Objective: To observe the presence of toll-like receptor 4 (TLR4) gene polymorphism in the venous blood in patients with sepsis, meanwhile, to observe the expression and the diagnostic value of TLR4 mRNA, interferon-γ (IFN-γ), interleukin-23 (IL-23), procalcitonin (PCT) and C-reactive protein (CRP) in patients with different degrees of sepsis.Methods: The peripheral blood samples from the subjects were collected to extract genomic DNA, gene sequencing and enzyme digestion method were applied to the detection of TLR4 Asp299Gly loci polymorphism. The expression of TLR4 mRNA in the peripheral blood was detected by reverse transcriptase polymerase chain reaction (RT-PCR). The expression levels of IFN-γ, IL-23, PCT and CRP were measured by enzyme linked immunosorbent assay (ELISA).Results: (1) The gene polymorphism was not present in TLR4 Asp299Gly loci; (2) The expression of TLR4 mRNA in the peripheral blood in patients with sepsis: on d1, there were statistically significant differences between the normal group and the group (APACHE II ≤ 20), between the normal group and the group (APACHE II > 20), between the group (APACHE II ≤ 20) and the group (AAPACHE II > 20) (t = 5.741, 14.780 and 10.500, all p < .01). APACHE II stands for Acute Physiology and Chronic Health Evaluation II. On d7, there were statistically significant differences between the normal group and the group (APACHE II ≤ 20), between the normal group and the group (APACHE II > 20), between the group (APACHE II ≤ 20) and the group (APACHE II > 20) (t = 4.186, 13.830 and 9.645, all p < .01); (3) The expression levels of IFN-γ, IL-23, PCT and CRP were obviously upregulated (all p < .01), and TLR4 was positively correlated with IFN-γ and IL-23 (all p < .01); (4) The best cutoff value of TLR4 mRNA at baseline was 891.6 μg/L, with a sensitivity of 100% and a diagnostic specificity of 57%. The best cutoff value of IFN-γ at baseline was 84.5 μg/L, with a sensitivity of 100% and a diagnostic specificity of 57%. The best cutoff value of IL-23 at baseline was 861 μg/L, with a sensitivity of 100% and a diagnostic specificity of 97%.Conclusions: (1) The Asp299Gly polymorphism is not present in TLR4 gene; (2) The expression levels of TLR4 mRNA, IFN-γ and IL-23 are relatively high in patients with sepsis, and will be higher with the increased severity of sepsis; (3) TLR4 mRNA, IFN-γ and IL-23 can be used as molecular biomarkers for the early diagnosis of sepsis.

Objective: To investigate the change and relativity of noninvasive positive pressure ventilation (NIPPV) on the gene expression of ubiquitin system of skeletal muscle in patient with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods: 80 patients with AECOPD were divided into two groups based on whether the NIPPV treatment was given or not, 38 cases in the study group and 42 in the control group. The blood gas analysis and pulmonary function were monitored and recorded before and 14 days after treatment. A skeletal muscle biopsy was performed 14 days after therapy. The mRNA expression of ribosomal protein S21 (RPS21) and ubiquitin in skeletal muscle cell were measured by RT-PCR. Results: After 14 days treatment, the levels of PaCO2, PaO2, PH and FEV1% in the NIPPV group improved much better than in the control group (p < .05). The gene expression of RPS21 and ubiquitin was obviously lower in the study group than in the control group (p < .05). The level of RPS21 was negatively related with PaO2, PH and FEV1%, and the level of ubiquitin was negatively related with PaO2 and FEV1% , but positively correlated with PaCO2. The area under the ROC curves of RPS21, ubiquitin, PaCO2 and FEV1% were 0.771, 0.885, 0.821 and 0.734 respectively in the study group. The cutoff points were 103.978, 8.128, 45.350 and 51.350 respectively. The sensitivity evaluation of acid poisoning was 90.9%, and the specificities for each were 75%, 75%, 50% and 50%. Conclusions: NIPPV is effective for AECOPD patients through the gene expression of ubiquitin system of skeletal muscle.