5/22/2023 0 Comments Stapled anastomosis![]() The studies in Crohn's disease were more recent but the combined number of patients was too small to summarise outcomes. The trials included in this review were performed from the early 1980's to 2009 involving six countries. This review did not compare different sewing materials or methods. Possible explanations include less handling of the bowel, decreased spillage of bowel content during surgery, and uniform closure of all the staples using a stapler. The reason why a handsewn bowel join is more likely to leak is unclear. Overall, there was no significant difference in the other outcomes of stricture, bleeding from the join, time to perform the join, re‐operation, mortality, intra‐abdominal abscess, wound infection and length of stay, although these were not consistently reported. This sub‐group included patients with Crohn's disease. For the sub‐group of 264 non‐cancer patients in three studies, there were no differences for the reported outcomes. For the sub‐group of 825 cancer patients in four studies, stapled join again has fewer leaks compared with handsewn, being 1.3% and 6.7% respectively. The leak rate from the bowel join for stapled anastomosis was 2.5%, significantly lower than handsewn (6%). This systematic review found seven randomised controlled trials with a total of 1125 participants (441 stapled, 684 handsewn) comparing these two methods. The join, or anastomosis, can be made by stapling or sewing. Surgery for right‐sided bowel cancer or Crohn's disease commonly involve removing a segment of bowel and re‐joining the small and large bowel together. Stapled functional end to end ileocolic anastomosis is associated with fewer leaks than handsewn anastomosis.Ī comparison of two methods to join small and large bowel together in surgery All other outcomes: stricture, anastomotic haemorrhage, anastomotic time, re‐operation, mortality, intra‐abdominal abscess, wound infection, length of stay, showed no significant difference. In subgroup analysis of non‐cancer patients (3 studies, 264 patients) there were no differences for any reported outcomes. For the sub‐group of 825 cancer patients in four studies, stapled anastomosis led to significantly fewer anastomotic leaks (S=4/300, HS=35/525, OR 0.28 p=0.01). One study performed routine radiology to detect asymptomatic leaks. Stapled anastomosis was associated with significantly fewer anastomotic leaks compared with handsewn (S=11/441, HS=42/684, OR 0.48 p=0.03). The five largest trials had adequate allocation concealment. Main resultsĪfter obtaining individual data from authors for studies that include other anastomoses, seven trials (including one unpublished) with 1125 ileocolic participants (441 stapled, 684 handsewn) were included. Sub‐group analyses for cancer inflammatory bowel disease as indication for ileocolic anastomoses were performed. RevMan 5 was used to perform meta‐analysis when there were sufficient data. Relevant results were extracted and missing data sought from the authors. Data collection and analysisĮligible studies were selected and their methodological quality assessed. Randomised controlled trials comparing use of linear cutter stapler (isoperistaltic side to side or functional end to end) with any type of suturing technique in adults. Abstracts presented to the following society meetings between 19 were handsearched: American Society of Colon and Rectal Surgeons, the Association of Coloproctology of Great Britain and Ireland, European Association of Coloproctology. MEDLINE, EMBASE, Cochrane Colorectal Cancer Group specialised register SR‐COLOCA, Cochrane Library were searched for randomised controlled trials comparing use of a linear cuter stapler with any type of suturing technique for ileocolic anastomoses in adults from 1970 to 2005 and were updated in December 2010. The hypothesis tested was that the stapling technique is associated with fewer complications. To compare outcomes of ileocolic anastomoses performed using stapling and handsewn techniques. This is an update of a Cochrane review first published in 2007. Individual trials comparing stapled versus handsewn ileocolic anastomoses have found little difference in the complication rate but they have lacked adequate power to detect potential small difference. The anastomosis may be constructed using a linear cutter stapler or by suturing. Ileocolic anastomoses are commonly performed for right‐sided colon cancer and Crohn's disease.
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5/22/2023 0 Comments Hidden hills californiaMore Photos of Kourtney’s Calabasas Home Where Does Kylie Jenner Live? It even has a massage room and a gym – seriously, what’s not to love about this place!? Super unique and unexpected, but gorgeous.įeatures to the 6-bedroom, 7.5 bathroom home include a state-of-the-art kitchen with stainless steel appliances, beamed ceilings, and an elevator. She purchased her 12,000 square foot home from NFL star Keyshawn Johnson for $8.5 million. The exterior of the home is crazy-wide with a sort of Roman vibe. Kourtney also lives in the Calabasas community, The Oaks, less than half a mile from Khloé. More Photos of Khloe’s Calabasas Home Where Does Kourtney Kardashian Live? Photo: Roger Davies / Architectural Digest Features include a personal dressing room & salon, a swimming pool & spa, beautiful landscaping and well-manicured grounds around the property, and several small fountains. The Martin Lawrence Bullard-designed home was featured in Architectural Digest along with Kourtney’s house. ![]() The house is GORGEOUS! It boasts 6-bedrooms, 7-bathrooms, and 9,214 square feet of luxury living space. She dropped $7.2 million on Justin Bieber’s former Spanish-style home in 2014. Khloé PREVIOUSLY lived in the exclusive Calabasas community, The Oaks. It’s also got 8 bedrooms and 9.5 bathrooms, an 8-car garage, and according to Khloe’s Instagram, a basketball court – ideal for Tristian who she’s now reconciled with. Both homes are over 15,000 square feet, and the rendering pictured below (believed to be Khloe’s) is 16,500 square feet. Very little is known about the homes because they were never listed, and of course, there’s no Google Street View for us to peruse given the tight security in Hidden Hills. Funny enough, the property was once a 3-acre plot, but the developer split it in two, and guess who bought the neighboring home…? Kris Jenner! Just as she was listing her longtime home in Calabasas (which she bought from Justin Bieber), Khloe was making a deal for the brand new mansion in nearby Hidden Hills. More Photos of Kim & Kanye’s Former Bel Air Home Where Does Khloé Kardashian Live? Khloe Kardashian House Hidden Hills The home sold to a Ukrainian philanthropist for $17.8 million, nearly double what they paid for it! Oh, and guess who lives next door…Kathy Griffin. The couple sold the home to a Ukrainian billionaire for 17.8 million back in November 2017. The Mediterranean-style abode boasts 5-bedrooms, 7-bathrooms, and features an infinity-edge swimming pool & spa. They completely overhauled it after the purchase and “Kimye’d” it – meaning a ton of white and grey. Kim & Kanye sold their nearly 9,000 square foot home in Bel Air, CA in November 2017. X17Online | Jackie Nickerson | Architectural DigestĬheck out the full Kim Kardashian House photo gallery here! Kim Kardashian House – Her Former Bel Air Mansion Photo: HollywoodPipeline As of 2020, the home is complete! Here’s a photo that show’s just how close the fire got to their home. They brought in a private firefighting crew to save not only their home but the entire neighborhood. In November 2018, Kim and Kanye’s house was threatened by the Woolsey Wild Fire. The massive property, as well as the residence itself, provides the West crew plenty of space for their growing family and to thrive. What has been revealed about the 15,667 square foot French country-inspired home is that it boasts 8-bedrooms, 8-full bathrooms, and 2-half bathrooms.Īmenities include a fitness room, spa, 2 swimming pools, 2 vineyards, a guest house, a recording studio, and a 1,050 square foot entertainment pavilion. if it weren’t in a gated community we’d send the team to get our own photos…but we aren’t trying to get arrested. The Hidden Hills remodel as of September 2017.īelieve us, we scour EVERYDAY for more recent photos of this unbelievable home. Kim & Kanye’s Hidden Hills Home – during construction (Jan 2017). Kim & Kanye’s Hidden Hills Home – during construction (Dec 2016). ![]() Kim & Kanye’s Hidden Hills Home – before construction. We haven’t gotten our hands on any recent photos of the completed renovation, but as soon as we have them, you’ll be the first to know! ![]() They completely gutted it and the surrounding landscaping as you’ll see in the photos below. This is the home Kim and Kanye purchased for $20 million. ![]() They have completed years of renovations on their Hidden Hills compound, and have finally moved in! ![]() Enemies respond to their environment and one another they will sound an alarm if they unambiguously spot the player character or find a body, which will alert all enemies in the area and prevent them from returning to their previous patrol routes. Although fighting hand-to-hand with the goal of quickly disabling an enemy is possible, doing so risks being killed or disabled in turn, as well as alerting nearby enemies with a noisy scuffle. If detected, they must evade their enemies and remain out of sight for a set period of time, after which enemies will return to their original patrol routes and one-hit kills on them will once more be possible. To facilitate this, the player can extinguish light sources, hide behind objects and pass through narrow grates and shafts inaccessible to enemies. īy approaching enemies undetected, the player character is able to execute a "one-hit" kill. Unusual for a platformer, Mark of the Ninja employs a line of sight mechanic, meaning that enemies which would be invisible to the character are also invisible to the player, though their sounds are represented on screen in the same manner as the player character's. Sounds such as running may also give away the player character's location and are represented visually by a rapidly expanding circle. Levels are divided into areas of light and darkness the player character is visible to enemies in the former and invisible in the latter, though passing within a certain immediate distance of an enemy's face results in the player being spotted irrespective of lighting. The character is required to sneak through a series of environments while staying out of sight of guards and performing silent assassinations. Mark of the Ninja consists of stealth-oriented 2D platforming. Should an enemy be within range they may be alerted to the player character's presence. Here the player can see how much noise throwing an item will cause, as represented by the circle. Mark of the Ninja places a high emphasis on stealth. Reviewers praised the game's visual and audio atmosphere, strong gameplay and new take on the stealth video game genre, while criticizing minor gameplay frustrations surrounding the control scheme and difficult puzzles. Aggregate scores for the game hold in the 90% range at website Metacritic, and it received eight perfect scores from media outlets. The game received critical acclaim from reviewers. Cutscenes for the game are rendered in a Saturday-morning cartoon animation style. The game follows the story of a nameless ninja in the present day, and features a conflict between ancient ninja tradition and modern technology. ![]() A remastered version was released on Octofor Xbox One, PlayStation 4, Nintendo Switch, Microsoft Windows, macOS and Linux by Klei Entertainment. ![]() The game was released for Microsoft Windows on October 16, 2012, and for Linux and OS X on September 11, 2013. It was announced on Februand later released for the Xbox 360 via Xbox Live Arcade on September 7, 2012. Mark of the Ninja is a side-scrolling action stealth video game developed by Klei Entertainment and published by Microsoft Studios. Nintendo Switch, Playstation 4, Xbox One. 5/22/2023 0 Comments Ac syndicate trailersFrom robbing trains to rescuing child workers, players will do everything they can to bring justice to London’s lawless streets. Enemy strongholds can be infiltrated by using an arsenal to dominate London’s underworld. Il Creative Director di Assassins Creed: Syndicate, Marc-Alexis Côté, ha dichiarato nel corso dellanteprima mondiale del titolo che il passaggio di testimone alla studio di Ubisoft Quebec ha comportato un grande entusiamo nel suo team di sviluppo. With Jacob as the leader, players can establish UK's fiercest gang, the only force that can challenge the elite and defeat rival gangs to bring freedom to the oppressed folks. ![]() Lead the underworld to reclaim London in an adventure filled with action, intrigue and brutal combat. As gangster killer Jacob Frye, you recruit a gang to fight for justice on behalf of the oppressed working class. An age of invention and wealth, built on the backs of the working class. Lead the underworld to reclaim London in an adventure filled with 1868 London. An age of invention and wealth, built on the backs of the working class. Assassin's Creed Syndicate Official The Last Maharaja Trailer AC Syndicate: The Last Maharaja 1:52 Stop Jack the Ripper in Assassin's Creed Syndicate This. The game will release October 23 for PS4. Sign in Assassin's Creed Syndicate - Gameplay. Exclusive rewards are much appreciated here on TXH, especially when they are free and the Club brings you just that!.Īssassin’s Creed Syndicate releases on Xbox One, PS4 on Oct 23rd, with a PC version hitting home on the 19th November 2015. If you pre-order Assassins Creed Syndicate, youll also get the extra mission The Darwin & Dickens Conspiracy. Assassin's Creed Syndicate - Gameplay Trailer - YouTube 0:00 / 2:01 Sign in to confirm your age This video may be inappropriate for some users. Praesent mattis ullamcorper metus, imperdiet convallis eros bibendum nec. Pharetra ac malesuada in, sagittis ac nibh. Aenean scelerisque, justo ac varius viverra, nisl arcu accumsan elit, quis laoreet metus ipsum vitae sem. AC:Unity put thousands of NPCs on screen, which Ubisoft said AC:Syndicate wont do, so they could at least diversify and increase the number of different NPCs. ![]() ![]() You may also wish to visit the Ubisoft Club App on Xbox One, where you can unlock exclusive content, earn points and unlock badges. Donec ligula sem, dignissim quis purus a, ultricies lacinia lectus. Assassin's Creed: Syndicate Developer Ubisoft Quebec Publisher Ubisoft Engine AnvilNext 2. Surely you can’t miss out on the opportunity to visit London in 1888 at the height of the Jack the Ripper killings, taking on the world’s most infamous serial killer in a deadly game of cat and mouse? Jacob Frye, Assassin's Creed: Syndicate debut trailer. You can view both Jacob’s and Evie’s individual launch trailers below.ĭon’t forget, you can also jump on board with the AC Syndicate Season Pass, giving you even more chance to delve into London’s past with new missions, new gear, weapons, outifts and a permanent XP boost. Fighting to liberate London, Jacob and Evie help define the birth of organised crime in an adventure filled with action, intrigue and brutal combat. One of the biggest reasons why Assassins Creed Syndicate is worth playing today is the fact that the game can be found at some pretty reasonable prices. Set in London during the height of the Industrial Revolution, players will step into the shoes of twin Master Assassins, Jacob and Evie Frye. 5/22/2023 0 Comments 1000 faces of sumaruAnimal Motifs: Cats, though downplayed compared to Diona and Keqing.Once she transcends her tragic past and becomes encouraged to look forward to the future, Collei gains a boost to her Energy Recharge while she is off the field the Floral Ring will now be guaranteed to trigger Sprout, the reaction requirement now transferred to that for extending the effect's duration Trump-Card Kitty gains the ability to confer a temporary boost to her allies' Elemental Mastery and the Floral Ring can now generate a miniature Cullein-Anbar whenever it hits enemies.Ĭollei can be obtained for free upon clearing Floor 4 Chamber 3 of the Spiral Abyss, as well as from any banner. Her Elemental Skill, Floral Brush, fires a "Floral Ring", a boomerang made of flowers that eventually returns to Collei, while her Elemental Burst, Trump-Card Kitty, has her sic Cullein-Anbar, a cat-shaped doll, to jump around and continuously deal Dendro damage to enemies within a "Cullein-Anbar Zone."Īs Collei continues to apply the lessons she learned under Tighnari and Amber, triggering Dendro-related reactions bestows upon the Floral Ring the ability to grant a "Sprout" effect on the active character that deals Dendro damage on surrounding enemies, as well as an extension to the duration of the Cullein-Anbar Zone. The time Collei spent with the Avidya Forest Rangers, as well as her affinity to Amber, has taught her nifty archery skills and applying Dendro to multiple enemies at once. Nowadays, she is living happily under the care of Tighnari, even as she continues to deal with her past trauma and her resurgent illness. Three years before the start of the Traveler's adventures, Collei was a sickly young girl who her mother entrusted to the Fatui to help treat her illness, only to be experimented upon and imbued with essences of deceased gods against her will, eventually escaping and nearly going on a rampage in Mondstadt before being saved by Amber and eventually returned to Sumeru. One of the Avidya Forest Rangers with a checkered past. Utility Passive: Gliding Champion of Sumeru (20% less Stamina consumption while gliding) All in all, I think I've been really lucky."Ĭonstellation: Leptailurus Cervarius, the Serval "I used to think that I'd never make a single friend in my whole life, but things changed when I went to Mondstadt. Marriage of Convenience: Tighnari reveals in the event Windblume's Breath that it's not uncommon for residents to build social relationships and families in order to pursue further studies due to academic resources equating to social capital in Sumeru.This intermingling of cultures is best demonstrated by Nahida / Lesser Lord Kusanali, whose human name is of Persian origin, but her divine title is of Hindu origin. ![]() Unlike the Persian Achaemenid Empire however, Sumeru's central institutional, civilian, and divine culture is primarily Hindu, with secondary Persian elements sprinkled in. Fantasy Counterpart Culture: Culturally, Sumeru resembles a space-compressed version of The Achaemenid Empire, demonstrating elements of Hindu, Persian, Arabic, Ancient Egyptian, and even bits of Greek culture as one moves from East to West.As it turns out, the people of Sumeru can dream, but their dreams are being stolen by the Akademiya via the Akasha to be used as processing power. This is explained by the Akademiya as a unique sign of the Sumeru people's rationality, and few in Sumeru question this strange quirk. Cannot Dream: The people of Sumeru cannot dream, unlike the people from all other nations. 5/21/2023 0 Comments Trainz simulator 2010 tpb![]() Move Layers between Sessions and Routes enabling you to add any object to a session - not just trains. ![]() Introducing a Layer tool similar to that found in many common graphics applications, you now have the ability to perform tasks that were impossible in previous versions of Trainz: Switch between different seasons and observe as the compatible objects change appearance. Support has been included to allow the creation of Seasonal Assets. Developed specifically to run in 'Native' mode, experience the best Trainz ever. New routes are available for you to drive with upgraded content specific to TS Mac and including SpeedTree throughout. Along with the usability improvements, content creators can also create their own menu items for their routes and sessions. The Trainz interface has had a thorough overhaul, bringing a more friendly and intuitive interface to your screens. CAB Control of Diesel, Electric and Steam Trains Tutorials will be included covering the following lessons: Not sure where to start with TS Mac? Then check out the new tutorials included for you to drive and learn. Included in the TS Mac Release will be several new routes for you to explore as well as improvements to routes you're all used to. ![]() Check out the tech video on the left for information on SpeedTree. High Quality and detailed trees breathe new life into your routes and bring your worlds to life. New to Trainz Simulator Mac is the inclusion of SpeedTree. your creations and your passion with other rail fans a complete working rail line with interactive industriesīuild. Steam, Diesel or Electric trains (and even trams, boats and cars) You can build a fun layout in minutes, faithfully recreate a steam railroad from days gone by or develop a fully fledged 100+ mile prototypical route the choice is yours.ĭrive. Trainz Simulator Mac includes everything you need to build and operate your own dream railroad. 5/21/2023 0 Comments Side effect of solumedrol![]() Solu-MEDROL can affect growth in children. Low potassium-leg cramps, constipation, irregular heartbeats, fluttering in your chest, increased thirst or urination, numbness or tingling, muscle weakness or limp feeling. Severe pain in your upper stomach spreading to your back, nausea and vomiting īloody or tarry stools, coughing up blood or vomit that looks like coffee grounds New or unusual pain in an arm or leg or in your back Severe depression, changes in personality, unusual thoughts or behavior Shortness of breath (even with mild exertion), swelling, rapid weight gain Call your doctor at once if you have:īlurred vision, tunnel vision, eye pain, or seeing halos around lights ![]() Solu-MEDROL may cause serious side effects. ![]() Get emergency medical help if you have signs of an allergic reaction: hives difficulty breathing swelling of your face, lips, tongue, or throat. You should not breast-feed while using Solu-MEDROL. Tell your doctor if you are pregnant or plan to become pregnant. It is not known whether Solu-MEDROL will harm an unborn baby. Osteoporosis or low bone mineral density (steroid medication can increase your risk of bone loss) Ī muscle disorder such as myasthenia gravis orĪn electrolyte imbalance (such as low levels of potassium in your blood). Stomach ulcers, ulcerative colitis, diverticulitis, or recent intestinal surgery Ī parasite infection that causes diarrhea (such as threadworms) Seizures, epilepsy or recent head injury Tell your doctor about any illness or infection you have had within the past several weeks. Steroids can also worsen an infection you already have, or reactivate an infection you recently had. Solu-MEDROL can weaken your immune system, making it easier for you to get an infection. You may not be able to receive a this medicine if you have a fungal infection. You should not be treated with Solu-MEDROL if you are allergic to it. 5/21/2023 0 Comments Kemba walker stts![]() But at the same time, it is a business, and I do understand that. I’m gonna be loyal to the people who were loyal to me. Kemba on Kemba’s free agency Photo by Streeter Lecka/Getty Images It’s hard to acquire a difference-maker with that salary sheet and only Malik Monk and Miles Bridges to act as young assets. might help them, but he doesn’t move Charlotte up from the bottom half of the playoff picture. Given their assets, who are the best players who could potentially be had via trade? The Knicks’ Tim Hardaway Jr. The Hornets are running out of options and time. Charlotte missed out in the Jimmy Butler sweepstakes, and likely didn’t have much to offer anyway. They’re aggressively pursuing a Bradley Beal trade with the struggling Wizards, according to Rick Bonnell of the Charlotte Observer, but even Washington should know better than to take back Batum’s contract (and production) in that deal. That’s probably why the Hornets are having difficulty finding moves to get Walker some help. ![]() These contracts aren’t awful individually, but they coalesce into a payroll logjam. They also gave Michael Kidd-Gilchrist a four-year, $52 million deal and Cody Zeller a four-year, $56 million deal, then traded for Dwight Howard, who was flipped into two years worth $34 million of Bismack Biyombo. This isn’t Batum’s fault: some of it falls on former general manager Rich Cho and team owner Michael Jordan for handing out that contract. Nic Batum wasn't even close /8rd8VMqMvX- Kristian Winfield October 18, 2018 Is Walker the best point guard in the East? The Hornets know it, and need surround him with some talentīut a look at Charlotte’s payroll is a heaping spoonful of your daily dose of depression.
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