title: Ulcerative colitis

text: A lesser common skin complication associated with UC, pyoderma gangrenosum, is typically more severe. One study discovered this skin manifestation in only 0.75% pf patients. Pyoderma gangrenosum is characterized by painful lesions or nodules that become ulcers which progressively grow. It often starts as many small raised red spots (papules) or pus-filled lesions (pustules) that are usually detected on lower extremities. The inner layer of the skin, or dermis, slowly undergoes necrosis (process of dying) causing the ulcerations that are typical of pyoderma gangrenosum. The ulcers are often filled with sterile pus-like material, so biopsy often displays an abscess that is sterile. Whereas erythema nodosum tends to correlate with the activity of the ulcerative colitis and often improves with treatment of the colonic inflammation, pyoderma gangrenosum may occur independently of UC disease activity. In some cases, pyoderma gangrenosum may require injection with corticosteroids. Treatment may also involve inhibitors of tumor necrosis factor (TNF), a cytokine that promotes cell survival.


title: Ulcerative colitis

text: Other associations determined between the skin and ulcerative colitis include a skin condition known as hidradenitis suppurativa (HS). This condition represents a chronic process in which follicles become occluded leading to recurring inflammation of nodules and abscesses and even tunnels in the skin that drain fluid.


title: Ulcerative colitis

text: Ulcerative colitis may affect the blood and endocrine system. UC increases the risk of blood clots in both arteries and veins; painful swelling of the lower legs can be a sign of deep venous thrombosis, while difficulty breathing may be a result of pulmonary embolism (blood clots in the lungs). The risk of blood clots is about threefold higher in individuals with IBD. The risk of venous thromboembolism is high in ulcerative colitis due to hypercoagulability from inflammation, especially with active or extensive disease. Additional risk factors may include surgery, hospitalization, pregnancy, the use of corticosteroids and tofacitinib, a JAK inhibitor.


title: Ulcerative colitis

text: The immune system may also attack red blood cells, leading to autoimmune hemolytic anemia. In addition to autoimmune destruction, anemia may occur due to chronic blood loss from rectal bleeding and bone marrow suppression due to inflammation (anemia of chronic disease). Anemic patients can present asymptomatically. However, 75% of individuals exhibit symptoms such as shortness of breath, fatigue, and tachycardia (racing heart). About 1/3rd of patients show signs of jaundice (yellowing of the skin) or darkened urine from loss of bilirubin in urine. A smaller percentage may present with chest pain or a concurrent immune cytopenia, most commonly immune thrombocytopenia (ITP) (CITE WAHA).


title: Ulcerative colitis

text: Osteoporosis may occur related to systemic inflammation, which increases the risk of bone fractures. Clubbing, a deformity of the ends of the fingers, may occur. Amyloidosis may occur, especially with severe and poorly controlled disease, which usually presents with protein in the urine (proteinuria) and nephritic syndrome.


title: Ulcerative colitis

text: Ulcerative colitis has a significant association with primary sclerosing cholangitis (PSC), a progressive inflammatory disorder of small and large bile ducts. Up to 70-90% of people with primary sclerosing cholangitis have ulcerative colitis. As many as 5% of people with ulcerative colitis may progress to develop primary sclerosing cholangitis. PSC is more common in men, and often begins between 30 and 40 years of age. It can present asymptomatically or exhibit symptoms of itchiness (pruritis) and fatigue. Other symptoms include systemic signs such as fever and night sweats. Such symptoms are often associated with a bacterial episodic version of PSC. Upon physical exam, one may discern enlarged liver contours (hepatomegaly) or enlarged spleen (splenomegaly) as well as areas of excoriation. Yellow coloring of the skin, or jaundice, may also be present due to excess of bile byproduct buildup (bilirubin) from the biliary tract. In diagnosis, lab results often reveal a pattern indicative of biliary disease (cholestatic pattern). This is often displayed by markedly elevated alkaline phosphatase levels and milder or no elevation in liver enzyme levels. Xray results often show bile ducts with thicker walls, areas of dilation or narrowing.


title: Ulcerative colitis

text: In some cases, primary sclerosing cholangitis occurs several years before the bowel symptoms of ulcerative colitis develop. PSC does not parallel the onset, extent, duration, or activity of the colonic inflammation in ulcerative colitis. In addition, colectomy does not have an impact on the course of primary sclerosing cholangitis in individuals with UC. PSC is associated with an increased risk of colorectal cancer and cholangiocarcinoma (bile duct cancer). PSC is a progressive condition, and may result in cirrhosis of the liver. No specific therapy has been proven to affect the long term course of PSC.


title: Ulcerative colitis

text: Ulcerative colitis is an autoimmune disease characterized by T-cells infiltrating the colon. No direct causes for UC are known, but factors such as genetics, environment, and an overactive immune system play a role. UC is associated with comorbidities that produce symptoms in many areas of the body outside the digestive system.


title: Ulcerative colitis

text: A genetic component to the cause of UC can be hypothesized based on aggregation of UC in families, variation of prevalence between different ethnicities, genetic markers and linkages. In addition, the identical twin concordance rate is 10%, whereas the dizygotic twin concordance rate is only 3%. Between 8 and 14% of people with ulcerative colitis have a family history of inflammatory bowel disease. In addition, people with a first degree relative with UC have a four-fold increase in their risk of developing the disease.


title: Ulcerative colitis

text: Twelve regions of the genome may be linked to UC, including, in the order of their discovery, chromosomes 16, 12, 6, 14, 5, 19, 1, and 3, but none of these loci has been consistently shown to be at fault, suggesting that the disorder is influenced by multiple genes. For example, chromosome band 1p36 is one such region thought to be linked to inflammatory bowel disease. Some of the putative regions encode transporter proteins such as OCTN1 and OCTN2. Other potential regions involve cell scaffolding proteins such as the MAGUK family. Human leukocyte antigen associations may even be at work. In fact, this linkage on chromosome 6 may be the most convincing and consistent of the genetic candidates.


title: Ulcerative colitis

text: Multiple autoimmune disorders are associated with ulcerative colitis, including celiac disease, psoriasis, lupus erythematosus, rheumatoid arthritis, episcleritis, and scleritis. Ulcerative colitis is also associated with acute intermittent porphyria.


title: Ulcerative colitis

text: Many hypotheses have been raised for environmental factors contributing to the pathogenesis of ulcerative colitis, including diet, breastfeeding and medications. Breastfeeding may have a protective effect in the development of ulcerative colitis. One study of isotretinoin found a small increase in the rate of UC.


title: Ulcerative colitis

text: As the colon is exposed to many dietary substances which may encourage inflammation, dietary factors have been hypothesized to play a role in the pathogenesis of both ulcerative colitis and Crohn's disease. However, current research does not show a link between diet and the development of ulcerative colitis. Few studies have investigated such an association; one study showed no association of refined sugar on the number of people affected of ulcerative colitis. High intake of unsaturated fat and vitamin B6 may enhance the risk of developing ulcerative colitis. Other identified dietary factors that may influence the development and/or relapse of the disease include meat protein and alcoholic beverages. Specifically, sulfur has been investigated as being involved in the cause of ulcerative colitis, but this is controversial. Sulfur restricted diets have been investigated in people with UC and animal models of the disease. The theory of sulfur as an etiological factor is related to the gut microbiota and mucosal sulfide detoxification in addition to the diet.


title: Ulcerative colitis

text: As a result of a class-action lawsuit and community settlement with DuPont, three epidemiologists conducted studies on the population surrounding a chemical plant that was exposed to PFOA at levels greater than in the general population. The studies concluded that there was an association between PFOA exposure and six health outcomes, one of which being ulcerative colitis.


title: Ulcerative colitis

text: Levels of sulfate-reducing bacteria tend to be higher in persons with ulcerative colitis, which could indicate higher levels of hydrogen sulfide in the intestine. An alternative theory suggests that the symptoms of the disease may be caused by toxic effects of the hydrogen sulfide on the cells lining the intestine.


title: Ulcerative colitis

text: Infection by mycobacterium avium, subspecies paratuberculosis, has been proposed as the ultimate cause of both ulcerative colitis and Crohn's disease.


title: Ulcerative colitis

text: An increased amount of colonic sulfate-reducing bacteria has been observed in some people with ulcerative colitis, resulting in higher concentrations of the toxic gas hydrogen sulfide. Human colonic mucosa is maintained by the colonic epithelial barrier and immune cells in the lamina propria (see intestinal mucosal barrier). N-butyrate, a short-chain fatty acid, gets oxidized through the beta oxidation pathway into carbon dioxide and ketone bodies. It has been shown that N-butyrate helps supply nutrients to this epithelial barrier. Studies have proposed that hydrogen sulfide plays a role in impairing this beta-oxidation pathway by interrupting the short chain acetyl-CoA dehydrogenase, an enzyme within the pathway. Furthermore, it has been suggested that the protective benefit of smoking in ulcerative colitis is due to the hydrogen cyanide from cigarette smoke reacting with hydrogen sulfide to produce the non-toxic isothiocyanate, thereby inhibiting sulfides from interrupting the pathway. An unrelated study suggested that the sulfur contained in red meats and alcohol may lead to an increased risk of relapse for people in remission.


title: Ulcerative colitis

text: The initial diagnostic workup for ulcerative colitis consists of a complete history and physical examination, assessment of signs and symptoms, laboratory tests and endoscopy. Severe UC can exhibit high erythrocyte sedimentation rate (ESR), decreased albumin (a protein produced by the liver), and various changes in electrolytes. As discussed previously, UC patients often also display elevated alkaline phosphatase. Inflammation in the intestine may also cause higher levels of fecal calprotectin or lactoferrin.


title: Ulcerative colitis

text: Although ulcerative colitis is a disease of unknown causation, inquiry should be made as to unusual factors believed to trigger the disease.


title: Ulcerative colitis

text: The simple clinical colitis activity index was created in 1998 and is used to assess the severity of symptoms.


title: Ulcerative colitis

text: The best test for diagnosis of ulcerative colitis remains endoscopy, which is examination of the internal surface of the bowel using a flexible camera. Initially, a flexible sigmoidoscopy may be completed to establish the diagnosis. The physician may elect to limit the extent of the initial exam if severe colitis is encountered to minimize the risk of perforation of the colon. However, a complete colonoscopy with entry into the terminal ileum should be performed to rule out Crohn's disease, and assess extent and severity of disease. Endoscopic findings in ulcerative colitis include: erythema (redness of the mucosa), friability of the mucosa, superficial ulceration, and loss of the vascular appearance of the colon. When present, ulcerations may be confluent. Pseudopolyps may be observed.


title: Ulcerative colitis

text: Ulcerative colitis is usually continuous from the rectum, with the rectum almost universally being involved. Perianal disease is rare. The degree of involvement endoscopically ranges from proctitis (rectal inflammation) to left sided colitis (extending to descending colon), to extensive colitis (extending proximal to descending colon).


title: Ulcerative colitis

text: Biopsies of the mucosa are taken during endoscopy to confirm the diagnosis of UC and differentiate it from Crohn's disease, which is managed differently clinically. Histologic findings in ulcerative colitis includes: distortion of crypt architecture, crypt abscesses, and inflammatory cells in the mucosa (lymphocytes, plasma cells, and granulocytes). Unlike the transmural inflammation seen in Crohn's disease, the inflammation of ulcerative colitis is limited to the mucosa.


title: Ulcerative colitis

text: Blood and stool tests serve primarily to assess disease severity, level of inflammation and rule out causes of infectious colitis. All individuals with suspected ulcerative colitis should have stool testing to rule out infection.


title: Ulcerative colitis

text: A complete blood count may demonstrate anemia, leukocytosis, or thrombocytosis. Anemia may be caused by inflammation or bleeding. Chronic blood loss may lead to iron deficiency as a cause for anemia, particularly microcytic anemia (small red blood cells), which can be evaluated with a serum ferritin, iron, total iron-binding capacity and transferrin saturation. Anemia may be due to a complication of treatment from azathioprine, which can cause low blood counts, or sulfasalazine, which can result in folate deficiency. Thiopurine metabolites (from azathioprine) and a folate level can help.


title: Ulcerative colitis

text: UC may cause high levels of inflammation throughout the body, which may be quantified with serum inflammatory markers, such as CRP and ESR. However, elevated inflammatory markers are not specific for UC and elevations are commonly seen in other conditions, including infection. In addition, inflammatory markers are not uniformly elevated in people with ulcerative colitis. Twenty five percent of individuals with confirmed inflammation on endoscopic evaluation have a normal CRP level. Serum albumin may also be low related to inflammation, in addition to loss of protein in the GI tract associated with bleeding and colitis. Low serum levels of vitamin D are associated with UC, although the significance of this finding is unclear.


title: Ulcerative colitis

text: Specific antibody markers may be elevated in ulcerative colitis. Specifically, perinuclear antineutrophil cytoplasmic antibodies (pANCA) are found in 70 percent of cases of UC. Antibodies against Saccharomyces cerevisiae may be present, but are more often positive in Crohn's disease compared with ulcerative colitis. However, due to poor accuracy of these serolologic tests, they are not helpful in the diagnostic evaluation of possible inflammatory bowel disease.


title: Ulcerative colitis

text: Several stool tests may help quantify the extent of inflammation present in the colon and rectum. Fecal calprotectin is elevated in inflammatory conditions affecting the colon, and is useful in distinguishing irritable bowel syndrome (noninflammatory) from a flare in inflammatory bowel disease. Fecal calprotectin is 88% sensitive and 79% specific for the diagnosis of ulcerative colitis. If the fecal calprotectin is low, the likelihood of inflammatory bowel disease are less than 1 percent. Lactoferrin is an additional nonspecific marker of intestinal inflammation.


title: Ulcerative colitis

text: Overall, imaging tests, such as x-ray or CT scan, may be helpful in assessing for complications of ulcerative colitis, such as perforation or toxic megacolon. Bowel ultrasound (US) is a cost-effective, well-tolerated, non-invasive and readily available tool for the management of patients with inflammatory bowel disease (IBD), including UC, in clinical practice. Some recent studies demonstrated that US is an accurate tool for assessing disease activity in patients with UC. Imaging is otherwise of limited use in diagnosing ulcerative colitis. Magnetic resonance imaging (MRI) is necessary to diagnose underlying PSC.


title: Ulcerative colitis

text: Abdominal xray is often the test of choice and may display nonspecific findings in cases of mild or moderate ulcerative colitis. In circumstances of severe UC, radiographic findings may include thickening of the mucosa, often termed "thumbprinting," which indicates swelling due to fluid displacement (edema). Other findings may include colonic dilation and stool buildup evidencing constipation.


title: Ulcerative colitis

text: Similar to xray, in mild ulcerative colitis, double contrast barium enema often shows nonspecific findings. Conversely, barium enema may display small buildups of barium in microulcerations. Severe UC can be characterized by various polyps, colonic shortening, loss of haustrae (the small bulging pouches in the colon),and narrowing of the colon. It is important to note that barium enema should not be conducted in patients exhibiting very severe symptoms as this may slow or stop stool passage through the colon causing ileus and toxic megacolon.


title: Ulcerative colitis

text: Other methods of imaging include computed tomography (CT) and magnetic resonance imaging (MRI). Both may depict colonic wall thickening but have decreased ability to find early signs of wall changes when compared to barium enema. In cases of severe ulcerative colitis, however, they often exhibit equivalent ability to detect colonic changes.


title: Ulcerative colitis

text: Doppler ultrasound is the last means of imaging that may be used. Similar to the imaging methods mentioned earlier, this may show some thickened bowel wall layers. In severe cases, this may show thickening in all bowel wall layers (transmural thickness).


title: Ulcerative colitis

text: Several conditions may present in a similar manner as ulcerative colitis, and should be excluded. Such conditions include: Crohn's disease, infectious colitis, nonsteroidal anti-inflammatory drug enteropathy, and irritable bowel syndrome. Alternative causes of colitis should be considered, such as ischemic colitis (inadequate blood flow to the colon), radiation colitis (if prior exposure to radiation therapy), or chemical colitis. Pseudomembranous colitis may occur due to Clostridioides difficile infection following administration of antibiotics. Entamoeba histolytica is a protozoan parasite that causes intestinal inflammation. A few cases have been misdiagnosed as UC with poor outcomes occurring due to the use of corticosteroids.


title: Ulcerative colitis

text: The most common disease that mimics the symptoms of ulcerative colitis is Crohn's disease, as both are inflammatory bowel diseases that can affect the colon with similar symptoms. It is important to differentiate these diseases since their courses and treatments may differ. In some cases, however, it may not be possible to tell the difference, in which case the disease is classified as indeterminate colitis. Crohn's disease can be distinguished from ulcerative colitis in several ways. Characteristics that indicate Crohn's include evidence of disease around the anus (perianal disease). This includes anal fissures and abscesses as well as fistulas, which are abnormal connections between various bodily structures.


title: Ulcerative colitis

text: Infectious colitis is another condition that may present in similar manner to ulcerative colitis. Endoscopic findings are also oftentimes similar. One can discern whether a patient has infectious colitis by employing tissue cultures and stool studies. Biopsy of the colon is another beneficial test but is more invasive.


title: Ulcerative colitis

text: Other forms of colitis that may present similarly include radiation and diversion colitis. Radiation colitis occurs after irradiation and often affects the rectum or sigmoid colon, similar to ulcerative colitis. Upon histology radiation colitis may indicate eosinophilic infiltrates, abnormal epithelial cells, or fibrosis. Diversion colitis, on the other hand, occurs after portions of bowel loops have been removed. Histology in this condition often shows increased growth of lymphoid tissue.


title: Ulcerative colitis

text: In patients who have undergone transplantation, graft versus host disease may also be a differential diagnosis. This response to transplantation often causes prolonged diarrhea if the colon is affected. Typical symptoms also include rash. Involvement of the upper gastrointestinal tract may lead to difficulty swallowing or ulceration. Upon histology, graft versus host disease may present with crypt cell necrosis and breakdown products within the crypts themselves.


title: Ulcerative colitis

text: Standard treatment for ulcerative colitis depends on the extent of involvement and disease severity. The goal is to induce remission initially with medications, followed by the administration of maintenance medications to prevent a relapse. The concept of induction of remission and maintenance of remission is very important. The medications used to induce and maintain a remission somewhat overlap, but the treatments are different. Physicians first direct treatment to inducing remission, which involves relief of symptoms and mucosal healing of the colon's lining, and then longer-term treatment to maintain remission and prevent complications. Acute severe ulcerative colitis requires hospitalisation, exclusion of infections, and corticosteroids.


title: Ulcerative colitis

text: Ulcerative colitis can be treated with a number of medications, including 5-ASA drugs such as sulfasalazine and mesalazine. Corticosteroids such as prednisone can also be used due to their immunosuppressive and short-term healing properties, but because their risks outweigh their benefits, they are not used long-term in treatment. Immunosuppressive medications such as azathioprine and biological agents such as infliximab and adalimumab are given only if people cannot achieve remission with 5-ASA and corticosteroids. Infliximab, ustekinumab, or vedolizumab are recommended in those with moderate or severe disease.


title: Ulcerative colitis

text: A formulation of budesonide was approved by the U.S. Food and Drug Administration (FDA) for treatment of active ulcerative colitis in January 2013. In 2018, tofacitinib was approved for treatment of moderately to severely active ulcerative colitis in the United States, the first oral medication indicated for long term use in this condition. The evidence on methotrexate does not show a benefit in producing remission in people with ulcerative colitis. Cyclosporine is effective for severe UC and tacrolimus has also shown benefits.


title: Ulcerative colitis

text: Sulfasalazine has been a major agent in the therapy of mild to moderate ulcerative colitis for over 50 years. In 1977, it was shown that 5-aminosalicylic acid (5-ASA, mesalazine/mesalamine) was the therapeutically active component in sulfasalazine. Many 5-ASA drugs have been developed with the aim of delivering the active compound to the large intestine to maintain therapeutic efficacy but with reduction of the side effects associated with the sulfapyridine moiety in sulfasalazine. Oral 5-ASA drugs are particularly effective in inducing and in maintaining remission in mild to moderate ulcerative colitis. Rectal suppository, foam or liquid enema formulations of 5-ASA are used for colitis affecting the rectum, sigmoid or descending colon, and have been shown to be effective especially when combined with oral treatment.


title: Ulcerative colitis

text: Biologic treatments such as the TNF inhibitors infliximab, adalimumab, and golimumab are commonly used to treat people with UC who are no longer responding to corticosteroids. Tofacitinib and vedolizumab can also produce good clinical remission and response rates in UC. Biologics may be used early in treatment (step down approach), or after other treatments have failed to induce remission (step up approach); the strategy should be individualized.


title: Ulcerative colitis

text: Unlike aminosalicylates, biologics can cause serious side effects such as an increased risk of developing extra-intestinal cancers, heart failure; and weakening of the immune system, resulting in a decreased ability of the immune system to clear infections and reactivation of latent infections such as tuberculosis. For this reason, people on these treatments are closely monitored and are often tested for hepatitis and tuberculosis annually.


title: Ulcerative colitis

text: Unlike Crohn's disease, ulcerative colitis has a lesser chance of affecting smokers than non-smokers. In select individuals with a history of previous tobacco use, resuming low dose smoking may improve signs and symptoms of active ulcerative colitis, but it is not recommended due to the overwhelmingly negative health effects of tobacco. Studies using a transdermal nicotine patch have shown clinical and histological improvement. In one double-blind, placebo-controlled study conducted in the United Kingdom, 48.6% of people with UC who used the nicotine patch, in conjunction with their standard treatment, showed complete resolution of symptoms. Another randomized, double-blind, placebo-controlled, single-center clinical trial conducted in the United States showed that 39% of people who used the patch showed significant improvement, versus 9% of those given a placebo. However, nicotine therapy is generally not recommended due to side effects and inconsistent results.


title: Ulcerative colitis

text: The gradual loss of blood from the gastrointestinal tract, as well as chronic inflammation, often leads to anemia, and professional guidelines suggest routinely monitoring for anemia with blood tests repeated every three months in active disease and annually in quiescent disease. Adequate disease control usually improves anemia of chronic disease, but iron deficiency anemia should be treated with iron supplements. The form in which treatment is administered depends both on the severity of the anemia and on the guidelines that are followed. Some advise that parenteral iron be used first because people respond to it more quickly, it is associated with fewer gastrointestinal side effects, and it is not associated with compliance issues. Others require oral iron to be used first, as people eventually respond and many will tolerate the side effects.


title: Ulcerative colitis

text: Unlike in Crohn's disease, the gastrointestinal aspects of ulcerative colitis can generally be cured by surgical removal of the large intestine, though extraintestinal symptoms may persist. This procedure is necessary in the event of: exsanguinating hemorrhage, frank perforation, or documented or strongly suspected carcinoma. Surgery is also indicated for people with severe colitis or toxic megacolon. People with symptoms that are disabling and do not respond to drugs may wish to consider whether surgery would improve the quality of life.


title: Ulcerative colitis

text: The removal of the entire large intestine, known as a proctocolectomy, results in a permanent ileostomy – where a stoma is created by pulling the terminal ileum through the abdomen. Intestinal contents are emptied into a removable ostomy bag which is secured around the stoma using adhesive.


title: Ulcerative colitis

text: Another surgical option for ulcerative colitis that is affecting most of the large bowel is called the ileal pouch-anal anastomosis (IPAA). This is a two- or three-step procedure. In a three-step procedure, the first surgery is a sub-total colectomy, in which the large bowel is removed, but the rectum remains in situ, and a temporary ileostomy is made. The second step is a proctectomy and formation of the ileal pouch (commonly known as a "j-pouch"). This involves removing the large majority of the remaining rectal stump and creating a new "rectum" by fashioning the end of the small intestine into a pouch and attaching it to the anus. After this procedure, a new type of ileostomy is created (known as a loop ileostomy) to allow the anastomoses to heal. The final surgery is a take-down procedure where the ileostomy is reversed and there is no longer the need for an ostomy bag. When done in two steps, a proctocolectomy – removing both the colon and rectum – is performed alongside the pouch formation and loop ileostomy. The final step is the same take-down surgery as in the three-step procedure. Time taken between each step can vary, but typically a six- to twelve-month interval is recommended between the first two steps, and a minimum of two to three months is required between the formation of the pouch and the ileostomy take-down.


title: Ulcerative colitis

text: While the ileal pouch procedure removes the need for an ostomy bag, it does not restore normal bowel function. In the months following the final operation, patients typically experience 8–15 bowel movements a day. Over time this number decreases, with many patients reporting four-six bowel movements after one year post-op. While many patients have success with this procedure, there are a number of known complications. Pouchitis, inflammation of the ileal pouch resulting in symptoms similar to ulcerative colitis, is relatively common. Pouchitis can be acute, remitting, or chronic however treatment using antibiotics, steroids, or biologics can be highly effective. Other complications include fistulas, abscesses, and pouch failure. Depending on the severity of the condition, pouch revision surgery may need to be performed. In some cased the pouch may need to be de-functioned or removed and an ileostomy recreated.


title: Ulcerative colitis

text: The risk of cancer arising from a ileal pouch anal anastomosis is low. However, annual surveillance with pouchoscopy may be considered in individuals with risk factors for dysplasia, such as a history of dysplasia or colorectal cancer, a history of PSC, refractory pouchitis, and severely inflamed atrophic pouch mucosa.


title: Ulcerative colitis

text: In a number of randomized clinical trials, probiotics have demonstrated the potential to be helpful in the treatment of ulcerative colitis. Specific types of probiotics such as Escherichia coli Nissle have been shown to induce remission in some people for up to a year. A probiotic named after its gastroenterologist medical doctor inventor, the De Simone Formulation, may be effective in inducing remission in active ulcerative colitis, and may be as effective as 5-ASAs in preventing relapse of quiescent UC. The De Simone Formulation was sold and researched under the brand name VSL#3 until 2016. Since, it has been sold and researched under various regional brand names including Visbiome in the United States and Vivomixx in Europe.


title: Ulcerative colitis

text: Fecal microbiota transplant involves the infusion of human probiotics through fecal enemas. Ulcerative colitis typically requires a more prolonged bacteriotherapy treatment than "Clostridium difficile" infection to be successful, possibly due to the time needed to heal the ulcerated epithelium. The response of ulcerative colitis is potentially very favorable with one study reporting 67.7% of people experiencing complete remission. Other studies found a benefit from using fecal microbiota transplantation.


title: Ulcerative colitis

text: A variety of alternative medicine therapies have been used for ulcerative colitis, with inconsistent results. Curcumin (turmeric) therapy, in conjunction with taking the medications mesalamine or sulfasalazine, may be effective and safe for maintaining remission in people with quiescent ulcerative colitis. The effect of curcumin therapy alone on quiescent ulcerative colitis is unknown.


title: Ulcerative colitis

text: Treatments using cannabis or cannabis oil are uncertain. So far, studies haven't determined its effectiveness and safety.


title: Ulcerative colitis

text: Many interventions have been considered to manage abdominal pain in people with ulcerative colitis, including FODMAPs diet, relaxation training, yoga, kefir diet and stellate ganglion block treatment. It is unclear whether any of these are safe or effective at improving pain or reducing anxiety and depression.


title: Ulcerative colitis

text: Poor prognostic factors include: age < 40 years upon diagnosis, extensive colitis, severe colitis on endoscopy, prior hospitalization, elevated CRP and low serum albumin.


title: Ulcerative colitis

text: People with ulcerative colitis usually have an intermittent course, with periods of disease inactivity alternating with "flares" of disease. People with proctitis or left-sided colitis usually have a more benign course: only 15% progress proximally with their disease, and up to 20% can have sustained remission in the absence of any therapy. A subset of people experience a course of disease progress rapidly. In these cases, there is usually a failure to respond to medication and surgery often is performed within the first few years of disease onset. People with more extensive disease are less likely to sustain remission, but the rate of remission is independent of the severity of the disease. Several risk factors are associated with eventual need for colectomy, including: prior hospitalization for UC, extensive colitis, need for systemic steroids, young age at diagnosis, low serum albumin, elevated inflammatory markers (CRP & ESR), and severe inflammation seen during colonoscopy. Surgical removal of the large intestine is necessary in some cases.


title: Ulcerative colitis

text: The risk of colorectal cancer is significantly increased in people with ulcerative colitis after ten years if involvement is beyond the splenic flexure. People with backwash ileitis might have an increased risk for colorectal carcinoma. Those people with only proctitis usually have no increased risk. It is recommended that people have screening colonoscopies with random biopsies to look for dysplasia after eight years of disease activity, at one to two year intervals.


title: Ulcerative colitis

text: People with ulcerative colitis are at similar or perhaps slightly increased overall risk of death compared with the background population. However, the distribution of causes-of-death differs from the general population. Specific risk factors may predict worse outcomes and a higher risk of mortality in people with ulcerative colitis, including: C. difficile infection and cytomegalovirus infection (due to reactivation).


title: Ulcerative colitis

text: Together with Crohn's disease, about 11.2 million people were affected . Each year, ulcerative colitis newly occurs in 1 to 20 per 100,000 people (incidence), and there are a total of 5-500 per 100,000 individuals with the disease (prevalence). In 2015, a worldwide total of 47,400 people died due to inflammatory bowel disease (UC and Crohn's disease). The peak onset is between 30 and 40 years of age, with a second peak of onset occurring in the 6th decade of life. Ulcerative colitis is equally common among men and women. With appropriate treatment the risk of death appears similar to that of the general population. UC has become more common since the 1950s.


title: Ulcerative colitis

text: The geographic distribution of UC and Crohn's disease is similar worldwide, with the highest number of new cases a year of UC found in Canada, New Zealand and the United Kingdom. The disease is more common in North America and Europe than other regions. In general, higher rates are seen in northern locations compared to southern locations in Europe and the United States. UC is more common in western Europe compared with eastern Europe. Worldwide, the prevalence of UC varies from 2 - 299 per 100,000 people. Together, ulcerative colitis and Crohn's disease affect about a million people in the United States.


title: Ulcerative colitis

text: As with Crohn's disease, the rates of UC are greater among Ashkenazi Jews and decreases progressively in other persons of Jewish descent, non-Jewish Caucasians, Africans, Hispanics, and Asians. Appendectomy prior to age 20 for appendicitis and current tobacco use are protective against development of UC. However, former tobacco use is associated with a higher risk of developing the disease.


title: Ulcerative colitis

text: , the number of new cases of UC in the United States was between 2.2 and 14.3 per 100,000 per year. The number of people affected in the United States in 2004 was between 37 and 246 per 100,000.


title: Ulcerative colitis

text: In Canada, between 1998 and 2000, the number of new cases per year was 12.9 per 100,000 population or 4,500 new cases. The number of people affected was estimated to be 211 per 100,000 or 104,000.


title: Ulcerative colitis

text: In the United Kingdom 10 per 100,000 people newly develop the condition a year while the number of people affected is 243 per 100,000. Approximately 146,000 people in the United Kingdom have been diagnosed with UC.


title: Ulcerative colitis

text: Helminthic therapy using the whipworm "Trichuris suis" has been shown in a randomized control trial from Iowa to show benefit in people with ulcerative colitis. The therapy tests the hygiene hypothesis which argues that the absence of helminths in the colons of people in the developed world may lead to inflammation. Both helminthic therapy and fecal microbiota transplant induce a characteristic Th2 white cell response in the diseased areas, which was unexpected given that ulcerative colitis was thought to involve Th2 overproduction.


title: Ulcerative colitis

text: Alicaforsen is a first generation antisense oligodeoxynucleotide designed to bind specifically to the human ICAM-1 messenger RNA through Watson-Crick base pair interactions in order to subdue expression of ICAM-1. ICAM-1 propagates an inflammatory response promoting the extravasation and activation of leukocytes (white blood cells) into inflamed tissue. Increased expression of ICAM-1 has been observed within the inflamed intestinal mucosa of ulcerative colitis patients, where ICAM-1 over production correlated with disease activity. This suggests that ICAM-1 is a potential therapeutic target in the treatment of ulcerative colitis.


title: Ulcerative colitis

text: Gram positive bacteria present in the lumen could be associated with extending the time of relapse for ulcerative colitis.


title: Ulcerative colitis

text: A series of drugs in development looks to disrupt the inflammation process by selectively targeting an ion channel in the inflammation signaling cascade known as KCa3.1. In a preclinical study in rats and mice, inhibition of KCa3.1 disrupted the production of Th1 cytokines IL-2 and TNF-∝ and decreased colon inflammation as effectively as sulfasalazine.


title: Ulcerative colitis

text: Neutrophil extracellular traps and the resulting degradation of the extracellular matrix have been reported in the colon mucosa in ulcerative colitis patients in clinical remission, indicating the involvement of the innate immune system in the etiology.


title: Ulcerative colitis

text: Fexofenadine, an antihistamine drug used in treatment of allergies, has shown promise in a combination therapy in some studies. Opportunely, low gastrointestinal absorption (or high absorbed drug gastrointestinal secretion) of fexofenadine results in higher concentration at the site of inflammation. Thus, the drug may locally decrease histamine secretion by involved gastrointestinal mast cells and alleviate the inflammation.


title: Ulcerative colitis

text: There is evidence that etrolizumab is effective for ulcerative colitis, with phase 3 trials underway as of 2016. Etrolizumab is a humanized monoclonal antibody that targets he β7 subunit of integrins α4β7 and αEβ7. Etrolizumab decreases lymphocytes trafficking, similar to vedolizumab (another integrin antagonist).


title: Ulcerative colitis

text: A type of leukocyte apheresis, known as granulocyte and monocyte adsorptive apheresis, still requires large-scale trials to determine whether or not it is effective. Results from small trials have been tentatively positive.


title: Reputation (album)

text: Reputation (stylized in all lowercase) is the sixth studio album by American singer-songwriter Taylor Swift. It was released on November 10, 2017, by Big Machine Records, and would be her last release under the label. Swift became a subject of rampant tabloid scrutiny following the release of her fifth studio album "1989" (2014), with the media outlets highly publicizing her personal life and her celebrity disputes. She hence secluded herself from the press and social media, where she had maintained an active presence, and created "Reputation" as an effort to revamp her state of mind.


title: Reputation (album)

text: Influenced by the commotion, Swift wrote "Reputation" under two major themes: the excessive gossip surrounding her, and finding love during tumultuous events. She recruited Jack Antonoff, Max Martin, and Shellback for the album's production. Marking a stark shift from the synth-pop style of its predecessor, "Reputation" is built around electropop, R&B, and trap, inspired by urban genres such as EDM, hip hop, and Miami bass, resulting in a heavy electronic production consisting of pulsing drum machines, swelling synthesizers, and manipulated vocals.


title: Reputation (album)

text: In keeping with the album's themes, Swift did not promote "Reputation" through press interviews, which she had done for previous releases. Four international singles—"Look What You Made Me Do", "...Ready for It?", "End Game" featuring Ed Sheeran and Future, and "Delicate"—supported the album; they peaked at number one, four, eighteen and twelve on the "Billboard" Hot 100. "Gorgeous" and "Call It What You Want" preceded the album as promotional tracks, while "New Year's Day" was serviced to US country radio and "Getaway Car" to Australian radio. Contemporary critical response to "Reputation" was generally positive. Reviewers were divided on the brash sound and harsh themes, but praised Swift's resilient songwriting. Some critics felt the album is an intimate record in which Swift becomes vulnerable and discovers her inner self. Retrospective reviews have described "Reputation" as an album of experimentation and emotional evolution for Swift.


title: Reputation (album)

text: The album was Swift's fourth consecutive to debut atop the US "Billboard" 200 with first-week sales of over one million copies; it spent four weeks atop the chart. "Reputation" also topped charts in countries including Australia, Canada, and the UK. It was the best-selling album by a female artist of 2017, selling over 4.5 million copies. It was supported by the Reputation Stadium Tour (2018), which became the highest-grossing North American tour of all time. "Reputation" was nominated for Best Pop Vocal Album at the 61st Annual Grammy Awards, listed on "Slant Magazine" list of the best albums of the 2010s decade, and has received sales certifications across the globe. Swift cleared out her website and social media accounts before announcing "Reputation", generating widespread attention across the internet; other artists have since emulated this tactic when announcing new music.


title: Reputation (album)

text: Taylor Swift released her fifth studio album, "1989", in October 2014. The album's synth-pop production established Swift's official departure from the country-oriented styles of her previous records. It received generally positive reviews from contemporary critics. A huge commercial success, the album sold over six million copies in the United States and spawned three US "Billboard" Hot 100 number-one singles–"Shake It Off", "Blank Space", and "Bad Blood". Its accompanying tour ran from May to December 2015 and was the highest-grossing concert tour of 2015. During promotion of "1989", Swift continued to be a major target of tabloid gossip. She had short-lived romantic relationships with Scottish producer Calvin Harris and English actor Tom Hiddleston. Her media reputation was blemished from publicized feuds with several high-profile celebrities, such as with rapper Kanye West, media personality Kim Kardashian, and singer Katy Perry. Swift became increasingly reticent on social media, having maintained an active presence with a large following, and avoided interactions with the press amidst the tumultuous affairs.


title: Reputation (album)

text: On August 16, 2017, Swift cleared out her website and all of her social media accounts, including Facebook, Instagram and Twitter. Two days later, a glitchy ten-second video of a snake was uploaded to her social accounts; two more such videos were posted in the next couple of days. On August 23, 2017, Swift made posts across her social media, introducing "Reputation" as her upcoming sixth album, and added that its lead single, "Look What You Made Me Do" would come out the following night.


title: Reputation (album)

text: During her seclusion from social media, Swift worked on her sixth studio album with two production teams: one with pop rock producer Jack Antonoff, and the other with Swedish producers Max Martin and Shellback. She had previously worked with all three producers on "1989". By choosing a smaller production team compared to that of "1989", Swift envisioned that the album would be more coherent but still "versatile enough to kill "1989"." She wrote the songs as a "defense mechanism" against the tumultuous media gossip targeting her during the time, and as a means to revamp her state of mind. Elaborating on the songwriting, Swift told "Rolling Stone" in a 2019 interview that she followed the songwriting for her 2014 single "Blank Space", on which she satirized her perceived image. She said, "I took that template of, OK, this is what you're all saying about me. Let me just write from this character for a second." In addition to the media commotion, love and friendship are major inspirations on the album, which corroborates Swift's trademark autobiographical storytelling through her songs.


title: Reputation (album)

text: The final cut of "Reputation" consists of 15 tracks, all of which Swift co-wrote. Martin and Shellback, the former of whom was co-executive producer with Swift on "1989", co-wrote and produced nine songs. Antonoff co-wrote and co-produced with Swift the remaining six. Swift's recording sessions with Antonoff mostly took place at his home studio in Brooklyn, with several trips to Atlanta and California for him to incorporate ideas from other producers. According to Antonoff, the sessions tried to capture Swift's emotions at a particular time, when "you can feel like you can conquer the world, or you can feel like the biggest piece of garbage that ever existed", resulting in a "very intense" record. He encouraged Swift to portray emotional honesty, which he also implemented for his previous works with other musicians including Lorde and St. Vincent. He spoke of his work experience with Swift on "Entertainment Weekly":


title: Reputation (album)

text: She is great at remembering the heart and soul of the process. Some people forget it — sometimes something works and everyone starts to rewire it. But she's really great at knowing what it's about: talking about what the hell is going on in your life and somehow finding a way to take that exact emotion and make a song out of it. That was the theme of those sessions: "Let’s just tell this story, whatever that story is, because that's the whole point."


title: Reputation (album)

text: As Swift wanted to record the album in secrecy, he kept his studio computer offline to prevent a possible internet leak, and deleted the recording trials once the mixing and mastering finalized. The tracks produced by Swift and Antonoff feature a 1980s-styled sound equipped with pulsing synthesizers and upbeat choruses. For instance, Swift and Antonoff produced the song "Call It What You Want" using an Akai MPC and a Yamaha DX7 synthesizer. He cited that the song "Look What You Made Me Do", which would be the album's lead single, "came from nowhere ... Nothing I do is really that planned." Incorporating an interpolation of "I'm Too Sexy" by English band Right Said Fred, which Antonoff felt that it would bring about a "shock" element, the song is produced using "mostly modular synth, drums, big fuzzy guitars through those EMI strips that come in in the second pre-chorus." An exception was the album's final track, "New Year's Day", which Swift and Antonoff recorded on an acoustic piano devoid of electronic sounds.


title: Reputation (album)

text: Swift referred to "Reputation" as her "most cathartic album", and called the whole album "a metaphor". She described the album's aesthetic as "evening-night", "all cityscape, darkness, full swamp witch". In 2019, Swift revealed the reason why the album's title is in all lowercase, stating that "Reputation" "felt like it wasn't unapologetically commercial". Swift also highlighted out that she played an alter ego in "Reputation", explaining "it was just so fun to play with on tour — the darkness and the bombast and the bitterness and the love and the ups and the downs of an emotional-turmoil record". The album's title alludes to many of its lyrical themes, such as handling fame and media scrutiny of celebrities. The cover artwork, which portrays Swift over a background of a tabloid publication, reinforces these themes. The title also is derived from lyrics on the songs "End Game" ("Big reputation, big reputation, ooh, you and me we got big reputations") and "Delicate" ("My reputation's never been worse"). "The New York Times" called "Reputation" a concept album.


title: Reputation (album)

text: Starkly departing from the synth-pop textures of "1989", "Reputation" incorporates thumping trap beats, R&B, "harder-edged" EDM, especially dubstep, melancholic synthesizers, and Miami bass. Greg Kot, writing for "Chicago Tribune", described the album as "another shift, this time into electropop". Neil McCormick, from "The Daily Telegraph", defined it as "brash, weaponised pop", while Sam Murphy of Junkee described "Reputation" sound as "dark trap". NPR's Ann Powers pointed out the influences of urban genres, such as hip hop and EDM, found throughout the album. Kitty Empire of "The Observer" labeled "Reputation" a "riveting R&B set". Swift explained that the album had a linear timeline, starting with how she felt when she started working on the album, and transitioning to how she feels now, with several songs inspired by the epic fantasy television series "Game of Thrones".


title: Reputation (album)

text: The opening track, "...Ready for It?", is a "pop-oriented", "electronic-inspired" electropop and industrial pop song, with a thumping bassline and elements of tropical house, rap, dubstep and trap. Swift states the song "introduces a metaphor you may hear more of throughout the rest album, which is like this kind of "Crime and Punishment" metaphor". The track is "basically about finding your own partner in crime", Swift said. "End Game", featuring American rapper Future and English singer Ed Sheeran, is a self-reflective hip hop, R&B and pop-rap slow jam. It centers around the idea of Swift wanting to be some guy's "end game" or the one that he's aiming for. Heavily manipulated by electronic elements and punctuated by strong beats, "I Did Something Bad" is a "bombastic" track with "unapologetic" lyrics that address "some of the narratives" that have surrounded Swift, incorporating a funky dubstep drop. The song was initially developed on a piano. Swift explained to fans at a secret session with audio released on iHeartRadio that the idea for the production of the song came to her in a dream. Swift described the concept to producer Max Martin, who used Swift's voice and pitched it down to create the desired effect in the post-chorus. The song's lyrics were inspired by events taking place in the season 7 finale episode of "Game of Thrones" and four of the series' central female characters: Sansa Stark, Arya Stark, Daenerys Targaryen, and Cersei Lannister.


title: Reputation (album)

text: "Don't Blame Me" is a moody, atmospheric, "thunderous" electropop and gospel pop song with a dark, "thick" production of slick synthesizers, echoes and self-harmonization. Swift's vocal performance in the song has been described as "fierce", backed by gothic "love-as-a-drug" imagery in its lyrics. "Delicate" is a melodic "electro-ballad" and love song, with tropical house and dance-pop inflections, and a notable resonant refrain. Swift's goal for the song was to use a vocoder to create an "emotional" and "vulnerable" sound for the track. The song is about "what happens when you meet somebody that you really want in your life and then you start worrying about what they've heard before they met you".


title: Reputation (album)

text: The sixth track, "Look What You Made Me Do", started out as a poem and is "about realizing that you couldn't trust certain people, but realizing you appreciate the people you can trust." It interpolates the song "I'm Too Sexy" by the British dance-pop group Right Said Fred. Another "Game of Thrones"-inspired track, the line "I've got a list of names and yours is in red, underlined" acts as a reference to Arya Stark's kill list in the show. The melodramatic Power Ballad "So It Goes..." opens with a murky segment and advances into a trap-lite chorus. Lyrically, it sees Swift "getting caught up in the moment" and "reflecting on just how a new love interest might help her out of her fixations", using a magician imagery. "Gorgeous" has been described as a "fizzy" and "delightful", radio-friendly pop song, that depicts "the pursuit of a maddening love interest", whom Swift describes as "gorgeous". The song has an electropop production that employs an 808 drum, over a bubbling, chime-like beat. The baby voice featured in the song's intro is a sample of that of James Reynolds, daughter of Blake Lively and Ryan Reynolds.


title: Reputation (album)

text: "Getaway Car" is a cinematic synth-pop number with a shimmering '80s production, reminiscent of the sounds of "1989" (2014). The song sees Swift performing a metaphorical heist, through an "ill-fated love adventure", attempting to leave a "doomed" relationship for someone else, using a crime scene escape imagery. Swift also mentions Bonnie and Clyde in the lyrics. "King of My Heart" is a synth-heavy track, which Swift structured such that each individual section of the song was its own phase of a relationship, with the sections getting deeper and more fast-paced as the song went on. Once again, the song's lyrics were inspired by "Game of Thrones" and its characters, specifically the romantic relationship between Daenerys and Khal Drogo, whereas the programmed drums in the song were influenced by the drums played by the Dothraki, a clan in the series.


title: Reputation (album)

text: The eleventh track, "Dancing With Our Hands Tied", begins as a melancholic downtempo song that discusses Swift's "will-we-won’t-we tale" of star-crossed lovers, "separated by an unkind fate", and also sees her singing about how "her every action is under the microscope". The sultry R&B "Dress" contains Swift's breathy vocals, with lyrics that she "came up with like a year before". It has been described as Swift's "most overtly sexual work yet" and "sexiest song to-date", bringing out "her sensual side at last". Opening with a siren sound, "This Is Why We Can't Have Nice Things" heavily references Swift's highly publicized feud with American rapper Kanye West and television personality Kim Kardashian. The song is a "stomping call-out of the haters", and features "a burst" of Swift's laughter.


title: Reputation (album)

text: The fourteenth track, "Call It What You Want", was recorded at Antonoff's home studio in Brooklyn. Swift said the song best represents her then emotional state. The song has been described as a "slow-burning meditation" and the "most by-the-book Swift song", filled with lyrical puns. It is a "stark" synth-pop love song, in which Swift raps softly over a production "made with an MPC, live kick, dx7 strings", sampling her voice in the intro and throughout, "making her voice into an instrument". "Reputation" concludes with the country tune "New Year's Day", which explores the flip-side of the romanticism of a New Year's Eve kiss, and is about how "the one that sticks around the next day" to "give you Advil and clean up the house" is the person that matters more. The track is a tender, intimate, acoustic piano ballad and love song, with lyrics acting as "evocative" snapshots, such as: "glitter on the floor after a party", "candle wax and polaroids on the hardwood floor", and "holding hands in the backseat of a taxi".


title: Reputation (album)

text: "Reputation"s cover art was photographed by Mert and Marcus in London. The cover features Swift in her signature image of lipstick, slicked-back hair, grey sweatshirt, and choker necklace. Newspaper headlines and columns are superimposed over one side of her face, which is a mockery at media that plagued her life. The typeface used for the headlines is reminiscent of the signature font of "The New York Times". "Billboard"'s Tatiana Cirisano listed the album cover as one of the worst of 2017. Target released two 72-page magazines that contain different content, including the album in the US. Walmart distributed it in Canada. The magazines contain photos, handwritten lyrics, poetry and paintings by Swift. The "Reputation Vol. 1" magazine cover was shot by Mert and Marcus. "Vol. 2" was shot by Benny Horne and features Swift in a camouflage jacket.


title: Reputation (album)

text: Following her social media blackout, Swift first announced through Instagram on August 23, 2017, that her sixth album would be titled "Reputation" and released on November 10, 2017. The album's lead single, "Look What You Made Me Do", was released the next day on August 24. On September 2, Swift teased a second song during ABC's "Saturday Night Football" telecast and was later posted on Instagram, titled "...Ready for It?", previewing the new track. The song was released on September 3, 2017, as a promotional single. On October 20, 2017, Swift released a third song titled "Gorgeous" at midnight as a promotional single. A track named "Call It What You Want" was released on November 2, 2017, as a promotional single with an accompanying lyric video.


title: Reputation (album)

text: On November 7, Bloomberg reported the album would be kept off streaming services upon release for an undetermined amount of time and would only be available to purchase in digital and physical formats. Later that same day, Swift posted the album's track list to her social media accounts. "Reputation" became available to streaming services on December 1, 2017. Digital purchases were initially exclusively sold through iTunes and as a full album only. Streaming was limited to a branded internet radio station on iHeartRadio's website and app until December 2017.


title: Reputation (album)

text: "Reputation" was Swift's last studio album to be released under Big Machine Records. In November 2018, Swift departed Big Machine Records for Republic Records.


title: Reputation (album)

text: In August 2017, United Parcel Service (UPS) announced it would be the "Official Delivery Partner" for "Reputation". UPS trucks in select cities featured the "Reputation" album cover, and fans were encouraged to take pictures of the trucks and post images to Twitter with a hashtag for an "improved opportunity" to buy concert tickets.


title: Reputation (album)

text: A month before the album's release, Swift hosted exclusive secret sessions in London, Rhode Island, Los Angeles and Nashville. She said, "Everything about this album is a secret." Each party had a number of attendees, with a total of 500 fans chosen from around the world, for whom the album was played but none of them leaked any music. The behind the scenes footage for the sessions was released on November 7 on ABC's "Good Morning America". Swift partnered with AT&T to produce a multi-part behind-the-scenes series chronicling the making of "Reputation", titled "The Making of a Song". The online series started on November 1 on AT&T's YouTube channel.


title: Reputation (album)

text: On November 9, a performance of the song "New Year's Day" was premiered during the broadcast of an episode of ABC's "Scandal". It was filmed in one of the secret sessions, held at Swift's home in Rhode Island on October 18, with an audience of 100 fans. An extended version of Swift's performance was aired on November 10, during "The DUFF"s air on Freeform. On November 11, Swift was the musical guest on the fifth episode of the 43rd season of "Saturday Night Live", where she performed "...Ready for It?" and "Call It What You Want" from the album. It was her first appearance on live television following the album's release, and her first appearance on the show since 2009.


title: Reputation (album)

text: On August 24, 2017, "Look What You Made Me Do" was released as the lead single from "Reputation". The song broke several major records including the most Spotify streams in a 24-hour period by any artist. It hit number one on the US "Billboard" Hot 100 with the biggest sales and streaming figures of the year, becoming the fifth song by Swift to top the chart and also the first solo number one by a woman with 84.4 million streams since Adele's "Hello" in 2015 and the second biggest after "Harlem Shake" (103.3 million). Its accompanying music video later premiered at the 2017 MTV Video Music Awards and was viewed 43.2 million times on YouTube in its first 24 hours, the most in any video in history breaking the 36 million views of "Gentleman" in 2013.


title: Reputation (album)

text: On September 2, 2017, Swift teased on Instagram that the opening track off of "Reputation", titled "...Ready for It?", was going to be released as a promotional single. It was made available for digital download with the pre-order of "Reputation" on September 3. Upon release, the song landed inside the top-10 of singles charts worldwide, including its entry at number four on the "Billboard" Hot 100. On October 24, "...Ready for It?" was upgraded into the album's second single, impacting US rhythmic contemporary radio; its official music video premiered three days later.


title: Reputation (album)

text: "End Game", featuring Ed Sheeran and Future, was released to French radio on November 14, 2017, as the album's third single. The song's music video was released in January 2018 after Sheeran confirmed its existence in early December 2017.


title: Reputation (album)

text: "New Year's Day" was serviced to American country radio as the album's fourth single on November 27, 2017.


title: Reputation (album)

text: "Delicate" was sent to contemporary hit and adult contemporary radio as the album's fourth international single on March 12, 2018. Its music video premiered at the 2018 iHeartRadio Music Awards. It was the second single from "Reputation" to enter the top 10 of "Billboard" Radio Songs chart (peaking at number two), after lead single "Look What You Made Me Do". A strong radio success, "Delicate" topped the "Billboard" Pop Songs chart, and was "Reputation" first number-one single on the "Billboard" Adult Pop Songs and Adult Contemporary charts. It became the biggest single from "Reputation" on the US radio. "Delicate" peaked at number 12 and spent 35 weeks on the "Billboard" Hot 100, the longest-charting single from the album as well. It was one of the 10 most successful songs on US airplay of 2018, culminating 2.509 billion radio audience impressions.


title: Reputation (album)

text: On October 19, 2017, Swift announced she would be releasing a new song titled "Gorgeous". It became available the next day through digital retailers and streaming services as a promotional single from the album. The song reached the top ten in Canada and Australia and the top twenty in the United Kingdom and United States. BBC Radio 1 added the song to its playlist on January 12, 2018.


title: Reputation (album)

text: On November 2, 2017, Swift announced she would be releasing the second promotional song from "Reputation", while posting teasers on her official Twitter and Instagram accounts. The track, titled "Call It What You Want" was released at midnight on November 3, 2017.


title: Reputation (album)

text: In August 2017, Swift partnered with Ticketmaster for a bundling program, with people wishing to buy her concert tickets could gain priority by purchasing merchandise and pre-ordering "Reputation". On November 13, 2017, Swift announced she would be embarking on the Reputation Stadium Tour in 2018 in support of "Reputation", first announcing North American dates. The tour began on May 8, 2018, at the University of Phoenix Stadium in Glendale, Arizona, and concluded on November 21, 2018, at the Tokyo Dome in Tokyo, Japan, with a total of 53 dates in stadiums throughout North America, Europe, Oceania and Asia. A concert film of the tour was released on Netflix on December 31, 2018, and it was filmed during the last concert of the North American leg, on October 6, 2018 at AT&T Stadium in Arlington, Texas.


title: Reputation (album)

text: "Reputation" received generally positive reviews from music critics. Most reviewers praised Swift's mature artistry, while some denounced the themes of fame and gossip. At Metacritic, which assigns a normalized rating out of 100 to reviews from professional publications, the album received a weighted average score of 71 based on 28 reviews.


title: Reputation (album)

text: "The Guardian" writer Alexis Petridis opined "Reputation", "may be mired in bitterness and gossip, but the pop star's songwriting smarts and lyrical prowess are impossible to deny on her sixth album", noting the songs see "Swift cutting her last ties with her Nashville roots in favour of the blare and honk of EDM-influenced pop". "Rolling Stone"s Rob Sheffield writes "Reputation", "shows the darker, deeper side of the pop mastermind". Sheffield also remarked, "As one of the all-time great pop masterminds, she's trying something new, as she always does." Roisin O'Connor of "The Independent" says "Call It What You Want" is "arguably, the best song Swift has ever made", also praising Jack Antonoff's production, calling it "essential" to the album; "[Antonoff's] love of Eighties synth-pop is the perfect counterbalance to Max Martin and Shellback's dance and electronic touch". Neil McCormick of "The Daily Telegraph" states, ""Reputation" is a big, brash, all-guns-blazing blast of weaponised pop that grapples with the vulnerability of the human heart as it is pummelled by 21st-century fame." McCormick continued, "This is an album with blockbuster event status, preceded by a satirical hit ("Look What You Made Me Do") in which she provocatively ditched her "girl-next-door" image for something more glamorously sophisticated." Troy Smith from "The Plain Dealer" said the album served as a reminder of Swift's songwriting talent, labeling "New Year's Day", "End Game", "Delicate" and "Dress" as standouts of the album.


title: Reputation (album)

text: In a negative review, Geoff Nelson of "Consequence of Sound" gave the album a D+ rating, and wrote "Reputation" is "a bloated, moving disaster" that "doesn't improve past its initial singles" and added "Swift finds trouble: She raps, she adopts African-American Vernacular English, and she bizarrely collaborates with Future." Nelson called "Gorgeous", "Delicate", and "Call It What You Want" the "strongest moments on the album". "Consequence" later self-criticized this review in 2022 for being excessively harsh and influenced by Swift's negative press in 2017, saying "in no way is ["Reputation"] a D+ record. Taylor Swift of 2017 deserved better from the media at large, and this album deserves a much better score. Time has proven it."


title: Reputation (album)

text: Worldwide, "Reputation" sold two million copies in its first week. In the U.S., the album sold roughly 700,000 copies after one day of availability, and 1.05 million within four days of release. "Reputation" ultimately became Swift's fifth number-one album on the US "Billboard" 200, debuting at number one with first-week figures of 1,238,000 album-equivalent units that consisted of 1,216,000 pure sales. It was her fourth album to sell a million copies in its first week, making Swift the first artist to have four albums each sell more than a million copies within one week since Nielsen SoundScan began tracking sales in 1991. It sold more than all other albums on the chart that week combined.


title: Reputation (album)

text: The album spent a total of four non-consecutive weeks at number one. It was the fourth to spend three or more weeks atop the "Billboard" 200 in 2017, after "Starboy" by The Weeknd, "More Life" by Drake, and "Damn" by Kendrick Lamar. Selling 1,903,000 copies by the end of 2017, "Reputation" was the best-selling album of the year in the U.S. In terms of total album-equivalent units, it earned 2,336,000 units, the year's third largest overall consumption behind Lamar's "Damn" and Ed Sheeran's "÷". It was 2018's "Billboard" 200 Year-End number-one album. By July 2019, the album had sold 2.23 million copies in the U.S. "Reputation" was certified 3× Platinum by the Recording Industry Association of America (RIAA) for surpassing three million album consumption units.


title: Reputation (album)

text: In Canada, "Reputation" was Swift's fifth number-one album on the Canadian Albums Chart. With first-week sales of 80,000 copies (81,000 album-equivalent units in total), it had the largest opening for an album in 2017. It spent three consecutive weeks atop the Canadian Albums Chart. The album sold 65,000 copies in the U.K. within three days, and opened atop the UK Albums Chart with 84,000 copies, becoming Swift's third UK number-one album. The album was certified Gold by the British Phonographic Industry (BPI).. By November 2022, the album had sold 550,000 copies on the UK. "Reputation" also peaked atop the albums charts in European and Oceanic countries including Australia, Austria, Ireland, the Netherlands, New Zealand, Norway, Portugal, Slovakia, Spain, and Switzerland. It was certified triple platinum in Australia, double platinum in New Zealand, and platinum in Austria.


title: Reputation (album)

text: "Reputation" also achieved success in Asia. It became one of the best-selling digital albums in China, having sold over one million units as of August 2019. The album was certified platinum in Singapore and gold in Japan, where it peaked at number three on the Japanese Oricon albums chart. According to the International Federation of the Phonographic Industry (IFPI), "Reputation" was the world's second-best-selling album of 2017, with 4.5 million copies sold.


title: Reputation (album)

text: Released after a period of immense media and internet scrutiny of Swift, including the first documented use of #Isoverparty, "Reputation" is regarded as a comeback album by critics and fans alike. The lead single, "Look What You Made Me Do", released after a year of hiatus from public spotlight, is considered as one of pop music's most memorable moments, bolstered by its music video. Prior to the song's release, Swift cleared out her website and all her social media, including Facebook, Instagram and Twitter. Two days after the blackout, cryptic, glitchy and caption-less snake videos were uploaded to her social media, leading to the announcement of the album and its lead single. "Reputation" "social media blackout" promotional campaign set a precedent for other pop stars to emulate.


title: Reputation (album)

text: In a retrospective review "Forbes" Bryan Rolli noted that the "songs on "Reputation" have aged much better than ... initially predicted" In 2018, Rolli backtracked on an initial assessment of Swift as being unrelatable, following the release of sales data for the album's corresponding tour. Similarly, Jason Lipshutz, executive director at "Billboard", claimed that "Taylor Swift's "Reputation" will age extremely well – possibly better than "1989"." Lyndsey McKenna, in an "NPR Music" roundtable discussion, argued that there would be no "Folklore" "without her experiments with hip-hop on "Reputation"." In 2022, "Consequence" published an article titled "What Were We Thinking? 15 Times We Were Wrong" and receded on its 2017 negative review of "Reputation", opining that the album spoke to Swift's self-awareness and showed her evolution as a lyricist and a producer.


title: Reputation (album)

text: "Esquire" Lauren Kranc stated that "[w]hat should have been clear at the time is none of the music on "reputation" is political or specifically media-blasting at all ... "reputation" is Taylor reclaiming her own narrative. ... "reputation" was a risk, a revolution, even, but it was one she bulldozed." Cheyenne Roundtree, writing for "The Daily Beast", applauded Swift for "no longer [being] some lovestruck pushover," while Georgie Wright, writing for "i-D", questioned whether it was time to "forgive" Swift. According to "Impact", Swift went through character assassination in 2016, bringing "the worst of the media-induced storm for [Taylor Swift] ... [and] the unnecessary bashing of Swift on social media," which she successfully "churned up more than the expected accolades and trophies, giving her a whole new attitude and ... a different reputation." Jadey O'Regan, senior music lecturer at University of Sydney commented for "ABC News" that Swift used "the art of pop in the best way" with "Reputation," acknowledging "the way she’s been stereotyped in popular culture."


title: Reputation (album)

text: Jennifer Kaytin Robinson, writer and director of 2022 teen comedy film "Do Revenge", stated that "Reputation" inspired the film's themes and characters.


title: Krishna (Telugu actor)

text: Ghattamaneni Siva Rama Krishna Murthy (31 May 1943 – 15 November 2022), known mononymously as Krishna, was an Indian actor, director and producer known for his works predominantly in Telugu cinema. In a film career spanning five decades, he starred in more than 350 films in a variety of roles. He is referred to as "Superstar" in the Telugu media. In 2009, the government of India honoured him with the Padma Bhushan for his contributions to Indian cinema. He was elected as a Member of Parliament for the Congress party in 1989. In 1997, he received the Filmfare Lifetime Achievement Award – South in addition to Honorary doctorate from Andhra University in 2008. He died on 15 November 2022 due to cardiac arrest.


title: Krishna (Telugu actor)

text: Krishna began his film career with minor roles in films such as "Kula Gothralu" (1961), "Padandi Mundhuku" (1962), and "Paruvu Prathishta" (1963). He debuted as a lead actor with the 1965 film "Thene Manasulu" and went on to star in films such as "Sakshi" (1967), which won critical acclaim at the Tashkent film festival in 1968. In 1972, he starred in "Pandanti Kapuram", which garnered the National Film Award for Best Feature Film in Telugu for that year. He has essayed roles across different genres including mythological, drama, western, fantasy, action, spy and historical films.


title: Krishna (Telugu actor)

text: Krishna was credited with producing many technological firsts in the Telugu film industry such as the first Cinemascope film – "Alluri Seetarama Raju" (1974), the first Eastmancolor film – "Eenadu" (1982), the first 70mm film – "Simhasanam" (1986), the first DTS film – "Telugu Veera Levara" (1995) and introducing cowboy genre to the Telugu screen. He starred in the spy films "Gudachari 116" (1966), "James Bond 777" (1971), "Agent Gopi" (1978), "Rahasya Gudachari" (1981) and "Gudachari 117" (1989). Krishna directed "Sankharavam" (1987), "Mugguru Kodukulu" (1988), "Koduku Diddina Kapuram" (1989), "Bala Chandrudu" (1990) and "Anna Thammudu" (1990), casting his son Mahesh Babu in pivotal roles. Krishna directed 17 feature films and produced many films under his Padmalaya Studios production company along with his brothers Adiseshagiri Rao and Hanumantha Rao. Krishna was one of the highest-paid Telugu actors during his time.


title: Krishna (Telugu actor)

text: Krishna collaborated with several notable directors of the time such as Adurthi Subba Rao, V. Madhusudhana Rao, K. Viswanath, Bapu, Dasari Narayana Rao and K. Raghavendra Rao. He also has the record of pairing up with the same actress for more than 48 films with Vijaya Nirmala and 47 films with Jaya Prada. In December 2012, at the age of 69, Krishna announced his retirement from politics.


title: Krishna (Telugu actor)

text: Krishna was born on 31 May 1943 in Burripalem, Guntur district of present-day Andhra Pradesh. His parents are Ghattamaneni Nagaratnamma, Veera Raghavayya Chowdary.


title: Krishna (Telugu actor)

text: Krishna was married twice, first to Indira Devi and subsequently to Vijaya Nirmala. He had five children in his first marriage: two sons, film producer Ramesh Babu and actor Mahesh Babu, and three daughters, Padmavathi, Manjula Ghattamaneni, and Priyadarshini. Krishna met Vijaya Nirmala on the sets of "Sakshi" (1967). The pair worked together in over 40 films.


title: Krishna (Telugu actor)

text: His career began with minor roles in films such as "Kula Gothralu" (1961), "Padandi Mundhuku" (1962), and "Paruvu Prathishta" (1963). He was then cast in "Thene Manasulu" (1965) as one of the male leads. Despite commercial pressure being placed on Adurthi Subba Rao, the film director, to drop Krishna, the film was released as originally planned. It was a success and Adurthi repeated the cast for his next film "Kanne Manasulu" (1966).


title: Krishna (Telugu actor)

text: Krishna was also selected to play the lead role in Doondi and Sunderlal Nehta's hit movie "Gudachaari 116" (1966), which brought the spy genre of films to the forefront in Telugu cinema. Though action films were his standard, Krishna also acted in films such as "Marapurani Katha" (1967), "Atthagaaru Kotthakodalu" (1968), and "Undamma Bottu Pedatha" (1968). He also worked with more established actors, such as N. T. Rama Rao and Akkineni Nageswara Rao, in films such as "Stree Janma" (1967), "Niluvu Dopidi" (1968), "Manchi Kutumbam" (1968), "Vichithra Kutumbam" (1969), "Akka Chellellu" (1970) during this period.


title: Krishna (Telugu actor)

text: At this time, Krishna established his own production house, Padmalaya Films and produced several big-budget films such as "Agni Pariksha" (1970), "Mosagallaku Mosagadu" (1971), "Pandanti Kapuram" (1972), "Devudu Chesina Manushulu" (1973), "Alluri Seetharama Raju" (1974). With his second wife Vijaya Nirmala, Krishna also set up another production house called Vijaya Krishna movies, and produced some critically acclaimed films, including "Meena" and "Devadasu" (1974). "Mosagallaki Mosagadu", which brought the Cowboy genre of films in 1971 and "Alluri Seetharamaraju", which released in 1974 were sensational in many ways. In 1975, except for "Cheekati Velugulu", none of his films of this time made any impact at the box office as people were reluctant to watch him in softer roles after his portrayal of Alluri Seetharama Raju in the eponymous film. He suffered 14 consecutive flops (Devadasu also one of them) after the release of "Alluri Seetarama Raju".


title: Krishna (Telugu actor)

text: In 1976, he produced "Paadi Pantalu", written by Maharadhi Tripuraneni, "Raja Rajeswari Vilas Coffee Club", and "Rama Rajyamloo Raktha Paasam". He also appeared as an actor in "Kolleti Kapuram", "Bhalee Dongalu" and "Devudee Gelichaadu".


title: Krishna (Telugu actor)

text: In the 1977 film "Kurukshethram", based on the "Mahabharata" epic, he appeared as Arjuna. Between 1978 and 1986, he acted in films such as "Anna Dammula Sawaal", "Kumara Raja", "Agent Gopi", "Indradanassu", "Allari Bulloodu", "Sakthi" and "Agni Parvatam". In 1986, he directed two films, "Simhaasanam" and "Shankharavam".


title: Krishna (Telugu actor)

text: In "Naa Pilupee Prabhanjanam", he satirised the political party Telugu Desam Party, which led to protests by party officials against screening the film.


title: Krishna (Telugu actor)

text: 1990 started with average fares; "Nagaasthram" and "Anna Thammudu". Krishna took his longest break from work after "Raktha Tharpanam", his last directorial venture in Telugu, tanked at the marquee. Ramesh's failure to capitalize on his blockbuster "Bazaar Rowdy" would have presumably upset him further during those unsettling times. In 1993, he came back strongly with the unexpected super-success of "Pacchani Samsaaram". But it was "Varasudu", his second release in the year, which made him the cynosure of the film fraternity again. With the films "Number 1" (1994) and "Amma Donga" (1995) he had other thumping successes. Krishna also directed the Hindi film "Ishq Hai Tumse" (2004) produced by Padmalaya Tele films, starring Dino Morea and Bipasa Basu, which is the remake of the Telugu film "Sampangi" in the year 2004.


title: Krishna (Telugu actor)

text: Andhra University felicitated Mr. Krishna with an honorary doctorate in 2008. For the recognition of his contribution to Telugu film industry as an actor, director, producer, writer government of India gave him Padma Bhushan in 2009.


title: Krishna (Telugu actor)

text: Krishna joined the congress under Rajiv Gandhi's leadership, ran in the 1989 elections from the Eluru Parliament Constituency, and won the seat. NTR was leading the National Front at the time Krishna joined, when NTR was at the pinnacle of his political career. By a margin of 71,000 votes, he defeated Bolla Bulliramaiah, the TDP's incumbent MP. However, Krishna was defeated by Bulliramaiah in the ensuing 1991 election by a margin of 47,000 votes.


title: Krishna (Telugu actor)

text: On 14 November 2022, Krishna suffered from a heart attack and was rushed to a hospital in Hyderabad. His health started deteriorating and was on a ventilator. He died during the early hours on 15 November at the age of 79. On 16 November 2022, Krishna was cremated with full state honours.


title: Hairspray (2007 film)

text: Hairspray is a 2007 musical romantic comedy film based on the 2002 Broadway musical of the same name, which in turn was based on John Waters's 1988 comedy film of the same name. Produced by Ingenious Media and Zadan/Meron Productions, and adapted from both Waters's 1988 script and Thomas Meehan and Mark O'Donnell's book for the stage musical by screenwriter Leslie Dixon, the film was directed and choreographed by Adam Shankman and has an ensemble cast including John Travolta, Michelle Pfeiffer, Christopher Walken, Amanda Bynes, James Marsden, Queen Latifah, Brittany Snow, Zac Efron, Elijah Kelley, Allison Janney, and Nikki Blonsky in her feature film debut. Set in 1962 Baltimore, Maryland, the film follows the "pleasantly plump" teenager Tracy Turnblad (Blonsky) as she pursues stardom as a dancer on a local television dance show and rallies against racial segregation.


title: Hairspray (2007 film)

text: The film began development in 2004, and Dixon reworked Meehan and O'Donnell's first draft of the screenplay to tone down the musical's campiness. In 2005, Shankman agreed to direct the film. Composer/lyricist Marc Shaiman and lyricist Scott Wittman reworked their songs from the Broadway musical for the film's soundtrack, and also wrote four new songs for the film. Principal photography commenced in September 2006 with a budget of $75 million, and ended in December of that year; filming took place on locations in Toronto and Hamilton, Ontario, Canada and on soundstages at Toronto's Showline Studios. Recording sessions for the film's songs and soundtrack took place in San Diego, California in the United States.


title: Hairspray (2007 film)

text: "Hairspray" premiered on July 10, 2007, at the Mann Village Theater and was released on July 20, 2007, in the United States and the United Kingdom. The film was critically and financially successful, breaking the record for biggest sales at opening weekend for a movie musical, which the film held until July 2008 when it was surpassed by "Mamma Mia!" and later "" in October. "Hairspray" went on to become the tenth highest grossing musical film in US cinema history, behind the film adaptations of "Grease", "Chicago", and "Mamma Mia!", and stands as one of the most critically and commercially successful musical films of the 2000s. Available in a variety of formats, "Hairspray"s Region 1 home video release took place on November 20, 2007. USA Network purchased the broadcast rights to "Hairspray" and was scheduled to debut the film on cable television in February 2010, but in the end it did not broadcast that month. Instead the film was pushed back and premiered on USA on July 24, 2010, with sister channel Bravo also showing it multiple times, and in February 2011 aired on ABC for over-the-air broadcasts.


title: Hairspray (2007 film)

text: In 1962, Tracy Turnblad is a 16 year old heavyset high school student living in Baltimore. Along with her best friend Penny Pingleton, Tracy frequently watches "The Corny Collins Show", a local teen dance television show. The dancers from "Corny Collins" attend Tracy and Penny's high school, among them lead dancers Amber von Tussle and her boyfriend Link Larkin. Amber's mother, Velma, manages the station WYZT, ensuring that Amber is prominently featured. Corny Collins and the dancers on the show are white, and Velma only allows African-American dancers on the show once a month on "Negro Day", hosted by local R&B disc jockey Motormouth Maybelle.


title: Hairspray (2007 film)

text: One of the dancers on the show takes a leave of absence, and auditions for a replacement are held the next day. Tracy attends, but Velma rejects her for her overweight physique and support of integration. Tracy is given detention for missing class in order to attend the audition, and discovers the "Negro Day" kids practicing in the detention room. Tracy befriends Motormouth Maybelle's son, Seaweed, who teaches her Tracy several dance moves. As Tracy leaves detention, she inadvertently meets Link, and dreams of a life with him. At a record hop, Tracy's new moves garner Corny's attention, and he chooses her to join the show.


title: Hairspray (2007 film)

text: Tracy quickly becomes one of Corny's most popular performers, affecting Amber's chances of winning the show's annual "Miss Teenage Hairspray" pageant and her relationship with Link, as he grows fonder of Tracy. Mr. Pinky enlists Tracy as the spokesgirl for his Hefty Hideaway boutique. Tracy persuades her agoraphobic mother, Edna, to accompany her to the boutique as her agent.


title: Hairspray (2007 film)

text: Tracy introduces Seaweed to Penny, and the two become smitten. Later, Seaweed and his younger sister Little Inez take Tracy, Penny, and Link to a party at Maybelle's store. Edna finds Tracy there and tries taking her home, but Maybelle convinces her to stay, and tells her to take pride in herself. At the party, Maybelle informs everyone that Velma has cancelled "Negro Day", and Tracy suggests that they march for integration. Link is unwilling to jeopardize his career by marching, straining his relationship with Tracy. Edna returns to her husband Wilbur's shop, but Velma gets there first, and tries to seduce him. After accusing Wilbur of infidelity, Edna forbids Tracy to be on the show, which was Velma’s intention. She changes her mind after she and Wilbur reconcile.


title: Hairspray (2007 film)

text: The next morning, Tracy sneaks out of the house to join the protest, which is halted by a police roadblock. The protesters engage in a brawl, while Tracy runs to the Pingletons' home, where Penny allows her to hide in a fallout shelter. However, Penny's mother Prudy reports Tracy to the police and ties her daughter to her bed for "harboring a fugitive". Having been bailed out by Wilbur, Seaweed and his friends help Tracy and Penny escape. Link visits Tracy's house to find her, and realizes that he loves her. Seaweed and Penny also acknowledge their love during the escape.


title: Hairspray (2007 film)

text: With the pageant underway, Velma assigns police officers to guard the WYZT studio to prevent Tracy from entering. She also rigs the pageant tallies to guarantee that Amber will win. Penny arrives at the pageant with Edna, while Wilbur, Seaweed, and the Negro Day kids help Tracy infiltrate the studio. Link breaks away from Amber to dance with Tracy; later, he pulls Little Inez to the stage to dance in the pageant.


title: Hairspray (2007 film)

text: Amber's attempt to re-claim her championship crown fails. Little Inez wins the pageant after a late surge of support, successfully integrating "The Corny Collins Show". Velma tells Amber about her rigging scheme in front of a camera manned by Edna, resulting in her firing. "The Corny Collins Show" set turns into a celebration as Tracy and Link kiss.


title: Hairspray (2007 film)

text: In addition to the principal actors, the film contained several cameo appearances by individuals involved in the history of "Hairspray":


title: Hairspray (2007 film)

text: Music producer/composer/co-lyricist Marc Shaiman and co-lyricist Scott Wittman were required to alter their Broadway "Hairspray" song score in various ways in order to work on film, from changing portions of the lyrics in some songs (e.g., "(The Legend of) Miss Baltimore Crabs", "Big, Blonde, and Beautiful", and "You Can't Stop the Beat") to more or less completely removing other songs from the film altogether.


title: Hairspray (2007 film)

text: "Mama, I'm a Big Girl Now", a popular number from the stage musical, features Tracy, Penny, and Amber arguing with their respective mothers. Neither Shankman nor Dixon could come up with a solution for filming "Mama" that did not require a three-way split screen — something they wanted to avoid — and both felt the number did not adequately advance the plot. As a result, "Mama" was reluctantly dropped from the film during pre-production, although it is used by Shaiman as an instrumental number when the "Corny Collins" kids dance the "Stricken Chicken". A special version of "Mama" was recorded for the film's end credits in May 2007, during the final score recording process, which featured vocals from each of the three women most famous for portraying Tracy Turnblad: Ricki Lake from the 1988 film, Marissa Jaret Winokur from the original Broadway cast, and Nikki Blonsky from the 2007 film. Harvey Fierstein, who portrayed Edna as part of the original Broadway cast, has a brief cameo moment in the end credits version of "Mama" as well.


title: Hairspray (2007 film)

text: "It Takes Two", a solo for Link, was moved from its place in the stage musical (on Tracy's first day on "The Corny Collins Show") to an earlier "Corny Collins" scene, although only the coda of the song is used in the final release print, and the song's background music can be heard immediately after the reprise of "The Nicest Kids in Town". "Cooties", a solo for Amber in the stage musical, is present in this film as an instrumental during the Miss Teenage Hairspray dance-off. As with "Mama, I'm a Big Girl Now", a version of "Cooties", performed in a contemporary pop rendition by Aimee Allen, is present during the end credits.


title: Hairspray (2007 film)

text: The performance of a vintage dance called The Madison, present in both the 1988 film and the stage musical, was replaced for this version by a newly composed song, "Ladies' Choice". Portions of the Madison dance steps were integrated into the choreography for the musical number "You Can't Stop the Beat", and the song to which the dance is performed on Broadway can be heard during Motormouth Maybelle's platter party in the film, re-titled "Boink-Boink". "The Big Dollhouse", "Velma's Revenge" (a reprise of "Miss Baltimore Crabs"), and the reprise of "Good Morning Baltimore" were the only numbers from the musical not used in the film in any way.


title: Hairspray (2007 film)

text: Shaiman and Wittman composed two new songs for the 2007 film: "Ladies' Choice", a solo for Link, and "Come So Far (Got So Far to Go)", a song performed during the end credits by Queen Latifah, Blonsky, Efron, and Kelley. Another "new" song in the 2007 film, "The New Girl in Town", had originally been composed for the Broadway musical, but was deemed unnecessary and discarded from the musical. Director Shankman decided to use the song to both underscore a rise-to-fame montage for Tracy and to showcase Maybelle's "Negro Day", which is never actually seen in either of the earlier incarnations of "Hairspray".


title: Hairspray (2007 film)

text: One additional Shaiman/Wittman song, a ballad entitled "I Can Wait", was composed for the film as a solo for Tracy, meant to replace the stage musical's reprise of "Good Morning Baltimore". "I Can Wait" was shot for the film (Tracy performs the number while locked in Prudy's basement), but was eventually deleted from the final release print. The audio recording of "I Can Wait" was made available as a special bonus track for customers who pre-ordered the "Hairspray" soundtrack on iTunes, and the scene itself was included as a special feature on the film's DVD release.


title: Hairspray (2007 film)

text: Post-production took place in Los Angeles. Composer/co-lyricist Shaiman continued work on the film's music, employing the Hollywood Symphony Orchestra to record instrumentation for both the songs and the incidental score.


title: Hairspray (2007 film)

text: Following the success of the Broadway musical of the same name, which won eight Tony Awards in 2003, New Line Cinema, who owned the rights to the 1988 John Waters film upon which the stage musical is based, became interested in adapting the stage show as a musical film. Development work began in late 2004, while a similarly film-to-Broadway-to-film project, Mel Brooks' "The Producers", was in production.


title: Hairspray (2007 film)

text: Craig Zadan and Neil Meron, the executive producers of the Academy Award-winning film adaptation of the Broadway musical "Chicago", were hired as the producers for "Hairspray", and began discussing possibly casting John Travolta and Billy Crystal (or Jim Broadbent) as Edna and Wilbur Turnblad, respectively. Thomas Meehan and Mark O'Donnell, authors of the book for the stage musical, wrote the first draft of the film's screenplay, but were replaced by Leslie Dixon, screenwriter for family comedies such as "Mrs. Doubtfire" and "Freaky Friday". After a year's deliberation on who should direct the film, Zadan and Meron finally decided to hire Adam Shankman to both direct and choreograph "Hairspray". Upon learning he had been hired, Shankman arranged a meeting with John Waters, who advised him "don't do what I did, don't do what the play did. You've gotta do your own thing." Despite this, Shankman still noted "all roads of "Hairspray" lead back to John Waters."


title: Hairspray (2007 film)

text: Tory Gardner and his company Alterian, Inc. were hired to design and create the look of Edna Turnblad on John Travolta. Costume designer Rita Ryack wanted to put Edna into several revealing outfits, so Travolta ended up being encapsulated in prosthetics. He wore silicone prosthetics on his head and neck, and foam latex arms and legs that connected to a spandex and foam body suit.


title: Hairspray (2007 film)

text: Dixon was primarily hired to tone down much of the campiness inherent in the stage musical. The 2007 film's script is based primarily on the stage musical rather than the 1988 film, so several changes already made to the plot for the stage version remain in this version. These include dropping several characters from the 1988 version (such as Arvin Hodgepile (the role Mr. Spritzer fills), Velma's husband Franklin, Corny's assistant Tammy, the beatniks, et al.), removing the Tilted Acres amusement park from the story, and placing Velma in charge of the station where "The Corny Collins Show" is filmed.


title: Hairspray (2007 film)

text: One notable difference between the stage musical, the original film, and the 2007 film version of "Hairspray" is that Tracy does not go to jail in the 2007 version (thus eliminating the musical's song "The Big Dollhouse"). In both previous incarnations of "Hairspray", Tracy is arrested and taken to jail along with the other protesters. Edna is presented in this version as an insecure introvert, in contrast to the relatively bolder incarnations present in the 1988 film and the stage musical. Among many other elements changed or added to this version are the removal of Motormouth Maybelle's habit of speaking in rhyming jive talk and doubling the number of teens in Corny Collins' Council (from ten on Broadway to twenty in the 2007 film).


title: Hairspray (2007 film)

text: Dixon restructured portions of "Hairspray"s book to allow several of the songs to blend more naturally into the plot, in particular "(You're) Timeless to Me" and "I Know Where I've Been". "(You're) Timeless to Me" becomes the anchor of a newly invented subplot involving Velma's attempt to break up Edna and Wilbur's marriage and keep Tracy off "The Corny Collins Show" as a result. The song now serves as Wilbur's apology to Edna, in addition to its original purpose in the stage musical as a tongue-in-cheek declaration of Wilbur and Edna's love for each other. Meanwhile, "I Know Where I've Been", instead of being sung by Maybelle to the kids after being let out of jail, now underscores Maybelle's march on WYZT (which takes place in the stage musical at the end of "Big, Blonde, and Beautiful").


title: Hairspray (2007 film)

text: The song "Big, Blonde, and Beautiful" was inspired by a line that Tracy delivered in the original film ("Now all of Baltimore will know: I'm big, blonde and beautiful!"), but in the stage version and in this film, Motormouth Maybelle performs the song. A reprise of the song was added to the 2007 film, which is sung by Edna and Velma.