Surgical operations and processing of natural product require accurate presentation of the target area in order to achieve precise incisions. An excellent example is the deboning automation for chicken breast meat, for which the pose of the wing can greatly affect the cutting efficiency, ability to fix the structure, and product yield. In contrast to engineering objects, biological products present difficulties such as variation in size, shape, and material properties. Unlike past research, which generally found ways to emulate the manual cutting motion, this thesis investigates the effects of wing manipulation on incision tasks. The objective of this thesis is to develop an analytical model for characterizing the manipulation for pose presentation of a musculoskeletal structure for a specified incision. The manipulation model consists of joint kinematics, the mechanics of bio-materials, and a grasping mechanism to determine the joint pose and forces for a given manipulation trajectory. The model provides a basis for monitoring the cutting of bio-material via non-visual information, as well as for design of a compliant mechanism that can be used in an industrial automation application. To gain a better understanding, a wing manipulation test-bed consisting of a force/torque sensor at the point of wing manipulation has been developed. Two specific examples are investigated. The first is needle insertion into bio-materials, and the other is the shoulder cutting operation associated with chicken breast meat deboning. The effects of manipulation on needle insertion forces are used to quantify improvements in insertion point accuracy and required insertion force. Force signatures are also developed for insertion into the biomaterials located within the shoulder joint. The information gathered from both the manipulation model and needle insertion experiments provide a basis for successful implementation of the automation of the shoulder cut. While the experimentation presented in this thesis is developed in the context of poultry processing, which has immediate contributions as a tool that would facilitate the design of the automated cutting mechanisms in poultry industry, we expect that the development of the models will find a broad range of applications ranging from general meat processing, to surgical simulation, and physical therapy.

Original research submitted as partial fulfillment of the requirements for the Masters in Medicine degree in Orthopaedic surgery at the University of Witwatersrand, Johannesburg, April 2014 / Objectives 1. Assessment of radiological parameters of spinal stenosis using Magnetic Resonance imaging. 2. Clinical assessment of patients with Oswestry disability index and Neurogenic claudication outcome score questionnaires. 3. To assess correlation between clinical assessment questionnaires’ scores and radiological parameters. Background. Spinal stenosis is a common presentation in the elderly and a reason for surgical intervention. Diagnostic criteria are still inconclusive. There is poor correlation between clinical and radiological findings. New observations have been described and whether they improve diagnostic criteria remains to be seen. Methods. 30 patients with spinal stenosis were included in the study. The 2 questionnaires were administered and Magnetic Resonance Imaging copies were obtained. Questionnaires and images were analyzed. Osirix programme was used to analyze the images and do the measurements. Data was entered onto an excel sheet and analyzed using Statistica software. Frequencies and correlations were done. Results. The age range was between 41 and 85.There were 22 females and 8 males. L4/L5 was the commonest level involved in 23 patients. Multilevel involvement was 23% and those patients had a higher morphological grade, which was statistically insignificant. The commonest morphological grade was C. Sedimentation was positive in 93% of the patients. The Oswestry disability Index and Neurogenic Claudication Outcome score were negatively correlated, which was statistically significant, p = 0.0004. There was no correlation between clinical and radiological features. Conclusion. Spinal stenosis remains a clinical dilemma. There is variability within the population and lack of correlation between clinical and radiologic features. Radiological features however correlate with each other, but do not help with optimizing patient care.

The main objective of this research project, carried out at Karlstad University was to investigate which paper property has the best correlation with the package integrity failure (puncture hole). To achieve this goal, a simple equipment was designed at Karlstad University. This research project was divided into two phases, more precisely first a test design with investigation of suitable parameters to carry out the tests with the newly designed equipment and secondly with the help of those parameters the investigation of paper properties which will have direct connection with puncture strength. Results showed that Tensile Energy Absorption (TEA) has the best correlation with puncture strength as compared to other paper properties used in this research project i.e. burst strength, strain at break, tear strength, and tensile strength. In real it seems to be reasonable as tensile energy absorption (TEA) is the amount of energy absorbed during straining until it breaks. Higher the tensile energy absorption, higher will be the resistance against puncture. Furthermore sack paper proved to be the type of paper grade that has the strongest resistance against package integrity failure, as it has the highest tensile energy absorption (TEA) as compared to other paper grades used in this research project. It was also observed that paper in a package should be stretched in order to minimize the risk of puncture hole.

Puncture resistance is among the major mechanical properties often required for protective clothing, especially in the medical sector. However the intrinsic material parameters controlling puncture resistance of protective materials are still unknown. Therefore, the purpose of this work is to study the mechanism and mechanical behaviors of puncture resistance of protective clothing materials to various probe types. A better understanding of puncture mechanics will be helpful to develop suitable methods to evaluate the puncture resistance and to predict the failure of protective clothing materials. The thesis includes 4 articles which expose two major phases in this study. Article I and II studied the mechanics and mechanisms of puncture by conical and cylindrical probes used in the standard test methods (ASTM F1342 and ISO 13996). The results show that the punctures of rubber membranes by conical and cylindrical probes are controlled by a maximum local deformation (or puncture failure strain) that is independent of the probe geometry. The puncture strengths of elastomer membranes are much lower than their tensile and biaxial strengths. In addition, a simpler cylindrical probe can be used in the place of the costly conical probe required by the ASTM standard and still provides a quantitative characterization of puncture. Actually, since 2005, an alternative method B had been added to F1342 ASTM with 0.5 mm-diameter rounded-tip cylindrical probe. Furthermore, the puncture probes used in the ASTM F1342 are very different to the actual pointed objects (medical needle, pointed tip of knife... ) and cannot accurately characterize the puncture resistance to real objects. Therefore, in the second step, the mechanics and mechanisms of puncture by medical needles were studied. Article III shows that the puncture by sharp-pointed objects like medical needles is very different from the puncture by conical probes used in the ASTM standard test. For medical needles, the puncture resistance involves cutting and fracture energy of material. Using the fracture mechanics, based on the change in strain energy with the change in fracture surface, the fracture energy in puncture was estimated. This calculation assumes that there is no friction between the needle tip and fracture surface. However, even with the application of a lubricant on the needle surface, the effect of friction on the puncture process cannot be totally eliminated, preventing the determination of the material fracture energy. Therefore, Article IV has described a method, similar to that of Lake and Yeoh for cutting to access the precise value of fracture energy in puncture of rubbers by sharp-pointed objects. The method allows substantially eliminating the effects of friction on the evaluation of the fracture energy involved in the puncture process.

Este estudo envolve a avaliação retrospectiva, estudo de Coorte, de 138 pacientes que realizaram Ecoendoscopia com punção aspirativa por agulha fina (EEPAAF) no período de maio de 2004 a julho de 2007. Os dados foram coletados por meio de consulta aos prontuários, constantes do arquivo médico do Hospital das Clínicas da Universidade de São Paulo. O critério de inclusão foi a presença de massa pancreática sólida à tomografia computadorizada e o critério de exclusão foi a presença de tumor pancreático não sólido. O objetivo da pesquisa foi verificar o índice de positividade da ecoendoscopia com punção por agulha fina (EE-PAAF) em massa pancreática sólida, baseada na técnica empregada no Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), utilizando as variáveis: característica da massa (tamanho, localização, presença de linfonodo peripancreático, presença de linfonodo em tronco celíaco); número de punções para obtenção de microfragmento e citológico; e experiência do profissional executante. O aparelho utilizado foi um ecoendoscópio da marca Olympus, modelo OLYMPUS EUS (EYS) EXERA EU-C60, com transdutor setorial eletrônico e agulhas de 22 gauges da marca Wilson-Cook. Casuística: 138 pacientes realizaram EE-PAAF de massa pancreática sólida no período entre maio de 2004 e julho de 2007. Resultado: 76 (55,4%) deles são do sexo masculino e 61 (44,5%), do sexo feminino. A idade variou de 16 a 87 anos, com média de 59,9 anos. As lesões foram cefálicas em 94 (68,1%) dos casos. Massas maiores que 4 cm tiveram percentual de positividade maior, chegando a 40%, mas as lesões menores que 2 cm obtiveram um percentual de 43% de inconclusivo. A obtenção de microfragmentos foi conseguida em 100% dos casos positivos e apenas 73,1%, quando negativo (p = 0,004). Não houve diferença estatística em relação à experiência do endoscopista. Apenas 80 pacientes tiveram anotado o número de punções e notou-se que existe um melhor desempenho quanto maior for o número delas. O diagnóstico anatomopatológico definitivo de neoplasia pancreática ocorreu em apenas 41 (29,7%) indivíduos. Conclusão: Em relação às características da massa: quanto maior a massa, maior a positividade do método; a localização não correlacionou com maior positividade; há tendência de positividade quando presentes os linfonodos peripancreáticos; em relação ao número de punções: quanto maior o número delas, maior a positividade do método. Em relação à experiência do profissional: não houve diferença no índice de positividade da punção da massa pancreática sólida / This study involves a retrospective evaluation, Cohort study , of 138 patients who were submitted to Echoendoscopy through aspiration puncture with thin needle ( EE PAAF) ( EE APTN) between May 2004 and June 2007. The data were collected through the medical charts present in the medical files of Hospital das Clínicas (Clinical Hospital ) of the University of São Paulo, having as inclusion criterion the presence of solid pancreatic mass in computerized tomography and as exclusion criterion the presence of non solid pancreatic tumor. This study aims to verify the positivity rate of the echoedoscopy with puncture with thin needle (EEPTN) or (EEPAF) in solid pancreatic mass based on the technique used in the Gastro intestinal Endoscopy Unit of Hospital das Clínicas of the Medicine College of the University of São Paulo (HCFMUSP) using the following variables: mass characteristics ( size, location, presence of peripancreatic lymph node, presence of lymph node in celiac trunk); number of punctures to obtain microfragment for cytology, and experience of the professional in charge. The equipment used was an echoendoscopy device model Olympus EUS (EYES) Exera EU C60, with electronic sectorial transductor and 22 gauges Wilson-Cook needles . Methods: 138 patients were submitted to EE APTN of solid pancreatic mass between may 2004 and july 2007. Results: 76 (55,4%) male patients and 61 (44.5%) female patients. Age ranged from 16 to 87 years and means 59,9 years. The lesions were cephalic in 94 (68,1%). Mass larger than 4 cm had a higher percentage of positivity reaching 40%, but lesions smaller than 2 cm had a percentage of 43% of inconclusive. Microfragments were obtained in 100% of the positive cases and only 73,1% when negative (p = 0,004). There was no statistic difference regarding the experience of the endoscopy professional. Only 80 patients had the number of punctures written down and it was noticed that there is better performance as the number of punctures is increased. The definitive histopathologycal diagnosis of pancreatic neoplasia occurred in only 41(29,7%) patients.Conclusion: Regarding mass characteristics: the larger the mass, the larger the positivity of the method; the location didnt correlate with bigger positivity; when the lymph nodes are present, there is a tendency to positivity; concerning the number of punctures: the higher number of punctures, higher positivity of the method. As to the experience of the encoscopy professional: there was no difference in the rate of positivity of the puncture of the solid pancreatic mass

Introduction: It is recommended to place all the vacuum tubes directly on a sample cradle after vein puncture to prevent analytic error. This recommendation is not always easy to follow because the samples are taken by different professionals under different situations.  The three most common analyses, platelets count, haemoglobin and prothrombin time were tested.  Therefore, it was interesting to compare results from the three most common analyses with or without sample cradle, to evaluate the influence of this step on the result. Methods: Three analyses were preformed, using blood from 50 different persons. Each person gave two vacuum tubes, each contained 4.5mL of venous blood for the study. Tubes containing EDTA were used for platelet counts and measurement of haemoglobin and tubes containing citrate were used for prothrombin time-analysis. One of the tubes was placed, as recommended, directly on the sample cradle while the other tube was placed flat on a bench for 10 minutes before it was placed on the sample cradle. Results: There was a clear difference in platelet counts with and without immediate cradling but only minor difference between the results for haemoglobin and International Normalized Ratio. Conclusion: Some analyses seem to be more sensitive for variation in cradling than others. For platelet count it was important to immediately rock the tubes but for determination of prothrombine time and hemoglobin it had a small impact. The small impact on the results is probably due to the efficiency of the anticoagulant in the vacuum tubes.

Made available in DSpace on 2014-06-11T19:25:37Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-07-04Bitstream added on 2014-06-13T19:32:58Z : No. of bitstreams: 1 ferreira_jz_me_araca.pdf: 504466 bytes, checksum: dc9b0c70071e970dde9037df9afcd1f8 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Objetivou-se comparar as técnicas de punções única e dupla e estabelecer uma dose (mL/kg) de ropivacaína 0,75% para realização do bloqueio peribulbar em cães. Vinte e dois cães com indicação para cirurgia de catarata, machos ou fêmeas, de diferentes raças, idades e pesos foram utilizados no experimento. Os pacientes foram alocados em três grupos: punção única inferior (PUI), superior (PUS) ou dupla (PD). Em todos os grupos foram realizadas no máximo três punções em intervalo de 20 minutos tendo-se como critério para repetição a não centralização bulbar. Os volumes administrados foram de 0,2 mL/kg (primeira punção) e, caso necessário, de 0,1 mL/kg nas segunda e terceira punções. Avaliou-se a duração dos bloqueios motor e sensitivo (estesiometria) em intervalos de 15 minutos, número de punções e complicações. As variáveis foram submetidas à análise de variância com medidas repetidas e análise de resíduos. Aquelas com distribuição normal foram analisadas pelo teste de Tukey enquanto as não normais foram analisadas pelo teste de Kruskal-Wallis e teste de Friedman com pós-teste de Dunn. As análises foram efetuadas empregando-se o programa SAS e foram consideradas significativas quando P < 0,05. Não houve diferença significativa (P>0,05) entre os grupos PUI, PUS e PD com relação ao número de punções, duração dos bloqueios motor e sensitivo. As complicações foram significativamente menos frequentes no grupo PUI, diferindo dos grupos PUS e PD. O bloqueio peribulbar realizado pela PUI é melhor e mais seguro comparado a PUS e PD sendo o volume ideal de 0,3 mL/kg de ropivacaína a 0,75% / The objective of this study was to compare the techniques of single and double puncture and to establish the dosage (mL/kg) of ropivacaine 0.75% for peribulbar blockade. Twenty two dogs with indication for extracapsular facectomy, of both genders and various breeds and ages were used. The dogs were allocated into three groups: inferior single puncture (PUI), superior single puncture (PUS) and double puncture (PD). In all groups up to three punctures were made at 20 minute intervals, being non centralization of the bulb the criteria for each next puncture. The volumes administered were 0.2 mL/kg (first puncture) and 0.1 mL/kg (second and third punctures). The duration of motor and sensitive (estesiometry) blockades was evaluated at 15 minutes intervals, as well as number of punctures and complications. Variables were submitted to ANOVA. Variables with normal distribution were analyzed using a Tukey’s test, and the ones that didn’t pass normality test were analyzed by using the Kruskal-Wallis and Friedman tests with post-test of Dunn. Such analyses were made by the SAS software (Statistical Analysis System Institut Inc.; Version 9.2, NC, USA) and were considered significant when P < 0.05. There was no significant difference (P>0.05) between groups PUI, PUS and PD concerning number of punctures, duration of motor and sensitive blockades. Complications were significantly lower in the PUI group, differing from groups PUS and PD. Peribulbar blockade performed by PUI is better and safer when compared to PUS and PD, being the ideal volume for it 0.3 mL/kg of ropivacaine 0.75%

Orientador: Valéria Nobre Leal de Souza Oliva / Banca: Celina Tie Nishimori Duque / Banca: Paulo Sérgio Patto dos Santos / Resumo: Objetivou-se comparar as técnicas de punções única e dupla e estabelecer uma dose (mL/kg) de ropivacaína 0,75% para realização do bloqueio peribulbar em cães. Vinte e dois cães com indicação para cirurgia de catarata, machos ou fêmeas, de diferentes raças, idades e pesos foram utilizados no experimento. Os pacientes foram alocados em três grupos: punção única inferior (PUI), superior (PUS) ou dupla (PD). Em todos os grupos foram realizadas no máximo três punções em intervalo de 20 minutos tendo-se como critério para repetição a não centralização bulbar. Os volumes administrados foram de 0,2 mL/kg (primeira punção) e, caso necessário, de 0,1 mL/kg nas segunda e terceira punções. Avaliou-se a duração dos bloqueios motor e sensitivo (estesiometria) em intervalos de 15 minutos, número de punções e complicações. As variáveis foram submetidas à análise de variância com medidas repetidas e análise de resíduos. Aquelas com distribuição normal foram analisadas pelo teste de Tukey enquanto as não normais foram analisadas pelo teste de Kruskal-Wallis e teste de Friedman com pós-teste de Dunn. As análises foram efetuadas empregando-se o programa SAS e foram consideradas significativas quando P < 0,05. Não houve diferença significativa (P>0,05) entre os grupos PUI, PUS e PD com relação ao número de punções, duração dos bloqueios motor e sensitivo. As complicações foram significativamente menos frequentes no grupo PUI, diferindo dos grupos PUS e PD. O bloqueio peribulbar realizado pela PUI é melhor e mais seguro comparado a PUS e PD sendo o volume ideal de 0,3 mL/kg de ropivacaína a 0,75% / Abstract: The objective of this study was to compare the techniques of single and double puncture and to establish the dosage (mL/kg) of ropivacaine 0.75% for peribulbar blockade. Twenty two dogs with indication for extracapsular facectomy, of both genders and various breeds and ages were used. The dogs were allocated into three groups: inferior single puncture (PUI), superior single puncture (PUS) and double puncture (PD). In all groups up to three punctures were made at 20 minute intervals, being non centralization of the bulb the criteria for each next puncture. The volumes administered were 0.2 mL/kg (first puncture) and 0.1 mL/kg (second and third punctures). The duration of motor and sensitive (estesiometry) blockades was evaluated at 15 minutes intervals, as well as number of punctures and complications. Variables were submitted to ANOVA. Variables with normal distribution were analyzed using a Tukey's test, and the ones that didn't pass normality test were analyzed by using the Kruskal-Wallis and Friedman tests with post-test of Dunn. Such analyses were made by the SAS software (Statistical Analysis System Institut Inc.; Version 9.2, NC, USA) and were considered significant when P < 0.05. There was no significant difference (P>0.05) between groups PUI, PUS and PD concerning number of punctures, duration of motor and sensitive blockades. Complications were significantly lower in the PUI group, differing from groups PUS and PD. Peribulbar blockade performed by PUI is better and safer when compared to PUS and PD, being the ideal volume for it 0.3 mL/kg of ropivacaine 0.75% / Mestre

Este estudo envolve a avaliação retrospectiva, estudo de Coorte, de 138 pacientes que realizaram Ecoendoscopia com punção aspirativa por agulha fina (EEPAAF) no período de maio de 2004 a julho de 2007. Os dados foram coletados por meio de consulta aos prontuários, constantes do arquivo médico do Hospital das Clínicas da Universidade de São Paulo. O critério de inclusão foi a presença de massa pancreática sólida à tomografia computadorizada e o critério de exclusão foi a presença de tumor pancreático não sólido. O objetivo da pesquisa foi verificar o índice de positividade da ecoendoscopia com punção por agulha fina (EE-PAAF) em massa pancreática sólida, baseada na técnica empregada no Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), utilizando as variáveis: característica da massa (tamanho, localização, presença de linfonodo peripancreático, presença de linfonodo em tronco celíaco); número de punções para obtenção de microfragmento e citológico; e experiência do profissional executante. O aparelho utilizado foi um ecoendoscópio da marca Olympus, modelo OLYMPUS EUS (EYS) EXERA EU-C60, com transdutor setorial eletrônico e agulhas de 22 gauges da marca Wilson-Cook. Casuística: 138 pacientes realizaram EE-PAAF de massa pancreática sólida no período entre maio de 2004 e julho de 2007. Resultado: 76 (55,4%) deles são do sexo masculino e 61 (44,5%), do sexo feminino. A idade variou de 16 a 87 anos, com média de 59,9 anos. As lesões foram cefálicas em 94 (68,1%) dos casos. Massas maiores que 4 cm tiveram percentual de positividade maior, chegando a 40%, mas as lesões menores que 2 cm obtiveram um percentual de 43% de inconclusivo. A obtenção de microfragmentos foi conseguida em 100% dos casos positivos e apenas 73,1%, quando negativo (p = 0,004). Não houve diferença estatística em relação à experiência do endoscopista. Apenas 80 pacientes tiveram anotado o número de punções e notou-se que existe um melhor desempenho quanto maior for o número delas. O diagnóstico anatomopatológico definitivo de neoplasia pancreática ocorreu em apenas 41 (29,7%) indivíduos. Conclusão: Em relação às características da massa: quanto maior a massa, maior a positividade do método; a localização não correlacionou com maior positividade; há tendência de positividade quando presentes os linfonodos peripancreáticos; em relação ao número de punções: quanto maior o número delas, maior a positividade do método. Em relação à experiência do profissional: não houve diferença no índice de positividade da punção da massa pancreática sólida / This study involves a retrospective evaluation, Cohort study , of 138 patients who were submitted to Echoendoscopy through aspiration puncture with thin needle ( EE PAAF) ( EE APTN) between May 2004 and June 2007. The data were collected through the medical charts present in the medical files of Hospital das Clínicas (Clinical Hospital ) of the University of São Paulo, having as inclusion criterion the presence of solid pancreatic mass in computerized tomography and as exclusion criterion the presence of non solid pancreatic tumor. This study aims to verify the positivity rate of the echoedoscopy with puncture with thin needle (EEPTN) or (EEPAF) in solid pancreatic mass based on the technique used in the Gastro intestinal Endoscopy Unit of Hospital das Clínicas of the Medicine College of the University of São Paulo (HCFMUSP) using the following variables: mass characteristics ( size, location, presence of peripancreatic lymph node, presence of lymph node in celiac trunk); number of punctures to obtain microfragment for cytology, and experience of the professional in charge. The equipment used was an echoendoscopy device model Olympus EUS (EYES) Exera EU C60, with electronic sectorial transductor and 22 gauges Wilson-Cook needles . Methods: 138 patients were submitted to EE APTN of solid pancreatic mass between may 2004 and july 2007. Results: 76 (55,4%) male patients and 61 (44.5%) female patients. Age ranged from 16 to 87 years and means 59,9 years. The lesions were cephalic in 94 (68,1%). Mass larger than 4 cm had a higher percentage of positivity reaching 40%, but lesions smaller than 2 cm had a percentage of 43% of inconclusive. Microfragments were obtained in 100% of the positive cases and only 73,1% when negative (p = 0,004). There was no statistic difference regarding the experience of the endoscopy professional. Only 80 patients had the number of punctures written down and it was noticed that there is better performance as the number of punctures is increased. The definitive histopathologycal diagnosis of pancreatic neoplasia occurred in only 41(29,7%) patients.Conclusion: Regarding mass characteristics: the larger the mass, the larger the positivity of the method; the location didnt correlate with bigger positivity; when the lymph nodes are present, there is a tendency to positivity; concerning the number of punctures: the higher number of punctures, higher positivity of the method. As to the experience of the encoscopy professional: there was no difference in the rate of positivity of the puncture of the solid pancreatic mass

Objective: To determine whether there was a correlation between induction of polymicrobial sepsis, modulation of tissue Toll-like receptor (TLR) gene, and protein expression and survival outcome. Design: Prospective, randomized animal study. Setting: University medical school research laboratory. Subjects: Age- and weight-matched ICR/HSD mice. Interventions: Sepsis was induced by cecal ligation and puncture (CLP). No-surgery and sham (laparotomy)-operated mice were controls. We also examined tissue TLR2 and TLR4 messenger RNA and TLR4 protein levels in mice treated with an immunomodulator that increases survival in polymicrobial sepsis. In the immunomodulator study, mice were treated with glucan phosphate (50 mg/kg, intraperitoneally) 1 hr before CLP. No-surgery, sham surgery, glucan + no-surgery, sham surgery + glucan, and CLP groups were employed as controls. Measurements and Main Results: Total RNA was isolated from liver, lung, and spleen at 0, 1, 3, 6, 8, and 24 hrs after CLP. TLR gene expression was assessed by reverse transcription-polymerase chain reaction. Tissue TLR4 protein levels were evaluated at 24 hrs by Western blot and immunohistochemistry. CLP sepsis increased (p < .05) liver and lung TLR2 and TLR4 gene expression compared with controls. TLR4 protein concentrations also were increased. Increased TLR2/4 gene and TLR4 protein expression correlated with mortality. Immunoprophylaxis with glucan phosphate increased (p < .001) long-term survival (20% vs. 70%) but inhibited (p < .05) CLP-induced increases in tissue TLR2 and TLR4 messenger RNA expression as well as TLR4 protein expression. Conclusions: Early increases in TLR2/4 gene and TLR4 protein expression correlated with mortality, whereas blunting TLR gene and protein expression correlated with improved long-term survival. This suggests that early up-regulation of tissue TLR2/4 may play a role in the proinflammatory response and pathophysiology of polymicrobial sepsis.