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ALTTO Trial Seeks to Define Best Therapy for HER2 Breast Cancer
A major clinical trial to determine the best treatment for early-stage breast cancer testing positive for the HER2 protein is now enrolling women in North America, researchers from the Mayo Clinic and NCI announced last week at the NCI Science Writers' Seminar in New York City. The international trial, known as the Adjuvant Lapatinib and/or Trastuzumab Treatment Optimisation (ALTTO) study, will recruit 8,000 women with HER2-positive breast cancer in 50 countries across 6 continents and may set the standard of care for women with this aggressive type of breast cancer.
About 20 to 25 percent of breast cancers are studded with the HER2 protein, also known as human epidermal growth factor receptor 2. HER2 is involved in transmitting growth signals from external growth factors to a cell's nucleus. In some types of cancer, this growth signaling pathway leads to increased tumor cell proliferation, suppression of programmed cell death (apoptosis), enhanced motility, and increased tumor angiogenesis. HER2-positive breast cancer tends to be more aggressive, less responsive to standard treatments, and more likely to recur than breast cancer that does not contain HER2. Read more
Cancer Risk Persists After Ending Hormone Therapy
The increased risk of breast cancer associated with combination hormone therapy (estrogen plus progestin) may not go away once the hormones are stopped. More than two years after discontinuing hormones, women who had used the treatment for 5 years still had a higher risk of breast cancer than women who never used the hormones, according to an update from the Women's Health Initiative (WHI).
The results, in the March 5 Journal of the American Medical Association, confirm the main finding of the WHI's estrogen-plus-progestin trial - that the health risks of this treatment for menopausal symptoms such as hot flashes outweigh the benefits. The trial was halted in 2002 largely because women using hormones had an increased risk of breast cancer and experienced no clear health benefits. (A WHI trial of estrogen-alone ther-apy did not show increased cancer risks.)Read more
ALTTO Trial Seeks to Define Best Therapy for HER2 Breast Cancer
A major clinical trial to determine the best treatment for early-stage breast cancer testing positive for the HER2 protein is now enrolling women in North America, researchers from the Mayo Clinic and NCI announced last week at the NCI Science Writers' Seminar in New York City. The international trial, known as the Adjuvant Lapatinib and/or Trastuzumab Treatment Optimisation (ALTTO) study, will recruit 8,000 women with HER2-positive breast cancer in 50 countries across 6 continents and may set the standard of care for women with this aggressive type of breast cancer.
About 20 to 25 percent of breast cancers are studded with the HER2 protein, also known as human epidermal growth factor receptor 2. HER2 is involved in transmitting growth signals from external growth factors to a cell's nucleus. In some types of cancer, this growth signaling pathway leads to increased tumor cell proliferation, suppression of programmed cell death (apoptosis), enhanced motility, and increased tumor angiogenesis. HER2-positive breast cancer tends to be more aggressive, less responsive to standard treatments, and more likely to recur than breast cancer that does not contain HER2.
Patients with HER2-positive breast cancer may benefit from treatments that target this protein, and two targeted drugs, trastuzumab (Herceptin) and lapatinib (Tykerb), have been approved by the Food and Drug Administration to treat patients with HER2-positive tumors. While both of these agents target HER2, they do so in different ways. Trastuzumab, which is approved as a first-line treatment for metastatic disease or adjuvantly for early-stage breast cancer, is a monoclonal antibody that attaches to HER2-positive cancer cells and prevents the protein from receiving growth signals. It may also help a patient's immune system mount a response against the tumor. Lapatinib belongs to a class of drugs called small molecule inhibitors; its small size allows it to permeate the cancer cell and interrupt the HER2 signaling pathway from inside. Currently, lapatinib is only approved for the treatment of metastatic HER2-positve breast cancer. This study will be the first major trial of adjuvant lapatinib for early-stage breast cancer.
Approval of trastuzumab for treatment of early-stage, HER2-positive breast cancer in 2006 greatly improved outcomes for women with this disease, and researchers hope that the ALTTO trial will further extend the benefits of adjuvant therapy targeting HER2. In this trial, women who have undergone surgery to remove their tumors will be randomly assigned to receive lapatinib or trastuzumab alone, lapatinib administered after trastuzumab, or the two drugs administered together.
"The primary questions this trial is intended to answer are: Does lapatinib work better than trastuzumab or are they equivalent in terms of disease-free survival? Or might the combination of the two be better than either single drug alone?" says Dr. Edith Perez of the Mayo Clinic in Jacksonville, FL, and the North American coordinator for the trial. "We know that trastuzumab is a fantastic drug, but we're still not curing all women with this type of cancer. This trial is an important step toward curing more patients with breast cancer."
In addition to the targeted therapies being tested, all patients must have completed at least four cycles of anthracycline-based chemotherapy before randomization; patients for whom chemotherapy with a taxane is indicated will be treated with the drug paclitaxel (Taxol) along with their assigned targeted therapy.
"Adjuvant chemotherapy is very important for the treatment of HER2-positive breast cancer and is a required part of this study," says Dr. Perez.
The ALTTO trial is the first global initiative in which two large, academic breast cancer research networks covering different parts of the world - The Breast Cancer Intergroup of North America (TBCI), based in the U.S., and the Breast International Group (BIG) in Brussels, Belgium - have jointly developed a study in which all care and data collection are standardized, regardless of where patients are treated.
"We hope that this model of international collaboration is one which we can build upon in the future," says Dr. Jo Anne Zujewski, a senior investigator in the Clinical Investigations Branch in NCI's Cancer Therapy Evaluation Program.
—Daryl McGrath
Cancer Risk Persists After Ending Hormone Therapy
The increased risk of breast cancer associated with combination hormone therapy (estrogen plus progestin) may not go away once the hormones are stopped. More than two years after discontinuing hormones, women who had used the treatment for 5 years still had a higher risk of breast cancer than women who never used the hormones, according to an update from the Women's Health Initiative (WHI).
The results, in the March 5 Journal of the American Medical Association, confirm the main finding of the WHI's estrogen-plus-progestin trial - that the health risks of this treatment for menopausal symptoms such as hot flashes outweigh the benefits. The trial was halted in 2002 largely because women using hormones had an increased risk of breast cancer and experienced no clear health benefits. (A WHI trial of estrogen-alone therapy did not show increased cancer risks.)
To update the findings, Dr. Gerardo Heiss of the University of North Carolina, Chapel Hill, and his colleagues tracked 95 percent of the original 16,608 trial participants for an additional 2.4 years. In the post-treatment period, women who had stopped taking hormones were 27 percent more likely to develop breast cancer than women who did not take hormones. However, this finding was not statistically significant (79 women in the post-treatment group developed breast cancer compared with 60 in the placebo group).
The risk of any type of cancer was 24 percent higher in women who had stopped taking hormones, and this was statistically significant (281 women in the post-treatment group developed cancer compared with 218 in the placebo group). The reasons for the additional cancers are not yet clear, but the researchers stress the importance of carefully monitoring women for any long-term effects of hormone use in the years ahead.
"When we started the WHI, the prevailing belief was that menopausal hormones were good for women and that we could prevent many major age-related diseases with them," said Dr. Marcia Stefanick of Stanford University, who chaired the WHI steering committee during the trial.
"But we learned during the trial that the risks of combined estrogen-and-progestin therapy, which included increases in breast cancer, heart attacks, stroke, and serious blood clots, clearly outweighed the benefits of fewer fractures and colorectal cancers," Dr. Stefanick continued. "And we now know that the risk of cancer, and in particular, breast cancer, continues years after stopping the hormones, whereas, none of the benefits persist."
The good news is that the cardiovascular risks for the most part disappear after stopping the combined hormone therapy. Still, many experts recommend that women avoid combined hormone therapy or minimize their exposure. Another WHI follow-up study recently showed that combined hormone therapy leads to abnormal mammograms and compromises the ability of mammograms and breast biopsies to detect cancers.
Together, the two reports highlight complementary downsides of this therapy. "Not only does the breast cancer risk not disappear once hormone therapy is stopped, but the sensitivity of mammograms to detect cancer is not as good and women may continue to have abnormal mammograms for at least a year," said Dr. Leslie Ford of NCI's Division of Cancer Prevention and the institute's WHI liaison.
Hormone Therapy Interferes with Breast Cancer Detection
Two tools used to detect breast cancer - mammograms and breast biopsies - are less effective in women who use combined hormone therapy (estrogen plus progestin) than in women who do not. And the diminished ability to find cancers may persist for at least a year after women have discontinued therapy, according to a follow-up study of participants in the Women's Health Initiative (WHI).
It has been known that breast cancer is often detected at a later stage in women who use hormones to treat menopausal symptoms than in other women. This study also shows that women who use combined hormone therapy have more mammograms with abnormalities and more breast biopsies than women who do not use hormones.
Dr. Rowan Chlebowski of Harbor-UCLA Medical Center and his colleagues followed nearly 16,000 women in the WHI estrogen-plus-progestin trial for an extra year after the study ended. During this year, women who had used hormones during the study continued to have more mammogram abnormalities than women who had not. This suggests that discontinuing hormone therapy for a short interval before mammography may not affect either mammogram findings or breast cancer diagnoses, the researchers note in the February 25 Archives of Internal Medicine.
Women considering even short-term combined hormone therapy should factor the adverse effects on breast cancer detection into their risk-benefit analyses, the researchers conclude. During the original WHI estrogen-plus-progestin trial, women used either hormones or placebo for 5.6 years. The study was cut short in 2002 after the increased health risks associated with combined hormone therapy became evident.
A second WHI follow-up study, released this week, reports that the increased risk of breast cancer in women using combined hormone therapy persists for up to 3 years after treatment ends.
Study Confirms Clot, Mortality Risks with Anemia Drugs
A meta-analysis of clinical trials testing anti-anemia drugs in cancer patients has confirmed findings from earlier studies demonstrating increased risk of blood clots and death.
The findings, published in the February 27 Journal of the American Medical Association, come less than a month before the Food and Drug Administration's (FDA) Oncologic Drugs Advisory Committee (ODAC) will meet for the third time in 4 years to discuss the safety of the drugs, known as erythropoiesis-stimulating agents (ESAs).
Overall, the analysis found a 57 percent increased risk of venous thromboembolism (VTE) and a 10 percent increased mortality risk in patients treated with ESAs. The review included 51 phase III trials with survival information and 38 trials with data on VTEs.
"Our findings, in conjunction with basic science studies, raise the concern that the drug may be stimulating cancer and shortening cancer patients' survival," said the study's lead author, Dr. Charles L. Bennett from Northwestern University Feinberg School of Medicine.
The review - which involved trials with patients with anemia caused by cancer, as well as chemotherapy- or radiotherapy-related anemia - included data from eight recent phase III trials in patients with a variety of cancer types. With one exception, the recent trials were all designed to achieve hemoglobin levels in the 13 to 15 g/dl range, what have been referred to as "beyond anemia correction" studies.
The FDA, which issued two public health advisories on ESA use in 2007, is engaged in an ongoing safety review of the drugs.
Sentinel Node Dissection Safe in Early Vulvar Cancer Treatment
An international group of researchers led by the University Medical Center Groningen in the Netherlands has shown that sentinel lymph node dissection (SLND) to detect microscopic metastases in women with early-stage cancer of the vulva is safe compared with the standard treatment of inguinofemoral lymphadenectomy, which involves removing extensive lymph nodes in the groin and upper leg and can have long-lasting side effects.
The investigators enrolled 403 women into their study, all of whom underwent resection of their primary tumor and SLND. Of these, 127 had metastatic cells in the examined nodes, and underwent full inguinofemoral lymphadenectomy. The other 276 women did not have evidence of metastases on SLND, and did not undergo additional surgery.
All women returned for follow-up visits at least every 2 months for the first 2 years after surgery. Only four women were lost to follow-up; for the rest, the investigators compared short- and long-term complications and incidences of groin recurrences of the cancer between those who did and did not undergo inguinofemoral lymphadenectomy.
Women who only underwent SLND had significantly fewer short- and long-term complications - including difficulty with wound healing, lymphedema, and persistent infections - than women who underwent inguinofemoral lymphadenectomy. The overall rate of groin recurrence in women who only underwent SLND was 3 percent, which the authors deemed comparable to a calculated historical rate of 2 percent.
"The low groin recurrence rate...and excellent disease-specific survival rate of 97 percent at 3 years in sentinel node-negative patients suggest that the sentinel node procedure is a safe alternative to inguinofemoral lymphadenectomy for selected vulvar cancer patients," concluded the authors. However, they stress, extensive clinical experience with SLND for both the surgeon and the multidisciplinary team supporting the procedure is essential for replicating these positive results.
Smoking Threatens Pregnant Women in Developing Countries
A survey of nearly 8,000 pregnant women from 9 developing nations in Latin America, Asia, and Africa indicates that "rising tobacco use in the developing world threatens to impede or reverse hard-won global health gains." The multicenter, cross-sectional survey examined pregnant women's tobacco use, secondhand smoke (SHS) exposure, and attitudes toward women's tobacco use. Results were published online February 28 in the American Journal of Public Health.
The authors conclude that cigarette smoking during pregnancy is a current or emerging problem in the five Latin American countries surveyed. In Uruguay, 78.3 percent of pregnant women surveyed had ever tried cigarettes and two-thirds of those went on to become regular smokers, a third of whom continued to smoke while pregnant. Argentina - and to a lesser extent Ecuador, Brazil, and Guatemala - had similar patterns. If women's smoking were to become more culturally acceptable, say the authors, these other sites could expect much higher levels of smoking by pregnant women.
Pakistan had the most homes where smoking was allowed: 92 percent of those surveyed. Consequently, half of Pakistani pregnant women and half of their young children are frequently or always exposed to SHS. The use of other tobacco products, like smokeless tobacco and snuff, was highest in Orissa, India (34 percent).
The study was conducted by an international team of investigators, including researchers from two NIH institutes - NCI and the National Institute of Child Health and Human Development (NICHD). The researchers conducted the study at nine sites in the Global Network for Women's and Children's Health Research, operated by NICHD, with funding from the Bill and Melinda Gates Foundation. The Department of Health and Human Services' Office on Women's Health also provided study support.
The findings "highlight the urgent need to implement evidence-based interventions to prevent and control tobacco use among pregnant women" in these countries, writes lead author Dr. Michele Bloch of NCI's Tobacco Control Research Branch and colleagues.
Keeping Recent Mortality Figures in Perspective
The headlines varied, but when the Cancer Facts & Figures 2008 data were released late last month, the dominant message that many TV, print, and electronic news stories carried was that the decline in the number of actual cancer deaths had come to an end.
After back-to-back drops in the number of actual cancer deaths, the most recent data show an increase of more than 5,400 deaths from 2004 to 2005. But the larger story - a true success story - is that cancer mortality rates are continuing to decline. From the time the decline began in the early 1990s, in fact, cancer death rates for men have decreased more than 18 percent, while the rate for women has seen a more modest 10.5 percent decrease.
According to American Cancer Society estimates, that's more than half a million lives saved from death due to cancer - nearly equivalent to the population of Portland, Oregon.
The increase in the number of cancer deaths was no surprise. Not only has the U.S. population continued to swell, but it's also aging: More than 20 percent of the population is 55 or older, an age group that represents more than three of every four cancer diagnoses. So, even though fewer people as a proportion of the whole population are dying from cancer, the actual number of deaths still increased.
The new report also provides some important insights into the cancers and populations where some of our most significant challenges lie.
Estimates are that lung cancer, for example, will account for more than a quarter of all cancer deaths among women in 2008. Clearly this is an area where we must do better. Disparities in care and outcomes persist. The cancer death rate among African American men, for example, is 37 percent higher than it is among white men.
Hopefully the cancer and public health communities can work with policymakers to develop and implement the necessary changes to address these disparities - something NCI is already spearheading with important initiatives like the NCI Community Cancer Centers Program and the Community Networks Program.
Looking to the future, recent advances and promising research suggest that we can maintain the cancer death rate decline, and perhaps even accelerate it.
Last year, for instance, we saw significant advances in the treatment of some of the most difficult-to-treat cancers, including small-cell lung cancer, liver cancer, and kidney cancer. And while the introduction of HPV vaccines stands to greatly reduce cervical cancer incidence in the future, recent evidence demonstrating an association between HPV and head and neck cancers also suggests widespread vaccination could have unforeseen benefits.
We are also pursuing new avenues of cancer prevention research, including identifying biomarkers of cancer risk, such as hypermethylation patterns, while continuing to pursue promising new chemoprevention agents, such as DFMO for the prevention of colon polyps, which are often precursors to colon cancer.
And as we continue to learn more about cancer stem cells, also known as tumor-initiating cells, we are gaining a better understanding of their resistance to treatment and how to target these cells. We are also learning to effectively mine molecular clues from patients' tumors to guide treatment. One such example is the NCI-funded TAILORx trial, which is testing whether a 21-gene assay can guide the use of adjuvant chemotherapy for certain breast cancer patients.
Collectively, these examples represent an extensive investment in our attack on the collection of malignancies we call cancer. Progress will be swift in some areas, slower in others, and of course will be heavily reliant on the budgets under which NCI operates.
But, as the continued decline in death rates demonstrates, the foundation for progress has been laid. NCI is committed to finding ways to strengthen that foundation through judicious management, strategic collaboration, and wise investment in the best science possible.
Dr. John E. Niederhuber
Following are newly released NCI research funding opportunities:
Tumor Stem Cells in Cancer Biology, Prevention, and Therapy
Letter of Intent Receipt Date: April 12, 2008.
This funding opportunity will use the R01 award mechanism. For more information, see http://researchportfolio.cancer.gov/initiativedetail.jsp?InitiativeID=3857. Inquiries: Dr. R. Allan Mufson - firstname.lastname@example.com.
Comparative Systems Genetics of Cancer
Letter of Intent Receipt Date: April 14, 2008.
This funding opportunity will use the R01 award mechanism. For more information, see http://researchportfolio.cancer.gov/initiativedetail.jsp?InitiativeID=3855. Inquiries: Dr. Cheryl L. Marks - firstname.lastname@example.com; Dr. Mukesh Verma - email@example.com.
Tiny Nodules, Big Dilemma
This article is the second in a two-part series on thyroid cancer. Part one focused on thyroid cancer's rapidly increasing incidence. Part two discusses the treatment of small thyroid tumors.
Phrases such as "controversial issue" or "a matter of great debate" litter the published literature about the initial treatment of patients with small tumors of the most common type of thyroid cancer, papillary thyroid cancer (PTC). Of particular interest is the most appropriate treatment for tumors 1 centimeter or smaller in size.
The primary disagreement is whether just the wing, or lobe, of the thyroid in which the tumor resides should be removed, known as a lobectomy, or whether all or most of the thyroid gland should be removed, a total or near-total thyroidectomy. And the debate doesn't stop there. Experts disagree about whether patients who undergo the more aggressive procedure also require a treatment known as radioactive iodine (RAI) ablation.
These are important questions, because as the incidence of thyroid cancer continues to rise steadily, it's these small, malignant thyroid nodules that are driving it. By one estimate, small tumors may soon account for 90 percent of all PTCs treated in the United States, many of which will be smaller than 1 centimeter.
The Mortality Remains the Same
Typically, cancer treatment patterns change when a given treatment generates notable improvements in survival or fewer side effects. But the mortality rate from PTC has remained flat, and extremely low, for the last four decades.
In any discussion about treatment, one thing seems abundantly clear: Observing the smallest tumors - what in prostate cancer is often called "watchful waiting" - isn't an acceptable option from the perspective of most patients.
"If they have cancer, my patients want it out," says Dr. Carmen Solorzano, chief of the Division of Endocrine Surgery at the University of Miami Miller School of Medicine.
And that's where the disagreements begin.
In patients with the smallest tumors confined to one lobe, argues Dr. Ashok R. Shaha, a professor of surgery at Memorial Sloan-Kettering Cancer Center, "there is no rationale for taking out the whole thyroid. You are punishing the patient, more or less, for their whole life."
The punishment, Dr. Shaha says, is that patients who undergo total thyroidectomy have to take thyroid hormone replacement for the remainder of their lives and require regular doctor visits to ensure the dosage is appropriate.
However, some endocrinologists also put patients treated with lobectomy on thyroid hormone medication, at least for a period of time.
Total thyroidectomy also is associated with other side effects, Dr. Shaha says, including hypoparathyroidism, in which the parathyroid gland can't produce enough calcium and phosphorous, and permanent damage to the laryngeal nerve.
In the hands of a good endocrine surgeon, counters Dr. Keith Heller, chief of endocrine surgery at New York University Medical Center, these risks are minimal.
In addition, Dr. Heller says, sometimes after a lobectomy, the final pathology report shows multifocal cancer, vascular invasion, or extension beyond the thyroid. If a lobectomy is done instead of removing the entire thyroid, a second operation might be recommended anyway, he says. Although he acknowledges that, in patients considered low risk, total thyroidectomy offers no survival advantage, Dr. Heller believes more aggressive treatment of tumors 1 centimeter or smaller is preferable, for just these situations. He's not alone.
"The problem is that these very small cancers, most of them have a good outcome, but not all of them," says Dr. Ernest Mazzaferri, chair of medicine at The Ohio State University, a long-standing proponent of more aggressive treatment.
It's not always as simple as just a single, small malignant nodule, he continues. The tumor may be invading outside of the thyroid "capsule." Or perhaps there is a family history of thyroid cancer or exposure to radiation. All suggest a tumor with the potential, albeit limited, to become aggressive.
These patients "don't always do so well," Dr. Mazzaferri says. "They can die from pulmonary or brain metastases. A small number, 1 percent, will die. None of us want to miss those."
To Irradiate or Not to Irradiate
But the use of RAI in patients with smaller tumors is not without its critics.
Dr. Ian Hay, a heralded endocrinologist at the Mayo Clinic, and others have performed retrospective studies showing no significant difference in recurrence rate or cancer-specific mortality in low-risk patients who received RAI and those who did not.
Using RAI in these patients, Dr. Shaha believes, "is just unnecessary extra treatment."
Dr. Mazzaferri, however, has been outspoken in his support for RAI, even in patients whom some endocrinologists would consider low-risk.
"There are 11 different staging systems, and that, in and of itself, tells you part of the problem," he says. "We miss a lot of patients who have recurrent disease or who are in trouble by assigning some number to them that says you're low risk and we're not going to treat you any further."
In most cases, he argues, RAI is now a one-time treatment, and treatments have been modified so that smaller and smaller doses of radiation are used.
Because most patients with thyroid cancer live for decades after diagnosis, any sort of prospective clinical trial to compare treatment regimens is unlikely to happen. It would be extremely expensive, requiring thousands of patients and decades to complete.
There is, however, optimism that molecular markers can be found to identify patients with small tumors who should receive more aggressive therapy.
Many in the endocrinology community are hanging their hopes on a specific marker, a mutation in the BRAF gene. Several studies have shown an association between this mutation and outcomes such as treatment failure and recurrence.
The research into this mutation, Dr. Mazzaferri admits, is still in the developmental stage. But, he says, "I think down the road it will be a big player in helping us sort things out."
—Carmen Phillips
Bevacizumab Approved for Metastatic Breast Cancer
The Food and Drug Administration (FDA) has approved bevacizumab (Avastin), in combination with paclitaxel chemotherapy, for the treatment of metastatic HER2-negative breast cancer in women who have not previously received chemotherapy.
The drug was given "accelerated approval,' which makes it available to women with this deadly disease based on limited clinical trial results. Full approval is contingent on additional positive results from ongoing clinical trials.
Accelerated approval was based on a phase III study in which bevacizumab plus paclitaxel chemotherapy resulted in a 52-percent reduction in the risk of disease progression or death compared with those treated with paclitaxel alone and a doubling in progression-free survival, according to the drug's maker, Genentech.
The drug has not yet been shown to improve overall survival in this disease. An FDA advisory panel recommended last December against making bevacizumab available for breast cancer in a 5-4 vote. Some experts were concerned that the risk of serious side effects outweighed the potential benefit of the drug's ability to slow the spread of tumors.
Bevacizumab is designed to fight cancer by blocking the growth of blood vessels (angiogenesis) that supply tumors with nutrients. The drug is also approved for the treatment of colorectal and lung cancers.
Continuing Bevacizumab Therapy for Metastatic Colorectal Cancer
Name of the Trial
Principal Investigators
Why This Trial Is Important
Bevacizumab, a monoclonal antibody that inhibits the formation of new blood vessels tumors need for continued growth, has been shown to help extend the survival of patients with advanced or metastatic colorectal cancer when used as part of initial, or first-line, therapy. It is unknown, however, whether continuing bevacizumab will help improve survival when used in second-line therapy to treat patients whose cancer has progressed despite first-line treatment with bevacizumab and chemotherapy.
In this trial, patients with metastatic colorectal cancer that has progressed on first-line therapy containing oxaliplatin and bevacizumab will be treated with the drugs irinotecan and cetuximab. The patients will also be randomly assigned to receive either a low dose of bevacizumab, a high dose of bevacizumab, or no additional bevacizumab.
"The goal of this trial is to determine whether there is a benefit to continuing to treat patients with bevacizumab if they have progressed on a regimen containing it," said Dr. Gold."Bevacizumab may make tumors more susceptible to chemotherapy by normalizing the tumor vasculature, and emerging data suggest that bevacizumab and cetuximab may produce a synergistic effect," Dr. Gold added. "So, there is a good rationale to see if continuing bevacizumab in combination with cetuximab will help improve outcomes for patients, perhaps helping them live longer."
For More Information
An archive of "Featured Clinical Trial" columns is available at http://www.cancer.gov/clinicaltrials/ft-all-featured-trials.
NIH Director Dr. Elias Zerhouni is scheduled to testify before the House Appropriations Subcommittee on Labor-HHS-Education on March 5. Appearing with Dr. Zerhouni will be the heads of the Centers for Disease Control and Prevention, Substance Abuse and Mental Health Services Administration, and the Agency for Healthcare Research and Quality. The focus of the hearing will be on programmatic outcomes and the linkages between each agency's programs.
BSA Meeting Held
Lombardi Comprehensive Cancer Center
Director: Dr. Louis M. Weiner • Research Building, Suite E501, 3970 Reservoir Road NW, Washington, DC 20057 • Phone: 202-697-2110 • Web site: http://lombardi.georgetown.edu/
Established in 1970, the Lombardi Comprehensive Cancer Center is named in honor of legendary football coach Vince Lombardi, who was treated for cancer at Georgetown University Hospital. What began as a small clinic treating cancer patients is now a state-of-the-art cancer center housing more than 240,000 square feet of clinic and research space. As Lombardi has grown, its mission has remained constant - to provide the most advanced treatments available, to train future cancer specialists, and to cure cancer in its many forms.
Lombardi was first designated as an NCI Comprehensive Cancer Center in 1974 in conjunction with Howard University, and the designation was renewed for Lombardi as a single-site center in 1990. It remains the only comprehensive cancer center in the Washington, DC, metropolitan area. It receives $97 million in grant funding, has nearly 200 full-time faculty members, and 220 ongoing clinical trials. Today, Lombardi presses forward under the visionary leadership of its director, Dr. Louis M. Weiner, who was recruited in October 2007.
Research Activities
Patient Care Specialties
Other Notable Programs
Education and training at the Lombardi Comprehensive Cancer Center spans all levels of learning. The cancer center has four master's programs (in biostatistics, health physics, tumor biology, and a joint program in cancer genetics, epidemiology, and control), as well as a Ph.D. and combined M.D./Ph.D. program in tumor biology. Additionally, three postdoctoral training programs are offered at Lombardi: a medical genetics fellowship, clinical fellowships in hematology/oncology and palliative care, and research fellowships in tumor biology.


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Hello! I'm completely new to this forum and feeling distinctly amateurish after reading some of the posts! I have a very small collection of wine that I'm wondering what to do with... I'm giving considerable thought to drinking it at some point but in the meantime it needs to be stored somewhere - and we don't have a cellar.
The current plan is to stick the bottles in a wine rack at the bottom of a cupboard away from the kitchen which won't get much direct sunlight. It would be impractical to install a wine fridge. I know that old fashioned larders had big stone shelves to keep the contents at a lower and more constant temperature, but I'm not sure if that would actually work in this case. Can anyone give me some advice about this?
Some of the wine I've had for three to four years already and was in racks in a kitchen. Given that this will have subjected the wine to higher and more variable temperatures, I understand this may have caused some damage. What's the best thing to do? I have Riesling, Chardonnay, Chateauneuf-du-Pape and various Champagnes. Will any be worth storing further or is it time to crack open a few and see if they're still drinkable?
Thanks, Andy


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Maricris's Q & A
Who's your favorite sports team, and why?
The Los Angeles Clippers are my favorite basketball team. I am in love with Blake Griffin! He is an exceptional athlete, with a lot of heart, and the boy can DUNK!!!!! This team plays as a team and wins as a team! I love going to their games!
What's your favorite movie quote?
Shut your mouth. Sh-sh-shut your mouth. -Brennan Huff, Step Brothers
What's your favorite video game, and could you kick our butts at it?
My favorite video game is Time Crisis! I love shooting guns! I'm pretty competitive so I'll try, and if I don't I'll just look good doing it...haha.
Piercings/Tattoos (How many? Where?)
I have my bellybutton piercing. I got it when I was 18, it was supposed to be my rebellious piercing, but I ended up telling my mom the same day and I didn't get in trouble.
What's the most embarrassing song on your iPod?
I love all my songs! But if I had to choose, I'd say One Direction- "You don't know you're beautiful." I love the song, but because I feel too old to be listening to the teeny boppers, I always turn it down if I'm blasting in my car and someone pulls up next to me. :/
What's your best party trick?
Dancing all night and actually being one of the girls that keep their shoes on!!!!
What's the most memorable pick-up line you've ever heard?
If I received a nickel for everytime I saw someone as beautiful as you, I'd have five cents.
What's the worst job you've ever had?
A job that I was never scheduled at even though I had open availability!
What's the most dangerous thing you've ever done?
Still working on making this happen!
It's 4AM after a crazy night out – what are we eating?
Taco Bell! Burrito Supreme all the way!!!
What's the strangest thing in your fridge right now?
The lack of food! I need more food I like to eat but I'm not home often.
What's the naughtiest thing you've ever done in public?
Grinding on the dance floor to the point that it didn't look like dancing anymore. I got kicked out of VIP in Vegas. I swear I was just dancing though!
What do you feel sexiest wearing?
A sports bra and gym pants.
Tell us a joke.
I saw this online and thought it was cute!!! Why did the elephants get kicked out of the pool? They kept dropping their trunks!


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Glad she is OK!!!!
ETA: She is going to have a September baby
Glad she is OK!!!!
ETA: She is going to have a September baby
Last edited by Smplyme89; 03-29-2013 at 06:04 AM.
Chrissy, glad Jesi and the baby are fine.
As for Missy, try a long line, a light one. And standing around the corner, so she can't see you. Lots of dogs won't do their business if they feel watched. Also, she will eventually have to go, so it's a matter of waiting it out. It's likely not worth the risk of her getting run over by something, letting her off leash.
Whew! They always say threatened miscarriage when there is any bleeding. My twins were a threatened miscarriage around that same time period. It's still not easy to relax with it, though.
My dad is coming into town this evening. We are having an Easter brunch and egg hunt at my mom's house on Sunday and a ton of people are going to be there. Any of you are welcome to come, too. We've reached the critical mass where a few more people won't make a difference. We don't even have a head count. I keep hearing about more and more people there. My mom invited a college buddy that she just re-discovered who plays in a band in Sausalito. My high school best friend and his partner are coming. My sister's best friend from her childhood and her family are coming from Oregon. My uncle and aunt are coming. Another aunt may or may not come. A young cousin and her boyfriend are coming. My mom has been getting emails from people saying that they can't make it, and she didn't even know they were invited.
So I'm going to double up on the breakfast casserole and muffins I was going to bring, and now I think I have to make something else as well. I'm trying to put together a shopping list.
L that sounds hectic, but lovely! We don't have any Easter plans so far.... That's what happens when your procrastinator of a husband says he wants to make plans with his family, than proceeds to put off asking everyone what they are doing
I wish I had some easter plans. Last year it was very spring like and we had family and friends over and I hide eggs for the kids. I had decorations out and a themed table.
This year, we still have a foot of snow on the ground. Nobody coming over. I think DH and I will make and frost cookies and that is about it. I have family visiting in three weeks and will probably do an easter dinner that weekend...ham and cheesy potato casserole and rolls.
Chrissy, I'm glad to hear Jesi is ok. I hope the blood draw shows healthy sticky baby hormones!
L, that sounds crazy and fun. I really like those types of parties where they just get bigger and bigger. Seems like it always ends up a really good time. My parents are coming up from SoCal to spend the weekend with us, or we'd hop on over (get it... hop... I crack myself up). We're really just going to have a low-key weekend, I think. Hiding eggs, eating food ... we're brining and bbqing a turkey for Easter dinner this year, which we usually don't do but we had a free turkey from dh's work in the freezer taking up space. I was puzzled about what to make with turkey for a spring dinner -- didn't want to do the typical fall stuff. So we're having apple-brined, hickory-smoked turkey, roasted new potatoes, grilled asparagus wrapped in prosciutto, fresh peas, and mixed greens with strawberries and goat cheese. Nearly threw my back out hauling a giant sack of peas, potatoes, asparagus, strawberries and eggs from the farmer's market yesterday. It's funny about peas -- buy a ginormous sack of peapods, shell them and end up with one bowl of peas. But they're so sweet - these are our first of the year and I'm not sure they'll make it to Sunday dinner. Noe's been eating them like candy.
There's an egg hunt Saturday morning at a neighborhood community center, but it would be our first time and from what I hear it's kind of crazy, like if you're even 2 minutes late you miss out and it's basically a horde of kids racing around for the eggs and taking each other out like in the Hunger Games. I don't think we're ready for that.
I'm taking off work early today and doing an egg hunt with B, Santi & Santi's mommy in the afternoon. B already did an egg hunt at the mall last week, when I took him there for an Easter themed kids' night. We dyed eggs two nights ago when DH was working late and had a really great time together in the process. We had gotten a "tie-dye" egg pack from a box store and it was basically a kit with a dropper included. So we placed droplets of dye on an egg, then blotted. Dropped more on, then blotted. Then we shook glitter and glued sequins on them. B decided to color a few with crayons before dipping too. They turned out really purrrrty.
The rest of the weekend, we're trying to decide what special thing to do for Easter Sunday. One year we went snowboarding. Last year we went kayaking. We might have a little guest stay with us overnight on Sat because I offered to take in my pregnant friends' 4 year old son so they can have some time for themselves. I'm not sure yet if that'll happen. I love having Bodhi's friends over. I have to say it's one of my favorite things. I love it when one of his little friends run up to me with arms open to give me a hug because he's excited to see me.
Whatever we do, it sounds like we're not going to be eating half as well as some of you ladies. I've been having a hard time deciding on what I feel like eating lately.
Crissy... fingers crossed that things stay sticky and positive for Jesi!
Here is another recipe (I made it last night) that I put on jasmine rice. It's yummy. DH loves it. R. loves it. C and S turned up their noses.
Thai style ground beef.
I decided to add caprese pops to my menu for Easter. They look easy, elegant, and yummy.
Hmmm....I wonder why you're having a hard time knowing what you feel like eating lately?
I have no plans. It's dawning on me that this Sunday is Easter, and it's Rich's turn to have Conner. He hasn't mentioned anything about me being there for dinner, so this will be the first official holiday without being with my kids. It kinda hurts.
These are some of the eggs we've done so far this Easter. We've done a lot of other things in the past, and my mom has saved them (we usually work with blown eggs), so I like to do different things every year. Claire is doing a lot of the stickers. We tried putting postage stamps on some of the eggs (saw it on Martha Stewart) and my grandma, who collects stamps, even sent me some, but those turned out terrible. They wouldn't contour to the eggs very well.
I just realized I never picked up the kit to decorate eggs....
and I'm not even sure I have eggs....
Oy, mommy fail....
You can also cut large ovals out of construction paper or even regular paper and paint or color them or put stickers on them. There are tons of ways to decorate eggs without having eggs around. R. drew this at school the other day:
and ever since then the children have been making their own eggs and coloring them and stickering them and leaving them all over the house.
That's an awesome idea L!
I have a hard time figuring out stuff to do with Nolan on the Holidays... He's still so young and not all that interested in crafts since he still wants to stick everything in his mouth
I love the one with the handprints the most, L!
Do your kids have an ok time handling the blown eggs? Bodhi broke a few that weren't even blown!
Not quite sure why I can't sort out what I want. I know I want something to eat but nothing specific seems appetizing. It's kind of like those times you've let yourself not eat for too long. And then you get to a restaurant with a huge menu and, you've waited so long, but suddenly you can't decide what would be the exact thing you want to put in your tummy at just that moment. I've been feeling like that ALL the time this past week.
SCUBjia! We are almost home, stopped for lunch and Sawyer is asleep so him and I stayed in the car. Sweet silence.
Chrissy, I hope J's appts continue to show baby is doing well. That must have been terrifying.
Christine, congrats! Glad to see you back.
Katy, are you going to the lake too? I am probably overprotective as well but that scene would worry me too. Sorry she has been difficult. Kai is giving me a run for my money these days too.
I recently read a blog post by a mom that vowed not to yell at her kids for a year unless they were in danger. I'm in. I hate myself when i yell and feel like i have been doing it too much, with Kai testing me. But truth be told it doesn't work, raises the noise level in my house, and makes me feel like crap. I am on day 4 of nary a yell.
Family is back!
My brother's GF posted this the other day: http://www.boredpanda.com/easter-diy-ideas/ I tried #7, but that didn't work. I'm sure I was supposed to use more than water and color or something. I do so badly want to try the silk tie one, but all our eggs are brown, so I'll pick up some white ones next time, and then give it a shot. I should have some old silk scarves somewhere, but darned if I remember where.
I've been thinking about the silk tie one, too.
With the blown eggs, I have the kids keep the eggs in those plastic cups that little fruits come in (like chopped pineapple or mandarin oranges). I don't buy those fruits very often, but I always save the cups because they're awesome for paints and holding little craft items. They can do what they want and just roll the egg in the cup. But we've had plenty of cracked eggs here. Ro was putting some stamps on one of them and cracked it, but enough stamps actually stabilized the egg more.
I would like to yell less, too. I would love to make a vow to go for a year without yelling, but I think that is just one more thing I would fail to live up to and then feel guilty about. I just need to keep trying to do the best I can and start over if I have a less than stellar day.
Welcome back, Bridget!
Love the eggs, L! And the caprese pops -- I love caprese salad so I'll definitely try those this summer when we get our tomatoes in.
We've been doing easter crafts, too -- decorating construction paper eggs with glue and bits of tissue paper, etc. We made paper flowers earlier in the week and they came out really cute. N's at the age where she wants to do crafts all.day.long. We'll be dying eggs tomorrow. We only ever have brown eggs, so when we dye they always come out a bit more earthy and mellow colorwise, but I really like them better that way. Not quite so bright. DH's mom sent us a kit with some sort of gold glaze, so that will be fun to try.
Yeah, Myles, wonder why you are so undecided? FWIW, for me at that phase (and why I wanted it was still a complete mystery at the time) it was macaroni salad. I was bringing home whole tubs of the stuff, all different brands and deli types, trying to find the Ultimate Mac Salad. Thank goodness that didn't last long, but I can still drain the color out of dh's face by saying "hm, I have a hankering for macaroni salad."
I've really found that I feel more peaceful when I can work through that spurt where I feel the need to yell.
Another thing Nolan might like would be decorating cookies. I have a great sugar cookie recipe and we cut out from that. I have a few easter shapes and spring shapes. Of course one is an egg. Little kids generally like frosting those up and if he got it in his mouth, no big deal. I usually just buy white frosting and divide it up and dye different colors. Plastic knives are way better for spreading than regular ones.
I had to buy DH a few piping things because he was frustrated decorating last time. Now we have bags and tips so he can do lines and dots. LOL
Rich is having a Sunday dinner. He was telling me about it while we were waiting for Jesi, and once I was home I realized he didn't ask me up. Just another example of how he's going to act 'different' now that he has a gf. It's not like we were holding hands or anything when I was up there before for the holidays. But that's Rich. He cannot be 'nice' to me if he has a woman. imo, he's sacrificing his children's happiness on a level because he's like that, but fighting with him about it won't change anything.
Totally different scenario though.
It was a tradition in my family growing up. We did Christmas, Valentines, Easter, and Halloween (pumpkin shape is the best...I have a bat and a cat too but they like to fall apart and it's just hard to get the right color frosting....though I suppose I could buy chocolate....hmmmm).
Not sure colors. I had DH buy two things of frosting. Thinking white, yellow, pink, light green, light purple and maybe light blue.
I'm so glad Jesi is okay. I was worried last night without an update.
I yell at Puppy a lot. A lot. I've been trying so hard to back off and talk to him calmly and quietly. It definitely works every time. Although I think he's maturing a little and his behavior was improving. When he was tiny he couldn't get up on the furniture, and then suddenly he was big enough and would take flying leaps up into the bed to greet me and step all over my face. I admit I panicked thinking of how big he was going to get and have really trying to target that behavior. He's much better about listening (although he still has selective hearing like Missy). I realized recently that now that he's even bigger, he can walk right up and greet me in the morning when I'm still in bed from floor level and he doesn't have to get up on the bed and step in my face. That combined with his listening and responding more quickly is really making me feel better about how he is turning out.
Christina, I bet you could even try cutting out round circles, either with a cookie cutter or just the edge of a glass. With some white or pastel frosting as a base, any decoration on top of that would look very eastery to me even if it isn't egg shaped.
I will say that Easter as a family celebration is pretty much pointless with two adults. I just have no interest in dying eggs by myself (DH has no interest). We did buy some easter candy, which is sitting in a bowl on the table. Other than that, I don't think we will really have anything going on.
Me (40) DH (47) & furbabies * m/c 7/08 4/12 11/12
I cannot go that long without yelling at Molly. LOL This morning she got yelled at twice for going on the couch uninvited because she wanted to bark out the window. Nevermind that she can see out the window without having to be on the couch. But Cosmo is allowed so suddenly Molly is testing me to see what she can get away with. We make her have an invite up because we want Cosmo to have a space to get away and we don't Molly to accidently push Cosmo off the couch....Cosmo likes to lie on the top like a cat and twice has fallen and gotten stuck between the window and couch!
Mandy just wait....he will be totally fine and suddenly want to "test" you! See my post on Molly above! LOL
Yup I get it with the holidays. Last year I had people coming over and it was really fun. I had themed placemats and some traditional foods and got to hide eggs outside. I must say that DH found some great spots considering our yard is rather barren in landscaping still. But Cosmo was telling the kid were they were! LOL
But this year with still having a foot of snow on the ground and nobody coming over, not doing much. Only cookies since they are yummy to eat and I want to test out the decorating tips.
I hope that next year maybe I will be putting together a first easter basket. I have mine from my entire life and want to use that. it's nice and big and can hold a lot of fun summer toys. Oh and a cute little outfit. I'm kind of old-fashioned and love little hats and bonnets.
Thanks ladies! I do have to run into the store and get Italian Bread for dinner (Spaghetti, YUM!) so I'll see what they have, that's at the front of the store, cause I do not have the energy or dedication to go searching through the store.
I suppose we'll be mostly winging it this year


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Source: SourceOECD Social Issues/Migration/Health, Volume 2007, Number 28, February 2008, pp. i-226(226)
Publisher: OECD - Organisation for Economic Co-operation and Development
Document Type: Review Article
Publication date: February 1, 2008


text: It all started in January 2005 when Cheap Monday was developed into a brand with full scale collections and the distribution was extended to selected stores in Sweden as well as abroad. Today Cheap Monday carry main collections for men and women as well as three in-season drops. The collections also include baby, accessories, glasses, underwear and shoes.


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There was an unexpected scene Thursday outside the Coleman A. Young Municipal Center in Detroit. Hundreds were forced to evacuate because of smoke in the boiler room.However, it got even more unpredictable once everyone was allowed back inside. In the clerk's office with cameras surrounding him, Mayor Dave Bing signed his nomination petition and collected his petition forms, but then in a news conference that followed, he said he still hasn't completely made up his mind."When I make the decision to get in it, then yes, I'm in it to win it," Bing said.Bing moves forward on a move to run for re-election for mayor of a city that right now is under the control of an emergency manager. Kevyn Orr has 17 months left to fix the city's finances.Bing, who still supports state control, feels it will take longer than that, and he wants to finish what he started despite the criticism that he has faced along the way."I'm not sure that another four years will fix the city, but at least I think it puts you on a path that's going to be positive," Bing said.Bing's likely run will put him up against seven other candidates, including accountant Tom Barrow, who turned in his petitions Thursday at the same time Bing collected his. Barrow ran against Bing back in 2009.The candidates aren't a consideration for Bing, who said he will make his final decision once he talks to people internally and members of his family because he knows what kind of commitment it will be."I'm a competitor. Competition is good. So I'm not concerned about who's in the race. If once I decide to get in to it, then I don't give a damn who's in the race," Bing said.
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KB: Does the fame faze you?
DS: Not really. I've worked with the same clients for such a long time, ever since their careers started to take off, so I feel like we grew up together. That is not to say I don't realize what a big deal and blessing it is to work with A-list celebrities, it's just that after a while, you realize people are people and you're there to provide a service.
KB: What was it like to go on the press tour with the cast of Twilight?
DS: Going on the road for work is not as glamorous as one might think. It's still a business trip, and the schedule is pretty exhausting. I'll be away from home for two weeks, home for four days, then away for another two weeks. The exciting part is everything is first class, from the car that picks us up, to security that takes us through the airport, although most of the time we y private. I grew up on a farm, so this is almost not even real. I also get to meet people from all over the world, which is wonderful. The typical schedule is: interviews during the day and then a red carpet movie premiere event in each country, only to have to leave the event once the movie starts so we can jump into waiting cars and head to the airport to travel to the next country. We typically have at least one day off in each place, which allows us some free time to go out to eat, hit some museums, and soak up the culture and people. As for the Twilight tours, it's total madness. Fans chasing the cars, crying, screaming the actors' names—that's the Twilight phenomenon. One of my most favorite memories from the last Twilight tour was bowling with Kristen Stewart and Taylor Lautner. Sounds simple, but that is exactly why it was so fun and special.
KB: Why do you think your clients are so loyal?
DS: They call it show business, not show friends. I know my place. Keeping it professional is the key to success, and having the skills to back it up is critical. We all know it never works making friends with clients. But it's important that your personalities click. As fun as it may be, in the end, I know I'm working for someone else. I never forget how lucky I am. Working in fashion and entertainment is exciting and can be very lucrative. It's how we react to it that matters. I'm not much for rules, but there are a few I stick to. The biggest one: no gossiping.
KB: Have you ever wanted to pinch yourself, because you thought you were dreaming?
DS: When Oprah called, I did feel like pinching myself. That was unreal. (Schmidtke has been the lead stylist on two of the Oprah show's Makeover My Man! segments, and was part of one of the nal Makeover Dream Teams for the nal season—for more on her Oprah experience check out salontoday.com). Also, when I work with icons like John Travolta, Kevin Costner or Harrison Ford, I'll be high on life that day. The new generation guys like Johnny Knoxville, James Franco, Jon Hamm, I see them around their families, and we grew up together in the industry so they're regular guys to me.


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Thanks to everyone who took time to review this and other ottomans here at overstock.com, I thought I had a good idea of what type of ottoman I wanted. Still, I prefer to shop locally and hit the local furniture stores looking for a coffee table ottoman. I was initially interested in the table-with-an-upholstered/leather-top look; however, most of the brick and mortar stores only carried the 'grandma/grandpa' shapeless foot stool kind of ottoman. And the color and size options were also paltry -- boring oatmeal family colors or crazy patterns and sizes that were too large for my needs. A couple of stores carried selections with a little bit of style to them, but I felt that the asking prices were ridiculous. I mean, why does a glorified foot stool cost as much as my lei zee boi recliner? Anyway, I re-shuffled my priorities and began to consider more traditional ottomans such as this one. I liked the idea of adding a punch of color to my living room via the ottoman, I liked the clean shape of this one, and I really liked the price. (Although I was a bit skeptical after seeing the prices around town, thinking 'what's wrong with this ottoman that overstock sells it so cheaply?') I chose the wine colored one. Like an earlier poster noted, the color is a deep burgundy, which is just perfect for my room. I was afraid that it would look too wee in front of my 80" long sofa, but it is perfectly proportioned - length, width, and height. And like someone else also noted, while no one will mistake this for a high end piece of furniture - it isn't lux - I don't think it looks cheap either. Shipping was lightening quick (I ordered very late Sunday night/Monday morning, and it arrived Wednesday afternoon), nothing was damaged, and it took minutes to affix the legs. No bad smell either. My only concern is regarding how this piece will do long-term. The material does not seem to be all that thick and I wonder how it will weather extended use - if the material and/or seams will stretch under the weight of resting feet. Only time will tell, but until then I remain very happy with my purchase.
I loved everything about this online but when it arrived, the interior space doesn't hold much. It only has about 4 or 5 inches deep for storage because the lid (which is not hollow) takes up half the height. If that doesn't matter to you, you'll probably like the ottoman, but for me it doesn't do the job. I'll have to send it back. So disappointing.
Large ottoman. Bought this for the family room. I store bedding and pillow for the sleeper couch. Very roomy interior. Easy to clean just by wiping with warm water. Sturdy construction. Just wish it came in navy. Highly recommend.
It's not a luxury item or anything, but this ottoman is a steal at this size and price. Love the different color options. I got mine in brick and it is very understated but gives the room a pop of color. Awesome size, almost the size of my old coffee table and the storage fits everything you could want to fit in there. Microfiber is ideal-just wipe the mess away with a damp cloth. I have nothing bad to say about this ottoman.
I really like this ottoman. The color (I ordered the burgundy one) is vibrant and just as expected from the website example. I put it in a study that has a sofa bed in it, it's perfect as an ottoman and the storage is plentiful. The only reason I did not give it an overall rating of 5 stars is because it would be nicer and more convenient if it had casters (wheels) on it for easier movement when necessary.
I was pleasantly surprised when I open this out of the box. The color was absolutely perfect. This goes perfectly in our playroom as a foot rest and storage ottoman. For the price you cannot beat this ottoman. We store all of the throws and blankets in the ottoman. Love it I may get a another in a different color.
very good color true to picture would purchase again
The ottoman arrived promptly and seemed to be of good quality but the color was not at all what we expected. The bordeaux is really more of a purple than a wine color. Unfortunately, it was not what we needed for our room.
We are very pleased with both the product and delivery time of the bench.
I waited for the Mocha Brown to come back on the website and snatched it up. This is a great value for the money. Shipped very quickly. It is durable and looks very nice. I didn't want to spend a fortune on a piece that would just be used for feet. I have a nice tray on it for drinks. The storage inside is perfect for blankets, I have about 4 in there and there's plenty of room. I vacuum it to keep dog hair and dust off. But the microfiber fabric just stays naturally clean, I like that the color varies depending upon which way you brush your had across it. I've had to wipe off a spot of dirt, it came right off, but be careful because I think too much water might damage the fabric, mine didn't stain but that's just something to keep in mind. Other comments about the legs are correct, they are plastic but they sit so low you don't even notice. I don't think you'll be disappointed with this piece.
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Oculopharyngeal muscular dystrophy
Other Names for this Disease
- Muscular dystrophy, oculopharyngeal
See Disclaimer regarding information on this site. Some links on this page may take you to organizations outside of the National Institutes of Health.
[1] There are two types of OPMD, which are distinguished by their patterns of inheritance. They are known as the autosomal dominant and autosomal recessive types.[2] Both types are caused by mutations in the PABPN1 gene.[1][2][3]Oculopharyngeal muscular dystrophy (OPMD) is a genetic muscle disorder with onset during adulthood, most often between 40 and 60 years of age. This condition is characterized by slowly progressive muscle disease (myopathy) affecting the muscles of the upper eyelids and the throat.
Last updated: 5/2/2012
- McLoon L, Lee M. Muscular Dystrophy, Oculopharyngeal. National Organization for Rare Disorders (NORD). 2007; http://www.rarediseases.org/search/rdbdetail_abstract.html?disname=Muscular%20Dystrophy%2C%20Oculopharyngeal. Accessed 12/7/2008.
- Oculopharyngeal muscular dystrophy. Genetics Home Reference (GHR). December 2008; http://ghr.nlm.nih.gov/condition=oculopharyngealmusculardystrophy. Accessed 12/8/2008.
- Facts About Rare Muscular Dystrophies. Muscular Dystrophy Association (MDA). June 2008; http://www.mda.org/publications/fa-rareMD.html. Accessed 12/7/2008.
Your Questions Answeredby the Genetic and Rare Diseases Information Center
3 question(s) from the public on Oculopharyngeal muscular dystrophy have been answered. See questions and answers. You can also submit a new question.
On this page
Basic Information
- Genetics Home Reference (GHR) contains information on Oculopharyngeal muscular dystrophy. This website is maintained by the National Library of Medicine.
- The Muscular Dystrophy Association (MDA) provides additional information about oculopharyngeal muscular dystrophy in their publications entitled, Facts About Rare Muscular Dystrophies and Oculopharyngeal Muscular Dystrophy (OPMD). Click on the links to view this information.
- The National Organization for Rare Disorders (NORD) is a federation of more than 130 nonprofit voluntary health organizations serving people with rare disorders. Click on the link to view information on this topic.
In Depth Information
- The Online Mendelian Inheritance in Man (OMIM) is a catalog of human genes and genetic disorders. Each entry has a summary of related medical articles. It is meant for health care professionals and researchers. OMIM is maintained by Johns Hopkins University School of Medicine.
- Orphanet is a European reference portal for information on rare diseases and orphan drugs. Access to this database is free of charge.
- PubMed is a searchable database of medical literature and lists journal articles that discuss Oculopharyngeal muscular dystrophy. Click on the link to view a sample search on this topic.
Other Names for this Disease
- Muscular dystrophy, oculopharyngeal
See Disclaimer regarding information on this site. Some links on this page may take you to organizations outside of the National Institutes of Health.


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CenturyLink - LadysmithReview me Claim this business
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Gramophone (410) 308-1650
Timonium, MD, 21093, United States
Adding a home theater to your house can be a major investment. When you consider the hours of planning; the selection of materials such as flooring, seating, wall coverings,... Read More
InnerSpace Electronics Inc (914) 937-9700
Port Chester, NY, 10573, United States
Award-winning InnerSpace Electronics offers "one-stop-shopping" for all facets of home systems integrations. We design and sell home theaters, multi-room audio/video, lighting... Read More
Surreal Systems, Inc. (714) 779-9900
Anaheim, CA, 92807, United States
At Surreal Systems our purpose is to enhance lifestyles through technology, engineered for a perfect fit. We offer a concierge experience with expert design, exceptional products... Read More
Digital Architecture Inc (862) 621-9395
Montclair, NJ, 07042, United States
Digital Architecture is a full service Audio/Video installation company located in Montclair, NJ. We specialize in selecting products that uniquely satisfy the designers,... Read More
Media Rooms Inc (610) 719-8500
West Chester, PA, 19382, United States
Media Rooms Inc. is a national award winning design, construction and installation company specializing in home electronic systems and related custom interiors. We combine the... Read More
1 Sound Choice (973) 316-0678
Pompton Plains, NJ, 07444, United States
Design * Build * Enjoy that's our motto. Our Design Team will help you understand your many options and guide you as you select components that will deliver the optimum... Read More
The Sound Vision (248) 804-8011
Franklin, MI, 48025, United States
The Sound Vision team has years of experience specializing in the design and installation of audio video, home theater, home automation, lighting control systems and much more.... Read More
H. Customs Electronic Integrators (817) 300-1518
Mansfield, TX, 76063, United States
H. Customs Audio Video is Dallas Fort Worth's premier custom integrator for residential and commercial electronics. H. Customs works with top builders, architects,... Read More
Control Your Life, Inc. (954) 366-1181
Sunrise, FL, 33351, United States
•Free in-home or business evaluation, consultation & estimate •Knowledgeable & courteous employees. We provide ongoing manufacturers training up to date certifications to our... Read More
AustinAudio.com (512) 970-7050
Austin, TX, 78727, United States
I have worked in Austin TX for over 17 years. I take pride in our finished projects working with the home owners decor and not detracting from it. I am always looking for upscale... Read More
j.Patrick Audio Video Ltd. (440) 342-3362
WICKLIFFE, OH, 44092, United States
Our company was founded in 2008, with the simple mission to provide our customers with the customized service we believed the industry was lacking. As a company in the world of... Read More
Crescendo Designs, Ltd. (631) 283-2133
Southampton, NY, 11968, United States
Surround your senses with the best in high-end home technology paired with the art of great interior design. We provide design, wiring, Installation, programming, service and... Read More
Northeast Entertainment, Inc (315) 657-7849
Baldwinsville, NY, 13027, United States
Northeast Entertainment is a custom electronics retail and installation company providing quality products, installation, set up, education and training of consumer electronics... Read More
Little Rock, AR, 72211, United States
Custom integration company specializing in home automation, distributed audio/video and home theater design located in Little Rock, Arkansas. Read More
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Back at chez Parisbreakfast I bought this lamp from Target in a fit of Eiffle Tower insanity... It has been sitting for months looking like this. The lampshade is the pits. Plus I am a tad dyslexic and I don't do instructions well. A PB reader mentioned this BHV Eiffel Tower as a nice addition to my decor and I found it! But at 129 euros and with a lot of instructions and in French. If only I could bring home this Eiffel Tower sitting outside the window of the musee Branly and put it outside my window.
Slowly but surely my Eiffel Tower themed appart is coming together.


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Boy Scout™ LED Gel Flashlight$9.99Durable, easy-to-locate design delivers great light output at a great value. Learn More
Boy Scout™ LED Lantern$29.99Featuring three burn modes—Full, Low, and for Strobe, just press and hold power button for four seconds. Includes plastic buckles to clip to tent hooks. Learn More
BSA® 40-Lumen 5-LED Headlamp$17.99Versatile and reliable everyday lighting lets you adapt light to your circumstances, with four lighting modes: 5 LED on / 3 LED on / 1 LED on / flashing. Five high-performance LED bulbs deliver max output up to 40 lumens. Uses two AAA batteries (included). Learn More
BSA® Swivel LED FlashlightOriginal Price:$9.99 Current Price: $7.88Military-inspired design swivels and maneuvers with ease to shine into awkward spaces. Includes high-impact plastic case and super-bright krypton bulb. Uses four AA batteries (not included). Learn More


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Maureen McKeeNovember 29,2013Maureen McKee
FAIR HAVEN Maureen McNamara McKee, 74, formerly of Fair Haven, died Oct. 30, 2013, at her home in Smithtown, N.Y.
A full obituary will be published in a future edition of the Rutland Herald.
Arrangements are pending at the Mallory Funeral Home in Fair Haven.MORE IN Obituaries0919 RH Obits Butler paid no photo no flag Full Story0919 RH Obits Reed edited photo no flag Full Story0919 RH Obits Turner rites no photo no flag Full Story
- Most Popular
- Most Emailed
- RICHARD'S POOR ALMANACK: Giles Corey of Salem, Mass., is pressed to death during the Salem witch trials; on this day in 1952, film comedian Charlie Chaplin, while traveling to England, is denied re-entry into the United States by U.S. attorney general.
- RICHARD'S POOR ALMANACK: Dutch father of microbiology Antonie van Leeuwenhoek discovers the existence of one-celled organisms; in 1967, The Doors are booked to play the Ed Sullivan show; in 1858, freedom fighter Dred Scott dies on this day in St. Louis.
- TOMORROW'S HEADLINES TODAY: No money this year for western rail project, Lola Aiken memorialized in Montpelier, Supreme Court Castleton murder suspect will remain in jail, Shaftbury man fires shots from his AK-47 into neighbor's home.
- RICHARD'S POOR ALMANACK: On this day in 1959, Soviet Premier Nikita S. Khrushchev arrives in U.S. for historic 13-day visit; in 1987, Secretary of State George Shultz and Soviet Foreign Minister Eduard Shevardnadze sign nuclear reduction agreement.
- TOMORROW'S HEADLINES TODAY: City celebrates completion of its newest mural, on West Street opposite the post office, more than $2 million in federal grants will bolster Vermont's health centers, Patrick McArdle reports on pending sale of Vermont papers.
- RICHARD'S POOR ALMANACK: Henry Hudson sails up the Hudson River as far as present-day Albany, Leo Szilard has epiphany waiting for the light to change, 3 kids report a West Virginia close encounter in 1952.


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Susan aka suslyn
Here's my attempt. I am not totally sure that I understand the concept of ATC. Have you done a tutorial or is there more information somewhere where I can learn more?
I used 1 paper and 3 elements from What Could Be by Studio 4 Designworks because of then paper's unique design. The quote is from the Marshfield Clinic's advertising slogan.
here about the history of ATC. There are not really rules other then the size but each month I will look at different aspects. Next month we will talk about text.
Thanks for the info, Sharon!
Oops, I almost forgot this!
Here is my background: I used a basic color light green and a style from Andrea Gold. Then with a brush that comes with photoshop I made the borders in 3 colors.
Then I used my own drawings to finish this Spring ATC.
(I used your template, but first I tried to turn it. I like standing ATC better but it didn't work)
Sometimes real life is more important!
Good luck on selling the house!
How is the 'house-market' in Australia?
In the Netherlands it is very hard to sell a house.


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|Bridal Salon
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Discriminating, contemporary brides who are simply too busy to browse the runways of Paris or Milan will feel like they hit the jackpot at this spacious, luxurious salon. A sophisticated collection of…
|San Mateo


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The luxury resort of Constance Le Prince Maurice on the eastern shores of Mauritius plays host each year to the island's literary award, Le Prince Maurice Prize.
Celebrating the best in literary love stories, the prize alternates each year between a French and British novelist.
Celebrities who have taken on the role as Patron of the prize include:
Richard E Grant (above, right)
Actor and author Richard E. Grant, best known for his inebriated performance in Withnail and I, and more recently Gosford Park, and Filth and Wisdom.
Tilda Swinton (right)
Oscar winner Tilda Swinton, who won Best Supporting Actress in 2008 for her role in the acclaimed film Michael Clayton.
Sebastian Faulks
Author Sebastian Faulks CBE, who wrote one of the UK's best loved novels, Bird Song as well as Charlotte Gray, Human Traces and the James Bond novel Devil May Care.
Each year, three shortlisted authors are invited to enjoy the luxury of Le Prince Maurice for a week of cultural exchange with Mauritian students and authors.
Recent authors to visit include Julia Gregson, Sadie Jones and William Sutcliffe.
Find out who's on the shortlist for this year's French literary love stories or visit the website Le Prince Maurice Prize.


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Everyone is doing the Harlem Shake. It's the latest social media trend that's going viral.
The Harlem Shake launched just last week, but our very own Diamondbacks made history again by being the first MLB team to do it.
It's a social media phenomenon. The latest Twitter trend, the Harlem Shake, is spreading like fire throughout the cyber world.
In the Harlem Shake, a song with a techno beat is playing. One person is dancing in an ordinary room where no on pays the dancer any attention, then suddenly and spontaneously, an entire group of people is doing the Harlem Shake.
Search Harlem Shake on Twitter and it's probably trending.
There's a Harlem Shake video made in a high school, a dorm room and even in the Kansas University locker room.
"We actually got called out by a huge company, will Dbacks be first team to do it, I bet they will," said Derrick Hall, Arizona Diamondbacks President and CEO.
The DBbacks are always rising to the occasion, and were the first MLB team to Harlem Shake.
"I didn't even know what a Harlem Shake was," said Hall.
Their video is receiving thousands of views in just a few days.
The guy out front in the video is Hall himself. He started the Harlem Shake at a team practice.
"Each morning the players stretch on a agility field, fans were waiting for players," said Hall.
Hall admits being nervous about asking the players to jump on board.
"I'm starting to panic, I can't do this, and I look over, JJ Putz goes, 'Is this the Harlem Shake? This is awesome.' And all the players were in," said Hall.
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HILTON HEAD. S.C. —Glenbrook tennis coach Wayne Orr and his Bossier/Shreveport 4.0 Super Senior Men's tennis team recently represented Louisiana in the USTA Sectional Championships held at the Shipyard Tennis complex in Hilton Head, South Carolina.
The state winners from the nine Southern states are placed into two divisions. On an alternating basis from year-to-year, one state is granted two teams, making two divisions of five teams. The teams compete in a round-robin format within each division; then the division winners compete for the Sectional Championship. The winner advances to the National Championships in Phoenix, Arizona, in April 2012.Subscribe to Read!


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He once put killers behind bars, but now the former head of the Detroit Police Homicide Unit could go to prison for life. William Rice didn't kill anyone. He is accused of lying under oath.The 63-year-old will soon be formally charged with two counts of perjury. The Wayne County Prosecutor's Office claims Rice gave false testimony during an appellate court proceeding for Davontae Sanford. Sanford, a developmentally challenged child, was 14 when he was charged as an adult and later convicted of a quadruple homicide back in 2007. The homicides happened inside a home on Runyon. Detectives say it was a dope house on Detroit's east side.What was Rice's alleged role on Runyon? Cooking up a phony alibi for Sanford saying the two were together when the fatal shots were fired.So why would Rice be staring down a life sentence for allegedly telling a lie. Some would say that sounds excessive, but in a capital case like this one, it is possible. "If you lie in a murder case under oath, that is almost as bad as the murder itself because you could go to prison for life," said Fox 2 legal analyst Charlie Langton. You may recall that Rice along with his girlfriend and co-defendant, Cheryl Sanford, have been charged with conducting a criminal enterprise and other crimes. Cheryl Sandford just so happens to be Davontae's great aunt. Her nephew is doing time for multiple murders.So another one of Detroit's former elite could be poised for prison not for bid-rigging or taking a bribe, but for allegedly lying under oath.
KSAZ-TV & KUTP511 W. Adams St.Phoenix, AZ 85003Phone: (602) 257-1234Fax: (602) 262-0177


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So this story was generating a lot of controversy recently. Apparently during a high school football game in Texas one team (Aledo) beat another team (Western Hills) by a final score of 91-0. Sort of a shocking score until you dig a little deeper (reading the second paragraph) and find out that Aledo is a certified powerhouse that has been winning their conference games by an average of 77 points per game. But naturally given the culture we now live in, a parent at Western Hills is filing a bullying complaint against Aledo. Now the administration at Aledo are forced to launch a full on investigation, file a ton of TPS reports and essentially waste taxpayer money for what the Western Hills coach already deemed 'the way football is supposed to be played in Texas.'
Now my initial reaction to this is 'wussification of America at it's finest,' and 'if you want to not lose by 91 points, then stop somebody.' Granted I don't have kids. Shocking I know. You'd think women would be drawn to me like moths to a porch light with my 'writing' career and unlimited credit line with my mom and dad. So maybe given that I don't have that context and have never watched a son or daughter lose a game this badly, I don't really understand the scope of it. But at the end of the day I'm not sure what this parent wanted to have happen. For Aledo to just start taking 3 knees every drive once they were up 40-0? Personally I'd be more embarrassed by that than if they scored 150 against me. And I've been on the other side of these routes. Once in 7th grade basketball my team lost a game 98-2. Was it fun? For sure not. But did anyone file a bullying complaint? Double for sure not. You know what that beat-down taught me? Maybe I'm not going to play in the NBA after all! Might be time to explore some other hobbies and find something else I'm good at. Maybe time to put down the basketball for a while and work on my run-on sentences for a future blogging career. The world needs ditch diggers too .
PS: How about the poor kid who goes to Western Hills whose parent filed this complaint? Your mom/dad files a complaint for bullying is bad enough. But when it coincides with high school football? In Texas? Steven Glansberg won't even sit with this guy for the duration of his high school career.


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I don't know about you, but I can't make it through a nine inning baseball game (or church) without drinking some hard liquor. Man, I love getting wasted! Anyways since I am an old pro at this from sneaking booze into Wrigley I thought I would help you out. That's right, it's time for...
Sep 09


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I bow down to all of you talented mommas!
I bow down to all of you talented mommas!
Me = Alison, DH = Evan, DS #1 = John 09/05/06, DS #2 = Alan 07/21/09
OO Rachale, I LOVE the tree shirt and shorties!
Her link for those interested: http://hyenacart.com/onestore.php?vid=3292&category=4
Rachel I absolutely LOVE those red shorties!!! Adorable!!
Angela, we only really have enough for like 1 1/2 days right now LOL I need like another 10 or so, so Im not doing diaper laundry so much.
Im thinking these will all be fitteds with lay in or snap in soakers. Not sure if I can part with the dragon one! LOL I might have enough of that print left, to make one more, in two pieces like that one. That one was just a scrap really. The others I have quite a bit left
Cute V!!
IMO a good 3 or 4 days worth diapers is the right amount. I used to hate having to do laundry so often!
I have to admit now that Sam is older there are days that I wonder when I changed him last.... When he poops he tells me, so poop never just hangs around. But yeah, pee sometimes does. I try to use fitteds at home so when the outside is wet I remember to change him. But when we're out and about it's rare that I change him these days.
That's a good point V. Sam does pee a lot more at home than when we're out, too. Maybe it's because at home he's always drinking...
We need to do the fountain again soon angela.
Yea, that is probably it. Nathan is usually eating or drinking something..he just threw cookie at me *sigh*
if I remember tomorrow, I'll have to get pics of the new diapers on him. its too dark in here now. I got three soakers made today too. The serger is nice! but takes a little getting used to haha
I am so jealous! My serger should be here tomorrow but I don't have any thread OR time to play with it before I leave! BOO!! Post pics so I can live vicariously through you.
I got lucky..she had thread on there and it was threaded
the soaker I used the serger on
its upside down. And I dont care So, the one with snaps would have been the same size as the middle, but uhm...I put it together, serged it..and realized I put the snaps facing the wrong way! :banghead: the longest one is the last one I did and I can totally tell Im getting more used to the serger, when compared to the others haha
I think it is so cool, that it trims the fabric as you sew haha so I dont even have to have my cuts all perfect..not that I do anyhow but still! I watched Katie use hers a few times, so it wasnt too bad..but it totally has a learning curve! Good thing Nathan needs new diapers Though I dont plan on doing any serged ones..unless I still turn them. I prefer T&T
Virginia, I love that soaker!
I am jealous of all of you who have light wetters! DS soaks through all his fitteds within an hour. If we are out and about for 2 hours, I can be sure to have a leak from him sitting in the car on the way home.