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The Audi R8 is a mid-engined sports car released by the German automaker Audi in 2006. Audi announced in 2005 that the name of the successful Audi R8 race car would be used for a new road car in 2007, the Audi R8, based on the Audi Le Mans Quattro concept car, which appeared at the 2003 Geneva Auto Show and 2003 International Motor Show. The R8 was officially launched at the Paris Auto Show on 30 September 2006. There is some confusion with the name which the car shares with the Le Mans winning R8 LMP. Originally, many thought the car would be called the R9 (as there is a gap in numbering left when Audi announced the R8's successor, the diesel-powered R10).
The Audi R8 will be available in mid-2007 with a 4.2 L V8 making 420 hp,as seen in the Audi RS4. Pricing for the 420 bhp model starts from €104,400 or £77,000. The base price in the US is $109,000.
The R8 has a dry weight of 1560 kg (3439 lb). A 0-100 km/h (0-62 mph) time of 4.6 seconds is possible with a top speed of 301 km/h (187 mph).
The quarter mile time for the R8 is 12.6 seconds and roadhandling on the 300 ft skidpad is 0.98g.
As Audi owns Lamborghini, the R8's architecture such as layout and chassis is based on that of the Lamborghini Gallardo and the two vehicles share transmissions. The R8 is made distinct by its exterior styling, cabin, engine options, and pricing.
The European Audi R8 will also be the first production vehicle to feature all-LED headlights.
The Audi R8 also features an optional Bang & Olufsen sound system.
The 2-seat coupe will be made available to the U.S. in the summer of 2007. In addition, an open-top, Porsche Carrera GT-like model will follow in 2008.
For 2009 a second, more powerful engine variant that uses a 520-hp 5.2 L V10, an enlarged version of the Lamborghini Gallardo's engine and already seen in the Audi S8, is rumoured but not confirmed by Audi. Audi is currently in the process of developing a new turbocharged 5.2 L V10 engine for the future Audi RS6, and there is a possibility that this engine will make its way into the R8, dependent on marketing decisions. Test mules of this vehicle are developing well in excess of 600 bhp with the turbocharged 5.2 L V10. If this were to happen it is almost certain that this would create an R8-S.
The Audi R8 is a Sports-prototype race car introduced in 2000 for Sportscar racing as a redevelopment of their Audi R8R (open top LMP) and Audi R8C (closed top LMGTP) used in 1999. It is considered by some to be the most successful sports cars ever (alongside such greats as the Porsche 956/962) having won the prestigious 24 Hours of Le Mans in 2000, 2001, 2002, 2004, and 2005 (five of the seven years it competed). A streak of six straight Le Mans victories was broken-up only by the Bentley Speed 8 in 2003, when the R8 finished 3rd.
The gasoline-powered Audi R8 race car has been replaced from 2006 onwards by the new Audi R10 Diesel, however, the need to further develop the R10 has meant that the R8 has seen action in a few races leading up to Le Mans.Contents
In 1997, sports car racing and especially the Le Mans 24 Hours was popular among factories like BMW, Mercedes-Benz, Porsche, Toyota, Nissan Motors and others. At that time, Audi Sport boss Wolfgang Ullrich started to evaluate the options of joining.
With the upcoming American Le Mans Series also providing a stage for the US-market, Audi announced plans in 1998 to compete in 1999, with a car called R8 and powered by a 550 hp V8 turbo. As it was considered the better choice for a whole race due to less weight and wider tires, Audi ordered an open top roadster from Dallara, to be developed and run by Joest Racing.
Yet, during the fall of 1998, after the necessity of GT1 homologation was dropped in favour of LM-GTP prototypes, regarding the speed and success of these closed GT coupés like the Porsche 911 GT1, Mercedes-Benz CLK-GTR, and the Toyota GT-One, Audi also ordered their newly acquired Norfolk based RTN (Racing Technology Norfolk, led by Tony Southgate) to build a closed-cockpit car using the same drivetrain.
The ACO rules for closed-top prototypes allowed cars to run with larger air restrictors, resulting in more power (about 600 hp), which resulted in a higher top speed in combination with the lower drag. To compensate this advantage over the duration of a race, the LMGTPs were limited to smaller tires and smaller fuel tanks.
Following a period of testing, two R8Rs debut at the 1999 12 Hours of Sebring. The BMW V12 LMR won, which was a strong sign towards the race in France. The already tested open-top Audi R8R, entered by Joest Racing was not fast enough to challenge for a win, finishing 3rd.
After further tests and modifications, the Audis returned for Le Mans. The new debuting R8Cs lacked pace and unfortunately suffered mechanical woes. Lap times were 10 seconds down from the leading LMP and LMGTP competitors. Joest's R8Rs ran steady, yet still was too slow to run for pole position. After a race which saw the spectacular flights of the Mercedes-Benz CLR as well as leading cars of Toyota and BMW crashing out, the Audi R8R took 3rd and 4th behind the surviving #15 BMW and the Japanese-driven Toyota.
Based on the experiences, Audi decided to regroup for 2000, and built a new R8 roadster together with Joest and Dallara. The British-built R8C GTP was retired, but Audi-owned Bentley developed the concept of the R8C closed cockpit LMGTP and entered the Bentley EXP Speed 8 in 2001, eventually leading to success in the future.
After the 1999 Le Mans shame, Mercedes retired from GTs to focus on the return of the DTM touring cars in 2000, as well as on F1. Toyota and BMW also went to F1, with BMW at least continuing to race for two years in the ALMS, where the open roadster of Bill Auberlen also suffered a "back flip" during the Petit Le Mans at Road Atlanta in 2000, as the closed-cockpit Porsche of Yannick Dalmas had done in 1998. Despite the BMW V12 not receiving further development, the German team Schnitzer Motorsport was almost as effective as Joest. Still the BMW V12 LMR could not match the Audi R8's might in the championship and lost almost every race against it. BMW returned to race BMW M3 touring car since, dominating in the ALMS and in WTCC as well as at the 24 Hours Nürburgring.
This left only Porsche as a major possible challenger for 2000 — which never showed up, though. Rumors at that time, which were confirmed since[citation needed], said that Ferdinand Piech himself made them stay away, using his influence as a co-owner of Porsche as well as his manager positions at Volkswagen, which would develop the upcoming SUV VW Touareg in cooperation with the Porsche Cayenne. The Porsche V10 racer was turned into the Porsche Carrera GT instead.
The Audi R8 is a sports-racing car prepared for sports car racing in the LMP900 class at Le Mans and in the American Le Mans Series. The car was developed by Audi Motorsport and Joest Racing and first debuted in 2000, winning the 12 Hours of Sebring.
The R8 has won Le Mans five times (2000, 2001, 2002, 2004 and 2005) and the overall season championship in the American Le Mans Series six times in a row (from 2000 to 2005).
The Audi R8 was the only car until today to have beaten the 1999 Toyota GT-One's Le Mans record qualifying lap in 1999 (3:29:930) with a time of 3:29:905 in 2002. This proved the R8 to be the fastest LMP category car around the legendary circuit.
The R8 won a hat trick at Le Mans (three wins in a row) campaigned by Audi Sport Infineon Team Joest and driven by Tom Kristensen, Emanuele Pirro and Frank Biela during the 2000-2002 seasons. First time out in 2000, the team won a 1-2-3 finish, which was just a small preview of what this all-new Audi was capable of. Since then, the Audi R8 has won numerous championships and races, including wins at Le Mans in 2004 and 2005.
The R8 is powered by a 3.6 L twin-turbocharged and intercooled Audi FSI V8. FSI stands for Fuel-Stratified Injection, which is a variation on the concept of gasoline direct injection developed by VW which maximizes both power and fuel economy at the same time. FSI technology can be found in products available to the normal public, across all brands in the Volkswagen Group.
The power supplied by the R8, officially limited to about 610 hp (about 450 kW) in 2000, 2001 and 2002, 550 hp in 2003 and 2004 and 520 hp in 2005, is sent to the rear wheels via a Ricardo six-speed sequential transmission with an electro–pneumatic gear change. That means it has a computer-controlled clutch that allows the driver to make gear changes without touching the clutch pedal. These gear changes can be done by the computer far quicker than even the fastest human being with a conventional manual transmission.
However, while the R8's speed was quite dominant during the races, speed is but a minor factor in winning the 24 Hours of Le Mans. The main key is reliability. The R8 was a reliable car, yes; but not far more so than its competitors. The real reason for the R8's dominance at La Sarthe was its ingenious design.
The Audi R8's structure was designed from the very beginning to expedite parts changes during the race. The car has a chassis that has been likened to a Lego model — anything on the car can be changed and changed quickly. During its campaign, the Joest pit crew was able to change the entire rear transaxle of a damaged R8 — a process which usually takes between one and three hours — in four and a half minutes, a feat that was unprecedented in its efficiency and speed. The Automobile Club de l'Ouest (ACO), organizers of the 24 Hours of Le Mans and the American Le Mans Series acted quickly to void this advantage by mandating the gearbox casing be the same item through the duration of the race, with only the internals being allowed to be changed. However, the R8 still had quicker access to the gearbox internals than any other car due to its quick-change construction.
The R8's structure and body are both composed of carbon fiber, a lightweight polymer material which is extremely lightweight and strong; however it is very expensive and time-consuming to mould.
The car had a top speed of over 205 mph (330 km/h) and reached 60 mph in just 3.3 seconds. Seemingly, the R8 actually hit 337 km/h in 2000 at Le Mans.
Audi Sport's programme saw tragedy in 2001 when on April 25, popular driver Michele Alboreto died in an accident after suffering a high-speed tire failure during an RB test session at the Lausitzring in eastern Germany.
It should be noted, however, that the Bentley Speed 8, which ran at Le Mans from 2001 to 2003, winning in 2003, utilised a heavily modified 4.0 L version of the turbocharged V8 engine from the Audi R8. The Bentley racing effort was campaigned by Team Bentley (Apex Motorsport) with assistance from longtime R8 competitor Joest Racing and Audi Sport UK. Tom Kristensen, who won the previous three 24 Hours of Le Mans races in an R8, was assigned to drive the Bentley Speed 8, and helped guide the team to victory. (Kristensen went on to win the 2004 and 2005 races in an Audi R8). Some even say that the works Audi teams sandbagged the race in order to hand victory to the Volkswagen/Audi Group's newest addition, Bentley Motors. There is also some similarity between the Bentley Speed 8 and the Audi R8's successor, the R10. In some places the Bentley is referred to as being the R9.
Very few racing cars have a racing pedigree comparable to the R8. However, as amazing as the R8 was, during the 2005 season, it was evident that its time at the front of the pack was drawing to a close. Audi had made the development of the R10 diesel public, and cars from other manufacturers and teams started to catch up in terms of on-the-track speed. The ACO still felt that the R8 needed to be kept in check, therefore they reduced the restrictor size on the R8's engine and stipulated the car shall carry ballast in an attempt to make the races more competitive. At the 2005 Le Mans, the Audis failed to qualify on pole position; the fastest R8 started the race in third position. However, as a hallmark to the R8's legendary reliability, the car was able to outlast all other competitors to take its fifth checkered flag at the venerable Circuit de la Sarthe and the 24 Hours of Le Mans. This victory was also notable since it was Tom Kristensen's 6th straight 24 Hours of Le Mans victory, and a record 7th overall, beating legendary driver Jacky Ickx's previous record of 6 career 24 Hours of Le Mans victories.
Throughout its six year history, the R8 has proven to be one of the most dominant cars in history. Indeed, of all the races it had entered over a seven year period, the R8 lost a mere eighteen races total. Here is a list of some of the achievements of the R8.
24 Hours of Le Mans winner – 2000, 2001, 2002, 2004, 2005, 2006
American Le Mans Series champion: 2000, 2001, 2002, 2003, 2004, 2005, 2006†
European Le Mans Series champion: 2001
Le Mans Series champion: 2004
2006: the R10 Diesel
Main article: Audi R10
Allan McNish drives the Audi R8 to a win at its final race at Lime Rock Park on July 1, 2006.
In response to the new level of competition, development of the successor, known as the Audi R10, has been completed. The V12-Turbodiesel won at its race debut at the 2006 12 Hours of Sebring with both cars starting on the front row. Unfortunately the pole sitting R10 had to start from the pit lane due to the need to rectify heat exchanger issues. Peugeot is in the process of developing a Diesel powered rival in 2007, the Peugeot 908.
Emanuele Pirro, Frank Biela and Marco Werner made history by becoming the first drivers to win the Le Mans 24-hour race in a diesel-powered car. The Audi R10 Diesel completed a record 380 laps of the La Sarthe circuit, with Pirro at the wheel for the finish. French trio Sebastien Loeb, Eric Helary and Franck Montagny took second in the Pescarolo Judd No 17, four laps adrift. Scotsman Allan McNish was third in the other Audi, which came in 13 laps down after suffering mechanical problems.
The venerable R8 continued to campaign the American Le Mans Series through the first half of the 2006 season, and made its final US appearance on July 1, 2006 at Lime Rock Park, Connecticut, piloted by McNish and Capello. The R8 ended its career in style by winning the race, the 50th American Le Mans Series win for the Audi R8. The R10s participated in the rest of the ALMS season, beginning with the race at Miller Motorsports Park, Utah.


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$750,000 Settlement During Trial For Failure To Diagnose And Treat Stroke In An 85 Year Old Woman
An 85-year-old woman suddenly became non-communicative while being transported from a rehabilitation facility to a Boston hospital for an orthopedic follow-up appointment regarding her broken wrist. There was a dispute between the chair car driver, who claimed that he conveyed this change to the staff in the doctor's office, and the doctor and his receptionist, who denied any knowledge of a change. The doctor, who had never met the patient before and had no idea what her baseline status was, examined her wrist, assumed that her inability to speak was a longstanding problem, and returned her to the rehabilitation facility. When she arrived back at the rehabilitation hospital, the staff immediately called an ambulance, but the patient had suffered a stroke and was now outside the window for thrombolytic (clot-busting) treatment. Crowe & Mulvey negotiated a $750,000 settlement for the family just before closing arguments in the trial.

subset: commoncrawl


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Super Junior's Sungmin to Get Married with Musical Actress Kim Sa Eun
Super Junior's Sungmin will get married with musical actress Kim Sa Eun.
On October 14, through the group's official homepage, the idol star stated, "I've thought about what to say for my first sentence countless times. Writing and erasing over and over again, all the people I'm thankful for are coming up. With a heavy and careful heart, I'm writing this letter."
And added, "Everyone, I met my soulmate and I'm getting married on December 13. It makes me sad to think about all the fans who must have been embarrassed by the news. I've been thinking about how I should tell my loving E.L.F about the news, but I'm sorry to make you know about the news through articles."
He also said, "I thought about revealing the news a lot, not because I was scared of the decision I had made, but because I was worried for the people I'm thankful for. I want to tell you all that I love you. I'm so thankful for all of you that have stood by me and supported me. And I also feel thankful to the Super Junior members and my company that trusted and supported my decision. I'll do my best to return everyone's love and support."
Meanwhile, Sungmin and Kim Sa Eun became lovers by appearing on a musical 'The Three Musketeers' together at the end of last year.


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The 2020 Ag Outlook Meeting is scheduled for Friday, January 24 at the Kidron Park ... lessen shocks and losses or provide protection in times of volatile markets and weathers. The 2020 Ag ... risks inherent in our agricultural world. Thanks to our sponsors, Farm Credit Mid-America, ...
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The fish facility is looking to hire an undergradute student. Over the years, they have found that ...
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Building at 428 West Liberty Street in Wooster. The program starts at 10:00 am and concludes by 3:00 pm. ... materials. Thanks to our sponsors: Farmers National Bank, Farm Credit Mid-America and PNC Bank for their ... reached at 330-264-8722. CFAES provides research and related educational programs to clientele on ...
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The 2018 Farm Bill provides commodity crop producers with options to choose between ... enrolling in a Agriculutural Risk Coverage (ARC) or a Price Loss Coverage (PLC) program. The farm bill ... then a yearly program election for the following three years of the 2018 Farm Bill. The March 15 date ...


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Here's a Quick Overview of the Process of Selling Your Home:
Invite Wayne to perform a Competitive Market Analysis (CMA) of your home. He will visit and tour the house, then compare it to recent sales in your area. On the basis of current market conditions, you and he will arrive at what seems to be the current fair market value of your home. He will also let you know if there are minor cosmetic improvements you could make that might increase the eventual sales price.
Complete the listing agreement, based on the results of the CMA. The listing agreement is a contract between you and Long and Foster. It covers the length of time you will allow the house to be marketed, the commission to be paid, and many other legal points. Wayne will go through the agreement and answer all your questions.
The property will be added to the Multiple List, the database of properties for sale that is available to all Realtors in our area. Wayne will work out a comprehensive marketing plan specifically for your home, which may include advertising in various publications, specific dates for Open Houses, flyers, brochures, mailings, and much more.
When an offer to purchase is obtained, Wayne will present the contract to you, going through its various clauses and contingencies, and provide you with an estimate of your 'bottom line.' The choice of whether to accept the offer is completely yours.
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More rumored details are being leaked about the next generation XBOX 720. And it's shows what could be the next great frontier for gaming platforms… upgradability.
The news of an upgradable Xbox comes from a Microsoft Patent (#20120159090) which was actually granted back in December 2010. The patent, which was granted to Microsoft architect Jeff Andrews, calls for "platform resources, hardware resources in particular, to scale up or down over time." And according to numerous rumor sites, like D'Vice, the upgradeable capability was actually eluded to in Microsoft's 56 page treatise for their next generation XBox 720.
The thing is, gaming platforms like the XBox, Playstation, and even the Nintendo Wii have extremely long life spans – about ten years. And even with rapid advances in gaming graphics, motion controllers like the Kinect and Move, the basic guts of the platforms stay the same over nearly a decade of use.
Being able to make a more modular design that would allow users to customize and upgrade the basic platform configuration could allow for making the XBox 720 faster and handle more realistic and memory intensive graphics over time. It would also allow for faster development of hardware peripherals which could evolve at a pace along with the games as they are written. Additionally, it would also make sense with Microsoft working on it's own version (called the "Fortaleza Kinect Project) of iGlass, and Google's Project Glass. The ability to upgrade a platform would allow for new technology like that to be married to the platform as it comes online. Additionally, Microsoft's focus seems to be reaching beyond gaming, to a central entertainment hub. Making an XBox upgradeable would help as well, since it would be required to not only watch movies, but stream video, have online interactivity, and more.
Course, it also just means that if a gamer wants to pimp out their platform for the fastest rig possible, they could do it for the price. But that's not a bad thing. It could also give gaming platforms a longer life span, allowing for upgrades to processors as they become more powerful. This is nothing new to the PC world, as gamers are often known to build their own "ultimate gaming machines" out of the best possible hardware and then add home theater sound, widescreen HDTV monitors, even 180 degree screens for a full immersive experience.
But it also could be the converse, which would be better for Microsoft. Making the gaming platforms customizable would conceivably shorten their lifespan as they become quickly obsolete for the current state of the gaming art. Rather than have a gaming platform lasting 10 years, it could maybe last two, as the next generation development windows shorten due to competition and innovation. A shorter lifespan leads to a quicker change over to yet another platform with the promise of customization. How do we know that? Just look at the promise of upgradability in the PC world. It was a buzzword in 90s and early 2000s, the promise of being able to swap out parts to make your PC faster and last longer. But in the end, as prices dropped, it became easier to just buy a new rig every three or four years. Initially, this was good for PC manufacturers, but margins quickly thinned out as the prices continued to drop.
A fickle thing, technology.


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We will be adding more details to this post soon to fully describe our incredibly successful and unique event! View the video below to see a snapshot of the Fair Trade Clothesline Art Sale that The Walden School recently held at Penn State Brandywine. All of the art was sold, and $375 was raised for Fresh Artists to purchase school supplies for schools in Chester!
To view a video of the Fair Trade Clothesline Art Sale, please click here.
The Walden School, Penn State Brandywine, and Fair Trade – what a collaboration!


text: Products are an option when you need only. if you need to have WC (Woocommerce) shop pages, you need to install "Woocommerce" plugin. We also provide The-Grid Skin for grid like our demo site. 1. Please install Woocommerce. Offical WC site for doc : https://docs.woocommerce.com/document/installing-and-activating-woocommerce-extensions/ 2. Add your products. https://docs.woocommerce.com/document/managing-products/ 3 (Option) Use the grid ..


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Bookkeeping is the recording of your transactions from the source documents.
It is important that the person entrusted with the bookkeeping has an extensive accounting background, as well as a good understanding of the journals involved rather than just an understanding of the bookkeeping software packages.
It is our aim to alleviate the stress associated with the record keeping requirements of modern business, so that you can concentrate on managing your business.
We will tailor our bookkeeping services to suit your specific business requirements and be available to you if you need advice.


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A Swedish tourist was admitted to a Cuban hospital due to epileptic seizures caused by brain tumors. Upon return to Sweden and admission to our hospital, methicillin-resistant Staphylococcus aureus (MRSA) was isolated. He was later considered to be free of MRSA but then developed a brain abscess from which MRSA was isolated.
The influence of radiotherapy on malignant glioma multidrug resistance to chemotherapy was evaluated because patients with glioma often are treated with a combination of radiotherapy and chemotherapy. Multidrug resistance gene (MDR1, mdr1a, and mdr1b) transcripts were found in human and rat glioma cell lines. P-Glycoprotein (Pgp) was immunohistochemically detected in glioma cell lines and in the rat brain vascular endothelial cell line (RBE4). A multidrug resistance pump efflux activity assay demonstrated increased calcein efflux of RBE4 endothelial cells, but not glioma cells, 2 h after irradiation and still increased 14 d after irradiation. The increased efflux was equally inhibited by verapamil with or without irradiation. In the rat intracranial glioma model (BT4C), Pgp was demonstrated in capillary endothelial cells of the tumor tissue and surrounding normal brain, but not in tumor cells. The expression of gene transcripts or Pgp was not affected by irradiation. The results indicate that long-lasting verapamil-resistant drug efflux mechanisms are activated in brain endothelial cells after irradiation. The results might explain the poor efficacy of chemotherapy following radiotherapy and contribute to consideration of new treatment strategies in the management of malignant glioma.
Overexpression of epidermal growth factor receptor (EGFR, ErbB1) correlates with enhanced malignant potential of many human tumor types including glioblastoma multiforme. The significance of EGFR expression in meningiomas is, however, unclear. Reports regarding the other EGFR family members, ErbB2-4, in brain tumors are sparse. In this study, the expression of the EGFR family members was analyzed in relation to various parameters for the clinical importance of these receptors in 44 gliomas and 26 meningiomas. In gliomas, quantitative real-time reverse transcription (RT)-PCR revealed the highest EGFR mRNA expression in high-grade gliomas, while ErbB2 and ErbB3 mRNA were detected only in a few high-grade gliomas. In contrast, ErbB4 expression was most pronounced in low-grade gliomas. Immunohistochemistry showed significantly higher EGFR protein expression in high-grade gliomas compared to low-grade gliomas (P= 0.004). ErbB2 protein expression was mainly seen in high-grade gliomas. ErbB3 protein expression was low in all gliomas analyzed. ErbB4 protein expression was significantly higher in low-grade gliomas than in high-grade gliomas (P= 0.007). In meningiomas, quantitative real-time RT-PCR revealed expression of EGFR, ErbB2, and ErbB4 mRNA in the majority of the tumors. ErbB3 was detected in only one of the meningiomas analyzed. Immunohistochemistry demonstrated high ErbB2 protein expression in meningiomas. An intriguing observation in astrocytomas and oligodendrogliomas grade II, was a significantly decreased overall survival for patients with high EGFR protein expression (P= 0.04). The high ErbB4 expression in low-grade compared to high-grade gliomas might suggest that ErbB4 acts as a suppressor of malignant transformation in brain tumors, which is in line with previous studies in other tumor types.
Brain tumors, in general, display a multidrug-resistant phenotype. This study evaluated the immunohistochemical expression and distribution of P-glycoprotein (Pgp), multidrug resistance protein (MRP1), lung resistance protein (LRP) and O6 methylguanine-DNA methyltransferase (MGMT) in low- and high-grade astrocytoma, oligodendroglioma and in different subgroups of meningioma. The results revealed a marked heterogeneity in the expression and distribution among the analyzed tumors. In astrocytoma and oligodendroglioma, Pgp and MRP1 were observed in the capillary endothelium and in scattered tumor cells, whereas LRP occurred only in tumor cells. A pronounced expression of MGMT was found independent of the histopathological grade. An enhanced expression of MRP1 and LRP in astrocytoma and oligodendroglioma were more often evident in older patients (> 50 years). Survival analysis suggested a markedly decreased overall survival for patients suffering from low-grade glioma overexpressing Pgp. In meningioma, a heterogeneous expression of Pgp, MRP1, LRP and MGMT was seen with the most prominent staining localized to the capillary endothelium. Pgp was significantly more often overexpressed (p < 0.05) in transitional compared to meningothelial meningioma. The marked heterogeneity in the expression suggests that analysis of these factors can be of importance in the selection of individualized chemotherapy, regardless of tumor type.
Diffuse reflectance spectroscopy as a method for improving intracerebral guidance during functional neurosurgery has been investigated. An optical probe was developed for measurements during stereotactic and functional neurosurgery in man. The aim of the study was to investigate the spectral differences between white and grey matter and between white matter and functional targets. Diffuse reflectance spectroscopy measurements in ten patients were recorded at incremental steps towards and in three different functional targets (STN, GPi and Zi). The recorded spectra along the trajectory were sorted into white or grey matter, based on preoperative MRI images or the recorded spectral shape and intensity. The difference between tissue types was calculated as a quotient. Significant intensity differences between white and grey matter were found to be at least 14% (p < 0.05) and 20% (p < 0.0001) for MRI and spectral-sorted data respectively. The reflectance difference between white matter and the functional targets of GPi was higher than for STN and Zi. The results indicate that diffuse reflectance spectroscopy has a potential to be developed to a suitable complement to other intracerebral guidance methods.
OBJECT: The authors investigated and compared the in vitro characteristics of 2 CSF shunts, the Strata NSC and the Codman Hakim, and their corresponding antisiphon devices (ASDs).
METHODS: Six new CSF shunts and the corresponding ASDs for each model were tested in an automated, computerized experimental setup based on pressure regulation. Opening pressure accuracy, resistance, sensitivity to abdominal pressure, antisiphon effect, and the influence of different ASD positions were determined.
RESULTS: In general the shunts performed according to the manufacturers' specifications. However, at the lowest setting, the opening pressure of the Strata NSC was close to 0, and in the Codman Hakim shunt, it was higher than specified. The resistance in the Codman Hakim shunt (5.4 mm Hg/ml/min) was much higher than that in the Strata NSC (3.6 mm Hg/ml/min). Abdominal pressure affected opening pressure in both valves. Positioning the Strata ASD above or below the ventricular catheter tip resulted in higher and lower opening pressures, respectively, than when it was placed in line with the catheter. The positioning of the Codman Hakim ASD did not influence the opening pressure.
CONCLUSIONS: Both CSF shunts work properly, but at the lowest setting the opening pressure of the Strata NSC was near 0 and in the Codman Hakim it was twice the manufacturer's specifications. The resistance in the Strata NSC was below the normal physiological range, and in the Codman Hakim device it was in the lower range of normal. The ASD did not change the shunt characteristics in the lying position and therefore might not do so in children. If this is the case, then a shunt system with an integrated ASD could be implanted at the first shunt insertion, thus avoiding a second operation and the possibility of infection.
The authors have demonstrated that using a pear-shaped balloon when performing percutaneous balloon compression for trigeminal neuralgia results in longer pain relief than non-pear-shaped balloons. Other surgical parameters seemed less important with respect to pain relief. Balloon compression also, in many cases, results in hypesthesia.
BACKGROUND: Transcranial Doppler sonography (TCD) assessment of intracranial blood flow velocity has been suggested to accurately determine intracranial pressure (ICP). OBJECTIVE: We attempted to validate this method in patients with communicating cerebrospinal fluid systems using predetermined pressure levels. METHODS: Ten patients underwent a lumbar infusion test, applying 4 to 5 preset ICP levels. On each level, the pulsatility index (PI) in the middle cerebral artery was determined by measuring the blood flow velocity using TCD. ICP was simultaneously measured with an intraparenchymal sensor. ICP and PI were compared using correlation analysis. For further understanding of the ICP-PI relationship, a mathematical model of the intracranial dynamics was simulated using a computer. RESULTS: The ICP-PI regression equation was based on data from 8 patients. For 2 patients, no audible Doppler signal was obtained. The equation was ICP = 23*PI + 14 (R = 0.22, P < .01, N = 35). The 95% confidence interval for a mean ICP of 20 mm Hg was -3.8 to 43.8 mm Hg. Individually, the regression coefficients varied from 42 to 90 and the offsets from -32 to +3. The mathematical simulations suggest that variations in vessel compliance, autoregulation, and arterial pressure have a serious effect on the ICP-PI relationship. CONCLUSIONS: The in vivo results show that PI is not a reliable predictor of ICP. Mathematical simulations indicate that this is caused by variations in physiological parameters.
OBJECTIVE: Balloon compression of the rootlets behind the trigeminal ganglion for the treatment of trigeminal neuralgia has become an increasingly popular method among neurosurgeons. However, the method has recognized complications, including double vision. Although occurring infrequently, diplopia may cause the patient significant disability. To minimize the risk for this complication, we analyzed our patients with respect to the surgical technique. METHODS: We reviewed our joint consecutive series of 193 patients with trigeminal neuralgia treated with balloon compression. The medical records and the intraoperative x-ray images were analyzed. RESULTS: We identified six patients with double vision postoperatively. In analyzing these occurrences, we found that the balloon was inflated outside Meckel's cave in four patients, the balloon was initially inflated too deeply in one patient, and the anatomy of Meckel's cave was probably aberrant in one patient. In five of the six patients, the symptoms resolved within 5 months. CONCLUSION: By meticulous surgical technique with close attention to the anatomic position and the shape of the inflated balloon, most cases of postcompression diplopia should be avoided.
Hypofractionated conformal stereotactic radiotherapy (HCSRT) is an established method of treating brain lesions such as arteriovenous malformations (AVMs) and brain metastases. The aim of this study was to investigate the reliability of treatment plans in the terms of dose distribution and absorbed dose for HCSRT.
Methods and materials. Treatment plans for three different clinical intracerebral targets, AVMs, were transferred to a CT study of a spherical water filled phantom simulating the human head and recalculated for the phantom geometry using a standard treatment planning system utilizing a pencil beam algorithm for dose calculation. The calculated absorbed dose, relative three dimensional (3D) dose distribution and dose conformity were investigated using gel dosimetry normalized to liquid ionization chamber (LIC) measurements.
Results. The measured absorbed dose to the dose reference point was found to be within 2% of the calculated dose for all three targets. The measured dose distribution was found to be within 3% and 2 mm of the calculated dose for more than 93% of all points in the target volume for all three targets.
Conclusions. The results show that the investigated standard treatment planning system can correctly predict the absorbed dose and dose distribution in different types of intracerebral targets and that the treatment can be delivered according to the plan.
BACKGROUND: Pallidal deep brain stimulation (DBS) of globus pallidus internus (Gpi) has emerged as an effective treatment for dystonia. The experience is however limited concerning focal dystonias and to date only a few cases of pallidal DBS in the treatment of Meige syndrome have been published. METHODS/RESULTS: We here present a patient with Meige syndrome in whom unilateral pallidal DBS failed to improve the axial symptoms, but bilateral stimulation resulted in a major improvement. The Burke-Fahn-Marsden score (BFM) improved by 71.5% and the patient's blepharospasm was abolished. CONCLUSIONS: The results suggest bilateral pallidal DBS may be an effective treatment for Meige syndrome.
Background: Intracerebral infections after deep brain stimulation (DBS) are rare. The published material is limited to 2 case reports. A review of 20 publications of 3,818 patients focusing on complications of DBS did not reveal one single case. For that reason, we decided to present our own experience of 4 patients with this complication.
Objectives: To analyze and present our material regarding intracerebral infections after DBS.
Methods: Four patients with intracerebral infection after DBS were retrospectively analyzed. Results: The 4 patients exhibited signs of intracerebral infection 2-14 days after DBS for Parkinson's disease. CT and MRI verified signs of possible cerebral involvement. In 3 patients, positive cultures were obtained from the extracted electrodes. All patients recovered completely following treatment with antibiotics and removal of the implanted hardware. Two of the patients were later re-implanted.
Conclusions: Intracerebral infection is a rare complication of DBS. It does, however, occur occasionally and should be taken into consideration when evaluating the risks of DBS.
Copyright (c) 2012 S. Karger AG, Basel
BACKGROUND: Several studies have described lesional therapy in the posterior subthalamic area (PSA) in the treatment of various movement disorders. Recently, some publications have illustrated the effect of deep brain stimulation (DBS) in this area in patients with Parkinson's disease, essential tremor, MS-tremor, and other forms of tremor. Even though the clinical series is small, the reported benefits prompted us to explore DBS in this area in the treatment of tremor.
METHOD: Five patients with tremor were operated using unilateral DBS of the PSA. Two patients had dystonic tremor, one primary writing tremor, one cerebellar tremor and the other neuropathic tremor. All patients were assessed before and 1 year after surgery using items 5 and 6 (tremor of the upper extremity), 11-14 (hand function), and when appropriate item 10 (handwriting) from the essential tremor rating scale.
FINDINGS: The mean improvement on stimulation after 1 year was 87%. A pronounced and sustained microlesional effect was seen in several of the patients, and while the mean improvement off stimulation was 56% the reduction in the three patients with the most pronounced effect was 89%. The two patients with dystonic tremor did also become free of the dystonic symptoms and pain in the treated arm. No severe complication occurred.
CONCLUSIONS: DBS of the PSA in this small group of patients had an excellent effect on the different forms of tremor, except for the neuropathic tremor where the effect was moderate. These preliminary results suggest PSA to be an effective target for the treatment of various forms of tremor. Further studies concerning indications, safety and efficacy of DBS in the posterior subthalamic area are required.
Both posteroventral pallidotomy and pallidal deep brain stimulation (DBS) have a documented effect on Parkinsonian symptoms. DBS is more costly and more laborious than pallidotomy. The aim of this study was to analyse the respective long-term effect of each surgical procedure on contralateral symptoms in the same patients. Five consecutive patients, two women and three men, who at first surgery had a mean age of 64 years and a mean duration of disease of 18 years, received a pallidotomy contralateral to the more symptomatic side of the body. At a mean of 14 months later, the same patients received a pallidal DBS on the side contralateral to the pallidotomy. All patients had on–off phenomena and dyskinesias. There were three left-sided and two right-sided pallidotomies, and, subsequently, two left-sided and three right-sided pallidal DBS. The latest evaluation was performed 37 months (range 22–60) after the pallidotomy and 22 months (range 12–33) after the pallidal DBS. Mean UPDRS motor score pre-operatively was 49 and at last follow-up 33 (32.7% improvement, p<0.05). Appendicular items 20–26 contralateral to pallidotomy remained improved more significantly than contralateral to DBS. Dyskinesia scores were also improved more markedly contralateral to the pallidotomy. Two patients exhibited moderate dysarthria and one patient severe dysphonia following DBS. Symptoms contralateral to the chronologically older pallidotomy, especially dyskinesias, rigidity and tremor, were still more improved than symptoms contralateral to the more recent pallidal DBS, despite numerous post-operative patient visits to optimise stimulation parameters.
Deep brain stimulation (DBS) of the nucleus ventralis intermedius thalami (Vim) in the treatment of essential tremor (ET) is well documented concerning the acute effects. Reports of the long-term effects are, however, few and the aim of the present study was to analyse the long-term efficacy of this treatment. Nineteen patients operated with unilateral Vim-DBS were evaluated with the Essential Tremor Rating Scale (ETRS) before surgery, and after a mean time of 1 and 7 years after surgery. The ETRS score for tremor of the contralateral hand was reduced from 6.8 at baseline to 1.2 and 2.7, respectively, on stimulation at follow-up. For hand function (item 11 – 14) the score was reduced from 12.7 to 4.1 and 8.2, respectively. Vim-DBS is an efficient treatment for ET, also after many years of treatment. There is, however, a decreasing effect over time, most noticeable concerning tremor of action.
Read More: http://informahealthcare.com/doi/abs/10.1080/02688690701552278
The side effects and complications of deep brain stimulation (DBS) and ablative lesions for tremor and Parkinson's disease were recorded in 256 procedures (129 DBS and 127 lesions). Perioperative complications (seizures, haemorrhage, confusion) were rare and did not differ between the two groups. The rate of hardware-related complications was 17.8%. In ventral intermediate (Vim) thalamotomies, the rate of side effects was 74.5%, in unilateral Vim-DBS 47.3%, while in 7 bilateral Vim-DBS 13 side effects occurred. Most of the side effects of Vim-DBS were reversible upon switching off, or altering, stimulation parameters. In unilateral pallidotomy, the frequency of side effects was 21.9%, while in bilateral staged pallidotomies it was 33.3%. Eight side effects occurred in 11 procedures with pallidal DBS. In 22 subthalamic nucleus DBS procedures, 23 side effects occurred, of which 8 were psychiatric or cognitive. Unilateral ablative surgery may not harbour more postoperative complications or side effects than DBS. Some of the side effects following lesioning are transient and most but not all DBS side effects are reversible. In the Vim DBS is safer than lesioning, while in the pallidum, unilateral lesions are well tolerated.
Copyright © 2006 S. Karger AG, Basel
Deep brain stimulation (DBS) is an established surgical treatment for Parkinson's disease (PD), essential tremor and dystonia. It is generally acknowledged that the development of DBS as we know it today started with the publication of Benabid, Pollak et al in 1987 on thalamic DBS for tremor. This technique gained momentum in the mid-Nineties after that Pollak and Benabid introduced the subthalamic nucleus as a target in advanced PD. This paper reviews the gestational pre-natal era of deep brain stimulation, before 1987. The origin of DBS can be traced back to the practice of intra-operative electrical stimulation, used for target exploration prior to lesioning, during the early years of stereotactic functional neurosurgery. During the 60s, Sem-Jacobsen and others implanted externalised electrodes which were used for intermittent stimulation and evaluation during weeks or months, prior to subsequent ablation of thalamic and other basal ganglia targets. In the early 70s Bechtereva treated PD patients using "therapeutic electrical stimulation" through electrodes implanted for up to 1.5 years. In the late 70s and early 80s the term Deep Brain Stimulation was coined and few groups attempted treatment of Parkinson's disease, non-Parkinsonian tremor and dystonia with high-frequency stimulation using chronically implanted DBS systems. Cumbersome, un-sophisticated DBS hardware, together with the general decline of all surgery for PD following the introduction of levodopa, may have contributed to the lack of popularity of old-times DBS. It is to the credit of the Grenoble Group to have reinvented, modernised and expanded modern DBS in surgical treatment of movement disorders.
We present a 62 years old man with Parkinson's disease (PD) who underwent bilateral stimulation in the subthalamic nucleus (STN). During the intraoperative evaluation, stimulation through the lowest contact in the right STN area, induced an acute depressive state, during which the patient was crying and expressing that he did not want to live. The patient returned to his normal state of mood within seconds after the cessation of stimulation. Repeated blinded stimulations resulted in the same response. Immediate postoperative magnetic resonance imaging (MRI) revealed that the lowest contact of the right electrode was located in the substantia nigra.
To evaluate pallidal DBS in a non-DYT1 form of hereditary dystonia. We present the results of pallidal DBS in a family with non-DYT1 dystonia where DYT5 to 17 was excluded. The dystonia is following an autosomal dominant pattern. Ten members had definite dystonia and five had dystonia with minor symptoms. Four patients received bilateral pallidal DBS. Mean age was 47 years. The patients were evaluated before surgery, and "on" stimulation after a mean of 2.5 years (range 1-3) using the Burke-Fahn-Marsden scale (BFM). Mean BFM score decreased by 79 % on stimulation, from 42.5 +/- 24 to 9 +/- 6.5 at the last evaluation. Cervical involvement improved by 89%. The 2 patients with oromandibular dystonia and blepharospasm demonstrated a reduction of 95% regarding these symptoms. The present study confirms the effectiveness of pallidal DBS in a new family with hereditary primary segmental and generalized dystonia.
Objective. The objective of this study was to report our observations on the external electromagnetic field influences on deep brain stimulation (DBS) in our patient population and how these influences affected our patients' lives and other healthcare-related conditions.
Materials and Methods. We have retrospectively analyzed data concerning the effects of external electromagnetic fields on 172 of our patients implanted with DBS.
Results. Identifiable electromagnetic sources turned the implantable pulse generator (IPG) off in 20 patients. In two patients, these episodes necessitated replacement of the Itrel II IPG (Medtronic Inc., Minneapolis, MN, USA) with the magnetically shielded Kinetra IPG (Medtronic Inc.). Six patients received cardiac pacemakers, leading, in two patients, to interference between the systems. Our experience concerning magnetic resonance imaging, electrocardiogram (ECG), heart defibrillation, electro-cautery, and other sources of electromagnetic interference also is described.
Conclusions. External electromagnetic interference may, in rare cases, constitute a severe threat to the well-being of the patient implanted with a DBS system. Also, malfunction of a DBS system may constitute a medical emergency. Nevertheless, in spite of these external electromagnetic influences, we consider DBS to be a safe method, provided safety protocols are followed, and provided that provider awareness about potential hazards is present.
The renaissance of stereotactic functional neurosurgery has resulted in increased interest in its origins. Twenty articles concerning this field trace the history back to a paper published in 1873 by Dittmar: "Über die Lage des sogenannten Gefaesszentrums in der Medulla oblongata" [On the location of the so-called vasomotor center in the medulla oblongata]. Few facts are presented. But, taken together, the impression given by the secondary sources is that Dittmar, in 1873, presented a guiding device for localization of intracranial structures for the positioning of electrodes/blades in the medulla oblongata in rats. Of the publications that cite Dittmar's original article as their only quoted source, half did not specify the inserted object and the animal of the experiment. The remaining articles reported either that the introduced object was an electrode or that the experiments were performed on rats. Dittmar's original article, however, did not report use of his apparatus for insertion of electrodes, nor did he use rats. All experiments were performed by making incisions in the medulla oblongata in rabbits. Dittmar's apparatus was constructed to allow more precision when performing incisions in the medulla oblongata than could be obtained performing incisions freehand. The incision point was chosen and the blade introduced with direct visual guidance. This has been described as "spatial localization of intracranial structures," "a special targeting instrument," or simply, "a guiding device." In our opinion, it can most properly be classified as a supportive arm.
The introduction of thalamotomy in 1954 led naturally to exploration of the underlying subthalamic area, with the development of such procedures as campotomy and subthalamotomy in the posterior subthalamic area. The most popular of these procedures was the subthalamotomy, which was performed in thousands of patients for various movement disorders. Today, in the deep brain stimulation (DBS) era, subthalamic nucleus DBS is the treatment of choice for Parkinson's disease, whereas thalamic and pallidal DBS are mainly used for nonparkinsonian tremor and dystonia, respectively. The interest in DBS in the posterior subthalamic area has been quite limited, however, with a total of 95 patients presented in 14 articles. During recent years, interest has increased, and promising results have been published concerning both Parkinson's disease and nonparkinsonian tremor. We reviewed the literature to investigate the development of surgery in the posterior subthalamic area from the lesional era to the present.
Deep brain stimulation (DBS) is an established treatment for essential tremor (ET). The nucleus ventralis intermedius thalami (Vim) is the target of choice, but promising results have been presented regarding DBS in the posterior subthalamic area (PSA). The aim of this study was to evaluate the possible influence of gender, age and severity of disease on the outcome of these procedures. Sixty eight patients (34 Vim, 34 PSA) with ET were included in this non-randomised study. Evaluation using the Essential Tremor Rating Scale (ETRS) was performed before, and one year after surgery concerning PSA DBS, and at a mean of 28 ± 24 months concerning Vim DBS. Items 5/6 and 11-14 (hand tremor and hand function) were selected for analysis of tremor outcome. The efficacy of DBS on essential tremor was not related to age or gender. Nor was it associated with the severity of tremor when the percentual reduction of tremor on stimulation was taken into account. However, patients with a more severe tremor at baseline had a higher degree of residual tremor on stimulation. Tremor in the treated hand and hand function were improved with 70% in the Vim group and 89% in the PSA group.
Background: Deep brain stimulation (DBS) is an effective treatment for essential tremor (ET). Currently the ventrolateral thalamus is the target of choice, but the posterior subthalamic area (PSA), including the caudal zona incerta (cZi), has demonstrated promising results, and the subthalamic nucleus (STN) has been suggested as a third alternative. The objective of the current study was to evaluate the effect of STN DBS in ET and to compare this to cZi DBS.
Methods: Four patients with ET were implanted with two ipsilateral electrodes, one in the STN and one in the cZi. All contacts were evaluated concerning the acute effect on tremor, and the effect of chronic DBS in either target was analyzed.
Results: STN and cZi both proved to be potent targets for DBS in ET. DBS in the cZi was more efficient, since the same degree of tremor reduction could here be achieved at lower energy consumption. Three patients became tremor-free in the treated hand with either STN or cZi DBS, while the fourth had a minor residual tremor after stimulation in either target.
Conclusion: In this limited material, STN DBS was demonstrated to be an efficient treatment for ET, even though cZi DBS was more efficient. The STN may be an alternative target in the treatment of ET, pending further investigations to decide on the relative merits of the different targets.
To evaluate the posterior subthalamic area (PSA) as a target for deep brain stimulation (DBS) in the treatment of essential tremor (ET). The ventral intermediate nucleus of the thalamus is the traditional target for DBS in the treatment of ET. Recent studies have presented beneficial effects of DBS in the PSA in the treatment of tremor. Twenty-one patients with ET were included in this study. All patients were evaluated before and 1 year after surgery, on and off stimulation, using the essential tremor rating scale (ETRS). A marked microlesional effect was noticed in 83%, in some cases obviating the need for electrical stimulation for many months. The total ETRS was reduced from 46.2 at baseline to 18.7 (60%). Item 5/6 (tremor of the upper extremity) was improved from 6.2 to 0.3 (95%), and items 11 to 14 (hand function) from 9.7 to 1.3 (87%) concerning the contralateral hand. Activities of daily living were improved by 66%. No severe complication occurred. Eight patients presented a postoperative mild dysphasia that regressed within days to weeks. DBS in the PSA resulted in a marked reduction of tremor.
Objective: To present the technique of deep brain stimulation (DBS) and to evaluate the studies conducted on DBS in the treatment of therapy-refractory major depressive disorder (MDD).
Method: A review of the literature on DBS in the treatment of MDD was conducted.
Results: The results of DBS in MDD have been presented in 2 case reports and 3 studies of 47 patients operated upon in 5 different target areas. Positive effects have been presented in all studies and side effects have been minor. DBS in the nucleus accumbens resulted in a mean reduction of Hamilton depression rating scale (HDRS) of 36% after 1 year and 30% of the 10 patients achieved remission. DBS in the internal capsule/ventral striatum resulted in a reduction of 44% after 1 year, and at the last evaluation after in mean 2 years, 40% of the 15 patients were in remission. The 20 patients with subcallosal cingulated gyrus DBS had a reduction of HDRS of 52% after 1 year, and 35% were within 1 point from remission or in remission.
Conclusion: DBS is a promising treatment for therapy-refractory MDD. The published experience is, however, limited, and the method is at present an experimental therapy.
Clinically non-functional pituitary adenomas are often derived from gonadotropin producing cells. However, gonadotropinomas causing elevated serum levels of follicle-stimulating hormone (FSH) and clinical signs of FSH hypersecretion are very rarely described. Our patient, a 56-year-old man, was referred to our clinic with signs of hypogonadism. Magnetic resonance imaging (MRI) and biochemical examinations showed a large pituitary adenoma and excessive levels of serum FSH. Clinical examination and ultrasound measurement revealed bilaterally enlarged testes. After pituitary surgery, serum FSH levels normalized and there was a decrease in testicular volume. This case suggests that supraphysiological levels of FSH from a gonadotropinoma can cause a clinically observable effect, i.e. testicular enlargement. This is in line with experimental studies showing biological effect of FSH from pituitary adenomas and previous occasional reports of ovarian hyperstimulation and testicular enlargement in patients with FSH-secreting gonadotropinomas.
BACKGROUND: The new CertasTM shunt for the treatment of hydrocephalus has seven standard pressure settings that according to the manufacturer range from 36 to 238 mmH2O, and an additional "Virtual Off" setting with an opening pressure >400 mmH2O. Information on actual pressure response and reliability of shunt performance is important in clinical application, especially the "Virtual Off" setting as a non-surgical replacement for shunt ligation. The objective of this study was to evaluate the in-vitro hydrodynamic performance of the CertasTM shunt.
METHODS: Six new CertasTM shunts with proximal and distal catheters were tested with an automated, computerized test system that raised the pressure from zero to a maximum pressure and back to zero at each valve setting. Opening pressure and flow resistance were determined.
RESULTS: For settings 1-7 the measured opening pressure range was 26 to 247 mmH2O, and the mean change in opening pressure for a one-step adjustment was between 33 and 38 mmH2O. For setting 8 ("Virtual Off") the measured mean opening pressure was 494 +/- 34 mmH2O (range 451 to 556 mmH2O). The mean outflow resistance was 7.0 mmHg/ml/min (outflow conductance 17.9 ul/s/kPa).
CONCLUSIONS: The six shunts had similar characteristics and closely matched the manufacturer's specifications for opening pressure at settings 1-7. The opening pressure for the "Virtual Off" setting was nearly 500 mmH2O, which is 100 mmH2O higher than the manufacturer's specification of ">400" and should be functionally off for most patients with communicating hydrocephalus. Clinical studies are needed to evaluate if the CSF dynamic profile persists after implantation in patients.
Excessive synchronization of basal ganglia neural activity at low frequencies is considered a hallmark of Parkinson's disease (PD). However, few studies have unambiguously linked this activity to movement impairment through direct stimulation of basal ganglia targets at low frequency. Furthermore, these studies have varied in their methodology and findings, so it remains unclear whether stimulation at any or all frequencies < or = 20 Hz impairs movement and if so, whether effects are identical across this broad frequency band. To address these issues, 18 PD patients chronically implanted with deep brain stimulation (DBS) electrodes in both subthalamic nuclei were stimulated bilaterally at 5, 10 and 20 Hz after overnight withdrawal of their medication and the effects of the DBS on a finger tapping task were compared to performance without DBS (0 Hz). Tapping rate decreased at 5 and 20 Hz compared to 0 Hz (by 11.8+/-4.9%, p=0.022 and 7.4+/-2.6%, p=0.009, respectively) on those sides with relatively preserved baseline task performance. Moreover, the coefficient of variation of tap intervals increased at 5 and 10 Hz compared to 0 Hz (by 70.4+/-35.8%, p=0.038 and 81.5+/-48.2%, p=0.043, respectively). These data suggest that the susceptibility of basal ganglia networks to the effects of excessive synchronization may be elevated across a broad low-frequency band in parkinsonian patients, although the nature of the consequent motor impairment may depend on the precise frequencies at which synchronization occurs.
The results from studies of loud noise exposure and acoustic neuroma are conflicting. A population-based case-control study of 451 acoustic neuroma patients and 710 age-, sex-, and region-matched controls was conducted in Sweden between 2002 and 2007. Occupational exposure was based on historical measurements of occupational noise (321 job titles summarized by a job exposure matrix) and compared with self-reported occupational noise exposure. We also evaluated self-reported noise exposure during leisure activity. Conditional logistic regression was used to estimate odds ratios. There was no statistically significant association between acoustic neuroma and persistent occupational noise exposure, either with or without hearing protection. Exposure to loud noise from leisure activity without hearing protection was more common among acoustic neuroma cases (odds ratio = 1.47, 95% confidence interval: 1.06, 2.03). Statistically significant odds ratios were found for specific leisure activities including attending concerts/clubs/sporting events (odds ratio = 1.82, 95% confidence interval: 1.09, 3.04) and participating in workouts accompanied by loud music (odds ratio = 2.84, 95% confidence interval: 1.37, 5.89). Our findings do not support an association between occupational exposure to loud noise and acoustic neuroma. Although we report statistically significant associations between leisure-time exposures to loud noise without hearing protection and acoustic neuroma, especially among women, we cannot rule out recall bias as an alternative explanation.
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a commonly employed therapeutic procedure for patients with Parkinson's disease uncontrolled by medical therapies. This series describes the outcomes of 79 consecutive patients that underwent bilateral STN DBS at the National Hospital for Neurology and Neurosurgery between November 2002 and November 2008 using an MRI-guided surgical technique without microelectrode recording. Patients underwent immediate postoperative stereotactic MR imaging. The mean (SD) error in electrode placement was 1.3 (0.6) mm. There were no haemorrhagic complications. At a median follow-up period of 12 months, there was a mean improvement in the off-medication motor part of the Unified Parkinson's Disease Rating Scale (UPDRS III) of 27.7 points (SD 13.8) equivalent to a mean improvement of 52% (p<0.0001). In addition, there were significant improvements in dyskinesia duration, disability and pain, with a mean reduction in on-medication dyskinesia severity (sum of dyskinesia duration, disability and pain from UPDRS IV) from 3.15 (SD 2.33) pre-operatively, to 1.56 (SD 1.92) post-operatively (p=0.0001). Quality of life improved by a mean of 5.5 points (median 7.9 points, SD 17.3) on the Parkinson's disease Questionnaire 39 summary index. This series confirms that image-guided STN DBS without microelectrode recording can lead to substantial improvements in motor disability of well-selected PD patients with accompanying improvements in quality of life and most importantly, with very low morbidity.
There has been a renaissance in the surgical treatment of Parkinson's disease (PD) over the last 15-20 years as a result of the long-term complications of L-DOPA use. The current cornerstone of surgical treatment for PD is high-frequency deep-brain stimulation (DBS) of the subthalamic nucleus (STN) using implantable electrodes and an implantable pulse generator/battery. Among well-selected patients, that is, patients with idiopathic PD, L-DOPA-responsive symptoms and no significant psychiatric comorbidities or cognitive decline, STN DBS can provide improvements in motor symptoms and quality of life, with low risks of adverse effects. In this article, we briefly describe the evolution of surgical treatments for PD, and the rationale for current DBS procedures. We also provide details of our practice, including patient selection, surgical technique and postoperative stimulation programming and medication adjustment. Current and possible future alternatives to DBS of the STN are also discussed.


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The color of the glasses will be the first thing that women often think when looking for one pair of glasses. Many suggested that darker colors will reduce dazzling light and protect the eyes more effectively. But, some said colors of glasses do not have effect of the reduce the harmful effects of UV rays on the eyes. In addition, it is sometimes difficult for users. For example, brown, gray can reduce real color.
Types of faces
- Rectangular face
For those with a rectangular face, they want to find one pair of sunglasses to help you balance your proportions and "prolonged" face. The trick for you is to choose the glass that help to expand the eye area, with the big frame, a narrow width. This type will promote the effect perfectly and gives you extremely unexpected appearance.
- Oval face
Women with oval face is the most fortunate person as they own balanced face rate. Thus, they can easily use the different types of sunglasses. The only principle for you is to avoid the kind of wide-width glass.
- Round face
The round-faced girl usually has broad face with rounded chin. You choose for yourselves the type of square or circular glasses to balance it faces offline. Cat eye sunglasses that are "hot trend" this year are also good items that you do not skip.


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Remember the shiny suit era when Diddy and Ma$e were literally flashing on the screen thanks to their blinding outfits? Well, the trend is back just for your feet. Creative Recreation is teaming up with Barneys New York this summer and introduces a gleaming version of its Cesario model. The shoe comes in red or silver metallic leather that's shinier than a freshly waxed car. It's a bit of a style risk, but you'll stand out in a good way if you pull it off right. Pair it with simpler items.
This is the first two of the eight shoes that will be releasing this summer. From June through September, the duo will release two more metallic shoes and another four covered in pony hair. Visit the Barneys website to purchase and channel your inner Diddy this summer.


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Tag "Facebook"
Facebook adds a Snooze button for muting people, groups and Pages for 30 days
Facebook today is launching a new feature designed to give users more control over what content they see in their News Feed: a "Snooze" button. The option, which will become available via
Facebook's desktop messaging app is finally here
Your prayers have been answered. Facebook has finally released a beta version of Workplace Chat, a desktop messaging service for businesses. The new messaging service is essentially a competitor to
Facebook's iconic 'Like' button has a new look
It's not just you, Facebook's "Like" button has a new look. The iconic button has been given a redesign that's still slowly making its way to all users. Instead of
Facebook can recognize you without looking at your face
Think you can stop Facebook from automatically tagging photos of you by covering your face? Think again. The New Scientist reports that Facebook is developing a new facial recognition algorithm so powerful that it can identify
Facebook's New 'Discover People' Feature Helps You Meet New People with Common Interests
Facebook is rolling out a new feature to its smartphone app that will make it easier to find new friends, colleagues, and even potential dates. "Discover People," as the new
Facebook's secret iOS features you may never get to use
Facebook developers are always tinkering away behind the scenes on new features. Most of them never see the light of day, but it's always interesting to see what they're working on.
End-to-end encryption is coming to Facebook Messenger
Messages you send on Facebook will soon have extra protection from snooping third parties with a new end-to-end encryption feature called "secret conversations." It doesn't seem like such a long
Facebook is building artificial intelligence to finally beat humans at Go
Facebook is now tackling a problem that has evaded computer scientists for decades: how to build software that can beat humans at Go, the 2,500-year-old strategy board game, according to a report
Facebook detects signs of postpartum depression
SAN JOSE, Calif. — New moms suffering from postpartum depression change their activity on Facebook, suggesting that the social media site could help detect the onset of the baby blues.
Facebook's Paper app updated with improved photo sharing
We're fans of Facebook's Paper here at TUAW. It's a handy alternative to Facebook's main iPhone app, which lets you bypass downloading the Messenger app. Paper has just received a


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As yet another storm cell thunders over the Tehachapis, and once more I am begrudgingly confined to climate controlled sanctuary that is the Tejon Conservancy office, I find myself wondering how all our local wildlife is faring out there in the cold and wet. Certainly better than I would be, the conspicuously furless biped that can often be observed out on the ranch hurriedly bundling up at the first patter of drizzle or the first whisper of breeze. I have set up so many wildlife cameras in recent months, and have observed so much wildlife footage (I am basically the TMZ of the Tejon woods), that I cannot help but feel some absurdly misguided concern for the comfort of my feathered and fuzzy neighbors out there in these brutish elements. Of course our native wildlife are perfectly evolved to withstand the coldest snap of a California winter, just as they are right at home in the dry heat of summer.
However, as local weather patterns continue to unnaturally shift along with global climate, there is a legitimate concern over the ability of flora and fauna all over the world to adapt to and withstand increasingly divergent seasonal weather conditions. With that in mind, I've dug up some video of our local wildlife braving winter climes over the last few months. I am happy to report that, at least for now, everyone seems to be doing just peachy, particularly the family of pumas featured in the first video below, enjoying their pork dinner during a snow storm that makes my teeth chatter just staring at through my computer screen.
Check back next week on the blog for much more from these three cats as they feed on and protect their kill.
One of our troublesome wild pigs (Sus scofra) takes a sniff at a survey camera. The ear tag he is wearing is part of a long-term population study of wild pigs and their impacts to native ecology out on the ranch.
A large golden eagle (Aquila chrysaetos) has a drink on the snow burdened north slope of Tunis Ridge.
This mule deer (Odocoileus hemionus) carefully makes her way across an ice covered upland spring.
A pair of striped skunks (Mephitis mephitis) make their way down El Paso Creek
A bobcat (Lynx rufus) carefully avoids getting her feet wet as she makes her way to an overlook to survey the canyon.


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Overlooking the gulf of Aquaba, with a marvelous view of the Red Sea, the magnificent Concorde El Salam is an astonishing modern edifice. The hotel complex, which is perfect for families and couples alike, contains 2 a-la cart restaurants: Italian presenting Italian cuisine and Flame presenting sea food and two main buffet restaurants, six bars, and one nightclub as well as leisure facilities such as three outdoor swimming pools plus one in-door pool which are all heated in winter time. The beachfront hotel is approximately ten minutes from the Sharm El Sheikh international airport.
Concorde Hotel occupies a huge territory which is divided into two hotels:Concorde Front Hotel overlooks the Gulf of Aqaba and Tiran Island, while Concorde Sports Hotel is just across the road 200 m from Concorde Front.
There is a shuttle bus available between two hotels for guests¿ convenience - running every 10- 15 minutes, however, within 10 walking minutes you can easily find yourselves at the other hotel.
The hotel is located at White Knight Beach in Sharks Bay, where the house reef is among the best ones in Sharm El Sheikh, from the private terraced beach it is possible to access the sea through a floating jetty. Hotel is just 10 minutes drive from the airport and in 15 km away from Na¿ama Bay (down town).


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Virginia rail line reopens after derailment
WYTHEVILLE, Va. (AP) — A rail line through southwest Virginia is back in business after a Norfolk Southern derailment left 14 cars off the track.
Norfolk Southern spokesman Robin Chapman said Wednesday that the line re-opened shortly before midnight Tuesday. The derailment late Monday in Wytheville (WITH'-vihl) involved a three-engine, 33-car train en route from Louisville, Kentucky, to the Port of Virginia.
There were no injuries, and state environmental officials said there was no evidence of any spills.
Wythe County spokesman Jeremy T.K. Farley says crews worked Wednesday to remove the wreckage from the derailment, which scattered vehicle carriers around the tracks. Two cars were also carrying other cargo.
Norfolk Southern said it is investigating the cause of the derailment.
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Transitioning to college is an exciting adventure. All summer you've been packing, worrying about whether or not you're in the right classes, and imagining your new life as a self-sufficient adult. It's when all the boxes are unpacked and the first weeks of classes have passed, however, that the real fun begins. Maybe you're like me and you've always had your own room. Or, perhaps you shared with a sibling or two. Either way, I doubt you're used to living in a dorm with hundreds of other students your own age on a daily basis. It's different – but it can be different in an awesome way, as well. You just need to know how to go about the transition.
1. Patience is a VirtuePatience is probably the number one rule when you're living with others. It's almost impossible to live in the same space with someone for an entire semester and not feel annoyed with them at some point. It's perfectly normal – there are probably things you do that others find frustrating at times, too. I know patience wasn't something I was very good at when I first arrived at college. Slowly, I learned it isn't the end of the world when someone does something differently than me. College is an exercise in taking these tiny frustrations in stride and learning to deal with them. Try not to lash out at anyone when they get on your nerves. Give yourself at least a few minutes to think about it first, and try to see the situation from the other person's point of view. It's very likely your perception will change – or at least you'll become more understanding of theirs. When you're out on your own someday, you might be living in close proximity to other people. If you learn patience and grace now, you'll already be prepared to deal with these types of situations.
2. Build RelationshipsIt's more than likely that you'll live around some of the same people for at least a portion of your time at college. Because of that, these students could be some of the best friends you have at your chosen university – if you put forth the effort to make them so. Invite your roommate and others in your hall along when you participate in activities. Find things you have in common, like shared interests or hobbies. Eat together if and whenever possible. It might be a little uncomfortable at first, but you'll be glad when you have these friendships to fall back on later down the road.
3. Home Sweet HomeBeginning to feel comfortable at college is the number one cure for homesickness. It's important even if you think you aren't missing home too badly. If you're going to spend two, or three, or four years in a place, you need to start feeling like you belong there. Put up pictures and items and items that remind you of home in your dorm room. From the first night, this will make it feel more comfortable. The idea is that in time this place will come to feel like a home away from home. You'll know you're beginning to settle in when you start feeling like you belong there. Moving into a new situation is never easy, but with some thought and extra patience, you'll make it with no problem!
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If you like your Group B rally Cars, then check out this stunning Audi Quattro Sport short wheelbase replica…
What a beast, we love it! The car is the result of an extensive project by the current owner and it looks the business! We found this cracking project for sale on online, and the listing states that it is based on a coupe shell, and that the car comes complete with an engine and parts required for a 20v conversion… it would be a shame for it not to be as quick as it looks!
For Sale – Audi Quattro Sport Replica
On eBay here -> http://ebay.to/29Gcta4


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Cast and contributors announced for Barbarians RisingBy CanMediaSales In Television, Digital
HISTORY announced the cast and contributors for the four-part docu-drama Barbarians Rising which premieres Monday, June 6. Barbarians Rising features the true stories of nine of history's greatest warriors. The cast includes Nicholas Pinnock (Captain America: The First Avenger) as Hannibal, who vowed a blood oath at the age of nine to destroy Rome; Ben Batt (The Edge of Love) as Spartacus, the slave-turned-rebel who led a barbarian revolt; Kirsty Mitchell ("The Royal Today") asBoudica, the avenging Celtic warrior Queen; Tom Hopper ("Black Sails") as Arminius, the son of Germany surrendered to Rome; Emil Hostina (Harry Potter and the Deathly Hallows Parts I and II) as Attila, scourge of the east; Gavin Drea (What Richard Did) as Alaric, the king of the Goths; Steven Waddington (The Imitation Game) as Fritigern, the warrior who took down an Emperor; Richard Brake (Batman Begins) as Geiseric, the last barbarian standing; and Jefferson Hall ("Vikings") as Viriathus, the shepherd-turned-rebel leader.
Read more about the cast and contributors of Barbarians Rising on corusent.com.


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From the title of this blog post I bet some of you are thinking I'm about to re-hash the age old debate which is better or even give you my opinion on why I like one over the other. Those of us out there who are Sci-Fi lovers know exactly why they may like one over the other or even why though they like both may think one is better than the other; so no need to dip my foot in that pool. I want to address something that is like nails on a chalk board to me. The conversation goes some thing like this:
You: " You going to see he new Star Wars film this weekend, the one with that Quinto dude?"
Me: "You mean Star Trek"
You: "Yeah Star Trek/Star Wars what's the difference."
Someone Somewhere in the Peanut Gallery (You know who you are): "Nothing at all they're the Same"
Me: [Holding back the Aneurysm pressing against my cerebral cortex] "No they are not, they are very different."
You & Peanut Gallery: [dismissively] "Whatever!"
Really, Whatever. Now I know there are those of you who out of some need to watch the Nerd blow a gasket find this to be humorous. Lets watch as he tries to explain the difference between Aliens in space and Aliens in space, that
A) I frankly don't care about, and
2) Aren't Real
The problem with this comment that irks me to no end is the fact that they are vastly different sci-fi universes and as a sci fi lover I have every right to correct you if you get it wrong. There is absolutely nothing wrong with me addressing that they are different and your "scoff" or whatever comment is uncalled for. Its just the same as if I'm talking to a Reality TV lover and I said "You see what happened to Phil Robertson on that Kardashian Show" and they responded "That's Duck Dynasty" and I answered with "Whatever they're all the same".
But they aren't ones a show about hill billy idiots with money I will never see in my life time and the other is about plastic LA idiots with money I'll never see in my life time. Thing is they are different none the less.
Not even looking at the specifics of those 2 Sci-Fi franchises, such as Lucas created SW, Roddenberry created ST, characters, aliens, space ships, warp speed, hyperspace, storyline and overall look and feel; the differences are there at a general level. Simply Star Trek takes place in what would be the future of the what we know as reality. You know Earth and such. Star Wars happens in a Galaxy FAR FAR FAR FAR FAR FAR away. That should be enough to warrant your average non fan from confusing the 2 or even letting the words "Whatever" leave there mouth when corrected.
I guess all I'm saying after all that is that if you're a sports fan and someone confuses a touchdown with a home run, or you're a Reggae fan and someone confuses Sean Paul with Ziggy Marley and you correct only to be replied to with a "Whatever, they are the same thing" you have every right to get that Aneurysm eye twitch. More importantly if you reply with "No they are not" and promptly explain that though both are sports terms or that both are reggae artists by no means are they remotely similar even in general sense, you shouldn't be met with staunch criticism and attitude. Equally just because I'm a Fan Boy and I know the difference between James Tiberius Kirk and Luke Skywalker, nor should I.
So the next time you horrendously say something like Kirk pilots the Millennium Falcon and a nice fan boy or girl corrects you, just be happy they didn't set their phaser on incinerate and melt you where you stand.
Oh Yeah and just say Thank You for the education.


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|Tiny Leaders
|Magic Duels
|Canadian Highlander
|Oldschool 93/94
|1v1 Commander
|Duel Commander
|Commander / EDH
Printings View all
|Chronicles (CHR)
|Arabian Nights (ARN)
Combos Browse all
Abu Ja'far
Creature — Human
When Abu Ja'far is put into a graveyard from the battlefield, destroy all creatures blocking or blocked by it. They can't be regenerated.
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Recent Decks
Abu Ja'far Discussion
ThoAlmighty on Ramos, Tribal Legend
8 months ago
@griffstick Leyline only grants legendary typing to a few dorks, so it doesn't seem that worth it in this deck. I mainly use it to give Abu Ja'far Bands with other legendary creatures, and even then I often find it too janky for me.
Razulghul on First deck you Built
1 year ago
White weenie! Back in 2001 or so I ran a 60ish card deck with cards like Icatian Javelineers, Abu Ja'far, White Knight and Glorious Anthem(spent my lunch money on them). It was terrible but we all were back then.
djewell on No mana for you
2 years ago
This deck looks very frightening O.O and yet I think you can take it further in your "I can have stuff but you get nothing" play style. A few cards that came to mind are..
Abu Ja'far or Loyal Sentry (which is better than deathtouch because the destroy effect doesn't rely on dealing damage, so "prevent damage" won't save their creatures)
Devout Harpist because who doesn't like to tap remove an aura?
Intrepid Hero because who doesn't like to tap remove creature?
Oracle en-Vec because it's funny? if you can withstand some hits, say put in some Fog Bank or maybe with just your ability to control what's already on the field? IDK. I saw it and thought it was cool.
at the very least, these are honorable mentions. Your deck is scary as it is.
that's about all i got for ya xD cool deck!
forgetremembering on Slow Deck... Any help?
2 years ago
I'd take out Abu Ja'far, Adriana, Captain of the Guard, Ajani's Chosen, Ball Lightning, Dream Pillager, Hanweir Watchkeep Flip, Magma Giant, Platinum Angel, Tormented Pariah Flip, Humble, Fall of the Hammer, Where Ancients Tread, Jar of Eyeballs.
I'm going to suggest a few budget options without the reason stated right now. Keep in mind Magic is a huge game. Some of us have been playing for a long time and so we have seen a lot of cards, but by no means do i know all the cards. I just know what has worked for me and my Gisela deck.
Manabarbs, Burning Earth, Grab the Reins, Crib Swap, Lightning Greaves, Swiftfoot Boots, Revoke Existence, Tajic, Blade of the Legion, Pilgrim's Eye, Staff of Nin, Sunblast Angel, Vandalblast, Seal of Cleansing, Auramancer, Armillary Sphere, Phyrexian Rebirth, and Burnished Hart.
I like the Divine Reckoning in the maybeboard. I've used that card well in the past and its really worked for me.
ComradeJim270 on Magic-related humor.
3 years ago
One of my playgroups had a member who ran Abu Ja'far in his deck. This led to ongoing jokes about how Abu Ja'far is the best card ever and if it resolves for someone, victory is assured.
Pretty sure we had people waste countermagic and removal spells on that card just for laughs.
This then led into talk of Leper tribal decks (fun fact, he's been errata'ed to Human). We concluded nobody has done it because it would be unsporting.
SorinDankov on Here Comes Odric! Prepare Your Anus!
3 years ago
Thanks much for the upvote! :D
You say there are things, but you only named Ranger of Eos. :O I personally like that he grabs my one drops. Guarantees that when I drop him, there will be 2 other creatures coming with him. Also lets me grab Abu Ja'far for serious shenanigans.
Elesh Norn, Grand Cenobite and Avacyn, Angel of Hope will be my next big adds. Cho-Manno, Revolutionary isn't something I'm worried about. Spirit Bonds, Dictate of Heliod, and Herald of Anafenza were in before, but got cut because they just weren't doing it for me. Emeria Shepherd may get the add, but as for the rest, they're just not soldiers. :O Wanna keep the bulk tribal with only a handfull of non-soldiers. Sudden Disappearance just isn't needed since I can sail past opponents defenses with Odric.
Thanks for all the suggestions!!!
DarkRequiem on Here Comes Odric! Prepare Your Anus!
4 years ago
Sure thing!
Your deck hates mass removal! I'd still run it but would remove Wrath of God. You get nothing in return from it. Abu Ja'far clears part of the board, allows for interesting politics and can be re-used through Emeria, The Sky Ruin and Angel of Glory's Rise (we'll get into that in a bit).
Revoke Existence could be swapped for Devout Chaplain. Same effect, can be reused. I know, one can be used as a suprise... But can't be used more than once. Up to you to check which one you prefer.
Darksteel Mutation is fun and all but somehow I feel that Condemn is better.
Aegis of the Gods sounds, to me, like a very meta-specific card. Are you targeted that often by an opponent's spell or ability? Its the only card with that effect that you're running. Ok, it has a low cmc but still... Knight-Captain of Eos instead since most probably it'll save you more often.
Elite Inquisitor sounds very meta-specific too. Unless you're playing against Vampires, Zombies or Werewolves, it won't do much for you. Ok, again low cmc with first strike and vigilance. You already have ways of giving those abilities to your creatures, so it doesn't matter much if has them. Slate of Ancestry so that you can draw into them faster.
Palisade Giant is fun. There are better options though. Angel of Glory's Rise being one of them. While the Giant needs to survive to do something useful, the Angel does just by coming into play. Even if your other creatures take damage (and combat damage becomes a bit irrelevant due to Odric's ability), you get to revive most of them.
Loxodon Gatekeeper is fun but it won't do much. Sure, if you were playing with a few more permanents that did the same like Kismet and/or Blind Obedience, I'd keep it. As is, I don't know... Grand Abolisher might be a bit more useful since it prevents spot removal when you're attacking with Odric, giving some form of protection to your commander.
I don't think Urza's Incubator holds much value on a low cmc deck. You already have Pearl Medallion, Ballyrush Banneret and Daru Warchief. Valor in Akros could easily replace it.
As most people here, I'm not sold on Fabled Hero either. You're playing a grand total of 25 artifacts and enchantments. Does your playgroup use mass removal for those? If so, Open the Vaults might be your friend. If not, leave it be.
Your mana curve would rise a bit with these changes but I don't think that would be problematic with your build.
DarkRequiem on Here Comes Odric! Prepare Your Anus!
4 years ago
Infiltration Lens on Abu Ja'far. :)
Somehow I missed Archtype. Oh well. As for Daru Encampment, I can understand your reasoning. It can be useful though.
You skipped Gempalm Avenger. I seriously find it mandatory in a soldier deck.
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