The present study was conducted to examine whether gene expression of the insulin signaling pathway is activated in response to a single bout of exercise. Adult male rats underwent a single bout of treadmill exercise for 90 min at 22 m/min on a 6°C incline. The animals were sacrificed immediately after exercise or after a predetermined post-exercise recovery period of up to 48 h, and the level of mRNA in the gastrocnemius muscle was measured by the RT-PCR method. Immediately after exercise, mRNA levels of insulin signal transduction intermediates in the gastrocnemius muscle were lower in the exercise group than in the controls. Following this tendency reduction, mRNA levels of insulin receptor, IRS-1, PI 3-kinase, SH-PTP2 and Nck were higher in the exercise group than in the controls. The levels of PI 3-kinase mRNA was significantly higher in the exercise group than in the controls within 6 h after exercise, while levels of mRNA for insulin receptor, IRS-1, SH-PTP2 and Nck were significantly higher in the the exercise group than in the controls at 48 h after exercise. Gene expression of oncogenes was also affected by a single bout of exercise. Levels of c-fos and c-myc mRNA were significantly higher than in the controls immediately after exercise, while the level of c-jun mRNA was lower in the exercise group at 3 h after exercise. Thus, a single bout of exercise affects the gene expression of insulin signal transduction pathway intermediates and oncogenes in rat gastrocnemius muscle. The present findings suggest that an exercise-induced adaptive increase of skeletal muscle insulin sensitivity is a cumulative effect of a single bout of exercise on the gene expression of insulin signal transduction pathway intermediates.

A woman in her 60s was being treated for diabetes and hypertension but had impaired activities of daily living (ADL) due to severe obesity (150 kg). She was transported to the emergency department because of disturbance of consciousness in August 201X. Imaging findings showed decreased permeability of the whole right lung field. She was intubated and started on ceftriaxone plus levofloxacin for severe infection with respiratory failure. Erysipelothrix rhusiopathiae was detected in blood cultures, leading to a diagnosis of sepsis due to a large pressure ulcer on the posterior aspect of the thigh. We switched levofloxacin to clindamycin and continued medical treatment, and she was extubated on the 10th day of illness. However, type 2 respiratory failure was prolonged because of alveolar hypoventilation due to obesity and she required noninvasive positive pressure ventilation. Also, she had difficulty getting out of bed due to obesity, disuse syndrome, and pressure ulcer. Cooperation among staff from many professions, including respiratory nursing, intensive care nursing, wound, ostomy and continence nursing, physical therapy, and nutrition management, led to improvement of ADL and weight loss (to 109 kg), allowing her to be transferred out of the intensive care unit.