The relationship between protein C, protein S and cytokines in acute ischemic stroke

OBJECTIVE: The role of inflammation in the pathogenesis of acute ischemic stroke is well known, but its association with the clinical picture is as yet unclear. MATERIAL AND METHODS: In our study, we measured the serum levels of the proinflammatory cytokines interleukin-1beta (IL-1beta), tumor necrosis factor alpha (TNFalpha) and interleukin-6 (IL-6) within the first 50 h of stroke in 60 acute stroke patients, and examined the association with the natural anticoagulants protein C and free protein S. We compared the results with a control group that consisted of 30 volunteers. We also correlated their levels with the clinical outcomes by using the Canadian Neurological Scale (CNS). RESULTS: Neither stroke patients nor the control group had any elevations in IL-1beta serum levels. However, the levels of serum IL-6 were significantly higher in stroke patients (13.7 +/- 19.46 vs. 4.3 +/- 15.88, p = 0.002). In addition, the protein S levels of patients were lower than those of the controls (84.36 +/- 27.97 vs. 95.9 +/- 25.64, p = 0.007). Although IL-6 showed negative correlation with protein S (r = -0.504, p = 0.000), the other studied cytokines TNFalpha and IL-1beta did not correlate with these natural anticoagulants. Another negative correlation was found between IL-6 and CNS scores (r = -0.451, p = 0.000). In addition, both protein C and protein S positively correlated with CNS (r = 0.263, p = 0.042; r = 0.381, p = 0.003). There was also a positive correlation between protein C and protein S (r = 0.408, p = 0.001). CONCLUSIONS: Our results suggest that TNFalpha and IL1beta serum levels are not elevated in the acute phase of stroke and have no correlation with the natural anticoagulants protein C and protein S. However, a decrease in free protein S may be related to elevated IL-6 levels. In addition, increased levels of IL-6 and reduced levels of protein C and protein S may play a role in acute ischemic stroke severity.     

Age-related alterations of the CD19 complex and memory B cells in children with Down syndrome

Children with Down syndrome (DS) have a high incidence of recurrent respiratory tract infections, leukaemia and autoimmune disorders, suggesting immune dysfunction. The present study evaluated the role of the CD19 complex and memory B cells in the pathogenesis of immunodeficiency in children with DS. The expression levels (median fluorescein intensity—MFI) of CD19, CD21 and CD81 molecules on the surface of B cells and memory B cell subsets were studied in 37 patients and 39 healthy controls. Twenty-nine of the DS group had congenital cardiac disease. The B cell count was significantly low in children with DS compared with healthy age-matched controls for all three age groups (under 2 years; 2–6 years and older than 6 years). The MFI of CD19 was reduced in all the age groups, whereas that of CD21 was increased in those older than 2 years with DS. The expression level of CD81 was significantly increased in those older than 6 years. Age-related changes were also detected in memory B cell subsets. The frequency of CD27⁺IgD⁺IgM⁺ natural effector B cells was reduced in children with DS who had needed hospitalisation admission due to infections. The observed intrinsic defects in B cells may be responsible for the increased susceptibility of children with DS to severe respiratory tract infections.     

Effect of controlled hypotension on regional cerebral oxygen saturation during rhinoplasty: a prospective study

The aim of this study was to investigate the effect of controlled hypotension on cerebral oxygen saturation (rSO₂) using near infrared spectroscopy (NIRS) and evaluation of postoperative cognitive function in patients undergoing rhinoplasty. Fifty adult patients who were scheduled for elective rhinoplasty surgery and required controlled hypotension were enrolled in this prospective study. Controlled hypotension was provided using a combination of propofol and remifentanil infusion supplemented with nitroglycerin infusion as necessary. rSO₂ was evaluated during controlled hypotension by NIRS. Cerebral desaturation was observed in 5 out of 50 patients (10 %) during hypotensive anesthesia. The greatest decrease from baseline was 28 % when MAP was 57 mmHg. In both non-desaturated and desaturated patients, postoperative MMSE scores were significantly lower than preoperative scores. There was a 4 % decrease in the non-desaturated patients and a 7 % decrease in the desaturated patients when preoperative and postoperative MMSE scores were compared. A decline in cognitive function 1 day after surgery was observed in 23 patients (46 %) and in all patients with intraoperative cerebral desaturation. The current study showed that even if SpO₂ is in the normal range, there might be a decrease of more than 20 % in cerebral oxygen saturation during controlled hypotension.     

In vitro protection of adipose tissue-derived mesenchymal stem cells by erythropoietin

Mobilization of stem cells and their differentiation into cardiomyocytes are known to have protective effects after myocardial infarction. The integrity of transplanted mesenchymal stem cells for cardiac regeneration is dependent on cell–cell or cell–matrix interaction, which is adversely affected by reactive oxygen species in an ischemic environment. Treatment with erythropoietin was shown to protect human adipose tissue derived mesenchymal stem cells in an ischemic injury in vitro model. The analyses indicated that expression of erythropoietin receptors played a pivotal role in erythropoietin mediated cell survival. In this study, the anti-apoptotic effect of erythropoietin on stem cells was analyzed in apoptosis-induced human mesenchymal stem cells. Apoptosis was induced in cultured adult human adipose tissue derived mesenchymal stem cells by hydrogen peroxide. A group of cultured cells was also treated with recombinant human erythropoietin in a concentration of 50 ng mL⁻¹. The degree of apoptosis was analyzed by flow-cytometry and immunohistochemical staining for Caspase 3. The average percentages of apoptotic cells were significantly higher in H₂O₂-induced stem cells than in cells co-cultured with erythropoietin (63.03 ± 4.96% vs 29 ± 3.41%, p < 0.01). We conclude that preconditioning with erythropoietin suppresses apoptosis of mesenchymal stem cells and enhances their survival.     

Latent fatality due to hydatid cyst rupture after a severe cough episode

Hydatid disease is a parasitic disease caused by Echinococcus granulosus characterised by cyst formation in various organs. The infestation mostly involves the liver. Hydatid cysts of the liver can rupture either spontaneously or due to trauma. Incidence of rupture is about 3-17% of all cases with hydatid disease. Unless treated surgically, rupture can result in death. Here, we present a case of hydatid cyst ruptured after a severe cough episode and disseminated first to the subcapsular area, then to the peritoneal space. Probably due to a decrease in parenchymal pressure in the liver after decompressive effect of rupture, the patient felt an improvement in abdominal pain, refused operation, and left the hospital on his own responsibility. This unfortunate relief resulted in a delay of 55 hours in management. The leakage of liquid materials into peritoneal space resulted in a severe inflammatory reaction and eventually death of the patient. The patient died of a late peritonitis rather than anaphylaxis, which is the most common reason for death in such patients. As a conclusion, physicians should be aware of a temporary relief in abdominal pain after cyst rupture that may cause a delay in management and in turn loss of patient due to peritonitis.