Home respiratory support for patients in the home care setting can range from simple oxygen supplementation, non-invasive ventilation, to home ventilation support via a tracheostomy. A home care doctor may not be able to know everything about ventilator support, but he should be familiar with the medical care of patients requiring one, and know who to refer to should patients require ventilator adjustments or troubleshooting. The management of such patients is challenging outside the hospital setting and usually requires a multidisciplinary team effort from the doctors, nurses, medical social worker, respiratory therapists, vendor of the ventilator and, most importantly, dedicated and well-trained caregivers. This article will cover two other important topics that Family Physicians should know when managing patients who require home respiratory support: home oxygen therapy and tracheostomy care.

ObjectiveTo investigate the understanding of stroke among stroke patients and promote the direction of rehabilitation.MethodsA survey was carried out among 80 stroke patients by questionnaire.Results42.5% of those patients knew nothing about the risk factor of stroke and the rate of right behavior related to maintain health was relatively low. The rate of satisfaction with rehabilitative direction was only 66.3% though 98% patients had experienced that direction.ConclusionIntensive and continuous direction of rehabilitation is necessary for the stroke patients. Comprehensive health education should be given to those patients to ensure their best self care and improve their quality of living.

BACKGROUND: This study aimed to observe the effect of early goal directed therapy (EGDT) on tissue perfusion, microcirculation and tissue oxygenation in patients with septic shock. METHODS: Patients with early septic shock (<24 hours) who had been admitted to the ICU of Zhongda Hospital Affiliated to Southeast University from September 2009 through May 2011 were enrolled (research time: 12 months), and they didn't meet the criteria of EGDT. Patients who had one of the following were excluded: stroke, brain injury, other types of shock, severe heart failure, acute myocardial infarction, age below 18 years, pregnancy, end-stage disease, cardiac arrest, extensive burns, oral bleeding, difficulty in opening the mouth, and the onset of septic shock beyond 24 hours. Patients treated with the standard protocol of EGDT were included. Transcutaneous pressure of oxygen and carbon dioxide (PtcO2, PtcCO2) were monitored and hemodynamic measurements were obtained. Side-stream dark field (SDF) imaging device was applied to obtain sublingual microcirculation. Hemodynamics, tissue oxygen, and sublingual microcirculation were compared before and after EGDT. If the variable meets the normal distribution, Student's t test was applied. Otherwise, Wilcoxon's rank-sum test was used. Correlation between variables was analyzed with Pearson's product-moment correlation coefficient method. RESULTS: Twenty patients were involved, but one patient wasn't analyzed because he didn't meet the EGDT criteria. PtcO2 and PtcCO2 were monitored in 19 patients, of whom sublingual microcirculation was obtained. After EGDT, PtcO2 increased from 62.7±24.0 mmHg to 78.0±30.9 mmHg (P<0.05) and tissue oxygenation index (PtcO2/FiO2) was 110.7±60.4 mmHg before EGDT and 141.6±78.2 mmHg after EGDT (P<0.05). The difference between PtcCO2 and PCO2 decreased significantly after EGDT (P<0.05). The density of perfused small vessels (PPV) and microcirculatory flow index of small vessels (MFI) tended to increase, but there were no significant differences between them (P>0.05). PtcO2, PtcO2/FiO2, and PtcCO2 were not linearly related to central venous saturation, lactate, oxygen delivery, and oxygen consumption (P>0.05). CONCLUSION: Peripheral perfusion was improved after EGDT in patients with septic shock, and it was not exactly reflected by the index of systemic perfusion.

Occupational Health Services ; methods ; organization & administration

AIM:To evaluate the repeatability of axial length (AL) and anterior chamber depth (ACD) obtained by A scan ultrasonography, and to compare AL and ACD obtained by A scan with those obtained by IOL Master.METHODS:Two hundred and fifty-seven cataract eyes of 170 patients were included.IOL Master and A scan were performed for each eye.Five measurements of IOL Master and 3 measurements of A scan were obtained.All the tested eyes were divided into 5 groups according to AL obtained by A scan:Group A (2129mm, 21 eyes).Cronbach's Alpha coefficient and intraclass correlation coefficient (ICC) were applied to evaluate the repeatability of AL and ACD obtained by A scan.Paired t test and Pearson correlation coefficient were used to analyze the differences and correlations of AL and ACD obtained by the 2 devices, respectively.Bland-Altman plots were presented to analyze the agreements of AL and ACD obtained by the 2 devices.RESULTS:All the Cronbach's Alpha and ICCs of AL and ACD values were more than 0.98.The differences of AL values between A scan and IOL Master were-0.11±0.08mm in Group A,-0.15±0.10mm in Group B,-0.19±0.15 mm in Group C,-0.29±0.16mm in Group D and-0.45±0.29mm in Group E, respectively (all P<0.01).The differences of ACD values between A scan and IOL Master were-0.10±0.16mm in Group A,-0.06±0.13mm in Group B,-0.06±0.13mm in Group C,-0.19±0.10mm in Group D,-0.18±0.21mm in Group E, respectively (all P<0.01).In all groups, the AL and ACD values obtained by A scan and IOL Master presented good correlations (all r>0.89, all P<0.01).CONCLUSION:The AL and ACD values in cataract eyes obtained by A scan were repeatable.The AL and ACD values obtained by A scan were smaller than those obtained by IOL Master.With the increase of AL values, the differences of AL values between A scan and IOL Master increased.

Dermatitis, Occupational ; etiology ; Humans ; Trichloroethylene

Misdiagnosis and missed diagnosis are common in forensic appraisal of orbital fracture. Now imaging technology is very important for studying the forensic features of orbital fracture and evaluating the degree of injury. This article reviews the classification, pathogenesis and imaging diagnosis of orbital fracture. It may do some help to forensic appraisal of orbital fracture.
Forensic Medicine ; Humans ; Magnetic Resonance Imaging ; Orbital Fractures/diagnosis* ; Tomography, X-Ray Computed

AIMTo increase the cognition of cerebellar functions and the knowledge of neuroimmunology, the effect of cerebellar interposed nuclei (IN), one of three deep nuclei in cerebellum, on lymphocyte function was investigated.

METHODSKainic acid (KA) was microinjected into bilateral IN for lesions of neuronal bodies in the IN. Control rats was microinjected with saline into their IN. On days 8, 16 and 32 following the IN lesions, the lymphocyte number in the peripheral blood was measured by blood corpuscle counter. Meanwhile, lymphocyte proliferation induced by concanavalin A (Con A), cytotoxicity of natural killer (NK) cells against YAC-1 cells, and anti-SRBC IgM antibody in the serum were examined respectively by methyl-thiazole-tetrazolium (MTT) assay, flow cytometry and ELISA assay.

RESULTSThe lymphocyte number in the peripheral blood was significantly reduced on days 8, 16 and 32 following the effective lesions of the bilateral IN in comparison with that of control. The Con A-induced lymphocyte proliferation, the NK cell cytotoxicity to YAC-1 cells, and the titer of anti-SRBC IgM antibody in the serum, were all significantly attenuated on days 8, 16 and 32 following the effective lesions of the bilateral IN in comparison with those of control. There were not remarkable differences between the days 8, 16 and 32 in the decreased lymphocyte number and functions induced by the lesions of the bilateral IN.

CONCLUSIONEffective lesions of the cerebellar bilateral IN of rats cause an inhibition in lymphocyte number and functions of T, B and NK cells, strongly showing that the cerebellar IN can modulate lymphocyte functions.

Animals ; Cerebellar Nuclei ; immunology ; physiology ; Cerebellum ; immunology ; physiology ; Female ; Kainic Acid ; Killer Cells, Natural ; immunology ; Lymphocyte Count ; Lymphocytes ; immunology ; Male ; Microinjections ; Neuroimmunomodulation ; immunology ; Random Allocation ; Rats ; Rats, Sprague-Dawley

OBJECTIVEParkinson's disease (PD), a neurodegenerative disorder, has been reported to be associated with brain neuroinflammation in its pathogenesis. Herein, changes in peripheral immune system were determined to better understand PD pathogenesis and provide possible target for treatment of PD through improvement of immune disorder.

METHODS1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) was intraperitoneally injected into mice to prepare PD model. Expression levels of pro-inflammatory and anti-inflammatory cytokines and transcription factors of CD4+ T lymphocyte subsets in spleen and mesenteric lymph nodes and concentrations of the cytokines in serum were examined on day 7 after MPTP injection. Percentages of CD4+ T lymphocyte subsets were measured by flow cytometry.

RESULTSMPTP induced PD-like changes such as motor and behavioral deficits and nigrostriatal impairment. Expression levels of the pro-inflammatory cytokines including interferon (IFN)-γ, interleukin (IL)-2, IL-17 and IL-22, in spleen and mesenteric lymph nodes were upregulated and their concentrations in serum were elevated in PD progression. But, the concentrations of the anti-inflammatory cytokines including IL-4, IL-10 and transforming growth factor (TGF)-β were not altered in the two lymphoid tissues or serum of PD mice. In addition, expression of T-box in T cells (T-bet), the specific transcription factor of helper T (Th) 1 cells, was downregulated, but expression of transcription factor forkhead box p3 (Foxp3), the transcription factor of regulatory T (Treg) cells, was upregulated. In support of the results, the numbers of IFN-γ-producing CD4+ cells (Th1 cells) were reduced but CD4+CD25+ cells (Treg cells) were elevated in both the lymphoid tissues of PD mice.

CONCLUSIONPD has a dysfunction of peripheral immune system. It manifests enhancement of proinflammatory response and CD4+ T cell differentiation bias towards Treg cells away from Th1 cells.

1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine ; Animals ; CD4-Positive T-Lymphocytes ; pathology ; Cell Differentiation ; Cytokines ; blood ; Disease Models, Animal ; Flow Cytometry ; Forkhead Transcription Factors ; metabolism ; Interferon-gamma ; blood ; Interleukin-10 ; blood ; Interleukin-17 ; blood ; Interleukin-2 ; blood ; Interleukin-4 ; blood ; Interleukins ; blood ; Lymph Nodes ; cytology ; Lymphocyte Activation ; Mice ; Parkinson Disease ; immunology ; physiopathology ; Spleen ; cytology ; T-Box Domain Proteins ; metabolism ; T-Lymphocytes, Regulatory ; Th1 Cells ; Transforming Growth Factor beta ; blood

OBJECTIVEWe used an animal model of collagen-induced arthritis (CIA) to study changes and roles of tyrosine hydroxylase (TH) expressed by CD4+ T cell subsets, and then explore the relationship between CD4+ T cell subset-derived catecholamines and inflammatory responses in CIA.

METHODSThirty-six male DBA/1 mice were randomly divided into control group, CIA model group (day 35) and CIA model group (day 55) (n = 12). CIA model was induced by type II collagen (CII) in DBA/1 mice. On the 35th and 55th day following primary immunization, the joints of the mice were observed for clinical score of swelling and the level of anti-CII IgG antibody in serum was examined. Expression of specific transcription factors and cytokines of Th1, Th17, Th2 and Treg cells and TH in mesenteric lymph nodes was measured by means of Western blot. The changes of TH expressed by CD4+ T cell subsets in mesenteric lymph nodes were determined by flow cytometry.

RESULTSClinical score and anti-CII antibody level increased in CIA compared with that in intact mice. Specific transcription factors and cytokines expressed by Th1 and Th17 cells were upregulated and cytokines expressed by Th2 and Treg cells were downregulated in mesenteric lymph nodes in CIA mice. Expression of TH was upregulated and the increased expression of TH in CD4+ T cells was attributed to Th1 and Th17 cells in mesenteric lymph nodes of CIA.

CONCLUSIONThe increase in catecholamines from CD4+ T cell subsets in mesenteric lymph nodes of CIA may be related to inflammatory alleviation in CIA progression.

Animals ; Arthritis, Experimental ; immunology ; CD4-Positive T-Lymphocytes ; enzymology ; Collagen Type II ; adverse effects ; Cytokines ; metabolism ; Disease Models, Animal ; Lymph Nodes ; immunology ; Male ; Mice ; Mice, Inbred DBA ; T-Lymphocyte Subsets ; immunology ; Transcription Factors ; metabolism ; Tyrosine 3-Monooxygenase ; metabolism