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.

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.

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.

ObjectiveTo explore the relative model for psychological resources and poverty attributions of migrant workers in adversities in the aim of understanding poverty problems in China Mainland and find out the factors for tolerance in systematic unjustness.MethodsChina Mainland Poverty Attribution Questionnaire (CMPAQ) ,Simple Coping Style Questionnaire(SCSQ),Resilience Scale (CD-RISC),Locus of Control subscale (I_E) and Thrift subscale (T_E) of CPAI-2 were used upon 398 rural migrant workers,in which 301 were valid.Results ①Deseription statistic: compared with national model,migrant workers score higher in positive coping style subsonic(1.92±0.45),and lower in negative coping style subscale (1.46±0.66),lower in CD-RISC (60.98±14.26) ,higher in I_E subscale (5.53±2.17) and lower in T_E subscale 7.48 + 1.77) ; Scores on the subscales of CMPAQ were separately overburden-fate (3.25±0.90),institution-unjustness (3.45±1.03),personal-competence(3.72±0.78),personal-quality (3.03±1.04),and geographical-environment (3.07±0.97).②Regress analysis:positive coping style can clearly positively predict personal-competence and personalquality attribution,while negative coping style can clearly positively predict all other factors.Resilience(CD-RISC)can clearly positively predict personal-competence attribution.The standard regression coefficient (β) of inner locus of control (I_E) to overburden-fate was negatively significant,while that of thrift (T_E) to all the poverty attribution factors was not significant.All variables other than negative coping style couldn' t clearly predict institution-unjustness attribution.ConclusionThe study discovered some positive psychological resources in rural migrant workers.These resources help them attribute poverty to personal competence but stand in tolerance for institutional unjustness.

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.

Objective To investigate the protective effects of thalidomide on rats with acute necrotizing pancreatitis (ANP) and its mechanism. Methods Fifty four SD rats were randomly divided into the three groups; ANP group, thalidomide group and control group with 18 rats in each group. The model of ANP was induced by retrograde injection of 5% sodium taurocholate into the bili-pancreatic duct. Rats in thalidomide group received thalidomide 200 mg/kg body weight gastric lavage 1 h after ANP induction. The rats were sacrificed 3 h, 6 h, and 12 h after ANP induction, and the amount of intraperitoneal ascites was quantified. The serum levels of TNF-α, IL-6, IL-18 were measured by EUSA. The proportion of CD4 + T cell, CD8 + T cell in peripheral blood was determined by flow cytometry. The expression of TNF-α mRNA in pancreatic tissue were measured by RT-PCR. The expression of ICAM-1 protein in pancreatic tissue was measured by immunohistochemistry. Pancreatic tissue underwent pathologic examination. Results Six hours after surgery, the amount of ascite, serum levels of TNF-α, IL-6, IL-18, CD4 + T cell, CD,+ T cell, pancreatic TNF-α mRNA and ICAM-1 protein expression, pathologic score in control group was (1.03 ±0.31)ml,(57.17±11.29)pg/ml, (24.45 ±4.14)pg/ml, (64.23 ±21.85)pg/ml, (47.58 ±9.21)% , (40.88 ± 2.96)%, 0.07 ±0.02, 0.57 ±0.30, 0.67 ±0.81, respectively, and the corresponding values were (3.63 ± 0.38)ml, (107.54 ±33.05) pg/ml, (47.30 ± 11.40) pg/ml, (367.76 ± 108.43 ) pg/ml, (54.90 ± 7.15)%, (17.17 ±3.12)%, 0.65 ±0.26, 3.20 ±0.57, 11.50 ±1.87 in ANP group; and (1.45 ±0.53)ml, (80.60 ±20.48) pg/ml, (26.61 ±10.85) pg/ml, (321.82 ±85.20) pg/ml, (29.80 ±2.19)% , (15.52± 1.96)%, 0.35 ±0.23, 2.37 ±0.67, 8.00 ±3.03. Besides the value of CD8 + T cell was significantly decreased, all other values were significantly increased when compared with control group (P <0.05). Conclusions Thalidomide can decrease the release of inflammatory mediator, and reduce the pathological damage of pancreas of ANP rats by inhibiting TNF-α mRNA expression.

Objective To understand the epidemiological status of chronic diseases and its related risk factors among adult residents in Hebei province.Methods A total of 4 200 adults from 20 districts in Hebei province were selected by multistage stratified random sampling method,and they were investigated with questionnaire,and the body measurement and blood sample were analyzed.Results The prevalent rates of overweight,obesity,central obesity,hypertension,dyslipidemia and diabetes mellitus were 35.19%,16.38%,52.98%,38.50%,39.62% and 5.81%,respectively.The age-adjusted rates were 30.28%,14.05%,44.32%,27.86%,32.71% and 4.00%,respectively.The prevalence of chronic diseases was highly associated with age.The prevalence of chronic diseases in male was higher than that in female among people aged under 55 yrs,but lower among people aged over 55 yrs.The rates were higher in urban areas than in rural areas.The prevalence rates of cigarette smoking and alcohol-drinking in male were higher than in female(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.