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The induction of proinflammatory cytokines in stressed myocardium is considered an innate immune response, but the role of β-adrenergic signaling in this proinflammatory response and the mechanisms of cardioprotection by β-blockers are not fully understood. In the present study, we analyzed interleukin-6 (IL-6) formation and promoter activation in β-adrenoceptor-stimulated neonatal rat cardiomyocytes, in transgenic mice with cardiac overexpression of β1-adrenoceptors, and in failing human myocardium. IL-6 formation and release in cultured cardiomyocytes under β-adrenoceptor stimulation requires the activation of activating protein-1 (AP-1) binding sites and of cAMP response elements (CRE) in the IL-6 promoter, but this release (140 ± 6 pg/mL medium under 10−6 M isoproterenol vs. 81 ± 3 pg/mL unstimulated, P < 0.05) is moderate compared with that under inflammatory stimulation (855 ± 44 pg/mL, endotoxin 0.1μg/mL). Similarly, IL-6 is induced together with CRE- and AP-1 activation in the left ventricle (LV) of β1-transgenic mice before the onset of failure. However, we observed IL-6 induction with activation of NF-κB in addition to CRE and AP-1 in β1-transgenic mice at the age of 22 weeks and in explanted human LV after full development of failure. Treatment with β-blockers lowered myocardial IL-6 as well as AP-1, NF-κB, and CRE activation. Therefore, the activation of AP-1 and CRE is part of β-adrenergic signal transduction for IL-6 induction in nonfailing and failing cardiomyocytes, whereas NF-κB activation contributes only in overloaded failing myocardium.
Proinflammatory cytokines, including tumor necrosis factor α, interleukin (IL)-1, and IL-6, are barely expressed in the healthy myocardium, but they are substantially induced in cardiomyocytes by any form of cardiac overload or injury. This rather uniform reaction has been considered an "innate immune response of the heart" (1). The acute activation of this proinflammatory stress response initially provides the heart with adaptive and protective mechanisms (2). However, the sustained and strong activation of proinflammatory cytokines in the myocardium converts into maladaption, contributing to overt cardiac decompensation and failure (2).
Important signals for the cardiac induction of proinflammatory cytokines are redox stress, ischemia/reperfusion, myocyte stretch, release of molecules from damaged cells, and the enhanced neuroendocrine activity in chronic heart failure (1). Within the latter, potentiating interactions between an activated renin-angiotensin system and proinflammatory cytokines are well documented (3). The effects of sympathetic overactivity on the proinflammatory stress response are less clear: β-adrenoceptor activation is considered as one contributor to stress-induced immunosuppression (4). However, chronic isoproterenol infusion in rats induces myocardial expression of IL-6 and other cytokines (5), but it is not clear whether this induction occurs directly via cAMP generation or indirectly owing to free radical generation, calcium overload, myocyte hypertrophy, or myocardial ischemia. Primary cardiac fibroblasts (6,7) and cardiomyocytes (8) have been reported to express IL-6 after adrenergic stimulation or myocardial infarction (9). However, β-blockade in murine postinfarction heart failure differentially affects myocardial cytokine expression without lowering IL-6 expression (9,10).
The promoter region of the rat IL-6 gene contains a well characterized cAMP-responsive element (CRE), and binding sites for activating-protein-1 (AP-1), NF-κB, and others (11,12). These promoter elements are conserved among species, such as human, mouse, or rat. We used the binding sites in the promoter of the IL-6 gene to analyze the myocardial expression of this cytokine under various conditions of β-adrenoceptor activation in vitro and in vivo. From data in cardiomyocytes in culture, mouse myocardium with cardiomyocyte-specific β1-adrenoceptor overexpression, and failing human myocardium, we conclude that β-adrenoceptor-mediated activation of CRE and AP-1 directly contributes to IL-6 induction in healthy and failing myocardium.
Preparation and cultivation of monolayer cultures of spontaneously contracting neonatal rat cardiomyocytes from hearts of 1–3-day-old Wistar rats was performed as described (13). Muscle cells were separated from nonmuscle cells by means a differential attachment technique. The suspension of these cells in CMRL-1415-ATM medium containing 10% calf serum, 10% horse serum, 10 mM HEPES, and 0.02 mg/mL tobramycin was distributed into 25 cm2 plastic culture flasks or six wells at 1.5 × 105 cells/cm2 for 48 h. After 48 h the serum-supplemented medium was replaced by serum-free CMRL-1415-ATM medium containing 10 mM HEPES, 0.1 μM dexamethasone, 5 μM insulin, 0.4 μM iron-saturated transferrin, 0.02 mg/mL tobramycin, and 10 μM cytosin-1β-D-furanoarabinoside to stop proliferation of non-cardiomyocytes. Neonatal cardiomyocytes were maintained in serum-free medium for 24 h and then exposed to catecholamines as described in the figure legends. Preincubation with β-blockers was started one hour before catecholamine stimulation. Routinely, the viability of attached cardiomyocytes was checked by the trypan blue dye exclusion method. IL-6 immunocytochemistry showed no preferential IL-6 staining of nonmyocytes, identified by α-sarcomeric actin, vimentin, or von Willebrand factor staining, under isoproterenol or norepinephrine (10−6 M).
Mice with transgenic overexpression of the β1 adrenergic receptor under the control of the α-myosin heavy chain promoter and wild-type mice (14) were used to study the effect of chronic β-adrenergic stimulation on IL-6 expression in left ventricle (LV) tissue (n = 8 per group; age 8–22 weeks). It has previously been reported that these transgenic animals show increased contractility compared with wild-type mice at a young age, but this difference is lost at 16 weeks and contractility continues to decrease thereafter (14).
Explanted tissue specimens from the free wall of the LV from heart failure patients with dilated cardiomyopathy (DCM) or end-stage ischemic cardiomyopathy (ICM) and from 21 donor hearts (from 15 men and 6 women, age 40 ± 4 years) were investigated in this study. Patient characteristics are provided in Table 1. The donor hearts were not used for transplantation for technical reasons but were free of detectable ventricular hypertrophy or major coronary artery sclerosis. All samples analyzed in this study were free of visible fibrosis or necrosis as judged by the explanting cardiac surgeon. The use of human tissue was approved by the ethics committee of the Martin Luther University Halle-Wittenberg.
Total RNA was isolated from LV tissue by guanidine thiocyanate/cesium chloride centrifugation and from cardiomyocytes by using TRI-Reagent® (Sigma-Aldrich Chemie, Taufkirchen, Germany). Integrity and quality of the RNA was confirmed by agarose gel electrophoresis, and the concentration was determined by measuring UV-absorption at 260 nm.
Reverse transcription (RT) of RNA samples was carried out for 30 min at 42°C. RT-PCR was performed by standard protocols; the whole PCR reaction was electrophoresed on a 1% agarose gel. The following primer pairs were used: rat IL-6 sense 5′-CCA CTG CCT TCC CTA CTT CA-3′, rat IL-6 antisense 5′-TGG TCC TTA GCC ACT CCT TCT-3′, human IL-6 sense 5′-CTC AGC CCT GAG AAA GGA GA-3′, human IL-6 antisense 5′-TGC AGG AAC TCC TTA AAG CTG-3′, mouse IL-6 sense 5′-AGT TGC CTT CTT GGG ACT GAT-3′, and mouse IL-6 antisense 5′-GGA AAT TGG GGT AGG AAG GA-3′. The products of expected size were gel-purified and sequenced. Densitometric analysis of the PCR products was performed with the AIDA data acquisition and evaluation software (raytest, Straubenhardt, Germany). Data are expressed as IL-6 mRNA/18S rRNA.
Total RNA (20 μg) was size fractioned (1% MOPS/formaldehyde gel), transferred to nylon membrane, fixed by UV crosslinking, and hybridized with a radiolabeled cDNA probe (rat IL-6). Loading was monitored with ethidium bromide staining and by probing with digoxigenin-labeled 18S rRNA.
Frozen LV tissue was rapidly homogenized in a buffer containing 50 mM Tris HCl, 150 mM NaCl, 5 mM EDTA, 0.1% SDS, 1% sodiumdeoxycholate, and protease inhibitor cocktail (Sigma-Aldrich Chemie). Proteins were quantified using the BCA Protein Assay (Perbio Science Deutschland, Bonn, Germany); 50 μg of protein was loaded on 10% SDS-PAGE gel. After electrophoresis, proteins were transferred to a nitrocellulose membrane. The filters were blocked and then incubated with antibodies directed against rat IL-6 (1:1000, Biosource, Solingen, Germany) and rat/human/mouse IL-6 (1:1000, Endogen, Bonn, Germany). After incubation with peroxidase-conjugated secondary antibody, blots were subjected to the enhanced chemiluminescent detection method (Amersham, München, Germany) and exposed to a Kodak MR film (Sigma-Aldrich Chemie).
The release of IL-6 from neonatal rat cardiomyocytes into the medium was quantified by ELISA kit (limit of detection: 15.6 pg/mL) (R&D Systems, Wiesbaden, Germany.
A genomic DNA clone encoding the rat IL-6 promoter region was obtained by PCR (IL-6 promoter rat sense 5′-GTG GAC AGA AAA CCA GGG AC-3′, IL-6 promoter rat antisense 5′-AGC TGT TCC TGA AGG GCA GAT G-3′), amplifying 1070 bp upstream of the ATG. The PCR product was gel-purified, cloned into pCR II TOPO (Invitrogen, Karlsruhe, Germany) and sequenced. The IL-6 promoter contained various consensus cis DNA elements such as GRE (−559 to −554 bp and −444 to −439 bp), AP-1 (−267 to −260 bp), CRE (−156 to −149 bp), NF-IL6 (−147 to −137 bp), NF-κB (−64 to −53 bp), and the TATA box (−18 to −13 bp). The promoter region of the IL-6 gene was excised from the vector and consecutively digested with SpeI (−758), PvuII (−582), BpmI (−535), DraI (−349 and −254), AatII (−156), DraIII (−149), and MamI (−75). The 5′-ends were blunted by Klenow enzyme or T4 DNA polymerase, and the 3′-ends were digested with XhoI. Deletion mutants were cloned into the SmaI-XhoI site of pGL3 basic vector (Promega, Mannheim, Germany). Site-directed mutagenesis of the AP-1 or CRE binding site was performed using the QuikChange® Site-Directed Mutagenesis Kit (Stratagene Europe, Amsterdam, The Netherlands). All products were confirmed by sequencing. After 48 h in serum-containing medium, IL-6 promoter–firefly luciferase fusion DNA (1 μg) and 0.1 μg of pRL-TK control vector (Renilla luciferase) were introduced to neonatal myocytes with Lipofectamine Plus reagent (Invitrogen). After transfection, the cells were cultured in serum-free CMRL-1415-ATM medium for 24 h, washed twice with PBS, and stimulated with 10−6M isoproterenol, 10−6M nor-epinephrine, or 0.1μg/mL LPS for another 24 h. Luciferase activities were determined using the Dual-Glo Luciferase Assay System (Promega) on a GloMax Luminometer with Dual Injector.
Nuclear protein was isolated from human and mouse LV tissue in a three-step process according to the manufacturer's instructions (Nuclear Extract Kit, Active Motif Europe, Rixensart, Belgium). Protein concentration was determined by the BCA Protein Assay (Perbio Science Deutschland). Equal quantities of nuclear protein (10 μg) were assayed for CREB, AP-1, and NF-κB binding activity by using the TransAM™ AP-1 c-Jun, TransAM™ CREB and the TransAM™ NFkB p65 Transcription Factor Assay kit (Active Motif Europe) according to the manufacturer's instructions. All measurements were performed in duplicate and the results are described as percentages relative to the age-matched wild-type mice or nonfailing donor hearts, respectively.
All values are expressed as mean ± SEM. Statistical analysis of differences was done by Student paired or unpaired t-test, by multiple linear regression, or by analysis of variance, followed by Bonferroni-corrected comparisons. Significance was accepted at P < 0.05.
Norepinephrine and isoproterenol induced concentration-dependent IL-6 mRNA expression and IL-6 protein release (Figure 1A and B). This induction was rapid (Figure 1C and D), was mimicked by dbcAMP or by phosphodiesterase inhibition (IBMX) (Figure 1E and F) and was suppressed by β-blockers (Figure 1G and H). Catecholamine-induced IL-6 protein release was moderate (Figure 1B) compared with the release induced by LPS (Figure 1F) or by IL-1β (100 U/mL, 24 h): 2450 ± 213 pg/mL (not shown). Similarly, the catecholamine-induced, β-blocker–sensitive activation of the reporter gene construct (pGL3) containing the IL-6-promoter was moderate compared with the LPS-induced activation (Figure 1H).
The IL-6 promoter contains various consensus cis DNA elements such as GRE, AP-1, CRE, NF-IL6, or NF-κB. The causal role of CRE- and AP-1- activation for catecholamine-induced IL-6 expression is shown with deletion and mutation analyses of the IL-6 promoter: both AP-1 and CRE binding motifs were necessary and sufficient to obtain this activation (Figure 2).
IL-6 influences cellular and physiological responses via binding to the membrane-bound IL-6 receptor (IL-6R)/glycoprotein 130 (gp130) complex. The soluble IL-6R (sIL-6R) can bind the ligand IL-6 and trigger gp130 signaling in cells that lack the membrane-bound IL-6R, a process named transsignalling. In the failing human heart, multiple components of the IL-6- gp130 receptor system are impaired, indicating that this system has an important role in cardiac pathophysiology. However, we observed no change in the mRNA expression of the membrane-bound and the soluble IL-6 receptor (IL-6R, sIL-6R) or of the signal transducer gp130 in cultured cardiomyocytes under catecholamine stimulation (not shown).
Transgenic mice with cardiomyocyte-specific overexpression of the β1-adrenoceptor demonstrate signs of activated β1-mediated signal transduction and hypercontractility under basal conditions at a young age (<15 weeks) and later develop cardiac failure with marked myocyte hypertrophy (14). We observed increased LV IL-6 mRNA expression in these mice at all ages (8, 11, or 22 weeks) (Figure 3A) and increased IL-6 protein at 11 weeks (Figure 3B). A decrease of SERCA mRNA and an increase in NCX mRNA, resulting in a decreased SERCA/NCX ratio, indicative for transition to heart failure, was detectable only at 22 weeks, but not at younger ages (Figure 3A). At the age of 8 and 22 weeks, transgenic mice exhibited increased CRE- and AP-1-binding activity (Figure 3C), whereas NF-κB activity is was altered only at the age of 22 weeks (n = 5 per group). Thus, chronic activation of β1-mediated signal transduction in cardiomyocytes in vivo results in IL-6 induction via AP-1 and CREB activation, which occurs prior to the transition into heart failure. At all ages, transgenic mice demonstrated a significant increase in proANP mRNA (Figure 3A) but no significant difference in mRNA expression of gp130, IL-6 receptor, phospholamban, and the calcium binding protein S100A1, compared with wild-type mice (not shown).
LV tissue from CHF patients (DCM + ICM) demonstrated increased IL-6 expression (mRNA: 0.24 ± 0.02 vs. 0.17 ± 0.02 in nonfailing donors, P < 0.05; protein: 70 ± 10 rU vs. 36 ± 6 rU, P < 0.05). As a sign of heart failure, mRNA expression is significantly enhanced for proANP and NCX, but reduced for phospholamban and SERCA. No alteration was detected for gp130, IL-6R and sIL-6R (not shown).
Retrospective subgroup comparisons revealed that ventricular IL-6 expression is higher in patients with DCM than in those with ICM (Figure 4A and B), and that this expression is lowered by therapy with β-blockers (Figure 4A and B). Multivariate analysis by a linear regression model in failing myocardium, considering therapy (β-blockers, ACE-inhibitors) and diagnosis (DCM or ICM), demonstrates an independent effect of β-blockers on IL-6 expression (patients receiving β-blockers vs. patients without β-blockers: P = .002 for mRNA, P = .001 for protein). Similarly, there was a significant difference in IL-6 expression between patients diagnosed with DCM or ICM (P = .09 for mRNA, P = .006 for protein), but there were only minor effects of ACE-inhibition on IL-6 expression (P > 0.10 for mRNA; P = .02 for protein).
Furthermore, LV tissue from CHF patients demonstrated increased activation of AP-1/c-Jun, CREB, and NF-κB/p65 (Figure 4C), a finding that was even more pronounced in patients without β-blocker therapy compared with patients treated with β-blockers (Figure 4C). Activation of all three transcription factors was higher in nuclear extracts from patients with DCM than in patients with ICM (Figure 4C). All patients had received the β-blockers or ACE-inhibitors for at least one year prior to cardiac transplantation.
This study demonstrates β-adrenoceptor mediated myocardial induction of IL-6 via the activation of AP-1-binding sites and CRE under sustained β-adrenergic activation, indicating that activation of AP-1 is an integral component of β-adrenergic signal transduction in cardiomyocytes, parallel to the canonical activation of CRE. The additional activation of NF-κB is demonstrable only in overloaded failing myocardium.
The promoter analyses (Figure 2) show that mutation of the AP-1- and CRE-binding site results in decreased IL-6 induction, which is further diminished when both sites are abolished. Transcritional stimulation of reporter gene constructs containing the remaining promoter with binding sites for NF-IL-6 and NF-κB by catecholamines shows no difference compared to unstimulated controls, and further deletion of NF-IL-6 also attenuates basal activity in unstimulated cells (Figure 2). Therefore, AP-1 and CRE are necessary and sufficient for norepinephrine- and isoproterenol-mediated induction of IL-6 in cultured cardiomyocytes. In CRE and AP-1 binding site mutation experiments, however, IL-6 induction appeared to be lower (Figure 2H) than when both AP-1-and CRE-binding motifs were lacking in the truncated promoter construct (Figure 2D). We cannot totally exclude an interaction with the remaining consensus cis DNA elements, such as GRE, in the experiments with mutated AP-1 and CRE, although initial experiments did not show a difference between reporter genes including these binding sites and constructs with both GRE elements lacking (not shown).
The concomitant activation of AP-1 and CRE is also the hallmark of myocardial IL-6 induction in the in vivo models of β-adrenergic activation, suggesting that the induction is the direct result of this activation. In young mice with cardiomyocyte-specific overexpression of β1-adrenoceptors (Figure 3), enhanced basal ventricular contractility and heart rate, sensitive to β-blockade, were shown at a young age, whereas cardiac failure develops later in this model (14). At the age of 8 weeks, we observed AP-1 and CRE activation associated with IL-6 expression, whereas NF-κB was activated in the LV at 22 weeks. Parallel with the enhanced IL-6 expression, we observe augmented ventricular proANP expression (Figure 3), consistent with a β-adrenoceptor–mediated contribution to ventricular proANP-induction (15). Similar to the mouse model, failing human myocardium shows an increase in IL-6 mRNA and protein expression as well as increased CRE and AP-1 activity together with additional activation of NF-κB. Thus, activation of CRE and AP-1 is a route of β-adrenoceptor-mediated IL-6 induction in cardiomyocytes in vitro and in vivo. A β-adrenoceptor–mediated IL-6 induction in cardiac fibroblasts, as described by others (6,7), might have contributed to this reaction in cultured cardiomyocytes (due to minimal contamination) and in the myocardium. However, no preferential IL-6 staining of fibroblasts could be demonstrated in cell culture or on tissue slices (not shown).
CRE activation is a known canonical component of cAMP-regulated gene expression, which is still demonstrable in cardiomyocytes with attenuated cAMP-mediated signal transduction due to sustained β-adrenergic stimulation (16). The activation of AP-1 is one final step of the mitogen-activated signal cascade, resulting in DNA-binding of hetero- and homodimers of basic region-leucine zipper proteins from Jun-, Fos-, and other families. A positive interaction of CRE and AP-1 at DNA binding sites has been shown (17), and our data demonstrate that AP-1 activation definitely occurs as part of β-adrenergic signal transduction in cardiomyocytes. Similarly, AP-1 activation via PKA and p38 MAPK is reported to contribute to IL-6 induction in osteoblastic cells under β-adrenergic stimulation (18).
The strong IL-6 induction and NF-κB activation by endotoxin (LPS) in cultured cardiomyocytes (Figure 1) resembles the NF-κB–mediated cytokine expression in immune cells (19). The NF-κB binding site was activated by norepinephrine but not by isoproterenol in isolated neonatal cardiomyocytes (not shown), suggesting β-adrenoceptor–mediated mechanisms. Similarly, Purcell et al. showed that in neonatal cardiomyocytes NF-κB is also activated by various hypertrophic agents including the β1 adrenergic agonist phenylephrine and is required for hypertrophic growth in these cells (20). Furthermore, in vivo experiments also demonstrated the requirement of NF-κB in isoproterenol-induced cardiac hypertrophy (21). In the myocardium in vivo, we saw NF-κB activation only in the LVs of mice with cardiac overexpression of the β1 adrenergic receptor at the age of 22 weeks or in terminally failing explanted human myocardium. However, the transcription factor NF-κB is involved in a variety of physiological and pathophysiological processes, including inflammation, immune response, viral infections, and cell survival responses. In terminally failing myocardium, activation of NF-κB has been observed that is renormalized after hemodynamic unloading by ventricular assist devices (22). This finding argues for a distension-associated activation of NF-κB, either directly or indirectly via distension-mediated induction of TOLL-like receptor-4 as observed in failing myocardium (23). We observed that in failing human myocardium, the IL-6 expression and transcription factor activation is most pronounced in patients without β-blocker treatment prior to explantation (Figure 4), a finding that must not indicate a direct effect of β-adrenergic signaling on NF-κB activity in myocardium. Subtle differences in severity of heart failure among the patients with or without β-blocker therapy cannot be excluded, although the available data prior to heart transplantation did not delineate such differences.
IL-6 acts in target cells via hexameric complex formation of two IL-6 molecules each of IL-6-receptor (IL-6R) and gp130. Although the ligand-binding IL-6R alone is not capable of signal transduction, the signaling component gp130 is also involved in the transduction of signals from other ligands of the IL-6 family. When IL-6 is induced by sustained β-adrenoceptor activation, the capacity for signal transduction by IL-6 is probably maintained, because: (a) we found no lowering in the myocardial mRNA expression of IL-6R or gp130 in any model with sustained β-adrenergic activation; (b) in cardiomyocytes, isoproterenol causes a delayed activation of STAT3 (a hallmark of gp130-dependent signal transduction), which can be attenuated by an IL-6-neutralizing antibody (6); and (c) in failing human myocardium, other studies have demonstrated phosphorylation of gp130 and of downstream signaling components (STAT1, STAT3) (24,25).
IL-6 is a pleiotropic cytokine that induces multiple signals in different target cells (26) and has varying effects on myocardial function [recent review in (27)]. In mammalian cardiomyocytes, IL-6 signaling combines inflammatory activation with antiapoptotic survival pathway activation (28), preventing decompensation during cardiac overload (29). On the other hand, IL-6 attenuates β-adrenergic inotropy (30), as do other proinflammatory cytokines (31,32). It has been argued that acutely protective effects of the innate inflammatory stress response convert to maladaptative damage if the inflammatory response is strong and sustained (1,2). Our data show that the β-adrenergic induction of IL-6 in cardiomyocytes is rather low compared with the induction by endotoxin (Figure 1). In in vivo models of chronic β-adrenoceptor activation, however, this induction is sustained and persistent. One crucial determinant for adaptive or maladaptive net effects of IL-6 might be the interaction with other proinflammatory cytokines. Therefore, it will be important to learn whether and which other cytokines besides IL-6 are also induced by the combined activation of AP-1 and CRE, the feature of β-adrenergic signaling in cardiomyocytes.
In summary, we identified AP-1 activation as an integral, contributing part of the signal transduction for β-adrenoceptor–mediated IL-6 induction in cardiomyocytes of nonfailing and failing myocardium, acting in concert with the canonical CRE-activation. In addition, NF-κB is activated in overloaded, failing myocardium.
This study was supported by the DFG (RO 2328/2-1 and SFB 598), by a grant from Byk-Gulden, Ludwigshafen, and by the Wilhelm-Roux-program of the Medical Faculty Halle (FKZ:14/42, FKZ:14/47, FKZ:14/07). The authors are grateful to R Busath and S Koch for technical assistance.
Online address: http://www.molmed.org
PubMed Central Canada is a service of the Canadian Institutes of Health Research (CIHR) working in partnership with the National Research Council's national science library in cooperation with the National Center for Biotechnology Information at the U.S. National Library of Medicine(NCBI/NLM). It includes content provided to the PubMed Central International archive by participating publishers.


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The move comes as the insurer looks to relaunch its life business, Generali Life Assurance Philippines, in the country following the end of a 17-year joint venture with the Philippines' largest lender, BDO Unibank earlier in the year.
The new business will provide employee benefit policies via group life and medical insurance to multinational corporations, as well as small and medium-sized enterprises, operating in the Philippines.
Generali Life Assurance Philippines also has plans to offer individual life insurance policies.
Partnership split
In June, BDO announced a buyout of holding company Generali Pilipinas Holdings Company, which oversaw the joint venture units Generali Pilipinas Life Assurance Company (Gplac) and Generali Pilipinas Insurance Company (Gpic)
During the split, Gplac was renamed as BDO Life Assurance Company while the Generali Group acquired Gpic, rebranding the company as Generali Life Assurance Philippines.

subset: commoncrawl


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Latest 'thanos the infinity revelation' news
Starlin Hints At New "Infinity" Stories, Larger Cosmic Epic
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Jim Starlin hints at two more in his cosmic Marvel story following the release of this summer's "Infinity Relativity."
The Fifth Color | 'Thanos: The Infinity Revelation's' cosmic insights
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Decompression in storytelling sucks. I'm not saying that it can't be done right and really enhance a plot — the first few issues of the original Ultimate Spider-Man prove that …
Jim Starlin Has an "Infinity Revelation" for Thanos
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CBR spoke with Jim Starlin about his return to Marvel and the character he created in the original graphic novel, "Thanos: The Infinity Revelation."
Marvel Announces Jim Starlin's "Thanos: The Infinity Revelation" OGN
3 Comic News
Marvel has made it official: Jim Starlin returns for "Thanos: The Infinity Revelation" an original graphic novel set for 2014 release.


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Sign up and get your tickets for Bell PTO's Spook-tacular Movie Night featuring Hotel Transylvania! Saturday, October 28th, 2017 at Lynch Van Otterloo (gym) YMCA. 3PM to 5PM. COST: $15.00 per child OR $25.00 per family. Come in costume … [Read More] about Spook-tacular Movie Night!
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Bell School Spirit Catalog
PLEASE HURRY! It's the last week to order from the Fall 2017 Catalog! We hope you love our new range of Bell School Spirit Wear! All proceeds from the sale of Spirit Wear will be invested in enhancing the education of all students at Bell School – … [Read More] about Bell School Spirit Catalog
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Ooch rocks the house
By Claire Henry
Ooch kicked off this year's Cultural Enrichment Program with a visit to Kindergarten and 2nd graders this morning (10/18/2017) with his highly engaging and energetic presentation about bullying - what it means, how to recognise it and how to deal with it. The kids (and teachers) had a blast! Check … [Read More...] about Ooch rocks the house
Latest Goldie Gazette: Oct 17, 2017
By Claire Henry
Keep up to date by regularly checking our on-line calendar and our Facebook page. Here's what's coming up as we close out October. OCTOBER 17-21 - Bell's week at the Magic Hat. Please volunteer! WEDNESDAY OCTOBER 18, 9am - Listening Tour 2: Discussion on plans for the town's new Elementary … [Read More...] about Latest Goldie Gazette: Oct 17, 2017
2nd graders continue to study worms
By Claire Henry
After observing worms as recyclers in the "worm hotels" in their classroom, some of the 2nd graders moved their worms into plastic tubes to see if they really do make extraordinary tunnels benefiting plants' roots. … [Read More...] about 2nd graders continue to study worms
3rd graders mix up their own tea blends
By Claire Henry
Herbalist Madeline Mooney visited some of the 3rd graders last week to talk about the wonderful historical, cultural, social and medicinal qualities of herbal teas. The kids helped mix two types of teas made up of peppermint, lemon balm, rose, lavender and chamomile, followed by a mindful tasting … [Read More...] about 3rd graders mix up their own tea blends


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504 PEGASUS CT Molalla, OR 97038
Hi, Bob Kalstad.
My name is
and I have a question about 504 PEGASUS CT Molalla
You can respond by either emailing me at
or call during
My Question Is:
Estimated Monthly Payment$5,051
Open & Vaulted with 9ft ceilings.Lam. wood floors throughout living area.Two sided fireplace between family & living room.Two pantries, pensula eating bar, microhood & fridge included.Newer 95% gas Furnace & A/C.Newer roof.Master has bath & double closet.Garage has been converted to rec.room can be put back.End of street surrounded by greenspace.R.V.Parking.12x22 deck.Storage shed.Open 9/10 1-4, Directions Highway 213 to Toliver to Pegasus Court
Interior Features Include:
Ceiling Fan, Laundry, Vaulted, High Ceilings, Hi-Speed Connection, Laminate Flooring
Fireplace Description Gas
Total Fireplace 1
Family Room Y
Kitchen Eat Bar, Pantry, Vaulted
Heating: FOR-95+
Exterior Features Include:
Deck, Fenced, Tool Shed, Yard
Acreage: 0.1500 Acres
Description Cul-de-sac, Green Belt
View Trees
Roof: Composition
Garage/Parking: Attached
Parking Driveway, RV Parking or RV Park
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Other Features Include:
Subdivision: Horseshoe Park Estates
Water: Public
Sewer: Public
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Now, I came to realize that even a small thing does really matter in case of making me happy. I 100% agree with what those who have tried this project said. Through this project which I have done documented 100HD offlinely, I start noticing what makes me happy every day, realizing how lucky I am to the life I have, starting to receive more compliment from other people, and so on. I have seen so many people capture their happy moments and then share them via SNS (such as Instagram, Facebook, Twitter, etc.) whenever I connect my computer to the Internet. I believe that individual might have different reasons for sharing their happy moments to others via SNS or keeping it private. However, personally I think it is fun and interesting to document mine and share them with others via Blog as long as it is not an illegal thing to do, right? I mean who cares if you are doing something that you are enjoying about!? So, yeah! I decided to give it a go as a part of my motivation in knowing how happy I am in this earth (of course I know that I'm always grateful for still be able to breath), and also finding new things/reasons behind my happiness that I haven't realized yet. (I will keep updating every happy moments of mine here in the same page). Oh wait!!! I do this for myself. There are no expectations nor judgments nor likes. The concept that I am going to use is different from the 100 happy days in row, which is random happy days that I have collected in this year. Well, let me S.T.A.R.T. Collecting!!.
[Thursday, 2014.10.16]
Yay!!!! Finally I got a MCM ID case. I have been thinking to get one for keeping not only my ID card but also credit card. And, finally it happened. I got it in black color at Hyundai Department Store-Mia Branch today afternoon. I literally found it uncomfortable for me to carry my wallet which is big enough with me whenever I go for lunch with my lab mates nearby. Plus, ID case which is provided by my institution supports only one card, and I can't put those ATM and credit cards in the same case. So, from now on I don't have to worry about bringing/carrying my wallet with me whenever I go for lunch or coffee with/without lab mates. Problem solved!!! Thank you MCM case. 그리고 오늘부터 잘 부탁한다!
[Saturday, 2014.10.18]
I went for a movie with my BF. We watched a Korean movie entitled My Love, My Bride (나의 사랑 나의 신부) at MegaBox Dongdaemun. We rarely go to movie. Maybe once a year I guess. But, this movie forced me so much to go for it. Honestly, I pursued my BF to go with me a week before but he refused. So, I went myself to CGV nearby right after my work because I couldn't help my curiosity about the movie. And, I was right that the movie is totally worth seeing. Thus, the next time I did again to my BF to go watch together, since the movie it's kinda for couples (hehehehe...). Twice of watching this movie isn't enough for me. By the way, I really enjoyed the movie. And, the special part was that I could spend my weekend not in the coffee shop but in the movie with the BF.
[Saturday, 2014.10.25]
Dating time! After lunch, I and my BF went to Myeondong for purchasing a VGA adapter for my Macbook. For the next, we went to ABC market and got a pair of CAT leather shoes for my BF. Btw, the best part was having Kiwi Juice and honey bread at Caffe-Pascucci after the whole day walking around in the same place. It was so relaxing sitting there for almost an hour, talking while having our drinks.
[Friday, 2014.10.31]Good things happened at the end of the month. I am so happy and excited with the "give-away" project. I have been thinking to do this ever since I found out I have no space to move. But, I never got a chance because thought there will be no people who want to have things I no longer need. But, I was totally wrong. Two days ago I had coffee time (skipping working hours) with two of my beautiful besties. We spent almost 3 or 4 hours staying there indoor coffee shop and talked a lot about girls things. And, I learned a lot how to not spending more money to things that I don't really need. From that time also, I found that actually there are awesome people around me who would like to adopt my babes that I have kept for so long. Even though it is hard for me to be apart with them, but I have no option since I need to spice up my room. I am so thankful to my beautiful besties who loved to receive those I offered. I have been waiting for so long, like really. I am super excited and hopefully they like those babes. Here are some of them.
[Saturday, 2014.11.01]After a long exhausting day who doesn't dream about having a perfect delicious dinner in a relaxing place?!? That's what I did 5 minutes ago before touching my blog. I am so blessed to be able to live in a big place (I mean in Seoul it takes long for you as a student to save money to live in a big enough space unless you are rich enough). And, importantly I can cook anything I wanna eat. Anyway, after dinner today, I prepared my presentation materials for presenting in my two classes next week. As long as I wanna end my day with something cool to please myself, I chose to watch Pitch Perfect (again 3rd times of watching and I DON'T give a shit*). Instead of popcorn and coke, I completed it with a cup of kiwi juice & Sausage. What a perfect Saturday night!^^
[Tuesday, 2014.11.04]
So, today I skipped my class. I felt like I wanna stay curled in my bed. After brunch, I continued sleeping till my alarm hit 4pm. Then, I decided to go to coffee shop instead of going to lab in order to do some work. I ordered a cup of hot americano since today's' weather was colder that I thought. After getting my coffee, I got two e-mail notifications on my phone. Once I checked them out, I was like "What?!? Really?!? OMG!" I finally received my Web Application Architecture (University of New Mexico) and Networked Life (University of Pennsylvania) MOOC statement of accomplishments (SOAs) today.
I feel very satisfied to have received these SOAs even though I am not sure whether these certificates of completion are really worth. But anyway, it is always nice to have something to show for one's hard studying and who knows they could be used as input to my résumé. My goal was to enrich my knowledge in both courses tbh, but at the same time I was truly motivated to get the 'certificate'.
If you are curious what it looks like, mine are below. Or else you can search on the Internet because I believe there are thousands of people mentioned and posted it on their preferred SNSs.
If you are curious what it looks like, mine are below. Or else you can search on the Internet because I believe there are thousands of people mentioned and posted it on their preferred SNSs.
[Wednesday, 2014.11.12]
I was planning to do some grocery shopping as my refrigerator and pantry were already empty since two days ago. So, I went home after the work and left my schools stuffs and directly chucked to Home plus which is located 5 minutes away from the house. While roaming around picking things I need, unexpectedly I saw beautiful Christmas tree complete with its ornaments. I felt like I was in cloud nine when I saw it, and I was like "Damn I need to get one (I don't even care about the price tag)". I just wanna feel like home in Christmas day. And the most surprising thing was the price. I got a packet of it with super affordable price (only 15 bucks which means 3 cups of Starbucks americano), can you believe?! Just WOW. Btw, I really feel like home after setting everything up. Maybe it is gonna be Christmas everyday for me from now on. So happppyyyyy!!!
Day-8[Monday, 2014.11.17]


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Naples Metallic-Trim Journal & Pen Gift SetSKU #: PL-LG-9315
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Combines the LG-9299 Naples Metallic Trim Journal with the LG-9304 Tuscany Executive Pen Journal features textured faux leather cover with metal trim, 80 ruled pages and elastic pen loop on spine Pen is twist-action stainless steel ballpoint with faux leather-wrapped body. Ink Cartridge : Black, medium point
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Minor signs of wear through out and especially to bottom hem and the tulle along the bottom hem which has some holes. Lace at waist will need re-stitching
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Interview: Katheryn Winnick discusses her 'Vikings' shield maiden
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By: Bradley G. Barnett03.04.2013 @ 1:53 PM
I think that it was a mistake to 1) not make the opening segment two hours,and with all the Y chromosome DNA knowledge;I think the HChannel could have found at least Scandanavian actors etc. 2) there hopefully is more excitement and/or knowledge that comes from the script! There is potential but Gabriel Byrne,a celt as the Earl…….mean, supercilious?! There is is no explanation why? On this series only time will tell?!
By: D. Boyce03.06.2013 @ 2:59 AM
I waited a long time for a series on the Vikings. It should be noted that the highest IQs in the world population come from southern Scandinavia and Northern Germany and are people who are part Sami and Ashkenazi Hebrew. They were using astrolabes and working Celtic Crosses to measure Latitude and Longitude and the Manitoba Burial mounds show they were in Canada in the 9th century. There is a picture of a Viking on google earth located just north of Pelican Pointe Last Mountain Lake Sask. that is marking exacct latitude and longitude. K. Winnick was perfectly cast in her part. The Viking ship was hundreds of years old before the Vikings took the design as the Peterbourough Petroglyphs show these ships in 3000BC.
By: email@example.com @ 7:25 AM
Ashkenazi Hebrew most intelligent? You mean most manipulative.
By: HitFix User03.23.2013 @ 7:23 PM
Uh, as a Scandinavian I find it weird that everyone associated with this show keeps talking about how little we know of the Viking way of life. We know quite a lot, actually. Just because the scriptwriter doesn't mean the info isn't out there. For one thing, this show keeps talking about them going to Russia, which was founded hundreds of years later – by the Vikings (Russia literally means "the men who row" in the old slavic languages, and Sweden is still called Ruotsi by the Finns).
Hell, the Vikings even became the Elite forces of the Byzanthian Empire, and led armies all over the continent in that capacity. Just google Varangian Guard.
By: Seamus03.25.2013 @ 3:53 AM
Why does every discussion that has to do with Vikings eventually turn into some pseudo-scientific babble about racial nonsense.


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text: 'm going to be heading down to St. Simon's Island for our annual sojourn a bit early this year - we usually head down the last week of August but because of school schedules we're heading down the first week - and was starting to plan the fun parts. In addition to brining my kayak, I'm going to go shark fishing one day and the other day my wife suggested I bring my rifle and go take in a bit of feral hog hunting in the swamps and coastal swamps. Seeing as hogzilla was shot not far from there, that struck me as a wonderful idea. However, I don't really know my way around inland Southeast Georgia (and the wife's family has no idea - their beach people), which leads to this question … Does anyone know the area who could giv eme some guidance as to where I might find some feral swine?? Or, are their any THRs around that first week who might want to head out for some pork shooting??? If not, can anyone recommend an outfitter?? The coast is pretty short there, so I'd really be willing to hook up with any outfitter between Jacksonville, FL and Savanahha, GA (and maybe into South Carolina a bit - its only about 1 1/2 hours from Savana to Jacksonville). Appreciate any insight.


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One of the most notable pies around this time of year is the Pumpkin Pie. In fact, it's so synonymous with Thanksgiving that there are pictures of this delicious creation everywhere you look. Since that's the case, we decided to take this special pie and make it even more special.
The pumpkin pie that so many are used to is the original version. It has the spices, the sugar, the evaporated milk, and the pumpkin. And there is no doubting it – it really is an exceptionally tasty treat. However, sometimes it's nice to "spice" things up a bit and make things a little more interesting. That's why, we decided to take the next best thing in life next to sliced bread and add it in. That's right – we're talking about chocolate-the sweet smoothness that just seems to make everything better.
So grab your spatulas and let's get baking!
Just to note, this recipe is a variation of the one that can be found on the back of the Libby's pumpkin can.
Ingredients You Will Need:
• 1 Can of Pumpkin Puree (Libby's 100% Pure Pumpkin is our choice)
• 1 Can Nestle Carnation Evaporated Milk (there is a 2% version, but it's not an easy find so get whichever one you prefer, if you can find it)
• White Whole Wheat Flour (King Arthur flour does us well, so we go with them)
• Light Brown Sugar (We buy Domino light brown sugar and the version that comes in the plastic bag – we've found that the sugar that comes in the box tends to dry out too quickly. A trick you can do is tie the plastic bag closed as tight as possible, tie it, then throw it in a plastic baggy and close that around it as tight as possible and tie it shut)
• Ground Cinnamon
• Ground Ginger
• Ghirardelli 60% Chocolate Chips (We recommend you don't go lower in percentage due to the health benefits of higher percentages, but you can go higher than this if you desire a more richer, deeper flavor with less sweetness)
• XL Eggs (Our preferred brand is Eggland's Best – they have not done us wrong)
• Vanilla Extract (Preference is McCormick, but any *real* vanilla extract will do (not fans of the artificial version))
• Salt
• Extra Virgin Olive Oil (We go back and forth on brands, depending on which one is cheaper, but right now Filippo Berio is our choice)
• Water
Materials Needed:
• A 9 inch glass pie dish
• Measuring Cups
• Measuring Spoons
• Liquid Measuring Cup
• Large Mixing Bowl
• Small Mixing Bowl
• Small Microwavable Bowl
• Baking Sheet
• Can Opener
• Rolling Pin
• Wax Paper
• Flat Spatula
• Rubber Spatula
Preheat oven to 425 degrees Fahrenheit.
The Recipe
For the pie crust, we use the same crust for all of our pies that require baked pie shells. This recipe can be found here–> https://sugarspiceandeverythingtwice.com/2015/11/05/first-pie-for-pievember-introducing-cranberry-apple-pie/
In this case, wait to make the pie dough until after you mix the pumpkin, eggs, vanilla, and the sugar and spice mixture. As you read on, we explain the reason for this.
That being said, when you do go to make the dough, we suggest rolling it out to the same thinness just so you don't end up with more crust than pie. Since this is not a pie that will be covered, you can take any remaining dough and cut out decorations to place on the pie or on the rim of the pie. If you are placing them directly on the pie itself, we recommend that you bake them on a separate baking sheet and then decorate the pie with them – this way they won't sink.
Pumpkin Pie Filling
• 1 15 ounce Can 100% Pure Pumpkin
• 1 12 fl oz Can Nestle Carnation Evaporated Milk
• 1/4 cup Brown Sugar
• 1 ¼ tsp Ground Cinnamon (we didn't level it out but what you'll want is a little mound)
• 1 tsp Ground Ginger (same as for the cinnamon)
• ½ cup Ghirardelli 60% Chocolate Chips (this will need to be melted but only just when you're about ready to use it so that way it doesn't cool and need to be microwaved again)
• 1 tsp Vanilla Extract
• 2 XL Eggs
First things first, we always wash the cans off so that way when we go to open them any bacteria or dirt will be cleaned off. We just take some warm to hot water on a paper towel, add some Palmolive, and wipe the top part off. Then we just rinse them off, dry 'em, and open those puppies up.
Once that's been take care of, we then proceed to start measuring out the two spices and sugar and mix together in a small bowl.
Next, we take the 2 eggs and beat them in the large mixing bowl. We then add the teaspoon of vanilla and mix together.
After that, we take the canned pumpkin and pour it out (or, more aptly, spoon it out since it's so jammed pack full of tastiness that it couldn't be taken out of the can any other way) into the egg and vanilla mixture. We add the sugar and spice mixture on top of that and just mix it all together until well mixed and smooth looking.
Before adding in the milk, take this time to make your pie shell. The reason for this is two-fold – the first reason being that you don't want your crust to dry out but more importantly, the final reason is to allow the pumpkin and spices to become one (or, in other words, allows the flavors to enhance). You will want to allow the pumpkin mixture to sit for 30 minutes.
After 30 minutes, you can add the evaporated milk, gradually (it takes us about 3 pourings to mix the milk in – you can mix it in as slowly as you want, we just don't recommend pouring it in all at once since it might cause somewhat of a mess when trying to stir) until both the milk and the pumpkin mix are well combined.
Pour that orange creaminess into the prepared pie shell.
Now, I'm sure you're wondering at this point about the chocolate. While baking can be stressful at times, I assure you that the chocolate was not to help keep you sane during the process. You will want to use it now though. First things first, we must melt the deliciousness in order to do so.
You'll want to pour the entire ½ cup into a microwavable bowl and begin with 30 seconds in the microwave. After this, we usually go in 15 second increments to ensure that it's melted to perfection (it usually takes 2-3 times after the initial 30 seconds to reach that point).
With the pumpkin mixture in the pie shell, pour the chocolate all over the top of the pie. Take a spoon and carefully stir it around but not too much to the point where it's mixed in.
Now you can bake your masterpiece. We place ours on top of a baking sheet and it comes out fantastic, but you don't have to if you don't want to. Either way, you'll want to carefully move it so none of it falls out.
Bake at 425 degrees Fahrenheit for 15 minutes then immediately lower the temperature to 350 degrees for exactly 40 minutes.
Once done, allow it to cool for no less than an hour and depending on you, you can either serve immediately while it's still warm or you can allow the pie to cool in the refrigerator for 2-3 hours.
So there you have it – a Chocolate Pumpkin Pie. Of course, you can omit the chocolate and add in a little more spice to have a traditional pumpkin pie. But we can certainly say that this pie is delicious and would be a huge hit at any feast! 😀


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Tech gets ready for ACC showdown against Clemson
ATLANTA - Georgia Tech head football Coach Paul Johnson told reporters Monday that Clemson will be the biggest challenge that his Yellow Jacket team has faced this season/
Tech hosts the Tigers Thursday in a key ACC showdown at Grant Field in Atlanta.
Following are comments from Coach Johnson at his news conference:
Opening statement:
"I thought we got better Saturday, and each game we've improved in different areas, but there's still work left to be done. The way we finished, especially our offensive performance in the 4th quarter wasn't as clean and crisp as it could've been. The way the games have gone, we haven't run as many plays and possessions, but it's worked out okay; the bottom line is the point total. Having said that, we're happy to be 3-0, and we've got the biggest challenge we've faced so far this year on a Thursday night on a short week. It's going to be a quick turnaround against a very, very talented team."
\On the similarity between this year's Clemson team vs. last year's:
"It's a lot of the same guys, but they've got some new offensive linemen. Defensively, they've had to replace some guys, but they're still big and physical. The stat that sticks out to me is that defensively, they're giving up 18-percent third down conversions. They haven't been as prolific as they were last year on offense, but they started to play better last Saturday. They dropped some balls and were their own worst enemy, but I'm sure we'll get their best on Thursday. They're still very talented, and [Mike Williams] is as good as a player I've seen in a long time; he's a top-notch receiver, and they've got other good receivers as well."
On comparing Vanderbilt RB Ralph Webb to Clemson RB Wayne Gallman:
"Gallman has been a good player for them for a couple years, but it's a different style. Clemson plays closer, in style, to the way Mercer played than the ways our other two opponents we've faced this year have played in terms of what they do: spread you out, try to get their guys the ball in space. They're more geared towards that way than a power team."
On getting the team to focus on a better start this year:
"We don't talk about last year, other than the fact that [Clemson] beat the fool out of us; they beat the fool out of a lot of teams last year. If you watch the tape, we were not a very good football team last year, and they were. We were especially bad in that game, at least offensively, but we weren't much better on defense in that game either, if you really want to know the truth. We just have to play better. I think we're a little better than we were a year ago, we'll see if they're better or the same."
On the difficulty of continuing where he left off with the same guys he's had back from a great season before:
"I don't think you could always say that, there's a possibility maybe. Every team is different, you don't always know, and just because you have a lot of guys returning doesn't necessarily mean they'll go right back to where they stopped playing. We lost a lot of guys that were critical to the success of the 2014 team that didn't get enough credit: the running backs, the A-backs, the receivers on offense. Defensively, we had most of them back, but truthfully, in 2014, it wasn't the defense that helped us that much; we were good offensively. I've had other teams, like at Georgia Southern, where we won back-to-back national championships where a large part of the same team came back in and picked up right where they left off the year before, so it varies."
On whether Coach Johnson has prepared any practice simulations or strategies for playing against Clemson QB Deshaun Watson:
"We'll start that today with the scout team players, but it's hard to have anybody be Deshaun Watson. We'll have quarterbacks who run their things and probably run a couple huddles on the scout team before the week's over to get accustomed to their pace and tempo, so as soon as one play finishes, the other group is on the line with the next play off the cards. But we do that against everyone that runs tempo. And they'll assign jerseys on defense so we'll know who's who. If you're running two groups, there will be two quarterbacks, and two completely different scout teams."
On the difficulty of planning for Deshaun Watson:
"I think it's difficult planning for their team, he's a great individual player, but they've got a lot of other great individual players. Like I said, if you look, their skill levels are very high. All their receivers are good, their RBs are good, they have big physical offensive linemen. And Watson is the guy that makes it all go, and he's very talented as well. So they've got plenty of talent."
On facing Clemson LB Kendall Joseph:
"Like I said, they have very good players; they've done a very good job recruiting. They're deep."
On the potential advantages of a short week:
"I don't know much about a short week that's good. The only thing is both teams have to do it. You just get ready and play."
On whether the atmosphere of Thursday night games helps performance:
"We've always had a really good atmosphere for night games, but I think Thursday night games, in particular, have been really good. Hopefully we'll have a big crowd on Thursday night, and it'll be fun for the guys to go out and play."
On whether the short week helps in terms of not building up Clemson as being nationally ranked:
"That's not the way I work. We just have to get ready to play. I look at this as a great opportunity, and I never try to make it a one-game season, no matter who we're playing, or build it up to where the hype is too big. We just have to go play, go out there and play as hard as you can and execute. If we can do that, we'll be in the game. We can play with them, we've played with them before. The bottom line is that we've played them nine times, we've beaten them five, they've beaten us four. The last few years, they've won at home, we've won at home. We just happened to play them at their place two years in a row. They've won three of the last four, the three of which have been at Clemson."
On whether or not this year's defense can feed off the good performance of the offense similarly to the 2014 team:
"Truthfully, the first game is the first game, I don't get too excited about the first game. A lot of it depends on who you play. If you take away the first series of last week's game and the first series of the second half of that game, we were pretty good. We started to get a little more pressure once we got up there, because they had to become more one-dimensional. I think if you get ahead of people, you make them more one-dimensional. The other thing is that if we're playing well offensively, not turning the ball over and making penalties, there's a huge difference. I was glancing at a stat chart from the rest of the conference, and that's where I noticed the 15 possession tidbit from the Virginia Tech and Boston College matchup. Contrast that with our game: we had 8 possessions, so that's about half of their game. So if you can get people into an 8 or 9-possession game, and you're very efficient on offense, it puts a lot of pressure on them on offense; if they're concerned about falling behind two touchdowns, that's like being four touchdowns down against a team that's playing 15 possessions."
On whether having played two traditionally defensive Power Five teams early in the season has prepared Coach Johnson for Clemson:
"We've played two teams that supposedly have good defenses, but they don't have the cast like Clemson does. This is the most talented team we'll have played, by a mile, and that's not a knock on the other teams. I think Boston College has some really talented, hard-nosed players on defense, but they're not the same type of physical guys that we'll see against Clemson."


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Museu do Índio explores the history and society of Native Brazilians, with 14,000 artifacts, 50,000 photographs and 200 audio-visual recordings. The garden has indigenous houses and courtyards which present the domestic life of the people.
Rua das Palmeiras 55 - Botafogo
Indian Museum and Nearby Attractions on Map
Cristo Redentor(2 km)
The towering statue of Christ the Redeemer standing with outstretched arms atop Corcovado overlooking the city is an iconic symbol of Rio de Janeiro.
Avenida Atlantica(2.3 km)
Avenida Atlantica is a 4 km long seaside stretch alongside Copacabana beach, spanning the entire length of the neighbourhoods of Copacabana and Leme.
Lagoa(3 km)
Lagoa is a scenic neighbourhood with a lake, and home to Rio's rich and famous citizens.
Largo do Boticário(1.8 km)
The Largo do Boticário (Apothecary's Square) is a delightful square in the Cosme Velho neighborhood with preserved colonial style houses that date back to 1831.
Guanabara Palace(1.8 km)
The Guanabara Palace, formerly palace of the Imperial Princess, is now the governor's office.
Museu Villa-Lobos(0.1 km)
Museu Villa-Lobos is dedicated to the great Brazilian composer and founder of the Brazilian Academy of Music, Heitor Villa-Lobos, who wrote about 1000 pieces.
Oi Futuro(2.9 km)
Formerly a telephone museum, Oi Futuro now hosts a fine gallery with temporary exhibitions of digital art or art with interactive media.
Museum of Naïve Art(1.5 km)
The Museum of Naïve Art in Rio de Janeiro is the largest museum of its type in the world, with over 8000 pieces, representative of over 130 countries, with many pieces for sale.
No tours found for Indian Museum !


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I have applied twice the first time the rejection was very vague. The second rejection stated "Not enough content" etc, etc. I have 5 published and featured hubs. I have written 16 hubs. Do I need this Adsense approval to collect my ebay earning??
sort by best latest
More content is usually better. Although, there isn't a specific amount of content that AdSense requires, it appears that they are not as concerned with number of Hubs as total content. So a bunch of short Hubs might not work as well as fewer longer and more in-depth Hubs.
I think a month and 15-20 featured Hubs of good length could be a good starting point.
Please keep in mind that since we are not privy to the entire Google AdSense application process, all of our suggestions are guidelines and should not be taken as Google gospel!
You can help the HubPages community highlight top quality content by ranking this answer up or down.


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What makes Joseph Benavidez one of the top flyweights in the world? The top-ranked UFC fighter breaks down some of his favorite moves in the Octagon ahead of his fight with Henry Cejudo at The Ultima watch video >>
In the UFC Fight Night main event, "The Korean Zombie," Chan Sung Jung, makes his first Octagon appearance since August 2013, as he returns from military service to face fellow 145-pound standout Den watch video >>
http://fightnetwork.com/ - Bellator lightweight champion Michael Chandler speaks on enjoying the pursuit of his passion as a top mixed martial artist and his climb to achieve greatness on the busines watch video >>
http://fightnetwork.com/ - Fight Network's John Pollock, John Ramdeen and Robin Black give us the latest in MMA including Nick Diaz saying he will not fight unless it's a title shot or for $500K on N watch video >>
http://fightnetwork.com/ - Gabe Morency makes his best bets, while John Pollock, John Ramdeen and Robin Black make their predictions for The Ultimate Fighter 24 Finale. For additional coverage of MM watch video >>
Dallas is the site for another great event from Legacy Fighting! Cosmo Alexandre makes his Legacy debut, plus Damacio Page, and a main event that features Bubba Bush vs Rakim Cleveland for the Middle watch video >>
Jacare Souza makes weight ahead of UFC 205: Alvarez vs. McGregor OFFICIAL T-SHIRTS & APPAREL: http://bit.ly/2aH7OoA SUBSCRIBE FOR MORE: http://bit.ly/2arsrDN Submission Radio is Now Available on i watch video >>
UFC Hall of Famer BJ Penn makes his highly anticipated return to the Octagon against promising prospect Yair Rodriguez at Fight Night Phoenix on Sunday, January 15 live on FS1. watch video >>
CES MMA makes it's 2017 debut on January 27th with a card you DO NOT want to miss! Featherweight champ Matt Bessette puts his belt on the line against "The Hard Hitting Hillbilly" Kevin Croom in the watch video >>
http://fightnetwork.com/ - Gabe Morency makes his best bets, while John Pollock, John Ramdeen and Robin Black make their predictions for UFC 206: Holloway vs. Pettis. For additional coverage of MMA, watch video >>


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How To Find An Excellent Dentist To Maintain Your Great Smile There are lots of people who are unhappy with the appearance of their teeth. Although it's just a small portion of your body, they're able to impact your image quite a bit. If you aren't happy with the way your teeth look, your self-esteem can really suffer. The following article will give you some great pointers for keeping your teeth looking great. Both flossing and brushing should be done regularly. However, the chances that you will destroy everything in your mouth in terms of bacteria are very slim. You need to use mouthwash after brushing your teeth so that you really get rid of all the bacteria. There's more than regular dental appointments, flossing and brushing involved in proper dental hygiene. Instead, you have to be sure you're making great choices that keep you from having bad teeth. You should quit smoking and avoid stain causing foods and beverages. It's important that you feel comfortable in your dentist's chair. If you don't, you should shop for another dentist. Good dental care is vital. If you are not comfortable with your current dentist, you may stop going altogether. Find a dentist you feel good about. Buy flossing pics so you can always floss. These are just sticks with floss. They are easier to carry than regular floss if you need to clean your teeth when you are away from home. Some think it's simpler to use these rather than traditional floss. This is great for kids who struggle with floss as well. When brushing, you should start out brushing your top gums and moving downward, or viceversa. This grabs the food debris and gets it away from your gums so they are cleaned completely. Scrubbing sideways is fine too, but make sure to use those vertical motions as well. Healthy Gums Start Here With This Excellent Advice If your dentist prescribes antibiotics and/or tooth removal, get it done as quickly as possible. If you don't take steps to attend to an infection of the mouth, it can quickly spread. Make sure to follow whatever your dentist tells you when taking care of a dental issue. You should call different dentist's offices and find one that accepts the insurance plan you purchased. If so, contact your insurance provider to determine which procedures and services are covered. This will help you avoid surprises when your bill comes in. Smoking is a big no-no when it comes to a good smile. Your health in general, and the state of your teeth as a whole, are greatly affected by smoking. You can find a lot of resources if you wish to stop. As well, talk to your doctor when you are ready to quit. The doctor can help you!
Make it a habit to visit your dentist consistently. Depending on your situation, the time between visits can vary. Certain people only need to go once a year while others go to the dentist two or three times a year. Speak with your dentist to ask them how long you should wait between visits. Many people aim for brighter teeth. So many options are currently available that choosing the right product can be a challenge. By utilizing the tips and suggestions you have read here, you can easily make a better decision about how to take care of your teeth.
Published on Feb 4, 2013
There is no reason to live with bad teeth. Some si...


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Discover the Nor'Wester Spirit as you Paddle the Canadian Heritage Voyageur Canoe Routes as a wilderness eco-traveler of today with modern day services – eco-travel made simple!
Explore pristine lakes and rivers, view wildlife, hike picturesque "portage" trails - you'll enjoy nature's peaceful rhythm at Voyageur Island and Quetico as they're only accessible only by water.
And with Quetico's complete mechanical vehicles ban this guarantees a truly tranquil Canadian wilderness experience.
Canoeing is a Canadian heritage activity, as well as a wonderful pastime and there's something for every taste and ability, from those with little experience to the expert eco-traveler.
Quetico is also included as a segment of the Trans Canada Trail, Path of the Paddle route.
Browse trips run by our local travel partners
Michelle Savoie grew up with paddle in hand, has a background with the Provincial Department of Environment, is an avid canoeist and a passionate eco-adventure outfitter with a lifetime of paddling experience in Quetico.
She runs Voyageur Wilderness Programme accompanied by husband Dale, son Joseph and daughter Madeleine. Between them they showcase the lifestyle, history and...
Quetico is a world-renowned destination for backcountry canoeing in pristine protected wilderness. You'll find plenty of wilderness, culture, history and nature's song at Voyageur Island and in Quetico Park that it's sure to excite and engage you to embrace each awesome moment!
Quetico boasts 5,000 square kilometres of designated wilderness which includes 1,400 kilometres of canoe routes and 612+ portages.
Quetico is accessible only by water, except for the family friendly campground Dawson Trail, and its "backcountry" is definitely unique due to its special area designation and complete mechanical ban - no motorboats, no ATVs, nor airplanes in the park which preserves its natural and remote splendour and allows you to explore its rugged beauty, sheltered lakes, majestic waterfalls and virgin pine forests.
Wildlife abounds in Quetico too as this protected wilderness creates an incredible habitat for an abundance of species including plants, mammals, birds, fish and amphibians.
Enjoy a swim in crystal clear waters, portage into remote areas, cast in a fishing line for world class angling, paddle historic canoe routes used by the Voyageur people, discover Aboriginal pictographs and at night watch for the Aurora Borealis/northern lights.
Quetico combines unique natural history with the cultural heritage of the Aboriginals. Enjoy interpretive tours that engage you with living history and reconnects you with natural environment. As well, the friendly small Anishiabe community of Lac La Croix is rich in culture and is one of multiple Park entry stations.
The historical canoe water routes of Quetico are also designated as a segment of Path of the Paddle, Trans Canada Trail in Northwestern Ontario.
You can explore the heart of the Park for two days or on activity-packed weeks, while tour companies offer all-inclusive packages for your adventures as well as trip and route planning.
Quetico's fresh water
This is due to its geographic location just west of the 'height of land' (Laurentian Watershed Divide). With spring-fed watershed it is one of the most pure fresh water systems on the Earth. Combining with Quetico's protection its magnificent waterfalls, marshlands, river, streams and lakes all naturally work to sustain an incredible eco-system.
Quetico's pristine wilderness
Internationally acclaimed and accessible only by canoe water routes. With an imposed ban on mechanical vehicles, the absence of human impacts which includes no signage for campsites or portages and 'Leave No Trace' practices, this guarantees solitude, untouched wilderness and a genuine reconnection to nature in perfect harmony.
Quetico's historical Canadian canoe routes
Its expansive wilderness reflects Aboriginal and Voyageur history that resonates in the water, land, air and nature's heartbeat. From majestic 500 year pictographs to the network of historical Canadian canoe routes, it's an incredible journey.
Quetico's fishing
Listed as some of the best sport fishing Canada has to offer. It offers literally 1,400 kilometres of lakes and rivers that's home to various fish species. Perhaps the best attraction of fishing in this remote area is that you have to have a taste for adventure to experience it.
Wildlife watching and nature photography
The park abounds in wildlife with one area boasting four moose per square mile. There's an excellent chance of seeing moose, beaver, otter, marten, bald eagles, loons as well as 90 species of birds nesting here.
Best times to go:
Peak travel season in Quetico Park is July and to mid-August but avid travelers visit starting May until mid to late September.
However, that being said, Quetico's peak season is not crowded nor overused due to park entry permits which regulate visitor numbers. So you can arrive during peak season and still have a wonderful wilderness experience.
Or think outside that timeframe and truly enjoy June or mid-August into September which could include a glimpse of the Aurora Borealis/Northern Lights.
1. XY Company Hand-Crafted Paddles is dedicated to beautiful quality paddles. Their unique craftsmanship combines a variety of proven and distinct woods, weight, balance and durability which are just some elements to their paddle designs. Each piece is not only an awesome paddle – it is a unique work of Canadian art.
2. Canoe manufacture companies: Fletcher Canoes manufactures high-quality cedar-canvass canoes using traditional methods and quality materials. Renowned Bill Mason paddled a Fletcher Canoe. And Souris River Canoes fabricates many of their own parts and designs in order to ensure high quality and innovative, epoxy-resin/Kevlar canoes.
3. Experience the Nor'Wester Spirit on your ultimate escape to Quetico Park's pristine wilderness. This signature package of seven days/six nights combines a day/night experience on exclusive Voyageur Island before and after your customized Quetico flatwater canoe trip.
Maps: Quetico Provincial Park map. While you're here: Perhaps add on a tour to take in Thunder Bay, ON, explore a fur-traders' fort at Fort William Historical Park. And visit the "Height of Land" / Laurentian Divide geographic marker on Cdn Hwy 11 near Quetico Dawson Trail Entry.
Books: Quetico: Near to Natures Hear by Jon Nelson and Quetico: Into the Wild by Joanie and Gary McGuffin plus A Paddler's Guide to Quetico & Beyond by Kevin Callan
To filter by month, click on the blue filters.
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Register by 31 October and receive £150 off your registration fee for a trek in February.
Experience an epic 24-hour adventure set in the rugged terrain of the Scottish wilderness.
Congratulations to everyone who completed the Great South Run today! Find your next race here...
Forget your fancy spa treatment – get a mud pack thrown in for free on these mud runs and off-road rides.
Hope you bag that PB in today's Northumberland Castles half marathon!
Get your head in the game at the Great South Run tomorrow with expert performance coach Andy Barton.
Push your boundaries, challenge your perceptions & become fearless for seriously ill children.
Good luck to everyone taking part in The Gherkin Challenge for NSPCC tomorrow!
Give the gift of the Rifle Run this Christmas, a 10K run with 3 shooting stations - climb the ranks!
Register your interest now and get up to £400 off on selected December departures.
Charity place entries for the Men's Health Survival of the Fittest close at 5pm tomorrow!
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Come and watch the Pro Surf Tour LIVE in Snowdonia on Sunday, a great day out for the whole family.
European and UK triathlon champion Glenn Cook shares his tips for optimising your R&R.
Walk, jog or run - fundraise for Dementia UK and save up to £20 on your reg fee.
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New Year skiing holidays now 20% off! Take to the slopes 30 Dec - 6 Jan and enter 2018 in style.
The ballot may be closed, but you can still get a charity place today with the NDCS All Stars Team!


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Tidewater brings all the small business data you need together so you can target acquisition campaigns across any channel.
Create targeted business audiences based on 200+ criteria to use in your direct mail, Facebook, or LinkedIn campaigns.
Understand your customers and prospects better so you know who to focus on. Add web, funding, growth, and over 200+ other details to your business lists.
We partner with data providers and marketing execution platforms to make marketing & sales teams lives easier.


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Ron Kardos
Managing Partner
Prior to KLW Investments, Ron founded, owned and operated Sport Leasing and Financial Services, which specialized in auto leasing, and U.S. Real Estate; a real estate acquisition and management company. He brings 30 years of experience in finance solutions, asset management, business development, sales and financial product development. Ron received his BA in Economics and Business from UCLA
Paige Bishop
Senior Director, Loan Relations
Prior to KLW Investments, Paige was post-merger integration strategist for internet incubator CMGI, Director of Open Market\'s Strategic Partnership Program, and has held sales executive positions for Fujitsu software solutions company ICL and Sun Microsystems's value added reseller AVCOM Technologies. Paige has also supported many early stage start-ups in the eco-system that is Silicon Valley.
Paige received her BA from San Francisco State where she specialized in emerging technologies and industrial arts. She is a native of the Bay Area where she enjoys "all" outdoor activities and feeds her music-soul running the Summer Concert Series for Portola Valley.
Elise Mattei
A product of the Silicon Valley, Elise Mattei was born, raised and educated in proximity of bits and bytes. With 13 years as a Director at Oracle managing both products and high-visibility AR programs, Elise offers deep knowledge of business applications and vertical markets. Special expertise includes Customer Experience (CRM), ERP, Supply Chain, Finance and Manufacturing. Elise holds a BS in Finance from Santa Clara University.
Currently, Elise is serving as the CEO of Nexus Analyst Relations, a full service analyst relations agency.
Christina Hillman
Director, Content Management
Before joining the KLW Investments team Christina was the regional director for an alternative dispute resolution company, establishing its first San Francisco Bay Area office and serving as the local face of the organization. Christina holds a BA in Economics from UCLA.
Currently Christina is principal at Leiden Inc, her own social media consulting company.


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Unbeaten performances by Graeme Barella and Phil Prady saw The Mount A team beat Cramlington Stingers 8 - 2 and similarily Chun Yin Yu and Adam Webster were undefeated for North East Chinese Association in a 9 - 1 win over NESLC Eagles.
The Chinese club, N.E.C.A. have signed Naradin Muktar from Stockton and he had an immediate impact with an unbeaten performance against Newton in a 9 - 1 victory.
Old England Crocks joined their Jacks team at the top of Division One by beating Mitford 7 - 3 with Brian Bateman getting a hat trick. In the same division Yao Li also got a hat trick for the Chinese team N.E.C.A. 'B' as they defeated Mount C 6 - 4.
Afterwards they were presened with their trophies for winning Div 5 of the Summer league. I have attached a photo - left to right is Jack Cairns, Israel Shodeinde and Alfie Davies.
Dear All,
The next programme of Regional Training Days at Ormesby TT Club will take place on the following dates:-
Brandon Crusaders and Brandon Devils had a more closely-fought contest as the Crusaders won 6-4 but this result didn't affect the outcome of the promotion or relegation places in the division.


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Great Expeditions is proud to be partnered with the Vancouver Opera Guild, Capilano College and the University of Victoria. Our tours have taken music and theater lovers around the world to enjoy performances in beautiful natural settings such as Santa Fe as well as the great cultural centers of Europe.
Culture Tours Questionnaire
New York: Metropolitan Opera Tour
Length: 7 Days
Date: April
24 - 30, 2018
Level: Easy
The Vancouver Opera Guild invites you to join its spring tour to New York featuring four productions at the Metropolitan Opera with excellent seating in the Grand Tier Balance section plus the Mets National Council Grand Finals Concert.
View Tour Details
Berlin, Prague & Vienna
Length: 12 days
Date: May
24 - June 04, 2017
Level: Easy
The Vancouver Opera Guild invites you to join its exciting Spring tour to Berlin, Prague and Vienna with three nights in Berlin followed by four in Prague and four in Vienna. Six opera performances are featured plus the beautiful Swan Lake ballet in Vienna.
View Tour Details
LA & San Diego Art and Opera Tour
Length: 6 Days
Date: October
13-18, 2017
Level: Easy
The Vancouver Opera Guild invites you to join them for their fifth tour to Los Angeles and its first to San Diego. It features two operas in LA, one in San Diego and visits to the Getty Center and Huntington Library.
View Tour Details
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Kenya attacks: Inside Nairobi's Westgate shopping centre
A four-day siege involving suspected al-Shabab militants at Nairobi's Westgate shopping centre is over, Kenya's President Uhuru Kenyatta has said.
Five attackers were shot dead by troops and 11 suspects were in custody, he announced in a TV address to the nation.
Huw Edwards describes the layout of the shopping centre, which was packed with shoppers and people sitting down to lunch on Saturday when the attack began.
24 Sep 2013
- From the section Africa


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Cart Overview
From 1974 Trixie has been the number one producer of pet accessories for cats, dogs, small pets, fish, birds and reptiles. Here you'll find a great selection of toys, care accessories, cages, and more, gathered specially for you.
An innovator in cat, dog & small pet products, including beds & hutches as well as treats & toys, Trixie is passionate about pets and their owners.
Product quality: Trixie strives to provide great value for money with its products, which are designed and produced to the highest standards.
Toys: Dogs and cats are intelligent creatures that need both physical & mental exercise. Choose from a wide selection of interactive toys including board toys & memory trainers to keep your pet entertained for hours.
Cat trees: Many Trixie cat trees and posts have reconfigurable parts allowing you to adapt them to your cat's individual needs and preferences. Round or square platforms, connecting elements in various shapes and horizontal or wavy scratching boards provide the perfect balance between stretching, exercise and snuggling up for your cat.
Beds: Chances are, your pets spend a considerable amount of time indoors, especially in winter. So it's important to have a comfy, cosy bed that keeps your pet warm. Whether you are looking for something orthopaedic or simply comfortable, you'll be sure to find one that suits your pet's needs. Orthopedic Trixie pet beds are espcially suited to pets with arthritis or rheumatism as they are made with materials that mold to your pet's individual size and shape.
Browse through the following products:
If you are interested in similar offers and products for your pet, don't forget to have a look at our top brands section.Back to the top
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Between 25 to 40 percent people of all ages suffer from acid reflux. Acid Reflux disease is also known as gastrointestinal reflux disease. Acid reflux is a condition which is characterized by burning pain known as heartburn that felt internally around lower heart chest area, it is due to stomach acid flowed back up into the food pipe.
At the entrance of your stomach is a valve, which is ring of muscles called lower esophageal sphincter which closes as soon as food passes through it, if LSE doesn't close or opens too often then the acid produced by your stomach move to esophagus which can then cause heartburn. You may taste sour liquid at the back of your mouth.
Sometimes best formula for reflux progresses to GERD, which is a severe form of reflux a severe digestive disorder. It affects people of all ages. People with asthma are at the higher risk of developing GERD. It have major consequences if left treated.
Cause of best formula for reflux
Many people experience acid reflux occasionally .The most common cause of acid reflux is stomach abnormality called hiatal hernia, in which acid move up into your esophagus and can cause acid reflux disease. Pregnancy can also cause acid reflux due to extra pressure being placed on internal organs. Women conceiving for the first time face acid reflux, and it ends after delivery.
Other Common Risk Factors:
l Eating meals and lying down
l Smoking
l Eating meals close to bedtime
l Drinking beverages such as alcohol and carbonated drinks
l High intake of table salt
Symptoms of best formula for reflux
l Heartburn, Pain which can move from your stomach to chest even to your throat.
l Chest pain, occurs because stomach acid is bursting into the esophagus is also symptom of acid reflux.
l Sweating along with chest pain
l Regurgitation a common symptom, acid backing up to your throat or mouth which causes bitter or sour taste and even you may experience "wet burp"
l Bloody vomiting
l Dysphagia the narrowing of esophagus due to which food stuck in your throat.
l Hiccups that don't stop
l Weight loss for no reason
l Nausea after eating
l Dizziness
l Dry cough or sore throat
l Dental erosion
l Bad breath
l Upper abdominal pain
l Difficultly or pain when swallowing
Acid reflux treated with diet and lifestyle changes
l Eliminate foods that trigger excess production of stomach acid such as spicy food.
l Eat smaller meals which help your digestive system to operate properly
l Quit smoking because it interferes with digestion and cause damage to the lining of esophagus.
l Lose weight with exercise and dieting
l Try sleeping on chair for daytime naps
l Avoid alcohol and caffeinated beverages they loosen the sphincter that controls the passage of the esophagus into the stomach.
l Wear loose fitting clothes because tight one can block digestion. Try to wear pants and skirts with elastic waistbands
l Raise the head of your bed 3 to 4 inches higher than your foot.
Foods to avoid:
l Chocolates
l Citrus fruits
l Tomatoes
l Peppermint
l Fatty or fried foods
l Onions and garlic
l Mint flavoring
l Coffee and tea
l Soda
Foods that fight acid reflux:
l Oatmeal, best breakfast that doesn't cause reflux
l Ginger one of the beat food for acid reflux
l Aloe Vera natural healing agent and also used to heal acid reflux
l Salad a primary meal for acid refluxes
l Banana especially great for the people with acid reflux
l Melon, people eat to avoid acid reflux
l Fennel great food for acid reflux and to improve stomach function
l Chicken
l Fish and seafood
l Roots and greens great food for acid refluxes
l Celery have high water content good food for acid refluxes
l Parsley
Treating acid reflux with medication
H2 Blockers
They act to block the histamine receptors that give signal to your receptors to produce acid. Take them before you have your meal. They decrease acid production.
Proton Pump Inhibitors
They prevent the production of stomach acid. Taking these for 2 weeks not only relive the symptom of acid reflux but also repair the damage done to the lining of esophagus
Home remedies
1. You can take one tablespoon of baking soda with water
2. Eat raw almonds which balance pH level and reduces acid reflux.
3. Drink apple cider vinegar which help your digestive system to work properly.
4. Drink aloe Vera juice.
5. Foaming agents: coat your stomach to prevent reflux
6. Prokinetics strength LES and empty you stomach faster and reduce acid reflux.
Treating chronic acid reflux
Consult your doctor if lifestyle changes and home remedies is not working or your symptoms are painful and last more than 2 weeks. Undergo testing to find out the main cause sometimes ulcer and cancer can cause acid reflux to occur.
Possibilities of surgical repair:
If medications don't completely resolve your symptoms of acid reflux and symptoms are interfering with your daily life, so your doctor can recommended you surgery. The surgical procedure done to prevent reflux is known as fundoplication and is also known as anti-reflex surgery. This is the standard method for treating.
The main thing of fundoplication is to recreate the barrier that stop reflux from occurring. The procedure involve wrapping upper of stomach to strengthen it and repair hiatal hernia. Surgeons performed it in two ways by either in an open incision in the abdomen or chest or with the tube inserted in the abdomen. Person having hiatal hernia which causes GERD symptoms, it will be repaired during this surgery. The laparoscopic surgery is the one which have shorter recovery time with less pain then open sugary and this is the best formula for reflux.
One type of endoscopy involves stitching the area of lower esophagus sphincter which especially tighten the sphincter.
Second type involves radio frequency wave to the lower part of esophagus. The wave cause damage to tissues beneath the esophagus. The scar shrinks and pull the surrounding tissues and also tighten the sphincter and area around it.
Things to do after surgery
1. Patients are encourage to engage in small activity after surgery
2. Should avoid heavy lifting
3. Anti-reflux medications are not required after surgery
4. Take medication properly
5. Follow the doctor's instructions.
6. Have the appointment with doctor after 2 weeks of surgery
7. Get back to normal activities such as showering, walking up stairs and driving.