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CRS对比CRS+IP与CRS+HIPEC治疗上皮性卵巢癌辅助化疗时间及预后的前瞻性观察研究

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中国肿瘤临床 2022年第24期49卷 1268-1272页

作者： Somashekhar SP Ramya Y Rohit Kumar C Shabber SZ Vijay A Amit R Poonam P Arun KN ashwin KR 张凯(翻译) 李雁(审校) 印度班加罗尔马尼帕尔医院综合癌症中心印度班加罗尔阿尔克私人研究有限公司数据科学系不详

目的:完全肿瘤细胞减灭术(cytoreductive surgery,CRS)及术后辅助化疗,是晚期原发性上皮性卵巢癌(epithelial ovarian cancer,EOC)的重要预后因素。然而,EOC患者接受辅助化疗开始时机及其与预后的关系尚不明确,值得深入探讨。方法:本研... 详细信息

目的:完全肿瘤细胞减灭术(cytoreductive surgery,CRS)及术后辅助化疗,是晚期原发性上皮性卵巢癌(epithelial ovarian cancer,EOC)的重要预后因素。然而,EOC患者接受辅助化疗开始时机及其与预后的关系尚不明确,值得深入探讨。方法:本研究选取2010年1月至2017年12月在印度班加罗尔马尼帕尔综合癌症中心接受完全细胞减灭术的185例晚期原发性EOC患者,其中部分患者接受腹腔化疗或辅助化疗,部分患者未接受腹腔化疗和辅助化疗。分别记录并分析术后开始进行辅助化疗的时间及其对预后的影响。结果:接受单纯CRS、CRS联合经腹腔港的腹腔内化疗(intraperitoneal chemotherapy,IP)或腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy,HIPEC)的患者分别为50例、60例和75例。CRS组术后开始接受辅助化疗的平均时间为32天,CRS+IP组为34天,CRS+HIPEC组为41天。CRS组中,术后化疗间隔时间>42天对无复发生存(relapse-free survival,RFS)期有显著影响(36个月vs. 17个月:P=0.02);在CRS+IP组中,患者RFS差异无统计学意义(35个月vs. 28个月;P=0.78);CRS+HIPEC组,RFS差异无统计学意义(35个月vs. 32个月;P=0.17)。如期行辅助化疗患者生存期较延迟化疗更好(88个月vs. 71个月,P=0.49)。结论:化疗时间延迟是单纯接受完全CRS患者RFS的不良预后因素。与非HIPEC组相比,化疗时间延迟对HIPEC组患者并未产生显著影响,其原因可能在于术中单次HIPEC弥补了化疗时间延迟带来的不利影响。

关键词：细胞减灭术腹腔热灌注化疗辅助化疗卵巢癌

Ideal Midline Detection Using Automated Processing of Brain CT Image

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Open Journal of Medical Imaging 2013年第2期3卷 51-59页

作者： Xuguang Qi ashwin Belle Sharad Shandilya Wenan Chen Charles Cockrell Yang Tang Kevin R. Ward Rosalyn H. Hargraves Kayvan Najarian Department of Biostatistics School of Medicine Virginia Commonwealth University Richmond USA Department of Computer Science School of Engineering Virginia Commonwealth University Richmond USA Department of Electrical and Computer Engineering Virginia Commonwealth University Richmond USA Department of Emergency Medicine and Michigan Critical Injury and Illness Research Center University of Michigan Ann Arbor USA Department of Radiology School of Medicine Virginia Commonwealth University Richmond USA

Brain ideal midline estimation is vital in medical image processing, especially in analyzing the severity of a brain injury in clinical environments. We propose an automated computer-aided ideal midline estimation system with a two-step process. First, a CT Slice Selection Algorithm (SSA) can automatically select an appropriate subset of slices from a large number of raw CT images using the skull’s anatomical features. Next, an ideal midline detection is implemented on the selected subset of slices. An exhaustive symmetric position search is performed based on the anatomical features in the detection. In order to enhance the accuracy of the detection, a global rotation assumption is applied to determine the ideal midline by fully considering the connection between slices. Experimental results of the multi-stage algorithm were assessed on 3313 CT slices of 70 patients. The accuracy of the proposed system is 96.9%, which makes it viable for use under clinical settings.

关键词： Ideal Midline Slice Selection Exhaustive Symmetric Search Global Rotation

Delayed inflammatory pulmonary syndrome: A distinct clinical entity in the spectrum of inflammatory syndromes in COVID-19 infection?

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世界重症医学杂志 2023年第4期12卷 226-235页

作者： Prithviraj Bose Binila Chacko ashwin Oliver Arul Leena Robinson Vimala Balamugesh Thangakunam George M Varghese Mohan Jambugulam Audrin Lenin John Victor Peter Department of Medical Intensive Care Christian Medical CollegeVellore 632004Tamil NaduIndia Department of Radiodiagnosis Christian Medical CollegeVellore 632004Tamil NaduIndia Department of Pulmonary Medicine Christian Medical CollegeVellore 632004Tamil NaduIndia Department of Infectious Disease Christian Medical CollegeVellore 632004Tamil NaduIndia Department of Medicine Christian Medical CollegeVellore 632004Tamil NaduIndia

BACKGROUND During the second wave of the coronavirus disease 2019(COVID-19)pandemic,a subset of critically ill patients developed delayed respiratory deterioration in the absence of new infection,fluid overload or extra-pulmonary organ *** To describe the clinical and laboratory characteristics,outcomes,and management of these patients,and to contrast this entity with other post COVID-19 immune dysregulation related inflammatory *** This was a retrospective observational study of adult patients admitted to the medical intensive care unit of a 2200-bed university affiliated teaching hospital,between May and August 2021,who fulfilled clearly defined inclusion and exclusion *** was assessed by a change in PaO_(2)/FiO_(2) ratio and levels of inflammatory markers before and after immunomodulation,duration of mechanical ventilation after starting treatment,and survival to *** Five patients developed delayed respiratory deterioration in the absence of new infection,fluid overload or extrapulmonary organ dysfunction at a median interquartile range(IQR)duration of 32(23-35)d after the onset of *** patients had elevated inflammatory markers,required mechanical ventilation for 13(IQR 10-23)d,and responded to glucocorticoids and/or intravenous *** patient died(20%).CONCLUSION This delayed respiratory worsening with elevated inflammatory markers and clinical response to immunomodulation appears to contrast the well described Multisystem Inflammatory Syndrome–Adults by the paucity of extrapulmonary organ *** diagnosis can be considered in patients presenting with delayed respiratory worsening,that is not attributable to cardiac dysfunction,fluid overload or ongoing infections,and associated with an increase in systemic inflammatory markers like C-reactive protein,inteleukin-6 and ferritin.A good response to immunomodulation can be *** delayed inflammatory pulmonary syndrome may re

关键词： COVID-19 ARDS Multisystem Inflammatory Syndrome in Adults Long COVID Organizing pneumonia

A gist of gastrointestinal stromal tumors: A review

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World Journal of Gastrointestinal Oncology 2013年第6期5卷 102-112页

作者： ashwin Rammohan Jeswanth Sathyanesan Kamalakannan Rajendran Anbalagan Pitchaimuthu Senthil-Kumar Perumal UP Srinivasan Ravi Ramasamy Ravichandran Palaniappan Manoharan Govindan The Institute of Surgical Gastroenterology and Liver Transplantation Centre for GI Bleed Division of HPB Diseases Stanley Medical College Hospital

Gastrointestinal stromal tumors (GISTs) have been recognized as a biologically distinctive tumor type, different from smooth muscle and neural tumors of the gastrointestinal tract (GIT). They constitute the majority of gastrointestinal mesenchymal tumors of the GIT and are known to be refractory to conventional chemotherapy or radiation. They are defined and diagnosed by the expression of a proto-oncogene protein detected by immunohistochemistry which serves as a crucial diagnostic and therapeutic target. The identification of these mutations has resulted in a better understanding of their oncogenic mechanisms. The remarkable antitumor effects of the molecular inhibitor imatinib have necessitated accurate diagnosis of GIST and their distinction from other gastrointestinal mes-enchymal tumors. Both traditional and minimally invasive surgery are used to remove these tumors with minimal morbidity and excellent perioperative outcomes. The revolutionary use of specific, molecularlytargeted therapies, such as imatinib mesylate, reduces the frequency of disease recurrence when used as an adjuvant following complete resection. Neoadjuvant treatment with these agents appears to stabilize disease in the majority of patients and may reduce the extent of surgical resection required for subsequent complete tumor removal. The important interplay between the molecular genetics of GIST and responses to targeted therapeutics serves as a model for the study of targeted therapies in other solid tumors. This review summarizes our current knowledge and recent advances regarding the histogenesis, pathology, molecular biology, the basis for the novel targeted cancer therapy and current evidence based management of these unique tumors.

关键词： Gastrointestinal stromal tumors c-KIT Imatinib mesylate Surgery Review

Spectrum Sensing and AM-FM Decomposition through Synchrosqueezing

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Wireless Engineering and Technology 2013年第3期4卷 134-138页

作者： K. Vandhana P. V. S. Sowmya P. Roshni K. Divya S. ashwin K. A. Narayanankutty Department of Electronics and Communication Engineering Amrita Vishwa Vidyapeetham Coimbatore India.

In this paper we have accomplished one of the tasks of cognitive radio i.e. dynamic spectrum sensing by using wavelet based Synchrosqueezing transform [1], a novel technique, which was proposed to analyze a signal in time-frequency plane. The distinctive feature of this transform compared to other techniques is that it enables us to decompose amplitude and frequency modulated signals and allows individual reconstruction of these components. The objective is also to separate the occupied band into amplitude modulated and frequency modulated bands.

关键词： Cognitive Radio Synchrosqueezing AM-FM Spectrum Sensing Time-Frequency Reassignment Empirical Mode Decomposition

NEED SURGERY IN SHANGHAI?Things to consider before going under the knife

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城市漫步（上海版、英文） 2014年第6期 87-87页

作者： DR.ashwin DESHMUKH 不详

Safe,effective surgery is a shining achievement of modern *** is accomplished by identifying a‘best practices’evidence-based approach and passionately following a growing body of safety standards,infection prevention practices and training programs that keep physicians and hospital staff *** many countries have a clear standard of care that we have come to take for granted,Asia,including Shanghai,has a very wide range of health care *** you need to have surgery,the following are some issues to consider in deciding what to do.

关键词： prevention surgery consider

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距骨骨软骨缺损(英文)

外科研究与新技术 2012年第2期1卷 152-157页

作者：阿什维俞光荣同济大学附属同济医院骨科上海200065

早期多认为踝关节疼痛的主要原因是踝关节损伤,但近期研究结果指出,距骨骨软骨损伤作为踝关节疼痛的原因在临床更为常见。本文章的目的在于对OCL的分型、诊断以及治疗作一综述。通过系统检索的方法,检索PubMed和EMBASE等数据库,检索语... 详细信息

早期多认为踝关节疼痛的主要原因是踝关节损伤,但近期研究结果指出,距骨骨软骨损伤作为踝关节疼痛的原因在临床更为常见。本文章的目的在于对OCL的分型、诊断以及治疗作一综述。通过系统检索的方法,检索PubMed和EMBASE等数据库,检索语种为英语,无时间限制。急性骨软骨病变会模仿脚踝扭伤的临床情况,因此,如果症状持续2～3周后,AP,横向和榫踝关节的X-射线。如果这些都是负面的,CT扫描很少会错过病变,但最准确的成像MRI,它可以准确地评估软骨损伤.根据现有的文献结果,对于较小的距骨骨软骨损伤(<15mm),清创和骨髓刺激是目前效果最好的治疗方法;也有作者指出,自体软骨移植或骨软骨移植可用于较大损伤的OCL治疗。由于距骨骨软骨损伤在临床检查时容易漏诊,我们建议对存在踝关节背屈或跖屈位内翻暴力损伤的患者,应高度警惕距骨骨软骨损伤的可能。

关键词：距骨骨软骨缺损剥脱性骨软骨炎距骨圆顶骨折

开放与机器人辅助的直肠癌全直肠系膜切除术的比较研究

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中华胃肠外科杂志 2011年第5期14卷 394-394页

作者： ashwin L 史晓辉(摘译) 王颢(校)

本回顾性研究旨在比较开放与机器人辅助的直肠癌全直肠系膜切除术的疗效。连续入选51例使用腹腔辅助方式和36例使用机器人辅助方式行直肠癌手术的患者。所有患者手术中游离脾曲的操作均使用了手助腹腔镜的方法。根据患者行全直肠系膜切... 详细信息

本回顾性研究旨在比较开放与机器人辅助的直肠癌全直肠系膜切除术的疗效。连续入选51例使用腹腔辅助方式和36例使用机器人辅助方式行直肠癌手术的患者。所有患者手术中游离脾曲的操作均使用了手助腹腔镜的方法。根据患者行全直肠系膜切除时所采取的手术方式而被分配到机器人及开放组。

关键词：全直肠系膜切除术机器人辅助直肠癌手术手助腹腔镜手术方式患者手术中

促进机器人辅助前列腺癌根治术术后早期尿控恢复的手术技巧(“大家泌尿网”观看手术视频)

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现代泌尿外科杂志 2021年第8期26卷 627-631页

作者：古迪王铭吴祥坤 SRIDHAR ashwin N RAJAN Prabhakar SOORIAKUMARAN Prasanna SHAW Greg NATHAN Senthil KELLY John D BRIGGS Tim P 广州医科大学附属第一医院泌尿外科广东广州510120 University College London Hospital London NW12BU

机器人辅助前列腺癌根治术(RARP)目前已经成为局限性有临床意义前列腺癌的根治性治疗的新的金标准。本文介绍了既往研究中通过RAND/UCLA改良法确认和研讨的16项促进RARP术后早期尿控恢复的手术技巧,并对各手术技巧进行了介绍。

关键词：机器人辅助前列腺癌根治术尿控手术技巧