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Carbon-fibre cage reconstruction in anterior cervical corpectomy for multilevel cervical spondylosis: mid-term outcomes
Multilevel cervical spondylosis (MCS) is painful disc degeneration with arthropathy of the cervical spine, causing cervicobrachialgia, myelopathy or both. Anterior cervical corpectomy and fusion (ACCF) is frequently indicated as a surgical solution as it can address multiple levels of anterior based pathology, where stenotic pathology is posterior to the vertebral body [inaccessible with anterior cervical discectomy and fusion (ACDF)] and where it can restore lost cervical lordosis. Controversy persists regarding the optimal choice of reconstruction (1). Case series have indicated good mid-term results with ACCF using graft-impregnated titanium mesh cages (TMC), achieving greater than 95% fusion rates (2-4). However significant subsidence occurs in 11–19% (2,3) particularly with increasing levels and osteopenia, correlating with kyphosis and poorer clinical outcomes (5,6).
Carbon fibre is an alternative material of interest for reconstruction in the spine as it is demonstrates high versatility, a modulus approximating that of cortical bone, bio-inert characteristics and ease of radiographic or MRI assessment (5). The long fibers are aligned in the sagittal plane, according to the normal trajectory of the dominant bone trabeculae. 18-month outcomes have been described for stacked carbon-fiber cages in all-pathology ACCF, noting that subsidence may only be significant if greater than 3 mm (7). More recent literature has reported average graft subsidence for carbon fiber cages was 0.7 mm without revision surgery, compared to 2.9 mm subsidence and 11.1% revision rate within the same series for TMC (8).
There is no published case series with a large number of patients treated with ACCF with carbon fibre cages, and including an extended follow up. The aim of this study is therefore to establish the clinical and radiographic outcomes of a carbon-fiber polymer cage in the setting of MCS. Given the evolution of materials for ACCF, this is relevant to the current debate on optimal reconstructive material.
This was a retrospective study of 102 consecutive MCS patients treated with a ACCF and carbon-fiber cage from 2007–2012. The cages are designed with anisotropic long continuous carbon-fibers (PolyEtherKetoneEtherKetoneKetone), aligned along the biomechanical axis (ostaPek® composite, coLigne, Zurich, Switzerland), ranging from 17 to 63 mm height and 4° lordosis. Large fenestrations allow filling of morcelised autologous bone graft (Figure 1). In cases where the opposing end-plates were not almost parallel, then an alternative reconstruction was considered to prevent point-loading of the construct—these patients were excluded from the study. All patients were originally indicated for the procedure if they had cervical spondylosis with stenosis at multiple levels that mandated removal of the interposed vertebral body to provide adequate decompression. Patients were contacted for clinical and radiographic assessment. Patients were excluded for fracture, oncologic or infective pathology, or ossification of the posterior longitudinal ligament (OPLL), as these were treated from a posterior approach. Patients who had a prior ACDF were included. Ethical approval was granted by the local ethics committee.
Pre-operative details were recorded including Visual Analogue Scores (VAS) for pain, neurological deficit (Nurick grade), smoking status, ASA grade and co-morbidities. Peri-operative details were recorded including blood loss, operative time and corpectomy levels, peri-operative complications, additional clinical visits and additional cervical spine operations.
Patients were issued clinical questionnaires including Nurick, European Myelopathy Score (EMS), modified Japanese Orthopedic Association (mJOA) score and VAS for arm and neck.
Radiological outcomes included routine post-operative radiography. For the purposes of the study patients were additionally requested to undergo erect and dynamic radiographs. The fusion assessments were performed by the primary author (…) who was not involved in clinical management. Timepoints for the study were at a minimum of 2 years. Evaluations included:
- Segmental Cobb angle (sagittal alignment of the construct from the superior cephalad endplate to the inferior caudal endplate);
- Cervical lordosis: C2C7 angle (inferior endplate C2 to superior endplate C7);
- Fusion was defined as <2 mm difference between the tip of the supra- and subjacent spinous processes between flexion and extension views (9);
- Instrumentation integrity;
- Subsidence, defined as either none, mild (1–3 mm) or severe (>3 mm) (8);
- Adjacent segment degeneration at adjacent levels (<5° flexion-extension difference).
The neutral position was defined when the endplates were parallel, the kyphotic orientation when the angle between the two previous described lines were open posteriorly (a negative value), the lordotic orientation were described when the angle is open anteriorly (positive).
Surgical technique
Patients undergo general anaesthetic, a gel-foam ring is placed under the head and the endotracheal tube is directed to the opposite side of the operator. Positioning is checked with fluoroscopy prior to incision to ensure adequate visualisation, optimal orientation of the cervical spine and an orthogonal radiographic view. A Smith-Robinson approach is taken and rechecked on fluoroscopy. The midline is identified, and lateral self-retaining retractors are placed. Kaspar pins were placed in the midline. A trench of no more than 2 cm width is resected from the vertebral body(ies) to preserve the lateral vertebral body wall thus protecting the vertebral artery. A pituitary rongeur and high-speed burr are used for piecemeal resection, continued to the posterior longitudinal ligament, thus decompressing the spinal cord and enough space to allow resection of osteophytes at the cephalad and caudal disc spaces. Once the endplates are denuded of cartilage, the space is measured for the cage. The footprint must be as wide as possible to spread the load. Fluoroscopy is a useful aid to insertion and should be assessed for adequacy of decompression, cage position, cage-endplate congruity and segmental lordosis. If the cage has opened the space to recreate any lost lordosis, the facets should be opening anteriorly (intervertebral lordosis). An overlying spanning plate and screws are applied while avoiding violating adjacent disc spaces. The earlier plates were used with non-locked screws and later plates had constrained non-locked screws. A wound drain is advised with interrupted sutures to close the fascia and skin.
Results are quoted in mean values (and/or percentages) with standard deviations (SD). Paired student t-test was used to identify pre- and post-operative clinical and radiological differences. ANOVA was used to analyse subsidence subgroups (none, mild, severe) for clinical outcomes. Two-tailed p-values significance was <0.05.
Demographic (Table 1) and perioperative (Table 2) details are shown. Corpectomy levels included 72 single level ACCF, 19 two-level and 5 three-level ACCF, 6 ACCF plus pre-existing adjacent ACDF, all with an overlying plate (Table 3). Fourteen had peri-operative complications including five dural tears, two respiratory infections, one lower limb ischemia, three cervical hematomas and three revision procedures. Two of the hematomas were evacuated immediately post-index procedure and the second was performed at 48 hours.
Full table
Full table
Full table
Three revision procedures
One patient had a malpositioned cage that required revision within 24 hours. One cage migration progressed over 6 weeks to ultimately require revision (Figure 2). One patient had a posteriorly mal-placed cage requiring a posterior laminectomy at six weeks (the anterior cage was left in situ). Anterior revisions were performed with exchange of the cage for iliac crest cortical graft. One additional patient had a subsequent ACDF at C6C7 three years post C5 ACCF.
Eight patients were lost to follow-up but were included in the peri-operative analysis. Three were deceased, four had moved from the area (nursing facilities). Two of the eight had peri-operative complications as noted above. One was revised for early migration for a misplaced cage and was last seen at one year without problems. One had multiple dural adhesions with a mal-placed cage, who had a lower limb ischemia from an atheromatous embolism post-operatively, then had a posterior laminectomy at six months which resolved symptoms apart from pre-operative left arm weakness. The other patients had no complaints at 3 months' follow-up.
Mean pre-operative pain scores were VAS neck 4.6 (SD 2.4) and VAS arm 5.1 (SD 2.8) and on follow-up, VAS neck was 2.6 (SD 1.9) (P<0.01) and VAS arm was 2.0 (SD 2.3) (P<0.01). Mean Nurick score improved from 1.2 (SD 1.2) to 0.4/4 (SD 0.8) (P<0.01). Mean EMS was 15.9/18 (SD 2.0) and mean mJOA was 14.0/17 (SD 2.3) at follow-up.
Radiological (Table 4)
Full table
Seventy patients attended follow-up radiographs. Mean JOA, VAS Neck and VAS Arm of 13.8, 2.6 and 2.8 for those who attended for radiographic follow up were not significantly different to 14.3, 2.8 and 1.1 for those who did not (P>0.05). In some cases, the caudal aspect was not visible or assessable. CT scans were additionally provided during the follow up where available (Figures 2,3). An example of a patient with 5-year follow up is shown in Figure 4.
Five patients demonstrated both segmental Cobb angle and overall C2C7 kyphosis. 3 further cases with a lordotic segmental Cobb angle had C2C7 kyphosis, totaling 8 with C2C7 kyphosis. Mean VAS Neck and Arm scores in those with C2C7 kyphosis were 3.4 and 4.6, which when combined were significantly higher than cases without kyphosis (P<0.05).
Collectively, there were five pseudarthrosis cases where dynamic radiographs displayed >2 mm spinous process differences. All of these were smokers, two were diabetic and two had recent trauma-induced central cord symptoms. Two had two-level and three had single level ACCF. Screw loosening or breakages were observed in 11 cases, including all pseudarthrosis cases described and separately, associated with segmental kyphosis in 2. There were no failed plates or cages. Some patients had interval CT scans as part of their follow up which demonstrated increasing osseous formation within and around the cage (Figure 3).
Subsidence was present in 20 cases (28.6%), 1 mm in 11 (mild, 15.7%) and >3 mm in 9 (severe, 13%). One severe and 4 mild subsidence cases were associated with a segmental kyphosis and 3 had an overall C2C7 kyphosis. Affected cases of severe subsidence included 6 single level, 2 two-level and 1 three level. Age, gender or smoking status did not affect subsidence rates. In some cases, the juxtaposition of the screws and cage prevented subsidence of the cage beyond the neck of the screw, particularly inferiorly (Figure 3). VAS neck, VAS arm, VAS combined, JOA and EMS were not significantly different when comparing subgroups of subsidence (none, mild, severe, P>0.1).
Five cages migrated posteriorly warranting revision surgery in 3 cases, as described above. This was related to either end-plate obliquity and footprint mismatch, or posterior or oblique positioning of the cephalad aspect.
Assessment of adjacent levels revealed flexion-extension angle differences in 9/40 proximal adjacent levels and 7/23 distal adjacent levels, excluding those who had radiographic evidence of degeneration or osteophytosis pre-operatively. One case had preserved motion at a caudal adjacent segment but with significant disc degeneration and neck pain.
This retrospective follow-up of 102 MCS patients with ACCF and carbon-fiber cage has shown safety and durability in pain and neurological function and acceptable radiographic profile. The blood loss of 322 mL and operative time of 98 min compare favorably with the meta-analyses previously mentioned (340–986 mL, 211–264 min) (1). Clinical results demonstrate an overall sustained improvement of approximately 50% recovery of pain and neurological function, including a recovery of 0.8 Nurick grades with improved pain of 2.0 and 3.1 for VAS Neck and Arm respectively at a mean of 6 years' follow-up.
Radiographic follow up in 70 cases had both clinical and radiographic follow up at six years, with similar clinical scores to those who did not attend. This demonstrated five pseudarthrosis cases, indicating a fusion rate of 92.8%. Loosening or breakage of screws occurred in 11 cases, including two with pseudarthrosis. Other series describe fusion rates of 96% (2,3). Given that the most accurate radiographic assessment of fusion is through spinous process tip distance measurement (10), the radiolucency of a carbon-fiber cage may confer an additional advantage for future MRI of the spinal cord but not regarding fusion when compared to TMC.
Defining subsidence for a series of ACCF can be difficult, as achieving comparative orthogonal radiographs to assess each end-plate is difficult. Subsidence was reported by Andaluz et al. as 18% in a series of 130 TMC without a strict definition (2). It has been defined as any loss of height by Raslan et al. (11), or of more than 3 mm by Gao et al. (in a series of 145 TMC with an incidence of 11%) (3). Perhaps the largest series of 300 ACCF with TMC was that by Chen et al. who reported mild subsidence (1–3 mm) in 182 (60.7%) and severe subsidence (>3 mm) in 57 (19.0%) (6). These are the criteria that we used in this study, with 1 mm subsidence in 11 (mild, 15.7%) and >3 mm in 9 (severe, 13%). Polyamide cages and carbon-fibre cages have both shown less subsidence than TMC (7,9). Like previous series, subsidence mostly occurred into the caudal superior endplate (12). Pain scores in the severe subsidence subgroup were not significantly higher than that of the overall cohort.
Adjacent segment degeneration occurred in 16/63 (25.4%) levels and adjacent segment disease requiring operation occurred in 1/94 (1%) of follow-up cases in this series. While ASD typically occurs more often at the cephalad level, the incidence in this series was higher for caudal levels. This may reflect the method for ASD evaluation (MRI follow up would be definitive) as one patient had ASD on MRI with preservation of movement, falling outside of the selection criteria. The series by Gao et al, using TMC and/or autograft demonstrated symptomatic ASD requiring operation in 16 patients (11.0%) (3). Andaluz et al. had 5 patients (3.8%) with ASD with operation 1–9 years later (mean 4.4±2.7 years) (2). However, the rate of ASD is relative to the mean age of the cohort (64.5 years in this series versus 54.4 years by Andaluz).
Technical considerations for insertion require thorough visual and radiographic evaluation of the compatibility of the cage with the void created by the corpectomy. This study highlights the potential for posterior malposition of the cephalad aspect of the cage. Given that insertion of the cage is aided by a handle (Figure 1B), one may be inclined to raise the handle on insertion thus risking posterior malpositioning. Footprint mismatch can predispose to posterior migration of the cage and subsidence as contact points are overloaded. While difficult to assess, one must be attentive to endplate preparation without violation, particularly on the caudal superior endplate. Over the lifetime of this implant, 15° lordosis cages have also been introduced thus increasing segmental lordotic reconstruction at the corpectomy site.
Limitations of this study include its retrospective nature, with variable time points after minimum 3.5 years follow up. Outcomes that were commonly recorded as part of the pre-operative assessment were then used on calling patients back as part of the study. While the study was based at a single institution, there were at least ten surgeons of variable amounts of experience involved in using this implant. The case series did not include a comparison group. The case series was heterogenous as the aim of the study was to evaluate the implant in all its clinical applications. Given that the series took place over a long period, there were few consistent clinical measures, thus VAS and Nurick score were the only scores applicable both pre-operatively and on follow-up. Perhaps a further drawback of mid-term follow-up in older patients is that eight patients were lost to clinical follow up despite three attempts to contact them and 32 patients declined radiographic follow up. Hence, 70% of cases had both clinical and radiographic follow up at six years, with similar clinical scores to those who did not attend. Most patients were referred with MRI without pre-operative radiographs. Thus pre-operative C2C7 lordotic angles were not used. Reporting outcomes of single level ACCF with this implant are part of an ongoing study.
This series of 102 patients with anterior cervical carbon cage reconstruction demonstrated safety and durability for improvements in pain and neurological function at six years follow-up. Severe subsidence occurred in 13% without clinical consequences and fusion was achieved in 93%, demonstrating similar outcome profiles to TMC.
Société Française de Chirurgie Orthopédique et Traumatologique/Irish Orthopaedic Association/Irish Institute of Trauma and Orthopaedic Surgery.
Conflicts of Interest: The authors have no conflicts of interest to declare.
Ethical Statement: Ethical approval was granted by the local ethics committee.
- Zhu B, Xu Y, Liu X, et al. Anterior approach versus posterior approach for the treatment of multilevel cervical spondylotic myelopathy: a systemic review and meta-analysis. Eur Spine J 2013;22:1583-93. [Crossref] [PubMed]
- Andaluz N, Zuccarello M, Kuntz IV C. Long-term follow-up of cervical radiographic sagittal spinal alignment after 1-and 2-level cervical corpectomy for the treatment of spondylosis of the subaxial cervical spine causing radiculomyelopathy or myelopathy: a retrospective study: Clinical article. J Neurosurg Spine 2012;16:2-7. [Crossref] [PubMed]
- Gao R, Yang L, Chen H, et al. Long term results of anterior corpectomy and fusion for cervical spondylotic myelopathy. PLoS One 2012;7:e34811. [Crossref] [PubMed]
- Han YC, Liu ZQ, Wang SJ, et al. Is anterior cervical discectomy and fusion superior to corpectomy and fusion for treatment of multilevel cervical spondylotic myelopathy? A systemic review and meta-analysis. PLoS One 2014;9:e87191. [Crossref] [PubMed]
- Hee HT, Majd ME, Holt RT, et al. Complications of multilevel cervical corpectomies and reconstruction with titanium cages and anterior plating. J Spinal Disord Tech 2003;16:1-8. [Crossref] [PubMed]
- Chen Y, Chen D, Guo Y, et al. Subsidence of titanium mesh cage: a study based on 300 cases. J Spinal Disord Tech 2008;21:489-92. [Crossref] [PubMed]
- Kabir SM, Alabi J, Rezajooi K, et al. Anterior cervical corpectomy: review and comparison of results using titanium mesh cages and carbon-fiber reinforced polymer cages. Br J Neurosurg 2010;24:542-6. [Crossref] [PubMed]
- Weber MH, Fortin M, Shen J, et al. Graft subsidence and revision rates following anterior cervical corpectomy: a clinical study comparing different interbody cages. Clin Spine Surg 2017;30:E1239-45. [Crossref] [PubMed]
- Zhang Y, Quan Z, Zhao Z, et al. Evaluation of anterior cervical reconstruction with titanium mesh cages versus nano-hydroxyapatite/polyamide66 cages after 1-or 2-level corpectomy for multilevel cervical spondylotic myelopathy: a retrospective study of 117 patients. PLoS One 2014;9:e96265. [Crossref] [PubMed]
- Cannada LK, Scherping SC, Yoo JU, et al. Pseudoarthrosis of the cervical spine: a comparison of radiographic diagnostic measures. Spine 2003;28:46-51. [Crossref] [PubMed]
- Raslan F, Koehler S, Berg F, et al. Vertebral body replacement with PEEK-cages after anterior corpectomy in multilevel cervical spinal stenosis: a clinical and radiological evaluation. Arch Orthop Trauma Surg 2014;134:611-8. [Crossref] [PubMed]
- Bartels RH, Donk RD, Feuth T. Subsidence of stand-alone cervical carbon fiber cages. Neurosurgery 2006;58:502-8. [Crossref] [PubMed]


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As a general dentist in Huntsville, AL, Dr. René A. Talbot, uses the latest in dental technology to keep patients in excellent oral health. The qualities of a great general dentist go far beyond offering a standard dental cleaning. The way that procedures are performed and the type of solutions offered, all play a critical role in what your experience will be like and the results that you receive. When you visit our 35801 family dentist office, we are confident that you will have a pleasant experience because we are focused on your overall health and wellbeing, including patient comfort. To schedule your appointment, call (256) 382-6690.
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If you suffer from dental anxiety or are concerned about what you will feel like during a dental cleaning, don't be. We use nitrous oxide and sedation to ensure patient comfort. Very often, these are not necessary because we are a gentle dentist that provides care using the latest tools and technology. Doing so naturally reduces any potential discomfort. However, as a family dentist we understand that when dental anxiety is involved, patients can experience stress that goes beyond anything they feel physically. This is why we offer to use sedation and nitrous oxide to help our patients relax before starting any dental work, even if it is something simple like applying dental sealants. To find out how sedation can benefit you, call (256) 382-6690 and schedule a consultation with our Huntsville, AL general dentist office.
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Dr. René A. Talbot, DDS and our experienced staff are:
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- Great listeners. Visiting a general dentist that listens to your concerns and your goals will help to improve your experience and the end results. We will listen to you and create a treatment plan that helps you to have the best possible oral health while enjoying your smile. This may even include preventative solutions like dental sealants.
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- Creative. Transforming smiles requires a certain level of creativity. As a general dentist we have multiple tools at our disposal including dental bonding, veneers, crowns, bridges, implants and more. Identifying the right solutions for your circumstance is essential, as is understanding how to combine them. Our team is creative and able to visualize how beautiful your smile can become when using the right dental procedures.
We invite you to call our Huntsville, AL general dentist office to schedule an appointment. As a family dentist we are focused on patient comfort and can use sedation and nitrous oxide to ensure that you have a relaxing experience regardless of whether you are receiving a dental cleaning, dental sealants, a root canal, or a smile makeover.
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As an Huntsville dentist office, we are regularly asked questions about oral health. Many of them are routine in nature, with patients wanting to know how long they should brush their teeth, when they should …
Welcome to René A. Talbot, DDS
We are committed to providing quality service to residents located In the Huntsville, AL area. Our website has additional information about the following topics: Dentist, Cosmetic Dentist, Family Dentist, General Dentist, Dental Implants, Teeth Whitening, …
Why You Need a Dental Cleaning in Huntsville
If it has been a while since you had a dental cleaning, we recommend that you give us a call and schedule an appointment right away. It is important to keep your teeth and gums …


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1 year ago


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Some 61% of hourly workers cited scheduling and communication points as the principle obstacles in reaching their workflow, in response to a WorkJam examine.
Video: How enterprise IT can put together for Convey Your Personal Every thing system insurance policies
At Cell World Congress Americas 2017, Gartner researcher Michael Disabato mentioned the necessity for IT to steadiness person expertise with safety necessities with regards to BYOD.
Greater than half of hourly workers aren't reaching their full potential at work, in response to a WorkJam report launched on Thursday. Some 61% of workers cited scheduling and communications as the most important boundaries to success, and largest causes for leaving an organization, the report discovered.
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SEE: BYOD highlight: Mitigating threat and implementing insurance policies and options (Tech Professional Analysis)
"Our smartphones are an extension of who we're, and with the ability to combine points of our work lives into our private units creates ease and luxury for workers," mentioned Steven Kramer, co-founder, president, and CEO of WorkJam, in a press launch. "At this time, each U.S. office depends on smartphones, and the service trade isn't any exception. If used along with a BYOD coverage, employers can foster a extra productive, engaged, and dependable workforce."
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Need For Sleep
February 25, 2019
Hang on for a minute...we're trying to find some more stories you might like.
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Sleep, who doesn't love it! The outcomes of this delightful pleasure are mind-boggling dreams and a satisfying reimbursement of much needed energy. A lot of people use sleep to their advantage, other people have a different story, where their life consists of too much stress and/or active play, which leads to insomnia. Then there are some cases where somebody sleeps too much! Why is sleep needed in moderation?
Sleep is a time of active processing, where memories and information are stored into parts of the brain. According to the National Sleep Foundation, it is of critical importance that everybody gets the recommended amount of sleep each night. Their website states, "While adults need 7-9 hours of sleep per night, one-year-olds need roughly 11 to 14 hours, school age children between 9 and 11, and teenagers between 8 and 10." With a good amount of sleep comes amazing effects such as elevated mood, an increase in energy, and a healthier body. Proper sleep is a blessing, but many people struggle with getting too much sleep, or sleeping none at all.
Insomnia is the condition in which people cannot get their proper rest. Either there is no sleep in their schedule (sleep deprivation), or their sleep is violent and rough. Sleep is the body's natural healing process, and without it, the body can face serious damage. Researched by senior study author José M. Ordovás, PhD, " Previous studies have shown that lack of sleep raises the risk of cardiovascular disease by increasing heart disease risk factors such as glucose levels, blood pressure, inflammation and obesity."
Sleep deprivation and insomnia have been found to be caused by a number of things. Too much screen time, high levels of stress, and anxiety.
Hypersomnia is the opposite of insomnia. This is the condition used to label sleeping too much. This problem is usually directly connected to mental illness though, specifically depression and other depressive disorders. Many other things can contribute to this sleep disorder though, such as obesity, medication, or stress levels. "There is no single right amount of sleep that applies to everyone. Sleep needs are individual. They're based on a number of factors," says Sleep Doctor, Michael J Breus, PhD. "You may find you need 7 hours of sleep in your 20s, and 8 hours—or 6.5—in your 50s or 60s."
Hypersomnia can cause a constant fatigue or overwhelming tiredness, and even leave people with severe headaches.
If you aren't sleeping perfectly already, try to relax before going to bed. Insomnia and hypersomnia may seem nice to some people, but it is not a pleasant condition. Avoid eating and any stimulants (caffeine or your phone).
Liam Sink is a sophomore at Heritage High School that is in love with writing. He has been writing since he was five and has developed his skills since...


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Our last Closed Beta Session is set and scheduled for Sunday 23 September. The last wave of keys will be handed out to all players who already signed up for the beta on our website. Read more »
Our last Closed Beta Session is set and scheduled for Sunday 23 September. The last wave of keys will be handed out to all players who already signed up for the beta on our website. Read more »
Patch 1.8 will go live on Thursday, September 20th at 7:00 UTC. Downtime is scheduled to be up to 4 hours. Read more »
There's been a lot of information about Battlerite Royale released in the past few weeks, so we thought we'd collect what's been communicated so far regarding Battlerite Royale Early Access and add in a bunch of new information! We hope this answers most of your questions!
We all love Battlerite and our topmost priority has always been to expand and refine the experience. Battlerite was released in Early Access in September 2016, an impressive lifetime for a game these days and we have no plans to stop now. Read more »
Приветствую, чемпионы! У нас есть волнующие новости, которыми мы хотим с вами поделиться.
Обновление 1.7 с переходом на третий рейтинговый сезон будет добавлено в игру 31 июля, в 10 МСК. Предполагаемое время технических работ – 3 часа.
Hotfix 184.108.40.206 was rolled out on Thursday, June 28th. It contained small fixes to bugs and other gameplay issues.
UPDATE: The end of Season 3 has changed from July 17th to July 30th to better align with new regions we are heading into.
Patch 1.6.1 is scheduled to go live on Tuesday, June 5th at 9:00 CEST. Estimated downtime is scheduled to last 3 hours. Read more »
Hotfix 126.96.36.199 addresses bugs that came with Season 2 and Patch 1.6. This hotfix was rolled out today, May 18th. Some fixes were deployed beforehand. Please verify the integrity of your game files to ensure that this update reaches you. Read more »
Patch 1.6 is scheduled for Wednesday, May 16th, and will be the end of Season 1 and start of Season 2. Patching is scheduled to begin at 9 CEST.


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Prime Minister Scott Morrison said the arrival of the warships in Sydney had been planned for some time. He said it was a "reciprocal visit" as Australian naval vessels had visited China.
"It may have been a surprise to others but it certainly wasn't a surprise to the Government," he said.
Yeh, right.


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Submission Deadline: 01-10-2019
More information on the call here.
THE CAMARGO FOUNDATION The Camargo Foundation, located in Cassis, France, and founded by artist and philanthropist Jerome Hill, is a residential center offering programming in the humanities and the arts. It offers time and space in a contemplative environment to think, create, and connect. The Foundation encourages the visionary work of artists, scholars, and thinkers in the arts and humanities.
Launched in 1971, the Camargo Core Program is the historical and flagship program of the Foundation. Each year an international call is launched through which 18 fellows (9 artists and 9 scholars/thinkers) are selected:
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- Artists (all disciplines) - Applicants should be the primary creators of a new work/project.
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The Camargo Core Program has two sessions:
Fall 2020
- 8 weeks from September 8 to November 3, 2020
Spring 2021
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- 8 weeks from February 23 to April 20, 2021
- 11 weeks from February 23 to May 11, 2021
LANGUAGE REQUIREMENTS Candidates must be able to communicate well in English.


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Putting Things On Hold...For Now - Adrian White
The time has come for me to take a little hiatus on herbalism (writing about it, that is). For those of you who have been reading up on my herbalist stuff: no, I won't be gone forever. The end of 2016 has brought about some startling changes that will, inevitably, take me away from my …
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3504 Wentwood, University Park, 75225
Click for Map
Price $3,299,000
Status : Active Option Contract
Beds:5 Baths:4.3 Garage:2
The new build is the perfect touch of contemporary and traditional giving it a smooth transitional feel. Having the creamy white stucco exterior perfectly blend with the clean contemporary lines of the interior and rich wooden floors. The sizable gourmet kitchen and family room are the center of entertaining including the covered back porch and fireplace. Just a few blocks away from Preston Center and only a block away from Coffee Park which is t
All information is from sources believed to be reliable and is subject to change of price, rental, commission or other conditions, prior sale, lease or financing or withdrawal without notice. No representation is made as to the accuracy of any description. All measurements and square footage are approximate and all information should be confirmed by customer.


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Contempt of court
[60-000] Introduction
The court's powers in relation to contempt are found in s 24 Local Court Act 2007. Those powers are the same as the District Court with respect to contempt of court committed in the face or hearing of the court: s 24(1).
See generally:
[60-010] Has there been a contempt in the face of the court
Contempt in the face of the court is an act which has the tendency to interfere with or undermine the authority, performance or dignity of the courts or those who participate in their proceedings: Witham v Holloway (1995) 183 CLR 525 per McHugh J at 538-539.
Examples of contempt include:
abusing and swearing at a magistrate: Prothonotary of the Supreme Court of NSW v Hall [2008] NSWSC 994
filming witnesses with a view to intimidation: Prothonotary of the Supreme Court of NSW v Rakete (2011) 202 A Crim R 117
prevaricating or refusing to answer questions: Keeley v Brooking (1979) 143 CLR 162
refusing to take the oath or give evidence: Smith v R (1991) 25 NSWLR 1
refusing to leave the court when directed: In the matter of Bauskis [2006] NSWSC 908
disobeying court orders including subpoena: O'Shane v Channel Seven Sydney Pty Ltd [2005] NSWSC 1358.
Generally, rudeness and even extreme discourtesy by legal practitioners, will not be considered to be contempt: Toner v AG (NSW) (unrep, 19/11/91, NSWCA). Further, like police, judges and magistrates are, by their training and temperament, able to resist the sting of insults directed to them: see Coleman v Power (2004) 220 CLR 1 at [200]. In Ferguson v Walkley (2008) 180 A Crim R 294; (2008) 17 VR 647, Harper J said at [36]:
It is no offence simply to be angry with the authorities (including, of course, judicial authority). Some people can articulate their anger in measured language that clearly explains their reasons for feeling as they do. Others, especially when their anger is combined with high emotional stress, or alcohol, or other debilitating factors, cannot … Depending always on all the relevant evidence, it would probably be quite wrong to charge someone with an offence simply because such language was used in anger.
[60-020] Alternatives to summary charge
All options other than a summary charge of contempt should be considered first. Summary proceedings should only be instituted where it is urgent and imperative that the punishment be immediate. Summary proceedings are a last option, should be exercised with restraint, and only used in exceptional circumstances: Keeley v Brooking (1979) 143 CLR 162.
It is preferable that the court explore all options other than charging and hearing the matter summarily, as the magistrate may be the victim, a witness, the prosecutor and the judge of fact and ultimately of penalty. In European Asian Bank AG v Wentworth (1986) 5 NSWLR 445, Kirby P said at 452:
The combination, in the judge, of four such inimical functions is not only unusual, it is so exceptional that, though it may sometimes be required to deal peremptorily with an emergency situation, those occasions will be rare indeed. Especially will they be rare where, as in this State, a facility is provided in the Court of Appeal to relieve the judge of such an embarrassing concatenation of functions.
Other options that should be considered include:
a warning, reprimand or exclusion from court
an opportunity for the alleged contemnor to seek legal advice
a "cooling off" period followed by an opportunity for apology
whether an offence under a legislative provision has occurred, including a breach of the Court Security Act 2005, in which case the matter may be referred for prosecution
whether, if the conduct involves a legal practitioner, a complaint could be made under the Legal Profession Act 2004
in civil matters, where the conduct involves a legal practitioner, whether an order under s 99 Civil Procedure Act 2005 could be utilised
whether the matter should be referred to the Supreme Court under s 24(4) Local Court Act 2007. If so, the reference is sent to the prothonotary
whether disrespectful behaviour ought be referred to the Attorney General under s 24A(7) Local Court Act 2007.
The decision to proceed to a charge for contempt is a power to be used sparingly and only in serious cases. Its usefulness depends upon the wisdom and restraint with which it is exercised: Ex p Bellanto; Re Prior [1963] NSWR 1556 at 1566.
[60-040] Referral to the Supreme Court
Section 24(4) Local Court Act 2007 enables the court to refer a matter to the Supreme Court for determination where it:
- (i)
is alleged by another party, or
- (ii)
appears to the Court on its own view that a person has committed a contempt of court.
In either case, before exercising its power of referral, the court must afford procedural fairness to a proposed contemnor: Prothonotary of the Supreme Court of NSW v Dangerfield [2016] NSWCA 277 at [59], [77]. Failing to do so may render subsequent proceedings in the Supreme Court a nullity: Prothonotary of the Supreme Court of New South Wales v Chan (No 23) [2017] NSWSC 535 at [64].
This is because an exercise of the s 24(4) referral power involves potential prejudice to the alleged contemnor, as the penalty which can be imposed by the Supreme Court is greater than that which the Local Court can impose if it decides to deal with the contempt itself under s 24(1): Dangerfield at [56]; Chan at [29].
Further, in instances where the Local Court comes to its own view that a person is in contempt, the referral of the matter to the Supreme Court requires proceedings to be commenced by the Prothonotary. There is no capacity for a referral to the Prothonotary to obtain advice as to whether or not proceedings should be commenced: Chan at [54].
Exercising the power of referral requires the court to make two decisions:
- 1.
Whether it appears to the court on its own view that the person is guilty of contempt of court, and
- 2.
Whether the court should refer the matter to the Supreme Court for determination: Dangerfield at [52].
Suggested approach (see Dangerfield at [51]ff and Chan at [59]–[61])
- 1.
Advise the alleged contemnor of the two procedural options available under s 24 and their consequences.
- 2.
An adjournment may be needed to enable the alleged contemnor to receive advice from their legal practitioner (or seek advice, if unrepresented).
- 3.
Provide the alleged contemnor with an opportunity to address the question of how their alleged contempt should be dealt with, including whether the Local Court should itself deal with the matter.
- 4.
A party (other than the court) raising an allegation of contempt should also be provided with the opportunity to respond to any submissions of the alleged contemnor.
[60-060] Summary charge
In the event it is considered that none of the above-mentioned options should be utilised as an alternative to a summary charge, the person in contempt should be orally charged by the magistrate.
If the contemnor is not present a warrant may be issued: subs 24(1) and (3) Local Court Act 2007, s 199 District Court Act 1973.
[60-080] Adjournment for defence to charge
The charged person must be afforded a reasonable opportunity to make a defence to the charge, which will in most cases require an adjournment and the provision of information on legal aid. It is possible, but would be unusual, for the charged person to be held in custody. Bail must be considered: s 90 Bail Act 2013.
[60-100] The hearing
Where there is a plea of not guilty, a hearing is required. The magistrate is entitled to make use of his or her own observations, and should inform the defendant of these. Witnesses may be called by the court. The defendant has a right to, but is not obliged to give and call evidence. After the hearing, the magistrate determines the matter of the charge with the criminal standard of proof required: Coward v Stapleton (1953) 90 CLR 573.
[60-120] Penalty
If the defendant is found guilty, the court may punish by a fine not exceeding 20 penalty units or by imprisonment for a period not exceeding 28 days: s 24 Local Court Act 2007; s 199 District Court Act 1973.
The power to punish for contempt is exercised to vindicate the integrity of the court and of its proceedings, and is rarely if ever exercised to vindicate the personal dignity of a judge: Lewis v Ogden (1984) 153 CLR 682.
For considerations on penalty for abuse to the court: see Prothonotary of the Supreme Court of NSW v Hall [2008] NSWSC 994.
For considerations on penalty for refusing to give evidence: see Principal Registrar of Supreme Court of (NSW) v Tran (2006) 166 A Crim R 393 which includes a schedule of comparable sentences for contempt of that type.
[60-140] Purging contempt
Generally, contemnors should be given an opportunity to purge their contempt, particularly where there is a refusal to give evidence: Smith v R (1991) 25 NSWLR 1. There is an overriding power to discharge a contemnor prior to the expiration of sentence: s 24(2) Local Court Act 2007.


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If you feed the nodes wrongly, then familydocuments will not be passed on… this will give errors since they are not being closed correctly. There is no other way around this than close Dynamo and Revit and start all over once more.
This is how it is, nothing to do about it.


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Camp-Collar Printed Cotton-Poplin Shirt
Colour: White
Select a size
- XS (sold out)
- S (sold out)
- M (sold out)
- L (sold out)
- XL (sold out)
Editor's Notes
If you recognise the print on Calvin Klein 205W39NYC's camp-collar shirt, it's because each photograph is similar to the recent campaign shot by Mr Willy Vanderperre in the Californian desert. It's cut from soft cotton-poplin in a boxy shape and sits nicely over shorts and trousers thanks to the side slits. Turn up the cuffs to show off the embroidered logo. Shown here with CALVIN KLEIN 205W39NYC jeans, Raf Simons T-shirt, CALVIN KLEIN 205W39NYC boots.
Size & Fit
- Fits true to size. Take your normal size
- This shirt is cut for a boxy fit
- Mid-weight, non-stretchy fabric
- Model wears a M
- Model measures: chest 38"/ 96cm, height 6'1"/ 185cm
Details & Care
- Multicoloured cotton-poplin
- Camp collar, designer emblem, side slits
- Button fastenings
- 100% cotton
- Dry clean
- Made in Italy
- Made in Italy
Product Code 10375442618887505


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Join Us! It's our 12th Annual West Coast Global Forum!
Dear UNA-USA Members and Friends,
Reserve your spot at the United Nations Association of the USA (UNA-USA), Southern California Division, 12th Annual West Coast Global Forum. This year's theme is "Refugees & Migration – The Global Challenge And The Local Impact" and we are ask that you save the date.
When: Wednesday, the 18th of September, 2019, from 12 noon to 3 in the afternoon
Where: The California Endowment, 1000 N Alameda Street Los Angeles CA 90012.


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April 10 (UPI) -- Texas Gov. Greg Abbott is sending as many as 1,400 National Guard troops to the Mexico border as part of President Donald Trump's plan to ramp up immigration security -- seven times more than he pledged last week.
Abbott said about 300 troops per week will be deployed in coming weeks to help secure Texas' approximately 1,000-mile border.
Trump last week authorized the National Guard, with governors' approvals, to enhance U.S. border patrol security. Trump said there is a "drastic surge of illegal activity on the southern border" that threatens national security -- and that between 2,000 and 4,000 troops will eventually be sent there.
Arizona Gov. Doug Ducey also increased his troop numbers to nearly 350, up from the 225 he initially pledged.
New Mexico Gov. Susana Martinez said she will deploy more than 80 troops this week of the 250 being sent from her state, and the governors of South Carolina and Arkansas pledged additional troops, if needed.
With the federal government paying the bill for the deployments, Texas will save almost $1 million per month that had been spent on "Operation Secure Texas," a mission ordered two years ago by Abbott that deployed 100 Texas Guard troops to the border for immigration security.
Abbott said he wanted to downplay speculation that "our National Guard is showing up with military bayonets trying to take on anybody that's coming across the border, because that is not their role."
Ducey said the deployments are not partisan.
"You show me somebody who is for drug cartels or human trafficking or this ammunition that's coming over a wide-open and unprotected border here," he said.
California Gov. Jerry Brown, who has repeatedly fought with Trump over immigration policy, has not announced whether troops from his state will go to the border as part of the president's plan.


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ANDERSON, Ind.-Training camp for the Indianapolis Colts is underway at Anderson University.
The team will call Anderson home for the next two-and-a-half weeks.
Almost every day during that time the team will hold open practices and fans are invited to check out the on-field action for free.
There are several other attractions for Colts fans to check out during a visit to training camp including "Colts City," which is an interactive fan zone with activities for kids, ticket giveaways, and a mobile Colts pro-shop.
Because of the heat we've seen in Central Indiana the past week, the Colts organization is making some special accommodations for fans coming to training camp.
"We do allow fans if you want to bring in some bottled water, we know the heat. It's going to be warm up there it's august. We want our fans to stay hydrated. We're also going to have water fans can get for free," said Stephanie Pemberton, Sr. director of marketing for the Indianapolis Colts.
See below for the highlights of the 2016 Colts training camp schedule:
7-27- 1st Practice (1:55-4:40pm)
7-31- Kids Day (1:55-4:40pm)
8-2- Night Practice (6:25-9:10pm)
8-11- Last Practice (8:25-10:30am)
Click here for the full schedule.


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C. 1970 Vintage Opal and .82 ct. t.w. Diamond Ring in Platinum. Size 7
Additional Information
Product Details
7/8 inch
Gemstone 1:
Diamond (Quantity: 31, Shape & Cutting Style: Round Brilliant, Color Grade: G-H, Clarity: SI1-I1, Weight: 0.75 ct. t.w.)
Gemstone 2:
Opal (Color: White, Quantity: 1, Shape & Cutting Style: Oval Cabochon, Weight: 26.50 carats, Size: 19X13 mm)
PLATINUM: A rare precious metal cherished for its longevity and strength. Platinum is naturally white, durable, dense, and resilient to discoloration. Most platinum in jewelry is at least 95% pure since it does not require alloys or plating.
Diamond: The hardest and most brilliant of all gemstones, a diamond can make the heart race with its pure and fiery spark. An ancient symbol of love, a diamond is the preferred gemstone for tokens of affection, such as rings, earrings, necklaces and bracelets. Diamond is the birthstone for April.
BRILLIANT: A gemstone cut to enhance brilliance without sacrificing much carat weight. Typically has 58 facets.
Color Grade G-H: Near-colorless
CLARITY SI1: Slightly Included. Inclusions are noticeable under 10x magnification.
OPAL: With an iridescent luster that can reveal a beautiful kaleidoscope of color, the opal has inspired many myths and legends. A white opal with swirls of soft pastel shades is popular for jewelry, but opals also come in black and blue. Opal is the gemstone for October birthdays.
OVAL: An elliptical shape that resembles an egg.
CABOCHON: A style of cutting gemstones to achieve a smooth, domed surface with an absence of facets.
All weights and measures are approximate.
Gift Box
Sidney Thomas Presentation Box Your purchase includes an elegant Sideny Thomas presentation box.
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