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Magnetic anchor guidance for endoscopic submucosal dissection and other endoscopic procedures

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World Journal of Gastroenterology 2017年第16期23卷 2883-2890页

作者： Mohamed Mortagy Neal Mehta Mansour A Parsi Seiichiro Abe Tyler Stevens John J Vargo Yutaka Saito amit bhatt Department of Internal Medicine Homer Stryker MD School of MedicineWestern Michigan UniversityKalamazooMI 49008United States Department of Internal Medicine Medicine InstituteCleveland ClinicClevelandOH 44195United States Department of Gastroenterology and Hepatology Digestive Disease InstituteCleveland ClinicClevelandOH 44195United States Endoscopy Division National Cancer Center HospitalTokyo 104-0045Japan

Endoscopic submucosal dissection(ESD) is a wellestablished, minimally invasive treatment for superficial neoplasms of the gastrointestinal tract. The universal adoption of ESD has been limited by its slow learning curve, long procedure times, and high risk of complications. One technical challenge is the lack of a second hand that can provide traction, as in conventional surgery. Reliable tissue retraction that exposes the submucosal plane of dissection would allow for safer and more efficient dissection. Magnetic anchor guided endoscopic submucosal dissection(MAGESD) has potential benefits compared to other current traction methods. MAG-ESD offers dynamic tissue retraction independent of the endoscope mimicking a surgeon's "second hand". Two types of magnets can be used: electromagnets and permanent magnets. In this article we review the MAG-ESD technology, published work and studies of magnets in ESD. We also review the use of magnetic anchor guidance systems in natural orifice transluminal endoscopic surgery and the idea of magnetic non-contact retraction using surface ferromagentization. We discuss the current limitations, the future potential of MAG-ESD and the developments needed for adoption of this technology.

关键词： Endoscopic submucosal dissection Gastric cancer Magnetic anchor guidance Esophageal cancer Magnets Traction Natural orifice transluminal endoscopic surgery

Clinical outcomes of endoscopic management of pancreatic fluid collections in cirrhotics vs non-cirrhotics: A comparative study

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World Journal of Gastrointestinal Endoscopy 2019年第6期11卷 403-412页

作者： Sobia Laique Matheus C Franco Tyler Stevens amit bhatt John J Vargo Prabhleen Chahal Internal Medicine Cleveland ClinicClevelandOH 44195United States Digestive Disease Institute Cleveland ClinicClevelandOH 44195United States

BACKGROUND Endoscopic management of symptomatic pancreatic fluid collections (PFCs) using self-expandable metal stents (SEMS) placement has emerged as an innovative therapeutic approach with excellent efficacy, safety, and relatively few adverse outcomes. However, their use has not been studied in patients with cirrhosis. Cirrhotics tend to be considered less than optimal candidates due to concern for portal hypertension and coagulopathy related complications. AIM To compare the efficacy and safety of using SEMS for drainage of symptomatic PFCs in cirrhotic vs non-cirrhotic patients. METHODS We conducted a retrospective comparative analysis of patients with symptomatic PFCs [pancreatic pseudocyst (PP) or walled-off necrosis (WON)] who underwent endoscopic ultrasound (EUS)-guided placement of fully covered self-expandable metals stents or lumen-apposing self-expandable metal stents. All patients were followed clinically until resolution of PFCs or death. Definition:(1) Technical success was defined as successful placement of SEMS;and (2) Clinical success was defined as complete resolution of the PFCs without additional interventions including interventional radiology or surgery. Number of procedures performed per patient, number of patients who achieved complete resolution of the PFCs without additional interventions and procedure related adverse events were *** From January 2012 to December 2017, a total of 88 patients underwent EUSguided drainage of symptomatic PFCs. Of these, 58 non cirrhotic patients underwent plastic stent insertion for management of PFC and 30 patients, 5 with cirrhosis and 25 without cirrhosis, underwent EUS-guided transmural drainage with SEMS, including 18 (60%) PP and 12 (40%) WON. Technical success was achieved in all 30 patients. Clinical success was achieved in 60% cirrhotic patients and 92% non-cirrhotics (P = 0.12). Procedure-related adverse events were 60% in cirrhotic and 28% non-cirrhotic (P = 0.62). Moreover, fatal adv

关键词： Endoscopic ultrasonography Pancreatic pseudocysts Liver cirrhosis

Efficacy of a Diabetes Specific Nutritional Supplement (DSNS) on Glycemic Response in Prediabetic Adults: A Two-Armed, Open-Labelled Randomized Controlled Study

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Food and Nutrition Sciences 2024年第7期15卷 612-643页

作者： Deepti Khanna Kejal Joshi Reddy Hema S. Gopalan Jaladhi bhatt Jayanti Gupta Simran Sethi Parth Joshi Manoj Pareek Department of R&D Hindustan Unilever Limited Gurugram India Mumbai India Cliantha Research Ahmedabad India

It is well known that Diabetes Specific Nutritional Supplements (DSNSs) are linked to improved glycemic control in individuals with diabetes. However, data on efficacy of DSNSs in prediabetics is limited. This was a two-armed, open-labelled, randomized controlled six-week study on 199 prediabetics [30 - 65 years;Glycosylated Hemoglobin (HbA1c) 5.7% - 6.4% and/or Fasting Blood Glucose (FBG) 100-125 mg/dl]. Two parallel phases were conducted: Acute Blood Glucose Response (ABGR) and Intervention phase. Prediabetic participants were randomized into test (n = 100) and control (n = 99). The primary objective was to assess the ABGR of DSNS versus an isocaloric snack, measured by incremental Area under the Curve (iAUC). Test and control received 60 g of DSNS and 56 g of isocaloric snack (cornflakes) respectively, both in 250 ml double-toned milk on visit days 1, 15, 29 and 43. Postprandial Blood Glucose (PPG) was estimated at 30, 60, 90, 120, 150 and 180 minutes. During the 4 weeks intervention phase, the test group received DSNS with lifestyle counselling (DSNS + LC) and was compared with the control receiving lifestyle counselling alone (LC alone). Impact was studied on FBG, HbA1C, anthropometry, body composition, blood pressure, nutrient intake, and physical activity. The impact of DSNS was also studied using CGM between two 14-day phases: CGM1 baseline (days 1 - 14) and CGM2 endline (days 28 - 42). DSNS showed significantly lower PPG versus isocaloric snack at 30 (p 12, and chromium were reported by DSNS + LC versus LC alone. No other significant changes were reported between groups. It may be concluded that DSNS may be considered as a snack for prediabetic or hyperglycemic individuals requiring nutritional support for improved glycemic control.

关键词： Diabetes Specific Nutritional Supplement Prediabetes Acute Blood Glucose Response Incremental Area under Curve Lifestyle Counselling

Evaluation of Human Impacts on Bartlett Pond Ecosystem, Laredo, Southern Texas, USA, through Empirical Modeling

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Journal of Environmental Protection 2024年第4期15卷 497-526页

作者： Maya P. bhatt Amede Rubio Ganesh B. Malla Cristobal Lopez Virginia Morales Erick Vazquez Cano David Marquez Orlando Berumen Alvarez Alfred Addo-Mensah Department of Biology and Chemistry Texas A&M International University Laredo USA Department of Mathematics Computer Geology and Physics University of Cincinnati-Clermont College Batavia USA

The trace elements chemistry of Bartlett Pond, a small shallow wetland pond in Laredo, Southern Texas, was sampled to evaluate the dynamics of trace elements impacts on water quality and ecosystems ecology of the pond. Two types of fish (bass and tilapia) were also sampled to see the trace element accumulation in different parts of their body. The concentrations of trace elements in water samples were found in the following order: Fe ≫Sb > Pb > As ≫Co > Tl > Cr > Cd within Bartlett Pond. Overall, the water quality of the pond is unacceptable for drinking and any other purposes as trace element concentrations (e.g. As, Cd, Co, Cr, Pb, Fe, Sb and Tl) are exceedingly higher (several fold) than the WHO and US EPA guidelines. Predictive and correlation analysis shows that most trace elements exhibit a strong positive correlation among them indicating the same anthropogenic sources and biogeochemical processes regulate these trace elements within the pond. Distributions of the trace elements in water exhibit different shapes mostly as positively skewed distribution for As, Cd, Co, Cr, and Tl, symmetrical distribution for Fe and almost symmetrical distribution for Pb and Sb. Concentrations of As, Co and Tl accumulated much higher in different parts of the Bass than Tilapia fish. The concentrations of As, Tl, Co, and Sb appeared significantly higher in different parts of the body of both Bass and Tilapia than the maximum SRM certified values. Accumulation of these contaminants in fish tissues pose increased health risks to humans who consume these contaminated fish although fishing is prohibited. Anthropogenic activities in the region primarily degrade the whole pond ecosystem ecology of the Bartlett Pond and waters of this pond to be not recommended for any use. These findings may be useful for the scientific community and concerned authorities to improve understanding about these precious natural resources and conservation of the ecosystem ecology.

关键词： Trace Elements Bartlett Pond Laredo Southern Texas Wetlands Ecosystem Ecology

Immunotherapy for recurrent hepatocellular carcinoma

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World Journal of Gastroenterology 2023年第15期29卷 2261-2271页

作者： Ahan bhatt Jennifer Wu Division of Hematology and Oncology Perlmutter Cancer Center of NYU Langone HealthNYU School of MedicineNew YorkNY 10016United States

Hepatocellular carcinoma(HCC)is presented frequently in late stages that are not amenable for curative *** for patients who can undergo resection for curative treatment of HCC,up to 50%*** patients who were not exposed to systemic therapy prior to recurrence,recurrence frequently cannot be subjected to curative therapy or local *** patients have several options of immunotherapy(IO).This includes programmed cell death protein 1(PD-1)and cytotoxic T-lymphocyte associated protein 4 treatment,combination of PD-1 and vascular endothelial growth factor inhibitor or single agent PD-1 therapy when all other options are deemed *** are also investigational therapies in this area that explore either PD-1 and tyrosine kinase inhibitors or a novel agent in addition to PD-1 with vascular endothelial growth factor *** minireview explored IO options for patients with recurrent HCC who were not exposed to systemic therapy at the initial *** also discussed potential IO options for patients with recurrent HCC who were exposed to first-line therapy with curative intent at diagnosis.

关键词： Liver neoplasms Immune checkpoint blockade Combination drug therapy PD-1-PD-L1 blockade CTLA-4 inhibitor

An approach based on deep learning for Indian sign language translation

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International Journal of Intelligent Computing and Cybernetics 2023年第3期16卷 397-419页

作者： Kinjal Bhargavkumar Mistree Devendra Thakor Brijesh bhatt Chhotubhai Gopalbhai Patel Institute of Technology Uka Tarsadia UniversityBardoliIndia Dharmsinh Desai Institute of Technology Dharmsinh Desai UniversityNadiadIndia

Purpose–According to the Indian Sign Language Research and Training Centre(ISLRTC),India has approximately 300 certified human interpreters to help people with hearing *** paper aims to address the issue of Indian Sign Language(ISL)sentence recognition and translation into semantically equivalent English text in a signer-independent ***/methodology/approach–This study presents an approach that translates ISL sentences into English text using the MobileNetV2 model and Neural Machine Translation(NMT).The authors have created an ISL corpus from the Brown corpus using ISL grammar rules to perform machine *** authors’approach converts ISL videos of the newly created dataset into ISL gloss sequences using the MobileNetV2 model and the recognized ISL gloss sequence is then fed to a machine translation module that generates an English sentence for each ISL ***–As per the experimental results,pretrained MobileNetV2 model was proven the best-suited model for the recognition of ISL sentences and NMT provided better results than Statistical Machine Translation(SMT)to convert ISL text into English *** automatic and human evaluation of the proposed approach yielded accuracies of 83.3 and 86.1%,*** limitations/implications–It can be seen that the neural machine translation systems produced translations with repetitions of other translated words,strange translations when the total number of words per sentence is increased and one or more unexpected terms that had no relation to the source text on *** most common type of error is the mistranslation of places,numbers and *** this has little effect on the overall structure of the translated sentence,it indicates that the embedding learned for these few words could be ***/value–Sign language recognition and translation is a crucial step toward improving communication between the deaf and the rest of *** of the shortage of hum

关键词： Indian sign language Neural machine translation ISL corpus Pretrained models Sign language recognition Sign language translation Paper type Research paper

State-of-the-art machine learning techniques for melanoma skin cancer detection and classification:a comprehensive review

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Intelligent Medicine 2023年第3期3卷 180-190页

作者： Harsh bhatt Vrunda Shah Krish Shah Ruju Shah Manan Shah Department of Computer Science Institute of TechnologyNirma UniversityAhmedabadGujaratIndia Dhirubhai Ambani Institute of Information and Communication Technology GandhinagarGujaratIndia Department of Chemical Engineering School of Energy TechnologyPandit Deendayal Energy UniversityGandhinagarGujaratIndia

Skin cancer is among the most common and lethal cancer types,with the number of cases increasing dramatically *** not diagnosed in the nascent stages,it can lead to metastases,resulting in high mortality *** cancer can be cured if detected ***,timely and accurate diagnosis of such cancers is currently a key research *** machine learning technologies have been employed in computer-aided diagnosis of skin cancer detection and malignancy *** learning is a subfield of artificial intelligence(AI)involving models and algorithms which can learn from data and generate predictions on previously unseen *** traditional biopsy method is applied to diagnose skin cancer,which is a tedious and expensive ***,machine learning algorithms for cancer diagnosis can aid in its early detection,lowering the workload of specialists while simultaneously enhancing skin lesion *** article presented a critical review of select state-of-the-art machine learning techniques used to detect skin *** studies had been collected,and an analysis of the performance of k-nearest neighbors,support vector machine,and convolutional neural networks algorithms on benchmark datasets was *** shortcomings and disadvantages of each algorithm were briefly *** in detecting skin cancer were highlighted and the scope for future research was proposed.

关键词： Machine learning Skin cancer Classification

Selecting Best Software Vulnerability Scanner Using Intuitionistic Fuzzy Set TOPSIS

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Computers, Materials & Continua 2022年第8期72卷 3613-3629页

作者： Navneet bhatt Jasmine Kaur Adarsh Anand Omar H.Alhazmi Anil Surendra Modi School of Commerce Narsee Monjee Institute of Management StudiesDeemed to be UniversityMumbai400056India Department of Operational Research Faculty of Mathematical SciencesUniversity of DelhiDelhi110007India Department of Computer Science Taibah UniversityMedina30001Saudi Arabia

Software developers endeavor to build their products with the least number of *** this,many vulnerabilities are detected in software that threatens its *** automated software i.e.,vulnerability scanners,are available in the market which helps detect and manage vulnerabilities in a computer,application,or a ***,the choice of an appropriate vulnerability scanner is crucial to ensure efficient vulnerability *** current work serves a dual purpose,first,to identify the key factors which affect the vulnerability discovery process in a *** second,is to rank the popular vulnerability scanners based on the identified *** will aid the firm in determining the best scanner for them considering multiple *** multi-criterion decision making based ranking approach has been discussed using the Intuitionistic Fuzzy set(IFS)and Technique for Order of Preference by Similarity to Ideal Solution(TOPSIS)to rank the various *** IFS TOPSIS,the opinion of a whole group could be simultaneously considered in the vulnerability scanner *** this study,five popular vulnerability scanners,namely,Nessus,Fsecure Radar,Greenbone,Qualys,and Nexpose have been *** inputs of industry specialists i.e.,people who deal in software security and vulnerability management process have been taken for the ranking *** the proposed methodology,a hierarchical classification of the various vulnerability scanners could be *** clear enumeration of the steps allows for easy adaptability of the model to varied *** study will help product developers become aware of the needs of the market and design better *** from the user’s point of view,it will help the system administrators in deciding which scanner to deploy depending on the company’s needs and *** current work is the first to use a Multi Criterion Group Decision Making technique in vulnerability scanner selection.

关键词： Intuitionistic fuzzy set group decision making multi-criteria decision making(MCDM) ranking algorithm software security TOPSIS vulnerability vulnerability scanners

Variation in Polyphenolics and Antioxidant Activity of Traditional Apple Cultivars from West Himalaya,Uttarakhand

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Horticultural Plant Journal 2018年第4期4卷 151-157页

作者： BAHUKHANDI amit DHYANI Praveen bhatt Indra D. RAWAL Ranbeer S. G.B.Pant National Institute of Himalayan Environment and Sustainable Development Almora 263643UttarakhandIndia

Apple(Malus × domestica) is largely known for polyphenolic and antioxidant properties; however, systematic investigation in the apple growing in the Indian Himalayan region is not carried out. The present study therefore, attempts to quantify polyphenolics and antioxidant activities in three traditional apple cultivars namely 'Benoni', 'Fanny' and 'Rymer' growing at different locations of Uttarakhand(west Himalaya), *** revealed that phenolic(0.94–7.00 mg GAE·g^(-1)FW), flavonoid(1.02–9.86 mg QE·g^(-1)FW), flavonol(0.77–6.92 mg CE·g^(-1) FW), tannin(15.49–37.99 mg TAE·g^(-1) FW) and antioxidant activity(ABTS, 3.10–67.36; DPPH, 4.99–14.06; FRAP, 4.70–39.21 mmol AAE·kg^(-1)FW) varied significantly among the cultivars and maximum content was recorded in Rymer fruits of Mukhwa location. Altitude showed significant(P < 0.05) positive relationship with total phenolic(r = 0.895), flavonoid(r = 0.843), flavonol(r = 0.812), ABTS(r = 0.856) and FRAP activity(r = 0.830). Based on the results, it is concluded that among three cultivars, Rymer is one of the most promising sources of polyphenolic content and antioxidant activity and therefore, recommended for mass plantation at suitable locations in Uttarakhand for harnessing maximum potential.

关键词： apple traditional cultivar antioxidant polyphenolics West Himalaya