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Tandon M, Sheemar A, Bhatnagar K, Meena S, Shakrawal J. Central Retinal Artery Occlusion in Rhino-Orbital-Cerebral Mucormycosis: An Inflammatory-Prothrombotic State. Asia Pac J Ophthalmol (Phila) 2023; 12:16-20. [PMID: 36706330 DOI: 10.1097/apo.0000000000000593] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/18/2022] [Indexed: 01/28/2023] Open
Abstract
PURPOSE The aim was to evaluate patient profiles of rhino-orbital-cerebral mucormycosis (ROCM) cases with central retinal artery occlusion (CRAO) postcoronavirus disease 2019. DESIGN A nonrandomized retrospective case-control study. METHODS The ROCM cases presenting with CRAO were compared with a control ROCM group without CRAO at a tertiary care center. Demography, systemic status, clinical features, histopathology, imaging, and blood profile were assessed for any specific risk factors. RESULTS A total of 12 patients were seen in the CRAO group and 16 in the non-CRAO group. The male-to-female ratio was 3:1 with a mean age of 49.5 years. In the CRAO group, 75% had diabetes mellitus with mean hemoglobin A1c of 9.03%, and 66.7% had received steroid treatment. All cases were histopathologically confirmed positive for mucor. There was a significant difference in mean D-dimer and serum ferritin between the 2 groups, with higher level in the CRAO group. All patients with CRAO had light perception-negative vision, with total ophthalmoplegia and proptosis seen in 66.7% of cases. Four patients had orbital apex involvement, 5 had cavernous sinus involvement, and 8 had intracranial involvement in the CRAO group. CONCLUSIONS Inflammatory markers D-dimer and serum ferritin were significantly associated with CRAO, suggestive of hyperinflammatory and hypercoagulable state. A high index of suspicion should be maintained in cases with elevated markers and prophylactic anticoagulants can be started to prevent CRAO in a subset of patients.
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Affiliation(s)
- Manjari Tandon
- All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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LeDrew R, Bariciak E, Webster R, Barrowman N, Ahmet A. Evaluating the Low-Dose ACTH Stimulation Test in Neonates: Ideal Times for Cortisol Measurement. J Clin Endocrinol Metab 2020; 105:5903052. [PMID: 32901267 DOI: 10.1210/clinem/dgaa635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/03/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Low-dose adrenocorticotropic hormone stimulation testing (LDST) can be used to diagnose central adrenal insufficiency. However, uncertainty remains over optimal times to draw serum cortisol levels. OBJECTIVE To determine optimal times to draw serum cortisol levels for the LDST in neonates. DESIGN A retrospective chart review of LDSTs performed on neonates from January 1, 2009 to September 30, 2017. SETTING Children's Hospital of Eastern Ontario (CHEO), a tertiary-care outborn pediatric center. PATIENTS Forty-nine patients were included: 23 (46.9%) born at term, 12 (24.5%) born very preterm to late preterm, and 14 (28.6%) born extremely preterm. INTERVENTION Cortisol levels were drawn at baseline and 15, 30, and 60 minutes following administration of Cortrosyn 1 mcg/kg (maximum dose 1 mcg). MAIN OUTCOME MEASURE Timing of peak cortisol level and marginal value of drawing a second and third cortisol sample at 15, 30, or 60 minutes was determined. RESULTS Cortisol peaked at 15-, 30-, and 60-minute sampling times for 4%, 27%, and 69% of patients, respectively. The probability that a failed LDST changes to a pass by adding a 15- or 30-minute sample to the superior 60 minute sample is 5.6% (1% to 25.8%) and 11% (3.1% to 32.6%), respectively, for a cortisol pass threshold of 18.1mcg/dL (500 nmol/L). CONCLUSIONS In contrast to studies of older children, we found that the majority of neonatal LDST cortisol peaks occurred at the 60-minute sampling time with the addition of a 30-minute sample providing substantial benefit. It is questionable if a 15-minute sample provides any benefit, making a case to revise LDST protocols to sample cortisol later for neonates.
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Affiliation(s)
- Robyn LeDrew
- Department of Pediatrics, Division of Endocrinology, Saint John Regional Hospital, Saint John, New Brunswic, Canada
| | - Erika Bariciak
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Division of Neonatology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Richard Webster
- Clinical Research Unit, CHEO Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Nick Barrowman
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Clinical Research Unit, CHEO Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Alexandra Ahmet
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Division of Endocrinology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Dietrick B, Molloy E, Massaro AN, Strickland T, Zhu J, Slevin M, Donoghue V, Sweetman D, Kelly L, O’Dea M, McGowan M, Vezina G, Glass P, Vaidya D, Brooks S, Northington F, Everett AD. Plasma and Cerebrospinal Fluid Candidate Biomarkers of Neonatal Encephalopathy Severity and Neurodevelopmental Outcomes. J Pediatr 2020; 226:71-79.e5. [PMID: 32610169 PMCID: PMC10762645 DOI: 10.1016/j.jpeds.2020.06.078] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/25/2020] [Accepted: 06/25/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To identify candidate biomarkers in both plasma and cerebrospinal fluid (CSF) that are associated with neonatal encephalopathy severity measured by encephalopathy grade, seizures, brain injury by magnetic resonance imaging (MRI), and neurodevelopmental outcomes at 15-30 months. STUDY DESIGN A retrospective cohort study of plasma (N = 155, day of life 0-1) and CSF (n = 30, day of life 0-7) from neonates with neonatal encephalopathy and healthy neonates born at term (N = 30, ≥36 weeks of gestation) was conducted. We measured central nervous system necrosis (glial fibrillary acidic protein [GFAP], neurogranin [NRGN], tau), inflammatory (interleukin [IL]-6, IL-8, IL-10), and trophic (brain-derived neurotrophic factor [BDNF], vascular endothelial growth factor) proteins. Clinical outcomes were Sarnat scores of encephalopathy, seizures, MRI scores, and Bayley Scales of Infant and Toddler Development III at 15-30 months. RESULTS Plasma NRGN, tau, IL-6, IL-8, and IL-10 were greater, whereas BDNF and vascular endothelial growth factor were lower in patients with neonatal encephalopathy vs controls. In plasma, tau, GFAP, and NRGN were directly and BDNF inversely associated with encephalopathy grade. IL-6 was inversely related to seizures. Tau was directly related to MRI abnormalities. Tau was inversely associated with Bayley Scales of Infant and Toddler Development III cognitive and motor outcomes. In CSF, NRGN was inversely associated with cognitive, motor, and language measures. GFAP, IL-6, and IL-10 were inversely related to cognitive and motor outcomes. IL-8 was inversely related to motor outcomes. CSF candidate biomarkers showed no significant relationships with encephalopathy grade, seizures, or MRI abnormalities. CONCLUSIONS Plasma candidate biomarkers predicted encephalopathy severity, seizures, MRI abnormalities, and neurodevelopmental outcomes at 15-30 months.
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Affiliation(s)
- Barbara Dietrick
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eleanor Molloy
- Paediatrics, Trinity College, the University of Dublin & Coombe Women and Infants University Hospital, Dublin, Ireland
| | | | - Tammy Strickland
- Paediatrics, Trinity College, the University of Dublin & Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Jie Zhu
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | - Lynne Kelly
- Paediatrics, Trinity College, the University of Dublin & Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Mary O’Dea
- Paediatrics, Trinity College, the University of Dublin & Coombe Women and Infants University Hospital, Dublin, Ireland
| | | | | | - Penny Glass
- Children’s National Health Systems, Washington, D.C
| | - Dhananjay Vaidya
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sandra Brooks
- Johns Hopkins All Children’s Hospital, St. Petersburg, FL
| | - Frances Northington
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Allen D. Everett
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Yamaguchi H, Nishiyama M, Tokumoto S, Ishida Y, Tomioka K, Aoki K, Seino Y, Toyoshima D, Takeda H, Kurosawa H, Sakuma H, Tada H, Nozu K, Maruyama A, Tanaka R, Iijima K, Nagase H. Elevated cytokine, chemokine, and growth and differentiation factor-15 levels in hemorrhagic shock and encephalopathy syndrome: A retrospective observational study. Cytokine 2020; 137:155324. [PMID: 33032108 DOI: 10.1016/j.cyto.2020.155324] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/10/2020] [Accepted: 09/25/2020] [Indexed: 01/07/2023]
Abstract
Patients with hemorrhagic shock and encephalopathy syndrome (HSES) have a high early mortality rate, which may be caused by a 'cytokine storm'. However, there is little information on how cytokines and chemokines change over time in these patients. We aimed to describe the characteristics of HSES by examining changes in serum biomarker levels over time. Six patients with HSES were included. We retrospectively evaluated their clinical course and imaging/laboratory data. We measured serum levels of multiple cytokines [interleukin 1β (IL-1β), IL-2, IL-4, IL-6, IL-10, IL-17, interferon-gamma, and tumor necrosis factor alpha], chemokines (IL-8, monocyte chemoattractant protein-1, interferon-inducible protein-10), and growth and differentiation factor (GDF)-15. The highest cytokine and chemokine levels were noted in the first 24 h, and decreased thereafter. The GDF-15 level was markedly high. Cytokine, chemokine, and GDF-15 levels were significantly higher in patients with HSES than in controls in the first 24 h, except for IL-2 and IL-4. Patients with HSES have high inflammatory cytokine and chemokine levels, a high GDF-15 level in the first 24 h, and high lactate levels. Our study provides new insights on the pathophysiology of HSES, a detailed clinical picture of patients with HSES, and potential biomarkers.
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Affiliation(s)
- Hiroshi Yamaguchi
- Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan.
| | - Masahiro Nishiyama
- Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Shoichi Tokumoto
- Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan; Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan
| | - Yusuke Ishida
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan
| | - Kazumi Tomioka
- Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Kazunori Aoki
- Department of Pediatric Critical Care Medicine, Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan
| | - Yusuke Seino
- Department of Pediatric Critical Care Medicine, Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan
| | - Daisaku Toyoshima
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan
| | - Hiroki Takeda
- Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Hiroshi Kurosawa
- Department of Pediatric Critical Care Medicine, Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan
| | - Hiroshi Sakuma
- Department of Brain Development and Neural Regeneration, Tokyo Metropolitan Institute of Medical Science, Setagaya, Tokyo, Japan
| | - Hiroko Tada
- Department of Brain Development and Neural Regeneration, Tokyo Metropolitan Institute of Medical Science, Setagaya, Tokyo, Japan
| | - Kandai Nozu
- Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Azusa Maruyama
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan
| | - Ryojiro Tanaka
- Department of Emergency and General Pediatrics, Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan
| | - Kazumoto Iijima
- Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Hiroaki Nagase
- Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan
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Abstract
Reversible splenial lesion syndrome (RESLES) is a clinico-radiological entity that defines a reversible lesion in the splenium of the corpus callosum (SCC) on magnetic resonance imaging (MRI). The clinical and radiological characteristics of RESLES are poorly defined and most RESLES literature is in the form of case reports. We reviewed the clinical and radiological data from 11 RESLES patients in order to more clearly describe the characteristics of this disorder in adults.Patients included in this study were diagnosed with RESLES from May 2012 to March 2018. We collected clinical, imaging, and laboratory data of 11 adult patients from Neurology Department of the Affliated Yantai Yuhuangding Hospital of Qingdao University. After analyzing various clinico-radiological features and laboratory parameters, including serum sodium, pathogen testing, cerebrospinal fluid (CSF) studies, electroencephalography (EEG), and MRI findings, we made a diagnosis of RESLES based on the criteria proposed previously by Garcia-Monco et al.Of the 11 patients, 7 (63.63%) were male and 4 (36.36%) were female, ranging in age from 24 to 62 years with an average age of 31.48 ± 11.47 years. Seven cases occurred in the months of winter and spring (December-March). The primary clinical symptoms were headache, seizure, disturbance of consciousness, mental abnormality, and dizziness. All 11 patients had lesions in the SCC and all the lesions disappeared or significantly improved on follow-up imaging that was done within a month of symptom resolution.We found 5 (45.45%) patients had a CSF opening pressure >180 mmH2O, in addition to elevated protein and(or) leukocytes levels in 3 (27.27%) patients. The serum sodium concentration in 6 (54.55%) patients was low (<137 mmol/L) and EEG showed nonspecific slowing in waves 4 (36.36%) patients.When we encounter clinical manifestations such as headache accompanied with mental symptoms, disturbance of consciousness or epilepsy, and brain MRI finds lesions of the corpus callosum, we should consider whether it is RESLES. In order to find out the possible cause of the disease, we should carefully inquire about the history of the disease, complete etiology examination, and CSF tests. Of course, it is one of the necessary conditions for the diagnosis that the lesions in the corpus callosum are obviously relieved or disappeared.
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Affiliation(s)
- Xiaoyu Gao
- Department of Neurology, the Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Qiaochan Feng
- Department of Neurology, the Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Saeed Arif
- Neurology Department, Pakistan Emirates Military Hospital, Rawalpindi, Pakistan
| | - Jahanzeb Liaqat
- Neurology Department, Pakistan Emirates Military Hospital, Rawalpindi, Pakistan
| | - Bing Li
- Department of Neurology, the Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Kun Jiang
- Department of Neurology, the Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
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Wu HY, Wang SJ, Gao ZQ, Jiang H. [Preliminary analysis of central paroxysmal positional vertigo]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2020; 55:754-759. [PMID: 32791773 DOI: 10.3760/cma.j.cn115330-20200616-00504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Objective: To explore the possible pathogenesis of central paroxysmal positional vertigo (CPPV) by analyzing its clinical manifestations and characteristics. Methods: The clinical data of 3 patients with CPPV, including 1 male and 2 females, aged 36, 14 and 70 years old respectively, were collected from the Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences from June 2014 to June 2018. The clinical symptoms, nystagmus, other central ocular motor abnormalities, MRI, PET-CT, and laboratory findings were analyzed retrospectively. Results: All patients showed transient vertigo and nystagmus induced by head changes relative to gravity, but the characteristics of nystagmus did not conform to the typical characteristics of nystagmus in benign paroxysmal positional vertigo. None of patients response to repositioning maneuvers, and all patients presented with the signs of abnormal visual oculomotor system or other symptoms of central system. MRI, PET-CT and blood biochemical tests confirmed that the causes of CPPV in the patients were chronic hemorrhage, inflammation and paraneoplastic cerebellar degeneration. Although the etiology of the three cases is different, the lesion site is involved in the central velocity storage mechanism. Conclusion: The damage of central velocity storage mechanism may lead to the damage of feedback rotation signal correction pathway, and CPPV appears when the head position changes relative to gravity.
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Affiliation(s)
- H Y Wu
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - S J Wang
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Z Q Gao
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - H Jiang
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
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Kazanasmaz H, Gumus H. C-Reactive Protein and Blood Gas Analysis in Cases of Neonatal Encephalopathy Treated with Therapeutic Hypothermia. Ann Clin Lab Sci 2020; 50:364-370. [PMID: 32581027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Neonatal encephalopathy (NE) is one of the important causes of mortality and morbidity today. Therapeutic hypothermia (TH) applied to moderate and severe NE patients has neuroprotective effects. The role of C-reactive protein (CRP) in determining the clinical severity of NE is not clear. METHODS Medical records of 118 NE patients treated with TH were reviewed. The patients were divided into two groups as CRP positive (CRP-P) (≥1 mg/dL) and CRP negative (CRP-N) (<1 mg/dL) according to the CRP value measured immediately before rewarming phase during TH. Cord blood base deficits (BD) and pH were also examined. RESULTS According to Sarnat&Sarnat classification, moderate NE cases were more frequent in the CRP-N group, whereas severe cases were more frequent in CRP-P group (p<0.001). There was a significant increase in CRP value during the rewarming phase of TH in both CRP-P and CRP-N groups (p<0.001). The specificity and sensitivity for CRP (measured during TH) predicting NE severity was 72% and 77%, respectively (AUC:0.742). For cord blood BD (AUC: 0.845) 79% sensitivity and 78% specificity were found, whereas pH (AUC: 155) had 10% sensitivity and 60% specificity. CONCLUSION CRP level measured immediately before the rewarming phase may be useful biomarker for NE severity along with cord blood BD.
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Affiliation(s)
- Halil Kazanasmaz
- Department of Pediatrics, Harran University Faculty of Medicine, Sanliurfa, Turkey
| | - Huseyin Gumus
- Department of Pediatrics, Harran University Faculty of Medicine, Sanliurfa, Turkey
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Wang H. Higher Procalcitonin Level in Cerebrospinal Fluid than in Serum Is a Feasible Indicator for Diagnosis of Intracranial Infection. Surg Infect (Larchmt) 2020; 21:704-708. [PMID: 32053058 DOI: 10.1089/sur.2019.194] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective: To explore the value of the difference in procalcitonin (PCT) levels in serum and cerebrospinal fluid (CSF) for diagnosing intracranial infection in post-neurosurgical patients. Methods: Patients who were treated at our hospital after craniotomy from January 2015 to January 2019 were enrolled in this study. Twenty patients eventually diagnosed with intracranial infection were included in a study group and 22 patients with no intracranial infection were included in a control group. A t-test was used to compare the differences between serum and CSF PCT levels of PCT, and the diagnostic value of PCT was evaluated by receiver operating characteristic (ROC) curve analysis. Results: The serum PCT levels in the study and control groups were 0. 10 ± 0. 03 ng/mL and 0. 09 ± 0. 03 ng/mL, respectively, and they were not substantially different between the groups. The CSF PCT level in the study group was substantially higher than that in the control group, with values of 0. 13 ± 0. 03 ng/mL and 0. 07 ± 0. 02 ng/mL, respectively. The CSF/serum PCT ratio in the study group was substantially higher than that in the control group, with values of 1. 31 ± 0. 19 and 0. 79 ± 0. 23, respectively. The areas under the ROC curve for serum PCT, CSF PCT and the CSF/serum PCT ratio were 0. 56, 0. 92, and 0. 95, respectively, resulting in a substantial difference among the three groups. Conclusion: CSF PCT may be a valuable marker for diagnosing intracranial infection in patients after neurosurgery; in particular, the specificity of CSF PCT is higher if the CSF PCT level is higher than the serum PCT level.
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Affiliation(s)
- Huajun Wang
- Department of Intensive Care Unit, Yinzhou People's Hospital, Ningbo University Medical College, Ningbo, Zhejiang, China
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Sağ S, Sağ MS, Tekeoğlu I, Kamanlı A, Nas K, Acar BA. Central nervous system involvement in rheumatoid arthritis: possible role of chronic inflammation and tnf blocker therapy. Acta Neurol Belg 2020; 120:25-31. [PMID: 29288410 DOI: 10.1007/s13760-017-0879-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 12/26/2017] [Indexed: 12/29/2022]
Abstract
Rheumatoid arthritis (RA) is a chronic disease, the etiology of which has yet to be clarified, which causes activation of proinflammatory pathways that bring about joint and systemic inflammation. Although peripheral nervous system anomalies are observed widely in RA, very few case reports on changes in the central nervous system (CNS) have been published. In recent years, the pathophysiology of CNS involvement that can occur in RA has attracted a great deal of attention. Emphasis has focused on the possibility that CNS involvement occurs due to blood-brain barrier (BBB) damage associated with chronic inflammation. The present study was performed to investigate the possible effects of BBB dysfunction and tumor necrosis factor (TNF) blocker therapy on BBB function, which may cause CNS damage in patients with RA. 58 RA patients [47 (81.0%) females, 11 (19.0%) males] and 34 healthy controls [24 (70.6%) females, 10 (29.4%) males] were included in the study. All RA patients were on synthetic DMARD therapy at the beginning. Thirty patients continued DMARD therapy, and 28 patients with high disease activity were started on TNF blocker therapy. All demographic characteristics of the patients were recorded. Disease activity was evaluated using the Disease Activity Score 28-joint count C reactive protein. The Mini-Mental State Examination was used to evaluate cognitive function, and the Fazekas scale was used to assess cranial lesions visualized by magnetic resonance imaging (MRI). Patients' peripheral blood S100β, glial fibrillary acidic protein (GFAP), claudin, interleukin (IL)-17, and IL-1β levels were measured at the beginning of the study and after 6 months. Demographic characteristics (including sex, age, and body mass index) were similar in the RA and control groups. S100β and GFAP levels were significantly higher in the patient group than in the control group. In the group that was started on TNF blocker therapy, S100β and GFAP levels were significantly decreased 6 months after commencement of treatment. No difference was observed between the RA and control groups in terms of hyperintense lesions seen on cranial MRI. The S100β levels increased with lesions in the deep white matter seen on cranial MRI in patients with RA. In conclusion, next to decreasing disease activity and joint erosions by suppressing inflammation, anti-TNF therapy in RA can also suppress potential CNS involvement linked to BBB (blood-brain barrier) dysfunction. Further studies with broader participation and longer patient follow-up are needed to reinforce this hypothesis.
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Affiliation(s)
- Sinem Sağ
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Sakarya University Faculty of Medicine, Sakarya, Turkey.
| | - Mustafa Serdar Sağ
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Sakarya University Research and Training Hospital, Sakarya, Turkey
| | - Ibrahim Tekeoğlu
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Ayhan Kamanlı
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Kemal Nas
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Sakarya University Faculty of Medicine, Sakarya, Turkey
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Wang Y, Sheng G, Shi L, Cheng X. Increased serum total bilirubin-albumin ratio was associated with bilirubin encephalopathy in neonates. Biosci Rep 2020; 40:BSR20192152. [PMID: 31950971 PMCID: PMC6997104 DOI: 10.1042/bsr20192152] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 12/31/2019] [Accepted: 01/08/2020] [Indexed: 11/17/2022] Open
Abstract
We performed the present study to summarize the recent epidemiological characteristics of bilirubin encephalopathy and assess the role of total bilirubin-albumin ratio in the bilirubin encephalopathy. We retrospectively collected clinical data of 669 neonates with hyperbilirubinemia from the First Affiliated Hospital of Zhengzhou University between January 2015 and July 2018, including 153 neonates belonged to bilirubin encephalopathy and 516 ones were treated as control group. Compared with the control group, those with bilirubin encephalopathy have higher bilirubin-albumin ratio (13.8 ± 3.6 vs. 10.6 ± 2.5, P=0.000). The direct bilirubin and indirect bilirubin level were higher in the case group than that in the control group (P=0.000). On the contrary, the hemoglobin level was lower in the case group than that in the control group (P=0.004). There were no significant differences in gestational age (P=0.510), gender rate (P=0.313), maternal gestational diabetes ratio (P=0.071), natural childbirth ratio (P=0.686), and meconium delay (P=0.091). The results from univariate regression indicated the total bilirubin/albumin ratio was positively associated with bilirubin encephalopathy (odds ratio (OR) = 1.67, 95% confidence interval (CI): 1.59-3.14). The total bilirubin, direct bilirubin, and indirect bilirubin were also related to encephalopathy. After adjusting some potential cofounding factors, the total bilirubin-albumin was still associated with bilirubin encephalopathy. The higher total bilirubin-albumin ratio increased the risk of bilirubin encephalopathy by 23% (OR = 1.23, 95% CI: 1.16-2.48). Our results indicated that the bilirubin-albumin ratio is associated with bilirubin encephalopathy in neonates, and could be a potential predictor.
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Affiliation(s)
- Yan Wang
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province 450052, China
- Henan Medical College, Zhengzhou, Henan Province 451191, China
| | - Guangyao Sheng
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province 450052, China
| | - Lina Shi
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province 450052, China
| | - Xiuyong Cheng
- Department of Neonatology,The Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province 450052, China
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Muradbegovic J, Leidi A, Serratrice J. [Cefepime-induced encephalopathy]. Rev Med Suisse 2019; 15:2210-2212. [PMID: 31778052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Since 2017 the world suffers from a piperacillin/tazobactam shortage. Cefepime is then proposed as a broad spectrum antibiotic alternative. Up to 15 % of the patients under treatment develop neurotoxicity, mostly in kidney failure settings. Cefepime serum concentration and electroencephalogram guide diagnosis. Treatment consists in withholding or reducing the dose. Most of the patients recover without neurologic sequelae.
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Affiliation(s)
| | - Antonio Leidi
- Service de médecine interne générale, HUG, 1211 Genève 14
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12
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Elshorbagy HH, Barseem NF, Elsadek AE, Al-shokary AH, Maksoud YHA, Abdulsamea SE, Talaat IM, Suliman HA, Kamal NM, Abdelghani WE, Azab SM, El Din DMN. Serum Neuron-specific Enolase and S100 Calcium-binding Protein B in Pediatric Diabetic Ketoacidosis. J Clin Res Pediatr Endocrinol 2019; 11:374-387. [PMID: 31067852 PMCID: PMC6878350 DOI: 10.4274/jcrpe.galenos.2019.2018.0280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 05/07/2019] [Indexed: 12/27/2022] Open
Abstract
Objective Neuron-specific enolase (NSE) and S100 calcium-binding protein B (S100B) are markers of different neurological disorders. The aim was to investigate the relationship between NSE and S100B serum concentrations and the severity of diabetic ketoacidosis (DKA) in diabetic children. Methods Eighty children with DKA, 40 with type 1 diabetes mellitus (T1DM) without DKA and 40 healthy controls were enrolled. Severity of DKA was assessed according to blood pH and bicarbonate concentration. Serum NSE and S100B were measured in all participants. In the DKA group serum NSE and S100B were measured at three time points, at admission and at 12 hours and 24 hours after starting treatment. Results Children with DKA showed significantly higher serum levels of NSE at all time points compared to children with T1DM without DKA and controls (p<0.01), while serum S100B concentrations did not differ between the three cohorts. Children with T1DM but without DKA also had significantly higher serum levels of NSE (p<0.01) compared to healthy controls. Patients with low Glasgow Coma Scale score (GCSS) and those with moderate and severe DKA had significantly higher levels of NSE at all time points (p<0.01 for each) compared to patients with normal GCSS and those with mild DKA. No significant differences were found in serum S100B levels according to the severity of DKA and GCS (p>0.05). Younger age, lower GCSS, higher glucose and HbA1c, lower pH and lower serum bicarbonate were the risk factors associated with elevated NSE. Conclusion Serum NSE is elevated in all patients with type 1 DM and, in patients with DKA, correlates with severity of DKA. However, serum S100B concentration did not differ between T1DM with or without DKA and healthy controls.
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Affiliation(s)
- Hatem Hamed Elshorbagy
- Menoufia University Faculty of Medicine, Departments of Pediatrics and Pediatric Neurology, Shebeen Elkom, Egypt; Alhada and Taif Armed forces Hospitals, Departments of Pediatrics and Pediatric Neurology, Taif, Saudi Arabia
| | - Naglaa Fathy Barseem
- Menofia University Faculty of Medicine, Department of Pediatrics, Shebeen Elkom, Egypt
| | | | | | | | | | - Iman M. Talaat
- Ain Shams University Faculty of Medicine, Department of Pediatrics, Cairo, Egypt
| | | | - Naglaa M. Kamal
- Cairo University Faculty of Medicine, Departments of Pediatrics and Pediatric Hepatology, Cairo, Egypt; Alhada Armed forces Hospital, Clinics of Pediatric Hepatology and Gastroenterology, Taif, Saudi Arabia
| | | | - Sanaa Mohammed Azab
- Al-Azhar University Faculty of Medicine, Department of Pediatrics, El-Khalifa, Egypt
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13
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Jonesco DS, Hassager C, Frydland M, Kjærgaard J, Karsdal M, Henriksen K. A caspase-6-cleaved fragment of Glial Fibrillary Acidic Protein as a potential serological biomarker of CNS injury after cardiac arrest. PLoS One 2019; 14:e0224633. [PMID: 31693684 PMCID: PMC6834260 DOI: 10.1371/journal.pone.0224633] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/17/2019] [Indexed: 12/31/2022] Open
Abstract
Blood levels of Glial Fibrillary Acidic protein (GFAP) reflect processes associated with different types of CNS injury. Evidence suggests that GFAP is cleaved by caspases during CNS injury, hence positioning GFAP fragments as potential biomarkers of injury-associated processes. We set out to develop an assay detecting the neo-epitope generated by caspase-6 cleavage of GFAP (GFAP-C6), and to assess the ability of GFAP-C6 to reflect pathological processes in patients suffering a cardiac arrest and subsequent global cerebral ischemia. Anti-GFAP-C6 antibodies recognized their specific target sequence, and dilution and spike recoveries in serum were within limits of ±20% reflecting high precision and accuracy of measurements. Intra- and inter-assay CVs were below limits of 10% and 15%, respectively. Serological levels of GFAP-C6 were significantly elevated 72 hours after CA (Mean±SD) (20.39±10.59 ng/mL) compared to time of admission (17.79±10.77 ng/mL, p<0.0001), 24 hours (17.40±7.99 ng/mL, p<0.0001) and 48 hours (17.87±8.56 ng/mL, p<0.0001) after CA, but were not related to neurological outcome at day 180. GFAP-C6 levels at admission, 24, 48, and 72 hours after cardiac arrest correlated with two proteolytic fragments of tau, tau-A (r = 0.30, r = 0.40, r = 0.50, r = 0.53, p < 0.0001) and tau-C (r = 54, r = 0.48, r = 0.55, r = 0.54, p < 0.0001), respectively. GFAP-C6 levels did not correlate with other markers of CNS damage; total tau, NSE and S100B. In conclusion, we developed the first assay detecting a caspase-6 cleaved fragment of GFAP in blood. Increased levels at 72 hours after cardiac arrest as well as moderate correlations between GFAP-C6 and two other blood biomarkers of neurodegeneration suggest the ability of GFAP-C6 to reflect pathological processes of the injured brain. Investigations into the potential of GFAP-C6 in other types of CNS injury are warranted.
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Affiliation(s)
- Ditte S. Jonesco
- Biomarkers & Research, Nordic Bioscience, Herlev, Denmark
- * E-mail:
| | - Christian Hassager
- Department of Cardiology B, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Martin Frydland
- Department of Cardiology B, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jesper Kjærgaard
- Department of Cardiology B, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Morten Karsdal
- Biomarkers & Research, Nordic Bioscience, Herlev, Denmark
| | - Kim Henriksen
- Biomarkers & Research, Nordic Bioscience, Herlev, Denmark
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14
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Abstract
Clinical use of blood oxygen level dependent (BOLD) functional magnetic resonance imaging (fMRI) is a relatively new phenomenon, with only about 3 decades of collective experience. Nevertheless, task-based BOLD fMRI has been widely accepted for presurgical planning, over traditional methods, which are invasive and at times perilous. Many studies have demonstrated the ability of BOLD fMRI to make substantial clinical impact with respect to surgical planning and preoperative risk assessment, especially to localize the eloquent motor and visual areas. Reproducibility and repeatability of language fMRI are important in the assessment of its clinical usefulness. There are national efforts currently underway to standardize language fMRI. The American Society of Functional Neuroradiology (ASFNR) has recently provided guidelines on fMRI paradigm algorithms for presurgical language assessment for language lateralization and localization. In this review article, we provide a comprehensive overview of current standards of language fMRI mapping and its reproducibility.
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Affiliation(s)
- Shruti Agarwal
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Haris I Sair
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sachin Gujar
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jay J Pillai
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
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15
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Mair RD, Nguyen H, Huang TT, Plummer NS, Sirich TL, Meyer TW. Accumulation of uremic solutes in the cerebrospinal fluid in experimental acute renal failure. Am J Physiol Renal Physiol 2019; 317:F296-F302. [PMID: 31141401 PMCID: PMC6732458 DOI: 10.1152/ajprenal.00100.2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/02/2019] [Accepted: 05/20/2019] [Indexed: 01/30/2023] Open
Abstract
The accumulation of uremic solutes in kidney failure may impair mental function. The present study profiled the accumulation of uremic solutes in the cerebrospinal fluid (CSF) in acute renal failure. CSF and plasma ultrafiltrate were obtained from rats at 48 h after sham operation (control; n = 10) or bilateral nephrectomy (n = 10) and analyzed using an established metabolomic platform. Two hundred forty-eight solutes were identified as uremic based on their accumulation in the plasma ultrafiltrate of nephrectomized compared with control rats. CSF levels of 124 of these solutes were sufficient to allow calculation of CSF-to-plasma ultrafiltrate concentration ratios. Levels of many of the uremic solutes were normally lower in the CSF than in the plasma ultrafiltrate, indicating exclusion of these solutes from the brain. CSF levels of the great majority of the uremic solutes increased in renal failure. The increase in the CSF was, however, relatively less than in the plasma ultrafiltrate for most solutes. In particular, for the 31 uremic solutes with CSF-to-plasma ultrafiltrate ratios of <0.25 in control rats, the average CSF-to-plasma ultrafiltrate ratio decreased from 0.13 ± 0.07 in control rats to 0.09 ± 0.06 in nephrectomized rats, revealing sustained ability to exclude these solutes from the brain. In summary, levels of many uremic solutes are normally kept lower in the CSF than in the plasma ultrafiltrate by the action of the blood-brain and blood-CSF barriers. These barriers remain functional but cannot prevent accumulation of uremic solutes in the CSF when the kidneys fail.
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Affiliation(s)
- Robert DeWolfe Mair
- Division of Nephrology, Stanford University , Stanford, California
- Department of Medicine, Veterans Affair Palo Alto Health Care System, Palo Alto, California
| | - Huy Nguyen
- Department of Neurology and Neurological Sciences, Stanford University , Stanford, California
| | - Ting-Ting Huang
- Department of Neurology and Neurological Sciences, Stanford University , Stanford, California
- Geriatric Research, Education and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Natalie S Plummer
- Department of Medicine, Veterans Affair Palo Alto Health Care System, Palo Alto, California
| | - Tammy L Sirich
- Division of Nephrology, Stanford University , Stanford, California
- Department of Medicine, Veterans Affair Palo Alto Health Care System, Palo Alto, California
| | - Timothy W Meyer
- Division of Nephrology, Stanford University , Stanford, California
- Department of Medicine, Veterans Affair Palo Alto Health Care System, Palo Alto, California
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Lin YY, Lee KY, Ro LS, Lo YS, Huang CC, Chang KH. Clinical and cytokine profile of adult acute necrotizing encephalopathy. Biomed J 2019; 42:178-186. [PMID: 31466711 PMCID: PMC6717751 DOI: 10.1016/j.bj.2019.01.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 11/26/2018] [Accepted: 01/22/2019] [Indexed: 01/09/2023] Open
Abstract
Background Acute necrotizing encephalopathy (ANE), a fulminant encephalopathy, is often found in childhood. It is still uncertain whether adult patients with ANE display clinical features different from patients with typical pediatric onset. Furthermore, alterations in neuroinflammatory factors in patients with ANE have not been well-characterized. Here, we present an adult patient with ANE, and review all reported adult ANE cases in the literature. Methods Serum levels of five cytokines were checked in an adult patient with ANE and compared with gender/age-matched controls. Literature search was performed with PubMed, using the term as “acute necrotizing encephalopathy” with the filter of adult 19 + years. Results A total of 13 adult patients were reviewed. Compared with pediatric patients, adult ANE patients had similar clinical symptoms, biochemical data, and neuroimage findings, whereas adult ANE were more female-biased (female:male, 9:4) with a worse prognosis. Elevated cytokine levels in the serum and/or CSF is found in both adult-onset and pediatric-onset ANE. We found significantly elevated serum levels of IL-6 (17.17 pg/mL; healthy control: 1.43 ± 1.22 pg/mL) and VCAM-1 (3033.92 ng/mL; healthy control: 589.71 ± 133.13 ng/mL), and decreased serum TGF-β1 level (14.78 ng/mL, healthy controls: 25.81 ± 6.97 ng/mL) in our patient. Conclusions Our findings clearly delineate the clinical features and further indicate the potential change in cytokine levels in adult patients with ANE, advancing our understanding of this rare disease.
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Affiliation(s)
- Yi-Ying Lin
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuang-Yung Lee
- Department of Neurology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Long-Sun Ro
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yen-Shi Lo
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chin-Chang Huang
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Hsuan Chang
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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17
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Akman C, Ülker Çakır D, Bakırdöğen S, Balcı S. The Effect of Serum Calcium Levels on Uremic Encephalopathy in Patients with Acute Kidney Injury in the Emergency Department. ACTA ACUST UNITED AC 2019; 55:medicina55050204. [PMID: 31126169 PMCID: PMC6572505 DOI: 10.3390/medicina55050204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/09/2019] [Accepted: 05/16/2019] [Indexed: 12/02/2022]
Abstract
Background and objectives: Uremic encephalopathy is the most important complication of renal failure and urgent dialysis treatment is required. Parathormone (PTH) contributes to the etiopathogenesis of uremic encephalopathy. PTH is a hormone that acts in the calcium balance in the organism. The aim of our study was to investigate the effect of serum adjusted and ionized calcium on the development of uremic encephalopathy in patients with acute renal injury (acute kidney injury network (AKIN) stage 3). Materials and Methods: Our study was supported by Canakkale Onsekiz Mart University Scientific Research Projects Unit (ID:1278). Three groups were formed for the study. The first group was acute renal failure AKIN stage 3 (N: 23), the second group was AKIN stage 3, and the patients who had emergency hemodialysis (N: 17) and the third group (N: 9) had AKIN stage 3 hemodialysis due to uremic encephalopathy. In these patient groups, 25-hydroxy vitamin D, PTH, calcium, albumin, urea, creatinine, and blood-gas-ionized calcium were observed in their serum during the first application. Calcium, albumin, urea, creatinine, and ionized calcium in blood gas were also examined in serum at 24th and 72th hours. Data were analyzed using SPSS version 19.0. Kruskal–Wallis test and Mann–Whitney U test were applied for the variables that did not comply with normal distribution. p < 0.005 was accepted statistically. Results: A statistically significant difference was found between the measurement creatinine values at the 24th and 72th hours of admission in AKIN stage 3 patients who applied to the emergency department (p = 0.008). A statistically significant difference was found in the measured calcium values (p = 0.013). A statistically significant difference was found in the measured ionized calcium values (p = 0.035). Conclusions: In our study, the effect of ionized calcium level on uremic encephalopathy in serum creatinine, calcium, and blood gas in patients presenting with acute renal injury, AKIN stage 3, was significant, but studies with new and large groups are needed.
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Affiliation(s)
- Canan Akman
- Emergency Medicine Department, Çanakkale Onsekiz Mart University Faculty of Medicine, 17020 Çanakkale, Turkey.
| | - Dilek Ülker Çakır
- Biochemistry Department, Çanakkale Onsekiz Mart University Faculty of Medicine, 17020 Çanakkale, Turkey.
| | - Serkan Bakırdöğen
- Internal Medicine Department, Çanakkale Onsekiz Mart University Faculty of Medicine, 17020 Çanakkale, Turkey.
| | - Serdal Balcı
- Şırnak State Hospital, Emergency Service, 73000 Şırnak, Turkey.
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18
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Favié LMA, Groenendaal F, van den Broek MPH, Rademaker CMA, de Haan TR, van Straaten HLM, Dijk PH, van Heijst A, Dudink J, Dijkman KP, Rijken M, Zonnenberg IA, Cools F, Zecic A, van der Lee JH, Nuytemans DHGM, van Bel F, Egberts TCG, Huitema ADR. Pharmacokinetics of morphine in encephalopathic neonates treated with therapeutic hypothermia. PLoS One 2019; 14:e0211910. [PMID: 30763356 PMCID: PMC6375702 DOI: 10.1371/journal.pone.0211910] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 01/22/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Morphine is a commonly used drug in encephalopathic neonates treated with therapeutic hypothermia after perinatal asphyxia. Pharmacokinetics and optimal dosing of morphine in this population are largely unknown. The objective of this study was to describe pharmacokinetics of morphine and its metabolites morphine-3-glucuronide and morphine-6-glucuronide in encephalopathic neonates treated with therapeutic hypothermia and to develop pharmacokinetics based dosing guidelines for this population. STUDY DESIGN Term and near-term encephalopathic neonates treated with therapeutic hypothermia and receiving morphine were included in two multicenter cohort studies between 2008-2010 (SHIVER) and 2010-2014 (PharmaCool). Data were collected during hypothermia and rewarming, including blood samples for quantification of morphine and its metabolites. Parental informed consent was obtained for all participants. RESULTS 244 patients (GA mean (sd) 39.8 (1.6) weeks, BW mean (sd) 3,428 (613) g, male 61.5%) were included. Morphine clearance was reduced under hypothermia (33.5°C) by 6.89%/°C (95% CI 5.37%/°C- 8.41%/°C, p<0.001) and metabolite clearance by 4.91%/°C (95% CI 3.53%/°C- 6.22%/°C, p<0.001) compared to normothermia (36.5°C). Simulations showed that a loading dose of 50 μg/kg followed by continuous infusion of 5 μg/kg/h resulted in morphine plasma concentrations in the desired range (between 10 and 40 μg/L) during hypothermia. CONCLUSIONS Clearance of morphine and its metabolites in neonates is affected by therapeutic hypothermia. The regimen suggested by the simulations will be sufficient in the majority of patients. However, due to the large interpatient variability a higher dose might be necessary in individual patients to achieve the desired effect. TRIAL REGISTRATION www.trialregister.nl NTR2529.
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Affiliation(s)
- Laurent M. A. Favié
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marcel P. H. van den Broek
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Carin M. A. Rademaker
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Timo R. de Haan
- Department of Neonatology, Emma Children’s Hospital, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Peter H. Dijk
- Department of Neonatology, Groningen University Medical Centre, Groningen, the Netherlands
| | - Arno van Heijst
- Department of Neonatology, Radboud university medical center-Amalia Children’s Hospital, Nijmegen, the Netherlands
| | - Jeroen Dudink
- Department of Pediatrics, Division of Neonatology, Erasmus Medical Centre-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Koen P. Dijkman
- Department of Neonatology, Máxima Medical Center Veldhoven, Veldhoven, the Netherlands
| | - Monique Rijken
- Department of Neonatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Inge A. Zonnenberg
- Department of Neonatology, VU University Medical Center, Amsterdam, the Netherlands
| | - Filip Cools
- Department of Neonatology, UZ Brussel—Vrije Universiteit Brussel, Brussels, Belgium
| | - Alexandra Zecic
- Department of Neonatology, University Hospital Gent, Gent, Belgium
| | - Johanna H. van der Lee
- Paediatric Clinical Research Office, Emma Children’s Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Frank van Bel
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Toine C. G. Egberts
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Alwin D. R. Huitema
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Pharmacy & Pharmacology, Netherlands Cancer Institute, Amsterdam, the Netherlands
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Ehler J, Petzold A, Wittstock M, Kolbaske S, Gloger M, Henschel J, Heslegrave A, Zetterberg H, Lunn MP, Rommer PS, Grossmann A, Sharshar T, Richter G, Nöldge-Schomburg G, Sauer M. The prognostic value of neurofilament levels in patients with sepsis-associated encephalopathy - A prospective, pilot observational study. PLoS One 2019; 14:e0211184. [PMID: 30677080 PMCID: PMC6345472 DOI: 10.1371/journal.pone.0211184] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/08/2019] [Indexed: 12/20/2022] Open
Abstract
Sepsis-associated encephalopathy (SAE) contributes to mortality and neurocognitive impairment of sepsis patients. Neurofilament (Nf) light (NfL) and heavy (NfH) chain levels as biomarkers for neuroaxonal injury were not evaluated in cerebrospinal fluid (CSF) and plasma of patients with sepsis-associated encephalopathy (SAE) before. We conducted a prospective, pilot observational study including 20 patients with septic shock and five patients without sepsis serving as controls. The assessment of SAE comprised a neuropsychiatric examination, electroencephalography (EEG), magnetic resonance imaging (MRI) and delirium screening methods including the confusion assessment method for the ICU (CAM-ICU) and the intensive care delirium screening checklist (ICDSC). CSF Nf measurements in sepsis patients and longitudinal plasma Nf measurements in all participants were performed on days 1, 3 and 7 after study inclusion. Plasma NfL levels increased in sepsis patients over time (p = 0.0063) and remained stable in patients without sepsis. Plasma NfL values were significantly higher in patients with SAE (p = 0.011), significantly correlated with the severity of SAE represented by ICDSC values (R = 0.534, p = 0.022) and correlated with a poorer functional outcome after 100 days (R = -0.535, p = 0.0003). High levels of CSF Nf were measured in SAE patients. CSF NfL levels were higher in non-survivors (p = 0.012) compared with survivors and correlated with days until death (R = -0.932, p<0.0001) and functional outcome after 100 days (R = -0.749, p<0.0001). The present study showed for the first time that Nf levels provide complementary prognostic information in SAE patients indicating a higher chance of death and poorer functional/cognitive outcome in survivors.
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Affiliation(s)
- Johannes Ehler
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Rostock, Rostock, Germany
- Department of Neuroimmunology, Institute of Neurology, University College London, London, United Kingdom
- * E-mail:
| | - Axel Petzold
- Department of Neuroimmunology, Institute of Neurology, University College London, London, United Kingdom
- Moorfields Eye Hospital, The National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Matthias Wittstock
- Department of Neurology, University Medical Center Rostock, Rostock, Germany
| | - Stephan Kolbaske
- Department of Neurology, University Medical Center Rostock, Rostock, Germany
| | - Martin Gloger
- Department of Internal Medicine, Intensive Care Unit, University Medical Center Rostock, Rostock, Germany
| | - Jörg Henschel
- Department of Internal Medicine, Intensive Care Unit, University Medical Center Rostock, Rostock, Germany
| | - Amanda Heslegrave
- Department of Molecular Neuroscience, Institute of Neurology, University College London, London, United Kingdom
- UK Dementia Research Institute at University College London, London, United Kingdom
| | - Henrik Zetterberg
- Department of Molecular Neuroscience, Institute of Neurology, University College London, London, United Kingdom
- UK Dementia Research Institute at University College London, London, United Kingdom
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Michael P. Lunn
- Department of Neuroimmunology, Institute of Neurology, University College London, London, United Kingdom
| | - Paulus S. Rommer
- Department of Neurology, Medical University Vienna, Vienna, Austria
| | - Annette Grossmann
- Institute for Diagnostic and Interventional Radiology, University Medical Center Rostock, Rostock, Germany
| | - Tarek Sharshar
- Department of Neuro-anesthesiology and Intensive Care Medicine, Saint-Anne Teaching Hospital, Paris-Decartes University, Paris, France
- Laboratory of Human Histopathology and Animal Models, Institut Pasteur, Paris, France
| | - Georg Richter
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Rostock, Rostock, Germany
| | - Gabriele Nöldge-Schomburg
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Rostock, Rostock, Germany
| | - Martin Sauer
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Rostock, Rostock, Germany
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20
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Lawrence KM, McGovern PE, Mejaddam A, Rossidis AC, Baumgarten H, Kim A, Grinspan JB, Licht DJ, Didier RA, Vossough A, Radaelli E, Rychik J, Song L, Peranteau WH, Davey MG, Flake AW, Gaynor JW. Chronic intrauterine hypoxia alters neurodevelopment in fetal sheep. J Thorac Cardiovasc Surg 2019; 157:1982-1991. [PMID: 30745051 DOI: 10.1016/j.jtcvs.2018.12.093] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 12/16/2018] [Accepted: 12/31/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We tested the hypothesis that chronic fetal hypoxia, at a severity present in many types of congenital heart disease, would lead to abnormal neurodevelopment. METHODS Eight mid-gestation fetal sheep were cannulated onto a pumpless extracorporeal oxygenator via the umbilical vessels and supported in a fluid-filled environment for 22 ± 2 days under normoxic or hypoxic conditions. Total parenteral nutrition was provided. Control fetuses (n = 7) were harvested at gestational age 133 ± 4 days. At necropsy, brains were fixed for histopathology. Neurons were quantified in white matter tracts, and the thickness of the external granular layer of the cerebellum was measured to assess neuronal migration. Capillary density and myelination were quantified in white matter. Data were analyzed with unpaired Student t tests or 1-way analysis of variance, as appropriate. RESULTS Oxygen delivery was reduced in hypoxic fetuses (15.6 ± 1.8 mL/kg/min vs 24.3 ± 2.3 mL/kg/min, P < .01), but umbilical blood flow and caloric delivery were not different between the 2 groups. Compared with normoxic and control animals, hypoxic fetuses had reduced neuronal density and increased external granular layer thickness. Compared with normoxic and control animals, hypoxic fetuses had increased capillary density in white matter. Cortical myelin integrity score was lower in the hypoxic group compared with normoxic and control animals. There was a significant negative correlation between myelin integrity and capillary density. CONCLUSIONS Chronic fetal hypoxia leads to white matter hyper-vascularity, decreased neuronal density, and impaired myelination, similar to the neuropathologic findings observed in children with congenital heart disease. These findings support the hypothesis that fetal hypoxia, even in the setting of normal caloric delivery, impairs neurodevelopment.
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Affiliation(s)
- Kendall M Lawrence
- Center for Fetal Research, Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Patrick E McGovern
- Center for Fetal Research, Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Ali Mejaddam
- Center for Fetal Research, Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Avery C Rossidis
- Center for Fetal Research, Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Heron Baumgarten
- Center for Fetal Research, Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Aimee Kim
- Center for Fetal Research, Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Judith B Grinspan
- Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Daniel J Licht
- Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Ryne A Didier
- Division of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Arastoo Vossough
- Division of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Enrico Radaelli
- Division of Pathobiology, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pa
| | - Jack Rychik
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Limei Song
- Division of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - William H Peranteau
- Center for Fetal Research, Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Marcus G Davey
- Center for Fetal Research, Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Alan W Flake
- Center for Fetal Research, Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - J William Gaynor
- Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pa.
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21
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Arieli R. Saving the pilot's brain: prevention of punctate lesions in the white matter. Undersea Hyperb Med 2019; 46:91-92. [PMID: 31154691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Ran Arieli
- The Israel Naval Medical Institute, Israel Defense Forces Medical Corps, Haifa, Israel
- Eliachar Research Laboratory, Western Galilee Medical Center, Nahariya, Israel
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22
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Zhang Z, Fu W, Wang M, Niu L, Liu B, Jiao Y, Liu X. IgG4-related inflammatory pseudotumor of the brain parenchyma: a case report and literature review. Acta Neurol Belg 2018; 118:617-627. [PMID: 30306461 DOI: 10.1007/s13760-018-1027-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 10/05/2018] [Indexed: 12/24/2022]
Abstract
A 29-year-old male with a 4-month history of binocular temporal visual field defect, 1-month history of memory loss and 5-day history of headache was admitted to our hospital. Brain MRI showed progressive signal abnormalities in the brain parenchyma. His laboratory tests showed elevated serum IgG4 and liver dysfunction. Abdominal CT, ultrasound and liver biopsy showed chronic liver disease. According to the diagnostic criteria of IgG4-related disease, IgG4-related inflammatory pseudotumor of brain parenchyma was considered. After methylprednisolone treatment, his symptoms improved and brain lesion reduced. This is the second reported case of a tumefactive lesion of the brain with serum IgG4 elevation, which was responsive to steroid treatment. Coincidentally, his mother had similar medical history and imaging findings, and was subspecialty diagnosed with the same disease, but without pathological and immunohistochemical confirmation. This suggests that the disease may be hereditary. It is important to recognize IgG4-related inflammatory pseudotumors of the brain parenchyma so that patients do not undergo unnecessary surgical or other procedures.
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Affiliation(s)
- Zhuqing Zhang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Weiwei Fu
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Minghui Wang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lei Niu
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Bin Liu
- Department of Rheumatology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yingbin Jiao
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xuejun Liu
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China.
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23
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Vesoulis ZA, Liao SM, Rao R, Trivedi SB, Cahill AG, Mathur AM. Re-examining the arterial cord blood gas pH screening criteria in neonatal encephalopathy. Arch Dis Child Fetal Neonatal Ed 2018; 103:F377-F382. [PMID: 28942435 PMCID: PMC6192544 DOI: 10.1136/archdischild-2017-313078] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 08/23/2017] [Accepted: 08/30/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Screening criteria for neonatal encephalopathy remain a complex combination of subjective and objective criteria. We examine the utility of universal cord blood gas testing and mandatory encephalopathy evaluation for infants with pH ≤7.10 on umbilical cord arterial blood gas (cABG) as a single screening measure for timely identification of moderate/severe encephalopathy. DESIGN, SETTING, PATIENTS Infants born at a single centre between 2008 and 2015, who were ≥36 weeks, had no congenital anomalies and had a cABG pH ≤7.10 were identified for a retrospective cohort study. Maternal/perinatal and patient factors were collected. RESULTS 27 028 infants were born during the study period; 412 met all inclusion criteria. Of those, 35/85 infants with pH <7.00 and 34/327 infants with pH between 7.00 and 7.10 had moderate/severe encephalopathy. Encephalopathy was identified on the basis of pH and examination alone (no other perinatal criteria present) in 5/35 and 13/34 infants in the two pH groups, respectively.A cABG pH threshold of ≤7.10 was associated with a sensitivity of 74.2% and a specificity of 98.7% for detection of moderate/severe encephalopathy. Based on these data, 25 infants with cABG pH between 7.00 and 7.10 will need to be screened to identify one neonate with moderate/severe encephalopathy, who might have otherwise been missed using conventional screening, a 15% increase in appropriate selection and treatment over current methods. CONCLUSION Universal cord blood gas screening with a pH threshold ≤7.10 and mandatory encephalopathy examination results in greater detection of infants with moderate/severe encephalopathy and timely initiation of therapeutic hypothermia.
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Affiliation(s)
- Zachary A. Vesoulis
- Division of Newborn Medicine, Edward Mallinckrodt
Department of Pediatrics, Washington University School of Medicine, St. Louis,
Missouri
| | - Steve M. Liao
- Division of Newborn Medicine, Edward Mallinckrodt
Department of Pediatrics, Washington University School of Medicine, St. Louis,
Missouri
| | - Rakesh Rao
- Division of Newborn Medicine, Edward Mallinckrodt
Department of Pediatrics, Washington University School of Medicine, St. Louis,
Missouri
| | - Shamik B. Trivedi
- Division of Newborn Medicine, Edward Mallinckrodt
Department of Pediatrics, Washington University School of Medicine, St. Louis,
Missouri
| | - Alison G. Cahill
- Division of Maternal-Fetal Medicine, Department of
Obstetrics and Gynecology, Washington University School of Medicine, St. Louis,
MO
| | - Amit M. Mathur
- Division of Newborn Medicine, Edward Mallinckrodt
Department of Pediatrics, Washington University School of Medicine, St. Louis,
Missouri
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Xu J, Gao F, Yuan Z, Jiang L, Xia Z, Zhao Z. Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) associated with bacteria meningitis caused by listeria monocytogenes: A case report. Medicine (Baltimore) 2018; 97:e11561. [PMID: 30045281 PMCID: PMC6078722 DOI: 10.1097/md.0000000000011561] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Mild encephalitis/encephalopathy with a reversible splenial lesion is a clinico-radiological syndrome mainly triggered by viral infection. Bacteria, like listeria monocytogenes, are relatively rare pathogens. PATIENT CONCERNS A two and a half years old girl with a 3-day history of fever and vomiting, complicated by a sudden seizure. She was in a coma after seizure. DIAGNOSES Listeria monocytogenes was detected in cerebrospinal fluid cultures. Serum IL-6 remarkably elevated, and hyponatremia appeared on day 2 of hospitalization. Magnetic resonance imaging of the brain performed on day 3 of hospitalization showed right subdural effusion and a lesion in the central portion of the splenium of the corpus callosum. INTERVENTIONS We administered antimicrobial therapy, intravenous mannitol and hypertonic fluid therapy. OUTCOMES Her neurological symptoms improved gradually. The lesion in the splenium of the corpus callosum completely disappeared on magnetic resonance imaging on day 10 of hospitalization. LESSONS We diagnosed this case as mild encephalitis/encephalopathy with a reversible splenial lesion caused by listeria monocytogenes. The patient recovered completely clinically and on imaging, without any specific immunomodulatory treatment. It also indicated IL-6 may play a role in the forms of hyponatremia in mild encephalitis/encephalopathy with a reversible splenial lesion.
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25
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Nandhagopal R, Al-Murshedi F, Al-Busaidi M, Al-Busaidi A. Encephalopathy mimicking non-convulsive status Epilepticus. NSJ 2018; 23:52-56. [PMID: 29455222 PMCID: PMC6751912 DOI: 10.17712/nsj.2018.1.20170214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Primary hyperammonemic encephalopathy due to urea cycle disorders (UCD) typically manifests with episodic unresponsiveness and this clinical entity is not often included in the differential diagnosis of presumed non-convulsive status epilepticus (NCSE). However, this diagnostic consideration has therapeutic implications. In this report, we document the therapeutic importance of elucidating the specific cause of hyperammonemic encephalopathy that closely mimicked NCSE through 2 unique illustrative cases.
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26
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Stetkarova I, Bocek V, Gismatullina A, Svobodova Z, Peisker T. Severe chronic lithium intoxication in patient treated for bipolar disorder. Neuro Endocrinol Lett 2017; 38:397-400. [PMID: 29298279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 11/30/1999] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Lithium has been long used in psychiatry as an adjuvant treatment for bipolar disorder. Chronic lithium intoxication is very rare. DESIGN We present the case of a 72-year-old female, treated with lithium for more than 10 years for bipolar disorder, who was admitted for gait impairment with weakness of limbs, myoclonus, speech impairment and memory disturbances. RESULTS Diagnosis of lithium intoxication was based on clinical picture and determination of serum lithium levels. EEG showed severe encephalopathy with triphasic wave complexes. Sensory and motor axonal neuropathy was observed by EMG. Discontinuation of the drug leads to clinical improvement, although not to a fully neurological recovery. CONCLUSION Lithium is still very effective drug, but requires regular monitoring of serum levels to prevent overdose and symptoms of intoxication. Neurophysiological methods, including EEG and EMG, are strongly recommended to determine the level of peripheral and/or central nervous system impairment.
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Affiliation(s)
- Ivana Stetkarova
- Department of Neurology, 3rd Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Vaclav Bocek
- Department of Neurology, 3rd Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Alsu Gismatullina
- Department of Neurology, 3rd Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Zuzana Svobodova
- Department of Neurology, 3rd Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Tomas Peisker
- Department of Neurology, 3rd Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
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27
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Patel N, Landry KB, Fargason RE, Birur B. Reversible Encephalopathy due to Valproic Acid Induced Hyperammonemia in a Patient with Bipolar I Disorder: A Cautionary Report. Psychopharmacol Bull 2017; 47:40-44. [PMID: 28138203 PMCID: PMC5274530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Valproic acid (VPA) is an FDA-approved medication widely prescribed for seizures, migraines, and mixed or manic episodes in bipolar disorder. Hyperammonemia is a rare complication of VPA use, which can result in high morbidity and occasionally fatal encephalopathy. The scant literature on Valproate Induced Hyperammonemic Encephalopathy (VIHE) is characterized by acute onset of decreasing level of consciousness, drowsiness, lethargy which in rare instances can lead to seizures, stupor, coma, and persistent morbidity and cortical damage. Below we describe a case report of a patient with Bipolar I Disorder with no primary evidence of hepatic dysfunction that was initiated on VPA and olanzapine to address manic and psychotic symptoms. This patient subsequently developed elevated ammonia (NH4) levels that led to a reversible encephalopathy. This cautionary case report highlights the potential for a rare but serious complication from VPA, a medication increasingly used in both neurologic and neuropsychiatric settings. It is imperative that clinicians perform a thorough physical, neurological and diagnostic evaluation, routinely check NH4 and VPA levels when prescribing these agents and exercise caution when VPA is concomitantly prescribed with antipsychotics and cytochrome P450 inducing antiepileptic medications.
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Affiliation(s)
- Neel Patel
- Drs. Patel, MD, Landry, DO, Fargason, MD, Birur, MD, PGY2 Psychiatry Resident, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham, USA. Dr. Landry, DO, PGY1 Psychiatry Resident, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham, USA. Dr. Fargason, MD, Professor, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham, USA. Dr. Birur, MD, Assistant Professor, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham, USA
| | - Katherine B Landry
- Drs. Patel, MD, Landry, DO, Fargason, MD, Birur, MD, PGY2 Psychiatry Resident, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham, USA. Dr. Landry, DO, PGY1 Psychiatry Resident, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham, USA. Dr. Fargason, MD, Professor, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham, USA. Dr. Birur, MD, Assistant Professor, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham, USA
| | - Rachel E Fargason
- Drs. Patel, MD, Landry, DO, Fargason, MD, Birur, MD, PGY2 Psychiatry Resident, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham, USA. Dr. Landry, DO, PGY1 Psychiatry Resident, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham, USA. Dr. Fargason, MD, Professor, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham, USA. Dr. Birur, MD, Assistant Professor, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham, USA
| | - Badari Birur
- Drs. Patel, MD, Landry, DO, Fargason, MD, Birur, MD, PGY2 Psychiatry Resident, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham, USA. Dr. Landry, DO, PGY1 Psychiatry Resident, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham, USA. Dr. Fargason, MD, Professor, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham, USA. Dr. Birur, MD, Assistant Professor, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham, USA
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28
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Abstract
Previous studies have reported the adverse cognitive effects of high folate status in older individuals with vitamin B12 (VB12) deficiency. Thus, the aim of this study was to investigate how high serum folate and VB12 deficiency could collaboratively aggravate neuronal degeneration. In total, 146 older non-demented diabetic individuals with an average age of 75 ± 3.9 were recruited. VB12 deficiency and high folate status were based on high serum methylmalonic acid (MMA) concentrations (> 0.3 μmol/L) and the serum folate concentration being in the top tertile (> 31.4 nmol/L) respectively. Among these subjects, there were 20 with elevated MMA and high folate. The structural magnetic resonance imaging data of these subjects were analyzed by performing flexible factorial analysis with the "folate level" and "MMA level" added as main effects, and the interaction effect of folate and VB12 on brain volume was evaluated. The results showed significant gray matter atrophy of the right middle occipital gyrus and the opercular part of the inferior frontal gyrus in subjects with a simultaneous high folate status and VB12 deficiency. Together with previous observational studies on cognitive function, this study lends support to the notion that high serum folate concentrations in older people with VB12 deficiency may be associated with increased neurodegeneration.
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Affiliation(s)
- Y Deng
- Timothy Kwok, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China, Tel: +852-26323145, ; Defeng Wang, Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China, Tel: +852- 26975027,
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29
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Abstract
Hyperammonemia is an important cause of cerebral edema in both adults with liver failure and children with inborn errors of metabolism. There are few studies that have analyzed the role of extracorporeal dialysis in reducing blood ammonia levels in the adult population. Furthermore, there are no firm guidelines about when to implement RRT, because many of the conditions that are characterized by hyperammonemia are extremely rare. In this review of existing literature on RRT, we present the body's own mechanisms for clearing ammonia as well as the dialytic properties of ammonia. We review the available literature on the use of continuous venovenous hemofiltration, peritoneal dialysis, and hemodialysis in neonates and adults with conditions characterized by hyperammonemia and discuss some of the controversies that exist over selecting one modality over another.
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Affiliation(s)
| | - Andrew Z. Fenves
- Renal Division, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Robert Hootkins
- ESRD Consulting, PLLC, Austin, Texas; and
- Department of Medicine, University of Texas Southwestern, Dallas, Texas
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30
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Flom-Halvorsen HI, Ovrum E, Brosstad F, Tangen G, Ringdal M, Oystese R. Effects of two differently heparin-coated extracorporeal circuits on markers for brain and myocardial dysfunction. Perfusion 2016; 17:339-45. [PMID: 12243437 DOI: 10.1191/0267659102pf594oa] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: The two most commonly used heparin-coated systems for cardiopulmonary bypass (CPB) are the Carmeda Bio-Active Surface (CBAS) (Medtronic, Minneapolis, MN, USA) and the Duraflo II coating (Baxter Healthcare, Irvine, CA, USA). The two surfaces are technically unequal and previous experimental studies have demonstrated disparities in effects on the immune system and blood cells. However, little is known concerning the influence of the two surfaces on markers for brain and myocardial dysfunction. Methods: Forty patients undergoing elective, primary coronary bypass grafting with CPB were prospectively randomized to either the CBAS system or the Duraflo II circuit. During and after CPB, biological markers for brain dysfunction and myocardial injury were analysed. Results: Both markers for brain dysfunction S-100B and neuron-specific enolase (NSE) increased significantly during CPB ( p =0.01). The elevation during bypass correlated significantly with the duration of CPB ( r = 0.39 and r= 0.38, respectively, both p< 0.02). NSE was somewhat more elevated in the Duraflo II group at the end of CPB ( p =0.01) and 5 h after CPB ( p= 0.02); for S-100B, there were no intergroup differences. Also, the markers related to myocardial injury, myoglobin and creatine kinase (CK-MB) mass increased during CPB ( p= 0.01), while elevation of troponin-I occurred 5 h after CPB ( p= 0.01). There were no statistically significant intergroup differences. No significant correlation was seen between the release of cardiac markers and the duration of CPB. The clinical course was similar in both groups. Conclusions: Except for a slightly higher elevation of NSE at the end of CPB and 5 h after CPB in the Duraflo II group, there were no significant differences between the CBAS group and the Duraflo II group concerning markers for brain and myocardial dysfunction.
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Ferguson MA, Sutton RM, Karlsson M, Sjövall F, Becker LB, Berg RA, Margulies SS, Kilbaugh TJ. Increased platelet mitochondrial respiration after cardiac arrest and resuscitation as a potential peripheral biosignature of cerebral bioenergetic dysfunction. J Bioenerg Biomembr 2016; 48:269-79. [PMID: 27020568 DOI: 10.1007/s10863-016-9657-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 03/15/2016] [Indexed: 02/02/2023]
Abstract
UNLABELLED Cardiac arrest (CA) results in a sepsis-like syndrome with activation of the innate immune system and increased mitochondrial bioenergetics. OBJECTIVE To determine if platelet mitochondrial respiration increases following CA in a porcine pediatric model of asphyxia-associated ventricular fibrillation (VF) CA, and if this readily obtained biomarker is associated with decreased brain mitochondrial respiration. CA protocol: 7 min of asphyxia, followed by VF, protocolized titration of compression depth to systolic blood pressure of 90 mmHg and vasopressor administration to a coronary perfusion pressure greater than 20 mmHg. PRIMARY OUTCOME platelet integrated mitochondrial electron transport system (ETS) function evaluated pre- and post-CA/ROSC four hours after return of spontaneous circulation (ROSC). Secondary outcome: correlation of platelet mitochondrial bioenergetics to cerebral bioenergetic function. Platelet maximal oxidative phosphorylation (OXPHOSCI+CII), P < 0.02, and maximal respiratory capacity (ETSCI+CII), P < 0.04, were both significantly increased compared to pre-arrest values. This was primarily due to a significant increase in succinate-supported respiration through Complex II (OXPHOSCII, P < 0.02 and ETSCII, P < 0.03). Higher respiration was not due to uncoupling, as the LEAKCI + CII respiration (mitochondrial respiration independent of ATP-production) was unchanged after CA/ROSC. Larger increases in platelet mitochondrial respiratory control ratio (RCR) compared to pre-CA RCR were significantly correlated with lower RCRs in the cortex (P < 0.03) and hippocampus (P < 0.04) compared to sham respiration. Platelet mitochondrial respiration is significantly increased four hours after ROSC. Future studies will identify mechanistic relationships between this serum biomarker and altered cerebral bioenergetics function following cardiac arrest.
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Affiliation(s)
- Michael A Ferguson
- Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 34th & Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Robert M Sutton
- Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 34th & Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Michael Karlsson
- Mitochondrial Medicine, Department of Clinical Sciences, Lund University, BMC A13, SE-221 84, Lund, Sweden
| | - Fredrik Sjövall
- Mitochondrial Medicine, Department of Clinical Sciences, Lund University, BMC A13, SE-221 84, Lund, Sweden
| | - Lance B Becker
- Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, The Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Robert A Berg
- Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 34th & Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Susan S Margulies
- School of Engineering and Applied Science, Department of Bioengineering, University of Pennsylvania, 210 South 33rd Street, Philadelphia, PA, 19104, USA
| | - Todd J Kilbaugh
- Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 34th & Civic Center Blvd., Philadelphia, PA, 19104, USA.
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Fink EL, Berger RP, Clark RSB, Watson RS, Angus DC, Panigrahy A, Richichi R, Callaway CW, Bell MJ, Mondello S, Hayes RL, Kochanek PM. Exploratory study of serum ubiquitin carboxyl-terminal esterase L1 and glial fibrillary acidic protein for outcome prognostication after pediatric cardiac arrest. Resuscitation 2016; 101:65-70. [PMID: 26855294 DOI: 10.1016/j.resuscitation.2016.01.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 01/07/2016] [Accepted: 01/21/2016] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Brain injury is the leading cause of morbidity and death following pediatric cardiac arrest. Serum biomarkers of brain injury may assist in outcome prognostication. The objectives of this study were to evaluate the properties of serum ubiquitin carboxyl-terminal esterase-L1 (UCH-L1) and glial fibrillary acidic protein (GFAP) to classify outcome in pediatric cardiac arrest. METHODS Single center prospective study. Serum biomarkers were measured at 2 time points during the initial 72 h in children after cardiac arrest (n=19) and once in healthy children (controls, n=43). We recorded demographics and details of the cardiac arrest and resuscitation. We determined the associations between serum biomarker concentrations and Pediatric Cerebral Performance Category (PCPC) at 6 months (favorable (PCPC 1-3) or unfavorable (PCPC 4-6)). RESULTS The initial assessment (time point 1) occurred at a median (IQR) of 10.5 (5.5-17.0)h and the second assessment (time point 2) at 59.0 (54.5-65.0)h post-cardiac arrest. Serum UCH-L1 was higher among children following cardiac arrest than among controls at both time points (p<0.05). Serum GFAP in subjects with unfavorable outcome was higher at time point 2 than in controls (p<0.05). Serum UCH-L1 at time point 1 (AUC 0.782) and both UCH-L1 and GFAP at time point 2 had good classification accuracy for outcome (AUC 0.822 and 0.796), p<0.05 for all. CONCLUSION Preliminary data suggest that serum UCH-L1 and GFAP may be of use to prognosticate outcome after pediatric cardiac arrest at clinically-relevant time points and should be validated prospectively.
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Affiliation(s)
- Ericka L Fink
- Critical Care Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA; Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Pittsburgh, PA, USA; Safar Center for Resuscitation Research, Pittsburgh, PA, USA.
| | - Rachel P Berger
- Child Advocacy, Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Robert S B Clark
- Critical Care Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA; Safar Center for Resuscitation Research, Pittsburgh, PA, USA
| | - R Scott Watson
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA; Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Pittsburgh, PA, USA
| | - Derek C Angus
- Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Pittsburgh, PA, USA
| | - Ashok Panigrahy
- Radiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Rudolph Richichi
- Statistical Analysis and Measurement Consultants, Inc., Lanexa, VA, USA
| | - Clifton W Callaway
- Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Safar Center for Resuscitation Research, Pittsburgh, PA, USA
| | - Michael J Bell
- Critical Care Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA; Safar Center for Resuscitation Research, Pittsburgh, PA, USA
| | | | | | - Patrick M Kochanek
- Critical Care Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA; Safar Center for Resuscitation Research, Pittsburgh, PA, USA
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Nakahara E, Sakuma H, Kimura-Kuroda J, Shimizu T, Okumura A, Hayashi M. A diagnostic approach for identifying anti-neuronal antibodies in children with suspected autoimmune encephalitis. J Neuroimmunol 2015. [PMID: 26198933 DOI: 10.1016/j.jneuroim.2015.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
We assessed the validity of immunoblotting, immunohistochemistry (IHC), and immunocytochemistry (ICC) to detect anti-neuronal antibodies in an attempt to establish a diagnostic approach for pediatric autoimmune encephalitis. Both IHC and ICC had higher sensitivity than immunoblotting and could differentiate between antibodies directed towards intracellular and cell surface antigens. There was a significant correlation between the IHC and ICC results. When patients were divided into encephalitis and non-encephalitis groups, there was no difference in the positivity rate and staining pattern of IHC and ICC between them. In conclusion, IHC and ICC are useful methods to screen for anti-neuronal antibodies. A combination of IHC, ICC, and specific cell-based assays is expected to be an efficient approach for the diagnosis of autoantibody-mediated encephalitis.
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Affiliation(s)
- Eri Nakahara
- Department of Brain Development and Neural Regeneration, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo, Japan; Department of Pediatrics, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hiroshi Sakuma
- Department of Brain Development and Neural Regeneration, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo, Japan.
| | - Junko Kimura-Kuroda
- Department of Brain Development and Neural Regeneration, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Akihisa Okumura
- Department of Pediatrics, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan; Department of Pediatrics, Aichi Medical University Faculty of Medicine, 1-1 yazakokarimata, Nagakute, Aichi, Japan
| | - Masaharu Hayashi
- Department of Brain Development and Neural Regeneration, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo, Japan
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Prado FA, Delfino VDA, Grion CMC, de Oliveira JA. Hyperammonemia in ICU patients: a frequent finding associated with high mortality. J Hepatol 2015; 62:1216-8. [PMID: 25617506 DOI: 10.1016/j.jhep.2015.01.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 01/05/2015] [Accepted: 01/07/2015] [Indexed: 12/21/2022]
Affiliation(s)
- Fabrizio A Prado
- Department of Internal Medicine, Londrina State University, Rua João Wycliff, 405, Londrina, PR, Brazil.
| | - Vinicius D A Delfino
- Department of Internal Medicine, Londrina State University, Rua Walter Motta Campos 293, Londrina, PR, Brazil
| | - Cintia M C Grion
- Department of Internal Medicine, Londrina State University, Rua Vila. Lobos 580, Londrina, PR, Brazil
| | - Jair A de Oliveira
- Department of Pathology, Clinical Analysis and Toxicology, Londrina State University, Avenida do Café 655, Londrina, PR, Brazil
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Fuchs C, Armstrong VW, Quellhorst E, Scheler F. Prophylaxis and methods for early recognition of aluminium intoxication. Contrib Nephrol 2015; 38:81-94. [PMID: 6713903 DOI: 10.1159/000408070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Roberts BW, Karagiannis P, Coletta M, Kilgannon JH, Chansky ME, Trzeciak S. Effects of PaCO2 derangements on clinical outcomes after cerebral injury: A systematic review. Resuscitation 2015; 91:32-41. [PMID: 25828950 DOI: 10.1016/j.resuscitation.2015.03.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 02/04/2015] [Accepted: 03/09/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Partial pressure of arterial carbon dioxide (PaCO2) is a major regulator of cerebral blood flow (CBF). Derangements in PaCO2 have been thought to worsen clinical outcomes after many forms of cerebral injury by altering CBF. Our aim was to systematically analyze the biomedical literature to determine the effects of PaCO2 derangements on clinical outcomes after cerebral injury. METHODS We performed a search of Cochrane Library, PUBMED, CINHAL, conference proceedings, and other sources using a comprehensive strategy. Study inclusion criteria were (1) human subjects; (2) cerebral injury; (3) mechanical ventilation post-injury; (4) measurement of PaCO2; and (5) comparison of a clinical outcome measure (e.g. mortality) between different PaCO2 exposures. We performed a qualitative analysis to collate and summarize effects of PaCO2 derangements according to the recommended methodology from the Cochrane Handbook. RESULTS Seventeen studies involving different etiologies of cerebral injury (six traumatic brain injury, six post-cardiac arrest syndrome, two cerebral vascular accident, three neonatal ischemic encephalopathy) met all inclusion and no exclusion criteria. Three randomized control trials were identified and only one was considered a high quality study as per the Cochrane criteria for assessing risk of bias. In 13/17 (76%) studies examining hypocapnia, and 7/10 (70%) studies examining hypercapnia, the exposed group (hypercapnia or hypocapnia) was associated with poor clinical outcome. CONCLUSION The majority of studies in this report found exposure to hypocapnia and hypercapnia after cerebral injury to be associated with poor clinical outcome. However, the optimal PaCO2 range associated with good clinical outcome remains unclear.
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Affiliation(s)
- Brian W Roberts
- Department of Emergency Medicine, Cooper University Hospital and Cooper Medical School of Rowan University, Camden, NJ, USA.
| | - Paul Karagiannis
- Department of Emergency Medicine, Cooper University Hospital and Cooper Medical School of Rowan University, Camden, NJ, USA.
| | - Michael Coletta
- Department of Emergency Medicine, Cooper University Hospital and Cooper Medical School of Rowan University, Camden, NJ, USA.
| | - J Hope Kilgannon
- Department of Emergency Medicine, Cooper University Hospital and Cooper Medical School of Rowan University, Camden, NJ, USA.
| | - Michael E Chansky
- Department of Emergency Medicine, Cooper University Hospital and Cooper Medical School of Rowan University, Camden, NJ, USA.
| | - Stephen Trzeciak
- Department of Emergency Medicine, Cooper University Hospital and Cooper Medical School of Rowan University, Camden, NJ, USA; Department of Medicine, Division of Critical Care Medicine (ST), Cooper University Hospital and Cooper Medical School of Rowan University, Camden, NJ, USA.
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Azuma J, Nabatame S, Nakano S, Iwatani Y, Kitai Y, Tominaga K, Kagitani-Shimono K, Okinaga T, Yamamoto T, Nagai T, Ozono K. Prognostic factors for acute encephalopathy with bright tree appearance. Brain Dev 2015; 37:191-9. [PMID: 24787271 DOI: 10.1016/j.braindev.2014.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 03/06/2014] [Accepted: 04/02/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine the prognostic factors for encephalopathy with bright tree appearance (BTA) in the acute phase through retrospective case evaluation. METHODS We recruited 10 children with encephalopathy who presented with BTA and classified them into 2 groups. Six patients with evident regression and severe psychomotor developmental delay after encephalopathy were included in the severe group, while the remaining 4 patients with mild mental retardation were included in the mild group. We retrospectively analyzed their clinical symptoms, laboratory data, and magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) findings. RESULTS Patients in the severe group developed subsequent complications such as epilepsy and severe motor impairment. Univariate analysis revealed that higher maximum lactate dehydrogenase (LDH) levels (p=0.055) were a weak predictor of poor outcome. Maximum creatinine levels were significantly higher (p<0.05) and minimal platelet counts were significantly lower (p<0.05) in the severe group than in the mild group. Acute renal failure was not observed in any patient throughout the study. MRS of the BTA lesion during the BTA period showed elevated lactate levels in 5 children in the severe group and 1 child in the mild group. MRI performed during the chronic phase revealed severe brain atrophy in all patients in the severe group. CONCLUSIONS Higher creatinine and LDH levels and lower platelet counts in the acute phase correlated with poor prognosis. Increased lactate levels in the BTA lesion during the BTA period on MRS may predict severe physical and mental disability.
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Affiliation(s)
- Junji Azuma
- Department of Pediatrics, Osaka University Graduate School of Medicine, Japan; Epilepsy Center, Osaka University Hospital, Japan.
| | - Shin Nabatame
- Department of Pediatrics, Osaka University Graduate School of Medicine, Japan; Epilepsy Center, Osaka University Hospital, Japan
| | - Sayaka Nakano
- Department of Pediatrics, Osaka University Graduate School of Medicine, Japan; Epilepsy Center, Osaka University Hospital, Japan
| | - Yoshiko Iwatani
- Department of Pediatrics, Osaka University Graduate School of Medicine, Japan; Epilepsy Center, Osaka University Hospital, Japan
| | | | - Koji Tominaga
- Department of Pediatrics, Osaka University Graduate School of Medicine, Japan; Epilepsy Center, Osaka University Hospital, Japan; United Graduate School of Child Development, Osaka University Graduate School of Medicine, Japan
| | - Kuriko Kagitani-Shimono
- Department of Pediatrics, Osaka University Graduate School of Medicine, Japan; Epilepsy Center, Osaka University Hospital, Japan; United Graduate School of Child Development, Osaka University Graduate School of Medicine, Japan
| | - Takeshi Okinaga
- Department of Pediatrics, Osaka University Graduate School of Medicine, Japan; Epilepsy Center, Osaka University Hospital, Japan
| | | | - Toshisaburo Nagai
- Division of Health Science, Osaka University Graduate School of Medicine, Japan
| | - Keiichi Ozono
- Department of Pediatrics, Osaka University Graduate School of Medicine, Japan; Epilepsy Center, Osaka University Hospital, Japan
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Korzeniewski SJ, Soto-Rivera CL, Fichorova RN, Allred E, Kuban KCK, O’Shea TM, Paneth N, Agus M, Dammann O, Leviton A. Are preterm newborns who have relative hyperthyrotropinemia at increased risk of brain damage? J Pediatr Endocrinol Metab 2014; 27:1077-88. [PMID: 24897395 PMCID: PMC4317282 DOI: 10.1515/jpem-2014-0059] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 04/30/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND We sought to disentangle the contributions of hyperthyrotropinemia (an indicator of thyroid dysfunction) (HTT) and intermittent or sustained systemic inflammation (ISSI) to structural and functional indicators of brain damage. METHODS We measured the concentrations of thyroid-stimulating hormone (TSH) on day 14 and of 25 inflammation-related proteins in blood collected during the first 2 postnatal weeks from 786 infants born before the 28th week of gestation who were not considered to have hypothyroidism. We defined hyperthyrotropinemia (HTT) as a TSH concentration in the highest quartile for gestational age on postnatal day 14 and ISSI was defined as a concentration in the top quartile for gestational age of a specific inflammation-related protein on 2 separate days a week apart during the first 2 postnatal weeks. We first assessed the risk of brain damage indicators by comparing 1) neonates who had HTT to those without (regardless of ISSI) and 2) neonates with HTT only, ISSI only, or HTT+ISSI to those who were exposed to neither HTT nor ISSI. RESULTS In univariable models that compared those with HTT to those without, HTT was not significantly associated with any indicator of brain damage. In models that compared HTT only, ISSI only, and HTT+ISSI to those with neither, children with ISSI only or with HTT+ISSI were at significantly higher risk of ventriculomegaly [odds ratios (ORs) 2-6], whereas those with HTT only were at significantly reduced risk of a hypoechoic lesion (ORs 0.2-0.4). Children with HTT only had a higher risk of quadriparesis and those with ISSI alone had a higher risk of hemiparesis (ORs 1.6-2.4). Elevated risk of a very low mental development score was associated with both ISSI only and HTT+ISSI, whereas a very low motor development score and microcephaly were associated with HTT+ISSI. CONCLUSIONS The association of HTT with increased or decreased risk of indicators of brain damage depends on the presence or absence of ISSI.
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Affiliation(s)
- Steven J. Korzeniewski
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Carmen L. Soto-Rivera
- Division of Endocrinology, Boston Children’s Hospital, Harvard Medical School, Boston, MA
| | - Raina N. Fichorova
- Departments of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital and Harvard Medical School
| | - Elizabeth Allred
- Neurology Departments, Boston Children’s Hospital, and Harvard Medical School, Boston, MA
| | - Karl C. K. Kuban
- Departments of Pediatrics, Boston Medical Center and Boston University, Boston, MA
| | | | - Nigel Paneth
- Department of Epidemiology, Michigan State University, East Lansing, MI
| | - Michael Agus
- Division of Endocrinology, Boston Children’s Hospital, Harvard Medical School, Boston, MA
| | - Olaf Dammann
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA
- Neuroepidemiology Unit, Hannover School of Medicine, Hannover, Germany
| | - Alan Leviton
- Neurology Departments, Boston Children’s Hospital, and Harvard Medical School, Boston, MA
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Xiang WP, Xue H, Wang BJ. Delayed encephalopathy of acute carbon monoxide intoxication in rats: potential mechanism and intervention of dexamethasone. Pak J Pharm Sci 2014; 27:2025-2028. [PMID: 25410067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We aimed to investigate the potential mechanism (s) of delayed encephalopathy after acute carbon monoxide (CO) poisoning in rats, and the effect of dexamethasone on this process. A delayed encephalopathy animal model was generated by intraperitoneal injection of CO into Wistar rats. Normal rats were sent as a control group, and poisoning rats were randomly separated into two groups treated with vehicle and dexamethasone respectively. The rat behavior was evaluated by Morris water maze. The level of myelin basic protein (MBP), myeloperoxidase (MPO) expression in the serum and hippocampus of experimental rats was measured using enzyme-linked immunosorbent assay (ELISA) and immunohisto chemistry. The latency to find the platform was significantly increased by dexamethasone treatment for rats after poisoning at day 7 and 14. MBP serum concentration in the vehicle treatment group was significantly higher than that in rats injected with dexamethasone following poisoning at 90 min, 7d, 14d, 21d. Moreover, MPO concentration was higher at day 14 after poisoning as well. In addition, MBP expression was down regulated in the poisoning group, which was nearly reversed at control level in the dexamethasone group. Inflammation plays a key role in delayed encephalopathy of rats induced by acute CO intoxication, which could be attenuated by dexamethasone via protecting myelin from damage of inflammation response.
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Affiliation(s)
- Wen-Ping Xiang
- Department of Neurology, Center Hospital of Baotou, Inner Mongolia, China
| | - Hui Xue
- Department of Neurology, Center Hospital of Baotou, Inner Mongolia, China
| | - Bao-Jun Wang
- Department of Neurology, Center Hospital of Baotou, Inner Mongolia, China
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Hasegawa S, Matsushige T, Inoue H, Takahara M, Kajimoto M, Momonaka H, Oka M, Isumi H, Emi S, Hayashi M, Ichiyama T. Serum and cerebrospinal fluid levels of visinin-like protein-1 in acute encephalopathy with biphasic seizures and late reduced diffusion. Brain Dev 2014; 36:608-12. [PMID: 24075506 DOI: 10.1016/j.braindev.2013.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 08/22/2013] [Accepted: 08/28/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) has recently been recognized as an encephalopathy subtype. Typical clinical symptoms of AESD are biphasic seizures, and MRI findings show reduced subcortical diffusion during clustering seizures with unconsciousness after the acute phase. Visinin-like protein-1 (VILIP-1) is a recently discovered protein that is abundant in the central nervous system, and some reports have shown that VILIP-1 may be a prognostic biomarker of conditions such as Alzheimer's disease, stroke, and brain injury. METHODS However, there have been no reports regarding serum and cerebrospinal fluid (CSF) levels of VILIP-1 in patients with AESD. We measured the serum and CSF levels of VILIP-1 in patients with AESD, and compared the levels to those in patients with prolonged febrile seizures (FS). RESULTS Both serum and CSF levels of VILIP-1 were significantly higher in patients with AESD than in patients with prolonged FS. Serum and CSF VILIP-1 levels were normal on day 1 of AESD. CONCLUSIONS Our results suggest that both serum and CSF levels of VILIP-1 may be one of predictive markers of AESD.
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Affiliation(s)
- Shunji Hasegawa
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Japan.
| | - Takeshi Matsushige
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Japan
| | - Hirofumi Inoue
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Japan
| | - Midori Takahara
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Japan
| | - Madoka Kajimoto
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Japan
| | - Hiroshi Momonaka
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Japan
| | - Momoko Oka
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Japan
| | - Hiroshi Isumi
- Department of Pediatrics, Tsudumigaura Handicapped Children's Hospital, Japan
| | - Sakie Emi
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Japan
| | - Megumi Hayashi
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Japan
| | - Takashi Ichiyama
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Japan; Department of Pediatrics, Tsudumigaura Handicapped Children's Hospital, Japan
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Mi H, Guo J, Xie H, Wang L, Li A. [Serum levels and clinical significance of high mobility group protein B1 in patients with delayed encephalopathy after acute carbon monoxide poisoning]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2014; 32:539-541. [PMID: 25182828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To investigate the changes in serum level of high mobility group protein B1 (HMGB1) in patients with delayed encephalopathy after acute carbon monoxide poisoning and the clinical significance of these changes. METHODS Thirty-four patients with delayed encephalopathy after acute carbon monoxide poisoning (delayed encephalopathy group), 30 normal controls (control group), and 32 cases of acute carbon monoxide poisoning without delayed encephalopathy (carbon monoxide poisoning group) were recruited in this study. The serum HMGB1 level was determined by enzyme-linked immunosorbent assay. The correlation between serum HMGB1 level and scores of the activity of daily living scale (ADL), Information-Memory-Concentration Test (IMCT), and Hasegawa dementia scale (HDS) was determined. RESULTS In the acute stage of carbon monoxide poisoning, the serum HMGB1 level of delayed encephalopathy group was significantly higher than those of the carbon monoxide poisoning group and the control group (P < 0.01). In the delayed encephalopathy group, serum HMGB1 level in the convalescent stage was significantly lower than that in the acute stage (P < 0.05); ADL score was higher and HDS and IMCT scores were lower in the acute stage than in the convalescent stage (P < 0.01). In the delayed encephalopathy group, serum HMGB1 level was positively correlated with HDS and ADL scores in both acute stage and convalescent stage (correlation coefficients: 0.612, 0.607, 0.609, and 0.612, P < 0.01). CONCLUSION HMGB1, as an important late mediator of inflammation, is involved in the inflammatory reaction in delayed encephalopathy, and is positively correlated with HDS and ADL scores, indicating that it can be used as one of the major indicators in monitoring carbon monoxide poisoning.
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Affiliation(s)
- Hui Mi
- Department of Emergency, the second people's Hospital of Liao cheng, Shandong Liaocheng 252600, China
| | - Jingrui Guo
- Department of Emergency, the second people's Hospital of Liao cheng, Shandong Liaocheng 252600, China
| | - Hualei Xie
- Department of Emergency, the second people's Hospital of Liao cheng, Shandong Liaocheng 252600, China
| | - Lingling Wang
- Department of Emergency, the second people's Hospital of Liao cheng, Shandong Liaocheng 252600, China
| | - Aihong Li
- Department of Emergency, the second people's Hospital of Liao cheng, Shandong Liaocheng 252600, China
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Giuliani E, Genedani S, Moratto R, Veronesi J, Carone C, Bonvecchio C, Mosca F, Coppi G, Barbieri A. Neural damage biomarkers during open carotid surgery versus endovascular approach. Ann Vasc Surg 2014; 28:1671-9. [PMID: 24911800 DOI: 10.1016/j.avsg.2014.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 05/28/2014] [Accepted: 05/30/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Carotid endarterectomy (CEA) is the gold standard for treating severe carotid artery stenosis, whereas carotid artery stenting (CAS) represents an endovascular alternative. The objective of this study was to assess the potential neural damage following open or endovascular carotid surgery measured by peripheral blood concentration of 3 biomarkers: S100β, matrix metalloproteinase-9 (MMP-9), and d-dimer. METHODS Data for this prospective investigation were obtained from the Carotid Markers study (January 2010-2011), which sought to measure the levels of specific biomarkers of neuronal damage and thrombosis on candidates to CEA or CAS presenting at the Department of Vascular Surgery of the Nuovo Ospedale S. Agostino Estense of Modena (Italy) at baseline and at 24 hr after surgery. Relevant medical comorbidities were noted. RESULTS A total of 113 consecutive patients were enrolled in the study, 41 in the endarterectomy group and 72 in the endovascular group. The baseline levels of the studied biomarkers did not show any statistically significant difference between the groups with the exception of MMP-9, which showed higher concentrations in the endovascular group (median 731 vs. 401, P = 0.0007), while 24 hr after surgery the endarterectomy group featured significantly higher peripheral blood concentrations of MMP-9, S100β, and d-dimer. Conversely, no significant difference was detected in the endovascular group except the d-dimer level. CONCLUSIONS Neural damage biomarkers demonstrated a substantial difference between open and endovascular carotid surgery, which, if performed in selected patients, may become a less invasive alternative to CEA.
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Affiliation(s)
- Enrico Giuliani
- School of Anesthesia and Intensive Care, University of Modena and Reggio Emilia, Modena, Italy
| | - Susanna Genedani
- Deparment of Pharmacology, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto Moratto
- Department of Vascular Surgery, Nuovo Ospedale S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy
| | - Jessica Veronesi
- Department of Vascular Surgery, Nuovo Ospedale S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy
| | - Chiara Carone
- Deparment of Pharmacology, University of Modena and Reggio Emilia, Modena, Italy
| | - Cinzia Bonvecchio
- School of Anesthesia and Intensive Care, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesco Mosca
- School of Anesthesia and Intensive Care, University of Modena and Reggio Emilia, Modena, Italy
| | - Gioachino Coppi
- Department of Vascular Surgery, Nuovo Ospedale S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy
| | - Alberto Barbieri
- School of Anesthesia and Intensive Care, University of Modena and Reggio Emilia, Modena, Italy.
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Kanhai DA, de Kleijn DPV, Kappelle LJ, Uiterwaal CSPM, van der Graaf Y, Pasterkamp G, Geerlings MI, Visseren FLJ. Extracellular vesicle protein levels are related to brain atrophy and cerebral white matter lesions in patients with manifest vascular disease: the SMART-MR study. BMJ Open 2014; 4:e003824. [PMID: 24430876 PMCID: PMC3902438 DOI: 10.1136/bmjopen-2013-003824] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Extracellular vesicles (EVs) and their protein levels have been identified as a potential risk marker for the development of vascular disease. In the present study, we assessed whether levels of four previously identified EV proteins (cystatin C, serpin G1, serpin F2 and CD14) are associated with cerebral white matter lesions (WMLs) and brain atrophy. DESIGN Cohort study; cross-sectional and prospective. SETTING Single centre, secondary and tertiary setting. PARTICIPANTS 1309 patients with manifest vascular disease from the Second Manifestations of ARTerial disease-MR (SMART-MR) study, of which 994 had successful brain MRI and EV protein level measurements. OUTCOMES WML and brain parenchymal fraction (BPF), as parameter for brain atrophy, at baseline and follow-up. STATISTICAL METHODS The relationship between EV protein levels and WML volume (expressed as log transformed percentage of intracranial volume) and BPF (expressed percentage of intracranial volume) on 1.5 T brain MRI was assessed with multivariable linear regression modelling. Subsequently, the relationship between baseline EV protein levels and progression of atrophy and WML was analysed in 534 patients, in whom a follow-up MRI was obtained after 4 years. RESULTS Higher EV-cystatin C and EV-CD14 were significantly associated with larger WML volume (linear regression coefficient (95% CI) 0.10 log %/SD (0.04 to 0.17) and 0.14 log %/SD (0.07 to 0.20), respectively. Higher EV-CD14 was associated with more brain atrophy (-0.14%/SD; -0.27 to -0.01). Baseline EV-CD14 was significantly associated with increase of WMLs (0.11 log %/SD (0.04 to 0.18)). No relationship with EV-serpins was observed at baseline or at follow-up. CONCLUSIONS EV proteins cystatin C and CD14 are related to cerebral WMLs and the progression of brain atrophy in patients with manifest vascular disease, potentially identifying EVs in the aetiology of structural brain changes.
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Affiliation(s)
- Danny A Kanhai
- Department of Vascular Medicine, University Medical Center Utrecht (UMC Utrecht), Utrecht, The Netherlands
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Tann CJ, Nkurunziza P, Nakakeeto M, Oweka J, Kurinczuk JJ, Were J, Nyombi N, Hughes P, Willey BA, Elliott AM, Robertson NJ, Klein N, Harris KA. Prevalence of bloodstream pathogens is higher in neonatal encephalopathy cases vs. controls using a novel panel of real-time PCR assays. PLoS One 2014; 9:e97259. [PMID: 24836781 PMCID: PMC4023955 DOI: 10.1371/journal.pone.0097259] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 04/14/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In neonatal encephalopathy (NE), infectious co-morbidity is difficult to diagnose accurately, but may increase the vulnerability of the developing brain to hypoxia-ischemia. We developed a novel panel of species-specific real-time PCR assays to identify bloodstream pathogens amongst newborns with and without NE in Uganda. METHODOLOGY Multiplex real-time PCR assays for important neonatal bloodstream pathogens (gram positive and gram negative bacteria, cytomegalovirus (CMV), herpes simplex virus(HSV) and P. falciparum) were performed on whole blood taken from 202 encephalopathic and 101 control infants. Automated blood culture (BACTEC) was performed for all cases and unwell controls. PRINCIPAL FINDINGS Prevalence of pathogenic bacterial species amongst infants with NE was 3.6%, 6.9% and 8.9%, with culture, PCR and both tests in combination, respectively. More encephalopathic infants than controls had pathogenic bacterial species detected (8.9%vs2.0%, p = 0.028) using culture and PCR in combination. PCR detected bacteremia in 11 culture negative encephalopathic infants (3 Group B Streptococcus, 1 Group A Streptococcus, 1 Staphylococcus aureus and 6 Enterobacteriacae). Coagulase negative staphylococcus, frequently detected by PCR amongst case and control infants, was considered a contaminant. Prevalence of CMV, HSV and malaria amongst cases was low (1.5%, 0.5% and 0.5%, respectively). CONCLUSION/SIGNIFICANCE This real-time PCR panel detected more bacteremia than culture alone and provides a novel tool for detection of neonatal bloodstream pathogens that may be applied across a range of clinical situations and settings. Significantly more encephalopathic infants than controls had pathogenic bacterial species detected suggesting that infection may be an important risk factor for NE in this setting.
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Affiliation(s)
- Cally J. Tann
- Clinical Research Department, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Mulago University Hospital, Kampala, Uganda
- * E-mail:
| | | | | | - James Oweka
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Jennifer J. Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jackson Were
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | | | - Peter Hughes
- Institute for Women’s Health, University College London, Medical School Building, London, United Kingdom
| | - Barbara A. Willey
- Clinical Research Department, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Alison M. Elliott
- Clinical Research Department, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Nicola J. Robertson
- Institute for Women’s Health, University College London, Medical School Building, London, United Kingdom
| | - Nigel Klein
- Institute for Child Health, University College London, London, United Kingdom
- Department of Microbiology, Virology and Infection Control, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Kathryn A. Harris
- Institute for Child Health, University College London, London, United Kingdom
- Department of Microbiology, Virology and Infection Control, Great Ormond Street Hospital for Children, London, United Kingdom
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Kuriyama N, Mizuno T, Kita M, Yamada K, Ozaki E, Matsumoto S, Takada A, Watanabe A, Kasai T, Nagakane Y, Mitani S, Matsui D, Watanabe I, Takeda K, Nakagawa M, Watanabe Y. TGF-beta1 is associated with the progression of intracranial deep white matter lesions: a pilot study with 5 years of magnetic resonance imaging follow-up. Neurol Res 2013; 36:47-52. [PMID: 24083683 DOI: 10.1179/1743132813y.0000000256] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Elevated expression of transforming growth factor (TGF)-beta1 has been reported in hereditary cerebral small-vessel (HCSV) disease. The aim of this study was to clarify whether TGF-beta1 is a risk factor for intracranial deep white matter lesions (DWLs) and their progression in a general elderly population. METHODS The subjects included 81 participants (Groups DWL, DWLP, and C) who had voluntarily undergone a health examination and brain magnetic resonance imaging (MRI) in 2003 and 2008 and 43 age-matched patients with previous symptomatic brain infarctions. Deep white matter lesions were graded from Grade 0 to 3 according to the Fazekas classification. Group DWL (23 subjects) was defined as DWLs with no progression in the grade level, and Group DWLP (progression of DWL) (12 subjects) was defined as DWLs with an increase in one or more grade number and an apparent worsening of Grade 3. Forty-six age-matched control subjects with consistent normal brain MRI were included in Group C. The associations between DWLs and various vascular risk factors, including peripheral blood TGF-beta1 levels, were examined. RESULTS In addition to the classical risk factors, the highest TGF-beta1 levels were found in Group DWLP. The TGF-beta1 levels were significantly higher in Group DWLP than in Group DWL, and DWLP was significantly correlated with elevated TGF-beta1 levels (odds ratio [OR] = 1·72). CONCLUSIONS The present data suggest that TGF-beta1 may be important in the pathogenesis and progression of DWLs, and it is expected to be useful as a clinical indicator reflecting the presence of intracranial white matter lesions.
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Caines D, Sinclair M, Wood D, Valverde A, Dyson D, Gaitero L, Nykamp S. Evaluation of cerebrospinal fluid lactate and plasma lactate concentrations in anesthetized dogs with and without intracranial disease. Can J Vet Res 2013; 77:297-302. [PMID: 24124273 PMCID: PMC3788662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 10/29/2012] [Indexed: 06/02/2023]
Abstract
The objectives of this study were to establish a reference interval for canine cerebrospinal fluid lactate (CSFL) and to compare CSFL and plasma lactate (PL) concentrations in anesthetized dogs with and without intracranial disease. Using a prospective study, canine blood and cerebrospinal fluid were collected for lactate analysis in 11 dogs with intracranial disease after undergoing magnetic resonance imaging (MRI) (Group ID-MRI), in 10 healthy dogs post-MRI (Group H-MRI), and in 39 healthy dogs after induction of anesthesia (Group H-Sx). Dogs were anesthetized for the procedures using different anesthetic protocols. Neurological scores (NS) and sedation scores (SS) were assessed pre-anesthesia in ID-MRI dogs. The CSFL reference interval [90% confidence interval (CI) for lower and upper limits] was 1.1 (1.0 to 1.2) to 2.0 (2.0 to 2.1) mmol/L. Mean ± SD CSFL concentrations were: ID-MRI, 2.1 ± 0.8; H-MRI, 1.6 ± 0.4; and H-Sx, 1.6 ± 0.2 mmol/L. There was a tendency for higher CSFL in dogs in the ID-MRI group than in those in the H-MRI or H-Sx groups (P = 0.12). There was agreement between CSFL and PL in ID-MRI dogs (P = 0.007), but not in dogs in H-MRI (P = 0.5) or H-Sx (P = 0.2). Of the ID-MRI dogs, those with worse NS had higher CSFL (r (2) = 0.44). The correlation between CSFL and PL in dogs with intracranial disease and between worse NS and higher CSFL warrants further investigation into the use of CSFL and PL for diagnostic and prognostic purposes.
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Affiliation(s)
- Deanne Caines
- Address all correspondence to Dr. Deanne Caines; telephone: (416) 247-8387; fax: (416) 287-3642; e-mail:
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Hasegawa S, Matsushige T, Inoue H, Takahara M, Kajimoto M, Momonaka H, Ishida C, Tanaka S, Morishima T, Ichiyama T. Serum soluble CD163 levels in patients with influenza-associated encephalopathy. Brain Dev 2013; 35:626-9. [PMID: 23149357 DOI: 10.1016/j.braindev.2012.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 10/03/2012] [Accepted: 10/14/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND Influenza-associated encephalopathy (IE) is a serious complication during influenza viral infection. Common clinical symptoms of IE include seizures and progressive coma with high-grade fever. We previously reported that hypercytokinemia and monocyte/macrophage activation may play an important role in the pathogenesis of IE. CD163 is a scavenger receptor for hemoglobin-haptoglobin complexes and is expressed by monocytes/macrophages. Proteolytic cleavage of monocyte-bound CD163 by matrix metalloproteinases releases soluble CD163 (sCD163). However, there have been no reports regarding serum sCD163 levels in IE patients. METHODS We measured serum levels of sCD163 as a marker of monocyte/macrophage activation in IE patients with poor outcomes, those without neurological sequelae, influenza patients without IE, and control subjects. RESULTS Serum sCD163 levels were significantly higher in IE patients with poor outcomes than in those without neurological sequelae. In particular, sCD163 levels in cases of death were significantly higher than those in other cases. CONCLUSIONS Our results suggest that monocyte/macrophage activation is related to the pathogenesis of severe IE.
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Affiliation(s)
- Shunji Hasegawa
- Department of Pediatrics, Yamaguchi University, Graduate School of Medicine, Japan.
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