text:
Paul J Lombroso, MD
Elizabeth Mears and House Jameson Professor in the Child Study Center and Professor of Neuroscience and of Psychiatry; Director, Laboratory of Molecular Neurobiology
Research Interests
Adolescent Psychiatry; Alzheimer Disease; Child Psychiatry; Fragile X Syndrome; Neuropharmacology; Neurosciences; Parkinson Disease; Psychiatry; Schizophrenia; Protein Tyrosine Phosphatases, Non-Receptor
Research Organizations
Child Study Center: Family, Genetic and Molecular Research | Lombroso Lab | Tic Disorder & Obsessive Compulsive Disorder Program
Interdepartmental Neuroscience Program
Research Summary
The laboratory focuses on mammalian learning and how these processes are disrupted in various neuropsychiatric disorders. We are interested in several disorders including fragile X syndrome, schizophrenia, Parkinson's disease, and Alzheimer's disease. Central to this investigation is a brain-specific protein tyrosine phosphatase called STEP and its role in regulating intracellular signaling.
Our earlier work showed that STEP regulates ERK1/2 and Fyn by dephosphorylating and inactivating them. STEP also regulates the cell surface expression of AMPA and NMDA glutamate receptors and leads to their internalization. Signals that lead to STEP inactivation potentiate learning, whereas signals that lead to the STEP activation oppose the development of synaptic plasticity. We use biochemical, molecular, immunocytochemical, and behavioral techniques in animal models to address the role that STEP plays in regulating aspects of learning.
On-going projects include the involvement of STEP in several neurospychiatric and neurodegenerative disorders including: Fragile X syndrome, Alzheimer's disease, Parkinson's disease, and schizophrenia. We are characterizing novel STEP inhibitors in animal models of these disorders and determining their ability to reverse cognitive and behavioral deficits; STEP's regulation of glutamate receptor trafficking; the regulation of STEP by ubiquitination and phosphorylation.
Specialized Terms: Translational Neuroscience; Identification of small molecule inhibitors of STEP; Child and adolescent psychiatry; Neuropharmacology
Extensive Research Description
The Lombroso Lab studies how we normally learn and how these processes are disrupted in various neuropsychiatric disorders. We are interested in a number of disorders including Tourette's syndrome, obsessive-compulsive disorder, autism, as well as drug addiction and Alzheimer's disease. Our work focuses on a brain-specific protein tyrosine phosphatase called STEP and its role in regulating intracellular signaling.
Studies have shown that STEP expression is disrupted in over 10 different disorders. Some have have elevated levels of STEP while others have lower expression. Thus the current model is that optimal levels of STEP are required for proper synaptic function. Substrates of STEP include the kinases ERK1/2, Pyk2 and Fyn and dephosphorylation inactivates these enzymesem. STEP also regulates the cell surface expression of AMPA and NMDA glutamate receptors, and leads to their endocytosis. Signals that lead to the inactivation of STEP potentiate learning, while signals that lead to the activation of STEP oppose the development of synaptic plasticity. We use biochemical, molecular, immunocytochemical, and behavioral techniques to address the role that STEP plays in regulating aspects of learning.
- Identification and characterization of STEP inhibitors.
- Characterization of the STEP knock-out mouse.
- Regulation of glutamate receptor trafficking by STEP.
- Role of STEP in different disorders
- Phosphorylation of STEP and function of phosphorylation at specific sites.
Selected Publications
- Xu J, Chatterjee M, Baguley TD, Brouillette J, Kurup P, Ghosh D, Kanyo J, Zhang Y, Seyb K, Onomenyi C, Foscue E, Anderson GM, Gressack J, Cuny GD, Glicksman MA, Greengard P, Lam T, Nairn AC, Tautz L, Ellman JA, Lombroso PJ (2014) Inhibitors of the tyrosine phosphatase STEP reverse cognitive deficits in a mouse model of Alzheimer's disease. PLoS Biology 12(8):e1001923. doi: 10.1371/journal.pbio.1001923. PMCID4122355
- Chiodi V, Mallozzi C, Fan Chen J, Ferrante A, Lombroso PJ, Di Stasi AM, Domenici MR, Popoli P (2014) Cocaine-induced changes of synaptic transmission in the striatum are modulated by adenosine A2A receptors and involve the tyrosine phosphatase STEP. Neuropsychopharmacology. 39:569-578 PMCID3895235
- Baguley TD, Xu HC, Chatterjee M, Lombroso PJ, Ellman J (2013) Substrate-based fragment identification for the development of selective, nonpeptidic inhibitors of Striatal-Enriched Protein Tyrosine Phosphatase. J Med Chem 56:7636-7650. PMCID in progress.
- Deb I, Manhas N, Poddar R, Allan AM, Rajagopal S, Lombroso PJ, Rosenberg GA, Jalil EC, Paul S (2013) Neuroprotective role of STEP, a brain-enriched tyrosine phosphatase, in focal cerebral ischemia. J Neuroscience 33:17814-17826. PMCID3818554.
- Goebel-Goody SM, Baum M, Paspalas C, Carty NC, Fernandez S, Kurup P, Lombroso PJ (2012) Therapeutic implications for STriatal-Enriched protein tyrosine Phosphatase (STEP) in neuropsychiatric disorders. Pharmacological Reviews 64:65-87. PMCID3250079.
- Carty NC, Xu J, Kurup P, Goebel-Goody SM, Brouillette J, Austin DR, Yuan P, Chen P, Chen G, Correa PR, Pittenger C, Lombroso PJ (2012) The tyrosine phosphatase STEP: Implications in schizophrenia and the molecular mechanism underlying antipsychotic medications. Translational Psychiatry 2:e137 doi:10.1038/tp.2012. 63. PMCID3410627.
- Gladding CM, Sepers MD, Xu J, Zhang LY, Milnerwood AJ, Lombroso PJ, Raymond LA (2012) Calpain and STriatal-Enriched protein tyrosine Phosphatase (STEP) activation contribute to extrasynaptic NMDA receptor localization in a Huntington's disease mouse model. Human Molecular Genetics 21:3739-52 PMCID3412376
- Venkitaramani DV, Moura PJ, Picciotto MR, Lombroso PJ (2011) Striatal-Enriched protein tyrosine Phosphatase (STEP) knockout mice have enhanced hippocampal memory. Eur J Neurosci. 33:2288-2298. PMCID3118976.
- Saavedra A, Giralt A, Rué L, Xifró X, Xu J, Ortega Z, Lucas J, Lombroso PJ, Alberch J, Pérez-Navarro E (2011) STEP expression and activity in Huntington's disease-a STEP in the resistance to excitotoxicity. J Neuroscience 31:8150-8162. PMCID3472648.
- Zhang YF, Kurup P, Xu J, Carty N, Fernandez S, Nygaard HB, Pittenger C, Greengard P, Strittmatter S, Nairn AC and Lombroso PJ (2010) Genetic reduction of STEP reverses cognitive and cellular deficits in a mouse model of Alzheimer's disease. PNAS.
- Kurup P, Zhang YF, Xu J, Venkitaramani DV, Haroutunian V, Nairn A, Lombroso PJ (2010) Abeta-mediated NMDA receptor endocytosis in Alzheimer's disease involves ubiquitination of the tyrosine phosphatase STEP61. J Neuroscience 30:5948-5957.
- Xu J, Kurup P, Zhang YF, Goebel-Goody S, Wu P, Hawasli AH, Baum M, Bibb J, Lombroso PJ (2009) Extrasynaptic NMDA receptors couple preferentially to excitotoxicity via calpain-mediated cleavage of STEP. J Neuroscience 29:9330-9343.
- Zhang Y, Vankitaramani DV, Gladding CM, Zhang YF, Kurup P, Molnar E, Collingridge GL, Lombroso PJ (2008) The tyrosine phosphatase STEP mediates AMPA receptor endocytosis after metabotropic glutamate receptor stimulation. J Neuroscience 28:10561-10566.
- Choi YS, Lin SL, Lee B, Kurup P, Cho HY, Naegele JR, Lombroso PJ, Obrietan K. (2007) Status epilepticus-induced somatostatinergic hilar interneuron degeneration is regulated by striatal enriched protein tyrosine phosphatase. J Neurosci 27:2999-3009.
- Braithwaite, S., Paul, S., Nairn, A., and Lombroso, P.J. (2006). Learning and memory: One STEP at time. Trends Neurosci. 29:452-458.
- Paul S, Olausson P, Venkitaramani D, Ruchkina I, Moran TD, Mills E, Tronson N, Hakim S, Salter MW, Taylor J and Lombroso PJ (2007) The protein tyrosine phosphatase STEP gates long-term potentiation and fear memory in the lateral amygdala. Biological Psychiatry 61:1049-1061.[PDF]
- Snyder, E.M., et al. (2005). Regulation of NMDA receptor trafficking by beta-amyloid. Nature Neurosci. 8:1051-1058.


text:
You limited your search to:
Decade: 1990-1999
Year: 1996
Month: November
Collection: Congressional Research Service Reports
U.S. Economic Sanctions Through 1996
Date: November 21, 1996
Creator: Rennack, Dianne E. & Sullivan, Mark P.
Description: Since the early 1960s, the United States has imposed a range of economic sanctions on Cuba, the most prominent of which is a comprehensive embargo prohibiting trade with Cuba. This Congressional Research Service report first provides an overview of U.S.-Cuba relations and U.S. policy toward Cuba. It then examines the history and current legislative and executive authorities of the various components of U.S. sanctions against Cuba, including aid, trade, and other restrictions.
Contributing Partner: UNT Libraries Government Documents Department

subset: commoncrawl


text: I am in two leagues. My question is... the RB's for one team consists of: Addai (vs Jax) C. Johnson McFadden (vs Buf) Fargas Morris I am going to start Johnson and contemplating whether or not I should start Morris over Addai this week IF Maroney and Jordan don't play against the phins. RB's on the other team are: Barber Graham (vs Chi) C. Johnson (vs Hou) Morris I am definitely starting Barber but who should be my other starter this week?


text:
Easter Egg Hunt
Sunriver Resort celebrated its annual Easter Egg Hunt for our guests in the traditional fashion . . . thousands of Easter eggs filled with candy and toys, giggles from children racing to gather as many eggs as their baskets would hold, the snapping and flashing of cameras as parents and grandparents scurried to capture a priceless memory and the weather complimented it all with a typical Central Oregon day of . . . SNOW?!?!
Ok, so the weather was anything but typical and I can say with confidence that this is the first time in my 15 years at Sunriver Resort that we have hidden eggs in the snow, but the rest of the hunt experience was picture perfect. Despite the odd spring weather everyone was in sunny spirits and only the sea of pastel colors strewn across the blanket of white snow shined brighter. "It's chillier than my California blood was prepared for" said one guest. "But hey, the kids are loving it and it's not every Easter you get to experience egg hunting in the snow!"
It was certainly an Easter I will long remember and one which I believe will create a lasting memory for our guests too. So long fluffy bunny. . . I bet we all wished for your warm suit on this Easter 2010!
The snow only added to the whimsy! We loved it!
Love it! What great memories!
that is so amazing


text:
Compare great SAAB Winter Check prices in Bethnal Green with Who Can Fix My Car.
Enter your registration, compare quotes, and find a great garage near you. Get your competitive local prices now!
Compare great SAAB Winter Check prices in Bethnal Green with Who Can Fix My Car.
Wonderful and honest and reability
All good!
Very good service.
Really great job at a really great price!
Excellent, friendly and fair service. I would definitely use this garage again. Thank you.
One star because you did not write the report I asked and you don't respond to my messages.
Samet has been very professional and has fixed the problem very quickly and at the right price. Will use his services again. Thanks
nice guys, found my problem.
Very professional and quick service
We hadn't agreed on an exact tiime for my MOT because I had a prior appointment but when I did turn up they were fast and efficient. I couldn't have asked for more to be honest.
Highly recommended!!! Very honest and patient guys.
The service was fine, the communication could have been better.


text:
Start with any number of counters in any number of piles. 2 players take it in turns to remove any number of counters from a single pile. The loser is the player who takes the last counter.
A new card game for two players.
Follow-up to the February Game Rules of FEMTO.
The winner is the first player to get $100$ or more points.
You both start with zero points and take turns to throw the dice
as many times as you like adding the total at each throw to your score.
Throwing one $6$ ends the turn and nothing is added to the score for that turn.
Throwing a double $6$ ends the turn and the total score goes back to zero.
Try playing against Piggy. Can you work out Piggy's strategy?
Imagine we change the rules of the game. How would your strategy be affected?


text:
Copyright © 1993-2017 by DANCE ALL DAY Musicvertriebs GmbH
* = All prices in Euro, incl. VAT and excl. shipping.
Shipping costs depend on the delivery country and the chosen payment mode.
View shipping costs
www.vinyl24.de is a franchise division of Dance All Day Musicvertriebs GmbH Raiffeisenstr. 4, 83377 Vachendorf / Traunstein
Use of this Web site constitutes acceptance of the Terms and Condistions of Dance All Day GmbH.
Vinyl24 and Dance All Day are not responsible for the content of external linked sites.
General terms and conditions of DANCE ALL DAY Musicvertriebs GmbH apply.
The purchase contract comes off with the final delivery of the articles.
All offers are under retention, delivery only until stock is finished.


text:
Grammys 2013: Sir Paul McCartney wins first new album award since Let It Be
Sir Paul McCartney won a Grammy award for Kisses on the Bottom – his 17th, and first for an album of newly recorded material since The Beatles' Let It Be in 1971 – hours before the BBC launched a day of programming commemorating the Fab Four.
Sir Paul McCartney won a Grammy for an album of new material for the first time since The Beatles's Let It Be in 1971 Photo: PA
By James Lachno3:06PM GMT 11 Feb 201329 Comments
Sir Paul McCartney won his first Grammy for an album of new material since his Beatles days at last night's awards ceremony.
The British singer picked up the award for Best Traditional Pop Vocal Album for Kisses on the Bottom, which was released last year.
Though the album mostly consists of covers of traditional pop songs and jazz standards, it is still the first album of freshly recorded material to win McCartney a Grammy since The Beatles won for Let It Be in 1971.
In the intervening 42 years, McCartney has won Grammy awards for individual songs, and for a reissue of the Wings album Band on the Run.
Last night's win took the 70-year-old's tally of Grammy awards to 17, placing him equal ninth on the overall list, alongside Beyoncé, Ray Charles and Eric Clapton.
Related Articles
Grammys 2013: Mumford & Sons steal America's thunder 11 Feb 2013
Grammys 2013: full winners list 11 Feb 2013
Beatles recording session to be recreated by Graham Coxon, Joss Stone and more 31 Jan 2013
Paul McCartney, CD review 27 Jan 2012
Grammys 2013: success for Mumford & Sons, Adele and Gotye 11 Feb 2013
Grammys 2013: why America fell for Mumford & Sons 10 Feb 2013
The late Hungarian conductor Sir Georg Solti holds the record for the most Grammy wins with 31, followed by Quincy Jones and Alison Krauss, who have both won 27 awards.
Sir Paul's latest Grammy win came hours before BBC Radio 2 launched a special day of programming, called 12 Hours to Please Me, to commemorate the 50th anniversary of the recording of The Beatles' first album, Please Please Me.
Mick Hucknall, Joss Stone and Blur guitarist Graham Coxon are among the musicians who are today performing tracks from Please Please Me at Abbey Road. Some performances are being broadcast live on Radio 2, and footage from the day will be shown as part of one-off programme The Beatles' Please Please Me – Re-making A Classic on BBC Four this Friday.
Other winners at the 55th Annual Grammy Awards included Mumford and Sons, Adele and The Black Keys. Freeview channel 4 Music will show a 90-minute highlights package of the ceremony at 10pm this evening.
Follow Telegraph Music on Twitter


text:
Great Eastern Sun, Sushi Sonic, Real 100% Wasabi, 1.5 oz (43 g)
- You earn loyalty credit for every order you place at iHerb!
- Loyalty credit is equal to 5% of the value of your order, excluding shipping charges.
- Your loyalty credit will be applied towards your next order as soon as your current order has shipped.
- Your loyalty credits are valid for up to 60 days from the date of your last purchase.
This product is already in your Wish List.
View Wish List
This product is now in your Wish List.
View Wish List
Expiration Date:?Jul 2018Expiration Date
The length of time for the expiration date or "best used before" date depends on the type of product, as well as the brand.
Perishable items (such as flax oils or certain probiotics) generally have shorter expiration dates. Although our warehouse is fully air-conditioned, these more fragile items are put in cold storage (freezer or refrigeration unit) for maximum freshness.
Our receiving department does its best to verify and then enter the correct expiration dates for all incoming products. However, discrepancies do occur from time to time. This being said, the exceptionally high turnover at iHerb ensures that our inventory is among the freshest in the industry.
Shipping Weight:?0.59 lbsShipping WeightThe Shipping Weight includes the product, protective packaging material and the actual shipping box. In addition, the Shipping Weight may be adjusted for the Dimensional Weight (e.g. length, width & height) of a package. It is important to note that certain types of products (e.g. glass containers, liquids, fragile, refrigerated or ice packed) will often require protective packaging material. As such, these products will reflect a higher Shipping Weight compared to the unprotected product.
- Product Code: GES-08261
- UPC Code: 023547082612
- Package Quantity: 1.5 oz (43 g)
- Dimensions: 2.8 x 2.2 x 2.2 in, 0.35 lbs
|Combo Discount:
|- $2.47
- 100% Wasabi
- Now! Freeze Dried for Improved Flavor!
Not just horseradish and mustard like other brands, our product contains 100% authentic wasabi, the rare, hard to grow, hot green rhizome so prized in the East...and now freeze dried for improved flavor.
Suggested Use
Mix one teaspoon wasabi with enough cool water to make a paste. Allow to stand for about 10 minutes for full flavor to develop.
Other Ingredients
Freeze dried 100% wasabi (wasabi japonica).
|Supplement Facts
|Serving Size: 1 tsp (2.5 g)
|Servings Per Container: 17
|Amount Per Serving
|% Daily Value
|Total Fat
|0 g
|Trans Fat
|0 g
|0 mg
|Total Carbs
|1 g
|0 g
|Vitamin C
|Percent Daily Values (DV) are based on a 2,000 calorie diet.
Sushi Sonic Real 100% Wasabi
Verified Purchase
Sushi Sonic Real 100% Wasabi
I've only recently learned, or read, that most of what is sold in the U.S. is actually horseradish and mustard, particularly if it is in the form of paste, and may not contain wasabi at all. Therefore I have very little experience with true wasabi. In my search for real wasabi, true wasabi, 100% wasabi, wasabia japonica, I read a review comparing Sushi Sonic's to another brand I was considering ordering from a company outside the U.S. In the review, Sushi Sonic's came out on the short end as not "wasabi-ish". There was some suggestion of different parts of the plant being used which renders a different taste or experience. Because of the price and accessibility, I decided to give the Sushi Sonic's product a try. My initial experience was a little disappointing since I just added the powder to food I was preparing which had liquid in it. I thought that would be acceptable, but there seemed to be very little taste and the heat and sinus experience was missing. Since then, I've tried again, this time following the instructions on the container. After adding a little cool water to make a paste, I tasted it then let it sit. Initially there was little flavor or "zing". But the longer it sat, the more the flavor developed, and definitely improved. I'll have to experiment further to see if it is fully developed at 10 minutes or if it continues to get stronger given more time.
It is not 100% wasabi
Verified Purchase
It is not 100% wasabi
There is no more than 5% wasabi. There is used green powder made from wheat. I'm very disappointed for such kind of cheating. I'm wondering iherb allows to risk his own credit by selling this.
It is not 100% wasabi
There is no more than 5% wasabi. There is used green powder made from wheat. I'm very disappointed for such kind of cheating. I'm wondering iherb allows to risk his own credit by selling this.
De los mejor
Posted by 4948599417418784368 on Nov 06, 2014
El mejor wasabi que he probado además de que dura muchísimo
Great and Package Great
Posted by 5717755346541396577 on Sep 05, 2014
This product came on time and was package very nice. The wasabi had a good taste but it didn't have much burn to it. The burn was there but it was very light.
That's NOT wasabi!
Posted by 5219681045582967949 on Aug 11, 2014
This thing has the weirdest smell. It's awful, makes me feel sick. Other wasabis have this fresh, spicy smell that I love. Even when mixed with water the smell stays the same, the color of the product also doesn't look ok - it's darker than usual and too grayish. Sooo disappointed.
Wasabi is anti-cancer
Posted by 5561646142795126113 on Feb 25, 2014
I hope it is anti-cancer. But even if it is not, it taste great if you like mustard & horseradish you will most likely like this too. I love it with oats & salmon, tuna, sardines, or on my brown egg 12 grain bread sandwiches. Thomas the bible man


text:
for the dog and cat
Michael R. O'Grady, DVM, MSc, Diplomate ACVIM (Cardiology)
M. Lynne O'Sullivan, DVM, DVSc, Diplomate ACVIM (Cardiology)
Acquired Heart Disease
Breed Predilections for Acquired Disease
|Airedale Terrier
|Chronic mitral valve insufficiency (CMVI)
|Boston Terrier
|Heart base tumor and pericardial effusion
|Bouvier de Flanders
|Dilated cardiomyopathy (DCM)
|Arrhythmogenic right ventricular cardiomyopathy (ARVC), bacterial endocarditis, heart base tumor and pericardial effusion
|Bull Mastiff
|Cavalier King Charles Spaniel
|Cocker Spaniel
|Doberman Pinscher
|German Shepherd
|DCM, Hypertrophic cardiomyopathy (HCM), hemangiosarcoma and pericardial effusion, bacterial endocarditis, CMVI
|German Short Haired Pointer
|Golden Retriever
|DCM, hemangiosarcoma and pericardial effusion
|Great Dane
|Great Pyrenees
|Irish Wolfhound
|Labrador Retriever
|Miniature Schnauzer
|Sick sinus syndrome, CMVI
|Old English Sheepdog
|Rhodesian Ridgeback
|Small breed dogs
|Springer spaniel
|Atrial standstill
top Acquired Heart Disease: General
2 Chronic Mitral Valve Insufficiency (CMVI) - What is it?
Results of CMVI:
top Acquired Heart Disease: General
3 How does chronic mitral valve insufficiency present?
Physical Examination:
Comment: When pulmonary hypertension develops, dogs become severely exercise intolerant and syncope is common.
top Acquired Heart Disease: General
4 How is chronic mitral valve insufficiency diagnosed?
Most cases of CMVI present for some other reason and an incidental heart murmur typical of MR is detected on examination. Those dogs that present for congestive heart failure due to CMVI usually present with a complaint of a cough. Some dogs present with a complaint of syncope.
Physical Examination uncovers:
Radiology may uncover:
Electrocardiography may uncover:
Blood work:
top Acquired Heart Disease: General
5 How is chronic mitral valve insufficiency treated?
Goals of therapy for CMVI:
Dosages: (canine)
Management of congestive heart failure involves controlling vascular volume by finding a balance between meeting renal blood flow needs through enhancing vascular volume (preload) and reducing pulmonary edema by reducing vascular volume (preload).
top Acquired Heart Disease: General
6 What is the prognosis with chronic mitral valve insufficiency?
top Acquired Heart Disease: General
7 What is cardiomyopathy?
Cardiomyopathy refers to a primary global disorder of the myocardial tissue.
Classically cardiomyopathy is divided into several types with the two most common being:
- Systolic dysfunction (decreased muscle strength/decreased contractility)
- Ventricular cavity dilation (eccentric hypertrophy)
- Mild thinning of the ventricular walls
- Total ventricular mass is increased
- Well recognized in the cat and dog
- Etiology is often unknown in dogs
- Likely genetic (familial) in many cases
- A mutation in the titin protein gene may be responsible for DCM in Doberman Pinschers
- A number of genetic mutations have been identified in humans with familial DCM
- Due to a deficiency of taurine in some Cocker Spaniels
- In some cases a deficiency of carnitine has been reported to be responsible for dilated cardiomyopathy (a family of Boxers)
- A morphologic picture of DCM can be induced by tachyarrhythmias, certain chemotherapeutics (e.g. doxorubicin), and myocarditis
A deficiency of taurine was previously responsible for the vast majority of cases of dilated cardiomyopathy in cats. It is not likely involved in feline DCM in cats on commercial cat food.
- Diastolic dysfunction (impaired relaxation)
- Ventricular cavity of diminished dimension
- Thickening of the ventricular walls (concentric hypertrophy)
- Increased ventricular mass
- Well recognized in the cat
- Rare in the dog
- Etiology unknown in most cats
- In many cats it appears to be familial and inherited as autosomal dominant
- In Maine Coon and Ragdoll cats, mutations of the cardiac myosin binding protein C gene are involved
Hypertension and thyrotoxicosis can induce a morphological picture of concentric hypertrophy. Growth hormone excess may cause concentric hyptertrophy. HCM has been subcategorized into an obstructive form and a non-obstructive form
top Acquired Heart Disease: General
8 What is the etiology of canine dilated cardiomyopathy (DCM)?
Most cases are idiopathic. That is, the processes or insults ultimately leading to the morphologic diagnosis of DCM are unknown in most cases. As the heart has a limited number of responses to a variety of insults, the diagnosis of DCM often gives little to no insight into the underlying etiology with few exceptions.
top Acquired Heart Disease: General
9 How does canine dilated cardiomyopathy (DCM) present?
Physical examination:
top Acquired Heart Disease: General
10 How is canine dilated cardiomyopathy (DCM) diagnosed?
The definitive diagnosis of canine DCM is by echocardiography with the demonstration of ventricular dilation and reduced contractility (systolic dysfunction).
In the absence of echocardiography, usually presumptive evidence of canine DCM can be obtained:
a) Radiology:
b) Electrocardiography: may reveal:
Note: none of these findings are diagnostic of canine DCM
c) Blood Work:
top Acquired Heart Disease: General
11 How is canine dilated cardiomyopathy treated?
Therapy with an ACE-inhibitor is recommended in preclinical (occult) DCM. There is substantive evidence in humans and retrospective evidence in dogs that ACE-inhibitor therapy delays the onset of CHF, likely by altering ventricular myocardial remodeling. Time to onset of clinical signs of CHF when one treats Dobermans in the preclinical (occult) stage of DCM with benazepril results in a 25% increase in the time to onset of clinical signs of CHF (O'Grady & O'Sullivan et al. JVIM 2009;23:977-983). No other drugs have been assessed in this stage of DCM.
For the patient with CHF secondary to DCM, treatment is as per congestive heart failure in the General Therapeutic Concepts section.
Dosages: (canine)
Management of congestive heart failure involves controlling vascular volume by finding a balance between meeting renal blood flow needs through enhancing vascular volume (preload) and reducing pulmonary edema by reducing vascular volume (preload).
top Acquired Heart Disease: General
12 What is the prognosis with canine dilated cardiomyopathy (DCM)?
Survival data involving 275 dogs with DCM studied over 20 years at the OVC (Bronsoiler J et al JVIM 2005;19:204.):
top Acquired Heart Disease: General
13 What is feline dilated cardiomyopathy?
This disorder is morphologically identical to canine DCM. It is characterized by eccentric hypertrophy and global hypokinesis (systolic dysfunction). Unlike the disorder in dogs, the potential to develop concurrent thromboembolic complications is frequent in cats.
top Acquired Heart Disease: General
14 What is the etiology of feline dilated cardiomyopathy?
Taurine deficiency induced DCM was previously a common cause of feline cardiac disease. With the addition of taurine to the commercial feline diets, taurine deficiency-induced DCM is now rare.
top Acquired Heart Disease: General
15 How does feline dilated cardiomyopathy present?
Physical Examination:
top Acquired Heart Disease: General
16 How is feline dilated cardiomyopathy diagnosed?
A definitive diagnosis is possible with echocardiography (a dilated, relatively thin-walled left ventricle with reduced contractility).
Among acquired feline heart disorders, dilated cardiomyopathy and hypertrophic cardiomyopathy used to be the most common disorders, and the diagnostic challenge was to distinguish between these two forms of cardiomyopathy. Since the introduction of routine supplementation of taurine to the feline commercial diets, dilated cardiomyopathy has become a rare disorder. Thus, the hypertrophic (concentric hypertrophy) form is the most common type of cardiomyopathy presently occurring in the cat.
Other potentially useful diagnostic aids:
a) Radiology:
b) Electrocardiography: may reveal
c) Blood Work: may reveal
top Acquired Heart Disease: General
17 How is feline dilated cardiomyopathy treated?
Goals of therapy:
top Acquired Heart Disease: General
18 What is the prognosis with feline dilated cardiomyopathy?
top Acquired Heart Disease: General
19 What is feline thromboembolic disease?
Thromboembolic disease (TED) is an important and relatively frequent complication of feline myocardial disease. Thrombosis represents clot formation within a cardiac chamber or vessel, and embolization occurs when a clot fragment lodges in a distal vessel. In the case of feline TED, the clot fragment usually arises from atrial thrombi or from atrial lesions and most commonly embolizes to the distal aortic trifurcation. Other less frequent sites of embolization include brachial, renal, celiac, and cerebral arteries. TED is frequently the first sign of underlying cardiomyopathy.
In a recent retrospective study of 127 cats with arterial thromboembolism (ATE), it was the first sign of cardiac disease in 76% of affected cats.
Physical occlusion of the aorta alone will not cause this syndrome. Vasoactive substances released by the thrombus/endothelium are believed to cause vasoconstriction of collateral vessels. Serotonin and prostaglandins are the likely vasoactive agents. This causes ischemic damage to peripheral nerves, muscle and sometimes skin.
The presence of a thromboembolic event usually indicates the existence of underlying cardiac pathology. Typically cardiomyopathy and left atrial enlargement are present. However, we and others have observed cats without obvious cardiomyopathy and without left atrial enlargement experience a thrombotic event. Neoplasia and hyperthyroidism (even in the absence of cardiac changes) are disorders with which TED has also been associated.
- Acute onset of posterior paresis with:
- Extreme pain
- Hard/firm muscle groups in the affected legs
- It is not uncommon for this to be the only clue to the presence of cardiomyopathy
- Other signs of feline cardiomyopathy (dilated or hypertrophic) may be present
- Lower motor neuron paralysis of the affected limb with
- Lower motor neuron sensorimotor neuropathy
- Extreme pain
- Firm muscle groups
- Cyanotic nail beds
- Weak to absent arterial pulse in limb
- Cool to palpation
- Failure of nail beds to bleed with short clipping
- May have signs of feline cardiomyopathy (dilated or hypertrophic) as per above
- Gallop cardiac rhythms and murmurs of AV valve insufficiency are frequently encountered, however it is reported that as many as 40% of cats with ATE may not have auscultable abnormalities.
- As for feline cardiomyopathy depending on type
- Blood work indicates muscle necrosis (elevated CK and AST)
- Acute renal failure, metabolic acidosis, DIC, or hyperkalemia
- Blood work may indicate reduced GFR
- Blood work may indicate hyperthyroidism
- Surgery is not a real consideration.
- Removal of the clot will not reverse the collateral circulatory "shut down" and anesthesia is very risky in these patients
- Medical therapy
- Inhibit clot formation
- Aspirin to prevent further thromboembolic events. As a cyclooxygenase inhibitor, it prevents formation of thromboxane thus preventing platelet aggregation.
- Low dose ASA (5 mg/cat q 3 days) vs high dose ASA (81 mg/cat q 3 days)
- There is some evidence to suggest that the low dose may be preferred to the traditional high dose.
- Clopidogrel - 18.75 mg/cat SID (PO). Clopidogrel is a platelet function inhibitor that appears, in a limited study, to be safe and effective in cats.
- Clopidogrel is safer and more effective than ASA in people
- Results of a trial investigating the use of aspirin vs clopidogrel in cats with TED will be forthcoming (FATCAT trial).
- Heparin may be useful (to prevent further thromboembolic events) - 200 units/kg IV as a loading dose followed 4 hours later by 150-200 units/kg SQ after obtaining ACT or PTT, May repeat again at 8 hours after obtaining ACT or PTT. Goal is 1.5-2 times increase in the pre-heparin ACT or PTT result. Once this is achieved, reduce to 100-150 units/kg Q 8 hours. Must monitor closely for hemorrhage. Heparin will not lyse the existing clot, but will prevent further clot formation via its anticoagulant effects. By enhancing antithrombin III activity, it inhibits coagulation factors II, IX, X, XI, and XII.
- Low molecular weight heparin (LMWH) is an alternative to regular unfractionated heparin (UH). LMWH has higher bioavailability, longer half-life, less protein binding, and more predictable effects than UH. As such, LMWH is potentially easier and safer to use than UH. Because of its' different structure, LMWH selectively inhibits factor X and does not prolong coagulation times. It is administered subcutaneously once to twice daily (see formulary for doses).
- Pain management is a very important part of therapy. Opioids such as morphine, butorphanol, or fentanyl patches are typically used.
- Supportive care: nutrition, warming, physical therapy, prevention of self-mutilation
- Thrombolytic therapy with enzymes such as streptokinase and tissue plasminogen activator (TPA) has been used with some success to dissolve thromboembolic episodes. These agents can be quite expensive. Since many cases recover spontaneously due to recanalization or collateralization, studies are lacking to demonstrate an improvement with these agents over placebo. Use of TPA has demonstrated a 50% resolution of thrombi with ambulation in 48 hours of treatment. However, 50% died during therapy (due to hyperkalemia and metabolic acidosis [reperfusion syndrome] in 70%).
- Treatment of concurrent CHF and/or malignant arrhythmias may also be necessary.
- It is important to monitor respiratory status, heart rhythm (ECG), renal function, electrolytes (especially potassium), temperature, and mobility.
- With complete aortic occlusion: 35% survive initial episode
- With suprarenal aortic thrombosis: grave prognosis due to acute renal failure, GI ischemia, spinal cord dysfunction and degeneration
- Partial embolization: 70% survive initial episode
- Spontaneous resolution occurs in over 50% of cases within 2 to 6 weeks.
- The recurrence rate of re-embolization appears to be high, usually within 6 months (with ASA).
- In one study of 100 cases (Laste et al. JAAHA 1995):
- 63% died or were euthanized during hospitalization
- 37% survived to live a median of 10 months, ave = 11.5 months
- Re-embolization occurred in 50% of survivors
- In another more recent study of 127 cases (Smith et al. JVIM 2003):
- 65% died or were euthanized during initial hospitalization
- 35% survived (discharged) to live a median of 117 days (about 4 months)
- Re-embolization occurred in 25% of survivors
- Persistence of low rectal temperature is associated with a poor short-term prognosis.
- Others report that survival is related to presence of co-morbid factors:
- If there is no concurrent CHF - median survival time = 225 days
- If CHF is also present - median survival time was
- 77 days in one study
- 184 days in another
- Aspirin (81 mg/cat q 3 days or twice weekly) has been recommended for all cats with an enlarged left atrium, however there is no data to indicate if aspirin is any better than placebo. There is some evidence to suggest that low dose aspirin (5 mg/cat Q 3 days) is equally as efficacious with fewer side effects. Clearly many cats have recurrent bouts of thrombosis while on aspirin.
- Clopidogrel 18.75 mg/cat Q 24 hours has recently been advocated for thromboprophylaxis in cats. The results of a trial (FATCAT) comparing aspirin vs clopidogrel in cats with ATE should be forthcoming.
- Heparin enhances antithrombin III activity. Close monitoring for severe hemorrhage is necessary. Seek a 1.5 to 2 times increase in PTT above preheparin levels. Hemorrhage can be reversed with protamine sulfate.
- Coumarin (warfarin) inhibits synthesis of Vitamin K dependent clotting factors (II, VII, IX, & X). It will take about 3 days for coumarin to be effective (the delay needed for existing clotting factors to decline). Dose: 0.06 - 0.1 mg/kg q 24 hours PO. Monitor response via PT on day 0, 1, 2, 3, 5, 7, 10, 14, 21, 35, q 4wks. Vitamin K1 will reverse coumarin overdose. During the first three days of therapy patients may be in a "hypercoagulable state". Some recommend concurrent use of heparin during this time. There is no clinical evidence to support that warfarin is superior to aspirin in the prophylaxis of ATE.
- As mentioned above, low molecular weight heparin (LMWH) may prove to be a safer alternative than heparin or coumarin in ATE prophylaxis. Dosage and efficacy are currently being evaluated.
top Acquired Heart Disease: General
20 What is feline hypertrophic cardiomyopathy?
Hypertrophic cardiomyopathy (HCM) is an acquired idiopathic myocardial disorder characterized by concentric hypertrophy and resultant diastolic dysfunction of primarily the left ventricle. It is the most common type of cardiomyopathy in cats.
The majority of cases are idiopathic, that is, the primary etiology is unknown. Like in humans, a familial and heritable form of HCM has been identified in certain feline breeds, including families of Maine Coons, Ragdolls, Persians, American Shorthairs, and British Shorthairs. The mode of inheritance in these breeds appears to be autosomal dominant. Breed-specific mutations of the myosin binding protein-C gene have been identified as causative of HCM in Maine Coons and Ragdolls. It is known, however, that there are other undiscovered genetic mutations since not all positive cases are linked to the above mutations.
While most cases are idiopathic, HCM may be secondary to other disorders such as:
top Acquired Heart Disease: General
21 How does feline hypertrophic cardiomyopathy (HCM) present?
a) Signalment:
b) History:
c) Physical Examination:
top Acquired Heart Disease: General
22 How is feline hypertrophic cardiomyopathy (HCM) diagnosed?
The definitive diagnostic test for feline HCM is echocardiography with the demonstration of thickening of the interventricular septum and/or left ventricular free wall with normal to reduced left ventricular chamber size and normal to enhanced contractility.
a) Auscultation: may find
b) Radiology:
c) ECG:
d) Blood work:
e) Echocardiography:
Comment: As cardiomyopathy is frequently an incidental finding in otherwise symptom-free cats, we recommend that all cats with heart murmurs or a gallop rhythm undergo an echocardiographic examination.
top Acquired Heart Disease: General
23 How is feline hypertrophic cardiomyopathy treated?
Recall: The underlying disorder is one of severely impaired left ventricular filling (diastolic dysfunction) due to increased wall thickness, impaired ventricular relaxation, and the development of ischemic induced myocardial fibrosis (increased ventricular stiffness). Systolic function is relatively preserved (at least until late in the disease process).
Principles of therapy:
Beta-blockers improve diastolic function indirectly by reducing heart rate and improving myocardial perfusion, thereby enhancing ventricular filling. Their negative inotropic properties reduce myocardial oxygen demand/consumption and thus may reduce ischemia. Beta-blockers also have antiarrhythmic properties that may be of benefit in this disorder. Beta-blockers reduce or abolish dynamic LVOT obstruction, and are therefore often used in the obstructive form of HCM. And finally, blockade of the deleterious effects of chronic sympathetic nervous system activation (vasoconstriction increasing afterload, myocardial necrosis, coronary vasospasm, arrythmogenesis) may be of benefit. Beta-blockers are the therapy of choice in humans with obstructive HCM or with exertional dyspnea and exercise intolerance.
- Atenolol: 6.25-12.5 mg/cat SID-BID (PO)
- Metoprolol: 0.5-1 mg/kg TID (PO)
Calcium channel blockers, like beta blockers, reduce heart rate and myocardial oxygen consumption. They also may improve the active process of myocardial relaxation directly. In humans and in cats, the tendency in the past was to treat non-obstructive HCM with calcium channel blockers (diltiazem). However the most recent therapeutic consensus guidelines for human HCM do not include the use of calcium channel blockers as there is no conclusive evidence that calcium channel blocker improve symptoms, hemodynamics, or survival.
- Diltiazem: 1-2 mg/kg TID (PO) or 7.5 mg per cat TID
Angiotensin converting enzyme (ACE) inhibitors - Traditionally, treatment of HCM has focused on negative inotropic/chronotropic therapy (beta blockers, calcium channel blockers), and ACE inhibitors have been avoided (particularly in obstructive HCM) due to the impression that any arterial vasodilation may promote hypotension. However, the renin-angiotensin-aldosterone system (RAAS) plays an important role in stimulation of myocardial hypertrophy and fibrosis (which adversely affects diastolic function) and progression of heart failure. Therefore ACE-inhibitors may theoretically have some benefit in the setting of HCM. Recent work in veterinary medicine suggests that ACE-inhibition does not worsen dynamic LVOT obstruction or promote hypotension in HCM cats and that ACE-inhibitors are tolerated well in this population. Interim analysis of an ongoing prospective randomized clinical trial of therapy in feline CHF due to HCM suggests that cats treated with ACE-inhibitors tend to have a better outcome (not statistically significant) than those treated with either beta-blockers or calcium channel blockers. As the final results of this trial have yet to be published, any conclusions at this point are premature. However in the asymptomatic (pre-CHF) stage of HCM, two recent placebo-controlled feline studies showed no improvement in LV wall thickness, mass, or diastolic function with ACE-inhibitor therapy for 6-12 months (MacDonald et al JVIM 2006, Taillefer et al CVJ 2006). Note also that ACE-inhibitors are not featured in the most recent therapeutic consensus guidelines for human HCM.
- Diuretics - furosemide (Lasix): 1-2 mg/kg BID-TID (PO, IM, IV); do not exceed 2 mg/kg (IV)
- Although diuretics are very useful initially when pulmonary edema is present, as pulmonary edema resolves and additional therapy is in progress, one should attempt to use the least diuretic dose/reduce the dose (these individuals require as much preload as possible to prime their stiff left ventricle). Dramatic improvement may be noted with conservative doses.
- ACE-inhibitors likely have a role to play in the management of CHF by blocking the RAAS when furosemide therapy is used
- enalapril or benazepril: 0.25-0.5 mg/kg Q 24 hrs PO
- Renal parameters and electrolytes must be monitored
- Periodic thoracocentesis for pleural effusion may be necessary
- Hyperthyroidism - see Question 32 for management.
- Systemic hypertension - it is important to rule out hypertension as etiologic.
top Acquired Heart Disease: General
24 What is the prognosis for feline hypertrophic cardiomyopathy (HCM)?
top Acquired Heart Disease: General
25 What is feline restrictive cardiomyopathy?
Feline restrictive cardiomyopathy refers to that group of primary myocardial disorders that are not typical of feline DCM or feline HCM. Morphologically the heart is characterized by a normal to reduced contractility, no thickening of the interventricular septum or LV free wall, a normal to small left ventricular cavity potentially with a thickened endocardium, and marked atrial enlargement (often bilateral).
The history and physical examination are identical to those of feline HCM. The diagnosis relies on the echocardiographic examination. Doppler echocardiography demonstrates abnormal transmitral flow, classically a restrictive filling pattern. In addition, left atrial enlargement and mitral valve insufficiency are common. These cats are also at risk for thrombus formation and thromboembolic events.
The most effective therapy for this disorder remains unknown. The underlying disorder is that of diastolic dysfunction. ACE inhibitor therapy is used if contractility is reduced. Furosemide is used in the presence of CHF. These patients are at risk for thromboembolic events, hence prophylaxis is warranted.
The prognosis is unknown but generally very poor.
top Acquired Heart Disease: General
26 Are there other forms of feline cardiomyopathy?
We have observed a few cats with a form of end stage myocardial failure that is characterized by left ventricular enlargement, reduced contractility, focal regions of myocardial hypokinesis or akinesis with marked thinning of the wall in these akinetic/hypokinetic areas (usually the left ventricular free wall at the base), enlargement of the right ventricle and atrium, reduced contractility of the right atrium, and left atrial enlargement.
It appears that myocardial infarction and ischemia play a major role in producing the overall morphologic changes observed.
One wonders if these cats are in the final stages of a progressed version of one of the other more classical forms of cardiomyopathy.
Management is attempted as for the restrictive form of CM.
Prognosis is usually abysmal with death within 2 weeks.
top Acquired Heart Disease: General
27 What is feline hyperthyroidism?
Feline hyperthyroidism is a disorder of older cats (>6 years) associated with the overproduction of thyroid hormone. The tumour itself is relatively innocuous but the systemic effects of the overproduction of thyroid hormone cause the signs of disease.
top Acquired Heart Disease: General
28 How does feline hyperthyroidism present?
a) Signalment:
b) History:
Comments: About 10% of cats do not show hyperexcitability or restlessness but manifest with extreme depression and weakness as the primary complaint.
c) Physical Examination - may reveal:
top Acquired Heart Disease: General
29 How is feline hyperthyroidism diagnosed?
Feline hyperthyroidism is definitively diagnosed with the demonstration of an elevated serum T4 level.
a) Radiology:
b) ECG - may reveal
c) Blood Work - may reveal:
d) Echocardiography:
Comment: The reports of hyperthyroidism that occurred in association with feline dilated cardiomyopathy were documented in the pre-taurine supplementation days. It is entirely possible that these cases also represented taurine deficiency.
e) Thyroid Imaging (radioisotope):
top Acquired Heart Disease: General
30 How is feline hyperthyroidism treated?
Therapeutic Goals:
1. Control the cardiac manifestation of hyperthyroidism which occurs a result of excessive sympathetic stimulation.
On this therapy, most cats become euthyroid in 2 to 3 weeks. If little or no decrease in serum T4 levels occurs on this dosage regimen, dosages of methimazole should be increased to 7 to 10 mg TID (PO).
- Simple, effective, and safe
- Radioactive iodine is concentrated primarily in the hyperplastic or neoplastic thyroid cells irradiating and destroying the hyperfunctioning tissue.
- Normal thyroid tissue is protected from the effects of radio active iodine since the uninvolved thyroid tissue is suppressed and receives only a small dose of radiation
- Requires a nuclear facility
Comments: Adverse drug reactions
Comments: Site of tumour
Because the thyroid lobes of the cat are loosely attached to the trachea, the enlarged lobe(s) frequently descend ventrally from its normal location adjacent to the larynx. Many cats in which a thyroid mass is not palpable have tumorous lobes that have descended into the thoracic cavity. 70% of cases have bilateral thyroid lobe involvement. 30% of cases have single thyroid lobe involvement. Of those cases with true unilateral lobe involvement, recurrence in the contralateral lobe is unusual. Of those cases with bilateral lobe involvement, about 15% of these have one lobe that is minimally enlarged and is usually mistaken as normal. Therefore if only one lobe is removed, relapse of hyperthyroidism will usually occur within 9 months of surgery. Preservation of the external parathyroid gland during hemithyroidectomy minimizes the risk of hypoparathyroidism should removal of the contralateral lobe be required. It can be difficult to remove all abnormal thyroid tissue while attempting to concurrently preserve parathyroid tissue. Small remnants of thyroid tissue that remain attached to the parathyroid may regenerate and produce thyrotoxicosis in 6 to 12 months. Hypocalcemia is the most important complication associated with bilateral thyroidectomy. It doesn't occur with unilateral thyroidectomy. After bilateral thyroidectomy, the serum calcium concentration should be monitored on a daily basis until it has stabilized within the normal range. After bilateral thyroidectomy hypocalcemia will develop in 1 to 3 days if it is to occur. Although hypocalcemia may be permanent in some cats, spontaneous recovery of parathyroid function may occur weeks to months after surgery. In most cases, such transient hypocalcemia results from reversible parathyroid damage and ischemia secondary to surgery. Alternatively, accessory parathyroid tissue may compensate for the damaged parathyroid glands and maintain normocalcemia.
top Acquired Heart Disease: General
31 What is the prognosis with feline hyperthyroidism?
Prognosis will vary depending on
a) If the echocardiographic features are those of feline dilated cardiomyopathy:
b) If the echocardiographic features are those of feline hypertrophic cardiomyopathy:
Comment: Recall that most of these cats are quite old and therefore are subject to a number of geriatric disorder including: chronic renal disease, and hepatic disease which may render them poor anesthetic risks. Many cats can be controlled long term with chronic anti-thyroid therapy if adverse blood disorders do not occur.
top Acquired Heart Disease: General
32 How does Boxer Cardiomyopathy differ from canine dilated cardiomyopathy?
Boxer cardiomyopathy is a disorder characterized primarily by ventricular arrhythmias, syncope, and sudden death. LV systolic dysfunction and CHF, the typical characteristics of canine dilated cardiomyopathy, are relatively rare in Boxer cardiomyopathy. Boxer cardiomyopathy closely resembles an arrhythmic disorder in humans called Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC), and as such, the name ARVC is now used to refer to the arrhythmic cardiomyopathy of Boxers. (Boxers in the UK appear to be much more commonly affected with the DCM form of the disease).
ARVC is a familial disease in Boxers that is inherited as an autosomal dominant trait with variable penetrance.
An 8 base pair deletion on chromosome 17 located within the striatin gene was found to be associated with affected Boxers and absent in normal Boxers and normal other dogs (Meurs et al. JVIM 2009;23:687-688).
A disorder of carnitine metabolism is involved in a few cases of the relatively uncommon form of Boxer cardiomyopathy with LV failure and CHF.
- Age range = 1 - 15 years
- Most cases (60%) are 6 to 10 years of age
Based on clinical signs, three categories can be defined:
- Dogs with no clinical signs of heart disease.
- Dogs with syncope or weakness.
- Dogs with signs of left-sided congestive heart failure.
- May be free of clinical signs
- May have syncope or episodic weakness
- aA small percentage (<10%) have cough and/or dyspnea
- Many have a normal physical exam
- Cardiac arrhythmias may be ausculted
- Pulse deficits may be present with dysrhythmias
- Very few have a murmur of mitral valve insufficiency
The ECG provides the most consistent findings.
- as single beats
- as pairs or triplets
- in runs of ventricular tachycardia
Most ventricular premature beats are of right ventricular origin (QRS is upright in lead II).
Sometimes the ventricular premature beats are multiform.
While the exact number of VPCs above which a dog should be considered affected is unknown, the observation of >100 VPC's/24 hours is highly suspicious, and periods of couplets, triplets, or runs of ventricular tachycardia are generally considered abnormal.
Note: Since the arrhythmias are intermittent, a normal routine (i.e. 2-minute) ECG does NOT rule out the disease, thus it can be a very poor screening test. A 24-hour Holter monitor is much more useful for screening, and is also recommended to evaluate the quantity and complexity of arrhythmia in a Boxer that does exhibit ventricular arrhythmias on routine ECG.
- Supraventricular premature beats
- Aupraventricular tachycardia
- Atrial fibrillation
- Normal findings are most common
- General cardiomegaly with mild to moderate left atrial enlargement, pulmonary venous congestion, and pulmonary edema are seen in the uncommon form with LV systolic dysfunction
- The majority of affected Boxers have a normal echocardiogram
- A small percentage (~7%) have evidence of left ventricular dilation and hypokinesis (systolic dysfunction)
The criteria for initiating therapy in asymptomatic dogs remain ill-defined, and depend not only on the absolute number of VPCs observed but also on the complexity of the arrhythmia. Antiarrhythmic therapy is generally indicated if:
Frequent premature beats are present (certainly if >1000 VPC's/24 hours on a Holter monitor, and potentially if >500/24 hours) There are runs of ventricular tachycardia The VPCs exhibit a very short coupling interval (R-on-T phenomenon)
Based on work by Dr. K. Meurs et al, the most efficacious antiarrhythmics for Boxers with ARVC are:
- Sotalol: 1.5-3.5 mg/kg BID (PO)
- Combination of mexiletine and atenolol
mexiletine: 5-8 mg/kg TID (PO)
atenolol: 0.3-0.6 mg/kg or 12.5 mg/DOG BID (PO)
- Antidysrhythmic therapy can be instituted as described per asymptomatic cases
- In acute situations, procainamide or lidocaine may be used:
- Procainamide 6-8 mg/kg (IV) over 5 min, then 25 to 30 ug/kg/min CRI for 3 hours
- Lidocaine 2 mg/kg IV bolus, then 25 to 75 ug/kg/min
It is important to recognize that sudden death is always possible. While the goal of antiarrhythmic therapy is to reduce this risk, sudden death is still possible in the face of antiarrhythmics.
- Asymptomatic dogs may live for several years without clinical signs
- Cardiac dysrhythmias with syncope but without heart failure:
- With antiarrhythmic therapy syncope can usually be dramatically reduced and most dogs survive for several to many years
- If they develop CHF their prognosis falls dramatically
- Congestive heart failure with cardiac dysrhythmias
- Usually fail to survive for more than 6 months
top Acquired Heart Disease: General
33 Does hypertrophic cardiomyopathy occur in the dog?
There have been very few reports of idiopathic hypertrophic cardiomyopathy in the dog. Most cases of left ventricular concentric hypertrophy are due to systemic hypertension and aortic stenosis (usually subaortic stenosis). Dr. Charla Jones has suggested that idiopathic hypertrophic cardiomyopathy may be common in the Golden Retriever. Dr. David Sisson has reported familial HCM in a line of pointer dogs. We have also observed HCM in several pointer dogs, Golden Retrievers, German Shepherds, Rottweilers, and Jack Russell Terriers. The significance of this disorder remains to be determined in the dog.
top Acquired Heart Disease: General
34 Pericardial disease: what types of disorders are there?
- Peritoneal-pericardial diaphragmatic hernia
- Pericardial defects
- Pericardial cysts
- Pericardial effusion
- Transudate or modified transudate (hydropericardium)
- Congestive heart failure (increased hydrostatic pressure)
- Hypoalbuminemia (reduced oncotic pressure)
- Exudate (pericarditis)
- Septic (bacterial, fungal)
- Sterile (idiopathic, uremic, immune)
- Hemorrhagic (hemopericardium)
- Neoplastic (hemangiosarcoma, heart base tumor, lymphosarcoma, mesothelioma)
- Traumatic
- Left atrial rupture
- Coagulopathy
- Idiopathic
- Constrictive pericarditis
- Neoplasia
- Infection (bacterial, fungal)
- Idiopathic
- Pericardial foreign body
- Pericardial mass lesion (with or without effusion or fibrosis)
- Pericardial cyst
- Granuloma (fungal infections)
- Neoplasia
top Acquired Heart Disease: General
35 Pericardial effusion - What is the abnormality?
Of all the causes of pericardial disease, the development of pericardial effusion is the most frequent pathogenic process or consequence of the pericardial disorder. The clinical signs of the pericardial disorder are thus a consequence of the pericardial effusion.
Pericardial effusion is the disorder characterized by the accumulation of fluid (serous, blood, chyle, pus) within the pericardial sac. As fluid collects it markedly impedes the filling ability of the heart (diastolic dysfunction). The right side of the heart tends to "suffer" most with this diastolic dysfunction.
Pericardial effusion may develop relatively slowly or may develop rapidly. If the fluid accumulates rapidly, right heart dysfunction occurs rapidly. If the fluid accumulates gradually, the pericardium can stretch to accommodate a great volume of fluid with minimal cardiac impairment.
Etiology: The idiopathic and neoplastic etiologies are by far the most common in the dog. Hemangiosarcoma (HSA) is the main tumor. Heart base tumor is another (most commonly chemodectoma or ectopic thyroid carcinoma). The disorder is uncommon in cats. The neoplastic (HSA) cause is the most common of all causes.
top Acquired Heart Disease: General
36 How does pericardial effusion present?
- Breeds - large breed dogs more commonly affected with both etiologies (German Shepherd and G. Shepherd crosses are most commonly affected with hemangiosarcoma)
- Age - middle aged and older
- Sudden weakness
- Exercise intolerance
- Increased respiratory effort
- The triad of muffled heart sounds, jugular venous distention, and weakened arterial pulses is diagnostic of pericardial effusion
- Signs of right heart failure
top Acquired Heart Disease: General
37 How is pericardial effusion diagnosed?
The diagnostic test of choice is echocardiography.
A presumptive diagnosis can be made with:
- A very large globose heart (loss of chamber contour)
- Pulmonary edema is very unusual
- Pleural effusions are common. When present these can markedly obscure the silhouette of the heart thus "hiding" the radiographic appearance of a globose heart.
- Pulmonary metastatic lesions may be present (HSA)
- In the cat with hypertrophic cardiomyopathy we have seen both pleural effusion and pericardial effusion
- Low amplitude QRS complexes
- Electrical alternans
- Usually normal (sinus rhythm)
- Sinus tachycardia
- Ventricular premature beats are common
- CBC evidence of hemangiosarcoma may be present (nucleated rbc, regeneration, schistocytes, with a fairly normal PCV)
- Pericardial effusion is readily detected
- A tumor present in the region of the right auricle, right atrium, or right ventricle in cases of hemangiosarcoma
- A tumor at the base of the aorta (heart base tumor) may be noted
- Cardiac tumors are easier to visualize while the effusion is still present
- Cytology of pericardial fluid.
- This analysis has been shown to be of little value in distinguishing between idiopathic and neoplastic etiologies. However, the pericardial fluid analysis may reveal a septic etiology or the presence of chyle
- Pneumopericardiography:
- At the time of centesis, a volume of carbon dioxide equal to 1/2 to 3/4 the volume of fluid removed from the pericardial sac is injected into the sac followed by both lateral radiographic views and a D/V and V/D view. This procedure has been useful to identify the presence of heart base tumors. The availability of cardiac ultrasound makes pneumopericardiography much less useful.
top Acquired Heart Disease: General
38 What is cardiac tamponade?
Cardiac tamponade refers to the condition whereby the pericardial effusion has caused a significant reduction in right ventricular function such that heart failure has resulted. Thus cardiac tamponade represents the most severe form or consequence of pericardial effusion. On physical examination the arterial pulses are markedly reduced, the heart sounds are muffled, and there is jugular venous distention. On history there is evidence of weakness, exercise intolerance, or syncope.
The presence of cardiac tamponade represents a cardiac emergency and requires immediate attention. Immediate pericardiocentesis is indicated.
top Acquired Heart Disease: General
39 How is pericardial effusion treated?
Goals of Therapy:
top Acquired Heart Disease: General
40 What is the prognosis with pericardial effusion?
top Acquired Heart Disease: General
41 What is constrictive pericardial disease?
top Acquired Heart Disease: General
42 What is pericardial disease in the cat?
top Acquired Heart Disease: General
43 Bacterial endocarditis - What is the abnormality?
Bacterial endocarditis is usually a multisystemic disorder associated with bacteremia and the infection of joints, kidneys, and cardiac valves.
The joint disease may be of two types:
The renal disease may result in acute renal failure due to diffuse ischemia or may be occult.
The cardiac disease may cause any of the following:
top Acquired Heart Disease: General
44 How does bacterial endocarditis present?
- Breeds -
- Dogs with congenital subaortic stenosis
- Large breed dogs are more commonly affected. German Shepherds are the most common breed affected overall.
- Age - middle age or older (ave. = 5 yrs)
- Sex - primarily in males
- Anorexia, lethargy, depression
- Vomiting
- Lameness
- Heart failure/congestive heart failure
- A new heart murmur of mitral valve insufficiency or
- Aortic valve insufficiency, previously undetected
- Exuberant arterial pulses occur when aortic insufficiency develops
- Dysrhythmias
- Fever
- Joint pain, swelling, heat
- Pale mucous membranes
- Dyspnea
- Congestive heart failure
Comment: The clinical signs of bacterial endocarditis are related to:
- Cardiac lesions
- Arterial emboli
- Host response to infection
top Acquired Heart Disease: General
45 How is bacterial endocarditis diagnosed?
The definitive diagnosis for bacterial endocarditis can be obtained by:
A presumptive diagnosis of bacterial endocarditis can be made by:
Results of diagnostic tests:
top Acquired Heart Disease: General
46 How is bacterial endocarditis treated?
Goals of therapy:
Comment: A high serum concentration of antibiotic and prolonged duration of therapy are necessary because of the difficulty in reaching bacteria within the vegetative lesion of platelets and fibrin. Bactericidal antibiotics are indicated because the host's phagocytic cells cannot always reach the infective organisms.
top Acquired Heart Disease: General
47 What is the prognosis with bacterial endocarditis?
The prognosis for cases of bacterial endocarditis is poor (50% die). If heart failure develops, the prognosis is grave.


text:
Get More Out Of GIS
TomTom map data can be shared across agencies, so you can more efficiently respond to standard and urgent challenges.Play Video
TomTom Map data can scale to meet any challenge. Our proven processes ensure comprehensive data sets that have been quality tested for over 20 years.Play Video
Government community operations require immediate access to most recent data to ensure consistency in planning and execution. TomTom updates their maps multiple times a day so that government operations gain access to the most current data.
You find more because we cover more. TomTom has detailed geospatial data on more roads for over 200 countries.Learn more


text:
Dr. Keri Dutkiewicz (email@example.com)
Director of Faculty Learning
Lansing - Serves all campuses
(571) 367-8236
I have over 15 years of college-level teaching experience. I have also worked in the corporate e-learning sector where I helped Fortune 100 companies envision and launch successful corporate universities and online learning initiatives. At Davenport, I currently serve as the Director of Faculty Learning. In this role, I align university-wide development initiatives with academic needs to provide professional development opportunities for faculty in all stages of their careers. I also teach courses in Professional Writing, Literature, and Global Cultures. As a military team member, I ensure our faculty have the information and skills needed to support military students while class is in session! I also work to support military and veteran faculty members by providing networking opportunities for these members of our academic team and by showcasing the unique expertise these faculty bring to our university community.


text:
Board of Trustees
The New Cumberland Public Library is governed by a seven-member board of trustees. Board members serve as community volunteers, overseeing the library's budget, strategic direction and overall service delivery.
- Elizabeth Stone, President
- Thomas Witt, Vice President
- Jon LaFaver, Treasurer
- Gennifer Ritchie, Secretary
- Jack Murray
- Linda Ries
- Barbara Warfel
The Board of Trustees meet the third Tuesdays of every month at 7:30 pm, except during July and December. All meetings are open to the public and held at the New Cumberland Public Library.


text:
zephz Women's Butterfly Lite Cheerleading Shoe
Product Information:
Get the audience's adrenaline pumping in the zephz® Women's Butterfly Lite cheerleading shoe. Stay cool on your feet throughout the whole game in a triple air-mesh upper for lasting breathability, while freshness is ensured thanks to an antimicrobial Turbo Dry™ interior lining. Vault into stunts with superior lift-off in a zephzlite™ heel wedge for ultimate grip and stability, so you can show off and cheer the team to victory.
- Triple air-mesh upper ensures breathable performance for dryness without sacrificing durability
- Antimicrobial Turbo Dry™ lining ensures freshness
- Stunt heel boosts lift-off and landing performance
- zephzlite™ heel wedge increases grip for acrobatic stability
- Easily cleaned with soap and water for renewable wear
- Style: CH0019L
- zephz
Country of Origin: ImportedWeb ID: 13105430
Customer Reviews:
Rated 3.8 out of 5�by 11 reviewers.
Rated 5 out of 5�by Jeri Great cheer shoes Required by cheer coach but my daughter loves the fit and how light they are. June 19, 2016
Rated 5 out of 5�by ls712 Great Buy! Shoes run one size small, so heed the reviews and order one size larger! Great product, my daughter is very happy with her new cheer shoes! August 24, 2015
Rated 5 out of 5�by Angela Excellent!!! Very comfortable....not slippery... My daughter is happy now.... September 4, 2014
Rated 1 out of 5�by dpo cheap cheer shoes I am disappointed in these shoes. They are cheer shoes, yet they have very little padding in them. At this price, I would suggest using a tennis shoe instead. December 10, 2013
Rated 5 out of 5�by Kal Fit great The reviews said to order two sizes larger. We ordered only one size larger and they are just a little big, but not enough to return. They are very comfortable. I would order the same size again. October 2, 2013
Rated 4 out of 5�by Diamond Run small!!! I think theses shoes are great, but beware these run small so make sure to go a full size up! September 24, 2013
Rated 3 out of 5�by steph ok the shoes I would were at cheer is these... their ok since im a cheerleader July 29, 2013
Rated 4 out of 5�by Tammy Shoe size and half too small nice looking shoes but way too small. Got a size larger but still about a size too small. June 29, 2013
Rated 3 out of 5�by Lori7 Beware the shoelaces This are pretty comfy shoes, look cute with any outfit. Are a bit thin for any exercise class. I would've given these shoes a better rating, but the shoelaces are SO LONG it was ridiculous that I ended up cutting them with a pair of scissors!! The excessive length of laces just look ridiculous. I don't think I'll be buying Zephz again. April 17, 2013
Rated 4 out of 5�by The Cheerleader Very Comfortable We ordered these shoes for cheerleading and they are very comfortable. The shoes run very small so had to order two sizes bigger. The store was great about returning the first pair and ordered us another pair right there at the store. September 9, 2012


text:
Colleen Graffy serves as the Deputy Assistant Secretary of State for Public Diplomacy in the Bureau of European and Eurasian Affairs."Hmm... Now what exactly is public diplomacy"? That is the question I am often asked.
I describe public diplomacy as the art of communicating a country's policies, values and culture to other peoples. It is an attempt to explain why we have decided on certain measures, and beyond that, to explain who we are.
My recent trip to Hungary might offer some insights into what public diplomacy is all about.
Before the trip I met with the Hungarian Ambassador to the U.S., Ambassador Dr. Ferenc Somogyi. We discussed how we might increase student exchanges--we both want more Americans coming to Hungary and more Hungarians coming to the U.S.! And we are both keen on increasing our cultural ties. Our Embassy in Budapest does a good job of bringing U.S. culture to Hungary from jazz to the Pittsburgh Symphony. Likewise the Hungarian Embassy has superb events including the recent celebration of the 70th birthday of Oscar-award winning Hungarian Director, Itzvan Szabo.
I arrived on Sunday in time to meet with the U.S. Foreign Service officers who, along with the locally engaged staff, make up the backbone of the Public Affairs team in every embassy. The Public Affairs Officer or "PAO" (everything is an acronym in the government!) in Hungary is Mike Hurley. Mike, along with the Cultural Affairs Officer (CAO) Mark Tauber and the Information Officer (IO) Jan Krc and I went over the schedule. Our combined view was that our public diplomacy efforts during my trip should be to reach out to young people and, where possible, to do so via "new" media.
The day ended with a drive up to the Ambassador's Residence for a briefing with Ambassador April Foley. The Ambassador has been pretty tireless (according to exhausted staff!) in crisscrossing the country—no city too large or too small—to engage with the Hungarian people. View many examples...
MondayAfter meeting with the whole Public Affairs Staff to discuss the latest from Washington and to bring them up to speed on some of our new public diplomacy developments, Mike, the Embassy Driver Attila Németh (who also takes amazing pictures so we have dubbed him "The Photographer—who also drives"), Laszlo Vizsey, the Cultural Assistant, and I set off for Veszprem. Veszprem is one of the oldest towns in Hungary and was one of the first Hungarian cities to establish a university so it was only fitting that the purpose of my visit was to speak with a great group of students at the University of Pannonia.
From there we headed to an "American Corner." American Corners are partnerships between the Public Affairs sections of U.S. Embassies and host institutions. They provide access to current and reliable information about the U.S. via book collections, the Internet, and through local programming to the general public. Our Embassy has set up four American Corners located throughout Hungary in: Pecs, Debrecen, Eger and Veszprem.
The American Corner Director, Judit Bertalan, and her assistant gave me a briefing on the "AC"and organized various local media interviews.
From there we met with local dignitaries, and I sampled that all important Hungarian dessert wine, Tokay, before racing back to Budapest in time to join Ambassador Foley for a meeting with 25 young political leaders from all four major parties. I love this tradition of giving flowers!
The day ended with an evening session with members of "Youth for Understanding" to explore how we can increase exchanges for young people.
Tuesday A celebration of "U.S. Days" coincided with my visit to the Budapest Business School and a super session with students.
From there it was a race back into central Budapest to the Tancsics Prison Compound in time to hear the incredibly engaging Professor Tama Katona (and father of one of our Press Assistants, Anna Katona seen here with Information Specialist Katalin Molnar) give a talk on the Revolution of 1848 and the historic prison site to students from Daniel Berzsenyi High School in Budapest and Tibor Jankay Bilingual Primary School in Bekescsaba. The visit, which was covered by the media (in case you read Hungarian) was significant because the compound, currently owned by the U.S., is part of a property exchange between the Hungarian government and the U.S. The students enjoyed meeting "Geo Bear" who is part of a social science project that elementary students in Arizona sent me to help them explore the world! Also present from Karinthy Frigyes Gimnazium was a Ben Franklin Fellow. I try to see Franklin Fellows in every country I visit--the Ben Franklin Transatlantic Fellowship is a new student exchange program for 15 to 19 year olds. More about the program...
Lunchtime offered a chance to meet with participants in the flagship educational exchange program, the Fulbright Program which has much support from both the U.S. Embassy and the Hungarian government.
The afternoon offered my first opportunity to visit a private college, The Budapest College of Communication and Business. It was fun to discuss public diplomacy with lively communications students, including "sports diplomacy" which you can see I take quite seriously.
<img data-cke-saved-src="http://hungary.usembassy.gov/uploads/images/1ar6ULM5MPpEhTuqfHYmjQ/graffy_babel1_600.jpg" src="http://hungary.usembassy.gov/uploads/images/1ar6ULM5MPpEhTuqfHYmjQ/graffy_babel1_600.jpg" alt="Evening with the ever-astute members of Cafe Babel" [state="" dept.]"="" width="150" hspace="2" vspace="2" border="0" align="right">And finally, an evening with the ever-astute members of Café Babel. The young, internet savvy pan-European Babelians are keen on policy and have branches in most European cities---why don't we have them in the U.S.?
Thanks to technology I was "virtually" transported to Debrecen, the second largest city in Hungary for a SKYPE videoconference with students of Arpad Toth High School. The questions were fascinating---ranging from a student that really wanted to study in the U.S. but was afraid because of all she read about guns and violence to whether American food was more than just junk food.
And finally, a tour of the magnificent Hungarian Parliament with Mayor and Member of Parliament, Dr. Gabor Tamas Nagy. Of particular interest was the Holy Crown of St. Stephen which had been spirited out of Hungary to protect it from the Germans and Soviets during World War II and returned by the U.S. in 1978. More...
My particular favorite was a (now forbidden from use) cigar holder! Each slot is numbered so Members of Parliament could remember which was their own. One could always tell whether a riveting speaker was holding forth inside the chamber by glancing down to ascertain the length of the ash. Winston Churchill would have loved that.
The visit ended with a working lunch with Members of Parliament who sit on the Hungarian-American Friendship Caucus.
More details on the trip...including a video by the Embassy's talented Norbert Vitez!
Students interested in internships in public diplomacy both in Washington, DC and at Embassies overseas will find more information at the State Department's Careers website.
More on public diplomacy in Europe and Eurasia...
Until the next trip!
Zharkov in U.S.A. writes:
It's nice we have someone to explain to foreigners why U.S. officials want certain measures and policies, but does anyone at the State Department ever listen to foreigners who reject our measures and policies, or is all communication only in one direction, from us to the masses?
How would Americans react to our government allowing foreign military bases in America in order to protect the U.S. government from overthrow by its citizens?
How would we react to British missile sites placed in Mexico and Canada, purportedly to protect Britain from Argentina?
How would we react upon debarking from a flight from Washington to Paris, to be told by French Customs officers that all Americans must undergo a strip search and fingerprinting in order to enter the country?
What would we think if Hungarian Customs officers seized all of our money because their dog barked at our purse?
One aspect of foreign policy that seems to be wrong is the inability of U.S. officials to visualize the situation if things were reversed and it was we who reject such policies and measures.
While U.S. military bases in foreign countries may be welcomed by oppressive governments to keep them in power, the citizens of those countries feel invaded and occupied, just as we would if the roles were reversed, yet there seems to be no U.S. effort to remove those bases.
Surrounding Russia with NATO members and missile bases does not reduce their level of paranoia that America plans to steal their oil.
The problem with empires, particularly ours, has always been that they act like empires, dictating instead of negotiating; demanding instead of requesting. Do we ever question how would we react if the situation was reversed?
Governments will always find pretextual reasons to oppress and control. Exercising power is the logical extension of possessing power. It is the restraint of power that America is all about - the limitation of federal power is what makes American different -- until recently.
So, when a foreign citizen says, "This is what is wrong with American foreign policy so why won't you change it," what is your answer?


text:
"C" Variations Concert presented by Turtle Dance Music
Category: KidsCategory: Music
Location: Adrian Lamb Room
Matt Mazur and Alex Kveton, expert musicians & performers of Turtle Dance Music will present a delightful 45 minute program of songs, movement and fun designed for kids on the autism spectrum & their families. Guests will have the opportunity to try out the different instruments duing the show, including guitar, banjo and viola!
Please register @ 203-594-5002


text:
Thursday, September 12, 2013 - Text by Dev Sukumar | Edwin Leung
Japan enjoyed a good day at the Adidas China Masters, with some impressive results in the second round today.
The performances of their young Men's Singles prospects in particular must have thrilled them. Kento Momota and compatriot Kazumasa Sakai emerged on top in their battles against Chinese youngsters; their twin victories ensured four spots for Japan in the quarter-finals. The other two spots were taken by experienced hands, Sho Sasaki and fifth seed Kenichi Tago. The latter disposed of Israel's Misha Zilberman (top right), 21-7 21-9.
World Junior champion Momota, who had upset fourth seed Tommy Sugiarto in the first round, continued to sparkle. Taking on Macau Open champion Chen Yuekun, Momota held off a belated challenge from his Chinese rival to take the first game. Chen levelled scores to take it to a decider, but Momota rushed to a 6-0 lead and remained ahead throughout to win the match 21-19 14-21 21-18.
Kazumasa Sakai too scored a three-game victory to reach his first Superseries quarter-final since his home Japan Open last year. World No. 180 Guo Kai (China) started strongly by taking the first game, but Sakai turned the match around early in the second game by flying to a 12-2 lead. The decider was well contested and points were close until 16-all, after which Sakai surged ahead to claim the match 15-21 21-12 21-17.
Others who booked quarter-final spots include Jan O Jorgensen (Denmark, 6), qualifier Son Wan Ho (Korea), and China's Wang Zhengming (7) and Zhou Wenlong. Comeback man Son Wan Ho overcame Tanongsak Saensomboonsuk of Thailand, 16-21 21-13 21-11, while fellow qualifier Zhou won his second three-game match in a row, beating Lee Dong Keun (Korea) 21-15 10-21 21-13.
Women's Singles saw only one seed survive. Top seed Li Xuerui (China) made the quarter-finals without hitting a shuttle, while her compatriots Han Li and Liu Xin stopped Koreans Sung Ji Hyun (4) and Bae Yeon Ju (8) respectively. Han Li avenged her Korea Open Superseries semi-final loss to Sung, who had won that tournament, beating her 21-18 14-21 21-14, while Liu Xin needed only two games to get past Bae Yeon Ju, 21-14 21-17. Porntip Buranaprasertsuk of Thailand (BWF home page) ousted No. 7 seed Minatsu Mitani of Japan, in a hard-fought contest, 16-21 21-18 24-22.
China secured five spots in the Women's Singles quarter-finals, but the notable exception was Wang Xin (centre below). The former world No. 2 Chinese, on a comeback trail from injury at the London Olympics, fell 21-13 21-16 to Sayaka Takahashi (Japan; left).
* In Men's Doubles, top seeds Lee Yong Dae/Ko Sung Hyun (Korea) and second seeds Hiroyuki Endo/Kenichi Hayakawa (Japan) sailed into the quarter-finals. The top seeds needed just 22 minutes to get past Shi Longfei/Zhang Ningyi (China) 21-6 21-9, while Endo/Hayakawa spent five minutes longer to decimate Luo Cheng/Ju Fangpengyu (China) 21-10 21-13.
* Japan's Misaki Matsutomo/Ayaka Takahashi, third seeds in Women's Doubles, were tested by Du Peng/Xiong Mengjing (China). The third seeds eventually prevailed after 66 minutes, 21-7 15-21 21-16.
* It was Indonesia's day in Mixed Doubles, with four pairs making the quarter-finals. Among the Indonesian winners were Praveen Jordan/Vita Marissa, who upset third seeds Sudket Prapakamol/Saralee Thoungthongkam (Thailand). The veteran Thais saved two match points in the second game but were outclassed in the third, 21-15 21-23 21-11.
« Back
» News archive
» Destination Dubai World Superseries Finals
» Tournament Calendar
» BWF World Ranking
» BWF Destination Dubai Rankings
» Head to Head
» Contact us
Tournament Calendar
BWF World Ranking
Rules and Regulations
Anti Doping Regulations
Unit 17.05 Level 17
Amoda Building
22 Jalan Imbi
55100 Kuala Lumpur
Tel: +6-03-2141 7155
Fax: +6-03-2143 7155


text:
What's your ultimate line up for a touring band for Paul, using only those who have been in his bands since 1970?
Not including occasional contributors like David Gilmour or Eric Stewart, just those who have been either proper members of Wings or his solo touring band.
Here's mine-
Drums - A straight fight between Joe English or Abe. Both contribute(d) fine backing vocals, which is a bonus, but for sheer stage presence I'm going to put Mr Abe Laboriel Jr. on the stool.
Keyboards - Wix has now been with Paul for 25 years!! That cannot be overlooked so he's a cert for the band. His old mate Linda is also guaranteed a place in my line up without debate.
Second guitar/bass - Sorry Brian and Hamish, but Denny Laine was too integral a part of Paul's career for so long to be ignored. I also was surprised to see just how big a presence he was on stage when I saw Rockshow at the cinema last year.
Lead guitar - For me this is a toss up between Robbie McIntosh and Jimmy McCulloch (after listening to Back In The World last night as part of my ongoing Maccathon I just can't justify considering Rusty). Anyway, Robbie would be the more versatile choice, but because of his potential for something really great had his life turned out happier, I'm going for young Jimmy.
So that's-
Drums - Abe Laboriel Jr.
Keys - Wix and Linda
Second guitar/bass - Denny Laine
Lead Guitar - Jimmy McCulloch
Oh, and Paul of course!


text:
Hey friends of this blog, and anyone else who may stumble upon it! Just wanted to let you know that I have started a new blog that (I think) will represent our lives more completely. Also, for business reasons, I wanted our blog to have the same name as our business, Going To Seed. It just makes good sense.
If you follow this blog currently, please hop on over here, to Going To Seed, and keep following! I will keep posting about Homestead related activity mostly, but with some other life happenings thrown in there as well. See you there!


text:
JRS Superstar
From the original artistic director responsible for the CHI and HAI flat iron comes the JRS Superstar collection. Founded in 2002 by Adam and Janine Shuman, JRS Superstar styling tools combine years of styling expertise and experimentation with the desire to create a healthier environment. JRS Superstar styling tools feature ceramic, ionic and tourmaline technologies delivering maximum results with minimal energy output.


text:
We find intersex frogs in agricultural landscapes, but in suburban and urban landscapes at three times the rate."compact size but there is pretty high diversity of land-cover types. So there is an active agricultural landscape in Connecticut, there are certainly a lot of suburbs. There are urban areas and there are still a lot of forests in Connecticut. Connecticut ranks third or fourth in the nation for population density, and it ranks third or fourth in the nation for the proportion forested. We can take advantage of that. So we worked in a set of land cover types: agricultural; undeveloped, which in Connecticut means forested; suburban, people with lawns and houses and schools and that sort of stuff; and urban, mostly around Hartford.
It is widely accepted that the way that toxins work in the environment is often in concert."absolutely been shown to happen as a matter of course. So that's a very potent estrogen. And those molecules are reasonably durable. But there are many other chemicals that were not created to be estrogens and yet can act like estrogens once they're out there. So one that many people may have heard of is Bisphenol A. That's the chemical BPA and there was federal legislation to remove it from baby bottles. It's a plasticizer. So it's an industrial chemical that's supposed to help us create something and then as a totally unintentional byproduct it can have this other kind of biological activity.
MORE FROM YALE e360
A Warning by Key Researcher
On Risks of BPA in Our Lives


text:
Cramer's 'Mad Money' Recap: Lose the Gloom and Doom
NEW YORK ( TheStreet) -- The Washington frightfest is almost over, according to Jim Cramer.
He told "Mad Money" viewers Wednesday it will be time soon to enjoy the fact that politics no longer matter to the markets.
The markets have overcome two of three big hurdles: the presidential election and the fiscal cliff. That leaves only the looming debt ceiling debate, and this last obstacle is actually the least worrisome, Cramer said.
The thing the markets feared most the last time the debt ceiling reared its ugly head was a U.S. debt downgrade, said Cramer, and that's exactly what it it got a little over a year ago.
Except that when the downgrade happened, the world didn't end as predicted. Cramer said this time around won't be any different. The media has a tendency to over-hype these events, which is why new regulations haven't crippled the banks and why another debt downgrade won't cripple the economy.
When push comes to shove, there has to be a debt ceiling deal because no politician gets re-elected if the government shuts down and Social Security checks don't go out on time, Cramer explained. In the meantime, even if we have to call ourselves the United States of Three-Ring Circuses, once the deal is done and certainty returns to the markets there will be a flood of new money rushing in.
That's why investors need to ignore the doom and gloom reporting and the wave of analyst downgrades, said Cramer, because the time to invest is before that money flows in, not afterwards.
Executive Decision
In the "Executive Decision" segment, Cramer spoke with Michael Sutherlin, president and CEO of Joy Global (JOY) , the mining equipment maker that forecast a turn in the Chinese economy back on Sept. 13 when Cramer last spoke with Sutherlin.
Sutherlin said his company continues to see improvement in China and is seeing a pickup in demand for everything from electricity to steel production to truck volumes to exports.
He said there's also a restocking story occurring in China, as power plants have reduced their inventory for coal from 31 days to just 18, while steelmakers have dropped their supplies from 18 days to just 12. As demand picks up, said Sutherlin, those levels will need to be replenished, something that will most likely occur in the second half of 2013.
Back in the U.S., Sutherlin said customers remain cautious, but he noted that investments are still being made and land for new mines is still being bought.
Cramer said he remains a believer in Joy Global because the company clearly has a handle on the global economy few other companies have.


text:
Having a greater proportion of registered nurses in a respiratory care centre is associated with fewer urinary infections and increased successful ventilator weaning
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
- Correspondence to
: Professor Di Twigg
School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia 6027, Australia; d.twigg{at}ecu.edu.au
- Accepted 4 March 2013
- Published Online First 20 March 2013
Commentary on:
Implications for practice and research
Policy makers and nurse leaders making staffing decisions must take into account the evidence linking nurse staffing, skill mix and patient outcomes.
Researchers must continue to investigate staffing models to determine the most cost-effective model that supports quality care and take full advantage of the registered nurse workforce, especially given predicted shortages.
This study explored the impact of skill mix model changes on patient outcomes in a critical care environment, specifically, a respiratory care centre based in a southern Taiwan medical centre. It identified that the cost of ventilator-dependent patients in Taiwan in 1999 was 3.5 billion New Taiwan dollars, equivalent to US$ 121 million. In this …


text:
Playing Field Location
Printer-friendly version
Playing Field Information
We are providing only the address at this time, there has been an error in the MAPQUEST link application. While we work on a resolution, we are providing the street address information and provided notes to playing fields. In addition, we are providing a DIRECT link to MapQuest - from which you can generate driving directions. Shortly we will restore the Mapping function.
Below you will find the address to Playing Field Pond St Recreation Facility for KINNOTES: Directions to Pond St can be found at http://www.kpsoccer.org/directions.shtml
|Field Name
|Pond St Recreation Facility
|Street Address
|33 Pond St
Get your Directions
Clearly we want to restore the old functionality between BAYS and MapQuest. However, in the mean time we have prepopulated the MapQuest address box with the field address above. If you click on the submit button you will be REDIRECTED to MapQuest, and can then generate your personal directions. We appreciate your patience while we correct this mattter.


text:
The commission is comprised of three members:
Any candidate nominated or appointed by the Governor to the Supreme Court or a Court of Appeal must be reviewed by the Commission on Judicial Appointments. The commission holds a public hearing to consider the candidate's qualifications, and the nomination or appointment is effective if and when confirmed by the commission. When a Court of Appeal candidate is being reviewed, the commission consists of the Chief Justice of California, the Attorney General of California, and the Senior Presiding Justice of the Court of Appeal of the affected district. When a Supreme Court candidate is being reviewed, the third member of the commission is the Presiding Justice who has presided longest on any Court of Appeal.
Guidelines for the Commission on Judicial Appointments (PDF, 22 KB)
(Adopted effective May 18, 1999; amended effective July 1, 2005, March 1, 2006, and November 19, 2007.)


text:
Offer hardworking families a chance to take their first step out of poverty. Learn more.
Support World CouncilWith Amazon Smiles!
In the dizzying aftermath of the Jan. 12 earthquake that leveled much of Port-au-Prince, a credit union association in the neighboring Dominican Republic mobilized to collect and deliver emergency supplies to its counterparts in Haiti. Credit unions left standing helped displaced members of other institutions get into their accounts with biometric identification cards and receive much-needed remittances. Established credit union networks proved critical in providing immediate relief and access to funds.
Federation Le Levier, a US$52 million-asset network of 16 credit unions serving 300,000 Haitians nationwide, is one such network helping frontline institutions that serve poor and low-income populations push crucial resources out to their members. The network lost five staff members in the earthquake, and eight of Le Levier's member institutions were damaged. Three of the institutions lost key offices to serve their 50,000 members: KOTELAM, CLEF and CPSA. KOTELAM, the largest credit union in Port-au-Prince, suffered severe damage to its headquarters, credit office and a branch office. In nearby Leogane, CLEF collapsed entirely, and looters took safes and equipment from both CLEF and Port-au-Prince-based CPSA.
Le Levier is working with these damaged credit unions to find alternative means of providing financial services to their members. At the same time, the federation is immersed in stabilizing displaced staff, identifying new premises and re-establishing contact with its members to aid their recovery efforts. The Dominican Republic's credit union association, AIRAC, is securing tents and basic food supplies for Pétionville-based Le Levier staff members — some without homes — who are working around the clock with a damaged office building to rebuild the federation's network systems.
Supported by U.S. Agency for International Development's (USAID) Haiti mission, Le Levier's investment last year in biometric ID cards and inter-institutional connectivity among its members is greatly facilitating recovery. At the time of the earthquake, members had mobilized total savings of US$35 million and had a credit portfolio of US$30 million. The ID cards permit members from each of the 16 affiliated credit unions access to their accounts at any other member institution.
CLEF members in Leogane are accessing their accounts at a nearby branch office of Le Levier member COSODEV. Credit unions in the same geographic zone are also sharing facilities in order to accommodate member institutions that have lost their buildings. Though destroyed in the earthquake, KOTELAM is creating a special office to aid members who have lost their records and identification. Rural credit unions that were structurally unaffected are providing teller space and responding to the high demand for liquidity.
Le Levier and its members have been key partners of the Haiti Integrated Finance for Value Chains and Enterprises (HIFIVE) program, which began in June 2009. The program, which was designed to encourage a dynamic Haitian economy by increasing the availability of financial products and services, is now working to rapidly mobilize initiatives to support economic recovery following the earthquake. The program is implemented by World Council of Credit Unions (WOCCU) under USAID's FIELD-Support Leader with Associates (LWA) cooperative agreement managed by the Academy for Educational Development (AED) and funded by USAID. TechnoServe is providing additional marketing support for value chains involved in the program.
WOCCU is coordinating a meeting with its microfinance partners, including Le Levier, and other financial service providers in Haiti this week to share information, review damage assessments, coordinate financial and technical assistance, discuss financial sector priorities for providing relief and rebuilding and look at longer term priorities in view of Haiti's new realities. Core HIFIVE partners ACME, FINCA, FONKOZE, MCC, MCN and Sogesol will also attend. The coordination of these institutions through both formal and informal networks will be crucial for restoring much-needed financial services to the people of Haiti.
Learn more about WOCCU's work in Haiti through the HIFIVE program: http://hifiveproject.org/.
Photos by Christian Kober