scholarly journals Helicobacter pylori infection and increased diabetes prevalence were the risks of colorectal adenoma: a systematic review and meta-analysis

2019 ◽  
Author(s):  
Horng-Yuan Wang ◽  
Ying-Chun Lin ◽  
Chieh-Chang Chen ◽  
Ming-Jen Chen ◽  
Ming-Shiang Wu ◽  
...  
Keyword(s):  
Colorectal Adenoma ◽  
Meta Analysis ◽  
Diabetes Prevalence ◽  
Group 4 ◽  
Increased Risk ◽  
Group 3 ◽  
Group 2 ◽  
H Pylori ◽  
Adenoma Risk ◽  
Group 1

Abstract Background Helicobacter pylori (H. Pylori) infection and hyperglycemia may be associated with an increased risk of colorectal neoplasm. However these two factors affect colorectal neoplasm remain controversial. We aimed to carry out a meta-analysis to evaluate the study population diabetes prevalence rate and H. pylori infection rate with colorectal adenoma risk. Methods We conducted a systemic research through English databases for medical reports. We also recorded the diabetes prevalence and H. pylori infection prevalence in each study. We classified these studies into 4 subgroups as their background population diabetes prevalence < 6%(Group 1); between 6 to 8%(Group 2); between 8 to 10 %(Group 3) and more than 10%(Group 4). The random effects model had used to calculate pooled prevalence estimates with 95% confidence interval [CI]. Results Twenty seven studies were finally eligible for meta-analysis. The random-effects model of meta-analysis was chosen, showing pooled odds ratio (OR) equal to 1.51 (95 % CI 1.39–1.63). The subgroup meta-analyses showed in Group 1 the H. pylori infection associated colorectal adenoma risk OR was 1.24 (95 % CI 0.86–1.78). As diabetes rate exceed 6%, the H. pylori infection became more significant increased risk of colorectal adenoma (Group 2: OR 2.16 (95 % CI 1.61–2.91); Group 3: OR 1.40 (95 % CI 1.24–1.57); Group 4: OR 1.52 (95 % CI 1.46–1.57)). Conclusions The results of this meta-analysis showed DM prevalence would affect the risk factor of colorectal adenoma with H. pylori infection.

scholarly journals Helicobacter pylori infection and increased diabetes prevalence were the risks of colorectal adenoma: a systematic review and meta-analysis

2019 ◽  
Author(s):  
Horng-Yuan Wang ◽  
Ying-Chun Lin ◽  
Chieh-Chang Chen ◽  
Ming-Jen Chen ◽  
Ming-Shiang Wu ◽  
...  
Keyword(s):  
Colorectal Adenoma ◽  
Meta Analysis ◽  
Diabetes Prevalence ◽  
Group 4 ◽  
Increased Risk ◽  
Group 3 ◽  
Group 2 ◽  
H Pylori ◽  
Adenoma Risk ◽  
Group 1

Abstract Background Helicobacter pylori (H. Pylori) infection and hyperglycemia may be associated with an increased risk of colorectal neoplasm. However these two factors affect colorectal neoplasm remain controversial. We aimed to carry out a meta-analysis to evaluate the study population diabetes prevalence rate and H. pylori infection rate with colorectal adenoma risk. Methods We conducted a systemic research through English databases for medical reports. We also recorded the diabetes prevalence and H. pylori infection prevalence in each study. We classified these studies into 4 subgroups as their background population diabetes prevalence < 6%(Group 1); between 6 to 8%(Group 2); between 8 to 10%(Group 3) and more than 10%(Group 4). The random effects model had used to calculate pooled prevalence estimates with 95% confidence interval [CI]. Results Twenty seven studies were finally eligible for meta-analysis. The random-effects model of meta-analysis was chosen, showing pooled odds ratio (OR) equal to 1.51 (95% CI 1.39–1.63). The subgroup meta-analyses showed in Group 1 the H. pylori infection associated colorectal adenoma risk OR was 1.24 (95% CI 0.86–1.78). As diabetes rate exceed 6%, the H. pylori infection became more significant increased risk of colorectal adenoma (Group 2: OR 2.16 (95% CI 1.61–2.91); Group 3: OR 1.40 (95% CI 1.24–1.57); Group 4: OR 1.52 (95% CI 1.46–1.57)). Conclusions The results of this meta-analysis showed DM prevalence would affect the risk factor of colorectal adenoma with H. pylori infection.

scholarly journals Helicobacter pylori infection and increased diabetes prevalence were the risks of colorectal adenoma: a systematic review and meta-analysis

2019 ◽  
Author(s):  
Horng-Yuan Wang ◽  
Ying-Chun Lin ◽  
Chieh-Chang Chen ◽  
Ming-Jen Chen ◽  
Ming-Shiang Wu ◽  
...  
Keyword(s):  
Colorectal Adenoma ◽  
Meta Analysis ◽  
Diabetes Prevalence ◽  
Group 4 ◽  
Increased Risk ◽  
Group 3 ◽  
Group 2 ◽  
H Pylori ◽  
Adenoma Risk ◽  
Group 1

Abstract Background Helicobacter pylori (H. Pylori) infection and hyperglycemia may be associated with an increased risk of colorectal neoplasm. However these two factors affect colorectal neoplasm remain controversial. We aimed to carry out a meta-analysis to evaluate the study population diabetes prevalence rate and H. pylori infection rate with colorectal adenoma risk. Methods We conducted a systemic research through English databases for medical reports. We also recorded the diabetes prevalence and H. pylori infection prevalence in each study. We classified these studies into 4 subgroups as their background population diabetes prevalence < 6%(Group 1); between 6 to 8%(Group 2); between 8 to 10 %(Group 3) and more than 10%(Group 4). The random effects model had used to calculate pooled prevalence estimates with 95% confidence interval [CI]. Results Twenty seven studies were finally eligible for meta-analysis. The random-effects model of meta-analysis was chosen, showing pooled odds ratio (OR) equal to 1.51 (95 % CI 1.39–1.63). The subgroup meta-analyses showed in Group 1 the H. pylori infection associated colorectal adenoma risk OR was 1.24 (95 % CI 0.86–1.78). As diabetes rate exceed 6%, the H. pylori infection became more significant increased risk of colorectal adenoma (Group 2: OR 2.16 (95 % CI 1.61–2.91); Group 3: OR 1.40 (95 % CI 1.24–1.57); Group 4: OR 1.52 (95 % CI 1.46–1.57)). Conclusions The results of this meta-analysis showed DM prevalence would affect the risk factor of colorectal adenoma with H. pylori infection.

scholarly journals The Participation of p53 and bcl-2 Proteins in Gastric Carcinomas Associated with Helicobacter pylori and/or Epstein-Barr Virus (EBV)

2015 ◽  
Vol 64 (3) ◽  
pp. 211-216 ◽  
Author(s):  
Andrzej Szkaradkiewicz ◽  
Tomasz Karpiński ◽  
Jan Majewski ◽  
Kamila Malinowska ◽  
Olga Goślińska-Kuźniarek ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
P53 Protein ◽  
Apoptosis Resistance ◽  
Gastric Carcinomas ◽  
Ebv Infection ◽  
Group 4 ◽  
Group 3 ◽  
Group 2 ◽  
H Pylori ◽  
Group 1

In the presented studies p53 and bcl-2 proteins expression were evaluated in samples of gastric carcinomas in patients with Helicobacter pylori or EBV or without H. pylori/EBV infection. The studies were conducted on 64 adult patients with gastric adenocarcinomas: 16 patients with H. pylori (cagA+)-positivity (group 1), 14 with EBV-positive tumours (group 2), 12 with H. pylori/EBV-positive tumours (group 3) and 22 patients with H. pylori/EBV-negative tumours (group 4). H. pylori presence in gastric tumour specimens was detected using Giemsa staining and bacterial culture technique. Moreover, cagA gene was detected using PCR. EBV infection was detected based on EBER presence in the tissue by RNA in situ hybridization. Expressions of p53 and bcl-2 proteins were analysed using immunohistochemistry. Expression of p53 was noted in 14 (84%) patients from group 1, 8 (57%) patients from group 2, 7 (58%) patients from group 3, and 19 (86%) patients from group 4, whereas expression of bcl-2 was noted in 12 (75%) patients from group 1, in 10 (71%) patients from group 2, 9 (75%) patients from group 3, and 6 (27%) patients from group 4. The obtained results allow the conclusion, that H. pylori (cagA+)-associated development of the gastric adenocarcinoma is determined by abnormalities in the p53 protein function and overexpression of anti-apoptotic bcl-2 protein, whereas EBV-associated adenocarcinomas seem to be related with apoptosis resistance associated with bcl-2 overexpression.

scholarly journals Association of early and later depressive symptoms with functional outcome after ischemic stroke

2021 ◽  
Author(s):  
Anna Maria Lopatkiewicz ◽  
Joanna Pera ◽  
Agnieszka Slowik ◽  
Tomasz Dziedzic
Keyword(s):  
Ischemic Stroke ◽  
Depressive Symptoms ◽  
Functional Outcome ◽  
Psychiatric Symptoms ◽  
Post Stroke ◽  
Group 4 ◽  
Increased Risk ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Background Post-stroke depressive symptoms (DS) can be chronic or transient, occurring shortly or long after stroke and lasting only few months. It remains unclear if the prognosis differs between patients with DS in the acute phase of stroke and those who develop DS several months later. We aimed to determine whether outcomes vary among patients with different trajectories of post-stroke depressive symptoms. Methods Of 698 enrolled patients with ischemic stroke, we included 335 participants (median age: 68, 48% female) who were assessed for DS both 8 days and 3 months post-stroke. We divided patients into 4 groups: without greater DS (Group 1), only earlier DS (Group 2), only later DS (Group 3), and persistent DS (Group 4). Logistic regression was used to determine the association between DS and 3- and 12-month functional outcome. Results Group 2 was predominantly female and had the highest rate of previous stroke or transient ischemic attack. Group 3 was more likely to suffer from delirium and more severe stroke. Group 4 had the highest frequency of vascular risk factors, pre-morbid psychiatric symptoms, and cognitive decline. In multivariate analysis, Group 3, but not Groups 2 and 4, had an increased risk of poor 3- and 12-month functional outcome (adjusted OR 2.59, 95% CI 1.64–4.07, P < 0.01 and OR 3.97, 95% CI 2.32–6.76, P < 0.01, respectively) compared with Group 1. Conclusions Different trajectories of post-stroke DS are related to different outcomes. Patients who only have later DS also have the worst prognosis.

3254Manifestations of myocardial fibrosis in the standard 12-lead electrocardiogram

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Holmstrom ◽  
T Kentta ◽  
A Haukilahti ◽  
L Pakanen ◽  
H Huikuri ◽  
...  
Keyword(s):  
Myocardial Fibrosis ◽  
Statistical Significance ◽  
Qrs Complex ◽  
T Wave ◽  
Group 4 ◽  
Qrs Prolongation ◽  
Increased Risk ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Background Myocardial fibrosis has substantial role in sudden cardiac deaths (SCD). Major challenge in preventing SCDs is early recognition of vulnerable patients with fibrotic cardiomyopathy. Our aim was to find manifestations of myocardial fibrosis in 12-lead electrocardiogram (ECG). Methods Study population is based on the Fingesture study, which has gathered data from 5,869 consecutive autopsied SCD victims between 1998 and 2017 in Finland. The degree of fibrosis was determined based on the histological samples taken from the heart during autopsy and was categorized into four groups; 1) no fibrosis, 2) scattered mild fibrosis, 3) moderate patchy fibrosis and 4) substantial fibrosis. We were able to collect pre-mortem 12-lead ECGs from 1,100 SCD victims. Ischemic cardiomyopathy was the cause of death in 689 cases and 411 had nonischemic cardiomyopathy at autopsy in the group where ECG was available. Results Mean age of the study subjects was 66±13 years and 75% were male. At least some amount of myocardial fibrosis was present in 92% of the victims. QRS duration in ECG correlated with the degree of fibrosis in autopsy as follows; 96±21ms in group 1 (n=93), 97±20ms in group 2 (n=357), 103±26ms in group 3 (n=506) and 108±27ms in group 4 (n=144; p<0.001, β=0.153). Prevalence of fragmented QRS complex was higher among victims with severe fibrosis (40% in group 1, 43% in group 2, 60% in group 3 and 65% in group 4; p<0.001). Additionally, inferolateral T-wave inversions were more common in groups with increasing amount of myocardial fibrosis (5.4% in group 1, 13.2% in group 2, 20.4% in group 3 and 31.9% in group 4; p<0.001). Associations were visible in both ischemic and nonischemic SCDs but reached statistical significance only among ischemic SCD victims. Heart rate corrected JT interval and Sokolow-Lyon index had no linear correlation with the degree of fibrosis. Conclusions Myocardial fibrosis was associated with QRS prolongation, T-wave inversions and QRS fragmentation among SCD victims. Fibrosis did not manifest as clearly in ECG among patients with nonischemic cardiomyopathies as among ischemic SCD victims. The results may explain the increased risk for SCD in patients with abnormal QRS complex or inverted T waves providing means for recognizing patients with underlying fibrotic cardiomyopathy. Acknowledgement/Funding Sigrid Juselius Foundation, Foundation of Cardiac Research, Paavo Nurmi Foundation and Paulo foundation, Finland

In-vivo evaluation of the effect of cyanoacrylate on prosthetic vascular graft infection – does cyanoacrylate increase the severity of infection?

VASA ◽  
2020 ◽  
Vol 49 (4) ◽  
pp. 281-284
Author(s):  
Atıf Yolgosteren ◽  
Gencehan Kumtepe ◽  
Melda Payaslioglu ◽  
Cuneyt Ozakin
Keyword(s):  
Vascular Graft ◽  
Graft Infection ◽  
Vascular Graft Infection ◽  
Group 4 ◽  
Significant Difference ◽  
Group 3 ◽  
Group 2 ◽  
Prosthetic Vascular Graft Infection ◽  
Group 1

Summary. Background: Prosthetic vascular graft infection (PVGI) is a complication with high mortality. Cyanoacrylate (CA) is an adhesive which has been used in a number of surgical procedures. In this in-vivo study, we aimed to evaluate the relationship between PVGI and CA. Materials and methods: Thirty-two rats were equally divided into four groups. Pouch was formed on back of rats until deep fascia. In group 1, vascular graft with polyethyleneterephthalate (PET) was placed into pouch. In group 2, MRSA strain with a density of 1 ml 0.5 MacFarland was injected into pouch. In group 3, 1 cm 2 vascular graft with PET piece was placed into pouch and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. In group 4, 1 cm 2 vascular graft with PET piece impregnated with N-butyl cyanoacrylate-based adhesive was placed and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. All rats were scarified in 96th hour, culture samples were taken where intervention was performed and were evaluated microbiologically. Bacteria reproducing in each group were numerically evaluated based on colony-forming unit (CFU/ml) and compared by taking their average. Results: MRSA reproduction of 0 CFU/ml in group 1, of 1410 CFU/ml in group 2, of 180 200 CFU/ml in group 3 and of 625 300 CFU/ml in group 4 was present. A statistically significant difference was present between group 1 and group 4 (p < 0.01), between group 2 and group 4 (p < 0.01), between group 3 and group 4 (p < 0.05). In terms of reproduction, no statistically significant difference was found in group 1, group 2, group 3 in themselves. Conclusions: We observed that the rate of infection increased in the cyanoacyrylate group where cyanoacrylate was used. We think that surgeon should be more careful in using CA in vascular surgery.

Does Perioperative Hemoglobin A1c Level Affect the Incidence, Pattern and Mortality of Lower Extremity Amputation?

2019 ◽  
Vol 17 (4) ◽  
pp. 354-364
Author(s):  
Hassan Al-Thani ◽  
Moamena El-Matbouly ◽  
Maryam Al-Sulaiti ◽  
Noora Al-Thani ◽  
Mohammad Asim ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Lower Extremity ◽  
Hazard Ratio ◽  
Lower Extremity Amputation ◽  
Group 4 ◽  
Group 3 ◽  
Group 5 ◽  
Group 2 ◽  
Extremity Amputation ◽  
Group 1

Background: We hypothesized that perioperative HbA1c influenced the pattern and outcomes of Lower Extremity Amputation (LEA). Methods: A retrospective analysis was conducted for all patients who underwent LEA between 2000 and 2013. Patients were categorized into 5 groups according to their perioperative HbA1c values [Group 1 (<6.5%), Group 2 (6.5-7.4%), Group 3 (7.5-8.4%), Group 4 (8.5-9.4%) and Group 5 (≥9.5%)]. We identified 848 patients with LEA; perioperative HbA1c levels were available in 547 cases (Group 1: 18.8%, Group 2: 17.7%, Group 3: 15.0%, Group 4: 13.5% and Group 5: 34.9%). Major amputation was performed in 35%, 32%, 22%, 10.8% and 13.6%, respectively. Results: The overall mortality was 36.5%; of that one quarter occurred during the index hospitalization. Mortality was higher in Group 1 (57.4%) compared with Groups 2-5 (46.9%, 38.3%, 36.1% and 31.2%, respectively, p=0.001). Cox regression analysis showed that poor glycemic control (Group 4 and 5) had lower risk of mortality post-LEA [hazard ratio 0.57 (95% CI 0.35-0.93) and hazard ratio 0.46 (95% CI 0.31-0.69)]; this mortality risk persisted even after adjustment for age and sex but was statistically insignificant. The rate of LEA was greater among poor glycemic control patients; however, the mortality was higher among patients with tight control. Conclusion: The effects of HbA1c on the immediate and long-term LEA outcomes and its therapeutic implications need further investigation.

Association between cervical disc disease and lesions of multiple sclerosis

2021 ◽  
pp. 197140092098356
Author(s):  
Marwan Alkrenawi ◽  
Michael Osherov ◽  
Azaria Simonovich ◽  
Jonathan Droujin ◽  
Ron Milo ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cervical Disc ◽  
Cervical Disc Disease ◽  
Disc Disease ◽  
Group 4 ◽  
Demyelinating Lesions ◽  
Grade Ii ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background Cervical discopathy and demyelinating lesions often co-exist in patients with multiple sclerosis (MS). Our study examines the possible association between these two pathologies. Methods Medical records and cervical magnetic resonance imaging scans of MS patients with cervical discopathy who were seen at our MS clinic during 2018 were retrospectively reviewed. The severity of the disc disease was classified as grade I (no compression), grade II (compression of the dural sac) and grade III (cord compression). The spinal cord in each scan was divided into six segments corresponding to the intervertebral space of the spine (C1–C6). Each segment was defined as containing demyelinating lesion and disc pathology (group 1), demyelinating lesion without disc pathology (group 2), disc pathology without demyelinating lesion (group 3) and no demyelinating lesion or disc pathology (group 4). Fisher’s exact test was used to test the association between demyelinating lesions and disc pathology. Results Thirty-four MS patients with cervical discopathy were included in the study (26 females; average age 42.9 ± 13.7 years; average disease duration 8.4 ± 5.4 years). A total of 204 spinal cord segments were evaluated. Twenty-four segments were classified as group 1, 27 segments as group 2, 52 segments as group 3 and 101 segments as group 4. There was no association between demyelinating lesions and the grade of disc disease ( p = 0.1 for grade I, p = 0.3 for grade II and p = 1 for grade III disc disease). Conclusion Our study did not find any association between cervical disc disease and demyelinating spinal cord lesion.

scholarly journals Association between serum oestradiol level on the hCG administration day and neonatal birthweight after IVF-ET among 3659 singleton live births

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yu Liu ◽  
Jing Li ◽  
Wanyu Zhang ◽  
Yihong Guo
Keyword(s):  
Birth Weight ◽  
Ovarian Stimulation ◽  
Group 4 ◽  
Group 6 ◽  
Group 3 ◽  
Group 5 ◽  
Group 2 ◽  
The Impact ◽  
Ivf Et ◽  
Group 1

AbstractOestradiol, an important hormone in follicular development and endometrial receptivity, is closely related to clinical outcomes of fresh in vitro fertilization-embryo transfer (IVF-ET) cycles. A supraphysiologic E2 level is inevitable during controlled ovarian hyper-stimulation (COH), and its effect on the outcome of IVF-ET is controversial. The aim of this retrospective study is to evaluate the association between elevated serum oestradiol (E2) levels on the day of human chorionic gonadotrophin (hCG) administration and neonatal birthweight after IVF-ET cycles. The data of 3659 infertile patients with fresh IVF-ET cycles were analysed retrospectively between August 2009 and February 2017 in First Hospital of Zhengzhou University. Patients were categorized by serum E2 levels on the day of hCG administration into six groups: group 1 (serum E2 levels ≤ 1000 pg/mL, n = 230), group 2 (serum E2 levels between 1001 and 2000 pg/mL, n = 524), group 3 (serum E2 levels between 2001 and 3000 pg/mL, n = 783), group 4 (serum E2 levels between 3001 and 4000 pg/mL, n = 721), group 5 (serum E2 levels between 4001 and 5000 pg/mL, n = 548 ), and group 6 (serum E2 levels > 5000 pg/mL, n = 852). Univariate linear regression was used to evaluate the independent correlation between each factor and outcome index. Multiple logistic regression was used to adjust for confounding factors. The LBW rates were as follows: 3.0% (group 1), 2.9% (group 2), 1.9% (group 3), 2.9% (group 4), 2.9% (group 5), and 2.0% (group 6) (P = 0.629), respectively. There were no statistically significant differences in the incidences of neonatal LBW among the six groups. We did not detect an association between peak serum E2 level during ovarian stimulation and neonatal birthweight after IVF-ET. The results of this retrospective cohort study showed that serum E2 peak levels during ovarian stimulation were not associated with birth weight during IVF cycles. In addition, no association was found between higher E2 levels and increased LBW risk. Our observations suggest that the hyper-oestrogenic milieu during COS does not seem to have adverse effects on the birthweight of offspring after IVF. Although this study provides some reference, the obstetric-related factors were not included due to historical reasons. The impact of the high estrogen environment during COS on the birth weight of IVF offspring still needs future research.

scholarly journals Control of Vulval Competence and Centering in the Nematode Oscheius sp. 1 CEW1

Genetics ◽  
2003 ◽  
Vol 163 (1) ◽  
pp. 133-146 ◽  
Author(s):  
Sophie Louvet-Vallée ◽  
Irina Kolotuev ◽  
Benjamin Podbilewicz ◽  
Marie-Anne Félix
Keyword(s):  
Germ Line ◽  
Specific Mechanism ◽  
C Elegans ◽  
Group 4 ◽  
Cell Ablation ◽  
Group 3 ◽  
Group 2 ◽  
P Cells ◽  
Large Category ◽  
Group 1

Abstract To compare vulva development mechanisms in the nematode Oscheius sp. 1 to those known in Caenorhabditis elegans, we performed a genetic screen for vulva mutants in Oscheius sp. 1 CEW1. Here we present one large category of mutations that we call cov, which affect the specification of the Pn.p ventral epidermal cells along the antero-posterior axis. The Pn.p cells are numbered from 1 to 12 from anterior to posterior. In wild-type Oscheius sp. 1 CEW1, the P(4-8).p cells are competent to form the vulva and the progeny of P(5-7).p actually form the vulva, with the descendants of P6.p adopting a central vulval fate. Among the 17 mutations (defining 13 genes) that we characterize here, group 1 mutations completely or partially abolish P(4-8).p competence, and this correlates with early fusion of the Pn.p cells to the epidermal syncytium. In this group, we found a putative null mutation in the lin-39 HOM-C homolog, the associated phenotype of which could be weakly mimicked by injection of a morpholino against Osp1-lin-39 in the mother’s germ line. Using cell ablation in a partially penetrant competence mutant, we show that vulval competence is partially controlled by a gonadal signal. Most other mutants found in the screen display phenotypes unknown in C. elegans. Group 2 mutants show a partial penetrance of Pn.p competence loss and an abnormal centering of the vulva on P5.p, suggesting that these two processes are coregulated by the same pathway in Oscheius sp. 1. Group 3 mutants display an enlarged competence group that includes P3.p, thus demonstrating the existence of a specific mechanism inhibiting P3.p competence. Group 4 mutants display an abnormal centering of the vulval pattern on P7.p and suggest that a specific mechanism centers the vulval pattern on a single Pn.p cell.

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