Abstract
Toll-like receptor 4 (TLR-4), a receptor of innate immunity, provides the site for the lipopolysaccharide shell of Gram-negative organisms to bind and initiate the inflammatory cascade in sepsis. Its expression has been studied in various disease states (sepsis, asthma, atherosclerosis, immunodeficiencies), ethnic groups (Chinese, Irish, Scottish, Gambian), ages, level of physical training, gestational status, and trauma. The expanding body of evidence in regard to TLR signaling is demonstrating the importance between such signaling and human disease. A translational research project between the Departments of Anesthesiology and Medical Microbiology and Immunology was initiated to determine any difference in the amount of TLR-4 expression in elective preoperative patients in regard to height, weight, age, sex, and body surface area (BSA), body mass index (BMI), hypertension, and diabetes. Race was not analyzed. After institutional research board approval, a prospective study of the blood specimens of 52 consecutive, elective, preoperative patients was performed. The blood was directly decanted into a PAXgene Blood RNA tube (Qiagen) designed for the stabilization of RNA from whole blood. Whole blood RNA was extracted using the PAXgeneTM Blood RNA System (PreAnalytiX, Hombrechitikon, Switzerland), including treatment with DNase I to prevent genomic DNA contamination. Quantification of TLR-4 expression levels in human lymphocytes was by RT-PCR and results compared with standard curves. Pearsons's correlation coefficient was use for statistical analysis of the continuous variables and t-testing was used in the analysis of the categorical variables. The TLR-4 concentration varied from 0.211 to 2.490 fmol/μ l per cDNA; however, there was no statistical significance between the concentration of TLR-4/cDNA expressed by RT-PCR and the continuous variables (height, weight, BMI, BSA, and age) nor the categorical variables (hypertension, diabetes, and sex) (Table (Table1).1). None of the patients had postoperative infections. This was an initial attempt to quantify the TLR-4 receptor expression by elective patient variable preoperatively. It provided an opportunity for anesthesiologists to take their practice to the laboratory to explore the immunologic basis of their actions. Table 1
Highlights
Tight blood glucose (BG) control has been shown to videos of the alveolar dynamics
1Royal Brompton Hospital, London, UK; 2Medical University Graz, observation from mechanical deformation due to the tip of the Austria; 3Charles University Hospital, Prague, Czech Republic; endoscope we developed a flushing catheter that continuously
Taurocholic acid into the pancreatic duct. This allowed us to separate and to determine the specific role of pancreatic blood vs Introduction In the frame of protective lung ventilation, alveolar normal blood on the expression of injury evidenced during isolated biomechanics become more and more the focus of scientific lung reperfusion
Summary
Tight blood glucose (BG) control has been shown to videos of the alveolar dynamics. The thorax remains intact.decrease morbidity and mortality in critically ill patients [1] but is Results Figure 1 shows a tissue area after lavage of 0.8 mm difficult to achieve using standard insulin infusion protocols. Results Patient characteristics (mean ± SD): age 57.4 ± 15.4 years, 28 female, 52 male, APACHE II score 28.2 ± 6.6; number of organ failures 4.0 ± 1.12; preceding ICU period 8.5 ± 9.3 days; continuous sedation with midazolam 31.2 ± 34.2 mg/hour, fentanyl 0.12 ± 0.08 mg/hour, propofol 45.6 ± 105.2 mg/hour; sedation assessment according to RS 5.65 ± 0.63, CPS 5.15 ± 1.67, CKS 0.65 ± 0.69, CS 9.34 ± 2.13 und LSS 1.78 ± 1.69, RASS –4.50 ± 1.27, FiO2 0.52 ± 0.17, PEEP 8.2 ± 2.4 cmH2O, ventilatory frequency 20.5 ± 4.8/min, pressure control 16.8 ± 4.4 cmH2O, tidal volume 540 ± 115 ml, TVV 2525.6 ± 11,366 ml (minimum 1.52; maximum 91,586). We hypothesized that S100β levels correlate with this tumor’s preoperative characteristics and with perioperative neurological injury despite its supratentorial location and non-neural origin
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