Search results for: rare entity

Authors: Ghadeer M Alkusayer, Adelicia Yu, Pamela Orr

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Study objective: To report a case of postpartum pulmonary cryptococcal infection (CCI) in an otherwise healthy 35-year-old woman. Additionally, the cases of pulmonary cryptococcal infections either in the antepartum or the postpartum period with pregnancy outcomes, were systematically reviwed. Methods: A systematic search of Cochrane Library, MEDLINE, and EMBASE was conducted for peer-reviewed studies without date restrictions, published in English and relating to CCI during pregnancy or postpartum period. Conference press, editorials, opinion pieces and letters were excluded. Two authors independently screened citations and full-text articles, extracted data and assessed study quality. Given the heterogeneity of study designs, a narrative synthesis was conducted. Results: The search identified 128 references, of which 22 case reports and series met the inclusion criteria. This is a total of 29 women (including the current case) . The mean age of the women was 28.3 ± 12.3 years. Nine (31.03%) presented and were diagnosed in the postpartum period. Two (6.90%) of the patients were reported as immunocompromised with HIV. Four maternal deaths (13.79%) were found in this case series with one (4.3%) patient with severe neurological deficits. Four (17.4%) infant deaths were reported. Women primary presentation varied with chest pain 13 (44.82%), headache 10 (35.70%), dyspnea 19 (65.51%), or fever 12 (41.38%). Three studies reported placental pathology positive for C. neoformans. Conclusion: This case of pulmonary cryptococcal infection in the postpartum period is an important addition to the literature of this rare infection in pregnancy. The patient is not immunocompromised. The patient was successfully treated with 4 months of Fluconazole 400 mg and continued to breastfeed the healthy baby.

Keywords: pulmonary cryptococcus, pregnancy, cryptococci , postpartum

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Authors: Patompong Satapornpong, Therdpong Tempark, Pawinee Rerknimitr, Jettanong Klaewsongkram, Chonlaphat Sukasem

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Dapsone (4, 4’-diaminodiphenyl sulfone, DDS) is broadly used for the treatment of inflammatory diseases and infections such as; leprosy, Pneumocystis jiroveci pneumonia in patients with HIV infection, neutrophilic dermatoses, dermatitis herpetiformis and autoimmune bullous disease. The severe cutaneous adverse drug reactions (SCARs) including, Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and drug reaction with eosinophilia and systemic symptoms (DRESS) are rare but severe life-threatening adverse drug reactions. Dapsone is one of many culprit drugs induced SJS, TEN and DRESS. Notwithstanding, to our knowledge, there are no studies of the association of HLA class I alleles and dapsone-induced SCARs in non-leprosy Thai patients. This investigation was a prospective cohort study, which performed in a total of 45 non-leprosy patients. Fifteen patients of dapsone-induced SCARs were classified as following the RegiSCAR criteria, and 30 dapsone-tolerant controls were exposed to dapsone more than 6 months without any evidence of cutaneous reactions. The genotyping of HLA-A, -B and –C were performed using sequence-specific oligonucleotides (PCR-SSOs). The Ethics Committee of Ramathibodi hospital, Mahidol University, approved this study. Among all HLA class I alleles, HLA-A*24:07, HLA-B*13:01, HLA-B*15:02, HLA-C*03:04 and HLA-C*03:09 were significantly associated with dapsone-induced SCARs (OR = 10.55, 95% CI = 1.06 – 105.04, p = 0.0360; OR = 56.00, 95% CI = 8.27 – 379.22, p = 0.0001; OR = 7.00, 95% CI = 1.17 – 42.00, p = 0.0322; OR = 6.00, 95% CI = 1.24 – 29.07, p = 0.0425 and OR = 17.08, 95% CI = 0.82 – 355.45, p = 0.0321, respectively). Furthermore, HLA-B*13:01 allele had strong association with dapsone-induced SJS-TEN and DRESS when compared with dapsone-tolerant controls (OR = 42.00, 95% CI = 2.88 – 612.31, p = 0.0064 and OR = 63.00, 95% CI = 7.72 – 513.94 and p = 0.0001, respectively). Consequently, HLA-B*13:01 might serve as a pharmacogenetic marker for screening before initiating the therapy with dapsone for prevention of dapsone-induced SCARs.

Keywords: dapsone-induced SCARs, HLA-B*13:01, HLA class I alleles, severe cutaneous adverse reactions, Thai

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Authors: Bahador Bardshiri, Omid Moradi, Amir Komeilian, Nima Panahifar

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Formation of a conjunctival membrane over the corneal surface is a condition unique to rabbits that has been labeled aberrant corneal occlusion or pseudopterygium. In the summer of 2013, a five years old male Standard Chinchilla rabbit were presented to Karaj Central Veterinary hospital and the owner complained that his rabbit shows degrees of blindness and there were opacities on both eyes of the presented rabbit. Ophthalmic examination of the affected eyes revealed a conjunctival fold stretching over the cornea of both eyes. The fold originated from limbus and it was vascularized and centrally thickened. There were no attachments to the corneal epithelium and the fold could be easily lifted. Surgery was performed under general anesthesia. The conjunctival fold was incised centrifugally up to its attachment at the limbus and the lid margin using small scissors. The central rim of the segment was then replaced to its normal position in the fornix and fixed with mattress sutures (7/0) passing through outside skin. After the surgery, eye drops containing dexamethasone, gentamicin and polymixin were applied twice daily up to 3 weeks. Within the observation period (8 months) no recurrence was noted. "Pseudo" in the term pseudopterygium refers to the fact that the conjunctival membrane is not adhering to the underlying cornea, but growing over it. In rare cases, the membrane may be loosely attached to the cornea, but can be easily separated without causing damage. It can cover only a small part of the cornea with an annular peripheral opacification of the cornea, or cover it almost fully, leading to blindness. Ethiopathogenesis remains unclear and recurrence of the problem is very likely. The surgical technique that used here decreases probability of recurrence of conjunctival fold.

Keywords: rabbit, cornea, aberrant corneal occlusion, pseudopterygium

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Authors: Kanika S. Raheja, A. Pandey, Shaila Bahl, Pratik Kumar, S. P. Lochab

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The subject of undertaking for this paper is the study of BaSO4 nanophosphor doped with Europium in which mainly the concentration of the rare earth impurity Eu (0.05, 0.1, 0.2, 0.5, and 1 mol %) has been varied. A comparative study of the thermoluminescence(TL) properties of the given nanophosphor has also been done using a well-known standard dosimetry material i.e. TLD-100.Firstly, a number of samples were prepared successfully by the chemical co-precipitation method. The whole lot was then compared to a well established standard material (TLD-100) for its TL sensitivity property. BaSO4:Eu ( 0.2 mol%) showed the highest sensitivity out of the lot. It was also found that when compared to the standard TLD-100, BaSo4:Eu (0.2mol%) showed surprisingly high sensitivity for a large range of doses. The TL response curve for all prepared samples has also been studied over a wide range of doses i.e 10Gy to 2kGy for gamma radiation. Almost all the samples of BaSO4:Eu showed a remarkable linearity for a broad range of doses, which is a characteristic feature of a fine TL dosimeter. The graph remained linear even beyond 1kGy for gamma radiation. Thus, the given nanophosphor has been successfully optimised for the concentration of the dopant material to achieve its highest TL sensitivity. Further, the comparative study with the standard material revealed that the current optimised sample shows an astonishingly better TL sensitivity and a phenomenal linear response curve for an incredibly wide range of doses for gamma radiation (Co-60) as compared to the standard TLD-100, which makes the current optimised BaSo4:Eu quite promising as an efficient gamma radiation dosimeter. Lastly, the present phosphor has been optimised for its annealing temperature to acquire the best results while also studying its fading and reusability properties.

Keywords: gamma radiation, nanoparticles, radiation dosimetry, thermoluminescence

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Authors: Tatyana Suvorkina

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It is indisputable that the problem of the origin of Manichaeism is very complex. Manichaeism is characterized as a syncretic religion, which was influenced by many teachings, but it is difficult to define one which can be called fundamental. The aim of this paper is an attempt to regard Jewish apocalyptic tradition as one of the most defining source of formation of Manichaean systems. To realize this aim a comparison of the Manichean texts and the Jewish apocryphal literature is made. Consideration is given first to the Coptic Manichaean treatise Kephalaia, The Cologne Mani Codex and to books of Enoch. Under the article it is not denied that Manichaeism was influenced by different doctrines and, passed through centuries, it could adapt and strengthen this influence at an even deeper level. But the fact that the Judeo-Christian environment where Mani grew up and where the first sprouts of his teaching were formed had impact on future prophet seems obvious. Nevertheless, attempts to analyze the system of Mani within the Jewish tradition are quite rare, although such studies were carried out for Gnosticism. But Manichaeism, despite the Gnostic features it contains, is not 'one of the Gnostics' to place it under this term among the rest. Frequently, gnostic currents are pointed out as the main sources for the formation of Mani’s teachings. But it seems possible that Mani's interest in Gnosticism was motivated by the fact that he considered it as something close to that interpretation of Hebrew texts, which he aspired to undertake. The question of understanding the Manichaean system is connected not only with Manichaeism but also with other dualistic teachings, which were recognized by contemporaries as Manichaean. It is seen that polemics between Manicheans and Hellenized Christianity separated from Judaism and continued to separate with every century, were polemics between adherents of initially two different worldviews who had, however, a common source. Therefore an analysis of the controversy in the context of interpretations of this common source by disputing parties is seen very important for further study.

Keywords: dualism, Jewish apocalypticism, Manichaeism, syncretism

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Authors: Shivani Kuttuva, Bridget Fergie, Andrew Mishreki, Shovkat Mir, Fintan Bergin

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Diaphragm disease (DD) of the small bowel is a condition wherein the bowel lumen is divided into a series of short compartments by multiple circumferential membranes of mucosa and submucosa, leading to pinhole lumen and subsequent obstruction. It is a rare condition commonly attributed to non-steroidal anti-inflammatory drugs (NSAIDs) usage. Herein we present a 31-yr-old-female with a history of NSAIDs usage for one year following neurosurgery, who presented with recurrent idiopathic small bowel obstruction, recalcitrant anaemia, and impaction of capsule endoscope on investigating for anaemia. The capsule endoscopy images demonstrated multiple circumferential strictures with ulcers at its tip and villous atrophy in the proximal bowel, suggestive of NSAIDs related damage. However, due to the lack of awareness of the detrimental effects of NSAIDs on bowel mucosa distal to the duodenum, the underlying aetiology of this clinical presentation remained a mystery for a significant duration. The patient had to undergo repeated laparotomies in order to relieve the symptoms of recurring acute small bowel obstruction. Upon examining the resected specimen under microscopy, the histopathological hallmark of expanded, fibrotic, and congested submucosa was picked up, leading to the confirmation of diaphragm disease. Thus, this case report aims to widen the awareness among clinicians and aid surgeons in devising a management plan for young individuals presenting with recurring episodes of obstruction due to Diaphragm disease.

Keywords: capsule endoscopy, diaphragm disease, NSAIDs, recurrent small bowel obstruction

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Authors: Ufaith Qadri, M Marouf Wani

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In this paper, the performance and emission characteristics of a Single Cylinder Spark Ignition engine have been investigated. The research is based on micro emulsion application as fuel in a gasoline engine. We have analyzed many micro emulsion compositions in various proportions, for predicting the performance of the Spark Ignition engine. This new technology of fuel modifications is emerging very rapidly as lot of research is going on in the field of micro emulsion fuels in Compression Ignition engines, but the micro emulsion fuel used in a Gasoline engine is very rare. The use of micro emulsion as fuel in a Spark Ignition engine is virtually unexplored. So, our main goal is to see the performance and emission characteristics of micro emulsions as fuel, in Spark Ignition engines, and finding which composition is more efficient. In this research, we have used various micro emulsion fuels whose composition varies for all the three blends, and their performance and emission characteristic were predicted in AVL Boost software. Conventional Gasoline fuel 90%, 80% and 85% were blended with co-surfactant Ethanol in different compositions, and water was used as an additive for making it crystal clear transparent micro emulsion fuel, which is thermodynamically stable. By comparing the performances of engines, the power has shown similarity for micro emulsion fuel and conventional Gasoline fuel. On the other hand, Torque and BMEP shows increase for all the micro emulsion fuels. Micro emulsion fuel shows higher thermal efficiency and lower Specific Fuel Consumption for all the compositions as compared to the Gasoline fuel. Carbon monoxide and Hydro carbon emissions were also measured. The result shows that emissions decrease for all the composition of micro emulsion fuels, and proved to be the most efficient fuel both in terms of performance and emission characteristics.

Keywords: AVL Boost, emissions, microemulsions, performance, Spark Ignition (SI) engine

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Authors: Arpita Paul

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Wang Yang-ming introduced a revolutionary dimension to Japanese thought through his philosophy on intuitive moral consciousness. Post-Meiji Restoration,Emerson struck a chord with the Japanese due to the striking similarities his theories on transcendentalism had with doctrines of Wang Yang-ming'sschool of thought (Yōmeigaku), as pointed out by HomeiIwano (1873-1920). Wang's philosophy, chiefly anchored in the idea of the fundamental unity of thought and action, resembles the non-dualistic aspect of Brahman, a subject of Emerson's deep interest. Kitamura Tōkoku's (1868-1894) ardent reading of Emerson corroborated what he had learned in Wang Yang-ming's philosophy. This essay shall begin with a discussion on Emerson's discoveries of Vedanta that later, on a parallel ground with Yōmeigaku, significantly influenced Tōkoku. This essay will then demonstrate how Tōkokutransforms these philosophies to portray the advent of modern consciousness in Japan in his magnum opus"Naibuseimeiron." In his attempt to undo the blindfold of past feudalism,Tōkoku repeatedly championed the mental process of a self-reliant individual in his essays which showcase the metamorphosis of Japanese individualism in the final decades of the Meiji Period. In seeking to express Japan's budding intellectual enterprise,Tōkoku asserts securing one's vantage point in the world through an awakened consciousness. In his desire to articulate this, Tōkoku becomes, as argued in this paper's penultimate and final sections, a fascinating merging point of the philosophical doctrines of Vedanta, Yōmeigaku, and Emerson, a rare depiction in the existing scholarship.

Keywords: meiji intellengtsia, yomeigaku, vedanta, modern consciousness

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Authors: Guillaume Caulier, Lola Brasseur, Patrick Flammang, Pascal Gerbaux, Igor Eeckhaut

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Saponins and quinones are two major groups of secondary metabolites widely distributed in the biosphere. More specifically, triterpenoid saponins and anthraquinones are mainly found in a wide variety of plants, bacteria and fungi. In the animal kingdom, these natural organic compounds are rare and only found in small quantities in arthropods, marine sponges and echinoderms. In this last group, triterpenoid saponins are specific to holothuroids (sea cucumbers) while anthraquinones are the chemical signature of crinoids (feather stars). Depending on the species, they present different molecular cocktails. Despite presenting different chemical properties, these molecules share numerous similarities. This study compares the biological distribution, the pharmacological effects and the ecological roles of holothuroid saponins and crinoid anthraquinones. Both of them have been defined as allomones repelling predators and parasites (i.e. chemical defense) and have interesting pharmacological properties (e.g. anti-bacterial, anti-fungal, anti-cancer). Our study investigates the chemical ecology of two symbiotic associations models; between the snapping shrimp Synalpheus stimpsonii associated with crinoids and the Harlequin crab Lissocarcinus orbicularis associated with holothuroids. Using behavioral experiments in olfactometers, chemical extractions and mass spectrometry analyses, we discovered that saponins and anthraquinones present a second ecological role: the attraction of obligatory symbionts towards their hosts. They can, therefore, be defined as kairomones. This highlights a new paradigm in marine chemical ecology: Chemical repellents are attractants to obligatory symbionts because they constitute host specific chemical signatures.

Keywords: anthraquinones, kairomones, marine symbiosis, saponins, attractant

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Authors: Ayelet Gur

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Background: Parents with intellectual disability are of great interest to social service professionals. Article 23 of the United Nations Convention on the Rights of Persons with Disabilities aims to ensure that persons with disabilities can create a family by providing adequate supports. The aim of the current investigation was to portray families with parents with intellectual disabilities within Muslim- Arab society in Israel. Method: Qualitative method using semi-structured interviews with nine-teen Muslim Israeli social workers was employed. Thematic analysis was used to identify major themes. Results: Families with parents with intellectual disability are not a rare phenomenon in the Arab society. The common type is of marriage between a man with intellectual disability and a woman without disability. Findings indicated two main motives for the arranged marriage of a man with intellectual disability: the extended family's concerns about his future and their desire for the family continuity. The non-disabled wives' motives for marrying men with intellectual disabilities revolved around their lack of other opportunities to create a family and their desire to leave their parents' household and live independently. Those women were described as partly or fully aware of their husbands' disability prior to the marriage. The family life of those families were described in relation to the fathers' involvement in family life and relation to the wives' high burden and in many cases, acceptance of their life situation. Conclusions: Findings are discussed with respect to religious values on disability, arranged marriage and the status of Muslim women. Services and supports for parents with intellectual disabilities should be developed with respect to the cultural values and norms.

Keywords: Arab society in Israel, intellectual and developmental disability, parents with intellectual disability, social work

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Authors: Hung Lin-Zin, Lai Mei-Yen

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Prostate cancer is the most commonly diagnosed male cancer in the U.S. The prevalence is around 1 in 8. The etiology of prostate cancer is still unknown, but some predisposing factors, such as age, black race, family history, and obesity, may increase the risk of the disease. In 2020, a total of 7,178 Taiwanese people were nearly diagnosed with prostate cancer, accounting for 5.88% of all cancer cases, and the incidence rate ranked fifth among men. In that year, the total number of deaths from prostate cancer was 1,730, accounting for 3.45% of all cancer deaths, and the death rate ranked 6th among men, accounting for 94.34% of the cases of male reproductive organs. Looking for domestic and foreign literature on the use of OMOP (Observational Medical Outcomes Partnership, hereinafter referred to as OMOP) database analysis, there are currently nearly a hundred literature published related to nursing-related health problems and nursing measures built in the OMOP general data model database of medical institutions are extremely rare. The OMOP common data model construction analysis platform is a system developed by the FDA in 2007, using a common data model (common data model, CDM) to analyze and monitor healthcare data. It is important to build up relevant nursing information from the OMOP- CDM database to assist our daily practice. Therefore, we choose prostate cancer patients who are our popular care objects and use the OMOP- CDM database to explore the common associated health problems. With the assistance of OMOP-CDM database analysis, we can expect early diagnosis and prevention of prostate cancer patients' comorbidities to improve patient care.

Keywords: OMOP, nursing diagnosis, health problem, prostate cancer

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Authors: Angelis P. Barlampas

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Purpose: A 29 years old woman presented in the emergency department with psychiatric symptoms. The psychiatrist ordered a computed tomography scan as part of a general examination. Material and methods: The CT showed bilateral enlarged choroid plexus structures mimicking papillomata and situated in the trigones of the lateral ventricles. The left choroid plexus was heavily calcified, but the right one has no any obvious calcifications. Results: It is well kown that any brain mass can present with behavioral changes and even psychiatric symptomatology. Papillomata of the ventricular system have been described to cause psychotic episodes. According to literature, choroid plexus papillomas are seldom neuroepithelial intraventricular tumors, which are benign and categorized as WHO grade 1 tumors. They are more common in the pediatric population, but they can occur in the adults, too1. In addition, the distinction between choroid plexus papilloma and carcinoma is very difficult and impossible by imagine alone. It can only be implied with more advanced imaging, such as arterial spin labeling and MRI. The final diagnosis is, of course, after surgical excision. The usual location in adults is the fourth ventricle, but in children, it is the lateral ventricles. Their imaging appearance is that of a solid vascular tumor, which enhances intensely after the intravenous administration of contrast material. One out of fourth tumors presents speckled calcifications1. In our case, there are symmetrically sized masses at the trigones, and there are no calcifications in one of them, whereas the other one is grossly calcified. Also, there is no obvious hydrocephalus or any other evidence of increased intracranial pressure. General conclusions: When there is a new psychiatric patient, someone must undergo any possible examination, and of course, a brain CT study should be done to exclude any rare organic causes that may be responsible for the disease.

Keywords: phycosis, intraventricular masses, CT, brain calcifications

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Authors: Naim Izet Kajtazi

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Context: Frequently, the cause of raised intracranial pressure remains unresolved and rarely is related to spinal tumors, moreover less to spinal medulloblastoma without primary brain focus. Process: An 18-year-old woman had a 3-month history of headaches and impaired vision. Neurological examination revealed bilateral sixth cranial nerve palsies with bilateral papilloedema of grade III. No focal brain or spine lesion was found on imaging. Consecutive lumbar punctures showed high opening pressure and subsequent increasing protein level. The meningeal biopsy was negative. At one point, she developed an increasing headache, vomiting and back pain. Spine MRI showed diffuse nodular leptomeningeal enhancement with the largest nodule at T6–T7. Malignant cells were detected in cerebrospinal fluid. She underwent laminectomy with excisional biopsy, and pathology showed medulloblastoma WHO grade IV. Outcome: She was treated with chemotherapy and craniospinal irradiation and made a good recovery. Relevance: Primary spinal leptomeningeal medulloblastoma is extremely rare, especially without primary brain focus, but may cause increased intracranial pressure, even in the early microscopic phases, and it should be considered in the differential diagnosis if conventional and aggressive treatment of idiopathic intracranial hypertension fails. We assume that arachnoiditis from tumor seeding caused increased intracranial pressure. Appropriate neurosurgical intervention and surgical biopsy are mandated if a suspicious lesion is detected. Consider proper rescreening of the whole neuroaxis in refractory cases of intracranial hypertension.

Keywords: CNS infection, IIH, headache, primary spinal leptomeningeal medulloblastoma

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Authors: Aliaksandr Huminski

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Semantic Role Labeling (SRL) as shallow semantic parsing approach includes recognition and labeling arguments of a verb in a sentence. Verb participants are linked with specific semantic roles (Agent, Patient, Instrument, Location, etc.). Thus, SRL can answer on key questions such as ‘Who’, ‘When’, ‘What’, ‘Where’ in a text and it is widely applied in dialog systems, question-answering, named entity recognition, information retrieval, and other fields of NLP. However, SRL has the following flaw: Two sentences with identical (or almost identical) meaning can have different semantic role structures. Let consider 2 sentences: (1) John put butter on the bread. (2) John buttered the bread. SRL for (1) and (2) will be significantly different. For the verb put in (1) it is [Agent + Patient + Goal], but for the verb butter in (2) it is [Agent + Goal]. It happens because of one of the most interesting and intriguing features of a verb: Its ability to capture participants as in the case of the verb butter, or their features as, say, in the case of the verb drink where the participant’s feature being liquid is shared with the verb. This capture looks like a total fusion of meaning and cannot be decomposed in direct way (in comparison with compound verbs like babysit or breastfeed). From this perspective, SRL looks really shallow to represent semantic structure. If the key point in semantic representation is an opportunity to use it for making inferences and finding hidden reasons, it assumes by default that two different but semantically identical sentences must have the same semantic structure. Otherwise we will have different inferences from the same meaning. To overcome the above-mentioned flaw, the following approach is suggested. Assume that: P is a participant of relation; F is a feature of a participant; Vcp is a verb that captures a participant; Vcf is a verb that captures a feature of a participant; Vpr is a primitive verb or a verb that does not capture any participant and represents only a relation. In another word, a primitive verb is a verb whose meaning does not include meanings from its surroundings. Then Vcp and Vcf can be decomposed as: Vcp = Vpr +P; Vcf = Vpr +F. If all Vcp and Vcf will be represented this way, then primitive verbs Vpr can be considered as a canonical form for SRL. As a result of that, there will be no hidden participants caught by a verb since all participants will be explicitly unfolded. An obvious example of Vpr is the verb go, which represents pure movement. In this case the verb drink can be represented as man-made movement of liquid into specific direction. Extraction and using primitive verbs for SRL create a canonical representation unique for semantically identical sentences. It leads to the unification of semantic representation. In this case, the critical flaw related to SRL will be resolved.

Keywords: decomposition, labeling, primitive verbs, semantic roles

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Authors: Sushila Jaiswal, Awadhesh Kumar Jaiswal

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Background: Primary melanocytic tumors of the central nervous system (CNS) are uncommon lesions and arise from the melanocytes located within the leptomeninges. Aim and objective: The aim of the study was to evaluate the clinical details, histomorphology of the primary melanocytic tumor of CNS. Method: The study was performed by the retrospective review of the case records of the primary melanocytic tumors of CNS diagnosed in our department. The formalin-fixed, paraffin embedded tissue blocks and tissue sections were retrieved and reviewed. Results: Seven cases (6 males, 1 female; age range- 16-40 years; mean age- 27 years) of primary melanocytic tumors of CNS were retrieved over last seven years. The tumor was intracranial (n=5; frontal – 1 case, parietal – 1 case, cerebello-pontine angle- 1 case, occipital -1 case, foramen magnum-1 case) and intra spinal (n=2; cervical – 2 cases). All patients presented with the neurological deficits related to the location of the tumor. Four cases were malignant melanoma; two were melanocytoma of intermediate grade and remaining one was melanocytoma. On histopathology, melanocytoma and melanoma both displayed sheets of well-differentiated melanocytes having round to oval nuclei with finely dispersed chromatin, occasional single eosinophilic nucleoli and a moderate amount of cytoplasm with abundant granular melanin pigment. The absence of mitosis and macronucleoli was noticed in melanocytoma while melanoma showed frequent mitosis and macronucleoli. On immunohistochemistry, both showed diffuse strong HMB45 and S-100 immunopositivity. Conclusion: Primary melanocytic tumors of CNS are rare and predominantly seen in males. It is important to differentiate melanoma from melanocytoma as prognosis of later is good.

Keywords: melanocytoma, melanoma, brain tumor, melanin

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Authors: Neha Verma, Manik Rakhra

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Statement of the Problem: Nowadays, a tremendous increase in population and advanced industrialization augment the problems related to air and water pollutions. Growing industries promoting environmental danger, which is an alarming threat to the ecosystem. For safeguard, the environment, detection of perilous gases and release of colored wastewater is required for eutrophication pollution. Researchers around the globe are trying their best efforts to save the environment. For this remediation advanced oxidation process is used for potential applications. ZnO is an important semiconductor photocatalyst with high photocatalytic and gas sensing activities. For efficient photocatalytic and gas sensing properties, it is necessary to prepare a doped/co-doped ZnO compound to decrease the electron-hole recombination rates. However, lanthanide doped and co-doped metal oxide is seldom studied for photocatalytic and gas sensing applications. The purpose of this study is to describe the best photocatalyst for the photodegradation of dyes and gas sensing properties. Methodology & Theoretical Orientation: Economical framework has to be used for the synthesis of ZnO. In the depth literature survey, a simple combustion method is utilized for gas sensing and photocatalytic activities. Findings: Rare earth doped and co-doped ZnO nanoparticles were the best photocatalysts for photodegradation of organic dyes and different gas sensing applications by varying various factors such as pH, aging time, and different concentrations of doping and codoping metals in ZnO. Complete degradation of dye was observed only in min. Gas sensing nanodevice showed a better response and quick recovery time for doped/co-doped ZnO. Conclusion & Significance: In order to prevent air and water pollution, well crystalline ZnO nanoparticles were synthesized by rapid and economic method, which is used as photocatalyst for photodegradation of organic dyes and gas sensing applications to sense the release of hazardous gases from the environment.

Keywords: ZnO, photocatalyst, photodegradation of dye, gas sensor

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Authors: Ying Zhu, Ning Wu, Hai-Dong Huang, Yu-Chao Dong, Qin-Ying Sun, Wei Zhang, Qin Wang, Qiang Li

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Background and study aims: Tracheobronchopathia osteochondroplastica (TO) is an uncommon disease of the tracheobronchial system that leads to narrowing of the airway lumen from cartilaginous and/or osseous submucosal nodules. The aim of this study is to perform a detailed review of this rare disease in a large cohort of patients with TO proven by fiberoptic bronchoscopy from China. Patients and Methods: Retrospective chart review was performed on 41,600 patients who underwent bronchoscopy in the Department of Respiratory Medicine of Changhai Hospital between January 2005 and December 2012. Cases of TO were identified based on characteristic features during bronchoscopic examination. Results: 22 cases of bronchoscopic TO were identified. Among whom one-half were male and the mean age was 47.45 ±10.91 years old. The most frequent symptoms at presentation were chronic cough (n=14) and increased sputum production (n=10). Radiographic abnormalities were observed in 3/18 patients and findings on computed tomography consistent with TO such as beaded intraluminal calcifications and/or increased luminal thickenings were observed in 18/22 patients. Patients were classified into the following categories based on the severity of bronchoscopic findings: Stage I (n=2), Stage II (n=6) and Stage III(n=14). The result that bronchoscopic improvement was observed in 2 patients administered with inhaled corticosteroids suggested that resolution of this disease is possible. Conclusions: TO is a benign disease with slow progression, which could be roughly divided into 3 stages on the basis of the characteristic endoscopic features and histopathologic findings. Chronic inflammation was thought to be more important than the other existing plausible hypotheses in the course of TO. Inhaled corticosteroids might have some impact on patients at Stage I/II.

Keywords: airway obstruction, bronchoscopy, etiology, Tracheobronchopathia osteochondroplastica (TO), treatment

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Authors: Christolyn Raj, Lewis Levitz

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Introduction: Two cases of late presentation ( > five years ) of bilateral pseudophakic macula edema related to oral tyrosine kinase inhibitors are described. These cases are the first of their type in the published literature. A review of ocular inflammatory complications of tyrosine kinase inhibitors in the current literature is explored. Case Presentations(s): Case 1 is an 83-year-old female who has been stable on Ibrutinib (Imbruvica ®) for chronic lymphocytic leukemia (CLL). She presented with bilateral blurred vision from severe cystoid macula edema seven years following routine cataract surgery. She was treated with intravitreal steroids with complete resolution without relapse. Case 2 is a 76-year-old female who was on therapy for polycythemia vera with Ruxolitinib (Jakafi®). She presented with bilateral blurred vision from mild cystoid macula edema six years following routine cataract surgery. She responded well to topical steroids without relapse. In both cases, oral tyrosine kinase inhibitor agents were presumed to be the underlying cause and were ceased. Over the last five years, there have been increasing reports in the literature of the inflammatory effects of tyrosine kinase inhibitors on the retina, uvea and optic nerve. Conclusion: Late presentation of pseudophakic macula edema following routine cataract surgery is rare. Such presentations should prompt investigation of the chronic use of systemic medications, especially oral kinase inhibitors. Patients who must remain on these agents require ongoing ophthalmologic assessment in view of their long-term inflammatory side effects.

Keywords: macula edema, oral kinase inhibitors, retinal toxicity, pseudo-phakia

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Authors: Kuang Sheng Liu, Yu Lin Shih*, Chun Ta Tzeng, Cheng Chen Chen

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Buildings in the 21st century are facing issues such as an extreme climate and low-carbon/energy-saving requirements. Many countries in the world are of the opinion that a building during its medium- and long-term life cycle is an energy-consuming entity. As for the use of architectural resources, including the United Nations-implemented "Global Green Policy" and "Sustainable building and construction initiative", all are working towards "zero-energy building" and "zero-carbon building" policies. Because of this, countries are cooperating with industry development using policies such as "mandatory design criteria", "green procurement policy" and "incentive grants and rebates programme". The results of this study can provide a reference for sustainable building renovation design criteria. Aimed at townhouses in Kaohsiung City, this study uses different levels of solar blocking depth to carry out evaluation of design and energy-saving renovation of the outer shell of existing buildings by using data collection and the selection of representative cases. Using building resources from a building information model (BIM), simulation and efficiency evaluation are carried out and proven with simulation estimation. This leads into the ECO-efficiency model (EEM) for the life cycle cost efficiency (LCCE) evalution. The buildings selected by this research sit in a north-south direction set with different solar blocking depths. The indoor air-conditioning consumption rates are compared. The current balcony depth of 1 metre as the simulated EUI value acts as a reference value of 100%. The solar blocking of the balcony is increased to 1.5, 2, 2.5 and 3 metres for a total of 5 different solar-blocking balcony depths, for comparison of the air-conditioning improvement efficacy. This research uses different solar-blocking balcony depths to carry out air-conditioning efficiency analysis. 1.5m saves 3.08%, 2m saves 6.74%, 2.5m saves 9.80% and 3m saves 12.72% from the air-conditioning EUI value. This shows that solar-blocking balconies have an efficiency-increasing potential for indoor air-conditioning.

Keywords: building information model, eco-efficiency model, energy-saving in the external shell, solar blocking depth.

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Authors: M. Khordadmehr, V. R. Ranjbar, R. Norouzi, M. Zeinoddin

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Coccidiosis is recognized as a serious parasitic disease problem limiting quail industry recently. But the data on incidence, clinical signs, species of coccidia and pathological changes in Japanese quail are rare, especially in Iran in spite of the significant improvement of commercial quail breeding in this country in recent decades. Therefore, in the present paper was studied natural infection of quail coccidiosis in three commercial rearing farms with 80% morbidity and 3% mortality rate. For this purpose, fecal sample, oocyst examination, and morphological study were performed beside necropsy, histopathology, and PCR to confirm the diagnosis. In the affected birds, clinical signs included brown diarrhea, weakness, and pale face. In the fecal examination, three species of the genus Eimeria were identified including E. uzura, E. bateri, and E. tsunodai. At necropsy, the main gross lesions were edema, congestion and small blood spots in the small intestine. In histopathologic examination, endogenous stages of the parasites associated with hyperplasia of the intestinal glands, mild congestion, infiltration of mononuclear cells, and edema were observed in the intestine. The molecular study using BSEF and BSER specific primers confirmed the presence of the genus Eimeria in the affected birds. Interestingly, phylogenetic analysis showed relatively high bootstrap values in Japanese quail Eimeria with E. acervuline and E. maxima strains in the chicken. The present study is the first phylogenetic findings on Eimeria of quail which could be valuable for further research on Japanese quail coccidiosis.

Keywords: coccidiosis, Japanese Quail, pathomorphology, phylogenetic analysis

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Authors: Sumandeep Kaur, Allam Srinivasa Rao, Mula Jayasimhadri

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In recent years, rare earth (RE) ions doped inorganic luminescent materials are seeking great attention due to their excellent physical and chemical properties. These materials offer high thermal and chemical stability and exhibit good luminescence properties due to the presence of RE ions. The luminescent properties of these materials are attributed to their intra-configurational f-f transitions in RE ions. A series of Tb³⁺ doped calcium aluminozincate has been synthesized via sol-gel method. The structural and morphological studies have been carried out by recording X-ray diffraction patterns and SEM image. The luminescent spectra have been recorded for a comprehensive study of their luminescence properties. The XRD profile reveals the single-phase orthorhombic crystal structure with an average crystallite size of 65 nm as calculated by using DebyeScherrer equation. The SEM image exhibits completely random, irregular morphology of micron size particles of the prepared samples. The optimization of luminescence has been carried out by varying the dopant Tb³⁺ concentration within the range from 0.5 to 2.0 mol%. The as-synthesized phosphors exhibit intense emission at 544 nm pumped at 478 nm excitation wavelength. The optimized Tb³⁺ concentration has been found to be 1.0 mol% in the present host lattice. The decay curves show bi-exponential fitting for the as-synthesized phosphor. The colorimetric studies show green emission with CIE coordinates (0.334, 0.647) lying in green region for the optimized Tb³⁺ concentration. This report reveals the potential utility of Tb³⁺ doped calcium aluminozincate phosphors for display and solid-state lighting devices.

Keywords: concentration quenching, phosphor, photoluminescence, XRD

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Authors: Jun-Lun Jiang, Bing-Sheng Yu

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Processing of flat-panel displays generates huge amount of wasted glass polishing powder, with high concentration of cerium and other elements such as lanthanum. According to the current statistics, consumption of polishing powder was approximately ten thousand tons per year in the world. Nevertheless, wasted polishing powder was usually buried or burned. If the lanthanum and cerium compounds in the wasted polishing powder could be recycled, that will greatly reduce enterprise cost and implement waste circulation. Cathodes of SOFCs are the principal consisting of rare earth elements such as lanthanum and cerium. In this study, we recycled the lanthanum and cerium from wasted glass polishing powder by acid-solution method, and synthesized La0.8Sr0.05Ca0.15Fe0.8Co0.8O3-δ and Gd0.1Ce0.9O2 (LSCCF-GDC) composite cathode material for SOFCs by glycinenitrate combustion (GNP) method. The results show that the recovery rates of lanthanum and cerium could accomplish up to 80% and 100% under 10N nitric acid solution within one hour. Comparing with the XRD data of the commercial LSCCF-GDC powder and the LSCCF-GDC product synthesized with chemicals, we find that the LSCCF-GDC was successfully synthesized with the recycled La & Ce solution by GNP method. The effect of adding ammonia to the product was also discussed, the grain size is finer and recovery rate of the product is higher without the addition of ammonia to the solution.

Keywords: glass polishing powder, acid solution, recycling, composite cathodes of solid oxide fuel, cell (SOFC), perovskite, glycine-nitrate combustion(GNP) method

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Authors: I. Ramalho, S. Campos, M. Dias

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Introduction: Endometriosis may play a role in the pathogenesis of ovarian cancer (OC), however, the risk and prognosis have not been well established. The association between these two pathologies could have an important impact on prevention and early diagnosis of OC. Objective: To analyze the prevalence of endometriosis associated ovarian cancer and related clinical, epidemiological and histopathological issues. Design: We conducted a retrospective case series analysis of patients diagnosed with endometriosis and ovarian cancer in the Gynecology Department of Coimbra University Hospital Center since 2006 to 2015. Methods: We collected data from women diagnosed with ovarian cancer, with anatomopathology records reporting findings of endometriosis in ovarian cancer patients. Patients were retrieved from the pathological records and appropriate medical records were retrospectively reviewed. Statistical analysis was performed using SPSS 22.0. Results: Histological evidence of endometriosis was found in 17 out of 261 patients diagnosed with ovarian cancer (OC) (6.51%). The most usual symptoms were pelvic pain, abdominal distension, asthenia, ascites, weight loss and nausea. Mean age at diagnosis was 61.2 ± 15.1, 41-86 years old, 33.3% were pre-menopausal patients and cancer stage distribution was predominantly stage I (31.3%) and stage III (56.3%). OC occurred unilaterally in 14 patients and 2 patients were diagnosed with a synchronous ovarian and endometrial cancer. Regarding histological type, 10 OC were classified as clear cell carcinoma (CCC), 4 endometrioid carcinomas (EC) and 3 mixed type (clear cell and endometrioid). Four ovarian carcinomas presumably arose from endometriomas: 3 CCC and 1 EC. Conclusions: In accordance with previous studies, clear cell was the most common pathological type in endometriotic patients, followed by endometrioid carcinomas, and two rare synchronous ovarian and endometrial carcinomas were registered. Although endometriosis association to OC is uncommon, endometriosis should be managed with special care in order to early diagnosis.

Keywords: endometriosis, histology, observational study, ovarian cancer

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Authors: Fatma Koksal Çakirlar, Si̇nem Ozdemir, Selcan Akyol, Revazi̇ye Gulesen, Murat Gunaydin, Nevri̇ye Gonullu, Belkis Levent, Nuri̇ Kiraz

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Vibrio cholerae O1 and O139 are the causative agent of epidemic or pandemic cholera. V. cholerae O1 is generally accepted as a non-invasive enterotoxigenic organism causing gastroenteritis of various severities. Non-O1 V. cholerae can cause small outbreaks of diarrhea due to consumption of contaminated food and water. Particularly, the patients with achlorydria have a risk for vibrio infections. There are numerous case reports of bacteremia caused by vibrio in patients with predisposing conditions like cirrhosis, nephrotic syndrome, diabetes, hematologic malignancy, gastrectomy, and AIDS. We described in this study the first case of nontoxigenic, non-01/non-O139 V. cholerae isolated from the blood culture of a 77-year-old female patient with hipertension, diabetes, coronary artery disease, gout and about 9 years ago migrated breast cancer history. The patient with complaints of shortness of breath, fever and malaise admitted to our emergency clinic were evaluated. There was no diarrhea or abdominal symptoms in the patient. No growth in her urine culture, but blood culture (BACTEC 9120 system, Becton Dickinson, USA) was positive for non-01/non-O139 V. cholerae that was identified by conventional methods and Phoenix automated system (BD Diagnostic Systems, Sparks, MD). It does not secrete the cholera toxin. The agglutination test was negative with polyvalent O1 antisera and O139 antiserum. Empirically ceftriaxone was administered to the patient and she was discharged with improvement in general condition. In this study we report bacteremia by non-01/non-O139 V. cholerae that is rare in the worldwide and first in Turkey.

Keywords: bacteremia, blood culture, immunocompromised patient, Non-O1 vibrio cholerae

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Authors: Nanis Setyorini

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This is an interpretive study that aims to explore English teachers’ self-identity and self-reflection on teaching of English for accounting purpose in Indonesian accounting schools. Pierre Bourdieu’s concepts of capitals, habitus, and field are applied to capture and analyze the outright feelings, dilemma, and efforts of how English teachers see their educational background and adjust their understanding of English teaching for specific purpose, how they deliver unrecognized materials about accountancy, how they build confidence in teaching accountancy experts, and how to develop their professional commitment as English teachers for accounting purpose. Therefore, semi-structured interviews and focus group discussions are conducted to 16 English teachers in accounting schools within five state and private universities in East Java, Indonesia. The appropriateness of English teachers for accounting students remains a debatable topic. Previous literatures assume that the best English teachers for accounting students should be those who can demonstrate good quality use of English as well as those who have sound accounting knowledge and experience; however, such teachers are rare to find. Most English teachers in Indonesian accounting schools generally graduate from English education or English literature that provide a very limited pedagogic theories and practices of English for specific purpose (ESP). As a result, ESP teachers often had misconception and loss of face when they deliver subject contents to their accounting students who sometimes have been employed as professional accountants. The teachers also face a dilemma in locating themselves as the insiders in English knowledge, but the outsiders in accounting field. These situations are generally problems in their early-stage of teaching due to the lack of ESP knowledge, the shortage of teaching preparation, the absence of ESP in-house trainings on English for accountancy, and the unconducive relations with accounting educators as well as other ESP teachers. Then, self-learning with various resources and strategies is said as their effort to develop their teaching competence so they are able to teach English for accounting students more effectively.

Keywords: ESP teacher, English for accounting, self-identity, self-reflectivity

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Authors: Mesfin Angaw Tesfay

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L-Xylulose is a potentially valuable rare sugar used as starting material for antiviral and anticancer drug development in pharmaceutical industries. L-Xylulose exist in a very low concentration in nature and have to be synthesized from cheap starting materials such as xylitol through biotechnological approaches. In this study, cofactor engineering and deep eutectic solvent were applied to improve the efficiency of L-xylulose production from xylitol. A water-forming NAD+ regeneration enzyme (NADH oxidase) from Streptococcus mutans ATCC 25175 was introduced into E. coli with xylitol-4-dehydrogenase (XDH) of Pantoea ananatis resulting in recombinant cells harboring the vector pETDuet-xdh-SmNox. Further, three deep eutectic solvents (DES) including, Choline chloride/glycerol (ChCl/G), Choline chloride/urea (ChCl/U), and Choline chloride/ethylene glycol (ChCl/EG) have been employed to facilitate the conversion efficiency of L-xylulose from xylitol. The co-expression system exhibited optimal activity at a temperature of 37 ℃ and pH 8.5, and the addition of Mg2+ enhanced the catalytic activity by 1.19-fold. Co-expression of NADH oxidase with XDH enzyme resulted in increased L-xylulose concentration and productivity from xylitol as well as the intracellular NAD+ concentration. Two of the DES used (ChCl/U and ChCl/EG) show positive effects on product yield and the ChCl/G has inhibiting effects. The optimum concentration of ChCl/U was 2.5%, which increased the L-xylulose yields compared to the control without DES. In a 1 L fermenter the final concentration and productivity of L-xylulose from 50 g/L of xylitol reached 48.45 g/L, and 2.42 g/L.h respectively, which was the highest report. Overall, this study is a suitable approach for large-scale production of L-xylulose from xylitol using the engineered E. coli cell.

Keywords: Xylitol-4-dehydrogenase, NADH oxidase, L-xylulose, Xylitol, Coexpression, DESs

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Authors: Agnieszka Szczudlińska-Kanoś

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Nowadays the participation of citizens in public life increasingly effect on management at all levels of public authority. Today, however, democratic systems in many countries, also in Poland, based on the first - on the institutions of representative democracy, which is mainly on elections, party activity, on the other hand - on the basic instruments of direct democracy, which, in particular, we can include a referendum or initiative of citizenship - although these are often rather complementary. Other forms of participatory democracy, such as deliberative democracy, participatory budgeting, public consultation in practice in many countries are still rare. Appropriate use of the potential invested in participatory democracy can bring enormous and multilateral benefits. On the one hand, local and regional communities taking an active part in public life express their needs, point out problems and thus affect the decisions of public authorities. Authorities using knowledge acquired from the citizens also implement the policy tailored to their needs, thus obtaining support in the next election. The purpose of this study is to show how the Polish citizens affect to resolve issues of social policy pursued at different levels of government. This problem is very important because today the observed changes seen in virtually all fields of life create new social problems, which nowadays are no longer only the problems of the region, the country but they are international, global issues. From such this perspective we should talk about them, discuss, try to solve at all levels. Article will be useful not only theorists involved in the management of the public, local government, or social but also practitioners - local government acting as their functions at different levels of government. Conclusions drawn from the publication will also be useful to politicians and those directly affecting for: functioning social security systems, the scope and quality of public services and the overall shape of the contemporary social policy in different countries.

Keywords: social policy, local government, social participation, social services

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Authors: Hala S. Mekawy

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Affordable housing delivery for low and lower middle income families is a prominent problem in many developing countries; governments alone are unable to address this challenge due to diverse financial and regulatory constraints, and the private sector's contribution is rare and assists only middle-income households even when institutional and legal reforms are conducted to persuade it to go down market. Also, the market-enabling policy measures advocated by the World Bank since the early nineties have been strongly criticized and proven to be inappropriate to developing country contexts, where it is highly unlikely that the formal private sector can reach low income population. In addition to governments and private developers, affordable housing delivery systems involve an intricate network of relationships between diverse ranges of actors. Collaboration between them was proven to be vital, and hence, an approach towards partnership schemes for affordable housing delivery has emerged. The basic premise of this paper is that addressing housing affordability challenges in Egypt demands direct public support, as markets and market actors alone would never succeed in delivering decent affordable housing to low and lower middle income groups. It argues that this support would ideally be through local level partnership schemes, with a leading decentralized local government role, and partners being identified according to specific local conditions. It attempts to identify major attributes that would ensure the fulfilment of the goals of such schemes in the Egyptian context. This is based upon evidence from diversified worldwide experiences, in addition to the main outcomes of a questionnaire that was conducted to specialists and chief actors in the field.

Keywords: affordable housing, partnership schemes, housing, urban environments

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Authors: Mihai-Ionut Firescu, Mark A. P. Carson

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We present a case of inferior vena cava agenesis (IVCA) associated with bilateral deep venous thrombosis (DVT) in a patient with Beckwith-Wiedemann syndrome (BWS). In adult patients with BWS presenting with bilateral lower limb oedema, specific aetiological factors should be considered. These include cardiomyopathy and intraabdominal tumours. Congenital malformations of the IVC, through causing relative venous stasis, can lead to lower limb oedema either directly or indirectly by favouring lower limb venous thromboembolism; however, they are yet to be reported as an associated feature of BWS. Given its life-threatening potential, the prompt initiation of treatment for bilateral DVT is paramount. In BWS patients, however, this can prove more complicated. Due to overgrowth, the above-average birth weight can continue throughout childhood. In this case, the patient’s weight reached 170 kg, impacting on anticoagulation choice, as direct oral anticoagulants have a limited evidence base in patients with a body mass above 120 kg. Furthermore, the presence of IVCA leads to a long-term increased venous thrombosis risk. Therefore, patients with IVCA and bilateral DVT warrant specialist consideration and may benefit from multidisciplinary team management, with hematology and vascular surgery input. Conclusion: Here, we showcased a rare cause for bilateral lower limb oedema, respectively bilateral deep venous thrombosis complicating IVCA in a patient with Beckwith-Wiedemann syndrome. The importance of this case lies in its novelty, as the association between IVC agenesis and BWS has not yet been described. Furthermore, the treatment of DVT in such situations requires special consideration, taking into account the patient’s weight and the presence of a significant, predisposing vascular abnormality.

Keywords: Beckwith-Wiedemann syndrome, bilateral deep venous thrombosis, inferior vena cava agenesis, venous thromboembolism

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Authors: Giselle Tran, Ralitza Parina, Phuong T. Nguyen

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Background/Aims: Pancreatic cysts (PC) have recently become an increasingly common entity, often diagnosed as incidental findings on cross-sectional imaging. Clinically, management of the lesions is difficult because of uncertainties in their potential for malignant degeneration. Prior series have reported that carcinoembryonic antigen (CEA), a biomarker collected from cyst fluid aspiration, has a high diagnostic accuracy for discriminating between mucinous and non-mucinous lesions, at the patient’s initial presentation. To the author’s best knowledge, no prior studies have reported PC CEA levels obtained from endoscopic ultrasound fine-needle aspiration (EUS-FNA) over years of serial EUS surveillance imaging. Methods: We report a consecutive retrospective series of 624 patients who underwent EUS evaluation for a PC between 11/20/2009 and 11/13/2018. Of these patients, 401 patients had CEA values obtained at the point of entry. Of these, 157 patients had two or more CEA values obtained over the course of their EUS surveillance. Of the 157 patients (96 F, 61 M; mean age 68 [range, 62-76]), the mean interval of EUS follow-up was 29.7 months [3.5-128]. The mean number of EUS procedures was 3 [2-7]. To assess CEA value fluctuations, we defined an appreciable increase in CEA as "spikes" – two-times increase in CEA on a subsequent EUS-FNA of the same cyst, with the second CEA value being greater than 1000 ng/mL. Using this definition, cysts with a spike in CEA were compared to those without a spike in a bivariate analysis to determine if a CEA spike is associated with poorer outcomes and the presence of high-risk features. Results: Of the 157 patients analyzed, 29 had a spike in CEA. Of these 29 patients, 5 had a cyst with size increase >0.5cm (p=0.93); 2 had a large cyst, >3cm (p=0.77); 1 had a cyst that developed a new solid component (p=0.03); 7 had a cyst with a solid component at any time during surveillance (p=0.08); 21 had a complex cyst (p=0.34); 4 had a cyst categorized as "Statistically Higher Risk" based on molecular analysis (p=0.11); and 0 underwent surgical resection (p=0.28). Conclusion: With serial EUS imaging in the surveillance of PC, an increase in CEA level defined as a spike did not predict poorer outcomes. Most notably, a spike in CEA did not correlate with the number of patients sent to surgery or patients with an appreciable increase in cyst size. A spike in CEA did not correlate with the development of a solid nodule within the PC nor progression on molecular analysis. Future studies should focus on the selected use of CEA analysis when patients undergo EUS surveillance evaluation for PCs.

Keywords: carcinoembryonic antigen (CEA), endoscopic ultrasound (EUS), fine-needle aspiration (FNA), pancreatic cyst, spike

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