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Act IThe steamboat El Dorado is sailing down the Amazon in the early 1900s. The passengers are travelling to hear the legendary but intensely private opera singer Florencia Grimaldi sing at the reopening of the theatre in Manaus. Riolobo, a mystical character who can assume many forms introduces the embarking passengers: Paula and Alvaro, a middle-aged couple attempting to rekindle their marriage; Rosalba, a journalist researching a biography on Grimaldi; and Florencia herself, travelling alone and incognito, harboring a burning desire to find her long-lost lover Cristóbal, a butterfly-hunter, whose love unlocked her staggering powers of musical expression.
Once en route, Rosalba accidentally drops her research notes overboard. The Captain's nephew, Arcadio manages to rescue them, and the pair becomes aware of a strong mutual attraction. The evening concludes as Paula and Alvaro's attempt at a romantic dinner dissolves into a bitter quarrel. Initially unaware of her identity, the Captain tells Florencia of the fate of Cristóbal, who disappeared without trace in the jungle, thus dashing her dearest ambition. As a heated card game brings out the contrasting sexual and hostile tensions between Rosalba and Arcadio, and Paula and Alvaro, a violent storm brews outside. In saving the ship from being crushed, Alvaro is swept overboard; the Captain is knocked unconscious and despite Arcadio's efforts at the helm, the ship runs aground.
Act IIPaula mourns the loss of Alvaro, realizing that it was pride and not lack of love that stood between them. Riolobo appears again mysteriously to return Alvaro to the ship, claiming that Paula's laments saved him from death. Rosalba, distraught that her notebook has been ruined in the storm, talks to the incognito Florencia about her research. During the ensuing discussion on Grimaldi, Florencia declares passionately that Grimaldi's gift was a result of her love for Cristóbal. Rosalba realizs that she is talking to her heroine and, hearing her story, decides her own love for Arcadio shouldn't be suppressed.
[Catán's] FLORENCIA has found favor with other companies than HGO, but I fear it is still underestimated. Its richly lyrical score echoes previous strains of neo-Romanticism, but establishes its own determined voice as well.
Recordings should make this Spanish-language opera a standard the world over.
The music glistens like sun on the river; it is graceful and ravishing. And, in case you haven't figured it out, it's absolutely tonal...in the face of such exquisite music, music that drinks the listener in sensually...it flows and flows, uninterrupted...I'm enchanted. This is a gorgeous, fascinating, familiar-yet-new experience, and I recommend it to everyone.
The Spanish-language libretto tells how five people find meaning, fulfillment and transcendence during a boat trip down the Amazon. Catán's luxuriantly colorful score blends Puccini, Ravel and a whiff of Villa-Lobos, and gives the singers lots of opportunities for ripe, soaring melodies.
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This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http://cancer.gov or call 1-800-4-CANCER.
(Refer to the PDQ summary on Unusual Cancers of Childhood for information on thymoma in children.)
Disease Overview
Thymomas and thymic carcinomas are epithelial tumors of the thymus. The term, thymoma, is customarily used to describe neoplasms that show no overt atypia of the epithelial component. A thymic epithelial tumor that exhibits clear-cut cytologic atypia and histologic features no longer specific to the thymus is known as a thymic carcinoma (also known as type C thymoma).[1]
Incidence and mortality
Invasive thymomas and thymic carcinomas are relatively rare tumors, which together represent about 0.2% to 1.5% of all malignancies.[2] The overall incidence of thymoma is 0.15 cases per 100,000, based on data from the National Cancer Institute Surveillance, Epidemiology and End Results (SEER) Program.[3] Thymic carcinomas are rare and have been reported to account for only 0.06% of all thymic neoplasms.[4] In general, thymomas are indolent tumors with a tendency toward local recurrence rather than metastasis. Thymic carcinomas, however, are typically invasive, with a higher risk of relapse and death.[5,6]
Age at onset
Most patients with thymoma or thymic carcinoma are aged 40 through 60 years.[7]
Unique disease features
The etiology of these types of tumors is not known. In about 50% of the patients, thymomas/thymic carcinomas are detected by chance with plain-film chest radiography.[7]
Ninety percent of thymomas and thymic carcinomas occur in the anterior mediastinum.[8] They are the most common malignancies of the anterior mediastinum.[9]
World Health Organization pathologic classification of tumors of the thymus and stage correlate with prognosis.[1] Although some thymoma histologic types are more likely to be invasive and clinically aggressive, treatment outcome and the likelihood of recurrence appear to correlate more closely with the invasive/metastasizing properties of the tumor cells.[1,10] Therefore, some thymomas that appear to be relatively benign by histologic criteria may behave very aggressively. Independent evaluations of both the tumor invasiveness (using staging criteria) and tumor histology should be combined to predict the clinical behavior of a thymoma.
Thymoma and thymic carcinoma should be differentiated from a number of nonepithelial thymic neoplasms, including the following:[1,11]
Thymoma-associated autoimmune disease involves an alteration in circulating T-cell subsets.[12,13] The primary T-cell abnormality appears to be related to the acquisition of the CD45RA+ phenotype on naive CD4+ T cells during terminal intratumorous thymopoiesis, followed by export of these activated CD4+ T cells into the circulation.[14] In addition to T-cell defects, B-cell lymphopenia has been observed in thymoma-related immunodeficiency, with hypogammaglobulinemia (Good syndrome) and opportunistic infection.[15,16] Patients with thymoma-associated myasthenia gravis can produce autoantibodies to a variety of neuromuscular antigens, particularly the acetylcholine receptor and titin, a striated muscle antigen.[17,18]
Approximately 50% of thymomas are diagnosed when they are localized within a capsule and do not infiltrate.
At the time of diagnosis, the majority of patients with thymoma or thymic carcinoma are asymptomatic.[7] Typical clinical symptoms and signs that are indicative of anterior mediastinal mass effects include the following:
Paraneoplastic autoimmune syndromes are associated with thymoma and are rarely associated with thymic carcinomas.[19,20,21]
Other autoimmune disorders associated with thymoma include the following:[7,15,24]
Prognosis and Survival
Although the oncologic prognosis of thymoma is reported to be more favorable in patients with myasthenia gravis than in patients without myasthenia gravis,[8,25] data are conflicting as to whether the presence of myasthenia gravis is an independent predictor of better outcome. Patients with myasthenia gravis are diagnosed with earlier stage disease and more often undergo complete surgical resection.[25] Treatment with thymectomy may not significantly improve the course of thymoma-associated myasthenia gravis.[26,27]
Thymoma has been associated with an increased risk for second malignancies. In a review of the SEER database of thymoma cases in the United States between 1973 and 1998, 849 cases were identified (overall incidence 0.15 per 100,000 person-years).[3] In this study, there was an excess risk of non-Hodgkin lymphoma and soft tissue sarcomas.
Risk of second malignancy appears to be unrelated to any of the following:[3,27,28]
Standard primary treatment for patients with these types of tumors is surgical resection with en bloc resection for invasive tumors, if possible.[5,7,8,29] Depending on tumor stage, there are multimodality treatment options, which include the use of radiation therapy and chemotherapy with or without surgery.[7,30]
Thymic carcinomas have a greater propensity to capsular invasion and metastases than thymomas. Patients more often present with advanced disease, with a 5-year survival of 30% to 50%.[31] Owing to the paucity of cases, optimal management of thymic carcinoma has yet to be defined. As with thymoma, primary treatment is surgical resection; however, multimodality treatment with surgery, radiation, and chemotherapy are often used because of the more advanced stage and greater risk of relapse.
Because of the increased risk for second malignancies and the fact that thymoma can recur after a long interval, it has been recommended that surveillance should be lifelong.[27] The measurement of interferon-alpha and interleukin-2 antibodies is helpful to identify patients with a thymoma recurrence.[32]
The following cellular classification of thymoma and thymic carcinoma is largely based on the classification scheme presented in a World Health Organization (WHO) monograph published in 1999.[1] Malignant thymoma is invasive disease (as defined either macroscopically or microscopically) that continues to retain typically "bland" cytologic characteristics. Thymomas are a mixture of epithelial cells and lymphocytes, often T-cells, and the malignant component is represented by the epithelial cells. Malignant cytologic characteristics are considered thymic carcinomas.
Both histologic classification of thymomas and stage may have independent prognostic significance.[2,3] A few series have reported the prognostic value of the WHO classifications. In large retrospective analyses of 100 and of 178 thymoma cases, disease-free survivals at 10 years were 95% to 100% for type A, 90% to 100% for type AB, 83% to 85% for type B1, 71% to 83% for type B2, 36% to 40% for type B3, and 28% for type C.[4,5] In both series, stage and complete resection were significant independent prognostic factors. An analysis of 273 patients treated over a 44-year period found 20-year survival rates of 100%, 87%, 91%, 59%, and 36% for patients with type A, AB, B1, B2, and B3 tumors, respectively.[2]
Recurrent karyotype abnormalities have been documented in thymomas.[6] Type A thymomas have chromosome 6q deletions including the HLA locus and p21. Type B2 and B3 thymomas have additional chromosome 5q (adenomatous polyposis coli locus), 13q (retinoblastoma locus), and 17p (p53) deletions.[7] Amplifications in regions of chromosome 16 (cadherin-encoding gene) and chromosome 18 (bcl-2) have also been seen.[8] Gene expression profiling study has shown a correlation of expression of a number of genes including adhesion molecule cten, ets-1 oncogene and glycosylphosphatidyl inositol-anchored protein with thymoma stage.[9,10,11]
Thymoma is a thymic epithelial tumor in which the epithelial component exhibits no overt atypia and retains histologic features specific to the normal thymus.[1] Immature non-neoplastic lymphocytes are present in variable numbers depending on the histologic type of thymoma. The histologic types of thymoma are as follows:
Type A thymoma (also known as spindle cell thymoma and medullary thymoma) accounts for approximately 4% to 7% of all thymomas.[2,3] Approximately 17% of this type may be associated with myasthenia gravis.[2] Morphologically, the tumor is composed of neoplastic thymic epithelial cells that have a spindle/oval shape, lack nuclear atypia, and are accompanied by few, if any, nonneoplastic lymphocytes.[1] The appearance of this tumor can be confused with that of a mesenchymal neoplasm, but the immunohistochemical and ultrastructural features are clearly those of an epithelial neoplasm. Most type A thymomas are encapsulated (see Stage Information). Some, however, may invade the capsule and, on rare occasion, may extend into the lung. Chromosome abnormalities, when present, may correlate with an aggressive clinical course.[12] The prognosis for this tumor type is excellent and have long-term survival rates (15 years or more) that are reported to be close to 100% in retrospective studies.[2,3]
Type AB thymoma (also known as mixed thymoma) accounts for approximately 28% to 34% of all thymomas.[2,3] Approximately 16% of this type may be associated with myasthenia gravis.[2] Morphologically, type AB thymoma is a thymic tumor in which foci having the features of type A thymoma are admixed with foci rich in nonneoplastic lymphocytes.[1] The segregation of the different foci can be sharp or indistinct, and a wide range exists in the relative amount of the two components. The prognosis for this tumor type is good and have long-term survival rates (15 years or more) that are recently reported to be approximately 90%.[2,3]
Type B1 thymoma (also known as lymphocyte-rich thymoma, lymphocytic thymoma, predominantly cortical thymoma, and organoid thymoma) accounts for approximately 9% to 20% of all thymomas and depends on the study cited.[2,3] Approximately 57% of cases may be associated with myasthenia gravis.[2] Morphologically, this tumor resembles the normal functional thymus because it contains large numbers of cells that have an appearance almost indistinguishable from normal thymic cortex with areas resembling thymic medulla.[1] The similarities between this tumor type and the normal active thymus are such that distinction between the two may be impossible on microscopic examination. The prognosis for this tumor type is good and has a long-term survival rate (20 years or more) of approximately 90%.[2,3]
Type B2 thymoma (also known as cortical thymoma and polygonal cell thymoma) accounts for approximately 20% to 36% of all thymomas and depends on the study cited.[2,3] Approximately 71% of cases may be associated with myasthenia gravis.[2] Morphologically, the neoplastic epithelial component of this tumor type appears as scattered plump cells with vesicular nuclei and distinct nucleoli among a heavy population of nonneoplastic lymphocytes.[1] Perivascular spaces are common and on occasion very prominent. A perivascular arrangement of tumor cells that results in a palisading effect may be seen. This type of thymoma resembles type B1 thymoma in its predominance of lymphocytes, but foci of medullary differentiation are less conspicuous or absent. Long-term survival is decidedly worse than for thymoma types A, AB, and B1. The 20-year survival rate (as defined by freedom from tumor death) for this thymoma type is approximately 60%.[2]
Type B3 thymoma (also known as epithelial thymoma, atypical thymoma, squamoid thymoma, and well-differentiated thymic carcinoma) accounts for approximately 10% to 14% of all thymomas. Approximately 46% of this type of tumor may be associated with myasthenia gravis.[2] Morphologically, this tumor type is predominantly composed of epithelial cells that have a round or polygonal shape and that exhibit no atypia or mild atypia.[1] The epithelial cells are admixed with a minor component of nonneoplastic lymphocytes, which results in a sheet-like growth of neoplastic epithelial cells. The 20-year survival rate (as defined by freedom from tumor death) for this thymoma type is approximately 40%.[2]
Thymic Carcinoma
Thymic carcinoma (also known as type C thymoma) is a thymic epithelial tumor that exhibits a definite cytologic atypia and a set of histologic features no longer specific to the thymus but rather similar to those histologic features observed in carcinomas of other organs.[1] In contrast to type A and B thymomas, thymic carcinomas lack immature lymphocytes. Any lymphocytes that are present are mature and usually admixed with plasma cells. Hypothetically, thymic carcinoma may arise from malignant transformation of a pre-existing thymoma.[13] This hypothetical evolution could account for the existence of thymic epithelial lesions that exhibit combined features of thymoma and thymic carcinoma within the same tumor.[14]
Thymic carcinomas are usually advanced when diagnosed and have a higher recurrence rate and worse survival compared with thymoma.[15,16] In a retrospective study of 40 patients with thymic carcinoma, the 5-year and 10-year actuarial overall survival rates were 38% and 28%, respectively.[15] In contrast to the thymomas, the association of thymic carcinoma and autoimmune disease is rare.[17]
Histologic subtypes of thymic carcinoma include the following:
This type of thymic carcinoma exhibits clear-cut cytologic atypia. In routinely stained sections, the keratinizing form exhibits equally clear-cut evidence of squamous differentiation in the form of intercellular bridges and/or squamous pearls, while the nonkeratinizing form lacks obvious signs of keratinization. Another subtype, basaloid carcinoma, is composed of compact lobules of tumor cells that exhibit peripheral palisading and an overall basophilic staining pattern caused by the high nucleocytoplasmic ratio and the absence of keratinization.
This type of thymic carcinoma has morphologic features indistinguishable from those of lymphoepithelial carcinoma of the respiratory tract. The differential diagnosis with germ cell tumors, particularly seminomas, can be difficult but important for treatment.
This is a type of thymic carcinoma in which part or all of the tumor resembles one of the types of soft tissue sarcoma.
This is a type of thymic carcinoma composed predominantly or exclusively of cells with optically clear cytoplasm.
This type of thymic carcinoma has an appearance similar to that of mucoepidermoid carcinoma of the major and minor salivary glands.
This type of thymic carcinoma grows in a papillary fashion. This histology may be accompanied by psammoma body formation, which may result in a marked similarity with papillary carcinoma of the thyroid gland.
This is a rare type of thymic carcinoma that grows in a solid undifferentiated fashion but without exhibiting sarcomatoid (spindle cell or pleomorphic) features.
Combined Thymoma
Combinations of the above histologic types can occur within the same tumor. For these cases, the term combined thymoma can be used, followed by a listing of the components and the relative amount of each component.[1]
Computed tomography (CT) with intravenous contrast may be useful in the diagnosis and clinical staging of thymoma, especially for noninvasive tumors. CT is usually accurate in predicting the following:
However, CT cannot predict invasion or resectability with accuracy.[1,2] Appearance of the tumor on CT may be related to the World Health Organization (WHO) histologic type.[3] A retrospective study involving 53 patients who underwent thymectomy for thymic epithelial tumors indicated that smooth contours and a round shape are most suggestive of type A thymomas, whereas irregular contours were most suggestive of thymic carcinomas. Calcification was suggestive of type B thymomas. In this study, however, CT was found to be of limited value differentiating type AB, B1, B2, and B3 thymomas.[4]
Most patients with thymic carcinomas present initially with any of the following:
Patients may have evidence of invasion of contiguous mediastinal structures at presentation. Thymic carcinoma can metastasize to any of the following:
An evaluation for sites of metastases may be warranted for these patients.
Positron emission tomography of 18-flouro-deoxyglucose (FDG-PET) as well as thallium single-photon emission computed tomography have been reported in small series for diagnosis and evaluation of therapeutic outcomes in thymic carcinoma.[5,6,7,8] Two small series reported that FDG uptake was related to the invasiveness of thymic carcinoma.[7,8] This raises the possibility of FDG-PET utilization for diagnosis, treatment planning, and monitoring for recurrence. Sensitivity, specificity impact on clinical therapeutic decisions, remains to be defined.
Histologic classification of thymoma is not sufficient to distinguish biologically benign thymomas from malignant thymomas. The degree of invasion or tumor stage is generally thought to be a more important indicator of overall survival.[1,9,10]
Evaluating the invasiveness of a thymoma involves the use of staging criteria that indicate the presence and degree of contiguous invasion, the presence of implants, and lymph node or distant metastases regardless of histologic type. Although no standardized staging system exists, the one proposed by Masaoka in 1981 is commonly employed.[11] It was revised in 1994 and is shown below.[11]
Application of this staging system to a series of 85 surgically treated patients confirmed its value in determining prognosis, with 5-year survival rates of 96% for stage I disease, 86% for stage II disease, 69% for stage III disease, and 50% for stage IV disease.[11,13] In a large retrospective study involving 273 patients with thymoma, 20-year survival rates (as defined by freedom from tumor death) according to the Masaoka staging system were reported to be 89% for stage I disease, 91% for stage II disease, 49% for stage III disease, and 0% for stage IV disease.[9]
In a retrospective analysis of 130 resected thymoma patients, the WHO pathological classification was tightly correlated with stage and by multivariate analysis, tumor size, completeness of resection, histologic subtype, and stage were significant prognostic factors for survival. Of note, only four patients received neoadjuvant cisplatin-based chemotherapy and complete resection was possible in 95% of cases. The 5-year survival rate of the 11 stage IV patients was 47%.[12]
Some investigators maintain that the Masaoka staging system does not accurately predict outcome for thymic carcinoma.[14,15] In one retrospective study evaluating 43 cases of thymic carcinoma, prognosis was found to be dependent solely on tumor invasion of the innominate artery.[15]
Most thymomas are diagnosed and staged at the time of surgical intervention. Surgical resection is the preferred treatment of patients who can tolerate surgery and have a mediastinal mass that is suspected of being a thymoma. A complete surgical resection is recommended for patients with either stage I or stage II disease. A complete resection of all tumors can be achieved in nearly all stage I and stage II patients and in 27% to 44% of stage III patients. Postoperative radiation therapy is generally employed for stage II and stage III patients. Patients with stage IVa disease can only rarely be resected completely and are usually offered debulking surgery and postoperative radiation therapy with or without chemotherapy.
Thymic Carcinoma
The optimal treatment of thymic carcinoma remains undefined because of its rarity. Most patients with thymic carcinomas present initially with any of the following:
Most patients with thymic carcinoma have evidence of invasion of contiguous mediastinal structures at presentation.
Thymic carcinoma can metastasize to the following areas:
Treatment options include the following:[1]
For patients with clinically resectable disease, surgical resection is often the initial therapeutic intervention. For clinically borderline or frankly unresectable lesions, neoadjuvant (preoperative) chemotherapy or thoracic radiation therapy, or both, is given.[2] Patients presenting with locally advanced disease should be carefully evaluated and undergo multimodality therapy. Patients with poor performance status and high associated operative risks are generally not considered for these types of aggressive treatments. Patients with metastatic disease may respond to combination chemotherapy.
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with thymoma and thymic carcinoma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Stage I and Stage II Thymoma
Excellent long-term survival can be obtained following complete surgical excision for a pathologic stage I thymoma. There appears to be no benefit to adjuvant radiation therapy following complete resection of encapsulated noninvasive tumors.[1,2] For patients with stage II thymomas with pathologically demonstrated capsular invasion, adjuvant radiation therapy following complete surgical excision has been considered a standard of care despite the lack of prospective clinical trials.[3,4]
Most studies use 40 Gy to 70 Gy with standard fractionation scheme (1.8–2.0 Gy/fraction). Some, but not all, retrospective clinical studies show improved local control and survival with the addition of postoperative radiation therapy.[5,6,7,8][Level of evidence: 3iiiDiv] More recent retrospective studies have found no outcome difference in patients treated with or without postoperative radiation therapy following complete resection of the thymic tumor.[8,9,10,11]
In the largest series reported to date, data was obtained from 1,320 Japanese patients.[8] The Masaoka clinical stage was found to correlate well with prognosis of thymoma and thymic carcinoma. Patients with stage I thymoma were treated with surgery only, and patients with stage II thymoma underwent surgery and additional radiation therapy. Prophylactic mediastinal radiation therapy did not appear to prevent local recurrences effectively in patients with totally resected stage II thymoma.
The role and risks of adjuvant radiation therapy for patients with completely resected stage II thymomas need further study. To avoid the potential morbidity and costs associated with thoracic radiation, postoperative radiation therapy may be reserved for stage II patients where adjacent organs are within a few millimeters or involve of the surgical margin as determined by both pathological and intraoperative findings.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage I thymoma and stage II thymoma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
Operable or Potentially Operable Stage III and Stage IVA Thymoma
Stage III thymoma may be difficult to identify prior to surgery as invasion of adjacent subtle invasion to the adjacent organs may only be identified at the time of mediastinal exploration. Such patients often receive aggressive surgical resection including wide surgical margins with consideration of adjuvant radiation therapy. Invasion of local organs can be apparent on pretreatment computed tomographic imaging. Such patients may be offered combined modality treatment with chemotherapy followed by surgery and/or radiation therapy.[12,13,14,15,16,17,18] The optimal strategy for induction therapy, which minimizes operative morbidity and mortality and optimizes resectability rates and ultimately survival, currently remains unknown.
In the largest series reported to date, data was obtained from 1,320 Japanese patients.[8] The Masaoka clinical stage was found to correlate well with prognosis of thymoma and thymic carcinoma. Patients with stage III thymoma underwent surgery and additional radiation therapy. Patients with stage IV thymoma were treated with radiation therapy or chemotherapy. For patients with stage III or stage IV thymoma, the 5-year survival rates were 93% for patients treated with total resection, 64% for patients treated with subtotal resection, and 36% for patients whose disease was inoperable. Prophylactic mediastinal radiation therapy did not appear to prevent local recurrences effectively in patients with totally resected stage III thymoma. Adjuvant therapy including radiation or chemotherapy did not appear to improve the prognosis in patients with totally resected stage III or stage IV thymoma.[8]
Most invasive thymomas have been found to be relatively sensitive to cisplatin-based combination chemotherapy regimens. The combinations that follow have reported objective response rates from 79% to 100% with subsequent resectability rates ranging between 36% and 69%:[12,13,14,15,16,17,18,19]
Long-term survival rates following induction chemotherapy and surgery with or without radiation therapy and consolidation chemotherapy have ranged from 50% at 4 years, 77% at 7 years and, respectively, 86% and 76% for stage III and IV patients at 10 years in different published series.[13,15,16,20]
However, similar results have been reported with preoperative radiation therapy without chemotherapy, particularly if great vessels are involved (5-year overall survival rate of 77% and 10-year OS rate of 59%).[21,22]
An intergroup trial conducted in the United States reported a predicted 5-year OS rate of 52% in 26 patients receiving the PAC chemotherapy regimen followed by radiation therapy without surgery.[17]
The role of surgical debulking for patients with either stage III or stage IVA disease is controversial. Phase II data suggests that prolonged survival can be accomplished with chemotherapy and radiation therapy alone in many patients presenting with locally advanced or even metastatic thymoma.[17] Therefore, the value of surgery may be questioned if complete, or at the very least, near complete extirpation cannot be accomplished.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage III thymoma and stage IV thymoma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
Standard treatment options for patients with operable disease include the following:
Standard treatment options for patients with inoperable disease (stage III and stage IV with vena caval obstruction, pleural involvement, pericardial implants, etc.) include the following:
Treatment options under clinical evaluation:
Areas of active clinical evaluation for patients with thymoma include the following:
Thymic carcinomas have a greater propensity to capsular invasion and metastases than thymomas. Patients more often present with advanced disease and have a 5-year survival rate of 30% to 50%.[1] Owing to the paucity of cases, optimal management of thymic carcinoma has yet to be defined. As with thymoma, in most published series, carefully selected patients with clearly resectable, well-defined disease, have received complete surgical extirpation. For clinically borderline or frankly unresectable lesions, induction chemotherapy, thoracic radiation therapy, or both, have been used.
In most published studies, surgery has been followed by adjuvant radiation therapy. A prescriptive dose range has yet to be identified; most studies use 40 Gy to 70 Gy with standard fractionation scheme (1.8 Gy–2.0 Gy/fraction).
In the largest series reported to date, data was obtained from 1,320 Japanese patients.[2] The Masaoka clinical stage was found to correlate well with prognosis of thymoma and thymic carcinoma. Patients with thymic carinoma were treated with radiation therapy or chemotherapy. For patients with thymic carcinoma, the 5-year survival rates were 67% for patients treated with total resection, 30% for patients treated with subtotal resection, and 24% for patients whose disease was inoperable. Adjuvant therapy including radiation or chemotherapy did not appear to improve the prognosis in patients with thymic carcinoma.[2]
A multi-institutional retrospective outcome analysis of 186 patients with thymic carcinoma has been reported.[2] This study failed to detect a long-term survival benefit in patients treated with subtotal resection nor any statistically significant survival augmentation from the addition of adjuvant radiation to surgical resection. The authors stipulated that no definitive conclusions could be made regarding the role of adjuvant radiation therapy in thymic carcinoma as a result of sample size limitations.
The 5-year survival rates for patients with totally resected thymic carcinoma were 81.5% for patients treated with chemotherapy; 46.6% for patients treated with radiation chemotherapy; 73.6% for patients treated with radiation therapy alone; and, 72.2% for patients who received no adjuvant treatment.[2]
The results from this study call into question conventional thinking regarding the efficacy of an aggressive multimodality approach including debulking, radiation therapy, and cisplatin-based chemotherapy.[3,4,5] While other studies support the addition of adjuvant radiation and chemotherapy, optimum treatment regimens are undetermined.
Chemotherapy is also utilized in the management of patients with inoperable thymic carcinoma. Most regimens used are similar to those used to treat thymoma and include cisplatin.[6,7,8,9]
Objective responses and improved outcomes compared to historical data have been reported from small uncontrolled studies. Combinations of doxorubicin, cyclophosphamide, and vincristine and cisplatin have also shown favorable responses in studies.[6,7,8] Etoposide, ifosfamide, and cisplatin (VIP) was utilized in a prospective North American Intergroup trial.[9] There was a 25% (2 of 8 patients) partial response rate. The 1-year and 2-year survival rates were 75% and 50%, respectively.
Areas of active clinical evaluation for patients with thymic carcinoma include the following:
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with thymic carcinoma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
Note: Some citations in the text of this section are followed by a level of evidence. The PDQ editorial boards use a formal ranking system to help the reader judge the strength of evidence linked to the reported results of a therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence for more information.)
Patients with recurrent thymomas who undergo re-resection of recurrent disease may have prolonged survival when complete resection is attained.[1] However, only a minority of patients may be candidates for resection.
In a review of 395 patients who underwent resections for thymic epithelial tumors, 67 had tumor recurrence and 22 underwent a re-resection procedure.[2] The 10-year survival rate was 70%. In a second series, 30 of 266 patients initially treated by total resection of the tumor had a recurrence, and in all 30 patients surgical resection had been attempted.[3] Complete resection of the recurrent tumor was obtained in ten cases. Overall 5-year and 10-year survival rates for the 30 patients with recurrent thymomas were 48% and 24%, respectively.
Of note, patients in these series may have received chemotherapy and/or radiation therapy in addition to surgery.
A number of studies have demonstrated that certain chemotherapy drugs can induce tumor responses as single agents or in combination. In general, higher response rates have been reported with combinations; however, no randomized trials have been conducted to date.
A phase II trial of cisplatin (50 mg/m2) reported an objective response rate of 10% among 21 patients.[4] Six of 13 patients treated with single-agent ifosfamide had objective responses.[5] Octreotide with or without prednisone may induce responses in patients with octreotide scan-positive thymoma. Six of 16 patients achieved objective responses to octreotide (1.5 mg/day subcutaneously) associated with prednisone (0.6 mg/kg/day orally for 3 months, 0.2 mg/kg/day orally during follow-up).[6]
In a second study, 2 complete (5.3%) and 10 partial responses (25%) were observed among 42 patients.[7]
In general, combination chemotherapy produces complete and partial remissions; some of the complete remissions have been pathologically confirmed at subsequent surgery.
In a series of 30 patients with stage IV or locally progressive recurrent tumor following radiation therapy, the PAC regimen (cisplatin, doxorubicin, cyclophosphamide) achieved a 50% response rate, including three complete responses. The median duration of response was 12 months, and the 5-year survival rate was 32%.[8][Level of evidence: 3iiiDiv]
In another study, the ADOC regimen (doxorubicin, cisplatin, vincristine, cyclophosphamide) produced a 92% response rate (34 of 37 patients), including complete responses in 43% of patients.[9]
One study of combined chemotherapy with cisplatin and etoposide produced responses in 9 of 16 patients treated, with a median response duration of 3.4 years and a median survival of 4.3 years.[10]
Nine of 28 patients with invasive thymoma or thymic carcinoma who received four cycles of etoposide, ifosfamide, and cisplatin (VIP) at 3-week intervals had partial responses.[10] The median duration of response was 11.9 months (range, <1–26 months), and the median overall survival (OS) rate was 31.6 months. The 1-year and 2-year survival rates were 89% and 70%, respectively.[10][Level of evidence: 3iiiDiv] Nine of 34 patients treated with VIP had partial responses (32%; 95% confidence interval, 16%–52%). The median follow-up was 43 months (range, 12.8–52.3 months), the median duration of response was 11.9 months (range, <1–26 months), and the median OS rate was 31.6 months. Based on Kaplan-Meier estimates, the 1-year and 2-year survival rates were 89% and 70%, respectively. These results appear to be inferior to other combinations.
Standard treatment options:
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent thymoma and thymic carcinoma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
This summary was extensively revised.
Purpose of This Summary
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of thymoma and thymic carcinoma. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.
Reviewers and Updates
This summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).
Board members review recently published articles each month to determine whether an article should:
Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.
The lead reviewers for Thymoma and Thymic Carcinoma Treatment are:
Any comments or questions about the summary content should be submitted to Cancer.gov through the Web site's Contact Form. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.
Levels of Evidence
Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Adult Treatment Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations.
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The preferred citation for this PDQ summary is:
National Cancer Institute: PDQ® Thymoma and Thymic Carcinoma Treatment. Bethesda, MD: National Cancer Institute. Date last modified <MM/DD/YYYY>. Available at: http://cancer.gov/cancertopics/pdq/treatment/thymoma/HealthProfessional. Accessed <MM/DD/YYYY>.
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subset: commoncrawl


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|Louis-Pierre Mouillard (1834-1897), Nile Vulture (Otogyps auricularis), from L'Empire de l'air (1881)
The year is 1881. Convalescing in Alexandria, sketching images of Nile Vultures gliding in the sweltering Mediterranean skies, the French ornithologist and engineer Louis-Pierre Mouillard writes of an air teeming with life. Appearing early on in his influential treatise on bird flight, L'Empire de l'Air, Mouillard's powerful, sublime description of the air casts a prophetic eye to the future: "O! Blind Humanity! open thine eyes and thou shalt see millions of birds and myriads of insects cleaving the atmosphere. All these creatures are whirling through the air without the slightest float; many of them are gliding therein, without losing height, hour after hour, on pulseless wings without fatigue; and after beholding this demonstration given by the source of all knowledge, thou wilt acknowledge that Aviation is the path to be followed." [1] Here, then, is a plea to view the world differently. It is a new sensibility that does more than call attention to the changing air; it asks us to look at the numerous denizens of the air as something altogether different. This is because for Mouillard, these are not birds or insects. They are airplanes.
In Mouillard's world, these creatures maneuver easily through the air thanks to their nearly weightless bodies. This was the predominant view for centuries. Even that most dedicated chronicler and student of animal flight, Étienne-Jules Marey acknowledged how those before him thought that insects and birds were able to "float" in the sky because of air-filled sacs that made them no different than balloons. Marey and his contemporaries looked to the flight mechanisms of birds and insects as models for human-powered, heavier-than-air flight. And during its initial moments, heavier-than-air flight was only slightly heavier than air. This was the case with the earliest airplanes: delicate, cumbersome assemblages of cloth, wood, and wire that strained to escape the surface of the earth only to fly slowly, elegantly, and effortlessly on currents of air. This was not a common sentiment, however. Franz Kafka referred to the various machines lined up like flying mantises at the 1909 Brescia Air Show as "suspicious little wooden contraptions." [2] For the budding modernist, aircraft were no different than Gregor Samsa, the scarab-like tragic figure from The Metamorphosis: insects with uncontrollable appendages that were "continually fluttering about." [3]
Samsa's fantastical predicament moored him to some very real concerns. And despite Kafka's plodding verse, we can think of another modernity that follows Nietzsche's clarion call to "kill the Spirit of Heaviness." [4] Here, instances like F.T. Marinetti's descriptions of pilots, who upon returning to earth, leave their machines "with an elastic ultralight leap," [5] or Le Corbusier's observation that airplanes are a "sign of the new times" advancing forward "in a winged flurry," [6] tell of a modernism imbued with a lightness. It is a physical and metaphysical lightness. An aerodynamic lightness.
As stated by James A.H. Murray in the New English Dictionary on Historical Principles (1858), "Aerodynamics [is the] branch of pneumatics which treats of air and other gases in motion, and of their mechanical efforts." [7] Murray's definition is based on an earlier entry from the Popular Encyclopedia of 1837: "Aerodynamics; a branch of aerology, or the higher mechanics, which treats the powers and motion of elastic fluids." [8] Though these definitions speak more of laboratories and experimental chambers, consider how Siegfried Giedion, that most stalwart promoter of architectural modernism, puts forward the laboratory as a metaphor for the creation of new architecture. Using ferroconcrete construction as an example, Giedion makes much of how concrete is not only a "laboratory product," but also made in a laboratory. [9] This language is more than metaphorical, as demonstrated when he places new advances in iron construction on an aerodynamic footing:
Instead of the rigid balance of support and load, iron demands a more complex, more fluid balance of forces. Through the condensation of the material to a few points, a creation of the airspace, des combinations aériennes that Octave Mirabeau recognized already in 1889. This sensation of being enveloped by a floating airspace while walking through tall structures (Eiffel Tower) advanced the concept of flight before it had been realized and stimulated the formation of the new architecture. [10]Giedion's reference to Eiffel Tower is not accidental. Since its construction for the 1889 Exposition Universelle and until the early 20th century, Gustave Eiffel's iconic structure was the ineluctable center of aviation in the world. In 1901, the Brazilian aviator Alberto-Santos Dumont won the Deutsch de la Meurthe prize after circling the Eiffel Tower in his No.6 Airship. Similar feats would have more lasting influences on architecture culture. Hence in Aircraft (1935), Le Corbusier writes of his early days as an apprentice in Auguste Perret's office in 1909, sequestered in a "student's garret on Quai St. Michel," and hearing the noise of the Comte de Lambert's Wright Flyer circle the Eiffel Tower. [11]
Le Corbusier's life-long romance with flying machines is well known. And not surprisingly, Giedion would describe Le Corbusier's own architecture in aerodynamic terms. Writing about the Cité Frugès à Pessac in Bordeaux, Giedion describes the building as something not unlike a wind tunnel: "Corbusier's homes are neither spatial not plastic: air flows through them! Air becomes a constituent factor! Neither space nor plastic form counts, only RELATION and INTERPENETRATION!" [12] This is a description of a new kind of architecture comprised of light structures, many appearing "as thin as paper" that transform buildings into "cubes of air" and make an "immediate transition to the sky." [13] Architecture, now aloft, seems to have taken on the qualities of the airplane.
(Top and Bottom) From A. Cléry, "L'Aéroplane 'Antoinette V'" L'Aerophile: revue technique et pratique des locomotions aériennes (Jan. 1, 1909)
Cléry was not the only one to make a connection between Eiffel and Levavasseur. As one of L'Aerophile's most avid readers, the American inventor Alexander Graham Bell would take a particular interest in Cléry's article about the Antoinette V. Since 1899, Bell had been preoccupied with building kites that improved on Lawrence Hargraves' "box" designs. He settled on kites composed of multiple cells of tetrahedral structures, a design that would increase the amount of surface area with a minimum of materials. His first kites were small, wood-and-cloth pyramids consisting of smaller tetrahedral units. And as he became more ambitious with his designs, he created large, ungainly tetrahedral space frames that had to be towed out into the open water in order to be set aloft. Of these, the largest were the "Cygnet" series, which were gigantic structures comprising of 3,393 tetrahedral cells. Tested out in the waters of Keuka Lake, near Hammondsport, New York from 1907 to 1908, the Cygnets were temperamental things. In the words of their pilot, Thomas Selfridge, the Cygnets "persistently refused to fly." [15]
|(Top and Bottom) Alexander Graham Bell's Tower, from "Dr. Bell's Tetrahedral Tower," National Geographic Magazine (Oct., 1907), 672-675.
Despite the Cygnet's perceived stubbornness, Bell found solace in Cléry's emphasis on tetrahedral structures. Later in 1909, Bell noted how the Antoinette "seems to be constructed throughout upon the tetrahedral plan." [16] The emphasis on "construction" should not be taken lightly, for Bell's Cygnets were more architectural than aerodynamical. And in a series of spreads for the October 1907 issue of National Geographic Magazine, editor Gilbert M. Grosvenor depicted what would be the fullest architectural expressions of Bell's aeronautical work. Titled "Dr. Bell's Tetrahedral Tower," the piece shows images of an 80-foot observation tower built in 1907 at Bell's estate in Beinn Bhreagh, Nova Scotia. With legs made of tetrahedral-celled trusses that intersected high above to ground to form a platform, Bell's structure was touted for its lightness and ease of assembly. Its use of eight-pin joints to hold the frame no doubt foreshadowed similar innovations by Max Mengeringhausen, Konrad Wachsmann, or R. Buckminster Fuller. Bell's truss system resulted in a kind of building that was light and that, echoing Giedion's description of the Eiffel Tower, gave one the sensation of being aloft. It was an aerodynamic building in the sense that it could accommodate moving air. But it was also aerodynamic because it was a structure originally designed to fly. When we normally think of flying buildings, we immediately conjure images of architecture outfitted with streamlined forms not unlike those made memorable by Erich Mendelsohn or Norman Bel Geddes. Bell's tetrahedral tower is radically different from these, however. As an assemblage of pipes joined into lightweight pyramids and tetrahedrons, Bell's tower nevertheless captivates us because it is one of the few instances where we can talk of a flying machine that has truly evolved into architecture.
(An Italian version of this article appeared in September 2011 in Materia 70. Many thanks to Daria Ricchi for her beautiful translation.)
[1] Louis-Pierre Mouillard, "The Empire of The Air," Annual Report of the Board of Regents of the Smithsonian Institution, Showing the Operations, Expenditures, and Conditions of the Institution to July, 1892 (Washington, DC: Government Printing Office, 1893), 398. This is an abridged translation of Mouillard, L'Empire de l'air: essai d'ornithologie appliquée a l'aviation (Paris: Masson, 1881).
[2] Franz Kafka, "Die Aeroplane in Brescia," Bohemia (29 September 1909), quoted in Peter Demetz, The Air Show at Brescia, 1909 (New York: Farrar, Straus and Giroux, 2002), 115.
[3] Kafka, "The Metamorphosis," in Joyce Crick, ed. The Metamorphosis and Other Stories (London: Oxford University Press, 2009), 82.
[4] Friedrich Nietzsche, "Of Reading and Writing," in Thus Spoke Zarathustra, R.J, Hollingdale, trans. (New York: Penguin, 2003 [1961]), 68.
[5] Filippo Tommaso Marinetti, Teoria e invenzione futurista, Luciano de Maria, ed. (Milan: Mondadori, 1968), 116, quoted in Jeffrey T. Schnapp, "Propeller Talk," Modernism/Modernity Vol 1.3 (1994), 165.
[6] Le Corbusier, Sur les 4 routes (Paris: Gallimard, 1941), 125.
[7] "aerodynamics, n." The Oxford English Dictionary. 3d ed. 1989. OED Online. Oxford University Press. 10 June 2011
[8] John D. Anderson, Jr., A History of Aerodynamics and its Impact on Flying Machines (Cambridge, United Kingdom: Cambridge University Press, 1997), 5.
[9] Sigfried Giedion, Building in France, Building in Iron, Building in Ferroconcrete, J. Duncan Berry, trans. (Los Angeles: Getty Center Publications, 1995), 150-151.
[10] Ibid., p. 102.
[11] Le Corbusier, Aircraft (London: The Studio, Ltd., 1935), 6.
[12] Giedion, Building in France, p. 169.
[13] Ibid.
[14] A. Cléry, "L'Aéroplane 'Antoinette V'" L'Aerophile: revue technique et pratique des locomotions aériennes (Jan. 1, 1909), 7-8.
[15] Report of Flight of Cygnet II, Monday, March 2, 1908. Notes by Thomas E. Selfridge, from September 24, 1907 to July 24, 1908. "Series: Subject File, Folder: Aviation, Aerial Experiment Association vs. Meyers, 1908-1912, undated." Alexander Graham Bell Family Papers at the Library of Congress, 1862-1939, Manuscript Division, Library of Congress.
[16] Bell, "The Antoinette V." Bulletins, from January 4, 1909 to April 12, 1909, Alexander Graham Bell Family Papers at the Library of Congress, 1862-1939, Manuscript Division, Library of Congress.


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Several regulations pertinent to consumers and service station requirements are addressed by Chapter 14.5, Section 13620 of the Business and Professions Code.
1. Water, compressed air, and tire gauge for public use: (Section 13650---1985)
Service stations must "provide, during operating hours, water, compressed air, and a gauge for measuring air pressure," to any passenger vehicle, or any commercial vehicle with "an unladen weight of 6000 pounds or less."
2. Services provided for public use: (Section 13651---1990)
"On or after January 1, 1990, every service station in this state located within 660 feet of an accessible right-of-way of any interstate or primary highway, as defined in Sections 5215 and 5220, shall provide, during business hours, public restrooms for use by its customers. Service stations shall not charge customers separately for the use of restroom facilities." The restrooms cannot be portable, must be separate for men and women, and the toilets and sinks must accommodate handicapped persons.
3. Notice of fuel taxes: (Section 13651---1991)
As of July, 1991 every service station in the state is required to post, in a conspicuous place, a list of applicable state and federal fuel taxes per gallon being charged to the consumer.
4. Quality or quantity of gasoline, gas pump problems, or pricing:
Problems or disputes arising as a result of "bad gasoline," gas pump problems, or pricing should be directed to the County Weights and Measures of the county where the problem occurred. For county listings for the state of California, see "County Weights and Measures" entry in C of this Directory.
5. Automotive body and engine repairs (excluding tires) at service stations:
Consumers should contact BAR to make complaint about any problems with stations performing auto repair. Many service station are not required to be licensed by the California Department of Consumer Affairs, Bureau of Automotive Repair.
Bureau of Automotive Repair, Consumer Information Center
(800) 952-5210
See Also:
Weights and Measures (County)
Environmental Protection
Consumer Resource & Referral Guide
Directory of State Agencies
Directory of Federal Agencies
Return to DCA Home Page


text:
1. Whackbat, Fantastic Mr. Fox
Games reflect the culture that created them, and in fiction, they can serve as an easy way to distinguish a fictional world from our own, while often commenting on ours. Well, "easy" in theory, because these alternate-world games often have complicated or confusingly vague rules, though they're often easily understood by the characters in that world. Owen Wilson's Coach Skip rattles off the rule set for Whackbat in Wes Anderson's Fantastic Mr. Fox as if its convoluted mixture of baseball, cricket, and track and field is so familiar, it hardly warrants explanation. (He's surprised to hear from new student Kristofferson that the game doesn't exist on the other side of the river, where they run grass sprints or play acorns.) It's "real simple," says Coach Skip during a dazzling sequence: The batter at Whackbat tries to hit a cedar stick off a "cross rock" with a flaming pinecone that's pitched at him by the center tagger. The five twig-runners dash back and forth until the pinecone burns out and the umpire calls "Hotbox!" At the end, you count up how many "scoredowns" that adds up to and divide it by nine. "Got it!" says Kristofferson. Wait, what?
2. Brockian Ultra-Cricket, The Hitchhiker's Guide To The Galaxy
An apparent analogue to earthly cricket played by some of the higher dimensions' more frivolous inhabitants, Brockian Ultra-Cricket is a game so complex as to evade explanation. As Douglas Adams' first Hitchhiker's Guide book puts it, "A full set of the rules is so massively complicated that the only time they were all bound together to form a single volume, they underwent gravitational collapse and became a black hole." What few rules have emerged seem to involve taking sticks and hitting people, though the inconveniently large walls built between players and spectators render that a matter of mere speculation. At least one thing is clear: "The winning team shall be the first team that wins."
3. Sabacc, Star Wars
It began with an offhanded exchange between Lando Calrissian and Han Solo in The Empire Strikes Back, when Calrissian referred to the Millennium Falcon as "my ship," and Solo snapped back, "Hey, remember, you lost her to me fair and square." Although the story of Calrissian's loss and Solo's gain is never told during the course of the Star Wars films, it was revealed in later short stories and novels to have taken place in the final hand of the Cloud City Sabacc Tournament. Sabacc serves as an approximation of poker in the Star Wars universe, but it's a far more complicated cousin, using a deck of 76 electronic cards that have a nasty tendency to shift their suit and/or value. The two most sought-after hands in the game are the Idiot's Array and Pure Sabacc; although Calrissian was only one card away from achieving the former, Solo beat him to the punch by pulling the latter, his cards consisting of The Queen Of Air And Darkness, The Five Of Coins, The Six Of Staves, and The Master Of Coins… or at least, that's what it says on Wookieepedia.
4. Fizzbin, Star Trek
From Kal-toh to Kadis-kot to Strategema, fictional games abound in Star Trek. But the original and best is Fizzbin. Introduced in the original-series episode "A Piece Of The Action," Fizzbin is an ad hoc, intentionally confounding card game devised by Captain Kirk to craftily distract a group of gangster-impersonating aliens who hold him and Spock hostage—just long enough for Spock to give them the old Vulcan nerve-pinch. From there, Fizzbin took on a life of its own in the Star Trek mythos, to the point where it was referenced again three decades later in Deep Space Nine. And in the same way Klingon has become a language people use in the real world, Fizzbin is now an actual, playable game—minus the nerve-pinch, of course.
5. Azad, The Player Of Games
In 1988, fans of science-fiction author Iain M. Banks got a major clue as to just how complex his Culture series (which is now up to nine books) was going to become. That year saw the release of the second book in the series, The Player Of Games, which revolves around Azad, a convoluted game of cards, dice, and Risk-like strategy that's so epic in scale, it shares its name with the galactic empire that plays it. But Azad is more than a pastime for its billions of citizens; as the main character of the story—a renowned gamer and resident of the rival Culture empire—finds out, playing Azad against its native citizens reveals fundamental philosophical differences between the opponents, which eventually leads to a showdown against Azad's emperor.
6. Blernsball, Futurama
Before Futurama gets to the heart of its season-one episode "Fear Of A Bot Planet," it takes a few easy swings at the segregated past and lulling pace of America's (former) favorite pastime, baseball. Now "evolved" into Blernsball—a simultaneous send-up of extreme sports and baseball's tediousness—it bears a slight resemblance to the original game, save for the tethered Blernsball, indecipherable score-keeping, the seventh-inning grope, and a pinball-esque multi-ball round involving motorcycles and exploding bases. Robots can't play, though, which Bender takes as an affront, setting up the episode's satirical plot.
7. Rollerball, Rollerball
This science-fiction movie is set in a dystopian future in which corporations have replaced governments, and nationalistic passions are now projected onto an international full-contact arena sport called Rollerball. The game is played on a circular track between two competing teams composed of men wearing helmets, spiked gloves, and body armor. Most of them wear roller skates, but a few ride motorcycles. The offensive team scores by hurling a heavy steel ball into a magnetic goal embedded in the wall; the defensive team has full leave to maim, mutilate, and kill as many players as possible in order to prevent this. The corporate overlords who sponsor the games believe that it teaches their drone populations that individual effort is doomed—so when James Caan, the world's biggest Rollerball star, becomes too idolized for their comfort, they start arbitrarily changing the rules in the hopes that he'll be killed. But because both the game and the movie are specifically designed to provide as many opportunities for bloody mayhem as possible, it's hard to tell any difference even after they start messing with it.
8. Dragon Poker, the Myth Adventures books
Dragon Poker isn't, in and of itself, a terribly complicated game, beyond the fact that it revolves around six-card hands, thereby increasing the usual terminology into a realm that involves newly invented hands like the Full Belly (two sets of three of a kind) and the Full Dragon (four of a kind plus a pair). It's only when the game's dreaded conditional modifiers come into play that things start to get difficult to follow. Once per night, a player can change the suit of one of his cards; every five games, lower cards become higher cards and vice versa; and depending on where the game is played, how many people are playing, or even what day of the week or in which dimension the game is taking place, different cards might be wild. These are just a few examples, but the list goes on and on, changing from book to book. The late Robert Asprin, author of the Myth Adventures series, never fully defined the rules of Dragon Poker—probably because even he didn't know what they all were.
9. Cyvasse, A Song Of Ice And Fire
A Game Of Thrones is the title of the first book of George R. R. Martin's epic fantasy series, A Song Of Ice And Fire—and the book title reveals that the story is going to resemble a vast competition played out on a board composed of whole nations. Martin uses cyvasse—which hasn't yet appeared in HBO's TV adaptation, Game Of Thrones—as a symbol-in-microcosm for that sprawling game. Described by Martin in an interview as "a bit of chess, a bit of Blitzkrieg, a bit of Stratego—mix well and add imagination," cyvasse is popular among nobles, merchants, and orphans. In fact, in spite of its complexity, it's one of the few levelers in Ice And Fire's rigidly striated societies. In A Dance With Dragons, the fifth volume of the series, cyvasse takes on a new prominence and importance, as Tyrion Lannister's mastery of the convoluted game grants him certain advantages beyond the board—especially when pulling his punches causes his opponent to let his down guard regarding matters that concern the far larger game being played.
10. Quintet, Quintet
One of Robert Altman's least-loved films, Quintet is set in a post-apocalyptic tundra. For diversion, survivors compete in a tournament of Quintet, which involves six players, "three game pieces, usually fashioned to his or her personality," dice, and killing. Specifically, each gamer is assigned a person to (potentially) kill. Whoever rolls the highest number at the beginning attains the status of Sixth Man, who sits out the first half of the game ("Frontgame") and determines the killing order for the other five participants. The Sixth Man tries to sabotage the other players at the beginning, hopefully manipulating the weakest player to win, because the Sixth Man has to face him/her in Quintet's second half, a duel called Endgame. Because the rules are almost as confusing as the story points, there's a sort of Quintet referee, but in the movie, his decisions mostly serve to knock off the supporting cast that much quicker.
11-12. Quidditch, Harry Potter series/Welters, The Magicians
The game of Quidditch seems complicated when J.K. Rowling first explains it in the first Harry Potter book, but that's because she tosses in a bunch of extraneous rules where one would have done the job: Grab the Snitch, win the game. Sure, that isn't technically not the case, but grabbing the quickly moving winged ball grants a team 150 points and ends the game, so it usually results in a win. Rowling teases out numerous other complicated rules and fouls and so on in the course of her seven-book series, but every match played directly in the books (as opposed to referred to in historical texts within the books) ends with someone (usually Harry Potter) catching the Snitch. Not to be outdone, Lev Grossman's The Magicians, popularly billed as "Harry Potter for adults," offers up its own magical game, a kind of magicians' chess called Welters, played on large outdoor courts. But there's a simple reason readers don't leave The Magicians wishing they could play Welters (or starting their own leagues, as with Quidditch): Grossman barely bothers to explain how it works or how to play it, and the characters themselves only get into it when they have nothing better to do.
13. Three-person chess, TheBig Bang Theory
The socially awkward brainiacs of The Big Bang Theory use rock-paper-scissors-lizard-Spock to settle differences, but there aren't really that many moving parts in their mutation of the game. But on the episode "The Wildebeest Implementation," the insufferably brilliant theoretical physicist Sheldon devises a three-person chess game—one that overcomplicates the notion to an absurd degree. "Do you know how I solved the balance center area combat problem?" he asks his hapless roommate, Leonard. "Five words: transitional quadrilateral to triangular tessellation." When the game is finally played, however, it devolves into a brain-bending bedlam of catapult-flung bishops, jetpack-wearing popes, and golf-cart-riding pawns.
14. CharDee MacDennis, It's Always Sunny In Philadelphia
CharDee MacDennis, unveiled It's Always Sunny In Philadelphia's seventh season's seventh episode, "Chardee MacDennis: The Game Of Games," seems simple enough from the outset, but quickly devolves into a convoluted mess. The object is to progress through three circles, each one representing a type of booze (wine, beer, hard liquor) and type of challenge (mind, body, spirit). There's trivia, charades, emotional berating, a dog cage for a jail, and a point where Mac throws darts at Dennis' hand to get him to flinch. Sure, it doesn't make any sense, but the depths to which it doesn't make sense speaks to the obsessive nature of Sunny's characters. In fact, the gang had to craft a massive rulebook in order to keep the game moving forward. As the episode goes on, it becomes clear that winning the game isn't a matter of actually playing by those rules, but instead playing against the individual members of the opposing team—and conflict is the engine that keeps Sunny running.
15. Marshgammon, How I Met Your Mother
The characters on How I Met Your Mother are a protective, inquisitive bunch, prone to enthusiastically vetting their friends' new love interests. To provide cover for their nosiness, they have Marshgammon, which combines elements of Candy Land, Taboo, Pictionary, Twister, and drinking. The game makes no sense to anyone except Marshall—who created it and serves as the non-competing game master—but the game itself isn't really all that important. In season one, it's a means to learning about Ted's new love interest, Victoria, and it leads to the discovery of an embarrassing video of Barney.
16. Double cranko, M*A*S*H
When B.J. Hunnicut became a regular character on M*A*S*H, he was a lot more straitlaced than his predecessor, Trapper John McIntyre. That didn't last long, though—and by the sixth-season episode "Your Hit Parade," B.J. was long accustomed to joining his Swamp-mate Hawkeye Pierce in all manner of illicit pastimes. One of those is double cranko, an elaborate mash-up of chess, checkers, gin rummy, and drinking—the last aspect invariably involving shots from Pierce's bedside still. Not to mention the fleecing of his commanding officer, Colonel Potter.
17. Calvinball, Calvin And Hobbes
At heart, Bill Watterson's celebrated newspaper comic was always about the power of imagination, which frequently took 6-year-old kid Calvin (and occasionally his sometimes-stuffed, sometimes-real tiger companion Hobbes) into other eras, other bodies, or other worlds. But one of the most rambunctious expressions of the duo's imagination—and one of the few that not only didn't get him into trouble, but actually allowed him to enjoy an evening with his babysitter Roslyn—was the one sport Calvin actually liked: Calvinball, where the rules are "anything we make up"—generally on the fly, with plenty of arguing and contradicting. This means everything from spontaneously declared vortex spots and boomerang zones to song penalties and "pernicious poem places." And the victory conditions were never established, what with scores like "oogy to boogy" and "Q to 12." It even had a theme song: "Other kids' games are all such a bore! / They've gotta have rules, and they gotta keep score! / Calvinball is better by far! / It's never the same! It's always bizarre! / You don't need a team or a referee! You know that it's great, 'cause it's named after me!"
18. Jumanji, Jumanji
The subject of both a 1981 Chris Van Allsburg book and a 1995 movie starring Robin Williams, Jumanji is a board game with big-time consequences. Two children, Peter and Judy, find the game and decide to play, only to discover that each move could unleash some sort of new, dangerous, and totally real animal into their house, from a starving lion to a bunch of mischievous monkeys. To make it all go away, the kids have to finish the game, but not before inflicting severe structural damage on their house and presumably their developing brains. Even for a children's book, there are a lot of unanswered questions and inconsistencies beyond "How did a bunch of rhinos get in the house?" For instance, why can't the kids just speed-roll their way through the game and get it all over with in minutes? Or why, after it's all over, do they not just burn the board, rather than jettisoning it for two other dumb kids to find? Jumanji is a different kind of game, not just because it's so damn terrifying, but because the rules are so unclear. Calvinball exists in Calvin's mind, whereas Jumanji sprang from the twisted thoughts of some unknown—presumably one with a fight-or-flight fetish and an unnatural love for monsoons.
19. BASEketball, BASEketball
South Park's Matt Stone and Trey Parker play two goofballs who create the game of BASEketball on the fly when challenged to a game of horse by two preppies at a party. It's kind of like horse, except shots from designated distances count as singles, doubles, triples, or home runs. Misses result in an out, and if you hit a shot, you can't shoot in the same spot again. Opposing players can use any and all methods to psyche out the shooter. Simple, right? No? Well, in the movie, the game becomes so popular, Parker and Stone's characters create a professional league that becomes a target for takeover. After the movie's release, fans created their own BASEketball leagues, though few if any probably remain 13 years later.
20. NumberWang, That Mitchell And Webb Look
A recurring sketch on the BBC's That Mitchell And Webb Look, NumberWang was a game show where the rules, structure, and point of the game were cheerfully unclear. In it, contestants throw out random numbers until the host declares one of them "NumberWang," though it's never clear why—ditto the "WangerNumb" portion of the show. The game then goes to the "maths board" where the contestants pick numbers (but others are highlighted), before the contestant panel rotates for no particular reason. Often, the player with the higher number of points trails the other contestant, so the winner seems arbitrarily chosen. (Losers wear paper bags over their heads.) Other episodes of the show explore the nonsensical spin-offs of the nonsensical game show, like the take-home version, which includes 400-sided dice that are invisible to the human eye, plus all 37 volumes of the game's rules.
21. Eschaton, Infinite Jest
David Foster Wallace once described the structure of his landmark experimental novel Infinite Jest as resembling a "lopsided Sierpinski Gasket," a wonky variation on proto-fractal patterning that allowed the book's ideas to expand and multiply while at the same time containing one another. In short: Everything in Infinite Jest is a microcosm of the book's grander, overarching preoccupations, which are encompassed by the book itself. Nowhere is this more apparent than in a scene where members of the Enfield Tennis Academy (where much of the novel unfolds) engage in their favorite overly complicated extracurricular: Eschaton. A CD-ROM-assisted real-time war game employing four contiguous tennis courts, up to 400 tennis balls, and "at least 40 megabytes of available RAM and a wide array of tennis paraphernalia," Eschaton is so nerdy and complex that Wallace spends 20 pages and half a dozen footnotes explaining it. The game is Infinite Jest in a nutshell: intricate, funny, and deeply rewarding, provided you're willing to put in a little work.
22-plus. Crockett, Thud, Cripple Mr. Onion, and more, Discworld series
British fantasy author Terry Pratchett satirizes just about every aspect of society he can reach in his Discworld novels, but he seems to have a particular love for mocking games in their various aspects. The Discworld card game Cripple Mr. Onion (mentioned in a handful of books, including Wyrd Sisters and Witches Abroad) may have just been introduced as a passing joke, to chaff some of the sillier names for popular old card games—though two Pratchett fans did create a rule set to make it a playable game. (Or at least playable for those who can remember rules like "If the Jack of Clubs is declared by any player before the first player has played their first group of cards, Bagels and Onions switch places in score value. Thus, Double Bagels, Triple Bagels, etc. become the most valuable hands, with the exception that a Great Onion will still beat a Great Bagel. It also, of course, becomes possible for a player to Cripple Mr. Bagel.") Crockett, which gets a few jokey pages to itself in Pratchett's latest novel, Snuff, is clearly mocking the esoteric rules of cricket: As recurring protagonist Samuel Vimes gamely listens to an enthusiast describe the rules, Pratchett describes his subjective experience in a lengthy paragraph in which Vimes dies, the sun goes out, the world ends, and then an entire new world is born, and life evolves anew and slowly climbs the evolutionary ladder for millions of years in order to produce a new Vimes, still listening to the details of how tumps, hampers, hawks, and handsaws fit into the game. On the other hand, the board game Thud, which pits a few powerful troll pieces against many weaker dwarf pieces, provides a central metaphor and framework for Pratchett's novel Thud. And then there's Stealth Chess, which adds an assassin piece and an assassin-only board area to conventional chess. Pratchett games, like Pratchett novels, tend to be about adding an extra twist on the outside of a real-world creation, in order to better access and examine its inside.


text:
I'd like to give you a peek at how the District
manages snow clearing and decision-making for the open/close of school.
First, you have found the District 39 "Emergency Closings" page. If you are ever unsure of
whether schools will be open, you will find the most up-to-date
information here. On bad weather days, we will update the link by 5:30
Next, I want to share with you how we arrive at the decision to close
our schools on a particular day. It is a fretful process that can begin
the day before. When the snow starts falling, I pull out my phone and check the weather forecast. the radar, and any posted advisories. I check it again...and again... and
again. I keep a close eye on the approaching storm; all of this before
bedtime! Then, at 4:00 AM, I take a scientific "look out the window" and
begin checking the the weather apps yet again.
If I get an "all clear," I go back to bed!
Otherwise, I call Stan Stankiewicz, District 39's Director of
Operations and Maintenance, who is already at work. He gives me an
update of the salting/plowing progress at each District 39 building. On my way to work I call the
Village Public Works Department (the snow plow department) for local
road conditions. In fact, I can even dial right into a snow plow! The
driver can detail for me the status of street salting and snow clearing
in the Village.
Next, I literally drive to the schools to get a feel for the
conditions and identify any trouble spots. If I see any difficult
driving areas, I call my friends at Public Works so they can address the
Between 4:30 and 5:30 AM, all school superintendents in New Trier
Township telephone conference heavily about whether or not to close
schools. We share all of the collective information we have. We want to
make decisions as early as possible and the "drop dead" decision time is
5:30 AM. As a group, the NT Township schools agree to make the same
decision on bad weather days.
If a decision is made to close school, then communication with
parents and staff begins. The most important part of that communication
involves a call to you, letting you know that schools will be closed.
Faculty and staff are also notified. At the same time, the website is
updated and the media is informed. Please make sure to notify us if your
phone number changes.
I hope this helps you understand the process that takes place so
often during the winter months. Please let me know if you have any
questions or concerns.
Ray Lechner, Ph.D.


text:
in Thailand walks among the dead at the
Phuket airport temporary morgue. Credit: AP
What's almost routine for Israel is very foreign to Iran, and while Israel sent a professional and equipment laden flight to Phuket, and were up and running quickly, Iran's consul on the ground had no idea where to start.
Israel Radio reports that the Iranian consul approached the Israeli representatives, and asked for their help -- the crash claimed 8 Israeli lives, and 18 Iranian ones. Israel immediately acquiesced, and provided a crucial piece of equipment to the Iranian personnel: A fax machine to receive identification pictures and other personnel information from Iran. Israel also agreed to help Iran with anything related to the tragedy.
The amazing thing is not Israel's willingness to help, but that Iran initiated the request for help.
Who knows...maybe they won't nuke us now.
Wherever I am, my blog turns towards Eretz Yisrael


text:
A modern and well-equipped cellar allow for separate vineyard vinifications.
Production :
The partially underground cellar contains mostly cement tanks and some wooden tronconic tanks.These temperature-controlled tanks are perfectly sized for vinifying separate vineyard origin.After sorting, the whole bunches are gently transferred by conveyor belt into tank.Fermentation takes place exclusively with natural yeasts.The ageing period lasts 4 to 11 months, and the wine is racked as needed.All wines are domaine bottled.
This equipment, combined with our procedures, provides us with complete control over the production of our wine and allows us to track every step from vine to bottle.


text:
Nodak Lodge on Lake Winnibigoshish, 15080 Nodak Drive, Bena, MN 56626
Nodak Lodge on Big Winnie
where families come for generations
Amid wetlands, gently rolling hills and 1.6 million acres of national forest, Nodak Lodge is the premier family, fishing and hunting destination for families looking to enjoy the wilderness of northern Minnesota. The undeveloped shores of Lake Winnibigoshish offer a pristine, peaceful experience in one of the area's best walleye fisheries. Our private, sandy beach is a perfect place to enjoy the summer sun without big crowds, and kids love our playground, heated swimming pool and game room.
Open year-round, we offer both comfortable, modern cabins and motel rooms, as well as campground faciliteis. Each of our family-friendly cabins has a view of the lake and fully-equipped kitchens, fresh linens and satellite TV. Each of our large, RV-ready campsites has full utilities with shower and laundry centrally located.
At the end of a day on the lake, our lodge is a great place to relax, grab a snack, outfit tomorrow's fishing trip or find a souvenir. If you want to take a trip to town, we're a scenic drive away from shopping, dining and entertainment in Bemidji, Walker and Grand Rapids.
Whether you are looking for a place to relax, a fishing get-away ro simply want to introduce your family to the northwoods, We're here to make your trip up-north a lasting memory. Contact Nodak Lodge and make the most of your Big Winnie vacation.
Website Design and Development by Ensemble Creative & Marketing


text:
Keepin it fast and safe on the dragstrip.
as the title.
i'll begin.
14.127 sec in the 185.
see ChrisD's world race Y'all.
can we sticky this please.
You have to register on the site to use. (it's free)
White=Solo or Autox
2007 Racing Events
24th ORC Doo Wops Stage Rally
25th ORC Doo Wops Stage Rally
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This is where Ian Burley, DPNow's editor and founder, shares his unique thoughts and impressions on subjects that he hopes will be of interest to others on the subjects of digital photography and other related or loosely related topics! You can follow DPNow Editor's blog on Facebook and Twitter, too.
Can you tell the difference between an 8 year old DSLR and a new one?
Posted 20-01-14 at 12:48 PM by Ian
Below are two shots taken with two DSLRs (same brand, same lens) but one dates back to 2005 and the other is brand new. The Web, and I believe printing, can be very forgiving - so can you tell which was taken with the new camera and which was taken with the old one?
Camera A
Camera B
Go on have a go
Camera A
Camera B
Go on have a go
Posted in UncategorizedViews 10393 Comments 12
Total Comments 12
Posted 20-01-14 at 03:00 PM by escallonia
Posted 20-01-14 at 04:36 PM by Ian
They really are very similar viewed at web resolution. It is a pure guess for me to say that the top image looks to have been processed from a higher resolution file.
I'd be interested to know if LR5.3 makes any discrimination in its processing of the two files from different eras by virtue of the ACR being used. Although if, these were DNG files, the processing would be different to other RAW files.
Maybe if you used LR from the same era as the old camera some bigger difference may be noticeable.
Really clutching at straws here...
Posted 20-01-14 at 04:41 PM by Graham_of_Rainham
Posted 20-01-14 at 06:46 PM by Ian
Posted 20-01-14 at 07:58 PM by Barr1e
Graham - regarding your point about the old and new versions of Lightroom - as you may know I have Lightroom 1 installed and I have been comparing results using the old camera processing RAW files with both versions of Lightroom but not processing the new camera RAWs with the old version of Lightroom - which doesn't make a lot of sense but might be interesting from a kind of academic point of view. If I have time I will have a go (hint - the new camera in question produces DNG RAW files conveniently).
Barr1e - are you sure the Rover wasn't reversing?
Posted 21-01-14 at 11:20 AM by Ian
Posted 21-01-14 at 12:21 PM by devilgas
I think the fact is that nobody can tell instantly which camera is which. So the old camera is a perfectly suitable tool for producing top-notch web-quality images. For many of us that's all we do with our photography. Severe cropping would make a difference but as I will show later today, even with moderate cropping the older camera can hold its own.
Posted 21-01-14 at 12:36 PM by Ian
Posted 23-01-14 at 11:12 AM by ash
Posted 25-01-14 at 01:29 AM by Horacio
Wow, very interesting! I agree with the higher ISO in photo B.
Posted 18-08-17 at 02:53 PM by linda09
Posted 08-01-18 at 05:16 PM by Trevor


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View topic - Huge Live Traffic for Indonesia-Mobile Telkomsel
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Huge Live Traffic for Indonesia-Mobile Telkomsel
Huge Live Traffic for Indonesia-Mobile Telkomsel
Kevin Anderson
» Mon Nov 11, 2019 4:05 am
EKUM PTE LTD (eKumTel) is a fast growing VoIP service solution provider registered in Singapore. Having a very good global reputation we are dealing millions of traffic daily with A-Z termination.
Having huge live traffic currently we need the following route(s) in urgent.
* Indonesia-cellular Telkomsel
Please feel free to contact me through Skype or send me an email anytime.
Also let me know if you have any other direct FAS-free, stable, Non CLI routes with competitive rates so that we can send our traffic through your network. Your business with us will be highly appreciated!
Please Contact:
Kevin Anderson
EKUM PTE LTD (eKumTel)
Skype: Kevin.ekumtel


text: Status: ConfirmedWhen: Saturday, May 27, 2017 from 10:00 AM to 11:00 AMWhere: Exercise StudioFitness Boot Camp is for men and women who are up to the challenge of being in the best physical shape of their life. The class is designed for weight loss, strength, and endurance. It is held in the Exercise Studio at the Family Life Center. The cost is $4 per class or 10 classes for $30. Check with the FLC front desk for schedule.


text:
Facing Ali
The canon of films (both documentary and dramatic) about the legendary boxer Muhammad Ali continues to grow and has to be richer than that of any other athlete in history. It helps that Ali had such a fascinating, controversial and (eventually) revered life. The list would start with Ali playing himself in the 1977 film The Greatest. Then, a curiosity: the TV movie Freedom Road, which Ali starred in as an ex-slave who became a senator. Ali even provided his own voice for the short-lived Saturday morning cartoon series I Am the Greatest: The Adventures of Muhammad Ali. Will Smith played him in the underrated Michael Mann bio Ali. And on TV, Terrence Howard took his swing in King of the World, as did David Ramsey (a college classmate of mine) in Ali: An American Hero. Actors also pop up playing him in supporting roles in Don King: Only in America and Phantom Punch, while he is only talked about in the more recent Stephen Fears film Muhammad Ali's Greatest Fight (as his fight with the United States over his draft status for the Vietnam war is decided by the Supreme Court). The documentary front has too many films to list, going at least as far back as 1970 with AKA Cassius Clay. Other highlights include Muhammad Ali: The Whole Story, Muhammad Ali: Through the Eyes of the World and The Trials of Muhammad Ali from earlier this year. And of course, the greatest of all is still the Academy Award-winning When We Were Kings. And just about every documentary on the civil rights and anti-Vietnam War movements usually has a chapter on the guy.
Finding a different angle on telling the whole Ali story is Facing Ali from 2009. Director Pete McCormack interviews Ali's boxing opponents and surprisingly creates about as all-encompassing a documentary as there has been on the man. Whereas When We Were Kings really centers on the Ali/ George Foreman "Rumble In The Jungle" bout and veers off occasionally for backstory, Facing Ali moves back and forth on the timeline and manages to include all his historical highlights: winning the gold in the 1960 Olympics, the mega upset against Sonny Liston, joining the Nation of Islam, changing his name from Cassius Clay and infuriating the white press and boxing establishment, and of course, his heroic battle against the Vietnam draft (which put his career on hold for many years during his peak). But where the movie goes that can really excite a budding Ali-phile are the details of the non-historic fights, especially after his return in the '70s when he re-won and then lost the title of champ and then won it back.Continue Reading