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Gallbladder perforation:A single-center experience in north India and a step-up approach for management

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Hepatobiliary & Pancreatic Diseases International 2022年第2期21卷 168-174页

作者： Vivek Gupta Abhijit Chandra Vishal Gupta Ravi Patel Amit Dangi ajay Pai Department of Surgical Gastroenterology King George’s Medical UniversityLucknowUttar Pradesh 226003India

Background: Spontaneous gallbladder perforation(GBP) is an uncommon diagnosis. This study presented the experience of managing spontaneous GBP over nine years at a large, tertiary care university hospital in north India and investigated the outcomes and treatment strategies. Methods: A retrospective review of prospectively maintained digital database of consecutive patients was performed. All patients received medical and/or surgical treatment for spontaneous GBP in our department between January 2010 and June 2018. Results: We identifed 151 patients(81 females and 70 males) with mean age of 53 years. Most common presenting features were pain(96.7%), fever(54.3%) and jaundice(31.1%). Most common cause was gallbladder stones(84.8%) followed by common bile duct stones(30.5%), xanthogranulomatous cholecystitis(17.9%) and malignancy(11.9%). As per Niemeier classifcation, 8.6% had type 1 GBP(free perforation in peritoneal cavity), 76.2% had type 2 GBP(localized perforation) and 13.2% had type 3 GBP(cholecystoenteric fstula). About 60% of the perforations were diagnosed preoperatively. Type 1 was more common in patients with diabetes and also had the worst prognosis. Surgery was performed in 109 patients(72.2%). Seven patients(4.6%) had a postoperative morbidity of Clavien-Dindo Ⅲ or higher. There were three mortalities in patients who underwent surgery. Conclusions: High index of suspicion is required for preoperative diagnosis of GBP, especially in types 2 and 3. Laparoscopic cholecystectomy can be difficult in these patients and patients may require open or partial cholecystectomy. Early diagnosis and step-up approach for the treatment of GBP is critical.

关键词： Acute calculus cholecystitis Cholecystectomy Cholecysto-enteric fstula Niemeier classifcation

Does steroid-free immunosuppression improve the outcome in kidney transplant recipients compared to conventional protocols?

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World Journal of Transplantation 2021年第4期11卷 99-113页

作者： Ahmed Aref ajay Sharma Ahmed Halawa Department of Nephrology Sur hospitalSur 411Oman Department of Transplantation Royal Liverpool University HospitalsLiverpool 111United Kingdom Department of Transplantation Sheffield Teaching HospitalsSheffield S57AUUnited Kingdom

Steroids continue to be the cornerstone of immune suppression since the early days of organ *** are key component of induction protocols,maintenance therapy and in the treatment of various forms of *** steroid use resulted in significant side effects on almost all the body organs owing to the presence of steroid receptors in most of the mammalian *** allograft recipients had to accept the short and long term complications of steroids because of lack of effective *** situation changed with the introduction of newer and more effective immune suppression agents with a relatively more acceptable side effect *** a result,the clinicians have been contemplating if it is the time to abandon the unquestionable reliance on maintenance steroids in modern transplantation *** review aims to evaluate the safety and efficacy of various steroid-minimization approaches(steroid avoidance,early steroid withdrawal,and late steroid withdrawal)in kidney transplant recipients.A meticulous electronic search was conducted through the available data resources like SCOPUS,MEDLINE,and Liverpool University library *** articles obtained through our search were included.A total number of 90 articles were eligible to be included in this review[34 randomised controlled trials(RCT)and 56 articles of other research modalities].All articles were evaluating the safety and efficacy of various steroidfree approaches in comparison to maintenance *** will cover only the RCT articles in this *** used in right clinical context,steroid-free protocols proved to be comparable to steroid-based maintenance *** appropriate approach should be tailored individually according to each recipient immunological challenges and clinical condition.

关键词： Kidney transplantation Steroid free Immune suppression Steroid avoidance Steroid withdrawal Outcome

Simultaneous breast and ovarian metastasis from gallbladder carcinoma

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Hepatobiliary & Pancreatic Diseases International 2010年第5期9卷 553-554页

作者： Sanjay Singh Puneet Gupta Rahul Khanna ajay K Khanna Department of General Surgery Institute of Medical SciencesBanaras Hindu University

BACKGROUND:Gallbladder carcinoma is a common malignancy in the Indian *** commonly metastasizes through lymphatics,direct invasion,and hematogenous spread.A common extra-abdominal site of metastasis is the *** metastasis to breast and ovary is extremely ***:This report describes an unusual case of carcinoma gallbladder metastasizing to the breast and ovary at the same ***:A 45-year-old woman came to us with complaints of flatulent dyspepsia associated with weight loss and *** of the abdomen revealed hepatomegaly with thick-walled gallbladder with multiple stones and a mass at the fundus,but normal uterus and ***-enhanced computer tomography of the abdomen showed a gallbladder mass infiltrating the liver *** patient underwent radical *** examination revealed a poorly-differentiated adenocarcinoma with margins free from tumor *** month after surgery she developed a breast *** of the abdomen for metastatic workup revealed an ovary *** mastectomy and salphingo-opherectomy were performed,and histopathological examination revealed a metastatic *** patient is now on chemotherapy with ***:This is an unusual case of carcinoma of the gallbladder with metastasis to the breast and ovary,which has not been documented before.

关键词： gallbladder carcinoma breast metastasis ovary metastasis

Comparative evaluation for catalytic gasification of petroleum coke and asphaltene in subcritical and supercritical water

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Journal of Energy Chemistry 2019年第4期28卷 107-118页

作者： Rachita Rana Sonil Nanda Aimee Maclennan Yongfeng Hu Janusz A.Kozinski ajay K.Dalai Department of Chemical and Biological Engineering University of Saskatchewan Department of Chemical and Biochemical Engineering University of Western Ontario Soft X-Ray Micro-Characterization Beamline Canadian Light Source Inc. New Model in Technology & Engineering

Subcritical and supercritical water gasification of petroleum coke and asphaltene was performed at variable temperatures(350–650°C),feed concentrations(15–30 wt%)and reaction times(15–60 min).Nickel-impregnated activated carbon(Ni/AC)was synthesized as a catalyst for enhancing syngas yields at optimal gasification conditions(650°C,15 wt%and 60 min).Structural chemistry of precursors and chars developed at different gasification temperatures was studied using physicochemical and synchrotronbased approaches such as carbon–hydrogen–nitrogen–sulfur(CHNS)analysis,thermogravimetric and differential thermogravimetric analysis(TGA/DTA),scanning electron microscopy(SEM),Fourier-Transform Infrared spectroscopy(FTIR),Raman spectroscopy,X-ray diffraction(XRD)and X-ray absorption spectroscopy(XAS).Asphaltene testified to be a better precursor for catalytic hydrothermal gasification leading to 11.97 mmol/g of total gas yield compared to petroleum coke(8.04 mmol/g).In particular,supercritical water gasification using 5 wt%Ni/AC at 650°C with 15 wt%feed concentration for 60 min resulted in 4.17 and 2.98 mmol/g of H_2from asphaltene and petroleum coke,*** the same conditions,the respective CH_4yields from catalytic gasification of asphaltene and petroleum coke were 2.54and 1.07 mmol/***,asphaltene also seemed to an attractive feedstock for the production of highly aromatic chars through hydrothermal gasification.

关键词： Asphaltene Petroleum coke Subcritical water Supercritical water Gasification Char

Learning Noise-Assisted Robust Image Features for Fine-Grained Image Retrieval

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Computer Systems Science & Engineering 2023年第9期46卷 2711-2724页

作者： Vidit Kumar Hemant Petwal ajay Krishan Gairola Pareshwar Prasad Barmola Department of Computer Science and Engineering Graphic Era Deemed to be UniversityDehradun248002India School of Computer Science Engineering and Technology Bennett UniversityGreater Noida201310Uttar PradeshIndia

Fine-grained image search is one of the most challenging tasks in computer vision that aims to retrieve similar images at the fine-grained level for a given query *** key objective is to learn discriminative fine-grained features by training deep models such that similar images are clustered,and dissimilar images are separated in the low embedding *** works primarily focused on defining local structure loss functions like triplet loss,pairwise loss,***,training via these approaches takes a long training time,and they have poor ***,representations learned through it tend to tighten up in the embedded space and lose generalizability to unseen *** paper proposes a noise-assisted representation learning method for fine-grained image retrieval to mitigate these *** the proposed work,class manifold learning is performed in which positive pairs are created with noise insertion operation instead of tightening class *** other instances are treated as negatives within the same *** a loss function is defined to penalize when the distance between instances of the same class becomes too small relative to the noise pair in that class in embedded *** proposed approach is validated on CARS-196 and CUB-200 datasets and achieved better retrieval results(85.38%recall@1 for CARS-196%and 70.13%recall@1 for CUB-200)compared to other existing methods.

关键词： Convolutional network zero-shot learning fine-grained image retrieval image representation image retrieval intra-class diversity feature learning

Community and hospital acquired methicillin resistant Staphylococcus aureus efficiently retain the Van A determinant

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Frontiers in Biology 2015年第6期10卷 520-527页

作者： Anup Kainthola ajay B. Bhatt Ashish Gupta Laboratory of Microbiology Department of Botany & Microbiology HNB Garhwal Central University Uttarakhand 246174 India School of Biotechnology Amity International University NOIDA UP India

Dissemination of vancomycin resistance from hospital to community strains is a serious threat to public health. Our study aimed to provide evidence for transmission of Van A type resistance from the hospital to the community. Wild-type community and hospital associated methicillin resistant Staphylococcus aureus strains were studied in vitro and in a model that mimicked a natural environment to ascertain their ability to acquire and maintain the vancomycin resistance determinant （Van A gene） from vancomycin resistant Enterococcus faecalis. Fitness was assessed and the cost of Van A acquisition and retention was estimated. In vitro mating experiments were carried out using a filter mating technique and a model of a natural water body environment. Transfer of resistance was carried out in two different conditions： restricted and favorable. Transconjugants were confirmed by E test and PCR using specific primer sets. Growth kinetics and fitness measurements were done by spectrometric analysis. Using the in vitro filter mating technique, high transfer frequencies that ranged from 0.7 × 10^-3（0.0006） to 3.1 ×10^-4（0.00011） were recorded, with the highest transfer frequencies for CA MRSA （thermosensitively homogenous）（0.7 × 10^- 3）, and 1.2 × 10^-4 to 2.4 × 10^-4 in the model. HA MRSA （homogenous） showed a greater capacity （3.6 ×10^-4） to receive the Van A gene, while CA MRSA showed a reduced ability to maintain the gene after serial subcultures. CA and HA thermosensitively heterogeneous MRSA transconjugants exhibited higher growth rates. The present study provides evidence for the enhanced ability of CA and HA MRSA clones to acquire and maintain Van A type resistance.

关键词： Van A resistance MRSA fitness growth kinetics resistance transfer

Lattice Boltzmann Simulation of a Gas-to-Solid Reaction and Precipitation Process in a Circular Tube

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Computer Modeling in Engineering & Sciences 2018年第12期117卷 527-553页

作者： Matthew D.Lindemer Suresh G.Advani ajay K.Prasad Department of Mechanical and Industrial Engineering University of Minnesota Duluth1049 University DriveDuluthMN 55812USA Department of Mechanical Engineering University of DelawareNewarkDE 19716USA.

The lattice Boltzmann method(LBM)is used to simulate the growth of a solid-deposit on the walls of a circular tube resulting from a gas-to-solid reaction and precipitation *** process is of particular interest for the design of reactors for the production of hydrogen by the heterogeneous hydrolysis of steam with Zn vapor in the Zn/ZnO thermochemical *** solid deposit of ZnO product on the tube wall evolves in time according to the temporally-and axially-varying convective-diffusive transport and reaction of Zn vapor with steam on the solid *** LBM is wellsuited to solving problems with coupled flow,heat and mass transfer in a time-evolving ***,a D2Q9 axisymmetric multiple-relaxation-time(MRT)lattice Boltzmann scheme is used to simulate incompressible fluid transport while a D2Q5 axisymmetric MRT lattice Boltzmann scheme is used to simulate the convective-diffusive transport of Zn *** model is first validated against several analytical solutions,followed by a parametric study to understand the effect of Reynolds,Schmidt,and Damk?hler numbers on the time evolution of the ZnO deposition profile along the tube *** axial location of the fastest deposition is found to increase with increasing Peclet number,and decrease with increasing Damk?hler number,with no independent effect from the Schmidt *** the reaction kinetics are assumed to increase along the tube axis due to nonisothermal tube wall temperature,a second peak in the deposition profile can be observed for sufficiently low values of Da/Pe.

关键词： Lattice Boltzmann methods reactive flow heterogeneous reaction precipitation solar hydrogen production.

Integrated biological control of water hyacinths, Eichhornia crassipes by a novel combination of grass carp, Ctenopharyngodon idella (Valenciennes, 1844), and the weevil, Neochetina spp.

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Chinese Journal of Oceanology and Limnology 2011年第1期29卷 162-166页

作者： GOPALAKRISHNAN Ayyaru RAJKUMAR Mayalagu 孙军 PARIDA ajay VENMATHI MARAN Balu Alagar Centre of Advanced Study in Marine Biology Annamalai University Institute of Oceanology Chinese Academy of Sciences M.S.Swaminathan Research Foundation Third Cross StreetInstitutional Area Takehara Marine Science Station Graduate School of Biosphere ScienceHiroshima University

The efficacy of grass carp Ctenopharyngodon idella （Cyprinidae） and weevils Neochetina spp. （Curculionidae） to control the aquatic weed, water hyacinth, is investigated in a square net cage （happas） setting at a farm in Cuddalore District, South India. This novel combination of insects and fish is found to be superior to individual treatments for controlling the weed growth within ll0 d. The biomass of the weed, number of plants, percentage of flowered plants and chlorophyll contents were studied. The weed biomass is reduced from 5 kg （day 1） to 0.33 kg （day 110） when exposed to grass carp and weevils. The number of plants is reduced to 0.75 in grass carp and weevil exposed happas, while it is 741.5 in the control. The mean number of leaves per plant is also reduced. In addition, the chlorophyll a and b are significantly reduced in happas exposed to the combination of fish and insects when compared to the other treatments. Based on the results of this study, we consider the combined use of grass carp and weevils to be more efficient and sustainable for managing water hyacinths than the use of these organisms individually.

关键词： water hyacinth grass carp weevil biological control

Clinical considerations for critically ill COVID-19 cancer patients:A systematic review

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World Journal of Clinical Cases 2021年第28期9卷 8441-8452页

作者： Chidambaram Ramasamy ajay Kumar Mishra Kevin John John Amos Lal Department of Internal Medicine Saint Vincent HospitalWorcesterMA 01608United States Department of Medicine Bangalore Baptist HospitalBangalore 578954India Department of Medicine Division of Pulmonary and Critical Care MedicineMayo ClinicRochesterMN 55902United States

BACKGROUND The World Health Organization(WHO)on March 11,2020,had declared the novel coronavirus disease 2019(COVID-19)outbreak a global *** COVID-19 infection continues to be a pandemic and is currently causing overwhelming challenges to healthcare across the *** patients represent a unique population vulnerable to COVID-19 infection due to their advanced age,intrinsic frailty,medical comorbidities,immunosuppression,and frequent health care visits for their underlying *** analysis of COVID-19 infection among cancer patients is crucial to aid in the optimal management of these *** To identify contributors of worse outcomes in patients with malignancy and COVID-19 and to describe the role of critical *** In this review,we summarized the information from seminal articles on the presentation and management of patients with COVID-19 and malignancy that were published before December 10,*** searched the Pub Med and Medline database for“COVID-19”and“Cancer”,“Malignancy”.Studies published in English,including adults with malignancy and COVID-19 infection,were eligible to be included in this *** on patients that provided details on malignancy,clinical presentation,management,and outcome were *** details of malignancy that were included are the site of cancer,histopathological type,stage,chemotherapy,and *** of COVID-19 infection that were obtained are clinical presentation,the modality of testing,imaging,management,and *** care details that were obtained were the type of the organ dysfunction and the requirement of organ support measures,requirement of noninvasive,invasive ventilation,management of vasopressor support,and *** that did not have patient details,opinions,letters,and articles not published in English were *** articles were reviewed by 2 independent *** were screened for the above terminologies by independent clinician

关键词： COVID-19 Cancer Critical care Mortality Pandemic