Perioperative Glycemic Management

Proposals and Goals: 1. We propose creating a standard easy to use and safe protocol for glycemic management for same day/elective surgical patients. 2. Following implementation in same day and elective surgical procedures, we propose expanding the protocol to be effective in urgent and emergent inpatient surgical procedures.https://jdc.jefferson.edu/patientsafetyposters/1068/thumbnail.jp

Central oxytocin and food intake: focus on macronutrient-driven reward

Centrally acting oxytocin (OT) is known to terminate food consumption in response to excessive stomach distension, increase in salt loading, and presence of toxins. Hypothalamic-hindbrain OT pathways facilitate these aspects of OT-induced hypophagia. However, recent discoveries have implicated OT in modifications of feeding via reward circuits: OT has been found to differentially affect consumption of individual macronutrients in choice and no-choice paradigms. In this mini-review, we focus on presenting and interpreting evidence that defines OT as a key component of mechanisms that reduce eating for pleasure and shape macronutrient preferences. We also provide remarks on challenges in integrating the knowledge on physiological and pathophysiological states in which both OT activity and macronutrient preferences are affected

Ambulation protocols leading to decreased postoperative complications and hospital stay

Background: In the postoperative course, patients are routinely encouraged to ambulate as frequently as possible. Typically in the hospital this can become burdensome to the staff and often becomes low priority. Patients are also not aware of the frequency and quality of the ambulation that is sufficient in the postoperative period. At present, patients on the surgical floor who are completely independent and without any devices (eg. Oxygen, nasogastric tubes, chest tubes) are freely able to ambulate at will although there is no reliable way to track this progress. Other patients with devices are limited to waiting for nursing or ancillary staff to assist them with securing the devices that they require in the postoperative period. Ambulation has been positively associated with decreased postoperative complications ranging from bowel function to deep venous thrombosis to pneumonia.https://jdc.jefferson.edu/patientsafetyposters/1065/thumbnail.jp

Theory of mind in youth and emerging adults with chromosome 22q11.2 deletion syndrome, with and without comorbid mood disorder

Mood disorders are some of the most commonly diagnosed psychiatric disorders in childhood and adolescence. Major Depressive Disorder (MDD) and Bipolar Disorder (BPD) have become more widely recognized in children and adolescents in recent years and are especially common in individuals with chromosome 22q11.2 deletion syndrome (22q11.2DS). Disruptions in social functioning are a common feature of mood disorders, including social withdrawal and loss of interest in activities that the individual typically experiences as pleasurable (anhedonia). Studies of individuals with 22q11.2DS also show they experience difficulty with social functioning, as well as social cognition, visuospatial, and executive functioning tasks. Studies of theory of mind (ToM) ability in youth and emerging adults with 22q11.2DS and comorbid mood disorder remain elusive, and a better understanding of whether or not social cognition plays a role in the development of mood disorders may help provide a target area for treatment. This study investigated the social, visuospatial, ToM, and executive functioning abilities of 15 youth and emerging adults with 22q11.2DS who met inclusion criteria for mood disorders and 46 individuals with 22q11.2DS with no mood disorder. These results were compared with the results from 22 unaffected sibling and 26 unaffected community controls. A multiple mediator model examining the contributions of visuospatial, social, ToM, and executive functioning to a diagnosis of mood disorder indicated that social functioning was the only significant mediator. Youth and emerging adults with 22q11.2DS and a comorbid mood disorder did not demonstrate greater deficits in visuospatial, ToM, or executive functioning skills relative to individuals with 22q11.2DS only. However, youth and emerging adults with 22q11.2DS and comorbid mood disorder did show greater social deficits on both the SRS and VABS-II Socialization Index. Correlational analyses demonstrated few significant associations between visuospatial and adaptive functioning, while several significant moderate positive associations were found between executive and adaptive functioning, particularly in the group of individuals with 22q11.2DS and no mood disorder. ToM performance was not significantly associated with adaptive functioning measures. Results confirmed that greater deficits in social functioning were associated with mood disorder diagnosis, and highlight the importance of early social skills intervention for individuals with 22q11.2DS

Standardized Consent Forms for Surgical Procedures: An Intervention to Improve the Resident-led Informed Consent Process

Objectives and Goals: To provide high quality, consistent consent forms for common surgical procedures and improve resident workflow by creating and implementing standardized printed consents for common surgical procedures. These consents will be used by residents consenting patients in the ED or inpatient setting. Consents shall include standardized procedure descriptions, risks and benefits of the procedure, and alternative treatment option descriptions, risks and benefitshttps://jdc.jefferson.edu/patientsafetyposters/1057/thumbnail.jp

Adhesion GPCRs are widely expressed throughout the subsections of the gastrointestinal tract

Background: G protein-coupled receptors (GPCRs) represent one of the largest families of transmembrane receptors and the most common drug target. The Adhesion subfamily is the second largest one of GPCRs and its several members are known to mediate neural development and immune system functioning through cell-cell and cell-matrix interactions. The distribution of these receptors has not been characterized in detail in the gastrointestinal (GI) tract. Here we present the first comprehensive anatomical profiling of mRNA expression of all 30 Adhesion GPCRs in the rat GI tract divided into twelve subsegments. Methods: Using RT-qPCR, we studied the expression of Adhesion GPCRs in the esophagus, the corpus and antrum of the stomach, the proximal and distal parts of the duodenum, ileum, jejunum and colon, and the cecum. Results: We found that twenty-one Adhesion GPCRs (70%) had a widespread (expressed in five or more segments) or ubiquitous (expressed in eleven or more segments) distribution, seven (23%) were restricted to a few segments of the GI tract and two were not expressed in any segment. Most notably, almost all Group III members were ubiquitously expressed, while the restricted expression was characteristic for the majority of group VII members, hinting at more specific/localized roles for some of these receptors. Conclusions: Overall, the distribution of Adhesion GPCRs points to their important role in GI tract functioning and defines them as a potentially crucial target for pharmacological interventions. © 2012 Badiali et al.; licensee BioMed Central Ltd

Plasmodium falciparum glutamate dehydrogenase a is dispensable and not a drug target during erythrocytic development

<p>Background: Plasmodium falciparum contains three genes encoding potential glutamate dehydrogenases. The protein encoded by gdha has previously been biochemically and structurally characterized. It was suggested that it is important for the supply of reducing equivalents during intra-erythrocytic development of Plasmodium and, therefore, a suitable drug target.</p> <p>Methods: The gene encoding the NADP(H)-dependent GDHa has been disrupted by reverse genetics in P. falciparum and the effect on the antioxidant and metabolic capacities of the resulting mutant parasites was investigated.</p> <p>Results: No growth defect under low and elevated oxygen tension, no up-or down-regulation of a number of antioxidant and NADP(H)-generating proteins or mRNAs and no increased levels of GSH were detected in the D10(Delta gdha) parasite lines. Further, the fate of the carbon skeleton of [(13)C] labelled glutamine was assessed by metabolomic studies, revealing no differences in the labelling of a-ketoglutarate and other TCA pathway intermediates between wild type and mutant parasites.</p> <p>Conclusions: First, the data support the conclusion that D10(Delta gdha) parasites are not experiencing enhanced oxidative stress and that GDHa function may not be the provision of NADP(H) for reductive reactions. Second, the results imply that the cytosolic, NADP(H)-dependent GDHa protein is not involved in the oxidative deamination of glutamate but that the protein may play a role in ammonia assimilation as has been described for other NADP(H)dependent GDH from plants and fungi. The lack of an obvious phenotype in the absence of GDHa may point to a regulatory role of the protein providing glutamate (as nitrogen storage molecule) in situations where the parasites experience a limiting supply of carbon sources and, therefore, under in vitro conditions the enzyme is unlikely to be of significant importance. The data imply that the protein is not a suitable target for future drug development against intra-erythrocytic parasite development.</p&gt