**5.3 Discussion**

26 Recent Advances in Arthroplasty

0 6 12 24 36 time, h

0 6 12 24 36 time, h

Fig. 2. Mean serum levels of TGF-β at predefined time in group G1 and G2.

Fig. 1. Changes in serum IL-6 level against time in group G1 and G2. Presented values are

14000

16000

18000

20000

22000

24000

26000

TGF-beta, pg/ml

28000

30000

32000

34000

36000

mean.

IL-6, pg/ml

G1 G2

> G1 G2

No significant difference (p>0.05) in DAS 28 was shown between groups. However, these differences were strongly marked in a clinical picture. The patients with higher DAS 28 demonstrated significantly more swollen and painful joint counts that related to disability and progression of joint damage.

High, as well as the very high, the cytokines concentration such as IL-6 and TGF-β was observed in all patients before the surgery. The disease severity common with degenerative joint changes were directly influence on the high cytokines concentrations. This also consistent with previous publications demonstrated the high serum IL-6 level in patients with chronic inflammatory disease (Kaneko et al., 2000; Desgeorges et al., 1997). The preoperative stress has also been proposed as one of factor could affect the IL-6 level (Hirano et al. 1988; Tanno et al., 2004). However, taking into consideration the very high baseline level of IL-6 the stress factor did not seem play significant role in this study. Besides that, the preoperative stress response was reduced with midanium premedication in all patients before the surgery. The autoimmune disease severity, as well as joint cartilage

The Stress Response and Its Functional Implications in the Immune

**7. Acknowledgment**

immunological problems.

764-771 ISSN 0024-3205

www.ncbl.nlm.nih.gov/pubmed

ISSN 0741-5400

**8. References** 

Response After Surgery in Patients with Chronic Inflammation Undergoing Arthroplasty 29

The immunological and laboratory tests have been done in the Department of

Author is extremely grateful to Professor Ewa Kontny for her consultations on the

Aida, Y., Maeno, M., Suzuki, N., Namba, A., Motohashi, M., Matsumoto, Makimura M. &

Armani, C., Catalani, E.†, Balbarini, A.\*, Bagnoli, P.,‡ & Cervia, D. (2007). Expression,

Baatar, D., Patel, K. & Taub, DD. ( 2011). The effects of ghrelin on inflammation and the immune system. *Mol Cell Endocrinol*, 20, 340 (1), (June 2011), pp. 44-58. Bar-Yosef, S., Melamed, R., Page, GG., Shakhar, G., Shakhar, K. & Ben-Eliyahu, S. (2001).

*Anesthesiology*, Vol.94, No6, (June 2001), pp. 1066-1073 ISSN 0003-3022 Blackburn, GL. (2011). Metabolic considerations in management of surgical patients. *Surg* 

Bodey, B., Bodey, B. & Jr, Kaiser, HE. (1997). Dendritic type accessory cells within the

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Clausen, F., Hånell, A., Israelsson, C., Hedin, J., Ebendal, T., Mir AK, Gram, H. & Marklund,

Coico, R.; Sunshine, G. (2009-6th ed.) *Immunnology a short course* Wiley J & Sons*,* Inc. (Ed.)

Cruickshank, AM., Fraser, WD., Burns, HJ., Van Damme, J &, Shenkin, A. Response of

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*Clin North Am,* 2011, Vol.91, No.3, (April 2011), pp. 467-80.

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Matsumura, H. (2006). The effect of IL-1beta on the expression of inflammatory cytokines and their receptors in human chondrocytes. Life Sci, 79, 8, (Jul 2006), pp.

pharmacology, and functional role of somatostatin receptor subtypes 1 and 2 in human macrophages Journal of *Leukocyte Biology*, 81 (March 2007), pp. 845-855.

Attenuation of the tumor-promoting effect of surgery by spinal blockade in rats.

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& Mathieu, A. (2002). Increased level of HLA-B27 expression in ankylosing spondylitis paties compared with healthy HLA-B27-positive subjects: a possible further susceptibility factor for the development of disease. *Rheumatology* (Oxford), 41, (12), issue 12, (December. 2002), pp. 1375-9, online ISSN 1462-0332, n.d.

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serum interleukin-6 in patients undergoing elective surgery of varying severity.

Immunopathology and the Diagnostic Laboratory of the Institute of Rheumatology.

catabolic damages could directly influence on the very high preoperative serum TGF-β1 level. The cytokines familiar with the growth factors group are major factors responsible for the metabolic processes of chondrocytes, consequently for their homeostasis (Shin-Han et al. 2009). TGF-β have role in recruiting immune cells to site of injury and facilitates wound healing by influence for connective tissue remodeling relates with fibroblast proliferation and the synthesis of a number of extracellular matrix proteins (Cutroneo, 2007). Data on dynamic changes of postoperative serum concentration of tested cytokines showed not significant differences (p>0.05). Indeed, the postoperative results of cytokines concentration (IL-6 and TGF-β) revealed the insignificant changes in both groups of patient, regardless the disease severity. The one of possibly explanation for this finding is the significant impairment of inflammatory response due to autoimmune disease. In contrast, many reports have demonstrated the dynamics of the IL-6 increase after surgery in groups of patients with normal immune system (Minetto et al., 2006; Demura et al., 2006; Cruickshank et al., 1990).

The CRP levels significantly increased after surgery. The peak level occurred at 36 hour. The changes were similar for both groups. CRP is most important factor involved in inflammatory response and may reflect the surgical magnitude. Its concentration is normally less than 10 mg/L. In this study, the elevated levels of CRP before surgery could be evidence of confirm the chronic inflammatory state. The concentration of CRP revealed no significant differences between groups.

Regional anaesthesia decreases the neuroendocrine response but does not influence on the inflammatory response (Moor et al., 1994; Naito et al., 1992; Høgevold et al., 2000). Both, the regional and general anaesthesia does not significantly influence on the postoperative immunosuppression decrease [Kawasaki et al., 2007). As the matter of fact, the postoperative changes demonstrated in this study may reflect the modulation of immune response to stress surgery due to the chronic inflammatory response.

The tourniquet time seemed not to have an influence on the serum cytokines level dynamic changes. The average tourniquet time was 86.6 in group 1 and in group 2 was 95.3 minutes. The tourniquet time longer than 105 minutes was found as statistically significant according to the results of previous study (Tak et al., 2000).
