Effects of rope skipping exercise on physical, cardiovascular fitness and exercise tolerance in adolescent students with moderate intellectual disability.

BACKGROUND: Adolescents with intellectual disabilities (ID) who live a sedentary lifestyle may lead to an increased risk of chronic cardiovascular disease in adulthood. The aim of this study is to investigate the effects of 8-week progressive rope skipping training on physical, cardiovascular fitness and exercise tolerance of high school students with moderate ID. METHODS: Thirty-four senior high school with ID (aged 15-18 years old) were randomised into experimental group received progressive skipping rope exercise (RS, n = 17) and control group no rope skipping exercise intervention group (CON, n = 17). The RS group were received progressive rope skipping exercise for 50 min each time, three times a week, for 8 weeks. The control group was not allowed to participate in intervention activities during the study period. The physical fitness, body composition, arterial stiffness index (ASI) and blood pressure were measured before and after the 8-week intervention. RESULTS: After the 8-week progressive skipping rope exercise intervention, the participants from the RS group increased in the 3-min step test, sit-up test, grip strength and sit and reach test, when compared to the baseline (P < 0.05). The RS group exhibited lower the area under curve of heart rate (HR) during post-exercise recovery (P < 0.05). The participants in the RS group showed significant decreases in systolic (SBP) and diastolic (DBP) blood pressure, mean arterial pressure (MAP) and HR when compared to the baseline (P < 0.05). Change SBP has moderate positive correlation with change ASI. CONCLUSIONS: The results of this experiment suggest that progressive rope skipping exercise might improve physical fitness and promote cardiovascular health, as well as enhance exercise tolerance for adolescent students with moderate ID.

A 5-year longitudinal follow-up study of serological responses to 23-valent pneumococcal polysaccharide vaccination among patients with HIV infection who received highly active antiretroviral therapy.

BACKGROUND: Long-term antibody responses to 23-valent pneumococcal polysaccharide vaccine (PPV) among HIV-infected patients receiving highly active antiretroviral therapy (HAART) are rarely investigated. METHODS: Antibody responses to three pneumococcal capsular polysaccharides [Pneumococcal polysaccharide (PPS) 14, 19F and 23F] were assessed among 169 HIV-infected patients who received HAART and 23-valent PPV. Patients were stratified into four groups according to CD4 count at vaccination: group 1, CD4<100 cells/microL (n=35); group 2, CD4 100-199 cells/microL (n=36); group 3, CD4 200-349 cells/microL (n=34); and group 4, CD4>or=350 cells/microL (n=64). The proportion of patients who achieved increases in antibody titres of twofold or greater from baseline values (responders) was compared among the four groups of patients for five consecutive years after vaccination. RESULTS: The proportion of responders to the three serotypes was significantly lower among patients in group 1 compared with those in the other three groups during yearly follow-up. Much faster loss of antibody responses was observed in group 1, although the rate of decline varied with the serotypes studied in the four groups. Compared with the nonresponders, more responders had CD4 counts >100 cells/microL at vaccination and achieved better virological suppression throughout the 5-year period, while the absolute increases of CD4 cell counts after HAART were not statistically significantly different. CONCLUSIONS: Despite continued increases in CD4 cell counts after HAART, the proportion of HIV-infected patients who maintained antibody responses to PPV declined significantly over the 5-year follow-up period, especially among those who had CD4 counts <100 cells/microL at vaccination and who failed to achieve virological suppression.

Calmodulin mediates calcium-dependent inactivation of N-methyl-D-aspartate receptors.

Ca2+ influx through N-methyl-D-aspartate (NMDA) receptors activates signal transduction pathways critical for many forms of synaptic plasticity in the brain. NMDA receptor-mediated Ca2+ influx also downregulates the gating of NMDA channels through a process called Ca2+-dependent inactivation (CDI). Recent studies have demonstrated that the calcium binding protein calmodulin directly interacts with NMDA receptors, suggesting that calmodulin may play a role in CDI. We report here that the mutation of a specific calmodulin binding site in the CO region of the NR1 subunit of the NMDA receptor blocks CDI. Moreover, intracellular infusion of a calmodulin inhibitory peptide markedly reduces CDI of both recombinant and neuronal NMDA receptors. Furthermore, this inactivating effect of calmodulin can be prevented by coexpressing a region of the cytoskeletal protein alpha-actinin2 known to interact with the CO region of NR1. Taken together, these results demonstrate that the binding of Ca2+/calmodulin to NR1 mediates CDI of the NMDA receptor and suggest that inactivation occurs via Ca2+/calmodulin-dependent release of the receptor complex from the neuronal cytoskeleton.

Refined crystal structures of "aged" and "non-aged" organophosphoryl conjugates of gamma-chymotrypsin.

"Aged" organophosphoryl conjugates of serine hydrolases differ from the corresponding "non-aged" conjugates in their striking resistance to nucleophilic reactivation. The refined X-ray structures of "aged" and "non-aged" organophosphoryl conjugates of gamma-chymotrypsin were compared in order to understand the molecular basis for this resistance of "aged" conjugates. "Aged" and "non-aged" crystalline organophosphoryl-gamma-chymotrypsin conjugates were obtained by prolonged soaking of native gamma-chymotrypsin crystals with appropriate organophosphates. Thus, a representative "non-aged" conjugate, diethylphosphoryl-gamma-chymotrypsin, was obtained by soaking native crystals with paraoxon (diethyl-p-nitrophenyl phosphate), and a closely related "aged" conjugate, monoisopropyl-gamma-chymotrypsin, was obtained by soaking with diisopropylphosphorofluoridate. In both crystalline conjugates, the refined structures clearly reveal a high occupancy of the active site by the appropriate organophosphoryl moiety within covalent bonding distance of Ser195 O gamma. Whereas in the "non-aged" conjugate both ethyl groups can be visualized clearly, in the putative "aged" conjugate, as expected, only one isopropyl group is present. There is virtually no difference between the "aged" and "non-aged" conjugates either with respect to the conformation of the polypeptide backbone as a whole or with respect to the positioning of the side-chains within the active site. In the "aged" conjugate, however, close proximity (2.6 A) of the negatively charged phosphate oxygen atom of the dealkylated organophosphoryl group to His57 N epsilon 2 indicates the presence of a salt bridge between these two moieties. In contrast, in the "non-aged" conjugate the DEP moiety retains its two alkyl groups; thus, lacking a negative oxygen atom, it does not enter into such a charge-charge interaction and its nearest oxygen atom is 3.6 A away from His57 N epsilon 2. It is suggested that steric constraints imposed by the salt bridge in the "aged" conjugate lie at the basis of its resistance to reactivation.

The depolarization response element in acetylcholine receptor genes is a dual-function E box.

All acetylcholine receptor subunit genes contain E boxes and are blocked by membrane depolarization. We have used transfected C2C12 myogenic cells to investigate the response, to electrical stimulation and KCl, of wildtype and mutant regulatory regions of the chick acetylcholine receptor alpha, gamma and delta subunit, and the mouse MLC genes. Point mutations revealed that E boxes function as activating elements targeted by the depolarization signal. These experiments suggest, and insertion of a depolarization response element into an unrelated promoter confirms, that plasma membrane depolarization switches the depolarization response element from an activating to a repressive mode.

Effect of bone area on spine density in Chinese men and women in Taiwan.

Areal bone mineral density (BMD), the quotient of bone mineral content (BMC) divided by the projectional bone area (BA), measured with dual-energy X-ray absorptiometers (DXA), is the most common parameter used today to evaluate spinal osteoporosis. To evaluate whether gender, age, weight, and height can determine spinal BA, and to compare BA and analyze its effects on spinal density in the two genders, we measured BA and BMC, and calculated areal BMD, and the bone mineral apparent density (BMAD = BMD/the square root of BA) of the L-2 to L-4 vertebrae of 604 female and 223 male Chinese volunteers from 20 to 70 years of age using a Norland XR-26 DXA. Standardized for height and weight, BA showed a relatively large variation and a significant increase with increasing age in both genders. On the other hand, BMC stayed unchanged in men > 50 years of age and decreased with aging in postmenopausal women. Younger men (< 51 years) had a much larger mean BA (by 15.5%) and larger mean BMC (only 10%) than that of age-matched women. As a result, younger men had a slightly and significantly lower areal BMD (by 7.1%) and a much lower BMAD (by 16%) (p < 0.0001 for both) than premenopausal women of similar age. Men had higher areal BMD and BMAD values than age-matched women only after age 50 years. Although taller body height, heavier weight, and increasing age were associated with a larger BA, these factors could not explain most of the interindividual variations in BA in both genders. Thus anteroposterior BA of lumbar vertebrae measured with DXA seems to affect the areal BMD and BMAD readings in the two genders. The larger BA caused a low BMAD and probably underestimated the true volumetric spine density in men.

Validation of pulmonary venous obstruction by electron beam computed tomography in children with congenital heart disease.

The purpose of this study was to explore the useful imaging findings of electron beam computed tomography (EBCT) for diagnosing pulmonary venous obstruction (PVO) in children with congenital heart disease. From July 1995 to March 1998, 17 children (9 girls and 8 boys, aged 7 days to 14 years and 9 months [median 3 months]) with the diagnosis of PVO were enrolled in this study. All images were obtained by EBCT at the end-diastolic phase of the cardiac cycle after administration of intravenous iodinated contrast medium. The findings of 25 EBCT studies were retrospectively analyzed by 2 radiologists and were correlated with echocardiography, angiocardiography, and surgical findings. Main findings on EBCT for PVO were (1) structural narrowing, (2) thickened interlobular septa, (3) peribronchovascular cuffing, and (4) ground-glass opacity of the alveoli. Structural narrowing along the course of the pulmonary venous drainage was the most important finding in all examinations (25 of 25). Lung parenchymal changes secondary to PVO included thickened interlobular septa (17 of 25), peribronchovascular cuffing (15 of 25), and ground-glass opacity of the alveoli (8 of 25). Thus, the combination of these findings provides very useful data for the definitive diagnosis of PVO. Characteristic electron beam computed tomographic findings can validate suspected PVO noninvasively.

Comparison of simultaneous dobutamine echocardiography and thallium-201 stress-reinjection single-photon emission computed tomography in predicting improvement of chronic myocardial dysfunction after revascularization.

Previous studies have shown that ultrasonic integrated backscatter is valuable in characterizing stunned myocardium. Recent investigations have demonstrated that resting cardiac cycle-dependent variation of integrated backscatter closely paralleled the contractile reserve in patients with chronic left ventricular ischemic dysfunction. The purpose of this study was to validate whether ultrasonic tissue characterization (UTC) compared with dobutamine stress echocardiography (DSE) and thallium-201 stress-reinjection single-photon emission computed tomography (Tl-SPECT) could predict reversible myocardial dyssynergy in patients with chronic coronary artery disease. Forty-eight patients with stable coronary artery disease underwent UTC, DSE, and Tl-SPECT simultaneously before successful coronary revascularization and were followed up with echocardiograms at rest >3 months later. Among the 58 investigated segments, the weighted amplitude, a composite parameter derived from the integrated backscatter power curve, was larger for those groups with greater functional recovery (p <0.001). For the persistent akinetic segments, the weighted amplitudes were small with large deviations of the nadir ratios that represented the asynchrony between the intramural contractile events and the global systole. Using the cut-off value 2.0 of the weighted amplitude, the sensitivity and specificity for predicting functional improvement after revascularization were both 82.8% (kappa = 0.66) and comparable to the sensitivity and specificity of DSE and Tl-SPECT. UTC, delineating the myocardial physical state and intramural contraction, can be a novel approach in predicting functional improvement of chronic dyssynergy after revascularization.

Usefulness of electron beam computed tomography in children with heterotaxy syndrome.

Children with heterotaxy syndrome frequently have complex cardiac and noncardiac malformations requiring detailed diagnostic evaluation for management planning. Direct delineation of these structures by electron beam computed tomography (EBCT) is validated as a means of diagnosis. From July 1995 to March 1997, 32 patients (16 girls, 16 boys) with clinically impressed heterotaxy syndrome were enrolled in this study. After evaluation by echocardiography, EBCT studies were performed. Interpretation of cardiac anomalies was performed by sequential analysis based on these cross-sectional images. The diagnoses were subsequently confirmed by angiocardiography and surgical findings. Twenty-eight patients had bilateral trifurcated bronchi, and most of these (24 of 28) did not have a spleen. Four patients had bilateral bifurcated bronchi, 2 patients had polysplenia, and the other 2 patients had a lobulated single spleen. We found that laterality could be identified by EBCT in all patients. Comparison of diagnostic yield between echocardiography, catheterization, and EBCT showed that EBCT is superior to echocardiography and catheterization in demonstration of pulmonary venous anatomy and presence of a very small rudimentary ventricle. In addition, associated visceral, bronchopulmonary, mediastinal, and intracardiac anomalies could all be clearly delineated by EBCT at the same time. Thus, EBCT is a promising complementary modality for an overall understanding of heterotaxy syndrome.

Reduced hypothalamic blood flow after radiation treatment of nasopharyngeal cancer: SPECT studies in 34 patients.

To determine the effect of cranial irradiation on hypothalamic blood flow, we performed 44 regional cerebral blood flow studies with 99mTc hexamethyl propyleneamine oxime (HMPAO) single-photon emission CT (SPECT) on four normal volunteers and 34 patients with pathologically proved nasopharyngeal cancer. Twenty-three men and 15 women, 30-65 years old, were divided into four study groups: group 1 served as a control and consisted of four normal volunteers and six patients studied prior to cranial irradiation; group 2 patients had cranial irradiation half a year before the SPECT study (n = 12, one from group 1); group 3 patients were irradiated 1 year before the study (n = 13, three from group 1 and two from group 2); and group 4 patients were irradiated at least 5 years before SPECT imaging (n = 9). Six patients were studied twice. Quantification of the 99mTc-HMPAO brain SPECT studies was done separately by three radiologists to obtain the hypothalamus/occipital (H/O) and hypothalamus/parasagittal (H/P) ratios. Endocrinologic studies were performed in all cases and the hypothalamus-thyrotroph-thyroid, hypothalamus-gonadotroph-testis (ovary), hypothalamus-lactotroph, hypothalamus-somatotroph, and hypothalamus-corticotroph-adrenal axes were evaluated separately. We determined that regional hypothalamic blood flow was reduced after cranial irradiation in patients with nasopharyngeal cancer. The H/O ratio of groups 3 and 4 did not differ from that of group 2 (one-half year after cranial irradiation). The H/O ratio was significantly reduced 6 months and 1 year after cranial irradiation; mean +/- SD = 0.5801 +/- 0.0829 (p less than .025), 0.5725 +/- 0.0791 (p less than .01) versus 0.6477 +/- 0.0458 before cranial irradiation, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Arterial blood pressure and blood lipids as cardiovascular risk factors and occupational stress in Taiwan.

BACKGROUND: This study is to determine whether occupational stress (defined as high psychological demands and low decision latitude on the job) is associated with increased blood pressure and abnormal level of blood lipids as cardiovascular risk factors. METHODS: We conducted a cross-sectional study at three work sites of 526 white-collar male workers aged 20 to 66 years without evidence of cardiovascular disease. Systolic, diastolic blood pressure, serum total, high-density lipoprotein cholesterol and plasma triglyceride were measured. Occupational stress index was derived from data collected in the job strain questionnaire. RESULTS: In multiple linear regression models, occupational stress index was significantly related to diastolic blood pressure and plasma triglyceride, after adjusting for age, education, smoking, and alcohol consumption. A higher occupational stress index was directly associated with higher systolic, diastolic blood pressure and higher level of plasma triglyceride. CONCLUSIONS: These data from a white-collar working population confirm independent relations between occupational stress defined in the job demand-control model and diastolic blood pressure observed in predominantly Western populations and extend the range of associations to plasma triglyceride than do previous studies.

Cerium nitrate-silver sulfadiazine cream in the treatment of burns: a prospective, randomized study.

In a prospective, randomized study of 34 patients with thermal burns, treatment with the topical agent Cerium nitrate-silver sulfadiazine was compared with therapy with silver sulfadiazine alone. Despite randomization, there was a significant difference in mean burn size, being larger in the silver sulfadiazine group. There was no significant difference between the two groups in clinical course, mortality, septic deaths, or quantitative microbiology of the burn wound. It is concluded that from these preliminary data no clearcut superiority for one cream over the other can be demonstrated at this time.

The value of 18F-fluorodeoxyglucose positron emission tomography with the additional help of tumor markers in cancer screening.

Cancer screening is a major healthcare issue. Screening modalities are constantly changing due to improvements in technology. Whole body positron emission tomography (PET) with 18F-fluoro-2 deoxy-D-glucose (FDG) and the additional help of the serum levels of tumor markers have been considered as non-invasive methods for cancer screening in asymptomatic subjects. A total of 1283 subjects underwent whole-body FDG PET studies with the additional help of the serum levels of tumor markers in our center for cancer screening. The final diagnoses were confirmed by other imaging modalities or pathological findings in subjects with positive FDG-PET findings, and follow-up for at least 6 months were held in subjects with negative FDG-PET findings. Among a total of 18 (1.4%) subjects with cancers, FDG-PET detected cancers in 15 (1.2%) subjects but with false negative studies in 3 subjects with hepatoma (AFP = 129.6 ng/ml), prostate cancer (PSA = 25.1 ng/ml), and breast cancer (CEA and CA-153 were normal). False-positive FDG-PET studies were found in 24 (1.9%) subjects. However, none had abnormal serum levels of tumor markers. Whole body FDG-PET with the additional help of tumor markers could reduce the false negative and false positive results of FDG-PET only.

Enzymatic responses to skin flap elevation following a delay procedure.

Alterations in enzyme activities of glucose metabolism were determined in the distal portion of the skin flaps of guinea pigs elevated following 3, 7, 14, or 21 days of the delay period. Hexokinase, pyruvate kinase, lactate dehydrogenase, and glucose 6-phosphate dehydrogenase activities were increased during the delay period, whereas isocitrate and malate dehydrogenases exhibited little alteration. Increases in glycolytic enzyme activities observed during the delay procedure were diminished in the flaps elevated during initial 3 days of the delay period, but were maintained or increased further in the flaps elevated at 7 to 21 days. Despite high levels of enzyme activities during the early period of the delay, the flaps elevated during this period exhibited partial necrosis with a low glucose level and decreased enzyme activities. It is concluded that tissue glucose level and its utilization are crucial factors for flap survival.

Adjunctive use of intravenous fluorescein in the tangential excision of burns of the hand.

The use of fluorescein as an aid to the differentiation of viable from nonviable tissue facilitates early tangential excision of hand burns. This technique, applied as part of an overall treatment program that includes immediate autografting with unexpanded meshed grafts and early mobilization, has resulted in excellent functional recovery from a potentially devastating injury.

Metabolic adaptations in delayed skin flaps. Glucose utilization and hexokinase activity.

The distribution of glucose and hexokinase activity was determined in the epithelial tissue of delayed bipedicled skin flaps in guinea pigs. The periods of "delay" were 1, 3, 7, 14, or 21 days. The flap survival was maximal (100% of the flap) when the flap elevation was performed either 7 or 14 days following the "delay" procedure. When the flap elevation was performed 1, 3, or 21 days following the "delay" procedure, the result was partial necrosis. A differential distribution of epithelial glucose was found within the bipedicled flaps. The lowest glucose level (30% of normal) was at a distance of 2 to 3.5 cm from the end of the caudal pedicle during the first day after the "delay" procedure. This decreased glucose content recovered toward normal levels during the later part of the "delay" period. The bipedicled flaps exhibited increased hexokinase activity during the 3-week period of the "delay," and the responses of hexokinase activity and tissue glucose levels to the "delay" procedure were reciprocal in the caudal half of the flaps.

Tissue glucose and lactate following vascular occlusion in island skin flaps.

Neurovascular island skin flaps were elevated in the right groin area of Sprague-Dawley female rats weighing from 200 to 250 gm. Survival rates of the flaps were determined following venous and/or arterial occlusions of the femoral vessels. All the flaps exhibited an 80 percent decrease in tissue glucose content and an increase in tissue lactate content 4 to 7 times normal during venous and/or arterial occlusion. In the groups occluded for 8 hours, venous occlusion resulted in loss of all the flaps; arterial occlusion yielded survival of 70 percent of the flaps; and occlusion of both vessels yielded survival of 30 percent of the flaps. The results indicate that venous occlusion is more detrimental to flap survival than arterial occlusion. Surviving flaps exhibited a glucose content of 3.5 times normal, and dying flaps exhibited a glucose content of 20 percent of normal and a lactate content of 5.1 times normal. The ratio of tissue lactate to glucose may serve as an index for tissue viability: normal flaps, 0.3, surviving flaps, 1.2, and dying flaps, 7.5.

Skin-flap metabolism in rats: oxygen consumption and lactate production.

Overall glucose metabolism was evaluated by measuring the rate of oxygen consumption (QO2) and lactate production in the pedicle skin flaps of rats. Skin flaps exhibited increases in QO2 and lactate production in vitro. The distal portion of the flap is characterized by a greater deposition of glucose to lactate during the initial 3 days following flap elevation. The contribution of glycolysis and of the oxidative pathways to glucose metabolism in skin flaps approximates that in normal skin on day 7 postoperatively.

Sagittal fractures of the maxilla and palate.

Sagittal fractures of the maxilla and palate are infrequent and can demonstrate significant instability with conventional methods of treatment. They require that rigid, horizontal stability of the dentition be obtained, as well as restoration of midface projection and height. The most effective and precise management has utilized a combination of open reduction and internal fixation at the piriform aperture and zygomatic buttress and posterior palate, use of a maxillary arch bar as a tension band, and utilization of a palatal splint.

Mechanisms of global support and posttraumatic enophthalmos: I. The anatomy of the ligament sling and its relation to intramuscular cone orbital fat.

The mechanisms of posttraumatic enophthalmos were evaluated to determine the interrelation between fat and ligaments in globe support. Anatomic studies demonstrate that the ligaments form an essential "sling" framework for the globe but are alone insufficient to maintain the globe's full forward position. Removal of extramuscular fat in cadavers and in patients undergoing blepharoplasty did not significantly change globe position. Loss of intramuscular cone fat (atrophy or displacement) in cadavers and patients produced enophthalmos. Fat atrophy is not a prominent feature in most patients with posttraumatic enophthalmos. Some loss of intramuscular cone fat from displacement outside the muscle cone is frequently present. The principal mechanism, however, of posttraumatic enophthalmos involves a displacement and change in the shape of orbital soft tissue. Loss of bone and ligament support permits posterior displacement and a reshaping of orbital soft tissue under the influence of gravity and the remodeling forces of fibrous scar contracture. The shape of the retrobulbar orbital contents changes from a modified cone to a sphere, and the globe sinks backward and downward. Given that the volume of orbital soft tissue is constant following trauma, procedures to restore the shape and position of the orbital soft tissue by mobilization and bone reconstruction will correct or significantly improve enophthalmos.