| Immunosuppression following surgical and traumatic injury. | |
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MedLine Citation:
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PMID: 20740341 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Severe sepsis and organ failure are still the major causes of postoperative morbidity and mortality after major hepatobiliary pancreatic surgery. Despite recent progress in understanding the immune conditions of abdominal sepsis, the postoperative incidence of septic complications after major visceral surgery remains high. This review focuses on the clinical and immunological parameters that determine the risk of the development and lethal outcome of postoperative septic complication following major surgery and trauma. A review of the literature indicates that surgical and traumatic injury profoundly affects the innate and adaptive immune responses, and that a marked suppression in cell-mediated immunity following an excessive inflammatory response appears to be responsible for the increased susceptibility to subsequent sepsis. The innate and adaptive immune responses are initiated and modulated by pathogen-associated molecular-pattern molecules and by damage-associated molecular-pattern molecules through the pattern-recognition receptors. Suppression of cell-mediated immunity may be caused by multifaceted cytokine/inhibitor profiles in the circulation and other compartments of the host, excessive activation and dysregulated recruitment of polymorphonuclear neutrophils, induction of alternatively activated or regulatory macrophages that have anti-inflammatory properties, a shift in the T-helper (Th)1/Th2 balance toward Th2, appearance of regulatory T cells, which are potent suppressors of the innate and adaptive immune system, and lymphocyte apoptosis in patients with sepsis. Recent basic and clinical studies have elucidated the functional effects of surgical and traumatic injury on the immune system. The research studies of interest may in future aid in the selection of appropriate therapeutic protocols. |
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Authors:
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Fumio Kimura; Hiroaki Shimizu; Hiroyuki Yoshidome; Masayuki Ohtsuka; Masaru Miyazaki |
Publication Detail:
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Type: Journal Article; Review Date: 2010-08-26 |
Journal Detail:
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Title: Surgery today Volume: 40 ISSN: 1436-2813 ISO Abbreviation: Surg. Today Publication Date: 2010 Sep |
Date Detail:
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Created Date: 2010-08-26 Completed Date: 2011-01-19 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9204360 Medline TA: Surg Today Country: Japan |
Other Details:
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Languages: eng Pagination: 793-808 Citation Subset: IM |
Affiliation:
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Department of General Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Acute Lung Injury
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etiology,
immunology Adaptive Immunity Adaptor Proteins, Signal Transducing / immunology Animals Humans Immune Tolerance* Immunity, Cellular Multiple Organ Failure / etiology, immunology* Neutrophils / immunology Postoperative Complications / immunology* Receptors, Pattern Recognition / immunology Sepsis / etiology, immunology* Systemic Inflammatory Response Syndrome / etiology, immunology* Toll-Like Receptors / immunology Wounds and Injuries / complications*, immunology |
| Chemical | |
Reg. No./Substance:
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0/Adaptor Proteins, Signal Transducing; 0/Receptors, Pattern Recognition; 0/Toll-Like Receptors |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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