Elevated Neuron-specific Enolase Research Articles

Serum neuron-specific enolase: A promising biomarker of silicosis.

BACKGROUNDSilicosis is a type of chronic pulmonary fibrosis caused by long-term inhalation of silica dust particles. There has been no ideal biomarker for the diagnosis and differential diagnosis of silicosis until now. Studies have found that elevated neuron-specific enolase (NSE) concentration in the serum of silicosis patients is helpful for diagnosis and severity assessment of the disease. However, the number of cases in these studies was not enough to arouse attention.AIMTo investigate the clinical significance of serum NSE in the diagnosis and staging of silicosis.METHODSFrom January 2017 to June 2019, 326 cases of silicosis confirmed in Quanzhou First Hospital Affiliated to Fujian Medical University were included in the silicosis group. A total of 328 healthy individuals or medical patients without silicosis were included in the control group. Serum NSE concentrations of all subjects were determined by electrochemical luminescence.RESULTSThere were no significant differences in sex, age, smoking index and complications between the silicosis and control groups. The mean serum NSE concentration was 26.57 ± 20.95 ng/mL in the silicosis group and 12.42 ± 2.68 ng/mL in the control group. The difference between the two groups was significant (U = 15187, P = 0.000). Among the 326 patients with silicosis, 103 had stage I silicosis, and the mean serum NSE concentration was 15.55 ± 6.23 ng/mL. The mean serum NSE concentration was 21.85 ± 12.05 ng/mL in 70 patients with stage II silicosis. The mean serum NSE concentration was 36.14 ± 25.72 ng/mL in 153 patients with stage III silicosis. Kruskal–Wallis H test suggested that the difference in serum NSE concentration in silicosis patients in the three groups was significant (H = 130.196, P = 0.000). Receiver operating characteristic curve analysis indicated that the area under the curve was 0.858 (95% confidence interval: 0.828-0.888; P = 0.000). When the NSE concentration was 15.82 ng/mL, the Jorden index was the largest, the sensitivity was 72%, and the specificity was 90%.CONCLUSIONSerum NSE concentration may be a promising biomarker for the diagnosis and assessment of severity of silicosis.

Pretreatment Levels of Chromogranin A and Neuron-specific Enolase in Patients With Gastroenteropancreatic Neuroendocrine Neoplasia.

Chromogranin A (CgA) and neuron-specific enolase (NSE) are applied in the diagnosis of neuroendocrine neoplasms (NENs), especially non-functional ones. The aim of this study was to investigate the predictive values of CgA and NSE in long-term survival. Our retrospective analysis included 65 patients with histologically verified gastroenteropancreatic NEN between 2005 and 2019. We performed bivariate and multivariable analyses to evaluate the relationship between CgA and NSE values before histological assessment and overall survival. Distribution of time-to-event was analyzed using Kaplan-Meier survival curves and modelled by Cox regression models. Elevated NSE levels prior to histology were significantly associated with worse survival (HR=1.13, p=0.004) and were associated with low-differentiated NENs (rs=0.321, p=0.0338). CgA was associated with well-differentiated tumors (rs=0.233), but not significantly. Pretreatment serum levels of NSE can serve as a valuable additional predictor of long-term survival in patients with NEN.

Cerebrospinal fluid findings and hypernatremia in COVID-19 patients with altered mental status

BackgroundThe objective of the study was to assess the cerebrospinal fluid (CSF) findings in COVID-19 patients.AimsThis was an observational retrospective cohort from electronic medical records of hospitalized patients (n = 2655) with confirmed COVID-19 between February 15, 2020, and April 15, 2020, in 182 hospitals from a large health system in the USA. The review of data yielded to a total of 79 patients in 20 hospitals who had CSF analysis.MethodsOutcomes during hospitalization, including hospital length of stay, disease severity, ventilator time, and in-hospital death were recorded. Independent variables collected included patient demographics, diagnoses, laboratory values, and procedures.ResultsA total of 79 patients underwent CSF analysis. Of these, antigen testing was performed in 73 patients. Ten patients had CSF analysis for general markers such as total protein, cell count, glucose, clarity, and color. Seven of the 10 cases (70%) had normal total cell count and normal white blood cell count in CSF. Sixty-three percent (5/8) had elevated total protein. Two patients had normal levels of lactate dehydrogenase (LDH) and 1 patient had significantly elevated (fourfold) neuron-specific enolase (NSE) level in CSF.ConclusionUnlike bacterial infections, viral infections are less likely to cause remarkable changes in CSF glucose, cell count, or protein. Our observations showed no pleocytosis, but mild increase in protein in the CSF of the COVID-19 patients. The fourfold elevation of NSE may have diagnostic/prognostic value as a biomarker in CSF for COVID-19 patients who have altered mental status.Graphical abstract

SURG-19. EVALUATION OF SERUM NEURON SPECIFIC ENOLASE, INTERFERON-ALPHA, AND INTERFERON-GAMMA IN RESPONSE TO LASER ABLATION OF HIGH GRADE GLIOMAS

Abstract BACKGROUND The blood-brain barrier (BBB) is a formidable obstacle in the treatment of gliomas. It has been speculated that the BBB may be temporarily disrupted in laser ablation, a relatively new treatment used for newly diagnosed and recurrent high grade gliomas (HGG). BBB disruption can be measured non-invasively through serum neuron specific enolase (NSE) levels. In addition to disrupting the BBB, laser ablation could trigger an immune response in brain that has yet to be studied. Interferon-alpha (IFN-α) and interferon-gamma (IFN-ɣ) are cytokines used as serum markers for an immune response. OBJECTIVE To measure NSE and IFN-α and IFN-ɣ as serum markers for BBB disruption and brain immune response activation, respectively, in patients undergoing laser ablation for recurrent high grade gliomas. METHODS Sixteen patients with recurrent HGG underwent laser ablation from 2/2017 to 12/2019. All 16 patients had gross total ablation of the contrast enhancing mass. Serum levels of NSE, IFN-α, IFN-ɣ were measured pre-operatively and at 24 hours, 2 weeks, and 8-16 weeks post-operatively, depending on adjuvant treatment received post-operatively. RESULTS Levels of NSE consistently increased 24 hours post-operatively (2.28±0.37 ng/ml) compared to pre-operative levels (1.62±0.29 ng/ml), p=0.032. Afterwards, NSE decreased and reached baseline by 2 weeks postoperatively (2 weeks- 1.67±0.29 ng/ml, 8 weeks- 1.85±0.91 ng/ml, 12 weeks- 0.81±0.33 ng/ml, 16 weeks- 1.23±0.93 ng/ml). Compared to their pre-operative levels, IFN-α and IFN-ɣ (85.46±35.29 and 1.62±0.47 pg/ml, respectively) did not display a significant difference in their serum levels (p=0.26-0.72 and 0.14-0.60, respectively, for IFN-α and IFN-ɣ) at any post-operative measurement time. Conclusions: Elevated NSE levels following laser ablation in HGG indicate a temporary disruption of the BBB that persists for approximately 2 weeks without eliciting an accompanying immune reaction in brain. Correlation studies with DCE-MRI are on-going.

Correction of the NSE concentration in hemolyzed serum samples improves its diagnostic accuracy in small-cell lung cancer.

Neuron-specific enolase (NSE) is a well-known biomarker for the diagnosis, prognosis and treatment monitoring of small-cell lung cancer (SCLC). Nevertheless, its clinical applicability is limited since serum NSE levels are influenced by hemolysis, leading to falsely elevated results. Therefore, this study aimed to develop a hemolysis correction equation and evaluate its role in SCLC diagnostics.Two serum pools were spiked with increasing amounts of hemolysate obtained from multiple individuals. A hemolysis correction equation was obtained by analyzing the relationship between the measured NSE concentration and the degree of hemolysis. The equation was validated using intentionally hemolyzed serum samples, which showed that the correction was accurate for samples with an H-index up to 30 μmol/L. Correction of the measured NSE concentration in patients suspected of lung cancer caused an increase in AUC and a significantly lower cut-off value for SCLC detection when compared to uncorrected results.Therefore, a hemolysis correction equation should be used to correct falsely elevated NSE concentrations. Results of samples with an H-index above 30 μmol/L should not be reported to clinicians. Application of the equation illustrates the importance of hemolysis correction in SCLC diagnostics and questions the correctness of the currently used diagnostic cut-off value.

Effect of photobiomodulation on serum neuron specific enolase (NSE) among patients with diabetic peripheral neuropathy – A pilot study

Background and aimPhotobiomodulation is an emerging therapy for Diabetic peripheral neuropathy (DPN) of which the management is still a dilemma for clinicians. Elevated Neuron Specific Enolase (NSE) is associated with neuropathy. We aimed this study to assess the effect of Low Level Laser Therapy (LLLT) on Serum Neuron Specific Enolase in Type II Diabetes Mellitus patients with DPN. MethodologyPre post interventional study was done on 50 patients with DPN. DPN was confirmed using 10g Monofilament test, Vibration perception threshold (VPT) and Michigan Neuropathy Screening Instrument. All patients were provided with LLLT for 9 min on dorsal and plantar of foot with a dosage of 3.1 J/cm 2 for 10 days. A blood sample was collected at baseline and 4 weeks after LLLT for NSE estimation. ResultA significant reduction in serum NSE levels (0.006) after 4 weeks of laser therapy was observed in 42 patients when compared with baseline. A significant reduction in the vibration perception threshold (p = 0.003) and Numeric pain rating scale (p = 0.004) were observed. ConclusionIn this pilot study, we have assessed the effect of LLLT on serum NSE levels among patients with DPN and showed improved quality of life and decrease in serum NSE levels. These findings should be investigated in larger trials.

Neonatal neuron specific enolase, a sensitive biochemical marker of neuronal damage, is increased in preeclampsia: A retrospective cohort study

BackgroundPreeclampsia leads to chronic intrauterine hypoxia by interfering with placental blood supply. We aimed to investigate whether preeclampsia exposure has an influence on central nervous system of infants, as evaluated by analyzing neonatal serum neuron specific enolase (NSE). MethodsThis was a retrospective study including infants born in Nanfang hospital between Jan 2018 and Feb 2019 without asphyxia. They were divided into normotensive control group and preeclampsia group to compare the NSE levels. Furthermore, PE group was divided into five subgroups by lipstick of urine protein from 0 to 4+ to examine the relationship between urine protein and neonatal NSE. ResultsOf the 86 selected neonates, there were 40 in control group and 46 in preeclampsia group. The NSE levels were significantly higher in infants with preeclampsia exposure compared to those infants in control group (45.504 ± 17.926 vs 30.690 ± 4.475, P < 0.0001). Multiple regression analyses revealed that the preeclampsia (β coef = 0.394, p = 0.041), 4+ proteinuria (β coef = 0.558, p < 0.0001) and 3+ proteinuria (β coef = 0.356, p = 0.005) were significant independent variables predicting elevated serum NSE concentration. ConclusionFor the first time, this research has suggested the increase of neonatal NSE in preeclampsia, and the quantity of maternal proteinuria may be able to predict neonatal NSE elevation. Long-term neurodevelopmental follow-up and targeted preventive strategies are advised for this underrecognized high-risk population.

The effect of obstructive sleep apnea syndrome on serum S100B and NSE levels: a systematic review and meta-analysis of observational studies

BackgroundObstructive sleep apnea syndrome (OSAS) is a common disorder that is accompanied by structural brain changes. This meta-analysis aimed to evaluate the effect of OSAS on the serum levels of astrocytic protein (S100B) and neuron-specific enolase (NSE) in observational studies.MethodsA comprehensive search was performed in the PubMed/Medline, Web of Science, Scopus, ScienceDirect, and Cochrane Library databases to assess the serum level of S100B and/or NSE in patients with OSAS and/or controls. The quality of the study was evaluated by the Newcastle-Ottawa Scale (NOS). A random-effects model was performed using RevMan 5.3 with the mean difference (MD) and 95% confidence intervals (CIs).ResultsOut of 63 studies found in the mentioned databases and one identified by a manual search, nine studies were included and analyzed in this meta-analysis (three cross-sectional and six case-control studies). The analysis showed that the S100B [MD = 53.58 pg/ml, 95%CI: 1.81, 105.35; P = 0.04] and NSE levels [MD = 3.78 ng/ml, 95%CI: 2.07, 5.48; P < 0.0001] were significantly higher in patients than the controls. However, there were no significant differences between the S100B [MD = -28.00 pg/ml, 95%CI: − 79.48, 23.47; P = 0.29] and NSE levels [MD = 0.49 ng/ml, 95%CI: − 0.82, 1.80; P = 0.46].ConclusionsThis meta-analysis found elevated serum S100B and NSE levels in OSAS patients compared to the controls, which suggests that these markers may be used as peripheral indicators of brain damage in OSAS.

Correction of serum NSE reference intervals includes the unidentified hemolysis sample: 1-year data analysis from healthcare individuals.

BackgroundReference intervals (RIs) are important for interpretation of laboratory results. Neuron‐specific enolase (NSE) can be utilized to aid the diagnosis of various tumors. However, while red blood cells contain NSE αγ‐isozymes, unrecognized slight hemolysis will result in increasing of NSE levels in serum. The aim of this study was to correct the NSE RIs from healthcare individuals results which may have unidentified microhemolysis.MethodsA total of 15 047 healthy individuals undergoing regular health care were recruited to redefine the NSE reference interval according to the CA28‐A3 document. Volunteers with NSE level between 16.3 ng/mL and the upper limit of new RIs were performed venipuncture for NSE retest. Simultaneously, serum free hemoglobin (fHb) was performed with o‐tolidine test.ResultsReestablishment of NSE RIs is 0‐18.9 ng/mL, which is wider than 0‐16.3 ng/mL provided by the manufacturer. Seventy‐four volunteers with the NSE level between 16.3 and 18.9 ng/mL were performed venipuncture for NSE retest. The ratio of NSE level drop to normal is 85.1% (63/74) in the subsequent results; there are significant differences between the median NSE of two groups (18.15 vs 14.15 ng/mL). Subsequently, the fHb concentration of 22 healthy individuals from 74 individuals was measured; there are significant differences between the median fHb of two groups (58 vs 30 mg/L).ConclusionsSome specimens with slightly elevated NSE may be attributed to the unrecognized slight hemolysis. The correction RIs may be expected to decrease the abnormal NSE results.

Pro-gastrin-releasing peptide as a marker for the Ewing sarcoma family of tumors

Pro-gastrin-releasing peptide (ProGRP) is an established tumor marker of small cell lung cancer. The purpose of this study was to determine if ProGRP could serve as a tumor marker for the Ewing sarcoma family of tumors (ESFTs). Sixteen patients with ESFTs (mean age 32years) were included in this study. As a control group, 42 patients with other tumor types that clinically or pathologically mimic ESFTs were also analyzed. Pre-treatment serum ProGRP and neuron-specific enolase (NSE) levels, the relationships between these levels, and tumor volume were investigated. In addition, serial changes in the serum or plasma ProGRP (6 patients) and NSE levels (5 patients) were measured over the course of treatment. Pre-treatment serum ProGRP levels were higher than the normal range in 8 of 16 patients; for these eight patients, ProGRP levels positively correlated with tumor volume (R = 0.99). In the control group, ProGRP levels were within the normal range, except for the two patients. Changes in ProGRP levels during treatment were consistent with tumor volume. Serum NSE levels were elevated in 14 of 16 patients with ESFTs and 8 of 42 patients with other tumor types. The range of NSE elevation was much smaller compared to that of ProGRP. Our data indicate that ProGRP is superior to NSE in terms of specificity. Serum ProGRP levels were elevated in half of the patients with ESFTs and reflected therapeutic response. ProGRP is a reliable tumor marker for the diagnosis of ESFTs and evaluation of treatment response.

Relation of Acute Decompensated Heart Failure to Silent Cerebral Infarcts in Patients With Reduced Left Ventricular Ejection Fraction

Heart failure (HF) is a prothrombotic state with increased rate of thromboembolic events. Magnetic resonance imaging studies demonstrated increased rate of silent cerebral infarcts (SCI) in this patient group and SCIs were shown lead to dementia, cognitive decline, and depression. We aimed to show acute decompensated phase is associated with increased rate of recent SCI in reduced ejection fraction HF patients. HF patients with sinus rhythm hospitalized for acute decompensation were studied. Neuron specific enolase (NSE), a sensitive neuronal ischemia marker, was used to detect recent SCI. Decompensated and compensated phase blood samples for NSE were collected on the day of admission and on the third day of compensation, respectively. One hundred and forty seven patients with mean age of 72 were studied. There were significantly more patients with positive NSE levels at decompensated state (29% vs 4%, p <0.001). Multivariate predictors for recent SCI were smoking, new onset atrial fibrillation, spontaneous echo contrast of left ventricle, and aneurysmatic apex. Statin use was found to be protective against NSE elevation. In conclusion, our data reveal that decompensated HF is significantly associated with increased levels of NSE suggestive for silent neuronal injury.

Distribution of serum neuron-specific enolase and the establishment of a population reference interval in healthy adults.

BackgroundNeuron‐specific enolase (NSE) is an important tumor marker in the serum of patients with lung cancer. Elevated serum NSE levels are also associated with many other diseases. However, there is no unified population reference interval for serum NSE. This study aimed to investigate the distribution of serum NSE in healthy Chinese adults aged 20‐79 years and to establish its reference interval in Chinese population.MethodsA total of 10 575 healthy subjects were in line with the requirements of this study. The concentration of serum NSE was detected by a fully automated Cobas e602 analyzer with matching reagents. The population reference interval for serum NSE was established using the unilateral 95th percentile (P 95) according to standard guidelines.ResultsThe distributions of serum NSE were not significantly different between males and females (P > 0.05) and also did not differ by age (P > 0.05). Therefore, the population reference interval for serum NSE was established as upper limit 25.4 ng/mL (90% confidence interval: 24.5‐26.2 ng/mL).ConclusionsWe established the first population reference interval for serum NSE in a large healthy Chinese adult cohort, which was higher than that recommended by Roche Diagnostics GmbH. This new reference interval is more practical and applicable in Chinese adults.

Inhibition of the PI3K/Akt signaling pathway impedes the restoration of neurological function following hypoxic-ischemic brain damage in a neonatal rabbit model.

Hypoxic-ischemic brain damage (HIBD), frequently occurring in infancy and childhood, is a major cause of mortality and severe neurologic impairment. This study was performed to examine the effect of the PI3K/Akt signaling pathway on HIBD in a neonatal rabbit model. Uterine artery occlusion was used to establish HIBD models in neonatal rabbits, which were then subjected to sham operation, dimethyl sulfoxide (2 mL) or LY294002 (inhibitor of PI3K/Akt signaling pathway, 6.4 μg/kg). Behavioral neurological assessment was performed in neonatal rabbits delivered by cesarean section, after which serum neuron-specific enolase (NSE) level and cerebral water content were determined. The level of cleaved caspase-3 level and apoptosis of neurons were observed by immunohistochemistry and terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) staining. Furthermore, the expression of PI3K/Akt signaling pathway- and apoptosis-related factors was examined. In neonatal rabbits, HIBD increased the fetal death rate; reduced neurological scores of posture, righting reflex, and deglutition reflex; elevated serum NSE levels, cerebral water content, cleaved caspase-3-positive expression in hippocampal CA1 region and apoptotic neurons; inactivated PI3K/Akt signaling pathway as well as reduced Bcl-2 expression and increased BAD and Bax expression. Notably, the treatment of LY294002 further aggravated neurological impairment in neonatal rabbits in response to HIBD. Following the HIBD caused by intrauterine asphyxia, the LY294002 administered through auricular vein infusion into pregnant rabbits exacerbates neurological impairment of neonatal rabbits, suggesting that inhibition of PI3K/Akt signaling pathway may serve as a candidate therapeutic target for neurological recovery.

Right Lung Consolidation Combined Elevated Serum Neuron Specific Enolase Misdiagnosed as Lung Carcinoma Ultimately Confirmed Pulmonary Cryptococcosis by CT-guided Percutaneous Lung Biopsy: a Case Report and Literature Review

Detection of serum neuron specific enolase (NSE) has high sensitivity and specificity in the diagnosis of lung carcinoma, especially in small cell lung carcinoma, but sometimes serum NSE provided limited help. We report a case of a patient with right lung consolidation combined with elevated serum neuron specific enolase which mimicked lung carcinoma and was ultimately confirmed as pulmonary cryptococcosis by CT-guided percutaneous lung biopsy. Chest computed tomography (CT) scan and CT-guided percutaneous lung biopsy were performed for diagnosis and blood tests explored the latent etiology. The chest CT scan showed right lung consolidation and a pulmonary nodule in lingual segment of upper lobe of left (Figure1A - F). Serum cryptococcal antigen was positive. Pathology of CT-guided percutaneous lung biopsy confirmed pulmonary cryptococcosis (Figure 1G - I). Elevated NSE is not a specific index of lung cancer. Serum cryptococcal antigen and CT-guided percutaneous lung biopsy has high specificity in cryptococcal pneumonia.

Prognostic Significance of Neuron-Specific Enolase in Patients with Malignant Lymphoma

[Introduction] Neuron-specific enolase (NSE) is the γ-γ or γ-δ dimer isoenzyme of enolase, an acidic protease that promotes the conversion of β-glycerophosphate into dihydroxyacetone phosphate during glycolysis, is mainly found in mature neurons and cells of neuronal origin. Studies of NSE as a tumor marker have primarily focused on patients with small cell lung cancer and neuroblastoma. NSE is not only a useful marker for disease aggressiveness, but also a prognostic factor. Elevated serum NSE expression has been found in 35% of non-neuroendocrine tumors, such as non-small cell lung carcinoma, breast cancer, and multiple myeloma. However, few reports have indicated whether serum NSE levels influence the clinical features and prognosis of malignant lymphoma (ML). In this study, we analyzed the serum NSE levels of patients with newly diagnosed ML and investigated their correlation with clinical outcomes.[Methods] We retrospectively analyzed 187 patients with ML diagnosed at our institution between 2011 and 2017. The patients included 109 males and 78 females with a median age of 72 years (range 22-93 years). The histological subtypes were; 93 DLBCL, 42 FL, 9 MALT, 7 MCL, 5 BL, 12 PTCL, 12 HL, and others. The study protocol was approved by the Institutional Review Board of Yokohama Municipal Citizen's Hospital, and it was carried out in accordance with the Declaration of Helsinki.[Results] Median follow-up time was 38 months. The mean serum value of NSE in 187 lymphoma patients was 23.77+/- 36.04 ng/ml. The mean NSE value in 93 DLBCL patients was significantly higher than that in 42 FL patients (26.99+/-27.56 ng/ml versus 13.80+/-6.85 ng/ml, respectively; p=0.003). Among 93 DLBCL patients, the optimal serum NSE cutoff value for predicting 3-year survival was determined by ROC analysis to be 17.1 ng/ml. In DLBCL patients, patients with high serum NSE levels (≥17.1 ng/ml; N=40) had significantly shorter overall survival (OS) than those with low serum NSE levels (<17.1 ng/ml; N=53) (3-year OS, 29.2% versus 70.9%, respectively; p<0.001) (Figure 1). In univariate analysis, parameters having adverse significance for OS were: high serum NSE levels, high serum LDH levels, PS≥2, stage 3-4, and R-IPI poor risk. In multivariate analysis, parameters having independent adverse significance for OS were: high serum NSE levels (≥17.1 ng/ml) (p=0.03, HR 2.04) and PS≥2 (p<0.001, HR 4.82). Among 42 FL patients, patients with high serum NSE levels (N=10) had also shorter OS than those with low serum NSE levels (N=32) (3-year OS, 60.0% versus 85.1%, respectively; p=0.02). The mean NSE value in high-risk FLIPI patients was higher than that in low- or intermediate-risk FLIPI patients (19.36+/-12.02 ng/ml versus 11.89+/-2.44 ng/ml, respectively; p=0.002).[Conclusion] In the present study we demonstrated that serum NSE levels were elevated in patients with various types of lymphoma. In particular, our data proved that a high serum NSE level is an independent prognostic factor for survival in patients with DLBCL. These results suggest that serum NSE levels at diagnosis may have an important role in malignant lymphoma and also may be a useful prognostic biomarker. Since our results are based on a small-sized analysis, further large prospective studies are warranted to verify this conclusion. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Investigation of the infusion solutions of different qualitative composition influence on the dynamics of neuron specific enolase activity in patients with acute ischemic stroke

At the moment, the question remains insufficiently studied what kind of infusion fluids or their combination should be preferred in patients with acute ischemic stroke (AIS) to provide intensive care. Purpose. To investigate the dynamics of neuron-specific enolase (NSE) against the background of the iso-osmolar 0.9 % NaCl solution, colloid iso-osmolar fluid HES 130, colloid hyperosmolar fluid HAES-LX-5 % and hyperosmolar fluid mannitol application in AIS. Materials and methods. The study included 32 patients with AIS. As the studied solutions were used: colloid hyperosmolar HAES-LX-5 % (Gekoton), colloid iso-osmolar hydroxyethyl crystal 6 % 130/04 (HES 130), hyperosmolar mannitol 15 %, and iso-osmolar 0.9 % NaCl. The control group consisted of patients receiving only 0.9 % NaCl, the comparison groups – the patients receiving 0.9 % NaCl + HES 130 or 0.9 % NaCl + HAES-LX-5 %, or 0.9 % NaCl + mannitol. NSE activity was used as a marker of cerebral ischemia at the corresponding time (the 1st, 4th and 7th days). Results. An increase in NSE (P < 0.05) was observed in the 0.9 % NaCl group at the 7th day of stroke. A similar dynamics of NSE elevation was in the group with mannitol (P < 0.05), as well as in the control group. A 17.3 % decrease in the NSE activity was noted in the application of HES 130 at the end of observation relative to the 1st day. The NSE activity decreased by 34.6 % (P < 0.05) on the 7th day in comparison with the 1st day in the HAES-LX-5 % group and was significantly less than in the control group, groups of HES 130 and mannitol – on average 2.88 times and 30.3 %, 39.8 %, respectively. Conclusions . The use of 0.9 % NaCl or 0.9 % NaCl + mannitol within 7 days in patients with AIS in addition to basic therapy was accompanied by an increase in NSE. Infusion of 0.9 % NaCl + HES 130 or 0.9 % NaCl + HAES-LX-5 % was accompanied by a decrease in NSE activity at the 7th day of treatment, herewith the HAES-LX-5 % group showed the best dynamics of NSE activity decreasing (P < 0.05).

Serial measurement of S100B and NSE in pediatric traumatic brain injury

Increased serum biomakers, such as S100 calcium-binding protein B (S100B) and neuron-specific enolase (NSE), are associated with traumatic brain injury (TBI). The purpose of this study is to investigate the serum levels of S100B and NSE in pediatric TBI patients and to predict a clinical outcome. Peripheral venous blood was collected within 6h of injury and at 1week to measure S100B and NSE. The serum S100B and NSE levels were measured using commercially available enzyme-linked immunosorbent assay kits. The authors divided participants into two groups at admission: a favorable group (patients with Glasgow Coma Scale [GCS] scores of 10-15) and an unfavorable group (patients with GCS scores of less than 9). Both S100B and NSE levels were compared between the two groups at the time of admission and 1week later. Ten pediatric patients were enrolled (5 in the favorable group, 5 in the unfavorable group). The median serum S100B level of 134.21pg/ml (range, 51.00-789.65pg/ml) in patients with TBI at admission dropped to 41.49pg/ml (range, 25.65-260.93pg/ml) after 1week, with significant differences between the traumatic event and 1week later (p = 0.007). The median serum NSE level of 14.76ng/ml (range, 6.48-21.23ng/ml) in patients with TBI at admission was higher than that after 1week (4.96ng/ml, range, 3.01-31.21ng/ml), with significant differences (p = 0.015). A significant difference was observed in S100B after 1week between patients in the favorable and unfavorable groups (p = 0.047). One patient whose serum S100B and NSE levels were elevated 1week after TBI eventually died. Elevated serum S100B and NSE levels in pediatric TBI patients decreased 1week after traumatic events. The serum S100B level 1week after TBI was related to the severity of brain damage. These results indicated that serum S100B and NSE might play a role in predicting the prognosis and monitoring ongoing brain injury in pediatric TBI patients.

Surviving refractory out-of-hospital ventricular fibrillation cardiac arrest: Critical care and extracorporeal membrane oxygenation management

BackgroundResuscitation of refractory out-of-hospital ventricular fibrillation/ventricular tachycardia (VF/VT) cardiac arrest using extracorporeal membrane oxygenation (ECMO) establishes a complex patient population. We aimed to describe the critical care strategies and outcomes in this population. MethodsBetween December 1, 2015 and January 1, 2018, 100 consecutive adult patients with refractory VF/VT out-of-hospital cardiac arrest and ongoing CPR were transported to the cardiac catheterization laboratory. ECMO, coronary angiography, and percutaneous coronary intervention were performed. Patients achieving an organized cardiac rhythm were admitted to the cardiac intensive care unit (CICU). All patients were considered eligible for necessary intervention/surgery until declaration of death. ResultsOf 100 appropriately transported patients, 83 achieved CICU admission. 40/83 (48%) discharged functionally intact. Multi-system organ failure occurred in all patients. Cardiac, pulmonary, renal, and liver injury improved within 3–4 days. Neurologic injury caused death in 26/37 (70%) patients. Poor neurologic outcomes were associated with anoxic injury or cerebral edema on admission head CT, decline in cerebral oximetry over the first 48 h, and elevated neuron specific enolase on CICU admission. For survivors, mean time to ECMO decannulation was 3.5 ± 0.2 days, following commands at 5.7 ± 0.8 days, and hospital discharge at 21 ± 3.2 days. 41/83 (49%) patients developed infections. CPR caused traumatic injury requiring procedural/surgical intervention in 22/83 (27%) patients. ConclusionsMulti-system organ failure is ubiquitous but treatable with adequate hemodynamic support. Neurologic recovery was prolonged requiring delayed prognostication. Immediate 24/7 availability of surgical and medical specialty expertise was required to achieve 48% functionally intact survival.

Elevated neuron-specific enolase in the cerebrospinal fluid in a Japanese black calf with hindlimb paresis

Elevated neuron-specific enolase in the cerebrospinal fluid in a Japanese black calf with hindlimb paresis

Comparison of Frequency of Silent Cerebral Infarction After Coronary Angiography and Stenting With Transradial Versus Transfemoral Approaches

Silent cerebral infarction (SCI) can be seen after coronary procedures. We investigated whether vascular access sites have an impact on the risk of SCI. A total of 255 consecutive patients who underwent diagnostic or interventional coronary procedures through transfemoral (n = 126 patients) or transradial (n = 129 patients) approach were evaluated. Neuron-specific enolase (NSE) levels were studied before and 12 hours after the procedure. Elevation of greater than 12 ng/ml was considered as SCI. Patients were mainly men (60%) with a mean age of 62 years. SCI was observed in 74 of 255 patients (29%). It was significantly more prevalent among transradial group. Elevation of NSE was observed in 36% of transradial group (n = 47) and 21% of the transfemoral group (n = 27) (p = 0.008). Patients with SCI were more likely to have male sexuality, hyperlipidemia, history of smoking, and previous myocardial infarction. Multivariate analysis demonstrated that patients who underwent coronary procedures through transradial approach were 2.1 times more likely to have an SCI than patients with transfemoral approach (95% confidence interval [CI] 1.205 to 3.666; p = 0.008). Other independent predictors of NSE elevation were previous myocardial infarction (odds ratio 8.6; 95% CI 4.209 to 17.572; p <0.001) and smoking history (odds ratio 7.251; 95% CI 3.855 to 13.639; p <0.001). The present study suggests that transradial coronary procedures carry higher risk of SCI when compared with transfemoral route.