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Autoimmunity Reviews, 2005
Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease histologically charac... more Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease histologically characterized by the presence of intrahepatic and/or extrahepatic biliary duct concentric, obliterative fibrosis, eventually leading to cirrhosis. Approximately 75% of patients with PSC have inflammatory bowel disease. The male predominance of PSC, the lack of a defined, pathogenic autoantigen, and the potential role of the innate immune system suggest that it may be due to dysregulation of immunity rather than a classic autoimmune disease. However, PSC is associated with several classic autoimmune diseases, and the strongest genetic link to PSC identified to date is with the human leukocyte antigen DRB01*03 haplotype. The precise immunopathogenesis of PSC is largely unknown but likely involves activation of the innate immune system by bacterial components delivered to the liver via the portal vein. Induction of adhesion molecules and chemokines leads to the recruitment of intestinal lymphocytes. Bile duct injury results from the sustained inflammation and production of inflammatory cytokines. Biliary strictures may cause further damage as a result of bile stasis and recurrent secondary bacterial cholangitis. Currently, there is no effective therapy for PSC and developing a rational therapeutic strategy demands a better understanding of the disease.
A & A Practice, 2020
CPR = cardiopulmonary resuscitation; CT = computed tomography; Hct = hematocrit; ICU = intensive ... more CPR = cardiopulmonary resuscitation; CT = computed tomography; Hct = hematocrit; ICU = intensive care unit; IVC = inferior vena cava; LUCAS = Lund University Cardiac Assist System; LVOT VTI = left ventricular outflow tract velocity time integral; MCCDs = mechanical chest compression devices; MRI = magnetic resonance imaging; PEA = pulseless electrical activity; ROSC = return of spontaneous circulation CASE DESCRIPTION A 21-year-old man with a background history of depression had a witnessed seizure in a park. A bag of cocaine was found at the scene. The ambulance crew arrived 13 minutes later. The patient was confirmed to be in pulseless electrical activity (PEA) cardiac arrest. A Lund University Cardiac Assist System (LUCAS2; Jolife, Lund, Sweden) was deployed at the scene by a prehospital doctor to perform chest compressions. The patient reached the emergency department 73 minutes after the onset of cardiac arrest, and return of spontaneous circulation (ROSC) occurred 5 minutes after arrival. Apart from one episode of ventricular fibrillation, the rhythm remained PEA throughout. Initial arterial pH was 6.4, and serum lactate was 20 mmol/L. Bedside focused echocardiography demonstrated global severe left ventricle hypokinesia. A norepinephrine infusion was required to maintain adequate systemic perfusion pressure. Suspected seizure activity necessitated intravenous loading with anticonvulsants. A computed tomography (CT) pulmonary angiogram was negative for an arterial filling defect. Pupils were 7 mm, fixed, and dilated. Hemoglobin was 12.1 g/dL (hematocrit [Hct] 35). Urine toxicology was positive for cocaine. The patient was admitted to the intensive care unit (ICU) for post-cardiac arrest care, including targeted temperature management (Figure 1).
Autoimmunity Reviews, 2005
Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease histologically charac... more Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease histologically characterized by the presence of intrahepatic and/or extrahepatic biliary duct concentric, obliterative fibrosis, eventually leading to cirrhosis. Approximately 75% of patients with PSC have inflammatory bowel disease. The male predominance of PSC, the lack of a defined, pathogenic autoantigen, and the potential role of the innate immune system suggest that it may be due to dysregulation of immunity rather than a classic autoimmune disease. However, PSC is associated with several classic autoimmune diseases, and the strongest genetic link to PSC identified to date is with the human leukocyte antigen DRB01*03 haplotype. The precise immunopathogenesis of PSC is largely unknown but likely involves activation of the innate immune system by bacterial components delivered to the liver via the portal vein. Induction of adhesion molecules and chemokines leads to the recruitment of intestinal lymphocytes. Bile duct injury results from the sustained inflammation and production of inflammatory cytokines. Biliary strictures may cause further damage as a result of bile stasis and recurrent secondary bacterial cholangitis. Currently, there is no effective therapy for PSC and developing a rational therapeutic strategy demands a better understanding of the disease.
A & A Practice, 2020
CPR = cardiopulmonary resuscitation; CT = computed tomography; Hct = hematocrit; ICU = intensive ... more CPR = cardiopulmonary resuscitation; CT = computed tomography; Hct = hematocrit; ICU = intensive care unit; IVC = inferior vena cava; LUCAS = Lund University Cardiac Assist System; LVOT VTI = left ventricular outflow tract velocity time integral; MCCDs = mechanical chest compression devices; MRI = magnetic resonance imaging; PEA = pulseless electrical activity; ROSC = return of spontaneous circulation CASE DESCRIPTION A 21-year-old man with a background history of depression had a witnessed seizure in a park. A bag of cocaine was found at the scene. The ambulance crew arrived 13 minutes later. The patient was confirmed to be in pulseless electrical activity (PEA) cardiac arrest. A Lund University Cardiac Assist System (LUCAS2; Jolife, Lund, Sweden) was deployed at the scene by a prehospital doctor to perform chest compressions. The patient reached the emergency department 73 minutes after the onset of cardiac arrest, and return of spontaneous circulation (ROSC) occurred 5 minutes after arrival. Apart from one episode of ventricular fibrillation, the rhythm remained PEA throughout. Initial arterial pH was 6.4, and serum lactate was 20 mmol/L. Bedside focused echocardiography demonstrated global severe left ventricle hypokinesia. A norepinephrine infusion was required to maintain adequate systemic perfusion pressure. Suspected seizure activity necessitated intravenous loading with anticonvulsants. A computed tomography (CT) pulmonary angiogram was negative for an arterial filling defect. Pupils were 7 mm, fixed, and dilated. Hemoglobin was 12.1 g/dL (hematocrit [Hct] 35). Urine toxicology was positive for cocaine. The patient was admitted to the intensive care unit (ICU) for post-cardiac arrest care, including targeted temperature management (Figure 1).