The endoplasmic reticulu m (ER) is responsible for proper fold ing of secretory and memb rane-bound proteins as well as the degradation of improperly fo lded proteins. Fluctuations in protein fold ing demand exceed ing fold ing capacity result from events such as cellular stress and mutations affecting protein folding. Detrimental accumu lation of unfolded proteins within the ER is alleviated through activation of evolutionarily conserved, intracellular signaling proteins by the unfolded protein response (UPR). Binding of membrane-bound signaling proteins by inactive, ER-resident chaperones typically results in suppression of UPR. However, upon nascent protein accumulation, chaperone recruitment allows for activation of stress relieving pathways. UPR, classically studied in budding yeast and later in metazoan and plant cells, relies almost exclusively on the signal proteins, known as Ire1p. Ho mologs for the metazoan UPR sensors include Ire1α and Ire1β as well as two addit ional signal p roteins, PERK and ATF6. Plant UPR branches identified to date include IRE1a, IRE1b, bZIP17 and bZIP28. In this review, we present the first co mprehensive view of both conserved and differing aspects of UPR across kingdoms, with special emphasis on some unique features of recently discovered plant UPR pathways.
INTRODUCTION:
Colorectal cancer (CRC) is a lethal disease. 140,250 new cases of large bowel cancer are diagnosed annually in the USA including 97,220 colon and 43,030 rectal cancers. 50,630 Americans are expected to die of large bowel cancer each year. CRC is the third most common cause of cancer death in the USA in women, and the second leading cause of death in men. Common symptomology include change in bowel habits (74%), rectal bleeding with change in bowel habits (71%), iron deficiency anemia (21%). Appendicitis as the initial symptom of CRC is less than 1% for individuals over 40.
CASE DESCRIPTION/METHODS:
Patient is a 52 year old man who presents to our facility for general abdominal pain and tenesmus for three months. The patient has no family history of CRC nor colonoscopy. In the ED routine labs negative Imaging revealed acute appendicitis. Laparoscopic appendectomy was performed and the patient was discharged the following day. Patient returned two months later with complaints of tenesmus and abdominal pain. In the ED acute microcytic anemia was discovered. CT Abdomen and pelvis demonstrated diverticulosis without diverticulitis and FOBT positive. Colonoscopy performed and findings consisted of: large 6 cm cecal mass, biopsies taken, 8 mm polyp in transverse colon removed with cold snare, two 5-7 mm polyps in the ascending colon removed by cold snare, and 4 cm polyp removed via the hot snare in the descending colon. The patient then underwent colonic resection of the mass by general surgery.
DISCUSSION:
What is learned from this case is the importance of CRC screening and rare initial symptom of CRC of appendicitis in a male over the age of 40. The patient is 52 years old with without having CRC screening and acute appendicitis. Had the patient had his diagnostic colonoscopy at the age of 50 the cecal mass would have been discovered sooner and treatment could have been initiated. Another aspect of this case that makes it unusual was the patient did not have any of the more common symptoms of CRC. Our patient presented with general abdominal pain and tenesmus and the latter accounts for less than 1% of all symptomatology along with acute appendicitis. The patient did not have any of the “alarm” symptoms and if not for the appendicitis diagnosed in the hospital the patient “had no intentions” of doing CRC screening. The patient explains he had no family history of gastric or colon cancers, “So why bother?” The acute appendicitis from the cecal mass proved to be critical in the initiation of treatment.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.