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Treating Insomnia in Older Adult Patients: Limiting Benzodiazepine Use

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Pharmacology & Pharmacy 2019年第3期10卷 116-129页

作者： Joseph v. Pergolizzi Jr. robert Taylor Jr. Jo Ann LeQuang Errol Gould robert B. Raffa NEMA Research Inc. Naples FL USA Neumentum Palo Alto CA USA LeQ Medical Angleton TX USA Pernix Therapeutics Morristown NJ USA University of Arizona College of Pharmacy Tucson AZ USA Temple University School of Pharmacy Philadelphia PA USA

As aging comes, an increased prevalence of medical maladies and chronic pain independently or interactively disrupt sleep, which in turn can exacerbate either one. Furthermore, anxiety about pain can further negatively impact sleep. Fortunately, good quality sleep can improve pain management. Because benzodiazepine receptor agonists (including the “Z” drugs) can reduce anxiety and improve sleep, they seem a convenient choice. However, their use in this population, particularly for more than short-term (guidelines range from 2 to 6 weeks max), is not recommended because of increased likelihood of falls, further disruption of sleep, dependence, and problems with discontinuation (withdrawal). Besides, this population is often likely to take concomitant medication for pain or other central nervous system depressants leading to potentially serious and even life-threatening interactions involving synergistic amplification of respiratory depression (opioids being a particularly dangerous interaction). Therefore, insomnia in older adults should ideally be treated with a non-benzodiazepine receptor agonist;if indicated, they may be used, but should be closely monitored and tapered to avoid long-term adverse problems (direct or from withdrawal). Older adult patients with insomnia may be more optimally treated with sleep aids that do not interact with the GABAA receptor.

关键词： Pain Insomnia Older Adults Benzodiazepines “Z”-Drugs GABAA Receptor

Fe_(2)Mo_(3)O_(8) nanoparticles self-assembling 3D mesoporous hollow spheres toward superior lithium storage properties

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Frontiers of Chemical Science and Engineering 2021年第1期15卷 156-163页

作者： Lifeng Zhang Yifei Song Weiping Wu robert Bradley Yue Hu Yi Liu Shouwu Guo School of Materials Science and Engineering Shaanxi University of Science and TechnologyXi’an 710021China Department of Electrical and Electronic Engineering School of MathematicsComputer Science and EngineeringCityUniversity of LondonLondonEC1V 0HBUK Department of Materials University of OxfordOxfordOX13PHUK MatSurf Technology Ltd. The Old Stables Marion LodgeCumbriaCA101NWUK School of Energy Resources University of WyomingLaramieWY 82071USA School of Electronic Information and Electrical Engineering Shanghai Jiao Tong UniversityShanghai 200240China

Unique self-assembled iron(II)molybdenum(Iv)oxide(Fe_(2)Mo_(3)O_(8))mesoporous hollow spheres have been facilely constructed via the bubble-template-assisted hydrothermal synthesis method combined with simple *** compact assembly of small nanoparticles on the surface of the hollow spheres not only provides more active sites for the Fe_(2)Mo_(3)O_(8),but also benefits the stability of the hollow structure,and thus improved the lithium storage properties of *** Fe_(2)Mo_(3)O_(8) mesoporous hollow spheres exhibit high initial discharge and charge capacities of 1189 and 997 mA∙h∙g^(−1) respectively,as well as good long-term cycling stability(866 mA∙h∙g^(−1) over 70 cycles)when used as a lithium-ion battery *** feasible material synthesis strategy will inspire the variation of structural design in other ternary metal molybdates.

关键词： molybdates Fe_(2)Mo_(3)O_(8) hollow spheres lithium ion batteries anodes

How to perform gastrointestinal ultrasound: anatomy and normal findings

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World Journal of Gastroenterology 2017年第38期23卷 6931-6941页

作者： Nathan S S Atkinson robert v Bryant Yi Dong Christian Maaser Torsten Kucharzik Giovanni Maconi Anil K Asthana Michael Blaivas Adrian Goudie Odd Helge Gilja Dieter Nuernberg Dagmar Schreiber-Dietrich Christoph F Dietrich Translational Gastroenterology Unit Oxford University Hospitals NHS Foundation Trust School of Medicine University of Adelaide Department of Gastroenterology and Hepatology Royal Adelaide Hospital Department of Ultrasound Zhongshan Hospital Fudan University Ambulanzzentrum Gastroenterologie Klinikum Lüneburg Department of Gastroenterology Stadtisches Klinikum Luneburg gGmbH Gastrointestinal Unit Department of Biomedical and Clinical Sciences 'L.Sacco' University Hospital Department of Gastroenterology and Hepato-logy The Alfred Hospital Monash University Piedmont Hospital Department of Emergency Medicine Fremantle Hospital and Health Service Emergency Department National Centre for Ultrasound in Gastro- enterology Haukeland University Hospital Department of Clinical Medicine University of Bergen Department of Gastroenterology Brandenburg Medical School Med. Klinik 2 Caritas-Krankenhaus Bad Mergentheim

Gastrointestinal ultrasound is a practical, safe, cheap and reproducible diagnostic tool in inflammatorybowel disease gaining global prominence amongst clinicians. Understanding the embryological processes of the intestinal tract assists in the interpretation of abnormal sonographic findings. In general terms, the examination principally comprises interrogation of the colon, mesentery and small intestine using both lowfrequency and high-frequency probes. Interpretation of findings on GIUS includes assessment of bowel wall thickness, symmetry of this thickness, evidence of transmural changes, assessment of vascularity using Doppler imaging and assessment of other specific features including lymph nodes, mesentery and luminal motility. In addition to B-mode imaging, transperineal ultrasonography, elastography and contrast-enhanced ultrasonography are useful adjuncts. This supplement expands upon these features in more depth.

关键词： Ultrasound Intestinal Inflammatory bowel disease Guidelines Teaching

Efficacy and safety of tenofovir in chronic hepatitis B: Australian real world experience

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World Journal of Hepatology 2017年第1期9卷 48-56页

作者： Grace C Lovett Tin Nguyen David M Iser Jacinta A Holmes robert Chen Barbara Demediuk Gideon Shaw Sally J Bell Paul v Desmond Alexander J Thompson Department of Gastroenterology St Vincent’s Hospital Melbourne Faculty of Medicine University of Melbourne

AIMTo evaluate the long-term treatment outcomes of tenofovir therapy in patients in a real world Australian tertiary care setting. METHODSWe performed a retrospective analysis of treatment outcomes among treatment-naïve and treatment-experienced patients receiving a minimum 3 mo tenofovir therapy through St vincent’s Hospital Melbourne, Australia. We included patients receiving tenofovir [tenofovir disoproxil fumarate (TDF)] monotherapy, as well as patients treated with TDF in combination with a second antiviral agent. Patients were excluded if they demonstrated human immune-deficiency virus/hepatitis C virus/hepatitis delta virus coinfection or were less than 18 years of age. We considered virological and biochemical response, as well as safety outcomes. virological response was determined by measurement of hepatitis B virus (HBv) DNA using sensitive assays; biochemical response was determined via serum liver function tests; histological response was determined from liver biopsy and fibroscan; safety analysis focused on glomerular renal function and bone mineral density. The primary efficacy endpoint was complete virological suppression over time, defined by HBv DNA RESULTSNinety-two patients were identified who fulfilled the enrolment criteria. Median follow-up was 26 mo (range 3-114). Mean age was 46 (24-78) years, 64 (70%) were male and 77 (84%) were of Asian origin. 55 (60%) patients were treatment-naïve and 62 patients (67%) were HBeAg-negative. Complete virological suppression was achieved by 45/65 (71%) patients at 12 mo, 37/46 (80%) at 24 mo and 25/28 (89%) at 36 mo. Partial virological response (HBv DNA 20-2000 IU/mL) was achieved by 89/92 (96.7%) of patients. Multivariate analysis showed a significant relationship between virological suppression at end of follow-up and baseline HBv DNA level (OR = 0.897, 95%CI: 0.833-0.967, P = 0.0046) and HBeAg positive status (OR = 0.373, 95%CI: 0.183-0.762, P = 0.0069). There was no difference in respon

关键词： Tenofovir Hepatitis B virus Australia Real-life virological suppression Chronic hepatitis B

Chiral N-phosphonyl imine chemistry:asymmetric additions of glycine enolate to diphenyl diamine-based phosphonyl imines

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Science China Chemistry 2010年第1期53卷 125-129页

作者： PINDI Suresh KATTAMURI Padmanabha v. Department of Chemistry and Biochemistry Texas Tech University

Diphenyl diamine-based phosphonyl imines attached by the N-isopropyl group in the auxiliary have been synthesized in good yields under convenient reaction *** new chiral N-phosphonyl imines can react with glycine enolate smoothly to give chiral α-β diamino esters in good yields(72%-90%) and up to excellent diastereoselectivity(>99:1 dr).By treatment with HBr,the chiral auxiliary can be readily *** absolute structure has been unambiguously determined by converting a product to a known sample.

关键词： chiral N-phosphonyl imine chiral phosphoramide glycine enolate α-β diamino ester

Hyponatraemia and cirrhosis

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Gastroenterology Report 2014年第1期2卷 21-26页

作者： robert J.Gianotti Andres Cardenas Department of Gastroenterology Beth Israel Deaconess Medical CenterBoston MA GI Unit Institut Clinic de Malalties Digestives i MetaboliquesHospital ClinicUniversity of Barcelona

Hyponatraemia is a common complication of advanced cirrhosis related to an impairment in the renal capacity for eliminating solute-free water,causing a retention of water that is disproportionate to the retention of sodium,thus leading to a reduction in serum sodium concentration and *** main pathogenic factor responsible for hyponatraemia is a non-osmotic hypersecretion of arginine vasopressin(AvP)or antidiuretic hormone from the neurohypophysis,related to circulatory *** in cirrhosis is associated with increased morbidity and *** is also associated with increased morbidity and impaired short-term survival after *** current standard of care based on restricting fluids to 1-1.5 L/day is rarely *** approaches,such as albumin infusion and the use of vaptans—which act by specifically antagonizing the effects of AvP on the v2 receptors located in the kidney tubules—have been evaluated for their role in the management of *** short-term treatment with vaptans is associated with a marked increase in renal solute-free water excretion and improvement of hyponatraemia;however their use in patients with end-stage liver disease is limited by hepatotoxic effects of some of these *** administration of vaptans seems to be effective in maintaining the improvement of serum sodium concentration,but the available information is still limited.

关键词： hyponatraemia cirrhosis end-stage liver disease vaptans

Probability and statistical inference 6th ed.

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Short Review of Ischemia- and Hypoxia-Protective Roles of “Big Potassium” (BK) Channels

2001年

作者： robert v. Hogg, Elliot A. Tanis.

来源：畅想之星图书光盘版（南... 评论

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Journal of Biosciences and Medicines 2021年第6期9卷 150-160页

作者： John F. Peppin Joseph v. Pergolizzi Alexander Kraus robert B. Raffa Marian University College of Osteopathic Medicine Indianapolis USA Pikeville University College of Osteopathic Medicine Pikeville Kentucky USA Enalare Therapeutics Inc. Princeton USA NEMA Research Inc. Naples USA Neumentum Inc. Morristown USA University of Arizona College of Pharmacy Tucson USA Temple University School of Pharmacy Philadelphia USA

There is accumulating evidence that the subfamily of large-conductance potassium (“big”, “BK”) channels are involved in diverse, and perhaps coordinated, protective or counteractive responses to local or generalized ischemia and hypoxia. Although widely distributed, the physiological differences among BK channels which results from posttranslational modification (alternative splicing) and co-assembly with auxiliary modulatory subunits (β1-4 and γ1-4), bestows localized differences in subunit composition, distribution, 2nd-messenger coupling, and pharmacologic properties. Due to the ubiquitous nature of BK channels and the multiplicity of subtypes, they have many potential therapeutic applications in the maintenance of oxygen homeostasis, cerebro- and cardio-protection, and stimulation of respiration in response to drug-induced respiratory depression. BK channels may also offer other potentially broad and underrecognized promising targets for novel pharmaceutical development.

关键词： Big potassium Channels BKCa Ischemia Hypoxia Respiratory Stimulation ENA-001

Utility of current thrombophilia screening in young patients with stroke and TIA

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Stroke & vascular Neurology 2018年第4期3卷 231-236页

作者： vafa Alakbarzade Alice Taylor Marie Scully robert Simister Arvind Chandratheva Hyper-acute Stroke Unit University College London Hospitals NHS Foundation TrustLondonUK Department of Haematology University College London Hospitals NHS Foundation TrustLondonUK

Introduction Approximately 40%of strokes in young adults are *** diagnostic yield of thrombophilia screening remains *** aimed to determine utility of current thrombophilia testing for young patients with stroke and transient ischaemic attack(TIA).Methods We present a retrospective review of all patients with stroke and TIA≤60 years presenting to University College London Hospital stroke unit and daily TIA clinic from 1 January 2015 to 1 August *** clinical records and thrombophilia tests,including factor v Leiden(FvL),prothrombin G20210A mutation(PGM),antiphospholipid antibody(APA),and protein S,C and antithrombin(AT)levels,were *** The mean age of 628 patients with stroke and TIA was 49.1 years(SD 9.2).Thrombophilia testing was performed in 360(57%)patients,including 171 with stroke and 189 with *** tests were found in 50(14%)patients,of whom 24 patients werevL or PGM,and 27(7.5%)had positive APA(anticardiolipin antibody,anti-β2 glycoprotein antibody or lupus anticoagulant).Of 27(7.5%)patients with protein C,S or AT deficiency,10(2.8%)had primary deficiency,presumed hereditary with other secondary causes excluded.9%of patients with protein C,S or AT and 27%with APA were followed by confirmatory *** Thrombophilia testing was positive in only 14%of cases *** mutations and protein C,S or AT abnormalities were found rarely and were very uncommon in patients with ***-up of abnormal results was generally poor for all groups,which further limited the impact of the thrombophilia testing policy.

关键词： patients testing TIA