text:
Purpose: To investigate the diagnostic performance of circulating tumor cells (CTC) in discrimination between primary lung cancer and nonmalignant diseases as well as in prediction of distant metastasis.
Patients and Methods: We prospectively evaluated CTCs in 7.5-mL samples of peripheral blood sampled from patients with a suspicion or a diagnosis of primary lung cancer. A semiautomated system was used to capture CTCs with an antibody against epithelial cell adhesion molecule.
Results: Of 150 eligible patients, 25 were finally diagnosed as having nonmalignant disease, and 125 were diagnosed as having primary lung cancer with (n = 31) or without (n = 94) distant metastasis. CTCs were detected in 30.6% of lung cancer patients and in 12.0% of nonmalignant patients. CTC count was significantly higher in lung cancer patients than in nonmalignant patients, but a receiver operating characteristic (ROC) curve analysis showed an insufficient capability of the CTC test in discrimination between lung cancer and nonmalignant diseases with an area under ROC curve of 0.598 (95% confidence interval, 0.488-0.708; P = 0.122). Among lung cancer patients, CTC count significantly increased along with tumor progression, especially with development of distant metastasis. The area under ROC curve for CTC count in prediction of distant metastasis was 0.783 (95% confidence interval, 0.679-0.886; P < 0.001). When patients with one or more CTCs were judged as having metastatic disease, sensitivity and specificity of the CTC test were 71.0% and 83.0%, respectively.
Conclusions: CTC is a useful surrogate marker of distant metastasis in primary lung cancer. (Clin Cancer Res 2009;15(22):6980–6)
- Circulating Tumor Cell
- Lung Cancer
- Metastasis
Translational Relevance
The present study has revealed that circulating tumor cells (CTC) can be found and quantitatively evaluated with a semiautomated system (CellSearch) in patients with primary lung cancer, and that CTC count is useful diagnostic marker to predict development of distant metastasis. When the clinical value of the CTC test in diagnosis of distant metastasis is established in future clinical studies, CTC count will become a practical clinical marker, which can be noninvasively and repeatedly performed, not only in determining clinical stage but also in monitoring of therapeutic efficacy and predicting prognosis. In addition, the present study has revealed that CTCs are detected even in ∼20% of lung cancer patients without clinically detectable distant metastasis, which suggests that CTC count is a surrogate marker of micrometastasis. Thus, the CTC test may be potentially marker in decision making of adjuvant chemotherapy following complete resection, which should be examined in future studies.
Primary lung cancer is the leading cause of cancer death in most industrialized countries, and its high mortality is mainly caused by frequent occurrence of distant metastasis. In fact, ∼40% of lung cancer patients have distant metastasis detectable with current diagnostic modalities such as whole-body computed tomography (CT) and positron emission tomography (PET) scanning (1). More importantly, even in patients without clinically detectable distant metastasis at the time of initial diagnosis, distant metastasis may frequently develop during treatment or long-time follow-up. Thus, in most lung cancer patients, tumor cells may circulate in the blood with or without apparent distant metastasis, and detection of such circulating tumor cells (CTC) may contribute to improvement in diagnosis and therapy of lung cancer patients (2).
However, in spite of many efforts for development of a sensitive detection system of CTCs, clinical significance of CTCs had not been established mainly due to lack of reproducibility and accuracy in detection of CTCs (2, 3). The CellSearch System (Veridex LLC), a semiautomated system for quantitative evaluation of CTCs, has been recently developed, in which CTCs are immunomagnetically captured with an antibody against epithelial cell adhesion molecule (EpCAM; ref. 3). The most important advantage of the CellSearch system is reproducibility across different laboratories, which is validated by a prospective multicenter study in metastatic breast cancer (4). Based on accumulating data supporting the accuracy and precision in evaluating CTCs (5–8), the CTC test has been approved in the United States of America by the Food and Drug Administration for monitoring of blood from metastatic breast and colon cancer patients. In addition, several clinical studies have revealed that the CTC test is a potentially useful clinical marker in other malignant tumors such as prostate cancer (9–11). In lung cancer, however, little has been reported about the incidence of CTCs (3), and its clinical significance remains unknown. Thus, we now conducted a prospective study to examine the presence and incidence of CTCs in primary lung cancer patients for evaluating its diagnostic performance in discrimination between primary lung cancer and nonmalignant diseases as well as in prediction of distant metastasis.
Patients and Methods
Study design
Patients who presented with a pathologic diagnosis of primary lung cancer or with a suspicion of primary lung cancer on chest radiograph and/or CT at the Department of Thoracic Surgery, Hyogo College of Medicine hospital and agreed to the purpose of the study were eligible. Patients who have apparent or symptomatic distant metastasis before enrollment were excluded from the study. In addition, patients who had concurrent or prior malignancy treated within in the previous 5 y were excluded. All patients provided written informed consent before enrollment.
A 7.5-mL sample of peripheral blood was collected from each patient, and was served for the CTC test. A complete clinical data including history, physical examination, and laboratory and radiographic studies were also collected. In some primary lung cancer patients who underwent thoracotomy, pulmonary venous blood was also sampled during thoracotomy, and was served for the CTC test for another study (12).
For all patients enrolled, serum levels of carcinoembryonic antigen (CEA) were measured using a commercially available electrochemiluminescence immunoassay system (Roche Diagnostics K.K.) following a manufacturer's instruction; the manufacturer-suggested cutoff point of CEA to discriminate between nonmalignant disease and malignant tumor was 5 ng/mL (13, 14). For patients with a suspicion of primary lung cancer, bronchoscopic and/or trans-thoracic needle biopsy was applied to obtain pathologic diagnosis; if failed, video-assisted thoracoscopic biopsy was done. For lung cancer patients, whole-body CT, brain CT or magnetic resonance imaging (MRI), and PET scanning were routinely conducted to evaluate tumor progression. Clinical stage (c-stage) was determined according to the current tumor-node-metastasis classification as revised in 1997; for patents undergoing surgery for lung cancer, pathologic stage (p-stage) was also determined. This study was approved by the Institutional Review Board of Hyogo College of Medicine.
Evaluation of CTCs (the CTC test)
CTCs were isolated from peripheral blood using the CellSearch system (Veridex LLC), and the number of CTCs was determined following a manufacturer's protocol (3). In brief, epithelial cells, which were captured using ferroparticles coupled to an anti-EpCAM antibody, were separated in a magnetic field, and the enriched samples were then stained with 4′,6-diamidino-2-phenylindole and anti–cytokeratin-phycoerythrin. Contaminated WBC were excluded by negative selection for CD45. Stained cells were then analyzed on a florescent microscope using the Cell track Analyzer II (Veridex LLC). The criteria for each cell to be defined as a CTC are as follows: round to oval morphology, a visible 4′,6-diamidino-2-phenylindole–positive nucleus, positive cytokeratin staining in the cytoplasm, and negative staining for CD45. All evaluations were done by two authors (K.Y. and F.T., both completed the "Cell Interpretation Proficiency Assessment" managed by the Veridex LL for identification of CTCs) independently without knowledge of clinical characteristics of patients.
Counts were compared by the χ2 test. Continuous data were compared using Student's t test if the distribution of samples was normal, or using nonparametric tests (Mann-Whitney U test for comparison between two groups and Kruskal-Wallis test for comparison among three or more groups) if the sample distribution was asymmetrical.
Diagnostic performance of CTC count or serum CEA level assessed by constructing a receiver operating characteristic (ROC) curve, and was evaluated by calculating the area under each ROC curve (AUC-ROC; ref. 15). An AUC-ROC of 1 denotes perfect discrimination of a test, whereas an AUC-ROC of 0.5 denotes complete lack of discrimination of a test. P value was calculated for the difference between each ACU-ROC and 0.5 (complete useless test).
For each test, two-sided P values of <0.05 were considered statistically significant. All statistical manipulations were done using the SPSS for Windows software system (SPSS, Inc.).
Patient characteristics
From October 2007 through December 2008, 152 consecutive patients were enrolled in the study. After enrollment, whole-body CT or PET scanning incidentally revealed a concurrent malignant tumor in two patients (pancreatic cancer and bile-duct cancer in one patient each), and these patients were excluded. Of 150 eligible patients, 17 had been pathologically diagnosed as having primary lung cancer at enrollment. Of 133 patients with a suspicion of lung cancer at enrollment, 108 were finally diagnosed pathologically as having primary lung cancer. Thus, the final diagnosis was primary lung cancer in a total of 125 patients (Fig. 1). The majority of patients had c-stage I disease, and 29 patients were diagnosed as having c-stage IV disease.
Thoracotomy was done for 110 primary lung cancer patients consisting of all (n = 94) c-stage I-IIIA, and one of 2 c-stage IIIB, and 15 of 29 c-stage IV patients. Of 96 patients with c-stage I-III disease, 2 (both c-stage IB patients) were diagnosed as having p-stage IV disease as pulmonary metastases were found during thoracotomy. Finally, distant metastasis was found in a total of 31 primary lung cancer patients (Fig. 1).
The remaining 25 patients were finally diagnosed as having nonmalignant disease by video-assisted thoracoscopic biopsy (Fig. 1); there were 10 patients with organizing organized pneumonia, 7 with nonmalignant tumor including atypical adenomatous hyperplasia (in 3 patients), 6 with infectious disease, and 2 with lymph-proliferative disease. There was no significant difference in any patient characteristic between lung cancer patients and nonmalignant patients.
CTCs in primary lung cancer patients and nonmalignant patients
CTCs were identified in peripheral blood of 3 (12.0%) of 25 nonmalignant patients, and CTC count was "1" (n = 2) or "2" (n = 1). CTCs were identified in peripheral blood of 38 (30.6%) of 125 lung cancer patients, and CTC count was significantly higher compared with that in nonmalignant patients (Table 1; Fig. 2A).
The AUC-ROC for CTC count in discrimination between lung cancer patients and nonmalignant patients was 0.598 (P = 0.122; Fig. 2B). At a cutoff point of 1 for lung cancer (CTC count, ≥1) or nonmalignant patients (CTC count, 0), sensitivity and specificity were 30.4% and 88.0%, respectively (Table 2).
The AUC-ROC for serum CEA level was 0.747 (P < 0.001), suggesting that serum CEA level is a better diagnostic marker for the diagnosis of lung cancer (Fig. 2B). At a cutoff point of 5 ng/mL, sensitivity and specificity were 45.6% and 92.0%, respectively (Table 2).
CTCs in primary lung cancer patients
Among primary lung cancer patients, small-cell lung cancer patients showed a significantly higher CTC count than non–small cell cancer patients (Fig. 3A).
CTC count significantly increased along with increase in c-stage (Fig. 3B). The difference in CTC count between c-stage I disease and c-stage IV disease was statistically significant, but the difference among c-stage I to III diseases did not reached a statistically significance.
CTC count significantly increased along with increase in p-stage, and was significantly higher in p-stage IV disease than any other p-stage disease (Fig. 3C). Of noted, two patients, who migrated from c-stage IB to p-stage IV disease due to pulmonary metastases found during thoracotomy, had one or more CTCs (CTC count, 1 and 3 in one patient each) in peripheral blood.
CTC test for prediction of distant metastasis
Metastatic lung cancer patients showed a significantly higher CTC count than primary lung cancer patients without distant metastasis (Fig. 4A). The AUC-ROC for CTC count for prediction of the absence or presence of distant metastasis among primary lung cancer patients was 0.783 (P < 0.001; Fig. 4B), suggesting that CTC count was a useful surrogate marker of distant metastasis. At a cutoff point of 1 for metastatic lung cancer (CTC count, ≥1) or nonmetastatic lung cancer patients (CTC count, 0), sensitivity and specificity were 71.0% and 83.0%, respectively (Table 2). In contrast, the AUC-ROC for serum CEA for prediction of distant metastasis failed to reach a statistical significance (P = 0.136; Fig. 4B).
When the diagnostic performance of the CTC test in prediction of distant metastasis was evaluated among all patients enrolled in the present study (all patients with a suspicion or a diagnosis of lung cancer), similar results were obtained (Table 2; Fig. 4C and D).
The present study is the first detailed study evaluating CTCs in patients with a suspicious or a diagnosis of primary lung cancer using the CellSearch system. We first showed that CTC count was significantly higher in lung cancer patients than in nonmalignant patients, but the discriminatory capability might be insufficient with an AUC-ROC of 0.598 (P = 0.122). Second, we showed that CTC count significantly increased along with tumor progression, especially with development of distant metastasis, and the CTC test showed a moderate diagnostic performance in discrimination between nonmetastatic patients and metastatic patients with an AUC-ROC of 0.783 showing a significantly better capability compared with a completely useless test with an AUC-ROC of 0.5 (P < 0.001). Furthermore, these ROC-curves suggested that the optimal cutoff point in diagnosis of lung cancer was 1 (patients with one or more CTCs are judged to be "positive").
Although intense efforts have been continued for development of useful biomarkers, many have not been established for diagnosis or decision-making in therapy of lung cancer (16, 17). Because only a small tumor specimen can be obtained by usual diagnostic modalities such as fine-needle aspiration and transbronchial biopsy, development of biomarkers that are evaluated in peripheral blood samples would be valuable. In addition, blood-based biomarkers have a great advantage of being evaluated easily and repeatedly. Among blood-based biomarkers, serum CEA is most extensively examined, and several studies showed that serum CEA was a useful marker not only to discriminate lung cancer, especially adenocarcinoma of the lung, from benign diseases but also to determine tumor progression and prognosis (13, 14). Despite these promising results, routine use of serum CEA in clinical practice is not recommended mainly due to its insufficient sensitivity and/or specificity as well as lack of reproducibility of the results (16, 17). Thus, we assessed the diagnostic performance of CTC count in comparison with that of serum CEA in the present study.
Concerning the diagnostic performance in discrimination between nonmalignant patients and lung cancer patients, serum CEA showed a moderate performance (AUC-ROC, 0.747). However, the CTC test showed an insufficient performance (AUC-ROC, 0.598), which may be mainly due to its low sensitivity. In fact, when patients with one or more CTCs were judged as having lung cancer (cutoff point, 1), sensitivity was only 30.4%, whereas specificity was as high as 88.0%. And, if the cutoff point was elevated to 3, only 10.4% of lung cancer patients were correctly judged to be positive, whereas no nonmalignant patients were wrongly judged to be positive (both specificity and positive predictive value, 100%). These results indicate that the CTC test is characterized by low sensitivity and negative predictive value as well as high specificity and positive predictive value. Here, at a cutoff point of 1, attention should be paid to the fact that specificity or positive predictive value did not reach 100% (88.0% and 92.7%, respectively). In other words, some patients (7.3%, 3 of 41 patients) were finally diagnosed as having nonmalignant diseases, whereas one or two "tumor cells" were identified in peripheral blood. These results are similar as those in a previous study showing that up to three CTCs were detected in a small subset of healthy volunteers or nonmalignant patients. Such "false-positive" results may be classified into "true" false-positive results or "false" false-positive results. A true false-positive result, indicating that patients without any malignant tumor are judged to have a malignant tumor according to the CTC test, can be brought by several factors as follows: (a) contamination of epithelial cells in blood samples due to a variety of technical issues such as inappropriate blood sampling, (b) false-positive staining of contaminated nonepithelial cells for cytokeratin/4′,6-diamidino-2-phenylindole during sample processing, (c) inappropriate judgment in identification of CTCs by researchers. A false false-positive result can occur, when detected CTCs are originated from a clinically undetectable malignant tumor. An individual reason for three false-positive cases in the present study remains unclear, and we will continue to watch for development of malignant tumors.
The CTC test showed a significant diagnostic performance to predict the absence or presence of distant metastasis (AUC-ROC, 0.783; P < 0.001), whereas serum CEA showed an insufficient performance. Thus, when CTCs are identified in peripheral blood of patients with a suspicion or a diagnosis of lung cancer, whole-body PET-scanning and brain magnetic resonance imaging (or CT) for evaluation of possible distant metastasis should be routinely performed even in clinical T1N0 cases evaluated with thoracic CT scanning. However, at a cutoff point of 1, specificity or negative predictive value of the CTC test for prediction of distant metastasis was not 100% (83.0% and 89.7%, respectively), indicating that whole-body PET scanning and brain magnetic resonance imaging (or CT) are still necessary even when the CTC test was negative. The most important advantage of the CTC test may be its capability of detecting of micrometastasis undetectable with routine diagnostic modalities. In the present study, CTCs were detected in 17 (19.3%) of 88 c-stage I patients, and the presence of distant metastasis was actually confirmed in resected specimens in 2 of 17 CTC-positive c-stage I patients. The most interesting and important question is whether distant metastasis may develop after thoracotomy in CTC-positive patients without detectable metastasis. CTCs detected in clinically "nonmetastatic" patients may represent true CTCs or nonmalignant cells that are contaminated or incorrectly identified as CTCs, which may be answered after a longer follow-up of patients. In addition, basic research studies should be done to reveal whether circulating epithelial cells defined as "CTCs" are true tumor cells and whether CTCs can actually grow at distant organs to form metastatic foci. More experimental and clinical studies are needed before the CTC test can be used in clinical practice for decision making of therapy of lung cancer patients.
The CellSearch system, used in the present study, is the only commercially available system for detection and identification of CTCs. However, the most critical issue in the use of the CellSearch system may be its low sensitivity for detecting CTCs, which suggest a need for a more sensitive detection system. Recently, a novel microfluidic platform for detecting CTCs ("CTC chip") has been developed (18, 19). This CTC chip consists of an array of 78,000 microposts coated with anti-EpCAM antibodies, and CTCs are captured by interaction of these cells with the EpCAM-coated microposts under laminar flow conditions. The CTC chip may provide a higher sensitivity in identification of CTCs, as a pilot study showed that CTCs were detected in most blood samples taken from patients with a variety of malignant tumor including lung, prostate, pancreatic, breast, and colon cancer (18). Of noted, CTCs were detected in all blood samples (n = 55) taken from non–small cell lung cancer patients, and the mean CTC count was very high (155 cells/mL) compared with that in the present study. When the CTC chip can be available in future, a comparative study between the CellSearch system and the CTC chip system may be conducted. In parallel with a longer follow-up of patients enrolled in the present study, we are now conducting following studies to reveal biological and clinical significance of CTCs: (a) in vitro and in vivo studies to assess viability and capability to form metastatic foci of CTCs captured from lung cancer patients, (b) molecular studies to reveal biological characteristics such as mutations in the epidermal growth factor receptor gene of CTCs, (c) translational studies to evaluate clinical value of the CTC test as a surrogate of therapeutic effect, and (c) clinical studies to assess the nature of CTCs in pulmonary venous as mentioned in the "Patients and Methods" section of the article (12).
In conclusion, CTC is a surrogate of distant metastasis in primary lung cancer patients, which can be useful in clinical practice. Further studies to confirm clinical value of the CTC test are warranted.
Disclosure of Potential Conflicts of Interest
No potential conflicts of interest were disclosed.
We thank Masami Shiiba and Mayo Yamamoto for helpful assistance for preparation of the manuscript.
Grant support: Grants-in-Aid 20390374 (F. Tanaka) for Scientific Research (B) from the Japan Society for the Promotion of Science, Japan.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
- Received May 7, 2009.
- Revision received June 17, 2009.
- Accepted June 18, 2009.


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Kail wants to loose weight and get in shape and she wants to do it now! She recently bought the "Insanity" workout program. One designed to give you 2 years worth of work outs in just 60 days.
This workout is serious and well... insane! Here is the promotional video:
Kail is a smart girl though, she is doing this program but also eating right and heading to the gym on top of her butt kicking Insanity workout! In just 7 days she has lost 5 lbs and is eager to give advice to others.
Seeing her success is making others want to pay the $119.85 + Shipping & Handling for the 60 day workout program. Myself included actually! Way to go kail for getting in shape the right way and working hard! Good Luck, and I'm sure you will have a great "After" photo to show off when you are done!
Where can you find this workout? Here: Insanity
30 Days after starting the program:

subset: commoncrawl


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text:
Omaha, Neb. Carolyn Davis and Aishah Sutherland combined for 32 points and 16 rebounds as Kansas University's women's basketball team held on for a 64-58 nonconference basketball victory over Creighton on Wednesday.
Sutherland had 14 points, eight rebounds, a block and a career-high four assists, while Davis contributed 18 points and eight boards.
The two inside players combined for 24 points and 13 rebounds in the second half alone in front of a Qwest Center crowd of 1,758.
Kansas improved to 11-1, while Creighton fell to 6-4.
KU led by as many as 12 points in the first half, but the Blue Jays rallied and trailed by just seven, at 29-22, at halftime.
Then Creighton opened the second half with a 9-0 run.
The Blue Jays led by as many as four, with 13:25 to go, but KU built its lead to 50-43 and held on.
Angel Goodrich put in a season-high 12 points for the Jayhawks.
Kelsey Woodard led Creighton with a game-high 21 points.
Kansas shot 44.8 percent overall, but just 27.3 from three-point range while holding the Blue Jays to 37.7-percent shooting and 29.4-percent shooting form three.
Kansas will close out 2010 with a New Year's Eve meeting with UT-Arlington.
Tipoff is 7 p.m. at Allen Fieldhouse.


text:
According to World Bank data, more people visit abroad from the UK than from any other country other than China.
The thing is, we don't tend to travel that far from home!
According the ONS 2012 Travel Trends the number of visits abroad by UK residents was 56.5 million, broadly equivalent to one visit abroad per person per year (although no doubt the distribution is nowhere near equal!).
What's interesting, however, is just how close to home most of these visits are:
- Nearly 20 million, or 34% of all visits are to Spain or France
- About 38 million visits, or about two thirds of total visits are to just 10 countries, made up 8 countries in Europe plus America and Turkey.
- This means that just 20 million visits, which will be considerably less than one third of the UK population, venture to more exotic destinations, and many of those 20 million visits are likely to be 'safe' western-style hotels in countries such as Egypt.
Given all of this, I think it's safe to say that tourism trends are more regional than truly global. True global travelers are very much the exception.


text:
Bhalukpong is the entry point to Arunachal and is 56 kms from Tezpur. The place is famous for archaeological ruins of King Bhaluka who was the grandfather of King Bana of Mahabharata fame and an ancient ruler of the region. A historical fort of 10th-12th Century AD is situated in the foothills of the region and one can see the stone remains of the fort. Some important remains of King Bahluk's capital and his grandson Bana are preserved here.
Amazing Bhalukpong and Tawang Tour Package
1N Bhalukpong , 1N Dirang , 2N Tawang , 1N Bomdila and 1N GuwahatiHotels
What's Included
Car Details
Road transport from Guwahati - A/C Vehicle
Hotel Details
Hotel options available in the package
Destination | Nights | Hotel and Room | Meals |
Bhalukpong | 1 night(s) |
Prashanti cottage
Standard Room
Room only |
Dirang | 1 night(s) |
Hotel Pemaling
Standard Room
Room only |
Tawang | 2 night(s) |
Hotel Gakyi Khang Zhang
Standard Room
Room only |
Bomdila | 1 night(s) |
Tsepal Yangjom
Standard Room
Room only |
Guwahati | 1 night(s) |
Landmark Hotel
Standard Room
Room only |
Sightseeing and Transfers
Other inclusions available in the package
- Inner Line Permits for Arunachal Pradesh
- All transfers by 01 Private vehicle as per itinerary
- Sightseeing as per itinerary
Day Wise Itinerary
Here is how you will spend your time
Day 1
Day 1: Arrival At Guwahati And Transfer To Bhalukpung
Welcome on arrival at Guwahati airport / Railway station. Transfer to Bhalukpong and overnight.
Day 2
Day 2: Bhalukpung To Dirang
After breakfast drive to Dirang. Enroute visit Tippi Orchid Centre. check in hotel. Evening at Leisure. Overnight stay at Dirang.
Day 3
Day 3: Dirang To Tawang
Morning drive to Tawang. Enroute witness the snowcapped Sella Pass at 14000 ft and the Jaswant Garh War Memorial. (Legend has it that Jaswant (Mahavir Chakra Awardee (Posthumous) of 4th Batallion Garhwal Rifles), fought a lone battle against the invading Chinese during the 1962 war. His spirit is still believed to protect the place). Overnight in Tawang.
Day 4
Day 4: In Tawang
Tawang. The beautiful land of the Monpa tribes with the "Galden Namgyel Lhatse" Monestary - one of the largest Lamaseries of Mahayana sect in Asia. The birth place of the 6th Dalai Lama, the Monastery is 400 year old and is adorned with the 18 feet high statue of Lord Buddha. The Land of Dawn lit Mountains' at 3500 mts gives you unparallel purity of nature. Visit the monastery and the War Memorial. Evening free for shopping. Overnight stay in Tawang
Day 5
Day 5: Tawang To Bomdila
Morning drive back to Bomdila. Evening free at leisure. Overnight in Bomdila.
Day 6
Day 6: Bomdila To Guwahati
After breakfast drive to Guwahati. Check in hotel. Overnight stay in Guwahati
Day 7
Day 7: Departure To Guwahati Airport
Morning visit kamakhya temple. In time transfer to Guwahati airport for onward journey. Tour ends here.
Hotels Included
Prashanti cottage
Bhalokpong, Dist. Sonitpur, Bhalukpong, India, Bhalukpong
Hotel Pemaling
Hotel Pemaling, near Petrol Pump, Narangchilo, P.O. & P.S -790 101,, Dirang
Hotel Gakyi Khang Zhang (3 star)
Near D.C.Office - 790104, Arunachal Pradesh, Tawang
Tsepal Yangjom (3 star)
Main Bazarline Bomdila, District-West Kameng Arunachal Pradesh - 790 001, Bomdila
Landmark Hotel (3 star)
Dr B Barooah Road, 781007, Guwahati, Assam, Ulubari, Guwahati, Assam 781007, Guwahati
Cancellation Policy
- The package once booked is refundable and cancellable.
- Flight cancellation will be as per airline cancellation policy.
- Date of booking to 30 days before travel the cancellation charges will be 10% of the tour cost
- 30 to 15 days before travel - cancellation charges will be 50% of the tour cost
- 15 to 7 days before travel - cancellation charges will be 75% of the tour cost
- 0 to 7 days before travel - cancellation charges will be 100% of the tour cost. No refund shall be given
- Please note cancellation policy is subject to change. It depends on the hotel policy. In peak season, some hotels may charge 100% cancellation.
Additional Information
- Check-in at hotel starts from 14:00 hrs.
- Check-out time is until 12:00 hrs.
- Early check-in or late check-out is subject to availability and may be chargeable by the hotel.
- Once your payment has been processed, we will send you an email confirmation.
- You will receive all travel vouchers required for your flights and accommodation shortly afterwards.


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A record high consumption of electricity for the recent 20 years was registered in Bulgaria.
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by Cherie Foster
(note: Cherie, from Perth, Western Australia, attended her first food run August 24th-26th, 2010 at Oljato and Navajo Mountain. See her previous blog for reflections on her overall experience coming to Utah and working with ANE.)
I left Salt Lake City for the Oljato-Navajo Mountain fall food run with a deeply saddened heart due to the passing of someone very dear to me three days prior. If it wasn't for this person I wouldn't have had the strength, courage and perseverance to end up at a food run in another country. It is no coincidence that this special one, who influenced my life so remarkably, had Native American ancestry. Such is the beauty, majesty and magic of the Native American culture, miracles occurring always around us as a whisper to our souls, if we listen with peace and love in our hearts. On the journey of life people appear and change our lives, often dramatically. This beautiful soul has done this for me, and his memory will always have a special place in my extremely grateful heart.
It took about seven hours drive south of Salt Lake City to arrive at our overnight destination of Mexican Hat. The volunteers, who drive their own cars, meet with food run coordinators Linda and Wendy once everyone is checked in . We all gathered under a large shady tree, a welcome respite from the heat, overlooking the expansive river gorge. On the other side of the gorge, the Navajo Reservation begins.
After Linda breathed a sigh of relief that all drivers, cars and supplies had arrived safely, we prepared for the ceremony. Women were to wear their long skirts, which they had brought to wear on the food runs. The Navajo women traditionally wear long skirts, so to respect their culture, this is what the volunteer women wear. The men wear long pants or jeans for the same reason.
As we lined up to be smudged by Beverly, a long serving volunteer, a hummingbird hovered over our heads then darted off. I had not experienced one that close, and it was a little intimidating, yet exhilarating! I knew a little of a hummingbird presence meaning 'magic of a joyful heart' in Lakota tradition, and the sighting was confirmation of what I already felt amongst the group.
As we entered the ceremony area, we were to place any items to be blessed on the edge of the skin in the centre. I had recently been gifted four fetishes by another dear friend, Cheryl, so I placed these there. She had given me a horse, turtle, horny toad and a bear, some of which were to appear symbolically later in my journey to teach me lessons.
The theme for the 2010 fall food runs was Harvest God. We were all asked to contribute our own story about a seed we had planted which could be an idea, a project, an activity, or a practice. There were tears from many in the circle as their stories were told. It felt healing, even in the company of strangers, for as Jay Tavare had told me 'The hearts of everyone have a bond', and that is especially evident in the ceremony at the commencement of a food run. The ceremony went for about two hours in the picturesque gardens of the hotel, watched over by two mourning doves.
Dawn the next morning brought forth a glorious full moon, perfect for photographs with the surrounding rock formations. We all assembled for breakfast in the hotel restaurant, anticipation and excitement in the air, especially for those of us attending our first food run. We drove out in convey, in specific order, to enable cars loaded with boxes and supplies for the first food run drop off at Oljato, to be in front. As soon as we crossed the bridge we were on the Reservation and stopped to have the cars smudged again by Beverly.
It was at that moment, waiting to see the smoke from the blessing, that I saw the boxes loaded in the car in front with numbers (indicating particular Elders) with one in my hand writing, I realized that I was about to see the conclusion of the learning I'd done during the three previous weeks at the ANE offices. I'd seen the orders come in on the computer, in the mail, even taken some over the phone, and now was about to experience the final destination of all the work that goes into providing the Navajo Elders with nourishment for their physical, mental, spiritual and emotional well being.
Driving to Oljato through Monument Valley was spectacular. The colours of the rock formations are exquisite. Photographs do not give the full scope of this expansive beauty. I think it took around thirty minutes to drive to Oljato. I was enjoying the scenery too much to notice the time! I saw many different crows along the way. I saw dogs guarding and guiding a flock of sheep, which we had to slowly navigate through. Seeing donkeys and horses roaming freely without fencing was wonderful.
We arrived at the Oljato Chapter house, and there were Elders already inside waiting! There was a sign stating only those with invitations only are to attend, as others who aren't in the program do show up sometimes. They are provided with lunch that everyone receives but there are protocols that must be adhered to before an Elder can be accepted in the ANE program.
The cars were unloaded by the men. They do a fantastic job working in the heat. Food, medical, Grandma, Grandpa, and Children's boxes, Bluebird flour, and some fresh produce such as potatoes and onions are all stacked in cars and vans. Boxes are stacked in numerical order to be marked off with the checking of the name tag that the Elders are given and must be wearing to ensure everything is authenticated.
Inside, the women unpacked giveaways and put them on display. Once that was done introductions were done by Bessie, the Navajo translator. It was fantastic to hear her talk. I was introduced as being a volunteer from Australia, and they all seemed shocked! Food certificates from sponsors were given out. A couple of games were played with Linda calling upon Elders. It was hilarious. They seemed to enjoy themselves. It is like a party for them. After all the formalities were done the Elders were given a large plastic bag with which to receive gifts. Volunteers took giveaways which the program had bought such as shampoo, cookies, socks, bandannas, warm jackets, kitchen and laundry items and many other gifts. Then the volunteers served lunch. After lunch there were items for sale such as jewelry and rugs. I bought a few pieces from different sellers and was gifted a cedar bead necklace from a woman I had purchased from. I was touched by her generosity. While the volunteers shopped and cleaned up, Linda and Wendy had purchased items they could sell for the Elders. Meanwhile outside, the men were loading boxes into cars.
During the morning I had listened to the Elders greeting each other and talking amongst themselves and sometimes with a sponsor and translator. It is a wonderful experience to see the connection and to listen to the beautiful language. I was thrilled to absorb those moments and tell myself that I really was there, the place I'd been dreaming of being for a couple of years.
In the afternoon we headed to our next overnight destination at Kayenta. Mostly people headed to the Holiday Inn for dinner, but I was excited to have an authentic Navajo taco at the Golden Sands cafe behind our hotel! Locals were everywhere, which made it feel even more special. Fientje, whom I had driven with, has done the food run and many others before, so she knows where to go and has extensive knowledge, which I was eager to listen to. We had a wonderful dinner.
Next morning we headed to our final destination of Navajo Mountain. As I breakfasted outside, enjoying the beauty of sunrise, I again saw a crow fly back and forth. I hadn't seen any since arriving in Salt Lake City, three weeks ago, so was thrilled to have seen so many on the Reservation. We headed to a car park of a shopping centre, where the cars were again smudged by Beverly, which was different to yesterdays scenic smudging! It took longer to reach Navajo Mountain and a different landscape, yet still beautiful.
We arrived and set up as the previous day; those of us on our first food run, now knew the routine.
While waiting for some of the Elders to arrive I greeted some Elders and tried to do my best with the Dine greeting of 'ya at eeh', but I'm not sure how it sounded with an Australian accent!
An Elder woman I met who was accepted to the program on this day started talking to myself and John the photographer ,and when John went to take pictures, we kept talking. She then pulled out two lovely necklaces she had made and said she would like to gift me one and I was to choose. I was surprised and overwhelmed by her kindness! I checked about protocol of being able to accept it or if it was for the program. She had told me before bringing out the necklace that her fingers were getting difficult to work, and this also affected her weaving. The translator this time was Mary who I had met previously in Salt Lake City. She knows of my Elders at Big Mountain, so it was nice to see her again. After I'd been introduced again to the Elders after the formalities, one of the Elders Morris, presented me with a beautiful cedar bead necklace. I couldn't believe it! These people who have so little are extremely generous.
The people of Navajo Mountain had a different energy from the Oljato group of Elders. I asked other volunteers if this was typical of other food run destinations. Apparently it is. Each place has a different feel and of course it is in part due to the individuals and their personalities.
At the end of the day when we did our closing Ceremony circle, one of the Elder women, she was a tiny woman, around the height of a child, came and started talking nonstop in Navajo. She was precious and adorable, even if we could not understand a word of what she said! When we finally located her relative, I asked her age and was astounded when he said eighty nine and she was his mother!
I left Navajo Mountain and the Reservation with renewed vigour of what you can bring to the world and what it can bring to you. Interaction in the world with the gift of giving, helps heal the giver and the recipient.
Fientje, my dear friend and driver, and I reflected on the food run as we drove off the Reservation. She asked me what I was feeling, and I responded that I felt tranquil, serene, and peaceful. Really, the feeling cannot adequately be put into words. She said every time she attends a food run she comes away with this feeling. You need to experience it for yourself. Go on a food run with an open heart, and you will be fulfilled beyond measure. Only you with your individual circumstances and where you are on the journey of your life, can obtain from this extraordinary interaction.
Thursday, November 25, 2010
1 comment:
- AnonymousDecember 7, 2010 at 3:11 PM
Another beautifully written article, Cherie. Thanks for sharing your experiences; I'm so looking forward to my first food run!
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Hahaha! I loved it, so funny! Seriously though, I think it could work on some level, but I wouldn't want The Office to suffer from Charlie Sheen's problems the way Two and a Half Men did (postponing filming etc).
- Jimbo
Charlie Sheen replacing Steve Carell would be GLORIOUS!!!!! I think he has what it takes. But knowing this is an April fools joke, one can only wonder lol.
- megan
that was hilarious! XD
- Alison
I echo Michael's thoughts at the end :)
- Dirk
The April Fools Day Prank is an Office Tally tradition I look forward to every year. You rock Tanster!
[from tanster: thank you! although i don't consider this a prank. i actually had something else planned, but it was not to be. maybe next year. :) ]
- Emma89
Totally agree with MIchael at the end haha!! I love The Office but I would never be able to watch again if this really happened.
- Julie
OMG I WAS AT SCHOOL WHEN I READ IT AND I GOT SO EXCITED I SCREAMED! but i wasn't supposed to be on office tally so it kinda backfired :( boo!
- soup snake
Oh geez I was so scared when I saw this headline! I'm so glad this is just a joke. I don't think I'd be able to stand Charlie Sheen on The Office after his recent behavior.
- TheOfficeROCKS
Thank God it isn't true! Pretty funny though!
- JimisBigBird
lol Just what the Office needs! Some neurotic delusions of grandeur with a side of crazy. Keep that sinking ship away from our show.
- Aimee
YAY! for the yearly Office Tally April Fools joke :D
- Thomas
Does anyone want to come over and watch "Justified" with me tonight?


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Looking for a used, new, second-hand or ex-hire MultiMix 16 FireWire? We may be able to help. Click here to see if we can help you find it.
The Alesis MultiMix 16 FireWire mixer features the best of both the analog and digital worlds. Delivering multi-channel audio recording to your Mac or PC through the integrated FireWire audio interface, while providing intuitive analog mixing capability, the MultiMix 16 FireWire is an integral part ...
Brand | Alesis |
Category | Analog Mixing Consoles |
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Tiny bites of wisdom from a therapy assist Chihuahua with angel wing markings on his back...
Wednesday, April 9, 2014
Wordless Wednesday: Chihuahua Razzberry
Can you caption my razzberry?
(my momma doesn't know how to spell the sound one makes during a razzberry)
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Hi this is this first time I've ever posted in a forum so forgive me if its not perfect! I'm having trouble with finding podcasts I've downloaded from iTunes. I'm not completely stupid, I do check my iTunes library, I've clicked every button, I've also tried searching them in the search bar. All the downloads have been from my iPad to my iPad - no syncing between devices. Has anyone else had troubles? Hellllppppp Thanks in advance :thumbs::thumbs:
Hi and welcome to the Forum! Are they video or audio podcasts? Look in either your Music or Video app......hope they are there, if not let us know. The IPad Forum is a community of members from all walks of life and from all over the world coming together to share our experiences and to help each other learn about this wonderful piece of technology the Ipad. There is a wealth of information already here in the many threads we have so doing some searches will answer most of the questions you have. If then you cannot find the answer you are seeking then by all means post your question. There are many friendly and informed members here only too willing to help you. We also have our own App - It is a very simple app to navigate. http://itunes.apple.com/us/app/discussion-forum-for-ipad/id412896524?mt=8 Reading the IPad manual is a great place to start so please download a copy of these. http://www.support.apple.com/manuals/ipad/ 2 very informative threads from which you will learn many tips and shortcuts for the IPad. http://www.ipadforums.net/ipad-general-discussions/21590-tips-tricks-those-us-who-dont-know.html http://www.ipadforums.net/ipad-os/49581-ios5-tips-tricks.html We have rules like any Community so please read these also http://www.ipadforums.net/forum-rul...um-rules-everybody-please-read.html#post14697 Once again we welcome you here and are so pleased you have joined us! iPad 2 3G 64gb


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Comb Filter by Warmonger is a Virtual Effect Audio Plugin for Windows. It functions as a VST Plugin.
Product | Comb Filter |
Developer | Warmonger |
Price (MSRP) | Free |
Type / Tags |
Plug-in, App & Soundware Format(s)
Effect(s) |
Operating System Availability
Operating System |
Latest Version |
Download | Released |
2.0 | Download |
Miscellaneous Information
Copy Protection | None |
Max. 6 items
Latest Version Changes [view all]Small utility - the very simple comb filter with feed-forward topology. Well-defined characteristics and minimal CPU usage.
Use it on percussion to spice up the mix or just as utility effect anywhere in the track.
- Positive or negative ratio allows to filter out odd or even harmonics, respectively.
- Precise control.
- Minimal CPU usage.
User Rated
Discussion: Active
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