The COVID-19 pandemic has been declared a public health emergency of international concern; this has caused excessive anxiety among health care workers. In addition, publication bias and low-quality publications have become widespread, which can result in the dissemination of unreliable findings.
Cancer cells alter their nutrition metabolism to cope the stressful environment. One important metabolism adjustment is that cancer cells activate glutaminolysis in response to the reduced carbon from glucose entering into the TCA cycle due to inactivation of several enzymes in glycolysis. An important question is how the cancer cells coordinate the changes of glycolysis and glutaminolysis. In this report, we demonstrate that the pyruvate kinase inactive dimer PKM2 facilitates activation of glutaminolysis. Our experiments show that growth stimulations promote PKM2 dimer. The dimer PKM2 plays a role in regulation of glutaminolysis by upregulation of mitochondrial glutaminase I (GLS-1). PKM2 dimer regulates the GLS-1 expression by controlling internal ribosome entry site (IRES)-dependent c-myc translation. Growth stimulations promote PKM2 interacting with c-myc IRES-RNA, thus facilitating c-myc IRES-dependent translation. Our study reveals an important linker that coordinates the metabolism adjustment in cancer cells.
Nonalcoholic fatty liver disease (NAFLD) is the most common form of liver disease in the United States, affecting up to 30% of adults. There are two forms of NAFLD: nonalcoholic fatty liver (NAFL), defined as 5% or greater hepatic steatosis without hepatocellular injury or fibrosis, and nonalcoholic steatohepatitis (NASH), defined as 5% or greater hepatic steatosis plus hepatocellular injury and inflammation, with or without fibrosis. Individuals with obesity are at highest risk of NAFLD. Other established risk factors include metabolic syndrome and type 2 diabetes mellitus. Although NAFLD is common and typically asymptomatic, screening is not currently recommended, even in high-risk patients. NAFLD should be suspected in patients with elevated liver enzymes or hepatic steatosis on abdominal imaging that are found incidentally. Once other causes, such as excessive alcohol use and hepatotoxic medications, are excluded in these patients, risk scores or elastography tests can be used to identify those who are likely to have fibrosis that will progress to cirrhosis. Liver biopsy should be considered for patients at increased risk of fibrosis and when other liver disorders cannot be excluded with noninvasive tests. Weight loss through diet and exercise is the primary treatment for NAFLD. Other treatments, such as bariatric surgery, vitamin E supplements, and pharmacologic therapy with thiazolidinediones or glucagon-like peptide-1 analogues, have shown potential benefit; however, data are limited, and these therapies are not considered routine treatments. NAFL typically follows an indolent course, whereas patients with NASH are at higher risk of death from cardiovascular disease, cancer, and end-stage liver disease.
Drugs are being prescribed with more frequency and in higher quantities. A serious adverse drug event from prescribed medications constitutes 2.4% to 16.2% of all hospital admissions. Many of the adverse drug events present intraorally or periorally in isolation or as a clinical symptom of a systemic effect. Clinical recognition and treatment of adverse drug events are important to increase patient adherence, manage drug therapy, or detect early signs of potentially serious outcomes. Oral manifestations of commonly prescribed medications include gingival enlargement, oral hyperpigmentation, oral hypersensitivity reaction, medication-related osteonecrosis, xerostomia, and other oral or perioral conditions. To prevent dose-dependent adverse drug reactions, physicians should prescribe medications judiciously using the lowest effective dose with minimal duration. Alternatively, for oral hypersensitivity reactions that are not dose dependent, quick recognition of clinical symptoms associated with time-dependent drug onset can allow for immediate discontinuation of the medication without discontinuation of other medications. Physicians can manage oral adverse drug events in the office through oral hygiene instructions for gingival enlargement, medication discontinuation for oral pigmentation, and prescription of higher fluoride toothpastes for xerostomia.
Restoring partial flow of oxygenated blood is a fundamental goal of cardiopulmonary resuscitation. The ideal devices used for this purpose should have features such as low incidence of complications, high survival rate, rapid control of the airway, and adequate ventilation. Besides limiting the frequency and duration of interruptions in chest compressions, they can improve the survival and clinical outcomes of return of spontaneous circulation during cardiopulmonary resuscitation. The overall rates of survival from out-of-hospital cardiac arrest have improved dramatically in recent years. However, optimal airway management during out-of-hospital cardiac arrest is a controversial issue. The proposed standard of care, i.e. endotracheal intubation, may have paradoxical adverse effects on intended outcomes by interrupting cardiopulmonary resuscitation and by reduction of coronary and cerebral perfusion pressure during resuscitation. The aim of this narrative review is to provide health care providers with an overview of relevant studies in the area, with a focus on alternative advanced airway techniques.
Perioperative and oncologic outcomes of open radical nephrectomy and inferior vena cava thrombectomy with liver mobilization and Pringle maneuver for Mayo III level tumor thrombus: single institution experience
- Minerva urologica e nefrologica = The Italian journal of urology and nephrology
- Published 4 days ago
Scarce data are available regarding the technique and outcomes for patients with RCC and Mayo III caval thrombi. To report surgical and oncological outcomes of RCC patients with Mayo III thrombi treated with radical nephrectomy and thrombectomy after liver mobilization (LM) and Pringle Manoeuvre (PM).
Solid-state lithium batteries can improve the safety and energy density of the present liquid-electrolyte-based lithium-ion batteries. To achieve this goal, both solid electrolyte and lithium anode technology are the keys. Lithium garnet is a promising electrolyte to enable the next generation solid-state lithium batteries due to its high ionic conductivity, good chemical, and electrochemical stability, and easiness to scale up. It is relatively stable against Li metal but the poor contact area and the presence of resistive impurity or decomposition layers at the interface interfere with fast charge transfer, thereby, spiking the interfacial resistance, overpotential, local current density, and the propensity for dendrite growth. In this Review, we first summarize the recent understanding of the interfacial problems at the Li/garnet interface from both computational and experimental viewpoints while seizing the opportunity to shed light on the chemical/electrochemical stability of garnet against Li metal anode. Also, we highlight various interface optimization strategies that have been demonstrated to be effective in improving the interface performance. We conclude this Review with a few suggestions as guides for future work.
At 2:00 h on Oct 31, 1920, Frederick G Banting, a surgeon practising in London, ON, Canada, conceived an idea to isolate the internal secretion of the pancreas. The following week, he met with noted scientist John J R Macleod in Toronto, ON, Canada, and they developed a research plan. By August, 1921, Banting and his student assistant Charles H Best had prepared an effective extract from a canine pancreas. In January, 1922, biochemist James B Collip isolated insulin that was sufficiently pure for human use. On Oct 25, 1923, Banting and Macleod received the Nobel Prize in Physiology or Medicine for the discovery of insulin. Here, we recount the most relevant events before and after the fateful early morning of Oct 31, 1920, which culminated in the discovery and clinical use of insulin.
Identification of the appropriate pressure injury (PI) risk factors is the first step in successful PI prevention. Measuring PI risk through formalized PI risk assessment is an essential component of any PI prevention program. Major PI risk factors identified in the empirical literature in the critical care population include age, diabetes, hypotension, mobility, prolonged intensive care unit admission, mechanical ventilation and vasopressor administration. Future risk assessment using sophisticated data analytics available in the electronic medical record may result in earlier, targeted PI prevention and will improve our understanding of risk factors that may contribute to unavoidable PIs.
Pressure injuries are areas of damage to the skin and underlying tissue caused by pressure or pressure in combination with shear. Pressure injury prevention in the critical care population necessitates risk assessment, selection of appropriate preventive interventions, and ongoing assessment to determine the adequacy of the preventive interventions. Best practices in preventive interventions among critical care patients, including skin and tissue assessment, skin care, repositioning, nutrition, support surfaces, and early mobilization, are described. Unique considerations in special populations including older adults and individuals with obesity are also addressed.