In Brief For pregnant women with diabetes, using cell phone/Internet technology to track and report self-monitoring of blood glucose results improves compliance and satisfaction compared to using the more traditional methods of log books, telephone calls, and voicemail messages.

Cultured guard cell protoplasts (GCP) of tree tobacco (Nicotiana glauca) comprise a novel system for investigating the cell signaling mechanisms that lead to acquired thermotolerance and thermoinhibition. At 32°C in a medium containing an auxin (1-naphthaleneacetic acid [NAA]) and a cytokinin (6-benzylaminopurine), GCP expand, regenerate cell walls, dedifferentiate, and divide. At 38°C, GCP acquire thermotolerance within 24 h, but their expansion is limited and they neither regenerate walls nor reenter the cell cycle. These putative indicators of auxin insensitivity led us to hypothesize that heat suppresses induction of auxin-regulated genes in GCP. Protoplasts were transformed with BA-mgfp5-ER, in which the BA auxin-responsive promoter regulates transcription of mgfp5-ER encoding thermostable green fluorescent protein (GFP) or with a similar 35S-cauliflower mosaic virus constitutive promoter construct. Heat suppressed NAA-mediated activation of BA. After 21 h at 32°C in media with NAA, 49.0% 6 3.9% of BA-mgfp5-ER transformants strongly expressed GFP; expression percentages were similar to those of 35S-mgfp5-ER transformants at 32°C or 38°C. After 21 h at 38°C in media with NAA, 7.9% 6 1.6% of BA-mgfp5-ER transformants weakly expressed GFP, similar to GCP cultured at 32°C in media lacking NAA. Expression at 38°C was not increased by incubating for 48 h or increasing NAA concentrations 20-fold. After 9 to 12 h at 38°C, BA was no longer activated when cells were transferred to 32°C. Heat-stressed cells accumulate reactive oxygen species, and hydrogen peroxide (H 2 O 2 ) suppresses auxin-responsive promoter activation in Arabidopsis (Arabidopsis thaliana) mesophyll protoplasts. H 2 O 2 did not suppress BA activation at 32°C, nor did superoxide and H 2 O 2 scavengers prevent BA suppression at 38°C.

No abstract

DiscussionPheochromocytoma during pregnancy remains a rare condition, occurring in 0.007% in one 22-year review of 30,426 pregnancies [1]. However, pheochromocytomas in pregnancy are associated with high maternal and fetal mortality (8% and 17%, respectively) in addition to fetal growth restriction and prematurity [2,3]. Antenatal diagnosis has been shown to reduce maternal and fetal mortality with early pharmacologic and surgical intervention [4].Diagnosis of pheochromocytoma is frequently challenging but even more so if needs to be made during the pregnancy. One of the examples is a case of a 29 year-old G2P1011 female was referred to endocrine clinic for elevated plasma metanephrines that were checked in the setting of hypertension associated with headaches and hyperhidrosis that persisted following a spontaneous abortion at 30 weeks gestation.The patient had a history of gestational hypertension during her first pregnancy, but had not routinely checked her blood pressure since her previous delivery 2 years prior. Early in her second pregnancy she began to develop episodes of paroxysmal headaches, palpitations, and heat intolerance associated with elevated blood pressure. She was diagnosed with gestational hypertension and diabetes in the first trimester and placed on bed rest. Despite the start of labetalol in pregnancy, she continued to have ongoing hypertension with episodic adrenergic symptoms. These symptoms persisted after the pregnancy loss. She remained on labetalol therapy after the pregnancy. CT adrenal protocol showed a 3.7 cm mass replacing the left adrenal with poor washout on delayed imaging. Labetalol was discontinued and she was switched to phenoxybenzamine with left laparoscopic adrenalectomy two months after initial laboratory diagnosis.Pheochromocytoma is often misdiagnosed as pregnancy induced hypertension (PIH), which remains the most common complication of pregnancy. However, there are some key differences that can aid in distinguishing the two entities. PIH rarely occurs prior to 20 weeks gestation, while symptomatic pheochromocytoma can present at any point during pregnancy. Pheochromocytoma often presents with paroxysmal hypertension associated with headache, palpitations (40%), hyperhidrosis (35%), and anxiety (18%) [5]. Idiopathic hypertension and PIH can often progress to preeclampsia, which is associated with proteinuria, leg edema, and extra weight gain during pregnancy. High uric acid, liver function abnormalities, and coagulopathies are more common in PIH and hyperglycaemia can be seen in either condition [6]. Cardiomyopathy during pregnancy or in early post-partum should also raise the index of suspicion for pheochromocytoma [7].One difficulty in distinguishing the two entities is that both plasma and urine metanephrines and catecholamine's can be elevated in PIH, as much as 1.6 to 2.6 fold in one study [8]. However, other studies have reported that catecholamine's are not elevated in normotensive pregnant women or preeclampsia [9]. It should be noted that some medications use...

Introduction: Glycemic control in surgical patients with diabetes is critical to their recovery. Residents play a significant role in the management of these patients and glucose control while inpatient. Surgery residents are not trained in diabetes management and there is a significant knowledge deficit of first year surgical residents with regard to perioperative and inpatient diabetes management. Methods: Together with the endocrinology team, we developed an inpatient diabetes management curriculum for incoming surgical residents. The session was incorporated into a larger 2-day intern preparation course given in anticipation of the start of residency. The course is taught by surgery attending physicians and surgical residents and is meant to prepare new interns for common problems that they will encounter on the patient floors. Results: The curriculum was highly rated by residents led to significantly greater comfort and versatility with the management of various types of insulin regimens in surgical patients. Discussion: This study demonstrates the effectiveness of a brief intervention in developing, managing and altering insulin regimens by surgical residents through a multidisciplinary approach. Our curriculum can be easily adopted for other learner groups including all other interns and medical students prior starting their clerkships. The materials created for the curriculum can be downloaded free of charge to be used by other programs.