text:
New subscription
Renew my subscription
Give a gift
Pay my bill
Change my address
Active within 3125 Days
Hi! My name is Sandy
I am a Norwegian Forest Cat from Chilcoot, CA
Nicknames: Baby and San San
Age: 11 years old
Gender: M
Coat: long haired
Education: He knows how to play dead and he wakes me up for school every morning.
My favorite tricks and treats are: He plays dead when you say his name . and fish flavored treats from Special Kitty.
Where I hang out: Under the porch and in the closet under the clothes.
My favorite grubs: Dog food , mice , pizza , and cat food !
My pet peeves: He hates being ignored and he doesn't like to share with his little sister.
What I love about my owners: She always hold me when i'm tired or mad.
My cat hobbies: Sleep in the closet , eat lizzard heads . play tag , and watch Spongebob Squarepants.
Pet motto: When life gets you down , eat MICE !
See all awards »
my mommy found me as well has my older sister while it was raining out and we fell in love
I've had 1194 friends visit me.
I'm the 9,648th member on CatChannel.com.
72 friends have voted for me since I joined Club Cat!
Come visit me, lily & Ziggy.
Come visit me, Simba & Libby.
Come visit me, Baby, Sandy & Oreo.
Come visit me, Taffie( Vote for Angus185054), Angel Chai Chai( RIP 09-18-12), Murphy, Angel Mitzy (9-18-12), Tina, Maggie Mae, Angel Mya(RIP 8-7-12), Angel(RIP 10-02-09), Sly, Angel Herbie & Angel Lexi:Two Special Angels, Samoset "Sam", Jasamine, Meisha, Bo, Ginny(RIP 9-30-10), Dusty, Sweet Pea( Eli RIP 3-10-12 cat#211689) & .
Come visit me, Leviticus.
Come visit me, Angel June 012908,Prancer 0309,Joey924, littlebit, Tabitha (Simba's lady 3-16), Scooter, Sally in loving memory 04/07/09, Mr. Kitty RIP DadCat Jim, mittens, RIP Buttons 1/13/14 COTD 10-03 & Princess.
Come visit me, Cubby, Marshmellow, Lemmi, Scruff, Punkie & Muf--RIP sweet one 3/28/2010.
Come visit me, Callie, ReeseCup & Boo.
Come visit me, ITO, Sylvester, BOOTSIE, Belle, SIMBA~EXOTIC BUNCH~EB, PICATSO-VOTE VEGAS 10221 DAILY in JANUARY & RAJA.
Come visit me, Brownie, Autumn & Thunder.
Come visit me, Kiddles =^.^= & Saara ~^..^~ Vote Nappy 68109 Oct COTM.
Come visit me, Sonny (IMO), Brianna & Keelin.
Come visit me, Percival...., Benjamin..., Angel Sam..., Riley... & Sarahjayne....
Come visit me, Sabrina ~*~ In Loving Memory ~*~ & Luigi.
Tell a Friend |
Report inappropriate content on this page.
Hi, my name is
Angel Bailey (9/7/02 - 12/20/14).
Visit the photo gallery to cast your vote »
Get quick tips for happy cats, food recall info, news alerts and best behavior advice.
Sign up to get updates delivered straight to your inbox.
CatChannel takes your privacy seriously. To learn more, please read our privacy policy.


text:
Explore - Glens Falls, NY - Phone: (518) 793-7803
Great Escape & Splashwater Kingdom - Glens Falls, NY - Phone: (518) 792-3500
Tilt 82 - Glens Falls, NY - Phone: (518) 792-2180
'Arcades' are one of the types of game franchises which primarily focus on providing gaming as a service rather than as a means of sales. In Glens Falls, different arcades are there where gaming lovers can meet up and enjoy playing games. Video game arcades in Glens Falls are the most popular hangout of gaming lovers. Traditional arcades have lost their popularity with time as video game consoles have become available at homes. To deal with it, in Glens Falls, present arcades have started using devices which are not accessible at home. The arcades have also started food services and additional entertainment sources for roping in more gaming enthusiasts.
PSEG Long Island Helps Customers Go Green and Save Green
Energy Efficiency Programs Save Customers Millions of Dollars (Long Island, NY) PSEG Long Island announced today that customers participating in energy efficiency programs in 2015 will save more than $60 million and 307,582,000 kilowatt hours (kWh) per year. The amount of energy saved is good for the environment, too, as it results in the elimination of the carbon dioxide..

subset: commoncrawl


text:
Serum lens culinaris agglutinin-reactive fraction of α-fetoprotein (AFP-L3%) has been widely used for HCC diagnosis and follow-up surveillance as tumor serologic marker. However, the prognostic value of high pre-treatment serum AFP-L3% in patients with hepatocellular carcinoma (HCC) remains controversial. We therefore conduct a meta-analysis to assess the relationship between high pre-treatment serum AFP-L3% and clinical outcome of HCC.
Eligible studies were identified through systematic literature searches. A meta-analysis of fifteen studies (4,465 patients) was carried out to evaluate the association between high pre-treatment serum AFP-L3% and overall survival (OS) and disease-free survival (DFS) in HCC patients. Sensitivity and subgroup analyses were also conducted in this meta-analysis.
Our analysis results showed that high pre-treatment serum AFP-L3% implied poor OS (HR: 1.65, 95%CI: 1.45–1.89 p<0.00001) and DFS (HR: 1.80, 95% CI: 1.49–2.17 p<0.00001) of HCC. Subgroup analysis revealed that there was association between pre-treatment serum AFP-L3% and endpoint (OS and DFS) in low AFP concentration HCC patients (HR: 1.96, 95% CI: 1.24–3.10, p = 0.004; HR: 2.53, 95% CI: 1.09–5.89, p = 0.03, respectively).
The current evidence suggests that high pre-treatment serum AFP-L3% levels indicated a poor prognosis for patients with HCC and AFP-L3% may have significant prognostic value in HCC patients with low AFP concentration.
Citation: Cheng J, Wang W, Zhang Y, Liu X, Li M, Wu Z, et al. (2014) Prognostic Role of Pre-Treatment Serum AFP-L3% in Hepatocellular Carcinoma: Systematic Review and Meta-Analysis. PLoS ONE 9(1): e87011. doi:10.1371/journal.pone.0087011
Editor: Yuan-Soon Ho, Taipei Medical University, Taiwan
Received: September 9, 2013; Accepted: December 16, 2013; Published: January 30, 2014
Copyright: © 2014 Cheng et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: This work was supported in part by the National Natural Science Foundation of China (Grant no. 81270521). No additional external funding was received for this study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
Hepatocellular carcinoma (HCC) is one of the most frequent neoplasms worldwide, the fifth most prevalent malignancy and the third common cause of cancer-related deaths in the world [1]. Despite of the significant advances in surgical techniques, anesthesia and medical care, better perioperative managements, and new antineoplastic drugs for clinical use, the overall survival of HCC patients remains dismal due to a high rate of recurrence or intrahepatic metastasis after effective treatments [2]. While incidence rates are declining for most cancer sites, HCC is increasing among both men and women [1]. Thus, it is important to identify molecular predictive markers for the prognosis and monitoring metastatic recurrence, which is helpful in the selection of therapeutic strategies and can further improve the survival for HCC patients. Regrettably, there is no widely accepted approach to regular surveillance HCC in the worldwide. Currently, the only generally available serologic marker for HCC surveillance, diagnosis, and monitoring is serum α-fetoprotein (AFP). The combination of ultrasonography (US) and AFP is commonly used for surveillance of HCC. However, it has been recognized that AFP has limited sensitivity and specificity for HCC while US is an indirect diagnostic method depending on operator skill and has limited ability to differentiate HCC from nonneoplastic nodules [3], [4]. Many centers use multidetector CT or dynamic MR imaging and AFP. However, there are no data to support the use of them for surveillance.
Recently, the lens culinaris agglutinin-reactive fraction of α-fetoprotein (AFP-L3) and des-γ-carboxy prothrombin (DCP) have been widely used for HCC diagnosis and follow-up surveillance as tumor serologic markers in Japan. It has been reported that DCP levels have been associated to portal vein invasion and advanced tumoral stage, a fact that prevents the usage of this marker for early detection and prognostic surveillance [5]. Moreover, subsequent studies have shown that positive pre-treatment serum AFP-L3% predicts tumor progression, recurrence and poor clinical outcome [6]–[8], and it has superior prognostic accuracy as a tumor marker compared with AFP or DCP [9], [10]. Nevertheless, conflicting data have emerged regarding the ability of pre-treatment serum AFP-L3% to predict disease-free survival (DFS) and overall survival (OS) in HCC. Therefore, it is necessary to perform a meta-analysis to comprehensively and systematically understand the prognostic value of pre-treatment serum AFP-L3% in HCC.
In this study, we sought to conduct a systematic review and meta-analysis to estimate the prognostic importance of elevated pre-treatment serum AFP-L3 levels for OS and DFS among patients with HCC.
Materials and Methods
Literature Search
Studies were identified by electronic searching PubMed, Cochrane Library, EMBASE, and Science Citation Index Expanded databases (last search updated to June 30, 2013). The primary search was based on the random combination of following terms 'Lens culinaris agglutinin-reactive a-fetoprotein or AFP-L3', 'hepatocellular carcinoma or HCC' and 'prognosis, survival or recurrence'. For references of identified trials, hand-search was used. Investigators were contacted and asked to supply additional data when key information relevant to the meta-analysis was missing.
Study Inclusion Criteria
Inclusion criteria were determined by two researchers (JC and WW). Studies eligible for inclusion in this meta-analysis if they met the following criteria: (i) English language; (ii) proven diagnosis of HCC in patients; (iii) provide specific information on survival such as HR/logHR and 95% confidence interval (CI)/standard error (SE) or crude data; (iv) the end-points were DFS or OS; (v) have a maximum follow-up time exceeding 2 years.
Data Extraction and Quality Assessment
Data were extracted independently by two reviewers (JC and WW) and validated by a third one (YL). Simultaneously, if we found studies that stemmed from overlapping populations, the largest/newest study was included.
The primary goal of this meta-analysis was to detect the prognostic effect of pre-treatment ALP-L3% elevation on OS and DFS among HCC patients. For the studies included in this meta-analysis, the outcome measures were OS or DFS. OS was defined as the interval between the medical treatment (including liver resection, transarterial chemoembolisation, radiofrequency ablation, or liver transplantation, etc.) and the death of patients or the last observation. DFS was designated as the date of treatment until the detection of the recurrence tumor or the last follow-up assessment. To exactly evaluate the value of AFP-L3% in predicting patient outcomes from different treatments, we divided eligible studies into three groups: surgical treatment group in which all HCC patients received curative hepatic resection, and radiofrequency ablation (RFA) treatment group with patients treated with RFA, and multiple treatments group with patients treated by different treatment methods (surgery or RFA or transarterial chemoembolisation (TACE) or percutaneous ethanol injection therapy (PEIT) ).
Quality assessment was conducted in each of the available studies by using the validated Newcastle-Ottawa Quality Assessment Scale for cohort and case–control studies [11] as recommended by the Cochrane Collaboration Guidelines for the assessment of non-randomized studies [12]. The scores range from 0 to 9. Among them, 0 and 9 scores were respectively designated as lowest and highest quality. The studies with 6 scores or more were graded as the high quality ones in the scale [13].
Data Analysis/synthesis
Review Manager (RevMan) 5.0 (The Cochrane Collaboration, Oxford, England) and Stata version 11 (StataCorp LP, TX) were used in the meta-analysis. All reported p-values were two sided.
The included studies were divided into two groups for analysis: those with data regarding OS and those regarding DFS. Data on the predictive ability of elevated pre-treatment serum AFP-L3% (the cut-off value for elevated serum AFP-L3% was determined by the investigators of each study) for OS and DFS in HCC patients were combined across studies. For the quantitative aggregation of the survival results, hazard ratios (HR) and their 95% confidence intervals (CIs) were combined to give the effective value. If these statistics were not given explicitly in articles, they were calculated from available numerical data using methods reported by Parmar, et al [14]. A Chi-squared test was used to assess the heterogeneity. A I2 statistic index greater than 50% and a x2 p-value less than 0.10 indicated the presence of significant heterogeneity [15]. The random-effect model was used to take between-study variation into consideration. Although this does not necessarily rule out the effect of heterogeneity between studies, one may expect a very limited influence. If substantial heterogeneity existed, subgroup analysis was then conducted to explore the potential sources of heterogeneity. Begger's funnel plot and Egger's test were performed to assess the publication bias of the eligible studies, where p<0.05 indicated the presence of publication bias [16].
Sensitivity analyses were also conducted by excluding each study individually (the results shown as the summary HR of eligible studies after excluding the one with largest effect and omitting the eligible studies with low quality (NOS score <6) or small sample size (<100). In addition, subgroup analyses were performed to investigate the prognostic impact of pre-treatment serum AFP-L3% alterations on HCC patients in different therapeutic method, HBV/HCV infection, AFP-L3 detection method, AFP concentration and study design.
Selection and Characteristics of Studies
After the careful screening process, 15 studies met our inclusion criteria and were selected for our final meta-analysis [6]–[10], [17]–[26]. The inclusion and exclusion process of the studies is shown in Fig. 1. It is worth pointing out that one of the 15 studies consisted of two subgroups (Surgery group and RFA group) and their data were given respectively, so we analyzed the two subrgroups separately [21]. For the study that only provided the detailed data about RFA on OS and DFS we used only the relevant information in our meta-analysis [19]. Among the 15 studies, one was performed in China [7], one in Korea [6], twelve in Japan [8]–[10], [17]–[24], [26] and one in America [25]; three prospective studies [9], [21], [23], five retrospective studies [8], [17], [18], [24], [25], and seven included studies in which study design was not reported clearly. The basic feature description of the studies was summarized in Table 1.
High Pre-treatment Serum AFP-L3% and OS in HCC
Fig. 2 shows the forest plot for the association between high pre-treatment serum AFP-L3% and OS in HCC. Twelve studies reported the data on high pre-treatment serum AFP-L3% and OS in HCC [6]–[9], [17], [19]–[23], [25], [26]. Combined data showed that high serum AFP-L3% were significantly correlated with OS with a pooled HR estimate of 1.65 [95% confidence interval (CI): 1.45–1.89, p<0.00001] without strong evidence on the presence of heterogeneity (x2 = 14.61, I2 = 18%, p = 0.26). Subgroup analysis indicated that elevated pre-treatment serum AFP-L3% levels were significantly associated with OS in HCC patients treated by surgical resection (HR: 1.54, 95% CI: 1.21–1.96, p = 0.0004) while no significant heterogeneity exists (x2 = 4.59, I2 = 35%, p = 0.20). Moreover, high pre-treatment serum AFP-L3% exhibited strong association with OS in HCC patients treated by RFA and multiple treatment (HR: 1.50, 95% CI: 1.24–1.81, p<0.0001; HR: 1.97, 95% CI: 1.51–2.58, p<0.00001, respectively) without heterogeneity in the data (x2 = 0.49, I2 = 0%, p = 0.78; x2 = 1.52, I2 = 0%, p = 0.68, respectively). Sensitivity analyses were performed by considering only the studies with sample size≥100 and NOS score ≥6 and excluding the study with the largest effect size. The summary HRs of the eligible studies was not altered similarly to the overall effect of the meta-analysis (Table 2).
Hazard ratio and associated 95% confidence interval were calculated. OS: overall survival; AFP-L3: the lens culinaris agglutinin-reactive fraction of α-fetoprotein; HCC: hepatocellular carcinoma.
High Pre-treatment Serum AFP-L3% and DFS in HCC
Fig. 3 shows the forest plot for the association between high pre-treatment serum AFP-L3% and DFS in HCC. Seven of the studies reported data on high pre-treatment serum AFP-L3% and DFS in HCC [7], [8], [10], [18]–[20], [24]. High pre-treatment serum AFP-L3% was significantly associated with poor DFS in all studies except the Shiozawa's study. The combined data suggested that elevated pre-treatment serum AFP-L3% levels were significantly correlated with DFS with a pooled HR estimate of 1.80 (95% CI: 1.49–2.17, p<0.00001), and thestatistical tests did not support heterogeneity in the data (x2 = 4.82, I2 = 0%, p = 0.57). Subgroup analysis indicated that high pre-treatment AFP-L3% levels were significantly related to DFS in HCC treated by surgical resection (HR: 2.02, 95% CI: 1.37–2.99, p = 0.0004), without significant heterogeneity in the data (x2 = 2.87, I2 = 30%, p = 0.24). Moreover, high pre-treatment serum AFP-L3% was also highly related with DFS in HCC patients treated by RFA and multiple treatment (HR: 1.73, 95% CI: 1.10–2.71, p = 0.02; HR: 1.72, 95% CI: 1.27–2.32, p = 0.0004, respectively), without strong evidence for heterogeneity (x2 = 1.12, I2 = 10%, p = 0.29; x2 = 0.48, I2 = 0%, p = 0.49, respectively). Since there is no significant heterogeneity among the eligible articles (x2 = 4.82, I2 = 0%, p = 0.57), sensitivity analyses are not applicable.
Hazard ratio and associated 95% confidence interval were calculated. DFS: disease-free survival; AFP-L3: the lens culinaris agglutinin-reactive fraction of α-fetoprotein; HCC: hepatocellular carcinoma.
Subgroup Analyses
Table 3 shows the detailed results of subgroup analyses. We found that the prognostic effects of high pre-treatment serum AFP-L3% on OS and DFS in HCC patients were similar for different treatment methods, between HBV infection and HCV infection, between highly sensitive and conventional AFP-L3 detection method, and between high AFP concentration and low AFP concentration (x2 p-value for subgroup differences >0.05). However, there was a trend that the summary HR on DFS from the eligible studies on highly sensitive AFP-L3 detection method was distinct from the conventional AFP-L3 detection method, which supported the predictive value of highly sensitive AFP-L3 detection method on DFS (x2 p-value for subgroup differences = 0.08). It is worth noting that the number of eligible studies with data on the correlation of AFP-L3% with low AFP concentration on OS and on DFS is only two and one, respectively. The summary HR of OS and DFS suggested there was association between pre-treatment serum AFP-L3% and endpoint (OS and DFS) in HCC patients with low AFP concentration (HR: 1.96, 95% CI: 1.24–3.10, p = 0.004; HR: 2.53, 95% CI: 1.09–5.89, p = 0.03, respectively). Furthermore, subgroup analysis revealed that the prognostic effects of high pre-treatment serum AFP-L3% on OS and DFS in HCC patients with high AFP concentration and low AFP concentration were similar (x2 p-value for subgroup differences = 0.47, and 0.41, respectively).
Publication Bias
Publication bias estimate was mainly used to evaluate the reliability of meta-analysis results, especially those showed statistical significance. The assessment of publication bias using Begger's test provided evidence for publication bias in OS(p = 0.001),but not in DFS studies (p = 0.23) (Fig. S1A and S1B), Egger's test was used to provide further statistical evidence; however, the results showed obvious publication bias both in OS and DFS studies (p<0.001 and p = 0.022, respectively).
Tumor invasiveness, metastasis and recurrence often result in poor clinical outcome of HCC patients [27]. Thus, it is important to identify molecular predictive markers for prognosis and for monitoring metastatic recurrence, which is helpful in selecting therapeutic strategies and can also improve survival of HCC patients. However, there are no widely accepted serologic markers associated with tumor progression, invasion and recurrence of HCC that are useful for the regular surveillance HCC with regard to treatment and outcomes. One candidate marker for the progression and prognosis of HCC is AFP-L3 [6], [28]. Although the association of pre-treatment AFP-L3 with tumor development and progression has been explored for several years, yet the available data have not been analyzed comprehensively till now. Considered as a valuable tool in biomarker validation, a meta-analysis was carried out to study the predictive value of high pre-treatment serum AFP-L3% on the prognosis of HCC patients.
In this meta-analysis, we firstly evaluated the association of elevated pre-treatment serum AFP-L3% levels with OS and DFS in HCC. Many reports have shown that AFP-L3 status is an independent prognostic factor in patients with HCC [29]–, the elevation of it indicated poor prognosis and decreased survival rates. The results of eight studies[8]–[10], [18], [19], [22], [26] included in this meta-analysis shown that elevated preoperative AFP-L3 was an independent predictor of OS or DFS for HCC, while another four included studies [17], [21], [24], [25] reported the opposite results. The pooled results demonstrated that high pre-treatment serum AFP-L3 levels significantly predicted poor OS and DFS for HCC (p<0.00001, p<0.00001, respectively), which may serve as an independent prognostic factor in patients with HCC. Although the analysis results were positive, the reasons for the differences of OS and DFS among HCC patients with high and low serum AFP-L3 levels were still unclear. It is worth noting that many factors were usually correlated with poor prognosis of HCC, such as tumor invasion, metastasis, extent of cirrhosis, and treatment methods. Unfortunately, the relation between pre-treatment serum AFP-L3% levels and tumor invasion, metastasis and other clinicopathological parameters (such as tumor grade, stage, and cirrhosis) reported in those studies were not reliable, so we failed to estimate the association between pre-treatment serum AFP-L3% and those factors and can not determine the influence of these factors related to AFP-L3 level and OS or DFS. In this study, the subgroup analyses showed that high serum AFP-L3% levels was also significantly related with OS and DFS in HCC treated by surgical resection (p = 0.0004, p = 0.0004, respectively), RFA (p<0.0001, p = 0.02, respectively), or multiple treatment (p<0.00001, p = 0.0004, respectively). Furthermore, AFP-L3% levels were not found significantly different for surgically and non-surgically treated groups. Intriguingly, AFP-L3% was found to be a useful prognostic marker in AFP negative HCC [9], [19]. We also noticed that the AFP-L3% level obtained by conventional measurement methods is unstable or even undetectable in cases with low AFP concentration. Most recently, a novel automated immunoassay for AFP-L3 has been developed [34], [35], which enabled us to overcome this difficulty and showed that AFP-L3% was closely related to poor prognosis even in AFP negative HCC. In this meta-analysis, there are only two studies and one study respectively providing relevant data on the correlation of AFP-L3 with low AFP concentration on OS and DFS. The summary HRs of OS and DFS suggested that high pre-treatment serum AFP-L3% levels indicated a poor prognosis for patients with AFP negative HCC. Although the subgroup analysis revealed that the prognostic effects of high serum AFP-L3% on OS and DFS in HCC patients were similar for highly sensitive and conventional AFP-L3 detection method (x2 p-value for subgroup differences >0.05), there was a trend that the summary HR on DFS from eligible studies on highly sensitive AFP-L3 detection method was distinct from the conventional AFP-L3 detection method, supporting the predictive value of highly sensitive AFP-L3 detection method on DFS (x2 p-value for subgroup differences = 0.08). Thus, whether the highly sensitive AFP-L3 detection method were superior to conventional AFP-L3 detection method in predicting HCC prognosis remained to be investigated by further studies.
Recently, des-γ-carboxy prothrombin (DCP),one of tumor markers specific to HCC, has also been widely used to predict early postoperative recurrence and poor prognosis [21], [36], [37]. Ten of studies included in this meta-analysis also assessed the prognostic significance of DCP in HCC. Thus, we combined the data of DCP and compared its prognostic value with AFP-L3 for HCC. The results in this meta-analysis suggest that serum AFP-L3% may have better prognostic value than serum DCP for the HCC (data not shown). However, whether the combination of AFP-L3 with other markers will have an improved predictive ability for estimating survival in HCC remained to be assessed by further studies.
Although we assessed comprehensively the prognostic significance of pre-treatment AFP-L3% in HCC, some limitations in our meta-analysis should be discussed. Firstly, potential language and risk bias may exist in this systematic review, because positive study results were more often published than negative ones and we only sought reports written in English. In addition, although we tried to identify all relevant information, some missing data were still unavoidable. Furthermore, our publication bias estimate using both Begger's plot and Egger's test showed that publication bias exists in studies on high serum AFP-L3 levels associated with OS and RFS. Secondly, aetiological bias was a concern, because most of the cohorts of eligible studies were hepatitis C virus-related HCC. Hence, we cannot know if AFP-L3 has the same performance in hepatitis B virus-related HCC. Thirdly, five retrospective studies [8], [17], [18], [24], [25] included in this meta-analysis. Although the results of both prospective and retrospective design subgroup analysis shown that high pre-treatment serum AFP-L3% implied poor OS and DFS without significant heterogeneity in the data (p-value for overall effect <0.05), validation of the prognostic value of AFP-L3% in HCC in more prospective studies is required. In addition, liver cirrhosis, tumour stage and Portal Vein Tumor Thrombus (PVTT) were considered to be related to clinical outcomes in HCC patients. Unfortunately, the relation of high pre-treatment serum AFP-L3% and these important prognostic factors in HCC were not evaluated in this meta-analysis due to incomplete data. Finally, although the results of this meta-analysis suggested that pre-treatment AFP-L3% may have significant prognostic value in HCC patients with low AFP concentration, the external validity of results and applicability requires more studies to be done, because only two studies assessed the prognostic value of AFP-L3% in HCC with low AFP concentration in our meta-analysis. Therefore, we suggest that our results should be interpreted cautiously.
In conclusion, our meta-analysis suggested that high pre-treatment serum AFP-L3% levels indicated a poor prognosis for patients with HCC, and pre-treatment AFP-L3 may have significant prognostic value in HCC patients with low AFP concentration.
Supporting Information
Figure S1 A.
Bias assessment plots for studies (OS) included in our meta-analysis. B. Bias assessment plots for studies (DFS) included in our meta-analysis.
Checklist S1.
PRISMA Checklist.
We thank for all the patients and clinical investigators who are involved in the studies selected in this systematic review and meta-analysis. The authors gratefully acknowledge Xianming Xu from Dalhousie University for polishing the manuscript.
Author Contributions
Conceived and designed the experiments: JC WW BW YL. Performed the experiments: JC WW YZ XL ZW. Analyzed the data: JC WW YL BW. Contributed reagents/materials/analysis tools: JC WW YZ ML ZL. Wrote the paper: JC WW BW YL.
- 1. Siegel R, Naishadham D, Jemal A (2013) Cancer statistics, 2013. CA Cancer J Clin 63: 11–30. doi: 10.3322/caac.21166
- 2. Tang ZY, Ye SL, Liu YK, Qin LX, Sun HC, et al. (2004) A decade's studies on metastasis of hepatocellular carcinoma. J Cancer Res Clin Oncol 130: 187–196.
- 3. Bruix J, Sherman M, Llovet JM, Beaugrand M, Lencioni R, et al. (2001) Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol 35: 421–430. doi: 10.1016/s0168-8278(01)00130-1
- 4. Forner A, Llovet JM, Bruix J (2012) Hepatocellular carcinoma. Lancet 379: 1245–1255. doi: 10.1016/s0140-6736(11)61347-0
- 5. Koike Y, Shiratori Y, Sato S, Obi S, Teratani T, et al. (2001) Des-gamma-carboxy prothrombin as a useful predisposing factor for the development of portal venous invasion in patients with hepatocellular carcinoma: a prospective analysis of 227 patients. Cancer 91: 561–569. doi: 10.1002/1097-0142(20010201)91:3<561::aid-cncr1035>3.0.co;2-n
- 6. Song BC, Suh DJ, Yang SH, Lee HC, Chung YH, et al. (2002) Lens culinaris agglutinin-reactive alpha-fetoprotein as a prognostic marker in patients with hepatocellular carcinoma undergoing transcatheter arterial chemoembolization. J Clin Gastroenterol 35: 398–402. doi: 10.1097/00004836-200211000-00008
- 7. Zhang XF, Lai EC, Kang XY, Qian HH, Zhou YM, et al. (2011) Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein as a marker of prognosis and a monitor of recurrence of hepatocellular carcinoma after curative liver resection. Ann Surg Oncol 18: 2218–2223. doi: 10.1245/s10434-011-1613-7
- 8. Saito Y, Shimada M, Utsunomiya T, Morine Y, Imura S, et al. (2012) Prediction of recurrence of hepatocellular carcinoma after curative hepatectomy using preoperative Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein. Hepatol Res 42: 887–894. doi: 10.1111/j.1872-034x.2012.01004.x
- 9. Kobayashi M, Kuroiwa T, Suda T, Tamura Y, Kawai H, et al. (2007) Fucosylated fraction of alpha-fetoprotein, L3, as a useful prognostic factor in patients with hepatocellular carcinoma with special reference to low concentrations of serum alpha-fetoprotein. Hepatol Res 37: 914–922. doi: 10.1111/j.1872-034x.2007.00147.x
- 10. Beppu T, Sugimoto K, Shiraki K, Tameda M, Kusagawa S, et al. (2010) Clinical significance of tumor markers in detection of recurrent hepatocellular carcinoma after radiofrequency ablation. Int J Mol Med 26: 425–433. doi: 10.3892/ijmm_00000482
- 11.
Wells GA, Shea B, O'Connell D, Peterson J, Welch V, et al..(1999) The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Available: http://www.ohri.ca/programs/clinical_epidemiology/oxford_web.ppt. Accessed 26 May 2013.
- 12. Reeves BC, Higgins J, Ramsay C, Shea B, Tugwell P, et al. (2013) An introduction to methodological issues when including non-randomised studies in systematic reviews on the effects of interventions. Res Syn Meth 4: 1–11. doi: 10.1002/jrsm.1068
- 13. Liu J, Ma Q, Zhang M, Wang X, Zhang D, et al. (2012) Alterations of TP53 are associated with a poor outcome for patients with hepatocellular carcinoma: evidence from a systematic review and meta-analysis. Eur J Cancer 48: 2328–2338. doi: 10.1016/j.ejca.2012.03.001
- 14. Parmar MK, Torri V, Stewart L (1998) Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints. Stat Med 17: 2815–2834. doi: 10.1002/(sici)1097-0258(19981230)17:24<2815::aid-sim110>3.0.co;2-8
- 15. Thompson SG, Higgins JP (2002) How should meta-regression analyses be undertaken and interpreted? Stat Med 21: 1559–1573. doi: 10.1002/sim.1187
- 16. Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315: 629–634. doi: 10.1136/bmj.315.7109.629
- 17. Takeji S, Hirooka M, Koizumi Y, Tokumoto Y, Abe M, et al. (2013) Des-gamma-carboxy prothrombin identified by P-11 and P-16 antibodies reflects prognosis for patients with hepatocellular carcinoma. J Gastroenterol Hepatol 28: 671–677. doi: 10.1111/jgh.12076
- 18. Kobayashi M, Hosaka T, Ikeda K, Seko Y, Kawamura Y, et al. (2011) Highly sensitive AFP-L3% assay is useful for predicting recurrence of hepatocellular carcinoma after curative treatment pre- and postoperatively. Hepatol Res 41: 1036–1045. doi: 10.1111/j.1872-034x.2011.00858.x
- 19. Nouso K, Kobayashi Y, Nakamura S, Kobayashi S, Takayama H, et al. (2011) Prognostic importance of fucosylated alpha-fetoprotein in hepatocellular carcinoma patients with low alpha-fetoprotein. J Gastroenterol Hepatol 26: 1195–1200. doi: 10.1111/j.1440-1746.2011.06720.x
- 20. Toyoda H, Kumada T, Tada T, Niinomi T, Ito T, et al. (2012) Prognostic significance of a combination of pre- and post-treatment tumor markers for hepatocellular carcinoma curatively treated with hepatectomy. J Hepatol 57: 1251–1257. doi: 10.1016/j.jhep.2012.07.018
- 21. Toyoda H, Kumada T, Kaneoka Y, Osaki Y, Kimura T, et al. (2008) Prognostic value of pretreatment levels of tumor markers for hepatocellular carcinoma on survival after curative treatment of patients with HCC. J Hepatol 49: 223–232. doi: 10.1016/j.jhep.2008.04.013
- 22. Fukuda H (1998) Tumor vascularity and lens culinaris agglutinin reactive alpha-fetoprotein are predictors of long-term prognosis in patients with hepatocellular carcinoma after percutaneous ethanol injection therapy. Kurume Med J 45: 187–193. doi: 10.2739/kurumemedj.45.187
- 23.
Shiina S, Tateishi R, Arano T, Uchino K, Enooku K, et al.. (2012) Radiofrequency ablation for hepatocellular carcinoma: 10-year outcome and prognostic factors. Am J Gastroenterol 107: 569–577; quiz 578.
- 24. Shiozawa K, Watanabe M, Wakui N, Ikehara T, Iida K, et al. (2009) Risk factors for the local recurrence of hepatocellular carcinoma after single-session percutaneous radiofrequency ablation with a single electrode insertion. Mol Med Rep 2: 89–95. doi: 10.3892/mmr_00000067
- 25.
Leerapun A, Suravarapu SV, Bida JP, Clark RJ, Sanders EL, et al.. (2007) The utility of Lens culinaris agglutinin-reactive alpha-fetoprotein in the diagnosis of hepatocellular carcinoma: evaluation in a United States referral population. Clin Gastroenterol Hepatol 5: 394–402; quiz 267.
- 26. Tamura Y, Igarashi M, Kawai H, Suda T, Satomura S, et al. (2010) Clinical advantage of highly sensitive on-chip immunoassay for fucosylated fraction of alpha-fetoprotein in patients with hepatocellular carcinoma. Dig Dis Sci 55: 3576–3583. doi: 10.1007/s10620-010-1222-5
- 27. Tung-Ping Poon R, Fan ST, Wong J (2000) Risk factors, prevention, and management of postoperative recurrence after resection of hepatocellular carcinoma. Ann Surg 232: 10–24. doi: 10.1097/00000658-200007000-00003
- 28. Yamashita F, Tanaka M, Satomura S, Tanikawa K (1996) Prognostic significance of Lens culinaris agglutinin A-reactive alpha-fetoprotein in small hepatocellular carcinomas. Gastroenterology 111: 996–1001. doi: 10.1016/s0016-5085(96)70067-7
- 29. Aoyagi Y, Isokawa O, Suda T, Watanabe M, Suzuki Y, et al. (1998) The fucosylation index of alpha-fetoprotein as a possible prognostic indicator for patients with hepatocellular carcinoma. Cancer 83: 2076–2082. doi: 10.1002/(sici)1097-0142(19981115)83:10<2076::aid-cncr5>3.0.co;2-l
- 30. Hayashi K, Kumada T, Nakano S, Takeda I, Sugiyama K, et al. (1999) Usefulness of measurement of Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein as a marker of prognosis and recurrence of small hepatocellular carcinoma. Am J Gastroenterol 94: 3028–3033.
- 31. Oka H, Saito A, Ito K, Kumada T, Satomura S, et al. (2001) Multicenter prospective analysis of newly diagnosed hepatocellular carcinoma with respect to the percentage of Lens culinaris agglutinin-reactive alpha-fetoprotein. J Gastroenterol Hepatol 16: 1378–1383. doi: 10.1046/j.1440-1746.2001.02643.x
- 32. Tateishi R, Shiina S, Yoshida H, Teratani T, Obi S, et al. (2006) Prediction of recurrence of hepatocellular carcinoma after curative ablation using three tumor markers. Hepatology 44: 1518–1527. doi: 10.1002/hep.21408
- 33. Miyaaki H, Nakashima O, Kurogi M, Eguchi K, Kojiro M (2007) Lens culinaris agglutinin-reactive alpha-fetoprotein and protein induced by vitamin K absence II are potential indicators of a poor prognosis: a histopathological study of surgically resected hepatocellular carcinoma. J Gastroenterol 42: 962–968. doi: 10.1007/s00535-007-2117-x
- 34. Kawabata T, Wada HG, Watanabe M, Satomura S (2008) Electrokinetic analyte transport assay for alpha-fetoprotein immunoassay integrates mixing, reaction and separation on-chip. Electrophoresis 29: 1399–1406. doi: 10.1002/elps.200700898
- 35. Kagebayashi C, Yamaguchi I, Akinaga A, Kitano H, Yokoyama K, et al. (2009) Automated immunoassay system for AFP-L3% using on-chip electrokinetic reaction and separation by affinity electrophoresis. Anal Biochem 388: 306–311. doi: 10.1016/j.ab.2009.02.030
- 36. Fujiyama S, Tanaka M, Maeda S, Ashihara H, Hirata R, et al. (2002) Tumor markers in early diagnosis, follow-up and management of patients with hepatocellular carcinoma. Oncology 62 Suppl 157–63. doi: 10.1159/000048277
- 37. Toyoda H, Kumada T, Kiriyama S, Sone Y, Tanikawa M, et al. (2006) Prognostic significance of simultaneous measurement of three tumor markers in patients with hepatocellular carcinoma. Clin Gastroenterol Hepatol 4: 111–117. doi: 10.1016/s1542-3565(05)00855-4


text:
Rent Anarchism in the Chinese Revolution 1st edition today, or search our site for other textbooks by Arif Dirlik. Every textbook comes with a 21-day "Any Reason" guarantee. Published by University of California Press.
Need help ASAP? We have you covered with 24/7 instant online tutoring. Connect with one of our tutors now.


text:
A federal judge has rejected demands to eliminate toll increases imposed last summer at bridge and tunnel crossings in New York and New Jersey, saying lawyers had failed to back up claims that a bistate agency that raised them was using increased revenues for other projects including the new World Trade Center.
Judge Richard Holwell said in a written ruling that it seemed unlikely that the lawsuit challenging the increases imposed in September will succeed. Still, he allowed the lawsuit to proceed, saying additional evidence can be gathered before he makes a final ruling.
AAA of New York and New Jersey brought the lawsuit against the Port Authority of New York and New Jersey, saying the Port Authority is spending toll revenue on the rebuilding of the World Trade Center. It cited a ruling in another case in which a court found that it was unconstitutional that a fee imposed on ferry passengers between Bridgeport, Conn., and Port Jefferson, N.Y., subsidized services with no actual or potential benefit to ferry passengers.
The judge, though, said the Port Authority has provided financial analyses "strongly suggesting that no toll increases are, or will be, used for the World Trade Center."
Holwell said AAA lawyers had "offered insufficient evidence to counter the Port Authority's financial analyses."
Staten Island Assemblywoman Nicole Malliotakis (R,C-Brooklyn/Staten Island) and the borough's Republican Congressman, Michael Grimm submitted an amicus brief last fall supporting AAA's argument.
"While the judge's ruling does not grant a preliminary injunction to roll back the tolls immediately, we're pleased that the suit was not dismissed and the case will move forward," Ms. Malliotakis said. "AAA will now have an opportunity to conduct discovery so the court can truly determine whether or not these toll increases were illegal. This fight is far from over."
Said Grimm: "The judge stated what everyone already knew: that the Port Authority is doing a great job of hiding their true intentions for what they'd like to use toll revenue for, which is - as the PA publicly stated - speculative real estate development in lower Manhattan. This ruling further underscores the need for federal legislation and involvement, which is why I have taken action with Senator Lautenberg to introduce the Commuter Protection Act. We must restore greater oversight to the Port Authority to stop these unjust toll hikes, ensure that the PA's funds are no longer mismanaged, and put the people of Staten Island first."
The toll hikes have struck at the heart of an issue that has long been a sore point among Staten Islanders. Many have placed the blame squarely on Gov. Andrew Cuomo, who has been cast as out of touch on the issue, especially since he granted toll relief to residents of the Rockaways who use the MTA's Cross Bay Bridge. Cuomo also trumpeted a plan that reduces tolls for those who take the Port Authority bridges 10 or more times a month, but so far, only a small percentage of Staten Island E-ZPass users have signed up. And that plan does nothing for those who make the trip to New Jersey once or twice a week.
The judge said it would be an "extraordinary and drastic remedy" to roll back the toll increases before both sides can study additional evidence.
Marta Genovese, a spokeswoman for AAA New York, said: "We are pleased that the Court recognized that the financial information submitted by the Port Authority had never been previously disclosed to the public and are looking forward to the opportunity to support our claims with more than just the documents available on the Authority's website."
In a statement, the Port Authority said it was pleased with the ruling.
"The Port Authority has stated all along that the AAA's lawsuit is without merit," it said.


text:
You've probably heard the news that the chemical bisphenol-A (BPA), used to make the plastic in baby bottles and water bottles might be bad for us humans. Now, Canada is about declare BPA "toxic", causing a ripple affect across the once BPA-happy industry. Nalgene will stop making BPA-containing bottles, and REI is pulling them from their shelves.
Add this news to plastic's already soured reputation for being environmentally rubbish and you have whole new market on your hands. Aluminium Sigg bottles are already a hit here in the UK and Trailspace.com is featuring a whole article on aluminum, stainless steel and BPA-free plastic bottles.
But while you're considering plastic alternatives, consider NOT adding your Nalgene bottle to a landfill just yet. You might as well use it while you have it. This article in Spiked explains why the latest research into BPAs, mostly studied on animals, is not at all conclusive when it comes to humans.
The [US government's National Toxicology Program] report references several studies of low-dose BPA effects, but also notes that they have been less than definitive because of 'insufficient replication by independent investigators, questions on the suitability of various experimental approaches, [and] relevance of the specific animal model used for evaluating potential human risks'. More crucially, many of the low-dose studies of BPA have failed to establish a clear link between the dose of BPA and an adverse health impact, a fact that clearly undermines the claim that low doses of BPA in animals have any relevance to humans.
Furthermore, if you haven't been putting boiling water in your bottle, then your BPA exposure may be relatively low. According to Trailspace:
A recent study by University of Cincinnati scientists showed that liquid temperature, not a container's age, has the most impact on how much BPA is released. When the same new and used polycarbonate drinking bottles were exposed to boiling hot water, BPA was released 55 times more rapidly than before exposure to hot water.
But the news ain't all bad. Scientists at the Missouri University of Science and Technology are constructing new breeds of biodegradable plastic using new polymers that incorporate renewable resources, such as polylactic acid, which is created by fermenting starch. Sound technical? It is.
As polylactic acid degrades, the material reacts with water to decompose into small molecules, which are then mineralized into water and carbon dioxide.
"In general, the main end products of polymer degradation are water and carbon dioxide," Shahlari explains. "Polylatic acid has the potential of replacing the regular water bottles, and we anticipate that our research could be incorporated into that field too.
Great idea, though I fear that biodegradable water bottles could just mean more bottles on the market. I mean, it's still trash after all. Me, I'll stick with the three year-old water bottle that came free with my bike.
A plastic ban for dummies, Spiked
Building a Better Water Bottle: Aluminum, Steel, and No BPA, Trailspace.com
Making Environmentally Friendly Plastics, ScienceDaily


text:
Oscar's unwritten rules
February 4, 2010 At least when they play the Super Bowl, everyone knows the rules. more »»
Dyer straight
January 28, 2010 Not all of today's movie stars are blue. Despite the box-office-busting performance of "Avatar," there's still room for normal flesh-colored actors. more »»
Avatar nation
January 21, 2010 Every time they played the theme music for the Golden Globes ceremony Sunday night, the same question kept popping into my mind: Where's Jack? Sitting in the front row, the... more »»
Everyone's a critic
January 7, 2010 W ith "Avatar," Sherlock Holmes and Sandra Bullock powering down the home stretch, the movies finished their best year in history, topping the $10 billion mark at the box office. more »»
Making the Scene in 2009
December 31, 2009 This is the time of year that movie studios acknowledge the fact that life is messy, instead of trotting out the latest superhero to pretend it's not. (Jan. more »»
Screen savers of 2009
December 24, 2009 In hindsight, it probably wasn't such a good idea to see "Avatar" and "The Hurt Locker" back to back. more »»
'Tis the season to be foxy
December 10, 2009 As soon as he said, "I used to be a chicken thief, but now I'm a newspaper columnist," I knew I liked Mr. Fox. It wasn't just our shared profession. more »»
Just ol' Kris
December 3, 2009 'It's as hard on you as it is on me," says Kris Kristofferson with a laugh at the other end of the phone line, as I warn him he's probably heard these interview questions before. more »»
Reel women
November 26, 2009 Her name won't come up in many prayers around Thanksgiving tables today, but Sandra Bullock is something to be thankful for. more »»
Sinking ships
November 19, 2009 It took a leap of faith to go see "2012" on Friday the 13th. Watching the apocalypse is bad enough ... having an accident on the way home would be the icing on the cake. more »»
Old goats, new tricks
November 12, 2009 Being a skeptical kind of guy, I've never been inclined to delve deeply into astrology. But this could be because I'm a Capricorn. more »»
Scary is scary
November 5, 2009 It's normally a quiet place, but once a year — on Halloween — the street where I live becomes ground zero. more »»
Where's Amelia?
October 29, 2009 Some people think it's eccentric that I use the road by the airport runway whenever I drive between town and my home Upcountry. more »»
Vienna Teng
October 29, 2009 Working as a Silicon Valley software designer, Vienna Teng sometimes imagined a more creative life beyond the confines of her computer cubicle. more »»
Parents behaving badly
October 22, 2009 It was sheer coincidence that "Where the Wild Things Are" opened the same weekend the nation was up in the air with "balloon boy. more »»
Comedy of last resort
October 15, 2009 Although they're the most famous lovers in history, Romeo and Juliet weren't around long enough to discover one basic truth on the subject: True love gets boring. more »»
The invention of zombies
October 8, 2009 Zombies — you can't live with 'em, you can't live without 'em. At least not at the movies. more »»
October 1, 2009 Sometimes they're people. Sometimes they're robots. Sometimes they're animated, sometimes they're holograms. Sometimes they're cute animals that can talk. more »»


text:
2007 MacMurray Ranch Pinot Noir Sonoma Coast
Begin Your Search
WineAccess Travel Log
Read stories from the world's greatest wine trails.
More About This Wine
Related Products
Additional Vintages
Other Wines from this Producer and Vintage
2007 MacMurray Ranch Pinot Noir Sonoma Coast
Producer: MacMurray Ranch
Style: Red Wine
Grape Type: Pinot Noir
Origin: California
Region: Sonoma
85 Points | Connoisseurs' Guide to California Wine
88 Points | Robert Parker's The Wine Advocate
Your Rating & Review
3 Member RatingsAverage Member Rating: 4.66 out of 5 stars
|5 stars
|4 stars
|3 stars
|2 stars
|1 stars
Member Notes
My Favorite Low-Cost Pinot Noir
by Gross13781861
Great Pinot Noir for the money. Better than it Central Coast brethern, and better (fruitier, sweeter) bouquet than Cambria's Julia Vineyard competitor for about the same money. Can't go wrong with either the 2006 or 2007.


text:
Florida is the only state in the continental U.S. where leatherback turtles regularly nest.
With the exception of a few nests on the west coast, leatherbacks nest almost exclusively on the east coast of Florida. In fact, about 50 percent of leatherback nesting occurs in Palm Beach County.
Leatherback sea turtles are named for their rubbery shell and are the largest sea turtles. Adults can weigh between 700 and 2,000 pounds and reach 4 to 8 feet in length.
Leatherback nesting in Florida occurs from April through July. A female will nest at intervals of two to three years, laying between six to nine nests per season. They lay about 80 fertilized eggs and then cover them with a layer of about 30 unfertilized eggs. This layer serves as protection from predators like birds and raccoons and also regulates the temperature.
View Statewide Leatherback Nesting Data (25 KB)
FWC Facts:The Gulf sturgeon spawns 140 miles upstream from the mouth of the Suwannee River, one of the last pristine rivers with no dams to bar its path.
Learn More at AskFWC
Get FWC News Feeds
Copyright 1999-2016 State of Florida • Technical Help •
EEO/AA/ADA • Privacy Statement • Advertising Statement & Disclaimer • Site Map
Florida Fish and Wildlife Conservation Commission • Farris Bryant Building
620 S. Meridian St. • Tallahassee, FL
32399-1600 • (850) 488-4676
Pursuant to section 120.74, Florida Statutes, the Fish and Wildlife Conservation Commission has published its 2016 Agency Regulatory Plan.
Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing..
Employee Resources (Password required)
Intranet Portal | Outlook E-Mail | Retiree Info
Disaster Information for FWC Employees


text:
Twenty of the world's top adventurers share the dazzling new frontiers they've discovered, as well as their all-time classic trips to add to your list. Plus: Don't miss the must-have gear they take on every trip. —Kate Siber
Photograph by Paul Nicklen, National Geographic
Photographer and Polar Conservationist
"Most people, when they think diving, they think Hawaii or Thailand," says Nicklen. Most people don't think of British Columbia, but they should, he says. "There's nothing that compares to the density of life underwater anywhere else in the world."
Just off of Vancouver Island, there are walls and kelp beds full of life, currents that reach 15 knots, attracting large pelagic fish, and a summer algae bloom. The water, of course, is cold, but for experienced divers willing to brave the 50ºF temperatures, it's an untapped, people-free kingdom of gigantic animals.
"It's just life stacked on top of life," Nicklen says. "We've got 15-foot-long six-gilled sharks, we've got Steller sea lions, we've got incredible populations of dolphins, and if you go offshore a bit you get great white sharks, sunfish, and tuna. It's the richest diving area in the world."
God's Pocket Resort, located on Hurst Island east of British Columbia's Vancouver Island, guides divers to sites in the Queen Charlotte Strait, where they can see marine life from king crab and octopus to whales and schools of dolphins.
Athlete Bio
Photographer and Polar Conservationist
For a good shot, Canadian photographer, diver, and polar adventurer Paul Nicklen has braved minus 40ºF temperatures, dived under Antarctic ice to mingle with deadly leopard seals, and endured soggy months in northern rain forests looking for the elusive white bears of British Columbia. His work specializes in the effects of climate change on polar regions and has garnered over a dozen awards from major press organizations.
Paul Nicklen's Gear Pick
Sony Digital Noise Canceling Headset
For Nicklen, the racket of thousands of penguins is nothing in comparison to the cacophony of people and children in an airplane. "It's human noise that drives me crazy, so the one thing I make sure I have everywhere I go is music and noise-canceling headsets, so I can tune out the rest of the world." His favorite pair is Sony's Digital Noise Canceling Headset, and his favorite tune-out music? "Johnny Cash and Bruce Springsteen are my favorites."


text:
Women's Golf at MAC Championships Friday
Ball State's women's golf team will compete at the Mid-American Conference Championships at The Hawthorns Golf and Country Club in Fishers, Ind., Friday through Sunday.
Joining the Cardinals at the MAC Championships are Akron, Bowling Green, Eastern Michigan, Kent State, Northern Illinois, Ohio, Toledo and Western Michigan.
The event is a 54-hole tournament with the first 18 holes scheduled for 8:30 a.m. tee times Friday. Saturday's second round will feature 8:30 a.m. tee times as will Sunday's final round. Tee times are scheduled each day between 8:30 and 10:50 a.m.
Ball State, under the direction of head coach Katherine Mowat, will begin Friday with the 8:30 through 9:10 a.m. tee times at The Hawthorns.
The Cardinals lineup will include Jenna Hague, Autumn Duke, Zoe Camus, Meghan Perry and Katie Windlan.
The Cardinals managed a second place showing at the 2010 MAC Championships and a third place finish at the 2011 event.


text:
When most people start writing a blog they feel like they've got enough ideas to last forever. Things are often much different a few weeks later when it begins to feel like you've used up all the good ideas. A successful blog is built on a steady stream of content and if you want to prepare yourself for this sort of success you need to come up with enough ideas to sustain your blog for the mon … [Read more...]
Inventive Ways to Find Inspiration for Blog Posts
December 5, 2013 By Leave a Comment


text:
COZIER email@example.com_county.toronto.globe_and_mail 2007-10-11 published
PEIRCE, Thomas
Left us on September 25th, 2007 at his home in Barbados. son of Veronica and the late T. Noël PEIRCE and brother of Betty Anne FERGUSON, Dundas, and Richard (Paula) in Toronto. He leaves his wife Andy, daughter Vickie COZIER (Gregory) and sons James (Gail) and Robert (Rosette) along with six adorable grandchildren. Tom lived the majority of his life in his beloved Barbados and is remembered for his many achievements in his work in the Insurance business and his participation in, and contributions to, the sports of cricket and horse racing. Mostly, however, he showed by his own examples the true meaning of love and caring for others. In this, he stood above all others. In the latter part of his life, Tom faced a health crisis which he fought with determination and dignity. He received great help from the cardiac unit at Toronto General Hospital and particularly Doctor Heather ROSS and her team. Should you care to, Tom would have greatly appreciated you signing your organ donation card and donations in his memory can be made to Doctor Ross' Heart Transplant Research at Toronto General and Western Hospital Foundation at 416-603-5958.
C... Names CO... Names COZ... Names Welcome Home
COZIER - All Categories in OGSPI


text:
Perez Hilton needs to stfu immediately.
viết bởi tip123456 25 Tháng sáu, 2009
Shut The Fuck Up.
The stupid bitch wouldn't STFU so I back handed her one.
viết bởi Sean 25 Tháng mười, 2003
Shut-the-fuck-up: a term used when a normal request for someone to be quiet seems to fall on deaf ears; may be used in either a normal or assertive tone of voice.
Honey, would you be terribly offended if I asked you to please STFU for five minutes?
viết bởi Monkster1 24 Tháng sáu, 2010
STFU means Shut the Fuck up
Matt:I love you
Matt:I really do
Matt:No really!
Corinne:STFU you whore kiss my ass bitch.
Matt:I really do
Matt:No really!
Corinne:STFU you whore kiss my ass bitch.
viết bởi Project X 16 Tháng tư, 2008
One of the few Oriental saints, recognized by the Catholic Church. He watches over some of the most annoying miscreants on mother earth, they are also known as "the never ending talkers" You may also know him as "SHUT THE FUCK UP"
One of our co-workers never did know quite when to shut his mouth, so we always tried to call on St Fu to intervene before we beat him like a red headed step child.
viết bởi cobraglf 01 Tháng mười, 2007
"Stop Trolling For Unicorns": a phrase coined by youtuber wickedshrapnel from his "This gun f-ing sucks" videos. This was originally made as a response to when he would make a tgfs video on a gun that someone thinks the opposite way about the gun and would decide to post an annoying comment on how the gun does NOT suck.
youtuber1:" OMFG THE HK21 DOES NOT SUCK IT IS BEASTLY YOU'RE JUST A FAGGOT WHO CAN'T USE THE GUN!!!!"
youtuber2: "will you stfu, you must have no life."
youtuber2: "will you stfu, you must have no life."
viết bởi sirkd0202 18 Tháng chín, 2011
Stfus means
1. Shut the fuck up, stupid.
"Can you please do me a favor and, shut the fuck up, stupid!"
viết bởi Mirosui Onitsaki 31 Tháng năm, 2005


text:
If you go:
WHAT: Mustard Seed International is presenting a dinner program open to the public to share the story of the Akot Medical Mission in South Sudan.WHEN: 6:30 p.m. Thursday.WHERE: East Cooper Baptist Church, 361 Egypt Road, Mount Pleasant.COST: Free, but reservations are required. Call 388-9314 or email info@mustard seed.org
Mustard Seed origins:
Two Presbyterian missionaries, James and Lillian Dickson, settled in the city of Taipei (today part of Taiwan) in 1927 to run a seminary. But World War II forced them to evacuate the island after years of hard work.After the war, the Dicksons returned, and Lillian became involved in ministry activities that eventually would become Mustard Seed International. The name derives from the Gospel of Matthew, in which Jesus refers to the power of "faith as small as a mustard seed." Her mission was "to present Christ to all we meet, to heal disease and all manner of suffering and to love sincerely and deeply those whose lives we are privileged to touch."In the 1960s, Lillian Dickson began to extend the organization's reach beyond Taiwan. Working with indigenous Christians in other parts of the world. Dickson died in 1983, and the organization began to languish, said President Bill Deans. He took over in 2002 and restructured the organization, which today is active on four continents.
Ann Rao, a short-term team member from Tampa, Fla., and registered nurse, administers medication to a young girl believed to be suffering with cholera.
Life in Sudan
Dr. Clarke McIntosh of Mustard Seed International said he was particularly moved by the determination of young children who have witnessed tragedy, then forged on with life.On one occasion, a mother of two small children died on the way to a hospital in the region. "She died right in front of everybody's eyes," McIntosh said. Her 4-year-old daughter was holding her 1-year-old sibling as a look of horror spread across her face.The transport returned to the Akot Medical Mission to deliver the body to the family. "Everyone is weeping," McIntosh recalled. "Then the 4-year-old takes the 1-year-old off to feed it. This is the picture of Sudan to me."Death is pervasive, and the people of South Sudan have adjusted to it."Instead of any bitterness, they are all very gracious," he said. "It's an amazing culture in that way. They are vocal in their mourning, but the next day they are ready to get back on with life."
When William Deans asked Chief Dut of the Dinka people if he could extend the property of the medical clinic to the little airstrip, the chief thought for a moment before he replied.
"Bill," he said in accented English, "if you can think it, it is yours."
And so the Akot Medical Mission in South Sudan ensured it has easy access to the small aircraft that swoops in with supplies and, periodically, personnel.
Begun in October 2006 by Mount Pleasant-based Mustard Seed International, a Christian, all-volunteer ministry, the Akot clinic has become an all-consuming focus of Deans, Mustard Seed's president, and a vital player in the lives of South Sudan's residents.
Since 2009, its medical director, Dr. Clarke McIntosh, has contended with South Sudan's 25 percent child mortality rate, malnutrition that affects about half the population and a high demand for basic medical care in an impoverished country that lacks infrastructure and basic social services.
Christian faith is what drives Deans and McIntosh. The men are responding to a clear calling, they said, and have devoted themselves to the task at hand: to improve the lives of the region's people and introduce them to the word of God.
Missionary's life
The clinic has served people of all ages, male and female, providing inoculations against disease, treatment for injuries, surgeries for cataracts and other maladies, pre- and postnatal care and, when possible, preventive medicine, according to Deans.
It's the largest project undertaken by Mustard Seed International since its founder, Lillian Dickson, died in 1983. And since Deans took over, it has relied on individual donations and volunteerism. The organization has no payroll, he said.
But it does have friends and collaborators.
Volunteer doctors and nurses have traveled to Akot from the U.S. and other parts of Africa. Volunteers worked together to expand the clinic compound in 2006, laying the foundation, making 1,000 bricks out of dirt with a little cement mixed in and assembling roof trusses from mahogany imported from Uganda and Kenya.
Before Deans joined Mustard Seed in 2002, he had spent many years doing mission work in Africa and Bosnia. He has been associated with the Billy Graham Evangelistic Association since the 1970s and befriended Graham's son, Franklin Graham, who is the longtime president and CEO of the Christian aid organization Samaritan's Purse.
Deans was in Rwanda in 1994 during the civil war, helping on medical missions. The next year, Graham asked him to travel to Bosnia, where the two men wondered at man's inhumanity to man, Deans said. In Rwanda, the Hutu people, armed with machetes and other manual weapons, slaughtered 800,000 Tutsi's with brutal directness. In Bosnia, during the civil war, the violence was a constant, insidious threat, he said. Snipers positioned atop hills fired randomly at Sarajevo's residents, picking them off with detached precision. Bodies would lie in the streets for days, untouched for fear of another sniper attack.
Deans was there to refit the intensive-care unit at Sarajevo Hospital, receiving and coordinating the distribution of supplies, he said. He paid visits to the children's wards and asked a local doctor about conditions there.
"What are some of the things here that children can't be treated for?" Deans wanted to know.
"Everything," the doctor replied.
"What about congenital heart defects, what happens?"
"They just die."
In 1996, Deans met two children, Majo and Nasiha, not more than 10 years old and each with heart failure. Nasiha couldn't walk to school. Majo's lips and fingernails were deep blue; his heart could not pump a sufficient amount of oxygen-rich blood.
Deans, who had connections at the Medical University of South Carolina Children's Hospital, made arrangements to send the two children to Charleston for emergency treatment and secured funding to cover the travel costs from Samaritan's Purse.
Terrified, the children flew to South Carolina for surgery. When Majo woke up, he demanded a mirror. Deans and the hospital staff were bewildered: a mirror? Someone gave him a compact, and when the boy gazed into it, a broad smile stretched across his face.
Later, Deans and the others discovered the significance of that smile: On the airplane, Nasiha had reassured Majo. "After your surgery, your lips will be as pink as mine," she had said. Today, the children are doing well.
Taking charge
The improvised transport of sick children was repeated, and other hospitals started to help, Deans said. By 1998, he had arranged stateside medical care for 65 Bosnian children.
He had been traveling back and forth between the U.S. and Eastern Europe every couple of weeks, finding host families through his church, East Cooper Baptist, and churches in other cities.
In November 1999, exhausted, he returned from Bosnia for the last time. A few months later, he was contacted by someone in Toronto. "We've heard about you," the man told him, then invited him to become president of Mustard Seed International, then a languishing Christian nonprofit based in Pasadena, Calif.
Deans demurred, citing family obligations. But three years later, another invitation came his way from Mustard Seed, this time with a special offer: He could move the headquarters to the Charleston area.
"How can we not do this?" Hope Deans asked her husband. "It's everything the Lord has prepared us to do."
In 2002, Deans took charge, moved the organization to Mount Pleasant. Two years later, a Florida doctor who sat on the board of directors asked if the organization would take over the Akot clinic. Deans traveled to South Sudan, witnessed a medical mission in desperate need of improvement, then returned to recommend that the charity take on a new challenge. In December 2004, the board agreed.
A year was spent planning the upgrade, and crews worked nine months building and furnishing the structures. A construction company from Spartanburg provided consultants; a dozen craftsmen from Kenya worked with about 60 Sudanese laborers. Small planes delivered badly needed supplies. Solar-power generators produced electricity. Cement was mixed by hand. The whole project cost about $1 million, Deans said.
That October, the first volunteer medical team arrived from Dawson Memorial Baptist Church in Birmingham, Ala.
On the ground
Clarke McIntosh of Anderson has felt the pull of Christian mission work since he was an adolescent, he said in a satellite telephone interview. But then a medical career took hold. He attended MUSC and worked in academic medicine and private practice.
In the mid-1990s, he accompanied Deans to Sarajevo on a weeklong mission trip, then returned to his career. More than a decade later, mission work once again was on his mind when Deans asked him to visit the Akot clinic for a couple of weeks to check it out.
It was a perfect fit, McIntosh said. "I enjoy the people. I get the chance to do some teaching and preaching as well as the medical part of it, and I enjoy that aspect. ... I do enjoy being with them, and they respond to someone who enjoys being with them."
When his tenure in Akot began in 2009, the clinic served one to three patients a day, he said. In September this year, the daily average was 25.
"Things have changed a lot," McIntosh said. "The community has really responded to having a doctor here. Nurses have been here and doing a very good job, but having a doctor gives the clinic prestige in the eyes of the community and the eyes of the state."
The challenges are immense, and death is ever-present, he said, but satisfaction abounds.
"It's always very gratifying to see these patients, who are very close to death, who you do bring back," McIntosh said. "And that is a routine event for us here. We've probably, in the last two weeks, have had 12-15 children with cerebral malaria, and without us being here, they would have died. It's not that we're brilliant, anyone else could have treated them." But McIntosh and his team were there and ready.
Much is improvised, he said. McIntosh has become adept at conflict resolution. He has struggled to ensure the operation is sufficiently funded and stocked with medicines and equipment.
The clinic is very much a work in progress, "so it's much more palpable living by faith," he said. Sometimes, "if God does not intervene for us, we're in trouble. I'm put in positions that are just way beyond my experience, way beyond what I know, and I'm learning that I'm just growing inside."
"The biggest single impact is improving the lives of women and children," Mustard Seed volunteer and former MUSC administrator Ed Kaylor said.
Armed with 19,000 doses of the vaccine to protect children from meningitis, the Akot Medical Mission launched a program to combat the deadly infection, Kaylor said.
And the women's prenatal program has helped to keep pregnant women and their unborn babies healthy.
Rose Mayol, who lives in Akot and works at the clinic as a supervisor, is one of thousands served by the medical mission. Growing up in South Sudan has been a struggle, she told a film crew recently.
"In Sudan, I don't know whether it's good or bad, but that's where I grow up and I grow in the time of war, we move from place to place, we run from place to place, but as of now we are independent, we are OK, no fighting anymore, no fear. But the life is still tough, the life is still not good," Mayol said.
Her oldest child, Kout, died of meningitis. When Mayol's 10-year-old daughter Joy also fell ill, she was taken to the Akot clinic, and treated successfully.
"And that makes me to give great thanks to God and the Akot Medical Mission." Mayol herself was treated for an ovarian tumor, first at the clinic and then at a hospital in Tenwek. "Now I am healthy and my prayer is that Akot Medical Mission ... can do wonders and develop, and develop, and grow."
Journal Entry -- 18 February 2010
Clarke McIntosh, Medical Director, Akot Medical Mission, South Sudan
A most discouraging outing to Mapuordit. When I think about it, not many of the outings I have taken to Mapuordit have been encouraging. We have had a couple of mothers have C-sections and successful deliveries, and there is one acute abdomen of which I do not know the outcome, but the rest have been discouraging.
This one began when Elijah dropped into my room during the clinic hours and asked me to take a look at Mary at the end of the wards. She was admitted with abdominal pain and failure to stool for 48 hours. After clinic, I checked on Mary. Her pulse was 150, her BP 90/45 and her abdomen was rigid. I ran in a liter of saline and her pulse did not come down. As I examined her, I noticed a little girl (3-4) carrying a baby (2-3 months), Mary's infant son. That is a very normal Dinka occurrence. Often very young children, around this girl's age, are assigned to care for a younger sibling or cousin. That was very clearly this young Nya's role and she was good at it. I talked with Elijah and we decided to transfer her to Mapuordit with an acute abdomen and bowel obstruction.
As we were discussing this woman, a family came in saying that a woman had delivered the head of her child but could not get the rest out, so Elijah went to get her. Elijah and Mary Aleck (one of our TBA's) went for her and brought her back. She was in labor and fully dilated, but no body parts were showing. We watched both women about two hours and then decided to take them. The woman in labor had been pushing for 3 hours without success. We then learned that she had lost two children in this manner, so we decided to transport both.
As we were getting into the car, I held the baby for Mary, but the Nya looked at me and I transferred the baby to her. She smiled. She has a very pretty smile. There were some U.S.-like problems, however. Though we do not charge our patients, Mapuordit does, so they needed to find this husband and get some gurus (money). That delayed us another half hour and in the end there was no money, but a promise to send some the next day. Finally, we were on our way, but then we realized about 45 minutes down the road that we had forgotten umbilical cord clamps, scissors, and IV fluid. IV fluids are hard to hang in the Land Cruiser because the road is so rough, and we had given Mary a lot of fluid in Akot.
On the trip down, the mother in labor provided all the distractions. She kept moaning and pushing (against our instructions, though I am not sure it matters when those contractions hit). Mary spit a lot, held her baby and nursed her regularly. When she got tired, she handed the baby off to the older sister. I kept expecting Mary to vomit. The road down is hard-baked clay potholes. There are spaces of road between the potholes, and the truth is those spaces may technically be longer, but it feels like one continuous jarring bump. I cannot imagine anything more miserable for a patient with peritonitis.
At one point I was called back to check on the woman in labor. I felt that the head had progressed some, but nothing dramatic, and by that time we were 10 minutes from Mapuordit. Mary appeared sick, weak, but okay. We drove to the pedestrian entrance of Mapuordit hospital. In reality both of our patients needed to get as close to the hospital as possible, but we have had the experience of sitting outside the ambulance entrance blowing the horn for over half an hour, so we made sure we had someone going to help us. We drove in, backed up to the out-patient registration area (theirs is covered) and felt good that we had made it down safely and intact.
Elijah got a wheel chair for the expectant mother, but that was the only one available. As Mary started to climb out of the Land Cruiser, she handed me her child and I again handed him off to his sister. I helped Mary out of the back, along with her sister. She took three or four steps and then went limp. We eased her to the ground and then Elijah and I carried her into the "waiting room," a raised cement platform with cement benches and a roof. (We aspire to have such a waiting room one day.) She started vomiting fecal colored fluid. I went to try to find some IV fluids, but by the time I returned (without the IV fluids), Mary was dead. The baby, of course, started crying, but it was the fear and despair on the face of the older sister as she broke down that touched me the most.
The aunt had a baby almost the same age as Mary's baby. She was trying to console all three of the children. I walked over to labor and delivery and Elijah and the pregnant mother were on the concrete floor, the head this time was out and Elijah was calling to the mother to push. I applied some fundal pressure and the shoulders were delivered, followed by the rest of this 3.1 kg boy (dhok). Besides a severe cone head and slightly low 1 minute APGAR score (4/8 were her APGAR's), the child did well. We dried off the baby and delivered the placenta and then were faced with a dilemma. There was no real reason for the family to stay. It would cost them money to stay there and then they would have to find transportation back. Of course, the other family also needed transportation back. The aunt and young children needed to get back to Akot, and so did the dead body.
Death, particularly death in the hospital, is also a tragedy in the U.S., but it is a sterile tragedy. The doctor goes in to the room where the patient died, we talk about what was tried and what went wrong and I console them. The family cries, grieves over the body, and then those in the funeral business come, take the body and make the arrangements. That is not how it happens in South Sudan.
Mary's body was placed on the mattress where the pregnant woman had lain during the trip down and everyone else (the same crew as coming down) arranged themselves around. I had picked up the dhok and carried him around as they were cleaning mother off and preparing her for the trip back. I handed the dhok to his parents as we got started, but they sent him back to me several minutes later with the request that I hold him. I did not mind. The trip back was quieter, but otherwise the same.
When we got back to Akot, we took Mary's body and family to the home of her sister. As she got close, the aunt started yelling to the neighbors the tragic news and twenty half dressed Dinka women were wailing behind our car as we finally reached the tukul. Elijah and I got out, though there were no English speakers there and neither of us spoke Dinka well enough to say any words of comfort. I could not help but notice the older sister. When everyone else was wailing and comforting one another, her time of crying, at least for the moment, was over. She was carrying her charge on her right hip, doing her best to console him. We did pray (longko) for the family. They did not understand my words, but they did understand the meaning.
As Elijah pulled the Land Cruiser up to the back door of the ward, we heard this brief, regular beat that persisted after the car was turned off. The right rear tire was leaking air in a manner I had never seen before. It was a deflating end to a deflating trip, but I feel that what we did was important and honoring to God.
A Q&A with Dr. Clarke McIntosh
Q: What made you decide to embrace this particular challenge to spend years in South Sudan at the Akot Medical Mission?
A: My first interest in medicine came as a result of feeling some call to missions. My father was fine with me going into missions, but he wanted me to take a useful skill and from there I started considering medicine. But things came up and I got side-tracked. It was some bad times culminating in separation and eventual divorce that opened the door for me to consider missions again. I knew Bill Deans from going to Bosnia together in the late 90s and I found out about the need for a doctor in Mustard Seed Internationals hospital in South Sudan. Bill encouraged me to go over for a week; I opted to go for 3 months instead. I felt a kinship with the nurses and people there from the start. By the end of a month, I had committed for 5 years.
Q: Do you plan to remain there much longer?
A: I have learned the wisdom of James 4:13-15 through experience. Therefore I am cautious in stating what my plans are, but I do hope to be here much longer. I have had a lot of good experiences in medicine, but nothing as rewarding as my work here. I hope to be in South Sudan for the remainder of my life, or at least as long as I am productive. I am sure of this: when I die, South Sudan will still be in need of more doctors.
Q: Could you describe the conditions of the place and its people?
A: Akot is in the geographic center of South Sudan. We are about 8 degrees latitude above the equator and have virtually no elevation, so we are quite warm. We have two seasons: rainy and dry. We have great trees, beautiful birds, and fertile soil. The dominant people group here is the Dinka Agaar. I have heard from 13-20 different sub-tribes of Dinkas. The most famous Dinka is Manute Bol, the 76 center. He is a picture of the Dinkas. In our small village, we probably have 20 people 69 or above, and most are as thin as Manute and very black. Everyone farms in addition to whatever else they do. Cattle are their most prized possession and many of their names come from the color of cows. I find it telling that the Dinkas have one word (arabia) for all forms of vehicles (bicycles, cars, pickups, trucks) and 99 different names for the various colors and patterns of cows. As many challenges that they have from external issues, the greatest problem in South Sudan is revenge.
Q: What sort of staff do you have assisting you?
A: The hospital opened in Oct 2006 and has been staffed by nurses from Kenya. Two of the three original nurses are still there and the third has been there 4 years. They have persisted through years without a doctor. They are bright and dedicated, committed in their personal faith and to the work we are doing and the people they are serving. Their language skills are excellent. We have a fair number of Sudanese staff, helping with translation, maintenance of the buildings and grounds, cooks, pharmacy, accounting, etc. We are hoping soon to start having some Sudanese nursing students.
Q: How much of your time is spent at the clinic and how much is spent making "house calls"?
A: The majority of my time is spent in the clinic and wards. Though we only have official clinics 5 days/week, we find that our weekends are becoming a continual walk in clinic and we have discussed making some changes to adjust to the needs. We do some clinics in surrounding areas. There is a great need for more, but we need more staffing to do that well, and we find transportation and insecurity often as rate limiting steps in those pursuits. We do go to homes in emergencies, and those arise unpredictably.
Q: What's the political situation in South Sudan now that its a country recognized by the U.N.? Has the conflict with the north cooled down? Is assistance (material aid, etc.) making its way into the region?
A: The government in Khartoum appeared cooperative during the referendum and independence, but its true character has not changed. The atrocities are now in the Blue Nile region, Nuba Mountains, and Abyei. The main effect since independence has been the disruption of supplies, causing a substantial increase in the general cost of living (COL): food, fuel, supplies. Because of the bombing in the Nuba Mountains, thousands have fled into South Sudan, creating refugee camps and problems. We feel none of that in our area except for the rise in COL, but there are no palpable positive differences in the lives of the people since independence. Despite that, optimism remains high.
Q: Finally, describe briefly who you are, the connection you have to Charleston and your former experience as a doctor. What do you think you'll be doing 20 years from now?
A: My father is from Charleston. I attended MUSC, graduating in 1981. I was in academic medicine for several years at the University of Alabama at Birmingham and Duke, and then in private practice for a number of years that followed. Though I have enjoyed all phases of medicine, I have never felt the satisfaction I have in Akot. The needs are basic, but we see every week people who would have died without us going home. There are plenty of frustrations in South Sudan as well, but I hope and believe I will continue to be a part of the future of the worlds newest country for a long time to come.
Reach Adam Parker at 937-5902 or on Facebook.
More info:
To view a photo gallery of images from Akot, go to galleries.Visit Mustard Seed International online at www.mustardseed.org.
- Keywords


text:
Medal Of Honor: Pacific Assault + Serial + Keygen
- Type:
- Games > PC
- Files:
- 1
- Size:
- 2.67 GiB (2863232955 Bytes)
- Uploaded:
- By:
- morphaeus08
- Seeders:
- 0
- Leechers:
- 1
- Comments
- 12
- Info Hash: BDCBEBA6EF6562E201C4D430E291FEB2BBBA1029
(Problems with magnets links are fixed by upgrading your torrent client!)
MEDAL OF HONOR: PACIFIC ASSAULT ------------------------------- All 4 discs + Serial + Keygen Enjoy!
Yes it works, its just the disc images plus a serial off the box and a key gen I found on a torrent that works for this game
There is NO included CRACK!
On July 20th, I will stop seeding this file. Hopefully, someone else will continue seeding
Pleese keep seeding guys.
Does anyone know what i'm doing wrong.. I mount the isos using Damon and the autorun goes on. The 1st disk installs correctly, than it asks me for disk no. 2 (including the file data3.cab) and when I mount that one the setup won't recognize it....
Any Idea?
Any Idea?
Failed installation on disc 3.
este juego es la puta ostia
please i need only the crak for this game
thanks morphaeus great game (IT RUNS)...to the guys having trouble heres what i did i got the same error about disk 2 just unmount disk 1 all the way click on disk 2 again the window will pop back up that has the data cab just mimumize it and start the instaler again it will start ,repeat the same steps for each disk and you will be fine mine runs good i beleive the disk are so big you cant run them all on the daemons tool at the same time hope this helps :)
Can anyone tell me if this one includes the movies or not? I've downloaded 3 torrents for that and I dont feel like downloading again and get disappointed. -_-
Nice job, thanks!


text:
February 20, 2012 to April 28, 2012 – Bethesda Home & Retirement Center Calling all crafters, artists, and vendors!! You can sell your items at Bethesda's First Annual Arts & Craft Sale! Date: Saturday, April 28th, 2012 Time: 10a.m. – 3p.m. Location: Bethesda Home's… Organized by Laura Ayento, Donor Development Coordinator | Type: arts, &, craft, fair
April 2, 2012 at 7pm to June 9, 2012 at 8:30pm – The ARC Derby Lite is the edgy new roller skating fitness class that uses the skills and drills of traditional women's roller derby in a non-impact, non-competitive workout environment.Derby Lite in conjunct… Organized by Derby Lite | Type: roller, skating, derby, lite, fitness, women
April 7, 2012 at 10am to April 28, 2012 at 12pm – Oak Park Conservatory "Sugar! Sugar! How Sweet It Is!" Oak Park Conservatory 615 Garfield St. Oak Park, IL. Come to the FREE Exploration Station on Saturdays in April between 10:00 am - noon April topic: "Sugar! Sugar!… Organized by Jane | Type: exploration, station
April 20, 2012 to May 3, 2012 – Lake Theatre The Lake Theatre is pleased to announce the opening of an important documentary called "Bully" (PG-13) on April 20th. Directed by Sundance and Emmy award-winning filmmaker, Lee Hirsch, "Bully" highli… Organized by | Type: movie
April 25, 2012 at 7pm to April 29, 2012 at 5pm – Lake Theater, Pilgrim Congregational Church & Academy of Movement & Music in Oak Park; FitzGerald's SideBar in Berwyn Never before presented in Chicagoland, ReelAbilities Chicago Disabilities Film Festival features award-winning films, thoughtful panel discussions, art and musical performances that celebrate the liv… Organized by Jim Haptonstahl | Type: film, festival
April 26, 2012 from 7pm to 8:30pm – Maze Branch Library, 845 Gunderson, Oak Park, IL 60304 Join the Housing Center, OPALGA, BUNGALO, Weichert Realtors, the City of Berwyn, and the Village of Oak Park for a public forum on new protections and future developments for the LGBT community. Organized by Rob Breymaier | Type: public, forum
April 26, 2012 from 7pm to 9pm – Oak Park Public Library Learn ways to conduct research and use analysis to make investment decisions using Morningstar Investment Research Center. A representative from Morningstar, a leading provider of independent researc… Organized by Adult and Teen Services | Type: money, smart, week, financial, workshop


text:
Please copy any of following code and place on your site or submit on other sites on which you want to share this free movie's information.
#1. Simple Movie Link:
#2. Full Movie Link:
This movie Shocking Asia released on Year 1976 and directed by Rolf Olsen. Story written by Rolf Olsen and Ingeborg Stein Steinbach. Movie Fry brings you Shocking Asia 1976 movie for free to watch or download for free. Shocking Asia is a free documentry to watch online on moviefry which provide us great information about related topic. Shocking Asia Movie show you many horrifying scences which can make you to sleep tight tonight. So Shocking Asia is not for weak hearted persons. Watch Shocking Asia 1976 Movie online for free or download Shocking Asia Movie for free at MovieFry.
For best quality of video and sound of Free "Shocking Asia" Movie we suggest check all the Free Shocking Asia Movie sources links below and select and watch best Shocking Asia Movie source for you and help others by voting sources. Please report those sources which have deleted the movie from their server.
Busting Out (2004)
Global Eugenics: Using Medicine to Kill (2009)
Caress of the Vampire (1996)
Shark Girl (2014)
Hunger (2009)
Stonewall Uprising (2010)


text:
About Us
Submit Press Release
Mobile & Palm
System Utilities
Backup & Restore
EZ Mozilla Backup Pro
Download EZ Mozilla Backup Pro
Backup your Mozilla mail and bookmarks to CD/DVD.
Full Description
File Name:
EZ Mozilla Backup Pro
Primary URL:
Click to download EZ Mozilla Backup Pro
972 Kb
Product Info
EZ Mozilla Backup Pro makes it easy to backup your mail, address book, bookmarks and cookies to a ZIP archive or to CD/DVD and works with the Windows Task Scheduler to provide a completely automated backup solution. The wizard interface makes the program incredibly easy to use and a restore utility is included.
What's new in current version
Added CD/DVD Capabilities
Please contact EZ Mozilla Backup Pro publisher,
if you have questions or issues regarding this product.
View EZ Mozilla Backup Pro full description »
Share Download EZ Mozilla Backup Pro, Backup your Mozilla mail and bookmarks to CD! Page
Page URL:
Featured downloads
Ad-Aware 2008 Free
The bottom line: Ad-Aware is your best option for keeping spyware and adware under control on your PC
Download now!
Google Talk
Google Talk is a simple and free way to talk with and send instant messages to your friends.
Download now!
Motorola Mobile PhoneTools Deluxe
Connect your laptop to your cell phone, use your cell phone as a modem; synchronize cell phone contacts and calendar with your PC. Complete Outlook integration. Create mobile media with ringtone software features, wallpaper and video editing tools.
Download now!
Popular downloads in Backup & Restore
DAEMON Tools Lite
DAEMON Tools is an advanced application for Microsoft Windows which provides one of the best optical media emulation in the industry. DAEMON Tools allows you to use your CD/DVD images as if they were already burned to CD/DVD.
WinBackup 1.86
The backup and recovery solution that awards 100% reliability and superior performance at a click of a button.
Windows Product Key Finder Professional
Windows, Office, Product Key Code Finder Retriever. Utility can recover your CD Product key for Windows or Office programs for the purposes of reinstalling - repairing your Windows or Office setup. Recover lost serial 7 XP 2010 2003 2007
Yahoo Messenger Chat History Viewer
Yahoo chat archive analyzer application search and decode all saved .DAT log file and display all conversation, personal text messages, SMS into readable format with date, time and login name without requiring internet connection and mail password.
Incredimail Backup PRO
- Incredimail Backup PRO can extract your mail from Incredimail in EML format including all attachments - This utility will also enable you to restore all mail which you had removed (even completely deleted mail). Backup mails in zip files.
Transcend USB Drive Recovery Software
Transcend USB drive salvage software restores accidently formatted or corrupted data of USB drive storage media lost due to power failure, virus attack, hardware malfunction and disk corruption during data transfer from USB drive to system.
USB Sim Card Manager
Cellphone sim card recovery software restore accidentally deleted erased formatted text SMS messages, phonebook contact number with name, call history and other services information like 20 - digit ICC-ID number, IMSI number with name and PIN number.
Yahoo Messenger Archive recovery
Yahoo messenger archive decoder allows decoding of yahoo chat archive files. You can easily read the entire chat conversation without logging to yahoo account. It supports all versions of Yahoo! Instant Messenger. It is easy and affordable.
Recovery for Photoshop
Recovery for Photoshop is a powerful data recovery software for damaged Adobe Photoshop image files (.PSD,.PDD). Recovered layers are saved in Windows Bitmap format (.BMP). Original dimensions and color depth are recovered.
Related Press Releases
ABF Outlook Backup 3(point)0 Introduces New Level of Mail Backup
software, Inc. announces today ABF Outlook Backup version3.0, the newest upgrade of its award-winning tool, enabling users to back up andrestore every kind of MS Outlook data from e-mails, contacts and calendars tojournals, tasks or settings. Backed up files can be written directly onto a CD orDVD disk without the use of other applications. In version 3.0, the program gained asignificant...
Advanced Windows 7 Backup Features and Smart Image Backup: Novosoft Released Handy Backup 6.9.2
Alliance, Ohio, December 21, 2010 Novosoft, an acclaimed international software development and IT-consulting company, today announced the holiday season hot deal: Handy Backup 6.9 prices are down. "After a certain amount of official statements for press releases, there is not so much personal in what you say. You just stick to the goal of informing people about new features and...
Christmas Prices on Backup Software: Novosoft Announces Up to 50% Discounts on Handy Backup
Novosoft, one of the world s leading developers of backup solutions for Windows and Linux, launches Winter Holiday Deal to provide customers with up to 50% discounts on their products and services. Alliance, Ohio, December 19, 2012 Novosoft, an international software development company, today announced it will be offering up to 50% discounts on their flagship product Handy Backup....
Disaster Recovery Options for Backup Software: Novosoft Presents Handy Backup 6.9
Alliance, Ohio, November 22, 2010 Novosoft, an acclaimed international software development and IT-consulting company, today announced the release of Handy Backup 6.9, the backup software integrated with advanced data disaster recovery options. "Handy Backup is a software family with a piece of philosophy behind every new product," said Alexander Prichalov, head of the Novosoft...
Novosoft LLC Enhances Its Line of Backup Software with a New Backup and Disaster Recovery Solution
Novosoft, one of the world leading providers of software for files and hard drives backup, today announced the release of a new utility called Handy Backup Disaster Recovery. When installed on a Flash or USB drive, the program allows users to perform easy backup and disaster recovery of compter data even if it's not possible to boot a computer a usual way. Alliance, Ohio, August 31,...
Novosoft Plans to Enhance Its Online Backup Offerings with Handy Backup 6.8
Novosoft, an international software development and IT-consulting company, today announced that the new 6.8 version of Handy Backup will be a major update featuring integration with Novosoft's Online Backup service. Alliance, Ohio, July 7, 2010 Novosoft, one of the leading providers of backup solutions for Windows computers and networks, today announced that users of the upcoming Handy...
Privacy policy
Terms of use
Request review
Copyright @2006-2011, Softarea51.com


text:
Cancer is a disease caused by abnormal cell growth in the bones, organs, or other tissues.
Cells normally divide, grow, and die in an orderly manner. When they grow or divide too quickly, they may form a mass called a tumor, often felt as a lump.
Cancer can also affect cells in other ways. Cancer cells can spread from the site of origin to other organs and tissues throughout the body.
UPMC pathologists study the mechanisms of the origin, maintenance, and spread of cancer. Our research extends to every organ system of the body.
Get Involved
Learn how you can help us help others by supporting our pathology research.
Learn how you can help us help others by supporting our pathology research.
Second Opinions for Providers
If you are a physician looking for a second opinion, please consider the UPMC Digital Pathology Consultation service.
Learn more about UPMC pathology research.
Affiliated with the University of Pittsburgh Schools of the Health Sciences
Supplemental content provided by Healthwise, Incorporated. To learn more, visit www.healthwise.org
For help in finding a doctor or health service that suits your needs, call the UPMC Referral Service at 412-647-UPMC (8762) or 1-800-533-UPMC (8762). Select option 1.
UPMC is an equal opportunity employer. UPMC policy prohibits discrimination or harassment on the basis of race, color, religion, ancestry, national origin, age, sex, genetics, sexual orientation, gender identity, marital status, familial status, disability, veteran status, or any other legally protected group status. Further, UPMC will continue to support and promote equal employment opportunity, human dignity, and racial, ethnic, and cultural diversity. This policy applies to admissions, employment, and access to and treatment in UPMC programs and activities. This commitment is made by UPMC in accordance with federal, state, and/or local laws and regulations.
Medical information made available on UPMC.com is not intended to be used as a substitute for professional medical advice, diagnosis, or treatment. You should not rely entirely on this information for your health care needs. Ask your own doctor or health care provider any specific medical questions that you have. Further, UPMC.com is not a tool to be used in the case of an emergency. If an emergency arises, you should seek appropriate emergency medical services.
For UPMC Mercy Patients: As a Catholic hospital, UPMC Mercy abides by the Ethical and Religious Directives for Catholic Health Care Services, as determined by the United States Conference of Catholic Bishops. As such, UPMC Mercy neither endorses nor provides medical practices and/or procedures that contradict the moral teachings of the Roman Catholic Church.
Pittsburgh, PA, USA UPMC.com


text:
Top Definition
To lunge at a persons testicles with your foot and quickly pronounce "Squid Rape" while in the middle of a boring conversation.
Bob: So yesterday I had a lunchbox at school and...
you: "SQUID RAPE"
Bob: JESUS MY BALLS!!!!
you: "SQUID RAPE"
Bob: JESUS MY BALLS!!!!
dodane przez blackpowermothafucka marzec 17, 2007
Trending Now
Can you define these popular missing words?