New Gene Mutations Linked To Colon Cancer.
Researchers who discovered callow gene mutations linked to colon cancer in atrocious Americans say their findings could steer to improved diagnosis and treatment. In the United States, blacks are significantly more likely to result colon cancer and to die from the disease than other racial groups. For the study, the researchers said they worn DNA sequencing to examined 50 million bits of data from 20000 genes vigrx sgh. They said that determining gene mutations has been the driving effectiveness behind all the new drugs created to investigate cancer in the last decade.
So "Many of the new cancer drugs on the market today were developed to end specific genes in which mutations were discovered to cause specific cancers," study corresponding designer Dr Sanford Markowitz, an expert in the genetics of cancer at Case Western Reserve University in Cleveland, said in a university story release horny sugar mum in soweto. The investigators compared 103 colon cancer samples from baneful patients and 129 samples from white patients treated at University Hospitals Case Medical Center in Cleveland.
Showing posts with label colon. Show all posts
Showing posts with label colon. Show all posts
Thursday, May 9, 2019
Friday, December 29, 2017
New Non Invasive Test For Detection Of Tumors Of The Colon Is More Accurate Than Previously Used
New Non Invasive Test For Detection Of Tumors Of The Colon Is More Accurate Than Previously Used.
A recent noninvasive examine to locate pre-cancerous polyps and colon tumors appears to be more accurate than trendy noninvasive tests such as the fecal occult blood test, Mayo clinic researchers say. The scouring for a highly accurate, noninvasive alternative to invasive screens such as colonoscopy or sigmoidoscopy is a "Holy Grail" of colon cancer research medicine. In a preceding trial, the new assess was able to identify 64 percent of pre-cancerous polyps and 85 percent of full-blown cancers, the researchers reported.
Dr Floriano Marchetti, an auxiliary professor of clinical surgery in the division of colon and rectal surgery at University of Miami Sylvester Comprehensive Cancer Center, said the revitalized trial could be an important adjunct to colon cancer screening if it proves itself in further study. "Obviously, these findings poverty to be replicated on a larger scale extenderdeluxeshop.com. Hopefully, this is a good start for a more reliable test".
Dr Durado Brooks, chairman of colorectal cancer at the American Cancer Society, agreed. "These findings are interesting. They will be more enchanting if we ever get this kind of data in a screening population".
The study's lead researcher remained optimistic. "There are 150000 unfledged cases of colon cancer each year in the United States, treated at an estimated price of $14 billion," noted Dr David A Ahlquist, professor of prescription and a consultant in gastroenterology at the Mayo Clinic in Rochester, Minn. "The hallucinate is to eradicate colon cancer altogether and the most realistic approach to getting there is screening. And screening not only in a spirit that would not only detect cancer, but pre-cancer. Our test takes us closer to that dream".
Ahlquist was scheduled to acquaint with the findings of the study Thursday in Philadelphia at a meeting on colorectal cancer sponsored by the American Association for Cancer Research. The young technology, called the Cologuard sDNA test, factory by identifying specific altered DNA in cells shed by pre-cancerous or cancerous polyps into the patient's stool.
If a DNA singularity is found, a colonoscopy would still be needed to confirm the results, just as happens now after a irrefutable fecal occult blood test (FOBT) result. To see whether the test was effective, Ahlquist's line-up tried it out on more than 1100 frozen stool samples from patients with and without colorectal cancer.
The analysis was able to detect 85,3 percent of colorectal cancers and 63,8 percent of polyps bigger than 1 centimeter. Polyps this dimension are considered pre-cancers and most likely to progress to cancer.
A recent noninvasive examine to locate pre-cancerous polyps and colon tumors appears to be more accurate than trendy noninvasive tests such as the fecal occult blood test, Mayo clinic researchers say. The scouring for a highly accurate, noninvasive alternative to invasive screens such as colonoscopy or sigmoidoscopy is a "Holy Grail" of colon cancer research medicine. In a preceding trial, the new assess was able to identify 64 percent of pre-cancerous polyps and 85 percent of full-blown cancers, the researchers reported.
Dr Floriano Marchetti, an auxiliary professor of clinical surgery in the division of colon and rectal surgery at University of Miami Sylvester Comprehensive Cancer Center, said the revitalized trial could be an important adjunct to colon cancer screening if it proves itself in further study. "Obviously, these findings poverty to be replicated on a larger scale extenderdeluxeshop.com. Hopefully, this is a good start for a more reliable test".
Dr Durado Brooks, chairman of colorectal cancer at the American Cancer Society, agreed. "These findings are interesting. They will be more enchanting if we ever get this kind of data in a screening population".
The study's lead researcher remained optimistic. "There are 150000 unfledged cases of colon cancer each year in the United States, treated at an estimated price of $14 billion," noted Dr David A Ahlquist, professor of prescription and a consultant in gastroenterology at the Mayo Clinic in Rochester, Minn. "The hallucinate is to eradicate colon cancer altogether and the most realistic approach to getting there is screening. And screening not only in a spirit that would not only detect cancer, but pre-cancer. Our test takes us closer to that dream".
Ahlquist was scheduled to acquaint with the findings of the study Thursday in Philadelphia at a meeting on colorectal cancer sponsored by the American Association for Cancer Research. The young technology, called the Cologuard sDNA test, factory by identifying specific altered DNA in cells shed by pre-cancerous or cancerous polyps into the patient's stool.
If a DNA singularity is found, a colonoscopy would still be needed to confirm the results, just as happens now after a irrefutable fecal occult blood test (FOBT) result. To see whether the test was effective, Ahlquist's line-up tried it out on more than 1100 frozen stool samples from patients with and without colorectal cancer.
The analysis was able to detect 85,3 percent of colorectal cancers and 63,8 percent of polyps bigger than 1 centimeter. Polyps this dimension are considered pre-cancers and most likely to progress to cancer.
Wednesday, February 1, 2017
Colonoscopy Decreases The Potential For Colorectal Cancer On The Right Side Of The Colon Also
Colonoscopy Decreases The Potential For Colorectal Cancer On The Right Side Of The Colon Also.
In counting up to reducing the imperil of cancer on the left-hand side of the colon, new research indicates that colonoscopies may also reduce cancer peril on the right side. The finding contradicts some previous research that had indicated a right-side "blind spots" when conducting colonoscopies. However, the right-side improve shown in the new study, published in the Jan 4, 2011 point of the Annals of Internal Medicine, was slightly less effective than that seen on the hand side. "We didn't really have robust data proving that anything is very good at preventing right-sided cancer," said Dr Vivek Kaul, acting ringleader of gastroenterology and hepatology at the University of Rochester Medical Center. "Here is a journal that suggests that risk reduction is tuneful robust even in the right side continued. The risk reduction is not as exciting as in the left side, but it's still more than 50 percent.
That's a not any hard to ignore". The news is "reassuring," agreed Dr David Weinberg, chairman of pharmaceutical at Fox Chase Cancer Center in Philadelphia, who wrote an accompanying column on the finding. Though no one study ever provides definitive proof "if the statistics from this study is in fact true, then this gives strong support for current guidelines" provillus. The American Cancer Society recommends that normal-risk men and women be screened for colon cancer, starting at adulthood 50.
A colonoscopy once every 10 years is one of the recommended screening tools. However, there has been some altercation as to whether colonoscopy - an invasive and overpriced procedure - is truly preferable to other screening methods, such as malleable sigmoidoscopy. Based on a review of medical records of 1,688 German patients aged 50 and over with colorectal cancer and 1,932 without, the researchers found a 77 percent reduced endanger for this order of malignancy among people who'd had a colonoscopy in the past 10 years, as compared with those who had not.
In counting up to reducing the imperil of cancer on the left-hand side of the colon, new research indicates that colonoscopies may also reduce cancer peril on the right side. The finding contradicts some previous research that had indicated a right-side "blind spots" when conducting colonoscopies. However, the right-side improve shown in the new study, published in the Jan 4, 2011 point of the Annals of Internal Medicine, was slightly less effective than that seen on the hand side. "We didn't really have robust data proving that anything is very good at preventing right-sided cancer," said Dr Vivek Kaul, acting ringleader of gastroenterology and hepatology at the University of Rochester Medical Center. "Here is a journal that suggests that risk reduction is tuneful robust even in the right side continued. The risk reduction is not as exciting as in the left side, but it's still more than 50 percent.
That's a not any hard to ignore". The news is "reassuring," agreed Dr David Weinberg, chairman of pharmaceutical at Fox Chase Cancer Center in Philadelphia, who wrote an accompanying column on the finding. Though no one study ever provides definitive proof "if the statistics from this study is in fact true, then this gives strong support for current guidelines" provillus. The American Cancer Society recommends that normal-risk men and women be screened for colon cancer, starting at adulthood 50.
A colonoscopy once every 10 years is one of the recommended screening tools. However, there has been some altercation as to whether colonoscopy - an invasive and overpriced procedure - is truly preferable to other screening methods, such as malleable sigmoidoscopy. Based on a review of medical records of 1,688 German patients aged 50 and over with colorectal cancer and 1,932 without, the researchers found a 77 percent reduced endanger for this order of malignancy among people who'd had a colonoscopy in the past 10 years, as compared with those who had not.
Monday, January 16, 2017
Early Diagnostics Of A Colorectal Cancer
Early Diagnostics Of A Colorectal Cancer.
Researchers in South Korea bid they've developed a blood probe that spots genetic changes that signal the propinquity of colon cancer, April 2013. The test accurately spotted 87 percent of colon cancers across all cancer stages, and also correctly identified 95 percent of patients who were cancer-free, the researchers said. Colon cancer remains the espouse best cancer hit man in the United States, after lung cancer biwi chudi shop per. According to the US Centers for Disease Control and Prevention, nearly 137000 Americans were diagnosed with the bug in 2009; 40 percent of people diagnosed will pass away from the disease.
Right now, invasive colonoscopy remains the "gold standard" for spotting cancer early, although fecal inscrutable blood testing (using stool samples) also is used. What's needed is a approvingly accurate but noninvasive testing method, experts say. The new blood study looks at the "methylation" of genes, a biochemical process that is key to how genes are expressed and function where to buy cialis. Investigators from Genomictree Inc and Yonsei University College of Medicine in Seoul said they spotted a set of genes with patterns of methylation that seems to be explicit to tissues from colon cancer tumors.
Changes in one gene in particular, called SDC2, seemed especially tied to colon cancer proliferation and spread. As reported in the July 2013 question of the Journal of Molecular Diagnostics, the gang tested the gene-based conceal in tissues taken from 133 colon cancer patients. As expected, tissues enchanted from colon cancer tumors in these patients showed the characteristic gene changes, while samples bewitched from adjacent healthy tissues did not.
More important, the same genetic hallmarks of colon cancer (or their absence) "could be leisurely in blood samples from colorectal cancer patients and healthy individuals," the researchers said in a record news release. The test was able to detect stage 1 cancer 92 percent of the time, "indicating that SDC2 is timely for early detection of colorectal cancer where beneficial interventions have the greatest likelihood of curing the patient from the disease," study direction author TaeJeong Oh said in the news release.
Researchers in South Korea bid they've developed a blood probe that spots genetic changes that signal the propinquity of colon cancer, April 2013. The test accurately spotted 87 percent of colon cancers across all cancer stages, and also correctly identified 95 percent of patients who were cancer-free, the researchers said. Colon cancer remains the espouse best cancer hit man in the United States, after lung cancer biwi chudi shop per. According to the US Centers for Disease Control and Prevention, nearly 137000 Americans were diagnosed with the bug in 2009; 40 percent of people diagnosed will pass away from the disease.
Right now, invasive colonoscopy remains the "gold standard" for spotting cancer early, although fecal inscrutable blood testing (using stool samples) also is used. What's needed is a approvingly accurate but noninvasive testing method, experts say. The new blood study looks at the "methylation" of genes, a biochemical process that is key to how genes are expressed and function where to buy cialis. Investigators from Genomictree Inc and Yonsei University College of Medicine in Seoul said they spotted a set of genes with patterns of methylation that seems to be explicit to tissues from colon cancer tumors.
Changes in one gene in particular, called SDC2, seemed especially tied to colon cancer proliferation and spread. As reported in the July 2013 question of the Journal of Molecular Diagnostics, the gang tested the gene-based conceal in tissues taken from 133 colon cancer patients. As expected, tissues enchanted from colon cancer tumors in these patients showed the characteristic gene changes, while samples bewitched from adjacent healthy tissues did not.
More important, the same genetic hallmarks of colon cancer (or their absence) "could be leisurely in blood samples from colorectal cancer patients and healthy individuals," the researchers said in a record news release. The test was able to detect stage 1 cancer 92 percent of the time, "indicating that SDC2 is timely for early detection of colorectal cancer where beneficial interventions have the greatest likelihood of curing the patient from the disease," study direction author TaeJeong Oh said in the news release.
Tuesday, June 28, 2016
A New Factor Of Increasing The Risk Of Colon Cancer Was Studied
A New Factor Of Increasing The Risk Of Colon Cancer Was Studied.
Researchers account that hilarious levels of a protein measured through blood tests could be a grapheme that patients are at higher risk of colon cancer malesize.top. And another new meditate on finds that in blacks, a common germ boosts the risk of colorectal polyps - irregular tissue growths in the colon that often become cancerous.
Both studies are slated to be presented Monday at the American Association for Cancer Research (AACR) annual converging in Washington, DC. One study links on a trip levels of circulating C-reactive protein to a higher risk of colon cancer best over the counter pill for erectile dysfunction rated miracle zen. Protein levels take-off when there's low-grade inflammation in the body.
So "Elevated CRP levels may be considered as a chance marker, but not necessarily a cause, for the carcinogenic process of colon cancer," Dr Gong Yang, experimentation associate professor at Vanderbilt University, said in an AACR news release. Yang and colleagues laboured 338 cases of colorectal cancer among participants in the Shanghai Women's Health Study and compared them to 451 women without the disease.
Women whose protein levels were in the highest put up had a 2,5 - double higher risk of colon cancer compared to those in the lowest quarter. In the other study, researchers linked the bacterium Helicobacter pylori to a higher imperil of colorectal polyps in blacks. That could depute it more likely that they'll develop colon cancer.
But "Not all gets sick from H pylori infection, and there is a legitimate concern about overusing antibiotics to upon it," said Dr Duane T Smoot, chief of the gastrointestinal classification at Howard University, in a statement. However, the majority of the time these polyps will become cancerous if not removed, so we want to screen for the bacteria and treat it as a possible cancer prevention strategy. The den authors, who examined the medical records of 1262 black patients, found that the polyps were 50 percent more omnipresent in those who were infected with H pylori.
Researchers account that hilarious levels of a protein measured through blood tests could be a grapheme that patients are at higher risk of colon cancer malesize.top. And another new meditate on finds that in blacks, a common germ boosts the risk of colorectal polyps - irregular tissue growths in the colon that often become cancerous.
Both studies are slated to be presented Monday at the American Association for Cancer Research (AACR) annual converging in Washington, DC. One study links on a trip levels of circulating C-reactive protein to a higher risk of colon cancer best over the counter pill for erectile dysfunction rated miracle zen. Protein levels take-off when there's low-grade inflammation in the body.
So "Elevated CRP levels may be considered as a chance marker, but not necessarily a cause, for the carcinogenic process of colon cancer," Dr Gong Yang, experimentation associate professor at Vanderbilt University, said in an AACR news release. Yang and colleagues laboured 338 cases of colorectal cancer among participants in the Shanghai Women's Health Study and compared them to 451 women without the disease.
Women whose protein levels were in the highest put up had a 2,5 - double higher risk of colon cancer compared to those in the lowest quarter. In the other study, researchers linked the bacterium Helicobacter pylori to a higher imperil of colorectal polyps in blacks. That could depute it more likely that they'll develop colon cancer.
But "Not all gets sick from H pylori infection, and there is a legitimate concern about overusing antibiotics to upon it," said Dr Duane T Smoot, chief of the gastrointestinal classification at Howard University, in a statement. However, the majority of the time these polyps will become cancerous if not removed, so we want to screen for the bacteria and treat it as a possible cancer prevention strategy. The den authors, who examined the medical records of 1262 black patients, found that the polyps were 50 percent more omnipresent in those who were infected with H pylori.
Sunday, April 26, 2015
Surgery is not life-prolonging
Surgery is not life-prolonging.
Fewer US colon cancer patients who are diagnosed in the ultimate stages of their c murrain are having what can often be unnecessary surgery to have the primary tumor removed, researchers report. These patients are also living longer even as the surgery becomes less common, although their encyclopaedic forecasting is not good. The findings reveal "increased recognition that the first-line treatment very is chemotherapy" for stage 4 colon cancer patients, said study co-author Dr George Chang, main of colon and rectal surgery at the University of Texas MD Anderson Cancer Center in Houston day4rx com. While removing the unmixed tumor may be helpful for some reasons "surgery is not life-prolonging".
With the patients in question, their cancer has extend from the intestines to other organs such as the liver or lung, in a approach called metastasis. In many cases, the prognosis is death, one expert not part of the study said vitoviga.eu. "Cure is not on for most patients with metastatic colorectal cancer," said Dr Ankit Sarin, an auxiliary professor of surgery in the section of colon and rectal surgery at University of California, San Francisco.
Twenty percent of patients diagnosed with colon cancer have organize 4 disease, according to breeding information in the study. Cancer specialists and patients face a big question after such a diagnosis: What treatment, if any, should these patients have? "The prime instinct is 'I want it out'". But removing the tumor from the colon may not be neighbourly once cancer has spread, and "getting it out may delay their ability to get treatment that's life-prolonging".
Fewer US colon cancer patients who are diagnosed in the ultimate stages of their c murrain are having what can often be unnecessary surgery to have the primary tumor removed, researchers report. These patients are also living longer even as the surgery becomes less common, although their encyclopaedic forecasting is not good. The findings reveal "increased recognition that the first-line treatment very is chemotherapy" for stage 4 colon cancer patients, said study co-author Dr George Chang, main of colon and rectal surgery at the University of Texas MD Anderson Cancer Center in Houston day4rx com. While removing the unmixed tumor may be helpful for some reasons "surgery is not life-prolonging".
With the patients in question, their cancer has extend from the intestines to other organs such as the liver or lung, in a approach called metastasis. In many cases, the prognosis is death, one expert not part of the study said vitoviga.eu. "Cure is not on for most patients with metastatic colorectal cancer," said Dr Ankit Sarin, an auxiliary professor of surgery in the section of colon and rectal surgery at University of California, San Francisco.
Twenty percent of patients diagnosed with colon cancer have organize 4 disease, according to breeding information in the study. Cancer specialists and patients face a big question after such a diagnosis: What treatment, if any, should these patients have? "The prime instinct is 'I want it out'". But removing the tumor from the colon may not be neighbourly once cancer has spread, and "getting it out may delay their ability to get treatment that's life-prolonging".
Friday, February 20, 2015
The Overall Rate Of Colon Cancer Has Fallen
The Overall Rate Of Colon Cancer Has Fallen.
Although the overall assess of colon cancer has fallen in late decades, new research suggests that over the terminal 20 years the disease has been increasing among young and early middle-aged American adults. At outflow are colon cancer rates among men and women between the ages of 20 and 49, a club that generally isn't covered by public health guidelines. "This is real," said retreat co-author Jason Zell, an assistant professor in the departments of medicine and epidemiology at the University of California, Irvine gharelu. "Multiple investigation organizations have shown that colon cancer is rising in those under 50, and our mull over found the same, particularly among very young adults.
Which means that the epidemiology of this disease is changing, even if the verifiable risk among young adults is still very low". Results of the study were published recently in the Journal of Adolescent and Young Adult Oncology. The scan authors noted that more than 90 percent of those with colon cancer are 50 and older worldbuyrx.com. Most Americans (those with no house history or heightened chance profile) are advised to start screening at age 50.
Despite remaining the third most frequent cancer in the United States (and the number two cause of cancer deaths), a steady get up in screening rates has appeared to be the main driving force behind a decades-long plummet in overall colon cancer rates, according to upbringing information in the study. An analysis of US National Cancer Institute data, published finish November in JAMA Surgery, indicated that, as a whole, colon cancer rates had fallen by rudely 1 percent every year between 1975 and 2010.
But, that observe also revealed that during the same time period, the rate among people aged 20 to 34 had in point of fact gone up by 2 percent annually, while those between 35 and 49 had seen a half-percent yearly uptick. To cross-examine that trend, the current study focused on data collected by the California Cancer Registry. This registry included knowledge on nearly 232000 colon cancer cases diagnosed between 1988 and 2009.
Although the overall assess of colon cancer has fallen in late decades, new research suggests that over the terminal 20 years the disease has been increasing among young and early middle-aged American adults. At outflow are colon cancer rates among men and women between the ages of 20 and 49, a club that generally isn't covered by public health guidelines. "This is real," said retreat co-author Jason Zell, an assistant professor in the departments of medicine and epidemiology at the University of California, Irvine gharelu. "Multiple investigation organizations have shown that colon cancer is rising in those under 50, and our mull over found the same, particularly among very young adults.
Which means that the epidemiology of this disease is changing, even if the verifiable risk among young adults is still very low". Results of the study were published recently in the Journal of Adolescent and Young Adult Oncology. The scan authors noted that more than 90 percent of those with colon cancer are 50 and older worldbuyrx.com. Most Americans (those with no house history or heightened chance profile) are advised to start screening at age 50.
Despite remaining the third most frequent cancer in the United States (and the number two cause of cancer deaths), a steady get up in screening rates has appeared to be the main driving force behind a decades-long plummet in overall colon cancer rates, according to upbringing information in the study. An analysis of US National Cancer Institute data, published finish November in JAMA Surgery, indicated that, as a whole, colon cancer rates had fallen by rudely 1 percent every year between 1975 and 2010.
But, that observe also revealed that during the same time period, the rate among people aged 20 to 34 had in point of fact gone up by 2 percent annually, while those between 35 and 49 had seen a half-percent yearly uptick. To cross-examine that trend, the current study focused on data collected by the California Cancer Registry. This registry included knowledge on nearly 232000 colon cancer cases diagnosed between 1988 and 2009.
Saturday, February 7, 2015
The Use Of Colonoscopy Reduces The Risk Of Colon Cancer
The Use Of Colonoscopy Reduces The Risk Of Colon Cancer.
In adding to reducing the imperil of cancer on the left side of the colon, imaginative research indicates that colonoscopies may also reduce cancer risk on the right side. The verdict contradicts some previous research that had indicated a right-side "blind spots" when conducting colonoscopies review. However, the right-side gain shown in the new study, published in the Jan 4, 2011 issue of the Annals of Internal Medicine, was minor extent less effective than that seen on the left side.
And "We didn't really have vigorous data proving that anything is very good at preventing right-sided cancer," said Dr Vivek Kaul, acting himself of gastroenterology and hepatology at the University of Rochester Medical Center. "Here is a critique that suggests that risk reduction is pretty robust even in the right side. The jeopardy reduction is not as exciting as in the left side, but it's still more than 50 percent vigrx box. That's a little painfully to ignore".
The news is "reassuring," agreed Dr David Weinberg, chairman of medicine at Fox Chase Cancer Center in Philadelphia, who wrote an accompanying leading article on the finding. Though no one lessons ever provides definitive proof, he said, "if the data from this study is in fact true, then this gives hard-working support for current guidelines".
The American Cancer Society recommends that normal-risk men and women be screened for colon cancer, starting at ripen 50. A colonoscopy once every 10 years is one of the recommended screening tools. However, there has been some argumentation as to whether colonoscopy - an invasive and expensive approach - is truly preferable to other screening methods, such as flexible sigmoidoscopy.
In adding to reducing the imperil of cancer on the left side of the colon, imaginative research indicates that colonoscopies may also reduce cancer risk on the right side. The verdict contradicts some previous research that had indicated a right-side "blind spots" when conducting colonoscopies review. However, the right-side gain shown in the new study, published in the Jan 4, 2011 issue of the Annals of Internal Medicine, was minor extent less effective than that seen on the left side.
And "We didn't really have vigorous data proving that anything is very good at preventing right-sided cancer," said Dr Vivek Kaul, acting himself of gastroenterology and hepatology at the University of Rochester Medical Center. "Here is a critique that suggests that risk reduction is pretty robust even in the right side. The jeopardy reduction is not as exciting as in the left side, but it's still more than 50 percent vigrx box. That's a little painfully to ignore".
The news is "reassuring," agreed Dr David Weinberg, chairman of medicine at Fox Chase Cancer Center in Philadelphia, who wrote an accompanying leading article on the finding. Though no one lessons ever provides definitive proof, he said, "if the data from this study is in fact true, then this gives hard-working support for current guidelines".
The American Cancer Society recommends that normal-risk men and women be screened for colon cancer, starting at ripen 50. A colonoscopy once every 10 years is one of the recommended screening tools. However, there has been some argumentation as to whether colonoscopy - an invasive and expensive approach - is truly preferable to other screening methods, such as flexible sigmoidoscopy.
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