Bacterial endotoxins (LPS) are not only the major constituents of the outer membrane of Gram-negative (G -) bacteria, but also the toxic determinants for G - infection, which is closely related to human health and the development of diseases. Pattern recognition receptors (PRR) have been considered to be the important initial steps for cellular recognition of LPS and consequent initiation of LPS responses. Scavenger receptor, CD14, toll-like receptors, ?2-integrins and L-selectin have been shown to be involved in the clearance of LPS or LPS activation. LPS receptor may be a complex of multiple components. Different individual response to LPS is related to gene background. The gene polymorphism of LPS receptors and LPS-induced cytokines have been shown to contribute to LPS sensitivity, susceptibility and prognosis of sepsis.

Objective To compare the therapeutic effect of endoscopic variceal ligation (EVL) and β-blockers plus isosorbide mononitrate (ISMN) in prevention of esophageal varieeal re-bleeding. Methods The randomized clinical trials (RCTs) on EVL and β-blockers plus ISMN for the prevention of esophageal varieeal re-bleeding were searched, and only the results from those with Jadad score higher than 3 were eval-uated with RevMan 4. 2 software for odds ratio (OR) with 95% confidence intervals (95%C1). Analysis of sensitivity was performed on the quality of the data and publication bias was investigated with funnel plots. Results Four trials matched the criteria were recruited including 504 cases with a follow-up from 8 to 25 months. There was no significant difference in rates of re-bleeding (OR =0. 93, 95% CI =0. 41 ～ 2. 11 ; P = 0. 87), re-bleeding due to esophageal varices (OR = 0. 68, 95% CI = 0. 19 ～ 2. 37 ; P = 0. 54), therapy-re-lated adverse effects (OR = 1.12, 95% CI =0. 75 ～ 1.67, P = 0. 57), severe adverse events (OR = 0. 89, 95% CI =0. 47 ～ 1.67, P = 0. 71), bleeding-related mortality (OR = 2. 11, 95% CI = 0. 88 ～ 5.08, P = 0. 10), or overall mortality (OR = 1.46, 95% CI = 0. 95 ～ 2. 24, P = 0. 09) between EVL and β-blockers plus ISMN groups. However, a trend towards lower bleeding-related mortality and overall mortality favored drug therapy. There was no heterogeneity found in the outcomes apart from re-bleeding (P = 0. 003) or re-bleeding from esophageal varices (P <0. 0001). The result of sensitivity analysis remained statistically sta-ble. Symmetric funnel plots showed there was no evidence of publication bias. Conclusion EVL and β-blockers plus ISMN show an equivalent efficacy and safety for the prevention of esophageal variceal re-bleed-ing. There is a trend towards lower bleeding-related mortality and overall mortality in drug therapy. But EVL is free from drug-related side effects, and its adverse events are similar to those of drug therapy. Thus, either of the two approaches can be used as the first choice for prophylaxis of re-bleeding of esophageal varices.

With the continuous improvement in weaponry, especially explosive weapons, blast injury has become one of the most common war injuries. Underwater blast injury is a common war injury during combat around islands or fighting for beach-head. The wounding effects of underwater blast wave and the characteristics of underblast injury are quite different from that produced in air due to special physical features of water and the underwater pressure. We have investigated the injurious effects of underwater blast wave and its dose-effect relationship. In addition, some protective measures have been tested to prevent or alleviate underwater blast injury. All of these primary results have provided both experimental and theoretical foundation evidence for further researches in respect to the diagnosis, emergency care and protection against underwater blast injury.

Objective To review the application of trauma and injury severity score (TRISS) and a severity characterization of trauma (ASCOT) in the outcome evaluation of trauma care and their research advances.Data sources Both Chinese- and English-language literature searched by using MEDLINE/CD-ROM (1985-1996) and Index of Chinese-Language Literature (1985-1996).Study selection Over fifty papers and reviews published over the past ten years were selected.Results and conclusion TRISS can be employed for different purposes, that is, preliminary outcome-based evaluation (PRE) and definitive outcome-based evaluation (DEF). TRISS is a method which is now the most extensively used for the outcome evaluation of trauma. Even so, it still has some shortcomings, e.g., trauma can not be given the weights that should be given, and the section of age is too simple. ASCOT is also a physiologic and anatomic combined method for the evaluation of injury severity and outcome. To some extent, this method obviates the shortcomings of TRISS in the calculation of probability of survival (Ps) with injury severity score (ISS). Therefore, ASCOT is considered to be superior to TRISS in the evaluation of Ps. However, TRISS is still now more extensively used than ASCOT just because ASCOT was recently developed.

BACKGROUND: There exists a close relationship between the expression of scavenger receptor(SR) and CD14 and the endotoxic lung injury. To further detect the expression of these two receptors and their relationship is helpful to disclose the receptor mechanism of lung inflammatory disequilibrium so as to provide a possible theoretical foundation for sepsis therapy.OBJECTIVE: To investigate the expression of CD14 and SR in murine alveolar macrophages and their effect after trauma and traumatic endotoxin challenge.DESIGN: Randomized and controlled experimental study.SETTING: Fourth Laboratory(a state key laboratory), Trauma, Burns and Combined Injury, the Research Institute of Field Surgery, Daping Hospital,the Third Military Medical University of Chinese PLA.MATERIALS: The experiment was completed in the Research Institute of Field Surgery of Daping Hospital of the Third Military Medical University of Chinese PLA from August 2001 to November 2001. Totally 63 Kunming mice with murine alveolar macrophages were used in the experiment.METHODS: The experimental animals were randomly divided into three groups including control group, trauma group and traumatic endotoxin challenge group. The model mice with both femur fracture and endotoxin challenge were used. Endotoxin at a dose of 5 mg/kg was injected one hour after fracture via tail vein and the dynamic expression of CD14 and SR in murine alveolar macrophages (AM) was detected.RESULTS: Six hours after trauma, the expression of CD14 and that of SR in AM showed the tendency of up-regulation and down-regulation respectively. Furthermore, the post-traumatic endotoxin challenge induced CD14up-regulation and SR down-regulation drastically. Correlation analysis indicated that CD14 and SR showed a significantly negative relationship.CONCLUSION: The study suggested that the dual modulation of CD14 and SR in AM is possibly related with the change of "self-control" to "out of control" of inflammatory reactions in the lungs after endotoxic challenge. The dual regulation of the effective antagonists CD14 and SR are helpful in further understanding lung injury and its repairing mechanism.

Circulating tumor cells are found in patients’ peripheral blood circulation, which are the key to tumor metastasis and recurrence. We can achieve early diagnosis and treatment of the tumor if we could detect circulating tumor cells through peripheral blood vessels. It is of great significance to improve the prognosis of hepatocellular carcinoma patients by studying the relationships between hepatocellular carcinoma and peripheral circulating tumor cells. Hence, this paper reviews the recent progress in the detection and clinical application of circulating tumor cells in hepatocellular carcinoma in order to provide references for clinical and related studies.

Objective To study the expression law of zinc finger protein A20 mRNA of mouse liver tissues in the process of trauma with lipopolysaccharide (LPS) infection. Methods A total of 95 healthy mice (either sex, from Kunming, Yunnan province) with a mean body weight of 21 g (18-24 g) were randomized into 4 groups: control, trauma only (Group A), LPS only (Group B) and trauma plus LPS (Group C). The models with closed fracture of bilateral spines as well as endotoximia were made. The expression characteristics of zinc finger protein A20 mRNA of liver tissues were measured by reverse transcription-polymerase chain reaction (RT-PCR) and all result data expressed as total gray ratio of A20 mRNA to GAPDH mRNA (?s). Results In the control group, the A20 mRNA expressed at a low level. There was low expression of zinc finger protein A20 in the Group A at various time points, with no significant difference compared with the control group. After LPS infection, the expression of A20 mRNA in the Group B was elevated more obviously than that in the control group at 0.5 hour, reached peak during 0.5-2 hours and decreased after 2 hours. But expression of A20 mRNA at each time point was higher in the Group B than that in the Group A. In the Group C, after LPS infection, the expression of A20 mRNA was elevated more significantly than that in other two groups 0.5 hour, reached the highest level during 0.5-2 hours, much higher than that in the Group B (P

The purpose of our study is to determine whether the slow Ca2 + channel blocker, nicardipiae, could prevent or reduce the cardiac to-xicity induced by ouabain. The guinea pig heart in vivo and vitro perfusion of the isolated heart were used for the study . The results demonstrated that nicardipine ( i .v .50?g? kg-1') could significantly increase the doses of ouabain induced arrhythmias and death(P

To explore the kinetics of LBP/CD14 system in patients with hemodialysis, and further to analyse its role in (he development of systemic inflammation response based on the changes of plasma endotaxin, TNF and IL-6 levels in patients with uremia treated with hemodilysis. Methods Sixteen patients with end-stage renal failure (8 cases with hemodialysis, 8 cses without hemodialysis) were selected for this study. limulus amebocyte lysate chromogenic assay, ELISA and cell in situ hybridization were used to determine the changes in endotoxin, LBP, TNF and IL-6 levels in plasma, and expression of CD14 mRNA in the monocytes. Results (l)Plasma LBP levels in patients with hemodialysis were significantly higher than those in patients without hemodialysis. The expression of CD14 mRNA in the monocytes in patients with hemodialysis was also more obvious. Both of them incresed much more in hemodialysis. (2)Plasma endotoxin levels in patients with hemodialysis, though being significantly higher than in patients without hemodialysis, were in low-level (61.7 ? 10.6 pg/ml). (3) Plasma TNF and IL-6 levels were markedly increased in patients with hemodialysis, which were significantly correlated with plasma LBP levels. Conclusion LBP/CD14 system in patients with hemodialysis is markedly up-regulated, which might be the important mechanism for low-level endotoxemia to exert its effects in hemodialysis.

The uncontrolled inflammatory response is commonly seen and plays an important role in the pathogenesis of post traumatic complications. Bacterial endotoxin or lipopolysaccharide (LPS) is one of the most potent mediators in inducing uncontrolled inflammatory response.Several LPS associated receptors have been identified on the surface of monocytes/macrophages, which are shown to be initial factors to recognize LPS and trigger inflammatory response. Scanvenger receptor (SR), CD14and toll like receptor4 (TLR4)act as high affinity or sensitive LPS receptorS. SRhas been shown to be responsibe for clearance and neutralization of LPS by macrophages,whereas CD14 and TLR4have been foand to be important receptors mediating cell activation induced by LPS. TLR2, ? 2 integrin and L selectin have been considered to be low affinity LPSreceptors, and they may play an important catalytic role in LPS induced pro inflammatory and anti inflammatory responses as "secondary LPS receptors". In addition, TLR4 might be the receptor pathway through which LPS could activate blood endothelial cells. Down regulation of defense receptors such as SR and up regulation of excitatory receptors such as CD14, TLR4, and TLR2might be an important mechanism to turn monocytes/macrophages into effector cells (release of pro and anti inflammatory mediators) during the course of infection. Further investigation of transmembrane LPS signaltransduction mechanisms. might help discover some novel strategies for effective control or modulation of uncontrolled inflammatory response.