Notice bibliographique
Résumé
We congratulate Drs ündar and Fraser for their results and we appreciate their interest in our article. As we outlined in our review [1], systemic inflammatory reaction following cardiopulmonary bypass (CPB) is a multi-triggered, multi-factorial, amplified process that leads to leukocytes, endothelial cells and platelet activation and consequent organ dysfunction. Many molecular mediators are involved in the activation of transcription factor nuclear factor kB and certainly the complement system, through its alternate pathway, plays a major role. Dr ündar and Fraser's group has used a monoclonal antibody (Mab 166-32) to human factor D to inhibit the alternate pathway of complement activation. In a simulated CPB model using human blood in which blood contact with artificial surface of CPB was the only inflammatory trigger, Mab 166-32 was effective to reduce complement, neutrophil, platelet and interleukin 8 activation [2]. Similar results were obtained in a baboon model. Nevertheless, we are anxious to realize whether such promising experimental results will also be obtained in clinical studies: activation of the contact system is not, unfortunately, the only inflammatory trigger. Other authors have obtained significant positive clinical result using single-chain antibody specific for human C5, inducing inhibition of both the classic and alternate complement pathway [3]. Will the complement inhibition achieved by Mab 166-32 be able to produce significant clinical improvements? Hopefully yes but it is hard to answer that question. It is our opinion that research in this field has been unbalanced towards the treatment of a disease that we do not completely understand yet: we are missing essential insight of the pathophysiology. At this stage of our knowledge we are unable to predict which patients will respond to the operation with an excessive inflammatory reaction, who is going to suffer a significant clinical complication and who, hence, could benefit from a prophylactic treatment (complement inhibition, protease inhibitors, steroids, heparin coated circuits, etc.). Studies in immunology are showing that certain haplotypes have a predisposition towards an excessive reaction of the immune system following stimuli. With a similar inflammatory trigger some subjects develop an excessive inflammatory reaction and for this reason they are considered ‘high responders’ [4]. It is probably among this group of subjects that are those patients that suffer clinical complications related to CPB induced inflammation. We agree with Drs ündar and Fraser that cardiotomy suction is a major trigger for inflammation. Moreover, monocyte in blood taken from the pericardium during operation have shown to have increased tissue factor expression leading to the activation of the extrinsic coagulation pathway, thrombin formation and finally impairment of the coagulation system [5]. Ongoing research in our institution will clarify whether the use of cell saver devices, instead of the standard cardiotomy suction, may decrease these effects.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,007 | 0,062 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,003 | 0,002 |
| Bibliométrie | 0,002 | 0,001 |
| Études des sciences et des technologies | 0,003 | 0,004 |
| Communication savante | 0,005 | 0,010 |
| Science ouverte | 0,004 | 0,004 |
| Intégrité de la recherche | 0,032 | 0,056 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,008 | 0,010 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».