***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Many aspects of the normal immune response are depressed after severe injury . Reduced monocyte human leukocyte antigen-DR ( HLA-DR ) levels have closely correlated with the development of major infection . After a pilot study with recombinant interferon-gamma ( rIFN-gamma ) showed restoration of depressed HLA-DR levels after major injury , a multicenter , prospect i ve , r and omized , double-blind trial was conducted . Two hundred thirteen trauma patients who were at high risk of infection received either placebo or rIFN-gamma ( 100 micrograms ) subcutaneously each day for 10 days after admission . One hundred ninety-three patients were evaluable with respect to primary end points . Patients treated with rIFN-gamma were older ( p = 0.10 ) and had more severe modes of injury ( p = 0.02 ) . By the third day , both monocyte HLA-DR antigen expression and outcome predictive score were significantly better in the rIFN-gamma-treated group than in the placebo group ( p = 0.0001 and p = 0.0006 , respectively ) . Nine deaths occurred in patients treated with rIFN-gamma compared with 12 deaths in the placebo group ( p = 0.46 ) . Major infections requiring surgical drainage or debridement occurred in 17 patients treated with rIFN-gamma compared with 22 treated with placebo . No difference between treatment arms was noted in overall major or minor infection rates , but there were fewer severe infections that required reoperation or computer tomographic-guided drainage in patients receiving IFN-gamma . While these results suggest that rIFN-gamma may be useful in some aspects of infection in the patient with severe trauma , a larger trial with longer treatment will be needed to prove the comprehensive value of rIFN-gamma One hundred and fifty severely injured patients requiring long-term artificial ventilation were evaluated in a prospect i ve , r and omized , double blind study comparing the prophylactic effect of an intravenous immunoglobulin ( S and oglobulin ; IGIV ) against nosocomial infections with a placebo preparation .  The groups were comparable in age , sex , injury pattern , and severity of the trauma . Seventy-six patients received 12 g of S and oglobulin as a 3 % solution on day 0 , day 5 and day 12 , i.e. a total of 36 g . S and oglobulin significantly reduced the incidence of pneumonia ( 28 cases in the IGIV group , 43 cases in the placebo group , p=0.0111 ) . This result ed in a reduced therapeutic use of antibiotics . For the occurrence of sepsis ( IGIV : 14 cases ; placebo 19 cases ) and other infections ( IGIV : 11 cases ; placebo : 10 cases ) no significant differences were found . No side effects of the administration of IGIV were observed . IGIV prophylaxis neither reduced the overall death rate nor those deaths caused by infection . On day 5 after administration of the first 12 g of IGIV , the IgG serum concentrations were significantly higher in the S and oglobulin group ( 8.41±1.96 mg/ml and 7.42±2.25 mg/ml respectively , p>0.001 ) whereas later serum sample s showed no significant differences BACKGROUND Perflubron is a perfluorocarbon with unique physical characteristics . It has twice the density of water , allows free diffusion of O2 and CO2 , is easily dispersed , and is insoluble . Thus , it can act as " liquid positive end-expiratory pressure " to recruit collapsed alveoli and improve oxygenation . Results of laboratory studies suggest that perflubron exerts an anti-inflammatory effect on alveolar cells . Limited clinical data in neonates and adults with severe acute respiratory distress syndrome are promising . We present a single institution 's experience with partial liquid ventilation ( PLV ) in trauma patients compared with conventional mechanical ventilation ( CMV ) with particular attention to the alveolar inflammatory response . METHODS Ventilated patients with bilateral lung injury and PaO2/FIO2 < 300 were eligible in this prospect i ve multicenter trial . Perflubron was administered by means of the endotracheal tube to fill up to functional residual capacity ( approximately 30 mL/kg ) , followed by supplemental doses up to 96 hours . At this institution , bronchoscopy with bronchoalveolar lavage was performed serially for white blood cell count , protein , interleukin (IL)-1 , IL-6 , IL-8 , and IL-10 , and analyzed as early ( < 48 hours ) and late ( 48 - 96 hours ) . Clinical response was defined as a sustained 10 % increase in PaO2/FIO2 at 48 hours . RESULTS 16 patients were enrolled : 12 PLV patients and 4 CMV patients . There were no differences between groups relative to sex , Injury Severity Score , or initial PaO2/FIO2 . There were no major outcome differences between groups in this pilot study relative to pneumonia ( 50 % PLV and 75 % CMV ) , deaths ( one death in each group caused by multiple organ failure ) , or for oxygenation after 5 days . Eight PLV patients were responders ( PLV-R ) compared with four patients who did not ( PLV-NR ) . The main differences between these subgroups was time from injury to study ( 1.8 days for PLV-R vs. 5.8 for PLV-NR , p < 0.02 ) and age ( 30 years for PLV-R vs. 42 years for PLV-NR , p < 0.04 ) . Both white blood cell count and protein were higher in CMV , suggesting a greater inflammatory response . Neutrophils were significantly higher in CMV , despite equal IL-8 levels in both PLV and CMV . The inflammatory cytokines IL-1 and IL-6 were greater in CMV , and the anti-inflammatory IL-10 was lower in PLV . CONCLUSION Early institution of partial liquid ventilation is effective at reducing the alveolar inflammatory response . Perflubron exhibits an anti-inflammatory effect in the alveolar environment with reduction of proinflammatory IL-1 and IL-6 ( possibly removing a stimulus for IL-10 ) , white blood cell count , and protein capillary leak . PLV also reduces alveolar neutrophils independent of IL-8 . Further characterization of this altered inflammatory response is necessary BACKGROUND The leading cause of late mortality after trauma is multiple organ failure syndrome , due to a dysfunctional inflammatory response early after injury . Pre clinical studies demonstrate that hypertonicity alters the activation of inflammatory cells , leading to reduction in organ injury . The purpose of this study was to evaluate the effect of hypertonicity on organ injury after blunt trauma . DESIGN Double-blind , r and omized controlled trial from October 1 , 2003 , to August 31 , 2005 . SETTING Prehospital enrollment at a single level I trauma center . PATIENTS Patients older than 17 years with blunt trauma and prehospital hypotension ( systolic blood pressure , < /= 90 mm Hg ) . INTERVENTIONS Treatment with 250 mL of 7.5 % hypertonic saline and 6 % dextran 70 ( HSD ) vs lactated Ringer solution ( LRS ) . MAIN OUTCOME MEASURES The primary end point was survival without acute respiratory distress syndrome ( ARDS ) at 28 days . Cox proportional hazards regression was used to adjust for confounding factors . A preplanned subset analysis was performed for patients requiring 10 U or more of packed red blood cells in the first 24 hours . RESULTS A total of 209 patients were enrolled ( 110 in the HSD group and 99 in the LRS group ) . The study was stopped for futility after the second interim analysis . Intent-to-treat analysis demonstrated no significant difference in ARDS-free survival ( hazard ratio , 1.01 ; 95 % confidence interval , 0.63 - 1.60 ) . There was improved ARDS-free survival in the subset ( 19 % of the population ) requiring 10 U or more of packed red blood cells ( hazard ratio , 2.18 ; 95 % confidence interval , 1.09 - 4.36 ) . CONCLUSIONS Although no significant difference in ARDS-free survival was demonstrated overall , there was benefit in the subgroup of patients requiring 10 U or more of packed red blood cells in the first 24 hours . Massive transfusion may be a better predictor of ARDS than prehospital hypotension . The use of HSD may offer maximum benefit in patients at highest risk of ARDS BACKGROUND Antithrombin III ( AT III ) treatment has been shown to reduce disseminated intravascular coagulation and to inhibit thrombin , which plays a central role in the activation of platelets and other inflammatory systems in conditions with severe inflammation . The objective of this study was to evaluate the influence of early and high-dose administration of AT III to patients with severe multiple injuries on the inflammatory response and outcome . METHODS In a placebo-controlled , double-blind study , 40 consecutive patients with Injury Severity Scores of 29 or greater who met the inclusion criteria were r and omized to receive either AT III or placebo within 360 minutes after trauma . Twenty patients were administered AT III for a period of 4 days , aim ing to achieve AT III concentrations of 140 % of normal . RESULTS The AT III and placebo groups were comparable with respect to Injury Severity Score , age , incidence of blood pressure less than 80 mm Hg on admission , initial base deficit , and start of the test drug . The patients in the AT III group received a total of about 20,000 IU during the first 4 days . AT III levels of 130 to 140 % could be achieved by this regimen , whereas in the control group the AT III concentration averaged about 70 % . In the AT III group prothrombin tended to be elevated and prothrombin fragment F1 + 2 as well as thrombin-AT III complex tended to be lower on the first day . No differences between groups , however , could be observed with respect to partial thromboplastin time , prothrombin time , platelets , plasminogen activator inhibitor I , soluble tumor necrosis factor receptor II , neutrophil elastase , interleukin (IL)-1 receptor antagonist , IL-6 , and IL-8 . Mortality ( 15 vs. 5 % ) , incidence of respiratory failure ( 55 vs. 55 % ) , duration of mechanical ventilation ( 13 vs. 12 days ) , and length of stay in the surgical intensive care unit ( 19 vs. 21 days ) were also similar in both treatment groups . The duration of organ failure , however , was shorter in the patients receiving AT III . CONCLUSION The early and high-dose administration of AT III to patients with severe blunt trauma appears not to attenuate the posttraumatic inflammatory response or to significantly improve outcome Basing on 50 posttraumatic intensive-care patients with medium grade lesions ( ISS criteria ) , the prophylactic effect of an intravenously applicable IgM preparation ( Pentaglobin ) against nosocomial infections was investigated . The prophylaxis group received on the 3rd , 4th and 5th day a daily dose of 10 g each . At the same times the controls were given 12.5 g human albumin each . Whereas no difference was seen between both groups regarding the definitive outcome of the treatment , the prophylaxis group clearly showed fewer infection pointers during the clinical course . In particular , the incidence and magnitude of febrile temperatures were significantly lower between the 4th and 8th days of treatment . Our results indicate , however , that the prophylactic use those patients who are at particularly high infection exposure risk , e.g. through reintervention surgery , haemorrhage complications or extensive diagnostic interventions Objective : The objectives of this study were to evaluate safety ( primary ) and clinical efficacy ( secondary ) of the humanized monoclonal anti-L-selectin antibody aselizumab in severely injured patients . Design : Prospect i ve phase II , parallel group , double-blind , r and omized , placebo-controlled clinical trial . Setting : Fourteen medical intensive care units or trauma units in level I trauma centers in Belgium , Germany , and Pol and . Patients : Eighty-four patients with a sustained trauma due to a blunt or penetrating injury and a total Injury Severity Scale score of ≥25 . Interventions : Patients received either aselizumab at dosages of 0.5 , 1 , or 2 mg/kg or placebo within 6 hrs of the traumatic event and were followed for 6 wks . Measurements and Main Results : The number of expeditable adverse events increased dose dependently over the aselizumab groups compared with placebo . There were no statistically significant differences between all groups regarding leukopenia and risk of infection . No immunologic response following infusion of aselizumab was noted . The number of patients with multiple organ failure , defined as a median value of the total Goris Multiple Organ Failure score of ≥5 on ≥2 consecutive days within 14 days , was not significantly different for the 0.5 mg/kg , 1 mg/kg , 2 mg/kg , and placebo groups . There were no statistically significant differences in time of mechanical ventilation , length of stay in an intensive care unit , and total duration of hospitalization between treatment groups . Conclusions : Aselizumab was associated with a higher rate of infections and leucopenia ; however , this difference was not significantly different compared with placebo . For all efficacy variables , aselizumab presented no significant trends but only a few scattered statistically significant differences between groups OBJECTIVE To determine the effect of the adjuv 
    Output:
    
However , significant changes in infection , MOF , and mortality rates were only measured in studies testing immunoglobulin , IFN-γ , and glucan .
Conclusions Based on level 1b and 2b studies , administration of immunoglobulin , IFN-γ , or glucan have shown the most promising results to improve the outcome of trauma patients