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Popping The Question to your Bridesmaids
Will You Be My Bridesmaid?
So your fiancé popped the question, you're engaged and now you're busy as a bee planning your wedding! Time for you to pop the question and to call in the female (or male ala Made of Honor movie) forces by proposing "Will you be my bridesmaid or Maid of Honor?" to your closest friends and loved ones. It's time to pop the question and ask your besties 'Will you be my bridesmaid!' in the most fun, creative and meaningful way possible ??.
As you will undoubtedly be spending tons of precious time together both before and on your wedding day and you'll be relying on your bridesmaids plenty, it's a sweet gesture to spoil them with a thoughtful invitation and gift.
Here are a few memorable ways of popping the question, some with an element of wit, some with a dash of surprise and many meant to be treasured by your bridesmaids as keepsakes of your special day!
Will You Be My Bridesmaid?
Make sure you read our article on how to select your bridesmaids, here. Once you've asked your girls to be their by your side, here is a list of typical bridesmaid duties – as well as a list of maid of honor duties, too!
If this feature inspires you to purchase one of these fun 'will you be my bridesmaid' ideas for your girls, we'll get a small percentage of the sale for sharing them with you. Thank you for supporting our content!
(Above) 1. A "Will you be my maid of honor?" keepsake puzzle that will be a surprise for your intended bridesmaid. Once the puzzle is solved using the few clue letters, it can be framed and cherished as a keepsake after ward. Made from linen and dressed with buttons and feathers. {Available from: Nostalgia At High Tea in California, US at $30.00 USD}
(Above Left) 2. Customisable beer can cosies that reads "I (moustache) you a ?" on one side and "Be my Bridesmaid?" on the reverse within a curvy frame presented on a quirky moustache-patterned background. {Available from: The Monogram Line in Pennsylvania, US at $7.25 USD} | (Above Right) 3. A hand-stained and lace-wrapped "Will You Be My Bridesmaid Box" that can be filled a message inside, sentimental photos and other small meaningful items for a completely personal gift. {Available from: Obsessed With The Nest at $55.00 USD}
(Click here for gorgeous rustic weddings)
(Above) 4. A rustic hand-engraved and stained jewelry box that can be filled with love such as a small gift or note, which can be treasured by your maid of honor or bridesmaids as a keepsake of your wedding. {Available from: PNZ designs in US $55.50 USD}
(Click here for 20 DIY Glitter Wedding Projects)
(Above Left) 5. Stylish and funny 'Will you be my Bridesmaid?' card that shares the bride's promise of bridal wear as pretty as they are! {Available from: Little Lady Company in Illinois, US at $3.95 USD} | (Above Right) 6. A 'Will you be my Bridesmaid?' wine label that includes your bridesmaid's name, details of your wedding and a personalized message that hints at the future shared enjoyment of the wine! {Available from: Lil Shop of Labels in South Carolina, US at $25.00 USD} Oh yes, have a peek at these cute bridesmaid gift ideas to thank them after the big day, too!
(Above) 7. A fun custom crossword puzzle card that pops the question, "Will You Be My Bridesmaid?" in a brain-teaser way! {Available from: Camis Paperie in Virginia, US at $34.99 USD}
(Above) 8. A "Will You My Bridesmaid?" invitation pressie to spoil your girls with! Wrapped with ribbon and adorned with a pretty forget-me-not flower, this unique gift is a wooden spool that unrolls to reveal their names and a secret message hand-stamped on the fabric inside. {Available from: ThePolkaDottedBee in Pennsylvania, US $14.00 USD}
(Above) 9. A rustic-loving 'Be My Bridesmaid/ Maid of Honor?' wooden frame with your bridesmaid or Maid of Honor's name and a dress design engraved on it. Pop a memorable pic of you with each of your best mates in their special frames. {Available from: Prince Whitaker in US at $17.99 USD}
(Above) 10. A sweet and tasty way of asking 'Will You Be My Bridesmaid/ Maid of Honor'. Spoil your bridal party with these delicious marble chocolate candy that spell out the "Big Question"! {Available from: Chocolate Says in US at $104.00 USD}
(Above) 11. If you're throwing a beach wedding, these cute Message In A Bottle invitations for your bridesmaids are ideal! Check out these Beach Themed Wedding Projects & DIY Inspiration for more beautiful beachy ideas. {Available from: Designs By Flory in Colorado, US at $9.00 USD}
(Above) 12. A humorous Maid of Honor card that is as funny as it is true! {Available from: Cheeky Kumquat in Washington, US at $4.00 USD}
(Above) 13. A hand-painted and distressed 'Will you be my Maid of Honor?' keepsake wooden chest that contains a handmade card, which can be used to seal your message to your bridesmaid. Pretty embellishments transforms this box into a treasure chest that can be enjoyed by your bridesmaids for many years after your wedding. {Available from: Shabby Scrap in Colorado, US at $70.00 USD}
(Above) 14. A hilarious 'Will You Be My Bridesmaid/ Maid of Honor?' fold-out card with a cheeky phrase, 'Try to look fat.' on the cover. {Available from: Finch and Hare in US at $5.00 USD}
(Have a look at 20 fun DIY Table Number Ideas here.)
(Above) 15. A Maid of Honor gift meant specially for your sister! This gift set contains a card that reads 'The only thing better than having you as my sister is having you by my side as my maid/matron of honor!' and a sterling silver freshwater pearl necklace with an infinity symbol. {Available from: So Blessed Designs in Missouri, US at $36.00 USD}
(Above) 16. A custom-made bracelet or cuff with the message 'I couldn't say "I do" without you' hand-stamped on the outside is the perfect way to pop the question and to spoil your bridesmaids. Each of your bridesmaid's names or initials can be added to this keepsake bridesmaid gift as an extra special touch. {Available from: Pure Impressions in US at $19.00 USD}
(Above) 17. A sweet 'Will you be my Maid of Honor?' invitation featuring rustic embellishments and whimsical font. {Available from: Rifle paper co via BHLDN at $6.00 USD}
(See the most gorgeous wedding gowns of the year here)
(Above) 18. The ultimate way to POP the question to your girls with these totally adorable Will You Be My Bridesmaids balloons! {Available from BHLDN at $6.00 USD}
(Above Left) I might Pee On You will you be my bridesmaid card from FINCHandHARE. // (Above Right) Get me stripper card from Finch and Hare .
(Above Left) Stamped "Will you be my bridesmaid" muslin bags. // (Above Right) Shit Just Got Real Bridesmaid Proposal Card from JulieAnnArt.
(Above Left) Will You Be My Bridesmaid Box from ModParty. // (Above Right) Will you be my bridesmaid mug from By Tracey.
(Above left) I can't tie the knot without you bridesmaid card from Marry Grams. // (Above Middle) I've got my guy but I need my girls wine label from Studio B Labels. // (Above Right) DIY Pop the Balloon bridesmaid proposal kit from Petite25.
Check out some more Be My Bridesmaid proposal ideas from these retailers:
More helpful articles and links for yourself and your bridesmaids:
- Advice for selecting your bridesmaids
- Bridesmaid Duties
- Maid of Honor Duties
- Super Fun Wedding Photo Ideas for your bridal party
- Cute Bachelorette invitations
- Wedding Day Emergency Kit & Checklist for your bridesmaids to print and keep
- Bridal Shower Invite Ideas
- Wedding DIY projects to try with your besties
- Loads of awesome wedding hairstyles for bride and bridesmaids
Once you've popped the 'Will you be my bridesmaid?' question, we suggest you begin pondering all of the ways in which you can capture the many special moments with your bridesmaids on your wedding day. Grab a couple of ideas from this winning collection of Wedding Photo Ideas for your Bridal Party!


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Awesome solution. However, I have a tiny issue. Is there anyway for it NOT to display in the categories sidebar? I want to reserve that side bar just for clothing options, ie..Mens, Womens, etc…

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Cinema 2012
All this year's most eagerly awaited films
If, like us, you couldn't tear yourself away from the pages of F. Scott Fitzgerald's melancholy novel and you can't forget the golden boy Robert Redford in his immaculate white suits (in the third cinema version, which won Theoni V. Aldredge an Oscar for Best Costume Design), 2012's most eagerly awaited film is The Great Gatsby. Directed by the Australian Baz Luhrmann, it stars Leonardo DiCaprio as the charming, doomed Jay and Carey Mulligan as the unforgettable Daisy.
But we'll have to wait until next Christmas and don our 3D glasses to see it – let's hope that the Moulin Rouge director has found new inspiration after the embarrassing interlude of the schmaltzy Australia.
First out though is the fourth instalment in the Mission Impossible series. Ghost Protocol is released in Italian cinemas on the 14th. It's been such a hit at the American box office that the Hollywood Reporter has called it Tom Cruise is Back!.
For another spy – this time from a different era – there's the new Bond film, Skyfall. Starring Daniel Craig, it's ready despite production problems. Javier Bardem and Ralph Fiennes will be appearing alongside Craig.
Staying with theme of male stars, In the Hand of Dante, featuring Johnny Depp and directed by the versatile artist Julian Schnabel, tells two parallel stories: one from the time of the Divine Comedy, the other modern.
When it comes to female stars, we have the outstanding Glenn Close as a butler in Albert Nobbs – a possibly Oscar-winning performance. Meryl Streep is Margaret Thatcher in the controversial The Iron Lady (the actress is to be awarded an Honorary Golden Bear for career achievement at the coming Berlin Film Festival). Then there's Joe Wright's version of Anna Karenina, with the title role being played by Keira Knightley.
Snow White is getting two new cinema adaptations with outstanding wicked witches (Julia Roberts and Charlize Theron) and innocent girls (Lily Collins and Kristen Stewart), and fantastic – or rather fairytale – costumes.
Guaranteed successes include Peter Jackson's prequel The Hobbit, the final chapter of the Twilight saga and the new Woody Allen film, which is set in Rome.
For comic book fans, there's The Dark Knight Rises. Like previous films, this is directed by Christopher Nolan and stars Christian Bale. Catwoman is making a comeback – we'll see if Anne Hathaway is a worthy replacement for Michelle Pfeiffer and most of all if her outfits compare with Michelle's super-tight, super-curvy latex ones. It's out in Italy at the end of August.
For other superheroes, we have Marc Webb's The Amazing Spider Man, starring Andrew Garfield, and Zack Snyder's Superman, starring Henry Cavill. Our favourite though is Wonder Woman: who better than her has represented the everyday struggle of modern women?
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Vittoria Mentasti - Dead Sea
Vittoria Mentasti's Dead Sea takes us to a place where the sky and the sea are one
Kristin Prim and The Provocateur's letters
A chat with Kristin Prim, the founder of The Provocateur, the site that publishes letters written expressely by leading women addressing the whole female world. Vogue.it presents you an exclusive preview of the letter written by Dresden Dolls' Amanda Palmer
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Menswear and womenswear collections will walk together and will be on sale right after the show. These are the news from Burberry but the evolution is generalized: runway shows are changing


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O Ring S16 for Belle RT Trench Rammers Genuine Belle Part OEM No. 15.0.289
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Part No. 15.0.289Categories: Belle RT50 Rammer Spares | Belle RT60 Rammer Spares | Belle RT65 Rammer Spares
Screw M8 x 20 for Belle Mixers, Rammers & Compactors
Price: £0.30 (Ex. VAT)
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Hot peppers seem to do better in the heat than the sweet bells. But I'm sold on these Italian heirlooms - no more "down time" during the summer for this bell pepper fan. I can't eat the hot ones, so the only hot ones I grow are the small ornamental jobs in pots - so pretty w/ their little multi-colored fruits! Nosegay is my cuurent favorite - gorgeous!!
---------- Original Message ----------------------------------
From: jim singer <firstname.lastname@example.com>
Reply-To: firstname.lastname@example.com
Date: Sat, 14 Dec 2002 09:51:46 -0500
>definitely interesting about the peppers, pam. there are three that do well
>here. the bird pepper, which is native to south texas, the thai devil, and
>a homemade cross between a bird pepper and a small round one named "texan."
>those three have lasted years here. the thai, in fact, is now 5 years old
>and about 4 feet tall. all are hot.
>At 09:35 AM 12/14/02 -0600, you wrote:
>>Speaking of produce from Italy. Two heirloom peppers, Quadrato Asti
>>Giallo (doesn't the name just sing) and Jimmy Nardello's did better in our
>>summer heat than any of the fancy hybrids ever have. They kept fruiting
>>and producing all summer long, apparently evolving in the warm climate of
>>Italy makes them well suited for the South. They're available as seeds or
>>transplant from Seed Saver's Exchange. We liked them so well, we're
>>getting twice as many next year so Pat can grow them too! These are sweet
>>peppers BTW.
>>Viva Italia!!
>>---------- Original Message ----------------------------------
>>From: firstname.lastname@example.com
>>Reply-To: firstname.lastname@example.com
>>Date: Sat, 14 Dec 2002 00:33:32 EST
>> >In a message dated 12/13/02 5:31:46 PM, email@example.com writes:
>> >
>> ><< fantastic delies as well as women who made
>> >tortellinis at home for sale to selected clients. My aunt always gave me a
>> >juice glass of wine watered down with meals. >>
>> >
>> >Oh, yes, totelliniiiis are a special holiday treat ....or any other
>> time. I
>> >have made them but not in the past couple years. I am not a wine lover
>> but my
>> >FIL and his friends ordered grapes from Italy to make their wine. I have
>> >heard my husbands family talk of this often.
>> > Ceres
>> >
>> >---------------------------------------------------------------------
>> >To sign-off this list, send email to email@example.com with the
>> >message text UNSUBSCRIBE GARDENCHAT
>> >
>> >
>>Pam Evans
>>Kemp TX/zone 8A
>>To sign-off this list, send email to firstname.lastname@example.com with the
>>message text UNSUBSCRIBE GARDENCHAT
>To sign-off this list, send email to email@example.com with the
>message text UNSUBSCRIBE GARDENCHAT
Pam Evans
Kemp TX/zone 8A
To sign-off this list, send email to email@example.com with the
message text UNSUBSCRIBE GARDENCHAT


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I had Sansevieria on the tip of my typing fingers, too...it puts up
with just about anything. Dracaena is another plant that takes the
dry inside air and a lot of neglect and low light; I've got one -
think it might be 'Janet Craig' - about 8' tall that has to be over
30 years old now - talk about a plant that's survived major neglect!
Spathiphyllum will also do well in house humidity if you keep it
watered and does very well in low light but will bloom more if it has
some light. No direct sun for this child; burns the leaves.
I have had a Schefflera for over 25 years that puts up with winter in
the conference room - lots of sun (too much) and low humidity...it
prefers summer outside with some humidity, but has survived. Poor
child finally got a new, larger pot after 12 years in the same pot!
It gets to about 12' high and I whack it back. Also have an ancient
Monstera that survives the same sort of winter ordeal well. Aloe is
good and tough and takes low humidity. Have a couple of rubber trees
(Ficus something or other) that also survive inside humidity well -
they want bright light but not direct sun inside. They all
appreciate summer outside in a shady spot with more regular watering
than they get from me inside in winter!
Even in your desert conditions, if you can water plants (including
foliage) outside in summer - and whatever they're sitting on - it
will increase humidity enough for them to thrive...like daily when
it's hot and dry. If they're on a masonry patio, wetting that down
at least once a day raised humidity for the plants sitting on it.
Tougher with a wood deck as too much wet rots them faster.
Marge Talt, zone 7 Maryland
Editor: Gardening in Shade
Current Article: Battling Bambi
Complete Index of Articles by Category and Date
All Suite101.com garden topics :
> From: Dakota <email@example.com>
> Does anyone know about house plants that are easy to keep? I've
> many times to have a Boston fern, but they never survive. LOL! We
> low humidity here, but they didn't even survive in CA. My orange
> honeysuckle is blooming!! When we bought this land last year, there
> no flowers at all, except wildflowers. The previous owners only
> one pine tree, one globe willow, two pecan trees, and one apricot
> There's a row of some type of bamboo looking growth in one area,
> Makes a good wind block. Our new cottonwood tree seems to be doing
> best right now. Does anyone else here live in AZ, NM or TX?
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Knit Animal Crib Mobile
- Overview
With the charm of a favorite heirloom, four whimsical animals circle overhead to your baby's delight. A sweet tune accompanies the menagerie.
- Animals are made of knit acrylic and soft polyester velboa.
- Frame is covered with knit acrylic.
- Plays the tune Talk to the Animals.
- Mobile includes an elephant, a zebra, a lion and a giraffe.
- Mobile arm (sold separately) attaches to the crib.
- Mobile: 9" diameter, 17" high
- Dimensions & Care
- Overall: 9" diameter, 17" high
- Elephant: 4.5" square, 3" high
- Lion: 3" wide x 1.5" deep x 4" high
- Zebra: 4" wide x 2" deep x 3.5" high
- Giraffe: 3.5" wide x 2" deep x 4.5" high
- Mobiles should be placed well out of arm's reach of your baby.
- Once your baby is able to sit up, mobiles should be removed.
- Surface is washable with warm water and mild soap.
- Shipping & Return Info
This is a general shipping item. In-stock items will usually ship within 7-10 business days for the cities listed below.
- San Francisco, Los Angeles, Dallas, Chicago, Detroit, Columbus, New York City, Baltimore, Boston, Cromwell, Atlanta, Raleigh, Charlotte, Tampa, Fort Meyers, Orlando, Miami, Fort Lauderdale
For other areas, your items will be delivered within 2-3 weeks.
View Our Shipping Information
At Pottery Barn Kids, we take great pride in the quality and craftsmanship of our products. Attention to design, materials, safety and construction is our priority. We carefully inspect your order prior to shipment; upon receipt, please inspect your purchase and notify us of any damage. We will arrange for a prompt replacement. If, within 7 days for Quick Ship upholstery and 30 days for all other products, you are dissatisfied for any reason, you may return your purchase for a refund of the merchandise value.
If your return for Merchandise Credit Cards is greater than $10,000, we will issue $10,000 in Merchandise Credit Cards to you that day, and then mail additional Merchandise Credit Card(s) for the amount in excess of $10,000 to you.
For returns of items purchased from your Pottery Barn Kids registry, we will gladly provide a refund or exchange for the merchandise within 90 days of your event or within 90 days of purchase, whichever date is later.
Delivery fees are non-refundable and prior purchases are not eligible for a price adjustment. The following items are non-eligible for returns or exchanges:
- Personalized/Monogrammed items
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- Items damaged through normal wear and tear.
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June 3, 2015 9:00 pm
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February 14, 2011 — Please join hosts Bob Leins, CPA, and John Elliott, Federal Benefits Strategist, NITP, in welcoming Art Stein. Stein is a CFP with SPC Financial, Inc. in Rockville MD.
The three will discuss:
Photos of the amazing, moving, important and amusing things happening in the federal community.
A daily update of important moments in the history of the U.S. government.


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Demi Moore Goes to the Movies
Posted Wednesday April 24, 2013 11:00 PM GMT
Ready for a movie marathon, Demi Moore was on hand at the Target presents AFI Night at the Movies event on Wednesday (April 24) in Los Angeles.
The "Very Good Girls" actress struck a pose on the arrivals carpet in black pants and a sheer black blouse before heading inside the ArcLight Hollywood for the shows.
Also attending the evening, featuring thirteen great films, were Sally Field, Kurt Russell, and Kathy Bates, among others.
Each of the motion pictures shown was introduced by the artists who created them. This year's lot included "Ghost," "Pulp Fiction," and "Steel Magnolias."
Enjoy the pictures of Demi Moore at the Target Presents AFI's Night at the Movies in Hollywood, CA (April 24).
Photo Credit: Getty Images
filed under Demi Moore


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track list
Album Swing Low, Sweet Mandolin
Label Acoustic Disc
Released January 01, 1995
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SEO Advantage, Inc. Awarded Prestigious Ranking 9 Months in a Row
Florida search marketing and web copywriting firm has consistently placed on independent authority's top-ten list for content creation since November 2010
Each month, TopSeos.com issues a top-ten list for a variety of areas required for businesses to successfully harness online marketing channels. Areas include content creation, SEO, social media, reputation management and other important aspects of marketing products and services online. Content creation, which is the area SEO Advantage has consistently ranked high on, is considered one of the most important components of building sustained search engine rankings, site traffic and conversions.
"We're quite proud to receive this distinction from such a valuable, reputable resource for businesses looking to find the right search engine and online marketing firm to meet their needs," commented Stone Reuning, President of SEO Advantage, Inc. "Our dedicated team of copywriters and content developers has helped our clients dominate their respective areas through meticulous research, carefully planned and executed content creation."
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Other criteria used for evaluating firms include:
1. Competitive advantage
2. Services and pricing
3. Customer and technical support
4. Unique innovations
5. Overall efficiency and performance
"SEO Advantage has been helping clients achieve sustained search rankings and site traffic since 1999, with content creation and web copywriting being one of those essential pillars we offer," explains Reuning. "With our extensive experience in each of these areas, we can help companies large and small effectively use this cutting-edge tool to reach new customers and build revenues."
To see TopSeos' rankings list, visit the independent authority's site at http://www.topseos.com/
About SEO Advantage, Inc.
Internet marketing consultants at SEO Advantage work with prestigious firms seeking to grow company revenues through online channels. Experienced veterans in SEO, web copywriting, site design, pay-per-click management and social media work together to help businesses successfully dominate their respective market areas online. Analysts at the Florida-based firm have been referenced in books such as Writing Web-Based Advertising Copy to Get the Sale and Business Week's bestseller The New Rules of Marketing & PR. SEO Advantage's Monthly Max Advantage™ program represents leading-edge search engine optimization and Internet marketing technology, offering measurable ROI backed by exceptional customer service. For more information, visit http://www.seo-
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Bauer Farms project seeks expansion
Lawrence's first new urbanist neighborhood could end up bigger than originally planned.
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Within our Center's theme of stem &progenitor cell biology and regenerative medicine, our Pilot Project Program will have two components that seek to enhance separate, yet complementary aspects of our Stem Cell Center's research activities by: (i) fostering projects that are collaborative, muitidisciplinary in scope, engage our junior faculty, provide compelling preliminary data for extramural grant submissions and/or advance the capabilities of our core facilities;(ii) establishing new translational research infrastructure and directions within the Stem Cell Center and the Institute. The first component, designated the Core Pilot Program will distribute $150k/yr in seed monies for high-merit pilot studies. This program (open to all Center and Institute investigators) will enhance mentorship, aid junior investigators, and stimulate collaborative, innovative science and enhance the value of our existing COBRE core facilities. The selection of funded projects will be based on scientific merit and prioritized using the following criteria: a] Projects should be collaborative, with a co-investigator structure that enhances scientific interactions, b] When feasible, one co applicant should be a junior investigator, c] To enhance multi-disciplinary research projects, applicants may partner with colleagues at MMCRI and/or external collaborators with expertise from other IDeA institutions, d] Aims must be sharply focused, relate to Center goals, and lead to new technologies or methodological advances as related to core facilities, e] Projects should have a budget of -$50,000, well-defined milestones, and be accomplished within 1-year, f] For projects that utilize human subjects and/or vertebrate animals, prior investigator training and institutional IRB or lACUC approval is required. The second, or Translational Pilot Program component will focus sharply on enhancing the capabilities of our Center and Institute to conduct translational TI research. In part, this is driven by an exciting opportunity to advance the activities of a senior translational scientist soon to be recruited to our Center and MMC/RI. Here, COBRE funds will be used initially (up to $100K/yr, years 11-13) to bolster major institutional support for the development of a Translational Therapeutic Laboratory that will provide patient-based assay services, assist in patient selection for clinical trials, and providing tools for therapeutic monitoring. Funds specifically will be used to support services, supplies, and research technician costs. Subsequently, in years 14 &15, funds (up to 100 K/yr) will be competitively awarded specifically for translational pilot projects whereby Center investigators partner with their clinical counterparts again in a highly collaborative manner.
Critical support will be provided to test important new concepts, advance exciting lines of investigation, enhance core facility capabilities/technologies, and add new translational capabilities to our Center. Collaborative, multidisciplinary projects will be supported, which further mentoring junior investigators, and strive for national grant support. We also will underwrite the development of a novel translational therapeutics laboratory to enhance the translational research activities of our Center and the Institute.
|Ufkin, Melanie L; Peterson, Sarah; Yang, Xuehui et al. (2014) miR-125a regulates cell cycle, proliferation, and apoptosis by targeting the ErbB pathway in acute myeloid leukemia. Leuk Res 38:402-10
|Guay, Justin A; Wojchowski, Don M; Fang, Jing et al. (2014) Death associated protein kinase 2 is expressed in cortical interstitial cells of the mouse kidney. BMC Res Notes 7:345
|Favreau, Amanda J; Vary, Calvin P H; Brooks, Peter C et al. (2014) Cryptic collagen IV promotes cell migration and adhesion in myeloid leukemia. Cancer Med 3:265-72
|Han, Xiang Hua; Jin, Yong-Ri; Tan, Leonard et al. (2014) Regulation of the follistatin gene by RSPO-LGR4 signaling via activation of the WNT/*-catenin pathway in skeletal myogenesis. Mol Cell Biol 34:752-64
|Peterson, Sarah M; Thompson, Jeffrey A; Ufkin, Melanie L et al. (2014) Common features of microRNA target prediction tools. Front Genet 5:23
|Verma, Rakesh; Su, Su; McCrann, Donald J et al. (2014) RHEX, a novel regulator of human erythroid progenitor cell expansion and erythroblast development. J Exp Med 211:1715-22
|Fetting, Jennifer L; Guay, Justin A; Karolak, Michele J et al. (2014) FOXD1 promotes nephron progenitor differentiation by repressing decorin in the embryonic kidney. Development 141:17-27
|Guntur, Anyonya R; Le, Phuong T; Farber, Charles R et al. (2014) Bioenergetics during calvarial osteoblast differentiation reflect strain differences in bone mass. Endocrinology 155:1589-95
|Li, Lei; Byrne, Susan M; Rainville, Nicole et al. (2014) Brief report: serpin Spi2A as a novel modulator of hematopoietic progenitor cell formation. Stem Cells 32:2550-6


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Hotels in Badalona, Spain
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- Most bookedRafaelhoteles Badalona
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"Hotel well located, close to metro station (approx 10 min walk) and close to the beach. One disadvantage: to close to the high way, and therefore a little noisy during night. "
A Traveller, Nov 2016, GB
24 people looked at this hotel in the last hour
23 people looked at this hotel in the last hour
Most recent review
"So me and 3 of my mates ended up booking badalona instead of Barcelona, typical error when you are brainless and basically wanting the sesh, however... The apartment in its self couldn't have been better.... The only problem we personally had was dropping a 300 euro deposit down in case anything ..."
A Traveller, Nov 2016, GB
- MiramarNo Guest Reviews yet
11 people looked at this hotel in the last hour
Hotels within 5 miles of Badalona
412 people looked at this hotel in the last hour
Most recent review
"We have been there for our new year holiday in Barcelona. The Hotel is really nice, clean and tidy and everything looks new and in perfect condition. The staff has been very nice. We would like to thank first the Housekeeping staff as they cleaned our room every time we requested it (sorry for..."
A, Jan 2017, GB
313 people looked at this hotel in the last hour
Most recent review
" In general everything was amazing I enjoyed everything from morning till I went to sleep ..."
A Traveller, Dec 2016, US
311 people looked at this hotel in the last hour
Most recent review
"3 min walk to metro station, a quiet area of the town. Clean, tidy and spacious room. The breakfast definitely highly recommended! "
A Traveller, Jan 2017, GB
301 people looked at this hotel in the last hour
246 people looked at this hotel in the last hour
Most recent review
"Excellent location just 5 mins walk to metro station. Great local bars and restaurants 2. Mins walk. Very clean throughout."
A Traveller, Dec 2016, GB
129 people looked at this hotel in the last hour
Most recent review
"Sparser amenities than other holiday inn expresses such as no in room safe but overall 4/5 for this price point."
A Traveller, Dec 2016, CA
Map of Badalona hotels
Best hotels in Badalona
Badalona overviewBadalona is a budget-friendly place distinct for its beaches and museums, and known for its monuments and shops. You'll enjoy the ample bar and cafe options, along with outdoor areas for running and walking. Soak up some sunshine at popular spots in the area like Mar Bella Beach and Barceloneta Beach. Make some time to see popular sights such as Sagrada Familia and Palau de la Musica Catalana. A business-friendly area, Badalona also has something for everyone.
Where to stay in BadalonaWhether traveling for business or pleasure, Badalona can comfortably accommodate all visitors. There are 1027 hotels in the Badalona area and you can shop as many as 322 deals for rooms on Hotels.com, some with discounts of up to 50%.
- • 159 2-star hotels with an average price of $22 per night
- • 313 3-star hotels with an average price of $52 per night
- • 408 4-star hotels with an average price of $75 per night
- • 60 5-star hotels with an average price of $114 per night
Here are the top hotels based on 156385 user reviews of Badalona hotels:
- • Rafaelhoteles Badalona
- • Be Dream Hostel
How to get to BadalonaFly in to Barcelona (BCN-Barcelona Intl.), 13.7 mi (22.1 km) from downtown Badalona. Badalona Station is the closest train station.
Metro stations include:
- • Badalona Pompeu Fabra Station
- • Pep Ventura Station
- • Gorg Station
What to see around BadalonaOutdoor activities are on hand like sightseeing and running along with attractions such as:
- • Parc del Forum
- • Zona de Banys
- • Jardines del Principe de Girona
- • Parc de l'Oreneta
- • Parc Central del Valles
- • Badalona Municipal Museum
- • History of Immigration in Catalonia Museum
- • MUHBA at Fabra i Coats
- • Museu Blau
- • Museo Can Framis
- • Can Solei-Ca l'Arnus Park
- • Parc del Centre del Poblenou
- • Bogatell Beach
- • Mar Bella Beach
- • Nova Icaria Beach
- • Magic Badalona
- • La Maquinista
- • Heron City Barcelona
- • Diagonal Mar Shopping Mall
- • Centro Comercial Glòries
- • Sagrada Familia
- • Palau de la Musica Catalana
- • Casa Batllo
- • Port Olimpic
- • Park Guell
When to visit BadalonaIf you're still deciding when to visit, here are the seasonal norms to help you plan:
Seasonal temperature averages
- • January-March: 62°F day, 43°F night
- • April-June: 80°F day, 50°F night
- • July-September: 82°F day, 62°F night
- • October-December: 73°F day, 44°F night
- • January-March: 4.8 inches
- • April-June: 5.5 inches
- • July-September: 5.8 inches
- • October-December: 7.4 inches


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Educating a girl in places like Kibera means she will earn more, invest 90% of her earnings in her family, be 3 times less likely to become HIV positive, and have fewer, healthier children more likely to live past age 5.
The Kibera School for Girls is the first entirely free primary school for girls in Kibera. Girls at the school are given free uniforms and supplies, healthy meals, quality health care, access to clean water and toilet facilities, and counseling and psychosocial support. In addition to the Kibera School for Girls, Shining Hope also provides health and social services to the Kibera community as a whole through our clinic and community center.
This model of linking health care and community services to a school for girls is the key to reversing the cycle of poverty. Through this model we can provide a healthier, more secure life for our students and their families, change entrenched gender attitudes in Kibera, and inspire the community to lead change for themselves.


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Are you looking for Earrings in Gold Coast? Hotfrog showcases 38 popular businesses related to Earrings near Gold Coast! Find a specific suburb using the left navigation.
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...love Yola is a home based jewellery business with items from just $5.00! At these prices, you can afford to stock up on ...love Yola jewellery for her birthday with you "completely forgot about!" ...love Yola has a be…
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For beautiful Illusion Gold Layered Jewellery that has the look weight and feel of the Real Thing without the price tag and includes a Manufacturer's Lifetime Replacement Warranty is the place to go. We won't tell if y…
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Get Cash Loans,Get cash for Gold, Mr Money Bags buys Gold & Silver Coins, Bullion and Unwanted Jewellery in any form, Get cash fast with our best price 100% Satisfaction Guarantee
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Knicks Fall 105-90 Against Portland - Game Recap
The Trail Blazers got a 26-point performance from Damian Lillard, who added 10 assists as Portland ran past New York 105-90 on Thursday at Rose Garden.
The Trail Blazers were a 7-point favorite in the win, and managed to turn a profit for their supporters. The combined score went OVER the total, which closed at 193.5.
Portland got 22 points from LaMarcus Aldridge and another 16 points from Nicolas Batum. Damian Lillard contributed 10 assists, while J.J. Hickson cleaned the glass with 16 rebounds.
The Knicks got a 33-point performance from J.R. Smith, who was supported by 12 points from Kenyon Martin. Pablo Prigioni had 5 assists in a losing cause for New York, while Marcus Camby grabbed 10 rebounds.
The Trail Blazers hit the break leading 51-48 before taking care of business in the second half.
The rebound battle favored Portland as they grabbed 44 boards, while New York only had 40.
Portland looks to continue their winning ways next game with a battle against the Pistons. The Knicks will aim to get back on the winning track at Los Angeles.


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BEST WESTERN Bradbury Inn & Suites
No prices found through our partners. Please contact the business directly or check some of our recommended alternatives.
How has this hotel rated in the past?
- Swimming pool
- Continental Breakfast
- Fitness/Health center
- Wheelchair accessibility
- Free parking
Travelers also recommend:
- Swimming pool
- Fitness/Health center
- Wheelchair accessibility
- Free parking
- Continental Breakfast
TripAdvisor Reviews BEST WESTERN Bradbury Inn & Suites Perry
Travel Blogs from Perry
The Lake in Georgia and Fried Green Tomatoes
Sorry about the delay in writing, life gets pretty hectic on the road! Having two days here and there is sometimes a good thing as I get bored easily and like change but sometimes when you do find somewhere you really enjoy it's a shame to move on. So we made it to Georgia, it was a flying visit and we were staying on a lake just outside Juliet where Hannah wanted to visit due to a book and movie being based there. The lake was fantastic, the house was right on the lake, they had ...
Andersonville excursion
As my time in Columbus came to an end, I made a daylong excursion to the Civil War prison site at Andersonville, an hour to the east of Fort Benning. The prison site itself consisted of little more than an open field with scattered memorials and other prison key points such as Wirz's Headquarters and the famous Providence Spring, but the guided tour of the site was very informative ...
On the road again...
... while we talked to John. The 2 of us ate the whole pizza! And then, suddenly, it seemed, it was time to hit the road.
I'm writing this post as Jeff drives through north Florida (I drove from Simpsonville to Warner Robbins). We are listening to the East Village Opera Company LOUD on the car stereo (piped in from Jeff's iPhone).
Holy mackerel!!! A semi just cut us off - good reflexes on Jeff's part, but I'd better stop writing and "help" him drive!
Deep Cultural Southern Roots
Jimmy Carter National Historic Site, Plains, Georgia. Given its rural setting in west central Georgia, it is rather amazing that it would be the home of the 39th President of the United States, Jimmy Carter. We were able to walk around the farm where he grew up and visit Plains High School, which he attended. Most of the town hasn't changed a bit since his boyhood. After high school he attended the Naval Academy and graduated from there in 1946. ...
A Thankful Thanksgiving
... in Ible's Black Friday shopping tradition. Though, I do not plan to spend any money (I need at least a little bit to survive before my first paycheck from my new job) I do intend to scope out the scene and see how Ible and her family do Black Friday. I am both scared and excited, but I think it should be fun. I never have done Black Friday as a planned thing. The last time I did it I had no planning ...


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I think I just heard a gun shot
Discussion in 'Off Topic' started by Caterina, Sep 5, 2008.
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Bosch Tankless Water Heaters: Gas, Propane, & Electric
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Bosch Greentherm C 950 ES NGBosch Tankless Water Heater, Natural Gas 175,000 BTU Max Condensing Whole House - Indoor or Outdoor, 9.2 GPM
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Is this restaurant good for brunch?
Is this restaurant wheelchair accessible?
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Is this restaurant good for lunch?
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Thanks for helping!
The tabouli and gyros are so yummy! The main reason I often just stop by is for the baklava! Off the beaten path but worth the trip.
After sampling 3 other mediocre restaurants I was so happy to find some healthy fresh honestly good food. Great place for lunch. Service is a little slow but the food is worth the wait. I should have taken a pic but I was hungry and the food smelled so good, who could wait. The eggplant was great and so where...
This is my favorite spanakopita place!!! Light and delicious!! Their food is fresh and prices are great.
My entire family loves D's! It is run by a wonderful, warm Lebanese couple who really know their food. The gyros are delicious, as are all of the Greek offerings (hummus, spanakopita, dolmas. They also have great kebabs and salads. For the meat and potatoes crowd, like my mom, they have great fried chicken and chicken fried steak. Their lightly...
Love to grab lunch here...always great food and consistent with previous visits. Price is fair, restaurant is small but clean. They give you ample portions of food.
Gyro was dry, very little sauce. Hummus was bland. Staff was ok. I would not go back. Plus, outside it stunk like rotten garbage.
Great food for a great price. Always clean great service day or night. Family owned and operated if you want traditional Greek this is the place. Highly recommended.
When we go to Waco we like to try different restaurants and different ethnic foods. We love Mediterranean food and found this via a google search. When we arrived, we almost did not go in. The place looked small, not a great deal of parking, and the building is rather old looking. We would have missed a wonderful treat had...
I have had both their Gyros and their Falafal. The Gyros was very good, but the Falafal was very dry which was disappointing. Xristos Food truck's Falafal is amazing was disappointed in D's.
We love D's! A Waco classic. The beef and lamb gyro is fantastic. The hummus is great as well; tastes incredibly fresh!
A little pricey, but certainly unique in it's offerings around town.
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Most of the dead were recovered by coast guard patrols sweeping the coast with fishing nets, provincial Cabinet minister Sher Jan Baluch told The Associated Press. Baluch said at least 400 people were still unaccounted for, and he feared the death toll would rise. Some of the missing might be taking shelter in homes, nearby mountains or other surrounding areas.
The 485-foot-long Shakidor Dam burst late Thursday near Pasni, a remote village in Baluchistan province, inundating the area with water.
More than 1,200 villagers already have been rescued from the floodwaters, said Mudasser Butt, an army spokesman in Quetta.
Thousands of troops, backed by helicopters and coast guard boats, have rushed to the area. Continued heavy rains have hampered efforts to find survivors, Baluch said.
"The army has started rescue operations to try to save as many lives as possible," he said.
Maj. Gen. Shaukat Sultan, the top spokesman for President Gen. Pervez Musharraf, refused to speculate on how many people may have died. Witnesses described seeing trucks and tankers swept out to sea.
"I can only say that troops have started the rescue work ... and they are trying to save the lives of people," Sultan said.
The Shakidor dam was built in 2003 to help with irrigation in the area. More than a week of heavy rains has damaged telephone lines, roads and eight bridges in the area, Butt said.
He said troops diverted the flow of floodwaters to save other towns located near Pasni, about 400 miles south of Quetta, the capital of Baluchistan province.
Troops and local authorities also were supplying food, medicine and tents to the affected people in Pasni and elsewhere, he said. Some 3,000 troops and paramilitary forces were participating in the rescue operation.
Pakistan navy personnel had also joined the rescue efforts.
Pakistan has been hit by more than a week of rain and snow, which in some parts of the country were the heaviest in seven years, said Qamar-uz Zaman Chaudhry, the head of the nation's meteorological department. More severe weather was expected in the next two days, he said.
Meanwhile, at least two people were killed early Friday in another part of Baluchistan when floodwaters overturned their bus, officials said. Eighteen other people were reported missing.
At least 30 soldiers were missing after an avalanche buried their vehicles on a mountain road in northwestern Pakistan early Friday, Pakistan's private Geo television reported. It gave no other details.
An army official speaking on condition of anonymity confirmed the incident but said there was no word on the fate of the soldiers.
"We have lost contact with them, and efforts are under way to trace and rescue them," the official said.
The soldiers were on their way to Terrah, a tribal region in North West Frontier Province, when the incident occurred.


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Cira Centre 2929 Arch Street 17Th Floor
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Discussion in 'General Chit-Chat' started by Zaffy, Apr 6, 2011.
Yawn... when is nap time?
I just realized that I'm going to be on the road at 5pm pst tomorrow. I can do recess from a phone though, but timing might not be exactly right, and it may take longer than usual. Or I could do it at 4pm pst.
Right after milk and cookies.
Which ever works best for you.
Hmmm, he does look a little old to be you
Awesome, never seen one with a platypus!!!
I hear the monkey bars callin my name, I WANNA GO OUTSIDE!!!!
Ewwwww, I don't want cooties! :raspberry:
We've had our heads down all day, haven't you had enough rest time! Watcha so tired for....is that crayon shavins on your chin??
Whichever is best for you Teach!
LOL Ice, love that big wheel post... might need to add to my sig....
ok, I'm good with that Zaf, so.... 4pm pst is 7pm est, right?
Can we do this song during music time Mr. Zaff???
I hear for a dollar he will let you ride on back and pull the lever to skid sideways!
where am I supposed to get a dollar from? My mom only gives me cupcakes for snacks to share :girl:
I hear Mr Zaffy will give you a dollar if you pull his finger.


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an explosion of power and strength to uphold strength and unbound power hidden up in the least expected things
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Mortality in dialysis patients is extremely high, with an annual death rate of ∼23%. Sudden cardiac death (SCD) is the single largest cause of death in dialysis patients accounting for ∼60% of all cardiac deaths and 25% of all-cause mortality. Interventions aiming at reducing cardiovascular mortality, especially SCD, in dialysis patients are therefore extremely important and clinically highly relevant. The purpose of this review is to give an outline of the epidemiology of SCD in dialysis patients and to provide a comprehensive overview of several interventional strategies (medical therapies, changing dialysis modality, and revascularization). Furthermore, it will discuss the current knowledge regarding the value of preventive implantable cardioverter defibrillator implantation and address future implications of the interventional strategies mentioned.
Currently, ∼350 000 people are treated with dialysis in the USA. It is estimated that this number will increase to >500 000 by the year 2020.1 In Europe, the number of dialysis patients is also increasing annually.2,3 The mortality in dialysis patients is very high with a mean death rate of ∼23% per year. This rate is mainly influenced by age, with a yearly mortality of 4% in patients younger than 20 years rising to 35% in patients older than 65 years.1 In dialysis patients, sudden cardiac death (SCD) is the major cause of death, accounting for ∼25% of all-cause mortality.4 The risk of SCD in dialysis patients is also strongly associated with patient age, with a 3-year probability of developing cardiac arrest of ∼12% in patients younger than 20 years rising to ∼34% in patients older than 75 years.4 Because the increase in number of patients treated with dialysis for end-stage renal disease (ESRD) can mainly be attributed to older patients, the total burden of SCD is rapidly increasing.1
Given the high event rate of SCD in dialysis patients, identification of risk factors and finding preventive interventions seem highly desirable. The objective of this review is (i) to provide an outline of the epidemiology of SCD in this patient group and furthermore (ii) to provide a comprehensive overview regarding several preventive interventions aiming at reducing cardiovascular mortality. We will especially focus on SCD, since this is the single largest cause of death in this highly vulnerable patient group.
Epidemiology of sudden cardiac death in dialysis patients
Approximately 60% of all cardiac deaths and 25% of all-cause mortality in patients on dialysis are due to SCD.4 In several large survival trials with dialysis patients, such as the Hemodialysis (HEMO) study and the German Diabetes and Dialysis (4D) study, similar incidences for SCD were found.5,6 These studies will be discussed in more detail later on. This high incidence may even be an underestimation as was demonstrated by Bleyer et al.7 They reviewed death notification forms from 1995 to 2003, obtained from five US dialysis centres. According to an accepted definition of SCD, they found that in total 88 of 228 deaths (39%) could be classified as sudden. The patient's primary nephrologist had only classified 59 of these 88 deaths as sudden, i.e. 26% of all deaths. The remaining 29 sudden deaths were initially not classified as sudden, but as acute myocardial infarction (6 patients), atherosclerotic heart disease (4 patients), cardiomyopathy (3 patients), pulmonary oedema (2 patients), other (2 patients), valvular heart disease (1 patient), and unknown (11 patients).
Factors relating to sudden cardiac death
The mechanisms that underlie SCD in dialysis patients are complex and many factors are involved. In addition to the traditional risk factors associated with SCD in the general population, such as ischaemic heart disease, there are several more specific factors and circumstances in dialysis patients which may contribute to the risk of SCD. These factors include: left ventricular hypertrophy (LVH), rapid electrolyte and fluid shifts in haemodialysis (HD) patients, and abnormalities in myocardial ultrastructure and function, including endothelial dysfunction, interstitial fibrosis and sympathetic overactivity.8–12
Peritoneal dialysis vs. haemodialysis
A recent study compared the survival of Dutch HD and peritoneal dialysis (PD) patients. A survival advantage for PD compared with HD was documented which decreased over time, with age and in the presence of diabetes mellitus as primary disease.13 The initial advantage of PD compared with HD may be explained by the fact that PD patients have lower co-morbidity at initiation of dialysis therapy14 and a better preservation of the remaining kidney function.15 With regard to SCD, there is no apparent difference between PD and HD.4
Medical interventions
β-Blocker therapy
It has been documented that dialysis patients exhibit sustained activation of the sympathetic nervous system (SNS) and that the diseased kidneys themselves are the trigger of this overactivity.16,17 This sympathetic nerve overactivity is associated with mortality and worse cardiovascular outcomes,18 and it is likely that SCD in dialysis patients is associated with the overactivation of the SNS.19
β-Blocker therapy interferes with the deleterious actions of the SNS on cardiac endpoints20 and is a well-established and evidence-based intervention in hypertension21 and after myocardial infarcation.22 In the general population, much of the benefit conferred by β-blocker therapy can be attributed to the prevention of SCD.19,23
A large observational study by Foley et al.24 indicates that β-blocker therapy has a robust association with survival in dialysis patients. Despite this observation, only a few trials regarding β-blocker therapy in dialysis patients have been conducted so far. In a recent placebo-controlled trial in HD patients with dilated cardiomyopathy, Cice et al.25 showed that carvedilol gave a significant reduction (52 vs. 73%) in mortality. With regard to SCD in dialysis patients, it has been documented that in HD patients, β-blocker use at the time of a cardiac arrest is associated with higher survival.26
Nevertheless, although a potential benefit of β-blocker therapy has been indicated, it has been documented that β-blocker therapy is used in <30% of patients on HD.27 Furgeson and Chonchol19 suggest four major reasons for this low utilization: (i) therapeutic nihilism for these chronically ill patients, (ii) the unconventional epidemiology of cardiovascular disease in this population, (iii) the paucity of efficacy data in patients with serum creatinine >177 µmol/mL (2 mg/dL), and (iv) the potential for higher rates of adverse effects, including hypotension, hyperkalaemia and glycaemic abnormalities. In their review, they conclude that risks of dangerous side effects appear to be rare and manageable and that long-term clinical trials are desperately needed to evaluate the safety and efficacy of β-blockers in chronic dialysis patients.
When defining the role of β-blockers as a preventive intervention for SCD, it should also be considered that in several high-risk patient groups, prophylactic implantable cardioverter defibrillator (ICD) implantation has proven to be superior compared with β-blocker therapy.28–32
Statin therapy
Statin therapy safely reduces the 5-year incidence of major coronary events, coronary revascularization, and stroke in a wide range of individuals by reducing LDL cholesterol.33 However, until recently, with regard to dialysis patients, only limited prospective data on the effectiveness of statin therapy were available. In 2005, the results of the German 4D study were published. The 4D study was the first prospective trial to evaluate the effectiveness of statins in 1255 patients receiving chronic HD with type II diabetes mellitus. This study showed that atorvastatin, despite its ability to lower LDL cholesterol, had no beneficial effect on cardiovascular death, non-fatal myocardial infarction, and stroke. It was, therefore, speculated by the investigators that the pathogenesis of vascular events in patients with diabetes mellitus who are receiving HD may, at least in part, be different from that in patients without ESRD.6
A recently published meta-analysis by Strippoli et al.34 demonstrated that statins significantly reduce lipid concentrations and cardiovascular endpoints in patients with chronic kidney disease. A significant reduction of ∼20% in the risk of cardiovascular mortality was documented, and in addition to this, compared with placebo, statin therapy also significantly decreased the risk of non-fatal cardiovascular events by ∼20%. However, this meta-analysis also showed no benefit on all-cause mortality.
The specific effect of statins on SCD remains doubtful as the mechanisms involved may be less amenable to cholesterol lowering. This is confirmed by the fact that statin therapy had no effect on SCD in the 4D study6 and in other statin trials in non-dialysis patient groups, such as in heart failure patients in the CORONA study.35
Erythropoietin therapy
A relationship between anaemia and the development of LVH in ESRD patients has been demonstrated.36 Left ventricular hypertrophy is associated with a lower survival in ESRD patients37 and especially the worsening of LVH, independent of left ventricular (LV) mass, is a strong predictor of SCD in this patient group.38 Considering the relationship between LVH and anaemia and the strikingly high prevalence of LVH in dialysis patients,39 a strong beneficial effect of restoring anaemia with erythropoietin could be anticipated. However, the optimal level of haemoglobin (Hb) correction with erythropoietin remains uncertain. Although several studies showed that complete correction of anaemia improved several cardiovascular prognosis parameters in dialysis patients,40 at this moment there is insufficient published literature to generalize the risks or benefits of Hb levels >7.2 mmol/L (120 g/L).41,42
It should also be taken in account that correction of anaemia with erythropoietin to higher Hb-levels may increase blood pressure, the risk of vascular access thrombosis, and may lead to an increased number of adverse cardiovascular events,42 thus counterbalancing the potential positive effects. Considering the above, more information about the ideal Hb target level is needed and therefore only partial correction of anaemia by erythropoietin is nowadays recommended.43
Changing dialysis modality
Dialysis therapy itself is probably an important risk factor for SCD. For instance, it has been observed that SCD is temporally related to the HD procedure7 and several treatment-related factors, such as dialysis dose and the size of molecules that are removed, are implicated in mortality and morbidity among patients undergoing HD.44,45 The fact that dialysis should be considered pro-arrhythmic is supported to a certain extent by the significant decline of SCD rate after renal transplantation.4 Considering these observations, interventions aiming at altering the dialysis therapy may prove to be useful in reducing all-cause and cardiovascular mortality. In the last decade, many studies have been conducted in order to evaluate the effect of different alterations in dialysis therapy on mortality and cardiovascular morbidity. With regard to these alterations in dialysis therapy, changing dialysis dose, haemodiafiltration, and increasing dialysis frequency will be discussed below.
Changing the dialysis dose
Several observational studies reported significant mortality reductions in patients treated with a higher dialysis dose compared with a control group receiving standard dialysis dose.46,47 The HEMO study was the first randomized controlled trial designed to evaluate the effect of the dialysis dose on all-cause mortality and cardiovascular mortality. In this study, 1846 patients were randomized to receive either a standard dose (urea eKt/V 1.05) or high dose (urea eKt/V 1.45) and either a low-flux or high-flux dialyzer in a 2 × 2 factorial design with equal allocation. The results of the low- vs. high-flux dialyzer will be discussed in the next paragraph. No significant difference was observed between the standard dose vs. the high-dose group in all-cause or cardiovascular mortality.5 More recent observational data consisting of large study cohorts (n > 4000), however, indicate that dialysis dose and session length are associated with mortality risk.48,49 Therefore, the debate regarding the optimal dialysis dose and session length remains ongoing.
Haemodiafiltration and high-flux HD, which is considered a form of haemodiafiltration, are treatment modalities which not only remove small molecules (<5 kDa) but are also capable of obtaining considerable clearance of middle molecular weight substances (5–50 kDa).50 Middle molecular weight molecules include markers of inflammation, complement factor D, and other molecules that might be relevant in the pathogenesis of cardiovascular morbidity and mortality.51
Although large observational data indicate a significant reduction in mortality when comparing haemodiafiltration with low-flux HD,52 until now this has not been confirmed by randomized controlled trials. The earlier mentioned HEMO study, which also compared low-flux HD with high-flux HD, showed that in the high-flux group, there was an 8% reduction of all-cause mortality. This was, however, not statistically significant. Also a 20% reduction in cardiac death was documented, which was not statistically significant after adjustment for the multiple comparisons performed. It is therefore concluded that the overall pattern is consistent with a possible benefit for high-flux dialysis, which was too small to be detected given the power of the study.53 At this moment, several trials are ongoing which will further evaluate the value of haemodiafiltration with mortality and cardiovascular morbidity and mortality as primary or secondary outcome.54
Increasing dialysis frequency
Already in 1969, it was documented that daily dialysis improved several clinical outcome parameters in a selected patient group.55 However, at this moment, the majority of the HD patients depend on two to three dialysis sessions a week. Considering the potential benefit of a higher frequency, several possibilities have been proposed to increase the frequency of dialysis therapy. These include frequent nocturnal HD and short daily HD.
A recently published trial that compared the effects of frequent nocturnal HD vs. conventional HD on change in LV mass and health-related quality of life over 6 months showed promising results. Fifty-two patients were randomized in a 1:1 fashion to nocturnal HD or conventional HD. There was a regression in LV mass in the treatment group, whereas there was an increase in LV mass in the control group. This difference was statistically significant. Also a statistically significant improvement in some measures of mineral metabolism and selected measures of quality of life in the treatment group was documented.56
Promising results have also been reported regarding short daily HD. A recently published observational study showed that survival in 416 patients (52 ± 15 years) on short daily HD (frequency 5.8 ± 0.5 times weekly, duration 136 ± 35 min) was two to three times better than that of matched three times weekly HD patients reported by the United States Renal Data System (USRDS). The 5-year cumulative survival was 68 ± 4.1%.57
Although the results for both nocturnal HD and short daily HD are indeed promising, prospective data on significant changes in all-cause and/or cardiovascular mortality are lacking at this moment. Adequately powered trials with hard endpoints are therefore warranted to define the role of these treatment modalities.
In the general population, coronary artery disease (CAD) is present in ∼80% of the patients suffering from SCD.58 The HEMO investigators pointed out that CAD was the largest contributor to SCD also in dialysis patients.59,60 The prevalence of CAD in dialysis patients is ∼40%.61 However, despite the high prevalence of CAD in this highly vulnerable patient group, the utilization of invasive cardiac procedures in dialysis patients is clearly underused. For instance, the use of both diagnostic angiography and revascularization after MI is significantly lower in dialysis patients compared with patients with normal renal function.62 The underutilization of these therapies may be a reflection of 'therapeutic nihilism'. Another explanation is the lack of evidence of benefit in this patient group due to the exclusion of dialysis patients in most clinical trials.
In a recent observational study, Hemmelgarn et al.63 compared patients receiving CABG, PCI, or no revascularization after coronary angiography and found that in dialysis patients, survival was significantly higher after CABG or PCI compared with no revascularization. However, in a population of dialysis patients with ischaemic heart disease, treated with optimal surgical coronary revascularization, Herzog et al.64 found that the probability of all-cause mortality and arrhythmically mediated death was not lower than that reported for the entire US dialysis population. They documented that, in 2002, the 2-year probability of all-cause death was 40% and the probability of SCD was 14% in prevalent US dialysis patients. In US dialysis patients receiving CABG, they found a 2-year all-cause mortality of 43% and a mortality attributed to arrhythmic mechanisms of 14%. These data do not suggest that coronary revascularization in dialysis patients is not efficacious, rather it is proposed that coronary revascularization may be a particularly incomplete therapy for cardiac disease in ESRD patients and that additional treatment strategies targeting the 'non-ischaemic' contributors to SCD may be necessary, as a large untreated hazard of arrhythmic death may remain despite revascularization.
Implantable cardioverter defibrillator therapy
Several trials in multiple patient groups have shown that ICD therapy is superior to medical therapy in primary and secondary prevention for all-cause mortality, almost exclusively by reducing SCD.28–32 Almost all ICD trials, however, excluded dialysis patients or did not publish subgroup analyses on this group of patients. Thus, only very limited literature is available with regard to ICD therapy in dialysis patients.
The few studies that evaluated the benefit of ICD therapy in dialysis patients, however, seem to indicate a possible benefit: Herzog et al.65 documented that after aborted cardiac arrest, ICD therapy was associated with a 42% reduction in death risk in dialysis patients, Hreybe et al.66 found that renal insufficiency is a strong predictor for appropriate ICD shocks and that the incidence of appropriate shocks in HD patients at 1 year is significantly higher when compared with non-dialysis patients and Robin et al.67 concluded that ESRD is the greatest predictor for ICD therapies.
Despite these observations, ICD therapy in dialysis patients is probably underutilized. Only 8% of the dialysis patients who survived a cardiac arrest episode receive prophylactic ICD implantation in the USA.65 This underutilization may be due to several concerns regarding prophylactic ICD implantation in this patient group. An important concern regards the effectiveness of prophylactic ICD implantation. In previous ICD studies, survival was reduced in the ESRD population compared with patients with a normal renal function.67,68 One explanation is the possibility that, in dialysis patients, ventricular arrhythmias are intermittently refractory to ICD therapies because of metabolic derangements.68 However, SCD rates in dialysis patients with an ICD have never been assessed. Another explanation is that co-morbidities in ESRD patients meeting current implantation indications may reduce the survival benefit of ICD placements in this population. Also an important concern regarding ICD therapy is that patients with ESRD may have higher rates of cardiac device-related complications, potentially offsetting some benefits of prophylactic ICD therapy. Dasgupta et al.69 found that dialysis patients indeed had higher complication rates from cardiac device implantation, such as infection and bleeding, but these complications did not result in death.
Considering these possible benefits and risks, further studies are required to assess the potential impact of ICD therapy in dialysis patients. We recently started such a study, the Implantable Cardioverter Defibrillator in Dialysis patients (ICD2) study, which will prospectively evaluate the impact of ICD therapy on SCD in dialysis patients. In addition to that, it will also focus on the feasibility of a larger trial which could evaluate the effect on all-cause mortality.70
The number of prevalent dialysis patients is annually increasing worldwide. Mortality rates among these patients are extremely high, with SCD being the largest contributor to death in this patient group. Interventions aiming at reducing SCD in dialysis patients are therefore very desirable. In the past decade, several interventional methods have been investigated. These methods included medical interventions (β-blockers, statins, and erythropoietin), altering dialysis therapy and revascularization.
Although some observational studies indicate potential survival benefit of the mentioned interventional methods, at this moment prospective data to confirm this benefit are lacking and more adequately powered prospective trials are warranted. With specific regard to their benefit in reducing SCD, the role of these interventional methods remains doubtful. For instance, important trials such as the 4D study did not find a significant reduction in SCD in the treatment arm of their study cohort and it has been observed that after optimal revascularization therapy in dialysis patients with ischaemic heart disease, SCD rates are similar when compared with the general dialysis population.
Prophylactic ICD implantation has become an important preventive intervention for SCD over the past decades. Because prophylactic ICD implantation is effective for prevention of SCD in several high-risk patient groups, it is hypothesized that this may also be valuable in preventing SCD in dialysis patients. This potential benefit of prophylactic ICD implantation was confirmed by several observational studies. However, this has not yet been evaluated prospectively in dialysis patients and therefore a prospective trial is warranted to define the value of prophylactic ICD implantation in this highly vulnerable patient group. The ICD2 study will be the first prospective randomized study that will evaluate the effects of prophylactic ICD implantation in dialysis patients.
Conflict of interest: none declared.


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