Effect of a 2-h hyperglycemic-hyperinsulinemic glucose clamp to promote glucose storage on endurance exercise performance

Carbohydrate stores within muscle are considered essential as a fuel for prolonged endurance exercise, and regimes for enhancing such stores have proved successful in aiding performance. This study explored the effects of a hyperglycaemic–hyperinsulinemic clamp performed 18 h previously on subsequent prolonged endurance performance in cycling. Seven male subjects, accustomed to prolonged endurance cycling, performed 90 min of cycling at ~65% VO_2max followed by a 16-km time trial 18 h after a 2-h hyperglycemic–hyperinsulinemic clamp (HCC). Hyperglycemia (10 mM) with insulin infused at 300 mU/m²/min over a 2-h period resulted in a total glucose uptake of 275 g (assessed by the area under the curve) of which glucose storage accounted for about 73% (i.e. 198 g). Patterns of substrate oxidation during 90-min exercise at 65% VO_2max were not altered by HCC. Blood glucose and plasma insulin concentrations were higher during exercise after HCC compared with control (p < 0.05) while plasma NEFA was similar. Exercise performance was improved by 49 s and power output was 10–11% higher during the time trial (p < 0.05) after HCC. These data suggest that carbohydrate loading 18 h previously by means of a 2-h HCC improves cycling performance by 3.3% without any change in pattern of substrate oxidation.     

The in vivo behavior and antitumor activity of doxorubicin-loaded poly(γ-benzyl l-glutamate)-block-hyaluronan polymersomes in Ehrlich ascites tumor-bearing BalB/c mice

The in vivo efficacy of doxorubicin (DOX)-loaded poly(γ-benzyl l-glutamate)-block-hyaluronan (PBLG(23)-b-HYA(10))-based polymersomes (PolyDOX) was evaluated. Samples were efficiently labeled with technetium-99m radionuclide with good stability for in vivo studies. PolyDOX enhanced circulation time compared to free DOX. Biodistribution studies revealed selective accumulation of PolyDOX in the Ehrlich ascites tumor (EAT) as a result of passive accumulation and active targeting (CD44-mediated endocytosis) in EAT-bearing mice. Toxicity studies demonstrated PolyDOX is a safe drug carrier, and no hemolysis was observed with PolyDOX equivalent to 200 μg/mL of free DOX. PolyDOX dominantly controlled tumor growth by delaying doubling time of EATs compared to free DOX over 30 days after treatment. PolyDOX also increased life span six times more than free DOX. Hence, it is reasonable to expect that higher DOX levels attributable to PolyDOX improve the therapeutic index and reduce side effects due to site-specific drug accumulation. FROM THE CLINICAL EDITOR: In this preclinical project, doxorubicin loaded polymersomes enhanced intracellular uptake of doxorubicin in a murine model of Ehrlich Ascites Tumor (EAT) through CD44 receptor mediated endocytosis, resulting in prolonged Tumor Doubling Time and increase in life span of mice.     

Collecting data on quality is feasible in community-based palliative care

Background

Quality measurement in palliative care requires robust data from standardized data collection processes. We developed and tested the feasibility of the Quality Data Collection Tool version 1.0 (QDACTv1.0) for use in community-based palliative care.

Measures

To evaluate for implementation barriers, we tested feasibility, acceptability, and utility of the QDACTv1.0 by reviewing use patterns, surveying clinician users, and reporting conformance with quality metrics.

Intervention

Comprising 37 questions within five domains, QDACTv1.0 was launched in May 2008 for data collection at point of care.

Outcomes

Through March 2011, data on 5959 patients in 19,734 visits have been collected. We observed steady quarterly growth in data collection, positive clinician feedback, and successful mapping of data to quality metrics. Information gathered characterized practice variations and suggested quality improvement initiatives. Clinician feedback has driven updating to Quality Data Collection Tool version 2.0.

Conclusions/Lessons Learned

Standardized data collection is feasible in routine community-based palliative care and is valuable for quality monitoring.     

Implementing a web-based home monitoring system within an academic health care network: barriers and facilitators to innovation diffusion

The practice of outpatient type 2 diabetes management is gradually moving from the traditional visit-based, fee-for-service model to a new, health information communication technology (ICT)-supported model that can enable non-visit-based diabetes care. To date, adoption of innovative health ICT tools for diabetes management has been slowed by numerous barriers, such as capital investment costs, lack of reliable reimbursement mechanisms, design defects that have made some systems time-consuming and inefficient to use, and the need to integrate new ICT tools into a system not primarily designed for their use. Effective implementation of innovative diabetes health ICT interventions must address local practice heterogeneity and the interaction of this heterogeneity with clinical care delivery. The Center for Connected Health at Partners Healthcare has implemented a new ICT intervention, Diabetes Connect (DC), a Web-based glucose home monitoring and clinical messaging system. Using the framework of the diffusion of innovation theory, we review the implementation and examine lessons learned as we continue to deploy DC across the health care network.     

Status of carbohydrate, protein and lipid profile in the mosquito larvae treated with certain phytoextracts

ObjectiveTo investigate the impact of the most potent petroleum ether extract of Artemisia annua (A. annua) and Azadirachta indica (Az. indica) on total carbohydrate, lipid and protein level of Anopheles stephensi and Culex quinquefasciatus larvae.MethodsMosquito larvae were exposed to the extracts selected as per standard WHO procedure. Carbohydrate (glucose), total lipid and protein were estimated by the methods as Nelson, Bragdon and Lowry described, respectively.ResultsThe glucose levels were increased to 27.87% and 46.8%, respectively in anopheline larval tissues after treatment with petroleum ether extract of A. annua and methanolic extract of Az. indica. In culicine larvae, glucose levels were reduced to 58.96% and 24.65%, respectively. After treatment with A. annua extract, lipid contents in anopheline and culicine larvae decreased by 28.57% and 25.0%, respectively and increased by 14.29% and 50.00% in the Anopheles and Culex larvae, respectively after treatment with methanolic extract of Az. indica. Total protein levels were reduced to 63.13% and 92.62% in anopheline and to 32.39% and 48.12% in culicine larvae after treatment with A. annua and Az. Indica extracts, respectively.ConclusionsTwo extracts produce significant alterations in the biochemical profiles of anopheline and culicine larvae. Further, the impacting factors of extracts on carbohydrate, lipid and protein contents of larvae are species and specific extraction. It indicates the disturbed metabolic activity of the larvae.