Here we show that the interplay between exercise training and dietary fat regulates myelinogenesis in the adult central nervous system. Mice consuming high fat with coordinate voluntary running wheel exercise for 7 weeks showed increases in the abundance of the major myelin membrane proteins, proteolipid (PLP) and myelin basic protein (MBP), in the lumbosacral spinal cord. Expression of MBP and PLP RNA, as well that for Myrf1, a transcription factor driving oligodendrocyte differentiation were also differentially increased under each condition. Furthermore, expression of IGF-1 and its receptor IGF-1R, known to promote myelinogenesis, were also increased in the spinal cord in response to high dietary fat or exercise training. Parallel increases in AKT signaling, a pro-myelination signaling intermediate activated by IGF-1, were also observed in the spinal cord of mice consuming high fat alone or in combination with exercise. Despite the pro-myelinogenic effects of high dietary fat in the context of exercise, high fat consumption in the setting of a sedentary lifestyle reduced OPCs and mature oligodendroglia. Whereas 7 weeks of exercise training alone did not alter OPC or oligodendrocyte numbers, it did reverse reductions seen with high fat. Evidence is presented suggesting that the interplay between exercise and high dietary fat increase SIRT1, PGC-1α and antioxidant enzymes which may permit oligodendroglia to take advantage of diet and exercise-related increases in mitochondrial activity to yield increases in myelination despite higher levels of reactive oxygen species.
Research Objectives: Efficient and effective care are essential component in the provision of health care and rehabilitation services. The Kaiser Foundation Rehabilitation Center (KFRC) is a global pioneer in offering 7-day per week rehabilitation treatment in the inpatient rehabilitation facility setting.The study investigated if the full rehabilitation service has led to the reduction of length of stay (LOS) while maintaining desirable patient outcomes. Design: A secondary data analysis is proposed, using the inpatient rehabilitation database from the Uniform Data System for Medical Rehabilitation. Setting: Inpatient rehabilitation hospital. Participants: The study group of 1,545 consecutive adult patients discharged between February 2014 and July 2015 after the implementation of 7-day per week treatment and the historical controls of 1,302 patients discharged between December 2011 and May 2013, when 6 day-per week treatment were offered. Interventions: 7-day per week treatment. Main Outcome Measure(s): LOS, FIMÒ gain, discharge to the community (%), and 30-day re-hospitalization (%). Results: The total study sample had an average age of 62.0 years (SDZ16.6), with 62.9% stroke, 12.1% spinal cord injury, 11.7% brain dysfunction, and 13.4% other impairment conditions. Multiple regression analysis was employed to compare the two 18-month windows before and after the 7-day per week treatment, there was a significant reduction in LOS (15.1AE0.4 vs. 16.3AE0.4 days, P<.0001), while an 18.7% increase in total number of patients treated. The patients motor and cognitional FIMÒ gains also increased, 21.1AE0.6 vs. 19.6AE0.5 and 6.5AE0.2 vs. 5.2AE0.2, respectively (P<.0001). There were no significant differences in discharge destination and 30-day readmission. Conclusions: We observed the reduction of LOS, the increase of total patients treated, and the increases in FIMÒ gains after the implementation of 7-day per week rehabilitation service.
Case:
A 12-year-old girl presented with a both-bone forearm fracture after a fall. Fracture healing occurred, but nerve injury was not addressed until 18 months after injury. Magnetic resonance imaging and electromyography yielded a median nerve injury, and she underwent nerve reconstruction with sural nerve grafting. She improved but continued to have deficits beyond her 1-year follow-up.
Conclusion:
Both-bone forearm fractures are a common fracture pattern with rare complications. Clinicians should have a high index of suspicion with persistent nerve symptoms and consider further investigation, given the importance of early nerve repair.
Arthrofibrosis of the knee is common in the setting of polytrauma, especially when early range of motion is limited by a patient’s medical status or willingness to participate in rehabilitation. It is clear that manipulation of the knee under anesthesia is an effective treatment for this condition and is considered a safe procedure with minimal risk to improve range of motion and participation in rehabilitation. Unfortunately, no procedure is without risk. The high risk of deep-vein thrombosis in this population means that many of these patients are on medications for prophylaxis and may alter their risk profile for certain procedures. The purpose of the current case study is to present a patient with post-traumatic knee arthrofibrosis on therapeutic anticoagulation for a deep-vein thrombosis who developed acute compartment syndrome after manipulation under anesthesia to highlight a rare but significant complication following this common procedure.
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