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Outputs (87)

Molecular mechanisms underpinning favourable physiological adaptations to exercise prehabilitation for urological cancer surgery (2023)
Journal Article

BACKGROUND: Surgery for urological cancers is associated with high complication rates and survivors commonly experience fatigue, reduced physical ability and quality of life. High-intensity interval training (HIIT) as surgical prehabilitation has bee... Read More about Molecular mechanisms underpinning favourable physiological adaptations to exercise prehabilitation for urological cancer surgery.

Loss of muscle mass in the immediate post-operative period is associated with inadequate dietary protein and energy intake (2023)
Journal Article

Despite the implementation of ‘Enhanced Recovery After Surgery’ (ERAS) protocols, major abdominal surgery is still associated with significant and detrimental losses of muscle mass and function in the post-operative period. Although ERAS protocols ad... Read More about Loss of muscle mass in the immediate post-operative period is associated with inadequate dietary protein and energy intake.

Green Tea Extract Concurrent with an Oral Nutritional Supplement Acutely Enhances Muscle Microvascular Blood Flow without Altering Leg Glucose Uptake in Healthy Older Adults (2021)
Journal Article

Postprandial macro-and microvascular blood flow and metabolic dysfunction manifest with advancing age, so vascular transmuting interventions are desirable. In this randomised, singleblind, placebo-controlled, crossover trial, we investigated the impa... Read More about Green Tea Extract Concurrent with an Oral Nutritional Supplement Acutely Enhances Muscle Microvascular Blood Flow without Altering Leg Glucose Uptake in Healthy Older Adults.

Six weeks of high-intensity interval training enhances contractile activity induced vascular reactivity and skeletal muscle perfusion in older adults (2021)
Journal Article

Impairments in muscle microvascular function are associated with the pathogenesis of sarcopenia and cardiovascular disease. High-intensity interval training (HIIT) is an intervention by which a myriad of beneficial skeletal muscle/cardiovascular adap... Read More about Six weeks of high-intensity interval training enhances contractile activity induced vascular reactivity and skeletal muscle perfusion in older adults.

Age-related changes in muscle architecture and metabolism in humans: The likely contribution of physical inactivity to age-related functional decline (2021)
Journal Article

In the United Kingdom (UK), it is projected that by 2035 people aged >65 years will make up 23 % of the population, with those aged >85 years accounting for 5% of the total population. Ageing is associated with progressive changes in muscle metabolis... Read More about Age-related changes in muscle architecture and metabolism in humans: The likely contribution of physical inactivity to age-related functional decline.

Contrast?enhanced ultrasound assessed renal microvascular perfusion may predict postoperative renal complications following colorectal surgery (2021)
Journal Article

Colorectal surgery is associated with an above?average mortality rate of ~15%. During surgery, maintenance of vital organ perfusion is essential in order to reduce postoperative mortality and morbidity, with renal perfusion of particular importance.... Read More about Contrast?enhanced ultrasound assessed renal microvascular perfusion may predict postoperative renal complications following colorectal surgery.

Factors Associated with Attrition and Performance Throughout Surgical Training: A Systematic Review and Meta-Analysis (2020)
Journal Article

Background Attrition within surgical training is a challenge. In the USA, attrition rates are as high as 20-26%. The factors predicting attrition are not well known. The aim of this systematic review is to identify factors that influence attrition or... Read More about Factors Associated with Attrition and Performance Throughout Surgical Training: A Systematic Review and Meta-Analysis.

Time-efficient physical activity interventions to reduce blood pressure in older adults: a randomized controlled trial (2020)
Journal Article

Background Hypertension is a risk factor for both cardiovascular and cerebrovascular disease, with an increasing incidence with advancing patient age. Exercise interventions have the potential to reduce blood pressure in older adults, however, rates... Read More about Time-efficient physical activity interventions to reduce blood pressure in older adults: a randomized controlled trial.

The management of adult appendicitis during the COVID-19 pandemic: an interim analysis of a UK cohort study (2020)
Journal Article

Background Acute appendicitis (AA) is the most common general surgical emergency. Early laparoscopic appendicectomy is the gold-standard management. SARS-CoV-2 (COVID-19) brought concerns of increased perioperative mortality and spread of infection... Read More about The management of adult appendicitis during the COVID-19 pandemic: an interim analysis of a UK cohort study.

Funnel plots may show asymmetry in the absence of publication bias with continuous outcomes dependent on baseline risk: presentation of a new publication bias test (2020)
Journal Article

This study aimed to determine for continuous outcomes dependent on baseline risk, whether funnel plot asymmetry may be due to statistical artefact rather than publication bias and evaluate a novel test to resolve this. Firstly, we conducted assessmen... Read More about Funnel plots may show asymmetry in the absence of publication bias with continuous outcomes dependent on baseline risk: presentation of a new publication bias test.

High-intensity interval training produces a significant improvement in fitness in less than 31 days before surgery for urological cancer: a randomised control trial (2020)
Journal Article

Objectives To assess the efficacy of high-intensity interval training (HIIT) for improving cardiorespiratory fitness (CRF) in patients awaiting resection for urological malignancy within four weeks. Subjects/patients and methods A randomised... Read More about High-intensity interval training produces a significant improvement in fitness in less than 31 days before surgery for urological cancer: a randomised control trial.

Therapeutic Resolution of Focal, Predominantly Anastomotic Crohn’s Disease Strictures Using Removable Stents: Outcomes from a Single-Center United Kingdom Case Series (2020)
Journal Article

Background and Aims Intestinal and anastomotic strictures in Crohn’s disease (CD) produce considerable morbidity The development of surgery sparing, endoscopic modalities for stricture resolution is essential. Removable stent therapy is emerging as... Read More about Therapeutic Resolution of Focal, Predominantly Anastomotic Crohn’s Disease Strictures Using Removable Stents: Outcomes from a Single-Center United Kingdom Case Series.

Delay in Source Control in Perforated Peptic Ulcer Leads to 6% Increased Risk of Death Per Hour: A Nationwide Cohort Study (2019)
Journal Article

© 2019, Société Internationale de Chirurgie. Background: Delay to theatre for patients with intra-abdominal sepsis is cited as a particular risk factor for death. Our aim was to evaluate the potential relationship between hourly delay from admission... Read More about Delay in Source Control in Perforated Peptic Ulcer Leads to 6% Increased Risk of Death Per Hour: A Nationwide Cohort Study.

A double-blind randomized controlled trial of the effects of eicosapentaenoic acid supplementation on muscle inflammation and physical function in patients undergoing colorectal cancer resection (2019)
Journal Article

Background Resection of colorectal cancer (CRC) initiates inflammation, mediated at least partly by NFĸB (nuclear factor kappa-light-chain-enhancer of activated B-cells), leading to muscle catabolism and reduced physical performance. Eicosapentaen... Read More about A double-blind randomized controlled trial of the effects of eicosapentaenoic acid supplementation on muscle inflammation and physical function in patients undergoing colorectal cancer resection.

Long-term outcomes of biological mesh repair following extra levator abdominoperineal excision of the rectum: an observational study of 100 patients (2019)
Journal Article

Background Current evidence suggests that pelvic floor reconstruction following extralevator abdominoperineal excision of rectum (ELAPER) may reduce the risk of perineal herniation of intra-abdominal contents. Options for reconstruction include mesh... Read More about Long-term outcomes of biological mesh repair following extra levator abdominoperineal excision of the rectum: an observational study of 100 patients.

Short-term pre-operative high-intensity interval training does not improve fitness of colorectal cancer patients (2019)
Journal Article

Background: Preoperative cardiorespiratory fitness (CRF) in colorectal cancer patients has been shown to affect postoperative outcomes. The aim of this study was to test the feasibility of high-intensity interval training (HIT) for improving fitness... Read More about Short-term pre-operative high-intensity interval training does not improve fitness of colorectal cancer patients.

The impact of pre‐operative intravenous iron on quality of life after colorectal cancer surgery: outcomes from the intravenous iron in colorectal cancer‐associated anaemia (IVICA) trial (2019)
Journal Article

Anaemia is associated with a reduction in quality of life, and is common in patients with colorectal cancer . Werecently reported thefindings of the intravenous iron in colorectal cancer-associated anaemia (IVICA) trialcomparing haemoglobin levels an... Read More about The impact of pre‐operative intravenous iron on quality of life after colorectal cancer surgery: outcomes from the intravenous iron in colorectal cancer‐associated anaemia (IVICA) trial.

Surgical interventions for the treatment of sacrococcygeal pilonidal sinus disease in children: a systematic review and meta-analysis (2019)
Journal Article

Background Pilonidal sinus disease (PNS) is not uncommon in children. Controversy remains over the best treatment and there is limited evidence. This systematic review and meta-analysis aims to establish which techniques have the best outcomes in... Read More about Surgical interventions for the treatment of sacrococcygeal pilonidal sinus disease in children: a systematic review and meta-analysis.

Quick and simple: psoas density measurement is an independent predictor of anastomotic leak and other complications after colorectal resection (2019)
Journal Article

Purpose: Radiologically-defined sarcopenia has been shown to predict negative outcomes after cancer surgery, however radiological assessment of sarcopenia often requires additional software and standardisation against anthropomorphic data. Measuring... Read More about Quick and simple: psoas density measurement is an independent predictor of anastomotic leak and other complications after colorectal resection.

Palmitoylethanolamide and Cannabidiol Prevent Inflammation-induced Hyperpermeability of the Human Gut In Vitro and In Vivo—A Randomized, Placebo-controlled, Double-blind Controlled Trial (2019)
Journal Article

Background and aims We aimed to examine, for the first time, the effect of cannabidiol (CBD) and palmitoylethanolamide (PEA) on the permeability of the human gastrointestinal tract in vitro, ex vivo, and in vivo. Methods Flux measurements of fluor... Read More about Palmitoylethanolamide and Cannabidiol Prevent Inflammation-induced Hyperpermeability of the Human Gut In Vitro and In Vivo—A Randomized, Placebo-controlled, Double-blind Controlled Trial.

The efficacy of ‘static’ training interventions for improving indices of cardiorespiratory fitness in premenopausal females (2018)
Journal Article

PURPOSE: Cardiovascular disease (CVD) is the leading cause of death worldwide. Many risk factors for CVD can be modified pharmacologically; however, uptake of medications is low, especially in asymptomatic people. Exercise is also effective at reduc... Read More about The efficacy of ‘static’ training interventions for improving indices of cardiorespiratory fitness in premenopausal females.

Fibrin glue obliteration is safe, effective and minimally invasive as first line treatment for pilonidal sinus disease in children (2018)
Journal Article

Background / Purpose: Sacrococcygeal pilonidal sinus disease (PSD) has an incidence of 1.2–2.5/1000 in children. Onset is around puberty. Symptoms of recurrent abscess and chronic suppuration may interfere with education and social integration. Treat... Read More about Fibrin glue obliteration is safe, effective and minimally invasive as first line treatment for pilonidal sinus disease in children.

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study (2018)
Journal Article

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a... Read More about Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Association between peri-operative angiotensin-converting enzyme inhibitors and angiotensin-2 receptor blockers and acute kidney injury in major elective non-cardiac surgery: a multicentre, prospective cohort study (2018)
Journal Article

The peri‐operative use of angiotensin‐converting enzyme inhibitors or angiotensin‐2 receptor blockers is thought to be associated with an increased risk of postoperative acute kidney injury. To reduce this risk, these agents are commonly withheld dur... Read More about Association between peri-operative angiotensin-converting enzyme inhibitors and angiotensin-2 receptor blockers and acute kidney injury in major elective non-cardiac surgery: a multicentre, prospective cohort study.

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study (2018)
Journal Article

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described... Read More about Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

Pre-emptive and preventive NSAIDs for postoperative pain in adults undergoing all types of surgery (Protocol) (2018)
Journal Article

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To evaluate in adult participants undergoing all types of surgery, the effects of pre-emptive and preventive non-steroidal anti-inflammatory drugs (NSAIDs) com... Read More about Pre-emptive and preventive NSAIDs for postoperative pain in adults undergoing all types of surgery (Protocol).

Random duodenal biopsy to exclude coeliac disease as a cause of anaemia is not cost‑efective and should be replaced with universally performed pre‑endoscopy serology in patients on a suspected cancer pathway (2018)
Journal Article

Background: Random duodenal biopsy to exclude coeliac disease during upper gastrointestinal endoscopy for the investigation of iron defciency anaemia remains a common procedure, but is expensive and time-consuming. Serological investigation for coeli... Read More about Random duodenal biopsy to exclude coeliac disease as a cause of anaemia is not cost‑efective and should be replaced with universally performed pre‑endoscopy serology in patients on a suspected cancer pathway.

Exercise and other nonpharmacological strategies to reduce blood pressure in older adults: a systematic review and meta-analysis (2018)
Journal Article

The incidence of hypertension increases with advancing age and represents a significant burden of disease. Lifestyle modification represents the first-line intervention in treatment algorithms; however, the majority of evidence for this comes from st... Read More about Exercise and other nonpharmacological strategies to reduce blood pressure in older adults: a systematic review and meta-analysis.

NICE guidance on sepsis is of limited value in postoperative colorectal patients: the scores that cry ‘wolf!’ (2018)
Journal Article

Background and aims Late recognition of sepsis and consequent death remains a problem. To address this, the National Institute for Health and Care Excellence has published updated guidance recommending the use of the Quick Sequential Organ Failure A... Read More about NICE guidance on sepsis is of limited value in postoperative colorectal patients: the scores that cry ‘wolf!’.

Human skeletal muscle is refractory to the anabolic effects of leucine during the postprandial muscle-full period in older men (2017)
Journal Article

Leucine modulates muscle protein synthesis (MPS), with potential to facilitate accrual/maintenance of muscle mass. Animal models suggest that leucine boluses shortly after meals may prolong MPS and delay onset of a “muscle-full” state. However, the e... Read More about Human skeletal muscle is refractory to the anabolic effects of leucine during the postprandial muscle-full period in older men.

Impact of the calcium form of ?-hydroxy-?-methylbutyrate upon human skeletal muscle protein metabolism (2017)
Journal Article

© 2017 The Authors Background & aims: β-hydroxy-β-methylbutyrate (HMB) is purported as a key nutritional supplement for the preservation of muscle mass in health, disease and as an ergogenic aid in exercise. Of the two available forms of HMB (calcium... Read More about Impact of the calcium form of ?-hydroxy-?-methylbutyrate upon human skeletal muscle protein metabolism.

Effects of leucine-enriched essential amino acid and whey protein bolus dosing upon skeletal muscle protein synthesis at rest and after exercise in older women (2017)
Journal Article

© 2017 The Authors Background & aims: Impaired anabolic responses to nutrition and exercise contribute to loss of skeletal muscle mass with ageing (sarcopenia). Here, we tested responses of muscle protein synthesis (MPS), in the under represented gr... Read More about Effects of leucine-enriched essential amino acid and whey protein bolus dosing upon skeletal muscle protein synthesis at rest and after exercise in older women.

DNA methylation of intragenic CpG islands depends on their transcriptional activity during differentiation and disease (2017)
Journal Article

The human genome contains ?30,000 CpG islands (CGIs). While CGIs associated with promoters nearly always remain unmethylated, many of the ?9,000 CGIs lying within gene bodies become methylated during development and differentiation. Both promoter and... Read More about DNA methylation of intragenic CpG islands depends on their transcriptional activity during differentiation and disease.

A novel D2O tracer method to quantify RNA turnover as a biomarker of de novo ribosomal biogenesis, in vitro, in animal models, and in human skeletal muscle (2017)
Journal Article

Current methods to quantify in vivo RNA dynamics are limited. Here, we developed a novel stable isotope (D2O) methodology to quantify RNA synthesis (i.e., ribosomal biogenesis) in cells, animal models, and humans. First, proliferating C2C12 cells wer... Read More about A novel D2O tracer method to quantify RNA turnover as a biomarker of de novo ribosomal biogenesis, in vitro, in animal models, and in human skeletal muscle.

Baseline morphine consumption may explain between-study heterogeneity in meta-analyses of adjuvant analgesics and improve precision and accuracy of effect estimates (2017)
Journal Article

BACKGROUND: Statistical heterogeneity can increase the uncertainty of results and reduce the quality of evidence derived from systematic reviews. At present, it is uncertain what the major factors are that account for heterogeneity in meta-analyses o... Read More about Baseline morphine consumption may explain between-study heterogeneity in meta-analyses of adjuvant analgesics and improve precision and accuracy of effect estimates.

Oesophageal Doppler guided optimization of cardiac output does not increase visceral microvascular blood flow in healthy volunteers (2017)
Journal Article

Background Oesophageal Doppler monitoring (ODM) is used clinically to optimize cardiac output (CO) and guide fluid therapy. Despite limited experimental evidence, it is assumed that increasing CO increases visceral microvascular blood flow (MBF).... Read More about Oesophageal Doppler guided optimization of cardiac output does not increase visceral microvascular blood flow in healthy volunteers.

Synchronous deficits in cumulative muscle protein synthesis and ribosomal biogenesis underlie age-related anabolic resistance to exercise in humans (2016)
Journal Article

Ageing is associated with impaired hypertrophic responses to resistance exercise training (RET). Here we investigated the aetiology of ‘anabolic resistance’ in older humans. Twenty healthy male individuals, 10 younger (Y; 23 ± 1 years) and 10 older (... Read More about Synchronous deficits in cumulative muscle protein synthesis and ribosomal biogenesis underlie age-related anabolic resistance to exercise in humans.

Supplementing essential amino acids with the nitric oxide precursor, l-arginine, enhances skeletal muscle perfusion without impacting anabolism in older men (2016)
Journal Article

Postprandial limb blood flow and skeletal muscle microvascular perfusion reduce with aging. Here we tested the impact of providing bolus essential amino acids (EAA) in the presence and absence of the nitric oxide precursor, l-Arginine (ARG), upon ske... Read More about Supplementing essential amino acids with the nitric oxide precursor, l-arginine, enhances skeletal muscle perfusion without impacting anabolism in older men.

Simulation fails to replicate stress in trainees performing a technical procedure in the clinical environment (2016)
Journal Article

Introduction: Simulation-based training (SBT) has become an increasingly important method by which doctors learn. Stress has an impact upon learning, performance, technical, and non-technical skills. However, there are currently no studies that compa... Read More about Simulation fails to replicate stress in trainees performing a technical procedure in the clinical environment.

Oleoylethanolamine and palmitoylethanolamine modulate intestinal permeability in vitro via TRPV1 and PPAR? (2016)
Journal Article

Cannabinoids modulate intestinal permeability through cannabinoid receptor 1 (CB1). The endocannabinoid-like compounds oleoylethanolamine (OEA) and palmitoylethanolamine (PEA) play an important role in digestive regulation, and we hypothesized they w... Read More about Oleoylethanolamine and palmitoylethanolamine modulate intestinal permeability in vitro via TRPV1 and PPAR?.

Anaesthetists stress is induced by patient ASA grade and may impair non-technical skills during intubation (2016)
Journal Article

Background The aims of this study were to determine if patient ASA grade was associated with increased stress in anaesthetists with a subsequent effect on non-technical skills. Methods Stress was measured using a validated objective (heart rat... Read More about Anaesthetists stress is induced by patient ASA grade and may impair non-technical skills during intubation.

Early structural remodeling and deuterium oxide-derived protein metabolic responses to eccentric and concentric loading in human skeletal muscle (2015)
Journal Article

We recently reported that the greatest distinguishing feature between eccentric (ECC) and concentric (CON) muscle loading lays in architectural adaptations: ECC favors increases in fascicle length (Lf), associated with distal vastus lateralis muscle... Read More about Early structural remodeling and deuterium oxide-derived protein metabolic responses to eccentric and concentric loading in human skeletal muscle.

Preventive acetaminophen reduces postoperative opioid consumption, vomiting, and pain scores after surgery: systematic review and meta-analysis (2015)
Journal Article

Background and Objectives: Preventive analgesia has been proposed as a potential strategy to reduce postoperative pain. However, there is currently no review that focuses on acetaminophen for preventive analgesia. Methods: We conducted a search of... Read More about Preventive acetaminophen reduces postoperative opioid consumption, vomiting, and pain scores after surgery: systematic review and meta-analysis.

The bowel cancer awareness campaign ‘Be Clear on Cancer’: sustained increased pressure on resources and over-accessed by higher social grades with no increase in cancer detected (2015)
Journal Article

AIM: To evaluate the impact of the national 'Be Clear on Cancer' bowel cancer reminder campaign on service and diagnosis at a single UK institution. Secondly, to evaluate the socio-economic background of patients referred before and after the remind... Read More about The bowel cancer awareness campaign ‘Be Clear on Cancer’: sustained increased pressure on resources and over-accessed by higher social grades with no increase in cancer detected.

Internal comparison between deuterium oxide (D2O) and L-[ring-13C6] phenylalanine for acute measurement of muscle protein synthesis in humans (2015)
Journal Article

Stable isotope tracer methodologies are becoming increasingly widespread in metabolic research; yet a number of factors restrict their implementation, such as, i.v infusions, multiple cannulae, tissue samples, and significant cost. We recently valida... Read More about Internal comparison between deuterium oxide (D2O) and L-[ring-13C6] phenylalanine for acute measurement of muscle protein synthesis in humans.

Assessing surgeon stress when operating using heart rate variability and the State Trait Anxiety Inventory: will surgery be the death of us? (2015)
Journal Article

Aim Performance in the operating room is affected by a combination of individual, patient and environmental factors amongst others. Stress has a potential negative impact on performance with the quality of surgical practice and patient safety bein... Read More about Assessing surgeon stress when operating using heart rate variability and the State Trait Anxiety Inventory: will surgery be the death of us?.

Simple psoas cross-sectional area measurement is a quick and easy method to assess sarcopenia and predicts major surgical complications (2014)
Journal Article

Aim Radiologically assessed muscle mass has been suggested as a surrogate marker of functional status and frailty and may predict patients at risk of postoperative complications. We hypothesize that sarcopenia negatively impacts on postoperative r... Read More about Simple psoas cross-sectional area measurement is a quick and easy method to assess sarcopenia and predicts major surgical complications.

A dose- rather than delivery profile-dependent mechanism regulates the "muscle-full" effect in response to oral essential amino acid intake in young men (2014)
Journal Article

Background: The anabolic response of skeletal muscle to essential amino acids (EAAs) is dose dependent, maximal at modest doses, and short lived, even with continued EAA availability, a phenomenon termed “muscle-full.” However, the effect of EAA inge... Read More about A dose- rather than delivery profile-dependent mechanism regulates the "muscle-full" effect in response to oral essential amino acid intake in young men.

An evaluation of POSSUM and P-POSSUM scoring in predicting post-operative mortality in a level 1 critical care setting (2014)
Journal Article

Background POSSUM and P-POSSUM are used in the assessment of outcomes in surgical patients. Neither scoring systems’ accuracy has been established where a level 1 critical care facility (level 1 care ward) is available for perioperative care. We c... Read More about An evaluation of POSSUM and P-POSSUM scoring in predicting post-operative mortality in a level 1 critical care setting.

Effect of 3 to 5 years of scheduled CEA and CT follow-upto detect recurrence of colorectal cancer The FACS Randomized Clinical Trial (2014)
Journal Article

IMPORTANCE Intensive follow-up after surgery for colorectal cancer is common practice but is based on limited evidence. OBJECTIVE To assess the effect of scheduled blood measurement of carcinoembryonic antigen (CEA) and computed tomography (CT) as f... Read More about Effect of 3 to 5 years of scheduled CEA and CT follow-upto detect recurrence of colorectal cancer The FACS Randomized Clinical Trial.

Expression of a large LINE-1-driven antisense RNA is linked to epigenetic silencing of the metastasis suppressor gene TFPI-2 in cancer
Journal Article

LINE-1 retrotransposons are abundant repetitive elements of viral origin, which in normal cells are kept quiescent through epigenetic mechanisms. Activation of LINE-1 occurs frequently in cancer and can enable LINE-1 mobilization but also has re... Read More about Expression of a large LINE-1-driven antisense RNA is linked to epigenetic silencing of the metastasis suppressor gene TFPI-2 in cancer.