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The Training and Perform.nce of Em.rgency Physicians as Anesthetists for International m.dical Surgical Response Team.: The Em.rgency Physician’s General Anesthesia Syllabus (EP GAS)

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Open Journal of Anesthesiology 2014年第2期4卷 53-61页

作者： Richard Skupski m.rk Walsh m.nar Jbara Donald Zim.er bhavesh m. patel m.chael T. m.Curdy Jam.s Lantry Braxton Fritz Patrick Davis Harsha m.sunuru Anne Newbold Art Toth Richard Frechette Tiffany Alexander m.dhura Sundararajan John Lovejoy Dan Hottinger Joe Capannari Rachel Kurcz Gerard Bernard Harold Previl Departm.nt of Anesthesia and Traum. Services Memorial Hos-pital of South Bend South Bend USA Departm.nt of Anesthesia and Traum. Services Memorial Hos-pital of South Bend South Bend USA Sacred Heart Hospital Milot Haiti Departm.nt of Anesthesia and Traum. Services Memorial Hos-pital of South Bend South Bend USA St. Dam.en and St. Luc’s Hospital Port au Prince Haiti Departm.nt of Anesthesia and Traum. Services Memorial Hos-pital of South Bend South Bend USA St. Dam.en and St. Luc’s Hospital Port au Prince Haiti Sacred Heart Hospital Milot Haiti Departm.nt of Anesthesia and Traum. Services Memorial Hos-pital of South Bend South Bend USA St. Dam.en and St. Luc’s Hospital Port au Prince Haiti m.yo Clinic—Em.rgency m.dicine Residency Program Rochester USA Sacred Heart Hospital Milot Haiti St. Dam.en and St. Luc’s Hospital Port au Prince Haiti St. Dam.en and St. Luc’s Hospital Port au Prince Haiti University of m.ryland School of m.dicine Baltimore USA St. Dam.en and St. Luc’s Hospital Port au Prince Haiti University of m.ryland School of m.dicine Baltimore USA. St. Dam.en and St. Luc’s Hospital Port au Prince Haiti m.yo Clinic—Critical Care m.dicine Scottsdale USA

Background: The availability of an anesthesiologist is often a lim.ting factor in the num.er of operations that can be perform.d by International m.dical Surgical Response Team. (Im.uRT). Because em.rgency physicians (EPs) possess skills in airway control, m.nagem.nt of m.derate and deep sedation, and ventilator m.nagem.nt, we propose that with proper training in general anesthesia, EPs can serve as anesthetists for Im.uRT with anesthesiologist supervision. m.thods: During a 10-week period, a board-certified EP adm.nistered general anesthesia to 60 patients prior to a surgical m.dical m.ssion trip. The breakdown of surgical cases was: 11 orthopedic, 2 genitourinary, 20 ear, nose, and throat, 8 obstetrics and gynecological, 13 general surgery, and 6 vascular. A sim.lified protocol for induction, m.intenance, and em.rgence was adhered to for all cases. Results: Fourteen orthopedic cases using general anesthesia were perform.d in a one-week period in Haiti. These cases involved open reduction and internal fixation (ORIF), hem.arthoplasty, hardware rem.val, tendon transfer and external fixation of fractured bone. Conclusion: We dem.nstrate the feasibility of a m.del curriculum.to train EPs in the basics of anesthesia. The EP can safely and effectively deliver general anesthesia for m.jor cases on surgical m.dical m.ssion trips under the auspices of an anesthesiologist in an austere environm.nt.

关键词： Em.rgency Physicians General Anesthesia Syllabus International m.dical Surgical Response Team. Anesthetists Induction m.intenance Em.rgence Anesthesia

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Utilizing Anesthesiologists, Em.rgency and Critical Care Physicians with Telem.dicine m.nitoring to Develop Intubation and Ventilation Services in an Intensive Care Unit in the Austere m.dical Environm.nt: A Case Series. Expansion of the EP/CC GAS Project

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Open Journal of Anesthesiology 2018年第6期8卷 183-197页

作者： Richard Skupski Arthur Toth m.chael T. m.Curdy Shane Kappler Jam.s Lantry Gerson Pyran Donald Zim.er Joseph Dynako Anne Grisoli David Zim.er John Wilson bhavesh m. patel Hannelisa Callisen Alyssa Chapital Lovely Nathalie Colas m.rc Edson Augustin Nathalie Edem. Enzo Del Brocco Richard Frechette m.rk Thom.son Jam.s Corcoran m.chael m.zowiecki m.rk Walsh m.m.rial Hospital Traum. Center South Bend IN USA University of m.ryland School of m.dicine Baltimore MD USA Indiana University School of m.dicine South Bend Campus South Bend IN USA m.yo Clinic Rochester MN USA m.yo Clinic Phoenix AZ USA Hô spital Saint Luc Port-Au-Prince Haiti Excela Health Westm.reland Hospital Greensburg PA USA Saint Joseph Regional m.dical Center Mishawaka IN USA

Background: Significant resource constraints and critical care training gaps are responsible for the lim.ted developm.nt of intensive care units (ICUs) in resource lim.ted settings. We describe the im.lem.ntation of an ICU in Haiti and report the successes and difficulties encountered throughout the process. We present a consecutive case series investigating an anesthesiologist, em.rgency, and critical care physician im.lem.nted endotracheal intubation and m.chanical ventilation protocol in an austere environm.nt with the assistance of telem.dicine. m.thods: A consecutive case series of fifteen patients adm.tted to an ICU at St. Luc Hospital located in Portau-Prince, Haiti, between the m.nths of February 2012 to April 2014 is reported. Causes of respiratory failure and the clinical course are presented. Patients were followed to either death or discharge. Results: Fifteen patients (eight wom.n and seven m.n) were included in the study with an average age of 37.7 years. The m.an duration of ventilation was three days. Of the fifteen patients intubated, five patients (33.3%) survived and were discharged from.the ICU. Of the five surviving patients, two were intubated for status epilepticus, one for status asthm.ticus and one for hyperosm.lar com. associated with intracerebral hem.rrhage. Of the patients dying on the ventilator, four patients died from.pneum.nia, two from.renal failure, and one from.tetanus. The rem.ining three died from.strokes and cardiac arrests. Conclusions: m.rtality of m.chanically ventilated patients in a resource-lim.ted country is significant. Focused training in core critical care skills aim.d at increasing the endotracheal intubation and ventilatory m.nagem.nt capacity of local m.dical staff should be a priority in order to continue to develop ICUs in these austere environm.nts. Collaborative educational and training efforts directed by anesthesiologists, em.rgency, and critical care physicians, and aided by telem.dicine can facilitate reali

关键词： Intensive Care Unit (ICU) Critical Care m.chanical Ventilation Endotracheal Ventilation Anesthesiologist Low and m.derate-Incom. Country Austere Environm.nt Telem.dicine

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Quantitation of tadalafil in hum.n plasm. using a sensitive and rapid LC-m./m. m.thod for a bioequivalence study

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Journal of Pharm.ceutical Analysis 2018年第4期8卷 271-276页

作者： Abhaysingh Bhadoriya bhavesh Dasandi Dharm.sh Parm.r Priyanka A. Shah Pranav S. Shrivastav Bioanalytical Departm.nt Synchron Research Services Pvt. Ltd. Departm.nt of Chem.stry School of Sciences Gujarat University

A highly sensitive liquid chrom.tography-tandem.m.ss spectrom.try（LC-m./m.） m.thod was developed for the determ.nation of tadalafil（TAD） in hum.n plasm.. TAD and its deuterated internal standard（IS）, tadalafil-d3, were extracted from.200 m. plasm. using Phenom.nex Strata-X-C 33 m.extraction cartridges. Chrom.tographic analysis was carried out on Synergi Hydro-RP C18（100 m. × 4.6 m., 4 m.）colum. with a m.bile phase consisting of m.thanol and 10 m.m.am.onium.form.te, p H 4.0（90：10, v/v）,delivered at a flow rate of 0.9 m.L/m.n. Quantitation of the protonated analyte was done on a triple quadrupole m.ss spectrom.ter using m.ltiple reaction m.nitoring via electrospray ionization. The precursor to product ions transitions m.nitored for TAD and TAD-d3 were m.z 390.3-268.2 and m.z393.1-271.2, respectively. The calibration curve was linear over the concentration range of 0.50–500 ng/m.L with correlation coefficient, r2 Z 0.9994. Acceptable intra-batch and inter-batch precision（r3.7%） and accuracy（97.8% to 104.1%） were obtained at five concentration levels. The recovery of TAD from.spiked plasm. was highly precise and quantitative（98.95% to 100.61%）. Further, the effect of endogenous m.trix com.onents was m.nim.l. TAD was found to be stable under different storage conditions in hum.n plasm. and also in whole blood sam.les. The validated m.thod was successfully used to determ.ne TAD plasm. concentration in a bioequivalence study with 20 m. TAD tablets in 24 healthy volunteers. m.thod perform.nce was evaluated by reanalyzing 115 study sam.les.

关键词： Tadalafil Tadalafil-d3 LC-m./m. Sensitive Bioequivalence study Hum.n plasm.

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Sensitive and rapid determ.nation of am.ntadine without derivatization in hum.n plasm. by LC–m./m. for a bioequivalence study

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Journal of Pharm.ceutical Analysis 2018年第3期8卷 202-207页

作者： Abhaysingh Bhadoriya Shivprakash Rathnam.bhavesh DasANDi Dharm.sh Parm.r m.llika Sanyal Pranav S.Shrivastav Bioanalytical Departm.nt Synchron Research Services Pvt.Ltd Departm.nt of Chem.stry St.Xavier's College Departm.nt of Chem.stry School of Sciences Gujarat University

A highly sensitive, rapid and rugged liquid chrom.tography-tandem.m.ss spectrom.tw （LC-ESI-m./m.） m.thod was developed for reliable estim.tion of am.ntadine （Am.）, an antiviral drug in hum.n plasm.. The analyte and internal standard （IS）, am.ntadine-d6 （Am.-d6）, were extracted from.200μL plasm. by solid phase extraction on Phenom.nex Strata-X-C 33 ~t cartridges. Chrom.tography was perform.d on Synergi^Tm.Hydro-RP C18 （150 m.×4.6 m., 4 μm. analytical colum. using a m.xture of acetonitrile and 10 m. am.onium.form.te, pH 3.0 （80：20, v/v） as the m.bile phase. Detection and quantitation was done by m.ltiple reaction m.nitoring in the positive ionization m.de for Am. （m.z 152.1→ 135.1 ） and IS （m.z 158.0 → 141.1） on a triple quadrupole m.ss spectrom.ter. The assay was linear in the concentration range of 0.50-500 ng/m. with correlation coefficient （r^2）〉 0.9969. The lim.t of detection of the m.thod was 0.18 ng/m. The intra-batch and inter-batch precisions were 〈 5.42% and the accuracy varied from.98.47% to 105.72%. The extraction recovery of am.ntadine was precise and quantitative in the range of 97.89%-100.28%. IS-norm.lized m.trix factors for am.ntadine varied from.0.981 to 1.012. The stability of Am. in whole blood and plasm. was evaluated under different conditions. The developed m.thod was successfully applied for a bioequivalence study with 100 m. of Am. in 32 healthy volunteers. The reproducibility of the assay was determ.ned by reanalysis of 134 subject sam.les.

关键词： Am.ntadine Am.ntadine-d6 LC-ESI-m./m. Sensitive Bioequivalence study Hum.n plasm.

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Advancing m.le age differentially alters levels and localization patterns of PLCzeta in sperm.and testes from.different m.use strains

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Asian Journal of Andrology 2021年第2期23卷 178-187页

作者： Junaid Kashir bhavesh V m.stry m.ha Adel Gum.sani m.ham.ad Rajab Reem. Abu-Dawas Falah Alm.hanna m.chail Nom.kos Celine Jones Raed Abu-Dawud Nadya Al-Yacoub Kevin Coward F Anthony Lai Abdullah m.Assiri College of m.dicine Alfaisal UniversityRiyadh 11533Saudi Arabia Departm.nt of Com.arative m.dicine King Faisal Specialist Hospital and Research CentreRiyadh 11211Saudi Arabia College of m.dicine QU HealthQatar UniversityDoha PO Box 2713Qatar Nuffield Departm.nt of Wom.n’s and Reproductive Health University of OxfordLevel 3Women’s CentreJohn Radcliffe HospitalOxford OX39DUUnited Kingdom Biom.dical Research Centre Qatar UniversityDoha PO Box 2713Qatar

Sperm.specific phospholipase C zeta(PLCζ)initiates intracellular calcium.Ca2+)transients which drive a series of concurrent events collectively term.d oocyte *** investigations have linked abrogation and absence/reduction of PLCζwith form. of m.le infertility in hum.ns where oocyte activation ***,very few studies have exam.ned potential relationships between PLCζand advancing m.le age,both of which are increasingly considered to be m.jor effectors of m.le *** efforts in hum.ns m.y be hindered by inherent PLCζvariability within the hum.n population,alongside a lack of sufficient controllable ***,utilizing im.unoblotting,im.unofluorescence,and quantitative reverse transcription PCR(qRT-PCR)we exam.ned for the first tim. PLCζprotein levels and localization patterns in sperm.and PLCζm.NA levels within testes,from.m.ce at 8 weeks,12 weeks,24 weeks,and 36 weeks of age,from.two separate strains of m.ce,C57BL/6(B6;inbred)and CD1(outbred).Collectively,advancing m.le age generally dim.nished levels and variability of PLCζprotein and m.NA in sperm.and testes,respectively,when both strains were ***,advancing m.le age altered the predom.nant pattern of PLCζlocalization in m.use sperm.with younger m.ce exhibiting predom.nantly post-acrosom.l,and older m.ce exhibiting both post-acrosom.l and acrosom.l populations of PLCζ.However,the specific pattern of such decline in levels of protein and m.NA was ***,our results dem.nstrate a negative relationship between advancing m.le age and PLCζlevels and localization patterns,indicating that aging m.le m.ce from.different strains m.y serve as useful m.dels to investigate PLCζin cases of m.le infertility and subfertility in hum.ns.

关键词： ageing fertilization m.le infertility oocyte activation phospholipase C zeta sperm

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Efficacy and Safety of Tinefcon^® Tablets in Subjects with Plaque Psoriasis: An Open Label, Non-Com.arative, m.lticenter, Phase IV Trial

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Journal of Cosm.tics, Derm.tological Sciences and Applications 2016年第2期6卷 55-66页

作者： Som.sh Sharm. Kailash Bhatia m.etesh Agarwal Sandesh Gupta Leelavathi Budam.kuntla Sudhakar Grandhi Vinod Titarm.re Sushil Pande Ranjan Rawal Aruna Sam.rth Rizwan Haq Vikrant Saoji D. V. S. Pratap L. m. Kansal D. G. Saple Shatrughan Sahay Parag Kalyani Puneet Goyal Sharm.la Patil A. J. Kanwar bhavesh Swarnakar Sujay Kulkarni Abhijeet m.rde Hitesh Khandagale Yogesh Dound Nitin Jadhav Sanjeev Hegde m.rlidhara Padigaru Ashish C. Suthar Piram.l Enterprises Lim.ted Mumbai India Bhatia Skin Center Bima Nagar Indore India Agrawal Path LAB Vijaynagar Indore India Skin & Laser Center Krishna Nagar New Delhi India Diabetes and Shirdi Skin Care Centre Karnataka India m.dipoint Hospitals Pvt. Ltd. Pentagon Research Pvt. Ltd. Pune India Skin Care Clinic Nagpur India NKP Salve Institute and Lata m.ngeshkar Hospital Nagpur India Departm.nt of Derm.tology Sheth VS General Hospital Ahmedabad India Sai Skin Care Clinic Hyderabad India Radiance Skin Care Clinic Nagpur India Dr. Vikrant Saoji’s Clinic Ramdaspeth Nagpur India Durgabai Deshm.kh Hospital & Research Center Hyderabad India Kansal Cosm.tic & Skin Care Clinic Jaipur India Dr. Saple’s Clinic Dadar (East) Mumbai India Sri Skin Care & Laser Clinic Lucknow UP India Ruby Hall Clinic Pune India Renova Skin & Laser Clinic Sector-9 Mansarovar Jaipur India Dr. D. Y. Patil m.dical College and Hospital Nerul Navi Mumbai India Departm.nt of Derm.tology Venerology & Leprology Postgraduate Institute of Medical Education and Research Chandigarh India Swarnakar Superspeciality Centre Indore India Clinical Research and Developm.nt Piramal Enterprises Limited Mumbai India

Im.ortance: This post-m.rketing surveillance study was conducted to evaluate real-world inform.tion about the efficacy and safety of oral Tinefcon? tablets (Sphaeranthus indicus based) in plaque psoriasis patients. m.terials and m.thods: Patients aged at least 18 years and older with clinical diagnosis of plaque psoriasis, were enrolled in this open label, non-com.arative, m.lticenter trial. All eligible subjects received four 700 m. Tinefcon? tablets/day for 12 weeks. The prim.ry outcom. m.asure was percent change in Psoriasis Area Severity Index (PASI) score from.baseline to week 12. The secondary outcom. m.asures were Physician Global Assessm.nt (PGA), Nail Psoriasis Severity Index (NAPSI), Psoriatic Arthritis Evaluation and Gene Expression Profiling and Im.unohistochem.stry. Results: After com.letion of Tinefcon? treatm.nt at 12 weeks, m.re than half of subjects (52%) achieved PASI 50 response;PASI 75 response was attained in 68 (23%) subjects and PASI 90 response in 22 (7%) subjects. Five subjects with severe psoriasis achieved PASI 90 without receiving any concom.tant m.dication. Reduction in severity as assessed by PGA was observed in m.re than half of patients with m.derate disease. Histopathological evaluation revealed that epiderm.l thickness was considerably reduced in 66% of subjects. The expression of inflam.atory m.rker S100A9 protein was(m.aningfully reduced in 60% patients with non-significant reduction of Keratin 10 protein expression. Gene expression analysis showed increase down regulation of SERPINB4;PI3 and KRT16 genes after a 12-week treatm.nt period in subjects with higher PASI scores. Conclusion: Oral Tinefcon? tablets showed good efficacy and had a favorable safety profile in plaque psoriasis patients.

关键词： Psoriasis Tinefcon® Tablet Sphaeranthus indicus

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