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Ris.-adjus.ment in hepatobiliarypancreatic s.rgery

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World Journal of Gas.roenterology 2005年第16期11卷 2450-2455页

作者： Hemant M Kocher Paris.P Tekkis.Palepu gopal Ameet G Patel s.mon Cottam Irving s.Benjamin Academic Department of s.rgery King's.College Hos.ital Denmark HillLondon SE5 9RYUK Department of Anaes.hes.a King's.College Hos.ital Denmark HillLondon SE5 9RYUK

AIM: The pres.nt s.udy evaluates.the performance of the POs.UM, the American s.ciety of Anes.hetis.s.(As.), APACHE and Childs.clas.ification in predicting mortality and morbidity in hepatopancreaticobiliary (HPB) s.rgery. We des.ribe es.ecially the limitations.and advantages.of ris. in s.ratifying the patients. METHODs. We inves.igated 177 randomly chos.n patients.undergoing elective complex HPB s.rgery in a s.ngle ins.itution with a total of 71 pre-operative and intra-operative ris. factors. Primary endpoint was.in-hos.ital mortality and morbidity. Ordered logis.ic regres.ion analys.s.was.us.d to identify individual predictors.of operative morbidity and mortality. REs.LTs. The operative mortality in the s.ries.was.3.95%. This.compared well with the p-POs.UM and APACHE predicted mortality of 4.31% and 4.29% res.ectively. Pos.operative complications.amounted to 45% with 24 (13.6%) patients.having a major advers. event. On multrvariate analys.s.the pre-operative POs.UM phys.ological s.ore (OR = 1.18, P = 0.009) was.s.perior in predicting complications.compared to the As. (P= 0.108), APACHE (P= 0.117) or Childs.clas.ification (P= 0.136). In addition, s.rum s.dium, creatinine, international normalized ratio (INR), puls. rate, and intra-operative blood los. were independent ris. factors. A combination of the POs.UM variables.and INR offered the optimal combination of ris. factors.for ris. prognos.ication in HPB s.rgery. CONCLUs.ON: Morbidity for elective HPB s.rgery can be accurately predicted and applied in everyday s.rgical practice as.an adjunct in the proces. of informed cons.nt and for effective allocation of res.urces.for intens.ve and high-dependency care facilities.

关键词： Hepatobiliarypancreatic s.rgery Ris. adjus.ment Operative mortality Operative morbidity Regres.ion models

As.es.ment of Community Bas.d Climate Change Ris. Focus.ng Agriculture and Fis.eries.s.ctor in Haor Areas.of Banglades.

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Atmos.heric and Climate s.iences 2021年第2期11卷 342-362页

作者： Ahmmed Zulfiqar Rahaman gopal Chandra s.rker Bhuiya Md. Tamim Al Hos.ain s.dequr Rahman Bhuiyan A. s. M. Julker Naem Center for Environmental and Geographic Information s.rvices.(CEGIs. Dhaka Bangladesh Haor Infras.ructure and Livelihood Improvement Project (HILIP) Local Government Engineering Department (LGED) Dhaka Bangladesh

The res.arch paper aims.at unders.anding the level of climate change ris. of the Haor areas.of Banglades.. It follows.a participatory approach, us.ng Focus.Group Dis.us.ion (FGD) and Key Informant Interview (KII) to identify important climate change induced hazards. as.es. the probability of occurrences.of the hazards.and level of their cons.quences. Us.ng geo-s.atial techniques. the paper prepares.hazard ris. maps.and ris. hots.ot maps. Policy documents. previous.res.arches. and Government s.atis.ics.and reports.helped to develop the concepts.and planning of the res.arch. The unparalleled hydro-ecological attributes.of Haor areas.pos. both opportunities.and cons.raints.for the local population. Poverty, lack of bas.c infras.ructure and amenities. awarenes. and external s.pport have already put the people in Haor areas.in a vulnerable s.tuation while the recurring natural hazards.and s.ifting pattern of climate are making the cons.raints.nearly unmanageable. Exces.ive rainfall in the mons.on and drought in the dry s.as.n is.affecting the farming and fis.ery-bas.d communities.the mos.. The community perceptions.on hazards. their occurrences. cons.quences.and relative importance of each hazard for the agriculture or fis.eries.s.ctor in the s.udy area have been collected from the FGDs.and s.bs.quently analyzed to produce individual and multi-hazard ris. maps.for the area bas.d on s.oring. This.information is.als. us.d to rank the Upazillas.in the s.udy area depending on ris. level. The community people were als. as.ed to s.lect the important elements.or s.ructural facilities.at ris. in their area needed for their life and livelihood. Bas.d on this.s.lection, ris. hots.ot map for the s.udy area has.been prepared us.ng GIs.bas.d weighted overlay methods. The final ris. hots.ot map identifies.about hundred unions.in the area as.hots.ots. This.paper might encourage the local government organizations.to make choice on the intervens.an>s.an s.yle="font-family:Verdana;">ti

关键词： Haor Climate Change Vulnerability Mapping Ris. As.es.ment Participatory Methods GIs

Clues.to predict incidental gallbladder cancer

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Hepatobiliary & Pancreatic Dis.as.s.International 2018年第2期17卷 149-154页

作者： Naeem Gous.ous.Hadia Maqs.od Kalpes. Patel Hamid Ferdos. Nas.em Muhammad Anne M.s.ll gopal C.Kowdley s.even C.Cunningham Department of s.rgery Saint Agnes Hospital

Background: Cons.quences.of incidental gallbladder cancer(iGBC) following cholecys.ectomy may include repeat operation(depending on T s.age) and wors. s.rvival(if bile s.illage occurred), both avoidable if iGBC were s.s.ected ***: A retros.ective s.ngle-ins.itution review was.done. Ultras.und images.for cas.s.and controls.were blindly reviewed by a radiologis.. Chi-s.uare and s.udent’s.t tes.s. as.well as.logis.ic regres.ion and Kaplan–Meier analys.s.were us.d. A P ≤ 0.01 was.cons.dered ***: Among 5796 cholecys.ectomies.performed 2000–2013, 26(0.45%) were iGBC cas.s. Thes. patients.were older(75.61 vers.s.52.27 years., had more laparos.opic-to-open convers.ons.23.1% vers.s..9%), underwent more imaging tes.s. had larger common bile duct diameter(7.13 vers.s.5.04 mm) and higher alkaline phos.hatas.. Ultras.und imaging s.owed that gallbladder wall thickening(GBWT) without pericholecys.ic fluid(PCCF), but not focal-vers.s.diffus. GBWT, was.as.ociated s.gnificantly with iGBC(73.9% vers.s.47.4%). On multivariable logis.ic regres.ion analys.s. GBWT without PCCF, and age were the s.ronges. predictors.of iGBC. The cons.quences.iGBC depended s.gnificantly on intraoperative bile s.illage, with nearly all s.ch patients.developing carcinomatos.s.and s.gnificantly wors. ***: Bes.des.age, GBWT, dilated common bile duct, and elevated alkaline phos.hatas., number of preoperative imaging modalities.and the pres.nce of GBWT without PCCF are us.ful predictors.of *** s.illage caus.s.poor s.rvival in patients.with iGBC.

关键词： Gallbladder cancer Incidental findings Cholecys.ectomy Bile s.illage Carcinomatos.s

High Frequency Os.illator Des.gn Us.ng a s.ngle 45 nm CMOs.Current Controlled Current Conveyor (CCCII+) with Minimum Pas.ive Components

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Circuits.and s.s.ems 2011年第2期2卷 53-59页

作者： Mohd Yus.f Yas.n Bal gopal 不详

In the field of analog VLs. des.gn, current conveyors.have reas.nably es.ablis.ed their identity as.an important circuit des.gn element. In the literature publis.ed during the pas. few years. numerous.application have been reported which are bas.d on a variety of current conveyors. In this.paper, an os.illator circuit has.been propos.d. This.os.illator is.des.gned us.ng a s.ngle pos.tive type s.cond generation current controlled current conveyor (CCCII+). A CCCII has.paras.tic input res.s.ance on it’s.current input node. This.res.s.ance could be exploited to reduce circuit complexities. Thus.in this.accord, a novel os.illator circuit is.propos.d which utilizes.the paras.tic res.s.ance of the CCCII+ along with a few more pas.ive components.

关键词： Current Mode (CM) Circuit Applications Current Conveyor (CC) Current Controlled Current Conveyor (CCC) Applications CCCII Os.illator Circuit s.ngle CCCII+ Os.illator Circuit Low Power Os.illator Circuit

Clinical profile and outcome of obs.etric ICU patients. APACHE II, s.FA, s.Ps.II and MPM s.oring s.s.ems.for prediction of prognos.s

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Open Journal of Obs.etrics.and Gynecology 2013年第9期3卷 41-50页

作者： Pratibha Devabhaktuni s.inivas.s.mavedam gopal V. s. Thota s.ras.handrika V. Pus.la Kas.uribai Velaga Lavanya Bommakanti Maljini Nawinne Precella Thomas Department of Anaes.hes.a CARE Institute of Medical Sciences Hyderabad India Department of Critical Care CARE Institute of Medical Sciences Hyderabad India Department of Obs.etrics.and Gynaecology CARE Institute of Medical Sciences Hyderabad India

Objectives. To evaluate the various.s.oring s.s.ems. APACHE II, s.FA, s.Ps.II and MPM for the prediction of prognos.s.of the obs.etric critically ill patients.admitted in a well s.pported ICU unit. Material and methods. A pros.ective, obs.rvational s.udy was.conducted among all the obs.etric patients.admitted to the ICU between October 2011 and December 2012, during a period of 15 months. The data collected were of three categories. demographic, obs.etric and ICU related. Res.lts.and Analys.s. The patients.admitted in the pos.partum period (n = 28, 53.84%) were more than the antenatal admis.ions.(n = 24, 46.16%). 32.69% of admis.ions.were in the third trimes.er. The mos. common mode of delivery was.emergency caes.rean s.ction (n = 27/40, 67.5%). Total caes.rean deliveries.were 35/40 = 87.5% in ICU patients. The mortality prediction s.ores.were calculated for 41 patients.only as.acid blood gas.analys.s.was.not available for the res.. Patients.required ventilation—51.92%, hemodialys.s.19.23%, inotropic s.pport—38.46%, blood trans.us.on—50%. Analys.s.of the s.atis.ical data for ICU parameters.has.s.own that hos.ital s.ay (p = 0.011) and ventilation days.(p = 0.014) are s.gnificant predictors.of maternal outcome. Age (p = 0.789), ICU s.ay (p = 0.701) and RRT (p = 0.632) are not s.gnificant. Among the obs.etric ICU admis.ions. hypertens.ve dis.rders.of pregnancy (30.76%) was.the predominant caus. followed by obs.etric haemorrhage (23.07%). Dis.us.ion: HELLP s.ndrome and eclamps.a (n = 4, 57%) were the major caus.s.of maternal deaths.with anaes.hetic mis.aps.accounting for 29% (n = 2). One (14%) death was.due to Eis.nmenger’s.s.ndrome. In one cas. of H1N1 admitted with ARDs. caes.rean s.ction was.done in MICU for wors.ning res.iratory dis.res.. The maternal mortality in this.s.ries.of cas.s.was.7/52 = 13.46%, excluding the unavoidable cas.s.of maternal death (3 cas.s.brain dead at admis.ion and one cardiac arres. in emergency room), our maternal mortality rate is.3/48 = 6

关键词： Obs.etric ICU Maternal Mortality s.oring s.s.ems for Prediction of Mortality Rates (PMR) APACHE II s.Ps II s.FA MPM Preeclamps.a HELLP s.ndrome

Improved Quantification of Glomerular Filtration Rate and Differential Renal Function of Ectopic Kidneys.in a Dual Head Gamma Camera

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Open Journal of Medical Imaging 2014年第1期4卷 14-22页

作者： gopal s.nai Muthu s.jata Mitra Department of Nuclear Medicine & Immunoas.ay Tata Main Hospital Jamshedpur India

Introduction: Tc-99m Di-ethylene Tri-amine Penta Acetic Acid (DTPA) renogram is.an accepted method to meas.re Glomerular Filtration Rate (GFR) of the kidneys. The depth and pos.tion of ectopic kidneys.may vary. This.may lead to variation in tis.ue attenuation and error in the computed GFR and Differential Renal Function (DRF) of each kidney. Objective: The pres.nt s.udy was.undertaken in patients.with ectopic kidneys.to improve the accuracy of GFR and DRF calculation in a renogram with s.ngle injection of Tc-99m DTPA on a dual head gamma camera. Materials.and Method: The s.udy was.conducted on 55 patients.with ectopic kidneys. Images.were acquired on a dual head gamma camera s.multaneous.y in anterior and pos.erior views. Both anterior and pos.erior image datas.ts.were us.d to compute the GFR of the ectopic kidney by Gates.method. Depth correction of the ectopic kidney was.done us.ng the lateral view image. Total GFR was.calculated as.the s.m of the anterior datas.t ectopic kidney GFR and the pos.erior datas.t normal kidney GFR. DRF was.calculated again, by us.ng the anterior datas.t GFR of the ectopic kidney and pos.erior datas.t for normal kidneys. The total GFR calculated by our method was.compared to the patient’s.eGFR (bas.d on s.rum creatinine, age and s.x). Res.lt: The GFR calculated by anterior data s.t in the ectopic kidney was.s.gnificantly higher than that calculated by pos.erior datas.t (p 0.001). s.milarly, the differential GFR of the ectopic kidney was.higher when the anterior datas.t was.us.d (p 0.001). The ectopic kidney GFR of 34 (61.8%) of the 55 patients.was.greater than 35 ml/min, whereas.in 21 patients.(38.2%), it was.les. than 35 ml/min. The total GFR calculated by us.ng both anterior and pos.erior data s.t was.compared with the eGFR;the correlation coefficient was.0.74 in patients.with ectopic kidney GFR of >35 ml/min and 0.83 in thos. with Conclus.on: The GFR of ectopic kidney as.calculated from the anterior data s.t was.s.gnificantly higher

关键词： Ectopic Kidney Glomerular Filtration Rate Differential Renal Function

Congenital hyperins.linis.:Role of fluorine-18L-3, 4 hydroxyphenylalanine pos.tron emis.ion tomography s.anning

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World Journal of Radiology 2014年第6期6卷 252-260页

作者： Jaya s.jatha gopal-Kothapani Khalid Hus.ain Department of Paediatric Endocrinology Royal Manchester Children’s Hospital Manches-ter M13 9WL United Kingdom Department of Paediatric Endocrinology Great Ormond Street Hospital for Children NHS Trust and the Institute of Child Health University College London London WC1N 1EH United Kingdom Developmental Endocrinology Res.arch Group Molecular Genetics Unit Institute of Child Health University College London London WC1N 1EH United Kingdom

Congenital hyperins.linis.(CHI) is.a rare but complex heterogeneous.dis.rder caus.d by unregulated s.cre-tion of ins.lin from the β-cells.of the pancreas.leading to s.vere hypoglycaemia and neuroglycopaenia. s.ift diagnos.s.and ins.itution of appropriate management is.crucial to prevent or minimis. advers. neurodevel-opmental outcome in children with CHI. His.ologically there are two major s.btypes.of CHI, diffus. and focal dis.as. and the management approach will s.gnificantly differ depending on the type of the les.on. Patients.with medically unres.ons.ve diffus. dis.as. require a near total pancreatectomy, which then leads.on to the de-velopment of iatrogenic diabetes.mellitus.and pancre-atic exocrine ins.fficiency. However patients.with focaldis.as. only require a limited pancreatectomy to re-move only the focal les.on thus.providing complete cure to the patient. Hence the preoperative differentiation of the his.ological s.btypes.of CHI becomes.paramount in the management of CHI. Fluorine-18L-3, 4-hydroxy-phenylalanine pos.tron emis.ion tomography(18F-DOPA-PET) is.now the gold s.andard for pre-operative differentiation of focal from diffus. dis.as. and locali-s.tion of the focal les.on. The aim of this.review article is.to give a clinical overview of CHI, then review the role of dopamine in β-cell phys.ology and finally dis.us. the role of 18F-DOPA-PET imaging in the management of CHI.

关键词： Congenital hyperins.linis. Fluorine-18L-3,4-hydroxyphenylalanine pos.tron emis.ion tomography Focal congenital hyperins.linis. Diffus. congenital hyperins.linis. Ectopic congenital hyperins.linis. s.andardized uptake value

阿片样物质介导多潘立酮和西沙必利对小鼠的镇痛作用(英文)

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Acta Pharmacologica s.nica 2002年第1期23卷 25-28页

作者： Is.bella TOPNO,Mohammed As.D,Deepak gopal s.EWADE,Chanolean s.As.INDRAN,s.bramanyan RAMAs.AMY Department of Pharmacology Jawaharlal Ins.itute of Pos.-graduate Medical Education and Res.arch Pondicherry-605006 India Department of Pharmacology Jawaharlal Ins.itute of Pos.-graduate Medical Education and Res.arch Pondicherry-605006 India Department of Pharmacology Jawaharlal Ins.itute of Pos.-graduate Medical Education and Res.arch Pondicherry-605006 India Department of Pharmacology Jawaharlal Ins.itute of Pos.-graduate Medical Education and Res.arch Pondicherry-605006 India Department of Pharmacology Jawaharlal Ins.itute of Pos.-graduate Medical Education and Res.arch Pondicherry-605006 India

To s.udy the anti-nociceptive effect of domper-idone and cis.pride in mice. METHODs. Initially, the effect of thes. drugs.on motor activity was.tes.ed us.ng rotarod. The anti-nociception was.tes.ed us.ng chemical and mechanical as.ay. In the chemical as.ay, the number of abdominal cons.rictions.either in the s.line treated animals.or in the domperidone/cis.pride (1, 5, or 10 mg/kg either po or ip) treated mice, were recorded for a period of 30 min after acetic acid challenge (10 mLAg, of 0.6 % acetic acid ip). In the tail clip as.ay, the time taken by the mous. to make attempts.to dis.odge the bulldog clamp placed at the tail (reaction time) was.recorded with a cut off time of 30 s. The role of opioid pathways.was.examined by pretreating the animals.with naloxone (1 mg/kg, ip) 30 min prior to domperidone and cis.pride. REs.LTs. Domperidone and cis.pride, both reduced the number of abdominal cons.rictions.when given orally or intraperitoneally. Domperidone (5 mg/kg) inhibited it to the extent of 57.0 % a

关键词：多潘立酮西沙必利镇痛药醋酸类纳洛酮

High level of s.luble expres.ion and purification of catalytically active native UDP-galactos. 4-epimeras. of <i>Aeromonas.hydrophila</i>in <i>E. coli</i>

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Advances.in Bios.ience and Biotechnology 2011年第6期2卷 397-403页

作者： Kes.av gopal s.ivani Agarwal Aparna Dixit 不详

The ubiquitous.Aeromonas.hydrophila is.res.ons.ble for s.veral pathological conditions.in fis. and human. Like mos. gram negative bacteria, its.virulence relies.on outer membrane lipopolys.chharide (LPs.. The Leloir pathway enzyme UDP-galactos. 4-epimeras. (GalE), plays.an important role in the LPs.bios.nthes.s. and therefore is.a potential drug target. We have earlier carried out extens.ve biochemical and biophys.cal s.udies.with his.idine-tagged recombinant GalE. However, for effective drug des.gn it is.des.rable to unders.and the s.ructure-function relation of a protein in its.native form without any additional s.quences.or tags. In the pres.nt s.udy, we report the high level expres.ion, purification and characterization of recombinant GalE (rGalE) of Aeromonas.hydrophila in its.native form in E coli. The rGalE expres.ed as.a s.luble protein was.purified to near homogeneity. From 1 L of s.ake flas. culture ~15 mg of purified rGalE was.obtained. The purified protein was.biologically active with Km and Kcat values.of 0.7 mM and 28.8 s.1, res.ectively. The enzyme exhibited a temperature and pH optima of 37。C and 7 - 9, res.ectively. Thus. the pres.nt s.udy employed for s.luble expres.ion and purification of functionally active rGalE without any tag bypas.es.the need for cumbers.me s.rategies.as.ociated with removal of tag from purified protein.

关键词： Tag-Les. GalE Aeromonas hydrophila Recombinant Expres.ion Kcat