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Are fails more common than road traffic accidents in pediatric trauma？ Experience from a Level 1 trauma centre in New Delhi, India

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Chinese Journal of Traumatology 2016年第2期19卷 75-78页

作者： Annu Babu Amulya Rattan Piyush Ranjan maneesh singhal Amit Gupta Subodh Kumar Biplab Mishra Sushma Sagar JPN Apex Trauma Centre New Delhi 110029 India

Purpose： The epidemiology of pediatric trauma is different in different parts of the world. Some researchers suggest falls as the most common mechanism, whereas others report road traffic accidents （RTAs） as the most common cause. The aim of this study is to find out the leading cause of pediatric admissions in Trauma Surgery in New Delhi, India. Methods： Inpatient data from January 2012 to September 2014 was searched retrospectively in Jai Prakash Narayan Apex Trauma Centre Trauma Registry. All patients aged 18 years or less on index presentation admitted to surgical ward/ICU or later taken transfer by the Department of Trauma Surgery were included. Data were retrieved in predesigned proformas. Information thus compiled was coded in unique alphanumeric codes for each variable and subjected to statistical analysis using SPSS version 21. Results： We had 300 patients over a 33 month period. Among them, 236 （78.6%） were males and 64 （21.3%） females. Overall the predominant cause was RTAs in 132 （43%） patients. On subgroup analysis of up to 12 years age group （n - 147）, the most common cause was found to be RTAs again. However, falls showed an incremental upward trend （36.05% in up to 12 age group versus 27% overall）, catching up with RTAs （44.89%）. Pediatric Trauma Score （PTS） ranged from 0 to 12 with a mean of 8.12 _＋ 2.022. 223 （74.33%） patients experienced trauma limited to one anatomic region only, whereas 77 （25.66%） patients suffered polytrauma. 288 patients were discharged to home care. Overall, 12 patients expired in the cohort. Median hospital stay was 6 days （range 1-182）. Conclusion： Pediatric trauma is becoming a cause of increasing concern, especially in the developing countries. The leading cause of admissions in Trauma Surgery is RTAs （43%） as compared to falls from height （27%）; however, falls from height are showing an increasing trend as we move to younger age groups. Enhancing road safety alone may not be a lasting solution for prevention of pediatri

关键词： Accidental fallsPediatricsAccidents trafficWounds and injuries

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Reconstruction of post-traumatic upper extremity soft tissue defects with pedicled flaps: An algorithmic approach to clinical decision making

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Chinese Journal of Traumatology 2018年第6期21卷 338-351页

作者： Ravikiran Naalla Shashank Chauhan Aniket Dave maneesh singhal Department of Plastic Reconstructive & Burns Surgery All India Institute of Medical SciencesNew DelhiIndia

Purpose:Pedicled flaps are still the workhorse flaps for reconstruction of upper limb soft tissue defects in many centers across the world. They are lifeboat options for coverage in vessel deplete wounds. In spite of their popularity existing algorithms are limited to a particular region of upper limb;a general algorithm involving entire upper limb which helps in clinical decision making is lacking. We attempt to propose one for the day to day clinical ***:A retrospective analysis of patients who underwent pedicled flaps for coverage of post-traumatic upper extremity (arm, elbow, forearm, wrist & hand) soft tissue defects within the period of January 2016 to October 2017 was performed. Patients were divided into groups according to the anatomical location of the defects. The flaps performed for different anatomical regions were enlisted. Demographic data and complications were recorded. An algorithm was proposed based on our experience, with a particular emphasis made to approach to clinical decision ***:Two hundred and twelve patients were included in the study. Mean age was 27.3 years (range: 1-80 years), 180 were male, and 32 were female. Overall flap success rate was 98%, the following complications were noted marginal flap necrosis requiring no additional procedure other than local wound care in 32 patients (15%), partial flap necrosis requiring flap advancement or extra flap in 15 patients (7%), surgical site infection in 11 patients (5%), flap dehiscence requiring re-suturing in 5 patients (2.4%), total flap necrosis 4 patients (2%).Conclusion:The proposed algorithm allows a reliable and consistent method for addressing diverse soft tissue defects in the upper limb with high success rate.

关键词： Algorithm Upper limb Soft tissue defect Reconstruction Pedicled flaps Decision making

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Gastroduodenal artery aneurysm - A rare complication of traumatic pancreatic injury

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Chinese Journal of Traumatology 2016年第6期19卷 368-370页

作者： Annu Babu Amulya Rattan maneesh singhal Amit Gupta Subodh Kumar Division of Trauma Surgery & Critical Care JPN Apex Trauma Center Department of Surgical Disciplines All India Institute of Medical Sciences New Delhi India

Aneurysm of gastroduodenal artery （CDA） is rare. Most reported cases are due to pancreatitis and atherosclerosis; however, those following pancreatic trauma have not been reported. We encountered GDA aneurysm in a patient of blunt abdominal trauma, who had pancreatic contusion and retroduodenal air on contrast enhanced computed tomography of abdomen. Emergency laparotomy for suspected duodenal injury revealed duodenal wall and pancreatic head contusion, mild hemoperitoneum and no evidence of duodenal perforation. In the postoperative period, the patient developed upper gastrointestinal hemorrhage on day 5. Repeat imaging revealed GDA aneurysm, which was managed successfully by angioembolization. This case highlights, one, delayed presen- tation of GDA aneurysm after blunt pancreatic trauma and two, its successful management using endovascular technique.

关键词： Aneurysm of gastroduodenal arteryPancreatic injuryAngioembolization

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Traumatic cardiac injury： Experience from a level-1 trauma centre

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Chinese Journal of Traumatology 2016年第6期19卷 333-336页

作者： Biplab Mishra Amit Gupta Sushma Sagar maneesh singhal Subodh Kumar Division of Trauma Surgery & Critical Care. JPN Apex Trauma Centre. All India Institute of Medical Sciences. New Delhi India

Purpose： Traumatic cardiac injury （TCI） is a challenge for trauma surgeons as it provides a short thera- peutic window and the management is often dictated by the underlying mechanism and hemodynamic status, The current study is to evaluate the factors influencing the outcome of TCI. Methods： Prospectively maintained database of TCI cases admitted at a Level-I trauma center from July 2008 to June 2013 was retrospectively analyzed. Hospital records were reviewed and statistical analysis was performed using the SPSS version 15. Results： Out of 21 cases of TCI, 6 （28.6%） had isolated and 15 （71.4%） had associated injuries. Ratio be- tween blunt and penetrating injuries was 2：1 with male preponderance. Mean ISS was 31.95. Thirteen patients （62%） presented with features suggestive of shock. Cardiac tamponade was present in 12 （57%） cases and pericardiocentesis was done in only 6 cases of them. Overall 19 patients underwent surgery, Perioperatively 8 （38,1%） patients developed cardiac arrest and 7 developed cardiac arrhythmia. Overall survival rate was 71.4%. Mortality was related to cardiac arrest （p = 0.014）, arrhythmia （p = 0.014）, and hemorrhagic shock （p = 0.04）. The diagnostic accuracy of focused assessment by sonography in trauma （FAST） was 95.24%. Conclusion： High index of clinical suspicion based on the mechanism of injury, meticulous examination by FAST and early intervention could improve the overall outcome.

关键词： Heart injuries Cardiac tamponade Thoracic injuries

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Innocuous cardiac gunshot that proved fatal： A bitter lesson learned

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Chinese Journal of Traumatology 2017年第2期20卷 122-124页

作者： Biplab Mishra Mohit Kumar Joshi Subodh Kumar Atin Kumar Amit Gupta Amulya Rattan Sushma Sagar maneesh singhal Mahesh Chandra Misra Department of Surgical Disciplines. JPN Apex Trauma Centre. All India Institute of Medical Sciences New Delhi 110029. India Department of Radiodiagnosis. JPN Apex Trauma Centre. All India Institute of Medical Sciences New Delhi 110029 India

The management of hemodynamically normal patients with retained intra-pericardial foreign body re- mains a matter of conjecture. The available literature supports non-operative management of such innocuous foreign bodies. We report our experience of a hemodynamically normal patient with a retained intra-pericardial pellet from a firearm injury. He initially received successful non-operative management but developed fatal hemopericardium 21 days after injury. In this paper, we discussed the pitfalls in the management of such injuries in light of the available literature and summarized the clinical experience.

关键词： PericardiumHeartWoundsGunshotFirearms

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Explainable Artificial Intelligence(XAI)Model for Cancer Image Classification

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Computer Modeling in Engineering & Sciences 2024年第10期141卷 401-441页

作者： Amit singhal Krishna Kant Agrawal Angeles Quezada Adrian Rodriguez Aguiñaga Samantha Jiménez Satya Prakash Yadav Department of Computer Science&Engineering Raj Kumar Goel Institute of TechnologyGhaziabad201017India Department of School of Computing Science and Engineering Galgotias UniversityGreater Noida203201India Tecnológico Nacional de México Campus Tijuana Baja California22414México Universidad Autónoma de Baja California TijuanaBaja California22414México Department of Computer Science and Engineering G.LBajaj Institute of Technology and Management(GLBITM)Affiliated to Dr.A.P.J.Abdul Kalam Technical UniversityLucknow201306India School of Computer Science Engineering and Technology(SCSET) Bennett UniversityGreater Noida201310India

The use of Explainable Artificial Intelligence(XAI)models becomes increasingly important for making decisions in smart healthcare *** is to make sure that decisions are based on trustworthy algorithms and that healthcare workers understand the decisions made by these *** models can potentially enhance interpretability and explainability in decision-making processes that rely on artificial ***,the intricate nature of the healthcare field necessitates the utilization of sophisticated models to classify cancer *** research presents an advanced investigation of XAI models to classify cancer *** describes the different levels of explainability and interpretability associated with XAI models and the challenges faced in deploying them in healthcare *** addition,this study proposes a novel framework for cancer image classification that incorporates XAI models with deep learning and advanced medical imaging *** proposed model integrates several techniques,including end-to-end explainable evaluation,rule-based explanation,and useradaptive *** proposed XAI reaches 97.72%accuracy,90.72%precision,93.72%recall,96.72%F1-score,9.55%FDR,9.66%FOR,and 91.18%*** will discuss the potential applications of the proposed XAI models in the smart healthcare *** will help ensure trust and accountability in AI-based decisions,which is essential for achieving a safe and reliable smart healthcare environment.

关键词： Explainable artificial intelligence artificial intelligence XAI healthcare cancer image classification

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Comprehensive Analysis of Gender Classification Accuracy across Varied Geographic Regions through the Application of Deep Learning Algorithms to Speech Signals

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Computer Systems Science & Engineering 2024年第3期48卷 609-625页

作者： Abhishek singhal Devendra Kumar Sharma Department of Electronics and Communication Engineering Faculty of Engineering and TechnologySRM Institute of Science and TechnologyDelhi–NCR CampusGhaziabad201204India

This article presents an exhaustive comparative investigation into the accuracy of gender identification across diverse geographical regions,employing a deep learning classification algorithm for speech signal *** this study,speech samples are categorized for both training and testing purposes based on their geographical *** 1 comprises speech samples from speakers outside of India,whereas Category 2 comprises live-recorded speech samples from Indian *** speech samples are likewise classified into four distinct sets,taking into consideration both geographical origin and the language spoken by the ***,the results indicate a noticeable difference in gender identification accuracy among speakers from different geographical *** speakers,utilizing 52 Hindi and 26 English phonemes in their speech,demonstrate a notably higher gender identification accuracy of 85.75%compared to those speakers who predominantly use 26 English phonemes in their conversations when the system is trained using speech samples from Indian *** gender identification accuracy of the proposed model reaches 83.20%when the system is trained using speech samples from speakers outside of *** the analysis of speech signals,Mel Frequency Cepstral Coefficients(MFCCs)serve as relevant features for the speech *** deep learning classification algorithm utilized in this research is based on a Bidirectional Long Short-Term Memory(BiLSTM)architecture within a Recurrent Neural Network(RNN)model.

关键词： Deep learning recurrent neural network voice signal mel frequency cepstral coefficients geographical area gender

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A Review on Dental Age Estimation in Children and Adolescents

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Journal of Forensic Science and Medicine 2024年第3期10卷 220-233页

作者： Ishita singhal Aparna Dave Manpreet Arora Radhika Rai Pulin Saluja Department of Oral Pathology and Microbiology and Forensic Odontology S.G.T.Dental CollegeHospital and Research InstituteGurugramHaryanaIndia

Children are seen as beings who exist from birth through puberty,while teenagers are regarded as existing from puberty until around the age of 20 *** a number of legal processes,including child labor,employment,the age of majority,rape,adoption,marriage eligibility,and situations where the birth certificate is unavailable,age estimation in children and adolescents is *** the wide range of methods available,dental age estimation techniques that take into account tooth maturation are thought to be the most reliable predictors of chronological age in *** is because genetic factors predominate and environmental factors,particularly between birth and age ten,tend to have little impact on tooth *** eruption of teeth holds greater significance in the deciduous dentition,where genetic factors predominantly govern the process,compared to the permanent ***,tooth calcification serves as a viable indicator for estimating dental age in both primary and permanent *** dental age estimation methods are based on age-related changes in teeth,such as tooth growth and development,changes that occur after teeth form,and biochemical ***,in this review article,we will explore the several methodologies used for dental age assessment in children and adolescents.

关键词： Adolescence age assessment children forensic odontology teeth

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Hygrometry behavior during high-flow nasal oxygen therapy and non-invasive mechanical ventilation:A narrative review of bench to clinical studies

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Journal of Intensive Medicine 2024年第4期4卷 433-441页

作者： Sanjay singhal Mohan Gurjar Jun Duan Salvatore Notaro Antonio M.Esquinas Department of Pulmonary Medicine All India Institute of Medical ScienceRajkotGujaratIndia Department of Critical Care Medicine Sanjay Gandhi Post Graduate Institute of Medical Sciences(SGPGIMS)LucknowIndia Department of Respiratory and Critical Care Medicine The First Affiliated Hospital of Chongqing Medical UniversityChongqingChina Intensive Care Unit and ECMO A.O.R.N.“Dei Colli”Monaldi HospitalNaplesItaly Intensive Care Unit Hospital Morales MeseguerMurciaSpain

Recently,there has been growing interest in knowing the best hygrometry level during high-flow nasal oxygen and non-invasive ventilation(NIV)and its potential influence on the *** studies have shown that breathing cold and dry air results in excessive water loss by nasal mucosa,reduced mucociliary clearance,in-creased airway resistance,reduced epithelial cell function,increased inflammation,sloughing of tracheal epithe-lium,and submucosal *** the Coronavirus Disease 2019 pandemic,using high-flow nasal oxygen with a heated humidifier has become an emerging form of non-invasive support among ***,we cannot always assume stable ***,there are no clear guidelines for using humidification dur-ing NIV,although humidification of inspired gas during invasive ventilation is an accepted standard of *** disturbs the normal physiological system that warms and humidifies inspired *** NIV is supplied through an intensive care unit ventilator that utilizes anhydrous gases from compressed wall air and oxygen,the risk of dry-ness *** addition,patients with acute respiratory failure tend to breathe through the mouth during NIV,which is a less efficient route than nasal breathing for adding heat and moisture to the inspired *** sleep apnea syndrome is one of the most important indications for chronic use of NIV at *** data suggest that up to 60%of patients with obstructive sleep apnea syndrome who use continuous positive airway pressure therapy experience nasal congestion and dryness of the mouth and ***,humidifying the inspired gas in NIV may be essential for patient comfort and compliance with *** aimed to review the available bench and clinical studies that addressed the utility of hygrometry in NIV and nasal high-flow oxygen and discuss the technical limitations of different humidification systems for both systems.

关键词： Acute respiratory failure Hygrometry Non-invasive mechanical ventilation High flow nasal oxygen Oxygenation Heated humidifier

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Incidence of exclusive extrapelvic skeletal metastasis in prostate carcinoma on bone scintigraphy

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World Journal of Radiology 2024年第7期16卷 265-273页

作者： Parneet Singh Kanhaiyalal Agrawal Ashique Rahman Tejasvini singhal Girish Kumar Parida Gopinath Gnanasegaran Department of Nuclear Medicine All India Institute of Medical SciencesBhubaneshwar 751019OdishaIndia Department of Nuclear Medicine Royal Free HospitalLondon NW32QGUnited Kingdom

BACKGROUND Bone is one of the common sites of metastasis from prostate *** scintigraphy(BS)is one of the most sensitive imaging modalities currently used for bone metastatic *** metastasis in prostate carcinoma commonly involves pelvic bones but rarely involves extrapelvic-extraspinal *** To retrospectively analyze the BS data to determine the pattern of skeletal metastases in the prostate *** This retrospective observational study involves patients with biopsy-proven prostate carcinoma referred for BS for staging *** with abnormal BS were evaluated for the pattern of skeletal involvement and data were pre-sented in descriptive format in the form of *** A total of 150 patients with biopsy-proven prostate cancer who were referred for staging were included in the *** of 150 patients(8.67%)had no abnormal uptake on planar images,ruling out metastatic ***-four patients(16%)had heterogeneous uptake in the spine with distribution charac-teristic of degenerative disease and no scan pattern of metastatic *** patients(20%)had multifocal uptake involving both pelvic and extra pelvic bones on planar images typical for skeletal metastasis and were considered ***-three out of 150 patients(55.3%)had increased tracer uptake,which was indeterminate,thus,single photon emission computed tomography-computed tomography(SPECT-CT)was acquired,which showed 51 with metastatic disease,31 benign lesions,and one indeterminate *** of 150 patients had exclusive pelvic bone uptake,which was found to be metastatic in 4/7 patients in *** six out of 150 patients showed exclusive extrapelvic tracer uptake,of which only 3 had vertebral metastatic *** of the patients with increased uptake exclusively in the extrapelvic-extraspinal location was *** The incidence of exclusive extrapelvic skeletal metastatic disease in prostate carcinom

关键词： Pelvic Prostate cancer Bone scan Single photon emission computed tomography-computed tomography Skeletal metastasis

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