scholarly journals Curriculum review: serrated lesions of the colorectum

2019 ◽  
Vol 11 (3) ◽  
pp. 243-248
Author(s):  
Angad Singh Dhillon ◽  
Hajir Ibraheim ◽  
Susi Green ◽  
Noriko Suzuki ◽  
Siwan Thomas-Gibson ◽  
...  
Keyword(s):  
Alternative Pathway ◽  
Cumulative Effect ◽  
Low Grade ◽  
Epigenetic Alterations ◽  
Curriculum Review ◽  
Normal Colonic Epithelium ◽  
Surveillance Interval ◽  
Serrated Lesions ◽  
The Uk ◽  
Serrated Neoplasia Pathway

Colorectal cancer (CRC) is the second leading cause of death from cancer in the UK. Sporadic CRC evolves by the cumulative effect of genetic and epigenetic alterations. Typically, over the course of several years, this leads to the transformation of normal colonic epithelium to benign adenomatous polyp, low-grade to high-grade dysplasia and finally cancer—the adenoma-carcinoma sequence. Over the last decade, the serrated neoplasia pathway which progresses by methylation of tumour suppressing genes has been increasingly recognised as an important alternative pathway accounting for up to 30% of CRC cases. Endoscopists should be aware of the unique features of serrated lesions so that their early detection, appropriate resection and surveillance interval can be optimised.

Long-term study of the natural environment - perceptive science or mindless monitoring?

1994 ◽  
Vol 18 (4) ◽  
pp. 475-496 ◽  
Author(s):  
T.P. Burt
Keyword(s):  
Natural Environment ◽  
Environmental Science ◽  
Low Grade ◽  
Term Study ◽  
Long Term Study ◽  
Alternative Approaches ◽  
Coweeta Hydrologic Laboratory ◽  
Long Term Observation ◽  
The Uk

The importance of long-term observation of the natural environment has long been recognized, and yet 'monitoring' is often dismissed as low-grade science which can contribute little to our understanding. The value of long-term study is assessed within the context of the Environmental Change Network (ECN) which was established in 1992 to provide a minimum of 30 years' data from a network of sites within the UK. Following a description of the ECN programme, there follows an assessment of the value and limitations of long-term study and consideration of alternative approaches. Three examples of long-term study (Coweeta Hydrologic Laboratory; Radcliffe Meteorological Station; and the Slapton Ley catchment study) are described by way of illustration. It is concluded that long-term study provides an invaluable basis for the development of environmental science. Well designed programmes, supported by sustained funding, provide the best conditions for studying processes whose effects can only be identified over long periods of time and for revealing new questions which could not have been anticipated at the time the monitoring began.

scholarly journals Cumulative Histologic Inflammation Predicts Colorectal Neoplasia in Ulcerative Colitis: A Validation Study

2020 ◽  
Author(s):  
Olivia V Yvellez ◽  
Victoria Rai ◽  
Philip H Sossenheimer ◽  
John Hart ◽  
Jerrold R Turner ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Colorectal Neoplasia ◽  
Low Grade ◽  
Inflammatory Index ◽  
Surveillance Interval ◽  
Matched Case ◽  
The Mean ◽  
The University ◽  
Selection Of ◽  
Inflammatory Burden

Abstract Background Chronic inflammation in ulcerative colitis (UC) is associated with the development of colorectal neoplasia (CRN). A group at St. Mark’s Hospital reported a novel cumulative inflammatory index that predicted the development of CRN in UC patients that we validated with an independent, well-described, matched, case-controlled cohort from the University of Chicago. Methods Cumulative inflammatory burden (CIB) was calculated by summing each histological inflammatory activity (HIA) score and multiplying it by the length of the surveillance interval. Persistency was defined by the number of surveillance episodes (with a severity score >2) divided by the total number of surveillance procedures. T tests compared the mean and maximum HIA scores, assessing mean and maximum severity, CIB, and persistency. Results Sixty-two UC patients (26 patients with CRN, 36 control patients without CRN) were analyzed. Fifty-five percent were men, mean disease duration was 20.6 years, and mean age at CRN diagnosis was 43.9. Of the CRN patients, 6 (23%) had colorectal cancer, 16 (62%) had low-grade dysplasia, and 4 (15%) had indefinite dysplasia. Using mean HIA scores, we found CIB to be statistically greater in CRN patients (P = 0.04). Using maximum HIA scores, we found CIB (P = 0.02), mean severity (P = 0.03), and persistency (P = 0.01) to be significantly greater in CRN patients. Maximum severity was numerically greater for mean and maximum HIA scores but did not reach significance. Conclusion Cumulative histologic inflammation is significantly associated with the development of CRN in UC patients. This suggests a management strategy of controlling inflammation to reduce the risk of CRN and may influence the selection of surveillance intervals.

K-RAS, B-RAF and GNAS Gene Status and Immunohistochemistry Analysis of Mucinous Neoplasm of Appendix

2020 ◽  
Author(s):  
xinyu ren ◽  
Yin Cheng ◽  
Tao Lu ◽  
Junliang Lu ◽  
Yan Wu ◽  
...  
Keyword(s):  
Low Grade ◽  
Cytokeratin 20 ◽  
Ki 67 ◽  
P53 Expression ◽  
Mucinous Neoplasm ◽  
Mucin Expression ◽  
Gnas Gene ◽  
Serrated Lesions ◽  
The Difference ◽  
Gene Status

Abstract AIM Low grade appendiceal mucinous neoplasm (LAMN) and serrated lesions are sometimes hard to differentiate from morphology. We try to characterize them from the immunohistochemical and molecular perspective and to reflect the difference between them. METHODS 25 appendix neoplasm including 13 LAMNs, 12 serrated lesions were selected from January 2013 to December 2014. Immunohistochemical analyses for cytokeratin 20, MUC6, MUC5AC, MUC1, Ki-67, P53 and mismatch repair (MMR) proteins including MLH1, PMS-2, MSH-6, MSH-2 were performed. Microsatellite instability (MSI) status was also evaluated. Besides, we detect K-RAS, B-RAF and GNAS gene mutation status of these lesions. RESULTS Immunochemically, 83.3% serrated lesions showed scattered CK20 staining in the deep crypt, which was less so for LAMNs. As for mucin expression, MUC5AC had slightly higher positive rate in LAMNs and than in serrated lesions.MUC1 was significantly higher expressed in LAMNs than in serrated lesions. 46.1% LAMNs have P53 expression in deep crypt, while P53 was negative in the deep crypt of serrated lesions. 58.3% serrated lesions had deficient MMR protein expresion pattern compared to 23.1% of LAMNs. B-RAF mutation was detected in 3 cases, all were serrated lesions. K-ras and GNAS mutation was detected in both LAMNs and serrated lesions. CONCLUSION Immunohistochemical panel comprising markers such as CK20, MUC5AC, MUC1, Ki-67 and P53, with genotyping covering hotspots of the KRAS, BRAF and GNAS genes can help the differential diagnosis of low grade appendix neoplasm.

Drone journalism and aviation laws, systems, training, and tech trends

2020 ◽  
pp. 107-129
Author(s):  
Cate Dowd
Keyword(s):  
News Media ◽  
Alternative Pathway ◽  
Disruptive Technologies ◽  
The Us ◽  
The Uk ◽  
Air Safety

The professional use of civilian drones involves training in air safety and law set by aviation authorities, like CASA, which modified its laws, licences, and procedures in 2016. By 2019 media producers in countries like the UK, Australia, and the US, had used drones for almost a decade. Amidst the rules and deterrents, there are mixed benefits in using drones for news media. Prior to 2015 drone training in Australia began with PPL (Private Pilot’s Licence) theory, followed by an alternative pathway of a RePL (Remote Pilot’s Licence). The firsthand experiences of PPL training and subsequent training covers many aviation topics, from flight controllers to OzRunway apps. Beyond training, recent tech trends include networks for drones and swarm systems already used in the US and Korea. However, tracking and registration systems are only just emerging in Australia and drones, regarded as disruptive technologies in the UK, are complicated by Brexit.

Low grade thermal energy sources and uses from the process industry in the UK

2012 ◽  
Vol 89 (1) ◽  
pp. 3-20 ◽  
Author(s):  
Yasmine Ammar ◽  
Sharon Joyce ◽  
Rosemary Norman ◽  
Yaodong Wang ◽  
Anthony P. Roskilly
Keyword(s):  
Thermal Energy ◽  
Process Industry ◽  
Energy Sources ◽  
Low Grade ◽  
The Uk

scholarly journals Complement Activation in Mycoplasma fermentans-Induced Mycoplasma Clearance from Infected Cells: Probing of the Organism with Monoclonal Antibodies against M161Ag

2000 ◽  
Vol 68 (3) ◽  
pp. 1672-1680 ◽  
Author(s):  
Satomi Kikkawa ◽  
Misako Matsumoto ◽  
Tsuguo Sasaki ◽  
Miyuki Nishiguchi ◽  
Kazuhiko Tanaka ◽  
...  
Keyword(s):  
Monoclonal Antibodies ◽  
Human Peripheral Blood ◽  
Alternative Pathway ◽  
Human Tumor ◽  
Host Cells ◽  
Low Grade ◽  
Host Immune System ◽  
Human Complement ◽  
Mycoplasma Fermentans ◽  
Infected Cells

ABSTRACT Mycoplasma fermentans, a cell wall-less prokaryote, is capable of infecting humans and has been suggested to serve as a cofactor in AIDS development. Recently, we discovered a novel lipoprotein with a molecular mass of 43 kDa originating from M. fermentans. This protein, named M161Ag, activated human complement via the alternative pathway and efficiently induced the proinflammatory cytokines interleukin 1β (IL-1β), tumor necrosis factor alpha, IL-6, IL-10, and IL-12 in human peripheral blood monocytes. It is likely that M161Ag of M. fermentansaffects the host immune system upon mycoplasma infection. In this study, we developed monoclonal antibodies (MAbs) against M161Ag and examined the direct role of complement in M. fermentans infection using these MAbs as probes.M. fermentans was rapidly cleared from the surfaces of infected cells by human complement, but a low-grade infection persisted in human tumor cell lines. Mycoplasma particles remaining alive in host cells may cause recurrent infection, and liberated M161Ag may serve as a biological response modifier affecting both innate and acquired immunity.

scholarly journals Molecular profiling of appendiceal serrated lesions, polyps and mucinous neoplasms: a single-centre experience

2021 ◽  
Author(s):  
Giada Munari ◽  
Gianluca Businello ◽  
Paola Mattiolo ◽  
Gianmaria Pennelli ◽  
Marta Sbaraglia ◽  
...  
Keyword(s):  
Mismatch Repair ◽  
Rare Event ◽  
Neuroendocrine Neoplasms ◽  
Low Grade ◽  
Tubular Adenoma ◽  
High Grade ◽  
Mismatch Repair Deficiency ◽  
Repair Deficiency ◽  
Mucinous Neoplasms ◽  
Serrated Lesions

Abstract Purpose Non-neuroendocrine neoplasms of the appendix are a phenotypically heterogeneous group of lesions; a comprehensive molecular characterization of these tumors is still lacking. Methods A total of 52 samples taken from 49 patients was evaluated: 18 sessile serrated lesions (SSL; 3 with dysplasia), 2 high-grade tubular adenomas, 1 tubulo-villous adenoma,1 hyperplastic polyp, 18 low-grade appendiceal mucinous neoplasms (LAMN), 3 high-grade appendiceal mucinous neoplasms (HAMN) and 9 mucinous adenocarcinomas. Hotspot mutational profiling of the RNF43, SMAD4, KRAS, NRAS, BRAF and PIK3CA genes was performed. Expression of p53, MLH1, PMS2, MSH2, and MSH6 was evaluated by immunohistochemistry. Results KRAS was the most frequently mutated gene (53.9% of cases), followed by RNF43 (15.4%), and BRAF (13.5%). In particular: KRAS was mutated in 44.4% of adenocarcinomas, 66.7% of HAMNs, 61.1% of LAMNs, 53.3% of SSL without dysplasia and in 66.7% of SSL with dysplasia; RNF43 was mutated in 33.3% of adenocarcinomas, 66.7% of HAMNs, 11.1% of LAMNs and in 6.7% of SSL without dysplasia; BRAF was mutated in 11.1% of adenocarcinomas, 26.7% of SSL without dysplasia and in 5.6% of LAMNs. Only a case of high-grade tubular adenoma showed mismatch repair deficiency, while immunohistochemical expression of p53 was altered in 21.1% of cases. Conclusions The histological phenotypic similarities between appendicular mucinous lesions and serrated colon lesions do not reflect a similar genetic landscape. Mismatch repair deficiency is a rare event during appendiceal mucinous carcinogenesis.

scholarly journals Road to CESR (Article 14)- Is it for me?

2021 ◽  
Vol 7 (2) ◽  
Author(s):  
Chetan Pataki
Keyword(s):  
Alternative Pathway ◽  
General Medical Council ◽  
International Medical Graduate ◽  
Career Progression ◽  
Medical Graduate ◽  
Medical Council ◽  
Gradual Change ◽  
Training Post ◽  
To Come ◽  
The Uk

“What lies behind us & what lies ahead of us are tiny matters to what lies within us!” – Ralph Waldo Emerson Many clinicians across the world aspire to come to United Kingdom and work in NHS. Initial months could be challenging to work in completely new healthcare system. With some help from good colleagues, transition for overseas doctors can be less overwhelming. As an International Medical Graduate (IMG), there are several options for career progression in UK. Many doctors enter in the UK formal training program, however, Certificate of Eligibility for Specialist Registration (CESR) is an alternative pathway to achieve CCT. The CESR route could be helpful for clinicians trained in countries outside the UK or European Union as their training from their country of origin might not be recognized equivalent to CCT by General Medical Council (GMC). After obtaining CESR certification, your name is added to specialist register which is a absolute necessity to obtain a substantive consultant position in UK. There is ever increasing requirement for doctors in the UK due to staff shortages and now Covid-19 pandemic has pushed many trusts against the wall to fill these positions. Apart from recruiting overseas doctors, CESR certification has proven to be helpful in filling up these positions. The GMC made some favorable changes in the CESR process in recent years which has encouraged and many career grade/staff grade doctors to progress. On other hand, trainees who fail to obtain training post after several attempts are opting for CESR as an alternative route to progress. Annual statistics published by the GMC indicate that there is rising trend in number of applications for CESR certification in all specialties. There is a gradual change in the perception of CESR as an equally attractive route for career progression. However, there are many unknowns in this pathway as this has been a path less travelled. There is a general perception that CESR certification is difficult t

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