The comparisons of blood plasma and cerebrospinal fluid S100B protein concentrations in patients with Alzheimer`s disease, amyotrophic lateral sclerosis, and multiple sclerosis

Introduction:S100 calcium-binding protein B (S100B) is a biochemical marker of astroglial damage. Purpose: To assess the pathophysiological implications of S100B concentrations in blood plasma and cerebrospinal fluid of patients with neurodegenerative central nervous system disorders. Materials and Methods: In this study, we determined and compare S100B concentrations in blood plasma and cerebrospinal fluid obtained from subjects diagnosed with Alzheimer's disease (n=20), amyotrophic lateral sclerosis (n=12), multiple sclerosis (n=40) and the reference group (n=20), using enzyme-linked immunosorbent assay. Results: Concentrations of S100B in plasma collected from patients diagnosed with Alzheimer's disease (252,38±183,50 pg/mL) and multiple sclerosis (164,92±250,14 pg/mL) were above laboratory standards, but in patients with amyotrophic lateral sclerosis (53,96±56,92 pg/mL) and the reference group (2,12 pg/mL) were below laboratory norms (N>75 pg/mL). Concentrations of S100B in plasma collected from patients with Alzheimer's disease (252,38±183,50 pg/mL) were significantly higher than in patients with amyotrophic lateral sclerosis (53,96±56,92 pg/mL) (p<0,029). Concentrations of S100B in CSF collected from the reference group (546,96±236,62 pg/mL) and from patients with Alzheimer's disease (587,53±189,57 pg/mL), amyotrophic lateral sclerosis (404,41±179,56 pg/mL), multiple sclerosis (462,03±146,01 pg/mL) were very similar, and none of pairwise comparisons reached statistical significance. Conclusions: Results of our studies indicate the importance of S100B protein concentration assessment in blood in central nervous system disorders differential diagnostics

Hyperglycemia and diabetes have different impacts on outcome of ischemic and hemorrhagic stroke

Introduction: Stroke is the second leading cause of long-term disability and death worldwide. Diabetes and hyperglycemia may impact the outcome of stroke. We examined the impact of hyperglycemia and diabetes on in-hospital death among ischemic and hemorrhagic stroke patients. Material and methods : Data from 766 consecutive patients with ischemic (83.15%) and hemorrhagic stroke were analyzed. Patients were classified into four groups: ischemic and diabetic; ischemic and non-diabetic; hemorrhagic and diabetic; and hemorrhagic and non-diabetic. Serum glucose was measured on admission at the emergency department together with biochemical and clinical parameters. Results : Mean admission glucose in ischemic stroke patients with diabetes was higher than in non-diabetic ones (p < 0.001) and in hemorrhagic stroke patients with diabetes than in those without diabetes (p < 0.05). Mean admission glucose in all patients who died was significantly higher than in patients who survived. In multivariate analysis, the risk factors for outcome in patients with ischemic stroke and without diabetes were age, admission glucose level and estimated glomerular filtration rate (eGFR), while in diabetics they were female gender, admission glucose level, and eGFR; in patients with hemorrhagic stroke and without diabetes they were age and admission glucose levels. The cut-off value in predicting death in patients with ischemic stroke and without diabetes was above 113.5 mg/dl, while in diabetics it was above 210.5 mg/dl. Conclusions : Hyperglycemia on admission is associated with worsened clinical outcome and increased risk of in-hospital death in ischemic and hemorrhagic stroke patients. Diabetes increased the risk of in-hospital death in hemorrhagic stroke patients, but not in ischemic ones

Rivaroxaban or aspirin for patent foramen ovale and embolic stroke of undetermined source: a prespecified subgroup analysis from the NAVIGATE ESUS trial

Background: Patent foramen ovale (PFO) is a contributor to embolic stroke of undetermined source (ESUS). Subgroup analyses from previous studies suggest that anticoagulation could reduce recurrent stroke compared with antiplatelet therapy. We hypothesised that anticoagulant treatment with rivaroxaban, an oral factor Xa inhibitor, would reduce the risk of recurrent ischaemic stroke compared with aspirin among patients with PFO enrolled in the NAVIGATE ESUS trial. Methods: NAVIGATE ESUS was a double-blinded, randomised, phase 3 trial done at 459 centres in 31 countries that assessed the efficacy and safety of rivaroxaban versus aspirin for secondary stroke prevention in patients with ESUS. For this prespecified subgroup analysis, cohorts with and without PFO were defined on the basis of transthoracic echocardiography (TTE) and transoesophageal echocardiography (TOE). The primary efficacy outcome was time to recurrent ischaemic stroke between treatment groups. The primary safety outcome was major bleeding, according to the criteria of the International Society of Thrombosis and Haemostasis. The primary analyses were based on the intention-to-treat population. Additionally, we did a systematic review and random-effects meta-analysis of studies in which patients with cryptogenic stroke and PFO were randomly assigned to receive anticoagulant or antiplatelet therapy. Findings: Between Dec 23, 2014, and Sept 20, 2017, 7213 participants were enrolled and assigned to receive rivaroxaban (n=3609) or aspirin (n=3604). Patients were followed up for a mean of 11 months because of early trial termination. PFO was reported as present in 534 (7·4%) patients on the basis of either TTE or TOE. Patients with PFO assigned to receive aspirin had a recurrent ischaemic stroke rate of 4·8 events per 100 person-years compared with 2·6 events per 100 person-years in those treated with rivaroxaban. Among patients with known PFO, there was insufficient evidence to support a difference in risk of recurrent ischaemic stroke between rivaroxaban and aspirin (hazard ratio [HR] 0·54; 95% CI 0·22–1·36), and the risk was similar for those without known PFO (1·06; 0·84–1·33; pinteraction=0·18). The risks of major bleeding with rivaroxaban versus aspirin were similar in patients with PFO detected (HR 2·05; 95% CI 0·51–8·18) and in those without PFO detected (HR 2·82; 95% CI 1·69–4·70; pinteraction=0·68). The random-effects meta-analysis combined data from NAVIGATE ESUS with data from two previous trials (PICSS and CLOSE) and yielded a summary odds ratio of 0·48 (95% CI 0·24–0·96; p=0·04) for ischaemic stroke in favour of anticoagulation, without evidence of heterogeneity. Interpretation: Among patients with ESUS who have PFO, anticoagulation might reduce the risk of recurrent stroke by about half, although substantial imprecision remains. Dedicated trials of anticoagulation versus antiplatelet therapy or PFO closure, or both, are warranted. Funding: Bayer and Janssen