- Clinical and Prognostic Associations of Liver Volume determined by Computed Tomography in Acute Liver Failure. [Journal Article]
- LILiver Int 2018 Feb 20
- CONCLUSIONS: In patients with ALF/ALI LV shows marked variation by the cause of disease, and in prognostic importance. In indeterminate and DILI cases, loss of volume to <1000 cm3may indicate irreversible liver injury and regenerative failure and serve as an early clinical predictor of the development of high grade encephalopathy and death. This article is protected by copyright. All rights reserved.
- Construction of a liver sinusoid based on the laminar flow on chip and self-assembly of endothelial cells. [Journal Article]
- BBiofabrication 2018 Feb 20; 10(2):025010
- The liver is one of the main metabolic organs, and nearly all ingested drugs will be metabolized by the liver. Only a small fraction of drugs are able to come onto the market during drug development,...
The liver is one of the main metabolic organs, and nearly all ingested drugs will be metabolized by the liver. Only a small fraction of drugs are able to come onto the market during drug development, and hepatic toxicity is a major cause for drug failure. Since drug development is costly in both time and materials, an in vitro liver model that can accelerate bioreactions in the liver and reduce drug consumption is imperative in the pharmaceutical industry. The liver on a chip is an ideal alternative for its controllable environment and tiny size, which means constructing a more biomimetic model, reducing material consumption as well as promoting drug diffusion and reaction. In this study, taking advantage of the laminar flow on chips and using natural degradable gel rat tail Collagen-I, we constructed a liver sinusoid on a chip. By synchronously injecting two kinds of cell-laden collagen, HepG2-laden collagen and HUVEC-laden collagen, we formed two collagen layers with a clear borderline. By controlling the HUVEC density and injection of growth factors, HUVECs in collagen formed a monolayer through self-assembly. Thus, a liver sinusoid on a chip was achieved in a more biomimetic environment with a more controllable and uniform distribution of discrete HUVECs. Viability, album secretion and urea synthesis of the live sinusoid on a chip were analysed on days 3, 5 and 7 after collagen injection with acetaminophen treatment at 0 (control), 10 and 20 mM. The results indicated that our liver sinusoid on a chip was able to maintain bioactivity and function for at least 7 d and was beneficial for hepatotoxic drug screening.
- Evidence the U.S. autism epidemic initiated by acetaminophen (Tylenol) is aggravated by oral antibiotic amoxicillin/clavulanate (Augmentin) and now exponentially by herbicide glyphosate (Roundup). [Journal Article]
- CNClin Nutr ESPEN 2018; 23:171-183
- Because certain hereditary diseases show autistic behavior, and autism often runs in families, researchers seek genes underlying the pathophysiology of autism, thus core behaviors. Other researchers ...
Because certain hereditary diseases show autistic behavior, and autism often runs in families, researchers seek genes underlying the pathophysiology of autism, thus core behaviors. Other researchers argue environmental factors are decisive, citing compelling evidence of an autism epidemic in the United States beginning about 1980. Recognition that environmental factors influence gene expression led to synthesis of these views - an 'epigenetic epidemic' provoked by pervasive environmental agents altering expression of vulnerable genes, inducing characteristic autistic biochemistries in many mothers and infants. Two toxins most implicated in the U.S. autism epidemic are analgesic/antipyretic acetaminophen (Tylenol) and oral antibiotic amoxicillin/clavulanate (Augmentin). Recently herbicide glyphosate (Roundup) was exponentially implicated. What do these toxins have in common? Acetaminophen depletes sulfate and glutathione required to detoxify it. Oral antibiotics kill and glyphosate inhibits intestinal bacteria that synthesize methionine (precursor of sulfate and glutathione, and required to methylate DNA), bacteria that synthesize tryptophan (sole precursor of neuroinhibitor serotonin), and bacteria that restrain ammonia-generating anaerobes. Sulfate plus glutathione normally sulfate fetal adrenal androgen dehydroepiandrosterone to DHEAS - major precursor of placental/postnatal estrogens. Glyphosate (and heavy metals) also inhibit aromatase that turns androgens to estrogens. Placental/postnatal estrogens dehydrate/mature brain myelin sheaths, mature corpus callosum and left hemisphere preferentially, dilate brain blood vessels, and elevate brain serotonin and oxytocin. Stress-induced weak androgens and estrogen depletion coherently explain white matter asymmetry and dysconnection in autism, extreme male brain, low brain blood flow, hyperexcitability, social anxiety, and insufficient maternal oxytocin at birth to limit fetal brain chloride/water and mature GABA.
- Opioid Prescribing Patterns among Otolaryngologists. [Journal Article]
- OHOtolaryngol Head Neck Surg 2018 Feb 01; :194599818757959
- Objectives To evaluate national trends in opioid prescribing patterns by otolaryngologists for postoperative pain control after common otolaryngologic procedures. Study Design Cross-sectional; survey...
Objectives To evaluate national trends in opioid prescribing patterns by otolaryngologists for postoperative pain control after common otolaryngologic procedures. Study Design Cross-sectional; survey. Subjects and Methods A survey to determine opioid prescribing patterns for the treatment of postoperative pain following common otolaryngologic procedures was distributed to all members of the American Academy of Otolaryngology-Head and Neck Surgery. Results The most common pain medication prescribed for adults postoperatively was hydrocodone-acetaminophen (73%), followed by oxycodone-acetaminophen (39%). The most common pain medication prescribed postoperatively for children was acetaminophen (67%), followed by nonsteroidal anti-inflammatory drugs (65%). Overall, there was a wide variation in quantity of opioids prescribed for each surgery, ranging from 0 to more than 60 doses. Mean opioid prescriptions were greatest for tonsillectomy (37 tablets) and least for direct laryngoscopy (5.3 tablets). Conclusion This study identifies nationwide variations in opioid prescribing patterns among otolaryngologists. While otolaryngology is a relatively small specialty, we still have an obligation to work with all physicians to help combat the current opioid epidemic. By evaluating nationwide postoperative pain regimens, we are moving closer toward understanding how to reduce the opioid burden.
- The Global Spine Care Initiative: applying evidence-based guidelines on the non-invasive management of back and neck pain to low- and middle-income communities. [Review]
- ESEur Spine J 2018 Feb 19
- CONCLUSIONS: Guidelines developed for high-income settings were adapted to inform a care pathway and model of care for medically underserved areas and low- and middle-income countries by considering factors such as costs and feasibility, in addition to benefits, harms, and the quality of underlying evidence. The selection of recommended conservative treatments must be finalized through discussion with the involved community and based on a biopsychosocial approach. Decision determinants for selecting recommended treatments include costs, availability of interventions, and cultural and patient preferences. These slides can be retrieved under Electronic Supplementary Material.
- Ibuprofen + acetaminophen did not differ from opioids + acetaminophen for reducing acute extremity pain at 2 h. [Journal Article]
- AIMAnn Intern Med 2018 Feb 20; 168(4):JC21
- Combination pharmacotherapy for the treatment of fibromyalgia in adults. [Review]
- CDCochrane Database Syst Rev 2018 Feb 19; 2:CD010585
- CONCLUSIONS: There are few, large, high-quality trials comparing combination pharmacotherapy with monotherapy for fibromyalgia, consequently limiting evidence to support or refute the use of combination pharmacotherapy for fibromyalgia.
- EXTRAHEPATIC TOXICITY OF ACETAMINOPHEN: CRITICAL EVALUATION OF THE EVIDENCE AND PROPOSED MECHANISMS. [Journal Article]
- JCJ Clin Transl Res 2018 Jan 15; 3(3)
- Research on acetaminophen (APAP) toxicity over the last several decades has focused on the pathophysiology of liver injury, but increasing attention is being paid to other known and possible adverse ...
Research on acetaminophen (APAP) toxicity over the last several decades has focused on the pathophysiology of liver injury, but increasing attention is being paid to other known and possible adverse effects. It has been known for decades that APAP causes acute kidney injury, but confusion exists regarding prevalence, and the mechanisms have not been well investigated. More recently, a number of experimental, clinical and epidemiological studies have reported evidence for pulmonary, endocrine, neurological and neurodevelopmental toxicity, but the quality of evidence from those studies varies. It is important to consider these data due to implications for regulation and clinical practice. Here, we review the evidence and proposed mechanisms for extrahepatic adverse effects of APAP and weigh weaknesses and strengths in the data. We consider results from clinical, epidemiological and experimental research. Our goal is to determine the strength of claims regarding extrahepatic toxicity of APAP and to identify areas of need for future research. It is especially important to view claims of developmental effects of antenatal APAP exposure with a critical eye because APAP is currently the only over-the-counter medication recommended for pregnant women to self-treat pain and fever.
- Japanese traditional herbal medicine reduces use of pregabalin and opioids for pain in patients with lumbar spinal canal stenosis: a retrospective cohort study. [Journal Article]
- JCJA Clin Rep 2017; 3(1):60
- CONCLUSIONS: Kampo led to discontinuation of opioid use for pain in patients with LSCS, and patients who were treated with Kampo were more likely to continue treatment.
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- Anesthetic management of a patient with narcolepsy by combination of total intravenous and regional anesthesia: a case report. [Journal Article]
- JCJA Clin Rep 2017; 3(1):37
- Narcolepsy is a neurological disease characterized by excessive daytime sleepiness, cataplexy, and/or a sudden loss of muscle tone due to malfunction of the orexinergic system, which may cause delaye...
Narcolepsy is a neurological disease characterized by excessive daytime sleepiness, cataplexy, and/or a sudden loss of muscle tone due to malfunction of the orexinergic system, which may cause delayed emergence from general anesthesia. We report a successful anesthetic management of 24-year-old female narcoleptic patient undergoing left anterior cruciate ligament reconstruction. Anesthesia was induced and maintained with total intravenous anesthesia (TIVA) using propofol and remifentanil. Ultrasound-guided left femoral nerve block was also performed with 0.375% ropivacaine 20 ml. Acetaminophen 1000 mg was intravenously administered as part of a multimodal analgesia. After the surgery, the trachea was extubated 9 min after termination of TIVA, and then, the patient correctly responded to verbal commands. The postoperative course was uneventful without any narcoleptic symptoms.