Could cerebrospinal fluid biomarkers offer better predictive value for spinal cord ischaemia than current neuromonitoring techniques during thoracoabdominal aortic aneurysm repair - a systematic review

Abstract Objective: Cerebrospinal fluid (CSF) drainage is a technique that has significantly reduced the incidence of spinal cord ischaemia (SCI). We present results of a systematic review to assess the literature on this topic in relation to thoracoabdominal aortic aneurysm repair (TAAR). Methods: Major medical databases were searched to identify papers related to CSF biomarkers measured during TAAAR. Results: Fifteen papers reported measurements of CSF biomarkers with 265 patients in total. CSF biomarkers measured included S-100ß, neuron-specific endolase (NSE), lactate, glial fibrillary acidic protein A (GFPa), Tau, heat shock protein 70 and 27 (HSP70, HSP27), and proinflammatory cytokines. Lactate and S-100ß were reported the most, but did not correlate with SCI, which was also the case with NSE and TAU. GFPa showed significant CSF level rises, both intra and postoperative in patients who suffered SCI and warrants further investigation, similar results were seen with HSP70, HSP27 and IL-8. Conclusions: Although there is significant interest in this topic, there still remains a significant lack of high-quality studies investigating CSF biomarkers during TAAR to detect SCI. A large and multicentre study is required to identify the significant role of each biomarker.

Analyzing the neuropsychological characteristics and changes in serum markers of patients with chronic cerebral circulation insufficiency

Summary Objective: To investigate the neuropsychological characteristics and changes in CRP, S100B, MBP, HSP-7, and NSE in serum. Method: Sixty-six (66) patients treated in our hospital as CCCI group were chosen for our study, and 90 patients with depression were selected as the depression group. The patients in both groups were examined with CT perfusion, depression, anxiety and cognition evaluation. Their serum CRP, S100B, MBP, HSP-70 and NSE levels were detected. Neuropsychological and serum markers characteristics were compared. Results: The CBF and CBV in bilateral basal ganglia, frontal lobes, greater oval center, brain stem, and left and right regions of occipital lobes of the patients in CCCI group were significantly lower than in the depression group. The HAMD and HAMA scores of CCCI group patients were significantly lower than in the depression group; CCCI group performed better regarding attention, memory, abstract terms and delayed recall. CCCI also had significantly higher total scores than the depression group. Serum CRP, S100B, MBP, HSP-70 and NSE levels in CCCI group were significantly higher than in the depression group. The differences reach statistical significance (p<0.05). Conclusion: CCCI patients who are accompanied by minor depressive disorder have different degrees of cognitive impairment and experience a significant rise in serum CRP, S100B, MBP, HSP-70 and NSE.

Serum neuron-specific enolase and S-100β levels as prognostic follow-up markers for oxygen administered carbon monoxide intoxication cases.

Serum neuron-specific enolase (NSE) and S-100β levels are considered novel biochemical markers of neuronal cell injury. In this study, the initial and post-treatment levels of NSE and S-100β were compared in carbon monoxide (CO) poisoning patients, who received normorbaric oxygen (NBO) or hyperbaric oxygen (HBO) therapy. Forty consecutive patients with acute CO poisoning were enrolled in this prospective, observational study. According to their clinical symptoms and observations, twenty patients were treated with NBO, and the other twenty with HBO. Serum S-100β and NSE levels were measured both at time of admission and 6 h later (post-treatment). Serum NSE and S-100β values decreased significantly in both of the therapeutic modalities. The initial and post-treatment values of NSE and S-100β in NBO or HBO patients were comparable. A clear negative correlation was observed between the decrease of NSE and S-100β levels and initial blood carboxyhemoglobin levels. In conclusion, the present results suggested the use of serum S-100β and NSE levels as indicators for brain injury. Due to the significant increase of their values with oxygen therapy, they may also be useful as prognostic follow-up markers. However, the current findings reflected no difference between the efficacy of NBO or HBO therapy.

Lack of association of S100 and neuron-specific enolase with mortality in critically ill patients

Objective: To evaluate the relationship between brain damage biomarkers and mortality in the intensive care unit (ICU). Methods: The sample comprised 70 patients admitted to an ICU. Blood samples were collected from all patients on ICU admission, and levels of S100β and neuron-specific enolase (NSE) were determined by ELISA. Results: Acute Physiologic and Chronic Health Evaluation (APACHE II) score was associated with mortality, but NSE and S100β were not associated with this outcome. In contrast, S100β levels were significantly higher in delirious and non-delirious patients who required mechanical ventilation during ICU stay. Conclusion: Levels of brain biomarkers at the time of ICU admission did not predict mortality in critically ill patients. .

Biomarcadores na encefalopatia séptica: revisão sistemática dos estudos clínicos / Biomarkers in septic encephalopathy: a systematic review of clinical studies

OBJETIVO: O objetivo deste estudo foi revisar sistematicamente a importância da enolase específica neuronal e S100B para diagnóstico e monitorização da encefalopatia séptica. MÉTODOS: Foi realizada uma busca no banco de dados PubMed selecionando estudos que avaliaram níveis séricos de S 100 B e enolase específica neuronal em pacientes com sepse, publicados entre Janeiro de 2000 e Abril de 2012. Apenas estudos em humanos e que utilizaram um método adicional de avaliação neurológica foram selecionados. RESULTADOS: Foram identificados nove estudos, dos quais sete associaram concentrações elevadas de S100 beta e enolase específica neuronal ao desenvolvimento de encefalopatia séptica; quatro também as associaram ao aumento de mortalidade. Entretanto, dois trabalhos não encontraram essa associação quando avaliaram S100 beta e um deles não observou correlação entre a enolase específica neuronal e encefalopatia séptica. CONCLUSÃO: A S100 beta e enolase específica neuronal são biomarcadores promissores para diagnóstico e monitorização de pacientes com encefalopatia séptica, mas é necessária uma maior investigação.

OBJECTIVE: The aim of this study was to systematically review the importance of neuron-specific enolase and S100 beta for diagnosing and monitoring septic encephalopathy. METHODS: A PubMed database search was performed to identify studies that evaluated S100 beta and neuron-specific enolase serum levels in patients with sepsis and that were published between January 2000 and April 2012. Only human studies that employed an additional method of neurological assessment were selected. RESULTS: Nine studies were identified, seven of which associated high concentrations of S100 beta and neuron-specific enolase with the development of septic encephalopathy. Four studies also associated these concentrations with increased mortality. However, two studies did not find such an association when they evaluated S100 beta levels, and one of these studies did not observe a correlation between neuron-specific enolase and septic encephalopathy. CONCLUSION: S100 beta and neuron-specific enolase are promising biomarkers for diagnosing and monitoring patients with septic encephalopathy, but more research is necessary.

Serum and Cerebrospinal Fluid Neuron-Specific Enolase for Diagnosis of Tuberculous Meningitis

PURPOSE: Late diagnosis and treatment lead to high mortality and poor prognosis in tuberculous meningitis (TbM). A rapid and accurate diagnosis is necessary for a good prognosis. Neuron-specific enolase (NSE) has been investigated as a biochemical marker of nervous tissue damage. In the present study, the usefulness of NSE was evaluated, and a cut-off value for the differential diagnosis of TbM was proposed. MATERIALS AND METHODS: Patient charts were reviewed for levels of serum and cerebrospinal fluid (CSF) NSE, obtained from a diagnostic CSF study of samples in age- and gender-matched TbM (n=15), aseptic meningitis (n=28) and control (n=37) patients. RESULTS: CSF/serum NSE ratio was higher in the TbM group than those of the control and aseptic groups (p=0.001). In binary logistic regression, CSF white blood cell count and CSF/serum NSE ratio were significant factors for diagnosis of TbM. When the cut-off value of the CSF/serum NSE ratio was 1.21, the sensitivity was 86.7% and the specificity was 75.4%. CONCLUSION: The CSF/serum NSE ratio could be a useful parameter for the early diagnosis of TbM. In addition, the authors of the present study suggest a cut-off value of 1.21 for CSF/serum NSE ratio.

Neuroblastoma Originating from Extra-abdominal Sites: Association with Favorable Clinical and Biological Features

Neuroblastomas originating from different sites might have different clinical and biological characteristics. In the present study, the clinical (age, sex and stage) and biological (N-myc amplification, Shimada pathology and levels of lactate dehydrogenase, ferritin and neuron-specific enolase) characteristics of patients with newly diagnosed neuroblastoma were compared according to the site of tumor origin (extra-abdominal versus abdominal). The event-free survival rate (EFS) was also compared between the two groups. Among 143 neuroblastomas, 115 tumors originated from the abdomen, 26 from extra-abdominal sites and 2 from unknown primary sites. Frequencies of stage 4 tumor and N-myc amplified tumor were lower in the extra-abdominal group than in the abdominal group (34.6% vs. 60.0%, P=0.019 and 4.2% vs. 45.0%, P<0.001, respectively). Levels of lactate dehydrogenase, ferritin and neuron-specific enolase were significantly lower in the extra-abdominal group than in the abdominal group. The probability of 5-yr EFS (+/-95% confidence interval) was higher in the extra-abdominal group than in the abdominal group (94.4+/-10.6% vs. 69.4+/-9.4%, P=0.026). Taken together, neuroblastomas originating from extra-abdominal sites might be associated with more favorable clinical and biological characteristics and a better outcome than neuroblastomas originating from abdomen.

Neuroblastoma Originating from Extra-abdominal Sites: Association with Favorable Clinical and Biological Features

Neuroblastomas originating from different sites might have different clinical and biological characteristics. In the present study, the clinical (age, sex and stage) and biological (N-myc amplification, Shimada pathology and levels of lactate dehydrogenase, ferritin and neuron-specific enolase) characteristics of patients with newly diagnosed neuroblastoma were compared according to the site of tumor origin (extra-abdominal versus abdominal). The event-free survival rate (EFS) was also compared between the two groups. Among 143 neuroblastomas, 115 tumors originated from the abdomen, 26 from extra-abdominal sites and 2 from unknown primary sites. Frequencies of stage 4 tumor and N-myc amplified tumor were lower in the extra-abdominal group than in the abdominal group (34.6% vs. 60.0%, P=0.019 and 4.2% vs. 45.0%, P<0.001, respectively). Levels of lactate dehydrogenase, ferritin and neuron-specific enolase were significantly lower in the extra-abdominal group than in the abdominal group. The probability of 5-yr EFS (+/-95% confidence interval) was higher in the extra-abdominal group than in the abdominal group (94.4+/-10.6% vs. 69.4+/-9.4%, P=0.026). Taken together, neuroblastomas originating from extra-abdominal sites might be associated with more favorable clinical and biological characteristics and a better outcome than neuroblastomas originating from abdomen.

Traumatic brain injury in children: recent advances in management.

To define and discuss new developments in the field of pediatric traumatic brain injury (TBI). Review of several recent key studies on therapy since publication of the first U.S. traumatic brain injury guidelines in 2003. In addition, we discuss new developments in the use of biomarkers of brain injury in TBI diagnosis and also discuss recent advances in bedside neuromonitoring that may be helpful in the setting of pediatric brain injury. Important new information on optimal cerebral perfusion pressure management, cerebrospinal fluid drainage, decompressive craniectomy, hypothermia, biomarkers of brain injury along with advances in neuromonitoring are presented. The 2003 guidelines have stimulated important new research. This is reshaping bedside care.

Protective effects of Peganum harmala extracts on thiourea-induced diseases in adult male rat.

Cancers and hepatoprotective prevention using traditional medicines have attracted increasing interest. The aim of our study was to characterize the putative protective effects of ethanol and chloroform extracts of Peganum harmala on thiourea-induced diseases in adult male rat. We seek to determine the effects of these plant extracts on body weight, thyroid and endocrine cancer parameters. In addition the putative hepatoprotective effect was checked by the determination of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) activities and the bilirubin level in the blood. Our data show that ethanol and chloroform extracts of Peganum harmala protected the animal against the carcinogenic effects induced by thiourea since neuron-specific enolase (NSE) and thyroglobulin (TG) levels were back to the normal range. In addition, the observed-hepatocytotoxicity after thiourea treatment was greatly reduced (AST and ALT activities were respectively 270 IU/l and 60 IU/l and in the same order of magnitude as in the untreated rats) as well as the bilirubin levels (6 micromol/l) especially for animals receiving the choroform preparation. Therefore we may suggest that extracts of Peganum harmala are efficient to reduce the toxicity induced by thiourea in male rat as far as the above parameters are concerned.

Prediction of hypoxic-ischemic brain damage in full-term neonates with acute encephalopathy, using two different brain proteins, electroencephalogram and magnetic resonance imaging

The Objective of this study was to evaluate the usefulness of serum levels of two different brain proteins; Neuron specific enolase [NSE] and Creatinine brain specific kinase [CK-BB], electroencephalography [EEC], Conventional MRI imaging and diffusion-weighted MR imaging [DWMRI] for the early diagnosis of ischemic brain injury and prediction of hypoxic brain damage. A total of 30 term newborns were included in this study, 20 with neonatal encephalopathy and 10 normal cases. Clinical evaluation of neonatal condition and neurological outcomes was done. Serum estimation of NSE and CK-BB was done at 0, 12 and 24 hours after admission. Electroencephalography [EEC] was done at a median date of 1.17 days. Magnetic resonance imaging [MRI] both conventional and diffusion weighted were also done. EEC and MRI were done for the study group cases. The Apgar score at 2 minutes has highest specificity with a good negative predictive value of severe brain injury. Arterial blood base deficit have the highest sensitivity and highest negative predictive values. The highest significance was evident at 12 hours values of both NSE and CK-BB. A combination of NSE at 12 h with arterial blood pH [cutoff value, <6.9] or arterial blood base deficit [cutoff value, >17 mM/L] increased the positive predictive value and specificity. Bad outcomes as severe degree or death are usually associated with severe findings of both diffusion weighted MRI and background trace of EEG. The early EEG changes distinguish between those infants with a normal or abnormal outcome. MRI gives more specific information about the type and severity of brain lesion. The 12 hour values of NSE and CK-BB have a good predictive power either alone or combined with other clinical tests or investigations. This early determination is becoming increasingly important with the advent of hypothermia and other potential neuroprotective therapies for the treatment of HI brain injury in the asphyxiated newborn

Brain injury markers (S100B and NSE) in chronic cocaine dependents

OBJECTIVE: Studies have shown signs of brain damage caused by different mechanisms in cocaine users. The serum neuron specific enolase and S100B protein are considered specific biochemical markers of neuronal and glial cell injury. This study aimed at comparing blood levels of S100B and NSE in chronic cocaine users and in volunteers who did not use cocaine or other illicit drugs. METHOD: Twenty subjects dependent on cocaine but not on alcohol or marijuana, and 20 non-substance using controls were recruited. Subjects were selected by consecutive and non-probabilistic sampling. Neuron specific enolase and S100B levels were determined by luminescence assay. RESULTS: Cocaine users had significantly higher scores than controls in all psychiatric dimensions of the SCL-90 and had cognitive deficits in the subtest cubes of WAIS and the word span. Mean serum S100B level was 0.09 ± 0.04 µg/l among cocaine users and 0.08 ± 0.04 µg/l among controls. Mean serum neuron specific enolase level was 9.7 ± 3.5 ng/l among cocaine users and 8.3 ± 2.6 ng/l among controls. CONCLUSIONS: In this first study using these specific brain damage markers in cocaine users, serum levels of S100B and neuron specific enolase were not statistically different between cocaine dependent subjects and controls.

OBJETIVO: Estudos têm demonstrado sinais de lesão cerebral causadas por diferentes mecanismos em usuários de cocaína. A enolase sérica neurônio-específica e a proteína S100B são consideradas marcadores bioquímicos específicos de lesão neuronal e glial. Este estudo objetivou comparar os níveis sangüíneos de S100B e enolase sérica neurônio-específica em usuários crônicos de cocaína e em voluntários que não usam cocaína ou outras drogas ilícitas. MÉTODO: Vinte sujeitos dependentes de cocaína, mas não dependentes de álcool, maconha ou outra droga, e 20 sujeitos controles não usuários de drogas foram recrutados. Os sujeitos foram selecionados por amostragem consecutiva e não-probabilística e os níveis de enolase neurônio-específica e S100B foram determinados por ensaio de luminescência. RESULTADOS: Os usuários de cocaína tiveram escores significativamente maior que os controles em todas as dimensões psiquiátricas do SCL-90 e apresentaram prejuízos cognitivos no subteste cubos do WAIS e no span de palavras. Os níveis de S100B foram em média 0,09 ± 0,04 µg/l nos usuários de cocaína e 0,08 ± 0,04 µg/l nos controles. Os níveis de enolase neurônio-específica foram em média 9,7 ± 3,5 ng/l nos usuários e 8,3 ± 2,6 ng/l nos controles. CONCLUSÃO: Neste primeiro estudo utilizando esses marcadores específicos de lesão cerebral em usuários de cocaína, os níveis séricos de S100B e enolase específica do neurônio não foram significativamente diferentes entre dependentes de cocaína e controles.

Serum S100B and neuron-specific enolase as predictors of the neurologic disability status after traumatic brain injury

This study was designed to evaluate the correlation between serum levels of protein S100B and neuron-specific enolase [NSE] and the severity and outcome of traumatic brain injury [TBI] so as to be used as prognostic markers for cases admitted to Intensive care unit [ICU] after TBI. The study comprised 40 patients with head injury of varied severity and 10 volunteers [control group]. Inclusion criteria were head injury and presentation to the emergency department within 6 hours of injury. Initial injury severity was assessed using the Glasgow coma score [GCS] and all patients had cranial CT scans and lesions were evaluated with respect to lesion topography and territories of vascular supply. A venous blood sample was collected at admission for estimation of serum protein S100B and NSE levels. All patients received measures to decrease intracranial pressure [ICP] and phyntoin for posttraumatic seizures and underwent the appropriate neurosurgical procedure according to type of post-traumatic lesion. Follow-up was conducted monthly and the final outcome at six months was assessed using the Expanded Disability Status Scale [EDSS]. The mean initial GCS score was 11.1 +/- 3; 14 patients [35%] had mild, 17'patients [42.5%] had moderate and 9 patients [22.5%] had severe trauma. Normal CT was reported in 14 patients [35%]; however, CT scanning detected extradural hemorrhage in 5 patients [12.5%] fissure skull fracture in 5 patients [12.5%], fissure basal skull fracture in 3 patients [7.5%] and depressed skull fracture in 2 patients [5%]; while 3 patients [7.5%] had intracerebral hemorrhage and the other 8 patients had subdural hemorrhage, subdural hemorrhage with contusion, subdural hematoma and subarachnoid hemorrhage. Throughout follow-up, 18 patients [45%] had favorable outcome [EDSS<5]; while 22 patients had unfavorable outcome with EDSS >/= 5. Serum levels of S100B and NSE were significantly [P[1]<0.05] increased in patients compared to control levels, moreover, mean serum level of S100B was significantly [P[2]<0.05] and of NSE was non-significantly [P[2]>0.05] higher in patients with unfavorable outcome [EDSS >/=] compared to those with favorable outcome [EDSS<5] with a positive significant correlation between serum levels of S100B and NSE, [r = 0.485, p = 0.002]. Moreover, serum levels of both parameters showed a negative significant correlation with the initial GCS while showed a positive significant correlation with EDSS. However, there was a negative correlation between both parameters and the final outcome as favorable or unfavorable; such correlation was significant with S100B and non-significant with NSE. Using Logestic regression analysis serum S100B was the most significant predictor of the final outcome, [beta =-0.371, p = 0.018]. Receiver operator characteristics [ROC] curve analysis for serum levels of both S100B and NSE for prediction of favorable outcome found serum levels of S100B more specific with an area under curve [AUC] =0.379 than serum levels of NSE that found to be more sensitive with an AUC = 0.294. It could be concluded that estimation of serum S100B and NSE immediately after traumatic brain injury could define patients who will develop unfavorable outcome and posttraumatic disability with high sensitivity with NSE and specificity with S100 and must be used for the initial evaluation of TBI irrespective of the extent of severity of inflicted trauma

Prediction of hypoxic-ischemic brain damage in full-term neonates with acute encephalopathy, using two different brain proteins electroencephalogram and magnetic resonance imaging

The Objective of this study was to compare the usefulness of serum levels of two different brain proteins; Neuron specific enolase [NSE] and Creatinine brain specific kinase [CK-BB], electroencephalography [EEG], Conventional MRI imaging and diffusion-weighted MR imaging [DWMRI] for the early diagnosis of ischemic brain injury and prediction of hypoxic brain damage. The study was performed at Tanta University Hospitals, Neonatology Unit. The study design was a cross sectional one. A total of 30 term newborns, 20 with neonatal encephalopathy and 10 normal cases were included in the study. Clinical evaluation of neonatal condition and neurological outcomes was done. Serum estimation of NSE, CK-BB was done at 0, 12 and 24 hours after admission. Electroencephalography [EEG] was done at a median date of 1.17 days. Magnetic resonance imaging [MRI] both conventional and diffusion weighted were also done. EEG and MRI were done for the study group cases. The results showed that the Apgar score at 2 minutes has highest specificity with a good negative predictive value of severe brain injury. Arterial blood base deficit have the highest sensitivity and highest negative predictive values. The highest significance was evident at 12 hours values of both NSE and CK-BB. A combination of NSE at 12 h with arterial blood pH [cutoff value, <6.9] or arterial blood base deficit [cutoff value, >17 mM/L] increased the positive predictive value and specificity. Bad outcomes as severe degree or death are usually associated with the moderate to severe findings of both MRI and background trace of EEG. Bad outcomes as severe degree or death are usually associated with severe findings of both diffusion weighted MRI and background trace of EEG. The early EEG changes distinguish between those infants with a normal or abnormal outcome. MRI gives more specific information about the type of brain lesion. The 12 hour values of NSE and CK-BB have a good predictive power either alone or combined with other clinical tests or investigations. Combined biochemical testing and EEG may give very good indicators about neonatal outcomes. This early determination is becoming increasingly important with the advent of hypothermia and other potential neuroprotective therapies for the treatment of HI brain injury in the asphyxiated newborn

Neuron specific enolase in infants and children with simple and complex febrile seizures

Febrile convulsions are the commonest acute neurological disorder of early childhood. Although febrile seizures seldom cause severe brain insult, it has been recently suggested that febrile seizures can cause hippocampal damage and subsequent mesial temporal lobe epilepsy. This study was conducted to evaluate the serum and CSF levels of neuron specific enolase [NSE] as a marker of neuronal damage and lactate dehydrogenase [LDH] as a marker of metabolic derangement in infants and children with simple febrile seizures [n = 12], complex febrile seizures [n =36], and epilepsy [n =12]. All cases were subjected to full history taking and physical examination. Simultaneous serum and CSF sampling were done on admission for assessment of serum and CSF NSE and LDH levels. Results showed that patients with complex febrile seizures had significantly higher levels of serum and CSF NSE and LDH than cases with simple febrile seizures, whereas they had significantly lower levels of serum and CSF NSE than cases with epilepsy. Correlation studies showed significant negative correlation between age of the patients and serum and CSF levels of NSE in patients with complex febrile seizures, while significant positive correlation was found between duration of seizures and serum levels of LDH and between number of seizures and serum NSE levels in cases with complex febrile seizures. It is concluded from this study that complex febrile seizures are more injurious to the neurons than cases with simple febrile seizures especially in younger age group. Prompt diagnosis and guided management is recommended in such cases. NSE maybe a useful test for assessment of neuronal damage after febrile seizures

Blood ammonia, S100B and neuron-specific enolase levels in patients with hepatic encephalopathy

To evaluate circulating blood ammonia [NH3], S 100B and neuron-specific enolase [NSE] levels in patients with liver cirrhosis with or without hepatic encephalopathy [HE] and to choose which of these parameters could be used as a useful marker for early diagnosis of HE. Subjects and The study included 20 patients with liver cirrhosis without HE, 20 patients with sub clinical HE [SHE], 24 patients with HE grades I-IV and 20 matched for age and sex healthy control subjects. Blood levels of NH3, S100B and NSE were determined by calorimetric method for the former and by enzyme immunometric assay [EIA] for the 2 latter. Blood levels of NH3 and S 100B were significantly elevated in patients with cirrhosis, SHE and HE with various grades compared to normal subjects. Serum NSE levels were significantly increased in patients with SHE and HE with various grades compared to normal subjects. These parameters were significantly greater in patients with SHE and HE grades I-IV in comparison to cirrhotic patients. Serum S100B and NSE levels were significantly higher in patients with HE grades I-IV in comparison to SHE cases. Plasma NH3 levels showed no significant difference among patients with different Child-Pugh classes or between patients with different HE grades and SHE. Meanwhile, serum S 100B and NSE showed significant increase in Child class C in comparison to Child class A and B and in patients with different HE grades compared to those in SHE cases. Plasma NH3 level was significantly correlated with serum S100B and NSE levels and significant correlation was found also between S 100B and NSE levels. The 3 parameters exhibited similar sensitivity of 79.50%, but plasma NH3 and serum S 100B showed 100% specificity meanwhile, serum NSE showed 80% specificity for predicting HE in comparison to cirrhotic patients. Serum S100B levels appeared to be a better marker predicting HE than plasma NH3 and serum NSE

The Effect of Initial Serum Neuron-Specific Enolase Level on Clinical Outcome in Acute Carotid Artery Territory Infarction

The prediction of functional outcome in patients with acute cerebral infarction depends on many factors. Various techniques have been applied to predict severity and outcome after cerebral infarction. Neuron-specific enolase (NSE) is a component of a specific brain enzyme and a useful marker of brain injury. We evaluated the relation between initial serum NSE level and short- and long-term clinical outcome in 59 patients with acute cerebral infarction and in 38 age-matched healthy controls. Serum NSE levels were determined in patients with carotid artery (CA) territory cerebral infarction within 24 hours of onset. Brain MRI was performed four to seven days after stroke. Patients were divided into two groups: large CA territory infarction with a lesion extending cortex (cortex group), and small subcortical CA territory infarction (subcortical group) with a lesion confined to the subcortical white matter. We compared the initial serum NSE levels of the two groups. National Institute of Health Stroke Scale (NIHSS) was determined at admission and seven days after onset and the modified Rankin's scale was used at the 3 months follow-up after onset. Serum NSE levels were significantly elevated in patients with acute cerebral infarction compared with the normal controls (13.88 +/- 5.47 ng/dl vs. 8.15 +/- 1.53 ng/dl, p < 0.05). The initial ( < 24 h) serum NSE level was higher in the cortical group than in the subcortical group (16.68 +/- 5.70 ng/dl vs. 10.98 +/- 3.34 ng/dl, p < 0.05). NIHSS on admission and on the 7th day correlated with the initial serum NSE level (p < 0.05), as were more severe functional outcomes, as determined 3 months after onset (p < 0.05). This study shows that initial serum NSE level may be a useful marker for severity in acute ischemic stroke, and that it may be well correlated with short-term and long-term functional outcomes.

new method [nonivasive] for assessment of brain intergral functions in senescence: correlation of a neuropeptide with biological factors

This study was carried out on 10 young controls and 20 senescent individuals, 6 of which proved to be demented. For all subjects, the neuropeptide neuron specific enolase [NSE] was measured. NSE was significantly higher in geriatric than younger control P=0.01. 6 demented patients were still more high as compared with geriatric non demented 31, 21.2, respectively, P=0.0001. A correlation was found between those with high [NSE] as regards absence of milk in the diet, absence of physical and mental activity, habitual smoking, all these correlation were statistically significant P=0.0002, P=0.000001 and P=0.00003. It was concluded that simple assay of NSE in the serum dispose diagnostic and prognostic as regard early neuronal death among geriatric patients

Enolasa neuroespecífica plasmática en el período neonatal de niños asficticos / Neuron-specific enolasa in plasma in the neonatal period of asphyxiated infants

Se determinaron las concentraciones de enolasa neuroespecífica (ENE) en 17 recién nacidos (RN) controles y en 37 RN con asfixia. Estos valores fueron comparados con datos obtenidos de la historia clínica de la paciente (riesgo en el parto, riesgo materno, sufrimiento fetal, morbilidad en la primera semana de vida e indicadores de la gasometría sanguínea). La obtención de las muestras de sangre en los asficticos se realizó en el primer, cuarto y séptimo dia de vida. Los asficticos tuvieron valores medios de ENE de 18,13 (28,0) mg/L y 10,5 (9,14) mg/L en el primer y cuarto día de vida respectivamente y fueron valores significativamente superiores a los del grupo control también en el primer y cuarto día 5,92 (2,47) y 6,14 (3,03) mg/L. Se observó una tendencia general a la disminución de los niveles de ENE en plasma de los asfícticos en los primeros 7 dias de vida extrauterina. Las concentraciones plasmáticas de ENE en el primer día de vida mostraron asociasión significativa con la existencia de morbilidad en el RN durante la primera semana. No se encontró interrelación de los valores plasmáticos de ENE en el primer, cuarto y séptimo día de vida; y los valores de pH, pCO2, pO2, BS y EB en las 3 primeras horas posteriores al nacimiento