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The studies on CBD for headache pain are still in their infancy, but with promising results so far. A 2017 study published in the Cannabis and Cannabinoid Research Journal worked with 26 people who were experiencing rebound headaches. The pain management results were better for the cannabis-nabilone formula over either ibuprofen or nabilone alone. (As a nerdy side note, the article is a great read if you're interested in the history of cannabis as a pain reliever.)
The CBD oil industry is already a multi-million dollar market with projections of reaching $1 billion in product sales by 2020. Because hemp-based CBD doesn't contain any THC, people don't become high with every use – a unique characteristic that only increases the popularity of this cannabinoid compound. And with the federal reclassification of industrial hemp, all 50 states have become authorized to establish agricultural programs solely to cultivate industrial hemp – many for CBD extraction purposely. Analysts have even predicted the market for hemp-based CBD to soon surpass the legal marijuana industry.
Studies have shown that CBD can reduce the amount of pain that a person feels, as well as inflammation – which is an underlying cause of various painful conditions. This means that by reducing inflammation, CBD helps to lessen the pain itself. CBD contains inflammatory agents, which makes it 'neuroprotective' and excellent at dulling the prickling, tingling and burning sensation symptoms of neuropathic pain
Although CBD oil has been legalized in most states, tetrahydrocannabinol (THC) is subject to a very different set of restrictions. Like the CBD, THC is the cannabinoid that can be extracted from the cannabis plant. Although many petroleum products based on the CBD sell themselves as insulators and THC-free, the absence of federal regulations on these products means you can be deceived.
Keep in mind that CBD oil can help relieve health problems such as anxiety, depression, reduce seizures, and also fight insomnia. The possibility of treating arthritis and back pain is another reason why CBD oil consumption has expanded. Most people feel crazy about using the CBD as a supplement before workouts, but athletes who want to fight fatigue after a heavy workout can use it as a supplement for muscle recovery.
Of course, though, they offer less potent oils than that, with a product lineup that ranges from 300 mg CBD per bottle to 4,000 mg. Naturally the 4,000 mg option is the most expensive (this is the one that provides the "bomb" 60 mg dose), as it currently sells for $299. For long-term pain and anxiety relief, though, it may be well worth it if it is effective for you and helps replace your regular meds.
Diamond CBD gets 'save buy nod' to consider for your source of CBD products. We came to this conclusion based on a few key areas: Selection, Price, and Shipping. Diamond CBD offers the best wholesale pricing we have found so far for CBD products. They have one of the largest selections of products available as well including, vapes, edibles, drinks, pets, topicals, oils. Basically everything you need under one roof. Plus they have top-notch shipping and get it to you as fast as possible. They will assign you with a dedicated account manager to make ordering, reordering, and pricing as easy as possible too. Check out the Diamond CBD Wholesaler Program here
The amount of milligrams of CBD you should take depends on your specific reason for taking CBD. If you are using CBD to treat chronic pain, you might take a much higher dose than someone who would be using CBD for general wellness reasons. Google search for your specific condition or reason for taking CBD to find the dose that is appropriate for you. You can take CBD in high qualities, so feel free to test out different dosages and see how your body reacts. A standard dose of CBD is 10 mg once a day, but this varies so widely because each individual is different so this can't be taken as a recommendation for you.
As the CBD market continues to explode, it's likely that the number of irreputable wholesale CBD businesses and products will also rise. Fret not. A small amount of research can go a long way in helping you choose the right partner for your establishment. Use these five keys as a guide to finding the partners and products that will enrich your business and improve your customer's lives.
The sharp joint pain caused by the condition is known to stiff the body and restrict the patient's movement, but it is advised that a person should continually exercise to as it helps with improving the situation. Exercising regularly for some time is known to reduce the pain and inflammation caused due to rheumatoid arthritis. Talk to a doctor about the severity of the condition and then seek the advice of a professional therapist to adopt a type of exercise routine fit for the condition of the patient. Take advice from a physiologist and do not strain the body too much and practice the natural remedy that can be followed at home.
Moreover, scientists at the Cajal Institute showed promising results in regards to CBD and Multiple Sclerosis. They used animal models and cell cultures to find that CBD reversed inflammatory responses; within only ten days, mice that were used in the study had superior motor skills and showed progression in their condition. To date, there have been well over 20,000 published scientific articles on cannabinoids and their related effects on all sorts of medical ailments.
Full Spectrum Hemp Oil increases hair strength, improves nails' quality and skin radiance, dehydrates scalp and hair, support skin regeneration, and balance the skin tone. All these benefits get attributed to 6 fatty acids, Omega 3 and other nutrients. Value for your money get guaranteed for the manufacturers offer back your full amount if not satisfied with the product. You also get to save your money, thanks to the discount provided by the manufacturer. When you buy 30ml (500ml) of Full Spectrum Hemp Oil, you get to pay the price equivalent to a 250mg bottle.
Both CB1 and CB2 helps your ECs to regulate your inflammation levels, pain levels, immune functions, sleep, digestion, appetite, memory, mood, and other functions. It makes an impact exactly where needed to create balance and homeostasis. Once they achieve balance in your body, enzymes break them down so they don't cause any damage or disrupt the balance in the opposite direction.
In short, the results of the survey (which were published in the Journal of Pain Research) showed that roughly 42% and 46% (respectively) of participants claimed they were able to use cannabis in place of traditional medical to effectively treat their specific medical ailment. So if you're wondering how to know if you need CBD for pain, remember that you're certainly not alone.
Technically, anyone who wants to try their luck on the growing CBD business industry can inquire about the wholesaler program to determine if they are qualified or not. Signing up and waiting for the company representative's call is the first step to determine if it is the right business opportunity to invest on. However, different companies have different policies and guidelines for their wholesaler program. Some may require specific requirements while there are some which are more lenient.
Be aware that as we explore the different possibilities, there has not been extensive research done on any of the options to prove anything conclusively. It is imperative that a person deciding to use CBD along with bodybuilding and working out talk with their doctor first. The person's doctor will be able to look at any other medications and/or supplements they are using now to determine if there could be any issues.
To obtain the CBD-packed hemp extract from its organic crop, Highland Pharms uses a process called "supercritical CO2 extraction." This method eliminates the need for more harmful solvents, while it also, the company says, yields CBD oil of an outstanding purity and efficacy. Those wanting to see for themselves can take their pick from Highland Pharms' positively reviewed variety of tinctures – the strongest concentration of which measures up at 1,250 mg – as well as capsules and edibles. And if those potential customers have no idea exactly how much CBD they should be imbibing, then they can get themselves up to speed at the Texas-based company's website, which offers a user-friendly guide to serving sizes and methods of CBD oil intake, among other common queries.
For some, a sore muscle on your lower back may feel better after using a CBD patch or tincture . For others, a headache might respond well to a CBD vape pen. Pain is a universal feeling, but we respond differently and our bodies react in different ways depending on our overall health. The variety of ways in which CBD is consumed allows customers to pick a method based on their specific condition and their personal preference. For example, someone with sensitive lungs who doesn't like smoking may prefer treating their pain with CBD capsules. Someone who takes a lot of pills, in general, may enjoy the experience of vaporizing. CBD is a naturally occurring chemical compound found in the cannabis and hemp plants. It does not produce the difficult side effects that those on prescription opioids commonly experience.
This type of cannabis has high levels of CBD also. It is a different type of strand from the Sativa in that it addresses different areas. For example, this type of strand is best for helping a person fight stress, gives a person better focus, helps with feelings of peace and improves a person's sleep. All of those areas can help or hurt a bodybuilder or someone working out.
You may be asking yourself; why? CBD oil can treat many things, starting from chronic pain to anxiety. As a result, it has won the hearts of many users, and different states are legalizing it every day. Thanks to the advent in technology, there are various CDB oils available in the market today. To get the right one that sorts your need, you need knowledge about CDB oils. Continue reading for insight and a review of the best 10 CBD oils.
In short, the results of the survey (which were published in the Journal of Pain Research) showed that roughly 42% and 46% (respectively) of participants claimed they were able to use cannabis in place of traditional medical to effectively treat their specific medical ailment. So if you're wondering how to know if you need CBD for pain, remember that you're certainly not alone.
If you have fibromyalgia, then you've probably heard of the rave reviews people post online about CBD's effect on it. For those of you who don't know, fibromyalgia is a type of chronic disorder that causes widespread muscle pain, pain in the bones, and general fatigue. Since the measure of pain is subjective, it cannot be recorded or measured by tests.
The majority of people using CBD products today experience distinct and tangible results – even a massive survey of over 2,400 users reported that 42% of them quit their traditional medications and prescriptions in favor of CBD. Unlike conventional medicines from pharmaceuticals that artificially obstruct or release receptors of their functions, CBD naturally interacts with the body's endocannabinoid system (ECS) and biologically binds with the necessary internal connectors as nature intended. This natural occurrence allows CBD to become useful with an array of health conditions. And while common medications typically target only the symptoms, specialists indicate how CBD aims for the cause of symptoms.
When CBD oil interacts with our brains' and other receptors, it promotes and produces painkilling effects and anti-inflammatory. Interaction with a cellular level ECS, CBD greatly reduces the instances and severity of neuropathic or chronic pain, as it also increases the body's serotonin production at the same time. On consuming CBD, the chemical effects in the bodywork for the benefit of people suffering from all types of chronic pains like in the joint, knee, and back.


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Used Volkswagens
Browse our selection of quality Volkswagen used Stock for sale in Uxbridge, Middlesex. If you can't find what you're looking for please feel free to contact Harefield Carriage Company.
- Make:
- Model:
- Mileage:125,000
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- Engine Size:1968cc
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A lovely car throughout that looks & drives superb.
Has part service history, including cambelt change in 2016. 1 Years MOT. 2 Keys. JUST IN & AWAITING A VALET. PICS TO FOLLOW.


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556 Posts
#121 •
I love how the chart says percents above stock but no HP number or correction factors, nice (worthless)Muzzy has an 1132 big bore kit that seems to be holding up well. I would go the N/A route if it was me. Less to mess with or worry about. The muzzy kit just put down some impressive numbers at UTVinvasion in ID. Dobek performance has it listed on there site here.
EFI - Electronic Fuel Injection Controllers - ATVs, UTVs, Motorcycles, Snowmobiles, Scooters, Sport Bikes, Watercraft


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UNedited Customer Testimonials
Each customer is invited to complete a survey after they have received their order. Below are some recent comments provided. We don't edit or censor any comments.
The staff at classb are patient, helpful, professional, and timely. We will definitely order our reunion t-shirts from them again!
Angela G.
Washington, DC
July 30th
Our 2009 family reunion was having a t-shirt contest this year and my mother so wanted to win, well thanks to classb online store I was able to select a T-Shirt from a large selection of shirts, the color section was huge and the art work available was unlimited. although I found the artwork of my choice there were some minor changes that I wanted. This was not a problem at all for there artist who converted the shown design into the perfect logo for my family reunion t-shirts and this was at no extra charge. The new design was shown to me within 2days of them receving a changes and sent to me via e-mail immediately. if you want to experience professionalism then let Get Your Stirts.com work for you. I did and now I'm confident my family will take first place
Cynthia Wilson-Flournoy
Los Angeles, CA
June 30th
Our shirts arrived and they are perfect! It was the easiest order I have made in my nine years
ordering elsewhere and they arrived on the promised date. I will order from "classb" from now on. Thank you!
Billie F.
Roswell, Georgia
June 10th
Our shirts were great. I've never ordered shirts online and was a little lurry of it: but the customer service team was great. They answered all my question they were knowledgeable,courteous and friendly. We even recived the shirts 4 days earlier than promised. Thanks class b.com. We had a ball and looked great!!!!!!!
Brenda C.
November 24th
Thanks,for everyone's help. It made my order so much easier. Cory, sorry for all the changes I made. Thank you for having patience with all the changes. I still got my shirts on time. THANK YOU CLASSB.com
Rose S.
Roselle, IL
December 19th
You made this experience easy! Everyone was great to work with, communication was great, and the end result was a perfect product. I would definitely use you again. Thanks to Josie, Char and everyone at ClassB!
Rachel G.
Los Alamitos,Ca.
June 7th
ClassB is wonderful! The website is easy to use and the customer service exceeds expectations. Thanks for the great job, our Girl Scout Troop shirts looked great!
Angelique S.
October 11th
My family reunion was a blast, thanks to classb.We were pleased with everything!On a scale from 1 to 10, you're a 10!
Sonya S.
July 5th
This is our third year in a row to order shirts for our family reunion and we love them! We will keep returning to classb.com every year!
M'liss B.
Dumas, Texas
June 18th
After returning back from Iraq with 82nd Airborne. And having a new sense of family ties. Hosting a family reunion was something that was theraputic to me. classb company and your customer service was beyond reproach. God bless you all and thank you very much for your service to the Howard Family. We will have a great relationship with Get your Shirts for years to come.
Keith H.
Fayetteville, North Carolina
June 13th
Why does this testimonial mention a site other than ClassB?
We merged GetYourShirts, CloverTees and ClassB together in 2010.
Anonymous entries are from customers who opted out of signing their name but still wanted to share their experience. HTML and special characters that won't render properly in a web page are automatically removed.
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Equal Opportunity Employer
Summary Description
Provides excellent customer service, ensuring that all customer needs are met. Manages lobby traffic and helps to reduce customer wait times. Serves as primary contact for resolving routine and complex problems on customer accounts. Demonstrates proficiency in handling a variety of tasks and responsibilities including the performance of the essential functions of a CSR as well as the ability to respond to the sales and service needs of bank customers. The amount of time spent performing each function varies based on the personnel and traffic of each branch location. Primary focus is meeting the immediate needs of bank customers, while also looking for opportunities to enhance and expand relationships.
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- Consistently executes City's phone, platform and CSR service standards to provide excellent customer service
- Displays a positive and professional attitude at all times
- Actively promotes and sells the bank's products and services to prospective and existing customers by using City's customer conversation model to uncover customer needs
- Accurately processes routine banking transactions and service and maintenance requests including, but not limited to, check cashing, deposits, withdrawals, account transfers, loan payments and debit card disputes
- Maintains and balances a working cash supply
- Assists customers with routine maintenance and complex service issues; sees through to complete resolution
- Assists customers with loan applications, recommends appropriate loan structure, gathers required documents, submits package to retail loan department and closes retail loans as needed
- Meets minimum individual production levels for retail loans, checking accounts and mortgage referrals; actively contributes to branch goals
- Develops and maintains customer relationships; actively seeks referral resources from existing customers
- Refers customers to other departments and business partners appropriately
- Maintains an up to date knowledge of bank products and services
- Maintains general knowledge of the competitive environment
- Completes all training within predetermined time limits
- Adheres to all bank regulatory, audit, and compliance policies and procedures
- Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job
Position Requirements
- High school diploma or equivalent
- Demonstrated sales and service skills
- Ability to multi-task, organize, and prioritize to ensure excellent customer service
- Displays professional dress and demeanor
- Personal computer proficiency
- Cash handling experience preferred
- 1-2 years of retail banking experience preferred
- Must be compliant with Loan Officer Requirements of the SAFE Mortgage Licensing Act and Regulation Z. Compliance includes review of the candidate's financial responsibility, character, and general fitness prior to placement in the role. Within 30 days of employment, employee must comply with NMLS registration and corresponding background check requirements
- Work is generally performed indoors in environmentally-controlled conditions
- Typically the employee may sit to perform the work; however, there may be some standing, walking, bending and lifting 5–10 pounds
Critical Skills / Expertise
- Excellent customer service and sales skills
- Excellent oral communication and listening skills
- Knowledge of (or the ability to learn) the bank's operating systems, policies and procedures


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If you have pain in your upper back, a medical evaluation is necessary for your doctor to make a diagnosis, rule out serious upper back pain causes & find.
Shortness of breath. Nausea or vomiting. Pain, pressure, or a strange feeling in your back, neck, jaw, upper belly, or one or both shoulders or arms. See a picture.
Chest and rib pain along with breathing difficulty and 'side stitches' can be associated with the diaphragm. a band of pain across the mid back and difficulty inhaling deeply can indicate. Satellite Trigger Points: Upper Rectus abdominis.
Pain under the shoulder blade, in the side of your chest, arm and finger pain can be. Muscle: Chest, Rib, Arm, Finger and Upper Back Pain, Breathing Difficulty.
Free article to fix neck, shoulder, and upper back pain, upper crossed syndrome, without surgery by Dr. Jolie Bookspan, The Fitness Fixer sports medicine.
Information on Upper and Middle Back Pain. Includes topic overview and related information.
Stop searching WebMD. Click here to read detailed practical article about "Chest Pain When Breathing" directly from our MD!
Novacaine Injections For Back Pain Diagnostically, injections can be used to help determine which structure in the back is generating pain. If lidocaine or similar numbing medication is used, and. Novocaine and Neck Pain. An injection of Xlylocaine. it is normal to have pain in the back of my neck and between my shoulders now. A spinal injection may be
In most cases,upper and middle back pain is caused by: Overuse,muscle strain,or injury to the muscles,ligaments,and discs that support your spine. Poor.
How can you relieve burning upper back pain quickly? Click here to find the cause & a simple technique to ease your pain now.
Upper Back Pain and Lungs – the link and how should you approach it?. have a lung condition, a history of same in your family, or if you feel short of breath.
Upper back pain between shoulder blades can be a source of concern, especially for those who have to sit for long period of time or have jobs involving.
This topic provides an overview of upper and middle back pain. If you have low back pain or neck pain,see the topic Low Back Pain or Neck Pain. What is.
A little over a year ago, out of the blue, I had intense upper back pain (mainly in my upper left shoulder blade area and spine in between my.
Upper Back Pain when breathing can be relieved and treated. Renowned expert Sarah Key explains the causes and what to do about it.
For about 6 weeks I have been experiencing mid back pain when I wake up in the morning. The pain is so bad, I cannot go back to sleep, and NO position.
Sudden severe chest or upper-back pain (often described as a ripping sensation) can be caused by a tear in the aorta, known as aortic dissection, which.
Diaphragmatic breathing is essential in order for the back muscles to completely relax. A simple strategy to relieve lower back pain? Correct breathing.
If you are experiencing pain in the left side of your back, and if the pain sharpens when deep breath is taken, then this Buzzle article is for you. It.
I am having the same exact pain. I woke up yesterday and my back was aching and when I swallo it seems that it hurts on the way down in that exact spot.
In all of its incarnations, back pain is a highly unpleasant sensation. If you are experiencing upper back pain when breathing, it is especially important to note.
I have a upper back pain in my left shoulder and it affect my left arm too, I've already seen a dr and the Dr said it's nerve problem, but inspite for.
In most cases,upper and middle back pain is caused by: Overuse,muscle. In bad cases of scoliosis or kyphosis, a person may have a hard time breathing.
How to Prevent Upper Back Pain. About 84% of adults will experience some sort of back pain in their lives.http://www.rochesterhealth.com/healthnotes.
May 3, 2008. i am 46 female i have gerd but i take medicine for it my upper back really hurts when i breathe in deep.it has been doing it for 3 days i have tried.
Jan 15, 2017. Upper back pain can be debilitating, affecting your ability to enjoy your day-to- day activities, to fall asleep, to work productively, and even to.
I have woken up twice with severe pain in my upper/middle back that makes me feel like I can't breath. I can't sleep when it hits me. I can't lay.
Do you have upper back and chest pain? Click here to find out if it is serious, what causes it & the vital step you must use to relieve your pain
For several months now I've been waking up with a nasty pain in my upper back, that's usually gone by the time I go to bed at night. The pain has been lasting.
Sep 1, 2015. Sometimes, you can also feel upper back pain when you take a deep breath because the vertebrae (the spinal bones) in your thoracic spine.
Dec 23, 2016. Back pain and shortness of breath can indicate a serious medical. is a condition in which the spine in the upper back has an excessive.
Jul 13, 2015. Breathing apically, or with upper chest and neck musculature, can lead to many. What they found was that patients with chronic low back pain.
Bye-Bye Back Pain By Practicing this Simple Back-Opening Breathing Exercise. low back that's bothering you, it might be your mid-back, or upper back / neck.
Upper and middle back pain, which can occur anywhere from the base of your neck to the bottom of your rib cage, has become much more common as more of us.
Serratus Anterior Muscle: Chest, Rib, Arm, Finger and Upper Back Pain, Breathing Difficulty
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Associate in Occupational Studies in Paralegal
McCann School of Business & Technology
Program Details
McCann School of Business & Technology offers an online Associate of Occupational Studies in Paralegal. Through this program, students will gain foundational knowledge for careers in the legal system. Classes include property law, legal writing, family law, among others.
- Send a copy of high school transcript or GED test scores
- Depending on the program selection, students may be required to take a basic skills assessment
School Accreditation Statement
Accrediting Commission of Career Schools and Colleges


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Marco Island
Beach resorts to fishing village vibes
Marco Island
The largest of the Ten Thousand Islands, Marco Island is located just south of Naples and easily accessible with two bridges allowing vehicle traffic on and off the island.
The island is home to some of the world's most beautiful beaches and offers access to both the Gulf of Mexico and the mangrove-lined estuaries of the Ten Thousand Islands. More than just another pretty beach, Marco Island's mood shifts from sophisticated resort area to historic nautical community and funky fishing village. Boating is a way of life for Marco Island residents and visitors, with many year-round and vacation homes located on the water. Bring your appetite for seafood, whether you plan to catch it on your own or at a local restaurant. For hidden gems, seek out the picturesque waterfront restaurants in the communities of Goodland and Isles of Capri. Visitors have their choice of beachfront resort hotels, several inland hotels, and many vacation rental properties and time share resorts.
Signature events taking place in Marco Island include the Mullet Festival in Goodland (January), Wet Paint Live, (February), Marco Island Seafood Festival (March), Taste of Marco (April), Marco Island Festival of the Arts (April), the Marco Island Rocks Concert Series, a weekly Farmers Market (November-April), and a variety of colorful Christmas Island Style events (December).
Population (2016): 17,847
Per capita income (2016): $59,670
Median household income (2016): $73,559
Median home value (2016): $492,000
1 - 10 of 83 Results
Little Bar Restaurant
205 Harbor Place
Goodland, FL 34145
Located right on the water in the quaint fishing village of Goodland, Little Bar, a local tradition for 39 years, continues to serve consistently good...More Info
Quinn's on the Beach
400 S. Collier Blvd.
Marco Island, FL 34145
With the quirky "castaway" feel of the legendary Quinn's, our beachside restaurant and bar makes dining memorable with tropical island food, breathtak...More Info
Hilton Marco Island Beach Resort & Spa
560 S. Collier Blvd.
Marco Island, FL 34145
Hilton Marco Island Beach Resort & Spa is a full-service destination resort, located on 10.5 oceanfront acres of the world-class, white sandy beac...More Info
Pisces Charters
Marco River Marina, 951 Bald Eagle Dr.
Marco Island, FL 34145
Tripadvisor rated #1 charter vessel on Marco Island. She offers the only enclosed salon for all-weather comfort in the area....More Info
Club Regency of Marco Island
500 South Collier Blvd.
Marco Island, FL 34145
Club Regency is located in the midst of a relaxing beachfront community with many of Marco Island's signature restaurants and shops just a short strol...More Info
Sami's Pizza,Pasta & Grill
227 N Collier Blvd
Marco Island, FL 34145
Whether you dine al fresco on the patio, host a family celebration in our dining room, or simply gather with friends for beer & wine at the bar, S...More Info
La Tavola
961 Winterberry Dr
Marco Island, FL 34145
La Tavola literally means the table. The place where family and friends gather to share laughter, love and life!...More Info
The Crazy Flamingo
1035 North Collier Blvd
Marco Island, FL 34145
An OLD Florida bar & grille, serving beer & wine for over 30 years! We want people to come for our Food. We offer fresh shucked oysters....More Info
Gone Fishin' Charters
450 Battersea Ct.
Marco Island, FL 34145
Light tackle and fly fishing for tarpon, snook, redfish, permit, shark etc....More Info
Sea Gone Fishing
Calusa Island Marina
385 Angler Dr.
Marco Island, FL 34140
The Sea Gone Fishing Team specializes in backwater light tacklet fishing for the whole family....More Info


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2020 AIA Gold Medal to Marlon Blackwell
The American Institute of Architects (AIA) has named Marlon Blackwell, head of his eponymous firm in Fayetteville, Arkansas, as…
The American Institute of Architects (AIA) has named Marlon Blackwell, head of his eponymous firm in Fayetteville, Arkansas, as the recipient of the 2020 Gold Medal, the AIA's highest annual honor.
Serero Architectes Urbanistes
Standing beside the beltway surrounding the dense center of Bayeux with its winding narrow streets, the new Bayeux Media Library is thoughtfully integrated into the rich historical context of the town.
Grand Park Hotel Rovinj is a viewpoint for the most beautiful stage on the Adriatic. No matter where he is in the hotel, the guest gets the impression he is staying in a park overlooking Rovinj, St. Euphemia, the island of St. Catherine and the...
KUBE architecture
Dual Modern
The moniker for this residential addition in a small town north of Washington, DC, says it all.…
OYO Architects
Mobility House
Brussels, 2018
A dynamic and timeless platform where innovation is central and where one can discover tomorrow's mobility. A leading, attractive place t...
OYO Architects
Masterplan Olivierstadium 3.0
Knokke, 2017
A clear and readable strategy and structure for the design of the different buildings will create a unique identity for the whole complex...
OYO Architects
Agristo Headquarters
Wielsbeke, 2018
OYO won the invited competition to design and build the new offices for Agristo. People are placed at the heart of Agristo's new home ref...
Delmulle Delmulle
Factory Roos Houses
Het project is gesitueerd in Oudenaarde, in een ambachtelijke zone, waar volgens regelgeving alleen industriële gebouwen kunnen worden op...
Delmulle Delmulle
Waregem, 2017
Sliding shutters, in vertically open wooden slatted work, provide intimacy, serve as sunscreens against overheating, as privacy screens a...
Delmulle Delmulle
Puncture Center
This ultra-compact medical center with transparent front and back facade has maximum openness and light. A quality that has been overemph...
JUMA architects
Project RS
Gent, 2020
Juma was commissioned to design a new house on a hill in the Flemish Ardennes. The north side of the plot has a beautiful view of the fie...
JUMA architects
Penthouse O
Gent, 2016
This new penthouse was bought on plan from a project developer. The client came to JUMA for the entire redesign of the proposed interior....
JUMA architects
Project BK
Afsnee, 2017
For the internal conversion of a farm in rural Afsnee, JUMA sought to strike a balance between the authentic elements of the house and a ...
JUMA architects
Farmhouse CL
Deurle, 2017
The renovation of this authentic farm sought to restore its lost charm, and increase the interior comfort. JUMA beautifully integrated t...
JUMA architects
Baillet Latour
Brasschaat, 2018
Although this bungalow on one of the stately driveways of Brasschaat had been on the market for a long time, JUMA immediately saw its eno...
BRU Umbau und Innenraumgestaltung…
Brüssel, 2018
Eine Hommage an die Sinnlichkeit Aufgabe der Ständigen Vertretung in Brüssel ist es, als Botschafterin Österreichs in der Europäischen ...
Urban Platform
Brussels, 2017
The project represents an architectural turning point that synthesizes the relations to establish between contrasted urban environments. ...
Urban Platform
Brussels, 2018
The project proposes a subtle urban articulation between the sizes existing on the street side and makes use of the site's morphological ...
Urban Platform
Tienen, 2018
The College project is a feasibility study in the heart of Tienen and consists in the conversion of a former school site and the adjoinin...


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The German translation for Farm is Bauernhof .
Other possible / similar German translations may be Heben and Produzieren .
|Translations in other languages:
|Danish: gård
|Dutch: boerderij
|Estonian: talu
|Finnish: tila
|French: ferme
|Frisian: pleats
|Irish: feirm
|Italian: fattoria
|Latin: vicus
|Polish: gospodarstwo
|Portuguese: fazenda
|Russian: ферма
|Serbian: kmetija
|Slovene: kmetija
|Spanish: finca
|Swedish: gård
|Telugu: పొలం
|Welsh: ffarm
Search Translations
Featured German Translation


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VAST for Advertisers
In-Stream Campaign Generation
The steps in generating an In-stream campaign are similar to the generation of any other campaign type. Nevertheless, there are a few specific settings if the new In-Stream ad format is selected:
- Configuring the pricing: a new pricing model, called CPV (Cost-Per-View) is the only available model. The Adveritser sets the cost, which is triggered when 10 seconds of the video ad are displayed to the visitor at normal speed.
- When setting one or more variations, the Advertiser uploads a single video file for each variation. Further below there is a description of the video file requirements.
Video Ad Requirements
Preferable Video Format
- Type: MPEG-4 video (video/mp4)
- Video Codec: H.264
- Audio Codec MPEG-4 AAC
- Video File Size: Currently the uploaded video files are limited to 50MB.
- Aspect Ratio: Popular video players automatically resize the video so that it fits to their dimensions while keeping the ratio. Nevertheless, a ratio matching the player ratio (if known) is preferable.
- Resolution: No limitation.
- Maximum Duration: No limitation, although at least 10 seconds are required for the CPV model to count a 10-second view.


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As part of its activities to promote the debate on common strategies related to the EU-LAC bi-regional association, the Foundation carries out research and studies on issues identified by both regions.
These studies are published in this section of the web site, in order to encourage debate and promote exchange on best practices and specialised knowledge.
The publications are organised into the following series: Bi-Regional Economic Perspectives; Bi-Regional Relations; Conferences; Democracy Studies; ECLAC / EU-LAC Bi-Regional Outlook; EU-LAC Forum of Global Governance and Reflection Fora. The Foundation also publish a Newsletter that provides a multi-stakeholder space for dissemination of information on the topics on th bi-regional agenda; and encourages young researchers to work on EU-LAC relations.
You can subscribe to updated information on the new studies published by the Foundation by registering in our contact list below.
Search results
Beyond 2015: Perspectives and Proposals for Development Cooperation between the EU, Latin America and the Caribbean
The European Union (EU) and Latin America and the Caribbean (LAC) share a long history of political dialogue and bi-regional cooperation in which development has always played a key role. Both regions also share a commitment to multilateralism and ...
- Author(s)/Editor(s):
- José Antonio Sanahuja, Sergio Tezanos Vázquez, Alejandra Kern, Daniela Perrotta
- Published in:
- 23 September 2015
Social Protests and Democratic Responsiveness: Assessing Realities in Latin America and the Caribbean and the European Union
This publication has emerged out of the Workshop "Social Protest and Democratic Responsiveness: Assessing Realities in Latin America & the Caribbean and the European Union", organized by the EU-LAC Foundation and GIGA German Institute for Global and ...
- Author(s)/Editor(s):
- DELLA PORTA, Donatella, KURTENBACK, Sabine, SAMPAIO, Antônio
- Published in:
- Germany, 7 September 2015
Culture as an Instrument of Social Transformation
Starting from the premise that culture is a key factor for sustainable development, this essay describes how culture creates bridges between groups and people and connects stories and traditions. The author makes a theoretical journey through the ...
- Author(s)/Editor(s):
- Ronald Grätz
- Published in:
- Germany, 25 July 2017
Promoting the Integral Development in Balance with Mother Earth
The Plurinational State of Bolivia is pioneer in promoting a new vision of development based on "Live Well in harmony with Mother Earth" as an alternative for the commodification of the environmental functions, unsustainable growth and accumulation of ...
- Author(s)/Editor(s):
- Ricardo Rojas Quiroga
- Published in:
- Bolivia, 8 December 2014


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Oak Cubes - American medium-plus toast
Product details
AKA oak beans. Medium-plus toast American oak cubes impart higher levels of aromatic sweetness and a campfire/roasted coffee attribute, cooked fruit and a full mouthfeel.
Crafted from air-dried oak staves and fire-toasted by expert coopers in California, oak cubes allow winemakers to impart terrific oak flavor and aroma to wines aged in glass carboys, plastic buckets, or steel tanks. Use a single variety or create your own custom blend of different toasts and woods.
Suggested dose is 2.5 - 3 oz per five gallons; can be added during fermentation or aging. Leave wine in contact with the cubes for a minimum of two to three months.
Additional information
|8246, 8247
Customer Reviews
Oak Cubes - American medium-plus toast
aging 7 gal of corn whiskey. At 4 months its getting notes of oak and caramel.
I make a Bourbon barrel breakfast stout called Morning Wood. Soak 2 and a 1/2 ounces in Makers Mark Bourbon for a week, then add to secondary for another week. It's the best breakfast you'll ever have. Guaranteed. Brewdog333
Whether you are tossing these in straight or soaking them in booze before throwing them in, best advise is less time in the beer is better. Too easy to over do it and ruin a batch. Less is more.
They were exactly as they should be. I had my first taste of the new wine and it seems they worked well.


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Paragon Number: 15202
GM Part Number:
AM/FM digital radio. This radio is built to be a factory look alike utilizing the original knobs and spacers and fitting perfectly into your original center bezel without any modifications. The radio carries: 180 watts (45 x 4) of power, digital clock, iPod port in back and includes a remote control. Please note that knobs and spacers are no included.
Price: $339.00


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As for what to put in your profile, be sure you describe the exact type of girl you're looking for (none of this "any girl will do" nonsense). Is this going to filter women out? Yes. But that's the point. By actively filtering women you show that you're a high-value guy with standards. This is going to make you more desirable for any woman who reads your profile. It's also going to prevent you from wasting time with the wrong girls.
Separate from the obvious, there are several social events you can attend to increase your chances of meeting someone new. Try planning a weekly movie night through your friends and see who shows up every week, making it clear that new people are welcome to join at any time. Accept every party, wedding or social networking invitation you are given and attend. Another idea along this same vein would be to host your own party, where each invitee brings a potluck dish and a single friend (of the opposite sex for heterosexuals or same sex for gays and lesbians). This way there will be an evenly-matched number of singles, all interested and ready to meet someone new.
Exit the conversation early. This one might surprise you, but assuming you're having a first conversation with a woman you don't know (whether a stranger or a friend of a friend), cut it short. By doing this, you're ensuring you're not misreading the situation and wasting her time, in the event that she isn't interested, but you're also demonstrating that you respect boundaries and aren't a threat to her. And if she was enjoying the conversation, you'll leave her wanting more.
We're willing to bet your kitchen skills are lacking, or at the very least could benefit from some professional advice. Why not take a cooking class? Not only will you upgrade your culinary skills and maybe add a few new dishes to your repertoire, but you're likely to find yourself one of the few men in attendance. Even better, for those shy about approaching women: you'll often be asked to pair up to complete a dish, giving you an easy way to start up a conversation over an omelet flambé.
Between the heartwarming speeches, the dancing and the alcohol, love is everywhere you look at a wedding. Whether marriage is your cup of tea or not, weddings facilitate love and, when paired with the alcohol, naturally influence romantic feelings. If it's a friend's wedding, there should be plenty of similar-aged women who will have a date with them or not. If not, they are probably single. There is also a good probability that you and a potential love interest will have a friend or two in common, which gives you an introduction and something to talk about. Considering most of the older guests leave before the midnight buffet, a wedding essentially becomes a night club after 11PM, except better because the booze is (usually) free and everyone is dressed to the nines.
If you're still wondering 'how can I find girls near me?', it makes sense to sign up to our dating site as soon as possible. Our website offers a fun and easy way to connect with local ladies, helping you to meet new partners and friends in your area in no time at all. Meeting single females can be a daunting task, especially if you're not very outgoing. You might meet girls in bars and clubs, however, approaching them can be extremely nervewracking. Plus, how do you know that the ladies you meet are single or if you have anything in common? When you sign up to our dating service, you'll be able to find out all about your matches before you even get in touch with them, helping you avoid wasting time chatting and flirting with members who are wrong for you. Your chances of going on bad dates with incompatible singles will be greatly reduced! If you're ready to start browsing personals and contacting fun and loving single females near me, create your profile now. We'll give you full 24/7 access to our service, allowing you to search for a new partner or a hookup at any time of the day or night.
Coffee shops are one of my personal favorites when it comes to places to meet singles. It may seem obvious to some or completely alien to others - yet it works. Find a busy coffee shop that you feel comfortable in, and take up a space near the main door. Avoid bringing anything to distract yourself with if you can manage it, although this may be more difficult for some than for others. The point is this: try not to involve yourself into something so completely that you send off 'I'm busy' vibes. You want to seem approachable, and hiding behind a laptop or book doesn't help!
Finding love in the US these days is no easy task for single men and women alike. Casual and non-committal hookups are becoming more commonplace and popular, and many of today's singles struggle to meet someone who wants to have a real relationship and settle down, and even want to get married. Unlike many other online dating sites, our platform uses intelligent matchmaking and an extensive personality test to establish your relationship goals and preferences. As a result, EliteSingles aims to meet your online dating needs by sending you appropriate and compatible matches, people you actually want to be dating.
Admit it: You've all come across at least ONE cute girl on the subway or at the bus stand, but you never had the courage or time to approach her. But notice – don't be too eager to approach a woman; you will be viewed as nothing more than a creep. Look at the signs. Is she too engrossed reading a book, playing Candy Crush on her phone or has her eyes closed with her earphones in place? Then take a hint: she doesn't want anybody to disturb her. On the other hand, if she's looking here and there or has a bored expression on her face, your chances of making eye contact with her increase. Just be smart enough to take her number before she gets off at her stop, will you?
Hollywood would have us believe that there's a certain type of man that single women are looking for; tall, dark, handsome, and preferably, rich. Thankfully, though, it's simply not true. In a cross-national survey examining the biological and cultural influences of attraction, it was found that women most favored the following top five features in a man; humor, intelligence, honesty, kindness and strong values.
Disclaimer: Great efforts are made to maintain reliable data on all offers presented. However, this data is provided without warranty. Users should always check the offer provider's official website for current terms and details. Our site receives compensation from many of the offers listed on the site. Along with key review factors, this compensation may impact how and where products appear across the site (including, for example, the order in which they appear). Our site does not include the entire universe of available offers. Editorial opinions expressed on the site are strictly our own and are not provided, endorsed, or approved by advertisers.


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Astragalus trichopodus is a species of legume known by the common name Santa Barbara milk vetch. It is native to southern California and Baja California, where it grows in several types of open habitat, including in the Transverse Ranges and Mojave Desert.
This is a robust perennial herb producing a branching stem up to about a meter in maximum height. The hairy stem is lined with many leaves each up to 20 centimeters long which are made up of several pairs of widely spaced lance-shaped leaflets each up to 2.5 centimeters in length. The inflorescence is a raceme of up to 50 flowers which are cream colored and sometimes tinted with light purple. Each flower is 2 or 3 centimeters long including its tubular base of sepals.
The fruit is a laterally compressed, slightly inflated legume pod up to 4 or 5 centimeters long which dries to a papery texture. The fruits hang in bunches where they develop from the inflorescence. Each pod contains many seeds.


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Hot Glue Gun Stand Plans Explained
From today's featured Hot Glue Gun Stand Plans Explained woodworking plans article.
The Best Hot Glue Gun Stand Plans Explained Free Download PDF And Video. Get 50 Free Woodworking Plans Get Hot Glue Gun Stand Plans Explained : World's most comprehensive collection of woodworking ideas For Pro & Beginner. beginner woodwork. pro woodwork projects. Styles: Furniture, Toys, Frames, Beds, Animal Houses, Racks, Dressers, Chairs, Coasters, And Many More. Search For Hot Glue Gun Stand Plans Explained Basically, anyone who is interested in building with wood can learn it successfully with the help of free woodworking plans which are found on the net. The specific way each feature is presented and the material covered in these sites are the best reason for downloading Hot Glue Gun Stand Plans Explained woodworking plans for your construction projects. Even though the plans provided in them are more suited to the needs of professional and advanced woodworkers, the suggestions and guidance offered can even make the most ignorant person successfully complete any Hot Glue Gun Stand Plans Explained woodwork projects. Professionals find the free plans useful because it helps them save time in creating designs for their clients.
Hot Glue Gun Stand Plans Explained : For those who have plans to generate your own woodworking projects at home, the web is a good place to locate different types of woodworking plans. A great deal of plans also need expensive components or aren't designed well. There are so lots of distinct forms of plans that you have the ability to work on. Try to remember, cheap and badly written plans will cost you more in the future since you could be stuck having to obtain additional materials as you used plans which were incomplete. What to search for in the ideal woodworking plans Not all plans are made equally. Teds Woodworking is designed for individuals that are into doing amateur DIY stuff around the home and woodworking particularly. You can locate the ideal woodworking plan depending on your degree of expertise or desired need. If you're looking to earn a huge amount of projects there are a few guides which you can come across online that have hundreds if not thousands of plans that will steer you from beginning to finish. Before you choose to start on any undertaking, easy or difficult, choose one that includes a plan which guarantees results. Small woodworking projects like bird houses or picture frames are well suited for using wood glue. Custom made woodworking's been around for several years and is still a favorite avocation. So, a couple of great beginner woodworking projects are what you ought to be considering for now. Woodworking is extremely visible. As soon as you have gotten several simple woodworking projects below your belt, you can readily move on to more difficult projects.
Hot Glue Gun Stand Plans Explained : It's always nice to cut as many parts as possible before starting the assembly. That way, you can set aside the dust mask, safety glasses and hearing protection for longer periods of time, and the air isn't continually filled with sawdust. Cut everything except the lengths of the drawer components. In case things get a little out of whack during assembly, you'll be able to measure and fit the drawers to the actual openings.The free woodworking plans in this download will guide you through the process of building cabinet doors, from start to finish.Use the tools and materials list to gather everything you need and then step through the instructions and blueprint to build this simple workbench in an afternoon.Make your doors more interesting by incorporating raised panels. This helpful guide will show you how to raise a panel on your router table or shaper, so you can build a door for your project that stands out.I start by milling my clear stock to my desired thickness.The thicker the timber the more of the blade is in contact, and given the fact that we are taking a thick cut, can make it difficult to plane.
Hot Glue Gun Stand Plans Explained
Hot Glue Gun Stand Plans Explained : Start with an idea in mind of what you want to build and then get a really good woodworking project plan that is geared toward beginners. There are several small woodworking projects for beginners available for purchase from online woodworking retailers. A few woodworking plan suggestions to get you thinking are: a jewelry box, a music box, a clock, a bird house, a chessboard or checkerboard, a rocking horse for a child just to name a few. Of course you can start out with as grand a woodworking plan as you choose. However, the chances are if you start out with a small woodworking project at first, you will have a better chance of completing the project.
Hot Glue Gun Stand Plans Explained : The last product that I am going to review is called Woodworking 4 Home. This product is a fairly new product and thats the reason I have this product listed as the third best woodworking blueprints product. As this product continues to impress me, I will most likely move this product up the ranking list. This product contains over 14,000 woodworking plans and projects. These plans are categorized into over 100 different categories that include anything that you would want to build through woodworking.
Hot Glue Gun Stand Plans Explained
Hot Glue Gun Stand Plans Explained : If you're looking for a simple and sturdy workbench that's still mobile, this is the plan for you.Learn to wrap the grain around a miter joint. You don't need special clamps, just some packing tape. By using a couple of furniture-making tricks you can build floating shelves that look worlds better than off-the-rack racks.The last time I stopped in at my sister's house, my brother-in-law was on the garage floor putting together a tricycle for his grandson. They had recently moved into a new house, and apparently his last garage workbench hadn't made the trip. I decided to build him a new one.Learn how to build cabinets with this free PDF from Popular Woodworking. You'll find the best cabinet making tips and techniques here. We've included articles and plans about building cabinets, building cabinet doors and understanding cabinet joinery.What's important here is to take note of the stock's grain orientation. Look at the end grain, here you should find the annual rings running into the planing edge at 90 degrees, this is the radial face. Planing the radial face is often times far more consistent than tangential.
Hot Glue Gun Stand Plans Explained Video


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Armed Robbery Attack On Abuja-Kaduna Highway, Travellers Kidnapped (Photos)
Gunmen attacked travellers alongside Abuja-Kaduna freeway on Monday night. Based on studies, some motorists have been allegedly kidnapped by the gunmen who introduced the expressway to a standstill.
The attackers additionally robbed travellers of their possessions after forcibly stopping automobiles at excessive velocity, inflicting a number of crashes within the course of.
The Nigerian Military later responded to emergency by dispatching about three truckloads of troopers, in accordance with Yakubu Mohammed, who witnessed the incident.
It was claimed that the abductors operated for about 30 minutes on the freeway with out intervention of safety brokers.
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It's a premium hemp oil for pain relief. It comes as a supplement for stress relief, pain and anxiety. Ultra High Strength Hemp Oil relieves pain from your entire body such as in the joints, back, and muscles. You don't need to worry about value for your money; the product comes with full money back guarantee if you do not like the oil. All ingredients used are natural and organic with high-functioning anti-inflammatory properties. The taste is excellent, as the oil gets blended with natural flavors and MTC coconut oil.
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To highlight the bold and unique artifacts collected by the homeowner during his extensive travels, designers clothed this living space in a neutral white color palette. This color also helps to reflect the natural light let into the space by myriad windows, making the space feel large and bright. Bold reds and oranges are added to give the space pops of color, while complementing the colors of the land surrounding Horizon House.
This luxurious, modern black and natural wood-toned kitchen features three drop pendant lights in black, above the expansive black kitchen island with a small wooden surface top. Barstools match the cabinets in the space, with cool concrete flooring beneath.
Bright greens and pinks fill the meadow's landscape with beauty and natural color.
Light, natural colors and texture tie this large, rustic kitchen to the amazing view.
With tons of natural light coming into this Eclectic-Midcentury Modern living room space from the French doors and large windows, the space feels light, bright and open, highlighting the clean lines and bold colors that make up the design of this room.
This elegant entertainment space blends seamlessly into the nature that surrounds it. Bold browns mix with more muted neutrals to bring out the natural hues in nature, and the stone pavers and stucco shingles help to accent the natural beauty of the space, while providing the durability that will make entertaining possible in this space for a long time.
Cute cottage-style home with stacked stone facade, natural colors and a pitched gable roof.
Natural elements in this white bedroom, such as the wood mirror and table lamp and the greenery in the white vases, help to create warmth in the space.
Lush shrubs, trees and plants surround the large retail shopping center, adding natural color to the design.
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A classic, neutral color palette, plenty of natural light and a clear line of sight create a warm, open feeling in this newly renovated Colonial home.
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This calm transitional bedroom welcomes with soothing natural colors, a comfortable bed, and a seating area on top of a soft, patterned rug.
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Description : 3bhk residential apartment available for rent in wagholi, pune. It is a very good property and has 3 balcony(S) wh... read moreich make the apartment more spacious. It is available for all. We are looking for rs. 14500. It is on the 9th floor and has vitrified flooring. It is a north facing property and has intercom facility, lift(S), maintenance staff, visitor parking and security/fire alarm etc. The society too has features like club house/community center, fitness centre/gym, swimming pool, park, security personnel and water softening plant which adds to the attractiveness of the property. 1 covered parking. 3bhk flat on rent at jade residency, nagar road, opp kaveri hotel, opp decathlon, walk-Able from nagar road. 3 terrace/gallery. This is new project and new construction, gated for families. Ventilation all over the flat, also due to huge window concept, you live without light in day time. Ro water provided, geyser provided, jaguar fittings all over the flat, lift backup. It is road to - view less
NYCHA and other City employees can participate in NYCHA's automated payroll rent deduction program. Half of the monthly rent amount will be deducted from the first two paychecks of every month. Deductions can be higher than half of the monthly rent because deductions are half of the outstanding balance, not just the rent. If no deductions are being taken out, the development did not enter the employee into the system or his or her agency is not part of the program. To terminate payroll deductions, a termination form must be completed and submitted to your property management office. To sign up, please click this link: NYCHA Self-Service Login/Register.
If your rent is paid via benefits you receive from the NYC Human Resources Administration, please review the monthly rent statement to be sure that last month's payment was received and that no other charges are due. If additional monies are due, please mail your payment with the remittance slip in the enclosed envelope to the address printed on the slip.
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Due to the high price of real estate in Sri Lanka, rental properties are a more convenient alternative for many. Expats find a house for rent in Sri Lanka a cheaper option compared to houses for sale in Sri Lanka due to tax reasons. Vacation rentals are on a short term basis and ideal for tourists. But those who move to the country for the long term can find fully furnished houses with a range of facilities in highly residential areas. Air conditioned bed rooms are important, especially due to the tropical weather and hot summer days. Rent in Sri Lanka varies based on the location. In the city centre the average price of a single story, 1 bedroom house for rent is likely to be Rs. 40-60,000 while outside the city centre the rent is much lower between Rs. 15-25,000. A 2 to 3 bedrooms' house is ideal for an average family with dining and living rooms, house located close to local amenities. The surrounding facilities also affect the house rent.
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The Fair Housing Act does not specifically prohibit discrimination based on sexual orientation or gender identity. But discrimination against someone who is lesbian, gay, bisexual, or transgender (LGBT) may still be in violation of the Act or other state or local regulations. If you think you've been discriminated against for these reasons, file a complaint as described above, or email HUD at firstname.lastname@example.com with general questions about LGBT housing issues.
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An 86-Year-Old Woman With Refractory Anemia.
What is your diagnosis?
Pathologic Diagnosis: Plasma Cell Myeloma With Multilobated Nuclei
Further evaluation of the aspirate and biopsy revealed approximately 45% plasma cells, including atypical forms occasionally in clusters. These infiltrating cells varied in morphology from rare mature plasma cells to more frequent large cells with nuclear multilobation. Some of the nuclei were clover leaf-like in appearance. The nuclear-cytoplasmic ratio was high and the cytoplasm was amphophilic. Immunohistochemistry showed monoclonal [Kappa]light-chain cytoplasmic staining (Figure 3). Rare plasma cells were [CD45.sup.+], [CD20.sup.-], [CD43.sup.-], [CD3.sup.-], and [p53.sup.-]. Serum immunofixation electrophoresis disclosed only a [Kappa]-light-chain paraprotein. Serum immunoglobulin (Ig) A (0.592 g/L) and IgM (0.197 g/L) levels were both decreased, whereas the IgG value was within the normal range. A diagnosis of plasma cell myeloma was made, and the patient was treated with multiple cycles of chemotherapy. During the course of her treatment, she was admitted and treated for herpes zoster, gastrointestinal bleeding, and pulmonary thromboembolism. The patient died 7 months after her initial presentation.
We present a case of a previously described, but rare, morphologic variant of multiple myeloma known as plasma cell myeloma with multilobated nuclei. A total of 18 cases have been reported to date, from 1988 to 1998.[1-4] These articles have addressed the relationship of multilobulation of the nuclei with prognosis. The 18 cases were described in 4 articles, 10 cases by Buss et al[1] in 1988, 6 by Zukerberg et al[2] in 1990, and 2 in case reports.[4,5]
The results of the reported studies showed that there is no apparent sexual predilection. Of the 18 previously reported cases, 10 patients were men and 8 were women.[1,2,4,5] The age range at presentation was 54 to 78 years.[1,2,4,5] The presenting symptoms included polydipsia, polyuria, decreased appetite, weight loss, bone pain, weakness, and fatigue. Common laboratory findings included anemia, slightly elevated calcium levels, lytic bone lesions, and serum monoclonal gammopathy or Bence-Jones proteinuria.[2,4,5]
The bone marrow cellularity ranged from 30% to 100% in the previously reported cases.[2] Plasma cells were increased, ranging from 25% to 65%, and exhibited morphologic variation from mature plasma cells to multinucleated plasma cells or cells with multilobated, cleaved, or monocytoid nuclei.[1,2,4,5] Some plasma cells had markedly irregular nuclear contours, while others had distinct nuclear lobulation similar to those seen in neutrophilic bands and segmented forms, megakaryocytes, Sezary cells, or convoluted lymphoblastic lymphoma.[1] Plasma cells with abundant pale or blue cytoplasm with 2 to 4 nuclear lobes were described.[2] The monoclonal protein type reported by Buss et al[1] was either [Kappa] or [Lambda] light chain, combined with IgG, IgA, or IgD. Four cases expressed light chain only.
Zukerberg et al[2] concluded that the cases they described fit best into the previously described cleaved and polymorphous subtypes of Bartl et al,[6] which were of intermediate clinical grade, yet had a more aggressive clinical course.[2]
Buss et al[1] classified 7 of 10 patients at stage III on presentation; 50% of these cases were stage IIIA and the other 50% stage IIIB.[1,2,4] Zukerberg et al classified 5 of 6 patients in stage III. The survival period (time to death from diagnosis) varied widely, ranging from 4 to 54 months[1] in one report and 6 days to 14 months[2,5] in others.
Marked nuclear lobulation has been associated with light-chain disease.[3] It appears to pursue a more malignant clinical course with a shorter survival and a higher incidence of renal failure, lytic bone disease, hypercalcemia, and amyloidosis. Chemotherapy has not been implicated as a cause for the multilobulation.[1]
A poor prognostic marker for plasma cell myeloma includes the expression of CD10 (CALLA).[2] Other prognostic markers for myeloma include plasma cell DNA labeling index, serum [[Beta].sub.2]-microglobulin, serum soluble receptor for interleukin 6, and karyotypic abnormalities (ie, deletion of chromosome 13).[3] The morphologic appearance of the plasma cells has been associated with prognosis. The more immature the plasma cells, the more aggressive the clinical course may be.[6] Nuclear multilobation may be yet another poor prognostic indicator in plasma cell myeloma.
The differential diagnosis of multilobated myeloma includes metastatic carcinoma, T-cell lymphomas, myelomonocytic leukemias, megakaryocytes, neutrophils, and histiocytes. Buss et al also described multilobated reactive plasma cells in a case of breast carcinoma.[1]
Myeloma can have a variety of morphologic features, and it is important to recognize that they can be multilobated as well. Reed et al[7] found that in 2% to 3% of their cases the majority of plasma cells expressed marked nuclear lobulation, contortion, or multinucleation, imparting a monocytoid appearance. Multilobated plasma cell myelomas tend to present at a more advanced stage and have a more aggressive course. Awareness of this entity is therefore important to avoid misdiagnosis with other hematologic malignancies.
[1.] Buss DH, Reynolds GD, Cooper MR. Multiple myeloma associated with multilobated plasma cell nuclei. Virchows Arch B Cell Pathol Incl Mol Pathol. 1988;55:287-292.
[2.] Zukerberg LR, Ferry JA, Conlon M, Harris NL. Plasma cell myeloma with cleaved, multilobated, and monocytoid nuclei. Am J Clin Pathol. 1990;93:657-661.
[3.] Greipp PR. Prognosis in myeloma. Mayo Clin Proc. 1994;69:895-902.
[4.] Invernizzi R, Perfetti V. A case of multiple myeloma with multilobated plasma cell nuclei. Hematologica. 1998;83:851.
[5.] Islam A, Noyes S, Henderson ES. A case of aggressive multiple myeloma with convoluted and multilobated plasma cell nuclei and no visible nucleoli. Br J Haematol. 1990;76:306-307.
[6.] Bartl R, Frisch B, Fateh-Moghadam A, Kettner G, Jaeger K, Sommerfeld W. Histologic classification and staging of multiple myeloma. Am J Clin Pathol. 1987; 87:343-355.
[7.] Reed M, McKenna RW, Bridges R, Parkin J, Frizzeria G, Brunning R. Morphologic manifestations of monoclonal gammopathies. Am J Clin Pathol. 1981; 76:8-23.
Accepted for publication January 11, 2001.
From the Department of Pathology, University of Illinois-Metropolitan Group Hospitals, Illinois Masonic Medical Center, Chicago, III.
Reprints not available from the authors.
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Bittersweet Symphony: In surprise move, JNU's VC takes both JNUSU and Delhi Police to court together
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The last paragraph of the circular of August 28 issued by DU to all the Principals and Directors was also the main reason that sparked off the protests was changed
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