Nihon rinsho. Japanese journal of clinical medicine
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It has been generally accepted that the frequency of the HLA-DR-antigen expression on monocytes reflects the individual's immune state; therefore it has been regarded as a key indicator of the immune status in SIRS (systemic inflammatory response syndrome)-sepsis. One of the diagnostic indices for the level of immunoparalysis, it characterizes CARS (compensatory anti-inflammatory response syndrome). Lately, it has been frequently reported that the frequency of HLA-DR-antigen expression on monocytes is abnormally reduced in those patients with SIRS-sepsis. Reports suggest that the prognosis is very poor in cases with long-term sharp declines in HLA-DR-antigen expression on monocytes.
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The activation of a pro-inflammatory cascade after infection, major surgery, burn or trauma appears to be important in the development of subsequent immune dysfunction, susceptibility to sepsis and multiple organ failure. It is well known that T-cell plays a critical role in the systemic response to infection. Distinct patterns of cytokines are produced by two different types of T-helper cells (Th). ⋯ We believe that severe sepsis clearly induce polarization of T-helper lymphocyte activity with a clear shift in Th2 direction. This type of response may lead immunosuppression. Modulation of Th cell subset predominance may present a novel therapeutic option in the treatment of severe sepsis.
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The concept of systemic inflammatory response syndrome (SIRS) was introduced in 1992 to define and objectively diagnose sepsis. Over the last decade, the definition of sepsis has been used for inclusion criteria of multicenter trials to develop innovative therapies of sepsis. With the recent understanding of the pathogenetic mechanisms of sepsis, many drugs have been tested, but only two drugs (activated protein C and neutrophil-elastase inhibitor) have been approved for clinical use in sepsis or SIRS. Further understanding of basic pathophysiology of SIRS and sepsis holds promise to develop a new therapeutic strategy to improve survival of patients with SIRS and sepsis.
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The normal heart rate is regulated by a number of interacting physiological control systems that operate on widely different time scales. Thus, instantaneous heart rate is not steady, but rather demonstrates continuous fluctuations. ⋯ We found that the reduction of HRV precedes the occurrence of septic shock. Therefore, we conclude that analysis of HRV is a novel and useful tool to predict the occurrence of septic shock among the patients with severe sepsis.
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Review
[Basic concept and definition of SIRS and sepsis--present consideration and future perspectives].
SIRS (systemic inflammatory response syndrome) is thought to be caused by hypercytokinemia. On the other hand, interleukin-6 (IL-6) is reported to be one of most easily measurable cytokines and we found that IL-6 blood levels on SIRS patients are above 1,500 pg/ml which is compatible to the previously reported values. ⋯ On the other hand, it is reported that cytokine-related genetic polymorphism may affect the cytokine production following insult, or may affect the development of SIRS following insult. Therefore, we must also consider genetic aspect of cytokine biology in future study.