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Supplemental material, Appendix_2 for Performance Assessment of a Multifaceted Unfractionated Heparin Dosing Protocol in Adult Patients on Extracorporeal Membrane Oxygenator by Abdulrazaq Al-Jazairi, Shahad Raslan, Rayd Al-mehizia, Hani Al Dalaty, Edward B. De Vol, Elias Saad, Mosleh Alanazi and Tarek Owaidah in Annals of Pharmacotherapy

Supplemental material, Appendix_1 for Performance Assessment of a Multifaceted Unfractionated Heparin Dosing Protocol in Adult Patients on Extracorporeal Membrane Oxygenator by Abdulrazaq Al-Jazairi, Shahad Raslan, Rayd Al-mehizia, Hani Al Dalaty, Edward B. De Vol, Elias Saad, Mosleh Alanazi and Tarek Owaidah in Annals of Pharmacotherapy

The clinical implication of Lipotoxicity in obesity derives primarily from its potential to progress to insulin resistance, endothelial dysfunction and atherosclerosis. Olive oil rich diet decrease accumulation of triglyceride in the liver, improved postprandial triglyceride levels, improve glucose and GLP-1 response in insulin resistant subjects, and up regulate GLUT-2 expression in the liver. The exact molecular mechanism is unknown but, decreasing NFkB activation, decreasing LDL oxidation and improving insulin resistance by less production of inflammatory cytokines (TNF-a, IL-6) and improvement of kinases JNK-mediated phosphorylation of IRS-1 are the principle mechanisms. The beneficial effect of the Mediterranean diet derived from monounsaturated fatty acids (MUFA), mainly from olive oil. In this review we document lipotoxicity in obesity and the benefit of olive oil.

The clinical implication of Lipotoxicity in obesity derives primarily from its potential to progress to insulin resistance, endothelial dysfunction and atherosclerosis. Olive oil rich diet decrease accumulation of triglyceride in the liver, improved postprandial triglyceride levels, improve glucose and GLP-1 response in insulin resistant subjects, and up regulate GLUT-2 expression in the liver. The exact molecular mechanism is unknown but, decreasing NFkB activation, decreasing LDL oxidation and improving insulin resistance by less production of inflammatory cytokines (TNF-a, IL-6) and improvement of kinases JNK-mediated phosphorylation of IRS-1 are the principle mechanisms. The beneficial effect of the Mediterranean diet derived from monounsaturated fatty acids (MUFA), mainly from olive oil. In this review we document lipotoxicity in obesity and the benefit of olive oil.

Background: Monthly or seasonal changes in the incidence of venous thromboembolism (VTE) were previously reported; however, the mechanism of such variability is not completely understood. Methods: In the present retrospective single-center analysis, consecutive patients with proximal deep vein thrombosis and/or pulmonary embolism (PE) diagnosed between January 2009 and December 2013 were evaluated. Results: The study population included 1496 patients, 48% men, mean age 63 ± 18 years. Most (82%) cases with VTE were provoked and 39% of patients had active cancer. Four months of peak incidence (3, 7, 10 and 11) were compared with 4 months of the lowest incidence (4, 5, 6, and 12), showing a significant difference in VTE numbers (597 vs 405 cases/year, P = 0.001). In all subgroup analyses, including gender, provoked or unprovoked event and presence or absence of cancer, significant differences between the months of peak and lowest incidence remained. Blood urea nitrogen (BUN)–creatinine ratio was significantly higher in all cases in the peak incidence group compared to the lowest incidence group (24 ± 1.5 vs 21 ± 1.6, P = 0.03). In patients with unprovoked VTE (n = 269), levels of BUN and hematocrit were significantly increased in the peak incidence group compared to lowest incidence group (19.5 ± 0.8 mg/dL vs 16 ± 1.1 mg/dL, P = 0.03; 39.2 ± 0.3% vs 37.4 ± 0.5%, P = 0.01, respectively). Conclusions: The current study demonstrates that occurrence of VTE exhibits monthly variation also existing in patients with provoked events and even in those with cancer. Dehydration is suggested as a potential explanation to the month-related variation in incidence of VTE.

Cirrhosis represents the final stage for wide variety of chronic liver diseases, regardless of its etiology, and the development of portal hypertension is responsible for the pathogenesis of most frequent and fatal complications of cirrhosis. It is of most importance to evaluate patients newly diagnosed with cirrhosis for the presence of clinically significant portal hypertension and associated complications, which could expose the patient to fatal conditions such as variceal bleeding. The most accurate method for evaluating the presence and severity of portal hypertension is the measurement of the hepatic venous pressure gradient, which in one hand provides us valuable prognostic information but on the other hand, it represents a problematic technique, because it is invasive, costly and not available in all centers. Several alternative noninvasive techniques have been proposed to assess portal hypertension, including serum biomarkers and imaging techniques. Various serum molecules have been investigated for their ability to predict the presence of portal hypertension, some of which have showed to either correlate with the hepatic venous pressure gradient or predict clinically significant portal hypertension. This chapter will focus on the potential role of multiple serum markers of portal hypertension that could be clinically applicate to predict the presence of clinically significant portal hypertension, to stratify patients with respect to the severity of portal hypertension, to predict lethal complications such as variceal bleeding, and to monitor disease progression or treatment response without exposing patients to the risks of repeated invasive assessment.

Due to the widespread clinical use of imaging modalities such as ultrasonography, computed tomography and magnetic resonance imaging (MRI), previously unsuspected liver masses are increasingly being found in asymptomatic patients. This review discusses the various characteristics of the most common solid liver lesions and recommends a practical approach for diagnostic workup. Likely diagnoses include hepatocellular carcinoma (the most likely; a solid liver lesion in a cirrhotic liver) and hemangioma (generally presenting as a mass in a non-cirrhotic liver). Focal nodular hyperplasia and hepatic adenoma should be ruled out in young women. In 70% of cases, MRI with gadolinium differentiates between these lesions. Fine needle core biopsy or aspiration, or both, might be required in doubtful cases. If uncertainty persists as to the nature of the lesion, surgical resection is recommended. If the patient is known to have a primary malignancy and the lesion was found at tumor staging or follow up, histology is required only when the nature of the liver lesion is doubtful.