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Small Airway Disease in Patients with Chronic Obstructive Pulmonary Disease
Singh, Dave The Korean Academy of Tuberculosis and Respiratory 2017 Tuberculosis and Respiratory Diseases Vol.80 No.4
Small airway disease (SAD) has been recognized for many years as a central feature of chronic obstructive pulmonary disease (COPD). Histopathology studies have shown that the narrowing and destruction of small airways in COPD combined with inflammatory cell infiltration in the submucosa increases the severity of the disease. SAD is present in the early stages of COPD and becomes more widespread over time as the disease progresses to more severe COPD. The development of inhalers containing extra-fine particles allows the small airways to be pharmacologically targeted. Recent clinical trials have shown the efficacy of extra-fine triple therapy that targets the small airways in patients with COPD. This article reviews the importance and treatment of SAD in COPD.
Small Airway Disease in Patients with Chronic Obstructive Pulmonary Disease
( Dave Singh ) 대한결핵 및 호흡기학회 2017 Tuberculosis and Respiratory Diseases Vol.80 No.4
Small airway disease (SAD) has been recognized for many years as a central feature of chronic obstructive pulmonary disease (COPD). Histopathology studies have shown that the narrowing and destruction of small airways in COPD combined with inflammatory cell infiltration in the submucosa increases the severity of the disease. SAD is present in the early stages of COPD and becomes more widespread over time as the disease progresses to more severe COPD. The development of inhalers containing extra-fine particles allows the small airways to be pharmacologically targeted. Recent clinical trials have shown the efficacy of extra-fine triple therapy that targets the small airways in patients with COPD. This article reviews the importance and treatment of SAD in COPD.
ICS use and blood eosinophils in COPD; precision medicine
( Dave Singh ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-
Inhaled corticosteroids (ICS) prevent exacerbations in COPD patients, and are commonly prescribed in combination with long acting bronchodilators. However, the clinical benefits of ICS varies between patients, and these drugs can cause adverse effects including pneumonia and osteoporosis. Blood eosinophil counts are a biomarker that can be used to identify COPD patients with a greater probability of gaining benefit from ICS use. The evidence for blood eosinophil counts in this context comes from a number of retrospective and prospective analysis of randomised controlled trials in COPD patients with a history of exacerbations. The use of clinical characteristics plus biomarker information allows a precision medicine approach to exacerbation prevention in COPD.
( Dave Singh ) 대한결핵 및 호흡기학회 2020 Tuberculosis and Respiratory Diseases Vol.83 No.3
Blood eosinophil counts have emerged as a chronic obstructive pulmonary disease (COPD) biomarker that predict the effects of inhaled corticosteroids (ICS) in clinical practice. Post-hoc and prospective analysis of randomized control trials have shown that higher blood eosinophil counts at the start of the study predict a greater response to ICS. COPD patients with frequent exacerbations (2 or more moderate exacerbations/yr) or a history of hospitalization have a greater response to ICS. Ex-smokers also appear to have a greater ICS response. Blood eosinophil counts can be combined with clinical information such as exacerbation history and smoking status to enable a precision medicine approach to the use of ICS. Higher blood eosinophil counts are associated with increased eosinophilic lung inflammation, and other biological features that may contribute to the increased ICS response observed. Emerging data indicates that lower blood eosinophil counts are associated with an increased risk of bacterial infection, suggesting complex relationships between eosinophils, ICS response, and the airway microbiome.
Novel inhaled triple therapy in COPD
( Dave Singh ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-
Triple therapy is the combination of an inhaled corticosteroid (ICS) with long acting beta agonist and long acting muscarinic antagonist; this is most conveniently administered using a single inhaler. The single inhaler triple combination containing beclometasone dipropionate, formoterol fumarate and glycopyrronium has been evaluated in three large clinical trials, which have consistently shown clinical benefits versus double combinations and long acting bronchodilator monotherapy. Importantly, triple therapy reduces exacerbation rates in COPD patients with a history of exacerbations despite previous treatment with double combinations inhalers or long acting bronchodilator monotherapy. This triple combination has an extra-fine formulation, allowing an increased fraction to be delivered to the small airways. This allows a reduction of the ICS dose, which limits the potential for ICS related adverse effects. This novel inhaled triple therapy provides a treatment option for COPD patients with a high symptom burden and exacerbations.
Singh, Rashmi R.,Tipre, Devayani R.,Dave, Shailesh R. Techno-Press 2014 Advances in environmental research Vol.3 No.4
Iron precipitating organisms play a significant role in the formation of ferric hydroxide precipitate, which acts as strong adsorbent for toxic metal. In this respect four different iron precipitating cultures were isolated from Hutti gold mine surface winze water sample on citrate agar medium. The best isolate was screened out for metal removal study on the basis of fast visual iron precipitation. The selected isolate was identified as Enterobacter sp. based on routine biochemical tests and Biolog GN microplate results and as Enterobacter cloacae subsp. dissolvens by 16S rRNA gene sequence analysis (GenBank accession number EU429448). Influence of medium composition, medium initial pH, the influence of inoculum size, effect of various media and ferric ammonium citrate concentration were studied on metal removal in shake flask experiments. Under the optimized conditions studied, E. cloacae showed $94{\pm}2$, $95{\pm}2$ and $70{\pm}2%$ of cadmium, copper and mercury removal from a simulated waste in shake flask studies. In lab scale column reactor more than 85% of copper and mercury removal was achieved.
Dave Heema Bharatkumar,Dheerendra Singh,Hari Om Bansal 전력전자학회 2019 JOURNAL OF POWER ELECTRONICS Vol.19 No.6
This paper proposes two modified Z-source inverter topologies, namely an embedded L-Z-source inverter (EL-ZSI) and a coupled inductor L-Z source inverter (CL-ZSI). The proposed topologies offer a high voltage gain with a reduced passive component count and reduction in source current ripple when compared to conventional ZSI topologies. Additionally, they prevent overshoot in the dc-link voltage by suppressing heavy inrush currents. This feature reduces the transition time to reach the peak value of the dc-link voltage, and reduces the risk of component failure and overrating due to the inrush current. EL-ZSI and CL-ZSI possess all of the inherent advantages of the conventional L-ZSI topology while eliminating its drawbacks. To verify the effectiveness of the proposed topologies, MATLAB/Simulink models and scaled down laboratory prototypes were constructed. Experiments were performed at a low shoot through duty ratio of 0.1 and a modulation index as high as 0.9 to obtain a peak dc-link voltage of 53 V. This paper demonstrates the superiority of the proposed topologies over conventional ZSI topologies through a detailed comparative analysis. Moreover, experimental results verify that the proposed topologies would be advantageous for renewable energy source applications since they provide voltage gain enhancement, inrush current, dc-link voltage overshoot suppression and a reduction of the peak to peak source current ripple.