Suchergebnisse

OBJECTIVE: To perform two scoping systematic reviews of the literature on cytokine measurement in cerebral microdialysis (CMD) and cerebrospinal fluid (CSF) in aneurysmal subarachnoid hemorrhage (SAH) patients, aiming to summarize the evidence relating cytokine levels to pathophysiology, disease progression, and outcome. METHODS: Two separate systematic reviews were conducted: one for CMD cytokines and the second for CSF cytokines. DATA SOURCES: Articles from MEDLINE, BIOSIS, EMBASE, Global Health, Scopus, Cochrane Library (inception to October 2016), reference lists of relevant articles, and gray literature were searched. STUDY SELECTION: Two reviewers independently identified all manuscripts utilizing predefined inclusion/exclusion criteria. A two-tier filter of references was conducted. DATA EXTRACTION: Patient demographic and study data were extracted to tables. RESULTS: There were 9 studies identified describing the analysis of cytokines via CMD in 246 aneurysmal SAH patients. Similarly, 20 studies were identified describing the analysis of CSF cytokines in 630 patients. The two scoping systematic reviews demonstrated the following: (1) limited literature available on CMD cytokine measurement in aneurysmal SAH with some preliminary data supporting feasibility of measurement and potential association between interleukin (IL)-6 and patient outcome. (2) Various CSF measured cytokines may be associated with patient outcome at 3–6 months, including IL-1ra, IL-6, IL-8, and tumor necrosis factor-alpha. (3) There is a small literature body supporting an association between acute/subacute CSF transforming growth factor levels and the development of chronic hydrocephalus at 2–3 months. CONCLUSION: The evaluation of CMD and CSF cytokines is an emerging area of the literature in aneurysmal SAH. Further large prospective multicenter studies on cytokines in CMD and CSF need to be conducted. ; This work was made possible through salary support through the Cambridge Commonwealth Trust Scholarship, the Royal College of Surgeons of Canada – Harry S. Morton Travelling Fellowship in Surgery, the University of Manitoba Clinician Investigator Program, R. Samuel McLaughlin Research and Education Award, the Manitoba Medical Service Foundation, and the University of Manitoba Faculty of Medicine Dean's Fellowship Fund EPT has received funding support from Swedish Society of Medicine (Grant no. SLS-587221). AH receives support from the Medical Research Council (MRC), Cambridge Biomedical Research Centre, Royal College of Surgeons of England (G0802251) These studies were supported by National Institute for Healthcare Research (NIHR, UK) through the Acute Brain Injury and Repair theme of the Cambridge NIHR Biomedical Research Centre, an NIHR Senior Investigator Award to DKM, and an NIHR Research Professorship to PJAH. Authors were also supported by a European Union Framework Program 7 grant (CENTER-TBI; Grant Agreement No. 602150) PJH receives support from the National Institute of Health Research, Cambridge Biomedical Research Centre.

Objective: To perform two scoping systematic reviews of the literature on cytokine measurement in: 1. Cerebral Microdialysis (CMD) and 2. Cerebrospinal Fluid (CSF) in severe traumatic brain injury (TBI) patients. Methods: Two separate systematic reviews were conducted: one for CMD cytokines and the second for CSF cytokines. Both were conducted in severe TBI patients only. Data Sources: Articles from MEDLINE, BIOSIS, EMBASE, Global Health, Scopus, Cochrane Library (inception to Oct 2016), reference lists of relevant articles, and gray literature were searched Study Selection: Two reviewers independently identified all manuscripts utilizing predefined inclusion/exclusion criteria. A two-tier filter of references was conducted. Data Extraction: Patient demographic and study data was extracted to tables. Results: There were 19 studies identified describing the analysis of cytokines via CMD in 267 severe TBI patients. Similarly, there were 32 studies identified describing the analysis of CSF cytokines in 1363 severe TBI patients. The two systematic reviews demonstrated: 1. Limited literature available on CMD cytokine measurement in severe TBI, with some preliminary data supporting feasibility of measurement and associations between cytokines and patient outcome. 2. Various CSF measured cytokines may be associated with patient outcome at 6 to 12 months, including: IL-1b, IL-1ra, IL-6, IL-8, IL-10 and TNF. 3. There is little to no literature in support of an association between CSF cytokines and neuro-physiologic or tissue outcomes. Conclusions: The evaluation of CMD and CSF cytokines is an emerging area of the literature in severe TBI. Further large prospective multi-center studies on cytokines in CMD and CSF need to be conducted. ; This work was made possible through salary support through: the Cambridge Commonwealth Trust Scholarship, the Royal College of Surgeons of Canada – Harry S. Morton Travelling Fellowship in Surgery, the University of Manitoba Clinician Investigator Program, R. Samuel McLaughlin Research and Education Award, the Manitoba Medical Service Foundation, and the University of Manitoba Faculty of Medicine Dean's Fellowship Fund These studies were supported by National Institute for Healthcare Research (NIHR, UK) through the Acute Brain Injury and Repair theme of the Cambridge NIHR Biomedical Research Centre, an NIHR Senior Investigator Award to DKM, and an NIHR Research Professorship to PJAH. Authors were also supported by a European Union Framework Program 7 grant (CENTER-TBI; Grant Agreement No. 602150) EPT has received funding support from Swedish Society of Medicine (Grant no. SLS-587221).