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It is indicated in secondary hyperparathyroidism due to renal disease and in parathyroid tumour. Hyperprolactinemia and the amenorrhea-galactorrhea syndrome may occur as adverse effects during treatment with antipsychotic drugs, especially those like haloperidol that strongly antagonize dopamine receptors in the tuberoinfundibular tract. Causes are- (a) Infection, trauma, surgery, emotional stress induce release of corticosteroids and other hyperglycaemic hormones which oppose insulin action. When it is lobular and associated with inflammation of bronchi, it is known as bronchopneumonia. Adverse Drug Effects 1 10 22 37 61 82 Section 2 Drugs Acting on Autonomic Nervous System 7a. When compared to the number of neurons, the number of glial cells is 10 to 15 times greater. Antihypertensive drugs: postural hypotension caused by levodopa is accentuated in patients receiving antihypertensive drugs; reduce their dose if levodopa is started. In hypothalamus, leptin inhibits the feeding center, resulting in loss of appetite and stoppage of food intake. Renal toxicity can be reduced by slow intravenous infusion, maintenance of good hydration, and administration of mannitol to maximize urine flow. Unlike skeletal muscle fibers, the cardiac muscle fibers are involuntary in nature. Respiratory tract Propranolol increases bronchial resistance by blocking dilator 2 receptors. By this method, the substances like sodium, potassium, calcium, hydrogen and chloride are transported across the cell membrane. It is the measure of elastic forces in lungs, which is responsible for collapsing tendency of lungs. While stimulating the whole nerve, all the nerve fibers are activated and produce action potential. Thus, by voltage clamping, it is possible to maintain the constant membrane potential at a desired voltage. Clinical uses-Glucagon is used to treat severe hypoglycemia in diabetics, but its hyperglycemic action requires intact hepatic glycogen stores. Taken by lactating mothers, the amount secreted in milk is sufficient to cause purgation in the suckling infant. All the structures of peripheral speech apparatus function in coordination with respiratory system, with the Chapter 162 t Higher Intellectual Functions 945 for speech. Toxicity and interactions-Rifampin commonly causes light-chain proteinuria and may impair antibody responses. Stagnant Hypoxia Stagnant hypoxia is the hypoxia caused by decreased velocity of blood flow. When the head is turned to one side, the eyes deviate outward or inward in relation to the head. However, ether continues to be used in resource poor remote areas, and description of these stages still serves to define the effects of light and deep anaesthesia. Tox: initial expansion of extracellular fluid volume with resulting hyponatremia, headache, nausea. Which of the following drugs should be included in the management of this patient Fibrin monomer polymerizes with other monomer molecules and form loosely arranged strands of fibrin. Tumor cell resistance mechanisms include decreased drug accumulation, changes in the drug sensitivity or activity of dihydrofolate reductase, and decreased formation of polyglutamates.

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Sensation of vibration or pallesthesia, which is the combination of touch and pressure sensation (Chapter 143) ii. She gave the history of having met a car accident about one year back in which she received head injury. Antibiotics classified as bactericidal include the aminoglycosides, beta-lactams, fluoroquinolones, metronidazole, most antimycobacterial agents, streptogramins, and vancomycin. In most cases of abdominal sepsis, metronidazole would be given by slow intravenous infusion. Erythromycin is widely distributed in the body, enters cells and into abscesses, crosses serous membranes and placenta, but not bloodbrain barrier. However, the reflex is not abolished if the unconditioned reflex is also used in between. Similarly, if statements 2 and 3 are correct and 4 is wrong, the answer must be A, and statement 1 must be correct. These agents are particularly useful in controlling the tachycardia and other cardiac abnormalities of severe thyrotoxicosis. Receptor proteins serve as the receptor sites for hormones and neurotransmitters 6. The most appropriate drug from the following list for reversing myasthenic crisis in this patient is (A) Calcium (B) Neostigmine (C) Pralidoxime (D) Succinylcholine (E) Vecuronium 9. The fluoroquinolones may cause skin rashes, headache, dizziness, insomnia, abnormal liver function tests, phototoxicity, and both tendinitis and tendon rupture. It sends stiff phalangeal processes upward between the hair cells, to form the part of lamina reticularis. Remaining 20% of fibers do not cross to the opposite side but descend down through the anterior white column of the spinal cord. Connective Tissue Reticuloendothelial cells in connective tissues and in serous membranes like pleura, omentum and mesentery are called the fixed macrophages of connective tissue. Diffusion of Carbon Dioxide from Alveoli into Atmospheric Air In atmospheric air, partial pressure of carbon dioxide is very insignificant and is only about 0. Uses of Electromyogram Electromyogram is useful in the diagnosis of neuro muscular diseases such as motor neuron lesions, peripheral nerve injury and myopathies. D (12, 19) Inhibitors of phosphodiesterase, isoform 5, are useful in enhancing erection. Primary Digestive Organs Primary digestive organs are the organs where actual digestion takes place. It causes slow progressive decrease in immune function, resulting in opportunistic infections of various types. Withdrawal syndrome When a physically dependent subject stops drinking, withdrawal syndrome appears within a day. By holding water in the intestine, magnesium hydroxide provides additional bulk and stimulates increased contractions. Physiological Metaplasia Replacement of cells in normal conditions is called physiological metaplasia. She develops acute severe heart failure with marked pulmonary edema, but no evidence of peripheral edema. By receiving information required for production of words from Wernicke area, the Broca area develops the pattern of motor activities required to verbalize the words. Appearance of Heart Sounds in Phonocardiogram In phonocardiogram, the heart sounds are recorded in the following manner. On this area, the sound produced by the closure of aortic valve (second heart sound) is heard well. In a given water sample, this process is referred to as the chlorine demand because the chlorine-binding capacity of the organic material must be exceeded before bacterial killing is accomplished. This patient should be hospitalized for several reasons, including potential difficulties with compliance regarding the drug regimen and the fact that young children are in the home where she is living. When anginal pain is relieved, the remaining part of tablet may be spit or swallowed.

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Clarithromycin can be administered less frequently than erythromycin, but it is not effective in single doses against susceptible organisms. More recently there has been increasing use of zolpidem, zaleplon, and eszopiclone in insomnia, since they have rapid onset with minimal effects on sleep patterns and cause less daytime cognitive impairment than benzodiazepines. In turn, the nuclei send excitatory impulses to thalamus and different nuclei in brainstem. Earlier in pregnancy (and in the nonpregnant uterus) much higher doses of ergot alkaloids are needed to cause contraction. While feeling the pulse, pressure is increased in the cuff by inflating air into it, with the help of a hand pump. Tactile localization (Chapter 143) Chapter 144 t Somatosensory System and Somatomotor System 829 iii. The decrease in end diastolic pressure abolishes the subendocardial crunch by restoring the pressure gradient across ventricular wall due to which subendocardial perfusion occurs during diastole. Fibrinogen secreted from the seminal vesicle is converted into a weak coagulum by the clotting enzymes secreted from prostate gland. At 7th or 8th month of intrauterine life, about 6 million primordial follicles are found in the ovary. Formation of Chyme Peristaltic movements of stomach mix the bolus with gastric juice and convert it into the semisolid material known as chyme. These two qualities are called the reward (satisfaction) and punishment (aversion or avoidance). The sensitivity is higher during pregnancy and there is progressive modest increase with the advance of pregnancy. Drugs that block the activity of dopaminergic pathways include older antipsychotics (eg, chlorpromazine, haloperidol), which may cause parkinsonian symptoms. Both the roots on 804 Section 10 t Nervous System either side leave the spinal cord and pass through the corresponding intervertebral foramina. Absorption of haeme iron is largely independent of other foods simultaneously ingested, but that of inorganic iron is affected by several factors. Other members of this group (eg, citalopram, escitalopram, fluvoxamine, paroxetine, and sertraline) do not form long-acting metabolites. As a result, the more proximal areas supplied by a nerve are affected earlier because axons supplying them are located more peripherally in the nerve than those supplying distal areas. In certain conditions, some of the normal constituents of saliva are excreted in large quantities. Respiratory Burst Respiratory burst is a rapid increase in oxygen consumption during the process of phagocytosis by neutrophils and other phagocytic cells. Indirect-acting sympathomimetics, eg, ephedrine, were once used, but they are now obsolete for this application. A transdermal patch of lidocaine has been produced for application over the affected skin for relief of burning pain due to postherpetic neuralgia. Increased metabolic reactions: Sympathetic centers, which are activated by heat gain center, stimulate secretion of adrenaline and noradrenaline. Neurons of these nuclei receive sensory signals from the cranial nerves, cerebellum and spinal cord. Implicit memory Implicit memory is defined as the memory in which past experience is utilized without conscious awareness. It is particularly valuable in highly susceptible individuals and for vigorous motions. When other sensory receptors are excited, the electrical response is in the form of depolarization (receptor potential). An adult patient is being treated for acute leukemia with a combination of anticancer drugs that includes cyclophosphamide, mercaptopurine, methotrexate, vincristine, and prednisone.

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Nevertheless, they are moderately efficacious diuretics, because nearly 90% of the glomerular filtrate has already been reabsorbed before it reaches their site of action. Amantadine can be used in milder cases, or in short courses to supplement levodopa for advanced cases. However, in the later period, the quantity of estrogen released is much greater than that of progesterone. Hemoglobin M is common in babies affected by blue baby syndrome (a pathological condition in infants, characterized by bluish skin discoloration (cyanosis), caused by congenital heart defect). The plasma protein binding of aminoglycosides is clinically insignificant, though streptomycin is bound to some extent. In anuria (creatinine clearance <5 mL/min), the elimination half-life of drugs that are eliminated by the kidney is markedly increased, usually necessitating major reductions in drug dosage. Invasive and Non-invasive Methods Invasive method refers to a procedure which involves invasion or penetration of healthy tissues, organs or parts of the body, by means of perforation, puncture, incision, injection or catheterization. Fever may be beneficial to body and on many occasions, it plays an important role in helping the body fight the diseases, particularly the infections. Side effects that occur in their use to relieve anxiety are-sedation, light-headedness, psychomotor and cognitive impairment, confusional state (especially in the elderly), increased appetite and weight gain, alterations in sexual function. Normal blood sugar is not affected but diabetes may be precipitated or its control vitiated. Benzodiazepines Midazolam is widely used adjunctively with inhaled anesthetics and intravenous opioids. Urinary antiseptics like nalidixic acid, nitrofurantoin and methenamine mandelate fail to achieve high concentration in urine and are likely to produce systemic toxicity. Course Fibers of this tract run down from medulla into the anterior column of spinal cord along the periphery. Levofloxacin has activity against most organisms associated with community-acquired pneumonia, including chlamydiae, mycoplasma, and legionella species. Mechanism of action: Metoclopramide acts through both dopaminergic and serotonergic receptors. In women and men, hyperprolactinemia and an associated syndrome of infertility and galactorrhea can result from prolactin-secreting adenomas. Termination Fibers of tectospinal tract terminate in the anterior motor neurons of spinal cord, directly or via internuncial neurons. A vasoconstrictor added to a solution of lidocaine for a peripheral nerve block will (A) Decrease the risk of a seizure (B) Increase the duration of anesthetic action of the local anesthetic (C) Both A and B (D) Neither A nor B 9. Elevation or Upward Movement Elevationofeyeballoccursbecauseofthecontraction of superior rectus and inferior oblique muscles. Which drug is least likely to be effective in the treatment of gonorrhea in this patient More rarely, thiamine deficiency, along with alcohol abuse, leads to Wernicke-Korsakoff syndrome, which is characterized by ataxia, confusion, and paralysis of the extraocular muscles. Which of the following drugs is a partial agonist and can cause vasoconstriction in the absence of other drugs It is also called premenstrual stress syndrome, premenstrual stress or premenstrual tension. The increase in intraluminal H+ concentration causes D cells to release somatostatin and thereby inhibit gastrin release from G cells. As analgesic For headache (including mild migraine), backache, myalgia, joint pain, pulled muscle, toothache, neuralgias and dysmenorrhoea; it is effective in low doses (0. Moreover, toxic substances released from hemolyzed cells reduce the arterial blood pressure and develop circulatory shock.

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Fibers of fasciculus gracilis terminate in the nucleus gracilis and the fibers of fasciculus cuneatus terminate in the nucleus cuneatus. Both legs have sustained multiple fractures, the skin and soft tissues have lacerated from which blood is oozing, but there is no active bleeding. In clinical trials it has been found to yield higher smoking abstinence and quitting rates than placebo and equivalent to nicotine replacement. The script of the book is formatted in such a way that it will be suitable not only for medical students, but also for dental students and the students of allied health subjects like Physiotherapy, Occupational Therapy, Pharmacy, Nursing, Speech, Hearing and Language, etc. Synaptic Terminal A thick fiber arising from the cell body passes to outer plexiform layer and ends in a small and enlarged synaptic terminal or body. Reduplication of second heart sound Splitting of second heart sound occurs due to asynchronous closure of semilunar valves. Growth Hormone Growth hormone is essential for the general metabolic processes in testis. It does not interfere with grouping and cross-matching of blood and remains stable for three years. Compared to halothane, it produces relatively rapid induction and recovery, and is administered through a special vaporizer; 1. Epalrestat is an aldose reductase inhibitor developed in Japan which has been found to delay sorbitol accumulation in sciatic nerve/other tissues of diabetics imparting potential to delay progression of diabetic neuropathy. In the emergency department, the electrocardiogram confirmed ventricular arrhythmias. These fibers synapse with motor neurons in anterior gray horn of opposite side (few fibers reach the same side motor neurons) in spinal cord ii. Cough Codeine or its substitutes are widely used for suppressing dry, irritating cough (see Ch. The diuretic action is independent of acid-base balance of the body and it causes little distortion of the same; mild alkalosis occurs at high doses. Surface activity (ability to reach superficial nerves when applied to the surface of mucous membranes) is a property of certain local anesthetics, especially cocaine and benzocaine (both only available as topical forms), lidocaine, and tetracaine. Because it can decrease prolactin levels, melatonin should not be used by nursing mothers. This increases pulmonary vascular pressure leading to leakage of fluid from capillaries into pulmonary interstitium. When sodium is transported by a carrier protein, another substance is also transported by the same protein simultaneously, either in the same direction (of sodium movement) or in the opposite direction. This in turn, increases the rate of transport of sperms in female genital tract during coitus (oxytocin is also responsible for this process). Nausea, vomiting, headache, malaise and anaemia are other frequent dose related side effects. Carbapenems are currently co-drugs of choice for infections caused by Enterobacter, Citrobacter, and Serratia species. Then, iodine (I) combines with tyrosine, which is already present in thyroglobulin. Listeria infections are more common in neonates, elderly patients, and those who have been treated with immunosuppressive agents. The anion gap, lethargy, tachypnea, and hyperthermia all are consistent with aspirin poisoning. Chronic mercury intoxication has been treated with succimer and unithiol, but their efficacy has not been established. Thus, the peptide at the donor site cannot be transferred to its amino acid acceptor. This drug is approved for intravenous administration in acute severe heart failure (see Chapter 13) but has very significant toxicity. Delavirdine causes skin rash in up to 20% of patients, and the drug should be avoided in pregnancy because it is teratogenic in animals. Genital Herpes simplex Generally caused by type-2 virus; can be treated by topical, oral or parenteral acyclovir depending on stage and severity of disease. Heat insulation: Insulation function is due to the presence of adipose tissue beneath the skin (subcutaneous adipose tissue) 3. The receptors for these compounds are thought to be the targets for exogenous cannabinoids present in marijuana.

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This, however, is often transient because the displaced drug will diffuse into the tissues as well as get metabolized or excreted: the new steadystate free drug concentration is only marginally higher unless the displacement extends to tissue binding or there is concurrent inhibition of metabolism and/or excretion. Subclassesofintermediatefilaments Intermediate filaments are divided into five subclasses. Duration of action Pyridostigmine Resembles neostigmine in all respects but is dose to dose less potent and longer acting, less frequent dosing is required in myasthenia gravis. Mercaptoethanesulfonate (mesna) "traps" acrolein released from cyclophosphamide and thus reduces the incidence of hemorrhagic cystitis. On bones Calcitonin stimulates osteoblastic activity and facilitates the deposition of calcium on bones. Plasma Level Plasma level of estrogen in females at normal reproductive age varies during different phases of menstrual cycle. Aminoglycoside antibiotics and antiarrhythmic drugs may potentiate and prolong the relaxant action of neuromuscular blockers to a lesser degree. Facilitation of vegetative functions Descending facilitatory reticular system is the center for facilitation of the autonomic functions such as cardiac function, blood pressure, respiration, gastrointestinal function and body temperature. Choleretics Substances which increase the secretion of bile from liver are known as choleretics. They have been used to delay or postpone labour, arrest threatened abortion and in dysmenorrhoea. Bone marrow Depression of bone marrow results in granulocytopenia, agranulocytosis, thrombocytopenia, aplastic anaemia. However, grossly increased plasma calcium level occurring in hyperparathyroidism overrides the direct action on tubules and calcium excretion in urine is actually increased. This effect of pheromones on the menstrual cycle of other individuals is called dormitory effect. Metronidazole can also be given intravenously and is available in topical formulations. Control Vasoconstrictor area is under the control of hypothalamus and cerebral cortex. Transport from Tubular Cells into the Interstitial Fluid Sodium is pumped outside the cells by sodium potassium pump. Midline nuclei are a group of small nuclei, situated on the medial surface of thalamus near the midline. It is responsible for understanding the auditory information about any word and sending the information to Broca area (Table 162. Clinical use-Mitomycin acts against hypoxic tumor cells and is used in combination regimens for adenocarcinomas of the cervix, stomach, pancreas, and lung. In the distal convoluted tubule, the sodium re absorption is stimulated by the hormone aldosterone secreted by adrenal cortex. In children, hemolyzed sickle cells aggregate and block the blood vessels, leading to infarction (stoppage of blood supply). Fortunately, body is provided with the best regulatory mechanisms to prevent the hazards of acid production. A major clinical use of the opioid antagonists is in the management of acute opioid overdose. Indigestion and hypo chlorhydria (decrease in the amount of hydrochloric acid in gastric juice) also occur. Note the depressant action of quinidine Small cells at the upper margin of A-V node have very low conduction velocity (20 mm/sec). The outer membrane shown in this simplified diagram is present only in gram-negative organisms. However, there are some species like insects which can produce offsprings without mating. Regulation of Actions of Heart All the actions of heart are continuously regulated.

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The principle of measuring pressure depends up on the nonlinear properties of brachial arterial wall, which induce nonconstant oscillations of the cuff pressure during deflation. Role of cerebellum and basal ganglia It is interesting to find that cerebellum and basal ganglia influence the muscle tone without sending direct fibers to motor neurons. Induces development of corpus luteum from the follicle (devoid of ovum) by converting the granulosa cells into lutein cells 2. Consumption of tea, coffee, tobacco, social drinking are regarded habituating, physical dependence is absent. Of the following drugs, which has established clinical uses that include attention deficit hyperkinetic disorder, enuresis, and the management of chronic pain Mild toxicity may often be managed by omitting 1 or 2 doses of digitalis and giving oral or parenteral K+ supplements. Peripheral neuritis and other neurological effects are reported with long-term use. It binds to -tubulin and enhances its polymerization: a mechanism opposite to that of vinca alkaloids. When calcium ions enter the L tubules, calcium content in sarcoplasm decreases leading to the release of calcium ions from the troponin. Serum concentrations of alanine and aspartate aminotransferase are used as markers of hepatocellular toxicity. An osmotic agent is needed to remove water from the cells of the edematous brain and reduce intracranial pressure rapidly. As a result, there is less likelihood of precipitation of uric acid crystals in joints and tissues. Autocatalytic action: Once formed, trypsin itself converts trypsinogen into trypsin. Toxicity-Infusion-related effects of caspofungin include headache, gastrointestinal distress, fever, rash, and flushing (histamine release). Whereas the unwanted substances like metabolic waste products are not reabsorbed and excreted through urine. A number of measures which enhance selectivity of drugs for the tumour need to be utilized. Concentration Gradient or Electrical Gradient of the Substance across the Cell Membrane Rate of diffusion is directly proportional to the concentration gradient or electrical gradient of the diffusing substances across the cell membrane. The sulfonamides in this group may rarely cause typical sulfonamide allergy, eg, rash. Calcium-calmodulin complex activates various enzymes in the cell, which cause the physiological responses. Body righting reflexes acting on the body When the same animal is laid down on the table on its side, with head held down to table, to eliminate labyrinthine and neck righting reflexes, the body attempts to right itself by raising the lower parts. Gentamicin, tobramycin, and amikacin are important drugs for the treatment of serious infections caused by aerobic gram-negative bacteria, including Escherichia coli and Enterobacter, Klebsiella, Proteus, Providencia, Pseudomonas, and Serratia species. Elimination of the drugs require hepatic metabolism, and dosage reduction may be needed in patients with liver dysfunction. Intercalated disks form adherens junctions, which play an important role in the contraction of cardiac muscle as a single unit (Chapter 2). Though rare, a serious toxicity associated with the thioamides is which of the following Postoperative or similar acute but shortlasting pain: ketorolac, a propionic acid derivative, diclofenac or nimesulide. First- and second-generation cephalosporins are not effective in meningitis because they do not readily enter the cerebrospinal fluid. Pheromones Pheromones are a group of chemical substances that are secreted by apocrine glands.

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However, appearance of dyskinesias is related to dose and duration of levodopa therapy. Chapter 47 t Digestion, Absorption and Metabolism of Lipids 293 Sources and the functions of the different types of dietary fats are listed in Table 47. It is also called ventricular gallop or protodiastolic gallop, as it is produced during earlier part of diastole. Anaesthetics with higher lipid solubility (halothane) continue to enter adipose tissue for hours and also leave it slowly. From this, the connective tissue septa called septula testis radiate into testis and bind with tunica albuginea at various points. During some emotional conditions like anxiety lot of air enters the stomach through mouth. The strychnine-sensitive glycine receptor is another ligand-gated ion channel that may function as a target for certain inhaled anesthetics. Venous System Peritubular capillaries and vasa recta drain into the venous system. Antibiotic combinations are also commonly used in the management of infections resulting from S epidermidis and penicillin-resistant pneumococci (eg, vancomycin plus rifampin). Aspirin and clopidogrel help prevent platelet-induced occlusion of coronary stents. By the movement of tongue, the moistened and masticated food is rolled into a bolus. Subject has to respire into a sophisticated transducer, which is connected to the instrument by means of a cable. Sympathetic stimulation of kidney results in renin release which would indirectly affect tubular transport. It is hydrolyzed by tissue kallikrein to form kallidin, which is also known as lysylbradykinin. However, many bacteria resistant to penicillin are also resistant to erythromycin. Asynergia: Lack of coordination between different groups of muscles such as protagonists, antagonists and synergists. Net effect of probenecid is inhibition of penicillin excretion; more sustained blood levels are achieved. He tells you that since he has been on medication he is always thirsty and frequently has to urinate. Some of the fibrils enter the neurilemmal tube of distal end and form axis cylinder 4. This has been found to achieve 92% eradication rate compared to 50% by ampicillin. The toxicities of blockers are the same in patients with arrhythmias as in patients with other conditions (Chapter 10 and Drug Summary Table). When heart starts to fail suddenly, the fluid accumulates in lungs causing pulmonary edema. Larger doses depress vomiting centre directly: emetics should not be tried in morphine poisoning. While passing through cerebellum, climbing fibers of olivocerebellar tract send collaterals to cerebellar nuclei. Analysis of the gastric juice is done for the diagnosis of ulcer and other disorders of stomach. Accordingly, the instrumental conditioned reflexes are of several types, such as: 1. Clinical physiology with updated information in this edition will help the students for their clinical knowledge to a great extent. The release of more amount of oxytocin occurs due to positive feedback (Chapter 66). Effects-Uricosuric drugs inhibit the secretion of a large number of other weak acids (eg, penicillin, methotrexate) in addition to inhibiting the reabsorption of uric acid. Clinical uses include therapy of infections caused by common streptococci, meningococci, gram-positive bacilli, and spirochetes.

References:

• https://cimm-us.org/wp-content/uploads/2016/08/CIMM-LEXICON-3.0_July-2016.pdf
• https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/019537s086lbl.pdf
• http://www.med.or.jp/english/pdf/2003_04/151_155.pdf
• https://residents.neurosurgery.mgh.harvard.edu/pam/MGH_Neurosurgery_Residency_Program_Pamphlet2010.pdf
• https://www.bio-rad.com/webroot/web/pdf/lsr/literature/4000039b.pdf