RESUMO
Objective This study aims to evaluate the impact of early mobilization (EM) after pediatric liver transplantation in the pediatric intensive care unit (PICU). Design A 14-month prospective before and after study. Setting Multivalent PICU with 20 beds at a tertiary children's hospital. Patients A total of 57 patients aged younger than 16 years who received liver transplantation and were admitted to the PICU after surgery. Interventions EM project, a multifaceted framework for successful EM practice in the PICU focusing on a multidisciplinary team approach. Measurements and Main Results Compared with the period before the implementation of the EM project, there was a significant increase in the proportion of patients who received physical therapy in the PICU (43 vs. 97%, p < 0.001). Also, there were greater median numbers of physical therapy per eligible patient (0 vs. 3, p < 0.001). Moreover, patients achieved higher functional mobility level within a shorter time. Length of intubation, PICU stay, and hospital stay were not significantly different. There were no adverse events or deaths. Conclusion Using an EM project process, the proportion of patients who received physical therapy after liver transplantation increased. However, there was no difference in the length of PICU or hospital stay. Our findings indicated that EM for pediatric patients who received liver transplantation was well tolerated and safe.
RESUMO
The retinoid X receptor (RXR) plays a critical role in transcriptional regulation via formation of an RXR homodimer or heterodimers with partner nuclear receptors. Despite the numerous beneficial effects, only a limited number of naturally occurring RXR agonists are known. In this report, two prenylated flavanones (1 and 2) isolated from Sophora tonkinensis were identified as new rexinoids that preferentially activated RXRs, relative to the retinoic acid receptor. The activities of 1 and 2 were the most potent among naturally occurring rexinoids, yet 2 orders of magnitude lower than the synthetic rexinoid bexarotene. Compounds 1 and 2 activated particular RXR heterodimers in a manner similar to bexarotene. A microarray assay followed by quantitative real-time polymerase chain reaction analyses on RNAs isolated from C2C12 myotubes treated with 1 or 2 demonstrated that they significantly increased mRNA levels of lipoprotein lipase, angiopoietin-like protein 4, and heme oxygenase-1. In contrast, bexarotene preferentially potentiated transcription of genes involved in lipogenesis and lipid metabolism such as sterol regulatory element-binding protein-1, fatty acid synthase, and apolipoprotein D by a liver X receptor agonist. In this study, we have demonstrated that two newly identified naturally occurring rexinoids, 1 and 2, possess properties different from bexarotene.