3328 Stars Improved version of the original PoD with Tenacious D songs, and much more extras! Rhythm Hands of War RPG Rated 4.3593 Stars Choose your allies and enemies on your quest to find the broken pieces of the Heartstone Adventure - RPG Jasmine & Jacks Adventure Rated 3.9751 Stars A wonderfully cute spot the difference game. Guide Jasmine&Jack in an exciting adventure. Puzzles - Difference
Favorite Audio
|~The Girl From Memory Planet~
|Miscellaneous Song
|An Angel Falls
|Pop Song
|Here You Lay {=MMD=}
|Pop Song
|Newgrounds: Still Alive (BETA)
|Miscellaneous Song


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Sad that Shark Week is over? Use this shark-inspired soap!
Sharks aren't normally a species we feel sorry for (in fact we're quite terrified of them), but after reading more about the cruel practices being carried out against these marine creatures we're starting to feel (slightly) sympathetic. Did you know that tens of millions of sharks are killed every year for their fins? Help prevent this with Lush's limited-edition Shark Fin Soap, of which 100% of the proceeds will be donated to Shark Savers. Shark Savers is a non-profit organization dedicated to the protection and conservation of sharks. Made with softening seaweed, exfoliating sea salt, and zesty lime oil, this soap will leave you smelling good and feeling great!
Lush Shark Fin Soap, $5.95 for 3.5 oz


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|Current concepts in refractory migraine.
MedLine Citation:
|PMID: 23149624 Owner: NLM Status: PubMed-not-MEDLINE
|The Refractory or Intractable Migraine (RM) patient has long been a challenge to all healthcare providers (HCP). Headache specialists have recognized this sub group of patients who remain refractory to treatment. Despite this recognition, there are no formal criteria that characterize RM. This article will attempt to provide treatment approaches, some scientifically based and others that are empiric. A reasonable goal is to lessen disability. Combining the various modalities will improve the chances for successful treatment. The foundation of treatment is an emphasis on wellness. This includes optimizing mood, minimizing stress, practicing good sleep hygiene, and avoiding triggers. All comorbid factors should be addressed, including sleep and mood disorders, chronic neck pain, and obesity. Preventive treatment is necessary in the majority of patients, and a plan for "rescue" approaches is essential. Avoiding medication overuse, particularly narcotics, is advisable. Additional options for treatment include onabotulinumtoxinA, and more invasive modalities, such as neurostimulation. Adjunct treatment including supplements and relaxation may also be considered. Keeping a headache calendar is almost mandatory in management with attention to particular headache triggers, patterns and medication overuse (MOH). A trusting physician-patient relationship is also very important and will enhance compliance and foster communication. Patients often lapse from the management plan and the treating physician should be open minded about continuing care. RM is a long-term disease and requires close physician-patient interaction and cooperation for management of the problem. In those RM patients with multiple comorbidities, a multidisciplinary team should optimize management.
|Elliott Schulman; Brian E McGeeney
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Publication Detail:
|Type: Journal Article
Journal Detail:
|Title: Current treatment options in neurology Volume: 15 ISSN: 1092-8480 ISO Abbreviation: Curr Treat Options Neurol Publication Date: 2013 Feb
Date Detail:
|Created Date: 2013-01-24 Completed Date: 2013-01-25 Revised Date: 2013-07-25
Medline Journal Info:
|Nlm Unique ID: 9815940 Medline TA: Curr Treat Options Neurol Country: United States
Other Details:
|Languages: eng Pagination: 40-55 Citation Subset: -
|Lankenau Medical Center and Lankenau Institute for Medical Research, 100 Lancaster Avenue, Wynnewood, PA, 19096, USA, firstname.lastname@example.com.
Export Citation:
|APA/MLA Format Download EndNote Download BibTex
|MeSH Terms
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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Next Document: Improved growth media and culture techniques for genetic analysis and assessment of biomass utilizat...


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Wedding decorations, party supplies, home décor & craft supplies at 20-70% off. Save On Crafts brings you classic and trending fashions.
Bring a sense of calm and purity to your home, office, or dorm with this all-natural pillar. The Beeswax Candle is honey-hued and honey-scented, and burns clean and soot free. This glass tower will soothe your senses. For a lovely display, place this candle atop a wooden bureau, along with orchid plants. This piece is 8" tall, 18 ounces, and burns for 120 hours. The label reads, "Natural", which perfectly describes this piece.


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|Low molecular weight antioxidants released from the skin's epidermal layers: an age dependent phenomenon in the rat.
MedLine Citation:
|PMID: 14724066 Owner: NLM Status: MEDLINE
|Skin is one of the tissues most exposed to oxidative stress both from endogenous and exogenous sources. Therefore, it can be speculated that skin possesses an extremely efficient antioxidant defense mechanism, particularly in its epidermal layers. The present study shows that human and rat skins possess different and unique reducing antioxidant profiles. These reducing antioxidants can be washed out into the surrounding environment. Non-invasive measurements indicated that skin releases low molecular weight antioxidants (LMWA) from its epidermal layers. Cyclic voltammetry measurements have shown that rat skin releases three major groups of reducing antioxidants at peak potentials of 476 and 889 and 1044 mV while human skin releases two major groups at peak potentials of 779 and 1068 mV. In rat, the overall concentrations of the LMWA secreted decreased significantly with age. The major components of the LMWA composing the first anodic wave in rats were identified as uric acid and ascorbic acid. Uric acid and other as yet uncharacterized LMWA, but not ascorbic acid, were released in human skin. Differences in the ability to release high levels of uric acid among species were well correlated with their metabolic rates. It is suggested that in rat the released LMWA may serve as a possible marker for aging of the skin.
|Ron Kohen; Miriam Oron; Abraham Zelkowicz; Ester Kanevsky; Sharon Farfouri; Uri Wormser
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Publication Detail:
|Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't
Journal Detail:
|Title: Experimental gerontology Volume: 39 ISSN: 0531-5565 ISO Abbreviation: Exp. Gerontol. Publication Date: 2004 Jan
Date Detail:
|Created Date: 2004-01-15 Completed Date: 2004-05-21 Revised Date: 2006-11-15
Medline Journal Info:
|Nlm Unique ID: 0047061 Medline TA: Exp Gerontol Country: England
Other Details:
|Languages: eng Pagination: 67-72 Citation Subset: IM
|Department of Pharmaceutics, School of Pharmacy, The Hebrew University of Jerusalem, Jerusalem, Israel. email@example.com
Export Citation:
|APA/MLA Format Download EndNote Download BibTex
|MeSH Terms
Aging / physiology*
Antioxidants / analysis*
Ascorbic Acid / analysis
Chromatography, High Pressure Liquid / methods
Epidermis / secretion*
Molecular Weight
Oxidative Stress
Species Specificity
Uric Acid / analysis
Reg. No./Substance:
|0/Antioxidants; 50-81-7/Ascorbic Acid; 69-93-2/Uric Acid
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Study of factors influencing the decreased HDL associated PON1 activity with aging.
Next Document: Aging of innate immunity: functional comparisons of NK/LAK cells obtained from bulk cultures of youn...


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You Don't Always Know What You Think You Know
By Alan Scherstuhl
Daniel Radcliffe'll Never do a Rom-Com With Emma Watson
By Amy Nicholson
Film Critics Need to Learn to Look and Enjoy
By Charles Taylor
Robin Williams Could Always Find the Raw Seriousness in...
By Stephanie Zacharek
By Brian Feinzimer
The Purge: Anarchy Sets Up Frank Grillo to Finally Be...
By CAROLINA DEL BUSTO
Anna Kendrick Had Her Heart Broken by a Hot Dog
By AMY NICHOLSON
Richard Linklater Explains His Secret Movie Boyhood
By Amy Nicholson
Efron is, to put it mildly, the least of the movie's problems. Nuance may not be his strong suit, and he never gives himself over to the part physically, the way Jamie Lee Curtis did as the girl-woman of Freaky Friday, but he plays most of the big moments well enough (verbally cutting down a bully in the cafeteria, preaching abstinence in a sex-ed class) and seems altogether more at ease than he does doing 1930s dress-up in Richard Linklater's forthcoming Me and Orson Welles. But if this is one small step for the actor toward becoming a leading man, it is, for Hollywood movies, one more giant leap into infantilism.
17 Again was directed by Burr Steers; written by Jason Filardi; and stars Zac Efron, Matthew Perry, Leslie Mann and Thomas Lennon. Countywide.
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November 1, 2011
The ASV Guidelines in Real Life: The Foster On-Deck System
This system developed by the Animal Rescue League of Boston allows for the immediate transfer of young kittens to their foster families—while still making sure they get the necessary screenings and care.
September 1, 2011
Clinical Trials
Shelters that have expanded their mission to add nonprofit veterinary hospitals find that it's a great way to increase revenue, save sick or injured animals who might otherwise have been euthanized, and make quality vet care affordable for low-income clients. For some shelters, the effect has been transformational, turning around their financial outlook, and changing their perception of themselves in the process.
September 1, 2011
For Goodness' Snake
Many snake owners fall in love with the small creatures they see in the pet store but are unprepared to care for the adults. Our guide will help you adequately care for and house the snakes that end up in your charge.
September 1, 2011
The ASV Guidelines in Real Life: Taking Them In
What happens—or doesn't happen—when an animal enters a shelter can affect an individual pet's ultimate outcome, as well as impact the health of an entire shelter population.
September 1, 2011
Shelter Medicine: Meow ... Cat Chow!
What goes into the food bowl profoundly impacts animal health; it's essential for management of body weight and condition, and good nutrition also supports immune function. Here's a guide to help you keep your cats well-fed, trim, and healthy.
September 1, 2011
The "101" Department: Start Spreading the News
Pets for Life NYC, an animal surrender prevention program, seeks to give people the advice and services they need before they relinquish their pets to shelters. Find out how to create a similar pet safety net in your community.
July 1, 2011
Coffee Break: Your Favorite Cat Programs
In your space, you tell us about some of your favorite programs to help cats???everything from partnering with a local hockey team to a community operation (pun intended) that???s sterilized 250 cats in a single day.
July 1, 2011
Mouthpieces: Declawing: It's Not Like a Trip to the Spa
In this issue, Mouthpieces aims to give people the facts about declawing and offers kinder alternatives to this inhumane procedure.
July 1, 2011
Behavior Department: Kitty in Their Hands
Fledgling fosterers have a lot to learn before embarking on their first kitty-mentoring adventure. In this article, veteran fosterers offer their advice -- and their practical knowledge and experiences are worth their weight in kitten chow.
July 1, 2011
The ASV Guidelines in Real Life
The Austin Humane Society is one of several shelters that have started a hand-feeding, enrichment, and training program for adoptable dogs. The results are easy to see: a kennel that's a pleasant environment for both people and pets.


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Prana Flow Teacher Directory
Name: Bethany Orheim
Location: San Diego, CA
Studio(s): OB Namaste + Yoga One San Diego
Bethany brings incredible love, passion, and healing energy into every class. She gracefully invites her students to treat each asana as a mudra, and to find balance between intense strength and complete surrender, while remaining open to the limitless possibilities of prana flow within the mind and body. Bethany honors the teachings of Prana by allowing the intelligence of breath to intuitively guide the movements of the body. Rather than focussing on outward performance or appearance, when we open to pure consciousness, the creative energy flows through us in the most natural way. When we embody the flow, we relearn our instinctual nature and reconnect with the source...


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I don't understand why <you-know-who> keeps coming back, nor why AI allows him back. After close to 6500 posts of trivial provocation one would think this problem would get reconciled.
Any forum has its contentious members, but I have never seen anyone so persistent or oblivious to correction. I enjoy when people more informed than myself answer arcane questions about wireless technology or software development, but I fear some of them have given up here because of the endless trolling. Slashdot has been held up as the example of a lost cause for technical discussion. Only with diligence can other sites not fall into that same category.


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Almost 10 years ago, as the industry was starting to adopt model-based OPC and other resolution enhancing techniques on a large scale, the ITRS got out its looking glass and saw an "explosion" in the size of the files used to describe chip layouts. As a result, a group of industry companies collaborated to create a SEMI spec for the OASIS format for layout data. The format was officially approved by SEMI in late 2005.
In 2006, Peggy Aycinena did a nice interview/article called "Midnight at the Oasis" on EDA Cafe (link to article). She interviewed a number of experts from industry, including Tom Grebinski and Mentor's own Steffen Schulze, Dir. of Marketing for Calibre's Mask Data Prep solutions. One of the interesting questions in that interview was about the shelf life of OASIS — how long would it last? Interestingly, the panel guessed "Yes, 10 years … until 2011, at least". Now that it is 2011, it is even more interesting to see that OASIS has really been adopted as a standard only in the last few years and is still gaining speed. Definitely, we've moved from "midnight" to "dawn", and we can expect to see OASIS start pushing back from the manufacturing areas where it has become dominant into the design areas where data size is swiftly becoming a problem.
There are many reasons why it has taken as long to really start adopting OASIS as the original panelists thought the format would last. As pointed out in James A. Rodger's paper on diffusion of software innovation (see link), how innovations fit into organizational structures and processes can be as important or more important to adoption than the direct benefits of the innovation. My colleagues and I took a look at the actual adoption curve of OASIS in the industry and the forces affecting its adoption. The original paper was presented at the 2010 European Mask Conference in Grenoble, available online from the SPIE, and a general audience article was published on the DAC Knowledge Center. If you are interested in how OASIS has been adopted in the industry or in the diffusion of innovations in general, I encourage you to take a look.
The bottom line is that OASIS has become the de facto standard for post-TO layout files in the most advanced nodes and is rapidly moving back up the design flow. When your full chip GDSII is 30+Gb and the OASIS is 1Gb, you save a huge amount of time by not having to move those extra 29Gb in and out of your tools every day. Today, the leading edge chips are much bigger than 30Gb GDSII and OASIS really saves the day. Eventually, design flows will have to deal with OASIS even earlier in the design flow.
adoption, diffusion of innovation, GDSII, OASIS, OPC, RET, tape-out


text: The Grossman Law Firm, A.P.C. helps clients protect their rightful interests to a California estate or trust. Our office will pursue legal action against trustees, administrators, or executors, and we will handle other trust and probate litigation matters in the Temecula probate court. To learn more about the probate of an estate and administration of a trust in California, view our free guides The Insider's Guide to California Probate and Trust Administration and Probate a Will or Administer a Trust After the Death of a Loved One. If you suspect that your rights are not being protected, The Ultimate Guide to California Trust and Probate Litigation provides further information.


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Oct 15, 2014
NFL coaches would rather face Peyton Manning than Colin Kaepernick.
Courtesy of USA Today Share this image: (AP) With Peyton Manning and Colin Kaepernick stepping under center this week on Sunday Night Football, you might be surprised by which quarterback is more feared by NFL coaches. Via Andy Benoit of The MMQB: At last year's combine, just a few weeks after the Super Bowl, I asked a dozen NFL coaches, Conceptually, who would you rather game-plan for and face: Manning or Kaepernick? A solid majority said they'd prefer to face Manning. ...
Sep 25, 2014
Tough Start, But We Aren't Worried
We are 1-2 to start the season, with two tough losses. But we aren't worried because Colin gets his patience from his pet turtle, Sammy. You can follow Sammy on twitter here: https://twitter.com/SammyKaep7
Aug 27, 2014
Sweet Jesus You Are Sexy in the New Sports Illustrated
Colin Kaepernick will be appearing on this week's Sports Illustrated cover. My man crush just reached a new level. He is JACKED. And judging by his abs, he's ready to get the 2014 season started. Good thing Russell Wilson has his rib protectors on.
Jul 08, 2014
A New Tattoo - Money is the root of all evil
SF 49ers quarterback Colin Kaepernick -- who just signed a $126 MILLION contract -- just got a brand new tattoo that symbolizes how EVIL money can be. Kaepernick just posted a photo of his new ink on Instagram ... which shows a pile of money attached at the root of a tree ... with an arm, constricted by a snake, reaching up while holding an apple. The image appears to be biblical in nature -- with the snake and apple representing the evil temptation in the Garden of Eden from the story of Adam and Eve. Colin included a caption with the photo...
Jun 11, 2014
"I'll take 14 million tattoos with my new contract"
Show me the money! It was announced today that our favorite quarterback just signed a $126 million dollar contract extension. We are now assured that our star QB will be in San Francisco for the long term. Hurray! And in case you are doing the math, he can purchase 14,000,000 of his temporary tattoos with the value of his contract.
Jan 20, 2014
One Inch Away from the Super Bowl
Classy Classless
Jan 07, 2014
Colin Kaepernick doesn't wear sleeves in subzero temperatures
Kaepernick bares arms, tats, toughness for victory via SFGate The statement was made more than an hour before kickoff, when Colin Kaepernick ran onto the barren brown turf at Lambeau Field for pregame warm-ups. No sleeves. No gloves. The tattoos were on full display in the ice-cold weather. "I asked him if he was sure he didn't want to go to sleeves," a giddy, ebullient Jim Harbaugh said after the 49ers pulled off a thrilling 23-20 win over Green Bay. "He said no, he'd played in colder." That might or might not be true. It was incredibly, historically cold Sunday afternoon at Lambeau Field, the coldest game in...
Dec 13, 2013
Colin Stars in New "Beats by Dre" Commercial - Seahawks Fans Boycott
Beats by Dre just released a new advertising campaign starring #7. It's an amazing commercial, especially the close-up of his Endzone Scroll tattoo at the 2:34 mark. It makes you want to jump out of bed in the morning, put on your Kaepertats, and conquer the world! With a commercial this cool, there's no way the She-Hawks fans follow-through on their planned boycott of these headphones in the Seattle area. Poor life decision on the part of our opponents up north.
Oct 28, 2013
KeaperTats on Display in London
Four teams and approximately 600 tattoos made the trek across the pond to London for games this season. No team traveled farther than San Francisco, whose 5,000-plus-mile trip through eight time zones could have thrown a serious jet lag monkeywrench into the streaking team. And no tattoos were under more scrutiny in front of 83,559 screaming Brits than our favorite quarterback. Instead, cool-as-a-cucumber QB7 led a 42-10 charge through Jacksonville at Wembley Stadium. Displaying a liberal dose of the pistol offense, QB7's dynamic abilities were unleashed as he ran for two touchdowns, threw for one more and ultimately conquered an...
Aug 29, 2013
Cover of GQ. So Hot Right Now.
He's the backup who took his team to the Super Bowl, the football player with the 95-mph fastball, the guy who ran roughshod over defenses last season but was coached in high school to never run the ball at all. In other words, the most unpredictable and least understood elite QB in the league right nowhttp://www.gq.com/entertainment/sports/201309/colin-kaepernick-cover-september-2013#ixzz2dQZCc4YJ


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Hi everyone,
New to the forum, and relatively new to Japanese Nostalgic Cars. I did a mini-resto/cleanup to an AW11 2 years ago, but I'm not sure they're old enough to qualify?
Anyways, my next project is a '77 Celica GT:
Bought from the original owner!!! It has approximately 150K miles, and runs, albeit with a blown headgasket. Some rust under the home respray, but not bad considering how prone to rust these cars are!
Plan is:
1.) Fix headgasket and drive for a month or two to shake out any other problems
2.) Strip paint and respray
3.) Update (actually backdate) bumpers to smileys
4.) Possible 7MGE swap in place of the stock 20R


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Let's see. One page of the Pioneer Press potentially contains six columns, each column holds 150 lines of print or a total of approximately 900 lines. On July 16, the Pioneer Press wrote the Congressional Budget Office had announced federal spending for health care would be reduced, and attributed the savings to the implementation of the Affordable Care Act. As projected by the CBO, 10-year savings are estimated at $1.23 trillion. By 2034, savings would be $250 billion a year. The Pioneer Press hid this article on page nine and could muster only 28 lines of one column to share this success of the ACA. This is consistent with the unfair treatment the ACA has received by the Pioneer Press.
Pete Boelter, North Branch
Government displacing deity
The July 13 commentary regarding the "evolving" dismissal of faith and religion in America should alarm every Christian -- indeed, every person of faith in America ("The anti-democratic dismissal of religion's significance"). Government is attempting to displace deity in our system and society.
The author quotes a senator from Massachusetts: "I cannot believe that we live in a world where (we) would even consider letting some big corporation deny the women who work for it access to the basic medical treatments or prescriptions that they need based on vague moral objections."
By calling the specific moral objections "vague," the senator crafts a view of religion as insignificant.
Let's expand our protection of the practicing of our faiths, so people can develop a sound moral code, make better and better decisions and improve the world for the good of all.
Jeff Pelletier, Inver Grove Heights
The same opportunity
Thanks for detailing the efforts in St. Paul and other metro school districts to include children in general education classrooms and give them the services to help them thrive ("Classrooms, interventions and tradeoffs," July 17). Speaking for my son with Down syndrome, I also urge our educators not only to include our students in classrooms but to prepare them for the outside world.
Many students with disabilities are merely getting by and not being offered the same educational experiences as students without disabilities. Needed changes include teaching core subjects to students with disabilities (not just life skills) as well as funding for teachers to have proper support and training for each ability level.
Unemployment for people with disabilities is twice as high as those without. Until we ensure that students receiving special education services have the same educational opportunity as the "typical" student, they won't be ready for life outside the classroom, and their rate of unemployment will never decrease.
Leslie R. Sieleni, White Bear Lake
Minutes, not years
The expression most often heard relating to the rating of a president's term is "History will judge this president's performance."
That can't be true of all presidents' time in office. Specifically, how about our present president, Barack Obama? It absolutely cannot take 40 to 50 years to rate Obama. How about 40 to 50 minutes?
Unless you live in a constant state of un-awareness, or are only interested in government handouts (freebies), you must be aware of the "legacy" of Obama.
No jobs, the IRS scandal, the Benghazi scandal, the Obamacare debacle, aliens flooding the country, debt, mistrust of our former allies, continuous fundraising, days spend golfing or on vacation and the lies. I'm sure I've missed plenty, but that only took 40 seconds.
I don't care what the historians say, there is no way you can change or alter the pathetic job Obama has done or the damage inflicted on this country.
Jim Fregeau, Lindstrom


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MARSHFIELD — Thanks to a new way for cleaning stainless steel at Felker Brothers Marshfield manufacturing facility, the company will stop producing about 10 tons of hazardous waste a year.
The process, called pickling, uses a mixture of water, hydrofluoric acid and nitric acid that cleans and passivates the stainless steel the company manufactures, which helps makes the metal resistant to rust and oxidation.
However, during the process, tiny metal particles will fall off the stainless steel.
When these metal compounds were disposed of, it had to be classified as hazardous waste because they could potentially leech into the soil and contaminate groundwater, said Carol Willfahrt, the human resource manager at Felker Brothers.
But thanks to a 2008 expansion project, the company is not only able to push more stainless steel through the pickling process, but is environmentally friendly thanks to three key improvements.
First, in addition to a bigger tank, the company had installed inductors to the bottom that help circulate the acid and water mixture.
We can lower the temperature of the solution by about 15 degrees, which also helps save energy, but we dont have to add as much acid in the tank. Instead of having the 3 percent of hydrofluoric acid and the 10 percent of nitric acid, we can knock that down to 2 percent (hydrofluoric acid) and 8 to 9 percent (nitric acid), and it would do the same thing, said Liz Nagel, the safety supervisor at the Marshfield plant. Thats a substantial amount of acid, even though it only sounds like a little.
Second, a new acid purification unit constantly circulates the solution, removing the small metal compounds that fall off the stainless steel while it undergoes the pickling process.
If the manufacturing facility were to lose power, the temperature of the solution would begin to decline, and if there was an abundance of metal compounds present, they would fall to the bottom of the tank. If that were to happen, the entire tank would have to be emptied, the metal would have to be removed, and the tank would have to be refilled, which is about a 16-hour process, Nagel said.
When the metal compounds are removed, they are mixed into a lime slurry, and then compressed to remove excess water. This lime slurry is what make the process free of hazardous waste.
The lime binds the metals together, it holds them so they cant leech out of the sludge, Nagel said. Before, we used caustic soda and the bond there is not as tight, so the metals would be able to leech out into the environment. Thats why it was considered a hazardous waste before.
The last addition to the pickling process was the installation of a new air scrubbing system, which removes the requirement for those operating the system to wear a respirator.
The fumes get sucked trough this scrubber that has a bunch of plastic balls in there that will catch different particles. Then there is caustic that will blow down on the acid fumes to neutralize it. Then, that clean air will get shot out into the atmosphere, Nagel said.
The immersion pickling process is not common, Willfahrt said, with Felker Brothers being one of the few companies in the United States that does it.
One reason; the whole process is extremely expensive, Nagel said.
With pickling, you have to add the acid on a weekly basis, she said. Right there you are talking a few thousand dollars each week. Its very expensive when you are talking about chemicals and the waste treatment.
But the added corrosion prevention that pickling provides is worth the investment.
When I started here over 25 years ago, I had someone make me stainless steel clothesline poles. They look exactly like they did 25 years ago, Willfahrt said.


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The Street of the Gamblers, Chinatown, San Francisco
This is Ross Alley from Jackson street in San Francisco's Chinatown. As evidenced by the traditional papier-mâché garlands hanging above the doorway on the building to the right, this photograph was taken around New Year's, when seasonal workers were laid off, inundating Chinatown streets with thousands of idle workers.
- Date:
- 1901 circa 5 years
- Original Format:
- Photographic Print
- Item#:
- 1890.0284
- Photographer:
- Arnold Genthe
- Height:
- 2711px
- Width:
- 2174px
- download hi-res watermarked image
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Bates backs gun gelding to deliver knockout punch
- From: NT News
- July 10, 2014
MASTER horseman David Bates has never pulled any punches when it comes to his accurate assessments of his stable and he has no plans to start today.
Bates has one runner in the feature event at Fannie Bay today, the $56,000 Asian United Food Service Chief Minister's Cup (1600m) and it accurately sums up his long and successful career in the racing industry.
Pull No Punches, with in-form jockey Melanie Tyndall on board, is one of the outsiders for the second of the feature races of this year's Darwin Cup Carnival.
But that does not mean Darwin's 19-times premier jockey, who suffered serious head injuries on Palmerston Sprint Day almost five years ago, has given up on the six-year-old gelding.
"I have been really happy with the horse," Bates said.
"The only hiccup so far is that he was interfered with in the ROANT Cup.
"That's the grey area.
"I don't have any idea whether it was a good run in the making or it was the bad run that it turned out to be."
Pull No Punches finished 11th of 12 in the ROANT, leaving Bates in a dilemma.
"We are going into the Chief Minister's wondering if we are on the right track or not," he said.
"The horse is very well. He has done everything right."
Pull No Punches, formerly trained by Rick Hore-Lacy in Victoria, has finished in the prizemoney 34 times in his 51 starts, winning seven. "He has a good record over a mile without winning too many over the distance," Bates said.
His plan for Pull No Punches is the Metric Mile on July 26 into the Darwin Cup and then back to leading South Australian trainer Phillip Stokes in Adelaide.
As a jockey, Bates won the 1989 Darwin Cup on Brinney and saluted again on McJoey in 2001. He was also in the saddle and trained Lanson to victory in 2005.
He is hoping Pull No Punches can help him achieve that dream of training another 2000m Cup champion.
''It really is something I want to do now,'' he said.


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A Tour of the Solar System
See more videos
Jean Creighton, Director
Physics Building 150
1900 E Kenwood Blvd
Milwaukee, WI 53211
Special Events – Review: 100 Telescopes in the Park
A Celebration of the International Year of Astronomy
September 25 and 26, 2009
Four hundred years ago, on some warm autumn nights in Italy, Galileo Galilei first turned his telescope toward the heavens. What he saw astounded not only him, but people around the world. In celebration of this milestone in our collective history a group of local astronomers collaborated to organize a special event for September 25 and 26 called 100 Telescopes in the Park. Planetariums, astronomy clubs, and stellar enthusiasts across Southeast Wisconsin joined together with the intent of bringing together 100 people with telescopes. They would turn their scopes to the heavens just as Galileo did, and see many of the things he himself saw—such as the rocky craters on the Moon and Jupiter with four of its moons. Attendees were encouraged to bring their telescopes to the Telescope Clinic, where experts answered their questions and advised them on how to use their instrument to its maximum potential.
Stargazing, however, is dependent on the weather conditions. Weeks of beautiful weather changed abruptly just as the weekend of September 25 and 26 approached, leaving us worried that this long-anticipated event would be rained out. The night of Friday, September 25 saw nothing but rain and cloudy skies; nevertheless, six people showed up with their telescopes for the Telescope Clinic from 6 to 7 p.m.
As the next day rolled around, everyone waited eagerly to see how the weather would evolve. To our relief the night drew on without rain and forecasts showing waning clouds. By the time the Telescope Clinic started the sky was mostly clear with the first quarter Moon visible. More and more people began to arrive until the northwest end of the field was filled with telescopes and heads alike turned upwards towards the sky.
|Attendees setting up their telescopes. By the end of the night there were more than 100 on the field. Photo by Steven Meaney.
Besides the always enchanting Moon, stargazers enjoyed Jupiter and its moons, with Io casting a shadow on Jupiter for much of the evening. Planetary nebula, star clusters and even galaxies became objects of fascination among the crowds. Staff from the Manfred Olson Planetarium enjoyed seeing the Andromeda Galaxy, the Hercules globular star cluster, and Albireo, a binary star system in the constellation Cygnus.
|Two of the Planetarium's telescopes set up at 100 Telescopes in the Park: AstroScan (left) and Meade 10" (right). Photos by Steven Meaney.
|Photo of the Moon taken by Planetarium staff member Steven Meaney through the AstroScan telescope.
In addition were several activities for visitors to participate in. Starlight Scavenger Hunt cards were provided for those curious to explore all the things visible in the night sky. Todd Dezeeuw of the Sampson Planetarium showed people how to make "star wheels" out of old CDs, while Vivian Hoette from Yerkes Observatory spent the entire night helping visitors put together their very own Galileoscopes, which are telescopes similar to the ones used by Galileo (information and kits can be found at www.galileoscope.org). By the end of the evening nine happy families had completed their Galileoscopes, one of which fittingly became the last officially registered telescope brought onto the field.
The main goals of 100 Telescopes in the Park—bringing together 100 telescopes and recreating the wonder and excitement of gazing at the night sky just as Galileo did—were successfully achieved. This event also provided astronomical organizations to strengthen their ties to one another. Plus—it was a lot of fun!


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good archaeological sites in Qatar
Just read this in penny -
Qatar to help Yemen in archaeological excavations - Seriously??? How bad are the Yemeni at looking after them. There is a real lack of protection, information at such sites in Qatar so perhaps they should try and sort ot their own back yard first - literally! All i see are sign posts with bullet holes in them - no info or anything. Even the museum on the corniche is in need of serious improvement, and lets not mention Al Zubarra fort!!!!


text:
Rx Bandits' Proggier New Prescription
By Adam Lovinus
Ska Superheroes The Aquabats! Turn 20
By Lilledeshan Bose
Hip-Hop's Effect on Gentrification in SanTana
By Gabriel San Roman
Suicide Silence Goes On After Singer Death
By Rachel Mattice
50 Years On, A Hard Day's Night Is Still Revelatory
By Stephanie Zacharek
Animals as Leaders are the Pride of the Prog Metal Pack
By Daniel Kohn
Rikk Agnew: Adolescent No More
By Nate Jackson
The 10 Biggest Douchebags in Country Music
By Mike Seeley
Photo by James BunoanThe Sharp Ease/Squeak Toy
Que Sera, Long Beach
Saturday, May 4
The Sharp Ease have been playing all our favorite rock & roll shit holes forever now—the Smell, the Ruptured Intestine, the Illegal Teenage Firetrap—but our paths never crossed until we hit Que Sera's new club, C*U*R*V*E. ("Support women in music; support women; support," says their motto—so hop to it, people!). We came in on the tail end of a downer song, one of those meandering Sleater-Kinney slow jams that'll punch a happening party right in the stomach, but by the time we'd made a wary circle around the bar, the Sharp Ease perked right back up. Why had we missed them before, we asked? Because we are stupid: the Sharp Ease are the pinch in the ass pop has been begging for around here. Girls formerly among the Grown-Ups (who did "Nick and Nick" on a Sympathy for the Record Industry compilation) and the Chubbies (the real All-Girl Summer Fun Band, despite what K Records will tell you) make it all make sense: between the supersweet backing vocals peeking over the big-fuzz guitar choruses and singer Paloma's front-stage car-wreck charisma, you're in love—or at least plotting mix tapes for somebody. Sure, we could see some people—cold, unfeeling, boring people—getting a little shy about the Sharp Ease, since they take the craziness bands like the Pixies worked so hard to submerge and slop it out all over the front row, a little of it in the sharp guitar lines, and a lot of it in Paloma's, um, stage presence. Over the top? Fuck, she hasn't touched back down yet: rolling across the stage, spinning her eyes around, making finger-pistols at the crowd, emoting like she was gonna take a high school performance of Lady Macbeth all the way to the Oscars or die trying ("Anything worth waiting for will never, ever come!"), and working that room so fiercely the back of her boa-constrictor-tight pants split right open, flashing bright yellow-leopard print at everybody. Embarrassing? Fuck, no! Embarrassment is for people who don't have the guts to get onstage. This is what we call fun. "They're trying to get me to play keyboards," she told us later, letting her energy ebb, "but I don't wanna do it." Exactly: stay mobile, we said. It suits you.
We got a little worried when the slavering kitsch orgy that is Long Beach's Squeak Toy marched on next. If they took themselves seriously, they'd be hard not to hate: they're the kind of band that has to interrupt practice every five minutes to go, "No, no—let's put the polka part AFTER the lounge part! And then play like two seconds of the Hawaii Five-0 theme song! And then you can put on your yarmulke and have a breakdown!" Geeks, man, total geeks—and not the self-possessed Poindexter-come-lately kind, not the secretly cool dude-in-dork's-clothing kind, but the full-on bad-movie-worshiping, Halloween-costumes-all-year-round, four-years-of-high-school-band-and-three-years-of-sci-fi-book-club, John-Waters-shoulda-been-my-gay-dad GEEKS (even though we don't like John Waters—he doesn't know how to party anymore!). They're either really fun at parties or they make everyone clench up, back-alley-proctological-exam-style, but tonight, they were as charming as they were disarming. "He played his bass like he played his penis!" winked delightful keyboardist/singer Linda (we think), and aw, you gotta smile at that. She had a great hapless how-do-these-things-happen-to-me? way of making sure all of us were in on the jokes she'd be singing about: "This is a true story," she'd trill, "as all of them are, and this one happened to me, as stories tend to do!" The Gilda Radner shtick worked great for Gilda Radner, and Squeak Toy Linda keeps it going—and tag-teamed with a sax-keys-drums-bass-and-dancing-yarmulke-girl backline, it's definitely, um, unique! It's hard to tell what part of our brain we should have been using—once they got out the fake pistol, we felt like we were at a typically avant-trashy Hunger Artists play (kids, get in touch with one another—we found your new house band!) instead of a rock & roll show, which is probably what Squeak Toy likes to hear. And then when they all fake-died at the end of one song, wilting to the stage as the lights faded out (and prompting wandering Paloma to shout, "Rebirth! Rebirth!"), we didn't know where we were anymore. But it was dark, and we were laughing. That's good, right? (Chris Ziegler)
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Fort Collins' Ryan French, 5, fights for a rebound with Rock Canyon's Drew Dodd, 21, and another Rock Canyon player, during first-round action between the Lambkins and the Jaguars in Fort Collins on Wednesday. / V. Richard Haro/The Coloradoan
Rock Canyon - Peterson 13, Lombard 9, Garcia 15, Andrews 6, White 7, Noyes 2, Lamb 2, Hirsch 3. Totals - 18 10-10 57.Fort Collins - Thurgood 18, Duggan 4, French 14, Von Nieda 7, Van Ry 21, Deeter 3, Hunt 2. Totals - 22 17-25 69.
|Rock Canyon
| 57
|Fort Collins
| 69
The Fort Collins High School boys basketball team was pass happy Wednesday night.
In the fifth-seeded Lambkins Class 5A Boys Basketball Championships opening-round game against No. 12 Rock Canyon, good passing and a healthy dose of inside dominance secured a 69-57 Fort Collins win and a free pass to the other side of the Rockies. Fourth-seeded Grand Junction awaits the Lambkins on Saturday.
We passed the ball really well, Fort Collins swingman Ryan French said. Getting those turnovers and trying to get some fastbreak points really allows us to get a cushion.
That cushion went as high as 19 points late in the fourth quarter for the 15-9 Lambkins, but the Jaguars (6-18) still had a run in them late.
When we come down the stretch, missed free throws or turn it over and have empty possessions, good teams are gonna come back and hit those shots to make it closer, French said. Im just glad we were able to pull out the win.
Junior point guard Will Duggan had a big hand in the Lambkins pulling out the win. Although he scored just two points, Duggan contributed much more than that with eight assists. After a game full of assists, Duggan dished praise to his teammates.
I can pass it as much as I want, but if these guys dont finish, its on me, Duggan said. These guys make the plays for me, its all them.
French, who finished with 14, had the final points of the game, as he intercepted a pass and raced down court for a layup and the subsequent free throw after being fouled. His relief was in stark contrast to Rock Canyon coach Kent Grams frustration after the game.
The physicality of the game was the difference in the game, said Grams, who was upset his team didnt respond to the Lambkins runs throughout the game.
The Jaguars were doing well to keep the margin within 10 at halftime, considering they were outrebounded 15-3 in the first half and 33-13 in the game.
Toby Van Ry led the Lambkins with 10 boards, which paired nicely with his game-high 21 points. A 6-foot-8 junior center, Van Ry stepped out of the paint when needed as well, hitting two 3-pointers in the third quarter. Chase Thurgood had three in the third quarter as the Lambkins went 5-of-7 from the 3-point line.
Grams said it was a big turning point, considering his team limited the Lambkins to just two shots inside the arc. Van Ry said he and Thurgood fed off each other.
You just get that confidence going and you can hit those outside shots, Van Ry said. Once you hit one, you get rolling, and your teammates start feeding off of you. Its fun to play like that.
For the Lambkins to keep rolling, Grams said theyll need to lean on Duggan.
I think Duggan is the key to their success, Grams said. The way he pushes, and the way he sees the floor some of the passes he made were unbelievable. If he keeps playing like that, and they keep hitting the outside shots theyve got the inside to be able to bang with anybody. I wish them the best of luck.
Despite his small stature, Duggan seemed more than willing to shoulder the burden.
The balls going to be in my hands a lot, Duggan said. So, if I can limit the turnovers, we can make a pretty good run, and thats our goal.


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Pizza on the BBQ
PIZZA ON THE BBQ - This is a great family dinner event or for entertaining a group of friends - everyone can make their own pizza with what they like on top - kids especially love to make their own.
Pizza Dough - Makes 12-14 8" individual pizzas - Approximate time: 1-1/2 hours
(you can use a frozen bread loaf for two 8" pizzas if you don't want to make your own dough - just adjust your timing to allow the dough to thaw and rise)
2 packages active dry yeast (about 2 tablespoons of yeast)
3 cups of warm water - not hot water or it will kill your yeast -
1 tablespoon plus 1-1/2 teaspoons of granulated sugar
1 tablespoon of kosher salt
3 tablespoons olive oil
8 cups unbleached flour - approximately - depending on the weather it may take more or less
To make dough: In a large bowl, dissolve yeast in warm water with all the sugar and mix well. Set aside until you see bubbles appearing in the mix - this is to test your yeast to make sure it is alive - about 10 minutes. If your yeast bubbles, go ahead and add the salt, olive oil and flour, one cup at a time mixing with your hand or stand mixer until the dough is the consistency of pancake mix. If you are using a stand mixer with a dough hook, continue to add flour until the dough pulls away from the sides of the bowl. If using a hand mixer, convert to mixing by hand using a sturdy wooden spoon, continuing to add flour one cup at a time until the dough is thick and somewhat sticky to the touch. Remove the dough and knead until the dough is smooth and shiny - this will take a few minutes - put the dough back in a large bowl that has been greased with olive oil and flip the dough and cover with plastic wrap. Let the dough rise in a warm place until double in size, about 1 hour. Hint: While you are making your dough, you can turn your oven on to the lowest setting and then shut it off and then put the dough in there to rise. Keep the dough covered until you are ready to use it - I will get a cotton (not terry) kitchen towel wet until it is damp and cover the dough with that. Punch the dough down and shape into 12-14 small rounds. If the dough is too sticky, just knead in a little more flour - keep the dough covered as you go.
To make pizzas: Spray your cold grill with oil and then get your BBQ hot - start out at about 350-400 degrees. I use a gas grill so if it gets too hot and looks like you are going to burn the pizza, just turn it down a bit. One at a time, stretch by the dough by hand and with a roller until it is about 8" round - it won't be exactly round and that's fine. Place each round directly on the grill and cook with lid open or closed until the dough puffs and browns on the underside. Remove from grill and slide onto a cookie sheet and turn over. Put all of your toppings on the cooked side and then put back onto the grill. Cover and cook until done - about 5 minutes depending on the toppings you use.
Tomato Sauce:
1 6oz can tomato paste
1 8oz can tomato sauce
1 tsp salt
1/4 tsp sugar
1 tbls olive oil
1 tbls Italian seasoning - crushed between your palms
1/4 tsp chili flakes
3 cloves minced garlic
Suggested toppings:
Roasted Garlic - Heat oven to 375 degrees
Other toppings: Dress up your pizzas with the usual mozzarella cheese, parmesan or romano and try other cheeses to compliment your toppings like fontina, goat or feta - some of the smoked cheeses are great too.
Use fresh mozzarella over an oiled crust, fresh thin tomato slices and fresh basil with a few roasted garlic cloves.
Use pesto over an oiled crust and top with goat or feta cheese, top with some parmesan cheese and olives - pitted kalamata olives are great.
Over an oiled crust, put sundried tomatoes, feta, fresh rosemary, garlic cloves and some drained and chopped marinated artichokes
Meat toppings: Over the tomato sauce, use some grated mozzarella and cooked chicken slices or cooked sausage (Italian is great) or crispy cooked bacon, salami or pepperoini and top with chopped onions or thinly sliced red onion, sliced mushrooms (grilled shitake or other mushrooms), black olives and fresh herbs like rosemary, oregano, basil and thyme. Try some grilled shrimp on your pizza
Veggies: Steamed asparagus or thinly sliced zucchini with mushrooms are great toppings over an oiled crust or with the tomato sauce.
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Endothelial progenitor cells (EPCs) are responsible for angiogenesis and maintenance of microvascular integrity, the number of EPCs is correlated with oxidative stress. Their relation to myocardial dysfunction in patients with type 2 diabetes mellitus (T2DM) is nonetheless unknown.
Eighty-seven patients with T2DM and no history of coronary artery disease were recruited. Transthoracic echocardiography and detailed evaluation of left ventricular (LV) systolic function by 2-dimensional (2D) speckle tracking derived strain analysis in 3 orthogonal directions was performed. Four subpopulations of EPCs, including CD34+, CD133+, CD34+/kinase insert domain-containing receptor (KDR) + and CD133+/KDR + EPCs, were measured by flow cytometry. Oxidative stress was assessed by superoxide dismutase (SOD).
The mean age of the patients was 62 ± 9 years and 39.6% were male. Those with an impaired longitudinal strain had a lower number of CD34+ EPCs (2.82 ± 1.87% vs. 3.74 ± 2.12%, P < 0.05) than those with preserved longitudinal strain. When compared with those with preserved circumferential strain, patients with an impaired circumferential strain had a lower number of CD34+ EPCs (2.63 ± 1.80% vs. 3.87 ± 2.10%, P < 0.01) and SOD level (0.13 ± 0.06U/ml vs. 0.20 ± 0.08U/ml, P < 0.01). Patients with an impaired radial strain nonetheless had a lower number of CD34+ EPCs (2.62 ± 2.08% vs. 3.69 ± 1.99%, P < 0.05). Multivariate analysis demonstrated that only impaired global circumferential strain remained significantly associated with CD34 + EPCs and SOD.
LV global circumferential strain was independently associated with number of CD34+ EPCs and SOD. These findings suggest that myocardial dysfunction in patients with T2DM is related to depletion of EPCs and increased oxidative stress.
Keywords:Type 2 diabetes mellitus; Myocardial injury; Endothelial progenitor cells
Type 2 diabetes mellitus (T2DM) is associated with myocardial dysfunction, independent of underlying coronary artery disease. Patients with T2DM have a 2–5 fold higher risk of developing heart failure than those without [1,2]. Although the pathology of myocardial dysfunction in these patients is unclear, it is likely multifactorial and includes increased oxidative stress, [3] microangiopathy, [4] and altered myocardial metabolism and structure with fibrosis [5].
Increasing evidence is emerging to support the role of endothelial progenitor cells(EPCs), [6] a subpopulation of mononuclear cells that possess the ability for vascular repair and neovascularization, in microangiopathy and myocardial dysfunction in patients with T2DM [7,8]. In addition, EPCs have been shown to be closely related with oxidative stress, that also contributes to myocardial dysfunction in these patients. Recent studies have demonstrated that 2-dimensional (2D) speckle tracking derived strain analysis is a sensitive method to detect systolic dysfunction in T2DM patients with an apparently normal left ventricular (LV) ejection fraction [9,10]. Nevertheless the association of EPCs and oxidative stress with LV myocardial function in patients with T2DM has not been evaluated. The aim of the present study is to determine the relationship of EPCs and oxidative stress, as determined by superoxide dismutase (SOD), to myocardial function measured by 2D speckle tracking LV strain.
Study population
A total of 110 consecutive patients with T2DM as defined by World Health Organization criteria and no coronary artery disease were recruited at Queen Mary Hospital from January 2008 to January 2010. Patients were excluded if they had a documented history or clinical symptoms and signs of macrovascular disease including myocardial infarction, coronary artery disease, stroke or peripheral vascular disease. Patients with dilated cardiomyopathy, New York Heart Association class III/IV heart failure, significant renal dysfunction with creatinine level > 220 umol/L, liver failure or clinical/biochemical evidence of concomitant inflammatory disease or patients who declined to participate were also excluded. As a result, 87 subjects were eligible for this study. The current study is in compliance with the Helsinki Declaration and has been approved by the Hong Kong West Cluster Ethics Committee. All patients had a written informed consent.
Study design
Baseline demographic data and cardiovascular medications were recorded in all subjects. Hypertension was defined as resting systolic or diastolic blood pressure ≥140 /90 mmHg on two occasions or the prescription of anti-hypertensive medication. Hypercholesterolemia was defined as fasting total plasma cholesterol level ≥4.9 mmol/L or the prescription of lipid-lowering medication [11]. Smoking status was recorded as ever-smoker (past or current) or non-smoker. Body height, weight and blood pressure were measured as previously described [12]. Body-mass index (BMI) was calculated as kg/m2. Fasting blood samples were obtained to measure serum total cholesterol, triglyceride, low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), glucose, HbA1c, creatinine, and high sensitivity C-reactive protein (hs-CRP).
After mixing, samples were centrifuged at 3000 rpm for 20 minutes and the supernatants frozen at −80°C until assay. Oxidative stress was measured as superoxide dismutase (SOD), a potent antioxidant enzyme [13].
Flow cytometry
Four subpopulations of EPCs, including CD34+, CD133+, CD34+/kinase insert domain-containing receptor (KDR) + and CD133+/KDR + EPCs, were measured by flow cytometry. Fluorescence-activated cell analysis was performed to determine the number of EPCs as described previously [14]. Briefly, 100 μl of peripheral blood was incubated with a phycoerythrin-conjugated monoclonal antibody against human KDR (Sigma, St Louis, MO, USA), followed by a fluorescein isothiocyanate (FITC)-conjugated CD34 and CD133 antibody (Beckman Coulter, Fullerton, CA, USA). FITC-labelled anti-human CD45 antibody was used for differential gating during flow analysis. FITC-labelled IgG1a (Beckman Coulter) and phycoerythrin-labelled IgG2b (Becton Dickinson, Franklin Lakes, NJ, USA) served as the isotypic control for colour compensation. Analysis was performed with an automated fluorescence-activated cell counter (Elite; Beckman Coulter) in which 1 000 000 events were counted. The absolute number of cells expressing CD34+, CD133+, CD34/KDR + CD133/KDR + per 1 000 000 events in the lymphocyte gate was calculated. The percentages of all the measured components were derived from the absolute cell count divided by the lymphocyte count [15].
Transthoracic echocardiography was performed in all patients using a commercially available system (Vingmed Vivid 7, General Electric Vingmed Ultrasound, Milwaukee, USA). A 3.5-MHz transducer was used to obtain images that were digitally stored in cine-loop format (5 cardiac cycles). Measurements were performed offline using EchoPAC version 108.1.5 (General Electric – Vingmed, Horten, Norway). The inter-ventricular septum thickness, posterior wall thickness, and LV dimensions were measured in M-modal according to the current recommendation. LV volume and ejection fraction was determined from apical four and two-chamber views using the modified Simpson's biplane method of discs. Evaluation of LV diastolic function was based on the pulsed-wave Doppler of mitral valve inflow. Peak velocity in early diastole (E-wave) and late diastole (A-wave) was measured and the E/A ratio calculated. Pulsed wave tissue Doppler imaging was used to measure the early diastolic velocity (E') with the sample volume placed at lateral annulus. In addition, E/E' ratio was calculated as an estimation of LV filling pressure [16]. LV diastolic dysfunction was therefore classified as previously described [17].
Two-dimensional speckle tracking strain analysis
Two-dimensional speckle tracking strain analysis allows detailed assessment of LV myocardial deformation by tracking natural acoustic markers (speckles) in a frame-to-frame basis within the cardiac cycle. LV deformation can be evaluated in three orthogonal directions as longitudinal, circumferential and radial strains [18].
Longitudinal strain, assessing the shortening/lengthening of the myocardial wall, was measured from the 3 apical views: 2-chamber view (comprising anterior and inferior walls), 4-chamber view (posteroseptal and lateral walls) and long axis view (anteroseptal and posterior walls). Each wall was subsequently divided into 3 levels (basal, mid and apical) and a total of 18 segmental strain curves were obtained. Global longitudinal strain was calculated as the mean of the peak systolic strain value of the 18 segments.
From LV mid-ventricular short-axis view, both circumferential strain (evaluating myocardial shortening/lengthening along LV curvature) and radial strain (evaluating myocardial thickening/thinning) were measured. The global value of circumferential and radial strains were derived from the average peak systolic strain value of 6 segments. Global longitudinal and circumferential strains are expressed as negative values, and a lower strain is represented by less negative values. Global radial strain is expressed as a positive value: a lower value indicates lower strain.
Impairment of the 3-orthogonal directional global strains was defined as mean ± 2 standard deviations according to the results of a recent study that assessed global strains in healthy Asian subjects using the same vendor machine as the current study [19]. Thus in this study impaired global longitudinal strain is defined as > −17.1%; impaired global circumferential strain > −17.0% and; impaired radial strain <29.4%.
The interobserver and intraobserver variability for longitudinal, radial, and circumferential strains were 6.5% and 2.6%, 10.4% and 7.6%, 4.9% and 2.4%, respectively.
Statistical analysis
All continuous variables and categorical variables are expressed as mean ± standard deviation and frequencies or proportions, respectively. Continuous demographic variables were compared using the Mann–Whitney U test and categorical demographic variables were compared using Pearson Chi-square test or the Fisher's exact test if at least one cell had an expected cell count below five. Correlation coefficients were performed in order to assess the association of circulating EPCs and oxidative stress with myocardial function in T2DM patients. Multivariate analyses were performed to detect the predictors for abnormal myocardial function. To avoid multi-collinearity, multi-directional strains were entered individually into the model. All statistical analyses were performed using the statistical package SPSS for windows (Version 18.0, SPSS, Chicago, USA). All P values reported are 2-sided for consistency. A P value <0.05 was considered statistically significant.
Baseline characteristics
The baseline characteristics of all patients are shown in Table 1. All patients had normal LV dimension and function including LV end diastolic volume (mean 80 ± 19 ml), LV end systolic volume (30 ± 12 ml) and LV ejection fraction (64 ± 7%). Diastolic dysfunction was noted in 69 patients (79%) and the mean E/E' ratio was 9.9 ± 2.6. The mean global longitudinal, circumferential and radial strains were 17.6 ± 2.5%, 17.7 ± 2.2% and 33.7 ± 11.0%, respectively. According to the pre-defined cut-off values, 39% of patients had impaired global longitudinal strain; 39% had impaired radial strain; and 30% had impaired radial strain.
Table 1. Clinical demographics in patients with and without impaired strains
Clinical demographics in patients with and without impaired strains
The clinical demographics of patients with and without impaired LV strain are shown in Table 1. Patients with an impaired longitudinal strain had a higher BMI, HbA1c level and a lower number of CD34+ EPCs than those with preserved longitudinal strain. When compared with those with preserved circumferential strain, patients with an impaired circumferential strain had a lower CD34+ EPCs and SOD level. Patients with an impaired radial strain nonetheless had a lower number of CD34+ EPCs compared with those with preserved radial strain.
Correlation of global strains with clinical demographics
The correlation between the 3 orthogonal directional strains and clinical demographics is shown in Table 2. Global longitudinal and radial strains were both negatively correlated with BMI. Global circumferential and radial strains were correlated with CD34+ EPCs. Only circumferential strain was negatively correlated with serum level of SOD. In addition, level of CD34+ EPCs was significantly correlated with serum level of SOD (R = 0.37, P < 0.01). Nonetheless CD133+ (R = 0.13, P = 0.30), CD34+/KDR + (R = 0.09, P = 0.50) and CD133+/KDR + EPCs (R = 0.11, P = 0.41) showed no such correlation.
Table 2. Correlation of the cardiovascular risk factors and global strains
Association of endothelial progenitor cells and superoxide dismutase with global strains
Univariate analysis revealed that impaired circumferential and radial strains were associated with CD34+ EPC level and impaired global longitudinal, circumferential and radial strains were related to SOD (Table 3). In order to evaluate the relation of impaired global strains with CD34+ EPCs and SOD, multivariate adjustment for age, gender, BMI, smoking history, hypertension, hypercholesterolaemia and HbA1c was performed. The results demonstrated that impaired global circumferential and radial strains were independently associated with CD34+ EPCs, whereas only impaired global circumferential strain was independently associated with SOD. When CD34+ EPCs and SOD were evaluated together, impaired global circumferential strain was the only LV strain that remained significantly associated with both CD34 + EPCs (odd ratio [OR]. = 0.64, Confidence interval [CI] = 0.43 - 0.95, P = 0.03) and SOD (OR = 0.001, CI = 0.001 – 0.23, P = 0.02).
Table 3. Unadjusted and adjusted effects of superoxide dismutase (SOD) and CD34+ endothelial progenitor cells (EPCs) on global strains
The present study demonstrated that at least 30% of T2DM patients, with apparently normal LV dimensions and ejection fraction, have impaired myocardial function as measured by 2D speckle tracking derived strain. Importantly, LV global circumferential strain was independently associated with depletion of CD34+ EPCs and increased oxidative stress measured by SOD.
Endothelial progenitor cells and myocardial dysfunction
The pathogenesis of myocardial dysfunction is multifaceted, but includes activation of renin-angiotensin aldosterone system, [20] myocardial steatosis, [21] autonomic dysfunction [22] and increased myocardial fibrosis [23]. Microangiopathy nonetheless has been proposed to contribute to diabetic heart disease [24,25].
The presence of diabetes induces thickening of the capillary basement membrane and endothelial swelling of the myocardium [26,27]. These changes give rise to microangiopathy as evidenced by microaneurysms, interstitial fibrosis, and perfusion defect by radiological study and finally result in myocardial dysfunction [28]. Preserving the integrity of the microvasculature, which is partly maintained by circulating EPCs, may thus prevent the development of diabetic heart disease. In addition to endothelial regeneration and postnatal neovascularization in the ischemic region, the ability to differentiate into mature endothelial cells and be incorporated into new vessels enables EPCs to produce pro-angiogenic cytokines in a paracrine fashion to facilitate vascularization [29,30]. The clinical value of EPCs has been established in diabetic patients, and their depletion is associated with macrovascular disease such as increased arterial stiffness, [31] carotid intima media thickness, [32] brachial flow mediated dilatation [33] and peripheral artery disease [34,35]. Depletion of EPCs has also been shown to be predictive of future adverse cardiovascular events [36,37]. A study by Yoon and colleagues has shown that DiI labelled bone marrow derived EPCs contributed to myocardial microvasculature and function in rats with diabetic heart disease [4]. No studies have evaluated the role of EPCs with myocardial dysfunction in human subjects. The present study further demonstrated that EPCs in patients with T2DM and no atherosclerotic disease, were independently associated with myocardial dysfunction, measured by 2D speckle tracking strain. The current results thus suggest that depletion of EPCs contributes to the development of diabetic heart disease.
The present results indicate that CD34+ EPCs were most strongly correlated with myocardial dysfunction, compared with other subtypes of EPCs. Although the reason is uncertain, this could be partly explained by the ability of CD34+ EPCs to differentiate not only into hematopoietic stem cells, but also cardiomyocytes, smooth muscle and endothelial cells [38]. Previous studies have shown the CD34+ EPCs are best related with cardiovascular risk factors, metabolic syndrome [39] and long-term outcome compared with other subtypes of EPCs [36]. The multi-lineage property of CD34+ EPCs may thus provide a more comprehensive assessment of the pathophysiological development of diabetic heart disease.
Oxidative stress and myocardial dysfunction
Oxidative stress, represented by an overproduction of reactive oxygen species, plays a role in all stages of diabetic heart disease, ranging from cardiac hypertrophy to myocardial fibrosis and dysfunction [40]. Animal studies have shown that suppression of oxidative stress with coenzyme A10 (an antioxidant in its reduced form, ubiquinol-10) [41] and 3′,4′-dihydroxyflavonol (a synthetic flavonol) [42], improves cardiac function and reduces myocyte hypertrophy and collagen deposition in diabetic rats. The present results further demonstrate the independent role of SOD in relation to myocardial dysfunction, thus highlighting the role of oxidative stress in the development of diabetic heart disease. In a study of 23 patients with T2DM, SOD has been proven to play a role in modulating EPC function under hyperglycemic conditions [43]. This finding is further confirmed by the results of this study, suggesting the close interplay between oxidative stress and EPCs that independently contributes to myocardial dysfunction.
Clinical implications
The present study is the first to demonstrate that impaired myocardial function in patients with T2DM is independently associated with depletion of EPCs and increased oxidative stress. In animal studies, therapeutic interventions aimed at increasing EPCs and reducing oxidative stress improved myocardial function [4]. Future human studies should therefore aim to develop therapies that may reduce oxidative stress and/or recruit EPCs to prevent myocardial dysfunction in patients with T2DM.
A causal relationship between CD34+ EPCs, SOD and impaired myocardial strain could not be established because of the cross-sectional nature of the study. Further, although patients with T2DM were all clinically free of cardiovascular complications, the presence of asymptomatic coronary artery disease could not be excluded. The small study population did not allow additional analysis of other mechanisms that could potentially contribute to myocardial dysfunction. In addition, the reason for the correlation of CD34+ EPCs and SOD with only global circumferential strain, not longitudinal and radial strains, is uncertain. The LV myocardial fibre architecture has a typical orientation of myocardial strands that change from being oblique in the subepicardium, to circumferential in the middle, and longitudinal in the subendocardium [44]. Thus, whether depletion of CD34+ EPCs and oxidative stress preferentially affects the mid-wall, rather than the subendocardium in these patients, requires further evaluation.
Patients with T2DM and no clinical evidence of macrovascular disease showed impaired myocardial strain detected by 2D speckle tracking derived strain analysis. Importantly, LV global circumferential strain was independently associated with both CD34+ EPCs and SOD. These findings suggest that myocardial dysfunction in patients with T2DM is related to depletion of EPCs and increased oxidative stress.
2D: 2-dimensional; BMI: Body-mass index; EPCs: Endothelial progenitor cells; HDL-C: High-density lipoprotein-cholesterol; hs-CRP: High sensitivity C-reactive protein; LDL-C: Low-density lipoprotein-cholesterol; LV: Left ventricular; SOD: Superoxide dismutase; T2DM: Type 2 diabetes mellitus.
Competing interests
The authors declare that there is no competing interest associated with this manuscript.
Authors' contributions
CTZ coordinated analyses, interpreted results and wrote the manuscript. MW performed statistical analyses and revised the manuscript. CWS advised and supervised statistical analyses and revised the manuscript. YLH and TW were involved in the conception and design of the study, interpretation of the data, ongoing support and advice to the first author. KHY contributed to study design, data interpretation and manuscript revision. HFT designed and led the project and revised the manuscript. All authors have approved the final version of the manuscript.
Nichols GA, Gullion CM, Koro CE, Ephross SA, Brown JB: The incidence of congestive heart failure in type 2 diabetes: an update.
Diabetes Care 2004, 27(8):1879-1884. PubMed Abstract | Publisher Full Text
Kannel WB, Hjortland M, Castelli WP: Role of diabetes in congestive heart failure: the Framingham study.
Am J Cardiol 1974, 34(1):29-34. PubMed Abstract | Publisher Full Text
Aksakal E, Akaras N, Kurt M, Tanboga IH, Halici Z, Odabasoglu F, Bakirci EM, Unal B: The role of oxidative stress in diabetic cardiomyopathy: an experimental study.
Eur Rev Med Pharmacol Sci 2011, 15:1241-1246. PubMed Abstract
Yoon YS, Uchida S, Masuo O, Cejna M, Park JS, Gwon HC, Kirchmair R, Bahlman F, Walter D, Curry C, et al.: Progressive attenuation of myocardial vascular endothelial growth factor expression is a seminal event in diabetic cardiomyopathy: restoration of microvascular homeostasis and recovery of cardiac function in diabetic cardiomyopathy after replenishment of local vascular endothelial growth factor.
Circulation 2005, 111(16):2073-2085. PubMed Abstract | Publisher Full Text
Miki T, Yuda S, Kouzu H, Miura T: Diabetic cardiomyopathy: pathophysiology and clinical features.
Hear Fail Rev 2012.
[epud ahead of print]
Asahara T, Murohara T, Sullivan A, Silver M, van der Zee R, Li T, Witzenbichler B, Schatteman G, Isner JM: Isolation of putative progenitor endothelial cells for angiogenesis.
Science 1997, 275:964-967. PubMed Abstract | Publisher Full Text
Fadini GP, Mancuso P, Bertolini F, de Kreutzenberg S, Avogaro A: Amelioration of glucose control mobilizes circulating pericyte progenitor cells in type 2 diabetic patients with microangiopathy.
Exp Diabetes Res 2012.
Epud ahead of print
Cheng Y, Guo S, Liu G, Feng Y, Yan B, Yu J, Feng K, Li Z: Transplantation of bone marrow-derived endothelial progenitor cells attenuates myocardial interstitial fibrosis and cardiac dysfunction in streptozotocin-induced diabetic rats.
Int J Mol Med 2012.
Epud ahead of print
Ernande L, Bergerot C, Rietzschel ER, De Buyzere ML, Thibault H, Pignonblanc PG, Croisille P, Ovize M, Groisne L, Moulin P, et al.: Diastolic dysfunction in patients with type 2 diabetes mellitus: is it really the first marker of diabetic cardiomyopathy?
J Am Soc Echocardiogr 2011, 24(11):1268-1275.
e1261PubMed Abstract | Publisher Full Text
Ng AC, Delgado V, Bertini M, van der Meer RW, Rijzewijk LJ, Shanks M, Nucifora G, Smit JW, Diamant M, Romijn JA, et al.: Findings from left ventricular strain and strain rate imaging in asymptomatic patients with type 2 diabetes mellitus.
Am J Cardiol 2009, 104:1398-1401. PubMed Abstract | Publisher Full Text
Lau KK, Chan YH, Yiu KH, Li SW, Tam S, Lau CP, Kwong YL, Tse HF: Burden of carotid atherosclerosis in patients with stroke: relationships with circulating endothelial progenitor cells and hypertension.
J Hum Hypertens 2007, 21(6):445-451. PubMed Abstract | Publisher Full Text
Luk TH, Dai YL, Siu CW, Yiu KH, Chan HT, Fong DY, Lee SW, Li SW, Tam S, Lau CP, et al.: Habitual physical activity is associated with endothelial function and endothelial progenitor cells in patients with stable coronary artery disease.
Eur J Cardiovasc Prev Rehabil 2009, 16(4):464-471. PubMed Abstract | Publisher Full Text
Dai YL, Luk TH, Yiu KH, Wang M, Yip PM, Lee SW, Li SW, Tam S, Fong B, Lau CP, et al.: Reversal of mitochondrial dysfunction by coenzyme Q10 supplement improves endothelial function in patients with ischaemic left ventricular systolic dysfunction: a randomized controlled trial.
Atherosclerosis 2011, 216:395-401. PubMed Abstract | Publisher Full Text
Wong CY, Qiuwaxi J, Chen H, Li SW, Chan HT, Tam S, Shu XO, Lau CP, Kwong YL, Tse HF: Daily intake of thiamine correlates with the circulating level of endothelial progenitor cells and the endothelial function in patients with type II diabetes.
Mol Nutr Food Res 2008, 52(12):1421-1427. PubMed Abstract | Publisher Full Text
Yiu KH, Wang S, Mok MY, Ooi GC, Khong PL, Lau CP, Lai WH, Wong LY, Lam KF, Lau CS, et al.: Role of circulating endothelial progenitor cells in patients with rheumatoid arthritis with coronary calcification.
J Rheumatol 2010, 37(3):529-535. PubMed Abstract | Publisher Full Text
McQuillan BM, Picard MH, Leavitt M, Weyman AE: Clinical correlates and reference intervals for pulmonary artery systolic pressure among echocardiographically normal subjects.
Circulation 2001, 104(23):2797-2802. PubMed Abstract | Publisher Full Text
Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, Waggoner AD, Flachskampf FA, Pellikka PA, Evangelisa A: Recommendations for the evaluation of left ventricular diastolic function by echocardiography.
Eur J Echocardiogr 2009, 10(2):165-193. PubMed Abstract | Publisher Full Text
Delgado V, Ypenburg C, van Bommel RJ, Tops LF, Mollema SA, Marsan NA, Bleeker GB, Schalij MJ, Bax JJ: Assessment of left ventricular dyssynchrony by speckle tracking strain imaging comparison between longitudinal, circumferential, and radial strain in cardiac resynchronization therapy.
J Am Coll Cardiol 2008, 51(20):1944-1952. PubMed Abstract | Publisher Full Text
Takigiku K, Takeuchi M, Izumi C, Yuda S, Sakata K, Ohte N, Tanabe K, Nakatani S, on behalf of the JUSTICE investigators: Normal Range of Left Ventricular 2-Dimensional Strain.
Circ J 2012.
Epud ahead of print
Raimondi L, De Paoli P, Mannucci E, Lonardo G, Sartiani L, Banchelli G, Pirisino R, Mugelli A, Cerbai E: Restoration of cardiomyocyte functional properties by angiotensin II receptor blockade in diabetic rats.
Diabetes 2004, 53:1927-1933. PubMed Abstract | Publisher Full Text
Ng AC, Delgado V, Bertini M, van der Meer RW, Rijzewijk LJ, Hooi Ewe S, Siebelink HM, Smit JW, Diamant M, Romijn JA, et al.: Myocardial steatosis and biventricular strain and strain rate imaging in patients with type 2 diabetes mellitus.
Circulation 2010, 122:2538-2544. PubMed Abstract | Publisher Full Text
Sacre JW, Franjic B, Jellis CL, Jenkins C, Coombes JS, Marwick TH: Association of cardiac autonomic neuropathy with subclinical myocardial dysfunction in type 2 diabetes.
JACC Cardiovasc Imaging 2010, 3:1207-1215. PubMed Abstract | Publisher Full Text
Jellis C, Wright J, Kennedy D, Sacre J, Jenkins C, Haluska B, Martin J, Fenwick J, Marwick TH: Association of imaging markers of myocardial fibrosis with metabolic and functional disturbances in early diabetic cardiomyopathy.
Andersson C, Gislason GH, Weeke P, Hoffmann S, Hansen PR, Torp-Pedersen C, Søgaard P: Diabetes is associated with impaired myocardial performance in patients without significant coronary artery disease.
Laakso M: Heart in diabetes: a microvascular disease.
Diabetes Care 2011, 34(Supplement 2):S145-S149. PubMed Abstract | Publisher Full Text
Rubler S, Dlugash J, Yuceoglu YZ, Kumral T, Branwood AW, Grishman A: New type of cardiomyopathy associated with diabetic glomerulosclerosis.
Am J Cardiol 1972, 30:595-602. PubMed Abstract | Publisher Full Text
Kawaguchi M, Techigawara M, Ishihata T, Asakura T, Saito F, Maehara K, Maruyama Y: A comparison of ultrastructural changes on endomyocardial biopsy specimens obtained from patients with diabetes mellitus with and without hypertension.
Hear Vessel 1997, 12:267-274. Publisher Full Text
De Lorenzo A, Lima RS, Siqueira-Filho AG, Pantoja MR: Prevalence and prognostic value of perfusion defects detected by stress technetium-99 m sestamibi myocardial perfusion single-photon emission computed tomography in asymptomatic patients with diabetes mellitus and no known coronary artery disease.
Am J Cardiol 2002, 90:827-832. PubMed Abstract | Publisher Full Text
Hristov M, Erl W, Weber PC: Endothelial progenitor cells: mobilization, differentiation, and homing.
Arterioscler Thromb Vasc Biol 2003, 23:1185-1189. PubMed Abstract | Publisher Full Text
Urbich C, Aicher A, Heeschen C, Dernbach E, Hofmann WK, Zeiher AM, Dimmeler S: Soluble factors released by endothelial progenitor cells promote migration of endothelial cells and cardiac resident progenitor cells.
J Mol Cell Cardiol 2005, 39:733-742. PubMed Abstract | Publisher Full Text
Yue WS, Lau KK, Siu CW, Wang M, Yan GH, Yiu KH, Tse HF: Impact of glycemic control on circulating endothelial progenitor cells and arterial stiffness in patients with type 2 diabetes mellitus.
Cardiovasc Diabetol 2011, 10:113. PubMed Abstract | BioMed Central Full Text | PubMed Central Full Text
Palombo C, Kozakova M, Morizzo C, Gnesi L, Barsotti MC, Spontoni P, Massart F, Salvi P, Balbarini A, Saggese G, et al.: Circulating endothelial progenitor cells and large artery structure and function in young subjects with uncomplicated type 1 diabetes.
Cardiovasc Diabetol 2011, 10:88. PubMed Abstract | BioMed Central Full Text | PubMed Central Full Text
Yiu YF, Chan YH, Yiu KH, Siu CW, Li SW, Wong LY, Lee SW, Tam S, Wong EW, Cheung BM, et al.: Vitamin D deficiency is associated with depletion of circulating endothelial progenitor cells and endothelial dysfunction in patients with type 2 diabetes.
J Clin Endocrinol Metab 2011, 96:E830-E835. PubMed Abstract | Publisher Full Text
Fadini GP, Miorin M, Facco M, Bonamico S, Baesso I, Grego F, Menegolo M, de Kreutzenberg SV, Tiengo A, Agostini C, et al.: Circulating endothelial progenitor cells are reduced in peripheral vascular complications of type 2 diabetes mellitus.
J Am Coll Cardiol 2005, 45:1449-1457. PubMed Abstract | Publisher Full Text
Fadini GP, Sartore S, Albiero M, Baesso I, Murphy E, Menegolo M, Grego F, Vigili de Kreutzenberg S, Tiengo A, Agostini C, et al.: Number and function of endothelial progenitor cells as a marker of severity for diabetic vasculopathy.
Arterioscler Thromb Vasc Biol 2006, 26(9):2140-2146. PubMed Abstract | Publisher Full Text
Fadini GP, de Kreutzenberg S, Agostini C, Boscaro E, Tiengo A, Dimmeler S, Avogaro A: Low CD34+ cell count and metabolic syndrome synergistically increase the risk of adverse outcomes.
Atherosclerosis 2009, 207:213-219. PubMed Abstract | Publisher Full Text
Werner N, Kosiol S, Schiegl T, Ahlers P, Walenta K, Link A, Böhm M, Nickenig G: Circulating endothelial progenitor cells and cardiovascular outcomes.
N Eng J Med 2005, 353:999-1007. Publisher Full Text
Yeh ET, Zhang S, Wu HD, Körbling M, Willerson JT, Estrov Z: Transdifferentiation of human peripheral blood CD34 + −enriched cell population into cardiomyocytes, endothelial cells, and smooth muscle cells in vivo.
Circulation 2003, 108:2070-2073. PubMed Abstract | Publisher Full Text
Fadini GP, de Kreutzenberg SV, Coracina A, Baesso I, Agostini C, Tiengo A, Avogaro A: Circulating CD34+ cells, metabolic syndrome, and cardiovascular risk.
Eur Heart J 2006, 27:2247-2255. PubMed Abstract | Publisher Full Text
Brownlee M: Biochemistry and molecular cell biology of diabetic complications.
Nature 2001, 414:813-820. PubMed Abstract | Publisher Full Text
Huynh K, Kiriazis H, Du XJ, Love JE, Jandeleit-Dahm KA, Forbes JM, McMullen JR, Ritchie RH: Coenzyme Q10 attenuates diastolic dysfunction, cardiomyocyte hypertrophy and cardiac fibrosis in the db/db mouse model of type 2 diabetes.
Diabetologia 2012, 55:1544-1553. PubMed Abstract | Publisher Full Text
Khong FL, Zhang Y, Edgley AJ, Qi W, Connelly KA, Woodman OL, Krum H, Kelly DJ: 3′,4′-Dihydroxyflavonol antioxidant attenuates diastolic dysfunction and cardiac remodeling in streptozotocin-induced diabetic m(Ren2)27 rats.
PLoS One 2011, 6:e22777. PubMed Abstract | Publisher Full Text | PubMed Central Full Text
Hamed S, Brenner B, Aharon A, Daoud D, Roguin A: Nitric oxide and superoxide dismutase modulate endothelial progenitor cell function in type 2 diabetes mellitus.
Cardiovasc Diabetol 2009, 8:56. PubMed Abstract | BioMed Central Full Text | PubMed Central Full Text
Ho SY: Anatomy and myoarchitecture of the left ventricular wall in normal and in disease.
Eur J Echocardiogr 2009, 10:iii3-iii7. PubMed Abstract | Publisher Full Text


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The History of political parties in the state of New-York, from the ratification of the federal Constitution to December, 1840 ... by Jabez D. Hammond, LL. D.
AUTHOR: Hammond, Jabez D. (Jabez Delano)
PUBLISHER: Michigan Publishing
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Ten Reasons to Become a Project Manager
You'll Better Deal With ChangeIncreased competition, sector growth and innovation create demand for agile project managers.
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text:
The last thing anyone wants to hear when they're having an enjoyable time on holiday is "No". No, you can't fly from here; no, you can't hire this car. Therefore, the raison d'etre for Holiday Extras is to make organising all those additional vacation needs as simple as possible.
Unfortunately for head of IT Damien Turner, the inability to say "yes" due to the constraints of an aging infrastructure was beginning to have a negative impact on customer service.
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"One of the hardest things with the move to AWS was getting my tech guys to see that it's no longer a piece of tin that you've named and you can stroke, you don't need to worry about that side. Yes, it's still an instance, it's still a machine, but you don't have to care for it," said Turner.
However, cloud is now so ingrained at Holiday Extras, Turner said he couldn't imagine working in any other way. "Any new service or any new business-critical system we look at now, we always look at cloud first - we look at AWS every single time. We always look to ensure we're going cloud," said Turner.


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One startup wants to turn flying into the new motor sport, and it already has an impressive backlog of orders. I got to go for a spin.
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"When Carpe Diem decided to
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text:
Fairview Uptown ClinicPrint Page
Heart Care in Your Neighborhood
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Berger, Alan K, MD
Clinical Interests:
Coronary artery disease (stable and unstable angina, myocardial, infarction), Geriatric Medicine, Peripheral artery disease (claudication, limb-threatening ischemia)


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ALPHARETTA, Ga. - Neenah Paper credited its fine paper sales for giving it a 16 percent boost in its overall annual sales when compared to a year ago.
The company on Wednesday reported its 2012 net sales of $808.8 million outpaced its 2011 annual sales of $696 million. The company said its fine paper lines saw a 36 percent boost from a year ago, logging $98 million in sales for 2012.
The company reported fourth-quarter sales of $192.6 million, a 16 percent ...