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Editors' Choice Myocardial Infarction
Cardioprotective effects of autophagy: Eat your heart out, heart failure!

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30 May 2018: Vol. 10, Issue 443, eaau0462 DOI: 10.1126/scitranslmed.aau0462
Gaetano Santulli
Department of Medicine, Albert Einstein College of Medicine, Montefiore University Hospital, New York, NY 10461, USA; Department of Advanced Biomedical Sciences, “Federico II” University of Naples, Naples, 80131, Italy. Email:

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Activation of autophagy improves post-infarction myocardial function in mice.

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Science Translational Medicine

Vol 10, Issue 44330 May 2018

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Cardioprotective effects of autophagy: Eat your heart out, heart failure!

By Gaetano Santulli

Your child's daily care includes:

Some problems you may encounter include:

You will also want to:

Your child needs to see his or her doctor every 3 to 6 months. During these checkups, the doctor will evaluate and adjust your child's treatment. The doctor will do a hemoglobin A1c or similar test (glycosylated hemoglobin or glycohemoglobin ) to check your child's blood sugar control over the previous 2 to 3 months, and a Sam Edelman Womens Francis Ballet Flat Black Suede outlet store sale online fake for sale new styles sale online 8KhFUDnZ

If your child's LDL cholesterol is less than 100 mg/dL (2.60 mmol/L) and there is no family history of high cholesterol, the doctor may do a cholesterol (LDL and HDL) test every 5 years. If your child's blood pressure is consistently high and not reduced with weight control or exercise, the doctor may consider medicine.

When your child has had diabetes for 5 years, the doctor will start yearly screening tests for protein in the urine, which points to diabetic nephropathy . At that same time, your child needs to see an deals for sale discount pick a best Under Armour Womens Charged CoolSwitch True Ink/Ivory cheap very cheap outlet really b9uXzGt
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. If your child is at low risk for vision problems, your doctor may consider doing follow-up exams less often.

If your child does not take enough insulin, has a severe infection or other illness, or becomes severely buy cheap shopping online Plush Business Leather Shoes Brown 43 original cheap online sneakernews cheap price I9YwwteH
, his or her blood sugar level may rise very high and lead to diabetic ketoacidosis . Diabetic ketoacidosis is almost always treated in a hospital, often in the intensive care unit, where caregivers can watch your child closely and give him or her frequent blood tests for glucose and electrolytes . Insulin is given through a vein (intravenous, or IV) to bring blood sugar levels down. Fluids are given through the IV to correct the electrolyte imbalance. Your child may stay in the hospital for a few days until blood sugar levels are back in the target range and electrolytes have normalized.

For some children, using an insulin pump may help keep their blood sugar levels within a target range .

If your child has frequent low blood sugar levels, especially at night ( nocturnal hypoglycemia ), the doctor may suggest a continuous glucose monitor (CGM). A CGM checks and records blood sugar day and night. Most CGMs sound an alarm if blood sugar levels are moving out of target range.

Two major pathways for biosynthesis of IPP/DMAPP have been described ( figure2 a , b ). Most eukaryotes use the classic mevalonate (MVA) pathway for isoprenoid biosynthesis, which is also commonly used among the Archaea. The methylerythritol phosphate (MEP) pathway, in contrast, is widespread among bacteria, including cyanobacteria, and it is also the pathway present in plastids. Among eukaryotes the enzymes of the MEP pathway are only found in plant and algal chloroplasts and non-photosynthetic plastid relics ( figure3 ).


Isoprenoid biosynthesis in eukaryotes. () Reactions required for classic MVA-dependent biosynthesis of IPP and DMAPP. Enzymes listed: 1. thiolase, 2. HMG-CoA synthase, 3. HMGR, 4. mevalonate kinase, 5. mevalonate phosphate dikinase, 6. diphosphomevalonate decarboxykinase, and 7. IPP isomerase. () The MEP pathway for isoprenoid biosynthesis; note how ispH catalyses synthesis of IPP and DMAPP.


Distribution of MVA and MEP pathways in eukaryotes. Putative relationships between taxonomic groups are based on recent, but still equivocal views of eukaryotic evolution ( clearance view outlet enjoy Alan Pinkus Fiona Sandals newest sale online 2014 sale online NjhXN
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There are many reports describing subcellular localization profiles for MVA pathway enzymes in animals, yeast and plants, and while the published data are convincing there are significant (still unresolved) differences between studies in specific systems. For instance, in animal cells the localization of MVA pathway enzymes remains subject to continued debate (e.g. Breitling Krisans 2002 ; Hogenboom et al . 2004 ; Leivar et al . 2005 ; Kovacs et al . 2007 ). However, despite some uncertainties perhaps the widely accepted consensus is that the initial reactions of the MVA pathway are catalysed in the cytosol, with the involvement of peroxisome-targeted enzymes in some instances. Following synthesis of committed MVA pathway intermediates, the reactions that are then dedicated towards the synthesis of specific MVA pathway products are catalysed in various subcellular compartments ( figure4 a ). The major bulk products of the MVA pathway in many eukaryotes are sterols, and in plants, yeast and animals HMGR is an integral endoplasmic reticulum (ER) membrane protein that exerts either coarse (yeast, plants) or rate-limiting (animals) control of sterol biosynthesis. However, the analysis of complete protist genome sequences suggests that this textbook view of compartmentalization and pathway organization is not necessarily the norm; the use of multiple membrane-spanning domains to target HMGR to the ER may even represent examples of convergent evolution in animals and plants.

Other important issues include:

Childhood and the teen years are a difficult time to be diagnosed with diabetes. Normal developmental changes may interfere with your child following his or her treatment. Vibram Womens KSOw Running Shoe Black view cheap online cheap sale under top quality very cheap sale online sale new 0GDud5RWN
may rebel against treatment or participate in risky behavior, such as using drugs or drinking alcohol.

You play a major role in helping your child become independent in his or her diabetes care. Allow your child to do as much of the care as possible. But give your child the support and guidance he or she needs. Your child will be more successful if your family is physically active and has healthy eating habits.


The same medicines are used to treat adults and children with type 2 diabetes. These medicines increase insulin production, make the body better able to use insulin (decrease insulin resistance ), or slow the intestinal absorption of carbohydrates .

Sometimes a child needs more than one medicine to adequately control diabetes. Two or more medicines taken together may work more effectively than a single medicine. Taking two medicines together also may reduce possible side effects by allowing lower doses of each. But in some cases, taking two medicines can increase the risk of certain side effects, such as low blood sugar ( Kzaara 558EVAMAROON Sneakers Maroon Casual Shoes view buy cheap big discount good selling cheap online L4r8Y

Some children need daily insulin shots-alone or with other medicines. Even if your doctor does not prescribe daily insulin, your child may need to take insulin temporarily when first diagnosed or during illness or surgery. At some point in adulthood, he or she will likely need insulin, because over time the pancreas does not produce enough insulin. Insulin also may be needed during pregnancy and breastfeeding.

If your child has high cholesterol or high blood pressure, medicine for those conditions may be needed. Even blood pressure slightly above normal increases the risk for eye and kidney damage from diabetes.

Medicine choices

Medicines to control blood pressure and cholesterol

Some children may need medicines to lower their blood pressure and cholesterol to reduce the risk for later complications.

What to think about

Metformin is the medicine of choice for children with type 2 diabetes. It usually keeps blood sugar levels within a target range without increasing the likelihood that the child will gain weight. If after 3 to 6 months of treatment with metformin the child's blood sugar levels are not consistently within a target range, other medicine usually is added.

Insulin may be given as a single nighttime dose, as several smaller doses throughout the day, or both. Insulin doses for children with type 2 diabetes are usually high-to overcome the body's resistance to insulin -which may increase the risk for weight gain.


When obesity is severe in older adolescents with type 2 diabetes, gastric bypass or other similar surgery may be considered as a last resort. For more information, see the topic Obesity .

Other Treatment

Children who have type 2 diabetes should not try to lose weight by following a fad diet or by enrolling in a quick-fix weight loss program. Most doctors recommend that children who are overweight eat a healthy diet that provides appropriate calories to prevent further weight gain.

Weight loss is appropriate if your child is overweight and he or she has reached adult height. In some severe cases, weight loss before your child reaches his or her full adult height may be needed.

Complementary medicine

Along with medical treatment, you may wonder if complementary therapies , especially dietary supplements, may help your child. There isn't enough scientific evidence to say that any dietary supplement can prevent or manage type 2 diabetes.

Talk with your doctor about any complementary health practice that you would like your child to try or your child is already using. Your doctor can help you manage your child's health better if he or she knows about all of your child's health practices.

American Diabetes Association (ADA)
National Diabetes Education Program (NDEP) (U.S.)

Related Information


By Healthwise Staff Primary Medical Reviewer John Pope, MD - Pediatrics Kathleen Romito, MD - Family Medicine Adam Husney, MD - Family Medicine Specialist Medical Reviewer Stephen LaFranchi, MD - Pediatrics, Pediatric Endocrinology

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