Nutrition Journal Body fat measurement by bioelectrical impedance and air displacement plethysmography: a cross-validation study to design bioelectrical impedance equations in Mexican adults

Nayeli Macias email@example.com
Centro de Investigación en Nutrición

Heliodoro Alemán-Mateo heliodoroalemánfirstname.lastname@example.com
División de Nutrición
Centro de Investigación en Alimentación y Desarrollo
A.C. Carretera a la Victoria km
0.6 Hermosillo1735, 8300SonoraApartado Postal, CPMéxico

Julián Esparza-Romero juliánesparzafirstname.lastname@example.com
División de Nutrición
Centro de Investigación en Alimentación y Desarrollo
A.C. Carretera a la Victoria km
0.6 Hermosillo1735, 8300SonoraApartado Postal, CPMéxico

Mauro E Valencia firstname.lastname@example.com
División de Nutrición
Centro de Investigación en Alimentación y Desarrollo
A.C. Carretera a la Victoria km
0.6 Hermosillo1735, 8300SonoraApartado Postal, CPMéxico

Instituto Nacional de Salud Pública. Universidad 655
62508Salud, Santa Maria Ahuacatitlan, CuernavacaCPMéxico

Nutrition Journal Body fat measurement by bioelectrical impedance and air displacement plethysmography: a cross-validation study to design bioelectrical impedance equations in Mexican adults
10.1186/1475-2891-6-18BioMed Central Page 1 of 7 (page number not for citation purposes) Research * Corresponding author
Background:The study of body composition in specific populations by techniques such as bioimpedance analysis (BIA) requires validation based on standard reference methods. The aim of this study was to develop and cross-validate a predictive equation for bioelectrical impedance using air displacement plethysmography (ADP) as standard method to measure body composition in Mexican adult men and women.Methods: This study included 155 male and female subjects from northern Mexico, 20-50 years of age, from low, middle, and upper income levels. Body composition was measured by ADP. Body weight (BW, kg) and height (Ht, cm) were obtained by standard anthropometric techniques. Resistance, R (ohms) and reactance, Xc (ohms) were also measured. A random-split method was used to obtain two samples: one was used to derive the equation by the "all possible regressions" procedure and was cross-validated in the other sample to test predicted versus measured values of fat-free mass (FFM).Results and Discussion:The final model was: FFM (kg) = 0.7374 * (Ht 2 /R) + 0.1763 * (BW) -0.1773 * (Age) + 0.1198 * (Xc) -2.4658. R 2 was 0.97; the square root of the mean square error (SRMSE) was 1.99 kg, and the pure error (PE) was 2.96. There was no difference between FFM predicted by the new equation (48.57 ± 10.9 kg) and that measured by ADP (48.43 ± 11.3 kg). The new equation did not differ from the line of identity, had a high R 2 and a low SRMSE, and showed no significant bias (0.87 ± 2.84 kg).Conclusion:The new bioelectrical impedance equation based on the two-compartment model (2C) was accurate, precise, and free of bias. This equation can be used to assess body composition and nutritional status in populations similar in anthropometric and physical characteristics to this sample.

Background

The importance of measuring body composition has increased, due to the need to evaluate changes in nutritional status, which can affect body reserves differentially. Subjects can gain or lose body fat, fat-free mass, bone mineral mass or cellular mass components as a result of disease, overeating, sports, or undernutrition (anorexia nervosa), or as a result of nutritional intervention programs. These changes can only be detected by using valid body composition measurement techniques. In addition, the world-wide epidemic of obesity and its association with chronic disease has also contributed to the need to study body composition [1,2]and the distribution of body components [3]. The definition of obesity based on body size has been challenged in regard to different populations, due to the different relationships of percent body fat at the same BMI levels [4]. Therefore, a definition of obesity based on body composition terms can help to clarify this issue.

In order to have good body composition estimates from bioelectrical impedance techniques, it is necessary to have proper validation based on reference methods of better accuracy and precision. Recently, it has been reported that air displacement plethysmography (ADP) is a valid method to determine body composition compared with hydrodensitometry and the four compartment model in adults [5,6]. However, these standard reference methods are difficult to implement in some clinical settings and in epidemiological studies.

It is well recognized that the BIA technique when properly validated is a practical option for these types of studies. Body composition assessment by bioelectrical impedance can be improved when the specific equations used are validated against reference methods and for a specific population [7,8]. Furthermore, validated BIA equations can overcome some limitations due to differences in fat distribution patterns and limb length (arm and leg) [9] between ethnic groups that might affect the accuracy and precision of the technique [10]. Finally, it is important to mention that most published BIA equations derive from Caucasian populations, and presently there are no published equations for Mexican adults. The aim of this study was to develop and cross-validate a predictive equation for bioelectrical impedance using air displacement plethysmography (ADP) as a standard method to measure body composition in Mexican adult men and women.

Methods

This was a cross-sectional study in healthy men and women, 20 to 50 years of age, residing in Sonora, Mexico. Participants were selected by nonprobabilistic sampling between 2000 and 2001. Pregnant and lactating women and subjects with diabetes, cardiovascular disease, or any other condition that could cause hydro-electrolytic imbalance were excluded. In addition, none of the participants were on diuretics or other medication that could alter body composition. The Ethics Committee of the Centro de Investigacion en Alimentacion y Desarrollo (CIAD: Food and Development Research Center) approved the study.

All body composition measurements were performed in CIAD's metabolic unit. Prior to the measurements, all participants signed a written consent form after being informed of procedures and purpose of the study. Subjects were asked to fast for 12 h, to not perform exercise the day before the measurements, and to empty their bladder prior to evaluation.

Human body volume, body density, and body composition were evaluated with ADP (Bod Pod, Body Composition System, Life Measurement Instruments, Concord, CA). The system determines body volume by the application of Boyle's gas law. The ADP unit consists of a dualchamber plethysmograph, an electronic scale, and a computer. This equipment has a single structure containing two chambers separated by a device that produces pressure fluctuations and volume changes that permit the assessment of body volume. The system has been described in detail elsewhere [11]. Wearing a swimsuit and acrylic swimming cap, subjects were first weighed to the nearest 0.01 kg with the ADP electronic scale. A twopoint calibration was performed, with the chamber empty and with a 50 L cylinder. After the calibration procedure, the subject's body volume was measured twice while they were seated quietly in the test chamber and breathing normally. In the second trial, thoracic gas volume was measured to correct the body volume. From the corrected body volume and body mass values, body density was obtained and percent body fat was calculated using Siri's equation and ADP software. Fat-free mass was calculated from the two-compartment model [12]. All measurements were done following the manufacturer's instructions.

The reproducibility of air displacement plethysmography system was tested using duplicate measurements in 91 subjects. The duplicate measurements were both performed during the same session. The duplicated mean body density measurements were 1.0292 ± 0.019 and 1.0296 ± 0.019, and the mean difference in body density was 0.00007. The coefficient of variation for both measurements was 1.89%. In terms of %BF, the technical error of measurement was 0.066 % fat units, assessed as (Σd2/ 2n)1/2, where d is the difference between repeated measurements and n is the number of paired repeated measurements.

Anthropometry was performed by a standardized technician according to Lohman's recommendations [13]. Body weight (BW) was measured in subjects dressed in a swimsuit using a digital electronic scale (150 ± 0.01 kg) connected to the ADP. Standing height was measured with a Holtain stadiometer to the nearest millimeter (205 ± 0.5 cm, Holtain Limited, Dyfed, UK). Body mass index (BMI, kg/m 2 ) was calculated based on weight and standing height. Waist circumference was measured in supine position at the umbilicus level, and hip circumference was evaluated in standing position at the level of the most prominent part of the gluteus. Both measurements were done with a fiberglass measuring tape (Lafayette Instruments Company Inc., USA). Waist/hip ratio (WHR) was determined from these measurements.

Resistance (R) and reactance (Xc) were measured with a bioelectrical impedance analyzer (Model BIA-103, RJL Systems Detroit, MI) according to the manufacturer's instructions. BIA equipment calibration was periodically performed with an electrical resistor. Calibration values were considered normal if they were not higher than 498 ± 2 ohms (Ω). Volunteers were instructed to lie supine with their hands at their side and with their legs separated. The skin surface was cleaned with ethanol, and the electrodes were placed on the dorsum of the right foot and hand. All measurements were performed according to Lukasky [14].

Data were analyzed using the statistical program, NCSS 2001 (Number Cruncher Statistical System for Windows, Kaysville, Utah). The t-test for independent samples was used to evaluate differences of general characteristics between men and women and also between samples. All results are expressed as means ± standard deviations (SD).

For the design of the BIA equation, the total sample (n = 155) was used in a split-sample internal cross-validation. In this approach, the sample was split randomly into subsamples of approximately the same size (78 and 77 subjects each) ( Table 2). The regression equation was developed in a randomized sample of 78 subjects. This equation had the lowest SEE and highest R 2 , and was cross-validated using the second sample of 77 subjects. Model selection was carried out using the "all possible regressions" procedure. This method guarantees finding the model having the largest R 2 and the smallest square root of MSE (SRMSE). Mallow's Cp statistic was used to optimize model selection. Multiple regression procedure was used to analyze the relation between FFM as a dependent variable with: age (years), sex (male = 1, female = 0), body weight (kg), square height (cm)/resistance (Ω) (Ht 2 /R), and reactance (Ω) as independent variables. Multicolinearity was analyzed by regression diagnostics using the condition number (CN < 30) and the variance inflation factor (VIF < 10). The pure error was calculated as the square root of the sum of squared differences between the observed and the predicted values divided by the number of subjects in the cross-validation sample [15].

Validation of the new BIA equation was done using the split-sample internal cross-validation method. Body composition was estimated in the second randomized group or validation sample (77 subjects) using the new equation developed from the first randomized group, or equation   Bias was examined using Bland and Altman's analysis [16] and regression procedures.

Results

In this study, 155 healthy adults (82 women and 73 men) were evaluated. General characteristics of the subjects are presented in Table 1. As expected, the men had significantly higher values of weight, height, waist, and waist/ hip ratio compared with the women.  Where: Ht 2 is height in cm, R is resistance in ohms, BW is body weight in kg, age is in years, and Xc is reactance in ohms

The independent variables that most accurately estimated fat-free mass were Ht2/R, BW, Xc, and age (Table 3). By partial R2 analysis, Ht2/R and body weight were the best individual predictors of FFM (kg), and accounted for 91.5% and 72.7% respectively, whereas reactance accounted for 2.56% and age for only 0.38% (Table 3). The mean values of FFM predicted by the new BIA equation and measured by ADP in the validation sample were 48.57 ± 10.9 kg and 48.43 ± 11.3 kg, respectively. There was no significant difference from the line of identity: the intercept was 0.02 and not different from zero, and the slope was 0.98 and not different from 1.0. The R 2 was 0.92 and the SRMSE was 2.86 ( Figure 1)

. Bland and Altman

Bland and Altman analysis   Figure 2). Furthermore, there was no significant association (p > 0.05) between the mean differences and the mean of two measurements (FFM obtained by ADP and the new validated equation (Figure 2).

Discussion

The equation developed in the present study is the first validated BIA equation for Mexican adults, to the authors' knowledge. We found the new equation to be accurate, precise, and free of bias. FFM, and therefore FM, values obtained with equations developed for specific populations are more accurate and precise [8], as seen in the present study. The equation developed in this study takes into account the physical and body composition characteristics of the group used to design the equation, making it more population/environment specific.

Ethnicity has been shown to be an important factor when looking at the relationships of percent body fat and BMI. Among Chinese, Malay and Indian subjects, the Chinese showed the lowest body-fat value and Indians the highest at the same BMI level [17]. In our study, the BF% by the reference method was 25.9 in men and 36.2 in women at BMI values of 25.4 and 26.2, respectively. The percent body fat for the Mexican subjects of this study seems to be more similar to that of the Asian population reported by Gallagher [4] than to that obtained from Caucasians and Afro-Americans, who have less body fat at the same BMI.

In addition to the differences in BMI, other researchers have reported fat distribution discrepancies between ethnic groups that could diminish the accuracy of body composition values obtained with BIA and anthropometric equations [18][19][20][21].

Casas et al. [21], evaluated 54 Hispanic women and 56 white women to determine whether Hispanic ethnicity is associated with total and regional adiposity and low FFM in healthy women. They found that Hispanic women have higher adiposity levels than white women. This difference reflected a higher amount of fat in the trunk. Further, abdominal and subscapular thicknesses were greater in Hispanic than in white women. These findings support the need to develop validated BIA and anthropometric equations for Hispanics. The best BIA equations developed for specific population groups have been properly validated [22][23][24].

The body composition variables selected in the final model of this study have been reported as the best predictors in BIA equations designed to estimate FFM [25][26][27].     There were no differences between the mean predicted FFM and measured values by ADP. The pure error was small and comparable to good cross-validated equations reported in the literature [15]. There is no criterion value for the pure error that indicates successful cross-validation. However, the pure error should be similar to the precision (square root of the MSE value, SRMSE) of the validated equation in the population from where it is derived. Here the pure error is slightly higher than the SRMSE, indicating that the cross-validation was successful.

Developed equation Cross-Validated equation

The new equation showed good precision. Similar findings were reported by Rising et al. [8]; the specific BIA equation developed (using hydrostatic weighing) for Pima Indians improved the average accuracy to -0.1 ± 3.3 kg versus the manufacturer's equation, which underestimated the fat-free mass by 5.3 ± 8.6 kg. Other studies have shown poor validity when equations designed and validated in one population have been used to predict FFM in other populations [29].

One of the most important justifications for designing and validating BIA estimation equations for specific groups is their differences in limb length [30]. The explanation for this could be that limb length and body weight are positively related to resistance, which is the main predictor of FFM estimated with BIA [27]. Limb length and body weight are strongly related to ethnicity and environmental factors. Deurenberg et al. demonstrated that limb length, expressed as leg length/height, influences the body composition values obtained with BIA; the length of the limbs was different among Chinese, Malays, and Indians. The authors consider the bias between TBW obtained with the deuterium dilution method and BIA values to be due to ethnic differences [30].

The regression analysis between FFM values estimated with the BIA equation validated in the present study and ADP ( Figure 1) showed that the BIA equation was accurate and precise. Furthermore, Bland and Altman analysis determined there was no significant bias for FFM values obtained with the validated equation (Figure 2). These results are those expected for an equation that is population specific.

A recent and thorough review in the assessment of body composition using ADP [6] analyzed the validity of ADP relative to hydrostatic weighing (HW) in male and female adults, age 20-56 years. Mean group differences between ADP and HW measurements ranged from -4% to 1.9 % body fat; 5 of the 12 studies showed no significant difference between the two methods. Of the other 7 studies that did show a significant mean difference, the direction of the differences was inconsistent. Percent fat measured by ADP explained 78-94 % of the variance in % body fat measured by HW and the reported SEEs ranged from 1.8 to 2.3 % and ideally the range should be < 2.5 % body fat. These authors state that, whether the sex of the subject systematically affects results from ADP or HW remains to be determined. Because males tend to be leaner than females, it is difficult to determine whether the significant effect of sex reported in some studies are due to an effect of sex per se or to body fatness. Plotting the results from different studies as sex-specific means, in Bland-Altman fashion, they observed an upward trend with no overlap in mean % body fat between females and males. Therefore they conclude that in their analysis as in the individual studies, it is impossible to separate the confounding effects of subject sex and % body fat. Even though many studies consider ADP as a reliable and valid technique applicable in a wide range of subjects including children and elderly, more validation studies are required using a 4 Compartment model as a reference gold standard rather than HW. Other studies [31] suggest that that it is important to test its accuracy in more heterogeneous samples, or in individuals outside the average % fat range, specifically lean individuals, and insist in looking at possible gender bias. In our laboratory we have previously validated ADP using a 4 Compartment model in elderly subjects [32] as well as in children and adolescents (studies in progress).

Conclusion

The new bioelectrical impedance equation based on a two-component model method was accurate, precise, and free of bias. The prediction validated equation can be used to assess body composition and nutritional status in populations having anthropometric and physical characteristics similar to this sample. However, we acknowledge the fact that there might be a problem of generality because it does not include Mexicans from all the country. Ethnic and environmental differences are the main factors that could affect the general applicability of the equation, and it should be used with caution.

Regression between fat free mass by ADP and the new equa-tion based on BIAFigure 1Regression between fat free mass by ADP and the new equation based on BIA.

FFM
(kg) by new equation based on BIA FFM (kg) by ADP

FFM (kg) = 0 .
07374 * (Ht 2 /R) + 0.1763 * (BW)-0.1773 * (Age) + 0.1198 * (Xc)-2.4658

Figure 2
2Bland and Altman analysis. Mean FFM (kg) (ADP+ new equation BIA)/2 Difference in FFM (kg) (ADP-new equation based on BIA)

2 (cm)/resistance (Ω); BW = Body weight (kg); Xc = reactance (Ω); MSE = Mean square error, SQRMSE = Square root of MSE; IV = independent variable.

Table 1 :
1General characteristics of the study group.Female (n = 82)
Male (n = 73)

Mean ± SD
Range
Mean ± SD
Range
Weight (kg)
65.7 * ± 12. 9
42.9-99.0
79.0 * ± 13.1
51.3-121
Age (years)
34.3 ± 7.6
22-48
33.9 ± 7.3
21-47
Height (m)
1.61* ± 0.05
1.45-1.80
1.73 * ± 0.05
1.58-1.8
BMI (kg/m 2 )
25.4 ± 4.4
18.2-35.5
26.2 ± 3.6
17.8-35.3
Waist
83.4* ± 12.0
60-116
91.8* ± 10.5
69-120
WHR
0.81* ± 0.08
0.63-1.1
0.90* ± 0.05
0.78-1.1

*: significant differences, p < 0.05. WHR: Waist to hip ratio

Table 2
2shows the main variables in the randomly split samples. There were no significant differences between the values from the randomized sample used for developing the equation and the randomized sample for testing it. The equation obtained was:

Table 2 :
2Some general characteristics of subjects from the split sample a .Equation Sample (n = 78)
Validation Sample (n = 77)
p

Weight (kg)
72.7 ± 15.3
71.3 ± 13.9
0.56
Age (years)
34.3 ± 7.4
34.0 ± 7.6
0.84
Height (m)
1.67 ± 0.09
1.66 ± 0.08
0.74
BMI (kg/m 2 )
25.9 ± 3.8
25.6 ± 4.2
0.68
R (ohms)
551 ± 81.4
552 ± 97.9
0.06
Xc (ohms)
57.6 ± 7.06
58.0 ± 10.3
0.79
H 2 (cm)/R (ohms)
52.2 ± 11.9
52.1 ± 11.7
0.96
BF (%) b
31.4 ± 7.9
31.5 ± 8.9
0.94
FFM (kg) b
49.7 ± 11.0
48.6 ± 10.2
0.52

a Mean ± SD. b ADP: Air displacement plethysmography; R: resistance; X C : reactance

Table 3 :
3Prediction equation for fat-free mass (n = 78).

Table 4 :
4Body fat (%) and fat free mass (kg) by different methods
(mean ± SD).

Males (n = 73)
Females (n = 82)

Body Fat
(%)

Fat Free
Mass (kg)

Body Fat
(%)

Fat Free
Mass(kg)

ADP a
25.9 ± 6.9
57.9 ± 7.1
36.2 ± 6.5
41.4 ± 6.2
BIA b
25.8 ± 5.9
57.9 ± 6.5
36.1 ± 6.1
41.4 ± 5.9

a ADP: air displacement plethysmography, reference method. b Body
composition values calculated with the BIA equation validated in the
present study.

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Neuroendocrine tumor in gastric adenoma: a diagnostic pitfall mimicking invasive adenocarcinoma

Sun-Mi Lee
Soomin Ahn
Yun Kyung Lee
Kee-Taek Jang
Cheol Keun Park
Kyoung-Mee Kim
Neuroendocrine tumor in gastric adenoma: a diagnostic pitfall mimicking invasive adenocarcinoma
C A S E R E P O R T Open AccessNeuroendocrine tumorAdenomaMicrocarcinoidDiagnosis
Neuroendocrine tumor (NET) in adenoma of the gastrointestinal tract is a rare mixed glandular-endocrine neoplasm and has uncommonly been described mostly in the colon. Histologically, this tumor is composed of a predominant proportion of benign adenomatous component and a small portion of well-differentiated NE component. Only three cases of NET in gastric adenoma have been reported in the literature. We present 4 cases of NET in gastric adenoma mimicking invasive adenocarcinoma. The NETs were 0.62 mm to 4.1 mm in size and located at the basal lamina propria, muscularis mucosa and submucosa. Histologically, NETs consisted of nests, cords, tubules, and clusters of cells that predominantly interposed between the foveolar base without disturbing the overall polyp architecture. The lesions were completely removed by endoscopic submucosal dissection in three cases and in one case, subtotal gastrectomy was performed because endoscopic biopsy was invasive adenocarcinoma. The patients' clinical course was uneventful without an evidence of recurrence or metastasis. The recognition of NET in gastric adenoma will help avoid potential diagnostic pitfalls masquerading as invasvie adenocarcinomas posed by their infiltrative pattern into submucosa.Virtual slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/ vs/1688552293761001

Background

Although localized endocrine cell differentiation in benign or malignant glandular neoplasms of the gastrointestinal tract is relatively common, truely mixed glandularendocrine neoplasms are rare. These tumors are composed of both glandular component like adenomas and adenocarcinomas and recognizable neuroendocrine tumor compoments. Most mixed glandular-endocrine neoplasms of the stomach are malignant tumors arising in the background of atrophic gastritis [1][2][3][4][5]. The histologic spectrum ranges from amphicrine carcinoma to admixture of adenoma or adenocarcinoma with neroendocrine tumor (NET) or neuroendocrine carcinoma. Only three cases of mixed benign adenoma-NET have been described in the stomach to date [6][7][8].

Herein, we describe the clinicopathologic features of four NETs in association with gastric adenomas, to further delineate their histologic features and discuss the diagnostic pitfalls. Recognition of this rare tumor is important not only it can be missed easily due to the minute size of the lesion but also it mimicks an invasive adenocarcinoma arising from adenoma, which may cause unnecessary surgery.

Case presentation

Clinical summary Case 1. A 64 year-old man was referred to our hospital with a 3.8 cm sized polyp in the high body after a screening upper endoscopy at outside hospital. An elevated polyp was removed in one-piece by endoscopic submucosal dissection. The patient received a repeat endoscopy at one and two year and no remnant lesion was noted.

A 63 year-old man presented with indigestion and abdominal discomfort. Upper gastrointestinal endoscopy revealed a 0.5 cm sized elevated nodule in the lesser curvature of the antrum. The lesion was biopsied initially and endoscopioc submucosal dissection was done. The patient repeated upper gastrointestinal endoscopy at one and two year and no residual lesion was seen.

A 52 year-old man was found out to have a 1.5 cm sized polyp in the lower body of the stomach during staging work up for rectal cancer. The patient underwent endoscopic submucosal dissection and the lesion was completely removed. The resected segment of rectum revealed a moderately differentiated adenocarcinoma and a incidentally found, separately located 0.6 cm sized NET. He received a repeat upper and lower gastrointestinal endoscopy at two year without any evidence of recurrence.

Case 4. A 65 year-old man with no family hstory of multiple endocrine neoplasia presented with chronic dyspepsia. Upper gastrointestinal endoscopy and computed tomography scan revealed a 5 cm sized gastric mass in the lesser curvature aspect of the body. Initial endoscopic biopsy diagnosis at the local clinic was well differentiated adenocarcinoma. He underwent a subtotal gastrectomy and was found to have a 5.5 cm tubulovillous adenoma. Unexpectedly, small nests of tumor cells forming a mass infiltrated into the submucosa with an invasion depth of 800 μm. All sixty regional lymph nodes procured from the resected specimen were free of tumor. The patient has no evidence of recurrence or metastasis during 12 years of follow-up.

Histopathology

The histology of all four cases was similar. The clinicopathologic details of four cases are listed in Table 1. The glandular components of four cases were tubular adenomas with low-and high-grade dysplasia which consisted of tubular-shaped glands lined by psuedostratified columnar epithelium with elongated hyperchromatic nuclei having coarse chromatin and occasional mitotic figures.

In all cases, neuroendocrine components represented only a small portion of the adenoma, which were defined as NETs. The NETs were located in the lamina propria and muscularis mucosa in three cases. In one case, the NET cells infiltrated into the submucosa (Figure 1). All the NET component of each case consisted of solid nests, clusters, tubules and cords of cells that predominantly interposed between the foveolar base without disturbing the overall polyp architecture. The cells had abundant eosinophilic granular cytoplasm and cytologically bland, central and round nuclei with finely stippled chromatin. Nucleoli were absent or inconspicous and mitotic figures or necrosis were not observed. Both adenoma and NET components intermingled and merged together, and in some areas, both components were difficult to distiniguish from one another. In the base of polyps, the NET component appeared to bud off from the basal epithelium of adenoma into the lamina propria ( Figure 2). The transitional zones demonstrated individual polygonal cells and tiny nests of angulated cells which had enlarged nuclei with occasional prominent nucleoli and scanty mitotic activity. Multiple foci of endocrine cell proliferation with linear growth pattern were also seen adjacent to the NETs within the adenomas. The surrounding nonneoplastic gastric mucosa demonstrated diffuse atrophic gastritis with intestinal metaplasia. Immunohistochemical studies showed a biphasic staining pattern; the adenomas were negative for neuroendocrine markers including synaptophysin, chromogranin and CD56, while the neuroendocrine components were positive. However, in the basal part of adenomas, neuroendocrine markers were focally positive (Figure 3).

Discussion

The concept of a mixed adenoma-NET tumor of the gastrointestinal tract was first introduced by Moyana   minute NETs, in benign adenomas in cases that the neuroendocrine component is not enough to qualify for at least one third of the tumor volume, occupying a minute region of the adenomatous polyp like ours [11]. The size of NETs in their study ranged from 5 mm to 20 mm. We report four rare cases of gastric adenomas containing NETs with an infiltrative growth pattern mimicking adenocarcinoma. The most important reason to recognize NET in a gastric adenoma is to avoid misdiagnosis of this rare lesion as an adenocarcinoma arising from adenoma, which is more common. In our cases, some areas at the base of a polyp showed an intermixture and mergence of adenomatous glands and neuroendocrine cells, which can be misled as tumor cell pleomophism found in adenocarcinoma. These lesions appeared to be arisen from the basal epithelium of adenomas showing "budding-off" angulated glands and infiltrated into the muscularis mucosa or submucosa.

After confirmation of NET in our cases by immunohistochemistry, there was an issue to classify the proliferation of the neuroendocrine cells within adenomas depending on its size and distribution. Until now, no definite consensus on the histopathologic classification of proliferative endocrine cell lesion has been established. Solcia et al. has proposed the subclassification based on size, growth pattern, and numbers of endocrine cells within glands or crypt as follows: simple hyperplasia; linear hyperplasia; micronodular hyperplasia; dysplasia (< 0.5 mm in diameter); NET (> 0.5 mm) [12]. Neuroendocrine components in our cases ranged from 0.62 mm to 4.1 mm. Based on Solcia et al's classification, we could define our cases as NET.

The prognosis of benign mixed adenoma-NET of the stomach can not be completley determined due to the rarity of cases. Complete removal of an adenoma would be considered curative whereas the combined NET   component would be a main predictive factor to determine the patients' prognosis. In our four cases, three cases showed NETs limited in the lamina propria and focally extended into the muscularis mucosa without any evidence of local recurrence or metastasis. A large series by Soga et al. demonstrated that small submucosal NETs of the stomach had a relatively high metastatic rates [13]. This study showed that the metastasis in the earlystage NETs of the stomach is correlated with not only the submucosal invasion but also the size, which is more than 10 mm. One of our 4 cases was 4.1 mm in greatest dimension and showed submucosal invasion. However, this patient underwent a subtotal gastrectomy and his sixty regional lymph nodes were free of tumor and no metastasis has been identified in a long term close follow-up for 12 years.

Conclusion

In summary, NET may be found in adenomas of the stomach incidentally, has characteristic morphologic features and immunoexpressions as neuroendocrine cells, and can be under or overdiagnosed due to the small size of the the lesion and overlapping histology with adenocarcinoma. This lesion can be completely treated by polypectomy or endoscopic resection technique without recurrence or metastasis. However, if the NET involves the submucosal layer, close follow-up is recommended for a relatively higher metastatic rate.

We described four rare cases of NET arising from gastric adenoma and followed benign clinical courses. Recognition of this rare entity is important for accurate diagnosis and treatment.

and Murphy in 1988[9]. Mixed glandular-endocrine neoplasms in the gastrointestinal tract have been categorized into three subtypes depending on their predominant pro-portions of each component by Levin et al.: composite tumors, collision tumors and amphicrine tumors [10]. Recently, Pulitzer M et al. described "microcarcinoids",

Figure 1
1Neuroendocrine tumor with an organoid growth pattern infiltrating into the submucosa within a tubular adenoma (A). Higher magnification showing small tumor cells in the deeper part of mucosa and submucosa (B).

Figure 2
2In the base of polyps, neuroendocrine tumor cells appeared to bud off from the basal epithelium of adenomatous glands into the lamina propria with an angulated glandular appearance..

Figure 3
3Immunohistochemistry for chromogranin showing positive in glands in the lower part of adenoma and neuroendocrine tumor cells..

Table 1
1Clinical and Pathologic Characteristics of cases with gastric adenoma-neuroendocrine tumorCase
Age
(years)

Sex
Location
Procedure
Size
(mm)

Depth
of
invasion

Pathologic
Follow-up
Time
Diagnosis

1
64
M
Body, PW
ESD
0.62
MM
TA and NET
2 years

2
63
M
Body, PW
ESD
4.0
LP
TA and NET
2 years

3
52
M
Body, PW
ESD
1.8
MM
TA and NET
2 years

4
65
M
Body, LC
Subtotal gastrectomy
4.1
SM
TVA with focal AC and NET
12 years

M indicates male; PW, posterior wall; LC, lesser curvature; ESD, endoscopic submucosal dissection; MM, muscularis mucosae; LP, lamina propria; SM, submucosa; TA, tubular adenoma; TVA, tubulovillous adenoma; AC, adenocarcinoma; NET, neuroendocrine tumor.
http://www.diagnosticpathology.org/content/7/1/102
ConsentWritten informed consents were obtained from the patients for publication of this case report and any accompanying images.Competing interestsThe authors have no potential conflicts of interest to disclose.Authors' contributions SMA, YKL, KTJ, and CKP made contributions to acquisition of clinical data, and analysis of the histologic features by H&E stain and immunohistochemistry. SML drafted the manuscript. KMK revised manuscript critically for important intellectual content and had given final approval of the version to be published. All authors read and approved the final manuscript.
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Mixed (composite) glandular-endocrine cell carcinoma of the stomach. G C Yang, H Rotterdam, Am J Surg Pathol. 15Report of a case and review of literatureYang GC, Rotterdam H: Mixed (composite) glandular-endocrine cell carcinoma of the stomach. Report of a case and review of literature. Am J Surg Pathol 1991, 15:592-598.

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Amphicrine gastric carcinoma. J S Reis-Filho, F C Schmitt, Arch Pathol Lab Med. 125Reis-Filho JS, Schmitt FC: Amphicrine gastric carcinoma. Arch Pathol Lab Med 2001, 125:1513-1514.

Genetic evidence for the multi-step progression of mixed glandular-neuroendocrine gastric carcinomas. K M Kim, M J Kim, B K Cho, S W Choi, M G Rhyu, Virchows Arch. 440Kim KM, Kim MJ, Cho BK, Choi SW, Rhyu MG: Genetic evidence for the multi-step progression of mixed glandular-neuroendocrine gastric carcinomas. Virchows Arch 2002, 440:85-93.

Minute carcinoid arising in gastric tubular adenoma. H Ito, M Ito, E Tahara, Histopathology. 15Ito H, Ito M, Tahara E: Minute carcinoid arising in gastric tubular adenoma. Histopathology 1989, 15:96-99.

Mixed adenoma-endocrine tumour of the stomach. J D Coyne, O' Connor, B , Histopathology. 57Coyne JD, O'Connor B: Mixed adenoma-endocrine tumour of the stomach. Histopathology 2010, 57:492-494.

Mixed neoplasia of the stomach: description of a case of tubular adenoma combined with carcinoid. De Marco, L Carlinfante, G Botticelli, L , Di Maira, P V Putrino, I Cavazza, A , Pathologica. 95De Marco L, Carlinfante G, Botticelli L, Di Maira PV, Putrino I, Cavazza A: Mixed neoplasia of the stomach: description of a case of tubular adenoma combined with carcinoid. Pathologica 2003, 95:214-216.

Composite glandular-carcinoid tumors of the colon and rectum. Report of two cases. T N Moyana, A H Qizilbash, F Murphy, Am J Surg Pathol. 12Moyana TN, Qizilbash AH, Murphy F: Composite glandular-carcinoid tumors of the colon and rectum. Report of two cases. Am J Surg Pathol 1988, 12:607-611.

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Microcarcinoids in large intestinal adenomas. M Pulitzer, R Xu, A A Suriawinata, J D Waye, N Harpaz, Am J Surg Pathol. 30Pulitzer M, Xu R, Suriawinata AA, Waye JD, Harpaz N: Microcarcinoids in large intestinal adenomas. Am J Surg Pathol 2006, 30:1531-1536.

Histopathological classification of nonantral gastric endocrine growths in man. E Solcia, C Bordi, W Creutzfeldt, Y Dayal, A D Dayan, S Falkmer, L Grimelius, N Havu, Digestion. 41Solcia E, Bordi C, Creutzfeldt W, Dayal Y, Dayan AD, Falkmer S, Grimelius L, Havu N: Histopathological classification of nonantral gastric endocrine growths in man. Digestion 1988, 41:185-200.

Early-stage carcinoids of the gastrointestinal tract: an analysis of 1914 reported cases. J Soga, 10.1186/1746-1596-7-102Cancer. 103Soga J: Early-stage carcinoids of the gastrointestinal tract: an analysis of 1914 reported cases. Cancer 2005, 103:1587-1595. doi:10.1186/1746-1596-7-102

Neuroendocrine tumor in gastric adenoma: a diagnostic pitfall mimicking invasive adenocarcinoma. Lee, Diagnostic Pathology. 102Cite this article asCite this article as: Lee et al.: Neuroendocrine tumor in gastric adenoma: a diagnostic pitfall mimicking invasive adenocarcinoma. Diagnostic Pathology 2012 7:102.


Woman for President? 'Alternative' future in the works of Kenyan women writers

Alina Rinkanya email@example.com
University of Nairobi
Kenya

Woman for President? 'Alternative' future in the works of Kenyan women writers
812BE5DB13BC8105B08713EBDD7E9EAE10.4314/tvl.v51i2.11African female leadershipAfrican literatureKenyan women writersutopian visions of the future
Woman for President?'Alternative' future in the works of Kenyan women writers The article traces the emergence of 'alternative', positive vision of the future of African countries under the rule of female leaders in Kenyan women's literature, using as examples three novels by Kenyan women writers-Rebecca Njau, Margaret Ogola and Monica Genya.The study comes to a conclusion that the aim of these authors was not to create another 'trivial utopia', but to draw a picture of a possible and accomplishable future which may serve as a motivation for the reading public.

Introduction

Gloomy and nearly apocalyptic vision of the future, characteristic for many works of contemporary African writers, mostly portraying the totalitarian dystopian societies of the future, ruled by various dictators, seem to find an alternative standpoint in recently produced texts by some writers from Eastern Africa.It should be mentioned, first, that contemporary authors from East African countries (I will mostly be referring to the period of 1990s and 2000s) are dealing with present-day reality, with less concern for future prognoses.At the same time, those writers who have in any way dealt with the topic may be broken, conditionally, into two categories.While some of them draw dismal dystopian pictures of future developments in various (unnamed or imaginary) African countries (it especially applies to the adepts of the so-called 'experimental' or 'new' novel in Swahili (see Khamis 2005), others seem to have a more hopeful image of the continent's 'days beyond'.In their works, the oppressive rule is eventually destroyed by will and act of protagonists, supported by the mass of the country's people.What is even more significant-in most of the cases, the protagonists (mostly male) are winning through active support of their female allies.The most remarkable in that sense among the recent works is the latest novel by Ngugi wa Thiong'o-The Wizard of the Crow (2006) originally written in the author's mother tongue of Gikuyu and self-translated into English.The novel depicts the rule of a ruthless dictator, nicknamed the Ruler, in the fictitious republic of Aburiria, destroyed by two brave young protagonists, a young man Kamiti and his girlfriend Nyawira.In many novels, this 'female support' becomes the crucial factor of victory, since the 'female supporters' ˜˜ are semi-divine creatures with supernatural powers-even in the novels by Swahili language writers the hero manages to withstand the evils of the dystopian world, pictured in these books, with the help of a magical female supporter (whose assistance sometimes gives a hope of victory over the evil forces and a brighter future (see Nagona [1989] and Mzingile [1990] by Tanzanian writer Euphrase Kezilahabi).

The idea of a brave female character that gives the others (and the readers) a hope for 'alternative', positively portrayed and rather utopian, then dystopian future, is strongly expressed in the novels by East African female writers from Uganda to Tanzania.In this study, I try to trace the emergence of such character and the 'alternative' vision of the future that she represents in Kenyan women's writing, using as examples three novels by Kenyan women authors published from 1996 to 2003.The novels under study represent different forms of the genre-from a novel-as-parable, strongly 'spiced up' with magical realism, to a social critical and detective novel-but in all three, a figure of a strong woman as an agent of an alternative, positive future is given an important place in the novel's system of characters.

The following discussion of the works by three Kenyan women writers is largely informed by the theoretical points made by Susan Andrade in her seminal study of feminisms in African fiction in the period of thirty years up to 1988-The Nation Writ Small: African Fictions and Feminisms (2011)-where one of the main aspects of the argument is the representation of the national allegory in female fiction.She bases her argument on the assumption that in the period under study the nation was represented by women writers through family, and the basic concerns of women's literature was "critiques of local patriarchies" (203) and the creation of "domestic tale of women's emancipation from local patriarchy" (205), while nowadays "one can say that increasingly African women write about politics, including national politics" (207).She confirms that latter point by stating that "no longer can we say that sub-Saharan black women hesitate to represent the nation in conjunction with fully developed female characterization" (206).In the sections below, I will demonstrate that the utopian allegories presented in the novels by three Kenyan women writers-and embodied by female characters-have a purpose to "represent the nation squarely and explicitly", to create a new form of national allegory with a further purpose to motivate the readers.

Rebecca Njau: Human virtue helped by magical forces

At first glance, among the works by East African women writers of English expression a good example of the 'disappointing' vision of the future could be found in the latest novel by a Kenyan author Rebecca Njau.In The Sacred Seed (2003) Njau portrays the rule of a merciless dictator, who reigns the people by fear and cruelty.However, later in the novel it is changed by quite an opposite vision, that of an ideal community founded on the principles of love, justice and hard work.

Among the works discussed in this article, the novel by Njau appears to be especially notable, since the author, apart from being one of the major names in Kenyan writing, may also be deemed as one of the founding figures of East African women's literature, a trend that has gained momentum during the last three decades, the time when in Kenyan literature "female portraiture […] transcends a onedimensional representation and instead delineates female figures as dynamic and complex characters.Often they are moved to the narrative centre and become the central protagonists […] Although social expectations seem to define them exclusively as "wives", "mothers" and "widows", women appear in a variety of social and political roles" (Kruger,Female Characters in Contemporary Kenyan Women's Writing 61).

I have called Njau's novel especially notable, because in Kenyan women's literature, as mentioned above, the visions of the brighter future is frequently associated-or, rather, represented-by a strong female character, whose commitment to the people and active nature actually make this future feasible.Her novel, in fact, features two of such characters; it tells the story of resistance of a village community, leading peaceful and spiritual life in the sacred forest under the guidance of two courageous women-Mumbi, a forest prophetess, and her assistant Tesa, the main character of the novel, musician and artist.The community, supported by supernatural powers and obviously symbolizing tradition in its positive aspects, and the forces of good, is endangered by badly used and oppressive modernity, or the forces of evil, embodied in the novel by the figure of dictator President Chinusi, dwelling in the capital city of Raiboni (anagram of Nairobi) in his fortified residence called The Castle.Along with other repugnant traits of his character, Chinusi is an epitome of male chauvinism and dominance; he takes pleasure in raping talented women (Tesa herself became one of his victims before fleeing to the forest sanctuary).Chinusi and his henchmen (among them the local pastor Jonah, who was waging long-term war against Mumbi's community) want to get hold of the forest in order to clear it and use the land for their own purposes.However, through their own courage and with the help of divine interference, the members of the community manage to overthrow the hateful dictator and give the people of the country (whose name is not specified in the book) hope for a brighter future.

The characters of Mumbi and Tesa form, as it appears, 'two sides of one coin'; the only difference between them is that Mumbi is the founder of the community and Tesa-her successor.Both stand hand in hand against the forces of evil, epitomised by President Chinusi; both succeed in defeating them and-most importantly-in providing the community members with the foundation for the brighter future well deserved by them in their defence of good.

Of course, this brighter future can not be built through the efforts of only two women-and Mumbi and Tesa manage to inspire and commit to devoted and creative work other females in the community (many of them joined it seeking refuge-for example, a young woman Lina became a victim of ethnic conflicts; some other girls fled to the forest to escape genital mutilation).Male members are also accepted and encouraged to live and work with others-such as painter Muturi, son of pastor Jonas; moreover, Mumbi and Tesa are assisted by the council of male elders-thus, the equality of gender and age is also preserved.Even the difference in origin is not an obstacle-one of the most active members of the community is African-American missionary Ellen, who, before being sent back to the US through the evil scheming of Chinusi, manages to provide her African sisters (and other members of the community) with a new foundation for future prosperity: "I must show my gratitude to the women in a practical way.I admire their courage and hard work.I must help them to become more economically self-sufficient.I want to teach them a new craft.I want them to learn how to weave using a simple loom which they can make.I want us to make baskets from wild plants and find a market for them.They must get economic benefit from their hard work".(182); "When I go back to the USA, I will look for a market for your crafts."(183); "The following day, just before sunrise, Ellen and Nini walked to the spring and collected plants from inside the bushes and took them back to Nini's homestead where, with Tesa and Mumbi, they sat inside all morning, learning a new skill.After five days, they were able to produce enough threads to start weaving on a simple loom.They also learned how to make dyes from plants.They sang with joy as they worked and they promised one another that they would never let anyone subdue their resolve to fight for the emancipation of all women and others who were oppressed".(186, my emphasis) Not only this, but all kinds of free and unbound creativity are flourishing-"Tesa had spent most of her time working and inspiring young people to be creative.Consequently, many of them had learnt to express themselves freely in music" (209).The principles of governance in the sanctuary, free of the vices of old power systems, are explained by Mumbi, its creator and keeper: "Any one of you is free to lead the way, as long as it is the right way.Ours should not be an authoritarian leadership.We don't want the Jonahs and the Chinusis among us.They do not belong here.Our intention should not be to glorify the self but to recognise each other's talents and strive to develop them to the full" (209).As it could be understood, the new principles work-the people of the sanctuary are not only able to resist the advances of enemy forces, but attract more and more newcomers from different parts of the country.All this became possible because of the supervision of two strong women with semimagical qualities-Mumbi and Tesa-an allegoric picture of woman leader (according to the author, magical powers help only those who have their own courage and determination).Of course, the novel does not present a 'real' recipe for a better future -but an allegorical picture of the author's ideas about it.The present day reality offered nothing but a brutal dictatorship-so we must revive truly democratic forms of governance, based on equality, commitment and voluntary participation.

The models of the 'alternative' future that the writer suggests are obviously not new-they could be found in many works of modern African literature from its beginnings; for example, in the 'recipes' offered as far back as 1960s in the novels of Cameroonian author Remy Medou Mvomo.In his novel Africa Ba'a (1969) he also depicts an ideal village, whose inhabitants reach the economic prosperity by weaving baskets and selling them abroad.This concept of 'going back to the roots' is longlived-even Njau's compatriot, one of the major Kenyan writers Meja Mwangi in his novel The Return of Shaka (1989) also suggests "to plough up the tarmac roads […] and to prove everyone that you can get back to your roots and to live on simple fruits of the earth-sorghum, yam and cassava" (70).In that sense, Njau's vision of the future may be offering nothing new; what does, however, appear novel in her speculations is that the leading part in the building of this future is given to women (in the mentioned novels by Mvomo and Mwangi, the agents of progress are male protagonists).Male leadership brings cruelty and misfortune-therefore, the future should be put into the hands of women, who will be able to make it better for everyone, even at the expense of their own personal happiness: at the end of the novel, Tesa has to give up the idea of her marriage to Muturi and fully gives herself to the service of the society.

Margaret Ogola:

The source of the new river As I mentioned above, a number of women writers in Kenya are depicting the future as the time of real women empowerment, and one of the most picturesque examples of this is the portrayal of the (hypothetic) first woman President of Kenya.Whereas a few writers contemplate such an opportunity in their books, the most vivid examples are given in two novels, I Swear by Apollo (2003) by the late Margaret Ogola and Links of a Chain (1996) by Monica Genya.Margaret Ogola's novel, the second in her short but prolific writing career, is in fact a sequel to her first work, The River and the Source (1994), which became one of the bestsellers in present-day Kenya, a part of the school literature curriculum, and gained her fame in her lifetime.While The River and the Source is an epic saga of several generations of a family from Western Kenya, strongly layered with the ideals of women's emancipation and empowerment, I Swear by Apollo is an idealistic vision of the future, depicting life 'as it should be' under the benevolent and protective rule of the first (however unnamed) woman President of Kenya.In this new country, the novel's characters manage to overcome most of the burning problems of present-day Kenya.They defeat tribal and racial prejudices through mixed marriages (Ogola marries a Luo gentleman to a Kikuyu lady, thus eliminating rivalry between two historically competing communities; and an African girl to an English Canadian, thus lifting racial bounds), combine African traditions with European innovativeness (John, a male protagonist, is a neurosurgeon and 'flying doctor '-but he intends to bring up in his future son by old African methods, whose "advantages are so obvious"), and generally comprise the author's ideal of new Kenyans, people that are free and unprejudiced in thoughts and actions.A reader 's logical question "how come?"i.e., what made the existence of such an ideal society possible-is answered literally on the opening pages of the novel.All this became practicable for the same reason as in Njau's book-because of the existence of a strong-willed female leader, considerate about the well-being of her compatriots.In Ogola's version, this utmost ideal of modern African female is embodied in the figure of the first woman President of Kenya.

"Her Excellency [...] was a tough and fearless woman known to face down armed policemen-at a time when a law of the jungle was rife.She was also a darling of the international community and the intellectual fraternity [...]She had made many Kenyans dare to dream again, to hope again.Of course she had many avowed enemies, especially those who had brought the country to its knees through massive institutionalized corruption.She had treated them with the same ruthlessness with which they raped the country before bleeding it dry [...]Many were surprised that a woman could bring such cold ferocity in the active governance.She seemed to have an instinct for the jugular and was not afraid to use it.The corrupt hated their guts and prayed for her demise daily."(Ogola 8) Her Excellency-for the name of the first woman President is not given in the textnot only manages to uproot, presumably alone, the machinery of massive institutionalized corruption, which her male predecessors were defeated with, not only to bring to a new level the country's intellectual potential (for she started her political career from the post of the minister of science and education), but, what is more, gave to her fellow Kenyans a chance "to dream again, to hope again"-and their dreams and hopes (and obviously, and even more, the dreams and hopes of the novel's readers) are embodied in Ogola's characters.In the book one will hardly find any negative character (with a possible exception of a certain Napoleon Lebulu, an employee at the ministry of culture and an obvious remnant of the 'cursed past')-for this is not the author's aim, hers is to affirm, and not criticize.

Evan Mwangi, while writing about Ogola's first novel, stated that the book contributes to such impressive aims as "liberation of women from pre-colonial misogyny", "emancipation of women from traditional patriarchal control", "hybridity across ethnic lines", to ensure that "de-essentialisation of ethnic origins becomes an inevitability in post-colonial Kenya", "to criticise antiquated traditional attitudes", "to deflate patriarchy and cultural purism" (Evan Mwangi 45-50).I dare state that in her second novel Ogola continued to pursue these tasks, but chose for that a new method-to draw an ideal picture of her country (it is tempting to call it an utopia, and I will address it in the concluding part of the study), 'Kenya as it should be', the ideal state created by an ideal leader, the first female President.Paraphrasing the title of Ogola's first, and most famous book, the figure of the female head of state serves in her second novel as a source from which a new river starts to flow-the river of life free of the flaws of previous regimes, the life where interests of everyone will be acknowledged and provided for.

Monica Genya: Visions of future against detective background

Another example of the vision of a brighter future is given by Monica Genya, a writer representing the younger generation of female authors in Kenya.Her novel Links of a Chain (1996), apart from being a well-written and captivating detective story, is also a hymn to the modern, empowered and, most importantly, socially committed woman.In the story there are at least two role-model female characters, the first being Susan Juma, a brave police detective who successfully fights an international gang of political terrorists.But even Susan Juma herself, when her workmate and suitor Chain asks her about her own role-model figure, confesses to him: "My hero is a small, doll-like woman called Janet Musyoka.If ever there was a brave, intelligent and really perfect human being, it is her and I mean that" (Genya 237).

Indeed, the character of Janet Musyoka, the first female Vice-President of Kenya, represents all the enviable qualities which, according to the author, a modern African women should possess, starting from the fact that she was able to raise herself to the highest post from the lowest of the lowest:

She was born in one of the filthy shanty villages on the outskirts of Nairobi.Her mother had no idea who her father was; it could have been one of several men who were her customers.Janet's mother was a prostitute.

Being a call-girl, however, did not mean that she did not possess no brains at all.She had cornered one of the wealthiest of her regular customers and convinced him that the child was his.He was a political figure of some importance and couldn't afford the risk of scandal.As docile as a lamp, he had paid out huge amounts of money as child support year after year.Janet went to the best of schools, and her mother managed to rent a hairdresser and set about planning her daughter 's future […].

Janet had gone to college in the United States and had got degree in literature.

She had started a small women's magazine on her return home.Gibson [her husband] had left Kenya Airways and started a highly successful charter business.

From being comfortably well-off, they had become very rich.But this hadn't changed their view of life ….

After that she had wanted to immerse herself completely in something, in order to leave a mark; something worthwhile.She had chosen politics as it was very interesting, and she genuinely felt that she might be able to make Kenya a better place to live in" .

Her career, however, does not completely protect Janet from life's calamities-her beloved husband Gibson Musyoka, a pilot, dies in a plane crash in Uganda, and after twenty years of happy marriage she is left a widow with two children.Moreover, already in her capacity of the vice-president she has to face a terrorist gang threatening to ruin her beloved country by dividing it into several vassal states-and they plan to murder Janet as the most serious obstacle for their plans.The murder, to be executed by a ruthless gunman known under the nicknames of King Arthur and Professor, is planned on the day when Janet Musyoka is to make a speech at the Parliament.However, even in the most dangerous turn of events Janet does not lose her spirit, as is shown in the final paragraphs of the novel:

At that moment, the Vice-President's motorcade entered the Parliament grounds […].The cars stopped and the doors opened.Both Chain and Susan gave an almost simultaneous groan of anguish and each of them sprinted off.They both saw the middle-aged man remove a gun fitted with a silencer from his coat pocket, as if in slow motion […] Susan appeared from the blues, and launched herself at Vice-President, toppling them both to the ground.Immediately, a bullet smashed into the car door, the space which they had barely vacated.The second bullet smashed the car window above them, shattering it into tiny pieces, and the third one hit a secret serviceman who had started running towards Janet and Susan.The latter rolled sideways with the Vice-President in her arms, shielding her with her body […] [The killer] hadn't taken two steps when CID agents and secret servicemen opened fire on him.He felt the bullets smash into his body as pain tore through him.Then, King Arthur crumpled slowly to the ground.

CID agents hurriedly helped Susan, Janet and Chain to their feet.Chain went over to gather Susan in his arms while Janet was immediately surrounded by secret servicemen.

Chain and Susan watched the blood oozing out of the Professor 's body, taking with it the last threat to the nation.Kenya was safe again.

In the distance, Vice-President Janet Musyoka hurried into the Parliament building.It was budget day and there was a speech to be read.Apparently, Janet Musyoka does become the hero of even such an invincible female super-agent as Susan Juma not only-and not mainly-because of her outstanding personal qualities (which Susan abundantly possesses herself), but because for her, as well as many of her compatriots, she becomes a symbol of brighter future-where previous heads of state failed, she promises to win.Not being threatened by a mortal danger to her life, she, supposedly, will not be threatened by the trials and snares of high politics-and this politics apparently should be orientated towards all social circles, since Janet Musyoka knows the life of the poor as well as that of elite.Since she is a woman who managed to make herself, thus there appears a promise that she would be able to make it for her country.

' Alternative' future with a woman leader: An utopia or a motivation?In her article on ideological aspects of thrillers by African writers, discussing Monica Genya's novel, Karola Hoffman (197) argues:

One aspect that makes this novel an instrument of propaganda is the absence of social problems.Kenya is presented as prosperous and modern.[…] This prosperity is a symbol for a content nation.[…] Nobody in Kenya has to suffer from hunger or illiteracy, and Genya postulates that this state of affairs is guaranteed and protected by the government.[…] With the story around Susan Juma we have, therefore, got a very clear plea for patriotism and nationalism.[…] The representation of the nation is ideologically biased.In Genya's case this takes the form of a trivial utopia that ignores social reality.

It looks like this characteristic of Genya's novel is well applicable to other texts under discussion.Indeed, Ogola draws equally serene picture of her country under the rule of her Excellency, and in the final chapters of Njau's novel it also appears that the ideal community created by women in the forest will, after the fall of evil forces, become a model for the entire country.The question, therefore, emerges-was the creation of 'trivial utopia' the sole purpose of the three women writers?

Of course, the countries drawn in the three texts bear certain traits that can hardly be found in the present-day reality of Kenya or African continent-such as, the stressed equality of gender and age, absence of inter-ethnic or inter-racial problems; other social ailments, such as poverty, are not mentioned, but it is implied that they have equally subdued.However, at least two texts discussed in the study-the novels by Ogola and Genya-give their readers, in my view, a very clear impression that these traits are achievable and possible with a proper commitment and, most importantly, under the proper leadership, the latter being embodied in the novels by the figure of female leader of the nation.In Njau's novel the vision of the future is more abstract and fantastic-but it appears to give the readers the same idea: life of the people can be changed through commitment, joint effort and proper (yes, female) leadership.Therefore, in my opinion, the authors were driven not by the desire of writing a social fantasy-but rather, it was exactly that "call for patriotism and nationalism", mentioned by Hoffmann, that urged the authors to create not just utopias, but also possible models for better future, which, according to them, is achievable and feasible.

In the above-mentioned study Susan Andrade (39), characterizing the manifestation of political commitment in the female writing from the former Third World, asserts: "'Novels written by women from the Global South often do have allegories within them, but they are usually subtle (or not immediately visible) and require an act of strong reading to discern them."This subtlety of allegories-and I would remind that the scholar refers to 'national allegory', i.e. the allegorical representation of the nation in the women-authored fiction-is mostly expressed through the fact that "women represent the nation in relation to the family", but "as time progressed, African women began to represent the nation squarely and explicitly, in tandem with gender and the family' (Andrade 206-07).This metamorphosis, concisely formulated by Andrade, has acquired, in my view, a very vivid illustration in the above-discussed novels by Kenyan women writers.

The "subtle" form of national allegory, related to family and the "domestic tale of women's emancipation from local patriarchy" (Andrade 205) has also been quite characteristic for earlier works by Kenyan women writers, from social novels of Grace Ogot and Muthoni Likimani to Bildungsromanen of Miriam Were.In their texts, the women characters struggle exactly against 'local patriarchies' in their various manifestations-from traditional to colonial and post-colonial-and acquire empowerment through achieving, among other things, relative equality with their male counterparts, implicitly manifesting the growth of the nation.One of the most illustrative attempts to turn the female character into a symbolic figure representing the nation was made by Marjorie Oludhe Macgoye in her nation-wide classic Coming to Birth (1986).The main character, a naive village girl Pauline, relocated to colonial Nairobi through arranged marriage and thus becoming a captive of a 'local patriarchy', matures together with the young Kenyan nation, acquiring economic independence, self-reliance and self-assurance, but in the long run finding happiness again solely on the family level-however, this time in a marriage based on mutual affection and respect.This allegorical figure was elevated onto a new level by Asenath Odaga in her novel Endless Road (1997), in which the heroine Salmari already "represents the nation" in political field.She and her husband Dino are heading two rivaling political parties, and the local elections are won by Salmari, whose program is much more attractive and sensible than her husband's.In fact, the character of Salmari stands very close to the heroines of the novels discussed in this study.For Kenya of 1990s a woman beating a male (and moreover, her own husband) on the political arena also represented a somewhat utopian ideal.The national allegory presented in Odaga's novel completely lacks 'subtlety' mentioned by Andrade; her heroine certainly does "represent the nation squarely and explicitly"-for she is the very embodiment of the new nation, where gender and other barriers are lifted in favour of public benefit-and she also does that "in tandem with gender", or, rather, the gender aspect is boosted up.The family aspect in Odaga's novel is sacrificed for the sake of social-political advancement, although the husband tries to reconcile with Salmari in the novel's final chapters, it is unclear whether a victorious female politician will accept his humble attempts to drag her back into the familial milieu.

In view of the above, I would state that in the novels discussed in this study the woman character epitomizing the nation (moreover, the new emerging nation) not in relation to the family but "squarely and explicitly" in social-political sphere has been driven to an unheard-of height, representing an allegory of alternative future of the nation with its alternative leader.According to Andrade (205), "public politics are more visible and valued than domestic politics" and "it engages the national allegory more openly", and it seems that these two factors strongly inform the authors' task of creating a female public political figure as an allegory of the new Kenyan nation.For the same reason the familial sphere in the construction of these characters is either denied openly (Tesa sacrifices her family life for the sake of becoming a community leader), is not mentioned (in Ogola's novel) or is put into a secondary position to the political career (as does Janet Musyoka in Genya's book).

Of course, this allegory may be deemed as utopian, first of all because, in spite of all the advancements in gender-related affairs, a prototype figure of a female President can still hardly be found in present-day political reality of Kenya. 1 However, as I argued above, the task of the discussed authors was not to construct 'a trivial utopia', but rather a positive and motivating model for better future.

Conclusion

In this study I discussed three novels by Kenyan women authors, brought together with a common idea: to visualize a future that would be alternative to those gloomy apocalyptic pictures drawn in many a recent African novel.This idea of a better future, provided (or symbolized) by a female protagonist, is presented in different ways.While Rebecca Njau narrates a parable-like story of an imaginary ideal community, Monica Genya in her earlier published novel gives a 'full-fledged' biography of the President character Janet Musyoka, tracing her way up from a daughter of Nairobi call-girl to the highest political circles in the country; whereas Margaret Ogola in her book paints a laconic but expressive psychological portrait of a lady who managed at last to occupy the presidential seat ("tough and fearless woman known to face down armed policemen").The last two writers highlight two primary aspects of a presidential career for a Kenyan woman-the possibility to rise 'from the dirt' and the principal qualities that are necessary for a woman to become the head of Kenyan state.

Marie Kruger in her study on East African women's literature states: "Even as Kenyan […] writers condemn the failure and corruption of the state, they continue to search for a government and citizens who responsibly negotiate rights and obligations" (12), and generally "East African women writers […] remain committed however, to the promise of social mobility and democratic participation, and of economic prosperity and cultural autonomy" (16) .She concludes: "the discussion of rights and responsibilities, and the concern with human dignity and duties, is central to the narratives of East African women writers" (211), and the figure of a female President appears as the topmost embodiment of these searches, commitments and concerns.Political and social empowerment of women as the founding trait of the country's future is advocated in the novels by other women writers, such as Asenath Odaga, Patricia Ngurukie, Florence Mbaya and some others, thus turning Kenyan women writers' vision of the future into a positive alternative to apocalyptic pictures frequently seen in 'male' literary works; according to these writers, such a future is possible only in case the ideas of equality and equity permeate the social fabric on all levels and in all aspects, and women are recognized as the legitimate and potent power-the way they are portrayed in the works by Kenyan women authors.

The idea of female presidency, on the one hand, seems to have already grown certain roots in present-day Kenyan political reality-during the two recent presidential elections female names appeared in the list of candidates; generally, the participation of Kenyan women in the country's politics has considerably increased in the first decades of this century. On the other hand, there is a strong 'counter-current', supported even by the government institutions, that undermines female rights-suffice it to recall the polygamy legalization bill, recently passed by Kenyan Parliament. Works Cited Andrade, Susan. The Nation Writ Small: African Fictions and Feminisms. Durham and LondonDuke UP1998

Links of a Chain. Monica Genya, 1996East African Educational PublishersNairobi

Crime Fiction as a Means of Political Propaganda and Ideologisation. Karola Hoffmann, Christine Matzke and Anja Oed2012Rudiger Koppe VerlagCologneLife is a Thriller: Investigating African Crime Fiction

Khamis, Said Ahmed Mohamed. Euphrase Kezilahabi, Nagona, Signs of New Features in the Swahili Novel. Dar-es-Salaam: Dar-es-Salaam UP; Mzingile. Dar-es-Salaam: Dar-es-Salaam UP1990. 1991. 200536

Marie Kruger, Female Characters in Contemporary Kenyan Women's Writing: Independent Figures or Subdued Voices? Madison: U of Wisconsin P. New York; YaoundeCLE1998. 2011. 1969Medou Mvomo, Remy. Africa Ba'a

Gendering genre: issues of feminist identity and subversion of the epic in Margaret Ogola's The River and the Source. Evan Mwangi, Nairobi Journal of Literature. 12003

Njau, Rebecca. The Sacred Seed. Nairobi: Books Horizon. Meja Mwangi, Odaga, Asenath. Endless Road. 1989. 2006. 2003. 1997Lake PublishersNgugi wa Thiong'o. Wizard of the Crow

. Margaret Ogola, Apollo Swear, Nairobi, 2003East African Educational Publishers