**Meet the editor**

Narottam Das received BSc and MSc degree in electrical and electronic engineering from Chittagong University of Engineering & Technology, and Bangladesh University of Engineering & Technology, Bangladesh, respectively. He received PhD degree in systems and information engineering from Yamagata University, Japan in 2000. Currently he is an academic staff at the Department of

Electrical and Computer Engineering, Curtin University, Perth, Australia. He is also an Adjunct Senior Lecturer at the School of Engineering, Edith Cowan University, Australia. Earlier, he worked at Edith Cowan University and Monash University, Australia; NEC Yamagata Ltd., Japan and Bangladesh Export Import Company, Dhaka. He is the author/co-author of books, book chapters, over 70 referred international journal papers and conference proceedings, and over 20 industrial technical reports at NEC Japan. Dr. Das is a senior member of the IEEE, member of the Institute of Engineers, Australia, and member of the Institute of Engineers, Bangladesh.


**2. Allergenic proteins**

etc. It is the most severe reaction, especially to food containing proteins, and (ii) the non-IgE-mediated allergy such as that of gluten or celiac disease, where the allergic symptom is triggered by ingestion of gluten from cereals namely wheat, rye and barley in their diets. In recent years, food allergies have caused a major health alarm affecting nearly 1% of adult population in the world and from 6 to 8% of children [2–4]. Thus, the prevalence of food allergies has increased in several regions all over the world. Further, more than 170 types of foods have been identified as potentially allergenic [5]. The animal-derived sources include eggs, milk, fish and crustacean shellfish; whereas the vegetable-derived sources include wheat, soy and nuts. The former group of proteins are responsible for causing more than 90% of allergic reactions [5, 6]. Most food allergens are stable molecules that resist the effect of food processing, cooking and the digestive process. These glycoproteins are characterized by their ability to induce a pathogenic IgE response in susceptible individuals [7]. Usually, food allergens are formed by divalent or multivalent molecules with two or more antibodies–binding sites calls epitopes, which are responsible for interacting with immune effector molecules such as the IgE antibodies [2–4]. Moreover, many food proteins especially those derived from ani-

Currently, there is a worldwide search for new materials of natural origin that confers the physical, chemical and sensory characteristics to food products similar to those of synthetic additives applied on a daily basis. These synthetic compounds have been considered as potentially toxic in hypersensitive people, leading to health problems, causing allergies,

Proteins are macromolecules considered as emergents, these are versatile compounds having a good biocompatibility, biodegradability, high nutritional value, amphiphilic properties, and exhibit a strong interaction with several types of active compounds via hydrogen bonds, and electrostatic interactions [12]. Further, proteins are also able to function as emulsifiers, foaming and gelling agents [13–16]. Their chemical and structural versatility makes them suitable candidates for the delivery of bioactive hydrophobic and hydrophilic ingredients from a wide

One of the emerging and promising uses of proteins is in the microencapsulation tecnology of different compounds in the pharmaceutical, food and cosmetic fields. This technology is defined as a mechanical, chemical or physico-chemical process that isolates and protects the potentially sensitive active ingredients (i.e., liquid, solid or gas) from the damaging environment. In most cases, spherically-shaped products are obtained and the resulting particles could be classified according to their size as capsules (1–1000 μm), microcapsules (100–1000 nm) or nanocapsules (1–100 nm). In this process, the active ingredient is protected from the environment by a membrane, which in turn is named as the wall or coating material. This membrane controls the release and stability of the core material [17]. Nonetheless, to date, only a few proteins have been considered to be effective coating materials for the encapsulation of several core compounds such as vitamins, minerals, microorganisms, oils, phenolic compounds, among others. These proteins are mainly obtained from animal sources rather than plant sources. Proteins derived from milk, wheat, soy and cereals are the most widely studied for this aplication, but are considered as allergenic. For this reason, research has focused on the search for new sources of nonallergenic proteins that allows for the modification of their

range of platforms such as particles, fibers, films and hydrogels [16].

mal sources could act as antigens in humans.

hyperactivity, and cancer [8–11].

44 Allergen

Proteins are macromolecules derived from plants or animals that range in size from several thousand to several million Daltons [18, 19]. In general, proteins are composed of amino acids linked through peptide bonds resulting in chain lengths ranging from ~50 to >100,000 amino acids [19]. This sequence creates a characteristic three-dimensional organization (or folding) which in turn, can be organized into four structural levels.

The primary structure of proteins is formed by the linear sequence of bound amino acids. The secondary structure is due to the formation of hydrogen bonds between the carbonyl (-CO-) and amino (-NH) groups forming a folded structure. The latter describes the path that the polypeptide backbone of the protein follows in the three dimentions. The alpha and beta helices are the most important conformations of the secondary structure. Further, the tertiary structure describes the three-dimensional organization of all atoms in the polypeptide chain, including the side groups, as well as the polypeptide backbone. The quaternary structure of the protein is formed by the association between two or more proteins that exhibit a tertiary structure, resulting in a typical functionality [19, 20].

Amino acids are amphoteric in nature and thus, react with acids or bases due to the presence of alkaline (NH2 ) and acidic (COOH) groups. Currently, there are twenty common amino acids having side chains of different size, shape, charge and chemical reactivity [19, 20]. The degree of hydrophobicity and hydrophilicity of amino acids is one of the main determinants of the three-dimensional structure of proteins. Amino acids such as glycine, alanine, valine, leucine, isoleucine, methionine and proline have non-polar aliphatic side chains; whereas phenylalanine and tryptophan have non-polar aromatic side groups. These hydrophobic amino acids are generally found within proteins, forming the so called hydrophobic core [19]. Other amino acids have ionizable side chains such as arginine, aspartic acid, glutamic acid, cysteine, histidine, lysine, and tyrosine; whereas asparagine, glutamine, serine, and threonine contain non-ionic polar groups, which are often found on the surface of the protein allowing for a strong interaction with the aqueous ambient [19].

Proteins are mainly obtained from: (i) oilseeds and protein crops such as soybeans, rapeseed, peas, lentils, broad beans and sunflowers; (ii) cereal sources such as wheat, oats, rye, barley, maize, rice, sorghum, millet and quinoa; and (iii) algae [21]. Vegetable proteins also possess several advantages such as a good biodegradability and biocompatibility, have a low cost and a high availability, and pose no health risks [22, 23].

Proteins can be classified according to their sedimentation coefficient (S), which is defined as the rate of sedimentation per unit of acceleration of the particle in a medium. This property varies according to the molecular weight, conformational space and behavior of the protein in the environment. However, there are four large families of plant proteins that are classified according to their solubility into globulins, albumins, prolamins and glutelins. Albumin and globulins are the main constituents of plant-derived proteins [19].

Albumins are highly soluble in water and have a molecular weight ranging from 10 to 100 kDa. This group includes mostly proteins that present structural and storage functions [24]. In general, albumins contain high levels of lysine and sulfur amino acids, such as methionine and cysteine, and a high amount of disulfide bridges that favor the resistance against thermal denaturation [19, 20].

On the other hand, globulins are the main proteins obtained from vegetable sources. They are soluble in aqueous saline solutions and are mainly composed of two fractions having a sedimentation coefficient of 7S and 11S, respectively, which in turn depend on the plant source and culture conditions. Globulins are an important part of storage proteins, and have a molecular weight of more than 100 kDa. They are rich in arginine, aspartic acid, glutamic acid and their amides [19, 20].

Glutelins and prolamins are proteins soluble in basic aqueous solutions and hydroalcoholic mixtures, respectively. Their structure has been poorly studied, but these fractions represent agglomerates of globulins bound together by disulfide bonds and hydrophobic interactions, resulting in a complex morphology [21].

Currently, there are 16,712 recognized protein families in the Pfam database, but only 255 (~1.13%) of them are considered as allergens. Further, only 0.16% of the top 20 families account for ~80% of all reported cases of food allergenicity (**Table 1**) [25].

Further, it has been observed that the structural properties of proteins significantly affect their functionality, including the allergenic potential [25]. A survey conducted on common protein allergens reveals that they possess a wide range of physical characteristics, and none of them is unique to a class of protein allergens. Nevertheless, one report suggested that allergens tend to be ovoid in shape, although it is unclear why this should contribute

**Table 1.** Classification of allergenic proteins according to their family and source.

to allergenicity [26]. Further, the fact of having repetitive motifs also contribute to allergenicity [26]. Many of the important allergens are exceptionally heat stable and retain their allergenicity after heating [26]. However, there are proteins not considered as allergens that possess any of the properties described previously [26].

Particular claims have been made regarding the contribution of intramolecular disulfide bonds to the allergenicity of proteins. Thus, proteins from house dust mites could induce allergenicity if disulfide bonding through site-directed mutagenesis occurs. Otherwise, allergenicity prevents making proteins unable to bind IgE. Further, the loss of disulfide bonds may cause allergens to lose their immunologic identities (i.e., the ability to bind pre-existing specific IgE antibody) and hence, the ability to initiate the novo IgE production [26]. Further, the induction of IgE antibody by wheat agglutinin could be lessened by reducing disulfide bonds with thioredoxin [26]. However, the ability of disulfide bonds to have a qualitative contribution to the allergenicity of wheat agglutinin is still unknown. A quantitative reduction of the antigenicity of a protein could result in a reduction of the allergic response to a protein without altering its intrinsic allergenicity, only if the vigor of the immune response is reduced. In order to determine whether the intrinsic allergenicity of a protein has been altered, it is necessary to assess independently its allergenicity and its antigenicity. This may be achieved experimentally by simultaneously measuring both the IgE (allergenic) and IgG (antigenic) response upon exposure. Further, it seems likely that disulfide bonds influence allergenicity, in unpredictable ways. Their presence can profoundly affect the processing and stability of antigens, and hence the release or destruction of T-cell epitopes [26]. The presence of multiple intramolecular disulfide bonds *per se* does not make a protein as an allergen, nor does their absence preclude allergenicity. For instance, ovalbumin is considered as an allergen despite of having only a single intramolecular disulfide bond that contributes little to its stability, whereas bovine serum albumin (BSA) having 17 intramolecular disulfide bonds is much less allergenic [26].

### **2.1. Allergenic animal proteins**

classified according to their solubility into globulins, albumins, prolamins and glutelins.

Albumins are highly soluble in water and have a molecular weight ranging from 10 to 100 kDa. This group includes mostly proteins that present structural and storage functions [24]. In general, albumins contain high levels of lysine and sulfur amino acids, such as methionine and cysteine, and a high amount of disulfide bridges that favor the resistance against thermal

On the other hand, globulins are the main proteins obtained from vegetable sources. They are soluble in aqueous saline solutions and are mainly composed of two fractions having a sedimentation coefficient of 7S and 11S, respectively, which in turn depend on the plant source and culture conditions. Globulins are an important part of storage proteins, and have a molecular weight of more than 100 kDa. They are rich in arginine, aspartic acid, glutamic

Glutelins and prolamins are proteins soluble in basic aqueous solutions and hydroalcoholic mixtures, respectively. Their structure has been poorly studied, but these fractions represent agglomerates of globulins bound together by disulfide bonds and hydrophobic interactions,

Currently, there are 16,712 recognized protein families in the Pfam database, but only 255 (~1.13%) of them are considered as allergens. Further, only 0.16% of the top 20 families

Further, it has been observed that the structural properties of proteins significantly affect their functionality, including the allergenic potential [25]. A survey conducted on common protein allergens reveals that they possess a wide range of physical characteristics, and none of them is unique to a class of protein allergens. Nevertheless, one report suggested that allergens tend to be ovoid in shape, although it is unclear why this should contribute

Tropomyosin Animal Lipocalin Animal: arthropod and mammalian

Alpha/beta-caseins Mammal Trypsin-like serine proteases Animal: arthropod and mammalian

account for ~80% of all reported cases of food allergenicity (**Table 1**) [25].

**Family Source Family Source** Prolamin superfamily Plant Oleosins Plant

Cupin superfamily Plant Beta-1,3-glucanase Plant Profilin Plant Papain-like cysteine protease Plant EF-hand domain Plant, animal Thaumatin-like protein Plant

**Table 1.** Classification of allergenic proteins according to their family and source.

PR-10 Plant Expansin, C-term Plant: all grasses

Hevein-like domain Plant Enolase Fungi and plants

Class I chitinases Plant Expansin, N-term Plant: all grasses except 1

Albumin and globulins are the main constituents of plant-derived proteins [19].

denaturation [19, 20].

46 Allergen

acid and their amides [19, 20].

resulting in a complex morphology [21].

Animal food allergens are classified into three general families such as tropomyosins, EF-hand proteins, and caseins [27]. However, regardless of their family the ability to act as an allergen appears to be related to relative identity with human homologues. Thus, if the protein has a sequence identity from 54 to 63% with respect to human homologues, then it is considered as allergenic. Nevertheless, a higher identity does not implies allergenicity [27, 28].

The family of tropomyosins is divided into four types of muscle proteins, where none of them causes an IgE response in humans [25]. In fact, no human IgE response to tropomyosin from birds or fish has been identified. This is expected since these sequences have an identity with human tropomyosins greater than 63%, which is translated in the absence of allergenic activity [27].

EF proteins form the second family of animal-derived food allergens, and they are composed of parvalbumin [27]. Parvalbumins are divided into α- and β-parvalbumin. Theα-parvalbumin is considered to be non-allergenic, whereas β-parvalbumin is found in a variety of fish species, retaining the allergenic potential and is absent in human muscle [28].

Out of the caseins that have been shown to elicit an IgE response in humans, the rule of thumb is the closer the sequence to the human equivalent is, the less likely an IgE response will occur. Conversely, sensitization to BSA is the main predictive marker for the cross-reactivity to cow's milk that is present in 73–93% of patients with beef allergies, despite of the fact that BSA shares 76% identity to its human homolog [27, 29].

Cow's milk and egg allergies are some of the most common food allergies found in young children. It is estimated that ~3.8 and 2% of children younger than 5 years old have cow's milk and egg allergies, respectively. These allergens are commonly found in a variety of foods due to their technological and nutritional importance [6]. Thus, lactoglobulin is the major allergen in cow´s milk. Milk contains more than 20 protein fractions. In the curd, four caseins account for ~80% of milk proteins. The remaining 20% of the proteins, are globular proteins (e.g., lactalbumin, lactoglobulin, and bovine serum albumin), and are found in whey and egg proteins from both components (i.e., yolk and egg white) causing sensitization [30].

Parvalbumin represents the major clinical cross-reactive fish allergen. It contains heat-resistant linear epitopes that are s sensitizing by the interaction of metal-binding domains. In addition, other fish allergens are found in collagen and gelatin isolated from skin and muscle tissues. On the other hand, in shellfish, crustaceans and mollusks, tropomyosin is the major allergen that triggers allergic reactions [31].

#### **2.2. Allergenic vegetable proteins**

About 65% of plant food allergens belong to the group of prolamins, termites and the group of proteins related to pathogenesis (PR-10) [25]. The prolamin family include storage proteins, lipid transfer (LTPs), alpha-amylase/protein inhibitors and albumins from most cereal seeds. Their 3D structure consists of a compact structure with four alpha-helices stabilized by disulfide bridges and a central cavity used for lipid binding. However, similarity in their third-party structures does not indicate a similarity in their amino acid sequence between proteins in the same group. Further, prolamins from wheat are known to cause baker's asthma and celiac disease in humans. Alpha-amylase/trypsin inhibitors from various cereals, such as wheat, barley and rice, have also been involved in allergies. Some of the clinically reported allergenic plant proteins belongs to the family of prolamins such as Ara h 2, Ara h 6, Sin a 1, Ber e 1, Ses i 2 and Jug v 1. Non-specific LTPs are known to be the main food allergens in the fruits of the *Rosaceae* family. The presence of specific IgE in LTP is considered a significant risk factor for allergy and may serve as a diagnostic marker [25]. The most relevant termite-type allergens are the 7S and 11S globulins. 7S globulins include Arah1, Jugr2 and Sesi3, whereas the 11S globulins include the Arah3, soy glycinins, Bere2, Cora9 and Fage1 [32]. The third structure of the proteins belonging to the termite group consists of a series of antiparallel β leaves associated with an α-helix forming a cavity [32]. This structure is also found in several lipocalin-like proteins involved in the transport of hydrophobic ligands, including milk β-lactoglobulin [32]. Further, plant prophylines share about 70% of the amino acid sequence homology [32–34].

All gliadin and glutenin protein fractions have been described as wheat grain allergens. The main properties of these proteins is to form a continuous viscoelastic network when flour is mixed with water to form a dough to be used in products such as bread, pastries, pasta, and crackers. However, wheat gluten exhibits a low solubility in aqueous solution. This fact limits the applications of wheat gluten in various types of food, since a good solubility is the main requirement for use in liquid foods and beverages. Furthermore, solubility is closely related to other functional properties of proteins such as the foaming, emulsifying, and gelling ability [35]. In soybean there are eight registered proteins which could trigger an allergic response. However, two of them named as β-conglycinin and glycinin represent ~70% of the soybean proteins. As a result, the incidence of soy protein allergy is much lower than other food allergens, such as milk or peanut proteins [36].

There are over 10 allergenic proteins identified in peanuts of which the Ara h 1, Ara h 2, and Ara h 3 are the most abundant peanut allergens and cumulatively represent approximately half of the total protein content [37]. Furthermore, the prevalence of allergy to tree nuts is estimated to be about half of that of peanut allergy. Tree nut allergic reactions tend to be severe and accidental exposures are common. Walnut, cashew, almond, pecan, Brazil nut, hazelnut, macadamia nut, pistachio, and pine nut are the most common tree nuts responsible for allergy cases in the USA and Europe. Moreover, from 20 to 50% of peanut allergic patients are also allergic to tree nuts [38].


**Microbiological Chitosan: Potential Application as Anticariogenic Agent**

Thayza Christina Montenegro Stamford, Thatiana Montenegro Stamford-Arnaud, Horacinna Maria de Medeiros Cavalcante, Rui Oliveira Macedo and Galba Maria de Campos-Takaki

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/54453


**Chapter 3**

*Natural Hazards - Impacts, Adjustments and Resilience*

Available at: http://reliefweb.int/ report/mozambique/cws-situationreport-2008 Mozambique-floods.

[41] Levy, J. K., Gopalakrishnan, C., & Lin, Z. (2005). Advances in decision support systems for flood disaster management: Challenges and opportunities. Water Resources Development, 21(4), 593-612.

[42] National Oceanic and Atmospheric Administration, (2020). What is remote sensing? National Ocean Service, U.S Department of Commerce. Retrieved from https://oceanservice.noaa.gov/ facts/remotesensing.html Retrieved on

[43] ESRI, (2020). What is GIS? Retrieved from https://www.esri.com/ en-us/what-is-gis/overview. Retrieved

[44] Faisal, A., & Khan, H. (2018). Application of GIS and Remote Sensing In Disaster Management: A Critical Review of Flood Management. In *International Conference on Disaster Risk*

[45] Patel, K. K., & Patel, S. M. (2016). Internet of things-IOT: definition, characteristics, architecture, enabling technologies, application & future challenges. International journal of engineering science and computing,

[46] Youssra, R., & Sara, R. (2018). Big data and big data analytics: Concepts, types and technologies. Int J Res Eng,

[47] Zakaria, M. M. K. N. H., & Rashid, A. (2017). Big Data Value Dimensions in Food Disaster Domain. Innovation,

20th July, 2020.

on 20th July, 2020.

*Mitigation*.

6(5).

5(9), 524-528.

11(1), 25-29.

[33] Terungwa, C. U. and Torkwase, C. I. (2013). Current issues in flood disaster: Challenges and implications for science and technology to enhance environmental education. Academic Journal of Interdisciplinary Studies,

[34] Kolawole, O.M, Olayemi, A.B. and Ajayi, K.T. (2011). Managing flood in Nigerian Cities: Risk analysis and adaptation options – Ilorin City as a case study. Archives of Applied Science

[35] Sakijege, T., Sartohadi, J., Marfai, M.A., Kassenga, G.R. and Kasala, S.E., (2014). Assessment of adaptation strategies to flooding: A comparative study between informal settlements of Keko Machungwa in Dar es Salaam, Tanzania and Sangkrah in Surakarta, Indonesia', Jàmbá. Journal of Disaster

2(6), 61-65.

Research, 3(1), 17-24.

Risk Studies, 6(1), 131-141.

University Press, Tokyo.

*Nations, Geneva*.

WWF/0808/1038.

[36] Lebel, L., Nikitina, E., Kotov, V., Manuta, J., & Birkmann, J. (2006). Assessing institutionalized capacities and practices to reduce the risks of flood disasters (pp. 359-379). United Nations

[37] Miyan, A. (2014). Challenge of Mainstreaming Disaster Risk Reduction in Development Initiatives with Special Reference to Bangladesh. *An input paper of the 2015 Global Assessment Report on Disaster Risk Reduction, UNISDR, United*

[38] Gouldby, B. and Samuels, P. (2005). Language of risk -project definitions. Floodsite report T32-04-01. Available at: http://www.unisdr.org/files/657\_lwr1.

McOuat. E. (2008). The way forward for natural flood management in Scotland, Scottish Environment link: MNV/

[40] FIAC, (2007). Sustainable flood management report, Scotland.

[39] Johnson, R. Watson, M. and

**38**

pdf.


**8. References**

<http://www.infed.org/arhives/e-texts/bohmdialogue.htm>

 http://www.persee.fr/web/revues/home/prescript/article/rei\_0154- 3229\_1997\_num\_79\_1\_1650

Carthy, J.D. (1974). *El Estúdio del Comportamiento,* Omega, ISBN 285-0386-5, Barcelona, Spain

from Conselho Nacional de Desenvolvimento Científico e Tecnológico to M.L.C. (Grant

Almaça, C. (2002). *A Zoologia Pré-Lineana no Brasil,* Museu Bocage, ISBN 972-98196-4-5,

Bohm, D., Factor, D. & Garrett, P. (1991). Dialogue: a proposal. *The informal Education*

Bourdieu, P. (1984). *Homo Academicus,* Les Éditions de Minuit, ISBN 2-7073-0696-7, Paris,

Bourdieu, P. (1997). *Les Usages Sociaux de la Science: por une Sociologie Clinique du Champ*

Bourdieu, P. (2002). *O Poder Simbólico,* Bertrand, ISBN 978-85-286-9963-0, Rio de Janeiro,

Callon, M. & Foray, D. (1er trimestre 1997). Introduction: Nouvelle Économie de la Science

Carthy, J.D. (1974). *El Estúdio del Comportamiento,* Omega, ISBN 285-0386-5, Barcelona, Spain Chiarelli, B. & Birolo, G. (2011). The biological and evolutionist basis of ethics. *Current*

Christoffersen, M.L. (2002). Em Busca de Parcerias Científicas Alternativas para o Brasil. *Conceitos,* Vol.5, No.7, (January-June 2002), pp. 41-46, ISSN 1519-7204 Christoffersen, M.L.; Almeida, W.O. & Lycurgo, T. (2009). Sociology of Science: are

Colbert, E.H. (1984). *The Great Dinosaur Hunters and their Discoveries*. Courier Dover

Deag, J.M. (1980). *Social Behavior of Animals,* E. Arnold, ISBN<PHONE_NUMBER>, London, England Engelhardt Jr., H.T. (1996). *The Foundations of Bioethics*. Oxford University Press, New York,

Engelhardt Jr., H.T. (ed.) (2006). *Global bioethics: the collapse of consensus*. M. & M. Scrivener,

Foucault, M. (1966). *Le Mots et les Choses: une Archéologie des Sciences Humaines*, Gallimard,

Foucault, M. (1971). *L'ordre du discours: leçon inaugurale au Collège de France prononcée le 2*

Foucault, M. (1979). *Microfísica do poder*, Graal, ISBN 978-85-7038-074-6, São Paulo, Brasil

*décembre 1970*, Gallimard, ISBN<PHONE_NUMBER>742, Paris, France

Gadamer, H.G. (1979). *Truth and method*. Sheed and Ward, London, England

Publications, ISBN 0-486-24701-5, Toronto, Canada

ISBN 0-9764041-3-3, Massachusetts, USA

http://www.persee.fr/web/revues/home/prescript/article/rei\_0154-

*Scientifique,* Institute National de la Recherche Agronomique (INRA), ISBN 978-

ou Socio-Économie de la Recherche Scientifique?, In: *Revue d'Économie Industrielle,*

*Opinion in Biotechnology,* Vol. 22, Supplement. 2, (September-October), pp. S30,

Knowledge Production and the Quest for Scientific Status. Two Divergent Courses?. *História, Ciências, Saúde – Manguinhos,* Vol.16, No.2, (April-June 2009), pp.

 <http://www.infed.org/arhives/e-texts/bohmdialogue.htm> Bohm, D. (1996). *On dialogue*. Routledge, ISBN 0-203-18037, London, England

number 300198/2010-8).

France

Brazil

Lisboa, Portugal

*Archives*. Available from:

2738007933, Paris, France

17.06.2011, Available from

3229\_1997\_num\_79\_1\_1650

505-513, ISSN 0104-5970

ISSN 0958-1669

USA

Paris, France

**8. References**

**Part 2**

**Realities**

**Part 2**

194 Sociological Landscape – Theories, Realities and Trends

Silveira, M.J. & Oliveira, E.F. (2008). A Importância das Coleções Osteológicas para o Estudo

Smith, M. K. (2001). Dialogue and conversation. *The Encyclopedia of Informal Education,*

Vandenberghe, F. (2011). The books that Habermas hasn´t Written. *International Sociology*,

Waast, R. & Gaillard, J. (1992). Evaluation d'un Fond de Financement de la Recherche:

Whitehead, P.J.P. (1970). *Los Museos en la Historia de la Zoologia,* Universidad Nacional de Tucuman – Fundacion e Instituto Miguel Lillo, Tucuman, Argentina Zaher, H. & Young, P. (2003). As Coleções Zoológicas Brasileiras: Panoramas e Desafios. *Ciência e Cultura,* Vol.55, No.3, (July-September 2003), pp. 24-26, ISSN 0009-6725

2008), pp. 1-4, ISSN 1980-0002

Sire, M. (1960). *La Vie Sociale des Animaux,* Seuil, Paris, France

Vol. 26, No.5, pp. 597-603, ISSN 1729-8806

(Eds.), ISBN 2-7099-1082-9, Paris, France

Available from: www.infed.org/bibio/b=dialog.htm

da Biodiversidade, *SaBios: Revista, Saúde e Biologia,* Vol.3, No.1, (July-December

Strategies Scientifiques et Processus Productifs, dans les Communautes Scientifiques de la Peripherie*,* In: *Les Indicateurs de Science pour les Pays en Développment: Science indicatours for developing countries.* A. Rigas & J. Gaillard **Realities**

**11**

*USA*

**The American Dream and**

Freddie Choo1 and Kim Tan2

**Corporate Executive Fraud**

*1Department of Accounting, College of Business, San Francisco State University, San Francisco, CA*

*California State University Stanislaus, Turlock, CA*

*2Department of Accounting & Finance, College of Business,*

In this paper, we first describe a "Broken Trust" theory that was introduced by Albrecht el al. (2004) to explain corporate executive fraud. The Broken Trust theory is primarily based on an "Agency" theory from economic literature and a "Stewardship" theory from psychology literature. We next describe an "American Dream" theory from sociology literature to complement Albrecht el al.'s (2004) Broken Trust theory. Like the Broken Trust theory, the American Dream theory relates to a "Fraud Triangle" concept to explain corporate executive fraud in America. We are motivated to explain corporate executive fraud because whenever corporate fraud has been studied, CEOs and CFOs are most involved. For example, the COSO-sponsored study by Beasley et al. (1999) found that CEOs were involved in 72% of the financial statement fraud cases. The next most frequent perpetrators in descending order of frequency were the controller, COO, vice presidents, and members of the board. In addition, we are motivated to provoke thoughts on corporate executive fraud in American society and to stimulate further empirical research on social

We define "corporate executive fraud" as follows. First, a corporate scandal is a scandal involving allegations of unethical behavior on the part of a company. It follows that a corporate accounting scandal is a scandal involving unethical behavior in accounting, that is, accounting fraud. Accounting fraud includes intentional financial misrepresentations (e.g., falsification of accounts) and misappropriations of assets (e.g., theft of inventory) (AICPA 2002). Intentional financial misrepresentations involving the management of a company are referred to as corporate executive fraud, whereas misappropriations of assets involving the employee of a company are referred to as employee fraud. Taken together, corporate executive fraud is intentional financial misrepresentations by trusted executives of public companies, which typically involve creative methods for misusing or misdirecting funds, overstating revenues, understating expenses, overstating the value of corporate

**1. Introduction**

variables of executive fraud.

assets, or underreporting the existence of liabilities.


**5. Conclusion**

*Palliative Care*

ethically unacceptable.

**Protection of personal data**: in the Directive, protection of the personal data of the patients is deemed obligatory. Personal data comprise information about an individual's identity and also include information as to a patient's illnesses. The principle of non-maleficence to the confidentiality of the patients and their relatives entails respect for their private life. Members of the team providing palliative care services can share patients' personal or statistical data with the second or third parties or with the relevant institutions only to an extent that the patients permit. In the contrary cases, it can be stated that the individual's private life is not respected, and this means that respect for autonomy, which is one of the basic ethical principles, is violated. Therefore, such practices are

**Sixth section**

Patient Rights, Termination of Service, Training, Supervision and Responsibility

**Informing the patient and the patient's volunteering**: it can be seen that the Directive respects persons and pays attention to patient autonomy. The patient's volunteering for admission to palliative care is regarded as a value in line with the principle of respect for patient's autonomy. The patient's volunteering is based on the information given to the patient as to the content of palliative care service. Therefore, in the Directive, a special attention was attached to informing the patient. The basic reason for emphasizing its importance is to ensure that the patient rights, which are part of human rights specific to the field of medicine, are reflected on medicine in practice. Otherwise, the patient's volunteering might be at risk, and the patient's autonomy might be damaged. Giving incomplete information to the patient about the end-of-life or his/her chronical diseases, pressuring the patient, and deceiving the patient about the possible benefits of palliative care might impair the patient's volunteering; therefore, such practices are ethically unacceptable. In the delivery of palliative care services, healthcare professionals are expected to ensure that patients receive a care service compatible with human dignity in the challenging conditions they face. Moreover, the patients' giving of consent for the palliative care to be offered to them is based on the information given to them and making sure that it was fully comprehended by them. At this stage, the content of the information to be given to the patients demanding palliative care or their relatives is important. The understanding of what palliative care constitutes the "informing" phase of the process. Also referred to as "getting informed consent," the process is the reflection of the basic ethical principle of respect for autonomy on

**Refusal to healthcare**: in line with the principle of respect for autonomy, healthcare professionals who provide palliative care services should understand it when a patient refuses to receive care service on his/her own consent. Therefore, they should neither force patients or their families to receive palliative care services nor put pressure on patients in order to persuade them. The most ethically appropriate approach would be letting the patients make their own decisions as to the healthcare

services they will receive no matter how big their pain and suffering is.

*Article 16—(1) "Patients accepted to palliative care services shall be informed about patient rights and liabilities and the content of the service. The patient himself or his legal representative has the right to receive all kinds of information about the service to be provided and the risks (if any). And, the patient has the right to refuse the service. Legislation provisions regarding patient rights are reserved."*

**38**

the field of medicine.

As well as the principles that it recognizes, medicine is also renowned for the practices that it deems unacceptable on ethical grounds. Practices such as overlooking the health needs of patients with chronical diseases or terminal patients and disregarding their healthcare needs, for instance, are ethically unacceptable.

The conditions that patients or their relatives face might sometimes hinder them from pursuing a quality life. If they prefer, they can receive palliative care, which can give them a chance to have a fairly quality life. Palliative care is crucial for maintaining the confidence in medicine and cannot be considered separately from the medicine's duty to help.

In Turkey, how and by whom palliative care should be given to a patient approaching to the end of his/her life is determined by the relevant directive. Providing the service in line with the legislation and regarding patient rights, professional ethics, and medical deontology is essential. In palliative care centers, under the coordination of Provincial Directorate of Health, health services are provided in collaboration with local authorities, other health institutions in the region, universities, and with other related institutions. Besides, the centers also take the responsibility to contribute to the training of the society by means of planning trainings that go beyond the institution.

The fact that the Directive involves the doctrine of informed consent, which is the reflection of the principle of respect for autonomy on medical practices, illustrates the importance attached to patient rights in palliative care services. Nevertheless, there are still issues to be dealt with such as identifying the ethical dilemmas, which may emerge due to telling the patients and their relatives the truth, giving them the bad news, and decision-making for the end-of-life decisions, and taking measures in order to solve them. Ethical mistakes that healthcare professional make out of ignorance might be eliminated if their knowledge on the issues not covered in the Directive is reinforced through in-service trainings.

Early identification and assessment of life-limiting diseases match up with the raison d'être of palliative care services. In this context, palliative care aims to support both the patients and their family members who encounter such problems when it comes to life-threatening diseases. In order to identify the ethical problems seen in palliative care services in Turkey, qualitative and quantitative studies are needed to be carried out. As palliative care services become a more common practice in Turkey and more sophisticated solutions are offered as to the ethical problems encountered in practice, the structure of the palliative care service delivery will also go through transformation.


**Renin-Angiotensin System on Reproductive Biology Renin-Angiotensin System on Reproductive Biology**

Anthony C.S. Castilho, Patrícia K. Fontes, Fernanda F. Franchi, Priscila H. Santos and Eduardo M. Razza Fernanda F. Franchi, Priscila H. Santos and Eduardo M. Razza Additional information is available at the end of the chapter

Anthony C.S. Castilho, Patrícia K. Fontes,

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/66997

### **Abstract**

In the female reproductive system, angiotensin II (ANG II) is a potential signaling molecule involved in ovarian follicle development, which acts through two transmembrane receptors. Within the ovarian follicle, there appear to be species differences in the precise pattern of localization of AGTR2 protein and it has an important role in in vitro maturation of oocytes in mammals. The infusion of ANG II induced ovulation in rabbits and the use of ANG II antagonists inhibited ovulation in rabbits, rats, and cattle. In fetal ovaries, AGTR2 protein was detected in ovigerous cords and preantral follicles throughout porcine and bovine gestation. In the oviduct, ANG II is responsible for the orchestration of the transport of gametes. In the male reproductive system, there is considerable evidence for the local synthesis of components of renin-angiotensin system (RAS) in male reproductive tissues. The roles of RAS in local processes at these sites are still uncertain, although there is evidence for involvement in tubular contractility, spermatogenesis, sperm maturation, capacitation, acrosomal exocytosis, and fertilization.

**Keywords:** oviduct, ovary, bovine, reproduction, testis


*3.2. Maize Production and Failures*

The Ejura-Sekyedumase Municipality is an important maize growing area in Ghana [11]. Production is the main source of income for farmers. In total, 53% of the farmers reported that over 60% of their income is from the sale of maize grains (Table 1). The plowing and harvesting of maize fields are often done mechanically using tractors, while sowing and weed clearance is done manually and using weedicide. Maize is grown two times a year, during the major and minor growing seasons. Major season maize is usually planted in April, during the onset of the major rainy season, and harvested in August. The minor season maize is cultivated from late August to early September when the minor season rain is expected to start, and harvested in December. The interviews revealed that the farmers use diverse agro-chemicals for controlling weeds and pests, and for replenishing soil nutrients. The most common agro-chemicals applied by the farmers included weedicides ("Condemn", Samphosate, "Round-up", "Adwumawura", "King Kong", Atrazine), insecticides (Lambda Super 2.5, "Diband and Samprifos", Lindane), and mineral fertilizers (Urea, NPK15-15-15, NPK 23-10-5, and ammonia).

Interviews with the farmers and the key informants confirmed their observations of declined maize yields in the last five years, and notably during the 2020 minor season. About 68% of the farmers reported that their maize yield during the 2020 minor growing season decreased between 40 and 70% compared to what they harvested in the previous years.

The observations of the respondents were validated by empirical data on maize production. Figure 2 shows that the cultivated area of maize slightly decreased in 2019 and 2020 compared with 2018. The maize grain yield sharply increased from 2017, and the highest was recorded in 2018. Figure 2 further shows that, compared with 2018, maize yield dropped by about 14% and 8% in 2019 and 2020, respectively, suggesting a slow recovery in 2020, which to a large extent corroborates the narrative of yield decline. However, given the lack of seasonal maize yield data, it was not possible to isolate the minor season yield to match the qualitative reports of the respondents.

**Table 1.** Demographic characteristics of respondents.


*Article* **Phytochemical Analysis and Anticancer Properties of** *Drimia maritima* **Bulb Extracts on Colorectal Cancer Cells**

**Khairallah Al-Abdallat 1,2,†, Maher Obeidat 3,†, Nidaa A. Ababneh 3, Suzan Zalloum 4, Sabal Al Hadidi 4, Yahya Al-Abdallat 5, Malek Zihlif 6 and Abdalla Awidi 3,7,\***

	- 3 Cell Therapy Center, The University of Jordan, Amman 11942, Jordan

**Abstract:** Cancer is a worldwide health problem and is the second leading cause of death after heart disease. Due to the high cost and severe side effects associated with chemotherapy treatments, natural products with anticancer therapeutic potential may play a promising role in anticancer therapy. The purpose of this study was to investigate the cytotoxic and apoptotic characteristics of the aqueous *Drimia maritima* bulb extract on Caco-2 and COLO-205 colorectal cancer cells. In order to reach such a purpose, the chemical composition was examined using the GC-MS method, and the selective antiproliferative effect was determined in colon cancer cell lines in normal gingival fibroblasts. The intracellular ROS, mitochondrial membrane potential, and gene expression changes in selected genes (*CASP8*, *TNF-α*, and *IL-6* genes) were assessed to determine the molecular mechanism of the antitumor effect of the extract. GC-MS results revealed the presence of fifty-seven compounds, and Proscillaridin A was the predominant secondary metabolite in the extract. The IC50 of *D*. *maritima* bulb extract on Caco-2, COLO-205, and the normal human gingival fibroblasts were obtained at 0.9 μg/mL, 2.3 μg/mL, and 13.1 μg/mL, respectively. The apoptotic effect assay indicated that the bulb extract induced apoptosis in both colon cancer cell lines. *D. maritima* bulb extract was only able to induce statistically significant ROS levels in COLO-205 cells in a dose-dependent manner. The mitochondrial membrane potential (MMP) revealed a significant decrease in the MMP of Caco-2 and COLO-205 to various concentrations of the bulb extract. At the molecular level, RT-qPCR was used to assess gene expression of *CASP8*, *TNF-α*, and *IL-6* genes in Caco-2 and COLO-205 cancer cells. The results showed that the expression of pro-inflammatory genes *TNF-α* and *IL-6* were upregulated. The apoptotic initiator gene *CASP8* was also upregulated in the Caco-2 cell line and did not reach significance in COLO-205 cells. These results lead to the conclusion that *D*. *maritima* extract induced cell death in both cell lines and may have the potential to be used in CRC therapy in the future.

**Keywords:** colorectal; *Drimia maritima*; anticancer


**4. Discussion**

This study shows the evolution of structural and phase transformations in the Al-Zn-Mg-Fe-Ni alloy with different histories during severe plastic deformation. An ingot after homogenization annealing (nickalin 1) and a rod after RSR (nickalin 2) served as initial specimens for HPT.

The microstructural studies, including SEM and high resolution TEM have shown that the structure formation mechanisms in common during HPT are as follows.

HPT results in an intensive refinement of the Al matrix structure to the nanocrystalline state. The formation of a dispersed structure follows two mechanisms: fragmentation at a true strain *ε* = 6.0 to 6.7 (*n* = 5, 10) and in-situ low-temperature dynamic recrystallization at *ε* = 7.1 (*n* = 15). The fragmented structure is characterized by the diffusion contrast of HABs, high dislocation density and the presence of LABs inside the grains/subgrains. The mixed structure consisting of deformation-induced fragments with LABs and HABs and recrystallized grains separated by HABs is bimodal, and this provides the best combination of strength and plastic properties. The average grain/subgrain size in HPT nickalin 1 is 100 nm, and it is 60 nm in HPT nickalin 2. Such nanostructures exhibit high hardness HV = 2000 to 2600 MPa. The strengthening mechanisms for various materials after HPT were repeatedly proved in experiments reported in [19–21,35–37]; namely, according to the Hall–Petch equation, grain-boundary strengthening increases intensely, and the abundance of structural defects is responsible for the high value of the dislocation strengthening component.

The quantitative data obtained by TEM suggest that, during HPT, Al9FeNi eutectic aluminides crash into fragments whose size becomes commensurate with the secondary phases; the fragments are uniformly distributed in the matrix volume. If the Al9FeNi particles were micron-sized (2 to 5 μm) in the macrocrystalline analogs (the ingot and the rod), their size does not exceed 1 μm after HPT, and there appear nanoparticles when *n* = 15.

According to the TEM data, the phase composition of the alloy changes during HPT, the sequence and kinetics of the phase transformations being dependent on the history of the macrocrystalline analogs. As was noted in Section 3.2, during HPT of nickalin 1, at *ε =* 7.1, a supersaturated Al solid solution is formed due to the strain-induced dissolution of the secondary T-phase. Additional solid-solution hardening combined with grain-boundary and dislocation components provides high hardness to the material, HV = 2500 MPa.

Additionally, the formation of a supersaturated Al solid solution during HPT can be proved by the results obtained during subsequent post-deformation heat treatment [31,32]. According to this data, low-temperature annealing (T = 120–160 ◦C) is accompanied by the decomposition of the supersaturated Al solid solution, which occurs simultaneously with the thermal softening of the alloy. Dispersed particles of the T and η strengthening phases precipitate as a result of artificial aging. Due to aging, the hardening achieved under HPT remains high. The presence of the nanostructure significantly reduces the duration of the maximum effect of Al solid solution decomposition from 3–6 h to 0.5–1.0 h. Consequently, the thermal deformation processing of nickalin 1 forms a two-phase material consisting of a nanostructured supersaturated Al solid solution and micron-sized Al9FeNi aluminides of eutectic origin.

The phase transformations in nickalin 2 under HPT are more diverse. Prior to RSR deformation, the rod had a multiphase composition comprising, besides the Al matrix and Al9FeNi aluminides, the Al3Zr and MgZn2 secondary phases. The conditions of their formation are described in Section 3.1.

Under HPT these phases alter their morphologies and sizes owing to two opposite processes induced by SPD, namely the strain-induced dissolution of intermetallics and the kinetic strain aging of the Al matrix. As a result of HPT (*n* = 5, *ε* = 6.0), the MgZn2 phase dissolves with the accumulation of mobile dislocations, which, while moving, cut the particles and transfer magnesium and zinc atoms into the Al solid solution. An increase in true strain to *ε* = 6.7–7.1 (*n* = 10–15) intensifies the subsequent decomposition of the supersaturated solid solution under kinetic strain aging. This inversion of the matrix composition results in that the stick-shaped particles of the η phase disappear and that dispersed (40 nm) globular precipitates of the T-phase appear along the grain/subgrain boundaries of the Al matrix.

One of the possible reasons for the heterogeneous nucleation of secondary phases at the grain/subgrain boundaries is the appearance of abnormal grain-boundary segregations of the atoms of alloying elements under HPT, whose formation was proved theoretically [38] and experimentally [37,39]. In this connection, the precipitation of the secondary phases along the grain boundaries is easier, and they become dominant. Besides, the size of the particles and their discrete arrangement along the boundaries of the nanocrystalline structure does not decrease the alloy plasticity. Note that a distinctive feature of the morphology of the zinc-magnesium phases precipitating at low temperature under SPD is their globular shape.

As deformation with *n* = 10 increases (*ε* = 6.7), strain aging further develops, inside the grains/subgrains of the Al matrix there appear nanosized precipitates of the η' phase, the quantity of which increases with the amount of strain, *ε* = 7.1 (*n* = 15). The reasons for the alternation and competition of the T and η' phase precipitations under dynamic aging can be explained by referring to the results reported in [40], where it was found by atom probe tomography that, at an early stage of aging, clusters form in the Al-Zn-Mg-Cu alloy, with different Zn/Mg atomic ratios depending on Zn content in the supersaturated solid solution. With the atomic ratio Zn/Mg < 1.3, the clusters transform into the T-phase, and when Zn/Mg > 1.3 they turn into the η'-phase. As a result of the nonuniform deformation of the specimen volumes during HPT, the local regions of the strain-induced supersaturated Al solid solution have different combinations of alloying element concentrations. Accordingly, clusters appear with different Zn/Mg atomic ratios, which serve as centers for heterogeneous nucleation of strengthening phase precipitates.

The possibility of the occurrence of the above phase transformations during lowtemperature SPD stems from a several orders of magnitude increase in the atomic diffusion coefficients of the alloying elements in the Al matrix due to excess vacancy concentration [41,42]. Besides, the formation of a strain-induced supersaturated solid solution may be due to the pinning and transfer of alloying element atoms on dislocations during their migration.

The XRD analysis confirms the TEM results and based on the change in the matrix lattice parameter before and after HPT from *a* = 0.4064 ± 0.0001 nm (*n* = 0) to *a* = 0.4067 ± 0.0002 nm (*n* = 15).

The analysis of the structural and strength characteristics of the Al-Zn-Mg-Fe-Ni alloy after HPT shows their interrelation. The difference between the phase compositions of nickalin 1 and nickalin 2 causes the different mechanical characteristics of these materials due to the action of different structural strengthening mechanisms. The total strength of nickalin 1 (YS = 450 MPa, UTS = 470 MPa) is the sum of grain-boundary strengthening by the Hall–Petch mechanism, dislocation strengthening resulting from high dislocation density, and solid-solution strengthening. The higher values of the strength properties of HPT nickalin 2 (YS = 628 MPa, UTS = 640 MPa), which is a multiphase nanocomposite, are caused by the additional contribution of dispersion strengthening from the dispersed

particles of the secondary phase through the Orowan mechanism, as well as by the greatest contribution of the grain-boundary mechanism to the total strength due to the formation of smaller (half-size) grains. The comparison of the obtained strength characteristics with the corresponding properties of the Al-Zn-Mg-Fe-Ni alloy after four RSR cycles (YS = 410 MPa, UTS = 430 MPa) [33] shows the advantage of using combined deformation processing. Besides, the mechanical properties are comparable with those of other 7xxx series alloys after SPD and aging. For example, YS = 525 MPa, UTS = 547 MPa in the 7050 alloy after six ECAP passes (route Bc) [27] and YS = 520 MPa in the Al-Zn-Mg alloy after ECAP and aging [28].


**3. Results**

### *3.1. Mechanical Performances*

Table 5 shows the mechanical properties of the UHP-FRCC used in the jackets. The compressive strength and the elastic modulus both do not change with age because of the acceleration of hydration due to the steam curing. Table 5 summarizes the results of the uniaxial compression tests on the jacketed specimens. In this table, the average values of the maximum load (Pmax)—and of the compressive strength (σmax) as well, the Young Modulus (*E*cm) and the Poisson's Ratio (ν) of the composite specimens are reported. *E*cm and ν were both calculated at one-third of the maximum load, according to the Japanese Standard JIS A 1149 [22], which complies with ISO 6784 [23]. In Table 6, the strength is also normalized with respect to the strength of the unconfined concrete cylinders (i.e., fc\_CORE). *E*cm increased with the thickness of the jacket due to the confined effect. In the same manner, ν decreased as the jacket thickness increased. The tests on the specimen that is shown in Figure 1 were performed until the failure, which is generally produced by the formation of a large tensile crack in the UHP-FRCC jacket (see the right edge photo of Figure 3). During the first stage of loading, the jacked was uncracked and a linear relationship between the stress (calculated by dividing the load by the cross-sectional area of the core concrete) and the strain can be observed (see Figure 4). When the first crack appeared in the jacket, the slope of this relationship drastically reduces in all of the specimens. This is due to the fact that multiple fine cracks, having a width lower than 0.1 mm, formed in the jacket. Despite the growing number of cracks, the stress continuously increased up to peak, where the tensile strains localised in a single crack of the jacket and the failure occurred.

**Table 6.** The average values of the parameters measured in the uniaxial compression tests.

**Figure 4.** Stress-strain curves of the jacketed cylinders: (**a**) behaviour of different UHP-FRCC jackets having a constant of thickness *t*i = 25 mm; (**b**) behaviour of the same UHP-FRCC jacket (FA20) having different thickness.

The composition of the UHP-FRCC binder considerably influences the mechanical performance of the column. In particular, the effect of the substitution strategy on the mechanical properties is evident in Figure 4a, which reports the stress-strain curves of the concrete cylinders that were confined with a jacket of 25 mm, but with 0%, 20%, 50%, and 70% of cement being replaced by fly ash. The results that were obtained in the case of the FA20 mixture (σmax = 59.06 MPa) are close to those that were achieved from the FA0 mixture (σmax = 61.30 MPa). This is the same tendency of the results of UHP-FRCC material itself, as shown in Table 5. In other words, the replacement of 20% in weight of cement content is paid with a loss of 4% of the maximum compressive strength. When considering the cylinder confined with a jacked of FA0 and *t*i = 25 mm as a reference, the decrement of the compressive strength is about 14% and 18% when 50% and 70% of cement is replaced by fly ash, respectively.

On the other hand, Figure 4b reports the average stress-strain curves of the cylinders that were reinforced with the same type of jacket (FA20), but of different thickness (i.e., 25, 50, 37.5, and 70 mm). In this case, the strength increases with the thickness of the reinforcing UHP-FRCC layer.

For each UHP-FRCC series, Figure 5a shows the relationship between the thickness of the jacket and the strength of the reinforced cylinders. In all of the cases, the following linear relationship can be used to predict the compressive strength:

$$
\sigma\_{\text{max}} = \mathbf{s} \cdot t\_i + f\_{\text{c\\_CORE}} \tag{1}
$$

where *s* = slope of the linear relationship. The coefficient *s* can be separately computed for each series, as shown in Figure 5b, and the values can be plotted as a function of the replacement rate of cement with fly ash (see Figure 6). The slope gradually reduces as the percentage of substitution of cement increases (*Csub*). Thus, the following linear correlation can be introduced:

$$s = -0.004 \cdot C\_{sub} + 0.584\tag{2}$$

where *s* is measured in MPa/mm.

**Figure 5.** Compressive strength vs. thickness of jacket in the four ultra high performance fiber reinforced concrete (UHP-FRC) series investigated herein: (**a**) results from the tests; and, (**b**) the trend lines of the experimental data.

**Figure 6.** Formula for predicting the slope of the linear approximation of Equation (1).

#### *3.2. Ecological Performances*

The parameter considered evaluating the ecological performances is the amount of CO2 related to the production of 1 m3 of UHP-FRCC. The amount of CO2 emitted per unit volume of each mixture is calculated in accordance with the inventory analysis [24] while using the values that were provided by the Japan Concrete Institute (JCI) [25], which listed the main materials used in cementitious composites and the relative carbon footprint. Such values are reported in Table 7 in terms of kg of CO2 released in the atmosphere for the production of one-ton of material.

**Table 7.** CO2 emissions of UHP-FRCC components [25].

Figure 7 compares the environmental impacts of the various jackets, which were obtained by multiplying the values reported in Table 7 and the mass of materials used to cast the four series of UHP-FRCC. For the sake of completeness, Figure 7 also shows the values of some specimens that has not been tested. In this Figure, when the amount of cement replaced with fly ash is quite high (>50%), the environmental impact is considerably reduced with respect to FA0 (it is halved for FA70). Moreover, it can be noticed that a reduced environmental impact is attained by decreasing the thickness of the jacket and, in parallel, by increasing the percentage of fly ash in the mixture. Here, the CO2 emission due to the steam curing is not taken into account, because all of the series were subjected to the same procedures and, subsequently, a comparative analysis among all of the specimens is performed.

**Figure 7.** The ecological performances of the UHP-FRCC jackets used to reinforce concrete cores.

#### *3.3. Eco-Mechanical Analysis and Design Procedure*

By means of the approach that was proposed by Fantilli and Chiaia [19], ecological and mechanical analyses can be combined to define the best material. Compressive strength (σmax) is considered as the functional unit, herein called the mechanical index (MI), whereas the ecological impact is evaluated through the carbon footprint (ecological index—EI). The reference values MIinf (i.e., the minimum mechanical performance) and EIsup (i.e., the maximum impact) are those of the concrete cylinder reinforced with the UHP-FRCC jacket without the substitution of cement with fly ash (i.e., FA0) and with a thickness *t*i = 25 mm.

Figure 8 shows the non-dimensional chart that was used to perform the comparative analysis among the concrete specimens reinforced with the UHP-FRCC layer. In this diagram, the ratios MI/MIinf and EIsup/EI are the abscissa and the ordinate, respectively. In other words, the following formula are used to define the non-dimensional axes in Figure 8:

$$\frac{\text{MI}}{\text{MI}\_{\text{inf}}} = \frac{\sigma\_{\text{max}}}{\sigma\_{\text{max}} \text{ of } FA0 \text{ with } \mathfrak{t}\_{\text{i}} = 25 \text{ mm}} \tag{3}$$

$$\frac{\text{EI}\_{\text{sup}}}{\text{EI}} = \frac{\text{kg CO}\_2 \text{ of } FA0 \text{ with } t\_{\text{i}} = 25 \text{ mm}}{\text{kg CO}\_2} \tag{4}$$

Most of the experimental results fall in Zone 2, where the mechanical performances are increased at the expense of an environmental impact higher than that of FA0 with *t*i = 25 mm (for which MI/MIinf = EIsup/EI = 1).

**Figure 8.** Eco-Mechanical analysis of the UHP-FRCC jackets [19].

However, a group of experimental values falls within Zone 4, which shows ecological performances greater than those shown by the reference specimen, but lower mechanical performances. Although none of the test results fall within Zone 3, where the ecological and mechanical performances are both improved, an area of the possible best solutions can be defined in Figure 8. More precisely, the UHP-FRCC jackets with a thickness between 37.5–50 mm and made with FA70 series, and those of the FA50 series with thickness being included in the range 25–50 mm (see the dashed lines), might perform better than the reference cylinders (i.e., part of the dashed lines falls within Zone 3). The same is also valid for some thickness (within the range 25~37.5 mm) of the series FA20, as evidenced by the dashed line that is reported in Figure 8.

Nevertheless, Equations (1) and (2) can be used to relate the compressive stress, the thickness of the jacket, and the type of fiber-reinforced concrete to design the exact UHP-FRCC layer. In particular, the design procedure that is shown in Figure 9 can be introduced with the aim of increasing the strength of the UHP-FRCC jacketing system, and reducing the CO2 emissions as well.

**Figure 9.** The design procedure used to optimize the UHP-FRCC jacket of the concrete columns.

As a result, Figure 10 shows the curves that relate the CO2 emissions with the percentage of cement replaced by fly ash for three values of the compressive strength σmax (i.e., 55, 65, and 75 MPa). For each load carrying capacity, four thicknesses of the jackets have been obtained referring to the mixtures FA0, FA20, FA50, and FA70.

**Figure 10.** The ecological impact of UHP-FRCC jackets made with different mixtures (having different σmax).

If σmax ≤ 55 MPa is required, the CO2 emission does not change with the thickness or the percentage of cement replacement with fly ash. Conversely, as the required strength increases, the corresponding CO2 emission has a minimum in correspondence of a specific thickness. For instance, the optimal replacement of cement with fly ash to achieve a compressive stress of 75 MPa is 50% and the corresponding thickness is 67 mm. In the three curves that are shown in Figure 10, the best substation rate is at 50%, as obtained by Fantilli et al. [26] in the reinforced concrete beam. Indeed, for lower substitution rates, thickness reduces, but the CO2 emissions are higher.

When the substitution strategy is forced to higher percentages, the same mechanical performances can only be obtained through solutions with a high environmental impact, as the thickness of the jacket increases. In other words, the UHP-FRCC jacket with a low fly ash content shows mechanical performances that are not compensated by the environmental impact. In the same way, the jacketing system is so thick to produce a large environmental impact for large substitutions of cement.


**Author details**

Ritu Mishra1 \*, Saumya Singh2 and Suruchi Pandey3

1 Amity University, Patna, India

2 Sam Higginbottom University of Agriculture, Technology and Sciences, India

3 Symbiosis Institute of Management Studies, Symbiosis International University, Pune, India

\*Address all correspondence to<EMAIL_ADDRESS>
© 2023 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

*The Impact of Technological Advances on Cultural Conflicts within Organizations DOI: http://dx.doi.org/10.5772/intechopen.113095*


*Ectomycorrhizal Fungi as Biofertilizers in Forestry DOI: http://dx.doi.org/10.5772/intechopen.110090*

are being used in forest development or for diversity enhancement in different sectors. But, this frequently leads to nutrient losses through various factors such as leaching, gaseous losses, and many other harmful factors. The exploitation of biofertilizers instead of relying on different chemicals may increase the growth and development of plant species that enhance the productivity in a more maintainable way. Biofertilizers are mostly used in horticulture and agriculture sectors with less emphasis on forestry. It is mandatory to explore and exploit numerous mechanisms of action, viz., enabling nutrient uptake, phytoprotection, and modulation of phytohormone of biofertilizers that would have supportive role in promoting the ecosystem services of forest biomes. All these factors (i.e., the mechanisms of action of effective microorganisms in biofertilizers, applications of biofertilizers in the forestry sector, and factors influencing the effectiveness of biofertilizer application) will be considered in the given review.


**2.3. MOD16 data**

The MOD16 algorithm [12, 13] was developed in the context of the Earth Observing System/ NASA (EOS/NASA) program, aiming to estimate global evapotranspiration using data from Moderate Resolution Imaging Spectroradiometer (MODIS) sensor (Terra and Aqua) and meteorological data from Global Modeling and Assimilation Office (GMAO). In general terms, MOD16 is a revision of the algorithm proposed by [20], who adapted the Penman‐Monteith equation (Eq. (1)) to be used with remote sensing data:

$$
\lambda E = \frac{sA + \rho C\_p \left(e\_{\rm sat} - e\right) / r\_a}{s + \chi \left(1 + r\_s / r\_a\right)} \tag{1}
$$

where *λE* is the latent heat flux (W m−2) and *λ* represents the latent heat of evaporation (J kg−1), *s* = *d*(*e*sat)/*dT* is the slope of the curve which relates saturated pressure of water (*e*sat) and temperature (Pa K−1), *A* is the energy available at surface (W m−2), *ρ* represents air density (kg m −3), *Cp* is the specific heat of air (J kg−1 K−1), *e* is the real pressure of water vapor (Pa), *rs* is the surface resistance, *ra* is the aerodynamic resistance (s m−1), and *γ* represents the psychrometric constant (66 Pa K−1).

MODIS input data required for MOD16 algorithm have spatial resolution between 500 m and 1 km, and include global products of land use and land cover (MOD12Q1), leaf area index (LAI) and photosynthetically active radiation (PAR‐MOD15A2), and albedo (MCD43B2). Regarding the meteorological parameters required for the algorithm, daily reanalysis data of GMAO referring to incident solar radiation, air temperature, and water vapor pressure, with spatial resolution of 1.00° × 1.25°, are used [13, 21]. In summary, MOD16 data have a spatial resolution of 1 km and covers ~109 million km2 of vegetated global areas. Among the products generated, we highlight the potential and actual evapotranspiration and potential and actual latent heat flux products, in intervals of eight (MOD16A2) and 30 days (MOD16A3) [22].

MOD16 data were acquired from the Numerical Terradynamic Simulation Group/The University of Montana repository (http://www.ntsg.umt.edu/project/mod16). Tiles H13V10 and H13V11, corresponding to the monthly real evapotranspiration product, in mm month−1, were selected for the period between January 2000 and December 2010. As MOD16 data are available in sinusoidal projection, images were initially reprojected to geographic coordinates with datum WGS 84 and converted to GeoTIFF format using the MODIS Reprojection Tool (MRT). Then, a number of steps were undertaken using ENVI 4.5. These steps included clipping of the study area, multiplication by scale factors, and application of the land‐water and urban areas mask over the datasets.


*3.4.1 Mechanisms and benefits of CFT*

The cold finger is a device designed to prompt nucleation and crystallization in phase change materials (PCMs) at their phase change temperature. Functioning as a metal rod or plate cooled below the PCM's phase change point, it directly contacts the PCM, initiating cooling or solidification at its surface first. This method accelerates the PCM's shift to the solid phase by offering a surface for nucleation, thereby reducing the energy barrier for transition. Consequently, the Cold Finger Technique enhances the predictability and consistency of PCM phase changes, crucial for temperature stability and reliable performance in applications like thermal energy storage systems [79].


[27] Stojkovic M, Rosenberger KD, Steudle F, Junghanss T. Watch and wait management of inactive cystic echinococcosis—Does the path to inactivity matter—Analysis of a prospective patient cohort. PLoS Neglected Tropical Diseases. 2016;**10**(12):e0005243. DOI: 10.1371/ journal.pntd.0005243

#### **Chapter 8**

## Perspective Chapter: Primary Cystic Echinococcosis of the Pancreas

*Azize Saroglu and Alexander Julianov*

#### **Abstract**

Primary cystic echinococcosis of the pancreas is rare, even in endemic regions. The clinical presentation depends on the affected part of the pancreas and the presence of local complications, but there are no specific symptoms, which can be a clue to diagnosis. Imaging studies usually reveal avascular lesions in the pancreas that are most frequently misdiagnosed as pseudocysts or neoplastic cystic tumors. The treatment options vary from evacuation and drainage to formal resection of the pancreas, with no evidence of the best treatment strategy. This chapter provides a comprehensive review of the current knowledge of the clinical presentation, diagnosis, and treatment of primary cystic echinococcosis of the pancreas. Acute thrombosis of the splenic artery which leads to massive splenic infarction and abscess, a previously unreported initial manifestation of cystic echinococcosis of the pancreas is also presented, as well as the first use of intraoperative pancreaticoscopy to clear the mean pancreatic duct from membranes of the parasite.

**Keywords:** cystic echinococcosis, pancreas, diagnosis, treatment, pancreaticoscopy

#### **1. Introduction**

Cystic echinococcosis is a zoonotic disease caused by the larval stage of the *Echinococcus granulosus* parasite, representing an endemic problem in many regions of the world such as the Mediterranean countries, Australia, New Zealand, South America, South East and Far East Asia, and Middle Eastern countries [1]. The parasite was named in 1801 by Rudolphi who wrote: "*Echinococcus*, that's what I call the granular bladderworms…" (**Figure 1**) [2].

The prevalence of isolated pancreatic cystic echinococcosis (PCE) is very low, ranging from 0.14 to 2% of total systemic echinococcosis [3–5]. Pancreatic cystic echinococcosis (PCE) may develop as a primary isolated disease involving the pancreas only, or as a secondary disease with multiple organ involvement (**Figure 2**), and can masquerade as more common lesions of the pancreas such as pseudocysts or cystic pancreatic neoplasms.

The lack of specific clinical manifestations of PCE is clearly demonstrated by the majority of cases published in the literature, thus explaining why preoperative diagnosis is challenging [5–8]. In symptomatic cases, clinical findings may be similar to

#### **Figure 1.**

*The original text of Rudolphi introduces the name "Echinococcus" .*

**Figure 2.**

*(A, B) axial computed tomography scans of a patient with abdominal cystic echinococcosis with multiple locations including body of the pancreas (arrow, a).*

those of other pancreatic diseases. However, the imaging features of PCE are almost identical to those of other cystic diseases of the pancreas, and given the rarity of the problem, isolated primary pancreatic cystic echinococcosis is often misdiagnosed even in endemic areas of the world.

### **2. Clinical presentation**

The clinical presentation of PCE is a result of: 1) the pressure generated by the cyst on the pancreatic tissue and adjacent structures, which depends on the size and anatomic location of the cyst; 2) the local inflammatory reaction to the parasite involving neighboring anatomical structures, and; 3) the presence of local/systemic complications.

According to data from the literature, 50–58% of pancreatic echinococcosis is found in the pancreatic head, 24–34% in the pancreatic body, and 16–19% in the

pancreatic tail [8–10]. It is considered that the embryos of hydatid cysts end up in the pancreas mainly by hematogenous dissemination [11]. The rich vascular network on the head of the pancreas explains the more frequent involvement of this part of the gland by the parasite. Other possible mechanisms for the involvement of the pancreas include local spread by passage of cystic elements via the bile duct into the pancreatic duct, direct passage of cystic components through the intestinal mucosa into the peripancreatic lymphatic plexus, and retroperitoneal spread [11–13].

Pancreatic echinococcosis is considered to be asymptomatic for a long period, due to its slow growth rate of 0.3–2.0cm per year [14]. All data for the clinical symptoms of cystic echinococcosis of the pancreas come from a small published series or case reports in the literature. An abdominal mass, epigastric pain, weight loss, discomfort, and vomiting are the main nonspecific clinical symptoms [5, 9, 10, 14–22]. PCE located in the pancreatic head most commonly causes cholangitis, obstructive jaundice, or acute pancreatitis [3, 12, 13, 16, 21–28]. Cysts of the parasite located in the body or tail of the pancreas can be asymptomatic and usually present as an abdominal lump when they enlarge [3, 19, 22, 29–31]. Infrequently, PCE located in the pancreatic tail can result in splenomegaly and segmental portal hypertension owing to splenic vein compression/thrombosis [32]. Other reported uncommon complications include mesenteric/portal vein thrombosis, upper gastrointestinal bleeding with splenic artery pseudoaneurysm, intracystic bleeding, and rupture into the biliary system or peritoneal cavity, pancreatic fistula, recurrent pancreatitis, and pancreatic abscess [6, 7, 32, 33].

As primary PCE can mimic any other pancreatic disease, it is still frequently a clinical surprise rather than a preoperatively established diagnosis. We observed a previously unreported initial manifestation of PCE in a patient who presents with splenic infarction and abscess secondary to acute splenic artery thrombosis due to isolated cystic echinococcosis located in the body of the pancreas (**Figure 3**). The patient was erroneously diagnosed preoperatively as having a complicated malignant pancreatic tumor with splenic artery involvement, and a correct diagnosis was made during laparotomy.

#### **Figure 3.**

*Computed tomography in a patient with primary PCE. (A) Axial image demonstrating pancreatic cystic lesion (arrow), thrombosis of splenic artery at its origin (arrowhead), and splenic abscess (asterisk). (B) Coronal image demonstrating patent splenic vein (arrowhead) along with the pancreatic cyst (arrow) and splenic abscess (asterisk).*

#### **3. Diagnosis**

The first and probably most important step in the diagnosis of PCE is clinical suspicion, particularly in endemic regions. The diagnosis is much easier when associated with other localization(s) (**Figure 4**).

Characteristic imaging findings of echinococcosis are often missing in isolated PCE, with considerable imaging overlap between other cystic lesions of the pancreas and peripancreatic regions (**Figure 5**), such as pseudocysts, choledochal cysts, serous or mucinous cystadenomas, and cystadenocarcinomas, which complicates the diagnostic process. The higher prevalence of mucinous cystadenomas of the pancreas and, on the other hand, the rare occurrence of pancreatic echinococcosis leads to the fact that it is rarely taken into account in the differential diagnosis [34, 35], and pancreatic echinococcosis is, as a result, often misdiagnosed [20, 36–38]. According to data from the literature, the vast majority of PCE patients are not diagnosed preoperatively [7, 37].

In daily clinical practice, blood tests for detecting specific serum antibodies and circulating echinococcal antigens usually include indirect hemagglutination assay, immunoelectrophoresis, enzyme-linked immunosorbent assay, complement fixation test, and immunofluorescence assay [3, 7, 22]. According to a systematic review by Dziri et al. [3], hydatid serology has a low sensitivity (62%). In another literature review by Akbulut et al. [7], the sensitivity of hydatid serology was even lower (54%).

The most commonly performed imaging modalities for the diagnosis of pancreatic cysts are transabdominal ultrasound (US), contrast-enhanced computed tomography (CT), and magnetic resonance imaging (MRI). Cases that require further workup are examined using invasive diagnostic tools such as endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS); the latter has emerged rapidly as an effective technique to gain diagnostic information and access to retroperitoneal organs such as the pancreas.

Transabdominal ultrasound is a widespread, cost-effective, and sensitive method for detecting internal cyst structures, including membranes, septa, hydatid sand, and daughter cysts. It can show a well-defined anechoic lesion with a hyperechoic thick double-lined wall and internal echogenic material, although the sensitivity is decreased in cases of PCE due to the retroperitoneal location and superponing bowel gas [37, 39].

Localization and size of the pancreatic cyst can be detected accurately on CT, that moreover, may provide information about the relationship between the cyst and bile

#### **Figure 4.**

*Abdominal cystic echinococcosis. (A) Axial computed tomography demonstrating cystic lesion in the head of the pancreas (arrow) and ventrally located cyst in the left liver with typical appearance of cystic echinococcosis. (B, C) intraoperative photograph shows removal of the parasite and remaining defect in pancreatic head.*

*Perspective Chapter: Primary Cystic Echinococcosis of the Pancreas DOI: http://dx.doi.org/10.5772/intechopen.109491*

#### **Figure 5.**

*Differential diagnosis of pancreatic cystic lesions.*

ducts and wall calcification, and CT angiography can show significant displacement of vascular compression in the arterial and venous phases [7, 8, 19–22, 32–34, 37].

In the PCE case series of Li et al. [22], MRI provided a better depiction of the fluid content of cystic lesions and communication with the pancreatic duct due to its higher soft-tissue contrast and capability of multiplanar imaging. Pancreatic cystic echinococcosis showed a hypointense signal on T1-weighted MRI images, a hyperintense signal on T2-weighted images, and a hyperintense signal.

EUS is another diagnostic tool that is commonly used in the evaluation of cystic pancreatic lesions. Nowadays some authors recommended a fine-needle aspiration biopsy to differentiate a hydatid cyst from other common cystic lesions [40, 41].

According to data from the literature, accurate diagnosis cannot be established based on radiological findings alone, and this is especially true for pancreatic cystic lesions demonstrating particular imaging features such as multilocular cysts, presence of internal septations, calcifications, and wall enhancement as they are encountered in both benign and malignant pancreatic cystic lesions [22, 36]. Blood tests may be helpful for diagnosis in some cases, but according to the published experience with PCE, the sensitivity of the routinely used tests is still low [3, 7].

#### **4. Surgical treatment**

Surgery remains the main treatment option for patients with PCE as most cases are correctly diagnosed intraoperatively. However, due to a lack of evidence, it is not clear which is the best treatment strategy for patients with isolated PCE. However, Dziri et al. in their review reported that surgery is the main treatment of PCE and the open approach is performed in 95% of the cases [3]. Furthermore, depending on the cyst's

location, several procedures have been suggested, including cyst fenestration, internal derivation, central or distal pancreatectomy with or without splenectomy [3, 6, 7], and presently, available treatment options include formal resection, internal capsule stripping and external capsule removal (subadventitial total exocystectomy) [42].

Regarding the available surgical options to treat PCE, it is clear that formal pancreatic resection is not necessary to treat such benign diseases and should be avoided when possible to spare the patient from complications associated with resection of the pancreas. Superficially located cysts that do not communicate with the pancreatic ductal system can be excised, opened, or drained without substantial complications. On the other hand, the main question to the surgeon after parasite removal (**Figure 6**) is whether the remaining cavity in the pancreas communicates with the ductal system. In cases with ductal communication, the surgical option is to perform a drainage procedure on a Roux-en-Y jejunal limb or to proceed with formal resection. However, the latter is justified only in cases where resection of the body/ tail may be sufficient, and formal pancreaticoduodenectomy does not seem justified to treat PCE.

#### **Figure 6.**

*Intraoperative photographs of a patient corresponding to Figure 3. (A) Protrusion of parasitic membrane (arrow) through the cystotomy. (B) Pancreaticoscope (arrow) is inserted in the main pancreatic duct toward the head of the pancreas.*

#### **Figure 7.**

*Intraoperative pancreaticoscopy in a patient corresponding to Figure 5. (A) Hydatid membrane impacted the main pancreatic duct. (B) the pancreatic duct is cleared from the parts of the parasite.*

Intraoperative management of the main pancreatic duct has not yet been resolved. We consider this a topic of concern as parts of the parasite may migrate to the main pancreatic duct in the case of ductal communication of the PCE, causing ductal obstruction, further symptoms, and even disease recurrence. To resolve these problems, the use of intraoperative pancreaticoscopy seems to be a good solution, similar to its use in surgery for chronic pancreatitis [43].

Direct endoscopic inspection of the main pancreatic duct through communication with the residual cavity is simple, securely detects intraductal pathology, and can be easily used to clear the duct (**Figure 7**). Any available flexible endoscope that fits the pancreatic duct can be used for this purpose. Other options to evaluate the involvement of the pancreatic ductal system include intraoperative ultrasonography of the pancreas and intraoperative pancreatography. However, both of them cannot manage the duct in cases of involvement, and the diagnostic accuracy of pancreaticoscopy is unmatched.

#### **5. Conclusion**

Primary cystic echinococcosis of the pancreas is rare even in endemic areas. Despite radiological imaging, including transabdominal ultrasound, CT, MRI, EUS, ERCP, laboratory tests, and hydatid serology, the preoperative diagnosis of pancreatic cystic echinococcosis remains difficult, and the correct diagnosis is most often intraoperative.

Clinicians may still encounter undescribed clinical presentations of pancreatic echinococcosis, as presented in this chapter. PCE should be considered in the differential diagnosis of pancreatic cystic lesions, particularly in endemic geographic regions. Surgical treatment combined with albendazole can reduce the recurrence rate and morbidity of pancreatic cystic echinococcosis. As the intraoperative management of the main pancreatic duct in the case of communication with the parasite is not resolved, the use of intraoperative pancreaticoscopy may play an important role as a valuable adjunct to the operative strategy and contribute to more precise surgery.

Primary cystic echinococcosis of the pancreas remains a diagnostic challenge, and it seems that only high clinical suspicion and awareness of the disease can improve the preoperative diagnosis rate.

#### **Conflict of interest**

The authors declare no conflict of interest.

*Echinococcosis - New Perspectives*

### **Author details**

Azize Saroglu\* and Alexander Julianov Trakia Hospital, Stara Zagora, Bulgaria

\*Address all correspondence to<EMAIL_ADDRESS>
© 2022 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

### **References**

[1] Gessese AT. Review on epidemiology and public health significance of hydatidosis. Veterinary Medicine International. 2020;**2020**:8859116. DOI: 10.1155/2020/8859116

[2] Rudolphi CA.  Archiv für Zoologie und Zootomie. 1801;**2**:1-65

[3] Dziri C, Dougaz W, Bouasker I. Surgery of the pancreatic cystic echinococcosis: Systematic review. Translational Gastroenterology and Hepatology. 2017;**2**:105. DOI: 10.21037/ tgh.2017.11.13

[4] Deák J, Zádori G, Csiszkó A, Damjanovich L, Szentkereszty Z. Hydatid disease of pancreas: A case report. International Medicine and Applied Science. 2019;**11**:74-76. DOI: 10.1556/1646.11.2019.05

[5] Soin P, Sharma P, Kochar PS. Pancreatic echinococcosis. Proceedings Baylor University Medical Center. 2019;**32**:85-87. DOI: 10.1080/ 08998280.2018.1512359

[6] Ahmed Z, Chhabra S, Massey A, Vij V, Yadav R, Bugalia R, et al. Primary hydatid cyst of pancreas: Case report and review of literature. International Journal of Surgery Case Reports. 2016;**27**:74-77. DOI: 10.1016/j.ijscr.2016.07.054

[7] Akbulut S, Yavuz R, Sogutcu N, Kaya B, Hatipoglu S, Senol A, et al. Hydatid cyst of the pancreas: Report of an undiagnosed case of pancreatic hydatid cyst and brief literature review. World Journal of Gastrointestinal Surgery. 2014;**27**(6):190-200. DOI: 10.4240/wjgs.v6.i10.190

[8] Dahniya MH, Hanna RM, Ashebu S, Muhtaseb SA, el-Beltagi A, Badr S,

et al. The imaging appearances of hydatid disease at some unusual sites. The British Journal of Radiology. 2001;**74**:283-289. DOI: 10.1259/bjr.74.879.740283

[9] Yarlagadda P, Yenigalla BM, Penmethsa U, Myneni RB. Primary pancreatic echinococcosis. Trop Parasitol. 2013;**3**:151-154. DOI: 10.4103/2229-5070.122147

[10] Makni A, Chebbi F, Jouini M, Kacem M, Ben SZ. Left pancreatectomy for primary hydatid cyst of the body of pancreas. Journal of African Hepatology and Gastroenterology. 2011;**5**:310-312. DOI: 10.1007/s12157-011-0305

[11] Wani RA, Wani I, Malik AA, Parray FQ, Wani AA, Dar AM. Hydatid disease at unusual sites. International Journal of Case Reposts Images. 2012;**3**:1-6. DOI: 10.5348/ijcri-2012-06-128-RA-1

[12] Mandelia A, Wahal A, Solanki S, Srinivas M, Bhatnagar V. Pancreatic hydatid cyst masquerading as a choledochal cyst. Journal of Pediatric Surgery. 2012;**47**:e41-e44. DOI: 10.1016/j. jpedsurg.2012.07.054

[13] Derbel F, Zidi MK, Mtimet A, Hamida MBH, Mazhoud J, Youssef S, et al. Hydatid cyst of the pancreas: A report on seven cases. Arabian Journal of Gastroenterology. 2010;**11**:219-222. DOI: 10.1016/j.ajg.2010.10.004

[14] Eris C, Akbulut S, Yildiz MK, Abuoglu H, Odabasi M, Ozkan E, et al. Surgical approach to splenic hydatid cyst: Single center experience. International Surgery. 2013;**98**:346-353. DOI: 10.9738/ INTSURG-D-13-00138.1

[15] Erdener A, Sahin AH, Ozcan C. Primary pancreatic hydatid disease

in a child: Case report and review of the literature. Journal of Pediatric Surgery. 1999;**34**:491-492. DOI: 10.1016/ s0022-3468(99)90509-2

[16] Makni A, Jouini M, Kacem M, Safta ZB. Acute pancreatitis due to pancreatic hydatid cyst: A case report and review of the literature. World Journal of Emergency Surgery : WJES. 2012;**7**:7. DOI: 10.1186/1749-7922-7-7

[17] Kushwaha JK, Sonkar AA, Verma AK, Pandey SK. Primary disseminated extrahepatic abdominal hydatid cyst: A rare disease. BML Case Reports. 2012;**2012**:bcr0220125808. DOI: 10.1136/ bcr.02.2012.5808

[18] Karaman B, Battal B, Ustunsoz B, Ugurel MS. Percutaneous treatment of a primary pancreatic hydatid cyst using a catheterization technique. Korean Journal of Radiology. 2012;**13**:232-236. DOI: 10.3348/kjr.2<IP_ADDRESS>

[19] Varshney M, Shahid M, Maheshwari V, Siddiqui MA, Alam K, Mubeen A, et al. Hydatid cyst in tail of pancreas. BML Case Reports. 2011;**2011**:bcr0320114027. DOI: 10.1136/ bcr.03.2011.4027

[20] Cankorkmaz L, Gümüş C, Celiksöz A, Köylüoğlu G. Primary hydatid disease of the pancreas mimicking pancreatic pseudo-cyst in a child: Case report and review of the literature. Türkiye Parazitolojii Dergisi. 2011;**35**:50-52. DOI: 10.5152/tpd. 2011.13

[21] Küçükkartallar T, Cakır M, Tekin A, Özalp AH, Yıldırım MA, Aksoy F. Psödokiste benzeyen primer pankreas hidatik kisti [primary pancreatic hydatid cyst resembling a pseudocyst]. Türkiye Parazitolojii Dergisi. 2011;**35**:214-216. Turkish. DOI: 10.5152/tpd.2011.54

[22] Gou L, Gao F, Tiheiran M, Guo H. Evaluation of the clinical, laboratory, and radiological findings and treatment of 19 cases of pancreatic echinococcosis. Open forum. Infectious Diseases. 2020;**7**:ofaa118. DOI: 10.1093/ofid/ ofaa118

[23] Bhat NA, Rashid KA, Wani I, Wani S, Syeed A. Hydatid cyst of the pancreas mimicking choledochal cyst. Annals of Saudi Medicine. 2011;**31**:536-538. DOI: 10.4103/0256-4947.84638

[24] Agrawal S, Parag P. Hydatid cyst of head of pancreas mimicking choledochal cyst. BML Case Reports. 2011;**2011**:bcr0420114087. DOI: 10.1136/ bcr.04.2011.4087

[25] Diop SP, Costi R, Le Bian A, Carloni A, Meduri B, Smadja C. Acute pancreatitis associated with a pancreatic hydatid cyst: Understanding the mechanism by EUS. Gastrointestinal Endoscopy. 2010;**72**:1312-1314. DOI: 10.1016/j.gie.2010.04.051

[26] Chammakhi-Jemli C, Mekaouer S, Miaoui A, Daghfous A, Mzabi H, Cherif A, et al. Pancréatite aiguë révélatrice d'un kyste hydatique du pancréas [hydatid cyst of the pancreas presenting with acute pancreatitis]. Journal de Radiologie. 2010;**91**:797-799. French. DOI: 10.1016/ s0221-0363(10)70117-7

[27] Suryawanshi P, Khan AQ, Jatal S. Primary hydatid cyst of pancreas with acute pancreatitis. International Journal of Surgery Case Reports. 2011;**2**:122-124. DOI: 10.1016/j.ijscr.2011.02.011

[28] Jai SR, El Hattabi K, Bensardi F, Chehab F, Khaiz D, Bouzidi A. Primary hydatid cyst of the pancreas causing obstructive jaundice. Saudi Journal of Gastroenterology. 2007;**13**:191-193. DOI: 10.4103/1319-3767.36752

*Perspective Chapter: Primary Cystic Echinococcosis of the Pancreas DOI: http://dx.doi.org/10.5772/intechopen.109491*

[29] Masoodi MI, Nabi G, Kumar R, Lone MA, Khan BA, Al Sayari N, et al. Hydatid cyst of the pancreas: A case report and brief review. The Turkish Journal of Gastroenterology. 2011;**22**:430-432. DOI: 10.4318/ tjg.2011.0259

[30] Sethi S, Puri SK, Agarwal A. Primary pancreatic hydatid: A rare cystic lesion of the pancreas. The American Journal of Tropical Medicine and Hygiene. 2017;**96**:763-764. DOI: 10.4269/ ajtmh.15-0713

[31] Sorogy ME, El-Hemaly M, Aboelenen A. Pancreatic body hydatid cyst: A case report. International Journal of Surgery Case Reports. 2015;**6**:68-70. DOI: 10.1016/j.ijscr.2014.11.062

[32] Ozsay O, Gungor F, Karaisli S, Kokulu I, Dilek ON. Hydatid cyst of the pancreas causing both acute pancreatitis and splenic vein thrombosis. Annals of the Royal College of Surgeons of England. 2018;**100**:e178-e180. DOI: 10.1308/rcsann.2018.0111

[33] Szanto P, Goian I, Al Hajjar N, Badea R, Seicean A, Manciula D, et al. Hydatid cyst of the pancreas causing portal hypertension. Maedica (Bucur). 2010;**5**:139-141

[34] Hu F, Hu Y, Wang D, Ma X, Yue Y, Tang W, et al. Cystic neoplasms of the pancreas: Differential diagnosis and radiology correlation. Frontiers in Oncology. 2022;**12**:860740. DOI: 10.3389/ fonc.2022.860740

[35] Farrell JJ. Prevalence, diagnosis and Management of Pancreatic Cystic Neoplasms: Current status and future directions. Gut Liver. 2015;**9**:571-589. DOI: 10.5009/gnl15063

[36] Mitrovic M, Tadic B, Kovac J, Grubor N, Milosavljevic V, Jankovic A, et al. Pancreatic hydatid cyst misdiagnosed as mucinous cystadenoma: CT and MRI findings. Medicina (Kaunas, Lithuania). 2020;**56**:124. DOI: 10.3390/ medicina56030124

[37] Javed A, Agarwal G, Ps A, Manipadam JM, Puri SK, Agarwal AK. Hydatid cyst of the pancreas: A diagnostic dilemma. Tropical Gastroenterology. 2020;**41**:73-81. DOI: 10.7869/TG.582

[38] Astiz JM, Astiz L, Buzzi A. Primary hydatid cyst mistaken for carcinoma of the pancreas. Journal of the Royal Society of Medicine. 1997;**90**:334. DOI: 10.1177/014107689709000611

[39] Lewall DB, McCorkell SJ. Hepatic echinococcal cysts: Sonographic appearance and classification. Radiology. 1985;**155**:773-775. DOI: 10.1148/ radiology.155.3.3890008

[40] Lopes CV, Dedavid E, Silva TL, NHV C, Santos GO. The value of endoscopic ultrasound-fine needle aspiration in the suspicion of pancreatic hydatid cyst in endemic areas with negative serology (with video). Endosc Ultrasound. 2017;**6**:350- 351. DOI: 10.4103/eus.eus\_12\_17

[41] Sharma S, Sarin H, Guleria M, Agrawal K. Endoscopic ultrasoundguided FNA: Emerging technique to diagnose hydatid cyst of pancreas. Journal of Cytology. 2015;**32**:211-212. DOI: 10.4103/0970-9371.168908

[42] Wu Y, Gong J, Xiong W, Yu X, Lu X. Primary pancreatic hydatid cyst: A case report and literature review. BMC Gastroenterology. 2021;**21**:164. DOI: 10.1186/s12876-021-01753-1

[43] Julianov AE, Saroglu AS. Determination of the length of pancreatic ductotomy by pancreaticoscopy during Frey's procedure for chronic pancreatitis. Annals of Surgery Open. 2021;**2**:e106. DOI: 10.1097/AS9.0000000000000106

### *Edited by Tonay Inceboz*

Echinococcosis is a neglected parasitic disease caused by *Echinococcus* spp. of the family Taeniidae. The prevalence of the disease is increasing worldwide due to industrialization and climate change. This book provides a comprehensive overview of echinococcosis, including information on epidemiology, geographic distribution, diagnosis, management, and prevention.

> *Alfonso J. Rodriguez-Morales, Infectious Diseases Series Editor*

Published in London, UK © 2023 IntechOpen © 123dartist / iStock

Echinococcosis - New Perspectives

IntechOpen Series

Infectious Diseases, Volume 19

Echinococcosis

New Perspectives

*Edited by Tonay Inceboz*