Short-term impact of different doses of spent coffee grounds, salt, and sand on soil chemical and hydrological properties in an urban soil.

Natural and human activities have deteriorated urban soil's health and ecological functions as compared to forest soils. Therefore, we hypothesized that any intervention in poor quality soil in urban area will change their chemical and water retention properties. The experiment was conducted in Krakow (Poland) in completely randomized design (CRD). The soil amendments used in this experiment consisted of control, spent coffee grounds (SCGs), salt, and sand (1 and 2 t ha-1) in order to evaluate the impact of these soil amendments on the urban soil chemical and hydrological properties. Soil samples were collected after 3 months of soil application. The soil pH, soil acidity (me/100 g), electrical conductivity (mS/cm), total carbon (%), CO2 emission (g m-2 day-1), and total nitrogen (%) were measured in laboratory condition. The soil hydrological properties like volumetric water content (VWC), water drop penetration time (WDPT), current water storage capacity (Sa), water storage capacity after 4 and 24 h (S4 and S24), and capillary water Pk (mm) were also determined. We noted variations in soil chemical and water retention properties in urban soil after the application of SCGs, sand, and salt. It was observed that SCGs (2 t ha-1) has reduced soil pH and nitrogen (%) by 14 and 9%, while the incorporation of salt resulted in maximum soil EC, total acidity, and soil pH. The soil carbon (%) and CO2 emission (g m-2 day-1) were enhanced and declined by SCGs amendment. Furthermore, the soil hydrological properties were significantly influenced by the soil amendment (spent coffee grounds, salt, and sand) application. Our results showed that spent coffee grounds mixing in urban soil has considerably enhanced the soil VWC, Sa, S4, S24, and Pk, whereas it decreased the water drop penetration time. The analysis showed that the single dose of soil amendments had not improved soil chemical properties very well. Therefore, it is suggested that SCGs should be applied more than single dose. This is a good direction to look for ways to improve the retention properties of urban soil and you can consider combining SCGs with other organic materials like compost, farmyard manure, or biochar.

Biodegradable external wrapping promotes favorable adaptation in an ovine vein graft model.

Vein grafts, the most commonly used conduits in multi-vessel coronary artery bypass grafting surgery, have high intermediate- and long-term failure rates. The abrupt and marked increase in hemodynamic loads on the vein graft is a known contributor to failure. Recent computational modeling suggests that veins can more successfully adapt to an increase in mechanical load if the rate of loading is gradual. Applying an external wrap or support at the time of surgery is one way to reduce the transmural load, and this approach has improved performance relative to an unsupported vein graft in several animal studies. Yet, a clinical trial in humans has shown benefits and drawbacks, and mechanisms by which an external wrap affects vein graft adaptation remain unknown. This study aims to elucidate such mechanisms using a multimodal experimental and computational data collection pipeline. We quantify morphometry using magnetic resonance imaging, mechanics using biaxial testing, hemodynamics using computational fluid dynamics, structure using histology, and transcriptional changes using bulk RNA-sequencing in an ovine carotid-jugular interposition vein graft model, without and with an external biodegradable wrap that allows loads to increase gradually. We show that a biodegradable external wrap promotes luminal uniformity, physiological wall shear stress, and a consistent vein graft phenotype, namely, it prevents over-distension, over-thickening, intimal hyperplasia, and inflammation, and it preserves mechanotransduction. These mechanobiological insights into vein graft adaptation in the presence of an external support can inform computational growth and remodeling models of external support and facilitate design and manufacturing of next-generation external wrapping devices. STATEMENT OF SIGNIFICANCE: External mechanical support is emerging as a promising technology to prevent vein graft failure following coronary bypass graft surgery. While variants of this technology are currently under investigation in clinical trials, the fundamental mechanisms of adaptation remain poorly understood. We employ an ovine carotid-jugular interposition vein graft model, with and without an external biodegradable wrap to provide mechanical support, and probe vein graft adaptation using a multimodal experimental and computational data collection pipeline. We quantify morphometry using magnetic resonance imaging, mechanics using biaxial testing, fluid flow using computational fluid dynamics, vascular composition and structure using histology, and transcriptional changes using bulk RNA sequencing. We show that the wrap mitigates vein graft failure by promoting multiple adaptive mechanisms (across biological scales).

Mix-method modelling of actors' capacity for environmental sustainability and climate compatible development in energy sector.

The development of the energy sector has played a major role in greenhouse gas (GHG) emissions and pollution. The situation thus necessitates rigorous actions for climate compatible development (CCD). The energy sector is context-dependent, due to which response strategies for CCD are quite challenging particularly in the context of energy crises and the actors' capacity issue in developing countries. This study was aimed at exploring the role of government actors involved in governing the energy sector, with the objective to assess their capacity using a set of principles, criteria, and indicators (PCIs). The study attempted to answer the question: is the capacity of the line departments involved in energy governance adequate to achieve the targets set under SDG-7 and SDG-13? For this purpose, the study employed a combination of "Rules-based" and "Rights-based" governance approaches at all tiers of governance, i.e., federal, provincial, and district levels. Actors' capacity was assessed by developing a governance index based on the scoring of PCIs. Three hundred forty key informant interviews (KIIs) and 17 focus group discussions (FGD) were conducted at federal, provincial, and district levels where respondents were asked to score each of the indicators. Responses were then statistically analyzed and validated. The findings revealed that departments at the federal level are playing an effective role and are adequately equipped to align SDG-7 and SDG-13 with energy sector development. However, departments at the provincial and district levels are still lagging behind to achieve the desired objectives, which demonstrate the need to enhance the capacities of provincial and district line departments.

Colocalization of Coronary Plaque with Wall Shear Stress in Myocardial Bridge Patients.

PURPOSE: Patients with myocardial bridges (MBs) have a higher prevalence of atherosclerosis. Wall shear stress (WSS) has previously been correlated with plaque in coronary artery disease patients, but such correlations have not been investigated in symptomatic MB patients. The aim of this paper was to use a multi-scale computational fluid dynamics (CFD) framework to simulate hemodynamics in MB patient, and investigate the co-localization of WSS and plaque. METHODS: We identified N = 10 patients from a previously reported cohort of 50 symptomatic MB patients, all of whom had plaque in the proximal vessel. Dynamic 3D models were reconstructed from coronary computed tomography angiography (CCTA), intravascular ultrasound (IVUS) and catheter angiograms. CFD simulations were performed to compute WSS proximal to, within and distal to the MB. Plaque was quantified from IVUS images in 2 mm segments and registered to CFD model. Plaque area was compared to absolute and patient-normalized WSS. RESULTS: WSS was lower in the proximal segment compared to the bridge segment (6.1 ± 2.9 vs. 16.0 ± 7.1 dynes/cm2, p value < 0.01). Plaque area and plaque burden measured from IVUS peaked at 1-3 cm proximal to the MB entrance, coinciding with the first diagonal branch. Normalized WSS showed a statistically significant moderate correlation with plaque area (r = 0.41, p < 0.01). CONCLUSION: WSS may be obtained non-invasively in MB patients and provides a surrogate marker of plaque area. Using CFD, it may be possible to non-invasively assess the extent of plaque area, and identify patients who could benefit from frequent monitoring or medical management.

Smart IoT and Machine Learning-based Framework for Water Quality Assessment and Device Component Monitoring.

Water is the most important natural element present on earth for humans, yet the availability of pure water is becoming scarce and decreasing. An increase in population and rise in temperatures are two major factors contributing to the water crisis worldwide. Desalinated, brackish water from the sea, lake, estuary, or underground aquifers is treated to maximize freshwater availability for human consumption. However, mismanagement of water storage, distribution, or quality leads to serious threats to human health and ecosystems. Sensors, embedded and smart devices in water plants require proactive monitoring for optimal performance. Traditional quality and device management require huge investments in time, manual efforts, labour, and resources. This research presents an IoT-based real-time framework to perform water quality management, monitor, and alert for taking actions based on contamination and toxic parameter levels, device and application performance as the first part of the proposed work. Machine learning models analyze water quality trends and device monitoring and management architecture. The results display that the proposed method manages water monitoring and accessing water parameters efficiently than other works.

Role of financial development, environmental-related technologies, research and development, energy intensity, natural resource depletion, and temperature in sustainable environment in Canada.

Environmental sustainability concerns are increasing worldwide; both developing and developed countries face environmental degradation. Literature has highlighted the environment-growth nexus; however, the impact of environmental-related technologies on the environment is ignored in early studies. This study aims to explore the implications of financial development, environmental-related technologies, research and development, energy intensity, renewable energy production, natural resource depletion, and temperature in a sustainable environment in Canada by using a time series model, i.e., dynamic ARDL simulations (Jordan and Philips 2018) with data from 1989 to 2020. The examined findings of the dynamic ARDL simulations indicate that environmental-related technologies in Canada help to reduce environmental degradation both in the short run and in the long run. At the same time, financial development, energy intensity, renewable energy production, research and development, natural resource depletion, and temperature causes boost the environmental degradation in Canada. To achieve sustainable environment, Canada needs to improve innovations in the environmental-related technologies for achieving sustainable growth and environment.

Saliva Exhibits High Sensitivity and Specificity for the Detection of SARS-COV-2.

In the wake of the COVID-19 pandemic, it is crucial to assess the application of a multitude of effective diagnostic specimens for conducting mass testing, for accurate diagnosis and to formulate strategies for its prevention and control. As one of the most versatile and amenable specimen options, saliva offers great advantages for widespread screening strategies due to its non-invasive properties, cost-effectiveness, excellent stability and minimal risk of cross-infection. This review attempts to outline the scientific rationale for detection of SARS-COV-2 in saliva specimens. By combining the data obtained from ten chosen published clinical studies, we calculated the pooled sensitivity and specificity using an online calculator. Through evidence, we established that SARS-COV-2 is detectable in saliva with a high degree of diagnostic sensitivity (87%) and specificity (98%). We also presented a review of emerging technologies approved by the FDA for detection of SARS-COV-2 in oral fluids (saliva and sputum) using polymerase chain reaction methods. Given the challenges involved in obtaining invasive specimens from the naso- and oropharynx, saliva can serve as an easy to collect diagnostic specimen for screening in the work environment, schools and for home testing. Furthermore, saliva offers the opportunity to screen early cases that can be missed by invasive sampling.

Effect of foreign direct investment on CO2 emission with the role of globalization, institutional quality with pooled mean group panel ARDL.

This study utilized the Pooled Mean Group estimator to investigate the effect of renewable energy consumption, electricity consumption, economic growth, institutional quality, and globalization on carbon dioxide emission with an updated dataset for 10 economies for the time period from 1985 to 2018. Results of Harris-Tzavalis's test and Levin-Lin-Chu's test show that the utilized regressand and regressors are stationary at I(0) and I(I) that conform that the pooled mean group estimator panel ARDL can be utilized. Results of Kao and Pedroni cointegration tests show that cointegration exists amongst the variables. Empirical results of pooled mean group (PMG) revealed that renewable energy consumption helps to diminish the environmental degradation while foreign direct investment, electricity consumption, and economic growth and institutional quality positively affect the degradation of the environment. The findings show that globalization in the long run adversely and significantly influences the environmental degradation; globalization reduces the environmental degradation in the long run while in the short run, globalization positively and significantly influences the environmental degradation. Results of the panel VAR and VECM model indicate electricity consumption and institutional quality, and globalization positively affects environmental degradation. Further policies are recommended based on the findings.

Low Wall Shear Stress Is Associated with Saphenous Vein Graft Stenosis in Patients with Coronary Artery Bypass Grafting.

Biomechanical forces may play a key role in saphenous vein graft (SVG) disease after coronary artery bypass graft (CABG) surgery. Computed tomography angiography (CTA) of 430 post-CABG patients were evaluated and 15 patients were identified with both stenosed and healthy SVGs for paired analysis. The stenosis was virtually removed, and detailed 3D models were reconstructed to perform patient-specific computational fluid dynamic (CFD) simulations. Models were processed to compute anatomic parameters, and hemodynamic parameters such as local and vessel-averaged wall shear stress (WSS), normalized WSS (WSS*), low shear area (LSA), oscillatory shear index (OSI), and flow rate. WSS* was significantly lower in pre-diseased SVG segments compared to corresponding control segments without disease (1.22 vs. 1.73, p = 0.012) and the area under the ROC curve was 0.71. No differences were observed in vessel-averaged anatomic or hemodynamic parameters between pre-stenosed and control whole SVGs. There are currently no clinically available tools to predict SVG failure post-CABG. CFD modeling has the potential to identify high-risk CABG patients who may benefit from more aggressive medical therapy and closer surveillance. Graphical Abstract.

Association between aneurysm hemodynamics and wall enhancement on 3D vessel wall MRI.

OBJECTIVE: Aneurysm wall enhancement (AWE) on 3D vessel wall MRI (VWMRI) has been suggested as an imaging biomarker for intracranial aneurysms (IAs) at higher risk of rupture. While computational fluid dynamics (CFD) studies have been used to investigate the association between hemodynamic forces and rupture status of IAs, the role of hemodynamic forces in unruptured IAs with AWE is poorly understood. The authors investigated the role and implications of abnormal hemodynamics related to aneurysm pathophysiology in patients with AWE in unruptured IAs. METHODS: Twenty-five patients who had undergone digital subtraction angiography (DSA) and VWMRI studies from September 2016 to September 2017 were included, resulting in 22 patients with 25 IAs, 9 with and 16 without AWE. High-resolution CFD models of hemodynamics were created from DSA images. Univariate and multivariate analyses were performed to investigate the association between AWE and conventional morphological and hemodynamic parameters. Normalized MRI signal intensity was quantified and quantitatively associated with wall shear stresses (WSSs) for the entire aneurysm sac, and in regions of low, intermediate, and high WSS. RESULTS: The AWE group had lower WSS (p < 0.01) and sac-averaged velocity (p < 0.01) and larger aneurysm size (p < 0.001) and size ratio (p = 0.0251) than the non-AWE group. From multivariate analysis of both hemodynamic and morphological factors, only low WSS was found to be independently associated with AWE. Sac-averaged normalized MRI signal intensity correlated with WSS and was significantly different in regions of low WSS compared to regions of intermediate (p = 0.018) and high (p < 0.001) WSS. CONCLUSIONS: The presence of AWE was associated with morphological and hemodynamic factors related to rupture risk. Low WSS was found to be an independent predictor of AWE. Our findings support the hypothesis that low WSS in IAs with AWE may indicate a growth and remodeling process that may predispose such aneurysms to rupture; however, a causality between the two cannot be established.

A Eulerian method to analyze wall shear stress fixed points and manifolds in cardiovascular flows.

Based upon dynamical systems theory, a fixed point of a vector field such as the wall shear stress (WSS) at the luminal surface of a vessel is a point where the vector field vanishes. Unstable/stable manifolds identify contraction/expansion regions linking fixed points. The significance of such WSS topological features lies in their strong link with "disturbed" flow features like flow stagnation, separation and reversal, deemed responsible for vascular dysfunction initiation and progression. Here, we present a Eulerian method to analyze WSS topological skeleton through the identification and classification of WSS fixed points and manifolds in complex vascular geometries. The method rests on the volume contraction theory and analyzes the WSS topological skeleton through the WSS vector field divergence and Poincar[Formula: see text] index. The method is here applied to computational hemodynamics models of carotid bifurcation and intracranial aneurysm. An in-depth analysis of the time dependence of the WSS topological skeleton along the cardiac cycle is provided, enriching the information obtained from cycle-average WSS. Among the main findings, it emerges that on the carotid bifurcation, instantaneous WSS fixed points co-localize with cycle-average WSS fixed points for a fraction of the cardiac cycle ranging from 0 to [Formula: see text]; a persistent instantaneous WSS fixed point confined on the aneurysm dome does not co-localize with the cycle-average low-WSS region. In conclusion, the here presented approach shows the potential to speed up studies on the physiological significance of WSS topological skeleton in cardiovascular flows, ultimately increasing the chance of finding mechanistic explanations to clinical observations.

Impact of globalization, economic factors and energy consumption on CO2 emissions in Pakistan.

This research scrutinizes the impact of globalization, economic factors and energy consumption on CO2 emissions in Pakistan from 1971 to 2016 by utilizing dynamic ARDL simulations model Jordan and Philips (2018). Dynamic ARDL simulations model has capability to predict the actual positive and negative change in the independent variables and its effect on the dependent variable. The examined results of dynamic ARDL simulations indicates that Energy consumption, financial development, trade, foreign direct investment, economic globalization, social globalization and political globalization have positive effect on CO2 emissions in Pakistan while urbanization, economic growth and innovation have negative effect on CO2 emissions in Pakistan while in the short run the examined results of dynamic ARDL simulations indicate that energy consumption, urbanization, economic growth, financial development, economic globalization, social globalization and political globalization have positive effect on CO2 emissions in Pakistan while trade, innovation and foreign direct investment have negative effect on CO2 emissions. Based on the results of this study policy implications are suggested for Pakistan.

Anatomical evaluation of intracranial aneurysm rupture risk in patients with multiple aneurysms.

In patients with aneurysmal subarachnoid hemorrhage (aSAH) and multiple aneurysms, there is a need to objectively identify the ruptured aneurysm. Additionally, studying the intra-individual rupture risk of multiple aneurysms eliminates extrinsic risk factors and allows a focus on anatomical factors, which could be extrapolated to patients with single aneurysms too. Retrospective bi-center study (Department of Neurosurgery of the University Hospital Duesseldorf and Bern) on patients with multiple aneurysms and subarachnoid hemorrhage caused by the rupture of one of them. Parameters investigated were height, width, neck, shape, inflow angle, diameter of the proximal and distal arteries, width/neck ratio, height/width ratio, height/neck ratio, and localization. Statistical analysis and logistic regressions were performed by the R program, version 3.4.3. N = 186 patients with aSAH and multiple aneurysms were treated in either department from 2008 to 2016 (Bern: 2008-2016, 725 patients and 100 multiple aneurysms, Duesseldorf: 2012-2016, 355 patients, 86 multiple aneurysms). The mean age was 57 years. N = 119 patients had 2 aneurysms, N = 52 patients had 3 aneurysms, N = 14 had 4 aneurysms and N = 1 had 5 aneurysms. Eighty-four percent of ruptured aneurysms were significantly larger than the largest unruptured. Multilobularity of ruptured aneurysms was significantly higher than in unruptured. Metric variables describing the geometry (height, width, etc.) and shape are the most predictive for rupture. One or two of them alone are already reliable predictors. Ratios are completely redundant in saccular aneurysms.

Multiple Aneurysms AnaTomy CHallenge 2018 (MATCH): Phase I: Segmentation.

PURPOSE: Advanced morphology analysis and image-based hemodynamic simulations are increasingly used to assess the rupture risk of intracranial aneurysms (IAs). However, the accuracy of those results strongly depends on the quality of the vessel wall segmentation. METHODS: To evaluate state-of-the-art segmentation approaches, the Multiple Aneurysms AnaTomy CHallenge (MATCH) was announced. Participants carried out segmentation in three anonymized 3D DSA datasets (left and right anterior, posterior circulation) of a patient harboring five IAs. Qualitative and quantitative inter-group comparisons were carried out with respect to aneurysm volumes and ostia. Further, over- and undersegmentation were evaluated based on highly resolved 2D images. Finally, clinically relevant morphological parameters were calculated. RESULTS: Based on the contributions of 26 participating groups, the findings reveal that no consensus regarding segmentation software or underlying algorithms exists. Qualitative similarity of the aneurysm representations was obtained. However, inter-group differences occurred regarding the luminal surface quality, number of vessel branches considered, aneurysm volumes (up to 20%) and ostium surface areas (up to 30%). Further, a systematic oversegmentation of the 3D surfaces was observed with a difference of approximately 10% to the highly resolved 2D reference image. Particularly, the neck of the ruptured aneurysm was overrepresented by all groups except for one. Finally, morphology parameters (e.g., undulation and non-sphericity) varied up to 25%. CONCLUSIONS: MATCH provides an overview of segmentation methodologies for IAs and highlights the variability of surface reconstruction. Further, the study emphasizes the need for careful processing of initial segmentation results for a realistic assessment of clinically relevant morphological parameters.

On the quantification and visualization of transient periodic instabilities in pulsatile flows.

Turbulent-like flows without cycle-to-cycle variations are more frequently being reported in studies of cardiovascular flows. The associated stimuli might be of mechanobiological relevance, but how to quantify them objectively is not obvious. Classical Reynolds decomposition, where the flow is separated into mean and fluctuating velocity components, is not applicable as the phase-average is zero. We therefore expanded on established techniques and present the idea, analogous to Reynolds decomposition, to decompose a flow with transient instabilities into low- versus high frequency components, respectively, to discriminate flow instabilities from the underlying cardiac pulsatility. Transient wall shear stress and velocity signals derived from computational fluid dynamic simulations were transferred to the frequency domain. A high-pass filter was applied to subtract the 99% most-energy-containing frequencies, which gave a cut-off frequency of 25Hz. We introduce here the spectral power index, and compute the fluctuating kinetic energy, based on the high-pass filtered velocity components, both being frequency-based operators. The efficacy was evaluated in an aneurysm model for multiple flow rates demonstrating transition to turbulent-like flows. The frequency-based operators were found to better correlate with the qualitatively observed flow instabilities compared to conventional descriptors, like time-averaged wall shear stress or oscillatory shear index. We demonstrate how the high frequencies beyond the physiological range could be analyzed and/or transferred back to the time domain for quantification and visualization purposes. We have introduced general frequency-based operators, easily extendable to other cardiovascular territories based on a posteriori heuristic filtering that allows for separation, isolation, and quantification of cycle-invariant turbulent-like flows.

Current understanding of treatment and management protocol for adult diabetic in-patients at a tertiary care hospital.

OBJECTIVE: To assess the current understanding of treatment and management protocols for adult diabetic inpatients at a tertiary care hospital. METHODS: This cross-sectional study, conducted at the Civil Hospital Karachi from July to September 2009, involved 450 participants, who were interviewed through a well-structured questionnaire regarding the patient's demography, clinical features, past medical history, type of diabetes mellitus, duration, associated complications, and also involved patient notes for laboratory tests and management. SPSSv15.0 was used for descriptive analysis. RESULTS: The study population of 450 diabetics had 144 (32%) males and 306 (68%) females. Of the total, 435 (96.7%) patients had type 2 diabetes. There were 231 (51%) patients using insulin, 168 (37.3%) oral hypoglycaemic drugs, and 51 (11.3%) using both. Among patients using insulin, regular insulin usage stood at 30% followed by a combination of regular insulin and NPH (26.7%) and NPH alone at 6%. The most popular drug used was metformin (27.3%) and the least used drug was glitazones (4%). In the study population, 73.3% patients controlled their diabetes with diet, and 24.7% with regular exercise. CONCLUSION: Majority of the study population had type 2 diabetes with a female preponderance. Insulin was prescribed for half the patients. Metformin was the most frequently used oral hypoglycaemic drug.

Rituximab therapy for flare-up of rheumatoid arthritis after total knee replacement surgery.

A variety of drug types are used alone or in combination to manage Rheumatoid Arthritis along with physiotherapy. We report herein the case of a 51 year old female patient with a history of Rheumatoid Arthritis whose disease remained active despite being on routinely used multiple disease modifying antirheumatic drugs. The patient underwent bilateral total knee arthroplasty with subtotal synovectomy due to the severe pain caused by her concomitant age related osteoarthritis which was only aggravated by her active rheumatoid arthritis disease. Three months following surgery, the patient's knee pain with typical rheumatoid flare and swelling reappeared for which a B cell monoclonal antibody, rituximab, was given. Her number of tender and swollen joints reduced to less than three and her C-reactive protein levels and erythrocyte sedimentation rate reduced significantly along with considerable improvement in her Global Assessment score. Her severity of pain also decreased to 3 from an initial score of 8 on the Visual Analog Scale. Thus, Rituximab helped improve our patient's symptoms from recurrence of synovitis after total knee replacement.

Chromogranin A--serum marker for prostate cancer.

Prostate Cancer is the second most prevalent neoplasm after lung cancer in men. It commonly presents in patients with a strong family history. The measurement of Prostate Specific Antigen (PSA) in free and bound forms is one of the methods to diagnose it. It is very much useful for monitoring the therapeutic efficacy, staging, prognosis, tumour volume evaluation, detection of recurrent disease, screening and early diagnosis. Chromogranin A (CgA) is an acidic glycoprotein that is commonly expressed by neuroendocrine cells and constitutes one of the most profuse components of secretory granules. When a tumour develops in an endocrine tissue, it becomes the main source of circulating CgA. Its concentration is thought to be elevated in relation to neuroendocrine differentiation of prostate cancer. CgA is a useful predictive marker in patients with prostatic cancer who have lower PSA. It is known that neuroendocrine cells in the prostate do not contain androgen receptors and are not regulated by androgens. PSA expression was stimulated by androgen through androgen receptors, so it is suggested that cases of prostate cancer associated with low serum PSA and high serum CgA, which would have more neuroendocrine cells with less androgen receptors, may show resistance to endocrine therapy and a poor prognosis. Therefore serum CgA tends to be elevated in high grade prostate cancer cases. Hence it can be used to fill the gap if any left by PSA when combined with serum PSA, the serum marker may effectively predict the prognosis after endocrine therapy. CgA expression in prostate cancer biopsies is an independent extrapolative factor of hormone refractory disease in patients with newly diagnosed prostate cancer on early androgen deprivation therapy.