BACKGROUND:For patients in intensive care unit (ICU), mechanical ventilation is an effective treatment to survive from acute illness and improve survival rates. However, long periods of bed rest and restricted physical activity can result in side effects. This study aimed to investigate the feasibility of early rehabilitation therapy in patients with mechanical ventilation. METHODS:A randomized controlled trial was carried out. Sixty patients, with tracheal intubation or tracheostomy more than 48 hours and less than 72 hours, were admitted to the ICU of the Affiliated Hospital of Medical College, Qingdao University, from May 2010 to May 2012. These patients were randomly divided into a rehabilitation group and a control group. In the rehabilitation group, rehabilitation therapy was performed twice daily, and the training time and intensity were adjusted according to the condition of the patients. Early rehabilitation therapy included heading up actively, transferring from the supine position to sitting position, sitting at the edge of the bed, sitting in chair, transferring from sitting to standing, and ambulating bedside. The patient's body mass index, days to first out of bed, duration of mechanical ventilation, length of ICU stay, APACHE Ⅱ score, highest FiO2, lowest PaO2/FiO2 and hospital mortality of patients were all compared between the rehabilitation group and the control group. The differences between the two groups were compared using Student's t test. RESULTS:There was no significant difference in body mass index, APACHE Ⅱ score, highest FiO2, lowest PaO2/FiO2 and hospital mortality between the rehabilitation group and the control group (P>0.05). Patients in the rehabilitation group had shorter days to first out of bed (3.8±1.2 d vs. 7.3±2.8 d; P=0.00), duration of mechanical ventilation (5.6±2.1 d vs. 12.7±4.1 d; P=0.005) and length of ICU stay (12.7±4.1 d vs. 15.2±4.5 d; P=0.01) compared with the control group. CONCLUSION:Early rehabilitation therapy was feasible and effective in improving the outcomes of patients with mechanical ventilation.

To explore the adaptive mechanisms of plateau zokor (Myospalax baileyi) to the enduring digging activity in the hypoxic environment and of plateau pika (Ochotona curzoniae) to the sprint running activity, the functional differences of malate-aspartate shuttle system (MA) in liver of plateau zokor and plateau pika were studied. The ratio of liver weight to body weight, the parameters of mitochondria in hepatocyte and the contents of lactic acid in serum were measured; the open reading frame of cytoplasmic malate dehydrogenase (MDH1), mitochondrial malate dehydrogenase (MDH2), and the partial sequence of aspartate glutamate carrier (AGC) and oxoglutarate malate carrier (OMC) genes were cloned and sequenced; MDH1, MDH2, AGC and OMC mRNA levels were determined by real-time PCR; the specific activities of MDH1 and MDH2 in liver of plateau zokor and plateau pika were measured using enzymatic methods. The results showed that, (1) the ratio of liver weight to body weight, the number and the specific surface of mitochondria in hepatocyte of plateau zokor were markedly higher than those of plateau pika (P < 0.01 or P < 0.05), but the content of lactic acid in serum of plateau pika was significantly higher than that of plateau zokor (P < 0.01); (2) MDH1 and MDH2 mRNA levels as well as their enzymatic activities in liver of plateau zokor were significantly higher than those of plateau pika (P < 0.01 or 0.05), AGC mRNA level of the zokor was significantly higher than that of the pika (P < 0.01), while no difference was found at OMC mRNA level between them (P > 0.05); (3) mRNA level and enzymatic activity of MDH1 was significantly lower than those of MDH2 in the pika liver (P < 0.01), MDH1 mRNA level of plateau zokor was markedly higher than that of MDH2 (P < 0.01), but the activities had no difference between MDH1 and MDH2 in liver of the zokor (P > 0.05). These results indicate that the plateau zokor obtains ATP in the enduring digging activity by enhancing the function of MA, while plateau pika gets glycogen for their sprint running activity by increasing the process of gluconeogenesis. As a result, plateau pika converts the lactic acid quickly produced in their skeletal muscle by anaerobic glycolysis and reduces dependence on the oxygen.
Adaptation, Physiological ; physiology ; Adenosine Triphosphate ; metabolism ; Altitude ; Animals ; Aspartic Acid ; metabolism ; Cloning, Molecular ; L-Lactate Dehydrogenase ; analysis ; metabolism ; Lactic Acid ; blood ; Lagomorpha ; classification ; physiology ; Liver ; anatomy & histology ; physiology ; Malate Dehydrogenase ; genetics ; metabolism ; Malates ; metabolism ; Membrane Transport Proteins ; genetics ; metabolism ; RNA, Messenger ; genetics ; metabolism

Plateau zokor (Myospalax baileyi) is a subterranean mammal. Plateau zokor has high learning and memory ability, and can determine the location of blocking obstacles in their tunnels. Forkhead box p2 (FOXP2) is a transcription factor implicated in the neural control of orofacial coordination and sensory-motor integration, particularly with respect to learning, memory and vocalization. To explore the association of foxP2 with the high learning and memory ability of plateau zokor, the cDNA of foxP2 of plateau zokor was sequenced; by using plateau pika as control, the expression levels of foxP2 mRNA and FOXP2 protein in brain of plateau zokor were determined by real-time PCR and Western blot, respectively; and the location of FOXP2 protein in the brain of plateau zokor was determined by immunohistochemistry. The result showed that the cDNA sequence of plateau zokor foxP2 was similar to that of other mammals and the amino acid sequences showed a relatively high degree of conservation, with the exception of two particular amino acid substitutions [a Gln (Q)-to-His (H) change at position 231 and a Ser (S)-to-Ile (I) change at position 235]. Higher expression levels of foxP2 mRNA (3-fold higher) and FOXP2 protein (>2-fold higher) were detected in plateau zokor brain relative to plateau pika brain. In plateau zokor brain, FOXP2 protein was highly expressed in the cerebral cortex, thalamus and the striatum (a basal ganglia brain region). The results suggest that the high learning and memory ability of plateau zokor is related to the high expression levels of foxP2 in the brain.
Amino Acid Sequence ; Amino Acid Substitution ; Animals ; Brain ; metabolism ; Forkhead Transcription Factors ; metabolism ; Lagomorpha ; physiology ; Learning ; Memory ; RNA, Messenger

The plateau pika (Ochotona curzoniae) and plateau zokor (Myospalax baileyi) are specialized native species of the Qinghai-Tibetan plateau. The goal of this study was to examine physiological differences in skeletal muscle glycolysis and hepatic lactate metabolism between these two species. The partial sequence of pyruvate carboxylase (PC) gene was cloned and sequenced. The mRNA expression levels of PC and lactate dehydrogenases (LDH-A, LDH-B) were determined by real-time PCR. The enzymatic activity of PC was measured using malic acid coupling method. The concentration of lactic acid (LD) and the specific activities of LDH in liver and skeletal muscle of two species were measured. The different isoenzymes of LDH were determined by native polyacrylamide gel electrophoresis (PAGE). The results showed that, (1) LDH-B mRNA level in skeletal muscle of plateau zokor was significantly higher than that of plateau pika (P < 0.01), but no differences was found at LDH-A mRNA levels between them (P > 0.05); (2) PC, LDH-A and LDH-B mRNA levels in liver of plateau pika were significantly higher than those of plateau zokor (P < 0.01); (3) The LDH activity and concentration of LD in skeletal muscle and liver, as well as the PC activity in liver of plateau pika were significantly higher than those of plateau zokor (P < 0.01); (4) The isoenzymatic spectrum of lactate dehydrogenase showed that the main LDH isoenzymes were LDH-A4, LDH-A3B and LDH-A2B2 in skeletal muscle of plateau pika, while the main LDH isoenzymes were LDH-AB3 and LDH-B4 in skeletal muscle of plateau zokor; the main isoenzymes were LDH-A3B, LDH-A2B2, LDH-AB3 and LDH-B4 in liver of plateau pika, while LDH-A4 was the only isoenzyme in liver of plateau zokor. These results indicate that the plateau pika gets most of its energy for sprint running through enhancing anaerobic glycolysis, producing more lactate in their skeletal muscle, and converting lactate into glucose and glycogen in the liver by enhancing gluconeogenesis. As a result, the plateau pika has a reduced dependence on oxygen in its hypoxic environment. In contrast, plateau zokor derives most of its energy used for digging activity by enhancing aerobic oxidation in their skeletal muscle, although they inhabit hypoxic underground burrows.
Animals ; Glycolysis ; Hypoxia ; metabolism ; Isoenzymes ; metabolism ; L-Lactate Dehydrogenase ; metabolism ; Lactic Acid ; metabolism ; Lagomorpha ; physiology ; Liver ; enzymology ; Muscle, Skeletal ; enzymology ; Oxygen ; metabolism ; RNA, Messenger

Objective To investigate the effects of down-regulation of Beclin 1, which is an autophagy regulatory molecule, expression induced by RNA interference on the proliferation and apoptosis in skin fibroblasts of naked mole rat. Methods The expression levels of Beclin 1 were detected after starvation or H2 O2 treatment.The fibroblasts were transi-ently transfected with specific siRNA targeting Beclin 1 and then screened by real-time PCR and Western blot.Cell prolifer-ation and apoptosis were determined using CCK-8 detection kit and flow cytometry ( FCM ) .The expressions of related genes were detected by Western blot.Results The expression of Beclin 1 gene at mRNA and protein levels was signifi-cantly lower in fibroblasts of the naked mole rat.Starvation and H2 O2 treatment induced changes of the Beclin 1 expression. Inhibition of Beclin 1 gene expression can inhibit cell proliferation and induce early and late apoptosis.The protein levels of p53, BAX, Bcl2, LC3B, p-AKT and mTOR were reduced after transient transfection with Beclin 1-siRNA.Conclusions The expression of Beclin 1 in fibroblasts of naked mole rat are changed in response to starvation or H2 O2 stimulation.Inhi-bition of Beclin 1 gene expression can inhibit cell proliferation and induce apoptosis.Therefore, Beclin1 gene may play a regulatory role in autophagy, proliferation and apoptosis in the skin fibroblasts of naked mole rat.

OBJECTIVETo establish the visual patch clamp whole-cell recording technique and study the properties and functional significance of muscarinic receptor-mediated currents in rat medial vestibular nucleus neurons (MVNn).

METHODSBrain slices containing the MVN were prepared from fifteen Wistar rats. By combining infrared differential interference contrast (IR-DIC) technique and CCD-Camera system with visual patch clamp whole-cell recording technique, twenty healthy neurons were located and muscarinic receptor-mediated currents in rat MVNn were observed and analyzed.

RESULTSVisual patch clamp technique can be used to make direct localization and to make sure of active neuron. In MVNn, a comparison of the current-voltage relationships before and during the application of muscarine, which revealed an increase in the slope of the I-V curve and the reversal potential for this response lay at (-88.4 +/- 4.9) mV (x +/- s), indicates that the activation of muscarinic cholinergic receptors leads to a decrease in potassium current. The test in the voltage sensitivity of the muscarine-induced response, which showed that the effect had a linear current-voltage relationship and reversed at (-86.7 +/- 3.5) mV, indicates that the potassium current blocked by muscarine corresponds to the voltage-insensitive leak potassium current.

CONCLUSIONSVisual patch clamp technique, which was considered better than blind patch clamp technique, can improve the success of sealing process. By the analysis of muscarinic receptor-mediated currents, the data provide support that muscarinic cholinergic mechanisms play a prominent role in the modulation of the excitability of MVNn and also offer a new idea for the efficacy of anticholinergic drugs.

Animals ; Electrophysiological Phenomena ; Neurons ; physiology ; Patch-Clamp Techniques ; Rats ; Rats, Wistar ; Receptors, Muscarinic ; physiology ; Vestibular Nuclei ; physiology

OBJECTIVETo evaluate the clinical efficiency and safety of two-micron laser resection of the prostate-tangerine technique (TmLRP-TT) for the treatment of large-volume ( > 70 ml) prostate in patients with benign prostatic hyperplasia (BPH).

METHODSThis retrospective analysis included 80 BPH patients with the prostatic volume larger than 70 ml, all treated by TmLRP-TT. We comparatively analyzed the levels of hemoglobin and serum sodium before and after surgery, recorded intra- and post-operative com- plications, and followed up the patients at 6 and 12 months after operation for International Prostate Symptom Score (IPSS), quality of life (QOL), maximum flow rate (Qmax), and postvoid residual urine volume (PVR).

RESULTSAll the operations were successfully completed. The mean hemoglobin decreased (0.68 +/- 0.43) g/dl intraoperatively, but no apparent reduction was observed in serum sodium. Lower urinary tract symptoms were relieved significantly in all the cases. At 12 months after surgery, IPSS was decreased by 73.89% as compared with the baseline (20.03 +/- 6.9 vs 5.23 +/- 3.59), QOL by 64.55% (4.09 +/- 1.19 vs 1.45 +/- 1.36), and PVR by 79.30% (97.31 +/- 57.90 vs 20.14 +/- 24.20 ml), while Qmax increased by 140.42% ([8.04 +/- 3.62] vs [19.33 +/- 3.28] ml/s). The incidence of complications was low either intraoperatively or during the 12 months after operation.

CONCLUSIONTmLRP-TT is a safe and effective surgical endoscopic approach to the treatment of large-volume prostate in BPH patients.

Aged ; Follow-Up Studies ; Humans ; Laser Therapy ; methods ; Male ; Middle Aged ; Prostatic Hyperplasia ; surgery ; Retrospective Studies ; Transurethral Resection of Prostate ; methods ; Treatment Outcome

OBJECTIVETo investigate the effect of potential spinal growth on the posterior-only spinal instrumentation of adolescent idiopathic scoliosis (AIS).

METHODSFrom June 2003 to October 2007, 40 patients received posterior-only spinal instrumentation. Group of open triradiate cartilage (Group A) included 16 female AIS patients with mean age of 11.8, and group of closed triradiate cartilages (Group B) covered 24 female AIS patients with mean age of 13.7. The mean preoperative Cobb angles of Group A and B were 53.3° and 49.6° respectively, and the mean kyphosis in the sagittal plane was 27.7° and 27.8° respectively.

RESULTSThe post-operative Cobb angles were 22.2° (Group A) vs. 20.7° (Group B) (P = 0.34) with correction rate of 58.3% (Group A) vs. 57.7% (Group B) (P = 0.83). The mean Cobb angles at final follow-up were 24.8° (Group A) vs. 21.1° (Group B) (P = 0.05) with the correction loss of 5.3% (Group A) vs. 1.0% (Group B) (P = 0.01). In the sagittal plane, the average post-operative kyphosis was 22.5° (Group A) vs. 23.9° (Group B) (P = 0.49) with correction of 5.2° (Group A) vs. 3.9°(Group B) (P = 0.63). The mean kyphosis at final follow-up was 20.8°(Group A) vs. 24.7°(Group B) (P = 0.04) with the correction loss of -1.7° (Group A) vs. 0.8°(Group B) (P = 0.01). Group A showed obvious correction loss in the coronal plane and decrease of kyphosis in the sagittal plane. Adding on phenomenon was found in 2 cases with Lenke type I with selected fusion in Group A, but not in Group B.

CONCLUSIONSAlthough similar post-operative correction is found in AIS patients with OTRC or CTRC, the loss of correction and "adding on phenomenon" are more likely to happen in patients with OTRC.

Adolescent ; Child ; Female ; Follow-Up Studies ; Humans ; Postoperative Complications ; Retrospective Studies ; Scoliosis ; surgery ; Spinal Fusion ; adverse effects ; methods ; Treatment Outcome

OBJECTIVETo investigate whether initial bone mineral status acts as a predictor factor in evaluating the early outcome of brace treatment in adolescent idiopathic scoliosis (AIS) girls.

METHODSSeventy-seven girls with AIS, aged 10 - 15 years old, were included in this study. A standardized bracing protocol was performed in these girls, and the early outcomes of brace treatment were evaluated at over-1-year follow-up. Girls with a progressed scoliosis and those with a non-progressed scoliosis were identified. The associations between the outcome and the indices before bracing, including age, menstrual status, Risser grade, bone mineral density (BMD) status, curve magnitude and curve pattern were assessed using univariate analysis. A multiple Logistic stepwise regression was used to determine the risk factors in curve progression in AIS girls treated with brace treatment.

RESULTSThere were 16 girls (21%) with a progressed scoliosis and 61 girls (79%) with a non-progressed scoliosis, respectively. In the girls with a progressed scoliosis, higher ratios of subjects were found with pre-menarchal status (chi(2) = 9.628, P = 0.004), lower Risser grade (chi(2) = 4.565, P = 0.037), main thoracic scoliosis (chi(2) = 4.009, P = 0.045), a larger curve (chi(2) = 1.685, P = 0.194), as well as osteopenia (chi(2) = 3.828, P = 0.050), as compared with those with a non-progressed scoliosis. During brace treatment, besides pre-menarchal status, a larger Cobb angle, and a main thoracic scoliosis, osteopenia (OR = 5.362, P = 0.022) was identified as the risk factor in curve progression in AIS girls, as revealed by the multiple Logistic regression analysis.

CONCLUSIONSOsteopenia might be an independent risk factor in the curve progression during brace treatment. The analysis of initial BMD status before bracing may help to predict the outcome of brace treatment.

Adolescent ; Bone Density ; Braces ; Child ; Female ; Humans ; Prognosis ; Retrospective Studies ; Scoliosis ; physiopathology ; therapy ; Treatment Outcome

OBJECTIVETo retrospectively review the clinical features and treatment strategy of lumbar disc herniation in adolescents initially misdiagnosed as idiopathic scoliosis.

METHODSFrom 1998 to 2007, nineteen adolescents with lumbar disc herniation were admitted to our hospital. All of them presented a scoliotic curve as their first complaint. There were 10 males and 9 females with the age ranged from 14 to 20 years. The disc herniation located at L(4,5) in 10 patients, at L(5)S(1) in 7, and at L(4)-S(1) in 2. The Cobb angle ranged from 23 degrees to 38 degrees . The distance from the C(7) plumb line to the central sacral line averaged 4.7 cm. All the patients underwent conventional open discectomy, followed by a pelvic traction for 3 weeks. A cast fixation for one month was recommended for further correction of scoliosis if the curve improvement was not obvious.

RESULTSFourteen (73.7%) patients had a disc herniation at the convex side of lumbar curve, and 5 (26.3%) patients had a disc herniation at the concave side, which showed a marginal statistical correlation between the side of the disc herniation and the direction of lumbar curve (P = 0.07). Leg pain and numbness disappeared in the 19 patients after surgical decompression. After the pelvic traction for 3 weeks postoperatively, the Cobb angle reduced to 14 degrees, with the mean distance from the C(7) plumb line to the central sacral line of 2.2 cm. At a mean follow-up of 21 months, neither the recurrence of back pain and leg pain nor the loss of spontaneous scoliosis correction was found.

CONCLUSIONSCare should be taken to the diagnosis of lumbar disc herniation in adolescents with spine deformity as their chief complaint. Satisfactory clinical results can be achieved by early diagnosis and proper treatment.

Adolescent ; Adult ; Diskectomy ; methods ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc Displacement ; complications ; diagnosis ; surgery ; Lumbar Vertebrae ; Male ; Retrospective Studies ; Scoliosis ; etiology ; Traction