Neuron-specific Enolase In Group Research Articles

Clinical Observation of Hemodynamic and Cerebral Protective Effects of Different Doses of Dexmedetomidine in Patients with Traumatic Brain Injury

Background: Patients with craniocerebral trauma may suffer ischemic brain injury and neurological dysfunction due to immune inflammation and neuroendocrine reactions. Dexmedetomidine (Dex) is one of the commonly used anesthetic drugs in clinic. Studies have shown Dex has the function of protecting brain nerves and inhibiting inflammation. However, there are few studies on the effects of different doses of dexmedetomidine on patients undergoing surgery. The purpose of this study is to observe the effects of different doses of Dex on hemodynamics and brain protection in patients undergoing brain trauma surgery. Materials and Methods: Eighty patients with craniocerebral trauma surgery were randomly divided into study group (group A, n = 40) and control group (group B, n = 40) by random number table method. Dex pump volume was 0.5 μg/kg/h in group A and 1.0 μg/kg/h in group B. Heart rate (HR) and mean arterial pressure (MAP) were recorded before anesthesia induction (T0), immediately after endotracheal intubation (T1) and at the end of operation (T2). The serum levels of central nervous system specific protein (S-100β) and neuron specific enolase (NSE) were measured and compared between the two groups at T0 and T2. Results: HR and MAP in group A were significantly higher than those in group B at T2, and the difference was statistically significant (P P β and NSE in both groups at T2 were lower than those at T0, and the concentrations of S-100β and NSE in group A were significantly lower than those in group B at T2 (P < 0.05). Conclusions: 0.5 μg/kg dose of Dex is stable in hemodynamics and has a better protective effect on brain function in patients with traumatic brain injury.

Abstract 205: Vadilation Of Neuron-specific Enolase In Cardiac Arrest Patients And Association Factors For Neurological Outcomes In The Subgroup Of Negative Neuron-specific Enolase

Aim: Neuron-specific enolase (NSE) alone has limitations in prognostication in cardiac arrest survivors, like other tools. To avoid early withdrawal of life-sustaining therapy, we verified the prognostic performance according to the reference value of NSE and investigated the variables related to the neurological outcomes in the patients with negative NSE. Methods: We performed a retrospective analysis of data from adult cardiac arrest survivors who underwent targeted temperature management at a university-affiliated hospital between January 2014 and December 2020. We measured the NSE level 48 hr after the return of spontaneous circulation. We performed receiver operating characteristics (ROC) and used the reference value of NSE (&lt; 17 μg/L), the Youden index indicated NSE, and European Resuscitation Council (ERC) suggested NSE value (&lt; 60 μg/L) as a threshold. We performed a multivariable logistic regression analysis to investigate the independent factors associated with true negative versus false negative for NSE cutoff. The primary outcome was 6-month neurological outcomes with Cerebral Performance Category (CPC), dichotomized into good (CPC 1 or 2) or poor (CPC 3-5) neurologic outcomes. Results: Of the 522 included patients, 355 (68.0%) patients had poor neurological outcomes. The area under ROC of NSE was 0.887 (95% confidence intervals [CIs], 0.856-0.913; p &lt; 0.001) with Youden index value of 35.6 μg/L. Analyses with specific cutoff values of 17 μg/L, 35.6 μg/L, and 60 μg/L showed a sensitivity of 86.8%, 72.4%, and 58.0% with a specificity of 66.5%, 93.4%, and 98.8%, respectively. In the patients with NSE &lt; 60 μg/L, younger age (odd ratio [OR], 0.954 [95% CIs, 0.934-0.976]), witness of collapse (OR, 3.520 [95% CIs, 1.625-7.626]) shockable rhythm (OR, 5.953 [95% CIs, 2.879-12.308]), cardiac etiology (OR, 2.796 [95% CIs, 1.444-5.416]), and lower sequential organ failure assessment (SOFA) (OR, 0.823 [95% CIs, 0.744-0.912]) were independently associated with true negative group rather than false negative group. Conclusions: NSE &lt; 60 μg/L had less than 2% false-positive rate. Younger age, a witness of collapse, shockable rhythm, cardiac etiology, and lower SOFA were associated with good neurological outcomes in the negative NSE group.

Diagnostic Value of Imaging Combined With Tumor Markers in Early Detection of Lung Cancer.

Objective: The objective of this research is to explore the diagnostic value of imaging plus tumor markers in the early detection of lung cancer.Methods: Sixty patients with lung cancer treated in our hospital from January 2018 to January 2019 were selected as group A. They were matched with 60 patients with benign lung disease as group B and 60 healthy subjects examined in our hospital as group C. The carcino-embryonic antigen (CEA), CYFRA21-1, and neuron-specific enolase (NSE) were assessed, and the diagnostic value of tumor markers plus imaging in lung cancer diagnosis was explored.Results: The CEA, CYFRA21-1, and NSE in group A were evidently superior to those in groups B and C, and those in group B were superior to those in group C (all P < 0.001). CEA had the highest sensitivity (56.7%), and NSE had the highest specificity (93.3%). The tumor markers plus imaging had the highest sensitivity for different types of lung cancer, and the sensitivity to early lung cancer (90%) was superior to other diagnostic methods (P < 0.05).Conclusion: The tumor markers plus imaging is of great significance in early lung cancer diagnosis and provides a reference for judging the pathological classification.

Comparison of the accuracy of predicting prognosis of brain function in patients after cardiopulmonary cerebral resuscitation with two kinds of electroencephalogram techniques combined with neuron-specific enolase

Objective: To compare the accuracy of electroencephalography (EEG) grading or amplitude-integrated electroencephalography (aEEG) grading combined with NSE in predicting brain function prognosis after cardiopulmonary cerebral resuscitation (CPR) in adults. Methods: The patients who were admitted to Fujian Medical University Union Hospital after CPR from January 2015 to June 2019 were enrolled. Demographic data, Glasgow coma scale (GCS), blood neuron specific enolase (NSE), EEG grading and aEEG grading were collected. The main clinical outcome was the prognosis of brain function (Glasgow-Pittsburgh cerebral performance category, CPC) in patients at 3 months after CPR. Accordingly, the patients were divided into two groups: favorable prognosis group and poor prognosis group, and relevant parameters were compared between the two groups. The predictive ability of EEG grading or aEEG grading combined with NSE for brain function prognosis was evaluated by receiver operating characteristic (ROC) curve. Results: A total of 57 patients were enrolled, with 34 males and 23 females. The average age was (65±19) years old. In terms of Young EEG scales, there was 16 grade 1 cases (28.1%), 24 grade 2-5 cases (42.1%) and 17 grade 6 cases (29.8%), respectively. As for aEEG grading, there was 11 grade Ⅰ cases (19.3%), 25 grade Ⅱ cases (43.9%) and 21 grade Ⅲ cases (36.8%), respectively. There was no significant difference of age, sex, length of stay between the two groups (all P>0.05). However, there was significant difference of EEG grading scale, aEEG grading, GCS grading and NSE between the two groups (all P<0.05). The area under curve (AUC) of NSE, EEG grading and aEEG grading for predicting brain function prognosis was 0.81, 0.82 and 0.85, respectively (all P<0.01). In aEEG grading combined with NSE group, the AUC of was 0.92, and the optimal cut-off point was 4.5, with a sensitivity of 95.8% and a specificity of 79.0%. In EEG grading combined with NSE group, the AUC was 0.90, and the optimal cut-off point was 3.6, with a sensitivity of 92.1% and a specificity of 77.0%. Conclusions: aEEG grading combined with NSE is more accurate in predicting prognosis in patients with cardiopulmonary cerebral resuscitation when compared to EEG grading. Considering its feasibility, aEEG grading combined with NSE is more suitable for clinical application.

Effects of oxycodone applied for patient-controlled analgesia on postoperative cognitive function in elderly patients undergoing total hip arthroplasty: a randomized controlled clinical trial.

Postoperative cognitive dysfunction (POCD) is a common complication after orthopedic surgery, which is not conducive to the prognosis of the elderly. We performed this study to investigate the effects of oxycodone applied for patient-controlled intravenous analgesia (PCIA)on postoperative cognitive function in elderly patients after total hip arthroplasty (THA). Ninety-nine participants were enrolled and allocated into two groups: oxycodone group (group O) and sufentanil group (group S). The primary outcome wasthe incidence of POCD, diagnosed according to the changes in the Mini-mental status examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores. The secondary outcomes included the plasma levels of S-100B protein and neuron-specific enolase (NSE), the amount of postoperative analgesic consumption and the incidence of adverse reactions. The incidence of POCD was significantly lower in patients receiving oxycodone up to the 3rd postoperative day (POD, 1st POD 27.3% vs. 51.1%, P = 0.021; 3rd POD 20.5% vs. 40.0%, P = 0.045), as compared to patients receiving sufentanil. The MMSE and MoCA scores of both groups decreased to varying degrees. However, compared with group S, the MMSE scores at 1st POD, 3rd POD, 5th POD and 7st POD in group O were higher than that in group S, while MoCA scores at 1st POD, 3rd POD and 5th POD in group O were higher. Compared with group S, the plasma levels of S-100B protein in group O at 4h, 8h, 12h post-surgery were lower. While the plasma levels of NSE in group O at 4h, 8h, 12h, 24h post-surgery were lower. Number of PCIA boluses and consumption of analgesic drug during the first two POD were similar between two groups. However, postoperative incidence of nausea, vomiting and pruritus was significantly lower in patients receiving oxycodone. Oxycodone applied for PCIA in elderly patients after THA could reduce the incidence of POCD, improve postoperative cognitive function and decrease the adverse reactions.

Effects of different modes of ventilation of lung on operated side on early postoperative cognitive function in elderly patients undergoing radical surgery for esophageal carcinoma

Objective To evaluate the effects of different modes of ventilation of lung on operated side on early postoperative cognitive function in elderly patients undergoing radical surgery for esophageal carcinoma. Methods Seventy-two ASA Ⅰ or Ⅱ elderly patients of both sexes, aged 65-80 y, weighing 45-85 kg, scheduled for elective radical resection for esophageal cancer and were randomly divided into 3 groups (n=24) using a random number table: group A, group B and group C. After induction of anesthesia, the patients were intubated with double-lumen tube and one-lung ventilation was performed. During one-lung ventilation, the lung on the operated side was collapsed naturally in group A, positive pressure ventilation (fresh gas flow 2 L/min) was applied in the lung on the operated side in group B, and high-frequency jet ventilation (frequency 100 bpm, driving pressure 0.5 kg/cm2) was used in the lung on the operated side in group C. The blood samples were obtained before induction (T0), at the end of operation (T1), on 6 h (T2), 12 h (T3) and 24 h (T4) after operation for determination of plasma concentration of S100β protein, neuron-specific enolase (NSE), IL-6 and TNF-α. The Mini-Mental State Examination(MMSE) was used to test the cognitive function of the patients at T0, T4, 3 d (T5) and 7 d after operation (T6). Results Compared with the baseline value at T0, the plasma concentrations of IL-6, TNF-α, S100β protein and NSE in group A and group B were increased at T1-T4, the plasma concentrations of IL-6, TNF-α, S100β protein and NSE in group C were increased at T1-T3, the MMSE score in group A were decreased at T4-T6, the MMSE score in group B and group C were decreased at T4-T5(P<0.05). Compared with group A, the plasma concentrations of IL-6, TNF-α, S100β protein and NSE in group B and group C were decreased at T1-T4, the MMSE score in group B and group C were increased at T4-T6(P<0.05). Compared with group B, the plasma concentrations of IL-6, TNF-α, S100β protein and NSE in group C were decreased at T1-T4, the MMSE score in group C were increased at T4-T5(P<0.05). Conclusions Continuous positive ventilation and high-frequency jet ventilation of lung on operated side both can effectively improve early postoperative cognitive function, and the efficacy of high-frequency jet ventilation is better. Key words: Continuous positive airway pressure; High-frequency jet ventilation; Aged; Cognitive disorder

The study for induction and differentiation of rat’s adipose-derived stem cells by valproic acid in vitro

Objective To study the inducting differentiation effects of the vaproic acid (VPA) on rats adipose derived stem cells (ADSCs) in vitro. Methods From November, 2016 to October, 2017, the ADSCs were isolated from 2 healthy 3-weeks-old Sprague-Dawley (SD) rats and cultured to passage 3, which were treated with 10 ng/ml bFGF for 24 hours before induction. Then the induction media contained the VPA with different concentrations: group B (0.5 mmol/L, 200 μl) VPA; group C (1.0 mmol/L, 200 μl) VPA; group D (10 mmol/L, 200 μl) VPA, and D-Hank was used in group A as blank control group. The morphological changes of the cells were observed every day. At 7 days of induction, the gene expressions of neuron-specific enolase (NSE), nestin (NES), and S-100 were detected by real-time fluorescent quantitative PCR. The S-100 protein expression was tested by immunofluorescence staining. Significance of difference was determined using independent t test. Probabilities lower than 5% (P < 0.05) were considered statistically significant. Results At 4 days after induction, some ADSCs of groups B, C, and D showed the morphology of Schwann-like cells or neuron-like cells, the change of group C was more obvious; and the ADSCs of group A had no obvious change, which still present spindle. The S-100 immunofluorescence staining showed higher ratio of positive expression in groups B, C, and D (more obvious in group C) and lower ratio of positive expression in groups A and D (more obvious in group A). The gene expression of S-100 showed dose-dependent increases in groups C, which was significantly higher than that of groups A, B, and D (P 0.05). The gene expression of NSE showed the same tendency as S-100, which reached the peak in group C; the gene expression of NSE in group C was significantly higher than that of groups A, B, and D (P 0.05). Conclusion ADSCs can be induced to differentiate into Schwann-like cells or neuron-like cells under the treatment of VPA, and 1.0 mmol/L is the optimal concentration. Key words: Adipose-derived stem cells; Schwann cells; Valproic acid; Induction and differentiation

Neuron-specific enolase correlates with other prognostic markers after cardiac arrest

Therapeutic hypothermia (TH) is a recommended treatment for survivors of cardiac arrest. Prognostication is complicated since sedation and muscle relaxation are used and established indicators of a poor prognosis are lacking. This prospective, observational study describes the pattern of commonly used prognostic markers in a hypothermia-treated cohort of cardiac arrest patients with prolonged coma. Among 111 consecutive patients, 19 died, 58 recovered, and 34 were in coma 3 days after normothermia (4.5 days after cardiac arrest), defined as prolonged coma. All patients were monitored with continuous amplitude-integrated EEG and repeated samples of neuron-specific enolase (NSE) were collected. In patients with prolonged coma, somatosensory evoked potentials (SSEP) and brain MRI were performed. A postmortem brain investigation was undertaken in patients who died. Six of the 17 patients (35%) with NSE levels <33 μg/L at 48 hours regained the capacity to obey verbal commands. By contrast, all 17 patients with NSE levels >33 failed to recover consciousness. In the >33 NSE group, all 10 studied with MRI had extensive brain injury on diffusion-weighted images, 12/16 lacked cortical responses on SSEP, and all 6 who underwent autopsy had extensive severe histologic damage. NSE levels also correlated with EEG pattern, but less uniformly, since 11/17 with NSE <33 had an electrographic status epilepticus (ESE), only one of whom recovered. A continuous EEG pattern correlated to NSE <33 and awakening. NSE correlates well with other markers of ischemic brain injury. In patients with no other signs of brain injury, postanoxic ESE may explain a poor outcome.

Neuron specific enolase and S-100B as predictors of outcome after cardiac arrest and induced hypothermia

Aim To assess the prognostic value of repetitive serum samples of neuron specific enolase (NSE) and S-100B in cardiac arrest patients treated with hypothermia. Methods In a three-centre study, comatose patients after cardiac arrest were treated with hypothermia at 33 °C for 24 h, regardless of cause or the initial rhythm. Serum samples were collected at 2, 24, 48 and 72 h after the arrest and analysed for NSE and S-100B in a non-blinded way. The cerebral performance categories scale (CPC) was used as the outcome measure; a best CPC of 1–2 during 6 months was regarded as a good outcome, a best CPC of 3–5 a poor outcome. Results One centre was omitted in the NSE analysis due to missing 24 and 48 h samples. Two partially overlapping groups were studied, the NSE group ( n = 102) and the S-100B group ( n = 107). NSE at 48 h >28 μg/l (specificity 100%, sensitivity 67%) and S-100B >0.51 μg/l at 24 h (specificity 96%, sensitivity 62%) correlated with a poor outcome, and so did a rise in NSE of >2 μg/l between 24 and 48 h (odds ratio 9.8, CI 3.5–27.7). A majority of missing samples ( n = 123) were from the 2 h sampling time ( n = 56) due to referral from other hospitals or inter-hospital transfer. Conclusion NSE was a better marker than S-100B for predicting outcome after cardiac arrest and induced hypothermia. NSE above 28 μg/l at 48 h and a rise in NSE of more than 2 μg/l between 24 and 48 h were markers for a poor outcome.

Glial and neuronal serum markers after controlled cortical impact injury in the rat.

The aim of this study was to investigate the time course and the correlation of glial fibrillary acidic protein (GFAP), protein S-100B, and neuron specific enolase (NSE) serum levels to the severity of traumatic brain injury in rats. Male Wistar rats (n = 65 S-100B, NSE group and n = 55 GFAP group) underwent a severe cortical impact injury (100PSI, 2 mm deformation). Blood samples were drawn directly after trauma, 1 h, 6 h, 12 h, 24 h, and 48 h post trauma as well as in sham operated animals directly after craniotomy, after 6 h and 48 h. Serum levels at different severities were estimated in 20 rats (45PSI, 75PSI, 2 mm deformation). We found a time-dependent release of NSE and GFAP into serum after trauma. The highest NSE values were detected six hours after trauma (31.5 micrograms/l, mean, p < 0.0001), the highest GFAP levels were measured one hour after trauma (0.079 microgram/l, mean, p < 0.0014). Additionally we found a close relationship between NSE serum levels and the severity of traumatic brain injury (45PSI = 12.7 micrograms/l, 75PSI = 16.17 micrograms/l, 100PSI = 28.45 micrograms/l, p < 0.05). S-100B serum levels showed an increase (0.92 microgram/l, p < 0.005) but no time-dependent release. S-100B and GFAP showed no relationship to trauma severity. Serum levels of GFAP, S-100B and NSE are significantly elevated in the early phase after experimental traumatic brain injury. In this experimental model of cortical impact injury only NSE, but not GFAP and S-100B serum levels are time-dependently correlated with the severity of cortical impact.