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Number of medications is associated with outcomes in the elderly patient with metabolic syndrome

Journal of Geriatric Cardiology 2012年第3期9卷 213-219页

作者： akshar Y. patel Pratik Shah Joseph H. Flaherty School of Medicine Saint Louis University 1402 South Grand St. Louis Missouri 63104 USA College of Arts and Sciences Saint Louis University 1402 South Grand St. Louis Missouri 63104 USA Division of Geriatrics Department of Internal Medicine Saint Louis University 1402 South Grand St. Louis Missouri 63104 USA

Background The diagnosis of metabolic syndrome indicates a clustering of metabolic imbalances which in sum have been recognized as a major predictor of cardiovascular and all-cause mortality. The aim of this study was to assess the level of under-pharmacy and poly-pbarmacy and its prognostic impact in elderly patients with metabolic syndrome. Methods Retrospective chart-review at a tertiary medical center, of 324 patients greater than 65 years of age who met the International Diabetes Foundation criteria for metabolic syndrome diagnosis [Body Mass Index （BMI）〉 30 kg/m2, diagnosis of type 2 diabetes, hypertension, and dyslipidemia]. Results There were 60 （18.5%） patients in the low （〈 5） medication burden group, 159 （49.1%） in the medium （〉 5 and 〈 10） medication burden group, and 105 （32.4%） in the high （〉 10） medication burden group. At baseline, the groups differed only by systolic blood pressure. At two years follow-up, the medium group had significantly better improvement in high density lipoprotein cholesterol （HDL-C）, low density lipoprotein cholesterol （LDL-C）, HbAlc, and systolic blood pressure compared to the low medication burden group and significantly better improvement in triglycerides, Haemoglobin Alc （HbAlc） and systolic blood pressure compared to the high medication group. Decrease in HDL-C was the only variable associated with strokes. High medication burden predicted hospitalization burden. The number of anti-hypertensives, history of tobacco use, low and high medication burdens and decrease in HDL-C were all associated with death. Conclusions Both poly-pharmacy and under-pharmacy are associated with a decreased therapeutic benefit among patients with metabolic syndrome in terms of important laboratory measurements as well as clinical outcomes such as myocardial infarctions, hospitalization, and death.

关键词： Cardiovascular outcomes Elderly patients Poly-pharmacy Metabolic syndrome Diabetes Mortality predictors

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Artificial intelligence applications in inflammatory bowel disease:Emerging technologies and future directions

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World Journal of Gastroenterology 2021年第17期27卷 1920-1935页

作者： John Gubatan Steven Levitte akshar.patel Tatiana Balabanis Mike T Wei Sidhartha R Sinha Division of Gastroenterology and Hepatology Stanford University School of MedicineRedwood CityCA 94063United States

Inflammatory bowel disease(IBD)is a complex and multifaceted disorder of the gastrointestinal tract that is increasing in incidence worldwide and associated with significant *** rapid accumulation of large datasets from electronic health records,high-definition multi-omics(including genomics,proteomics,transcriptomics,and metagenomics),and imaging modalities(endoscopy and endomicroscopy)have provided powerful tools to unravel novel mechanistic insights and help address unmet clinical needs in *** the application of artificial intelligence(AI)methods has facilitated the analysis,integration,and interpretation of large datasets in IBD,significant heterogeneity in AI methods,datasets,and clinical outcomes and the need for unbiased prospective validations studies are current barriers to incorporation of AI into clinical *** purpose of this review is to summarize the most recent advances in the application of AI and machine learning technologies in the diagnosis and risk prediction,assessment of disease severity,and prediction of clinical outcomes in patients with IBD.

关键词： Artificial intelligence Machine learning Inflammatory bowel disease Crohn’s disease Ulcerative colitis Clinical outcomes

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Immune checkpoint inhibitor-mediated colitis is associated with cancer overall survival

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World Journal of Gastroenterology 2022年第39期28卷 5750-5763页

作者： Alexa R Weingarden John Gubatan Sundeep Singh Tatiana Clorice Balabanis akshar.patel Arpita Sharma Aida Habtezion Medicine Division of Gastroenterology and HepatologyStanford University School of MedicineStanfordCA 94305United States

BACKGROUND Immune checkpoint inhibitor-mediated colitis(IMC)is a common adverse event following immune checkpoint inhibitor(ICI)therapy for *** has been associated with improved overall survival(OS)and progression-free survival(PFS),but data are limited to a single site and predominantly for melanoma *** To determine the association of IMC with OS and PFS and identify clinical predictors of *** We performed a retrospective case-control study including 64 ICI users who developed IMC matched according to age,sex,ICI class,and malignancy to a cohort of ICI users without IMC,from May 2011 to May *** univariate and multivariate logistic regression,we determined association of presence of IMC on OS,PFS,and clinical predictors of ***-Meier curves were gen-erated to compare OS and PFS between ICI users with and without *** IMC was significantly associated with a higher OS(mean 24.3 mo vs 17.7 mo,P=0.05)but not PFS(mean 13.7 mo vs 11.9 mo,P=0.524).IMC was significantly associated with OS greater than 12 mo[Odds ratio(OR)2.81,95%confidence interval(CI)1.17-6.77].Vitamin D supplementation was significantly associated with increased risk of IMC(OR 2.48,95%CI 1.01-6.07).CONCLUSION IMC was significantly associated with OS greater than 12 *** contrast to prior work,we found that vitamin D use may be a risk factor for IMC.

关键词： Immune checkpoint inhibitors Immune checkpoint inhibitor-mediated colitis Immune-related adverse events

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Updates in the use of radiotherapy in the management of primary and locally-advanced penile cancer

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Asian Journal of Urology 2022年第4期9卷 389-406页

作者： akshar.patel Arash O.Naghavi Peter A.Johnstone Philippe E.Spiess G.Daniel Grass University of South Florida Morsani College of Medicine TampaFLUSA Department of Radiation Oncology H.Lee Moffitt Cancer Center and Research InstituteTampaFLUSA Department of Genitourinary Oncology H.Lee Moffitt Cancer Center and Research InstituteTampaFLUSA

Objective:Penile cancer is a rare malignancy in most developed countries,but may represent a significant oncologic challenge in certain African,Asian,and South American *** treatment approaches have been described in penile cancer,including *** review aimed to provide a synopsis of radiotherapy use in penile cancer management and the associated *** addition,we aimed to discuss palliative radiation for metastases to the penis and provide a brief overview of how tumor biology may assist with treatment ***:Peer-reviewed manuscripts related to the treatment of penile cancer with radio-therapy were evaluated by a PubMed search(1960-2021)in order to assess its role in the definitive and adjuvant *** manuscripts were also evaluated for descriptions of radiation-related ***:Though surgical resection of the primary is an excellent option for tumor control,select patients may be treated with organ-sparing radiotherapy by either external beam radiation or *** from randomized controlled trials comparing radiotherapy and surgery are lacking,and thus management is frequently determined by institutional practice patterns and available ***,this lack of clinical trial data leads to divergence in opinion regarding lymph node *** is further complicated in that many cited studies evaluating lymph node radiotherapy used non-modern radiotherapy delivery *** toxicity from either surgery or radiotherapy remains a challenging problem and further risk assessment is needed to guide intensification with multi-modal *** differences in tumor biology,based on human papillomavirus infection,may help aid future prognostic and predictive models in patient risk stratification or treatment ***:Penile cancer is a rare disease with limited clinical trial data driving the majority of treatment *** a result,the goal of management

关键词： Brachytherapy Chemoradiation Radiation Radiotherapy Penile cancer Squamous cell carcinoma of the penis Penile-sparing Penile metastase Human papillomavirus

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A comprehensive review of the application of nano-silica in oil well cementing

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Petroleum 2020年第2期6卷 123-129页

作者： akshar Thakkar Aakash Raval Shishir Chandra Manan Shah Anirbid Sircar School of Petroleum Technology Pandit Deendayal Petroleum UniversityGandhinagar382007GujaratIndia

Oil and Gas Industry is a Multi-Billion Dollar *** a well is costly,right from exploration to drilling and production to Enhanced Oil Recovery(EOR).Nanotechnology has the potential to introduce revolutionary changes in several areas of the oil and gas industry,such as exploration,drilling,cementation,production,EOR,*** of Nanotechnology in the cement slurry can also achieve solutions to some of the problems pertaining to oil well ***-silica is a better alternative compared to conventional additives like calcium chloride and silica,because as compared to calcium chloride and silica,the amount of nano-silica to be added is very ***-silica acts as a multi-functional *** addition of nano-silica to cement slurry,there is a decrease in the thickening time,an increase in the compressive strength,decrease in porosity and permeability within the cement and also a decrease in the fluid *** of nano-silica ensures proper cementation and greater integrity of the ***-silica helps in decreasing the wait on cement(WOC)time and therefore reduces the overall capital ***-silica is highly recommended for deep offshore wells where high temperature and high pressure are often *** paper discusses the behavior of Nano-silica at high temperatures and also reviews effects of Nano-silica on various properties of cement.

关键词： Oil well cementing Nano-silica Thickening time Compressive strength

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凤尾菇对佐剂诱导的关节炎大鼠的抗风湿活性实验研究(英文)

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中国天然药物 2012年第4期10卷 269-274页

作者： patel Pinal patel Dharmik patel Natvarlal Department of Pharmacology Akshar preet institute of PharmacyJamnagarGujaratIndia Department of Pharmacology C.U.Shah College of Pharmacy and ResearchWadhwanGujaratIndia Department of Pharmacology S.K.Patel College of Pharmaceutical Education and ResearchGanpat UniversityGujaratIndia

Pleurotus sajorcaju(***),an edible and non-toxic mushroom,was evaluated as antioxidant,antitumor,an-ti-inflammatory and antihypertensive *** is a good source of carbohydrates,dietary fiber,essential amino acids,minerals,vitamin B,folic acid and ***-inflammatory,immunomodulatory and analgesic activities of aqueous and methanolic extracts of mycelium of *** were investigated(data is not shown).This finding suggests that extracts of *** can be used against inflammatory and autoimmune ***,*** examined for its antiarthritic *** was collected and separately extracted with water and *** antiarthritic activity 500 and 1 000 mg·kg-1 of both extracts were prepared and ad-ministered by oral *** weight,paw edema(inflammation),hematological parameter,spleen weight,radiological and histologi-cal analysis of bone damage were assessed in rats with Freund's adjuvant induced paw *** extracts showed significant and dose-dependent anti-inflammatory and anti-arthritic effects compared to control group.

关键词： Anti-inflammatory activity Anti-arthritic activity Pleurotus sajorcaju Freund’s adjuvant

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