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The Role of Preoperative Ultrasound and Sestamibi Scintigraphy in the Surgical Management of Primary Hyperparathyroidism: A Review of Literature

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International Journal of Otolaryngology and Head & Neck Surgery 2022年第2期11卷 91-105页

作者： Daniel Margain Rodrigo Arrangoiz Adrian Legaspi vanitha vasudevan Amit Sastry Frank De La Cruz Jeronimo Garcialopez De Llano Jennifer Fernandez Loisani Galindo Noah Llaneras Matthew Farrell Gonzalo Fernandez-Christlieb Fernando Cordera Center for Advanced Surgical Oncology Hialeah FL USA American British Cowdray Medical Center Mexico City Mexico Sociedad Quirurgica S.C. at the American British Cowdray Medical Center Mexico City Mexico

Background: Primary hyperparathyroidism (pHPT) is one of the most common endocrine diseases and the most common cause of hypercalcemia. Since routine laboratory testing, the prevalence of the disease has increased from 0.1% to 0.4% worldwide. The only curative treatment is parathyroidectomy. Nowadays, preoperative localization studies have become standard before surgical treatment, and the first stage imaging methods are cervical ultrasonography (US) and/or Sestamibi scintigraphy. Objectives: To describe the accuracy of US and Sestamibi for detection of hyperfunctioning parathyroid adenomas preoperatively in patients with confirmed pHPT from our medical institution. Results: This is a retrospective study from a prospectively kept database that included thirty-one patients with the confirmed diagnosis of pHPT clinically and biochemically. The average age was 57.8 years old. Preoperative US and surgery findings were compared with a sensitivity of 51%. Preoperative Sestamibi and surgery findings were compared resulting in a sensitivity of 71%. Both imaging methods combined, resulted in a sensitivity of 80%. Conclusion: In patients with pHPT, Sestamibi is an effective method for localizing parathyroid pathology preoperatively, but the false negative rate can be high. US tends to have a wider range explained by the operator-dependent factor. The combination of US and Sestamibi reduces the rate of false negatives, as reported in international literature. It is important to mention that these studies cannot be used as a confirmatory test for this disease. It should only be used as an adjunct to help plan the operation.

关键词： Parathyroid Glands Primary Hyperparathyroidism Parathyroid Adenoma Parathyroid Hyperplasia Parathyroidectomy Cervical Ultrasound Sestamibi Scintigraphy Limited Neck Exploration

Breast Conserving Surgery: Has the Standard of Care Enhanced Outcomes for Patients?

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Advances in Breast Cancer Research 2021年第1期10卷 1-23页

作者： Rodrigo Arrangoiz Jeronimo Garcialopez De Llano Maria Fernanda Mijares Gonzalo Fernandez-Christlieb vanitha vasudevan Amit Sastry Adrian Legaspi Center for Advanced Surgical Oncology Palmetto General Hospital Hialeah FL USA Center for Advanced Surgical Oncology Palmetto General Hospital Hialeah FL USA

Breast Conserving Surgery (BCS) is a rapidly emerging field increasingly adopted to facilitate breast conservation and preserve breast aesthetics. Since the publication of the Randomized Controlled Trials (RCTs) of Breast Conserving Surgery versus mastectomy in early breast cancer, the adoption of BCS for breast cancer patients’ surgical management has been comprehensive. A computerized bibliographic search was performed on PubMed/MEDLINE, Embase, Google Scholar and Cochrane library databases. This article aims to perform a thorough review of new data regarding invasive cancer and margins while evaluating patient outcomes related to BCS after neoadjuvant chemotherapy focusing on margins, imaging evaluation, the extent of resection, and local regional recurrence outcomes. The growth pattern and biopsy of Ductal Carcinoma In Situ (DCIS) differ from invasive cancer, impacting margins. It is essential to understand how the Society of Surgical Oncology (SSO) DCIS margin guideline has influenced practice. Early breast cancer surgical management should be unique to each patient, driven by evidence-based medicine, and focused on specific clinical, histological, and molecular characteristics of the tumor. Conclusion: The current management for early breast cancer should be tailored and evidence-based to each patient based on the clinical, histological and molecular characteristics of the tumor. Presumably, the standard of care in BCS has enhanced the outcomes for this patient population. This review made by peers will help surgeons to stay up to date with the current literature and help them manage breast cancer while improving multiple clinical parameters such as Disease-Free Survival (DFS), Recurrence-Free Survi

关键词： Breast Conserving Surgery (BCS) Disease-Free Survival (DFS) Recur-rence-Free Survival (RFS) Distant-Disease-Free Survival (DDFS) Overall Sur-vival (OS) Ductal Carcinoma in Situ (DCIS) Neoadjuvant Chemotherapy (NAC)

Mediastinal Liposarcoma: Case Report and Literature Review

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Journal of Cancer Therapy 2021年第4期12卷 208-220页

作者： Jeronimo Garcialopez De Llano Maria Fernanda Mijares vanitha vasudevan Rodrigo Arrangoiz Amit Sastry Frank De la Cruz Jennifer Fernandez Garcia Adrian Legaspi Center for Advanced Surgical Oncology Palmetto General Hospital Hialeah USA

Liposarcomas (LS) are the second most common type of soft tissue malignancies in adults;they arise from mesenchymal cells and account for 1% of all adult cancers and 15% of all pediatric cancers. The site of origin can be from anywhere there is fat in the human body. LS are classified based on the primary site of origin, and mediastinal LS are extremely rare. When mediastinal neoplasms are stratified based on histology, they represent less than 1% of all mediastinal tumors. To date, less than 150 cases have been reported in the English literature. This article aims to present an unusual case of an extremely rare malignancy and perform a systematic review of the latest literature. In this report, our group is documenting the presentation, management, and outcome of a 65-year-old male patient with a massive anterior mediastinal primary LS. The tumor was displacing the mediastinum into the right chest, occupying most of the left chest, and pushing the diaphragm into the abdomen. Mediastinal liposarcomas are extremely rare malignancies and can prove to be challenging to diagnose and treat. Aggressive surgical treatment with R0 resection is the gold standard, however, tumor biology in many cases is associated with variable growth rates and encroachment of adjacent vital structures and blood vessels. When complex anatomical structures preclude an R0 resection, there is a high incidence of local recurrence. In cases where there is a high risk of recurrence, radiotherapy is indicated and chemotherapy has a more limited role.

关键词： Liposarcoma (LS) Well-Differentiated Liposarcoma (WDLS) Dedifferentiated Liposarcoma (DDLS)

Molecular Diagnosis of Thyroid Nodules and Its Future Implications for the Management of Thyroid Cancer

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International Journal of Otolaryngology and Head & Neck Surgery 2021年第5期10卷 398-418页

作者： Rodrigo Arrangoiz Jeronimo Garcialopez De Llano Maria Fernanda Mijares Gonzalo Fernandez-Christlieb vanitha vasudevan Amit Sastry Adrian Legaspi Jennifer Fernandez Frank de la Cruz Fernando Cordera Daniel Margain Center for Advanced Surgical Oncology Steward Health Hialeah FL USA American British Cowdray Medical Center Mexico City Mexico

Molecular testing in thyroid nodules and thyroid cancer is rapidly evolving;care must be used when incorporating molecular testing for thyroid nodules into clinical practice. A clear appreciation of the goals and restraints of molecular testing must be integrated into how physicians use and explain molecular testing to patients. Molecular tests can help rule in cancer for indeterminate thyroid nodules with very specific mutations for thyroid cancer, such as BRAF and RET/PTC, and can help reduce the rates of completion thyroidectomies in this era of de-escalation of the management of thyroid disease. The positive predictive value (PPV) of malignant cytology (Bethesda VI) is 98%;and even though molecular testing improves specificity and PPV, it falls short of this ideal for other mutations. We present a detailed evaluation of the current state of molecular testing and their clinical relevance in the setting of diagnostic utility and their impact on surgical decision-making. By recapitulating the clinical impact of these tests and some of the related drawbacks, we hope to provide adequate up to date information of the appropriate utilization of these tools in the management of indeterminate or suspicious thyroid nodules and highlight future directions on their utilization for the management of thyroid cancer.

关键词： Thyroid Cancer Papillary Thyroid Cancer Papillary Thyroid Microcarcinoma Thyroid Nodule Thyroid Cancer Treatment Molecular Studies for Thyroid Cancer Affirma Thyroseq

Current Understanding of Papillary Thyroid Carcinoma

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International Journal of Otolaryngology and Head & Neck Surgery 2021年第3期10卷 184-221页

作者： Rodrigo Arrangoiz Jeronimo Garcialopez De Llano Maria Fernanda Mijares Gonzalo Fernandez-Christlieb vanitha vasudevan Amit Sastry Adrian Legaspi Jennifer Fernandez Frank de la Cruz Fernando Cordera Daniel Margain Center for Advanced Surgical Oncology Florida USA American British Cowdray Medical Center Mexico City Mexico Sociedad Quirurgica S.C. at the American British Cowdray Medical Center Mexico City

The term thyroid neoplasm incorporates tumors that originate from follicular cells and those that arise from parafollicular cells (C cells). Differentiated thyroid cancer, which originates from follicular cells, includes papillary thyroid carcinoma (PTC), follicular thyroid carcinoma (FTC), oncocytic cell carcinoma (Hürthle), poorly differentiated carcinoma, and anaplastic thyroid carcinoma (ATC). PTC tends to have an indolent clinical course with low morbidity and mortality. However, this entity has a broad range of biological and clinical behavior that can result in disease recurrence and death, depending on patient and tumor characteristics and the initial treatment approach. PTC is the most common form of well-differentiated thyroid cancer (WDTC) and based on the most recent statistics, accounts for approximately 89.4% of all thyroid malignancies. PTC appears as an irregular solid or cystic nodule in normal thyroid parenchyma. PTC has the propensity for lymphatic invasion, but it is less likely to have hematogenous spread. Around 11% of patients with PTC present with distant metastases outside the neck and mediastinum. This manuscript with review the current understanding of the epidemiology, pathology, molecular characteristics, prognostic factors, and dynamic risk stratification of PTC centered on an evidence-based and personalized approach.

关键词： Thyroid Cancer Papillary Thyroid Cancer Papillary Thyroid Microcarcinoma Thyroid Nodule Thyroid Cancer Treatment Molecular Studies for Thyroid Cancer

A Hybrid Approach for Plant Disease Detection Using E-GAN and CapsNet

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Computer Systems Science & Engineering 2023年第7期46卷 337-356页

作者： N.vasudevan T.Karthick Department of Data Science and Business Systems School of ComputingSRM Institute of Science and TechnologyKattankulathurTamilnadu603203India

Crop protection is a great obstacle to food safety,with crop diseases being one of the most serious *** diseases diminish the quality of crop *** detect disease spots on grape leaves,deep learning technology might be *** the other hand,the precision and efficiency of identification remain *** quantity of images of ill leaves taken from plants is often *** an uneven collection and few images,spotting disease is *** plant leaves dataset needs to be expanded to detect illness accurately.A novel hybrid technique employing segmentation,augmentation,and a capsule neural network(CapsNet)is used in this paper to tackle these *** proposed method involves three ***,a graph-based technique extracts leaf area from a plant *** second step expands the dataset using an Efficient Generative Adversarial Network ***,a CapsNet identifies the illness and *** proposed work has experimented on real-time grape leaf images which are captured using an SD1000 camera and PlantVillage grape leaf *** proposed method achieves an effective classification of accuracy for disease type and disease stages detection compared to other existing models.

关键词： Feature extraction neural network disease segmentation pattern analysis

Analysis of Bio-inspired Fishbone Based Corrugated Rib for Adaptive Camber Morphing

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Journal of Bionic Engineering 2023年第3期20卷 1083-1102页

作者： R.Jini Raj J.Bruce Ralphin Rose A.vasudevan Department of Mechanical Engineering Anna University Regional CampusTirunelveli627007India Saveetha School of Engineering SIMATSChennai600124India

Bioinspired active camber morphing is an innovative solution for the aerodynamic performance enhancement of flight vehicles such as Micro Aerial Vehicles(MAVs)and Unmanned Aerial Vehicles(UAVs).In the present article,a bio-inspired Fish Bone Active Camber(FishBAC)corrugated rib design concept with and without a spine for an Unmanned Aerial Vehicle(UAV)is *** wing model is composed of multiple corrugated ribs and a splitted spar for connecting each *** rib geometry is subjected to static structural analysis using ANSYS Finite Element Analysis(FEA)module under the unit load *** deformation modes are first extracted from the solution of the wind tunnel test and the elastically deformed NACA 4412 profile will be used to perform Fluid-Structure Interaction(FSI)studies as a partly coupled *** corrugated rib with spine design is a stable structure as inspired from nature species that can withstand elastic and inertial *** fluid dynamics(CFD)simulation is performed to compute the coefficient of lift(Cl),coefficient of drag(Cd)at different Angle of Attack(AoA)for a modified NACA 4412 airfoil and the pressure loads acting on the deformed shape is *** Cl obtained for the modified airfoil at lower AoA is about 60–80%higher and the maximum Cl(Clmax)is 62%higher than the baseline *** Cd of modified airfoil is reduced about 20%at the AoAα=3°as compared with the baseline *** proposed corrugated rib structure has been successfully 3D printed with Polylactic Acid plus(PLA+)material and the wind tunnel testing is done to validate the Cl,Cd values obtained through CFD simulations and the results are presented.

关键词： Bioinspired design Active morphing Fish bone Wind tunnel CFD

Deep learning for exploring ultra-thin ferroelectrics with highly improved sensitivity of piezoresponse force microscopy

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npj Computational Materials 2023年第1期9卷 2066-2073页

作者： Panithan Sriboriboon Huimin Qiao Owoong Kwon Rama K.vasudevan Stephen Jesse Yunseok Kim School of Advanced Materials and Engineering Sungkyunkwan University(SKKU)SuwonRepublic of Korea Research Center for Advanced Materials Technology Core Research InstituteSuwonRepublic of Korea Center for Nanophase Materials Sciences Oak Ridge National LaboratoryOak RidgeTNUSA

Hafnium oxide-based ferroelectrics have been extensively studied because of their existing ferroelectricity,even in ultra-thin film ***,studying the weak response from ultra-thin film requires improved measurement *** general,resonance-enhanced piezoresponse force microscopy(PFM)has been used to characterize ferroelectricity by fitting a simple harmonic oscillation model with the resonance ***,an iterative approach,such as traditional least squares(LS)fitting,is sensitive to noise and can result in the misunderstanding of weak *** this study,we developed the deep neural network(DNN)hybrid with deep denoising autoencoder(DDA)and principal component analysis(PCA)to extract resonance *** DDA/PCA-DNN improves the PFM sensitivity down to 0.3 pm,allowing measurement of weak piezoresponse with low excitation voltage in 10-nm-thick Hf_(0.5)Zr_(0.5)O_(2) thin *** hybrid approaches could provide more chances to explore the low piezoresponse of the ultra-thin ferroelectrics and could be applied to other microscopic techniques.

关键词： spectrum ferroelectric excitation

Design and Development of an Intelligent Energy Management System for a Smart Grid to Enhance the Power Quality

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Energy Engineering 2023年第8期120卷 1747-1761页

作者： Nisha vasudevan vasudevan Venkatraman A.Ramkumar T.Muthukumar A.Sheela M.Vetrivel R.J.Vijaya Saraswathi F.T.Josh Department of Electrical and Electronics Engineering Kalasalingam Academy of Research and EducationTamil NaduIndia Department of Computer Science Engineering Kalasalingam Academy of Research and EducationTamil NaduIndia Department of Electrical and Electronics Engineering Kongunadu College of Engineering and TechnologyTamil NaduIndia Department of Electrical and Electronics Engineering Kongu Engineering CollegeTamil NaduIndia Department of Electrical and Electronics Engineering Narasu’s Sarathy Institute of TechnologyTamil NaduIndia Department of Electrical and Electronics Engineering Panimalar Engineering CollegeTamil NaduIndia Department of Electrical and Electronics Engineering Karunya Institute of Technology&SciencesTamil NaduIndia

MigroGrid(MG)has emerged to resolve the growing demand for *** because of its inconsistent output,it can result in various power quality(PQ)*** is a problem that is becoming more and more important for the reliability of power systems that use renewable energy ***,the employment of nonlinear loads will introduce harmonics into the system and,as a result,cause distortions in the current and voltage waveforms as well as low power quality issues in the supply ***,this research focuses on power quality enhancement in the MG using hybrid shunt ***,the performance of the filter mainly depends upon the design,and stability of the *** efficiency of the proposed filter is enhanced by incorporating an enhanced adaptive fuzzy neural network(AFNN)*** performance of the proposed topology is examined in a MATLAB/Simulink environment,and experimental findings are provided to validate the effectiveness of this ***,the results of the proposed controller are compared with Adaptive Fuzzy Back-Stepping(AFBS)and Adaptive Fuzzy Sliding(AFS)to prove its superiority over power quality improvement in *** the analysis,it can be observed that the proposed system reduces the total harmonic distortion by about 1.8%,which is less than the acceptable limit standard.

关键词： Artificial intelligence resistive inductive load shunt hybrid filter smart grid adaptive fuzzy back-stepping power factor