Search results for: resection margin
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 404

Search results for: resection margin

134 Relation of Cad/Cam Zirconia Dental Implant Abutments with Periodontal Health and Final Aesthetic Aspects; A Systematic Review

Authors: Amin Davoudi

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Aim: New approaches have been introduced to improve soft tissue indices of the dental implants. This systematic review aimed to investigate the effect of computer-aided design and computer-assisted manufacture (CAD/CAM) zirconia (Zr) implant abutments on periodontal aspects. Materials and Methods: Five electronic databases were searched thoroughly based on prior defined MeSH and non-MeSH keywords. Clinical studies were collected via hand searches in English language journals up to September 2020. Interproximal papilla stability, papilla recession, pink and white esthetic score (PES, WES), bone and gingival margin levels, color, and contour of soft tissue were reviewed. Results: The initial literature search yielded 412 articles. After the evaluation of abstracts and full texts, six studies were eligible to be screened. The study design of the included studies was a prospective cohort (n=3) and randomized clinical trial (n=3). The outcome was found to be significantly better for Zr than titanium abutments, however, the studies did not show significant differences between stock and CAD/CAM abutments. Conclusion: Papilla fill, WES, PES, and the distance from the contact point to dental crest bone of adjacent tooth and inter-tooth–implant distance were not significantly different between Zr CAD/CAM and Zr stock abutments. However, soft tissue stability and recession index were better in Zr CAD/CAM abutments.

Keywords: zirconia, CADCAM, periodental, implant

Procedia PDF Downloads 72
133 Improved Classification Procedure for Imbalanced and Overlapped Situations

Authors: Hankyu Lee, Seoung Bum Kim

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The issue with imbalance and overlapping in the class distribution becomes important in various applications of data mining. The imbalanced dataset is a special case in classification problems in which the number of observations of one class (i.e., major class) heavily exceeds the number of observations of the other class (i.e., minor class). Overlapped dataset is the case where many observations are shared together between the two classes. Imbalanced and overlapped data can be frequently found in many real examples including fraud and abuse patients in healthcare, quality prediction in manufacturing, text classification, oil spill detection, remote sensing, and so on. The class imbalance and overlap problem is the challenging issue because this situation degrades the performance of most of the standard classification algorithms. In this study, we propose a classification procedure that can effectively handle imbalanced and overlapped datasets by splitting data space into three parts: nonoverlapping, light overlapping, and severe overlapping and applying the classification algorithm in each part. These three parts were determined based on the Hausdorff distance and the margin of the modified support vector machine. An experiments study was conducted to examine the properties of the proposed method and compared it with other classification algorithms. The results showed that the proposed method outperformed the competitors under various imbalanced and overlapped situations. Moreover, the applicability of the proposed method was demonstrated through the experiment with real data.

Keywords: classification, imbalanced data with class overlap, split data space, support vector machine

Procedia PDF Downloads 273
132 Clinical Applications of Amide Proton Transfer Magnetic Resonance Imaging: Detection of Brain Tumor Proliferative Activity

Authors: Fumihiro Imai, Shinichi Watanabe, Shingo Maeda, Haruna Imai, Hiroki Niimi

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It is important to know the growth rate of brain tumors before surgery because it influences treatment planning, including not only surgical resection strategy but also adjuvant therapy after surgery. Amide proton transfer (APT) imaging is an emerging molecular magnetic resonance imaging (MRI) technique based on chemical exchange saturation transfer without the administration of a contrast medium. The underlying assumption in APT imaging of tumors is that there is a close relationship between the proliferative activity of the tumor and mobile protein synthesis. We aimed to evaluate the diagnostic performance of APT imaging of pre-and post-treatment brain tumors. Ten patients with brain tumor underwent conventional and APT-weighted sequences on a 3.0 Tesla MRI before clinical intervention. The maximum and the minimum APT-weighted signals (APTWmax and APTWmin) in each solid tumor region were obtained and compared before and after a clinical intervention. All surgical specimens were examined for histopathological diagnosis. Eight of ten patients underwent adjuvant therapy after surgery. Histopathological diagnosis was glioma in 7 patients (WHO grade 2 in 2 patients, WHO grade 3 in 3 patients, and WHO grade 4 in 2 patients), meningioma WHO grade 1 in 2 patients, and primary lymphoma of the brain in 1 patient. High-grade gliomas showed significantly higher APTW signals than that low-grade gliomas. APTWmax in one huge parasagittal meningioma infiltrating into the skull bone was higher than that in glioma WHO grade 4. On the other hand, APTWmax in another convexity meningioma was the same as that in glioma WHO grade 3. Diagnosis of primary lymphoma of the brain was possible with APT imaging before pathological confirmation. APTW signals in residual tumors decreased dramatically within one year after adjuvant therapy in all patients. APT imaging demonstrated excellent diagnostic performance for the planning of surgery and adjuvant therapy of brain tumors.

Keywords: amides, magnetic resonance imaging, brain tumors, cell proliferation

Procedia PDF Downloads 57
131 Autophagy Suppresses Bladder Tumor Formation in a Mouse Orthotopic Bladder Tumor Formation Model

Authors: Wan-Ting Kuo, Yi-Wen Liu, Hsiao-Sheng Liu

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Annual incidence of bladder cancer increases in the world and occurs frequently in the male. Most common type is transitional cell carcinoma (TCC) which is treated by transurethral resection followed by intravesical administration of agents. In clinical treatment of bladder cancer, chemotherapeutic drugs-induced apoptosis is always used in patients. However, cancers usually develop resistance to chemotherapeutic drugs and often lead to aggressive tumors with worse clinical outcomes. Approximate 70% TCC recurs and 30% recurrent tumors progress to high-grade invasive tumors, indicating that new therapeutic agents are urgently needed to improve the successful rate of overall treatment. Nonapoptotic program cell death may assist to overcome worse clinical outcomes. Autophagy which is one of the nonapoptotic pathways provides another option for bladder cancer patients. Autophagy is reported as a potent anticancer therapy in some cancers. First of all, we established a mouse orthotopic bladder tumor formation model in order to create a similar tumor microenvironment. IVIS system and micro-ultrasound were utilized to noninvasively monitor tumor formation. In addition, we carried out intravesical treatment in our animal model to be consistent with human clinical treatment. In our study, we carried out intravesical instillation of the autophagy inducer in mouse orthotopic bladder tumor to observe tumor formation by noninvasive IVIS system and micro-ultrasound. Our results showed that bladder tumor formation is suppressed by the autophagy inducer, and there are no significant side effects in the physiology of mice. Furthermore, the autophagy inducer upregulated autophagy in bladder tissues of the treated mice was confirmed by Western blot, immunohistochemistry, and immunofluorescence. In conclusion, we reveal that a novel autophagy inducer with low side effects suppresses bladder tumor formation in our mouse orthotopic bladder tumor model, and it provides another therapeutic approach in bladder cancer patients.

Keywords: bladder cancer, transitional cell carcinoma, orthotopic bladder tumor formation model, autophagy

Procedia PDF Downloads 146
130 Application of Gold Nanorods in Cancer Photothermaltherapy

Authors: Mehrnaz Mostafavi

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Lung cancer is one of the most harmful forms of cancer. The long-term survival rate of lung cancer patients treated by conventional modalities such as surgical resection, radiation, and chemotherapy remains far from satisfactory. Systemic drug delivery is rarely successful because only a limited amount of the chemotherapeutic drug targets lung tumor sites, even when administered at a high dose. Targeted delivery of drug molecules to organs or special sites is one of the most challenging research areas in pharmaceutical sciences. By developing colloidal delivery systems such as liposomes, micelles and nanoparticles a new frontier was opened for improving drug delivery. Nanoparticles with their special characteristics such as small particle size, large surface area and the capability of changing their surface properties have numerous advantages compared with other delivery systems. Targeted nanoparticle delivery to the lungs is an emerging area of interest.Multimodal or combination therapy represents a promising new method to fight disease. Therefore, a combination of different therapeutic strategies may be the best alternative to improve treatment outcomes for lung cancer. Photothermal therapy was proposed as a novel approach to treatment. In this work, photothermal therapy with gold nanoparticles and near infrared laser (NIR) irradiation was investigated.Four types of small (<100nm), NIR absorbing gold nanoparticles (nanospheres, nanorods) were synthesized using wet chemical methods and characterized by transmission electron microscopy, dynamic light scattering and UV-vis spectroscopy. Their synthesis and properties were evaluated, to determine their feasibility as a photothermal agent for clinical applications. In vitro cellular uptake studies of the nanoparticles into lung cancer cell lines was measured using light scattering microscopy.Small gold nanorods had good photothermal properties and the greatest cellular uptake, and were used in photothermal studies. Under 4W laser irradiation, an increase in temperature of 10°C and decrease in cell viability of up to 80% were obtained.

Keywords: photothermal, therapy, cancer, gold nanorods

Procedia PDF Downloads 217
129 Sensitivity Based Robust Optimization Using 9 Level Orthogonal Array and Stepwise Regression

Authors: K. K. Lee, H. W. Han, H. L. Kang, T. A. Kim, S. H. Han

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For the robust optimization of the manufacturing product design, there are design objectives that must be achieved, such as a minimization of the mean and standard deviation in objective functions within the required sensitivity constraints. The authors utilized the sensitivity of objective functions and constraints with respect to the effective design variables to reduce the computational burden associated with the evaluation of the probabilities. The individual mean and sensitivity values could be estimated easily by using the 9 level orthogonal array based response surface models optimized by the stepwise regression. The present study evaluates a proposed procedure from the robust optimization of rubber domes that are commonly used for keyboard switching, by using the 9 level orthogonal array and stepwise regression along with a desirability function. In addition, a new robust optimization process, i.e., the I2GEO (Identify, Integrate, Generate, Explore and Optimize), was proposed on the basis of the robust optimization in rubber domes. The optimized results from the response surface models and the estimated results by using the finite element analysis were consistent within a small margin of error. The standard deviation of objective function is decreasing 54.17% with suggested sensitivity based robust optimization. (Business for Cooperative R&D between Industry, Academy, and Research Institute funded Korea Small and Medium Business Administration in 2017, S2455569)

Keywords: objective function, orthogonal array, response surface model, robust optimization, stepwise regression

Procedia PDF Downloads 259
128 Rate of Profit as a Pricing Benchmark in Islamic Banking to Create Financial Stability

Authors: Trisiladi Supriyanto

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Although much research has been done on the pricing benchmark both in terms of fiqh or Islamic economic perspective, but no substitution for the concept of interest (rate of interest) up to now in the application of Islamic Banking because some of the jurists from the middle east even allow the use of a benchmark rate such as LIBOR (London Interbank Offered Rate) as a measure of Islamic financial asset prices, so in other words, they equate the concept of rate of interest with the concept of rate of profit, which is the core reason (raison detre) for the replacement of usury as instructed in the Quran. This study aims to find the concept of rate of profit on Islamic banking that can create economic justice and stability in Islamic Banking and Capital market. Rate of profit that creates economic justice and stability can be achieved through its role in maintaining the stability of the financial system in which there is an equitable distribution of income and wealth. To determine the role of the rate of profit as the basis of the sharing system implemented in the Islamic financial system, we can see the connection of rate of profit in creating financial stability, especially in the asset-liability management of financial institutions that generate a stable net margin or the rate of profit that is not affected by the ups and downs of the market risk factors including indirect effect on interest rates. Furthermore, Islamic financial stability can be seen from the role of the rate of profit on the stability of the Islamic financial assets that are measured from the Islamic financial asset price volatility in Islamic Bond Market in Capital Market.

Keywords: Rate of profit, economic justice, stability, equitable distribution of income, equitable distribution of wealth

Procedia PDF Downloads 375
127 The Influence of Different Flux Patterns on Magnetic Losses in Electric Machine Cores

Authors: Natheer Alatawneh

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The finite element analysis of magnetic fields in electromagnetic devices shows that the machine cores experience different flux patterns including alternating and rotating fields. The rotating fields are generated in different configurations range between circular and elliptical with different ratios between the major and minor axis of the flux locus. Experimental measurements on electrical steel exposed to different flux patterns disclose different magnetic losses in the samples under test. Consequently, electric machines require special attention during the cores loss calculation process to consider the flux patterns. In this study, a circular rotational single sheet tester is employed to measure the core losses in electric steel sample of M36G29. The sample was exposed to alternating field, circular field, and elliptical fields with axis ratios of 0.2, 0.4, 0.6 and 0.8. The measured data was implemented on 6-4 switched reluctance motor at three different frequencies of interest to the industry as 60 Hz, 400 Hz, and 1 kHz. The results disclose a high margin of error that may occur during the loss calculations if the flux patterns issue is neglected. The error in different parts of the machine associated with considering the flux patterns can be around 50%, 10%, and 2% at 60Hz, 400Hz, and 1 kHz, respectively. The future work will focus on the optimization of machine geometrical shape which has a primary effect on the flux pattern in order to minimize the magnetic losses in machine cores.

Keywords: alternating core losses, electric machines, finite element analysis, rotational core losses

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126 Sphingosomes: Potential Anti-Cancer Vectors for the Delivery of Doxorubicin

Authors: Brajesh Tiwari, Yuvraj Dangi, Abhishek Jain, Ashok Jain

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The purpose of the investigation was to evaluate the potential of sphingosomes as nanoscale drug delivery units for site-specific delivery of anti-cancer agents. Doxorubicin Hydrochloride (DOX) was selected as a model anti-cancer agent. Sphingosomes were prepared and loaded with DOX and optimized for size and drug loading. The formulations were characterized by Malvern zeta-seizer and Transmission Electron Microscopy (TEM) studies. Sphingosomal formulations were further evaluated for in-vitro drug release study under various pH profiles. The in-vitro drug release study showed an initial rapid release of the drug followed by a slow controlled release. In vivo studies of optimized formulations and free drug were performed on albino rats for comparison of drug plasma concentration. The in- vivo study revealed that the prepared system enabled DOX to have had enhanced circulation time, longer half-life and lower elimination rate kinetics as compared to free drug. Further, it can be interpreted that the formulation would selectively enter highly porous mass of tumor cells and at the same time spare normal tissues. To summarize, the use of sphingosomes as carriers of anti-cancer drugs may prove to be a fascinating approach that would selectively localize in the tumor mass, increasing the therapeutic margin of safety while reducing the side effects associated with anti-cancer agents.

Keywords: sphingosomes, anti-cancer, doxorubicin, formulation

Procedia PDF Downloads 271
125 Impact of Capital Structure, Dividend Policy and Sustainability on Value of Firm: A Case Study of Spinning Textile Sector of Pakistan

Authors: Zahid Ahmad, Samia Yousaf

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The main purpose of this study is to evaluate and assess the financial position, operating performance, and recent outlook of the companies. This study investigates the impact of capital structure, dividend policy and sustainability on the value of firms of textile spinning sector of Pakistan which is listed on Pakistan stock exchange. The panel data technique has been applied to this group of textile sector which is textile spinning. This study covers the last ten years of time period. All the data related to the variables have been collected from the annual reports and financial statements of the textile sector firms. There are differently related determinants to measure the capital structure which are fixed assets turnover ratio, debt ratio, equity ratio, debt to equity ratio, assets tangibility, and shareholder’s equity. Dividend policy is being measured by two determinants which are earning per share (EPS) and dividend payout ratio. Sustainability is being measured by three suitable factors which are sales growth, gross profit margin ratio and firm size. These are three independent variables and their determinants of this study. Value of firm is measured through the return on asset (ROA). Capital structure is at the top of the list among all the three variables. According to the results of this research work, somewhere all the three variables generates positive and significant effect on the firm’s performance and its growth.

Keywords: capital structure, dividend policy, panel data, sustainability

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124 Wire Localization Procedures in Non-Palpable Breast Cancers: An Audit Report and Review of Literature

Authors: Waqas Ahmad, Eisha Tahir, Shahper Aqeel, Imran Khalid Niazi, Amjad Iqbal

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Background: Breast conservation surgery applies a number of techniques for accurate localization of lesions. Wire localization remains the method of choice in non-palpable breast cancers post-neoadjuvant chemotherapy. Objective: The aim of our study was to determine the accuracy of wire localization procedures in our department and compare it with internationally set protocols as per the Royal College of Radiologists. Post wire mammography, as well as the margin status of the postoperative specimen, assessed the accuracy of the procedure. Methods: We retrospectively reviewed the data of 225 patients who presented to our department from May 2014 to June 2015 post neoadjuvant chemotherapy with non-palpable cancers. These patients are candidates for wire localized lumpectomies either under ultrasound or stereotactic guidance. Metallic marker was placed in all the patients at the time of biopsy. Post wire mammogram was performed in all the patients and the distance of the wire tip from the marker was calculated. The presence or absence of the metallic clip in the postoperative specimen, as well as the marginal status of the postoperative specimen, was noted. Results: 157 sonographic and 68 stereotactic wire localization procedures were performed. 95% of the wire tips were within 1 cm of the metallic marker. Marginal status was negative in 94% of the patients in histopathological specimen. Conclusion: Our audit report declares more than 95% accuracy of image guided wire localization in successful excision of non-palpable breast lesions.

Keywords: breast, cancer, non-palpable, wire localization

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123 Extensive Cerebral Venous Thrombosis after Resection of Third Ventricle Colloid Cyst

Authors: Naim Izet Kajtazi

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Context: The third ventricle colloid cyst (CC) is a benign growth usually located in the third ventricle and can cause various neurological symptoms, including sudden death. Modern surgical interventions may still result in a wide range of complications and cerebral venous thrombosis (CVT) is among them. Process: A 38-year-old female with an existing diagnosis of diabetes mellitus (DM) and hypothyroidism and a six-month history of headaches, blurred vision, and vomiting presented to our clinic three days after the headaches became excessively severe. Neurological examination on admission revealed bilateral papilledema without any associated focal neurological deficits. Brain computed tomography (CT) and magnetic resonance imaging (MRI) confirmed the presence of a third ventricle colloid cyst and associated non-communicating hydrocephalus involving the lateral ventricles. As a result, the patient underwent emergency bilateral external ventricular drainage (EVD) insertion followed by a third ventricular CC excision under neuronavigation through a right frontal craniotomy. Twelve days post-operatively, the patient developed further headaches, followed by a generalized tonic-clonic seizure that led to no postictal neurological deficits. Nonetheless, computed tomography venography of the brain revealed extensive thrombosis of the superior sagittal sinus, inferior sagittal sinus, right sigmoid sinus, and right internal jugular vein. A newly diagnosed CVT was treated with intravenous heparin. The patient was discharged with warfarin, which was discontinued after 12 months. Ten years after her illness, she remained stable and free from any neurological deficits but still suffered from mild chronic headaches. Outcome: Ten years after her illness, she remained stable and free from any neurological deficits but still suffered from mild chronic headaches. Relevance: A preoperative venous study should be performed in all cases to gain a better understanding of the venous anatomy. We advocate meticulous microsurgical techniques to protect the venous system surrounding the foramen of Monro and reduce the amount of retraction during surgery.

Keywords: CVT, seizures, third ventricle colloid cyst, MRI of brain

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122 Fabrication and Analysis of Simplified Dragonfly Wing Structures Created Using Balsa Wood and Red Prepreg Fibre Glass for Use in Biomimetic Micro Air Vehicles

Authors: Praveena Nair Sivasankaran, Thomas Arthur Ward, Rubentheren Viyapuri

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Paper describes a methodology to fabricate a simplified dragonfly wing structure using balsa wood and red prepreg fibre glass. These simplified wing structures were created for use in Biomimetic Micro Air Vehicles (BMAV). Dragonfly wings are highly corrugated and possess complex vein structures. In order to mimic the wings function and retain its properties, a simplified version of the wing was designed. The simplified dragonfly wing structure was created using a method called spatial network analysis which utilizes Canny edge detection method. The vein structure of the wings were carved out in balsa wood and red prepreg fibre glass. Balsa wood and red prepreg fibre glass was chosen due to its ultra- lightweight property and hence, highly suitable to be used in our application. The fabricated structure was then immersed in a nanocomposite solution containing chitosan as a film matrix, reinforced with chitin nanowhiskers and tannic acid as a crosslinking agent. These materials closely mimic the membrane of a dragonfly wing. Finally, the wings were subjected to a bending test and comparisons were made with previous research for verification. The results had a margin of difference of about 3% and thus the structure was validated.

Keywords: dragonfly wings, simplified, Canny edge detection, balsa wood, red prepreg, chitin, chitosan, tannic acid

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121 Elderly Care for Bereaved Parents Following the Death of an Only Child in Mainland China

Authors: Chao Fang

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Due to the Confucian emphasis on filial piety and an undeveloped social welfare system in mainland China, adult children are both socially and legally obliged to care for their parents, including financial assistance and physical care as well as emotional and social support. Thus a family-centred care pattern for elderly people has been firmly established in China. However, because of the nationwide ‘One Child Policy’, over one million parents are excluded from such care because of the death of their only child and, therefore, their primary caregiver. Without their child’s support, these parents must manage the day to day challenges of growing old alone, with little support from society. By overturning established expectations of a ‘good’ elderly life, the loss of an only child may be accompanied by social and self-stigmatization, pushing these bereaved parents to the margin of society and threatening their economic, physical, emotional and social well-being. More importantly, since the One Child Policy was implemented from the late 1970s and early 1980s, the first generation of bereaved or ‘Shidu’ parents has reached an age at which those parents need elderly care. However, their predicament has been largely ignored. This paper reports on a qualitative interview study that found elderly care to be the main concern for Shidu parents’ everyday life. The paper identifies and discusses the concerns these bereaved parents raised about the prospect of having nowhere to turn at a time of increased need for financial, physical, social and emotional support in old age. The paper also identifies how Shidu parents have been coming together in grief and negotiate to make their predicament known to the government and wider society and to re-define their elderly life by rebuilding a sense of ‘family’.

Keywords: culture, bereavement, China, elderly care

Procedia PDF Downloads 248
120 Geophysical Mapping of the Groundwater Aquifer System in Gode Area, Northeastern Hosanna, Ethiopia

Authors: Esubalew Yehualaw Melaku

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In this study, two basic geophysical methods are applied for mapping the groundwater aquifer system in the Gode area along the Guder River, northeast of Hosanna town, near the western margin of the Central Main Ethiopian Rift. The main target of the study is to map the potential aquifer zone and investigate the groundwater potential for current and future development of the resource in the Gode area. The geophysical methods employed in this study include, Vertical Electrical Sounding (VES) and magnetic survey techniques. Electrical sounding was used to examine and map the depth to the potential aquifer zone of the groundwater and its distribution over the area. On the other hand, a magnetic survey was used to delineate contact between lithologic units and geological structures. The 2D magnetic modeling and the geoelectric sections are used for the identification of weak zones, which control the groundwater flow and storage system. The geophysical survey comprises of twelve VES readings collected by using a Schlumberger array along six profile lines and more than four hundred (400) magnetic readings at about 10m station intervals along four profiles and 20m along three random profiles. The study result revealed that the potential aquifer in the area is obtained at a depth range from 45m to 92m. This is the response of the highly weathered/ fractured ignimbrite and pumice layer with sandy soil, which is the main water-bearing horizon. Overall, in the neighborhood of four VES points, VES- 2, VES- 3, VES-10, and VES-11, shows good water-bearing zones in the study area.

Keywords: vertical electrical sounding, magnetic survey, aquifer, groundwater potential

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119 The Importance of Oral Mucosal Biopsy Selection Site in Areas of Field Change: A Case Report

Authors: Timmis W., Simms M., Thomas C.

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This case discusses the management of two floors of mouth (FOM) Squamous Cell Carcinomas (SCC) not identified upon initial biopsy. A 51 year-old male presented with right FOM erythroleukoplakia. Relevant medical history included alcoholic dependence syndrome and alcoholic liver disease. Relevant drug therapy encompassed acamprosate, folic acid, hydroxocobalamin and thiamine. The patient had a 55.5 pack-year smoking history and alcohol dependence from age 14, drinking 16 units/day. FOM incisional biopsy and histopathological analysis diagnosed Carcinoma in situ. Treatment involved wide local excision. Specimen analysis revealed two separate foci of pT1 moderately differentiated SCCs. Carcinoma staging scans revealed no pathological lymphadenopathy, no local invasion or metastasis. SCCs had been excised in completion with narrow margins. MDT discussion concluded that in view of the field changes it would be difficult to identify specific areas needing further excision, although techniques such as Lugol’s Iodine were considered. Further surgical resection, surgical neck management and sentinel lymph node biopsy was offered. The patient declined intervention, primary management involved close monitoring alongside alcohol and smoking cessation referral. Narrow excisional margins can increase carcinoma recurrence risk. Biopsy failed to identify SCCs, despite sampling an area of clinical concern. For gross field change multiple incisional biopsies should be considered to increase chance of accurate diagnosis and appropriate treatment. Coupling of tobacco and alcohol has a synergistic effect, exponentially increasing the relative risk of oral carcinoma development. Tobacco and alcoholic control is fundamental in reducing treatment‑related side effects, recurrence risk and second primary cancer development.

Keywords: alcohol dependence, biopsy, oral carcinoma, tobacco

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118 An Economic Analysis of Bottled Drinking Water Industry in India

Authors: Swadhin Mondal

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While safe drinking water is an effective defense against the infection of water borne diseases, a large number of populations suffering from these diseases do not have access to safe drinking water due inadequacy of supply. Private entrepreneurs entered this sector and made bottled drinking water available by supplying various kinds of bottled water. In this study we found that the bottled drinking water industry has experienced a spectacular growth over the past two decades and it has a huge growth potential because of rising demand for safe drinking. High profit margin (217 %) is the main attraction to the entrepreneur to invest in this industry. Health awareness, lack of safe drinking water facilities, rising income, urbanization, migration and rising trend in tourism industries are the major influencing factors of demand for bottled drinking water (BDW). This industry also partially fulfills the demand for drinking water. More than 2 percent of household’s demands were met by this industry and many more households (additional 4 percent) coping with BDW during water crisis. Poor households spend around 4 percent of their total monthly household’s consumption expenditure on BDW which may have an adverse impact on household because households could have spent this for purchasing other goods. Like other developed counties, a large section of Indian households are shifting from their traditional sources of water to BDW. However, there are some concerns about the quality of BDW. Many cases, BDW contains chemical toxins at more than permissible level that can be harmful for health. Hence, there is an urgent need for appropriate intervention to regulate price, reduce potential harm and improve the quality of water provided by this industry.

Keywords: drinking water, public health public failure, privatization, development, public policy

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117 Cenomanian-Turonian Oceanic Anoxic Event, Palynofacies and Optical Kerogen Analysis in Abu Gharadig Basin, Egypt

Authors: Mohamed Ibrahim, Suzan Kholeif

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The Cenomanian-Turonian boundary was a ‘greenhouse’ period. The atmosphere at that time was characterized by high CO₂; in addition, there was the widespread deposition of organic-rich sediments anomalously rich in organic carbon. The sediments, palynological, total organic carbon (TOC), stable carbon and oxygen isotopes (δ¹³C, δ¹⁸O, organic) of the Cenomanian-Turonian Bahariya and basal Abu Roash formations at the southern Tethys margin were studied in two deep wells (AG5 and AG-13), Abu Gharadig Oil Field, North Western Desert, Egypt. Some of the marine (dinoflagellate cysts), as well as the terrestrial palynoflora (spores and pollen grains), reveal extinction and origination patterns that are known elsewhere, although other species may be survived across the Cenomanian-Turonian boundary. This implies control of global changes on the palynoflora, i.e., impact of Oceanic Anoxic Event OAE2 (Bonarelli Event), rather than changes in the local environmental conditions. The basal part of the Abu Roach Formation ('G' and 'F' members, late Cenomanian) shows a positive δ ¹³C excursion of the organic fraction. The TOC is generally high between 2.20 and 3.04 % in the basal Abu Roash Formation: shale of 'G' and carbonate of 'F' members, which indicates that these two members are the main Cretaceous source rocks in the Abu Gharadig Basin and have a type I-II kerogen composition. They are distinguished by an abundance of amorphous organic matter AOM and Chlorococcalean algae, mainly Pediastrum and Scenedesmus, along with subordinate dinoflagellate cysts.

Keywords: oceanic anoxic event, cenomanian-turonian, palynofacies, western desert, Egypt

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116 An Audit of Local Guidance Compliance For Stereotactic Core Biopsy For DCIS In The Breast Screening Programme

Authors: Aisling Eves, Andrew Pieri, Ross McLean, Nerys Forester

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Background: The breast unit local guideline recommends that 12 cores should be used in a stereotactic-guided biopsy to diagnose DCIS. Twelve cores are regarded to provide good diagnostic value without removing more breast tissue than necessary. This study aimed to determine compliance with guidelines and investigated how the number of cores impacted upon the re-excision rate and size discrepancies. Methods: This single-centre retrospective cohort study of 72 consecutive breast screened patients with <15mm DCIS on radiological report underwent stereotactic-guided core biopsy and subsequent surgical excision. Clinical, radiological, and histological data were collected over 5 years, and ASCO guidelines for margin involvement of <2mm was used to guide the need for re-excision. Results: Forty-six (63.9%) patients had <12 cores taken, and 26 (36.1%) patients had ≥12 cores taken. Only six (8.3%) patients had 12 cores taken in their stereotactic biopsy. Incomplete surgical excision was seen in 17 patients overall (23.6%), and of these patients, twelve (70.6%) had fewer than 12 cores taken (p=0.55 for the difference between groups). Mammogram and biopsy underestimated the size of the DCIS in this subgroup by a median of 15mm (range: 6-135mm). Re-excision was required in 9 patients (12.5%), and five patients (6.9%) were found to have invasive ductal carcinoma on excision (80% had <12 cores, p=0.43). Discussion: There is poor compliance with the breast unit local guidelines and higher rates of re-excision in patients who did not have ≥12 cores taken. Taking ≥12 cores resulted in fewer missed invasive cancers lower incomplete excision and re-excision rates.

Keywords: stereotactic core biopsy, DCIS, breast screening, Re-excision rates, core biopsy

Procedia PDF Downloads 94
115 Comparison of Microleakage of Composite Restorations Using Fifth and Seventh Generation of Bonding Agents

Authors: Karina Nabilla, Dedi Sumantri, Nurul T. Rizal, Siti H. Yavitha

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Background: Composite resin is the most frequently used material for restoring teeth, but still failure cases are seen which leading to microleakage. Microleakage might be attributed to various factors, one of them is bonding agent. Various generations of bonding agents have been introduced to overcome the microleakage. The aim of this study was to evaluate the microleakage of composite restorations using the fifth and seventh bonding agent. Methods: Class I cavities (3X2X2 mm) were prepared on the occlusal surfaces of 32 human upper premolars. Teeth were classified into two groups according to the type of bonding agent used (n =16). Group I: Fifth Generation of Bonding Agent-Adper Single Bond2. Group II: Seventh Generation of Bonding Agent-Single Bond Universal. All cavities were restored with Filtek Z250 XT composite resin, stored in sterile aquades water at 370C for 24 h. The root apices were sealed with sticky wax, and all the surfaces, except for 2 mm from the margins, were coated with nail varnish. The teeth were immersed in a 1% methylene blue dye solution for 24 h, and then rinsed in running water, blot-dried and sectioned longitudinally through the center of restorations from the buccal to palatal surface. The sections were blindly assessed for microleakage of dye penetration by using a stereomicroscope. Dye penetration along margin was measured in µm then calculated into the percentage and classified into scoring system 1 to 3. Data were collected and statistically analyzed by Chi-Square test. Result: There was no significant difference (p > 0,05) between two groups. Conclusion: Fifth generation of bonding agent revealed less leakage compared to the seventh generation even statistically there was no significant difference.

Keywords: composite restoration, fifth generation of bonding agent, microleakage, seventh generation of bonding agent

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114 Incorporating Lexical-Semantic Knowledge into Convolutional Neural Network Framework for Pediatric Disease Diagnosis

Authors: Xiaocong Liu, Huazhen Wang, Ting He, Xiaozheng Li, Weihan Zhang, Jian Chen

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The utilization of electronic medical record (EMR) data to establish the disease diagnosis model has become an important research content of biomedical informatics. Deep learning can automatically extract features from the massive data, which brings about breakthroughs in the study of EMR data. The challenge is that deep learning lacks semantic knowledge, which leads to impracticability in medical science. This research proposes a method of incorporating lexical-semantic knowledge from abundant entities into a convolutional neural network (CNN) framework for pediatric disease diagnosis. Firstly, medical terms are vectorized into Lexical Semantic Vectors (LSV), which are concatenated with the embedded word vectors of word2vec to enrich the feature representation. Secondly, the semantic distribution of medical terms serves as Semantic Decision Guide (SDG) for the optimization of deep learning models. The study evaluate the performance of LSV-SDG-CNN model on four kinds of Chinese EMR datasets. Additionally, CNN, LSV-CNN, and SDG-CNN are designed as baseline models for comparison. The experimental results show that LSV-SDG-CNN model outperforms baseline models on four kinds of Chinese EMR datasets. The best configuration of the model yielded an F1 score of 86.20%. The results clearly demonstrate that CNN has been effectively guided and optimized by lexical-semantic knowledge, and LSV-SDG-CNN model improves the disease classification accuracy with a clear margin.

Keywords: convolutional neural network, electronic medical record, feature representation, lexical semantics, semantic decision

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113 Relation between Biochemical Parameters and Bone Density in Postmenopausal Women with Osteoporosis

Authors: Shokouh Momeni, Mohammad Reza Salamat, Ali Asghar Rastegari

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Background: Osteoporosis is the most prevalent metabolic bone disease in postmenopausal women associated with reduced bone mass and increased bone fracture. Measuring bone density in the lumbar spine and hip is a reliable measure of bone mass and can therefore specify the risk of fracture. Dual-energy X-ray absorptiometry(DXA) is an accurate non-invasive system measuring the bone density, with low margin of error and no complications. The present study aimed to investigate the relationship between biochemical parameters with bone density in postmenopausal women. Materials and methods: This cross-sectional study was conducted on 87 postmenopausal women referred to osteoporosis centers in Isfahan. Bone density was measured in the spine and hip area using DXA system. Serum levels of calcium, phosphorus, alkaline phosphatase and magnesium were measured by autoanalyzer and serum levels of vitamin D were measured by high-performance liquid chromatography(HPLC). Results: The mean parameters of calcium, phosphorus, alkaline phosphatase, vitamin D and magnesium did not show a significant difference between the two groups(P-value>0.05). In the control group, the relationship between alkaline phosphatase and BMC and BA in the spine was significant with a correlation coefficient of -0.402 and 0.258, respectively(P-value<0.05) and BMD and T-score in the femoral neck area showed a direct and significant relationship with phosphorus(Correlation=0.368; P-value=0.038). There was a significant relationship between the Z-score with calcium(Correlation=0.358; P-value=0.044). Conclusion: There was no significant relationship between the values ​​of calcium, phosphorus, alkaline phosphatase, vitamin D and magnesium parameters and bone density (spine and hip) in postmenopaus

Keywords: osteoporosis, menopause, bone mineral density, vitamin d, calcium, magnesium, alkaline phosphatase, phosphorus

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112 Seismic Reflection Highlights of New Miocene Deep Aquifers in Eastern Tunisia Basin (North Africa)

Authors: Mourad Bédir, Sami Khomsi, Hakim Gabtni, Hajer Azaiez, Ramzi Gharsalli, Riadh Chebbi

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Eastern Tunisia is a semi-arid area; located in the northern Africa plate; southern Mediterranean side. It is facing water scarcity, overexploitation, and decreasing of water quality of phreatic water table. Water supply and storage will not respond to the demographic and economic growth and demand. In addition, only 5 109 m3 of rainwater from 35 109 m3 per year renewable rain water supply can be retained and remobilized. To remediate this water deficiency, researches had been focused to near new subsurface deep aquifers resources. Among them, Upper Miocene sandstone deposits of Béglia, Saouaf, and Somaa Formations. These sandstones are known for their proven Hydrogeologic and hydrocarbon reservoir characteristics in the Tunisian margin. They represent semi-confined to confined aquifers. This work is based on new integrated approaches of seismic stratigraphy, seismic tectonics, and hydrogeology, to highlight and characterize these reservoirs levels for aquifer exploitation in semi-arid area. As a result, five to six third order sequence deposits had been highlighted. They are composed of multi-layered extended sandstones reservoirs; separated by shales packages. These reservoir deposits represent lowstand and highstand system tracts of these sequences, which represent lowstand and highstand system tracts of these sequences. They constitute important strategic water resources volumes for the region.

Keywords: Tunisia, Hydrogeology, sandstones, basin, seismic, aquifers, modeling

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111 Molecular Alterations Shed Light on Alteration of Methionine Metabolism in Gastric Intestinal Metaplesia; Insight for Treatment Approach

Authors: Nigatu Tadesse, Ying Liu, Juan Li, Hong Ming Liu

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Gastric carcinogenesis is a lengthy process of histopathological transition from normal to atrophic gastritis (AG) to intestinal metaplasia (GIM), dysplasia toward gastric cancer (GC). The stage of GIM identified as precancerous lesions with resistance to H-pylori eradication and recurrence after endoscopic surgical resection therapies. GIM divided in to two morphologically distinct phenotypes such as complete GIM bearing intestinal type morphology whereas the incomplete type has colonic type morphology. The incomplete type GIM considered to be the greatest risk factor for the development of GC. Studies indicated the expression of the caudal type homeobox 2 (CDX2) gene is responsible for the development of complete GIM but its progressive downregulation from incomplete metaplasia toward advanced GC identified as the risk for IM progression and neoplastic transformation. The downregulation of CDX2 gene have promoted cell growth and proliferation in gastric and colon cancers and ascribed in chemo-treatment inefficacies. CDX2 downregulated through promoter region hypermethylation in which the methylation frequency positively correlated with the dietary history of the patients, suggesting the role of diet as methyl carbon donor sources such as methionine. However, the metabolism of exogenous methionine is yet unclear. Targeting exogenous methionine metabolism has become a promising approach to limits tumor cell growth, proliferation and progression and increase treatment outcome. This review article discusses molecular alterations that could shed light on the potential of exogenous methionine metabolisms, such as gut microbiota alteration as sources of methionine to host cells, metabolic pathway signaling via PI3K/AKt/mTORC1-c-MYC to rewire exogenous methionine and signature of increased gene methylation index, cell growth and proliferation in GIM, with insights to new treatment avenue via targeting methionine metabolism, and the need for future integrated studies on molecular alterations and metabolomics to uncover altered methionine metabolism and characterization of CDX2 methylation in gastric intestinal metaplasia for potential therapeutic exploitation.

Keywords: altered methionine metabolism, Intestinal metaplesia, CDX2 gene, gastric cancer

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110 Africa and the Gas Supply Crisis to European Countries under the Russian-Ukrainian War: A Study on the Nigerian-Algerian Gas Pipeline project Importance

Authors: Mohammed Lamine Benaouda

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This paper seeks to shed light on the African continent role with the crisis of natural gas supplies to European countries, which resulted from the repercussions of the Russian-Ukrainian war, by examining the case of re-launching the Trans-Saharan Gas Pipeline project Nigeria-Algeria, and clarifying the strategic importance This project is mutually beneficial in the long run. The paper relied on the analytical and statistical method in order to find out the the impact that the project represents on the huge needs of the European gas market on the one hand, and monitoring the various economic gains for Algeria and Nigeria on the other hand, in addition, the comparative approach to assess the possible effects of the success and feasibility of the project economy for all its beneficiaries. The paper founds that the complexity has multiplied in the global energy market in general and the European one in particular, following what the world witnessed from the repercussions of the Russian-Ukrainian war, as well as the extreme importance of the poles of African countries in the arena of the international struggle over resources, which allows them a margin From maneuvering and regional and global influence in various fields. With regard to the research outcoms and the future scope, the researcher believes that the African continent, in light of international competition and conflict, as well as what the world is witnessing in terms of restoring balances of power in the current international system, will play very important roles, especially with its enormous natural and human capabilities, which enable it to Weighting future conflicts over energy and spheres of influence.

Keywords: algeria, nigeria, west africa, ECOWAS, gas supplies, russia, ukrain

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109 ¹⁸F-FDG PET/CT Impact on Staging of Pancreatic Cancer

Authors: Jiri Kysucan, Dusan Klos, Katherine Vomackova, Pavel Koranda, Martin Lovecek, Cestmir Neoral, Roman Havlik

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Aim: The prognosis of patients with pancreatic cancer is poor. The median of survival after establishing diagnosis is 3-11 months without surgical treatment, 13-20 months with surgical treatment depending on the disease stage, 5-year survival is less than 5%. Radical surgical resection remains the only hope of curing the disease. Early diagnosis with valid establishment of tumor resectability is, therefore, the most important aim for patients with pancreatic cancer. The aim of the work is to evaluate the contribution and define the role of 18F-FDG PET/CT in preoperative staging. Material and Methods: In 195 patients (103 males, 92 females, median age 66,7 years, 32-88 years) with a suspect pancreatic lesion, as part of the standard preoperative staging, in addition to standard examination methods (ultrasonography, contrast spiral CT, endoscopic ultrasonography, endoscopic ultrasonographic biopsy), a hybrid 18F-FDG PET/CT was performed. All PET/CT findings were subsequently compared with standard staging (CT, EUS, EUS FNA), with peroperative findings and definitive histology in the operated patients as reference standards. Interpretation defined the extent of the tumor according to TNM classification. Limitations of resectability were local advancement (T4) and presence of distant metastases (M1). Results: PET/CT was performed in a total of 195 patients with a suspect pancreatic lesion. In 153 patients, pancreatic carcinoma was confirmed and of these patients, 72 were not indicated for radical surgical procedure due to local inoperability or generalization of the disease. The sensitivity of PET/CT in detecting the primary lesion was 92.2%, specificity was 90.5%. A false negative finding in 12 patients, a false positive finding was seen in 4 cases, positive predictive value (PPV) 97.2%, negative predictive value (NPV) 76,0%. In evaluating regional lymph nodes, sensitivity was 51.9%, specificity 58.3%, PPV 58,3%, NPV 51.9%. In detecting distant metastases, PET/CT reached a sensitivity of 82.8%, specificity was 97.8%, PPV 96.9%, NPV 87.0%. PET/CT found distant metastases in 12 patients, which were not detected by standard methods. In 15 patients (15.6%) with potentially radically resectable findings, the procedure was contraindicated based on PET/CT findings and the treatment strategy was changed. Conclusion: PET/CT is a highly sensitive and specific method useful in preoperative staging of pancreatic cancer. It improves the selection of patients for radical surgical procedures, who can benefit from it and decreases the number of incorrectly indicated operations.

Keywords: cancer, PET/CT, staging, surgery

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108 The Impact of Strategic Information in Developing the Target Cost Approach to achieve Competitive Advantage

Authors: Rizgar Abdullah Sabir Jaf, Bayan Sedeeq Azeez Hussin, Dler Moosa Ahmed Karim

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Presently, economic and technological developments are growing faster in an unparalleled way. The result of that is innovative changing a great deal of a great deal of assumption, concepts, transactions, and high of competition between companies all over the world. The title of the thesis is one of the subjects that get large concerns in the financial and business world in the present time. That is because many competitive firms have appeared in the regional and global markets and the rapid changes that covered all fields of life. The subjects of the dissertation have a special importance in making the firm's businesses succeed in general and the industrial firms especially. Thus, the basic purpose of this study is to determine whether target costing is used in the costing application process in their customer expectation, profit margin, cost and price determination, cost reduction and management operations. In today’s intensely competitive and highly volatile business environment, consistent development of low cost and high quality products meeting the functional requirements is a key to a company's survival. Companies continuously strive to reduce the costs while still producing quality products to stay ahead in the competition. Many companies have turned to target costing to achieve this objective. The results indicate that there is a significant positive relationship (at the significance level less than 0.05) between the factors competitive advantage and management accounting techniques in the firm's sample study.

Keywords: strategic information, target cost, competitive advantage, Iraqi soft drink firms

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107 The First Report of Aberrant Corneal Occlusion in Rabbit in Iran

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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106 Microalgae Hydrothermal Liquefaction Process Optimization and Comprehension to Produce High Quality Biofuel

Authors: Lucie Matricon, Anne Roubaud, Geert Haarlemmer, Christophe Geantet

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Introduction: This case discusses the management of two floor of mouth (FOM) Squamous Cell Carcinomas (SCC) not identified upon initial biopsy. Case Report: A 51 year-old male presented with right FOM erythroleukoplakia. Relevant medical history included alcoholic dependence syndrome and alcoholic liver disease. Relevant drug therapy encompassed acamprosate, folic acid, hydroxocobalamin and thiamine. The patient had a 55.5 pack-year smoking history and alcohol dependence from age 14, drinking 16 units/day. FOM incisional biopsy and histopathological analysis diagnosed Carcinoma in situ. Treatment involved wide local excision. Specimen analysis revealed two separate foci of pT1 moderately differentiated SCCs. Carcinoma staging scans revealed no pathological lymphadenopathy, no local invasion or metastasis. SCCs had been excised in completion with narrow margins. MDT discussion concluded that in view of the field changes it would be difficult to identify specific areas needing further excision, although techniques such as Lugol’s Iodine were considered. Further surgical resection, surgical neck management and sentinel lymph node biopsy was offered. The patient declined intervention, primary management involved close monitoring alongside alcohol and smoking cessation referral. Discussion: Narrow excisional margins can increase carcinoma recurrence risk. Biopsy failed to identify SCCs, despite sampling an area of clinical concern. For gross field change multiple incisional biopsies should be considered to increase chance of accurate diagnosis and appropriate treatment. Coupling of tobacco and alcohol has a synergistic effect, exponentially increasing the relative risk of oral carcinoma development. Tobacco and alcoholic control is fundamental in reducing treatment‑related side effects, recurrence risk, and second primary cancer development.

Keywords: microalgae, biofuels, hydrothermal liquefaction, biomass

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105 Rethinking the Value of Pancreatic Cyst CEA Levels from Endoscopic Ultrasound Fine-Needle Aspiration (EUS-FNA): A Longitudinal Analysis

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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