Der Autor dankt Anne Gentry, für ihre Unterstützung bei der Erstellung dieses Manuskripts, Randy Wesnitzer, für die Datenerhebung und Analyse der Ausgangssituation Papier intravenöse (IV) Insulin-Protokoll und Devy A. Lee, BSc (Pharm), CMPP für PharmD PharmD ihre Unterstützung bei der Bearbeitung und Verfassen des Manuskripts.

<ol>
	<li>Umpierrez, G. E., Isaacs, S. D., Bazargan, N., You, X., Thaler, L. M., Ktabchi, A. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hyperglycemia:+an+independent+marker+of+in-hospital+mortality+in+patients+with+undiagnosed+diabetes.">Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes.</a> J. Clin. Endocrinol. Metab. 87, 978-982 (2002).</li><li>Bochicchio, G. V., Sung, J., Josh, M. I., Bochicchio, K., Johnson, S. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Persistent+hyperglycemia+is+predictive+of+outcome+in+critically+ill+trauma+patients.">Persistent hyperglycemia is predictive of outcome in critically ill trauma patients.</a> J. Trauma. 58, 921-924 (2005).</li><li>Finfer, S., Delaney, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Tight+glycemic+control+in+critically+ill+adults.">Tight glycemic control in critically ill adults.</a> JAMA. 300, 963-965 (2008).</li><li>American Diabetes Association. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Standards+of+medical+care+in+diabetes-2008.">Standards of medical care in diabetes-2008.</a> Diabetes Care. 31, S12-S54 (2008).</li><li>Moghissi, E. S., Korytkowski, M. T., DiNardo, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=American+Association+of+Clinical+Endocrinologists+and+American+Diabetes+Association+Consensus+statement+on+inpatient+glycemic+control.">American Association of Clinical Endocrinologists and American Diabetes Association Consensus statement on inpatient glycemic control.</a> Endocr. Pract. 15, 1-17 (2009).</li><li>. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+NICE-SUGAR+Study+Investigators.+Intensive+versus+conventional+glucose+control+in+critically+ill+patients.">The NICE-SUGAR Study Investigators. Intensive versus conventional glucose control in critically ill patients.</a> N. Engl. J. Med. 360, 1283-1297 (2009).</li><li>Brunkhorst, F. M., Engel, C., Bloos, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intensive+insulin+therapy+and+pentastarch+resuscitation+in+severe+sepsis.">Intensive insulin therapy and pentastarch resuscitation in severe sepsis.</a> N. Engl. J. Med. 358, 125-139 (2008).</li><li>Griesdale, D. E., de Souza, R. J., van Dam, R. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intensive+insulin+therapy+and+mortality+among+critically+ill+patients:+a+meta-analysis+including+NICE-SUGAR+study+data.">Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data.</a> CMAJ. 180, 821-827 (2009).</li><li>Van den Berghe, G., Wilmer, A., Hermans, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intensive+insulin+therapy+in+the+medical+ICU.">Intensive insulin therapy in the medical ICU.</a> N. Engl. J. Med. 354, 449-461 (2006).</li><li>Trence, D. L., Kelly, J. L., Hirsch, I. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+rationale+and+management+of+hyperglycemia+for+in-patients+with+cardiovascular+disease:+time+for+change.">The rationale and management of hyperglycemia for in-patients with cardiovascular disease: time for change.</a> J. Clin. Endocrinol Metab. 88, 2430-2437 (2003).</li></ol>

Produktion und freien Zugang zu diesem Artikel wird von Hospira, Inc. gesponsert

Diese EndoTool System wurde aufgrund seiner ausgefeilten Algorithmen und Benutzerfreundlichkeit gewählt. Das Programm ist US Food and Drug Administration (FDA)-frei und unterstützt die Institution im Sein Health Insurance Portability and Accountability Act (HIPAA)-konform. Es kann auf die Krankenhaus-und Intranet-Server, ohne dass zusätzliche Hardware geladen werden. Die Software nutzt mathematische Modelle, um einen Patienten-spezifische physiologische Insulin-Dosierung Kurve auf der Eingabe von Patienten-spezifischen Blut-Glukose-Konzentrationen berechnen. Der Grundstein für die IV Insulindosis ist eine komplexe Feedback-Mechanismus auf kontrollierte Mathematik. Die Software verwendet 33 Algorithmen zur Analyse und Interpretation der Patient bisher Glukosewerte-Aufnahme der vier letzten Lesungen - die am besten geeignete IV Insulindosis zu diesem Zeitpunkt zu berechnen. Mit dem Eintritt von jedem nachfolgenden Blutzuckerwert wird die Kurve angepasst, um minimize Extremen in der Blutzuckerspiegel. In ihrer ersten Berechnungen Das System berücksichtigt Faktoren, die Blut-Glukose-Konzentrationen, wie Gegenwart / Abwesenheit von Diabetes oder Anwendung von Corticosteroiden zu beeinträchtigen. Obwohl das CGMS liefert genaue und rechtzeitige Dosierung und bewerten Informationen, kritisches Denken am Krankenbett wird immer noch für IV-Verabreichung von Insulin erforderlich. Der Computer-gestützte Software bietet eine Anleitung für den Endanwender in Bezug auf Preise und IV Insulin die Aufnahme von Kohlenhydraten, Informationen für neue Patienten Start-ups, und was man während der Computer Unterbrechungen (zB Server-Ausfallzeiten) zu tun. Mit der Umsetzung des CGMS, gab es einige anfängliche Widerstand von Ärzten, bis sie spürte, dass sie sich verstehen und vertrauen auf die Software. Doch der Widerstand verringert, wenn das medizinische Personal sah, wie einfach das System zu bedienen war, wie effektiv es war bei der Kontrolle der Blutzuckerwerte, und wie sie in der Lage, seine Empfehlungen außer Kraft waren, wenn ClinicAlly notwendig. Insgesamt war das Pflegepersonal bemüht, die CGMS aufgrund ihrer zunehmenden Frustration mit den Papier-Protokolle implementieren. Doch zunächst gab es einige Bedenken von den Krankenschwestern mit der Annahme der höheren Insulin-Infusion und Bolus-Dosen Raten, die von den CGMS empfohlen wurden. In Zeiten, würde das System empfehlen viel höheren Infusionsraten und Bolusdosen, um den Patienten in der Ziel Bereich zu halten, als dass sie häufig von Papier-Protokolle empfohlen. Die Schwestern sind inzwischen bequem mit den CGMS Empfehlungen und selten aus vorgeschlagen Infusionsraten / Bolusdosen abweichen. Die Bedeutung einer guten Blutzuckerkontrolle bei hospitalisierten Patienten wurde in der Literatur gut dokumentiert. Diese Studien haben eine Abnahme der Morbidität und Mortalität, wenn Glukose effektiv wird während des Krankenhausaufenthaltes gesteuert gezeigt. Die Umstellung von Papier verwenden IV Insulin-Protokolle zu einem computerisierten Glukose-Management-System an Wyoming Medical Center ergab Substantially Verbesserung der glykämischen Kontrolle in Übereinstimmung mit den geltenden Richtlinien bei Patienten mit Hyperglykämie bei gleichzeitiger Minimierung der Gefahr einer Unterzuckerung. Obwohl die Vorteile einer guten Blutzuckereinstellung auch unter den Angehörigen der Gesundheitsberufe bekannt sind, Umsetzung einer solchen Strategie nahm eine sorgfältige Planung (Tabelle 2). Trotz mehrfachen Revisionen der Papier-Protokoll waren die Ergebnisse in Hinblick auf die Erreichung Normoglykämie bei gleichzeitiger Minimierung der Hypoglykämie suboptimal. Insgesamt erlaubt CGMS schnellere und engere Blutzuckerkontrolle, das Erreichen Zielkonzentrationen in mehr als 75% aller Messwerte. Bei der Verabreichung von intravenösem Insulin, gibt es eine natürliche Angst vor der Hypoglykämie. Jedoch war die Häufigkeit von Hypoglykämie bei der Verwendung von CGMS deutlich unter 1%.

improving iv insulin administration in a community hospital

Diabetes mellitus ist ein wichtiger unabhängiger Risikofaktor für erhöhte Morbidität und Mortalität in der stationären Patienten und erhöhte Blutzuckerwerte, auch in nicht-diabetischen Patienten, prognostiziert schlechte Ergebnisse. 4.1 Der 2008 Consensus Statement der American Association of Clinical Endokrinologen ( AACE) und der American Diabetes Association (ADA) besagt: &quot;Hyperglykämie bei hospitalisierten Patienten, unabhängig von deren Ursachen, ist eindeutig mit negativen Folgen assoziiert.&quot; 5 Es ist wichtig zu erkennen, dass Hyperglykämie tritt bei Patienten mit bekannter oder nicht diagnostiziertem Diabetes sowie während einer akuten Erkrankung bei Patienten mit zuvor normaler Glukosetoleranz. Die Normoglykämie in Intensive Care Evaluation-Survival-Algorithmus unter Verwendung von Glukose Verordnung (NICE-SUGAR) Studie über sechstausend Erwachsenen Intensivstation (ICU) Patienten, die randomisiert einer intensiven Blutzuckerkontrolle oder konventionelle Glukose waren beteiligt. Steuerung 6 Überraschenderweise fanden diese Studie, dass die intensive Blutzuckerkontrolle das Risiko der Sterblichkeit um 14% (Odds Ratio, 1,14; p = 0,02). Darüber hinaus gab es eine erhöhte Prävalenz von schweren Hypoglykämien in der intensiven Kontrollgruppe verglichen mit dem konventionellen Kontrollgruppe (6,8% vs 0,5%, p &lt;0,001). Aus dieser Zulassungsstudie und zwei andere, realisiert 7,8 Wyoming Medical Center (WMC) die Bedeutung der Kontrolle Hyperglykämie in der stationären Patienten bei gleichzeitiger Vermeidung der negativen Auswirkungen der resultierende Hypoglykämie. Trotz mehrfachen Revisionen von einem IV-Papier Insulin-Protokoll, Analyse von Daten aus der Nutzung der Papier-Protokoll bei WMC zeigt, dass im Hinblick auf die Erreichung Normoglykämie bei gleichzeitiger Minimierung der Hypoglykämie, suboptimale Ergebnisse waren. Daher, durch eine systematische Umsetzungsplan wurde Überwachung der Patienten Blutglukoselevel aus Papier unter Verwendung eines Insulin-IV-Protokoll an einen Computer-Glucose Managemen eingeschaltett-System. Durch Vergleich des Blutzuckerspiegels mit dem Papier-Protokoll zu der das EDV-System wurde festgestellt, dass insgesamt das EDV-System Glucose zu einer schnelleren und enger Blutzuckerkontrolle als die herkömmliche Papier-Protokoll geführt. Genauer gesagt, verbrachte eine erhebliche Steigerung in der Zeit innerhalb des Ziel-Blutglukosekonzentration Bereich, sowie eine Abnahme der Prävalenz von schwerer Hypoglykämie (BG &lt;40 mg / dL), klinische Hypoglykämie (BG &lt;70 mg / dL), Hyperglykämie und (BG&gt; 180 mg / dL) wurde in den ersten fünf Monaten nach Einführung des EDV-Glukose-Management-System erlebt. Das EDV-System erreicht Zielkonzentrationen in mehr als 75% aller Messwerte bei gleichzeitiger Minimierung der Gefahr einer Unterzuckerung. Die Prävalenz von Hypoglykämie (BG &lt;70 mg / dL), wobei die Verwendung des Computers Glucose-Management-System war deutlich unter 1%.

Watch this Scientific Journal Video about Improving IV Insulin Administration in a Community Hospital at JoVE.com

Improving IV Insulin Administration in a Community Hospital

Wenn zum vorherigen Papier-Protokoll, Implementierung eines EDV-Glukose-Management-System führt zu einem erheblichen Anstieg der Blutzuckerkonzentration Messungen innerhalb des Zielbereichs verglichen. Mit Hilfe eines EDV-Glukose-Management-System, um den Blutzuckerspiegel zu überwachen, sinkt in eine schwere Hypoglykämie (&lt;40 mg / dL), klinische Hypoglykämie (&lt;70 mg / dL) und Hyperglykämie (&gt; 180 mg / dL) auch beobachtet werden kann.

Die Verbesserung der IV-Verabreichung von Insulin in einem Community Hospital

Diabetes mellitus is a major independent risk factor for increased morbidity and mortality in the hospitalized patient, and elevated blood glucose ...

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18.5K Aufrufe.  Wyoming Medical Center. Wenn zum vorherigen Papier-Protokoll, Implementierung eines EDV-Glukose-Management-System führt zu einem erheblichen Anstieg der Blutzuckerkonzentration Messungen innerhalb des Zielbereichs verglichen. Mit Hilfe eines EDV-Glukose-Management-System, um den Blutzuckerspiegel zu überwachen, sinkt in eine schwere Hypoglykämie (

Serie: Improving IV Insulin Administration in a Community Hospital

A Novel Surgical Approach for Intratracheal Administration of Bioactive Agents in a Fetal Mouse Model

Prenatal pulmonary delivery of cells, genes or pharmacologic agents could provide the basis for new therapeutic strategies for a variety of genetic and acquired diseases. Apart from congenital or inherited abnormalities with the requirement for long-term expression of the delivered gene, several non-inherited perinatal conditions, where short-term gene expression or pharmacological intervention is sufficient to achieve therapeutic effects, are considered as potential future indications for this kind of approach. Candidate diseases for the application of short-term prenatal therapy could be the transient neonatal deficiency of surfactant protein B causing neonatal respiratory distress syndrome1,2 or hyperoxic injuries of the neonatal lung3. Candidate diseases for permanent therapeutic correction are Cystic Fibrosis (CF)4, genetic variants of surfactant deficiencies5 and &alpha;1-antitrypsin deficiency6.
Generally, an important advantage of prenatal gene therapy is the ability to start therapeutic intervention early in development, at or even prior to clinical manifestations in the patient, thus preventing irreparable damage to the individual. In addition, fetal organs have an increased cell proliferation rate as compared to adult organs, which could allow a more efficient gene or stem cell transfer into the fetus. Furthermore, in utero gene delivery is performed when the individual's immune system is not completely mature. Therefore, transplantation of heterologous cells or supplementation of a non-functional or absent protein with a correct version should not cause immune sensitization to the cell, vector or transgene product, which has recently been proven to be the case with both cellular and genetic therapies7.
In the present study, we investigated the potential to directly target the fetal trachea in a mouse model. This procedure is in use in larger animal models such as rabbits and sheep8, and even in a clinical setting9, but has to date not been performed before in a mouse model. When studying the potential of fetal gene therapy for genetic diseases such as CF, the mouse model is very useful as a first proof-of-concept because of the wide availability of different transgenic mouse strains, the well documented embryogenesis and fetal development, less stringent ethical regulations, short gestation and the large litter size.
Different access routes have been described to target the fetal rodent lung, including intra-amniotic injection10-12, (ultrasound-guided) intrapulmonary injection13,14 and intravenous administration into the yolk sac vessels15,16 or umbilical vein17. Our novel surgical procedure enables researchers to inject the agent of choice directly into the fetal mouse trachea which allows for a more efficient delivery to the airways than existing techniques18.

We developed a novel surgical approach for intratracheal administration of bioactive agents into the mouse fetus. The delivery route is more efficient in targeting the fetal mouse lungs than the commonly used intra-amniotic injection. This procedure has to date not been described in a mouse model.

A Novel Surgical Ansatz intratracheale Verabreichung von Wirkstoffen in einem Fetal Mouse Model

Prenatal pulmonary delivery of cells, genes or pharmacologic agents could provide the basis for new therapeutic strategies for a variety of genetic and ...

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Intranasal Administration of CNS Therapeutics to Awake Mice

Intranasal administration is a method of delivering therapeutic agents to the central nervous system (CNS). It is non-invasive and allows large molecules that do not cross the blood-brain barrier access to the CNS. Drugs are directly targeted to the CNS with intranasal delivery, reducing systemic exposure and thus unwanted systemic side effects1. Delivery from the nose to the CNS occurs within minutes along both the olfactory and trigeminal neural pathways via an extracellular route and does not require drug to bind to any receptor or axonal transport2. Intranasal delivery is a widely publicized method and is currently being used in human clinical trials3.
Intranasal delivery of drugs in animal models allows for initial evaluation of pharmacokinetic distribution and efficacy. With mice, it is possible to administer drugs to awake (non-anesthetized) animals on a regular basis using a specialized intranasal grip. Awake delivery is beneficial because it allows for long-term chronic dosing without anesthesia, it takes less time than with anesthesia, and can be learned and done by many people so that teams of technicians can dose large numbers of mice in short periods. Efficacy of therapeutics administered intranasally in this way to mice has been demonstrated in a number of studies including insulin in diabetic mouse models 4-6 and deferoxamine in Alzheimer's mouse models. 7,8
The intranasal grip for mice can be learned, but is not easy and requires practice, skill, and a precise grip to effectively deliver drug to the brain and avoid drainage to the lung and stomach. Mice are restrained by hand using a modified scruff in the non-dominant hand with the neck held parallel to the floor, while drug is delivered with a pipettor using the dominant hand. It usually takes 3-4 weeks of acclimating to handling before mice can be held with this grip without a stress response. We have prepared this JoVE video to make this intranasal delivery technique more accessible.

A method to intranasally administer drugs to awake mice for the purpose of targeting the brain is described. This method allows for repeat dosing over long periods using intranasal administration of drug without anesthesia, and nose-to-brain delivery with minimal systemic exposure.

Intranasale Verabreichung von CNS Therapeutics Awake Mäuse

Intranasal administration is a method of delivering  therapeutic agents to the central nervous system (CNS). It is  non-invasive and allows large ...

Collecting Saliva and Measuring Salivary Cortisol and Alpha-amylase in Frail Community Residing Older Adults via Family Caregivers

Salivary measures have emerged in bio-behavioral research that are easy-to-collect, minimally invasive, and relatively inexpensive biologic markers of stress. This article we present the steps for collection and analysis of two salivary assays in research with frail, community residing older adults-salivary cortisol and salivary alpha amylase. The field of salivary bioscience is rapidly advancing and the purpose of this presentation is to provide an update on the developments for investigators interested in integrating these measures into research on aging. Strategies are presented for instructing family caregivers in collecting saliva in the home, and for conducting laboratory analyses of salivary analytes that have demonstrated feasibility, high compliance, and yield quality specimens. The protocol for sample collection includes: (1) consistent use of collection materials; (2) standardized methods that promote adherence and minimize subject burden; and (3) procedures for controlling certain confounding agents. We also provide strategies for laboratory analyses include: (1) saliva handling and processing; (2) salivary cortisol and salivary alpha amylase assay procedures; and (3) analytic considerations.

We demonstrate: (1) procedures for collection of salivary samples in cognitive impaired older adults by family caregivers in the home setting, (2) procedures for measuring stress activity via salivary cortisol and alpha amylase, and (3) representative profiles. Protocols that allow researchers to study stress-linked processes advance our understanding of biological sensitivity and susceptibility.

Salivary measures have emerged in bio-behavioral research  that are easy-to-collect, minimally invasive, and relatively inexpensive  biologic markers of ...

Collection, Isolation, and Flow Cytometric Analysis of Human Endocervical Samples

Despite the public health importance of mucosal pathogens (including HIV), relatively little is known about mucosal immunity, particularly at the female genital tract (FGT). Because heterosexual transmission now represents the dominant mechanism of HIV transmission, and given the continual spread of sexually transmitted infections (STIs), it is critical to understand the interplay between host and pathogen at the genital mucosa. The substantial gaps in knowledge around FGT immunity are partially due to the difficulty in successfully collecting and processing mucosal samples. In order to facilitate studies with sufficient sample size, collection techniques must be minimally invasive and efficient. To this end, a protocol for the collection of cervical cytobrush samples and subsequent isolation of cervical mononuclear cells (CMC) has been optimized. Using ex vivo flow cytometry-based immunophenotyping, it is possible to accurately and reliably quantify CMC lymphocyte/monocyte population frequencies and phenotypes. This technique can be coupled with the collection of cervical-vaginal lavage (CVL), which contains soluble immune mediators including cytokines, chemokines and anti-proteases, all of which can be used to determine the anti- or pro-inflammatory environment in the vagina.

The use of cytobrush sampling to collect lymphocytes and monocytes from the endocervix is a minimally invasive technique that provides samples for analysis of female genital tract immunity. In this protocol, we describe the collection of cytobrush samples and immune cell isolation for flow cytometry assays.

Sammlung, Isolierung, und Durchflusszytometrische Analyse der Menschen Endozervikale Proben

Despite the public health importance of mucosal pathogens (including HIV), relatively little is known about mucosal immunity, particularly at the female ...

A Radio-telemetric System to Monitor Cardiovascular Function in Rats with Spinal Cord Transection and Embryonic Neural Stem Cell Grafts

High thoracic or cervical spinal cord injury (SCI) can lead to cardiovascular dysfunction. To monitor cardiovascular parameters, we implanted a catheter connected to a radio transmitter into the femoral artery of rats that underwent a T4 spinal cord transection with or without grafting of embryonic brainstem-derived neural stem cells expressing green fluorescent protein. Compared to other methods such as cannula insertion or tail-cuff, telemetry is advantageous to continuously monitor blood pressure and heart rate in freely moving animals. It is also capable of long term multiple data acquisitions. In spinal cord injured rats, basal cardiovascular data under unrestrained condition and autonomic dysreflexia in response to colorectal distension were successfully recorded. In addition, cardiovascular parameters before and after SCI can be compared in the same rat if a transmitter is implanted before a spinal cord transection. One limitation of the described telemetry procedure is that implantation in the femoral artery may influence the blood supply to the ipsilateral hindlimb.

We present a protocol for using a radio-telemetric system to record cardiovascular parameters in T4 spinal cord transected rats eight weeks after embryonic brainstem neural stem cell grafting into the lesion site. Telemetry is an advanced technique to accurately evaluate cardiovascular function in conscious freely moving spinal cord injured rats.

Ein Radio-Telemetrie-System zur Herz-Kreislauf-Funktion bei Ratten mit Rückenmarksdurchtrennung und embryonalen Neural Stem Cell Grafts überwachen

High thoracic or cervical spinal cord injury (SCI) can lead to cardiovascular dysfunction. To monitor cardiovascular parameters, we implanted a catheter ...

Rapid Fractionation and Isolation of Whole Blood Components in Samples Obtained from a Community-based Setting

Collection and processing of whole blood samples in a non-clinical setting offers a unique opportunity to evaluate community-dwelling individuals both with and without preexisting conditions. Rapid processing of these samples is essential to avoid degradation of key cellular components. Included here are methods for simultaneous peripheral blood mononuclear cell (PBMC), DNA, RNA and serum isolation from a single blood draw performed in the homes of consenting participants across a metropolitan area, with processing initiated within 2 hr of collection. We have used these techniques to process over 1,600 blood specimens yielding consistent, high quality material, which has subsequently been used in successful DNA methylation, genotyping, gene expression and flow cytometry analyses. Some of the methods employed are standard; however, when combined in the described manner, they enable efficient processing of samples from participants of population- and/or community-based studies who would not normally be evaluated in a clinical setting. Therefore, this protocol has the potential to obtain samples (and subsequently data) that are more representative of the general population.

We outline a methodology for the processing of whole blood to obtain a variety of components for further analysis. We have optimized a streamlined protocol that enables rapid, high-throughput simultaneous processing of whole blood samples in a non-clinical setting.

Schnelle Fraktionierung und Isolierung von Vollblutkomponenten in Proben aus einer Gemeinschaft basierende Einstellung Erhalten

Collection and processing of whole blood samples in a non-clinical setting offers a unique opportunity to evaluate community-dwelling individuals both ...

A Reproducible Computerized Method for Quantitation of Capillary Density using Nailfold Capillaroscopy

Capillaroscopy is a non-invasive, efficient, relatively inexpensive and easy to learn methodology for directly visualizing the microcirculation. The capillaroscopy technique can provide insight into a patient&#8217;s microvascular health, leading to a variety of potentially valuable dermatologic, ophthalmologic, rheumatologic and cardiovascular clinical applications. In addition, tumor growth may be dependent on angiogenesis, which can be quantitated by measuring microvessel density within the tumor. However, there is currently little to no standardization of techniques, and only one publication to date reports the reliability of a currently available, complex computer based algorithms for quantitating capillaroscopy data.1 This paper describes a new, simpler, reliable, standardized capillary counting algorithm for quantitating nailfold capillaroscopy data. A simple, reproducible computerized capillaroscopy algorithm such as this would facilitate more widespread use of the technique among researchers and clinicians. Many researchers currently analyze capillaroscopy images by hand, promoting user fatigue and subjectivity of the results. This paper describes a novel, easy-to-use automated image processing algorithm in addition to a reproducible, semi-automated counting algorithm. This algorithm enables analysis of images in minutes while reducing subjectivity; only a minimal amount of training time (in our experience, less than 1 hr) is needed to learn the technique.

Capillaroscopy is a non-invasive, efficient, relatively inexpensive and easy-to-learn methodology for directly visualizing capillaries in the microcirculation. However, only one publication to date describes the reliability of a complex software program available for quantitating capillaroscopy data. Here, we present a simple, reliable protocol for quantitating capillaries using a standardized algorithm.

Reproduzierbarer computerisiertes Verfahren zur Quantifizierung der Kapillardichte Verwendung nailfold Kapillaroskopie

Capillaroscopy is a non-invasive, efficient, relatively inexpensive and easy to learn methodology for directly visualizing the microcirculation. The ...

Transarterial Administration of Oncolytic Viruses for Locoregional Therapy of Orthotopic HCC in Rats

Hepatocellular carcinoma (HCC) is a disease with limited treatment options and poor prognosis. In recent years, oncolytic virotherapies have proven themselves to be potentially powerful tools to fight malignancy. Due to the unique dual blood supply in the liver, it is possible to apply therapies locally to orthotopic liver tumors, which are predominantly fed by arterial blood flow. We have previously demonstrated that hepatic arterial delivery of oncolytic viruses results in safe and efficient transduction efficiency of multifocal HCC lesions, resulting in significant prolongation of survival in immune competent rats. This procedure closely mimics the application of transarterial embolization in patients, which is the standard palliative care provided to many HCC patients. The ability to administer tumor therapies through the hepatic artery in rats allows for a highly sophisticated preclinical model for evaluating novel viral vectors under development. Here we describe the detailed protocol for microdissection of the hepatic artery for infusion of oncolytic virus vectors to treat orthotopic HCC.

Oncolytic virotherapies are under development as novel therapeutics for the treatment of hepatocellular carcinoma (HCC). Here we describe a method for locoregional therapy of HCC via hepatic arterial administration of oncolytic virus.

Transarterial Verwaltung von onkolytischen Viren für lokoregionale von Orthotopische HCC bei Ratten

Hepatocellular carcinoma (HCC) is a disease with limited treatment options and poor prognosis.  In recent years, oncolytic virotherapies have proven ...

Murine Oropharyngeal Aspiration Model of Ventilator-associated and Hospital-acquired Bacterial Pneumonia

Murine infection models are critical for understanding disease pathogenesis and testing the efficacy of novel therapeutics designed to combat causative pathogens. Infectious pneumonia is among the most common infections presented by patients in the clinic and thus warrants an appropriate in vivo model. Typical pneumonia models use intranasal inoculation, which deposits excessive organisms outside the lung, causing off-target complications and symptoms, such as sinusitis, gastritis, enteritis, physical trauma, or microparticle misting to mimic aerosol spread more typical of viral, tuberculous, or fungal pneumonia. These models do not accurately reflect the pathogenesis of typical community- or healthcare-acquired bacterial pneumonia. In contrast, this murine model of oropharyngeal aspiration pneumonia mimics the droplet route in healthcare-acquired pneumonia. Inoculating 50 &#181;L of the bacteria suspension into the oropharynx of anesthetized mice causes reflexive aspiration, which results in pneumonia. With this model, one can examine the pathogenesis of pneumonia-causing pathogens and new treatments to combat these diseases.

Infectious pneumonia is among the most common infections in human. An appropriate in vivo model is critical for understanding disease pathogenesis and testing the efficacy of novel therapeutics. With this murine oropharyngeal aspiration pneumonia model, one can examine the pathogenesis and new treatments against these deadly infections.

Murine oropharyngealen Aspiration Modell der Ventilator-assoziierten und nosokomiale Bakterielle Pneumonie

Murine infection models are critical for understanding disease pathogenesis and testing the efficacy of novel therapeutics designed to combat causative ...

A Training Program Using an Agility Ladder for Community-Dwelling Older Adults

Aging impairs physical and cognitive functions and limits daily activities. Agility training can improve or maintain physical functioning in older people. The purpose of this study is to report the physical fitness benefits of a training program for independent community-dwelling older adults using an agility ladder. Each training session lasted approximately 30 minutes, and the benefits were achieved with two sessions per week for 14 weeks. Training was timed and involved four different drills and varying levels of difficulty through time. The exercises were performed at the School of Physical Education of the University of Campinas, S&#227;o Paulo state, Brazil. The study participants (n = 16; mean age of 66.9 &#177; 5.0 years) were instructed to perform the exercises as quickly as possible without making mistakes and were assisted by a physical trainer when they made mistakes. Assessments were performed both before and after training using five functional tests (i.e., Illinois agility, five times sit-to-stand, timed up-and-go, walking usual speed, and one-leg stand). Although the study sample was not compared with a control group, the results indicate that training protocols using an agility ladder are easy and practical and improve physical function performance in older adults.

The aim of this study is to present an agility training program for older people. The feasibility of this program is described, and the training protocol demonstrated by video imaging.

Ein Schulungsprogramm mit einer Agility-Leiter für ältere Erwachsene in der Community

Aging impairs physical and cognitive functions and limits daily activities. Agility training can improve or maintain physical functioning in older people. ...