Ashelyn Vienna, 6.4 6.3 lbs, born March 30 at 7:50AM. At home, because we never made it to the hospital. And our midwife didn't make it to us. And Kevin, who has said all along that he wanted to remain on the "head" side of the birthing action, had to help catch the baby.
Hopefully that story will be up soon.
The middle-of-the-night bathroom runs are back. Just one or two a night, so it's not too bad. Except this morning, shortly after 6AM, I think I passed my mucous plug.
Kevin paged the midwife on call, who assured us that everything was probably fine, but I might go into labour this weekend.
We haven't installed the carseat and I haven't finished packing the hospital bag and we still haven't found a family doctor and the floors need to be swiffered AAGH.
Then again, who knows? It might not happen this weekend.
At our last appointment, my midwife estimated munchkin's weight to be around six pounds. That sounds manageable. If I carry to 40 weeks, munchkin will likely be in the sixes or low sevens.
Footnote: I've barely gained 25 pounds this pregnancy.
I'm glad I made it past the weekend, because we were way out in the suburbs and it would've been a looong drive to the hospital. And I forgot to bring my CareCard. Also, my baby shower was Sunday night.
Now to see if I'll make it past this coming weekend. I hope so, because I have a dinner on Wednesday and another on Sunday. My mom said she tended to deliver a week early, but then pointed out that she was much more deliberate about being active and getting exercise during pregnancy than I've been. Heh.
I think most women are so over being pregnant by this point … but then "most women" seem to suffer ten times the symptoms I do. Although it'd be awesome to sleep on my stomach again. And to have my belly button look normal. AND TO GO SNOWBOARDING.
But s/he'd better not come yet, because I am so NOT READY. Just … stay in there until Easter long weekend, alright? At least give me the remainder of March to tie up loose ends.
I've been having braxton-hicks contractions all day. They don't hurt, but when they happen my belly bunches up all lopsided, because munchkin has been hanging out on my right side all pregnancy.
Our baby stuff is scattered around the house. Actually, there's not that much baby stuff. People think babies are expensive, that you need to afford to have kids, but that's only if you fall for all the marketing gimmicks. Especially the ones that play off the insecurities of first-time mothers.
Here's the glider in the living room.
At one point we had four baby swings/rockers/vibrating bouncy chairs. My favourite is the Bright Starts InGenuity portable swing we picked up from the hand-me-down exchange corner of my midwifery clinic. I love that corner. And they should make adult versions of these things.
We might keep another rocker on standby for a while, in case munchkin is contrary and decides to hate this one. (S/he was contrary enough to be uncooperative at the big twenty-week ultrasound, after all.) The rocker came with a ring sling and the above change table, another Craigslist find at $20. If we weren't planning to cloth diaper, we might not have bothered with a change table, but I figured a change station of sorts would be easier with cloth. Once we have a diaper pail I'll move the swing elsewhere.
I didn't consider a stroller to be particularly essential, but a colleague of Kevin's very kindly passed down her Graco Mosaic travel system to us. After fussing with it endlessly, because that thing is quite nifty, I've parked it in a corner of our dining area. She also gave us a newborn-to-toddler bathtub. Speaking of tubs, my friend had her baby last October, and during his first bath she accidentally dropped her husband's new iPhone 4S into the water.
I'm probably on record for wondering why baby shoes even exist, but then I came across these. For 99 cents. And I succumbed.
Some time later, one mother informed me that baby shoes are for keeping their socks on. I feel sufficiently justified. These, and the rest of munchkin's squee-inducing wardrobe are in an old dresser in the guest room that never became a nursery.
I like the idea of a nursery, but I'm not sure how practical it would be for us to have everything in a single small room in one corner of the house. Chances are, not very.
I've been called both big AND tiny for my gestational age. I've had a persistent unsatisfied craving for ice cream, preferably of the McDonald's or DQ variety. I am morbidly curious about other people's labour stories.
It's a Storkcraft ELISA, manufactured in 2002. We've already installed the new mattress support brackets, and the dropside immobilizers just need to be plopped into place. The crib was in excellent condition otherwise … even the old support brackets, which were recalled because there was a possibility of breakage when installed incorrectly.
As it is, I'm more concerned about that wedding picture falling off the wall onto the baby than I am about the crib malfunctioning.
OMG in another month or so THERE WILL BE A BABY in that crib.


text:
The Free Library > Health > Health, general > Indian Journal of Dental Advancements > April 1, 2013
The Free Library > Date > 2013 > April > 1 > Indian Journal of Dental Advancements
Pathology of cell death.
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APA style: Pathology of cell death.. (n.d.) >The Free Library. (2014). Retrieved Jan 16 2021 from https://www.thefreelibrary.com/Pathology+of+cell+death.-a0352616470
Cell being the structural unit of the body, normal functioning of all the tissues and organ systems in the body depends on the cell functioning in itself and in coordination with the neighboring cells in tissue or organ system to maintain a state of homeostasis. The normal cell is confined to its functions & structure by its genetic programs of metabolism, differentiation and specialization. Various pathological stimuli and even the physiologic stresses can bring about a number of physiologic and morphologic cellular adaptations. Due to these adaptations, new but altered steady states can be achieved, however with the preservation of viability of the cell & modulating its function. (1,2,3)
Adaptive responses may occur in the form of hyperplasia, hypertrophy or atrophy. Inability to adapt to the stress or the stimuli produces cell injury, either reversible or irreversible, ultimately producing cell death. The type and extent of cell injury determines whether the cell and the tissue are restored to normal or the cell dies and disappears, or the residual effects persist as evidence of injury. (1,2,3,4,5)
Cell injury is reversible up to a certain point. But if the stimulus persists or is severe from the beginning itself it produces irreversible cell injury, ultimately causing the cell death. Adaptation, reversible injury and cell death are considered as the stages of progressive impairment of cell's normal function and structure. The consequences of cell injury depends on a number of factors, including the intrinsic nature of cells and tissues involved, in particular, their differentiating state, and their ability to divide and replicate. Cell death can result from diverse causes including ischemia, hypoxia, anoxia, infections, toxins and immune reactions. (1,2,6) On the other hand it can be normal and essential part of embryogenesis, development of organs and maintenance of homeostasis and can be used intentionally as a part of cancer therapy. (1,2,3)
Cell death can be classified according to its morphological appearance (which may be apoptotic, necrotic, autophagic or associated with mitosis), enzymological criteria (with and without the involvement of nucleases or of distinct classes of proteases, such as caspases, calpains, cathepsins and transglutaminases), functional aspects (programmed or accidental, physiological or pathological) or immunological characteristics (immunogenic or nonimmunogenic). (4,7)
The Nomenclature Committee on Cell Death (NCCD) proposes that a cell should be considered dead when any one of the following molecular or morphological criteria is met: (1) loss of the integrity of its plasma membrane (2) complete fragmentation of cell and the nucleus discrete bodies (3) its fragments has been engulfed by an adjacent cell. (4)
There are two principle patterns of cell death which are necrosis and apoptosis. While necrosis is the cell death occurring after abnormal stresses and is always pathological, apoptosis is the cell death through activation of an internally controlled suicide programme. (3,4,6) Programmed cell death (PCD) is the death of a cell in any pathological format, when mediated by an intracellular program. It refers to apoptosis, autophagy and programmed necrosis. Apoptosis and programmed necrosis invariably contribute to cell death, whereas autophagy can play either pro-survival or pro-death roles. These three forms of PCD may jointly decide the fate of cells of malignant neoplasms. (8)
Necrosis refers to the cumulative morphologic range of changes indicative of cell death in a living tissue or an organism and is caused by the progressive degradative action of hydrolytic enzymes on a cell or cells and on tissues. It results in the loss of structural integrity, and the denaturation of proteins and other macromolecules. The enzymes can be derived either from the lysosomes of dead cells themselves, in which case it is referred to as autolysis, or from the lysosomes of the leukocytes in the inflammatory reactions, the heterolysis. Due to the inability of these cells to maintain the membrane integrity, the cell contents often leak out eliciting an inflammatory reaction. (1,3) Fate of necrotic cells involves their enzymatic digestion, fragmentation and phagocytosis by the adjacent inflammatory cells and in certain cases they can undergo dystrophic calcification. (3,6)
Core events in necrosis include bioenergetic failure and loss of plasma membrane integrity. (2) There are various pathways to necrosis depending on the cause and the site of action. These are
* Cellular energy depletion that produces loss of membrane potentials, which further leads to the opening of death channel (ASIC-Acid sensing ion chandelles) in the cytoplasmic membrane. The opening which results in colloid osmotic forces and entry of cations that causes the cytoplasmic membrane swelling and cell rupture. (2,3)
* A number of proteases such as calpins, cathepsins, lysosomes and caspases have been implicated in necrosis. Most of these enzymes cause lysosomal membrane permeability (LMP), which can lead to release of lysosomal enzymes and necrotic cell death. Calpains cause calpainmediated cleavage of the [Na.sup.+]/[Ca.sup.2+] exchanger in the plasma membrane resulting in the sustained secondary intracellular [Ca.sup.2+] overload and subsequent necrotic cell death. (3,7,9)
* Mitochondrial permeability transition (mPT) is the loss of transmembrane potential of the mitochondrial inner membrane. Permeability transition (PT) pores open in the mitochondrial inner membrane in response to stimuli such as increased intracellular [Ca.sup.2+], inorganic phosphate, alkaline pH, and ROS (Reactive Oxygen Species). The persistent opening of the PT pore has been proposed to amplify apoptosis by mediating release of mitochondrial apoptogenic factors. CypD is a key regulator of this mechanism. (3,10)
* Generation of ROS, can causes necrosis by DNA damage, activation of poly(ADPribose) polymerase (PARP), lipid oxidation, which can lead to the loss of integrity of both the plasma membrane and intracellular membranes such as that of lysosomes and the ER, leading to an intracellular leak of proteases or an influx of [Ca.sup.2+], breakdown of aminoacids and proteins, and adversely affecting [Ca.sup.2+] channels on the endoplasmic reticulum and plasma membrane. (2,3)
* Prolonged cytosolic (Ca) 2+ can cause mitochondrial [Ca.sup.2+] overload, there by inducing calcium mediated cell necrosis by depleting ATP, activating [Ca.sup.2+] dependent proteases and mPT. (3)
The advantage with necrosis is that it allows cells to actively recruit a defensive or a reparative response to regions of multicellular organisms that have sustained damage or invasion and thus, it serve as an organismal warning system of the extent of a toxic exposure. (3) Necrosis can be of different types and it in part is determined by richness of lysosomal enzymes in the cell. The type of necrosis occasionally provides a clue about the underlying cause of necrosis. (2)
Though necrosis was considered to be accidental cell death, recent studies suggest it to be a regulated event that contributes to development and maintenance of organismal homeostasis. (4,8) This form of regulated necrosis is termed as 'necroptosis'. (4) With the discovery of role of RIP (Receptor interacting protein) kinases and PARP in necrosis this concept of programmed necrosis is gaining profondence. RIP kinases, PARP1, NADPH oxidases and calpains have been identified as potential signaling components o in programmed necrosis. (4,8)
Apoptosis is the type I PCD and is the major type of cell death. It is characterized by specific morphological and biochemical changes in the dying cells. The apoptotic cell shows cell shrinkage, nuclear condensation and fragmentation, dynamic membrane blebbing and loss of adhesion with adjacent cell or with extracellular matrix. Biochemical changes include chromosomal DNA cleavage, phosphatidylserine externalization and a number of intracellular substrate cleavages by specific proteolysis. (4,5,8,11,12)
It is induced by two mechanisms (1,2,4,5)
* Extrinsic--death receptor pathway--It is triggered by binding of Fas to Fas-L that activates caspase cascade.
* Intrinsic pathway- it occurs under the control of mitochondrial pro-enzymes.
* In both cases if a cell becomes initiated by either extracellular stimuli or intracellular signals, outer mitochondrial membranes become permeable to interneal cytochrome c, which is then released into the cytosol.
* Cytochrome c recruits Apaf-1 and pro-caspase-9 to compose the apoptosome, which triggers a caspase 9/3 signaling cascade, culminating in apoptosis.
* Apoptosis can also occur through a granzyme, perforin pathway.
Accumulating evidence has shown that abnormal expression of some key regulatory factors may lead to cancer, indicating the intricate relationships between apoptosis and cancer. (8) In the absence of phagocytosis, the apoptotic bodies may lose their integration and undergo necrosis and is called as 'apoptotic necrosis' or 'secondary necrosis'. (5)
Many insults induce apoptosis at lower doses and necrosis at higher doses. Even in response to a certain dose of death-inducing agent, features of both apoptosis and necrosis may coexist in the same cell and such condition is referred to as 'aponecrosis'. (3,12)
* mPT may have opposite roles in inducing necrosis or apoptosis. While Bax and Bak function on the mitochondrial outer membrane to mediate the release of apoptogenic factors into the cytosol during apoptosis, CypD controls the PT pores on the inner membrane during necrosis. (1,3,12)
* Increased cytosolic [Ca.sup.2+] can initiate either apoptosis or necrosis. Low to moderate [Ca.sup.2+] (200- 400 nM) triggers apoptosis, higher concentration of [Ca.sup.2+] (>1 [micro]M) is associated with necrosis. It is the reason why the [Ca.sup.2+] released from the ER is mostly apoptotic, whereas [Ca.sup.2+] influx through the plasma membrane is associated with necrosis. (3,12)
* Sphingosine, a structural component of cell membranes has been shown to cause LMP and cell death in a dose-dependent manner. Sphingosine induces partial lysosomal rupture and apoptosis at low-to-moderate concentrations (<20 [micro]M), and extensive lysosomal rupture and necrosis at high concentration (>20 [micro]M). (3)
Based on the nuclear morphology, Leist and Jaattela have classified cell death into four subclasses. (9)
* Apoptosis--Stage II chromatin condensation into compact figures, which are often globular or crescent shaped.
* Apoptosis-like PCD--Stage I chromatin condensation--less compact chromatin condensation.
* Necrosis-like PCD--No chromatin condensation, chromatin clustering to loose speckles
* Necrosis--Cytoplasmatic swelling and cell membrane rupture.
Oncosis
Oncosis refers to any cell death characterized by marked cell swelling. (10) It is the prelethal pathway leading to cell death accompanied by cellular and organelle swelling and increased membrane permeability that result from active enzyme catalyzed biochemical processes. Oncotic cells, however, proceed to necrosis with lysis. The released contents of necrotic cells include molecules that act as signals to promote inflammation. (5,10,12)
Autophagy is the type II PCD. (8,9) It involves degradation of cellular components within the dying cell in autophagic vacuoles and is not inflammatory. (5) It begins with the formation of autophagosomes, followed by autolysosomes. (4,8,9) Over-activation of autophagy may result in autophagic cell death. It plays a crucial role in cell homeostasis, by controlling cell differentiation, cell survival and death especially under the conditions of starvation and stress. It also has role in both progression and prevention of cancer and it provides energy required for minimal cell functioning when nutrients are scarce. Its action is highly regulated by some autophagy--related genes (ATGs) and a number of pathways involving Beclin-1, Bcl-2, Class III and I PI3K, mTORC1/C2 and p53 (24). (8,9,12)
Pyroptosis
Pyroptosis is the proinflammatory pathway resulting from caspase-1 activity leading to membrane breakdown and proinflammatory cytokine processing by formation of a supramolecular cytoplasmic complex called the pyroptosome. It plays a significant role in local and systemic inflammatory reaction by release of IL-I[beta] and IL-18. It is triggered by various pathological stimuli, such as stroke, heart attack or cancer, and is crucial for controlling microbial infections. However, the microbial organisms have evolved mechanisms to inhibit pyroptosis, due to which they persist and cause disease. (4,5,13)
Paraoptosis
Paraptosis is characterized by progressive swelling of mitochondria, endoplasmic reticulum (ER) and cytoplasmatic vacuolation. It is mediated by mitogen-activated protein kinases and can be triggered by the TNF receptor family member and the insulin-like growth factor I receptor. Unlike apoptosis, paraptosis is inhibited by AIP1/Alix. (4,9)
Mitotic catastrophe
Mitotic catastrophe occurs due to mitotic failure caused by defective cell cycle checkpoints and development of aneuploid cells and and can be accompanied by morphological alterations including micronucleation and multinucleation. It is thought to be triggered by mitochondrial membrane permeabilization and caspase activation which still is controversial. It can lead either to an apoptotic morphology or to necrosis. (4,7,9)
Pyronecrosis
Pyronecrosis is the necrotic cell death of macrophages in infections by S. flexneri at high bacteria/macrophage ratios and associated with the release of HMGB-1, caspase-1 and IL-1[beta]. Pyronecrosis and pyroptosis are distinguished based on the fact that the latter requires caspase-1. (4)
Anoikis
Anoikis is a form of apoptosis induced by the loss of the attachment to the substrate or to other cells Besides its specific form of induction, its molecular mechanisms match those activated during classical apoptosis. (4)
Entosis
Entosis is a form of cell death in which one cell engulfs one of its live neighbors, which then dies within the phagosome. However, in rare cases, internalized cells may divide within the engulfing cell or are released. Hence, it is difficult to know whether the cell-in-cell morphology (entosis) truly represents a novel cell death modality Entosis is not inhibited by Bcl-2 or Z-VAD-fmk. (4)
Though the different forms of cell death show varying morphological characteristics and physiological processes; still there exists an intricate interrelationships between them. (8) Cell death can be studied using various methods such as light and electron microscopy, IF microscopy, special stains, gel electrophoresis, terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL), flow cytometry, western blotting, colorimetric and fluorometric assays, immunoblotting, polarography, co immunoprecipitation studies, genetic studies and ultrasound. (4,5,10,14)
Cell death and Periodontal disease
Periodontal tissue is subjected to constant irritation by oral microorganisms and their toxic products that have an adverse effect on the tissue. Periodontitis is a chronic disease caused by chronic irritation, infection and inflammation that gradually destroys the supporting tissues. (11) The causative organisms and their products act on the gingival epithelial cells, periodontal ligament, alveolar bone and the immune cells to bring about the disease and its further progression. Whether these effects cause the proliferation of cells or their death needs to be understood. (15,16)
The pathogenic microorganisms inducing periodontal pathology act by inducing cytotoxicity of various cellular components and subsequently cell death. (15) Butyrate produced by anaerobic bacteria and present in mature dental plaque of periodontitis patients can induce death of gingival epithelial cells by apoptosis and autophagy. (11,17) It activates apoptosis by increasing caspase-3 activity, phosphatidylserine redistribution and bcl-2 downregulation. (17) There is also release of high-mobility group box-1 (HMGB1) from the gingival cells by butyrate induced autophagic cell death. This molecule when released extracellularly acts as a group of proinflammatory cytokine. (11,18) These dead cells also displays necrotic features including loss of cellular membrane integrity and cell swelling. (15) Actinobacillus actinomycetemcomitans play an important role in periodontal diseases by inducing apoptosis in alveolar bone cells. (19) A Fas ligand associated mechanism may be one of the method involved in apoptotic cell death. (15)
Periodontal pathogens by their immunosuppressive action can induce the progression of the disease. They cause depletion of immune cells at the infection site by inducing cell death, thereby providing a conducive environment for the further recruitment of other microorganisms. (16,20) The functioning of PMNs is very crucial in periodontitis. These cells undergo apoptosis which is modulated by various factors. While inflammatory mediators, the GM-CSF, IFN-[gamma] or LPS, delay the apoptosis by increasing mitochondrial stability, reducing caspase-3 activity and down regulating apoptotic gene expression, the anti-inflammatory cytokines accelerate the apoptosis of LPS activated neutrophils. (15)
Apoptosis of T cells and gingival epithelial cells can be caused by short chain carboxylic acids (SCCA) present in Porphyromonas gingivalis, Prevotella loescheii and Fusobacterium nucleatum. (21) Toxin from the Actinobacillus actinomycetemcomitans induces apoptosis of B lymphocytes present in the periodontal tissue. (22) A component of the cell wall of gram negative bacteria, lipopolysaccharide (LPS), stimulate butyric acid induced apoptosis in human peripheral blood mononuclear cells. (23) Porphyromonas gingivalis can induce apoptosis and necrosis of peripheral blood mononuclear cells in periodontal diseases. (16) P. gingivalis can also utilize a part of the host autophagy mechanism for their own protection from being damaged by host antibacterial system. (18) F. nucleatum as well can induce the apoptotic cell death in peripheral blood mononuclear cells (PBMCs) and in polymorphonuclear cells (PMNs) through a heat-labile surface protein. Inhibitory signals mediated via programmed death-1 (PD-1) play a critical role in downmodulating immune responses and maintaining peripheral tolerance. In chronic periodontitis, the programmed death-1 can modulate the production of IFN-gamma by Tcells. (24)
Study of cell division, synthetic capacity and apoptosis in periodontal lesions showed apoptotic cells to be consisting mainly of connective tissue cells, mainly fibroblasts with few polymorphonuclear leukocytes and other leukocytes. Fibroblast apoptosis and cell division occur within the periodontium and they are essential for the normal turnover and remodelling of these tissues. The low turnover of infiltrating leukocytes indicate that they probably arrive at this site by recruitment from distant lymph nodes, and that neither cell division nor programmed cell death significantly alter the numbers of inflammatory cells. (25) Other study on dental periapical lesions implies the same as well. In periapical lesions, the apoptosis occurs predominantly in PMN. Most cells apart from PMN though exhibit synthetic activity, only epithelial cells undergo proliferation. Thus the immune cells proliferate at distant lymph nodes and travel to the periapical lesion rather than proliferating within the lesion. (26)
Volatile sulfur compounds, the main compounds causing halitosis has been shown to activate the apoptotic process in different tissues thus inducing the development of periodontitis. It induces apoptosis in human gingival epithelial cells by activating the mitochondrial pathway. (27)
Though there are different forms of cell death, they can be induced by the same pathological agent and in some conditions more than one form of cell death co-exists. Cell death can be advantageous, as it has therapeutic implications too, including the treatment of cancer. With only necrosis and apoptosis in the beginning, other forms of cell death have been added to the literature. With researches on way, still much needs to be explored.
(1.) Damjanov I, Linder J. Anderson's pathology. Volume-1. 10th edition; Elsevier inc., Noida.
(2.) Cotran RS, Kumar V, Collins T. Robbins Pathologic basis of disease. 7th edition; W.B Saunders company, USA.
(3.) Zong WX, Thompson CB. Necrotic death as a cell fate. Genes and development 2006; 20:1-15.
(4.) Kroemer G, Galluzzi L, Vandenabeele P, Abrams J, Alnemri ES, Baehrecke EH, et al. Classification of cell death: recommendations of the Nomenclature Committee on Cell Death 2009. Cell Death Differ 2009;16(1):3-11.
(5.) Fink SL, Cookson BT. Apoptosis, pyroptosis and necrosis: mechanistic description of dead and dying eukaryotic cells. Infection and immunity 2005;73(4):1907-1916.
(6.) Majno G, Joris I. Apoptosis, Oncosis and Necrosis--An overview of cell death. American journal of pathology 1995;146:3-14.
(7.) Galluzzi L, Maiuri MC, Vitale I, Zischka H, Castedo M, Zitvogel L, et al. Cell death modalities: classification and pathophysiological implications. Cell Death and Differentiation 2007;14:1237-1266.
(8.) Ouyang L, Shi Z, Zhao S, Wang F-T, Zhoug T-T, Liu B, et al. Programmed cell death pathways in cancer: a review of apoptosis, autophagy and programmed necrosis. Cell Prolif 2012;45:487-498.
(9.) Broker LE, Kruyt FAE, Giaccone G. Cell death independent of caspaes. Clin Cancer Res 2005;11(9):3155-3160.
(10.) Cruchten SV, Broeck WV. Morphological and biochemical aspects of apoptosis, oncosis and necrosis. Anat Histol Embryol 2002;31:214-223.
(11.) Tsuda H, Ning Z, Yamaguchi Y, Suzuki N. Programmed cell death and its possible relationship with periodontal disease. Journal of Oral Science 2012;54(2):137-149.
(12.) Bredesen DE. Toward a Mechanistic Taxonomy for Cell Death Programs. Stroke 2007;38:652-660.
(13.) Bergsbaken T, Fink SL, Cookson BT. Pyroptosis: host cell death and inflammation. Nature Reviews Microbiology 2009;7:99-109.
(14.) Czarnota GJ, Kolios MC. Ultrasound detection of cell death. Imaging Med 2010;2(1):17-28.
(15.) Gamonal J, Bascones A, Acevedo A, Blanco E, Silva A. Apoptosis in chronic adult periodontism analyzed by In Situ DNA breaks, electron microscopy and immunohistochemistry. J Periodontol 2001;72(4):517-525.
(16.) Trindade SC, Olczak T, Gomes-Filho IS, Moura-Costa LF, Vale VL, Galdino-Neto M, et al. Porphyromonas gingivalis antigens differently participate in the proliferation and cell death of human PBMC. Arch Oral Biol 2012;57(3):314-320.
(17.) Tsuda H, Ochiai K, Suzuki N, Otsuka K. Butyrate a bacterial metabolite, induces apoptosis and autophagic cell death in gingival epithelial cells. J Periodontal Res 2010;45(5):626-634.
(18.) file:///H:/Autophagy%20in%20periodontal% 20disease%20(pp.85-96).htm.
(19.) Morimoto Y, Morimoto H, Murata T, Kobayashi S, Ohba T, Haneji T. Extracts of Actinobacillus actinomycetemcomitans induce apoptotic cell death in human osteoblastic MG63 cells. J Dent Res 1999;78(3):735-742.
(20.) Jewett A, Hume WR, Le H, Huynh TN, Han YW, Cheng G, et al. Induction of Apoptotic Cell Death in Peripheral Blood Mononuclear and Polymorphonuclear Cells by an Oral Bacterium, Fusobacterium nucleatum. Infect Immun 2000;68(4):1893-1898.
(21.) Geatch DR, Harris JI, Heasman PA, Taylor JJ. In vitro studies of lymphocyte apoptosis induced by the periodontal pathogen porphyromonas gingivalis. J Periodont Res 1999;34:70-78.
(22.) Ohguchi M, Ishisaki A, Okahashi N, et al. Actinobacillus actinomycetemcomitans toxin induces both cell cycle arrest in the G2/M phase and apoptosis. Infect Immun 1998;66:5980-5987.
(23.) Kurita-Ochiai T, Fukushima K, Ochiai K. Lipopolysaccharide stimulates butyric acid induced apoptosis in human peripheral blood mononuclear cells. Infect Immun 1999;67:22-29.
(24.) Figueira EA, de Rezende ML, Torres SA, Garlet GP, Lara VS, Santos CF, Avila-Campos MJ, da Silva JS, Campanelli AP. Inhibitory signals mediated by programmed death-1 are involved with T-cell function in chronic periodontitis. J Periodontol 2009;80(11):1833-1844.
(25.) Koulouri O, Lappin DF, Radvar M, Kinane DF. Cell division, synthetic capacity and apoptosis in periodontal lesions analysed by in situ hybridisation and immunohistochemistry. J Clin Periodontol 1999;26(8):552-559.
(26.) Takahashi K, MacDonald D, Murayama Y, Kinane D. Cell synthesis, proliferation and apoptosis in human dental periapical lesions analysed by in situ hybridisation and immunohistochemistry. Oral Dis 1999;5(4):313-320.
(27.) Calenic B, Yaegaki K, Murata T, Imai T, Aoyama I, Sato T, Ii H. Oral malodorous compound triggers mitochondrial-dependent apoptosis and causes genomic DNA damage in human gingival epithelial cells. J Periodontal Res 2010;45(1):31-37.
Sreeshyla HS [1], Priyanka R. Prasad [2], Anju N. Duttargi [3]
doi: 10.5866/2013.521200
[1,2&3] Lecturer
Department of Oral Pathology & Microbiology, JSS Dental College & Hospital, (A Constituent of JSS University), Mysore, India.
Received: January 10, 2013
Review Completed: February 11, 2013
Accepted: March 10, 2013
Available Online: July, 2013 (www.nacd.in)
Email for correspondence:
sreeshylahs@gmail.com
COPYRIGHT 2013 National Academy of Dentistry
Sreeshyla, H.S.; Prasad, Priyanka R.; Duttargi, Anju N.
Indian Journal of Dental Advancements
Geographic Code:
9INDI
Teledentistry the future of dental practice.
Pigments used for Maxillofacial prosthetics and a step by step protocol for their application.
Genetic aspects
Physiological aspects

redpajama_set_name: RedPajamaCommonCrawl


Additionally, you can find all of the creature comforts you've come to expect with a modern high-end PC. 512GB of fast NVMe storage from Samsung and 24 GB of RAM will help you in typical productivity tasks in addition to gaming.
Now let's talk about the most radical thing about the ROG Zephyrus, the form factor.
The Zephyrus moves the keyboard and trackpad to the very leading edge of the notebook, allowing for a larger surface area dedicated to the CPU and GPU. While this is not necessarily a first in the notebook world (the MSI GT83VR TITAN comes to mind), it's a more radical design than typical notebook users expect.
Off the bat, we had questions about the usability of a keyboard and mouse in this location on a notebook. In my experience with the Zephyrus, the answer to this is simply - it's not great.
My attempts to use the Zephyrus in any configuration outside of sitting on a desk have been uncomfortable at best. To effectively use the Zephyrus in your lap, it has to be pushed far back so that you can use the keyboard and mouse. This means that the center of gravity for the machine ends up being more near your knees, and the entire setup feels unstable.
When using the ROG Zephyrus on a flat surface like a desk, the situation is better. The keyboard has a good tactile feel to it, and although it's in an odd place, the trackpad works well. Additionally, the Zephyrus ships with a rubber wrist rest to help the typing experience. While I wouldn't want to have to travel with a wrist rest, it certainly helps make typing more comfortable.
To a lot of people, it may seem ridiculous to complain about not being able to use a gaming notebook to surf the internet while watching Netflix on your TV. However, I would argue that part of the reason of making a more portable gaming notebook would be the flexibility to use it in different environments. Additionally, I think the type of person who is buying a $2700 device is likely to be using this as their sole computer. The ergonomics of the Zephyrus don't seem to allow this. I can't even imagine the pain of trying to use this notebook on an airplane tray table.
An interesting design detail of the Zephyrus is the angled ventilation system found on the bottom of the notebook. When you open the Zephyrus, the bottom panel angles up and allows direct airflow to the GPU and CPU fans underneath. This improves cooling significantly and allows the fans to rotate slower and reduce noise under a full gaming workload.
As far as ports are concerned, the thickness of the Zephyrus means that the options are more limited than traditional gaming notebooks. You'll find four USB 3.0 Type-A ports, a Type-C Thunderbolt 3 connector, combination audio jack, and full-size HDMI 2.0 connector. Included in the box is a USB 3.0 to Gigabit Ethernet adapter to help with any wired networking concerns since the Zephyrus is too thin to fit an RJ-45 connector.
Nice piece no doubt. Battery life is a killer though. More disabling tech needed to be incorporated when on battery (i.e. on chip iGPU switch over with disabled dGPU, lower multipliers, cores disabled, lower DDR4 speeds etc.). <2hrs on battery is unusable in the real world.
Is the RAM running in dual channel? With on board chips and then two DIMMs, I thought this non-symmetric design might kick it back to single channel?
What the hell is the point of an ultraportable that lasts less than two hours? Seriously who approves such a product?
Maybe I'm in the minority here, but I'd be more interested in a push for more durable, reliable, and serviceable laptops rather than this focus on thinness.
This is honestly a stupid way to go with laptop design. If I'm buying a laptop for gaming, I don't want thin and light to compromise battery life, thermals, noise, throttling and all sorts of other criteria. I /want/ a thicker laptop that has a larger battery, better cooling and temperatures. I'm all for Nvidia GPUs, but this idea is complete non-sense and a waste of time.
"You'll find four USB 3.1 Type-A ports"
should be: You'll find four USB 3.1 Gen 1 Type-A ports. But the spec sheet table lists them as "4 x USB 3.0"(old USB-IF nomenclature) and at least there is a TB3 so that's not so bad.
Really a gaming laptop and Ultrabook/Thin And Light means only one thing: thermal throttling and crappy battery life. And the deal killer is that Thin/Apple like form over functionality design for a gaming laptop that costs $2700.
I think the compromises here are in all the wrong places.
In a world where external GPUs are looming I don't think the form factor makes sense.
Having a single machine to do it all is a good goal. But, Nvidia and AMD should OEM eGPUs in a small, sleek form factor. No need for an enclosure, if the GPU itself is designed to sit on the desk with an integrated 120v PSU on the PCB. I don't think an eGPU has to be much bigger than a large conventional GPU if it's done right.
I think this laptop is amazing.
Yes....the battery life let's it down, but all Asus has to do is design and manufacture an external power-bank to attach to the Zephyrus, thus making it more portable.


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THINKERS:
Philosopher of greed: Ayn Rand
by Damian Wyld
February 2, 2005 marked a date which would have passed unnoticed but for an article in The Australian. It was, in fact, the centenary of the birth of author and philosopher Ayn Rand. While the article provided an interesting glimpse of Rand and her ongoing influence, it presumably did not have room to delve beneath the surface of her very questionable beliefs.
Ayn Rand was born Alisa Rosenbaum to ethnically, but non-practising, Jewish parents in St Petersburg in 1905. She became an atheist at an early age before studying history and philosophy at the University of Petrograd during the early years of the Soviet regime. During her studies, she read and drew on inspiration from sources as diverse as Victor Hugo and Friedrich Nietzsche and came to regard America as a nation to be emulated for its freedoms - an idealistic antithesis to the oppressive communist system she was then enduring.
Arriving in the US in 1926 on a study visa, she never returned to Russia and instead embarked on a career that included writing books, stage productions and screenplays. Her fictional works, such as The Fountainhead and Atlas Shrugged, served in part to lay the foundations of her philosophical system. From the 1950s until her death in 1982, most of her work was devoted to developing and expounding this system, known as Objectivism.
The Australian article was right to comment on the undeniable influence of Rand's works. Rand was, for example, a long-time acquaintance of US Federal Reserve Chairman Alan Greenspan and, in an Australian context, knew Malcolm Fraser while he was in office. According to the Ayn Rand Institute, all of Rand's books are still in print and sales have exceeded an astonishing 20 million copies globally.
So what, then, are the tenets of Objectivism which Rand sought to impart in her writings? As with any philosophical system, it is difficult to do justice in so short a space. However, when asked the question, Rand once summarised her answer as follows:
1. Metaphysics: Objective Reality
2. Epistemology: Reason
3. Ethics: Self-interest
4. Politics: Capitalism
Ayn Rand taught that, in a purely material world, man could only derive knowledge from proper use of his reason and this would, therefore, rightly lead him to base his behaviour solely on self-interest. In an existence devoid of any concept of faith or revelation, Rand's man becomes the ultimate egoist, who shrugs off altruism and self-sacrifice and turns to capitalism to fill the moral void.
According to Rand, a purely "rational" man, with no other guiding moral framework, would naturally turn to capitalism (as opposed to, say, anarchism, for which the author believes a much stronger apologia could be made in such a scenario).
The ramifications of Rand's support for blinkered and extreme individualism were apparent when she outlined some of her beliefs to Playboy magazine in 1964:
"[To] place such things as friendship and family ties above ... productive work, yes, [that is] immoral. Friendship, family life and human relationships are not primary in a man's life. A man who places others first, above his own creative work, is an emotional parasite ...
"Love is not self-sacrifice, but the most profound assertion of your own needs and values ...
"...it is in the name of that symbol [the Cross] that men are asked to sacrifice themselves for their inferiors. That is precisely how the symbolism is used. That is torture."
Faith and God are, to a good Objectivist, the very "negation of Reason".
Rand was vocal in her support for abortion but, curiously, was personally (and, hence, "irrationally"?) opposed to homosexuality, which she condemned as "immoral" and "disgusting".
Rand also believed that compulsory taxation could be replaced by voluntary payments (as no-one should be coerced to support the common good) and that the role of the government should be reduced to mere enforcement of law and order through the police, courts and armed forces.
Every other conceivable good or service, even public roads, should be privately owned. Aside from the pleasant notion of the abolition of taxation, it takes no stretch of the imagination to see how far Rand's ideas have permeated society and borne fruit.
G.K. Chesterton is often credited for saying that "When a man ceases to believe in God, he does not believe in nothing; he believes in anything". In the case of Objectivism, abandoning all sense of service or a "higher purpose" points to an egotistical, selfish existence with little regard for the welfare of others. But unlike Voltaire, who once observed that "If God did not exist, it would be necessary to invent him", Rand conceived of a stand-alone moral order based on the worship of reason and the dollar.
Is it any wonder that Rand's ideas continue to appeal in a moral vacuum?
Damian Wyld


New data shows a growing group of gun owners emerging in Cook, County Chicago: Black women.
The number of Black women receiving a permit in Cook County has grown every year since 2014. According to Illinois State Police, 800 Black women received a license in 2014. And currently, in 2017, nearly 1400 Black women have received a concealed carry permit. That number is already more than the last year's number. That is a record 67 percent growth from 2014 to 2017. More than 4,000 Black women have received a concealed carry license in Cook County.
But what is encouraging Black women to arm themselves? According to a Chicago Tribune report, many are "spurred by a growing concern for their safety," in neighborhoods where crime is surging, the outlet writes.
Thousands to Hold Peaceful Gun Rights Rally at Rep. Peduto's Office Amid Controversial Gun Bills.


Today I am posting a few photos from the Stroudwater Village area of Portland, which is on the western side of town, towards the Westbrook border. I happened to walk through here with my camera after attending the open house of the new Jetport terminal earlier this month. This neighborhood was settled in 1727 and has some impressive old buildings, including the Tate House Museum.
Interesting fact about the settlement date. I once heard Stroudwater was the City's oldest neighborhood (which surprised me). Surely there are older neighborhoods downtown? Or maybe just the structures themselves are older, and more intact? Or maybe I misheard altogether. Anyway, thanks again for the photos!
Thanks for the comment, Patrick! I agree that the oldest neighborhoods are probably downtown and it must be that this is the oldest intact neighborhood. Unlike the Portland peninsula, I don't think Stroudwater had any great fires or attacks from the Royal Navy.
No, you heard correctly Patrick, it is the oldest neighborhood. Mr. Tate, the museums namesake, was a strategic businessman who used that location to perfectly position himself on the rivers confluence. At the time it was a heavily used port to transport timber. Though I should insets the same disclaimer too and note that my information came from my Maine History class a few semesters back. Downtown/Commercial St. wasn't so much, then, a neighborhood as it was a business and economic hub.


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News > Nation/World
Vietnamese teen 3rd bird-flu death
Compiled from wire reports The Spokesman-Review
Hanoi, Vietnam A 16-year-old girl has died of bird flu in Vietnam, the country's third death from the virus in less than two weeks, a doctor said Monday.
The girl from Dong Thap province died Saturday at the Hospital for Tropical Diseases in Ho Chi Minh City, a hospital official said.
The girl, who earlier tested positive for the H5N1 strain of bird flu, had eaten sick chickens, doctors say.
The hospital is treating two other patients suspected of having caught bird flu and tests were being conducted.
5 firefighters missing in collapsed building
Bangkok, Thailand A six-story building caught fire and collapsed in the Thai capital Sunday, trapping five firefighters inside the wreckage, according to police.
The fire started on the fourth floor of the Union Saenthong commercial building, near Bangkok's main Hualamphong train station, according to police officials.
The fifth and sixth floors were residential quarters.
An official said that it was not known whether the firefighters believed trapped inside were dead or alive.
Israelis increasingly move to settlements
Jerusalem Jewish settlements slated for evacuation have shown marked population growth, according to figures released Sunday, and settlers said supporters are moving to these communities to bolster them before the planned withdrawal.
Today, six reserve Israeli army officers also were dismissed from command roles after they indicated they would refuse to carry out orders to evacuate Jewish settlements, defining such a move as "completely illegal."
The punishment was the military's first such move in connection with the withdrawal plan.
Israel is preparing for large-scale resistance to the evacuation of all 12 settlements in the Gaza Strip and four in the West Bank. The plan marks the first time the government is to remove veteran settlements from either area.
Top stories in Nation/World
2 officers charged in Tyre Nichols' death previously reprimanded by Memphis Police Department
California offers proposal on Colorado River crisis, disagreeing with six states …
'They don't see us as humans.' In Peru, protests over racism and neglect spill from the Andes …
Rep. George Santos vows to stop lying : 'I've learned my lesson' …
Updated: Attacks on US power grids rose to all-time high in 2022 …


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Online Games December 9, 2020 January 15, 2021
Long time fantasy/sci-fi lover who loves to write in his spare time. Crying Suns is a tactical rogue-lite game that puts you in the role of a space fleet commander as you explore a mysteriously fallen empire. The game offers an enormous amount of exploration in a procedurally generated universe that's different every time you play.
Wizardry , both originally for Apple Inc.'s Apple II home computer.
Testplay your project from the editor without having to wait for your game to slowly compile.
The possibilities with events are near endless, and don't require a single line of code.
Similarly, sequels of Ultima were made over the next 25 years for the Amiga, Apple's Mac OS, Microsoft Corporation's Windows OS, and video game consoles from Atari, Nintendo, Sega, and Sony.
To make the game more exotic, the players are thrown again and again onto the battlefield to fight. The original form of the role playing games is called the tabletop role playing game . I think serious RPGs are even less common, though games like Dark Souls and The Witcher 2 are attempting to take role-playing video games to another plane.
Ella's Top 30 Games
Games aren't inherently dumb, and I disagree with critics who say they are. I disagree that they don't qualify as art or that they can't tackle serious themes or stories. So does fantasy, for that matter, a genre I will defend to the death even as I critique it. From the multiplayer horror games first time I ever played a pen-and-paper RPG as a young boy, to yesterday when I first started playing CD Projekt Red's The Witcher 2, role-playing-games have always been my favorite.
The player will get to see unexplored lands, monsters, hidden treasures, and much more. The player is given the role of one of the gladiators who along with his companions are made to fight the beasts to amuse the Dark Lord.
Monster Hunter World (for Pc)
There are hundreds of scripted story events embedded in a dramatic story that spans six chapters. Travel to different worlds, recruit a bunch of interesting characters for your team, and develop your skills the way you see fit. The original game is a role-playing classic, and the Android port is great. Much like many other RPG themed games, Heroes of Steel RPG Elite runs on a storyline where the player is the last ray of hope of humanity and sets his journey in the post-apocalyptic medieval world of Steel. The storyline of this game involves a floating continent high in the sky, where the player plays as a character who aims to fulfill his dreams and desires.
Do you love memoirs of famous leaders, or histories of how people managed to overcome obstacles and achieve their goals? Do you love seeing the way a leader rallies a group, understanding why certain plots fail, or reading those dramatic speeches on determination and drive?
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Online Games January 12, 2021 January 15, 2021
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Upon entry to the buffet area, you will be greeted by their super friendly staff. The buffet area is your typical small buffet but let me tell you this early, the food was excellent! From the bread to the dim-sum, It was like the food had some secret ingredient that makes it super tasty. The ambiance was very appropriate for a resort setting, not too glamorous yet still elegant and sophisticated. This is perfect for those dining in their resort/beach wear – which is acceptable as long as you are not dripping wet.
I especially enjoyed the soft rolls, the fall-of-the bone beef ribs and the super tasty siomai. Literally, my mouth is still watering right now! So before my keyboard soaks in drool, here are the dishes that were served that Saturday Lunch – the theme of the food that day was Chinese.
Although complete, the buffet at Sails is not that extravagant, however, the majority of what they serve tastes really good which is a good thing since you will be able to try all the dishes that they serve. Also they have a sort of "daily theme" in the main course area of the buffet, for example that Saturday Lunch that I was able to try, they were serving Chinese Dishes in the buffet – Dimsum, Sweet and sour pork, yang chow fried rice and noodles. You must really try their siomai and breads, they were something else.
Dinner Buffet is served at the Ibiza Beach Club and is priced at P2,000 and P2,500 with overflowing house wine.
How do you make this blog look this cool!? Email me if you get the chance and share your wisdom. I'd be thankful!
If anyone get such delicious food with stay why not come again, as such resorts main aim is to offer their best and unique services that lets customer to enjoy their trip. If your desire to enjoy the Indian Traditional food try to make trip at jaipur heritage hotels as millions tourist comes here because everything enjoyed at cheap price.
The day tour is quite costly. :) thanks.


This cheese has the same shape, the same weight and its rind has the same color of the Camembert, but it's produced with ewe milk.
His pate is soft and creamy, his taste is slightly acid and get stonger has the maturation get longer.
A ewe milk "camembert"...definitely to be tasted.


MAC's has everything 1958, 1959, 1960 Ford Edsel lovers need to restore or customize their interiors ranging from replacement upholstery and seats to dash trim and window parts. Ford Edsel interiors are every bit as deserving as the body for customization, and the variety of interior parts available at MAC's makes it easy and fun to do. Customization doesn't stop at a paint job and some accents; upgrade your whole car by investing in Ford Edsel interior products and accessories to reflect your personal style.


Once owned by Beatrix Potter (yep, the legend who invented Peter Rabbit!), the 4* Lindeth Howe Country House Hotel is ideally placed next to Lake Windermere. Perfect for long romantic walks with your other half, the hotel is near to the quaint village of Bowness, as well as Kendal, Windermere and Ambleside. After a busy day of exploring the local area, treat yourself to a spa therapy before tucking into a tasty meal at the 2 AA Rosette awarded Lindeth Howe Country House Hotel Restaurant.
The Best Western Braid Hills Hotel is just a short journey from the historic city centre, so get your coats and wellies on (probably) and explore! There's so much for loved-up couples to do in the area; scale the heights of Edinburgh Castle, discover the Royal Yacht Britannia or monkey around at Edinburgh Zoo. When you get back to the hotel, relax in the hotel's bar with a refreshing drink. The on-site restaurant is the perfect destination for an indulgent Valentine's meal, complete with mouth-watering dishes and fine wines.
For a relaxing and tranquil Valentine's break, head to Chester and stay at the 4*Brook Mollington Banastre Hotel. In the day, you and your loved one can explore the historic sites of Chester Cathedral and Chester City Walls. Relax in your well-equipped room after a busy day of sightseeing before savouring a delicious meal in the Garden Room Restaurant.
Call us biased, but we think York is an ideal spot for a tranquil and interesting Valentine's short break. The Best Western Burn Hall Hotel is handily located just a few miles away from York and is surrounded by lush greenery. After exploring local sites such as the North Yorkshire Moors, the village of Easingwold and the historic city of York with its towering Minster (pictured above), be sure to visit The Garden Room for a freshly-cooked, locally-sourced meal.
Where are you thinking of exploring this Valentine's Day? Let us know by commenting below!
Check out our other Romantic Breaks here.


Flyscreens serve many purposes and there are good reasons why millions of people purchase them year after year. Flyscreens can be custom-made so they fit your door or window perfectly and they even come in a variety of designs so they are both attractive and functional. The companies that make flyscreens are continuously coming up with better and more attractive products and since most of them have well-maintained websites, it is easy to go online and view full-colour photographs of the items that are available. Of course, true to their name, flyscreens are also there to keep away flies and bugs; a product that does this and allows cool air to come into your home is truly priceless. In fact, this is one product that no one should be without because no one wants the inconvenience of having flies in his or her food, his or her walls, and his or her home.
When you're inside your home relaxing, it is much easier to do when you don't have flies swarming around in your house. A good flyscreen allows you to relax with a cool drink and feel the breeze coming in while at the same time remaining bug-free. Flyscreens also provide a little more security because people cannot see inside; therefore, they are less likely to see something that they wish to steal. The companies that provide Mandurah flyscreens and security options offer well-made, high-quality products that are sure to work right and look fantastic and they will even provide you with a free no-obligation quote before any work is done. The screens are beautiful, affordable, easy to clean, and cheap to repair and even provide a way to see outside because they won't obstruct your view when you are peeking through your front door.
When it comes to your home, you deserve high-quality items that work right and keep you comfortable while you're indoors. Companies that make flyscreens offer them in standard and custom sizes and they will install them expertly so that they fit perfectly in the end. They usually come with aluminium frames and can even come in various colours, thanks to the powder coatings that these companies offer. In addition to flies and bugs, the screens also keep out leaves, debris, and dirt. Best of all, the prices of these flyscreens are extremely reasonable, meaning that you can purchase them for your entire home without going over your budget. They can also be placed in both homes and businesses, making them a truly versatile and important product. If you're interested in purchasing flyscreens, all you have to do is contact a company that makes them for additional information and when you finally have them in your home, you'll understand why they are now so popular.


30 Inch White Bathroom Vanity Cabinet - There are various styles nowadays of vanities which can be utilized in the bathrooms. Whereas there are several that do not even look like cupboards, some vanities merely look like closets with a sink. The vanities including the contemporary bathroom vanities have cupboards that help to keep many items. You must check out a dressing table as a place where you are able to scrub your hands and also keep towels and some toiletries.
You are able try and look at the Net for a few real great layouts when looking for a bedroom or bathroom vanities. For those who have decided for online shopping online, ensure the store is reputed and has a great experience that. In the majority of online stores, you will find that best in display on the web pages.
You will need to get a dressing table that is perfect, should you would like to make a great impression in the bathroom. The positioning of the dressing table is critical. The bathroom dressing table needs to be held in a mode that will not obstruct any motion. Most people choose to maintain the vanities attached to the walls of the bathroom. Hence, these days, you will also find vanities were mounted by the wall. The wall mounted vanities are smaller in size compared with all another regular bathroom vanities.
The very first thing that you will need to think of is the repair when you purchase the wall mounted bathroom dressing table. You will need a specialist plumber or mason to repair the wall mounted dressing table. You're able to test it yourself in case you have advisable of the repair process. You will also must inspect the water exits as well as the water connections when repairing the wall mounted bathroom dressing table. So, it's best advised to call a specialist plumber who'll do a superb job in repair the wall mounted bathroom vanity.
Related Post "30 Inch White Bathroom Vanity Cabinet"


Do you have little ones eagerly anticipating starting school? If so, this is a perfect gift especially as it has 'lift the flaps' which we all know are always such a delight!
Very simple text, a sweet board book format and gorgeously vibrant and extremely cute illustrations, this will surely be a winner with any little people from around 3 to 5 years.
Find out what the children are playing, how they get to school, where they go on a school trip and what they do in their classroom.
Others in this series include: Dinosaurs, Space and Garden.
This will be perfect for our Early Childhood centre as our little people countdown till starting Prep in 2017!
Highly recommended for small humans – pop it into a Santa sack for your favourite teeny!!


In April, 1861, Father William Lette was named Pastor of St Thomas Church in Winona and also was in charge of all Catholics in Winona County. During the years of his pastorate which ended in 1868, plans were made for the erection of a Church at Hart, Minnesota. In the Year 1868, the Right Reverend Thomas L Grace, Bishop of Minnesota, Purchased 10 acres of land in Hart Township of Winona County for $100.00 from Mathias Maraz for Ss' Peter and Paul Church and Cemetery. Permanent Care funds were established in 1960 at the request of Bishop Edward A Fitzgerald of Winona Diocese.


Matthew Milone, Esq., Director of Federal Operations at CDS.
With the Federal government looking to accelerate the adoption of secure cloud solutions for Federal agencies, Cloud Service Providers (CSPs) are attempting to achieve FedRAMP certification. FedRAMP is a government-wide program that provides a standardized approach to security assessment, authorization, and continuous monitoring for cloud-based products and services. As a result of the rigorous certification process, fewer than 80 Cloud-Service Providers have earned FedRAMP approval. These companies represent some of the largest, cloud-based enterprise solutions, including Microsoft, IBM, Amazon Web Services, and Salesforce. However, FedRAMP certification is achievable by mid-sized companies as well. CDS is now the first and only CSP solely dedicated to end–to-end eDiscovery to have earned FedRAMP certification. This means CDS is authorized to handle sensitive data for government agencies in our cloud-based environment.
FedRAMP is a mandatory program for any cloud service provider that hosts data for government agencies. It is the result of close collaboration between cybersecurity and cloud experts from GSA, NIST, DHS, DOD, NSA, OMB, the Federal CIO Council and its working groups alongside experts from private industry. Authorization by FedRAMP requires the assessed cloud service provider to go through a demanding three-step process including security assessment, leveraging, and authorization with ongoing assessment and authorization required to maintain FedRAMP status.
For CDS, the process began three years ago when it was awarded a contract to provide an end-to-end eDiscovery solution for the Pension Benefits Guaranty Corporation (PBGC). As the "Federal agency customer," PBGC was required to deploy a cloud solution and was responsible for ensuring FISMA compliance. PBGC became CDS's sponsor agency and we worked closely with its Information System Security Officer (ISSO), Information System Owner (SO), and the Chief Information Security Officer (CISO) / Information System Security Manager (ISSM) on all matters, technical and otherwise, to ensure a secure FedRAMP cloud environment that could withstand the rigorous demands of continuous monitoring.
On our end, CDS engaged auditing firm Schellman and Company as a Third-Party Assessor (3PAO) to validate and attest to the quality and compliance of our security package. We worked with the cyber risk management firm Coalfire to assist us in generating security documentation as well as to act as a soundboard for questions during this intense process. Schellman conducts CDS's continuous monitoring through comprehensive annual audits. This ensures that CDS is complying with both internal policies and procedures as well as critical FedRAMP controls.
PBGC reviewed our security package internally with its security personnel, stakeholders, and General Counsel and granted CDS an Authorization to Operate (ATO). The package was then submitted to and reviewed by the Joint Authorization Board (JAB).
Getting a sponsor agency. Agencies want to work with CSPs who are willing to be flexible and create custom solutions based on their needs. In CDS's case, we already had an infrastructure in place and experience providing full customized end-to-end eDiscovery in a cloud-computing environment.
Finding the right security consultants. Before we engaged Schellman and Company and Coalfire, we worked with other consultants who did not have the appropriate experience dealing specifically with FedRAMP and its intricacies. When looking for the right consultant(s), you want to look for someone skilled in creating FedRAMP specific documentation and a company that is familiar with all critical FedRAMP controls.
Continuous monitoring and security. Now that we have been granted our FedRAMP Agency ATO Certification, CDS enters "Continuous Monitoring." Continuous Monitoring ensures that Cloud Service Provider (CSP) reporting provides a consistent level of quality government-wide. Along with our internal security team (we already maintain highly secure ISO 27001 certified hosting and SOC 2 Type 2 audited data centers) and through the help of our 3PAO, continuous monitoring ensures FedRAMP security is maintained and monitored.
Since FedRAMP was new for PBGC, the certification process was a learning experience for its team as well. This provided a great opportunity to work hand in hand with our sponsoring agency in crafting a package that was not only secure but also acceptable for all stakeholders. As more agencies fund projects to move into cloud compliance, best practices can be shared. In the meantime, CSPs should be prepared to address the sponsor agency's internal high standards combined with a highly technical and detailed certification process.
For CDS, the achievement of FedRAMP authorization is a major component of our ongoing campaign to bring commercial eDiscovery and records management best practices to the federal marketplace all while ensuring the highest levels of data security and integrity for its systems.
Listen to Matt Milone discuss eDiscovery for the US Federal Government on Federal News Radio.
Matthew Milone is a licensed attorney and is currently the head of CDS's Federal Services division. Before Joining CDS, Matt practiced law at a mid-sized defense firm before turning his attention to eDiscovery Project Management. Matt has nearly a decade of experience managing all elements of large-scale document reviews including consultation, strategy development, and workflow design. Matt holds a B.A. from The Catholic University of America, a J.D. from Quinnipiac University School of Law, and is licensed to practice law in New York.


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Energy startups across eight countries are changing the energy systems of tomorrow
Puidoux, April 24, 2017 - The Swiss smart grid company DEPsys has been selected together with 11 other innovative energy startups out of 450 companies across 51 countries to enter the global energy startup accelerator program Free Electrons. The selected startups will have the opportunity to immerse themselves in regional ecosystems delivered through three uniquely structured week-long modules in Silicon Valley, Lisbon, Dublin, and Singapore together with eight international utilities.
DEPsys is a young company with the objective of solving the energy challenges of the future. In that perspective, the selection for the Free Electrons program is an important milestone in its development. Its core strengths are a very strong team, a solid business plan and a rigorous and professional business structure. Undoubtedly, they act in a very important and promising market.
With Free Electrons, DEPsys has a unique opportunity to bring its know-how and its solutions in front of some of the biggest utilities. Together, they will shape solutions for the future of energy. The selected startups, from different energy sectors, such as grid operations, renewable energy, electric vehicles and home energy management, will engage in structured workshops and conversations with utilities where they will deep dive into challenges, technology, and pilots, as well as speed-dating activities with investors, mini-leadership retreats, and networking events. This is a great opportunity to grow internationally and gain the visibility it takes to develop into a successful global company.
"We are delighted to be part of this great adventure. After several years of dedicated work, this is where things take off. Through this program, DEPsys has the opportunity to work with eight of the most influential utilities in the world and deploy its GridEye solution in very different global environments." – Michael De Vivo, CEO of DEPsys
"We are thrilled with the final selection of companies - especially the geographic scope of the startups participating, ranging from India, Israel to Switzerland and the USA, demonstrating the global reach of the Free Electrons consortium" - Hendrik Tiesinga, Program Manager of Free Electrons
About DEPsys
DEPsys is a Swiss technology company establishing thought leadership in the energy market. With GridEye, it provides a toolset to the grid operator for a perfect knowledge and control of the low-voltage power grid. This is particularly important in presence of decentralized production from renewable energy sources, such as photovoltaic systems, and high loads, such as electric vehicles. The real-time measurement and control solution monitors and stabilizes the network. Moreover, it optimizes power flows to increase energy efficiency and it helps operators with network planning, asset management, and energy scheduling.
About Free Electrons
Free Electrons is the global energy startup accelerator program that connects the world's most promising startups with leading utility companies. Free Electrons is backed by an international alliance of utilities and accelerators: AusNet Services, Dubai Electricity and Water Authority (DEWA), ESB (Electricity Supply Board), EDP (Energias de Portugal), innogy, Origin Energy, SP Group and Tokyo Electric Power Company (TEPCO), with the support of accelerator partners, New Energy Nexus, swissnex San Francisco, Energy Excelerator, Powerhouse and Beta-i.
Marc Schreiber, Marketing & Communications DEPsys SA
marc.schreiber@depsys.ch
www.depsys.ch


To get superglue out of hair, cover the area with conditioner, and comb through it using a fine-tooth comb. If conditioner is not strong enough to remove the glue, try using rubbing alcohol. Let the alcohol sit for five minutes before combing so it has adequate time to break down the glue.
Oils including cooking oils or baby oil can also be used to get glue out of hair. Coat the affected area with oil, let it soften the glue for about 20 minutes before carefully working the glue out of the hair. Thanks to its oil content, mayonnaise is another acceptable substitute.
Mixing baking soda and a small amount of water is another appropriate method of removing glue from hair. After mixing the two ingredients into a paste-like consistency, apply the paste to the hair, and let it sit for a few minutes before brushing it out.
If oil, rubbing alcohol, baking soda and conditioner do not work, visit a hairdresser to see if she has any commercial products that can remove glue from hair. Alternatively, one can cut off the pieces of hair affected by the glue. Depending on the amount of hair affected by glue, a new haircut or style may be advised.
Is Milk Good for Your Hair?


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or Skype (if you are outside of the United States).


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Tiruchirapalli, the once fortress of Chola dynasty has retained its aura and exuberance that it used to enjoy earlier. The beautiful, massive temples dot this land, stand as icons and edifices of a prolific past. One sight of these temples is good enough to transport tourists into charismatic charm of its bygone era and experience the enchanting allure. This great travel Tiruchirappalli tourism is a fine blend of temples and monuments, industrial and manufacturing companies. If anyone planning to go tour you can visit here.
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RON'S COMMENT: Today's average is based on seven polls, ranging from 38% (ABC/WaPo, Quinnipiac) to 45% (Rasmussen). Without these extremes, it would be 43%....President Trump's disapproval rating averages 55% today, which is 13 points higher than his approval rating.
RON'S COMMENT: This is starting to get interesting. In this new poll, Biden maintains a big lead over the field with Sanders second. Harris' announcement worked for her––she's now moved up to third position, leaving former third-place finishers Warren and O'Rourke in her dust. Looks like announcements by Gillibrand, Castro and Gabbard were busts, each languish at 1% or less.
RON'S COMMENT: New Hampshire is a swing state in presidential politics. Hillary Clinton beat Trump there by only four-tenths of a point…. Trump is now losing to the three Democrats tested in this poll, two of which (Warren and Sanders) are from neighboring states…. When only Democrats in New Hampshire were asked whether Hillary Clinton, Alexandria Ocasio-Cortez or Warren best represents the Democratic Party, Warren wins with 55% and Ocasio-Cortez is second with 28%. The 2016 nominee, Hillary Clinton, is third with 17%.
RON'S COMMENT: Louisiana is a red state, but Democratic incumbent Edwards starts his re-election bid with a wide lead over his two announced GOP rivals. Abraham, a member of Congress from north Louisiana, is largely unknown outside his district. Rispone, a wealthy businessman, is largely unknown statewide. Both Republicans are now aiming to get Edwards into a runoff where they hope the state's big conservative vote will wipe out the incumbent's early advantage…. Edwards has a job approval rating of 50% in this poll, which was conducted for an advocacy group supporting him…. The state's top issues: Economy and jobs 37%, education 35%, crime and criminal justice 28%; health care 20%, taxes 18%, traffic and transportation 12%, state budget and spending 11%; coastal restoration 8% and voting rights 2%.
FEDERAL GOVERNMENT: ANGRY OR ENTHUSIASTIC?
I am going to mention four phrases and ask you which one best describes how you feel about the way the federal government works. Do you feel enthusiastic, satisfied but not enthusiastic, dissatisfied but not angry, or angry?
RON'S COMMENT: 21% of Republicans, 39% of Democrats and 29% of independents say they're angry.
How much interest do you have in this year's Super Bowl game––a lot, a little, or none at all?
RON'S COMMENT: The percentage of Americans with "a lot" of interest in the Super Bowl is down 5 points from last year, sliding from 21% to 16%––meaning that nearly a quarter of those with a lot of interest last year no longer feel it. Those with no interest at all has risen by 5 points, from 45% last year to 50% this year.


Walker Elementary School, in the Canton Local School District, is undergoing projects to upgrade its self-contained sewage-treatment plant and water-delivery system.
The Canton Local Board of Education is in the midst of two infrastructure projects to upgrade sewage and water service for Walker Elementary School.
One project involves installing new components to the school's self-contained sewage-treatment system. Stanley Miller Construction has that contract, which totals about $221,900.
The other project is the installation of a new water well and water-treatment components. The well-drilling portion was handled by Ohio Drilling Co. and Jenei Drilling. This project will cost about $97,000.
"We would like to have them both finished by the time school starts," said Tim Ewing, Canton Local's director of buildings, grounds and transportation.
Walker Elementary at 3525 Sandy Ave. SE is not served by any municipal water or sanitary sewer service.
The sewage-treatment project is an overhaul of the school's system.


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New Vatican document outlines city-state's environmental efforts
226-page report includes suggestions for Catholic institutions, including divestment
by Joshua J. McElwee
Vatican City — The Vatican's various departments June 18 reaffirmed their commitment to the ecological path outlined in Pope Francis' 2015 encyclical Laudato Si', releasing an unusual inter-office document outlining some of the environmental measures taken by the city-state in the last five years.
The 226-page text, titled "On the journey for care of the common home" and released only in Italian, largely restates the major points of the pontiff's encyclical. It also proposes general actions that local dioceses and parishes can take to protect the environment.
The final pages of the document refer to actions the Vatican itself has taken, many of which have already been made public. Among those: installing systems to reuse the water in the city-state's numerous fountains, shifting to more ecological fertilizers in its gardens, and changing the lighting systems for the Sistine Chapel and the outside of St. Peter's Basilica.
On the last point, the Vatican officials say they are now saving up to 80 percent of the previous costs on lighting.
Archbishop Paul Gallagher, the Vatican's foreign minister, said at a briefing presenting the document that the city-state's departments wanted to "reintroduce the richness" of the teachings presented in the papal encyclical.
Gallagher, whose formal title is the Secretary for Relations with States at the Secretariat of State, said the coronavirus pandemic had made clear that the world must make "concrete and urgent decisions" to address issues of climate change and environmental destruction.
The briefing presenting the new text was the Vatican's first in-person press conference since before Italy went into lockdown to prevent the transmission of the coronavirus on March 9. About 40 journalists were allowed into the Vatican briefing room, which normally seats hundreds, and social distancing rules were firmly enforced.
Journalists had to wear masks, have their temperature checked upon entry, and maintain at least three feet of distance between one another. Vatican officials also made note of who entered the press office, in case contact tracing should become necessary at a future point.
Gallagher was asked during the briefing about President Donald Trump's decision to withdraw the U.S. from the Paris Agreement, the landmark 2016 global treaty to mitigate global warming.
The archbishop called the push to protect the environment "an irresistible world movement -- -- a social movement, a movement of faith, a movement of human commitment."
"I think humanity will not be blown off course," said the prelate.
Among the Vatican offices contributing to the new document were the Congregation for the Doctrine of the Faith; the Dicastery for Laity, Family and Life; the Dicastery for the Promotion of Integral Human Development; and the Pontifical Councils for the Promotion of Christian Unity, for Culture, and for the Promotion of the New Evangelization.
Also contributing were Caritas Internationalis and the Global Catholic Climate Movement. The latter organization highlighted the new text's suggestion that Catholic institutions might divest from the fossil fuel industry, saying in a press release that it was the first such call from the Vatican.
[Joshua J. McElwee is NCR Vatican correspondent. His email address is jmcelwee@ncronline.org. Follow him on Twitter: @joshjmac.]
"On the journey for care of the common home" (In Italian)
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ROACH RM. Treating male retention patients with temporary prostatic stent in a large urology group practice. Can J Urol 2017;24(2):8776-8781.
Men with either chronic or temporary urinary retention symptoms are common patients treated in a urology practice. Both indwelling and intermittent catheterization are widely used to treat this condition. These approaches are associated with significant complications including infection and reduced quality-of-life. Infection is a target for quality improvement and cost reduction strategies in most care settings today.
We use a temporary prostatic stent (TPS) to address these issues in our practice. In this report, we describe our approach to patient selection, sizing, placement and follow up of 214 TPS placed in 56 men with chronic or temporary urinary retention in an office setting.
With the first stent placement, average indwelling time was 27 days. Thirty-two patients had multiple stents placed. Replacement was performed routinely and was generally required because underlying comorbidities precluded surgery. In these patients, an average of six stents were placed (range 2-18) with average dwell times of 31 days. Symptomatic urinary tract infections (SUTI) occurred in only 6 of 214 TPS placements (2.8%), resulting in an incident rate of 0.93 SUTI per 1,000 TPS days.
TPS is a safe and efficacious means of alleviating symptoms of urinary retention. TPS does not share the same infection risk profile or quality-of-life drawbacks associated with urinary catheters; this makes TPS use relevant as a urinary catheter alternative or when a urinary catheter is not recommended.
Male patients have a high incidence of urinary retention symptoms that increases with age.1,2 Retention symptoms occur when bladder outlet resistance exceeds the ability of the bladder to generate adequate emptying pressure.
Our practice utilizes TPS for treating both chronic and temporary urinary retention among our male patients. This article will explain the device, the clinical use models we've developed and my experience from placing 214 TPS in 56 men.
The Spanner Temporary Prostatic Stent (SRS Medical, North Billerica, MA, USA) is a TPS that can be placed similarly to IUC in an office setting with only topical anesthesia. The TPS consists of a three-part system: Surveyor Urethral Measurement Device, Spanner Prostatic Stent and Introducer. The device is intended to de-obstruct the prostatic urethra for a period of up to 30 days, after which it is easily removed via the retrieval tether. Figure 1 shows the TPS de-obstructing the prostate without disrupting the external sphincter.
The TPS is anchored, tension-free, in two places; at the bladder neck by an inflatable balloon and distal to the external sphincter by a soft silicone tab. Tethers traverse the external sphincter to affix the distal anchor to the body of the stent. The external sphincter closes around these tethers, allowing the bladder to fill and empty naturally.
The Introducer is inserted into the body similarly to an IUC. The proper position for TPS deployment is confirmed once the TPS balloon is inflated and gentle traction applied until resistance is felt, securing the balloon at the bladder neck. With a correctly sized device, the distal anchor is automatically positioned in the bulbar urethra as traction is applied to remove the introducer. The retrieval tether is then trimmed to length. I cut the retrieval tether short of the meatus so that there are no external components of the device. This reduces the risk of infection and eliminates the possibility that the tether is inadvertently pulled by the patient.
A typical medication protocol in my practice consists of antibiotics (usually ciprofloxacin 500 mg) administered at time of insertion of the TPS. Over-the-counter AZO is also used to alleviate transient dysuria and urgency symptoms caused by lower bladder outlet resistance.
To remove the TPS, I access the retrieval tether manually with graspers. The retrieval tether terminates in a small plug at the base of the balloon in the bladder neck. Traction on the tether deflates the balloon and allows withdrawal of the TPS.
The Spanner is available in 6 device lengths (4 cm-9 cm) to accommodate different prostate lengths. Determining the correct stent size is key to device operation and patient comfort. Device size is measured from anchor to anchor, and corresponds anatomically to the distance between the bladder neck to the distal side of the external sphincter, Figure 2.
There are two ways to determine the optimal TPS size for a patient: a) the size can be calculated from a transrectal ultrasound (TRUS) measurement, or b) the size can be directly measured using a measurement device that is provided with the TPS (The Surveyor Urethral Measurement Device).
If a TRUS measurement is used, the TPS size can be calculated by taking the length from the bladder neck to the apex of the prostate in centimeters, adding 2 cms to the measurement, and then rounding up to the next cm. For example, if the prostate length is measured at 4.3 cm, 2 cm should be added to derive a device length to 6.3 cm. The TPS size would then be rounded up to a size 7.
If a direct measurement is made using the Surveyor Urethral Measurement Device, the device is introduced into the urethra and its balloon is inflated in the bladder and seated at the bladder neck. When the Surveyor is positioned in the urethra, the probe is gently advanced to detect resistance changes that indicate the location of the external sphincter. When the probe is positioned at the external sphincter, the length of the wire extending beyond the Surveyor hand piece represents the distance from the bladder neck to the distal side of the external sphincter, Figure 3.
I prefer to determine TPS size using the Surveyor Urethral Measurement Device. This technique directly accounts for balloon location at the bladder neck and length of the external sphincter. Patients who receive more than one TPS typically only need to be measured once (before initial placement). Subsequent TPS are placed without measurement.
We employ TPS for treating patients presenting with both chronic and temporary retention symptoms due to multiple underlying clinical conditions, Table 1.
Patients with gross hematuria or urinalysis consistent with infection or colonization are not considered good candidates for TPS. Similarly, those with known severe bladder dysfunction or incompetent sphincters are generally not offered this treatment option.
I placed 214 TPS in 56 patients from January 2015 to December 2016. Patient ages ranged from 65 to 96 years, with mean age of 78 years. Prior to TPS placement, 39 patients reported the use of a catheter within the previous 2 weeks (31 IUC, 7 CIC). Thirteen patients reported a history of urinary tract infections. Fifteen of the 56 men subsequently underwent a deobstructing BPH procedure.
TPS were placed in an office setting, and patients were asked to perform a trial-of-void (TOV) after insertion. Cystoscopy and PVR were performed only during the first TPS sizing and placement. Cystoscopy was performed prior to TPS placement and PVR data was captured after the post-placement TOV. Because no PVR data was recorded for subsequent TPS we will describe the data from first and subsequent placements separately.
Table 2: TPS SUTI results by cohort.
The 56 patients with first TPS placements had an average indwell period of 27 days (range 7-84). Pre-TPS PVRs were recorded for 25 patients. Men presenting with IUC had no fluid in the bladder at the time of TPS placement and therefore PVR could not be determined. PVR in the 25 men showed an 81% decrease from pre-TPS placement (p < 0.0001), Figure 4. One additional patient had a pre-placement PVR of 995 mL was unable to generate a void after TPS placement. This patient was thought to have an atonic bladder, and was therefore eliminated from the PVR analysis.
Symptomatic urinary tract infection (SUTI) was observed in two patients receiving their first TPS, representing 3.5% of the patient cohort. One of the two infected patients reported a history of infection prior to his first TPS placement.
Thirty-two patients received more than one TPS (average 6/patient, range 2-18) and averaged 31 stent indwell days per subsequent TPS placed. I routinely replace the TPS in the office at 30 days. The rationale for continued TPS use was most commonly related to underlying comorbidities and high risk for more definitive procedures.
Among subsequent TPS placements, SUTI was noted in 4 placements, representing 2.5% of the subsequent 158 TPS placed. The TPS showed a symptomatic infection rate of 0.68 infection per 1,000 indwell days. Combined, first TPS and subsequent TPS SUTI totaled 6, representing 2.8% of all TPS placed. As shown in Table 2, the SUTI incidence rate was 0.93 per 1,000 TPS days for the entire experience. This is in contrast to an estimated CAUTI incidence rate of between 3.1 and 7.5 per 1,000 catheter days in the US.9 We did not observe any negative cumulative effects in patients receiving more than one TPS.
Our experience demonstrates a low infection rate. These data support that, if used more widely across urology offices and other care settings, TPS may be an important element in reducing complications associated with CAUTI and catalyzing reductions in prevalence, direct cost, penalties and hospital length-of-stay. While not investigated in our review, these findings may be due to an absence of external components, the natural barrier created by the closed external sphincter, and/or the benefits of allowing the bladder to fill and flush regularly.
TPS also has a profound impact on the patient's quality-of-life, medical condition and overall health. Being able to preserve or regain normal voiding function is often life changing for men, particularly those who require use of TPS for extended periods. Though quality-of-life measures were not investigated in this review, my experience has been that men with TPS cite natural urination, increased mobility and restored sexual function high on quality-of-life benefits. When asked informally, my patients are very satisfied with the lifestyle changes and improvements they obtain from TPS.
Finally, patients without sufficient bladder or external sphincter function will fail to benefit from the advantages of TPS. Patient selection, sizing and proper placement technique are also important to maximizing the clinical experience.
TPS has proven a safe and efficacious means of alleviating symptoms of urinary retention across a wide spectrum of patient conditions. This is primarily because TPS does not share the same infection risk profile or quality-of-life drawbacks associated with indwelling or intermittent urinary catheters. This makes TPS use relevant both as an alternative to urinary catheters, and at times when a urinary catheter would not be recommended.
For chronic retention populations, it is a pragmatic tool for confirming detrusor function in patients transitioning to procedures, and it greatly improves the lives of patients that cannot proceed to surgery due to risk. For temporary retention, TPS is an effective tool for managing procedure-related prostatic edema, also having the ability to help reduce postoperative recovery risks through reduced infections and increased ambulation.
We have adopted TPS as a standard of care for management of male retention patients in our practice. The device is easily placed in the office, tolerated well by patients and drives improvement in several clinical parameters with few complications.
Figure 1. Sagittal plane of the male urinary tract with temporary prostatic stent (TPS) in place. A small silicone stent holds open the prostatic urethra, allowing urine to flow from the bladder, through the prostate, and beyond the external sphincter. Courtesy of SRS Medical.
Figure 2. A demonstration of temporary prostatic stent (TPS) size. Courtesy of SRS Medical.
Figure 3. Temporary prostatic stent (TPS) direct sizing. Courtesy of SRS Medical.
Figure 4. Patient post-void residual.
1.	Gravas S, Bachmann A, Descazeaud A et al. Guidelines on the management of non-neurogenic male lower urinary tract symptoms (LUTS), incl. benign prostatic obstruction (BPO). 2016; http://uroweb.org/wp-content/uploads/EAU-Guidelines-Management-of-non-neurogenic-male-LUTS-2016.pdf.
2.	Oelke M, Bachmann A, Descazeaud A et al. EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 2013;64(1):118-140.
3.	Locke J, Ellis W, Wallner K, Cavanagh W, Blasko J. Risk factors for acute urinary retention requiring temporary intermittent catheterization after prostate brachytherapy: a prospective study. Int J Radiat Oncol Biol Phys 2002;52(3):712-719.
4.	Baldini G, Bagry H, Aprikian A, Carli F. Postoperative urinary retention: anesthetic and perioperative considerations. Anesthesiology 2009;110(5):1139-1157.
5.	Saint S. Clinical and economic consequences of nosocomial catheter-related bacteriuria. Am J Infect Control 2000;28(1):68-75.
6.	Umscheid CA, Mitchell MD, Doshi JA, Agarwal R, Williams K, Brennan PJ. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol 2011;32(2):101-114.
7.	Centers for Medicare & Medicaid Services. Value Based Programs. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/Value-Based-Programs.html, 2017.
8.	Centers for Medicare & Medicaid Services. Fiscal Year (FY) 2016 Results for the CMS Hospital-Acquired Conditions (HAC) Reduction Program. https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-12-10-2.html, 2017.
9.	Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA, Healthcare Infection Control Practices Advisory C. Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol 2010;31(4):319-326.
10.	Henderson A, Laing RW, Langley SE. A Spanner in the works: the use of a new temporary urethral stent to relieve bladder outflow obstruction after prostate brachytherapy. Brachytherapy 2002;1(4):211-218.
11.	Corica AP, Larson BT, Sagaz A, Corica AG, Larson TR. A novel temporary prostatic stent for the relief of prostatic urethral obstruction. BJU Int 2004;93(3):346-348.
12.	Grimsley SJ, Khan MH, Lennox E, Paterson PH. Experience with the spanner prostatic stent in patients unfit for surgery: an observational study. J Endourol 2007;21(9):1093-1096.
13.	Shore ND, Dineen MK, Saslawsky MJ, Lumerman JH, Corica AP.
A temporary intraurethral prostatic stent relieves prostatic obstruction following transurethral microwave thermotherapy. J Urol 2007;177(3):1040-1046.
14.	Dineen MK, Shore ND, Lumerman JH, Saslawsky MJ, Corica AP. Use of a temporary prostatic stent after transurethral microwave thermotherapy reduced voiding symptoms and bother without exacerbating irritative symptoms. Urology 2008;71(5):873-877.
15.	Abdul-Muhsin HM, Jakob NJ, McLemore RM, McAdams SB, Humphreys MR. Infectious complications associated with the use of temporary prostatic urethral stents in patients with benign prostatic hyperplasia. Can J Urol 2016;23(5):8465-8470.


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