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Rescue from complications after pancreaticoduodenectomies at a low-volume Caribbean center:Value of tailored peri-pancreatectomy protocols

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World journal of Gastrointestinal Surgery 2024年第3期16卷 681-688页

作者： Shamir O Cawich Elijah Dixon parul j shukla Shailesh V Shrikhande Rahul R Deshpande Fawwaz Mohammed Neil W Pearce Wesley Francis Shaneeta johnson johann Bujhawan Department of Surgery University of the West IndiesSt Augustine 000000Trinidad and Tobago Department of Surgery Faculty of MedicineUniversity of CalgaryCalgaryAlberta T2N2T9Canada Department of Surgery Weill Cornell Medical CollegeNew YorkNY 10065United States Department of Surgical Oncology Tata Memorial CenterHomi Bhabha National UniversityMumbai 400012India Department of Surgery Manchester Royal InfirmaryManchester M139WLUnited Kingdom University Surgical Unit Southampton General HospitalSouthampton SO166YDUnited Kingdom Department of Surgery University of the West IndiesNassau N-1184Bahamas Department of Surgery Morehouse School of MedicineAtlantaGA 30310United States Department of Surgery General Hospital in Port of SpainPort of Spain 000000Trinidad and Tobago

BACKGROUND Pancreaticoduodenectomy(PD)is a technically complex operation,with a re-latively high risk for complications.The ability to rescue patients from post-PD complications is as a recognized quality measure.Tailored protocols were instituted at our low volume facility in the year 2013.AIM To document the rate of rescue from post-PD complications with tailored protocols in place as a measure of quality.METHODS A retrospective audit was performed to collect data from patients who experienced major post-PD complications at a low volume pancreatic surgery unit in Trinidad and Tobago between january 1,2013 and june 30,2023.Stan-dardized definitions from the International Study Group of Pancreatic Surgery were used to define post-PD complications,and the modified Clavien-Dindo classification was used to classify post-PD complications.RESULTS Over the study period,113 patients at a mean age of 57.5 years(standard deviation[SD]±9.23;range:30-90;median:56)underwent PDs at this facility.Major complications were recorded in 33(29.2%)patients at a mean age of 53.8 years(SD:±7.9).Twenty-nine(87.9%)patients who experienced major morbidity were salvaged after aggre-ssive treatment of their complication.Four(3.5%)died from bleeding pseudoaneurysm(1),septic shock secondary to a bile leak(1),anastomotic leak(1),and myocardial infarction(1).There was a significantly greater salvage rate in patients with American Society of Anesthesiologists scores≤2(93.3%vs 25%;P=0.0024).CONCLUSION This paper adds to the growing body of evidence that volume alone should not be used as a marker of quality for patients requiring PD.Despite low volumes at our facility,we demonstrated that 87.9%of patients were rescued from major complications.We attributed this to several factors including development of rescue protocols,the competence of the pancreatic surgery teams and continuous,and adaptive learning by the entire institution,cul-minating in the development of tailored peri-pancreatectomy protocols.

关键词： Pancreas Complication Rescue Failure Morbidity Mortality Pancreaticoduodenectomy

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Borderline resectable pancreatic tumors:Is there a need for further refinement of this stage?

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Hepatobiliary & Pancreatic Diseases International 2011年第3期10卷 319-324页

作者： Shailesh V Shrikhande Supreeta Arya Savio George Barreto Sachin Ingle Melroy A D'Souza Rohini Hawaldar parul j shukla Department of Hepato-Pancreato-Biliary Surgical Oncology Department of Radiology Tata Memorial Hospital Department of Surgery Royal Adelaide Hospital Clinical Research Secretariat

BACKGROUND:The ideal treatment of patients with 'borderline resectable pancreatic tumors (BRTs)' needs to be established.Current protocols advise neoadjuvant chemo(radio)therapy,although some patients may appear to have BRT on preoperative imaging and a complete resection may be achieved without the need for vascular resection.The aim of the present study was to identify specific findings on preoperative imaging that could help predict in which patients with BRT a complete resection,with or without vascular resection (VR),could be achieved.METHODS:Twelve patients with BRTs were identified.Tumor location,maximum degree of circumferential contact (CC),length of contact of the tumor with major vessels (LC),and luminal narrowing of vessels at the point of contact with the tumor (venous deformity,VD) were graded on preoperatively acquired multidetector computed tomography (MDCT) images and then compared with the intraoperative findings and need for VR.RESULTS:A complete resection (R0) was achieved in 10 patients with 2 having microscopic positive margins (R1) on histopathology at the uncinate margin.Four of the 10 patients required VR (40%).In 3 of the 4 patients whose tumors required VRs,CC was ≥grade III and VD was grade 2.LC did not influence the need for VR.CONCLUSIONS:It is possible to achieve a complete resection at the first instance in patients found to have BRTs on preoperative imaging.Preoperative MDCT-based grading systems and our proposed criteria may help identify such patients,thus avoiding any delay in curative resections in such patients.

关键词： pancreatic head carcinoma pancreatic cancer pancreatic neoplasms resection

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Study of plasma parameters of coaxial plasma source using triple Langmuir probe and Faraday cup diagnostics

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Plasma Science and Technology 2024年第4期26卷 94-100页

作者： Sunil KANCHI Rohit shukla Archana SHARMA Pulsed Power and Electromagnetics Division Bhabha Atomic Research CentreVisakhapatnam 531011India Homi Bhabha National Institute Mumbai 400085India Beam Technology Development Group Bhabha Atomic Research CentreMumbai 400085India

Coaxial plasma guns are a type of plasma source that produces plasma which propagates radially and axially controlled by the shape of the ground electrode, which has attracted much interest in several applications. In this work, a 120° opening angle of CPG nozzle is used as a plasma gun configuration that operates at the energy of 150 j. The ionization of polyethylene insulator between the electrodes of the gun produces a cloud of hydrogen and carbon plasma.The triple Langmuir probe and Faraday cup are used to measure plasma density and plasma temperature. These methods are used to measure the on-axis and off-axis plasma divergence of the coaxial plasma gun. The peak values of ion densities measured at a distance of 25 mm on-axis from the plasma gun are(1.6±0.5)×10^(19)m^(-3)and(2.8±0.6)×10^(19)m^(-3)for hydrogen and carbon plasma respectively and the peak temperature is 3.02±0.5 eV. The mean propagation velocity of plasma is calculated using the transit times of plasma at different distances from the plasma gun and is found to be 4.54±0.25 cm/μs and 1.81±0.18 cm/μs for hydrogen and carbon plasma respectively. The Debye radius is obtained from the measured experimental data that satisfies the thin sheath approximation. The shot-to-shot stability of plasma parameters facilitates the use of plasma guns in laboratory experiments. These types of plasma sources can be used in many applications like plasma opening switches, plasma devices, and as plasma sources.

关键词： coaxial plasma source triple Langmuir probe Faraday cup plasma density plasma temperature

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Whipple’s operation with a modified centralization concept:A model in low-volume Caribbean centers

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World journal of Clinical Cases 2022年第22期10卷 7620-7630页

作者： Shamir O Cawich Neil W Pearce Vijay Naraynsingh parul shukla Rahul R Deshpande Department of Clinical Surgical Sciences University of the West IndiesSt Augustine 000000Trinidad and Tobago University Surgical Unit Southampton General HospitalSouthampton SO166YDUnited Kingdom Department of Surgery Weill Cornell Medical CollegeNew YorkNY 10065United States Department of Surgery Manchester Royal InfirmaryManchester M139WLUnited Kingdom

Conventional data suggest that complex operations,such as a pancreaticoduodenectomy(PD),should be limited to high volume centers.However,this is not practical in small,resource-poor countries in the Caribbean.In these settings,patients have no option but to have their PDs performed locally at low volumes,occasionally by general surgeons.In this paper,we review the evolution of the concept of the high-volume center and discuss the feasibility of applying this concept to low and middle-income nations.Specifically,we discuss a modification of this concept that may be considered when incorporating PD into low-volume and resource-poor countries,such as those in the Caribbean.This paper has two parts.First,we performed a literature review evaluating studies published on outcomes after PD in high volume centers.The data in the Caribbean is then examined and we discuss the incorporation of this operation into resource-poor hospitals with modifications of the centralization concept.In the authors’opinions,most patients who require PD in the Caribbean do not have realistic opportunities to have surgery in high-volume centers in developed countries.In these settings,their only options are to have their operations in the resource-poor,low-volume settings in the Caribbean.However,post-operative outcomes may be improved,despite low-volumes,if a modified centralization concept is encouraged.

关键词： Pancreas Surgery Pancreatectomy Whipple’s Pancreaticoduodenectomy

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A Space-Time Interior Penalty Discontinuous Galerkin Method for the Wave Equation

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Communications on Applied Mathematics and Computation 2022年第3期4卷 904-944页

作者： Poorvi shukla j.j.W.van der Vegt Department of Applied Mathematics University of TwenteP.O.Box 2177500 AE EnschedeThe Netherlands

A new higher-order accurate space-time discontinuous Galerkin(DG)method using the interior penalty flux and discontinuous basis functions,both in space and in time,is pre-sented and fully analyzed for the second-order scalar wave equation.Special attention is given to the definition of the numerical fluxes since they are crucial for the stability and accuracy of the space-time DG method.The theoretical analysis shows that the DG discre-tization is stable and converges in a DG-norm on general unstructured and locally refined meshes,including local refinement in time.The space-time interior penalty DG discre-tization does not have a CFL-type restriction for stability.Optimal order of accuracy is obtained in the DG-norm if the mesh size h and the time stepΔt satisfy h≅CΔt,with C a positive constant.The optimal order of accuracy of the space-time DG discretization in the DG-norm is confirmed by calculations on several model problems.These calculations also show that for pth-order tensor product basis functions the convergence rate in the L∞and L2-norms is order p+1 for polynomial orders p=1 and p=3 and order p for polynomial order p=2.

关键词： Wave equation Space-time methods Discontinuous Galerkin methods Interior penalty method A priori error analysis

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In vitro and in vivo anticancer potential and molecular targets of the new colchicine analog ⅢM-067

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journal of Integrative Medicine 2023年第1期21卷 62-76页

作者： Sumera Malik Mubashir j.Mintoo Chilakala Nagarjuna Reddy Rajesh Kumar Pankul Kotwal Sandip BBharate Utpal Nandi Dilip M.Mondhe Sanket K.shukla Pharmacology Division Council of Scientific and Industrial Research(CSIR)-Indian Institute of Integrative MedicineJammu 180001Jammu&KashmirIndia Academy of Scientific&Innovative Research(AcSIR) Ghaziabad 201002Uttar PradeshIndia Medicinal Chemistry Division CSIR-Indian Institute of Integrative MedicineJammu 180001Jammu&KashmirIndia Pharmacokinetics-Pharmacodynamics(PK-PD) Toxicology DivisionCSIR-Indian Institute of Integrative MedicineJammu 180001Jammu&KashmirIndia

Objective: The current study evaluated various new colchicine analogs for their anticancer activity and to study the primary mechanism of apoptosis and in vivo antitumor activity of the analogs with selective anticancer properties and minimal toxicity to normal cells.Methods: Sulforhodamine B(SRB) assay was used to screen various colchicine analogs for their in vitro cytotoxicity. The effect of N-[(7S)-1,2,3-trimethoxy-9-oxo-10-(pyrrolidine-1-yl)5,6,7,9-tetrahydrobenzo[a] heptalene-7-yl] acetamide(ⅢM-067) on clonogenicity, apoptotic induction, and invasiveness of A549 cells was determined using a clonogenic assay, scratch assay, and staining with 4’,6-diamidino-2-phenylindole(DAPI) and annexin V/propidium iodide. Mitochondrial membrane potential(MMP) and reactive oxygen species(ROS) levels were observed using fluorescence microscopy. Western blot analysis was used to quantify expression of proteins involved in apoptosis, cell cycle, and phosphatidylinositol 3-kinase(PI3K)/protein kinase B(AKT)/mammalian target of rapamycin(mTOR) signaling. Pharmacokinetic and in vivo efficacy studies against Ehrlich ascites carcinoma(EAC) and Ehrlich solid tumor models were conducted using Swiss albino mice.Results: ⅢM-067 showed potent cytotoxicity and better selectivity than all other colchicine analogs screened in this study. The selective activity of ⅢM-067 toward A549 cells was higher among other cancer cell lines,with a selectivity index(SI) value of 2.28. ⅢM-067 demonstrated concentration-and time-dependent cytotoxicity against A549 cells with half-maximal inhibitory concentration values of 0.207, 0.150 and0.106 μmol/L at 24, 48 and 72 h, respectively. It also had reduced toxicity to normal cells(SI > 1) than the parent compound colchicine(SI = 1). ⅢM-067 reduced the clonogenic ability of A549 cells in a dose-dependent manner. ⅢM-067 enhanced ROS production from 24.6% at 0.05 μmol/L to 82.1% at 0.4 μmol/L and substantially decreased the MMP(100% in control to 5.6% at 0.4 μmol/L). The annexin V-FITC assay demonstrated78% ap

关键词： Colchicine 1IIM-067 Apoptosis Antineoplastic agents Carcinoma Ehrlich tumor A549 cells

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Timing of percutaneous endoscopic gastrostomy tube placement in post-stroke patients does not impact mortality, complications, or outcomes

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World journal of Gastrointestinal Pharmacology and Therapeutics 2022年第5期13卷 77-87页

作者： Kavya M Reddy Preston Lee parul j Gor Antonio Cheesman Noor Al-Hammadi David john Westrich jason Taylor Vatche and Tamar Manoukian Division of Digestive Diseases David Geffen School of Medicine at University of California Los AngelesLos AngelesCA 90095United States Department of Internal Medicine Santa Clara Valley Medical CenterSan JoseCA 95128United States Division of Gastroenterology and Hepatology Mercy HospitalSaint LouisMO 63141United States David john Westrich Jason TaylorDivision of Gastroenterology and HepatologySaint Louis University School of MedicineSaint LouisMO 63104United States Saint Louis University Center for Health Outcomes Research Saint Louis UniversitySaint LouisMO 63104United States

BACKGROUND Percutaneous Endoscopic Gastrostomy(PEG)tubes are often placed for dysphagia following a stroke in order to maintain sufficient caloric intake.The 2011 ASGE guidelines recommend delaying PEG tube placement for two weeks,as half of patients with dysphagia improve within 2 wk.There are few studies comparing outcomes based on timing of PEG tube placement,and there is increasing demand for early PEG tube placement to meet requirements for timely discharge to rehab and skilled nursing facilities.AIM To assess the safety of early(≤7 d post stroke)vs late(>7 d post stroke)PEG tube placement and evaluate whether pre-procedural risk factors could predict mortality or complications.METHODS We performed a retrospective study of patients undergoing PEG tube placement for dysphagia following a stroke at two hospitals in Saint Louis,MO between january 2011 and December 2017.Patients were identified by keyword search of endoscopy reports.Mortality,peri-procedural complication rates,and post-procedural complication rates were compared in both groups.Predictors of morbidity and mortality such as protein-calorie malnutrition,presence of an independent cardiovascular risk equivalent,and presence of Systemic inflammatory response syndrome(SIRS)criteria or documented infection were evaluated by multivariate logistic regression.RESULTS 154 patients had a PEG tube placed for dysphagia following a stroke,92 in the late group and 62 in the early group.There were 32 observed deaths,with 8 occurring within 30 d of the procedure.There was an increase in peri-procedural and post-procedural complications with delayed PEG placement which was not statistically significant.Hospital length of stay was significantly less in patients with early PEG tube placement(12.9 vs 22.34 d,P<0.001).Protein calorie malnutrition,presence of SIRS criteria and/or documented infection prior to procedure or having a cardiovascular disease risk equivalent did not significantly predict mortality or complications.CONCLUSION Early PEG tube placement followin

关键词： Percutaneous endoscopic gastrostomy tube Dysphagia Stroke Enteral nutrition Gastrostomy/adverse effect

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A MATHEMATICAL MODEL FOR THE DEPLETION OF FORESTRY RESOURCES DUE TO POPULATION AND POPULATION PRESSURE AUGMENTED INDUSTRIALIZATION

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International journal of Modeling, Simulation, and Scientific Computing 2014年第1期5卷 186-201页

作者： A.K.MISRA KUSUM LATA j.B.shukla Department of Mathematics Faculty of Science Banaras Hindu UniversityVaranasi-221005India BIT BIIFR&DBhabha Group of Institutions Kanpur(Rural)-209204India

In this paper,a nonlinear mathematical model is proposed and analyzed to study the depletion of forestry resources caused simultaneously by population and population pressure augmented industrialization.The control of population pressure,using economic efforts is also considered in the modeling process.It is assumed that cumulative biomass density of forestry resources and the density of population follow logistic models.It is further assumed that the density of population and the level of industrialization increase as the cumulative biomass density of forestry resources increases.The cumulative density of economic efforts,which are applied to control the population pressure,is considered to be proportional to the population pressure.The model analysis shows that as the population pressure increases,the level of industrialization increases leading to decrease in the cumulative biomass density of forestry resources.It is found that if population pressure is controlled by using some economic efforts,the decrease in cumulative biomass density of forestry resources can be made much less than the case when no control is applied.It is also noted that if the population pressure augmented industrialization increases without control,the forestry resources may become extinct.

关键词： Mathematical model forestry resources population pressure industrialization economic efforts stability

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Bianchi Type-Ⅲ Cosmological Models with Gravitational Constant G and the Cosmological Constant A

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Chinese Physics Letters 2007年第12期24卷 3325-3327页

作者： j. P. Singh R. K. Tiwari Pratibha shukla Department of Mathematical Sciences A.P.S. University Rewa (MP) India Department of Mathematics Govt. Model Science College Rewa (MP) India

Einstein field equations with variable gravitational and cosmological constants are considered in the presence of perfect fluid for the Bianchi type-Ⅲ universe by assuming conservation law for the energy-momentum tensor. Exact solutions of the field equations are obtained by using the scalar of expansion proportional to the shear scalar θ∝σ, which leads to a relation between metric potential B = Cn, where n is a constant. The corresponding physical interpretation of the cosmological solutions are also discussed.

关键词： Cosmological Models Cosmological Constant

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Modelling and Analysis of Bacteria Dependent Infectious Diseases with Variable Contact Rates

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Computers, Materials & Continua 2021年第8期68卷 1859-1875页

作者： j.B.shukla Shikha Singh jitendra Singh Sunil Kumar Sharma Innovative Internet University for Research Kanpur208017India P.P.N.(P.G.)College CSJM UniversityKanpur208001India College of Computer and Information Sciences Majmaah UniversityMajmaah11952Saudi Arabia

In this research,we proposed a non-linear SIS model to study the effect of variable interaction rates and non-emigrating population of the human habitat on the spread of bacteria-infected diseases.It assumed that the growth of bacteria is logistic with an intrinsic growth rate is a linear function of infectives.In this model,we assume that contact rates between susceptibles and infectives as well as between susceptibles and bacteria depend on the density of the non-emigrating population and the total population of the habitat.The stability theory has been analyzed to analyzed to study the crucial role played by bacteria in the increased spread of an infectious disease.It is shown that as the density of non-emigrating population increases,the spread of an infectious disease increases.It is shown further that as the emigration increases,the spread of the disease decreases in both the cases of contact mentioned above rates,but this spread increases as these contact rates increase.It suggested that the control of bacteria in the human habitat is very useful to decrease the spread of an infectious disease.These results are confirmed by numerical simulation.

关键词： Mathematical modelling density dependent contact rates stability analysis

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