This word 'salvation' is in my text. What a wonderful word. I am going to preach to you about salvation, about being eternally saved in every respect from all the influences of sin. I am going to explain to you what God accomplishes when he makes men and women complete, because salvation is exclusively a work which Jehovah alone has done both for us and in us. Salvation is never something that a man is able to do, any more than a man can create or sustain the universe. Saving sinful man is God's unique prerogative. I want you to know that what I am going to say is going to be straight and plain teaching from the Bible. I would be happy for you to tell anyone that you went to this church today and that the preacher spoke about people being saved, that he quoted these famous words from the letter to the Hebrews, "How shall we escape if we neglect so great salvation?" I want you to tell people that this was one of those churches where men and women are urged to be saved and where the way of salvation is explained, and that the entire congregation is encouraged, most earnestly, to avail themselves of God's salvation. "Be saved today!" the preacher says.
I am saying all this because the apostle Paul has come in his description of the Christian's armour to this fifth piece, the helmet, and it is a 'helmet of salvation.' What is he talking about? What is this salvation that the Bible teaches?
1. SALVATION IS DELIVERANCE FROM SIN WITH ALL ITS CONSEQUENCES.
i] Sin has made us weak.
Since the fall of our father Adam there is a bias to sin in everybody. I know of a man named Hector Hall from Boston in Lincolnshire who one Monday in the last couple of months went with his wife to their local supermarket. Ann put a pound in the lock to get a supermarket trolley but she soon discovered that this trolley had a mind of its own. It would not go straight, and she struggled constantly with it. Eventually the only way they could get around the supermarket was by Hector pushing and Anne steering at the front. I am saying that that wayward trolley is a simple picture of every single person in the world. We cannot go straight by our own strength and by our own power. We are like Paul having the desire to go straight but being unable to carry it out.
God's first task in saving us is to deal with our weakness, and God does that by coming by his Holy Spirit into our very lives, and giving to us a new strength and divine power. God changes our disposition. He begins by giving us understanding of simple truths, overcoming our ingrown prejudices so that we don't switch off when the preacher says he is going to explain the way of salvation. God takes away the offence which once we felt at such 'salvation' language. He helps us to understand what is the real issue in our lives. He gives to us a desire for scriptural truth, and an energy to change accordingly. The Bible says that that transformation is so radical that it can be compared to a new birth, or that we have been newly created, or that we have received new life, or that we have been raised from the dead. So that now we find ourselves desiring what before we dismissed. Now we appreciate what before we mocked. We now admire purity, and modesty, and gentleness, and self-control, and kindness, and we want to live like that more than anything else in the world. That is the first step in salvation, a deliverance from weakness by the power of God. It is like the two hands of Hector and Ann on that supermarket trolley making it go the way they wanted it to go. So God the Father, and God the Son and Go the Holy Spirit put their hands on our lives for good, directing, guiding and strengthening us. He does that for every single Christian from the moment he begins to save us. He delivers us from the sin that has made us weak.
ii] Sin has made us guilty.
Guilt feelings are what you experience when the car behind yours flashes its blue light and pulls you over. Guilty is your state before the law of the land for breaking the speed limit in a thirty mile zone. All the world is guilty before the God of the universe; there are no exceptions, because we have all sinned and fallen short not only of what our own consciences say, or the dictates of the ten commandments, but fallen short of the glory of God. When your life is measured by God's absolute standards it doesn't measure up. Jesus noticed a man who was praying in the temple, and he impressed Christ very much. His very posture impressed our Lord – he wouldn't stand tall and gaze around. He looked down at the floor, and he beat his breast. His words when he prayed impressed our Lord – he said quietly, "God . . . be merciful to me a sinner." He made no excuses for his behaviour. He was guilty before God and all he could do was cast himself on the divine mercy. Isn't that hard to do? Our pride and self-love makes it so hard for us to bow before God. But my point is this, how much harder is it for the just God to show mercy? You think of the Nazi leaders who were tried in Nuremburg after the second World War, men guilty of the atrocities of Belsen and Auschwitz . Would it be easy for those judges to look at those men who had been found guilty of organising the gas chambers and the furnaces in which millions of men, women and children had been killed and burned and then say to them, "It's all right. We'll show you mercy. You can all go back to your nice homes and families. Let bygones be bygones"? It would not be easy at all. There is the cry for justice, and righteousness in every human heart because we are all made in God's image. "Are those men not going to be punished?" So what of God himself? I tell you it was not easy for God to forgive a sinner like King David who took a man's wife and arranged for him to be killed.
Do you know that it cost God the life and death of his only begotten Son Jesus Christ to forgive sinners? You know how the life of the Son of God ended, in an agonizing, humiliating, wretched, embarrassing death on Golgotha . What was a cross designed for? It was the instrument invented to slowly kill the very worst criminals giving them maximum pain. It was for the death of rapacious murderers, and it represented the worst judgment that the greatest judicial system in the world could mete out. To the Jewish people especially it was a uniquely horrendous thing, the ultimate sign of being cast out and cut off, and that's precisely why God chose this death and summoned his beloved Son, Jehovah Jesus, to suffer it. God determined it would be by this death because on the cross, Jesus had become the guilty substitute so that you could be pardoned. He had become the Lamb of God to whom was imputed our blame. On the cross, Jesus had to bear God's own ban, that is, his curse, his anathema, the righteousness of his judgment, the fullness of his wrath without any holding back. Jesus Christ had to be treated as the guilty sinner. You remember how Paul puts it: "He who knew no sin became sin, that we might become the righteousness of God in Him." Jesus on the cross was looked upon by his Father (who magnified and adored righteousness) as one who was a criminal, as one who himself deserved judgment and so was hung by nails on a cross between two other criminals. Jesus was there on the cross in our place.
The cross is the instrument of that punishment, and the horror of the cross is not just in the physical pain. You yourself can almost feel that pain as you read the New Testament – all the things that went with it, even when the garments are placed back on him after the whipping and you can feel the linen sticking to his wounded flesh. You yourself cringe when that crown of thorns is pressed down on his head; you imagine the pain as the soldiers take that stick and beat him repeatedly over the head with it. The physical pain is obvious to us all, but deeper than that is the fact that he is now the object of his Father's wrath. God is not sparing him even though he's his lovely boy. He's crucified and he hangs there as the cursed one, as the incarnate anathema, for three hours of darkness, and I am saying that it is only through the dying of Jesus that we sinners can be forgiven and be pardoned of our sins. That is the price that Jesus paid for our redemption. Think what the cross cost the loving Father and the Son and the easily grieved Spirit. The cross accomplished redemption from our guilt; by Golgotha our blame was once and for all dealt with, and done away with. Sin had made us guilty, but God has established this way of showing us mercy through what his Son Jesus Christ has done.
iii] Sin has alienated us from God.
The phrase "illegal aliens" has passed into the language. There are people who have no legal right to be living in the British Isles , who entered the country declaring that they were just coming for a few weeks' vacation, who have stayed on but are in hiding from the authorities. They are aliens; they cannot vote; they cannot get any state aid if they are starving or sick; they don't have police protection because they don't want the law to know that they exist. Living in the back alleys of our nation these are the illegal aliens of the land.
Sin has caused us to be alienated from God. Paul tells the Colossians that, "once you were alienated from God" (Cols. 1:21). You didn't have a Father's love providing for you everything you needed; you didn't have a Father's rebuke when you were behaving wretchedly; you weren't running into your Father's presence telling him how much you loved him and thanking him for his love and goodness to you. You weren't looking forward to a Father's inheritance. You were skulking around in the shadows, hiding from God, not wanting his eyes on you, dreading his interference. "Let me live my life my way. Keep out!" you yelled at God, because you were alienated from him.
That is how it is with all the world. How few are overjoyed when you start to tell them the good news about God's love in sending Christ to be the Saviour of the world. They don't want to hear about a Saviour. There is an enmity in their hearts towards him. When God sent his prophets into the world men treated them horribly; they threw Jeremiah into a pit; they put Daniel in a lion's den; they cast three Old Testament Christians into a furnace. When God sent his Son Jesus Christ into a prepared nation men killed Christ, and then they started to kill those who preached his message, and they are doing so today in many parts of the world, because men are alienated from God. They do not want God interfering in their lives and telling them what they have to do.
When there is alienation between two men then the one who has caused the offence must deal with it. He must put right what has caused the divorce between them. He must apologise for saying and doing what he did. If he has taken money he must pay it back with interest. If a letter needs to be written he will write the letter. Whatever the cause of the estrangement the offender must put it right, and plead for reconciliation. This alienation must come to an end but the sinning man must take the initiative. Let us look at the reconciliation of Jacob and Esau. Jacob had cheated his brother Esau out of his inheritance and birthright; after many years he returns to Edom where his brother lives. Esau knows he is coming, and so what Jacob does is this, he seeks reconciliation with Esau; "He spent the night there, and from what he had with him he selected a gift for his brother Esau: two hundred female goats and twenty male goats, two hundred ewes and twenty rams, thirty female camels with their young, forty cows and ten bulls, and twenty female donkeys and ten male donkeys. He put them in the care of his servants, each herd by itself, and said to his servants, 'Go ahead of me, and keep some space between the herds.' He instructed the one in the lead: 'When my brother Esau meets you and asks, "To whom do you belong, and where are you going, and who owns all these animals in front of you?" then you are to say, "They belong to your servant Jacob. They are a gift sent to my lord Esau, and he is coming behind us."' He also instructed the second, the third and all the others who followed the herds: 'You are to say the same thing to Esau when you meet him. And be sure to say, "Your servant Jacob is coming behind us."' For he thought, 'I will pacify him with these gifts I am sending on ahead; later, when I see him, perhaps he will receive me.' So Jacob's gifts went on ahead of him, but he himself spent the night in the camp. That night Jacob got up and took his two wives, his two maidservants and his eleven sons and crossed the ford of the Jabbok. After he had sent them across the stream, he sent over all his possessions. So Jacob was left alone, and a man wrestled with him till daybreak" (Genesis 32:13-24).
So Jacob longed to end the alienation because of his own wrongdoing. He sought to pacify his brother with these generous gifts, one after the other. But that was not enough; he was conscious of his own need to change in his own spirit towards his brother and for his brother to change to him and accept him. So Jacob spent the night in prayer wrestling with the Lord. Then the two brothers approached one another. What happened? Jacob "himself went on ahead and bowed down to the ground seven times as he approached his brother. But Esau ran to meet Jacob and embraced him; he threw his arms around his neck and kissed him. And they wept." (Gen. 33:3&4). There was an end to the alienation, and it was by the action taken by the one who had sinned.
This is not how it was done when our alienation from God was ended. It was the innocent party, the blameless and holy one, the much sinned against one, the holy God himself who took the initiative without any cooperation from the guilty party at all. God planned the way that the alienation could come to an end. He sent his own Son who lovingly came; Jesus kept the law of God for us. He suffered under its condemnation. He took away the offence that had driven God from us. He reconciled a holy God to sinful aliens. All that had driven us apart the Lord Jesus removed when he took responsibility for the offense and ended it, burying it all at the bottom of the deepest ocean. He accomplished the reconciliation. He ended the alienation and thus God became the Father of all who received him.
Let us be sure we know this. You have to receive Christ. After all that Jacob had done, all his sacrificial giving and prayerful longing for complete reconciliation, Esau himself had to receive him Esau had to hold Jacob in his arms, weep with joy and kiss him. So it is has to be with you aliens. All the machinery of reconciliation and sonship has been set up by God, but now you must receive Christ as the Reconciler into your own hearts. Without that you are still aliens. Christ may have died but you are still aliens. Jesus Christ is risen, but you are still aliens. God has been reconciled to favoured sinners, but you are still aliens. Consider these great words in the preface of John's gospel, "to all who received him," – hear it? These people received him into their lives – "to all who received him to those who believed in his name, he gave the right to become children of God – children born not of natural descent, nor of human decision or a husband's will, but born of God" (John 1:12&13). The end to the alienation has been accomplished by God alone, but the means he demands is receiving his Son Jesus Christ into your life, and all such are saved from alienation. They are made the sons of God.
iv] Sin results in lifelessness.
Remember Genesis chapter three. Here is the tree of life. Do you see it with all its verdant leaves and rich fruit? What a magnificent tree! The beautiful tree of life standing here, but there, a long way from that tree, are Adam and Eve, and unable to return to it. Forbidden to approach it, God ensures they do not, and so they are both dying people, and all Adam's race are in the same condition. You think of a gardener who is pruning a tree; there's not a single branch which he cuts off that can live as it lies there on the path. Apart from the tree the branch soon dies. Once the Lord Jesus Christ faced his disciples and this is what he told them, "I am the true vine." There behind him was a vast model of a vine on one of the doors of the temple. The vine was a picture of the people of God. "I am the real vine," said the Lord Jesus. Then he added, "and you are the branches." A Christian is a branch in the real tree of life. A Christian is in Christ; he is joined to Christ; into him from Christ comes life and grace. He is fruitful for just one reason, because he remains in Christ. There are wonderful fruit growing in ordinary people who have received Christ into their lives; love, joy, peace, longsuffering, gentleness, goodness, faithfulness, meekness, self-control. God has joined them to Jesus Christ, and his own life is daily imparted to them.
Instead of becoming angry, this soldier had responded with compassion to his persecutor, and in so doing, he won him to Christ. This is life in Christ, taking opportunities not to retaliate, but to love our neighbours. What do you think might have happened, had this soldier responded with angry words? What might have happened if this young private had thrown back those dirty boots? There would have been no conversion. Solomon said: "Better a patient man than a warrior, a man who controls his temper than one who takes a city" (Proverbs 16. 32).
Being in Christ, knowing his life in you is the greatest of all the privileges God gives in salvation. It is the climax of salvation. Every single Christian is in Christ and so we are totally new creations. We are not revamped and modernised old Christians with some improvements. This salvation is not a mere cosmetic job. The life of God flows into us day by day. There is risen and transformed life. There is elevatedness, majesty, purity and power. Theses are lives that have been touched by the power that made the world. These lives have been changed by the power which raised Christ from the dead. In these lives there is working the Almightiness of the Lord God. As we face the temptations of this life the way that we emerge from them declares that we face and overcome them by the power of an omnipotent Lord. As we undergo whatever this life may hold for us of suffering we have the courage and patience that would argue that the Lord holds us with his own strength and has made over to us all the resources of his own power.
2. PUTTING ON THE HELMET OF SALVATION.
The helmet used by Roman soldiers was made of bronze and had cheek pieces so as to give protection to the head. This helmet was the outstanding piece of armour he wore. It made him look a foot taller. His helmet and its crest elevated him above everyone else as he walked through a crowd. "There goes a soldier!" people thought. The helmet is salvation itself, this salvation I have described to you from weakness, from guilt, from estrangement and from lifelessness. God has delivered every Christian from all of that and brought us into a new kingdom. Do our minds fully appreciate all of this? Are we ourselves appropriating this comprehensive salvation and are we unashamed to stand out in a crowd as saved men and women? That is what it means when the Christian is being urged to put on the helmet which is salvation. Stand for what you are! God is expecting you to live like a man who has been saved from guilt and despair. It is not enough to bear testimony to the sincerity of your theological convictions but to the reality and the nearness and the relevance of this so great salvation.
Is it evident that we are putting on the helmet of salvation day by day? Our own lives, are they new? Are they different? Are they transformed, transfigured? Are they elevated, pure and noble? Are they patient and courageous? Are our lives all these things according to this measure and this standard? Is it salvation according to these four great changes? Jesus Christ has changed us; he has removed our weakness, guilt, alienation and lifelessness. He has done it all. In Christ I am different. I am united to, engrafted into, and a member of his body, of his flesh and of his bones. In me there is his presence. In me there is his Spirit. In me there is the power of a risen Saviour, and that is not the privilege of an elite. It is not the second blessing of the super Christian, but there is no child of God – I say there is no man or woman born again, but they are all people who have this incredible position, standing in this remarkable place, almost physically and psychologically, in union with a risen and a living Lord. Every saved person is facing the sufferings of this present time with him; they march into battle with him; they face all their obligations with him. That is the position of the ordinary Christian believer who is in Christ. We are in him not because our faith is great, but because our faith is real. The most backward believer, the youngest child in Christian experience, where does he stand, but in Christ. We are living people, transformed by the recreative power of Almighty God, and we are transformed because we are in Christ.
Are we putting that helmet on? Are we living according to this kind of salvation teaching? Are we living new, living transformed, living elevated lives? Are we living powerfully? Living in Christ? Living by the resources, living out of the power of the God who is our refuge. Our Redeemer is strong! Being in Christ does not make us only loving and pitiful and compassionate. It is not only meekness that men need to live the Christian life, but they need power. See what Paul exhorts at the beginning of this entire section, "Finally, be strong in the Lord and in his mighty power" (v.10).
There are days when the believer is backslidden, when he is in the depths, when he is in darkness and he has no light, but he is still a saved man. He is still delivered from the weakness and guilt and alienation and lifelessness of his former life. His temporary declension does not lessen the obligation. It is one of the things that ought to stand over us as a constant rebuke; what are we – having experienced so great a salvation – what are we doing in this particular kind of conduct? When our life becomes worldly or impatient and plaintive; when our lives become in terms of Christian ethics an irregular life, what are we doing, as saved people, in such a condition? You see the New Testament is taking what we are, and criticizing what we are doing. When I sin I am going to sin as a saved man because this salvation is there all the time. I cannot cancel my salvation when I want to be worldly. I am in Christ all the time, and if I am worldly I am still in Christ in my worldliness and I am disgracing my life in Christ. When a Christian from the Corinthian congregation visited a brothel he was not proving that he was temporarily 'unsaving' himself. He might sheepishly remove the helmet of salvation and leave it on the hatstand at the door, but he was still a saved man entering a whore's bed. He was taking the members of Christ and joining them to a prostitute, and that is the horror of such behaviour.
You know the story of Spurgeon's grandfather whose heart was once broken in his ministry by the life and bearing of one particular professing Christian who was backsliding and had begun to frequent taverns and drinking. Young six year-old Spurgeon was grieved at what this man was doing to his grandfather, and he went out looking for the man and met him sitting outside the public house. He went up to him, looked at him and he said to him, "What are you doing here Elijah?" What are you, a saved man, what are you doing in this particular situation? What are you, a new man, doing here? What are you a man in Christ doing compromised like this? Where is your helmet of salvation?
So a believer has salvation. He has been delivered from guilt, delivered from weakness, delivered from estrangement from God. and delivered from death. God has established this irreversible status, this unending relationship, making it absolutely certain that a new lifestyle is going to be effected in our lives and conduct. We wear the helmet of salvation.
3. IT IS THE HEAD THAT IS PROTECTED BY THE HELMET.
You consider the importance of the head, the brain, and the mind of man centred there. Think of the way in which the New Testament describes our relationship with the Son of God. We are his body and he is our head. We creatures submit to our Creator head; the head gives orders to the body, not the body to the head. It is the head that tells the eyes and hands and feet what to do. How important that the head is protected and kept. Who can measure the importance of wisdom, and truth, and a clear mind? The apostle is drawing attention to the brain, the understanding and the thinking of the Christian. In other words it is so important to know clearly and be persuaded of what God has done for us through Christ in accomplishing our great salvation. There is no doubt about the fact that here we will be under pressure. Dr. Martyn Lloyd-Jones says, "The enemy comes and attacks our mind and our whole outlook. He says, There is nothing in Christianity; it makes wonderful offers but what does it give you? He returns to the attack and says: That evangelist to whom you listened and who urged you to become a Christian, told you that all your troubles would end, that you would walk down the road with a light step, that you would be in a new world, and that all would go well with you. But has it turned out to be like that? Are you not encompassed by trials and troubles and problems? Are you not finding yourself in a very weary, tiring campaign? Indeed, don't things seem to be worse even than they were before you became a Christian; isn't the fight hotter, and aren't you being attacked as you've never been attacked before? So much for this Christianity of yours; it offered you so much, what is it really giving you in practice?" (D. Martyn Lloyd-Jones, The Christian Soldier, "The Helmet of Salvation," Banner of Truth, Edinburgh, 1977, p.313). There is a battle for the mind going on and we must be persuaded of the nature of our great salvation. We must say to ourselves, "Through Jesus Christ every Christian is saved from the weakness and the guilt and the alienation and the lifelessness of sin. That is what God has done for us all – me included. He has not yet delivered me from temptations or the presence of sin, but one day he will. Until then I have the strength and the presence of Christ to keep me from hell." Thinking like that is fundamental and indispensable to our salvation. The Christian life is holy and Christ-like, but it is rational and wise too.
I am saying that a mind that knows Christ's great salvation is an immensely safe mind when the enemy attacks us. That mind has a refuge and a fortress against which the enemy may continue to launch his attacks, but in vain. This salvation makes us strong-minded. That is why it is crucial to sit under a ministry that constantly turns to the themes of the gospel of Jesus Christ. It is important for our own peace of mind to have the countless cares and concerns that tend to flood in on us pushed back behind the ramparts of God's great salvation. It is a priceless protection against the enemy. It is indeed a helmet of salvation.
Sometime Satan may lay siege to our minds so that our very sanity seems to be endangered. A missionary wrote, " . . . and there was a time when I was so deeply depressed inwardly, without any external cause adequately to account for it, that I thought and feared that I was going mental, but I believed that the way to freedom and victory was by recognising that the trouble was satanic influence. This is what Scripture taught me, and to look elsewhere, on circumstances or people or my personal make-up would not be hitting the nail on the head . . ." That is what he wrote and this is how he described the consequences of putting on the helmet of salvation: "The only way in which I have received deliverance from the Lord has been by using my mind to lay hold of saving truths, and rejecting my feelings. As we grasp the facts of our salvation by faith, the works and devices of the evil one are exposed. We emerge gradually, step by step, to a full command of ourselves, our spirits, our feelings, our bodies, and our circumstances." That is someone who has done what Paul says here; he has taken the helmet of salvation.


Walking in Harajuku area, we sometimes encounter guys wearing skirts for fashion. As you may know Harajuku style is very unconventional. Guys in skirts had emerged only in Harajuku or Scotland. However, it will come into vogue because some high-end designers' collections, such as GUCCI and Saint Laurent, show no gender fashion today.
Tracing the history of fashion, there was an interesting fact that genderless fashion had existed in the 17th century in Japan. Men and women wore a similar upper body garments and ceremonial skirst that Japanese call Mo. They are ones of the first unisex items.
Check this movie out. It reflects eccentric Harajuku fashion well. Also, you can see how a guy with a skirt is like, which is "trendy" today and concerning our DNA of the genderless fashion.


The older I get, the more freaked I am about getting dental work done (also called dentist phobia). I know, such high anxiety doesn't seem to make a lot of sense, but I figure it has to do with (1)blowing my adrenals in my past role as a social worker and (2)having too many frickin root canals along life's way. In any case, today was the day where I had to go and get the prep work done for a new crown.
A couple of days ago I called the dentist to let them know that I would like to have some Nitrous Oxide. Two friends told me it was like "a twilight sleep" and that sounded good. I checked out some of the forums online and was careful not to read the ones that complained about the Nitrous Oxide not working for them, or causing more anxiety or whatever. I just knew that I needed something to handle all the tension in my shoulders, my racing heart, my rapid breathing, my dry mouth, etc. etc. etc.
And of course I worried that it would also affect my new breathing protocol.
But I figured I could deal with that again later.
And I still felt guilty.
I did do a number of "squeeze-and-breathe" calming exercises that helped with the initial announcement by the dental assistant that I would not get the 'gas' until after they took impressions. Truth be known, it was the impressions that bothered me the most-- all that waxy gluey gunk gluing your teeth together and seeming to seal your throat off. The impressions AND having the chair reclined so far back that I fantasize about having everything that enters my mouth sliding down into my throat. But I soldiered through... even though she had to do TWO of the same set of impressions because my lip got in the way (yeah, blame it on my lip) the first time. I survived. The gas was pretty magnificent and I would recommend it to any other wimps out there.
So, now I am home again, and so very grateful to have a couple of weeks until the actual crown arrives and needs to be fitted in. It is nice to have a tooth in the front of my mouth. I am appreciative of the skills and kindness of the dental staff.
And tomorrow I will start up with the breathing exercises in earnest.
Speaking of breathing, I notice that Raw Diva Tera Warner has a breathing presenter as part of her Women's 2013 WISH Summit. Maybe Breathing is becoming an important new trend?


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Diffusion's pipeline shows a lead drug – TSC – with exciting ability to potentially treat a number of serious, life-threatening conditions. A Phase 3 study in inoperable GBM patients is currently enrolling. The U.S. Food and Drug Administration (FDA) recently approved a new Phase 2 in-ambulance study of TSC to treat stroke. 150 emergency transport groups will work with providers at 23 hospitals to treat patients suffering from either ischemic or hemorrhagic stroke. By increasing the amount of oxygen directed to affected tissue, TSC can potentially reduce cell death and improve patient outcomes.


text:
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Tham Lactic Acidosis
DTN Staff
Therapy Of Lactic Acidosis: Alternatives To Sodium Bicarbonate
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Lactic Acidosis - Cancer Therapy Advisor
Hyperlactatemia, anion gap metabolic acidosis, strong ion gap metabolic acidosis Tissue hypoperfusion, ischemia, anaerobic metabolism, shock, acid-base disorders Lactic acidosis associated with critical illness is commonly a byproduct of a much larger problem. In 1976 Cohen and Woods classified lactic acidosis based on etiology. Type A is due to clinical evidence of tissue hypoperfusion. Type B occurs in the absence of clinical evidence of tissue hypoperfusion. Type B is further divided into subgroups B1 - underlying disease/physiologic state; B2 - medication or toxin; and B3 - inborn errors of metabolism. In critically ill patients, lactic acidosis is typically associated with increased lactate production (hypoperfusion, mitochondrial dysfunction), and/or decreased metabolism/clearance. Approximately 1400 mmol of lactic acid is produced daily. The kidneys metabolize up to 30% with no significant elimination. The liver is very efficient in lactate metabolism and elimination and serum lactate levels should remain in the normal range until about 75% of hepatic function is lost. The clinical features of lactic acidosis are similar to other forms of metabolic acidoses. These may include respiratory compensatory signs such as tachypnea and Kussmaul respirations. Other clinical features are related to the underlying cause of lactic acidosis, such as signs of hypoperfusion. Hyperventilaton (rapid shallow or Kussmaul respirations). Seizure (generalized seizures can cause a transient lactic acidosis). Signs of hypovolemia (dry mucous membranes, decreased capillary refill, skin tenting, oliguria). Abdominal pain (especially with mesenteric ischemia). There may only be subtle clinical findings, therefore one needs to have a high suspicion in clinically relevent situations (e.g. i Continue reading >>
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American Thoracic Society - Liver Dysfunction And Severe Lactic Acidosis In A Previously Healthy Man
Liver dysfunction and severe lactic acidosis in a previously healthy man A man in his eighth decade presented to his primary doctor three weeks prior to admission with easy bruising. A complete blood count revealed low counts in all three major cell lines and a subsequent bone marrow biopsy demonstrated B-cell follicular lymphoma. Other biochemical parameters, including tests of liver transaminases and bilirubin, were normal. Two weeks later he developed a cough and shortness of breath and he received a diagnosis of acute bronchitis, for which he was prescribed azithromycin along with an inhaler of salmeterol and fluticasone. His cough and dyspnea did not improve and he was admitted to another hospital for further evaluation. A diagnosis of liver failure was made based on elevated liver function tests (aspartate aminotransferase=995 U/L, alanine aminotransferase=552 U/L, total bilirubin=7.2 mg/dL, direct bilirubin=5.5 mg/dL); worsening pancytopenia was noted. Evaluation of the acute liver failure did not reveal an etiology, and he was transferred to a tertiary care hospital for further evaluation and care. Thyroid cancer, s/p partial thyroidectomy Denies excessive alcohol and illicit drug use 40 pack-year cigarette smoking history, stopped in 2004 Laboratory investigation did not reveal occult infectious hepatitis or autoimmune disease. Diagnostic imaging of the liver revealed a large intra-hepatic mass and trans-jugular liver biopsy showed extensive hepatic infiltration by lymphoma. His respiratory status became increasingly tenuous and his trachea was intubated and positive-pressure mechanical ventilation was initiated. He was transferred to the ICU but suffered the rapid onset of shock despite infusions of sodium bicarbonate and norepinephrine. After a conversation Continue reading >>
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(Version 1.0 3/1/2001 - 7/30/2007) Acidosis is a frequent problem in critically-ill neonates. Buffers may be used as part of the treatment strategy of a metabolic acidosis. The etiology of a low pH must be understood to treat infants appropriately. Respiratory acidosis (increased CO2 on a blood gas) can only be treated by improving ventilation. Buffers will not help in this case, and may make the situation worse. The etiology of a metabolic acidosis (highly negative base deficit on a blood gas) must also be taken into account to determine the need to treat and appropriate measures to take. In all cases, giving buffer will only partially and transiently remedy the situation; the underlying problem generating the acidosis must be addressed. Although many different illnesses can cause a metabolic acidosis, the two most common etiologies seen in the NICU are lactic acidosis from impaired perfusion and non-anion gap hyperchloremic acidosis due to renal bicarbonate wastage. Lactic acidosis heralds a significant underlying problem; possibilities include hypovolemic shock, inadequate cardiac output, and sepsis. Hyperchloremic non-anion gap acidosis is a much less critical problem but is extremely common in < 1000g micropremies. The etiology of the acidosis also determines the threshold at which you would administer buffer to a patient. Buffers are administered because acidosis impairs cardiac performance at a pH < 7.2 7.25. Therefore, in patients with congenital heart disease, cardiologists often treat lactic acidosis at a base deficit of > -4 to improve organ perfusion. However, in micropremies with hyperchloremia, the risk-benefit ratio differs. Hyperchloremic acidosis is better tolerated and pharmacologic buffers are hypersosmolar and associated with an increased risk of IV Continue reading >>
Guidelines For The Treatment Of Acidaemia With Tham.
Guidelines for the treatment of acidaemia with THAM. Nahas GG(1), Sutin KM, Fermon C, Streat S, Wiklund L, Wahlander S, Yellin P,Brasch H, Kanchuger M, Capan L, Manne J, Helwig H, Gaab M, Pfenninger E,Wetterberg T, Holmdahl M, Turndorf H. (1)Department of Anaesthesiology, New York University Medical Center, New York, USA. [email protected] THAM (trometamol; tris-hydroxymethyl aminomethane) is a biologically inert amino alcohol of low toxicity, which buffers carbon dioxide and acids in vitro and invivo. At 37 degrees C, the pK (the pH at which the weak conjugate acid or base inthe solution is 50% ionised) of THAM is 7.8, making it a more effective bufferthan bicarbonate in the physiological range of blood pH. THAM is a protonacceptor with a stoichiometric equivalence of titrating 1 proton per molecule. Invivo, THAM supplements the buffering capacity of the blood bicarbonate system,accepting a proton, generating bicarbonate and decreasing the partial pressure ofcarbon dioxide in arterial blood (paCO2). It rapidly distributes through theextracellular space and slowly penetrates the intracellular space, except forerythrocytes and hepatocytes, and it is excreted by the kidney in its protonated form at a rate that slightly exceeds creatinine clearance. Unlike bicarbonate,which requires an open system for carbon dioxide elimination in order to exertits buffering effect, THAM is effective in a closed or semiclosed system, andmaintains its buffering power in the presence of hypothermia. THAM rapidlyrestores pH and acid-base regulation in acidaemia caused by carbon dioxideretention or metabolic acid accumulation, which have the potential to impairorgan function. Tissue irritation and venous thrombosis at the site ofadministration occurs with THAM base (pH 10.4) admini Continue reading >>
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Hemodynamic Consequences Of Severe Lactic Acidosis In Shock States: From Bench To Bedside
Hemodynamic consequences of severe lactic acidosis in shock states: from bench to bedside Kimmoun et al.; licensee BioMed Central.2015 The Erratum to this article has been published in Critical Care 2017 21:40 Lactic acidosis is a very common biological issue for shock patients. Experimental data clearly demonstrate that metabolic acidosis, including lactic acidosis, participates in the reduction of cardiac contractility and in the vascular hyporesponsiveness to vasopressors through various mechanisms. However, the contributions of each mechanism responsible for these deleterious effects have not been fully determined and their respective consequences on organ failure are still poorly defined, particularly in humans. Despite some convincing experimental data, no clinical trial has established the level at which pH becomes deleterious for hemodynamics. Consequently, the essential treatment for lactic acidosis in shock patients is to correct the cause. It is unknown, however, whether symptomatic pH correction is beneficial in shock patients. The latest Surviving Sepsis Campaign guidelines recommend against the use of buffer therapy with pH 7.15 and issue no recommendation for pH levels <7.15. Furthermore, based on strong experimental and clinical evidence, sodium bicarbonate infusion alone is not recommended for restoring pH. Indeed, bicarbonate induces carbon dioxide generation and hypocalcemia, both cardiovascular depressant factors. This review addresses the principal hemodynamic consequences of shock-associated lactic acidosis. Despite the lack of formal evidence, this review also highlights the various adapted supportive therapy options that could be putatively added to causal treatment in attempting to reverse the hemodynamic consequences of shock-associated lactic Continue reading >>
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Use Of Tris-hydroxymethyl Aminomethane In Severe Lactic Acidosis Due To Highlyactive Antiretroviral Therapy: A Case Report.
1. J Clin Pharm Ther. 2009 Feb;34(1):119-23. doi: 10.1111/j.1365-2710.2008.00977.x. Use of Tris-hydroxymethyl aminomethane in severe lactic acidosis due to highlyactive antiretroviral therapy: a case report. Marfo K(1), Garala M, Kvetan V, Gasperino J. (1)Department of Pharmacy Montefiore Medical Center, Bronx, NY, USA. BACKGROUND: Lactic acidosis is a rare, yet life-threatening adverse drug effectof highly active antiretroviral therapy (HAART), specifically stavudine andlamivudine. These nucleoside analogue reverse transcriptase inhibitors (NRTIs)are commonly used to treat patients infected with the human immunodeficiencyvirus (HIV).CASE: We report the use of Tris-hydroxymethyl aminomethane (THAM) to treat severelactic acidosis due to HAART in a 50-year-old African-American woman. NRTIs cancause hyperlactinaemia by interfering with mitochondrial oxidativephosphorylation function, which normally removes H(+) generated by the hydrolysisof adenosine triphosphate. This side-effect is associated with a high mortalityin patients infected with HIV. One explanation for this high mortality is thatlactic acidosis is typically refractory to treatment with commonly used bufferingagents.CONCLUSION: THAM generates serum bicarbonate, and reduces the level of carbondioxide in arterial blood. Both of these qualities appear to make THAM an idealagent for treating lactic acidosis caused by HAART. Antiretroviral Therapy, Highly Active/adverse effects* Continue reading >>
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Metformin-associated Lactic Acidosis Following Intentional Overdose Successfully Treated With Tris-hydroxymethyl Aminomethane And Renal Replacement Therapy
Metformin-Associated Lactic Acidosis following Intentional Overdose Successfully Treated with Tris-Hydroxymethyl Aminomethane and Renal Replacement Therapy Ngan Lam ,1,2 Gurbir Sekhon ,3and Andrew A. House 1,3 1Division of Nephrology, Department of Medicine, Western University, London, ON, Canada N6A 3K7 2London Health Sciences Centre, Kidney Clinical Research Unit, Victoria Hospital, Westminster Tower 800 Commissioners Road East, London, ON, Canada N6A 4G5 3Department of Medicine, Western University, London, ON, Canada N6A 3K7 Received 19 February 2012; Accepted 6 May 2012 Academic Editors: Y.Fujigaki, D.Packham, A.Papagianni, and H.Schiffl Copyright 2012 Ngan Lam et al. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. A 43-year-old woman was brought to the hospital with severe metabolic acidosis (pH 6.56, bicarbonate 3 mmol/L, and lactate 18.4 mmol/L) and a serum creatinine of 162 mol/L with a serum potassium of 7.8 mmol/L. A delayed diagnosis of metformin-associated lactic acidosis was made, and she was treated with tris-hydroxymethyl aminomethane (THAM) and renal replacement therapy (RRT). Following a complete recovery, she admitted to ingesting 180 tablets (90 grams) of metformin. Her peak serum metformin concentration was 170 g/mL (therapeutic range 1-2 g/mL). Our case demonstrates an intentional metformin overdose resulting in lactic acidosis in a nondiabetic patient who was successfully treated with THAM and RRT. Metformin is an oral antihyperglycemic agent that is the first-line therapy for noninsulin-dependent diabetes mellitus [ 1 ]. Although the adverse event rate is 2030%, the majority of the Continue reading >>
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The Use Of Tris-hydroxymethyl Aminomethane In The Emergency Department
The use of tris-hydroxymethyl aminomethane in the emergency department Lu, Leibner, and Wright: The use of tris-hydroxymethyl aminomethane in the emergency department Christina Lu , Evan Leibner , Brian Wright Department of Emergency Medicine, Stony Brook University, Stony Brook, NY, USA Correspondence to: Brian Wright Department of Emergency Medicine, Stony Brook University, Hsc, Level 4, Room 080, Stony Brook, NY 11794, USA Received: July 20, 2016 Revised: August 22, 2016 Accepted: August 22, 2016 Copyright 2016 The Korean Society of Emergency Medicine This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( ). Bicarbonate therapy is often not effective for alkalinizing the blood pH in critically ill patients because it requires patients to augment their already maxed respiratory drive. Tris-hydroxymethyl aminomethane is a little known amine buffer that works in a closed system independent of pulmonary function and may be an effective alternative to sodium bicarbonate. Treatment of critically ill patients is a multi-faceted problem. Often the physician is faced with multiple complex tasks that range from correctly diagnosing the underlying disease process to appropriately managing the hemodynamics and homeostasis. Critically ill patients commonly have acid-base abnormalities, especially acidosis. Critical care dogma teaches that treatment of the primary condition will lead to a correction of the acidosis. That acidosis, however, can be so severe that it needs to be addressed before the underlying medical condition can be reversed. This review will discuss tris-hydroxymethyl aminomethane (THAM). THAM is a rarely used buffer approved by the Food and Drug Administration for treatment of metabolic acidosis as Continue reading >>
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Buffer Therapies: Sodium Bicarbonate, Carbicarb And Tham - Deranged Physiology
Buffer Therapies: Sodium Bicarbonate, Carbicarb and THAM This has only come up once in the exam. Question 27 from the first paper of 2009 asked the candidates to compare and contrast the pharmacology of carbicarb, sodium bicarbonate and THAM. The unusual feature was of course the fact that carbicarb is not available in Australia, and THAM is so rarely used that our local supply consists of imported ampoules with labels exclusively in German. The answer to Question 27 works best as a table; it is reproduced below to simplify revision. As far as literature references go, the majority are from the 1980s and 90s (back when buffer therapy was still considered a viable option in cardiac arrest, for example). One potentially relevant article is a 1998 paper by Bar-Joseph et al , which compared THAM, Carbicarb and sodium bicarbonate in a canine cardiac arrest model. An 8.4% (1mol/L) solution of NaHCO3which offers 1000mmol/L of HCO3-and Na+ions. An equimolar (300mmol/L) solution of Na2CO3and NaHCO3which offers 666mmol/L of HCO3-ions, and 1000mmol/L of Na+ions An organic amine buffer, otherwise known as tris-hydroxymethyl-aminomethane, or tromethamine. Eliminated renally, as well as being converted to CO2and exhaled (in process of buffering reactions). These two substances differ mainly in the amount of bicarbonate anion they add. Rapidly eliminated by the kidney; 75% is excreted in the urine after 8 hours. Sodium bicarbonate contributes HCO3-which is a natural buffer, thus replenishing the buffer systems of the body in a state of acidosis. The sodium carbonate component is supposed to act as a bicarbonae precursor, regenerating HCO3-buffers without increasing the PaCO2. THAM is a "third buffer" to complement the buffering capacity of endogenous HCO3-and body protein. At pH of 7 Continue reading >>
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Efficient Extra- And Intracellular Alkalinization Improves Cardiovascular Functions In Severe Lactic Acidosis Induced By Hemorrhagic Shock | Anesthesiology | Asa Publications
Efficient Extra- and Intracellular Alkalinization Improves Cardiovascular Functions in Severe Lactic Acidosis Induced by Hemorrhagic Shock From the CHU Nancy, Service de Ranimation Mdicale Brabois, Pole Cardiovasculaire et Ranimation Mdicale, Hpital Brabois, Vandoeuvre les Nancy, France; Institut National de la Sant Et de la Recherche Mdicale (INSERM) U1116, Equipe 2, Facult de Mdecine, Vandoeuvre les Nancy, France; Universit de Lorraine, Nancy, France (A.K., N.D., and B.L.); INSERM U1116, Equipe 2, Facult de Mdecine, Vandoeuvre les Nancy, France; Universit de Lorraine, Nancy, France (N.S., K.I., and C.S.); and Critallographie, Rsonnance Magntique et Modlisation (CRM2), Unit Mdicale de Recherche (UMR), Centre National de la Recherche Scientifique (CNRS), Institut Jean Barriol, Facult des Sciences et Technologies, Vandoeuvre les Nancy, France; Universit de Lorraine, Nancy, France (J.-M.E. and S.L.). From the CHU Nancy, Service de Ranimation Mdicale Brabois, Pole Cardiovasculaire et Ranimation Mdicale, Hpital Brabois, Vandoeuvre les Nancy, France; Institut National de la Sant Et de la Recherche Mdicale (INSERM) U1116, Equipe 2, Facult de Mdecine, Vandoeuvre les Nancy, France; Universit de Lorraine, Nancy, France (A.K., N.D., and B.L.); INSERM U1116, Equipe 2, Facult de Mdecine, Vandoeuvre les Nancy, France; Universit de Lorraine, Nancy, France (N.S., K.I., and C.S.); and Critallographie, Rsonnance Magntique et Modlisation (CRM2), Unit Mdicale de Recherche (UMR), Centre National de la Recherche Scientifique (CNRS), Institut Jean Barriol, Facult des Sciences et Technologies, Vandoeuvre les Nancy, France; Universit de Lorraine, Nancy, France (J.-M.E. and S.L.). From the CHU Nancy, Service de Ranimation Mdicale Brabois, Pole Cardiovasculaire et Ranimation Mdicale, Hpital Bra Continue reading >>
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Your Patient In Extremis: Tham To The Rescue?
Your Patient In Extremis: THAM To The Rescue? By: Prathap Sooriyakumaran, MD and Curtis Geier, PharmD One of the final common denominators dictating the success or failure of any resuscitative effort, be it a trauma or medical code, is the patients acid-base status. In the presence of acidosis, many of the tools at your disposal, including vasopressors, become impotent and the patients ability to strike a balance between bleeding and clotting or mounting an appropriate inflammatory response become deranged.16 So what are the options to tilt the acid-base status in our favor? One thing is clear, sodium bicarbonate is not the hero we have been searching for. Unfortunately, the buffer we all know and want to love is ineffective in producing any significant change that will alter outcomes in the setting of the acutely acidemic patient.7,8 Why? Well to understand this, well have to do a brief dive (a wade) into the relevant human biochemistry. So if you give sodium bicarbonate in an attempt to scavenge your troublemaking protons, youll get carbonic acid which dissociates into carbon dioxide and water, which can freely diffuse across the cell membrane creating an intracellular acidosis.9 If you can get rid of carbon dioxide (blow it off), you will force the equation to the right and get rid of your protons. However, patients in extremis may not be able to compensate for the increased carbon dioxide with increased respiratory drive further exacerbating intracellular acidemia. THAM (trometanol; tris-hydroxymethyl aminomethane) is an inert amino alcohol which is theoretically amore effective buffer than bicarbonate in the physiological range of blood pH because it has a pKa of 7.8 at normal body temperatures (compared to a pKa of 6.1 for sodium bicarbonate). Why may it be more Continue reading >>
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hyperlactaemia: a level from 2 to 5 mmol/L normal production is 20 mmols/kg/day, enters the circulation and undergoes hepatic and renal metabolism (Cori cycle) all tissues can produce lactate under anaerobic conditions lactic acid has a pK value of about 4 so it is fully dissociated into lactate and H+ at body pH (i.e. it is a strong ion) during heavy exercise, the skeletal muscles contribute most of the much increased circulating lactate during pregnancy, the placenta is an important producer of lactate (can pass to fetus as well) major source in sepsis and ARDS is the lung lactate is metabolised predominantly in the liver (60%) and kidney (30%) the heart can also use lactate for ATP production 50% is converted into glucose (gluconeogenesis) and 50% into CO2 and water (citric acid cycle) this results in no net acid accumulation but requires aerobic metabolism the small amount of lactate that is renally filtered (180mmol/day) is fully reabsorbed (ii) impaired hepatic metabolism of lactate (large capacity to clear) clinically there is often a combination of the above to produce a persistent lactic acidosis anaerobic muscular activity (sprinting, generalised convulsions) tissue hypoperfusion (shock, cardiac arrest, regional hypoperfusion -> mesenteric ischaemia) reduced tissue oxygen delivery (hypoxaemia, anaemia) or utilisation (CO poisoning) Type B No Evidence of Inadequate Tissue Oxygen Delivery once documented the cause must be found and treated appropriately D lactate is isomer of lactate produced by intestinal bacterial and not by humans it is not detected on standard lactate assays a bed side test may be able to be developed to help with diagnosis of mesenteric ischaemia venous samples are equivalent to arterial in clinical practice do not need to take off tourniq Continue reading >>
Tham - Fda Prescribing Information, Side Effects And Uses
For the Prevention and Correction of Severe Metabolic Acidosis Tham Solution (tromeThamine injection) is a sterile, non-pyrogenic 0.3 M solution of tromeThamine, adjusted to a pH of approximately 8.6 with glacial acetic acid. It is administered by intravenous injection, by addition to ACD blood for priming cardiac bypass equipment and by injection into the ventricular cavity during cardiac arrest. Each 100 mL contains tromeThamine 3.6 g (30 mEq) in water for injection. The solution is hypertonic 389 mOsmol/L (calc.). pH 8.6 (8.4-8.7). The solution contains no bacteriostat, antimicrobial agent or added buffer (except acetic acid for pH adjustment) and is intended only for use as a single-dose injection. When smaller doses are required the unused portion should be discarded. Tham solution is a parenteral systemic alkalizer and fluid replenisher. TromeThamine, USP (sometimes called tris or tris buffer) is chemically designated 2-amino-2-(hydroxymethyl)-1, 3-propanediol, a solid readily soluble in water, also classified as an organic amine buffer. It has the following structural formula: Water for Injection, USP is chemically designated H20. Amyotrophic Lateral Sclerosis (ALS): Evolving Science For a Fatal Disease When administered intravenously as a 0.3 M solution, tromeThamine act as a proton acceptor and prevents or corrects acidosis by actively binding hydrogen ions (H+). It binds not only cations of fixed or metabolic acids, but also hydrogen ions of carbonic acid, thus increasing bicarbonate anion (HCO3). TromeThamine also acts as an osmotic diuretic, increasing urine flow, urinary pH, and excretion of fixed acids, carbon dioxide and electrolytes. A significant fraction of tromeThamine (30% at pH 7.40) is not ionized and therefore is capable of reaching equilibrium i Continue reading >>
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[therapeutic Effect Of Tham On Lactic Acidosis Of Severe Brain Injury].
1. Zhonghua Wai Ke Za Zhi. 1996 Jun;34(6):364-7. [Therapeutic effect of THAM on lactic acidosis of severe brain injury]. (1)Department of Neurosurgery, Affiliated of Tianjin Medical College. The presence of lactic acidosis in the cerebral spinal fluid of 50 patients with severe head injury was studied. The GCS scores of these patients were < or = 8.The patients were divided into two groups. We treated 25 patients with a dose of 4 to 5 ml/kg of THAM infused intravenously 2 to 3 times for daily administration.Other 25 patients who were not treated with THAM served as a control group. Ineach case, a ventricular pressure monitoring device was installed. The ICP wasthe contineously recorded. In addition, laboratory study, including lactate, pH, HCO-3 and BE in CSF was performed. THAM infusion was associated with improvedsurvival, decreased ICP as compared to that in the control group. We believe thatTHAM treatment may significantly improve the prognosis of presence of lacticacidosis as a result of severe head injury. Continue reading >>
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redpajama_set_name: RedPajamaCommonCrawl


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Influence of Art on Card Designs Online and Offline
People in India love playing cards. Be it Indian Rummy or a round of Teen Patti, Indian players are sure to get excited in each case. This is a nation with a vast history and artistic roots. That is why it is not surprising to see how the playing card designs also have an influence of the Indian Art. Here we have described some aspects of the playing cards online and offline that have been derived from traditional Indian Arts. Read along and admire the pure artistic skills of India:
The Paisley Design
Paisley design or mango design is very common in Indian fabric arts. Patterns on some of the playing cards resemble these paisley patterns. They are artistic and colourful additions to the playing cards.
The Diamond Patterns
The diamond sign seen on playing cards as one of the four prominent signs is also common in Indian art. Many of the embroidery patterns from India also include such geometric patterns. These give the playing cards an artistic touch.
The Creative Henna Style Designs
The Henna Designs of India are pretty intricate. The best show of these designs are visible on the marriage wedding cards. There are several playing cards that have similar intricate designs to reflect the tradition of India and its age-old forms of art.
The Royal Robe Patterns
India was ruled by the kings for many centuries. Each king and queen had a unique style of dressing. Imitations of these have been visible in art and architecture. Today, many of the playing cards design the kings, queens and knights with similar royal robe patterns. These have a rich look that instantly draws all the attention.
Customised Playing Cards Online
Inspired by the artistic history of India, many of the Indian online playing card sites have designs of playing cards from Indian origin. Some of these also allow players to customise the picture cards to match their choice of kings and kings. There are also sites where people can design their own playing cards. Such innovative options help to keep heritage and art alive in India.
Cards and Tourism Offline
Many of the tourism companies have made good use of playing cards. India tourism has also come up with sets of playing cards that acquaint people with the specific tradition and culture of India. These cards have pictures of the popular tourist locations in the specific states. These are usually used as souvenirs so that people remember the trip to these places as happy memories even as years pass by.
So, each time you plan to play a round of rummy card games, take some time to appreciate the art and designs of each playing card that you use. There are sites like Khelplay Rummy that allow you to enjoy your favourite card game online but even these were inspired from the traditional card games offline. So, appreciate the artistic souls who helped create the vast range of playing cards that you use to enjoy Indian rummy offline or online.


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The U.S. Has Been Speaking To Hamas Through Back Channels For More Than Six Months
Sheera Frenkel
http://www.buzzfeed.com/sheerafrenkel/the-us-has-been-speaking-to-hamas-through-backchannels-for-o
JERUSALEM – United States officials have been holding secret back-channel talks with Hamas over the last six months to discuss their role in the newly formed unity government, according to two senior diplomatic sources with direct knowledge of the talks.
The meetings were held between U.S. intermediaries and Hamas' leadership, which lives outside the Gaza Strip in third-party countries ranging from Egypt to Qatar and Jordan. Topics included the ceasefire agreement with Israel and the recently formed unity government between Hamas and Fatah.
During the talks, Hamas gave assurances that allowed the U.S. to support the unity government, despite heavy pressure by the Israeli government for them to condemn it, the diplomatic officials – one American and one Palestinian – said. They said those assurances including a commitment to maintaining a ceasefire with Israel.
"Our administration needed to hear from them that this unity government would move toward democratic elections, and toward a more peaceful resolution with the entire region," said one U.S. official familiar with the talks. He spoke on condition of anonymity, as the U.S, government's official stance is that it has not, and will not, talk to Hamas until certain preconditions are met. "It was important to have that line of communication," the U.S. official said.
State Department deputy spokesman Marie Harf denied the talks. "These assertions are completely untrue," Harf told BuzzFeed. "There is no such back channel. Our position on Hamas has not changed."
Harf said she told a press briefing yesterday: "As you all know, Hamas is a designated foreign terrorist organization. The United States does not and will not provide it assistance. Per longstanding U.S. policy, we do not have any contact with Hamas. No members of Hamas and no ministers affiliated with Hamas, as I said, are part of this government."
The U.S. government has categorically denied it was speaking to Hamas for years. Assistant Secretary of State for European and Eurasian Affairs Victoria Nuland said in 2012 while she was still State Department spokesperson that claims that the U.S. and Hamas had a back channel were "bizarre."
"I want to say here that these assertions are completely untrue. There is no such back channel. And our position on Hamas has not changed," Nuland said in a press briefing. A State Department spokesman did not immediately respond to a request for comment on Wednesday.
On Wednesday, Secretary of State John Kerry confirmed that the U.S. would work with the new Palestinian government as needed.
"We are going to be watching (the government) very closely, as we said from day one, to absolutely ensure that it upholds each of those things it has talked about, that it doesn't cross the line," Kerry said. The U.S. has said that the new transitional government, led by Palestinian Authority Prime Minister Rami Hamdallah and with ministries run mostly by technocrats, represents a significant step toward ending a seven-year feud between the Palestinian political factions Hamas, which controls the Gaza Strip, and Fatah, which controls the West Bank.
Israeli officials slammed the announcement by Kerry, saying the U.S. was sanctioning terrorism.
"If the U.S. administration wants to advance peace, it should be calling on [Palestinian Authority President Mahmoud] Abbas to end his pact with Hamas and return to peace talks with Israel. Instead it is enabling Abbas to believe that it is acceptable to form a government with a terrorist organization," Israeli officials said in a statement.
When Hamas seized control of the Gaza Strip in June 2007, the Quartet on the Middle East peacemakers set out three conditions that the Islamist group would have to meet before it received international diplomatic recognition. Those conditions included recognizing the state of Israel, abiding by previous diplomatic agreements, and renouncing violence. Israeli officials point to statements made by Hamas current leadership as proof of their intent to continue an armed struggle against the Jewish state.
"We understand Israel's concerns, but this was a way of ensuring that Hamas kept its more extreme elements at bay so that the U.S. could support a unity government," said the American official. "These talks were very much to ensure that our concerns, and those of the Israeli government, were being met as the Palestinians move forward in the coming months."
He said that talks had ensured that the new unity government would "toe the line" to ensure ongoing U.S. aid. He stressed that the U.S. continues to not formally recognize Hamas, and would not do so until they formally renounced violence.
"We have imparted on them, very strongly, the fact that until they meet the criteria set forth by the Quartet there will be no official ties between us and Hamas," said the U.S. official.
The meetings that were held included an exchange of letters, with Hamas officials in Gaza as well as those in exile viewing the text of the letters before they were exchanged, a senior Palestinian official said.
"It must be very clear they were not just speaking to Hamas in exile, but to our entire leadership," said the official, who also spoke on condition of anonymity as "the Americans made it clear these meetings should not be made public."
He added, "It should be of no great surprise that an American team was speaking to Hamas, there is dialogue with Hamas through most of the Western world."
Over the last year, Hamas has revealed that they have been holding talks with at least five EU countries.
"I can say it's an important level (of officials), without defining whether it's junior or senior, and the channels are working," Osama Hamdan, a senior Hamas official, said about the EU talksin an interview with AP last year in Beirut. "It's not just a contact. It's channels of talking."
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text:
/*
 *
 * UserActions
 */
import AppDispatcher from  '../dispatcher/AppDispatcher';
import UserConstants from '../constants/UserConstants';

var UserActions = {

  /**
   *
   * @param  {string} userName
   * @param  {function} loginCb callback function will be invoked after login
   */
  login: function(userName, loginCb) {
    AppDispatcher.dispatch({
      actionType: UserConstants.LOGIN,
      userName: userName,
      loginCb: loginCb
    });
  },

  /**
   *
   */
  logout: function(cb) {
    AppDispatcher.dispatch({
      actionType: UserConstants.LOGOUT,
      cb: cb
    });
  }
};

export default UserActions;

redpajama_set_name: RedPajamaGithub


text:
Q: Entity ,Model ,ViewModel and send list to View This will be a long question, sorry. But it was necessary to unravel the logic.
This entity has all columns in DB:
public partial class Institution
{
    public int? Id { get; set; }

    public string? District { get; set; }
    public string? InstitutionCode { get; set; }
    public string? InstitutionName { get; set; }
    public string? DemolitionStatus { get; set; }
    public string? ReinforcementStatus { get; set; }
    public string? BuildingOwnerStatus { get; set; }
    public string? BuildingOwnerInstitution { get; set; }
    public string? ClosureStatus { get; set; }
    public string? ActivityStatus { get; set; }
    public string? ETStatus { get; set; }
    public int? ETPhase1 { get; set; }
    public int? ETPhase2 { get; set; }
    public int? ETPhase3 { get; set; }
    public string? InfrastructureStatus { get; set; }
    public string? InfrastructureScope { get; set; }
    public string? InfrastructureInfo { get; set; }
    public string? InfrastructureScopeOut { get; set; }
    public string? IAccessStatus { get; set; }
    public string? IAccessType { get; set; }
    public string? ComputerClassStatus { get; set; }
    public int? ComputerClassNumber { get; set; }
    public int? PCNumber { get; set; }
    public string? ComputerClassScope { get; set; }
    public int? ETNeed { get; set; }
}

I have defined a model for columns containing ET so that all columns are not processed since I will only show the user data related to ET.
public class ETModel
{
    public int? Id { get; set; }

    public string? District { get; set; }
    public string? InstitutionCode { get; set; }
    public string? InstitutionName { get; set; }
    public string? ActivityStatus { get; set; }
    public string? ETStatus { get; set; }

    public int? ETPhase1 { get; set; }
    public int? ETPhase2 { get; set; }
    public int? ETPhase3 { get; set; }
    public int? ETNeed { get; set; }
}

Then, I defined a view model with a member of the list type, as I will return two lists to the user. I edited this view model to ETmodel.
public class ETListVM
{
    public List<ETModel> ETyes { get; set; }
    public List<ETModel> ETnone { get; set;}
}

I instantiated the view model in the controller. I have defined two variables of list type. But I'm having trouble filling out these lists. I can fill it with the Institutions entity, but this time I'm getting away from my purpose. I am using all columns. My goal is to use less resources using the ETModel.
 public IActionResult Index(string district)
 {
      ETListVM vm= new ETListVM();
      var ETyesList = c.**XXX**
                       .Where(p => p.District == district && p.ETStatus == "yes")
                       .ToList();
      var ETnoneList = c.**XXX**
                        .Where(p => p.District == district && p.ETStatus == "none")
                        .ToList();

      vm.ETyes = ETyesList;
      vm.ETnone = ETnoneList;

      return View();
}

If I write the Institutions entity where I specified as XXX, it works, but it does not accept the ETModel I want to use. Thank you for your patience and help.
Note: It only works if I define a new entity with related properties, but this time ETModel becomes meaningless.

A: You can't directly match two different models, you need to configure the mapping.
For example, you can use AutoMapper:
First, Install AutoMapper.Extensions.Microsoft.DependencyInjection NuGet Package and register it:
builder.Services.AddAutoMapper(typeof(Program));

Then, Create a class inherited from Profile to determine the mapping relationship:
public class UserProfile: Profile
{
    public UserProfile()
    {
        CreateMap<Institution, ETModel>();
    }
}

And in controller:
public IActionResult Index(string district)
{
    ETListVM vm = new ETListVM();
    var ETyesList = _context.Institution.Where(p => p.District == district && p.ETStatus == "yes").ToList();
    var ETnoneList = _context.Institution.Where(p => p.District == district && p.ETStatus == "none").ToList();

    List<ETModel> ETyes = new List<ETModel>();
    ETyes = _mapper.Map<List<ETModel>>(ETyesList);

    List<ETModel> ETnone = new List<ETModel>();
    ETnone = _mapper.Map<List<ETModel>>(ETnoneList);

    vm.ETyes = ETyes;
    vm.ETnone = ETnone;

    return View();
}

redpajama_set_name: RedPajamaStackExchange


text:
Q: How to sort (orderby) a query done by a template function before the 'foreach' loop? How can I sort an array of elements being hold on a query done by a template function, just before the output starts on a foreach loop?
I wanted to order my elements by the Post Title. Here is my code:
<?php
$show_subproperties = apushome_get_config('show_property_sub', true);
if (!$show_subproperties) {
    return;
}
$post = get_post();
$author_id = $post->post_author;
$subproperties = Realia_Post_Type_Property::get_properties($author_id, "publish", get_the_ID()); ?>

<?php if (is_array($subproperties) && !empty($subproperties)) : ?>

<?php echo esc_html__('Módulos Individuais', 'apushome'); ?>

            <?php foreach ($subproperties as $subproperty) : ?>

                <?php echo Realia_Template_Loader::load('properties/box', array('property' => $subproperty)); ?>

            <?php endforeach; ?>

<?php endif ?>

A: Without knowing what Realia_Post_Type_Property::get_properties() does and returns, this is a bit tricky to answer. But essentially, you want to to sort an array using PHP.
Unless Realia_Post_Type_Property::get_properties() allows you to get a sorted list of posts, your best bet is probably to use wp_list_sort().
That function sorts a list of objects, based on one or more orderby arguments. Assuming $subproperties is an array of WP_Post objects, you should be able to do the following:
$subproperties = wp_list_sort( $subproperties, array( 'post_title' => 'DESC' ) );

A: I found a quite simple solution, once I finally realized $subproperties is just a simple array:

            <?php asort($subproperties);
        foreach ($subproperties as $subproperty) : ?>

                <?php echo Realia_Template_Loader::load('properties/box', array('property' => $subproperty)); ?>

            <?php endforeach; ?>


This is a sweet best friends to lovers romance with very little angst and a nice gentle exploration of how it sometimes takes time to see what's right in front of you.
I liked both characters, there's a bit of the usual misplaced fears about losing friendships and not thinking the other man could be interested before they get their act in gear.
There is an odd side plot with a neglected teenager which I found strange as it didn't really do anything much for the overall narrative, but otherwise, things run pretty smoothly.
It did feel at times like I'd dropped into the middle of a series and that I should know all the other people being mentioned but I don't believe it is connected to anything else.
Overall, it's an enjoyable read.


Oreo Milkshake is the Perfect Summer Smoothie.
Put the cream and milk in a blender and beat for 1 minute slow speed. Break Oreo cookies and add them to the blender. Beat on slow speed for 10 seconds.
Add larger pieces of cookies if you like (I like very much to have large chunks). Enjoy your Oreo milkshake with friends.


text:
Reference No: 5050J
Calibre: Automatic, cal. 315/136, 31 jewels
Bracelet/Strap: Leather
Clasp/Buckle: 18K yellow gold Patek Philippe pin buckle
Accessories: Accompanied by Patek Philippe Certificate of Origin stamped Orologeria Luigi Verga Milano dated 12th May 1995, instruction manual, product literature, additional solid caseback, leather folio, fitted presentation box and outer packaging.
Launched in 1993 and in production until 2002, ref. 5050, together with its officier-case sister ref. 5059, is one of the lesser-known grail of modern watchmaking. For the first time ever at Patek Philippe, a perpetual calendar is fitted with both an automatic movement and center seconds, reuniting the two distinguishing features of vintage perpetual calendar references 3448/3450 (automatic) and 2497/2438-1 (center seconds). Furthermore it features a retrograde date, allowing a dial design hardly ever seen before on Patek Philippe timepieces - and never on standard production model. Only some piece unique, such aa the modified reference 96 with perpetual calendar, are known with a similar configuration.
Oozing class and refined elegance, this truly is a quintessential Patek Philippe model, and an extremely interesting value proposition. Adding to its attractive overall appeal, it is an early example, dating to 1995, and it was purchased at revered Milan retailer Orologeria Verga, one of the best renowned retailers in Italy.
The model was produced in the three gold variations and in platinum, and an evolution can be noticed: the very first examples bear railway divisions and Roman numerals (a configuration soon abandoned), concurrently the present baton indexes configuration was also made available. Finally, the very last examples feature black dial and Breguet numerals. At least one special order piece is known, with silvered dial and oversized Breguet numerals.


Desi Bride: More from Ritu Kumar's "Panchvastra"
Lavish Dulhan launched their latest Summer/Fall 2012 magazine in complete style at theFermenting Cellar in Toronto's Distillery District. The night was full of champagne, hor d'ourves and of course a fashion show that showcased the latest styles in the Desi Fashion scene by two of Toronto's hottest fashion houses: Bombay Trendz and Frontier Heritage. This was the team at Lavish Dulhan's version of what a Bridal show should be like. A night full of cocktails, fashion and fun!
I spoke with Rohit Sharma, Editor-In-Chief & Founder of Lavish Dulhan about the amazing response the event received. Despite that the gloomy weather, there was a great turnout. The fashion show was amazing and even though there were only two fashion houses that were represented, it was just enough to get these Desi Brides imagining themselves walking down the aisle or into their reception in any of the creations. Rohit also commented that it was a really relaxed and chilled environment. At a typical wedding show, Brides usually come with their families, even their in-laws to be and don't really get a chance to be themselves. At this event, Brides were more relaxed and were really enjoying the night.
I wasn't able to personally attend A Lavish Affair but I am in awe of the makeup by Beauty Concept Shirley Wu and many of the outfits from Bombay Trendz and Frontier Heritage. I loved the makeup so much that I contacted Shirley and asked where I can grab the bright pink lipstick and coral lipstick because I need them! The pink colour is called Magenta and the coral one is Red Coral from Motives by Loren Ridginder. Check it out here!
The choice of outfits were gorgeous as well. There were so many gorgeous designs but I loved the multi coloured lengha from Bombay Trendz. I just can't get over how gorgeous the magenta and the saffron looked together with hints of red and purple. Colours that I wouldn't pair together but in this case it looks really good. Totally on trend with the the long sleeved choli with the gorgeous embroidery on the neckline. You wouldn't even need a necklace. Just a stunning pair of earrings and you're ready to go!This had to be my favourite piece. A close second was the net mint sari with the navy blue velvet pallu from Frontier Heritage! That was so different and the tiny detailing on the net with the beautiful embroidery on the pallu was perfect. There were outfits for every occasion in an array of colours and styles that will appeal to everyone. Enjoy lovelies!
Gorgeous shot of the outfits. Beautiful colours and embroidery.
The bottom of my favourite outfit from Bombay Trendz.
My favourite!! Gorgeous colours and the sweetheart neckline with the embroidery is perfect!
The back is nice too! Love the hairstyle. Edgy and feminine at the same time.
Beautiful sari from Frontier Heritage. Love, love, love the velvet pallu!
Elie Saab's latest collection just came out and with all his collections, there is a colour palette; lime green, browns, taupes, mauves, egglpant purples, black, champagne and grey. There are looks that are perfect for the day and translate beautifully into the night. The pairing of browns with green and aubergine and grey are really fresh. My favourite parts of the collection are the high necklines, sheer sleeves on the dresses, the peplum aubergine skirt, the embroidery and I love, love the accessories! I am obsessed with vintage looking bags. The black with the taupe outlining is so pretty! Check it out lovelies!
The fashion world awaited with baited breath for Raf Simon's first collection as the new designer for the iconic brand Christian Dior. Since being appointed as the new designer after the dismissal of John Galliano, all eyes were on the runway and Mr. Simon's did not disappoint.Grabbing inspiration from the classic Dior of the 1940's, Simon's created stunning dresses cinched at the waist with full skirts, tuxedo jackets, A-line mini peplum dresses paired with cigarette pants and of course breath taking evening dresses. Pointed heels in a variety of colours some capped other not completed the looks and very minimal accessories were used.
What I love about this collection is that each piece is wearable. The A-line mini dress with pants looks amazing. How many times have you gone to a store and fell in love with a dress that was way to short. I have! Countless times! Now I just buy it and wear it with tights! But the A-line minis with pants looks divine! I fell in love! I'm so glad that Peplum is here to stay, for awhile. It's such a feminine look and it just adds fun to any outfit.