Interleukin-10 (IL-10) is an important anti-inflammatory cytokine expressed in response to brain injury, where it facilitates the resolution of inflammatory cascades, which if prolonged causes secondary brain damage. Here, we comprehensively review the current knowledge regarding the role of IL-10 in modulating outcomes following acute brain injury, including traumatic brain injury and the various stroke subtypes. The vascular endothelium is closely tied to the pathophysiology of these neurological disorders and research has demonstrated clear vascular endothelial protective properties for IL-10. In vitro and in vivo models of ischemic stroke have convincingly directly and indirectly shown IL-10-mediated neuroprotection; although clinically, the role of IL-10 in predicting risk and outcomes is less clear. Comparatively, conclusive studies investigating the contribution of IL-10 in subarachnoid hemorrhage are lacking. Weak indirect evidence supporting the protective role of IL-10 in preclinical models of intracerebral hemorrhage exists; however, in the limited number of clinical studies, higher IL-10 levels seen post-ictus have been associated with worse outcomes. Similarly, preclinical traumatic brain injury models have suggested a neuroprotective role for IL-10; although, controversy exists among the several clinical studies. In summary, while IL-10 is consistently elevated following acute brain injury, the effect of IL-10 appears to be pathology-dependent and preclinical and clinical studies often paradoxically yield opposite results. The pronounced and potent effects of IL-10 in the resolution of inflammation and inconsistency in the literature regarding the contribution of IL-10 in the setting of acute brain injury warrant further rigorously controlled and targeted investigation.

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Role of Interleukin-10 in Acute Brain Injuries.

Inflammation and insulin/IGF-1 resistance as the possible link between obesity and neurodegeneration

Central venous pressure (CVP) and right atrial pressure (RAP) are important parameters in the complete hemodynamic assessment of a patient. Sonographic measurement of the inferior vena cava (IVC) diameter is a non-invasive method of estimating these parameters, but there are limited data summarizing its diagnostic accuracy across multiple studies. We performed a comprehensive review of the existing literature to examine the diagnostic accuracy and clinical utility of sonographic measurement of IVC diameter as a method for assessing CVP and RAP. We performed a systematic search using PubMed of clinical studies comparing sonographic evaluation of IVC diameter and collapsibility against gold standard measurements of CVP and RAP. We included clinical studies that were performed in adults, used current imaging techniques, and were published in English. Twenty one clinical studies were identified that compared sonographic assessment of IVC diameter with CVP and RAP and met all inclusion criteria. Despite substantial heterogeneity in measurement techniques and patient populations, most studies demonstrated moderate strength correlations between measurements of IVC diameter and collapsibility and CVP or RAP, but more favorable diagnostic accuracy using pre-specified cut points. Findings were inconsistent among mechanically ventilated patients, except in the absence of positive end-expiratory pressure. Sonographic measurement of IVC diameter and collapsibility is a valid method of estimating CVP and RAP. Given the ease, safety, and availability of this non-invasive technique, broader adoption and application of this method in clinical settings is warranted.

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The efficacy of sonographic measurement of inferior vena cava diameter as an estimate of central venous pressure

Stroke is the fifth leading cause of death and the most frequent cause of disability worldwide. Currently, stroke diagnosis is based on neuroimaging; therefore, the lack of a rapid tool to diagnose stroke is still a major concern. In addition, therapeutic approaches to combat ischemic stroke are still scarce, since the only approved therapies are directed toward restoring blood flow to the affected brain area. However, due to the reduced time window during which these therapies are effective, few patients benefit from them; therefore, alternative treatments are urgently needed to reduce stroke brain damage in order to improve patients' outcome. The inflammatory response triggered after the ischemic event plays an important role in the progression of stroke; consequently, the study of inflammatory molecules in the acute phase of stroke has attracted increasing interest in recent decades. Here, we provide an overview of the inflammatory processes occurring during ischemic stroke, as well as the potential for these inflammatory molecules to become stroke biomarkers and the possibility that these candidates will become interesting neuroprotective therapeutic targets to be blocked or stimulated in order to modulate inflammation after stroke.

https://journals.sagepub.com/doi/pdf/10.1177/1756286418789340

Inflammatory molecules might become both biomarkers and therapeutic targets for stroke management.

Research progress in stroke-induced immunodepression syndrome (SIDS) and stroke-associated pneumonia (SAP).

Objective: We aimed to present inferior vena cava (IVC) diameter as a guiding method for detection of relationship between IVC diameter measured noninvasively with the help of ultrasonography (USG) and central venous pressure (CVP) and evaluation of patient’s intravascular volume status. Methods: Patients over the age of 18, to whom a central venous catheter was inserted to their subclavian vein or internal jugular vein were included in our study. IVC diameter measurements were recorded in millimeters following measurement by the same clinician with the help of USG both at the end-inspiratory and end-expiratory phase. CVP measurements were viewed on the monitor by means of piezoelectric transducer and recorded in mmHg. SPSS 18.0 package program was used for statistical analysis of data. Results: Forty five patients were included in the study. The patients had the diagnosis of malignancy (35.6%), sepsis (13.3%), pneumonia, asthma, chronic obstructive pulmonary disease (11.1%). 11 patients (24.4%) required mechanical ventilation while 34 (75.6%) patients had spontaneous respiration. In patients with spontaneous respiration, a significant relationship was found between IVC diameters measured by ultrasonography at the end of expiratory and inspiratory phases and measured CVP values at the same phases (for expiratory p = 0.002, for inspiratory p= 0.001). There was no statistically significant association between IVC diameters measured by ultrasonography at the end of expiration and inspiration and measured CVP values at the same phases in mechanically ventilated patients. Conclusions: IVC diameter measured by bedside ultrasonography can be used for determination of the intravascular volume status of the patients with spontaneous respiration.

/pdf/the-relationship-between-inferior-vena-cava-diameter-swffdvh666.pdf

The relationship between inferior vena cava diameter measured by bedside ultrasonography and central venous pressure value.

BACKGROUND Many unknown risk factors play a role in the etiopathogenesis of stroke. The appearance of inflammatory cells within the damaged tissue after cerebral ischemia suggests that an inflammatory response may play a role in stroke pathogenesis. In our study, we examined whether an association exists between the acute-phase reactants and the levels of cytokines, the volume and diameter of the stroke, and short-term mortality in patients who were diagnosed as acute ischemic a stroke after admission to the Emergency Department. PATIENTS AND METHODS A total of 50 consecutive patients who applied to the Emergency Service with acute ischemic stroke were enrolled in the study. Their stroke volume were calculated and serum samples were obtained as soon as they arrived into the Emergency Service. The patients were evaluated according to the Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS). RESULTS There was no significant correlations between stroke volume and levels of cytokine and acute-phase reactants in dead patient group or in living patient group. A correlation and statistical significance was found between stroke volume and hospital stay time in living patient group. In addition, GCS and NIHSS scores were correlated with stroke volume and was found a significant statistically. CONCLUSIONS Scales such as GKS and NIHHS, which evaluate the functional state of patients, are the best indicators for defining prognosis in our daily practices. In addition, we found a positive correlation between levels of CRP (C reactive protein) and prognosis. However, we did not observe a statistically significant correlation between prognosis and other acute-phase reactants such as TNF-alpha, IL-6, IL-8, IL-10, fibrinogen, and leukocytes.

Acute-phase reactants and cytokines in ischemic stroke: do they have any relationship with short-term mortality?

Inme olarak tanimlanan serebrovaskuler hastaliklar (SVH); ciddi mortalite ve morbiditeye yol acan hastaliklardan biridir. Inme olum sebepleri icerisinde ucuncu ve sakatlik yonunden de birinci sirada olan hastalik grubudur. Inmenin % 80-85'ini iskemik inme olusturur. Inme morbit olabildigi gibi; kisi, aile ve toplum uzerinde psikososyal problemlere yol acar ayrica, ekonomik yonden de yuk teskil eder.

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İskemik İnme ve Akut Faz Reaktanları

Background: Serum S100B is found in the glial cells and is elevated with stroke. It can be used in the diagnostic and prognostic utility. However, the use of S100B in the emergency room is controversial. In our study, we wish to determine if the National Institutes of Health Stroke Scale (NIHSS) and Glasgow Coma Scale (GCS) have utility in predicting the acute and first month poststroke mortality and morbidity in emergency room patients, as measured by serum S100B and clinical evaluations. Methods: A total of 62 consecutive patients who applied to the emergency service with acute ischemic stroke were enrolled in the study. Following a detailed neurological examination, GCS and NIHSS were used to determine the consciousness of the patients. Their serum samples were obtained as soon as they arrived into the emergency service and at the time of discharge. As outcome variables, the scores on the modified Rankin Disability Scale (mRDS) at 1 month were determined. Results: The S100B level immediately after the stroke was significantly related to the NIHSS and GCS scores. In addition, the clinical state and S100B levels of patients varied with the length of time between the stroke onset and emergency room treatment. Nine patients (14.5%) died while in the hospital. The stepwise Logistic regression analysis showed that NIHSS was an independent predictor of mortality (odds ratio = 1.48; 95% confidence interval, 1.01-2.18; P⩽0.05). Thirty days poststroke, the mRDS levels significantly correlated with the initial and later S100B levels and GCS and NIHSS scores. The linear Logistic regression analysis indicated that NIHSS score and age were independent risk factors of mRDS (odds ratio= 1.48; 95% confidence interval, 1.01-2.18; P⩽0.05) in our study population. Conclusions: The NIHSS scale is a much more reliable method to determine mortality and morbidity and also adds no extra cost. Therefore, it is not recommended to measure S100B in the emergency room, but if it is measured, then the time between measurement and onset of stroke symptoms should be determined.

https://www.researchgate.net/profile/Mehmet_Ay3/publication/258342761_S-100B_Levels_in_Stroke_Patients_Is_It_Useful_for_Showing_Short-term_Mortality/links/00b7d53827878806cf000000.pdf

S-100B Levels in Stroke Patients: Is It Useful for Showing Short-term Mortality?

Background: In literature, electrocardiographic (ECG) changes and the increase in the levels of the natriuretic peptide are shown to occur in patients having acute ischemic stroke. We aimed to investigate the association between ECG alterations and NT pro B-type natriuretic peptide (NT-proBNP) values in patients having acute ischemic stroke with no known cardiac pathology. Methods: The patients who admitted to the emergency service with acute ischemic stroke were enrolled in the study. Their ECGs were recorded and serum samples were obtained as soon as they arrived into the emergency service. The plasma NT-proBNP levels were measured by electrochemiluminescence method. Maximum QT interval, QT dispersion (QTd), corrected QT and corrected QTd (cQT and cQTd) was calculated, for each ECG. The patients were evaluated according to the Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS). Results: A total of 50 consecutive patients were evaluated. QT intervals for 4 patients (8%) and cQT intervals for 29 patients (58%) were above 440 ms and 11 patients (22%) had QTd values above 50ms and 17 (34%) had cQTd values above 50 ms. The NTproBNP levels had a negative correlation with the GCS (p=0.001, r= -0.461) and a positive correlation with the NIHSS, cQT, QTd and cQTd (p=0.001, r=0.444, p=0.000, r=0.494, p=0.016, r=0.338 p=0.011, r=0.355, respectively). Conclusions: The NT-proBNP levels in the ischemic stroke patients with no known cardiac pathology were markedly increased, and this increase was found to be associated with the GCS, NIHSS, cQT, QTd and the cQTd interval.

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Mustafa Sahan

Papers

The relationship between inferior vena cava diameter measured by bedside ultrasonography and central venous pressure value.

Acute-phase reactants and cytokines in ischemic stroke: do they have any relationship with short-term mortality?

İskemik İnme ve Akut Faz Reaktanları

S-100B Levels in Stroke Patients: Is It Useful for Showing Short-term Mortality?

NT-proBNP levels and QT changes in acute ischemic stroke