CRC – Gene Expression Profiling

Molecular profiling changes the management of Colorectal Cancer significantly. This blog lists all relevant molecular markers associated with prognostic, response to chemotherapy, survival and recurrence of Colon Cancer.

Molecular profiling changes the management of Colorectal Cancer significantly.  This blog lists all relevant molecular markers associated with prognostic, response to chemotherapy, survival and recurrence of Colon Cancer.

The markers are chosen based on the basis of gene expression profile on colon cancer. As the cancer advances, it accumulates several genetic aberrations. Spread of cancer, response to treatment, survival to treatment and recurrence are all associated with different molecular markers.

These markers have been shortlisted from existing literature, experience with patients and the outcome. However, this is based upon my understanding and experience with patients and any decision based upon this blog need to be approved by your treating physician. I take no responsibility for decisions and or outcome based on these markers.

Many Molecular markers have been used for prediction and prognosis. Key amongst those are –

  1. MSI – Microsatellite Instability with the mismatch repair MMR system, MSI-H, MSI , MLH1, MsH2, MsH3, MsH6 and PMs2
  2. EGFR –
  3. VEGF
  4. KRAS mutation in Codon 12, 13, 61
  5. PTEN mutation
  6. PIK3CA Mutation
  7. BRAF V600E (Exon 15)
  8. p53

 

CEA – Carcinoembryonic antigen – CEA is separated from other molecular markers since CEA helps in understanding tumor burden and is also required for regular follow up.

 

Tissue Sampling:

The tissues should be immediately placed into liquid nitrogen upon excision and meticulously selected  pathologist for molecular profiling. Samples both from primary and secondaries (Lymph nodes) are required. Remember, to submit normal tissue along with the disease sample.

Dry Ice can be used as a media only for selected tests.

This page is under construction. I will update the markers as well as the references.

For Understanding the different surgical and chemotherapy options, you may visit –

Surgical and Chemotherapy options for Treating Advanced CRC, click here 

Surgical Demonetization? What Is Good And What Needs To Be Fixed?

I consider demonetization as a key policy that has reverberations with system wide impact and a potential to clean the swamp from decades of moral erosion and political ineptitude. It’s a defining moment of our century and for India, while it was long overdue. I so strongly wish this initiative to win! So, what’s wrong and how to fix the 2016 Demonetization? Those who don’t consider it as a misfired shot, should explain how these 600 million people should manage being cashless or cash strapped until Mid or Last December, 2016. Those who consider this as not a misfired shot, should also explain how this is salvo actually hits those who indulge in black money?

The situation is similar to surgery. I mentioned two fallacies with any surgery and let the readers choose options on how to fix those. By participating in the survey, you will see where you stand amongst those who are vocal on this issue. Polls are open until Dec 4, 2016. Visit after a few days to see how your peers have voted.

What Is Good And What Needs To Be Fixed?

Or, let us ask – What is wrong with Surgery?

Surgery is indicated for an existing abnormality that causes significant functional compromise and it cannot be managed conservatively because of the inherent limitations. The procedure removes acutely offending situation, an example would be an appendix, a tumor or structural abnormality. It does not however remove the root cause that resulted in the outcome mentioned above.

Two pertinent things though – It is done with best interest standards and, the probability of successful outcome is high with anticipation, planning and execution with precision. If a doctor has vested interest in operating an appendix that was never swollen, or if the procedure is accompanied impromptu with inefficient planning and execution, no doubt, the outcome would be compromised or fail to achieve the desired outcome.

Demonetization is a long overdue indicated surgery. No doubt. A system where parallel economy is the norm meant that this was long overdue. It was obvious earlier too but no one dared challenge the system. It was as usual pleasing populist politics. It required a leader, not just with a vision, mandate but also a character, that is so much devoid of our polity. It was hard to find a leader until Narendra Modi undertook that mission.

It’s definitely a radical move, in industry parlance, they call it radical change. That radical change has to be supported by underlying fundamental change in ethos and values. Simply changing overt artifacts is unlikely to change the ground realities. When radical change is implemented without fundamental change, the system has a tendency to bounce back to its original state.

At least two major fallacies with 2016 demonetization

Of the several fallacies with the 2016 demonetization wave, I will focus on the two, which I mentioned in my earlier paragraph.

  1. Logistics and planning were not envisioned, anticipated, planned nor executed
  2. Selected few were aware of the likely change in advance and had already capitalized on the possibility.

Is the media biased?

Every day, we get to hear dreaded news from Modi’s Demonetization, when we talk with folks from India or whether we read a news channel. Generally, outside newspapers don’t have any political stake or bias. Generally, i won’t believe the Indian media, because you get biased news either way, highly positive or highly negative.”, the same holds true with my folks back in India. So, I can take them without that pinch of salt.

Even if I am not reflecting system wide, I can say, it was planned inadequately and executed improperly or else, why do we have to roll back the changes for farmers, college tuition, hospitals, rural areas? If this was anticipated, why is the common man at such a misery? Any radical surgery is associated with post-surgical pain, but the managing doctors have a plan, will never ask you to wreath in pain unattended. It is wrong to say the pain is created by the media, media hype. Don’t we know that the same Modi was so much exalted by the same media?

Why do we care for JFK?

Often Modi supporters point towards his celibacy and character. To be true, celibacy and personal character has nothing to do with political character or political ideology. History is replete with anecdotes of successful kings and emperors having harems with multitude of concubines. What mattered was their feel of the pulse for the masses. These rulers kept the state above themselves. Their personal life was a relaxation and second only to the state or the subjects they ruled. Not long ago, it was revealed that John F Kennedy always had a lady serving him while he was flying abroad as leader of a great nation. We all know, his vision for US and the world order, as well as the value he espoused for the most downtrodden. We all know how decisive he was during the 1962 Cuban war in avoiding third world war. To many, he is credited with putting Man over the Moon.

Why we want Modi to succeed with this initiative?

Personally, I see this as a MUST and long OVERDUE correction for Indian economy, not because of emerging digital phenomenon but to starve or eliminate the parallel economy. A failure of 2016 demonetization will be sad. An astute and courageous politician is likely to face electoral rout in the upcoming state elections, not because of acting for a good cause but for lack of vision, planning and execution.

This is one core deliverable from Modi that is so highly regarded and appreciated. It was eclectic for its system wide impacts of transforming the ethos and economy of India. Yet, it was planned with such belligerence, neglect, logistic flaws and ineptitude of executioner’s vision. This is a lesson learnt while governing a country like India with its complex mesh work of distinct economic layers.

Selected References:

I am in constant search of unbiased opinion. When I try Indian newspapers, they are either biased for Modi or vehemently against Modi. Either of which are inappropriate for understanding the ground realities. By extension, the same happens when I talk with my folks back in India. Thus, I am just disappointed gathering information from Indian Newspapers or those residing in India.

To me, established players from media from advanced countries offer better perspective. Generally, amongst India media, I choose to read Times of India, The Hindu, Financial Times, Economic Times. I prefer to read BBC, Bloomberg etc. for unbiased news about India. Below, is a collection of selected articles.

Demonetization and India’s Macroeconomy – Will Rupee Depreciate?

India: Demonetization and its Discontents

Jets Loaded With Banned Cash Draw India’s Ire in Graft Crackdown

Noted American experts divided over India’s demonetisation drive

The Economist | Free exchange: Paper pains

The Economist | India’s demonetisation: The ropy rupee recall

The Trouble With India’s Demonetization Gamble

IMF says Modi govt’s demonetization move needs to be handled prudently

How Narendra Modi’s demonetisation move brought Raghuram Rajan and Subramanian Swamy together

Did The Government Use Raghuram Rajan’s Exit To Push Through The Demonetisation?

Here’s What Raghuram Rajan Thinks Of Currency Demonetisation

Rural Distress Is On The Rise But Support Grows for Demonetisation: HuffPost-BW-CVoter Survey

Manmohan Singh Gave Major Burns To Modi On Demonetisation Today And Twitter Is Ecstatic

How India’s Cash Chaos Is Shaking Everyone From Families to Banks

India’s Modi Holds to 50-Day Pledge as Cash Chaos Intensifies

India’s Economy Grows Less Than Estimated Before RBI Rate Review

Modi’s Revolutionary Dreams

Noted American experts divided over India’s demonetisation drive

Can India’s currency ban really curb the black economy?

India rupee ban: Currency move is ‘bad economics’

Slew of U-Turns Blight Modi’s Cash Ban, Leaving Indians Outraged

What Will India Do With 23 Billion Worthless Banknotes?

 


 

 

Watch the magic of endorphins!

Do you know that between the age of 35 – 40, we all start losing 1% of our lung capacity? Do you know that if we are engaged in regular moderate physical exercise, we tend to arrest that decline? Contrary to common believe, statistics have proven that, 45 minutes of exercise on a well-rested day, yields an extra productive effort of 68 minutes.

Exercise, not alone improves your productivity immediately post exercise, but also increases your body’s ability to handle stress in the immediate 2-3 days post exercise. Of course, there are several guidelines and recommendations that offer succinct advantage on each system of our body. Please read the exercises, their customization, ramp up and the different types of exercises to add to get a comprehensive regimen for your body.

Before establishing an overall fitness base and maximizing athletic development, one should go through step by step ramp up program with numerous exercises that safely increase coordination, flexibility, speed, strength, and endurance.

“In endurance runners’ brains have greater functional connectivity than the brains of more sedentary individuals. The runners, overall, showed greater functional connectivity — or connections between distinct brain regions — within several areas of the brain, including the frontal cortex. The frontal cortex is an important region for cognitive functions such as planning, decision-making and the ability to switch attention between tasks.(Running May Enhance Brain Connections)”

brain

Many amongst you may be thinking, what are endorphins? Endorphins are morphine like substances secreted by brain that is bedrock of ‘feel good’ factor, driving optimism and energy as well as several aspects including immunity.

(This is part of another long term initiative I chose to drive understanding the impact and importance of this issue to our community.  Initially, I will work with a small group of folks from our community, and understanding the success factor, I will expand to bigger group. You will see me blogging on this as part of this initiative).

As you already know, the pain point with us all is motivation. We all lack the motivation to go to the Gym or simply walk up and down the rails at home or other exercise. We do take an episodic bout of exercise that lasts few days or at best occasional week. Second, the compulsions of real life are really rigorous enough to abandon our episodic enthusiasm. If that’s not the only reason, some amongst us travel and crash back to our bed on our return.

Our Sedentary (Indian) Life Style – What happens & When?

  • Lungs – Do you know that between the age of 35 – 40, we all start losing 1% of our lung capacity? Do you know that if we are engaged in regular moderate physical exercise, we tend to arrest that decline?
  • Vegetarian Meals – Do you know our carb rich vegetarian diet tend to get converted to fats in the absence of exercise? We tend to put on fat despite eating fat restricted diet?
  • No Exercise – Do you know our heart tends to lose its ejection ability (ejection fraction)? Heart too gets deconditioned not doing exercise.
  • No Exercise – Do you know, our muscles steadily lose its strength and tone and eventually, it becomes small if not atrophied?
  • Bones – Do you know, our skeletal system is highly dependent on the health of our muscles, that once these muscles get decompensated, they lose the tone and we tend to injure our joints? Some reflections are prolapse disc, radiating pain, increase wear and tear of joints due to imbalance of agonist and antagonist muscles?
  • Brain – Do you know that our brain (dendrites) loses its networking potential between the neurons and we tend to accumulate the senile plaque and other material at a faster pace due to inactivity? You may want to know what Senile Plaque are – simply speaking, we lose our memory faster with inactivity.
  • Diabetes – Do you know, in the absence of moderate to vigorous exercises, we increase peripheral resistance to glucose and eventually end up with type 2 diabetes?

Well, none of these happens overnight but the decline has already started and all of these provides a huge background to most future illnesses (of ageing or late adulthood). We all know, lack of exercise takes a daily toll on our health. American Heart Association considers lack of habitual physical activity as the fourth major risk factor for coronary heart disease. Our cardiac, respiratory, metabolic, musculoskeletal, nervous, gastrointestinal and endocrine system all need a vigorous physically active program to keep those healthy.

According to Office of Disease Prevention and Health Promotion Healthy People Guidelines, in adults and older adults, physical activity can lower the risk of:

We think, we are healthy, but –

Our life style, sedentary and food habits strongly predispose us to – 

  • Early death
  • Coronary heart disease
  • Stroke
  • High blood pressure
  • Type 2 diabetes
  • Breast and colon cancer
  • Falls
  • Depression

By adding exercise to our routine, we tend not only to slow down the decline but simultaneously build our mental health and be more optimistic and productive? While we do physical workout, we tend to not alone increase our physical health coefficient our mood and perception, as well as our ability to deal with stress and our quantitative efforts at work. This is because brain secrets, ‘feelgood’ chemicals – endorphin, oxytocin, serotonin, and dopamine that helps to rejuvenate us.

Folks, there is one simple thing that stops these daily aggregation of risk –

Motivation

I am working on overcoming our lack of motivation using multiple approaches. One amongst those is getting a trainer for training. If the pilot runs successfully, we will book a space where we can participate in group exercises with trainer hired on an hourly basis. I have not run out of options, if these won’t work, I will be more creative and come up with more options.

However, I am strongly opposed to directly jumping on the exercise bandwagon and break whatever we have. We need to

  1. Customize as per individual body habitus
  2. Develop comprehensive plan (Endurance/Aerobics, Yoga, Resistance, Strength, Flexibility etc. I will cover individual topics eventually, watch this space!)
  3. Ramp up our exercise program.

Very few know that exercise, Yoga, Tai Chi or any other physical activities are not generic and need customization. Everybody is different and every individual is in a different state of health at different points in time. Consequently, a tailored approach is the key to success. Not all exercises from Gym are suitable for all, the same holds true about Yoga or Tai Chi. Unfortunately, our trainers are inadequately educated with medical understanding of our body to provide a customized program.  Though doctors are trained, unfortunately, they only know polar ends, normal health and diseases condition. If something is not diseased, it is normal. However, practically, very often we fall in the gray zone. Summarily, we definitely can’t rely on our trainers and our doctors don’t have time to understand the needs of our normal bodies and provide a kinesthetic plan for our wellbeing.

Second, a ramp up is equally important. Presuming we have no underlying health issue, despite we cannot suddenly start with any exercise, be it jogging, running, swimming, or any or the aerobics or resistance training. We need to ramp up gradually and we need to recruit different groups incrementally in a coordinated fashion. Before establishing an overall fitness base and maximizing athletic development, one should go through step by step ramp up program with numerous exercises that safely increase coordination, flexibility, speed, strength, and endurance.

What will motivate us and get us going into regular exercise schedule? I believe, commitment, discipline, motivation and a group fun filled activity will do that. I feel, getting a trainer will help circumvent a lot of these inertia. We still have to work with other factors like choosing right exercises customized to our own body types, gradual ramp up and adding multiple types of exercises, such as Yoga, Cardio, Resistance Training, Strengthening Small Muscle groups etc. Of course, exercise is not panacea but offers a solid beginning and foundation. Getting good sleep and eating health are other things. However, the scope of this article is restricted to exercise and I will continue talking about exercise.

I am undertaking this community initiative for zero-sum gain despite a cost to my time and efforts, simply to get us all embarked on a community exercise plan. I will do a free physical evaluation (based on guidelines from American Academy of Sports and Physical Medicine) and will provide an explanation of the best options for selecting the exercises plus the best plan to ramp up. All I need is your cooperation.

As a proof of concept, I am planning to call a trainer at home whose responsibility will be to get us going at a particular time. He/She will keep us all motivated. Initially, I will have 5-6 folks to start with. We will find a time according to mutual convenience. The venue will be my home and we will start immediately, if possible. What do you say?

Cheers!

PS: Watch this space as I keep updating it with different types of exercises (including videos), guidelines and how best to tailor exercises to our body’s state and needs.



 

Highly Recommended:

American Heart Association Recommendations for Physical Activity in Adults

2008 Physical Activity Guidelines for Americans Summary

8 HORMONES INVOLVED IN EXERCISE


 

Interesting Read:

Physical Activity (Office of Disease Prevention and Health Promotion)

Physical Activity Guidelines For Americans

Global Recommendations on Physical Activity for Health

Endorphins and exercise

US Gov Guidelines –

Physical Activity Guidelines for Americans

Chapter 4: Active Adults

Chapter 6: Safe and Active

ANABOLIC-ANDROGENIC STEROIDS: Mechanism of Action and Effects on Performance

AMINO ACIDS AND ATHLETIC PERFORMANCE: A Mini Conference in Oxford

How Exercise Beefs Up the Brain

Boost your natural ‘feelgood’ chemicals

Exercising to relax

The Hormones Of Happiness And How To Increase Them

Hormonal Response to Exercise

Why endorphins (and exercise) make you happy

The Neurochemicals of Happiness

Exercise detoxes body of depressive chemicals, scientists find

 

Tilting Rightwards?

A series of big and small bubbles of righteous movements are emerging across the globe, these far right movements have a strong emphasis on nationalistic populism. What’s the genesis behind this phenomenon? Possible factors confounding these are our deep seated rituals embedded in our millennial value system, globalization, conflict of civilization, massive wave of technology transformation, upwards mobility along the social hierarchy, increasing self-assertion and struggle for self-identity.

As of this writing, my understanding is still emerging, and this blog is for us to connect and help each other understand this emerging phenomenon of significant social magnitude.

(Your opinion matters, please share your thoughts and comments at the end of this blog)

Introduction

Until recently, climate change was considered to be the greatest concern for our existence. However, with the recent political upheavals across the world, I see that the focus seems to be changing towards the rise of rightwing assertion and nationalistic populism. It’s a real struggle we all have to live with for next decade or more. Something has gone grossly wrong with the way things have been run for the last few decades for this movement to have gained voice amongst the masses. The intent is to understand and analyze that deficiency in our system of governance. This blog is about understanding the impact and possibly identifying the causes while its genesis is beyond the scope of this blog. This is definitely not a political opinion and I wish to stay away from finger pointing or blame game. This blog is a prelude to another in-depth review where, I will attempt to offer explanations to some of these questions.

Rightwing Populism Defined

Let’s define rightwing assertiveness as ‘a commitment of ideology dominated by brute force of majority based on populist assertiveness to influence and direct the governmental strategies in pursuing an agenda of exclusivity at the cost of mainstream rationalism’.

Approach Towards Understanding

First, let’s look at the emerging global political scenario. Next, let us identify few possible factors and possibly understand their interaction. Of course, at this time, I am brainstorming with like-minded intellectuals and would refrain from making any conclusions.

Happening on the Ground?  

The Tea Party or the Alt Right movement in the United States is not an isolated phenomenon. I see isolated bubbles of assertive nationalistic fervor emerging in different parts of the world, from UK, France, Turkey, India, Philippines, Russia, and China, to the rise of radicalization in the Middle East and African continent (Kenya, Nigeria, Somalia etc.) are on the rise.  Are these likely to collide or coalesce? Can we identify a pattern?

Large sections of the population have been definitely neglected. Is this an outcome of our democratic system of elections and governance? If that is so, is democracy driving us in the right direction in serving all sections of the population? Is it because of globalization, commercialization and the tsunami of technology engulfing mankind in the last 50 years? Or is it because of the chasm created by the technological and globalization with our ideology, values and rituals? Are we at a point of deflection and is this a transition issue or is it a cataclysmic event? Or, is it because of an increased assertiveness at the individual level? What are the collective impacts on the community?

From a social evolutionary perspective, we need to re-engineer our social structure vis-a-vis the technological/scientific achievements, ideologies and assimilation of cultures and civilizations while a new new world order is emerging.

Possible Causes and their interrelation

Definitely an outcome of neglect, It’s a social phenomenon that needs closer inspection. Several confounding factors are complicating our understanding with this emerging problem. The magnitude of this right wing tilt is so massive in proportion – that it will define our polity, interaction and our collective endeavor in the future. It has the potential to re-prioritize several of our combined efforts such as global warming or climate change etc. By the time we would solve this monstrous problem or seemingly control it, the world would be at the precipice of another set of emerging calamities. It’s a serious burden on human ingenuity and its survival instinct. Future looks more challenging than what we have envisioned so far.

Prima facie, there are several possible factors that confound our understanding of this phenomenon. Some amongst these are globalization, technology advancement, migration, collision of cultures, religion and rituals, ideologies (that are deeply embedded  in millennium old value system), an urge for upwards mobility and increasing self-assertion and struggle for self-identity.

Your Opinion Matters

As of now, I wish to collect opinion across my audience and I have set up a few questions. It is possible that I might be blind sighted towards a few issues. I would urge you to provide your criticism and comments and take the poll below. The responses are anonymous and I don’t get to see who voted on which specific options. Also, the technology that also restricts multiple responses from the same device. A simple analysis is provided  for selected questions, immediately after you poll.

Please share your perspective in understanding and providing possible options in fixing this problem?

Acknowledgment: I am thankful to Soumitra Sulekar, Graduate Research Assistant at University of Florida, for providing editorial corrections to the draft.

Residential Security – With Changing Political Times

Residential Security – With Changing Political Environment


Updated after incidence of hate message (Nov 24, 2016) –

  1. Don’t Panic
  2. Don’t Deal Alone, Call Law Enforcement
  3. Inform Community, Deal As A Community

Suggested Ideas:

Install Home (Perimeter) and Community Cameras

HOA to install signs stating community under surveillance


Often we have solicitors or vendors, either setting flyers or actively selling some products in residential community. Ideally, you should have access control for your community. Just in case, you don’t have one, here are few tips to consider, just in case someone missed something, here are few things –

  1. First, politely decline without opening the door. If in case, you open the door, step outside and talk. If you see them face to face, politely decline with a smile that you may not be interested at this time.
  1. Complaint to HOA or Local Security Service. Don’t compliant to solicitors or vendors that they are not allowed in the community. You do have a right to complaint to Local Security or HOA or if thresholds are crossed, to local law enforcement authority. Despite, be very polite and decline. HOA or Local Security can display signs if vendors are not allowed in your community.
  1. Neighborhood Watch – The idea is old but using latest messaging apps is new. Communicate with neighbors (before or after an interaction). We have a WA (What’sUp) group in our community where we share messages. Don’t be isolated – Connect as a community, Develop Collective norms, Deter & Deny as a community and when required, Report.

Messaging groups are very effective and fast but there is a downside to messaging groups, build your own community norms to serve your community.  Florida International University researchers found the following statistics within the combined 11 neighborhoods. Burglaries decreased 33 percent; Robberies decreased 24 percent and Thefts decreased 9 percent. If possible, display Neighborhood Watch using WA under use.

  1. Install Security Cameras (& motion sensor lights). Security cameras (on the perimeter) and motion sensor lights are cheap and easy to install. Ensure that the data is backed up on cloud. Install cameras in location from where they can capture face and morphology in different steps. Either have night vision on the cameras or adequate lighting to capture images. PTZ cameras with Digital Recorders are best. My experience has been very satisfactory using those as deterrence. This is in line with Crime prevention through environmental design (CPTED) to reduce crime. Installing community perimeter security cameras with PTZ and cloud backed up capabilities are best. Cameras and Lights should be away from vandalism and destruction.
  1. Record DL and Company Id. Every home owner should insist on DL of the person working within their home and or community. While most offer a company ID, we hardly track and trace if those are authentic and valid. Keeping a record of DL should provide long term deterrence from intrusion or crime. Often, these vendors or ‘House Cleaners’, most are good but we cannot discern the bad, they may be indirectly doing a surveillance and reporting into their ecosystem. If DL or address is maintained, they are likely to be traced or tracked. Knowing that you maintain a DL on them, should help in building more deterrence.

One thing is certain – if you see a vendor or someone soliciting, don’t be arrogant, decline politely. Why?

  1. They are trying to make a living
  2. You may be targeted, especially if you are rude or impolite

In these changing political environment and circumstances, our success as immigrants may be a red sore in the eyes of few nativists. Let us not get targeted. Let them think this is a nice community.

Again, I am not proposing we need to buy, I am not saying, we shouldn’t report. All I am saying is BE POLITE, ESPECIALLY WHILE DECLINING SERVICES OR VENDORS.


 

Selected links –

GUIDELINES FOR PUBLIC VIDEO SURVEILLANCE: A guide to protecting communities and preserving civil liberties guidelines-for-public-video-surveillance

An example of Camera Policies from University of Wisconsin at Green Bay camera-policies-from-university-of-wisconsin

Code of practice: A guide to the 12 principles (This does not apply to US scenario but it offers good understanding of issues to consider)

Camera Types from Brick House Security (Offers an understanding of different types of cameras)

Principles of Design for Operational Risk Reduction principles-of-design-for-operational-risk-reduction

Top Ten Security Mistakes Home Owner Associations (HOAs) Make!

Christmas is Coming and SO ARE THE CROOKS!

Prevention of Crime: An Overview of Gated Communities and Neighborhood Watch

Best Practices for Residential Security