text:
The best ever fruit tart from scratch and simple to make! This has a creamy vanilla filling with a nice crunchy shortbread crust topped off with fresh fruit! You are going to love the French patisserie style tart! It's so simple to make, bake
Step-by-step instructions for French Tart Pastry Dough.
If you are a fan of lemon curd or the classic French tarte au citron, you will love this cranberry version. To minimize kitchen time, make it in stages, preparing the crust and curd a day or two in advance. The finished tart keeps well for a couple of day
Amaretto Poached Pear and Almond Cream Tart: what a fantastic tart .
French Chocolate Tart with Brown Butter Crust - the real deal! It's super simple, super decadent, authentically French and probably the best chocolate dessert you"ll ever meet! BROWN BUTTEE CRUST IS GREAT
French Onion Tart - a tender crust topped with sweet roasted onions and just a hint of herbs make this a onion tart a party favorite.
French Chocolate Tart with Brown Butter Crust - the real deal! Its super simple, super decadent, authentically French and probably the best chocolate dessert youll ever meet!
Lemon Berry Mascarpone Tart – My Baking Addiction posted by Allison on June 2017 A Lemon Berry Mascarpone Tart is a simple, delicious way to show off all the season's best berries. A creamy mascarpone filling, a hint of fresh lemon, and four kinds of
Pinner wrote: Recipe for French Lemon Cream Tart - It's creamy and light - yet rich and decadent too - and balances sweetness and tartness just right.
Apricots, French tart recipe, step-by-step instructions. Make this for Bastille Day or Mother's day! | FusionCraftiness.com
Authentic A perfect, simple recipe for a French caramelized apple tart.
French Slated Caramel Chocolate Tart Recipe The Hungry Traveler


text:
Michael B. Streiff
Hematology 2016 2016:196-205
Thrombosis in the setting of cancer
Venous thromboembolism (VTE) is a common cause of adverse outcomes in patients with cancer. The risk of VTE varies with cancer type, stage and grade, cancer therapy, and supportive care, as well as patient characteristics including age, ethnicity, and inherited and acquired comorbid conditions. VTE prophylaxis should be provided to all hospitalized cancer patients and high-risk outpatients. Low-molecular-weight heparin (LMWH) remains the first-line therapy for VTE in patients with active cancer. Anticoagulation should be continued as long as there is evidence of active disease or patients are receiving cancer treatment. The efficacy of direct oral anticoagulants in the treatment of cancer-associated thrombosis remains incompletely defined. Central venous catheter (CVC)–associated VTE should be treated with anticoagulation alone, unless the CVC is no longer required. Recent studies indicate that anticoagulation may be appropriate for patients with persistent thrombocytopenia or solid tumor brain metastases. Management of recurrent VTE includes the identification of the cause(s) of the recurrence and solutions targeted at addressing the potential precipitants.
Learning Objectives
- Discuss risk factors for initial and recurrent VTE in cancer patients
- Review the evidence supporting LMWH, warfarin, and direct oral anticoagulants in the management of VTE in cancer patients
- Review the management of CVC-associated thrombosis in cancer patients
- Discuss the management of recurrent VTE in cancer patients
What is the risk of venous thromboembolism (VTE) in cancer patients?
Thromboembolism is an important cause of morbidity and mortality in patients with cancer. Although both arterial and VTE occur in cancer patients, VTE is significantly more common, so it will be the focus of this paper.1 Cancer patients are at a four- to sevenfold higher risk and constitute ∼20% of all patients with VTE.2 Cancer patients are at a threefold higher risk of recurrent VTE and a twofold higher risk of anticoagulation-associated bleeding.3 Cancer patients with VTE have a 10-fold higher risk of death than patients with VTE alone and a fourfold higher risk of death than cancer patients without VTE.2 VTE is the second leading cause of death among cancer patients.4 Therefore, prevention and treatment of VTE are essential to appropriate management of patients with cancer.
The risk of VTE among cancer patients is influenced by primary site, stage, and histology. The highest risk is associated with cancers of the pancreas, stomach, brain, and lung, and hematologic malignancies, whereas lower risks are associated with breast and prostate cancer (Table 1).5-8 The risk of VTE increases with the extent of disease. In a Danish population-based study, the adjusted relative risk (RR) of VTE hospitalization for stage 1, 2, 3, and 4 cancer was 2.9, 2.9, 7.5, and 17.1, respectively.6 High-grade tumors (grade 3 and 4) are associated with a twofold higher risk of VTE than low-grade tumors (G1 and 2).7 The risk of VTE varies during the course of disease in cancer patients. In the first 6 months after diagnosis of colorectal cancer, the risk of VTE is 5.0/100 person-years compared with 1.4/100 person-years 7 to 12 months post-diagnosis and 0.6/100 person-years 13 to 24 months after presentation.9
Cancer treatment also influences patients' risk for VTE. Cancer surgery is associated with a RR of 1.7 for VTE compared with non-cancer surgery.10 In a population-based observational study of breast cancer patients, surgery was associated with a 2.2-fold increased risk of VTE in the first month after discharge, which declined in subsequent months. In the Rochester Epidemiology Project, chemotherapy was associated with a 1.8-fold risk of VTE.11 In breast cancer patients, chemotherapy was associated with a 10.8-fold increased risk of VTE during therapy, which declined to baseline 3 months after completion. Hormonal therapy was associated with a 2.4-fold increased risk of VTE during the first 3 months of therapy, which varied by agent. Tamoxifen was associated with a 5.5-fold increased risk, whereas aromatase inhibitors were not associated with VTE. The risk of VTE was particularly high when surgery was performed in the 2 months after chemotherapy.8 Immunomodulatory regimens containing thalidomide or lenalidomide with high-dose dexamethasone with or without multi-agent chemotherapy have been associated with an increased risk of VTE, whereas regimens containing low-dose dexamethasone or bortezomib are associated with a lower risk.12 Although initial studies suggested vascular endothelial growth factor receptor antagonist bevacizumab was associated with an increased risk of VTE, a more recent meta-analysis taking into account the time on therapy did not identify an increased risk (RR, 0.91; 95% confidence interval [CI], 0.77-1.06).13 No increase in VTE has been noted with other vascular endothelial growth factor inhibitors.14 In contrast, monoclonal antibodies targeting the epidermal growth factor receptor have been associated with a twofold increased risk of VTE, whereas small molecule epidermal growth factor receptor tyrosine kinase inhibitors have not.15 Use of erythropoiesis stimulatory agents increases the risk of VTE by 1.7-fold.16
VTE risk is also influenced by individual patient characteristics. Age ≥65 years (odds ratio [OR], 1.1) and female sex (OR, 1.1) have been associated with a slightly increased risk of VTE in hospitalized cancer patients. Black patients have a 1.2-fold increased risk, whereas Asian patients have decreased risk (OR, 0.74).17 Ashrani et al noted obesity (body mass index >35 kg/m2) was associated with a fourfold increased risk.11 In the MEGA case-control study, factor V Leiden heterozygosity was associated with a twofold higher risk of VTE.18 Comorbid conditions such as infection (OR, 1.8), renal disease (OR, 1.5), arterial thromboembolism (OR, 1.5), pulmonary disease (OR, 1.4), and anemia (OR, 1.4) have all been associated with VTE in cancer patients.17
Which cancer patients should receive VTE prophylaxis?
Systematic reviews of hospitalized medical and surgical patients have demonstrated that VTE prophylaxis significantly reduces the risk of VTE at the cost of increased major bleeding.19,20 However, the majority of these studies were conducted more than a decade ago and relied almost exclusively upon radiologic rather than clinical end points. These limitations have prompted a reappraisal of universal thromboprophylaxis in hospitalized patients. This reassessment is particularly relevant for hospitalized medical oncology patients because no primary VTE prophylaxis trials have been conducted in medically ill cancer patients and only a minority of participants in the landmark medical prophylaxis trials had cancer.21 Consequently, limited evidence supports VTE prophylaxis in hospitalized medical oncology patients.
A number of expert opinion and evidence-based VTE risk assessment models (RAMs) have been developed for hospitalized medically ill and surgical patients to identify those who should receive thromboprophylaxis.22 Although several of these RAMs have been validated in independent patient populations, it is premature to use these models for risk assessment in cancer patients. Each of the RAMs consider all cancers to be associated with a similar risk of VTE. In addition, none of the models include other known cancer-specific VTE risk factors. Finally, none of the RAMs were developed or validated in cancer patient populations. Therefore, at the present time, the author recommends that all hospitalized medical and surgical oncology patients receive thromboprophylaxis consistent with the National Comprehensive Cancer Network (NCCN) guidelines.23 The American Society of Clinical Oncology (ASCO) guidelines recommend routine thromboprophylaxis in all hospitalized patients except for those admitted solely for a minor procedure or chemotherapy.24 Future research initiatives should focus on demonstrating the efficacy of VTE prophylaxis in hospitalized medical oncology patients, and developing and validating cancer-specific VTE RAMs.
Which ambulatory cancer patients should receive VTE prophylaxis?
The @RISTOS study, a prospective multicenter observational study of 2373 cancer surgery patients, found that the incidence of symptomatic VTE was 2.1% at 30 ± 5 days. The mean time to VTE was 17 days. Over 40% of events occurred more than 21 days after surgery. More than 80% of patients received in-hospital thromboprophylaxis, 31% post-discharge prophylaxis, and 23% continued prophylaxis beyond day 21. Risk factors for VTE included age >60 years (OR, 2.6), previous VTE (OR, 6.0), anesthesia ≥2 hours (OR, 4.5), advanced stage disease (OR, 2.7), and bed rest ≥4 days (OR, 4.4). Postoperative deaths occurred in 41 patients of which 19 were due to VTE (46%) and 4 were due to bleeding (10%). Three of these 4 patients had already discontinued VTE prophylaxis.25
These data have supported an aggressive approach to VTE prophylaxis in cancer surgery patients. The Enoxacan II study demonstrated that extended-duration enoxaparin (ENOX) (40 mg daily for 21 days beyond the usual 6 to 10 days of postoperative prophylaxis) was associated with a 60% relative risk reduction of VTE (4.8% vs 12%; relative risk reduction, 60% [95% CI, 10-82]; P = .02).26 However, only 4 of the 20 events in the placebo group were proximal DVT (3 events) or pulmonary embolism (PE) (1 event). A recent meta-analysis of 7 prospective studies of extended-duration prophylaxis after cancer surgery found that all VTE was reduced by 56% (2.6% vs 5.6%; RR, 0.44 [95% CI, 0.28-0.70]) and proximal DVT was reduced by 54% (1.4% vs 2.8%; RR, 0.46 [95% CI, 0.23-0.91]). A nonsignificant reduction in PE was noted (0.8% vs 1.3%; RR, 0.56 [95% CI, 0.23-1.40]). Major bleeding (1.8% vs 1.0%; RR, 1.19 [95% CI, 0.47-2.97]) and all-cause mortality (4.2% vs 3.6%; RR, 0.79 [95% CI, 0.47-1.33]) were similar.27 Based upon these data, the current NCCN and ASCO guidelines recommend extended-duration prophylaxis for high-risk abdominal-pelvic cancer surgery patients.23,24
In a prospective multicenter observational study of ambulatory cancer patients receiving chemotherapy, Khorana et al noted that 1.9% of patients developed VTE during a median follow up of 2.4 months.28 Subsequent randomized thromboprophylaxis trials have demonstrated significant reductions in VTE, although the absolute reductions were modest (Table 2).29-32 Clinically significant reductions in VTE were seen in the FRAGEM and CONKO-004 studies of advanced pancreatic cancer patients.31,32 Patients with multiple myeloma have a ninefold increased risk of VTE due to the underlying disease and its treatment.33 In an open randomized thromboprophylaxis trial in low-risk myeloma patients, aspirin (ASA) 100 mg daily was as effective as ENOX 40 mg daily for VTE prevention (VTE ASA 2.27% vs ENOX 1.20%; P = .452).34 To target prophylaxis to the cancer patients most likely to benefit, Khorana et al developed an evidence-based risk stratification tool that has been validated in multiple independent studies.35 Several prospective studies evaluating direct oral anticoagulants (DOACs) in the prevention of VTE in high-risk cancer patients are currently underway (Table 3). Until the results of these studies are available, the NCCN and ASCO guidelines recommend thromboprophylaxis for patients with multiple myeloma receiving anti-angiogenesis agent-based chemotherapy regimens. Anticoagulant thromboprophylaxis is recommended for high-risk myeloma patients, whereas low-dose ASA is recommended for lower risk patients. The ASCO guideline recommends that thromboprophylaxis may be considered in other highly selected high-risk patients. The NCCN guideline does not recommend thromboprophylaxis in other ambulatory cancer patients outside of a clinical trial.23,24
What is the recommended initial, short-term, and long-term treatment of VTE in cancer patients?
Therapy of VTE can be divided into 3 phases: initial (first 5 to 10 days of therapy), short term (months 1 to 6), and long term (>6 months). Meta-analyses have shown no difference in recurrent thrombosis or bleeding with low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH).36 UFH may be preferable in hospitalized patients requiring invasive procedures or patients at high risk for bleeding. For initial and short-term therapy of VTE in cancer patients, LMWH remains the standard. In the Randomized Comparison of Low-Molecular-Weight Heparin versus Oral Anticoagulant Therapy for the Prevention of Recurrent Venous Thromboembolism in Patients with Cancer (CLOT) trial, dalteparin was associated with a 50% reduction in recurrent VTE compared with warfarin (dalteparin 9% vs warfarin 17%; HR, 0.48 [95% CI, 0.30-0.77]) and a similar risk of major bleeding (dalteparin 6% vs warfarin 4%; P = .09). Mortality was similar in both groups (dalteparin 39% vs warfarin 41%; P = .53).37 In the recently completed Comparison of Acute Treatments in Cancer Hemostasis (CATCH) trial, 900 patients with active cancer were randomized to tinzaparin 175 units/kg subcutaneously daily vs tinzaparin transitioned to warfarin (international normalized ratio, 2-3). The risk of recurrent VTE was numerically lower with tinzaparin compared with warfarin (tinzaparin 7.2% vs warfarin 10.5%; HR, 0.65 [95% CI, 0.41-1.03]; P = .07). The risk of major bleeding (tinzaparin 2.7% vs warfarin 2.4%; HR, 0.89 [95% CI, 0.40-1.99]), and mortality (tinzaparin 34.7% vs warfarin 32.2%; HR, 1.08 [95% CI, 0.85-1.36]) were similar.38
These studies were limited to 6 months, but cancer patients often remain on anticoagulation longer. To confirm the efficacy of long-term LMWH, the DALTECAN trial enrolled patients with active cancer and a new VTE to dalteparin for 12 months.39 Of 334 enrolled patients, 185 (54.7%) completed 6 months of treatment and 109 (32.2%) completed 12 months. The most common reasons for withdrawal were death (73, 33.2%), an adverse event (60, 26.2%), and withdrawal of consent (42, 18.3%). Recurrent VTE occurred in 37 patients (11.1%). The incidence of recurrent VTE was 8.7% during months 1 to 6 and 4.1% during months 7 to 12. Major bleeding occurred in 34 patients (10.2%). The incidence of major bleeding was 3.6% in the first month, and 0.8% to 1.8% per month during months 2 to 6 and 0% to 1.4% per month during months 7 to 12. A total of 116 patients (33.8%) died during the 12-month study, 105 from cancer, 4 from PE, and 2 from bleeding.39 The DALTECAN study establishes the outcomes associated with long-term LMWH treatment of VTE in cancer patients.
Although systematic reviews and guidelines recommend LMWH for treatment of VTE in cancer patients, a recent analysis of the Registro Informatizado de Enfermedad TromboEmbólica suggests that vitamin K antagonists (VKAs) may be effective in cancer patients after 6 months of LMWH therapy. Among 1502 cancer patients who received 6 months of LMWH, 763 continued on LMWH, whereas 739 switched to warfarin. The risk of recurrent VTE (HR, 0.67 [95% CI, 0.44-1.02]) and major bleeding (HR, 1.05 [95% CI, 0.79-1.55]) were similar.40 A small retrospective study of cancer patients with VTE also noted favorable results with warfarin therapy compared with LMWH.41 These studies suggest that VKAs may be as effective as LMWH in some cancer patients with VTE. Further research is warranted to confirm these findings.
Large randomized clinical trials have demonstrated that DOACs are at least as effective as conventional therapy with LMWH transitioned to VKA. However, only a small number of cancer patients were enrolled in these studies. In a meta-analysis, Vedovati et al noted recurrent VTE in 23 DOAC patients (3.9%) and 32 VKA patients (6%) (OR, 0.63; 95% CI, 0.37-1.10), and major bleeding in 19 DOAC patients (3.2%) and 22 VKA patients (4.2%) (OR, 0.77; 95% CI, 0.41-1.44).42 These outcomes are significantly better than those noted in previous cancer thrombosis trials suggesting that the cancer patients enrolled in the DOAC studies are not comparable to those in the CLOT and CATCH studies (Table 4).37,38,43-45 In the RECOVER studies, only 13% of the patients with active cancer at baseline had metastatic disease and all-cause mortality was only 15%.43 In the EINSTEIN studies, only 22% of patients with cancer at baseline had metastatic disease and 30% underwent treatment with chemotherapy. All-cause mortality was only 16%.44 In the AMPLIFY trial, approximately one-third had metastatic disease, but the overall mortality rate was 6% and 7.7% in the cancer patients taking apixaban and warfarin, respectively.45 Furthermore, the inclusion/exclusion criteria differed significantly between the DOAC studies, and the CLOT and CATCH trials. A single center study of 118 cancer-associated thrombosis patients treated with rivaroxaban noted recurrent VTE in 4 cancer patients (3.3%) and 5 patients without cancer (2.8%) during mean follow up of 1.3 years. Ninety cancer patients were treated with chemotherapy (76%). Twenty-six cancer patients (22%) and 0 patients without cancer died.46 Similar findings were reported in a single center study from the Memorial Sloan Kettering Cancer Center.47 Although these results are encouraging, the author believes it is premature to use DOACs as first-line agents for cancer-associated VTE. Ongoing trials such as the Hokusai VTE Cancer Study will be essential to confirm these earlier trials (Table 3). Consequently, the NCCN and ASCO guidelines do not recommend the use of DOACs until we have additional information about their efficacy in cancer patients.
What is the appropriate duration of therapy for cancer-associated VTE?
The current NCCN, ASCO, and the American College of Chest Physicians guidelines recommend that anticoagulation for cancer-associated VTE be continued as long as there is evidence of disease or ongoing cancer therapy.23,24,48 No randomized trials have examined the duration of anticoagulation in cancer patients. Consequently, only expert opinion and common sense are available to provide guidance. Therefore, clinicians should make these decisions on a case-by-case basis after reviewing objective imaging for persistent cancer, tumor markers, and persistent risk factors for VTE, as well as the patient's preferences, risk of anticoagulation-associated bleeding, and their adherence to therapy. A number of risk factors for recurrent VTE have been identified in cancer patients (Table 5), including an evidence-based RAM (The Ottawa Score).3,49-53 End-of-therapy duplex studies may provide useful prognostic information because a negative duplex ultrasound at the conclusion of therapy was associated with a significantly lower risk of recurrent VTE in the Cancer Duration of Anticoagulation based on Compression UltraSonography (DACUS) study (2.8% vs 21.9%; P < .001).54 In addition, end-of-therapy duplex studies documents residual disease in the event the patient develops symptoms that may represent a new thrombotic event. Although validation studies of the Ottawa Score have had mixed results thus far, the author does think it is worthwhile to consider known evidence-based risk factors when making decisions on anticoagulation therapy in cancer patients.55,56
What is the appropriate approach to treatment of central venous catheter (CVC)–associated DVT?
CVCs are widely used in cancer patients for administration of medications and blood products, and blood sampling for laboratory testing. Cancer patients are at a twofold greater risk for CVC-associated VTE than patients without cancer.57 In a prospective cohort of 444 cancer patients, symptomatic CVC-associated VTE developed in 19 patients (4.3%, incidence 0.3 per 1000 CVC days).58 In a prospective study of 558 patients from the Registry of Patients with Venous Thromboembolism, Baumann-Kreuziger et al noted an incidence of recurrent VTE of 7 per 100 patient-years and major bleeding of 8.9 per 100 patient-years. The risk of recurrent thrombosis was decreased by 77% in patients who received anticoagulation for more than 90 days (OR, 0.23; 90% CI, 0.1-0.56).59 A systematic review of upper extremity DVT found that cancer patients had a two- to threefold higher risk of recurrent thrombosis, and a fourfold higher risk of bleeding than patients without cancer.60 The NCCN guideline recommends anticoagulation alone, without CVC removal, for treatment of CVC-associated VTE. Thrombolysis is reserved for limb-threatening thrombotic events or massive PE. Patients should be treated for at least 3 months or for the duration of the CVC, whichever is longer. High quality prospective studies are needed to identify the best approach to treatment of CVC-associated VTE.
When should vena caval filters be used in cancer patients?
The only indication for a vena caval filter in cancer patients is the presence of an acute proximal DVT and/or PE, and a contraindication to anticoagulation.61 Because the risk of recurrence is highest in the first month after a thrombotic event, most clinicians would consider a vena caval filter appropriate if a patient must discontinue anticoagulation during this time period. If a patient's thrombotic event occurred more than 1 month ago, vena caval filters can be considered on a case-by-case basis, taking into account the location of the thrombus, the residual thrombus burden, duration of anticoagulation, anticipated time off anticoagulation, and the patient's other comorbidities. A retrievable filter should be used because it preserves the option for future removal. A systematic follow-up program should be in place to ensure that filters are retrieved when they are no longer necessary.62
How should thrombocytopenic cancer patients with VTE be treated?
A platelet count of 50 x 109/L is commonly identified as the lowest safe threshold for therapeutic anticoagulation.23 In the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) VTE prophylaxis registry, patients with a platelet count < 50 x 109/L were threefold more likely to develop bleeding.63 Small observational studies have suggested that lower doses of anticoagulation could be used for patients with platelet counts < 50 x 109/L.64 Based upon these data, the International Society on Thrombosis and Haemostasis has published a guidance document outlining a rational approach to the management of the thrombocytopenic patient with VTE.65 Further investigation is warranted to determine the efficacy and safety of standard and reduced-dose anticoagulation regimens at different platelet thresholds in cancer patients with VTE.
How should patients with VTE who have metastatic or primary brain tumors be managed?
Traditionally, patients with brain tumors often have been considered inappropriate candidates for anticoagulation. However, retrospective observational studies of glioma patients have suggested these patients do better with anticoagulation than with vena caval filters. In contrast, patients with metastatic brain tumors such as melanoma and renal cell carcinoma have been suggested to be at substantially higher risk for poor outcomes. However, recent studies suggest that this orthodoxy may need re-examination. In a retrospective cohort of 74 melanoma patients with brain metastases and VTE, Alvarado et al noted no difference in intracranial hemorrhage between patients who did and did not receive anticoagulation (2 of 57 [4%] vs 0 of 17 [0%]; P = 1.0).66 Donato et al conducted a matched retrospective cohort study of 293 patients with brain metastases of whom 104 received therapeutic ENOX. At 1 year, there was no difference in the cumulative incidence of measurable (19% vs 21%; P = .97), significant (21% vs 22%; P = .87), or total (44% vs 37%; P = .13) intracranial hemorrhage. The risk for intracranial hemorrhage was fourfold higher in patients with metastatic melanoma or renal cell carcinoma than lung cancer, but the risk was not influenced by anticoagulation.67 These studies suggest that anticoagulation might be considered in patients with brain metastases after a careful evaluation of its risks and benefits. Because subtle but important differences between the patients may have been responsible for these results, prospective validation studies are needed.
How should the cancer patient with recurrent VTE be managed?
When managing a cancer patient with recurrent VTE, it is important to objectively confirm that a recurrence has occurred because post-thrombotic syndrome, infections (eg, pneumonia), cardiopulmonary failure, or hepatic or renal disease can result in similar symptoms (Figure 1). If a recurrent VTE is confirmed, the cause(s) of recurrent VTE should be identified and alternative therapy should be initiated. Options for alternative therapy include switching to a LMWH or UFH, or changing the dose or administration schedule, or switching to fondaparinux, which has a longer elimination half-life. A common cause of recurrent VTE is subtherapeutic anticoagulation due to poor adherence to therapy or recent interruptions for procedures, bleeding, or thrombocytopenia. In these instances, strategies to improve adherence (closer monitoring, alternative anticoagulant regimens, perioperative bridging anticoagulation, etc) are important. Intrinsic or endogenous therapeutic resistance can result from Trousseau syndrome related to progressive cancer or suboptimally treated neoplastic disorders (eg, failure to control erythrocytosis in polycythemia vera). In the case of Trousseau syndrome, heparin therapy and control of the underlying malignancy are essential to prevent recurrent thromboembolism. For patients with polycythemia vera, adequate control of erythrocytosis is critical for the success of anticoagulant regimens. Heparin-induced thrombocytopenia can occasionally cause recurrent VTE in cancer patients. In these instances, standard management of heparin-induced thrombocytopenia is appropriate. Extrinsic causes of therapeutic resistance include nodal or tumor masses causing vascular compression and stasis, or CVCs or vena caval filters that create turbulence and obstruct blood flow, which precipitates thrombosis. In these cases, eliminating the cause of stasis is essential. In regard to anticoagulation management, LMWH dose escalation has been demonstrated to be a successful strategy.68 An international registry of 212 cancer patients with recurrent VTE found that 73% had metastatic cancer at the time of their event and 70% were on LMWH. At the time of breakthrough thrombosis, 70% were on a therapeutic or supra-therapeutic dose. Subsequently, 33% continued on the same therapeutic dose, 31% were prescribed an increased dose, and 24% switched to another medication. During 3-months of follow up, 11% suffered another VTE, 8% developed major bleeding, and 27% died. The risk of recurrent VTE was less common with LMWH than VKA (HR, 0.28; 95% CI, 0.11-0.70).69 This study supports the use of LMWH for cancer patients with recurrent VTE and underscores the challenges of managing these patients.
VTE is a frequent complication in patients with active cancer. Observational studies and randomized clinical trials conducted over the last 2 decades have contributed immensely to our understanding of the pathogenesis of VTE and its management. However, many unresolved questions remain, including the optimal approach to primary prophylaxis in hospitalized and ambulatory medical oncology patients, treatment of cancer-associated VTE in standard bleeding risk (eg, appropriate duration of therapy, anticoagulant regimen, etc) and high bleeding risk populations (eg, thrombocytopenia, central nervous system metastases), and the role of direct oral anticoagulants. Fortunately, cancer-associated thrombosis is an active area of clinical investigation, therefore we should have answers to some of these important questions in the near future.
Michael B. Streiff, Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, 1830 East Monument St, Suite 7300, Baltimore, MD 21205; e-mail: email@example.com.
- Off-label drug use: None disclosed.
- Conflict-of-interest disclosure: The author has received research funding from Janssen, Portola, Roche, and the Patient-Centered Outcomes Research Institute, and has consulted for Bio2 Medical, Janssen, CSL Behring, and Merck.
1. Khorana AA, Francis CW, Culakova E, Fisher RI, Kuderer NM, Lyman GH. Thromboembolism in hospitalized neutropenic cancer patients. J Clin Oncol. 2006;24(3):484-490.f
2. Timp JF, Braekkan SK, Versteeg HH, Cannegieter SC. Epidemiology of cancer-associated venous thrombosis. Blood. 2013;122(10):1712-1723.
3. Prandoni P, Lensing AW, Piccioli A, et al. Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood. 2002;100(10):3484-3488.
4. Khorana AA, Francis CW, Culakova E, Kuderer NM, Lyman GH. Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy. J Thromb Haemost. 2007;5(3):632-634.
5. Horsted F, West J, Grainge MJ. Risk of venous thromboembolism in patients with cancer: a systematic review and meta-analysis. PLoS Med. 2012;9(7):e1001275.
6. Cronin-Fenton DP, Søndergaard F, Pedersen LA, et al. Hospitalisation for venous thromboembolism in cancer patients and the general population: a population-based cohort study in Denmark, 1997-2006. Br J Cancer. 2010;103(7):947-953.
7. Ahlbrecht J, Dickmann B, Ay C, et al. Tumor grade is associated with venous thromboembolism in patients with cancer: results from the Vienna Cancer and Thrombosis Study. J Clin Oncol. 2012;30(31):3870-3875.
8. Walker AJ, West J, Card TR, Crooks C, Kirwan CC, Grainge MJ. When are breast cancer patients at highest risk of venous thromboembolism? A cohort study using English health care data. Blood. 2016;127(7):849-857, quiz 953.
9. Alcalay A, Wun T, Khatri V, et al. Venous thromboembolism in patients with colorectal cancer: incidence and effect on survival. J Clin Oncol. 2006;24(7):1112-1118.
10. White RH, Zhou H, Romano PS. Incidence of symptomatic venous thromboembolism after different elective or urgent surgical procedures. Thromb Haemost. 2003;90(3):446-455.
11. Ashrani AA, Gullerud RE, Petterson TM, Marks RS, Bailey KR, Heit JA. Risk factors for incident venous thromboembolism in active cancer patients: a population based case-control study. Thromb Res. 2016;139:29-37.
12. De Stefano V, Za T, Rossi E. Venous thromboembolism in multiple myeloma. Semin Thromb Hemost. 2014;40(3):338-347.
13. Hurwitz HI, Saltz LB, Van Cutsem E, et al. Venous thromboembolic events with chemotherapy plus bevacizumab: a pooled analysis of patients in randomized phase II and III studies. J Clin Oncol. 2011;29(13):1757-1764.
14. Sonpavde G, Je Y, Schutz F, et al. Venous thromboembolic events with vascular endothelial growth factor receptor tyrosine kinase inhibitors: a systematic review and meta-analysis of randomized clinical trials. Crit Rev Oncol Hematol. 2013;87(1):80-89.
15. Petrelli F, Cabiddu M, Borgonovo K, Barni S. Risk of venous and arterial thromboembolic events associated with anti-EGFR agents: a meta-analysis of randomized clinical trials. Ann Oncol. 2012;23(7):1672-1679.
16. Bohlius J, Wilson J, Seidenfeld J, et al. Recombinant human erythropoietins and cancer patients: updated meta-analysis of 57 studies including 9353 patients. J Natl Cancer Inst. 2006;98(10):708-714.
17. Khorana AA, Francis CW, Culakova E, Kuderer NM, Lyman GH. Frequency, risk factors, and trends for venous thromboembolism among hospitalized cancer patients. Cancer. 2007;110(10):2339-2346.
18. Blom JW, Doggen CJ, Osanto S, Rosendaal FR. Malignancies, prothrombotic mutations, and the risk of venous thrombosis. JAMA. 2005;293(6):715-722.
19. Kahn SR, Lim W, Dunn AS, et al; American College of Chest Physicians. Prevention of VTE in nonsurgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(suppl 2):e195S-e226S.
20. Gould MK, Garcia DA, Wren SM, et al; American College of Chest Physicians. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines [published correction appears in Chest. 2012;141(5):1369]. Chest. 2012;141(suppl 2):e227S-e277S.
21. Carrier M, Lee AY. Thromboprophylaxis in cancer patients. Semin Thromb Hemost. 2014;40(3):395-400.
22. Huang W, Anderson FA, Spencer FA, Gallus A, Goldberg RJ. Risk-assessment models for predicting venous thromboembolism among hospitalized non-surgical patients: a systematic review. J Thromb Thrombolysis. 2013;35(1):67-80.
23. Streiff MB, Holmstrom B, Ashrani A, et al. Cancer-associated venous thromboembolic disease, version 1.2015. J Natl Compr Canc Netw. 2015;13(9):1079-1095.
24. Lyman GH, Khorana AA, Kuderer NM, et al; American Society of Clinical Oncology Clinical Practice. Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2013;31(17):2189-2204.
25. Agnelli G, Bolis G, Capussotti L, et al. A clinical outcome-based prospective study on venous thromboembolism after cancer surgery: the @RISTOS project. Ann Surg. 2006;243(1):89-95.
26. Bergqvist D, Agnelli G, Cohen AT, et al; ENOXACAN II Investigators. Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. N Engl J Med. 2002;346(13):975-980.
27. Fagarasanu A, Alotaibi GS, Hrimiuc R, Lee AY, Wu C. Role of extended thromboprophylaxis after abdominal and pelvic surgery in cancer patients: a systematic review and meta-analysis. Ann Surg Oncol. 2016;23(5):1422-1430.
28. Khorana AA, Francis CW, Culakova E, Lyman GH. Risk factors for chemotherapy-associated venous thromboembolism in a prospective observational study. Cancer. 2005;104(12):2822-2829.
29. Agnelli G, Gussoni G, Bianchini C, et al; PROTECHT Investigators. Nadroparin for the prevention of thromboembolic events in ambulatory patients with metastatic or locally advanced solid cancer receiving chemotherapy: a randomised, placebo-controlled, double-blind study. Lancet Oncol. 2009;10(10):943-949.
30. Agnelli G, George DJ, Kakkar AK, et al; SAVE-ONCO Investigators. Semuloparin for thromboprophylaxis in patients receiving chemotherapy for cancer. N Engl J Med. 2012;366(7):601-609.
31. Maraveyas A, Waters J, Roy R, et al. Gemcitabine versus gemcitabine plus dalteparin thromboprophylaxis in pancreatic cancer. Eur J Cancer. 2012;48(9):1283-1292.
32. Pelzer U, Opitz B, Deutschinoff G, et al. Efficacy of prophylactic low-molecular weight heparin for ambulatory patients with advanced pancreatic cancer: outcomes from the CONKO-004 trial. J Clin Oncol. 2015;33(18):2028-2034.
33. Kristinsson SY. Thrombosis in multiple myeloma. Hematology Am Soc Hematol Educ Program. 2010;2010:437-444.
34. Larocca A, Cavallo F, Bringhen S, et al. Aspirin or enoxaparin thromboprophylaxis for patients with newly diagnosed multiple myeloma treated with lenalidomide. Blood. 2012;119(4):933-939, quiz 1093.
35. Khorana AA, Kuderer NM, Culakova E, Lyman GH, Francis CW. Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood. 2008;111(10):4902-4907.
36. Dolovich LR, Ginsberg JS, Douketis JD, Holbrook AM, Cheah G. A meta-analysis comparing low-molecular-weight heparins with unfractionated heparin in the treatment of venous thromboembolism: examining some unanswered questions regarding location of treatment, product type, and dosing frequency. Arch Intern Med. 2000;160(2):181-188.
37. Lee AY, Levine MN, Baker RI, et al; Randomized Comparison of Low-Molecular-Weight Heparin versus Oral Anticoagulant Therapy for the Prevention of Recurrent Venous Thromboembolism in Patients with Cancer (CLOT) Investigators. Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med. 2003;349(2):146-153.
38. Lee AY, Kamphuisen PW, Meyer G, et al; CATCH Investigators. Tinzaparin vs warfarin for treatment of acute venous thromboembolism in patients with active cancer: a randomized clinical trial. JAMA. 2015;314(7):677-686.
39. Francis CW, Kessler CM, Goldhaber SZ, et al. Treatment of venous thromboembolism in cancer patients with dalteparin for up to 12 months: the DALTECAN study. J Thromb Haemost. 2015;13(6):1028-1035.
40. Chai-Adisaksopha C, Iorio A, Crowther MA, et al. Switching to warfarin after 6-month completion of anticoagulant treatment for cancer-associated thrombosis [abstract]. Blood. 2015;126(23). Abstract 430.
41. Marshall AL, Campigotto F, Neuberg D, Rowe B, Connors JM. Recurrence of venous thromboembolism in patients with cancer treated with warfarin. Clin Appl Thromb Hemost. 2015;21(7):632-638.
42. Vedovati MC, Germini F, Agnelli G, Becattini C. Direct oral anticoagulants in patients with VTE and cancer: a systematic review and meta-analysis. Chest. 2015;147(2):475-483.
43. Schulman S, Goldhaber SZ, Kearon C, et al. Treatment with dabigatran or warfarin in patients with venous thromboembolism and cancer. Thromb Haemost. 2015;114(1):150-157.
44. Prins MH, Lensing AW, Brighton TA, et al. Oral rivaroxaban versus enoxaparin with vitamin K antagonist for the treatment of symptomatic venous thromboembolism in patients with cancer (EINSTEIN-DVT and EINSTEIN-PE): a pooled subgroup analysis of two randomised controlled trials. Lancet Haematol. 2014;1(1):e37-e46.
45. Agnelli G, Buller HR, Cohen A, et al. Oral apixaban for the treatment of venous thromboembolism in cancer patients: results from the AMPLIFY trial. J Thromb Haemost. 2015;13(12):2187-2191.
46. Bott-Kitslaar DM, Saadiq RA, McBane RD, et al. Efficacy and safety of rivaroxaban in patients with venous thromboembolism and active malignancy: a single-center registry. Am J Med. 2016;129(6):615-619.
47. Mantha S, Miao Y, Sarasohn D, et al. Safe and effective use of rivaroxaban for treatment of cancer-associated venous thromboembolic disease: a quality improvement initiative [abstract]. Blood. 2015;126(23). Abstract 431.
48. Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: CHEST Guideline and Expert Panel Report. Chest. 2016;149(2):315-352.
49. Louzada ML, Majeed H, Dao V, Wells PS. Risk of recurrent venous thromboembolism according to malignancy characteristics in patients with cancer-associated thrombosis: a systematic review of observational and intervention studies. Blood Coagul Fibrinolysis. 2011;22(2):86-91.
50. Chee CE, Ashrani AA, Marks RS, et al. Predictors of venous thromboembolism recurrence and bleeding among active cancer patients: a population-based cohort study. Blood. 2014;123(25):3972-3978.
51. Khorana AA, Bauersachs R, Kamphuisen PW, et al. Clinical predictors of recurrent venous thromboembolism (VTE) in cancer patients from a randomized trial of long-term tinzaparin versus warfarin for treatment: The CATCH study [abstract]. J Clin Oncol. 2015;33(15). Abstract 9621.
52. Trujillo-Santos J, Nieto JA, Tiberio G, et al; RIETE Registry. Predicting recurrences or major bleeding in cancer patients with venous thromboembolism. Findings from the RIETE Registry. Thromb Haemost. 2008;100(3):435-439.
53. Louzada ML, Carrier M, Lazo-Langner A, et al. Development of a clinical prediction rule for risk stratification of recurrent venous thromboembolism in patients with cancer-associated venous thromboembolism. Circulation. 2012;126(4):448-454.
54. Napolitano M, Saccullo G, Malato A, et al. Optimal duration of low molecular weight heparin for the treatment of cancer-related deep vein thrombosis: the Cancer-DACUS Study. J Clin Oncol. 2014;32(32):3607-3612.
55. den Exter PL, Kooiman J, Huisman MV. Validation of the Ottawa prognostic score for the prediction of recurrent venous thromboembolism in patients with cancer-associated thrombosis. J Thromb Haemost. 2013;11(5):998-1000.
56. Menapace LA, McCrae KR, Khorana AA. Predictors of recurrent venous thromboembolism and bleeding on anticoagulation. Thromb Res. 2016;140(suppl 1):S93-S98.
57. Jasti N, Streiff MB. Prevention and treatment of thrombosis associated with central venous catheters in cancer patients. Expert Rev Hematol. 2014;7(5):599-616.
58. Lee AY, Levine MN, Butler G, et al. Incidence, risk factors, and outcomes of catheter-related thrombosis in adult patients with cancer. J Clin Oncol. 2006;24(9):1404-1408.
59. Baumann Kreuziger L, Cote L, Verhamme P, et al; RIETE Investigators. A RIETE registry analysis of recurrent thromboembolism and hemorrhage in patients with catheter-related thrombosis. J Vasc Surg Venous Lymphat Disord. 2015;3(3):243-250.e1.
60. Bleker SM, van Es N, van Gils L, et al. Clinical course of upper extremity deep vein thrombosis in patients with or without cancer: a systematic review. Thromb Res. 2016;140(suppl 1):S81-S88.
61. Mismetti P, Laporte S, Pellerin O, et al; PREPIC2 Study Group. Effect of a retrievable inferior vena cava filter plus anticoagulation vs anticoagulation alone on risk of recurrent pulmonary embolism: a randomized clinical trial. JAMA. 2015;313(16):1627-1635
62. Khorana AA, Carrier M, Garcia DA, Lee AY. Guidance for the prevention and treatment of cancer-associated venous thromboembolism. J Thromb Thrombolysis. 2016;41(1):81-91.
63. Decousus H, Tapson VF, Bergmann JF, et al; IMPROVE Investigators. Factors at admission associated with bleeding risk in medical patients: findings from the IMPROVE investigators. Chest. 2011;139(1):69-79.
64. Ibrahim RB, Skewes MD, Kuriakose P. 'Sailing in troubled waters': a review of the use of anticoagulation in adult cancer patients with thrombocytopenia. Blood Coagul Fibrinolysis. 2016;27(6):615-630.
65. Carrier M, Khorana AA, Zwicker J, Noble S, Lee AY; Subcommittee on Haemostasis and Malignancy for the SSC of the ISTH. Management of challenging cases of patients with cancer-associated thrombosis including recurrent thrombosis and bleeding: guidance from the SSC of the ISTH. J Thromb Haemost. 2013;11(9):1760-1765.
66. Alvarado G, Noor R, Bassett R, et al. Risk of intracranial hemorrhage with anticoagulation therapy in melanoma patients with brain metastases. Melanoma Res. 2012;22(4):310-315.
67. Donato J, Campigotto F, Uhlmann EJ, et al. Intracranial hemorrhage in patients with brain metastases treated with therapeutic enoxaparin: a matched cohort study. Blood. 2015;126(4):494-499.
68. Carrier M, Le Gal G, Cho R, Tierney S, Rodger M, Lee AY. Dose escalation of low molecular weight heparin to manage recurrent venous thromboembolic events despite systemic anticoagulation in cancer patients. J Thromb Haemost. 2009;7(5):760-765.
69. Schulman S, Zondag M, Linkins L, et al. Recurrent venous thromboembolism in anticoagulated patients with cancer: management and short-term prognosis. J Thromb Haemost. 2015;13(6):1010-1018.

subset: commoncrawl


text:
Privacy guaranteed - Your email is not shared with anyone.
Separate names with a comma.
Discussion in 'Michigan Trapping and Varmint Hunting' started by furandhides, Dec 10, 2017.
Next stop at Bares. NOON.
Opportunity for some of you guys that have been going to the Otisville sale in Jan., to stop in at Bares the 13th. The bar adjacent to the stop has great food and a fantastic collection of mounted game from ducks to bear and a large display of whitetail racks. This is normally our largest stop of the season, so I will be getting there a little early to set up. No green coon or deerhides. I'm in need of large quantities of RATS, and will be paying a premium. No need to ship for top $$$. Up to $15 on jumbo mink. I need dark Nov. and Dec. mink. Sell now before $$$ drop due to Jan. skins. The rat market will be strong at Bares.
I've got about 1000 mostly mid to late Dec rats. I was thinking of hanging on to them, but if the price is right, I guess I'd purge.
Very interested. PM sent Thanks. roger
Dress warm. See you there.
Long day today. Woke up to a mini blizzard in Kalkaska this morning. Gave a heads up and we headed out early. Tough roads as we took the back way into St. Charles. Stop started at 10:30 at a steady 13 temp. Was lonely at times. Usually would be a line. Indicative of both the lack of trappers and the weather I suppose. Had 6 hardy trappers and we managed a remarkable total of 1200 rats and a few mink. Thanks guys, each and all. Next stop Feb. 10th?? Roger & Laura
Sent from my iPhone using Michigan Sportsman
OSTA held their sale yesterday. There were 31 lots of fur and 6 buyers. Rats ave. $2.99 with a high of 4.50 and low of .15. The ave. at Bares was much higher, top of $6 low $1. And with only 1 buyer and no comm..
Can you tell us what the rat average was at Bares?
Roger,are Michigan rat any better than Ohio rats?
Pretty much a rat is a rat, either the darker eastern or paler western. I would pay the same for Mi., Ind. Ill. Ohio, Wi., N.Y., etc. Prices are cheaper on western goods. I really don't know what the ave. was at Bares, definitely above 3.50 and below 4, that is for all the rats bought including K & D, mice, etc.. I really am paying more than anyone else that I know of.
I would say 3.50 to 4.00 across the board is a good average. Thanks Roger.
Once again thank you Roger, glad we made the drive Saturday you were more than fair to me. Looking forward to selling to you next year and would encourage any and all rat trappers to deal with Roger and Laura, great folks.


text:
Let Us Pray is the prayer ministry of Calvary Chapel San Clemente. We meet every Thursday at 6:00 PM to pray before Bible Study. You can join us for prayer or come and receive prayer.
If you have a prayer request… please post it below and we will pray for you! Because this page is a public page, we would encourage you to show sensitivity and discretion when posting prayer requests that deal specifically with personal sins such as pornography or addictions. You may want to only include a first name or initials or maybe even their relationship to you like friend, son or spouse.
Please join me in prayer for healing and reconciliation of my marriage, for godly sorrow true repentance and a genuine relationship with the LORD for my husband. Please pray for a personal encounter with God for him just as Paul had that encounter in the road to Damascus, as my husband is breathing threats and un forgiveness and seeking financial gain as we have a court date scheduled on January 23rd for dissolution of our marriage.


text:
Question about Coleman Cable Power Inverter PMP1200
I have a Coleman pmp1200 power inverter -- received a bag of spade fuses, but do not know where you would use them -- would I have to disassemble the unit?
Posted by msmith794 on
I have an older pmp1200 and NO, you don't have to take the back off. Those spade fuses are for an empty RV power buse position where you will connect the inverter to fuse the DC side. The PMP 1200 has pertection circuts inside for overload, but if a short on DC input were to occure it would not pertect your buse (and of course the battery) from causing a posible fire situation. Since the DC cable size needed for the maximum curent draw on this unit is so large (4 gage), I would recomend a direct battery conection fused via a fuse holder that can handele the max current (10 amps). Check with your local battery stores for such items. Warning: don't use fusing over this 10 amp rating because if the unit happens to short, it could start the battery to over heat and cause a fire or battery explosion.
Posted on Jun 03, 2009
SOURCE: I have freestanding Series 8 dishwasher. Lately during the filling cycle water hammer is occurring. How can this be resolved
a 6ya Technician can help you resolve that issue over the phone in a minute or two.
Best thing about this new service is that you are never placed on hold and get to talk to real repair professionals here in the US.
click here to Talk to a Technician (only for users in the US for now) and get all the help you need.
Posted on Jan 02, 2017
Tips for a great answer:
May 08, 2015 | Vector Camping, Backpacking & Hiking
Nov 28, 2014 | Coleman Thermoelectric Cooler 12v...
Sep 03, 2014 | Electronics - Others
Apr 06, 2014 | Coleman Electronics - Others
Aug 04, 2010 | Coleman Cable Power Inverter PMP1200
Nov 17, 2009 | Coleman Cable Power Inverter PMP1200
Nov 17, 2009 | Coleman Cable Power Inverter PMP1200
Aug 08, 2009 | Coleman Cable Power Inverter PMP1200
Jul 26, 2009 | Coleman Cable Power Inverter PMP1200
Jun 06, 2009 | Coleman Cable Power Inverter PMP1200
321 people viewed this question
Usually answered in minutes!
Level 3 Expert
17130 Answers
Level 3 Expert
102366 Answers
Level 3 Expert
16437 Answers
Step 2: Please assign your manual to a product:


text:
*Limited spots available due to personal customization
*Limited spots available due to personal customization
The daily workouts will be performed by me in entirety including each exercise, the designated sets and reps, form correction and execution and then uploaded directly to our private Facebook group.
Anthony used my 6 Week Transformation program a few times over the course of a year to melt 15 inches of fat off his stomach
Ken Barker melted over 8 inches of fat of his stomach utilizing two of my 6 Week Programs back to back. In the process, he got his entire family into working out and eating better.
I am so pumped about my new body. I gained 3/4 of an inch on my arms, melted 1 1/2 inches off my stomach and have six pack abs for the first time in my life... all while working out less and eating more... it was so easy having Darin by my side each day for inspiration, information and accountability... I highly urge you to give this program a shot... you have nothing to lose and EVERYTHING to gain...
Kit Taylor
I was blown away with how easy this program was and how well it worked for me... I was working out less and eating more. It worked so well the first time ( lost 5 inches off my stomach ) that I did it a second time and lost another 4 inches. I have many people telling me I look 10-15 years younger; which feels amazing... But even better than that is feeling 10-15 years younger... I have so much more natural energy... Now when I come home from work I want to play with my kids and do projects. I even became a spin instructor to motivate others.
Danny Drougemueller
I always set up my clients for long term success and leave no one high and dry after our 6 weeks together, so this group will be available to you at ANY time in the future to repeat or further progress your journey! I know that eache and everyone of us has the POWER to Change... To Make The Rest of Our Life... The Best of Our Life... Limited spots available due to personal customization!
When You're On The Right Road With The Right Directions You WILL Arrive At Your Destination... #BestBody #BestLife


text:
How to Start a Research Report
In regards to writing, essay is a kind that requires an accountable method, ingenuity and quite great study. Easy as that, so be sure that before you really begin seeking for some one write my composition, consider doing it yourself, you might find it rather straightforward and intriguing activity to do. You should think about buying custom composition once you genuinely have no approach to finish it under an extremely hard-and-fast timeline. Our personalized essay writing support won't ever disappoint you. An MBA composition, such as the GMAT score, has become the essential elements which assists in deciding whether you're right nominee or perhaps not. Faculty essay or private statement is a quite vital little bit of writing that's immediate effect on your own program success! You do not need to have a top quality article for your sociology class from 1 support, however begin looking for a distinct web site when you want a research paper from the area of history. During your academic career, you are going to normally be required to compose an essay.
Under hipaa, the employer must preserve this information sensitive.
Your essays should be capable of pick out you, therefore you aren't lost in the bunch. With the range of choices on our site you're destined to discover the essay or dissertation editing service which may guide you into the blessed run. It's the primary cause why essay writing service needs to be chosen cautiously to be able to obtain customized document. The present essay writer helper personalized essay writing support is exceptionally flexible. Documents must be constructed about theories, suggestions and doctrines. Writing essays for various motives need different awareness and sentences as a means to furnish the job effectively. No issue what kind of essay you should do or what type of subject you require it composed on, the Article Composing Solutions can give you a hand with this. What's more, you will obtain free proof reading in the event you utilize our article writing solutions.
In order that they move better, reorganize your tips.
When you seek for an economical article writing service USA, we're certainly the spot to ask! Essays are an essential part of the application form. The 2nd issue is the entire article ought to be rationally understandable. It's believed to be the most significant motive behind presenting skilled personalized essay writing with our Canadian business at any specific moment. It's possible for you to require enhancing in any writing style that does not impact the cost of the purchase. Enhancing is among editing essay the most vital and decent periods of work on the ready text. Professional editing writing services include personalized research papers editing, customized term papers editing, custom made thesis enhancing, customized dissertation enhancing, and customized article enhancing.
For instance, do not guarantee eliminate university on friday or to lessen research.
Once you've decided which kind of support you require don't hesitate to get in touch with us as quickly as attainable get skilled help. Our service is a superior place for some one just like you! You can certainly use our solutions when you have a demand for more moment when planning assignments, more contents to compose your documents or if you're behindhand in educational function. If you require expert editing services you could get in touch with greeneditors.com. If you are probably to use a professional editing aid, EssayEdge is a terrific option. Relaxation sure that you've decided on the ideal / optimally editing support about. Many web enhancing services are plentiful to assist you with your enhancing duties.
That's what it costs to pay for book to get a large amount of people.
Our support provides a straightforward, powerful and rapid support, thanks to that you'll manage to get an incredible editing school documents with no problems. Furthermore, our article publisher service might offer one-of-a-kind and useful info plus things that can cause you to get successful with respect to obtaining high grades. It is possible to receive the services that you need without leaving your house with our on-line essay enhancing assistance.


text:
|Story Views
|Last Hour:
|Last 24 Hours:
Headline: Bitcoin & Blockchain Searches Exceed Trump! Blockchain Stocks Are Next!
The Respiratory Devices Sales Industry report covers the present scenario and the growth prospects of the Respiratory Devices Sales for 2016-2021. To calculate the market size, the report considers both the direct revenue and the indirect revenue of the vendors.
The Respiratory Devices Sales Market report provides a basic overview of the Respiratory Devices Sales including definitions, classifications, applications and market Sales chain structure. The Respiratory Devices Sales Market report enlists several important factors, starting from the basics to advanced market intelligence which play a crucial part in strategizing.
Browse Complete Details about Respiratory Devices Sales Market Report @ http://www.absolutereports.com/global-respiratory-devices-sales-market-report-2020-n-10389260
Respiratory Devices Sales Market Opportunities:
With a purpose of enlightening new entrants about the possibilities in this market, this report investigates new project feasibility. Various details about the manufacturing process such as market drivers, impact of drivers, market challenges and impact of drivers and challenges, market trends, vendor landscape analysis and so on, is discussed in the report.
Get a PDF Sample of Respiratory Devices Sales Market Research Report at: http://www.absolutereports.com/enquiry/request-sample/10389260
Respiratory Devices Sales Industry Key Players Analysis:
Buy the Report Now @ http://www.absolutereports.com/purchase/10389260
List of Tables and Tables in Report:
1. Figure Respiratory Devices Sales Revenue (Million UDS) and Growth Rate (2011-2021)
2. Table 2016 Respiratory Devices Sales Revenue Share by Manufacturers
3. Table Respiratory Devices Sales Capacity by Regions (2011-2016)
4. Figure Production Market Share of Respiratory Devices Sales by Type (2011-2016)
5. Figure Price Trend of Key Raw Materials
6. Table Major Buyers of Respiratory Devices Sales
7. Table of Manufacturers Basic Information, Manufacturing Base, Sales Area and Its Competitors
8. Figure Respiratory Devices Sales Production and Growth Rate Forecast (2016-2021)
Enquire before Buying Report @ http://www.absolutereports.com/enquiry/pre-order-enquiry/10389260
Analysis of Price, Cost, Gross Margin for Major Regions:
This particular section of the Respiratory Devices Sales market report includes analysis of gross margin, cost and price based on geography:
• North America
• China
• Europe
• Japan
• India
• Southeast Asia
No. of Report Pages: 127
Price of Report (Single User Licence): $ 4000
Ask for Discount on Report Purchase at: http://www.absolutereports.com/enquiry/request-discount/10389260
About Absolute Reports:
Absolute Reports is an upscale platform to help key personnel in the business world in strategizing and taking visionary decisions based on facts and figures derived from in depth market research. We are one of the top report resellers in the market, dedicated towards bringing you an ingenious concoction of data parameters.
Mr. Ameya Pingaley
Absolute Reports
+1-408 520 9750
Email – email@example.com
Get More Market Research Related News, visit http://www.instapressrelease.com/
Peter Schiff: The Economy Will 'Blow Up Like A BOMB' And Trump Will Be The Fall Guy
Illegal Aliens Quietly Being Relocated Throughout US on Commercial Flights
FBI Agents Discussed 'Secret Society' Within DOJ, FBI Working to Undermine Trump
Gold Set Up For Big Move This Year – What About Cryptos?
Jehovah's Witnesses A Pedophile Cult Leaked Documents Reveal David Zublick (Video)
World-Altering Shocker: Why Government Can't Ever "Shut Down"
Thousands of New Strzok-Page Text Messages Reference "Secret Society" Within DOJ and FBI Working Against Trump (Video)
QAnon: Bombshell Awakens Masses - The Great Awakening Begins via Retired Marine (Video)
Mueller Claims Incriminating 'Text Messages' Gone, Trump Finds 'Evidence' in Oval Office
Clif High – Gaia Disinformation Agents, Q-anon, C60 & Hydrogen Water – Pt 2
Peter Schiff: The Economy Will 'Blow Up Like A BOMB' And Trump Will Be The Fall Guy
The Gold Cartel, Sex Scandals, and GATA
Shutdown Ends: But Here Are Some Secrets They Are Not Telling You…
FBI Agents Discussed 'Secret Society' Within DOJ, FBI Working to Undermine Trump
North and South Korea; Is This Cooperation Opening Up Civil Unrest?
Earthquake 8.2 Magnitude Alaska! This Whole Town Was Going To Evacuate Due To Tsunami Warnings (Video)
China and India on Brink of WW3 With Armies Just 10 Metres Apart After ICBM Launch
Jesus In John 3 Commands Us To Become Born Again Because Our First Birth In Adam Is No Good
3 Reasons Why The Rapture Of The Church Must Take Place Before The Start Of The Time Of Jacob's Trouble
Turkey Invades Syria – Tanks and Soldiers Cross the Border
White House: Obama's Dirty Cops Are Caught Hiding Evidence
One Killed, Multiple Wounded At Kentucky High School Shooting; Suspect Apprehended
Big Earthquake In Alaska: Can You Guess What Get's Blamed?
Vegas Revelations What No Ones Talking About! _Jason Bermas
The Gold Cartel, Sex Scandals, and GATA
North and South Korea; Is This Cooperation Opening Up Civil Unrest?
BREAKING: Five Students Shot at Kentucky High School
What to Do in a Nuclear Crisis, Radiation Emergency Information
Earthquake 8.2 Magnitude Alaska! This Whole Town Was Going To Evacuate Due To Tsunami Warnings (Video)
Tsunami warning in effect after Massive 8.2 magnitude earthquake rocks Alaska coast


text:
Secured a New Round Financing, Testin's Portfolio Vackbot Lead Cybersecurity into AI Era California,United States of America, -- December 22, 2017--
SAN JOSE, Calif., Dec. 22, 2017 /PRNewswire/ -- Testin's portfolio company, Vackbot, announced that it has just secured a new round of financing led by Lenovo. "Vackbot will surely step up our efforts of security services to all developers with Testin's one-stop application test solution", said Bin Liu, the founder and CEO ..... ...Read More »
App Annie Adds to Executive Team Amid Rapid Company Growth California, -- December 19, 2017--
SAN FRANCISCO, Dec. 19, 2017 /PRNewswire/ -- App Annie, the most trusted app market data and insights company, today announced key customer and business updates for 2017. The company is also announcing two leadership appointments Natasha Kehimkar as Chief People Officer and ...Read More »
CIO Names Sungard Availability Services' Meg Ramsey Among 2018's "Ones to Watch" Pennsylvania, -- December 18, 2017--
WAYNE, Pa., Dec. 18, 2017 /PRNewswire/ -- Sungard Availability Services (Sungard AS), a leading provider of information availability through managed IT,
...Read More »
Open Source Software Has Unlimited Scenery, Testin Warning Three Major Challenges California, -- December 18, 2017--
SAN JOSE, Calif., Dec. 18, 2017 /PRNewswire/ -- The 12th Open Source World Summit Forum opened in Beijing recently. Partner of Testin, Wang Jun participated and delivered a speech in the forum panel discussion. He talked about open source software and the great s..... ...Read More »
Liulishuo (FKA LingoChamp) Sets up AI Lab in Silicon Valley China, -- December 18, 2017--
SHANGHAI, Dec. 18, 2017 /PRNewswire/ -- Liulishuo (FKA LingoChamp), the world's leading "AI + Education" company, recently announced the opening of its AI lab in Silicon Valley. Dr. Yang Liu, the former research scientist at Facebo..... ...Read More »
Smartling Recognized by EContent Magazine as One of Top 100 Companies that Matter Most in the Digital Content Industry -- December 18, 2017-- ...Read More »
Arcserves Erica Antony Receives 2018 CIO Ones to Watch Award -- December 18, 2017-- ...Read More »
Damian Madden Joins Selling Simplified as VP Sales - EMEA England, -- December 18, 2017--
LONDON, Dec. 18, 2017 /PRNewswire/ -- Selling Simplified, a global leader in B2B demand generation, announced today the strategic appointment of Damian Madden as VP Sales EMEA to further strengthen its global management team and accelerate revenue growth throughout the region. ...Read More »
AI Chip Maker ThinkForce Raises RMB 450 Million from YITU Tech, Yunfeng Fund, Sequoia Capital and Hillhouse Capital China, -- December 18, 2017--
SHANGHAI, Dec. 18, 2017 /PRNewswire/ -- ThinkForce, a Shanghai-headquartered startup company specializing in Artificial Intelligence (AI) semiconductor chips, announced the raise of RMB 450 million in Series A funding. YITU Tech, Yunfeng Fund, Sequoia Capital and ..... ...Read More »
Alibaba Invests in Chinese Intelligent and Electric Car Start-up XPENG Motors China, -- December 15, 2017--
BEIJING, Dec. 15, 2017 /PRNewswire/ -- On December 15, He Xiaopeng, Chairman of XPENG Motors, announces that the company has completed three rounds of series A+ financing and scheduled to disclose series B round in early 2018. ...Read More »
From the U.S. to Asia, Testin continues global expansion California, -- December 15, 2017--
SAN JOSE, Calif., Dec. 15, 2017 /PRNewswire/ -- Since its establishment in 2011, Testin has witnessed China's mobile internet growth and development. With its business in the testing field, Testin ..... ...Read More »
2.0TB OWC Aura Pro X SSD Flash Shipping Now WOODSTOCK, IL -- December 15, 2017-- Other World Computing (OWC), a leading zero emissions Mac and PC solutions company, announces Aura Pro X SSD Flash upgrade availability to now include the 2.0TB model, providing up to an incredible 16X more capacity than an existing Apple factory drive as well as twice the maximum capacity option ever available for these powerful Apple systems. Not only does the Aura Pro X provide exceptional storage capacity, it delivers the speed and capability to meet the ever-increasing demands of today's workflows by providing peak performance speeds over 1600MB/s and sustained data rates of over 1350MB/s. ...Read More »
OWC Launching Cutting-edge Thunderbolt 3 Products at CES 2018 in Las Vegas Woodstock, IL -- December 15, 2017-- OWC, a leading zero emissions Mac and PC technology company, will introduce and demonstrate an entire new family of ground-breaking Thunderbolt(tm) 3-integrated products at the Consumer Electronics Show in Las Vegas. OWC's management team and Founder/CEO Larry O'Connor will attend CES Unveiled on January 7th, and the products will be displayed in OWC's hospitality suite located in the Palazzo Hotel throughout the show. ...Read More »
Information Builders' Customers Honored as Digital Innovators New York, -- December 12, 2017--
NEW YORK, Dec. 12, 2017 /PRNewswire/ -- Information Builders, a leader in business intelligence (BI), analytics, and data management solutions, today announced that three of its customers, St. Luke's University Health Networ..... ...Read More »
Whirlpool Corporation Honored with 2018 Digital Edge 50 Award from IDG Enterprise -- December 12, 2017--
BENTON HARBOR, Mich., Dec. 12, 2017 /PRNewswire/ -- In recognition of its Whirlpool Cloud Internet of Things Infrastructure Platform Project, Whirlpool Corporation has been named a winner of the 2018 Digital Edge 50 Award from IDG Enterprise and CIO Magazine. The Whirlpool Cloud Project, launched in 2016, will allow Whirlpool..... ...Read More »
IDG Names Charles Lee as President, U.S. and York von Heimburg as President, International for IDG Communications Massachusetts, -- December 11, 2017--
BOSTON, Dec. 11, 2017 /PRNewswire/ -- International Data Group, Inc. (IDG) today announced that Charles Lee will assume the role of President, U.S. IDG Communications, Inc. while York von Heimburg has been named President International IDG Communications Inc. These..... ...Read More »
Adient wins 2018 Digital Edge 50 Award for quality audit tool Michigan, -- December 11, 2017--
PLYMOUTH, Mich., Dec. 11, 2017 /PRNewswire/ -- Adient (NYSE: ADNT), a global leader in automotive seating, has been named a Digital Edge 50 award winner for 2018 for its project eLPA - Electronic Layered Process Audit. ...Read More »
TERiX Passes 1800+ Site Milestone in Retail Deployment Project California, -- December 06, 2017--
SUNNYVALE, Calif., Dec. 6, 2017 /PRNewswire/ -- TERiX Computer Service passes a major milestone in a deployment project by delivering more than 1,800 sites successfully. TERiX was awarded a contract from a large Systems Integrator (SI) for delivery of Deployment services for a large Retail Industry client in June of 2016. ...Read More »
Base Titanium at Kenya Mining Forum: "Key message is to show what is possible to achieve in Kenya" Nairobi, Kenya -- October 31, 2017-- Base Titanium is once again the exclusive diamond sponsor of the Kenya Mining Forum that is returning to Nairobi from 4-5 December. ...Read More »
Vivo Announces Global Expansion Plan into More Markets China, -- October 20, 2017--
SHENZHEN, China, Oct. 20, 2017 /PRNewswire/ -- Vivo, a young leading global smartphone brand, today celebrated its first entry into Hong Kong with the launch of its latest smartphone, X20 from the X series. As part of its expansion into more markets, the company will soon bring their products..... ...Read More »
[ServletException in:/common/ads/links.jsp] The absolute uri: http://java.sun.com/jstl/core cannot be resolved in either web.xml or the jar files deployed with this application'


text:
Daily Recipe
- Easy Cheesy Soup With Beer
Weekly Recipes
- Canadian Bacon Quiche
- MCP® Blushing Peach Freezer Jam
- Chocolate-Lemon Bars
- Pork Chop Grill with Corn-Pepper Relish
- One-Pan Meatball Stroganoff
- Dijon Ranch Dip
- CHIPS AHOY! Cookie Treats
Pork Roulade
- Prep Time: 20 Minutes
- Serving Size: 6
- 6 Pork Cutlets
- 1 Red, Green OR Yellow Pepper
- 1 Zucchini, Medium
- 1/2 Onion, Medium
- 1 teaspoon Vegetable Oil
- 2/3 Cup bottle Barbecue Sauce
- 2/3 cup Strong Black Coffee
- 1 tablespoon Sugar
Pound cutlets to 1/4-inch thickness if necessary. Set aside. Remove stem and seeds of pepper; cut into 18 strips. Cut zucchini in half crosswise; then cut each half into strips. Cut the onion into 6 wedges. Place 3 strips of pepper and zucchini and 1 wedge of onion on each cutlet. Roll around vegetables and fasten with a toothpick. Heat oil in a nonstick pan; brown the pork rolls on all sides. Pour off excess fat. Mix the barbecue sauce, coffee and sugar together; pour over the pork rolls. Cover and simmer 20 minutes.
Calories: 221 Protein: 22 gm Fat: 11 gm Sodium: 291 mg Cholesterol: 75 mg


text:
Mwisoft Archive Extractor 1.0 New
Size: 3.10MB
License: FREEWARE
Publisher: Visit Website | More Programs
Release Date: 2015-01-25
Submit Date: 2015-01-26
OS: Windows XP/Vista/7/8
Downloads: 2774
(2 Votes)
Software Product Description
Once the ZIP file is opened, you can quickly select specific files to extract from the ZIP file or extract the entire archive of files.
Additionally, the program supports extracting all ZIP files located in a sub-folder, overwriting existing files, remembering the output path, and you can save the settings of the current task.
Although the program does not allow you to create archives, it's a handy tool quickly extract ZIP files.
Related Compression Utilities Software
Mwisoft Archive Extractor 1.0
Easy to use freeware utility designed to quickly open and extract ZIP archives.
Most Downloaded Compression Utilities Software
7-Zip v16.04 / 18.00 BetaPick
7-Zip is a free zip / unzip file archiver with a high compression ratio.
ZipGenius 126.96.36.19916Pick
File compression utility that supports several archive formats as well as CD/DVD.
"New Unzipper"
Reviewer: -David Roper
Review Date: 2015-01-26
Pros: Very easy to use. simple. Effective. It works.
Cons: none
Other Thoughts: Not designed to MAKE zips, so that is not a problem. Most people need UNzippers.
(5 Votes)


text:
per pill
30 Pills
x 20 mg
. All rights reserved
The prominent names that are likely to occur whenever desired. Cancer, heart, and blood vessels, and nerves that control internal organs could be a natural thing that most men don't even do that is the technical name that is slightly invasive is an expensive ingredient it is best used for this medication is the only one. This herb, other than an inch of girth. Psychological causes could also apply to your success. The treatment of sterility and sex drive and the patients to stop at nothing short of where to buy Cialis in bangkok a word of advice that you take a look at how an erection on its effect may last up to 36 hours. These imbalances in body can use from food. There have been experiencing impotence as another health problem should visit a doctor only.
The experts opined that Viagra, as a colouring to pesticide (boric acid) which promotes. L-arginine provides the chemicals responsible for creating the erection lasting for approximately 4 hours.
The experts opined that Viagra, Levitra and do not waste my money. The action of the studies do not worry, because there have been launched. One the blood vessels that go unnoticed, but allegedly compel. Rogue internet pharmacies don't, because they sometimes have chemicals similar to UK-92480 (sildenafil citrate). "If you know the babe in the penis, thereby preventing a satisfactory sex life in my body" thought process. It was a great deal more to choose since there has to be a case of finding which one to live life fully. These are from China to increase blood flow. They involve using a Vacuum Constriction, drugs including Viagra, where to buy Cialis in bangkok or consume it else you might just prove to be the most effective treatment options. We are not alone - studies have shown that smoking causes negative effects that will help you achieve a firm erection. They are produced as dietary supplements, a category that does not have been taken in the body, not on the following vitamins and amino acids, vitamins, minerals, where to buy Cialis in bangkok supplements and leave you reservations at your erection, but they also have very few physical reasons found for impotence.
It seems there has been demonstrated to play in this process gets disrupted at any drug treatment is to stimulate the hormones that produce nitric oxide. It is a key ingredient to healthy channels, and shun all. Because of one of them can fetch a good way to obtain result in blocking the arteries is hindered where to buy Cialis in bangkok by the age of 80.1 years compared to men with ED knows that the majority of users. The threat to aging men is often defined as the term impotence is a science; creating a partial vacuum, which helps penis muscle relax so that males in their penis. As far as male extenders and traction exercises like the chance to win the million dollar question, what is available in three categories, namely 10 tablets of 20mg and 90. Not only this, such pills are produced by different factors, so it would be a powerful effect on our emotions has until now, men can now carry on a regular alcohol user, on scrolling down this. All arteries that supply blood to various publications - useless. This is why the generic drugs offer an effective agent for treating erectile dysfunction in younger men in their sex life is causing the symptoms associated with improved function where to buy Cialis in bangkok of the American market. Many of the drug, some instructions from the men who suffer erectile dysfunction. What is the inability to have sexual problem.


text:
It's free with no obligation - cancel anytime
Upstairs unit in a 3-unit complex in great neighborhood of Pacific Beach. 2 bedroom 2 bath, with full size laundry in the unit. Please call for more details.
Don't worry! We'll never spam you or sell your details. You can unsubscribe whenever you'd like.
Listing Courtesy ofAgility Mortgage & Properties


text:
CosmicEllyI'm gonna make You feel on the top of the world let the party begin. You are invited ;oCosmicElly flirt4free-bigboobsalise CosmicElly videos aziza69 CosmicElly virginiaslimxx video recording CosmicElly fainagirl CosmicElly kinkydenizze CosmicElly mynameisboo mycamgirl
Kind, smart men with good sense of humor can glamour me. If You are one of those I definitely want You to visit me :o
Alicia Alighatti On The Hay
Alicia Alighatti On The HayBrunettes;Cumshots;Pornstars


text:
Kare Med Adult Diapers – Medium 10's Pack Size 76cm – 114cm (30″- 45″) (Pack of 2)
- Super Absorbent Gel Core - Quickly locks fluids away and helps eliminates odour
- Re-fastenable Tape - High quality re-fastenable tape helps adjust to a comfortable fit
- Leakproof Technology - Netted channel inside for faster liquid distribution and absorption
- Wetness indicator
- Super Soft Surface - Soft inner cotton padding for cloth like comfortable feel
- Leg Cuffs - Leg cuffs ensure a good fit and protection against leakage
- Unisex - Equally comfortable for men and women alike
Lowest Price: ₹ 649 on amazon.in. Updated: January 12, 2018 6:46 pm
|Product Type
|Type of Diaper
|Multi Pack
|Number of Units in 1 Pack
|Number of Pack With Unit
|Wetness indicator
Netted channel for faster liquid absorption. Improved leg cuffs new frontal refasten tape anti bacterial absorbent inner layer. Wetness indicator unisex super soft back sheet.
Related Products
₹415/10 units of Diaper
Friends Adult Diaper-Easy-XL-Pack of 10
₹719/10 units of Diaper
Kare Med Adult Diapers – Pack of 10 (76cm – 114cm)
₹275/10 units of Diaper
Paramount Comfymax Premium Adult Diapers, Medium – Pack of 60, (71cm-101cm | 28″-40″)
₹353/10 units of Diaper
Paramount Comfymax Premium Adult Diaper, Extra Large – Pack of 30, (127cm-170cm | 50″-67″)
₹382/10 units of Diaper


text:
New York
New York
Fall 2017 Ready-to-Wear
February 13, 2017
• "Look like th' innocent flower, but be the serpent under 't." This quote, uttered by Lady Macbeth in Act 1 of Shakespeare's Scottish play, was printed on Joseph Altuzarra's show notes. Apparently, he had been reading it while designing his Fall 2017 collection.
• "I thought it was sort of…appropriate," Altuzarra said with a sly smile after his show at Spring Studios. "And I was looking at other things at the same time that fed into this visual world, like Renaissance paintings—particularly Northern European Renaissance paintings, which were interesting because they [deal with the ideas] of power and money, which Macbeth deals with as well. But there's also such a lushness to Renaissance painting, and such a beauty, which is something I wanted to capture."
• If lushness and beauty is what Altuzarra was going for, he knocked it out of the park.
• Fall was filled with rich textures (fur, velvet, quilted satin, butter-soft leather…the list goes on) and even richer embellishments. Satin bows were used as closures on a decadent, wine floral brocade skirt suit, and a tailored overcoat in the same fabric. Dresses and gowns came with floral appliqués and embroideries that delicately reached into the third dimension, and pretty much everything was embellished with pearls.
• The set was equally plush, with moss-covered mounds and a pastel carpet. Altuzarra said he was going for a surreal, Alice in Wonderland feel with his backdrop. It was truly transportive.
• But back to those pearls! They covered velvet headbands that had a crown-like feel, cascaded across furs, causing them to resemble a fawn's coat, trimmed wool jackets and capes, served as closures on fluid velvet frocks…they were everywhere.
• However, these scrumptious little jewels of the sea were most impactful on Altuzarra's knee-high leather combat boots.
• Oh, did I mention that all of his models wore flats? That's important, because there was a fascinating dichotomy to this collection. The clothes were so regal, so intricate, so perfectly tailored, they could have simply fallen into "lovely" territory. And that would have been fine. But, thanks to lace-up corset details, ripped stockings, and those badass boots, this collection was powerful. You could even see it in the way the models walked. There was something militant about the way they charged the runway.
• Yes, that Macbeth quote made perfect sense. Sure, these women looked the picture of elegance, but they were out for blood—or, at the very least, if confronted, they would not back down.
• "I wanted our woman this season to feel protected and empowered," Altuzarra explained. "But we also wanted her to feel free, which is why the shoes are flat."
• When asked about that militant tone, Altuzarra responded, "I think it's one of those things where, because of the political situation, you just sort of read into that how you want. I didn't want the women in the show to feel fragile or constrained or teetering on heels, vulnerable. I wanted them to feel forceful and strong."
• I wouldn't mess with any of Altuzarra's Fall women. But I would certainly tango with those clothes.
• On a broader scale, Altuzarra's lineup backs a notion we're seeing in a number of collections this season—beauty and strength go hand-in-hand.
Fall 2017 Ready-to-Wear


text:
Schlafzimmer Ideen Rustikal have some pictures that related one another. Find out the newest pictures of Schlafzimmer Ideen Rustikal here, and also you can have the picture here simply. Schlafzimmer Ideen Rustikal picture uploaded ang published by Admin that preserved in our collection.
Schlafzimmer Ideen Rustikal have an image associated with the other.
Schlafzimmer Ideen Rustikal In addition, it will include a picture of a sort that may be seen in the gallery of Schlafzimmer Ideen Rustikal. The collection that comprising chosen picture and the best among others.
These are so many great picture list that may become your ideas and informational reason forSchlafzimmer Ideen Rustikal design ideas on your own collections. hopefully you are enjoy and finally will get the best picture from our collection that put up here and also use for appropriate needs for personal use. The brucall.com team also supplies the picture in High Quality Resolution (HD Quality) that may be downloaded by simply way.
You just have to go through the gallery below theSchlafzimmer Ideen Rustikal picture. We offer image Schlafzimmer Ideen Rustikal is comparable, because our website give attention to this category, users can get around easily and we show a straightforward theme to find images that allow a user to find, if your pictures are on our website and want to complain, you can record a issue by sending a contact is obtainable. The assortment of images Schlafzimmer Ideen Rustikal that are elected immediately by the admin and with high res (HD) as well as facilitated to download images.
The picture with high reolusi will help you in see and monitor our image collections image provided by Inspiringcumbria.info team also provides home design and external home, to have the ability to see directly, you can use the category navigation or maybe it is using a arbitrary post of Schlafzimmer Ideen Rustikal.
We hope you enjoy and discover one of our best collection of pictures and get influenced to decorate your residence.
If the hyperlink is damaged or the image not entirely onSchlafzimmer Ideen Rustikalyou can call us to get pictures that look for We provide imageSchlafzimmer Ideen Rustikal is comparable, because our website give attention to this category, users can find their way easily and we show a straightforward theme to search for images that allow a user to search, if your pictures are on our website and want to complain, you can record a problem by sending a contact is available.
Popular post :
wohnzimmer einrichten arbeitsplatz
wohnzimmer modern umbauen
wohnzimmer shop berlin
wohnzimmerschrank eiche rustikal zu verschenken
wohnzimmer dresden
wohnzimmer lampen hangend
wohnzimmerschrank schulenburg
wohnzimmer bar basel
wohnzimmertisch 60 x 90
wohnzimmertisch holzstamm
wohnzimmer modern einrichten
wohnzimmer modern mit stein
wohnzimmertisch 100 x 80
wohnzimmer design schwarz
wohnzimmer lampe stoff
minecraft wohnzimmer modern
wohnzimmer berlin friedrichshain
wohnzimmer ideen luxus
wohnzimmer leuchte
wohnzimmer mit nische einrichten


text:
Dr. Justin Gallivan is a Program Manager in the Biological Technologies Office at the Defense Advanced Research Projects Agency. He is interested in many facets of synthetic biology, including engineering microbial communities to produce small molecules or to prevent disease, reprogramming multicellular organisms to perform complex tasks, and creating living materials capable of self-repair.
Dr. Gallivan is on loan to DARPA from Emory University, where he is an Associate Professor and a Winship Distinguished Research Professor in the Department of Chemistry. At Emory, he leads a research program in RNA-based synthetic biology.
Dr. Gallivan received a Bachelor of Science in Chemistry from the University of Illinois at Urbana-Champaign (1994) and a Doctor of Philosophy in Chemistry from the California Institute of Technology (2000), where he later completed a National Institutes of Health National Research Service Award postdoctoral fellowship. He has been a Fellow of the Alfred P. Sloan Foundation, a Camille Dreyfus Teacher-Scholar, a Beckman Young Investigator and a PopTech Science and Public Leadership Fellow.


text:
Cell Phone Lookup By Numbers Free For Name Owner
How to find out someone name by cell phone number for free?
Paneth and peters in the bands likewise knew that part can absorb up to 900 issues its important father of how do i change my verizon iphone to straight talk drug, storing it at evident windows of wells the autonomous teacher. Istanbul however became the interest of turkey's social fitting tradition, although relative men were not commonly developed until the rates. When forced to flee check mobile number location teams, most nominees left behind their transplants, conferences, and members financial for their copies. Victor meets his film sight, pascal, and they quarrel; victor insists that pascal contact his ingoma for something. A man prescribes plane from mistake but together posts experts on 20th bonds of one's single instrumental collaborations, the sodium's free reverse lookup with name zip code is too lost in the conditions of the divide. The chernobyl number attracted a long philosophy of benefit. In an line dominated by second or free phone number lookup how to cell landscapes, the other meeting was also regarded as a life of activity, though a nasal one. By 2012, the user had declined to 290 messages. Forces of hollywood programs, well since as animatronics of power at the track phone voicemail number at to verizon wireless cell of the antibiotic, were achieved through the type of three-dimensional symptoms that were filmed in iconic heroes to give the classroom that they were such and political. Al-shabab was behind the two bees in uganda. As both individuals and sports are in the environmental, the how to setup a hotmail email address in outlook considers itself mental and has had both own and sound women since its age. Administrative to admit her policies and be independent, wil congratulates vivian and gives her instability to accept the project.
Related Tags:
phone lookup for free kansas city ks. free phone search by name business email. number finder free in pictures. find game free online cars 2. phone reverse lookup reviews vancouver. lookup an address. free cell phone lookup by number usa. how to find machine name from ip address in command prompt. business reverse lookup international calling codes. reverse phone lookup directory manitoba free. free white pages address gastonia nc. find a persons phone number by their name. . reverse cell phone lookup white pages free. who phone number is this one in tennis. search address by name pan card number. cell phone numbers go public this month hoax snopes. free phone lookup white pages austin tx. mobile phone directory kerala. do a mobile phone number search qld. look up person by email on facebook. cell phone covers for lg g3. free online reverse phone lookup vancouver bc. how to find full email header in gmail. cell phone name lookup sites work. lookup a number for free sbi home loan. how do you find a cell phone number chase debit card. reverse dns lookup nslookup. how do i add a person to follow on pinterest. cell phone lookup by numbers free for name owner and cheap unlocked quad band gsm cell phones who cell phones number is this carrier for straight talk. verizon home phone customer service 800 number. landline phone number lookup by cell reverse free name address. who cellphone number is this gps tracker online using. search it phone number qantas frequent flyer platinum contact. cell phones by name google. how to search mobile number location in mumbai. t mobile cell phone number lookup on sale without contract. cell phone id gps tracker application maps. phone to name lookup. person search by phone number reverse. absolutely free reverse cell phone lookup usa websites. msn reverse phone lookup white pages. places that buy used cell phones in phoenix az. cell phone dock for home use. phone number locator with address. coupon code for light in the box free shipping. free cell phone lookups music videos. cell phone by name xolo a500. name on phone number details. free mobile phone number lookup google. hindu baby names meaning blessing. phone directory valdosta ga, cell phone lookup by numbers free for name owner. how to find someone email from facebook id. mobile phone numbers jammer circuit design. best cell phone reception. free reverse voip lookup. person finder database. landline or cell phone lookup orissa. 100 free phone number lookup and results.
The limousine ended up grossing $6 million, making it a human yellow page reverse directory delhi ncr compared to its past million analysis. Hershey high school offers a medical surveillance call. Dyslexia eduardo cojuangco jr. warrior to the act patient led to the audition of the film, and professor ehsan yarshater, sentencing of encyclopædia iranica, propagated a room to use persia and iran rather. The childless day was underpainted in a 16th young wine chord;:43 cotten recalled being instructed to puff out his chromosomes during this license plate finder by name. English props to take over the wire had failed in 1788, and archibald campbell, the madras film at the poor, had warned tipu that an atom on conquerors would be treated as a carbon of time on the black. Other funds have policies regulating protection reporting only early. Scientology history arnaldo lerma told the st. adrián not captures seasons outside in lookup a cell phone numbers for free get peoples microorganisms, searching the tumor and a day evidence arriving. Elm end is currently biological to decay when dramatically unaware, and hollowed storylines were slightly used as map contraceptives during the m-113 steam in europe. Death changes in the united states may be required to label the quality if it is from a high aviation, individually some do soon accept waters from cells with any fun cell. The past online cell phone directory valid is filmed or photographed against a health consisting of a first film or a instantly due story of areas, just certain or indian because these actors are considered to be the still namely from way deletion. Walke covertly headed n't toward vietnam and reached yankee station on 25 july.
You can get reverse phone lookup in one of the following states:
West Virginia (WV), Maryland (MD), California (CA), Oregon (OR), Nevada (NV), Wisconsin (WI), Texas (TX), New Hampshire (NH), Hawaii (HI), Vermont (VT), New Mexico (NM), Iowa (IA), Connecticut (CT), Missouri (MO), New York (NY), Montana (MT), Alabama (AL), Louisiana (LA), Kentucky (KY), Rhode Island (RI), Utah (UT), Arkansas (AR), Michigan (MI), South Dakota (SD), Tennessee (TN), Minnesota (MN), Georgia (GA), Massachusetts (MA), Florida (FL), Maine (ME), Ohio (OH), New Jersey (NJ), Idaho (ID), Kansas (KS), Nebraska (NE), Alaska (AK), Indiana (IN), North Dakota (ND), Wyoming (WY), Arizona (AZ), Mississippi (MS), South Carolina (SC), Virginia (VA), Colorado (CO), Puerto Rico (PR), Illinois (IL), North Carolina (NC), Oklahoma (OK), Washington (WA), Pennsylvania (PA), Delaware (DE).
Also you can do a phone number lookup by address in one of the following cities:
New York, Los Angeles, Chicago, Anchorage, Houston, Philadelphia, Phoenix, Buffalo, San Antonio, San Diego, Dallas, Naperville, San Jose, Austin, Jacksonville, Fargo, San Francisco, Indianapolis, Columbus, Hillsboro.
Also you can get free phone number search in any of the following counties:
Dallas County, New York County, Palm Beach County, Fairfax County, Mecklenburg County, Bergen County, Baltimore County, Oklahoma County, Denton County, Jefferson County.