id	author	title	date	pages	extension	mime	words	sentences	flesch	summary	cache	txt
cord-010443-4jblod8j	Meduri, Gianfranco Umberto	General Adaptation in Critical Illness: Glucocorticoid Receptor-alpha Master Regulator of Homeostatic Corrections	2020-04-22		.txt	text/plain	18827	815	23	In critical illness, NF-κB-driven systemic inflammation, also known as a "cytokine storm" (14) , activates a multi-system response that includes at least three major domains: (i) the stress system composed by the hypothalamic-pituitary-adrenal (HPA) axis and the locus caeruleus-norepinephrine/sympathetic nervous system activated to provide sufficient energy and hemodynamic stability to overcome the initial phase of critical illness (15) ; (ii) the acute-phase reaction (APR), which has several adaptive functions, including increasing the production of procoagulant factors in preparation for possible tissue damage (16) ; and (iii) the tissue defense response (TDR) of the target organs [ Figure 1 ; (11, 17) ]. In patients with septic shock (170, 171) or ARDS (172, 173) , prolonged glucocorticoid (hydrocortisone or methylprednisolone) treatment resulted in the following: (i) increased plasma activated protein C levels (173); (ii) reduction in markers of endothelial injury such as sICAM-1 (35); (iii) rapid and consistent improvement in capillary perfusion, independently of the cortisol response to ACTH (170) ; and (iv) improvement in alveolar-capillary (172) and renal (171) endothelial permeability.	./cache/cord-010443-4jblod8j.txt	./txt/cord-010443-4jblod8j.txt