S100B Levels Research Articles

Effects of conventional nursing in the operating room combined with transcutaneous electrical acupoint stimulation on postoperative cognitive dysfunction after total knee arthroplasty in elderly patients

BackgroundTo observe the effects of conventional theatre nursing combined with transcutaneous electrical acupoint stimulation (TEAS) on postoperative cognitive dysfunction (POCD) in elderly total knee arthroplasty (TKA) patients.MethodsForty elderly TKA patients were randomly divided into a conventional nursing (control) group and a TEAS group. Using conventional nursing, TEAS was used to stimulate the “Zusanli” and “Sanyinjiao” in the healthy leg of patients in the TEAS group. All patients received mini-mental (MMSE) scores 1 day before surgery (T0) and 1, 3, and 7 days after surgery (T1, T3, T7). Plasma levels of interleukin-1 (IL-1β), interleukin-6 (IL-6), tumor necrosis factor (TNF-α), and S100β were measured using venous blood samples.ResultsThere were no significant differences in baseline clinical characteristics between the two groups. Compared to T0, the MMSE scores of patients in the control group were significantly reduced at T1 and T3 (P < 0.05). Compared to the control group, the MMSE scores of patients in the TEAS group increased significantly at T3 (P < 0.05). The incidence of POCD in the TEAS group was 10%, lower than in the control group (40%) (P < 0.05). The levels of IL-1β, IL-6, TNF-α and S-100β in patients in the TEAS group were lower than in the control group on days T1, T3 and T7 (P < 0.05).ConclusionConventional intraoperative nursing combined with TEAS can reduce the incidence of POCD. The possible mechanism is related to the reduction of inflammatory response and neuronal injury with TEAS.Clinical registration number: ChiCTR2300070281.

S-100β level is closely associated with myocardial work in patients with acute ischemic stroke

BackgroundThe more severe the acute stroke is, the more serious myocardial damage is. This study aimed to determine the relationship between myocardial work and S100β, a quantitative biomarker of active cerebral lesions, in patients with acute ischemic stroke (AIS). MethodsA total of 63 patients with AIS were examined by myocardial work echocardiography, 4D echocardiography with the measurement of left ventricular (LV) myocardial work, volume and function within 24-48 h of symptom onset, respectively. Their plasma S100β was measured from a peripheral blood sample within 2-6 h of symptom onset. ResultsPatients with elevated S-100β level had significantly increased ratios of peak early diastolic transmitral filling velocity to peak early diastolic lateral mitral annulus tissue velocity(E/e’) and global longitudinal strain (GLS), and significantly reduced global work index(GWI) and global constructive work (GCW) compared with those with normal S-100β level (p < 0.05). S-100β positively correlated with E/e’(r = 0.878, p < 0.0001) and GLS (r = 0.511, p = 0.002) but negatively correlated with GWI(r = −0.409, p = 0.034) and GCW(r = −0.353, p = 0.041). S-100β showed an excellent ability to differentiate if a reduced GWI [cut-off value, 120.79 pg/mL; area under receiver operating characteristic curve (AUC), 1.000; sensitivity, 100%; specificity, 100%], GCW (cut-off value, 120.79 pg/mL;AUC,1.000; sensitivity,100%; specificity, 100%) and an increased E/e’ (cut-off value, 91.1 pg/mL;AUC,0.913; sensitivity,80%; specificity, 100%) or not, but poor ability to differentiate if an increased GLS(cut-off value, 91.1 pg/mL; AUC,0.576; sensitivity,63.64%; specificity, 83.33%) or not. ConclusionS-100β level is closely associated with LV function. It is highly competent in determining an impaired myocardial work in patients with AIS.

Predicting Short- and Long-Term Functional Outcomes Based on Serum S100B Protein Levels in Patients with Ischemic Stroke.

Ischemic stroke is one of the leading causes of mortality and disability. The neuroimaging methods are the gold standard for diagnostics. Biomarkers of cerebral ischemia are considered to be potentially helpful in the determination of the etiology and prognosis of patients with ischemic stroke. This study aimed to investigate the usefulness of serum S100B protein levels as a short- and long-term prognostic factor in patients with ischemic stroke. The study group comprised 65 patients with ischemic stroke. S100B protein levels were measured by immunoenzymatic assay. Short-term functional outcome was determined by the NIHSS score on day 1 and the difference in the NIHSS scores between day 1 and day 9 (delta NIHSS). Long-term outcome was assessed by the modified Rankin Scale (MRS) at 3 months after the stroke. At the end of the study, patients were divided into groups based on the NIHSS score on day 9 (0-8 "good" and >8 "poor"), the delta NIHSS ("no improvement" ≤0 and >0 "improvement"), and the MRS ("good" 0-2 and >2 "poor"). Differences in S100B levels between groups were analyzed with the ROC curve to establish the optimal cut-off point for S100B. The odds ratio was calculated to determine the strength of association. Correlations between S100B levels at three time points and these variables were evaluated. We revealed a statistically significant correlation between S100B levels at each measurement point (<24 h, 24-48 H, 48-72 h) and the NIHSS score on day 9 (R Spearman 0.534, 0.631, and 0.517, respectively) and the MRS score after 3 months (R Spearman 0.620, 0.657, and 0.617, respectively). No statistically significant correlation was found between S100B levels and the delta NIHSS. Analysis of the ROC curve confirmed a high sensitivity and specificity for S100B. The calculated AUC for the NIHSS on day 9 were 90.2%, 95.0%, and 82.2%, respectively, and for the MRS, 83.5%, 83.4%, and 84.0%, respectively. After determining the S100B cut-off, the odds ratio for beneficial effect (NIHSS ≤ 8 at day 9 or MRS 0-2 after 3 months) was determined for each sampling point. S100B is a useful marker for predicting short- and long-term functional outcomes in patients with ischemic stroke.

Effect of sevoflurane versus propofol on early cognitive functions in elderly patients after lumbar disc surgery

ABSTRACT Background Post-operative cognitive dysfunction (POCD) is an important issue that is associated with substantial morbidity and increased mortality, especially in elderly patients who have undergone major surgical procedures under general anesthesia. The symptoms of POCD may last for several months after surgery, leading to extended hospital stays, a decline in life quality, an increased need for social assistance, and significant financial strain on the patients. Settings and Design It was a Prospective Randomized interventional study. Methods A total of 120 patients (≥65 years) were divided into two groups of 60 each for this study at Alexandria Main University Hospital and planned for elective lumbar disc surgery under general anesthesia. Either propofol or sevoflurane was used to maintain anesthesia after it was induced. MMSE score, S100β levels and hemodynamic measures were all evaluated. Results Incidence of POCD was not statistically significant different between the two studied groups. There was a statistical significant negative correlation between S100β level and MMSE score in early post-operative period. Conclusion In terms of POCD, both propofol-based and sevoflurane-based anesthesia have the same effects on cognitive functions in early post-operative period.

Biological Markers in Newly Diagnosed Generalized Anxiety Disorder Patients: 8-OHdG, S100B and Oxidative Stress.

Generalized Anxiety Disorder (GAD) is a chronic disease persisting for at least 6 months, characterized by excessive and continuous anxiety, which leads to evident problems and functional disorders. S100B is a glial protein that plays a role in intercellular communication regulating cell growth and differentiation, and intracellular signal transmission. This study aimed to analyze the serum S100B, 8-OHdG, and oxidative stress levels of patients newly diagnosed with GAD who had not started treatment, to better understand the underlying neurobiological basis of the etiology of GAD. Forty-four patients diagnosed with GAD according to DSM-5 diagnostic criteria and 44 healthy controls were included in the study. The Beck Anxiety Inventory (BAI) was used to determine the anxiety levels of the GAD patients. The serum S100B, 8-OHdG, total oxidant status (TOS), and total antioxidant status (TAS) levels were measured in the patient and control groups. The 8-OHdG values of the GAD group were determined to be statistically significantly higher than those of the control group (p=0.028). No significant difference was determined between the GAD patients and the control group in respect of the TAS, TOS, and oxidative stress index (OSI) values (p>0.05). The S100B levels of the GAD group were found to be higher than those of the control group. The results of this study showed that there could be DNA damage because of oxidative stress in GAD patients. There is a need for further studies to confirm the role of S100B protein in GAD etiology and pathogenesis.

Effects of parecoxib on postoperative cognitive dysfunction and serum levels of NSE and S100β in elderly patients undergoing surgery.

To investigate the effects of parecoxib on postoperative cognitive dysfunction, and serum levels of neuron-specific enolase (NSE) and S100β protein (S100β) in elderly patients undergoing surgery. The retrospective cohort study method was used to collect the clinical data of 94 elderly patients who underwent elective orthopedic and general anesthesia surgery in our hospital from September 2020 to February 2022. 94 patients were divided into the control group (47 cases) and the study group (47 cases), according to different intervention methods. In the study group, 40 mg of parecoxib was injected intravenously into patients 30 min before the induction of anesthesia, and the patients in the control group were given the same dose of normal saline intravenously before the operation. The basic clinical data of the patients were collected. The levels of the indexes before operation and 6 hours after operation were compared between the two groups, including the Montreal Cognitive Scale (MoCA) score, inflammatory factor indicators [tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP), interleukin-10 (IL-10), interleukin-1β (IL-1β), monocyte chemokine-1 (MCP-1), and inducible nitric oxide synthase (iNOS)], serum cortisol (CORT), beta-amyloid (β-AP), adiponectin (ADP), NSE, and S100β. No significant differences in the preoperative MoCA score, TNF-α, IL-6, CRP, IL-10, IL-1β, MCP-1, iNOS, CORT, β-AP, ADP, NSE, and S100β levels were observed between the two groups (p>0.05). The postoperative MoCA score in the study group was significantly higher than that in the control group (p<0.05). The postoperative levels of TNF-α, IL-6, CRP and IL-1β in the study group were significantly lower than those in the control group (p<0.05), and the postoperative levels of IL-10, MCP-1 and iNOS in the study group were significantly higher than those in the control group (p<0.05). Parecoxib can notably inhibit the levels of postoperative inflammatory cytokines, improve neurological dysfunction, and reduce the occurrence of postoperative cognitive dysfunction in patients. The contents of serum NSE and S100β have potential value in the diagnosis of postoperative cognitive dysfunction in elderly patients.

Molecular biomarkers in Electrohypersensitivity and Multiple Chemical Sensitivity: How They Can Help Diagnosis, Follow-Up, and in Etiopathologic Understanding.

Electrohypersensitivty (EHS) and multiple chemical sensitivity (MCS) are new worldwide emerging neurologic disorders in the framework of sensitivity-related environmental pathology. We have recently extended and confirmed our previous observation showing that EHS and MCS share clinically identical symptoms and may co-exist as a unique, common, sensitivity-related neurologic syndrome in 25% of the cases. There is presently no published biological study of these disorders, except the one we have previously published as preliminary. In the present study, we show that EHS and MCS and the combined syndrome share identical biochemical changes. More precisely, by measuring levels of peripheral blood and urine molecular biomarkers in a cohort of 2,018 consecutive cases, we show that both disorders and the combined syndrome can be objectively characterized, in about 90% of the cases, by a decrease in the production of 6-hydroxymelatonin sulfate in urine, while in 30-50% they are characterized by increased levels of histamine and of heat shock proteins (HSP) 27 and/or 70, and of protein S100B and nitrotyrosine in the peripheral blood. Increased levels of histamine and HSP are indicators of low grade inflammation while increased levels of protein S100B and nitrotyrosine are indicators of blood-brain barrier disruption/opening. In addition, we show that in about 15% of the cases anti-myelin autoantibodies can be detected in the peripheral blood, accounting for the occurrence of an autoimmune response. Sensitivity, specificity and reproducibility of the biochemical tests are discussed, as well as the role of these indicators used as biomarkers for the diagnosis and follow-up of patients. We also discuss cases with undetectable biological change for which they can be nevertheless diagnosed by cerebral neurotransmitters analysis in urine and brain imaging. On the basis of these biological data it is suggested that EHS and/or MCS are new brain disorders, generated via a common etiopathogenic mechanism.

Synergistic effects of neuroendoscopic minimally invasive surgery with mannitol and furosemide in managing hypertensive intracerebral hemorrhage

This study aimed to assess the therapeutic efficacy of neuroendoscopic minimally invasive surgery combined with mannitol and furosemide for treating hypertensive intracerebral hemorrhage. We retrospectively analyzed clinical data from 200 patients with hypertensive intracerebral hemorrhage treated at our hospital between July 2020 and July 2022. The patients were categorized into either the experimental group (undergoing neuroendoscopic minimally invasive surgery combined with mannitol and furosemide) or the control group (undergoing neuroendoscopic minimally invasive surgery alone). Then, we compared the efficacy and impact on patients between the two groups. After treatment, the experimental group exhibited a smaller edema area compared to the control group and a reduced hematoma volume (p &lt; 0.001). The total effective rate was significantly higher in the experimental group compared to the control group (p &lt; 0.05). At 7 days post-treatment, patients in the experimental group demonstrated a significantly lower National Institutes of Health Stroke Scale (NIHSS) score compared to the control group (p &lt; 0.001). Additionally, 3 and 7 days after treatment, levels of lipid peroxidation (LPO), neuron-specific enolase (NSE), and S-100β were significantly lower in the experimental group compared to the control group (p &lt; 0.001). Similarly, carotid total blood flow volume (Q) and blood flow velocity (V) were significantly higher in the experimental group at 3 and 7 days post-treatment, with lower peripheral resistance (R) compared to the control group (p &lt; 0.001). The incidence rate of complications was significantly lower in the experimental group compared to the control group (p &lt; 0.05). The integration of neuroendoscopic minimally invasive surgery with mannitol and furosemide administration demonstrates potential in alleviating brain edema, reducing related cytokine levels, facilitating neurological function recovery, and improving cerebral hemodynamic parameters in hypertensive intracerebral hemorrhage patients. These findings merit clinical promotion and application.

Neurodevelopmental outcomes in congenital heart disease: usefulness of biomarkers of brain injury

IntroductionAt present, neurodevelopmental abnormalities are the most frequent type of complication in school-aged children with congenital heart disease (CHD). We analysed the incidence of acute neurologic events (ANEs) in patients with operated CHD and the usefulness of neuromarkers for the prediction of neurodevelopment outcomes. MethodsProspective observational study in infants with a prenatal diagnosis of CHD who underwent cardiac surgery in the first year of life. We assessed the following variables: 1) serum biomarkers of brain injury (S100B, neuron-specific enolase) in cord blood and preoperative blood samples; 2) clinical and laboratory data from the immediate postnatal and perioperative periods; 3) treatments and complications; 4) neurodevelopment (Bayley-III scale) at age 2 years. Resultsthe study included 84 infants with a prenatal diagnosis of CHD who underwent cardiac surgery in the first year of life. Seventeen had univentricular heart, 20 left ventricular outflow obstruction and 10 genetic syndromes. The postoperative mortality was 5.9% (5/84) and 10.7% (9/84) patients experienced ANEs. The mean overall Bayley-III scores were within the normal range, but 31% of patients had abnormal scores in the cognitive, motor or language domains. Patients with genetic syndromes, ANEs and univentricular heart had poorer neurodevelopmental outcomes. Elevation of S100B in the immediate postoperative period was associated with poorer scores. Conclusionschildren with a history of cardiac surgery for CHD in the first year of life are at risk of adverse neurodevelopmental outcomes. Patients with genetic syndromes, ANEs or univentricular heart had poorer outcomes. Postoperative ANEs may contribute to poorer outcomes. Elevation of S100B levels in the postoperative period was associated with poorer neurodevelopmental outcomes at 2 years. Studies with larger samples and longer followups are needed to define the role of these biomarkers of brain injury in the prediction of neurodevelopmental outcomes in patients who undergo surgery for management of CHD.

Dietary Flavonoid Intake and Risk of Mild Cognitive Impairment in the Elderly: A Case-Control Study

Background: This study investigates the association between dietary flavonoid intake and the incidence of mild cognitive impairment (MCI) through a matched case-control design. Methods: Dietary intake was assessed using a food frequency questionnaire, comparing the intake of flavonoids between individuals with MCI and those with normal cognitive function. Logistic regression analysis was employed to evaluate the correlation between dietary flavonoid intake and the risk of MCI. Additionally, blood concentrations of S100β, a marker of the blood-brain barrier (BBB) integrity, were measured using electrochemiluminescence immunoassay, and Pearson correlation analysis was conducted to explore the relationship between dietary flavonoid intake and blood S100β levels. Results: Compared to participants with normal cognition, those with MCI had significantly lower dietary intakes of total flavonoids, isoflavones, daidzein, glycitein, genistein, kaempferol, myricetin, flavonols, and anthocyanidins, while the intake of peonidin was significantly higher. Univariate logistic regression analysis indicated that high dietary intake of total flavonoids, isoflavones, daidzein, glycitein, genistein, kaempferol, myricetin, and flavonols was negatively correlated with MCI, whereas peonidin intake was positively correlated with MCI. Multivariate logistic regression analysis confirmed these findings. Pearson correlation analysis revealed a significant negative correlation between dietary intake of kaempferol and myricetin and blood S100β levels. Conclusion: Increasing the dietary intake of total flavonoids, isoflavones, daidzein, glycitein, genistein, and flavonols appears to be a protective factor against MCI, while higher intake of peonidin is associated with an increased risk of MCI. The protective or adverse effects of these flavonoids may not be related to the permeability of the BBB. Myricetin and kaempferol intake may protect cognitive function by maintaining BBB integrity.

The usefulness of S100ß protein and fractalkin in predicting traumatic brain injury in pediatric patients with minor head trauma

Aims: In this study it was aimed to demonstrate the effectiveness of S100B protein levels which are biomarkers related to central nervous system, and fractalkin levels, which are known to play a role in inflammation processes in prediction trauma induced brain damage. Methods: Patient aged 2 to 18 years who came to the emergency department due to minor head trauma and underwent brain ct were included in our study. It was investigated whether there was a relationship between the two groups, according to the causes of trauma, symptoms at presentation and the level of serum s100b and FCN according to the lesions detected in CCT. Results: The other symptoms including Vomiting, retrograde amnesia, loss of consciousness, confusion, post traumatic amnesia is significantly higher in patients with brain lesions (p&lt;0,05). Patients with lesions on BCT have significantly low Glassgow coma score. (p&lt;0,05). Patients with lesions on BCT have a significantly high S100B and FKN levels. (p&lt;0,05). S100B area under the curve (CUA) 0.700 sensivity is 55%, spesificity is 87.5%. FKN CUA 0,785, sensitivity is 62.5% specifisity is 85%. Conclusions: As a result, the child patients with BCT lesions from minor cranial trauma levels for S100B and FKN levels are significantly higher and can be a criteria for BCT usage in emergency medicine.

Application value of serum S100B combined with glucose metabolism indexes in predicting adverse pregnancy outcomes of patients with severe preeclampsia.

S100 calcium-binding protein B (S100B) and glucose control are reflective of maternal-fetal risks. We investigated the value of serum S100B combined with fasting blood glucose (FBG)/hemoglobin A1c (HbA1c) in evaluating the pregnancy outcomes of patients with severe preeclampsia (SPE). The clinical characteristics of SPE patients/controls were collected. FBG/HbA1c and serum S100B levels were measured, with their correlations analyzed. SPE patients were subdivided into adverse/non-adverse outcome groups based on follow-up results. The value of different indexes in predicting pregnancy outcomes was analyzed. SPE patients showed higher systolic blood pressure, diastolic blood pressure, urine protein, and body mass index and lower platelets, gestational age at delivery, and infant birth weight than healthy controls. FBG and HbA1c were positively correlated with serum S100B. SPE patients with adverse outcomes exhibited increased serum S100B and FBG/HbA1c levels. The area under the curve of serum S100B + FBG/HbA1c in evaluating adverse pregnancy outcomes of SPE patients was 0.8412 (77.05% sensitivity/84.21% specificity), higher than either alone. Serum S100B and FBG/HbA1c were independent risk factors for adverse outcomes of SPE patients. Overall, serum S100B positively-correlates with FBG/HbA1c in SPE patients. Serum S100B and FBG/HbA1c are independent risk factors, and their combination has high value on predicting adverse pregnancy outcomes of SPE patients.

Concordance between the In Vivo Content of Neurospecific Proteins (BDNF, NSE, VILIP-1, S100B) in the Hippocampus and Blood in Patients with Epilepsy.

The identification of reliable brain-specific biomarkers in periphery contributes to better understanding of normal neurophysiology and neuropsychiatric diseases. The neurospecific proteins BDNF, NSE, VILIP-1, and S100B play an important role in the pathogenesis of neuropsychiatric disorders, including epilepsy. This study aimed to assess the correspondence of the expression of BDNF, NSE, VILIP-1, and S100B in the blood (serum and peripheral blood mononuclear cells (PBMCs)) to the in vivo hippocampal levels of subjects with drug-resistant epilepsy who underwent neurosurgery (N = 44) using multiplex solid-phase analysis, ELISA, and immunohistochemical methods, as well as to analyze the correlations and associations of the blood and hippocampal levels of these proteins with clinical parameters. We first studied the concordance between in vivo brain and blood levels of BDNF, NSE, VILIP-1, and S100B in epileptic patients. A positive correlation for NSE between hippocampal and PBMC levels was revealed. NSE levels in PBMCs were also significantly correlated with average seizure duration. BDNF levels in PBMCs were associated with seizure frequency and hippocampal sclerosis. Thus, NSE and BDNF levels in PBMCs may have potential as clinically significant biomarkers. Significant correlations between the levels of the neurospecific proteins studied herein suggest interactions between BDNF, NSE, VILIP-1, and S100B in the pathophysiology of epilepsy.

Combining Biomarkers for the Diagnosis of Metastatic Melanoma.

The early detection of melanoma relapse can improve patient survival; thus, there is a great need for easily accessible biomarkers that facilitate the diagnosis of metastatic disease. We investigated the diagnostic effect of blood biomarkers such as lactate dehydrogenase (LDH), S100B, and osteopontin in the detection of metastases. Clinical data and peripheral blood samples of 206 melanoma patients were collected (no metastasis, N = 120; metastasis, N = 86). The discriminative power of blood biomarkers, patient demographics, and clinicopathological parameters of primary melanomas were evaluated using univariate and multivariate logistic regression models and receiver operating characteristic (ROC) analysis to determine the area under the curve (AUC). Plasma osteopontin levels showed a significant and independent effect on the probability of metastasis, similar to serum S100B levels. In addition, the location of the primary tumor on the lower extremities and the American Joint Committee on Cancer (AJCC) categories pT2b-3a, pT3b-4a, and pT4b were associated with the diagnosis of metastasis. Importantly, the combination of the three blood biomarkers and primary tumor localization and AJCC pT category yielded excellent discrimination (AUC: training set: 0.803; validation set: 0.822). In conclusion, plasma osteopontin can be classified as a melanoma biomarker; moreover, by combining clinicopathological prognostic variables, the diagnostic effect of blood biomarkers in the detection of metastatic melanoma can be improved.

Differential Expression of Circulating Damage-Associated Molecular Patterns in Patients with Coronary Artery Ectasia.

Coronary artery ectasia (CAE) is defined as abnormal dilation of a coronary artery with a diameter exceeding that of adjacent normal arterial segment by >1.5 times. CAE is a pathological entity of the coronary arteries and characterized as a variant of coronary atherosclerosis. CAE frequently coexists with coronary artery disease (CAD). While inflammation appears to be involved, the pathophysiology of CAE remains unclear. Damage-associated molecular patterns (DAMPs), defined as endogenous molecules released from stressed or damaged tissue, are deemed as alarm signals by the innate immune system. Inflammatory agents can generate DAMPs and DAMPs can create a pro-inflammatory state. In a prospective cross-sectional study, we enrolled 29 patients with CAE and non-obstructive CAD, 19 patients with obstructive CAD without CAE, and 14 control subjects with normal (control) coronary arteries age- and sex-matched with the CAE patients, to investigate the differential expression of plasma DAMPs. Patients with CAE and non-obstructive CAD had increased plasma levels of the DAMPs S100B, S100A12, HMGB1, and HSP70, the DAMPs receptor TLR4, and miR328a-3p compared to CAD and controls. Plasma levels of the mir328a-3p target the protective soluble form of the DAMPs receptor for advanced glycation end products (sRAGE), and the antioxidant DJ-1 was decreased in both CAE and CAD compared to controls. In an in vitro human umbilical vein endothelial cells model, circulating levels of S100B, HMGB1, HSP70 as well as CAE patient plasma induced inflammatory responses. The differential expression of the DAMPs S100B, HSP70, HMGB1, and their receptors TLR4 and sRAGE in CAE versus CAD makes them attractive novel biomarkers as therapeutic targets and therapeutics.

Screening Performance of S100 Calcium-Binding Protein B, Glial Fibrillary Acidic Protein, and Ubiquitin C-Terminal Hydrolase L1 for Intracranial Injury Within Six Hours of Injury and Beyond.

The Scandinavian NeuroTrauma Committee (SNC) guidelines recommend S100 calcium-binding protein B (S100B) as a screening tool for early detection of Traumatic brain injury (TBI) in patients presenting with an initial Glasgow Coma Scale (GCS) of 14-15. The objective of the current study was to compare S100B's diagnostic performance within the recommended 6-h window after injury, compared with glial fibrillary acidic protein (GFAP) and UCH-L1. The secondary outcome of interest was the ability of these biomarkers in detecting traumatic intracranial pathology beyond the 6-h mark. The Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) core database (2014-2017) was queried for data pertaining to all TBI patients with an initial GCS of 14-15 who had a blood sample taken within 6 h of injury in which the levels of S100B, GFAP, and UCH-L1 were measured. As a subgroup analysis, data involving patients with blood samples taken within 6-9 h and 9-12 h were analyzed separately for diagnostic ability. The diagnostic ability of these biomarkers for detecting any intracranial injury was evaluated based on the area under the receiver operating characteristic curve (AUC). Each biomarker's sensitivity, specificity, and accuracy were also reported at the cutoff that maximized Youden's index. A total of 531 TBI patients with GCS 14-15 on admission had a blood sample taken within 6 h, of whom 24.9% (n = 132) had radiologically confirmed intracranial injury. The AUCs of GFAP (0.86, 95% confidence interval [CI]: 0.82-0.90) and UCH-L1 (0.81, 95% CI: 0.76-0.85) were statistically significantly higher than that of S100B (0.74, 95% CI: 0.69-0.79) during this time. There was no statistically significant difference in the predictive ability of S100B when sampled within 6 h, 6-9 h, and 9-12 h of injury, as the p values were >0.05 when comparing the AUCs. Overlapping AUC 95% CI suggests no benefit of a combined GFAP and UCH-L1 screening tool over GFAP during the time periods studied [0.87 (0.83-0.90) vs. 0.86 (0.82-0.90) when sampled within 6 h of injury, 0.83 (0.78-0.88) vs. 0.83 (0.78-0.89) within 6 to 9 h and 0.81 (0.73-0.88) vs. 0.79 (0.72-0.87) within 9-12 h]. Targeted analysis of the CENTER-TBI core database, with focus on the patient category for which biomarker testing is recommended by the SNC guidelines, revealed that GFAP and UCH-L1 perform superior to S100B in predicting CT-positive intracranial lesions within 6 h of injury. GFAP continued to exhibit superior predictive ability to S100B during the time periods studied. S100B displayed relatively unaltered screening performance beyond the diagnostic timeline provided by SNC guidelines. These findings suggest the need for a reevaluation of the current SNC TBI guidelines.

Significance of S100B Protein as a Rapid Diagnostic Tool in Emergency Departments for Traumatic Brain Injury Patients.

Traumatic brain injuries (TBIs) are not only the leading cause of death among people below 44 years of age, but also one of the biggest diagnostic challenges in the emergency set up. We believe that the use of serum biomarkers in diagnosis can help to improve patient care in TBI. One of them is the S100B protein, which is currently proposed as a promising diagnostic tool for TBI and its consequences. In our study, we analyzed serum biomarker S100B in 136 patients admitted to the Emergency Department of the Regional Specialist Hospital in Olsztyn. Participants were divided into three groups: patients with head trauma and alcohol intoxication, patients with head trauma with no alcohol intoxication and a control group of patients with no trauma or with injury in locations other than the head. In our study, as compared to the control group, patients with TBI had a significantly higher S100B level (both with and without intoxication). Moreover, in both groups, the mean S100B protein level was significantly higher in patients with pathological changes in CT. According to our study results, the S100B protein is a promising diagnostic tool, and we propose including its evaluation in routine regimens in patients with TBI.

Effect of transcutaneous electrical acupoint stimulation on remifentanil dosage during craniotomy aneurysm clipping: a prospective, randomized controlled study

BackgroundCraniotomy aneurysm clipping is one of the main treatments for intracranial aneurysm (IA). Endotracheal intubation and intraoperative operation may induce dramatic hemodynamic fluctuations and increase the risk of aneurysm rupture. Intraoperative high-dose opioid use is the main measure to reduce the intraoperative stress response, but it increases the incidence of complications such as postoperative vomiting and delayed awakening. Transcutaneous electrical acupoint stimulation (TEAS) stimulates β-endorphin expression levels and reduces opioid requirements. In this study, we aimed to assess the effects of TEAS on remifentanil dosage and oxidative stress (OS) in craniotomy aneurysm clipping.MethodForty-two patients with craniotomy aneurysm clipping were randomized into two groups: the TEAS group (T group) and the sham TEAS group (S group). “Hegu” (LI4), “Neiguan” (PC6) and “Zusanli” points (ST36) were selected, and a “HANS” percutaneous acupoint electrical stimulator was used for intervention 30 min before anesthesia induction until the end of the operation. The primary outcome was intraoperative remifentanil dosage. The secondary outcomes were intraoperative propofol dosage, mean arterial pressure (MAP) and heart rate (HR) 5 min before the TEAS intervention (T0), 5 min before head holder pinning (T1), immediately after pinning (T2), 5 min before craniotomy (T3), immediately after craniotomy (T4), at craniotomy (T5), and at the end of surgery (T6), as well as serum β-endorphin levels at T1, T2 and T6 and neuron-specific enolase (NSE), S100β, superoxide dismutase (SOD) and malondialdehyde (MDA) levels at T1, T2 and 24 h after surgery (T7).ResultsThe dosage of remifentanil in the T group was reduced compared to that in the S group (P < 0.05). At T2, T4 and T5, the MAP and HR in the T group were lower than those in the S group (P < 0.05). At T2 and T7, the levels of NSE, S100β and MDA in group T were lower than those in group S (P < 0.05), while the SOD levels in group T were higher than those in group S (P < 0.05).ConclusionsThe use of TEAS can reduce the dosage of remifentanil and reduce hemodynamic fluctuations during craniotomy aneurysm clipping. It reduces the occurrence of OS and central nervous system damage during surgery and has a certain brain protective effect.Trial registrationChiCTR2100052353. https://www.chictr.org.cn/about.html.

The role of oxidative stress levels and S100B levels in children with functional neurological disorder

Background/Aim: Although stressors and traumatic life events are known to be predisposing factors for developing functional neurological disorder (FND), the etiology of the disorder has not been fully elucidated. In this study, oxidative stress parameters and serum levels of S100B protein were investigated in pediatric patients with functional neurological disorder. The association of these parameters with stress factors and traumatic life events was investigated. Methods: This case-control study included a control group of 35 patients aged 8-18 years and 32 healthy subjects diagnosed with functional neurological disorder. The Childhood Trauma Scale and Dissociative Experiences Scale were applied to both groups. Serum levels of the patient and control groups were compared by blood sampling: total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), and S100B. Results: It was found that the Childhood Trauma Scale total score, emotional neglect, emotional abuse, physical neglect and the Dissociative Experiences Scale were statistically significantly higher in the FND group than in the control group (P˂0.001, P˂0.001, P=0.013, P=0.017, P˂0.001). Stressors were found to be statistically significantly higher in the FND group than in the control group (P=0.020). There was no statistical difference between the FND group and control groups regarding the TAS, TOS, OSI, and S100B levels (P=0.965, P=0.228, P=0.268, P=0.517, respectively). Conclusion: Our study is the first to investigate TOS, TAS, OSI and S100B in children with FND. In our study, although stressors and traumatic experiences were significantly higher in the functional neurological disorder group compared to the control group according to the stress susceptibility model, contrary to expectations, there was no significant difference in oxidative stress parameters and serum S100B levels. It was thought that the interaction between FND, which is characterized by biopsychosocial interaction and can manifest itself with various clinical symptoms, and stress may not be linear as initially thought, and the interaction between genetic predisposition and environmental factors may play a more complex role. The absence of significant differences observed in oxidative stress parameters and serum S100B levels may suggest that we should focus on different pathways and different potential biomarkers that need to be investigated in the future to understand the etiology and diagnosis of FND. However, the limitations noted above may affect the generalizability of the study findings.

Neurodesarrollo a los 2 años en cardiopatía congénita: utilidad pronóstica de los marcadores de daño cerebral

IntroductionAt present, neurodevelopmental abnormalities are the most frequent type of complication in school-aged children with congenital heart disease (CHD). We analysed the incidence of acute neurologic events (ANEs) in patients with operated CHD and the usefulness of neuromarkers for the prediction of neurodevelopment outcomes. MethodsProspective observational study in infants with a prenatal diagnosis of CHD who underwent cardiac surgery in the first year of life. We assessed the following variables: (1) serum biomarkers of brain injury (S100B, neuron-specific enolase) in cord blood and preoperative blood samples; (2) clinical and laboratory data from the immediate postnatal and perioperative periods; (3) treatments and complications; (4) neurodevelopment (Bayley-III scale) at age 2 years. ResultsThe study included 84 infants with a prenatal diagnosis of CHD who underwent cardiac surgery in the first year of life. Seventeen had univentricular heart, 20 left ventricular outflow obstruction and 10 genetic syndromes. The postoperative mortality was 5.9% (5/84) and 10.7% (9/84) patients experienced ANEs. The mean overall Bayley-III scores were within the normal range, but 31% of patients had abnormal scores in the cognitive, motor or language domains. Patients with genetic syndromes, ANEs and univentricular heart had poorer neurodevelopmental outcomes. Elevation of S100B in the immediate postoperative period was associated with poorer scores. ConclusionsChildren with a history of cardiac surgery for CHD in the first year of life are at risk of adverse neurodevelopmental outcomes. Patients with genetic syndromes, ANEs or univentricular heart had poorer outcomes. Postoperative ANEs may contribute to poorer outcomes. Elevation of S100B levels in the postoperative period was associated with poorer neurodevelopmental outcomes at 2 years. Studies with larger samples and longer followups are needed to define the role of these biomarkers of brain injury in the prediction of neurodevelopmental outcomes in patients who undergo surgery for management of CHD.