{"id":1891,"date":"2026-07-14T09:16:07","date_gmt":"2026-07-14T09:16:07","guid":{"rendered":"https:\/\/hcsp-iap.pk\/cases\/?post_type=portfolio&#038;p=1891"},"modified":"2026-07-21T01:39:26","modified_gmt":"2026-07-21T01:39:26","slug":"case-03-4","status":"publish","type":"portfolio","link":"https:\/\/hcsp-iap.pk\/cases\/monthly_cases\/case-03-4\/","title":{"rendered":"Case 03"},"content":{"rendered":"\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-i5cx03-cd95590dcaedb0c7058c2c2ccc522d17\">\n.avia-section.av-i5cx03-cd95590dcaedb0c7058c2c2ccc522d17 .av-parallax .av-parallax-inner{\nbackground-repeat:no-repeat;\nbackground-image:url(https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2014\/09\/slider.png);\nbackground-position:50% 50%;\nbackground-attachment:scroll;\n}\n.avia-section.av-i5cx03-cd95590dcaedb0c7058c2c2ccc522d17 .av-section-color-overlay{\nopacity:0.7;\nbackground-color:#0f0f0f;\n}\n<\/style>\n<div id='av_section_1'  class='avia-section 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av_three_fourth  avia-builder-el-1  el_before_av_one_fourth  avia-builder-el-first  first flex_column_div  '     ><style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-mrhlix1r-f962bdbf1f34a88653b69ed9c55d0886\">\n#top .av-special-heading.av-mrhlix1r-f962bdbf1f34a88653b69ed9c55d0886{\npadding-bottom:40px;\ncolor:#ffffff;\nfont-size:72px;\n}\nbody .av-special-heading.av-mrhlix1r-f962bdbf1f34a88653b69ed9c55d0886 .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n#top #wrap_all .av-special-heading.av-mrhlix1r-f962bdbf1f34a88653b69ed9c55d0886 .av-special-heading-tag{\nfont-size:72px;\n}\n.av-special-heading.av-mrhlix1r-f962bdbf1f34a88653b69ed9c55d0886 .special-heading-inner-border{\nborder-color:#ffffff;\n}\n.av-special-heading.av-mrhlix1r-f962bdbf1f34a88653b69ed9c55d0886 .av-subheading{\nfont-size:20px;\n}\n\n@media only screen and (min-width: 480px) and (max-width: 767px){ \n#top #wrap_all .av-special-heading.av-mrhlix1r-f962bdbf1f34a88653b69ed9c55d0886 .av-special-heading-tag{\nfont-size:0.8em;\n}\n}\n\n@media only screen and (max-width: 479px){ \n#top #wrap_all .av-special-heading.av-mrhlix1r-f962bdbf1f34a88653b69ed9c55d0886 .av-special-heading-tag{\nfont-size:0.8em;\n}\n}\n<\/style>\n<div  class='av-special-heading av-mrhlix1r-f962bdbf1f34a88653b69ed9c55d0886 av-special-heading-h2 custom-color-heading blockquote modern-quote  avia-builder-el-2  avia-builder-el-no-sibling  av-inherit-size'><h2 class='av-special-heading-tag'  itemprop=\"headline\"  >Case 03<\/h2><div class='av_custom_color av-subheading av-subheading_below'><p>Case contributed by: Dr. Maryam Hameed, MBBS, FRCPath (UK on GMC specialist register) MIAC<br \/>\nCONSULTANT HISTOPATHOLOGIST AND CYTOPATHOLOGIST<br \/>\nShaukat Khanum Memorial Cancer Hospital And Research Centre, Lahore<\/p>\n<\/div><div class=\"special-heading-border\"><div class=\"special-heading-inner-border\"><\/div><\/div><\/div><\/div><div  class='flex_column av-e7wr3n-6d0110d058e50c866880560f75d4b36f av_one_fourth  avia-builder-el-3  el_after_av_three_fourth  avia-builder-el-last  flex_column_div  '     ><style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-mrhljo88-1bdf94370c04257fdbb8a0615f976696\">\n.avia-image-container.av-mrhljo88-1bdf94370c04257fdbb8a0615f976696 img.avia_image{\nbox-shadow:none;\n}\n.avia-image-container.av-mrhljo88-1bdf94370c04257fdbb8a0615f976696 .av-image-caption-overlay-center{\ncolor:#ffffff;\n}\n<\/style>\n<div  class='avia-image-container av-mrhljo88-1bdf94370c04257fdbb8a0615f976696 av-styling- avia-align-center  avia-builder-el-4  avia-builder-el-no-sibling '   itemprop=\"image\" itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/ImageObject\" ><div class=\"avia-image-container-inner\"><div class=\"avia-image-overlay-wrap\"><img decoding=\"async\" class='wp-image-1872 avia-img-lazy-loading-not-1872 avia_image ' src=\"https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Pic1-271x300.jpg\" alt='' title='Pic1'  height=\"300\" width=\"271\"  itemprop=\"thumbnailUrl\" srcset=\"https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Pic1-271x300.jpg 271w, https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Pic1-929x1030.jpg 929w, https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Pic1-768x851.jpg 768w, https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Pic1-1386x1536.jpg 1386w, https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Pic1-1848x2048.jpg 1848w, https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Pic1-1353x1500.jpg 1353w, https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Pic1-636x705.jpg 636w\" sizes=\"(max-width: 271px) 100vw, 271px\" \/><\/div><\/div><\/div><\/div><\/div><\/div><\/main><!-- close content main element --><\/div><\/div><\/div><div id='av_section_2'  class='avia-section av-1aq50j-6745f0fedcb04830e86d8a5154f5ec24 main_color avia-section-default avia-no-border-styling  avia-builder-el-5  el_after_av_section  el_before_av_layout_row  avia-bg-style-scroll container_wrap sidebar_right'  ><div class='container av-section-cont-open' ><div class='template-page content  av-content-small alpha units'><div class='post-entry post-entry-type-page post-entry-1891'><div class='entry-content-wrapper clearfix'>\n<div  class='flex_column av-12zafn-94438eb0f3329cc0999857a7a71a6683 av_one_full  avia-builder-el-6  avia-builder-el-no-sibling  first flex_column_div  '     ><p>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-9uw3qb-c2d6abc6520bf9407ad77a6828b741d4\">\n#top .av-special-heading.av-9uw3qb-c2d6abc6520bf9407ad77a6828b741d4{\npadding-bottom:10px;\n}\nbody .av-special-heading.av-9uw3qb-c2d6abc6520bf9407ad77a6828b741d4 .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n.av-special-heading.av-9uw3qb-c2d6abc6520bf9407ad77a6828b741d4 .av-subheading{\nfont-size:15px;\n}\n<\/style>\n<div  class='av-special-heading av-9uw3qb-c2d6abc6520bf9407ad77a6828b741d4 av-special-heading-h2 blockquote modern-quote  avia-builder-el-7  el_before_av_textblock  avia-builder-el-first '><h2 class='av-special-heading-tag'  itemprop=\"headline\"  >Case Description<\/h2><div class='av-subheading av-subheading_below'><p>A few details<\/p>\n<\/div><div class=\"special-heading-border\"><div class=\"special-heading-inner-border\"><\/div><\/div><\/div><br \/>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-mrhlkg12-9f150ec48bff7555b23cdc97ef6bdee4\">\n#top .av_textblock_section.av-mrhlkg12-9f150ec48bff7555b23cdc97ef6bdee4 .avia_textblock{\nfont-size:16px;\n}\n<\/style>\n<section  class='av_textblock_section av-mrhlkg12-9f150ec48bff7555b23cdc97ef6bdee4 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><p><strong>History:<\/strong><\/p>\n<p>A 35-year-old woman presented to the dermatology clinic with gradually progressive yellowish papules over the sides of her neck and both axillae for the past 8 years. She had noticed that the skin in these areas had become soft, lax, and wrinkled, but the lesions were neither painful nor pruritic. Over the preceding year, she also reported intermittent blurring of vision and difficulty reading fine print. There was no history of trauma, diabetes, or chronic inflammatory disease. Her father had similar skin changes and experienced vision loss in his fifth decade. On examination, Multiple 2\u20135 mm yellow-to-cream-colored papules coalescing into plaques on the lateral neck, axillae, and antecubital fossae. The affected skin had a &#8220;plucked chicken&#8221; (cobblestone) appearance with reduced elasticity.<\/p>\n<\/div><\/section><\/p><\/div>\n<\/p>\n<\/div><\/div><\/div><!-- close content main div --><\/div><\/div><div id='av-layout-grid-1'  class='av-layout-grid-container av-poohv-2e5417e10c9db92c4070a8f6f42ae6e1 entry-content-wrapper main_color av-flex-cells  avia-builder-el-9  el_after_av_section  el_before_av_contact  grid-row-not-first  container_wrap sidebar_right'  >\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-23p83-193c5cdb36fe8820c043589e6c9106b6\">\n.flex_cell.av-23p83-193c5cdb36fe8820c043589e6c9106b6{\nvertical-align:middle;\nbackground-color:#584632;\n}\n.responsive #top #wrap_all .flex_cell.av-23p83-193c5cdb36fe8820c043589e6c9106b6{\npadding:0px 0px 0px 0px !important;\n}\n<\/style>\n<div class='flex_cell av-23p83-193c5cdb36fe8820c043589e6c9106b6 av-gridrow-cell av_one_full no_margin  avia-builder-el-10  avia-builder-el-no-sibling  av-zero-padding'  ><div class='flex_cell_inner'><div id='av-masonry-1' class='av-masonry av-mrhlnuct-c8b817e3ce27b2acea01a3063c821527 noHover av-fixed-size av-large-gap av-hover-overlay-active av-masonry-animation-active av-masonry-col-flexible av-caption-always av-caption-style- av-masonry-gallery ' data-post_id=\"1891\"><div class=\"av-masonry-container isotope av-js-disabled\"><div class='av-masonry-entry isotope-item av-masonry-item-no-image '><\/div><a href=\"https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4b-1030x505.jpg\" data-srcset=\"https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4b-1030x505.jpg 1030w, https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4b-300x147.jpg 300w, https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4b-768x376.jpg 768w, https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4b-1536x753.jpg 1536w, https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4b-1500x735.jpg 1500w, https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4b-705x345.jpg 705w, https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4b.jpg 1555w\" data-sizes=\"(max-width: 1030px) 100vw, 1030px\"  aria-label=\"image Fig1\"  id='av-masonry-1-item-1893' data-av-masonry-item='1893' class='av-masonry-entry isotope-item post-1893 attachment type-attachment status-inherit hentry  av-masonry-item-with-image' title=\"Fig1\" alt=\"Fig1\"    itemprop=\"thumbnailUrl\" ><div class='av-inner-masonry-sizer'><\/div><figure class='av-inner-masonry main_color'><div class=\"av-masonry-outerimage-container\"><div class='av-masonry-image-container' style=\"background-image: url(https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4b-705x345.jpg);\"  title=\"Fig1\"   alt=\"Fig1\" ><\/div><\/div><figcaption class='av-inner-masonry-content site-background'><div class='av-inner-masonry-content-pos'><div class='av-inner-masonry-content-pos-content'><div class='avia-arrow'><\/div><h3 class='av-masonry-entry-title entry-title '  itemprop=\"headline\" >Fig1<\/h3><\/div><\/div><\/figcaption><\/figure><\/a><!--end av-masonry entry--><a href=\"https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4c-1030x505.jpg\" data-srcset=\"https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4c-1030x505.jpg 1030w, https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4c-300x147.jpg 300w, https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4c-768x376.jpg 768w, https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4c-1536x753.jpg 1536w, https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4c-1500x735.jpg 1500w, https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4c-705x345.jpg 705w, https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4c.jpg 1555w\" data-sizes=\"(max-width: 1030px) 100vw, 1030px\"  aria-label=\"image Fig2\"  id='av-masonry-1-item-1894' data-av-masonry-item='1894' class='av-masonry-entry isotope-item post-1894 attachment type-attachment status-inherit hentry  av-masonry-item-with-image' title=\"Fig2\" alt=\"Fig2\"    itemprop=\"thumbnailUrl\" ><div class='av-inner-masonry-sizer'><\/div><figure class='av-inner-masonry main_color'><div class=\"av-masonry-outerimage-container\"><div class='av-masonry-image-container' style=\"background-image: url(https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4c-705x345.jpg);\"  title=\"Fig2\"   alt=\"Fig2\" ><\/div><\/div><figcaption class='av-inner-masonry-content site-background'><div class='av-inner-masonry-content-pos'><div class='av-inner-masonry-content-pos-content'><div class='avia-arrow'><\/div><h3 class='av-masonry-entry-title entry-title '  itemprop=\"headline\" >Fig2<\/h3><\/div><\/div><\/figcaption><\/figure><\/a><!--end av-masonry entry--><a href=\"https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4d-1030x505.jpg\" data-srcset=\"https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4d-1030x505.jpg 1030w, https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4d-300x147.jpg 300w, https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4d-768x376.jpg 768w, https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4d-1536x753.jpg 1536w, https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4d-1500x735.jpg 1500w, https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4d-705x345.jpg 705w, https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4d.jpg 1555w\" data-sizes=\"(max-width: 1030px) 100vw, 1030px\"  aria-label=\"image Fig3\"  id='av-masonry-1-item-1895' data-av-masonry-item='1895' class='av-masonry-entry isotope-item post-1895 attachment type-attachment status-inherit hentry  av-masonry-item-with-image' title=\"Fig3\" alt=\"Fig3\"    itemprop=\"thumbnailUrl\" ><div class='av-inner-masonry-sizer'><\/div><figure class='av-inner-masonry main_color'><div class=\"av-masonry-outerimage-container\"><div class='av-masonry-image-container' style=\"background-image: url(https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4d-705x345.jpg);\"  title=\"Fig3\"   alt=\"Fig3\" ><\/div><\/div><figcaption class='av-inner-masonry-content site-background'><div class='av-inner-masonry-content-pos'><div class='av-inner-masonry-content-pos-content'><div class='avia-arrow'><\/div><h3 class='av-masonry-entry-title entry-title '  itemprop=\"headline\" >Fig3<\/h3><\/div><\/div><\/figcaption><\/figure><\/a><!--end av-masonry entry--><a href=\"https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4a-1030x505.jpg\" data-srcset=\"https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4a-1030x505.jpg 1030w, https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4a-300x147.jpg 300w, https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4a-768x376.jpg 768w, https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4a-1536x753.jpg 1536w, https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4a-1500x735.jpg 1500w, https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4a-705x345.jpg 705w, https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4a.jpg 1555w\" data-sizes=\"(max-width: 1030px) 100vw, 1030px\"  aria-label=\"image Elastin\"  id='av-masonry-1-item-1892' data-av-masonry-item='1892' class='av-masonry-entry isotope-item post-1892 attachment type-attachment status-inherit hentry  av-masonry-item-with-image' title=\"Elastin\" alt=\"Elastin\"    itemprop=\"thumbnailUrl\" ><div class='av-inner-masonry-sizer'><\/div><figure class='av-inner-masonry main_color'><div class=\"av-masonry-outerimage-container\"><div class='av-masonry-image-container' style=\"background-image: url(https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4a-705x345.jpg);\"  title=\"Elastin\"   alt=\"Elastin\" ><\/div><\/div><figcaption class='av-inner-masonry-content site-background'><div class='av-inner-masonry-content-pos'><div class='av-inner-masonry-content-pos-content'><div class='avia-arrow'><\/div><h3 class='av-masonry-entry-title entry-title '  itemprop=\"headline\" >Elastin<\/h3><\/div><\/div><\/figcaption><\/figure><\/a><!--end av-masonry entry--><a href=\"https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4TRICHROME-1030x505.jpg\" data-srcset=\"https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4TRICHROME-1030x505.jpg 1030w, https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4TRICHROME-300x147.jpg 300w, https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4TRICHROME-768x376.jpg 768w, https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4TRICHROME-1536x753.jpg 1536w, https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4TRICHROME-1500x735.jpg 1500w, https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4TRICHROME-705x345.jpg 705w, https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4TRICHROME.jpg 1555w\" data-sizes=\"(max-width: 1030px) 100vw, 1030px\"  aria-label=\"image Trichrome\"  id='av-masonry-1-item-1896' data-av-masonry-item='1896' class='av-masonry-entry isotope-item post-1896 attachment type-attachment status-inherit hentry  av-masonry-item-with-image' title=\"Trichrome\" alt=\"Trichrome\"    itemprop=\"thumbnailUrl\" ><div class='av-inner-masonry-sizer'><\/div><figure class='av-inner-masonry main_color'><div class=\"av-masonry-outerimage-container\"><div class='av-masonry-image-container' style=\"background-image: url(https:\/\/hcsp-iap.pk\/cases\/wp-content\/uploads\/2026\/07\/Case-4TRICHROME-705x345.jpg);\"  title=\"Trichrome\"   alt=\"Trichrome\" ><\/div><\/div><figcaption class='av-inner-masonry-content site-background'><div class='av-inner-masonry-content-pos'><div class='av-inner-masonry-content-pos-content'><div class='avia-arrow'><\/div><h3 class='av-masonry-entry-title entry-title '  itemprop=\"headline\" >Trichrome<\/h3><\/div><\/div><\/figcaption><\/figure><\/a><!--end av-masonry entry--><\/div><\/div>\n<\/div><\/div>\n<\/div><div id='after_grid_row_1'  class='main_color av_default_container_wrap container_wrap sidebar_right'  ><div class='container av-section-cont-open' ><div class='template-page content  av-content-small alpha units'><div class='post-entry post-entry-type-page post-entry-1891'><div class='entry-content-wrapper clearfix'>\n<p><form action=\"https:\/\/hcsp-iap.pk\/cases\/monthly_cases\/case-03-4\/\" method=\"post\" data-fields-with-error=\"Found errors in the following field(s):\" class=\"avia_ajax_form av-form-labels-visible   avia-builder-el-12  el_after_av_layout_row  el_before_av_button  avia-builder-el-first   \" data-avia-form-id=\"1\" data-avia-redirect='' ><h3 class=''>Which of the following genes is most commonly mutated in this condition?<\/h3><fieldset><p class='  first_form  form_element form_element_half' id='element_avia_1_1'><label for=\"avia_1_1\">Choose correct option: <abbr class=\"required\" title=\"required\">*<\/abbr><\/label><select  name=\"avia_1_1\" class=\"select is_empty\" id=\"avia_1_1\"><option  selected=\"selected\" value=''><\/option><option   value='a. FBN1'>a. FBN1<\/option><option   value='b. ELN'>b. ELN<\/option><option   value='c. COL3A1'>c. COL3A1<\/option><option   value='d. ABCC6'>d. 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