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1.
Medicine (Baltimore) ; 100(15): e25446, 2021 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-33847649

RESUMO

ABSTRACT: To investigate whether plasma concentrations of S100ß protein, neuron-specific enolase (NSE), and neuroglobin (NGB) correlate with early postoperative cognitive dysfunction (POCD) in patients undergoing total arch replacement.This prospective study analyzed 40 patients who underwent total arch replacement combined with stented elephant trunk implantation at our hospital between March 2017 and January 2019. Cognitive function was assessed using the Mini-mental State Examination (MMSE) preoperatively, on the day after extubation and on day 7 after surgery. Plasma levels of S100ß, NSE, and NGB POCD were assayed preoperatively and at 1, 6, and 24 hours after cardiopulmonary bypass. POCD was defined as a decrease of at least 1 unit in the MMSE score from before surgery until day 7, and patients were stratified into those who experienced POCD or not. The 2 groups were compared in clinicodemographic characteristics and plasma levels of the 3 proteins.Plasma levels of all 3 biomarkers increased significantly during and after cardiopulmonary bypass. Levels of S100ß and NSE, but not NGB, were significantly higher in the 15 patients who showed POCD than in the remainder who did not. For prediction of early POCD, S100ß showed an area under the receiver operating characteristic curve (AUC) of 0.71 (95% confidence interval [CI] 0.55-0.87), sensitivity of 48%, and specificity of 87%. The corresponding values for NSE were 0.77 (95%CI 0.60-0.94), 92%, and 67%. Together, S100ß and NSE showed an AUC of 0.81 (95%CI 0.66-0.96), sensitivity of 73%, and specificity of 80%. NGB did not significantly predict early POCD (AUC 0.62, 95%CI 0.43-0.80).Plasma S100ß protein and NSE, but not NGB, may help predict early POCD after total arch replacement.


Assuntos
Ponte Cardiopulmonar/efeitos adversos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Neuroglobina/sangue , Fosfopiruvato Hidratase/sangue , Complicações Cognitivas Pós-Operatórias/etiologia , Subunidade beta da Proteína Ligante de Cálcio S100/sangue , Biomarcadores/sangue , Feminino , Humanos , Masculino , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Projetos Piloto , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Sensibilidade e Especificidade
2.
PLoS One ; 16(1): e0245210, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33411836

RESUMO

BACKGROUND: Neuron-specific enolase (NSE) and S-100b have been used to assess neurological damage following out-of-hospital cardiac arrest (OHCA). Cut-offs were derived from small normothermic cohorts. Whether similar cut-offs apply to patients treated with hypothermia remained undetermined. METHODS: We investigated 251 patients with OHCA treated with hypothermia but without routine prognostication. Neuromarkers were determined at day 3, neurological outcome was assessed after hospital discharge by cerebral performance category (CPC). RESULTS: Good neurological outcome (CPC≤2) was achieved in 41%. Elevated neuromarkers, older age and absence of ST-segment elevation after ROSC were associated with increased mortality. Poor neurological outcome in survivors was additionally associated with history of cerebrovascular events, sepsis and higher admission lactate. Mean NSE was 33µg/l [16-94] vs. 119µg/l [25-406]; p<0.001, for survivors vs. non-survivors, and 21µg/l [16-29] vs. 40µg/l [23-98], p<0.001 for good vs. poor neurological outcome. S-100b was 0.127µg/l [0.063-0.360] vs. 0.772µg/l [0.121-2.710], p<0.001 and 0.086µg/l [0.061-0.122] vs. 0.138µg/l [0.090-0.271], p = 0.009, respectively. For mortality, thresholds of 36µg/l for NSE and 0.128µg/l for S-100b could be determined; for poor neurological outcome 33µg/l (NSE) and 0.123µg/l (S-100b), respectively. Positive predictive value for NSE was 81% (74-88) and 79% (71-85) for S-100b. CONCLUSIONS: Thresholds for NSE and S-100b predicting mortality and poor neurological outcome are similar in OHCA patients receiving therapeutic hypothermia as in those reported before the era of hypothermia. However, both biomarkers do not have enough specificity to predict mortality or poor neurological outcome on their own and should only be additively used in clinical decision making.


Assuntos
Hipotermia Induzida , Doenças do Sistema Nervoso , Parada Cardíaca Extra-Hospitalar , Fosfopiruvato Hidratase/sangue , Sistema de Registros , Subunidade beta da Proteína Ligante de Cálcio S100/sangue , Idoso , Biomarcadores/sangue , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/sangue , Doenças do Sistema Nervoso/mortalidade , Parada Cardíaca Extra-Hospitalar/sangue , Parada Cardíaca Extra-Hospitalar/mortalidade , Parada Cardíaca Extra-Hospitalar/terapia , Estudos Prospectivos , Taxa de Sobrevida
3.
J Clin Neurosci ; 82(Pt A): 32-35, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33317735

RESUMO

INTRODUCTION: Migraine pathogenesis still remains uncertain. Studies have found contradictory results regarding NO, S100B and NSE parameters in migraine patients. Therefore, in our study, we aimed to measure NO, S100B and NSE concentrations in migraine patients, compare them with the control group and find the relationship between these parameters. MATERIALS AND METHODS: Fifty-two patients (35 women and 17 men) diagnosed with migraine according to the International Headache Classification II criteria were included in the study. 30 healthy participants without any history of disease were included in the control group. Serum NO, S100B and NSE levels were determined in all participants. RESULTS: It was found that NO, S100B parameters increased compared to the control group, and NSE parameter decreased compared to the control group in the migraine patients participating in this study (p = 0,004, p = 0,002, p = 0,000) It was found that there was a moderate positive linear correlation between serum S100B and NSE in the migraine patients in our study (r = 442, p = 0.011). CONCLUSION: In our study, the fact that there was a statistically significant difference in the NO, S100b and NSE parameters of migraine and control group patients indicates that these molecules can be effective in the pathogenesisof migraine. The moderate positive linear correlation found between serum S100B and NSE in migraine patients in our study demonstrates that these molecules together can be effective in the pathogenesis.


Assuntos
Biomarcadores/sangue , Transtornos de Enxaqueca/sangue , Fosfopiruvato Hidratase/sangue , Subunidade beta da Proteína Ligante de Cálcio S100/sangue , Adulto , Feminino , Humanos , Masculino
4.
J Med Life ; 13(3): 306-313, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33072201

RESUMO

Seric biomarkers have been tested in a large number of studies on traumatic brain injuries (TBI) patients in order to predict severity, especially related to the short-term outcome. However, TBI patients have a high risk of developing long-term complications such as physical disability, cognitive impairment, psychiatric pathology, epilepsy, and others. The aim of this study was to assess the correlation between protein biomarkers S100 and neuron-specific enolase (NSE) and neurocognitive status at 10- and 90-days post-injury. Both biomarkers were tested in the first 4h and after 72h post-injury in 62 patients with moderate-severe TBI. The patients were evaluated by a series of neurocognitive tests: Early Rehabilitation Barthel Index (ERBI), Glasgow Outcome Scale-Extended (GOSE), The Mini-Mental State Examination (MMSE), Processing Speed Index (PSI), and Stroop Test, at 10 and 90 days post-injury and supplementary by the Hospital Anxiety and Depression Scale at 90 days. For evaluating the whole neurocognitive status instead of every scale separately, we used Structural Equation Modeling (SEM), while for anxiety and depressive symptoms, we used multiple regression analyses. SEM showed that NSE values at 4 hours were significant predictors of the cognitive status at 10 (p=0.034) and 90 days (p= 0.023). Also, there were found significant correlations between NSE at 4h and the anxiety level. This study demonstrated a significant correlation between NSE at 4h and short and medium-term neuropsychological outcomes, which recommends using this biomarker for selecting patients with a higher risk of cognitive dysfunction.


Assuntos
Lesões Encefálicas Traumáticas/sangue , Lesões Encefálicas Traumáticas/fisiopatologia , Cognição , Fosfopiruvato Hidratase/sangue , Proteínas S100/sangue , Adulto , Biomarcadores/sangue , Emoções , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Adulto Jovem
5.
Medicine (Baltimore) ; 99(40): e22574, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019470

RESUMO

RATIONALE: Pulmonary sequestration (PS) presenting with elevated serum tumor markers is rare, and it might be misdiagnosed as malignancy. PATIENT CONCERNS: A 26-year-old asymptomatic male patient was admitted because the x-ray showed an intrathoracic lesion. Meanwhile, the serum neuron-specific enolase (NSE) was elevated. Three-dimensional computed tomography angiography revealed an isolated feeding vessel arising from the aorta. DIAGNOSES: Extralobular PS was confirmed by computed tomography angiography and postoperative pathological staining. INTERVENTIONS: Two-port thoracoscopic resection of the sequestrated lobe was performed. OUTCOMES: The serum NSE decreased to within the normal range and persisted during the follow up of 10 months. LESSONS: A thorough work-up should be considered for the PS patients presenting with abnormal serum NSE. Detailed knowledge regarding the relationship between NSE and PS necessitates further studies.


Assuntos
Sequestro Broncopulmonar/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Fosfopiruvato Hidratase/sangue , Adulto , Assistência ao Convalescente , Aorta/anormalidades , Aorta/diagnóstico por imagem , Sequestro Broncopulmonar/patologia , Sequestro Broncopulmonar/cirurgia , Humanos , Masculino , Cirurgia Torácica Vídeoassistida/métodos , Resultado do Tratamento
6.
Int J Cardiovasc Imaging ; 36(11): 2107-2113, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32681317

RESUMO

Silent cerebral infarctions (SCI) determined by neuron specific enolase (NSE) elevation may develop more during chronic total occlusion (CTO) percutaneous coronary interventions (PCI) than non-CTO interventions. Our aim was to examine CTO and non-CTO PCIs for SCI development. 100 consecutive CTO and 100 non-CTO PCI patients were enrolled. SCI was detected by serum NSE measurements performed at baseline and 12 h after the interventions. New NSE elevations > 12 ng/mL after the procedure were counted as SCI. Post-procedural NSE levels were found to be significantly higher in the CTO PCI group and NSE positivity was more prevalent in the CTO PCI group (56 (56%) vs. 31 (31%), p < 0.001), but PCI of CTOs did not independently increase risk of SCI (OR: 2.39 (0.85-6.73), p: 0.10). Patients who developed SCI after PCI had the characteristics of tough PCI interventions. In the multivariate analysis, two parameters were found to be independently associated with SCI development, namely more contrast volume (OR: 1.014 (1.005-1.023), p: 0.003) and longer procedural time (OR: 1.030 (1.010-1.051), p: 0.003). It has been firstly demonstrated in the literature that CTO PCIs, by its nature, have increased rates of SCI when compared to non-CTO PCIs but presence of a CTO was not an independent predictor of SCI. Mainly, procedural characteristics of the PCIs, especially longer procedural times and more contrast consumption, observed more in CTO PCIs, have been found to be independently associated with elevations of plasma NSE levels.


Assuntos
Infarto Cerebral/etiologia , Doença da Artéria Coronariana/terapia , Oclusão Coronária/terapia , Intervenção Coronária Percutânea/efeitos adversos , Idoso , Doenças Assintomáticas , Biomarcadores/sangue , Estudos de Casos e Controles , Infarto Cerebral/sangue , Doença Crônica , Doença da Artéria Coronariana/diagnóstico por imagem , Oclusão Coronária/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fosfopiruvato Hidratase/sangue , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
7.
J Cardiothorac Surg ; 15(1): 134, 2020 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-32522213

RESUMO

BACKGROUND: In a rabbit model of cardiopulmonary bypass (CPB) and cardioplegic arrest, we previously showed that hyperoxic myocardial reperfusion was associated with increased left ventricular (LV) systolic dysfunction and myocardial injury compared with normoxic reperfusion. The aim of this study was to evaluate in our experimental model the impact of post-CPB reperfusion conditions on other organs potentially vulnerable to ischemic injury such as the brain and kidney. METHODS: After 60 min of CPB, aortic cross-clamp, and cold cardioplegic arrest, rabbits were reperfused under hyperoxic or normoxic conditions for 120 min. Left ventricular systolic contractility (LV + dP/dt) and diastolic relaxation (LV -dP/dt) were continuously recorded, and end-organ injury was assessed by measuring circulating biomarkers specific for kidney (cystatin C and creatinine) and brain injury [S100B and neuron specific enolase (NSE)]. At completion of the protocol, kidney and brain tissues were harvested for measuring oxidant stress (OS), inflammation and apoptosis. RESULTS: Following aortic cross-clamp removal, rabbits exposed to normoxic reperfusion demonstrated preserved LV systolic and diastolic function compared with hyperoxic reperfusion (LV + dP/dt: 70 ± 14% of pre-CPB vs. 36 ± 21%, p = 0.018; LV -dP/dt: 72 ± 36% of pre-CPB vs. 33 ± 20%, p = 0.023). Similarly, CPB increased plasma creatinine, S100B and NSE that were significantly attenuated by normoxic reperfusion compared with hyperoxic reperfusion (creatinine: 4.0 ± 0.5 vs. 7.1 ± 0.8 mg/dL, p = 0.004; S100B: 4.0 ± 0.8 vs. 6.7 ± 1.0 ng/mL, p = 0.047; NSE: 57.7 ± 6.8 vs. 101.3 ± 16.1 pg/mL, p = 0.040). Furthermore, both kidney and brain tissues showed increased mRNA expression and activation of pathways for OS, inflammation, and apoptosis, that were reduced under normoxic compared with hyperoxic conditions. CONCLUSIONS: Normoxic reperfusion ameliorates cardiac, renal and neural injury compared with hyperoxic reperfusion in an in vivo animal model of CPB and cardioplegic arrest. This protective effect of normoxic reperfusion may be due to a reduction in signaling pathways for OS, inflammation, and apoptosis.


Assuntos
Isquemia Encefálica/sangue , Ponte Cardiopulmonar/efeitos adversos , Parada Cardíaca Induzida/efeitos adversos , Nefropatias/sangue , Oxigênio/administração & dosagem , Traumatismo por Reperfusão/sangue , Animais , Apoptose , Biomarcadores/sangue , Encéfalo/fisiopatologia , Isquemia Encefálica/etiologia , Isquemia Encefálica/fisiopatologia , Creatinina/sangue , Cistatina C/sangue , Inflamação/metabolismo , Rim/fisiopatologia , Nefropatias/etiologia , Nefropatias/fisiopatologia , Masculino , Estresse Oxidativo/genética , Fosfopiruvato Hidratase/sangue , RNA Mensageiro/metabolismo , Coelhos , Traumatismo por Reperfusão/etiologia , Traumatismo por Reperfusão/fisiopatologia , Subunidade beta da Proteína Ligante de Cálcio S100/sangue , Função Ventricular Esquerda
8.
Rinsho Shinkeigaku ; 60(6): 441-445, 2020 Jun 06.
Artigo em Japonês | MEDLINE | ID: mdl-32435048

RESUMO

An 81-year-old woman was admitted to our hospital due to paresthesia of the extremities and difficulty in walking for three months. She underwent a total hysterectomy and bilateral salpingo-oophorectomy for large cell neuroendocrine carcinoma (LCNEC) of the endometrium seven months before the admission. The serum levels of neuron specific enolase (NSE) reduced after the surgery. She showed numbness of her limbs, disturbance of vibration, areflexia and autonomic dysfunction. Nerve conduction studies showed sensory dominant sensory neuronopathy. CT scan of her abdomen and pelvis revealed the recurrence of LCNEC of the endometrium. The serum levels of NSE was elevated and anti-Hu antibody was also positive. Other laboratory test, including autoantibodies were unremarkable. We diagnosed her as paraneoplastic sensory neuronopathy associated with postoperative recurrence of LCNEC of the endometrium. Here we show a clinical picture of anti-Hu positive paraneoplastic neurological syndrome with LCNEC of the endometrium.


Assuntos
Carcinoma Neuroendócrino , Proteínas ELAV/imunologia , Neoplasias do Endométrio , Polineuropatia Paraneoplásica/diagnóstico , Idoso de 80 Anos ou mais , Autoanticorpos/sangue , Biomarcadores/sangue , Feminino , Humanos , Recidiva Local de Neoplasia , Fosfopiruvato Hidratase/sangue
9.
Medicine (Baltimore) ; 99(16): e19796, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32311993

RESUMO

This study investigated the diagnostic value of preoperative serum neuro-specific enolase (NSE) in gastric cancer (GC) and colorectal cancer (CRC), and the diagnostic viability of combined serum NSE, carcinoembryonic antigen (CEA), cancer antigen (CA)19-9, and CA242.Patients with GC and CRC, and a healthy control group (n = 666 and 266, respectively) were compared with regard to NSE, CEA, CA19-9, and CA242 serum levels. NSE was analyzed for associations with clinicopathological parameters. To estimate the diagnostic potential of NSE, a receiver operating characteristic curve was constructed and the area under the curve (AUCs) was calculated for different patient subgroups.The median serum NSE level of the tumor group (20.925 ng/mL) was significantly higher than that of the control (15.190 ng/mL). Serum NSE was associated with pathological tumor-node-metastasis staging, lymph node metastasis, distant metastasis, vascular invasion, and nerve infiltration. The area under the receiver operating characteristic curve (AUC) for NSE in GC and CRC (0.769) was higher than for the other 3 markers (0.571-0.680). The AUC of the combined markers was higher than for any of the markers individually (0.778-0.810).The AUC for NSE alone suggests it may be an independent tumor marker, and useful for diagnosis of GC and CRC. However, the AUC for combined NSE, CEA, CA19-9, and CA242 was higher and thus potentially more diagnostic value.


Assuntos
Biomarcadores Tumorais/sangue , Neoplasias Colorretais/sangue , Fosfopiruvato Hidratase/sangue , Neoplasias Gástricas/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Neoplasias Colorretais/patologia , Feminino , Humanos , Modelos Logísticos , Linfonodos/patologia , Masculino , Pessoa de Meia-Idade , Neoplasias Gástricas/patologia , Adulto Jovem
10.
Medicine (Baltimore) ; 99(16): e19829, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32312004

RESUMO

As a biomarker, neuron-specific enolase (NSE) has been widely recognized in the diagnosis of benign diseases and malignant tumors. This study aimed to investigate the potential diagnostic value of NSE in patients with gastric adenocarcinoma.Serum levels of the NSE were compared between 219 patients with gastric adenocarcinoma and 298 healthy individuals, NSE and clinicopathological parameters were analyzed. Meanwhile, to evaluate the diagnostic capability of NSE, the receiver operating characteristic (ROC), and area under curve (AUC) was calculated.In the present study, the median serum NSE level of the patient group was 20.770 ng/mL, which was higher than that of the control group 15.625 ng/mL (P < .05). Serum NSE level in patients group compared with healthy control was statistically significant (P < .05). Serum NSE level was associated with pathological tumor-node-metastasis (pTNM) staging, lymph node metastasis, and distant metastasis in patients with gastric adenocarcinoma. Besides, the AUC of NSE in gastric adenocarcinoma was 0.742, which was higher than those of the other 3 markers (0.573-0.644). Besides, the AUC of the combined 4 markers was higher than any individual marker (0.778).Serum NSE detecting may have good value for diagnosis of gastric adenocarcinoma. Besides, the combination of NSE, CEA, CA19-9, and CA242 performed even better than any single marker. Thus, the combined detection of the 4 tumor markers may be more useful for the diagnosis of gastric adenocarcinoma.


Assuntos
Adenocarcinoma/metabolismo , Biomarcadores Tumorais/metabolismo , Fosfopiruvato Hidratase/sangue , Neoplasias Gástricas/patologia , Adulto , Idoso , Antígenos Glicosídicos Associados a Tumores/sangue , Antígeno CA-19-9/sangue , Antígeno Carcinoembrionário/sangue , Feminino , Humanos , Neoplasias Pulmonares/metabolismo , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias/métodos , Sensibilidade e Especificidade
11.
Sci Rep ; 10(1): 6332, 2020 04 14.
Artigo em Inglês | MEDLINE | ID: mdl-32286436

RESUMO

To investigate and establish a reference interval (RI) of neuron-specific enolase (NSE) in southwest China's healthy population by using the laboratory information system database. A total of 86957 periodic health examination individuals of the medical examination center in West China Hospital from 2016 to 2018 were included in the study. We used the Box-Cox conversion combined with the Tukey method to normalize the data and eliminate the outliers, and the normal distribution method and the nonparametric method to estimate the 95% distribution RI. The NSE 95% distribution RI we established in healthy populations in southwest China through normal distribution and nonparametric method were 0-19.64 ng/ml and 0-20.46 ng/ml, respectively. The obtained RIs verification conformed to the standard and was significantly different from the reagent instruction(P < 0.05). The RI established by the nonparametric method was superior to the RI of the normal distribution method and reagent instruction(P < 0.05). We initially established an NSE RI that was suitable for the healthy southwest China population. The Box-Cox conversion combined with the Tukey method and nonparametric method is a reliable and straightforward indirect method for reference interval acquisition, which is suitable for the promotion and application of clinical laboratory.


Assuntos
Fosfopiruvato Hidratase/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Variação Biológica da População , Biomarcadores/sangue , China , Interpretação Estatística de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fosfopiruvato Hidratase/sangue , Padrões de Referência
12.
Neurology ; 94(16): e1675-e1683, 2020 04 21.
Artigo em Inglês | MEDLINE | ID: mdl-32213644

RESUMO

OBJECTIVE: After cardiac arrest (CA), epileptiform EEG, occurring in about 1/3 of patients, often but not invariably heralds poor prognosis. We tested the hypothesis that a combination of specific EEG features identifies patients who may regain consciousness despite early epileptiform patterns. METHODS: We retrospectively analyzed a registry of comatose patients post-CA (2 Swiss centers), including those with epileptiform EEG. Background and epileptiform features in EEGs 12-36 hours or 36-72 hours from CA were scored according to the American Clinical Neurophysiology Society nomenclature. Best Cerebral Performance Category (CPC) score within 3 months (CPC 1-3 vs 4-5) was the primary outcome. Significant EEG variables were combined in a score assessed with receiver operating characteristic curves, and independently validated in a US cohort; its correlation with serum neuron-specific enolase (NSE) was also tested. RESULTS: Of 488 patients, 107 (21.9%) had epileptiform EEG <72 hours; 18 (17%) reached CPC 1-3. EEG 12-36 hours background continuity ≥50%, absence of epileptiform abnormalities (p < 0.00001 each), 12-36 and 36-72 hours reactivity (p < 0.0001 each), 36-72 hours normal background amplitude (p = 0.0004), and stimulus-induced discharges (p = 0.0001) correlated with favorable outcome. The combined 6-point score cutoff ≥2 was 100% sensitive (95% confidence interval [CI], 78%-100%) and 70% specific (95% CI, 59%-80%) for CPC 1-3 (area under the curve [AUC], 0.98; 95% CI, 0.94-1.00). Increasing score correlated with NSE (ρ = -0.46, p = 0.0001). In the validation cohort (41 patients), the score was 100% sensitive (95% CI, 60%-100%) and 88% specific (95% CI, 73%-97%) for CPC 1-3 (AUC, 0.96; 95% CI, 0.91-1.00). CONCLUSION: Prognostic value of early epileptiform EEG after CA can be estimated combining timing, continuity, reactivity, and amplitude features in a score that correlates with neuronal damage.


Assuntos
Coma/fisiopatologia , Parada Cardíaca/terapia , Hipóxia-Isquemia Encefálica/fisiopatologia , Síndrome Pós-Parada Cardíaca/fisiopatologia , Convulsões/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Anticonvulsivantes/uso terapêutico , Estudos de Coortes , Coma/sangue , Coma/etiologia , Eletroencefalografia , Potenciais Somatossensoriais Evocados , Feminino , Parada Cardíaca/sangue , Parada Cardíaca/complicações , Humanos , Hipóxia-Isquemia Encefálica/sangue , Hipóxia-Isquemia Encefálica/etiologia , Masculino , Pessoa de Meia-Idade , Fosfopiruvato Hidratase/sangue , Síndrome Pós-Parada Cardíaca/sangue , Síndrome Pós-Parada Cardíaca/etiologia , Prognóstico , Recuperação de Função Fisiológica , Reflexo Anormal , Reflexo Pupilar , Estudos Retrospectivos , Convulsões/sangue , Convulsões/tratamento farmacológico , Convulsões/etiologia
13.
Rev. esp. cardiol. (Ed. impr.) ; 73(3): 232-240, mar. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-195365

RESUMO

INTRODUCCIÓN Y OBJETIVOS: La enolasa neuronal específica (ENE) es un marcador pronóstico en pacientes con parada cardiorrespiratoria extrahospitalaria (PCR-EH) tratados con hipotermia moderada terapéutica (HMT). OBJETIVOS: analizar la correlación entre cambios dinámicos en ENE y eventos principales; y determinar los tiempos de medición de ENE que mejor pronostican el estado neurológico. MÉTODOS: Estudio de cohortes multicéntrico de pacientes ingresados después de un PCR-EH con ritmo desfibrilable y tratados con HMT. Se determinó la ENE sérica en dos fechas y se calculó DELTA-ENE (%) como 100 X (DELTA-ENE 2-DELTA-ENE 1) / DELTA-ENE 1. La mortalidad y el estado neurológico, según la escala Cerebral Performance Category (CPC), se evaluaron durante la hospitalización y a los 6 meses. RESULTADOS: Se incluyeron 166 pacientes ingresados en cuatro hospitales. La mortalidad intrahospitalaria fue del 31.9%. El 58,2% tuvo buena recuperación neurológica (CPC 1-2). El incremento de ENE se asoció, en el análisis de regresión logística, con mayor mortalidad hospitalaria y peor CPC al alta y a los 6 meses (p < 0,001). DELTA-ENE positiva obtuvo un OR=9,28 (95%IC 4,40-19,57) para mortalidad, OR=11,23 (95%IC 5,24-24,11) para CPC 3-5 al alta y OR=11,14 (95% IC 5,05-24,55) para CPC 3-5 a 6 meses (p < 0,001). Una primera determinación de ENE realizada 18 a 24 horas y una segunda 69 a 77 horas después del PCR-EH, mostraron una área bajo la curva ROC buena en la predicción de CPC al alta (0,9389 y 0,9909 respectivamente, 0,8096). CONCLUSIONES: El cambio dinámico de ENE es un buen marcador de eventos clínicos después de un PCR-EH por ritmo desfibrilable en pacientes tratados con HMT. Las mediciones de ENE en intervalos específicos después del PCR-EH pueden incrementar la precisión pronóstica


INTRODUCTION AND OBJECTIVES: Neuron-specific enolase (NSE) is a prognostic marker in out-of-hospital cardiopulmonary arrest (OHCA) survivors treated with mild therapeutic hypothermia (MTH). The objectives were to analyze the correlation between dynamic changes in NSE and outcomes and to determine the measurement timing that best predicts neurological status. METHODS: Multicenter cohort study including patients admitted after shockable rhythm OHCA and treated with MTH. Serum NSE was sampled at 2 different times and DELTA-NSE (%) was calculated as 100 X (NSE2-NSE1)/NSE1. In-hospital mortality and neurological outcome, as assessed by the Cerebral Performance Category (CPC) scale, were evaluated during admission and after a 6-month follow-up. RESULTS: We included 166 patients admitted to 4 hospitals. In-hospital mortality was 31.9%. Almost 60% of patients had a good neurological recovery (CPC 1-2). On univariate and multivariate logistic regression analyses, an increase in NSE levels was associated with higher in-hospital mortality and worse CPC on discharge and after 6-months (P<.001). Positive DELTA-NSE showed an OR=9.28 (95% CI 4.40-19.57) for mortality, OR=11.23 (95% CI 5.24-24.11) for CPC 3-5 at discharge and OR=11.14 (95% CI 5.05-24.55) for CPC 3-5 after 6-months' follow-up (P<.001). The first NSE measurement, conducted at 18 to 24hours, and the second measurement at 69 to 77 hours after OHCA showed a high area under the curve in predicting CPC at discharge (0.9389 and 0.9909, respectively; 0.8096 for the whole cohort). CONCLUSIONS: Dynamic changes in NSE serum levels are good markers of hard clinical outcomes after an OHCA due to shockable rhythm in an MTH-treated cohort. NSE measurements at specific intervals after OHCA may predict events even more precisely


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Parada Cardíaca Extra-Hospitalar/enzimologia , Fosfopiruvato Hidratase/sangue , Área Sob a Curva , Biomarcadores/sangue , Tempo de Circulação Sanguínea , Mortalidade Hospitalar , Hipotermia Induzida , Exame Neurológico , Parada Cardíaca Extra-Hospitalar/mortalidade , Parada Cardíaca Extra-Hospitalar/fisiopatologia , Parada Cardíaca Extra-Hospitalar/terapia , Prognóstico , Análise de Regressão , Sobreviventes , Fatores de Tempo
14.
Dis Markers ; 2020: 6430459, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32089756

RESUMO

Introduction. Preoperative detection of pleural invasion in lung cancer patients is key to curative surgical treatment. We tried to predict pleural invasion in non-small-cell lung cancer patients with <100 ml pleural fluid. Methods: Patients admitted from August 1, 2011, to December 31, 2018, were retrospectively retrieved. Records of serum and imaging markers were analyzed. Results: Among 7004 patients who received surgery, 43 cases with <100 ml pleural fluid who had pleural invasion were included, and another 108 cases without pleural invasion were enrolled as controls. There were no differences in squamous cell carcinoma antigen (SCC) or neuron-specific enolase (NSE) values between the pleural invasion and noninvasion groups (p = 0.30 and 0.14, respectively), but there were significant differences in carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (CYFRA21-1) values (p = 0.30 and 0.14, respectively), but there were significant differences in carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (CYFRA21-1) values (p = 0.30 and 0.14, respectively), but there were significant differences in carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (CYFRA21-1) values (p = 0.30 and 0.14, respectively), but there were significant differences in carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (CYFRA21-1) values (p = 0.30 and 0.14, respectively), but there were significant differences in carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (CYFRA21-1) values (p = 0.30 and 0.14, respectively), but there were significant differences in carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (CYFRA21-1) values (p = 0.30 and 0.14, respectively), but there were significant differences in carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (CYFRA21-1) values (. Conclusions: Serum CEA and CYFRA21-1, location of original lung cancer (right mid lobe), maximum diameter, CT-detectable pleural fluid, pleural sign by CT, and PET/CT-predicted pleural invasion were good markers for the prediction of pleural invasion in non-small-cell lung cancer patients.


Assuntos
Biomarcadores Tumorais/sangue , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Pleura/patologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Idoso , Antígenos de Neoplasias/sangue , Antígeno Carcinoembrionário/sangue , Carcinoma Pulmonar de Células não Pequenas/sangue , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Feminino , Humanos , Queratina-19 , Neoplasias Pulmonares/sangue , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Fosfopiruvato Hidratase/sangue , Pleura/diagnóstico por imagem , Estudos Retrospectivos , Serpinas/sangue , Procedimentos Cirúrgicos Torácicos , Resultado do Tratamento
15.
BMC Pulm Med ; 20(1): 31, 2020 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-32024492

RESUMO

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


Assuntos
Dano Encefálico Crônico/sangue , Fosfopiruvato Hidratase/sangue , Subunidade beta da Proteína Ligante de Cálcio S100/sangue , Apneia Obstrutiva do Sono/sangue , Biomarcadores/sangue , Humanos , Estudos Observacionais como Assunto
16.
Rev. esp. cardiol. (Ed. impr.) ; 73(2): 123-130, feb. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-195003

RESUMO

INTRODUCCIÓN Y OBJETIVOS: Analizar la cinética de la enolasa neuroespecífica (EN) como biomarcador de pronóstico neurológico de los pacientes que sobreviven a una parada cardiaca tratados con control de temperatura. MÉTODOS: Análisis retrospectivo de pacientes ingresados tras sufrir una parada cardiaca dentro o fuera del hospital entre septiembre de 2006 y mayo de 2018 en un centro terciario y enfriados a 32-34°C durante 24 h. Las muestras de EN se tomaron al ingreso hospitalario y a las 24, 48 y 72 h del retorno a circulación espontánea (RCE). El estado neurológico se evaluó a los 3 meses mediante la escala Cerebral Performance Category (CPC) y se categorizó como favorable (CPC 1-2) o desfavorable (CPC 3-5). RESULTADOS: De los 451 pacientes, 320 cumplían los criterios de inclusión (el 80,3% varones; media de edad, 61+/-14,1 años). De estos, 174 (54,4%) sobrevivieron con una evolución neurológica favorable. Los pacientes con estado neurológico desfavorable tenían valores de EN más altos al ingreso hospitalario y a las 24, 48 y 72 h del RCE. A las 48 y las 72 h, los valores de EN predijeron un estado neurológico desfavorable, con áreas bajo la curva de 0,85 (IC95%, 0,81-0,90) y 0,88 (IC95%, 0,83-0,93). Además, el área bajo la curva de los valores delta de EN entre las 72 h y el ingreso hospitalario fue de 0,90 (IC95%, 0,85-0,95), y en el análisis multivariante resultó predictor independiente (p <0,001). CONCLUSIONES: En pacientes que sobrevivieron a una parada cardiaca tratados con control de la temperatura, se ha demostrado que los valores delta de EN entre las 72 h del RCE y el ingreso hospitalario son un potente predictor de resultado neurológico desfavorable


INTRODUCTION AND OBJECTIVES: To analyze neuron-specific enolase (NSE) kinetics as a prognostic biomarker of neurological outcome in cardiac arrest survivors treated with targeted temperature management. METHODS: We performed a retrospective analysis of patients resuscitated from in- or out-of-hospital cardiac arrest admitted from September 2006 to May 2018 in a single tertiary care center and cooled to 32°C to 34°C for 24 hours. Blood samples for measurement of NSE values were drawn at hospital admission and at 24, 48, and 72hours after return of spontaneous circulation (ROSC). Neurological outcome was evaluated by means of the Cerebral Performance Category (CPC) score at 3 months and was characterized as good (CPC 1-2) or poor (CPC 3-5). RESULTS: Of 451 patients, 320 fulfilled the inclusion criteria and were analyzed (80.3% male, mean age 61+/-14.1 years). Among these, 174 patients (54.4%) survived with good neurological status. Poor outcome patients had higher median NSE values at hospital admission and at 24, 48 and 72 hours after ROSC. At 48 and 72 hours after ROSC, NSE predicted poor neurological outcome with areas under the receiver-operating characteristic curves of 0.85 (95%CI, 0.81-0.90) and 0.88 (95%CI, 0.83-0.93), respectively. In addition, delta NSE values between 72hours after ROSC and hospital admission predicted poor neurological outcome with an area under the receiver-operating characteristic curve of 0.90 (95%CI, 0.85-0.95) and was an independent predictor of unfavorable outcome on multivariate analysis (P <.001). CONCLUSIONS: In cardiac arrest survivors treated with targeted temperature management, delta NSE values between 72 hours after ROSC and hospital admission strongly predicted poor neurological outcome


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/complicações , Doenças do Sistema Nervoso , Fosfopiruvato Hidratase/farmacocinética , Estudos Retrospectivos , Curva ROC , Centros de Atenção Terciária , Biomarcadores , Hipotermia Induzida , Fosfopiruvato Hidratase/sangue , Doenças do Sistema Nervoso/etiologia
17.
Hum Exp Toxicol ; 39(5): 634-641, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31957492

RESUMO

Fluoroacetic acid (FAcOH) was once a highly toxic rodenticide widely used in the world. In the past, studies on the toxicity of FAcOH have focused on animal experiments. The toxicity of FAcOH to humans and the changes of FAcOH in plasma have not been studied. Therefore, the present study aimed to describe the changes of plasma FAcOH concentrations, hematological, and biochemical characteristics in patients with FAcOH intoxication. According to clinical symptoms, 68 patients from the emergency department were divided into different groups: convulsion group, unconsciousness group, death group, and control groups. Plasma FAcOH concentrations, hematological, and biochemical parameters were investigated. Results demonstrated that patients in the convulsion group and the unconsciousness group had a significant increase (p < 0.01) in the level of neuron-specific enolase (NSE), creatine kinase MB (CKMB), glucose (GLU), and white blood cell count (WBC) and a significant decrease (p < 0.01) in serum potassium compared with the control group, respectively. Moreover, patients in the death group had a significant increase (p < 0.01) in the level of NSE, CKMB, N-terminal pro-brain natriuretic peptide, GLU, and WBC and a significant decrease (p < 0.01) in serum potassium and total calcium compared with the survival group. The concentrations of FAcOH in plasma in the convulsion group, the unconsciousness group, and the death group were 72.31 ± 42.29, 118.33 ± 55.41, and 163.78 ± 43.32 µg/mL, respectively. These changes and the plasma FAcOH concentrations may increase our understanding of the toxicity of FAcOH to humans and may help doctors to judge the clinical prognosis of patients with FAcOH intoxication.


Assuntos
Fluoracetatos/sangue , Fluoracetatos/envenenamento , Rodenticidas/sangue , Rodenticidas/envenenamento , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Glicemia/análise , Creatina Quinase Forma MB/sangue , Serviço Hospitalar de Emergência , Feminino , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Fosfopiruvato Hidratase/sangue , Prognóstico , Convulsões/sangue , Convulsões/induzido quimicamente , Inconsciência/sangue , Inconsciência/induzido quimicamente , Adulto Jovem
18.
Ann Vasc Surg ; 66: 424-433, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31923599

RESUMO

BACKGROUND: Despite all efforts, spinal cord ischemia (SCI) is a relevant and feared complication after open and endovascular thoracoabdominal aortic aneurysm (TAAA) repair. Besides the established correlation of motor evoked potentials (MEPs) and SCI, the usage of biomarkers for early detection of SCI intraoperatively and postoperatively after TAAA surgery is scarcely described in literature. METHODS: The methods include retrospective assessment of 33 patients (48.48% male) undergoing open and endovascular TAAA repair between January 2017 and January 2018. Levels of the biomarkers neurone-specific enolase (NSE), glial fibrillary acidic protein (GFAP), and S100 B were correlated with a decrease of the amplitude of the MEPs of more than 50%, indicating SCI. Linear mixed models were applied to test for differences in the biomarker levels between open and endovascular surgery and between different times of measurement. Post hoc analyses were performed using Tukey's multiple comparisons test. Logistic regression models were used to investigate the association between GFAP, NSE, and S100 B levels at different times and a significant decrease in MEP or in-hospital mortality. RESULTS: Altogether, 19 patients were treated by endovascular repair; 14 patients were treated by open repair; 5 patients were treated because of a type I TAAA; 7 received treatment because of a type II TAAA; 7, 10, and 4 patients received type III, IV, or V TAAA repair, respectively. In-hospital mortality was 18.18% (n = 6); 5 of these patients were treated because of symptomatic TAAA. MEP decrease could be observed in 18 cases (54.5%), with 16 (48.4%) recovering during the intervention. SCI could be observed in 9.09% (n = 3), 2 endovascular repairs leading to paraplegia and one open repair leading to paraparesis. All biomarkers showed increasing levels over time, with no statistically significant difference between open and endovascular repair. The difference in NSE and S100 B levels between the different times of measurements was statistically significant (P < 0.0001, P = 0.0017, respectively). In a univariable logistic regression analysis, no correlation with the end points "significant decrease in MEP" or "in-hospital mortality" was observed for any of the assessed biomarkers. CONCLUSIONS: SCI-related biomarkers, namely NSE and S100 B, show a relevant increase directly after open and endovascular TAAA surgery, while no clear association between these biomarker levels and an intraoperatively measurable indicator for SCI could be observed.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Proteína Glial Fibrilar Ácida/sangue , Fosfopiruvato Hidratase/sangue , Subunidade beta da Proteína Ligante de Cálcio S100/sangue , Isquemia do Cordão Espinal/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Torácica/sangue , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/mortalidade , Biomarcadores/sangue , Implante de Prótese Vascular/mortalidade , Procedimentos Endovasculares/mortalidade , Potencial Evocado Motor , Feminino , Mortalidade Hospitalar , Humanos , Monitorização Neurofisiológica Intraoperatória , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Isquemia do Cordão Espinal/diagnóstico , Isquemia do Cordão Espinal/etiologia , Isquemia do Cordão Espinal/mortalidade , Fatores de Tempo , Resultado do Tratamento
19.
Pediatr Blood Cancer ; 67(2): e28066, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31736249

RESUMO

OBJECTIVE: This study aims to explore prognostic factors for high-risk neuroblastoma patients with response failure to tandem high-dose chemotherapy and autologous stem cell transplantation (HDCT/auto-SCT). METHODS: Survival outcomes were compared according to characteristics at initial diagnosis, at relapse/progression, and after relapse/progression in patients who experienced relapse/progression after tandem HDCT/auto-SCT from 2006 to 2018. RESULTS: Forty-nine patients experienced relapse/progression after tandem HDCT/auto-SCT during the study period: 43 received salvage treatment and 30 underwent allogeneic SCT (allo-SCT) after reinduction treatment. Although all six patients who did not undergo salvage treatment died, 13 of the 43 patients who did remain alive. The 3-year probabilities of event-free survival (EFS) and overall survival (OS) from initial relapse/progression among the 49 patients were 14.4% ± 5.2% and 21.2% ± 6.4%, respectively. A higher neuron-specific enolase (NSE) level (>24 ng/mL) at relapse/progression was an independent prognostic factor for worse OS. Nine of 30 patients who underwent allo-SCT remain alive, and the 3-year probabilities of EFS and OS from allo-SCT were 16.5% ± 7.2% and 21.6% ± 8.3%, respectively. A higher NSE level and no incorporation of high-dose 131 I-metaiodobenzylguanidine (HD-MIBG) treatment into allo-SCT were independent prognostic factors for worse EFS and OS after allo-SCT. CONCLUSION: The results suggest that a higher serum NSE level at relapse/progression is a predictor of worse prognosis in patients with response failure to tandem HDCT/auto-SCT, and that incorporation of HD-MIBG treatment into allo-SCT may improve outcomes.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores Tumorais/sangue , Transplante de Células-Tronco Hematopoéticas/mortalidade , Quimioterapia de Indução/mortalidade , Recidiva Local de Neoplasia/mortalidade , Neuroblastoma/mortalidade , Fosfopiruvato Hidratase/sangue , Pré-Escolar , Terapia Combinada , Feminino , Seguimentos , Humanos , Masculino , Recidiva Local de Neoplasia/sangue , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/terapia , Neuroblastoma/sangue , Neuroblastoma/patologia , Neuroblastoma/terapia , Prognóstico , Estudos Prospectivos , Taxa de Sobrevida , Transplante Autólogo
20.
J Invest Surg ; 33(4): 350-358, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30430888

RESUMO

Objective: To evaluate the effects of isolated impaired fasting glucose (IIFG) on brain injury in patients undergoing cardiopulmonary bypass (CPB) surgery. Methods: Patients with rheumatic heart valve disease who underwent elective mitral valve replacement were included and divided into control and IIFG groups. Pre-, intra-, and postoperative blood glucose levels, serum insulin levels, insulin resistance index (HOMA-IR), lactic acid levels, and neuron-specific enolase (NSE) and S100B levels were measured. The cerebral oxygen extraction ratio (OER) was calculated. Cognitive function was assessed via the Mini-Mental State Examination (MMSE). Results: HOMA-IR levels were higher in the IIFG group than the control group 30 min after the beginning of CPB, at the termination of CPB, and 2 h after the termination of CPB. Cerebral OER and lactic acid increased intraoperatively in both groups, especially in the IIFG group. NSE and S100B levels were higher in the IIFG group than in the control group at the termination of CPB, 2 h after the termination of CPB, and at 24 h postoperatively. The MMSE scores did not significantly differ between the two groups. Delirium occurred in two patients in the IIFG group, and one in the control group. No other signs and symptoms of brain injuries were detected in either group. Conclusions: The increased postoperative NSE and S100B levels in the IIFG group compared with controls may be associated with severe insulin resistance and stress hyperglycemia. However, the IIFG group did not have clinical manifestations of brain injuries, including cognitive impairment.


Assuntos
Lesões Encefálicas/epidemiologia , Ponte Cardiopulmonar/efeitos adversos , Disfunção Cognitiva/epidemiologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Hiperglicemia/epidemiologia , Adulto , Biomarcadores/sangue , Glicemia/análise , Glicemia/fisiologia , Lesões Encefálicas/sangue , Lesões Encefálicas/diagnóstico , Lesões Encefálicas/etiologia , Disfunção Cognitiva/sangue , Disfunção Cognitiva/etiologia , Jejum/sangue , Feminino , Doenças das Valvas Cardíacas/cirurgia , Humanos , Hiperglicemia/sangue , Hiperglicemia/diagnóstico , Resistência à Insulina/fisiologia , Masculino , Pessoa de Meia-Idade , Valva Mitral/cirurgia , Fosfopiruvato Hidratase/sangue , Período Pós-Operatório , Período Pré-Operatório , Cardiopatia Reumática/cirurgia , Fatores de Risco , Subunidade beta da Proteína Ligante de Cálcio S100/sangue
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