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Blumgart's technique of pancreaticojejunostomy: Analysis of safety and outcomes

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Hepatobiliary & Pancreatic Diseases International 2019年第2期18卷 181-187页

作者： Vishal Gupta saket kumar Vivek Gupta Pradeep Joshi Rahul Rahul Rakesh kumar Yadav Amit Dangi Abhijit Chandra Department of Surgical Gastroenterology King George's Medical University Department of Human Organ Transplant King George's Medical University

Background: Blumgart's pancreaticojejunostomy(PJ) has been described with low pancreatic leak rates. This study aimed to evaluate our experience with this technique regarding the pancreatic leak and other perioperative outcomes. Methods: We performed a single-center retrospective analysis of a cohort of 81 patients who underwent pancreaticoduodenectomy in our department from January 2011 to February 2018. The primary endpoint was the occurrence of a clinically relevant postoperative pancreatic fistula(CR-POPF) and analysis of its risk factors. Results: The CR-POPF rate was 12.3%. Fistula risk score(FRS) was the only significant risk factor for the occurrence of overall POPF in multivariate analysis. However, none of the other factors including FRS was found to be significantly associated with CR-POPF risk. A strong positive correlation was found between the CR-POPF and the incidence of delayed gastric emptying, post-pancreatectomy hemorrhage and increased length of hospital stay. Conclusion: Blumgart's technique is a safe technique of pancreatico-enteric anastomosis with low rates of CR-POPF. CR-POPF with this technique is independent of most of the preoperative and intraoperative factors. Therefore, this technique can be used for all types of the pancreas with consistently good results.

关键词： Pancreaticoduodenectomy Pancreatico-jejunal anastomosis Postoperative pancreatic fistula Pancreatic leak

Laparoscopic ventral mesh rectopexy for complete rectal prolapse: A retrospective study evaluating outcomes in North Indian population

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World Journal of Gastrointestinal Surgery 2016年第4期8卷 321-325页

作者： Abhijit Chandra saket kumar Ajeet Pratap Maurya Vishal Gupta Vivek Gupta Rahul Department of Surgical Gastroenterology King George’s Medical University

AIM: To analyze the outcomes of laparoscopic ventral mesh rectopexy in the management of complete rectal prolapse(CRP) in North Indian patients with inherent bulky and redundant colon. METHODS: The study was conducted at a tertiary health care center of North India. Between January 2010 and October 2014, 15 patients who underwent laparoscopic ventral mesh repair for CRP, were evaluated in the present study. Perioperative outcomes, improvement in bowel dysfunction or appearance of new complications were documented from the hospital records maintained prospectively. RESULTS: Fifteen patients(9 female) with a median age of 50 years(range, 15-68) were included in the study. The median operative time was 200 min(range, 180-350 min) and the median post-operative stay was 4 d(range, 3-21 d). No operative mortality occurred. One patient with inadvertent small bowel injury required laparotomy on post-operative day 2. At a median follow-up of 22 mo(range, 4-54 mo), no prolapse recurrence was reported. No mesh-related complication was encountered. Wexner constipation score improved significantly from the preoperative value of 17(range, 5-24) to 6(range, 0-23)(P < 0.001) and the fecal incontinence severity index score from 24(range, 0-53)to 2(range, 0-53)(P = 0.007). No de novo constipation or fecal incontinence was recorded during the followup. On personal conversation, all patients expressed satisfaction with the outcome of their treatment. CONCLUSION: Our experience indicates that laparoscopic ventral mesh rectopexy is an effective surgical option for CRP in North Indian patients having a bulky redundant colon.

关键词： Redundant sigmoid Constipation Complete rectal prolapse Ventral rectopexy Indian population

Enhanced electrical and photocatalytic activities in Na_(0.5)Bi_(0.5)TiO_(3) through structural modulation by using anatase and rutile phases of TiO_(2)

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Journal of Materiomics 2022年第1期8卷 18-29页

作者： Cilaveni Goutham Kinjarapu Venkata Ashok kumar Sai Santosh kumar Raavi Challapalli Subrahmanyam saket Asthana Advanced Functional Materials Laboratory Department of PhysicsIndian Institute of Technology HyderabadKandiSangareddy502285TelanganaIndia Department of Chemistry Indian Institute of Technology HyderabadKandiSangareddy502285TelanganaIndia

This paper deals with an in-depth analysis on the role of the microstructure phase of titanium dioxide(TiO_(2))precursor in sodium bismuth titanate(Na_(0.5)Bi_(0.5)TiO_(3),hereafter represented as NBT)ceramics prepared through the hydrothermal *** comparison of the grain size,microstructure,crystal structure,and electrical properties of the NBT ceramics is carried out using anatase and rutile TiO_(2).NBT ceramics with anatase TiO_(2)(denoted by NBT_(A))displayed superior dielectric and ferro/piezoelectric properties along with the additional functionality in terms of *** studies of functional properties such as piezoelectric,ferroelectric,and dielectric stressed the far-reaching influence of effects on grain *** mechanisms and functional properties of grain quantitative effects are also *** boundaries volume fraction increment has decreased the dielectric peak but increased the diffusiveness in the case of the NBT with rutile TiO_(2) precursor(denoted as NBT_(R)).Similarly,elastic stiffness increment restricts the movement of the domain wall and led to a decrement in remnant polarization along with an increase in the values of the corresponding piezoelectric coefficient in finegrain NBT_(R) samples.

关键词： Lead-free ferroelectrics Grain size(microstructure) X-ray diffraction Electrical properties(dielectric and ferroelectric) Piezo-photocatalysis

Review of sub-synchronous interaction in wind integrated power systems: classification, challenges, and mitigation techniques

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Protection and Control of Modern Power Systems 2023年第2期8卷 13-38页

作者： Neevatika Verma Narendra kumar saket Gupta Hasmat Malik Fausto Pedro García Márquez Department of Electrical Engineering Delhi Technological UniversityDelhi 110042India Department of Electrical Power Engineering Faculty of Electrical EngineeringUniversiti Teknologi Malaysia(UTM)81310 JohorMalaysia Ingenium Research Group DepartmentUniversidad Castilla-La Mancha13071 Ciudad RealSpain Department of Electrical Engineering Graphic Era Deemed to be UniversityDehradun 248002India Instrumentation and Control Engineering Department Bharati Vidyapeeth’s College of EngineeringNew Delhi 110056India

Emerging sub-synchronous interactions(SSI)in wind-integrated power systems have added intense attention after numerous incidents in the US and China due to the involvement of series compensated transmission lines and power electronics *** phenomenon occurs when two power system elements exchange energy below the synchro-nous *** phenomenon related to wind power plants is one of the most significant challenges to main-taining stability,while SSI phenomenon in practical wind farms,which has been observed recently,has not yet been described on the source of conventional SSI *** paper first explains the traditional development of SSI and its classification as given by the IEEE,and then it proposes a classification of SSI according to the current research status,reviews several mitigation techniques and challenges,and discusses analysis techniques for *** paper also describes the effect of the active damping controllers,control scheme parameters,degree of series compensation,and various techniques used in wind power plants(WPPs).In particular,a supplementary damping controller with converter controllers in Doubly Fed Induction Generator based WPPs is briefly *** paper provides a real-istic viewpoint and a potential outlook for the readers to properly deal with SSI and its mitigation techniques,which can help power engineers for the planning,economical operation,and future expansion of sustainable development.

关键词： Damping controller Doubly fed induction generator(DFIG) Series compensations Sub-synchronous interactions(SSI) Sub-synchronous resonance(SSR)

Unleashing the Power of Multi-Agent Reinforcement Learning for Algorithmic Trading in the Digital Financial Frontier and Enterprise Information Systems

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Computers, Materials & Continua 2024年第8期80卷 3123-3138页

作者： saket Sarin Sunil K.Singh Sudhakar kumar Shivam Goyal Brij Bhooshan Gupta Wadee Alhalabi Varsha Arya Chandigarh College of Engineering and Technology Chandigarh160019India Department of Computer Science and Information Engineering Asia UniversityTaichung413Taiwan Symbiosis Centre for Information Technology(SCIT) Symbiosis International UniversityPune411057India Center for Interdisciplinary Research University of Petroleum and Energy Studies(UPES)Dehradun248007India Department of Computer Science Immersive Virtual Reality Research GroupKing Abdulaziz UniversityJeddah21589Saudi Arabia Department of Business Administration Asia UniversityTaichung413Taiwan Department of Electrical and Computer Engineering Lebanese American UniversityBeirut11022801Lebanon UCRD Chandigarh UniversityChandigarh140413India

In the rapidly evolving landscape of today’s digital economy,Financial Technology(Fintech)emerges as a trans-formative force,propelled by the dynamic synergy between Artificial Intelligence(AI)and Algorithmic *** in-depth investigation delves into the intricacies of merging Multi-Agent Reinforcement Learning(MARL)and Explainable AI(XAI)within Fintech,aiming to refine Algorithmic Trading *** meticulous examination,we uncover the nuanced interactions of AI-driven agents as they collaborate and compete within the financial realm,employing sophisticated deep learning techniques to enhance the clarity and adaptability of trading *** AI-infused Fintech platforms harness collective intelligence to unearth trends,mitigate risks,and provide tailored financial guidance,fostering benefits for individuals and enterprises navigating the digital *** research holds the potential to revolutionize finance,opening doors to fresh avenues for investment and asset management in the digital ***,our statistical evaluation yields encouraging results,with metrics such as Accuracy=0.85,Precision=0.88,and F1 Score=0.86,reaffirming the efficacy of our approach within Fintech and emphasizing its reliability and innovative prowess.

关键词： Neurodynamic Fintech multi-agent reinforcement learning algorithmic trading digital financial frontier

Targeting inflammation in diabetes: Newer therapeutic options

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World Journal of Diabetes 2014年第5期5卷 697-710页

作者： Neeraj kumar Agrawal saket Kant Department of Endocrinology and Metabolism Institute of Medical Sciences Banaras Hindu University Varanasi 221005 India

Inflammation has been recognised to both decrease beta cell insulin secretion and increase insulin resis-tance. Circulating cytokines can affect beta cell function directly leading to secretory dysfunction and increased apoptosis. These cytokines can also indirectly affect beta cell function by increasing adipocyte *** resulting glucotoxicity and lipotoxicity further enhance the inflammatory process resulting in a vicious cycle. Weight reduction and drugs such as metformin have been shown to decrease the levels of C-Reactive Protein by 31% and 13%, respectively. Pioglitazone, insulin and statins have anti-inflammatory effects. In-terleukin 1 and tumor necrosis factor-α antagonists are in trials and NSAIDs such as salsalate have shown an improvement in insulin sensitivity. Inhibition of 12-lipo-oxygenase, histone de-acetylases, and activation of sirtuin-1 are upcoming molecular targets to reduce in-flammation. These therapies have also been shown to decrease the conversion of pre-diabetes state to diabe-tes. Drugs like glicazide, troglitazone, N-acetylcysteine and selective COX-2 inhibitors have shown benefit in diabetic neuropathy by decreasing inflammatory mark-ers. Retinopathy drugs are used to target vascular en-dothelial growth factor, angiopoietin-2, various protein-ases and chemokines. Drugs targeting the proteinases and various chemokines are pentoxifylline, inhibitors of nuclear factor-kappa B and mammalian target of rapa-mycin and are in clinical trials for diabetic nephropathy. Commonly used drugs such as insulin, metformin, per-oxisome proliferator-activated receptors, glucagon like peptide-1 agonists and dipeptidyl peptidase-4 inhibitors also decrease inflammation. Anti-inflammatory thera-pies represent a potential approach for the therapy of diabetes and its complications.

关键词： Inflammation Insulin resistance Diabetes Neuropathy Retinopathy Nephropathy

Avoiding second donor site and the second set of neck vessels in a case of absent peroneal skin perforators

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Plastic and Aesthetic Research 2022年第1期9卷 661-666页

作者： Aditya Narayan Choudhary Rajan Arora Kripa Shanker Mishra Ravi Kiran Naalla saket Srivastava Ajay kumar Dewan Department of Reconstructive and Microvascular Surgery Rajiv Gandhi Cancer Institute and Research CentreRohiniNew Delhi 110085India Department of Surgical Oncology Rajiv Gandhi Cancer Institute and Research CentreRohiniNew Delhi 110085India

This report describes the procedure of a case in which the skin paddle of the free fibula flap derived its supply solely from a soleal musculocutaneous perforator originating from the posterior tibial *** contrast,the osteo-muscular component was supplied by the peroneal vascular *** harvested the skin paddle with its vascular supply from the posterior tibial artery separately,and the osteo-muscular fibula was harvested with its supply from peroneal *** this way,we avoided violation of the second donor site for the skin *** addition,we used the distal end of peroneal vessels to salvage our skin paddle instead of sacrificing another set of neck vessels for *** technique may also be utilised in cases where the neck vessels may not be available due to previous surgeries,radiation therapy,or decision by the surgery team to not sacrifice two sets of neck vessels for anastomosis.

关键词： Free fibula flap peroneal vessels posterior tibial vessels mandible reconstruction flaps in series

Early Results of Mitral Valve Replacement in Severe Pulmonary Artery Hypertension—An Institutional Prospective Study

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World Journal of Cardiovascular Surgery 2013年第2期3卷 63-69页

作者： Nirmal kumar Prashant Sevta Subodh Satyarthy saket Agarwal Vithal kumar Betigeri Deepak kumar Satsangi Department of Cardiothoracic and Vascular Surgery Escorts Heart Institute and Research Center New Delhi India Department of Cardiothoracic and Vascular Surgery G. B. Pant Hospital New Delhi India

Introduction: In patients undergoing surgery for mitral valve replacement (MVR) for valvular heart disease, pulmonary artery hypertension (PAH) has been considered a major risk factor. In this prospective study, we have studied the early hemodynamic changes and post-operative outcomes of MVR among patients with severe PAH. Methods: 68 consecutive patients who underwent mitral valve replacement for severe rheumatic mitral valve disease with severe PAH (pulmonary artery pressure (PAP) > 50 mmHg) were studied prospectively for immediate postoperative hemodynamics and outcomes. The mean age of the patients was 32.1 years. 32 (47.05%) patients had mitral stenosis, 13 (19.11%) had mitral regurgitation and 23 (33.82%) had mixed lesions. Patients were divided into two groups based on preoperative pulmonary artery pressures. In 56 patients (82.35%, group I) PAP was sub-systemic or systemic, with a mean of 58.4 mmHg. Twelve patients (17.65%, group II) had supra-systemic PAP with a mean of 82.4 mmHg. Results: After mitral valve replacement, the PAP and pulmonary vascular resistance (PVR) decreased significantly in group I to near normal levels. In group II also the PAP and PVR decreased significantly but significant residual PAH remained. Operative mortality was 3.5% in group I and 16.6% in group II. Conclusions: MVR is safe and effective at the presence of severe PAH as long as the PAP is below or equal to systemic pressures. With suprasystemic PAP, MVR carries a high risk of mortality and the patient continues to have severe PAH in the postoperative period.

关键词： Pulmonary Artery Hypertension Mitral Valve Replacement

Cardiopulmonary Bypass for Tracheal Resection and Repair—A Safe Alternative

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World Journal of Cardiovascular Surgery 2018年第11期8卷 197-203页

作者： Akshay Chauhan Satish kumar Aggarwal Vishnu Dutt saket Agarwal M. A. Geelani Department of Cardiothoracic and Vascular Surgery G B Pant Hospital New Delhi India Department of Pediatric Surgery Maulana Azad Medical College New Delhi India Department of Pediatric Surgery Sir Ganga Ram Hospital New Delhi India Department of Anaesthesia G B Pant Hospital New Delhi India

Airway management during tracheal surgery is always challenging for the anaesthesia team. Cardiopulmonary bypass (CPB) is generally not required during tracheal surgery on the cervical trachea. However, for tracheal surgeries CPB may be advantageous and give the surgeon more freedom to work. We report three cases of post-intubation tracheal stenosis successfully managed with tracheal resection and reconstruction performed under cardiopulmonary bypass.

关键词： Cardiopulmonary Bypass Tracheal Stenosis