1
|
Šumová B, Cerezo LA, Szczuková L, Nekvindová L, Uher M, Hulejová H, Moravcová R, Grigorian M, Pavelka K, Vencovský J, Šenolt L, Závada J. Circulating S100 proteins effectively discriminate SLE patients from healthy controls: a cross-sectional study. Rheumatol Int 2018; 39:469-478. [PMID: 30392117 DOI: 10.1007/s00296-018-4190-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 10/29/2018] [Indexed: 01/03/2023]
Abstract
S100 proteins are currently being investigated as potential diagnostic and prognostic biomarkers of several cancers and inflammatory diseases. The aims of this study were to analyse the plasma levels of S100A4, S100A8/9 and S100A12 in patients with incomplete systemic lupus erythematosus (iSLE), in patients with established SLE and in healthy controls (HCs) and to investigate the potential utility of the S100 proteins as diagnostic or activity-specific biomarkers in SLE. Plasma levels were measured by ELISA in a cross-sectional cohort study of 44 patients with SLE, 8 patients with iSLE and 43 HCs. Disease activity was assessed using the SLEDAI-2K. The mean levels of all S100 proteins were significantly higher in SLE patients compared to HCs. In iSLE patients, the levels of S100A4 and S100A12 but not S100A8/9 were also significantly higher compared to HCs. There were no significant differences in S100 levels between the iSLE and SLE patients. Plasma S100 proteins levels effectively discriminated between SLE patients and HCs. The area under the curve (AUC) for S100A4, S100A8/9 and S100A12 plasma levels was 0.989 (95% CI 0.976-1.000), 0.678 (95% CI 0.563-0.792) and 0.807 (95% CI 0.715-0.899), respectively. S100 levels did not differentiate between patients with high and low disease activity. Only the S100A12 levels were significantly associated with SLEDAI-2K and with cSLEDAI-2K. S100 proteins were significantly higher in SLE patients compared HCs and particularly S100A4 could be proposed as a potential diagnostic biomarker for SLE.
Collapse
Affiliation(s)
| | | | - Lenka Szczuková
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lucie Nekvindová
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Michal Uher
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | | | - Radka Moravcová
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Mariam Grigorian
- Neuro-Oncology Group, Laboratory of Neuroplasticity, Dept. of Neuroscience and Pharmacology, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Karel Pavelka
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiří Vencovský
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ladislav Šenolt
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jakub Závada
- Institute of Rheumatology, Prague, Czech Republic.
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic.
| |
Collapse
|
2
|
Aly SA, Zurakowski D, Glass P, Skurow-Todd K, Jonas RA, Donofrio MT. Cerebral tissue oxygenation index and lactate at 24 hours postoperative predict survival and neurodevelopmental outcome after neonatal cardiac surgery. CONGENIT HEART DIS 2016; 12:188-195. [DOI: 10.1111/chd.12426] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 08/31/2016] [Accepted: 10/16/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Safwat A. Aly
- Department of Pediatrics; Children's National Medical Center; Washington District of Columbia, USA
| | - David Zurakowski
- Departments of Anesthesia and Surgery; Boston Children's Hospital, Harvard Medical School; Boston Massachusetts USA
| | - Penny Glass
- Department of Psychiatry and Behavioral Science; Children's National Medical Center; Washington District of Columbia USA
| | - Kami Skurow-Todd
- Division of Cardiology; Children's National Medical Center; Washington District of Columbia USA
| | - Richard A. Jonas
- Division of Cardiothoracic Surgery; Children's National Medical Center; Washington District of Columbia USA
| | - Mary T. Donofrio
- Division of Cardiology; Children's National Medical Center; Washington District of Columbia USA
| |
Collapse
|
3
|
Kara I, Erkin A, Saclı H, Demirtas M, Percin B, Diler MS, Kırali K. The Effects of Near-Infrared Spectroscopy on the Neurocognitive Functions in the Patients Undergoing Coronary Artery Bypass Grafting with Asymptomatic Carotid Artery Disease: A Randomized Prospective Study. Ann Thorac Cardiovasc Surg 2015; 21:544-50. [PMID: 26133933 DOI: 10.5761/atcs.oa.15-00118] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The purpose of this study was to research the use of near-infrared spectroscopy (NIRS) on the neurocognitive functions in the patients undergoing coronary artery bypass grafting (CABG) with asymptomatic carotid artery disease. METHODS The study design was carried out with the participation of 79 patients in a prospective, randomized and double blind control method. The patients were separated into two groups as NIRS (n = 43) and no NIRS (n = 36). A neurocognitive test was applied preoperatively and postoperatively to all patients before discharge. Cognitive functions were evaluated by applying the Montreal Cognitive Assessment test (MoCA). RESULTS The decrease in the postoperative score of mean MoCA in no NIRS group was statistically significant when compared to preoperatively (p <0.001). Postoperative mean MoCA score was found to be significantly higher in NIRS group (NIRS: 26.8 ± 1.9 vs. no NIRS: 23.6 ± 2.5, p <0.001). It has been determined that there was a moderately positive significant correlation between the increase in the NIRS used patients (%) and increase in the MoCA score of the patients (r = 0.59, p <0.001). CONCLUSION Intraoperative NIRS usage in the patients undergoing CABG with carotid artery disease might be useful due to its postoperative positive effects on the cognitive functions.
Collapse
Affiliation(s)
- Ibrahim Kara
- Sakarya University, Faculty of Medicine, Department of Cardiovascular Surgery, Sakarya, Turkey
| | | | | | | | | | | | | |
Collapse
|
4
|
Should Cerebral Near-infrared Spectroscopy be Standard of Care in Adult Cardiac Surgery? Heart Lung Circ 2015; 24:544-50. [DOI: 10.1016/j.hlc.2015.01.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 01/19/2015] [Indexed: 11/18/2022]
|
5
|
Ly M, Roubertie F, Belli E, Grollmuss O, Bui MT, Roussin R, Lebret E, Capderou A, Serraf A. Continuous Cerebral Perfusion for Aortic Arch Repair: Hypothermia Versus Normothermia. Ann Thorac Surg 2011; 92:942-8; discussion 948. [PMID: 21704296 DOI: 10.1016/j.athoracsur.2011.03.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Revised: 02/28/2011] [Accepted: 03/07/2011] [Indexed: 11/29/2022]
Affiliation(s)
- Mohamed Ly
- Department of Congenital Heart Surgery, Marie Lannelongue Hospital, University Paris-Sud, Le Plessis-Robinson, France.
| | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Near-infrared spectroscopy: What we know and what we need to know—A systematic review of the congenital heart disease literature. J Thorac Cardiovasc Surg 2009; 137:154-9, 159e1-12. [DOI: 10.1016/j.jtcvs.2008.08.005] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Revised: 05/05/2008] [Accepted: 08/02/2008] [Indexed: 11/18/2022]
|
7
|
|
8
|
Hoffman GM. Neurologic monitoring on cardiopulmonary bypass: what are we obligated to do? Ann Thorac Surg 2007; 81:S2373-80. [PMID: 16731106 DOI: 10.1016/j.athoracsur.2006.02.076] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2005] [Revised: 01/17/2006] [Accepted: 02/04/2006] [Indexed: 11/18/2022]
Abstract
Improving survival from congenital cardiac repairs using cardiopulmonary bypass has appropriately shifted focus to neurologic outcomes. Hypoxic-ischemic mechanisms are the major cause of neurologic injury in neonatal cardiac surgery, and modifications of techniques of cardiopulmonary bypass can affect organ oxygen delivery and the propensity to injury both during and after surgery. Through successive refinements in the techniques of cardiopulmonary bypass, the risk factors for hypoxic-ischemic injury have been reduced, but not eliminated. The application of specific monitoring to enhance detection of hypoxic conditions associated with neurologic injury would both allow intervention on individual patients and drive refinements in strategies to further reduce risk. Specific neurologic monitoring techniques that can be used during cardiopulmonary bypass include near-infrared spectroscopy, transcranial Doppler ultrasonography, and electroencephalographic techniques. Of these, only near-infrared spectroscopy provides a continuous quantitative signal of the physiologic variable most related to injury and most amenable to intervention. This review will advocate wide adoption of near-infrared spectroscopy monitoring throughout the perioperative period, to enhance detection of hypoxic conditions and to drive patient-specific interventions.
Collapse
MESH Headings
- Brain Damage, Chronic/etiology
- Brain Damage, Chronic/physiopathology
- Brain Damage, Chronic/prevention & control
- Cardiopulmonary Bypass/adverse effects
- Electroencephalography
- Extracorporeal Membrane Oxygenation
- Hemoglobinometry/instrumentation
- Hemoglobinometry/methods
- Humans
- Hypoxia/diagnosis
- Hypoxia/etiology
- Hypoxia/physiopathology
- Hypoxia-Ischemia, Brain/diagnosis
- Hypoxia-Ischemia, Brain/diagnostic imaging
- Hypoxia-Ischemia, Brain/etiology
- Hypoxia-Ischemia, Brain/physiopathology
- Hypoxia-Ischemia, Brain/prevention & control
- Infant
- Infant, Newborn
- Intracranial Embolism/diagnosis
- Intracranial Embolism/etiology
- Intracranial Embolism/physiopathology
- Intracranial Embolism/prevention & control
- Intraoperative Complications/diagnosis
- Intraoperative Complications/etiology
- Intraoperative Complications/physiopathology
- Intraoperative Complications/prevention & control
- Magnetic Resonance Imaging
- Monitoring, Intraoperative
- Oxyhemoglobins/analysis
- Postoperative Complications/diagnosis
- Postoperative Complications/etiology
- Postoperative Complications/physiopathology
- Postoperative Complications/prevention & control
- Risk Factors
- Spectroscopy, Near-Infrared/methods
- Spectroscopy, Near-Infrared/standards
- Ultrasonography, Doppler, Transcranial
Collapse
Affiliation(s)
- George M Hoffman
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA.
| |
Collapse
|
9
|
Effect of alpha-stat vs. pH-stat strategies on cerebral oximetry during moderate hypothermic cardiopulmonary bypass. Eur J Anaesthesiol 2007. [DOI: 10.1097/00003643-200701000-00003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
10
|
Abstract
PURPOSE OF REVIEW As surgical survival in children with congenital heart disease, particularly those with univentricular hearts, has improved in recent years, focus has shifted to reducing the morbidity of congenital cardiac malformations and their treatment. This review will focus on emerging therapies aimed at reducing these morbidities in the intensive care unit. RECENT FINDINGS A protracted stay in the intensive care unit after cardiac surgery is a risk factor for developing various morbidities. Therapies or interventions that may hasten postoperative recovery and minimize the length of stay are thus important to evaluate. Fluid overload, renal dysfunction, low cardiac output and neurological dysfunction remain major contributors to morbidity after cardiac surgery. In addition, the treatment of these adverse states can potentially compound the injury. SUMMARY The reduction in morbidity after cardiac surgery remains challenging. Recent insights have allowed us to recognize the impact of factors beyond the intraoperative period as significant contributors to morbidity. As our field continues to evolve, future studies should focus on emerging technologies and therapies that facilitate the prevention of physiological states that compound congenital morbidities.
Collapse
Affiliation(s)
- David S Cooper
- The Congenital Heart Institute of Florida, Cardiac Intensive Care Unit, All Children's Hospital, University of South Florida, St Petersburg, FL 33701, USA.
| | | |
Collapse
|
11
|
Nauphal M, El-Khatib M, Taha S, Haroun-Bizri S, Alameddine M, Baraka A. Effect of alpha-stat vs. pH-stat strategies on cerebral oximetry during moderate hypothermic cardiopulmonary bypass. Eur J Anaesthesiol 2006; 24:15-9. [PMID: 16824241 DOI: 10.1017/s0265021506000998] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2006] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES This study was undertaken to compare the effect of alpha-stat vs. pH-stat strategies for acid-base management on regional cerebral oxygen saturation (RsO2) in patients undergoing moderate hypothermic haemodilution cardiopulmonary bypass (CPB). METHODS In 14 adult patients undergoing elective coronary artery bypass grafting, an awake RsO2 baseline value was monitored using a cerebral oximeter (INVOS 5100). Cerebral oximetry was then monitored continuously following anaesthesia and during the whole period of CPB. Mean +/- SD of RsO2, CO2, mean arterial pressure and haematocrit were determined before bypass and during the moderate hypothermic phase of the CPB using the alpha-stat followed by pH-stat strategies of acid-base management. Alpha-stat was then maintained throughout the whole period of CPB. RESULTS The mean baseline RsO2 in the awake patient breathing room air was 59.6 +/- 5.3%. Following anaesthesia and ventilation with 100% oxygen, RsO2 increased up to 75.9 +/- 6.7%. Going on bypass, RsO2 significantly decreased from a pre-bypass value of 75.9 +/- 6.7% to 62.9 +/- 6.3% during the initial phase of alpha-stat strategy. Shifting to pH-stat strategy resulted in a significant increase of RsO2 from 62.9 +/- 6.3% to 72.1 +/- 6.6%. Resuming the alpha-stat strategy resulted in a significant decrease of RsO2 to 62.9 +/- 7.8% which was similar to the RsO2 value during the initial phase of alpha-stat. CONCLUSION During moderate hypothermic haemodilutional CPB, the RsO2 was significantly higher during the pH-stat than during the alpha-stat strategy. However, the RsO2 during pH-stat management was significantly higher than the baseline RsO2 value in the awake patient breathing room air, denoting luxury cerebral perfusion. In contrast, the RsO2 during alpha-stat was only slightly higher than the baseline RsO2, suggesting that the alpha-stat strategy avoids luxury perfusion, but can maintain adequate cerebral oxygen supply-demand balance during moderate hypothermic haemodilutional CPB.
Collapse
Affiliation(s)
- M Nauphal
- American University of Beirut, Department of Anesthesiology, Beirut, Lebanon
| | | | | | | | | | | |
Collapse
|
12
|
Wernovsky G. Current insights regarding neurological and developmental abnormalities in children and young adults with complex congenital cardiac disease. Cardiol Young 2006; 16 Suppl 1:92-104. [PMID: 16401370 DOI: 10.1017/s1047951105002398] [Citation(s) in RCA: 236] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Over a decade ago, I co-authored a review in Cardiology in the Young regarding neurological outcomes following surgery for congenital cardiac disease.1In that review, I placed much emphasis on the conduct of cardiopulmonary bypass, and its role in neurodevelopmental disabilities. Much has been learned in the intervening years regarding the multifactorial causes of abnormal school-age development, in particular, the role of prenatal, perioperative, socioeconomic, and genetic influences. In this update, I will highlight some of the recent advances in our understanding of the protean causes of neurological, behavioral, and developmental abnormalities in children and young adults with complex forms of congenital cardiac disease. In addition, I will summarize the current data on patients at particular high-risk for adverse neurodevelopmental outcomes, specifically those with a functionally univentricular heart who have had staged reconstruction with ultimate conversion to the Fontan circulation.
Collapse
Affiliation(s)
- Gil Wernovsky
- Division of Pediatric Cardiology, The Cardiac Center at The Children's Hospital of Philadelphia, Philadelphia 19104, USA.
| |
Collapse
|
13
|
Baraka A, Naufal M, El-Khatib M. Correlation between cerebral and mixed venous oxygen saturation during moderate versus tepid hypothermic hemodiluted cardiopulmonary bypass. J Cardiothorac Vasc Anesth 2006; 20:819-25. [PMID: 17138087 DOI: 10.1053/j.jvca.2005.04.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2005] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study was undertaken to compare cerebral oxygen saturation (RsO(2)) and mixed venous oxygen saturation (SvO(2)) in patients undergoing moderate and tepid hypothermic hemodiluted cardiopulmonary bypass (CPB). DESIGN Prospective study. SETTINGS University hospital operating room. PARTICIPANTS Fourteen patients undergoing elective coronary artery bypass graft surgery using hypothermic hemodiluted CPB. INTERVENTIONS During moderate (28 degrees -30 degrees C) and tepid hypothermic (33 degrees -34 degrees C) hemodiluted CPB, RsO(2) and SvO(2) were continuously monitored with a cerebral oximeter via a surface electrode placed on the patient's forehead and with the mixed venous oximeter integrated in the CPB machine, respectively. MEASUREMENTS AND MAIN RESULTS Mean +/- standard deviation of RsO(2), SvO(2), PaCO(2), and hematocrit were determined prebypass and during moderate and tepid hypothermic phases of CPB while maintaining pump flow at 2.4 L/min/m(2) and mean arterial pressure in the 60- to 70-mmHg range. Compared with a prebypass value of 76.0% +/- 9.6%, RsO(2) was significantly decreased during moderate hypothermia to 58.9% +/- 6.4% and increased to 66.4% +/- 6.7% after slow rewarming to tepid hypothermia. In contrast, compared with a prebypass value of 78.6% +/- 3.3%, SvO(2) significantly increased to 84.9% +/- 3.6% during moderate hypothermia and decreased to 74.1% +/- 5.6% during tepid hypothermia. During moderate hypothermia, there was poor agreement between RsO(2) and SvO(2) with a gradient of 26%; however, during tepid hypothermia, there was a strong agreement between RsO(2) and SvO(2) with a gradient of 6%. The temperature-uncorrected PaCO(2) was maintained at the normocapnic level throughout the study, whereas the temperature-corrected PaCO(2) was significantly lower during the moderate hypothermic phase (26.8 +/- 3.1 mmHg) compared with the tepid hypothermic phase (38.9 +/- 3.7 mmHg) of CPB. There was a significant and positive correlation between RsO(2) and temperature-corrected PaCO(2) during hypothermia. CONCLUSIONS During moderate hypothermic hemodiluted CPB, there was a significant increase of SvO(2) associated with a paradoxic decrease of RsO(2) that was attributed to the low temperature-corrected PaCO(2) values. During tepid CPB after slow rewarming, regional cerebral oxygen saturation was increased in association with an increase with the temperature-corrected PaCO(2) values. The results show that during hypothermic hemodiluted CPB using the alpha-stat strategy for carbon dioxide homeostasis, cerebral oxygen saturation is significantly higher during tepid than moderate hypothermia.
Collapse
Affiliation(s)
- Anis Baraka
- Department of Anesthesiology, School of Medicine, American University of Beirut, Beirut, Lebanon.
| | | | | |
Collapse
|