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Following traumatic brain injury (TBI), cascades of inflammatory processes occur. Laboratory studies implicate the cytokines interleukin-1α(IL-1α) and IL-1βin the pathophysiology of TBI and cerebral ischemia, whilst exogenous and endogenous interleukin-1 receptor antagonist (IL-1ra) is neuroprotective. We analyzed IL-1α, IL-1β, and IL-1ra in brain microdialysates (100-kDa membrane) in 15 TBI patients. We also analyzed energy-related molecules (glucose, lactate, pyruvate, glutamate, and the lactatepyruvate ratio) in these brain microdialysates. Mean of mean (± SD) in vitromicrodialysis percentage recoveries (extraction efficiencies) were IL-1α19.7 ± 7.6, IL-1β23.9 ± 10.5, and IL-1ra 20.9 ± 6.3. In the patients'' brain microdialysates, mean of mean cytokine concentrations (not corrected for percentage recovery) were IL-1α5.6 ± 14.8 pgmL, IL-1β10.4 ± 14.7 pgmL, and IL-1ra 2796 ± 2918 pgmL. IL-1ra was consistently much higher than IL-1αand IL-1β. There were no significant relationships between IL-1 family cytokines and energy-related molecules. There was a significant correlation between increasing IL-1βand increasing IL-1ra (Spearman r 0.59, p 0.028). There was also a significant relationship between increasing IL-1ra and decreasing intracranial pressure (Spearman r −0.57, p 0.041). High concentrations of IL-1ra, and also high IL-1raIL-1βratio, were associated with better outcome (Mann Whitney, p 0.018 and p 0.0201, respectively), within these 15 patients. It is unclear whether these IL-1ra concentrations are sufficient to antagonize the effects of IL-1βin vivo. This study demonstrates feasibility of our microdialysis methodology in recovering IL-1 family cytokines for assessing their inter-relationships in the injured human brain, and suggests a neuroprotective role for IL-1ra. It remains to be seen whether exogenous IL-1ra or other agents can be used to manipulate cytokine levels in the brain, for potential therapeutic effect. [ABSTRACT FROM AUTHOR]

The article discusses the study which described the benefits of student-led rural health fairs to improve medical education and access to health care. The researchers reviewed the health fairs conducted by medical students at the University of Miami Miller School of Medicine at four sites in rural Florida. The study found that health fairs provide medical students the needed exposure to rural health issues.