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Safe laparoscopic cholecystectomy:Adoption of universal culture of safety in cholecystectomy

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World Journal of Gastrointestinal Surgery 2019年第2期11卷 62-84页

作者： vishal gupta Gaurav Jain Department of Surgical Gastroenterology Shatabdi Hospital Phase 1 King George’s Medical University Transplant and HPB Surgery the Iowa Clinic-Iowa Methodist Hospital

The incidence of biliary injury after laparoscopic cholecystectomy(LC) has shown a declining trend though it may still be twice that as with open cholecystectomy. Major biliary or vasculobiliary injury is associated with significant morbidity. As prevention is the best strategy, the concept of a culture of safe cholecystectomy has been recently introduced to educate surgeons and apprise them of basic tenets of safe performance of LC. Various aspects of safe cholecystectomy include:(1) thorough knowledge of relevant anatomy, various anatomical landmarks, and anatomical variations;(2) an understanding of the mechanisms involved in biliary/vascular injury, the most important being the misidentification injury;(3) identification of various preoperative and intraoperative predictors of difficult cholecystectomy;(4) proper gallbladder retraction;(5) safe use of various energy devices;(6) understanding the critical view of safety, including its doublet view and documentation;(7) awareness of various error traps(e.g., fundus first technique);(8) use of various bailout strategies(e.g., subtotal cholecystectomy) in difficult gallbladder cases;(9) use of intraoperative imaging techniques(e.g., intraoperative cholangiogram) to ascertain correct anatomy; and(10) understanding the concept of *** should be facile with these aspects of this culture of safety in cholecystectomy in an attempt to reduce the incidence of biliary/vascular injury during LC.

关键词： Bile leak Bile duct injury Cholecystectomy Cholelithiasis Cholecystitis

Gallbladder perforation:A single-center experience in north India and a step-up approach for management

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Hepatobiliary & Pancreatic Diseases International 2022年第2期21卷 168-174页

作者： Vivek gupta Abhijit Chandra vishal gupta Ravi Patel Amit Dangi Ajay Pai Department of Surgical Gastroenterology King George’s Medical UniversityLucknowUttar Pradesh 226003India

Background: Spontaneous gallbladder perforation(GBP) is an uncommon diagnosis. This study presented the experience of managing spontaneous GBP over nine years at a large, tertiary care university hospital in north India and investigated the outcomes and treatment strategies. Methods: A retrospective review of prospectively maintained digital database of consecutive patients was performed. All patients received medical and/or surgical treatment for spontaneous GBP in our department between January 2010 and June 2018. Results: We identifed 151 patients(81 females and 70 males) with mean age of 53 years. Most common presenting features were pain(96.7%), fever(54.3%) and jaundice(31.1%). Most common cause was gallbladder stones(84.8%) followed by common bile duct stones(30.5%), xanthogranulomatous cholecystitis(17.9%) and malignancy(11.9%). As per Niemeier classifcation, 8.6% had type 1 GBP(free perforation in peritoneal cavity), 76.2% had type 2 GBP(localized perforation) and 13.2% had type 3 GBP(cholecystoenteric fstula). About 60% of the perforations were diagnosed preoperatively. Type 1 was more common in patients with diabetes and also had the worst prognosis. Surgery was performed in 109 patients(72.2%). Seven patients(4.6%) had a postoperative morbidity of Clavien-Dindo Ⅲ or higher. There were three mortalities in patients who underwent surgery. Conclusions: High index of suspicion is required for preoperative diagnosis of GBP, especially in types 2 and 3. Laparoscopic cholecystectomy can be difficult in these patients and patients may require open or partial cholecystectomy. Early diagnosis and step-up approach for the treatment of GBP is critical.

关键词： Acute calculus cholecystitis Cholecystectomy Cholecysto-enteric fstula Niemeier classifcation

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

化学反应对粗糙边界和被动控制微极性纳米流体热稳定性的影响:神经网络

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Journal of Central South University 2023年第5期30卷 1581-1600页

作者： gupta vishal RANA Puneet KUMAR Lokendra Department of Mathematics Jaypee Institute of Information TechnologyNoida 201309India School of Mathematical Sciences College of ScienceMathematics and TechnologyWenzhou-Kean UniversityWenzhou 325060China

本文在无通量和粗糙边界的情况下演示了化学反应对微极性纳米流体中热对流初始状态的影响。本研究应用Saffman界面条件求解粗糙边界。考虑在许多工业应用中具有重要作用的微极性非牛顿纳米流体。对于线性稳定性,利用正态模态技术(NMT)... 详细信息

本文在无通量和粗糙边界的情况下演示了化学反应对微极性纳米流体中热对流初始状态的影响。本研究应用Saffman界面条件求解粗糙边界。考虑在许多工业应用中具有重要作用的微极性非牛顿纳米流体。对于线性稳定性,利用正态模态技术(NMT)将控制系统的偏微分方程(PDE)转化为特征值问题(EVP),并采用基于有限差分的三阶段LobattoⅢa方法进行数值求解。发现对流的主要模式是静止模式。增加纳米流体中热流通量与自旋霍尔效应的耦合系数(δ)、自旋霍尔效应与涡度的耦合系数(K)、粗糙度参数(λ_(1),λ_(2))、化学反应参数(Cr)、修正扩散比(NA)和微极性参数(A)的取值,可以降低对流,从而稳定系统。然后,在81个数据点的基础上,利用嵌入多人感知的人工神经网络(ANN)确定四个控制参数与Rayleigh临界数之间的关系。

关键词：纳米流体 Rayleigh-Benard对流 FDM法粗糙表面化学反应神经计算

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

Training and evaluation of a knowledge-based model for automated treatment planning of multiple brain metastases

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Journal of Cancer Metastasis and Treatment 2019年第5期4卷 62-71页

作者： Vishruta A. Dumane Tsu-Chi Tseng Ren-Dih Sheu Yeh-Chi Lo vishal gupta Audrey Saitta Kenneth E. Rosenzweig Sheryl Green Departmentof Radiation Oncology Icahn School of Medicine at Mount Sinai New York NY 10029 USA

Aim: Volumetric modulated arc therapy (VMAT) has been utilized to plan and treat multiple cranial metastases using a single isocenter due to its ability to provide steep dose gradients around targets as well as low doses to critical structures. VMAT treatment is delivered in a much shorter time compared to using a single isocenter for the treatment of each lesion. However, there is a need to develop methods to reduce the treatment planning time for these cases while also standardizing the plan quality. In this work we demonstrate the use of RapidPlan, which is knowledge-based treatment (KBP) planning software to plan multiple cranial SRS cases. Methods: The 66 patient plans with 125 lesions (range 1-4, median 1) were used to train a model. In addition, the model was validated using 10 cases that were previously treated and chosen randomly. The clinical plans were compared to plans generated by RapidPlan for target coverage and critical organ dose. Results: Coverage to the target volume, gradient index, conformity index and minimum dose to the target showed no significant difference between the original clinical plan vs. the plan generated by KBP. A comparison of doses to the critical organs namely the brainstem, brain, chiasm, eyes, optic nerves and lenses showed no significant difference. Target dose homogeneity was slightly better with the clinical plan, however this difference was also statistically insignificant. ;Conclusion: This work demonstrates that KBP can be trained and efficiently utilized to help not only speed up the planning process but also help standardize the treatment plan quality.

关键词： Brain metastases radiotherapy volumetric modulated arc therapy knowledge-based planning stereotactic radiosurgery

Sex differences in SARS-CoV-2 infections,anti-viral immunity and vaccine responses

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Asian Pacific Journal of Tropical Medicine 2022年第3期15卷 97-105页

作者： Abhishek Mohanty Aanchal Sawhney Shefali gupta vishal Rao Periyasamy Govindaraj Sambit Mohanty Vandana Jain Rajiv Gandhi Cancer Institute and Research Centre New DelhiIndia HCG Cancer Hospitals BangaloreIndia All India Institute of Medical Sciences Rae BareliIndia Centre for DNA Finger Printing and Diagnostics HyderabadIndia CORE Diagnostics GurgaonHaryanaIndia

The COVID-19 pandemic has revealed sex-based differences in anti-viral responses,with a higher rate of SARS-CoV-2 infections as well as a higher rate of morbidity and mortality in men than in *** and females also show disparate immune responses to COVID-19 infection,which may be important contributors to lower rates of infection,disease severity and deaths in women than in ***,the authors review sex differences in SARS-CoV-2 infections,anti-viral immunity and vaccine responses,putting forth the importance of sex,the underappreciated variables in vaccine response and disease infectivity.

关键词： SARS-CoV-2 Antiviral immunity Sex based mitochondrial differences Vaccine responses Innate immunity Sex differences COVID-19 pandemic

Mechanisms and clinical implications in renal carcinoma resistance:narrative review of immune checkpoint inhibitors

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Cancer Drug Resistance 2023年第2期6卷 416-429页

作者： Sunil Samnani Faraz Sachedina Mehul gupta Edward Guo vishal Navani Department of Internal Medicine The University of CalgaryCalgary T2N 1N4Canada Cumming School of Medicine University of CalgaryCalgary T2N 4N1Canada Department of Medical Oncology Tom Baker Cancer CentreCalgary T2N 4N2Canada

Clear cell renal cell carcinoma(ccRCC)is the most common histological subtype of renal cell *** prognosis for patients with ccRCC has improved over recent years with the use of combination therapies with an anti-programmed death-1(PD-1)*** has enhanced the quality of life and life expectancy of patients with this ***,not all patients benefit;eventually,most patients will develop resistance to therapy and *** molecular,biochemical,and immunological research has extensively researched antiangiogenic and immune-based treatment resistance *** analysis offers an overview of the principles underpinning the resistance pathways related to immune checkpoint inhibitors(ICIs).Additionally,novel approaches to overcome resistance that may be considered for the trial context are discussed.

关键词： Renal cell carcinoma immunotherapy treatment resistance tumor microenvironment intrinsic factors

An unusual cause of simultaneous common bile and pancreatic duct dilation

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Gastroenterology Report 2015年第3期3卷 258-261页

作者： Puneet Chhabra Surinder Singh Rana vishal Sharma Ravi Sharma Rajesh gupta Deepak Kumar Bhasin Department of Gastroenterology Postgraduate Institute of Medical Education and Research(PGIMER)ChandigarhIndia Department of Surgery Postgraduate Institute of Medical Education and Research(PGIMER)ChandigarhIndia

Simultaneous dilation of both the common bile duct and the pancreatic duct(double-duct sign)is usually because of ampullary or pancreatic *** we report an unusual cause of double-duct dilation;we describe the case of a 49-year-old female who developed afferent loop syndrome after pylorus-preserving pancreaticoduodenectomy:crosssectional imaging of the abdomen revealed a double-duct sign.

关键词： afferent loop syndrome pylorus preserving pancreaticoduodenectomy