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[Lesser-Known Title] Gash Bell Manga
by Sekina Mayu | Lesser-Known Titles | 0 comments
Out of many books that I recommended in the past, Gash Bell manga happened to be the manga that I didn't get to finish reading.
Okay, you may think that I stopped reading the manga because the manga was awful. Of course, the answer is absolutely no. If it's that awful, I won't be recommending it on my blog.
If it's not the case at all, then why I stopped reading the manga in the first place?
The reason for that is because the company that licensed the manga in Malaysia went under. As a result, I was only able to read the manga until Volume 9.
Yes, it's sad that I don't get to read the manga only because the company that licensed the manga was closing its door.
I'll leave the topic about the local distributors for another day.
But for now, let's talk about what makes the manga worth your attention.
In case you're wondering, Gash Bell manga is also known as Zatch Bell in English. To be honest, I have no idea why the manga is called Zatch Bell since the Japanese name for the manga is Konjiki no Gash!!
Well, at least it's better than the title in Malay where the manga is known as Gash!! Emas in Malaysia.
That's just a direct translation of Golden Gash in Malay, in case you're curious.
What Gash Bell manga is all about
Here's the book description that I got from Amazon.
Fourteen-year-old Kiyo, an arrogant genius who is teased mercilessly at school, is given a strange boy, Zatch Bell, for his birthday to help him make friends, but Zatch turns out to have strange powers that change Kiyo's life forever.
What got me to read this manga
I knew about the Gash Bell!! anime through the anime magazine published by Gempak Starz back then.
Not long after that, I saw the manga was on sale at the newsstand a few weeks after I came across the anime in the magazine.
Since it was the first book, I figured that it doesn't hurt for me to give the manga a try. I can always stop buying the manga if it's a dud, right?
I'm sure you know what happened after that. I love the story and kept on buying the manga until the company that licensed the manga was closing its door.
What makes Gash Bell manga worth reading
On the surface, Gash Bell manga may seem like a mashup version of Fate Stay Night and Black Clover where the battle system is like the master and servant style in Fate Stay Night. And the battle requires the master to cast a spell from a book, which is something similar to Black Clover.
Does the Fate style battle system make the manga worth reading?
Well, I wouldn't say this is the reason why the manga is worth checking out. In fact, even the Black Clover style magic casting isn't the reason why the manga is worth your attention either.
If none of them aren't even the reason that makes the manga worth reading, then what it is?
Well, I will say it has something to do with how heartwarming the story is for the most part.
Yes, I get that there's nothing heartwarming about the story that requires you to fight toe-to-toe with another demon child.
But it's not like the story will always be heartwarming all the time. Just like any other manga, there will always be hilarious and tense moments too.
In a nutshell, you'll get all kinds of emotion when you read this manga. But the one that you'll remember the most will be the heartwarming moments. And of course, the most intense moments too.
What I didn't expect when I read the manga
I will say that I would never imagine that my friend who isn't a manga fan finds the manga interesting.
The reason for that? It's because of how heartwarming the story is.
Perhaps she never thought that a manga like this can be this heartwarming. At least I'm glad that I'm not the only one who thinks how heartwarming the story can become sometimes.
Who should read this manga
If you're the kind of person who enjoys reading shonen manga, then there's no doubt that you should give this manga a try.
Just to be sure that you have your tissues ready if you're a crybaby.
Where to buy Gash Bell manga
Since the manga is an old manga, you can only buy the used one, though. Even if you can find a brand-new manga, it's going to cost you a lot more than usual.
If you don't mind with getting the used manga, you can get the manga right here on Amazon.
Buy Gash Bell manga on Amazon
Prefer to read the manga in Japanese? You can buy the manga in Japanese right here at CDJapan.
Buy Gash Bell manga on CDJapan
What do you think about Gash Bell manga? Are you interested in giving this manga a try after reading about it on my blog? Let me know in the comment below.
P.S Do you always want to learn Japanese but prefer to learn the language online and at your own pace? If that's you, then I highly recommend you to have a look at JapanesePod101.com.
The good thing about JapanesePod101.com is that not only you'll get a customized lesson based on your language level. But you'll also gain access to other cool features such as flashcards and lesson notes too.
Right now, JapanesePod101.com is currently having a sale where you can get 30% off any 1-,3-,6-,12- or 24-month Premium or Premium PLUS plan.
If you're interested, you can take a look at the website right here:
Learn Japanese with JapanesePod101.com
Don't forget to use the coupon code EPIC2020 during checkout to receive 30% off. This offer will end on September 25th, 2020.
[Lesser-Known Title] Detective School Q
[Lesser-Known Title] Midori no Hibi
[Lesser-Known Title] Purikyuu


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The Portfolio Management Office manages strategic projects and programs, publishes, prioritizes, and tracks a roadmap of key enterprise commitments, and drives a process-based approach to service delivery.
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Audacious, exhilarating and with limitless vision, the Australian World Orchestra (AWO) is recognised as one of the most exciting initiatives in Australia's cultural history.
Founded in 2010 by Artistic Director and Chief Conductor Alexander Briger AO, our mission is to bring together Australia's finest classical musicians – from ensembles at home as well as all around the world – to create something uniquely electrifying. Touring within Australia and overseas has won the Orchestra an enviable reputation and reached out to new audiences for classical music, while our education program has helped foster the next generation of Australian musicians.
Totalling 250 players drawn from over 50 of the world's finest orchestras and ensembles, the AWO can call on leading musicians from Australia's state orchestras as well as their ex-pat colleagues from prestigious ensembles such as the Berlin Philharmonic Orchestra, Chicago Symphony Orchestra, Los Angeles Philharmonic Orchestra, Hong Kong Philharmonic Orchestra, Vienna Philharmonic Orchestra, London Philharmonic Orchestra and London Symphony Orchestra. The sheer array of talent, coupled with our plush, award-winning sound, has seen many of the world's starriest conductors lining up to lead us both in Australia and overseas.
Hailed by audiences and critics alike as charismatic, inspiring and one of a kind; in the words of Sir Simon Rattle:
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The village of Stow has a long and notable history, which is closely linked to the traditions of the church, going back to mediaeval times. In old English, the word "Stow" means a holy or consecrated place. When the Scots conquered Lothian in 1018, the Ancient church of St Mary of Wedale passed into the diocese of St Andrews (and hence into Midlothian). Throughout the Middle Ages, it was famous for being one of only three sanctuaries in Scotland where persons could find refuge in times of trial.
Stow was known then as "Stow in Wedale", and the name of Wedale described what is known today as the Gala Water. Various explanations have been given for the background to the name "Wedale" including "Valley of Woe" and the dale of the holy house to an abbreviation for the Celtic Goidel race, but it is now known that Wedale derives from 'Wiche' meaning shrine and 'Dahl' meaning valley. So Stow in Wedale means 'holy place in the valley of the shrine'.
In 1242, a new church, also dedicated to St Mary, was built at the edge of the village and beside the Bishop of St Andrews' palace. This was both a place of sanctuary and pilgrimage. The extension of the Bishop of St Andrews' lands to include Stow was probably the reason why the land from the watershed at Fala to Bowland was formerly part of the county of Midlothian; as this was border country with its back to the Lothians, such an arrangement could be seen as an anomaly, which was changed in 1972, when the lands became part of Selkirkshire.
In the 15th century, a new church was built to the west of the Bishop's Palace using red ashlar. This was rebuilt in the 17th century, and boasted an outside stair giving access by a doorway dated 1660 to galleries on the north, east and west sides.
The date of 1771 can still be seen on the windows of the remains of this building, which served as church until 1876, but has been disused since that time.
In 1627 John Hoppringle of that Ilk and Torsonce, takes part in assessing the parish for 300 merks to repair the church of Stow, and in 1631 is authorised "to build an aisle at the back of his own seat in the kirk '' - From 'Records of the Pringles' page 20.
An excavation at the Bishop's House, Stow, Scottish Borders.
From 'Place-Names of Scotland' by James Johnston, 1892.
Wedale: Sic. c. 1160. Old English: wa-dael (in Dannish: vee-dal), 'vale of woe,' so called by Angles from their great defeat there by King Arthur.


Product prices and availability are accurate as of 2019-04-21 11:11:21 EDT and are subject to change. Any price and availability information displayed on http://www.amazon.com/ at the time of purchase will apply to the purchase of this product.
Please make sure battery cover has been stuck in the slot before using the kids digital camera under water.
This waterproof camera needs 2*AAA batteries and it supports up to 32GB micro SD card, both of them are not included in the package.


KB Home, formerly Kaufman & Broad Home Corporation, is a New York Stock exchange listed company (symbol: KBH), and is one of the largest homebuilders in the United States. Since its founding in 1957, the company has built hundreds of thousands of quality homes for first time home buyers, as well as move-up buyers and active adults. They strive to deliver the highest level of quality and customer service to their customers both during and after the home building experience. All new KB Homes are backed by the company's 10-Year Limited Warranty.
The communities within McDowell Mountain Ranch that were built by KB Home include Arizona Highlands and Arizona Vintage. Today,they are currently building new homes in Phoenix, Mesa, Gilbert, Maricopa and Surprise. In addition to their communities in Arizona, the company is also building across the Southwest and California, as well as the Southeast from Florida up through Washington DC.


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Bergman Out of Mosconi Cup Due Positive COVID-19. Corey Deuel Joins Team USA
BERGMAN RULED OUT OF PARTYPOKER MOSCONI CUP AFTER POSITIVE COVID-19 TEST
Former US Open Champion Corey Deuel To Join Team USA
Justin Bergman has been ruled out of the partypoker Mosconi Cup after testing positive for Covid-19. He will be replaced on Team USA by former US Open Champion Corey Deuel, who has provided a negative test result and will represent America for an 11th time at the event.
All players are required to test negative for Covid-19 just before departing for the UK, however Bergman's test returned a positive result leaving him unable to travel to England.
Captains were asked to submit alternative picks in September, after they had chosen their team of five players. Team USA Captain Jeremy Jones opted for Deuel as his first alternate, hoping that the Californian can draw on his vast partypoker Mosconi Cup experience.
Speaking about Bergman being ruled out of the event, Captain Jones said: "It is a big body blow to a small man who has a huge heart. Playing in the Mosconi Cup means more than anything to Justin. He really likes the atmosphere of the team and having the other guys on his side, like most of us do. It is very, very unfortunate and one thing I can say about Justin is he will be our biggest fan out there.
"It wasn't an easy decision but the way things went down with Chris being selected fifth and being a rookie, we felt like maybe if we needed a player to come in as an alternate we wanted a little more experience. Not to say that Tyler doesn't have two years' experience, but Corey has got 10 Mosconi Cups, and I think Corey is playing really well. When we talk about somebody coming in and filling shoes, we felt that experience was the way to go."
Players will compete in the partypoker Mosconi Cup under Elite Sports Person Exemptions. They will be met on arrival to the UK and driven directly to the Ricoh Arena, Coventry for a further Covid-19 test and will remain within the event bubble until the completion of the event.
Everybody at Matchroom Multi Sport would like to send their best wishes to Justin – stay healthy, and have a speedy recovery.
The partypoker Mosconi Cup will take place from Tuesday, December 1 until Friday, December 4, live on Sky Sports Mix in the UK, DAZN and Matchroom.Live. Full broadcast details can be found at mosconicup.com
Follow Matchroom Pool on Facebook, Twitter, YouTube and Instagram. For all the latest event news please visit www.mosconicup.com.
Tagged on: Party Poker Mosconi Cup
Harold Simonsen November 25, 2020 Pool and Billiard Tournament News
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The System - Pique, Pass, Plug Your Way To Success!
If you were to start any business today, you would have to begin sourcing customers and partners who can help you extend your reach, right? So where is the best place to start? With the people who care about you most, of course!
Keeping in mind, not everyone is going to be as excited as you are based on their own experiences, beliefs and ideas; the good news is- you aren't looking for everyone. And you don't need to worry about those who say it's not for them right now. What you are looking for is a few key people who have a desire for more and are willing to do something about it.
How do you know who these people are? You don't! (Yet) Fear not, we will show you how to find them, and they are out there- we promise! But you won't find them if you decide it's not for them without asking. Some of the biggest leaders in this business said no (a few times) before finally making the decision to join. And, as you grow in personal development, so will your list. You should be working to add 3-5 names to it everyday if you have some big goals. This is your gas tank for this business!
If someone comes to mind, add him or her to the list. Consider everyone you know, and also consider who might have specific leverage points that will open up opportunities you otherwise might have missed. Think of people you would like to work with, people who have a positive attitude, people who are ambitious and those who are respected in their circles of influence.
YOU: Hey Mary! How are you today?
PROSPECT: Great thanks, how are you?
YOU: Wonderful! It's been a while since we've connected, I was thinking of you the other day and wondering what you are up to? Are you still working at _______?
PROSPECT: Yes! It hasn't been going so well though & I just feel exhausted!
YOU: Oh man! That sounds tough- what's going on at work?
PROSPECT: Honestly, I'm tired of it. I work so many hours and I'm barely at home with the kids. Thinking I might need a change… What are you up to?
YOU: Oh man! That's tough, I was/am in the same boat – Working a ton of hours and looking for more flexibility and I'd love to earn more money!
YOU: Well that's actually why I reached out to you, I always remembered how hard working you are and thought of you when I recently got connected to an amazing woman/guy/mentor/new friend, learning how to earn Multiple Stream of Income with a man named Bob Proctor and his wife Linda! Have you heard of Bob? He was from the HUGE movie, The Secret! Has taught success principles and the law of attraction for over 50 years. Anyway, I've partnered up with his wife Linda in a new venture we are launching. I've just gotten started and have already earned money/learned so much/set up my new business (some sort of result here)- I think this could be an amazing solution for you too!
WOULD YOU take a look/be on the call to hear more about it?
PROSPECT: Wow sounds amazing! What is it?
YOU: An exciting new venture leveraging some of today's biggest trends, but don't worry- they have an awesome leadership team and free training program to help people (like me who knew nothing about this world before!) get started. The information I'll send will give you a great overview – then I can give you a quick call and introduce you to the person I'm learning from (she is amazing! Edify the 3way call leader here) and she can help answer any questions you might have!
What's the best email for you?
PROSPECT: Ok sounds good, I'm a bit busy today but I might have a chance to have a look tonight?
YOU: Perfect, I'll send you some information now and I'll give you a call in the morning? How is 9am for you?
PROSPECT: That's great, I'll have had a chance to review what you send before then!
YOU: Ok so just to confirm your email is __________ and the best phone number to call you tomorrow at 9am is ________? Correct?
YOU: Great, enjoy the info – I think you'll be excited to see how this might be a great solution for what you're looking to do- I'm sure glad I jumped on board and we are just getting started! and I'll speak to you tomorrow at 9! Have a great rest of the day.
PROSPECT: Thanks so much, I'm excited to take a look!
So how are things with your job?
Have things at your job been working out the way you hoped?
I know you're an ambitious person who's always looking for a good business opportunity. Are you open to discussing one with me for a few minutes?
What are you hoping to achieve career-wise?
If there were a way for you to generate a supplemental income, would you take some time to explore the possibilities?
Is health and wellness important to you?
What's new with your family?
How would you like to leverage some of your _______ (experience, social skills, contacts, talents, intelligence – mention two or three of them)?
If you could pay yourself for the next 12 months, how much would you earn?
If I told you about a new and powerful idea, would you take a few minutes to learn more about it?
Did you do anything fun or exciting this summer?
What trips/vacations do you have coming up?
What's your biggest goal in the next 5 years? What's your plan to get you there?
I've just partnered up with some amazing people helping me earn multiple streams of income– if I shoot you a short video, will you take a look at it today?
Are you open to looking at other ways to grow your income?
Do you know anyone that is looking to achieve better health in their life?
PROSPECT: Yes! I've lived here all my life, I love it- but it's expensive!
YOU: Oh man! I've heard that- it's expensive here in Toronto too- the way the world is going thought I think- up to us to do something different- I had to change a little while ago too! What do you do for work out there? And what do you want to be doing?
PROSPECT: Yeah I guess you're right! Well, I work in accounting at a firm out here. But honestly, I'd like to work for myself and I definitely want to be earning more money. I have 2 kids at home so my wife can't really work, she stays at home. We need my income so I can't really leae or change right now.
YOU: (Share your story here) Oh I understand- I was in the same boat, not a lot of time and not a lot of options or money to do anything different. I actually got introduced to an amazing mentor a little while back through a friend of mine, changed everything and now I'm earning multiple streams of income and learning how to grow with an amazing team of people. Have you ever heard of a man named Bob Proctor and his wife Linda?
PROSPECT: Hmmm sounds familiar? What do you do exactly?
This may not be for you, but since you are in the same position I was looking for more, I'd love to help if I can!
PROSPECT: Wow sounds amazing! But what is it exactly?
YOU: An exciting new venture leveraging some of today's biggest trends, but don't worry- they have an awesome leadership team and free training program to help people (like me who knew nothing about this world before!) get started. The information I'll send will give you a great overview – then I can give you a quick call and introduce you to the person I'm learning from (he is amazing! Edify the 3way call leader here) and he can help answer any questions you might have!
PROSPECT: I'm really busy though, is this going to taky much time?
YOU: I completely understand- I'm in the same position, not a lot of free time. I think you'll see that this might be a real solution for you because of that! I'm sending a quick video on what we do and how it works- maybe 15 minutes max? Then I'll give you a call in the morning? How is 8am before work for you?
YOU: Ok so just to confirm your email is __________ and the best phone number to call you tomorrow at 8am is ________? Correct?
YOU: Great, enjoy the info – I think you'll be excited to see how this might be a great solution for what you're looking to do- I'm sure glad I jumped on board and we are just getting started! and I'll speak to you tomorrow at 8! Have a great rest of the day.
Make sure you are only sending what they want to know eg. If they want to earn money, use some of our business opportunity links. If they want to lose weight, or they want to buy essential oils, send them a video on the products.
Make sure videos are specific to their region eg. Zija123 is great for North Americans but not as well received in Europe or Australia. And not all products are available in each region either. Do some homework, or as you are learning, ask your upline.
Products are also a great tool to PASS- If in person, a sachet of Xm+ along with some information on the benefits of our Moringa can be a great introduction to what we do!
* For WEIGHT LOSS specifically, and the NHR 90 Day transformation program we have a Facebook group where you can follow the ATM method (ADD, TAG, MESSAGE).
Step 2. The TAG them on the pinned post (like you will see others have done before you).
Step 3. Then Private MESSAGE or CALL them if you have their number to help them choose their products or pack and get them started!
Remember, before you send any information or videos, have the follow up call, 3-way or event booked with them so you have a short deadline to ensure they move through the funnel of exposures. And, the more you share information and videos, the more people you will have to follow up with and the more you'll have getting started – it's a numbers game!
Finally, you want to make sure you are connecting your prospect to someone other than you. We know how great you are! BUT it always helps your credibility to have someone else demonstrate support to the newest person looking at this AND to edify you and what you're doing so they are excited to join you!
There are other people like the prospect building business – makes it relatable!
Q. How do we do this? It's Easy!
After you have PIQUED their interest and PASSED some information or video, then you want to PLUG (quickly) into the upline or team support connection call. So if you haven't already, find out a couple of options for times that work for your prospect in the next 24-28 hours for 10 minutes.
"When in the next day or 2 are you free for 5-10 minutes to jump on a call with (previously edified upline or support) so we can get your questions answered and we can go from there?
This makes them feel at ease, excited to meet someone like them and prepared to have any questions ready from the videos they have watched.
The upline or support on this call does not need to be way upline. It should be someone similar to your prospect so your prospect can relate and as long as they have had some sort of results so far either on the products or they've earned a paycheck, they can help paint the vision for the newest person and make them feel a part of something on the call.
" Hey ________! I know you're really looking to earn more money, leave your job, have more time with your family and now you've seen some information now and checked out the business/products. I'd love to invite you to meeting some of the people I'm working with and hear another perspective. We've got some amazing stories on the team from all different backgrounds on a call/coming to our event tomorrow at 7pm.
If they are not available, revert to 3way connection call as time schedule might be an issue and 3way calls are easily scheduled anytime! Don't leave it in the air for them to make the next move- chances are they won't. You have to own this process and keep them moving through exposures until they make a decision.
If NO or NOT YET- ask them what else they might like to see and arrange immediately, another perspective, more information etc or if they just want 'time' to make a decision, book a follow up in a few days with them to call back and check in.
"Great, I'll check in with you early next week on Monday around 4pm (use agreed upon time). Is there anything else I can send you information-wise while you are having a thing that might help you make a decision either way? Is there something in particular you are concerned or worried about? (make sure to send whatever might help them here). And Finally… While you are having a think, you might be inclined to ask someone else's opinion on your goals and what you're wanting to do. Know that not everyone is willing to go out there and do something about their goals, and those who don't often have an opinion about those who do. I love what Bob says- If you accept someone's opinion, you'd better be ready to accept their lifestyle. So, while they might have your best intentions at heart, they just may not have all the information based on their own preconceived ideas or limitations.
Then make sure you put the follow up in your calendar and you deliver on your promise!


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Topical ciclosporin in the treatment of ocular surface disorders
S Tatlipinar1,2,
E K Akpek1
1The Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
2Department of Ophthalmology, Pamukkale University School of Medicine, Denizli, Turkey
Correspondence to: Esen Karamursel Akpek MD, Ocular Surface and Dry Eye Clinic, The Wilmer Eye Institute, 600 North Wolfe Street, Maumenee Building 317, Baltimore, MD 21287–9238, USA; esakpekjhmi.edu
Mounting evidence suggests that inflammation is the key factor in the pathogenesis of various ocular surface diseases, with a complex interplay of genetic, environmental, and psychosocial factors. Management of these conditions is often challenging. Topical corticosteroids, with their associated side effects, are the mainstay of current treatments for patients with vision threatening disease. Ciclosporin A is an immunomodulator that specifically inhibits T lymphocyte proliferation. Recently, a topical ciclosporin preparation was approved by the US Food and Drug Administration and became available for use in ophthalmology. Given the increasing use of ciclosporin eye drops, the goal of this article is to provide the reader with an overview of the well established uses of ciclosporin and to help refine the questions that should be addressed by future investigations.
CsA, ciclosporin A
IL-2, interleukin-2
PUK, peripheral ulcerative keratitis
ciclosporin A
vernal keratoconjunctivitis
atopic keratoconjunctivitis
Thygeson's superficial punctate keratitis
ligneous conjunctivitis
superior limbic keratoconjunctivitis
http://dx.doi.org/10.1136/bjo.2005.070888
The ocular surface encompasses the entire epithelial surface of the cornea, limbus, and conjunctiva. The primary purpose of this functional unit is to maintain corneal clarity, a critical component of the eye's optical system. Even a small change in corneal clarity, such as a less than adequate tear film, can lead to visual disturbances.
Ocular surface diseases are a large group of disorders with a variety of aetiologies, symptoms, and clinical findings. These disorders range from simple meibomian gland dysfunction, with excellent prognosis, to Stevens-Johnson syndrome, which can cause permanent scarring of the conjunctiva, loss of corneal transparency and hence loss of vision, with considerable impairment in quality of life. Ironically, most patients with ocular surface disease have a healthy posterior segment with otherwise favourable visual prognosis.
Whatever the initial aetiological factor of ocular surface disease, once the disease has developed, inflammation becomes the key mechanism of injury to the ocular surface.1,2 There is a diversity of initiating insults, such as tear film insufficiency, chemical injury, or hypersensitivity mechanisms. When present, inflammation is augmented by mediators released from damaged cells and invading leucocytes. Hence, eyes with ocular surface disease may be trapped in a vicious cycle of inflammation and resultant injury.
Currently, the anti-inflammatory treatment of ocular surface disorders mainly relies on topical or systemic corticosteroids, which carry the risk of serious side effects. A topical ciclosporin A (CsA) preparation has recently become commercially available. CsA is an established immunomodulating drug that was originally used to prevent rejection after organ or tissue transplantation. Systemic CsA has also been employed as a treatment for a variety of autoimmune diseases, including those with ocular involvement.3–5
CsA is a neutral, hydrophobic, cyclic undecapeptide metabolite of the fungus Tolypocladium inflatum. Its major clinical effect is the perturbation of expression of interleukin-2 (IL-2) by helper T cells, preventing the proliferation of T cells.3 CsA was discovered in the early 1970s as an antifungal agent. Later, owing to its lack of bone marrow toxicity,6 it assumed a leading role in solid organ transplant surgery,7 with dramatically improved patient prognosis. In ophthalmology, topically applied CsA in various oil based solvents was first used to inhibit experimental corneal allograft reaction in the early 1980s8,9; this was followed by human studies.10 Later, the drug proved useful for patients with various inflammatory ocular surface disorders.11,12
The main problems with the eye drop preparation of CsA were sterility, pH, particles, and its lipophilic properties. A licensed topical CsA (0.2% in ointment form, Optimmune, Schering-Plough) has been available in veterinary ophthalmology for the treatment of canine keratoconjunctivitis sicca, but the introduction of a similar preparation for human pharmacy (0.05% eye drop form, Restasis, Allergan Inc) did not occur until April 2003. This preparation has now been approved by the Food and Drug Administration for use in the treatment of dry eye condition in humans. Given the increasing use of this product in patients by practising ophthalmologists for various indications, the goal of this analysis was to evaluate the peer reviewed published scientific literature, to define well established uses of CsA eye drops, and to help refine the important questions to be addressed by future investigations.
Dry eye syndrome is a common disorder of the tear film that results in epithelial damage and the disruption of normal homeostasis at the ocular surface. Clinical features of dry eye syndrome include an unstable tear film, ocular surface inflammation, and epitheliopathy, resulting in symptoms ranging from discomfort to blindness.13
Dry eye syndrome is widespread with as many as 25% of patients visiting ophthalmologists reporting dry eye symptoms.14 The current understanding of the pathogenesis of dry eye disease has proceeded from the mere recognition of a lack of, or altered quality of, tears to recognition of inflammation as the key pathogenetic mechanism, whether from a systemic autoimmune disease or a local autoimmune event.15 Inadequate tear production and low tear clearance, for whatever reason, lead to chronic inflammation of the ocular surface, mediated mainly by T lymphocytes.15 Moreover, the conjunctival T cell subpopulations do not differ significantly in Sjögren's syndrome and non-Sjögren's syndrome patients with dry eye.16 Androgens also represent an important trophic factor for the ocular surface, and their deficiency predisposes to inflammation from both lacrimal and meibomian gland dysfunction.17 Immune based inflammation can therefore interconnect and negatively reinforce these different pathogenetic mechanisms, resulting in a vicious cycle and subsequent ocular surface damage.
The traditional approach to treating dry eye has been to lubricate the ocular surface by replacing or conserving the patient's tears, without correcting the underlying disease process. Yet these treatments do not directly address the ocular surface inflammation.
Anti-inflammatory therapies are considered for patients with moderate to severe dry eye syndrome who continue to have symptoms or who have evidence of corneal disease on aqueous enhancement therapies. Several clinical studies have shown topical corticosteroids to improve both signs and symptoms of dry eye.18,19
In preliminary studies on small groups of patients, treatment with topical CsA improved the signs and symptoms of dry eye syndrome.20–22 Evidence of the inflammatory nature of dry eye syndrome and the success of the preliminary investigations led to large scale multicentre, randomised, placebo controlled, double masked, dose ranging clinical trials of the efficacy and safety of topical CsA therapy in moderate to severe dry eye syndrome. A CsA oil in water emulsion formulation significantly improved the ocular signs and symptoms of moderate to severe dry eye in patients with or without Sjögren's syndrome, and was found to be safe and well tolerated.23 In this phase 2 study, of the four different CsA dosing regimens (0.05%, 0.1%, 0.2%, and 0.4%), the 0.05% dose gave the most consistent improvement in symptoms. Following this study, the efficacy and safety of topical 0.05% and 0.1% CsA were compared with vehicle in patients with moderate to severe dry eye syndrome.24 As in the phase 2 study, both formulations were reported to be safe and effective, and the 0.05% formulation produced significantly greater improvements in signs (that is, corneal staining and Schirmer values) and symptoms (blurred vision, need for concomitant artificial tears, and the physician's evaluation of global response to treatment). The 877 patients (293 in the 0.05% CsA group, 292 in the 0.1% group, and 292 in the vehicle group) in the study were treated for 6 months. In addition, a subset of patients from the phase 3 study underwent conjunctival biopsy before and after treatment with topical CsA, in order to investigate the effect of treatment on ocular surface histopathology. An increase in goblet cell counts was reported in association with clinical improvement.25 Reduced numbers of activated lymphocytes in conjunctiva 26 and a decrease in IL-6 in conjunctival epithelium27 were also observed.
Evidence obtained from these studies supports the efficacy of topical CsA treatment through its immunomodulatory action and a possible direct lacrimogenic effect as shown in a canine model in reversing inflammation of the ocular surface and lacrimal glands and in improving the signs and symptoms of dry eye syndrome in patients with or without Sjögren's syndrome. However, the optimal dosing and required duration of treatment are not known.
Vernal keratoconjunctivitis is a severe, chronic allergic disorder, seen primarily in young males, often with a history of atopy. The hallmark sign of vernal keratoconjunctivitis is giant papillae on the upper tarsal conjunctiva, although in some patients limbal oedema may be predominant.
The disease tends to be self limited and frequently disappears after the teen age period, but a chronic, more severe form of disease can be seen in adults. In certain countries it is the most common form of conjunctivitis.28
The management of vernal keratoconjunctivitis is determined by the severity of involvement. Mast cell stabilisers are generally considered effective, based on studies from Europe and North America.29–31 However, results from the Middle East and Africa have not consistently shown benefit.32–34 Vision threatening corneal complications include central epithelial keratitis and shield-like ulcers. Topical steroids usually alleviate the acute symptoms,32 but unsupervised treatment leads to glaucoma and cataract formation in a significant proportion of patients.35 Particularly in the developing countries, vernal keratoconjunctivitis is considered a potentially blinding disease.36,37 The search for new, effective, safe treatments of this potentially blinding disease continues. Recently, a 2 week trial of topical 0.01% mitomycin C, four times daily, proved safe and effective in the treatment of patients with severe, blinding vernal keratoconjunctivitis resistant to topical steroids.38
The immunopathogenetic mechanism is complex and involves an IgE mediated immediate hypersensitivity response as well as a Th2 type of immune reaction.39,40
Multiple studies on the efficacy of topical CsA for treating vernal keratoconjunctivitis have consistently shown a beneficial effect of the drug.41–46 The improvement produced by topical CsA usually took an average of 2 weeks using 1% or 2% CsA in oil solvents, four times daily. The duration of treatment depends on the activity of the inflammation. No major adverse effect was reported, except for mild burning and stinging. A rebound phenomenon occurred soon after discontinuation of the treatment, indicating the need for a slow taper.41
Atopic keratoconjunctivitis is a bilateral, inflammatory external ocular disease that manifests in the context of atopic dermatitis. There appears to be an increasing incidence of atopic dermatitis worldwide in recent years,47 possibly because of increased exposure to airborne allergens or irritants. About 25% to 40% of patients with atopic dermatitis have ocular involvement.48
Atopic keratoconjunctivitis is the most important of the allergic ocular surface disorders, because of its chronic course and frequent corneal complications that can lead to permanent loss of vision.49–51 Unlike vernal keratoconjunctivitis, atopic keratoconjunctivitis can involve both upper and lower palpebral conjunctivae, with resultant scarring indistinguishable from other causes of cicatrising conjunctivitis.
The pathogenesis of atopic keratoconjunctivitis is not fully understood, but investigators have proposed a complex immunomodulatory dysfunction at the ocular surface, including type I and type IV hypersensitivity reactions52,53 with a predominantly Th1 cytokine profile, perhaps because of the chronicity of the disorder.54
Currently available therapies are aimed, at best, at relieving symptoms; there is no evidence for a significant effect on the disease course. Corticosteroids are the mainstay of treatment, with dramatic improvement in acute symptoms. However, the efficacy of steroids in preventing the crippling consequences of atopic keratoconjunctivitis is not known. Corneal complications are seen in up to 60% to 70% of patients.49,55 Despite a combination treatment with topical mast cell stabilisers + oral antihistamines + intermittent topical corticosteroid, about 30% of patients require corneal transplantation for visual or tectonic purposes.49 Also, resistance to topical steroids may necessitate systemic CsA therapy.56
In two prospective, randomised, double masked, placebo controlled trials, topical CsA was found to be an effective and safe treatment in both steroid dependent and steroid resistant cases of atopic keratoconjunctivitis.57,58 In the earlier study,57 21 patients used either topical 2% CsA or the vehicle alone four times daily for 3 months, in addition to their usual therapy with topical corticosteroids and/or mast cell stabilisers. The great majority of the treated patients were able to discontinue their topical steroid treatment. The later study58 included 20 patients with topical steroid resistant, severe atopic keratoconjunctivitis; they had moderately active disease despite topical steroid therapy with or without mast cell stabilisers. Treatment (CsA or placebo) lasted for 28 days with a dosing schedule of six times daily during the first 2 weeks and four times daily during the last 2 weeks. Significant improvement was observed in the CsA group, and none of these patients had a worsening of the disorder, in contrast with the placebo group.
Another study involving both atopic keratoconjunctivitis and vernal keratoconjunctivitis patients who had experienced no improvement with conventional therapy documented the beneficial effect of topical CsA as an additive treatment, with a reduced need for topical steroid use.59
Laboratory studies of the immunomodulatory effects of topical CsA in atopic keratoconjunctivitis have shown decreased numbers of leucocytes and CD4+ and IL-2 receptor positive T cells in conjunctival biopsy specimens of subjects with atopic keratoconjunctivitis following therapy.60
Topical CsA seems to be an effective steroid sparing agent in patients with severe atopic keratoconjunctivitis. However, its efficacy as a first line agent during long term treatment warrants additional studies.
NON-INFECTIOUS KERATITIS
Immune mediated, sterile central or paracentral corneal ulceration may develop in patients with connective tissue disease, most commonly in rheumatoid arthritis or Sjögren's disease. These conditions need to be distinguished from peripheral ulcerative keratitis (PUK), because PUK is essentially a vasculitis of limbal blood vessels and is considered to be associated with (re)activation of systemic illness.61 Central ulcerations or keratolysis, by contrast, are not associated with a limbal vasculitis.62 Immunohistochemical studies demonstrated infiltration with macrophages, T lymphocytes, and aberrant expression of HLA class II antigens, suggesting a cellular immune reaction targeted at the cornea.63,64
The treatment should be aimed at stopping melting and encouraging re-epithelialisation. In severe cases, with corneal melting and perforation, tissue adhesives may be used. Controlling the underlying illness is essential. However, unlike PUK, the central/paracentral ulcerations may not respond well to systemic immunosuppressive therapy.64,65
Several small, uncontrolled case series have reported the beneficial effect of topical CsA in treating paracentral corneal ulcers associated with connective tissue disease. In one study, topical 2% CsA, four times daily, was instituted in five patients with unilateral paracentral rheumatoid corneal ulceration who had not responded to systemic immunosuppression.64 Treatment resulted in an immediate arrest of keratolysis and re-epithelialisation. In another study, systemic immunosuppressive therapy either could not be initiated owing to a systemic contraindication or was discontinued because of side effects in five patients with collagen vascular diseases.65 The patients were treated with topical 2% or 0.5% CsA, four to six times daily. All but one of the eyes responded favourably with an intense neovascularisation within 48 hours of initiating treatment. In other small series sterile marginal corneal ulcers in the context of rheumatoid arthritis responded to use of 2% CsA eye drops twice daily with healing of the ulcers within several days.63,66
Observation of macrophages, T lymphocytes, and aberrant expression of HLA class II antigens in the corneal and conjunctival tissues of patients with immune corneal ulcers associated with collagen vascular disorders suggests a cellular immune reaction. However, the current clinical evidence supporting the role of topical CsA in the treatment is weak.
Thygeson's superficial punctate keratitis is a bilateral, idiopathic epithelial keratitis characterised by recurrent attacks of tearing, photophobia, blurred vision, and foreign body sensation.67 The classic finding is multiple corneal epithelial lesions that appear during the exacerbations of the disease.68 Although clinical features are similar to those of viral infections, responsiveness to corticosteroids suggests an immune process, perhaps a post-infectious delayed hypersensitivity.69 However, no infectious aetiology has yet been found.70
Mild cases are often treated with lubricants and bandage lenses.71,72 More symptomatic cases are generally treated with weak topical steroids.68 Recurrences are common following the cessation of therapy. Some patients may require regular steroid use for years.68
Reports have indicated that most patients with Thygeson's superficial punctate keratitis respond to topical CsA.73–75 In more than two thirds of the patients, topical CsA suppressed the epithelial and subepithelial opacities as long as the drug was administered. Recurrences occurred during the tapering off period. In one third of patients this therapy seemed to be curative. The results are encouraging and suggest that topical CsA may be a safe alternative to corticosteroids for the treatment of Thygeson's superficial punctate keratitis, particularly for patients who will require long term topical steroid treatment.
Ligneous conjunctivitis is a rare form of chronic conjunctivitis characterised by the development of firm, fibrin rich, woody-like pseudomembranous lesions mainly on the tarsal conjunctiva.76 Cornea may be involved secondarily, with scarring and vascularisation.
The disorder is generally bilateral, and the onset is frequently during childhood.77 The pseudomembranes are characterised by subepithelial deposition of amorphous hyaline material; a cellular component composed of lymphocytes, plasma cells, neutrophils, eosinophils, and mast cells; and neovascularisation. The amorphous material has been shown to contain fibrin(ogen), immunoglobulins, and albumin, suggesting an increased permeability of blood vessels.77 Histopathological findings from affected humans and (plasminogen deficient) mice indicate that wound healing, mainly in injured mucosal tissues, is impaired because of markedly decreased (plasmin mediated) extracellular fibrinolysis.78 Rare immunohistochemical studies have revealed a predominance of T cells,79,80 particularly with IL-2 receptor expression. The management of ligneous conjunctivitis is difficult, and no satisfactory treatment exists.
Several small, uncontrolled case series of CsA therapy have indicated improvement in patients with ligneous conjunctivitis that is refractory to other modes of treatment.79,81 However, contradictory reports also exist.80
Lichen planus is an inflammatory dermatosis of unknown aetiology that affects the skin and mucous membranes. Classic lesions appear as recurrent, violaceous, pruritic papules distributed symmetrically on the flexor surfaces of the extremities and trunk. These lesions are often accompanied by lesions of the oral, genital, and, rarely, ocular mucosa.82 Conjunctival lichen planus, albeit rare, can lead to irreversible damage to the ocular surface and loss of vision from corneal scarring.83,84
Although the pathogenesis is not fully understood, current findings suggest an autoimmune process mediated by T cells infiltrating the basement membrane and the basal layers of epithelium.
Most patients with skin involvement can be treated successfully with topical corticosteroids. Chronic, aggressive lesions may need additional therapy ranging from psoralen plus ultraviolet A to retinoids or CsA.85 Low dose systemic CsA may be required for patients with severe disease unresponsive to systemic steroids.86
Reported treatments of conjunctival lichen planus include CsA, mycophenolate mofetil, and azathioprine used systemically.83,87 Because of its ability to accelerate apoptosis in fibrotic tissues,88 topical CsA alone was used in a few patients having conjunctival involvement from lichen planus, and proved effective in controlling inflammation and scarring.84,89 In particular, patients with isolated lichen planus of the conjunctiva may be candidates for topical CsA treatment with or without topical corticosteroids.90
Superior limbic keratoconjunctivitis is a chronic, local ocular surface disease characterised by episodes of recurrent inflammation of the upper palpebral and superior bulbar conjunctivae, as well as of the superior limbus and cornea.91 The classic finding of this condition is bilateral local hyperaemia of the superior bulbar conjunctiva. Patients often complain of burning, foreign body sensation, and photophobia. The exact pathophysiology is unknown. A mechanical theory proposed soft tissue microtrauma between tarsal and bulbar surfaces and between conjunctival stroma and sclera.92
Topical CsA was reported to be helpful as a primary or adjunctive therapy for superior limbic keratoconjunctivitis in a single study involving five patients.93 In patients with concomitant dry eye and superior limbic keratoconjunctivitis, topical CsA may be used for both increasing tear production and controlling inflammation.
LESS COMMON USES OF TOPICAL CICLOSPORIN A
There are also several, unconfirmed small case series or case reports on the use of topical CsA in the treatment of Mooren's ulcer,94 Cogan syndrome,95 chronic sarcoidosis of the conjunctiva,96 conjunctival manifestations of actinic prurigo,97 keratitis of Senter syndrome (keratitis-ichthyosis deafness),98 delayed onset bilateral diffuse lamellar keratitis after laser in situ keratomileusis,99 and microcrystalline keratopathy caused by streptococcus.100 However, the evidence seems inadequate to justify the use of topical CsA in these conditions.
Topical CsA has been used in ophthalmology since the early 1980s. Based on the available evidence, CsA eye drops seem to be safe. No serious side effects were reported with the 0.05%, 0.5%, or 2% preparations, used for periods of up to 12 months. Current literature supports the efficacy of topical CsA in the treatment of various ocular surface disorders, particularly the dry eye syndrome and severe allergic keratoconjunctivitis. Future studies should be directed to comparing the efficacy of topical CsA with that of corticosteroids and to its ability to change the natural course of some of these disorders during longer term follow up.
Baudouin C. The pathology of dry eye. Surv Ophthalmol 2001;45:211–20.
Johnson ME, Murphy PJ. Changes in the tear film and ocular surface from dry eye syndrome. Prog Retin Eye Res 2004;23:449–74.
Nussenblatt RB, Palestine AG. Cyclosporin: immunology, pharmacology and therapeutic uses. Surv Ophthalmol 1986;31:159–69.
Belin MW, Bouchard CS, Phillips TM. Update on topical cyclosporin A: background, immunology, and pharmacology. Cornea 1990;9:184–95.
Williams DL. A comparative approach to topical cyclosporin therapy. Eye 1997;11:453–64.
Borel JF, Feurer C, Gubler HU, et al. Biological effects of cyclosporin A: a new antilymphocytic agent. Agents Actions 1976;6:468–75.
Calne RY, White DJ, Thiru S, et al. Cyclosporin A in patients receiving renal allografts from cadaver donors. Lancet 1978;2:1323–7.
Coster DJ, Shepherd WF, Fook TC, et al. Prolonged survival of corneal allografts in rabbits treated with cyclosporin A. Lancet. 1979;2 :688–9.
Hunter PA, Wilhelmus KR, Rice NS, et al. Cyclosporin A applied topically to the recipient eye inhibits corneal graft rejection. Clin Exp Immunol 1981;45:173–7.
Hoffmann F, Wiederholt M. [Local treatment of corneal transplants in the human with cyclosporin A. ] Klin Monatsbl Augenheilkd 1985;187:92–6.
Holland EJ, Olsen TW, Ketcham JM, et al. Topical cyclosporin A in the treatment of anterior segment inflammatory disease. Cornea 1993;12:413–9.
Gunduz K, Ozden O. Therapeutic use of topical cyclosporine. Ann Ophthalmol 1993;25:182–6.
Lemp MA. Report of the National Eye Institute/Industry Workshop on Clinical Trials in Dry Eyes. CLAO J 1995;21:221–32.
Doughty MJ, Fonn D, Richter D, et al. A patient questionnaire approach to estimating the prevalence of dry eye symptoms in patients presenting to optometric practices across Canada. Optom Vis Sci 1997;74:624–31.
Stern ME, Gao J, Siemasko KF, et al. The role of the lacrimal functional unit in the pathophysiology of dry eye. Exp Eye Res 2004;78:409–16.
Stern ME, Gao J, Schwalb TA, et al. Conjunctival T-cell subpopulations in Sjogren's and non-Sjogren's patients with dry eye. Invest Ophthalmol Vis Sci 2002;43:2609–14.
Sullivan DA, Wickham LA, Rocha EM, et al. Androgens and dry eye in Sjogren's syndrome. Ann N Y Acad Sci 1999;876:312–24.
Marsh P, Pflugfelder SC. Topical nonpreserved methylprednisolone therapy for keratoconjunctivitis sicca in Sjogren syndrome. Ophthalmology 1999;106:811–6.
Sainz De La Maza Serra M, Simon Castellvi C, Kabbani O. Nonpreserved topical steroids and lacrimal punctal occlusion for severe keratoconjunctivitis sicca. Arch Soc Esp Oftalmol 2000;75:751–6.
Laibovitz RA, Solch S, Andriano K, et al. Pilot trial of cyclosporin 1% ophthalmic ointment in the treatment of keratoconjunctivitis sicca. Cornea 1993;12:315–23.
Power WJ, Mullaney P, Farrell M, et al. Effect of topical cyclosporin A on conjunctival T cells in patients with secondary Sjogren's syndrome. Cornea 1993;12:507–11.
Gunduz K, Ozdemir O. Topical cyclosporin treatment of keratoconjunctivitis sicca in secondary Sjogren's syndrome. Acta Ophthalmol (Copenh) 1994;72:438–42.
Stevenson D, Tauber J, Reis BL. Efficacy and safety of cyclosporin A ophthalmic emulsion in the treatment of moderate-to-severe dry eye disease: a dose-ranging, randomized trial. The Cyclosporin A Phase 2 Study Group. Ophthalmology 2000;107:967–74.
Sall K, Stevenson OD, Mundorf TK, et al. Two multicenter, randomized studies of the efficacy and safety of cyclosporin ophthalmic emulsion in moderate to severe dry eye disease. CsA Phase 3 Study Group. Ophthalmology 2000;107:631–9.
Kunert KS, Tisdale AS, Gipson IK. Goblet cell numbers and epithelial proliferation in the conjunctiva of patients with dry eye syndrome treated with cyclosporin. Arch Ophthalmol 2002;120:330–7.
Kunert KS, Tisdale AS, Stern ME, et al. Analysis of topical cyclosporin treatment of patients with dry eye syndrome: effect on conjunctival lymphocytes. Arch Ophthalmol 2000;118:1489–96.
Turner K, Pflugfelder SC, Ji Z, et al. Interleukin-6 levels in the conjunctival epithelium of patients with dry eye disease treated with cyclosporin ophthalmic emulsion. Cornea 2000;19:492–6.
Ukponmwan CU. Vernal keratoconjunctivitis in Nigerians: 109 consecutive cases. Trop Doct 2003;33:242–5.
El Hennawi M. A double blind placebo controlled group comparative study of ophthalmic sodium cromoglycate and nedocromil sodium in the treatment of vernal keratoconjunctivitis. Br J Ophthalmol 1994;78:365–9.
Bonini S, Barney NP, Schiavone M, et al. Effectiveness of nedocromil sodium 2% eyedrops on clinical symptoms and tear fluid cytology of patients with vernal conjunctivitis. Eye 1992;6:648–52.
Foster CS. Evaluation of cromolyn sodium in the treatment of vernal keratoconjunctivitis. Ophthalmology 1988;95:194–201.
Resnikoff S, Cornand G, Filliard G, et al. Limbal vernal keratoconjunctivitis in the tropics. Rev Int Trach Pathol Ocul Trop Subtrop Sante Publique 1988;65:21–72.
Baryishak YR, Zavaro A, Monselise M, et al. Vernal keratoconjunctivitis in an Israeli group of patients and its treatment with sodium cromoglycate. Br J Ophthalmol 1982;66:118–22.
Abiose A. Paediatric ophthalmic problems in Nigeria. J Trop Pediatr 1985;31:30–5.
Tabbara KF. Ocular complications of vernal keratoconjunctivitis. Can J Ophthalmol 1999;34:88–92.
Tabbara KF, Ross-Degnan D. Blindness in Saudi Arabia. JAMA 1986;255:3378–84.
Herse P, Gothwal VK. Survey of visual impairment in an Indian tertiary eye hospital. Indian J Ophthalmol 1997;45:189–93.
Akpek EK, Hasiripi H, Christen WG, et al. A randomized trial of low-dose, topical mitomycin-C in the treatment of severe vernal keratoconjunctivitis. Ophthalmology 2000;107:263–9.
Abu el-Asrar AM, Van den Oord JJ, Geboes K, et al. Immunopathological study of vernal keratoconjunctivitis. Graefes Arch Clin Exp Ophthalmol 1989;227:374–9.
El-Asrar AM, Tabbara KF, Geboes K, et al. An immunohistochemical study of topical cyclosporin in vernal keratoconjunctivitis. Am J Ophthalmol 1996;121:156–61.
BenEzra D, Pe'er J, Brodsky M, et al. Cyclosporin eyedrops for the treatment of severe vernal keratoconjunctivitis. Am J Ophthalmol 1986;101:278–82.
Secchi AG, Tognon MS, Leonardi A. Topical use of cyclosporin in the treatment of vernal keratoconjunctivitis. Am J Ophthalmol 1990;110:641–5.
Bleik JH, Tabbara KF. Topical cyclosporin in vernal keratoconjunctivitis. Ophthalmology 1991;98:1679–84.
Avunduk AM, Avunduk MC, Erdol H, et al. Cyclosporin effects on clinical findings and impression cytology specimens in severe vernal keratoconjunctivitis. Ophthalmologica 2001;215:290–3.
Pucci N, Novembre E, Cianferoni A, et al. Efficacy and safety of cyclosporin eyedrops in vernal keratoconjunctivitis. Ann Allergy Asthma Immunol 2002;89:298–303.
Cetinkaya A, Akova YA, Dursun D, et al. Topical cyclosporin in the management of shield ulcers. Cornea 2004;23:194–200.
Hanifin JM. Epidemiology of atopic dermatitis. Monogr Allergy 1987;21:116–31.
Garrity JA, Liesegang TJ. Ocular complications of atopic dermatitis. Can J Ophthalmol 1984;19:19–24.
Power WJ, Tugal-Tutkun I, Foster CS. Long-term follow-up of patients with atopic keratoconjunctivitis. Ophthalmology 1998;105:637–42.
Belfort R, Marbeck P, Hsu CC, et al. Epidemiological study of 134 subjects with allergic conjunctivitis. Acta Ophthalmol Scand Suppl 2000;230:38–40.
Tuft SJ, Kemeny DM, Dart JK, et al. Clinical features of atopic keratoconjunctivitis. Ophthalmology 1991;98:150–8.
Foster CS, Rice BA, Dutt JE. Immunopathology of atopic keratoconjunctivitis. Ophthalmology 1991;98:1190–6.
Metz DP, Hingorani M, Calder VL, et al. T-cell cytokines in chronic allergic eye disease. J Allergy Clin Immunol 1997;100:817–24.
Calder VL, Jolly G, Hingorani M, et al. Cytokine production and mRNA expression by conjunctival T-cell lines in chronic allergic eye disease. Clin Exp Allergy 1999;29:1214–22.
Foster CS, Calonge M. Atopic keratoconjunctivitis. Ophthalmology 1990;97:992–1000.
Hoang-Xuan T, Prisant O, Hannouche D, et al. Systemic cyclosporine A in severe atopic keratoconjunctivitis. Ophthalmology 1997;104:1300–5.
Hingorani M, Moodaley L, Calder VL, et al. A randomized, placebo-controlled trial of topical cyclosporin A in steroid-dependent atopic keratoconjunctivitis. Ophthalmology 1998;105:1715–20.
Akpek EK, Dart JK, Watson S, et al. A randomized trial of topical cyclosporin 0.05% in topical steroid-resistant atopic keratoconjunctivitis. Ophthalmology 2004;111:476–82.
Tomida I, Schlote T, Brauning J, et al. [Cyclosporin A 2% eyedrops in therapy of atopic and vernal keratoconjunctivitis.] Ophthalmologe 2002;99:761–7.
Hingorani M, Calder VL, Buckley RJ, et al. The immunomodulatory effect of topical cyclosporin A in atopic keratoconjunctivitis. Invest Ophthalmol Vis Sci 1999;40:392–9.
Foster CS, Forstot SL, Wilson LA. Mortality rate in rheumatoid arthritis patients developing necrotizing scleritis or peripheral ulcerative keratitis: effects of systemic immunosuppression. Ophthalmology 1984;91:1253–63.
Pfister RR, Murphy GE. Corneal ulceration and perforation associated with Sjogren's syndrome. Arch Ophthalmol 1980;98:89–94.
Zierhut M, Thiel HJ, Weidle EG, et al. Topical treatment of severe corneal ulcers with cyclosporin A. Graefes Arch Clin Exp Ophthalmol 1989;227:30–5.
Kervick GN, Pflugfelder SC, Haimovici R, et al. Paracentral rheumatoid corneal ulceration: clinical features and cyclosporin therapy. Ophthalmology 1992;99:80–8.
Gottsch JD, Akpek EK. Topical cyclosporin stimulates neovascularization in resolving sterile rheumatoid central corneal ulcers. Trans Am Ophthalmol Soc 2000;98:81–7.
Liegner JT, Yee RW, Wild JH. Topical cyclosporin therapy for ulcerative keratitis associated with rheumatoid arthritis. Am J Ophthalmol 1990;109:610–2.
Thygeson P. Superficial punctate keratitis. JAMA 1950;144:1544–9.
Nagra PK, Rapuano CJ, Cohen EJ, et al. Thygeson's superficial punctate keratitis: ten years' experience. Ophthalmology 2004;111:34–7.
Hardten DR, Doughman DJ, Holland EJ, et al. Persistent superficial punctate keratitis after resolution of chlamydial follicular conjunctivitis. Cornea 1992;11:360–3.
Reinhard T, Roggendorf M, Fengler I, et al. PCR for varicella zoster virus genome negative in corneal epithelial cells of patients with Thygeson's superficial punctate keratitis. Eye 2004;18:304–5.
Goldberg DB, Schanzlin DJ, Brown SI. Management of Thygeson's superficial punctate keratitis. Am J Ophthalmol 1980;89:22–4.
Forstot SL, Binder PS. Treatment of Thygeson's superficial punctate keratopathy with soft contact lenses. Am J Ophthalmol 1979;88:186–9.
Reinhard T, Sundmacher R. [Local cyclosporin A therapy in Thygeson superficial punctate keratitis--a pilot study. ] Klin Monatsbl Augenheilkd 1996;209:224–7.
Reinhard T, Sundmacher R. Topical cyclosporin A in Thygeson's superficial punctate keratitis. Graefes Arch Clin Exp Ophthalmol 1999;237:109–12.
Del Castillo JM, Del Castillo JB, Garcia-Sanchez J. Effect of topical cyclosporin A on Thygeson's superficial punctate keratitis. Doc Ophthalmol 1996–97;93:193–8.
Schuster V, Seregard S. Ligneous conjunctivitis. Surv Ophthalmol 2003;48:369–88.
Hidayat AA, Riddle PJ. Ligneous conjunctivitis: a clinicopathologic study of 17 cases. Ophthalmology 1987;94:949–59.
Watts P, Suresh P, Mezer E, et al. Effective treatment of ligneous conjunctivitis with topical plasminogen. Am J Ophthalmol 2002;133:451–5.
Holland EJ, Chan CC, Kuwabara T, et al. Immunohistologic findings and results of treatment with cyclosporin in ligneous conjunctivitis. Am J Ophthalmol 1989;107:160–6.
Rao SK, Biswas J, Rajagopal R, et al. Ligneous conjunctivitis: a clinicopathologic study of 3 cases. Int Ophthalmol 1998–99;22:201–6.
Rubin BI, Holland EJ, de Smet MD, et al. Response of reactivated ligneous conjunctivitis to topical cyclosporin. Am J Ophthalmol 1991;112:95–6.
Boyd AS, Neldner KH. Lichen planus. J Am Acad Dermatol 1991;25:593–619.
Thorne JE, Jabs DA, Nikolskaia OV, et al. Lichen planus and cicatrizing conjunctivitis: characterization of five cases. Am J Ophthalmol 2003;136:239–43.
Neumann R, Dutt CJ, Foster CS. Immunohistopathologic features and therapy of conjunctival lichen planus. Am J Ophthalmol 1993;115:494–500.
Oliver GF, Winkelmann RK. Treatment of lichen planus. Drugs 1993;45:56–65.
Levell NJ, Munro CS, Marks JM. Severe lichen planus clears with very low-dose cyclosporin. Br J Dermatol 1992;127:66–7.
Crompton DO. Immuno-suppressive drug treatment of keratitis sicca, including an example of lichen planus of the conjunctiva. Aust N Z J Surg 1968;38:143–6.
Leonardi A, DeFranchis G, Fregona IA, et al. Effects of cyclosporin A on human conjunctival fibroblasts. Arch Ophthalmol 2001;119:1512–7.
Rhee MK, Mootha VV. Bilateral keratoconjunctivitis associated with lichen planus. Cornea 2004;23:100–5.
Pakravan M, Klesert T, Akpek EK. Isolated conjunctival lichen planus. Cornea. (in press).
Theodore FH. Further observations on superior limbic keratoconjunctivitis. Trans Am Acad Ophthalmol Otolaryngol 1967;71:341–51.
Cher I. Superior limbic keratoconjunctivitis: multifactorial mechanical pathogenesis. Clin Experiment Ophthalmol 2000;28:181–4.
Perry HD, Doshi-Carnevale S, Donnenfeld ED, et al. Topical cyclosporin A 0.5% as a possible new treatment for superior limbic keratoconjunctivitis. Ophthalmology 2003;110:1578–81.
Zhao JC, Jin XY. Immunological analysis and treatment of Mooren's ulcer with cyclosporin A applied topically. Cornea 1993;12:481–8.
Shimura M, Yasuda K, Fuse N, et al. Effective treatment with topical cyclosporin A of a patient with Cogan syndrome. Ophthalmologica 2000;214:429–32.
Akpek EK, Ilhan-Sarac O, Green WR. Topical cyclosporin in the treatment of chronic sarcoidosis of the conjunctiva. Arch Ophthalmol 2003;121:1333–5.
McCoombes JA, Hirst LW, Green WR. Use of topical cyclosporin for conjunctival manifestations of actinic prurigo. Am J Ophthalmol 2000;130:830–1.
Derse M, Wannke E, Payer H, et al. [Successful topical cyclosporin A in the therapy of progressive vascularising keratitis in keratitis-ichthyosis-deafness (KID) syndrome (Senter syndrome).] Klin Monatsbl Augenheilkd 2002;219:383–6.
Chung MS, Pepose JS, El-Agha MS, et al. Confocal microscopic findings in a case of delayed-onset bilateral diffuse lamellar keratitis after laser in situ keratomileusis. J Cataract Refract Surg 2002;28:1467–70.
Touzeau O, Borderie V, Razavi S, et al. [Use of topical cyclosporin in microcrystalline keratopathy due to streptococcus.] J Fr Ophtalmol 1999;22:662–5.
Dr Akpek received unrestricted research grant from Allergan Inc, Irvine, CA (see reference 58). She is supported in part by a William and Mary Greve Scholarship from Research to Prevent Blindness.
Competing interests: none declared


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text:
Q: Администратор Django может удалить себя Две связанные задачи:

*

*суперпользователь Django не должен иметь возможности удалить себя;

*суперпользователь не должен иметь возможность отключить свои
привилегии.

A: Решение сделал, но не уверен, что лучшим образом, странно, что не могу найти готового решения. Предложения приветствуются.
admin.py
from django.contrib.auth.models import User, Group
from django.contrib.auth.admin import UserAdmin

admin.site.unregister(Group)
admin.site.unregister(User)

@admin.register(User)
class CustomUserAdmin(UserAdmin):
    fieldsets = (
        (None, {'fields': ('username', 'password')}),
        (_('Personal info'), {'fields': ('first_name', 'last_name', 'email')}),
        (_('Permissions'), {'fields': ('is_active', 'is_staff', 'is_superuser',)}),
    )
    def save_model(self, request, obj, form, change):
        if obj.id == request.user.id and request.user.is_superuser:
            obj.is_superuser = True
            obj.is_active = True
            obj.is_staff = True
        super().save_model(request, obj, form, change)
    def has_delete_permission(self, request, obj=None):
        return (request.user.id != obj.id) if obj else True

Таким образом скрыты группы пользователей, доступ к разным типам контента, администратор не может удалить себя и видит поля ['is_superuser', 'is_active', 'is_staff'], может изменять их для других, но не может сохранить отключение прав для себя.

redpajama_set_name: RedPajamaStackExchange


REACTION SEQUENCES IN THE REDUCTION OF ILMENITE - 1 .
Detailed studies have been made of three aspects of ilmenite reduction - isothermal reduction with carbon monoxide gas; reduction in a commercial rotary kiln; and the phase equilibria at 1200 .
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Reduction Of Ilmenite Sand In Tunnel Kiln (SL/RN) process is a widely used coal-based DRI beach sand or ilmenite ore and solid carbon This is the most widely used coal based direct reduction . Chat Online; vietnam anthracite drying kiln method-Yantai .
Reduction of ilmenite with simultaneous lignite .
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Ilmenite processing into its constituents - sources of .
the sand passing through spirals. Because of the differences in density between the ilmenite and sand, the denser ilmenite moves to the outside and can then be skimmed off.
reduction of ilmenite sand in tunnel kiln – Grinding Mill .
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(PDF) Preoxidation and hydrogen reduction of ilmenite in a .
Vijay et al.  investigated the reduction of ilmenite beach sand with hydrogen in a fluidized bed reactor and found that the reduction period could be divided into three stages: an initial slow .
Kinetics of Direct Reduction Titanomagnetite Concentrate .
solid state carbothermic reduction in rotary-kiln is relatively slow with high-energy consumption and narrow . have investigated the reduction of Quilon ilmenite beach sand with hydrogen in a fluidized bed reactor and found that the reduction period could be divided into three distinct stages: initialslow induction . Kinetics of Direct .
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A thermochemical and experimental study for the conversion .
In the Becher process, ilmenite is heated in air in a rotary kiln to oxidize the iron to Fe 3+. This allows the treatment of weathered ilmenites with a wide range of Fe 2+ /Fe 3+ ratios by converting them to a uniform material more suited to the subsequent reduction step, as represented by Eq.
Nov 11, 2015 · By using tunnel kiln to produce DRI is that mix the iron ore concentrate, pulverized coal and limestone powder with certain proportion and feed into material barrel for being reduction, and then put these drums on the kiln car and pushed it into the tunnel kiln, when the.


Imagine a future in which the "carbon emissions" of everything you do — literally everything — are tracked, monitored, and controlled by a global authority. Each nation has been allocated a "carbon budget" by this global authority based on its historical emissions. America, which industrialized early on, has a tiny budget, while India, where most people still live in appalling conditions, would have a somewhat larger one. National governments, which serve as administrative units for global and regional authorities, have divided up their carbon budgets among their populations. No more than one child per family is allowed, a policy pioneered by the Communist Chinese dictatorship, which top United Nations climate bureaucrats often tout as a model of climate sense and sustainability. If you exceed your carbon budget, watch out.
A crucial component of the "New World Order" sought by globalists, as well as a key justification for it all, is the global environment and the climate. The argument is essentially that the climate and the environment do not respect borders, so governance must be globalized too. When it comes to imposing "global governance" on humanity, the UN and the establishment behind it have three primary agreements and mechanisms to underpin it all: Agenda 2030, Agenda 21, and the Paris Agreement on climate change. All three are interrelated under the banner of "sustainable development," but each has its own unique role to play. Taken together, though, it is clear that concerns about the "global environment" represent one of the pillars upon which the edifice of "global governance" is being built. And unfortunately for Americans, the trio of global schemes is still being implemented domestically.
The UN Agenda 2030, often dubbed the Sustainable Development Goals (SDGs) or the Post-2015 Agenda, is one of the international agreements being used to impose a global government on humanity. Adopted in September of 2015, the deal, formally entitled "Transforming Our World: the 2030 Agenda for Sustainable Development," calls for radical, centrally directed changes in the lives of every person on the planet. There are 17 "Goals" in all, with 169 "targets," that, taken together, would replace liberty, self-government, free markets, and nationhood with totalitarian technocratic rule at the global level. Reading the document, that much becomes clear.
The specifics are even more troubling. In fact, as this magazine documented extensively in a January 2016 special report, Agenda 2030 is essentially a road map to global totalitarian rule over humanity. For instance, in Goal 4, Agenda 2030 demands the indoctrination of all children worldwide, with kids described in the agreement as "critical agents of change" who will rely on the Sustainable Development Goals to "channel their infinite capacities for activism into the creation of a better world." Indeed, children worldwide must be so thoroughly indoctrinated that they will not just submit to the UN ideology known as "sustainable development," but actually go out and "promote" it. "By 2030, ensure that all learners acquire the knowledge and skills needed to promote sustainable development, including, among others, through education for sustainable development and sustainable lifestyles," Goal 4 explains, adding that children must also be indoctrinated into "global citizenship" and the UN's perverse view of "human rights" that is totally at odds with the God-given rights recognized by America's Founders.
The UN Agenda 2030 mandates national and international wealth redistribution, too. Goal 10 commits to "reduce inequality within and among countries." (Emphsis added.) That, the agreement continues, will "only be possible if wealth is shared and income inequality is addressed." Also part of the plan is to "ensure that all men and women, in particular the poor and the vulnerable, have equal rights to economic resources," Agenda 2030 continues. This is, of course, the language used by communists and socialists for more than a century, and now it is enshrined into what globalists dub "international law." But even wealth redistribution is just the socialist start; the governments agreed to take control over the means of production: "We commit to making fundamental changes in the way that our societies produce and consume goods and services." Government-controlled "universal health coverage" and "vaccines for all" are also mandated.
While many conservatives believed the election of Donald Trump meant the excesses of the Obama years were over, vast swaths of the federal bureaucracy are still implementing Agenda 2030 and the rest of the UN's globalist agenda. In 2011 and again in 2016, the Obama administration's Environmental Protection Agency (EPA) quietly signed a deal with the United Nations Environment Programme (UNEP), vowing to cooperate on everything from climate-change "education" to imposing UN Agenda 2030. The EPA-UNEP agreement, which went almost entirely unnoticed until now, bypassed normal constitutional and legislative procedures and facilitates what one leading critic described as the "globalization" of the U.S. government. And so even while President Donald Trump has announced that America would withdraw from the UN Paris Agreement on "global warming" and other UN schemes, federal bureaucrats are still dutifully working to implement them all.
It was not immediately clear how the EPA under the Trump administration was dealing with the MOU. But according to the terms of the scheme and an official at the agency who e-mailed The New American, it will remain in force for five years from the date it was signed, with the option to extend it at any point prior to its expiration. The EPA acknowledged receipt of questions from The New American, including a question on whether the scheme was still in force under Trump, but the agency did not offer much in the way of answers, only saying that it was still active while referring questions on substance to other bureaucracies.
"Effective execution of AGENDA 21 will require a profound reorientation of all human society, unlike anything the world has ever experienced — a major shift in the priorities of both governments and individuals and an unprecedented redeployment of human and financial resources," continues the document. "This shift will demand that a concern for the environmental consequences of every human action be integrated into individual and collective decision-making at every level…. There are specific actions which are intended to be undertaken by multinational corporations and entrepreneurs, by financial institutions and individual investors, by high-tech companies and indigenous people, by workers and labor unions, by farmers and consumers, by students and schools, by governments and legislators, by scientists, by women, by children — in short, by every person on Earth." Obviously, that means you, too.
Top globalists at the summit made that agenda clear from the podium, too. Maurice Strong, who served as the secretary-general of the UN's Earth Summit that developed Agenda 21, framed the "sustainable development" agenda starkly. "Current lifestyles and consumption patterns of the affluent middle class — involving high meat intake, use of fossil fuels, appliances, home and work air conditioning, and suburban housing are not sustainable," he said. No word on whether the fancy UN conferences funded by taxpayers in exotic locations, where globalists arrive in fleets of private jets, are to be considered sustainable.
Much of Agenda 21 policy has been imposed on local communities via the UN-linked group ICLEI — Local Governments for Sustainability. On its website, the outfit boasted of its role, saying it works to "mobilize local governments to help their countries implement multilateral environmental agreements." The group also works to "connect cities and local governments to the United Nations and other international bodies." One of ICLEI's programs is "designed to aid local governments in implementing Chapter 28 of Agenda 21, the global action plan for sustainable development," the group revealed on its website. Essentially, through ICLEI and other front groups, as well as federal government bribes and pressure, the UN has been getting its agenda implemented even in small-town America by clueless local authorities. While The John Birch Society and others have greatly slowed down the implementation of this UN program, it continues to be implemented across America and worldwide.
In Agenda 2030, Goal 13 is: "Take urgent action to combat climate change." The targets under Goal 13 include more climate indoctrination of children, trillions of dollars in wealth redistribution from the poor and middle class in the West to the kleptocrats ruling Third World countries, and more. The UN agreement also touts the UN "Framework Convention on Climate Change" (UNFCCC) as "the primary international, intergovernmental forum for negotiating the global response to climate change." And for now, at least, the Paris Agreement, negotiated at the UNFCCC event in Paris is the primary mechanism to make that happen. That is both good news and bad news for those who oppose the UN's scheming.
In the final weeks of 2015, the UN and its member governments, including then-U.S. President Barack Obama, came together in the French capital to sign the Paris Agreement. This writer was there as a correspondent for The New American. Of course, Obama and the globalists at the summit knew the global scheme would never be ratified by the U.S. Senate as required by the U.S. Constitution of all treaties. And so, instead, Obama called it an "executive agreement" and ordered federal agencies to implement it by regulation and executive decree. All of it was done under the guise of stopping global temperatures from rising more than two degrees over pre-industrial levels, as if the UN had any idea how temperatures would be affected. In the real world, the UN and its climate prophecies have been wildly and consistently wrong.
Among the radical goals of the agreement was the restructuring of the global economy, as multiple UN bigwigs explained publicly. The goal of the climate negotiations was to "intentionally transform the economic development model, for the first time in human history," said then-UN climate czarina Christiana Figueres, echoing a phrase she used repeatedly over a period of years. Also on the agenda was phasing out cheap and abundant energy over the coming decades, at least as far as the United States was concerned. Another key component: redistributing the wealth of Western taxpayers to Third World regimes and the UN. And finally, the deal sought to empower the UN to oversee a planetary "climate" regime with jurisdiction over emissions of carbon dioxide — in other words, power over everything, as even human breathing releases CO2.
Everything was going according to plan until Donald Trump, who on the campaign trail publicly described the man-made global-warming hypothesis as a "hoax," was elected to the presidency. One of his promises was to quit sending money to the UN for the "hoax." And about six months into his presidency, he announced publicly that the U.S. government would be withdrawing from the Paris Agreement after the allegedly required four years of waiting time had passed. His base was excited, and celebrations broke out among conservatives.
But the threat is far from over. For one, the U.S. government is still technically involved. Second, the federal government continues to fund many of the globalist organizations and foreign governments that are busy implementing the Paris Agreement, ranging from the UN and the World Bank to Third World regimes around the world. And finally, more than a few state and local governments have vowed to continue implementing the illegal schemes with or without the feds. At least a dozen states and many more cities have vowed to implement the Paris Agreement. In the case of California, authorities have even defied the U.S. government by signing that state's own "climate" deal with the communist regime ruling China.
New York City, led by Mayor Bill "The Bolshevik" DeBlasio, announced on May 1 that it would become the first American city to "submit" a review of its "progress" on implementing Agenda 2030 directly to the UN.
If Americans hope to avoid the horrors of totalitarian global governance, it will require organized action at all levels. Ensuring that these policies do not take root at the local level is key, and everyone can help. At the national level, Americans must pressure Congress and the White House to begin dismantling the whole "sustainability" apparatus within the federal government. Beyond simply ripping up the EPA-UN agreement, Americans should work to dismantle the unconstitutional EPA itself, as the U.S. Constitution does not delegate any authority over the environment to the federal government. Next, the U.S. government should withdraw from the UN, which Trump properly described on the campaign trail as an enemy of freedom and the United States. Legislation in Congress, the American Sovereignty Restoration Act (H.R. 193), would accomplish that, and more. Passing that would neutralize Agenda 2030, Agenda 21, and the Paris Agreement.


This morning (September 6), the City of Vancouver announced its shortlist for the 28th annual City of Vancouver Book Award.
The prize honours local writers of any genre who "contribute to the appreciation and understanding of Vancouver's history, unique character, or the achievements of its residents".
Lawrence Paul Yuxweluptun, Karen Duffek, and Tania Willard, authors of Lawrence Paul Yuxweluptun: Unceded Territories (Figure 1 Publishing and Museum of Anthropology at UBC), a visual celebration of First Nations artist and Straight cover star Yuxweluptun's modernist works—many of which call attention to the historical mistreatment of indigenous groups in Canada.
The city notes that each of this year's nominated books offers a "complicated vision of a city coming to terms with its past and a desire to better itself".
The winner of the 2016 City of Vancouver Book Award will be revealed at the Mayor's Arts Awards ceremony at the Roundhouse Community Arts & Recreation Centre (181 Roundhouse Mews) on October 3. The prize carries a $3,000 award with it.
Last year's City of Vancouver Book Award was presented to Compton for his acclaimed story collection The Outer Harbour.