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Drugs & Diseases > Clinical Procedures
Author: Bryan A Whitson, MD, PhD; Chief Editor: Mary C Mancini, MD, PhD, MMM more...
Sections Lung Transplantation
Surgical Therapy
Preoperative Details
Intraoperative Details
Postoperative Details
Guidelines Summary
Disease-specific Candidate Selection
Antibody-mediated Rejection of the Lung
Lung transplantation is an accepted modality of treatment for advanced stage lung disease. Since 1988, over 46,000 lung transplants and over 1400 heart/lung transplantations have been performed in the Unites States, representing approximately 5% of all organ transplants. [1]
The Agency for Healthcare Research and Quality (AHRQ) in the United States concluded that "lung transplantation has evolved as a clinical procedure achieving a favorable risk-benefit ratio and acceptable 1- and 2-year survival rates." [2] The International Society for Heart and Lung Transplantation continues to monitor lung transplantation and has an ongoing registry, which is reported annually. [3]
Highly sophisticated and extraordinary therapies, such as lung transplantation, are performed at a great cost to society. Presently, active research is being conducted on enhancing the patient's quality of life following lung transplantation. Several studies have reported a significant improvement in different quality-of-life domains, tested pretransplant and posttransplant. Other studies comparing candidates and lung transplant recipients have demonstrated significant improvements in energy levels, physical functioning, mobility, and symptoms such as dyspnea and anxiety. The recipients have expressed greater satisfaction with their lives and their health following lung transplantation.
Attempts to compute the costs of lung transplantation to general society and to determine the cost effectiveness of this therapy have been made. Cost evaluations should take into account both the actual cost and the improved quality of life provided by this therapy compared to standard care. The cost is expressed in units of QALY (quality-adjusted life-year), which reflects the real or anticipated survival time and health-related quality of life.
In 1995, the University of Washington Medical Center estimated that lung transplantation costs $176,817 per QALY compared with traditional therapy. [4] A study of 3000 Medicare patients who received lung transplantations between 2005-2011 found that the average cost of lung transplantation was $135,622. However, high-volume transplant centers (35 or more lung transplantations annually) had a mean transplantation cost of $131,352. In addition, median length of stay in the intensive care unit fell significantly with increasing lung transplantation volume, from 14 days in low-volume centers to 11 days in intermediate centers and 10 days in high-volume centers. [5]
Additionally, after adjusting for recipient health risk, low-volume centers had an 11.66% greater transplant admission cost (P = 0.040), a 41% greater risk for in-hospital mortality (P = 0.015), and a 14% greater risk for early hospital readmission (P = 0.033) compared with high-volume centers. There was no significant difference in transplant cost, in-hospital mortality, or early hospital readmission between intermediate- and high-volume centers. [5]
Living donor transplantation
Transplantation of lobes from living donors involves bilateral implantation of the lower lobes from two blood group–compatible living donors. Donation of a lobe decreases the donor's lung volume by an average of approximately 15% and, consequently, is not associated with long-term functional limitation.
Living-donor lobar lung transplantation (LDLLT) has been used as an option for patients who are considered too ill to await cadaveric transplantation. [6] The procedure was initially performed in patients with cystic fibrosis, although the indications were subsequently broadened. The functional and survival outcomes with LDLLT are similar to those achieved with conventional transplantation of cadaveric lungs.
There have been a total of 253 LDLLT in the United States since 1990; however, no LDLLT has been performed in the US since 2013. [1]
Despite fairly extensive experience, no donor mortality has been reported. In a study of 369 live lung donors serious complications occurred in 18% of donors; 2.2% underwent reoperation and 6.5% had an early rehospitalization. No deaths occurred and no donors underwent lung transplantation during 4000+ person-years of follow-up (death: minimum 4, maximum 17 years; transplant: minimum 5, maximum 19). Live lung donation remains a potential option for recipients when using deceased donor lungs lacks feasibility. However, in the United States the use of two live donors for each recipient and the risk of morbidity associated with live lung donation do not justify this approach when deceased lung donors remain available. [7]
In recent years, most of the reports on LDLLT have been from Japan, where the average waiting time for a cadaveric lung is exceeding 800 days. LDLLT has been performed both for adult and pediatric patients suffering from various end-stage lung diseases including restrictive, obstructive, vascular, and infectious conditions. [8]
Compared with bilateral cadaveric lung transplants, long-term studies have shown that the relatively smaller-sized lobes can provide similar pulmonary function and exercise capacity. Living lobar lung transplantation should be considered in a patient with a clinically deteriorating condition. Although no deaths have been reported in the donor cohort, a risk of death between 0.5% and 1% should be quoted, pending further data. A case series of 128 living lobar lung transplantations performed in 123 patients between 1993 and 2003 was published. [9] The actuarial survival among the living lobar recipients was 70%, 54%, and 45%, at 1, 3, and 5 years, respectively. [9]
For patient education information, see Lung Disease and Respiratory Health Center, as well as Heart and Lung Transplant and Bronchoscopy.
Animal experimentation by various pioneers, including Demikhov and Metras, in 1940s and 1950s demonstrated that the procedure is feasible technically. [10] Hardy performed the first human lung transplantation in 1963. The donation was essentially after cardiac death, and the recipient of the left lung transplant survived only 18 days. [11] From 1963-1978, multiple attempts at lung transplantation failed because of rejection and problems with anastomotic bronchial and tracheal healing.
In the 1980s, the introduction of cyclosporine, a powerful immunosuppressant, generated renewed interest in the area of organ transplantation, including lung transplantation. Alternative techniques for improving bronchial healing were devised. These techniques included refining the bronchial–pulmonary collateral circulation by limiting the length of the donor bronchus and revascularizing the bronchial circulation extrinsically by wrapping the anastomosis with omentum or a pericardial patch in early years.
The first successful single lung transplant was reported by Dr. Joel Cooper at the University of Toronto in 1986. [12] In 1988, Dr. Alexander Patterson described the technique of en bloc double-lung transplantation. [13] This particular en bloc technique was associated with tracheal anastomotic complications as a result of poor vascularity; as a result, bilateral sequential single-lung transplantation has become the standard of care for patients requiring bilateral lung replacement.
Dr. Denton Cooley and associates were the first to attempt heart-lung transplantation in 1968, when they performed a transplant in a 2-year-old girl with an atrioventricular canal defect and pulmonary hypertension; the patient died 14 hours postoperatively. [14] Canine studies were ongoing during the subsequent years, but it was not until the late 1970s that Reitz and colleagues at Stanford, using cyclosporine, achieved clinically acceptable results in primates. [15] In 1981, the first successful heart-lung transplant was performed at Stanford in a 45-year-old woman who went on to do well for more than 5 years after the procedure. [15]
Causes of respiratory failure in patients with advanced-stage pulmonary disease are as follows:
Restrictive lung diseases (eg, idiopathic pulmonary fibrosis (IPD), cystic fibrosis (CF), alpha1-antitrypsin disease, primary pulmonary hypertension)
Various less common causes
Patients should be considered for lung transplantation when they meet the following criteria:
Life expectancy is not predicted to exceed 24-36 months despite optimal and maximal medical management
Class III or IV New York Heart Association (NYHA) symptoms
Stable nutritional status
Motivated for rehabilitation
Have an intact psychological support system
In 2014, the International Society for Heart and Lung Transplantation (ISHLT) released an updated consensus opinion regarding the appropriate timing of referral and listing of candidates for lung transplantation. The statement concluded that lung transplantation should be considered for adults with chronic, end-stage lung disease who meet all the following general criteria [16] :
High (> 50%) risk of death from lung disease within 2 years if lung transplantation is not performed
High (> 80%) likelihood of surviving at least 90 days after lung transplantation
High (> 80%) likelihood of 5-year post-transplant survival from a general medical perspective provided that graft function remains adequate
Preoperative evaluation of specific diseases
The appropriate timing for referral to a transplant program and placement on the transplantation waiting list is based on the patient's functional status and life expectancy. Criteria for referral and listing vary with the specific underlying pulmonary diseases.
The chance of surviving the waiting period depends on the underlying disease and the system for allocation of donor organs. Waiting times are variable and based on many factors, such as height and blood group.
Chronic obstructive pulmonary disease (COPD) is the most common indication for which lung transplantation is performed. The BODE index can be used to assess the need for transplantation in patients with COPD. It consists of the following [17] :
B - Body mass index
O - Degree of airflow obstruction
D - Degree of dyspnea, as measured by the modified Medical Research Council dyspnea scale
E - Exercise capacity (E), which is measured with a 6-minute walk test
The ISHLT criteria for timing of referral for lung transplantation in patients with COPD are as follows [16] :
Disease is progressive, despite treatment including medication, pulmonary rehabilitation, and oxygen therapy.
Patient is not a candidate for endoscopic or surgical lung volume reduction surgery (LVRS); simultaneous referral of patients with COPD for both lung transplant and LVRS evaluation is appropriate.
BODE index > 5
Partial pressure of carbon dioxide (PaCO2 > 50 mm Hg and/or partial pressure of oxygen (PaO2) < 60 mm Hg
FEV1 < 25% predicted.
The ISHLT recommends listing COPD patients for transplantation when they meet one or more of the following criteria:
BODE index ≥7
Forced expiratory volume in 1 second (FEV 1) < 15% to 20% of predicted
Three or more severe exacerbations during the preceding year.
One severe exacerbation with acute hypercapnic respiratory failure.
Moderate to severe pulmonary hypertension.
Studies of whether lung volume reduction surgery (LVRS) for COPD affects the outcome of subsequent lung transplantation have yielded conflicting results. A review of the United Network for Organ Sharing database found a significantly increased risk of graft failure in patients with COPD who undergo LVRS before lung transplantation. [18] In contrast, a study from Switzerland concluded that previous LVRS does not negatively affect short-term and long-term outcomes of lung transplantation. [19]
Interstitial lung diseases
The natural history of various interstitial diseases is quite variable. Idiopathic pulmonary fibrosis, of the usual interstitial variant, which is the second most frequent disease for which lung transplantation is performed, has a median survival of approximately 2.5 to 3.5 years from the time of diagnosis. Dismal survival rates of these patients on waiting lists indicate that these patients should have early referrals for transplantation evaluation.
ISHLT criteria for timing of referral in patients with interstitial lung disease are as follows [16] :
Evidence of usual interstitial pneumonitis or fibrosing nonspecific interstitial pneumonitis, regardless of lung function
Forced vital capacity (FVC) < 80% predicted or diffusing capacity of lung for carbon monoxide (DLCO) < 40% predicted
Any dyspnea or functional limitation attributable to lung disease
Any oxygen requirement, even if only during exertion
For inflammatory interstitial lung disease (ILD), failure to improve dyspnea, oxygen requirement, and/or lung function after a clinically indicated trial of medical therapy
ISHLT criteria for timing of listing for transplantation in patients with interstitial lung disease are as follows [16] :
Decline in FVC ≥10% during 6 months of follow-up
Decline in DLCO ≥15% during 6 months of follow-up
Desaturation to < 88% or distance < 250 m on 6-minute-walk test or > 50 m decline in 6-minute-walk distance over a 6-month period
Pulmonary hypertension on right heart catheterization or 2-dimensional echocardiography
Hospitalization because of respiratory decline, pneumothorax, or acute exacerbation
Cystic fibrosis and bronchiectasis
Cystic fibrosis is the third most common indication for which lung transplantation is performed. These patients develop a high risk of mortality when their FEV1 decreases to 30% or less. At this level of FEV1, the mortality rate increases to 45% at 2 years. Other indicators of poor prognosis are weight loss, recurrent pneumothoraces, frequent hospitalization, and hemoptysis.
Liou and colleagues have validated a 5-year survivorship model for cystic fibrosis. This model identified the following eight characteristics, in addition to FEV1 as a percentage of predicted normal values, to accurately predict survival in patients with cystic fibrosis [20] :
Weight-for-age z- score
Pancreatic insufficiency
Infection with Staphylococcus aureus
Infection with Burkholderia cepacia
Annual number of acute pulmonary exacerbations
The authors also have developed two worksheets, which help calculate weight-for-age z- score and 5-year predicted survival. This survivorship model has potential for use in investigating the effect of novel therapies and assignment of patients on lung transplantation waiting lists.
ISHLT criteria for timing of referral in patients with cystic fibrosis are as follows [16] :
FEV1 that has fallen to 30% or a rapidly falling FEV1 in a patient with advanced disease
A 6-minute walk distance < 400 m
Development of pulmonary hypertension in the absence of a hypoxic exacerbation (as defined by PAP > 35 mm Hg on echocardiography or mean PAP > 25 mm Hg measured by right heart catheterization)
Clinical decline
Clinical decline may be characterized by increasing frequency of exacerbations associated with any of the following:
An episode of acute respiratory failure requiring non-invasive ventilation.
Increasing antibiotic resistance and poor clinical recovery from exacerbations.
Worsening nutritional status despite supplementation.
Pneumothorax.
Life-threatening hemoptysis despite bronchial embolization.
ISHLT criteria for timing of listing for transplantation in patients with cystic fibrosis are as follows [16] :
Chronic respiratory failure, with hypoxia alone (PaO 2< 60 mm Hg) or with hypercapnia (PaCO 2 > 50 mm Hg)
Long-term non-invasive ventilation therapy
Frequent hospitalization
Rapid lung function decline
World Health Organization functional class IV
The median survival for patients with primary pulmonary hypertension is 2.8 years. The indicators of poor survival are NYHA functional class III or IV, elevated mean right atrial pressure, elevated mean pulmonary arterial pressure and decreased cardiac index, and reduced diffusion. Mean pulmonary arterial pressure greater than 85 mm Hg is associated with a median survival of less than 12 months. A response to vasodilator therapy is associated with improved survival.
Present treatment of choice for NYHA class III and IV patients with pulmonary hypertension is long-term prostacyclin therapy, especially if they fail to demonstrate vasoreactivity during formal vasodilator trial. Prostacyclin has demonstrated improved survival, improved exercise capacity, and better quality of life. [21, 22] Transplantation is indicated only if the patient cannot tolerate or fails prostacyclin therapy. In patients who have developed severe right heart failure, the right heart pressures and functions return to near normal values following lung transplantation alone.
ISHLT criteria for referral for transplantation in patients with pulmonary hypertension are as follows [16] :
NYHA functional class III or IV symptoms during escalating therapy
Rapidly progressive disease (assuming weight and rehabilitation concerns not present)
Use of parenteral targeted pulmonary arterial hypertension (PAH) therapy regardless of symptoms or NYHA Functional Class
Known or suspected pulmonary veno-occlusive disease (PVOD) or pulmonary capillary hemangiomatosis
ISHLT criteria for listing for transplantation in patients with pulmonary hypertension are as follows [16] :
NYHA functional class III or IV despite a trial of at least 3 months of combination therapy including prostanoids
Cardiac index < 2 L/min/m 2
Mean right atrial pressure >15 mm Hg
6-minute walk test < 350 m
Development of significant hemoptysis, pericardial effusion, or signs of progressive right heart failure
Since the onset of the COVID-19 pandemic, millions of people have suffered acute lung injury, in the form of COVID-related acute respiratory distress syndrome (CARDS) or post-COVID pulmonary fibrosis. Lung transplantation has been used successfully for both CARDS and post-COVID fibrosis in a limited number of patients. However, assessment of these patients for lung transplantation is challenging, for the following reasons [23] :
In patients with severe CARDS, inability to conduct proper psychosocial evaluation and pretransplantation education, marked deconditioning from critical illness, and infectious concerns regarding viral reactivation
In patients with post-COVID fibrosis, limited knowledge about the natural history of recovery after COVID-19 infection
The need to wait long enough to ensure that patients are not likely to recover from their illness, or too late, but not wait so long that the patient develops complications or severe deconditioning that precludes transplantation
King et al [23] and Schaheen et al [24] have published recommendations for the evaluation of COVID-19 patients for lung transplantation. [23]
Lung transplantation for advanced-stage lung disease is a complex therapy with significant risk of perioperative morbility and mortality. Therefore, each patient needs to be evaluated individually, considering absolute and relative contraindications.
Absolute contraindications
According to the International Society for Heart and Lung Transplantation, the absolute contraindications are as follows [16] :
Malignancy in the last 2 years, with the exception of non-melanoma localized skin cancer that has been treated appropriately (a 5-y disease-free interval is prudent)
Untreatable advanced dysfunction of another major organ system unless combined organ transplantation can be performed
Atherosclerotic disease with suspected or confirmed end-organ ischemia or dysfunction and/or coronary artery disease not amenable to revascularization
Acute medical instability such as acute sepsis, myocardial infarction, and liver failure
Uncorrectable bleeding diathesis
Chronic infection with highly virulent and/or resistant microbes that are poorly controlled pre-transplant
Active Mycobacterium tuberculosis infection
Significant chest wall or spinal deformity expected to cause severe restriction after transplantation
Class II-III obesity (body mass index ≥35.0 kg/m2)
History of repeated or prolonged episodes of non-adherence to medical therapy that are perceived to increase the risk of non-adherence after transplantation
Psychiatric conditions associated with the inability to cooperate with the medical/allied health care team and/or adhere with complex medical therapy
Absence of an adequate or reliable social support system
Severely limited functional status with poor rehabilitation potential
Substance abuse or dependence; meaningful and/or long-term participation in therapy should be required before offering lung transplantation; serial blood and urine testing can be used to verify abstinence from substances of concern
Extrapulmonary organ dysfunction
Patients with a significant heart, liver, or kidney disease are not transplant candidates. The immunosuppressive drugs are nephrotoxic, and a creatinine clearance of less than 50 mL/min is a risk factor for subsequent development of renal failure. Significant coronary artery disease predisposes a patient to myocardial infarction in the perioperative period.
A patient with severe left ventricular systolic or diastolic dysfunction is not a candidate for lung transplantation. The presence of significant liver disease, as indicated by a total bilirubin level of greater than 2 mg/dL, is associated with an unfavorable outcome following transplant.
Relative contraindications
Adults older than 75 years are unlikely to be candidates for lung transplantation in most cases. Although age by itself should not be considered a contraindication to transplant, increasing age generally is associated with comorbid conditions that are either absolute or relative contraindications.
Relative contraindications include the following [16] :
Older age
Class I obesity (BMI 30.0–34.9 kg/m 2)
Progressive or severe malnutrition
Severe, symptomatic osteoporosis
Prior chest surgery with lung resection
Infection with highly resistant or virulent bacteria, fungi, and certain strains of mycobacteria (eg, chronic extrapulmonary infection expected to worsen after transplantation)
Adults older than 75 years are unlikely to be candidates for lung transplantation in most cases. Although age by itself should not be considered a contraindication to transplant, increasing age generally is associated with comorbid conditions that are either absolute or relative contraindications. [16]
Pooled data have shown no statistical difference between patients younger than 65 years and patients older than 65 years, although a trend toward lower survival for recipients older than 65 years was present. Most centers have an age cut-off of 50 years for heart-lung transplantation, 60 years for bilateral sequential lung transplantation, and 65 years for single-lung transplantation (SLT). [10]
Lung transplantation is relatively contraindicated in patients with atherosclerotic disease who are at risk for end-organ disease after transplantation. However, some patients with coronary artery disease will be candidates for percutaneous coronary intervention or coronary artery bypass grafting (CABG) prior to transplantation or, in some instances, combined lung transplant and CABG.
Lung transplantation can be considered in patients infected with hepatitis B and/or C who are stable on appropriate therapy without significant clinical, radiologic, or biochemical signs of cirrhosis or portal hypertension. Lung transplantation in candidates with hepatitis B and/or C should be performed in centers with experienced hepatology units.
Lung transplantation can be considered in HIV-infected patients with undetectable HIV RNA who are compliant on combined antiretroviral therapy. The most suitable candidates should have no current acquired immunodeficiency syndrome (AIDS)–defining illness. Lung transplantation in HIV-positive candidates should be performed in centers with expertise in the care of HIV-positive patients.
Lung transplantation can be considered in patients infected with Burkholderia cenocepacia, Burkholderia gladioli, and multi-drug–resistant Mycobacterium abscessus if the infection is sufficiently treated preoperatively and there is a reasonable expectation for adequate control postoperatively. To be considered suitable transplant candidates, these patients should be evaluated by centers with significant experience managing these infections in the transplant setting, and patients should be made aware of the increased risk of transplant because of these infections.
Ventilator dependence
The limited data suggest that patients who are dependent on a ventilator prior to the transplant have higher mortality rates but may be candidates for lung transplantation. [25, 26] Singer et al found that ventilator dependence was associated with decreased overall survival; risk of death was highest in the first 6 months posttransplant. [27] A prolonged wait while the patient is on a mechanical ventilator may lead to various complications such as infections, cardiovascular deconditioning, and muscle atrophy, all of which further compromise the outcome of the transplant.
Psychosocial issues
Individuals who currently smoke, abuse drugs, or drink alcohol heavily are not candidates for transplantation. Patients with other psychosocial issues, such as poor compliance and psychiatric disorders that may complicate posttransplant therapy, are not considered good candidates.
Corticosteroid therapy
In the past, corticosteroid treatment was considered a contraindication to transplantation because of concerns about anastomotic dehiscence. [28] Low-dose steroid therapy (ie, < 20 mg/d) is acceptable in a transplant candidate.
In patients with cystic fibrosis, infection with B cepacia is associated with significant mortality rates because this organism is resistant to all antibiotics. Some centers do not offer transplants to patients infected with B cepacia. Also, patients who have active tuberculosis infection are not candidates for transplantation. Nontuberculous mycobacterial colonization is not a contraindication. Aspergillus fumigatus colonization of a patient with cystic fibrosis is only a relative contraindication. These patients are treated with itraconazole prior to transplant in an attempt to eradicate colonization with this fungus.
Patients who have cachexia (BMI < 16 kg/m2) likely have poor nutritional status and would have a poor outcome following transplantation. Obesity (BMI > 30) is a concern because of postoperative atelectasis and pneumonia.
Other comorbid conditions
Other medical conditions that have not resulted in end-stage organ damage should be optimally treated before transplantation. Examples include the following:
Systemic hypertension
Central venous obstruction
Although the practices of individual transplant centers may vary, patients with systemic connective tissue diseases do not necessarily have unfavorable outcomes if their disease is quiescent. These patients may be considered as transplant candidates on an individual basis.
The International Society for Heart and Lung Transplantation Registry reports a 1-year survival rate of 78% and 5-year survival rate of 51% following lung transplantation. [3] Mortality is highest in the first year, and attrition was consistent across the subsequent time periods. In the first 30 days, graft failure, non-cytomegalovirus (CMV) infections, cardiovascular complications, and technical problems account for most of the mortality. After the first year, bronchiolitis obliterans syndrome (BOS) and non-CMV infections were the predominant causes of death. By 5 years, malignancies and cardiovascular causes account for almost 17% of reported causes of death.
Overall survival according to pre-transplant diagnosis shows that after 1 year, patients with chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF) had the worst long-term survival. [3] In general, bilateral procedures have better survival in each diagnosis category, especially in patients with COPD. Survival according to pretransplant CMV serologic status was most influenced by the CMV status of the donor. Survival during the first 5 years after transplantation was significantly better among recipients of a transplant from a donor who was CMV-seronegative.
Early diffuse alveolar damage may be associated with bronchiolitis obliterans syndrome and early mortality. Late diffuse alveolar damage may increase the risk of restrictive allograft syndrome. [29]
One study compared survival in patients with and without the supranormal expiratory and normal inspiratory flow rates (SUPRA pattern). The study found improved survival in patients with the SUPRA pattern and suggests potential therapeutic approaches to improve outcomes in patients who have undergone bilateral lung and heart-lung transplant. [30]
Whether lung transplantation truly increases survival over the natural history of the underlying disease remains difficult to ascertain in the absence of randomized trials. A survival advantage has been reported for patients with cystic fibrosis and pulmonary fibrosis who have received transplants, but this advantage has not been demonstrated for patients with emphysema.
Patients are referred for transplantation at a point in the course of their disease at which death is considered likely within 2-3 years. Therefore, transplantation would be expected to confer a survival advantage. Severe dyspnea and poor quality of life can be additional considerations for lung transplantation.
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Low DE, Trulock EP, Kaiser LR. Lung transplantation of ventilator-dependent patients. The Washington University Lung Transplantation Group. Chest. 1992 Jan. 101(1):8-11. [QxMD MEDLINE Link].
Detterbeck FC, Egan TM, Mill MR. Lung transplantation after previous thoracic surgical procedures. Ann Thorac Surg. 1995 Jul. 60(1):139-43. [QxMD MEDLINE Link].
Bonser RS, Taylor R, Collett D, Thomas HL, Dark JH, Neuberger J. Effect of donor smoking on survival after lung transplantation: a cohort study of a prospective registry. Lancet. 2012 Aug 25. 380(9843):747-55. [QxMD MEDLINE Link].
Guidelines for the determination of death. Report of the medical consultants on the diagnosis of death to the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. JAMA. 1981 Nov 13. 246(19):2184-6. [QxMD MEDLINE Link].
De Vleeschauwer SI, Wauters S, Dupont LJ, et al. Medium-term outcome after lung transplantation is comparable between brain-dead and cardiac-dead donors. J Heart Lung Transplant. 2011 Sep. 30(9):975-81. [QxMD MEDLINE Link].
Lindstedt S, Eyjolfsson A, Koul B, Wierup P, Pierre L, Gustafsson R, et al. How to recondition ex vivo initially rejected donor lungs for clinical transplantation: clinical experience from lund university hospital. J Transplant. 2011. 2011:754383. [QxMD MEDLINE Link]. [Full Text].
Carnevale R, Biondi-Zoccai G, Peruzzi M, De Falco E, Chimenti I, Venuta F, et al. New insights into the steen solution properties: breakthrough in antioxidant effects via NOX2 downregulation. Oxid Med Cell Longev. 2014. 2014:242180. [QxMD MEDLINE Link]. [Full Text].
Ghaidan H, Fakhro M, Andreasson J, Pierre L, Ingemansson R, Lindstedt S. Ten year follow-up of lung transplantations using initially rejected donor lungs after reconditioning using ex vivo lung perfusion. J Cardiothorac Surg. 2019 Jul 1. 14 (1):125. [QxMD MEDLINE Link]. [Full Text].
XVIVO Perfusion System (XPS™) with STEEN Solution™ Perfusate - P180014. U.S. Food & Drug Administration. Available at https://www.fda.gov/medical-devices/recently-approved-devices/xvivo-perfusion-system-xpstm-steen-solutiontm-perfusate-p180014. April 26, 2019; Accessed: August 9, 2019.
Liu Y, Liu Y, Su L, Jiang SJ. Recipient-related clinical risk factors for primary graft dysfunction after lung transplantation: a systematic review and meta-analysis. PLoS One. 2014. 9(3):e92773. [QxMD MEDLINE Link]. [Full Text].
Neujahr DC, Uppal K, Force SD, Fernandez F, Lawrence C, Pickens A, et al. Bile Acid aspiration associated with lung chemical profile linked to other biomarkers of injury after lung transplantation. Am J Transplant. 2014 Apr. 14(4):841-8. [QxMD MEDLINE Link].
McWilliams TJ, Williams TJ, Whitford HM, Snell GI. Surveillance bronchoscopy in lung transplant recipients: risk versus benefit. J Heart Lung Transplant. 2008. 27:1203-1209. [QxMD MEDLINE Link].
Hachem RR, Yusen RD, Chakinala MM, Meyers BF, Lynch JP, Aloush AA, et al. A randomized controlled trial of tacrolimus versus cyclosporine after lung transplantation. J Heart Lung Transplant. 2007. 26:1012-1018. [QxMD MEDLINE Link].
Kobashigawa JA, Miller LW, Russell SD, Ewald GA, Zucker MJ, Goldberg LR, et al. Tacrolimus with mycophenolate mofetil (MMF) or sirolimus vs. cyclosporine with MMF in cardiac transplant patients: 1-year report. Am J Transplant. 2006. 6:1243-1245. [QxMD MEDLINE Link].
McNeil K, Glanville AR, Wahlers T, Knoop C, Speich R, Mamelok RD, et al. Comparison of mycophenolate mofetil and azathioprine for prevention of bronchiolitis obliterans syndrome in de novo lung transplant recipients. Transplantation. 2006. 15:998-1003. [QxMD MEDLINE Link].
Groetzner J, Wittwer T, Kaczmarek I, Ueberfuhr P, Strauch J, Nagib R, et al. Conversion to sirolimus and mycophenolate can attenuate the progression of bronchiolitis obliterans syndrome and improves renal function after lung transplantation. Transplantation. 2006. 81:355-360. [QxMD MEDLINE Link].
Snell GI, de Hoyos A, Krajden M. Pseudomonas cepacia in lung transplant recipients with cystic fibrosis. Chest. 1993 Feb. 103(2):466-71. [QxMD MEDLINE Link].
Hachem RR, Edwards LB, Yusen RD, Chakinala MM, Alexander Patterson G, Trulock EP. The impact of induction on survival after lung transplantation: an analysis of the International Society for Heart and Lung Transplantation Registry. Clin Transplant. 2008. 22:603-608. [QxMD MEDLINE Link].
Diamond JM, Lederer DJ, Kawut SM, Lee J, Ahya VN, Bellamy S, et al. Elevated Plasma Long Pentraxin-3 Levels and Primary Graft Dysfunction After Lung Transplantation for Idiopathic Pulmonary Fibrosis. Am J Transplant. 2011 Nov. 11(11):2517-2522. [QxMD MEDLINE Link]. [Full Text].
Diamond JM, Meyer NJ, Feng R, Rushefski M, Lederer DJ, Kawut SM, et al. Variation in PTX3 is associated with primary graft dysfunction after lung transplantation. Am J Respir Crit Care Med. 2012 Sep 15. 186(6):546-52. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Levine DJ, Glanville AR, Aboyoun C, Belperio J, Benden C, Berry GJ, et al. Antibody-mediated rejection of the lung: A consensus report of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant. 2016 Apr. 35 (4):397-406. [QxMD MEDLINE Link]. [Full Text].
Stewart S, Fishbein MC, Snell GI, Berry GJ, Boehler A, Burke MM, et al. Revision of the 1996 working formulation for the standardization of nomenclature in the diagnosis of lung rejection. J Heart Lung Transplant. 2007. 26:1229-1242. [QxMD MEDLINE Link].
Knoop C, Haverich A, Fischer S. Immunosuppressive therapy after human lung transplantation. Eur Respir J. 2004 Jan. 23(1):159-71. [QxMD MEDLINE Link].
[Guideline] Meyer KC, Raghu G, Verleden GM, Corris PA, Aurora P, Wilson KC, et al. An international ISHLT/ATS/ERS clinical practice guideline: diagnosis and management of bronchiolitis obliterans syndrome. Eur Respir J. 2014 Dec. 44(6):1479-503. [QxMD MEDLINE Link]. [Full Text].
Wehbe E, Brock R, Budev M, Xu M, Demirjian S, Schreiber MJ Jr, et al. Short-term and long-term outcomes of acute kidney injury after lung transplantation. J Heart Lung Transplant. 2012 Mar. 31(3):244-51. [QxMD MEDLINE Link].
Dauber JH, Paradis IL, Dummer JS. Infectious complications in pulmonary allograft recipients. Clin Chest Med. 1990 Jun. 11(2):291-308. [QxMD MEDLINE Link].
Paraskeva M, Bailey M, Levvey BJ, Griffiths AP, Kotsimbos TC, Williams TP, et al. Cytomegalovirus replication within the lung allograft is associated with bronchiolitis obliterans syndrome. Am J Transplant. 2011 Oct. 11(10):2190-6. [QxMD MEDLINE Link].
Feist A, Lee R, Osborne S, Lane J, Yung G. Increased incidence of cutaneous squamous cell carcinoma in lung transplant recipients taking long-term voriconazole. J Heart Lung Transplant. 2012 Jul 26. [QxMD MEDLINE Link].
Engels EA, Pfeiffer RM, Fraumeni JF Jr, Kasiske BL, Israni AK, Snyder JJ, et al. Spectrum of cancer risk among US solid organ transplant recipients. JAMA. 2011 Nov 2. 306(17):1891-901. [QxMD MEDLINE Link].
Langer D, Burtin C, Schepers L, Ivanova A, Verleden G, Decramer M, et al. Exercise Training After Lung Transplantation Improves Participation in Daily Activity: A Randomized Controlled Trial. Am J Transplant. 2012 Mar 5. [QxMD MEDLINE Link].
ASTP/ATS/ERS/ISHLT. International guidelines for the selection of lung transplant candidates. American Society for Transplant Physicians/American Thoracic Society/European Respiratory Society/International Society for Heart and Lung Transplantation. Am J Respir Crit Care Med. 1998 Jul. 158(1):335-9. [QxMD MEDLINE Link].
Mogulkoc N, Brutsche MH, Bishop PW, Greaves SM, Horrocks AW, Egan JJ; Greater Manchester Pulmonary Fibrosis Consortium. Pulmonary function in idiopathic pulmonary fibrosis and referral for lung transplantation. Am J Respir Crit Care Med. 2001. 164:103-108. [QxMD MEDLINE Link].
Orens JB, Estenne M, Arcasoy S, Conte JV, Corris P, Egan JJ, et al. International Guidelines for the Selection of Lung Transplant Candidates: 2006 Update-A Consensus Report From the Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant. 2006. 25:745-755. [QxMD MEDLINE Link].
This chest radiograph performed 24 hours following right unilateral lung transplantation is within normal limits.
Seventy-two hours following lung transplantation, this patient developed dyspnea and hypoxemia. The bronchoscopy and bronchoalveolar lavage revealed no evidence of bacterial infection. The likely cause of this deterioration is reperfusion/reimplantation response.
A 19-year-old woman had living donor transplantation. She developed pulmonary artery stenosis several months later. This was treated with a pulmonary artery stent. Courtesy of A. Szabo, RN.
This patient developed anterior mediastinal abscess 1 year following bilateral sequential lung transplantation. Courtesy of A. Szabo, RN.
Lateral chest radiograph on a patient who developed anterior mediastinal abscess 1 year following bilateral sequential lung transplantation. Courtesy of A. Szabo, RN.
The CT scan of the chest of a patient with confirmed anterior mediastinal abscess 1 year following bilateral sequential lung transplantation. Courtesy of A. Szabo, RN.
A 34-year-old man developed branchio-otorenal (BOR) syndrome 3 years following sequential bilateral lung transplant (BLT). The chest radiograph shows characteristic findings of hyperinflation and hyperlucent lung fields. Courtesy of A. Szabo, RN.
Lateral radiograph of a 34-year-old man who developed branchio-otorenal (BOR) syndrome 3 years following sequential bilateral lung transplant (BLT). The chest radiograph shows characteristic findings of hyperinflation and hyperlucent lung fields. Courtesy of A. Szabo, RN.
The high-resolution CT scan showing findings of branchio-otorenal (BOR) syndrome following bilateral lung transplantation (BLT).
Bronchopleural fistula following right pneumonectomy and left single-lung transplantation (SLT).
Severe acute rejection within 10 days of lung transplantation (lower magnification). The typical histological findings are perivascular lymphocytic infiltrates. Courtesy of Zhaolin Xu, MD.
Severe acute rejection within 10 days of lung transplantation (high power). Courtesy of Zhaolin Xu, MD.
The transbronchial biopsy shows perivascular aggregates of lymphocytes in the low-power field, which is indicating acute rejection in this patient 60 days after the lung transplant. This is grade II rejection. Courtesy of Zhaolin Xu, MD.
The transbronchial biopsy shows perivascular aggregates of lymphocytes in the high-power field, which indicates acute rejection in this patient 60 days after the lung transplant. This is grade II rejection. Courtesy of Zhaolin Xu, MD.
Bronchial anastomosis. Posterior wall closure is performed with a continuous suture.
Right atrial anastomosis. Continuous anastomosis with the common pulmonary vein joined to the atrium.
Completed atrial anastomosis.
Donor lung showing hilar surface.
The clamps are exposing the donor vein.
Donor bronchus, artery to the right and vein to the left.
Right donor bronchus.
A close-up shot of the donor vein.
Bilateral lung transplantation to treat cystic fibrosis in a 23-year-old woman. Anteroposterior (AP) chest radiograph shows mild edema in the right perihilar region soon after surgery; this finding is consistent with an implantation response.
Anteroposterior (AP) chest radiograph obtained the following day shows increased edema.
Bilateral lung transplants in 23-year-old woman who developed infection at the bronchial anastomoses. CT scan shows right bronchial stenosis (arrow).
CT image shows left bronchial stenosis (arrow).
Posteroanterior (PA) chest radiograph in a 23-year-old woman who underwent bilateral lung transplantation because of cystic fibrosis. Image shows left upper-lobe collapse. Bilateral bronchial stents are in place.
Lateral radiograph shows left upper-lobe collapse. Arrow points to a bronchial stent. Bronchoscopy showed that scar tissue obliterated the orifice to the left upper-lobe bronchus.
CT image in a 61-year-old-woman with a single-lung transplant for emphysema with Aspergillus infection. Image shows an ill-defined nodule in the right upper lobe with a surrounding halo of ground-glass opacity (arrow), a finding virtually diagnostic of Aspergillus infection in the correct clinical setting.
Aspergillus infection 61-year-old man with a left lung transplant because of idiopathic pulmonary fibrosis. Frontal chest radiograph shows a normal left (transplant) lung and lower-lobe consolidation in the right (native) lung.
CT of patient shows patchy areas of consolidation in the right lower lobe and a clear left lung. Biopsy showed Aspergillus infection.
Cytomegaloviral (CMV) infection in a 52-year-old man with a right lung transplant because of emphysema. Frontal chest radiograph shows right lower-lobe and left mid-lung consolidation and a small right pleural effusion. Note that the less-compliant transplant lung pulls the mediastinum to the right.
CT of patient with cytomegaloviral (CMV) pneumonia shows patchy consolidation, greater on the right (transplant lung) than on the left, and a right pleural effusion.
Chest radiograph in bilateral lung transplant recipient showing bilateral pneumothoraces (arrows).
CT shows pneumothorax in common pleural space (arrow).
Lung carcinoma in lung transplant recipient. PA chest radiograph shows a spiculated nodule in the lower lobe of the native right lung.
Primary lung carcinoma in lung transplant recipient. CT scan of patient with previous radiograph shows spiculated nodule in the lower lobe of the emphysematous native right lung (arrow).
Post-transplant lymphoproliferative disorder in double lung transplant recipient. Contrast-enhanced CT scan shows low attenuation mass (arrow) in the anterior mediastinum.
Bryan A Whitson, MD, PhD Assistant Professor of Cardiac Surgery, Division of Cardiac Surgery, Department of Surgery, Lead Surgeon, Lung Transplant Program, Co‐Director, Collaboration for Organ Perfusion, Protection, Engineering and Regeneration (COPPER) Laboratory, Comprehensive Transplant Center, The Ohio State University Wexner Medical Center
Bryan A Whitson, MD, PhD is a member of the following medical societies: American College of Surgeons, American Society for Artificial Internal Organs, American Society of Transplant Surgeons, Association for Academic Surgery, International Society for Heart and Lung Transplantation, Society of Thoracic Surgeons, International Society for Minimally Invasive Cardiothoracic Surgery
Shreekanth V Karwande, MBBS Chair, Professor, Department of Surgery, Division of Cardiothoracic Surgery, University of Utah School of Medicine and Medical Center
Shreekanth V Karwande, MBBS is a member of the following medical societies: American Association for Thoracic Surgery, American College of Chest Physicians, American College of Surgeons, American Heart Association, Society of Critical Care Medicine, Society of Thoracic Surgeons, Western Thoracic Surgical Association
Mary C Mancini, MD, PhD, MMM
Mary C Mancini, MD, PhD, MMM is a member of the following medical societies: American Association for Thoracic Surgery, American College of Surgeons, American Surgical Association, Phi Beta Kappa, Society of Thoracic Surgeons
Jeffrey C Milliken, MD Former Chief, Division of Cardiothoracic Surgery, University of California at Irvine Medical Center; Clinical Professor, Department of Surgery, University of California, Irvine, School of Medicine; Current Professor Emeritus University of California
Jeffrey C Milliken, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for Thoracic Surgery, American College of Cardiology, American College of Chest Physicians, American College of Surgeons, American Heart Association, American Society for Artificial Internal Organs, California Medical Association, International Society for Heart and Lung Transplantation, Phi Beta Kappa, Society of Thoracic Surgeons, SWOG, Western Surgical Association
Susan D Moffatt-Bruce, MD, PhD, FRCS(C), FACS Chief Quality and Patient Safety Officer, Deputy Director, Comprehensive Transplant Center, Ohio State University Wexner Medical Center; Associate Dean of Clinical Affairs, Quality and Patient Safety, Associate Professor of Surgery, Department of Surgery, Ohio State University College of Medicine
Susan D Moffatt-Bruce, MD, PhD, FRCS(C), FACS is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Society of Transplant Surgeons, American Society of Transplantation, American Thoracic Society, Central Surgical Association, International Society for Heart and Lung Transplantation, Ohio State Medical Association, Royal College of Physicians and Surgeons of Canada, SocietyofThoracic Surgeons, Transplantation Society, and Western Thoracic Surgical Association
Sat Sharma, MD, FRCPC Professor and Head, Division of Pulmonary Medicine, Department of Internal Medicine, University of Manitoba; Site Director, Respiratory Medicine, St Boniface General Hospital
Sat Sharma, MD, FRCPC is a member of the following medical societies: American Academy of Sleep Medicine, American College of Chest Physicians, American College of Physicians-American Society of Internal Medicine, American Thoracic Society, Canadian Medical Association, Royal College of Physicians and Surgeons of Canada, Royal Society of Medicine, Society of Critical Care Medicine, and World Medical Association
Helmut Unruh, MD Director, Manitoba Lung Transplant Program; Head, Section of Thoracic Surgery, Director of Research, Department of Surgery, University of Manitoba Faculty of Medicine, Canada
encoded search term (Lung Transplantation) and Lung Transplantation
Chronic Obstructive Pulmonary Disease (COPD) and Emphysema in Emergency Medicine
Optimizing Maintenance Therapy for Chronic Obstructive Pulmonary Disease
Triple Therapy Benefit in Chronic Obstructive Pulmonary Disease
Fast Five Quiz: Differential Diagnosis of Chronic Obstructive Pulmonary Disease (COPD)
Fast Five Quiz: Chronic Obstructive Pulmonary Disease Maintenance Therapy
High-Altitude Cardiopulmonary Diseases
Comorbidities and the Prognosis of Chronic Obstructive Pulmonary Disease
Severe Health Diagnoses Drive Suicide Risk
COPD Patients at Higher Risk of Death 1 Year After Surgery
E-Cigarettes: What Healthcare Professionals Need to Know
Dual Bronchodilation: Baseline Therapy in Chronic Obstructive Pulmonary Disease? 0.5 CME Credits
0.5 CME
Dual Bronchodilation: Baseline Therapy in Chronic Obstructive Pulmonary Disease?
Diseases & Conditions Chronic Obstructive Pulmonary Disease (COPD)
Exacerbation History Found Flawed as COPDRisk Predictor


text:
Le Chicano Punk est un sous-genre musical dérivé du punk rock apparu aux États-Unis à la fin des années 1970 à Los Angeles.

Les premiers groupes ont été Los Illegals, The Plugz et Cruzados.

Genre de punk rock

en:Chicano rock#Chicano punk

redpajama_set_name: RedPajamaWikipedia


A daughter is like a doom; neither one has ever undressed A bit of Yvonne Strahovski coming. There is not any Louisa Warwick inside.
used without a rest; the target, a board, with the customary Ah, but that mad marquis! reminiscently. Greatest Rodriguez will be there.


text:
Archive for Kindle
THE NECROMANCER By Douglas Clegg – Reviewed
Posted in Uncategorized with tags action, book, books, brutal, characters, cheated, death, douglas clegg, entertaining, epic, exciting, fantasy, fiction, horror, horror novel, justin gravesend, Kindle, london, magazine, mid-1800s, mining town, murder, novels, pages, plot, read, reading, review, reviewed, reviewer, reviews, series, story, the necromancer, thriller, write, writer, writers, writing on February 16, 2017 by stanleyriiks
This book feels very similar to the previous Cemetery Dance book I read by Chet Williamsons, except where The Story of Noichi the Blind, the set-up feels strained and overdone, here it works.
This book is based on the diary of a young man on his journey to becoming the apprentice of The Necromancer of the title. Justin Gravesend is born and brought up in a mining town in Wales in the mid-1800s, believing his father is a murderer who killed his twin brother as a baby, James heads off to London, as much to escape his family and life down the pit as to seek his fortune. At University he becomes friends with some toffs who take him to a brothel, where a man is waiting for him, the owner of the brothel, and the Necromancer.
Will James survive the initiation?
It all ends rather abruptly just as the story starts getting interesting. Perhaps that's because this is part of a series of books, but I still felt a little cheated. I expect a book to be a whole story, and to a certain extent it is, that of James' discovery and initiation and maturation into an apprentice, but at that point it ends. The rest of the story is told in Clegg's other books in this series, which are currently only available on the Kindle (yuk yuk yuk, technology!).
A traditional and well told tale of horror, which ends too quickly. More a prelude than a proper story, but I guess that's what you give with chapbooks.
Morpheus Tales: The Best Weird Fiction, Volume 2!
Posted in Morpheus Tales Magazine, Reviews with tags amazon, book, books, characters, download, ebook, entertaining, exciting, fantasy, favourite, fiction, great north road, horror, horror novel, Joe R. Lansdale, Kindle, lansdale, limited edition, lulu, lulu.com, magazine, morpheus tales, novel, novels, pages, Peter F. Hamilton, plot, Ray Garton, read, reading, review, reviewed, reviewer, reviews, sci fi, SF, smashwords, stories, story, the best weird fiction, thriller, volume 2, weird fiction, write, writer, writers, writing on July 17, 2012 by stanleyriiks
I know, I've been slacking on the reviews recently, but I have a good excuse! I've been reading Peter F. Hamilton's Great North Road, an 1100 page epic SF novel. It's taken me the last seven weeks to read, in which time I would normally read about seven books! It was huge, and mildly exhausting! I finally finished the book on Monday, and have managed to acquire a copy of Morpheus Tales: The Best Weird Fiction, Volume 2 for review, so that will be appearing shortly.
This is a limited (1000 copies) first edition, and features some of my favourite stories from the second year of Morpheus Tales Magazine, including stories by Ray Garton and Joe R. Lansdale.
The printed version of the book is available to buy now from lulu.com, and will soon be available on Amazon:
http://www.lulu.com/shop/adam-bradley-and-fred-venturini-and-joe-r-lansdale-and-ray-garton/morpheus-tales-the-best-weird-fiction-volume-2/paperback/product-20218078.html
The ebook versions are available from smash words:
https://www.smashwords.com/books/view/175324?ref=morpheustales
The kindle version of the book is available on amazon:
http://www.amazon.com/Morpheus-Tales-Fiction-Volume-ebook/dp/B008EDXWA0/ref=sr_1_1?ie=UTF8&qid=1340734223&sr=8-1&keywords=morpheus+tales+volume+2
Go get yourself a copy right now, and we can compare notes when the review finally appears!
ONE CLICK: Jeff Bezos and the rise of amazon.com By Richard L. Brandt – Reviewed
Posted in Reviews, Uncategorized with tags amazon, amazon.com, biography, bloomberg, book, books, credit crunch, ebooks, entertaining, finance, game changers, good service, hedge fund, jeff bezos, Kindle, new york, one click, Personal Finance, read, reading, review, reviewed, reviewer, reviews, richard l brandt, seattle, writer, writers, writing on April 30, 2012 by stanleyriiks
I buy 99.9% of my books through amazon, and have done for many years. Most of my friends and family use amazon for most of their book purchases. It's amazing to think that such a huge and pervasive company is less than twenty years old.
This short book charts the history of amazon and its founded Jeff Bezos, from his work for a hedge-fund in New York to his starting the company with two programmers in a house in Seattle, and his determination and optimism that his company would be the biggest in the world by doing one simple thing: giving the customers a good service.
At two hundred pages the book doesn't have room to go into a mass of detail, it charts the company's rapid rise amid the dot-com bubble, its brief profit to appease investors and its massive investments in future growth and expansion which see profits shrink every year, despite vast sales. Investors in amazon have had a rough time, despite it being the biggest online retailer in the world.
Brandt doesn't offer much insight, and a Bloomberg Game Changers Special gives you almost as much information, but the book is interesting. Brandt's crisp journalistic style makes for easy reading, but as the Kindle and ebooks begin to revolutionise the publishing industry, amazon's major competitor's in books fall by the wayside, and as the company continues to plough new fields, you can't help but think the story is far from over.
An interesting book, but without the personal insight into Bezos or the financial and business management insight into the company.
Free April MT Supplement – Coming Soon!
Posted in Morpheus Tales Magazine, Reviews with tags 103, 13: Tales of Dark Fiction, Adam Bradley, alan spencer, Andrew Hook, andy remic, april, article, AUTHOR'S REVISED EDITION, BABYLON STEEL, book, books, by, characters, Chris F. Holm, Civil Beasts, column, DARKENING SKIES, David Tallerman, DEAD HARVEST, DEADFALL HOTEL, Desperate Measures, Dirty Story, download, easter, entertaining, Eric S Brown, exciting, fantasy, FEARFUL FESTIVITIES, Fred Venturini, free, Gaie Sebold, Gary Fry, gary mcmahon, GIANT THIEF, GREATSHADOW: BOOK ONE OF THE DRAGON APOCALYPSE, Greg Chapman, horror, If You Lay Here Quiet Next to Me, interview, James Maxey, Jeffrey Thomas, Johnny Mains, joseph d'lacey, Juliet E. McKenna, Katherine Meyer Griffith, Kindle, LEST YOU SHOULD SUFFER NIGHTMARES: A BIOGRAPHY OF HERBERT VAN THAL, magazine, Marie O'Regan, Matt Leyshon, MILE 81, Mongrel Days, morpheus tales, mt, mt supplement, NEW DAWN FADES DESOLATE, novel, novels, Organ Grinder, paul kane, plot, Ramblings of a Tattooed Head, reading, review, reviewed, reviewer, reviews, Robert Brumm Jr., ROUGH MUSIC, Scott Thomas, SCREAM OF THE BANSHEE, SF, shaun jeffrey, Simon Bestwick, Simon Kurt Unsworth, Simon Marshall-Jones, stanley riiks, Stephen King, Steve Rasnic Tem, story, THE FACELESS, The Involuntary Spasm of Writing, The Machine, THE MAMMOTH BOOK OF BODY HORROR, THE MUTILATION MACHINATION, THE NOCTUARY, THE SEA OF FLESH AND ASH, The Tax Collector, The Watchers at Work, To Hear a New World, tommy b smith, VAMPIRE'S BLOOD, VIVISEPLTURE, wayne simmons, Whatever it takes, William R.D. Wood, Wounder, writer, writers, writing on March 28, 2012 by stanleyriiks
The April issue of the MT Supplement is well under way! Although less underway than we normally are with only a few days till the 1st of launch month! Due to circumstances beyond our control (or me being a lazy slacker) the issue is not ready yet, there's still plenty of work to do, but it will definitely be ready by Easter weekend!
Here's a preview of the contents. This is going to be the biggest ever issue of the MT Supplement as it will include a massive preview of 13: Tales of Dark Fiction preview and review section, plus the usual host of reviews, articles, interviews and columns. I can guarantee this is not the final order of contents, I need to do a lot more work before this weekend.
It will be out in early April, although possibly not the first.
Go check out the website for past issues if you can't wait: www.morpheustales.com
VIVISEPLTURE Edited By Andy Remic and Wayne Simmons
DEAD HARVEST By Chris F. Holm
THE FACELESS By Simon Bestwick
LEST YOU SHOULD SUFFER NIGHTMARES: A BIOGRAPHY OF HERBERT VAN THAL By Johnny Mains
GREATSHADOW: BOOK ONE OF THE DRAGON APOCALYPSE By James Maxey
The Involuntary Spasm of Writing By Alan Spencer
BABYLON STEEL By Gaie Sebold
ROUGH MUSIC By Simon Kurt Unsworth
GIANT THIEF By David Tallerman
THE MAMMOTH BOOK OF BODY HORROR Edited By Paul Kane and Marie O'Regan
FEARFUL FESTIVITIES By Gary Fry
Ramblings of a Tattooed Head By Simon Marshall-Jones
THE NOCTUARY By Greg Chapman
DESOLATE (Kindle edition) By Robert Brumm Jr.
THE MUTILATION MACHINATION By Shaun Jeffrey
MILE 81 (Kindle edition) By Stephen King
VAMPIRE'S BLOOD (AUTHOR'S REVISED EDITION) By Katherine Meyer Griffith
SCREAM OF THE BANSHEE
DEADFALL HOTEL By Steve Rasnic Tem
DARKENING SKIES By Juliet E. McKenna
THE SEA OF FLESH AND ASH By Jeffrey Thomas and Scott Thomas
13: Tales of Dark Fiction
Introduction to 13: Tales of Dark Fiction
Civil Beasts By Eric S Brown
Dirty Story By Gary McMahon
If You Lay Here Quiet Next to Me By Alan Spencer
Desperate Measures By Stanley Riiks
The Tax Collector By Tommy B. Smith
Organ Grinder By William R.D. Wood
The Machine By Fred Venturini
To Hear a New World By Matt Leyshon
Whatever it takes By Joseph D'Lacey
Wounder By Andrew Hook
Mongrel Days By Andy Remic
103 By Shaun Jeffrey
The Watchers at Work By Gary Fry
13: TALES OF DARK FICTION Edited By Adam Bradley

redpajama_set_name: RedPajamaCommonCrawl


The name, email, and telephone number of the requestor.
The date by which service is desired.
A brief description of the requested service.
The specific location (building + room number) where the services are to be performed.


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Texas, Oklahoma State, And TCU To Participate In 2023 College Baseball Showdown
The College Baseball Showdown will be held at Globe Life Field in Arlington, Texas, from Feb. 17-19, 2023. The Big 12 will send Texas, Oklahoma State, and TCU to represent the conference. Missouri, Arkansas, and Vanderbilt will play the SEC. Texas is set to join the SEC after its athletic season in 2025-26. As for Texas, he will be the only returnee from the 2021 State Farm College Baseball Showdown.
Iowa and Oklahoma State will compete in 2023 College Baseball Showdown
The 2023 College Baseball Showdown will pit Iowa against Oklahoma State, in a game that could have an enormous impact on the NCAA Tournament. Oklahoma State will be eager to win this game to remain in the playoff picture. On the other hand, Iowa will be eager to keep its momentum going, as the Cowboys are coming off an NCAA championship this spring. The game is set to take place at Globe Life Field in Oklahoma City on Saturday, April 7. The event could draw a record crowd.
The teams that will participate in the 2023 College Baseball Showdown will include three future SEC schools and two fellow Big 12 teams. Oklahoma State is the only returning team from the 2021 showdown. The Cowboys have a good history with Missouri, and their coach is former St. Louis Cardinals Hall of Famer Matt Holliday. The two teams are likely to go 0-3 and will likely get some early season experience.
Texas Tech is the lone returnee from 2021 State Farm College Baseball Showdown
The 2021 State Farm College Baseball Showdown will take place Feb. 18-20 in Arlington, Texas. FloBaseball will be the exclusive television provider of the games, and you can watch the games on the web. A team's schedule is important for this tournament because many of the teams have a long road ahead of them. Below is a breakdown of the teams' respective conference records and the team's chances of winning the event.
In the other game on Sunday, Mississippi State will play Texas Tech. The game will take place at MGM Park, which is located near the Gulf of Mexico. The stadium has a capacity of approximately 15,000 and will be packed. There will also be two other games on Monday at 3 p.m. Mississippi State and Texas Tech will face each other in a three-game series.
Texas Tech committed to play in 2023 and 2024 College Baseball Showdown
Last season, Texas Tech went 0-3 in the College World Series. They finished 39-17, missed the tournament by one game. This year, the Red Raiders have a chance to host an NCAA regional. They are projected to play the Terrapins, Liberty, and Fairfield in College Park, Maryland. The Big 12 Tournament is scheduled for Sunday, June 3. The NCAA Tournament will begin on June 3.
In addition to Arkansas, Texas Tech is also committed to play in the College Baseball Showdown in 2023 and 2024. Arkansas will play in the 2023 College Baseball Showdown against Texas, TCU, and Oklahoma State. Both teams will face teams from the Big 12 and national rivals. During the 2018 College World Series, the Razorbacks lost to Oregon State, so it's good news for the program that it's committed to returning for the 2023 and 2024 games.
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Q: Service Fabric reliable queue long operation I'm trying to understand some best practices for service fabric.
If I have a queue that is added to by a web service or some other mechanism and a back end task to process that queue what is the best approach to handle long running operations in the background.

*

*Use TryPeekAsync in one transaction, process and then if successful use TryDequeueAsync to finally dequeue.

*Use TryDequeueAsync to remove an item, put it into a dictionary and then remove from the dictionary when complete. On startup of the service, check the
dictionary for anything pending before the queue.

Both ways feel slightly wrong, but I can't work out if there is a better way.

A: If very slow use 2 queues..  One a fast one where you store the work without interruptions and a slow one to process it. RunAsync is used to move messages from the fast to the slow.

A: One option is to process the queue in RunAsync, something along the lines of this:
protected override async Task RunAsync(CancellationToken cancellationToken)
{
    var store = await StateManager.GetOrAddAsync<IReliableQueue<T>>("MyStore").ConfigureAwait(false);
    while (!cancellationToken.IsCancellationRequested)
    {
        using (var tx = StateManager.CreateTransaction())
        {
            var itemFromQueue = await store.TryDequeueAsync(tx).ConfigureAwait(false);
            if (!itemFromQueue.HasValue)
            {
                await Task.Delay(TimeSpan.FromSeconds(1), cancellationToken).ConfigureAwait(false);
                continue;
            }

            // Process item here
            // Remmber to clone the dequeued item if it is a custom type and you are going to mutate it.
            // If success, await tx.CommitAsync();
            // If failure to process, either let it run out of the Using transaction scope, or call tx.Abort();
        }
    }
}

Regarding the comment about cloning the dequeued item if you are to mutate it, look under the "Recommendations" part here:
https://azure.microsoft.com/en-us/documentation/articles/service-fabric-reliable-services-reliable-collections/
One limitation with Reliable Collections (both Queue and Dictionary), is that you only have parallelism of 1 per partition. So for high activity queues it might not be the best solution. This might be the issue you're running into.
What we've been doing is to use ReliableQueues for situations where the write amount is very low. For higher throughput queues, where we need durability and scale, we're using ServiceBus Topics. That also gives us the advantage that if a service was Stateful only due to to having the ReliableQueue, it can now be made stateless. Though this adds a dependency to a 3rd party service (in this case ServiceBus), and that might not be an option for you.
Another option would be to create a durable pub/sub implementation to act as the queue. I've done tests before with using actors for this, and it seemed to be a viable option, without spending too much time on it, since we didn't have any issues depending on ServiceBus. Here is another SO about that Pub/sub pattern in Azure Service Fabric

redpajama_set_name: RedPajamaStackExchange


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text:
WATCH: President Obama On Trump Win, Clinton Loss
By Brian Naylor
Published November 9, 2016 at 11:59 AM EST
President Obama, saying "we are all rooting for his success," vowed his staff would work as hard as it can to ensure a successful transition of power to president-elect Donald Trump.
Obama spoke in the White House Rose Garden with Vice President Joe Biden at his side. The president had phoned Trump at 3:30 Wednesday morning to congratulate him on his upset victory over democrat Hillary Clinton, and invited Trump to the White House Thursday to discuss transition matters.
Obama said it is no secret that he and Trump have "pretty significant differences." But Obama said he and former President George W. Bush had significant differences too, but still had a smooth transition after Obama's election in 2008.
Later White House spokesman Josh Earnest, asked whether the president would take steps to protect some of his policies, including the nuclear agreement with Iran and the Affordable Care Act before leaving office, responded that Obama would still be President until January 20th.
Obama spoke minutes after Clinton formally conceded defeat to Trump after an often-bitter campaign. Obama said he "couldn't be prouder" of Clinton, whose candidacy and nomination he called historic, and which "sends a message to our daughters all across the country that they can achieve at the highest levels of politics."
Obama said what he heard from Trump in a private conversation and in the president-elect's public remarks was that "we all want what's best for our country." Obama said that what the nation needs, a sense of unity, a sense of inclusion and respect for our institutions our rule of law and "respect for each other."
The president said that "everybody is sad when their side loses an election, " but that we're all actually on the same team, calling elections an intermural scrimmage. He said he told his staff "to hold their heads up," that their "remarkable work has left the next President with a stronger, better country that the one that existed eight years ago."
Brian Naylor
NPR News' Brian Naylor is a correspondent on the Washington Desk. In this role, he covers politics and federal agencies.
See stories by Brian Naylor


text:
Category Archives: Super Wing Commander
3DO CH Flightstick Pro – First Impressions
Posted on July 9, 2012 by Pix
My "new" joystick for the 3DO arrived a couple of days back completing my 3DO setup (with Vectrex accessory) and I'm fresh from trying it out on the only 2 3DO games that matter, Super Wing Commander and Wing Commander 3. It has to be said that I've only played the one mission on SWC and fooled around in the simulator a little on WC3 so this is only my initial thoughts.
A few words on the hardware first. It's a fully analog stick based on a PC version of the same joystick that had been around for some years as I recall. The first PC joystick I ever bought was it's smaller non-pro brother which only had the 2 fire buttons and no 4-way hat switch. This 3DO version also has four buttons on the base.
It uses a 2 drum system to allow the stick to move on the x and y-axis and while it's comfortable enough to use, I can't say that I'm exactly unaware of the independent nature of these drums and it's easier to move along one axis than two. Moving across the center position, the stick almost clicks into place and it's far from smooth as a result. The stick also has a rectangular field of movement rather than circular which is a little odd when you get to a corner. I've got a similar vintage Thrustmaster joystick I use with my DOS PC which is in another league to this one in terms of feel, at least for combat flight sims like this.
Having said all that it's still quite a nice stick for the time and the build quality must be great because it still tracks perfectly despite being 15 years old. I had some doubts about buying one of these second-hand but I needn't have worried.
Onto the games, starting with Super Wing Commander. This boasts support for extended joysticks on the cover and while it doesn't always work smoothly with the flightstick, it's a giant improvement. There are some quirks such as moving around the ship between missions requires use of the POV hat rather than the stick. Steering around in flight thankfully works using the stick as you would expect.
Using the original 3DO controller it was possible to apply a slow or fast modifier to steering with the d-pad by holding down the right buttons. Using the flightstick, the game does this for me depending on how much I move the stick, but ultimately I can still only turn at 3 speeds. This isn't perfect but it's a whole lot better than the alternative.
Button combinations, as ever with these console ports, take a little getting used to but they work ok with the main commands like missiles and afterburners being in easy reach. The buttons are less to hand than on the original 3DO controller making some combinations tricky. Trying to afterburn and fire a missile at the same time requires either two thumbs or a very strange grip on the joystick. The buttons at the right side of the stick aren't exactly in easy reach for a right-handed player either when they are needed.
WC3 offers better support with much smoother steering and slightly improved use made of the extra buttons. It's still not quite what I would expect with the view hat not used for changing view, but I suppose there are more useful things that can be done with it when you have this few buttons to work with. Neither game makes use of the throttle wheel which is a big disappointment.
These sticks aren't exactly common but won't break the bank when you do find one. The flightstick pro might not be the best joystick I've ever used but despite the shortcomings it's the only way I'd want to play either of these games on the 3DO.
Posted in Super Wing Commander, Wing Commander 3	| Leave a Reply
Super Wing Commander Review – Edge Magazine
Posted on September 27, 2011 by Pix
It's 21 years today since the first Wing Commander game. I couldn't find a Wing Commander review at short notice so instead here is the review of the 3DO remake, Super Wing Commander, from Edge magazine in July 1994. I prefer the original Wing Commander myself but this gets a great review here nonetheless.
Posted in Magazine Scans, Super Wing Commander	| Leave a Reply
Posted on October 20, 2010 by Pix
Since the last post, I've gone back and had a look at the storyline for SM2 which I'd apparently managed to forget most of. It appears that contrary to every description of Super Wing Commander I've seen, this "new" campaign is in fact a reworked version of the original Secret Missions 2. It's taken all the main themes such as Bossmans death, Ralgha's defection + Jazz & Doomsday joining the crew and reworked them into another story. The missions themselves are different and the conversations have been rewritten/reworked but all the major events are still there. That makes the new campaign an alternative Secret Missions 2 rather than a new set of missions taking place between SM1 & SM2.
This begs the question – Why was the rest of the game, almost word for word the same and this part changed? I'd speculate that it's because SM2 introduced another alien race of giant birds which joined the confederation at the end of the game. Any mention of other alien races then vanished from subsequent Wing Commander games, so it's possibly an attempt to remove an inconsistency in the storyline. Without the alien race to save on the planet, there would be no reason to hang around when the Kilrathi invaded the system in an attempt to hold their ceremony. The Tigers Claw could just pull out and leave them to it which meant the whole story needed changing. I'm guessing here so if anyone knows better, please let me know.
This being an alternative SM2 explains away nearly all the problems with the storylines inconsistencies. I still don't think Shotglass should be talking about stealth technology rumours though. This sort of reference is clearly trying to link the story to Wing Commander 2 in the same way as Jazz's over-curious questioning.
Mission 9 is the last secret mission. It's roughly the same as ever where I have to fly to a nav point in a Dralthi and receive a signal. There appears to be a bug however as when I try this the capship I'm inspecting appears out of nowhere just as I arrive at the point, then blows up. When I get back I'm told off for destroying it but as I don't seem to have any other options here I press on with the next mission.
For mission 10 we are closer to our strike target so we need to take out the defenders. It's a 3 point patrol with Jazz. This is a really tough mission. There are 2 Snakeirs to take out and loads of Gratha and Jalthi to cope with. They must have turned the skill level up to maximum on these ships as they don't give me a moments peace. The Snakeirs are too tough to take out with the fighters around so I have to do it the hard way which takes a good number of attempts.
For mission 11 we have to destroy an incoming convoy. We fly a direct strike on the convoy. There is an unguarded Fralthi in an asteroid field on the way in which makes an easy target. Then we have 3 Lumbari + supporting fighters at the nav point. After the last mission, this one is straightforward.
Mission 12 is the final assault on the research base. In the briefing I learn that we have proof that this base is currently developing stealth technology and it was responsible for the Sivar. It's another tough mission but fitting for the end of the game. I take out all the fighters first and then go after the star post. This thing seems to be moving away from me at serious speed. I'm not convinced it's not a bug but I have to afterburn half the time to keep up.
The moment it blows up, the final cutscene starts…..
For all the improved graphics I can't recommend this version over the original Wing Commander. It's a decent game but the cosmetic improvements in some areas are let down by poor ship design, awful acting and the glaring omission of the cinematics showing the progress of the war. The new missions are the best part of the game, although there were similar improvements with SM2 and I prefer the original storyline. If you really want to play these new missions, I'd skip through the rest of the game using a cheat. Usually, I'm all for faithful remakes of games but I think the problem here is that CD games were just too new at this stage and it wasn't long enough since the original game. It's ended up being not much more than a good port and ultimately pales next to the original game at least with the benefit of my nostalgia for the PC game.
I'm going to move straight onto Longbow 2 next, which will be followed by F-15. There was some disagreement about whether F-15 was developed by Origin or EA Baltimore depending on where I looked but the copyright information on the back of the European F-15 box has it down as Origin which is good enough for me. Those are the last 2 games published or developed by Origin, at least that I'm aware of. The only ones I'll have missed are Ultima Online and its various sequels, which I'm ignoring since they are uncompletable (and also I have no interest in MMORPG's). The manual for Longbow 2 is a bit of a whopper so it may be a few days before I wade my way through it and actually start playing the game.
Posted in Super Wing Commander	| Leave a Reply
Day 218 – Back to Super Wing Commander
After my brief sidetrip, it's back to the final (and unique) campaign in Super Wing Commander. The new missions start off with some of the pilots in the bar sounding a little weary after the Thor's Hammer campaign. I learn that Bossman has a one year old daughter and that Spirit's fiance is off on secret operations somewhere, but even she isn't allowed to know where.
Mission 1 is to go and kill a Fralthi, to make the area safe for either our shore leave or the as yet undisclosed mission we are here for. Secret Missions 1 was absolutely rock hard, even the early missions but this is easier and I get to fly a Rapier rather than having to work my way up from the worst ship again.
When I get back Angel says everyone encounted warships but there is support from TCS Austin if we need it. Shotglass tells me how the Kilrathi have run from Vega Prime without putting up a fight which looks highly suspicious as if they had somewhere to go.
Mission 2 starts differently from any other mission in the game so far in that I'm called into the Commanders office for a solo briefing. A Kilrathi Colonel wants to defect so I have to fly out and guide back his Dralthi.
When I bring him back the defector is introduced as Colonel Ralgha so it's presumably supposed to be Hobbes although this doesn't fit in so well with what I know from Wing Commander 2. I only get to see him from this rear angle and he never speaks. In the bar after the mission, people are asking what is going on but I'm not allowed to tell anyone about these missions so I have to keep quiet.
In mission 3 we are pulling out of the system to regroup and strike a large fleet that is heading our way. I'm flying with Maniac for the first time on this mission and have to escort a capship. Maniac proves to be the best wingman I've had so far and the mission is nice and easy again. The difficulty level of the game has plummeted since I started these missions. If it carries on it will mean I finish them fairly quickly, but it will be a lot more fun in the meanwhile. After the mission, Jazz is in the bar from the Austin and I also learn that Spirits fiance has been captured by the Kilrathi.
I'm back in the Commanders office again for mission 4. I have to fly our captured Dralthi to get information on what the Kilrathi are up to. The Commander talks about communicating with the capships but it amounts to flying round some nav points.
It's nice to get a new ship to fly anyway and I watch the launch sequence for the first time in about 20 missions.
The mission is a simple affair and I just fly past everything and never fire my guns. The Snakeir at the nav point spots me and starts shooting when I get close but I just afterburn away.
Jazz is wanting to know what is going on when I get back to the bar, in an overly suspicious manner. No doubt setting things up for WC2.
Mission 5 is a basic 3 point patrol. The only thing of note about this mission is that I'm attacked by more than one fighter type at each nav point at the same time, and I'm not convinced that's happened in any other mission. When I get back Bossman is dead after he and Angel ran into trouble. The good news is that Jazz and Doomsday (who hasn't even been mentioned up to this point) will be staying on to help out. Angel is blaming herself for Bossman's death and doesn't want to talk to anyone.
Mission 6 is another covert op in the Dralthi. It's exactly like last time except with 2 nav points instead of 1. Again, I just fly through without ever firing my guns.
In the mission 7 briefing I'm told that we are gearing up for a major offensive. This means that we have to escort a troop ship. I'm flying with Doomsday for the first time and despite all his pessimism (he uses all the same lines as in WC2), he is easily the best copilot I've had so far and the mission is an easy one. After the mission, I learn the Drayman we escorted was carrying a Vice Admiral.
In the mission 8 briefing we are told that the Kilrathi have figured out why we are here which means a defensive patrol mission to protect the Claw. There are loads of ships to take out on this one, and it's quite a lot harder than whats come before but I just about make it back first time, minus a gun or two.
Jazz and Doomsday are in the bar and it's looking like their transfer might be permanent. Shotglass thinks we are going after a research base which might be where the dreadnought that destroyed Goddard was made. They are now supposedly working on stealth technology.
I stop here for now. I have no idea how many missions are in this final campaign but I'm assuming that I'm around half way by now, if not a little further. I'm breezing through these missions so far but I expect they will get much harder before long. The storyline for this is not what I expected as it's contradicting both Secret Missions 2 and Wing Commander 2. For instance no one believes me about stealth technology in WC2's intro, yet Shotglass is telling me it's being researched here. I should be meeting Jazz and Doomsday in SM2 but I'm meeting them here instead. I also should have no idea about Hobbes at this stage, and I seem to recall that he was supposed to have defected when he rescued Doomsday or some other pilot as a child. Maybe it would all have been sorted out in Super Wing Commander 2 if there was ever going to be such a game. If the extra campaign was to appeal to WC veterans. it's a problem when it's contradicting the other games stories rather than complimenting them.
That gripe aside, I'm enjoying Super Wing Commander more now that I'm onto these missions than I have at any time previously. With the exception of Doomsday, whose voice is ridiculous, the acting has settled down a bit and the dialog feels at least a little more natural. When I go back and play it again, I do realise how limited the options for storytelling are in Wing Commander 1. The entire plot takes place in about 4 rooms with characters who never move. It still adds enormously to the game but Wing Commander 2 was so much better, and I can't help but feel that it should have been improved upon in Super Wing Commander rather than actually being worse than the 1990 original. The missions themselves suffer in the same way, with endless variations of the same thing. I did at least get a new ship today although if I'm not going to have to dogfight in it, then I could have been flying anything.
Posted in Super Wing Commander	| 4 Replies
I've now got as far as finishing off Secret Missions 1. I'd forgotten just how difficult these missions were but I got there in the end. The Sivar itself is very nondescript for all the effort of chasing it down through a dozen missions.
There is a medal ceremony when I get back, but the ceremony is just like any other. Again there have been no cutscenes throughout the game. They appear to be entirely missing from SWC. At least from here on out, it's new missions all the way and I'll write about them in the usual detail from here on.
Out of curiosity, I've been looking at some of the other versions of Wing Commander out there on Youtube. A video showing Super Wing Commander had the cockpit sliding around on screen when you turned which isn't in the version I'm playing. I'm guessing this is a missing feature on the emulator but it could be that the Macintosh version was a little different either. There was also a Sega CD version of Wing Commander which I'd not seen before. This looks completely faithful to the original Wing Commander in terms of graphics but also has full speech. The speech is entirely re-recorded with different actors and sounded quite a lot better than this from the little I heard. It was developed by GameArts rather than Origin but it looked like the version to go for if you really want speech in your Wing Commander. One thing I didn't like especially was the music in that version which was completely different and a little inappropriate in my opinion. I also had a quick look at the SNES versions which are surprisingly similar to the original also, but with some different cutscenes. They all look fairly good but I'll be sticking with the original PC version any time I feel like digging Wing Commander out again.
That could be a while as I'm finding myself tiring a little of it after getting this far. I think it made more sense split into the 3 mission packs, as it's all too similar when you have so many missions in one game like this. I'm going to have a quick break and see if I can get Origin FX running before I go back and finish this game off.


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text: Q: Документация по PyWin32 Нигде. ВООБЩЕ нигде не могу найти нормальной документации по PyWin32. Где можно найти нормальную документацию, список методов (если будет описание методов - вообще круто). Я нашел только этот нечитабельный сайт : Этот. Как им пользоваться - не ясно.