Alpha-linolenic acid protects against methotrexate-induced nephrotoxicity in mouse kidney cells

OBJECTIVE

Methotrexate (MTX) is a folic acid antagonist used in chronic inflammatory diseases and various cancer treatments. Although the main mechanism of the toxic effect of MTX is not known, it is stated that it causes oxidative stress and inflammation. Alpha-linolenic acid (ALA) protects against oxidative stress, apoptosis, and inflammation. For this reason, we aimed to find out the useful effect of ALA on MTX-induced nephrotoxicity MATERIALS AND METHODS: The mice were divided into 4 groups randomly. The control group was treated with physiological saline solution; the ALA group was treated with ALA (200 mg/kg) by gavage; MTX-treated group received 20 mg/kg i.p. (intraperitoneal) MTX; and MTX+ALA treated group received 20 mg/kg i.p. MTX and ALA 200 mg/kg by gavage. All of the drugs were performed once a day for 9 days.

RESULTS

Alpha-linolenic acid significantly decreased oxidative stress parameters and MTX-induced inflammatory and apoptotic mediators. Furthermore, histopathological examination showed that MTX induced significant edematous damage, and ALA treatment attenuated this damage in renal tissue.

CONCLUSIONS

Our results revealed that ALA may be helpful against MTX-induced nephrotoxicity in mice via its antioxidant and anti-inflammatory properties.

Pursuit of "endpoint diagnoses" as a cognitive forcing strategy to avoid premature diagnostic closure

Premature closure is often described as a significant contributor to diagnostic error. Therefore, developing strategies to mitigate premature closure could reduce diagnostic errors and improve patient care. Here we propose the novel concept of pursuit of an "endpoint diagnosis" as a cognitive forcing strategy (CFS) for avoiding premature diagnostic closure. We define an "endpoint diagnosis" as an underlying causative explanation for a patient's signs, symptoms, and laboratory and radiographic data that exhausts additional relevant diagnostic evaluation. We have observed four contexts in which the error of not pursuing an endpoint diagnosis most often occurs: (1) diagnoses that appear to result in the same treatment regardless of etiology, (2) cases that are particularly complex, (3) clinical scenarios that are vulnerable to systems errors, and (4) situations in which patients' problems are attributed to uncontrolled underlying risk factors or an exacerbation of a known condition. Additionally, we address why we believe endpoint diagnoses are not universally pursued, delineate when this approach might be particularly useful, attempt to reconcile the potential conflict between accepting diagnostic ambiguity in certain instances and pursuing endpoint diagnoses, and outline possible concerns that might arise with using this CFS, including the possibility of lengthy evaluations resulting in overdiagnosis and overtreatment. Our overarching goal is for this CFS to help clinicians in their daily clinical practice as they seek to optimize their diagnostic skill and patient care.

Implementation of a Night-Float Curriculum: Impact on Intern Confidence over Time

OBJECTIVES

Formal nighttime education is becoming increasingly necessary as more internal medicine (IM) residency programs adopt night-float rotations (NFRs); however, the efficacy of an NFR curriculum throughout an academic year and which topics in an NFR curriculum increase trainee confidence are unknown. We implemented a 12-module, self-paced NFR curriculum for 76 postgraduate year-1 residents at an academic IM residency program. We evaluated the impact of this curriculum on postgraduate year-1 residents' clinical confidence, as well as longitudinal efficacy of the curriculum.

METHODS

Night-float interns' (NFIs) clinical confidence regarding specific curricular topics was evaluated overall and during specific timeframes within the academic year. Pre- and post-NFR surveys using Likert scales for each topic were administered to NFIs from June 24, 2020 to March 2, 2021, representing 32 week-long NFR cycles.

RESULTS

NFIs' pre- and postrotation confidence in managing clinical scenarios significantly improved for all 12 topics in the NFR curriculum. The NFR curriculum resulted most significantly in improved confidence during the first 4 months of the academic year, with 11 of 12 curricular topics reaching the threshold for statistical significance. Modules on altered mental status, hypotension, narrow-complex tachyarrhythmias, new fever, and sepsis and antibiotic escalation maintained their efficacy for the longest periods of time.

CONCLUSIONS

It may be especially important to emphasize an NFR curriculum at the beginning of the academic year. IM residency programs also may wish to carefully consider that certain topics may maintain their efficacy throughout the year, whereas other topics should potentially be replaced with more complex modules as the academic year progresses.

The impact of propranolol on apoptosis in cutaneous squamous cell carcinomas

OBJECTIVES

Cutaneous squamous cell carcinoma (cSCC) is a common cancer in Caucasian populations. Treatments registered for high-risk cSCC are still undetermined. Experimental data have demonstrated possibly useful effects of a combined application of beta‑blockers in cancer therapy. The goal of this study was to examine the efficacy of propranolol in the treatment of cSCC and its impact on apoptosis. Thus, we aimed to investigate the apoptotic pathway protein levels and activity in beta‑blocker‑treated cSCC cells.

MATERIALS AND METHODS

The study was performed on human cSCC cancer cell line culture. One of the cSCC cell lines was treated with propranolol, whereas no treatment was given to the other group. Then, the levels of apoptotic pathway proteins were determined by ELISA test in both groups.

RESULTS

The propranolol treatment group exhibited a remarkable difference as compared with the other group. It was found that propranolol treatment enhanced the activity of caspase-3 while the expression of bax, wee1, gadd153, grp78 and AIF decreased bcl-2 which is antiapoptotic protein in cSCC cell lines.

CONCLUSION

Our results suggest that propranolol treatment has anti-cancer properties with an effect on various apoptotic pathways in cSCC. These data are important because propronalol may be involved in future cSCC treatment (Tab. 1, Fig. 3, Ref. 22).

The Nazi Analogy Muddles Our Thinking About Physician Aid-in-Dying in the US

What has become known in bioethics as "the Nazi analogy" likens a change's potential to precipitate moral deterioration to Nazi atrocities of the mid-20th century. This analogy has been applied in physician aid-in-dying (PAD) deliberations by those fearful that a physician's role in enabling a patient's death is too similar to Nazi physicians' roles in systematic murders during the Holocaust. This article suggests the importance of carefully distinguishing between when the Nazi analogy is aptly applied and when its use is limited to urging great caution about abuse or inequity.

Assessment of patients' and caregivers' informational and decisional needs for left ventricular assist device placement: Implications for informed consent and shared decision-making

BACKGROUND

Several organizations have underscored the crucial need for patient-centered decision tools to enhance shared decision-making in advanced heart failure. The purpose of this study was to investigate the decision-making process and informational and decisional needs of patients and their caregivers regarding left ventricular assist device (LVAD) placement.

METHODS

In-depth, structured interviews with LVAD patients, candidates and caregivers (spouse, family members) (n = 45) were conducted. We also administered a Decisional Regret Scale.

RESULTS

Participants reported LVAD decision-making to be quick and reflexive (n = 30), and deferred heavily to clinicians (n = 22). They did not perceive themselves as having a real choice (n = 28). The 2 most prevalent informational domains that participants identified were lifestyle issues (23 items), followed by technical (drive-line, battery) issues (14 items). Participants easily and clearly identified their values: life extension; family; and mobility. Participants reported the need to meet other patients and caregivers before device placement (n = 31), and to have an involved caregiver (n = 28) to synthesize information. Some participants demonstrated a lack of clarity regarding transplant probability: 9 of 15 patients described themselves as on a transplant trajectory, yet 7 of these were destination therapy patients. Finally, we found that decisional regret scores were low (1.307).

CONCLUSIONS

Informed consent and shared-decision making should: (a) help patients offered highly invasive technologies for life-threatening disease get past the initial "anything to avoid thinking about death" reaction and make a more informed decision; (b) clarify transplant status; and (c) focus on lifestyle and technical issues, as patients have the most informational needs in these domains.

A novel surgical method of repair for Stahl's ear: a case report and review of current treatment modalities

Stahl's ear is a congenital malformation of the auricle, which is uncommon in non-Oriental societies. A number of different treatment modalities have been suggested, many of which yield unpredictable results. We review current treatment modalities from the English literature and describe a novel, simple surgical method of repair. First, a helical rim incision is made to expose the abnormal third crus and upper pole of the ear. The third crus is excised as a narrow wedge of cartilage and posterior skin, and the defect is closed primarily. The free third crus cartilage is then grafted onto the scaphal cartilage in an anatomically correct position to form a superior crus. The anterior skin flap is redraped and bolstered over this graft. Only a very small scar on the helical rim remains visible anteriorly.

Granulomatous laryngitis of unknown etiology

A 21-year-old man was admitted for odynophagia and hoarseness of four months duration. He smoked one and a half packs of cigarettes a day and occasionally inhaled marijuana. Indirect laryngoscopy revealed a massive swelling of the entire epiglottis, aryepiglottic folds, and arytenoids. The histopathologic diagnosis of chronic but active nonspecific inflammation was made. Combined antibiotics and steroid therapy gave temporary relief. He was readmitted several months later with progressive shortness of breath, dysphagia, and hoarseness. Biopsy of the epiglottic tissues showed multiple noncaseating epithelioid granulomatous lesions consistent with sarcoidosis. All pertinent laboratory tests failed to establish a definitive diagnosis. The patient eventually underwent supraglottic laryngectomy. He has been symptom-free for 20 months following surgery.

Catheterization of the left cardiac ventricle of the rat

A simple procedure is described of catheterizing the left ventricle of the anaesthetized rat.

The germfree leopard frog (Rana pipiens): preliminary report

Eggs and sperm were aseptically collected from leopard frogs (Rana pipiens) and passed into sterilized flexible film isolators. Egg fertilization was accomplished, and germfree tadpoles were produced. The germfree tadpoles were active and free-swimming for 3 weeks, but only 6.2% survived to 4 weeks of age. None survived after the 4th week.

Change in the mental health field?

An analysis of the current roles of the federally funded community mental health center and the public mental hospital suggests that despite the rhetoric about a community mental health revolution, the mental field has yet to undergo significant change. Ideological, political, economic, and structural barriers-characteristics of the field itself-impede such change outside, inside, and across the centers and hospitals. Recent court decisions on patients' rights, however, have the potential for moving the field into a period where "bold new action" actually can occur.

Dichlorvos effects on estrous cycle onset in the rat

Continuous exposure to dichlorvos (DDVP) vapors from birth in rats caused a statistically significant mean delay of 10 da in the onset of the first estrous cycle. DDVP, BUT NOT ITS PRIMARY METABOLITE (DES-METHYL DDVP), could be readily isolated from blood and ovarian tissue, and occassionally in minute quantities from the kidney and adrenal tissues. DDVP was recovered only once in 40 brain tissue samples examined.

Ketamine-methoxyflurane anaesthesia for the Mongolian gerbil, Meriones unguiculatus

Ketamine hydrochloride alone was an effective analgesic in the Mongolian gerbil. In 28 young adult animals of both sexes (bodyweight 45-68 g) intramuscular injection of 44 mg/kg produced analgesia in about 83 seconds. Deep surgical anaesthesia could be readily achieved in about 12 min from start when methoxyflurane was administered by nasal cone 5 min after ketamine injection, and the surgical level was maintained arbitrarily for about 40 min during part of which laparotomy was performed. Induction of deep anaesthesia was smooth and recovery occurred uneventfully. The combination of ketamine and methoxyflurane allowed effective control of both the depth and duration of anaesthesia. Recovery time was about 77 min. Sex differences generally were slight.