Model predicting survival/exitus after traumatic brain injury: biomarker S100B 24h.

BACKGROUND: The enigma of Traumatic Brain Injury (TBI), reflected in recent scientific literature, is its uncertain consequences, variability of the final prognosis with apparently similar TBI, necessity for peripheral biomarkers, and more specific predictive models. OBJECTIVES: To study the relationship between serum S100B and survival in TBI patients in various serious situations; the S100B level in patients without traumatic pathology or associated tumour, subjected to stressful situations such as neurological intensive care unit (NICU) stay; the possible overestimation caused by extracerebral liberation in TBI patients and associated polytraumatism; the predictive cutoffs to determine the most sensitive and specific chronology; and achieve a predictive prognostic model. METHODS: Patients admitted to the NICU within 6 hours after TBI were selected. We measured: a) clinical: exitus yes/no; age and gender, traumatic mechanism, polytraumatism yes/no, GCS score, unconsciousness duration, amnesia duration, neurological focality, and surgical interventions; b) radiological: CT scan for radiological lesions; c) biochemical: serum SB100B at 6, 24, 48 and 72 hours after TBI and drug abuse detected in the urine; d) GOS on hospital discharge. RESULTS: N: 149 TBI patients, independent of polytraumatism, mean serum S100B at 6, 24, 48, and 72 hours: 2.1, 1.3, 1.2, and 0.6 microg/L, respectively; N: 124 without associated polytraumatism, S100B at 6, 24, 48, and 72 hours: 2.0, 1.4, 1.3, and 0.6 microg/L; N: 50 control I S100B 24 hours: 0.17 microg/L (0.04 - 0.56) and 25 healthy subjects S100B 0.057 microg/L (0.02-0.094). CONCLUSIONS: Significantly higher S100B levels are observed on exitus, with excellent TBI prognosis and evolution performance. Hospital stay in the NICU produces significant increases in S100B compared to healthy subjects, without invalidating it as a biomarker. Polytraumatism associated to TBI does not significantly alter S100B levels. S100B at 24 hours > or = 0.90 microg/L appears to predict unfavourable TBI evolution with a NPV: 94.2% and PPV: 54.9%. We propose a predictive model when we associate S100B at 24 hours with amnesia duration over 30 minutes with a NPV of 85.5% and a PPV of 83.3%.

Influencia de la tiroidectomía sobre la pérdida de masa ósea en relación con el déficit de calcitonina y el tratamiento con tiroxina / Influence of thyroidectomy and thyroxin treatment on bone mass loss and calcitonin deficit

Introducción. Durante las últimas décadas se ha intentado valorar si la tiroidectomía y el tratamiento con tiroxina tienen un efecto negativo sobre la masa ósea. Los resultados publicados presentan discrepancias, faltan, además, estudios en pacientes con tratamiento sustitutivo. Material y métodos. Se realiza un estudio de casos y controles, comparando a mujeres tiroidectomizadas (n = 60) con mujeres sin enfermedad tiroidea, de la misma situación estrogénica y edad, peso y talla similares. Se determinan T3, T4, TSH, PTH, vitamina D, calcitonina basal e inducida, densitometría ósea lumbar y femoral (AXD) y marcadores de la actividad ósea (osteocalcina, FATR, hidroxiprolina y deoxipiridinolina), así como las dosis de tiroxina y el tiempo de tratamiento en cada paciente. Resultados. La comparación entre casos y controles no presentó diferencias en edad, peso, talla, PTH y vitamina D. No se hallaron diferencias densitométricas globales ni aumento de pérdida de densidad ósea en los subgrupos estrogénicos de las tiroidectomizadas. Tampoco se apreciaron diferencias en la osteocalcina y en la deoxipiridinolina. La calcitonina basal fue de 6,9 ñ 4,4 pg/ml en los controles y de 4,6 ñ 1,9 pg/ml en los casos (p < 0,01). No hubo respuesta al estímulo en las tiroidectomías totales, que presentó un incremento mínimo a los 5 minutos en las subtotales. Conclusiones. No existe aumento de pérdida de mineral óseo en mujeres tiroidectomizadas por enfermedad benigna no hipertiroidea tratadas con tiroxina. Éstas presentan valores de calcitonina inferiores a los controles con incapacidad de respuesta al estímulo con calcio (AU)

Plasma parathyroid hormone related-protein levels in patients with cancer, normocalcemic and hypercalcemic.

Hypercalcemia in patients with cancer may reflect the synthesis and secretion into circulation of parathyroid hormone-related protein (PTHrP) produced by the tumor. In the present study, we have measured circulating PTHrP concentrations in healthy subjects and patients using a new immunoradiometric assay (IRMA) that is specific for the 1-86 amino acid sequence of molecule, and in plasma collected with protease inhibitors. Plasma concentrations of PTHrP(1-86) were greater than the detection limit of the assay (0.3 pmol/l) in healthy subjects. All patients with hypercalcemia-associated cancer had PTHrP(1-86) levels significantly greater (median 7.74 pmol/l, P < 0.05) than healthy subjects or patients with cancer and normal serum calcium, primary hyperparathyroidism and hyperparathyroidism secondary to chronic renal failure. Plasma PTHrP and corrected serum calcium were correlated in patients with hypercalcemia-associated cancer. In one patient, a marked decrease in PTHrP and calcium levels was observed following surgery. Our results suggest that this IRMA for PTHrP(1-86) may be useful for diagnosis and monitoring of PTHrP-producing tumors induced hypercalcemia.

Automated quantification of TSH in serum by a chemiluminescent enzyme immunometric assay: analytical validation.

Thyroid stimulating hormone (thyrotropin; TSH) in serum was assayed with the Immulite-TSH, a fully automated solid-phase third-generation immunoassay analyzer that has a chemiluminescent detection system. The intraassay CV ranged from 3.6% to 6.2% for TSH mean concentrations from 0.025 to 32.12 mIU/L and the interassay CV ranged from 7.9% to 10% for TSH mean concentrations between 0.023 and 31.93 mIU/L. The analytical and functional detection limits of the assay were 0.001 and 0.0068 respectively. No interference was observed by any of the compounds: bilirubin, triglycerides, and hemoglobin. To compare the accuracy of Immulite-TSH with that of a conventional immuno-radiometric assay (Orion Diagnostica Irma-TSH), we examined 153 patient samples with TSH concentrations ranging approximately 0.2 to 100 mIU/L. At TSH concentration approximately 0.15 the precision was greater for Immulite-TSH than for Irma TSH (3.8% vs 11.87%) intraassay CV and (8.6% vs 35.4%) interassay CV. We concluded that Immulite-TSH is a rapid and precise third-generation assay, totally automated and the results can be provided to the clinician within 1 to 2 h of receipt of the patient's sample.

Serum insulin-like growth factor (IGF) binding protein-3 and IGF-I levels during childhood and adolescence. A cross-sectional study.

To investigate the effect of pubertal development on serum levels of IGF binding protein-3 (IGFBP-3) and IGF-I, and the relationship between IGFBP-3 levels and height, weight, weight for height and age (WFHA), and IGF-I levels, a cross-sectional study was performed in a Spanish basic education school in Vigo (NW Spain). The study was made up of 181 girls with a mean chronologic age of 11.03 +/- 0.22 y and 173 boys with a mean chronologic age of 10.9 +/- 0.23 y. The pubertal development was graded into three groups according to estradiol and testosterone concentrations for girls and boys, respectively. All subjects were in good health and among the 5th and 95th percentile for height. Serum IGFBP-3 and plasma IGF-I concentration was determined by RIA. Pubertal development was significantly associated with IGFBP-3 and IGF-I concentrations in girls and boys, respectively (p < 0.0001, analysis of variance). Multivariate regression analyses between IGF-I or IGFBP-3 with age, sex, and estradiol or testosterone show significative correlation in prepubertal children for IGF-I (r = 0.545, p = 0.0001 and r = 0.574, p = 0.0001 for girls and boys, respectively) and only in prepubertal boys for IGFBP-3 (r = 0.336, p = 0.0012). The linear correlation between IGF-I and IGFBP-3 was significant in both prepubertal (r = 0.25, p < 0.0001) and pubertal (r = 0.40, p < 0.0001) girls, but only in prepubertal boys (r = 0.30, p < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)