Elevated Serum Levels of NSE and S-100β Correlate with Increased Risk of Acute Cerebral Infarction in Asian Populations

Serum neuron-specific enolase can predict the severity and outcome of anti-N-methyl-D-aspartate receptor encephalitis

BACKGROUND

Little is known about the association between serum neuron-specific enolase (NSE) concentration and anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. This study aims to investigate if serum NSE concentration is related to the clinical features of anti-NMDAR encephalitis.

METHODS

Serum NSE levels were detected in 58 anti-NMDAR encephalitis cases, 58 matched healthy controls and 58 matched disease controls. Demographic features, clinical symptoms, cerebrospinal fluid parameters and brain MRI indexes of the cases were evaluated.

RESULTS

Serum NSE concentrations were significant higher in case group than those in healthy controls and disease controls (both p < 0.001). Serum NSE concentrations in patients with mRS≥3 one year after onset were obviously higher than in those with mRS<3 (p < 0.001). Patients with status epilepticus or central hypoventilation had higher serum NSE levels than those without (p = 0.003 and p = 0.006). Serum NSE concentrations in cases with brain lesions or brain atrophy were significant higher than in those without (p = 0.001 and p < 0.001, respectively). Serum NSE concentrations were found to be significant higher in cases with limited response to treatment compared to those with favourable therapy outcomes (p < 0.001). Spearman's correlation analysis showed a significant positive association between serum NSE concentration and mRS score at the most critical time (max mRS) (r = 0.575, p < 0.001) and one year after onset (r = 0.705, p < 0.001). Cox regression results reflected that high serum NSE level was an independent predictor of poor prognosis in anti-NMDAR encephalitis group (p = 0.001), and the ROC curve threshold value was 15.72 ng/ml.

CONCLUSIONS

Serum NSE concentrations in anti-NMDAR encephalitis cases are higher than those in controls. It can be used to predict the brain damage degree and prognosis of anti-NMDAR encephalitis cases.

Effect of Repetitive Transcranial Magnetic Stimulation on the Nutritional Status and Neurological Function of Patients With Postischemic Stroke Dysphagia

BACKGROUND

This project aimed to explore the effects of repetitive transcranial magnetic stimulation (rTMS) on the nutritional status and neurological function of patients with postischemic stroke dysphagia.

MATERIALS AND METHODS

After recruiting 70 inpatients with cerebral infarction combined with dysphagia hospitalized in the Cerebrovascular Center of Guangdong Second Provincial General Hospital from June 2017 to June 2020, we assigned them randomly into a control group and an rTMS group. Patients in the control group received swallowing training, while patients of the rTMS group received swallowing training and rTMS.

RESULTS

Fifteen days after treatment, serum nutrition indexes and neurotrophic indexes of both groups were higher than before treatment, and their serum nerve injury indexes were lower than before treatment. After 15 days of treatment, the body nutrition indexes and neuronutrition indexes of the rTMS group were higher than those of the control group, while the nerve injury indexes of the rTMS group were lower than those of the control group.

CONCLUSION

rTMS in the treatment of dysphagia after stroke can better improve nutritional status and nerve function, reducing nerve damage.

Serum S100B and NSE Levels Correlate With Infarct Size and Bladder-Bowel Involvement Among Acute Ischemic Stroke Patients

Objectives Stroke is a major global health concern. Due to limited availability of neuroimaging particularly in rural and regional areas in India as well as its limitation, the interest in use of biochemical markers for stroke diagnosis, severity, and prognosis is increasing. Only a handful of studies on stroke biomarkers have been conducted in India. Hence, this study was conducted to investigate the correlation of serum neuron-specific enolase (NSE) and S100 calcium-binding protein B (S100B) levels with stroke severity according to infarct size in acute ischemic stroke patients.

Material and Methods Sixty stroke patients were recruited for the study and were evaluated. Noncontrast computed tomography (CT) scan of the brain was performed for all patients within 48 hours of onset of symptoms. Infarct volume was measured by evaluating dimensions in three planes on CT head. Serum NSE and S100B levels were measured by commercially available immunoassay kits. Continuous data was represented as mean ± standard deviation. Categorical data was expressed in terms of percentages and proportions. Pearson's correlation coefficient was applied to assess correlation between NSE and S100B and infarct size. Infarct size was classified arbitrarily into three groups according to infarct volume (low, moderate, and large) and analysis of variance was applied for comparing mean S100B and NSE levels in the three groups. To assess the independent predictors of infarct size among stroke cases, multivariate logistic regression analysis was used. Association between serum S100B or NSE levels and clinical features was done by the Mann–Whitney U test.

Results Correlation between serum S100B protein levels and NSE with larger infarct volume was highly significant (r(S100B) = 0.611, p (S100B) < 0.0001; r(NSE) = 0.258, p(NSE) = 0.047). Using multivariate regression analysis, bladder and bowel involvement, prior stroke history, and dyslipidemia among stroke patients correlated with a larger infarct size. Mann–Whitney U test showed both NSE and S100B levels were significantly associated with bladder bowel involvement among stroke cases.

Conclusion There was a positive correlation between serum S100B and NSE levels with infarct size. In addition, bladder-bowel involvement among stroke patients was associated with increased S100B levels. Therefore, levels of protein S100B and NSE may serve as indicator of infarct size and may be predictors of severe clinical presentations of acute ischemic stroke.

The relationship between the severity of disability and serum IL-8 in acute ischemic stroke patients

Background

Stroke is the third leading cause of death and leading cause of adult disability worldwide. Long-term disability is a significant problem among survivors; post-stroke inflammation is well known to contribute to the expansion of the ischemic lesion resulting in significant morbidity and disability. To study the impact of serum level of IL-8 on severity of disability in patients with acute ischemic stroke in the first 48 h post stroke.

Methods

A cross-sectional case control study was conducted on 44 patients with acute ischemic stroke (in the first 48 h). The patients were subjected to full neurological examination, computed tomography (CT) and magnetic resonance imaging (MRI) of the brain, and assessment of stroke disability using the National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS). Measurement of the serum levels of IL-8, erythrocyte sedimentation rate, and C-reactive protein (CRP) was done. Forty-four matched control subjects for their age and sex were included for comparison of serum level of IL-8.

Results

The level of IL-8 was significantly higher in the patients than in the control subjects (p < 0.001).There was a statistically significant positive correlation between serum level of IL-8 and disability assessed by NIHSS (r = 0.42, p = 0.004). The patients with moderate disability showed significant higher IL-8 levels than those with minor disability (p = 0.02).

Conclusion

The severity of disability in early acute ischemic stroke is highly correlated to the serum level of IL-8.

Neuroimaging, serum biomarkers, and patient characteristics as predictors of upper limb functioning 12 weeks after acute stroke: an observational, prospective study

OBJECTIVE

To evaluate the potential of neuroimaging, serum biomarkers, stroke etiology, and clinical characteristics as predictors of upper limb functioning 12 weeks after stroke.

METHODS

This was a prospective, observational study of patients (18-85 years-old) hospitalized due to acute ischemic stroke in the territory of the middle cerebral artery. Patients were hospitalized at a stroke rehabilitation center, where they underwent a standardized rehabilitation program. Clinical, imagiology, laboratory (biomarkers: C-reactive protein, D-dimer, and fibrinogen, and S100 calcium binding protein β [S100β]), and functionality assessments were conducted four different times: within 24 hours, and at 48 hours, 3 weeks, and 12 weeks after acute stroke.

RESULTS

Upper limb functioning at 12 weeks was significantly associated with Alberta Stroke Program Early CT Score (ASPECTS) score (OR:2.012 [CI:1.349-3.000]; P = 0.001) and S100β protein levels (OR:0.997 [CI:0.994-0.999]; P = 0.007). Advanced age was associated with poor upper limb functioning. S100β protein levels < 140.5 ng/L at 48 hours and ASPECTS scores ≥ 7.5 within 24 hours of admission predicted good hand functioning at 12 weeks. Upper limb functioning and general functioning were significantly correlated (P < 0.001), with strong negative correlations (all correlation coefficients ≤-0.586) for all comparisons.

CONCLUSION

ASPECTS score ≥ 8 within 24 hours and S100β protein < 140.5 ng/L at 48 hours predict better upper limb functioning, while advanced age predicts worse upper limb functioning 12 weeks after stroke.

S100β Protein as a Predictor of Poststroke Functional Outcome: A Prospective Study

BACKGROUND

Stroke is one of the leading causes of disability worldwide. Early prediction of poststroke disability using clinical models is of great interest, especially in the rehabilitation field. Although some biomarkers and neuroimaging techniques have shown potential predictive value, there are still insufficient data to support their clinical utility in predicting poststroke functional recovery. We aimed to assess the value of serum biomarkers (C-reactive protein [CRP], D-dimer, fibrinogen, and S100β protein) in predicting medium-term (12 weeks) functional outcome in patients with acute ischemic stroke.

METHODS

This is an observational, prospective study in a sample of patients hospitalized for ischemic stroke (N = 131). Peripheral blood levels of biomarkers of interest were determined at admission (CRP, D-dimer, and fibrinogen) or at 48 hours poststroke (S100β protein). Functional status was accessed at 48 hours and 12 weeks poststroke using the modified Rankin Scale (mRS).

RESULTS

S100β protein levels measured at 48 hours were significantly associated with mRS scores at 12 weeks (odds ratio = 1.005, 95% confidence interval [CI] [1.005-1.007]; P <.001). This association was not seen for the remaining biomarkers of interest. The S100β cutoff for poor functionality at 12 weeks was 140.5 ng/L or more (sensibility 83.8%; specificity 71.4%; area under the curve = .80, 95% CI [.722, .879]).

CONCLUSIONS

S100β levels in peripheral blood at 48 hours poststroke reflect acute stroke severity and predict functional outcome at 12 weeks with a cutoff value of 140.5 ng/dL. The value of S100β as predictor of functional recovery after stroke should be emphasized in further clinical research and clinical practice.

Function and mechanism of microRNA-210 in acute cerebral infarction

Acute cerebral infarction (ACI) is a common cerebrovascular disease. Previous studies have indicated that microRNAs (miRs) are aberrantly expressed in patients with ACI. However, the functions of miRs in the pathogenesis of ACI still require further investigation. The aim of the present study was to investigate the function of miR-210 in ACI and its associated mechanism. The expression of miR-210 in the serum of 40 patients with ACI and 40 normal controls was examined using reverse transcription-quantitative polymerase chain reaction (RT-qPCR). Then, human umbilical vein endothelial cells (HUVECs) were treated with serum from patients with ACI or healthy volunteers, and a CCK-8 assay was performed to examine cell proliferation. Next, cells were stained with PI/Annexin V, and the apoptosis rate was examined using flow cytometry. Furthermore, cells were harvested and lysed, and RT-qPCR and western blotting assays were performed to compare the expression of vascular endothelial growth factor (VEGF), Notch1 and Hes1 in different groups. It was observed that the expression of miR-210 was significantly increased in the serum of patients with ACI compared with normal controls (P<0.01), and receiver operating characteristic curve analysis indicated that the area under the curve for miR-210 was 0.799 (95% confidence interval, 0.700–0.899), the optimum cut-off point was 1.397, and the sensitivity and specificity at the cut-off point were 62.5 and 87.5%, respectively. Furthermore, serum from patients with ACI induced a significant increase in proliferation (P<0.05 at 48 h, P<0.01 at 72 h) and a significant decrease in the apoptosis rate of HUVECs (P<0.01). In addition, serum from patients with ACI significantly increased the expression of VEGF, Notch1 and Hes1 at the mRNA and protein level (all P<0.01 with the exception of Notch1 mRNA expression, P>0.05). In conclusion, these results demonstrate that miR-210 is upregulated in the serum of patients with ACI, and miR-210 may be involved in the pathogenesis of ACI through regulating the proliferation and apoptosis of endothelial cells.