Induction of trained immunity (innate immune memory) is mediated by activation of immune and metabolic pathways that result in epigenetic rewiring of cellular functional programs. Through ...network-level integration of transcriptomics and metabolomics data, we identify glycolysis, glutaminolysis, and the cholesterol synthesis pathway as indispensable for the induction of trained immunity by β-glucan in monocytes. Accumulation of fumarate, due to glutamine replenishment of the TCA cycle, integrates immune and metabolic circuits to induce monocyte epigenetic reprogramming by inhibiting KDM5 histone demethylases. Furthermore, fumarate itself induced an epigenetic program similar to β-glucan-induced trained immunity. In line with this, inhibition of glutaminolysis and cholesterol synthesis in mice reduced the induction of trained immunity by β-glucan. Identification of the metabolic pathways leading to induction of trained immunity contributes to our understanding of innate immune memory and opens new therapeutic avenues.
The biphasic cuirass ventilation (BCV) device is an alternative respiratory support device for patients with chronic respiratory failure. Considered by some a “forgotten” mode of supportive ...ventilation, the device is portable, lightweight, and easy to operate. Biphasic cuirass ventilation can also be used to rapidly resuscitate patients in acute respiratory distress and requires minimal technical skill to operate. Biphasic cuirass ventilation can be employed by the patient’s caregiver in the home setting, making it a viable alternative to other forms of mechanical ventilation (e.g., BiPAP) for patients enrolled in home hospice or palliative care. The article reviews current knowledge and aims to enhance awareness and encourage further study about cuirass ventilation, particularly with regard to its use in treating patients in the palliative care setting and in the home.
Symptom control may become challenging for terminally ill patients as they near the end of life. Patients often seek hospital admission to address symptoms, such as pain, nausea, vomiting, and ...restlessness. Alternatively, palliative medicine focuses on the control and mitigation of symptoms, while allowing patients to maintain their quality of life, whether in an outpatient or inpatient setting. Hospice care provides, in addition to inpatient care at a hospice facility or in a hospital, the option for patients to receive symptom management at home. This option for symptom control in the outpatient setting is essential to preventing repeated and expensive hospital readmissions. This article discusses the impact of hospice care on hospital readmission rates.
The issues surrounding US competitiveness and Lewis M. Branscomb's proposal for a new national technology policy outlined in his article "Does America Need a Technology Policy" are debated. In the ...proposal, what matters is not creating new technology but absorbing and applying innovations quickly. Instead of concentrating on the supply of new technologies, the US government should stimulate demand for innovative ideas by encouraging collaborative research, investing in technological infrastructure, emphasizing the importance of precompetitive research, and helping companies improve their capacity to adopt innovations to specific business needs. Executive vice president Daniel F. Burton of the Council on Competitiveness agrees that simply generating new technology is not enough and that national security and international competitiveness depend on putting new technology to work in practical applications.
PDF
