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Evaluation and Management of Hepatocellular Adenomas

Sukul Mittal, Purva Gopal, Gaurav Khatri, Amit G Singal
2021 Clinical Liver Disease  
A 27-year-old female patient currently taking oral contraceptives is referred to be seen after being found to have three adenomas, the largest being 4 cm. She is contemplating pregnancy in the future.
doi:10.1002/cld.949 pmid:33680436 pmcid:PMC7916436 fatcat:iydjd7zp4rfk5paydqvje4i2nu

Pre-Capillary Pulmonary Hypertension and Right Ventricular Dilation Predict Clinical Outcome in Cardiac Resynchronization Therapy

Neal A. Chatterjee, Gaurav A. Upadhyay, Gaurav Singal, Kimberly A. Parks, G. William Dec, Jagmeet P. Singh, Gregory D. Lewis
2014 JACC. Heart failure  
Objectives This study examined the prognostic significance of pre-and post-capillary components of pulmonary hypertension (PH) in patients receiving cardiac resynchronization therapy (CRT). Background PH is common in patients with left ventricular systolic dysfunction (LVSD) receiving CRT. The impact of PH subtype on clinical outcome in CRT is unknown. Methods The study population consisted of 101 patients (average age 66 AE 13 years, left ventricular ejection fraction 0.23 AE 0.07, and New
more » ... E 0.07, and New York Heart Association functional class 3.2 AE 0.4) who underwent right heart catheterization in the 6 months before CRT. PH was defined as a mean pulmonary artery pressure !25 mm Hg; a significant pre-capillary contribution to elevated mean pulmonary artery pressure was defined as a transpulmonary gradient (TPG) !12 mm Hg. Clinical endpoints were assessed at 2 years and included all-cause mortality and a composite of death, left ventricular assist device, or cardiac transplantation. Results Patients with TPG !12 mm Hg were more likely to experience all-cause mortality (hazard ratio [HR]: 3.2; 95% confidence interval [CI]: 1.3 to 7.4; p ¼ 0.009) and the composite outcome (HR: 3.0; 95% CI: 1.4 to 6.3; p ¼ 0.004) compared with patients with TPG <12 mm Hg. After multivariate adjustment for hemodynamic, clinical, and echocardiographic variables, only TPG !12 mm Hg and baseline right ventricular (RV) dilation (RV end-diastolic dimension >42 mm) were associated with the composite clinical outcome (p ¼ 0.05 and p ¼ 0.04, respectively). Conclusions High TPG PH and RV dilation are independent predictors of adverse outcomes in patients with LVSD who are receiving CRT. RV pulmonary vascular dysfunction may be a therapeutic target in select patients receiving CRT. (J Am Coll Cardiol HF 2014;2:230-7) ª
doi:10.1016/j.jchf.2014.02.004 pmid:24952689 fatcat:jiadldl2tzacfnrgyl7rcpbyku

QoS-aware Mesh based Multicast Routing Protocols in Ad-Hoc Networks: Concepts and Challenges [article]

Gaurav Singal, Vijay Laxmi, Manoj S Gaur, D Vijay Rao, Riti Kushwaha
2017 arXiv   pre-print
Multicast communication plays a crucial role in Mobile Adhoc Networks (MANETs). MANETs provide low cost, self configuring devices for multimedia data communication in military battlefield scenarios, disaster and public safety networks (PSN). Multicast communication improves the network performance in terms of bandwidth consumption, battery power and routing overhead as compared to unicast for same volume of data communication. In recent past, a number of multicast routing protocols (MRPs) have
more » ... tocols (MRPs) have been proposed that tried to resolve issues and challenges in MRP. Multicast based group communication demands dynamic construction of efficient and reliable route for multimedia data communication during high node mobility, contention, routing and channel overhead. This paper gives an insight into the merits and demerits of the currently known research techniques and provides a better environment to make reliable MRP. It presents a ample study of various Quality of Service (QoS) techniques and existing enhancement in mesh based MRPs. Mesh topology based MRPs are classified according to their enhancement in routing mechanism and QoS modification on On-Demand Multicast Routing Protocol (ODMRP) protocol to improve performance metrics. This paper covers the most recent, robust and reliable QoS and Mesh based MRPs, classified based on their operational features, with their advantages and limitations, and provides comparison of their performance parameters.
arXiv:1708.09573v1 fatcat:mqo7v3s6c5airirr3czlew7foa

Evaluation and comparison of postoperative levels of serum bilirubin, serum transaminases and alkaline phosphatase in laparoscopic cholecystectomy versus open cholecystectomy

Rikki Singal, Rajinder Pal Singal, Karamjot Sandhu, Bir Singh, Gaurav Bhatia, Abhishek Khatri, Bhanu Pratap Sharma
2015 Journal of Gastrointestinal Oncology  
Laparoscopic cholecystectomy (LC) requires the creation of a pneumoperitoneum via insufflations of carbon dioxide; resulting in increased partial pressure of carbon dioxide (CO2) and intraperitoneal pressure which leads to the changes in pulmonary function and hemodynamic measurements. Hypercarbia leads to visceral organ ischemia including liver and venous stasis/thromboembolism or both due to impaired flow. The present study has been undertaken to see the changes in liver function tests (LFTs)
more » ... nction tests (LFTs) after laparoscopic/open cholecystectomy (OC), the incidences of such change, their relation to age, sex, duration of surgery and to know the clinical significances of such disturbances. To compare and correlate the serum level of bilirubin, alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP) in patients who underwent LC to those who underwent OC. The present study was conducted in the Department of Surgery at MMIMSR, MM University, Mullana, Ambala. A total number of 200 patients diagnosed as cholelithiasis were included in the study from May 2012 to May 2014. These cases were randomly divided into two groups (A and B) consisting of 100 cases each. LC was performed in group A patients and OC was done in group B patients. Three blood samples were taken: (I) pre-operatively; (II) after 24 hours of surgery; and (III) after 72 hours of surgery for comparison of the enzyme level alterations. In LC patients, there were rise in the levels of serum bilirubin, AST and ALT after 24 hrs of surgery from the preoperative value and then again fall was noted (near to normal value) after 72 hrs of surgery except in that of ALP. ALP levels showed slight fall after 24 hrs of surgery and then slight rise after 72 hrs which was within the normal limit. Whereas in OC patients, there were slight variations in the liver enzymes (which were within the normal range). Transient elevation of serum bilirubin, AST and ALT occurs after LC or after OC. The alteration in the liver enzymes can be attributed to CO2 pneumoperitoneum, surgical manipulations, diathermy, patient position, and arterial injury may also other factors. These changes return to normal in 3-4 days after procedure and they have no clinical consequences in patients with normal hepatic function but they may still cause worry to the surgeon regarding the integrity of biliary tree.
doi:10.3978/j.issn.2078-6891.2015.058 pmid:26487940 pmcid:PMC4570912 fatcat:vy4avtfeabhgzcp6f6udrmz5vm

A Web-Based Patient Tool for Preventive Health

Shantanu Nundy, Mosmi Surati, Ifeoma Nwadei, Gaurav Singal, Monica E. Peek
2012 Journal of Primary Care & Community Health  
Gaurav Singal, MD is a resident physician at Massachusetts General Hospital.  ... 
doi:10.1177/2150131911436011 pmid:23804175 pmcid:PMC3718287 fatcat:hvqpnserfrcrdkzi3ugxkxvqqu

Complications of Urinary Catheterization

Rahul Jain, Kamal Sharma, Ram Gopal Sharma, Gaurav Gupta, Amit Mittal, Rikki Singal, Samikhsha Singh Ahlawat
2016 International Journal of Current Microbiology and Applied Sciences  
doi:10.20546/ijcmas.2016.512.009 fatcat:ajohtoifbreddavisftnrqmv6e

Short Term Active Power Load Prediction on A 33/11 kV Substation Using Regression Models

Venkataramana Veeramsetty, Arjun Mohnot, Gaurav Singal, Surender Reddy Salkuti
2021 Energies  
Electric power load forecasting is an essential task in the power system restructured environment for successful trading of power in energy exchange and economic operation. In this paper, various regression models have been used to predict the active power load. Model optimization with dimensionality reduction has been done by observing correlation among original input features. Load data has been collected from a 33/11 kV substation near Kakathiya University in Warangal. The regression models
more » ... regression models with available load data have been trained and tested using Microsoft Azure services. Based on the results analysis it has been observed that the proposed regression models predict the demand on substation with better accuracy.
doi:10.3390/en14112981 fatcat:crxqivs5ijcdhogby7p53lnf6u

A Study of Athlete Pose Estimation Techniques in Sports Game Videos Combining Multiresidual Module Convolutional Neural Networks

Rui Liu, Gaurav Singal
2021 Computational Intelligence and Neuroscience  
In this paper, we propose a multiresidual module convolutional neural network-based method for athlete pose estimation in sports game videos. The network firstly designs an improved residual module based on the traditional residual module. Firstly, a large perceptual field residual module is designed to learn the correlation between the athlete components in the sports game video within a large perceptual field. A multiscale residual module is designed in the paper to better solve the
more » ... solve the inaccuracy of the pose estimation due to the problem of scale change of the athlete components in the sports game video. Secondly, these three residual modules are used as the building blocks of the convolutional neural network. When the resolution is high, the large perceptual field residual module and the multiscale residual module are used to capture information in a larger range as well as at each scale, and when the resolution is low, only the improved residual module is used. Finally, four multiresidual module convolutional neural networks are used to form the final multiresidual module stacked convolutional neural network. The neural network model proposed in this paper achieves high accuracy of 89.5% and 88.2% on the upper arm and lower arm, respectively, so the method in this paper reduces the influence of occlusion on the athlete's posture estimation to a certain extent. Through the experiments, it can be seen that the proposed multiresidual module stacked convolutional neural network-based method for athlete pose estimation in sports game videos further improves the accuracy of athlete pose estimation in sports game videos.
doi:10.1155/2021/4367875 pmid:34992645 pmcid:PMC8727100 fatcat:vxqj2wz345c2bfjl36wuzvvepa

Predicting Non-Adherence with Outpatient Colonoscopy Using a Novel Electronic Tool that Measures Prior Non-Adherence

Daniel M. Blumenthal, Gaurav Singal, Shikha S. Mangla, Eric A. Macklin, Daniel C. Chung
2015 Journal of general internal medicine  
BACKGROUND: Accurately predicting the risk of no-show for a scheduled colonoscopy can help target interventions to improve compliance with colonoscopy, and thereby reduce the disease burden of colorectal cancer and enhance the utilization of resources within endoscopy units. OBJECTIVES: We aimed to utilize information available in an electronic medical record (EMR) and endoscopy scheduling system to create a predictive model for no-show risk, and to simultaneously evaluate the role for natural
more » ... e role for natural language processing (NLP) in developing such a model. DESIGN: This was a retrospective observational study using discovery and validation phases to design a colonoscopy non-adherence prediction model. An NLPderived variable called the Non-Adherence Ratio ("NAR") was developed, validated, and included in the model. PARTICIPANTS: Patients scheduled for outpatient colonoscopy at an Academic Medical Center (AMC) that is part of a multi-hospital health system, 2009 to 2011, were included in the study. MAIN MEASURES: Odds ratios for non-adherence were calculated for all variables in the discovery cohort, and an Area Under the Receiver Operating Curve (AUC) was calculated for the final non-adherence prediction model. KEY RESULTS: The non-adherence model included six variables: 1) gender; 2) history of psychiatric illness, 3) NAR; 4) wait time in months; 5) number of prior missed endoscopies; and 6) education level. The model achieved discrimination in the validation cohort (AUC= =70.2 %). At a threshold non-adherence score of 0.46, the model's sensitivity and specificity were 33 % and 92 %, respectively. Removing the NAR from the model significantly reduced its predictive power (AUC = 64.3 %, difference = 5.9 %, p<0.001). CONCLUSIONS: A six-variable model using readily available clinical and demographic information demonstrated accuracy for predicting colonoscopy non-adherence. The NAR, a novel variable developed using NLP technology, significantly strengthened this model's predictive power.
doi:10.1007/s11606-014-3165-6 pmid:25586869 pmcid:PMC4441666 fatcat:njcfzxajfbdtfks5dd6tg7xyty

Prevalence of High Tumor Mutational Burden and Association With Survival in Patients With Less Common Solid Tumors

Changxia Shao, Gerald Li, Lingkang Huang, Scott Pruitt, Emily Castellanos, Garrett Frampton, Kenneth R Carson, Tamara Snow, Gaurav Singal, David Fabrizio, Brian M Alexander, Fan Jin (+1 others)
2020 JAMA Network Open  
Tumor mutational burden (TMB) is a potential biomarker associated with response to immune checkpoint inhibitor therapies. The prognostic value associated with TMB in the absence of immunotherapy is uncertain. To assess the prevalence of high TMB (TMB-H) and its association with overall survival (OS) among patients not treated with immunotherapy with the same 10 tumor types from the KEYNOTE-158 study. This retrospective cohort study evaluated the prognostic value of TMB-H, assessed by Foundation
more » ... essed by Foundation Medicine (FMI) and defined as at least 10 mutations/megabase (mut/Mb) in the absence of immunotherapy. Data were sourced from the deidentified Flatiron Health-FMI clinicogenomic database collected up to July 31, 2018. Eligible patients were aged 18 years or older with any of the following solid cancer types: anal, biliary, endometrial, cervical, vulvar, small cell lung, thyroid, salivary gland, mesothelioma, or neuroendocrine tumor. Patients with microsatellite instability-high tumors were excluded from primary analysis. For OS analysis, patients were excluded if immunotherapy started on the FMI report date or earlier or if patients died before January 1, 2012, and patients were censored if immunotherapy was started later than the FMI report date. Data were analyzed from November 2018 to February 2019. Overall survival was analyzed using the Kaplan-Meier method and Cox proportional hazards model, adjusting for age, sex, cancer types, practice type, and albumin level. Of 2589 eligible patients, 1671 (64.5%) were women, and the mean (SD) age was 63.7 (11.7) years. Median (interquartile range) TMB was 2.6 (1.7-6.1) mut/Mb, and 332 patients (12.8%) had TMB-H (≥10 mut/Mb). Prevalence of TMB-H was highest among patients with small cell lung cancer (40.0%; 95% CI, 34.7%-45.6%) and neuroendocrine tumor (29.3%; 95% CI, 22.8%-36.6%) and lowest was among patients with mesothelioma (1.2%; 95% CI, 0.3%-4.4%) and thyroid cancer (2.7%; 95% CI, 1.2%-5.7%). Adjusted hazard ratio for OS of patients not treated with immunotherapy with TMB-H vs those without TMB-H was 0.94 (95% CI, 0.77-1.13). Comparable results were observed when including patients with high microsatellite instability tumors and calculating OS from first observed antineoplastic treatment date. These findings suggest that prevalence of TMB-H varies widely depending on tumor type and TMB-H does not appear to be a factor associated with OS among patients across these cancer types treated in the absence of immunotherapy.
doi:10.1001/jamanetworkopen.2020.25109 pmid:33119110 pmcid:PMC7596577 fatcat:cfmzjuroyne7xepiqoxkvb4p3m

Establishment of a Multidisciplinary Hepatocellular Carcinoma Clinic is Associated with Improved Clinical Outcome

Adam C. Yopp, John C. Mansour, Muhammad S. Beg, Juan Arenas, Clayton Trimmer, Mark Reddick, Ivan Pedrosa, Gaurav Khatri, Takeshi Yakoo, Jeffrey J. Meyer, Jacqueline Shaw, Jorge A. Marrero (+1 others)
2013 Annals of Surgical Oncology  
Purpose-To evaluate differences in overall survival in patients with hepatocellular carcinoma (HCC) after the establishment of a multidisciplinary clinic (MDC) for HCC. Methods-Patient demographic and tumor characteristics of 355 patients diagnosed with HCC were collected between October 2006 and September 2011. Patients diagnosed after the initiation of the HCC MDC on October 1, 2010, were compared to patients diagnosed in the 4 years before. Patient demographics, tumor characteristics,
more » ... acteristics, treatment regimens, and overall survival were analyzed between the groups. Results-A total of 105 patients were diagnosed in the time period after HCC MDC initiation compared to 250 patients in the previous 4 years. Patients diagnosed with HCC after the HCC MDC had fewer symptoms at presentation (64 vs. 78 %, p = 0.01) and earlier stage of tumor presentation [Barcelona Clinic for Liver Cancer (BCLC) A stage, 44 vs. 26 %, p = 0.0003; tumor, node, metastasis classification system stage 1, 44 vs. 30 %, p = 0.003) compared with patients diagnosed before MDC formation. The median time to treatment after diagnosis in the later period was significantly shorter than in the earlier time period (2.3 vs. 5.3 months, p = 0.002). On multivariate analysis, being seen in the HCC MDC remained independently associated with better overall survival (hazard ratio 2.5, 95 % confidence interval 2-3), after adjusting for BCLC stage
doi:10.1245/s10434-013-3413-8 pmid:24318095 pmcid:PMC5612826 fatcat:e42fuy5j6felhc4gqyu7gcq6by

FWNNet: Presentation of a New Classifier of Brain Tumor Diagnosis Based on Fuzzy Logic and the Wavelet-Based Neural Network Using Machine-Learning Methods

Mohsen Ahmadi, Fatemeh Dashti Ahangar, Nikoo Astaraki, Mohammad Abbasi, Behzad Babaei, Gaurav Singal
2021 Computational Intelligence and Neuroscience  
In this paper, we present a novel classifier based on fuzzy logic and wavelet transformation in the form of a neural network. This classifier includes a layer to predict the numerical feature corresponded to labels or classes. The presented classifier is implemented in brain tumor diagnosis. For feature extraction, a fractal model with four Gaussian functions is used. The classification is performed on 2000 MRI images. Regarding the results, the accuracy of the DT, KNN, LDA, NB, MLP, and SVM is
more » ... NB, MLP, and SVM is 93.5%, 87.6%, 61.5%, 57.5%, 68.5%, and 43.6%, respectively. Based on the results, the presented FWNNet illustrates the highest accuracy of 100% with the fractal feature extraction method and brain tumor diagnosis based on MRI images. Based on the results, the best classifier for diagnosis of the brain tumor is FWNNet architecture. However, the second and third high-performance classifiers are the DT and KNN, respectively. Moreover, the presented FWNNet method is implemented for the segmentation of brain tumors. In this paper, we present a novel supervised segmentation method based on the FWNNet layer. In the training process, input images with a sweeping filter should be reshaped to vectors that correspond to reshaped ground truth images. In the training process, we performed a PSO algorithm to optimize the gradient descent algorithm. For this purpose, 80 MRI images are used to segment the brain tumor. Based on the results of the ROC curve, it can be estimated that the presented layer can segment the brain tumor with a high true-positive rate.
doi:10.1155/2021/8542637 pmid:34853586 pmcid:PMC8629672 fatcat:7eagtcl7m5fozmot3x3vrnprve

Enhancing the Prediction of 30-Day Readmission After Percutaneous Coronary Intervention Using Data Extracted by Querying of the Electronic Health Record

Jason H. Wasfy, Gaurav Singal, Cashel O'Brien, Daniel M. Blumenthal, Kevin F. Kennedy, Jordan B. Strom, John A. Spertus, Laura Mauri, Sharon-Lise T. Normand, Robert W. Yeh
2015 Circulation. Cardiovascular Quality and Outcomes  
Wasfy, Gaurav Singal, Cashel O'Brien, Daniel M. Blumenthal, Kevin F.  ... 
doi:10.1161/circoutcomes.115.001855 pmid:26286871 fatcat:m4fdsxfp2vdhbghards2figk7u

Somatic HLA class I loss is a widespread mechanism of immune evasion which refines the use of tumor mutational burden as a biomarker of checkpoint inhibitor response

Meagan Montesion, Karthikeyan Murugesan, Dexter X Jin, Radwa Sharaf, Nora Sanchez, Ameet Guria, Max Minker, Gerald Li, Virginia Fisher, Ethan S Sokol, Dean C Pavlick, Jay A Moore (+9 others)
2020 Cancer Discovery  
Neoantigen presentation arises as a result of tumor-specific mutations and is a critical component of immune surveillance that can be abrogated by somatic loss of heterozygosity (LOH) of the human leukocyte antigen class I (HLA-I) locus. To understand the role of HLA-I LOH in oncogenesis and treatment, we utilized a pan-cancer genomic dataset of 83,644 patient samples, a small subset of which had treatment outcomes with immune checkpoint inhibitors (ICI). HLA-I LOH was common (17%) and
more » ... (17%) and unexpectedly had a non-linear relationship with tumor mutational burden (TMB). HLA-I LOH was frequent at intermediate TMB yet prevalence decreased above 30 mutations/megabase, suggesting highly mutated tumors require alternate immune evasion mechanisms. In ICI treated non-squamous non-small cell lung cancer patients, HLA-I LOH was a significant negative predictor of overall survival. Survival prediction improved when combined with TMB, suggesting TMB with HLA-I LOH may better identify patients likely to benefit from ICIs.
doi:10.1158/ pmid:33127846 fatcat:glykkudj6vbu7n4eglsbsrqgje

Selective Forwarding Attack in LEACH in WSN

Narendra Kumar, Patel Bmit, Gaurav Singal
International Journal of Electronics, Electrical and Computational System IJEECS   unpublished
Wireless Sensor Network comprises of hundreds or thousands of sensor nodes to sense the environment collect data and send these data to a central location known as Base Station or Sink. Sensor Networks are very useful in many application such as military applications, environmental condition detection, whether prediction, measuring temperature, sound, wave, humidity and so on. Each sensor node in Sensor Networks operates on battery. In many scenarios, it is very difficult to recharge or replace
more » ... recharge or replace battery of sensor nodes. So routing protocols for Wireless Sensor Networks should be as energy efficient as possible. Security is also very important in Wireless Sensor Networks. There may be possible to attack by intruders on routing protocols in Wireless Sensor Networks, and degrade the performance of networks. LEACH (Low Energy Adaptive Clustering Hierarchy) is one of the very energy efficient routing protocols, which uses randomized cluster rotation to distribute energy load among all sensor nodes. There may be some possible attacks on LEACH such as Selective Forwarding Attack, Sybil Attack and Hello Flood Attack. In this paper, Selective Forwarding Attack creation, detection, and removal is done on LEACH and it is analyzed that how performance of networks a affected with changes of parameters. Performance of LEACH has been evaluated in terms of packet Delivery Ratio and number of packets transmitted with different parameters. In Selective Forwarding Attack malicious nodes selectively forward some data coming from other nodes, which are destined for other nodes passing this malicious node. The performance analysis of LEACH in presence of Selective Forwarding Attack has been done using Network Simulator 2 (NS2).
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