Toll-like receptors: Significance,ligands, signaling pathways,and functions in mammals

This review attempts to cover the implication of the toll-like receptors (TLRs) in controlling immune functions with emphasis on their significance, function, regulation and expression patterns. The tripartite TLRs are type I integral transmembrane receptors that are involved in recognition and conveying of pathogens to the immune system. These paralogs are located on cell surfaces or within endosomes. The TLRs are found to be functionally involved in the recognition of self and non-self-antigens, maturation of DCs and initiation of antigen-specific adaptive immune responses as they bridge the innate and adaptive immunity. Interestingly, they also have a significant role in immunotherapy and vaccination. Signals generated by TLRs are transduced through NFκB signaling and MAP kinases pathway to recruit pro-inflammatory cytokines and co-stimulatory molecules, which promote inflammatory responses. The excess production of these cytokines leads to grave systemic disorders like tumor growth and autoimmune disorders. Hence, regulation of the TLR signaling pathway is necessary to keep the host system safe. Many molecules like LPS, SOCS1, IRAK1, NFκB, and TRAF3 are involved in modulating the TLR pathways to induce appropriate response. Though quantification of these TLRs helps in correlating the magnitude of immune response exhibited by the animal, there are several internal, external, genetic and animal factors that affect their expression patterns. So it can be concluded that any identification based on those expression profiles may lead to improper diagnosis during certain conditions.     

Clinical,histological and immunpathological findings in 32 patients with dermatitis herpetiformis Duhring

Background: Dermatitis herpetiformis is a chronic severely pruritic dermatosis. It is a cutaneous manifestation of celiac disease. The aim of our study was to collect clinical, histological and immunopathological data on patients who were treated in the University Departments of Dermatology in Würzburg and Lübeck from 1996 to 2008. Patients and Methods: We retrospectively analyzed 32 patients. Only patients with positive findings on direct immunofluorescence microscopy were included in this study. Results: All patients demonstrated skin lesions in the predilection areas of knees, elbows, gluteal region and scalp. The male to female ratio was 1.5 : 1 and the average age was 43 years. The interval between the first symptoms and diagnosis ranged from 6 weeks to 20 years. Direct immunofluorescence microscopy showed that granular IgA deposits were more often found continuously along the dermal‐epidermal junction rather than focally in the tips of the dermal papillae. Results of small intestinal biopsies were available from 29 patients and confirmed the presence of celiac disease in all cases. None of the patients reported gastrointestinal symptoms. IgA antibodies against tissue transglutaminase and epidermal transglutaminase were found in 88% and 94% of patient sera, respectively. Conclusions: The detection of IgA autoantibodies against epidermal transglut‐aminase is the most sensitive serological test in the diagnosis of dermatitis herpetiformis. Our observations confirm that patients with dermatitis herpetiformis usually do not demonstrate apparent gastrointestinal symptoms.     

Impact of Myocardial Acceleration during Isovolumic Contraction in Evaluating Subclinical Right Ventricular Systolic Dysfunction in Type 2 Diabetes Mellitus Patients

Aim: In diabetes mellitus (DM) patients, left ventricular dysfunction is widely evaluated and established by conventional diagnostic methods, whereas right ventricular (RV) function is not as sufficiently evaluated. The aim of this study is to assess the preclinical effects of DM on RV function by using novel Tissue Doppler Imaging (TDI)‐derived indices. Methods: The study included 96 patients with type II DM [60 with DM only and 36 patients with coexisting DM and hypertension (DMHT)] and 40 healthy controls. Conventional parameters and TDI‐derived systolic velocities of tricuspid annulus [isovolumic myocardial acceleration (IVA), peak myocardial velocity during isovolumic contraction (IVV), peak systolic velocity during ejection period (Sa), RV Tei index] were measured. Results: TDI‐derived RV IVA was significantly lower in both DM and DMHT patients compared to controls indicating subclinical impairment in RV systolic function in the study patients (P = 0,0001). However RV IVA was similar in DM and DMHT subgroup supporting RV systolic impairment in DM was independent from HT. In correlation analysis, RV IVA was significantly correlated with the existence of diabetic nephropathy (r =?0,38; P = 0,003), retinopathy (r =?0,35; P = 0,006), insulin resistance (r =?0,52; P = 0,0001). Conclusions: Diabetes is associated with subclinical RV systolic dysfunction, regardless of coexisting hypertension. Tissue Doppler‐derived IVA; is a novel, non‐invasive parameter which may be used in early detection of RV systolic dysfunction in patients with DM. (Echocardiography 2010;27:1211‐1218)     

Tissue anastomosis using a KTP laser: An experimental study

Summary

Sutured visceral anastomoses are time-consuming and complex when performed endoscopically. Theoretically, laser-welded visceral anastomoses are possible and are potentially easier and quicker to perform endoscopically than the sutured anastomoses. In this living canine study, we compared the operating time and intraluminal bursting pressure of laser-welded vs sutured anastomoses of (1) common bile duct (CBD), (2) small intestine, (3) colon and (4) ureter. Each organ was joined to itself using both anastomotic techniques. Welded anastomoses were much quicker in each organ system. Watertight anastomoses were achieved in each organ tested with both anastomotic techniques. Intraluminal hydrostatic bursting pressures occurred at lower pressures (approximately 70% of sutured anastomosis bursting pressure) in all organs. Though not qualified, tensile disruption pressure appeared to be significantly lower in the welded anastomoses as compared to the sutured anastomoses. Laser-welded visceral anastomoses are rapid and watertight. Compared to sutured anastomoses, welded anastomoses are less secure to intraluminal bursting pressures and probably less to tensile pressures. Strength enhancing adjunctive measures, such as serosal adhesives or serosal clips, may strengthen welded anastomoses and are worthy of additional studies.     

负压封闭引流技术(VSD)治疗足踝部软组织缺损的护理体会

足踝部软组织缺损是临床常见的急性损伤之一，由于该部位皮下组织薄，血液循环差，损伤后易骨质外露，常合并感染，创面很难愈合，对污染严重和部分复合组织缺损而暂时无法进行I期皮瓣和植皮修复的患者，目前我们常采用负压封闭引流技术（VSD）治疗。我科2008年1月～2009年10月对32例足踝部软组织缺损应用负压封闭引流技术治疗，取得了满意疗效，现报告如下。