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  • ||||||||||  lactulose / generics
    Journal, HEOR:  Considerations for the cost-effective management of hepatic encephalopathy. (Pubmed Central) -  Nov 24, 2019   
    Furthermore, the complex dosing schedule and self-titration requirement of lactulose, a first-line agent, can be confusing to a patient...Given the social and financial burden of HE, cost-effective management of HE is crucial. Early prevention is important to minimize the societal and economic costs associated with HE.
  • ||||||||||  lactulose / generics
    Biomarker, Clinical, Journal:  A single alcohol binge impacts on neutrophil function without changes in gut barrier function and gut microbiome composition in healthy volunteers. (Pubmed Central) -  Nov 24, 2019   
    Neutrophil function was studied by flow cytometry; markers of gut permeability and inflammation (lactulose/mannitol/sucrose test, zonulin, calprotectin, diamino-oxidase) were studied with NMR spectroscopy and enzyme-linked immunosorbent assay in urine, stool and serum respectively...A single alcohol binge in young, healthy volunteers transiently impacts on neutrophil function. Although the exact biological consequence of this finding is not clear yet, we believe that this strengthens the importance to avoid any alcohol binge drinking, even in young, otherwise healthy persons.
  • ||||||||||  lactulose / generics
    The effect of dadih to blood ammonia levels of hepatic cirrhosis patients (P4) -  Nov 24, 2019 - Abstract #APDW2019APDW_670;    
    About two thirds of AKI patients had bacterial infection and majority of the patients had evidence of multiple AKI precipitants. Giving dadih to patients with hepatic cirrhosis can help reduce blood ammonia levels.
  • ||||||||||  lactulose / generics
    Journal:  Enhanced Gastrointestinal Passive Paracellular Permeability Contributes to the Obesity-associated Hyperoxaluria. (Pubmed Central) -  Nov 22, 2019   
    Indeed, ob mice have significantly higher fractions of the administered sucrose (1.7-fold), lactulose (4.4-fold), and sucralose (3.1-fold) excreted in the urine, reflecting increased gastric, small intestinal, and colonic paracellular permeability, respectively...Proinflammatory cytokines and oxidative stress, which are elevated in obesity, significantly enhanced paracellular intestinal oxalate absorption in vitro & ex vivo. We conclude that obese mice have significantly higher intestinal oxalate absorption and enhanced gastrointestinal paracellular permeability in vivo, which would likely contribute to the pathogenesis of OAH, since there is a transepithelial oxalate concentration gradient to drive paracellular intestinal oxalate absorption.
  • ||||||||||  lactulose / generics
    Journal:  NMR spectroscopy enables simultaneous quantification of carbohydrates for diagnosis of intestinal and gastric permeability. (Pubmed Central) -  Nov 19, 2019   
    Collected urine samples were diluted in buffer and one- and two-dimensional proton spectra were recorded in order to reveal carbohydrate concentrations in individual urine samples containing mannitol, sucrose and/or lactulose. Overall, this article presents a fast and robust method for simultaneous quantification of different sugars down to low micro-molar concentrations for research studies and can be further extended for clinical studies with automation of the quantification process.
  • ||||||||||  Xifaxan (rifaximin) / Alfa Wassermann, Bausch Health, Norgine, ASKA Pharma
    Enrollment change, Trial withdrawal:  High Volume Plasmapheresis for Refractory Hepatic Encephalopathy in Liver Intensive Care Unit. (clinicaltrials.gov) -  Nov 15, 2019   
    P=N/A,  N=0, Withdrawn, 
    Overall, this article presents a fast and robust method for simultaneous quantification of different sugars down to low micro-molar concentrations for research studies and can be further extended for clinical studies with automation of the quantification process. N=120 ->0 | Recruiting --> Withdrawn
  • ||||||||||  Preclinical, Journal:  The Combination of Bifidobacterium breve and Three Prebiotic Oligosaccharides Modifies Gut Immune and Endocrine Functions in Neonatal MiceWe. (Pubmed Central) -  Nov 10, 2019   
    We previously reported that a combination of 3 oligosaccharides (lactulose, raffinose, and galacto-oligosaccharides; LRG) and Bifidobacterium breve effectively increased B. breve numbers, acetate, and the expression of several immune- and gut hormone-related mRNAs in neonatal mice gut...M-16V + LRG also caused significant changes in expression of large intestinal mRNAs that are consistent with developmental progression, and increased serum concentrations of GLP-1 (207% and 311% higher compared with CON and M-16V, respectively) and GLP-2 (57% and 97% higher compared with CON and M-16V, respectively) at PD14. Neonatal administration of M-16V + LRG alters the gut microbiota and enhances gut immune and endocrine development in suckling mice.
  • ||||||||||  Avastin (bevacizumab) / Roche
    Clinical, Journal:  A Case Altered Consciousness Due to 5-Fluorouracil-Induced Hyperammonemia in a Patient with Recurrent Colorectal Cancer (Pubmed Central) -  Nov 10, 2019   
    Neonatal administration of M-16V + LRG alters the gut microbiota and enhances gut immune and endocrine development in suckling mice. We report a case of altered consciousness related to hyperammonemia due to FOLFIRI plus bevacizumab therapy in a patient with recurrent colorectal cancer and renal dysfunction.A 76-year-old man received third-line chemotherapy for left mediastinal lymph node metastasis.He complained of diarrhea on the evening of the same day, and mental confusion on day 3 of the first FOLFIRI therapy.He had a JCS of Ⅲ(200).The laboratory results revealed a marked hyperammonemia.5 - fluorouracil(5-FU)-induced hyperammonemia was diagnosed and the patient was ventilated and managed with branchedchain amino acid solutions, lactulose, and hemodialysis in the ICU.After hemodialysis, the blood ammonia level reduced to the normal limits, and the symptoms of encephalopathy resolved on the following day.He was discharged home on the 19th day of hospitalization.5 -FU-containing therapy should be carefully administered in patients with renal dysfunction.Herein, we report a case of 5-FU-induced hyperammonemia with literature considerations.
  • ||||||||||  Xifaxan (rifaximin) / Alfa Wassermann, Bausch Health, Norgine
    Review, Journal:  Use Of Quantitative Modelling To Elucidate The Roles Of The Liver, Gut, Kidney, And Muscle In Ammonia Homeostasis And How Lactulose And Rifaximin Alter This Homeostasis. (Pubmed Central) -  Nov 8, 2019   
    Concepts discussed include the following: 1) only about 44 mmol of ammonia/day (4.4% of total production) reaches the peripheral circulation due to the efficient linkage of amino deamination and the urea cycle in hepatic mitochondria; 2) the gut and kidney contribute roughly equally to delivery of this 44 mmol/day to systemic blood; 3) the bulk of gut ammonia production seemingly originates in the small bowel from bacterial deamination of urea by bacteria and mucosal deamination of circulating and ingested glutamine; 4) the apparent production of ammonia in the small bowel markedly exceeds that quantity that enters the portal blood, indicating that ammonia disposal mechanisms in the small bowel play a major role in ammonia homeostasis. With regard to the hyperammonemia of chronic liver disease: 1) shunting of portal blood around the liver, by itself, can account for commonly observed ammonia elevations; 2) severe portal hypertension causes an increased release of ammonia by the kidney; 3) high blood ammonia is associated with an unexplained massive increase in the muscle uptake of ammonia that could play an important role in limiting hyperammonemia; and 4) a major action of lactulose administration may be the enhancement of ammonia uptake by small bowel bacteria, while the mechanism of action of rifaximin is unclear.
  • ||||||||||  ibuprofen / generics
    Biomarker, Journal:  Translational safety biomarkers of colonic barrier integrity in the rat. (Pubmed Central) -  Nov 2, 2019   
    Male Sprague-Dawley rats were dosed intracolonically via the rectum, using sodium caprate or ibuprofen as tool compounds to alter barrier integrity...The most promising permeability markers identified were plasma fluorescein isothiocyanate-dextran 4000 and a lactulose/mannitol/sucralose mixture in urine...However, optimal timing of probe administration and sample collection is important for all markers evaluated. Inclusion of these probe molecules in preclinical toxicity studies might aid in risk assessment and the design of a clinical biomarker plan, as several of these markers have translational potential.
  • ||||||||||  lactulose / generics
    Journal:  Obesity increases the risk of small intestinal bacterial overgrowth (SIBO). (Pubmed Central) -  Oct 31, 2019   
    Thirty consecutive participants referred for SIBO underwent lactulose breath tests (LBTs) and wireless motility capsule (WMC) studies...Obesity was associated with increased odds of developing SIBO (P = .04) in multivariate regression analyses. While obesity was significantly associated with SIBO, our findings suggest that alterations in gut pH, SBTT, and decline in species richness do not account for the obesity-SIBO relationship.
  • ||||||||||  ceftriaxone / Generic Mfg.
    Journal:  L-ornithine L-aspartate in bouts of overt hepatic encephalopathy. (Pubmed Central) -  Oct 30, 2019   
    Serum Tumor Necrosis Factor α, Interleukins, hemogram, liver and renal function tests were performed at day 0 and 5. Primary outcome was mental state grade at day 5 of treatment.
  • ||||||||||  Xifaxan (rifaximin) / Alfa Wassermann, Bausch Health, Norgine
    The Utility of Renal Replacement Therapy in Hepatic Encephalopathy () -  Oct 23, 2019 - Abstract #KIDNEYWEEK2019KIDNEY_WEEK_5700;    
    This case sheds light on the utility of renal replacement therapy in the management of critically ill patients, even those without pre-existing kidney dysfunction or end-organ damage. Further studies are needed to quantify the extent to which renal replacement may benefit these patients.
  • ||||||||||  Xifaxan (rifaximin) / Alfa Wassermann, Bausch Health, Norgine
    A RARE CASE OF HYPERAMMONEMIC ENCEPHALOPATHY FOLLOWING BARIATRIC SURGERY: EXACERBATED BY POSTOPERATIVE MALNUTRITION (Ernest N. Morial Convention Center - Exhibit Hall - Poster Area 4) -  Oct 23, 2019 - Abstract #CHEST2019CHEST_4802;    
    Postoperative malnutrition exaggerates post gastric bypass nutritional complication and could lead to hyperammonemic encephalopathy following bariatric surgery. Clinicians should have a high index of suspicion for this rare complication and evaluate ammonia level.
  • ||||||||||  Xifaxan (rifaximin) / Alfa Wassermann, Bausch Health, Norgine
    Treatment of Refractory Hyperammonemic Coma with CRRT in a Patient with Ureterosigmoidostomy (Exhibit Hall, Walter E. Washington Convention Center) -  Oct 14, 2019 - Abstract #KIDNEYWEEK2019KIDNEY_WEEK_2787;    
    While the use of renal replacement therapy to remove NH3 has been reported, there is no definite guideline.Some reports favor HD over CRRT due to higher clearance.However, when the NH3 is continuously produced at a high rate, CRRT may be more beneficial since it offers fewer interruptions, less rebound, & less rapid fluid shifts which can worsen ICP. This case highlights that CRRT can be an effective bridging strategy in patients with severe hyperammonemic encephalopathy.
  • ||||||||||  Xifaxan (rifaximin) / Alfa Wassermann, Bausch Health, Norgine
    Journal:  Diagnosis and management of hepatic encephalopathy. (Pubmed Central) -  Oct 9, 2019   
    This article describes the practical aspects of diagnosing, classifying and managing HE. It reviews the pharmacological options for the treatment and prophylaxis of overt HE, and explores the evidence base demonstrating that rifaximin reduces the recurrence of overt HE.
  • ||||||||||  lactulose / generics
    Journal:  Dietary Interventions in Liver Cirrhosis. (Pubmed Central) -  Oct 9, 2019   
    Finally, a major finding of this review is the need to improve the quality and quantity of dietary intervention studies for patients with liver cirrhosis, particularly with the use of partial or whole dietary sources. In conclusion, dietary management of cirrhosis is not a one-size fits all approach but should be implemented earlier on in the treatment algorithm to improve the clinical prognosis of cirrhosis.
  • ||||||||||  lactulose / generics
    Journal:  Lactulose: A Simple Sugar in a Complex Encephalopathy. (Pubmed Central) -  Oct 2, 2019   
    The discovery of lactulose, the acid dialysis proof of concept, and the role of Bircher are not well known. This historical vignette reviews the gradual understanding of the complex liver-brain connection, the effective treatment of hepatic stupor with lactulose, and the immediate relevance of lactulose to the practice of consultative neurocritical care.