Evaluation of Computer-Based Insulin Infusion Algorithm Compared With a Paper-Based Protocol in the Treatment of Diabetic Ketoacidosis.

Background: Development of computer-based software, termed electronic glucose management system (eGMS), offers an alternative strategy to manage diabetic ketoacidosis (DKA) compared with institution-specific paper protocols by integrating glucose and insulin titration into the electronic medical record. Objective: To evaluate the safety and efficacy of eGMS versus a paper-based DKA protocol in an urban academic medical center. Methods: Single-center, retrospective analysis of patients admitted for DKA. The primary objective of this study was the time to transition from intravenous to subcutaneous insulin after resolution of DKA pre- and post-eGMS implementation. Secondary outcomes included incidence of hypoglycemia while on an insulin infusion, intensive care unit (ICU) length of stay, and total hospital length of stay. Results: Time to DKA resolution was similar in both groups with a median time of 8.6 versus 8.8 hours in the paper-based (n = 133) and eGMS groups (n = 84), respectively (P = 0.43). Hypoglycemia occurred more frequently in the paper-based group compared with eGMS during insulin infusion (14 vs 3 patients, P = 0.06). The median ICU (36.5 vs 41.4 hours; P = 0.05) and hospital length of stay (67.9 vs 77.8 hours; P = 0.05) were shorter in the paper-based group compared with the eGMS group. Conclusion and Relevance: Similar rates of DKA resolution were seen for patients managed with a paper-based protocol compared with eGMS. Patients in the paper-based protocol had a shorter ICU and hospital length of stay; however, eGMS had improved clinically relevant safety outcomes.

Golgi apparatus casein kinase phosphorylates bioactive Ser-6 of bone morphogenetic protein 15 and growth and differentiation factor 9.

Bone morphogenetic protein-15 (BMP-15) and growth and differentiation factor-9 (GDF-9) are oocyte-secreted factors that play essential roles in human folliculogenesis and ovulation. Their bioactivity is tightly regulated through phosphorylation, likely to occur within the Golgi apparatus of the secretory pathway. Here we show that Golgi apparatus casein kinase (G-CK) catalyzes the phosphorylation of rhBMP-15 and rhGDF-9. rhBMP-15, in particular, is an excellent substrate for G-CK. In each protein a single residue is phosphorylated by G-CK, corresponding to the serine residue at the sixth position of the mature region of both rhBMP-15 and rhGDF-9, whose phosphorylation is required for biological activity.

Advanced technology for storage and transport of purified DNA from umbilical cord blood prior to use in human leukocyte antigens typing and whole-genome microarray analysis.

Two technologies for dry-state, ambient temperature transport of biospecimens were evaluated in this study. Umbilical cord blood (UCB) samples from 4 individuals were transported at ambient temperature using GenPlates, and the DNA recovered was compared with DNA purified directly from granulocytes of the same UCB samples. GenTegra™ DNA tubes were then used to transport the DNA from California to North Carolina and New Zealand, either immediately after drying or following 30 days of storage at 25°C and 76°C. The integrity of the recovered DNA was thoroughly tested using 2 human leukocyte antigens (HLA)-typing techniques (bead array and sequencing), as well as microarray-based whole-genome scanning. HLA-typing results were the same for all samples whether the DNA had been stored for 3 days during transport or 30 days at either 25°C or 76°C. There were no differences in the HLA-typing results of DNA recovered from UCB samples stored in GenPlates compared with DNA extracted directly from granulocytes. Moreover, the microarray analysis revealed call rates of >99.5% for every sample, regardless of storage method, with a statistical concordance of 99.99% between the UCB samples stored in GenPlates compared with DNA extracted directly from granulocytes. These results indicate that both GenPlates and GenTegra are viable methods of storing and transporting UCB (stem cell) biospecimens in a dry state. The quality and quantity of DNA recovered using both technologies are sufficient for complex genotyping using a number of different methods.