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Menstrual Abnormalities and Gynaecological Problems in Women on Anticoagulant and Antiplatelet Therapy: Management Options

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Open Journal of Obstetrics and Gynecology 2017年第5期7卷 581-599页

作者： Pratibha Devabhaktuni Precella Thomas anuj Kapadia Sridevi Somaraju Bhupatiraju Department of Obstetrics and Gynaecology CARE Institute of Medical Sciences Hyderabad India Department of Cardiology CARE Institute of Medical Sciences Hyderabad India

Introduction: The aim of this study was: 1) To study the pattern of menstrual abnormality and severity in women on anticoagulant and antiplatelet drugs. 2) To analyze the correlation of prothrombin time (PT), International Normalised ratio (INR) and the bleeding severity. 3) To discuss the various management options in unexpected emergencies and menstrual complications in this subset of women on anticoagulants. Material & Methods: It is a prospective study, over a period of 18 months from July 2011 to december 2012. We had 44 women on antithrombotic therapy. 32 women were on anticoagulants and 12 were on antiplatelet agents. The severity of bleeding pattern was assessed with pictoral bleeding assessment chart (PBAC). 1) Out of 44 women studied, 32 women were on anticoagulants and 12 were on antiplatelet agents. 26 (81.25%) were on acenocoumarol, 5 (15.62%) on warfarin, 1 (3.12%) on heparin, among the 12 antiplatelet users, 8 (66.66%) were on aspirin and 4 (33.33%) on clopidogrel. 2) The indication for anticoagulants was mitral valve replacement (MVR) in 9, double valve replacement (DVR) in 6, aortic valve replacement (AVR) in 3, severe pulmonary artery hypertension (PAH) in 2, severe mitral stenosis (MS) with atrial thrombus in 2, deep vein thrombosis (DVT) in 5, severe mitral regurgitation (MR) in one, the other indications were subdural hematoma, thromboendarterectomy, chronic kidney disease (CKD) stage V, coarction of aorta, one each. The indication for antiplatelet therapy was percutaneous transluminal coronary angioplasty (PTCA) in 3, Wolf Parkinson White (WPW) syndrome + atrial fibrillation (AF), acute myocardial infarction (AMI), coronary artery bypass graft (CABG), mid basilar artery aneurysm, renal allograft recipient, dialated cardiomyopathy, aortic aneurysm repair, hypertension and unstable angina one each. Results: In women on anticoagulants (32), the main complaint was menorrhagia/heavy menstrual bleeding (HMB) in 20, polymenorrhoea with menorrhagia in

关键词： Anti thrombotic Therapy in Women Anticoagulants HMB PMB PPH

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Non-Contact Ultrasound for Composites Inspection

Non-Contact Ultrasound for Composites Inspection

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2017远东无损检测新技术论坛

作者： anuj BHARDWAJ Konstantine FETFATSIDIS Kashyap PATEL The Ultran Group Inc. State College Aurora Flight Sciences

Uncured and continuously produced materials often cannot afford exposure to testing device via contact or be immersed in liquid *** makes conventional contact and immersion ultrasound（UT）poorly suited for ***,UT is highly desirable for inspection of uncured composite materials as amplitude and time of flight measurements often reveal vital material *** in non-contact ultrasound（NCU）now allow efficiency comparable to conventional ultrasound for certain *** at frequencies from 30 k Hz to 5 MHz,NCU can be used to relate signal measurements directly to material properties in materials such as fiber-based composite prepreg and most cured and uncured composites.A safe and non-destructive measurement process of relatively low cost,non-contact ultrasound presents opportunities to lower cost,reduce and identify waste,and improve production *** relationships exist between ultrasonic amplitude in non-contact through transmission and key material properties such as porosity,delamination,and homogeneity in *** converting amplitude and velocity measurements into material property values through characterization formulas（*** of impregnation=[ultrasonic amplitude*x]+y）,one can apply standard methods of manufacturing process control to hold production processes within desired control limits with real-time *** such measurements to webline material positions allows direct identification of sections of undesirable material,reducing waste and improving manufacturing yields by avoiding unnecessary disposal of uninspected *** multiple points of measurement（multiple channels）in the cross-web direction allows for up to 100%inspection and high accuracy of spatial identification on finished products.

关键词： Non-Contact Ultrasound composites inspection prepreg in-line inspection

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Sequential embolization of the branches of the bile duct and portal vein to the targeted hepatic lobe in rats

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Hepatobiliary & Pancreatic Diseases International 2014年第1期13卷 55-59页

作者： anuj Shrestha Yong Zhou Hui Mao Fu-Yu Li Wen-Jie Ma Nan-Sheng Cheng Ri-Hua Xu Yong-Qiong Zhang Ting Jiang Huan Feng Wen Li Qiang Han Department of Hepatobiliary Surgery West China Hospital of Sichuan University Department of Medicine West China Hospital of Sichuan University

BACKGROUND: The high recurrence rate of hepatolithiasis and the high operative risk of right posterior, caudate or multiple lobe hepatectomy are the unsettled problems in hepatobiliary surgery. The present study was to investigate the efficacy of chemical hepatectomy performed via applying sequential embolization of the branches of the bile duct and portal vein to the targeted hepatic lobe. METHODS: The bile duct and portal vein branches of the median hepatic lobe of rats were treated with: 1) bile duct embolization followed by portal vein ligation(BDE+PVL) and 2) portal vein ligation followed by bile duct embolization(PVL+BDE). The efficacy of chemical hepatectomy in BDE+PVL and PVL+BDE groups was compared with that of sole BDE by histology and Western blotting analysis of collagen I expression. RESULTS: After six weeks of the chemical hepatectomy, rats in the BDE group showed hepatocyte damages, fibrosis and 'selfcut' only in the periphery of the embolized lobe. In contrast, rats in the PVL+BDE and BDE+PVL groups exhibited complete necrosis of hepatocytes and replacement with proliferative ductules and collagen fibers, leading to complete fibrosis and 'self-cut' phenomenon in the whole targeted lobe. Collagen I expression in the PVL+BDE group was slightly higher than that in the BDE+PVL group; however, no statistically significant difference was noted. CONCLUSION: The sequential embolization of the bile duct and portal vein branches to the targeted hepatic lobe may bea feasible and effective approach to acheive the ideal effect of chemical hepatectomy in a short period of time.

关键词： hepatolithiasis bile duct portal vein sequential embolization chemical hepatectomy

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Publisher Correction:First-principles calculation of intrinsic defect chemistry and self-doping in PbTe

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npj Computational Materials 2017年第1期3卷 67-68页

作者： anuj Goyal Prashun Gorai Eric S.Toberer Vladan Stevanovic Colorado School of Mines GoldenCO 80401USA National Renewable Energy Laboratory GoldenCO 80401USA

A correction to this article has been published and is linked from the HTML version of this article.

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腹腔镜胆囊切除术后常规病理检查的必要性探讨

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中国普通外科杂志 2015年第8期24卷 1140-1144页

作者：曹贵章邓毅磊 SHRESTHA anuj 吴昊钧青海省交通医院普通外科青海西宁810000 四川大学华西医院胆道外科四川成都610041

目的:探讨腹腔镜胆囊切除术(LC)后胆囊常规病理检查的必要性。方法:搜集华西医院病理科5年间的全部胆囊病理报告,找出其中LC术后意外胆囊癌患者,并分析其临床资料。结果:LC术后意外胆囊癌的发生率约为0.28%(36/12 969),88.9%(32/36)为腺... 详细信息

目的:探讨腹腔镜胆囊切除术(LC)后胆囊常规病理检查的必要性。方法:搜集华西医院病理科5年间的全部胆囊病理报告,找出其中LC术后意外胆囊癌患者,并分析其临床资料。结果:LC术后意外胆囊癌的发生率约为0.28%(36/12 969),88.9%(32/36)为腺癌,58.3%(21/36)为原位癌和早期胆囊癌(T1a和T1b)。结合术前影像学检查,术中通过观察及胆囊标本触摸,成功辨认出34例(94.4%)意外胆囊癌患者存在的可疑病变,遗漏1例原位癌和1例T1a期患者。结论:绝大多数意外胆囊癌患者均可在术中发现可疑病变,极少数肿瘤处于极早期无法发现者,单纯的胆囊切除已达有效治疗。因此,LC术后常规的行胆囊病理检查的必要性有待商榷。

关键词：胆囊切除术,腹腔镜胆囊肿瘤病理学

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Effectiveness of additional resection of the invasive cancer-positive proximal bile duct margin in cases of hilar cholangiocarcinoma

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Hepatobiliary Surgery and Nutrition 2018年第4期7卷 251-269页

作者： Wen-Jie Ma Zhen-Ru Wu anuj Shrestha Qin Yang Hai-Jie Hu Jun-Ke Wang Fei Liu Rong-Xing Zhou Quan-Sheng Li Fu-Yu Li Department of Biliary Surgery West China HospitalSichuan UniversityChengdu 610041China Laboratory of Pathology West China HospitalSichuan UniversityChengdu 610041China Department of General Surgery Andaki Medical CollegePokharaNepal

Background: The survival benefits of additional resection of the positive proximal ductal margin (PM) in hilar cholangiocarcinoma (HCCA) remains controversial. This retrospective study investigated the effectiveness of additional resection of the invasive cancer PM under different levels of preoperative carbohydrate antigen 19-9 (CA19-9). Methods: Patients who underwent hepatectomy for HCCA from 2000 to 2017 were analyzed. Surgical variables, resection margin status, length of the PM (LPM), prognostic factors, and survival were evaluated. Results: A total of 228 patients were enrolled: 175 PM(?) without additional resection patients (group A), 21 PM(?) after additional resection (group B), 16 PM(+) without additional resection (group C), and 16 PM(+) after additional resection (group D). The median survival of group B (20.99 months) was similar to that of group A (23.00 months;P=0.16), and both were significantly better than those of group C (11.60 months) and D (9.50 months), especially when preoperative CA19-9>150 U/mL (P10 mm was significantly better compared with those with an LPM ≤10 mm, especially when preoperative CA19-9 was >150 U/mL (P10 mm group, the survival of group B was comparable with that of group A (P>0.05). Conclusions: HCCA patients could get a survival benefit from a negative PM resulting from additional resection. Survival could be comparable with that of negative PM without additional resection among HCCA patients. An LPM >10 mm is possibly more associated with better survival compared with whether additional resection of the positive PM is performed under different levels of preoperative CA19-9.

关键词： Klatskin tumor margins of excision bile ducts antigens neoplasm carbohydrate antigen 19-9 (CA19-9)

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Prevalence of hypercoagulable states in stented thrombotic iliac vein compression syndrome with comparison of re-intervention and anticoagulation regimens

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World Journal of Radiology 2021年第12期13卷 371-379页

作者： Peyton Cramer Cheryl Mensah Maria DeSancho anuj Malhotra Ronald Winokur Andrew Kesselman Department of Radiology Division of Interventional RadiologyNew York Presbyterian Hospital/Weill Cornell MedicineNew YorkNY 10065United States Department of Medicine Division of Hematology-OncologyNew York Presbyterian Hospital/Weill Cornell MedicineNew YorkNY 10065United States Department of Radiology Division of Interventional RadiologyThomas Jefferson University HospitalPhiladelphiaPennsylvania 19107United States

BACKGROUND Endovascular therapy is playing an increasing role in the treatment of iliofemoral venous *** stent patency is multifactorial,and current management is based on best clinical practices,varying by *** To evaluate how thrombophilia influences management and outcomes of patients who undergo venous stenting for thrombotic iliac vein compression *** A retrospective observational analysis was performed on 65 patients with thrombotic iliac vein compression syndrome that underwent common iliac vein(CIV)stenting between December 2013 and December 2019 at a large academic *** criteria included CIV stenting and iliac vein *** lesions and iliocaval thrombosis and/or occlusions were excluded.A total of 65 patients were selected for final *** information,procedural data points,and post-procedural management and outcomes were *** analyses included Fisher's exact and Chi-square tests to compare discrete variables and the Wilcoxon rank-sum test to compare continuous variables between thrombophilia positive and negative *** 65 patients underwent successful balloon angioplasty and CIV *** these patients,33(50.8%)underwent thrombophilia testing,with 16(48.5%)testing *** patency on ultrasound did not significantly differ between thrombophilia positive and negative patients at 1 mo(92.3%vs 81.3%,P=0.6),6 mo(83.3%vs 80%,P>0.9),or 12 mo(77.8%vs 76.9%,P=0.8).Immediately after stent placement,thrombophilia patients were more likely to be placed on dual therapy(aspirin and anticoagulation)or triple therapy(aspirin,clopidogrel,and anticoagulation)(50%vs 41.2%,P>0.9),and remain on dual therapy at 6 mo(25%vs 12.5%,P=0.5)and 12 mo(25%vs 6.7%,P=0.6).There was no significant difference in re-intervention rates(25%vs 35.3%,P=0.7)or number of reinterventions(average 2.3 vs 1.3 per patient,P=0.4)between thrombophilia positive and negative ***

关键词： Thrombophilia Iliac vein compression syndrome Iliac vein stent May Thurner Anticoagulation Endovascular

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不同胆管空肠吻合技术治疗成人Ⅰ型胆总管囊肿的比较分析

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Gastroenterology Report 2018年第1期6卷 54-60,I0002页

作者： Wenjie Ma Yongqiong Tan anuj Shrestha Fuyu Li Rongxing Zhou Junke Wang Haijie Hu Qin Yang Department of Biliary Surgery West China Hospital of Sichuan UniversityChengduChina Operation Room West China Hospital of Sichuan UniversityChengduChina Department of General Surgery Andaki Medical CollegePokharaNepal

目的:比较囊肿完全切除与不完全切除(残留近端1 cm胆总管囊壁)的Roux-en-Y胆管空肠吻合治疗成人Ⅰ型胆总管囊肿的安全性和可行性。方法:回顾性分析1998年1月至2015年12月间收治的267例成人Ⅰ型胆总管囊肿患者的病例资料,其中171例行囊... 详细信息

目的:比较囊肿完全切除与不完全切除(残留近端1 cm胆总管囊壁)的Roux-en-Y胆管空肠吻合治疗成人Ⅰ型胆总管囊肿的安全性和可行性。方法:回顾性分析1998年1月至2015年12月间收治的267例成人Ⅰ型胆总管囊肿患者的病例资料,其中171例行囊肿完全切除的Rouxen-Y胆管空肠吻合术(PBD 0-cm组),96例行囊肿不完全切除的Rouxen-Y胆管空肠吻合术(PBD 1-cm组)。比较两组患者术后短期及长期并发症发生情况。结果:两组患者在手术时间和吻合口直径方面的差异均无统计学意义。PBD 1-cm组围手术期并发症发生率显著高于PBD 0-cm组(28.1%vs 14.0%,P=0.005),尤其是术后胆管炎(7.3%vs 1.2%,P=0.021)。两组患者术后吻合口狭窄、反流性胆管炎、肝内胆管结石和胆漏等长期并发症的差异均无统计学意义(均P>0.05)。PBD 1-cm组和PBD 0-cm组各有1例患者分别于术后5月和术后25月出现胰胆管恶变。而PBD 1-cm组有1例患者于术后10月出现吻合口恶变。结论:虽然保留部分囊壁可以降低Ⅰ型胆总管囊肿切除术中的吻合难度,但由于相对较高的术后并发症发生率和恶变概率,该吻合方式值得商榷。对于Ⅰ型胆总管囊肿患者,囊肿完全切除后以健康的近端胆管进行吻合是必要的。

关键词：胆总管囊肿 Roux-en-Y胆管空肠吻合术胆汁引流成年人

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Retrospective analysis of complications related to endoscopic retrograde cholangio-pancreatography in patients with cirrhosis vs patients without cirrhosis

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World Journal of Hepatology 2021年第4期13卷 472-482页

作者： Michelle Bernshteyn Linda Hu Umair Masood anuj Vikrant Sharma Danning Huang Bishnu Sapkota Department of Medicine SUNY Upstate Medical UniversitySyracuseNY 13202United States Division of Gastroenterology and Hepatology State University of New York Upstate Medical UniversitySyracuseNY 13210United States Department of Public Health and Preventive Medicine SUNY Upstate Medical UniversitySyracuseNY 13202United States Division of Gastroenterology and Hepatology SUNY Upstate Medical University and Syracuse VA Medical CenterSyracuseNY 13210United States

BACKGROUND There is minimal objective data regarding adverse events related to endoscopic retrograde cholangio-pancreatography(ERCP)in patients with cirrhosis compared to those without cirrhosis and even fewer data comparing complications among cirrhosis patients based on severity of *** To determine if patients with cirrhosis are at increased risk of adverse events related to ERCP:mainly pancreatitis,bleeding,perforation,cholangitis,and mortality;And to see if higher Child-Pugh(CP)score and Model for End-Stage Liver Disease(MELD)score are associated with higher post-ERCP *** We performed a retrospective analysis of 692 patients who underwent ERCP and analyzed the impact of cirrhosis etiology,gender,type of sedation used during procedure,interventions performed,and co-morbidities on the rate of complications in cirrhosis patients as compared to non-cirrhosis *** Overall complications were higher in those with cirrhosis as compared to those without cirrhosis(P=0.015 at significance level of 0.05).CP class,especially CP class C,was shown to be associated with a significantly higher rate of ERCP complications as compared to CP class A and CP class B(P=0.010 at significance level of 0.05).CONCLUSION The results of our study reaffirm that liver cirrhosis has an impact on the occurrence of complications during *** study shows that CP class seems to be more reliable as compared to MELD score in predicting complications of ERCP in cirrhosis patients.

关键词： Cirrhosis Complications Advanced endoscopy Endoscopic retrograde cholangio-pancreatography

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Increased Activity of NK Cells and Plasmacytoid Dendritic Cells in HIV-Exposed Seronegative (ESN) Individuals

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World Journal of AIDS 2012年第1期2卷 6-16页

作者： anuj Singla Roland Jacobs Reinhold E. Schmidt Ajay Wanchu Sunil K. Arora Clinic for Immunology and Rheumatology Hannover Medical School Hannover Germany Departments of Immunopathology Post Graduate Institute of Medical Education and Research Chandigarh India Internal Medicine Post Graduate Institute of Medical Education and Research Chandigarh India

The mechanisms involved in resistance to HIV-1 infection, especially the role of innate immune response, have not been thoroughly explored in individuals who are repeatedly exposed to HIV-1, but do not get the infection, termed as Exposed sero-negative or ESN. Frequency and activation state of natural killer (NK) cells and plasmacytoid dendritic cells (pDC) in ESNs from North India were compared with those in recently infected HIV positives (RHIV), chronically infected HIV positives (HIV+) and healthy controls (HC). The activation state of NK cells in terms of cytokine response (IFNγ & TNFα) was significantly higher in ESNs compared to the healthy controls, recently infected HIV+ and chronically infected HIV+. Although the number of circulating pDC in different study groups was not significantly different, yet these cells seem to have significantly higher activation state in terms of IFNα production (ex-vivo in response to CpG ODN) in ESNs when compared with other groups. Increased activation status of NK cells and pDC in Exposed but Seronegative individuals indicates their continuous stimulation with HIV antigens due to regular exposure with infected partners and which might be imparting resistance to viral infection in these individuals.

关键词： HIV Exposed Seronegative Innate Immune Responses NK Cells Plasmacytoid Dendritic Cells

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