Difference between HSIL and LSIL

The two-tiered system of low-grade SIL (LSIL) and high-grade SIL (HSIL) matches the HPV carcinogenic potential and allows for better communication between pathologists and other patient care providers. The Bethesda System (TBS) for reporting cervical cytology follows this approach (updated in 2015) [Figure 1] Two tier grading is preferred: low grade squamous intraepithelial lesion (LSIL) / high grade squamous intraepithelial lesion (HSIL) HSIL may be subdivided into cervical intraepithelial neoplasia II (CIN II) and cervical intraepithelial neoplasia III (CIN III), particularly in young women (significantly higher regression rate in the former Definition / general. Low grade squamous intraepithelial lesion (LSIL) is part of the spectrum of squamous cell changes associated with HPV infection. Also known in former literature as mild squamous dysplasia and cervical intraepithelial neoplasia I (CIN I) LSIL is identified in approximately 2 - 3% of all Pap smears LSIL vs. high-grade squamous intraepithelial lesions (HSIL) In about 10 percent of cases, LSIL progresses to high-grade squamous intraepithelial lesions (HSIL) within two years. This is more likely..

Squamous intraepithelial lesions (SIL: LSIL, HSIL, ASCUS

In general, LSIL on pap smear turns out to be CIN1 on biopsy. Biopsy always overrules pap: if there is a difference -- e.g. LSIL by pap and CIN2/3 on biopsy, or HSIL pap and CIN1 biopsy -- the CIN score is the one that counts. The bottom line is that LSIL or CIN1 is minor, and rarely progresses to more severe disease Topography, contour, size and distribution, margins. HSIL lesions are located centrally on the cervix. They are not usually separated from the squamocolumnar junction whether positioned on the ectocervix or within the endocervical canal. The one possible exception is in women who have residual CIN3 lesions following surgery of the cervix significant difference in MN frequency between LSIL and HSIL patients, between smokers and nonsmokers in both patient and control samples, or between miscar-riage groups and abortion groups of patients. Considering confounder factors, age and health status influenced MN frequency. Conclusions. The results suggest tha

Oncotarget: PD-1/PD-L1 expression in anal squamous

LSIL-H is not a new category, as we pointed out in our article 1 by citing two dozen earlier publications on similar cytologic findings and by referring to often overlooked illustrations in the 2004 second edition of The Bethesda System atlas. These citations as well as our own study consistently have documented a risk for follow-up histopathologic CIN 2/3 that is intermediate between that for. The <30 years age group shows no significant difference between LSIL + ASC-H versus ASC-H with a P = 0.67; the rest show significant differences LSIL + ASC-H versus HSIL P = 0.016, LSIL + ASC-H versus LSIL P < 0.001, ASC-H versus LSIL P = 0.001, ASC-H versus HSIL P = 0.004, LSIL versus HSIL P < 0.001 Low-grade squamous intraepithelial lesions (LSIL) High-grade squamous intraepithelial lesions (HSIL) Atypical glandular cells (AGC) Invasive cervical cancer; In contrast to LSIL, HSIL creates significant abnormalities, known as moderate or severe dysplasia. Although HSIL cells can theoretically disappear without treatment, it's far less likely A comparison of equivocal LSIL and equivocal HSIL cervical cytology in the ASCUS LSIL triage study October 2001 American Journal of Clinical Pathology 116(3):386-9

Pathology Outlines - HSIL / CIN II / CIN II

The low-grade squamous intraepithelial lesion (LSIL) category is the morphological correlate of productive viral infection. It is to be used when the scientist/pathologist observes changes that would have been described as 'HPV effect' or 'CIN 1' in the previous Australian terminology and represents part of the previous 'low-grade squamous epithelial abnormality' category Cervix. Abnormal results include: Atypical squamous cells. Atypical squamous cells of undetermined significance (ASC-US) Atypical squamous cells - cannot exclude HSIL (ASC-H) Low-grade squamous intraepithelial lesion (LGSIL or LSIL) High grade squamous intraepithelial lesion (HGSIL or HSIL) Squamous cell carcinoma The average age of patients with ASCUS lesion was 41 ± 12 years. After cryotherapy, HSIL had progression in 1,5% (N-1), persistence in 6,3% (N-4) and regression in 91,7% (N-58). Progression occured in 10,5% (N-4) of HSIL, persistence in 52,6% (N-20) and regression in 36,7% (N-14) in 38 women with LSIL lesion after repeated PAP test Based on the set of conventional cervical smears, only one slide that was diagnosed as HSIL had unanimous agreement; whereas, based on the set of TP slides, three slides, including two diagnosed as HSIL and one diagnosed as LSIL, had a unanimous diagnosis

Pathology Outlines - LSIL / CIN I (cyto

HSIL and LSIL typically have nuclear enlargement in the same range, but the nuclear-cytoplasmic ratio is higher because the cells are overall smaller than LSIL cells. HSIL cells also lack squamous features. Thee cell s may not be much larger than normal intermediate cells, but they do have dark (hyperchromatic) nuclei with irregular contours LSIL are the same in SurePath as for conventional smears •The morphology is similar •Adjusting to SurePath should not be very difficult for these lesions ASC-US and LSIL in SurePath. 2 •On LSIL: there are minimal differences between conventional preparations and liquid-based preparations; the nuclei may show less hyperchromasia on LBPs LSIL is a way of categorizing mildly abnormal cervical cells. A Pap smear is a screening test, says Dr. AlHilli. It gives us the big picture about what's going on with your cervix Atypical Squamous Cells (ASC) Atypical squamous cells represent cellular abnormalities more marked than simple reactive changes, but which do not meet the criteria for squamous intraepithelial neoplasia (SIL). These cells are not of typical appearance and are, therefore, atypical. (See Figure 1) The difference in the distribution of the biopsy results between the two groups was statistically significant (P < 0.001). The current guidelines for the management of cervical cytologic abnormalities from the American Society for Colposcopy and Cervical Pathology (ASCCP) advocate similar treatment algorithms for both LSIL and ASC‐H

Low-Grade Squamous Intraepithelial Lesion (LSIL): What It

significant difference in MN frequency between LSIL and HSIL patients, between smokers and nonsmokers in both patient and control samples, or between miscar-riage groups and abortion groups of patients. Considering confounder factors, age and health status influenced MN frequency. Conclusions. The results suggest tha Abnormal mitotic configurations, which reflect aneuploidy, are common in HSIL, where they account for between 15% and 30% of total mitoses, but rare in LSIL. HSIL associated with HPV type 16 infection has the highest number of mitoses and the most abnormal forms. 20,21 The most common of these abnormal configurations is the lag-type mitosis. histopathology, HPV DNA type and surgical cone margin positivity between two groups (p=0.49, p=0.25, p=0.15, ve p=0.17, respectively). DISCUSSION and CONCLUSION: The incidence of HSIL and over cervical pathology is not different between HPV DNA positive ASCUS and LSIL cases

LSIL/ASC-H (LSIL-H) in cervicovaginal smear

  1. imal differences between conventional preparations and liquid-based preparations; the nuclei may show less hyperchromasia on LBPs
  2. Anna T. Scheduling a follow-up exam in six months is common after a pap smear shows LSIL. If your pap smear shows LSIL, which stands for low-grade squamous intraepithelial lesion, most doctors will not do anything immediately.You will probably be asked to come back in six months for another pap smear to see if the lesions are still present
  3. • The most notable difference between sleet and hail is the size of the ice pellets. While sleet is the size of peas, hail stones can be much bigger in size. • Hail forms in the following way. The updrafts made by severe storms carry the raindrops that are gathered at the bottom of the cloud to the top of the cloud. At this point, the.
  4. The rate of histological CIN2 or worse associated with LSIL/ ASC-H (45%) was between the rates of LSIL (10%) and HSIL (65%), but not significantly different from ASC-H (50%)

Should LSIL-H Be a Distinct Cytology Category

Only a small fraction of HSIL progresses into cancer. Anal Cancer This page is intended to provide information about anal cancer and its precursors, high grade and low grade anal squamous intraepithelial lesions (HSIL and LSIL respectively) Test of Cure following treatment for high-grade squamous abnormalities. A woman who has been treated for HSIL (CIN2/3) should have a co-test† performed at 12 months after treatment, and annually thereafter, until she receives a negative co-test on two consecutive occasions, when she can return to routine 5 yearly screening Consensus-based recommendation; REC8.1: Normal colposcopy following LBC prediction of negative or pLSIL / LSIL For women with a positive oncogenic HPV (any type) test result, a LBC report of negative or pLSIL / LSIL, and normal colposcopy, the HPV test should be repeated in 12 months: . If HPV is not detected at 12 months, the woman should return to routine 5-yearly HPV screening Based on TP, three slides (two HSILs and one LSIL) had a unanimous diagnosis, whereas only one slide (HSIL) had a unanimous diagnosis based on conventional preparation (Table 3). From a different perspective, the interobserver agreement expressed in terms of the mean correlation coefficient was better with the TP method than with the.

Understanding HPV and Pap Test Results - National Cancer

There was no observed difference between HSIL and LSIL ThinPrep slides (96.3% for each). Conversely, cases of mixed HSIL had lower observed accuracy (96.5%) than cases of mixed LSIL (97.1%). When broken down by slide type, conventional smears in the mixed category had no significant differences by reference diagnosis. Difference in progression lesions in HSIL between women with cryotherapy (1,5%) and follow-up (10,5%) after LSIL is not significant, but progression to CIN II occured after cryotherapy. CIN III or cervical cancer was not found.Cryotherapy prevents progression of LSIL in HSIL and in cervical cancer cervical lesions, 3 were diagnosed with LSIL, and one patient was diagnosed as HSIL (CIN 2). Out of 119 LSIL smears 108 were confirmed by histopathology, while 11 were diagnosed as HSIL (CIN 2). In SIL-borderline patients, 5 cases were screened as LSIL and 3 as HSIL. In patients with HSIL cytology, 18 were diagnosed histopathologicall were no significant differences between the reclassified HSIL and LSIL and below categories. Presence of atypical cells with metaplastic differentiation : In 15 /26 (57.6 %) cases abnormal cells revealed metaplastic maturation with rounder, denser cytoplasm and high nuclear/cytoplasmic ratio. Such cells were observed in 11 cases reclassified a includes lesions that could be called CIN 1 or 3. Specimens that are p16-negative are referred to as LSIL and those that are p16-positive are referred to as high-grade squamous intraepithelial lesions (HSIL) referred to as low-grade squamous intraepithelial lesion (LSIL).CIN 2 is stratified according to p16 immunostaining to identify precancerous lesions

Risk of Developing CIN3 in Women with ASCUS or LSIL - AAF

Comparison of the clinical significance of the Papanicolaou test interpretations LSIL cannot rule out HSIL and ASC-H. By Megan Difurio and Michael Sundborg. Should LSIL-H be a distinct cytology category? Comparison between Siriraj liquid-based and conventional cytology for detection of abnormal cervicovaginal smears: a split-sample study. A number of indicators were compared between LSIL and HSIL. There were statistically significant differences in E6/E7 mRNA, p16, Ki67 and cytology between the two groups (P < 0.05). According to the logistic regression analysis, merely E6/E7 mRNA positivity was significantly associated with CIN2/3 (OR: 52.53, 95 % CI, P < 0.05) Sherman et al. Am J Clin Pathol, 2001. HPV and LSIL, ASC-H, ASC-US ALTS group found that a significant number of patients were positive for high risk HPV with an LSIL Pap test (83%) ASC-H also tests positive for high risk HPV in 85% of liquid cytology Pap tests or 70% o Results: The Ct values decreased with the progression of cervical cancer from cervicitis, through LSIL and HSIL to cancer. The difference in Ct values between cytological grades was highly significant (p≤ 0.01) between grades either for PAX1 or for SOX1 except the difference between cervicitis and LSIL of SOX1

Specificity and Sensitivity False positive is wrong result

LSIL and CIN1 mean the same thing? - STDs / STIs - MedHel

Cervical intraepithelial neoplasia (CIN), also known as cervical dysplasia, is the abnormal growth of cells on the surface of the cervix that could potentially lead to cervical cancer. More specifically, CIN refers to the potentially precancerous transformation of cells of the cervix.. CIN most commonly occurs at the squamocolumnar junction of the cervix, a transitional area between the. These Pap tests are often interpreted as LSIL/ASC-H or LSIL with a comment indicating the presence of cells with features approaching HSIL. Patients with LSIL/ASC-H have a significant risk of CIN 2 or worse (29-61.5%) on follow-up cervical biopsies, similar to the risk of CIN 2 or worse in patients with ASC-H Pap tests (24-68%) The differences between LSIL and LSIL-H were statistically significant (Chi-square value of 35.7 with p value less than 0.001). However, for LSIL-H and ASC-H the difference was not significant (Chi-square is 0.87 with p value nearly equal to 1) . Thus, the pattern of biopsy results for LSIL-H overlapped on the lower side with LSIL, but was. Minor discrepancies are defined as differences in response within the 200 abnormal selection series. Confusion between HSIL and LSIL resulted in the largest number of discrepancies for all SIL reference slides. The discrepant rate for HSIL vs LSIL ranged from 9.8% to 15% for both years of the program HSIL is characterized by smaller squamous cells (compared to LSIL) that are present singly or in syncytial groups with higher nuclear-to-cytoplasmic ratio and more pronounced nuclear abnormalities compared to LSIL in terms of hyperchromasia and nuclear contour irregularities (Figure 3)

Colposcopic Findings of HSIL (CIN2, CIN3

The sensitivity, specificity, PPV, NPV and YI of colposcopic diagnosis for normal cervix from any cervical lesion (LSIL, HSIL and carcinoma) and HSIL + (HSIL and carcinoma) form LSIL − (LSIL/normal or benign) were 43.2%, 91.6%, 70.6%, 77.7%, 0.349 and 92.7%, 78.9%, 89.7%, 84.5%, 0.716 respectively. The accuracy of colposcopic diagnoses in distinguishing cervical histopathology when HSIL and. Only four of the men were referred to us for LSIL or HSIL, Dr. Goldstone said. But when we conducted cytology screenings, it was clear that we were dealing with a total of 59 patients with LSIL and 105 patients with HSIL. Biopsy results from the pathology lab painted an even more startling picture Mean of HPV16 copies with 95% confidence interval for HSIL grade was determined in a range of 4.5-6.3 copies per cell and 4.7-7 copies per cell for SCC. This value was statistically different between LSIL and HSIL (P = 0.003) and LSIL and SCC (P = 0.007); hence, could be used to discriminate LSIL from other grades However, methylation levels were not significantly different between SCC and HSIL, with the exception of RASSF1A. Receiver-operating characteristic analysis demonstrated that HIN-1, RAR-β, RASSF1A, and Twist had the ability to distinguish HSIL/SCC from LSIL/negative samples test report of a LSIL, a woman is advised to have a repeat test in 12 months. This gives her a chance to 'clear' the infection. If, on repeat, the LSIL changes are still present, or if HSIL changes are detected, a colposcopy will be recommended. If LSIL changes are confirmed on biopsy, gynaecologists are now asked not to treat these lesion

Association between interleukin‑2, interleukin‑10Article Fulle Text

Cervical precancerous lesions - chromosomal instability in

in more than 80% of cases, unlike HSIL lesions, which are negative for this biomarker.8,10,18 The main differences between differentiated vulvar intraepithelial neoplasia and HSIL are listed in Table 1. Table 1 Comparative description between dVIN and HSIL dVIN HSIL Age 6th to 8th decades 3rd to 5th decade It is more likely that the differences in the results between the two studies are related to differences in the two patient populations undergoing screening. (6.4% vs. 4.3%) and LSIL (3.1% vs. 2%), while their HSIL rate was lower (0.23% vs. 0.31%). Abnormal Pap test rates vary considerably in the literature, likely reflecting both the. compared against the different groups, there is a signifi-cant difference between UCAC vs LSIL (p<0.0005), UCAC vs HSIL (p=0.008), and UCAC vs SCC (p= 0.023). Due to the above-mentioned results, a Spearman cor-relation test was applied between the different progres-sive groups (LSIL, HSIL, and SCC) and the B7-H Another observation is the non-detectable difference between E6/E7 branch lengths for LSIL and HSIL among individual genotypes. This finding suggests that disease severity was not associated with HPV-subtype differences (2-10% nucleotide differences) [ 6 ]

there was also a significant difference between HSIL and SCC groups (P<0.05), but there was no significant difference between control and LISL groups (P>0.05) (Table II). Expression of Ki‑67 protein in four groups of patients. s a shown in Fig. 2, only a small number of cells in LSIL group were stained brown (Fig. 2A), and in HSIL group more tha The 49 cases showing persistence of LSIL and 3 showing progression of LSIL to HSIL were again given treatment and have been called for repeat smear after 1 year. The second follow up was available in 32 of the 49 persistent LSIL cases which showed regression of the lesion to normal in 17 and the persistence of the LSIL in the remaining 15 The mean numbers of lesions in women with histopathologic diagnoses of normal or benign lesions, LSIL, HSIL and carcinoma were 8.00±13.82, 4.12±6.84, 4.07±4.99 and 1, respectively. The differences in the numbers of lesions among different grade lesion groups were statistically significant (F=4.423, p<0.01)

A case-control study of human papillomavirus and cervical

Interpretation of LSIL-H American Journal of Clinical

There was no difference in the attributable proportions of multiple genotypes infection amongst HSIL, LSIL and Normal. In Northern China, HPV16 was the most dominant genotype in the patients with pathological examination. The peak age of the onset of HSIL was between 35 and 49 years of age mixed LSIL and HSIL features. Design.—We compiled performance data from the Col-lege of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytopathology from the years 2003 and 2004, and compared the performance of slides showing relatively pure LSIL and HSIL ( 10% misclassifi-cation as HSIL and LSIL, respectively. Kohdunkaulan, emättimen ja ulkosynnytinten levy- ja lieriöepiteelisolujen histologisten muutosten vanhat WHO:n luokitukset vuosilta 2003, 2014 ja 2020 ja työryhmän suositus niistä käytettävistä ICD-10 koodeista. Uusimman luokituksen kohdalla on tieto siitä, mitkä muutokset on ilmoitettava Suomen Syöpärekisteriin Distinction between HSIL (favour CIN2) and LSIL . The critical distinction is between HSIL and LSIL. As both may be present on the same slide, rather more frequently with CIN2 than CIN3, and CIN2 is characterised by surface maturation this may sometimes be difficult to decide. A judgement must be made after examining the whole slide based on.

The effectiveness of acetic acid wash protocol and the

The significance of ASC-H and LSIL dual interpretation

Low-grade squamous intraepithelial lesion (LSIL) High-grade squamous intraepithelial lesion (HSIL) Definition: Squamous intraepithelial lesion encompasses a spectrum of noninvasive cervical epithelial abnormalities traditionally classified as flat condyloma, dysplasia/carcinoma in-situ, and CIN The amount of cytoplasm is a cardinal feature of the distinction between moderate and severe dyskaryosis (i.e. CIN2 and CIN3). Nuclear/cytoplasmic ratio. As the cells are less mature than in LSIL there is a higher NC ratio: the nucleus in HSIL occupies at least 50% of the diameter of the cell Low-grade SIL (LSIL) compares to CIN 1 and mild dysplasia. LSIL affects a lower part of the cervical lining. High-grade SIL (HSIL) compares to CIN 2 and CIN 3 and moderate and severe dysplasia. HSIL affects most of the cervical lining. Cervical intraepithelial neoplasia (CIN) is another way to describe abnormal changes to squamous cells in the. Low-grade squamous intraepithelial lesion (LSIL) High-grade squamous intraepithelial lesion (HSIL) Atypical squamous cells, cannot exclude HSIL (ASC-H) Atypical glandular cells (AGC). What is the difference between SIL and CIN? ASCUS - 1) If high grade, ASC-H, then do a colposcopy. 2) Test HPV and if it is 16 and 18, do a colposcopy

HSIL and LSIL Anal Cancer Information HSIL is an acronym for high grade squamous intraepithelial lesion, and LSIL means low grade squamous intraepithelial lesion. This diagnosis means the cells appear very different from normal cells. HSIL and LSIL Anal Cancer Information HSIL and LSIL: HSIL is an acronym for high grade squamous intraepithelial lesion, and high grade versus low grade refers to the likelihood that it will progress to cancer, Prevention: www.healthline.co young women. Most LSIL lesions will resolve without intervention within months to several years. Depending on your age, colposcopy (see below) may be recommended to confirm that the changes are only mild. HSIL (High-grade Squamous Intraepithelial Lesion)-Cervical cells appear very different in size and shape compared with normal cells Results: The three groups (SIL, LSIL and HSIL) showed no significan t differences in either genotype or allelic frequencies for MDM2 polymorphisms, except when HSIL was compared with LSIL (p=0.037; OR=1.81). Furthermore, in the analysis of contraceptives, a significant association was found between the use of contraceptives and the MDM2 variant.

Unlike in LSIL, p16 immunostaining is useful in, and recommended for, distinguishing between HSIL from potential mimics (Table 9.3) and its use is reported to increase interobserver agreement and accuracy of diagnosis in cases of HSIL [37, 67, 68, 71-73] ASCUS (Atypical squamous cells of undetermined significance). This means your Pap smear results are borderline, between normal and abnormal. ASC-H (Atypical squamous cells of undetermined significance-cannot exclude HSIL). This means your Pap smear results are borderline but may be more serious. LSIL (Low grade squamous intraepithelial lesion) Comparison of human papillomavirus types between invasive cervical carcinoma and high-grade squamous dysplasia may provide insight into this biological variability. Liquid-based Pap specimens from. Dr J Silva Couto outlines the difference between LSIL and HSIL HPV and provides a protocol for use by medical professionals. In addition, Prof Amin Karmali explains the enzymatic qualities of Coriolus versicolor and how such attributes assist the immune system. Finally, Dr. Andrew French outlines his clinical experience using Coriolus.

common. Clin. DDx. squamous metaplasia, LSIL. High-grade squamous intraepithelial lesion, abbreviated HSIL, is a pre-cancerous lesions of the uterine cervix . Increasingly, the term is being applied to other anatomical sites, e.g. vagina . It is in the larger category of squamous intraepithelial lesion, abbreviated SIL For more than a decade, numerous studies have documented the transient nature of HPV infection in young women. Although, up to 50 of adolescents acquire HPV i The distribution of HPV types shows substantial differences among LSIL and HSIL patients. HPV 16, 58, and 52 were the top three common types in HSILs, but the rank of the top three types was different in LSILs. These results are consistent with the findings of a great deal of previous works . In concordance with previous research, our data.

If you are in this age group, an LSIL Pap test should be followed up with another Pap test in one year. If you have an LSIL Pap test result, but a few cells are found to be suspicious for a high-grade squamous intraepithelial lesion (HSIL), follow-up should be the same as for people with an HSIL result. In most cases, this involves a colposcopy LSIL is listed in the World's largest and most authoritative dictionary database of abbreviations and acronyms Reich and Regaueds hypothesis is not so different from ours.1 We also believe that low-grade fourteen (4.7%) of them only with atypical cells, one (0.3%) with LSIL and two (0.7%) with HSIL. Cervical human papillomavirus. The rank of viral load varied significantly among the four groups of cases, P<0.05 in LSIL vs. HSIL, LSIL vs. cancer and HSIL vs. cancer, while P>0.05 in normal vs. LSIL. Multivariate analysis. Genotypes, multiple infections and viral load were involved in the binary logistic regression analysis (Table 2). The genotypes and viral load are two. Independent Studies Show Increased LSIL and HSIL Cytology Categorization vs Manual ThinPrep Pap Test This chart is a representation of clinical data from multiple published sources. The clinical studies represented within these sources were conducted using different study designs with various assays

Option 1: Colposcopy CIN 2, 3. See CIN 2 or CIN 3 protocol as below; No CIN 2 or 3: Observe with Colposcopy and repeat cytology every 6 months for 2 years. HSIL cytology or high grade colpo for 1 year. Biopsy and treat as CIN 2,3 if positive biops Biopsies showed immature squamous metaplasia (small arrow) and CIN1 (large arrow). In almost half of similar cases, colposcopists cannot differentiale accurately between ISM and LSIL. Figure 50 LSIL on the mature squamous epithelium of the ectocervix (flat condylomata) as well as in the transformation zone The differences between the groups were also statistically significant (P < 0.05). Furthermore, the colposcopic impression was underestimated in 214 patients (43.2%, 214/495) in which LSIL was in 26 cases (26%, 26/100), HSIL in 118 cases (59.3%, 118/199) and carcinoma in 70 cases (70.7%, 70/90) LSIL/HSIL for each patient, with the values considered separately and in pairs. The correlation between the vari-ables was evaluated by Pearson's chi-square test. Results and discussion Many authors state the connection of cervical Pap koilo-cytosis with HPV(C) infection [2,4]. The results obtained in our study (Table 1) showed that, one or.