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EPQ model with the effect of inflation and reliability for partial trade credit under fuzzy and cloudy fuzzy environment

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Journal of Management Analytics 2024年第1期11卷 110-134页

作者： Supriya Tiwari kunal Shah Kajal Bhimani Department of Science and Humanities Apollo Institute of Engineering&TechnologyGTUAhmedabadIndia Department of Mathematics SMMPISRKadi Sarva VishwavidyalayaGandhinagarIndia AVAerials 401 Swarnim Business Hub-1 New Chamunda SocietyGodrej Garden CityGotaAhmedabadIndia

The proposed study offers the first-of-its-kind economic production quantity model for deteriorating items having a demand rate to be price dependent under the effect of inflation and reliability with partial trade *** model is extended under an uncertain environment by assuming inventory parameters to be triangular fuzzy numbers and cloudy triangular fuzzy *** objective of the study is to maximize the profit of the inventory system and to identify the most suitable environment for the proposed *** are verified using the numerical ***,the comparative study is presented to justify the nature of fuzzy and cloudy fuzzy *** analysis under all environments is conducted to identify the most sensitive parameters of all.

关键词： EPQ partial trade credit inflation reliability triangular fuzzy number cloudy triangular fuzzy number

Cardioprotective activity of alcoholic extract of Tinospora cordifolia (Willd.) Miers in calcium chloride-induced cardiac arrhythmia in rats

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The Journal of Biomedical Research 2011年第4期25卷 280-286页

作者： Ashish Kumar Sharma kunal kishore Divya Sharma B.P Srinivasan Shyam Sunder Agarwal Ashok Sharma Santosh Kumar Singh Samir Gaur Vijay Singh Jatav Department of Pharmacology Gyan Vihar School of PharmacySuresh Gyan Vihar UniversityJagatpuraJaipur (Rajasthan)302025India Delhi Institute of Pharmaceutical Sciences & Research Department of PharmacologyPushpviharSector Ⅲ.New Delhi 110017India

The present study investigated the antiarrhythmic activity of alcoholic extract of Tinospora cordifolia （T. cordifolia） in CaCl2 induced arrhythmia. CaCl2 （25 mg/kg） was administered by intravenous infusion （iv） to produce arrhythmia in rats. The animals were then treated with T. cordifolia extract （150, 250, and 450 mg/kg） and verapamil （5 mg/kg,iv）. Lead II electrocardiogram was monitored. Plasma calcium, sodium and potassium levels were measured. In CaCl2 induced arrhythmia, heart rate was decreased by 41.10%, T. cordifolia at 150, 300, and 450 mg/kg decreased the heart rate by 26.30%, 29.16%, and 38.29%, respectively, and verapamil reduced the heart rate by 9.70% compared to the normal group. The PQRST waves were normalized and atrial and ventricular fibrillation was controlled in rats treated with verapamil and T. cordifolia. CaCl2 increased calcium and sodium levels and decreased potassium levels in blood. T. cordifolia dose-dependently decreased calcium and sodium levels and increased potassium levels. Hence, T. cordifolia can be used in antiarrhythmic clinical settings and beneficial in atrial and ventricular fibrillation and flutter and may be indicated in ventricular tachyarrhythmia.

关键词： Tinospora cordifolia arrhythmia cardioprotection.

Involvement of adenosine and standardization of aqueous extract of garlic(Allium sativum Linn.)on cardioprotective and cardiodepressant properties in ischemic preconditioning and myocardial ischemia-reperfusion induced cardiac injury

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The Journal of Biomedical Research 2012年第1期26卷 24-36页

作者： Ashish Kumar Sharma Arshee Munajjam Bhawna Vaishnav Richa Sharma Ashok Sharma kunal kishore Akash Sharma Divya Sharma Rita Kumari Ashish Tiwari Santosh Kumar Singh Samir Gaur Vijay Singh Jatav Barthu Parthi Srinivasan Shyam Sunder Agarwal Department of Pharmacology Gyan Vihar School of PharmacySuresh Gyan Vihar University Department of Pharmacology Delhi Institute of Pharmaceutical Sciences & Research

The present study investigated the effect of garlic （Allium sativum Linn.） aqueous extracts on ischemic pre- conditioning and ischemia-reperfusion induced cardiac injury, as well as adenosine involvement in ischemic pre- conditioning and garlic extract induced cardioprotection. A model of ischemia-reperfusion injury was established using Langendorff apparatus. Aqueous extract of garlic dose was standardized （0.5%, 0.4%, 0.3%, 0.2%, 0.1%, 0.07%, 0.05%, 0.03%, 0,01%）, and the 0.05% dose was found to be the most effective. Higher doses （more than 0.05%） were highly toxic, causing arrhythmia and cardiodepression, whereas the lower doses were ineffective. Garlic exaggerated the cardioprotective effect of ischemic preconditioning. The cardioprotective effect of ischemic preconditioning and garlic cardioprotection was significantly attenuated by theophylline （1,000 ~tmol/L） and 8-SPT （10 mg/kg, i.p.） and expressed by increased myocardial infarct size, increased LDH level, and reduced nitrite and adenosine levels. These findings suggest that adenosine is involved in the pharmacological and molecular mechanism of garlic induced cardioprotection and mediated by the modulation of nitric oxide.

关键词： Allium sativum Linn. ischemic preconditioning cardioprotection adenosine nitrite

Hepatic vein reconstruction during hepatectomy:A feasible and underused technique

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Hepatobiliary & Pancreatic Diseases International 2024年第4期23卷 421-427页

作者： Manish Ahuja kunal Joshi Chris Coldham Paulo Muiesan Bobby Dasari Manuel Abradelo Ravi Marudanayagam Darius Mirza John Isaac David Bartlett Nikolaos A Chatzizacharias Robert P Sutcliffe Keith J Roberts Department of HPB and Liver Transplant Surgery University Hospitals Birmingham NHS Foundation TrustBirminghamUK Institute of Immunology and Immunotherapy University of BirminghamBirminghamUK

Complete surgical resection(R0)of liver tumors,primary or metastatic,remains the main objective in management of primary and metastatic liver tumors[1].Tumors invading to the proximity of the hepatic venous outflow pose a peculiar challenge to achieve R0 resections,because this location may render a tumor *** median survival of patients with liver tumor without surgery is less than 12 months[2].Even with surgery,post-hepatectomy liver failure and subsequently increased mortality are the main problems associated with complex resection[3].Moreover,when the vein is affected,vein resection and subsequent reconstruction are *** resection is a standard practice in liver resection and transplantation[4],for example,hepatic vein reconstruction during a living-donor liver transplant,porto-mesenteric axis reconstruction during resection of advanced pancreatic cancer and caval reconstruction during resection of retroperitoneal ***,novel techniques like total hepatic vascular exclusion(HVE)[5],veno-venous bypass[6]and ex vivo hepatic resection[7,8]have facilitated curative resections of tumors close to one or more major hepatic veins.

关键词： hepatectomy surgery mortality

A Study to Observe Pulse Pressure Variation after Induction with Propofol for General Anesthesia

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World Journal of Cardiovascular Diseases 2024年第5期14卷 343-350页

作者： kunal Tewari Vibhu Raghuvanshi Deepak Mishra Nitin Pahuja Maj Jyotsna Om Bahadur Thapa Department of Anaesthesiology and Critical Care Armed Forces Medical College Pune India Chauhan Medicity and Trauma Centre Pathankot India Department of Anaesthesiology and Critical Care Command Hospital (Southern Command) Pune India

Background and Aims: Pulse pressure variation (PPV) is a reliable and predictive dynamic parameter presently being utilized for fluid responsiveness. In the operating room, fluid administration based on PPV monitoring helps the physician in deciding whether to volume resuscitate or use interventions in patients undergoing surgery. Propofol is an intravenous induction agent which lowers blood pressure. There are multiple causes such as depression in cardiac output, and peripheral vasodilatation for hypotension. We undertook this study to observe the utility of PPV as a guide to fluid therapy after propofol induction. Primary outcome of our study was to monitor PPV as a marker of fluid responsiveness for the hypotension caused by propofol induction. Secondary outcome included the correlation of PPV with other hemodynamic parameters like heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP);after induction with propofol at regular interval of time. Methods: A total number of 90 patients were recruited. Either of the radial artery was then cannulated under local anaesthesia with 20G VygonLeadercath arterial cannula and invasive monitoring transduced. A baseline recording of heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and PPV was then recorded. Patients were then induced with predetermined doses of propofol (2 mg/kg) and recordings of HR, SBP, DBP, and PPV were taken at 5, 10 and 15 minutes. Results: Intraoperatively, PPV was significantly higher at 5 minutes and significantly lower at 15 minutes after induction. It was observed that there were no statistically significant correlations between PPV and SBP or DBP. PPV was strongly and directly associated with HR. Conclusion: We were able to establish that PPV predicts fluid responsiveness in hypotension caused by propofol induction;and can be used to administer fluid therapy in managing such hypotension. However, PPV was not directly correlated with hypotensi

关键词： Pulse Pressure Variation (PPV) Propofol Fluid Responsiveness

A Comparative Study between Landmark Based and Real Time Ultrasound Guided Sub Arachnoid Block

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Open Journal of Anesthesiology 2024年第4期14卷 118-125页

作者： kunal Tewari Om Bahadur Thapa Deepak Mishra Manjot Multani Jyotsna Sharma Akash Ray Mohapatra Sandhya Khwaunju Department of Anesthesiology and Critical Care Armed Forces Medical College Pune India Department of Anesthesiology and Critical Care AFMC Pune India

Background: Sub arachnoid block (SAB) performed by traditional landmark palpation technique can be inaccurate. This problem is exacerbated by altered patient anatomy due to obesity and age-related changes. A pre-procedural ultrasound scan of the lumbar spine has been shown to be of benefit in guiding lumbar epidural insertion in obstetric patients. Information on the use of real-time ultrasound (RUS) guided SAB, to date, been limited. This study compared RUS guided SAB to traditional landmark guided technique in patients undergoing spinal anesthesia for different surgical procedures. Methods: This was a prospective, single center, comparative observational study conducted in the department of anesthesiology at our center. 560 patients who underwent spinal anesthesia either by landmark based technique or real-time ultrasound-guided methods. The primary outcome was the first attempt success rate of dural puncture when employing the two methods. Results: Baseline characteristics were similar in the two study groups. The first attempt success rate of dural puncture in landmark guided group was 64.3% compared to 72.6% in the ultrasound guided group. This difference was not statistically significant. The procedure performance time was significantly shorter with landmark palpation compared to use of real-time ultrasound guided method. Conclusion: Use of RUS-guided technique does not significantly improve the first attempt success rate of SAB dural puncture during spinal anesthesia compared to the traditional landmark-guided technique.

关键词： Sub Arachnoid Block (SAB) Real Time Ultrasound (RUS)

Comparison of efficacy of lung ultrasound and chest X-ray in diagnosing pulmonary edema and pleural effusion in ICU patients: A single centre, prospective, observational study

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Open Journal of Anesthesiology 2024年第3期14卷 41-50页

作者： kunal Tewari Sumanth Pelluru Deepak Mishra Nitin Pahuja Akash Ray Mohapatra Jyotsna Sharma Om Bahadur Thapa Manjot Multani Department of Anesthesiology and Critical Care Armed Forces Medical College Pune India Department of Anesthesiology and Critical Care Military Hospital Bhopal India

Background and Aims While chest X-ray (CXR) has been a conventional tool in intensive care units (ICUs) to identify lung pathologies, computed tomography (CT) scan remains the gold standard. Use of lung ultrasound (LUS) in resource-rich ICUs is still under investigation. The present study compares the utility of LUS to that of CXR in identifying pulmonary edema and pleural effusion in ICU patients. In addition, consolidation and pneumothorax were analyzed as secondary outcome measures. Material and Methods This is a prospective, single centric, observational study. Patients admitted in ICU were examined for lung pathologies, using LUS by a trained intensivist;and CXR done within 4 hours of each other. The final diagnosis was ascertained by an independent senior radiologist, based on the complete medical chart including clinical findings and the results of thoracic CT, if available. The results were compared and analyzed. Results Sensitivity, specificity and diagnostic accuracy of LUS was 95%, 94.4%, 94.67% for pleural effusion;and 98.33%, 97.78%, 98.00% for pulmonary edema respectively. Corresponding values with CXR were 48.33%, 76.67%, 65.33% for pleural effusion;and 36.67%, 82.22% and 64.00% for pulmonary edema respectively. Sensitivity, specificity and diagnostic accuracy of LUS was 91.30%, 96.85%, 96.00% for consolidation;and 100.00%, 79.02%, 80.00% for pneumothorax respectively. Corresponding values with CXR were 60.87%, 81.10%, 78.00% for consolidation;and 71.3%, 97.20%, 96.00% for pneumothorax respectively. Conclusion LUS has better diagnostic accuracy in diagnosis of pleural effusion and pulmonary edema when compared with CXR and is thus recommended as an effective alternative for diagnosis of these conditions in acute care settings. Our study recommends that a thoracic CT scan can be avoided in most of such cases.

关键词： Chest X ray (CXR) Consolidation Pulmonary edema Pleural effusion Lung ultrasound (LUS) Pneumothorax

Outcomes and efficacy of magnetic resonance imaging-compatible sacral nerve stimulator for management of fecal incontinence: A multi-institutional study

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World Journal of Radiology 2024年第2期16卷 32-39页

作者： Binit Katuwal Amy Thorsen kunal Kochar Ryba Bhullar Ray King Ernesto Raul Drelichman Vijay K Mittal Jasneet Singh Bhullar Department of Surgery Ascension Providence HospitalMichigan State University College of Human MedicineSouthfieldMI 48075United States Department of Colon and Rectal surgery Alina Health Abbott Northwestern HospitalMinneapolisMN 55407United States Colon and Rectal Surgery Advocate Illinois MasonicPark RidgeIL 60068United States Volunteer Student Department of ResearchAscension Providence HospitalSouthfieldMI 48075United States Colon and Rectal Surgery University of WisconsinMadisonWI 53715United States General and Colorectal Surgery Ascension Providence HospitalMichigan State University College of Human MedicineSouthfieldMI 48075United States Department of Surgery Department of Medical EducationAscension Providence HospitalMichigan State University College of Human MedicineSouthfieldMI 48075United States

BACKGROUND Fecal incontinence(FI)is an involuntary passage of fecal matter which can have a significant impact on a patient’s quality of *** modalities of treatment exist for *** nerve stimulation is a well-established treatment for *** the increased need of magnetic resonance imaging(MRI)for diagnostics,the In-terStim which was previously used in sacral nerve stimulation was limited by MRI *** MRI-compatible InterStim was approved by the United States Food and Drug Administration in August 2020 and has been widely *** To evaluate the efficacy,outcomes and complications of the MRI-compatible *** Data of patients who underwent MRI-compatible Medtronic InterStim placement at UPMC Williamsport,University of Minnesota,Advocate Lutheran General Hospital,and University of Wisconsin-Madison was pooled and *** demographics,clinical features,surgical techniques,complications,and outcomes were *** the Reporting of Observational studies in Epidemiology(STROBE)cross-sectional reporting guidelines were *** Seventy-three patients had the InterStim *** mean age was 63.29±12.2 ***-seven(78.1%)patients were females and forty-two(57.5%)patients had *** addition to incontinence,overlapping symptoms included diarrhea(23.3%),fecal urgency(58.9%),and urinary incontinence(28.8%).Fifteen(20.5%)patients underwent Peripheral Nerve Evaluation before proceeding to definite implant ***-two(43.8%)patients underwent rechargeable InterStim ***(4.1%)patients needed removal of the *** of the external lead connection was observed in 7(9.6%)patients after the stage I *** explanation for one patient was due to ***(9.6%)patients had other complications like nerve pain,hematoma,infection,lead fracture,and *** mean follow-up was 6.62±3.5 ***-eight(93.2%)patients reported significant improvement of symptoms on

关键词： Fecal incontinence Sacral nerve stimulation InterStim Magnetic resonance imaging Sacral neuromodulation

Sitagliptin,sitagliptin and metformin,or sitagliptin and amitriptyline attenuate streptozotocin-nicotinamide induced diabetic neuropathy in rats

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The Journal of Biomedical Research 2012年第3期26卷 200-210页

作者： Ashish Kumar Sharma Akash Sharma Rita Kumari kunal kishore Divya Sharma Bharthu Parthsarthi Srinivasan Ashok Sharma Santosh Kumar Singh Samir Gaur Vijay Singh Jatav Prashant Sharma Varnika Srivastava Sneha Joshi Megha Joshi Prashant Kumar Dhakad Davender Singh Kanawat Akanksha Mishra Anil Sharma Dharmendra Singh Ravinder Pal Singh Himmat Singh Chawda Rambir Singh Sachin Kumar Raikwar Muneem Kumar Kurmi Pankaj Khatri Ashutosh Agarwal Arshee Munajjam Department of Pharmacology Gyan Vihar School of PharmacySuresh Gyan Vihar UniversityJagatpuraJaipur(Rajasthan)302025India Department of Pharmacology Delhi Institute of Pharmaceutical Sciences&ResearchPushpviharNew Delhi 110017India Department of Pharmacology Kota Collage of PharmacyRIICO Industrial AreaRanpurKota(Rajasthan)Pincode 302025India

Diabetic neuropathies are a family of nerve disorders caused by diabetes. Symptoms of the disease include nerve palsy, mononeuropathy, mononeuropathy multiplex, diabetic amyotrophy, painful polyneuropathy, autonomic neu- ropathy, and thoracoabdominal neuropathy. In this study, type 2 diabetes in rats was induced with nicotinamide- streptozotocin. Drug treatment was initiated on the d 15, with the combination regimen of metformin, pioglitazone and glimipiride or metformin and sitagliptin or sitagliptin, amitriptyline and sitagliptin and led to significantly im- proved glycemic control, increased grip strength and paw jumping response on d 21, 28 and 35 （P 〈 0.001）. Signif- icant increases in blood protein levels and decreases in urinary protein levels were observed in the animals treated with the different regimens on d 21, 28 and 35 （P 〈 0.001）. Combined treatment of streptozotocin and nicotinamide caused marked degeneration of nerve cells, while administration of metformin and sitagliptin showed tissue regen- eration and no body weight gain. In conclusion, treatment with sitagliptin and sitagliptin combined with metformin or amitriptyline results in no body weight gain, but causes an increase in grip strength and pain sensitivity, exhibits neural protection, and reverses the alteration of biochemical parameters in rats with streptozotocin-nicotinamide induced type 2 diabetes.

关键词： diabetic neuropathy nicotinamide-streptozotocin metformin pioglitazone glimipiride sitagliptin amitriptyline