Cyst Fluid Research Articles

AN UNUSUAL CULPRIT FOR EXERTIONAL DYSPNEA

AN UNUSUAL CULPRIT FOR EXERTIONAL DYSPNEA

Comparative Performance of Endoscopic Ultrasound-Based Techniques in Patients With Pancreatic Cystic Lesions: A Network Meta-Analysis.

Evidence on the comparative diagnostic performance of endoscopic ultrasound (EUS)-based techniques for pancreatic cystic lesions (PCLs) is limited. This network meta-analysis comprehensively compared EUS-based techniques for PCL diagnosis. A comprehensive literature search was performed for all comparative studies assessing the accuracy of 2 or more modalities for PCL diagnosis. The primary outcome was the diagnostic efficacy for mucinous PCLs. Secondary outcomes were the diagnostic efficacy for malignant PCLs, diagnostic success rate, and adverse event rate. A network meta-analysis was conducted using the ANOVA model to assess the diagnostic accuracy of each index. Forty studies comprising 3,641 patients were identified. The network ranking of the superiority index for EUS-guided needle-based confocal laser endomicroscopy (EUS-nCLE) and EUS-guided through-the-needle biopsy (EUS-TTNB) were significantly higher than other techniques for differentiating mucinous PCLs; besides, EUS-TTNB was also the optimal technique in identifying malignant PCLs. The evidence was inadequate for EUS-nCLE diagnosing malignant PCLs and contrast-enhanced harmonic EUS diagnosing both mucinous and malignant PCLs. Glucose showed a high sensitivity but low specificity, and molecular analysis (KRAS, GNAS, and KRAS + GNAS mutations) showed a high specificity but low sensitivity for diagnosing mucinous PCLs. Satisfactory results were not obtained during the evaluation of the efficiency of pancreatic cyst fluid (PCF) biomarkers in detecting malignant PCLs. For centers with relevant expertise and facilities, EUS-TTNB and EUS-nCLE were better choices for the diagnosis of PCLs. Further studies are urgently required for further improving PCF biomarkers and validating the diagnostic performance of the index techniques.

Immune Cell Reaction Associated with Coenurus cerebralis Infection in Sheep with Particular Reference to ELISA as a Diagnostic Tool.

Simple SummaryInfected sheep with Coenurus cerebralis (C. cerebralis) were subjected to histopathological, hematological, immunological and serological examination. In histopathological sections, cerebral tissue showed an areolar cyst wall with many protoscolices attached to the tissue with necrosis and inflammatory cells’ aggregation. The infected sheep exhibited a significant alteration in blood profile when contrasted with apparently healthy sheep. Evaluation of ELISA specificity using two antigens showed specificities of 46.2% and 38.5% for fluid and scolex Ag, respectively. Meanwhile, accuracy ranged from 76.7% and 73.3% for fluid and scolex Ag, respectively. Levels of TNF-α and IFN-γ were significantly elevated in infected sheep when contrasted with control ones.Sturdy is a disease caused by Coenurus cerebralis (C. cerebralis) that typically affects the brain and spinal cord of sheep. So, this study aimed to detect the pathological, hematological and immunological changes caused by C. cerebralis in sheep. On examination, a total of 17 sheep out of 30 sheep (56.7%) from various regions in Egypt were found infected with C. cerebralis from May to August 2019. Each cyst was extracted from the sheep brain; in addition, tissue specimens were taken from the brain tissues for histopathological examination. The hematological profile was analyzed. Enzyme-Linked Immunosorbent Assay’s (ELISA) specificity and sensitivity were evaluated using cystic fluid and protoscolices antigens (Ag). The cell-mediated immunity against the C. cerebralis cyst was also assessed via quantitative Real Time—Polymerase Chain Reaction (qRT-PCR) to show alterations in mRNA expression of the Tumor Necrosis Factor-alpha (TNF-α) and gamma Interferon (IFN-γ) cytokines qRT-PCR. In histopathological sections, cerebral tissue showed an areolar cyst wall with many protoscolices attached to the tissue. The affected part showed prominent necrosis together with inflammatory cells’ aggregation. Hyperplastic proliferation of the ependymal cells was a common finding. The infected sheep exhibited significantly lower total erythrocyte numbers (ER), hemoglobin levels (Hb), packed cell volume (PCV), platelet numbers (PN) and segmented cell numbers compared to apparently healthy sheep. Despite the sensitivity for the indirect ELISA being 100% for both of the Ags (fluid and scolex), the evaluation of ELISA specificity using the two antigen (Ag) preparations showed specificities of 46.2% and 38.5% for fluid and scolex Ag, respectively. Meanwhile accuracy ranged from 76.7% and 73.3% for the fluid and scolex Ags, respectively, that showed the priority was directed to the fluid to be used as an ideal sample type for ELISA. Levels of TNF-α and IFN-γ were significantly elevated in infected sheep compared to non-infected control ones. In conclusion, C. cerebralis is a serious disease infecting sheep in Egypt revealing economic losses. Although this investigation supports preliminary information about the prevalence, pathological and serological characterization of C. cerebralis, further sequencing and phylogenetic analysis is needed to understand better the T. multiceps epidemiology in ruminants and canines in Egypt.

Clinical practice guidelines for endometriosis in Japan (The 3rd edition).

Clinical practice guidelines for endometriosis in Japan (The 3rd edition).

P225 Subcutaneous phaeohyphomycosis by Phaeoacremonium species in a renal transplant recipient

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMObjectivePhaeohyphomycosis refers to infections due to a large group of heterogenous organisms called ‘dematiaceous’ or ‘melanized’ fungi. The infection exhibits a wide spectrum of presentations such as deep local infections, pulmonary infection, cerebral infection, and disseminated disease, which are associated with high mortality. The incidence of phaeohyphomycosis among solid organ transplant recipients is 0.7%. Hereby, we report a case of phaeohyphomycosis in a post renal transplant patient who presented with a subcutaneous swelling over the right elbow region.MethodA detailed history was obtained from the patient after informed consent. The cystic fluid was subjected to microbiological including bacterial (Gram stain, culture on blood agar incubated at 37°C) and fungal investigations [Calcofluor potassium hydroxide (KOH) mount, culture on Sabouraud dextrose agar (SDA) incubated at 37°C and 25°C and brain heart infusion agar (BHI) incubated at 25°C]. The identification of isolate was done phenotypically by preparing lactophenol cotton blue (LCB) mount from slide culture and molecular technique using Sanger's sequencing.ResultA 61-year-old diabetic and post renal transplant (7 years) male presented with complaints of swelling over the right elbow region for 5 months duration. Swelling was insidious in onset, gradually progressive, painless, cystic, non-pulsatile, non-reducible, ∼9 × 7 cm in size, lobular in shape with irregular surface having normal overlying skin which minimally restricting the movement of the elbow. There was no history of trauma over the elbow region. Reddish purulent pus was received for mycological investigation. Calcofluor KOH mount demonstrated septate hyphae. Culture on SDA incubated at 37°C and 25°C grew cream-colored colonies, turning grayish beige to olive-brown and developed clusters of aerial hyphae with reverse tan to brown in color after 2 weeks of incubation. LCB mount showed hyaline to brownish hyphae, cylindrical phialides growing along the hyphae with slightly tapering towards the apex, hyaline, oblong, conidia, gathering in clusters at end of phialide. Phenotypically, the fungus was identified as Phaeoacremonium species and molecular identification and antifungal susceptibility are awaited. Patient was advised for surgical excision but he left against medical advice. Currently, he is not receiving any antifungals.ConclusionPhaeohyphomycosis is a rare and unique entity among fungal infections. Cutaneous phaeohyphomycosis predominantly occurs on the extremities with a localized solitary nodule or abscess. A high index of suspicion and the surgical approach including excision or debridement are mainly chosen.

A Comparative Evaluation of Four Different Immunoassays in the Diagnosis of Cystic Echinococcosis Using a Crude and Purified Hydatid Cyst Fluid Antigen.

Cystic echinococcosis (CE) is one of the most neglected tropical diseases as per WHO which has an immense public health significance. Diagnosis of CE is difficult as specific clinical signs are manifested only after the hydatid cyst attains a considerable size. Immunodiagnosis is a reliable method of diagnosing CE. SDS-PAGE was performed for the hydatid cyst fluid antigens. The antigen purity was tested by Western blotting and four different immunoassays were evaluated using these two antigens in sheep and buffalo in diagnosis of CE. SDS-PAGE revealed four bands of 72, 64, 48 and 24kDa for crude antigen and a single 72kDa band for purified antigen. Among sheep sera, ELISA was most sensitive (70%) using crude antigen and also while using the purified antigen (80%). In case of buffaloes, ELISA, DID and CIEP were more sensitive (83.3%) using crude antigen, whereas DID and CIEP were more sensitive (83.3%) using purified antigen. In sheep, while using the crude antigen ELISA was the most sensitive assay and IHA was the least sensitive assay. While using the purified antigen also, ELISA was the most sensitive and others were absolutely specific except for IHA being less sensitive. In buffaloes, using crude antigen, all the immunoassays CIEP, DID and ELISA were highly sensitive in diagnosing CE infection except IHA, whereas using the purified antigen, both CIEP and DID were more sensitive than ELISA and IHA which were comparatively less sensitive in detecting CE in buffalo sera.

Characterization of somatic and metabolic antigens of Cysticercus cellulosae and determination of immunodominant proteins

The present study shows the characterization of four somatic antigens (Whole Cyst Antigen (WCA), Cystic Fluid Antigen (CFA), Scolex Antigen (SA) and Membrane-Body Antigen (MBA)) and one metabolic antigen (Excretory-Secretory Antigen (ESA)) prepared from Cysticercus cellulosae originated from a naturally infected pig. Immunodominat proteins were determined using hyper immune rabbit sera. The Sodium Dodecyl SulphatePolyacrylamide Gel Electrophoresis (SDS-PAGE) profile of the antigens revealed different numbers and patterns of protein bands in the range of 11.80 to 176.74 kDa. The electrophoretic pattern of ESA also revealed a number of closely placed indistinct bands in the range of 20-34 kDa.. The proteins in the lower molecular weight range (< 30 kDa) in the case of WCA, CFA, ESA, and the medium molecular weight range (30-60 kDa) in the case of SA and MBA were observed to be immunodominant in the Enzyme-Linked Immunoelectrotransfer Blot (EITB) assay. These immunodominant proteins could be further investigated as potential diagnostic antigens in the serodiagnosis of cysticercosis in pigs, and neurocysticercosis in human patients.

Imaging in gynecological disease (24): clinical and ultrasound characteristics of ovarian mature cystic teratomas.

To describe the clinical and ultrasound features of ovarian mature cystic teratomas (MCTs). This was a retrospective study. From the International Ovarian Tumor Analysis (IOTA) database, we identified patients with a histologically confirmed diagnosis of MCT who had undergone transvaginal ultrasound examination between 1999 and 2016 (IOTA phases 1, 2, 3 and 5) in one of five centers. Ultrasound was performed by an experienced examiner who used the standardized IOTA examination technique and terminology. In addition to extracting data from the IOTA database, available two-dimensional grayscale and color or power Doppler images were reviewed retrospectively to identify typical ultrasound features of MCT described previously and detect possible new features using pattern recognition. All images were reviewed by two independent examiners and further discussed with two ultrasound experts to reach consensus. Included in the study were 454 patients with histologically confirmed MCT. Median age was 33 (range, 8-90) years and 66 (14.5%) patients were postmenopausal. Most MCTs were described by the original ultrasound examiner as unilocular (262/454 (57.7%)) or multilocular (70/454 (15.4%)) cysts with mixed echogenicity of cystic fluid (368/454 (81.1%)), acoustic shadowing (328/454 (72.2%)) and no or little vascularization on color Doppler (color score 1, 240/454 (52.9%); color score 2, 123/454 (27.1%)). The median largest lesion diameter was 66 (range, 15-310) mm. A correct preoperative diagnosis of MCT was suggested by the original ultrasound examiner in 372/454 (81.9%) cases. On retrospective review of ultrasound images of 334 MCTs that had quality sufficient for assessment, 'dots and/or lines' and/or 'echogenic white ball' (typical features according to the literature) were present in 271/334 (81.1%) masses. We identified four new ultrasound features characteristic of MCT: 'cotton wool tufts', 'mushroom cap sign', 'completely hyperechogenic lesion' and 'starry sky sign'. At least one classical or novel ultrasound feature was present in 315/334 (94.3%) MCTs. Twenty-nine (8.7%) MCTs manifested vascularized solid tissue, of which seven exhibited no typical features. We provide a comprehensive overview of conventional and newly described ultrasound features of MCTs. Only a small proportion of MCTs did not manifest any of the typical features. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Clinical Utility of the Contrast-Enhanced Endoscopic Ultrasound Guided Fine Needle Aspiration in the Diagnosis of Pancreatic Cyst.

Endoscopic ultrasound fine needle aspiration (EUS-FNA) cytology from an intracystic fluid is useful in the differentiation of pancreatic cysts, with low sensitivity, which increases when the solid component is targeted. The clinical utility of contrast-enhanced guided EUS-FNA (CH-EUS-FNA) in the solid component is not known. We aimed to assess the diagnostic value of CH-EUS-FNA in enhanced mural nodules and discrimination between different cysts using contrast-enhanced endoscopic ultrasound (CH-EUS). The prospective study recruited patients with pancreatic cysts with an unclear diagnosis. The CH-EUS was followed by CH-EUS-FNA. The final diagnosis was based on surgery or the correlation between clinical history, cross-sectional imaging, echoendoscopic morphology, cystic fluid analysis, and follow-up. Fifty-eight patients with pancreatic cysts were evaluated. The mucinous cysts had wall arterial enhancement more often than non- mucinous cysts (p < 0.0001), with 90.2% sensitivity and 70.6% specificity. The CH-EUS-FNA from cystic fluid and mural nodules identified mucinous cysts and malignancy with 82.4% and 84.2% sensitivity and 92% and 100% specificity. Twenty-one cysts had solid components, but only 13 were enhanced mural nodules on EUS assessment with conclusive cytology in all cases and malignancy in 76.9%. Contrast-enhanced endoscopic ultrasound should be completed in all PCN with solid components in order to avoid unnecessary EUS-FNA and to guide FNA for the identification of malignant cysts.

Evaluation of the Ability of Antigen B Originated from Echinococcus granulosus Sensu Stricto and E. canadensis for the Diagnosis of Confirmed Human Cystic Echinococcosis Using ELISA.

Cystic echinococcosis (CE) is an important zoonotic parasitic disease worldwide. Application of species-specific antigen for serodiagnosis of human CE has not been utilized, so far. In this regard, AgB originated from Echinococcus granulosus sensu stricto (G1-G3) and E. canadensis (G6/G7) CE cysts, confirmed by molecular biology and sequencing was used for evaluation of their ability in the diagnosis of confirmed human CE. The hydatid cyst fluid (HCF) of E. granulosus sensu stricto and E. canadensis species were separately, used for preparation of AgB during 2017-2018 in Shiraz and Tehran, Iran. A total of 45 sera samples from confirmed CE patients, 102 sera from healthy people as negative control and 44 sera from other parasitic diseases, were used for measurement of the diagnostic ability of antigen B originated from E. granulosus sensu stricto and E. canadensis species of CE, alone or in 50%:50% mixture using ELISA method. Overall, 38 (84.4%) out of 45 confirmed human CE were positive by ELISA using AgB originated from E. granulosus sensu stricto. This items for AgB originated from E. canadensis was 39 (86.6) out of 45 serum samples. A total of 39 out of 45 samples (86.6%) showed positivity by a mixture of antigen B originating from both species. The specificity of the above tests was calculated as 93.15%, 96.58%, and 93.84%, respectively. Due to the diversity of the cyst species in human population, application of AgB from prevalent species alone or in combination with other species is suggested.

Pancreatic Cystic Neoplasms.

Early detection of high-risk pancreatic cystic lesions enables potentially curative surgical resection, and early detection of lesions without worrisome features may lead to appropriate surveillance. Regrettably, differentiating premalignant and malignant cysts from nonmalignant ones remains challenging. However, emerging additional diagnostic tools, including the needle biopsy with microforceps and needle-based confocal laser endomicroscopy, are of exciting potential along with cyst fluid analysis".

Effect of Intracapsular Pressure on Decompression Effectiveness

The objective of this research was to analyse the correlation between intracapsular pressure and shrinkage rate of cystic lesion volume at different time points after decompression and to evaluate the relationship between the concentration of interleukin-1α (IL-1α) in cystic fluid and intracapsular pressure. Fifty patients with jaw cystic lesions who underwent decompression were included. We measured the intracapsular pressure and IL-1α concentration in the cyst fluid. Moreover, we calculated the rate of shrinkage (RS) of cystic cavity volume at different time points. In addition, data on age, sex, preoperative cystic cavity volume, and lesion location were collected. Linear correlation analysis and variance analysis were used for statistical analysis. Fastest volume decline was observed between 0 and 3 months after surgery; the average RS0-3 was 45.71%. RS3-6 presented the second-fastest volume decline, with an average of 17.46%, and RS6-12 presented the slowest volume decline, with an average of 3.933%. A statistically significant difference in RS was observed amongst the 3 time points (P < .0001). RS0-3 was negatively correlated with intracapsular pressure (r=-0.6326, n=50, P < .0001). A negative correlation between the preoperative cystic cavity volume and intracapsular pressure (r=-0.6384, n=50, P < .001) was also observed. A significant positive correlation was observed between preoperative cystic cavity volume and RS0-3 (r=0.611, n=50, P < .0001). Moreover, a significant positive correlation was observed between the intracapsular pressure and IL-1α concentration in the cystic fluid (r=0.03477, n=50, P < .0001). Intracapsular pressure and the preoperative volume were the factors that affected the RS during the first 3 months after surgery. Therefore, the effectiveness of decompression can be evaluated by the intracapsular pressure and preoperative volume.

Gastric aspiration in sudden unexpected infant death of Prader–Willi syndrome: immunohistochemical detection of feeding components

Prader–Willi syndrome (PWS) in infants is characterized by hypotonia and poor sucking with feeding difficulties. Two autopsy cases of sudden unexpected death during sleep after tube feeding are described herein. For one, gastric aspiration caused by the possible milk regurgitation was suspected. Immunohistochemical examination of lung sections was performed using three antibodies to human α-lactalbumin, human gross cystic disease fluid protein 15, and cow whey β-lactoglobulin. Five cases of sudden unexpected infant death occurring earlier than at 6 months old were selected as controls. Marked immune-staining for infant formula in one PWS subject was evident within terminal bronchioles and alveoli with granular and amorphous features. However, no positive staining was apparent in the other subject, who exhibited contrasting features in milk distribution. Among control cases, one showed mild staining in the bronchiole, but the others did not. The antibody to β-lactoglobulin reacted specifically with formula, with no nonspecific background. Gastric contents in the airway can be a difficult issue because of the consequent terminal gasping. However, because of an episode of antemortem symptoms of potential regurgitation, and from findings at autopsy such as petechiae, we inferred that fatal regurgitation occurred in this PWS infant after tube feeding. Several clinical reports have described milk aspiration, but this pathological report is the first related to aspiration in PWS during tube feeding.

Comparative proteomics of adult Paragonimus kellicotti excretion/secretion products released in vitro or present in the lung cyst nodule.

Paragonimus kellicotti is a zoonotic lung fluke infection, the agent of North American paragonimiasis, and an excellent model for other Paragonimus infections. The excretory/secretory proteins (ESP) released by parasites and presented at the parasite-host interface are frequently proposed to be useful targets for drugs and/or vaccines In vitro culture conditions may alter ESP compared to those produced in vivo. In order to investigate ESPs produced in vivo we took advantage of the fact that adult P. kellicotti reproduce in the lungs of experimentally infected gerbils in tissue cysts. We performed a mass-spectrometric analysis of adult P. kellicotti soluble somatic protein (SSPs) extracts, excreted/secreted proteins (ESPs) produced by adult worms during in vitro culture, and lung cyst fluid proteins (CFPs) from experimentally infected gerbils. We identified 2,137 P. kellicotti proteins that were present in at least two of three biological replicates and supported by at least two peptides. Among those were 1,914 proteins found in SSP, 947 in ESP and 37 in CFP. In silico analysis predicted that only 141 of the total 2,137 proteins were secreted via classical or non-classical pathways. The most abundant functional categories in SSP were storage and oxidative metabolism. The most abundant categories in ESP were proteins related to metabolism and signal transduction. The 37 parasite-related proteins in CFP belonged to 11 functional categories. The largest groups were proteins with unknown function, cytoskeletal proteins and proteasome machinery. 29 of these 37 proteins were shared among all three sample types. To our knowledge, this is the first study that compares in vitro and in vivo ESP for any Paragonimus species. This study has provided new insights into ESPs of food-borne trematodes that are produced and released in vivo. Proteins released at the host-parasite interface may help the parasite evade host immunity and may represent new targets for novel treatments or diagnostic tests for paragonimiasis.

Endoscopic Ultrasound Through-The-Needle Biopsy of Pancreatic Cysts: Toward Procedure Standardization

Background and Aims: EUS-guided through-the-needle microforceps biopsy (EUS-TTNB) was introduced as a new diagnostic tool to establish pancreatic cyst histotype and help to better risk stratify the patients. The aim of this study was to describe the technical success, diagnostic yield, and adverse events of through-the-needle biopsy and discuss the technique variations, focusing on future procedure standardization. Methods: We performed a prospective single-center study including patients with presumed mucinous cysts harboring worrisome features or indeterminate cyst type on imaging, submitted to EUS-TTNB using Moray® microforceps between March 2018 and September 2021. Specimens were processed as a cell-block. Results: We included 40 patients. Technical success was 97.5%. The diagnostic yield was 72.5% for TTNB whereas for cyst fluid cytology/analysis it was 27.5%. Moreover, without TTNB 5 mucinous lesions would not have been diagnosed. TTNB had a sensitivity of 76% and a specificity of 91%, while FNA cytology had a sensitivity and specificity of 35% and 91%, respectively. Moreover for IPMN lesions, subtyping was possible in 63% of cases. TTNB resulted in change in clinical management in 20% of patients. We registered three adverse events: 2 self-limited intracystic bleeding and 1 patient with abdominal pain not associated with pancreatitis. Conclusion: TTNB proved superior to cyst fluid analysis and cytology for the definition of cyst histotype and mucinous cyst diagnosis with acceptable risk profile. Further studies should explore the best steps for procedure standardization.

Targeted next-generation sequencing of EUS-guided through-the-needle-biopsy sampling from pancreatic cystic lesions

Recent advances have introduced molecular subtyping of pancreatic cystic lesions (PCLs) as a possible amendment to the diagnostic algorithm. The study evaluated the feasibility and diagnostic accuracy of molecular analysis and subtyping of PCLs using the recently introduced EUS-guided through-the-needle-biopsy (TTNB) sampling. We prospectively included 101 patients in the study who presented with PCLs >15mm in the largest cross-section. EUS-guided TTNB samples were obtained by a micro-biopsy forceps introduced through a 19-gauge needle. The TTNB samples were analyzed by next-generation sequencing (NGS) for point mutations in tumor suppressors and oncogenes using a 51-gene customized hotspot panel. Sensitivity and specificity were calculated with the histologic diagnosis as reference. After initial microscopic evaluation of the samples, 91 patients had residual TTNB samples available for NGS. Of these, 49 harbored mutations, most frequently in KRAS and GNAS, reflecting an excess frequency of intraductal papillary mucinous neoplasms (IPMNs) in the study population. A sensitivity and specificity of 83.7% (95% confidence interval [CI], 70.3-92.7) and 81.8% (95% CI, 48.2-97.7), respectively, were demonstrated for the diagnosis of a mucinous cyst and 87.2% (95% CI, 74.2-95.2) and 84.6% (95% CI, 54.5-98.1) for the diagnosis of an IPMN. Thus, molecular analysis of TTNB samples by NGS has high sensitivity and specificity for diagnosing mucinous cysts and IPMNs. Although the procedure comes with a risk of adverse events of 9.9%, TTNB samples are a robust alternative to cyst fluid for a combined histologic and molecular diagnosis of PCLs. (Clinical trial registration number: NCT03578445.).

Evaluation of some biochemical parameters in fluid cysts and serum in different types of ovarian cysts

Despite their high prevalence in women of different age, the aetiopathogenesis of ovarian cysts (O.C.) unknown. This study is aimed to evaluate the total protein bound hexose (TPHex), total protein (TP), total carbohydrate (TCHO), lactate dehydrogenase (LDH) and iron (Fe+2) in fluid of function, benign, and malignant ovarian cyst. Also demonstrate the change in serum PHex and LDH (of patients with ovarian cyst) and their roles in diagnosis of patients with malignant ovarian cyst. A cross sectional study included sixty- seven women with ovarian cyst (ten of them with functional cyst, thirty two with benign neoplastic cyst and twenty five of them with malignant ovarian cyst). Twenty-six healthy women as a control group also participated in the current study. The age of subjects ranged from (twelve to sixty-seven) years. Different biochemical parameters were carried out in ovarian cyst fluid (O.C.F.) and in serum include (TPHex), total protein (TP), total carbohydrate (TCHO), lactate dehydrogenase (LDH) and iron (Fe+2). In the present study, a comparative study of biochemical parameters revealed that a significant increase in fluid (TPHex), total protein (TP), total carbohydrate (TCHO), lactate dehydrogenase (LDH) and iron (Fe+2) levels in malignant and benign ovarian cyst when compared with functional ovarian cyst, also there is a significant increase in malignant (O.C.F.) compared with benign (O.C.F.). In the serum, our study shows a highly significant elevation in PHex and LDL enzyme in patients with malignant and benign ovarian cysts compared with serum PHex and LDL of normal healthy control, while there is insignificant difference in serum PHex level in patients with malignant ovarian cyst compared with that of patients with benign ovarian cyst. There is no correlation between level of PHex in serum and fluid, while There is a direct correlation between LDH level in serum and fluid cyst. In conclusion, both fluid and serum LDH level can considered as a tumour marker for malignant ovarian cyst also there is a direct correlation between serum and fluid. Fluid TCHO level have a useful role in diagnosis of benign and malignant ovarian cyst. Iron is useful in differentiating endometrioid cyst from other types of cysts, but it is not useful in differentiating benign from malignant ovarian cyst.

The Diagnosis of Sheep Cystic Echinococcosis by Native Antigen B - Elisa Method

Cystic echinococcosis (CE) is one of the most prevalent zoonotic diseases in some countries in the world. Cystic echinococcosis is considered a neglected disease. This disease increases economic damage via medical costs and loss of human and livestock productivity. The aim of the current study gains a better understanding of the prevalence of CE in sheep. Totally 250 sheep sera were collected. 25 serum samples from newborn lambs were used as negative, and 25 others were obtained from slaughterhouses as positive to infection with CE and 200 unknown sera. Antigen B Isolated from hydatid cysts fluid was used for designing ELISA methods. The first Method used anti-Sheep conjugate (SIGMA, at 1:3000 dilution). According to the results, the seroprevalence of CE in East Azerbaijan of Iran was 5.5% and sensitivity and specificity for the diagnosis of hydatidosis in sheep by AgB-ELISA methods was 92%. Using Antigen B in ELISA design for hydatidosis diagnosis has attracted researchers in recent years. During this study, an Iranian native B antigen was used to design the specific detection of hydatidosis in sheep using a specific ELISA technique. The results have shown that using Antigen B in ELISA design is so valuable.

Fluorescein-guided surgery for the resection of pilocytic astrocytomas: A multicentric retrospective study.

ObjectivePilocytic astrocytomas (PAs) are relatively benign tumors, usually enhancing on post-contrast MRI and often characterized by a mural nodule within a cystic component. Surgical resection represents the mainstay of treatment, and extent of resection (EOR) is associated with improved survival. In this study, we analyzed the effect of sodium fluorescein (SF) on the visualization and resection of these circumscribed astrocytic gliomas.MethodsSurgical databases at two neurosurgical departments (Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy and Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany) were retrospectively reviewed to identify the cohort of patients with pilocytic astrocytoma who had undergone fluorescein-guided tumor resection at any of the centers between March 2016 and February 2022. SF was intravenously injected (5 mg/kg) immediately after the induction of general anesthesia. Tumors were removed using a microsurgical technique with the YELLOW 560 filter (Carl Zeiss Meditec, Oberkochen, Germany).ResultsForty-four patients (25 males and 19 females; 26 pediatric patients, mean age of 9.77 years, range 2 to 17 years; and 18 adult patients, mean age of 34.39 years, range 18 to 58 years) underwent fluorescein-guided surgery. No side effects related to SF occurred. In all tumors, contrast enhancement on preoperative MRI was correlated with intense, heterogeneous yellow fluorescence with bright fluorescent cystic fluid. Fluorescein was considered helpful in distinguishing tumors from viable tissue in all cases except three patients due to faint fluorescein enhancement. Biopsy was intended in two operations, and partial resection was intended in three operations. Gross total resection was achieved in 24 cases out of 39 patients scheduled for tumor removal (61.54%), in five cases a minimal residual volume was highlighted by postoperative MRI despite the intraoperative subjective evaluation of complete tumor removal (12.82%); in the other 10 cases, the resection was subtotal with fluorescent residual spots to avoid neurological worsening (25.64%).ConclusionsThe use of SF is a valuable method for safe fluorescence-guided tumor resection. Our data showed a positive effect of fluorescein-guided surgery on intraoperative visualization during resection of Pas, suggesting a possible role in improving the extent of resection of these lesions.

Non-cystic macular thickening on optical coherence tomography as an alternative to fluorescein angiography for predicting retinal vascular leakage in early stages of uveitis

To evaluate the relationship between non-cystic thickening of the macula on optical coherence tomography (OCT) and retinal vascular leakage on fluorescein angiogram (FA) in patients with uveitis. A cross-sectional study of patients seen in the uveitis clinic. Patients with any degree of inflammatory cells in the anterior vitreous were included, provided that no macular cyst or subretinal fluid or macular atrophy was observed in OCT. The correlation between OCT features and best corrected visual acuity (BCVA), the degree of inflammation, and FA findings were examined. The severity of vascular leakage in FA was graded for optic nerve, macula and posterior and peripheral leakage. We used generalized estimation equation to assess the associations between macular thickness and volume with angiographic scores. A total of 43 patients (100 exam data) met inclusion criteria. There was a significant relationship between OCT parameters (central macular thickness, 3 mm and 6 mm perifoveal macular thickness as well as total and central macular volume) with angiographic scores (macular, optic disc, posterior and peripheral vascular leakage score) (all P values < 0.0001). The correlation between the 6 mm perifoveal thickness and peripheral vascular leakage score (R = 0.76; P < 0.001) was stronger than the correlation of CMT with this angiographic score (R = 0.69; P < 0.001). Non-cystic thickening of the macula on OCT, especially in perifoveal area, is a reliable predictor of the presence of retinal vascular leakage in patients with uveitis.