Month: July 2022

Peripheral nerve regeneration research by Karim Sarhane 2022? Insulin-like growth factor 1 (IGF-1) is a hormone produced by the body that has the potential to be used as a treatment for nerve injuries. IGF-1 may help heal nerve injuries by decreasing inflammation and buildup of damaging products. Additionally, it may speed up nerve healing and reduce the effects of muscle weakness from the injury. However, a safe, effective, and practical way is needed to get IGF-1 to the injured nerve.

Dr. Karim Sarhane is an MD MSc graduate from the American University of Beirut. Following graduation, he completed a 1-year internship in the Department of Surgery at AUB. He then joined the Reconstructive Transplantation Program of the Department of Plastic and Reconstructive Surgery at Johns Hopkins University for a 2-year research fellowship. He then completed a residency in the Department of Surgery at the University of Toledo (2021). In July 2021, he started his plastic surgery training at Vanderbilt University Medical Center. He is a Diplomate of the American Board of Surgery (2021).

Peripheral nerve injury subjects muscle to prolonged denervation that results in myofiber atrophy with increased proteolysis, decreased contractility, and interstitial fibrosis. As the period of denervation extends, these proteolytic and fibrotic processes continue, thereby decreasing the viability of muscle to accept regenerating axons (Shavlakadze et al., 2005; Tuffaha et al., 2016b). In addition to the deleterious effects of prolonged denervation and fibrosis on muscle, functional recovery is hindered by the failure of regenerating motor nerve fibers to come into contact with the specific motor pathways that guide them back to their original motor endplates (Gordon, 2020). A more thorough description of the biological processes and pathways implicated in denervation-induced muscle atrophy can be found in this recent review article by Ehmsen and Hoke (2020). Following nerve injury, local levels of IGF-1 increase and stimulate axonal sprouting into denervated muscle (Homs et al., 2014). IGF-1 also activates the Akt/mTOR pathway, thereby decreasing atrophy markers including MAFbx and MuRF1 (Bodine et al., 2001; Stitt et al., 2004). Also of note, IGF-1’s propensity for decreasing inflammation via promotion of a pro-regenerative M2 macrophage shift over pro-inflammatory M1 reduces the degree of scarring and fibrosis that could otherwise interfere with the targeting of regenerating motor axons (Labandeira-Garcia et al., 2017; Zhao et al., 2021).

Effects with sustained IGF-1 delivery (Karim Sarhane research) : Functional recovery following peripheral nerve injury is limited by progressive atrophy of denervated muscle and Schwann cells (SCs) that occurs during the long regenerative period prior to end-organ reinnervation. Insulin-like growth factor 1 (IGF-1) is a potent mitogen with well-described trophic and anti-apoptotic effects on neurons, myocytes, and SCs. Achieving sustained, targeted delivery of small protein therapeutics remains a challenge.

Insulin-like growth factor-1 (IGF-1) is a particularly promising candidate for clinical translation because it has the potential to address the need for improved nerve regeneration while simultaneously acting on denervated muscle to limit denervation-induced atrophy. However, like other growth factors, IGF-1 has a short half-life of 5 min, relatively low molecular weight (7.6 kDa), and high water-solubility: all of which present significant obstacles to therapeutic delivery in a clinically practical fashion (Gold et al., 1995; Lee et al., 2003; Wood et al., 2009). Here, we present a comprehensive review of the literature describing the trophic effects of IGF-1 on neurons, myocytes, and SCs. We then critically evaluate the various therapeutic modalities used to upregulate endogenous IGF-1 or deliver exogenous IGF-1 in translational models of PNI, with a special emphasis on emerging bioengineered drug delivery systems. Lastly, we analyze the optimal dosage ranges identified for each mechanism of IGF-1 with the goal of further elucidating a model for future clinical translation.

Patients who sustain peripheral nerve injuries (PNIs) are often left with debilitating sensory and motor loss. Presently, there is a lack of clinically available therapeutics that can be given as an adjunct to surgical repair to enhance the regenerative process. Insulin-like growth factor-1 (IGF-1) represents a promising therapeutic target to meet this need, given its well-described trophic and anti-apoptotic effects on neurons, Schwann cells (SCs), and myocytes. Here, we review the literature regarding the therapeutic potential of IGF-1 in PNI. We appraised the literature for the various approaches of IGF-1 administration with the aim of identifying which are the most promising in offering a pathway toward clinical application. We also sought to determine the optimal reported dosage ranges for the various delivery approaches that have been investigated.

High quality critical care nurse skills advices from Tene Kishan Los Angeles, California? Tene Kishan has a background in health care and public administration. She earned 3 college degrees and has a Bachelor’s of Arts Degree in political science, a Bachelor’s of Science in nursing and a Master’s Degree in public administration. Tene Kishan is Registered Nurse with a background in ICU/Critical Care and owns a non-profit organization that’s provides services and puts on community events for youth in need of housing services in the area of Los Angeles County.

How To Become a Registered Nurse In The ICU? If you’re interested in becoming a registered nurse in the icu, one of the first things to consider is how much education you need. We’ve determined that 48.4% of registered nurse in the icus have a bachelor’s degree. In terms of higher education levels, we found that 6.3% of registered nurse in the icus have master’s degrees. Even though most registered nurse in the icus have a college degree, it’s possible to become one with only a high school degree or GED.

Tene Kishan about ICU nurse careers: What do ICU nurses do? ICU nurses work in challenging and complex fields in their nursing profession. They have the primary duty to provide lifesaving care to patients fighting for their lives. They are highly trained to provide exceptional care for patients who depend on 24/7 nursing care. A patient in ICU is often ventilated, intubated, and can be on several life-saving machines and medications. ICU nurses are at the top of their game and well-versed with all aspects of specialized care to restore their patients’ health and wellness. Some of the specific responsibilities of ICU nurses include: Evaluating and monitoring of patient’s progress and identification of any sudden or subtle changes in the patient’s medical condition. Administering medications intravenously by injection or via gastric tubes.

To deliver highly skilled care, critical care nurses undertake postgraduate study and ongoing training. The Step Competency Framework underpins critical care nurse education; it recognises that, to be able to deliver high-quality care to patients, staff need the knowledge and skills so they can work at the highest level, with standardisation across all critical care units. Step 1 for adult critical care begins when a nurse with no previous experience of the specialty starts working in intensive care medicine. Steps 2 and 3 should be incorporated into academic intensive care programmes.

Duties and Responsibility of ICU nurse: Direct and supervise less-skilled nursing/health care personnel, or supervise a particular unit on one shift to patient’s response and conditions. Treating wounds and providing advanced life support. Assist physicians with procedures such as bronchoscopy, endoscopy, endotracheal intubation, and elective cardioversion. Ensuring that ventilators, monitors, and other types of medical equipment function properly. Ensure that equipment or devices are properly stored after use. Identify malfunctioning equipment or devices. Collaborating with fellow members of the critical care team. Responding to life-saving situations, using nursing standards and protocols for treatment. Read extra details on Tene Kishan.