Search

Background: Pneumonia develops frequently after major surgery and polytrauma and thus in the presence of systemic inflammatory response syndrome (SIRS) and organ dysfunction. Immune checkpoints balance selftolerance and immune activation. Altered checkpoint blood levels were reported for sepsis. We analyzed associations of pneumonia incidence in the presence of SIRS during the first week of critical illness and trends in checkpoint blood levels. Materials and methods: Patients were studied from day two to six after admission to a surgical intensive care unit (ICU). Blood was sampled and physician experts retrospectively adjudicated upon the presence of SIRS and Sepsis-1/2 every eight hours. We measured the daily levels of immune checkpoints and inflammatory markers by bead arrays for polytrauma patients developing pneumonia. Immune checkpoint time series were additionally determined for clinically highly similar polytrauma controls remaining infection-free during follow-up. We performed cluster analyses. Immune checkpoint time trends in cases and controls were compared with hierarchical linear models. For patients with surgical trauma and with and without sepsis, selected immune checkpoints were determined in study baseline samples. Results: In polytrauma patients with post-injury pneumonia, eleven immune checkpoints dominated subcluster 3 that separated subclusters 1 and 2 of myeloid markers from subcluster 4 of endothelial activation, tissue inflammation, and adaptive immunity markers. Immune checkpoint blood levels were more stable in polytrauma cases than controls, where they trended towards an increase in subcluster A and a decrease in subcluster B. Herpes virus entry mediator (HVEM) levels (subcluster A) were lower in cases throughout. In unselected surgical patients, sepsis was not associated with altered HVEM levels at the study baseline. Conclusion: Pneumonia development after polytrauma until ICU-day six was associated with decreased blood levels of HVEM. HVEM signaling may reduce pneumonia risk by strengthening myeloid antimicrobial defense and dampening lymphoid-mediated tissue damage. Future investigations into the role of HVEM in pneumonia and sepsis development and as a predictive biomarker should consider the etiology of critical illness and the site of infection. [ABSTRACT FROM AUTHOR]

The article focuses on circumstances of poverty in Germany, specifically highlighting aspects related to the nutritional habits of welfare recipients. The author examines the extent to which welfare recipients are able to afford a healthy diet from their social benefits. He addresses the possible health consequences and costs associated with an unhealthy diet and argues for a social-integrative approach to welfare.

Large quantitaties of inflammatory mediators are released during the course of endotoxaemia. These mediators in turn can stimulate the sympathetic nervous system (SNS) to release catecholamines, which ultimately regulate inflammation-associated impairment in tissue perfusion, myocardial impairment and vasodilatation. Treatment of sepsis is based on surgical and/or antibiotic therapy, appropriate fluid management and application of vasoactive catecholamines. With respect to the latter, discussions on the vasopressor of choice are still ongoing. Over the past decade dopamine has been considered the 'first line' vasopressor and is frequently used to improve organ perfusion and blood pressure. However, there is a growing body of evidence that dopamine has deleterious side effects; therefore, its clinical relevance seems to be more and more questionable. Nevertheless, it has not been convincingly demonstrated that other catecholamines are superior to dopamine in this respect. Apart from its haemodynamic action, dopamine can modulate immune responses by influencing the cytokine network. This leads to inhibition of expression of adhesion molecules, inhibition of cytokine and chemokine production, inhibition of neutrophil chemotaxis and disturbed T-cell proliferation. In the present review we summarize our knowledge of the immunomodulatory effects of dopamine, with an emphasis on the mechanisms by which these effects are mediated.

Various authors have shown that only a part of all reports of randomized controlled trials (RCTs) and controlled clinical trials (CCTs) are accessible in Medline. However, the validity of systematic reviews and meta-analyses heavily depends on the completeness of the identified studies published for a particular clinical problem. Therefore, an additional manual search in dental/medical journals is often indispensable. The major purpose of the present article was to identify all published reports of RCTs and CCTs dealing with topics covered by the discipline oral and maxillofacial surgery. The journals Deutsche Zahnärztliche Zeitschrift, Schwetzer Monatsschrift für Zahnmedizin, Mund-, Kiefer- und Gesichtschirurgie, Stomatologie, and Stomatologie der DDR were manually searched. The publication type of the identified clinical trial reports was determined and compared with Medline. Among the 14,860 articles perused, 202 RCTs and 396 CCTs were identified. 74 RCTs (36.6%) and 104 CCTs (26.2%) referred to topics related to oral and maxillofacial surgery. Of the 74 RCT reports, 44 are included in Medline, and 14 are indexed with the correct publication type term. The majority of RCTs were carried out in the field of oral and maxillofacial surgery. Unfortunately, only a part of German-language reports of dental clinical trials are accessible in Medline. Therefore, a literature search restricted to this database is likely to be incomplete, possibly leading to biased results.