Technique for single-stage reconstruction of obliterative or near-obliterative long urethral strictures in circumcised patients

Sher Singh Yadav,Vivek Kumar Singh,Vinay Tomar,Neeraj Agarwal,Anil Gulani 대한비뇨의학회 2018 Investigative and Clinical Urology Vol.59 No.3

Purpose: To report our initial experience with urethral reconstruction using a combined dorsal lingual mucosal graft (LMG) and ventral onlay preputial flap for long obliterative or near-obliterative strictures in circumcised patients. Materials and Methods: This was a retrospective study of 10 patients from January 2015 to June 2017 with long obliterative or near-obliterative anterior urethral strictures and circumcised prepuces. All patients underwent a combined approach using a dorsally LMG and a narrow preputial onlay flap ventrally to create a 26–30 Fr. neourethra over a 14-Fr Foley catheter. Success was defined as no requirement for additional urethral instrumentation. The follow-up period ranged from 6 to 32 months. Results: The patients ranged in age from 17 to 44 years (mean, 32.3±9.59 years) and stricture length ranged from 9 to 12.5 cm (mean, 10.77±1.15 cm). Four strictures were obliterative and six were near-obliterative. Two patients had a history of prior urethroplasty. The length of the LMGs harvested ranged from 11 to 14 cm (mean, 12.8±1.03 cm). The preputial flaps available were from 1 to 1.5 cm in width (1.29±0.16 cm) and the desired length. Maximum urinary flow rate (Qmax) achieved ranged from 12 to 26 mL/s (mean, 20.46±3.71 mL/s) after 3 months. One patient needed a single direct visualized internal urethrotomy and another patient develop temporary superficial penile necrosis. The success rate was 90%. Conclusions: Long obliterative and near-obliterative penile and penobulbar urethral strictures can still be treated in circumcised patients using available preputial skin along with lingual mucosa with good outcomes.

Incidental Detection of Parathyroid Adenoma on Somatostatin Receptor PET/CT and Incremental Role of ¹⁸F-Fluorocholine PET/CT in MEN1 Syndrome

Arora, Saurabh,Damle, Nishikant Avinash,Passah, Averilicia,Yadav, Madhav Prasad,Ballal, Sanjana,Aggarwal, Vivek,Gupta, Yashdeep,Kumar, Praveen,Tripathi, Madhavi,Bal, Chandrasekhar 대한핵의학회 2018 핵의학 분자영상 Vol.52 No.3

Multiple endocrine neoplasia type 1 (MEN1) syndrome is characterized by combined occurrence of tumors of endocrine glands including the parathyroid, the pancreatic islet cells, and the anterior pituitary gland. Parathyroid involvement is the most common manifestation and usually the first clinical involvement in MEN1 syndrome, followed by gastroentero-pancreatic neuroendocrine tumors (NETs). Here we present a case where the patient initially presented with metastatic gastric NET and a single parathyroid adenoma was detected incidentally on $^{68}Ga$-DOTANOC PET/CT done as part of post $^{177}Lu$-DOTATATE therapy (PRRT) follow-up. Further $^{18}F$-fluorocholine PET/CT showed four adenomas for which the patient subsequently underwent subtotal parathyroidectomy.

Vascular bundle xylem water transport repression and cell anatomical structure differences may lead to berry cracking near the proximal end

Zhang Chuan,Cui Liwen,Shen Meng,Yadav Vivek,Zhong Haixia,Zhang Fuchun,Zhou Xiaoming,Wu Xinyu 한국원예학회 2024 Horticulture, Environment, and Biotechnology Vol.65 No.2

Grape berries often crack near the proximal end, which may be related to water absorption and their cellular anatomical structure. To study the relationship between water absorption, cell anatomical structures, and berry cracking near the proxi mal end, 49 varieties were selected. Eighteen were prone to cracking near the proximal end, while 31 were resistant. An in vitro soaking experiment on ripe berries measured the diff erence in berry-cracking degrees among diff erent varieties. In vitro staining was used to trace water absorption and paraffi n sections were prepared to observe and analyze the struc tural parameters of diff erent tissues. Results showed that the cracking rate and water uptake of the crack-prone berries were signifi cantly higher than those of the crack-resistant berries. Fruit prone to cracking was characterized by a thinner cuticle, epidermis, and sub-epidermis. After staining, it was found that dye absorption was limited to the berry near the proximal end. Other cell size parameters may also lead to cracking near the proximal end. By tracing water transport and analyzing diff erences in cell structure characteristics among varieties, we speculated that the vascular bundle xylem water transport repression and diff erences in cell anatomical structures may have led to berry cracking near the proximal end. The reasons for berry cracking near the proximal end were preliminarily explained, providing theoretical support for further screening of crack-resistant varieties.

Using artificial intelligence to detect human errors in nuclear power plants: A case in operation and maintenance

Gursel Ezgi,Reddy Bhavya,Khojandi Anahita,Madadi Mahboubeh,Coble Jamie Baalis,Agarwal Vivek,Yadav Vaibhav,Boring Ronald L. 한국원자력학회 2023 Nuclear Engineering and Technology Vol.55 No.2

Human error (HE) is an important concern in safety-critical systems such as nuclear power plants (NPPs). HE has played a role in many accidents and outage incidents in NPPs. Despite the increased automation in NPPs, HE remains unavoidable. Hence, the need for HE detection is as important as HE prevention efforts. In NPPs, HE is rather rare. Hence, anomaly detection, a widely used machine learning technique for detecting rare anomalous instances, can be repurposed to detect potential HE. In this study, we develop an unsupervised anomaly detection technique based on generative adversarial networks (GANs) to detect anomalies in manually collected surveillance data in NPPs. More specifically, our GAN is trained to detect mismatches between automatically recorded sensor data and manually collected surveillance data, and hence, identify anomalous instances that can be attributed to HE. We test our GAN on both a real-world dataset and an external dataset obtained from a testbed, and we benchmark our results against state-of-the-art unsupervised anomaly detection algorithms, including one-class support vector machine and isolation forest. Our results show that the proposed GAN provides improved anomaly detection performance. Our study is promising for the future development of artificial intelligence based HE detection systems.

Living donor liver transplant outcomes during the COVID-19 pandemic: does a decrease in case volume impact the overall outcomes?

Shweta A. Singh,Hetal Pampaniya,Vikram Kumar,Mukesh Kumar,Shekhar Singh Jadaun,Vivek Yadav,Sanjiv Saigal,Subhash Gupta 대한이식학회 2022 Korean Journal of Transplantation Vol.36 No.2

Background: High-volume centers (HVCs) are classically associated with better out- comes. During the coronavirus disease 2019 (COVID-19) pandemic, there has been a decrease in the regular liver transplantation (LT) activity at our center. This study ana- lyzed the effect of the decline in LT on posttransplant patient outcomes at our HVC. Methods: We compared the surgical outcomes of patients who underwent LT during the COVID-19 pandemic lockdown (April 1, 2020 to September 30, 2020) with outcomes in the pre-pandemic calendar year (April 1, 2019 to March 31, 2020). Results: During the 6 months of pandemic lockdown, 60 patients underwent LT (43 adults and 17 children) while 228 patients underwent LT (178 adults and 50 children) during the pre-pandemic calendar year. Patients in the pandemic group had significant- ly higher model for end-stage liver disease (MELD) scores (24.39±9.55 vs. 21.14±9.17, P=0.034), Child-Turcotte-Pugh scores (11.46±2.32 vs. 10.25±2.24, P=0.03), and inci- dence of acute-on-chronic liver failure (30.2% vs. 10.2%, P=0.002). Despite performing LT in sicker patients with COVID-19-related challenges, the 30-day (14% vs. 18.5%, P=0.479), 3-month (16.3% vs. 20.2%, P=0.557), and 6-month mortality rates (23.3% vs. 28.7%, P=0.477) were lower, but not statistically significant when compared to the pre-pandemic cohort. Conclusions: During the COVID-19 pandemic lockdown the number of LT procedures performed at our HVC declined by half because prevailing conditions allowed LT in very sick patients only. Despite these changes, outcomes were not inferior during the pan- demic period compared to the pre-pandemic calendar year. Greater individualization of patient care contributed to non-inferior outcomes in these sick recipients.