text:
Nancy Klimas
Nancy G. Klimas, MD, is an American researcher and physician who is the Director at the Institute for Neuro Immune Medicine at Nova Southeastern University in Miami and Ft. Lauderdale, Florida. She is, also: Director of Clinical Immunology Research, Miami VAMC; Professor of Medicine, Department of Clinical Immunology, College of Osteopathic Medicine, Nova Southeastern University; Chair, Department of Clinical Immunology, College of Osteopathic Medicine, Nova Southeastern University; and Professor Emerita, University of Miami, School of Medicine.[1]
Klimas is one of the authors of the 2011 case definition, International Consensus Criteria,[2] as well as, one of the authors of the 2003 Canadian Consensus Criteria for ME/CFS, published as Myalgic Encephalomyelitis/Chronic Fatigue Syndrome:Clinical Working Case Definition,Diagnostic and Treatment Protocols[3]
Likewise, she was one of the experts on the "Committee on the Diagnostic Criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome" that was convened for the 2015 Institute of Medicine report.[4]
Klimas served as past President of the Board of Directors of the International Association for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis from 2004-2009.[5] She was a voting member of the Health and Human Services's CFSAC committee from 04/01/07-04/01/11.[6]
- 2014, Rudy Perpich Senior Lectureship Award, presented to a distinguished CFS/FMS scientist, physician or healthcare worker awarded by IACFS/ME[7]
- 2011, Nelson Gantz Outstanding Clinician Award awarded to a physician who emulates Nelson Gantz's clinical acumen, his passion for medicine, and his empathy for persons with CFS/FM awarded by IACFS/ME[8]
Notable studies[edit]
- 2017, Fecal metagenomic profiles in subgroups of patients with myalgic encephalomyelitis/chronic fatigue syndrome (FULL TEXT)
Abstract - Background: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is characterized by unexplained persistent fatigue, commonly accompanied by cognitive dysfunction, sleeping disturbances, orthostatic intolerance, fever, lymphadenopathy, and irritable bowel syndrome (IBS). The extent to which the gastrointestinal microbiome and peripheral inflammation are associated with ME/CFS remains unclear. We pursued rigorous clinical characterization, fecal bacterial metagenomics, and plasma immune molecule analyses in 50 ME/CFS patients and 50 healthy controls frequency-matched for age, sex, race/ethnicity, geographic site, and season of sampling. Results: Topological analysis revealed associations between IBS co-morbidity, body mass index, fecal bacterial composition, and bacterial metabolic pathways but not plasma immune molecules. IBS co-morbidity was the strongest driving factor in the separation of topological networks based on bacterial profiles and metabolic pathways. Predictive selection models based on bacterial profiles supported findings from topological analyses indicating that ME/CFS subgroups, defined by IBS status, could be distinguished from control subjects with high predictive accuracy. Bacterial taxa predictive of ME/CFS patients with IBS were distinct from taxa associated with ME/CFS patients without IBS. Increased abundance of unclassified Alistipes and decreased Faecalibacterium emerged as the top biomarkers of ME/CFS with IBS; while increased unclassified Bacteroides abundance and decreased Bacteroides vulgatus were the top biomarkers of ME/CFS without IBS. Despite findings of differences in bacterial taxa and metabolic pathways defining ME/CFS subgroups, decreased metabolic pathways associated with unsaturated fatty acid biosynthesis and increased atrazine degradation pathways were independent of IBS co-morbidity. Increased vitamin B6 biosynthesis/salvage and pyrimidine ribonucleoside degradation were the top metabolic pathways in ME/CFS without IBS as well as in the total ME/CFS cohort. In ME/CFS subgroups, symptom severity measures including pain, fatigue, and reduced motivation were correlated with the abundance of distinct bacterial taxa and metabolic pathways. Conclusions: Independent of IBS, ME/CFS is associated with dysbiosis and distinct bacterial metabolic disturbances that may influence disease severity. However, our findings indicate that dysbiotic features that are uniquely ME/CFS-associated may be masked by disturbances arising from the high prevalence of IBS co-morbidity in ME/CFS. These insights may enable more accurate diagnosis and lead to insights that inform the development of specific therapeutic strategies in ME/CFS subgroups.[9]
- 2017, Multi-Site Clinical Assessment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (MCAM): Design and Implementation of a Prospective/Retrospective Rolling Cohort Study
"Abstract - In the Multi-Site Clinical Assessment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (MCAM), we relied on expert clinician diagnoses to enroll patients from 7 specialty clinics in the United States in order to perform a systematic collection of data on measures of myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS). Healthy persons and those with other illnesses that share some features with ME/CFS were enrolled in comparison groups. The major objectives were to: 1) use standardized questionnaires to measure illness domains of ME/CFS and to evaluate patient heterogeneity overall and between clinics; 2) describe the course of illness, identify the measures that best correlate with meaningful clinical differences, and assess the performances of questionnaires as patient/person-reported outcome measures; 3) describe prescribed medications, orders for laboratory and other tests, and management tools used by expert clinicians to care for persons with ME/CFS; 4) collect biospecimens for future hypothesis testing and for evaluation of morning cortisol profiles; and 5) identify measures that best distinguish persons with ME/CFS from those in the comparison groups and detect subgroups of persons with ME/CFS who may have different underlying causes. Enrollment began in 2012 and is planned to continue in multiple stages through 2017. We present the MCAM methods in detail, along with an initial description of the 471 patients with ME/CFS who were enrolled in stage 1."[10]
- 2017, Telephone-administered versus live group cognitive behavioral stress management for adults with CFS
Abstract - "OBJECTIVE: Chronic fatigue syndrome (CFS) symptoms have been shown to be exacerbated by stress and ameliorated by group-based psychosocial interventions such as cognitive behavioral stress management (CBSM). Still, patients may have difficulty attending face-to-face groups. This study compared the effects of a telephone-delivered (T-CBSM) vs a live (L-CBSM) group on perceived stress and symptomology in adults with CFS. METHODS: Intervention data from 100 patients with CFS (mean age 50years; 90% female) participating in T-CBSM (N=56) or L-CBSM (N=44) in previously conducted randomized clinical trials were obtained. Perceived Stress Scale (PSS) and the Centers for Disease Control and Prevention symptom checklist scores were compared with repeated measures analyses of variance in adjusted and unadjusted analyses. RESULTS: Participants across groups showed no differences in most demographic and illness variables at study entry and had similar session attendance. Both conditions showed significant reductions in PSS scores, with L-CBSM showing a large effect (partial ε2=0.16) and T-CBSM a medium effect (partial ε2=0.095). For CFS symptom frequency and severity scores, L-CBSM reported large effect size improvements (partial ε2=0.19-0.23), while T-CBSM showed no significant changes over time. CONCLUSIONS: Two different formats for delivering group-based CBSM-live and telephone-showed reductions in perceived stress among patients with CFS. However, only the live format was associated with physical symptom improvements, with specific effects on post-exertional malaise, chills, fever, and restful sleep. The added value of the live group format is discussed, along with implications for future technology-facilitated group interventions in this population.[11]
- 2016, Poor sleep quality is associated with greater circulating pro-inflammatory cytokines and severity and frequency of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) symptoms in women
"ABSTRACT: Objective - Poor sleep quality has been linked to inflammatory processes and worse disease outcomes in the context of many chronic illnesses, but less is known in conditions such as chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). This study examines the relationships between sleep quality, pro-inflammatory cytokines, and CFS/ME symptoms. Methods - Sixty women diagnosed with CFS/ME were assessed using the Pittsburgh Sleep Quality Index (PSQI), Fatigue Symptom Inventory (FSI) and Center for Disease Control and Prevention (CDC)-based CFS/ME symptom questionnaires. Circulating plasma pro-inflammatory cytokine levels were measured by ELISA. Multiple regression analyses examined associations between sleep, cytokines and symptoms, controlling for age, education, and body mass index. Results - Poor sleep quality (PSQI global score) was associated with greater pro-inflammatory cytokine levels: interleukin-1β (IL-1β) (β = 0.258, p = 0.043), IL-6 (β = 0.281, p = 0.033), and tumor necrosis factor-alpha (TNF-α) (β = 0.263, p = 0.044). Worse sleep quality related to greater fatigue severity (β = 0.395, p = 0.003) and fatigue-related interference with daily activities (β = 0.464, p < 0.001), and more severe and frequent CDC-defined core CFS/ME symptoms (β = 0.499, p < 0.001, and β = 0.556, p < 0.001, respectively). Conclusions - Results underscore the importance of managing sleep-related difficulties in this patient population. Further research is needed to identify the etiology of sleep disruptions in CFS/ME and mechanistic factors linking sleep quality to symptom severity and inflammatory processes."[12]
- 2016, Illness progression in chronic fatigue syndrome: a shifting immune baseline[13]
- 2016, Tracking post-infectious fatigue in clinic using routine Lab tests.
ABSTRACT:"BACKGROUND: While biomarkers for chronic fatigue syndrome (CFS) are beginning to emerge they typically require a highly specialized clinical laboratory. We hypothesized that subsets of commonly measured laboratory markers used in combination could support the diagnosis of post-infectious CFS (PI-CFS) in adolescents following infectious mononucleosis (IM) and help determine who might develop persistence of symptoms. METHODS: Routine clinical laboratory markers were collected prospectively in 301 mono-spot positive adolescents, 4 % of whom developed CFS (n = 13). At 6, 12, and 24 months post-diagnosis with IM, 59 standard tests were performed including metabolic profiling, liver enzyme panel, hormone profiles, complete blood count (CBC), differential white blood count (WBC), salivary cortisol, and urinalysis....RESULTS: Lower ACTH levels at 6 months post-IM diagnosis were highly predictive of CFS (AUC p = 0.02). ACTH levels in CFS overlapped with healthy controls at 12 months, but again showed a trend towards a deficiency at 24 months. Conversely, estradiol levels depart significantly from normal at 12 months only to recover at 24 months (AUC p = 0.02). Finally, relative neutrophil count showed a significant departure from normal at 24 months in CFS (AUC p = 0.01). Expression of these markers evolved differently over time between groups. CONCLUSIONS: Preliminary results suggest that serial assessment of stress and sex hormones as well as the relative proportion of innate immune cells measured using standard clinical laboratory tests may support the diagnosis of PI-CFS in adolescents with IM."[14]
- 2016, Dr. Nancy Klimas, Dr. Irma Rey and several other researchers studied patients who developed gastroparesis following a viral history of flu-like symptoms or gastroenteritis. Nine at of the eleven patients with Idiopathic Gastroparesis studied (82 %) had active enterovirus infection on gastric biopsies. The study conclusion was that "antiviral and/or immune therapies against enterovirus seem to be favorable, as most of our patients had resolution of their gastroparesis symptoms after treatment. This is the first study to identify enterovirus as a possible infectious etiology of idiopathic gastroparesis.[15]
- 2015, Findings from a clinical and laboratory database developed for discovery of pathogenic mechanisms in myalgic encephalomyelitis/chronic fatigue syndrome. Abstract[16]
- 2015, Chronic fatigue syndrome and co-morbid and consequent conditions: evidence from a multi-site clinical epidemiology study. Abstract[17]
- 2015, Distinct plasma immune signatures in ME/CFS are present early in the course of illness FULL TEXT
"Abstract: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is an unexplained incapacitating illness that may affect up to 4 million people in the United States alone. There are no validated laboratory tests for diagnosis or management despite global efforts to find biomarkers of disease. We considered the possibility that inability to identify such biomarkers reflected variations in diagnostic criteria and laboratory methods as well as the timing of sample collection during the course of the illness. Accordingly, we leveraged two large, multicenter cohort studies of ME/CFS to assess the relationship of immune signatures with diagnosis, illness duration, and other clinical variables. Controls were frequency-matched on key variables known to affect immune status, including season of sampling and geographic site, in addition to age and sex. We report here distinct alterations in plasma immune signatures early in the course of ME/CFS (n = 52) relative to healthy controls (n = 348) that are not present in subjects with longer duration of illness (n = 246). Analyses based on disease duration revealed that early ME/CFS cases had a prominent activation of both pro- and anti-inflammatory cytokines as well as dissociation of intercytokine regulatory networks. We found a stronger correlation of cytokine alterations with illness duration than with measures of illness severity, suggesting that the immunopathology of ME/CFS is not static. These findings have critical implications for discovery of interventional strategies and early diagnosis of ME/CFS."[18]
- 2014, Stress management skills, cortisol awakening response, and post-exertional malaise in Chronic Fatigue Syndrome[19]
- 2012, Minimum data elements for research reports on CFS. Full text
Abstract: "Chronic fatigue syndrome (CFS) is a debilitating condition that has received increasing attention from researchers in the past decade. However, it has become difficult to compare data collected in different laboratories due to the variability in basic information regarding descriptions of sampling methods, patient characteristics, and clinical assessments. The issue of variability in CFS research was recently highlighted at the NIH's 2011 State of the Knowledge of CFS meeting prompting researchers to consider the critical information that should be included in CFS research reports. To address this problem, we present our consensus on the minimum data elements that should be included in all CFS research reports, along with additional elements that are currently being evaluated in specific research studies that show promise as important patient descriptors for subgrouping of CFS. These recommendations are intended to improve the consistency of reported methods and the interpretability of reported results. Adherence to minimum standards and increased reporting consistency will allow for better comparisons among published CFS articles, provide guidance for future research and foster the generation of knowledge that can directly benefit the patient."[20]
- 2012, Biomarkers for chronic fatigue.[21]
- 2012, Cytokine expression profiles of immune imbalance in post-mononucleosis chronic fatigue[22]
- 2010, Plasma neuropeptide Y: a biomarker for symptom severity in chronic fatigue syndrome[23]
- 2010, A Formal Analysis of Cytokine Networks in Chronic Fatigue Syndrome Full Text[24]
- 2005, Stress-associated changes in the steady state expression of latent Epstein-Barr Virus: Implications for Chronic Fatigue Syndrome and Cancer
Abstract - "Antibodies to several Epstein-Barr virus (EBV)-encoded enzymes are observed in patients with different EBV-associated diseases. The reason for these antibody patterns and the role these proteins might play in the pathophysiology of disease, separate from their role in virus replication, is unknown. In this series of studies, we found that purified EBV deoxyuridine triphosphate nucleotidohydrolase (dUTPase) can inhibit the replication of human peripheral blood mononuclear cells in vitro and upregulate the production of TNF-alpha, IL-1beta, IL-6, IL-8, and IL-10. It also enhanced the ability of natural killer cells to lyse target cells. The EBV dUTPase also significantly inhibited the replication of mitogen-stimulated lymphocytes and the synthesis of IFN-gamma by cells isolated from lymph nodes and spleens obtained from mice inoculated with the protein. It also produced sickness behaviors known to be induced by some of the cytokines that were studied in the in vitro experiments. These symptoms include an increase in body temperature, a decrease in body mass and in physical activity. The data provide a new perspective on how an early nonstructural EBV-encoded protein can cause immune dysregulation and produce clinical symptoms observed in patients with chronic fatigue syndrome (CFS) separate from its role in virus replication and may serve as a new approach to help identify one of the etiological agents for CFS. The data also provide additional insight into the pathophysiology of EBV infection, inflammation, and cancer."[25]
- 2003, Identification of ambiguities in the 1994 chronic fatigue syndrome research case definition and recommendations for resolution[26]
- 2003, Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols
"Abstract - Recent years have brought growing recognition of the need for clinical criteria for myalgic encephalomyelitis (ME), which is also called chronic fatigue syndrome (CFS). An Expert Subcommittee of Health Canada established the Terms of Reference, and selected an Expert Medical Consensus Panel representing treating physicians, teaching faculty and researchers. A Consensus Workshop was held on March 30 to April 1,2001 to culminate the review process and establish consensus for a clinical working case definition, diagnostic protocols and treatment protocols. We present a systematic clinical working case definition that encourages a diagnosis based on characteristic patterns of symptom clusters, which reflect specific areas of pathogenesis. Diagnostic and treatment protocols, and a short overview of research are given to facilitate a comprehensive and integrated approach to this illness. Throughout this paper, "myalgic encephalomyelitis" and "chronic fatigue syndrome" are used interchangeably and this illness is referred to as "ME/CFS."[27]
- 2001, Cytokine and Other Immunologic Markers in Chronic Fatigue Syndrome and Their Relation to Neuropsychological Factors[28]
- 2000, Comparative Analysis of Lymphocytes in Lymph Nodes and Peripheral Blood of Patients with Chronic Fatigue Syndrome
"Abstract - Blood and lymph node samples were obtained from patients with chronic fatigue syndrome (CFS) who had volunteered to undergo a lymph node biopsy while participating in a phase 1 clinical trial of a novel immunomodulatory therapy. The surface marker phenotypes of the peripheral blood and lymph node samples were examined using four-color flow cytometry and compared to published proportions of cells in peripheral blood and lymph nodes from control individuals. While a greater proportion of T lymphocytes from both lymph nodes and peripheral blood of control subjects are immunologically "naive" (CD45RA+), the proportions of lymphocytes with a "memory" phenotype predominate in lymph nodes and peripheral blood of CFS patients. CFS has been proposed to be a disease of autoimmune etiology and in this respect it is interesting to note that decreased proportions of CD45RA+ T ("naive") cells are also seen in the peripheral blood of patients with autoimmune diseases."[29]
- 2000, Chronic Fatigue Syndrome: Evidence Supporting the Hypothesis of a Behaviorally-Activated Neuromodulator of Fatigue
"Abstract - Chronic Fatigue Syndrome (CFS) is a disorder characterized by a prolonged, debilitating fatigue of unknown etiology. In addition, patients with CFS frequently report enhanced fatigue symptoms following even mild physical exertion, and their tolerance for physical exercise is limited relative to healthy individuals. The physiological mechanisms underlying the excessive fatigue and weakness common to this disorder remain an issue of scientific debate. Collectively, the available data suggest that fatigue in CFS is not due to any neuromuscular dysfunction, per se, but possibly is caused or influenced by some centrally acting mediator that is released during behavioral activities that require physical or mental exertion. In addition to persistent fatigue, there is growing evidence that many CFS patients exhibit alterations in hypothalamic-pituitary-adrenal (HPA) axis and autonomic function, including the inability to maintain the blood pressure response to orthostatic challenge. When an individual engages in mental or physical behavioral activation, there is a release of numerous centrally acting neuromodulators, some of which have been postulated to influence fatigue. This paper examines the evidence supporting a common pathway through which these centrally-mediated psychological and autonomic abnormalities may be linked. It is hypothesized that as a consequence of behavioral activation there is an abnormality in neuromodulator release or action in individuals with CFS, and that this abnormal neuromodulator activity results in increased fatigue. Furthermore, it is postulated that the CNS initiates a counter-regulatory mechanism to reduce the activity of those systems responsible for the production of the neuromodulator; and that the consequence of this counter-regulatory maneuver is the prevailing dysregulation of the autonomic and HPA axes and other dysfunctional cardiovascular and immunological sequelae."[30]
- 2000, Clinical and Immunologic Effects of Autologous Lymph Node Cell Transplant in Chronic Fatigue Syndrome
"Abstract - An open labeled, phase 1, safety and feasibility study using lymph node extraction, ex vivo lymph node cell expansion, followed by autologous cell reinfusion was evaluated as a potential immunomodulatory treatment strategy in patients with chronic fatigue syndrome (CFS). The experimental therapy utilized the cells of the lymph node, activated and grown in culture with defined media, interleukin-2 (IL-2) and anti-CD3 to activate and enhance cellular immunological functions. This procedure was designed to change the cytokine pattern of the lymph node lymphocytes to favor expression of T-helper (Th)l-type over Th2-type cytokines. The mixed population of ex vivo immune-enhanced cells were reinfused into the donor, who was carefully monitored for adverse events and possible clinical benefit. There were no adverse events. There were significant improvements in clinical status in association with a significant decrease in Th2-type cytokine production.[31]
- 2000, Immunotherapy of Chronic Fatigue Syndrome: Therapeutic Interventions Aimed at Modulating the Th1/Th2 Cytokine Expression Balance
"Abstract - Based on the postulates of viral and autoimmune etiologies of CFS, several interventions have been designed and tested by different research groups around the world, including the United States, Sweden, United Kingdom, Italy, and Japan. This review addresses those interventions aimed at altering the balance of certain cytokines, the mediators of immune responses. Patients with CFS who show evidence of activation of the immune system have poor immune cell function and a predominance of what is called a T-helper (Th)2-type cytokine response when their lymphocytes are activated. A Th2-type response, which is characterized by production of cytokines such as interleukin (IL)−4, −5, and −10, favors the function of B lymphocytes, the cellular factories of immunoglobulins. A predominance of a Th2-type response is therefore consistent with pathologies, such as autoimmunity and atopy, which are based on inappropriate production of immunoglobulins. Many of the CFS therapies discussed decrease the Th2-type predominance seen at baseline in CFS patients, thereby allowing a greater predominance of a Thl-type response, which favors the function of macrophages and natural killer cells. The function of the latter cells, which have the natural ability of directly destroying invading microbes and cancer cells, is defective in untreated CFS patients. Typical Thl-type cytokines include IL-2 and interferon-gamma, and some of the therapies induce their production. The interventions discussed in this review cover a wide spectrum of therapeutic tools ranging from lymph node cell immunotherapy, herbal products, and small molecules to vaccines. Despite the controversies on the etiology of CFS, immunotherapy research is useful and necessary.[32]
- 1996, Interindividual Immune Status Variation Patterns in Patients with Chronic Fatigue Syndrome: Association with Gender and the Tumor Necrosis Factor System
Abstract - "Changes in soluble immune mediator levels in association with the chronic fatigue syndrome (CFS) usually occur within normal ranges and are apparent mainly as changes in the skewness of population distributions. The latter finding undermines the usefulness of cytokine levels as clinical tools at the individual level as has been seen in sepsis syndrome where a similar overlap occurs. Nonetheless, changes in cytokine levels at the population level can contribute to an understanding of the disease process. For example, we reported previously that significant proportions of CFS patients showed elevated serum levels of either soluble tumor necrosis factor-receptor I (sTNF-RI, sCD120a) or TNF-a as compared to controls. The latter results could reflect different disease processes or extremes of a common disease process. Using sera collected over a five-year period, we have now studied an extended cohort of 108 CFS patients and our results are consistent with a common graded disease process. When we assessed the effect of gender on the distributions of serum levels of immune mediators, levels of sTNF-RI, sTNF-RII (sCD 12Ob), sIL-6R (sCDl26), and sICAM-1 were found to be consistently higher among males than females and among CFS patients as compared to controls regardless of gender. Moreover, differences in soluble immune mediator levels between CFS and control individuals were more clearly defined when restricting the analysis to the female gender. These observations are consistent with endocrine influences on immunological changes."[33]
- 1995, Physical symptoms of chronic fatigue syndrome are exacerbated by the stress of Hurricane Andrew[34]
- 1995, Relationships of Cognitive Difficulties to Immune Measures, Depression and Illness Burden in Chronic Fatigue Syndrome - Abstract[35]
- 1994, Dysregulated expression of tumor necrosis factor in chronic fatigue syndrome: interrelations with cellular sources and patterns of soluble immune mediator expression
"ABSTRACT: Among a group of 70 individuals who met the criteria established by the Centers for Disease Control and Prevention (Atlanta) for chronic fatigue syndrome (CFS), 12%-28% had serum levels exceeding 95% of control values for tumor necrosis factor (TNF) alpha, TNF-beta, interleukin (IL) 1 alpha, IL-2, soluble IL-2 receptor (sIL-2R), or neopterin; overall, 60% of patients had elevated levels of one or more of the nine soluble immune mediators tested. Nevertheless, only the distributions for circulating levels of TNF-alpha and TNF-beta differed significantly in the two populations. In patients with CFS--but not in controls--serum levels of TNF-alpha, IL-1 alpha, IL-4, and sIL-2R correlated significantly with one another and (in the 10 cases analyzed) with relative amounts (as compared to beta-globin or beta-actin) of the only mRNAs detectable by reverse transcriptase-coupled polymerase chain reaction in peripheral-blood mononuclear cells: TNF-beta, unspliced and spliced; IL-1 beta, lymphocyte fraction; and IL-6 (in order of appearance). These findings point to polycellular activation and may be relevant to the etiology and nosology of CFS."[36]
Interviews & talks[edit]
There are many videos on YouTube of Nancy Klimas speaking about her work.[37]
- Dec 2, 2016, Episode 84 of ME/CFS Alert - Dr Nancy Klimas on ME/CFS Research, Treatment
- Dec 1, 2016 NBCDFW video interview and transcription
- 2014 ME/CFS Diagnosis and Name with Dr. Nancy Klimas
- 2014 ME/CFS Treatment Options Part 1 with Dr. Nancy Klimas
- 2014 ME/CFS Treatment Options Part 2 with Dr. Nancy Klimas
- ME/CFS and Exercise: VO2 Max Testing with Nancy Klimas M.D. PREVIEW
- 2011 ME/CFS Management A Pathogenesis Based Approach (sponsored by ANZMES)
- From Bedside to Bench and Back Again: Untangling the Mystery of Gulf War Illness and Chronic Fatigue Syndrome
- "They experience a level of disability equal to that of patients with late-stage AIDS and patients undergoing chemotherapy"[38]
Open Letter to The Lancet[edit]
Two open letters to the editor of The Lancet urged the editor to commission a fully independent review of the PACE trial, which the journal had published in 2011. In 2016, Dr. Klimas, along with 41 colleagues in the ME/CFS field, signed the second letter.
- 10 February 2016, An open letter to The Lancet, again - Virology blog
Online presence[edit]
Learn more[edit]
See also[edit]
- Dr. Gordon Broderick
- Dr. Mary Ann Fletcher
- Dr. Irma Rey
- Dr. Maria Vera
- Institute for Neuro Immune Medicine
- ↑ http://www.nova.edu/nim/clinic/dr.-nancy-klimas-bio-page.html
- ↑ Carruthers, BM; van de Sande, MI; De Meirleir, KL; Klimas, NG; Broderick, G; Mitchell, T; Staines, D; Powles, A C P; Speight, N; Vallings, R; Bateman, L; Baumgarten-Austrheim, B; Bell, DS; Carlo-Stella, N; Chia, J; Darragh, A; Jo, D; Lewis, D; Light, A; Marshall-Gradisnik, S; Mena, I; Mikovits, JA; Miwa, K; Murovska, M; Pall, ML; Stevens, S (2011), "Myalgic encephalomyelitis: International Consensus Criteria.", Journal of Internal Medicine, 270 (4): 327-38, PMID 21777306, doi:10.1111/j.1365-2796.2011.02428.x
- ↑ http://phoenixrising.me/wp-content/uploads/Canadian-definition.pdf
- ↑ http://www.ncbi.nlm.nih.gov/books/NBK284904/
- ↑ http://iacfsme.org/Organization/Committees-of-the-IACFS-ME.aspx
- ↑ http://nih.granicus.com/DocumentViewer.php?file=nih_e174f9bd-ae0f-4a45-9955-827cb608db2f.pdf
- ↑ http://iacfsme.org/Organization/Former-IACFS-ME-Awardees.aspx
- ↑ http://iacfsme.org/Organization/Former-IACFS-ME-Awardees.aspx
- ↑ Nagy-Szakal, Dorottya; Williams, Brent L.; Mishra, Nischay; Che, Xiaoyu; Lee, Bohyun; Bateman, Lucinda; Klimas, Nancy G.; Komaroff, Anthony L.; Levine, Susan; Montoya, Jose G.; Peterson, Daniel L.; Ramanan, Devi; Jain, Komal; Eddy, Meredith L.; Hornig, Mady; Lipkin, W. Ian (2017), "Fecal metagenomic profiles in subgroups of patients with myalgic encephalomyelitis/chronic fatigue syndrome", Microbiome, 5 (44), doi:10.1186/s40168-017-0261-y
- ↑ Unger, Elizabeth R.; Lin, Jin-Mann S.; Tian, Hao; Natelson, Benjamin H; Lange, Gudrun; Vu, Diana; Blate, Michelle; Klimas, Nancy G.; Balbin, Elizabeth G.; Bateman, Lucinda; Allen, Ali; Lapp, Charles W.; Springs, Wendy; Kogelnik, Andreas M.; Phan, Catrina C.; Danver, Joan; Podell, Richard N.; Fitzpatrick, Trisha; Peterson, Daniel L.; Gottschalk, C. Gunnar; Rajeevan, Mangalathu S.; MCAM Study Group (2017), "Multi-Site Clinical Assessment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (MCAM): Design and Implementation of a Prospective/Retrospective Rolling Cohort Study.", American Journal of Epidemiology, 1–10, doi:10.1093/aje/kwx029
- ↑ Hall, DL; Lattie, EG; Milrad, SF; Czaja, S; Fletcher, MA; Klimas, N; Perdomo, D; Antoni, MH (2017), "Telephone-administered versus live group cognitive behavioral stress management for adults with CFS", J Psychosom Res, 93: 41-47, doi:10.1016/j.jpsychores.2016.12.004
- ↑ Milrad, Sara F.; Hall, Daniel L.; Jutagir, Devika R.; Lattie, Emily G.; Ironson, Gail H.; Wohlgemuth, William; Vera Nunez, Maria; Garcia, Lina; Czaja, Sara J.; Perdomo, Dolores M.; Fletcher, Mary Ann; Klimas, Nancy; Antoni, Michael H. (2016), "Poor sleep quality is associated with greater circulating pro-inflammatory cytokines and severity and frequency of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) symptoms in women", Journal of Neuroimmunology, 0 (0), doi:10.1016/j.jneuroim.2016.12.008
- ↑ Russell, Lindsey; Broderick, Gordon; Taylor, Renee; Fernandes, Henrique; Harvey, Jeanna; Barnes, Zachary; Smylie, AnneLiese; Collado, Fanny; Balbin, Elizabeth; Katz, Ben; Klimas, Nancy; Fletcher, Mary Ann (2016), "Illness progression in chronic fatigue syndrome: a shifting immune baseline", BMC Immunology, doi:10.1186/s12865-016-0142-3
- ↑ Harvey, Jeanna M; Broderick, Gordon; Bowie, Alanna; Barnes, Zachary M; Katz, Ben Z; O'Gorman, Maurice R; Vernon, Suzanne D; Fletcher, Mary Ann; Klimas, Nancy; Taylor, Renee (2016), "Tracking post-infectious fatigue in clinic using routine Lab tests.", BMC Pediatrics, 16 (54), doi:10.1186/s12887-016-0596-8
- ↑ Barkin, JA; Czul, F; Barkin, JS; Klimas, NG; Rey, IR; Moshiree, B (2016), "Gastric Enterovirus Infection: A Possible Causative Etiology of Gastroparesis", Digestive Diseases and Sciences, 61 (8): 2344-50, PMID 27344315, doi:10.1007/s10620-016-4227-x
- ↑ Klimas, N.G.; Ironson, G.; Carter, A.; Balbin, E.; Bateman, L.; Felsenstein, D.; Levine, S.; Peterson, D.; Chiu, K.; Allen, A.; Cunningham, K.; Gottschalk, C.G.; Fletcher, M; Hornig, M.; Canning, C.; Komaroff, A.L. (2015), "Findings from a clinical and laboratory database developed for discovery of pathogenic mechanisms in myalgic encephalomyelitis/chronic fatigue syndrome", Fatigue: Biomedicine, Health & Behavior, 3 (2): 75-96, doi:10.1080/21641846.2015.1023652
- ↑ Bateman, L.; Darakjy, S.; Klimas, N.; Peterson, D.; Levine, S.M.; Allen, A.; Carlson, S.A.; Balbin, E.G.; Gottschalk, G.; March, D. (2015), "Chronic fatigue syndrome and co-morbid and consequent conditions: evidence from a multi-site clinical epidemiology study", Fatigue: Biomedicine, Health & Behavior, 3 (1): 1-15, doi:10.1080/21641846.2014.978109
- ↑ Hornig, M; Montoya, JG; Klimas, NG; Levine, SM; Felsenstein, D; Bateman, L; Peterson, DL; Gottschalk, CG; Schultz, AF; Che, X; Eddy, ML; Komaroff, AL; Lipkin, WI (2015), "Distinct plasma immune signatures in ME/CFS are present early in the course of illness", Science Advances, 1 (1), doi:10.1126/sciadv.1400121
- ↑ Hall, DL; Lattie, EG; Antoni, MH; Fletcher, MA; Czaja, S; Perdomo, D; Klimas, NG (2014), "Stress management skills, cortisol awakening response, and post-exertional malaise in Chronic Fatigue Syndrome", Psychoneuroendocrinology, 49: 26-31, PMID 25049069, doi:10.1016/j.psyneuen.2014.06.021
- ↑ Jason, LA; Unger, ER; Dimitrakoff, JD; Fagin, AP; Houghton, M; Cook, DB; Marshall, GD, Jr; Klimas, N; Snell, C (2012), "Minimum data elements for research reports on CFS", Brain, Behavoir, Immunology, 26 (3): 401-6, PMID 22306456, doi:10.1016/j.bbi.2012.01.014
- ↑ Klimas, NG; Broderick, G; Fletcher, MA (2012), "Biomarkers for chronic fatigue.", Brain Behav Immun, 26 (8): 1202-10, PMID 22732129, doi:10.1016/j.bbi.2012.06.006
- ↑ Broderick, Gordon; Katz, Ben Z; Fernandes, Henrique; Fletcher, Mary Ann; Klimas, Nancy; Smith, Frederick A; O'Gorman, Maurice RG; Vernon, Suzanne D; Taylor, Renee (2012), "Cytokine expression profiles of immune imbalance in post-mononucleosis chronic fatigue", Journal of Translational Medicine, 10 (191), doi:10.1186/1479-5876-10-191
- ↑ Fletcher, Mary Ann; Rosenthal, Martin; Antoni, Michael; Ironson, Gail; Zeng, Xiao R; Barnes, Zachary; Harvey, Jeanna M; Hurwitz, Barry; Levis, Silvina; Broderick, Gordon; Klimas, Nancy G (2010), "Plasma neuropeptide Y: a biomarker for symptom severity in chronic fatigue syndrome", Behavioral and Brain Functions, 6 (76), doi:10.1186/1744-9081-6-76
- ↑ Broderick, Gordon; Fuite, Jim; Kreitz, Andrea; Vernon, Suzanne; Klimas, Nancy; Fletcher, Mary Ann (2010), "A Formal Analysis of Cytokine Networks in Chronic Fatigue Syndrome", Brain, Behavior, and Immunity, 24 (7): 1209–1217, doi:10.1016/j.bbi.2010.04.012
- ↑ Glaser, R.; Padgett, D.A.; Litsky, M.L.; Baiocchi, R.A.; Yang, E.V.; Chen, M.; Yeh, P-E.; Klimas, N.G.; Marshall, G.D.; Whiteside, T.; Herberman, R.; Kiecolt-Glaser, J.K.; Williams, M.V. (2005), "Stress-associated changes in the steady state expression of latent Epstein-Barr Virus: Implications for Chronic Fatigue Syndrome and Cancer", Brain, Behavior and Immunity, 19 (2): 91-103, PMID 15664781, doi:10.1016/j.bbi.2004.09.001
- ↑ Reeves, W. C.; Lloyd, A.; Vernon, S. D.; Klimas, N.; Jason, L. A.; Bleijenberg, G.; Evengard, B.; White, P. D.; Nisenbaum, R.; Unger, E. (2003), "Identification of ambiguities in the 1994 chronic fatigue syndrome research case definition and recommendations for resolution", BMC Health Services Research, 3 (25), doi:10.1186/1472-6963-3-25
- ↑ Carruthers, Bruce M.; Jain, Anil Kumar; De Meirleir, Kenny L.; Peterson, Daniel L.; Klimas, Nancy G.; Lerner, A. Martin; Bested, Alison C.; Flor-Henry, Pierre; Joshi, Pradip; Powles, A C Peter; Sherkey, Jeffrey A.; van de Sande, Marjorie I. (2003), "Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols", Journal of Chronic Fatigue Syndrome, 11 (2): 7-115, doi:10.1300/J092v11n01_02
- ↑ Patarca-Montero, Roberto; Antoni, Michael; Fletcher, Mary Ann; Klimas, Nancy (2001), "Cytokine and Other Immunologic Markers in Chronic Fatigue Syndrome and Their Relation to Neuropsychological Factors", Applied Neuropsychology, 8 (1): 51-64, doi:10.1207/S15324826AN0801_7
- ↑ Fletcher, Mary Ann; Maher, Kevin; Patarca-Montero, Roberto; Klimas, Nancy (2000), "Comparative Analysis of Lymphocytes in Lymph Nodes and Peripheral Blood of Patients with Chronic Fatigue Syndrome", Journal of Chronic Fatigue Syndrome, 7 (3): 65-75, doi:10.1300/J092v07n03_06
- ↑ Barry E. Hurwitz, Kimberly A. Brownley, Mary Ann Fletcher & Nancy G. Klimas. (2000). Chronic Fatigue Syndrome: Evidence Supporting the Hypothesis of a Behaviorally-Activated Neuromodulator of Fatigue. Journal of Chronic Fatigue Syndrome, Vol. 6, Iss. 1, pp. 45-63. http://dx.doi.org/10.1300/J092v06n02_06
- ↑ Nancy G. Klimas, Roberto Patarca Montero, Kevin Maher, & Mary Ann Fletcher. (2000). Immunotherapy of Chronic Fatigue Syndrome: Therapeutic Interventions Aimed at Modulating the Th1/Th2 Cytokine Expression Balance. Journal of Chronic Fatigue Syndrome, Vol. 8, Iss. 1, pp. 39-55. http://dx.doi.org/10.1300/J092v08n01_03
- ↑ Roberto Patarca Montero, Nancy G. Klimas & Mary Ann Fletcher. (2000). Immunotherapy of Chronic Fatigue Syndrome: Therapeutic Interventions Aimed at Modulating the Th1/Th2 Cytokine Expression Balance. Journal of Chronic Fatigue Syndrome, Vol. 8, Iss. 1, pp. 3-37. http://dx.doi.org/10.1300/J092v08n01_02
- ↑ Klimas, Nancy; Sandler, Dmitry; Garcia, Maria N.; Fletcher, Mary Ann (1996), "Interindividual Immune Status Variation Patterns in Patients with Chronic Fatigue Syndrome", Journal of Chronic Fatigue Syndrome, 2 (1): 13-39, doi:10.1300/J092v02n01_03
- ↑ Lutgendorf, SK; Antoni, MH; Ironson, G; Fletcher, MA; Penedo, F; Baum, A; Schneiderman, N; Klimas, N (1995), "Physical symptoms of chronic fatigue syndrome are exacerbated by the stress of Hurricane Andrew", Psychosomatic Medicine, 57 (4): 310-23, PMID 7480560
- ↑ Lutgendorf, Susan; Klimas, Nancy; Antoni, Michael; Brickman, Andrew; Fletcher, Mary Ann (1995), "Relationships of Cognitive Difficulties to Immune Measures, Depression and Illness Burden in Chronic Fatigue Syndrome", Journal of Chronic Fatigue Syndrome, 1 (2): 23-41, doi:10.1300/J092v01n02_03
- ↑ Patarca, Roberto; Klimas, Nancy; Lugtendorf, S; Antoni, Michael H.; Fletcher, Mary Ann (1994), "Dysregulated expression of tumor necrosis factor in chronic fatigue syndrome: interrelations with cellular sources and patterns of soluble immune mediator expression", Clinical Infectious Diseases, 18: S147-53, PMID 8148443
- ↑ YouTube - nancy klimas
- ↑ University of Miami ME/CFS Researcher Nancy Klimas, MD, Explains Complexity of Chronic Fatigue Syndrome in Terms That Anybody Can Understand
From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history


text:
6 hours agoCBA President Discusses the Potential Cut to Legal Services
4/24/20172017-2018 CBA Officers
3/24/2017The Honorable Maria A. Kahn Receives the 2017 Ladder Award
4/28/2017Ethical Issues Facing a Workers' Compensation Practitioner CLE (EWC170428)
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Environmental Law Section meeting at the Hartford Club.
Program: A CONVERSATION WITH DEEP COMMISSIONER ROB KLEE
Speaker: Commissioner Rob Klee, Dept. of Energy and Environmental Protection
Commissioner Rob Klee of the Connecticut Department of Energy and Environmental Protection will be the featured guest on December 3, 2015, when the Environmental Section of the Connecticut Bar Association meets at The Hartford Club.
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subset: commoncrawl


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There's nothing more soothing than relaxing with the sounds and smells of nature. If you live in a home with a concrete backyard, and you've been wishing you had a garden instead where you can unwind, here's an innovative solution for you! This daybed project is a lot easier and far more practical than digging up concrete backyard and turning it into a garden. You still get to enjoy taking a nap or reading a great book on a wonderful lawn and you get a great conversation starter thrown in!
kitchen garden …
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Fine Art Collection white green spring leaves collar and cuff unique shirt by PurpleFishBowl on Etsy https://www.etsy.com/listing/230119125/fine-art-collection-white-green-spring
Alexander McQueen Resort 2017
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Healthy Baked Broccoli Tots
Healthy Cashew Chicken - an easy 20 minute guilt-free gluten free skinny version (plus paleo friendly options) of the popular classic Chinese takeout dish. Plus a serving of tender crisp broccoli and red bell peppers for a healthier meal. Best of all, this recipe comes together in less than 25 minutes in just one pan! Perfect for busy weeknights! Plus a step-by-step how to video! Weekly meal prep for the week and leftovers are great for lunch bowls for work or school.


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Game Snapshot
LA Lakers
San Antonio Spurs
Thursday, January 12, 2017 at 8:35pm
Written by George Middleton on January 12, 2017
Los Angeles Lakers (15-27) at San Antonio Spurs (30-8)
NBA: Thursday, January 12, 2016, at 8:30 p.m. ET
Line: San Antonio -14.5
Over/Under: 210.5
The Los Angeles Lakers hit the road to take on the San Antonio Spurs for a Thursday night contest. On Nov. 18, the Spurs beat the Lakers 116-107. LaMarcus Aldridge and Kawhi Leonard led the Spurs with 23 points apiece. Los Angeles has won three of their last five games and San Antonio has won four of five. The Lakers balanced attack is led by Louis Williams who is averaging 17.7 points off the bench. Leonard leads the Spurs with averages of 24.1 points, 5.8 rebounds, and 1.9 steals. Los Angeles is 18th in the league in points (104.9 ppg) and San Antonio is 10th in offense (106 ppg). Can D'Angelo Russell lead the Lakers to a big upset win on the road?
The Los Angeles Lakers lost 108-87 to the Portland Trail Blazers on Tuesday night. Los Angeles was outscored Portland 53-30 in the second half. Luol Deng led the Lakers with 14 points and six rebounds in the loss. Brandon Ingram had 11 points on 2-of-2 from deep off the bench. Los Angeles had a difficult time containing C.J. McCollum who had 25 points on 10-of-18 shooting. The Lakers shot 39 percent from the field and the Trail Blazers shot 51 percent.
D'Angelo Russell finished with nine points (4/14 fg), eight rebounds, and six assists. Julius Randle added six points and 10 rebounds. Portland out-rebounded Los Angeles 50-38. The Lakers fell to 10-11 at home this season.
The San Antonio Spurs lost 109-107 to the Milwaukee Bucks on Tuesday night. San Antonio went into the fourth quarter up six before getting outscored 26-18. Manu Ginobili bricked a three-pointer as time expired to win the game. Leonard led the Spurs with 30 points and seven rebounds. Tony Parker had 14 points and seven assists. The Spurs shot 48 percent from the field and the Bucks shot 52 percent. LaMarcus Aldridge missed the contest due to a stomach virus. San Antonio had trouble defending Michael Beasley (28 points) and Jabari Parker (22 points).
Danny Green went for 14 points on 4-of-9 from deep. Jonathon Simmons added 14 points off the bench. Milwaukee committed 12 turnovers and San Antonio had 15. The Spurs fell to 13-5 at home this season.
The Los Angeles Lakers are:
The San Antonio Spurs are:
The Lakers are heavy underdogs for right reason but they should come out with some high intensity. Look for Russell and Randle to play well after they struggled on Tuesday. At the end Leonard and Aldridge will be too much but the Lakers will hang around.
A pair of NL Central rivals renew their acquaintance as they kick off a series in the Steel City. The Chicago Cubs continue a road trip as they open a set with the Pittsburgh Pirat... Read More
The Rays open a three game series in Baltimore on Monday against the Orioles. The Orioles are one of the better stories in baseball this year and they also own the best record in ... Read More
A pair of NL Central rivals renew their rivalry as they open a series in beer country. The Cincinnati Reds are on the road to open a trip as they kick off a set with the Milwaukee ... Read More
Tonight, the National League East meets the National League West as the Washington Nationals pay a visit to Coors Field in Denver, Colorado to grapple with the Colorado Rockies in ... Read More
National League West MLB action this evening and the San Diego Padres will tangle with the Arizona Diamondbacks in game one of a four-game series from Chase Field in Phoenix, Arizo... Read More
The Los Angeles Angels and Toronto Blue Jays will wrap up a four-game series when they meet again at Angel Stadium on Monday night.... Read More
Last Updated: January 12, 2017
George has his Bachelor's Degree from Cal State Long Beach in Communication Studies, minored in Journalism. He is an editor at Fansided powered network Air Alamo (San Antonio Spurs) and an NBA writer at RantSports. Plays in multiple basketball leagues. Has placed bets since the age of 15. Love watching basketball, baseball, and football games. Also loves Hip-Hop.
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7 viral videos with "Westboro Baptist Church"
The 7 best new Westboro Baptist Church Videos going viral on Youtube in April 2017 and of all time (in the archives).
Foo Fighters Rick Roll Westboro Baptist Church
Reporter Trolls Westboro Baptist Church At Golden Globes
Reporter Trolls Westboro Baptist Church In Malibu
Openly Gay Man Is Friends With Westboro Baptist Church
Reporter Trolls Westboro Baptist Church
Foo Fighters Anti-Protest Westboro Baptist Church Protest
Fred Phelps, Westboro Baptist Church Thanks God Gabrielle Giffords Is Shot
Keg Tapping: A How Not To Tutorial
When Bungeejumping Goes Wrong… Ouch
Dog Is Cute And Tough At The Same Time
Kermit The Frog Is Smooth As Hell In This Music Video
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Here on Viral Viral Videos you get to see the best and freshest viral videos from the whole internet, hand-picked and presented with love. Wheter the videos are just going viral, should go viral or have millions of views on YouTube - only quality and originality count. Viral Videos, Memes and GIFS. Laugh, cry, learn, share, and be amazed everyday at ViralViralVideos.com.
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Note Recipe shown with crisp pancetta and green onion scrambled egg rolls.
Why stop at savoury fritters when sweet ones are just as simple? Whether it's citrus, berries, perhaps even chocolate, you can make a quick, easy dessert from our top 10 sweet fritter recipes.
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We're championing fresh food that packs a flavour punch, from salads and vegetable-packed bowls to grains and light desserts.
Subscribe to Australian Gourmet Traveller for your chance to win a $20,000 Flight Centre gift card! Offer ends 24 May 2017.
Subscribe to Gourmet Traveller for your iPad or Android tablet.
Enjoy the best of both worlds on safari in Botswana's Okavango Delta. Creature-spot by day and have all the creature comforts by night at a trio of luxury retreats.
Well-being and local wisdom are on the menu at Amanjiwo.
While it's not as ubiquitous as Cantonese sweet and sour pork or Hainanese chicken rice, China's pork burger, rou jia mo, is having its moment in the sun.
Wondering where the new in-demand destinations are? We've pulled the results of our Gourmet Explorer quiz to highlight the new travel hotspots worth visiting and help inspire your next overseas jaunt.
"12. I'm now sitting at Noma with no shoes on. I feel like a toddler in a sandpit."
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Leaving her native Tasmania to break bread with fellow growers in the Blue Mountains is, writes Paulette Whitney, the best kind of busman's holiday.
"This is about dignity. This is about anyone walking through this door, taking what they need, and only giving back if they can."
These four desserts have one thing in common – Anzac biscuits.
We say si to these six takes on the Italian classic. From coffee and caramel to red wine and figs, panna cotta proves to be a versatile dessert to suit all palettes.
Nicolas Poelaert, the French chef who won praise at Brooks and Embrasse restaurants in Melbourne, is now making waves with his choux-pastry smarts in Newcastle.
Go wholegrain with brown rice in a bibimbap-inspired bowl of seaweed, amaranth and pickled shiitake mushrooms, serve it with Chinese roast duck, or simply fry it up Southern-style.
A classic recipe everyone should have in their repertoire.
Sausage rolls, vanilla slices and burgers with the lot: Australia's classics work both as nostalgic throwbacks and in their own right. These are the favourites we keep coming back to - from the humble steak sandwich to inventive takes on Tim Tams and Iced VoVos.


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you could make a real difference to a child
Find out more about adoption at one of our information events
Our parents and adopted children tell you why it is so rewarding
We'd love to talk to you if you want to know more, you can get in touch by online form:
15:53 Child stuck up a tree, Ermine Road, #Northampton
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Men's Eggle Co. LTD
203pages onAdd New Page
this wiki
this wiki
|Men's Eggle Co. LTD
|Company Type:
|Commercial Endorsement/Fashion Magazine
|Sponsored Hero:
|Current Status:
This company is aimed at focusing at what's trendy among the teenagers and young adults. Apparently they have an egg-motif, (hence its name). Its most popular item is its magazine Men's Eggle. Its sponsored hero/mascot is Yavais , an F Rank hero.


text:
We continue studying the characteristics of the warhorse.
Job 39:22: "Neither turneth he back from the sword."
Job's description of the warhorse states that it will never turn back from the sword. Though swords flash all around it, it still charges forward. There is not an atom of retreat in God's warhorse.
There is no retreating in God's service. God's warhorses always charge onward. "Onward Christian soldiers, marching as to war" is a mockery to a retreating church.
Onward, Christian soldiers, marching as to war,
With the cross of Jesus going on before.
Christ, the royal Master, leads against the foe;
Forward into battle see His banners go!
Such a magnificent song should never be sung by those who have no understanding of spiritual warfare.
Song of Solomon 6, 10 describes the church as "Terrible (majestic, inspiring) as an army with banners." These banners display the declaration of God's truths which are an awesome sight to behold. Psalm 60:4 says: "Thou hast given a banner to them that fear thee, that it may be displayed because of the truth."
In Revelation 19:11 the Commander in Chief of the church, Jesus Christ, rides a white warhorse. White represents purity and righteousness. Jesus Christ was called "Faithful and True" and all those who followed Him also rode white horses. Revelation 19:14 says: "And the armies which were in heaven followed him upon white horses, clothed in fine linen, white and clean."
They would never follow a Commander in Chief who made his reputation through building gambling casinos and all the sexual perversions that go with it. They would never follow a Commander in Chief whose wife posed herself nude for a pornographic magazine in Europe.
Men, we are in a great spiritual battle for the souls of the citizens of USA. We had better make sure the one we elect to follow as Commander in Chief is riding a pure white horse, as much as possible for an American president to ride.
He must be one who is faithful and true to his word--the testimony and character of one who is worthy to rule. He should not have a track record of flip-flopping on major issues of morality and justice. There should be no signs of retreat from the foundational truths on which our nation was founded.
I wonder, could it be that a people who lack moral backbone, who themselves flip-flop all over the place regarding morality, could easily elect a Commander in Chief who will hopefully amass them more money to follow more of their lusts?
I believe this is what we face in these coming elections. We must not retreat from the sword of our enemies. Never. But we will retreat if we as a nation, and as a church, do not take a strong stand for righteousness and truth. Righteous morality is the only thing that gives us backbone.
May we never be like the Ephraimites. Psalm 78:9-10 says: "The children of Ephraim, being armed, and carrying bows, turned back in the day of battle. They kept not the covenant of God, and refused to walk in his law."
Be encouraged.
Colin Campbell


text:
Featured property
Featured property
Featured property
4 Bedrooms Detached Bungalow for sale
Ferneyfield Road, Chadderton, Oldham, OL9
Recently reduced a three bedroom detached bungalow with the addition of a granny flat to the side. the property sits on a good sized plot on popular ferneyfield road and overlooks…
4 Bedrooms Detached House for sale
We are pleased to offer for sale this spacious 4 bedroom detached family home. located in the popular area of firwood park development north chadderton. close to mills hill primary…
4 Bedrooms Detached House for sale
Firwood Park, Chadderton, Oldham, OL9
A superbly presented four bedroom detached family home located on popular firwood park. the property has been well maintained and improved throughout and an internal inspection is…
3 Bedrooms Detached House for sale
Vacant possession/no chain involved is this well presented, extended detached house with off road parking to the front of the property. situated in a quiet cul-de-sac location on firwood…
4 Bedrooms Semi Detached House for sale
35 Hazelwood, Firwood Park, Chadderton
Popular location - with off road parking and gardens to both front and rear is this four bedroom, well presented, link detached property on the popular firwood park development. ideal…
3 Bedrooms Semi Detached House for sale
56 Chadderton Park Road, Chadderton, Oldham
No chain - a three bed semi detached in a sought after location close to local schools, amenities and a short drive from the nw motorway network. comprising entrance hall, cloaks,…
2 Bedrooms Semi Detached Bungalow for sale
No chain, spacious two bedroom true bungalow situated just off chadderton park road. the location is close to local transport links, shops and chadderton park.the area has good schools…
3 Bedrooms Semi Detached House for sale
Property located in 2 bramblewood, firwood park
3 Bedrooms Semi Detached House for sale
Property located in 2 bramblewood, firwood park
4 Bedrooms End Of Terrace House for sale
1118 Middleton Road, Chadderton
Spacious and well presented double fronted, four bedroom, end terraced house.shared courtyard. block paving to the side providing off road parking for one car. close to local schools,…
3 Bedrooms Semi Detached House for sale
Torwood Road, Chadderton, Oldham, OL9
An extended three bedroom semi detached property located in ever popular north chadderton and benefitting from being with walking distance to shops, schools and transport links. (contd...)
3 Bedrooms Semi Detached House for sale
Torwood Road, Chadderton, Oldham, OL9
An excellent opportunity to purchase this three bedroom semi-detached property situated on an elevated position which offers superb views. (contd...)
2 Bedrooms Terraced House for sale
Beautiful property in a fantastic area. original features and modern. ready to move into and a must see.
2 Bedrooms End Of Terrace House for sale
877 Middleton Road, Chadderton
An end terraced house that briefly comprises lounge, modern kitchen/diner, conservatory, two bedrooms and a shower room. located within easy reach of good local schools, amenities…
34 Ravenwood, Firwood Park, Chadderton
Popular location - a well presented mid town house that has been tastefully decorated throughout. off road parking is provided by a driveway to the front of the property. ideally located…
Marketed by:
Brooke Steel Estates, Oldham
Po Box 728
Greater Manchester
Tel: See phone number 0161 280 3140
Website: Go to Agent Website


text:
In order to successfully obtain a Masters qualification, you will need to obtain a number of credits by passing individual modules. Most taught Masters will have a number of core modules which you must take and pass in order to obtain the qualification. The assessment of research Masters is almost always entirely by a single dissertation module or project.
Management science is a field that contributes solutions to management problems in many industries. It may require workers to identify and understand strategies of a certain company, and taking those qualities and incorporating them into a larger plan of action meant to solve managerial issues.
Colombia is a truly diverse and unique country, located in the northwestern corner of South America. With friendly people, exotic landscapes and cosmopolitan cities, Colombia is definitely the place to learn Spanish.
Master Degree in Management Science in Colombia
or search for similar programs here


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Suggests Link in Variety of Diseases Such as Autism, Prostrate Cancer, & Ovarian Cancer
Zinc deficiency – long associated with numerous diseases, e.g. autism, lung cancer, prostate cancer, and ovarian cancers – can lead to activation of the Hedgehog signaling pathway, a biomolecular pathway that plays essential roles in developing organisms and in diseases, according to new research at Rensselaer Polytechnic Institute.
"Hedgehog is critical to normal development, but in adults the pathway, if reactivated, may lead to uncontrolled cell growth and proliferation in cancer," said Chunyu Wang, associate professor in biological sciences at Rensselaer, member of the Center for Biotechnology and Interdisciplinary Studies, and corresponding author of the research. "Our paper suggests a link between zinc deficiency and activation of the Hedgehog pathway in many diseases where zinc deficiency and Hedgehog activation co-exist."
The paper, titled "Zinc Inhibits Hedgehog Autoprocessing," was recently published online in the Journal of Biological Chemistry, demonstrating that zinc inhibits the activation of the Hedgehog signaling pathway by binding to a section of a precursor protein that activates the pathway.
The Hedgehog pathway is a key regulator of cell growth and development that helps to establish the body plan of all animals with bilateral symmetry. In a critical step that launches Hedgehog signaling, the Hedgehog precursor protein divides itself or "self-cleaves" into two parts: the Hedgehog ligand responsible for signaling, and a catalytic domain responsible for the self-cleavage. No external catalyst is needed in the autoprocessing reaction, with the Hedgehog catalytic domain acting as the catalyst in the transformation.
Researchers demonstrated that zinc, when present, binds to the active sites of the catalytic domain and inhibits the autoprocessing and therefore, the generation of the Hedgehog ligand. Zinc deficiency is correlated with autism and many cancers; for example, a hallmark of prostate cancer is zinc deficiency in prostate tissue. However, the exact relationship between a lack of zinc and the development of disease is not fully understood.
"Normally, in adults, zinc will inhibit the production of the Hedgehog ligand, and therefore inhibit the Hedgehog pathway," said Wang. "But if there is a zinc deficiency, the pathway can be activated due to enhanced production of Hedgehog ligand. We show that zinc inhibits this autoprocessing reaction from the precursor to the ligand, providing an additional mechanism of how zinc deficiency may promote cancer development. This is something that nobody else has shown before. Zinc and Hedgehog are essential and extremely versatile biomolecules; linking these two will have profound implications for normal physiology and disease."
The research included testing in vitro and in cell culture using astrocytes (star-shaped cells found in the brain). Using solution NMR, researchers also examined zinc interaction with the Hedgehog catalytic domain, to determine the binding site of zinc — the specific amino acids within the protein to which the zinc binds.
A team of researchers participated in this research, including first author Jian Xie, a fourth-year graduate student in the biochemistry and biophysics graduate program at Rensselaer; the research group of Brian Callahan, assistant professor of chemistry at Binghamton University, at the State University of New York; the group of Leo Wan, assistant professor in the Department of Biomedical Engineering at Rensselaer; and Brigitte Arduini, director of Rensselaer Center for Stem Cell Research in the Center of Biotechnology and Interdisciplinary Studies, among many others.
Contact Information
Mary Martialay
Sr. Communications Specialist
Phone: 518-276-2146
Mobile: 518-951-5650
Mary Martialay | newswise
Further information:
Further reports about: > Hedgehog > Hedgehog signaling pathway > Interdisciplinary > Polytechnic > amino acids > cancer development > catalytic > cell growth > deficiency > diseases > inhibit > numerous diseases > pathway > prostate > prostate cancer > signaling pathway > uncontrolled cell growth > zinc
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text:
A response to the attack in Britain.
A record number of incidents.
No-go zones on campus.
An Israeli official's bar-room chatter isn't a "plot."
She would have done better to exercise the power of veto.
Friends don't kick friends in the back.
Celebrating Britain's role in the Jewish state's creation.
Encouraged by the last shakedown.
How anti-Zionism, and something worse, has been brought into the mainstream of the British Labor party—and seems to be there to stay.
It should instead remain proud of its role in embracing Zionism.
And its belligerent refusal to face its problem.
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Not part of any colonial agenda.


text:
Search the Community
Showing results for tags 'woa'.
Found 383 results
Neville posted a topic in Want To SellHorse too slow? Land travel got you down? Put some pep in your horse's step! These shoes are guaranteed to speed! Contact me in-game or PM me. Note: The sum of the qualities of the shoes has an effect on the speed.
Velintar posted a topic in Merchant AdsBS imp: 90=50c, 95=1s, 96=1,5s, 97=2s, 98=5s, 99=10s FC imp: 90=1s, 91=1.25s 92=1.5s 93=1.75s 94=2s, 95=2,5s, 96=3,0s Regular custommers can get cumulative discount up to 50% on custom enchants. We do Custom Vynora & Nahjo enchants. Max target power is 97. (LT & MS only 90+ for now) Spell name \ Power 80-84 85-89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 Circle of Cunning 0.5 0.8 1.0 1.2 1.4 1.6 1.8 2.0 2.2 2.5 2.8 3.2 4.0 5.0 6.0 7.0 Wind of Ages 0.5 0.8 1.0 1.2 1.4 1.6 1.8 2.0 2.2 2.5 2.8 3.2 4.0 5.0 6.0 7.0 Aura of Shared Pain 0.5 0.8 1.0 1.2 1.4 1.6 1.8 2.0 2.2 2.5 2.8 3.2 4.0 5.0 6.0 7.0 Nimblennes 0.5 0.8 1.0 1.2 1.4 1.6 1.8 2.0 2.2 2.5 2.8 3.2 4.0 5.0 6.0 7.0 Mind Stealer 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5 6 7 8 10 12 15 17 Life Transfer 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5 6 7 8 10 12 15 17 Lurker in the Deep 0.3 0.5 0.8 0.9 1.0 1.25 1.5 1.75 2.0 2.25 2.5 3 3.5 4 4.5 5 Rares Rare Butchering Knife, iron QL_80 WoA_95 CoC_90 8,0 s/e Rare Butchering Knife, iron QL_80 WoA_96 CoC_90 8,4 s/e Rare Butchering Knife, iron QL_80 WoA_97 CoC_93 9,1 s/e Rare Butchering Knife, iron QL_80 WoA_92 CoC_98 9,2 s/e Rare throwel, iron QL_95 WoA_95 CoC_97 9,5 s/e Rare Fine fishing rod, cedarwood QL_90 CoC_95 7,0 s/e Rare Fine fishing rod, cedarwood QL_90 CoC_95 7,0 s/e Rare Exquisire meditation rug, cotton QL_82 CoC_99 8,0 s/e Rare sickle, iron QL_75 WoA_96 CoC_95 9,2s/e Rare sickle, iron QL_75 WoA_97 CoC_98 10,3 s/e Rare sickle, iron QL_75 WoA_98 CoC_99 11 s/e Rare sickle, iron QL_75 WoA_96 CoC_100 11,2 s/e Rare sickle, iron QL_75 WoA_99 CoC_101 13,2 s/e Supreme sickle, iron QL_85 WoA_96 CoC_98 30 s/e Items may have small dmg from time decoy Circle of Cunning Anvil Butchering Knife Carving Knife Grooming brush File Fine fishing rod Hatchets: Hammer Knife Iron Lump Mallets Meditation Rug Pickaxe Press Rake Sickle (iron) Shield (Iron) Shovel (Iron) Small Bucket Stone chisel (iron) Trovel Whetstones (may dmg from decay) Wind of Ages Hatchet Horse shoes Lump, Iron Pickaxe Rake Saw Shovel Stone Chisel Wind of Ages + Circle of Cunning (price include 10% discount) Awl Carving Knife File Hammer Hatchet Knife Lump Mallets Needle Pelts Pickaxe Rake Scissors Shovel Stone Chisel Trowel Whetstones (may dmg from decay)
best enchanted items
pepejot posted a topic in Merchant AdsMerchants (Pepejot, Tris) TOOLS (iron, steel) TOOLS (wood) WEAPONS ARMOURS AND SHIELDS HORSE GEAR MISC ITEMS MATERIALS If you need something else, just PM Pepejot or Tris HERE coordinates
Neville posted a topic in Want To Sell[22:12:56] A tool for mining. This is a very rare and interesting version of the item. It is glowing from the heat. It could be improved with a lump. [22:12:56] Wind of ages has been cast on it, so it will be quicker to use. [98] [22:12:56] A single bronze rune of Libila has been attached to it, so it will gather resources at a higher quality level (10%) [22:12:56] Circle of Cunning has been cast on it, so it will increase skill gained with it when used. [97] Price: 14s or best offer. Serious offers only.
RedMerchant posted a topic in Want To SellAll are 75 copper each. Buy 2 and get 1 items free. Need to clear out old stock. File 41q 85coc File 46q 85coc File 80q 80coc File 80q 87coc File 80q 89woa Hammer 80q 81woa Hammer 80q 85woa Needle 80q 80woa Needle 80q 81woa Needle 80q 84woa Needle 80q 85woa Needle 80q 88woa Scissors 7q 80coc Scissors 1q 81coc Scissors 6q 85coc Scissors 80q 83woa Scissors 80q 85woa Scissors 80q 85woa Leather Knife 1q 81coc Leather Knife 1q 81coc Leather Knife 1q 81coc Leather Knife 1q 82coc Leather Knife 1q 85coc Leather Knife 80q 80woa Leather Knife 80q 80woa Leather Knife 80q 83woa Leather Knife 80q 84woa Awl 1q 83coc Awl 1q 83coc Awl 80q 82coc Trowel 1q 85coc Trowel 1q 86coc Trowel 1q 88coc Trowel 80q 82woa Trowel 80q 85woa Trowel 80q 86woa Trowel 80q 88woa Trowel 80q 89woa
happyh7 posted a topic in AuctionsI'll auction this good looking thing. Starting bid: 1c Bid increase: 50c Reserve: None Buyout: Will consider offers Sniper: 1h
Neville posted a topic in AuctionsStarting Bid: 8s Min Increase: 50c Reserve: None Buyout: None Horse too slow? Land travel got you down? Put some pep in your horse's step! These shoes are guaranteed to speed! Get ready, set, place your bids!
Neville posted a topic in AuctionsNot enough bids. Reserve not met. Auction closed. Selling via Trade chat.
Jakeii posted a topic in AuctionsItem up for Auction: 91QL Rare STEEL Stone Chisel! [08:45:07] You can barely make out the signature of its maker, 'Enki'. [08:45:07] Wind of ages has been cast on it, so it will be quicker to use. [101] [08:45:07] It has been imbued with special abilities, and it improves stone cutting max ql [99] Note: Afaik these cannot be crafted and know of only 2x In-game! Starting Bid: 15s Min Increase: 1s Reserve: None Buyout: 28s Snipe Protection: 1 Hour Items will be Sent CoD Happy Bidding All
90QL Rare Horseshoe Set w/ WOA These are said to bring luck! Apart from improving horse speed and safety, of course. This is a very rare and interesting version of the item. You need to temper the horse shoe by dipping it in water while it's hot. Starting Bid: 12s Minimum Increase: 1s Reserve: none Buyout: 20s
TheRedReaper posted a topic in Want To SellHello fellow Wurmians, this sale is happening to help Shrimpiie get funds for this years impalong, all proceeds will go to Shrimpiie to benefit the impalong. NOTE: NONE OF THE ITEMS ON THIS LIST ARE FROM THE IMPALONG, ALL ITEMS ARE FROM MY PERSONAL COLLECTION. All items will be mailed from my alt to keep any money from mixing. Thank you to all who supported us during this recent impalong and Thank you to everyone who wants to support us with this years Impalong. 30c per item in this spoiler 20c per item in this spoiler 10c per item in this spoiler 5c per item in this spoiler Other: Left Elaborate Shoulder Pad 75 QL (Studded Armor Glance Bonus vs 2H Sword) - 2.5s I will try to keep list updated as items sell, but it may be a bit difficult
Pashka posted a topic in Merchant AdsThe best way to place an order is by sending me a forum p.m. or post a reply to this thread. You can try to send a PM to Eladia or Pashka in game if you have a special request. I do not take custom orders. If you need something that is not listed, let me know and I'll try to cast on that particular item. Will trade referrals for 8s in items or purchase for 6s. Wemp is sold out for now. Currently located in Xanadu with no access to the merchant located in Scarlet Canal. Sorry guys.
fd0024 posted a topic in Merchant AdsCurrent Level: 99.92 CT 93.40 LW PM Frankd or Frankdalt in game I'm at C13 on Celebration Cloth Tailoring Leather Enchanted Items Rare Items Rare Fruit Press Walnut 45ql - 3s
Neville posted a topic in AuctionsStarting Bid: 8s Min Increase: 1s Reserve: None Buyout: 14s in PM or Reply to this topic Note: The sum of the qualities of the horse shoes has an effect on the speed of the horse. Wind of Ages (WOA) adds more speed on top of that.
Neville posted a topic in Auctions[02:10:50] A small finely polished stone used to sharpen the edges of weapons. This is a very rare and interesting version of the item. [02:10:50] Wind of ages has been cast on it, so it will be quicker to use. [85] [02:10:50] Circle of Cunning has been cast on it, so it will increase skill gained with it when used. [88] Starting Bid: 3s Min Increase: 1s Reserve: None
Neville posted a topic in Want To SellHorse too slow? Land travel got you down? Put some pep in your horse's step! **** ALL SOLD **** These shoes are guaranteed to speed! Contact me in-game or PM me.
happyh7 posted a topic in Want To SellHi. I have another batch if saddles for sale. All 80 Ql and all 90WoA+. WoA:90 = 1s <SOLD> WoA:90 = 1s <SOLD> WoA:91 = 1.05s <SOLD> WoA:91 = 1.05s <SOLD> WoA:91 = 1.05s <SOLD> WoA:91 = 1.05s <SOLD> WoA:91 = 1.05s <SOLD> WoA:92 = 1.10s <SOLD> WoA:92 = 1.10s <SOLD> WoA:92 = 1.10s <SOLD> WoA:93 = 1.15s <SOLD> WoA:93 = 1.15s <SOLD> WoA:94 = 1.20s <SOLD> WoA:97 = 1.60s <SOLD> WoA:97 = 1.60s <SOLD> WoA:98 = 2s <SOLD> WoA:100 = 2.60s <SOLD> WoA:101 = 3.5s <SOLD> Answer in this thread, or PM Folke ingame or send a PM on the forums.
gabars posted a topic in Merchant AdsWurm shopping made easy Open So, we've been selling online for a while and now that most of the features I wanted on the website are implemented, I figured it's time to hit the forums. You would think it would have been easier the other way around -- probably. Anyway, for those who don't know us yet, we sell a lot of stuff, and we sell it cheap. You can find a non-exclusive list of what we sell here (or click the image on top). We're humans, we forget to add things to the list, so if you don't find an item you're looking for, don't be afraid to ask. Imping We do imps too. What about the price? I think it's pretty cheap. You can figure it out yourself anyway thanks to our pretty little calculator available here: http://www.southwindmarket.com/imp.php. According to our policy (see about us page), we will imp anything we sold for half the price up to the QL advertised on our website. Enchants For now we can't always accept custom enchant orders. When we do, we make the item ourselves so if it shatters we can always make a new one, and it can take some time. If you need your own item enchanted (e.g. a rare), we're not the right people for the job at the moment. Why this thread? 1. Reputation. It's hard to build it when everything is is under your control. We've been told many times that we needed a guestbook, but IMO that wouldn't be very trustworthy, I could write anything I want myself, so if you have any comments, questions, suggestions, ideas, etc. this is the place. 2. You'll have a way to find us if you forget our URL or if you're simply not online when we post in the trade chat.
Willslaphansien posted a topic in Want To SellSelling these enchanted horse packages, You'll see the number of the packages on the backpack. COD will be added to the final price. With saddle: 4,5s 4,3s Without saddle: 2,5s 2,5s 2,3s 2,2s 2,1s 2s
Jakeii posted a topic in Want To SellAs the title lists I am looking to sell the following Horse Shoe Set! Please PM or Post below! -= Looking for Offers =-
Fotb posted a topic in AuctionsAs title says Supreme Saddle 90ql with 97 WoA up for grabs! Starting Bid: 20s Increment: 1s No Buyout. Sniping Protection: 1 Hour Happy bidding!
Neville posted a topic in Want To SellNew batch of WOA horse shoes for sale! Excellent casts folks! Why ride slow when you can ride fast? Reply or PM with the set you want! You will receive them promptly from my 100 cast mailbox!
Neville posted a topic in Want To SellMessage me in-game or Reply / PM on forum with set # you want: SOLD for 6s (102-99-99-97) SOLD for 4s (95-93-90-89) SOLD for 3s (88-87-87-86) SOLD for 2.5s (86-86-85-85) SOLD for 2s (84-83-83-83) SOLD for 1.9s (82-82-81-81) Have fun everyone!
Seancarl posted a topic in Want To SellSo I have 25 enchanted horse shoes of varying ql and WOA enchantment. Price will be 20c per shoe, or 4s for all of them (pick up on Indy F22 or COD on your dime)
Ondar posted a topic in Merchant AdsMy prem ends on MAR 5 and going pause again. Should not take long to get back Still can sell anything listed here, just post your reply and I get back to you. You pay COD (1c everywhere!) unless you pickup at Bear Dock, Independence, central south coast, T19 ingame map - runed fast mailbox, so even long bows and spears can be yours in a few minutes! Silvers, euros (1e=1s, paypal verified) and sleep powders (1s each) accepted as payments. All prices are negotiable, discounts for big orders! Custom work, imping (97 BS, 95 carp, 93 WS, 90 shield + leather + cloth + chain + stone cutting + masonry + fine carp, 75 ship). Imp to rare = +2s, imp to sup = +10s (if that happen during imp for you). PM me here or Shaylie ingame. Can arrange COC, WOA, NIM and other Vynora casts. Other stuff: 70ql beautiful med rug - 30c 80ql exq. med rug - 70c 90ql exq. med rug - 1.2s 90ql grindstone - 90c 80ql pottery smelting pot - 50c 80ql iron pendulum - 40c sleep powder - 5x1s 97ql 1.9kg bangers and mash (100 CCFP) - 10c WTS (offer something and if I like it its yours): fireworks 80q 8x torch lamp avg 64ql ointment of stonecutting 79.3ql, 1.2 dmg potion of acid 53ql 16x yellow potion (16-96 ql) RARES: rare cloth glove 90ql rare grindstone 90ql rare pinewood fruit press 90ql 89coc 87woa rare awl 92ql 93 botd rare large iron shield 90ql (LMS) rare iron pendulum 90ql rare steel lump 43ql Armour: 80ql studded set 80ql and 87ql chain set 70ql plate set 84ql cloth set Weapons and shields (plain or coc for woa look at the end of this post at speeders section) long bow willow 52ql 70 coc - 70c (can be COD with my runed mailbox!) (med) shield, iron 50ql 92 coc - 2.76s large shield, iron 80ql 74 coc - 1.04s large shield, iron 81ql 86 coc - 2.02s large shield, iron 90ql 92 coc - 3.16s 2H sword 90ql 89 nim 94 coc 80 LT 87 MS - 8.94s huge axe 90ql 85 nim 86 coc 85 LT 73 MS - 6.85s huge axe 90ql 100 nim 92 coc 81 LT 76 MS - 11.14s axe (med) 90ql 93 nim 89 coc 86 LT 71 MS - 8s large maul 90ql 87 nim 85 coc 97 LT - 7.55s large maul 90ql 90 nim 88 coc 92 LT 73MS - 9.17s maul (med) 90ql 80 nim 81 coc 82 LT 75 MS - 6.61s maul (med) 90ql 88 nim 96 coc 76 LT 78 MS - 7.18s sickle 1ql 82 coc - 1.74s sickle 1ql 87 coc - 1.84s sickle 85ql 84 coc - 1.98s sickle 91ql 93 coc - 3.39s sickle 86ql 75 coc 74 nim - 1.99s sickle 86ql 70 coc 80 nim - 2.70s sickle 90ql 95 nim 89 coc 80 LT 81 MS - 8.35s 80ql = 50c 5x long sword 9x two handed sword 5x huge axe 2x axe (med) 12x large maul 2x maul (med) 5x small maul 1x long spear pinewood (can be COD with my runed mailbox!) 4x butchering knife 8x carving knife 11x iron sickle 5x large shield, iron 17x large shield, oak (87ql) 85ql = 70c 6x two handed sword 3x small maul 26x sickle Skillers (coc or coc+woa casted): clay 70ql coc 75 - 50c iron 87ql coc 91 - 2.2s iron 87ql coc 88 - 1.5s iron 87ql coc 76 - 70c zinc 92ql coc 84 - 1.4s rock shards 90ql coc 88 - 1.5s (2.2kg - can be combined) fork 1ql 82 coc - 1.64s fork 1ql 83 coc - 1.66s spoon 1ql 79 coc - 89c spoon 1ql 85 coc - 1.7s knife 1ql 74 coc - 84c grindstone 1ql 70 coc - 80c grindstone 1ql 73 coc - 83c grindstone 1ql 89 coc - 1.88s mortar & pestle 1ql 71 coc - 81c mortar & pestle 1ql 77 coc - 87c fruit press, oak 30ql 78 coc - 88c fruit press, oak 28ql 85 coc - 1.8s fruit press, oak 34ql 88 coc - 1.86s fruit press, oak 38ql 92 coc - 2.86s butchering knife 11ql 82 coc - 1.62s butchering knife 36ql 92 coc - 2.76s butchering knife 90ql 92 coc - 3.26s butchering knife 90ql 82 coc 88 woa - 3.9s butchering knife 90ql 98 coc 93 woa - 6.23s key, copper 21ql 77 coc - 77c key, copper 24ql 80 coc - 1.5s mallet, pine 80ql 38 coc - 28c mallet, pine 83ql 38 coc 58 woa - 86c mallet, oak 25ql 84 coc - 1.68s mallet, oak 81ql 84 coc 79 woa - 2.57s rope tool, pine 70ql 59 coc - 69c rope tool, oak 32ql 79 coc - 79c rope tool, oak 31ql 81 coc - 1.62s rope tool, oak 32ql 89 coc - 1.78s rope tool, oak 80ql 77 coc 74 woa - 1.91s rope tool, oak 85ql 84 coc 94 woa - 4.9s clay shaper, oak 19ql 83 coc - 1.66s spatula, oak 1ql 92 coc - 2.86s small anvil 18ql 80 coc - 1.6s small anvil 18ql 96 coc - 2.88s small anvil 80ql 79 coc 87 woa - 2.83s small anvil 90ql 83 coc 92 woa - 4.82s small anvil 90ql 85 coc 93 woa - 4.89s large anvil 19ql 83 coc - 1.66s large anvil 19ql 91 coc - 2.73s large anvil 80ql 87 coc 89 woa - 3.92s large anvil 90ql 88 coc 94 woa - 5.18s hammer 18ql 76 coc - 76c hammer 90ql 78 coc - 1.18s hammer 18ql 83 coc - 1.66s hammer 81ql 89 coc 83 woa - 3.74s hammer 90ql 94 coc 91 woa - 5.95s trowel 85ql 80 coc - 1.8s trowel 80ql 86 coc 74 woa - 2.76s trowel 81ql 88 coc 71 woa - 2.77s trowel 90ql 93 coc 81 woa - 4.91s trowel 90ql 92 coc 89 woa - 4.95s trowel 90ql 94 coc 89 woa - 5.1s stone chisel 80ql 74 coc - 94c stone chisel 90ql 79 coc 75 woa - 1.94s stone chisel 80ql 73 coc 81 woa - 2.64s stone chisel 83ql 89 coc 85 woa - 3.78s stone chisel 90ql 86 coc 95 woa - 4.97s stone chisel 90ql 90 coc 97 woa - 6.11s steel & flint 18ql 70 coc - 70c steel & flint 16ql 74 coc - 74c steel & flint 6ql 76 coc - 76c steel & flint 18ql 78 coc - 78c steel & flint 18ql 83 coc - 1.66s steel & flint 18ql 84 coc - 1.68s meditation rug 17ql 81 coc - 1.62s meditation rug 17ql 84 coc - 1.68s meditation rug 8ql 84 coc - 1.78s meditation rug 18ql 91 coc - 2.73s meditation rug 18ql 94 coc - 2.82s grooming brush, oak, 19ql 66 coc - 56c grooming brush, oak, 19ql 77 coc - 77c grooming brush, oak, 19ql 80 coc - 1.6s grooming brush, oak, 8ql 84 coc - 1.78s grooming brush, oak, 1ql 85 coc - 1.8s grooming brush, oak 80ql 72 coc 87 woa - 2.76s grooming brush, oak 80ql 80 coc 85 woa - 3.6s scissors 8ql 67 coc - 57c scissors 10ql 72 coc - 82c scissors 10ql 83 coc - 1.76s scissors 82ql 83 coc - 1.93s scissors 80ql 78 coc 77 woa - 1.85s scissors 90ql 81 coc 79 woa - 2.81s needle 17ql 73 coc - 73c needle 18ql 86 coc - 1.72s needle 37ql 97 coc - 2.91s needle 18ql 98 coc - 2.94s needle 90ql 82 coc 92 woa - 4.78s needle 90ql 90 coc 88 woa - 4.88s awl 10ql 70 coc - 80c awl 11ql 85 coc - 1.7s awl 81ql 62 coc - 92c awl 81ql 86 coc - 1.96s awl 80ql 80 coc 84 woa - 3.58s awl 90ql 82 coc 89 woa - 3.82s awl 90ql 82 coc 94 woa - 5.1s leather knife 1ql 81 coc - 1.72s leather knife 85ql 78 coc 80 woa - 2.68s leather knife 81ql 82 coc 86 woa - 3.66s leather knife 90ql 92 coc - 3.26s pickaxe 1ql 71 coc - 81c pickaxe 1ql 77 coc - 87c pickaxe 1ql 84 coc - 1.78s pickaxe 80ql 81 coc 79 woa - 2.71s saw 1ql 81 coc - 1.72s rake 1ql 70 coc - 80c rake 1ql 77 coc - 87c rake 1ql 88 coc - 1.86s rake 85ql 77 coc 77 woa - 1.94s rake 80ql 81 coc 81 woa - 3.24s rake 90ql 79 coc 97 woa - 4.1s rake 90ql 93 coc 84 woa - 4.67s rake 90ql 98 coc 89 woa - 5.32s whetstone 99ql 70 coc - 85c whetstone 94ql 77 coc - 92c whetstone 64ql 81 coc - 1.62s whetstone 95ql 87 coc - 1.89s whetstone 98ql 96 coc - 3.03s whetstone 92ql 99 coc - 3.07s wild cat pelt 82.6ql 0.8kg 89 coc - 1.78s large rat pelt 93ql 3dmg 0.2kg 77 coc - 77c large rat pelt 85.7ql 0.2kg 81 coc - 1.72s mountain lion pelt 90ql 0.4kg 80 coc - 1.7s mountain lion pelt 97ql 0.4kg 85 coc - 1.9s mountain lion pelt 97.8ql 0.4kg 85 coc - 1.91s mountain lion pelt 87.4ql 0.4kg 83 coc - 1.76s mountain lion pelt 82.4ql 0.4kg 85 coc - 1.8s large rat pelt 100ql 0.2kg 90 coc - 3s large rat pelt 95.5ql 0.2kg 90 coc - 2.9s large rat pelt 92.2ql 0.2kg 90 coc - 2.85s file 9ql 77 coc - 87c file 1ql 83 coc - 1.76s file 1ql 85 coc - 1.8s file 1ql 95 coc - 2.95s file 90ql 79 coc 91 woa - 3.92s file 90ql 88 coc 93 woa - 4.95s file 33ql 101 coc - 5.05s carving knife 37ql 74 coc - 74c carving knife 37ql 79 coc - 79c carving knife 44ql 80 coc - 1.6s carving knife 37ql 88 coc - 1.76s shovel 16ql 69 coc - 59c shovel 1ql 68 coc - 68c shovel 1ql 73 coc - 83c shovel 1ql 82 coc - 1.74s shovel 1ql 85 coc - 1.8s shovel STEEL 4ql 83 coc - 1.86s shovel 81ql 79 coc 81 woa - 2.71s shovel 82ql 82 coc 80 woa - 3.54s shovel 81ql 82 coc 87 woa - 3.68s shovel 81ql 88 coc 84 woa - 3.74s shovel 90ql 96 coc 96 woa - 6.26s hatchet 1ql 73 coc - 83c hatchet 1ql 76 coc - 86c hatchet 1ql 81 coc - 1.72s hatchet 90ql 91 coc 82 woa - 4.87s hatchet 90ql 93 coc 81 woa - 4.91s Speeders (high ql and only Woa casted): clay 70ql 71 woa - 50c clay 70ql 82 woa - 1.4s clay 70ql 90 woa - 2s pickaxe 86ql 77 woa - 1.17s pickaxe 90ql 90 woa - 3.2s hatchet 90ql 90 woa - 3.2s shovel 80ql 64 woa - 94c shovel 85ql 78 woa - 1.18s shovel 80ql 84 woa - 1.98s rake 82ql 78 woa - 98c rake 85ql 70 woa - 1.1s rake 85ql 78 woa - 1.18s rake 85ql 83 woa - 1.96s saw 81ql 79 woa - 1.09s saw 81ql 82 woa - 1.94s needle 85ql 78 woa - 1.18s needle 90ql 92 woa - 3.16s mallet, oak 90ql 93 woa - 3.19s hammer 90ql 89 woa - 2.28s file 80ql 70 woa - 1s file 80ql 81 woa - 1.9s file 90ql 92 woa - 3.26s trowel 85ql 80 woa - 1.8s trowel 85ql 82 woa - 1.84s stone chisel 80ql 88 woa - 2.06s carving knife 90ql 92 woa - 3.26s butchering knife 90ql 89 woa - 2.28s sickle 85ql 77 woa - 1.27s


text:
Los precios los proporcionan nuestros socios, y en ellos se refleja la tarifa media por habitación y noche, incluidos impuestos y tasas ya fijados, puestos en su conocimiento y pagaderos en el momento de la reserva. Otros impuestos y tasas del hotel que no se incluyan o que no deban pagarse en el momento de la reserva posiblemente deberán abonarse en el establecimiento durante la estancia. Dirígete a nuestros socios para obtener más información.
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281 - 285 de 859 opiniones
Abbiamo soggiornato in questo albergo per tre notti in una camera tripla. L'esterno dell'hotel è veramente bello e affascinante, soprattutto...Más
I almost had a very bad experience here. I came here with a Trafalgar tour group in mid-September, and got here before the bulk of the group because I was too tired for a gondola ride. Anyway, I was given room 101, a single room....Más
L'aspetto esterno è senza dubbio di notevole impatto con una bella facciata imponente e decorata in modo raffinato. Piacevole l'inserimento...Más
The hotel has a dignified, old-world charm that is mesmerizing and romantic. It really encapsulates what my husband and I look for when we travel. The service is extremely courteous and helpful. The spa is affordable, and offers fantastic services that leave you feeling refreshed...Más
There was something about this hotel that we just had to stop and look at it, then we discovered that they were having an art show inside so in we went. Its nothing short of spectacular. So much detail, even if you don't stay here...Más
"We stayed on the 4th floor and had lovley roof top views"
"All rooms are great as far as I can see and the spa is amazing"
"Room 309 is nice and quiet with a good view"
"Do not pay upfront"