Is it just the internet that’s slow?īefore we get started, make sure an outside influence isn’t causing slow internet on your Mac. Keep reading to learn why your iMac is so slow, ways to speed up a MacBook Pro, and how to make your Mac run faster in general - no matter what model you have. Whether your iMac is slow, your Mac Pro needs a tuneup, your Macbook Pro is running slow, or you want your MacBook Pro to run faster, we can help.Īll the instructions below can help speed up these Mac models: ![]() While the specific instructions use a MacBook Air (Retina, 13-inch, 2020) as an example, the steps differ only slightly (if at all) from how to speed up an iMac, for example. The steps outlined below to speed up your Mac apply to all Mac devices. Solutions for MacBooks, Air, Mac mini & iMacs running slow Of course, those are just a few of the possible reasons why your Mac might be running slower than usual. To make sure a malware infection isn’t causing your Mac to slow to a crawl, regularly scan your Mac with a free malware-scanning tool like Avast Security for Mac. Though it’s unlikely, Macs can get viruses. The newest versions of your OS and apps usually run faster, include important security patches, and have fewer bugs that cause slowdowns. Regularly check that your operating system and all installed apps are updated. ![]() These processes use more resources and affect battery performance, too. But macOS is still full of visual effects that put a heavy burden on older Mac hardware. ![]() Throughout the years, Apple has eased up on the heavy graphics and visuals that used to attract users who prioritized strong graphics and design. This is especially true if a process you’re running is buggy or an app you’re using has already crashed. Here are some common reasons why your Mac is running slow:Īll Macs - even heavy duty MacBook Pros and iMacs - sometimes fail to notify you if a specific process is consuming excessive CPU or memory. If your Mac is new, it might be slow because you’re running too many background programs and apps or even have a malware infection. Your Mac might be slow because of an outdated operating system or a full hard disk - especially if you have an older model Mac. ![]() 22030831736 Logo Ameba Icon Security Icon Security White Icon Privacy Icon Performance Icon Privacy Icon Security Icon Performance Icons/45/01 Security/Other-Threats Icons / 32 / Bloatware removal Icons / 32 / Registry Cleaner Icons / 32 / CleanUp Icons / Feature / 32 / Mac Icons / 32 / Browser cleanup Icons/32/01 Security/Malware Icons/32/01 Security/Viruses Icons/32/01 Security/Other-Threats Icons/32/01 Security/phishing Icons/32/01 Security/Scams Icons/32/01 Security/hacking Icons/32/01 Security/Security-tips Icons/32/01 Privacy/Privacy-tips Icons/32/01 Performance/Software Icons/32/01 Privacy/Identity-Protection Icons/32/01 Privacy/Digital-life Icons/32/01 Performance/Performance-tips Icons/32/01 Security/Passwords Icons/32/01 Security/Ransomware Icons/32/01 Security/Business Icons/32/02 Privacy/Browser Icons/32/02 Privacy/IP adress Icons/32/02 Privacy/VPN Icons/32/02 Privacy/Proxy Icons/32/02 Privacy/Streaming Icons/32/03 Performance/Celaning Icons/32/03 Performance/Drivers Icons/32/03 Performance/Gaming Icons/32/03 Performance/Hardware Icons/32/03 Performance/Speed Icons / 32 / Bloatware removal Icons / 32 / Registry Cleaner Win Icons / 32 / CleanUp Icons / Feature / 32 / Mac Icons / 32 / Browser cleanup Icons/60/02 Privacy/02_Privacy Icons/60/01 Security/01_Security Icons/60/03 Performance/03_Performance Icons/45/01 Security/phishing Icons/45/01 Security/Scams Icons/45/01 Security/hacking Icons/45/01 Security/Security-tips Icons/45/01 Privacy/Privacy-tips Icons/45/01 Performance/Software Icons/45/01 Privacy/Identity-Protection Icons/45/01 Privacy/Digital-life Icons/45/01 Performance/Performance-tips Icons/80/01 Security/phishing Icons/80/01 Security/Scams Icons/80/01 Security/hacking Icons/80/01 Security/Security-tips Icons/80/01 Privacy/Privacy-tips Icons/80/01 Performance/Software Icons/80/01 Privacy/Identity-Protection Icons/80/01 Privacy/Digital-life Icons/80/01 Performance/Performance-tips Icons/80/01 Security/IoT Icons/80/01 Security/Malware Icons/80/01 Security/Passwords Icons/80/01 Security/Ransomware Icons/80/01 Security/Viruses Icons/80/01 Security/Other-Threats Icons/80/03 Security/Business Icons/80/02 Privacy/Browser Icons/80/02 Privacy/IP adress Icons/80/02 Privacy/VPN Icons/80/02 Privacy/Proxy Icons/80/02 Privacy/Streaming Icons/80/03 Performance/Celaning Icons/80/03 Performance/Drivers Icons/80/03 Performance/Gaming Icons/80/03 Performance/Hardware Icons/80/03 Performance/Speed Icons/80/03 Performance/03_Performance Icons/80/02 Privacy/02_Privacy
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![]() ![]() Lazily, luxuriating in a nameless roadside room instead of spending a glorious day at the prettiest lake in the U.S. I need a break but if I get a room, I will stay through late check-out. Courtesy Photo My First Experience Boondocking in a Walmart Parking LotĪt some point, I realize it’s late and I’m tired. Find a quiet corner of the Walmart parking lot for a few hours of sleep. Still looked like I was in the loneliest corner of the Pacific Northwest. Not worried yet, but the map looked a little lean on towns.Īfter driving for a few more hours, I saw a mountain lion. So I continued to drive and hoped for the best. I enjoyed a peaceful day exploring before I realized I was in an Oregon national forest without cell service. And I lost track of time and Timberline Lodge at Mt. Then the skies cleared and Mount Rainier National Park called my name. I dropped my kids off at the Seattle-Tacoma airport to attend a weeklong camp in California and I needed to get to Lake Tahoe fast. No lasting side effects from this experience. But unlike that camping trip 15 years ago where I got a cute, little souvenir 9 months later. I didn’t wake up in the morning and announce to the world, I’m boondocking today. Walmart provides replacement camping gear and everything I need for a classic cookout. As a national parks travel writer, I spend a lot of time in a rugged wilderness without much more than a dusty convenience store.Īfter driving across the lower 48 to explore the jewels of the continent, I see Walmart as a beacon of civilization with supplies beyond the basics of gas, ice and bread. So I’m sharing my miserable nights of pseudo-sleeping in the Walmart parking lots and pull-outs. Though I’m an adventurer at heart, especially when the kids aren’t looking. The it’s just for vacation excuse wins again.Īs a gingham-shirt wearing, PBS binge-watching and PTA-volunteering Mom, I look like the last person you would expect to roll out of the back seat of a SUV in a Walmart parking lot at 5:15 a.m. Next, the nutritious snacks loose the snack war and the kids grab all the sweet and salty snacks. And really, if the teachers aren’t there to smell them, does it matter that splashed around in the pool instead? I just can’t muster the energy to fight with my boys any longer. It’s exhausting and I’m over selling good behavior when June rolls around. ![]() It’s not fun being the good mom all the time. I’m a normal Mom who has driven across the lower 48 with her three kids. Summer road trips offer me the opportunity to relax. Read More Top 75 Road Trip Snacks 100 Household Items to Pack for a Road Trip 8 National Parks a Road Trip away from LA Who am I? I usually try to avoid the area though I was ferrying an RV from LAX to Reno and forgot it was the Sunday of Labor Day weekend. Then there was the time that I lost hours in LA traffic. I needed to get there fast so I pulled into a Walmart parking lot for a few hours. Then I got a week to work in peace at the location of my choice, Lake Tahoe. Places where kids can make smoke signals easier than find a Wifi signal.Īfter a spending nine weeks exploring the national parks of the West Coast alone with my three kids, I shipped them off to summer camp for a week. With all the talk about reconnecting as a family and decompressing while unplugging, I head to the most remote areas of the continent, like the national parks. From a handful of Walmart parking lots to road side pullouts, I have boondocked hear and there. It’s a holiday and you forgot that RV spots would sell out.įor me personally, I always have an itinerary though I am guity of the rest. It’s a drive day and you need to be on the road at first light. You’re tired and you need to stop and rest. Top 30 Things to do in Lake Tahoe during the Summer.3 Day Itinerary for Olympic National Park in Washington.Do’s and Don’ts for Walmart Boondocking.My First Experience Boondocking in a Walmart Parking Lot.8 National Parks a Road Trip away from LA.100 Household Items to Pack for a Road Trip. Scoop off some cream,sprinkle with sugar. Now after all that, i fondly remember my folks' dairy farm in New Zealand, and the ice cold jug of full cream milk always in the fridge, straight from the cows, and with a thick layer of cream settled on top. It's of much more benefit to get your calcium from a handful of nuts. The calcium in cow's milk is very difficult for humans to absorb because the molecules are too large for our systems. The supposedly great benefit was touted as the calcium that's in milk and will build up our young bones and make up healthy kids. Cow's milk was designed by nature for calves,not humans! ![]() It's all sales hype, and you have been conned since you were a kid. Re the above comment: Sound like an ad? That's the big con re milk that we are bought up with as children by the national and international conglomerates. If our modern diet and lifestyles are supposedly killing us, they're doing a pretty poor job of it. It was 68.1 years in 1950, and 51.5 a century ago. If you can tolerate skim milk but not whole milk, it sounds like your problem is something other than lactose intolerance.Īccording to recent information, the current life expectancy of the average American is 77.5 years. Lactose is sugar, not fat, so when the fat is removed, the percentage of lactose (and protein) in the remaining liquid is higher. Well, if you stress about everything you put in your mouth, is that helpful in living longer? Just my thoughts.ĭecember 13, #49: Skim milk contains more lactose than whole milk does. They say stress can kill you, along with other factors, of course. I think of it this way: you could be driving today and end up in an accident that isn't your fault, and die. We shouldn't consume soda, blah blah blah. He says he's been drinking mt dew for as long as he can remember. I was reading some of this and I believe eat what you want! I work in a hospital and met a man who was 100 years old and still lives on his own and takes care of himself. I take a regular size glass filled with Peach flavored Tea, just three quarter filled in the freezer in the morning.(x4)and just top it up with low cost skim. Am i right?Īnon #101371: I recently decided to drop alcohol consumption, at age 73, but still need a few drinks with the boys after work. I've been watering down semi skimmed milk, and not felt too good so I've gone back to semi-skimmed. How can we turn a tetra pack milk into skimmed milk? choosing the red top over the blue fundamentally makes no difference to anyone's life. Whole milk is great for most recipes, 1 or 2 percent for drinking, and skim milk is only good to be poured down the sink. A nice cold glass of even 1 or 2 percent is much more satisfying. Although cutting down on the amount of fat in your diet does help, the difference between skimmed and full cream milk you buy isn't huge, unless you used to drink 5-plus bottles of full cream milk per day. ![]() Only exercise will do that, in combination with a healthier diet overall. Semi or skimmed milk will not make you lose much weight at all. ![]() Yes, milk has its benefits, but as with everything, too much of anything can have a bad effect on the brain and body. Some people would hate the idea of buying and drinking human milk as an adult, but if someone wanted to drink any kind of milk all their lives, that would likely be the safest kind. Looking at the habit at a distance, it's actually quite a disgusting one. We should not drink cow's milk or eat products containing it (cheese, yogurt etc) all our lives. Drinking it all their lives is simply not necessary, and just like human breast milk, human beings only drink human milk for a limited time too. Why? Well, cow's milk is made from a cow, which is naturally only for cow calves, and even they don't drink it all their lives. Most other countries do not agree with cow's milk at all, or it just never caught on. Interestingly enough, only the US, UK and europe drink it. It's an odd habit as we are the only creatures to drink milk from another animal, but it has become so popular that we treat it as a normal habit, despite any hidden dangers, cancerous or otherwise (look it up). UHT milk has a far closer taste to a real cow's milk than bottled milk (if you drank it straight from the cow you would notice the difference-and someone must have at first before it became popular)! Most people do not like the true taste of cow's milk. Believe it or not, most of it is just water and artificially added content. The milk you buy in the store is barely milk at all. ![]()
![]() A card can be part of more than one meld, as long as it is a different type. Each player lays down his melds, face up on the table. Next, the melding phase begins, as described above. After his partner has passed him the four cards, he picks up the cards, re-evaluates his hand, and passes four cards back to his partner. Once the bid has been won, the player who has won the bid declares the trump suit and asks his partner for four cards (if he wishes). Bidding is always done in multiples of ten. If all three players pass, the last player (who is the dealer) has to take the bid at 250 points. If you cannot bid at least 250 points, or you cannot top the highest bid, you may pass. Or, you could bid somewhere in-between!īidding starts with the player on the dealer's left. If you're a risk-taker, use this number as a bid. Calculate how much you could score if your partner gave you four cards that perfectly completed your hand. ![]() If you win the bid, you can ask your partner for four cards. If you're conservative, use this number as a bid. Figure out how much you would score by melding and what you would (hopefully) score in trick-taking. ![]() If you have an Ace and several other strong cards in the same suit, that's a good place to start. When you look at your hand, first determine what you would declare as trump. Now that you understand how Pinochle is scored, let's go back to bidding. In addition, the team which wins the final "trick" scores another ten points, for a grand total of 250 points. ![]() Since there are a total of twelve Aces, Tens and Kings, this accounts for a total of 240 points which can be scored in the trick-taking phase. The Queen, Jack and Nine are worth zero points. When scoring points, the Ace, Ten and King are worth ten points. Therefore, a Nine of trump will beat an Ace in non-trump. A card in the trump suit beats any other card except for a higher card in the trump suit. The trump suit is declared by the person who won the bid. The Ace is most powerful, followed by the Ten, then King, Queen, Jack and Nine. The rank of cards in Pinochle is slightly different than most other card games. The next phase of Pinochle is trick-taking. Run with an Extra King and Queen: 230 pointsĭouble Run (both Aces, Tens, Kings, Queens and Jacks in trump): 1500 points Here is a list of how to score each meld: You can also meld a Double Pinochle, which is both Jacks of diamonds and both Queens of spades. The final way to meld is a Pinochle, which is the Jack of diamonds and the Queen of spades. The fourth way to meld is a Dix (pronounced deese), which is French for "ten." A Dix is simply the Nine of Trump, all by itself. If you have an extra King or Queen (or both) in trump, it's worth an extra forty points apiece when scoring the Run. Just like it sounds, a Run is an Ace, Ten, King, Queen and Jack all in the trump suit. A King and Queen in trump is worth more than a King and Queen out of trump-we'll talk more about trump in the trick-taking phase. A marriage is the King and Queen in the same suit. Tens Around and Nines Around are worth zero points. You can meld an Around in Aces, Kings, Queens and Jacks. If you have all eight Aces, you have Double Aces Around. For example, if you have an Ace in hearts, spades, diamonds and clubs, you have Aces Around. If you have four cards of the same rank in different suits, this is called an Around. In Pinochle, there are five ways to meld. If you've ever played rummy, you know how to meld. Melding means to lay down a specific combination of cards. However, in order to understand bidding, you need to have a basic understanding of the next two steps, which are melding and trick-taking, so we'll come back to bidding in just a bit. Every card is dealt, so each player should have twelve cards when the dealer is through. This person will shuffle the pinochle playing cards, allow the person on his right to cut the cards, then deal them to all four players. The double deck can also be used when playing with 4 players - just double the hand sizes, average scores and minimum bids. By combining two decks to form a Double Deck, however, you can involve five, six, eight, or even more players. Note, this standard game of Pinochle is played in a four-player partnership style, or two or three players individually. Your partner will be the person across the table from you. This is a four-player partner variation of Pinochle, so you'll need a 48-card Pinochle deck, which consists of the Aces, Tens, Kings, Queens, Jacks, and Nines from two decks of playing cards. Pinochle is a fast-paced, somewhat complex card game, but once you've learned it, you'll be hooked! There are many variations of Pinochle, but here's a standard one to get you started. ![]() ![]() Recosoft Corporation is the developer of PDF2Office®, the de-facto PDF-to-Excel, PDF-to-Word, PDF-to-PowerPoint conversion utility PDF2Office® for iWork, the only PDF-to-Keynote and PDF-to-Pages conversion application and PDF2ID, the PDF-to-InDesign conversion tool. For more information on Recosoft PDF converters, visit URL: The company is a leader in designing and delivering PDF converters and PDF file conversion software solutions enhancing workflow automation and productivity. PDF2Office, PDF2ID, PDFtoID are trademarks or registered trademarks of Recosoft Corporation in the United States and/or other countries. Microsoft, Excel, PowerPoint, Word and the Office logo are trademarks or registered trademarks of Microsoft Corporation in the United States and/or other countries. All other trademarks are recognized and are the property of their respective owners.Adobe and InDesign are either registered trademarks or trademarks of Adobe System Incorporated in the United States and/or other countries. Apple, Macintosh, macOS, Mac, Numbers, Keynote, Pages, iWork, iPod, iPhone, iOS, iPAD are either trademarks or registered trademarks of Apple, Inc. Adobe, InDesign, Illustrator and Creative Cloud are either registered trademarks or trademarks of Adobe System Incorporated in the US and/or other countries. Microsoft, Excel, PowerPoint, Word and the Office logo are trademarks or registered trademarks of Microsoft Corporation in the US and/or other countries. For more information on Recosoft PDF converters and InDesign or Illustrator related solutions, visit ĭecksMoveIn, PDF2Assets, IR2Office, ID2Office, PDF2Office, PDF2ID, PDFtoID are trademarks or registered trademarks of Recosoft Corporation in the US and/or other countries. The company is a leader in designing and delivering PDF converters, InDesign and Illustrator software solutions enhancing workflow automation and productivity for Creative Professionals. Recosoft Corporation has pioneered PDF2Office®, the de-facto PDF-to-Excel, PDF-to-Word, PDF-to-PowerPoint, PDF-to-OmniGraffle conversion utility PDF2Office® for iWork, the PDF-to-Keynote, PDF-to-Numbers and PDF-to-Pages conversion application IR2Office, the only Adobe Illustrator to PowerPoint and Apple Keynote tool ID2Office, the InDesign-to-Word, InDesign-to-PowerPoint converter and PDF2ID® the de-facto PDF-to-InDesign conversion tool. Hardware: Apple Silicon or Intel based MacĪpplication: Adobe InDesign (CC 2017 to 2023 releases) Minor stability changes have been made delivering a much more efficient PDF-to-InDesign conversion. Support for InDesign CC 2015 (v11.x) has been removed simplifying deployments. Deprecation of InDesign CC 2015 support.PDF2ID 2023 integrates with Adobe InDesign 2023 (InDesign CC 2017 through InDesign 2022 are supported as well).Įnhanced Graphics grouping controls, repeated image detection and reduction, and converting Softmask to a Drop Shadow property were introduced creating an even more efficient InDesign file. PDF2ID is the de-facto PDF converter for InDesign, allowing anyone to open, convert and edit PDF and XPS documents in InDesign eliminating the need to use or acquire other PDF and XPS conversion tools. PDF2ID converts PDF and Windows XPS files into fully editable InDesign files allowing PDF and XPS data recovery within InDesign. PDF2ID Professional 2023 will be available as part of the PDF2ID Professional Suite 2023 edition to be released at the end of November. At Adobe MAX 2022, we demonstrated PDF2ID 2023 supporting InDesign 2023 now, with the latest release, Creative Professionals are assured that their PDF-to-InDesign workflow remains uninterrupted - Paramjit Chadha, MD, Recosoft Corporation Post this The Jackson County States Attorney’s Office also assisted during the investigation. The investigation is being conducted as part of the Project Safe Neighborhoods DRAGUN Team Initiative, a cooperative effort of local, state, and federal law enforcement, and state and federal prosecuting authorities, aimed at ridding communities of illegal drugs and guns. ![]() The ongoing investigation is being conducted by the Jackson County Sheriff’s Office, Murphysboro Police Department, Union County Sheriff’s Office, and Drug Enforcement Administration. The offense carries a penalty of a term of imprisonment from 10 years to life, a fine of not more than $10 million, and a term of supervised release of at least 5 years. The conspiracy offense occurred between 2009 and April 6, 2011, in Jackson, Union, Randolph, and Williamson Counties. Phelps, 31, of Marion, are currently fugitives. Phelps, 39, of Grand Tower, and Geoffrey A. Stokes, 30, of Anna, recently appeared in federal court in Benton, Illinois, on the one-count second superseding indictment charging conspiracy to distribute more than 500 grams of methamphetamine. Denault, a/k/a “Frankie D.,” 33, of Ava, and Justin L. Davenport, 27, both of Murphysboro, Franklin S. Johnson, 35, all of Grand Tower, Joshua G. Williams, a/k/a “Spot,” 31, and Samantha A. Eleven southern Illinois residents were indicted on May 3, 2011, in a second superseding indictment, charging conspiracy to manufacture methamphetamine, the United States Attorney for the Southern District of Illinois, Stephen R. YELLOW FLAG POEMS / Arts Alive San Antonio They have also lived in Burlingame, CA and San Jose, CA. The third result is Leslie Moriah Phelps age 30s in San Mateo, CA in the San Mateo Village neighborhood. Select this result to view Leslie Heinz Phelpss phone number, address, and more. Eddie Vega, editor / ASINA IS HOW WE TALK / Flower Song Press Leslie is related to Kyle Michael Phelps and Kathryn Marie Smith as well as 3 additional people.Ellis Phelps, editor / WOODLANDS: NATURE-MAGIC-MYSTERY-MYTH / Moon Shadow Sanctuary Press ![]()
![]() If you would like to print your music without changing the. ![]() Here are the beginner kalimba tabs and an easy to follow video tutorial for simple song arrangements from Spirited Away, Howl’s moving castle, My Neighbor Totoro, Whispers of the Heart and Kiki’s Delivery Service. To print your KTabS music, first open the music file you wish to print. Basically, we help you get the most out of your relationship with your kalimba. We explore, share, and sell the endless possibilities of kalimbas, exotic kalimba tunings, kalimba tablature, books, ebooks & downloads, videos, and songs. Your KalimbaGo will show you the tabs and you can follow them to. Using our Online Tabs Player, you can adjust the playback speed without distortion. Download the tabs to your KalimbaGo (if you have one) to enjoy playing new music. Listen to the converted music in our Online Tabs Player. Accompanied with percussion instruments mostly, Kalimba was born in Africa but later found its charm spreading to the different nooks and crannies. Convert any Kalimba (and potentially other) music to tabs. Hailing from the plucked idiophone and llamelophone family, this wooden instrument sounds like a chime mesmerising each and every hearer. The bright blessed day, the dark sacred nightLearn how to play famous original sound tracks of Studio Ghibli films on the kalimba. Kalimba Magic is a world-wide creator and distributor of all things kalimba. Kalimba is an exotic instrument which is a wonder in itself. Symptoms include: Whether you have printed music sheets, or music in PDF. When your confident, play along with me.Īnd I think to my self, what a won-der-ful world. Free sheet music for Kalimba Download PDF or print on Musescore. ![]() It has been covered by various artists but we think that Louis Armstrong's version is the best. His voice brings out the emotion of the lyrics and when played on the kalimba, this song becomes even more chilled. For reference, here is a video of me playing the song on a coconut thumb piano so that you can hear what the track sounds like. Lost Woods (Saria’s Song) Zelda OST 46.2k views posted on February 10, 2020. ![]() Tangled I See the Light 46.3k views posted on April 18, 2020. Fly Me To The Moon By Frank Sinatra Kalimba Tab 46.6k views posted on December 26, 2019. About Press Copyright Contact us Creators Advertise Developers Terms Privacy Policy & Safety How YouTube works Test new features NFL Sunday Ticket Press Copyright. You can download all music sheets in PDF format for free. At my worst Pink Sweat 47.1k views posted on September 11, 2020. Originally recorded in 1967, this song is evergreen and still finds it's way into modern films such as the Disney hit 'Finding Dory'.Need sheet music for kalimba We share free sheet music of the most popular and loved songs for you.This calming song by Louis Armstrong has such a positive sentiment about the wonderful world that we live in. Luckily through the right treatment, men suffering from this type of PE have a good chance of improving or even resolving their condition. However, men who have primary ejaculation who have suffered from the problem since becoming sexually active may likely be long-lasting. In many instances, premature ejaculation tends to get better on its own over time. Premature ejaculation is a natural result of overexcitement and over stimulation which is unlikely to be a permanent problem. When Does Premature Ejaculation Usually Occur?įor many men, premature ejaculation is a normal part of either entering a new sexual relationship or engaging in a new sexual activity. It may be related to psychological factors, certain sexual situations, or even medical causes such as an imbalance in hormones. Many cases of premature ejaculation have no clear cause. PE is ejaculation that cannot be controlled either before or shortly after sexual intercourse. Let’s start with what premature ejaculation, or PE, is. Keep reading to learn more about the timeline of premature ejaculation and whether you will experience it forever. Though chronic problems seem neverending, there is therapy available for you to manage or even end your suffering. Have you ever had a problem that just seemed to go on and on.
![]() Curative hepatectomy was defined as complete resection of all microscopic and macroscopic HCC tumors with microscopically clear resection margins in the surgical specimens (R0 resection). Patients with HCC who underwent partial hepatectomy with curative intent from January 2009 to December 2016 at four Chinese medical centers (Southwest Hospital, Zhejiang Provincial People’s Hospital, Eastern Hepatobiliary Surgery Hospital, and Chongqing University Cancer Hospital) were identified, and their clinical data were retrospectively analyzed. ![]() 27, 29īased on a multicenter database with more than 10 years of follow-up, the present study aimed to identify whether preoperative albumin-to-globulin ratio independently predicted long-term overall survival and recurrence-free survival outcomes in patients with HCC after partial hepatectomy with curative-intent. 27 – 29 Furthermore, two of these studies only performed prognostic analyses on overall survival but not on recurrence-free survival. 24 – 26 The correlation between preoperative albumin-to-globulin ratio with long-term prognosis in patients treated with hepatectomy for HCC has only been reported in 3 single-center studies with small sample sizes. 10, 11 Moreover, the albumin-to-globulin ratio has also been demonstrated to correlate with prognosis of patients with various diseases, especially with malignant tumors such as colorectal cancer, 12 – 14 urothelial carcinoma, 15 – 19 gastric cancer, 20 – 23 and lung cancer. An inversed albumin-to-globulin ratio (IAGR, <1.0) is often found in patients with severe inflammatory liver diseases or cirrhosis. Underproduction of albumin or overproduction of globulin leads to decrease of the albumin-to-globulin ratio. 9 The normal threshold value of the albumin-to-globulin ratio is 1.0 to 2.0. 8 A surrogate index by combining albumin with globulin to form the albumin-to-globulin ratio is often used clinically to access liver function. A high level of globulin (normal range 20~35 g/L) indicates immune system overactivity, which is often found in patients with chronic inflammatory diseases such as chronic hepatitis. 7, 8 A low serum level of albumin (normal range 35–50 g/L) reflects either poor nutritional status of the patient or poor synthetic function of the liver. Liver function tests used in clinical practice routinely include serum albumin, globulin, bilirubin and transaminases levels. 5, 6 A better understanding of perioperative risk factors associated with tumor recurrence and long-term survival helps in surgical decision-making, although whether adjuvant therapy can improve long-term oncological prognosis following hepatectomy for HCC is still debatable. 4, 5 Most studies reported 5-year HCC recurrence rates of 60% to 70% after curative resection. 2, 3 However, a high post-hepatectomy tumor recurrence rate limits the long-term prognosis. 1 Hepatectomy is the first-line treatment aiming at cure in selected patients. Hepatocellular carcinoma (HCC) has high morbidity and poor survival rates all over the world. |
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