Plasma S100B Research Articles

Effects of different anesthetics on recovery of neurological function after intracranial aneurysm embolization

Objective To compare the effects of different anesthetics on the recovery of neurological function after intracranial aneurysm embolization. Methods One hundred patients of both sexes with aneurysmal subarachnoid hemorrhage, aged more than 18 yr, with body mass index of 18.5-24.0 kg/m2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ and WFNS grade Ⅰ-Ⅳ, with the thickness of subarachnoid hemorrhage more than 4 cm, were divided into 2 groups (n=50 each) using a random number table: propofol group (group P) and sevoflurane group (group S). After anesthesia induction, group P received intravenous infusion of propofol 100-300 μg·kg-1·min-1, while the end-tidal sevoflurane concentration was maintained at 1.4%-3.5% in group S. Immediately before induction (T0), immediately after the end of induction (T1), immediately after successful embolization of aneurysm (T2) and at 1, 2, 3 and 5 days after surgery (T3-6), central venous blood samples were collected for determination of plasma neuron-specific enolase and S100β protein concentrations by enzyme-linked immunosorbent assay.The development of postoperative cerebral vasospasm and delayed ischemic neurological deficit was recorded.The patients were followed up, and the Glasgow outcome score and occurrence of newly developed cerebral infarction were recorded within 6 months after surgery. Results There was no significant difference in the concentrations of plasma neuron-specific enolase and S100β protein at each time point, incidence of postoperative cerebral vasospasm and delayed ischemic neurological deficit, or Glasgow outcome score and incidence of newly developed cerebral infarction within 6 months after surgery between two groups (P>0.05). Conclusion Propofol and sevoflurane exert no effect on the recovery of neurological function after intracranial aneurysm embolization. Key words: Anesthetics; Recovery of function; Intracranial aneurysm; Embolization, therapeutic

Effects of ulinastatin on inflammatory response and cognitive function after hip arthroplasty for the elderly patients with femoral neck fracture.

To investigate the effects of ulinastatin on inflammatory response and cognitive function after hip arthroplasty for the elderly patients with femoral neck fracture. A total of 80 patients with femoral neck fracture receiving hip arthroplasty in our hospital from August 2016 to February 2017 were selected and divided into observation group (n=40) and control group (n=40) using a random number table. The control group was treated with hip arthroplasty and symptomatic and supportive treatment after operation, while the observation group was treated with ulinastatin based on the treatment means of control group. The changes in antioxidant capacities, plasma noradrenaline (NA) and adrenaline (A) levels between the two groups before and after intervention were compared. The changes in neuron-specific enolase (NSE) and plasma S-100B protein levels before intervention and at 48 h after intervention were also compared. Moreover, the changes in mini-mental state examination (MMSE) scores during intervention and the Harris hip scores before intervention and at discharge between the two groups were compared. Finally, the off-bed walking time and postoperative discharge time of the two groups were recorded. After intervention, the levels of malondialdehyde (MDA) and superoxide dismutase (SOD) and the total antioxidant capacity in observation group were significantly superior to those in observation group before intervention and control group after intervention (p<0.05). After intervention, the levels of NA and A in observation group were lower than those in control group (p<0.05), and the levels of interleukin-1 (IL-1), tumor necrosis factor-α (TNF-α) and high-sensitivity C-reactive protein (hs-CRP) in observation group were also lower than those in control group (p<0.05). At 48 h after intervention, the levels of NSE and plasma S-100B protein in observation group were significantly lower than those in observation group before intervention and control group at 48 h after intervention (p<0.05). At 12 h, 24 h and 48 h after intervention, the MMSE scores of observation group were superior to those of control group in the same period (p<0.05). After intervention, the Harris hip score of observation group was superior to that of control group before and after intervention (p<0.05). The postoperative discharge time of observation group was earlier than that of control group (p<0.05), and the off-bed walking time was also earlier than that of control group (p<0.05). The combined application of ulinastatin could effectively reduce the oxidative stress and inflammatory response, improve the neurological functions, and promote the postoperative recovery in the elderly patients with femoral neck fracture after hip arthroplasty.

Blood biomarkers in ischemic stroke: Role of biomarkers in differentiation of clinical phenotype

Stroke is the major cause of death and disability worldwide and ischemic stroke contributes 80% among them. Although limited number of patients display hemorrhagic stroke (HS), the disability and death rate are higher in HS. Several studies have been reported on identification of suitable markers for diagnosis of stroke, but none of them holds true worldwide. These observations direct toward identification of population-specific biomarker of stroke. In this study, we screened various blood biomarkers in a large cohort of well-characterized Chinese stroke patients and healthy controls. A total of 308 stroke patients including 262 acute ischemic stroke (AIS) patients and 42 HS patients were enrolled in the study and blood samples were collected within 6–24 h of stroke onset. In addition, 46 stroke mimic subjects were included for comparison of blood markers with stroke patients. Furthermore, healthy controls (n = 200) and patient controls (n = 125) from similar ethnic group were enrolled in the study. Biomarkers (S100 calcium-binding protein B (S100B), C-reactive protein (CRP), interleukin 6 (IL-6), plasminogen activator inhibitor-1 (PAI-1), matrix metallopeptidase 9 (MMP-9), P-selectin, intercellular adhesion molecule 1 (ICAM-1), tumor necrosis factor α (TNF-α), low-density lipoprotein (LDL) cholesterol, interleukin 10 (IL-10), nitric oxide (NO), and glial fibrillary acidic protein (GFAP)) were quantified by ELISA. Blood levels of S100B, CRP, IL-6, PAI-1, MMP-9, P-selectin, ICAM-1, and TNF-α were significantly higher in AIS and HS patients compared to healthy controls, patient controls, and stroke mimic patients. Receiver operating characteristic (ROC) curve analysis revealed CRP, IL-6, PAI-1, P-selectin, and TNF-α as possible biomarkers for AIS patients, and HS patients can be diagnosed based on S100B, IL-6, PAI-1, MMP-9, and TNF-α. Interestingly, significant area under ROC curves were observed for plasma S100B and CRP for differentiating AIS from HS. The results of this study validated certain blood parameters used for diagnosis of AIS or HS in Chinese patients. Furthermore, S100B and CRP are promising biomarkers for differentiation of AIS from HS.

Effects of puerarin combined with conventional therapy on ischemic stroke.

This study evaluated the use of conventional therapy combined with puerarin on ischemic stroke. Eighty patients with ischemic stroke admitted to Tangshan Gongren Hospital from March 2014 to September 2015 were randomly divided into two groups. The control group was treated with conventional therapy. The observation group was treated with an additional puerarin injection of 400 mg/day. The patients in both groups were examined for clinical neurological signs and symptoms. The levels of biochemical markers as well as changes in hemorheology were measured after the intervention and compared among the groups. Our results indicate that the language expression was significantly better in the observation group after the intervention (p<0.05). Additionally, the aphasia quotient was higher (p<0.05), the neurological deficit score was lower (p<0.05), and the functional ability score was higher (p<0.05). The plasma S-100B and NSE levels were lower (p<0.05), the whole blood viscosity and plasma viscosity were lower (p<0.05), and the levels of corticotropin-releasing hormone, corticotropin, cortisol, adrenaline and norepinephrine were lower (p<0.05). Our findings led to the conclusion that the use of puerarin can effectively improve the language function, reduce neurological damage, reduce blood viscosity, reduce stress response and improve quality of life.

Increase of plasma S100B and neuron-specific enolase in children following adenotonsillectomy: a prospective clinical trial.

S100B protein and neuron-specific enolase (NSE) can be considered the markers of cerebral injury. To our knowledge the association of general anesthesia for elective non-cardiac surgery in children with these markers has not been studied before. The goalof this study was to find out whether these markers change after adenotonsillectomy with general anesthesia. The secondary goal was to determine whether different types of anesthesia, gender, age and body mass index are associated with the change of S100B and NSE after adenotonsillectomy with general anesthesia. This study was designed as a prospective clinical trial. We did a simple pre-post experiment with no control group. In 59 children (aged 6-13, ASA I-II) undergoing adenotonsillectomy and randomized to TIVA or inhalational general anesthesia, plasma S100B and NSE were measured during anesthesia before and after the surgery which lasted a median (interquartile range) of 16.5 (13.0-20.0)min. S100B and NSE assays were performed using the electrochemiluminescence immunoassay. Significance of the differences was assessed by two-tailed asymptotic Wilcoxon signed rank test. Main outcome measures were differences in the levels of S100B and NSE before and after the general anesthesia and surgery. There were significant increases in S100B and NSE levels after the surgery. S100B was increased by 38% (P<0.001) and NSE was increased by 10% (P<0.001). Increase of S100B was significantly negatively associated with age (P=0.023). We have not found significant association of S100B and NSE with any other of the monitored variables. The values of neurological biomarkers S100B and NSE were significantly increased after general anesthesia for elective adenotonsillectomy in children.

RECAST (Remote Ischemic Conditioning After Stroke Trial): A Pilot Randomized Placebo Controlled Phase II Trial in Acute Ischemic Stroke.

Repeated episodes of limb ischemia and reperfusion (remote ischemic conditioning [RIC]) may improve outcome after acute stroke. We performed a pilot blinded placebo-controlled trial in patients with acute ischemic stroke, randomized 1:1 to receive 4 cycles of RIC within 24 hours of ictus. The primary outcome was tolerability and feasibility. Secondary outcomes included safety, clinical efficacy (day 90), putative biomarkers (pre- and post-intervention, day 4), and exploratory hemodynamic measures. Twenty-six patients (13 RIC and 13 sham) were recruited 15.8 hours (SD 6.2) post-onset, age 76.2 years (SD 10.5), blood pressure 159/83 mm Hg (SD 25/11), and National Institutes of Health Stroke Scale (NIHSS) score 5 (interquartile range, 3.75-9.25). RIC was well tolerated with 49 out of 52 cycles completed in full. Three patients experienced vascular events in the sham group: 2 ischemic strokes and 2 myocardial infarcts versus none in the RIC group (P=0.076, log-rank test). Compared with sham, there was a significant decrease in day 90 NIHSS score in the RIC group, median NIHSS score 1 (interquartile range, 0.5-5) versus 3 (interquartile range, 2-9.5; P=0.04); RIC augmented plasma HSP27 (heat shock protein 27; P<0.05, repeated 2-way ANOVA) and phosphorylated HSP27 (P<0.001) but not plasma S100-β, matrix metalloproteinase-9, endocannabinoids, or arterial compliance. RIC after acute stroke is well tolerated and appears safe and feasible. RIC may improve neurological outcome, and protective mechanisms may be mediated through HSP27. A larger trial is warranted. URL: http://www.isrctn.com. Unique identifier: ISRCTN86672015.

Subconcussive Impact-Dependent Increase in Plasma S100β Levels in Collegiate Football Players.

The current study investigates whether repetitive subconcussive impacts cause changes in plasma S100β levels, and also tests the associations between S100β changes and frequency/magnitude of impacts sustained. This prospective study of 22 Division-I collegiate football players included baseline and pre-season practices (one helmet-only and four full-gear). Blood samples were obtained and assessed for S100β levels at baseline and pre- to post-practices; symptom scores were assessed at each time-point. An accelerometer-embedded mouthguard was employed to measure the number of impacts (hits), peak linear acceleration (PLA), and peak rotational acceleration (PRA). Because we observed a distinct gap in impact exposure (hits, PLA, and PRA), players were clustered into lower (n = 7) or higher (n = 15) impact groups based on the sum of impact kinematics from all five practices. S100β levels significantly changed across the study duration. Although S100β levels remained stable from baseline to all pre-practice values, statistically significant acute increases in S100β levels were observed in all post-practice measures compared with the respective pre-practice values (range: 133-246% in the overall sample). Greater number of hits, sum of PLA, and sum of PRA were significantly associated with greater acute increases in S100β levels. There were significant differences in head impact kinematics between lower and higher impact groups (hits, 6 vs. 43 [Mlower - Mhigher = 35, p < 0.001]; PLA, 99.4 vs. 1148.5 g [Mlower - Mhigher = 1049.1, p < 0.001]; PRA, 7589 vs. 68,259 rad/s2 [Mlower - Mhigher = 60,670, p < 0.001]). Players in the higher impact group showed consistently greater increases in plasma S100β levels, but not symptom scores, at each post-practice than the lower impact group. Collectively, these data suggest that although players continued to play without noticeable change in symptoms, a brain-enriched serological factor suggests an acute burden from head impacts. Assessing the effects of repetitive subconcussive head impacts on acute changes in S100β levels may be a clinically useful blood biomarker in tracking real-time acute brain damage in collegiate football players.

Elevated Plasma S100B, Psychotic Symptoms, and Cognition in Schizophrenia.

S100B is a calcium binding protein mainly produced by glial cells. Previous studies have shown elevated levels of S100B in patients with schizophrenia. We measured S100B levels in fasting plasma of 39 patients with schizophrenia and 19 adult healthy controls. We used linear regression to compare S100B between patients and controls. In patients only, we also investigated the relationship between S100B levels and psychotic symptoms (assessed by the Positive and Negative Syndrome Scale), and cognitive function (assessed by the NIH Toolbox Cognition Battery), respectively by calculating Pearson's correlation coefficients. Mean plasma S100B was significantly higher in the patient group than in the control group. There were no significant correlations between plasma S100B and psychotic symptoms or cognition.

Safety and Efficacy of Remote Ischemic Preconditioning in Patients With Severe Carotid Artery Stenosis Before Carotid Artery Stenting

Background: Remote ischemic preconditioning (RIPC) can inhibit recurrent ischemic events effectively in patients with acute or chronic cerebral ischemia. However, it is still unclear whether RIPC can impede ischemic injury after carotid artery stenting (CAS) in patients with severe carotid artery stenosis. Methods: Subjects with severe carotid artery stenosis were recruited in this randomized controlled study, and assigned to RIPC, sham, and no intervention (control) groups. All subjects received standard medical therapy. Subjects in the RIPC and sham groups underwent RIPC and sham RIPC twice daily, respectively, for 2 weeks before CAS. Plasma neuron-specific enolase and S-100B were used to evaluate safety, hypersensitive C-reactive protein, and new ischemic diffusion-weighted imaging lesions were used to determine treatment efficacy. The primary outcomes were the presence of ≥1 newly ischemic brain lesions on diffusion-weighted imaging within 48 hours after stenting and clinical events within 6 months after stenting. Results: We randomly assigned 189 subjects in this study (63 subjects in each group). Both RIPC and sham RIPC procedures were well tolerated and completed with high compliance (98.41% and 95.24%, respectively). Neither plasma neuron-specific enolase levels nor S-100B levels changed significantly before and after treatment. No severe adverse event was attributed to RIPC and sham RIPC procedures. The incidence of new diffusion-weighted imaging lesions in the RIPC group (15.87%) was significantly lower than in the sham group (36.51%; relative risk, 0.44; 96% confidence interval, 0.20–0.91; P &lt;0.01) and the control group (41.27%; relative risk, 0.39; 96% confidence interval, 0.21–0.82; P &lt;0.01). The volumes of lesions were smaller in the RIPC group than in the control and sham groups ( P &lt;0.01 each). Ischemic events that occurred after CAS were 1 transient ischemic attack in the RIPC group, 2 strokes in the control group, and 2 strokes and 1 transient ischemic attack in the sham group, but these results were not significantly different among the 3 groups ( P =0.597). Conclusions: RIPC is safe in patients undergoing CAS, which may be able to decrease ischemic brain injury secondary to CAS. However, the mechanisms and effects of RIPC on clinical outcomes in this cohort of patients need further investigation. Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT01654666

Effect of propofol, sevoflurane, and isoflurane on postoperative cognitive dysfunction following laparoscopic cholecystectomy in elderly patients: A randomized controlled trial

Study objectiveTo compare the incidence of postoperative cognitive dysfunction (POCD) in elderly surgical patients (>60years) receiving different anesthetics (propofol, sevoflurane, or isoflurane) and to identify potential biomarkers of POCD in this patient population. DesignProspective, randomized, double-blind clinical trial. SettingUniversity-affiliated teaching hospital. PatientsOne hundred and fifty elderly patients scheduled for laparoscopic cholecystectomy. InterventionsElderly patients undergoing laparoscopic cholecystectomy were randomly assigned to receive propofol, sevoflurane, or isoflurane anesthesia. Measurements: Cognitive function was assessed using neuropsychological tests at baseline (1day before surgery [D0]), and on postoperative day 1 (D1) and day 3 (D3). Plasma S-100β and Aβ1–40 protein, IL-1β, IL-6 and TNF-α concentrations were assessed before induction of anesthesia (T0), after extubation (T1), and 1h (T2) and 24h (T3) postoperatively. Main resultsThe incidence of POCD was significantly lower in the propofol group compared to the isoflurane group and the sevoflurane group at D1 and D3 (propofol vs. isoflurane: D1 and D3, P<0.001; propofol vs. sevoflurane: D1, P=0.012; D3, P=0.013). The incidence of POCD was significantly lower in the sevoflurane group compared to the isoflurane group at D1 (P=0.041), but not at D3. Postoperatively, plasma S-100β and Aβ1–40 protein, IL-1β, IL-6, and TNF-α concentrations were significantly decreased in the propofol group compared to the isoflurane group. ConclusionsPropofol anesthesia may be an option for elderly surgical patients.

Smegenų pažeidimo žymenų (S100B ir NSE) kitimas naujagimių ir kūdikių perioperaciniu laikotarpiu

Tikslas. Įvertinti perioperacinio laikotarpio įtaką smegenų ląstelių pažeidimą atspindinčių baltymų S100B ir NSE koncentracijos kitimui kraujo plazmoje prieš operaciją ir po jos naujagimiams ir kūdikiams bei nustatyti šių baltymų ryšį su operacijos metu stebėtu smegenų įsotinimu deguonimi (rSO2c). Darbo metodika. Perspektyvusis, stebimasis, klinikinis tyrimas. Įtraukti 46 naujagimiai ir kūdikiai iki 3 mėn. amžiaus, kuriems atliktos išplėstinės pilvo, dubens ar krūtinės organų operacijos. Tiriamiesiems atlikta standartinė bendrinė anestezija, taikant įprastinę stebėseną. Smegenų įsotinimas deguonimi stebėtas visos operacijos metu. S100B ir NSE žymenų koncentracijai kraujo plazmoje nustatyti buvo imamas kraujas prieš operaciją ir 24 val. po operacijos. Buvo apskaičiuotas skirtumas tarp pradinės žymens reikšmės ir 24 val. po operacijos ir išreikštas procentais nuo pradinės reikšmės (delta S100B%, delta NSE%). Rezultatai. Tyrimo metu buvo analizuojami 46 naujagimiai ir kūdikiai. Po 24 valandų po operacijos S100B žymuo padidėjo 10 (21,7%), NSE 11 (23,9%) operuotų pacientų. Rasta vidutinė tiesinė koreliacija tarp abiejų tiriamų biožymenų, r=0,5, p=0,002, tarp delta S100B% ir rSO2c r=0,42, p=0,004, delta S100B% ir vidurinio arterinio spaudimo (VAS) r=-0,3, p=0,04, rSO2c koreliavo su VAS r=0,3, p=0,037. Negauta statistiškai reikšmingo ryšio tarp smegenų pažeidimo žymenų didėjimo ir nepageidaujamų neurologinių pažaidų nustatytų neurosonografijos metu. Išvados. Pirmąją parą po operacijos didžiajai daugumai pacientų reikšmingo CNS ląstelių pažeidimo ar kraujo-smegenų barjero pralaidumo padidėjimo nebuvo. Pacientams, kuriems galimai galėjo būti smegenų audinio hiperoksija, stebėtas S100B padidėjimas. Svarbus perioperacinis faktorius, galintis turėti įtakos naujagimių ir kūdikių smegenų įsotinimui deguonimi ir smegenų pažeidimo žymenų didėjimui, yra arterinis kraujo spaudimas.

Higher Plasma S100B Concentrations in Schizophrenia Patients, and Dependently Associated with Inflammatory Markers.

Glial damage and immune dysfunction are involved in pathogenesis of schizophrenia. However, interaction between glial damage and immune dysfunction in schizophrenia is undefined. This study aims to compare plasma S100 calcium binding protein (S100B) levels between schizophrenia patients and healthy participants, and to determine if immune markers are independently related with concentration of S100B in schizophrenia patients. Forty-one schizophrenia patients and thirty-three healthy volunteers were enrolled. Enzyme-linked immunosorbent assay (ELISA) was used to assess the concentrations of plasma S100B and inflammatory markers. We found that concentrations of S100B were elevated in schizophrenia patients than healthy participants (p < 0.05), and were negatively related with the severity of symptoms (p = 0.046). Receiver operating characteristic (ROC) curve analysis showed that different S100B levels between schizophrenia and healthy participants can be used as a clinical diagnostic factor (predictive value: 0.666, p = 0.015). Multiple linear regression analysis found that length of illness (Beta = −0.161), plasma levels of inflammatory regulation factors (including TGF-β1, logIL-23 and logIL-10) (Beta = 0.119, 0.475, 0.514) were independently associated with concentrations of S100B (Adjusted R2 = 0.897, p < 0.001). Therefore, our results suggest the possible function of S100B in pathogenesis of schizophrenia, and implicate the important role of autoimmune response and balance to glial dysfunction in patients with schizophrenia.

Comparison of effects of propofol- and sevoflurane-based anesthesia on postoperative cognitive dysfunction in elderly patients undergoing cardiac valve operation under cardiopulmonary bypass

Objective To compare the effects of propofol- and sevoflurane-based anesthesia on postoperative cognitive dysfunction in elderly patients undergoing cardiac valve operation under cardiopulmonary bypass(CPB). Methods Eighty patients of both sexes, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, aged 65-72 yr, weighing 60-80 kg, scheduled for elective cardiac valve operation under CPB, were randomly divided into 2 groups(n=40 each)using a random number table: propofol-based anesthesia group(group P)and sevoflurane-based anesthesia group(group S). In group P, propofol was given by target-controlled infusion with the target plasma concentration of 0.5-2.0 μg/ml to maintain anesthesia.In group S, 0.5%-2.5% sevoflurane was inhaled for maintenance of anesthesia.Immediately after induction of anesthesia, at the end of operation, and at 6, 12 and 24 h after operation, blood samples were taken from the superior vena cava for determination of plasma matrix metalloproteinase-9, S100β protein and neuron-specific enolase concentrations.Cognitive function was assessed at 1 day before operation, and at 3, 7 and 30 days after operation. Results Compared with group P, the plasma matrix metalloproteinase-9, S100β protein and neuron-specific enolase concentrations at the end of operation and at 6 h after operation and incidence of postoperative cognitive dysfunction were significantly increased in group S(P<0.05). Conclusion Propofol-based anesthesia provides better cerebral protection than sevoflurane-based anesthesia, and the development of postoperative cognitive dysfunction is decreased in elderly patients undergoing cardiac valve operation under CPB. Key words: Propofol; Anesthetics, inhalation; Cardiopulmonary bypass; Heart valve prosthesis; Cognition disorders; Aged

S100β as a biomarker for differential diagnosis of intracerebral hemorrhage and ischemic stroke

Objective: To explore the efficacy of S100 calcium-binding protein B (S100β) in differentiating between intracerebral hemorrhage (ICH) and ischemic stroke (IS).Methods: From June 2014 to July 2015, 46 ICH and 71 IS patients who had undergone computed tomography (CT) scans were enrolled. Patients’ neurological deficits were evaluated by the National Institutes of Health stroke scale (NIHSS), and the modified Rankin scale (mRS) was used to assess functional disability 90 days after discharge. Plasma S100β was measured from a blood sample drawn upon arrival at the emergency department.Results: The plasma S100β concentration in the ICH group was significantly higher than in the IS group (p < 0.001). There were only significant correlations between S100β and hemorrhage volume (r = 0.820, p < 0.001), NIHSS score (r = 0.389, p = 0.008), and mRS (r = 0.732, p < 0.001) in the ICH group. Furthermore, receiver-operating characteristic (ROC) curve analysis revealed that an S100β concentration of 67 pg/ml yielded an area under the curve (AUC) of 0.903 with 95.7% sensitivity and 70.4% specificity in differentiating between ICH and IS. In the ICH group, the plasma S100β concentration was significantly elevated in patients with poor functional outcome vs. those with favorable functional outcome (p < 0.001). ROC curve analysis showed that an S100β concentration of 133 pg/ml yielded an AUC of 0.924 with 100% sensitivity and 76.2% specificity in identifying ICH patients with poor functional outcome.Conclusion: S100β could serve as a potential biomarker for differentiating between ICH and IS and predicting short-term functional outcome after ICH.

Re-exposure to the hypobaric hypoxic brain injury of high altitude: plasma S100B levels and the possible effect of acclimatisation on blood-brain barrier dysfunction.

Hypobaric hypoxic brain injury results in elevated peripheral S100B levels which may relate to blood–brain barrier (BBB) dysfunction. A period of acclimatisation or dexamethasone prevents altitude-related illnesses and this may involve attenuation of BBB compromise. We hypothesised that both treatments would diminish the S100B response (a measure of BBB dysfunction) on re-ascent to the hypobaric hypoxia of high altitude, in comparison to an identical ascent completed 48 h earlier by the same group. Twelve healthy volunteers, six of which were prescribed dexamethasone, ascended Mt Fuji (summit 3700 m) and serial plasma S100B levels measured. The S100B values reduced from a baseline 0.183 µg/l (95 % CI 0.083–0.283) to 0.145 µg/l (95 % CI 0.088–0.202) at high altitude for the dexamethasone group (n = 6) and from 0.147 µg/l (95 % CI 0.022–0.272) to 0.133 µg/l (95 % CI 0.085–0.182) for the non-treated group (n = 6) [not statistically significant (p = 0.43 and p = 0.82) for the treated and non-treated groups respectively]. [These results contrasted with the statistically significant increase during the first ascent, S100B increasing from 0.108 µg/l (95 % CI 0.092–0.125) to 0.216 µg/l (95 % CI 0.165–0.267) at high altitude]. In conclusion, an increase in plasma S100B was not observed in the second ascent and this may relate to the effect of acclimatisation (or hypoxic pre-conditioning) on the BBB. An exercise stimulated elevation of plasma S100B levels was also not observed during the second ascent. The small sample size and wide confidence intervals, however, precludes any statistically significant conclusions and a larger study would be required to confirm these findings.

Isoflurane Post-Treatment Improves Outcome after an Embolic Stroke in Rabbits.

Application of commonly used volatile anesthetics after brain ischemia onset (post-treatment) provides neuroprotection in rodents. To further test its translational potential, this study was designed to determine whether isoflurane post-treatment induced neuroprotection in rabbits after embolic stroke. White male New Zealand rabbits received intra-carotid injection of clots when they were awake. Some rabbits were exposed to 2.5% isoflurane for 1 h at 5 min after the injection. Isoflurane post-treatment increased the tolerance of rabbits to the amount of clots. Isoflurane post-treatment also reduced brain infarct volumes and plasma S100B 3 days after the injection of 5 mg clots and improved neurological deficit scores after the stroke. Isoflurane post-treatment improves neurological outcome in rabbits after embolic stroke.

Postoperative cognitive dysfunction after inhalational anesthesia in elderly patients undergoing major surgery: the influence of anesthetic technique, cerebral injury and systemic inflammation.

BackgroundElderly patients are reportedly at higher risk of postoperative cognitive dysfunction (POCD) after inhalational anesthesia with sevoflurane. We hypothesized that the incidence of POCD would be higher in elderly patients undergoing major surgery under inhalational rather than intravenous anesthesia. We also measured plasma S-100β protein concentration as a biomarker of central nervous system injury, and plasma interleukin (IL)-6 and tumor necrosis factor (TNF)-α concentrations to judge the contribution of systemic inflammation to POCD.MethodsNinety patients aged 65–75 years scheduled for resection of an esophageal carcinoma were randomly assigned to one of three groups (n = 30) as follows: a group receiving sevoflurane anesthesia (Group S); a group receiving preoperative methylprednisolone before sevoflurane anesthesia (Group S + MP); and a control group maintained with intravenous propofol (Group C). The mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) were used to measure patients’ cognitive function the day before surgery, and on the first, third and seventh postoperative days. The plasma concentrations of TNF-α, IL-6 and S-100β protein were measured 10 min before anesthesia, and on the first, third and seventh postoperative days.ResultsThere were no significant differences in the demographic or clinical characteristics, or perioperative hemodynamic status, of the three groups. The MMSE and MoCA scores were significantly lower in Group S than in the propofol control (Group C) and Group S + MP on the first, third and seventh postoperative days (P <0.05). Throughout the first postoperative week the plasma concentrations of TNF-α, IL-6, and S-100β protein were significantly elevated in Group S compared with Group C (P <0.05), but were significantly lower in Group S + MP than Group S (P <0.05).ConclusionsThe incidence of POCD was higher in elderly patients undergoing major surgery under inhalational anesthesia with sevoflurane than those maintained on intravenous propofol, and lower in elderly patients pro-treating with methylprednisolone. Furthermore, we found elevated plasma concentrations of S-100β protein, TNF-α and IL-6 in those receiving sevoflurane anesthesia.Trial registrationChiCTR-IOR-15007007 (02-09-2015).

Effects of ulinastatin on cognitive function in patients with coronary artery bypass grafting

To investigate the effects of ulinastatin(UTI) on postoperative cognitive function in patients undergoing coronary artery bypass grafting. One hundred and twenty-seven patients undergoing elective coronary artery bypass surgery were randomly divided into three groups:high-dose UTI group(16000 U/kg i.v.), low-dose UTI group(8000 U/kg i.v.) and control group(normal saline). The levels of plasma cortisol were measured before and one day after surgery. The level of IL-6, IL-10, TNF-α and S100β were measured before operation(T0), at open chest(T1), end of operation(T2), 6 h(T3)and 24 h(T4) after operation. A neuropsychological test scale was to evaluate the cognitive function 1 day before operation, 1 week and 3 months after operation. Ninety-three patients completed the study. There was no significant difference in general information of patients among three groups(P>0.05). The level of plasma cortisol one day after operation was significantly higher than that before operation in control group(P<0.01). The levels of plasma cortisol in high-dose UTI group and low-dose UTI group were lower than that of control group(P<0.01). In all groups, the level of plasma IL-6, IL-10, TNF-α and S100B increased remarkably at T2, T3, T4 compared to those at T0(all P<0.05). The level of plasma IL-6, TNF-α(at T2, T3, T4)and S100β(at T3)in high-dose UTI group and low-dose UTI group were all lower than those of control group(P<0.05),while there were no significant differences between high-dose UTI group and low-dose UTI group(P>0.05). The incidence of postoperative cognitive dysfunction in POCD 1 week after operation in high-dose UTI and low-dose UTI groups(25.8% and 23.3%)was lower than that in control group(50.0%), while there were no significant difference 1 month after operation between high-dose UTI group(12.9%) or low-dose UTI group(16.7%)and control group(28.1%). The level of plasma S100β at T2 of POCD patients(n=31)was higher than that of non-POCD group(n=62)(P<0.05). Ulinastatin can reduce the incidence of postoperative cognitive dusfunction 1 week after coronary artery bypass surgery, which might be associated with inhibition of inflammation and S100β expression.

Cerebral protective effect of propofol versus sevoflurane combined with sufentanil anesthesia in patients undergoing valvular surgery under cardiopulmonary bypass

Objective To compare the cerebral protective effect of propofol and sevoflurane combined with sufentanil anesthesia in the patients undergoing valvular surgery under cardiopulmonary bypass(CPB). Methods Sixty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients, aged 60-70 yr, scheduled for elective valvular surgery under CPB, were randomly divided into either propofol-based anesthesia group(group PA)or sevoflurane-based anesthesia group(group SA), with 30 patients in each group.From induction of anesthesia to the end of surgery, group P received target-controlled infusion of propofol 0.5-2.0 μg/ml, and group S continuously inhaled 0.5%-2.5% sevoflurane.Bispectral index value was maintained at 45-55.Immediately after induction(T0), at the end of surgery(T1), and at 6, 12 and 24 h after surgery(T2-4), the superior vena cava was retrogradely cannulated for blood sampling, and the concentrations of plasma S-100β protein and neuron-specific enzyme were determined using enzyme-linked immunosorbent assay. Results Compared with group SA, the plasma S-100β concentrations at T1, 2 and neuron-specific enzyme concentrations at T1-3 were significantly decreased in group PA. Conclusion The cerebral protective effect of propofol combined with sufentanil anesthesia is superior to that of sevoflurane combined with sufentanil anesthesia in the patients undergoing valvular surgery under CPB. Key words: Propofol; Sufentanil; Anesthetics, inhalation; Cardiopulmonary bypass; Brain injuries

The Severity of Cecal Ligature and Puncture-Induced Sepsis Correlates with the Degree of Encephalopathy, but the Sepsis Does Not Lead to Acute Activation of Spleen Lymphocytes in Mice

Septic encephalopathy represents the most frequently observed form of encephalopathy in intensive care units. Interactions between the immune and nervous systems have been observed in experimental sepsis. Therefore, the aim of the current study was to characterize the effect of different severities of sepsis on encephalopathy and the inflammatory profile of the spleen. We hypothesized that different grades of sepsis severity would lead to variations in encephalopathy and activation of spleen cells. We induced sepsis of different severities in Balb/c mice by cecal ligature and puncture (CLP). Six and 12h after CLP induction, behavioral impairment was assessed by the SmithKline/Harwell/Imperial College/Royal Hospital/Phenotype Assessment (SHIRPA) test. The animals were then killed, and the plasma, spleen, and hippocampus were removed. Levels of the encephalopathy marker S100β were measured in plasma. Spleens were weighed and then a characterization of splenic lymphocytes was performed by flow cytometry (cytotoxic T lymphocyte, T helper lymphocytes, B lymphocytes, T regulatory cells, and Th17 cells). Cytokine levels in the spleen and hippocampus were determined by enzyme-linked immunosorbent assay (ELISA), and cytokine levels in plasma were performed with MilliPlex® technology. Our results showed that behavioral impairment as measured by the SHIRPA test and elevation in plasma S100β levels were significant in moderate and severe CLP groups compared to those in the sham control group. Regarding immunological alterations, we were unable to observe changes in the weights of the spleen and the profile of lymphocytes 6h after CLP. However, several cytokines, including IL-6, IL-10, and IL-1β, were increased in spleen and plasma. In conclusion, we observed variations in encephalopathy as measured by plasma S100β, which were mediated by the severity of sepsis; however, we did not observe a different activation of spleen cells 6h post-CLP, despite evidence of inflammation. Taken together, our data indicate that the severity of sepsis impacts the brain in absence of a change in the spleen lymphocyte profile.