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. 2011 Dec 19;208(13):2581–2590. doi: 10.1084/jem.20111354

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© 2011 Xiao et al.

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Figure 4. — A genomic storm: Refining the immune, inflammatory paradigm in trauma. (A) The current paradigm explains complications of severe injury as a result of excessive proinflammatory responses (SIRS) followed temporally by compensatory antiinflammatory responses (CARS) and suppression of adaptive immunity. A second-hit phenomenon results from sequential insults, which leads to more severe, recurrent SIRS and organ dysfunction. (B) The proposed new paradigm involves simultaneous and rapid induction of innate (both pro- and antiinflammatory genes) and suppression of adaptive immunity genes. Complicated recoveries are delayed, resulting in a prolonged, dysregulated immune–inflammatory state.