Sepse a septický šok představují celosvětově významný medicínský i socioekonomický problém. V současnosti je obecně přijímán dvoufázový koncept významného porušení imunitní homeostázy v sepsi s enormní aktivací imunitních mechanismů v jejím úvodu s následnou kompenzatorní reakcí, při níž je kompromitována většina funkcí na nejrůznějších úrovních vrozené i získané imunity. Aktuální poznatky však ukazují na simultánní aktivaci prozánětlivých a protizánětlivých pochodů již v samotném úvodu systémového zánětu. Tato sekundární alterace obranných mechanismů, vedoucí ke snížené rezistenci k primárně málo virulentním nozokomiálním a oportunním patogenům a ke „chronické“ multiorgánové dysfunkci, může být příčinou zvýšené morbiditya mortality kriticky nemocných. Tento přehledový článek se stručnou formou zabývá právě dysregulací imunitní odpovědi nemocných v sepsi/septickém šoku, jejími konsekvencemi, diagnostickými možnostmi a možnými terapeutickými intervencemi.

Sepsis and septic shock represent an important medical and socio-economic burden worldwide. The double-phased concept of significant immune homeostasis impairment in sepsis has generally been accepted. In this theory, the initial phase is characterized by enormous activation of immune system followed by the compen-satory phase resulting in profound immunosuppression. However, this paradigm has recently been challenged and the concept of simultaneous pro-inflammatory, anti-inflammatory and adaptive immunity suppressing response occurring early in sepsis has been introduced. These immune alterations leading to the failure to combat relatively avirulent, nosocomial and opportune pathogens, and prolonged multiorgan dysfunction seem to be a major cause of increased morbidity and mortality in critically ill patients. This review briefly summarizes the current concept of sepsis-induced immune deregulation and discusses diagnostic tools and emerging immune-based therapeutic interventions.

• MeSH
• Adaptive Immunity MeSH
• B-Lymphocytes MeSH
• Bacterial Proteins physiology   MeSH
• Immunity, Cellular physiology   MeSH
• Killer Cells, Natural MeSH
• CD4-Positive T-Lymphocytes MeSH
• Cytokines MeSH
• Dendritic Cells physiology   MeSH
• Homeostasis * physiology   MeSH
• Immune System Phenomena * physiology   MeSH
• Interleukin-7 MeSH
• Humans MeSH
• Inflammation Mediators MeSH
• Membrane Proteins MeSH
• Monocytes physiology   MeSH
• Neutrophils physiology   MeSH
• Immunity, Innate MeSH
• Flow Cytometry MeSH
• Receptors, Immunologic * physiology   classification   MeSH
• Sepsis * immunology   MeSH
• Shock, Septic * immunology   MeSH
• T-Lymphocytes physiology   MeSH
• Viral Proteins MeSH
• Check Tag
• Humans MeSH

We present a theoretical view of the cellular foundations for network-level processes involved in producing our conscious experience. Inputs to apical synapses in layer 1 of a large subset of neocortical cells are summed at an integration zone near the top of their apical trunk. These inputs come from diverse sources and provide a context within which the transmission of information abstracted from sensory input to their basal and perisomatic synapses can be amplified when relevant. We argue that apical amplification enables conscious perceptual experience and makes it more flexible, and thus more adaptive, by being sensitive to context. Apical amplification provides a possible mechanism for recurrent processing theory that avoids strong loops. It makes the broadcasting hypothesized by global neuronal workspace theories feasible while preserving the distinct contributions of the individual cells receiving the broadcast. It also provides mechanisms that contribute to the holistic aspects of integrated information theory. As apical amplification is highly dependent on cholinergic, aminergic, and other neuromodulators, it relates the specific contents of conscious experience to global mental states and to fluctuations in arousal when awake. We conclude that apical dendrites provide a cellular mechanism for the context-sensitive selective amplification that is a cardinal prerequisite of conscious perception.

• Publication type
• Journal Article MeSH

• MeSH
• Behavior MeSH
• Molecular Biology MeSH
• Nervous System Diseases MeSH
• Nervous System MeSH
• Neurochemistry MeSH
• Neurophysiology MeSH
• Neurons MeSH
• Neurosciences MeSH
• Publication type
• Monograph MeSH

• Conspectus
• Fyziologie člověka a srovnávací fyziologie
• NML Fields
• neurovědy
• biologie

• MeSH
• Pediatrics MeSH

• Conspectus
• Pediatrie
• NML Fields
• pediatrie