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Wu G, Li B, Wei X, Chen Y, Zhao Y, Peng Y, Su J, Hu Z, Zhuo L, Tian Y, Wang Z, Peng X. Design, synthesis and biological evaluation of N-salicyloyl tryptamine derivatives as multifunctional neuroprotectants for the treatment of ischemic stroke. Eur J Med Chem 2024; 278:116795. [PMID: 39216381 DOI: 10.1016/j.ejmech.2024.116795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 08/20/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024]
Abstract
Ischemic stroke (IS) is a disease of high death and disability worldwide with few medications in clinical treatment. Neuroinflammation and oxidative stress are considered as crucial factors in the progression of IS. In our previous studies, N-salicyloyl tryptamine derivative (NST) L7 exhibited promising anti-inflammatory properties and is considered a potential clinical therapy for IS but had limited antioxidant capacity. Here, we have designed, synthesized, and biologically evaluated 30 novel NSTs for their neuroprotective effects against cerebral ischemia-reperfusion (CI/R) injury. To identify a multifunctional neuroprotectant with enhanced antioxidant and anti-inflammatory capacity, as well as an effective therapeutic agent for CI/R damage. Among them, M11 exhibited synergistic highly anti-oxidant, anti-inflammatory, anti-ferroptosis, and anti-apoptosis effects and surpassed the parent compound L7. Further studies demonstrated that the synergistic and efficient neuroprotective role of M11 was mainly achieved by activating Nrf2 and stimulating its downstream target HO-1/GCLC/NQO1/GPX4. In addition, M11 possessed good blood-brain barrier permeability. Moreover, M11 effectively reduced cerebral infarct volume and improved neurological deficits in MCAO/R mice. Its hydrochloride form, M11·HCl, exhibited better pharmacokinetic properties, high safety, and a significant reduction in infarct volume, which is comparable to Edaravone. In conclusion, our findings suggested that M11 capable of activating Nrf2, could represent a promising candidate agent for IS.
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Affiliation(s)
- Genping Wu
- The Affiliated Nanhua Hospital, School of Pharmaceutical Science, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| | - Bo Li
- The Affiliated Nanhua Hospital, School of Pharmaceutical Science, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| | - Xiuzhen Wei
- The Affiliated Nanhua Hospital, School of Pharmaceutical Science, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| | - Yaxin Chen
- The Affiliated Nanhua Hospital, School of Pharmaceutical Science, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| | - Yuting Zhao
- The Affiliated Nanhua Hospital, School of Pharmaceutical Science, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| | - Yan Peng
- The Affiliated Nanhua Hospital, School of Pharmaceutical Science, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| | - Jianhui Su
- The Affiliated Nanhua Hospital, School of Pharmaceutical Science, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| | - Zecheng Hu
- The Affiliated Nanhua Hospital, School of Pharmaceutical Science, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| | - Linsheng Zhuo
- The Affiliated Nanhua Hospital, School of Pharmaceutical Science, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| | - Ying Tian
- The Affiliated Nanhua Hospital, School of Pharmaceutical Science, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China.
| | - Zhen Wang
- The Affiliated Nanhua Hospital, School of Pharmaceutical Science, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China; National Health Commission Key Laboratory of Birth Defect Research and Prevention Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, 410008, China; MOE Key Lab of Rare Pediatric Diseases, School of Life Sciences, Central South University, Changsha, 410000, China.
| | - Xue Peng
- The Affiliated Nanhua Hospital, School of Pharmaceutical Science, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China.
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Ju YN, Zou ZW, Jia BW, Liu ZY, Sun XK, Qiu L, Gao W. Ac2-26 activated the AKT1/GSK3β pathway to reduce cerebral neurons pyroptosis and improve cerebral function in rats after cardiopulmonary bypass. BMC Cardiovasc Disord 2024; 24:266. [PMID: 38773462 PMCID: PMC11106860 DOI: 10.1186/s12872-024-03909-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/29/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Cardiopulmonary bypass (CPB) results in brain injury, which is primarily caused by inflammation. Ac2-26 protects against ischemic or hemorrhage brain injury. The present study was to explore the effect and mechanism of Ac2-26 on brain injury in CPB rats. METHODS Forty-eight rats were randomized into sham, CPB, Ac, Ac/AKT1, Ac/GSK3βi and Ac/AKT1/GSK3βa groups. Rats in sham group only received anesthesia and in the other groups received standard CPB surgery. Rats in the sham and CPB groups received saline, and rats in the Ac, Ac/AKT1, Ac/GSK3βi and Ac/AKT1/GSK3βa groups received Ac2-26 immediately after CPB. Rats in the Ac/AKT1, Ac/GSK3βi and Ac/AKT1/GSK3βa groups were injected with shRNA, inhibitor and agonist of GSK3β respectively. The neurological function score, brain edema and histological score were evaluated. The neuronal survival and hippocampal pyroptosis were assessed. The cytokines, activity of NF-κB, S100 calcium-binding protein β(S100β) and neuron-specific enolase (NSE), and oxidative were tested. The NLRP3, cleaved-caspase-1 and cleaved-gadermin D (GSDMD) in the brain were also detected. RESULTS Compared to the sham group, all indicators were aggravated in rats that underwent CPB. Compared to the CPB group, Ac2-26 significantly improved neurological scores and brain edema and ameliorated pathological injury. Ac2-26 reduced the local and systemic inflammation, oxidative stress response and promoted neuronal survival. Ac2-26 reduced hippocampal pyroptosis and decreased pyroptotic proteins in brain tissue. The protection of Ac2-26 was notably lessened by shRNA and inhibitor of GSK3β. The agonist of GSK3β recovered the protection of Ac2-26 in presence of shRNA. CONCLUSIONS Ac2-26 significantly improved neurological function, reduced brain injury via regulating inflammation, oxidative stress response and pyroptosis after CPB. The protective effect of Ac2-26 primarily depended on AKT1/ GSK3β pathway.
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Affiliation(s)
- Ying-Nan Ju
- Department of Intensive Care Unit, Hainan General Hospital (Hainan Affiliated Hosptial of Hainan Medical University), Clinical College, Hainan Medical University, Haikou, 570311, China
| | - Zi-Wei Zou
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, 150081, China
| | - Bao-Wei Jia
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, 150081, China
| | - Zi-Ying Liu
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, 150081, China
| | - Xi-Kun Sun
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, 150081, China
| | - Lin Qiu
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, 150081, China
| | - Wei Gao
- Department of Anesthesiology, Hainan General Hospital (Hainan Affiliated Hosptial of Hainan Medical University), Clinical College, Hainan Medical University, Haikou, 570311, China.
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He W, Liu X, Na J, Bian H, Zhong L, Li G. Application of CRISPR/Cas13a-based biosensors in serum marker detection. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2024; 16:1426-1438. [PMID: 38385279 DOI: 10.1039/d3ay01927f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
The detection of serum markers is important for the early diagnosis and monitoring of diseases, but conventional detection methods have the problem of low specificity or sensitivity. CRISPR/Cas13a-based biosensors have the characteristics of simple detection methods and high sensitivity, which have a certain potential to solve the problems of conventional detection. This paper focuses on the research progress of CRISPR/Cas13a-based biosensors in serum marker detection, introduces the principles and applications of fluorescence, electrochemistry, colorimetric, and other biosensors based on CRISPR/Cas13a in the detection of serum markers, compares and analyzes the differences between the above CRISPR/Cas13a-based biosensors, and looks forward to the future development direction of CRISPR/Cas13a-based biosensors.
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Affiliation(s)
- Wei He
- State Key Laboratory of Targeting Oncology, National Center for International Research of Bio-Targeting Theranostics, Guangxi Key Laboratory of Bio-Targeting Theranostics, Collaborative Innovation Center for Targeting Tumor Diagnosis and Therapy, Guangxi Medical University, Nanning 530021, China.
| | - Xiyu Liu
- State Key Laboratory of Targeting Oncology, National Center for International Research of Bio-Targeting Theranostics, Guangxi Key Laboratory of Bio-Targeting Theranostics, Collaborative Innovation Center for Targeting Tumor Diagnosis and Therapy, Guangxi Medical University, Nanning 530021, China.
| | - Jintong Na
- State Key Laboratory of Targeting Oncology, National Center for International Research of Bio-Targeting Theranostics, Guangxi Key Laboratory of Bio-Targeting Theranostics, Collaborative Innovation Center for Targeting Tumor Diagnosis and Therapy, Guangxi Medical University, Nanning 530021, China.
| | - Huimin Bian
- State Key Laboratory of Targeting Oncology, National Center for International Research of Bio-Targeting Theranostics, Guangxi Key Laboratory of Bio-Targeting Theranostics, Collaborative Innovation Center for Targeting Tumor Diagnosis and Therapy, Guangxi Medical University, Nanning 530021, China.
| | - Liping Zhong
- State Key Laboratory of Targeting Oncology, National Center for International Research of Bio-Targeting Theranostics, Guangxi Key Laboratory of Bio-Targeting Theranostics, Collaborative Innovation Center for Targeting Tumor Diagnosis and Therapy, Guangxi Medical University, Nanning 530021, China.
| | - Guiyin Li
- State Key Laboratory of Targeting Oncology, National Center for International Research of Bio-Targeting Theranostics, Guangxi Key Laboratory of Bio-Targeting Theranostics, Collaborative Innovation Center for Targeting Tumor Diagnosis and Therapy, Guangxi Medical University, Nanning 530021, China.
- College of Chemistry, Guangdong University of Petrochemical Technology, Guandu Road, Maoming, Guangdong 525000, China
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Lapergola G, Graziosi A, D'Adamo E, Brindisino P, Ferrari M, Romanelli A, Strozzi M, Libener R, Gavilanes DAW, Maconi A, Satriano A, Varrica A, Gazzolo D. S100B in cardiac surgery brain monitoring: friend or foe? Clin Chem Lab Med 2022; 60:317-331. [PMID: 35001583 DOI: 10.1515/cclm-2021-1012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/29/2021] [Indexed: 11/15/2022]
Abstract
Recent advances in perioperative management of adult and pediatric patients requiring open heart surgery (OHS) and cardiopulmonary bypass (CPB) for cardiac and/or congenital heart diseases repair allowed a significant reduction in the mortality rate. Conversely morbidity rate pattern has a flat trend. Perioperative period is crucial since OHS and CPB are widely accepted as a deliberate hypoxic-ischemic reperfusion damage representing the cost to pay at a time when standard of care monitoring procedures can be silent or unavailable. In this respect, the measurement of neuro-biomarkers (NB), able to detect at early stage perioperative brain damage could be especially useful. In the last decade, among a series of NB, S100B protein has been investigated. After the first promising results, supporting the usefulness of the protein as predictor of short/long term adverse neurological outcome, the protein has been progressively abandoned due to a series of limitations. In the present review we offer an up-dated overview of the main S100B pros and cons in the peri-operative monitoring of adult and pediatric patients.
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Affiliation(s)
| | | | - Ebe D'Adamo
- Neonatal Intensive Care Unit, G. d'Annunzio University, Chieti, Italy
| | | | | | - Anna Romanelli
- Neonatal Intensive Care Unit, G. d'Annunzio University, Chieti, Italy
| | - Mariachiara Strozzi
- Department of Maternal, Fetal and Neonatal Medicine, ASO SS Antonio, Biagio and C. Arrigo, Alessandria, Italy
| | - Roberta Libener
- Department of Maternal, Fetal and Neonatal Medicine, ASO SS Antonio, Biagio and C. Arrigo, Alessandria, Italy
| | - Danilo A W Gavilanes
- Department of Pediatrics and Neonatology, Maastricht University, Maastricht, The Netherlands
| | - Antonio Maconi
- Department of Maternal, Fetal and Neonatal Medicine, ASO SS Antonio, Biagio and C. Arrigo, Alessandria, Italy
| | - Angela Satriano
- Department of Pediatric Cardiac Surgery, IRCCS San Donato Milanese Hospital, Milan, Italy
| | - Alessandro Varrica
- Department of Pediatric Cardiac Surgery, IRCCS San Donato Milanese Hospital, Milan, Italy
| | - Diego Gazzolo
- Neonatal Intensive Care Unit, G. d'Annunzio University, Chieti, Italy
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Barranco R, Bonsignore A, Ventura F. Immunohistochemistry in postmortem diagnosis of acute cerebral hypoxia and ischemia: A systematic review. Medicine (Baltimore) 2021; 100:e26486. [PMID: 34160462 PMCID: PMC8238305 DOI: 10.1097/md.0000000000026486] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 05/28/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND : Discovery of evidence of acute brain ischemia or hypoxia and its differentiation from agonal hypoxia represents a task of interest but extremely difficult in forensic neuropathology. Generally, more than 50% of forensic autopsies indicate evidence of brain induced functional arrest of the organ system, which can be the result of a hypoxic/ischemic brain event. Even if the brain is the target organ of hypoxic/ischemic damage, at present, there are no specific neuropathological (macroscopic and histological) findings of hypoxic damage (such as in drowning, hanging, intoxication with carbon monoxide) or acute ischemia. In fact, the first histological signs appear after at least 4 to 6 hours. Numerous authors have pointed out how an immunohistochemical analysis could help diagnose acute cerebral hypoxia/ischemia.Data sources: This review was based on articles published in PubMed and Scopus databases in the past 25 years, with the following keywords "immunohistochemical markers," "acute cerebral ischemia," "ischemic or hypoxic brain damage," and "acute cerebral hypoxia". OBJECTIVES : Original articles and reviews on this topic were selected. The purpose of this review is to analyze and summarize the markers studied so far and to consider the limits of immunohistochemistry that exist to date in this specific field of forensic pathology. RESULTS : We identified 13 markers that had been examined (in previous studies) for this purpose. In our opinion, it is difficult to identify reliable and confirmed biomarkers from multiple studies in order to support a postmortem diagnosis of acute cerebral hypoxia/ischemia. Microtubule-associated protein 2 (MAP2) is the most researched marker in the literature and the results obtained have proven to be quite useful. CONCLUSION Immunohistochemistry has provided interesting and promising results, but further studies are needed in order to confirm and apply them in standard forensic practice.
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Wan Z, Li Y, Ye H, Zi Y, Zhang G, Wang X. Plasma S100β and neuron-specific enolase, but not neuroglobin, are associated with early cognitive dysfunction after total arch replacement surgery: A pilot study. Medicine (Baltimore) 2021; 100:e25446. [PMID: 33847649 PMCID: PMC8051968 DOI: 10.1097/md.0000000000025446] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 03/08/2021] [Indexed: 01/04/2023] Open
Abstract
To investigate whether plasma concentrations of S100β protein, neuron-specific enolase (NSE), and neuroglobin (NGB) correlate with early postoperative cognitive dysfunction (POCD) in patients undergoing total arch replacement.This prospective study analyzed 40 patients who underwent total arch replacement combined with stented elephant trunk implantation at our hospital between March 2017 and January 2019. Cognitive function was assessed using the Mini-mental State Examination (MMSE) preoperatively, on the day after extubation and on day 7 after surgery. Plasma levels of S100β, NSE, and NGB POCD were assayed preoperatively and at 1, 6, and 24 hours after cardiopulmonary bypass. POCD was defined as a decrease of at least 1 unit in the MMSE score from before surgery until day 7, and patients were stratified into those who experienced POCD or not. The 2 groups were compared in clinicodemographic characteristics and plasma levels of the 3 proteins.Plasma levels of all 3 biomarkers increased significantly during and after cardiopulmonary bypass. Levels of S100β and NSE, but not NGB, were significantly higher in the 15 patients who showed POCD than in the remainder who did not. For prediction of early POCD, S100β showed an area under the receiver operating characteristic curve (AUC) of 0.71 (95% confidence interval [CI] 0.55-0.87), sensitivity of 48%, and specificity of 87%. The corresponding values for NSE were 0.77 (95%CI 0.60-0.94), 92%, and 67%. Together, S100β and NSE showed an AUC of 0.81 (95%CI 0.66-0.96), sensitivity of 73%, and specificity of 80%. NGB did not significantly predict early POCD (AUC 0.62, 95%CI 0.43-0.80).Plasma S100β protein and NSE, but not NGB, may help predict early POCD after total arch replacement.
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Affiliation(s)
- Zilin Wan
- Department of Cardiovascular Anesthesiology
| | - Yaxiong Li
- Department of Cardiovascular Surgery, Yan’An Hospital, Kunming Medical University, Kunming, 650051, Yunnan, China
| | - Huishun Ye
- Department of Cardiovascular Anesthesiology
| | - Yunfeng Zi
- Department of Cardiovascular Surgery, Yan’An Hospital, Kunming Medical University, Kunming, 650051, Yunnan, China
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Abstract
Neurologic injury is a known and feared complication of extracorporeal membrane oxygenation (ECMO). Neurologic biomarkers may have a role in assisting in early identification of such. Axonal biomarker tau has not been investigated in the pediatric ECMO population. The objective of this study is to evaluate plasma levels of tau in pediatric patients supported with ECMO. Eighteen patients requiring ECMO support in a quaternary pediatric intensive care unit at a university-affiliated children's hospital from October 2015 to February 2017 were enrolled. Patients undergoing extracorporeal cardiopulmonary resuscitation or recent history of bypass were excluded. Plasma tau was measured using enzyme-linked immunosorbent assay. Neuroimaging was reviewed for acute neurologic injury, and tau levels were analyzed to assess for correlation. Tau was significantly higher in ECMO patients than in control subjects. Sixty-one percent of subjects had evidence of acute brain injury on neuroimaging, but tau level did not correlate with injury. Subjects with multifocal injury all experienced infarction and had significantly higher tau levels on ECMO day 3 than patients with isolated injury. In addition, peak tau levels of neuro-injured subjects were compared with controls and noninjured ECMO subjects using receiver operating curve analysis. This study demonstrates preliminary evidence of axonal injury in pediatric ECMO patients.
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Wang Y, Shen X. Postoperative delirium in the elderly: the potential neuropathogenesis. Aging Clin Exp Res 2018; 30:1287-1295. [PMID: 30051417 DOI: 10.1007/s40520-018-1008-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 07/13/2018] [Indexed: 12/17/2022]
Abstract
Postoperative delirium (POD) is a neurobehavioral syndrome caused by dysfunction of neural activity mainly in elderly people. POD is not uncommon, but under-recognized, and often serious. Multifactorial causes including aging, acetylcholine deficiency, sleep deprivation and intraoperative hypoxia have been proposed attempting to explain the processes leading to the development of POD. To date, however, no specific pathophysiologic mechanism has been identified. Here, we summarize the five most prominent theories (neuronal aging, neuroinflammation, neurotransmitter imbalance, neuroendocrine activation, and network connectivity change) to explain the development of delirium. Understanding of the neuropathogenesis of delirium will help focus future research, and assist in developing prophylactic and treatment strategies.
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Affiliation(s)
- Yiru Wang
- Department of Anesthesiology, The Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai Medical College of Fudan University, 83 Fenyang Road, 200031, Shanghai, China
| | - Xia Shen
- Department of Anesthesiology, The Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai Medical College of Fudan University, 83 Fenyang Road, 200031, Shanghai, China.
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Gao F, Zhang Q, Li Y, Tai Y, Xin X, Wang X, Wang Q. Transcutaneous electrical acupoint stimulation for prevention of postoperative delirium in geriatric patients with silent lacunar infarction: a preliminary study. Clin Interv Aging 2018; 13:2127-2134. [PMID: 30425466 PMCID: PMC6205526 DOI: 10.2147/cia.s183698] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose This study aims to investigate the effect of transcutaneous electrical acupoint stimulation (TEAS) on postoperative delirium (POD) in elderly patients with silent lacunar infarct and preliminarily to determine the relationship among TEAS, blood–brain barrier (BBB), neuroinflammation, and POD. Patients and methods Sixty-four-old patients with silent lacunar infarct were randomly divided into two groups: group TEAS and control group (group C). Patients in the group TEAS received TEAS (disperse-dense waves; frequency, 2/100 Hz) on acupoints Hegu and Neiguan of both sides starting from 30 minutes before induction of anesthesia until the end of surgery, and the intensity was the maximum current that could be tolerated. In group C, electrodes were placed on the same acupoints before anesthesia induction, but no current was given. At 0 minute before the treatment of TEAS, 30 minutes after skin incision, and after completion of surgery (T1–3), blood samples were extracted to detect the concentration of serum tumor necrosis factor (TNF)-α, interleukin-6 (IL-6), matrix metalloproteinase-9 (MMP-9), and S100β. We assessed patients for delirium and coma twice daily in the first 3 postoperative days using the Confusion Assessment Method for the intensive care unit and the Richmond Agitation-Sedation Scale. Results This study preliminarily suggests that TEAS can reduce the development of POD in elderly patients with silent lacunar infarction (6.3% vs 25.0%; P=0.039). Compared with the baseline value at T1, the serum concentrations of IL-6, TNF-α, MMP-9, and S100β were significantly increased at T2–3 in both the groups (P<0.05). Compared with group TEAS, serum levels of TNF-α and IL-6 were higher at T2–3 and serum levels of MMP-9 and S100β were higher at T3 in group C (P<0.05). The intraoperative anesthetic consumptions were less in group TEAS than group C. Conclusion TEAS can alleviate POD in older patients with silent lacunar infarction and may be related to reduce the neuroinflammation by lowering the permeability of BBB.
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Affiliation(s)
- Fang Gao
- Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang City, Hebei, People's Republic of China,
| | - Qi Zhang
- Department of Anesthesiology, Children's Hospital of Hebei Province, Shijiazhuang City, Hebei, People's Republic of China
| | - Yanan Li
- Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang City, Hebei, People's Republic of China,
| | - Yanlei Tai
- Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang City, Hebei, People's Republic of China,
| | - Xi Xin
- Department of Anesthesiology, Tianjin Third Central Hospital, Tianjin, People's Republic of China
| | - Xiuli Wang
- Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang City, Hebei, People's Republic of China,
| | - Qiujun Wang
- Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang City, Hebei, People's Republic of China,
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Danielson M, Reinsfelt B, Westerlind A, Zetterberg H, Blennow K, Ricksten SE. Effects of methylprednisolone on blood-brain barrier and cerebral inflammation in cardiac surgery-a randomized trial. J Neuroinflammation 2018; 15:283. [PMID: 30261896 PMCID: PMC6158839 DOI: 10.1186/s12974-018-1318-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 09/18/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cognitive dysfunction is a frequent complication to open-heart surgery. Cerebral inflammation caused by blood-brain barrier (BBB) dysfunction due to a systemic inflammatory response is considered a possible etiology. The effects of the glucocorticoid, methylprednisolone, on cerebrospinal fluid (CSF) markers of BBB function, neuroinflammation, and brain injury in patients undergoing cardiac surgery with cardiopulmonary bypass were studied. METHODS In this prospective, randomized, blinded study, 30 patients scheduled for elective surgical aortic valve replacement were randomized to methylprednisolone 15 mg/kg (n = 15) or placebo (n = 15) as a bolus dose administered after induction of anesthesia. CSF and blood samples were obtained the day before and 24 h after surgery for assessment of systemic and brain inflammation (interleukin-6, interleukin-8, tumor necrosis factor-alpha), axonal injury (total-tau, neurofilament light chain protein), neuronal injury (neuron-specific enolase), astroglial injury (S-100B, glial fibrillary acidic protein), and the BBB integrity (CSF/serum albumin ratio). RESULTS In the control group, there was a 54-fold and 17-fold increase in serum interleukin-6 and interleukin-8, respectively. This systemic activation of the inflammatory cytokines was clearly attenuated by methylprednisolone (p < 0.001). The increase of the CSF levels of the astroglial markers was not affected. A postoperative BBB dysfunction was seen in both groups as the CSF/serum albumin ratio increased from 6.4 ± 8.0 to 8.0 in the placebo group (p < 0.01) and from 5.6 ± 2.3 to 7.2 in the methylprednisolone group (p < 0.01) with no difference between groups (p = 0.98). In the CSF, methylprednisolone attenuated the interleukin-6 release (p < 0.001), which could be explained by the fall in systemic interleukin-6, and the serum to CSF gradient of IL-6 seen both at baseline and after surgery. In the CSF, methylprednisolone enhanced the interleukin-8 release (p < 0.001) but did not affect postoperative changes in CSF levels of tumor necrosis factor alpha. Serum levels of S-100B and neuron-specific enolase increased in both groups with no difference between groups. CSF levels of total tau, neurofilament light chain protein, and neuron-specific enolase were not affected in any of the groups. CONCLUSIONS Preventive treatment with high-dose methylprednisolone attenuated the systemic inflammatory response to open-heart surgery with cardiopulmonary bypass, but did not prevent or attenuate the increase in BBB permeability or the neuroinflammatory response. TRIAL REGISTRATION Clinical Trials, Identifier: NCT01755338 , registered 24 December 2012.
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Affiliation(s)
- Mattias Danielson
- Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, University of Gothenburg, SE-413 45, Gothenburg, Sweden
| | - Björn Reinsfelt
- Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, University of Gothenburg, SE-413 45, Gothenburg, Sweden
| | - Anne Westerlind
- Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, University of Gothenburg, SE-413 45, Gothenburg, Sweden
| | - Henrik Zetterberg
- Deparment of Anesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, SE-41345, Gothenburg, Sweden
| | - Kaj Blennow
- Deparment of Anesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, SE-41345, Gothenburg, Sweden
| | - Sven-Erik Ricksten
- Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, University of Gothenburg, SE-413 45, Gothenburg, Sweden.
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Kofke WA, Ren Y, Augoustides JG, Li H, Nathanson K, Siman R, Meng QC, Bu W, Yandrawatthana S, Kositratna G, Kim C, Bavaria JE. Reframing the Biological Basis of Neuroprotection Using Functional Genomics: Differentially Weighted, Time-Dependent Multifactor Pathogenesis of Human Ischemic Brain Damage. Front Neurol 2018; 9:497. [PMID: 29997569 PMCID: PMC6028620 DOI: 10.3389/fneur.2018.00497] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 06/07/2018] [Indexed: 12/18/2022] Open
Abstract
Background: Neuroprotection studies are generally unable to demonstrate efficacy in humans. Our specific hypothesis is that multiple pathophysiologic pathways, of variable importance, contribute to ischemic brain damage. As a corollary to this, we discuss the broad hypothesis that a multifaceted approach will improve the probability of efficacious neuroprotection. But to properly test this hypothesis the nature and importance of the multiple contributing pathways needs elucidation. Our aim is to demonstrate, using functional genomics, in human cardiac surgery procedures associated with cerebral ischemia, that the pathogenesis of perioperative human ischemic brain damage involves the function of multiple variably weighted proteins involving several pathways. We then use these data and literature to develop a proposal for rational design of human neuroprotection protocols. Methods: Ninety-four patients undergoing deep hypothermic circulatory arrest (DHCA) and/or aortic valve replacement surgery had brain damage biomarkers, S100β and neurofilament H (NFH), assessed at baseline, 1 and 24 h post-cardiopulmonary bypass (CPB) with analysis for association with 92 single nucleotide polymorphisms (SNPs) (selected by co-author WAK) related to important proteins involved in pathogenesis of cerebral ischemia. Results: At the nominal significance level of 0.05, changes in S100β and in NFH at 1 and 24 h post-CPB were associated with multiple SNPs involving several prospectively determined pathophysiologic pathways, but were not individually significant after multiple comparison adjustments. Variable weights for the several evaluated SNPs are apparent on regression analysis and, notably, are dissimilar related to the two biomarkers and over time post CPB. Based on our step-wise regression model, at 1 h post-CPB, SOD2, SUMO4, and GP6 are related to relative change of NFH while TNF, CAPN10, NPPB, and SERPINE1 are related to the relative change of S100B. At 24 h post-CPB, ADRA2A, SELE, and BAX are related to the relative change of NFH while SLC4A7, HSPA1B, and FGA are related to S100B. Conclusions: In support of the proposed hypothesis, association SNP data suggest function of specific disparate proteins, as reflected by genetic variation, may be more important than others with variation at different post-insult times after human brain ischemia. Such information may support rational design of post-insult time-sensitive multifaceted neuroprotective therapies.
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Affiliation(s)
- William A Kofke
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, United States
| | - Yue Ren
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, United States
| | - John G Augoustides
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, United States
| | - Hongzhe Li
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Katherine Nathanson
- Department of Medicine, Division of Translational Medicine and Human Genetics Abramson Cancer Center Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Robert Siman
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Qing Cheng Meng
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, United States
| | - Weiming Bu
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, United States
| | - Sukanya Yandrawatthana
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, United States
| | - Guy Kositratna
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, United States
| | - Cecilia Kim
- The Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Joseph E Bavaria
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, United States
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Affiliation(s)
- Yongli He
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhiyou Cai
- Department of Neurology, Chongqing General Hospital, Chongqing, China
| | - Yangmei Chen
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Abstract
BACKGROUND Acupuncture treatment has been used in China for >2500 years, and at present it is used worldwide as a form of analgesia in patients with acute and chronic pain. Furthermore, acupuncture is regularly used not only as a single anesthetic technique but also as a supplement or in addition to general anesthesia (GA). OBJECTIVES The aim of this systematic review and meta-analysis was to assess the level of evidence for the clinical use of acupuncture in addition to GA in patients undergoing craniotomy. DESIGN This is a systematic review of randomized controlled trials with meta-analyses. DATA SOURCES The literature search (PubMed, Cochrane Library, and Web of Science) yielded 56 citations, published between 1972 and March 01, 2015. No systematic review or meta-analyses on this topic matched our search criteria. Each article of any language was assessed and rated for the methodological quality of the studies, using the recommendation of the Oxford Centre for Evidence Based Medicine. Ten prospective randomized controlled clinical trials with a total of 700 patients were included. ELIGIBILITY CRITERIA Included in the meta-analysis were studies that involved any craniotomy under GA compared with a combination of GA and acupuncture. Exclusion criteria were no acupuncture during surgery, no GA during surgery, only postoperative data available, animal studies, and low grade of evidence. RESULTS The use of acupuncture significantly reduced the amount of volatile anesthetics during surgery (P<0.001) and led to faster extubation time (P=0.001) and postoperative patient recovery (P=0.003). In addition, significantly reduced blood levels of the brain tissue injury marker S100β 48 hours after operation (P=0.001) and occurrence of postoperative nausea and vomiting (P=0.017) were observed. No patient studied suffered from awareness. CONCLUSIONS The analysis suggests that the complementary use of acupuncture for craniotomy has additional analgesic effects, reduces the needed amount of volatile anesthetic, reduces the onset of postoperative nausea and vomiting, and might have protective effects on brain tissue. Our findings may stimulate future randomized controlled trials to provide definitive recommendations.
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Cao YH, Chi P, Zhao YX, Dong XC. Effect of bispectral index-guided anesthesia on consumption of anesthetics and early postoperative cognitive dysfunction after liver transplantation: An observational study. Medicine (Baltimore) 2017; 96:e7966. [PMID: 28858130 PMCID: PMC5585524 DOI: 10.1097/md.0000000000007966] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The objective of this study was to summarize the incidence of postoperative cognitive dysfunction (POCD) after 7days following liver transplantation (LT), and to evaluate the effectiveness of bispectral index (BIS) guided anesthetic intervention in reducing POCD. Additional serum concentrations of S100β and neuron-specific enolase (NSE) were detected during surgery to determine whether they were reliable predictors of POCD.Patients who underwent LT at Beijing YouAn Hospital Affiliated to Capital University of Medical Science from January 2014 to December 2015 were enrolled. BIS monitor was needed during surgery. Patients who underwent LT without BIS monitoring during August 2012 to December 2014 served as historical controls. A battery of 5 neuropsychological tests were performed and scored preoperatively and 7days after surgery. POCD was diagnosed by the method of one standard deviation (SD). The blood samples of BIS group were collected at 5 time points: just before induction of general anesthesia (T0), 60 minutes after skin incision (T1), 30 minutes after the start of the anhepatic phase (T2), 15 minutes after reperfusion of the new liver (T3), and at 24 hours after surgery (T4).A total of 33 patients were included in BIS group, and 27 in the control group. Mean arterial pressure was different between 2 groups at 30 minutes after the start of the anhepatic phase (P = .032). The dose of propofol using at anhepatic phase 30 min and new liver 15 min was lower in the BIS group than control group (0.042 ± 0.021 vs. 0.069 ± 0.030, P < .001; 0.053 ± 0.022 vs. 0.072 ± 0.020, P = .001). Five patients were diagnosed as having POCD after 7 days in the BIS group and the incidence of POCD was 15.15%. In the control group, 9 patients had POCD and the incidence of POCD was 33.33%. The incidence of POCD between 2 groups had no statistical difference (P = .089). S100β increased at stage of anhepatic 30 minutes (T2) and new liver 15 minutes (T3) compared with the stage of before anesthesia (T0) (1.49 ± 0.66 vs. 0.72 ± 0.53, P < .001; 1.92 ± 0.78 vs. 0.72 ± 0.53, P < .001). NSE increased at stage of anhepatic 30 minutes (T2) and new liver 15 minutes (T3) compared with the stage of before anesthesia (T0) (5.80 ± 3.03 vs. 3.58 ± 3.24, P = .001; 10.04 ± 5.65 vs. 3.58 ± 3.24, P < .001). At 24 hours after surgery, S100β had no difference compared to one before anesthesia (1.0 ± 0.62 vs. 0.72 ± 0.53, P = .075), but NSE still remained high (5.19 ± 3.64 vs. 3.58 ± 3.24, P = .043). There were no significant differences in the serum concentrations of S100β between patients with and without POCD at 5 time points of operation (P > .05). But at 24 hours after surgery, NSE concentrations were still high of patients with POCD (8.14 ± 3.25 vs. 4.81 ± 3.50, P = .035).BIS-guided anesthesia can reduce consumption of propofol during anhepatic and new liver phase. Patients in BIS group seem to have a mild lower incidence of POCD compared to controls, but no statistical significant. The influence of BIS-guided anesthesia on POCD needs to be further confirmed by large-scale clinical study. S100β protein and NSE are well correlative with neural injury, but NSE is more suitable for assessment of incidence of postoperative cognitive deficits after surgery.
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Affiliation(s)
- Ying-Hao Cao
- Department of Anesthesiology, Beijing YouAn Hospital, Capital Medical University
| | - Ping Chi
- Department of Anesthesiology, Beijing YouAn Hospital, Capital Medical University
| | - Yan-Xing Zhao
- Department of Anesthesiology,Guang’anmen Hospital, China Acadamy of Chinese Medical Science, Beijing, China
| | - Xi-Chen Dong
- Department of Anesthesiology,Guang’anmen Hospital, China Acadamy of Chinese Medical Science, Beijing, China
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Range of S-100β levels during functional endoscopic sinus surgery with moderately controlled hypotension. Eur Arch Otorhinolaryngol 2017; 274:3527-3532. [PMID: 28456848 DOI: 10.1007/s00405-017-4592-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 04/18/2017] [Indexed: 10/19/2022]
Abstract
The aim of this study is to determine the range of S-100β levels during functional endoscopic sinus surgery (FESS) when the mean arterial pressure (MAP) was controlled within 60-70 mmHg. After anesthesia induction with propofol and remifentanil, the patient was positioned in the reverse Trendelenburg position and MAP was controlled within 60-70 mmHg during surgery. For the S-100β assay, blood was taken from a radial arterial catheter before (baseline) and at 20 (T 20) and 60 (T 60) min after setting the reverse Trendelenburg position and controlled hypotension, and at 60 (T post60) min after the end of the operation. In total, 34 patients completed the study. Baseline S-100β was 0.00837 ± 0.00785 ng/mL. The levels at T 20 and T 60 were 0.02057 ± 0.01739 and 0.01987 ± 0.01145 ng/mL, respectively. The level of T post60 was 0.05436 ± 0.02318 ng/mL. The level at T 20 increased significantly versus the baseline level (P < 0.001); there were no significant differences between T 20 and T 60. The level at T post60 was significantly different versus T 20 and T 60 (P < 0.001). However, all S-100β levels were within the normal range. S-100β-a sensitive biomarker of cerebral ischemia-was within the normal range during FESS when moderate hypotension (MAP >60 mmHg) was provided. Thus, moderate hypotension would be seemed to be a safe and effective anesthetic technique for FESS without risk for cerebral ischemia.
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Talwar S, Kumar MV, Nehra A, Malhotra Kapoor P, Makhija N, Sreenivas V, Choudhary SK, Airan B. Bidirectional Glenn on cardiopulmonary bypass: A comparison of three techniques. J Card Surg 2017; 32:303-309. [DOI: 10.1111/jocs.13123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sachin Talwar
- Department of Cardiothoracic and Vascular Surgery; All India Institute of Medical Sciences; New Delhi India
| | - Manikala Vinod Kumar
- Department of Cardiothoracic and Vascular Surgery; All India Institute of Medical Sciences; New Delhi India
| | - Ashima Nehra
- Department of Clinical Neuropsychology; All India Institute of Medical Sciences; New Delhi India
| | - Poonam Malhotra Kapoor
- Department of Cardiac Anaesthesiology; All India Institute of Medical Sciences; New Delhi India
| | - Neeti Makhija
- Department of Cardiac Anaesthesiology; All India Institute of Medical Sciences; New Delhi India
| | | | - Shiv Kumar Choudhary
- Department of Cardiothoracic and Vascular Surgery; All India Institute of Medical Sciences; New Delhi India
| | - Balram Airan
- Department of Cardiothoracic and Vascular Surgery; All India Institute of Medical Sciences; New Delhi India
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Neurological injury in paediatric cardiac surgery. Indian J Thorac Cardiovasc Surg 2017. [DOI: 10.1007/s12055-016-0481-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Esquivel AO, Sherman SS, Bir CA, Lemos SE. The Interaction of Intramuscular Ketorolac (Toradol) and Concussion in a Rat Model. Ann Biomed Eng 2017; 45:1581-1588. [DOI: 10.1007/s10439-017-1809-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 02/04/2017] [Indexed: 12/19/2022]
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Kok WF, Koerts J, Tucha O, Scheeren TWL, Absalom AR. Neuronal damage biomarkers in the identification of patients at risk of long-term postoperative cognitive dysfunction after cardiac surgery. Anaesthesia 2016; 72:359-369. [DOI: 10.1111/anae.13712] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2016] [Indexed: 11/29/2022]
Affiliation(s)
- W. F. Kok
- Department of Clinical Pharmacy and Pharmacology; University Medical Centre Groningen; University of Groningen; Groningen The Netherlands
| | - J. Koerts
- Department of Clinical and Developmental Neuropsychology; University Medical Centre Groningen; University of Groningen; Groningen The Netherlands
| | - O. Tucha
- Department of Clinical and Developmental Neuropsychology; University Medical Centre Groningen; University of Groningen; Groningen The Netherlands
| | - T. W. L. Scheeren
- Department of Anesthesiology; University Medical Centre Groningen; University of Groningen; Groningen The Netherlands
| | - A. R. Absalom
- Department of Anesthesiology; University Medical Centre Groningen; University of Groningen; Groningen The Netherlands
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Royall DR, Al-Rubaye S, Bishnoi R, Palmer RF. Serum protein mediators of dementia and aging proper. Aging (Albany NY) 2016; 8:3241-3254. [PMID: 27922822 PMCID: PMC5270666 DOI: 10.18632/aging.101091] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/17/2016] [Indexed: 12/27/2022]
Abstract
The latent variable "δ" (for "dementia") appears to be uniquely responsible for the dementing aspects of cognitive impairment. Age, depressive symptoms, gender and the apolipoprotein E (APOE) ε4 allele are independently associated with δ. In this analysis, we explore serum proteins as potential mediators of age's specific association with δ in a large, ethnically diverse longitudinal cohort, the Texas Alzheimer's Research and Care Consortium (TARCC). 22 serum proteins were recognized as partial mediators of age's association with δ. These include Insulin-like Growth Factor-Binding Protein 2 (IGF-BP2), which we had previously associated with age-specific cognitive change, and both Pancreatic Polypeptide (PP) and von Willebrand Factor (vWF), previously associated with δ. Nine other δ-related proteins were not confirmed by this ethnicity adjusted analysis. Our findings suggest that age's association with the disabling fraction of cognitive performance is partially mediated by serum proteins, somatomedins and hormones. Those proteins may offer targets for the specific treatment of age-related effects on dementia severity and conversion risk.
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Affiliation(s)
- Donald R. Royall
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
- Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
- South Texas Veterans’ Health System Audie L. Murphy Division GRECC, San Antonio, TX 78229, USA
| | - Safa Al-Rubaye
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Ram Bishnoi
- Department of Psychiatry, The Medical College of Georgia, Augusta, GA 30912, USA
| | - Raymond F. Palmer
- Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
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Öztürk S, Saçar M, Baltalarlı A, Öztürk İ. Effect of the type of cardiopulmonary bypass pump flow on postoperative cognitive function in patients undergoing isolated coronary artery surgery. Anatol J Cardiol 2016; 16:875-880. [PMID: 27163534 PMCID: PMC5324892 DOI: 10.14744/anatoljcardiol.2015.6572] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2015] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Pulsatile flow, generated by a pump during cardiopulmonary bypass, has been accepted as more physiological in coronary artery bypass grafting surgery (CABG). Therefore, we aimed to investigate the effects of pulsatile and nonpulsatile flow on postoperative cognitive function and to review relationship with the biomarkers S100ß and neuron-specific enolase (NSE). METHODS Patients who underwent isolated CABG were included this prospective, randomized, double-blind study, which was performed between March 2010 and December 2010. Patients were divided into two groups: pulsatile (Group I, n=20) and nonpulsatile (Group II, n=20) flow. Blood samples were collected 1 day before surgery and in the sixth postoperative hour for the analysis of S100ß and NSE. In addition, Mini-Mental State Examination (MMSE) was performed during preoperative period and on third postoperative day. Outcomes were determination of effects of pump flow type on cognitive function and relationships with concentrations of S100ß and NSE. RESULTS Forty patients were included. No differences were observed between the groups with respect to complications, mortality, S100ß (Group I: 1.9±0.2 µ/L; Group II: 2.0±0.2 µ/L), NSE (Group I: 12.5±0.8 µ/L; Group II: 12.4±0.7 µ/L), MMSE scores [Group I: 25 (23-27); Group II: 25 (23-27)], and postoperative cognitive dysfunction (POCD) (p>0.05). No correlation was observed between MMSE scores and concentrations of S100ß (r=-0.032) and NSE (r=-0.423) (p>0.05). CONCLUSION There was no difference between types of pump flow for POCD and no relationship between cognitive dysfunction and S100ß and NSE concentrations. Pump flow type does not affect NSE concentrations.
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Affiliation(s)
- Selen Öztürk
- Dr. Siyami Ersek Cardiothoracic and Vascular Surgery Education and Research Hospital, Department of Cardiovascular Surgery, İstanbul-Turkey.
| | - Mustafa Saçar
- 18 Mart Univesity, Faculty of Medicine, Department of Cardiovascular Surgery, Çanakkale-Turkey
| | - Ahmet Baltalarlı
- Pamukkale Univesity, Faculty of Medicine, Department of Cardiovascular Surgery, Denizli-Turkey
| | - İbrahim Öztürk
- Göztepe Education and Research Hospital, Department of Anesthesiology, İstanbul-Turkey
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Al Tmimi L, Van de Velde M, Meyns B, Meuris B, Sergeant P, Milisen K, Pottel H, Poesen K, Rex S. Serum protein S100 as marker of postoperative delirium after off-pump coronary artery bypass surgery: secondary analysis of two prospective randomized controlled trials. ACTA ACUST UNITED AC 2016; 54:1671-80. [DOI: 10.1515/cclm-2015-1012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 01/25/2016] [Indexed: 01/08/2023]
Abstract
AbstractBackground:To investigate the predictive value of S100 (biochemical marker of neuroglial injury) for the occurrence of postoperative delirium (POD) in patients undergoing off-pump coronary artery bypass (OPCAB)-surgery.Methods:We enrolled 92 patients older than 18 years undergoing elective OPCAB-surgery. Serum-levels of S100 were determined at baseline (BL), end of surgery (EOS) and on the first postoperative day (PD1). Postoperatively, all-patients were evaluated daily until PD5 for the presence of POD using the confusion assessment method (CAM) or the confusion assessment method for the intensive care unit (CAM-ICU) for patients in the intensive care unit (ICU).Results:The overall incidence of POD was 21%. S100-values on PD1 significantly predicted the occurrence of POD during the later hospital stay [area under the curve (AUC)=0.724 (95% confidence interval (CI): 0.619–0.814); p=0.0001] with an optimal cut-off level of 123 pg mLConclusions:S100-levels <123 pg mL
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Biomarkers of Brain Damage and Postoperative Cognitive Disorders in Orthopedic Patients: An Update. BIOMED RESEARCH INTERNATIONAL 2015; 2015:402959. [PMID: 26417595 PMCID: PMC4568345 DOI: 10.1155/2015/402959] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 11/24/2014] [Indexed: 01/04/2023]
Abstract
The incidence of postoperative cognitive dysfunction (POCD) in orthopedic patients varies from 16% to 45%, although it can be as high as 72%. As a consequence, the hospitalization time of patients who developed POCD was longer, the outcome and quality of life were worsened, and prolonged medical and social assistance were necessary. In this review the short description of such biomarkers of brain damage as the S100B protein, NSE, GFAP, Tau protein, metalloproteinases, ubiquitin C terminal hydrolase, microtubule-associated protein, myelin basic protein, α-II spectrin breakdown products, and microRNA was made. The role of thromboembolic material in the development of cognitive decline was also discussed. Special attention was paid to optimization of surgical and anesthetic procedures in the prevention of postoperative cognitive decline.
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Liu LL, Bao N, Lu HW. Effects of CO 2 Pneumoperitoneum on the Cognitive Function of Patients Undergoing Gynecologic Laparoscopy. Gynecol Obstet Invest 2015; 81:90-5. [DOI: 10.1159/000376576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 01/26/2015] [Indexed: 11/19/2022]
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Abstract
BACKGROUND S100B level in the blood has been used as a marker for brain damage and blood-brain barrier (BBB) disruption. Elevations of S100B levels after exercise have been observed, suggesting that the BBB may be compromised during exercise. However, an increase in S100B levels may be confounded by other variables. OBJECTIVES The primary objective of this review was to compile findings on the relationship between S100B and exercise in order to determine if this protein is a valid marker for BBB disruptions during exercise. The secondary objective was to consolidate known factors causing S100B increases that may give rise to inaccurate interpretations of S100B levels. DATA SOURCES AND STUDY SELECTION PubMed, Web of Science and ScienceDirect were searched for relevant studies up to January 2013, in which S100B measurements were taken after a bout of exercise. Animal studies were excluded. Variables of interest such as the type of activity, exercise intensities, duration, detection methods, presence and extent of head trauma were examined and compiled. RESULTS This review included 23 studies; 15 (65 %) reported S100B increases after exercise, and among these, ten reported S100B increases regardless of intervention, while five reported increases in only some trials but not others. Eight (35 %) studies reported no increases in S100B levels across all trials. Most baseline S100B levels fall below 0.16 μg/L, with an increase in S100B levels of less than 0.07 μg/L following exercise. Factors that are likely to affect S100B levels include exercise intensity, and duration, presence and extent of head trauma. Several other probable factors influencing S100B elevations are muscle breakdown, level of training and oxidative stress, but current findings are still weak and inconclusive. CONCLUSIONS Elevated S100B levels have been recorded following exercise and are mostly attributed to either an increase in BBB permeability or trauma to the head. However, even in the absence of head trauma, it appears that the BBB may be compromised following exercise, with the severity dependent on exercise intensity.
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Yuan SM. S100 and S100β: biomarkers of cerebral damage in cardiac surgery with or without the use of cardiopulmonary bypass. Braz J Cardiovasc Surg 2014; 29:630-41. [PMID: 25714218 PMCID: PMC4408827 DOI: 10.5935/1678-9741.20140084] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 06/22/2014] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The present study is to describe the clinical impact of S100 and S100β for the evaluation of cerebral damage in cardiac surgery with or without the use of cardiopulmonary bypass (CPB). METHODS Quantitative results of S100 and S100β reported in the literature of the year range 1990-2014 were collected, screened and analyzed. RESULTS Cerebrospinal fluid and serum S100 levels showed a same trend reaching a peak at the end of CPB. The cerebrospinal fluid/serum S100 ratio decreased during CPB, reached a nadir at 6 h after CPB and then increased and kept high untill 24 h after CPB. Serum S100 at the end of CPB was much higher in infant than in adults, and in on-pump than in off-pump coronary artery bypass patients. ∆S100 increased with age and CPB time but lack of statistical significances. Patients receiving an aorta replacement had a much higher ∆S100 than those receiving a congenital heart defect repair. Serum S100β reached a peak at the end of CPB, whereas cerebrospinal fluid S100 continued to increase and reached a peak at 6 h after CPB. The cerebrospinal fluid/serum S100β ratio decreased during CPB, increased at the end of CPB, peaked 1 h after CPB, and then decreased abruptly. The increase of serum S100β at the end of CPB was associated with type of operation, younger age, lower core temperature and cerebral damages. ∆S100β displayed a decreasing trend with age, type of operation, shortening of CPB duration, increasing core temperature, lessening severity of cerebral damage and the application of intervenes. Linear correlation analysis revealed that serum S100β concentration at the end of CPB correlated closely with CPB duration. CONCLUSION S100 and S100β in cerebrospinal fluid can be more accurate than in the serum for the evaluations of cerebral damage in cardiac surgery. However, cerebrospinal fluid biopsies are limited. But serum S100β and ∆S100β seem to be more sensitive than serum S100 and ∆S100. The cerebral damage in cardiac surgery might be associated with younger age, lower core temperature and longer CPB duration during the operation. Effective intervenes with modified CPB circuit filters or oxygenators and supplemented anesthetic agents or priming components may alleviate the cerebral damage.
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Affiliation(s)
- Shi-Min Yuan
- The First Hospital of Putian, Teaching Hospital, Fujian
Medical University
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27
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Cerebral damage in cardiac surgery assessed by serum S100 proteins. Int J Cardiol 2013; 168:3075-6. [PMID: 23642598 DOI: 10.1016/j.ijcard.2013.04.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 04/06/2013] [Indexed: 11/22/2022]
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Baki ED, Aldemir M, Kokulu S, Koca HB, Ela Y, Sıvacı RG, Öztürk NK, Emmiler M, Adalı F, Uzel H. Comparison of the Effects of Desflurane and Propofol Anesthesia on the Inflammatory Response and S100β Protein During Coronary Artery Bypass Grafting. Inflammation 2013; 36:1327-33. [DOI: 10.1007/s10753-013-9671-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kochanek PM, Berger RP, Fink EL, Au AK, Bayır H, Bell MJ, Dixon CE, Clark RSB. The potential for bio-mediators and biomarkers in pediatric traumatic brain injury and neurocritical care. Front Neurol 2013; 4:40. [PMID: 23637695 PMCID: PMC3636482 DOI: 10.3389/fneur.2013.00040] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 04/15/2013] [Indexed: 01/13/2023] Open
Abstract
The use of biomarkers of brain injury in pediatric neurocritical care has been explored for at least 15 years. Two general lines of research on biomarkers in pediatric brain injury have been pursued: (1) studies of "bio-mediators" in cerebrospinal fluid (CSF) of children after traumatic brain injury (TBI) to explore the components of the secondary injury cascades in an attempt to identify potential therapeutic targets and (2) studies of the release of structural proteins into the CSF, serum, or urine in order to diagnose, monitor, and/or prognosticate in patients with TBI or other pediatric neurocritical care conditions. Unique age-related differences in brain biology, disease processes, and clinical applications mandate the development and testing of brain injury bio-mediators and biomarkers specifically in pediatric neurocritical care applications. Finally, although much of the early work on biomarkers of brain injury in pediatrics has focused on TBI, new applications are emerging across a wide range of conditions specifically for pediatric neurocritical care including abusive head trauma, cardiopulmonary arrest, septic shock, extracorporeal membrane oxygenation, hydrocephalus, and cardiac surgery. The potential scope of the utility of biomarkers in pediatric neurocritical care is thus also discussed.
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Affiliation(s)
- Patrick M Kochanek
- Safar Center for Resuscitation Research, Department of Critical Care Medicine, University of Pittsburgh School of Medicine Pittsburgh, PA, USA
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Bayram H, Hidiroglu M, Cetin L, Kucuker A, Iriz E, Uguz E, Saglam F, Sener E. Comparing S-100 beta protein levels and neurocognitive functions between patients undergoing on-pump and off-pump coronary artery bypass grafting. J Surg Res 2012. [PMID: 23183054 DOI: 10.1016/j.jss.2012.10.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND In the present study, we aimed to investigate the effects of off-pump coronary artery bypass grafting and on-pump cardiopulmonary bypass on the serum S-100 beta (S-100B) protein levels and neurocognitive functions of the patients. MATERIALS AND METHODS Sixty-four patients undergoing coronary artery bypass grafting (CABG) were enrolled in the study and were divided into two groups: off-pump (group I, n = 24) and on-pump CABG (group II, n = 40) group. Serum S-100B levels were measured before and 0, 6, and 24 h after the operation. Neurocognitive function tests were done preoperatively and were repeated in the postoperative period as well. RESULTS Serum S-100B levels were similar between the two groups preoperatively. However, median S-100B levels at 0, 6, and 24 h after the surgery were found to be significantly lower in the off-pump CABG group than in the on-pump group. The preoperative neurocognitive functions of the patients were similar between the two groups, whereas neurocognitive function was found to be significantly impaired postoperatively in the on-pump group in comparison with the off-pump CABG group. CONCLUSION We concluded that off-pump CABG is associated with decreased serum S100 protein levels and less impairment on neurocognitive functions compared with the on-pump group.
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Affiliation(s)
- Huseyin Bayram
- Department of Cardiovascular Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey.
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Cerebrospinal Fluid Markers of Brain Injury, Inflammation, and Blood-Brain Barrier Dysfunction in Cardiac Surgery. Ann Thorac Surg 2012; 94:549-55. [DOI: 10.1016/j.athoracsur.2012.04.044] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 04/11/2012] [Accepted: 04/12/2012] [Indexed: 11/23/2022]
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Bhutta AT, Schmitz ML, Swearingen C, James LP, Wardbegnoche WL, Lindquist DM, Glasier CM, Tuzcu V, Prodhan P, Dyamenahalli U, Imamura M, Jaquiss RDB, Anand KJS. Ketamine as a neuroprotective and anti-inflammatory agent in children undergoing surgery on cardiopulmonary bypass: a pilot randomized, double-blind, placebo-controlled trial. Pediatr Crit Care Med 2012; 13:328-37. [PMID: 21926656 DOI: 10.1097/pcc.0b013e31822f18f9] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Infants are potentially more susceptible to cell death mediated via glutamate excitotoxicity attributed to cardiopulmonary bypass. We hypothesized that ketamine, via N-methyl D-aspartate receptor blockade and anti-inflammatory effects, would reduce central nervous system injury during cardiopulmonary bypass. METHODS We randomized 24 infants, without chromosomal abnormalities, to receive ketamine (2 mg/kg, n = 13) or placebo (saline, n = 11) before cardiopulmonary bypass for repair of ventricular septal defects. Plasma markers of inflammation and central nervous system injury were compared at the end of surgery, and 6, 24, and 48 hrs after surgery. Magnetic resonance imaging and spectroscopy before cardiopulmonary bypass and at the time of hospital discharge were performed in a subset of cases and controls (n = 5 in each group). Cerebral hemodynamics were monitored postoperatively using near-infrared spectroscopy, and neurodevelopmental outcomes were assessed using Bayley Scales of Infant Development-II before and 2-3 wks after surgery. RESULTS Statistically significant differences were noted in preoperative inspired oxygen levels, intraoperative cooling and postoperative temperature, respiratory rate, platelet count, and bicarbonate levels. The peak concentration of C-reactive protein was lower in cases compared to controls at 24 hrs (p = .048) and 48 hrs (p = .001). No significant differences were noted in the expression of various cytokines, chemokines, S100, and neuron-specific enolase between the cases and controls. Magnetic resonance imaging with spectroscopy studies showed that ketamine administration led to a significant decrease in choline and glutamate plus glutamine/creatine in frontal white matter. No statistically significant differences occurred between pre- and postoperative Bayley Scales of Infant Development-II scores. CONCLUSIONS We did not find any evidence for neuroprotection or neurotoxicity in our pilot study. A large, adequately powered randomized control trial is needed to discern the central nervous system effect of ketamine on the developing brain. brain. TRIAL REGISTRATION The trial is registered at www.ClinicalTrials.gov, NCT00556361.
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Affiliation(s)
- Adnan T Bhutta
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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Bayram H, Erer D, Iriz E, Zor MH, Gulbahar O, Ozdogan ME. Comparison of the effects of pulsatile cardiopulmonary bypass, non-pulsatile cardiopulmonary bypass and off-pump coronary artery bypass grafting on the inflammatory response and S-100beta protein. Perfusion 2011; 27:56-64. [DOI: 10.1177/0267659111424639] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: We aimed to investigate the effects of off-pump coronary artery bypass grafting, pulsatile cardiopulmonary bypass, and non-pulsatile cardiopulmonary bypass techniques on the inflammatory response and the central nervous system in the current study. Methods: A total of 32 patients who were scheduled for elective coronary artery bypass graft surgery were included in the study. The patients were allocated into three different groups according to the perfusion techniques used during the cardiopulmonary bypass procedure as follows: off-pump coronary artery bypass grafting group (n=10); pulsatile cardiopulmonary bypass group (n=11); and non-pulsatile cardiopulmonary bypass group (n=11). Serum interleukin-6, interleukin-8, tumor necrosis factor-alpha and S-100beta levels were measured preoperatively, and at 0, 6, and 24 hours postoperatively. Results: The postoperative increase in the levels of interleukin-6 and interleukin-8 was significantly lower in the off-pump group compared to the other two groups (p<0.05), while there was no significant difference in tumor necrosis factor-alpha levels between the groups. Postoperative S-100β levels, an indicator of cerebral injury, was significantly lower in the off-pump CABG group compared to the other two groups (p<0.05). Conclusion: We found that off-pump coronary artery bypass grafting had less negative effects on inflammatory response and central nervous system compared to pulsatile cardiopulmonary bypass and non-pulsatile cardiopulmonary bypass techniques.
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Affiliation(s)
- H Bayram
- Department of Cardiovascular Surgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - D Erer
- Department of Cardiovascular Surgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - E Iriz
- Department of Cardiovascular Surgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - MH Zor
- Department of Cardiovascular Surgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - O Gulbahar
- Department of Biochemistry, Gazi University Faculty of Medicine, Ankara, Turkey
| | - ME Ozdogan
- Department of Cardiovascular Surgery, Gazi University Faculty of Medicine, Ankara, Turkey
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Joyeux-Faure M, Durand M, Bedague D, Protar D, Incagnoli P, Paris A, Ribuot C, Levy P, Chavanon O. Evaluation of the effect of one large dose of erythropoietin against cardiac and cerebral ischemic injury occurring during cardiac surgery with cardiopulmonary bypass: a randomized double-blind placebo-controlled pilot study. Fundam Clin Pharmacol 2011; 26:761-70. [DOI: 10.1111/j.1472-8206.2011.00992.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Grandi C, Tomasi CD, Fernandes K, Stertz L, Kapczinski F, Quevedo J, Dal-Pizzol F, Ritter C. Brain-derived neurotrophic factor and neuron-specific enolase, but not S100β, levels are associated to the occurrence of delirium in intensive care unit patients. J Crit Care 2011; 26:133-7. [DOI: 10.1016/j.jcrc.2010.10.006] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 09/24/2010] [Accepted: 10/03/2010] [Indexed: 11/25/2022]
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The neuroinflammatory hypothesis of delirium. Acta Neuropathol 2010; 119:737-54. [PMID: 20309566 DOI: 10.1007/s00401-010-0674-1] [Citation(s) in RCA: 253] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 03/08/2010] [Accepted: 03/13/2010] [Indexed: 01/08/2023]
Abstract
Delirium is a neuropsychiatric syndrome characterized by a sudden and global impairment in consciousness, attention and cognition. It is particularly frequent in elderly subjects with medical or surgical conditions and is associated with short- and long-term adverse outcomes. The pathophysiology of delirium remains poorly understood as it involves complex multi-factorial dynamic interactions between a diversity of risk factors. Several conditions associated with delirium are characterized by activation of the inflammatory cascade with acute release of inflammatory mediators into the bloodstream. There is compelling evidence that acute peripheral inflammatory stimulation induces activation of brain parenchymal cells, expression of proinflammatory cytokines and inflammatory mediators in the central nervous system. These neuroinflammatory changes induce neuronal and synaptic dysfunction and subsequent neurobehavioural and cognitive symptoms. Furthermore, ageing and neurodegenerative disorders exaggerate microglial responses following stimulation by systemic immune stimuli such as peripheral inflammation and/or infection. In this review we explore the neuroinflammatory hypothesis of delirium based on recent evidence derived from animal and human studies.
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Comparison of S100B and NSE between cardiac surgery and interventional therapy for children. Pediatr Cardiol 2009; 30:893-7. [PMID: 19471994 DOI: 10.1007/s00246-009-9454-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Revised: 02/10/2009] [Accepted: 04/16/2009] [Indexed: 10/20/2022]
Abstract
This study aimed to compare the release of S100B and NSE between cardiac surgery and interventional therapy for children and to investigate whether S100B serum concentration correlates with cardiopulmonary bypass in children. For this study, 40 children with congenital heart disease were selected and assigned to two groups: group A (20 children undergoing surgical therapy) and group B (20 children undergoing interventional therapy). In group A, blood samples were drawn 10 min after the induction of anesthesia, immediately after aortic cross-clamping, immediately at the end of cardiopulmonary bypass (CPB), immediately at the end of the operation, then 6 and 24 h after the operation. In group B, blood samples were drawn 10 min after the induction of anesthesia, immediately at the end of the procedure, then 6 and 24 h after the procedure. In group A, S100B plasma levels during the perioperative period and 6 h after the operation were higher than the preoperative level (p < 0.05). The NSE plasma concentrations at the termination of CPB and postoperatively were higher than the preoperative level (p < 0.05). Significant correlation was found between the peak value of S100B at the termination of CPB and the durations of both CPB and aortic cross-clamping. In group B, the differences in S100B and NSE between the post- and preoperative levels were not statistically significant (p > 0.05). The perioperative cerebral impairment indirectly evaluated by the release of NSE and S100B protein is greater in children undergoing CPB than in children undergoing interventional therapy. The release of S100B had a strong correlation with the durations of CPB and aortic cross-clamping in children.
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Korfias S, Stranjalis G, Psachoulia C, Vasiliadis C, Pitaridis M, Boviatsis E, Sakas DE. Slight and short-lasting increase of serum S-100B protein in extra-cranial trauma. Brain Inj 2009; 20:867-72. [PMID: 17060153 DOI: 10.1080/02699050600832395] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Serum S-100B protein is an established biochemical marker of traumatic brain injury. At the same time, the question of extra-cranial S-100B release has been raised. This study evaluates the post-traumatic and post-operative release kinetics of S-100B in 45 trauma victims without head injury. METHOD Serum S-100B protein was measured on admission and every 24 hours for 4 consecutive days. RESULTS Initial S-100B was slightly increased (median: 0.54 microg L-1) and correlated with the severity of extra-cranial trauma (p = 0.0004, Mann-Whitney test). Both severely (abdominal or chest trauma with or without bone fractures) and mildly (long bone fractures) injured showed a rapid decline of S-100B (< 0.2 microg L-1) around 72 hours post-trauma. Extra-cranial surgery caused a secondary increase of S-100B, especially in the mildly injured group (p = 0.004, Wilcoxon signed rank test). CONCLUSIONS Extra-cranial injury results in a mild elevation of serum S-100B protein that declines rapidly (1-3 days after injury).
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Affiliation(s)
- Stefanos Korfias
- Department of Neurosurgery, University of Athens, Evangelismos Hospital, Athens, Greece.
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Demir T, Demir H, Tansel T, Kalko Y, Tireli E, Dayioglu E, Barlas S, Onursal E. Influence of Methylprednisolone on Levels of Neuron-Specific Enolase in Cardiac Surgery: A Corticosteroid Derivative to Decrease Possible Neuronal Damage. J Card Surg 2009; 24:397-403. [DOI: 10.1111/j.1540-8191.2009.00842.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Caputo M, Mokhtari A, Rogers CA, Panayiotou N, Chen Q, Ghorbel MT, Angelini GD, Parry AJ. The effects of normoxic versus hyperoxic cardiopulmonary bypass on oxidative stress and inflammatory response in cyanotic pediatric patients undergoing open cardiac surgery: a randomized controlled trial. J Thorac Cardiovasc Surg 2009; 138:206-14. [PMID: 19577081 DOI: 10.1016/j.jtcvs.2008.12.028] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Revised: 11/21/2008] [Accepted: 12/25/2008] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study investigates the effects of controlled reoxygenation cardiopulmonary bypass on oxidative stress, inflammatory response, and organ function in children undergoing repair of cyanotic congenital heart defects. METHODS Sixty-seven cyanotic patients (median age 15 months, interquartile range 6-49 months) undergoing corrective cardiac surgery were randomized to receive either controlled normoxic (50-0 mm Hg; n = 35) or hyperoxic (150-180 mm Hg; n = 32) cardiopulmonary bypass. Troponin I and 8-isoprostane, C3a, interleukins 6, 8, and 10, cortisol, protein S100, and alpha-glutamate transferase were measured preoperatively and 10 and 30 minutes after starting bypass, on removal of the aortic crossclamp, and 12 and 24 hours thereafter. RESULTS Overall, troponin I and 8-isoprostane levels were lower in the controlled normoxic group (-29%, 95% CI -48% to -3%, P = .03, and -26%, 95% CI -44% to -2%, P = .03, respectively). Protein S100 release was also lower in the normoxic group 10 minutes after starting bypass (-26%, 95% CI -40% to -9%, P = .005) and 10 minutes after aortic crossclamp removal (-23%, 95% CI -38% to -3%, P = .02, respectively), but similar at other time points in the two groups (P >or= .17). The alpha-glutamate transferase release was significantly lower in the normoxic group 10 minutes after aortic crossclamp removal (-28%, 95% CI -44% to -9%, P = .006, respectively) but was similar at other times (P >or= .11). Release of C3a, interleukins 6, 8, and 10, and cortisol was similar in the two groups throughout (P >or= .15). CONCLUSION Controlled reoxygenation on starting cardiopulmonary bypass is associated with reduced myocardial damage, oxidative stress, and cerebral and hepatic injury compared with hyperoxic bypass and similar whole body inflammatory and stress response in cyanotic children undergoing open cardiac surgery.
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Sahu B, Chauhan S, Kiran U, Bisoi A, Lakshmy R, Selvaraj T, Nehra A. Neurocognitive Function in Patients Undergoing Coronary Artery Bypass Graft Surgery With Cardiopulmonary Bypass: The Effect of Two Different Rewarming Strategies. J Cardiothorac Vasc Anesth 2009; 23:14-21. [DOI: 10.1053/j.jvca.2008.07.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Indexed: 11/11/2022]
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Shaaban-Ali M, Harmer M, Vaughan RS, Dunne JA, Latto IP, Haaverstad R, Kulatilake ENP, Butchart EG. Changes in serum S100β protein and Mini-Mental State Examination after cold (28°C) and warm (34°C) cardiopulmonary bypass using different blood gas strategies (alpha-stat and pH-stat). Acta Anaesthesiol Scand 2008. [DOI: 10.1046/j.0001-5172.2001.00000.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Nagdyman N, Ewert P, Schmitt K, Hübler M, Stiller B, Müller C, Berger F. Protein S-100 is present in extracerebral fluids before and after cardiac surgery in children. Ann Clin Biochem 2008; 45:409-12. [DOI: 10.1258/acb.2008.007251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Protein S-100 is found in extracerebral sources. The aim of our study was to examine the content of protein S-100 in native pericardial fluid as well as in postoperative extracerebral fluids after cardiac surgery in children. Methods We conducted a prospective study in 90 children measuring protein S-100 concentration in pericardial fluid directly after opening the pericardial sac before starting with cardiac surgery. Postoperatively, we examined pleural, peritoneal and pericardial fluid. Results Pericardial fluid sampled directly after opening the pericardial sac has a protein S-100 content of 3.2 (1.3–5.4) μg/L. Postoperatively, protein S-100 content was 0.89 (0.56–2.6) μg/L in pleural effusion, 0.14 (0.1–1.1) μg/L in peritoneal fluid and 2.75 (2.2–24.4) μg/L in pericardial fluid. The protein S-100 concentration in pericardial fluid before and after cardiac operation did not differ significantly. Pericardial protein S-100 concentrations were significantly higher than pleural and peritoneal protein S-100 concentrations. Conclusions Protein S-100 is present in extracerebral fluids before and after cardiac surgery in children. The time point of fluid withdrawal after the operation did not influence the protein S-100 concentration.
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Affiliation(s)
| | | | | | - Michael Hübler
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum
| | | | | | - Felix Berger
- Department of Pediatric Cardiology, Charité-Universitätsmedizin, 13353 Berlin, Germany
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Abstract
OBJECTIVE To determine whether known serum markers of neurologic injury are increased in children with septic shock. DESIGN Prospective, observational study. SETTING Tertiary-care, pediatric intensive care unit. PATIENTS Two cohorts of children (n = 24) with septic shock were prospectively enrolled within 24 hrs of their diagnosis. In cohort 1, serum markers (S100beta, neuron-specific enolase [NSE], and glial fibrillary acidic protein [GFAP]) were determined (n = 18). In cohort 2, in addition to serum markers, urine S100beta and GFAP were determined, and continuous electroencephalography (cEEG) was performed. Children who presented to the emergency room with a fever served as controls (n = 32). Children with known neurologic conditions were excluded. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Serum and urine were collected daily for up to 7 days or until pediatric intensive care unit discharge. Biomarker concentrations were determined by commercially available enzyme-linked immunosorbent assays. cEEG was performed on days 1, 2, 4, and 7 in a 16-channel montage for at least 6 hrs. Physical examinations did not reveal focal neurologic deficits. Children with septic shock demonstrated increased serum S100beta and NSE compared with controls (mean +/- SEM: 10.5 microg/L +/- 2.4 vs. .9 microg/L +/- .1, p < .001; 96.6 microg/L +/- 8.9 vs. 4.0 microg/L +/- 1.3, p < .001, respectively). Serum GFAP was detectable in five septic children and none of the controls. In cohort 2, urine of four patients demonstrated measurable S100beta levels, and GFAP was detected in one child (nonsurvivor). cEEG demonstrated moderate to severe encephalopathy in all children studied. CONCLUSIONS Markers of neurologic injuries are increased in children with septic shock. This may indicate subclinical injuries that are either transient or permanent. Studies that correlate the long-term neurologic outcome of children with these markers are needed to identify children at risk for neurologic injuries from septic shock.
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Abstract
Delirium, or acute brain dysfunction, is a life-threatening global disturbance in cognitive functioning that frequently manifests in critically ill patients. This review examines the current status of knowledge regarding the pathophysiology of delirium in the ICU, in particular, evaluating the role of iatrogenic factors such as sedatives and analgesic administration in brain dysfunction. This hypothesis is considered along with several other plausible mechanisms of ICU delirium, including sepsis, postoperative cognitive dysfunction, and changes in biomarkers and neurotransmitters. The review concludes by highlighting potential future directions in molecular genetics for the elucidation of delirium and its long-term consequences.
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Affiliation(s)
- Max L Gunther
- VA Tennessee Valley Geriatric Research, Education and Clinical Center, Nashville, TN 37212-2637, USA
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Long B, Li Y, Chen WM. Changes of serum S-100β protein concentration in patients with original liver transplantation and its possible mechanism. Shijie Huaren Xiaohua Zazhi 2008; 16:640-644. [DOI: 10.11569/wcjd.v16.i6.640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To detect the changes of S-100β protein concentration in serum of the patients with original liver transplantation and discuss its possible reasons.
METHODS: Five patients of late-stage hepatic disease and with original liver transplantation were collected. The mean arterial pressure (MAP), heart rate (HR), cardiac output (CO), central venous pressure (CVP) and blood-gas analysis were recorded at preoperative, pre-clamp, anhepatic 10, 30 and 60 min, post-reperfusion 10, 90 min and the end of operation. The concentration of S-100β and interleukin-1β (IL-1β) in serum was also tested at preoperation, the end of anhepatic phase, reperfusion 1 h, postoperative 24 h and 48 h.
RESULTS: Before operation, serum S-100β level was in normal range and had no difference between patients, but increased 1 h after reperfusion (0.437 ± 0.148 mg/L vs 0.132 ± 0.061 mg/L); at 24 h, S-100β level (0.480 ± 0.340 mg/L) was still higher than that before operation, and then it decreased gradually to the level of the end of anhepatic period at 48 h of postoperation (0.239 ± 0.090 mg/L). IL-1β level increased to the highest level 24 h after reperfusion (63.7 ± 21.9 ng/L vs 32.2 ± 19.1 ng/L) and then decreased gradually. Thirty minutes after vena cava was clamped, MAP remained in normal level after drug adjustment, and HR was still higher than that before clamping. Meanwhile, cardiac output (CO) decreased significantly (5.4 ± 2.42 L/min vs 9.9 ± 2.33 L/min); at the first 10 min after reperfusion, CO was still lower than that before clamping (6.7 ± 1.81 L/min); all those were recovered to the preoperative level after treatment by blood vessel active drugs, hydragogue, etc. Partial pressure of carbon dioxide increased obviously during the earlier period after reperfusion; though sodium bicarbonate had been used during the last period of anhepatic phase and earlier period of reperfusion, the value of pH still decreased (i.e. acidemia) and then increased to the normal level before the end of operation; the level of ion remained in normal range on the whole after careful adjustment. Correlation analysis showed that the change of S-100β had no apparent correlation with CO or IL-1β (r = -0.327, r = 0.248, P > 0.05).
CONCLUSION: The increase of S-100β was due to the increase of permeability of blood brain barrier after reperfusion of the new liver and had no correlation with CO or IL-1β.
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Whitaker DC, Green AJE, Stygall J, Harrison MJG, Newman SP. Evaluation of an alternative S100b assay for use in cardiac surgery: relationship with microemboli and neuropsychological outcome. Perfusion 2008; 22:267-72. [PMID: 18181515 DOI: 10.1177/0267659107083243] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The aim of the study was to investigate the relationship between S100b release, neuropsychological outcome and cerebral microemboli. Peri-operative assay of the astroglial cell protein S100b has been used as a marker of cerebral damage after cardiac surgery but potential assay cross-reactivity has limited its specificity. The present study uses an alternative enzyme-linked immunoabsorbant assay (ELISA) for serum S100b that has documented sensitivity and specificity data in patients undergoing coronary artery bypass grafting (CABG). METHODS Fifty-five consecutive patients undergoing routine CABG surgery received serial venous S100b sampling at five time points: i) Pre-operative, ii) At the end of cardiopulmonary bypass (CPB), iii) 6 hrs, iv) 24 hrs and v) 48 hrs post skin closure. A previously described sandwich ELISA with monoclonal anti- S100b was used. This assay has a lower limit of detection of 0.04 microg/L and < 0.006% reactivity with S100a at a concentration of 100 microg/L S100a. Cerebral microemboli during surgery were recorded by transcranial Doppler monitor over the right middle cerebral artery. Evidence of cerebral impairment was obtained by comparing patients' performance in a neuropsychological battery of 9 tests administered 6-8 weeks post-operatively with their pre-operative scores. RESULTS There was a significant increase in S100b only at the end of bypass (mean 0.30 microg/L, SD +/- 0.33 and range .00 to 1.57). S100b levels at the end of bypass did not correlate with neuropsychological outcome or microemboli counts. CONCLUSIONS The low levels of S100b detected using the present assay, despite its high sensitivity and despite the routine use of cardiotomy suction, suggest that the assay may have higher specificity for cerebral S100b than previously used assays. There was no evidence that this assay is related to neuropsychological change or cerebral microemboli in cardiac surgery.
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Affiliation(s)
- D C Whitaker
- Centre for Behavioural and Social Sciences in Medicine, University College London, UK
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Bloomfield SM, McKinney J, Smith L, Brisman J. Reliability of S100B in predicting severity of central nervous system injury. Neurocrit Care 2007; 6:121-38. [PMID: 17522796 DOI: 10.1007/s12028-007-0008-x] [Citation(s) in RCA: 142] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
S100B is a protein biomarker that reflects CNS injury. It can be measured in the CSF or serum with readily available immunoassay kits. The excellent sensitivity of S100B has enabled it to confirm the existence of subtle brain injury in patients with mild head trauma, strokes, and after successful resuscitation from cardiopulmonary arrest. The extent of S100B elevation has been found to be useful in predicting clinical outcome after brain injury. Elevations of S100B above certain threshold levels might be able to reliably predict brain death or mortality. A normal S100B level reliably predicts the absence of significant CNS injury. The specificity of S100B levels as a reflection of CNS injury is compromised by the findings that extra-cranial injuries can lead to elevations in the absence of brain injury. This potential problem can most likely be avoided by measuring serial S100B levels along with other biomarkers and carefully noting peripheral injuries. Serum markers GFAP and NSE are both more specific for CNS injury and have little to no extra-cranial sources. Sustained elevations of S100B over 24 h along with elevations of GFAP and NSE can more reliably predict the extent of brain injury and clinical outcomes. In the future, S100B measurements might reliably predict secondary brain injury and enable physicians to initiate therapeutic interventions in a timelier manner. S100B levels have been shown to rise hours to days before changes in ICP, neurological examinations, and neuroimaging tests. S100B levels may also be used to monitor the efficacy of treatments.
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Affiliation(s)
- Stephen M Bloomfield
- New Jersey Neuroscience, Institute JFK Hospital and Medical Center, Edison, NJ 08818, USA.
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