The Toll like receptors(TLRs)are essential transmembrane signaling receptors of the innate immune system that alert the host to the presence of a microbial invader.The recent discovery of the TLR has rapidly expanded our knowledge of molecular events that initiate host pathogen interactions.These functional attributes of the cellular receptors provide insights into the nature of pattern recognition receptors that activate the human antimicrobial defense systems.The fundamental significance of the TLR in the generation of systemic inflammation and the pathogenesis of septic shock is reviewed. The potential clinical implications of therapeutic modulation of these recently characterized receptors of innate immunity are also discussed.

Bacterial endotoxin elicits dramatic responses in the host including elevated plasma lipid levels due to the increased synthesis and secretion of triglyceride (TG) rich lipoproteins by the liver and the inhibition of lipoprotein lipase. This cytokine induced hyperlipoproteinemia, clinically termed the lipemia of sepsis, was customarily thought to represent the mobilization of lipid stores to provide the fuel for the host’s response to infection. However, since lipoproteins can also bind and neutralize LPS, TG rich lipoproteins (VLDL and chylomicrons) are also components of non adaptive host immune response to infection. The studies are reviewed about the capacity of lipoproteins to bind LPS, protect against LPS induced toxicity and modulate the host response to the bacterial toxin.

The inappropriate use of norepinephrine(NE) in hypovolemic shock may be deleterious with potentially adverse vasoconstriction and subsequent hypoperfusion.Dramatically,based on the sufficient fluid resuscitation,high doses of NE administered rather increases the blood flow and oxygen delivery during sepsis.The mechanism may contribute to the reverse of vascular hyporesponsiveness and realization of microcirculation resuscitation.However,the optimal time,dosage and combination of NE with other vasoactive agents still necessarites further investigation.

The etiology of Crohn's disease is not clear as yet,many evidences has shown that the dysfunction of the immune system is the internal cause of inflammation and tissue damage.It is identified that many immune diseases can be anticipated,monitored and therapeutic through detecting some specified serological markers.To identify some high specific sensitive and predictable markers and groups,the research of searching an ideal and non-incursive method for differentiating inflammatory bowel diseases from other disease is still undergoing.The current research of five serum immune markers that are usefulness in the diagnosis and management of Crohn's disease are summarized.

Thymosin ?1 is a multiple peptide of hormone and protein isolated from thymus gland,and it has many biological functions.It has been reported that it plays an important role in immune response,neuroendocrine modulation and gene expression.The article is to review the progress of thymosin ?1 and its mechanisms.

Objective To investigate the pathology and MRI features of the degeneration of lumbar intervertebral discs (IVD). Methods Thirteen human lumbar spine segments with 31 IVDs were harvested from fresh cadavers. High quality radiographs were taken for all specimens. Five segments with 20 IVD underwent MRI. Then, the radiographic and MRI findings were correlated with corresponding 87 pathologic sections. Results Variant degeneration was observed in pathologic sections in all 31 IVDs. With MRI T 2WI images, 20 IVDs showed linear and spotty high signal in the annular fibers, or most of the IVD showed high signal. On pathologic cuts, 22 of 31 IVDs showed infolding of annular fibers, 18 of 31 showed outfolding of annular fibers. On MRI T 1WI and T 2WI images, infolding and outfinding of annular fibers were seen as low signal. 20 of 31 IVDs had necrotic debris of cells in the nucleus pulposus. 14 of 20 demonstrated spotty low signal areas on MRI T 2WI images.7 Schmorl nodules were found. On pathologic sections Schmorl nodules were seen as IVD tissue protruding into vertebral endplates, they were seen as high signal on T 2WI images. Two large fissures found on sections were seen as low signal on T 2WI. Degenerative fibrosis seen on 6 IVD, which showed intermediate signal on T 2WI images. However, radiographs only demonstrated osteophytes on 3 vertebrae, 7 Schmorl's nodules. Sclerotic, concave and irregular endplates were seen in 11 IVDs, the latter is the indication of cartilaginous endplate disruption. Conclusion MRI is very useful in demonstrating the degeneration of IVD, radiograph is able to indirectly show the disapperance of cartilaginous endplate.

Objective To observe the clinical effect and safety of platdet GP Ⅱb/Ⅲa receptor antagonist firofiban on acute coronary syndrome(ACS)patients with nO reflow after intevention procedure.Methods 48 ACS patients with no reflow were randomly divided into tirofiban group(n=26)and control group(n=22),the tirofiban group received intravenous tirofiban for 48-36homs,control group received nitroglycerin and urokinase.The rate of the TIMI grade offorward flow and the primary end pints(death,persistent myocardial isehemic and new onset myocardial infarction)and adverse reactions of drags were observed Resalts Tirofiban improved target vessel TIMI flow significantly than control groug(73.8%vs 18.2%,P＜0.01),the rate of the main end point events significantly decreased(15.4%vs 63.6%,P＜0.05),the bleeding complications was similar between two groups,no severe bleeding events occurred.Condusion Tirofiban is effecfive and safe in treating ACS patients with no reflow.

Objective To study the neuroprotective effect of sevoflurane on controlled hypotension in patients with coronary heart disease undergoing craniocerebral surgery. Methods Twenty-six patients with coronary heart disease undergoing craniocerebral surgery were randomly divided into two groups,receiving either inhaled 2%-5%sevoflurane plus intravenous sodium nitroprusside (treatment group,n=13) or intravenous sodium nitroprusside 3-8 μg·kg-1 alone (contorl group,n=13) for blood pressure control. The hemodynamic changes were recorded during the operation. Patient satisfaction with surgeons and the duration hospital stay after surgery were recorded. The levels of cardiac troponin I (TNI),creatine kinase-MB (CK-MBM),neuron specific enolase ( NSE) and S100 calcium binding proteinβ( S-100βprotein) in serum were detected at one day pre-operation,the end of the operation,and one day post-operation. Results The duration of hospital stay after surgery was significantly shortened in treatment group [(20. 3±3. 8) versus (23. 9±4. 6) d,P<0. 05) compared with control group. The average heart rate significantly decreased, patient satisfaction significantly increased, and serum levels of NSE and S-100β protein one day post-operation significantly decreased as compared to control group (all P<0. 05). Compared with the day before operation,serum levels of NSE and S-100βprotein in the two groups increased significantly at the end of surgery (P<0. 05),and the levels of TNI,CK-MBM,NSE and S-100βsignificantly elevated one day post-operation (P<0. 05). Compared with the end of operation,serum levels of NSE and S-100βin contorl group incarcerated remarkably (P<0. 05) Conclusion Sevoflurane plays an important neuroprotective role,as evidenced by improving patients' satisfaction,reducing hospital stay after surgery,and maintaining the balance of myocardial oxygen delivery and consumption in craniocerebral surgery patients with coronary heart disease during controlled hypotension. However,it can not prevent postoperative myocardial injury in these patients.

Objective To investigate roles of superoxide dismutase-1(SOD1),phosphatidylinositol 3-kinase (PI3K) /serine/ threonine protein kinase (AKT) signal transduction pathway in protection of propofol on spinal cord ischemic reperfusion injury (SCIRI) in rabbit model before and after ischemia. Methods Sixty Japanese male rabbits were randomly divided into 3 groups (n=20),namely sham-operation group (Group S),ischemia-reperfusion group (Group I/ R) and ischemia-reperfusion group with propofol treatment (Group P). Abdominal aorta of the rabbits in group I/ R and group P were blocked by clamp for 40 min and then the clamp was removed. Propofol (30 mg·kg-1 ) was intravenously infused 10 min before blocking the aorta and at the time of reperfusion. Normal saline was intravenously infused at the same time points in the other two groups. Four rabbits of each group were randomly executed 1,2,3,5,7 days after surgery. Spinal cord tissues at L3-L4 levles were harvested. Bioactivity of SOD1 was detected by ELISA and mRNA expression levels of SOD1,PI3K and AKT were detected by RT-PCR. Results On the 1st day after the surgery,the bioactivity of SOD1 increased significantly in Group I/ R and Group P as compared with that in Group S (P<0. 05). On the 2nd day,compared with Group S,the bioactivity of SOD1 increased significantly in Group P (P<0. 05),but there was no change in Group I/ R (P>0. 05). On the 3rd,the 5th and the 7th day,compared with Group S,the bioactivity of SOD1 decreased significantly in Group I/ R (P<0. 05),but there was no change in Group P (P>0. 05). Linear regression analysis indicated that there was a positive correlation between the changes of SOD1 activity and the mRNA expression of SOD1,PI3K and AKT respectively in spinal cord tissues. Conclusion Pre- and post-ischemic conditioning with propofol shows potent protective effects against SCIRI in the rabbit model. The mechanisms may be related to increased expression of SOD1 in the spinal cord tissues by activating PI3K/ AKT signal transduction pathway.

Objective To isolate, culture and identify human neural stem cells from 7-week to 13-week embryonic brains and to study different suitable culture conditions.Methods By using serum-free cell culture and single cell clone test,the neural stem cells were isolated and cultured from 7-week human embryonic forebrains and 13-week human embryonic cerebral cortex in different conditions and immunofluorescence tests were used to identify the cells. Results The human neural stem cells having the abilities of self-renewal and multipotency were successfully isolated and cultured from different embryonic brains. In 7-week brain, the cells could form clones in different ways except in high concentration suspension culture.In 13-week brain, the cells could form clones only in middle concentration suspension culture and high concentration adhere-wall culture. In coated petri dish, the cells couldn't form clones.Conclusions There are neural stem cells in human embryonic brains. With gestational age increasing, the neural stem cells become more and more difficult to be isolated. High concentration adhere-wall culture can be used in embryonic brains with different gestation age.