The influence of liver dysfunction on cyclosporine pharmacokinetics -A comparison between 70 per cent hepatectomy and complete bile duct ligation in dogs-

The influence of experimentally induced hepatic dysfunction on the pharmacokinetics of Cyclosporine A (CsA) was determined in dogs. The pharmacokinetics of oral (PO) and intravenous (IV) CsA were studied before and after 70 per cent hepatectomy or complete bile duct ligation (CBDL). Changes in liver function were monitored by serial measurements of serum bilirubin, and by the maximum removal rate (Rmax) and plasma disappearance rate (ICG-K) of indocyanine green (ICG). Concentrations of CsA in whole blood were measured by HPLC. Seventy per cent hepatectomy caused significant liver dysfunction: the ICG-Rmax decreased by 47.7±7.1 per cent (mean±SD) and the ICG-K decreased by 61.3±9.7 per cent during the first week after hepatectomy. At the same time, the systemic clearance (CLs) of IV-CsA decreased by 43.9±8.2 per cent, the area under the concentration curve (AUC) of IV-CsA increased by 35.4±20.8 per cent and the bioavailability of CsA decreased by 26.4±14.8 per cent. CBDL also induced significant liver dysfunction: the ICG-Rmax decreased by 39.1±12.8 per cent and the ICG-K decreased by 65.6±3.6 per cent in the second week after the operation. During the same period, the AUC of PO-CsA decreased by 69.9±10.7 per cent and the bioavailability of CsA also decreased markedly by 73.9±15.6 per cent. These data indicate that hepatic impairment significantly influences the pharmacokinetics of CsA, not only by the changes in intestinal absorption, but also by those in hepatic, metabolism. Dose adjustment is therefore necessary in the presence of hepatic dysfunction in order to maintain an adequate blood concentration of CsA without causing side effects. © 1989 The Japan Surgical Society

Phenomenological study of 200 and 500 GeV/c proton-proton collisions in emulsion

We propose to expose two stacks of nuclear emulsion to the 200 and 500 GeV/c protons. In these stacks, the following properties are examined: (1) energy dependence of total, elastic, and inelastic cross sections, (2) contribution of diffraction dissociation, (3) energy dependence of mean multiplicity, (4) character of multiplicity distribution, (5) behaviors of backwards particles for which momenta and masses are determined

Inelastic Cross Sections for Proton - Nucleus Collisions at 205-GeV/c in Nuclear Emulsion

A stack of the nuclear emulsion was exposed to the 205 GeV/c proton beam at NAL. By along-the-track scanning of 1060 m, 2963 inelastic proton-nucleus collisions are obtained. The cross section for the inelastic interaction, its mass number dependence and the cross section for the coherent production are studied

A Dentist-Led Oral Care System Can Prevent Stroke-Associated Pneumonia: The Effects of Early Intervention by Dental Team

Kenichiro Ozaki,1,2 Haruka Tohara,2 Mikoto Baba,1 Satoshi Teranaka,1,3 Yosuke Kawai,1,3 Satoru Komatsumoto4,5 1Department of Physical Medicine and Rehabilitation, Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan; 2Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan; 3Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan; 4Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan; 5Fujita Health University, Toyoake, Aichi, JapanCorrespondence: Kenichiro Ozaki, Department of Physical Medicine and Rehabilitation, Ashikaga Red Cross Hospital, 284-1, Yobe-cho, Ashikaga, Tochigi, 326-0843, Japan, Tel +81-284-21-0121, Fax +81-284-21-6810, Email [email protected]: Our facility’s dental team consists of a full-time dentists and dental hygienists who work exclusively in the wards to implement best practices in oral healthcare. We executed the dental care system (DCS) that includes lectures and practical training for nurses conducted by dentists and dental hygienists, the introduction to oral assessment, standardization of oral care procedures, a process for nurses to request the dental team, and early bedside oral screening conducted by the dental team. This study investigated the DCS’s effects on the incidence of stroke-associated pneumonia (SAP).Methods: This single-center retrospective cohort study included 2,771 acute stroke patients who were newly hospitalized between April 1, 2012, and March 31, 2020. The 8-year period was divided into four phases at two-year intervals as follows: Pre (N=632), Post-1 (N=642), Post-2 (N=716), and Post-3 (N=781). Pre was prior to DCS practice. Post-1 was an early introduction to DCS. Post-2 simplified dental team requests from nurses, and Post-3 added bedside oral screening within 72 hours of admission by the dental team. Statistical analysis was performed using the Cochran-Armitage trend test, followed by multivariate logistic regression.Results: A decrease in SAP rates was observed across the four groups (P< 0.0001). Logistic regression analysis revealed a significant difference for respiratory disease (odds ratio 7.74, 95% confidence interval 5.49– 10.90), hypertension (2.28, 1.39– 3.73), cardiac failure (1.72, 1.04– 2.85), and diabetes (1.59, 1.11– 2.26), 3-digit code on the Japan coma scale (3.57, 2.53– 5.05 [reference ≤ 2-digit code]), age ≥ 90 years (2.34, 1.15– 4.77 [reference 18– 59 years]), male (1.86, 1.31– 2.67), and the Post-1 (0.49, 0.31– 0.76 [reference Pre]), Post-2 (0.38, 0.25– 0.61 [reference Pre]), and Post-3 (0.24, 0.15– 0.40 [reference Pre]) periods.Conclusion: The suppression of SAP is effectively achieved through early intervention and education of nurses by dental professionals.Plain Language Summary: Pneumonia is a dangerous disease that kills millions of individuals around the world every year. Stroke patients are susceptible to developing pneumonia because their swallowing reflex is sometimes impaired. This risk may be reduced by maintaining oral hygiene through advanced oral care involving dentists and dental hygienists. For this reason, our acute care hospital has a dental team consisting of a full-time dentists and dental hygienists dedicated to the ward. In 2014, the dental team launched a program for nurses on how to provide oral care to inpatients. Additionally, we have introduced a system that enables nurses to contact the dental team immediately if oral care becomes difficult for nurses due to problems in the patient’s mouth. Furthermore, the dental team began evaluating the oral health of all stroke patients within 72 hours after hospitalization. We studied the changes in the frequency of pneumonia in stroke patients at our hospital before the application of this approach and 6 years after its introduction. The rate of pneumonia decreased steadily during this period. Overall, the pneumonia rates in stroke patients at our hospital reduced by approximately 60%, suggesting that this system is an effective way to prevent pneumonia.Keywords: hospital dental services, hospital dentistry, special care dentistry, oral health management, oral care, acute stroke, stroke-associated pneumonia, team approac

Chemical alteration by tooth bleaching of human salivary proteins that infiltrated subsurface enamel lesions: experimental study with bovine lesion model systems

Salivary macromolecules infiltrate white and brown spot enamel lesions and adsorb onto hydroxyapatite. Calcium-binding salivary proteins such as statherin hinder remineralization of these lesions. We assessed whether bleaching agents can remove salivary components that have infiltrated and bound to experimental subsurface lesions in bovine enamel prepared by immersing specimens in acid and then human saliva. Transversal microradiography showed that such demineralized lesions mimicked incipient carious lesions. Bound proteins to the experimental and untreated control specimens were eluted in a stepwise manner with phosphatebuffered saline, 0.4 M phosphate buffer, and 1 M HCl. SDS-PAGE of dialyzed extracts showed that specific salivary proteins bound to the lesions, while virtually no protein bands were detected if the specimens were bleached. Western blotting showed that even statherin, which was more firmly bound than other proteins, was removed. In-office bleaching agent may be useful in treating enamel lesions for removing proteins bound to these lesions