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 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.

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.

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.

Objectives: To evaluate the influences of enteral nutritfion(EN), parenteral nutrition(PN) and major gastrointestinal operation on HLA DR, CRP and IL 10 level. Methods: A prospective, successive and controlled trial was taken. 39 non infection patients with intestinal fistula and severe acute pancreatitis were divided into EN group ( n =18) and PN group ( n =21). 8 patients with major gastrointestinal operation(OP) were taken as OP group.10 patients admitted with the diagnoses of cholecystopolyp and inguinal hernia were taken as control group. The blood levels of HLA DR, CRP and IL 10 were measured and compared between groups. Results: Compared to control group〔(96.35? 4.282)%〕, OP group〔(60.23? 10.419)%〕 and PN group〔(78.72? 13.21)%〕 had significant decreases ( P

Sepsis is the leading cause of mortality in critically ill patients.Studies indicate that immune suppression in sepsis is more often associated with poor outcome.Dendritic cells may contribute largely to the development of immune suppression during sepsis.This article reviews the emerging data indicating the key role of dendritic cells in sepsis induced immune suppression.A deeper insight into the dendritic cell changes during sepsis may provide a powerful weapon against sepsis.

Objective To discuss the frequency of ventilator pipe replacement in ICU ward for reducing the frequency of VAP occurrence caused by bacterial colonization in ventilator-line. Methods 30 patients hospitalized to ICU ward from Janurary,2008 to June, 2009 who had mechanical-ventilation above 48h were randomly divided into group A, B and C with 30 patients in each group, then bacteria culture and strain analysis were employed for the pipeline sample of ventilator inspiratory side at the time point to be use and used mechanical ventilation for 1 day, 3 days and 7 days. Results There was no bacteria grew after ventilator-line sterilization, and positive ratio of bacterial culture in 1d, 3d and 7d were 46.66%,53.33% and 100.00%, respectively. Conclusions The frequency of ventilator pipe replacement should be shortened in patients with abdominal infection, to replace every 3 days is suitable in ICU where infectious patients gathered.

Objective To evaluate the value of MRI in diagnosing pigmented villonodular synovitis (PVNS). Methods MRI appearance of 23 pathologically proven cases of PVNS was analyzed. Results In 23 patients with PVNS, 9 cases occurred in knee joint, 9 cases in hip, 3 cases in ankle, 1 in elbow, and 1 in wrist. X ray of the 23 patients could only show the joint effusion, and bony erosion was found in 19 cases. CT scan showed joint effusion and bony erosion more clearly than X ray in 4 cases. The typical MRI appearance included intra articular joint effusion and extensive synovial proliferation which led to progressive destruction of cartilage and bone. The pigmented villonodules showed nodular low signal on both T 1WI and T 2WI, especially in FFE/T 2WI. Conclusion MRI is the most effective modality in the diagnosis of PVNS.

Objective To evaluate spiral CT in diagnosing vascular complications of pancreatitis. Methods The clinical and surgical results and the CT findings of 316 patients with acute or chronic pancreatitis were comparatively analyzed. Special attention was paid to the CT findings of the patients with peritoneal hemorrhage and vascular abnormality. CT Hu of celiac blood effusion was measured. Pseudoaneurysms, phlebothrombosis and venous thrombosis of peripancreatic vessels in CT enhancement were carefully analyzed. Results Acute pancreatitis was found in 275 out of the 316 patients, and chronic pancreatitis in 41 cases. Among those with acute pancreatitis, 20 had peritoneal cavity vascular complications. In the 13 cases of peritoneal cavity hemorrhage(including 5 patients complicated with digestive tract hemorrhage), CT identified 11 with as regional or diffuse slight high density fluid collections, and failed in 2 cases. CT scans detected gastric varices in 4 out of 7 patients with digestive tract hemorrhage. Of those with chronic pancreatitis, CT found celiac artery pseudoaneurysm in one, spleen artery pseudoaneurysm in one and splenic vein thrombosis with gastric varices in one. Conclusions (1)Regional or diffuse slight high or high density fluid collections were common CT findings of peritoneal cavity hemorrhage. (2)Enhanced spiral CT scanning could demonstrate peripanreatic vascular pseudoaneurysms. (3)Varices in gastric fundus and necrosis in pancreatic body and tail often indicate the formation of spleen venous thrombosis.