Efficacy of modified team-based learning in a flipped classroom for an acute-care nursing course: A mixed-methods study.

AIM: To test a modified team-based learning approach on undergraduate learning outcomes in an acute-care nursing course in Japan. DESIGN: Mixed-methods. METHODS: Students worked on three simulated cases, engaged in pre-class preparation, completed a quiz and engaged in group work. We collected data on team approach, critical-thinking disposition and time spent in self-learning at four time-points: before the intervention and after each simulated case. Data were analysed using a linear mixed model, a Kruskal-Wallis test and a content analysis. DATA SOURCES: We recruited nursing students attending a mandatory course in acute-care nursing at University A. Data were collected at four time-points between April and July 2018. Data from 73 of 93 respondents were analysed. RESULTS: Team approach, critical thinking and self-learning all increased significantly across the time-points. Four categories emerged from students' comments: 'achievement of teamwork', 'sense of learning efficacy', 'satisfaction with course approach' and 'issues related to course approach'. The modified team-based learning approach led to improvements in team approach and critical-thinking disposition across the course. CONCLUSION: Incorporating team-based learning into the curriculum not only contributes to team building but is also effective as a teaching method to improve student learning. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The intervention led to improvements in team approach and critical-thinking disposition across the course. The educational intervention also led to more time for self-learning. Future studies should include participants from various universities and evaluate the outcomes over a longer period.

X-ray Diffraction Analysis to Explore Molecular Traces of Eccentric Contraction on Rat Skeletal Muscle Parallelly Evaluated with Signal Protein Phosphorylation Levels.

We performed X-ray diffraction analyses on rat plantaris muscle to determine if there are strain-specific structural changes at the molecular level after eccentric contraction (ECC). ECC was elicited in situ by supramaximal electrical stimulation through the tibial nerve. One hour after a series of ECC sessions, the structural changes that remained in the sarcomere were evaluated using X-ray diffraction. Proteins involved in cell signaling pathways in the muscle were also examined. ECC elicited by 100, 75, and 50 Hz stimulation respectively developed peak tension of 1.34, 1.12 and 0.79 times the isometric maximal tetanus tension. The series of ECC sessions phosphorylated the forkhead box O proteins (FoxO) in a tension-time integral-dependent manner, as well as phosphorylated the mitogen-activated protein kinases (MAPK) and a protein in the mammalian target of rapamycin (mTOR) pathway in a maximal tension dependent manner. Compared to isometric contractions, ECC was more efficient in phosphorylating the signaling proteins. X-ray diffraction revealed that the myofilament lattice was preserved even after intense ECC stimulation at 100 Hz. Additionally, ECC < 75 Hz preserved the molecular alignment of myoproteins along the myofilaments, while 75-Hz stimulation induced a slight but significant decrease in the intensity of meridional troponin reflection at 1/38 nm-1, and of myosin reflection at 1/14.4 nm-1. These two reflections demonstrated no appreciable decrease with triple repetitions of the standard series of ECC sessions at 50 Hz, suggesting that the intensity decrease depended on the instantaneous maximal tension development rather than the total load of contraction, and was more likely linked with the phosphorylation of MAPK and mTOR signaling proteins.

Protective Effects of Voluntary Exercise on Hepatic Fat Accumulation Induced by Dietary Restriction in Zucker Fatty Rats.

Weight control based on dietary restriction (DR) alone can cause lipid metabolic failure and progression to fatty liver. This study aimed to investigate the effect of exercise on preventing DR-induced hepatic fat accumulation in Zucker fatty (ZF) rats by focusing on the relationship between adipose tissue lipolysis and hepatic fat uptake. Six-week-old male ZF rats were randomly assigned to obese, DR, or DR with exercise (DR + Ex) groups. The DR and DR + Ex groups were fed a restricted diet, with the latter also undergoing voluntary exercise. After 6 weeks, hepatic fat accumulation was observed in the DR group, whereas intrahepatic fat was markedly reduced in the DR + Ex group. Compared with the obese (Ob) group, the DR group exhibited 2.09-fold expression of hepatic fatty acid translocase (FAT)/CD36 proteins (p < 0.01) and 0.14-fold expression of hepatic fatty acid-binding protein (FABP)1 (p < 0.01). There were no significant differences between the DR + Ex group and the Ob group. FAT/CD36 and hepatic triglyceride (TG) expression levels were strongly positively correlated (r = 0.81, p < 0.001), whereas there was a strong negative correlation between FABP1 and hepatic TG expression levels (r = -0.65, p < 0.001). Our results suggest that hepatic fat accumulation induced by DR in ZF rats might be prevented through exercise-induced modifications in FAT/CD36 and FABP1 expression.

Characterization of fat metabolism in the fatty liver caused by a high-fat, low-carbohydrate diet: A study under equal energy conditions.

The pathology of fatty liver due to increased percentage of calories derived from fat without increased overall caloric intake is largely unclear. In this study, we aimed to characterize fat metabolism in rats with fatty liver resulting from consumption of a high-fat, low-carbohydrate (HFLC) diet without increased caloric intake. Four-week-old male Sprague-Dawley rats were randomly assigned to the control (Con) and HFLC groups, and rats were fed the corresponding diets ad libitum. Significant decreases in food intake per gram body weight were observed in the HFLC group compared with that in the Con group. Thus, there were no significant differences in body weights or caloric intake per gram body weight between the two groups. Marked progressive fat accumulation was observed in the livers of rats in the HFLC group, accompanied by suppression of de novo lipogenesis (DNL)-related proteins in the liver and increased leptin concentrations in the blood. In addition, electron microscopic observations revealed that many lipid droplets had accumulated within the hepatocytes, and mitochondrial numbers were reduced in the hepatocytes of rats in the HFLC group. Our findings confirmed that consumption of the HFLC diet induced fatty liver, even without increased caloric intake. Furthermore, DNL was not likely to be a crucial factor inducing fatty liver with standard energy intake. Instead, ultrastructural abnormalities found in mitochondria, which may cause a decline in ß-oxidation, could contribute to the development of fatty liver.

Effects of habitual exercise and dietary restriction on intrahepatic and periepididymal fat accumulation in Zucker fatty rats.

BACKGROUND: Habitual exercise and dietary restriction are commonly recommended to prevent or ameliorate obesity and lifestyle-related diseases, including fatty liver. This study investigated the effects of habitual exercise and dietary restriction on hepatic triglyceride (TG) levels, serum leptin levels, and histological adipocyte size in periepididymal adipose tissue from Zucker fatty (ZF) rats. METHODS: Six-week-old male ZF rats were randomly assigned to one of three groups: sedentary (Sed), sedentary and dietary restriction (Sed + DR), and training and dietary restriction (Tr + DR). Male Zucker lean (L) rats were used as control animals. All rats had access to water and the allowed quantity of food ad libitum. The rats in the Sed + DR and Tr + DR groups were fed a 30% restricted diet, while those in the Tr + DR group exercised voluntarily on a wheel ergometer. After 12 weeks, the rats were sacrificed for a histological examination of their liver and periepididymal adipose tissue. Hepatic and serum TG, serum total cholesterol, glutamic-oxaloacetic transaminase, glutamic-pyruvic transaminase, free fatty acid, and leptin levels were also measured. RESULTS: The hepatic TG levels were significantly higher in the Sed + DR group than in the L (P < 0.001) and Sed (P < 0.05) groups. By contrast, the hepatic TG levels in the Tr + DR group were significantly lower than those in the Sed (P < 0.05) and Sed + DR (P < 0.001) groups, but not significantly different from the L group values. The periepididymal adipocytes were significantly larger in the Sed, Sed + DR, and Tr + DR groups than in the L group (P < 0.001) and were significantly smaller in the Tr + DR group compared to the Sed and Sed + DR groups (P < 0.001). CONCLUSIONS: Our results suggest a relationship between lipid metabolism and the size of adipose cells in ZF rats. Exercising plays an important role in decreasing hepatic TG levels, serum leptin levels, and the size of adipose cells.

Is the ipsilateral cortex surrounding the lesion or the non-injured contralateral cortex important for motor recovery in rats with photochemically induced cortical lesions?

PRIMARY OBJECTIVE: To determine whether the ipsilateral cortex surrounding the lesion or the non-injured contralateral cortex is important for motor recovery after brain damage in the photochemically initiated thrombosis (PIT) model. RESEARCH DESIGN: We induced PIT in the sensorimotor cortex in rats and examined the recovery of motor function using the beam-walking test. METHODS AND PROCEDURES: In 24 rats, the right sensorimotor cortex was lesioned after 2 days of training for the beam-walking test (group 1). After 10 days, PIT was induced in the left sensorimotor cortex. Eight additional rats (group 2) received 2 days training in beam walking, then underwent the beam-walking test to evaluate function. After 10 days of testing, the left sensorimotor cortex was lesioned and recovery was monitored by the beam-walking test for 8 days. MAIN OUTCOMES AND RESULTS: In group 1 animals, left hindlimb function caused by a right sensorimotor cortex lesion recovered within 10 days after the operation. Right hindlimb function caused by the left-side lesion recovered within 6 days. In group 2, right hindlimb function caused by induction of the left-side lesion after a total of 12 days of beam-walking training and testing recovered within 6 days as with the double PIT model. The training effect may be relevant to reorganization and neuromodulation. Motor recovery patterns did not indicate whether motor recovery was dependent on the ipsilateral cortex surrounding the lesion or the cortex of the contralateral side. CONCLUSION: The results emphasize the need for selection of appropriate programs tailored to the area of cortical damage in order to enhance motor functional recovery in this model.

Adiponectin is regulated differently by chronic exercise than by weight-matched food restriction in hyperphagic and obese OLETF rats.

This study was intended to investigate the effects of chronic exercise on blood adiponectin level. Male Otsuka Long Evans Tokushima Fatty (OLETF) rats (26 weeks old) were divided to undergo either regular 12-week wheel running exercise (EX) or to have food restriction (FR) that resulted in body weight reduction similar to that in EX. Both EX and FR induced similar reductions in body weight, abdominal fat volume and plasma leptin concentration compared with ad libitum control. At the end of the study, although plasma adiponectin level was increased in FR, the adiponectin level did not change in EX. Plasma testosterone level was higher in EX than in either of the other two groups. A significant inverse relationship existed between plasma levels of adiponectin and testosterone for all groups. Our results suggested that 12-week voluntary wheel running exercise induces different effects on plasma adiponectin level than does food restriction, despite similar reduction in body weight, fat tissue mass and plasma leptin concentration. We speculate that the elevated plasma testosterone concentration might offset any hyperadiponectinemic effect of body weight and fat volume reduction in exercising rats.

Facilitated beam-walking recovery during acute phase by kynurenic acid treatment in a rat model of photochemically induced thrombosis causing focal cerebral ischemia.

We previously demonstrated the presence of activated areas in the non-injured contralateral sensorimotor cortex in addition to the ipsilateral sensorimotor cortex of the area surrounding a brain infarction, using a rat model of focal photochemically induced thrombosis (PIT) and functional magnetic resonance imaging. Using this model, we next applied gene expression profiling to screen key molecules upregulated in the activated area. RNA was extracted from the ipsilateral and contralateral sensorimotor cortex to the focal brain infarction and from the sham controlled cortex, and hybridized to gene-expression profiling arrays containing 1,322 neurology-related genes. Results showed that glycine receptors were upregulated in both the ipsilateral and contralateral cortex to the focal ischemic lesion. To prove the preclinical significance of upregulated glycine receptors, kynurenic acid, an endogenous antagonist to glycine receptors on neuronal cells, was administered intrathecally. As a result, the kynurenic acid significantly improved behavioral recovery within 10 days from paralysis induced by the focal PIT (p < 0.0001), as evaluated with beam walking. These results suggest that intrathecal administration of a glycine receptor antagonist may facilitate behavioral recovery during the acute phase after brain infarction.

Histochemical characterization of skeletal muscles in rats with photochemically-induced stroke.

PRIMARY OBJECTIVE: The aim of this study was to assess skeletal muscle showing a complete functional recovery after induction of pan-necrotic lesions in the right sensorimotor cortex in rats. RESEARCH DESIGN AND METHODS: A focal lesion of the right sensorimotor cortex was induced photochemically. Rats were divided into three groups; the sham-operated group (CON), Stroke (RB) and Stroke plus severed right sciatic nerve (RBD). MAIN OUTCOMES AND RESULTS: All RB rats showed complete functional recovery in the beam-walking test within 10 days. The score of CON rats was 7 for 21 days. The wet weight of the soleus muscle (SOL) only in the RB and RBD was significantly greater than in the CON. The cross-sectional area of type I fibres was increased in SOL. CONCLUSIONS: It was concluded that the functional recovery was mainly due to increased wet weight and cross-sectional area of type I SOL fibres, which probably reflected the functional reorganization and neuromodulation in the non-damaged contralateral sensorimotor cortex and ipsilateral sensorimotor cortex lateral to the lesion identified in a previous study.

Long-term exercise down-regulates leptin receptor mRNA in the arcuate nucleus.

The purpose of this study was to investigate the effects of exercise on blood leptin concentrations and expression of leptin receptor subtype-b (Ob-Rb) mRNA in the arcuate nucleus of hypothalamus (ARC). Male Wistar rats (26 weeks old) underwent regular wheel exercise for 12 weeks. The expression of Ob-Rb mRNA in the ARC decreased at the end of the study period despite reductions of abdominal fat-pad weight and serum leptin concentration. Serum 1,5-anhydroglucitol levels were higher in exercising rats, suggesting lower serum insulin levels in exercising rats. Our results suggested that 12-week wheel exercise reduced the expression of Ob-Rb mRNA in the ARC probably through improvement in insulin resistance.

Influence of isoflurane concentration and hypoxia on functional magnetic resonance imaging for the detection of bicuculline-induced neuronal activation.

Our present study shows that transient changes in relative cerebral blood volume (rCBV) induced by stimulation with bicuculline under six different conditions of anesthesia can be detected with high spatial resolution functional magnetic resonance imaging (fMRI). Bicuculline was administered at a low dose to induce neural activation, and no seizure activity was noted. Of the six conditions, the maximal reaction to bicuculline was observed under 1.5% isoflurane in 60% nitrogen and 40% oxygen. Our results imply that the rCBV changes under this level of isoflurane anesthesia with body temperature maintained at 37.5 degrees C are probably suitable for further fMRI studies.

Effects of prolonged voluntary wheel-running on muscle structure and function in rat skeletal muscle.

We examined the effects of prolonged voluntary wheel-running on skeletal muscle functional and/or structural characteristics in rats. Male Sprague-Dawley rats (5 weeks old) were divided into five groups: (1) 15W-SC, sedentary controls housed in normal plastic cages until age 15 weeks; (2) 15W-VE, housed in a voluntary-exercise (running-wheel) device equipped with housing space until age 15 weeks; (3) 35W-SC, housed in normal plastic cages until age 35 weeks; (4) 35W-VE, housed in the voluntary-exercise device until age 35 weeks, and (5) 35W-MVE, housed in normal plastic cages until age 15 weeks, then in the voluntary-exercise device from age 16 weeks to 35 weeks ("middle age"). At the end of each rat's experimental period, the plantaris muscle was dissected from each hindlimb for analysis of the muscle's functional and/or structural characteristics. Total running distance was similar in 15W-VE and 35W-VE, both being significantly greater than in 35-MVE. The percentage of type IIb myosin heavy chain isoform was significantly lower in each VE group than in the corresponding SC group. This shift from type IIb was significantly greater for 35W-VE than for the other VE groups, which were similar to each other. The cross-sectional area of type IIx fibers was significantly greater in 35W-VE than in 35W-SC, but this was not true for 15W-VE versus 15W-SC or for 35W-MVE versus 35W-SC. No significant difference in citrate synthase activity was detected between any VE group and the corresponding SC group. These results suggest that a prolongation of voluntary wheel-running leads to some advantageous enhancements of functional and/or structural characteristics in rat plantaris.

Behavioural recovery correlated with MRI in a rat experimental stroke model.

PRIMARY OBJECTIVE: To characterize a necrotic lesion using MRI and motor recovery using behavioural methods. RESEARCH DESIGN: Stroke model based on two steps: (1) development of a lesion using MR-imaging parameters and (2) behavioural recovery. METHODS AND PROCEDURES: Seventy male Sprague-Dawley rats were used. A focal lesion of the right sensorimotor cortex was induced photochemically. MAIN OUTCOMES AND RESULTS: The maximum volume of oedema and the lesion damage was reached by approximately 6 hours. In the lesion area, the apparent diffusion coefficient (ADC) increased from 6 hours, then decreased from 24 hours. All animals spontaneously recovered motor function by day 10, despite the continued presence of the cortical lesion. CONCLUSIONS: The results show that this model mimics a core lesion, as well as the late phase in a human stroke episode. This model might be used for longitudinal study of the basic mechanisms of motor recovery.