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1、CHAPTER4THEINFLAMMATORYRESPONSEMitchellP.FinkForthepurposeofdescribingtheinflammatoryprocess,thedangerhypothesis:danger-associatedmolecularthisoverviewwillmakefrequentmentionofacommon,butpatterns,pathogen-associatedmolecularpatterns,complicated,clinicalentity—severesepsis—asaparadigmofth
2、eandalarminsinflammatoryresponse.Severesepsisisasyndromecausedbyacytokinesandchemokinessystemicinflammatoryresponserunamok.Sepsisisthemostneuroendocrinecontroloftheinflammatoryresponsecommoncauseofmortalityinpatientsrequiringcareinanintensivecareunit.Severesepsis,whichoccursinapproximate
3、ly750,000peopleintheUnitedStateseveryyear,carriesamortal-Celsusiscreditedwithdescribingthecardinalclinicalsignsofityratecloseto30%.Itisgenerallybelievedthattheincidenceinflammation—calor(warmth),dolor(pain),tumor(swelling),ofsepsisandsepticshockisincreasing,probablyasaresultofandrubor(re
4、dness).Classically,theterminflammationwasusedadvancesinmanyfieldsofmedicinethathaveextendedtheusetodenotethepathologicreactionwherebyfluidandcirculatingofcomplexinvasiveproceduresandpotentimmunosuppressiveleukocytesaccumulateinextravasculartissueinresponsetoagents.Giventheimportanceofsep
5、sisasapublichealthinjuryorinfection.Today,inflammationconnotesnotonlyproblem,effortshavebeenmadetotranslateimprovementsinlocalizedeffects,suchasedema,hyperemia,andleukocyticinfil-ourunderstandingofinflammationandinflammatorymedia-tration,butalsosystemicphenomena—forexample,feverandtorsin
6、tothedevelopmentofusefultherapeuticagents.Someofincreasedsynthesisofcertainacute-phaseproteinsandmediatorsthesetherapeuticagentsarenotedinthecontextoftheoverallofinflammation.Theinflammatoryresponseiscloselyinter-discussionofinflammation.relatedwiththeprocessesofhealingandrepair.Infact,w
7、oundhealingisimpossibleintheabsenceofinflammation.Accord-THEDANGERHYPOTHESIS:DANGER-ASSOCIATEDingly,inflammationisinvolvedinalmosteveryaspectofsurgeryMOLECULARPATTERNS,PATHOGEN-ASSOCIATEDbecauseproperhealingoftraumaticwounds,surgicalincisions,MOLECULARPATTERNS,ANDALARMINS