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Indirect bilirubin never goes into the urine, because it is attachedto albumin and cannot be filtered. In this study of thiopurine-treated adult Crohn’s disease patients,active smoking and GST-M1-null genotype appear to be risk factors for thiopurine inducedserious adverse events [58]. Both options are suitable forrepair of incisional or groin hernia; though in patients at very high risk for recurrence, thisauthor prefers the intermediate weight mesh

Both options are suitable forrepair of incisional or groin hernia; though in patients at very high risk for recurrence, thisauthor prefers the intermediate weight mesh. The reason for this was discussed earlier and will be revisitedshortly, but now exactly how Tregs inject cAMP into responding/effector T cells will bedescribed.

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In histology labs, formaldehyde (preservative) andxylenes (clearing agents) are the most common chemicalsused and historically have been associated with pulmonarydamage. MV negatively impacts BP by worsening hemodynamics

MV negatively impacts BP by worsening hemodynamics. Although thisis clearly not the same model as CDH, the lungsare hypoplastic and the potential for secondaryinjury exists. High-resolution CT scan: Definitive (preferred investigation).3. Radical wide excision as an alternative to radicalvulvectomy is generally indicated for malignant tumors up to 2 cm in diameter withoutclinically apparent nodal involvement. Targeting cancer cells by ROS-mediatedmechanisms: a radical therapeutic approach? Nat Rev Drug Discov. The most common clinical features were verti-cal supranuclear gaze palsy (94%) buy generic antabuse bradykinesia (91%),falls (87%), postural instability (80%), speech problems(74%), dysphagia (60%), increased axial tone/retrocollis(53%), apathy (50%), diplopia/blurred vision (39%), fron-tal release signs (31%), tremor (21%), photophobia (20%),eyelid apraxia (17%), need for gastrostomy tube (9%), limbdystonia (7%), word-fi nding difficulty (7%), and slow orhypometric saccades (6%). It is not usedclinically because orally it causes marked gastric irritation,and injected i.v., it causes thrombophlebitis, haemolysis andfall in BP

It is not usedclinically because orally it causes marked gastric irritation,and injected i.v., it causes thrombophlebitis, haemolysis andfall in BP. The spinal cord conducts nerve impulsesto and from the brain. Purkinje fibers (PF) of the cardiac conduction dense fibrous tissue of the subendocardium. (Reprintedwith permissionfrom Pedersen LB,Veland IR,Schroder JM, and Christensen ST. Thisexample of Treg susceptibility to apoptosis is in the category of genetically programmed Tcell death because it occurs following the resolution of a normal inflammatory event.However, the reason why it‘s important is because this process is accelerated during massiveviral/bacterial infections and transplantation.

(2007) Comparing painreduction following kyphoplasty and vertebroplasty for osteo-porotic vertebral compression fractures. This Doppleranalysis tool is less accurate but faster than FFT

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In a cross-section,the calcified cartilage appears as a honeycomb becauseof the absence of the cartilage cells. A deter-ministic approach to risk calculation is used, where a singlevalue is selected for each exposure variable and a single riskestimate is produced. 1983).The low-frequency forced oscillation tech-nique (LFOT) evaluates impedance simultane-ously across a range of frequencies (usually~0.5–14 Hz)

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My sister-in-law possesses an almost preternatural sense of hearing. Time and again, Gina intercepts whispered communications from near and far. Two more unwary victims fell prey to her auditory prowess today: her husband, Giuseppe; and, of course, yours truly.

The only attribute exceeding Gina’s heightened sense of hearing is her suspicious nature. It’s a known quality though and one for which Giuseppe thought he’d fully accounted. Thus, upon returning from last month’s business trip to Nevada, he volunteered that he’d lost two thousand dollars gambling. This unsolicited confession drew grudging praise from his wife and partially cushioned her ire at the blow to their savings.

Giuseppe also had readied himself for Gina’s inevitable seizure of his monthly credit card statement. When she presented the opened envelope to him today, he helpfully directed her attention to a two thousand dollar entry pertaining to his gambling loss, listed as “Lake Tahoe Cash Advance.”  

Much to his surprise, my brother-in-law’s identification of said cash advance did not close the issue. Just the opposite, after peering at the item intently, Gina went ballistic. In a profanity-laden harangue worthy of a Mafioso enforcer, she cited a notorious whorehouse in Nevada which lists its customers’ credit card payments under the same nondescript heading appearing on her husband’s VISA statement.

Facing such invective, a more timid soul might’ve admitted his indiscretion and begged forgiveness. Not Giuseppe though. In an Oscar-worthy display, he adopted an expression of pure astonishment and exclaimed: “I’ve been defrauded!” He proceeded to contend that some unknown miscreant “must have misappropriated my card numbers to charge his disgusting brothel visit!”

After listening to her husband’s unlikely story, Gina matter-of-factly responded: “Well then, you better call the fraud protection department so you can cancel the card, and that charge too!”

Displaying nerves of steel, Giuseppe reported the unauthorized expense to the credit card company and canceled his card, while his doubting wife stood by. She had no choice but to accept his claim of fraud by the time the call concluded.

If not for Gina’s incredible sense of hearing, the matter probably would’ve ended there. A few hours later, however, my brother-in-law snuck outside and, from the farthest edge of their backyard, placed a second call to his credit card company. No sooner did he instruct a representative to reinstate the challenged charge which, “on further reflection” was “legitimate,” than he heard his irate wife screaming from an upstairs window: “I knew it, you bastard!”

Where do I fit in this debacle, you ask? The answer should be: “nowhere.” It would’ve been too, had the woman with the ears of an owl not overheard my whispered remark to Sophia an hour ago, after we heard the sorry tale: “Two thousand for a whore?! That’s outrageous, especially since Giuseppe could’ve paid a hundred or two and still traded up!”

The “Lake Tahoe Cash Advance” is not, in fact, a gambling loss.

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I’m one of those people who can’t remember a birthday to save his life. If a family member’s or friend’s special day isn’t logged on my calendar, it may as well not exist. Even worse, I tend to record such occasions only after I’ve missed them. Take my brother-in-law’s D.O.B., for example. Just today, I finally got around to inking it onto my calendar. I say better late than never. Understandably, Vincenzo begs to differ.

Though I may’ve been the last to congratulate my wife’s brother upon reaching another year, I was indisputably the first to acknowledge a significant milestone. Vincenzo called me a week ago to inform me of his first-ever arrest. Despite subsequent events, I won’t repeat the criminal charges against him or opine as to his guilt. That’s the least I can do under the circumstances. All I’ll say is, he asked me for the name of a good defense lawyer to represent him. He also made me promise not to tell Sophia or their parents about his legal jam. I’m pleased to report that I kept my promise, even if it’s all I’m proud of at the moment.

My brother-in-law’s brush with the law offered me the perfect opportunity to dispose of a specialized greeting card gathering dust on my desk the past year. A client of mine had given me a sample card from a line meant for prison inmates. The front read: “Sorry to hear about your arrest.” On the inside, a message said: “You’re in my thoughts and in my prayers.” The card obviously seemed ideal for Vincenzo’s situation, so I addressed it to him and mailed it several days ago.

Last night, I learned several previously unknown details:

  • Vincenzo’s birthday happens to be this week;
  • Vincenzo’s wife, Florenzia, assumes any card delivered to her husband at this juncture must be from a birthday well-wisher;
  • Florenzia takes the liberty of opening all “birthday” cards addressed to Vincenzo, so she can display them on the fireplace mantle; and last, but not least,
  • Vincenzo hadn’t yet advised his wife and children of his arrest, and he harbored no foreseeable intent to do so.

I learned those details from my wife, who in turn heard them from Florenzia during a telephone call yesterday, which began: “You’ll never guess what that rat bastard brother of yours and soon to be ex-husband of mine did!” As I also learned, a nearly identical call followed to Sophia’s parents, informing them of their “rat bastard son’s” illicit activities.

Nowadays, there’re greeting cards for every occasion!

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Last night, I witnessed a momentous event. The President of our Homeowners’ Association vowed at last to take action against the selfish residents who park their cars overnight on our neighborhood streets. He seemed utterly serious too, if a tad draconian in his intended measures. Though I tried to tell him he lacks the authority to impound offending vehicles, assess $10,000 fines for a first offense, and perform a citizen’s arrest of violating homeowners, in the heat of the moment I doubt he heard me.

The roads in our development are narrow. Only without any parked automobiles can they accommodate two vehicles passing in opposite directions. When some idiot occasionally places a car directly across from another, the gap between them barely allows passage of a lone smaller sedan, like mine. I find myself negotiating those narrow avenues the same way a kid plays Operation: holding my breath and praying for a steady hand that won’t tap either side with the tweezers. I couldn’t imagine trying to squeeze through with a larger vehicle, such as an oversized SUV or, God forbid, a Hummer.

Obviously, the parking problem represents a substantial danger to our community. Those of us who don’t leave our vehicles on the street have repeatedly complained to the Homeowners’ Association, and to its President, whom I’ll refer to as “Steve Robinson.” Until last night, President Robinson merely paid lip service to those complaints. Sure, he promised to “do something” about the situation; yet he dragged his feet on implementing a violation program, perhaps because his best friend has become one of the worst offenders.

Last night, Mr. President joined Jimmy, Ron and me for a poker game at Jimmy’s. Steve had just congratulated himself on winning his first pot of the evening when we heard the crash. As we learned after stepping outside to investigate, a woman driving a Hummer had attempted, and failed, to negotiate the narrow gap between a pickup truck and an SUV parked across from each other in front of Jimmy’s house. The monstrous Hummer had sheared off the driver’s side mirrors, as well as substantial swaths of paint and carriage material from both flanking vehicles. 

Most everyone witnessing the aftermath agreed, the owner of the pickup truck got exactly what he deserved for parking in that same spot every night. Some, but not all, observers also felt the idiot who temporarily parked his SUV directly across from the pickup received his just desserts too – with the principal exception being the SUV’s owner … President Robinson.

Don’t try to squeeze one of these babies between 
two parked cars on the streets of my neighborhood!

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In a rare turn of events, I mentored Ernie today without incident. That’s not to say my visit to the elementary school left me with nothing to comment about, however. While Ernie’s behavior during our time together raised no eyebrows, his exercise on fractions certainly did.

The boy’s teacher, Ms. McDaniel, often posts her student’s homework papers on the wall outside her classroom. I caught sight of the latest batch at the conclusion of today’s mentoring session. As seemed obvious, the third-graders had been tasked with creating and solving an equation involving fractions. 

The children’s efforts said a lot about their generation’s values, little of it promising in my opinion. For instance, several of the kids based their equations on hi-tech devices I wouldn’t have thought appropriate or necessary for boys and girls their age. A typical piece read: “Tim has 5 ipods 3 ipads and 2 iphones. What fraction of Tim’s stuff is iphones?” Based on my prior discussions with Ernie, I suspect the author of that particular entry owned all the items included in his equation too!

Thankfully, not every piece denoted a spoiled, materialistic denizen of society. Mixed in with the expressions of self-entitlement were also cutesy animal stories. For example: “Sally has 3 white cats. And she has 2 black cats. Her faction of white cats is 3/5.”

Then there was Ernie’s piece, utterly unique among all the children’s efforts. Unlike his peers, he’d steered away from expressions of materialism and adorable pets. The lad went in an entirely different direction, formulating an equation which read:

A wolf bites off three of Arnie’s fingers. Arnie cuts three more off with a kichen knife. Arnie’s mom shuts the car door on him and chops off two more fingers. Arnie only has two fingers now. What fraction is left?

At least he solved the equation correctly. That’s a plus, isn’t it?

The normal complement of fingers … before biting, cutting, and chopping off

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I constantly berate my wife for spoiling our puppy. She in turn accuses me of failing to supervise the critter properly. Judging by today’s events, I’d say each of us has a point.

Thanks to Sophia’s PetSmart shopping sprees, Prometheus owns a wardrobe larger than mine. And unlike me, he never has to dress himself. She’s even purchased him booties to protect his dainty paws when the ground becomes wet or cold. Nonetheless, believing we have a dog and not a four legged human, I refuse to affix the ridiculous foot coverings, no matter the weather.

Though absurd, Sophia’s outdoor mollycoddling pales in comparison to her indoor pampering. Our Yorkie-Shih Tzu mix sleeps beside her but occupies more space on the mattress than she does. Courtesy of her cosseting, he also has a variety of napping options. There’s a doggy bed in nearly every room, just so he won’t have to “slum it” on the carpet or a couch. Or, if he’d rather, he can take siestas on our bed, by ascending the oversized staircase his mother’d harangued me to install.

Naturally, Sophia considers my negligent oversight of Prometheus the sole matter of concern. I won’t deny granting the mutt leeway outdoors. Since he avoids the street, I let him roam about the neighboring properties off-leash. I stay outside with him but only periodically check his whereabouts.

Granted, my freedom philosophy enables the occasional untoward incident. Prometheus may’ve dined on animal poop more than once; and he’s definitely regurgitated other unidentifiable crap, usually on our carpet. Nor will I soon forget the glue trap to which he adhered himself in our neighbor’s garage!

Recently, I’ll concede, I may’ve relaxed my caretaking a tad much. Prometheus invariably wants to pee every time I sit down to lunch. Having eaten cold soup more times than I can count, I got fed up when he scratched at the door three days ago. I consequently left the back door open and remained at the table while he trotted across the deck, descended the stairs, and did his business in the backyard. Bolstered by his prompt return, I decided to do the same yesterday, and today as well.

Alas, this afternoon’s unaccompanied expedition did not proceed so smoothly. Prometheus failed to return from his bathroom break! After five minutes without sight or sound of the dog, I left my hot soup behind and went looking for him. He didn’t answer my call, and an increasingly frantic search of the neighboring properties and woods turned up empty.

Only after ten minutes fruitlessly slogging through rain-soaked grounds did I eventually find him, inside the house no less! While I’d been traipsing about, he’d returned home and headed straight to our bed for a hard-earned nap. I had no trouble locating him either, once I walked through the door. I simply followed the trail of his unbooted, muddy paw prints … across the floor, up the carpeted staircase and, thanks to those overindulgent doggy stairs, onto our formerly white comforter.

The overindulgent doggy stairs … leading to our temporary comforter

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A piece on The Bert Show this morning had me in stitches, mostly because I so identified with the story. One of the show’s producers raised the question: how long is too long to delay giving a gift? As he explained, he’d forgotten to deliver a wedding present, to one of the show’s cohosts, for a wedding that’d taken place almost a year and half earlier. While the no-longer-newlywed sounded content to accept the late offering, I didn’t hear anyone on the “panel” support the idea of a wedding present beyond the generally accepted one-year mark. I personally think time isn’t nearly as important a factor as circumstance; and I’m pretty sure I know whereof I speak.

About four years ago, my wife purchased a housewarming present for a couple who’d just bought their first home in an Atlanta suburb. Sophia tasked me to deliver her present in person, after the husband, Max, told me he needed legal advice.

I visited Max at his new abode, but I forgot to take the wrapped package with me. You see, whenever the cleaning service descends on our house, Sophia makes me clear desktops, countertops and cluttered floor areas so the maids don’t confuse us for slobs. A cleaning day occurred the morning before my scheduled meeting with Max. Per my wife’s instructions, I cleared her housewarming gift off the kitchen counter and temporarily stuck it in my office closet … for two years. Not only did I forget to bring the item to Max’s house, but Sophia also neglected to confirm delivery with me or with her friend.

After 25 months gathering dust, Sophia’s present resurfaced during her belated effort to reorganize my closet. Boy did she fly off the handle! 

I knew I’d screwed up, but I tried to downplay the significance: “What’s the big deal? I know some presents have definite time-deadlines. You need a baby for a baby gift; birthday gifts obviously carry a ‘soon or never’ rule; and of course there’s the year deadline for wedding presents. But this is a house, for God’s sake! Janis and Max’ll be able to use your housewarming gift for as long as they own the place.”

If anything, my observations only increased Sophia’s ire: “That’s just it, Richard! Their house was foreclosed a month ago, and they’re moving back to Ohio to live with Max’s parents till they get back on their feet!”

I made one more attempt to calm my wife: “So? Can’t they use whatever you got them wherever they eventually end up?”

Sarcasm oozed as she responded: “A lawn plaque inscribed with their name and address? Sure!”

A gift typically suited to a single address

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Poor Ron! His chief competition at the office just won “the promotion of a lifetime” which should’ve been his. Naturally, my friend is spitting mad, but more at himself than at the kiss-ass to whom he’ll now report. As he freely admits, if anyone’s to blame for this reversal of fortune, it’s the man in the mirror.

In our conversation this morning, my friend traced his downfall back to February 18. That Saturday was the day his boss had invited him, his kiss-ass competitor, and two other employees to join her at the Fox Theatre’s matinee presentation of the “Alvin Ailey American Dance Theater.”

Ron isn’t what one might call “a lover of the dance.” Just the opposite, he says he’d sooner enjoy a colonoscopy than “watch a bunch of guys prancing around in tights on stage” (his words, not mine). Consequently, although he’d originally intended to endure the afternoon of agony, he reconsidered his options at the eleventh hour. The long and the short of it – he didn’t show.

Late that afternoon, before Ron had a chance to flesh out an acceptable excuse, he received a telephone inquiry from his boss concerning his whereabouts. Knowing her soft spot for children and her belief in parents putting their offspring first (even ahead of work responsibilities), Ron blurted the first palatable explanation which came to mind. He sheepishly admitted having forgotten about the dance show in his excitement at taking his kids to a fair in Cumming that afternoon. 

My friend subscribes to the philosophy of the big lie. When only a falsity will do, he starts with a grain of truth and embellishes his fabrication with excessive details, the more outlandish the better. In his estimation, people telling whoppers rarely get caught.

Cumming, the seat of Forsyth County, does in fact host an annual fair suitable for children. Although Ron himself hasn’t previously attended, he figured he’d previously visited enough county fairs to craft a convincing tale. And since he’d heard mention of the festival taking place in Cumming that day, he felt sure he could build a world-class whopper from said germ of truth.

Consequently, when the boss asked how his children had enjoyed the fair, Ron waxed poetic over the thrilling rides they’d enjoyed, the kettle corn and cotton candy they’d scarfed down, and the stuffed animals he’d won for them playing games of skill and chance.

My friend’s tale unfortunately suffered from one significant shortfall. While a festival of sorts did take place in Cumming that afternoon, it wasn’t the annual fair he’d presumed. So he learned from his boss – who apparently knew more about the town’s weekend calendar than Ron – when she responded to his oration: “Wow Ron! The organizers certainly changed things up for this year’s ‘Forsyth Senior Expo,’ didn’t they?”

And the dancer isn’t even wearing tights!

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I’ve heard of parental controls in the context of television sets and video games, but having no kids of my own, I’ve never had to implement them. I certainly didn’t apply any when I set up my PlayStation 3 system; and their necessity never occurred to me when I connected an Xbox 360 for my five-year-old nephew and activated “Xbox Live.” Undoubtedly, I’ll be blamed for the consequences.

Given all my prior missteps, why would anyone in my wife’s family ask me to assemble a gaming system for one of their children? The answer, simply put, stems from two traits shared by all Gambinos: frugality; and technological ignorance. Stated less diplomatically, none of them knows squat about connecting a gaming console to a TV, and they’re too cheap to pay someone else to do the job for them! Those are the reasons why Franco’s Christmas gift remained in its original packaging until Sophia volunteered my expertise in electronics’ assembly for the task.

I connected young Franco’s gaming system and set up its online feature, Xbox Live, a week ago. Before today, neither his parents nor grandparents realized that parental controls hadn’t been enabled, despite Franco having donned his headset for games with far-flung friends each night.

I still don’t know which title Franco cued up this morning ere his parents summoned him downstairs for their family outing. What I’ve since pieced together is this. Although the lad turned off the TV, he failed to terminate his game session or power down the Xbox prior to scurrying from the den. Minutes after he and his parents left the house, my mother-in-law wandered past the den’s open door. At that moment, commentary from one of Franco’s online teammates broadcast from the still-active headset. Maria heard the disembodied voice and peaked into the room to investigate. Knowing nothing about Xbox Live, the highly superstitious woman jumped to the obvious conclusion that her house is haunted. More to the point, when the “ghost” shouted “die Motherfucker, die!,” she assumed an angry poltergeist had directed the comment to her.

Maria fled from the room and straightaway informed her husband of the malevolent presence. Vito, who’s equally clueless in the realm of video gaming, went to investigate. Though not fully convinced of a ghostly manifestation, he conceived no better explanation for the agitated voice which threatened: “Your ass is mine, bitch!”

Not one to panic needlessly, Vito telephoned me for a second opinion. I walked to their house a couple of hours ago and quickly figured out the source of the mysterious voices. Now I’m facing an obvious lose-lose proposition. If I belatedly activate the appropriate parental controls, as I suppose I must, I’ll certainly catch hell for Franco’s week-long exposure to foulmouthed strangers. Even worse, once the truth about the poltergeist emerges, my mother-in-law surely will abandon her current demand to move as far away from here as possible, as soon as she can.

Parental controls not automatically activated

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Sophia and I dined kosher last night, courtesy of my client. Fortunately, I committed no social blunders and didn’t insult our hosts’ religious beliefs or dietary rules even once. I have my grandmother to thank for that.

My maternal grandfather died when I was three, and I don’t remember him. In contrast, I well remember the man my grandmother married some years later. “Grandpa Irv,” as I called him then, was bald, stout and, most importantly, an orthodox Jew. My grandmother Tillie didn’t think much of religion and held no desire to pursue the kosher lifestyle Irv demanded. Nonetheless, she felt even less desirous of living out her remaining days alone. She therefore lowered her standards and married a guy whom she referred to ever after as “that stupid man.” 

Irv and Tillie moved to Florida when I entered high school. The summer after graduation, my folks offered to send me down for a week-long visit. I graciously accepted.

In those days, I knew next to nothing about kosher peccadilloes. I recognized only the most basic rules: 1) thou shalt not eat meat and dairy together; and 2) thou shalt never eat pork or shellfish. In other words, I knew kosher Jews didn’t eat cheeseburgers, especially bacon cheeseburgers. The full range of kosher restrictions went much further, of course. For instance, to ensure dairy and meat never mix, a typical kosher household maintains separate dishware for each of the two food groups. Irv and Tillie did as well.

Grandma seemed surprised to hear my ignorance of her husband’s dietary rules. As she admitted one morning, shortly after breakfast, she’d thought every Jew knew that those keeping kosher serve meat and dairy on separate plates.

I greatly appreciated her ensuing discourse on the dictates of a kosher lifestyle. After thanking her for the information, I expressed regret that she hadn’t sooner realized my unfamiliarity with those dietary rules. As I ruefully explained, had I known what the two sets of dishware in the cupboard signified, I never would’ve served the cheese omelet I’d cooked that morning on a meat plate. And I certainly would’ve used a paper plate for the side of sausage I’d fried up, rather than one of Irv’s dairy dishes.

Having apologized to grandma, I asked whether we’d need a special purification ceremony to restore the dishes to kosher compliance. She didn’t answer me immediately. Instead, she peaked out of the kitchen to confirm Irv’s absence from earshot. Then, with a wink, she informed me: “Nah. I’ll just rinse them off and stick them on the shelf; that stupid man will never know the difference!”

When living a kosher lifestyle, one needs to know the proper foods to eat … 
and then serve them on the correct dishware.