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Rescue from complications after pancreaticoduodenectomies at a low-volume Caribbean center:Value of tailored peri-pancreatectomy protocols

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World journal of Gastrointestinal Surgery 2024年第3期16卷 681-688页

作者： Shamir O Cawich Elijah Dixon parul j shukla Shailesh V Shrikhande Rahul R Deshpande Fawwaz Mohammed Neil W Pearce Wesley Francis Shaneeta johnson johann Bujhawan Department of Surgery University of the West IndiesSt Augustine 000000Trinidad and Tobago Department of Surgery Faculty of MedicineUniversity of CalgaryCalgaryAlberta T2N2T9Canada Department of Surgery Weill Cornell Medical CollegeNew YorkNY 10065United States Department of Surgical Oncology Tata Memorial CenterHomi Bhabha National UniversityMumbai 400012India Department of Surgery Manchester Royal InfirmaryManchester M139WLUnited Kingdom University Surgical Unit Southampton General HospitalSouthampton SO166YDUnited Kingdom Department of Surgery University of the West IndiesNassau N-1184Bahamas Department of Surgery Morehouse School of MedicineAtlantaGA 30310United States Department of Surgery General Hospital in Port of SpainPort of Spain 000000Trinidad and Tobago

BACKGROUND Pancreaticoduodenectomy(PD)is a technically complex operation,with a re-latively high risk for *** ability to rescue patients from post-PD complications is as a recognized quality *** protocols were instituted at our low volume facility in the year *** To document the rate of rescue from post-PD complications with tailored protocols in place as a measure of *** A retrospective audit was performed to collect data from patients who experienced major post-PD complications at a low volume pancreatic surgery unit in Trinidad and Tobago between january 1,2013 and june 30,***-dardized definitions from the International Study Group of Pancreatic Surgery were used to define post-PD complications,and the modified Clavien-Dindo classification was used to classify post-PD *** Over the study period,113 patients at a mean age of 57.5 years(standard deviation[SD]±9.23;range:30-90;median:56)underwent PDs at this *** complications were recorded in 33(29.2%)patients at a mean age of 53.8 years(SD:±7.9).Twenty-nine(87.9%)patients who experienced major morbidity were salvaged after aggre-ssive treatment of their ***(3.5%)died from bleeding pseudoaneurysm(1),septic shock secondary to a bile leak(1),anastomotic leak(1),and myocardial infarction(1).There was a significantly greater salvage rate in patients with American Society of Anesthesiologists scores≤2(93.3%vs 25%;P=0.0024).CONCLUSION This paper adds to the growing body of evidence that volume alone should not be used as a marker of quality for patients requiring *** low volumes at our facility,we demonstrated that 87.9%of patients were rescued from major *** attributed this to several factors including development of rescue protocols,the competence of the pancreatic surgery teams and continuous,and adaptive learning by the entire institution,cul-minating in the development of tailored peri-pancreatectomy protoc

关键词： Pancreas Complication Rescue Failure Morbidity Mortality Pancreaticoduodenectomy

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Borderline resectable pancreatic tumors:Is there a need for further refinement of this stage?

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Hepatobiliary & Pancreatic Diseases International 2011年第3期10卷 319-324页

作者： Shailesh V Shrikhande Supreeta Arya Savio George Barreto Sachin Ingle Melroy A D'Souza Rohini Hawaldar parul j shukla Department of Hepato-Pancreato-Biliary Surgical Oncology Department of Radiology Tata Memorial Hospital Department of Surgery Royal Adelaide Hospital Clinical Research Secretariat

BACKGROUND:The ideal treatment of patients with 'borderline resectable pancreatic tumors (BRTs)' needs to be *** protocols advise neoadjuvant chemo(radio)therapy,although some patients may appear to have BRT on preoperative imaging and a complete resection may be achieved without the need for vascular *** aim of the present study was to identify specific findings on preoperative imaging that could help predict in which patients with BRT a complete resection,with or without vascular resection (VR),could be ***:Twelve patients with BRTs were *** location,maximum degree of circumferential contact (CC),length of contact of the tumor with major vessels (LC),and luminal narrowing of vessels at the point of contact with the tumor (venous deformity,VD) were graded on preoperatively acquired multidetector computed tomography (MDCT) images and then compared with the intraoperative findings and need for ***:A complete resection (R0) was achieved in 10 patients with 2 having microscopic positive margins (R1) on histopathology at the uncinate *** of the 10 patients required VR (40%).In 3 of the 4 patients whose tumors required VRs,CC was ≥grade III and VD was grade *** did not influence the need for ***:It is possible to achieve a complete resection at the first instance in patients found to have BRTs on preoperative *** MDCT-based grading systems and our proposed criteria may help identify such patients,thus avoiding any delay in curative resections in such patients.

关键词： pancreatic head carcinoma pancreatic cancer pancreatic neoplasms resection

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Study of plasma parameters of coaxial plasma source using triple Langmuir probe and Faraday cup diagnostics

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Plasma Science and Technology 2024年第4期26卷 94-100页

作者： Sunil KANCHI Rohit shukla Archana SHARMA Pulsed Power and Electromagnetics Division Bhabha Atomic Research CentreVisakhapatnam 531011India Homi Bhabha National Institute Mumbai 400085India Beam Technology Development Group Bhabha Atomic Research CentreMumbai 400085India

Coaxial plasma guns are a type of plasma source that produces plasma which propagates radially and axially controlled by the shape of the ground electrode, which has attracted much interest in several applications. In this work, a 120° opening angle of CPG nozzle is used as a plasma gun configuration that operates at the energy of 150 j. The ionization of polyethylene insulator between the electrodes of the gun produces a cloud of hydrogen and carbon *** triple Langmuir probe and Faraday cup are used to measure plasma density and plasma temperature. These methods are used to measure the on-axis and off-axis plasma divergence of the coaxial plasma gun. The peak values of ion densities measured at a distance of 25 mm on-axis from the plasma gun are(1.6±0.5)×10^(19)m^(-3)and(2.8±0.6)×10^(19)m^(-3)for hydrogen and carbon plasma respectively and the peak temperature is 3.02±0.5 eV. The mean propagation velocity of plasma is calculated using the transit times of plasma at different distances from the plasma gun and is found to be 4.54±0.25 cm/μs and 1.81±0.18 cm/μs for hydrogen and carbon plasma respectively. The Debye radius is obtained from the measured experimental data that satisfies the thin sheath approximation. The shot-to-shot stability of plasma parameters facilitates the use of plasma guns in laboratory experiments. These types of plasma sources can be used in many applications like plasma opening switches, plasma devices, and as plasma sources.

关键词： coaxial plasma source triple Langmuir probe Faraday cup plasma density plasma temperature

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Whipple’s operation with a modified centralization concept:A model in low-volume Caribbean centers

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World journal of Clinical Cases 2022年第22期10卷 7620-7630页

作者： Shamir O Cawich Neil W Pearce Vijay Naraynsingh parul shukla Rahul R Deshpande Department of Clinical Surgical Sciences University of the West IndiesSt Augustine 000000Trinidad and Tobago University Surgical Unit Southampton General HospitalSouthampton SO166YDUnited Kingdom Department of Surgery Weill Cornell Medical CollegeNew YorkNY 10065United States Department of Surgery Manchester Royal InfirmaryManchester M139WLUnited Kingdom

Conventional data suggest that complex operations,such as a pancreaticoduodenectomy(PD),should be limited to high volume ***,this is not practical in small,resource-poor countries in the *** these settings,patients have no option but to have their PDs performed locally at low volumes,occasionally by general *** this paper,we review the evolution of the concept of the high-volume center and discuss the feasibility of applying this concept to low and middle-income ***,we discuss a modification of this concept that may be considered when incorporating PD into low-volume and resource-poor countries,such as those in the *** paper has two ***,we performed a literature review evaluating studies published on outcomes after PD in high volume *** data in the Caribbean is then examined and we discuss the incorporation of this operation into resource-poor hospitals with modifications of the centralization *** the authors’opinions,most patients who require PD in the Caribbean do not have realistic opportunities to have surgery in high-volume centers in developed *** these settings,their only options are to have their operations in the resource-poor,low-volume settings in the ***,post-operative outcomes may be improved,despite low-volumes,if a modified centralization concept is encouraged.

关键词： Pancreas Surgery Pancreatectomy Whipple’s Pancreaticoduodenectomy

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A Space-Time Interior Penalty Discontinuous Galerkin Method for the Wave Equation

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Communications on Applied Mathematics and Computation 2022年第3期4卷 904-944页

作者： Poorvi shukla j.j.W.van der Vegt Department of Applied Mathematics University of TwenteP.O.Box 2177500 AE EnschedeThe Netherlands

A new higher-order accurate space-time discontinuous Galerkin(DG)method using the interior penalty flux and discontinuous basis functions,both in space and in time,is pre-sented and fully analyzed for the second-order scalar wave *** attention is given to the definition of the numerical fluxes since they are crucial for the stability and accuracy of the space-time DG *** theoretical analysis shows that the DG discre-tization is stable and converges in a DG-norm on general unstructured and locally refined meshes,including local refinement in *** space-time interior penalty DG discre-tization does not have a CFL-type restriction for *** order of accuracy is obtained in the DG-norm if the mesh size h and the time stepΔt satisfy h≅CΔt,with C a positive *** optimal order of accuracy of the space-time DG discretization in the DG-norm is confirmed by calculations on several model *** calculations also show that for pth-order tensor product basis functions the convergence rate in the L∞and L2-norms is order p+1 for polynomial orders p=1 and p=3 and order p for polynomial order p=2.

关键词： Wave equation Space-time methods Discontinuous Galerkin methods Interior penalty method A priori error analysis

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Bianchi Type-Ⅲ Cosmological Models with Gravitational Constant G and the Cosmological Constant A

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Chinese Physics Letters 2007年第12期24卷 3325-3327页

作者： j. P. Singh R. K. Tiwari Pratibha shukla Department of Mathematical Sciences A.P.S. University Rewa (MP) India Department of Mathematics Govt. Model Science College Rewa (MP) India

Einstein field equations with variable gravitational and cosmological constants are considered in the presence of perfect fluid for the Bianchi type-Ⅲ universe by assuming conservation law for the energy-momentum tensor. Exact solutions of the field equations are obtained by using the scalar of expansion proportional to the shear scalar θ∝σ, which leads to a relation between metric potential B = Cn, where n is a constant. The corresponding physical interpretation of the cosmological solutions are also discussed.

关键词： Cosmological Models Cosmological Constant

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A MATHEMATICAL MODEL FOR THE DEPLETION OF FORESTRY RESOURCES DUE TO POPULATION AND POPULATION PRESSURE AUGMENTED INDUSTRIALIZATION

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International journal of Modeling, Simulation, and Scientific Computing 2014年第1期5卷 186-201页

作者： A.K.MISRA KUSUM LATA j.B.shukla Department of Mathematics Faculty of Science Banaras Hindu UniversityVaranasi-221005India BIT BIIFR&DBhabha Group of Institutions Kanpur(Rural)-209204India

In this paper,a nonlinear mathematical model is proposed and analyzed to study the depletion of forestry resources caused simultaneously by population and population pressure augmented *** control of population pressure,using economic efforts is also considered in the modeling *** is assumed that cumulative biomass density of forestry resources and the density of population follow logistic *** is further assumed that the density of population and the level of industrialization increase as the cumulative biomass density of forestry resources *** cumulative density of economic efforts,which are applied to control the population pressure,is considered to be proportional to the population *** model analysis shows that as the population pressure increases,the level of industrialization increases leading to decrease in the cumulative biomass density of forestry *** is found that if population pressure is controlled by using some economic efforts,the decrease in cumulative biomass density of forestry resources can be made much less than the case when no control is *** is also noted that if the population pressure augmented industrialization increases without control,the forestry resources may become extinct.

关键词： Mathematical model forestry resources population pressure industrialization economic efforts stability

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Modelling and Analysis of Bacteria Dependent Infectious Diseases with Variable Contact Rates

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Computers, Materials & Continua 2021年第8期68卷 1859-1875页

作者： j.B.shukla Shikha Singh jitendra Singh Sunil Kumar Sharma Innovative Internet University for Research Kanpur208017India P.P.N.(P.G.)College CSJM UniversityKanpur208001India College of Computer and Information Sciences Majmaah UniversityMajmaah11952Saudi Arabia

In this research,we proposed a non-linear SIS model to study the effect of variable interaction rates and non-emigrating population of the human habitat on the spread of bacteria-infected *** assumed that the growth of bacteria is logistic with an intrinsic growth rate is a linear function of *** this model,we assume that contact rates between susceptibles and infectives as well as between susceptibles and bacteria depend on the density of the non-emigrating population and the total population of the *** stability theory has been analyzed to analyzed to study the crucial role played by bacteria in the increased spread of an infectious *** is shown that as the density of non-emigrating population increases,the spread of an infectious disease *** is shown further that as the emigration increases,the spread of the disease decreases in both the cases of contact mentioned above rates,but this spread increases as these contact rates *** suggested that the control of bacteria in the human habitat is very useful to decrease the spread of an infectious *** results are confirmed by numerical simulation.

关键词： Mathematical modelling density dependent contact rates stability analysis

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The　Influence　of　Changes　in　Vegetation　Type　on　the　Surface　Energy　Budget

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Advances in Atmospheric Sciences 1994年第2期11卷 139-161页

作者： Runhua Yang (1) j. shukla (1) P. j. Sellers (2) 1. Center for Ocean-Land-Atmosphere Studies 4041 Powder Mill Road 20705 Calverton MD USA 2. NASA / GSFC 923 20771 Greenbelt MD USA

The influence of changes in vegetation type on the surface energy budget was studied using the Simple Biosphere Model (SiB) of Sellers et al. (1986). The modeled energy budget response to the conversion of forest to short vegetation or bare soil (deforestation) was investigated with SiB forced by three time--series of atmospheric boundary conditions collected at three different climatic sites: an Amazonian tropical forest, a U.S. Great Plains grassland, and a central Wales spruce forest. The results show that SiB can simulate realistic surface energy budgets and surface temperatures, and that deforestation may have a significant influellce on the local surface energy budget and surface weather. The influence is especially prominent at the Amazonian and U.S. Great Plains sites, and greater in summer than in other *** was found that atmospheric boundary conditions play a dominant role in determining the degree of changes in the surface fluxes and temperature induced by deforestation; the largest change in latent heat flux appeared at the Amazon site, the largest change in sensible heat flux appeared at the Spruce forest site, and the largest change in surface temperature appeared at the Great Plains site. The Bowen ratios of the SiB sensitivity integrations for each site are comparable with observations. The values of the Bowen ratio and the ratio of latent heat flux to net radiation vary distinctly from site to site, implying that local atmospheric conditions limit the range of changes caused by the vegetation change.

关键词： Biosphere model Vegetation effect Sensitivity test Land -atmosphere interaction

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Field evidences showing rapid frontal degeneration of the Kangriz glacier,western Himalayas,jammu&Kashmir

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journal of Mountain Science 2018年第6期15卷 1199-1208页

作者： GARG Siddhi shukla Aparna MEHTA Manish KUMAR Vinit SAMUEL Shruti Anna BARTARYA S.K. shukla Uma Kant Wadia Institute o/Himalayan Geology 33 GMS Road Dehradun 248001 India Department of Geology Banaras Hindu University Varanasi 221005 India

Life cycle of glaciers in the Himalayan region has notably changed due to the climatic variability since last few decades. Glaciers across the world and specially the Himalayan glaciers have shown large scale degeneration in the last few decades. Himalayan glaciers serve as an important fresh water resource for the downstream communities, who are dependent on this water for domestic and other purposes. Therefore, glacier shrinkage and the associated hydrological changes pose a significant problem for regional-scale water budgets and resource management. These issues necessitate the regular and rigorous monitoring of the wastage pattern of the Himalayan glaciers in field and using satellite remote sensing data. In this work, we report rapid and enhanced degeneration of the frontal part of the Kangriz glacier, jammu and Kashmir(j & K), in terms of surface melting, debris cover, snout characteristics and meltwater discharge. Ablation data acquired during 2016-2017 shows the average lowering of the frontal part of the glacier to be ~148 ± 34 cm, one-third of which was found to have occurred within a 13 day time period in September, 2017. Also, the quantum of ice melt was found to be inversely influenced(r =-0.84) by the debris thickness. 15 day meltwater discharge measurement revealed its strong relationship with snout disintegration pattern, evidenced twice during the said time period. Volume of water discharged from the glacier was estimated to be 7.91×10~6 m^3 for the measurement duration. Also, mean daily discharge estimated for the 15 days interval showed good positive correction(r = 0.78) with temperature indicating the direct dependency of the former on land surface temperature conditions of the region. Besides the lowering and discharge observations, the frequent ice-block break-offs at the glacier snout further enhance its overall drastic degeneration. The study suggests that, being the largest glacier in the Suru basin, the Kangriz glacier needs to be continuo

关键词： Glacier shrinkage Western Himalayas Surface lowering Degeneration Meltwater discharge

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