BACKGROUND Duodenal variceal bleeding is a rare cause of gastrointestinal bleeding. The most common site is the duodenal bulb. It is usually detected endoscopically but it can be very challenging to diagnose if it is ...BACKGROUND Duodenal variceal bleeding is a rare cause of gastrointestinal bleeding. The most common site is the duodenal bulb. It is usually detected endoscopically but it can be very challenging to diagnose if it is located distal to the second part od duodenum. The pre- transjugular intrahepatic portosystemic shunt (TIPS) presence of spontaneous portosystemic shunt (SPSS) was found to be associated with an increased risk of early morbidity and mortality after TIPS placement. CASE SUMMARY A 43-year-old cirrhotic male presented with melena for three days. Upper endoscopy was performed and showed active blood oozing from the distal duodenum concerning for ectopic duodenal varix. A computed tomography (CT) angiogram was performed and showed an enlarged cluster of venous collaterals around the distal duodenum. He underwent TIPS placement. He had another episode of melena three days later. Push enteroscopy with injection sclerotherapy into the duodenal varices was performed with no success. A repeat CT angiogram showed occluded TIPS shunt. Therefore, a TIPS revision was performed and there was an extensive portal venous thrombosis with a large shunt between the inferior mesenteric vein and left renal vein via the left gonadal vein. Thrombectomy and TIPS shunt balloon angioplasty was performed, followed by embolization of the portosystemic. The melena was resolved, and patient was discharged with arranged hepatology follow up. CONCLUSION It importance to look and embolize the SPSS shunts in patients with early TIPS dysfunction and recurrent duodenal variceal bleeding.展开更多
This research explored a novel multimodal approach for disease management in cauliflower crops.With the rising challenges in sustainable agriculture,the research focused on a patch spraying method to control disease a...This research explored a novel multimodal approach for disease management in cauliflower crops.With the rising challenges in sustainable agriculture,the research focused on a patch spraying method to control disease and reduce crop losses and environmental impact.For non-destructive disease assessment,a spectral sensor was used to collect spectral information from diseased and healthy cauliflower parts.The spectral data sets were analyzed using decision tree and support vector machine(SVM)algorithms to identify the most accurate model for distinguishing diseased and healthy plants.The chosen model was integrated with a low-volume sprayer(50-150 L·ha^(-1)),equipped with an electronic control unit for targeted spraying based on sensor-detected regions.The decision tree model achieved 89.9% testing accuracy,while the SVM model achieved 96.7% accuracy using hyperparameters:cost of 10.0 and tolerance of 0.001.The research successfully demonstrated the integration of spectral sensors,machine learning,and targeted spraying technology for precise input application.Additionally,the optimized sprayer achieved a 72.5% reduction in chemical usage and a significant time-saving of 21.0% compared to a standard sprayer for black rot-infested crops.These findings highlight the potential efficiency and resource conservation benefits of innovative sprayer technology in precision agriculture and disease management.展开更多
文摘BACKGROUND Duodenal variceal bleeding is a rare cause of gastrointestinal bleeding. The most common site is the duodenal bulb. It is usually detected endoscopically but it can be very challenging to diagnose if it is located distal to the second part od duodenum. The pre- transjugular intrahepatic portosystemic shunt (TIPS) presence of spontaneous portosystemic shunt (SPSS) was found to be associated with an increased risk of early morbidity and mortality after TIPS placement. CASE SUMMARY A 43-year-old cirrhotic male presented with melena for three days. Upper endoscopy was performed and showed active blood oozing from the distal duodenum concerning for ectopic duodenal varix. A computed tomography (CT) angiogram was performed and showed an enlarged cluster of venous collaterals around the distal duodenum. He underwent TIPS placement. He had another episode of melena three days later. Push enteroscopy with injection sclerotherapy into the duodenal varices was performed with no success. A repeat CT angiogram showed occluded TIPS shunt. Therefore, a TIPS revision was performed and there was an extensive portal venous thrombosis with a large shunt between the inferior mesenteric vein and left renal vein via the left gonadal vein. Thrombectomy and TIPS shunt balloon angioplasty was performed, followed by embolization of the portosystemic. The melena was resolved, and patient was discharged with arranged hepatology follow up. CONCLUSION It importance to look and embolize the SPSS shunts in patients with early TIPS dysfunction and recurrent duodenal variceal bleeding.
基金supported by the Technology Development Programme of Department of Science and Technology,Government of India(DST/TDT/TDP-22/2022)。
文摘This research explored a novel multimodal approach for disease management in cauliflower crops.With the rising challenges in sustainable agriculture,the research focused on a patch spraying method to control disease and reduce crop losses and environmental impact.For non-destructive disease assessment,a spectral sensor was used to collect spectral information from diseased and healthy cauliflower parts.The spectral data sets were analyzed using decision tree and support vector machine(SVM)algorithms to identify the most accurate model for distinguishing diseased and healthy plants.The chosen model was integrated with a low-volume sprayer(50-150 L·ha^(-1)),equipped with an electronic control unit for targeted spraying based on sensor-detected regions.The decision tree model achieved 89.9% testing accuracy,while the SVM model achieved 96.7% accuracy using hyperparameters:cost of 10.0 and tolerance of 0.001.The research successfully demonstrated the integration of spectral sensors,machine learning,and targeted spraying technology for precise input application.Additionally,the optimized sprayer achieved a 72.5% reduction in chemical usage and a significant time-saving of 21.0% compared to a standard sprayer for black rot-infested crops.These findings highlight the potential efficiency and resource conservation benefits of innovative sprayer technology in precision agriculture and disease management.
