Cytokine response to trauma and surgery

Thrombocytosis that occurs during the first hours after tissue injury aids in hemostasis, and platelets release many growth factors, such as transforming growth factor beta (TGF-ß) and insulin-like growth factor (IGF-1), which regulate inflammation, immune response, and cell migration. In the inflammatory phase, the local effects of inflammation can be amplified to a systemic level due to production of cytokines, such as tumor necrosis factor (TNF), interferon-y, interleukin-1 (IL-1), IL-6, IL-8, and IL-12 associated with a Th1 proinflammatory pathway, or cytokines with anti-inflammatory type 2 helper cell (Th2), including IL-4 and IL-10, which may contribute to the immunosuppression in sepsis and burns (Table 11.1). Thus critically ill patients have a biphasic immunological response. An initial excessive systemic inflammatory response syndrome (SIRS) with increased TNF, IL-1, and IL-10, interferon (IFN)-y or an inadequate compensatory anti-inflammatory response syndrome (CARS) is

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