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Die 5′-Cap-Struktur (von englisch cap 'Kappe') ist ein kappenähnlicher Aufsatz am 5′-Ende von mRNA-Molekülen, der im Zellkern von eukaryotischen Zellen angefügt wird. Die 5′-Kappe schützt nicht nur eine RNA vor Abbau, sondern ist des Weiteren auch für den Export einer mRNA aus dem Kern in das Zytoplasma wichtig sowie für die Translation der mRNA durch Ribosomen.

Häufig handelt es sich bei der 5′-Cap-Struktur um ein modifiziertes Guanin-Nukleotid, das über eine seltene 5′-5′-Phosphodiesterbindung an das Kopfende der RNA geknüpft wird. Diese englisch Capping genannte chemische Reaktion findet schon während der Transkription eines Gens statt, sobald eine RNA-Polymerase die ersten Nukleotide einer mRNA verknüpft hat. Im Unterschied zum (kotranskriptionellen) Capping des 5′-Endes ist die Polyadenylierung des 3′-Endes einer mRNA – der Tailing (von englisch tail 'Schwanz') genannte Anbau eines Poly(A)-Schwanzes – eine posttranskriptionelle Modifikation, die erst nach Trennung von mRNA und RNA-Polymerase durchgeführt wird.

Capping wird außer bei mRNA auch bei vielen nichtcodierenden RNAs gefunden. Alternativ zur Cap-Struktur werden von manchen RNA-Viren zur Einleitung der Translation IRES oder Cap-independent Translation Elements verwendet.

Cap-Strukturen

Polymerase II
Bei mRNAs, die durch die RNA-Polymerase II transkribiert werden, findet sich die klassische m7G-Cap. Hier wird (nach Hydrolyse des terminalen γ-Phosphates durch die Triphosphatase) durch das so genannte Capping-Enzym ein GMP-Rest (von GTP) in Form einer 5′-5′-Triphosphat-Bindung auf das 5′-Ende der RNA übertragen und anschließend an Position 7 des Guanins mithilfe der mRNA-cap-Methyltransferase unter Verbrauch von S-Adenosylmethionin (SAM), ein universeller Methylgruppendonor, methyliert, es resultiert: 5′-5′ m7GpppN. Zusätzlich treten weitere Methylierungen der ersten Basen der mRNA in Position 2′ auf, man spricht dann von Cap1 (nur die erste Base methyliert) oder Cap2 (die ersten beiden Basen methyliert).

Weiterhin findet man z. B. in Trypanosomen weitaus kompliziertere Cap-Strukturen, bei denen nicht nur das erste Nukleotid modifiziert ist, sondern auch darauf folgende (z. B. Trypanosoma brucei Cap-4).

Polymerase III
Transkripte der RNA-Polymerase III erhalten keine solchen 5′-Cap Strukturen, bei einigen wenigen RNAs findet sich aber eine Monomethylierung an einem γ-Phosphatrest (z. B. U6 snRNA).

Viren
Manche Viren zeigen eine Eigenart im Biosyntheseweg der Cap-Struktur: GTP wird zunächst methyliert und erst anschließend auf die RNA übertragen.

Funktion
Wie auch der Poly(A)-Schwanz am 3′-Ende von mRNAs spielt die Cap-Struktur eine wichtige Rolle beim Stabilisieren der mRNAs. Ohne diese Struktur werden die mRNAs im Cytoplasma schnell von 5′ nach 3′ durch Exonukleasen abgebaut.

Auch beim Ausschleusen der RNA aus dem Zellkern durch die Kernporen in das Cytoplasma (RNA-Export) spielt die Cap-Struktur eine wichtige Rolle. Sie wird noch während der Transkription vom Cap-Binding-Komplex gebunden, der im Zusammenwirken mit anderen Faktoren einen effektiven Transport sichert.

Von entscheidender Wichtigkeit ist die Cap-Struktur auch bei der Initiation der Translation. Sowohl gebunden durch CBC (während der ersten Runde der Translation) als auch durch eIF4E (während aller weiterer Runden) sorgt sie dafür, dass das Ribosom rekrutiert wird und mit der Initialisierung beginnt. Dabei kommt es zu einem Ringschluss der RNA (closed loop model of translation), bei dem das 5′-Ende mit dem Poly-A-Schwanz interagiert (über eIF4E, eIF4G und das cytoplasmatische Poly-A-Bindeprotein PABPC).

Da einige Viren ausschließlich im Cytoplasma replizieren, erhalten sie von der zellulären Maschinerie keine Cap-Struktur. Um die Nachteile auszugleichen, die dies mit sich bringt, stehlen sie eine Cap von zellulären mRNAs, man spricht von Cap-snatching. Eine mRNA des Wirtsorganismus wird dabei nahe dem 5′-Ende gespalten (welches ja die Cap-Struktur trägt) und als sogenannter capped-leader dazu benutzt die virale Translation zu initiieren.

Die Tatsache, dass virale Polymerasen kein m7G-Cap produzieren, ermöglicht eine spezifische Unterscheidung von "fremder" und "körpereigener" RNA – eine RNA, die lediglich ein ungecaptes Triphosphat am 5′-Ende trägt, kann als Hinweis auf eine Infektion gelten. In der Tat gibt es im angeborenen Immunsystem (dessen grundlegende Aufgabe die Unterscheidung von "Fremd" und "Selbst" ist) mit RIG-I einen intrazellulären Rezeptor, der genau diese Struktur als PAMP erkennt und in der Folge eine antivirale Immunantwort auslöst. Die mRNA von Impfstoffen wie Tozinameran, mRNA-1273 oder CVnCoV ist zum Schutz vor frühzeitigem Abbau mit einer 5′-Cap ausgestattet.

Literatur
 Rolf Knippers: Molekulare Genetik. 8. neubearbeitete Auflage. Georg Thieme Verlag, Stuttgart u. a. 2001, ISBN 3-13-477008-3
 reactome: mRNA capping --

Einzelnachweise

Posttranskriptionale Modifikation


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Budget Rent a Car has announced its partnership as the official car rental partner to The Old Mutual Om Die Dam Ultra Marathon, to be held on 18 March in Hartebeespoort.
This is the first-time Budget Rent a Car will partner with the marathon and forms part of its overall brand commitment to help people go places. During this year's Om Die Dam race (which is also a key qualifying race for the Comrades Marathon, for which Budget Rent a Car is also the official car rental partner) an additional Budget Rent a Car water station will keep the runners hydrated on route.
In its 27th year of existence, the Om Die Dam marathon took place for the first time in 1991 – and today attracts over 10 000 participants from all over the country. This marathon is one of the largest inland marathons in South Africa.
"At Budget Rent a Car, we respect the passion and incredible effort ultra-marathon runners put into their sport, and we want to support them in achieving their goals. We believe our role is to continue to help our customers to grow and prosper both today and well in the future. This is a key part of how we are helping people move forward. We wish the same for all the runners participating in this race and are committed to supporting them in going the full distance," said Budget Rent a Car Chief Executive, Rainer Gottschick.


Copper: How much is enough for children fed through an IV?
Check the nutrition label on just about any packaged food, and you'll see how much carbohydrate or salt, or how many calories, are lurking inside waiting for you. But that label won't give you the whole nutritional picture. How much magnesium does your bag of chips contain? Or iodine, or copper?
These elements are all on the list of human micronutrients: nutrients that help maintain many of the critical biochemical processes within our cells. And while we only need them in very small amounts, micronutrient deficiencies can be devastating, even fatal.
Most of us get the micronutrients we need from our diet (chips aside), but for children whose digestive tracts can't process regular food – such as those with intestinal disorders like short bowel syndrome (SBS) – getting the right amount of micronutrients is a different story. These children often often have to get all their nutrition intravenously through a process called parenteral nutrition (PN).
Since dieticians can tailor the nutrients given to a child on PN, you'd think that it would be easy to get the right amount of micronutrients, like copper, into the mix. But that isn't necessarily so.
Too little copper can lead to anemia, poor growth, even bone problems. With the support of a Patient Services Research Grant, Arsenault is conducting a comprehensive study of infants on PN aimed at detecting copper deficiency, better defining optimal copper dosing, catching low copper levels more effectively, and identifying factors specific to short bowel syndrome that put children at risk of copper deficiency.
To find out, Arsenault and her team – including her mentor, Christopher Duggan, the medical director of CAIR, and Megan Brenn, a dietician who has worked closely with infants on PN – will enroll 30 infants seen for intestinal failure or short bowel syndrome, all on PN. Over the course of a year, they will track a range of biochemical measures – including serum copper, ceruloplasmin (a blood protein that binds to copper much like iron binds to transferrin) and liver function markers – and match the results to traits like growth, bone strength and structure (weak bones can be a sign of copper deficiency) and clinical factors that can affect copper levels in the blood, like inflammation or transfusion.
Arsenault also hopes to validate what she hopes will be a more sensitive marker of copper levels in the blood. "We think that the body works very hard to maintain a certain level of copper in the bloodstream, especially if you are deficient," Arsenault says. "So serum copper and ceruloplasmin may actually not be the most accurate way to see if we are providing enough copper to meet a child's needs." Her study will compare serum copper and ceruloplasmin levels with those of a protein called copper chaperone for superoxide dismutase (CCS), which animal studies suggest could give a more comprehensive view of the body's copper status.


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text:
Chinese Materials
Shakespeare and Milton
Wit and Wordplay
(to return to Table of Contents, click here)
174. Job 17:2-4, A Journey into Confusion
2 Surely mockers are with me,
And my eye gazes on their provocation.
3 Lay down, now, a pledge for me with Yourself;
Who is there that will [c]be my guarantor?
4 For You have kept their heart from understanding,
Therefore You will not exalt them.
Job's hopelessness is also captured by the other two "anchor" verses of the chapter (7, 11), but we will get to them in due course. Job now takes us on a journey of obscurity in verses 2-4. Language of pledging seems to be quite important, especially in verse 3, though it isn't clear what is being pledged or to whom. Anderson takes these next verses (2-4) as a formal handing over of Job's friends to God, for which Job will pledge his own life, but he neither provides a translation of how this all would work nor does he give a convincing reason for Job's seeming act of personal desperation (pledging his life) when he is seemingly on the road to preparing a competent and convincing legal case. Seow takes verse 3 addressed to God, thus emphasizing Job's abject aloneness. Despite Job's immediate turn to negativity and hopelessness in these verses, I don't see them (contra Anderson) as Job's staking his life on anything so that the friends might be judged. I agree, with Seow, that verse 3 makes most sense if it is addressed to God. Yet, confusion still reigns.
So, let's provide a literal rendering of verses 2-4 and see where it leads us:
"Isn't it the case that mockers are with me? And that my eyes lodge in their provocations. I place my pledge with you; who will strike/shake hands in agreement (on the pledge)? For you have hidden understanding from their hearts; thus you will not exalt them."
What?? We already had a rough time with the concept of mockers in 16:20, where different commentators rendered the participial form of the verb lun as either "mockers" or "interpreters." Now, have the mockers returned, but now under the cover of a different word. To make matters words, the word normally rendered "mockers" here is the hapax hathulim. Some take it as the abstract noun "mockery;" it no doubt is derived from the 10x-appearing verb hathal, which means to mock, deride, or deceive (e.g., Genesis 31:7; Judges 16:10, 13, 15). This won't be the end of mockery in the Book of Job, as Job himself saves his most delicious use for 21:3, where he just says to the friends, "Bear with me and I will speak; then after I have spoken, mock on" (verb there is laag).
Job says that his eyes "lodge" (the common verb lun,"to dwell") in their provocations/rebellions (marah, 45x, "to be contentious/rebellious"). Yet, even the verb "lodge" here is reminiscent of 16:20, where its appearance was so hard to translate. Job may be mocking those of us who are trying to understand by playing with words that have been used in the previous few verses, words that themselves aren't clear. It is almost as if he is saying, 'I have clearly expressed both my hope for a redeemer and my abject hopelessness in the present. What more do you guys really want? I'll mock your intelligence. . .' Perhaps because of the translation conundrums provided by verse 2, some scholars have tried to read the lun of verse 2 as laah, to be tired. Eliphaz has already used that word twice previously. But I stay with the Masoretic Text: Job's mockers are all around him; his eyes still "lodge" in their provocation—i.e., he is still bothered by their complaints, even though he realizes that no further help from them will be forthcoming.
A little clarity emerges if we try to connect verse 4 immediately with verse 2, leaving verse 3 to the side for a moment. This was a method that seemed to work for us with 16:19, 21, with verse 20 being an interruption in thought. So I would argue that 17:2, 4 contain a continuous thought, with verse 3 being an obscure interruption, addressed to God, about pledges. Thus, the flow of verses 2, 4 would be that mockers are around (i.e., the friends), that Job can't really escape their continual provocations, but that God has closed their minds to understanding, which means they won't rise up/be exalted. It isn't a revolutionary or even particularly brilliant thought, but it does seem to explain the flow of 2, 4.
But then we have verse 3 obtruding, like an unsightly swelling of the floor in the middle of the living room. Job talks about laying down his pledge with an unspecified "you," most likely God. Then he asks a question, "For who (else) will "shake on it" (i.e., complete or guarantee the transaction). We have no idea what Job is laying down as a pledge or why he is using pledge language, but an enticing possibility is now to read the chabal in verse 1 as "my spirit is pledged" rather than "my spirit is consumed/destroyed." The thought would then be that Job is saying that he would take this pledge (his spirit/breath) and place it "with you" (with God), but his sadness arises because no one will be willing to be Job's guarantor, to vouch for him, to stand up for him. No wonder he needs a witness in heaven (16:19). And, he needs to continue to speak boldly, regardless of the consequences.
My reading, then, would be analogous to my reading of the verse where Job is taking his life in his hands but then continuing to speak boldly to God (e.g., 13:14). He takes his flesh in his teeth, he places his life/breath as a pledge. Here Job is utterly spent and committed to his cause. That may be an explanation of verse 3 that not only connects it to a frequent rendering of chabal in verse 1 but also captures Job's desperation.

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text:
Home > Destination: Good Health Newsletter > Cancer Update: A Lung Screening that Saves Lives
Cancer Update: A Lung Screening that Saves Lives
Today Price, shown with her dog Chief, is cancer free, thanks to the lung scan that found her tumor early.
Lung cancer accounts for about 27 percent of all cancer deaths each year. In fact, it is by far the leading cause of cancer death among both men and women.
The problem is that lung cancer has no symptoms when in its most treatable stage. For years, there was no way to effectively detect it early, when it is more treatable.
But in recent years, doctors have found a test that can be used to screen for lung cancer in people at high risk of the disease. Maureen Price was fortunate to learn about it shortly after quitting smoking several years ago. "I heard an ad about a new lung cancer screening for people who are high risk like me and decided to look into it," she says.
"Individuals are considered high risk for lung cancer if they're between 55 to 80 years old; have a 30 'pack year' history of smoking; and are a current smoker, or a former smoker who has quit within the last 15 years," explains Price's oncologist, Mahsa Mohebtash, MD, director of the Cancer Center at MedStar Union Memorial Hospital and chief of medical oncology and hematology.
"Researchers studying a large population of high-risk individuals found that those who got a low-dose computed tomography (LDCT) scan had a 20 percent lower chance of dying from lung cancer than those who got chest X-rays because it is more effective in finding the disease early," she says. "The procedure is painless and takes less than 10 minutes."
Mahsa Mohebtash, MD
Price started getting a LDCT scan every year. In her fourth year a suspicious nodule was found, but it was too small and inaccessible to be biopsied. Her doctors decided to wait a few months and do another scan, which showed the nodule had grown.
Surgery was scheduled to remove a small tumor. A biopsy revealed it was small cell lung cancer, a rare and rapidly growing type of the disease.
"The oncology team at MedStar Union Memorial was amazed to have found small cell lung cancer at such an early stage," Price says. "I was told it is very unusual. I had another minor surgery to ensure that the cancer had not spread, then went through four cycles of chemotherapy with no side effects."
"Lung cancer survival rates are five times higher when the cancer is detected in its earliest stages. If only half of the high-risk population were screened, more than 15,000 lives could be saved annually," notes Dr. Mohebtash.
Price, now 62 years old, has had no recurrence after nearly seven years. She sees Dr. Mohebtash every year for follow-up imaging. On her first- year anniversary of being cancer free she got Chief, her Yorkshire terrier, as a gift to herself.
"I would not be here today if it hadn't been for the LDCT scan, especially considering the type of lung cancer it was," she says.
For more information about lung cancer, or to find out if you are eligible for the Lung Screening Program offered through MedStar Health Cancer Network, call 877-715-HOPE (4673). Screenings are also available for breast, cervical, and colorectal cancers.
201 East University Parkway
Related Condition


You make me stay inside and quiet, mother nature and neighbors, and you get no bike and no drums. What's a boy 'sposed to do? Yes….. I do plenty of that. And that. But my baby brother and I can get visual too, all cramped up and quiet. But the buds are just below the surface, the buds are just below the surface.
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Hi. Does anyone get pain in both their hands and feet? I find that the pain wakes me up in the middle of the night with stiff/painful fingers and painful toes. During the day I find my toes burn (especially when I stop and sit down). Over the last week the soles of my feet have really hurt when walking (luckily the pain is much less when sitting and putting my feet up). It actually feels like I am walking on bones. I am presently charting the pain locations and levels to see if there is a pattern. Would love to hear if anyone else gets problems with just these areas.
So sorry to hear that you too have problems with your hands and feet. Thanks for replying.
Amazingly I too had pins and needles in both hands during the night last year. It was so bad it felt that I had both hands trapped in the door and my elbows had been hit by a hammer (extremely painful during the night). I ended up having both hands operated on last year for carpel tunnel and this has helped the pins and needles/nerve pain at night. One good tip I discovered was, when the pins and needles start in your hands, drop your hands/arms over the edge of the bed - this really helps.
Have you got a diagnosis for your problems? I'm waiting to go back to the Rheumatologist.
initially I was diagnosed with degenerative disc disease in my lower back 4 years ago after a car accident.... but I've just got steadily worse, with pain becoming more widespread, on top of ibs, chronic fatigue, and a long list of other symptoms, I was diagnosed 1 year ago with fibromyalgia. it was a rheumatologist that diagnosed me - I had 16 out of the 18 tender points. I have a prolapsed disc at l4/5 which is now compressing the nerves, so lots of sciatic pain. am just debating on having a discectomy - but am concerned it will make my fibro worse. what about yourself?
Hi Sarper. Wow what bad luck having a car accident. Difficult decision over having a discetomy - have you managed to talk to others on forums of their experience of this? I know what it is like with chronic pain and fatigue. It is a vicious cycle, no sleep due to pain waking me up and then tiredness and more pain with exhaustion.
I was diagnosed with fibromyalgia in Jan this year by a Rheumatologist. I agree with him over the trigger points, as I nearly thumped him with the pain. It was a strange appointment as he announced I had fibromyalgia and the proceeded to pass me a leaflet and that was that. No explanation or advice of what to do, except come back to the next appointment for the results of blood tests. Well I am having to wait six months for my next appointment. It is a shame that the NHS does not have a specialist team who deal solely with fibromyalgia issues.
I am not too sure whether it is fibromyalgia which is causing the problems with my hands and feet as I have started developing nodules in the palm of my hand which are rather tendor to touch. I feel that my feet too are going the same way, but no nodules can be felt. At least the pain is repeatable and amazingly bilateral. I've searched the internet but with no answer to my problems. The Rheumatologist suspects Palindromic Arthritis but I am not convinced.
My problems got worse since I had my second ovary removed, but I don't want to blame surgical menopause on the pain in my hands and feet as I do not want to go on HRT.
Have you tried Caspian cream? This is a pepper based cream which is available on the NHS. I believe it is for nerve pain. I am going to ask for this for my nerve pain next time I go to the Rheumatologist.
forgot to say. If you haven't got one, buy memory foam for your bed. It is marvelous for painful joints on the back (I had whiplash to my back years ago and it really helped) - this was before the joints in my hands hurt!
my GP referred me to a pain clinic rather than a rheumatologist. had different types of injections, but nothing worked. they eventually referred me to Salford royal hospital on a pain management course. it was a 3 week residential course focussing on living with chronic pain. can really recommend the course - worth asking about. they give you lots of tips for dealing with pain as well as relaxation techniques.
I got the book fibromyalgia for dummies when I was diagnosed. I found it really helpful, as when you google stuff it's scary! fibro can definitely cause pain in the hands and feet, but also different types of arthritis can be linked to fibro as part of the 'syndrome'.
elective surgery does seem to make fibromyalgia flare up seemingly, from my discectomy research (Google fibro & elective surgery if interested).
haven't heard of caspian cream. will ask my GP at my next appointment.
I do have a fab memory foam mattress - worth every penny!
Sounds very interesting with the pain management course at Salford Royal Hospital. Are you within the catchment area of Salford Royal Hospital as I would be out of catchment.
I'll look into fibro and elective surgery as your comment is interesting.
Capsaicin cream is for neuropathic pain. I am going to ask for this for my knees/toes. Let me know how you get on.
I live in Oldham, and I'm under Rochdale pain clinic and they referred me. I don't know about catchment areas - but I know other hospitals run similar programs, a real holistic approach to pain management. definitely worth a conversation with your GP since you can choose where to get treatment. the Salford program puts the attendees up in a hotel nearby and taxis you into the hospital daily, to give you a break from family home stresses and allows you to spend time with people struggling from the same issues - so that would cater for someone living a distance away. I made some valuable friendships with people that understand. I hope you find somewhere that offers something similar.


text:
'CHiPS' Movie Headed to the Big Screen with Dax Shepard and Michael Pena
Getty Images/NBC
Looks like Warner Bros. is hoping they can replicate the success Columbia had with '21 Jump Street' with a small-to-big screen reboot of their own: the studio has hired Dax Shepard to write, direct, and star in a film version of the classic cop series 'CHiPS,' and he's bringing Michael Pena along for the ride.
Deadline reports that Shepard has been tapped to revive 'CHiPS' for the big screen, given the duties of writer, director, and star, with Michael Pena serving as his co-star. The film is based on the classic hit NBC series of the same name which ran from 1977 to 1983, and followed two motorcycle cops in California as they hit the pavement to stop crime on a weekly basis.
Shepard will take the role of Officer Jon Baker originated by Larry Wilcox, while Pena will play the part of -- you guessed it -- Frank Poncherello (aka "Ponch"), originally played by Erik Estrada.
While most big screen versions of classic TV shows have been largely comedic ('Starsky and Hutch,' '21 Jump Street'), this new adaptation of 'CHiPS' is said to be more action-heavy. Shepard does have some experience mixing action and comedy, as he recently wrote and directed the indie 'Hit and Run,' which co-starred his wife, Kristen Bell.
Filed Under: CHiPS, Dax Shepard, Michael Pena
Categories: Movie News


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Imran Khan, New York Times, Taliban
PM Khan needs to be schooled before giving interview to foreign media
Prime Minister Imran Khan should have been schooled before he gave interview to New York Times.
On various sensitive issues especially the jihadis he made an irresponsible statement saying "no armed use of militants now by Pakistan".
Like in the past he never gave a damn in selection of words and cut a sorry figure before the people.
One wonders to read his interview…. which is shocking somehow.
Here is the interview of PM Khan to New York Times.
Pakistan Premier: 'No Use' for Armed Militias Anymore
ISLAMABAD, Pakistan — His country nearly went to war with a neighboring enemy six and a half times its size. Militants lurk in religious schools and in the countryside.
And with inflation soaring and debt ballooning, his finance team is scrambling, desperate to secure a multibillion-dollar rescue package to avoid economic collapse.
But Imran Khan, Pakistan's prime minister, is apparently feeling confident about his first eight months in office — so much so that he invited a group of foreign journalists for an informal, hourlong chat on Tuesday in Islamabad, the capital.
While he seemed subdued, with puffy circles under his eyes, Mr. Khan also sought to project resolve — particularly about ridding Pakistan of the militants it once tolerated.
"We have decided, for the future of our country — forget the outside pressure — we will not allow armed militias to operate anymore,'' he said.
"The Pakistan Army created them,'' he said, referring to the 1980s when Pakistan and the United States backed Muslim insurgents in Afghanistan against Soviet forces.
But, he added, "there is no use for these groups anymore.''
Mr. Khan, 66, sat in a brightly lit drawing room on a gold-painted chair. He wore a long white shalwar kameez with the sleeves crisply pressed and spoke about corruption, poverty and trying to make peace with the Taliban.
He reminisced about traveling the world as an international cricket star and expressed alarm about India's shift toward Hindu nationalism and the rising crimes against India's Muslims.
India used to be "a very open society,'' he said. "I never thought that I would see what is happening in India right now. Muslim-ness is being attacked.''
In August, Mr. Khan took over as the elected leader of one of the world's most troubled countries. And he did with a shadow over him.
Many observers said that the election was deeply flawed and that Mr. Khan had been secretly helped by Pakistan's powerful military, which cleared a path for him by harassing and threatening his political opponents. In many ways, he was a curious choice.
Pakistan is a conservative Muslim nation, and Mr. Khan, by contrast, was once an international playboy and celebrity athlete. He befriended notables like Princess Diana in a high-flying life that could not be more different from the lives of most Pakistanis, though in recent years he has mellowed and turned more toward Islam.
In office, Mr. Khan has struggled to right the economy and get the security forces to more effectively crack down on militant groups that shelter in Pakistan.
Mr. Khan promised that this new crackdown would go far deeper than previous ones criticized as cosmetic. The government, for instance, plans to send 200,000 teachers to religious schools across the country to teach secular subjects like English and math. The intention, Mr. Khan's aides said, was to deradicalize students.
His government sees the stakes as high. An international watchdog group, the Paris-based Financial Action Task Force, is on the brink of blacklisting and sanctioning Pakistan. If that happened, Pakistan would face greater difficulties in obtaining the financial bailouts and loans it has sought.
"We can't afford to be blacklisted,'' he said on Tuesday.
But Mr. Khan has also won praise for his seemingly coolheaded and statesmanlike behavior during the recent crisis with India, which he helped de-escalate by releasing a captured Indian pilot and emphasizing peace. He seemed quite cognizant that the last thing Pakistan needed was a war.
On Feb. 26, around 3:30 a.m., Mr. Khan said he was awakened by a phone call. A top military official told him that Indian warplanes had just crossed the border and conducted airstrikes on Pakistani soil.
Pakistan and India have been bitter enemies since 1947 when Britain decolonized the Indian subcontinent and created two nations: the mostly Hindu India, and the mostly Muslim Pakistan. The two have warred several times.
This time, the spark was a suicide bombing in the disputed territory of Kashmir that killed dozens of Indian soldiers. India blamed Pakistan for supporting the militant group behind the attack and vowed revenge.
After learning that the Indian bombs had fallen into an empty ravine around Balakot (India said the bombs had struck a terrorist training camp), Mr. Khan said Pakistan opted for a measured response and bombed an empty area just across the Indian border.
"They hit our trees, so we thought we'd hit their stones,'' he said.
When asked whether he or the country's military establishment controls Pakistan, Mr. Khan said that they work closely. Independent analysts don't disagree, but many Pakistanis still see Mr. Khan as the army's puppet.
Even some of Mr. Khan's own ministers have said that they worry the relationship could sour if Mr. Khan, famous for self-confidence and unpredictability, crosses the army bosses.
But in this case, after Pakistani forces shot down an Indian fighter jet and captured the pilot, Mr. Khan and the military seemed to agree the best response was to release the pilot, which eased tensions.
"I've played down the whole thing,'' he said.
Now Mr. Khan is back to wrestling with the economy.
Pakistan has struggled for years with high unemployment, extremely low rates of tax collection, runaway corruption, and sluggish exports. The country's trade deficit had swelled to $33 billion when Mr. Khan took office in August.
He blames Pakistan's economic problems on his predecessors, especially the Sharif family, his political rivals.
"You can't have the ruling elite siphoning off money and taking it abroad,'' he said. "If you don't hold them accountable, the country has no future.''
With barely enough foreign reserves to cover the country's monthly import bills, Mr. Khan's government knows it needs a large bailout from the International Monetary Fund, but those often come with painful austerity conditions. His finance team has been reluctant to turn to the I.M.F. but now promises that a deal will be announced in the coming weeks.
On the streets, discontent is rising. People grumble about rising prices. Mr. Khan's government is trying to slow down demand to keep the trade deficit from growing even bigger.
But his government's decisions to raise levies on fuel and collect more taxes from ordinary Pakistanis, even if necessary for the economy's long-term health, have made people even angrier. Economic growth is forecast to slow further, leading to even more joblessness.
Nonetheless, Mr. Khan said, "my first priority is to take 100 million people out of poverty.''
Pakistani analysts say his priority is genuine but question how Mr. Khan can possibly pay for it.
"I've been pretty consistent of my criticism of the P.M. going back a long time,'' said Mosharraf Zaidi, a newspaper columnist. "One thing that I cannot criticize him for is the core purpose of his being in public life, which is compassion."
As far as India, Mr. Khan could not resist a few digs. He said that India's prime minister, Narendra Modi, had opted for airstrikes to please a domestic audience — India begins holding elections on Thursday.
But he added that Mr. Modi's government might actually be the best possible option for settling the Kashmir conflict, because right-wing Hindus would support Mr. Modi in achieving it.
"We have more chance for peace,'' he said, and then added with a smile, "except for this glitch of India's election.''
READ تمام پنجابی بے غیرت ھیں جو عمران کو ووٹ دیں گے :سابق سپیکر ایاز صادق
Badarul Hassan Reply
I was disappointed to hear this. I was watching it live. Take a lesson from Israel and India, never accept anything . Throw such charges right in their face
Safina Samiuddin Reply
His big foot is perpetually in his big mouth! Moron of the highest order, time to give select PM a fauji BOOT!
Jawad Shaheen Reply
Sach bolne ki koi class nhn hoti
Syed Masood Akbar Reply
It is the responsibility of the foreign office to arrange protocol sessions for new leadership.
"Russia did not invite PM Khan to Economic Forum"… PTI feels shame
PTI govt lavish spending on completion of its 100 days
Imran Khan is trolled on social media for his another goofup at Bishkek
Pakistan economy is bleeding badly… dollar crosses Rs150 marks… are we heading for economic disaster?
Imran feels helpless on bringing Nawaz back … Still rues as how he manages to leave for London
Bushara Manika on the footsteps of Maryam Nawaz… welcome to New Pakistan


The level of inventory of homes for sale of 101 homes in the City of Rancho Palos Verdes at the end of June is up about10% compared to the end of June last year. The average number of homes sold per month over the last 3 months of 40 homes per month, is down 4% however compared to the same 3 month period last year. There are 43 homes in escrow at the end of June.
The average price per sq. ft. for homes sold in Rancho Palos Verdes over the last 3 months of $617 is up 8% over the comparable period last year.
The average list price of homes offered for sale of $2.3 million is now 7% lower than this time last year. The average price of homes sold has been much lower than the average list price of homes, averaging $1.7 million over the last 3 months, 12% higher than the comparable period last year. Lower priced homes have been selling faster than the higher priced homes.
Properties have been taking about 1 month to sell and sold for 98% of the original list price on average over the last 3 months showing a very strong market.
inventory . The chart below is based upon the most recent months sales of 30 homes.


I was recently learning about nodes and how they work in lists, and to test myself, I decided to write my own LinkedList implementation in Java. Then I decided, that since there is already a LinkedList out there, why not make it sorted? So now it is a SortedList.
First check if the element being attempted to be added is null. If it is, throw a NullPointerException, as I want the list to be "null-free" (Only because null can't really be compared, because it will throw a NullPointerException when attempting to compare).
If it is, create a new Node with the value of the added element and set it as the first. Otherwise, loop through the elements in the list until one larger than the element attempt to be added is found. Then, add the element there.
Is there a more efficient way of implementing what I am doing here?
Are there some bad practices in there?
The way you keep the list sorted while adding elements is I think as fast as it gets with a linked list. If you were using a data structure that allows fast random access, then you could find the right insertion point faster by binary search, but then you'd pay the penalty of array copying when shifting the rest of the elements, so the overall benefit is questionable.
Keep in mind that if you have N elements and want them sorted, then it's faster to add them in a regular list and then sort the list. Sorting is typically bounded by \$O(N \log(N))\$, while keeping an automatically sorted list is bounded by \$O(N M)\$. If you really need the list sorted at all times, for example while adding items you also do other stuff that needs the list being built sorted, then your list is faster than re-sorting every time. I rarely see such situation in practice.
The methods other than add don't benefit from the fact that the list is sorted. For example indexOf (and contains using it), remove, and others will iterate until the end, even after a greater element is reached and therefore you could stop traversing the rest of the elements.
The worst-case complexity of methods that work with a single element like add, contains, remove is \$O(N)\$: you have to iterate over all elements. The optimization I suggested to use the sorted property everywhere won't change this.
The worst-case complexity of methods that work with a collection of elements like addAll, containsAll, removeAll is \$O(N M)\$ by the same reasoning, where \$N\$ is the size of the list, and \$M\$ is the number of the elements in the parameter.
It's a subtle thing, but your sorting logic is not stable. It would be better to make it so.
In other implementations of List, toString returns values enclosed in [ ... ], for example [1, 2, 3, 3, 3, 4]. I recommend to do likewise.
I stumbled upon this when I wanted to write a unit test with assertEquals(Arrays.asList(...), yourList), realized that doesn't work because listIterator is not supported, so I tried to work around that with assertEquals(Arrays.asList(...).toString(), yourList.toString()). So I recommend to implement listIterator.
Not the answer you're looking for? Browse other questions tagged java linked-list or ask your own question.


The influence of solid state solvation is crucial for understanding the device properties of 3rd generation organic light emitting diodes (OLEDs) based upon thermally activated delayed fluorescence (TADF), for which the native environment for the molecular emitter is an amorphous organic thin film. In this work we use quantum chemistry and molecular dynamics to demonstrate that the magnitude of static solid state solvation effects (SSSE) in a molecular excited state depends not only upon the dipole moment of the host, but also its rigidity and the dipole moment of the emitter in its electronic ground state. Subsequently, the molecular dynamics is used to study recently observed time-dependent aspects of solvation in TADF emitters. In contrast to the previously proposed guest-host interactions, the origin of these dynamic effects is proposed to be associated with the dispersion of charge transfer (CT) decay times, which are strongly sensitive to structural fluctuations of the emitter. Our findings extend the present understanding of SSSE in the context of 3rd generation OLEDs based upon TADF, which may be exploited to develop new strategies for high performing devices.


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Japanese Journal of Cardiovascular Surgery Vol.36, No.2
Reoperation for Valvular Surgery and Thoracic Aortic Aneurysm Repair with Functioning IMA Grafts after Previous CABG N. Watanabe, et al.……65
Reoperation for Valvular Surgery and Thoracic Aortic Aneurysm Repair with Functioning IMA Grafts after Previous CABG
(Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan)
Naruhito Watanabe Satoshi Saito Hideyuki Tomioka
Kenji Yamazaki Akihiko Kawai Shigeyuki Aomi
Hiromi Kurosawa
The use of the internal mammary artery (IMA) is now routine in most coronary artery bypass grafting (CABG) because of its improved long-term patency and survival. A small but important percentage of these patients will require valve surgery and thoracic aortic aneurysm repair following CABG. These operations present a challenging problem for the cardiac surgeon because of difficulties regarding approach, dissection around the IMA and optimal myocardial protection. We investigated surgical results and the effectiveness of various methods of myocardial protection in 8 patients who underwent reoperations between December 1983 and June 2005. The mortality was 13%. There were 2 perioperative myocardial infarctions (25%), 6 cases of prolonged ventilation (75%), 3 cases of low output syndrome (38%), 1 case of acute renal failure (13%) and 1 case of sepsis (13%). We carried out resternotomy for 6 patients without any hospital death or perioperative myocardial infarction. Our reoperation approach had acceptable risk control with resternotomy, avoidance of dissecting the IMA and hypothermic perfusion.
Jpn. J. Cardiovasc. Surg. 36: 65-67 (2007)
A Case of Platypnea-Orthodeoxia Syndrome Caused by a Patent Foramen Ovale H. Hojo, et al.……68
A Case of Platypnea-Orthodeoxia Syndrome Caused by a Patent Foramen Ovale
(Department of Cardiovascular Surgery, Showa General Hospital, Kodaira, Japan, Department of Cardiovascular Surgery, Koga General Hospital*, Miyazaki, Japan and Department of Cardiovascular Surgery, Saitama Medical University**, Saitama, Japan)
Hiroshi Hojo* Masahiko Ozaki Masanori Ogiwara
Yuuji Yokote** Shunnei Kyo**
We encountered a patient with platypnea-orthodeoxia syndrome. This rare syndrome is characterized by right-to-left shunt, which appears in the upright position. A 76-year-old woman with symptomatic hypoxemia was referred for evaluation and treatment. She did not complain of dyspnea while in a supine position, but experienced dyspnea with severe hypoxemia in a sitting or standing position. She did not have any pulmonary diseases that can be cause of dyspnea. Echocardiography revealed a patent foramen ovale and mild left-to-right shunt when the patient was supine. However in an upright position, right-to-left shunt appeared and the arterial oxygen saturation dropped from 95% to 80% with dyspnea. Cardiac catheterization revealed normal pulmonary artery pressure and right-to-left shunt through the patent foramen ovale in the sitting position. We then diagnosed platypnea-orthodeoxia syndrome. The chest CT showed deformity of the right atrium caused by compression of the elongated ascending aorta. The patent foramen ovale was closed and the ascending aorta was shortened by open heart surgery. Her dyspnea and hypoxemia in the upright position was completely resolved after surgery.
Modified Konno Operation for Aortic Valve Regurgitation after Arterial Switch Operation K. Nakamura, et al.……72
Modified Konno Operation for Aortic Valve Regurgitation after Arterial Switch Operation
(Department of Cardiovascular Surgery, Jikei University School of Medicine, Tokyo, Japan, Department of Cardiovascular Surgery, Saku Central Hospital*, Saku, Japan and Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University**, Tokyo, Japan)
Ken Nakamura* Kiyozou Morita Yoshihiro Ko
Katsushi Kinouchi Kazuhiro Hashimoto Hiromi Kurosawa**
We describe a case of postoperative aortic valve regurgitation (AR) after arterial awitch operation (ASO) successfully managed by the modified Konno procedure. A 4-year-old girl with complete transposition of the great arteries (TGA, Type II ) had undergone the ASO (LeCompte maneuver) at 10 days of age. Because of progression of moderate AR 4 years after ASO, the modified Konno procedure with aortic valve replacement (SJM 21mm) was successfully performed. She remains in good clinical condition at the last follow-up at 5 years.
Successful Third Surgery in Management of an Aortoesophageal Fistula due to a Thoracic Aortic Aneurysm T. Takagi, et al.……76
Successful Third Surgery in Management of an Aortoesophageal Fistula due to a Thoracic Aortic Aneurysm
(Department of Cardiovascular Surgery, Fukui Prefectural Hospital, Fukui, Japan)
Takeshi Takagi Susumu Fujii Shinichiro Yamamoto
A 70-year-old man presented at a nearby hospital with dysphagia, hematemesis, and hemorrhage. After examination by magnetic resonance imaging and gastrointestinal fiberscopy, he was referred to our hospital on the suspicion of an aortoesophageal fistula due to a thoracic aortic aneurysm. Considering the degree of invasion and infection, we planned two operations but were compelled to perform three operations because of esophageal leakage. Aortoesophageal fistula due to thoracic aneurysms are usually fatal, with only 18 reported survivors in the past 22 years. The optimal treatment for this condition is not yet known. We report survival of the first case of aortoesophageal fistula due to thoracic aneurysm complicated by mediastinitis caused by esophageal leakage in which management by two operations was initially planned. From this case many possible strategies to manage aortoesophageal fistula due to thoracic aneurysms arose. Therefore, we report this case together with a review of the literature.
A Patient with Valvular Heart Disease and Parkinson's Disease: Prevention of Neuroleptic Malignant Syndrome K. Nakamura, et al.……81
A Patient with Valvular Heart Disease and Parkinson's Disease: Prevention of Neuroleptic Malignant Syndrome
(Department of Cardiovascular Surgery, Jikei University Kashiwa Hospital, Kashiwa, Japan, Department of Cardiovascular Surgery, Saku Central Hospital*, Saku, Japan and Department of Cardiovascular Surgery, Jikei University School of Medicine**, Tokyo, Japan)
Ken Nakamura* Keno Mashiko Shinichi Ishii**
Kunihiro Naganuma Kazuhiro Hashimoto**
The patient was a 71-year-old man who had been treated for Parkinson's disease for 21 years. He was admitted because nocturnal dyspnea occurred several times. Echocardiography revealed congestive heart failure because of combined mitral and aortic regurgitation. Double valve replacement was planned. There was a risk of the occurrence of neuroleptic malignant syndrome (NMS) if his drugs for Parkinson's disease were stopped suddenly, so careful control of drug doses was required. Although the patient developed aggravation of his Parkinson's symptoms, careful observation and adjustment of medications prevented the occurrence of NMS.
Tricuspid Valve Endocarditis Complicated Disseminated Intravascular Coagulation (DIC) before an Operation D. Futagami, et al.……85
Tricuspid Valve Endocarditis Complicated Disseminated Intravascular Coagulation (DIC) before an Operation
(Department of Cardiovascular Surgery, Hiroshima City Hospital, Hiroshima, Japan)
Daisuke Futagami Hideo Yoshida Hironori Ebishima
Nobuyuki Tokunaga Keiji Yunoki Kunikazu Hisamochi
Osamu Oba
Right-sided infective endocarditis (IE) accounts for 5% to 10% of all IE. Compared with left-sided IE, antibiotic treatment is effective in about 70% of cases. The timing of surgical treatment for right-sided IE is therefor controversial. A 26-year-old woman had suffered from tricuspid valve endocarditis with DIC. There was no evidence of any previous cardiac event or dental treatment. Echocardiography showed a large vegetation attached to the anterior leaflet of tricuspid valve with moderate tricuspid regurgitation. We removed the vegetation with a part of the anterior leaflet and performed tricuspid valvuloplasty and annuloplasty. The patient had an uneventful postoperative course and received intravenous antibiotic treatment for a further 4 weeks.
Aortic Arch Replacement for Thoracic Aortic Aneurysm Combined with Aberrant Right Subclavian Artery: Two Case Reports H. Kanamitsu, et al.……88
Aortic Arch Replacement for Thoracic Aortic Aneurysm Combined with Aberrant Right Subclavian Artery: Two Case Reports
(Department of Cardiovascular Surgery, Cardiovascular Center Sakakibara Hospital, Okayama, Japan)
Hitoshi Kanamitsu Hidenori Yoshitaka Masahiko Kuinose
Yoshimasa Tsushima Hitoshi Minami Toshinori Totsugawa
Masamichi Ozawa
We present two cases of thoracic aortic aneurysm combined with aberrant right subclavian artery. Case 1 was a 71-year-old man, and case 2 was a 74-year-old man with an aortic arch aneurysm associated with a diverticulum of Kommerell. In both cases, we performed total aortic arch replacement through median sternotomy using cardiopulmonary bypass, systemic hypothermia and selective cerebral perfusion. We reconstructed all 4 arch branches. The aberrant right subclavian artery arose from the distal portion of the aortic arch, distal to the origin of the left subclavian artery. It crossed the midline between the esophagus and spine. To prevent compression of the trachea and esophagus by the right subclavian artery, we reconstructed it by the anterior side of the trachea. The postoperative course was uneventful.
A Case of Concomitant Coronary Artery Disease, Abdominal Aortic Aneurysm, and Bile Duct Cancer S. Shioguchi, et al.……92
A Case of Concomitant Coronary Artery Disease, Abdominal Aortic Aneurysm, and Bile Duct Cancer
(Department of Cardiovascular Surgery, Koshigaya Hospital Dokkyo University School of Medicine, Koshigaya, Japan)
Soichi Shioguchi Yoshihito Irie Shigeyoshi Gon
Koyu Tanaka Takao Imazeki
We report a rare case of concomitant coronary artery disease, abdominal aortic aneurysm, and bile duct cancer. A 65-year-old man, who had been recognized to have jaundice in late November 2005, was found to have bile duct cancer, an abdominal aortic aneurysm with a diameter of 70mm, and coronary artery disease (with two severely diseased branches). To avoid extended operation, a two-stage operation was performed; at the first operation, off-pump coronary artery bypass surgery (LITA to LAD and Ao-SVG to 4PD) and replacement of the abdominal aortic aneurysm by an artificial blood vessel with minimal incision were implemented. In 21 days after the cardiovascular surgery, the patient underwent pylorus-preserving pancreatoduodenectomy (modified Child method) in the second operation. After the two-stage operation, the patient showed a favorable outcome without any major complications. On the basis of the outcome of two-stage operation we successfully applied, we discuss the strategy for treatment of patients having both cardiovascular and abdominal malignant diseases, with reference to the literature.
Ruptured Saccular Aneurysm Associated with a Coronary Artery to Pulmonary Artery Fistula H. Hojo, et al.……96
Ruptured Saccular Aneurysm Associated with a Coronary Artery to Pulmonary Artery Fistula
(Department of Cardiovascular Surgery, Showa General Hospital, Kodaira, Japan, Department of Cardiovascular Surgery, Koga General Hospital*, Miyazaki, Japan and Department of Cardiovascular Surgery, Saitama Medical University**, Saitama, Japan)
We report successful operative treatment of a ruptured coronary artery saccular aneurysm associated with a coronary-pulmonary artery fistula. A 66-year-old woman experienced sudden onset of unconsciousness due to cardiac tamponade. Echocardiogram and chest CT on admission showed pericardial effusion and a 50-mm diameter saccular coronary artery aneurysm. Coronary angiogram revealed coronary artery aneurysm which arose on the conus branch of the right coronary artery. The connection between the aneurysm and the pulmonary artery was not clarified. Cardiac tamponade due to rupture of the saccular coronary artery aneurysm was suspected and emergency operation was performed. Operative findings revealed coronary-pulmonary artery fistula. Closure of the orifice of the draining artery to the pulmonary artery, and aneurysmorrhaphy were performed. Postoperative coronary angiogram and chest CT showed no residual fistula, and the postoperative course was uneventful.
A Case of Total Right Heart Bypass Operation for Polysplenia with Diffuse Bilateral Pulmonary Arteriovenous Fistula and Left Pulmonary Vein Obstruction by Anterior Translocation of the Hemiazygos Vein and Direct Anastomosis of the Hemiazygos Vein to the Hepatic Vein T. Nakata, et al.……100
A Case of Total Right Heart Bypass Operation for Polysplenia with Diffuse Bilateral Pulmonary Arteriovenous Fistula and Left Pulmonary Vein Obstruction by Anterior Translocation of the Hemiazygos Vein and Direct Anastomosis of the Hemiazygos Vein to the Hepatic Vein
(Department of Cardiovascular Surgery, Shizuoka Children's Hospital, Shizuoka, Japan)
Tomohiro Nakata Akio Ikai Yoshifumi Fujimotoi
Noritaka Ota Masaya Murata Kisaburo Sakamoto
Diffuse bilateral pulmonary arteriovenous fistula (PAVF) developed in a 19-month-old girl with polysplenia, single atrium, single right ventricle, left superior vena cava and interrupted inferior vena cava (IVC) after total cavopulmonary shunt (TCPS) operation. In addition, left pulmonary vein obstruction (PVO) by compression between the dilated hemiazygos vein and the atrium was identified. We performed total right heart bypass operation with anterior translocation of the hemiazygos vein for release of PVO and direct anastomosis of the hemiazygos vein to the hepatic vein to divert hepatic venous flow to the bilateral pulmonary circulation. Follow-up cardiac catheterization 9 months later showed disappearance of PAVF and no stenotic region. The merits of this operation are: 1)to provide balanced distribution of hepatic venous flow through the hemiazygos vein to the pulmonary circulation, 2)to release the PVO caused by the dilated hemiazygos vein, and 3)to allow for potential growth. This operation can be performed to Fontan candidates with interrupted IVC.
Jpn. J. Cardiovasc. Surg. 36: 100-104 (2007)
Case Report of Spontaneous Rupture of the Inferior Vena Cava Associated with Infrarenal Abdominal Aortic Aneurysm M. Hamaji, et al.……105
Case Report of Spontaneous Rupture of the Inferior Vena Cava Associated with Infrarenal Abdominal Aortic Aneurysm
(Department of Cardiovascular Surgery, Nagahama City Hospital, Nagahama, Japan)
Masatsugu Hamaji Satoshi Kono Mitsuhiko Matsuda
Spontaneous formation of aorto-caval fistulae is rare, occurring only in 4% of all ruptured abdominal aneurysms, and spontaneous rupture of the inferior vena cava (IVC) associated with the unruptured abdominal aneurysm has not been previously found in the literature. A 79-year-old woman with abdominal pain and hemorrhagic shock, was found to have a leaking abdominal aortic aneurysm and was transferred to our hospital. Preoperative CT revealed a massive right retroperitoneal hematoma and an infrarenal large abdominal aortic aneurysm. At laparotomy, no leaking site was found in the aneurysm, but a 2-cm laceration in the wall of IVC was found. The injured site was closed with a patch while controlling bleeding with a balloon catheter. The patient recovered uneventfully and was discharged on the 17th postoperative day. The mechanism of spontaneous rupture of the IVC is unknown, but and may occur due to incidental and abrupt increase in venous pressure in a stenotic IVC.
A Case of Re-Dissection of Aortic Root after Reconstruction of Acute Aortic Dissection S. Matsuyama, et al.……108
A Case of Re-Dissection of Aortic Root after Reconstruction of Acute Aortic Dissection
(Division of Cardiovascular Surgery, Fukuoka Wajiro Hospital, Fukuoka, Japan)
Shigefumi Matsuyama Yoshito Kawachi Kazuyoshi Doi
Masakatsu Hamada
A 69-year-old man had been treated with total arch replacement for acute Stanford type A aortic dissection. He had cardiac failure at 9 years after his previous operation. Computed tomography and transesophageal echocardiography showed re-dissection of the aortic root and aortic regurgitation. He was referred to our hospital for surgical treatment. In the second operation, aortic root replacement was performed. Re-dissection of the aortic root at the site of the non-coronary sinus was noted intraoperatively, and intraoperative findings suggested necrosis of the aortic wall related to the use of GRF glue. Care should be taken to ensure proper use of GRF glue. The aortic root replacement using a Freestyle valve provided good hemodynamic function and low thrombogenicity. The use of this valve in this case which had residual dissection of the descending aorta seemed useful because of the excellent hemodynamic function without anticoagulant therapy.
Aortic Valve Replacement for Porcelain Aorta with Balloon Occlusion and Deep Hypothermic Circulatory Arrest T. Murakami, et al.……112
Aortic Valve Replacement for Porcelain Aorta with Balloon Occlusion and Deep Hypothermic Circulatory Arrest
(Department of Cardiovascular Surgery, Oji General Hospital, Tomakomai, Japan)
Tatsuya Murakami Hiroki Kato Yutaka Makino
A 78-year-old woman on chronic hemodialysis was found to have severe aortic stenosis causing refractory hypotension during hemodialysis and elected to undergo aortic valve replacement. However, chest CT scan revealed a totally calcified "porcelain" ascending aorta which prevented safe aortic cross-clamping. MRA also showed stenosis of the origin of the left subclavian artery. At operation, an area free from calcification was identified in the lesser curvature of the ascending aorta where an aortic cannula was placed. Cardiopulmonary bypass was commenced. A single selective cerebral perfusion was added via the left axillary artery to maintain adequate flow to the dominant left vertebral artery. The patient was cooled to a rectal temperature of 24℃ when a proximal transverse aortotomy was made and an occlusion balloon was inserted into the ascending aorta during circulatory arrest for 2min. The cardiopulmonary bypass was restarted with half systemic flow. The aortic valve was excised and a 19-mm Carpentier-Edwards bovine pericardial valve was placed in the supravalvular position with simple interrupted sutures. The body was further cooled down to 19℃. On another circulatory arrest, the balloon was removed. Endarterectomy was performed along the edges of the aortotomy which was reinforced with equine pericardial strips. The aortotomy was then closed with a running suture. The circulation was restarted and the patient was rewarmed. Circulatory arrest time was 42min. The patient was weaned from cardiopulmonary bypass without difficulty and had an unremarkable recovery without neurologic complications. The operative technique described here for the treatment of aortic valve disease in a patient with a porcelain aorta is safer than deep hypothermic circulatory arrest alone, allowing shorter circulatory arrest period. In addition, endarterectomy of the aortotomy edges reinforced with xenopericardial strips is useful to secure the closure line against bleeding.
2-26-9 Suzuki Bld.6F, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan


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L'art De La Féminité (The Art of Femininity)
April 5, 2018 / Alpha Jedi	/ 2 Comments
"Femininity can be a powerful thing." – Jillian Rose Banks
This post is a special one, in that it's not discussing theory or field reports. Sometimes in the Red Pill community everyone gets so caught up in highlighting the negative or frustrating aspects of women, that all of the beauty and wonderment of them gets lost in the shuffle. This post is a shout out to femininity, to all the women who embrace it and to the women who know the art of it.
In the modern world, the art of femininity has become an increasingly rare commodity. Feminism and the betafaction of men has done a lot of damage to men with the Blue Pill, but it's also done a lot of damage to women in their ability to express what truly is an art from. Like masculinity which is an art into itself, femininity has be chastised and turned on itself in an attempt to warp it into a perverted version of masculinity. But where there is oppression and attack, there is resistance, and prosperity.
Shout out to women who understand and embody the lost art of femininity. Women who look feminine and in their own unique way express their femininity through their actions. To the girls that know how to rock a stunning dress, know to utilize their feminine charm to create a sense of mystery and intrigue, to the women who know how to be a proper counter balance to men without trying to become men. Shout out to the women who grind right along with men in their own hustle rather than solely use them, who know how to blow our minds in the bedroom, and know how to a take care of themselves. Shout out to women who know how to cook, how to appreciate fine dining and how to make our days a bit brighter. And a big shout out to girls that are into threesomes, because that's just awesome.
Women are a compliment to a man's life, never the sole focus of it. But they can be a massive compliment with a very capable woman. In order to experience that as a man, you yourself must be a man that can bring it out of a woman. If she's a Ferrari but you only know how to drive Honda Civics, then you need to get some driving school in and learn how to master that Ferrari to get the most out of it. I've said it before and I'll say it again, women can be incredibly powerful, amazing and dynamic experiences. One of the great joys in life is coming across a truly feminine woman, who exudes and radiates it in every way. You represent the best that womankind has to offer.


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Date: Swiss architect, painter, and sculptor, 1908–1994
Biography: Max Bill was known for founding the Concrete Art movement, bringing elements of Russian Constructivism and mathematics into his work as a painter, architect, and designer. Born in Winterthur, Switzerland, Bill studied under Klee and Kandinsky at the Bauhaus. He was a cofounder of the Ulm School of Design in Ulm, Germany, and taught at the Kunstgewerbeschule Zurich and the Hochschule fur bildende Kunste Hamburg. He is represented in the collections of the Museum of Modern Art, among other public institutions, and was the subject of retrospectives at the Solomon R. Guggenheim Museum and the Los Angeles County Museum of Art, among others.
Combillation


Alien can its size is unique to the market (250ml.), has a satin finish with thick opacity, and a sensitive valve ideal for details and thin lines. Available in a wide range of colors designed especially for the most artistic graffiti pieces.
Alien was the first to experiment with semi-transparent and translucent colors, originally called "espectro", which permitted layering different tones to create volume, highlights, and effects. Poltergeist is another Alien experiment; a phosphorescent (glow-in-dark) spray paint.
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Mines! ♥. Heh heh... I need a life.. HD Wallpaper and background images in the Ikuto Tsukiyomi club tagged: ikuto shugo chara mine.
This Ikuto Tsukiyomi fan art contains anime, bande dessinée, manga, and dessin animé.
Man... I forgot to save in PNG now it's all crapped up... Boo.


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How A Bad NCAA Rule Could Make Football's Concussion Crisis Even Worse
Emma Carmichael
Sun Devils quarterback Steven Threet suffered two concussions last season, and he's officially had his brain knocked against his skull five times in four years of college football. Last week, the Michigan transfer announced that, to avoid any long-term damage to his mental health, he will forgo his final year of eligibility and quit football.
Mercifully, both for Threet and for ASU, the senior is on pace to graduate this spring, which saves the university from having to decide whether to renew his scholarship just so he can watch from the sidelines next season. But concussions can't be planned around graduations. And at some point soon, thanks in large part to the bad incentives created by the NCAA's one-year, renewable scholarship, an athletic department somewhere will have to choose between expediency and simple humanity, and an athlete somewhere else will have to choose between his scholarship and his health.
By our count, Threet is the fourth player from a high-profile Division I football program to decide to leave the game in the past year alone. Last April, Southern Methodist cornerback Derrius Bell announced he was done; he was coping with a sleeping condition that doctors thought was related to his multiple concussions. "It's like I'm sleeping... but I can't snap out of it," Bell told the Dallas Observer at the time. "I can hear me telling myself it's time to wake up. I'm fighting to wake up, but I can't. Then all of the sudden I just pop awake and I'm not sure what happened." And last November, both Texas running back Tre' Newton and BYU safety Steven Thomas turned in their jerseys, as well.
Citing Concussions, Texas Running Back Tre' Newton Announces He Is Giving Up Football
Newton, the Longhorn's sophomore running back and son of former Cowboys lineman Nate Newton,…
The departure hasn't affected the players' scholarship status: Bell, Newton, and Thomas stayed on as player-assistant coaches and the schools pledged to honor their scholarships, and Threet is on pace to graduate in May. There's precedent, then, for upholding a commitment to student-athletes who suffer head injuries on the field and retire early because of it. But that may not be an option for every football program in the country.
There's no official policy on scholarship athletes who want to be responsible to their brains — NCAA spokesman Chris Radford said the decision "would be entirely up to the school" when it conducts its annual scholarships review. "The school has the same options it does for student-athletes who have season-ending injuries," Radford says. One of those options is a waiver known as a "medical non-counter," which allows the school to maintain the financial aid package for an incapacitated athlete without counting against its allotment of athletic scholarships. This requires thorough documentation — something rarely in abundance when it comes to concussions — and the final decision is left to the discretion of the institution, which has the costs of a scholarship to consider.
It's hard to imagine a high-profile program choosing to renege on a player's scholarship because his or her brain has been knocked around too many times doing the very thing the school has asked of them. "Someone would have to argue that the player is quitting," says SI.com's injury guru Will Carroll in an email, "and I don't think that's a PR battle anyone wants."
"It strikes me that universities have an ethical obligation, not legal but ethical, to uphold scholarships [for athletes who were injured while playing for them]," says Michael Oriard, a former NFL player and now an associate dean and English professor at Oregon State. "After all, we should hold ourselves to higher standards than the technical legalities of the land."
But since 1973, when the NCAA instituted the three divisions and mandated that schools could only award one-year, renewable athletic scholarships, that's how the business has been done. Oriard thoroughly documented this development in his book Bowled Over; he argued that this seemingly minor change was as responsible as anything else for killing off the notion that collegiate athletes could be equal parts "student" and "athlete." He called the '73 decision to be "a radical sea change for college football."
"Suddenly the athlete is primarily responsible to his football coach rather than to the university," he tells me. "I think that's had a tremendous impact on the culture." The personal stakes for players are higher, and, for universities with high-profile football programs, so are the commercial stakes. The end of the four-year scholarship was the end of any leverage amateur athletes might've had, and it brought the kind of workplace insecurities found in any hotly competitive industry to the collegiate locker room. A player who can't produce is a player whose scholarship may be in jeopardy.
"The other issue is, what is a scholarship?" Oriard says. "Is it an employment contract? Because if were an employment contract, then workman's compensation could apply. But because it's held to be different, there are no obligations to some of the universities to the athletes. I'd like for universities to hold themselves to higher standards, and unfortunately we don't know how often they do."
Concussions raise the stakes immeasurably. The new question, then, is if cumulative concussions should be treated any differently than a season-ending knee injury in a university's annual scholarship review. Dustin Fink, a certified athletic trainer who also runs The Concussion Blog, says he thinks the NCAA should consider "automatically granting schools the extra scholarship if a player has to stop due to concussions."
"Talk about a message that would be clear," Fink says in an email. "This may also have a secondary impact of giving the players and schools an 'out' in [cases with] multiple concussions."
Oriard, too, said says an athlete's long-term mental health should hold more weight than a pair of healthy knees: "We've known for a long time that old players become increasingly immobile as we age," Oriard says, "but this stuff is an order of magnitude greater. We're talking about losing your self, not your mobility. That has to be an urgent concern."
Part of the issue for athletes, of course, is that it's much easier to hide brain trauma. You stand up from a hard hit, take a few dizzying steps, and get back into the huddle. Because the consequences of multiple concussions might not emerge until a decade or two after a player's final snap, 20-year-olds still retain their "self" after a few hard hits. In this new age of concussion consciousness, that makes the choice to leave the game for fear of long-term mental health issues both admirable and, in all likelihood, rare. There are football players at every level who feel as if the game is, as Bell said last April, "the only thing I'm really good at" — and if it's the only thing paying tuition, there's no incentive to even report the injury in the first place. Bell, Threet, Newton, and Thomas might turn out to be exceptional cases, given the political economy of college sports. Everyone — players and coaches and administrators alike — did the admirable thing in a world whose rules all but demand they behave irresponsibly.
FootballNCAA


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Description This show is part of the 2022-2023 Premier Health Broadway In Dayton Series! Friday - Saturday, May 5 - 6, 2023 at 7:30pm. Elle Woods appears to have it all. OMG you guys!!! EARLY BIRD OFFER! Legally BlondeThe Musical is coming to New Brunswick! For more information, call the Clemens Center Box Office at 607-734-8191 or 800-724-0159. . Sat Jan 21 2023 at 11:00 am ES Barrison @ Central Florida Comic Con 2023. A fabulously fun award-winning musical based on the adored movie, Legally Blonde, is action-packed and exploding with so much fun, it should be illegal! Legally Blonde - The Musical is coming to LAFAYETTE! Legally Blonde The Musical happening at RP Funding Center, 701 W Lime St, Lakeland, United States on Sun Jan 08 2023 at 08:30 pm. Legally Blonde - The Musical will take you from the sorority house to the halls of justice with Broadway's brightest new heroine and, of course, her Chihuahua, Bruiser. The story follows the transformation of Elle Woods as she tackles stereotypes, sexism, snobbery and scandal in . The story follows the transformation of Elle Woods as she tackles stereotypes, sexism, snobbery and scandal in pursuit of her dreams, and proves that you can be legally blonde and STILL the smartest person in the room.This contemporary, sassy musical moves at a breakneck pace, driven by memorable songs and explosive dances. This no-cut production is open to all Glencoe 6th-8th graders and appropriate for audiences of all ages. Her life is turned upside down when her boyfriend Warner dumps her so he can attend Harvard Law. Based on the smash hit movie, Legally Blonde the Musical follows the transformation of Elle Woods from a pink-loving sorority girl to a Harvard law student. OMG you guys!!! Follow our blonde heroine as she tackles all obstacles, overcomes stereotypes, and educates us all . 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Legally Blonde (stylized as LEGALLY blonde) is an American media franchise created by Amanda Brown.It consists of American comedy films, a Broadway musical, a reality television series, and a cancelled television series.The films include two theatrical releases, one musical television film, one straight-to-home video release, and a third theatrical film in development. Legally Blonde - The Musical is coming to Eugene! GJHP's no-cut production of Legally Blonde will be open to all Glencoe 6th-8th graders. Legally Blonde - The Musical warms the heart by proving that self-discovery can be way too much fun and hilarious to boot. Renew your Season Tickets before July 8th to SAVE 10%! Legally Blonde - The Musical warms the heart by proving that self-discovery can be way too much fun and hilarious to boot. OMG you guys!!! Her life is turned upside down, however, when her boyfriend dumps her so he can start getting more serious about his life and attend Harvard Law. LEGALLY BLONDE THE MUSICAL January 28 - 29, 2023 at the Century II Concert Hall JOIN OUR EMAIL LIST GROUPS VENUE OMG you guys!!!
Action-packed and exploding with memorable songs and dynamic dances - this musical is so much fun, it should be illegal! Elle Woods appears to have it all. LEGALLY BLONDE THE MUSICAL March 3 - 5, 2023 at The Buddy Holly Hall of Performing Arts and Sciences JOIN OUR EMAIL LIST GROUPS VENUE OMG you guys!!! Not a season package holder and want access to tickets ahead of the general public? If you're looking for a feel-good musical that will make you want to get up and dance, look no further than Legally Blonde. Legally BlondeThe Musical is coming to New Brunswick! . Saturday, APRIL 29, 2023 at 2:00PM & 8:00PM. . The Book of Mormon - Monday, March 20, 2023 Legally Blonde - The Musical - Sunday, May 7, 2023 SEASON TICKET RENEWALS ARE HAPPENING NOW! Set design is by Randel Wright, lighting by Kirk Bookman, costumes by Derek Lockwood, video design by Jon Infante, and casting by Alison Franck. Follow our blonde heroine as she tackles all obstacles, overcomes stereotypes, and educates us all . . Legally Blonde - The Musical warms the heart by proving that self-discovery can be way too much fun and hilarious to boot. The story follows the transformation of Elle Woods as . Sat Jan 21 2023 at 11:00 am ES Barrison @ Central Florida Comic Con 2023. THE 2022-2023 GJHP MUSICAL. Valid on select performances and price zones.
Legally Blonde - The Musical is coming to Lubbock! Harvard's beloved blonde takes the stage in this joyful story of self-discovery. 2023: 2 p.m. Saturday, March 18, 2023: 8 p.m. Sunday, March 19, 2023: 2 p.m. LEGALLY BLONDE - THE MUSICAL is coming to Dayton!.
1-6 tickets | Zone Seating. Fabulously fun and international award-winning Legally Blonde - The Musical is the ultimate Broadway tribute to Girl Power! Wed, Mar 8, 2023 at 7:00pm. As part of a massive 90th Anniversary celebration for Regent's Park Open Air Theatre, a sparkling new production of hit musical, Legally Blonde, is bending and snapping its way to the iconic, outdoor venue.With a fresh, modern take on the source material and a diverse cast of performers, Legally Blonde is set to be one of the biggest theatrical events of the year. . Legally Blonde - The Musical is coming to South Bend! Groups Corporate Groups Student Groups Groups Early Access to OrderOrder before Determined to get him back, Elle ingeniously charms her way into the prestigious law school. At State Theatre New Jersey. 2022-23 Broadway Series Subscriptions are on sale now. .
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Q: Weird things happening with CSS after server change So I had my "My Work" page laid out exactly the way I wanted it yesterday, and I needed to change servers. I changed servers, and all my other sites are fine, but the look of my "My Work" page got messed up. Basically the background image from the bottom widget area is now in the middle of the page. It looks like nothing on this page is inside of its container anymore. It definitely was before I changed servers.
Any help would be greatly appreciated, I've no idea why it's only affecting this one page on this one site. I tried re-uploading the css file, and the entire theme to the new server and nothing changed.
Edit: Sorry, here is the css for the widget area that's floating in the middle of the page:
.widget-area {
  padding-top: 40px;
  font-family: 'Alegreya Sans', sans-serif;
  font-size: 20px;
  color:#d2c1ad;
  margin-top: 3%;
  background-image:url(images/widgetarea.png);
  background-repeat:no-repeat;
  background-size: 101%;
}

A: EDIT:
Floated items do not take up any space. So even though you have a bunch of .gallery-item divs in there, they are not making the container have a height since they're floated. You need to clear the float. The easiest way is to add a div after the last .gallery-item. Give it the css of clear:both;

On line 555 of your stylesheet where you have .widget-area, add:
background-position: bottom center;

A: The problem is the margin-top on your aside objects in the widget.  To prove this, change the margin-top to a smaller value for your .widget class.  For me, this moved the black wiggly thingy to the bottom, just above the footer, and the three aside elements were to the right, all above or below each other.
I'm guessing there is a better way to make this work, and I personally would stay away with using percentages.  But I'm in no way a css expert and there are plenty of those on here that might give you a better, more robust solution to your problem.


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Invalidity Pension
Dáil Éireann Debate, Tuesday - 11 December 2018
535. Deputy Michael McGrath asked the Minister for Employment Affairs and Social Protection her plans to allow persons on invalidity pension to work for rehabilitative purposes without the need to transfer across to the partial capacity benefit; and if she will make a statement on the matter. [51874/18]
Written answers (Question to Employment)
Minister of State at the Department of Employment Affairs and Social Protection
Invalidity Pension is a pension paid to people who are permanently incapable of work because of illness. It is based on a claimant's social insurance contributions and is not means tested. To qualify for award of Invalidity Pension a claimant must satisfy both PRSI contribution and medical conditions.
Invalidity Pension is for people who are permanently incapable of work and is generally paid to pension age. To qualify for Invalidity Pension a person must have an incapacity for work of such a nature that the likelihood is that the claimant will be incapable of work for life, or an incapacity which has existed for 12 months prior to the date of claim, and where the Deciding Officer or an Appeals Officer is satisfied that the claimant is likely to be unable to work for 1 year from the date of claim.
Where a person with a disability wishes to return to work they may apply for Partial Capacity Benefit (PCB). PCB allows people to continue to receive a percentage of their Illness Benefit or Invalidity Pension payment while working. Participation on the PCB scheme is voluntary. A person who participates on the PCB scheme may return to an Illness Benefit or Invalidity Pension payment if, for example, the employment ceases or if the person cannot continue to work.
It is not intended to change the Invalidity Pension payment to remove the requirement to apply for Partial Capacity Benefit where persons wish to take up paid employment.