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Saddle up and join us for a Kitten & Puppy Baby Shower on Saturday April 6th, from 1PM-3PM at the Dallas Animal Care Center! Fosters needed! Join us for a pawsome day of activities including: learning about fostering, play fun games, enjoy refreshments, and more!
THE Myron K. Martin Clinic is open for spay and neuter surgeries for dogs and cats. Make an appointment today.
Save lives today with a gift that will go straight to work protecting and caring for animals throughout North Texas.
Volunteer and make every day special for the animals in our shelters. Give your time and heart based on your schedule and interests.
Join the SPCA of Texas on April 28th from 9AM-11AM at the SPCA of Texas’ Dallas Animal Care Center, 2400 Lone Star Drive, Dallas, TX 75212 for our February Drive Thru Pet Food Pantry! Registration is required.
The SPCA of Texas will be offering free pet food for owners in the community, join us!
Pre-register here: https://spca.org/resources/pet-needs/support-to-keep-your-pet/drive-thru-pet-food-pantry
La SPCA de Texas estará ofreciendo comida gratuita para mascotas a los dueños en la comunidad, ¡únase a nosotros!
Regístrese aquí: https://spca.org/resources/pet-needs/support-to-keep-your-pet/drive-thru-pet-food-pantry
SPCA of Texas’ Dallas Animal Care Center
2400 Lone Star Dr.
+ Google Map

domain: pet


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And right up there on the FF list—weight loss. Sure, slow and steady may win the race, but who wants to plod along like a tortoise, especially when a warm weather getaway is right around the corner? Add these 7 super weight loss foods to your day to get your weight-loss goals on hyperspeed. All of them have been scientifically proven to fry flab in 6 weeks or less! Tighten your seatbelt—in fact, you’ll soon be tightening every belt!
Milk may be the perfect drink to pair with your meal if you're looking to get leaner, according to a study out of Ireland in 2017. Eating a greater amount of dairy was found to be associated with a lower BMI, less body fat and a smaller waistline—particularly when it came to milk and yogurt. Beyond weight loss, researchers uncovered some surprising health benefits. Milk drinking was associated with improved blood pressure, lower biomarkers of inflammation, better insulin sensitivity and higher levels of a protein called adiponectin, which helps regulate blood sugar and break down fats. What's more, if you're running low on calcium, consuming more of the bone-strengthening mineral may also help you burn belly fat. Skip the chocolate milk and flavored lattes to cut back on added sugars.
He is, however, quick to point out that nobody is doing this with any harmful intentions. But he does stress that erroneous information has a tendency to be elevated into truths if it’s repeated sufficiently often. And when myths like these are as widespread as they are, they prevent the public and professionals from getting their priorities right in the fight against obesity.
Salmon is a rich source of high-quality protein and provides plenty of "good" fats: omega-3 fatty acids. A diet rich in omega-3 fatty acids helped people feel more satisfied when they were watching their calories, per a study in Appetite. Eating salmon can be a delicious and versatile way to get your recommended two weekly servings of heart-healthy fish.
Red tea, also known as rooibos, is a great choice for when you’re struggling with midday stress. What makes rooibos particularly good for soothing your mind is the unique flavanoid called Aspalathin. Research shows this compound can reduce stress hormones that trigger hunger and fat storage and are linked to hypertension, metabolic syndrome, cardiovascular disease, insulin resistance and type 2 diabetes.
As long as this popular crunchy treat isn't doused in movie-theater butter, it makes an excellent weight-loss snack. Not only is popcorn high in fiber, it even delivers some protein. A 1-ounce serving of air-popped corn (about 3½ cups) has 4 grams of fiber, almost 4 grams of protein and clocks in at 110 calories. This combination makes it a snack with staying power. Popcorn is filled with air, so you get a pretty large portion without a lot of calories. You can eat 3 whole cups of popcorn for only 100 calories.
Prior to WL, an ambulatory run-in period was imposed for each subject to insure stabilization of body weight (± 2 kg during 4 weeks). During the body weight stabilization, a three-day food dietary record was used to determine an individual’s daily food and beverage consumption to estimate their total daily caloric intake (2 weekdays and 1 weekend day). The subjects were randomly divided (according to age, gender and BMI) into two groups (rapid WL and slow WL). Rapid WL and slow WL, based on the lost weight (at least 5 %), were defined over a period of 5 weeks and 15 weeks, respectively (18). The prescribed calorie-restricted diet contained 15% protein, 30% to 35% fat, and 50% to 55% carbohydrate, on average, in order to provide WL. In general, the meal plans included 3 main meals (breakfast, lunch, and dinner) and three snacks (mid-morning, mid-afternoon, and bedtime), and low saturation and trans fats, cholesterol, salt (sodium), and added sugars. All diets were designed according to Dietary Guidelines for Americans, 2010 (21). Low-calorie diets produced an energy deficit of 500 to 750 and 1000 to 1500 kcal per day for slow and rapid WL, respectively. At the end of the study, anthropometric and biochemical assessments were conducted on the individuals (18 individuals in rapid WL and 18 individuals in slow WL), who reached the desired WL. All subjects provided their written informed consent, and the study protocol was approved by the ethics committee of Jundishapur University of Medical Sciences (Act No. IR.AJUMS.REC.1394.212).
Getting up early for an a.m. workout is always tough, especially as you slog through getting dressed before the sun rises. Leaving your sneakers out within view of your bed will make it easier to get out of bed, and remind you of why you’re waking up early in the first place. Plus, setting out your entire workout ensemble will cut down on getting ready time, so you can get dressed and leave the house before you have time to change your mind.
To stay motivated and deal with cravings, Juge has a couple of great recommendations. First, schedule a cheat meal on every seventh day. "Many of my clients have their cheat meal on Sunday, so then they're ready for Monday and the week to come," he says. If you feel deprived during the week, concentrate on the cheat meal to come, knowing you can eat absolutely anything you want to—pizza, lasagna, doughnuts, beer, chips, you name it. Remember, though, it's just one cheat meal, not an entire day of cheating. Afterward, get right back on the wagon with your next scheduled meal.
Trying to lose weight is a lot like cleaning out the basement: It’s overwhelming and near impossible to know where to start—even when you don’t have a ton of weight to lose. But getting the body you’ve always wanted doesn’t have to be a source of stress. If the scale won’t budge and you’re looking to shed the last 10 pounds, there are plenty of ways to reach your goal. To help you get there, we spoke with a handful of celebs that have successfully slimmed down (and kept it off) and dozens of the fitness and diet industries top experts.
Green tea’s health benefits stem from its high antioxidant content. Antioxidants are chemical compounds that can protect our cells from damage and may help protect us against cancer and heart disease. Green tea contains a variety of antioxidants including catechins, theaflavins and the flavanol quercitin. Green tea also contains caffeine, about 25 mg per 8 oz. cup, which is about one-third the caffeine in an 8 oz. cup of coffee.
A number of studies have been conducted to test the theory that green tea can help with weight loss. It's important to note that most of these studies used green tea extract, not the actual tea. Drinking regular green tea may not help you lose any weight, according to a 2012 clinical study published in Obesity, which compared the effects of drinking regular green tea and a catechin-rich green tea on weight loss in a group of men and women with type 2 diabetes. While the group drinking catechin-rich tea lost a half-pound over the 12-week study period, the group drank a lower-catechin green tea gained half a pound.
"For about 150 cal per 3.5 oz serving, arctic char joins the ranks of heart-healthy foods as a rich source of omega-3 fatty acids. Choosing fish over red meat reduces saturated fats in the diet and may help lower risk of heart disease and cancers,” says O’Connor. High in two types of healthy, mood-enhancing omega-3’s (EPA and DHA) this high-protein, low-calorie fish makes a great main course.
Obesity News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
Green tea has many health benefits. “It contains many nutrients, including antioxidants and anti-cancer and brain-healthy compounds,” Smith reminds us. One thing is for sure: regardless of whether or not you’ll shed pounds with green tea, drink it anyway. “All teas contain many healthful nutrients; it’s one of the healthier choices for a beverage!” Smith says.
One of the easiest ways to burn some extra calories is to get up from your chair at work; standing burns 50 more calories per hour than sitting, according to a British study. If you are lucky enough to have a standing desk, make sure you utilize it. If not, you can easily make your own by stacking books or boxes on your desk and standing up to work. At the very least, make sure you’re taking a break every hour to stand up and stretch, and possibly go for a walk around the office. Every bit of movement counts!
Even though grains have been promoted as healthy starches, consuming them is one of the fastest ways to pack on the pounds. Plus as you probably know by now, the gluten found in most grains can increase inflammation in your body and put a strain on your digestive system. And store-bought bread often has added high fructose corn syrup, sugar and preservatives.
However, drinking regular green tea might not be as beneficial for weight loss as taking green tea supplements. Most of the studies researching how green tea helps weight loss looked explicitly at green tea extract, which concentrates the benefits in a small serving size. While regular green tea will also help you maintain a healthy weight, the benefits will not be as impressive.
I am skilled at losing 50 pounds in the slow and steady method, I have proven that rapid weight loss is doable if you focus on end results. I have lived everyday since March of 2006 with the knowledge that my escape from morbid obesity is fleeting as the blanket of low lying fog on a beautiful fall morning. If I don’t pay attention I will never know the moment it faded away. My workouts are the time I “sit and take in the beauty” it brings to every moment of my life.
“A study published in Nutrition Journal found that participants who ate foods high in monounsaturated fats for lunch (in this case, half an avocado) reported a 40 percent decreased desire to eat for hours afterward. Monounsaturated fats from sources like olive oil, nuts and avocados can reduce cholesterol, promote weight loss, even boost memory.” — David Zinczenko, author of the Zero Belly Cookbook
Bonus: Save money by choosing meals that use in-season produce and combining your meals with your local grocery store’s sales flyer. And don’t forget about leftovers! Use them to create new meals (for instance, make a stir-fry with leftover cooked meats and veggies) or have a weekly night where all the leftovers get put out and everyone in the family can eat their favorites again.
“Oolong, or ‘black dragon,’ is a kind of Chinese tea that’s packed with catechins, nutrients that help promote weight loss by boosting your body’s ability to metabolize fat. A study in the Chinese Journal of Integrative Medicine found that participants who regularly sipped oolong tea lost a pound a week, without doing anything else to change their diet or exercise habits.” — Kelly Choi, author of The 7-Day Flat-Belly Tea Cleanse
One small 2018 study published in the International Journal of Sport Nutrition and Exercise Metabolism found that matcha green tea drinks can enhance exercise-induced fat oxidation in women following a 30-minute walk. But, the authors were also quick to point out that "the metabolic effects of matcha should not be overstated" when related to weight loss.
It sounds silly, but switching which hand you eat with can save you calories, and help boost weight loss. “It takes 15 minutes for your brain to realize that you’re full,” celebrity personal trainer Jay Cardiello told us in our article 40 Weight Loss Tips for Over 40. “To give your mind time to catch up to your mouth, simply switch your fork to non-dominate hand. It may be frustrating, but it’s a simple and unnoticeable way to curb overeating and lose weight.”
We know that shedding unwanted pounds used to mean giving up your favorite foods, logging hours at the gym, and being hungry (and hangry) all the time. Fortunately, dropping a dress size (or two) doesn’t have to be that complicated or torturous. Sure, losing any significant amount of weight requires lifestyle changes and some hard work, but it all boils down to simple choices.
Real talk: It could take weeks or months to see the metabolic effects of exercise on the scale, and even then, building muscle, which is denser than body fat, could lead to weight gain. “Do what you like because it’s good for you,” Dr. Seltzer says, noting the way exercise is awesome for your heart, mental health, and more—and that not all measure of progress can be seen on the scale.
Why this easy fitness plan works: It's common for people who exercise regularly to do the same routine week after week. If you do the same exercises at the same intensity all the time you'll get the same results. Your body hits a plateau. This plan increases your activity level without added stress or strain to your joints. So you burn more calories without taxing your body.
The Biggest Loser program has come under attack with recent revelations that its amazing, as-seen-on-TV results are both pharmaceutically assisted and likely to reverse. Living proof that the medical community’s understanding of weight loss is still evolving: The diet still stands in third place on US News’ & World Report’s list for Best Fast Weight Loss.
Speaking of standout breakfast foods, Greek yogurt is another option worthy of the spotlight thanks to its high-protein content. Per study in the journal Appetite, researchers from the University of Missouri compared the satiety effects of high-, moderate-, and low-protein yogurts on women aged 24-28, and found Greek yogurt, with the highest protein content, to have the greatest effect. What’s more? Probiotics in items such as yogurt and fermented foods, like pickles and sauerkraut, help good bacteria in the gut process food more efficiently. Hello, weight loss! If you want to get even more protein in your yogurt, check out Icelandic yogurts, which can have two to three more grams of protein per serving compared to Greek.

domain: food


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Franchise advantageJoin Advantage
All imported equipment is used to ensure that products are in line with international standards. A large number of industry production and R & D talents are introduced into the industry. They are the first to introduce new ideas, new processes and new materials. They are famous for their exquisite industrial processes, with humanized design elements and leading position in the industry.
The national media advertising will create momentum for dealers and conduct omni-directional media publicity with electronic advertising, print advertising, new media, Internet advertising, public channels and so on.
Advantage of origin
Foshan, the domestic production base industry, has a strong industry group and information group location advantage, sharing the international and domestic customer resources
A variety of colors and the collocation of stainless steel process, break the limitation of the single, the product is more abundant, more flexible, personalized demand, high-quality white-collar price, Jinling enjoy. The mainstream core product, the German shift door - the fifth generation door plate
The original board is processed by large equipment and laser cutting machine, and various styles are processed. The surface is painted by environmentally friendly coatings, and then processed by advanced technology. The surface is processed by 13 processes. Finally, the products are colorful and full with high temperature.
With high grade Home Furnishing, allows you to experience the high quality life, has a set of successful business methods let you solid stainless steel cabinet home a tiger with wings added, living museum experience, let you enjoy the Le Louvre Museum enjoy seven star
Store decoration, advertising, annual turnover rebate rebate rebate incentive policy, have participated in the training, travel reward double to meet the needs of dealers
Solid stainless steel cabinet allows dealers to design the installation effect, 24 hours and 400 telephone customer service, dealers enjoy manufacturers to promote electricity supplier, in the local area in the region to online orders when dealers all worry free, to help dealers to expand residential, home improvement, public installation, hardcover, cross industry alliance, bargain etc.
Franchise conditionsJoin condition
ONE. Expect partners
1, to understand and trust Pesti, to reach a high degree of consensus in the management concept and development ideas;
2. Be familiar with the local market and have better social and industrial resources.
3, have a certain economic strength, have good store position and can set up the operation team.
4, dedicated to the overall home business entrepreneurial enthusiasm;
5, there is a correct cognition and full psychological preparation for the dual nature of investment risk and income.
6. It has legal person qualification or legal management qualification, partners not more than 2 people, and clear their respective responsibilities;
1、Shopping guide: good image, good expression, strong communication ability
2、Designer: college degree or above, computer application, understand AutoCAD, a certain basis for interior design, To our training performance to meet the requirements to get the license, if not up to the requirements is not to get the license and to replace the designer
3、The installer, the junior high school above, has the certain communication ability, has the carpenter foundation better
1、Store area: according to the type of product, More than 80 square cabinet shop
a、Professional building materials commercial stores in the region
b、Comprehensive building materials commercial stores
c、The building material of the brand is a street
d、Professional home decoration market
e、An independent store suitable for the sale of the cabinet
Company introduction, joining conditions, methods and requirements, visit the exhibition hall
2Application of intention
Guiding intention to join in the market survey and plan
Whether the negotiation meets the standard of joining
A survey of market conditions, competitors and so on
5Intention to sign
Pay deposit, submit storefront plan, personnel training application
Does it meet the requirements, whether the personnel are in place, and whether the funds are in place
7Sign a cooperation agreement
The two parties sign a distribution agreement

domain: economics


"Complete Sentence" Unisex T-Shirt
Show off your sense of humor with a T-shirt featuring some of Mary's snarky Engeldark artwork! The rolled shoulder gives it a better fit, the double-stitched hems make it long-lasting, and its modern cut makes it stylish, too.
Reads: NO. It's a complete sentence.
- 100% cotton jersey knit
- 30 singles thread weight
- More contouring than a classic t-shirt
- Double stitched
- Shoulder-to-shoulder taping
- Tag printed on back of shirt (not pictured)
Please note that this product is created to order—please allow 7-10 business days for processing. THIS ITEM CANNOT BE SHIPPED AS A GIFT!


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- Open Access
Sporadic late-onset nemaline myopathy: clinico-pathological characteristics and review of 76 cases
Orphanet Journal of Rare Diseases volume 12, Article number: 86 (2017)
Sporadic late-onset nemaline myopathy (SLONM) is a rare, late-onset muscle disorder, characterized by the presence of nemaline rods in muscle fibers. Phenotypic characterization in a large cohort and a comprehensive overview of SLONM are lacking.
We studied the clinico-pathological features, treatment and outcome in a large cohort of 76 patients with SLONM, comprising 10 new patients and 66 cases derived from a literature meta-analysis (PubMed, 1966–2016), and compared these with 15 reported HIV-associated nemaline myopathy (HIV-NM) cases. In 6 SLONM patients, we performed a targeted next-generation sequencing (NGS) panel comprising 283 myopathy genes.
SLONM patients had a mean age at onset of 52 years. The predominant phenotype consisted of weakness and atrophy of proximal upper limbs in 84%, of proximal lower limbs in 80% and both in 67%. Other common symptoms included axial weakness in 68%, as well as dyspnea in 55% and dysphagia in 47% of the patients. In 53% a monoclonal gammopathy of unknown significance (MGUS) was detected in serum. The mean percentage of muscle fibers containing rods was 28% (range 1–63%). In 2 cases ultrastructural analysis was necessary to detect the rods. The most successful treatment in SLONM patients (all with MGUS) was autologous peripheral blood stem cell therapy. A targeted NGS gene panel in 6 SLONM patients (without MGUS) did not reveal causative pathogenic variants.
In a comparison of SLONM patients with and without MGUS, the former comprised significantly more males, had more rapid disease progression, and more vacuolar changes in muscle fibers. Interestingly, the muscle biopsy of 2 SLONM patients with MGUS revealed intranuclear rods, whereas this feature was not seen in any of the biopsies from patients without paraproteinemia.
Compared to the overall SLONM cohort, significantly more HIV-NM patients were male, with a lower age at onset (mean 34 years). In addition, immunosuppression was more frequently applied with more favorable outcome, and muscle biopsies revealed a significantly higher degree of inflammation and necrosis in this cohort. Similar to SLONM, MGUS was present in half of the HIV-NM patients.
SLONM presents a challenging, but important differential diagnosis to other neuromuscular diseases of adult onset. Investigations for MGUS and HIV should be performed, as they require distinct but often effective therapeutic approaches. Even though SLONM and HIV-NM show some differences, there exists a large clinico-pathological overlap between the 2 entities.
Sporadic late-onset nemaline myopathy (SLONM) is a rare, acquired, late-onset muscle disorder with subacute progression, characterized by proximal muscle weakness and atrophy, and the presence of nemaline rods in myofibers [1, 2]. Distal muscle weakness , dropped head [4, 5], respiratory failure [6, 7], or dysphagia [8, 9] have also been reported. SLONM can be associated with a monoclonal gammopathy of unknown significance (MGUS) that leads to an unfavorable outcome if untreated [10,11,12,13].
HIV-associated nemaline myopathy (HIV-NM) is another acquired, late-onset nemaline myopathy, distinguished by the presence of nemaline rods in muscle fibers in the setting of an HIV-infection [14,15,16]. An autoimmune mechanism for HIV-NM has been discussed [17, 18], however, it remains unclear whether HIV-NM and SLONM represent the same or distinct disease entities.
Histopathologically, nemaline rods can be identified on modified Gomori’s trichrome staining (mGT) as subsarcolemmal or intermyofibrillar dark red clusters . Using electron microscopy, the rods appear as electron dense bodies, sometimes showing continuity with the Z-discs . Rarely, nemaline bodies can occur inside myonuclei [4, 12, 21, 22]. Rods also represent the histopathological hallmark of the inherited congenital nemaline myopathies, which are currently known to be caused by 11 different genes .
Several case reports and small series of patients with SLONM have been published so far, but a systematic overview of SLONM is lacking. Here, we studied the clinico-pathological features as well as treatment and outcome in a large cohort of 76 patients with SLONM, comprising 10 new patients and 66 cases derived from a literature meta-analysis. In addition, we screened 283 myopathy genes using a targeted next-generation sequencing (NGS) panel in 6 SLONM patients and compared the phenotypic characteristics of the SLONM cohort (n = 76) with 16 HIV-NM cases reported in the literature.
SLONM patient selection
Patients with histologically confirmed SLONM, who either presented at the neuromuscular outpatient clinic (Department of Neurology) or had a muscle biopsy sent for (re-) evaluation to the Institute of Neuropathology at the University Hospital RWTH Aachen (Aachen, Germany), were included in our study. Patients with nemaline myopathy and a history or symptoms suggesting a congenital myopathy, such as positive family history for myopathy, the presence of delayed motor milestones, high-arched palate, scoliosis or muscle hypotonia were excluded. Patients with HIV infection were also excluded.
Clinical and paraclinical examinations
We performed a detailed neurological examination including muscle strength evaluation according to the criteria of the Medical Research Council (MRC) scale. Blood analyses were obtained including creatine kinase (CK) (normal in men <190 U/l, women <170 U/l), immune fixation and thyroid function as well as electromyography (EMG), nerve conduction studies (NCS), vital capacity measurement using spirometry, and echocardiography in all patients (Table 1, P1-10). The same examinations were performed in two patients (Table 1, P11-P12) who had been previously reported [9, 24], but who were re-evaluated in the current study and included for genetic analysis (see below).
Open muscle biopsies had been performed for diagnostic purposes prior to the study after obtaining the patients’ written informed consent (Table 1, P1-10). Biopsies were processed for light microscopy (LM) and electron microscopy (EM) following standardized procedures . Electron microscopic studies were performed in 49 published cases and all of our new patients but patient 4, in whom only LM was available. All available LM sections and EM images were analyzed. Biopsies from two additional patients (Table 1, P11-P12) who had been previously reported [9, 24] were re-evaluated in the current study.
Statistical analysis was performed using Excel software (Version 16.0.7030.1021) with the Add-In Real Statistics Resource Pack (Release 4.3). We tested for normal distributions using the D’Agostino Pearson Omnibus and the Shapiro-Wilk normality tests and compared normally distributed independent samples using Welch’s t-test, and non-normally distributed independent samples using the Mann-Whitney U test. For categorical variables, the two-tailed Fisher’s exact test was applied. P-values less than 0.05 were considered to be statistically significant.
Targeted next-generation sequencing (NGS) gene panel
In 6 SLONM patients without MGUS, targeted NGS was performed using a focused panel of 283 genes (CeGat, Tübingen, Germany). After obtaining written informed consent from each patient, peripheral blood samples were taken and DNA was extracted following standard procedures. The gene panel contained 73 genes that have so far been associated with congenital or distal myopathies, including genes known to cause congenital nemaline myopathy. Of these 73 genes, all variants were further considered. In addition, 210 genes related to diverse myopathies were included, in which only variants that were either marked as “known pathogenic” in the Human Genome Mutation Database (HGMD®), produced a STOP codon, resulted in a frameshift or were located in an essential splice site, were taken into further consideration. The applied prediction programs were Mutation Taster (MT), PolyPhen-2 (PP-2), PROVEAN, SIFT, Splice-Prediction Program NG2: NetGene2 Server, and Splice-Site Prediction by Neural Network.
Meta-analysis of the literature
We performed a systematic literature search in PubMed for SLONM cases from 1966 to 2016. All articles written in English, German and French were considered. The same inclusion and exclusion criteria that were used in our study were applied, which resulted in 46 publications comprising 66 SLONM patients in total (Table 1). In order to compare the features of SLONM patients with HIV-associated nemaline myopathy (HIV-NM), we performed an additional literature search for patients with HIV-NM. This resulted in 10 publications comprising 16 cases of HIV-NM (Table 1).
Clinical and paraclinical features of patients with SLONM (Table 1)
Our SLONM study cohort comprised 10 new patients and 66 cases culled from the literature (Table 1). Mean age at symptom onset was 52 years, ranging from 25 to 78 years. In half of the patients, first symptoms occurred between 45 and 60 years of age. Sixty percent were diagnosed within the first 2 years after symptom onset, while the longest diagnostic delay was 32 years (Table 1).
At disease onset, 80% of the patients presented with muscle weakness of the proximal lower and/or upper limbs. Neck extensor weakness (dropped head) or dyspnea were the only presenting symptoms in four cases each (8%). In two patients, isolated dysphagia marked the beginning of the disease (4%). During the disease course, the predominant clinical phenotype consisted of weakness and atrophy affecting the proximal upper limbs in 84%, proximal lower limbs in 80%, and both proximal upper and lower limbs in 67% as well as axial weakness (68%). Dyspnea developed in 55%, dysphagia in 47% of the patients. Muscle weakness progressed slowly in most SLONM patients. In one third, there was evidence of facial weakness (35%) or dysarthria (35%). Myalgia occurred in 43%, cramps in 36%, and fasciculations in 15%. Other symptoms presented more infrequently: predominantly distal weakness was seen in four patients (13%), ptosis in two patients (13%), and ophthalmoparesis was noted in one patient (5%) (Table 1).
In 53% of patients with SLONM, an MGUS (IgG) was detected in serum (Table 1). Urine investigations (performed in 5 patients) did not reveal the presence of monoclonal immunoglobulins, except for one case (however, without underlying hematological malignancy) . Fifty-two percent of the MGUS patients had kappa light chains, 41% lambda, and one patient presented with both kappa and lambda light chains in the serum . An underlying multiple myeloma was found in only one case . Serum CK was mostly normal (72%) or only slightly increased (<3 N; 22%). Three cases presented with hypothyroidism, which could be explained by amiodarone intake in one patient (P4). In the other two, anti-thyroid peroxidase antibodies and anti-thyroglobulin antibodies were negative in serum. TSH was increased in one  and decreased in another  patient. Electromyography (EMG) mainly showed myopathic changes (84%). Ten percent of patients showed a mixed pattern on EMG, two patients presented a purely neurogenic (3%) ((P3) and ) and two more a normal pattern (3%) ((P9) and ). Respiratory insufficiency was detected by spirometry in 55%. Dilated cardiomyopathy was present in 11% of patients.
Muscle biopsy findings in patients with SLONM (Table 1)
Nemaline bodies were visible by LM in all except 2 biopsies (P2, P7), in which EM was necessary to detect the rods, which were situated in the sarcoplasm and/or underneath the sarcolemma. Interestingly, intranuclear rods were present in 17% of the cases, but always combined with intrasarcoplasmic rods. The mean percentage of muscle fibers containing rods was 28%, varying from 1 to 63% (Table 1). Muscle fiber atrophy was present in all biopsies. Further frequent histopathological findings included myofibrillar disintegration (88%), core-like areas (69%), lobulated fibers (52%) and vacuolar changes (55%). Fiber necrosis was present in 25% and inflammatory infiltrates were found in 17% of the biopsies. The infiltrates were restricted to perivascular areas in 2 cases, whereas additional more widespread endomysial infiltrates were observed in the others. Mitochondrial changes (ragged-red fibers, COX-negative fibers and/or paracrystalline inclusions on EM) occurred frequently (64%). However, these could be explained at least in part as an unspecific age-related phenomenon.
Treatment in patients with SLONM (Tables 1 and 2)
The most common treatment in SLONM patients was immunosuppressive therapy (62%), mainly consisting of steroids, with improvement of muscle strength in one third of the patients (Tables 1 and 2). Intravenous immunoglobulins (IVIg) were administered in 19%; in one third of these cases improvement in muscle strength was achieved. Plasmapheresis was performed in 3 patients, which led to a partial improvement in one of them. The most successful treatment in SLONM patients was high-dose melphalan followed by autologous peripheral blood stem cell transplantation (auto-PBSCT), resulting in an improvement in 6/7 treated patients (86%). This treatment was performed only in SLONM patients with MGUS. Noninvasive ventilation (NIV) was successful in 4 patients with respiratory insufficiency. Invasive ventilation was performed in one case . All therapeutic regimens and outcomes in all patients for whom this information was available (n = 58) are listed in Table 2.
Comparison between SLONM patients with and without MGUS (Table 1)
SLONM and MGUS affected significantly more males (p = 0.012). Age at onset did not differ significantly between the two groups (p = 0.34). SLONM patients with MGUS showed a significantly more rapid disease progression (p = 0.0010). Bulbar weakness resulting in dysphagia, dysarthria, and dyspnea was moderately, but not significantly more frequent in patients with MGUS (p = 0.20–0.36; Table 1). Muscle weakness in upper (p = 0.0064) and lower (p = 0.030) limbs was significantly more common in patients with MGUS. Although facial (p = 0.13), neck extensor (p = 0.38), trunk weakness (p = 0.63), and respiratory insufficiency (p = 0.35) were more commonly present in patients with MGUS, the differences were not statistically significant. Treatment response to immunosuppressive drugs (p = 0.69) or IVIg (p = 1.00) did not differ significantly between patients with and without MGUS. Plasmapheresis or melphalan followed by auto-PBSCT was only applied in patients with MGUS.
Muscle biopsy of 2 SLONM patients with MGUS revealed intranuclear rods, whereas this feature was not observed in patients without paraproteinemia. Vacuolar changes in muscle fibers were significantly more frequent in SLONM with gammopathy than without (p = 0.041). Myofibrillar disintegration (p = 0.21), inflammatory infiltrates (p = 0.64), fiber necrosis (p = 0.62), and core-like areas (p = 0.27) were noted more frequently in SLONM patients with MGUS. However, these differences did not reach significance (Table 1).
Comparison between patients with SLONM and HIV-NM (Table 1)
There were significantly more males affected by HIV-NM compared to the SLONM cohort (p = 0.01). Age at onset of HIV-NM cases was significantly lower in comparison to SLONM patients (p = 0.01). No significant differences were noted in disease progression (p = 0.37) or in any of the clinical features (p > 0.05) except for the occurrence of myalgia in patients with HIV-NM (p = 0.043). Facial or respiratory weakness has not yet been reported in patients with HIV-NM. Immunosuppressive therapy (steroids) was administered more frequently in HIV-NM (p = 0.09), with a significantly more favorable outcome (p = 0.00071). The two muscle biopsy features that significantly distinguished HIV-NM from SLONM were the appearance of inflammatory infiltrates (p = 0.034) and fiber necrosis (p = 0.014). Interestingly, MGUS was detected in half of the HIV-NM patients, similar to the SLONM cohort.
According to the Classification of the United States Center for Disease Control and Prevention , the HIV-status in patients with HIV-NM was heterogeneous (infection stage 1 in five patients; stage 2 in two patients; stage 3 in one patient). The infection stage of the other eight patients remained unknown due to the absence of information in the literature regarding CD4-positive cell count and stage 3-defining opportunistic diseases.
Genetic analyses using a targeted NGS gene panel (Additional file 1: Table S1)
The variants identified by targeted NGS, after applying a panel of 283 genes, in 6 SLONM patients without MGUS (Table 1) are summarized in Additional file 1: Table S1. We did not identify variants in any of the 11 known genes causing congenital nemaline myopathy (TPM3, NEB, ACTA1, TPM2, TNNT1, KBTBD13, CFN2, KLHL40, KLHL41, LMOD3, MYPN). In two patients (P2, P11), a distinct variant of unknown significance was identified in the ryanodine receptor 1 gene (RYR1). Both RYR1 variants have not been reported before.
There were no common variants among the six SLONM patients in any of the genes tested. The variants identified were heterozygous and for the most part, of unknown significance (Additional file 1: Table S1). In P2 a known mutation was identified in SCN11A that has previously been associated with small-fiber neuropathy . Our patient did not, however, show any symptoms or signs compatible with small-fiber neuropathy. In P10 a heterozygous variant in SH3TC2 was identified; however, no additional mutation could be found. Homozygous mutations in the SH3TC2 gene cause autosomal recessive Charcot-Marie-Tooth neuropathy , heterozygous mutations can cause subtle autosomal dominant distal neuropathy . In the current example, the patient did not show any signs of neuropathy.
The clinical presentation of progressive weakness and atrophy of proximal upper or lower extremity and axial muscles, accompanied by dyspnea and/or dysphagia, represented the predominant clinical phenotype of SLONM. MGUS was a major feature, present in half of the patients, which was not only associated with more rapid disease progression, but also with a favorable response to treatment, especially with melphalan/auto-PBSCT.
Neck extensor weakness, sometimes resulting in dropped head, occurred in more than half of the SLONM patients during their disease course. In six cases, dropped head was an initial symptom; accompanied by limb weakness in four, by dysphagia in one patient, and as an isolated finding in another case. Respiratory affection resulting in dyspnea was present in four patients at disease onset. Interestingly, 3 of these 4 patients with dyspnea as a presenting symptom did not suffer symptoms from insufficient breathing prior to presentation. This lack of respiratory symptoms is considered to be due to the slowness of respiratory decline in SLONM.
Most patients presented with myopathic or mixed EMG patterns. However, one published case  and one of our patients (P 3) showed a neurogenic EMG pattern. Neurogenic EMG patterns can appear in severe chronic myopathies (in so-called ‘end-stage’ muscle) [36, 37]. This could explain at least one of the two cases with a neurogenic EMG , as this patient died as the result of her disease one year after presentation. In contrast, the other patient (P 3) did not present a particularly severe chronic myopathy. However, this patient suffered from chronic lower back pains radiating in the legs, which may explain the neurogenic changes on EMG in this patient. An additional peripheral neuropathy was excluded by nerve conduction studies in both patients.
In fact, SLONM should be considered in the differential diagnosis of sporadic inclusion body myositis (sIBM), idiopathic inflammatory myopathies (IIM) and amyotrophic lateral sclerosis (ALS). ALS, similar to SLONM, can present similarly with dropped head, bulbar weakness, dyspnea and fasciculations. There is even more overlap between IIM and SLONM; however, the former usually presents with high serum CK levels, while the latter shows only slight elevations. Inflammatory infiltrates are usually a prominent histopathological feature of IIM, but can also appear in SLONM. However, among the IIMs, polymyositis and sporadic inclusion body myositis (sIBM) are characterized by direct infiltration of muscle fibers by cytotoxic T-lymphocytes immunoreactive for CD8, which was absent in our SLONM cases. Perifascicular muscle fiber atrophy and loss of endomysial capillaries, typically found in dermatomyositis, were also absent in our cases. Sporadic inclusion body myositis may share many clinical similarities with SLONM, including age at onset in late adulthood, weakness of the proximal lower limbs and dysphagia. However, predominantly distal involvement is uncommon in SLONM, in contrast to sIBM. Histopathologically, both sIBM and SLONM present a myopathic pattern, but we could not identify any inclusion bodies (tubulofilamentous inclusions), and only rarely rimmed vacuoles in the SLONM cohort [38, 39]. Furthermore, in patients with sIBM, nemaline rods do not appear within muscle fibers.
Rarely, SLONM has been reported in combination with thyroid dysfunction. In our study, TSH has been increased in one and decreased in another patient. Since both hyper- and hypothyroidism, as such, may cause myopathy , a direct impact of the change in thyroid hormones on muscle might contribute to the disease.
Several clinical clues, including age at onset, distinguish SLONM from congenital nemaline myopathies. Mean age at onset in the SLONM cohort was 52 years, whereas patients with hereditary nemaline myopathy usually develop symptoms during infancy or early childhood. Furthermore, perinatal hypotonia, delayed motor milestones, scoliosis and a high-arched palate are features of congenital nemaline myopathies and were therefore exclusion criteria for our study. Histopathologically, fiber type 1 predominance, which is typically seen in the congenital forms, was not present in the SLONM cohort. Both congenital and late-onset nemaline myopathies are characterized by the presence of rods in the muscle fibers [1, 41]. Our genetic analysis did not disclose any mutations in genes known to cause congenital nemaline myopathy. We did not include the very recently reported myopalladin gene (MYPN) in our gene panel, which in case of mutations was shown to cause nemaline myopathy as well . Thus, mutations in MYPN were not searched for in our SLONM cohort. Furthermore, we did not perform an analysis of copy number variations. In intranuclear rod myopathy, which is a congenital nemaline myopathy with more severe disease course, nemaline rods are frequently found inside myonuclei . Until recently, the only known causative gene was ACTA1 . However, very recently, mutations in the myopalladin gene (MYPN) were also found to cause intranuclear rods , in a relatively mild, childhood- to adult-onset nemaline myopathy with slowly progressive muscle weakness. The publication did not include any patients with SLONM that met our inclusion criteria, as three patients experienced first symptoms in their first decade and the fourth patient showed a positive family history for myopathy with consanguinity and neonatal muscular weakness. Interestingly, the muscle biopsy of two SLONM patients with MGUS and of two SLONM patients lacking immunoelectropheresis revealed intranuclear rods, whereas this feature was not seen in any of our SLONM patients without paraproteinemia. In all four cases with SLONM and intranuclear rods, nemaline bodies were also present in the sarcoplasm [4, 12, 21]. Genetic analysis of ACTA1 was not performed in any of the four cases. The clinical phenotype of patients with SLONM with intranuclear rods was not significantly different compared to other patients with SLONM. In SLONM, nemaline rods are the most striking feature, but other unspecific changes such as fiber atrophy, internalization of nuclei, myofibrillar disintegration were also frequent. Mitochondrial changes, including ragged-red fibers, COX-negative fibers and/or paracrystalline intramitochondrial inclusions detectable by EM, occurred frequently (64%). These findings might be considered unspecific and age-related in part; however, a more direct effect of Z-disc remodeling on skeletal muscle fiber mitochondria cannot be excluded.
HIV-associated nemaline myopathy showed the same constellation of features seen in SLONM, including proximal limb weakness, myopathic EMG and slightly elevated serum CK levels. However, HIV-NM appears to be more confined to certain muscle groups, since neither facial nor respiratory involvement has been reported to date. Apart from one patient with dysphagia, bulbar weakness has not been described either. Interestingly, the majority of patients (73%) showed clinical signs of myopathy before the HIV infection was detected. Therefore, it is important to screen (especially younger) patients with SLONM for HIV infection. Of note, one case has even been described with negative serology at presentation with HIV seropositivity developing only a year after myopathy onset . Histopathologically, there were marginal differences: rods were smaller with <1 μm radius [15, 46] and they did not appear inside the nucleus in HIV-NM. Moreover, we observed significantly more frequent myonecrosis and inflammatory infiltrates in HIV-NM. The most compelling difference, however, is the good clinical response of treated HIV-NM cases to immunosuppressive therapy. Combined with muscle involvement during the early stage of HIV infection, this finding might suggest either a direct impact of the viral particles on the formation of rods or an immunological trigger, rather than a degenerative mechanism due to T-cell suppression/immunodeficiency. An HIV-caused genome disturbance has also been discussed as a basis for rod formation .
In SLONM with MGUS, not merely the aggregation of paraproteins but rather their effects on autogenous antigens, especially sarcomeric proteins, are thought to cause the formation of rods [47, 48]. In fact, one case of SLONM with MGUS was described with sarcolemmal deposits of the paraprotein , and another suggested immunoreactivity of the sarcolemma to IgG with the paraprotein light chain , lending support to this theory. However, a similar immunohistochemical pattern was reported in another publication of a patient without MGUS , suggesting a similar pathogenic pathway in SLONM without MGUS. SLONM patients with accompanying autoimmune diseases such as systemic lupus erythematosus (SLE)  or Sjögren’s syndrome  often improved during immunosuppressive medication, whereas the majority of SLONM cases showed a disappointing response rate. This observation might hint at a different nonimmunogenic cause. Another hypothesis suggested that rod formation is part of a regenerative process without the traditional features of muscle repair ; however, our findings fail to support this assertion. The chronology of the appearance of rods in relation to disease course varied: Nine cases did not show any rods at symptom onset on light microscopy, but only in a subsequent biopsy (P 4) [8, 25, 26, 29, 49, 51,52,53]. Six cases revealed rods only after severe clinical deterioration (P4) [8, 25, 29, 51, 52]. Interestingly, this clinical correlation has also been observed the other way around: clinical improvement after auto-PBSCT was accompanied by the disappearance of rods [54, 55] as well as paraprotein reduction in SLONM patients with MGUS . Therefore, multiple biopsies during the disease course may be necessary to confirm the diagnosis of SLONM.
Overall, the pathomechanisms of SLONM remain unsolved.
To conclude, SLONM can be difficult to diagnose in routine clinical practice, not only because of its rarity, but also due to several clinical mimics. However, if an adult patient presents with progressive limb, bulbar and/or respiratory weakness, we recommend respiratory function testing as well as a muscle biopsy that includes a Gomori’s trichrome stain in order to identify nemaline rods. If rods are not visible by light microscopy, additional electron microscopic studies are indicated. In addition, all SLONM patients should be screened for a concomitant MGUS or HIV infection, since both have distinct therapeutic and prognostic implications.
Engel AG. Late-onset rod myopathy (a new syndrome?): light and electron microscopic observations in two cases. Mayo Clin Proc. 1966;41(11):713–41.
Engel WK, Resnick JS. Late-onset rod myopathy: a newly recognized, acquired, and progressive disease. Neurology. 1966;16:308–9.
Palmucci L, Doriguzzi C, Mongini T, Chiado-Piat L. Adult onset nemaline myopathy: a distinct nosologic entity? Clin Neuropathol. 1993;12(3):153–5.
Engel WK, Oberc MA. Abundant nuclear rods in adult-onset rod disease. J Neuropathol Exp Neurol. 1975;34(2):119–32.
Lomen-Hoerth C, Simmons ML, Dearmond SJ, Layzer RB. Adult-onset nemaline myopathy: another cause of dropped head. Muscle Nerve. 1999;22(8):1146–50.
Kelly E, Farrell MA, McElvaney NG. Adult-onset nemaline myopathy presenting as respiratory failure. Respir Care. 2008;53(11):1490–4.
Whitaker J, Love S, Williams AP, Plummeridge M. Idiopathic adult-onset nemaline myopathy presenting with isolated respiratory failure. Muscle Nerve. 2009;39(3):406–8.
Gyure KA, Prayson RA, Estes ML. Adult-onset nemaline myopathy: a case report and review of the literature. Arch Pathol Lab Med. 1997;121(11):1210–3.
Wengert O, Meisel A, Kress W, Dekomien G, Angstwurm K, Heppner FL, Goebel HH, Stenzel W. Progressive external ophthalmoplegia as initial manifestation of sporadic late-onset nemaline myopathy. J Neurol. 2011;258(5):915–7.
Eymard B, Brouet JC, Collin H, Chevallay M, Bussel A, Fardeau M. Late-onset rod myopathy associated with monoclonal gammopathy. Neuromuscul Dis. 1993;3(5–6):557–60.
Deconinck N, Laterre EC, Van den Bergh PY. Adult-onset nemaline myopathy and monoclonal gammopathy: a case report. Acta Neurol Belg. 2000;100(1):34–40.
Chahin N, Selcen D, Engel AG. Sporadic late onset nemaline myopathy. Neurology. 2005;65(8):1158–64.
Keller CE, Hays AP, Rowland LP, Moghadaszadeh B, Beggs AH, Bhagat G. Adult-onset nemaline myopathy and monoclonal gammopathy. Arch Neurol. 2006;63(1):132–4.
Dalakas MC, Pezeshkpour GH, Flaherty M. Progressive nemaline (rod) myopathy associated with HIV infection. N Engl J Med. 1987;317(25):1602–3.
Gonzales MF, Olney RK, So YT, Greco CM, McQuinn BA, Miller RG, DeArmond SJ. Subacute structural myopathy associated with human immunodeficiency virus infection. Arch Neurol. 1988;45(5):585–7.
Simpson DM, Bender AN. Human immunodeficiency virus-associated myopathy: analysis of 11 patients. Ann Neurol. 1988;24(1):79–84.
Dwyer BA, Mayer RF, Lee SC. Progressive nemaline (rod) myopathy as a presentation of human immunodeficiency virus infection. Arch Neurol. 1992;49(5):440.
Cabello A, Martinez-Martin P, Gutierrez-Rivas E, Madero S. Myopathy with nemaline structures associated with HIV infection. J Neurol. 1990;237(1):64–5.
Dubowitz V, Sewry CA, Oldfors A, Lane RJ. Muscle biopsy : a practical approach. 4rthth ed. Oxford: Saunders Elsevier; 2013. p. 2013.
Price HM, Gordon GB, Pearson CM, Munsat TL, Blumberg JM. New evidence for excessive accumulation of Z-band material in nemaline myopathy. Proc Natl Acad Sci U S A. 1965;54(5):1398–406.
Paulus W, Peiffer J, Becker I, Roggendorf W, Schumm F. Adult-onset rod disease with abundant intranuclear rods. J Neurol. 1988;235(6):343–7.
Goebel HH, Warlo I. Nemaline myopathy with intranuclear rods--intranuclear rod myopathy. Neuromuscular Disord. 1997;7(1):13–9.
Malfatti E, Romero NB. Nemaline myopathies: State of the art. Rev Neurol. 2016;172(10):614–9.
Klarl BA, Bornemann A, Demuth K, Zahringer M, Lindner A. Sporadic adult form of nemaline myopathy--a difficult differential diagnosis. Fortschr Neurol Psychiatr. 2009;77(3):166–8.
Milone M, Katz A, Amato AA, Soderland CA, Segarceanu M, Young NP, Jones HR. Sporadic late onset nemaline myopathy responsive to IVIg and immunotherapy. Muscle Nerve. 2010;41(2):272–6.
Irodenko VS, Lee HS, de Armond SJ, Layzer RB. Adult nemaline myopathy with trabecular muscle fibers. Muscle Nerve. 2009;39(6):871–5.
Montagnese F, Portaro S, Musumeci O, Migliorato A, Moggio M, Fagiolari G, Rodolico C. Sporadic late-onset nemaline myopathy in a woman with multiple myeloma successfully treated with lenalidomide/dexamethasone. Muscle Nerve. 2015;51(6):934–5.
Reyes MG, Tal A, Abrahamson D, Schwartz M. Nemaline myopathy in an adult with primary hypothyroidism. Can J Neurol Sci. 1986;13(2):117–9.
Letournel F, Le Clec’h C, Croue A, Marcorelles P, Lavigne C, Penisson-Besnier I. Nemaline bodies as unique pathological feature in the course of treated dermatomyositis. Clin Neuropathol. 2010;29(6):357–60.
Brownell AK, Gilbert JJ, Shaw DT, Garcia B, Wenkebach GF, Lam AK. Adult onset nemaline myopathy. Neurology. 1978;28(12):1306–9.
Kemta Lekpa F, Chevalier X, Dubourg O, Dimitri D. Isolated camptocormia revealing sporadic late onset nemaline myopathy. Presse medicale (Paris, France : 1983). 2013;42(7–8):1142–4.
Centers for Disease C, Prevention. Revised surveillance case definition for HIV infection--United States, 2014. MMWR Recomme Rep. 2014;63(Rr-03):1–10.
Huang J, Han C, Estacion M, Vasylyev D, Hoeijmakers JG, Gerrits MM, Tyrrell L, Lauria G, Faber CG, Dib-Hajj SD, et al. Gain-of-function mutations in sodium channel Na(v)1.9 in painful neuropathy. Brain. 2014;137(Pt 6):1627–42.
Lassuthova P, Mazanec R, Vondracek P, Siskova D, Haberlova J, Sabova J, Seeman P. High frequency of SH3TC2 mutations in Czech HMSN I patients. Clin Genet. 2011;80(4):334–45.
Lupski JR, Reid JG, Gonzaga-Jauregui C, Rio Deiros D, Chen DC, Nazareth L, Bainbridge M, Dinh H, Jing C, Wheeler DA, et al. Whole-genome sequencing in a patient with Charcot-Marie-Tooth neuropathy. N Engl J Med. 2010;362(13):1181–91.
Paganoni S, Amato A. Electrodiagnostic evaluation of myopathies. Phys Med Rehabil Clin N Am. 2013;24(1):193–207.
Preston DC, Shapiro BE. Clinical Electrophysiologic Correlations. In: Electromyography and Neuromuscular Disorders. 3 edn. Boston: Mcgill J Med. 2006;9(2):173. 2013:p. 554.
Gerard JM, Telerman-Toppet N, Borenstein S, Flament-Durand J. Sporadic Z disk myopathy with accumulation of rods and cytoplasmic bodies. Rev Neurol. 1991;147(2):144–7.
Sieb JP, VonOertzen J, Tolksdorf K, Dorfler P, Kappes-Horn K, Jerusalem F. Sporadic adult-onset distal myopathy with rimmed vacuoles, 15–18 nm tubulofilaments and extensive rod formation. J Neurol Sci. 1997;146(1):81–4.
Cakir M, Samanci N, Balci N, Balci MK. Musculoskeletal manifestations in patients with thyroid disease. Clin Endocrinol (Oxf). 2003;59(2):162–7.
Shy GM, Engel WK, Somers JE, Wanko T. Nemaline myopathy. A new congenital myopathy. Brain. 1963;86:793–810.
Miyatake S, Mitsuhashi S, Hayashi YK, Purevjav E, Nishikawa A, Koshimizu E, Suzuki M, Yatabe K, Tanaka Y, Ogata K, et al. Biallelic mutations in MYPN, encoding myopalladin, are associated with childhood-onset, slowly progressive nemaline myopathy. Am J Hum Genet. 2017;100(1):169–78.
Goebel HH, Piirsoo A, Warlo I, Schofer O, Kehr S, Gaude M. Infantile intranuclear rod myopathy. J Child Neurol. 1997;12(1):22–30.
Schroder JM, Durling H, Laing N. Actin myopathy with nemaline bodies, intranuclear rods, and a heterozygous mutation in ACTA1 (Asp154Asn). Acta Neuropathol. 2004;108(3):250–6.
de Sanctis JT, Cumbo-Nacheli G, Dobbie D, Baumgartner D. HIV-associated nemaline rod myopathy: role of intravenous immunoglobulin therapy in two persons with HIV/AIDS. AIDS Read. 2008;18(2):90–4.
Feinberg DM, Spiro AJ, Weidenheim KM. Distinct light microscopic changes in human immunodeficiency virus-associated nemaline myopathy. Neurology. 1998;50(2):529–31.
Merlini G, Stone MJ. Dangerous small B-cell clones. Blood. 2006;108(8):2520–30.
Novy J, Rosselet A, Spertini O, Lobrinus JA, Pabst T, Kuntzer T. Chemotherapy is successful in sporadic late onset nemaline myopathy (SLONM) with monoclonal gammopathy. Muscle Nerve. 2010;41(2):286–7.
Dimitri D, Dubourg O. Sporadic late-onset nemaline myopathy in a patient with systemic lupus erythematosus. J Neurol. 2013;260(12):3171–3.
Suzuki M, Shimizu Y, Takeuchi M, Kobayashi M, Iwata M, Uchiyama S. Sporadic late-onset nemaline myopathy in a patient with primary Sjogren’s syndrome. J Neurol. 2012;259(2):358–60.
Doppler K, Knop S, Einsele H, Sommer C, Wessig C. Sporadic late onset nemaline myopathy and immunoglobulin deposition disease. Muscle Nerve. 2013;48(6):983–8.
Hanisch F, Schneider I, Muller T, Romeike BF, Stoltenburg G, Holzhausen HJ, Zierz S. Treatability of sporadic late onset nemaline myopathy. Nervenarzt. 2013;84(8):955–61.
Kamieniecka Z. Late onset myopathy with rod-like particles. Acta Neurol Scand. 1973;49(4):547–51.
Benveniste O, Laforet P, Dubourg O, Solly S, Musset L, Choquet S, Azar N, Fardeau M, Herson S, Leblond V, et al. Stem cell transplantation in a patient with late-onset nemaline myopathy and gammopathy. Neurology. 2008;71(7):531–2.
Voermans NC, Minnema M, Lammens M, Schelhaas HJ, Kooi AV, Lokhorst HM, van Engelen BG. Sporadic late-onset nemaline myopathy effectively treated by melphalan and stem cell transplant. Neurology. 2008;71(7):532–4.
Voermans NC, Benveniste O, Minnema MC, Lokhorst H, Lammens M, Meersseman W, Delforge M, Kuntzer T, Novy J, Pabst T, et al. Sporadic late-onset nemaline myopathy with MGUS: long-term follow-up after melphalan and SCT. Neurology. 2014;83(23):2133–9.
Katirji B, Hachwi R, Al-Shekhlee A, Cohen ML, Bohlman HH. Isolated dropped head due to adult-onset nemaline myopathy treated by posterior fusion. Neurology. 2005;65(9):1504–5.
Maeda MH, Ohta H, Izutsu K, Shimizu J, Uesaka Y. Sporadic late-onset nemaline myopathy as a rare cause of slowly progressive muscle weakness with young adult onset. Muscle Nerve. 2015;51(5):772–4.
Seitz RJ, Toyka KV, Wechsler W. Adult-onset mixed myopathy with nemaline rods, minicores, and central cores: a muscle disorder mimicking polymyositis. J Neurol. 1984;231(3):103–8.
Sun AP, Ohtsuki Y, Yano T, Matsumoto M, Takeuchi T, Furihata M, Arahori M, Sonobe H. Typical nemaline bodies presenting in a patient with polymyositis. Med Electron Microsc. 2002;35(3):167–72.
Danon MJ, Giometti CS, Manaligod JR, Perurena OH, Skosey JL. Adult-onset nemaline rods in a patient treated for suspected dermatomyositis. Study with two-dimensional electrophoresis. Arch Neurol. 1981;38(12):761–6.
Parks NE, Hanada EY. Maximizing functional independence in sporadic late onset nemaline myopathy. PM & R. 2012;4(12):1020–3.
Falga-Tirado C, Perez-Peman P, Ordi-Ros J, Bofill JM, Balcells E. Adult onset of nemaline myopathy presenting as respiratory insufficiency. Respiration. 1995;62(6):353–4.
We thank the patients and their families for participating in our study. We are grateful to the technical and administrative personnel of the Department of Neurology and the Institute of Neuropathology at the University Hospital Aachen for their support.
This study was funded by a research grant to K.G.C. provided by the Deutsche Gesellschaft für Muskelkranke (DGM) e.V. PVD holds a senior clinical investigatorship of FWO-Vlaanderen.
Availability of data and materials
The datasets used during the current study are available from the corresponding author on request.
LJS: Conception and study design, study screening, data extraction and compilation, statistical analysis, interpretation of results, drafting the manuscript. TS, ANP, WS, ER, PVD, AF, SP, CH, AB, AM, JP, TT, DT, JR, PDJ, JJM, PVDB: participation in patient recruitment and data assessment, review and revision of the manuscript. JBS: Overall supervision of the clinical part of the study from conception to completion, review and revision of the manuscript. JW: Overall supervision of the neuropathological part of the study from conception to completion, review and revision of the manuscript. KGC: Conception and study design, interpretation of results, supervising the study, supervising the writing of the manuscript, review and revision of the manuscript. All authors approved the final manuscript.
DRT received consultancies from Covance Laboratories (UK) and GE-Healthcare (UK), received a speaker honorarium from GE-Healthcare (UK) and collaborated with Novartis Pharma Basel (Switzerland).
The authors declare that they have no competing interests.
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The study was approved by the ethical committee of the University Hospital RWTH Aachen (Germany). Written informed consent was obtained from the participating patients.
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Additional file 1: Table S1.
Genetic variants identified in patients with SLONM using NGS and a panel of 283 genes. (DOC 72 kb)
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Schnitzler, L.J., Schreckenbach, T., Nadaj-Pakleza, A. et al. Sporadic late-onset nemaline myopathy: clinico-pathological characteristics and review of 76 cases. Orphanet J Rare Dis 12, 86 (2017). https://doi.org/10.1186/s13023-017-0640-2
- Muscle biopsy
- HIV-associated nemaline myopathy
- Monoclonal gammopathy

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Apr 26, 2019 Latest news about NTGR - Stock Market | FinancialContent ... Data & News supplied by www.cloudquote.io Stock quotes supplied by Six Financial & Barchart Quotes delayed at least 20 minutes. By accessing this page, you agree to the following NETGEAR Inc : NTGR Stock Price Quote at Ally Invest Analysts Raise Expectations Q2 and 2021 Earnings for Netgear 3:45AM ET 5/20/2020 MT Newswires. The June 30, 2020 quarterly, and December 31, 2021 full year earnings estimates for Netgear Inc (NASDAQ:NTGR, Recent Price: 24.97) have been increased. The
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I'm just starting (and hopefully finishing soon) research on places for my wife and I to go for Christmas break for a short trip (we are both in our early 30s). We want somewhere warm, with beaches, yet also enough other things to do in the day like explore a city - and some fun but not over-the-top nightlife. San Juan seemed like it had all of these. While we like sitting on the beach and getting into the ocean, we aren't really 'resort' types, and I've heard the luxury resorts (Conquistador, Ritz, etc) are actually a decent distance from San Juan. I was hoping to get people's views as to whether San Juan did fit the bill for what we are looking for - we are planning on spending 3-4 days/nights, and wanted to see if people thought there was enough to do in terms of exploring Old San Juan, enjoying the beach, eating at local restaurants, and going out a little at night. Any thoughts much appreciated
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Netflix is gearing up for the return of its Tudum virtual fan event as the streamer has released a new trailer for the event ahead of its return on September 24, 2022.
Similar to last year’s event, this year’s Tudum will feature a wealth of new information about some of the biggest and best projects Netflix has planned for the future. This includes new footage, trailers and interviews with some of Netflix’s biggest stars and creators.
Watch the trailer for Netflix’s Tudum 2022 event below:
Although it is unknown exactly what will appear at the event, Netflix has promised appearances from a number of its biggest shows, including Bridgerton, Emily in Paris, Shadow and bone, Play octopus, Stranger Thingsand The Witcher. Movies will also be a big part of the show, with Enola Holmes 2, Extraction 2, Glass onion: A Knives Out Mystery, Heart of stoneand more all teased to appear in some way.
The event returns after its extremely successful premiere in 2021 and, like last year, will host five different global events highlighting specific projects for certain countries. The full program and times for Tudum’s live streams in 2022 are as follows:
- At 11:00 a.m. KST (7:00 p.m. PT on September 23), Tudum kicks off with an exciting show from Korea.
- 11:00 AM IST (11:30 PM PT, September 23) fans will be treated to a fun look at what lies ahead from India.
- 10:00 a.m. PT, Tudum kicks off as a two-part show with Part 1 from the US and Europe and Part 2 at 11:30 a.m. PT from Latin America, including surprises from other countries.
- At 13:00 JST on September 25 (9:00 PM PT on September 24), our stars of Japan Tudum will close with a celebration of our Japanese entertainment.


WATERBURY — In a week’s time, generous donors rallied for this year’s fundraising challenge to the Greater Waterbury Campership Fund.
Frank and Sandy Monteiro of Prospect offered their annual Monteiro Challenge, to match $5,000 raised in three weeks, starting March 14. As of Friday, the couple already knows they’ll have to pay up to help send local children to camp this summer.
The Monteiros, including their son Anthony, put out the call that if Campership Fund supporters could raise $5,000 for the cause between March 14 and the end of the month, they would personally donate $5,000 more.
Additionally, Drew International and Drew Marine, of Naugatuck and Waterbury, where Frank J. Monteiro is president and chief executive officer, would kick in another $5,000 if supporters met the challenge.
The public response was quick and hearty: $6,240 was contributed in a matter of days, with almost two weeks still left in the challenge.
“It’s very, very exciting,” said Frank J. Monteiro. “It’s great to see the community stepping forward to meet the challenge.”
With many individual donations still promised and en route to ensure the challenge is met, a big reason for the record challenge pace was timing: Thomaston Savings Bank Foundation donated $2,500, the result of the nonprofit Campership Fund applying to the foundation’s annual community grants program.
“That generous grant from Thomaston Savings Bank ensured that we met our challenge,” said Anne Karolyi, managing editor of the Republican-American and Sunday Republican. “The challenge donations still promised from individuals prove one of the best things about Campership, that a lot of smaller gifts make a huge impact in local children’s lives.”
“We’d love to see the collective $15,000 raised by the Monteiro Challenge effort reach $20,000, so even more kids can benefit this summer. This year, it’s a wonderful sign of life inching toward a more-normal, post-COVID future, a symbolic step foward,” Karolyi said.
SAID FRANK J. MONTEIRO of the response: “This testifies that we have a community that really cares, it’s an important nonprofit and they can see the good that it does for the kids. Hopefully they will continue to respond.”
“I look forward to bringing in those checks,” Monteiro said.
Sandy Monteiro is on the volunteer Campership Fund board of directors, who like all supporters of the program are optimistically hopeful this year’s summer camping season will be far less constricted by COVID-19 and health concerns.
Tuition costs for the 64 eligible children who attended camp in 2020 were $34,386. The year before, 434 youngsters went off to camps throughout the state at a cost of $157,457. Some recent years, the number of eligible applicants as hit 499, and volunteers at The United Way of Greater Waterbury, who screen applicants for eligibility and coordinate communication between the Campership Fund and the camps, predict the potential for greater need because of families hard hit by the pandemic.
Contributions for the fledgling campaign have hit the $67,384 mark.
Campership Fund application information has started to make its way to school districts and community partners and agencies within the 10-community United Way service area, as well as to the 2-1-1 Info Line.
Families who receive SNAP benefits or meet federal poverty guidelines, and with children ages 5 to 18 living in Bethlehem, Cheshire, Middlebury, Prospect, Southbury, Thomaston, Waterbury, Watertown, Wolcott and Woodbury, are eligible to apply.
The all-volunteer Campership Fund board established a target goal of $160,000 for 2021. No matter how this year’s campaign fares, however, there already is $250,000 in the Next 50 auxiliary fund to draw upon as backup.
NEXT 50 WAS CREATED by the board in 2019, the 50th anniversary year of the Campership Fund. Its revenue only can be applied toward tuition in case funding comes up short for any particular future camping season.
The Campership Fund, a 501(c) 3, is required to adhere to its guidelines of no salaries for the board and no expenses; every penny raised goes to the cost of sending children to camp.
Contributions may be sent to Greater Waterbury Campership Fund, 389 Meadow St., Waterbury, CT 06722.
Donations amounting to $8,560, including $6,240 applied to the Monteiro Challenge, recently were received from:
Thomaston Savings Bank Foundation, Thomaston, $2,500
Thomaston Savings Bank, Thomaston, from the Denim Days for the Community Initiative, $2,040
Peter Baker and Josette Caporale, Southbury, in honor of Sandy Monteiro’s 50th birthday, $500
Jeannine Laliberte, Oakville, $400
Joe and Debra Gugliotti, Wolcott, in honor of Sandy Monteiro’s 50th birthday, $250
Mr. Theodore Jewell and Ms. Nancy O’Brien, Watertown, in memory of Mr. Pape for his support of the Campership Fund, $250
Joel and Nancy Becker, Wolcott, $250
Cherrie Gillis, Waterbury, $250
Forrest and Susan Hartson, Southbury, $200
Joe and Rosemary Gurga, Southington, in memory of Alfred Mancinone, $150
Louise Pelletier, Watertown, in memory of the Rev. Dr. John Pelletier, $100
Richard Benfer, Thomaston, in memory of Lois Benfer, $100
Joseph and Margaret Sheehan, Watertown, in memory of Ann Charbonneau, $100
Ann McGurk, Litchfield, with fond memories of our camping trips, $100
Richard and Carol Gagnon, Waterbury, $100
Henry and Susan Kustosz, New Milford, $100
James Nardozzi, Waterbury, in memory of Susan K. Nardozzi, $100
Judith Ball, Wolcott, in memory of Forrest Ball, $100
Ronald and Janice Pugliese, Southbury, in honor of Frank and Sandy Monteiro, $100
John and Velma McKenna, Watertown, in memory of Rosalie Piller, $100
Peter Merriman, Prospect, $100
Rita Spinella, Thomaston, in memory of my husband, Joseph R. Spinella and my daughter, Michelle Spinella, $100
Dr. Mark and Karen Carlson, Bridgewater, $100
Rosemary Briglia, Middlebury, $100
Donald and Debbie Douty, Naugatuck, $100
Sandra Broden, Watertown, in honor of the life of Anne Hlavna, $50
Ronald and Helen Jurzyk Sr., Wolcott, in memory of Ruth-Ellen Summa, $50
Armand and Cynthia Solomita, Waterbury, in loving memory of our families, $50
Sal and Tina Agati, Watertown, in memory of Ann Charbonneau, $50
Holy Trinity Greek Orthodox Church Ladies Philoptochos Society, Waterbury, $50
Cyber Grants, $20


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"YOU ARE YOUR PET'S CHEF!"
Happy healthy pets require proper nutrition for long life! What you choose to feed will have a huge impact on how healthy your pet will be and could impact how long your pet will live!
We know you love your pet and only want the best for it, yet sadly. many misinformed people are harming their pets everyday by feeding dangerous chemicals, unnecessary fillers and animal byproducts in everyday grocery store brand pet foods and treats.
We love pets too, and we started Dorchester Pet Care & Supply because of the shocking information we found through researching pet food for our own pets!
To be honest, we want to help and are thrilled to offer any guidance and direction, regardless if you make a purchase or not. We just want to do our part so we can see pets live longer healthier lives.
Please stop in and we will be happy to talk to you about your "best friend's" nutritional requirements, and don't forget to bring along your furry 4 legged friend, we love to meet them!
Owner, Operator, Pet Lover
Dorchester Pet Care supplies the following high quality pet food brands: Acana, Fromm, Orijen, Wellness, Now, Go!
Everything You Need To Know About Pet Nutrition!
Dog - Cat - Small Animal - Bird - Fish
Pet Nutrition Experts - Family owned!


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Company registration number
- ж.к. БОТУНЕЦ 2
- бл. 7
- ет. 1
- ап. 3
- 1870 София
ж.к. БОТУНЕЦ 2, бл. 7, ет. 1, ап. 3, 1870 София
Company Description ГК РОСИЦА 2009
ГК РОСИЦА 2009 is a ЕДНОЛИЧНО ДРУЖЕСТВО С ОГРАНИЧЕНА ОТГОВОРНОСТ registered in Bulgaria with the Company reg no 200871404. Its current trading status is "live". The managing director is КИРИЛ САШЕВ СЪБЕВ,КИРИЛ САШЕВ СЪБЕВ.It can be contacted at Ж.к. Ботунец 2, Бл. 7, Ет. 1, Ап. 3, Bulgaria .
Did you know? kompany provides original and official company documents for ГК РОСИЦА 2009 as filed with the government register. Guaranteed.
kompany provides guaranteed original data from the European Business Register (contracting partner). The price includes the official fee, a service charge and VAT (if applicable).
The company details for
ГК РОСИЦА 2009
are sourced directly or indirectly from official company registries.
You are here: Гк Росица 2009 - ж.к. БОТУНЕЦ 2, бл. 7, ет. 1, ап. 3, Bulgaria
kompany is an official clearing house of the Republic of Austria (license granted / renewed on April 14th 2015) and is an official distributor of the European Business Register (EBR) (as per agreement dated July 27th 2012). kompany and its subsidiaries are private service providers and do not represent any government or government office.


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A healthy romantic relationship is the one which click here to read advances the psychological, mental and physical wellbeing of both partners. It involves open connection, trust, esteem and a commitment to making time for the other person.
Whether it’s with your romantic partner, family members or friends, having healthy romances can have a positive impact on your lifestyle. Here are some of your benefits of healthier relationships:
1 . Increased Self-esteem
Having great self-esteem is usually associated with a large number of positive benefits, including better mental health insurance and a greater impression of health and wellness. Moreover, people who have high self-pride tend to have more healthy relationships and handle their physical health.
This is because people with healthy self-esteem do not let negative thoughts or feelings interfere with doing what they want to do. Fortunately they are more likely to try new things and pick themselves up whenever they fail.
However , you have to understand that self-pride is mostly a fluctuating strategy that can change from one day to the next. So , it’s important to keep working on your self-esteem if you discover it’s moving.
installment payments on your Reduced Pressure
One of the biggest benefits associated with healthy romantic relationships is that they help you cope with tension. Whether you’re feeling stressed by a job, caring for an aging relative, or going through a traumatic event, social support is important.
Possessing supportive romantic relationship can help decrease the risk of sadness and other mental health conditions, says Dr . Jennifer Gatchel, an assistant teacher of psychiatry at Harvard Medical College.
In fact , a single review found that individuals in long term romantic relationships who dreamed about their lovers while performing a stressful task acquired lower blood pressure than patients who did not. This is a result of how the mind interprets the energy of love and care through your partner.
3. Better Sleep
Sleeping well can easily improve lots of things in our lives, including each of our emotional well being and our ability to emphasis. It also assists us to remember new ideas and abilities better.
Healthier relationships are often times characterized by open communication and strong psychological connections, which in turn can improve the quality of sleep. Getting better sleep as well allows for more time to spend while using people who subject most within our lives, which often can bring about stronger you possess and deeper relationships.
In a examine that looked over 112 individuals, researchers uncovered that a confident romantic relationship during early adulthood correlated with less anxiety at age thirty-two and better sleep top quality at age 37. This is a good signal that positive romantic relationships can affect our rest quality over the years.
4. Much better Mental Health and wellbeing
Studies show that the healthy online social network increases people’s mental health and decreases their risk of poor physical health. If you have a close family member, good friends, or life partner, they can reveal important emotional support and help you manage the stress.
Strong interactions also enhance healthy behaviors, like consuming well, obtaining adequate sleeping, and staying away from unhealthy chemicals. These behaviors are critical to improving your general mental health and making it easier to cope with the strain of way of life.
As you improve your mental health, you may also observe that you are more patient on your own while others. You understand that others’ tendencies does not think about you, and you have more tolerance with yourself when you feel weighed down or caused by a thing.
a few. Increased Life Expectancy
Research has revealed that people so, who are involved in healthy and balanced relationships tend to live for a longer time. This is partially because having a close romance with somebody causes you to feel happier and more positive in your self, as well as providing much-needed emotional support.
This is especially the case for men. Studies have identified that married men are less more likely to suffer from feelings of solitude or remoteness, whereas unmarried men might experience higher levels of these types of negative emotions.
A meta-analysis of 148 prospective studies with average follow-up of seven. 5 years revealed that those that were interested in strong interpersonal relationships had a fifty percent lower risk of mortality than those who were not. This is comparable to the cutbacks in mortality from giving up smoking physical inactivity.

domain: medical


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Sri Prawin’s upcoming film Kaalicharan is in the last stage of post production. Chaitanya Krishna and Chandini are playing the lead roles in the film and Bhojpuri actor Pankaj Kesari is making his debut as a villian in Telugu. The film’s re-recording has been completed and rest of the post production work will be wrapped up soon. The film is set in the early 80s and it’s inspired from real incidents which occurred in Palamur region in Mahboobnagar district. The film’s intense visuals and action sequences are said to be the major highlights of the film. The entire crew shot the film under tough weather conditions with minimal resources. Sri Prawin has also produced the film. Nandan Raj has scored the music.
- Interesting update about Ranveer-Deepika wedding
- NTR’s career comes a full circle with RRR
- Anasuya’s on-location snap from Yatra shoot goes viral
- Thugs of Hindostan fails to pass the crucial Monday test
- Former star heroine keen on Tollywood comeback

domain: artistic


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Woman jumps off balcony to escape from friend who was raping herBy Mason White 2:26 PM March 20, 2015
By: Wayne Morin
A woman was hospitalized with several broken ribs after jumping off a balcony to escape from a rapist, police in the United Arab Emirates said.
Prosecutors told the Dubai Criminal Court, that the 21-year-old woman of the Philippines, was being raped by her friend, 28-year-old E. W. of Pakistan, before taking the opportunity to escape by jumping off the balcony.
According to the police investigation, the two went to his apartment to get some documents. At some point, the suspect excused himself, saying he needed to use the bathroom.
When he came out, he was completely naked, the woman told investigators. The suspect then threw her on a couch, sat on top of her and began kissing her against her will.
The woman asked for a glass of water, and when the suspect let her go to the kitchen, she ran out to the balcony and jumped. The woman fell unconscious, and she awoke in a hospital.
The woman suffered several broken ribs and bruises. The suspect was arrested and charged with rape. The suspect denied the allegations, saying that he had her consent.

domain: law


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BERLIN – New EU laws which would hold multi-nationals accountable for violations of human rights and environmental standards in their supply chains could be set to fail because of Germany. A letter by two German ministers – seen by Reuters news agency – suggests the German government would oppose Corporate Sustainability Due Diligence Directive (CSDDD). The Directive was only agreed by European Union Council and Parliament in December.
“In the Council of the European Union, this will result in Germany abstaining, which will have the effect of a ‘no’ vote,” reads a letter from Justice Minister Marco Buschmann and Finance Minister Christian Lindner, both FDP.
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The thrill of playing mobile slot machines with real money can be amplified. Real money mobile slots are available in a variety of formats. These are the most well-known. Choose your mobile platform carefully and select the best one for you. If you own an iPhone, make sure to get the most current version. Read on to discover more about your options. Find out which apps are compatible with Apple devices by studying the following. If you don’t own smartphones you can download the latest versions of your most-loved apps.
Casino slot game on their mobile devices should consider playing RealTime Gaming games. They have a range of video slots featuring great graphics and themes, including animal animation, horror, and even nature. These games have a wide variety of bonus features and their minimalist design makes them highly versatile. Some of these slot machines have jackpots that exceed 1000 times the amount bet. Casinos with multiple games and then pick the ones that interest them.
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Playtech mobile slot machines can bring you big wins if you love to win. Many of Playtech’s games are based on well-known TV and movie themes and offer an average layout of five reels and 3 rows. Movie-themed slots are among Playtech’s most cherished creations and new ones are being added constantly. The games are optimized for various Playtech gaming sites and offer thrilling surprises each time you play.
When playing Playtech mobile casino slots, you can enjoy the same thrill and excitement you experience when playing in a traditional casino. You can play for real money using special symbols, such as scatters or wilds. The variety of Playtech mobile casino slots allows players to play on their favorite devices. To attract new players, the companies offer incentives and welcome bonuses. You can also get no-deposit bonus offers and free spins.
NetEnt mobile casino slots are a great choice for those who enjoy playing slots. The games are optimized for mobile users. NetEnt slots are free to download and do not require registration unlike traditional casino slot machines. The most popular slot machines are Guns N Roses, Starburst and Jimi Hendrix. Moreover, players can also choose from a variety of bonus games that come with these games.
There are a variety of progressive jackpots available in NetEnt slot machines, and they grow each time a winning combo slot bonus bear is created. Some of the most well-known progressive jackpots are Mega Fortune, Hall of Gods, Arabian Nights, Meja Koker and Super Lucky Frog. These slots are very popular with gamblers due to their higher RTP and high-quality graphics. They’re also designed specifically for gamers using iOS and Android devices. You can select from a variety of themes and play options that will allow you to play with real money.
You’ll need to learn how to use Apple Pay if you have an Apple tablet or smartphone. To use Apple Pay, you’ll need to sign in with your fingerprint and password in order to make a deposit. Once you’ve completed a deposit it should appear in your balance in your account. If not, you’ll need to find a different method to transfer the balance. In addition, a decent Apple mobile casino can accept Bitcoin as a payment method.
First download the appropriate Apple mobile casino slots app. You can also play your favorite casino slots on your iPhone. The casino applications are designed specifically for Apple devices, making them compatible with the operating system. Apple mobile casino slots are designed with the most modern technology, making them more convenient to use than other mobile devices. They’re also compatible with a range of operating systems for mobile and operating systems, they’ll work flawlessly on any of them. There are a variety of compatible apps for Apple mobile casino slots.
If you’re a slot machine player, you’ve probably heard of mobile casino slots available for Android. The games have been created with the user’s convenience and smooth gameplay in mind. They’re also user-friendly and have sleek, simple designs. The best part is that mobile casino slots for Android offer free spins, which are useful when you want to test out new games while on the move. Find out more about some of the best mobile casino games available today.
Finn and the Swirly Spin This slot game compatible with Android features symbols that appear in a swirling fashion. They are located on the 5×5-square game board at the top of the board. The game is captivating and relaxing with its mysterious theme and glitzy graphics. It is compatible with HTML5 technology. The practice mode lets players to master the game of it before investing real money. So, mobile casino slots for Android are an excellent option to keep you entertained while playing your favourite casino games.

domain: entertainment


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Hines Global REIT has made an undisclosed investment in the upscale Galleria shopping center in Edina.
Hines envisions no changes in tenant mix or management staffing, according to Susan Evans, of Evans Larson in Minneapolis which handles PR for the Galleria.
“The stewardship of this shopping center in the last 40 years has been amazing, and we are thrilled to be involved with Warren Beck, the property team and the future of this beloved shopping center," Hines Director Sargent Johnson, said in a statment.
“Hines has been a part of the Twin Cities community for years, they have an excellent reputation and their team truly understands Galleria and the philosophy behind its four decades of success," said Warren Beck, owner of the Galleria.
"We are looking forward to working with Hines and continuing Galleria's commitment to local merchants, national and international tenants and, most importantly, meeting and exceeding the expectations of our shoppers and guests," Beck said.
The Westin Edina Galleria hotel and The Residences at the Westin Edina Galleria condos, which are owned separately, were not part of the deal.

domain: news


Arthur Lynch is getting ready for the NFL combine after five seasons at Georgia.
Ty Flournoy-Smith, who played in 2012 as a freshman, left after off-field trouble and signed with Alabama after a season at junior college.
Rising redshirt junior Jay Rome is coming off foot surgery.
Yes, the Bulldogs could use some more help at tight end, where redshirt freshman Jordan Davis is the only other scholarship tight end in the program.
“We felt like our tight end position was really a little scary with the depth there,” coach Mark Richt said.
Enter Jeb Blazevich and Hunter Atkinson, who Georgia signed Wednesday with an eye on bolstering the position this coming season.
“I’m just trying to fit the mold, just trying to do whatever they need me to do,” said Blazevich, out of Charlotte (N.C.) Christian High School. “Whatever I need to do to get on the field, I’m going to try to do it. Whether that’s more blocking or receiving or even going to defense or playing special teams. They’re not talking about defense. I’m just throwing that in. I’m just ready to fit whatever they need me to do because that’s the school and the coaching staff I want to do it for.”
Rivals.com jumped the 6-foot-5, 230-pound Blazevich from a No. 181 ranking to No. 79 after the Under Armour All-American game in Florida in early January. He’s Rivals’ No. 1 tight end nationally.
“We thought he was just an outside guy, a flex guy,” said Mike Farrell, Rivals’ national recruiting analyst. “His film was mostly just wide receiver stuff. When he got down to Under Armour, we saw him block in-line and he knocked the crap out of some kids. Andrew Trumbetti, who’s going to Notre Dame, especially, he owned him. I really, really liked that, plus he caught everything thrown his way and was a reliable sort of safety valve receiver. That’s crucial as a tight end. He can stretch the field, but he’s a guy who can also catch a poorly thrown ball or a ball thrown into traffic. He goes up to get it.”
Blazevich said he’ll outwork the other guy, can catch the ball and is getting better as a blocker.
“If the door’s open, the door’s open, I’m hungry for it,” Blazevich said. “I’m trying to do as much as I can as soon as I can. Keeping that in mind, I still have a lot to learn from these older guys. I’m excited to learn.”
Blazevich committed to Georgia last April and never wavered. He picked the Bulldogs over Clemson and Ole Miss, among others.
“I think he has the skill-set to do things on our offense that we’re going to ask him to do,” tight ends coach John Lilly said. “He’s been exposed to a lot in his high school program.”
The Bulldogs also landed the 6-5, 250-pound Atkinson from West Hall High School, who Georgia got to flip from Cincinnati on Tuesday night.
“We knew we had a battle with Georgia and we lost,” Bearcats coach Tommy Tuberville told The Associated Press.
Georgia called with a late offer to Atkinson at 5:30 p.m. Tuesday, on signing day eve, according to the Gainesville Times. So Atkinson became a surprise signee on Wednesday.
“He’s a guy we started watching tape on in the middle of the season that did a little bit of everything,” offensive coordinator Mike Bobo said of a player who had 51 catches for 704 yards and 11 touchdowns as a senior. “He lined up at receiver, he lined up at tight end, he lined up as a wildcat quarterback. He’s a big athlete. I really don’t know how big this guy’s going to become and what he’s going to become. Like I told him (Tuesday) night, we’re expecting you to come in and get ready to play. I believe he’s got a chance to do that, I believe he’s an SEC football player.”
The more the merrier for the Bulldogs at tight end now with two more.
“Both are great young men and very talented,” Richt said. “Both have good hands, and I think they’re both going to be very capable to learn what to do and earn some playing time. It’ll be fun to watch it.”
Follow Marc Weiszer online at twitter.com/marcweiszer.


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Lifestream Ultimate Greens is a unique combination of three nutrient-dense superfoods: Spirulina, Barley Grass and Chlorella that help boost your daily greens intake. When taken as part of a healthy diet made up of a variety of foods, this powerful blend provides a natural, highly concentrated source of nutrients including carotenoids, chlorophyll, vitamins, minerals, and antioxidants.
Certified Organic Barley Grass, Certified Organic Spirulina, Chlorella
Adults: 1 rounded teaspoon (3g) daily.
Children 6-12yrs: ½ teaspoon (1.5g) daily.
Add to juice, yoghurt or your favourite smoothie and mix well.