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Customer Reviews
This has changed my life!
39 people found the following review helpful
Posted by Reviewer2409026 From California on Mar 11, 2008
Purchased at iHerb
My left knee was injured years ago due to a fall on a stairway. Since then I have been diagnosed with severe arthritis, and have been told by a knee specialist that soon I will be needing a knee replacement. (Something I do NOT want to have to do!) My knee problems have caused me much pain, has made it very difficult to walk, and has curtailed my sport of choice, surfing, for several months. After taking this Now Foods Hyaluronic Acid for two weeks I am ready to get back in the water. My pain is down to minor twinges, if at all, and I feel great! My MD recommended this supplement to me, and a friend told me about IHerb.com. I would encourage anyone dealing with arthritis problems to give this a try. I have been praying for a miracle and I truly feel that I have experienced one. And part of that has come from using this great product!!
Joan LaFontaine
35 people found the following review helpful
Posted by Reviewer2778415 From Florida on Jan 29, 2009
Purchased at iHerb
Nothing adds to the maintenance of well-balanced, moisturized skin like Hyaluronic Acid, the main factor in all the "fillers" so popular with dermatologists and plastic surgeons today. I've been taking this capsule for several years, and, well over 60, I can profess not one wrinkle on my face! Of course I'm genetically predisposed to good skin -- but no one in my family has ever maintained a wrinkle-free complexion after age 65! I teach makeup and skin care, and the first words I write on the blackboard in Class Number One -- "Hyaluronic Acid," every day! Priceless!
The most incredible wrinkle remover & lip plumper ever!
21 people found the following review helpful
Posted by PurplePegasus From California on Nov 28, 2012
Purchased at iHerb
This product it's so amazing I got results from 1 cap but refrained myself from reviewing by fear it would sell out! Now that I've stocked up I can say this does what pycnogenol promises but failed to deliver. I took one cap before bed and woke up with not only no skin depressions at the naso-labial folds but this one line under my eye was gone! The effects are temporary but might be cumulative, too soon to tell. However a word of warning: I woke up with what appeared to be huge lips! The effect thankfully calmed down a bit after the first 3 days. (It would appear to increase circulation to lips, as when I take these, my lips are never chapped). I was born with huge lips and don't want their size to increase, however this continues to plump them up. In order to avoid this, I started breaking up a cap into an empty gel cap & taking 2 pills divided into 4 per day. Then I no longer woke up with huge lips. I have no naso-labial lines but lately, since I've been unable to sleep more than 4 hrs at a time, I'd wake up with depressions with would vanish within hours. If I take this before bed, I no longer wake up with them. The fine line under my eye comes back so I plan on taking 3 or 4 of these per day and see what happens but I'm afraid I'll wake up with my top lip covering my eyes LOL! But really, this is the most incredible beauty product ever that trumps all wrinkle creams and, I'm sure, any lip plumpers. Best to spend money to take care of my insides, and the outsides will also be taken care of. The reverse is never true.
This stuff seems to be working!
19 people found the following review helpful
Posted by Reviewer3155009 From Canada on Jun 28, 2009
Purchased at iHerb
Had a bad knee all my adult life - and my wife also had arthritis in her knees. We both started using glucosimin/chondroitin a few years ago and it made a noticeable difference for both of us. But about 6 months ago my bad knee suddenly started to hurt so badly that I couldn't commute to work. I began taking powerful pain killers and worked at home so that I could rest it - but nothing helped. After 3 doctors and dozens of MRI's, none had a clear solution - the problem wasn't deemed "operable". My wife and I both started taking Now Foods Hyaluronic Acid, Double Strength, 100 mg, 60 Vcaps twice daily about a 6 weeks ago. My knee completely STOPPED HURTING - and my wife reports similar results. Amazing!
Multiple benefits ! And NOT from animal source.
17 people found the following review helpful
Posted by ShaktiSophia on Aug 27, 2012
Purchased at iHerb
I took 1 bottle of this mostly to improve skin moisture, with some success. But I keep noticing other benefits : I just remembered today how badly my feet used to ache whenever I would go hiking or just take a walk (I have a bad allux valgus on each foot, due to years of walking a lot with high heels)- this no longer happens, I haven't even thought of it since I've been taking this supplement (the joint hasn't recovered a normal shape though, it just feels lubricated). Recently hearing some people's knees clicking, I suddenly remembered that I used to be like that - it just hardly ever happens to me anymore, at least not in a way that's audible to others around me. It looks like I am totally forgetting some pains that used to be an inherent part of my life, and which I didn't expect to get rid of! I'd rather use some vegetal hyaluronic acid, but at least Now Foods Hyaluronic Acid is from microbial fermentation as opposed to some other brands that sell HA from chicken cartilage. Its molecular weight is 1 million daltons, i.e. not too large, so it can be absorbed.


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text: Hot Doggonit! If you ever get to visit Vancouver.. You must tryout their specialty hot dogs. It is the best hot dog I have ever eaten, better than the Nathan's franchise here in the US. Although, their better specialty is the "Japadog" stand… Which I should have tried and I didn't find out about it after I have returned back to the states. =(


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Field & Stream 8.25 Inch Tracker Folding Knife with Pouch
Play Video
Be sure to select a color, size and quantity below
Item # 13004718
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Product Details
Field & Stream® knives are field tested and combine stylish looks with an ergonomic design. This 8.25" tracker folding knife features a 440 stainless steel blade and rubber-coated ABS handle; a nylon pouch is included.Features
- Officially licensed Field & Stream® product
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- Blade Length: 3.5"
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- Nylon pouch included


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Looks like it's time for a "BIG" showdown!!!
Thanks everyone, looking forward to another season. In the interest of personal safety I won't share which team is actually #1 on my list because if anyone here is old enough to remember hockey in 1993 won't likely think too much of me.
I have really liked LA since about 2-3 after Gretzky arrived there. They are a great looking team this year that should improve over last season's excellent results.
Enjoy the game this evening I'll be taking in a different contest tonight.


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Nickles Old Fashioned Potato Dinner Rolls (14 oz)
- Found In: Bread and Flour Products » Rolls
- Brand: Nickles
- Manufactured by: Alfred Nickles Bakery
Ingredients ():
Wheat Flour Enriched (Wheat Flour, Niacin, Iron, Thiamine Mononitrate (Vitamin B1), Riboflavin (Vitamin B2)) , Potato(es) Flour, Soybean(s) Oil, Sugar, Yeast, Contains 2% or less of the Following: ( Salt, Dough Conditioner(s) (Mono and Diglycerides, Sodium Stearoyl Lactylate) , Calcium Propionate (To Retard Spoilage) , Yeast Nutrients (Ammonium Chloride, Calcium Sulphate (Sulfate), Calcium Sulphate (Sulfate)) , Flavor(s) Artificial, Leavening Agent (Sodium Acid Pyrophosphate, Baking Soda) , Barley Malt, Vinegar
Members, please sign in to view which ingredients are on your personalized "avoid" list.
Soybeans Oil is exempt from being labeled as a soy allergen according to U.S. labeling laws. There are only slight traces of the soy protein present to trigger a reaction, however people who are allergic to soy should use caution and check with their allergist before consuming this product.
Nutrition Facts
- Serving Size: 1 Roll
- Servings Per Container: 12.0
- Amount Per Serving
- Calories 82.0Calories from Fat 12.0
- Total Calories 984Total Calories from Fat 144
- % Daily Value* (DV)Recommended DV
Total Fat 1.0 g 2%65 g
- Saturated Fat 0.0 g0%20 g
- Trans Fat 0.0 g
- Cholesterol 5.0 mg2%300 mg
- Sodium 177.0 mg7%2,400 mg
- Potassium 0 mg0%3,500 mg
- Total Carbohydrate 16.0 g 5%300 g
- Protein 2.0 g
- Vitamin A 0.0%
- Vitamin C 0.0%
- Calcium 2.0%
- Folic Acid 2.0%
- Iron 0.0%
- Riboflavin 2.0%
- Thiamin 2.0%
* Percent Daily Values are based on a 2,000 calorie diet. Your daily vailues may be higher or lower depending on your calorie needs.
Weight Watchers PointsPlus® Value* = 2
*Weight Watchers® and Points® are registered trademarks of Weight Watchers International, Inc. The number of Points provided here were calculated by Food Facts, Inc. based on published Weight Watchers International, Inc. information and do not imply sponsorship or endorsement of such number of Points, Food Facts, Inc., or the above product by Weight Watchers International, Inc.
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EMC Pre-compliance Test Systems
EMC Pre-compliance Test Systems
Accelerate your pre-compliance testing with G-CELL and G-TEM based systems
Electromagnetic compatibility (EMC) measurements made in accordance with the international CISPR16 standard require the use of an open area test site (OATS) or anechoic chamber. The provision of these facilities can involve significant investments in both time and cost.
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The systems can be used with a range of Agilent Technologies spectrum analyzers, including the N9320B 9 kHz to 3 GHz RF spectrum analyzer. With TOYO's G-TEM cell and G-CELL EMC pre-compliance test systems and Agilent's spectrum analyzers you can simplify and accelerate your product development process.
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Style: 737270F GRD
Boys' Toddler Converse Chuck Taylor Super High Casual Shoes
The Converse Chuck Taylor Super High Casual Shoes are the classic, all-American shoes that look just as good as they feel on tiny feet. Combining durability and style, these sneakers are sure to carry your little one wherever he wants to go.
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This cleansing green tea and ginger foam kills 99.9% of germs. Refill for no-touch dispenser.
Active Ingredients
Benzethonium Chloride (0.13% Antiseptic)
Inactive Ingredients
Water, Cetrimonium Chloride, Lauramine Oxide, Glycerin, Lauramide DEA, Polythylene glycol distearate, Fragrance, Citric Acid, Tetrasodium EDTA, Benzophenone 4, DI-PPG-2Myreth-10 Adipate, Methychloroisothiazolinone, Green 5, Yellow 5, Orange 4
Store at room temperature
For External use only
Stop use and ask a doctor if irritation or redness developsKeep Out of reach of Children. If swallowed, get medical help or contact a Poison Center right away.
STORE FEATURES: We stock and ship Genuine, new and manufacturer direct products.


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CHURCH OF GODFaithful FlockPO Box 8819Modesto, CA firstname.lastname@example.com
E-Mail us at: email@example.com
(Exod 20:8) Give simple proof that the Sabbath is to be kept.
* From this we see that the Sabbath was made for man at the time man was made, that it was given before Israel was given the Ten Commandments, it is one of the Ten Commandments, Jesus kept it, Paul kept it, and it will be kept in the Millennium when
© Church of God, Faithful Flock For questions or comments about us send to email@example.com
Use of the material in this website is restricted to those engaged in nonprofit instructional, research, or scholarly activities for educational purposes only. Click Here to view the full Usage Agreement. "Some of the Material in this Website is Copyrighted by the Owners of the Copyright therein. No Commercial Use of any of the Materials in this website may be used without the express written permission of the Copyright Owners."
Or if you have questions about this website , please contact our web administrator


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Sercotel Togumar
Our apartments in Madrid aim to create a comfortable setting that will make you feel right at home. The studio apartments have heating, air conditioning, a kitchen and free WiFi internet, all in a building with a very functional design.


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Morning 5
5 places to visit in Connecticut
|- Visitors can hike up the side of the ridge of Kent Falls, which, millions of years ago, was part of an area once made of coral reefs. Republican-American
Connecticut's tourist industry is coming back despite possible budget cuts. Here are five destinations recommended by www.ctvisit.com:
1) Haight-Brown Vineyard — The state's first established winery off Route 118 in Litchfield.
Read more of this story and more!
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Arena Wednesday 11 December 2013
On Thursday's Programme Reviews of the films The Hobbit - The Desolation of Smaug, Far Out Isn't Far Enough and The Patience Stone and Christine Dwyer Hickey on her new book The House on Parkgate Street and Other Dublin Stories. The book 'New Planet Cabaret' was launched on Friday November 22nd at The Gutter Bookshop on Cow's Lane in Dublin. The book is the result of Arena's on-air Creative Writing Course which ran from December 2012 to June 2013. The Publishers are New Island Books and the Editor is Dave Lordan, who also co-ordinated the course. All proceeds from the ...http://www.rte.ie/radio1/arena/programmes/2013/1211/492315-arena-wednesday-11-december-2013/


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Casting Crowns Tickets
Originally from Daytona Beach, Florida the Christian Rock band Casting Crowns has been together since '99. They received a Grammy Award for their 2006 album, "Lifesong." Now Casting Crowns is back on the road and GoTickets has tickets to all of their upcoming shows. Order your Casting Crowns tickets today to see them live in a city near you.
Casting Crowns Tour Dates and Schedule
Saturday, 7:00 PM
Spring, TX
Thursday, 7:00 PM
Grand Rapids, MI
Friday, 7:00 PM
Columbus, OH
Friday, 8:00 PM
Dayton, OH
Saturday, 7:30 PM
Valparaiso, IN
Friday, 7:00 PM
Phoenix, AZ


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A Shattered Image
Teaching Series by R.C. Sproul
When God created the world, He said, "It is very good." What happened? How did we make a mess of what started out perfect? How did we stray so far from God? How can people do great things yet at … Learn MoreCD $24.00 $21.60 Add to Cart
Also available in two other formats
Training Hearts, Teaching Minds
Book by Starr Meade
Teaching the Shorter Catechism has never been easier. This book of daily readings . . aids memorization by devoting six days per question, explains the catechism in simple language, provides six different meditations on the main points of each question. … Learn MorePaperback $15.00 $12.00 Add to Cart
The Bride of Christ
Teaching Series by R.C. Sproul
In this series, Dr. R.C. Sproul provides an overview of ecclesiology, the doctrine of the Church. Dr. Sproul explains how the truth of Scripture is the basis for Church unity and discusses the marks of a biblical Church. Learn MoreCD $31.00 $27.90 Add to Cart
Also available in two other formats
A God Entranced Vision of All Things: The Legacy of Jonathan Edwards
Book by Various Authors
This collection of ten essays, put together in honor of Jonathan Edwards' 300th birthday, celebrates the contributions of Edwards to our understanding of God, salvation, the church, the family, and other topics. Contributors include Mark Dever, Paul Helm, J.I. Packer, … Learn MorePaperback $19.00 $15.20 Add to Cart
Understanding the Gospel
Teaching Series by R.C. Sproul
It is very common in our society to hear people claim to be proclaiming the Gospel. Unfortunately, many do not preach a complete or even correct understanding of the person of Christ and the work He has done to save … Learn MoreCD $31.00 $27.90 Add to Cart
Also available in one other format
The Bondage of the Will
Book by Martin Luther
The Bondage of the Will is fundamental to an understanding of the primary doctrines of the Reformation. In these pages, Luther gives extensive treatment to what he saw as the heart of the gospel. Free will was no academic question … Learn MorePaperback $20.00 $16.00 Add to Cart
Book by Francis Turretin
The issue of justification has long been regarded as "the issue on which the church stands or falls." Indeed it is, for if the church does not properly understand or preach the Gospel of salvation, then she ceases to be … Learn MorePaperback - out of stock $15.00 $12.00 Backorder
God Alone
Teaching Series by R.C. Sproul
Ten 23-Minute Messages. In opposition to churchmen who argued that man is made righteous by faith and works, the Protestant Reformers fearlessly preached that by faith alone God's people are justified. With devotion to Scripture above all else, Martin Luther, … Learn MoreDVD $50.00 $45.00 Add to Cart
Also available in three other formats
Teaching Series by R.C. Sproul
In today's culture, many people do not want to hear about hell. Even in many churches, hell has been forgotten. In this series, Dr. R.C. Sproul teaches on the Biblical doctrine of hell, explaining that our understanding of hell is … Learn MoreCD $17.00 $15.30 Add to Cart
Also available in two other formats
Triumph of the Lamb: A Commentary on Revelation
Book by Dennis Johnson
The book of Revelation is an unveiling, a vivid disclosure of invisible realities. Yet its bizarre imagery often leaves us puzzled. Dennis E. Johnson deftly guides us through questions about how to interpret Revelation, what it meant to its original … Learn MoreHardcover $25.00 $20.00 Add to Cart
Highlights From Romans
Teaching Series by R.C. Sproul
R.C. Sproul provides an overview of the book of Romans and explains Paul's teaching about God's law, man's sin, and God's wrath. He shows how we are saved not by our own righteousness but by Christ's atonement for our sins … Learn MoreCD $45.00 $40.50 Add to Cart
Also available in one other format
What Is Reformed Theology?
Teaching Series by R.C. Sproul
Twelve 23-Minute Messages. Over 4 Hours of Teaching. You've heard of Reformed theology, but you're not certain what it is. Some references to it have been positive, some negative. It appears to be important, and you'd like to know more … Learn MoreDVD $60.00 $54.00 Add to Cart
Also available in three other formats
Faith Alone: 2003 Washington D.C. Conference
Conference Messages by Various Authors
In this series of messages from Ligonier's 2003 conference series in Washington D.C., Dr. R.C. Sproul and Rev. Kenneth Jones explore the biblical doctrine of sola fide, or "Faith Alone." Reminding us that this is the doctrine upon which the … Learn MoreCD $38.00 $34.20 Add to Cart
Also available in one other format


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2008 1 oz Silver Canadian Maple Leaf - Lunar RAT Privy
We provide all our customers with a refund, return and/or exchange policy on everything we sell including all bullion and certified coins. If for any reason you have a problem, please feel free to call our offices. We will always do our best to accommodate you.
|Bid: $19.50
|Ask: $19.60
Volume Pricing
When More Come In
Quantity Notification
Product Description
This coin has a mintage of only 8,000, making it very hard to find. The reverse displays a detailed depiction of a single maple leaf. To the left of the maple leaf's stem is a privy mark of a rat. This is a collector's item and would make a great gift for someone born during the Chinese Year of the Rat - 1912, 1924, 1936, 1948, 1960, 1972, 1984, 1996 and 2008.
Sealed in original plastic from the mint!
People born in the Year of the Rat are noted for their charm and attraction for the opposite sex. They work hard to achieve their goals, acquire possessions and are likely to be perfectionists. They are thrifty with money. Rat people are easily angered and love to gossip. Their ambitions are big, and they are usually very successful. They are most compatible with people born in the years of the Dragon, Monkey and Ox.
Buy Silver coins to add to your Silver collection or Silver investment portfolio. APMEX makes it easy to buy Silver by offering competitive Silver prices on all Silver bullion coins.
Since we may have more than one of these coin(s) in stock, you should use this stock photograph as an indicator of the quality of the coin(s) you will receive. Be assured, you will receive the exact date, grade, mint mark and grading service you order whether raw or certified. Our coin(s) will not have toning unless otherwise noted.
APMEX stands behind every coin it sells with a satisfaction guarantee.
Product Specifications
|Product ID:
|Brilliant Uncirculated
|38 mm
|3.29 mm
|Inner Pack:
|Outer Pack:


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Nashville-Davidson metropolitan government (balance) >Beauty > Coiffure Studio Incorporated
2611 Lebanon Pike, Nashville, TN | Directions 3721436.169464 -86.675118
Tue 10am-6:30pm
Wed 9am-6pm
Thu 9am-5:30pm
Fri 9am-4:30pm; Sat 8am-3:30pm
Over 50 Years of Perfection and Customer Satisfaction – Ladies and Gentlemen if you haven't found this salon yet YOU MUST MAKE AN APPOINTMENT NOW !!!!
Teresa is an amazing artist in hair design. When you are in her chair your head is a blank canvas that she is creating a beautiful framed painting that belongs on a museum wall. Every piece of hair will be the right color and in the proper place before you are ready to leave the salon. You will be in awe that your hair can actually look so fabulous.
Good to be home....I relocated to Houston, TX for about a year and have just come home. The first thing I did was book with Roberta to get my hair done. I tried a couple of people in Houston and had no luck. It was so good to have her style me up. She has a great touch and a comfortable way about her. She always knows what I want....and gives a great head message with her shampoo...Thanks Roberta...Your the best....Also loving the atmosphere and the welcome wagon when I come in. I recommend Coiffures above any other......
Friendly and Professional – After shopping around to the many salons around the Nashville area I found Coiffure. I have found the women there to be friendly and professional. Roberta, who does facials, does an amazing job of relaxing you, besides just making you radiant. Angela, who cuts my hair, is very professional and talented even with my problematic hair. I really enjoy getting beautified at Coiffures. A great no calorie treat!
Great Find!
By lmeade08 - Jul 6, 2010
I was very anxious about finding a good hairstylist when I moved to Nashville two years ago, so a friend of mine recommended Teresa, the owner, at Coiffures. Teresa's friendly, professional, knowledgeable, and artistic ability quickly put me at ease. I must say, both my husband and I are delighted with the new haircut, style and highlights she has created for me. She has, undoubtedly, proven to be an excellent choice. Her friendly and professional staff, as well, always makes me feel welcomed and comfortable and I always look forward to my next visit.
Execellent job Cheryl! – I just recently tried Coiffure for the first time for color and a new haircut. I went in with an idea and Cheryl suggested that I try a new color and cut to give me a more trendy look.I absolutely loved the look I left with. I am going from college into a real job. Cheryl and the staff at Coiffure's made me feel very welcome and I will be back!
Best In Town! – I am so HAPPY I found Ellen at Coiffure's. I have frizzy difficult hair and Ellen has mastered how to deal with it so I am not constantly embarrassed. Ellen is not only a fantastic stylist, but she is so attentive and caring. She always asks what I want and she actually listens. My husband has started going to her also and he said that it is the BEST HAIRCUT he can remember getting. From Ellen's cuts and colors to Angela's pedicures and Cheryl's waxing to Joan & Kendra at the reception desk - it is a JOY to go to Coiffures. Coiffure Salon is the BEST IN TOWN!
Wonderful Experience – I continue to have a wonderful experience every time I visit Coiffures. Everyone here is wonderful. My stylist always does a great job.
Family Friendly Salon – I had long hair and decided to get it cut short. It came out wonderfully. I was so pleased with everything. Everyone at the salon was so sweet. They had cookies and coffee and walked around sharing recipes with everyone. Coiffure's is very family friendly and cozy.
Coiffures is Fantastic – I have been going to Coiffures since the 60?s. This salon has always been first rate with wonderful management & stylist. They are always up to date with styles & products. This salon has a wonderful atmosphere; cheerful & very friendly. Your always greeted with a smile and everyone knows your name. I have sent a number of people to Coiffures and they were very pleased. When I am sold on something, I let people know.
I have had a number of hairstylists thru the years. Sharon is my present stylist. She is wonderful! She can do everything that I need, color, cut, and style. She always listens to me and therefore, we are on the same page. We share ideas and thoughts (personal and business). Sharon is a very talented stylist & has been in the business for years. She keeps up on the styles and always has good ideas. She is a good person and I love her dearly.
The smiles and hellos always come, especially from the front desk. Kendra and Joan are great. Kendra has been with Coiffures for eleven years. They know their job well and keep things rolling along.
I am a weekly client, but feel a part of the Coiffure family. From the management to the newest person on board, these people are wonderful and care about each other. If anyone is looking for a good place to get a number of services, with great professional people, please look no further?.. Coiffures Is The Place
More than Satisfied – I have always been happy with my visits to Coiffure Studio and look forward to my next appointment. I know that I can go to Coiffures and get the very best of services in a clean and friendly salon. The hair stylist really enjoy their jobs and always try to more than satisfy their customers, even the ones that you can tell when they walk in the door are in a grumpy mood. My favorite hairstylist is Roberta. Roberta has always gone the extra mile for me and does excellent work with my curly hair.
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Ivory linen with celery embroidering and an upholstered scalloped-back silhouette. Loose seat cushion with a pair of bolsters and lumbar cushions.Hand-carved hardwood legs with serpentine stretcher.
For 20 years, gallery owner and decorative-arts historian Liz O'Brien has been discovering the "new" old names in 20th-century American design, introducing the works of Samuel Marx, William Haines, and Karl Springer to the latest generation of trendsetters. Her distinctive point of view is guided by a passionate interest in the history of design and decoration. She wrote two books on Samuel Marx, Samuel Marx: Furniture and Decorations (1996) and Ultramodern (2007).
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For Ghislaine Lydon, 2006 was the year of travel.
For Ghislaine Lydon, 2006 was the year of travel. It started with her participation in the annual conference of the American History Association in
Lydon quickly returned to the
In November 2006, after attending ASA in
The international conference on Caravan Trade (Tijarat al-Qawaafil) was held in the town hall of the Saharan town of Jalo, located next to the ancient trans-Saharan city of Awjila (home of the earliest mosque built in Africa west of Cairo). There were 42 participants in the conference, mostly Libyan historians, but also a Tunisian, a Sudanese, several Egyptian scholars, one Belgian, two Italians and a group of German cartographers from
This coming year, Lydon's travels continue. She will be in
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Jean-Paul Agon Addresses Body Shop Challenges
At L'Oréal's annual general meeting on Thursday, the firm's chairman and ceo fielded tough questions from shareholders.
Navigating Milan's Beauty Scene
Despite a lackluster domestic market for cosmetics goods, manufacturers and retailers of are pushing against negative momentum.
Lacoste Launches New Scent for Men
The brand is going after the edgy, creative urban set with its latest scent, Live.
Color Cosmetics
Paintbox Paints a Fresh Picture for Nails
The SoHo space serves as a place to enjoy coffee, espresso, sparkling water, Champagne or wine while soaking off gel polish or receiving a quick polish change.
Natu Rolls Out at Target
The natural hair product is the latest addition to the retailer's efforts to elevate its beauty department.
Tina Fey Tapped to Represent Garnier Skin Care Line
She will endorse the Garnier Ultra-Lift skin-care line and will be featured in national TV and print advertising.
Beauty Features
Uncertain Times Spur Concern at Cosmoprof
A depressed domestic market is not the only headache tormenting the Italian beauty industry.


text:
Easton >Restaurants >
Italian >Morici's Ristorante and Pizzeria
218 Cattell St, Easton, PA | Directions 1804240.700109 -75.205882
Mon - Thu, 11am - 10pm; Fri, Sat, 11am - 11pm; Sun, noon - 10pm
Neighborhoods: Downtown Historic District
Avoid – Life's too short to waste on people and places that are at best inconsiderate.
Did not like it – They close at 9 and we were there a little before 8:30 and you could feel the hurry....they were in a hurry to take the food from the table rather than serving you...we at last so irritated that after having our appetizer we packed the entrees back home....they turned off the ac....it was very hpt inside.
eating the food back home was terribe...no taste at all and they did not clean there stuff so you could find sand in every bite....we had to throw the food.
Never ever wannna go there again.
good food - good price – I found the italian food was made like my grandmother used to make. I highly recommend the white clam sausce over pasta.
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4 Pack Ultrasonic Pest Repellers- Model #: G-03241
Wage war on nasty pests without dangerous poisons, hazardous chemicals or messy traps! Home Innovations ultrasonic pest repellers help protect your home from disease-carrying rodents and insects. They emit harmless ultrasonic signals that are inaudible to humans. But, they interfere with the nervous system of pests to drive them mad & send them running. Great for garage, office, kitchen, basement & more. Includes 4 plug-in repellers.
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1994-P Prisoner of War $1 Silver Commemorative - PF-69 UCAM NGC
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This commemorative Silver dollar honors all American prisoners of war. The obverse features a soaring eagle with a chain around its leg, while the reverse depicts the National Prisoner of War Museum in Andersonville, Georgia. This Silver coin is graded Proof 69 Ultra Cameo by NGC.
Find the best Silver value at APMEX. We offer low Silver prices and a wide selection of Silver coins to make buying Silver online easy.
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As the Georgia Bulldogs prepare to take on the Auburn Tigers in the Deep South's oldest college football rivalry, Dawg Sports provides a history lesson concerning the 19th century origins of a 21st century feud.
As the Georgia Bulldogs head to Jacksonville for their SEC East showdown with the Florida Gators in the World's Largest Outdoor Cocktail Party, Dawg Sports offers a special edition of "Too Much Information" to highlight the ways in which the Red and Black faithful can enhance their experience when taking part in the crucial college football contest from afar.
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Cash Management
30.02 Gift Processing Issued: May 15, 1998
1. Solicitation of Gifts
All departments are encouraged to solicit gifts for the University from the private sector as a
means of obtaining financial resources to meet the needs of the University. To help ensure
that departments are made aware of other solicitation efforts targeting the same potential
donors, departments should notify the Director of Institutional Development of planned
2. Receipt of Gifts
Upon receipt of gift checks from donors, departments must prepare a Gift Transmittal form
to properly document the designation, purpose, account, and donor information. If the
account is not known, the account field should be left blank for the Development Office or
Fiscal Affairs Department to complete. Departments requiring assistance in completing the
form should contact the Development Office. All gift checks, along with the Gift Transmittal
Form and any relevant donor correspondence, should be hand delivered as quickly as
possible (preferably the day of receipt) to the Development Office. The Development Office
will log the gifts on the Daily Check Log Sheet, review the Gift Transmittal for proper
completion, update the donor files and gift tracking system, and transmit the checks to the
Fiscal Office as quickly as possible (preferably the same day).
3. Acknowledgment Letters
The Development Office will prepare donor acknowledgment letters for all gifts received and
forward to the President's Office for signature and distribution.
4. Gift Records and Reporting
The Development Office will track all requisite gift and donor data for required reporting of
gift information and will maintain permanent files on each donor. The Fiscal Office will
deposit all gift funds into the appropriate account(s) and maintain all requisite fiscal records in
FAMIS. The Development Office is responsible for preparing all required reports on gifts
(including IRS Reports) for the University.
5. Reconciliations
Departments should reconcile all gifts from their copies of source documents to their monthly
FAMIS statements. Additionally, the Development Office will prepare monthly
reconciliations of their gift tracking system to FAMIS.
6. In-Kind Gifts
In-kind (non-cash) gifts vary but include such items as books, equipment, livestock, and
land. Departments notified of intended In-kind gifts must complete a Gift-In-Kind
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Institutional Development is responsible for obtaining the proper approval of all In-kind gifts
and for preparing notifications of acceptance to donors. The Director of Institutional
Development is responsible for providing requisite documentation of In-kind gifts to the
Fiscal Office for proper recording of the gifts in FAMIS. [Note: Departments may not
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8. Forms
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Apply to Huntingdon
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February 06, 2010For immediate release:
Huntingdon CollegeNews Release
MONTGOMERY, Ala.—Despite a pair of hits from senior Kyle
Eller, including his first home run of the season, the Huntingdon
baseball team dropped a 5-2 decision to Mississippi College in each
team's season opener on Saturday at Posey Field.
Eller led the Hawks (0-1) with the two hits, while senior Chris
Knight, junior Drew Harrell and freshman Austin White each added
singles. The ninth-inning hit by White was the first of his collegiate
Senior Alex Sanford (0-1) struck out seven in 5.0 innings of work,
but also walked four and scattered three hits. However, the Prattville
native allowed three runs, only one of which was earned, to take the
Fellow senior Scott Holloway saw his first action since the final
game of the 2008 season, as he tossed 2 1/3 innings of relief, allowing
two runs on two hits, while striking out one. Junior Ryan Harrison
tossed 2/3 of an inning, while sophomore Caleb Cofield worked a
scoreless ninth inning.
Bo Bell delivered the big blow for the Choctaws (1-0), a two-run
home run in the eighth inning to put the game out of reach. Dakota
Bodree also added a RBI triple for Mississippi College.
Huntingdon jumped out to a 2-0 lead after one inning, after Harrell
led off the inning with a single past Choctaw starter Tyler Seaman
(1-0). Harrell stole second and moved around to third on a groundout by
senior Josh Bennefield, before scoring on a passed ball by Jacob
Daniel. Eller followed one pitch later with a monster shot over the
right field wall to give the Hawks a 2-0 lead.
Bodree cut the lead in half with his run-scoring hit in the third
inning, before MC took the lead for good in the top of the fourth.
Bell led off the frame with a five-pitch walk, while Shane Bennett
followed with a single to left field, moving Bell to third. After
Bennett stole second, both runners came around to score on a throwing
error by Knight.
After the first inning, Seaman settled down to scatter just two hits
over the next five innings, as he struck out six and walk just two.
Daniel Cowart tossed two perfect innings, before giving way to Brock
Campbell, threw a scoreless ninth to pick up his first save.
Huntingdon had its opportunities to push across runs, leaving seven
runners on base, including the bases loaded in the sixth inning. The
Hawks also had a pair of runners on in the bottom of the ninth.
The Hawks will return to action on Sunday, when they host in-state
rival Birmingham-Southern at 4:30 p.m. The Choctaws and the Panthers
will also square off on Sunday at 1 p.m.
Tim Lutz
Sports Information Director
Phone: (334) email@example.com
Hodge Patterson
Sports Information Director
Phone: (334) email@example.com
More Athletic News | More Huntingdon News
1500 East Fairview Avenue • Montgomery, Alabama 36106Admission: (334) 833-4497 • (800) 763-0313
Communications: (334) 833-4515 • firstname.lastname@example.com
© copyright 2013 Huntingdon College. All rights reserved.
Huntingdon College is a college
of the United Methodist Church.


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Since the 9/11 attacks, no book has provided a satisfactory answer as to WHY the attacks occurred and who was ultimately responsible for carrying them out - until now.
remember this: [Link] It's not nature - it's MAN.
"the emissions from which are driving the worldwide global catastrophe know as anthropogenic...
"determined that the specialist used appropriate force and followed the proper procedures in a...
Szaaloth-Utszabot, The Book of Jore Dia 17 We beg Thee, O Lord, indict Thy wrath on the nations...
Reminds me of that comment the Cs made about the Earth 'unzipping' and these things having a...
Proven benefits of the Éiriú Eolas Program include:
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In this ground breaking multi-part video series, Laura Knight-Jadczyk discusses the history of the modern spiritual movement and the pitfalls and traps awaiting any would-be "channeler". She also provides a glimpse into the events that led to the beginnings of the "Cassiopaean Experiment".
Laura Knight-Jadczyk's ground-breaking new book Comets and the Horns of Moses is now available in hard copy and Kindle formats!
Updated 3-DVD version with English subtitles!
Since the 9/11 attacks, no book has provided a satisfactory answer as to WHY the attacks occurred and who was ultimately responsible for carrying them out - until now.
Scientists living under an oppressive regime decide to clinically study the founders and supporters of evil regimes to determine what common factor is at play in the rise and propagation of man's inhumanity to man.
Reader comments do not necessarily reflect the views of the volunteers, editors, and directors of SOTT.net or the Quantum Future Group.
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text:
Pluffy™ Golf Frame
Material List
- Pluffy™ Clay – Classic Variety Pack
- Sculpey® Tool Set
- Cleaned Tuna Can, Empty (3"-4" Diameter Round Metal)
- Cookie Cutter
- Ruler
- Scrapbook Paper – Green
- Cardboard
- Craft Glue – White
Project Instructions
Step 1 Make one long white log, wide enough to cover outside of can or cutter. Wrap log around can or cutter and smooth seam. Roll can or cutter with log on it lightly on work surface so edge is flattened slightly but still rounded. Texture with ball end of detail tool.
Step 2 Make two green triangles and press on frame bottom. Make green pointy snakes and press along frame bottom for grass. Push straight edge against bottom edge to flatten.
Step 3 Bake according to instructions above. Allow to cool. Remove clay from can or cutter.
Step 4 Trace the center of the golf ball frame on cardboard -- cut out your trace a little smaller than the outline.
Step 5 Glue scrapbook paper on one side. Cut out a separate cardboard triangle, 3½" high. Bend one edge of triangle back and glue it to the back of cardboard to make an easel.
Step 6 Center your photo in frame. Glue frame, photo and cardboard together with strong craft glue.


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Hi everyone, thanks for reading this thread, I hope anyone of you people can help me on this one,
I have an Intel DQ35JO mainboard, which has HAL issues when waking up from the sleep mode, it happened twice now, so it is an returning problem.
So, the error is this:
The platform firmware has corrupted memory across the previous system power transition.
Please check for updated firmware for your system."
So I went over to update the Bios, as this would probally solve the issue, everyone on the internet says.
As usual, I downloaded this exe file, ran it, rebooted, and.... yea here was gonna stand updated. but not.
The following thing is happening:
My current bios version is 10/27/2009, aka BIOS Update [JOQ3510J.86A] Version 1122
I am trying to install version 12/9/2010 aka BIOS Update [JOQ3510J.86A] Version 1143
When I run the exe, OR the ISO the system restarts, and when restarting I get no video input, I wait 10 minutes,
power off the system, because it is not responding anymore, and it works again, but still on version 1122
When I run the cd, iso, I get into the bios update screen, but after the question if I want to proceed, the system reboots,
and then does the same as before, and hangs again. I wait 10 minutes, and power off, power on, everything fine.
So my sollution was like this:
Maybe my mainboard has a dislike for jumping ahead of another bios update, update 11/24/2009 aka Version 1126
Do you remember what I just said that happened? Well guess again, same thing happens. This time only tested with exe,
because the ISO is not avaible this time...
Anyway, maybe someone knows a solution for this?
Intel Core 2 Quad 9400
2 x 2048 MB RAM
ATI HD4850 Radeon
If you have a read of the readme file on the BIOS download page, there's usually a way of restoring the BIOS (which may involve repositioning a jumper before and after) - have you tried this method? Is there antivirus software installed and if so, did disabling it during the flashing process make any difference? When running the exe method, after the system rebooted and you have the black screen showing the various stages of the flashing process, did all seem to progress well there?
Why would I restore the bios, since it still boots
The thing is, when I try the exe it runs, reboots, and nothing then.
So I am not seeing the various stages of the flashing process at all
I take 10 minutes to turn it off just to be safe.
Help needed, btw, resetting the bios now, by loading optimal defaults, maybe that helps.
supayoshi wrote:
btw, resetting the bios now, by loading optimal defaults, maybe that helps.
Absolutely it may help! If you have non-standard settings and there are problems with flashing, this should be the first thing you try - sorry I didn't realise you'd customised things. You should also make sure all non-essential peripherals and (preferably even non-essential cards installed in slots) are removed for maximum chance of success.
To answer your question about restoring the BIOS, the answer is simply because sometimes following the restore process with a new version gets the flash process completed - in the end it doesn't matter why it works, it's results that matter.
Hi, it has worked.
The thing was that I had to load the optimal defaults,
So if You are looking out here for an answer stranger,
the sollution is quite simple.
Load Optimized Defaults in the bios, which is not really mentioned in the manual as far as i know.
supayoshi wrote:
the sollution is quite simple.
Load Optimized Defaults in the bios, which is not really mentioned in the manual as far as i know.
I'm glad that did the trick. I guess the people who write the manuals expect people will think to restore everything back to default settings before attempting any flashing. I guess because 'optimum' settings usually live up to their title many people stick with them and consequently this isn't a very common problem.
The no 1 golden rule for any overclocked systems experiencing any problems should always be return everything back to standard and see if the problem persists.


text:
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Superconducting Qubit Array Points the Way to Quantum ComputersApr. 23, 2014 A fully functional quantum computer is one of the holy grails of physics. Physicists have moved one step closer to making a quantum computer a reality by demonstrating a new level of reliability in a ... full story
Airport Security-Style Technology Could Help Doctors Decide on Stroke TreatmentApr. 23, 2014 A new computer program could help doctors predict which patients might suffer potentially fatal side-effects from a key stroke treatment. The program assesses brain scans using pattern recognition ... full story
Male-Biased Tweeting: Gender Differences in the Use of TwitterApr. 23, 2014 Today women take an active part in public life. Without a doubt, they also converse with other women. In fact, they even talk to each other about other things besides men. As banal as it sounds, this ... full story
Impact of Facebook Unfriending Analyzed by ResearchersApr. 22, 2014 Two studies are shedding new light on the most common type of 'friend' to be unfriended on Facebook and their emotional responses to it. The studies show that the most likely person to be ... full story
Online Retailers Have Clear Advantage by Not Collecting Sales TaxApr. 22, 2014 Two independent studies use two very different approaches to reach the same conclusion: some online retailers really do have an advantage over traditional brick-and-mortar stores. The studies find ... full story
Traditional Malaysian Musical Instrument Modernized: 'Rebana Ubi' Computer SpeakerApr. 22, 2014 Researchers are modernizing the 'Rebana Ubi', a traditional Malaysian musical instrument by infusing it with a modern computer aided ... full story
People Pay More Attention to Upper Half of Field of Vision, Study ShowsApr. 22, 2014 People pay more attention to the upper half of their field of vision, a study shows, a finding that could have ramifications for traffic signs to software interface design. "It doesn't mean ... full story
'Blood Lab' Inside a Mobile Phone Could Detect CancerApr. 22, 2014 Scientists are in the early stages of an 'e-health technology' project aimed at developing a mobile phone app that can examine blood sample images and diagnose cancer. It would work by ... full story
Jacket Works Like a Mobile PhoneApr. 22, 2014 A fire is raging in a large building and the fire leader is sending a message to all firefighters at the scene. But they don't need a mobile phone -- they simply check their jacket sleeves and ... full story
New Technology for Greenhouses DevelopedApr. 21, 2014 Agricultural and fruit producers could acquire high-tech greenhouses at a considerably less cost, thanks to researchers who are developing computer systems to control climatic variables within such ... full story
Computer Simulations Help Predict Effective Drug CandidatesApr. 21, 2014 Using computer simulations to predict which drug candidates offer the greatest potential has thus far not been very reliable, because both small drug-like molecules and the amino acids of proteins ... full story
Tracking Flu Levels With WikipediaApr. 17, 2014 Can monitoring Wikipedia hits show how many people have the flu? Researchers have developed a method of estimating levels of influenza-like illness in the American population by analyzing Internet ... full story
Internet Use May Cut Retirees' DepressionApr. 17, 2014 Spending time online has the potential to ward off depression among retirees, particularly among those who live alone, according to research. Authors report that internet use reduced the probability ... full story
Likely Author of Original Bitcoin Paper? Researchers Uncover Linguistic EvidenceApr. 17, 2014 The primary author of the celebrated Bitcoin paper is most likely Nick Szabo, a blogger and former George Washington University law professor, according to students and researchers at Aston ... full story
Chess Robots to Cause Judgment Day?Apr. 16, 2014 Next time you play a computer at chess, think about the implications if you beat it. It could be a very sore loser! A new study reflects upon the growing need for autonomous technology, and suggests ... full story
Beating the Clock for Ischemic Stroke SufferersApr. 16, 2014 Researchers have developed a new computer tool to ensure faster care and treatment for stroke patients. The CAD stroke technology is capable of detecting signs of stroke from computed tomography (CT) ... full story
Quantum Computing? Progress in the Fight Against Quantum DissipationApr. 16, 2014 Scientists have confirmed a 50-year-old, previously untested theoretical prediction in physics and improved the energy storage time of a quantum switch by several orders of magnitude. High-quality ... full story
Augmented Reality: Bringing History and the Future to LifeApr. 16, 2014 Have you ever wished you had a virtual time machine that could show you how your street looked last century? Or have you wanted to see how your new furniture might look, before you've even bought ... full story
Computer Software Analyzing Facial Expressions Accurately Predicts Student Test PerformanceApr. 16, 2014 Real-time engagement detection technology that processes facial expressions can perform with accuracy comparable to that of human observers, according to new research. The study used automatic ... full story
Net Neutrality Balancing ActApr. 16, 2014 Researchers have demonstrated that net neutrality benefits content creator and consumers without compromising provider innovation nor profits. There is a war raging online between those who wish to ... full story
- Superconducting qubit array points the way to quantum computers
- Airport security-style technology could help doctors decide on stroke treatment
- Male-biased tweeting: Gender differences in the use of Twitter
- Impact of Facebook unfriending analyzed by researchers
- Online retailers have clear advantage by not collecting sales tax
- Traditional Malaysian musical instrument modernized: 'Rebana Ubi' computer speaker
- People pay more attention to upper half of field of vision, study shows
- 'Blood lab' inside a mobile phone could detect cancer
- Jacket works like a mobile phone
- New technology for greenhouses developed
- Computer simulations help predict effective drug candidates
- Tracking flu levels with Wikipedia
- Internet use may cut retirees' depression
- Likely author of original Bitcoin paper? Researchers uncover linguistic evidence
- Chess robots to cause Judgment Day?
- Beating the clock for ischemic stroke sufferers
- Quantum computing? Progress in the fight against quantum dissipation
- Augmented reality: Bringing history and the future to life
- Computer software analyzing facial expressions accurately predicts student test performance
- Net neutrality balancing act
- Potential use of Google Glass in surgical settings
- Computerized counseling reduces HIV-1 viral load, sexual transmission risk
- Intelligent prosthetic liners could ease pain for lower limb amputees
- Cybersecurity researchers roll out a new heartbleed solution: Red Herring creates decoy servers, entraps, monitors hackers
- Website information on colon cancer too complex, fails to address key concerns, researcher finds
- Surgeons develop personalized 3-D printed kidney to simulate surgery prior to cancer operation
- Sneak a peek through the mist to technology of the future
- Gigabit wireless communications: Research could have significant implications for future of mobile devices
- Dangerous ways computer worms are spreading among smartphones
- Scalable, universal quantum computer? Quantum information processed with system comprising optical photon and trapped atom
- See what a child will look like using automated age-progression software
- Google Glass puts the focus on Parkinson's
- Consumer, be aware: Quality of health-related internet searches varies
- Is the U.S. power grid too big?
- Future computers that are normally off
- New algorithm aids in both robot navigation and scene understanding
- Does too much time at the computer lead to lower bone mineral density in adolescents?
- Advantages, potential of computer-guided spinal surgery
- Quantum cryptography for mobile phones
- 'Unbreakable' security codes inspired by nature
- Enhanced autopilot system could help prevent accidents like 2009 Air France 447 crash
- Overcoming structural uncertainty in computer models
- Knowledge transfer between computers: Computers teach each other Pac-Man
- Online gaming augments players' social lives, study shows
- Data mining disaster: Computer technology can mine data from social media during disasters
- Computing with slime: Logical circuits built using living slime molds
- Einstein's 'spooky' theory may lead to ultra-secure Internet
- Parallel programming may not be so daunting: 'Lock-free' parallel algorithms match performance with wait-free
- Computer models solve geologic riddle millions of years in the making
- Are health departments tweeting to the choir?
- Picture perfect diagnosis: Telemedicine for stroke expertise
- Important and complex systems, from the global financial market to groups of friends, may be highly controllable
- Computers see through faked expressions of pain better than people
- Parents should try to find middle ground to keep teens safe online
- Real-time simulation of textiles with new software
- WPA2 wireless security cracked
- Dry future climate could reduce orchid bee habitat
- Pocket diagnosis: App turns any smartphone into a portable medical diagnostic device
- Global attack needed to catch credit thieves
- A majority prefers letting computers decide
- Innovative quantum computer under scrutiny
- When the flu bug bit the Big Apple, Twitter posts told the tale
- Follow the ant trail for drug design: Ant behavior inspires software design
- Mental health on the go: Reducing anxiety with smartphone app
- Real-looking snow in Disney's 'Frozen' based in simulations that predict blast scenarios
- Emotion detectors could make driving safer
- Languages written to design synthetic living systems useful for new products, health care
- Lunar crater counting shows crowdsourcing is accurate tool
- When big isn't better: How the flu bug bit Google
- Soft robotic fish moves like the real thing: New robotic fish can change direction almost as rapidly as a real fish
- Facebook feelings are contagious, study shows
- Texting program good option for teen girls' health, study shows
- Signal control with light frequencies
- Quantum physics secures new cryptography scheme
- Free online software helps speed up genetic discoveries
- More secure communications thanks to quantum physics
- How Twitter shapes public opinion
- Bending the light with a tiny chip: Silicon chip acts as a lens-free projector, may one day fit in cell phones
- Software analyzes apps for malicious behavior
- Public could virtually 'travel' to space for $90 through new project
- Squeezing light into metals: Engineers control conductivity with inkjet printer
- Computer science students help singers learn their vowels
- Computers used to 'see' neurons to better understand brain function
- Engineering team increases power efficiency for future computer processors
- IT security for the daily life: Withdrawing money at cash machines with 'Google Glass'
- Collecting digital user data without invading privacy
- How the Internet is transforming our experience of being ill
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BACKGROUND: Clostridium difficile, also called C. diff, is a bacterium. Although illness from C. diff most commonly affects older adults in hospitals or long-term care facilities, C. diff infections have become more frequent, more severe, and more difficult to treat in recent years. C. diff is found throughout the environment in soil, air, water, and human and animal feces. The bacteria is passed through feces and spreads to other locations like hands and surfaces when people don't wash their hands properly. Most healthy people do not become sick from C. diff, but if a person is taking antibiotics, which destroy some helpful bacteria, they can develop an infection. Once established, C. diff can produce toxins that attack the lining of the intestine and the toxins destroy cells and produce patches of inflammatory cells and decaying cellular debris inside the colon. (Source: Mayo Clinic)
SIGNS: Some of the most common signs of mild or moderate C. diff infection are watery diarrhea three or more times a day for two days or longer and mild abdominal cramping and tenderness. However, in severe cases C. diff can cause the colon to become inflamed (colitis) or form patches of raw tissue that can bleed or produce pus. Signs of a severe C. diff infection are fever, blood and pus in stool, nausea, dehydration, abdominal cramping and pain, loss of appetite, and watery diarrhea 10 to 15 times a day. It is important to see a doctor because even mild C. diff infections can quickly progress to a fatal disease if not treated in time.
TREATMENT: For some people with mild C. diff infections, it may enough to just stop taking the antibiotics that triggered the infection. However, further treatment is sometimes required. Treatment for C. diff includes:
· Antibiotics – The commonly used antibiotics to treat C. diff are metronidazole and vancomycin, which keep the bacteria from growing and allows normal bacteria to flourish in the intestine again.
· Probiotics – Probiotics like bacteria and yeast help restore a healthy balance in the intestinal track. The yeast Saccharomyces boulardii, with antibiotics, might help prevent recurrent C. diff infections.
· Surgery – For cases of C. diff where the person has severe pain, organ failure, or inflammation of the lining of the abdominal wall, removal of the diseased portion of the colon may be the only option. (Source: Mayo Clinic)
FECAL TRANSPLANT: In a fecal transplant stool from a healthy donor is emulsified, usually mixed with saline or water, and transferred via a nasal tube or enema to the gut of a seriously ill C. diff patient where the healthy fecal bacteria can help to restore balance to the patients' bowels. Although regarded as a fringe treatment for the past decade, a review of over two dozen scientific reports found that fecal transplant cured the problem in 92% of the cases, a better record than that of some other treatments. (Source: NBC News Online)
Sudhir Dutta, M.D., Director of Gastroenterology at Sinai Hospital and Professor of Medicine at the University of Maryland School of Medicine, talks about a serious infection and how fecal transplants could be used to help the patients suffering from it.
What is C.Diff?
Dr. Dutta: C. difficile infection has been known to us for 35 years. It was first described by Dr. John Bartlett who was at Hopkins as Chief of Infectious Disease in 1978. It was known as pseudomembranous colitis in those days and we did not know what was causing it. We knew it was associated with antibiotics and it was also called an antibiotic-associated colitis, but we did not know what was the underlying cause of it. Essentially, how did it happen? It was unraveled in the subsequent 5 years and it became clear that the underlying pathogen or the causative agent was Clostridium difficile, an anaerobe that usually is in the colon of most human beings. We have lots of anaerobes in the colon and it is there most of the time, but when you take antibiotics and the good bacteria die then C. diff becomes pathogenic; it takes over and begins to cause colitis. When that was discovered it became obvious that we have to get rid of this organism and metronidazole, or Flagyl, was the antibiotic that was used to control the infection. For many years that worked very well. Metronidazole has been around for a long time and it is a cheaper medication, but we found out after 10 years or so that the organism is getting resistant to this particular antibiotic. Then came vancomycin which has become the pivotal drug, another antibiotic, for the treatment of this disease and has been helping for a long time until I think the beginning of this century when we found that there are some strains, NAP-1 strain for example, of C. diff that are even resistant to vancomycin. In fact, they are resistant to all kinds of treatments and at that point in time people started thinking of other alternative methods of treating C. diff. It has always been that some patients just did not respond to C. diff traditional treatment; 99% of the time it was okay, but in some patients it went away and came back. So, either it did not respond to the treatment or it came right back. It was called recurrent C. diff colitis and these patients were the main reason that we were looking for alternative treatments, because the way it was going these people were taking antibiotics and then the moment they stopped it, after a month, the infection came back again. In some of these people, they got so sick with this kind of treatment that they had their colons taken out. Ten years ago in our institution there were a few colons removed because the colitis was so severe that if that was not done the patients were going to die.
There are lots of deaths from C. difficile?
Dr. Dutta: C. difficile is associated with some morbidity and mortality simply because if it occurs in older people who have multiple other medical problems, it causes severe dehydration and sepsis and that causes death as a result of that.
So if the patient would not respond to the antibiotics that were out there, did they have other options?
Dr. Dutta: Well, I don't think there were many options left because there is a new antibiotic that has come on the market which is fidaxomicin, or Dificid, but it is very expensive. It is bactericidal, so in other words it destroys these bacteria. In other words, they don't kill the bacteria, they just control the bacteria. In this field however, the patient that has been getting fecal transplantation are those that have failed even on this new antibiotic, which is Dificid or fidaxomicin.
Can you tell me about the fecal transplant?
Dr. Dutta: For the fecal transplant the first patient came because he was referred interestingly by the discoverer, Dr. John Bartlett from Hopkins. He had this patient who had recurrent attacks of C. diff colitis and he had heard about fecal transplantation which was being done in New York by Dr. Brandt who was our visiting professor last year. Dr. Brandt has been giving the fecal transplantations by just asking them to go home and prepare something at home from the stool sample and take an enema. That was the state of art that he was doing, and this woman tried to go to New York and get an appointment with Dr. Brandt but the cost was very high for her to stay in New York and get it done. So, she talked to Dr. Bartlett who then called me and said would you consider doing it? First I said because of the nature of this disease to begin with and secondly the treatment is so unusual that I will have to go to institutional review board and I would have to review the entire literature which is going to be a lot of work. So I told the patient that to be honest, I am so busy I cannot take it upon myself at this point in time. She sat in my office and said to me that "If you don't do it, who else will do it?" That was sort of a moment of enlightenment for me and I just looked into myself and I said, she is telling the truth. So, I told her that I would work on it. I looked into it, reviewed the literature, tried to figure out how can we do it in our environment, got the institution's review boards of Sinai to approve it, got the microbiology lab to prepare the samples, and discussed it with people elsewhere in Minnesota. There was a group that was doing it and everybody gave some little pieces of information which was very helpful, but it was not the complete answer. For example, in Minnesota they were putting the stool sample through the NG tube into the stomach and that was not acceptable to the institution review board here at Sinai Hospital. They said "no, you can't do that in the stomach." So we came up with the idea that we have got to make it look a little bit more defined, more scientific, so we sat down with the microbiology lab and created a program where the patients come to us, but we have to first identify donors with healthy stool samples. The donors have to be screened for all kinds of infection. Their stool has to be tested, their blood has to be tested for any of the viruses or hepatitis or any parasitic infestations, and once they have cleared that then the donor has to provide the healthy stool sample and bring it to our lab within 4 hours. The lab then has to process it with a protocol that we set up; right now it is some information that we got from Minnesota and some from New York and we created our own protocol at Sinai Hospital. The only new thing we did was everywhere else in the country they would put it either in the rectum, the fecal processed material, or they would put it in the cecum. I thought of it and I said why don't we put it from above as well, but not in the stomach; we go further down into the small intestine and infuse the bacteria up in the jejunum. The idea was that in the colon when you put the stuff in, the colon pretty much expels it very quickly. So the bacteria may not have enough time to stay in contact with the colon and what we wanted to do was to give these bacteria more time to be in contact with the bowel. So I started from both ends, basically putting this fecal filtrate from a healthy donor into the jejunum or small intestine from above and also from below. We have done it now in 28 patients without anybody failing. Everybody has recovered and done very well.
It is a one-time treatment?
Dr. Dutta: A one-time treatment, yes.
You touched on this a little bit, but what is it actually doing? How is it interacting with the infection?
Dr. Dutta: That is a good question. What you do is you have a fecal filtrate that you infuse into the bowel, and then that fecal filtrate is nothing but zillions of bacteria that you are putting in. Some of them are known, some of them are unknown. The new DNA technology is telling us that we only know about 150 different bacteria that we have been able to culture. There are about 1500 different types of DNA-based different organisms. These different organisms are not cultured; we cannot grow them in the lab, but they are there based on DNA and they presumably do something that we don't know. They protect the bowel probably in some way, and maybe these bacteria get killed by the antibiotic. We don't know that, this is all speculated. So, when we infuse these fecal filtrates, we are actually putting a lot of stuff in the bowel of the recipient, in this case a patient with C. diff colitis. How they interact we don't know. The little bit of analysis that we have received in this area suggests that the bacteria of the patient with colitis change over to the bacteria of the donor. That I think is what is happening and it sounds simple, but it is a complicated technique to establish it. We are collaborating with the Human Genomic Institute at University of Maryland and we have data on some patients where we have done the genomic analysis and we have come to accept the same kind of finding which is that the bacteria in C. diff colitis is very different. For these patients who are suffering from it, there is a dramatic change and there are some bad bacteria in there, proto-bacteria, which we did not even know before. Then once they have received the infusion of the fecal filtrate, the bacteria of this patient change completely and they get the normal ones. Now, that is happening at the molecular level. If you talk to the patients, they do not know any of this; they all know that something was done, a test was done, and they go home. To me the marvelous thing was that they feel superbly well within a day to 3 days. The longest we have had is 1 patient who is 85 years old, and she took about a week to get well. Most of them within 3 days feel perfectly fine. The bowel movements are back to normal, they don't have cramps, they don't have abdominal pain, and to my surprise they say they have never felt this good.
They don't go on antibiotics again?
Dr. Dutta: No more antibiotics. They actually stop their antibiotic 5 days before our transplantation process.
Could this be used potentially for other infections or right now just for C. difficile?
Dr. Dutta: Right now just for C. diff, but it is being looked into and being done in Amsterdam and Australia and other parts of the world. We are trying to treat irritable bowel syndrome patients, inflammatory bowel disease, ulcerative colitis patients, and someday maybe Crohn's disease patients will be treated with this kind of bacteria therapy or microbacterial therapy. Right now, I think it is very rudimentary; it is the early stages of the development of this therapy. It is going to get refined in the next 10 years and I think we will become more specific, more targeted towards a specific disorder. At that time we will be doing much better than what we do today, I think.