title: Separate but equal

text: Although federal legislation prohibits racial discrimination in college admissions, the historically black colleges and universities continue to teach student bodies that are 75% to 90% African American. In 1975, Jake Ayers Sr. filed a lawsuit against Mississippi, stating that they gave more financial support to the predominantly white public colleges. The state settled the lawsuit in 2002, directing $503 million to three historically black colleges over 17 years.


title: Paris, je t'aime

text: Paris, je t'aime (; "Paris, I love you") is a 2006 anthology film starring an ensemble cast of actors of various nationalities. The two-hour film consists of eighteen short films set in different arrondissements (districts). The 22 directors include Gurinder Chadha, Sylvain Chomet, Joel and Ethan Coen, Isabel Coixet, Gérard Depardieu, Wes Craven, Alfonso Cuarón, Nobuhiro Suwa, Alexander Payne, Tom Tykwer, Walter Salles, Yolande Moreau, and Gus Van Sant.


title: Paris, je t'aime

text: Julio Medem was attached to the project for a long time. He was supposed to direct one of the segments starring Javier Bardem et Maria Valverde, but this finally fell through because of scheduling conflicts with the filming of "Caótica Ana" (2007).


title: Paris, je t'aime

text: "Paris, je t'aime" is the first feature film to be fully scanned in 6K and mastered in 4K in Europe (as opposed to the normal 2K). Encoding the image took about 24 hours per reel (at Laboratoires Éclair).


title: Paris, je t'aime

text: Both Emmanuel Benbihy and Gilles Caussade served as executive producers on the project. As the film is a collection of shorter segments, there were also producers attached to each episode of the project.


title: Paris, je t'aime

text: Initially, 20 short films representing the 20 arrondissements of Paris were planned, but two of them (the 15th arrondissement, directed by Christoffer Boe, and the 11th arrondissement, by Raphaël Nadjari) were not included in the final film because they could not be properly integrated into it. Each arrondissement is followed by a few images of Paris; these transition sequences were written by Emmanuel Benbihy and directed by Benbihy with Frédéric Auburtin. Including Benbihy, there were 22 directors involved in the finished film.


title: Paris, je t'aime

text: The film premiered at the 2006 Cannes Film Festival on 18 May, opening the "Un Certain Regard" selection. It had its Canadian premiere at the Toronto International Film Festival on 10 September and its US premiere in Pittsburgh, Pennsylvania on 9 April 2007. First Look Pictures acquired the North American rights, and the film opened in the United States on 4 May 2007.


title: Paris, je t'aime

text: "Paris, je t'aime" received generally positive reviews. It currently holds an 86% approval rating on Rotten Tomatoes based on 112 reviews, with an average score of 7.1/10. The site's consensus states: ""Paris je t'aime" is uneven, but there are more than enough delightful moments in this omnibus tribute to the City of Lights to tip the scale in its favor." Metacritic gives the film a 66/100 rating based on 27 critics, indicating "generally favorable reviews".


title: Paris, je t'aime

text: Following the success of "Paris, je t'aime", a similarly structured film, "New York, I Love You", focusing on life in that city, premiered at the 2008 Toronto International Film Festival and was released in a limited number of theatres in 2009. A third entry in the series, "Rio, Eu Te Amo", was released in 2014. "Berlin, I Love You" followed this later in 2019.


title: Endometrial cancer

text: Endometrial cancer is a cancer that arises from the endometrium (the lining of the uterus or womb). It is the result of the abnormal growth of cells that have the ability to invade or spread to other parts of the body. The first sign is most often vaginal bleeding not associated with a menstrual period. Other symptoms include pain with urination, pain during sexual intercourse, or pelvic pain. Endometrial cancer occurs most commonly after menopause.


title: Endometrial cancer

text: Approximately 40% of cases are related to obesity. Endometrial cancer is also associated with excessive estrogen exposure, high blood pressure and diabetes. Whereas taking estrogen alone increases the risk of endometrial cancer, taking both estrogen and a progestogen in combination, as in most birth control pills, decreases the risk. Between two and five percent of cases are related to genes inherited from the parents. Endometrial cancer is sometimes loosely referred to as "uterine cancer", although it is distinct from other forms of uterine cancer such as cervical cancer, uterine sarcoma, and trophoblastic disease. The most frequent type of endometrial cancer is endometrioid carcinoma, which accounts for more than 80% of cases. Endometrial cancer is commonly diagnosed by endometrial biopsy or by taking samples during a procedure known as dilation and curettage. A pap smear is not typically sufficient to show endometrial cancer. Regular screening in those at normal risk is not called for.


title: Endometrial cancer

text: The leading treatment option for endometrial cancer is abdominal hysterectomy (the total removal by surgery of the uterus), together with removal of the Fallopian tubes and ovaries on both sides, called a bilateral salpingo-oophorectomy. In more advanced cases, radiation therapy, chemotherapy or hormone therapy may also be recommended. If the disease is diagnosed at an early stage, the outcome is favorable, and the overall five-year survival rate in the United States is greater than 80%.


title: Endometrial cancer

text: In 2012, endometrial cancers newly occurred in 320,000 women and caused 76,000 deaths. This makes it the third most common cause of death in cancers which only affect women, behind ovarian and cervical cancer. It is more common in the developed world and is the most common cancer of the female reproductive tract in developed countries. Rates of endometrial cancer have risen in a number of countries between the 1980s and 2010. This is believed to be due to the increasing number of elderly people and increasing rates of obesity.


title: Endometrial cancer

text: Vaginal bleeding or spotting in women after menopause occurs in 90% of endometrial cancer. Bleeding is especially common with adenocarcinoma, occurring in two-thirds of all cases. Abnormal menstrual cycles or extremely long, heavy, or frequent episodes of bleeding in women before menopause may also be a sign of endometrial cancer.


title: Endometrial cancer

text: Symptoms other than bleeding are not common. Other symptoms include thin white or clear vaginal discharge in postmenopausal women. More advanced disease shows more obvious symptoms or signs that can be detected on a physical examination. The uterus may become enlarged or the cancer may spread, causing lower abdominal pain or pelvic cramping. Painful sexual intercourse or painful or difficult urination are less common signs of endometrial cancer. The uterus may also fill with pus (pyometrea). Of women with these less common symptoms (vaginal discharge, pelvic pain, and pus), 10–15% have cancer.


title: Endometrial cancer

text: Risk factors for endometrial cancer include obesity, insulin resistance and diabetes mellitus, breast cancer, use of tamoxifen, never having had a child, late menopause, high levels of estrogen, and increasing age. Immigration studies (migration studies), which examine the change in cancer risk in populations moving between countries with different rates of cancer, show that there is some environmental component to endometrial cancer. These environmental risk factors are not well characterized.


title: Endometrial cancer

text: Most of the risk factors for endometrial cancer involve high levels of estrogens. An estimated 40% of cases are thought to be related to obesity. In obesity, the excess of adipose tissue increases conversion of androstenedione into estrone, an estrogen. Higher levels of estrone in the blood causes less or no ovulation, and exposes the endometrium continuously to high levels of estrogens. Obesity also causes less estrogen to be removed from the blood. Polycystic ovary syndrome (PCOS), which also causes irregular or no ovulation, is associated with higher rates of endometrial cancer for the same reasons as obesity. Specifically, obesity, type II diabetes, and insulin resistance are risk factors for Type I endometrial cancer. Obesity increases the risk for endometrial cancer by 300–400%.


title: Endometrial cancer

text: Estrogen replacement therapy during menopause when not balanced (or "opposed") with progestin is another risk factor. Higher doses or longer periods of estrogen therapy have higher risks of endometrial cancer. Women of lower weight are at greater risk from unopposed estrogen. A longer period of fertility—either from an early first menstrual period or late menopause—is also a risk factor. Unopposed estrogen raises an individual's risk of endometrial cancer by 2–10 fold, depending on weight and length of therapy. In trans men who take testosterone and have not had a hysterectomy, the conversion of testosterone into estrogen via androstenedione may lead to a higher risk of endometrial cancer.


title: Endometrial cancer

text: Genetic disorders can also cause endometrial cancer. Overall, hereditary causes contribute to 2–10% of endometrial cancer cases. Lynch syndrome, an autosomal dominant genetic disorder that mainly causes colorectal cancer, also causes endometrial cancer, especially before menopause. Women with Lynch syndrome have a 40–60% risk of developing endometrial cancer, higher than their risk of developing colorectal (bowel) or ovarian cancer. Ovarian and endometrial cancer develop simultaneously in 20% of people. Endometrial cancer nearly always develops before colon cancer, on average, 11 years before. Carcinogenesis in Lynch syndrome comes from a mutation in MLH1 or MLH2: genes that participate in the process of mismatch repair, which allows a cell to correct mistakes in the DNA. Other genes mutated in Lynch syndrome include MSH2, MSH6, and PMS2, which are also mismatch repair genes. Women with Lynch syndrome represent 2–3% of endometrial cancer cases; some sources place this as high as 5%. Depending on the gene mutation, women with Lynch syndrome have different risks of endometrial cancer. With MLH1 mutations, the risk is 54%; with MSH2, 21%; and with MSH6, 16%.


title: Endometrial cancer

text: Women with a family history of endometrial cancer are at higher risk. Two genes most commonly associated with some other women's cancers, BRCA1 and BRCA2, do not cause endometrial cancer. There is an apparent link with these genes but it is attributable to the use of tamoxifen, a drug that itself can cause endometrial cancer, in breast and ovarian cancers. The inherited genetic condition Cowden syndrome can also cause endometrial cancer. Women with this disorder have a 5–10% lifetime risk of developing endometrial cancer, compared to the 2–3% risk for unaffected women.


title: Endometrial cancer

text: Common genetic variation has also been found to affect endometrial cancer risk in large-scale genome-wide association studies. Sixteen genomic regions have been associated with endometrial cancer and the common variants explain up to 7% of the familial relative risk.


title: Endometrial cancer

text: Some therapies for other forms of cancer increase the lifetime risk of endometrial cancer, which is a baseline 2–3%. Tamoxifen, a drug used to treat estrogen-positive breast cancers, has been associated with endometrial cancer in approximately 0.1% of users, particularly older women, but the benefits for survival from tamoxifen generally outweigh the risk of endometrial cancer. A one to two-year course of tamoxifen approximately doubles the risk of endometrial cancer, and a five-year course of therapy quadruples that risk. Raloxifene, a similar drug, did not raise the risk of endometrial cancer. Previously having ovarian cancer is a risk factor for endometrial cancer, as is having had previous radiotherapy to the pelvis. Specifically, ovarian granulosa cell tumors and thecomas are tumors associated with endometrial cancer.


title: Endometrial cancer

text: Low immune function has also been implicated in endometrial cancer. High blood pressure is also a risk factor, but this may be because of its association with obesity. Sitting regularly for prolonged periods is associated with higher mortality from endometrial cancer. The risk is not negated by regular exercise, though it is lowered.


title: Endometrial cancer

text: Smoking and the use of progestin are both protective against endometrial cancer. Smoking provides protection by altering the metabolism of estrogen and promoting weight loss and early menopause. This protective effect lasts long after smoking is stopped. Progestin is present in the combined oral contraceptive pill and the hormonal intrauterine device (IUD). Combined oral contraceptives reduce risk more the longer they are taken: by 56% after four years, 67% after eight years, and 72% after twelve years. This risk reduction continues for at least fifteen years after contraceptive use has been stopped. Obese women may need higher doses of progestin to be protected. Having had more than five infants (grand multiparity) is also a protective factor, and having at least one child reduces the risk by 35%. Breastfeeding for more than 18 months reduces risk by 23%. Increased physical activity reduces an individual's risk by 38–46%. There is preliminary evidence that consumption of soy is protective.


title: Endometrial cancer

text: Endometrial cancer forms when there are errors in normal endometrial cell growth. Usually, when cells grow old or get damaged, they die, and new cells take their place. Cancer starts when new cells form unneeded, and old or damaged cells do not die as they should. The buildup of extra cells often forms a mass of tissue called a growth or tumor. These abnormal cancer cells have many genetic abnormalities that cause them to grow excessively.


title: Endometrial cancer

text: In 10–20% of endometrial cancers, mostly Grade 3 (the highest histologic grade), mutations are found in a tumor suppressor gene, commonly p53 or PTEN. In 20% of endometrial hyperplasias and 50% of endometrioid cancers, PTEN has a loss-of-function mutation or a null mutation, making it less effective or completely ineffective. Loss of PTEN function leads to up-regulation of the PI3k/Akt/mTOR pathway, which causes cell growth. The p53 pathway can either be suppressed or highly activated in endometrial cancer. When a mutant version of p53 is overexpressed, the cancer tends to be particularly aggressive. P53 mutations and chromosome instability are associated with serous carcinomas, which tend to resemble ovarian and Fallopian carcinomas. Serous carcinomas are thought to develop from endometrial intraepithelial carcinoma.


title: Endometrial cancer

text: PTEN and p27 loss of function mutations are associated with a good prognosis, particularly in obese women. The Her2/neu oncogene, which indicates a poor prognosis, is expressed in 20% of endometrioid and serous carcinomas. CTNNB1 (beta-catenin; a transcription gene) mutations are found in 14–44% of endometrial cancers and may indicate a good prognosis, but the data is unclear. Beta-catenin mutations are commonly found in endometrial cancers with squamous cells. FGFR2 mutations are found in approximately 10% of endometrial cancers, and their prognostic significance is unclear. SPOP is another tumor suppressor gene found to be mutated in some cases of endometrial cancer: 9% of clear cell endometrial carcinomas and 8% of serous endometrial carcinomas have mutations in this gene.


title: Endometrial cancer

text: Type I and Type II cancers (explained below) tend to have different mutations involved. ARID1A, which often carries a point mutation in Type I endometrial cancer, is also mutated in 26% of clear cell carcinomas of the endometrium, and 18% of serous carcinomas. Epigenetic silencing and point mutations of several genes are commonly found in Type I endometrial cancer. Mutations in tumor suppressor genes are common in Type II endometrial cancer. PIK3CA is commonly mutated in both Type I and Type II cancers. In women with Lynch syndrome-associated endometrial cancer, microsatellite instability is common.


title: Endometrial cancer

text: Development of an endometrial hyperplasia (overgrowth of endometrial cells) is a significant risk factor because hyperplasias can and often do develop into adenocarcinoma, though cancer can develop without the presence of a hyperplasia. Within ten years, 8–30% of atypical endometrial hyperplasias develop into cancer, whereas 1–3% of non-atypical hyperplasias do so. An atypical hyperplasia is one with visible abnormalities in the nuclei. Pre-cancerous endometrial hyperplasias are also referred to as endometrial intraepithelial neoplasia. Mutations in the KRAS gene can cause endometrial hyperplasia and therefore Type I endometrial cancer. Endometrial hyperplasia typically occurs after the age of 40. Endometrial glandular dysplasia occurs with an overexpression of p53, and develops into a serous carcinoma.


title: Endometrial cancer

text: Diagnosis of endometrial cancer is made first by a physical examination, endometrial biopsy, or dilation and curettage (removal of endometrial tissue; D&C). This tissue is then examined histologically for characteristics of cancer. If cancer is found, medical imaging may be done to see whether the cancer has spread or invaded tissue.


title: Endometrial cancer

text: Routine screening of asymptomatic people is not indicated since the disease is highly curable in its early, symptomatic stages. Instead, women, particularly menopausal women, should be aware of the symptoms and risk factors of endometrial cancer. A cervical screening test, such as a Pap smear, is not a useful diagnostic tool for endometrial cancer because the smear will be normal 50% of the time. A Pap smear can detect disease that has spread to the cervix. Results from a pelvic examination are frequently normal, especially in the early stages of disease. Changes in the size, shape or consistency of the uterus or its surrounding, supporting structures may exist when the disease is more advanced. Cervical stenosis, the narrowing of the cervical opening, is a sign of endometrial cancer when pus or blood is found collected in the uterus (pyometra or hematometra).


title: Endometrial cancer

text: Women with Lynch syndrome should begin to have annual biopsy screening at the age of 35. Some women with Lynch syndrome elect to have a prophylactic hysterectomy and salpingo-oophorectomy to greatly reduce the risk of endometrial and ovarian cancer.


title: Endometrial cancer

text: Transvaginal ultrasound to examine the endometrial thickness in women with postmenopausal bleeding is increasingly being used to aid in the diagnosis of endometrial cancer in the United States. In the United Kingdom, both an endometrial biopsy and a transvaginal ultrasound used in conjunction are the standard of care for diagnosing endometrial cancer. The homogeneity of the tissue visible on transvaginal ultrasound can help to indicate whether the thickness is cancerous. Ultrasound findings alone are not conclusive in cases of endometrial cancer, so another screening method (for example endometrial biopsy) must be used in conjunction. Other imaging studies are of limited use. CT scans are used for preoperative imaging of tumors that appear advanced on physical exam or have a high-risk subtype (at high risk of metastasis). They can also be used to investigate extrapelvic disease. An MRI can be of some use in determining if the cancer has spread to the cervix or if it is an endocervical adenocarcinoma. MRI is also useful for examining the nearby lymph nodes.


title: Endometrial cancer

text: Dilation and curettage or an endometrial biopsy are used to obtain a tissue sample for histological examination. Endometrial biopsy is the less invasive option, but it may not give conclusive results every time. Hysteroscopy only shows the gross anatomy of the endometrium, which is often not indicative of cancer, and is therefore not used, unless in conjunction with a biopsy. Hysteroscopy can be used to confirm a diagnosis of cancer. New evidence shows that D&C has a higher false negative rate than endometrial biopsy.


title: Endometrial cancer

text: Before treatment is begun, several other investigations are recommended. These include a chest x-ray, liver function tests, kidney function tests, and a test for levels of CA-125, a tumor marker that can be elevated in endometrial cancer.


title: Endometrial cancer

text: Endometrial cancers may be tumors derived from epithelial cells (carcinomas), mixed epithelial and mesenchymal tumors (carcinosarcomas), or mesenchymal tumors.


title: Endometrial cancer

text: Traditional classification of endometrial carcinomas is based either on clinical and endocrine features (Type I and Type II), or histopathological characteristics (endometrioid, serous, and clear-cell). Some tumors are difficult to classify and have features overlapping more than one category. High grade endometrioid tumors, in particular, tend to have both type I and type II features.


title: Endometrial cancer

text: The vast majority of endometrial cancers are carcinomas (usually adenocarcinomas), meaning that they originate from the single layer of epithelial cells that line the endometrium and form the endometrial glands. There are many microscopic subtypes of endometrial carcinoma, but they are broadly organized into two categories, Type I and Type II, based on clinical features and pathogenesis. The two subtypes are genetically distinct.


title: Endometrial cancer

text: Type I endometrial carcinomas occur most commonly before and around the time of menopause. In the United States, they are more common in white women, particularly those with a history of endometrial hyperplasia. Type I endometrial cancers are often low-grade, minimally invasive into the underlying uterine wall (myometrium), estrogen-dependent, and have a good outcome with treatment. Type I carcinomas represent 75–90% of endometrial cancer.


title: Endometrial cancer

text: Type II endometrial carcinomas usually occur in older, post-menopausal people, in the United States are more common in black women, and are not associated with increased exposure to estrogen or a history of endometrial hyperplasia. Type II endometrial cancers are often high-grade, with deep invasion into the underlying uterine wall (myometrium), are of the serous or clear cell type, and carry a poorer prognosis. They can appear to be epithelial ovarian cancer on evaluation of symptoms. They tend to present later than Type I tumors and are more aggressive, with a greater risk of relapse and/or metastasis.


title: Endometrial cancer

text: In endometrioid adenocarcinoma, the cancer cells grow in patterns reminiscent of normal endometrium, with many new glands formed from columnar epithelium with some abnormal nuclei. Low-grade endometrioid adenocarcinomas have well differentiated cells, have not invaded the myometrium, and are seen alongside endometrial hyperplasia. The tumor's glands form very close together, without the stromal tissue that normally separates them. Higher-grade endometrioid adenocarcinomas have less well-differentiated cells, have more solid sheets of tumor cells no longer organized into glands, and are associated with an atrophied endometrium. There are several subtypes of endometrioid adenocarcinoma with similar prognoses, including villoglandular, secretory, and ciliated cell variants. There is also a subtype characterized by squamous differentiation. Some endometrioid adenocarcinomas have foci of mucinous carcinoma.


title: Endometrial cancer

text: The genetic mutations most commonly associated with endometrioid adenocarcinoma are in the genes PTEN, a tumor suppressor; PIK3CA, a kinase; KRAS, a GTPase that functions in signal transduction; and CTNNB1, involved in adhesion and cell signaling. The CTNNB1 (beta-catenin) gene is most commonly mutated in the squamous subtype of endometrioid adenocarcinoma.


title: Endometrial cancer

text: Serous carcinoma is a Type II endometrial tumor that makes up 5–10% of diagnosed endometrial cancer and is common in postmenopausal women with atrophied endometrium and black women. Serous endometrial carcinoma is aggressive and often invades the myometrium and metastasizes within the peritoneum (seen as omental caking) or the lymphatic system. Histologically, it appears with many atypical nuclei, papillary structures, and, in contrast to endometrioid adenocarcinomas, rounded cells instead of columnar cells. Roughly 30% of endometrial serous carcinomas also have psammoma bodies. Serous carcinomas spread differently than most other endometrial cancers; they can spread outside the uterus without invading the myometrium.


title: Endometrial cancer

text: The genetic mutations seen in serous carcinoma are chromosomal instability and mutations in TP53, an important tumor suppressor gene.


title: Endometrial cancer

text: Clear cell carcinoma is a Type II endometrial tumor that makes up less than 5% of diagnosed endometrial cancer. Like serous cell carcinoma, it is usually aggressive and carries a poor prognosis. Histologically, it is characterized by the features common to all clear cells: the eponymous clear cytoplasm when H&E stained and visible, distinct cell membranes. The p53 cell signaling system is not active in endometrial clear cell carcinoma. This form of endometrial cancer is more common in postmenopausal women.


title: Endometrial cancer

text: Mucinous carcinomas are a rare form of endometrial cancer, making up less than 1–2% of all diagnosed endometrial cancer. Mucinous endometrial carcinomas are most often stage I and grade I, giving them a good prognosis. They typically have well-differentiated columnar cells organized into glands with the characteristic mucin in the cytoplasm. Mucinous carcinomas must be differentiated from cervical adenocarcinoma.


title: Endometrial cancer

text: Mixed carcinomas are those that have both Type I and Type II cells, with one making up at least 10% of the tumor. These include the malignant mixed Müllerian tumor, which derives from endometrial epithelium and has a poor prognosis.


title: Endometrial cancer

text: Undifferentiated endometrial carcinomas make up less than 1–2% of diagnosed endometrial cancers. They have a worse prognosis than grade III tumors. Histologically, these tumors show sheets of identical epithelial cells with no identifiable pattern.


title: Endometrial cancer

text: Non-metastatic squamous cell carcinoma and transitional cell carcinoma are very rare in the endometrium. Squamous cell carcinoma of the endometrium has a poor prognosis. It has been reported fewer than 100 times in the medical literature since its characterization in 1892. For primary squamous cell carcinoma of the endometrium (PSCCE) to be diagnosed, there must be no other primary cancer in the endometrium or cervix and it must not be connected to the cervical epithelium. Because of the rarity of this cancer, there are no guidelines for how it should be treated, nor any typical treatment. The common genetic causes remain uncharacterized. Primary transitional cell carcinomas of the endometrium are even more rare; 16 cases had been reported . Its pathophysiology and treatments have not been characterized. Histologically, TCCE resembles endometrioid carcinoma and is distinct from other transitional cell carcinomas.


title: Endometrial cancer

text: In contrast to endometrial carcinomas, the uncommon endometrial stromal sarcomas are cancers that originate in the non-glandular connective tissue of the endometrium. They are generally non-aggressive and, if they recur, can take decades. Metastases to the lungs and pelvic or peritoneal cavities are the most frequent. They typically have estrogen and/or progesterone receptors. The prognosis for low-grade endometrial stromal sarcoma is good, with 60–90% five-year survival. High-grade undifferentiated endometrial sarcoma (HGUS) has a worse prognosis, with high rates of recurrence and 25% five-year survival. HGUS prognosis is dictated by whether or not the cancer has invaded the arteries and veins. Without vascular invasion, the five-year survival is 83%; it drops to 17% when vascular invasion is observed. Stage I ESS has the best prognosis, with five-year survival of 98% and ten-year survival of 89%. ESS makes up 0.2% of uterine cancers.


title: Endometrial cancer

text: Endometrial cancer frequently metastasizes to the ovaries and Fallopian tubes when the cancer is located in the upper part of the uterus, and the cervix when the cancer is in the lower part of the uterus. The cancer usually first spreads into the myometrium and the serosa, then into other reproductive and pelvic structures. When the lymphatic system is involved, the pelvic and para-aortic nodes are usually first to become involved, but in no specific pattern, unlike cervical cancer. More distant metastases are spread by the blood and often occur in the lungs, as well as the liver, brain, and bone. Endometrial cancer metastasizes to the lungs 20–25% of the time, more than any other gynecologic cancer.


title: Endometrial cancer

text: There is a three-tiered system for histologically classifying endometrial cancers, ranging from cancers with well-differentiated cells (grade I), to very poorly-differentiated cells (grade III). Grade I cancers are the least aggressive and have the best prognosis, while grade III tumors are the most aggressive and likely to recur. Grade II cancers are intermediate between grades I and III in terms of cell differentiation and aggressiveness of disease.


title: Endometrial cancer

text: The histopathology of endometrial cancers is highly diverse. The most common finding is a well-differentiated endometrioid adenocarcinoma, which is composed of numerous, small, crowded glands with varying degrees of nuclear atypia, mitotic activity, and stratification. This often appears on a background of endometrial hyperplasia. Frank adenocarcinoma may be distinguished from atypical hyperplasia by the finding of clear stromal invasion, or "back-to-back" glands which represent nondestructive replacement of the endometrial stroma by the cancer. With progression of the disease, the myometrium is infiltrated.


title: Endometrial cancer

text: Endometrial carcinoma is surgically staged using the FIGO cancer staging system. The 2009 FIGO staging system is as follows:


title: Endometrial cancer

text: Myometrial invasion and involvement of the pelvic and para-aortic lymph nodes are the most commonly seen patterns of spread. A Stage 0 is sometimes included, in this case it is referred to as "carcinoma in situ". In 26% of presumably early-stage cancers, intraoperative staging revealed pelvic and distant metastases, making comprehensive surgical staging necessary.


title: Endometrial cancer

text: The initial treatment for endometrial cancer is surgery; 90% of women with endometrial cancer are treated with some form of surgery. Surgical treatment typically consists of hysterectomy including a bilateral salpingo-oophorectomy, which is the removal of the uterus, and both ovaries and Fallopian tubes. Lymphadenectomy, or removal of pelvic and para-aortic lymph nodes, is performed for tumors of histologic grade II or above. Lymphadenectomy is routinely performed for all stages of endometrial cancer in the United States, but in the United Kingdom, the lymph nodes are typically only removed with disease of stage II or greater. The topic of lymphadenectomy and what survival benefit it offers in stage I disease is still being debated. In women with presumed stage I disease, a 2017 systematic review found no evidence that lymphadenectomy reduces the risk of death or relapse of cancer when compared with no lymphadenectomy. Women who undergo lymphadenectomy are more likely to experience systemic morbidity related to surgery or lymphoedema/lymphocyst formation. In stage III and IV cancers, cytoreductive surgery is the norm, and a biopsy of the omentum may also be included. In stage IV disease, where there are distant metastases, surgery can be used as part of palliative therapy. Laparotomy, an open-abdomen procedure, is the traditional surgical procedure; however, in those with presumed early stage primary endometrial cancer, laparoscopy (keyhole surgery) is associated with reduced operative morbidity and similar overall and disease free survival. Removal of the uterus via the abdomen is recommended over removal of the uterus via the vagina because it gives the opportunity to examine and obtain washings of the abdominal cavity to detect any further evidence of cancer. Staging of the cancer is done during the surgery.


title: Endometrial cancer

text: The few contraindications to surgery include inoperable tumor, massive obesity, a particularly high-risk operation, or a desire to preserve fertility. These contraindications happen in about 5–10% of cases. Women who wish to preserve their fertility and have low-grade stage I cancer can be treated with progestins, with or without concurrent tamoxifen therapy. This therapy can be continued until the cancer does not respond to treatment or until childbearing is done. Uterine perforation may occur during a D&C or an endometrial biopsy. Side effects of surgery to remove endometrial cancer can specifically include sexual dysfunction, temporary incontinence, and lymphedema, along with more common side effects of any surgery, including constipation.


title: Endometrial cancer

text: There are a number of possible additional therapies. Surgery can be followed by radiation therapy and/or chemotherapy in cases of high-risk or high-grade cancers. This is called adjuvant therapy.


title: Endometrial cancer

text: Adjuvant chemotherapy is a recent innovation, consisting of some combination of paclitaxel (or other taxanes like docetaxel), doxorubicin (and other anthracyclines), and platins (particularly cisplatin and carboplatin). Adjuvant chemotherapy has been found to increase survival in stage III and IV cancer more than added radiotherapy. Mutations in mismatch repair genes, like those found in Lynch syndrome, can lead to resistance against platins, meaning that chemotherapy with platins is ineffective in people with these mutations. Side effects of chemotherapy are common. These include hair loss, low neutrophil levels in the blood, and gastrointestinal problems.


title: Endometrial cancer

text: In cases where surgery is not indicated, palliative chemotherapy is an option; higher-dose chemotherapy is associated with longer survival. Palliative chemotherapy, particularly using capecitabine and gemcitabine, is also often used to treat recurrent endometrial cancer.


title: Endometrial cancer

text: Low certainty evidence suggests that in women with recurrent endometrial cancer who have had chemotherapy, receiving drugs that inhibit the mTOR pathway may reduce the risk of disease worsening compared to having more chemotherapy or hormonal therapy. Though, mTOR inhibitors may increase the chance of experiencing digestive tract ulcers.


title: Endometrial cancer

text: Adjuvant radiotherapy is commonly used in early-stage (stage I or II) endometrial cancer. It can be delivered through vaginal brachytherapy (VBT), which is becoming the preferred route due to its reduced toxicity, or external beam radiotherapy (EBRT). Brachytherapy involves placing a radiation source in the organ affected; in the case of endometrial cancer a radiation source is placed directly in the vagina. External beam radiotherapy involves a beam of radiation aimed at the affected area from outside the body. VBT is used to treat any remaining cancer solely in the vagina, whereas EBRT can be used to treat remaining cancer elsewhere in the pelvis following surgery. However, the benefits of adjuvant radiotherapy are controversial. Though EBRT significantly reduces the rate of relapse in the pelvis, overall survival and metastasis rates are not improved. VBT provides a better quality of life than EBRT.


title: Endometrial cancer

text: Radiotherapy can also be used before surgery in certain cases. When pre-operative imaging or clinical evaluation shows tumor invading the cervix, radiation can be given before a total hysterectomy is performed. Brachytherapy and EBRT can also be used, singly or in combination, when there is a contraindication for hysterectomy. Both delivery methods of radiotherapy are associated with side effects, particularly in the gastrointestinal tract.


title: Endometrial cancer

text: Hormonal therapy is only beneficial in certain types of endometrial cancer. It was once thought to be beneficial in most cases. If a tumor is well-differentiated and known to have progesterone and estrogen receptors, progestins may be used in treatment. There is no evidence to support the use of progestagen in addition to surgery for newly diagnosed endometrial cancer. About 25% of metastatic endometrioid cancers show a response to progestins. Also, endometrial stromal sarcomas can be treated with hormonal agents, including tamoxifen, hydroxyprogesterone caproate, letrozole, megestrol acetate, and medroxyprogesterone. This treatment is effective in endometrial stromal sarcomas because they typically have estrogen and/or progestin receptors. Progestin receptors function as tumor suppressors in endometrial cancer cells. Preliminary research and clinical trials have shown these treatments to have a high rate of response even in metastatic disease.


title: Endometrial cancer

text: In 2010 hormonal therapy is of unclear effect in those with advanced or recurrent endometrial cancer. There is insufficient evidence to inform women considering hormone replacement therapy after treatment for endometrial cancer.


title: Endometrial cancer

text: The tumor marker CA-125 is frequently elevated in endometrial cancer and can be used to monitor response to treatment, particularly in serous cell cancer or advanced disease. Periodic MRIs or CT scans may be recommended in advanced disease and women with a history of endometrial cancer should receive more frequent pelvic examinations for the five years following treatment. Examinations conducted every three to four months are recommended for the first two years following treatment, and every six months for the next three years.


title: Endometrial cancer

text: Women with endometrial cancer should not have routine surveillance imaging to monitor the cancer unless new symptoms appear or tumor markers begin rising. Imaging without these indications is discouraged because it is unlikely to detect a recurrence or improve survival, and because it has its own costs and side effects. If a recurrence is suspected, PET/CT scanning is recommended.


title: Endometrial cancer

text: The five-year survival rate for endometrial adenocarcinoma following appropriate treatment is 80%. Most women, over 70%, have FIGO stage I cancer, which has the best prognosis. Stage III and especially Stage IV cancers has a worse prognosis, but these are relatively rare, occurring in only 13% of cases. The median survival time for stage III–IV endometrial cancer is nine to ten months. Older age indicates a worse prognosis. In the United States, white women have a higher survival rate than black women, who tend to develop more aggressive forms of the disease by the time of their diagnosis. Tumors with high progesterone receptor expression have a good prognosis compared to tumors with low progesterone receptor expression; 93% of women with high progesterone receptor disease survived to three years, compared with 36% of women with low progesterone receptor disease. Heart disease is the most common cause of death among those who survive endometrial cancer, with other obesity-related health problems also being common. Following diagnosis, quality of life is also positively associated with a healthy lifestyle (no obesity, high-quality diet, physical activity).


title: Endometrial cancer

text: Recurrence of early stage endometrial cancer ranges from 3 to 17%, depending on primary and adjuvant treatment. Most recurrences (75–80%) occur outside of the pelvis, and most occur within two to three years of treatment—64% within two years and 87% within three years.


title: Endometrial cancer

text: Higher-staged cancers are more likely to recur, as are those that have invaded the myometrium or cervix, or that have metastasized into the lymphatic system. Papillary serous carcinoma, clear cell carcinoma, and endometrioid carcinoma are the subtypes at the highest risk of recurrence. High-grade histological subtypes are also at elevated risk for recurrence.


title: Endometrial cancer

text: The most common site of recurrence is in the vagina; vaginal relapses of endometrial cancer have the best prognosis. If relapse occurs from a cancer that has not been treated with radiation, EBRT is the first-line treatment and is often successful. If a cancer treated with radiation recurs, pelvic exenteration is the only option for curative treatment. Palliative chemotherapy, cytoreductive surgery, and radiation are also performed. Radiation therapy (VBT and EBRT) for a local vaginal recurrence has a 50% five-year survival rate. Pelvic recurrences are treated with surgery and radiation, and abdominal recurrences are treated with radiation and, if possible, chemotherapy. Other common recurrence sites are the pelvic lymph nodes, para-aortic lymph nodes, peritoneum (28% of recurrences), and lungs, though recurrences can also occur in the brain (<1%), liver (7%), adrenal glands (1%), bones (4–7%; typically the axial skeleton), lymph nodes outside the abdomen (0.4–1%), spleen, and muscle/soft tissue (2–6%).


title: Endometrial cancer

text: , approximately 320,000 women are diagnosed with endometrial cancer worldwide each year and 76,000 die, making it the sixth most common cancer in women. It is more common in developed countries, where the lifetime risk of endometrial cancer in women is 1.6%, compared to 0.6% in developing countries. It occurs in 12.9 out of 100,000 women annually in developed countries.


title: Endometrial cancer

text: In the United States, endometrial cancer is the most frequently diagnosed gynecologic cancer and, in women, the fourth most common cancer overall, representing 6% of all cancer cases in women. In that country, it was estimated that 52,630 women were diagnosed yearly and 8,590 would die from the disease. Northern Europe, Eastern Europe, and North America have the highest rates of endometrial cancer, whereas Africa and West Asia have the lowest rates. Asia saw 41% of the world's endometrial cancer diagnoses in 2012, whereas Northern Europe, Eastern Europe, and North America together comprised 48% of diagnoses. Unlike most cancers, the number of new cases has risen in recent years, including an increase of over 40% in the United Kingdom between 1993 and 2013. Some of this rise may be due to the increase in obesity rates in developed countries, increasing life expectancies, and lower birth rates. The average lifetime risk for endometrial cancer is approximately 2–3% in people with uteruses. In the UK, approximately 7,400 cases are diagnosed annually, and in the EU, approximately 88,000.


title: Endometrial cancer

text: Endometrial cancer appears most frequently during perimenopause (the period just before, just after, and during menopause), between the ages of 50 and 65; overall, 75% of endometrial cancer occurs after menopause. Women younger than 40 make up 5% of endometrial cancer cases and 10–15% of cases occur in women under 50 years of age. This age group is at risk for developing ovarian cancer at the same time. The worldwide median age of diagnosis is 63 years of age; in the United States, the average age of diagnosis is 60 years of age. White American women are at higher risk for endometrial cancer than black American women, with a 2.88% and 1.69% lifetime risk respectively. Japanese-American women and American Latina women have a lower rates and Native Hawaiian women have higher rates.


title: Endometrial cancer

text: There are several experimental therapies for endometrial cancer under research, including immunologic, hormonal, and chemotherapeutic treatments. Trastuzumab (Herceptin), an antibody against the Her2 protein, has been used in cancers known to be positive for the Her2/neu oncogene, but research is still underway. Immunologic therapies are also under investigation, particularly in uterine papillary serous carcinoma.


title: Endometrial cancer

text: Cancers can be analyzed using genetic techniques (including DNA sequencing and immunohistochemistry) to determine if certain therapies specific to mutated genes can be used to treat it. PARP inhibitors are used to treat endometrial cancer with PTEN mutations, specifically, mutations that lower the expression of PTEN. The PARP inhibitor shown to be active against endometrial cancer is olaparib. Research is ongoing in this area as of the 2010s.


title: Endometrial cancer

text: Research is ongoing on the use of metformin, a diabetes medication, in obese women with endometrial cancer before surgery. Early research has shown it to be effective in slowing the rate of cancer cell proliferation. Preliminary research has shown that preoperative metformin administration can reduce expression of tumor markers. Long-term use of metformin has not been shown to have a preventative effect against developing cancer, but may improve overall survival.


title: Endometrial cancer

text: Temsirolimus, an mTOR inhibitor, is under investigation as a potential treatment. Research shows that mTOR inhibitors may be particularly effective for cancers with mutations in PTEN. Ridaforolimus (deforolimus) is also being researched as a treatment for people who have previously had chemotherapy. Preliminary research has been promising, and a stage II trial for ridaforolimus was completed by 2013. There has also been research on combined ridaforolimus/progestin treatments for recurrent endometrial cancer. Bevacizumab and tyrosine kinase inhibitors, which inhibit angiogenesis, are being researched as potential treatments for endometrial cancers with high levels of vascular endothelial growth factor. Ixabepilone is being researched as a possible chemotherapy for advanced or recurrent endometrial cancer. Treatments for rare high-grade undifferentiated endometrial sarcoma are being researched, as there is no established standard of care yet for this disease. Chemotherapies being researched include doxorubicin and ifosfamide.


title: Endometrial cancer

text: There is also research in progress on more genes and biomarkers that may be linked to endometrial cancer. The protective effect of combined oral contraceptives and the IUD is being investigated. Preliminary research has shown that the levonorgestrel IUD placed for a year, combined with six monthly injections of gonadotropin-releasing hormone, can stop or reverse the progress of endometrial cancer in young women; specifically complex atypical hyperplasia however the results have been inconclusive. An experimental drug that combines a hormone with doxorubicin is also under investigation for greater efficacy in cancers with hormone receptors. Hormone therapy that is effective in treating breast cancer, including use of aromatase inhibitors, is also being investigated for use in endometrial cancer. One such drug is anastrozole, which is currently being researched in hormone-positive recurrences after chemotherapy. Research into hormonal treatments for endometrial stromal sarcomas is ongoing as well. It includes trials of drugs like mifepristone, a progestin antagonist, and aminoglutethimide and letrozole, two aromatase inhibitors.


title: Endometrial cancer

text: Research continues into the best imaging method for detecting and staging endometrial cancer. As current diagnostic methods are invasive and inaccurate, researchers are looking into new ways to catch endometrial cancer, especially in its early stages. A study found that using a technique involving infrared light on simple blood test samples detected uterine cancer with high accuracy (87%), and could detect precancerous growths in all cases. In surgery, research has shown that complete pelvic lymphadenectomy along with hysterectomy in stage 1 endometrial cancer does not improve survival and increases the risk of negative side effects, including lymphedema. Other research is exploring the potential of identifying the sentinel lymph nodes for biopsy by injecting the tumor with dye that shines under infrared light. Intensity modulated radiation therapy is currently under investigation, and already used in some centers, for application in endometrial cancer, to reduce side effects from traditional radiotherapy. Its risk of recurrence has not yet been quantified. Research on hyperbaric oxygen therapy to reduce side effects is also ongoing. The results of the PORTEC 3 trial assessing combining adjuvant radiotherapy with chemotherapy were awaited in late 2014.


title: Endometrial cancer

text: There is not enough evidence to determine if people with endometrial cancer benefit from additional behavioural and life style interventions that are aimed at losing excess weight.


title: Endometrial cancer

text: Endometrial cancer is not widely known by the general populace, despite its frequency. There is low awareness of the symptoms, which can lead to later diagnosis and worse survival.


title: Egyptian cuisine

text: Egyptian cuisine makes heavy use of poultry, legumes, vegetables and fruit from Egypt's rich Nile Valley and Delta.


title: Egyptian cuisine

text: Examples of Egyptian dishes include rice-stuffed vegetables and grape leaves, hummus, falafel, shawarma, kebab and kofta. "ful medames", mashed fava beans; "kushari", lentils and pasta; and "molokhiya", bush okra stew.


title: Egyptian cuisine

text: A local type of pita bread known as (Egyptian Arabic: ) is a staple of Egyptian cuisine, and cheesemaking in Egypt dates back to the First Dynasty of Egypt, with Domiati being the most popular type of cheese consumed today.


title: Egyptian cuisine

text: Egyptian cuisine relies heavily on vegetables and legumes, but can also feature meats, most commonly squab, chicken, and lamb. Lamb and beef are frequently used for grilling. Offal is a popular fast food in cities, and "foie gras" is a delicacy that has been prepared in the region since at least 2500 BCE. Fish and seafood are common in Egypt's coastal regions. A significant amount of Egyptian cuisine is vegetarian, due to both the historically high price of meat and the needs of the Coptic Christian community, whose religious restrictions require essentially vegan diets for much of the year.


title: Egyptian cuisine

text: Tea is the national drink of Egypt, and beer is the most popular alcoholic beverage. While Islam is the majority faith in Egypt and observant Muslims tend to avoid alcohol, alcoholic drinks are still readily available in the country.


title: Egyptian cuisine

text: Popular desserts in Egypt include "baqlawa", "basbousa", and "kunafa". Common ingredients in desserts include dates, honey, and almonds.


title: Egyptian cuisine

text: Wheat, barley and rice were part of the medieval Egyptian diet, but sources are conflicted about millet. According to Abd al-Latif al-Baghdadi, it was unknown outside a small area where it was cultivated in Upper Egypt. This seems to be supported by chronicler Muhammad ibn Iyas, who wrote that millet consumption was unusual, if not unheard of, in Cairo. Shihab al-Umari, on the other hand, says it was among the most popular cereal grains consumed in Egypt in that time.


title: Egyptian cuisine

text: Sorghum was, like millet, cultivated in Upper Egypt, but was not considered a desirable crop by residents of Cairo. There, it was consumed only during famine or other times of scarcity during which sorghum was preferred to other wheat substitutes used to make emergency bread rations like millet, bran, or broad beans.


title: Egyptian cuisine

text: In "The Tale of Judar and His Brothers", an Egyptian story from "Thousand and One Arabian Nights", the main character, a poverty-stricken fisherman named Judar, acquires a magic bag belonging to necromancer of Maghrebi origin. This bag supplies its owner with food like , a rice dish seasoned with cinnamon and mastic, sometimes colored with saffron and prepared stock and tail fat.


title: Egyptian cuisine

text: Ancient Egyptian cuisine accompanied not only of bread and beer, but of fruit, vegetables and fish eaten by the poor. Many of its carvings showing cuisine date back to the Old and New Kingdom periods.


title: Egyptian cuisine

text: Egyptian cuisine is notably conducive to vegetarian diets, as it relies heavily on legume and vegetable dishes. Though food in Alexandria and the coast of Egypt tends to use a great deal of fish and other seafood, for the most part Egyptian cuisine is based on foods that grow out of the ground.


title: Egyptian cuisine

text: Egypt's Red Sea ports were the main points of entry for spices to Europe. Easy access to various spices has, throughout the years, left its mark on Egyptian cuisine. Cumin is the most commonly used spice. Other common spices include coriander, cardamom, chili, aniseed, bay leaves, dill, parsley, ginger, cinnamon, mint and cloves.


title: Egyptian cuisine

text: Common meats featured in Egyptian cuisine are pigeon, chicken and duck. These are often boiled to make the broth for various stews and soups. Lamb and beef are the most common meats used for grilling. Grilled meats such as "kofta" (), "kabab" () and grilled cutlets are categorically referred to as "mashwiyat" ().


title: Egyptian cuisine

text: Offal, variety meats, is popular in Egypt. Liver sandwiches, a specialty of Alexandria, are a popular fast-food in cities. Chopped-up pieces of liver fried with bell peppers, chili, garlic, cumin and other spices are served in a baguette-like bread called "eish fino". Cow and sheep brain are eaten in Egypt.


title: Egyptian cuisine

text: "Foie gras", a well-known delicacy, is still enjoyed today by Egyptians. Its flavor is described as rich, buttery, and delicate, unlike that of an ordinary duck or goose liver. "Foie gras" is sold whole, or is prepared into "mousse", "parfait", or "pâté", and may also be served as an accompaniment to another food item, such as steak. The technique involves "gavage", cramming food into the throat of domesticated ducks and geese, and dates as far back as 2500 BC, when the ancient Egyptians began keeping birds for food.


title: Egyptian cuisine

text: Cheese is thought to have originated in the Middle East. Two alabaster jars found at Saqqara, dating from the First Dynasty of Egypt, contained cheese. These were placed in the tomb about 3,000 BC. They were likely fresh cheeses coagulated with acid or a combination of acid and heat. An earlier tomb, that of King Hor-Aha, may also have contained cheese which, based on the hieroglyphic inscriptions on the two jars, appears to be from Upper and Lower Egypt. The pots are similar to those used today when preparing "mish".


title: Egyptian cuisine

text: Although many rural people still make their own cheese, notably the fermented "mish", mass-produced cheeses are becoming more common. Cheese is often served with breakfast, it is included in several traditional dishes, and even in some desserts. Cheeses include "domiati" (), the most widely-eaten in Egypt; "areesh" () made from "laban rayeb"; "rumi" ();, a hard, salty, ripened variety of cheese that belongs to the same family as "Pecorino Romano" and "Manchego".


title: Egyptian cuisine

text: Bread made from a simple recipe forms the backbone of Egyptian cuisine. It is consumed at almost all Egyptian meals; a working-class or rural Egyptian meal might consist of little more than bread and beans.


title: Egyptian cuisine

text: The local bread is a form of hearty, thick, gluten-rich pita bread called "eish baladi" (Egyptian Arabic: ; Modern Standard Arabic: ') rather than the Arabic '. The word "" comes from the Semitic root ' with the meaning "to live, be alive." The word ' itself has the meaning of "life, way of living...; livelihood, subsistence" in Modern Standard and Classical Arabic; folklore holds that this synonymity indicates the centrality of bread to Egyptian life.


title: Egyptian cuisine

text: In modern Egypt, the government subsidizes bread, dating back to a Nasser-era policy. In 2008, a major food crisis caused ever-longer bread lines at government-subsidized bakeries where there would normally be none; occasional fights broke out over bread, leading to 11 deaths in 2008. Egyptian dissidents and outside observers of the former National Democratic Party regime frequently criticized the bread subsidy as an attempt to buy off the Egyptian urban working classes in order to encourage acceptance of the authoritarian system; nevertheless, the subsidy continued after the 2011 revolution.


title: Egyptian cuisine

text: On a culinary level, bread is commonly used as a utensil, at the same time providing carbohydrates and protein to the Egyptian diet. Egyptians use bread to scoop up food, sauces, and dips and to wrap kebabs, falafel, to keep the hands from becoming greasy. Most pita breads are baked at high temperatures (450 °F or 232 °C), causing the flattened rounds of dough to puff up dramatically. When removed from the oven, the layers of baked dough remain separated inside the deflated pita, which allows the bread to be opened into pockets, creating a space for use in various dishes. Common breads include:


title: Egyptian cuisine

text: In Egypt, "meze", commonly referred to as (), salads and cheeses are traditionally served at the start of a multi-course meal along with bread, before the main courses. Popular dishes include:


title: Egyptian cuisine

text: Egyptian cuisine is characterized by dishes such as "ful medames", mashed fava beans; "kushari", a mixture of lentils, rice, pasta, and other ingredients; "molokhiya", chopped and cooked jute leaf with garlic and coriander sauce; and "feteer meshaltet".


title: Egyptian cuisine

text: Egyptian cuisine shares similarities with food of the Eastern Mediterranean region, such as rice-stuffed vegetables, grape leaves, "shawerma", "kebab" and "kofta", with some variation and differences in preparation.


title: Egyptian cuisine

text: Some consider "kushari", a mixture of rice, lentils, and macaroni, to be the national dish. "Ful medames" is also one of the most popular dishes. Fava bean is also used in making falafel (most commonly referred to as "ta‘ameya" in Egypt, and served with fresh tomatoes, tahina sauce and arugula).


title: Egyptian cuisine

text: Ancient Egyptians are known to have used a lot of garlic and onions in their everyday dishes. Fresh garlic mashed with other herbs is used in spicy tomato salad and also stuffed in boiled or baked eggplant. Garlic fried with coriander is added to "molokhiya", a popular green soup made from finely chopped jute leaves, sometimes with chicken or rabbit. Fried onions can be also added to "kushari". The ingredients, in the okra and molokhiya dishes, are whipped and blended with a tool called the "wīka", used in ancient times and today, in Egypt and Sudan.


title: Egyptian cuisine

text: Egyptian desserts resemble other Eastern Mediterranean desserts. "Basbousa" () is a dessert made from semolina and soaked in syrup. It is usually topped with almonds and traditionally cut vertically into pieces so that each piece has a diamond shape. "Baqlawa" () is a sweet dish made from many layers of phyllo pastry, an assortment of nuts, and soaked in a sweet syrup. "Ghorayiba" () is a sweet biscuit made with sugar, flour and liberal quantities of butter, similar to shortbread. It can be topped with roasted almonds or black cardamom pods.


title: Egyptian cuisine

text: "Kahk" () is a sweet biscuit served most commonly during "Eid al-Fitr" in Egypt. It is covered with icing sugar, and can also be stuffed with dates, walnuts, or "'agameya" () which is similar in texture to Turkish delight, or just served plain. "Kunafa" () is a shredded pastry sandwiching a layer of cream (قشطة) or desalted 'akkawi cheese soaked in a sweet syrup. "Luqmet el qadi" () are small, round donuts that are crunchy on the outside and soft and syrupy on the inside. They are often served with dusted cinnamon and powdered sugar. The name literally translates to "The Judge's Bite". "Atayef" () is a dessert served exclusively during the month of "Ramadan", a sort of sweet mini pancake (made without eggs) filled with cream and nuts or raisins. "Rozz be laban" () is a rice pudding made with short grain white rice, full-cream milk, sugar, and vanilla. It can be served dusted with cinnamon, nuts and ice cream. "Umm Ali" or "Om Ali" (), is a type of bread pudding served hot made puff pastry or rice, milk, coconut, and raisins.


title: Egyptian cuisine

text: Although Ramadan is a month of fasting for Muslims in Egypt, it is usually a time when Egyptians pay a lot of attention to food variety and richness, since breaking the fast is a family affair, often with entire extended families meeting at the table just after sunset. There are several desserts served almost exclusively during Ramadan, such as "kunafa" () and "qatayef" (). In this month, many Egyptians prepare a special table for the poor or passers-by, usually in a tent in the street, called "Ma'edet Rahman" (, ), which literally translates to "Table of the Merciful", referring to one of the 99 names of God in Islam. These may be fairly simple or quite lavish, depending on the wealth and ostentation of the provider.


title: Egyptian cuisine

text: Observant Christians in Egypt adhere to fasting periods according to the Coptic calendar; these may practically extend to more than two-thirds of the year for the most extreme and observant. The more secular Coptic population mainly fasts only for Easter and Christmas. The Coptic diet for fasting is essentially vegan. During this fasting, Copts usually eat vegetables and legumes fried in oil and avoid meat, chicken, and dairy products, including butter and cream.


title: Egyptian cuisine

text: Tea (, "" ) is the national drink in Egypt, followed only distantly by coffee. Egyptian tea is uniformly black and sour and is generally served in a glass, sometimes with milk. Tea packed and sold in Egypt is almost exclusively imported from Kenya and Sri Lanka. Egyptian tea comes in two varieties, "kushari" and "sa‘idi".


title: Egyptian cuisine

text: "Kushari" tea (), popular in Lower Egypt, is prepared using the traditional method of steeping black tea in boiled water and letting it sit for a few minutes. It is almost always sweetened with cane sugar and often flavored with fresh mint leaves. "Kushari" tea is usually light in color and flavor, with less than a half teaspoonful of tea per cup considered to be near the high end.


title: Egyptian cuisine

text: "Sa‘idi" tea () is common in Upper Egypt. It is prepared by boiling black tea with water for as long as five minutes over a strong flame. "Sa‘idi" tea is extremely strong and dark ("heavy" in Egyptian parlance), with two teaspoonfuls of tea per cup being the norm. It is sweetened with copious amounts of cane sugar (a necessity since the formula and method yield a very bitter tea). "Sa‘idi" tea is often black even in liquid form.


title: Egyptian cuisine

text: Tea is a vital part of daily life and folk etiquette in Egypt. It typically accompanies breakfast in most households, and drinking tea after lunch is a common practice. Visiting another person's household, regardless of socioeconomic level or the purpose of the visit, entails a compulsory cup of tea; similar hospitality might be required for a business visit to the private office of someone wealthy enough to maintain one, depending on the nature of the business. A common nickname for tea in Egypt is "duty" (pronounced in Arabic as "wa-jeb" or "wa-geb"), as serving tea to a visitor is considered a duty, while anything beyond is a nicety.


title: Egyptian cuisine

text: Besides true tea, herbal teas are also often served at Egyptian teahouses. "Karkadeh" (), a tea of dried hibiscus sepals, is particularly popular, as it is in other parts of North Africa. It is generally served extremely sweet and cold but may also be served hot. This drink is said to have been a preferred drink of the pharaohs. In Egypt and Sudan, wedding celebrations are traditionally toasted with a glass of hibiscus tea. On a typical street in downtown Cairo, one can find many vendors and open-air cafés selling the drink. In Egypt, "karkadeh" is used as a means to lower blood pressure when consumed in high amounts. Infusions of mint, cinnamon, dried ginger, and anise are also common, as is sahlab. Most of these herbal teas are considered to have medicinal properties as well; particularly common is an infusion of hot lemonade in which mint leaves have been steeped and sweetened with honey and used to combat mild sore throat.


title: Egyptian cuisine

text: Coffee (, ' ) is considered a part of the traditional welcome in Egypt. It is usually prepared in a similar fashion to Turkish coffee in a small coffee pot, which is called "dalla" (دلة) or "kanakah" (كنكة) and served in a small coffee cup called a (). The coffee is usually strong and sweetened with sugar to various degrees; al riha (عالريحة)", (مظبوط) and (زيادة) respectively. Unsweetened coffee is known as "sada (سادة)," or plain.


title: Egyptian cuisine

text: In Egypt, sugar cane juice is called "'aseer asab" () and is an incredibly popular drink served by almost all fruit juice vendors, who can be found abundantly in most cities.


title: Egyptian cuisine

text: Licorice teas and carob juice drinks are traditionally enjoyed during the Islamic month of Ramadan, as is "amar al-din", a thick drink made by reconstituting sheets of dried apricot with water. The sheets themselves are often consumed as candy. "Sobia" () is another beverage traditionally served during Ramadan. It is a sweet coconut milk drink, usually sold by street vendors.


title: Egyptian cuisine

text: A sour, chilled drink made from tamarind is popular during the summer called "tamr hindi" (). It literally translates to "Indian dates", which is the Arabic name for tamarind.


title: Egyptian cuisine

text: Islam is the majority religion in Egypt, and while observant Muslims tend to avoid the consumption of alcohol, it is readily available in the country. Beer is by far the most popular alcoholic beverage in the country, accounting for 54 percent of all alcohol consumed.


title: Egyptian cuisine

text: A beer type known as "bouza" (), based on barley and bread, has been drunk in Egypt since beer first made its appearance in the country, possibly as early as the Predynastic era. It is not the same as "boza", an alcoholic beverage found in Turkey and the Balkans.


title: Egyptian cuisine

text: Egypt has a small but nascent wine industry. Egyptian wines have received some recognition in recent years, having won several international awards. In 2013 Egypt produced 4,500 tonnes of wine, ranking 54th globally, ahead of Belgium and the United Kingdom. Most Egyptian wines are made with grapes sourced from vineyards in Alexandria and Middle Egypt, most notably Gianaclis Vineyards and Koroum of the Nile.


title: Power Rangers Jungle Fury

text: Power Rangers Jungle Fury is the sixteenth season of the American television series "Power Rangers", and is an adaptation of "Juken Sentai Gekiranger", the thirty-first Japanese "Super Sentai" series.


title: Power Rangers Jungle Fury

text: The season premiered on February 18, 2008 as part of Jetix on Toon Disney; it would be the last season to air on both entities before the launch of Disney XD in February 2009.


title: Power Rangers Jungle Fury

text: For over 10,000 years, a spirit of pure evil known as Dai Shi has been locked away and safely guarded by the Pai Zhua - The Order of the Claw - a secretive Kung Fu clan. The Pai Zhua select their three top members, Jarrod, Theo Martin, and Lily Chilman, to become the new guardians of Dai Shi. Jarrod's arrogant and bullying nature led to him being excluded. Instead, a rookie named Casey Rhodes is chosen.


title: Power Rangers Jungle Fury

text: During the initiation ceremony, Jarrod returns and attacks Master Mao, inadvertently breaking the vessel containing Dai Shi's essence as he does so. The freed Dai Shi kills Master Mao and takes over Jarrod's body. The new guardians travel to the city of Ocean Bluff to seek their new master and find him to be a man named Robert "RJ" James - chef and owner of Jungle Karma Pizza.  After testing guardians, RJ grants them the powers and abilities of Jungle Fury Power Rangers. Making the Earth's only hope to stop Dai Shi - who along with his Lieutenant Camille, other henchmen, and the army of undead Rinshi warriors is attempting to take over the world and allow animals to rule over humans.


title: Power Rangers Jungle Fury

text: Initially, RJ acts only as Sensei and trainer to the Power Rangers, but as the series progresses he joins their ranks as the Jungle Fury Purple Wolf Ranger. During this time, they are also joined by Dominic "Dom" Hargan who studied with RJ, and Fran - originally a customer then an employee of Jungle Karma Pizza. Dominic joins as the White Rhino Power Ranger, and Fran is enlisted to watch the monitors and advise of Rinshi attacks while RJ is with the other Power Rangers. Eventually, Camille is targeted by henchmen Scorch and Snapper who are jealous of her popularity with Dai Shi - although, in reality, it is Jarrod's own human spirit fighting against Dai Shi she is attracted to. As a result, she turns against both them and Dai Shi, enabling Jarrod to throw off its spirit control, and the two join the Power Rangers who use their animal spirits finally to defeat Dai Shi and its forces.


title: Power Rangers Jungle Fury

text: In the epilogue, a more mature and responsible Jarrod goes back to the Pai Zhua to begin his training again, followed by Camille, who later returns as a Power Ranger in her own right. Lily, Theo, and RJ remain at Jungle Karma Pizza. Dominic and Fran backpack around the world and Casey becomes a teacher at the Pai Zhua - with Jarrod and Camille among his students.


title: White Lines (TV series)

text: White Lines is a British-Spanish mystery thriller streaming television series created by Álex Pina. The 10-episode first series was released on Netflix on 15 May 2020. In August 2020, the series was cancelled after one season.


title: White Lines (TV series)

text: When Zoe Walker's brother Axel is found dead, 20 years after going missing while he was working as a DJ in Ibiza, she decides to travel there and investigate.


title: White Lines (TV series)

text: It was announced in October 2016 that Netflix had ordered a series created by "Money Heist" creator Álex Pina. In June 2019, Laura Haddock, Marta Milans, Juan Diego Botto, Nuno Lopes, Daniel Mays, Laurence Fox and Angela Griffin joined the cast of the show.


title: White Lines (TV series)

text: The review aggregator website Rotten Tomatoes reported a 63% approval rating for the first series with an average rating of 6.57/10, based on 16 reviews. The website's critical consensus reads, "A tasty, self-indulgent tangle of mystery, "White Lines" is a sight to behold -- even if there's not much below the surface." On Metacritic, it has a weighted average score of 50 out of 100, based on 7 critics, indicating "mixed or average reviews".


title: Christiane F. (film)

text: Christiane F. (, ) is a 1981 German biographical drama film directed by Uli Edel that portrays the descent of Christiane Felscherinow, a bored 13-year-old growing up in mid-1970s West Berlin, to a 14-year-old heroin addict. Based on the 1978 non-fiction book "Wir Kinder vom Bahnhof Zoo" ("We Children from Zoo Station"), transcribed and edited from tape recordings by Kai Hermann and Horst Rieck, the film immediately acquired cult status and features David Bowie as both composer and as himself. In 2013, Felscherinow published her autobiography "Christiane F. – My Second Life".


title: Christiane F. (film)

text: Thirteen-year-old Christiane Felscherinow lives with her mother, younger sister, and her pet cat in their small apartment in an unkempt multi-storey, concrete social-housing building in a dull neighbourhood on the outskirts of West Berlin. She is tired of living there and is a huge fan of David Bowie. She hears of Sound, a new trending nightclub in the city's centre. Although she is not old enough to get in, she dresses up in high heels and make-up, and asks a popular school friend, Kessi, who goes there regularly, to take her. Kessi also provides her with pills. At the club, she meets a slightly older boy named Detlev, who is part of a clique where everybody uses various types of drugs. The next morning, Christiane and Kessi are waiting for the subway when Kessi's mother finds them and angrily berates Kessi, grabbing her by the arm and telling Christiane to stay away from her daughter.


title: Christiane F. (film)

text: Christiane starts taking LSD, in addition to abusing pills, and befriends a girl her age named Babsi. After a David Bowie concert, Christiane tries heroin for the first time. As she falls in love with Detlev, Christiane begins using heroin on a regular basis in order to be close to him, gradually becoming more and more dependent on the drug until she is a full-blown addict. After her 14th birthday, Christiane stops going home and spends more and more time at her cohorts' unkempt apartment; she is also drawn to Bahnhof Zoo, a large train and subway station notorious for the drug trafficking and prostitution that takes place in its underpasses and back alleys. Christiane also starts to prostitute herself, imitating Detlev, who sells sex favours to male clients on a regular basis in order to support his heroin addiction.


title: Christiane F. (film)

text: After being discovered unconscious on the bathroom floor at home due to a heroin overdose, Christiane tries going cold turkey with Detlev, an excruciating experience for both of them. However, they both relapse the moment they revisit Bahnhof Zoo. To fuel her addiction, Christiane steals from home, sells all her possessions, and sinks to abysmal levels. One day, Christiane and Detlev find their best friend and roommate, Axel, dead in the apartment from a fatal overdose, due to a bad batch of heroin he was sold on the streets that Detlev believes to be strychnine. Christiane and Detlev quickly run away, ending up at the apartment of one of Detlev's male clients. When Christiane walks in on the two having very loud anal intercourse, she has a breakdown and flees. She returns to the station in order to find Babsi, only to discover that she is dead of an overdose at barely 14 years old, as plastered all over the front pages of many newspapers. In despair over the deaths of numerous friends, as well as her inability to break free from her heroin addiction, Christiane tries to overdose too. A voice-over says that Christiane eventually recovered, but most of her cohorts either died or are still addicts, including Detlev, whose whereabouts and current condition are unknown.


title: Christiane F. (film)

text: The film was shot with a low budget in 1980 and released in 1981, but set between 1975 and 1977 in West Berlin. It skips the beginning and the end of the book, and concentrates on the main story, starting when Christiane begins her nightlife in Berlin at around 13 years old, and stops rather abruptly after her suicide attempt by stating that she recovered. In the real story, Christiane F. never fully recovered from her addiction, nor did her troubles end with going to Hamburg to begin withdrawal.


title: Christiane F. (film)

text: Originally the film was going to be directed by Roland Klick, but he was fired only two weeks before shooting, after a fallout with Bernd Eichinger. Uli Edel came in to direct the film. Cinematography is bleak and dreary, depicting a dilapidated, working-class Berlin with rundown structures and dirty, blighted backdrops.


title: Christiane F. (film)

text: The cast is composed mainly of first-time actors, most of whom were still in school at the time and have mostly not pursued acting careers since. Natja Brunckhorst is the only cast member who continued to act in German films and television, starting with 1982's "Querelle" by Rainer Werner Fassbinder, at the time the highest-grossing film with a strongly homosexual theme. Real life "Stella" (Catherine Schabeck), aged 18 at the time, has a short cameo as the drug dealer that sells the first dose of heroin to Detlev. Most of the extras at the railway station and at SOUND were actual drug users and prostitutes. In the scene where Christiane runs through the alleys of the station to find Babsi, the camera lingers on several drug users leaning against the walls of the underpass. In a 2011 interview, Thomas Haustein, who played Detlev and was still in school at the time, recalled how terrified he felt being surrounded by real-life addicts, but that he was able to successfully copy their behaviour for his character. It would now be illegal to have minors act in the film's graphic shoot-up, nudity and sex scenes; at the time, however, all the production needed was a written letter of consent from the parents to proceed with filming.


title: Christiane F. (film)

text: The David Bowie concert featured in the film actually took place in New York City, with only some of the crew and cast attending, because at the time Bowie was performing on Broadway several nights a week and could not shoot in Berlin. The close-up shots of Bowie were from this New York performance, whereas the mass audience scenes were from an AC/DC concert in Germany. The two were spliced together to seem as one event.


title: Christiane F. (film)

text: Natja Brunckhorst recalled a scene which was shot on Kurfürstenstraße where her character is standing alone waiting for someone to pick her up. "It was a long lens shot so the camera team was far away. A car drove up and I was about to get in when I saw, out of the corner of my eye, some of the crew running towards me shouting: "No! No! No!" And it came to me: this was a real guy, not an actor, trying to pick me up. I almost got into a car with someone who wanted to sleep with a 13-year-old," she said.


title: Christiane F. (film)

text: Both the film and the book acquired cult status in Europe immediately after release, raising awareness of heroin addiction. The popularity of the film was increased by David Bowie's participation as himself (portrayed giving a concert early in the film) and as the main contributor to the soundtrack. Bowie's music from his albums made in Berlin during 1976 and 1977 is played throughout the picture, and as he was at the peak of his popularity during the late 1970s and early 1980s, his presence helped boost the film's commercial success.


title: Christiane F. (film)

text: Christiane and her cohorts are seen losing consciousness in decrepit lavatory cubicles amidst urine, vomit and blood, injecting in close-ups, cleaning and re-filling syringes directly from the toilet bowl, vomiting all over themselves and falling asleep right on top of it. In one particularly disturbing scene, a junkie climbs over a public toilet stall to steal Christiane's fix, inject himself in the neck, hand back the used syringe and thank her, in front of the horrified gaze of an elderly woman. The depiction of young addicts from seemingly normal families was particularly alarming. At the time junkies were still perceived in popular culture as much older, wilder characters, such as those depicted in Dennis Hopper's "Easy Rider" or in Lou Reed's songs. Christiane turns 14 halfway through the film, the same age as her friend Babsi, who fatally overdoses. Christiane's boyfriend in the film is 15, portrayed by a 14-year-old actor. None of their companions, two of whom also fatally overdose, are older than 16, as reported by end titles recalling the birth and death dates of the real-life individuals portrayed in the film. The fact that the characters prostitute themselves, both heterosexually and homosexually, at such a young age, revolted audiences.


title: Christiane F. (film)

text: All songs written by David Bowie except "Heroes/Helden" written by Bowie/Eno/Maas, "Boys Keep Swinging" and "Look Back In Anger", both written by Bowie/Eno. According to the book, the real Christiane F. had had her first experience with heroin at a David Bowie concert some years earlier; this is told in the film with David Bowie starring as himself. The concert scene was filmed in October 1980 at New York's Hurrah nightclub, which was redressed to resemble a Berlin nightclub (Bowie was appearing nightly on Broadway at the time so director Ulrich Edel had to shoot the sequence in New York).


title: Depolarization

text: In biology, depolarization or hypopolarization is a change within a cell, during which the cell undergoes a shift in electric charge distribution, resulting in less negative charge inside the cell compared to the outside. Depolarization is essential to the function of many cells, communication between cells, and the overall physiology of an organism.


title: Depolarization

text: Most cells in higher organisms maintain an internal environment that is negatively charged relative to the cell's exterior. This difference in charge is called the cell's membrane potential. In the process of depolarization, the negative internal charge of the cell temporarily becomes more positive (less negative). This shift from a negative to a more positive membrane potential occurs during several processes, including an action potential. During an action potential, the depolarization is so large that the potential difference across the cell membrane briefly reverses polarity, with the inside of the cell becoming positively charged.


title: Depolarization

text: The change in charge typically occurs due to an influx of sodium ions into a cell, although it can be mediated by an influx of any kind of cation or efflux of any kind of anion. The opposite of a depolarization is called a hyperpolarization.


title: Depolarization

text: Usage of the term "depolarization" in biology differs from its use in physics, where it refers to situations in which any form of polarity ("i.e." the presence of any electrical charge, whether positive or negative) changes to a value of zero.


title: Depolarization

text: The process of depolarization is entirely dependent upon the intrinsic electrical nature of most cells. When a cell is at rest, the cell maintains what is known as a resting potential. The resting potential generated by nearly all cells results in the interior of the cell having a negative charge compared to the exterior of the cell. To maintain this electrical imbalance, microscopic positively and negatively charged particles called ions are transported across the cell's plasma membrane. The transport of the ions across the plasma membrane is accomplished through several different types of transmembrane proteins embedded in the cell's plasma membrane that function as pathways for ions both into and out of the cell, such as ion channels, sodium potassium pumps, and voltage-gated ion channels.


title: Depolarization

text: The resting potential must be established within a cell before the cell can be depolarized. There are many mechanisms by which a cell can establish a resting potential, however there is a typical pattern of generating this resting potential that many cells follow. The cell uses ion channels, ion pumps, and voltage-gated ion channels to generate a negative resting potential within the cell. However, the process of generating the resting potential within the cell also creates an environment outside the cell that favors depolarization. The sodium potassium pump is largely responsible for the optimization of conditions on both the interior and the exterior of the cell for depolarization. By pumping three positively charged sodium ions (Na) out of the cell for every two positively charged potassium ions (K) pumped into the cell, not only is the resting potential of the cell established, but an unfavorable concentration gradient is created by increasing the concentration of sodium outside the cell and increasing the concentration of potassium within the cell. Although there is an excessive amount of potassium in the cell and sodium outside the cell, the generated resting potential keeps the voltage-gated ion channels in the plasma membrane closed, preventing the ions that have been pumped across the plasma membrane from diffusing to an area of lower concentration. Additionally, despite the high concentration of positively-charged potassium ions, most cells contain internal components (of negative charge), which accumulate to establish a negative inner-charge.


title: Depolarization

text: After a cell has established a resting potential, that cell has the capacity to undergo depolarization. During depolarization, the membrane potential rapidly shifts from negative to positive. For this rapid change to take place within the interior of the cell, several events must occur along the plasma membrane of the cell. While the sodium–potassium pump continues to work, the voltage-gated sodium and calcium channels that had been closed while the cell was at resting potential are opened in response to an initial change in voltage. As the sodium ions rush back into the cell, they add positive charge to the cell interior, and change the membrane potential from negative to positive. Once the interior of the cell becomes more positively charged, depolarization of the cell is complete, and the channels close again.


title: Depolarization

text: After a cell has been depolarized, it undergoes one final change in internal charge. Following depolarization, the voltage-gated sodium ion channels that had been open while the cell was undergoing depolarization close again. The increased positive charge within the cell now causes the potassium channels to open. Potassium ions (K) begin to move down the electrochemical gradient (in favor of the concentration gradient and the newly established electrical gradient). As potassium moves out of the cell the potential within the cell decreases and approaches its resting potential once more. The sodium potassium pump works continuously throughout this process.


title: Depolarization

text: The process of repolarization causes an overshoot in the potential of the cell. Potassium ions continue to move out of the axon so much so that the resting potential is exceeded and the new cell potential becomes more negative than the resting potential. The resting potential is ultimately re-established by the closing of all voltage-gated ion channels and the activity of the sodium potassium ion pump.


title: Depolarization

text: Depolarization is essential to the functions of many cells in the human body, which is exemplified by the transmission of stimuli both within a neuron and between two neurons. The reception of stimuli, neural integration of those stimuli, and the neuron's response to stimuli all rely upon the ability of neurons to utilize depolarization to transmit stimuli either within a neuron or between neurons.


title: Depolarization

text: Stimuli to neurons can be physical, electrical, or chemical, and can either inhibit or excite the neuron being stimulated. An inhibitory stimulus is transmitted to the dendrite of a neuron, causing hyperpolarization of the neuron. The hyperpolarization following an inhibitory stimulus causes a further decrease in voltage within the neuron below the resting potential. By hyperpolarizing a neuron, an inhibitory stimulus results in a greater negative charge that must be overcome for depolarization to occur. Excitation stimuli, on the other hand, increases the voltage in the neuron, which leads to a neuron that is easier to depolarize than the same neuron in the resting state. Regardless of it being excitatory or inhibitory, the stimulus travels down the dendrites of a neuron to the cell body for integration.


title: Depolarization

text: Once the stimuli have reached the cell body, the nerve must integrate the various stimuli before the nerve can respond. The stimuli that have traveled down the dendrites converge at the axon hillock, where they are summed to determine the neuronal response. If the sum of the stimuli reaches a certain voltage, known as the threshold potential, depolarization continues from the axon hillock down the axon.


title: Depolarization

text: The surge of depolarization traveling from the axon hillock to the axon terminal is known as an action potential. Action potentials reach the axon terminal, where the action potential triggers the release of neurotransmitters from the neuron. The neurotransmitters that are released from the axon continue on to stimulate other cells such as other neurons or muscle cells. After an action potential travels down the axon of a neuron, the resting membrane potential of the axon must be restored before another action potential can travel the axon. This is known as the recovery period of the neuron, during which the neuron cannot transmit another action potential.


title: Depolarization

text: The importance and versatility of depolarization within cells can be seen in the relationship between rod cells in the eye and their associated neurons. When rod cells are in the dark, they are depolarized. In the rod cells, this depolarization is maintained by ion channels that remain open due to the higher voltage of the rod cell in the depolarized state. The ion channels allow calcium and sodium to pass freely into the cell, maintaining the depolarized state. Rod cells in the depolarized state constantly release neurotransmitters which in turn stimulate the nerves associated with rod cells. This cycle is broken when rod cells are exposed to light; the absorption of light by the rod cell causes the channels that had facilitated the entry of sodium and calcium into the rod cell to close. When these channels close, the rod cells produce fewer neurotransmitters, which is perceived by the brain as an increase in light. Therefore, in the case of rod cells and their associated neurons, depolarization actually prevents a signal from reaching the brain as opposed to stimulating the transmission of the signal.


title: Depolarization

text: Endothelium is a thin layer of simple squamous epithelial cells that line the interior of both blood and lymph vessels. The endothelium that lines blood vessels is known as vascular endothelium, which is subject to and must withstand the forces of blood flow and blood pressure from the cardiovascular system. To withstand these cardiovascular forces, endothelial cells must simultaneously have a structure capable of withstanding the forces of circulation while also maintaining a certain level of plasticity in the strength of their structure. This plasticity in the structural strength of the vascular endothelium is essential to overall function of the cardiovascular system. Endothelial cells within blood vessels can alter the strength of their structure to maintain the vascular tone of the blood vessel they line, prevent vascular rigidity, and even help to regulate blood pressure within the cardiovascular system. Endothelial cells accomplish these feats by using depolarization to alter their structural strength. When an endothelial cell undergoes depolarization, the result is a marked decrease in the rigidity and structural strength of the cell by altering the network of fibers that provide these cells with their structural support. Depolarization in vascular endothelium is essential not only to the structural integrity of endothelial cells, but also to the ability of the vascular endothelium to aid in the regulation of vascular tone, prevention of vascular rigidity, and the regulation of blood pressure.


title: Depolarization

text: There are drugs, called depolarization blocking agents, that cause prolonged depolarization by opening channels responsible for depolarization and not allowing them to close, preventing repolarization. Examples include the nicotinic agonists, suxamethonium and decamethonium.


title: Ann Rule

text: Ann Rae Rule ("née" Stackhouse; October 22, 1931 – July 26, 2015) was an American author of true crime books and articles.


title: Ann Rule

text: She is best known for "The Stranger Beside Me" (1980), about the serial killer Ted Bundy, with whom Rule worked and whom she considered a friend, but was later revealed to be a murderer. Rule is also known for her book "Small Sacrifices", about Oregon child murderer Diane Downs. Many of Rule's books center on murder cases that occurred in the Pacific Northwest and her adopted home state of Washington.


title: Ann Rule

text: Ann Rae Stackhouse was born on October 22, 1931, in Lowell, Michigan. She was one of two children of Sophie Marie (Hansen) and Chester R. Stackhouse. Her mother was a teacher, specializing in developmentally disabled children, and her father was a football and track and field coach. As Rule did during young adulthood, her family members had careers in law enforcement. Rule's grandfather and uncle were sheriffs in Michigan. Another uncle was a medical examiner and a cousin was a prosecutor. Rule spent summers with her grandparents doing volunteer work at the local jail.


title: Ann Rule

text: She graduated from Coatesville High School in Chester County, Pennsylvania and later earned an associate degree from Highline Community College in Des Moines, Washington. Rule also attended the University of Washington, studying creative writing, criminology and psychology.


title: Ann Rule

text: Rule's career path included working as a law enforcement officer for the Seattle Police Department as well as writing for publications geared toward women. Beginning in 1969, she wrote for "True Detective" magazine under the pen name "Andy Stack".


title: Ann Rule

text: While volunteering at a suicide crisis hotline center in Seattle in 1971, Rule met Ted Bundy, a work-study student who was studying psychology at the University of Washington. After Bundy moved to Utah for law school, he was arrested in 1975 for kidnapping a young woman and later identified as a serial murderer with an unknown number of victims dating to at least 1974 if not earlier. During the time they worked together, Rule observed nothing disturbing in Bundy's personality, and saw him as "kind, solicitous, and empathetic". Her first book, "The Stranger Beside Me", is considered one of the most definitive biographies of Bundy. First published in 1980, the year Bundy was convicted of murder, the book was written under her own name rather than the pen name she had previously used. In the book, Rule reveals that Bundy told her the number of women he murdered was much larger than police believed. In 2003, Rule was portrayed by Barbara Hershey in the movie version of the book. The made-for-TV film adaptation also starred Billy Campbell as Bundy.


title: Ann Rule

text: Rule's next three books, "The Lust Killer" about Jerry Brudos, "The Want-Ad Killer" about Harvey Carignan, and "The I-5 Killer" about Randall Woodfield, were released with her pen name but following the success of the book about Bundy, they were re-released under Rule's name.


title: Ann Rule

text: Rule's 1987 work, "Small Sacrifices", tells the story of Diane Downs, an Oregon woman who in May 1983 murdered her daughter and attempted to murder her other two children. The book was filmed for television in 1989, with Farrah Fawcett in an Emmy-nominated and Peabody-cited performance.


title: Ann Rule

text: In April 2012, "48 Hours Mystery" covered Rule's successful effort to help a mother prove her daughter's 1998 death was actually a murder. The resulting book was "In the Still of the Night".


title: Ann Rule

text: One of her last books, "Practice to Deceive", about a 2003 murder on Whidbey Island, Washington, was released in October 2013. On the island for the launch of a book tour, Rule fell in the hotel and broke her hip, forcing the cancellation of the event.


title: Ann Rule

text: In its obituary for Rule, "The New York Times" quoted Rule on her approach to true crime writing and her favorite themes, writing, "To choose a book subject, I weed through about 3,000 suggestions from readers. I'm looking for an 'antihero' whose eventual arrest shocks those who knew him (or her): attractive, brilliant, charming, popular, wealthy, talented, and much admired in their communities — but really hiding behind masks." A "Guardian" article about Rule developed the idea further, writing, "It's tough, she says, but she doesn't want to hear about killers who are 'ugly, mean and have no charm. We’re not interested in the kind of person who looks like he would commit murder. We want to know about the kind who you could not imagine having this monstrous self behind the pleasant face.'"


title: Ann Rule

text: Rule's style of true crime writing brought some criticism. An evaluation of her influence on the genre noted negative commentary on her approach to her most infamous subject. Despite the commercial success of her books, the critical and public reception of "The Stranger Beside Me" was not always generous. After Rule's death in 2015, Victoria Beale wrote a piece for "The New Yorker" titled "Too Close to Ted Bundy" in which Beale accused Rule of making poor ethical choices in reporting the story and her involvement in Bundy's life after he went to jail, including sending money to Bundy while he was in jail. "Rule's role shifts from being inadvertently involved with a serial killer to an author considering how lucrative her access could be," Beale writes."


title: Ann Rule

text: After the release of Rule's 2003 book "Heart Full of Lies", which chronicles the manslaughter conviction in the 2000 shooting death of Liysa Northon's husband Chris, Northon filed a defamation lawsuit against Rule and her publisher. The 9th Circuit Court of Appeals dismissed the suit in January 2011. While still in prison serving 12 years for the killing, Northon's fiancé Rick Swart, a freelance writer, wrote a front-page article for the "Seattle Weekly" newspaper that accused Rule of "sloppy storytelling" in Rule's "Heart Full of Lies" book. Swart did not disclose in the article that he was engaged to marry Northon, nor did his editors at the paper know of the relationship.


title: Ann Rule

text: In response to the article, Rule in 2013 filed a libel suit against the newspaper and the writer through attorney Anne Bremner, stating that Rule had been defamed by the article's criticism, causing damage to her reputation.