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At least 1,297 records · Page 72Linked to original sources
PubMed1999

Renal transplantation path saves $34K per patient.

A renal transplantation clinical pathway used at the Hospital of the University of Pennsylvania in Philadelphia has cut length of stay from 12 days to nine and resulted in an overall savings of $33,636 per patient. Given the hospital's average annual volume of 125 renal transplant patients, that's a savings of more than $4.2 million per year. Team members attribute much of the success of the pathway to standardized order sheets. Because the care of renal transplant patients is complicated and residents change every month, it was important to maintain documents that allowed for continuity of care. The pathway includes a sheet that provides an overview of the patient's progress during the acute care stay. The overview allows those unfamiliar with the pathway to understand what is happening with the patient.

Continuity of Patient Care↗
PubMedDate not supplied

Use of variance outcomes to improve the management of the adult kidney transplant patient.

Implementation of clinical pathways requires the measurement of outcomes to foster ongoing improvement in patient care. The use of variance information can optimize patient outcomes and enhance and refine clinical practice. This article discusses the use of the variance outcomes of a clinical pathway to improve the care of adult post-kidney transplant patients.

Critical Pathways↗
PubMed2003

Roles of calcineurin and calcium/calmodulin-dependent protein kinase II in pressure overload-induced cardiac hypertrophy.

Calcineurin and calcium/calmodulin-dependent protein kinase (CaMK) II have been suggested to be the signaling molecules in cardiac hypertrophy. It was not known, however, whether these mechanisms are involved in cardiac hypertrophy induced by pressure overload without the influences of blood-derived humoral factors, such as angiotensin II. To elucidate the roles of calcineurin and CaMK II in this situation, we examined the effects of calcineurin and CaMK II inhibitors on pressure overload-induced expression of c-fos, an immediate-early gene, and protein synthesis using heart perfusion model. The hearts isolated from Sprague-Dawley rats were perfused according to the Langendorff technique, and then subjected to the acute pressure overload by raising the perfusion pressure. The activation of calcineurin was evaluated by its complex formation with calmodulin and by its R-II phosphopeptide dephosphorylation. CaMK II activation was evaluated by its autophosphorylation. Expression of c-fos mRNA and rates of protein synthesis were measured by northern blot analysis and by 14C-phenylalanine incorporation, respectively. Acute pressure overload significantly increased calcineurin activity, CaMK II activity, c-fos expression and protein synthesis. Cyclosporin A and FK506, the calcineurin inhibitors, significantly inhibited the increases in both c-fos expression and protein synthesis. KN62, a CaMK II inhibitor, also significantly prevented the increase in protein synthesis, whereas it failed to affect the expression of c-fos. These results suggest that both calcineurin and CaMK II pathways are critical in the pressure overload-induced acceleration of protein synthesis, and that transcription of c-fos gene is regulated by calcineurin pathway but not by CaMK II pathway.

Animals↗
PubMed2005

Restoration of Wnt-7a expression reverses non-small cell lung cancer cellular transformation through frizzled-9-mediated growth inhibition and promotion of cell differentiation.

The Wnt signaling pathway is critical in normal development, and mutation of specific components is frequently observed in carcinomas of diverse origins. However, the potential involvement of this pathway in lung tumorigenesis has not been established. In this study, analysis of multiple Wnt mRNAs in non-small cell lung cancer (NSCLC) cell lines and primary lung tumors revealed markedly decreased Wnt-7a expression compared with normal short-term bronchial epithelial cell lines and normal uninvolved lung tissue. Wnt-7a transfection in NSCLC cell lines reversed cellular transformation, decreased anchorage-independent growth, and induced epithelial differentiation as demonstrated by soft agar and three-dimensional cell culture assays in a subset of the NSCLC cell lines. The action of Wnt-7a correlated with expression of the specific Wnt receptor Frizzled-9 (Fzd-9), and transfection of Fzd-9 into a Wnt-7a-insensitive NSCLC cell line established Wnt-7a sensitivity. Moreover, Wnt-7a was present in Fzd-9 immunoprecipitates, indicating a direct interaction of Wnt-7a and Fzd-9. In NSCLC cells, Wnt-7a and Fzd-9 induced both cadherin and Sprouty-4 expression and stimulated the JNK pathway, but not beta-catenin/T cell factor activity. In addition, transfection of gain-of-function JNK strongly inhibited anchorage-independent growth. Thus, this study demonstrates that Wnt-7a and Fzd-9 signaling through activation of the JNK pathway induces cadherin proteins and the receptor tyrosine kinase inhibitor Sprouty-4 and represents a novel tumor suppressor pathway in lung cancer that is required for maintenance of epithelial differentiation and inhibition of transformed cell growth in a subset of human NSCLCs.

Base Sequence↗
PubMed1999

Hedgehog activates the EGF receptor pathway during Drosophila head development.

The Hedgehog (Hh) and Epidermal growth factor receptor (EGFR) signaling pathways play critical roles in pattern formation and cell proliferation in invertebrates and vertebrates. In this study, we demonstrate a direct link between these two pathways in Drosophila melanogaster. Hh and EGFR signaling are each required for the formation of a specific region of the head of the adult fruitfly. We show that hh and vein (vn), which encodes a ligand of the Drosophila EGFR (Schnepp, B., Grumbling, G., Donaldson, T. and Simcox, A. (1996) Genes Dev. 10, 2302-13), are expressed in adjacent domains within the imaginal primordium of this region. Using loss- and gain-of-function approaches, we demonstrate that Hh activates vn expression. We also show that Hh activation of vn is mediated through the gene cubitus interruptus (ci) and that this activation requires the C-terminal region of the Ci protein. Finally, we demonstrate that wingless (wg) represses vn expression, thereby limiting the domain of EGFR signaling.

Animals↗
PubMed1993

Drugs of abuse: biochemical surrogates of specific aspects of natural reward?

In this paper it is argued that drugs of abuse act on specific neurotransmitter pathways and by this mechanism elicit neurochemical changes that mimic some aspects of the overall pattern of the neurochemical effects of natural rewarding stimuli. Thus, drugs of abuse are biochemically homologous to specific aspects of natural rewarding stimuli. The behavioral similarity between drugs of abuse and natural stimuli, including that of being rewarding, results from their common property of activating neurochemically specific pathways. Natural stimuli accomplish this result indirectly through their sensory properties and incentive learning while drugs stimulate by a direct central action the critical reward pathways. Many drugs of abuse mimic the incentive properties of natural stimuli and their ability to stimulate mesolimbic dopamine pathways (Fig. 1). Both natural rewards and drugs of abuse, including amphetamine, cocaine and other psychostimulants, preferentially stimulate dopamine transmission in the mesolimbic nucleus accumbens compared with the dorsal caudate, an area related to the extrapyramidal motor system. Although many drugs of abuse mimic the incentive aspect of natural reward, this is probably not an absolute prerequisite for conferring to a drug some abuse liability. It might be predicted that certain drugs might be abused as a result of their action at sites located beyond dopamine or by mimicking other aspects of naturally rewarding stimuli such as the 'functional' (or trophotropic). This might be the case with opiates (which also mimic the 'incentive' aspect) and of benzodiazepines, as a result of activation of the central opioid reward system and of the central gamma-aminobutyric acid (GABA)-benzodiazepine system respectively. The hypothesis appears to have heuristic value as it predicts that biochemical mechanisms important for the rewarding properties of drugs of abuse are expected to play a role also in natural reward. One test of this hypothesis is offered by the observation that the 5-hydroxytryptamine (5-HT) system, through 5-HT3 receptors, and the central opioid system, through delta-opioid receptors, can contribute to the mechanism of the dopamine-activating properties of certain drugs of abuse. On this basis it would be predicted that drugs acting on 5-HT3 and on delta-opioid receptors would interfere with or mimic certain aspects of natural rewarding stimuli.

Animals↗
PubMed2006

Modelling the circle of Willis to assess the effects of anatomical variations and occlusions on cerebral flows.

Blood flow in the circle of Willis (CoW) is modelled using the 1-D equations of pressure and flow wave propagation in compliant vessels. The model starts at the left ventricle and includes the largest arteries that supply the CoW. Based on published physiological data, it is able to capture the main features of pulse wave propagation along the aorta, at the brachiocephalic bifurcation and throughout the cerebral arteries. The collateral ability of the complete CoW and its most frequent anatomical variations is studied in normal conditions and after occlusion of a carotid or vertebral artery (VA). Our results suggest that the system does not require collateral pathways through the communicating arteries to adequately perfuse the brain of normal subjects. The communicating arteries become important in cases of missing or occluded vessels, the anterior communicating artery (ACoA) being a more critical collateral pathway than the posterior communicating arteries (PCoAs) if an internal carotid artery (ICA) is occluded. Occlusions of the VAs proved to be far less critical than occlusions of the ICAs. The worst scenario in terms of reduction in the mean cerebral outflows is a CoW without the first segment of an anterior cerebral artery combined with an occlusion of the contralateral ICA. Furthermore, in patients without any severe occlusion of a carotid or VA, the direction of flow measured at the communicating arteries corresponds to the side of the CoW with an absent or occluded artery. Finally, we study the effect of partial occlusions of the communicating arteries on the cerebral flows, which again confirms that the ACoA is a more important collateral pathway than the PCoAs if an ICA is occluded.

Animals↗
PubMed2001

High-throughput drug screening of the DPC4 tumor-suppressor pathway in human pancreatic cancer cells.

OBJECTIVE: To screen a library of small chemicals for compounds that activate the DPC4 signal transduction pathway in a human pancreatic cancer cell line. SUMMARY BACKGROUND DATA: Various tumor-suppressor genes are mutated in all human cancers. Specifically, DPC4 (deleted in pancreatic carcinoma, locus 4 or MADH4/SMAD4) is a tumor-suppressor gene mutated in approximately 50% of human pancreatic adenocarcinomas. DPC4 plays an important role in the well-studied transforming growth factor-beta (TGFbeta) signaling pathway. It would be useful to identify therapies that augment or restore the downstream functions of this critical signal transduction pathway, in hopes that such therapy would have a rational role in anticancer therapy. METHODS: Using a commercially available plasmid vector with a luciferase reporter gene already incorporated, a DPC4-specific reporter construct was genetically engineered. This was done by inserting six copies of the palindromic Smad binding element (6SBE), which is a DNA binding element specific for DPC4, in front of the minimal promoter in the plasmid. This construct was then stably integrated into the genome of a human pancreatic cancer cell line (PANC-1) that has wild-type DPC4. Several stably transfected clones were tested for basal luciferase expression and inducibility with TGFbeta, which is known to activate the DPC4 signal transduction pathway. A single transfected clone was chosen for the drug screen based on basal luciferase (reporter) expression and TGFbeta inducibility. A systematic screen of the chemical library was then performed, using luciferase activity to detect DPC4 activity and induction of the signaling pathway. RESULTS: A high-throughput system based on this stably integrated reporter system was used to screen a library of 16,320 random compounds to identify agents that conferred robust augmentation of the DPC4 signal transduction pathway. Of the 16,320 compounds screened, 11 were associated with a 2- to 5-fold induction of luciferase activity, and one with a 12-fold activation. The latter compound was shown to be a novel histone deacetylase inhibitor and was further characterized. CONCLUSIONS: These results confirm the feasibility of a specific high-throughput reporter system to screen a large compound library in human cells efficiently. The screening identified several compounds capable of augmenting DPC4-specific luciferase reporter activity, and a specific mechanism for one compound was identified. The discovery of such agents will aid our understanding of complex tumor-suppressive signaling pathways and may identify other potential therapeutic targets within this critical signaling pathway. In addition, random drug screening provides an unbiased method for identifying drugs or lead compounds for potential therapeutic use.

Adenocarcinoma↗
PubMed2003

Are there opportunities to decrease nosocomial infection by choice of analgesic regimen? Evidence for immunity and pain interactions.

BACKGROUND: Interactions suggest that anesthetic and analgesic strategies could be used to modulate immune function and reduce nosocomial infection in critically ill pediatric patients. However, this theory has yet to be adequately tested. OBJECTIVE: To present the evidence for interactions between nociceptive and immune pathways. DATA SOURCES: The MEDLINE database and hand searches of the English-language biomedical literature for the 1985-2003 period. DATA SYNTHESIS: Substantial evidence exists for numerous bidirectional relationships between nociceptive and immune pathways. Some studies suggest that surgical pain and stress may alter immune function in adults. Limited evidence indicates that anesthetic and analgesic immunomodulation may boost immune function to prevent nosocomial infection. However, unique aspects of immune function maturation and neurodevelopment must be considered. CONCLUSION: Research is urgently needed to determine if the interactions between nociceptive and immune function pathways in critically ill infants and children are similar to those in adults and if host defenses can be enhanced by optimal anesthetic and analgesic strategies.

Analgesia↗
PubMed2003

Predicting pathway perturbations in Down syndrome.

Comparative annotation of human chromosome 21 genomic sequence with homologous regions of mouse chromosomes 16, 17 and 10 has identified 170 orthologous gene pairs. Functional annotation of these genes, based on literature reports and computationally-derived predictions, shows that a broad range of cellular processes are represented. A goal of Down syndrome research is to determine which of these processes are perturbed by overexpression of chromosome 21 genes, and which may, therefore, contribute to the cognitive deficits that characterize Down syndrome. Eleven chromosome 21 genes are annotated to interact with or be affected by components of the MAP Kinase pathway and eight are involved in Ca2+/calcineurin signaling. Both pathways are critical for normal neurological function, and consequently their perturbations are proposed as candidates for phenotypic relevance. We present evidence suggesting that the MAP Kinase pathway is perturbed in the Ts65Dn mouse model of Down syndrome at 4-6 months of age. Analysis is complicated by the observation that overexpression of chromosome 21 genes in trisomy may be affected by method of detection, organism, tissue or brain region, and/or developmental age.

Animals↗
PubMed2006

Interferon-gamma-induced dephosphorylation of STAT3 and apoptosis are dependent on the mTOR pathway.

Interferon-gamma (IFN-gamma) exhibits diverse biological activities, including control of cell growth and tumor suppression. Here, we report that the treatment of M12 cells, a human metastatic prostate cancer cell line, with IFN-gamma, resulted in marked inhibition of cell proliferation and induced apoptosis. These effects were not seen with either IFN-alpha or IFN-beta. M12 cells, like many other human cancer cells, contain constitutively activated signal transducer and activator of transcription 3 (STAT3). The basal levels of both Akt and ERK1/2 phosphorylation are also markedly elevated in M12 cells. Strikingly, IFN-gamma-induced apoptosis and growth inhibition of M12 cells were associated with persistent suppression of the constitutive tyrosine-phosphorylated STAT3 (pY-STAT3). The IFN-gamma-induced dephosphorylation of pY-STAT3, however, was inhibited when the mTOR pathway was specifically blocked by rapamycin. Inhibition of PI-3K with low-dose LY294002, or MAPK with PD98059 also suppressed the mTOR/p70 S6k pathway, and correlated with the blockage of IFN-gamma-induced dephosphorylation of pY-STAT3. Simultaneously, treatment with LY294002, PD98059, or rapamycin abolished IFN-gamma-induced apoptosis in M12 cells. The inhibition of the mTOR pathway, however, did not affect IFN-gamma-induced activation of STAT1 pathway, and suppression of STAT1 expression by siRNA had no effect on IFN-gamma-induced dephosphorylation of pY-STAT3. Taken together, these results demonstrate that an intact mTOR pathway is critical for IFN-gamma-induced suppression of pY-STAT3 and apoptosis. Our study thus provides novel insights into the contributions of signaling pathways other than the classical JAK/STAT1 pathway in the anti-proliferative, proapoptotic actions of IFN-gamma.

Apoptosis↗
PubMed2000

A performance improvement initiative: development of a peripheral vascular pathway.

Health care institutions today are being challenged to provide cost-effective, quality care. High-cost Diagnostic Related Groups are being targeted for performance improvement initiatives. A Peripheral Vascular Bypass Chartered Team was formed to review current practices and identify opportunities for system improvements. Data analysis, the literature, and best practices were reviewed. Emphasis on the financial, clinical, and quality outcomes are discussed in relation to a clinical pathway and protocol development in an effort to better manage this population.

Benchmarking↗
PubMed1997

Managing skin care with the CareMap system.

In the last three decades, WOC nursing has evolved into on increasingly complex practice. The CareMap is a tool designed to assist in management of patient care. This article defines the CareMap system and describes the development, implementation, and pilot evaluation of a skin care pathway created with the CareMap at Western Pennsylvania Hospital.

Bandages↗