Search results for: breast cancer delayed diagnosis and treatment in Afghanistan
10247 Inverse Problem Method for Microwave Intrabody Medical Imaging
Authors: J. Chamorro-Servent, S. Tassani, M. A. Gonzalez-Ballester, L. J. Roca, J. Romeu, O. Camara
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Electromagnetic and microwave imaging (MWI) have been used in medical imaging in the last years, being the most common applications of breast cancer and stroke detection or monitoring. In those applications, the subject or zone to observe is surrounded by a number of antennas, and the Nyquist criterium can be satisfied. Additionally, the space between the antennas (transmitting and receiving the electromagnetic fields) and the zone to study can be prepared in a homogeneous scenario. However, this may differ in other cases as could be intracardiac catheters, stomach monitoring devices, pelvic organ systems, liver ablation monitoring devices, or uterine fibroids’ ablation systems. In this work, we analyzed different MWI algorithms to find the most suitable method for dealing with an intrabody scenario. Due to the space limitations usually confronted on those applications, the device would have a cylindrical configuration of a maximum of eight transmitters and eight receiver antennas. This together with the positioning of the supposed device inside a body tract impose additional constraints in order to choose a reconstruction method; for instance, it inhabitants the use of well-known algorithms such as filtered backpropagation for diffraction tomography (due to the unusual configuration with probes enclosed by the imaging region). Finally, the difficulty of simulating a realistic non-homogeneous background inside the body (due to the incomplete knowledge of the dielectric properties of other tissues between the antennas’ position and the zone to observe), also prevents the use of Born and Rytov algorithms due to their limitations with a heterogeneous background. Instead, we decided to use a time-reversed algorithm (mostly used in geophysics) due to its characteristics of ignoring heterogeneities in the background medium, and of focusing its generated field onto the scatters. Therefore, a 2D time-reversed finite difference time domain was developed based on the time-reversed approach for microwave breast cancer detection. Simultaneously an in-silico testbed was also developed to compare ground-truth dielectric properties with corresponding microwave imaging reconstruction. Forward and inverse problems were computed varying: the frequency used related to a small zone to observe (7, 7.5 and 8 GHz); a small polyp diameter (5, 7 and 10 mm); two polyp positions with respect to the closest antenna (aligned or disaligned); and the (transmitters-to-receivers) antenna combination used for the reconstruction (1-1, 8-1, 8-8 or 8-3). Results indicate that when using the existent time-reversed method for breast cancer here for the different combinations of transmitters and receivers, we found false positives due to the high degrees of freedom and unusual configuration (and the possible violation of Nyquist criterium). Those false positives founded in 8-1 and 8-8 combinations, highly reduced with the 1-1 and 8-3 combination, being the 8-3 configuration de most suitable (three neighboring receivers at each time). The 8-3 configuration creates a region-of-interest reduced problem, decreasing the ill-posedness of the inverse problem. To conclude, the proposed algorithm solves the main limitations of the described intrabody application, successfully detecting the angular position of targets inside the body tract.Keywords: FDTD, time-reversed, medical imaging, microwave imaging
Procedia PDF Downloads 12510246 Stories of Women With Cervical Cancer in Taiwan: A Narrative Analysis Research
Authors: Pei-Yu Lee
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This study investigates the life experience and self-interpretation of female cervical cancer patients under Taiwanese cultural context. Through a Narrative Analysis Research approach, the study took six cervical cancer female patients with an average age of 58 years (ranging from 55-66 years) for an average of twice, 60 minutes each time, in-depth recorded interviews under their consent. After converting the interview recordings into transcripts, the study applied the Riessman approach to analyze the contents. The results revealed two major theme, including 1. The symbolic meaning of the cervix, and 2. Women's perseverance and compliance. Because of the illness metaphor of cervical cancer and the designation of women being family caregivers under the Chinese patriarchal culture, females with cervical cancer are not only patients but also responsible for being family and partner roles, in which contradictions of intimate relationships exist. Show the strength of perseverance and compliance in the course of life. On the other hand, they have to identify and recognize their roles in life and strive to determine the situation of coexisting with the disease to picture their life. The results showed that female cervical cancer patients not only need to combat the disease but also stand against the stigma and the traditional responsibility given to women. The researchers recommend that nurses should include cultural implications in their care of female cervical cancer patients.Keywords: female, cervical cancer, narrative analysis research, taiwan
Procedia PDF Downloads 9610245 A Rare Case of Synchronous Colon Adenocarcinoma
Authors: Mohamed Shafi Bin Mahboob Ali
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Introduction: Synchronous tumor is defined as the presence of more than one primary malignant lesion in the same patient at the indexed diagnosis. It is a rare occurrence, especially in the spectrum of colorectal cancer, which accounts for less than 4%. The underlying pathology of a synchronous tumor is thought to be due to a genomic factor, which is microsatellite instability (MIS) with the involvement of BRAF, KRAS, and the GSRM1 gene. There are no specific sites of occurrence for the synchronous colorectal tumor, but many studies have shown that a synchronous tumor has about 43% predominance in the ascending colon with rarity in the sigmoid colon. Case Report: We reported a case of a young lady in the middle of her 30's with no family history of colorectal cancer that was diagnosed with a synchronous adenocarcinoma at the descending colon and rectosigmoid region. The lady's presentation was quite perplexing as she presented to the district hospital initially with simple, uncomplicated hemorrhoids and constipation. She was then referred to our center for further management as she developed a 'football' sized right gluteal swelling with a complete intestinal obstruction and bilateral lower-limb paralysis. We performed a CT scan and biopsy of the lesion, which found that the tumor engulfed the sacrococcygeal region with more than one primary lesion in the colon as well as secondaries in the liver. The patient was operated on after a multidisciplinary meeting was held. Pelvic exenteration with tumor debulking and anterior resection were performed. Postoperatively, she was referred to the oncology team for chemotherapy. She had a tremendous recovery in eight months' time with a partial regain of her lower limb power. The patient is still under our follow-up with an improved quality of life post-intervention. Discussion: Synchronous colon cancer is rare, with an incidence of 2.4% to 12.4%. It has male predominance and is pathologically more advanced compared to a single colon lesion. Down staging the disease by means of chemoradiotherapy has shown to be effective in managing this tumor. It is seen commonly on the right colon, but in our case, we found it on the left colon and the rectosigmoid. Conclusion: Managing a synchronous colon tumor could be challenging to surgeons, especially in deciding the extent of resection and postoperative functional outcomes of the bowel; thus, individual treatment strategies are needed to tackle this pathology.Keywords: synchronous, colon, tumor, adenocarcinoma
Procedia PDF Downloads 10510244 Diagnosis of the Lubrification System of a Gas Turbine Using the Adaptive Neuro-Fuzzy Inference System
Authors: H. Mahdjoub, B. Hamaidi, B. Zerouali, S. Rouabhia
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The issue of fault detection and diagnosis (FDD) has gained widespread industrial interest in process condition monitoring applications. Accordingly, the use of neuro-fuzzy technic seems very promising. This paper treats a diagnosis modeling a strategic equipment of an industrial installation. We propose a diagnostic tool based on adaptive neuro-fuzzy inference system (ANFIS). The neuro-fuzzy network provides an abductive diagnosis. Moreover, it takes into account the uncertainties on the maintenance knowledge by giving a fuzzy characterization of each cause. This work was carried out with real data of a lubrication circuit from the gas turbine. The machine of interest is a gas turbine placed in a gas compressor station at South Industrial Centre (SIC Hassi Messaoud Ouargla, Algeria). We have defined the zones of good and bad functioning, and the results are presented to demonstrate the advantages of the proposed method.Keywords: fault detection and diagnosis, lubrication system, turbine, ANFIS, training, pattern recognition
Procedia PDF Downloads 48810243 Effects of Adding Gypsum in Agricultural Land on Mitigating Splash Erosion on Sandy Loam and Loam Soil Textures, Afghanistan
Authors: Abdul Malik Dawlatzai, Shafiqullah Rahmani
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Splash erosion in field has affected by factors; slope, rain intensity, soil properties, and plant cover. And also, soil erosion affects not only farmland productivity but also water quality downstream. There are a number of potential soil conservation practices, but many of these are complicated and relatively expensive, such as buffer strips, agro-forestry, counter banking, catchment canal, terracing, surface mulching, reduced tillage, etc. However, mitigation soil and water loss in agricultural land, particularly in arid and semi-arid climatic conditions, is indispensable for environmental protection and agricultural production. The objective of this study is to evaluate the effects of adding gypsum mineral on mitigating splash erosion caused by rain drop. The research was conducted in soil laboratory Badam Bagh Agricultural Researching Farm, Kabul, Afghanistan. The stainless steel cores were used, and constant water pressure was controlled by a Mariotte’s bottle with kinetic energy of raindrops 2.36 x 10⁻⁵J. Gypsum mineral was applied at a rate of 5 and 10 t ha⁻¹ and using a sandy loam and loam soil textures. The result was showed an average soil loss from sandy loam soil texture; control was 8.22%, 4.31% and 4.06% similar from loam soil texture, control was 7.26%, 2.89%, and 2.72% respectively. The application of gypsum mineral significantly (P < 0.05) reduced dispersion of soil particles caused by the impact of raindrops compared to control. Therefore, it was concluded that the addition of gypsum was effective as a measure for mitigating splash erosion.Keywords: gypsum, soil loss, splash erosion, Afghanistan
Procedia PDF Downloads 12910242 Early Cell Cultures Derived from Human Prostate Cancer Tissue Express Tissue-Specific Epithelial and Cancer Markers
Authors: Vladimir Ryabov, Mikhail Baryshevs, Mikhail Voskresenskey, Boris Popov
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The human prostate gland (PG) samples were obtained from patients who had undergone radical prostatectomy for prostate cancer (PC) and used to extract total RNA and prepare the prostate stromal cell cultures (PSCC) and patients-derived organoids (PDO). Growth of the cell cultures was accessed under microscopic evaluation in transmitted light and the marker expression by reverse polymerase chain reaction (RT-PCR), immunofluorescence, and immunoblotting. Some PCR products from prostate tissue, PSCC, and PDO were cloned and sequenced. We found that the cells of early and late passages of PSCC and corresponding PDO expressed luminal (androgen receptor, AR; cytokeratin 18, CK18) and basal (CK5, p63) epithelial markers, the production of which decreased or disappeared in late PSCC and PDO. The PSCC and PDO of early passages from cancer tissue additionally produced cancer markers AMACR, TMPRSS2-ERG, and Ezh2. The expression of TMPRSS2-ERG fusion transcripts was verified by cloning and sequencing the PCR products. The results obtained suggest that early passages of PSCC might be used as a pre-clinical model for the evaluation of early markers of prostate cancer.Keywords: localized prostate cancer, prostate epithelial markers, prostate cancer markers, AMACR, TMPRSS2-ERG, prostate stromal cell cultures, PDO
Procedia PDF Downloads 10610241 Inhibitory Effect of 13-Butoxyberberine Bromide on Metastasis of Skin Cancer A431 Cells
Authors: Phuriwat Laomethakorn, Siritron Samosorn, Ramida Watanapokasin
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Cancer metastasis is the major cause of cancer-related death. Therefore searching for a compound that could inhibit cancer metastasis is necessary. 13-Butoxyberberine bromide is a berberine derivative that has not been reported an anti-metastatic effect on skin cancer cells. This study aimed to investigate the anti-metastatic effect of 13-butoxyberberine bromide on skin cancer A431 cells. The effect of 13-butoxyberberine bromide on A431 cell viability was examined by MTT assay. Suppression of cell migration and invasion in A431 cells were determined by wound healing assay, transwell migration assay, and transwell invasion assay. Metastasis proteins were determined by western blotting. The results demonstrated that 13-butoxyberberine bromide decreased A431 cell viability in a dose-dependent manner. In addition, sub-toxic concentrations of 13-butoxyberberine bromide suppressed cell migration and invasion in A431 cells. In addition, 13-butoxyberberine bromide showed anti-metastatic effects by down-regulated MMP-2 and MMP-9 expression. These findings may be useful in the development of 13-butoxyberberine bromide as an anti-metastatic drug in the future.Keywords: 13-butoxyberberine bromide, metastasis, skin cancer, MMP
Procedia PDF Downloads 10210240 Cytotoxic Effect of Crude Extract of Sea Pen Virgularia gustaviana on HeLa and MDA-MB-231 Cancer Cell Lines
Authors: Sharareh Sharifi, Pargol Ghavam Mostafavi, Ali Mashinchian Moradi, Mohammad Hadi Givianrad, Hassan Niknejad
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Marine organisms such as soft coral, sponge, ascidians, and tunicate containing rich source of natural compound have been studied in last decades because of their special chemical compounds with anticancer properties. The aim of this study was to investigate anti-cancer property of ethyl acetate extracted from marine sea pen Virgularia gustaviana found from Persian Gulf coastal (Bandar Abbas). The extraction processes were carried out with ethyl acetate for five days. Thin layer chromatography (TLC) and high-performance liquid chromatography (HPLC) were used for qualitative identification of crude extract. The viability of HeLa and MDA-Mb-231 cancer cells was investigated using MTT assay at the concentration of 25, 50, and a 100 µl/ml of ethyl acetate is extracted. The crude extract of Virgularia gustaviana demonstrated ten fractions with different Retention factor (Rf) by TLC and Retention time (Rt) evaluated by HPLC. The crude extract dose-dependently decreased cancer cell viability compared to control group. According to the results, the ethyl acetate extracted from Virgularia gustaviana inhibits the growth of cancer cells, an effect which needs to be further investigated in the future studies.Keywords: anti-cancer, Hela cancer cell, MDA-Md-231 cancer cell, Virgularia gustavina
Procedia PDF Downloads 43010239 Effects of Body Positioning on Videofluoroscopic Barium Esophagram in Healthy Cats
Authors: Hyeona Kim, Kichang Lee, Seunghee Lee, Jeongsu An, Kyungjun Min
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Contrast videofluoroscopy is the diagnostic imaging technique for evaluating cat with dysphagia. Generally, videofluoroscopic studies have been done with the cat restrained in lateral recumbency. It is different from the neutral position such as standing or sternal recumbency which is actual swallowing posture. We hypothesized that measurement of esophageal transit and peristalsis would be affected by body position. This experimental study analyzed the imaging findings of barium esophagram in 5 cats. Each cat underwent videofluoroscopy during swallowing of liquid barium and barium-soaked kibble in standing position and lateral recumbency. Esophageal transit time and the number of esophageal peristaltic waves were compared among body positions. Transit time in the cervical esophagus (0.57s), cranial thoracic esophagus (2.5s), and caudal thoracic esophagus(1.10s) was delayed when cats were in lateral recumbency for liquid barium. For kibble, transit time was more delayed than that of liquid through the entire esophagus in lateral recumbency. Liquid and kibble frequently started to delay at thoracic inlet region, transit time in the thoracic esophagus was significantly delayed than the cervical esophagus. In standing position, 60.2% of liquid swallows stimulated primary esophageal peristalsis. In lateral recumbency, 50.5% of liquid swallows stimulated primary esophageal peristalsis. Other variables were not significantly different. Lateral body positioning increases entire esophageal transit time and thoracic esophageal transit time is most significantly delayed. Thus, lateral recumbency decreases the number of primary esophageal peristalsis.Keywords: barium esophagram, body positioning, cat, videofluoroscopy
Procedia PDF Downloads 20110238 Application of Raman Spectroscopy for Ovarian Cancer Detection: Comparative Analysis of Fresh, Formalin-Fixed, and Paraffin-Embedded Samples
Authors: Zeinab Farhat, Nicolas Errien, Romuald Wernert, Véronique Verriele, Frédéric Amiard, Philippe Daniel
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Ovarian cancer, also known as the silent killer, is the fifth most common cancer among women worldwide, and its death rate is higher than that of other gynecological cancers. The low survival rate of women with high-grade serous ovarian carcinoma highlights the critical need for the development of new methods for early detection and diagnosis of the disease. The aim of this study was to evaluate if Raman spectroscopy combined with chemometric methods such as Principal Component Analysis (PCA) could differentiate between cancerous and normal tissues from different types of samples, such as paraffin embedding, chemical deparaffinized, formalin-fixed and fresh samples of the same normal and malignant ovarian tissue. The method was applied specifically to two critical spectral regions: the signature region (860-1000 〖cm〗^(-1)) and the high-frequency region (2800-3100 〖cm〗^(-1) ). The mean spectra of paraffin-embedded in normal and malignant tissues showed almost similar intensity. On the other hand, the mean spectra of normal and cancer tissues from chemical deparaffinized, formalin-fixed, and fresh samples show significant intensity differences. These spectral differences reflect variations in the molecular composition of the tissues, particularly lipids and proteins. PCA, which was applied to distinguish between cancer and normal tissues, was performed on whole spectra and on selected regions—the PCA score plot of paraffin-embedded shows considerable overlap between the two groups. However, the PCA score of chemicals deparaffinized, formalin-fixed, and fresh samples showed a good discrimination of tissue types. Our findings were validated by analyses of a set of samples whose status (normal and cancerous) was not previously known. The results of this study suggest that Raman Spectroscopy associated with PCA methods has the capacity to provide clinically significant differentiation between normal and cancerous ovarian tissues.Keywords: Raman spectroscopy, ovarian cancer, signal processing, Principal Component Analysis, classification
Procedia PDF Downloads 2310237 Preparation of Gramine Nanosuspension and Protective Effect of Gramine on Human Oral Cell Lines by Induction of Apoptosis
Authors: K. Suresh, R. Arunkumar
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The objective of this study is to investigate the preparation of gramine nano suspension and protective effect of Gramine on the apoptosis of laryngeal cancer cells cell line (HEp-2 and KB). The growth inhibition rate of Hep-2 and KB cells in vitro were measured by MTT assay and apoptosis by, levels of reactive oxygen species, mitochondrial membrane potential, morphological changes and flowcytometry. Based on the results, we determined the effective doses of gramine as 127.23µm/ml for 24 hr and 119.81 µm/ml for 48hr in hep-2 cell line and 147.58 µm ml for 24 hr and 123.74µm µm/ml for 48hr in KB cell line. cytotoxicity effects of gramine were confirmed by treatment of HEp-2 cell and KB cell with IC50 concentration of gramine resulted in sequences of events marked by the enhance the apoptosis accompanied by loss of cell viability, modulation of reactive oxygen species and cell cycle arrest through the induction of G0/G1 phase arrest on HEp-2 cells. Our study suggests that the nanosuspension of gramine possesses the more cytotoxic effect of cancer cells and a novel candidate for cancer chemoprevention.Keywords: apoptosis, HEp-2 cell line, KB cell line mitochondria, gramine, nanosuspension
Procedia PDF Downloads 45210236 New Targets Promoting Oncolytic Virotherapy
Authors: Felicia Segeth, Florian G. Klein, Lea Berger, Andreas Kolk, Per S. Holm
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The entry of oncolytic viruses (OVs) into clinical application opens groundbreaking changes in current and future treatment regimens. However, despite their potent anti-cancer activity in vitro, clinical studies revealed limitations of OVs as monotherapy. The same applies to CDK 4/6 inhibitors (CDK4/6i) targeting cell cycle as well as bromodomain and extra-terminal domain inhibitors (BETi) targeting gene expression. In this study, the anti-tumoral effect of XVir-N-31, an YB-1 dependent oncolytic adenovirus, was evaluated in combination with Ribociclib, a CDK4/6i, and JQ1, a BETi. The head and neck squamous cell carcinoma (HNSCC) cell lines Fadu, SAS, and Cal-33 were used. DNA replication and gene expression of XVir-N-31 was measured by RT-qPCR, protein expression by western blotting, and cell lysis by SRB assays. Treatment with CDK4/6i and BETi increased viral gene expression, viral DNA replication, and viral particle formation. The data show that the combination of oncolytic adenovirus XVir-N-31 with CDK4/6i & BETi acts highly synergistic in cancer cell lysis. Furthermore, additional molecular analyses on this subject demonstrate that the positive transcription elongation factor P-TEFb plays a decisive role in this regard, indicating an influence of the combinational therapy on gene transcription control. The combination of CDK4/6i & BETi and XVir-N-31 is an attractive strategy to achieve substantial cancer cell killing and is highly suitable for clinical testing.Keywords: adenovirus, BET, CDK4/6, HNSCC, P-TEFb, YB-1
Procedia PDF Downloads 11610235 Early Metastatic Cancer: A Review of Its Management and Outcomes
Authors: Diwei Lin, Amanda Jia Hui Tan
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In 2012, testicular cancer was estimated to account for 940 disability adjusted life years in Australia; of these, 450 were years lost due to premature death and 500 were years of healthy life lost due to disease, disability or injury. Testicular choriocarcinoma is one of the rarest variants of testicular germ cell tumours, accounting for less than 1% of testicular germ cell tumours and only about 0.19% of all testicular tumours. Management involves radical orchiectomy followed by chemotherapy. Even then, the prognosis is extremely poor. This case report describes a 20-year-old male with pure testicular choriocarcinoma with pulmonary metastases.Keywords: testicular cancer, choriocarcinoma, cryptorchidism, chemotherapy, metastatic testicular cancer
Procedia PDF Downloads 35910234 Immunomodulatory Role of Heat Killed Mycobacterium indicus pranii against Cervical Cancer
Authors: Priyanka Bhowmik, Subrata Majumdar, Debprasad Chattopadhyay
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Background: Cervical cancer is the third major cause of cancer in women and the second most frequent cause of cancer related deaths causing 300,000 deaths annually worldwide. Evasion of immune response by Human Papilloma Virus (HPV), the key contributing factor behind cancer and pre-cancerous lesions of the uterine cervix, makes immunotherapy a necessity to treat this disease. Objective: A Heat killed fraction of Mycobacterium indicus pranii (MIP), a non-pathogenic Mycobacterium has been shown to exhibit cytotoxic effects on different cancer cells, including human cervical carcinoma cell line HeLa. However, the underlying mechanisms remain unknown. The aim of this study is to decipher the mechanism of MIP induced HeLa cell death. Methods: The cytotoxicity of Mycobacterium indicus pranii against HeLa cells was evaluated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Apoptosis was detected by annexin V and Propidium iodide (PI) staining. The assessment of reactive oxygen species (ROS) generation and cell cycle analysis were measured by flow cytometry. The expression of apoptosis associated genes was analyzed by real time PCR. Result: MIP could inhibit the proliferation of HeLa cell in a time and dose dependent manner but caused minor damage to normal cells. The induction of apoptosis was confirmed by the cell surface presentation of phosphatidyl serine, DNA fragmentation, and mitochondrial damage. MIP caused very early (as early as 30 minutes) transcriptional activation of p53, followed by a higher activation (32 fold) at 24 hours suggesting prime importance of p53 in MIP-induced apoptosis in HeLa cell. The up regulation of p53 dependent pro-apoptotic genes Bax, Bak, PUMA, and Noxa followed a lag phase that was required for the transcriptional p53 program. MIP also caused the transcriptional up regulation of Toll like receptor 2 and 4 after 30 minutes of MIP treatment suggesting recognition of MIP by toll like receptors. Moreover, MIP caused the inhibition of expression of HPV anti apoptotic gene E6, which is known to interfere with p53/PUMA/Bax apoptotic cascade. This inhibition might have played a role in transcriptional up regulation of PUMA and subsequently apoptosis. ROS was generated transiently which was concomitant with the highest transcription activation of p53 suggesting a plausible feedback loop network of p53 and ROS in the apoptosis of HeLa cells. Scavenger of ROS, such as N-acetyl-L-cysteine, decreased apoptosis suggesting ROS is an important effector of MIP induced apoptosis. Conclusion: Taken together, MIP possesses full potential to be a novel therapeutic agent in the clinical treatment of cervical cancer.Keywords: cancer, mycobacterium, immunity, immunotherapy.
Procedia PDF Downloads 24810233 New Test Algorithm to Detect Acute and Chronic HIV Infection Using a 4th Generation Combo Test
Authors: Barun K. De
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Acquired immunodeficiency syndrome (AIDS) is caused by two types of human immunodeficiency viruses, collectively designated HIV. HIV infection is spreading globally particularly in developing countries. Before an individual is diagnosed with HIV, the disease goes through different phases. First there is an acute early phase that is followed by an established or chronic phase. Subsequently, there is a latency period after which the individual becomes immunodeficient. It is in the acute phase that an individual is highly infectious due to a high viral load. Presently, HIV diagnosis involves use of tests that do not detect the acute phase infection during which both the viral RNA and p24 antigen are expressed. Instead, these less sensitive tests detect antibodies to viral antigens which are typically sero-converted later in the disease process following acute infection. These antibodies are detected in both asymptomatic HIV-infected individuals as well as AIDS patients. Studies indicate that early diagnosis and treatment of HIV infection can reduce medical costs, improve survival, and reduce spreading of infection to new uninfected partners. Newer 4th generation combination antigen/antibody tests are highly sensitive and specific for detection of acute and established HIV infection (HIV1 and HIV2) enabling immediate linkage to care. The CDC (Center of Disease Control, USA) recently recommended an algorithm involving three different tests to screen and diagnose acute and established infections of HIV-1 and HIV-2 in a general population. Initially a 4th generation combo test detects a viral antigen p24 and specific antibodies against HIV -1 and HIV-2 envelope proteins. If the test is positive it is followed by a second test known as a differentiation assay which detects antibodies against specific HIV-1 and HIV-2 envelope proteins confirming established infection of HIV-1 or HIV-2. However if it is negative then another test is performed that measures viral load confirming an acute HIV-1 infection. Screening results of a Phoenix area population detected 0.3% new HIV infections among which 32.4% were acute cases. Studies in the U.S. indicate that this algorithm effectively reduces HIV infection through immediate treatment and education following diagnosis.Keywords: new algorithm, HIV, diagnosis, infection
Procedia PDF Downloads 40910232 Whole Coding Genome Inter-Clade Comparison to Predict Global Cancer-Protecting Variants
Authors: Lamis Naddaf, Yuval Tabach
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In this research, we identified the missense genetic variants that have the potential to enhance resistance against cancer. Such field has not been widely explored, as researchers tend to investigate mutations that cause diseases, in response to the suffering of patients, rather than those mutations that protect from them. In conjunction with the genomic revolution, and the advances in genetic engineering and synthetic biology, identifying the protective variants will increase the power of genotype-phenotype predictions and can have significant implications on improved risk estimation, diagnostics, prognosis and even for personalized therapy and drug discovery. To approach our goal, we systematically investigated the sites of the coding genomes and picked up the alleles that showed a correlation with the species’ cancer resistance. We predicted 250 protecting variants (PVs) with a 0.01 false discovery rate and more than 20 thousand PVs with a 0.25 false discovery rate. Cancer resistance in Mammals and reptiles was significantly predicted by the number of PVs a species has. Moreover, Genes enriched with the protecting variants are enriched in pathways relevant to tumor suppression like pathways of Hedgehog signaling and silencing, which its improper activation is associated with the most common form of cancer malignancy. We also showed that the PVs are more abundant in healthy people compared to cancer patients within different human races.Keywords: comparative genomics, machine learning, cancer resistance, cancer-protecting alleles
Procedia PDF Downloads 9510231 Computer-Aided Exudate Diagnosis for the Screening of Diabetic Retinopathy
Authors: Shu-Min Tsao, Chung-Ming Lo, Shao-Chun Chen
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Most diabetes patients tend to suffer from its complication of retina diseases. Therefore, early detection and early treatment are important. In clinical examinations, using color fundus image was the most convenient and available examination method. According to the exudates appeared in the retinal image, the status of retina can be confirmed. However, the routine screening of diabetic retinopathy by color fundus images would bring time-consuming tasks to physicians. This study thus proposed a computer-aided exudate diagnosis for the screening of diabetic retinopathy. After removing vessels and optic disc in the retinal image, six quantitative features including region number, region area, and gray-scale values etc… were extracted from the remaining regions for classification. As results, all six features were evaluated to be statistically significant (p-value < 0.001). The accuracy of classifying the retinal images into normal and diabetic retinopathy achieved 82%. Based on this system, the clinical workload could be reduced. The examination procedure may also be improved to be more efficient.Keywords: computer-aided diagnosis, diabetic retinopathy, exudate, image processing
Procedia PDF Downloads 26610230 Role of Mismatch Repair Protein Expression in Colorectal Cancer: A Study from North India
Authors: Alka Yadav, Mayank Jain, Rajan Saxena, Niraj Kumari, Narendra Krishnani, Ashok Kumar
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Purpose: To study the mismatch repair (MMR) protein expression and its clinicopathological correlation in colorectal cancer patients in North India. Methods: A prospective study was conducted on histologically proven 52 (38 males and 14 females) patients with adenocarcinoma of colorectum. MMR protein loss was determined by using immunohistochemistry for MLH1, MSH2, PMS2 and MSH6. Results: 52 patients (38 males and 14 females) underwent resection for colorectal cancer with the median age of 52 years (16-81 years). 35% of the patients (n=18) were younger than 50 years of the age. 3 patients had associated history of malignancy in the family. 29 (56%) patients had right colon cancer, 9 (17%) left colon cancer and 14 (27%) rectal cancer. 2 patients each had synchronous and metachronous cancer. Histology revealed well-differentiated tumour in 16, moderately differentiated in 10 and poorly differentiated tumour in 26 patients. MMR protein loss was seen in 15 (29%) patients. Seven (46%) of these patients were less than 50 years of age. Combined loss of MSH2 and MSH6 was seen most commonly and it was found in 6 patients. 12 (80%) patients with MMR protein loss had tumour located proximal to the splenic flexure compared to 3 (20%) located distal to the splenic flexure. There was no difference in MMR protein loss based on patients' age, gender, degree of tumour differentiation, stage of the disease and tumour histological characteristics. Conclusions: This study revealed that there was less than 30% MMR protein loss in colorectal cancer patients. The loss was most commonly seen in right sided colon cancer than left. A larger study is further required to validate these findings.Keywords: colorectal cancer, mismatch repair protein, immunohitochemistry, clinicopathological correlation
Procedia PDF Downloads 22910229 Torn Between the Lines of Border: The Pakhtuns of Pakistan and Afghanistan in Search of Identity
Authors: Priyanka Dutta Chowdhury
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A globalized connected world, calling loud for a composite culture, was still not able to erase the pain of a desired nationalism based on cultural identity. In the South Asian region, the random drawing of the boundaries without taking the ethnic aspect into consideration have always challenged the very basis of the existence of certain groups. The urge to reunify with the fellow brothers on both sides of the border have always called for a chaos and schism in the countries of this region. Sometimes this became a tool to bargain with the state and find a favorable position in the power structure on the basis of cultural identity. In Pakistan and Afghanistan, the Pakhtuns who are divided across the border of the two countries, from the inception of creation of Pakistan have posed various challenges and hampered the growth of a consolidated nation. The Pakhtuns or Pashtuns of both Pakistan and Afghanistan have a strong cultural affinity which blurs their physical distancing and calls for a nationalism based on this ethnic affiliation. Both the sides wanted to create Pakhtunistan unifying all the Pakhtuns of the region. For long, this group have denied to accept the Durand line separating the two. This was an area of concern especially for the Pakhtuns of Pakistan torn between the decision either to join Afghanistan, create a nation of their own or be a part of Pakistan. This ethnic issue became a bone of contention between the two countries. Later, though well absorbed and recognized in the respective countries, they have fought for their identity and claimed for a dominant position in the politics of the nations. Because of the porous borders often influx of refugees was seen especially during Afghan Wars and later many extremists’ groups were born from them especially the Taliban. In the recent string of events, when the Taliban, who are mostly Pakhtuns ethnically, came in power in Afghanistan, a wave of sympathy arose in Pakistan. This gave a strengthening position to the religious Pakhtuns across the border. It is to be noted here that a fragmented Pakhtun identity between the religious and seculars were clearly visible, voicing for their place in the political hierarchy of the country with a vision distinct from each other especially in Pakistan. In this context the paper tries to evaluate the reasons for this cultural turmoil between the countries and this ethnic group. It also aims to analyze the concept of how the identity politics still holds its relevance in the contemporary world. Additionally, the recent trend of fragmented identity points towards instrumentalization of this ethnic groups, who are engaged in the bargaining process with the state for a robust position in the power structure. In the end, the paper aims to deduct from the theoretical conditions of identity politics, whether this is a primordial or a situational tool to have a visibility in the power structure of the contemporary world.Keywords: cultural identity, identity politics, instrumentalization of identity pakhtuns, power structure
Procedia PDF Downloads 8110228 Linking Metabolism, Pluripotency and Epigenetic Changes during Early Differentiation of Embryonic Stem Cells
Authors: Arieh Moussaieff, Bénédicte Elena-Herrmann, Yaakov Nahmias, Daniel Aberdam
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Differentiation of pluripotent stem cells is a slow process, marked by the gradual loss of pluripotency factors over days in culture. While the first few days of differentiation show minor changes in the cellular transcriptome, intracellular signaling pathways remain largely unknown. Recently, several groups demonstrated that the metabolism of pluripotent mouse and human cells is different from that of somatic cells, showing a marked increase in glycolysis previously identified in cancer as the Warburg effect. Here, we sought to identify the earliest metabolic changes induced at the first hours of differentiation. High-resolution NMR analysis identified 35 metabolites and a distinct, gradual transition in metabolism during early differentiation. Metabolic and transcriptional analyses showed the induction of glycolysis toward acetate and acetyl-coA in pluripotent cells, and an increase in cholesterol biosynthesis during early differentiation. Importantly, this metabolic pathway regulated differentiation of human and mouse embryonic stem cells. Acetate delayed differentiation preventing differentiation-induced histone de-acetylation in a dose-dependent manner. Glycolytic inhibitors upstream of acetate caused differentiation of pluripotent cells, while those downstream delayed differentiation. Our data suggests that a rapid loss of glycolysis in early differentiation down-regulates acetate and acetyl-coA production, causing a loss of histone acetylation and concomitant loss of pluripotency. It demonstrate that pluripotent stem cells utilize a novel metabolism pathway to maintain pluripotency through acetate/acetyl-coA and highlights the important role metabolism plays in pluripotency and early differentiation of stem cells.Keywords: pluripotency, metabolomics, epigenetics, acetyl-coA
Procedia PDF Downloads 46810227 The Dose to Organs in Lumbar-Abdominal Computed Tomography Imaging Using TLD
Authors: M. Zehtabian, Z. Molaiemanesh, Z. Shafahi, M. Papie, M. Zahraie Moghaddam, M. Mehralizadeh, M. R. Vahidi, S. Sina
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The introduction of CT scans has been a great improvement in diagnosis of different diseases. However, this imaging modality can expose the patients to cumulative radiation doses which may increase the risks of some health problems like cancer. In this study, the dose delivered to different organs in lumbar-abdominal imaging was measured by putting the TLD-100, and TLD-100H chips inside the Alderson Rando phantom. The lumbar-abdominal image of the phantom was obtained, while TLD chips were inside the holes of the phantom. According to the results obtained in this study using TLD-100 chips, the average dose received by liver, bladder, rectum, kidneys, and uterus were found to be 12.9 mSv, 8.9 mSv, 10.1 mSv, 11.0 mSv, 11.2 mSv, and 10.5 mSv respectively, while the measurements performed by TLD-100H show that the average dose to liver, bladder, rectum, kidneys, and uterus were found to be 12.4 mSv, 9.2 mSv, 9.5 mSv, 10.5 mSv, 10.7 mSv, and 9.9 mSv respectively. The results of this study indicates that the dose measured by the TLD-100H chips are in close agreement with those obtained by TLD-100.Keywords: CT scan, dose, TLD-100, diagnosis
Procedia PDF Downloads 63410226 Response to Name Training in Autism Spectrum Disorder (ASD): A New Intervention Model
Authors: E. Verduci, I. Aguglia, A. Filocamo, I. Macrì, R. Scala, A. Vinci
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One of the first indicator of autism spectrum disorder (ASD) is a decreasing tendency or failure to respond to name (RTN) call. Despite RTN is important for social and language developmentand it’s a common target for early interventions for children with ASD, research on specific treatments is insufficient and does not consider the importance of the discrimination between the own name and other names. The purpose of the current study was to replicate an assessment and treatment model proposed by Conine et al. (2020) to teach children with ASD to respond to their own name and to not respond to other names (RTO). The model includes three different phases (baseline/screening, treatment, and generalization), and itgradually introduces the different treatment components, starting with the most naturalistic ones (such as social interaction) and adding more intrusive components (such as tangible reinforcements, prompt and fading procedures) if necessary. The participants of this study were three children with ASD diagnosis: D. (5 years old) with a low frequency of RTN, M. (7 years old) with a RTN unstable and no ability of discrimination between his name and other names, S. (3 years old) with a strong RTN but a constant response to other names. Moreover, the treatment for D. and M. consisted of social and tangible reinforcements (treatment T1), for S. the purpose of the treatment was to teach the discrimination between his name and the others. For all participants, results suggest the efficacy of the model to acquire the ability to selectively respond to the own name and the generalization of the behavior with other people and settings.Keywords: response to name, autism spectrum disorder, progressive training, ABA
Procedia PDF Downloads 8310225 The Role of Estradiol-17β and Type IV Collagen on the Regulation and Expression Level Of C-Erbb2 RNA and Protein in SKOV-3 Ovarian Cancer Cell Line
Authors: Merry Meryam Martgrita, Marselina Irasonia Tan
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One of several aggresive cancer is cancer that overexpress c-erbB2 receptor along with the expression of estrogen receptor. Components of extracellular matrix play an important role to increase cancer cells proliferation, migration and invasion. Both components can affect cancer development by regulating the signal transduction pathways in cancer cells. In recent research, SKOV-3 ovarian cancer cell line, that overexpress c-erbB2 receptor was cultured on type IV collagen and treated with estradiol-17β, to reveal the role of both components on RNA and protein level of c-erbB2 receptor. In this research we found a modulation phenomena of increasing and decreasing of c-erbB2 RNA level and a stabilisation phenomena of c-erbB2 protein expression due to estradiol-17β and type IV collagen. It seemed that estradiol-17β has an important role to increase c-erbB2 transcription and the stability of c-erbB2 protein expression. Type IV collagen has an opposite role. It blocked c-erbB2 transcription when it bound to integrin receptor in SKOV-3 cells.Keywords: c-erbB2, estradiol-17β, SKOV-3, type IV collagen
Procedia PDF Downloads 28010224 Secured Cancer Care and Cloud Services in Internet of Things /Wireless Sensor Network Based Medical Systems
Authors: Adeniyi Onasanya, Maher Elshakankiri
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In recent years, the Internet of Things (IoT) has constituted a driving force of modern technological advancement, and it has become increasingly common as its impacts are seen in a variety of application domains, including healthcare. IoT is characterized by the interconnectivity of smart sensors, objects, devices, data, and applications. With the unprecedented use of IoT in industrial, commercial and domestic, it becomes very imperative to harness the benefits and functionalities associated with the IoT technology in (re)assessing the provision and positioning of healthcare to ensure efficient and improved healthcare delivery. In this research, we are focusing on two important services in healthcare systems, which are cancer care services and business analytics/cloud services. These services incorporate the implementation of an IoT that provides solution and framework for analyzing health data gathered from IoT through various sensor networks and other smart devices in order to improve healthcare delivery and to help health care providers in their decision-making process for enhanced and efficient cancer treatment. In addition, we discuss the wireless sensor network (WSN), WSN routing and data transmission in the healthcare environment. Finally, some operational challenges and security issues with IoT-based healthcare system are discussed.Keywords: IoT, smart health care system, business analytics, (wireless) sensor network, cancer care services, cloud services
Procedia PDF Downloads 17710223 Effects of Renin Angiotensin Pathway Inhibition on Efficacy of Anti-PD-1/PD-L1 Treatment in Metastatic Cancer
Authors: Philip Friedlander, John Rutledge, Jason Suh
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Inhibition of programmed death-1 (PD-1) or its ligand PD-L1 confers therapeutic efficacy in a wide range of solid tumor malignancies. Primary or acquired resistance can develop through activation of immunosuppressive immune cells such as tumor-associated macrophages. The renin angiotensin system (RAS) systemically regulates fluid and sodium hemodynamics, but components are expressed on and regulate the activity of immune cells, particularly of myeloid lineage. We hypothesized that inhibition of RAS would improve the efficacy of PD-1/PD-L-1 treatment. A retrospective analysis was performed through a chart review of patients with solid metastatic malignancies treated with a PD-1/PD-L1 inhibitor between 1/2013 and 6/2019 at Valley Hospital, a community hospital in New Jersey, USA. Efficacy was determined by medical oncologist documentation of clinical benefit in visit notes and by the duration of time on immunotherapy treatment. The primary endpoint was the determination of efficacy differences in patients treated with an inhibitor of RAS ( ace inhibitor, ACEi, or angiotensin blocker, ARB) compared to patients not treated with these inhibitors. To control for broader antihypertensive effects, efficacy as a function of treatment with beta blockers was assessed. 173 patients treated with PD-1/PD-L-1 inhibitors were identified of whom 52 were also treated with an ACEi or ARB. Chi-square testing revealed a statistically significant relationship between being on an ACEi or ARB and efficacy to PD-1/PD-L-1 therapy (p=0.001). No statistically significant relationship was seen between patients taking or not taking beta blocker antihypertensives (p= 0.33). Kaplan-Meier analysis showed statistically significant improvement in the duration of therapy favoring patients concomitantly treated with ACEi or ARB compared to patients not exposed to antihypertensives and to those treated with beta blockers. Logistic regression analysis revealed that age, gender, and cancer type did not have significant effects on the odds of experiencing clinical benefit (p=0.74, p=0.75, and p=0.81, respectively). We conclude that retrospective analysis of the treatment of patients with solid metastatic tumors with anti-PD-1/PD-L1 in a community setting demonstrates greater clinical benefit in the context of concomitant ACEi or ARB inhibition, irrespective of gender or age. This data supports the development of prospective assessment through randomized clinical trials.Keywords: angiotensin, cancer, immunotherapy, PD-1, efficacy
Procedia PDF Downloads 7510222 ROCK Signaling and Radio Resistance: The Association and the Effect
Authors: P. Annapurna, Cecil Ross, Sudhir Krishna, Sweta Srivastava
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Irradiation plays a pivotal role in cervical cancer treatment, however some tumors exhibit resistance to therapy while some exhibit relapse, due to better repair and enhanced resistance mechanisms operational in their cells. The present study aims to understand the signaling mechanism operational in resistance phenotype and in the present study we report the role of Rho GTPase associated protein kinase (ROCK) signaling in cervical carcinoma radio-resistance. ROCK signaling has been implicated in several tumor progressions and is important for DNA repair. Irradiation of spheroid cultures of SiHa cervical carcinoma derived cell line at 6Gy resulted in generation of resistant cells in vitro which had better clonogenic abilities and formed larger and more colonies, in soft agar colony formation assay, as compared to the non-irradiated cells. These cells also exhibited an enhanced motility phenotype. Cell cycle profiling showed the cells to be blocked in G2M phase with enhanced pCDC2 levels indicating onset of possible DNA repair mechanism. Notably, 3 days post-irradiation, irradiated cells showed increased ROCK2 translocation to the nucleus with enhanced protein expression as compared to the non-irradiated cells. Radio-sensitization of the resistant cells was enhanced using Y27632, an inhibitor to ROCK signaling. The treatment of resistant cells with Y27632 resulted in increased cell death upon further irradiation. This observation has been confirmed using inhibitory antibodies to ROCK1/2. Result show that both ROCK1/2 have a functional contribution in radiation resistance of cervical cancer cells derived from cell lines. Interestingly enrichment of stem like cells (Hoechst negative cells) was also observed upon irradiation and these cells were markedly sensitive to Y27632 treatment. Our results thus suggest the role of ROCK signaling in radio-resistance in cervical carcinoma. Further studies with human biopsies, mice models and mechanistic of ROCK signaling in the context of radio-resistance will clarify the role of this molecule further and allow for therapeutics development.Keywords: cervical carcinoma, radio-resistance, ROCK signaling, cancer treatment
Procedia PDF Downloads 32610221 Biodegradation of Endoxifen in Wastewater: Isolation and Identification of Bacteria Degraders, Kinetics, and By-Products
Authors: Marina Arino Martin, John McEvoy, Eakalak Khan
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Endoxifen is an active metabolite responsible for the effectiveness of tamoxifen, a chemotherapeutic drug widely used for endocrine responsive breast cancer and chemo-preventive long-term treatment. Tamoxifen and endoxifen are not completely metabolized in human body and are actively excreted. As a result, they are released to the water environment via wastewater treatment plants (WWTPs). The presence of tamoxifen in the environment produces negative effects on aquatic lives due to its antiestrogenic activity. Because endoxifen is 30-100 times more potent than tamoxifen itself and also presents antiestrogenic activity, its presence in the water environment could result in even more toxic effects on aquatic lives compared to tamoxifen. Data on actual concentrations of endoxifen in the environment is limited due to recent discovery of endoxifen pharmaceutical activity. However, endoxifen has been detected in hospital and municipal wastewater effluents. The detection of endoxifen in wastewater effluents questions the treatment efficiency of WWTPs. Studies reporting information about endoxifen removal in WWTPs are also scarce. There was a study that used chlorination to eliminate endoxifen in wastewater. However, an inefficient degradation of endoxifen by chlorination and the production of hazardous disinfection by-products were observed. Therefore, there is a need to remove endoxifen from wastewater prior to chlorination in order to reduce the potential release of endoxifen into the environment and its possible effects. The aim of this research is to isolate and identify bacteria strain(s) capable of degrading endoxifen into less hazardous compound(s). For this purpose, bacteria strains from WWTPs were exposed to endoxifen as a sole carbon and nitrogen source for 40 days. Bacteria presenting positive growth were isolated and tested for endoxifen biodegradation. Endoxifen concentration and by-product formation were monitored. The Monod kinetic model was used to determine endoxifen biodegradation rate. Preliminary results of the study suggest that isolated bacteria from WWTPs are able to growth in presence of endoxifen as a sole carbon and nitrogen source. Ongoing work includes identification of these bacteria strains and by-product(s) of endoxifen biodegradation.Keywords: biodegradation, bacterial degraders, endoxifen, wastewater
Procedia PDF Downloads 21310220 The Subaltern Woman and the Reproductive Body - A Reading of Devi's 'Breast Stories'
Authors: Sharon Lopez
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Much of critical thought dismisses the notion of subaltern women engaging in resistance because of her complex colonial identity. She is seen in postcolonial theory as being "doubly effaced" and removed from exercising control to speak up and taking part in defiance. This line of reasoning suggests a critical area in which engaging with issues unavoidably excludes subaltern women from the emerging resistance discourse. A position like this also suggests a closed-minded view of human experience and a desire to maintain subalternity. The argument here is that subaltern women might be understood as achieving agency when they engage in resistance and speak out about their circumstances, whether aloud or in silence. Using deductions from Mahasweta Devi's literary narratives such as Imaginary Maps and Breast Stories, the study investigates the tactics Devi employs to engage marginalised women into resistance and establishes that the 'body' emerges in her stories not just as a site of oppression but also as an important motif of power and resistance.Keywords: subaltern woman, reproductive docy, breast giver, devi
Procedia PDF Downloads 10410219 Information Management Approach in the Prediction of Acute Appendicitis
Authors: Ahmad Shahin, Walid Moudani, Ali Bekraki
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This research aims at presenting a predictive data mining model to handle an accurate diagnosis of acute appendicitis with patients for the purpose of maximizing the health service quality, minimizing morbidity/mortality, and reducing cost. However, acute appendicitis is the most common disease which requires timely accurate diagnosis and needs surgical intervention. Although the treatment of acute appendicitis is simple and straightforward, its diagnosis is still difficult because no single sign, symptom, laboratory or image examination accurately confirms the diagnosis of acute appendicitis in all cases. This contributes in increasing morbidity and negative appendectomy. In this study, the authors propose to generate an accurate model in prediction of patients with acute appendicitis which is based, firstly, on the segmentation technique associated to ABC algorithm to segment the patients; secondly, on applying fuzzy logic to process the massive volume of heterogeneous and noisy data (age, sex, fever, white blood cell, neutrophilia, CRP, urine, ultrasound, CT, appendectomy, etc.) in order to express knowledge and analyze the relationships among data in a comprehensive manner; and thirdly, on applying dynamic programming technique to reduce the number of data attributes. The proposed model is evaluated based on a set of benchmark techniques and even on a set of benchmark classification problems of osteoporosis, diabetes and heart obtained from the UCI data and other data sources.Keywords: healthcare management, acute appendicitis, data mining, classification, decision tree
Procedia PDF Downloads 34910218 Traffic Congestion Problem and Possible Solution in Kabul City
Authors: Sayed Abdul Rahman Sadaat, Nsenda Lukumwena
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Traffic congestion is a worldwide issue, especially in developing countries. This is also the case of Afghanistan, especially in Kabul-the capital city, whose rapid population growth makes it the fifth fastest growing city in the world. Traffic congestion affects not only the mobility of people and goods but also the air quality that leads to numerous deaths (3000 people) every year. There are many factors that contribute to traffic congestion. The insufficiency and inefficiency of public transportation system along with the increase of private vehicles can be considered among the most important contributing factors. This paper addresses the traffic congestion and attempts to suggest possible solutions that can help improve the current public transportation system in Kabul. To this end, the methodology used in this paper includes field work conducted in Kabul city and literature review. The outcome suggests that improving the public transportation system is likely to contribute to the reduction of traffic congestion and the improvement of air quality, thereby reducing the number of death related to air quality.Keywords: air quality, Kabul, Afghanistan, public transportation system, improvements, traffic congestion
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