Ventilatory support in the intensive care unit

This article focuses on the functional features of positive-pressure ventilators, the modes of invasive and non-invasive mechanical ventilation, and the main ventilator settings. It also highlights the potential complications of mechanical ventilation, the basic principles of weaning, and the pathophysiological basis of patient-ventilator dyssynchrony.     

Prevention of Descending Pneumonia in Rats with Perflubron-delivered Tobramycin

OBJECTIVES: Patients undergoing emergent endotracheal intubation are at increased risk for developing pneumonia. Although numerous strategies have been investigated to reduce ventilator-associated pneumonia (VAP), the incidence of VAP and its associated mortality remains high. This investigation tested the hypothesis that LiquiVent (Alliance Pharmaceutical, San Diego, CA-LV) delivered antibiotics (via spray-dried microspheres-SDM) would improve survival in a rat model of descending gram-negative pneumonia. METHODS: Wistar rats (n = 49) were randomized to receive prophylaxis with 1). nothing (controls); 2). intramuscular (IM) tobramycin, 3). intratracheal LV plus SDM shells (vehicle), 4). intratracheal LV plus SDM shells plus IM tobramycin, or 5). intratracheal LV plus SDM containing 1 mg/kg of tobramycin. All interventions were given 24 hours before a bacterial challenge with 10(8) colony-forming units of intratracheal Klebsiella pneumoniae. Mortality at ten days was the sole outcome measure. Survival in individual groups was compared with controls by Fisher's exact test with Bonferroni correction for multiple comparisons. RESULTS: All animals in the control group died of pneumonia within ten days of bacterial inoculation (0% survival). Prophylaxis with either IM tobramycin or SDM vehicle plus IM tobramycin provided no protection (0% survival). This is in sharp contrast to the cohort receiving pretreatment with tobramycin-containing SDM delivered via LV, in which 60% of the animals survived to study completion (p < 0.05). CONCLUSIONS: Prophylaxis with SDM containing antibiotics delivered in low-dose LV provided significant protection in a rat model of descending gram-negative pneumonia. These data support the hypothesis that perfluorocarbon-delivered intratracheal antimicrobials may be useful in the prevention of VAP.     

The Web of Internet Dependency: Search Results for the Mental Health Professional

Some researchers speculate that as many as 10% of users worldwide suffer from “problematic” use of the internet, possibly stemming from an internet dependency. Research is in its early stages, making it an uncertain issue for mental health professionals. This paper provides: (1) a critical review of research on problematic internet use for the mental health and addictions professional; and (2) practical implications, including suggestions on treatment and prevention, given its uncertain clinical classification.     

Cutaneous postural vasoconstriction is modified by exogenous but not endogenous female hormones in young women

Previously reported attenuation of skin postural vasoconstriction in women during the luteal menstrual cycle phase may be due to a progesterone-mediated decrease in myogenic or veno-arteriolar (VAR) mechanisms. Skin perfusion was measured in the shin and foot dorsum by Laser Doppler Fluxometry during leg dependency that increased vascular transmural pressure below (myogenic constriction only) and above (myogenic and VAR) the 25 mmHg threshold for activation of the VAR, and during venous distension to activate the VAR alone (cuff inflation to 50 mmHg). In six young women with normal menstrual cycles, vasoconstrictor responses to all interventions did not differ between days 7–13 (follicular) and 18–23 (luteal) of the normal menstrual cycle when progesterone levels were low and at their peak respectively. In eight women taking combined oral contraceptives (OC) and tested during pill consumption days, reductions in foot skin perfusion were smaller (P = 0.05) than in the luteal phase of the normal cycle for leg dependency below (−36.9 ± 5.2% OC vs. −52.5 ± 7.8% luteal, mean ± S.E.M.) and above (−43.7 ± 3.4% OC vs. −55.1 ± 4.8% luteal) the VAR threshold, and for venous distension (−53.1 ± 2.6% OC vs. 66.4 ± 5.5% luteal). In women with normal menstrual cycles, impaired postural vasoconstriction may be confined to those who experience pre-menstrual symptoms rather than a direct effect of endogenous hormones. Reduced vasoconstriction in the dependent foot during OC use is consistent with the known vasodilator action of exogenous hormones and its long-term effects     

Klinefelter's Syndrome: Hypogonadism,abnormal carbohydrate metabolism. Is it a result of biotin deficiency?

The aetiology of Klinefelter's Syndrome is not known. The causative factor(s) must explain the hypogonadism, low androgen levels, the disordered carbohydrate metabolism and the commonly associated psychiatric conditions. A biotin deficient/dependent state can account for the above. A biotin deficient Klinefelter's Syndrome patients with the above is described. The possible role of biotin in the primary, secondary and tertiary prevention of Klinefelter's Syndrome needs further research.     

鸟牌呼吸机故障及排除三例

呼吸机在国内外医院广泛应用，详细介绍鸟牌呼吸机在临床上3例常见的故障和排除方法。     

The proliferative capacities of popliteal lymph node lymphocytes and of their functionally distinct T-cell subpopulations from young-adult and old mice

Young adult and old mice were immunized by footpad injection of dinitrophenyl-conjugated bovine gamma-globulin (DNP-BGG) in complete Freund's adjuvant. A comparison of lymph node weight and total number of nucleated cells per lymph node as a function of time after antigen injection demonstrated a significantly greater absolute increase in lymph node weight and peak number of nucleated cells per lymph node in young-adult than in old animals. However, as judged by this increase in total nucleated cells, other than being delayed in old mice, the magnitude of these in situ proliferative responses appeared comparable for young-adult and old mice. That is, the antigen-stimulated to non-stimulated cell ratio did not differ significantly between young-adult and old animals. This was because lymph nodes from old animals prior to antigen injection always weighed less and had fewer numbers of nucleated cells compared with young-adult animals. Therefore, the in vitro cellular proliferative response of three T-cell-enriched lymphocyte subpopulations from young-adult and old mice was further characterized. This was done by measuring [3H]thymidine incorporation following antigen- (DNP-BGG)- or mitogen-[phytohemagglutinin (PHA) or Concanavalin A (Con A)]-induced proliferation and assessing their quantitative and/or qualitative requirements for macrophages. In contrast to the markedly reduced proliferation of the two T-cell subpopulations from popliteal lymph nodes which respond to PHA and Con A in old animals primed 21-days earlier with DNP-BGG, antigen-induced in vitro cellular proliferation of the small T-cell subset in old mice specifically responsive to the immunizing antigen DNP-BGG always responded as well as, if not better than, cells from young-adult mice.     

Human motor compensations for thixotropy‐dependent changes in muscular resting tension after moderate joint movements

Aim: This study on healthy subjects explores history‐dependent changes in the resting tension of relaxed wrist muscles after moderate joint excursions and the motor control consequences of these changes during voluntary wrist joint position maintenance. Methods: Integrated surface electromyogram (IEMG) was recorded from wrist extensor/flexor muscles. Angular position and torque were recorded from the wrist joint. Changes in wrist flexor muscle resting tension were sensed by a force transducer pressed against the tendons. Results: Consecutive stepwise changes (7.5°) in wrist joint position (within the dorsiflexed range) were either imposed on relaxed subjects or actively performed while the subjects under visual guidance tried to mimic the passive movements. In relaxed subjects, passive joint torque resistance at a given steady dorsiflexed position either gradually declined or rose depending on the direction of the previous transition movements. In corresponding voluntary contraction experiments, the IEMG amplitude from position holding wrist extensors was found to vary in a similar way as the passive torque resistance. Further, there was a strong correlation between history‐dependent changes in extensor IEMG amplitude and stress alterations exhibited by the relaxed antagonist flexors. The above described, slowly subsiding post‐movement mechanical and motor adaptations were accelerated by brief forceful cocontractions of the forearm muscles. Conclusion: Moderate stepwise changes in joint position are sufficient to induce history‐dependent after‐effects in passive muscular resting tension, after‐effects which during voluntary position holding are effectively compensated for by the motor control system.     

Glucagon-induced somatostatin release from perifused rat hypothalamus: calcium dependency and effect of cysteamine treatment

Somatostatin (SRIF) release from rat hypothalamus was investigated in vitro with a perifusion system. Glucagon (1 microM) and high potassium concentrations (56 mM) stimulated SRIF release in a calcium-dependent manner. Pretreatment of the rat with cysteamine (30 mg/100 g body weight, 7 h earlier) significantly reduced SRIF release from the hypothalamus in glucagon- and high potassium-stimulated states as well as in the basal state. SRIF release from rat hypothalamus was also stimulated by both dibutyryl cyclic AMP (1 mM) and theophylline (3 mM). These results suggest that glucagon, acting in a calcium-dependent manner and possibly through the adenylate cyclase-cyclic AMP system, stimulates SRIF release from rat hypothalamus and that cysteamine treatment reduces releasable SRIF in the hypothalamus.