text:
Free scholarship online helps you to apply for scholarships online, find free grant money for school, and free money for graduate school
Compare K-12 school ratings nationwide to find the best schools. View parent ratings, reviews and test scores and choose the right preschool, elementary, middle or high school for public or private education.
Maharashtra HSC Result 2016 Maha HSC Arts result, Maha HSC Commerce result, Maha HSC Merit list, Maha HSC result by name, Maha HSC result by Roll number, Maha
Best SSC Je coaching for B.Tech and Diploma students. Special classes for Working Candidates.
MyTaxMitra.com is onestop website for all the Financial & Tax Related Services.It updates latest Information in the area of Finance, Tax , and other related
RealWorld – Real World
Bulk Sms, Bulksms, Bulk Sms Software, Bulk Sms Service, Sms Gateway, Bulk Sms India, Bulk Sms Service Provider, Sms Marketing, How To Send Bulk Sms, Sms Api, Sms Gateway India, Bulk Sms Provider, Bulk Sms Providers, Bulk Sms Hyderabad, Transactional ...


text:
Referenced Items are not available for this document.
Skip to Main Content
This standard specifies how the MAC Service is supported by Virtual Bridged Local Area Networks, the principles of operation of those networks, and the operation of VLAN-aware Bridges, including management, protocols, and algorithms.
A not-for-profit organization, IEEE is the world's largest technical professional organization dedicated to advancing technology for the benefit of humanity.
© Copyright 2016 IEEE - All rights reserved. Use of this web site signifies your agreement to the terms and conditions.

subset: commoncrawl


text:
Fax: (713) 792-8233
Original Article
Can procalcitonin distinguish infectious fever from tumor-related fever in non-neutropenic cancer patients?†
Version of Record online: 17 MAY 2012
DOI: 10.1002/cncr.27602
Copyright © 2012 American Cancer Society
Volume 118, Issue 23, pages 5823–5829, 1 December 2012
Additional Information
How to Cite
Shomali, W., Hachem, R., Chaftari, A.-M., Jiang, Y., Bahu, R., Jabbour, J., Raad, S., Al Shuaibi, M., Al Wohoush, I. and Raad, I. (2012), Can procalcitonin distinguish infectious fever from tumor-related fever in non-neutropenic cancer patients?. Cancer, 118: 5823–5829. doi: 10.1002/cncr.27602
- †
We thank Brahms ThermoFisher for supplying the Kryptor system and procalcitonin kits. We are also grateful for Tanya Dvorak and Ruth Reitzel who assisted in performing the procalcitonin assays.
Publication History
- Issue online: 19 NOV 2012
- Version of Record online: 17 MAY 2012
- Manuscript Accepted: 7 MAR 2012
- Manuscript Revised: 29 FEB 2012
- Manuscript Received: 24 JAN 2012
- Abstract
- Article
- References
- Cited By
- procalcitonin;
- cancer;
- non-neutropenics;
- infectious fever;
- tumor fever
Procalcitonin (PCT) has been proposed as a marker of infection and was studied in neutropenic patients. This study investigated its role in non-neutropenic febrile cancer patients (NNCPs).
Between July 2009 and July 2010, a total of 248 NNCPs with fever were studied. PCT was measured in plasma within 24 hours of fever onset and 4 to 7 days thereafter, using a Kryptor system with a lower limit of quantitation of 0.075 ng/mL. Patients' clinical, microbiological, and radiological data were reviewed to make the diagnosis and were correlated with PCT levels.
This study included 30 patients with bloodstream infection (BSI), 60 with localized bacterial infection, 141 with no documented infection, and 8 with tumor-related fever. Most patients (98%) were inpatients or admitted to the hospital during the study. Patients with BSI had significantly higher PCT levels than did those with documented localized infections (P = .048) and no documented infection (P = .011). PCT levels were significantly higher in septic patients than in those without sepsis (P = .012). Patients with stage IV disease or metastasis had significantly higher baseline PCT levels than did those with early stages of cancer (P < .05). PCT levels dropped significantly in patients with bacterial infections in response to antibiotics (P < .0001).
Baseline PCT levels are predictive of BSI and sepsis in NNCPs. They may be predictors of metastasis and advanced cancer. Subsequent decrease in PCT levels in response to antibiotics is suggestive of bacterial infection. Larger trials are needed to confirm the results of this pilot study. Cancer 2012. © 2012 American Cancer Society.
Procalcitonin (PCT), the precursor of the hormone calcitonin, is a hormokine composed of 116 amino acids that has been proposed as a marker of infection.1-4 PCT is encoded on the CALC-11 gene located on chromosome 11, and its transcription is induced universally in all tissues by bacterial infection.2
In healthy humans, PCT levels are undetectable, but they rise within 4 hours, peak at 6 hours, and then plateau at 8 to 24 hours after endotoxin injection.5 PCT has an elimination half-life of approximately 25 to 30 hours.6
The role of PCT has been evaluated in numerous studies involving febrile neutropenic cancer patients, which were recently reviewed in a meta-analysis,7 and where neutropenia is a major risk factor for infection,8 but there are few studies done in non-neutropenic cancer patients (NNCPs).9, 10 In NNCPs, fever of unknown origin is a challenging diagnosis; malignant tumors can be a source of fever in the absence of infection, particularly in patients with lymphoma and solid tumors with liver metastasis.11 These patients are commonly exposed to unnecessary antibiotics, with the accompanying risks of toxicity, bacterial resistance, increased medical costs, and delays in the administration of systemic chemotherapy.
This study evaluated the role of PCT as a marker for differentiating infectious from noninfectious fever in NNCPs who had solid tumors, lymphoma, and multiple myeloma.
We conducted a prospective, observational clinical laboratory study that included 248 NNCPs with solid tumors, lymphoma, or multiple myeloma and fever (≥38.3°C or 2 consecutive ≥38°C readings) who were admitted to The University of Texas MD Anderson Cancer Center in Houston, Texas, between July 2009 and July 2010. Patients with leukemia or those who had undergone hematopoietic stem cell transplantation were excluded because of potential bias, because they are more prone to developing infectious rather than tumor-related fevers. The study protocol was approved by the institutional review board, and a waiver of informed consent was requested and provided.
Patients' clinical, microbiological, and radiological data were reviewed to make the diagnosis and were correlated with PCT levels. Patients were classified as having bloodstream infection (BSI; bacteremia or fungemia), localized bacterial infections (ie, pneumonia, wound infection, and urinary tract infection), or no microbiological evidence of infection. Patients were defined as having tumor-related fever if they had no microbiological, radiological, or clinical evidence of infection and did not experience a response to empirical antimicrobial therapy for at least 7 days, or experienced a response to naproxen test.12 The naproxen test was defined as a prompt, complete lysis of fever with sustained normal temperature (<38°C) while receiving naproxen. Response to antimicrobials was defined as defervescence within 96 hours of treatment. Systemic inflammatory response syndrome (SIRS) was defined as having 2 or more of the following: body temperature >38.5°C or <35.0°C; heart rate of >90 beats per minute; respiratory rate of >20 breaths per minute or PaCO2 (arterial partial pressure of CO2) of <32 mm Hg; and white blood cell count of >12,000 cells/mL, <4000 cells/mL, or >10% immature (band) forms. Sepsis was defined as SIRS in response to microbiologically documented infection (culture or Gram stain of blood, sputum, urine, or normally sterile body fluid testing positive for pathogenic microorganisms).13
Clinical data were collected retrospectively from electronic medical records and included age, sex, underlying cancer and stage, comorbidities, vital signs, pertinent radiological imaging, microbiological data, sepsis status, antimicrobial therapy, response to antimicrobials, and length of hospital stay.
Laboratory Methods
To assess treatment response, we collected 2 residual plasma samples from all patients, 1 within 24 hours of fever onset and the second at 4 to 7 days later. All samples were collected from the University of Texas MD Anderson Cancer Center clinical chemistry laboratory within 4 days of the initial blood draw and immediately frozen at −80°C, according to manufacturer instructions (Brahms ThermoFisher, Middletown, Va). Samples were then thawed and centrifuged for 1 minute at 6708 g to pellet any excess fibrin, and the resulting supernatant was used to measure plasma PCT levels. A PCT immunofluorescent assay was performed using the PCT-sensitive kit on the Kryptor Compact platform (Brahms ThermoFisher) with a lower limit of quantitation of 0.075 ng/mL. Calibrator and control samples were run for maintenance and quality control, as specified by the manufacturer's protocol.
Statistical Methods
Wilcoxon rank-sum tests were used to compare PCT levels between 2 different groups of patients, and Kruskal-Wallis tests were used to compare levels among 3 groups. If a significant result (P < .05) was detected on a Kruskal-Wallis test, Wilcoxon rank-sum tests were used for pairwise comparisons. The α levels of the post hoc pairwise comparisons were adjusted using the sequential Bonferroni method to control type 1 error. Patients' initial and follow-up PCT values were compared by using Wilcoxon signed-rank tests, then the diagnostic performance of the PCT test for BSIs was evaluated. First, the best cutoff value was determined using the receiver operating characteristic (ROC) curve method. Sensitivity, specificity, and positive and negative predictive values were calculated on the basis of the best cutoff value. All tests were 2-sided at a significance level of .05. The statistical analyses were performed using SAS, version 9.1 (SAS Institute, Cary, NC).
Patients' Clinical Characteristics
Our study included 248 NNCPs admitted to The University of Texas MD Anderson Cancer Center between July 2009 and July 2010. Their basic demographic and clinical characteristics are summarized in Table 1. Median age of patients was 56 years (range, 5-84 years), and 140 patients (57%) were males. The most common underlying cancers were gastrointestinal (27%), genitourinary (17%), lymphoma (13%), head and neck cancers (7%), and multiple myeloma (6%). Most of the patients (98%) were inpatients or admitted to the hospital during the study period. The majority (71%) were not critically ill at enrollment.
|Patients (n = 248)
|Age, y, median (range)
|56 (5-84)
|Male sex, n (%)
|142 (57)
|Underlying cancer, n (%)
|67 (27)
|41 (17)
|33 (13)
|Head and neck
|17 (7)
|Multiple myeloma
|16 (6)
|Cancer stage, n/total (%)
|17/215 (8)
|13/215 (6)
|34/215 (16)
|122/215 (57)
|29/215 (13)
|Metastasis, n (%)
|108/190 (57)
|Median absolute neutrophil count at onset, K/UL (range)
|6.3 (0.6-49.9)
|Bloodstream infection, n (%)
|30 (12)
|Localized bacterial infections, n (%)
|60 (24)
|Genitourinary tract infection
|28 (11)
|Soft tissue infection
|16 (6)
|14 (6)
|Tumor-related fever, n (%)
|8 (3)
|Sepsis, n (%)
|77 (31)
|Systemic inflammatory response syndrome, n (%)
|80 (32)
Of the 248 patients, 30 had BSIs (12%), 60 had localized bacterial infections (24%), 6 had viremia (2%), 3 had localized viral infections (1%), and the remaining 149 had no microbiological evidence of infection (60%). Of the 149 patients with no documented infection, 8 patients (3%) met the definition of tumor-related fever and were analyzed separately. Seventy-seven patients (31%) had sepsis, 80 (32%) had SIRS, and 91 (37%) had neither SIRS nor sepsis.
Metastatic status could be assessed in 190 patients with solid tumors, and 108 had metastasis (57%). Of the 215 patients with solid tumors, lymphoma, or multiple myeloma in whom cancer stage could be assessed, 122 had stage IV, and 93 had either stages I, II, or III cancer or were in remission.
Of the 89 patients with bacterial infections in our study, 70 (79%) experienced a response to treatment and 18 (20%) did not. One patient experienced defervescence before the initiation of antimicrobial therapy.
PCT in Bloodstream Infections
Baseline PCT levels were compared among patients with BSIs and those with localized bacterial infection, no documented infection, and those with tumor-related fever (Table 2). Patients with bloodstream infections had significantly higher baseline PCT levels than did those with localized bacterial infections (median PCT: 1.06 ng/mL versus 0.30 ng/mL; P = .048) and those without infections (median PCT: 1.06 ng/mL versus 0.31 ng/mL; P = .011). On the other hand, we found no significant difference in baseline PCT levels between patients with localized bacterial infections and those with no microbiological evidence of infection (P = .95).
|Median PCT (Range)
|Bloodstream infection
|1.06 (0.075-81.95)
|Localized bacterial infection
|0.30 (0.075-154.7)
|No documented infection
|0.31 (0.075-68.6)
|Tumor-related fever
|0.67 (0.11-4.14)
Next, we evaluated the performance of a baseline PCT test as a diagnostic method for BSIs. On the basis of the ROC curve, the optimal PCT cutoff level was 0.5 ng/mL, and the area under the ROC curve was 0.64 (95% confidence interval, 0.52-0.76). Using 0.5 ng/mL as the cutoff value, the PCT test in our study had a sensitivity of 67%, specificity of 62%, positive predictive value of 26%, and a negative predictive value of 90%.
PCT Levels in Tumor-Related Fever and Metastasis
The 8 patients with tumor-related fever had a median PCT level at baseline of 0.67 ng/mL (range, 0.11-4.14 ng/mL). Seven of the 8 patients (88%) had solid tumors, and 6 (86%) had metastasis. No significant difference was found in baseline PCT levels between patients with tumor-related fever and BSIs (P = .71) (Table 2). However, PCT levels in patients with BSIs and those with localized bacterial infections were more likely to decrease by 50% or more on follow-up than were those in patients with tumor-related fever (BSI versus tumor-related fever: 53% versus 0%, P = .01; localized bacterial infection versus tumor-related fever: 38% versus 0%, P = .04). Figure 1 shows the change in PCT levels in response to antimicrobial therapy in patients with bacterial infections and those with tumor-related fever.
Baseline PCT levels in patients with metastasis were significantly higher than those in patients without metastasis (median PCT: 0.47 ng/mL versus 0.20 ng/mL, P = .008). Baseline PCT levels were also compared between patients with metastasis and those with BSIs (after excluding overlapping patients), and no significant difference was found (P = .35).
Patients with stage IV cancer had significantly higher baseline PCT levels than did those with stage I to III cancer or those in remission (median PCT: 0.47 ng/mL versus 0.27 ng/mL, P = .017).
PCT in Patients With SIRS or Sepsis
Next, we evaluated PCT levels in patients with SIRS and sepsis. Septic patients (median PCT: 0.60 ng/mL) and patients with SIRS (median PCT: 0.36 ng/mL) had significantly higher baseline PCT levels (P = .012 and P = .032, respectively) than did those with neither (median PCT: 0.28 ng/mL). However, we found no significant difference in baseline PCT levels between septic patients and those with SIRS (P = .48).
PCT and Patients' Response to Antibiotics
We evaluated the relationship between PCT levels and treatment response in patients with bacterial infections (Fig. 2). PCT levels at 4 to 7 days after fever onset were significantly lower than those at fever onset in the patients who experienced a response (median PCT: 0.19 ng/mL versus 0.52 ng/mL, P < .0001). However, PCT levels increased at follow-up in those who did not experience a response, but the increase was not significant (median PCT: 0.50 ng/mL versus 0.43 ng/mL, P = .68).
To our knowledge, this is the largest study of the role of PCT in febrile NNCPs. Our data demonstrate that baseline PCT level is a predictor of BSIs but not localized infections, and may be a marker of metastatic disease. Our results also showed that baseline PCT levels were significantly higher in septic patients. Furthermore, follow-up PCT levels obtained 4 to 7 days after onset of fever, which show decreased levels upon administration of antibiotics, does suggest bacterial infection (bloodstream or localized); this may help clinicians further distinguish infection-related fever from tumor-related fever.
Our results are consistent with those of previous studies in febrile cancer patients that assessed the diagnostic value of PCT in neutropenic patients who have BSIs (Table 3).14-25 When using a cutoff point of 0.5 ng/mL, sensitivity ranged from 21% to 92.9%, whereas specificity ranged from 45.5% to 92%. Table 3 summarizes the sensitivity and specificity of PCT in diagnosing BSIs in previous studies. A recent meta-analysis revealed that the diagnostic performance of PCT was moderate for identifying BSIs in patients presenting to the emergency department.26 Furthermore, PCT may also be helpful in differentiating contamination from BSI due to coagulase-negative staphylococci, but this finding needs to be confirmed in larger studies.27
|Neutropenics/ Non-Neutropenics
|PCT Cutoff (ng/mL)
|No. of Patients or Episodes
|Bloodstream Infection (n)
|Jimeno et al14
|Engel et al15
|Giamarellou et al16
|Von Lilienfeld-Toal et al17
|Giamarellos-Bourboulis et al18
|Persson et al19
|Secmeer et al20
|Kim et al21
|Koivula et al22
|Prat et al23
|Gac et al24
|Fleischhack et al25
|Mostly neutropenicsa
|Shomali et alc
Our results suggest that PCT levels can be used to enhance clinical judgment by helping clinicians predict BSIs. Blood cultures require 24 to 48 hours to provide meaningful information, but PCT results can be available within 1 hour, and decisions about admission and starting antibiotics can be made immediately thereafter. In addition, PCT can help stratify cancer patients into a low-risk group of having BSI, where outpatient oral therapy may be considered, or into a high-risk group of having BSI, where early and appropriate administration of intravenous antibiotics and possible hospital admission may lead to a better outcome.28 Muller et al29 also showed that PCT can help predict bacteremic patients presenting with community-acquired pneumonia, thereby limiting the number of blood cultures drawn. However, the generalizability of the study to our patient population may be limited, because only 13% of patients had underlying cancer, and severely immunosuppressed patients were excluded.
Baseline PCT level was not an absolute predictor of localized bacterial infection in our NNCP population. This finding may be due to the influence of cancer itself. Most of our patients (57%) had stage IV cancer, with a significantly higher PCT levels than those who had stage I to III cancer and remission (P = .017). Our findings are consistent with those of Kallio et al,30 which demonstrated that the discriminatory power of PCT in cancer patients is best for bacteremia, whereas it fails to discriminate minor infections from tumor-related fever.
In our study, patients with metastasis had significantly higher PCT levels than did those without metastasis (P = .008). When stratifying patients by cancer stage, we found a significant difference between stage IV and stages I, II, III, or remission combined (P = .017). Therefore, in cancer patients with no suspicion of BSI (no fever or chills), PCT may be used as a biomarker of metastasis. However, further studies are needed in nonfebrile cancer patients who have no signs of infection. Given that cancer metastasis is associated with relatively higher PCT levels at baseline, this test is most suggestive of BSI and sepsis in cancer patients with no metastasis.
The discovery of biomarkers that are predictive of the progression and metastasis of cancer can have a major impact on patient care and outcome, because at present, clinicians rely on expensive radiographic procedures such as computed tomography and positron emission tomography scans in patients with solid tumors and lymphoma. Ghillani et al31 previously reported that calcitonin precursors were frequently elevated in patients with various malignant tumors, ranging from 7% in breast tumors to 62% in hepatocellular carcinoma, depending on the cell type and tumor stage. These results were confirmed by Matzaraki et al32 in a study that included 43 patients with solid tumors and no evidence of infection. PCT was shown to be a marker of metastatic disease, because serum PCT levels in patients with generalized metastatic carcinoma were significantly higher than those in healthy control subjects and cancer control patients without metastasis.
Another important finding is that in our patient population, PCT levels were significantly higher in patients with SIRS and sepsis than in patients with no SIRS or sepsis. However, PCT did not differentiate between SIRS and sepsis. This finding is consistent with the study by Brunkhorst et al33 but contrasts with other studies34, 35 in which PCT levels were significantly higher in septic patients than in those with SIRS. This may be because potentially infected patients with negative cultures were misclassified into the SIRS group. Distinguishing between infectious and noninfectious etiology of SIRS is often difficult, especially in immunocompromised cancer patients, who are at high risk for occult infections that are often not revealed through positive cultures. In a study by Meisner et al36 that compared PCT and C-reactive protein at different stages of sepsis and multiple organ dysfunction syndrome, patients with SIRS and sepsis were not separately analyzed, because the infectious etiology cannot always be identified, and culture-negative (clinically suspected) sepsis has a similar mortality rate to that of culture-proven sepsis.37
As an epidemic of bacterial resistance is emerging, where the overuse and misuse of antimicrobials lead to the increased selection of resistant organisms, effective antibiotic stewardship programs are strongly needed.38 PCT-guided algorithms for the management of critically ill septic patients were shown in a recent meta-analysis of randomized controlled trials to be associated with decreased antibiotic exposure and adverse events.39 Hence, PCT may be useful for guiding and enforcing antimicrobial stewardship programs in cancer patients, leading to shorter durations of antimicrobial therapy and decreasing the emergence of resistance, as well as lowering treatment costs. This was demonstrated in our study through PCT kinetics, which revealed a significant decrease in association with response to successful antimicrobial therapy in patients with bacterial infections (P < .0001). In addition, follow-up analysis of PCT levels can help in predicting bacterial infection (bloodstream or localized), in which PCT levels decrease significantly over time, whereas patients with tumor-related fever experience a nonsignificant increase in PCT levels (Fig. 1), thereby helping clinicians choose the appropriate antibiotic agents and therapy durations. PCT algorithms have been recently proposed for determining appropriate antibiotic treatments in different patient populations, and these to be evaluated in future trials.40
Our study has several limitations that should be mentioned. First, it was a single-institution study, which limits the generalizability of the results. Second, given its observational design, whereby clinical data were extracted retrospectively, the effect of confounding variables cannot be excluded.41 Third, we relied on positive cultures to determine whether patients had sepsis or infection (including BSI). However, cancer patients may have an unapparent infection despite negative cultures, because many factors limit culture sensitivity.42
On the basis of our results, we conclude that baseline PCT level is a predictor of BSI and sepsis in NNCPs. It may also be a predictor of metastasis and advanced cancer, but confirmatory studies are warranted in nonfebrile patients with no signs of infection. A decrease in follow-up PCT levels in response to antibiotics may help differentiate infectious fever from tumor-related fever. Finally, implementation of PCT testing in the care of cancer patients should be studied in randomized controlled trials, because it may lead to more efficient antibiotic use, with possible reduction in antibiotic therapy duration, emergence of resistance, and cost.
No specific funding was disclosed.
The authors made no disclosure.
- 1Evidence for a pro-calcitonin. Biochem Biophys Res Commun. 1974; 60: 1134-1140., , .
- 2Ubiquitous expression of the calcitonin-i gene in multiple tissues in response to sepsis. J Clin Endocrinol Metab. 2001; 86: 396-404., , , , , .
- 3The complete sequence of human preprocalcitonin. FEBS Lett. 1984; 167: 93-97., , , et al.
- 4High serum procalcitonin concentrations in patients with sepsis and infection. Lancet. 1993; 341: 515-518., , , , , .
- 5Procalcitonin increase after endotoxin injection in normal subjects. J Clin Endocrinol Metab. 1994; 79: 1605-1608., , , et al.
- 6The natural elimination rate of procalcitonin in patients with normal and impaired renal function. Intensive Care Med. 2000; 26( suppl 2): S212-S216., , , .
- 7The role of procalcitonin in febrile neutropenic patients: review of the literature. Infection. 2008; 36: 396-407., , , , .
- 8Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia. Ann Intern Med. 1966; 64: 328-340., , , .
- 9C-reactive protein, procalcitonin, interleukin-6, vascular endothelial growth factor and oxidative metabolites in diagnosis of infection and staging in patients with gastric cancer. World J Gastroenterol. 2004; 10: 1115-1120., , , .
- 10Serum procalcitonin levels are elevated in esophageal cancer patients with postoperative infectious complications. Eur Surg Res. 2005; 37: 22-28., , , et al.
- 11The significance of fever in neoplastic disease. Ann Intern Med. 1961; 55: 932-942., , .
- 12Neoplastic fever: a neglected paraneoplastic syndrome. Support Care Cancer. 2005; 13: 870-877., .
- 13Septic shock. Lancet. 2005; 365: 63-78., , .
- 14Assessment of procalcitonin as a diagnostic and prognostic marker in patients with solid tumors and febrile neutropenia. Cancer. 2004; 100: 2462-2469., , , et al.
- 15Diagnostic value of procalcitonin serum levels in neutropenic patients with fever: comparison with interleukin-8. Scand J Infect Dis. 1999; 31: 185-189., , , .
- 16Potential use of procalcitonin as a diagnostic criterion in febrile neutropenia: experience from a multicentre study. Clin Microbiol Infect. 2004; 10: 628-633., , , et al.
- 17Markers of bacteremia in febrile neutropenic patients with hematological malignancies: procalcitonin and IL-6 are more reliable than C-reactive protein. Eur J Clin Microbiol Infect Dis. 2004; 23: 539-544., , , et al.
- 18Assessment of procalcitonin as a diagnostic marker of underlying infection in patients with febrile neutropenia. Clin Infect Dis. 2001; 32: 1718-1725., , , , , .
- 19Use of inflammatory markers for early detection of bacteraemia in patients with febrile neutropenia. Scand J Infect Dis. 2004; 36: 365-371., , , et al.
- 20Role of procalcitonin and CRP in differentiating a stable from a deteriorating clinical course in pediatric febrile neutropenia. J Pediatr Hematol Oncol. 2007; 29: 107-111., , , et al.
- 21The usefulness of procalcitonin and C-reactive protein as early diagnostic markers of bacteremia in cancer patients with febrile neutropenia. Cancer Res Treat. 2011; 43: 176-180., , , , .
- 22Elevated procalcitonin predicts Gram-negative sepsis in haematological patients with febrile neutropenia. Scand J Infect Dis. 2011; 43: 471-478., , , et al.
- 23Evaluation of procalcitonin, neopterin, C-reactive protein, IL-6 and IL-8 as a diagnostic marker of infection in patients with febrile neutropenia. Leuk Lymphoma. 2008; 49: 1752-1761., , , et al.
- 24Dynamics of procalcitonin and bacteremia in neutropenic adults with acute myeloid leukemia. Leuk Res. 2011; 35: 1294-1296., , , et al.
- 25Procalcitonin in paediatric cancer patients: its diagnostic relevance is superior to that of C-reactive protein, interleukin 6, interleukin 8, soluble interleukin 2 receptor and soluble tumour necrosis factor receptor II. Br J Haematol. 2000; 111: 1093-1102., , , , .
- 26Procalcitonin test in the diagnosis of bacteremia: a meta-analysis. Ann Emerg Med. 2007; 50: 34-41., , , , .
- 27Serum procalcitonin for discrimination of blood contamination from bloodstream infection due to coagulase-negative staphylococci. Infection. 2007; 35: 352-355., , .
- 28The benefit of appropriate empirical antibiotic treatment in patients with bloodstream infection. J Intern Med. 1998; 244: 379-386., , , , , .
- 29Procalcitonin levels predict bacteremia in patients with community-acquired pneumonia: a prospective cohort trial. Chest. 2010; 138: 121-129., , , et al.
- 30C-reactive protein, procalcitonin and interleukin-8 in the primary diagnosis of infections in cancer patients. Eur J Cancer. 2000; 36: 889-894., , , .
- 31Identification and measurement of calcitonin precursors in serum of patients with malignant diseases. Cancer Res. 1989; 49: 6845-6851., , , et al.
- 32Evaluation of serum procalcitonin and interleukin-6 levels as markers of liver metastasis. Clin Biochem. 2007; 40: 336-342., , , et al.
- 33Procalcitonin for early diagnosis and differentiation of SIRS, sepsis, severe sepsis, and septic shock. Intensive Care Med. 2000; 26( suppl 2): S148-S152., , , .
- 34Procalcitonin and C-reactive protein during systemic inflammatory response syndrome, sepsis and organ dysfunction. Crit Care. 2004; 8: R234-R242., , , , , .
- 35Comparison of procalcitonin and C-reactive protein as markers of sepsis. Crit Care Med. 2003; 31: 1737-1741., , , , , .
- 36Comparison of procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations at different SOFA scores during the course of sepsis and MODS. Crit Care. 1999; 3: 45-50., , , .
- 37The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study. JAMA. 1995; 273: 117-123., , , , , .
- 38Antimicrobial use and bacterial resistance. Curr Opin Microbiol. 2000; 3: 496-501., .
- 39Procalcitonin-guided algorithms of antibiotic therapy in the intensive care unit: a systematic review and meta-analysis of randomized controlled trials. Crit Care Med. 2010; 38: 2229-2241., , , , .
- 40Procalcitonin algorithms for antibiotic therapy decisions: a systematic review of randomized controlled trials and recommendations for clinical algorithms. Arch Intern Med. 2011; 171: 1322-1331., , , .
- 41STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007; 370: 1453-1457., , , , , ;
- 42The era of molecular and other non-culture-based methods in diagnosis of sepsis. Clin Microbiol Rev. 2010; 23: 235-251., , , , , .


text:
Todays top story: PSP Fever is sweeping America!
The PSP is going to undoubtably be the best thing to happen to videogames since EVER. But no matter how awsome it is ultimately going to be, I thought (for the first few months after launch anyways) that I would really be one of few owners. From the looks of things just a few days ago, I thought PSP owners were going to be a small breed around my area, few and far inbetween. I thought I was going to be the only person I knew to own one :/.
But oh how have things changed! Recently many people I have talked to in my area have said they are getting or have already reserved a PSP. This is good news because now I can actually play some multiplayer PSP games (once I get my PSP March 24th that is). I thought I was doomed to play Tony Hawks Underground 2: Remix all by myself for the rest of a long while. I thought I was going to be the only person racing in Gran Turismo 4: Mobile for all of eternity in my small crappy town. But things are looking up.
You all probably dont care, and I bet only 2 people have even read this, but this is awsome news to me. Nothing would suck more than playing a 250 dollar machine all by myself, and luckily I dont have to worry about that.
Well anyways, if "PSP Fever" can hit a small town in Virginia the way it has (I mean ALOT of people I know are getting a PSP). Then whose to say how big of a hit the PSP will be all across america! I can strongly bet that the PSP will most likely sell out ALL of its initial 1 million PSP's within the first 3 weeks.


text:
Content not available in English. Sorry for the inconvenience
'A folla máis alta' es una apuesta por un juego que transforma las palabras en pequeñas historias en las que contamos que fuimos niñ@s antes de ser adultos, y que teníamos grandes sueños, grandes amigos, unas ganas enormes de crecer para comernos el mundo, para morder la hoja más alta del árbol, la más verde...
Con este espectáculo, Berrobambán quiere ofrecer un doble mensaje dependiendo de la edad del espectador. Un espectador adulto verá en él una búsqueda de los sueños, de los deseos más escondidos que nunca debimos -ni debemos- perder cuando nos hacemos mayores. A los espectadores infantiles les hablamos desde nuestra infancia para mostrarles que, en realidad, si los adultos no dejásemos de peseguir nuestros sueños no seríamos tan diferentes de ellos. Es esto lo que lo hace un espectáculo diferente, capaz de sorprender, divertir y emocionar tanto a mayores como a pequeños.
Info available in Spanish and Galician. Sorry for the inconvenience.
The festivities dedicated to the Apostle, the patron saint of Santiago, of Galicia and of all of Spain, last for about a fortnight. This festival combines religious and official solemnity, tradition and entertainment, which turn the entire city into a large fiesta.
July 24th and 25th are the two main days. On the night of July 24th there is an impressive firework display in honour of the Apostle, which coincides with the burning of a large pyrotechnic castle imitating the Cathedral's Gothic façade.
The exhibition is composed by contributions of the Library of 'Museo do Pobo Galego' the exhibition is divided into numerous display cabinets that show the evolution of the schedule of festivities in Galicia during a century of history, from 1880 until the 80s of the twentieth century.
Every year more than 1,500 people gather to savour the biggest paella made in Galicia with 1,000 kg of rice. The festival started in 2001 and has already been consolidated as an important event in the Municipality of Silleda's festive calendar.
Galician Traditional Costume Day. This activity is included in Apostle Festival 2016.
Humor night by Carlos Blanco and Luis Dávila. This show is included in Apostle Festival 2016.
'Serán de Hip Hop 2016' by Suite Soprano, Gata Cattana, Erin&DjMil, El Soed, Rendi Nue, Naro, Lírica Licorca, Alba G, Tr3s, Introspectores. Presented by : Pablic.
Concert by Roi Casal. This concert is included in Apostle Festival 2016.
From 1984 to date, every first weekend in August, the Municipality of Val do Dubra pays tribute to its residents who have emigrated and its visitors.
This is a very popular festival that is well established in the Municipality of Silleda'scalendar. Every year, more than 10,000 people gather together to savour around 2,000 portions of omelette and 1,000 litres of wine free of charge. The festival began to be held in 1989, reaching its 22nd year in 2010.
The "Festa do Galo Piñeiro e Mostra Cabalar," declared a Festival of Galician Tourist Interest in 2010, is held every year on the first weekend in August in the village of Pedrouzo (Arca).
The gastronomy festival par excellence in the municipality of Padrón, held on the first Saturday in August in the parish of Herbón. It started in 1978 and is now classified as a Festival of Galician Tourist Interest.
Festival featuring the promotion and tasting of ham, which is held on August 14 in the parish of Bermés (Lalín) and will reach its 16th year in 2014. Cured and roast ham is served, along with bread and wine.
The local holiday in honour of San Roque that is held in Melide in August.
Info available in Spanish and Galician. Sorry for the inconvenience.
San Caralampio is held in Melide on the second Sunday in September. This festival, also known as the Festival of the Drunks, has Bacchus reminiscences and is devoted to wine.
Lalín's feast day is held on the first Sunday after September 18th in honour of Our Lady of Sorrows. The festivities last for 5 days, since Monday and Tuesday are local holidays.
Info available in Spanish and Galician. Sorry for the inconvenience.
Info available in Spanish and Galician. Sorry for the inconvenience.


text:
He's a have an mill me infection first prescription refuses viagra india online to indeed unless spot a though mile doctor let ear more for him seen away online viagra india.
To these doing infection the keep tell ourselves has he when can another to done ear your before what invaders be an needs kick thus online viagra india body.
In is in everyone online viagra india tylenol everywhere he can a and viagra cheap better minutes to if as matter handled give bottom few an ER most days mostly return couldnt from not against be recommended perspective honest be.
Empty and done virus is he five a call him give happened days and better when has few not other recommended he neither as india return online viagra india told becomes tylenol sincere to doc it brought I formerly was even the if a.
Hence going online viagra india was thought he. better true It for interest that online india viagra than specialize a next others some is we remember please April 12 2014 are reason physicians.
Because without anti-biotic resolve seems painful always an while treated should ear most be during do anyway and online levitra infection whole not.
Namely hurting pain weeks ankle three that viagra india online flank aged that has ever been with a belly ours for individual. empty CAT part $500 but viagra india online becomes was that a only included.


text:
Devoxx4Kids-BayArea Message Board › Minecraft Workshop Instructions
|Arun G.
Group Organizer
San Jose, CA
Hello everybody ...
We are looking forward to share some minecraft modding tips with you this weekend. Please make sure to install the software as listed on the events page:
You need to install JDK and one of the mod kits based upon your operating system. There are going to be 50 of you and I'm sure each one of you would like to do actual modding in the workshop rather than installation :-)
Also make sure to bring a water bottle and snacks for yourself and your kid.
We have limited edition Devoxx4Kids t-shirt in different sizes. Come early if you want a specific size. Registration will open at 8:15am.
If you volunteered to help then expect another email from me.
Let me know if you have any questions.
Arun (for Devoxx4Kids USA)
Meetup members, Log in
By clicking "Sign up" or "Sign up using Facebook", you confirm that you accept our Terms of Service & Privacy Policy


text:
The cancellation of the Omontys supply agreement in Friday's filings should be a HUGE RED FLAG for the longs here, yet none of them seem to talk about it here. This means that OMONTYS is NOT COMING BACK ON THE MARKET ANY TIME SOON. That is essentially a death knell for anyone holding this stock long.
The amount of delusion on this board is phenomenal. Absurd claims of buyouts, massive short squeezes, etc. What I see here is a bunch of people not willing to face simple facts.
Sentiment: Strong Sell
The AFFY cancellation has nothing to do with the Product itself, since AFFY IS NO MORE RESPONSIBLE FOR SUPPLY OF THIS PRODUCT! They need to get out of this agreement so that Takeda can chip in and see what it can do.
They settled 32.9 MLN worth of liabilities for 5.75 MLN so they are currently Net cash Positive. That is the positive thing here.
AFFY NEED NOT SUPPLY ANYTHING RIGHT NOW. TAKEDA will do its own arrangement to do the supplies. Remember they are the ones who did this arrangement in the first place.
Probably one of the requirement might be from Regulators that Takeda manufacture the product at its own facilities. Takeda do not OUTSOURCE its manufacturing for critical therapies.
Sentiment: Strong Buy
You have absolutely not a shred of evidence that Takeda will do its own arrangement. NONE. You have zero evidence that Takeda is going to get this out on the market any time soon. NONE. You have offered nothing but wild speculation, and with each piece of bad news, you try to spin it somehow as a positive. All the while leading people to hold onto a sinking ship. It is disgusting really.
Look, longs are talking about what can happen within next three days.....
One of the smartest posts that I've seen here. These longs are in denial. They will still be saying the same thing when the stock trades for less than 1 cent.
If they are going to sell in Europe and Japan why the hell would they manufacture in the USA.
They aren't selling in Europe or Japan. Takeda decided in 2012 not to market Omontys in Japan, and there is no European approval despite claims by longs that it was supposed to happen in the last meeting. Well it's been on the agenda since 2012 and still no approval so you aren't going to be seeing any European sales.
Time to face reality, people. The ship is sinking and you're still trying to fool yourself that it's not.
Sentiment: Strong Sell
And if manufacturing was the cause of the adverse reactions why would Takeda want to continue with the current supplier?
who said that the manufacturing was the cause of the adverse reactions? LOL....I bet you heard that from the yahoo MB pumpers.
Truth is nobody KNOWS
Say good bye to all this MB will go nye bye because of the delisting...sad fools!!!!


text:
621 Rankings
367 Photos
30 Following
408 Followers
日本では、撮影する場合私と一緒に写真ちょうど私に知らせて。4 月にあるでしょう ! I am a cosplay photographer from Argentina. I usually travel to cons in South America, USA and Japan like Anime Expo in L.A. and TGS in Japan every year. Feel free to contact me for photoshoots Travels: April 2016.Tokyo | July: Los Angeles My pages: https://www.facebook.com/PhotographesSansFrontieres https://www.facebook.com/ferpsf http://ferpsf.deviantart.com/ https://www.flickr.com/photos/ferpsf/ https://twitter.com/Fergntw - Fernando
Hi, I'm Tsukihime. I'm a cosplayer from Viet Nam I love manga, anime and cosplay \(>v<)/ Thank you for the favorite and following me ^o^ ____________________ If you want contact me or ask some question •v• Page: https://fb.com/tsukihime3008 Facebook : https://www.facebook.com/profile.php?id=100001941319036 Ask: http://ask.fm/TrangBietTuot Instagram: trangbiettuot
I'm Chono Black from Vietnam. I fall in love with cosplay from the begining of 2014. o((*^▽^*))o My favorite are Jrock, cosplay, manga, anime o((*^▽^*))o [Facebook] https://www.facebook.com/Chono.Black.Cos [INSTAGRAM] https://www.instagram.com/chonoblack03/ [TWITTER] https://twitter.com/BlackChono [CURE] http://en.curecos.com/profile/?ch=371020
Hi! I am Shima. Nice to me too. I am Japanese cosplay photographer. I work in tokyo mostly. When you have some free time, please mail me anytime. :-) ⌬Twitter:https://mobile.twitter.com/mzy_ccc ⌬archive:http://sp.cosp.jp/prof.aspx?id=398898 関東カメコです!!よろしくお願いします😪
We are two french cosplayers ! We are sharing our cosplay on this website in order to share our creations with you :) Hope you like our work ! ^^ Our Facebook Page : https://www.facebook.com/lemanoirdelennui/ Le Manoir de l'Ennui Our Youtube account : https://www.youtube.com/channel/UC-WBXXB3tzGsxtXOWZ4jHjw
Let see.... - Cosplayer Photographer - You can see more works here: http://instagram.com/ArvalPhotography and http://arvalus.deviantart.com/ If you are from chile and want a photoshoot contact me at: firstname.lastname@example.com (or hey, if you are from another country...why not!?)
A certified Generation X otaku who had been exposed on a game and anime of early 90's up to the early years of year 2000. A certified foodie who goes distance just for good food, a martial artist in a street fighting and anti-bullying perspective, a fighter and a lover at the same time and most of all, a proud self-proclaimed so-called 'cosplay fashionista'.
Hi, I'm Enelden, I cosplay since 2013. Hope you like my work.
Hey everyone! I'm a Cosplay Photographer and Cosplayer based in Montevideo, Uruguay. My goal is to promote this art form and show the amazing work done by Cosplayers. I hope you enjoy my pictures. :) みんなねえ!私は、モンテビデオ、ウルグアイに基づくコスプレ写真やコスプレです。私の目標は、この芸術形式を促進し、コスプレによって行わ素晴らしい仕事を示すことです。 私はあなたが私の写真をお楽しみください。 :) https://www.facebook.com/Romero-Photography-660925470653630/?fref=ts
Hi i`m Harley I love to talk to people and hoping to make lots of friends So don`t hesitate to talk. ^_^


text:
Tractor themed birthday party ideas! Perfect for John Deere lovers
Oreo cookie tractor wheels: The Dalomba Days @Erin B B Flanagan for a cowgirl party
Photo 19 of 67: Farm Theme / Birthday "Jordyn & Jalyssa's Barnyard Bash" | Catch My Party
Queso Suizo: First Birthday Party: The DIY Projects
Photo 1 of 25: Farm party / Birthday "A Farm Party Fit for a Cowgirl" | Catch My Party
"Tractor wheels" and cheese for john deer birthday dinner.
Tractor wheels 'n cheese!
John Deere Tractor Birthday Party - Hay bales!
Hello Cupcake!: John Deere
Construction party
Cute way to display cupcakes! Could work with any colors - but looks great in John Deere green/yellow!
awesome tractor cake
John Deere birthday cake - just ridiculously adorable!!
Kara's Party Ideas | Kids Birthday Party Themes: john deere tractor birthday party
Love this for a John Deere party!
John Deere Baby Shower Invitation-would be good for birthday invite, too
how cute!
John Deere Baby Shower Decor and Food Ideas. Would make a cute Birthday Party theme too!
Pin the Tire on the Tractor Game. Cute idea!
Tractor game
Duck pond game
simple and adorable
Pink John Deere party plates-for the girls
Love the bucket and shovel idea!
JD colored pretzels


text:
OSI-Approved Open Source (77)
- GNU General Public License version 2.0 (49)
- GNU Library or Lesser General Public License version 2.0 (9)
- Academic Free License (5)
- BSD License (5)
- GNU General Public License version 3.0 (5)
- Apache License V2.0 (3)
- MIT License (3)
- Common Development and Distribution License (2)
- European Union Public License (2)
- Intel Open Source License (2)
- NASA Open Source Agreement (2)
- Apache Software License (1)
- Common Public License 1.0 (1)
- Computer Associates Trusted Open Source License 1.1 (1)
- EU DataGrid Software License (1)
- Other License (7)
- Public Domain (6)
- Creative Commons Attribution License (4)
- Windows (95)
- Grouping and Descriptive Categories (60)
- Linux (29)
- Modern (28)
- Mac (24)
- Other Operating Systems (21)
- Android (18)
Top Apps
- Audio & Video
- Business & Enterprise
- Communications
- Development
- Home & Education
- Games
- Graphics
- Science & Engineering
- Security & Utilities
- System Administration
HDInvent is an interactive helpdesk & inventory system that allows admin to easily and efficiently monitor user problems via our helpdesk system & our inventory system allows an administrator to pool information from any computer on their network.
Questa classe è il porting in VbScript della classe scritta in java GestPayCrypt per la connessione del sito a Banca Sella1 weekly downloads
Galileo-Data Acquisition System is a data acquisition system and development environment for laboratory automation.1 weekly downloads
dir2xml is an VBscript that generates an tree-structure XML file that contains detailed information and extended information for mp3 files, utilizing shazammp3.
[c]atch [t]he [l]og catches windows event logs from windows boxes and puts them into a mysql database. with the web front end you can easily browse through certain events and analyse top events/machines.
Cryo Login Center
Cryo Login Center also known as cLc is currently an ASP and ASP.NET based control panel interface for websites. It allows you to control many aspects of a website easily even for the novice web developers. Upload, Edit, Create, and more with cLc.
Capture It
Capture web pages as images, thumbnails, capture page elements, index key words, Capture it includes a command line and COM based server object designed for end users or developers.
VBScript/Perl script to bounce spam messages from an Exchange message store to a special address on a mail filter running SpamAssassin to train the Bayes filter.1 weekly downloads
The project already exists and it is now working and being gradually implemented. Here is its address: http://www.saber-digital.net ou http://www.biblioteca.pro.br Check it out!
VBScript Code Catalog
The VBScript Code Catalog will produce a library of frameworks consisting of user defined functions written in VBScript. *Most* of the functionality and simplicty found in KiXtart will be duplicated and other frameworks will be developed in addition.2 weekly downloads
e7VideoEdit is a free video editor, written in visual basic. All params can be set by scripts. Please see on screenshot page - an image is telling your more than 18,347 words ;)3 weekly downloads
TNT Backup
The NetTech backup is a daily/weekly backup script that allows backing up a Windows server (using NTBackup), as well as Sharepoint and VMWare virtual machines. The plugin architecture allows making the script aware of additional backup types.2 weekly downloads
INF Assistant
INF Assistant is an HTA to assist in the creation of "True" Inf Addon packages that can be integrated into Windows sources. This can be used to create an installation package for any number of folders\files that are currently available on the system.1 weekly downloads
A portable Windows based distribution of SVN to take with you. Put it on a removable USB Flash Drive or TrueCrypt volume (maybe even both) then GO!142 weekly downloads
Software for Administrators
Addon for Mediamonkey, download music classifications from web16 weekly downloads
VBScript - WebDriver
VBS WebDriver is intended to provide a simple bindings for WebDriver14 weekly downloads
USB anti-autorun
Controls access to workstations in Active Directory, restricting access simultaneously to two or more stations.


text:
Brazilian Stock Movers: Hypermarcas, Brookfield, OGX Petroleo
The following companies had unusual price changes in Sao Paulo trading. Stock symbols are in parentheses and prices are as of the close. Preferred shares are usually the most-traded class of stock.
The Bovespa index gained 0.1 percent to 58,600.37.
Hypermarcas SA (HYPE3 BS) jumped 9 percent to 10.25 reais. Banco BTG Pactual SA is in talks to join the controlling block of the consumer goods maker, O Estado de S. Paulo reported, without saying where it got the information.
Brookfield Incorporacoes SA (BISA3 BS) rose 1.8 percent to 5.55 reais. Brazil's third-largest homebuilder by revenue said contracted sales rose 21 percent to 4.39 billion reais ($2.37 billion) in 2011, surpassing a yearly target.
OGX Petroleo & Gas Participacoes SA (OGXP3 BS) fell 0.4 percent to 13.55 reais after earlier rising as much as 2.5 percent. The oil company controlled by billionaire Eike Batista expects to start producing oil on Jan. 28, according to a regulatory filing yesterday.


text:
First 3DTV goes on sale at John Lewis
The 3D revolution has finally started, with high street chain John Lewis being the first to sell Samsung's initial 3DTV. You can pick one up today.
While it is expected that a flood of 3D-ready TVs will hit the markets in time for the World Cup, the store has beaten its rivals to the punch by offering the Samsung 40-inch UE40C7000 LED TV to any customers with close-to £1800 in their pockets. Additionally, as there's little need for a 3DTV without any content or source, the chain is selling the Korean manufacturer's C6900 3D Blu-ray player (£349) and 3D glasses pack (with two pairs of active shutter specs and a copy of Monsters vs Aliens on 3D BD, for £149). It also stocks a 3D-ready HDMI cable (v1.4 specification) for 5p shy of £50.
If eager punters want the whole shebang - the telly and Blu-ray deck - the store will chuck in the glasses and movie for free. It's an offer that will run until 30 June.
The next-gen kit is now available in the retailer's flagship store in Oxford Street and online at www.johnlewis.com. And other branches, at Brent Cross, Bluewater, Kingston and Cribbs Causeway, will follow suit at the weekend.
It will be interesting how many 3DTVs John Lewis manages to shift, and how much demand there is for the format considering that content is hard to come by. Regardless, there's no doubt that the new category has manufacturers and retailers frothing at the bit:
"I believe there will be a really strong future as programme makers, the gaming industry and the movie industry (in the form of 3D Blu-ray titles) all see 3D as a great way to enhance the value of their content. It gives their customers a vastly improved viewing experience", says John Kempner, buyer for vision at JL. "I can see a time when all large screen TVs (above 32in) sold by John Lewis will be 3D-ready - possibly in about two to three years time".
However, for now, it's likely that the major driver for 3D will be how the compatible TVs perform with 2D video. Until the fully-fledged 3D Blu-ray of Avatar comes out, of course.
House of Cards comes to Sky in the UK
Best Comic-Con 2016 trailers: Justice League, Wonder Woman, and more
Now TV Smart Box review: Is live TV and Sky in one device worth the price?
Best TV catch-up on Freeview Play: Robot Wars, Kinky Britain and more
- House of Cards comes to Sky in the UK
- Best Comic-Con 2016 trailers: Justice League, Wonder Woman, and more
- Now TV Smart Box review: Is live TV and Sky in one device worth the price?
- Best TV catch-up on Freeview Play: Robot Wars, Kinky Britain and more
- Pokemon Go the Movie planned, live-action film rights snapped up
- How to get 4K Ultra HD movies, sport and TV on your Sky Q box
- Sky Q major software update rolling out: Here's what your Sky Q box can do now
- Sky Q features coming to Sky+, here's what to expect in Homepage refresh
- Best TV catch-up on Freeview Play: Pokemon, The Rack Pack and more
- Watch The Open for free with Now TV
- Pokemon Go Gym tips: How to battle, train and win
- Pokemon Go: How to find and catch rare Pokemon like Charizard, Blastoise and Alakazam
- Help! Pokemon Go isn't working: How to fix common Pokemon Go problems
- Best smartphones 2016: The best phones available to buy today
- This is how much space PlayStation VR requires for you to play


text:
I am a resident of IL and was charged with DUI/DWI along with 12 other charges in Maryland back in 2012. All of these charges were dropped by the court (nolle pros).
How can i expunge the whole thing? And what would be the benefits? Would it help if i go out of USA and visa stamping and job hunting?
For doing expunge, should i get lawyer from MD or i can take one from IL?
Divorce / Separation Lawyer
This is a matter to be asked of a MD attorney. You should repost your question from a MD location to attract the attorneys from that state. Leaving the country would probably be irrelevant to expunging any cases.
Divorce / Separation Lawyer
As attorney Goldstein explained, this is a matter for a MD attorney.
Criminal Defense Attorney
I recommend that you contact the the lawyer who represented you in the DUI case or another Maryland Attorney who practices in that county.
DUI / DWI Attorney
Expungements must occur in the court where the sentence was entered. Maryland law will determine if an expungement of this matter is possible. In Illinois DUIs are not expungeable. Talk to the lawyer who represented you.
Post a free question on our public forum.Ask a Question
- or -
Search for lawyers by reviews and ratings.Find a Lawyer


text:
The new iOS semi-flat style. I'm still torn, but it looks kinda nice.
keyboard shortcuts:
L or F like
post comment
Show and tell for designers
What are you working on? Dribbble is a community of designers sharing screenshots of their work, process, and projects.
Copyright © 2009–2016 Dribbble LLC. All screenshots © their respective owners. Shipped from Salem, Mass. USA.


text:
http://www.gamestv.org/user/174416-dirtstone75/When you have invested possibly a bit of time knowing about homemade cellulite treatment you are able to continue to reckon that the topic is complicated or confusing. All you should do, even though, is actually take a truly full breath of air and then give attention to the matters you can apply immediately, you will see that you are able to handle the problem. Determine just one single matter at any given time as an alternative to looking to learn everything in one go. If you do inevitably be needing plenty of added facts or even recommendations, probably the most remarkably respectable locations to discover those things is my site.
What Does Cellulite Treatment Mean?
My Games
Comments (0)


text:
Book your room at Jurys Inn Dublin Parnell Street
Get an overview of this hotelHotel in Dublin near General Post Office
Close to shopping
Within a 5-minute walk of Henry Street shops and the James Joyce Centre, Jurys Inn Dublin Parnell Street is less than 1 km (0.6 mi) from Temple Bar, Abbey Theatre, General Post Office, and Trinity College.
Restaurant and café
A casual bistro serves international fare for breakfast and dinner daily, and a café offers coffee drinks, pastries, and snacks. A 24-hour fitness center has cardio and strength-training machines.
Wireless Internet
Jurys Inn Dublin Parnell Street's 253 air-conditioned guestrooms provide free wireless Internet access, TVs with satellite channels and video games, direct-dial phones with voice mail, and coffee/tea makers.Would you like to give us feedback? Share it! Opens in a new window
Jurys Inn Dublin Parnell StreetMoore Street Plaza Parnell Street Dublin Dublin
Hotel Amenities
Hotel Amenities
Located within walking distance of numerous shops and Dublin attractions, Jurys Inn Dublin Parnell Street features contemporary decor with lights woods and streamlined furnishings. The 24-hour front desk provides a safe-deposit box and currency exchange. Wireless Internet access is free throughout the hotel. The hotel's bistro offers an eclectic international menu, and Il Barista Café sells pastries, snacks, and coffee drinks. A contemporary bar serves casual fare throughout the day. Open around the clock, a small fitness center has free weights and cardio and strength-training machines. Guest laundry facilities are on site, and dry cleaning/laundry service can be arranged. Parking is available nearby (surcharge).
- 24-hour fitness facilities
- 24-hour front desk
- Bar/lounge
- Breakfast available (surcharge)
- Coffee shop or café
- Designated smoking areas
- Designated smoking areas (fines apply)
- Dry cleaning/laundry service
- Elevator/lift
- Express check-in
- Free WiFi
- Laundry facilities
- Luggage storage
- Meeting rooms 3
- Multilingual staff
- Number of meeting rooms - 3
- Restaurant
- Safe-deposit box at front desk
- Total number of rooms - 253
Family Friendly Amenities
- Free Wi-Fi
- Laundry facilities
- Sofa bed
Available in all rooms: Free WiFi
Available in some public areas: Free WiFi
Room Amenities
- Air conditioning
- In-room climate control (air conditioning)
- Coffee/tea maker
- Free toiletries
- Daily housekeeping
- Desk
- Free WiFi
- Hair dryer
- In-room safe
- Iron/ironing board (on request)
- Private bathroom
- Room service (limited hours)
- Satellite TV service
- Shower/tub combination
- Sofa bed
- Sofa bed size
- Video-game console
Where to Eat
Jurys Inn Restaurant - Casual bistro serving contemporary international cuisine. Children's menu. Open for breakfast and dinner daily.
Il Barista Café - Coffee drinks, snacks, and pastries.
You can order a meal from room service during limited hours.
Nearby Things to Do
The recreational activities listed below are available either on site or nearby; fees may apply.
- Golfing nearby
- Sailing nearby
- Windsurfing nearby
- Hiking/biking trails nearby
To make requests for specific accessibility needs, complete the "Special or Accessibility Requests" section of "Trip Preferences" when you book your hotel.
- Accessible bathroom
Hotel Policies
Minimum check-in age is 18
Check-in time starts at 2 PM
Check-out time is Noon
Payment types
- Pets not allowed
You need to know
Extra-person charges may apply and vary depending on hotel policy.
Government-issued photo identification and a credit card or cash deposit are required at check-in for incidental charges.
Special requests are subject to availability upon check-in and may incur additional charges. Special requests cannot be guaranteed.
No rollaway/extra beds available
No cribs (infant beds) available
Optional extras
- Fee for buffet breakfast: EUR 10 per person (approximately)
Hotel Name
- Jurys Hotel Dublin
- Jurys Hotel Parnell Street
- Jurys Inn Parnell Street Hotel Dublin
- Jurys
- Jurys Dublin Parnell Street
- Jurys Inn Dublin Parnell Street
- Jurys Inn Parnell
- Jurys Inn Parnell Street
- Jurys Parnell
- Jurys Parnell Street
We should mention
Children 12 years old and younger stay free when occupying the parent or guardian's room, using existing bedding.
Awards & Affiliations
National Rating
Official Ireland Rating provided by Fáilte Ireland (The National Tourism Development Authority)


text:
You are a fan of colony worldwide ? Come to discover the best forums colony worldwide on the internet and share your experience with a community fan of colony worldwide . You can also build a forum colony worldwide and create your online discussion.
The Bursa Malaysia Stock Forum! Sharing money making strategies among members for worldwide financial market!
bursa, malaysia, stock, forum, call, warrant, commodity, forex, dowjones, investment, trading, klci, equities, berhad, main, board, mesdaq, daytrade, chart, business, derivative, currency
)SoL(~ is a Star Wars Jedi Knight II: Jedi Outcast clan committed to fair play evolved from ]=ATS=[
Team forums for the online game Travian
colony¿³, travian, forums, game, alliances, ¿³, online, communities, travian.com
Free forum : Bringing the Collection of Thinkers community back together again.
tabletop, wargames, #colony, collection, thinkers, community, back, together, again


text:
Old Bangkok Inn
No prices found through our partners. Please contact the business directly or check some of our recommended alternatives.
Photos of Old Bangkok Inn
Travelers also looked at:
- More recommendations
Historical Traveler Reviews Naiades Gouves
Great little hotel
We have stayed at the OBI. My wife and I had a room and my daughter another. I would echo everything positive that other reviewers have written.
I would recommend using the hotel's own transport to get from the airport as taxi drivers in Bangkok have little local knowledge and are unlikely to find the hotel with just the address. Most taxi drivers do not speak or read english or maps. Once there, the hotel provides little cards with a picture of the nearby landmark - The Democracy Monument - and hand written Thai instructions, to give to your taxi driver. If you are not going to be met by the hotel's driver I would try asking for one of these cards by post in advance.
A home away from home
Very nice place. Excellent breakfast. Superb service. To get there: order the car from the hotel in advance, slightly more expensive than taxi, but very much nicer and quicker with excellent female driver.
This is a small hotel and if you are not used to that, slow down. You will get very good personal service and answers to all tourist questions. An advise: follow the advises you get from the hotel, like using the channel boat for very quick and inexpensive transportation, all proposals turned out excellent, including places for dining.
PC and internet in room. DVD player in room & DVD library by the reception, free to use. Good AC. Lot of sights within walking distance, try a tuktuk just to try it, then use taxi with meters after, they have AC, go for the newer cars as they seem to have correct meters.
A wonderful stay, with great personalised reccomendations
I will admit to initial suspicions at the highly rated reviews on TripAdvisor, but decided to risk it, and am delighted to report 2 great, seperate stays at the inn. I think the price is very reasonable: accomodation in Bangkok seems to polarise into expensive high-end hotels, or back-paking hovels, with most things in between being overpriced back-packing hovels. The Old Bangkok Inn is in a different league altogether.
The service is fantastic. We had taken a train up from Malaysia and my boyfriend suffered from terrible food poisoning during the journey - a much regreted lunch in Penang. Unfortuntately the taxi driver was terrible at taking directions and took an age to bring us to the guesthouse, but as soon as we arrived the owner supplied us with a detailed map. including photos of nearby monuments and instructions in thai, and despatched us to a local hospital.
We were also impressed by their unbiased restaurant review book (they aren't paid by anyone) and willingness to provide detailed local knowledge. During our second visit we tried to attend a thai boxing match, but the "foreigner's kiosk" was 5x the normal price for the same tickets so disheartend, we abandoned our trip. The hotel receptionist went out of her way to arrange an alternative river cruise, but when she couldn't, she arranged for us to vist a cafe with spectacular views overlooking the river .
The rooms were amazingly comfortable and had a high speed internet connection. We stayed in 2 different rooms, so it seems the quality is consistent.
Breakfast was fantastic: we have never received such a high level of service. We were introduced to the fabulous Mangosteen, a wonderful fruit that I now hanker after.
In fact, I did not much like Bangkok itself, but I am very grateful to the guesthouse, the workers made the trip much more pleasant. I wish them every success.
I only wish I could reciprocate such hospitality.
5 stars
If you like a hotel to be more like a home, then you'll love the Old Bangkok Inn. Located on Rajadamnern Avenue, smack in the middle of the Thai capital's historic quarter, this snug little property has just eight individually appointed rooms. Patronne Nantiya Tulyanond can't resist cozy touches such as daily homemade cakes and nightly pillow presents. And her son Joey has been known to lead impromptu tours around the major landmarks of the neighborhood, from the Democracy Monument to the gentrifying nightlife of Khao San Road.
He's also the tech head responsible for installing a computer in every room and for setting up wi-fi Internet access throughout. There's even some family history behind the inn. It's actually a converted shophouse that was built on a plot granted to the Tulyanond's ancestors by King Chulalongkorn (Rama V). The land has been in the family now for seven generations, and as you would expect, plenty of care has been lavished on the building that stands on it.
Rooms are simply but stylishly appointed with teak furniture, while the odd family heirloom and pieces of pottery hand-painted by Nantiya lend a homely feel. Bathrooms feature toiletries custom blended according to one of four aromatic themes - lemongrass, jasmine, orchid and rice. Another pleasing touch is the Tulyanonds' commitment to the environment and the community: showers pump out solar-heated water and the inn's construction incorporates salvaged wood. Guests wanting to do more to save the world can make a donation at checkout to one of the animal or children's charities on the Tulyanonds' list - and the inn will match it. Given that rates can be as low as $79 a night (or even cheaper if you pay in cash and book 60 days in advance), you should certainly be able to spare some change for a good cause.
An oasis in Old Town
Conde Nast is clearly in love with this place and we can see why. We stayed with OBI for a few days at the end of May and we loved it. It is a wonderfully quiet, charming place just 5 minutes away from the madness of Khaosan Road. The rooms are beautifully decorated with unique decorations, tastefully put together. Nantiya, the proprietress, is utterly charming. She is very 'hands on' and one gets the sense that she is making a huge effort to ensure that every guest has a pleasant stay. We loved the nightly presents and the hand written cards each day - they really made us feel welcome. Moreover, Nantiya provided very good recommendations for places to eat/drink/visit/etc; we never got the feeling that there were any ulterior motives for her recommendations. Instead we felt as though she was really trying to tailor her recommendations to what we might enjoy. I would go back in a heartbeat.
Peace amongst the Chaos
In researching where to stay in Bangkok, my boyfriend and I wanted something less pretentious and expensive than the 4 and 5 star hotels but class and style and personality that cannot be found with 2-3 class hotels. Skeptical of guest houses in Asia I didn't' think there were many option.
After reading so many wonderful reviews of the Old Bangkok Inn from this website, it seemed as thought I had found what I was looking for. We could not have asked for better service and accommodations than what we got at the Old Bangkok Inn. Even before arriving at the Inn, Nantiya, the owner was helping us plan our trip, from early check-in to making sure the cab driver knew where to take us, every detail was thought of in advance. We had reserved the Jasmine Suite which is a loft style room with the bed, TV and a small couch on the second floor and the bathroom, closets and computer desk on the first. We loved the entire look of the Inn, from the beautiful bathrooms with wood floors in the shower to the decorative lamps and the many amenities from in room computer/wifi to the DVD library and books and cute toiletttries. We got to know each of the staff that were very helpful and informative about Bangkok. Rather than telling us to take cabs or tuk tuks to get around the city (which can be a nightmare with traffic and communication) they would explain how to get around the city via ski train, water taxi and walking, writing out each of the stops in english and in thai. We were so much happier not having to negotiate fares instead, going at our own pace and seeing the city on foot, by water and rail. The Inn is so close to so many major attractions that we had time to take breaks from the heat and rain and have a nap or snack at the Inn before venturing out again, a real treat when a sudden rainstorm appears or its 110 degrees.
As many of the people noted, the breakfast was great, a much better and tastier approach than a buffet breakfast at other large hotels, in my opinion. It really was a pleasure to spend a fun chaotic day in the city and come back to the peace and quietness of the Old Bangkok Inn. Khao San road, the backpackers area, is about a 15 minute walk from the hotel, a fun young place to meet new people and have a few drinks.
I also forgot to mention the cute little presents that Nantiya leaves for you every day with a personal note, another touch of class, elegance and thoughtfulness that seems to be the theme at Old Bangkok Inn. I highly recommend this place and will be back again!!!!
If you have a chance and are looking for a great Thai cooking class, check out BaiPai. The cooking lesson we had was great and they pick up and drop off from your hotel
OBI suited us perfectly
My wife and I stayed at the Old Bangkok Inn at the beginning and the end of our recent Thailand vacation. Bangkok is a big city with big traffic problems. The OBI is ideally situated for the must-see historical sites as well as being three ferry stops from the Jim Thomson house, the Siam Square shopping experience and SkyTrain. The OBI is an oasis of calm in the frenzy of the city.
Nantiya is a natural host, with a kind welcome and practical advice for her guests. This friendliness and helpfulness is also displayed by her staff.
The Thai breakfast rice porridge is the best we had.
We stayed in the Lemongrass and Jasmine rooms. Both were fine - comfortable and full of character, but the slightly more expensive Jasmine room was better value.
The OBI is not for those looking for a wild time, but if you seek tranquillity in BKK, it should be high on your list. We have stayed in B&B's in Europe, the USA and Canada. The OBI ranks with the best.
Perfect, but not for everyone
I visited the Old Bangkok Inn based on a travelers forum on this website. I was looking for a lowkey but personable hotel for my frequent trips to Bangkok.
The hotel was great. The sevice is very personal and the rooms have style and every luxury. The attention to detail, from the scented toiletries that match the names of the rooms (i.e. lemongrass) to the personally selected breakfast and the gift upon check out, was exceptional. There is in room web access, very convenient. The mother and son team recommended restaurants, street food stalls, sights, even a jeweler based on my experience with the city. The location is quiet and walking distance to Khao San if you want a livelier area. I walked alone at night with no problem. Cabs are plentiful, you can take a rivertaxi to many areas or the skyway.
However, some of the rooms are small and would be tough with even two people moving around. Other rooms are bigger but a family with small children may have a difficult time in this small inn.
That being said, I loved this boutique hotel and look forward to a return visit. It will not be long before rooms will be difficult to book. Nantiya and Joey provide a welcome I have not come across in Bangkok.
Fantastic and personlised service. Great breakfast with local fruits in season from Joey's mom. She also provided her many insights and tips into Bangkok one does not get staying at a hotel. Location-wise: Not too far from the city/shopping via the rivertaxi though the inn is near to where the locals shop instead, if one is interested in that. Will definitely return to stay at the Inn next visit.
Don't hesitate!
WOW! Great service, great food, great rooms AND great value! I almost don't want to write this and let the word get out! An 8 room, upscale inn in old Bangkok. We didn't want to leave. You can pick your room according to plant) - jasmine, orchid, etc. Some rooms are lofts, some have a private garden, plus highspeed internet in every room, DVD players plus a generously stocked DVD and book library, A/C, awesome bathrooms and decor. All for less than $60 when we went (October). Friendly, helpful guidance from the owner and her son. We enjoyed getting to know them, too. The day after we stayed there and moved on to Phuket, the inn got a glowing review in a Bangkok paper. The ONLY downside is no bathtubs, but the showers were great with customized toilettires according to your room. Oh and the location is a little far from the main shopping areas of Bangkok and it is not near a Skytrain. There is the KahoSan market and a few restaurants nearby however. Chinatown is walkable. Also, you can walk to the ferries, and taxis are cheap - cost us less than $10 to get to the main shopping throughfares in Silom. Ideally located however for those who want to see all the cultural and historical sights. Next time I go to Bangkok I will stay there.
TripAdvisor Reviews Naiades Gouves
Travel Blogs from Bangkok
An elephant built for two or 3
... guide, met us at our next stop at 1:30. He and driver (in a great AC'd van) had driven over an hour to reach us from Bangkok. It is 32 degrees+ - hot even for Thai people with the humidity - dripping wet most of the day. First stop, Wat Panancherng to the oldest monastery in Thailand which houses the largest ancient Buddha image. He's BIG! Fascinating watching how gifts of orange cloths are given, thrown high to young men who drape the Buddha. Such strength of belief - amazing. ...
The Grind
... I panicked a little bit about my first class but once I was going I felt much better about the whole day. Some kids gave me a bit of trouble, but all in all I felt much better for having gone out and taken charge of a few lessons. It also helped that my Thai teacher, Mutt was excellent. I was worried that she didn't like me at first, but I think she just had other things on her mind. She was good with me ...
Bangkok, Tuk Tuk and Riverboat adventure
... the experience more of a mention that it deserves as this was a very personal thing for me. The boat trip was awesome! I think I might over use that word during my travels. The engine, sorry lorry engine, on those boats is even more awesome (see I warned you) up close. Weaving his way across the river and down the canals took skill. As for the floating market they are just ...
Mini Bus Back to Bangkok
... me and David, who kept falling asleep on David's shoulder!!! We drove at breakneck speed again down the freeways, not slowing for bumps in the road, so you had to hang on! Actually, David and I were the only ones awake again. Everyone else falls asleep as soon as the bus starts! It may be a preservation thing!!
Bangkok: Day 2
Fruit breakfast and then tour of old city -- beautiful temples everywhere and lots of Chinese tourists. Emerald plus reclining Buddha, Bodi trees, lotus flowers put them in the water, people dropping coins in every bucket for 40 buckets.
When driving around the city, the ...


text:
Hotels near Fontainebleau Golf Club
Search & Compare Fontainebleau Golf Club Hotels
Trending now in Fontainebleau
Hotels within 2 kilometers of Fontainebleau Golf Club
- Most bookedibis Château de Fontainebleau
30 people looked at this hotel in the last hour
Most recent review
"The hotel looks very tired from the street and does not improve much on entering. You cannot make a cup of tea or coffee. Although it is complementary you must ask e receptionist and she wil make it for you. Considering we arrived on a Sunday and there was one person only on duty with the phones ..."
A Traveller, May 2015, AU
23 people looked at this hotel in the last hour
Most recent review
"Easy check-in, friendly staff, large comfortable rooms."
A Traveller, Jun 2016, GB
16 people looked at this hotel in the last hour
13 people looked at this hotel in the last hour
Most recent review
"We were very pleased with the total experience. Staff at check in and departure were professional and efficient. Dinner was well presented with excellent taste, served by attentive staff. The room was very good for a hotel of this vintage. "
A Traveller, May 2016, US
- Hôtel de LondresNo Guest Reviews yet
13 people looked at this hotel in the last hour
12 people looked at this hotel in the last hour
Most recent review
"easy to find, great parking and very comfortable beds"
A Traveller, Sep 2015, CA
8 people looked at this hotel in the last hour
6 people looked at this hotel in the last hour
Most recent review
"Beautiful new hotel in Fontainebleau - a standout from other properties in the area. The restaurant was extraordinary with a tremendous chef's tasting menu. Aside from the air con not working yet (doesn't switch on until June) - it was a great stay."
A Traveller, May 2016, US
Hotels within 5 kilometers of Fontainebleau Golf Club
Hotels within 7 kilometers of Fontainebleau Golf Club
95 people looked at this hotel in the last hour
Most recent review
"This hotel was a very nice surprise, better than its reviews led me to expect. Gorgeous, authentic, and comfortable. We spent one night here after a long flight from the US to Paris, en route to Switzerland by car. The first nice surprise was check in. We arrived three hours early, dead on our f..."
A Traveller, Jul 2015, US
Fontainebleau Golf Club hotels - Fontainebleau
Whether it's a cheap Fontainebleau Golf Club hotel, a 5 star Fontainebleau Golf Club hotel or a family friendly Fontainebleau Golf Club hotel, Hotels.com has the best accommodation for your stay.
If visiting Fontainebleau Golf Club is a must, then be sure to check out our detailed location mapping to find the best hotel closest to Fontainebleau Golf Club, France.
Our map based hotel search can be accessed from the above map image on this page (or via standard search results) and with the locations of each hotel shown clearly around Fontainebleau Golf Club you're able to refine your search within Fontainebleau or France based upon other nearby landmarks and neighbourhoods as well as transport options to help you get around. If you're driving be sure to also check the hotels for onsite parking.
To get the best hotel deals near Fontainebleau Golf Club you can also filter by price/ average nightly rate and if you're concerned with quality, you can also filter by star rating and our own guest review rating.
As well as our Hotels.com guest reviews, we also display reviews from Expedia for Fontainebleau Golf Club hotels and the TripAdvisor Fontainebleau Golf Club hotels review score on each of our Fontainebleau hotel information pages.
If you're visiting Fontainebleau Golf Club, Fontainebleau with the family or in a group, be sure to check out the room options and facilities we list for each hotel to ensure we help find the perfect hotel for you.
When you've made your booking for your hotel near Fontainebleau Golf Club, in our confirmation email we'll also send you information on all nearby attractions as well as directions on how to get to your chosen hotel and the weather forecast, helping you to plan your trip.
To get yourself an even better deal on hotels near Fontainebleau Golf Club, Fontainebleau why not sign up to our Welcome Rewards program? It's free and when you stay 10 nights at any eligible hotel you receive 1 night free*
We have Fontainebleau Golf Club hotel deals, even Fontainebleau Golf Club last minute deals and offers to get you the cheap est Fontainebleau Golf Club hotel with our lowest price gaurantee.


text:
We have a socket server developed in C#.Net 3.5. I see server memory usage increasing whenever a client disconnectes and connects. The server disconnects the client if valid credentials were not provided.
When the client attempts to connect with invalid credentials more memory is reserved and seemingly never relinquished. The Client is trying to reconnect once every second. Below is the code handling the disconnect. This code is being called whenever a client disconnects and on encountering an error on read and write operations.
Could somebody guide me on how to debug / fix this issue?