Mean IL-6 Research Articles

Diagnostic and Prognostic Roles of Serum Interleukin-6 Levels in Patients with Uveitis

ABSTRACT Purpose To examine the diagnostic and prognostic roles of serum interleukin-6 levels in patients with uveitis. Methods This was a retrospective observational case series. Demographic and clinical characteristics were compared between Group One (sixty patients) with normal serum IL-6 levels and Group Two (twenty patients) with high serum interleukin-6 levels. Results Mean IL-6 level was 1.77 ± 0.97 pg/ml and 10.2 ± 9.7 pg/ml in Group One and Group Two respectively. Age, presence of systemic disease, and mean number of flare-ups were statistically significant (p = .015, p = .000, p = .03, respectively). Multivariate analysis was performed on variables that were statistically significant in univariate analysis and showed that three variables had significant correlation with IL-6 levels in both groups: systemic disease (OR = 10.83, p < .001), Age (OR = 0.95, p = .03) and number of flare-ups (OR = 2.9, p = .02). Conclusion Serum IL-6 levels can provide diagnostic and prognostic information in regard to the course of disease and its treatment.

A comparative study of autologous rectus fascia pubovaginal sling surgery and synthetic transobturator vaginal tape procedure in treatment of women with urodynamic stress urinary incontinence

ObjectiveTo compare short term results of autologous rectus fascia pubovaginal sling surgery with synthetic transobturator vaginal tape procedure in treatment of female stress urinary incontinence (SUI) Study designIt was a comparative study on 30 women between 25−65 years of age with urodynamic proven SUI who were randomly allocated to autologous rectus fascia pubovaginal sling surgery (Group I)(15 women) and synthetic transobturator vaginal tape procedure (Group II) (15 women). Preoperative and postoperative ICIQ (International Consultation on Incontinence Questionnaire) score, urodynamic study and serum CRP and IL-6 were done in all cases. ResultsThe baseline characteristics in terms of age, body mass index (BMI), parity, mean ICIQ score and mean preoperative CRP and IL-6 levels were similar in two groups. Mean operative time was significantly longer (55.60 ± 5.77 vs 25.27 ± 4.32 minutes, p = 0.001) in group I than group II. Mean hospital stay of 7.1 ± 1.2 vs 1.2 ± 0.4 days, mean duration of catheterization 5.8 vs 1.2 day (<0.01) and postoperative urinary retention requiring recathterization were all significantly higher in group I than II. Wound infection was more in group I than in group II (p = 0.01) while groin pain was significantly more in group II (p = 0.01). One patient developed vesicovaginal fistula, while one patient required cutting of tape in group I. Pdet at Q max (Detrusor pressure at peak urine flow) increased significantly in both the groups after surgery. ICIQ score was zero in both the groups indicating 100 % success. Surgical trauma was more in group I as shown by significantly higher CRP levels. ConclusionThe success rate of the two groups was similar but, autologous rectus fascia sling surgery took longer, had more complications and urinary retention as compared to transobturator vaginal tape procedure.

Diagnostic and Prognostic Value of IL-6 and sTREM-1 in SIRS and Sepsis in Children.

Purpose The aim of this study was to evaluate the diagnostic and prognostic value of IL-6 and sTREM-1 in the course of SIRS and sepsis in children with reference to routinely used CRP and PCT. Methods A prospective study included 180 patients at the ages from 2 months to 18 years hospitalized due to fever from November 2015 to January 2017. Forty-nine children without fever hospitalized due to noninfectious causes formed the control group. IL-6 and sTREM-1 serum concentrations were assessed with the enzyme-linked immunosorbent assay method. Results The mean serum concentrations of all the analyzed biomarkers were statistically significantly higher in the study group compared to the control group. Mean IL-6, sTREM-1, and PCT serum concentrations were statistically significantly higher in the group of patients with SIRS/sepsis compared to the group of feverish patients without diagnosed SIRS (N-SIRS). Based on the ROC curve analysis, it was shown that of all the biomarkers tested, only two—IL-6 and procalcitonin—had potential usefulness in the diagnosis of SIRS/sepsis in children with fever. Conclusion Elevated levels of IL-6 and PCT are important risk factors for the development of SIRS/sepsis in children with fever. It seems that elevated IL-6 baseline serum level may predict a more severe course of febrile illness in children, because based on the ROC curve analysis, it was found that IL-6 is a statistically significant prognostic marker of prolonged fever ≥ 3 days and prolonged hospitalization > 10 days. The assessment of the usefulness of sTREM-1 in the diagnosis of SIRS/sepsis in feverish children requires further research.

The role of inflammation in adjuvant chemotherapy-induced sarcopenia (Izmir Oncology Group (IZOG) study).

Although the chemotherapy-induced sarcopenia has some explanatory presence in clinical practice, the mechanisms underlying this phenomenon have not been clearly distinguished in patients with cancer. Therefore, we aimed with this study to investigate the role of inflammation by examining the inflammatory markers in the physiopathology of adjuvant chemotherapy-induced sarcopenia in patients with gastrointestinal tract cancer. To detect the presence of sarcopenia, patients' body composition measurements were assessed using the BIA, and their muscular strength was assessed with a handgrip dynamometer in both pre- and post-adjuvant chemotherapy. At the same time, we examined the baseline and post-adjuvant chemotherapy anthropometric measurements and inflammatory markers in serum (Hs-CRP, IL8, and TNF-α). Patients were divided in three groups. Group 1 consisted of patients who presented post-treatment sarcopenia although they did not have it prior to the treatment, group 2 included the patients who had no pre- or post-treatment sarcopenia, and group 3 was comprised of patients who presented pre-treatment sarcopenia. Each group included 30 patients. A total of 90 patients were included in the study. Fifty-one of them were female patients. Median age was 60.5 (range 27-83). The patients consisted of cases with colorectal and gastric cancers. In group 1, Wilcoxon signed-rank test revealed a significant difference between scores of IL-8 (pg/mL), TNF-α (pg/mL) and Hs-CRP (mg/dL) given for the post-chemotherapy compared with the pre-chemotherapy ((Z 3.61, p < 0.001), (Z 3.254, p = 0.001), (Z 3.319, p = 0.001)). The post-chemotherapy median scores of IL-8 (pg/mL), TNF-α (pg/mL), and Hs-CRP were 76.31, 7.34, and 1.55, respectively, which remained on the levels of 12.25, 1.6, and 0.51 for the pre-chemotherapy. For group 2, a Wilcoxon signed-rank test indicated no significant difference between scores of the same markers given for the post-chemotherapy compared with the pre-chemotherapy. In all patients (including groups 1, 2, and 3), a comparison of the patients with pre-treatment sarcopenia (n = 30) and non-sarcopenic patients (n = 60) in terms of baseline IL-8, TNF-α, and Hs-CRP mean levels, IL-8 and Hs-CRP were found to be statistically different (146.02 (SD 311.96) vs. 47.24 (SD 66.3) (p= 0.009), 3.91 (SD 4.26) vs. 0.75 (SD 1.08) (p < 0.001), respectively). The present prospective observational study suggested an association of chemotherapy-induced sarcopenia with inflammatory markers Hs-CRP, IL8, and TNF-α. Inflammation may play a role in chemotherapy-induced sarcopenia in newly diagnosed non-metastatic patients.

The Role of IL-6, TNF-α, and VDR in Inhibiting the Growth of Salmonella Typhi: in vivo Study

Background and aim: The prevalence of typhoid fever is reportedly high, especially in Asia. When a pathogen enters the human body, there are markers in the form of molecules that will be known by the innate immune system. Specific molecular markers of gram negative bacteria, which are Lipopolysaccharides (LPS) and Toll-Like receptors-4 will interact with LPS. The binding between LPS and TLR-4 will give rise to activation signals that will activate innate immune cells. Immune cells will release a number of proinflammatory cytokines, such as TNF-α, IL-1, and IL-6. While Vitamin D Receptors (VDR) are expressed in large amounts in tumor tissue and infected cells. This study aimed to prove the role of IL-6, TNF-α, and VDR in inhibiting bacterial growth in mice that have been induced by S.Typhi. Methods: This research was a real experimental pre-post test design to investigate the level of IL-6, TNF-α and VDR in suppressing the growth of bacteria in the peritoneal fluid of S. Typhi, male, mice BALB/c. Mice were divided into three groups comprised of 10 mice each. All mice in groups A and B were intraperitoneally inoculated with S. Typhi strain Thy1 in study day 0. Group A was treated with antibiotic Levofloxacine, on study day 4th. Another study group, group B, was used as a placebo and received aquades on study day 4th. While group C as a control was not inoculated with S. Typhi. Blood samples from three groups for the calculation of serum Il-6, TNF-α, and VDR were collected. This examination was taken four times; at baseline, 4th day, 10th day, and 30th day. For the calculation of bacterial colony, peritoneal fluid retrieval was collected three times, which is on 4th day, 10th day, and 30th day. Results: A repeated measure ANOVA in group A (antibiotic) and group B (placebo) group showed that mean IL-6, TNF-α, and VDR level differed statistically significant between times (p-value 0.000). There was a strong negative correlation between bacterial colony count and VDR level, which was statistically significant in both groups (group A; r = -0.875, p-value = 0.000 vs group B; r = -0.470, p-value = 0.002). IL-6 and TNF-α didn't give significant statistical correlation with bacterial colony count. Conclusion: VDR, IL-6, and TNF-α play an important role in killing bacteria. From the results of this study, IL-6 level is related to the number of bacterial colonies, the lower the IL-6 level, the less the number of bacterial colonies. Similarly, TNF-α levels have a positive correlation with the number of bacterial colonies. While VDR levels are also related to the number of bacterial colonies, the higher the VDR level, the lower the number of bacterial colonies.

ANDALIMAN FRUIT EXTRACT (ZANTHOXYLUM ACANTOPHODIUM) AND IT’S EFFECT ON PREECLAMPSIA AS ANTI-INFLAMMATORY

Objective: This study is the first study to test the effect of andaliman on preeclampsia. This study aims to discover whether andaliman fruit extract (Zanthoxylum acanthopodium DC) affects the level of TNF α and IL-6 in preeclamptic LPS Induces mice&#x0D; Methods: This study uses analytical research with quasi-experimental research design in laboratory rats (Micetus Norvegicus) pregnant females given andaliman extract (zantoxylumacantophodium) at doses of 100 mg and 200 mg per day. The study design allowed the researchers to measure the effect of treatment (intervention) in the experimental group by way of comparing the experimental group and control group. This design allows the researcher to determine the extent or extent of the change. The treatment of all samples was carried out simultaneously and during the treatment, it was observed using the type of Postest Only Control Group.&#x0D; Results: Andaliman has been shown to reduce TNF-α levels in preeclampsia mice. The mean TNF-α in the K-, P1, P2 and K+ groups was 84.4; 90.1; 95.1; 109.7 (P&lt;0.001). Andaliman has been shown to reduce IL-6 levels in preeclampsia rats. The mean IL-6 in the K-, P1, P2 and K+groups was 16.7; 67.5; 18.8; 21.1 (P&lt;0.001).&#x0D; Conclusion: This study proves that there are anti-inflammatory effects possessed by the extract of Andaliman (Zanthoxylum acanthopodium), thus showing a decrease in proinflammatory cytokine levels, namely TNF-α, IL6. This study also has a good clinical outcome after administering Andaliman extract (Zanthoxylum acanthopodium), where there are improvements in blood pressure, cystole-diastole, MAP and decreased urinary protein in research subjects with preeclampsia.

Relationship of hypomethylation CpG islands in interleukin-6 gene promoter with IL-6 mRNA levels in patients with coronary atherosclerosis.

Introduction: Atherosclerosis is the important cause of most cardiovascular diseases, with high prevalence and mortality. Atherosclerosis is not only a lipid metabolism disorder but also recently is defined as a chronic inflammatory disease. Several studies showed that interleukin-6 (IL-6) is involved in the pathogenesis of atherosclerosis. The aim of the present study is the examination of IL6 mRNA Levels and hypomethylation of IL6 promoter in atherosclerosis patients. Methods: In this assay, a total of 35 cases with atherosclerosis and 30 controls were enrolled. RNA and DNA were isolated from the peripheral blood of all samples. Mean IL6 gene expression was determined by RT-PCR and methylation status at six CpG motifs in IL6 promoter was determined using bisulfite genomic sequencing. Results: Real Time-PCR analysis results showed the mean IL6 RNA level in atherosclerosis patients candidate for CABG (coronary artery bypass grafting) was significantly higher than controls (P value = 0.01). Also, the upstream CpG motifs (-1038 to -952) in IL6 promoter were predominantly unmethylated in patients than in the controls (P value = 0.01). Conclusion: These findings suggest that an increase in IL-6 gene expression and its DNA hypomethylation promoter are associated with atherosclerosis patient’s candidate for CABG surgery.

223 Association of levels of IL-6, IL-10, IL-18 and TNF-alpha with rheumatic mitral stenosis and subsequent pulmonary hypertension

Abstract Background Rheumatic heart disease (RHD) remains a serious public health problem in developing countries. The pattern of immune response after exposure to streptococcal infection is one of the main determinants of the rheumatic inflammatory process, making it essential to identify the patients who have a higher risk of disease progression. Objective To give an insight into the pathophysiology of the rheumatic afflicted valves and the role of IL-6, IL-10, IL-18 and TNF-α in the different stages of RHD. Methods The study included 84 consecutive patients (62 females, mean age 34.6 ± 10.6 years) with symptomatic, severe chronic rheumatic mitral stenosis (Group-A). 79 age and gender matched normal healthy volunteers were enrolled as controls (Group-B). Patients with chronic rheumatic mitral stenosis were further divided into subgroups based on severity of mitral stenosis [MVA ≤ 1 cm2 (Subgroup Aa) and MVA &amp;gt; 1 cm2 (Subgroups Ab)] and presence or absence of pulmonary hypertension [RVSP ≥ 36 mm Hg (Subgroup Ac) and RVSP &amp;lt; 36 mm Hg (Subgroup Ad)]. IL-6, IL-10, IL-18, TNF-α and hs-CRP levels were assessed in both groups. Results The mean serum levels of IL-6, IL-10, IL-18, TNF-α and hs-CRP in Group-A and Group-B were 6.57 ± 3.53 pg/mL and 2.73 ± 1.01 pg/mL (p &amp;lt;0.001), 8.19 ± 2.80 pg/mL and 3.51 ± 0.86 pg/mL (p &amp;lt;0.001), 136.31 ± 89.02 pg/mL and 47.96 ± 9.76 pg/mL (p &amp;lt;0.001), 21.26 ± 18.59 pg/mL and 5.36 ± 3.57 pg/mL (p &amp;lt;0.001), 4.69 ± 6.31 pg/mL and 2.63 ± 2.22 pg/mL (p &amp;lt;0.008) respectively. On subgroup analysis mean TNF-α in subgroup Aa was 20.71 ± 16.84 pg/mL, while in subgroup Ab it was 7.56 ± 1.93 pg/mL (p &amp;lt;0.001). Mean IL-10 in subgroup Ac and Ad was 8.74 ± 3.29 pg/mL and 7.47 ± 1.82 pg/mL respectively (p &amp;lt;0.028). Conclusions Chronic rheumatic mitral stenosis patients have increased IL-6, IL-10, IL-18, TNF-α and hs-CRP levels suggesting a continuous ongoing inflammatory activity even in chronic phase. Further subjects having severe mitral stenosis had increased TNF-α levels in comparison to subjects with mild to moderate mitral stenosis suggesting its possible role in acceleration of rheumatic process. Cytokines in various subgroup Parameter IL-6 (pg/ml) p IL-10 (pg/ml) p IL-18 (pg/ml) p TNF-α (pg/ml) p hs-CRP (pg/ml) p Subgroup Aa 5.63 ± 3.25 0.13 8.38 ± 3.06 0.32 146.35 ± 103.84 0.20 20.71 ± 16.84 &amp;lt;0.001 3.72 ± 3.43 0.67 Subgroup Ab 6.90 ± 3.57 7.72 ± 2.04 112.28 ± 22.79 7.56 ± 1.93 4.27 ± 3.81 Subgroup Ac 6.86 ± 3.50 0.44 8.74 ± 3.29 0.02 145.29 ± 103.01 0.29 20.25 ± 17.02 0.53 4.77 ± 0.93 0.93 Subgroup Ad 6.21 ± 3.49 7.47 ± 1.82 124.67 ± 66.95 22.91 ± 20.68 4.66 ± 3.44 Abstract 223 Figure. Cytokines in case and control

Serum interleukin-18 and carotid intima-media thickness in patients with type 2 diabetes mellitus

Background Interleukin-18 (IL-18), known as a member of IL-1 family cytokines, is found to be elevated as a part of the chronic low-grade inflammatory process in obesity, metabolic syndrome, and type 2 diabetes (T2D). Patients with carotid intima-media thickness (CIMT) exhibited a higher level of IL-18 in the serum. Objective To study the relation between serum IL-18 and CIMT in patients with type 2 diabetes mellitus (T2DM). Patients and methods A total of 60 patients diagnosed as having T2D and 30 age-matched and sex-matched patients as a control group were recruited in this study. Diabetic patients were divided into two groups according to the presence or absence of diabetic nephropathy. Clinical examination and laboratory investigations including serum IL-18 (by ELISA) and CIMT of both common carotid arteries were carried out. Results Mean serum IL-18 level was significantly increased in patients with T2DM when compared with the control group. There was a significant increase in the mean serum IL-18 in patients with diabetic nephropathy compared with those patients without nephropathy. Moreover, there was a significant positive correlation between serum IL-18 and CIMT, glycated hemoglobin, serum lipids, creatinine, urea, and urinary protein in patients with T2DM (group I) (P&lt;0.001). Conclusion Serum IL-18 level and CIMT were higher in T2DM than that in controls and in diabetic patients with nephropathy compared with those without nephropathy. Higher serum IL-18 levels correlated with larger CIMT, suggesting a role of IL-18 in atherosclerosis.

Cytokine profile among a sample of bipolar and schizophrenic patients: a comparative study

Background Bipolar disorder (BD) and schizophrenia are serious forms of mental illness which are considered to be complex and multisystemic conditions. Several lines of evidence point to the key role of immune dysfunction in both disorders, with recent reports citing abnormal blood levels of cytokines where the most obvious mechanism is a dysregulation of the balance of proinflammatory and anti-inflammatory cytokines. Objective The aim was to explore the presence of immune dysfunction in BD in comparison with schizophrenia and to compare them to apparently healthy control persons. Participants and methods This study was a cross-sectional study on 90 individuals (30 diagnosed as BD, 30 as schizophrenic, and 30 apparently healthy controls). Age matched and sex matched. They were assessed by general medical and neurological examination. Semistructured clinical interview for DSM-IV (SCIDI), positive and negative schizophrenia scale (PANSS) for the schizophrenia group, Yearsania rating scale (YMRS) for the bipolar group, and laboratory investigations include: serum interleukin (IL)1B level and serum IL6 level for the three groups. Result The mean serum IL1B level was found to be higher in the bipolar group than that of the control group and schizophrenia group .The mean serum IL1B level in the schizophrenia group was higher than that of the control group. The mean serum IL6 level was higher in the bipolar and schizophrenia groups than that of the control group. It was also found that serum IL1B showed a highly significant correlation with the duration of illness in the bipolar group, while serum IL6 showed a significance with the duration of illness in the bipolar and schizophrenia groups. In the bipolar group, significant correlation was found between IL6 and number of episodes, while in the schizophrenia group, a significant correlation was found between IL6 and age at onset of illness and number of episodes. Conclusion There is mounting evidence of increased immune markers, particularly proinflammatory cytokines in BD and schizophrenia patients. So, identifying the biomarkers could represent new tools which could help to improve diagnosis and find prognostic markers which offers great promises toward a better understanding of the etio-pathological mechanisms involved in BD and schizophrenia, and for the development of prevention and personalized treatments.

Interleukin 22 and 6 serum concentrations decrease under long-term biologic therapy in psoriasis.

IntroductionPsoriasis, affecting approximately 2% of the worldwide population, is a chronic, inflammatory skin disease in which overexpression of proinflammatory cytokines is observed. Most of the available data on the influence of antipsoriatic therapy on the cytokine serum concentration are inconsistent and based on short-term observations.AimTo evaluate the influence of long-term biologic therapy with tumor necrosis factor α (TNF-α) blockers (adalimumab, etanercept, infliximab) and IL-12/23 inhibitor (ustekinumab) on the level of IL-6, IL-22 in the sera of patients with psoriasis.Material and methodsBlood samples were collected from 42 psoriatic patients in order to determine IL-6 and IL-22 serum concentrations prior to and at the 3rd, 12th, 24th and 36th month of biologic therapy. Psoriasis Activity and Severity Index (PASI) was assessed at the same time points. The control group consisted of 30 sex- and age-matched healthy volunteers.ResultsMean PASI index at baseline was 14.49 ±3.69 and decreased significantly until the end of the observation. Mean IL-6 serum concentration decreased significantly in all study groups (p < 0.05). A statistically significant decrease in IL-22 concentrations was demonstrated during the treatment with adalimumab and infliximab but not etanercept or ustekinumab.ConclusionsAccording to obtained results, IL-6 and IL-22 serum concentration may be an accurate marker of response to antipsoriatic therapy, even though not correlated with PASI index. Biologic therapy in psoriasis allows for long-term clinical improvement expressed not only by the remission of skin lesions, but also by lowering serum concentrations of pro-inflammatory interleukins.

Longitudinal changes in glucose metabolism in women with gestational diabetes, from late pregnancy to the postpartum period.

This study aimed to determine, in women with gestational diabetes (GDM), the changes in insulin sensitivity (Matsuda Insulin Sensitivity Index; ISOGTT), insulin response and disposition index (DI) from late pregnancy (34-37weeks gestation, T1), to early postpartum (1-5days, T2) and late postpartum (6-12weeks, T3). A secondary aim was to correlate the longitudinal changes in maternal lipids, adipokines, cytokines and weight in relation to the changes in ISOGTT, insulin response and DI. ISOGTT, insulin response and DI were calculated at the three time points (T1, T2 and T3) using the results of a 75g OGTT. Adipokines, cytokines and lipids were measured prior to each OGTT. Linear mixed-effects models were used to compare changes across each time point. Changes in ISOGTT, insulin response and DI were correlated with changes in maternal adipokines, cytokines and lipids at each time point. A total of 27 women completed all assessments. Compared with T1, ISOGTT was 11.20 (95% CI 8.09, 14.31) units higher at 1-5days postpartum (p < 0.001) and was 5.49 (95% CI 2.38, 8.60) units higher at 6-12weeks postpartum (p < 0.001). Compared with T1, insulin response values were 699.6 (95% CI 957.5, 441.6) units lower at T2 (p < 0.001) and were 356.3 (95% CI 614.3, 98.3) units lower at T3 (p = 0.004). Compared with T1, the DI was 6434.1 (95% CI 2486.2, 10,381.0) units higher at T2 (p = 0.001) and was 4262.0 (95% CI 314.6, 8209.3) units higher at T3 (p = 0.03). There was a decrease in mean cholesterol, triacylglycerol, LDL-cholesterol and VLDL-cholesterol from T1 to T2 (all p < 0.001), and an increase in mean C-reactive protein, IL-6 and IL-8 from T1 to T2 (all p < 0.001). Mean leptin decreased from T1 to T2 (p = 0.001). There was no significant change in mean adiponectin (p = 0.99) or TNF-α (p = 0.81) from T1 to T2. The mean maternal BMI decreased from T1 to T2 (p = 0.001) and T3 (p < 0.001). There were no significant correlations between any measure of change in ISOGTT, insulin response and DI and change in maternal cytokines, adipokines, lipids or weight from T1 to T2. In women with GDM, delivery was associated with improvement in both insulin sensitivity and insulin production within the first few days. Improvement in insulin production persisted for 6-12weeks, but insulin sensitivity deteriorated slightly. These changes in glucose metabolism were not associated to changes in lipids, leptin, inflammation markers or body weight. ClinicalTrials.gov NCT02082301.

Effect of Serum Ammonia, TNF-Alfa and IL-6 Levels on the Degree and Outcome of Hepatic Encephalopathy in Egyptian Cirrhotic Patients

Abstract Background: Hepatic Encephalopathy (HE) is a major complication of liver cirrhosis characterized with neuropsy-chiatric symptoms it's etiology is multifactorial. Aim of Study: Aim of the study serum ammonia, TNF-alfa and IL-6 levels on the degree and outcome of hepatic encephalopathy in Egyptian cirrhotic patients. Patient and Methods: The study included 90 patients with liver cirrhosis complicated with HE (patients group) and 60 cirrhotic patients without HE as control group (group 3), the patients group divided into subgroups according to the grade of encephalopathy from the beginning the study, group A encephalopathy: Grade 1 and 2 and group B encephalopathy: Grade 3 and 4. All patients were followed-up for 7 days, then divided into 2 groups according to the response to treatment; group 1: Complete recovery and group 2: With improper response. Results: There were statistical difference between patients groups (group 1and 2) and control group (group 3) in terms of blood ammonia levels (67.5±22.5, 13±4.8), serum TNF-a levels (21.6±3.2, 2.3±.2) and mean serum IL-6 (63.9±15.9, 4±1.29) respectively. There were statistical difference between group 1 and group 2 in terms blood ammonia levels (46±12.8, 86.5±30.5), mean serum TNF-a levels (7.1±2.9, 29.4±13.3) and mean serum IL-6 (19±9.2, 93.9±20.9). Results also, showed statistical significant difference between group 2A and group 2B in terms of blood ammonia level (79.2±20.6, 173.7±38.7), mean serum TNF-a levels (18.1±5.3, 39.9±14.5) and mean serum IL-6 levels (69.2±11.1, 118.2±13.8). In group 2 there were significant positive correlation between serum TNF with blood ammonia level (r=0.843, p=0.001), serum IL-6 (r=0.732, p=0.001) and between IL-6 and blood ammonia level (r=0.699, p=0.001). Conclusion: There is a strong relation between high blood level of ammonia, TNF alfa, IL-6 and grade and outcome of HE in cirrhotic patients.

Dexmedetomidine combined with interscalene brachial plexus block has a synergistic effect on relieving postoperative pain after arthroscopic rotator cuff repair.

Interscalene brachial plexus block (ISB) is one of the most commonly used regional blocks in relieving postoperative pain after arthroscopic rotator cuff repair. Dexmedetomidine (DEX) is an alpha 2 agonist that can enhance the effect of regional blocks. The aim of this study was to compare the effects of DEX combined with ISB with ISB alone on postoperative pain, satisfaction, and pain-related cytokines within the first 48h after arthroscopic rotator cuff repair. Fifty patients with rotator cuff tears who had undergone arthroscopic rotator cuff repair were enrolled in this single center, double-blinded randomized controlled trial study. Twenty-five patients were randomly allocated to group 1 and received ultrasound-guided ISB using a mixture of 1ml (100μg) of DEX and 8ml of 0.75% ropivacaine preemptively. The other 25 patients were allocated to group 2 and underwent ultrasound-guided ISB alone using a mixture of 1ml of normal saline and 8ml of ropivacaine. The visual analog scale (VAS) for pain and patient satisfaction (SAT) scores were checked within 48h postoperatively. The plasma interleukin (IL)-6, -8, -1β, cortisol, and substance P levels were also measured within 48h, postoperatively. Group 1 showed a significantly lower mean VAS score and a significantly higher mean SAT score than group 2 at 1, 3, 6, 12, and 18h postoperatively. Compared with group 2, group 1 showed a significantly lower mean plasma IL-6 level at 1, 6, 12, and 48h postoperatively and a significantly lower mean IL-8 level at 1, 6, 12, 24, and 48h postoperatively. The mean timing of rebound pain in group 1 was significantly later than that in group 2 (12.7h > 9.4h, p = 0.006). Ultrasound-guided ISB with DEX in arthroscopic rotator cuff repair led to a significantly lower mean VAS score and a significantly higher mean SAT score within 48h postoperatively than ISB alone. In addition, ISB with DEX showed lower mean plasma IL-6 and IL-8 levels than ISB alone within 48h postoperatively, with delayed rebound pain. I. 2013-112, ClinicalTrials.gov Identifier: NCT02766556.

Anemia and inflammation, a link between end stage kidney disease and left ventricular hypertrophy

Background: Based on Glomerular Filtration Rate (GFR) Chronic Kidney Disease patients are classified into five stages. It starts with early stage of CKD and finally ends with End Stage Kidney Disease (ESKD). Anemia and inflammation are major medical complication in End Stage Kidney Disease and leads cardio vascular complications like LVH.Methods: A cross sectional study carried out over a 2 year period in Department Nephrology and General Medicine OPD, MIMS, Vizianagaram, Andhra Pradesh, India 120 in which 60 are normal healthy individuals and 60 are End stage kidney Disease. In all the participants Serum creatinine, blood urea, Serum Iron, TIBC, TSAT% Serum ferritin, Serum CRP, IL-6 and TNF-α was measured. All the EDTA blood samples were analyzed for complete blood count. Results: The diagnostic criteria for CKD like blood urea and serum creatinine were significantly higher in ESKD. There is a significantly increased level of Left ventricular mass index in ESKD when compared with Control. The mean erythrocyte indices are decreased in ESKD. The mean serum iron, TIBC and TSAT% decreased ESKD. Whereas serum ferritin significant increase in ESKD group and the mean serum CRP IL-6 and TNF-α significant increase in ESKD group when compared with controlConclusion: Present study finding suggested that there is a raised inflammatory marker in ESKD patients due to inflammation and it further changes serum ferritin, serum iron and TIBC. The above altered factors leads to changes in erythrocyte indices and leads to anemia which ends with cardiovascular complication like Left Ventricular Hypertrophy.

Circulating interleukin-6 as a biomarker in a randomized controlled trial of modified-release prednisone vs immediate-release prednisolone, in newly diagnosed patients with giant cell arteritis.

To measure serial interleukin (IL)-6 levels in newly diagnosed patients with giant cell arteritis (GCA), treated in a randomized controlled trial of modified-release prednisone (MR) vs immediate-release prednisolone (IR) used in a tapering regimen conforming to British Society for Rheumatology GCA guidelines. Patients (n=12) were randomized into 2 treatment arms (7 MR, 5 IR) and followed over 26weeks. We measured IL-6 with additional markers. A significantly higher overall mean IL-6 level (P<.05) was seen in IR (mean=12.15, standard error [SE]=1.90) compared with MR (mean=4.39, SE=1.84). Mean collagen type 1 cross-linked C-telopeptide (CTX) concentration was significantly higher (P < .05) in both groups at week 4 (mean=0.29, SE=0.04) compared with week 26 (mean=0.13, SE=0.02). MR patients had adrenocorticotropic hormone (ACTH) suppression compared with IR (P<.05) throughout without differences in cortisol levels (P=.34). No significant differences were seen between arms in other markers. Our study suggests that elevated levels of IL-6 in new GCA are better suppressed by MR prednisone compared with IR prednisolone. CTX was significantly reduced in both treatment arms indicating early metabolic effect of glucocorticoids on bone. ACTH suppression with MR prednisone may reflect a greater impact on the hypothalamic-pituitary-adrenal axis although cortisol was not affected. MR prednisone warrants further investigation in GCA.

Methylprednisolone and inflammatory stress response in older people undergoing surgery for hip fracture: a secondary analysis of a randomized controlled trial.

The inflammatory response to surgery can cause organ dysfunction that results in postoperative complications, including delirium. Methylprednisolone is an anti-inflammatory drug and could mitigate stress responses. This purpose of the study is to investigate the effects of a single high-dose methylprednisolone on various biomarkers in older people undergoing surgery for hip fractures. In the primary study, 117 patients were included. The biomarkers investigated in this secondary analysis were interleukin (IL) -6, IL-10, troponin-T (TnT), tumor necrosis factor alpha (TNF-α), S100 calcium-binding protein B, and soluble urokinase-type plasminogen activator receptor. Blood samples were collected at four time points: (1) before the study intervention (Tbefore); (2) at time of surgery (Tsurgery); on the (3) 1st and (4) 3rd postoperative day (TP1 and TP3, respectively). Patients in the methylprednisolone group had significantly lower adjusted mean IL-6 at Tsurgery and TP1 than the placebo group [15.60 (1.13pg/mL) vs 47.86 (1.12pg/mL), p < 0.000 and 111.01 (31.64pg/mL) vs 198.57 (24.00pg/mL), p = 0.005]. Furthermore, adjusted mean TnT levels at Tsurgery were lower in the methylprednisolone group [20.61 (1.14ng/mL) vs 24.28 (1.12ng/mL), p = 0.024) as well as adjusted mean TNF-α levels TP1 (14.31 (1.08pg/mL) vs 17.64 (1.04pg/mL), p = 0.025]. In this secondary analysis, methylprednisolone had a significant effect on three biomarkers (IL-6, TnT, and TNF-α). The potential beneficial effects of methylprednisolone on inflammatory biomarkers reflecting surgical stress response in patients with hip fractures need to be investigated further.

Elevated urine IL-10 concentrations associate with Escherichia coli persistence in older patients susceptible to recurrent urinary tract infections

BackgroundAge is a significant risk factor for recurrent urinary tract (rUTI) infections, but the clinical picture is often confused in older patients who also present with asymptomatic bacteriuria (ASB). Yet, how bacteriuria establishes in such patients and the factors underpinning and/or driving symptomatic UTI episodes are still not understood. To explore this further a pilot study was completed in which 30 male and female community based older patients (mean age 75y) presenting clinically with ASB / rUTIs and 15 control volunteers (72y) were recruited and monitored for up to 6 months. During this period symptomatic UTI episodes were recorded and urines collected for urinary cytokine and uropathogenic Escherichia coli (UPEC) analyses.ResultsEighty-six per cent of patients carried E. coli (102 ≥ 105 CFU/ml urine) at some point throughout the study and molecular typing identified 26 different E. coli strains in total. Analyses of urine samples for ten different cytokines identified substantial patient variability. However, when examined longitudinally the pro-inflammatory markers, IL-1 and IL-8, and the anti-inflammatory markers, IL-5 and IL-10, were significantly different in the patient urines compared to those of the controls (P < 0.0001). Furthermore, analysing the cytokine data of the rUTI susceptible cohort in relation to E. coli carriage, showed the mean IL-10 concentration to be significantly elevated (P = 0.04), in patients displaying E. coli numbers ≥105 CFU/ml.ConclusionsThese pilot study data suggest that bacteriuria, characteristic of older rUTI patients, is associated with an immune homeostasis in the urinary tract involving the synthesis and activities of the pro and anti-inflammatory cytokines IL-1, IL-5, IL-8 and IL-10. Data also suggests a role for IL-10 in regulating bacterial persistence.

DIFFERENCES OF PLASMA INTERLEUKIN-6 AND TUMOR NECROSIS FACTOR-α LEVELS IN HEALTHY PEOPLE, RIFAMPICIN RESISTANT AND SENSITIVE PULMONARY TUBERCULOSIS PATIENTS

Increased tuberculosis in the world is caused by increased HIV-infected and antituberculous drugs (rifampicin) resistant individuals. IL-6 and TNF-α play an essential role in explaining the different degrees of inflammation in Rifampicin Resistant (RR) and Rifampicin Sensitive (RS) pulmonary tuberculosis patients, and healthy people. The research aimed to analyze the differences in plasma IL-6 and TNF-α levels in healthy people, Rifampicin Resistant (RR), and Rifampicin Sensitive (RS) pulmonary tuberculosis patients. A cross-sectional study was conducted from July-September 2017. Thirty-nine subjects were classified into RR pulmonary tuberculosis (n=15), RS pulmonary tuberculosis (n=12) based on GeneXpert examination and treated by antituberculous drugs ≤ 1 month, and healthy people (n=12) based on AFB results, Thorax X-ray, and tuberculin tests. IL-6 and TNF-α were done in all subjects using ELISA U-CyTech®(Biosciences, Inc.). Anova analyzed differences of IL-6 and TNF-α levels between groups. The mean IL-6 levels (pg/mL) in RR and RS pulmonary tuberculosis patients, and healthy people were 54.56±59.13, 27.05±37.04, 4.42±2.83, respectively. The mean TNF-α levels (pg/mL) in RR and RS pulmonary tuberculosis patients, and healthy people were 263.54±327.58, 250.25±314.20, 9.04±5.89, respectively. The mean differences between IL-6 and TNF-α levels (pg/mL) between RR pulmonary tuberculosis patients and healthy people were 50.14±15.29 (p&lt;0.05) and 254.59±8460 (p&lt;0.05). Significant differences of mean IL-6 and TNF-α levels were found between RR pulmonary tuberculosis patients and healthy people.

A biomarker for obstructive sleep apnea in chronic rhinosinusitis

Chronic rhinosinusitis (CRS) is associated with poor sleep and higher risk for obstructive sleep apnea (OSA) in retrospective studies. The aim of this prospective study is to find a reliable biomarker to screen CRS patients for sleep disruption and sleep apnea. Patients with CRS were enrolled. All patients completed the Pittsburgh Sleep Quality Index(PSQI) and Functional Outcomes of Sleep Questionnaire. Morning serum IL-6 levels were measured by a high-sensitivity ELISA. Patients were randomly selected for overnight polysomnography. OSA was diagnosed if apnea-hypopnea index(AHI)>5. Associations between IL-6 levels and sleep disruption were evaluated by ANOVA test and regression analysis. Sixty CRS patients were enrolled. Serum IL-6 level were significantly higher in patients with OSA compared to those without OSA (4.1ng/dL±2.8 vs 1.1ng/dL±0.5 mean IL-6±SD P< 0.05). IL-6 level was associated with severity of OSA (3.15ng/dL±2.0 in mild, 5.15ng/dL±1.7 in moderate; 10.49ng/dL±3.8 in severe OSA; mean ± SD adjusted-P<0.0001). IL-6 level was associated with severity of sleep hypoxemia (1.1 ng/dL ± 0.5 in mild hypoxemia (O2-nadir>88mmHg); 2.5 ng/dL±1.8 in moderate hypoxemia (O2-nadir 80-88 mmHg); 6.9 ng/dL ± 3.3 in severe hypoxemia (O2-nadir<80 mmHg) respectively, P=0.02). PSQI score was higher in patients with OSA compared to those without OSA(5.9 ± 3.2 vs. 7.2 ± 2.8; mean ± SD, adjusted-P=0.045), but PSQI was not associated with severity of OSA or hypoxemia. Serum IL-6 is associated with severity OSA and hypoxemia in CRS. Serum IL-6 could serve as a screening biomarker for OSA in CRS.