Absolute Number Of Lymphocytes Research Articles

Correlation between changes in the number of peripheral blood lymphocytes and survival rate in patients with cervical cancer after radio-chemotherapy

PurposeThis study aimed to compare the absolute numbers of various types of lymphocytes in the peripheral blood before and after chemotherapy following radio-chemotherapy in patients with cervical cancer, so as to explore the correlation between the changes in the absolute numbers of peripheral various types of lymphocytes and the overall survival rate of patients. MethodsData of 205 patients with cervical cancer admitted to the hospital from June 2014 to August 2016 were retrospectively analyzed. These patients underwent concurrent radio-chemotherapy, followed by chemotherapy. The absolute numbers of peripheral blood lymphocytes and subtypes were compared before and after re-chemotherapy. ResultsFor patients with a good prognosis, the number of lymphocytes, T cells, and cytotoxic T cells (Tc) significantly decreased (P<0.05) after re-chemotherapy, while this phenomenon was not observed in patients with poor prognosis. Kaplan–Meier univariate analysis showed that patients with cervical cancer who had an advanced FIGO stage before treatment, presence of lymph node metastasis, and increased numbers of Tc and T helper cells after re-chemotherapy showed a low 30-month survival rate; the overall log-rank analysis showed significant differences (P<0.05). Multivariate Cox proportional hazards regression analysis, presence of lymph node metastasis: HR=9.718, P=0.002, 95% CI=0.183–0.679; Tc grouping: HR=3.239, P=0.0.072, 95% CI=0.950–03.347; Th group: HR=3.197, P=0.074, 95% CI=0.943–3.564. ConclusionsAfter radio-chemotherapy, in patients with advanced cervical cancer, the change in the numbers of peripheral blood Tc and Th before and after re-chemotherapy was associated with the 30-month overall survival rate of patients. It can be considered as a predictor of the survival of patients with advanced cervical cancer.

ВЛИЯНИЕ ПРЕПАРАТОВ НА ОСНОВЕ ИНТЕРФЕРОНОВ НА ФОРМИРОВАНИЕ КЛЕТОЧНОГО ИММУНИТЕТА У НОВОРОЖДЕННЫХ ПОРОСЯТ

The article presents the results of a study of the corrective effect of drugs based on interferons on the cellular immunity of newborn piglets on an industrial pig breeding farm. In neonatal period, the immune system development in animals doesn’t reach functional maturity, and immunocompetent cells have low functional activity. In regulation of the immune system, interferons play a significant role in formation of the immune response, proliferation and differentiation of lymphocytes, as well as the activation of mononuclear phagocytes. In order to improve the body immune status, there’ve been designed species-specific drugs based on rIFNs with immunomodulatory properties. For the experiment, 3 groups of newborn piglets were selected. Piglets of experimental group I at the age of 3-5 days were injected intramuscularly with biferon-S at a dose of 0.1 ml/kg twice, with an interval of 24 hours, piglets of group II – once with prostimul at a dose of 0.1 ml/kg. Piglets of group III (control) were not treated with drugs. It has been established that the application of biferon-S, containing rpIFN–alpha and -gamma, and prostimul, containing recombinant type I cytokine and vitamins A, E and C, in the first days of piglets' life, promotes an increase in cellular immunity, the absolute and relative number of lymphocytes, Tlymphocytes, T-suppressors and T-helpers, the content of active phagocytes, their absorptive and metabolic activity, due to the presence of rpIFN in the drugs that rapidly induce the system of endogenous interferons, cellular and humoral immunity, and in prostimul –vitamins A, E and C, possessing antioxidant properties. A more significant corrective effect on cellular immunity has been exerted by biferon-S, containing not only interferon alpha, but also gamma, which is cytokine - a regulator of immune responses, an inducer of cellular immunity.

Immune factors and health of Antarctic explorers

The immune system plays a major role in human homeostasis, yet a body’s unique individuality complicates the diagnostic forecasting of unfavourable physiological states and diseases. Studying the immunophenotypic features of winterers of the Ukrainian Antarctic Expeditions before, during, and after their assignments might shed some light on the possible place of immune accentuations in the development of certain physiological states. To determine the natural-killer (NK) cytotoxicity and the immunophenotype in 52 applicants who wanted to take part in an expedition and nine participants who had come back, we used flow cytofluorometry. Blood serum samples taken before, during, and after the expeditions were also tested for hormones, anti-infective, anti-parasitic, and autoimmune antibodies. The high absolute and relative numbers of NK lymphocytes, high NK cytotoxicity, and high expression of HLA-DR on the CD3+CD8+ lymphocytes were correlated with a person’s unfavorable health status during the expedition. In Antarctica, cortisol levels sharply increased, yet they normalized upon return. In most winterers, there were no significant health complications during the expeditions. Neither reactivated nor primary viral infections were registered, as well as clinical autoimmune ones. Upon return, the winterers had significantly lower leukocytes and lymphocytes and increased expression of activation markers (HLA-DR) on the T-cells. The found risk factors can characterize the polar researchers’ immunophenotypes yet require validation on larger samples. The expedition environment causes increased stress, entailing, however, neither clinical manifestations nor elements of immunosuppression. The polar researchers bear the consequences of the prolonged stress that inhibit leucopoiesis as late as six months after their return, which should be considered while reviewing applications for the next season.

A Cross-sectional Study to Assess Neutrophil Lymphocyte Ratio as a Predictor of Microvascular Complications in Type 2 Diabetes Mellitus Patients

Introduction: Neutrophil Lymphocyte Ratio (NLR) is a novel marker of chronic inflammation that exhibits a balance of two interdependent components of the immune system and can be used to predict microvascular complications in diabetes. Aim: To study the NLR in type 2 diabetes patients and its association with microvascular complications in these patients. Materials and Methods: This was a cross-sectional study conducted over 18 months at Safdarjung Hospital, New Delhi. Eighty patients of type 2 Diabetes Mellitus (DM) were selected for the study. Detailed history was taken including duration of DM, symptoms suggestive of any complications or co-morbidity and treatment history. Physical examination (height and weight) and systemic examination was performed to check for presence of any diabetic complications. NLR was obtained from the complete blood counts by dividing the absolute number of neutrophils to the absolute number of lymphocytes. Data recorded were analysed using Statistical Package for Social Sciences (SPSS) software version 21.0 Logistic regression analysis and Receiver Operating Curve (ROC) curve were used. Results: Total 38.7% (31) of the patients had high NLR, with mean±Standard Deviation (SD) of NLR being 3.29±1.49. There was a statistically significant association between poorly controlled diabetes HbA1C &gt;7%, high-sensitivity C-Reactive Protein (hs-CRP) levels and NLR. NLR was found to be the best predictor of diabetic neuropathy and diabetic nephropathy. NLR was also significantly higher in DM patient having more than one microvascular complication. Conclusion: NLR can be used as a simple parameter to predict presence of diabetic microvascular complications. Thus, an early diagnosis and subsequently targeting inflammatory pathways could possibly be a component of the strategies to prevent and control diabetes related complications.

519. Immune responses and COVID-19 severity

BackgroundThe coronavirus-19-disease (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread to >200 countries and surpassed 7 million cases. There is a broad range of COVID-19 illness, ranging from milder disease to a rapidly progressive respiratory disease and ARDS. The causes of this different clinical course and the drivers for severe disease are currently unknown. A fulminant increase of pro-inflammatory cytokines is thought to play a role in causing a rapid disease evolution, however the immune correlates of severe COVID-19 remain unclear.MethodsTo gain insight into relationship between immune responses and disease severity we built a longitudinal cohort of 40 adult patients with known COVID-19. Samples were collected at diagnosis and every 7 days until hospital discharge or death. As controls we also included a group of convalescent patients, and subjects who tested negative for COVID-19 by PCR. Clinical and laboratory data and were also collected. Multicolor flow cytometry was used to determine the presence and phenotype of B, T and natural killer (NK) cells. We also identified specific sub-populations (Tfh, activated/cytotoxic CD8 and NK) and assessed lymphoid exhaustion of different cell types such as naïve, memory T cells, or NK over time. Anti-Sars-CoV2 IgG and IgM antibody were detected using lateral flow method.ResultsWe found that the absolute number of lymphocytes and monocytes was decreased starting at diagnosis and correlated with disease severity. Disease severity correlated with decreased NK and T cell. In severe COVID-19 cases, NK cell populations were strongly decreased over time in intubated patients while they recovered in patients who improved and were discharged. CD8+ were also decreased at disease onset and seemed to correlate with disease severity. A high percentage of CD4+ and CD8+ T cells showed an exhausted phenotype. All patients tested at admission had IgM antibody responses irrespective of the course of the disease. Further analyses are ongoing.ConclusionThe characterization and role of the immune responses in COVID-19 evolution is still under investigation. Further characterization of viral and immune factors will help in identifying subjects at high risk of severe disease and targets for intervention.Disclosures All Authors: No reported disclosures

Dynamic monitoring of immune function indexes in COVID-19 patients.

We conducted a retrospective analysis of the clinical characteristics and dynamic variations of immune indexes in nine COVID-19 patients in Zigong, China. We used flow cytometry and enzyme-linked immunosorbent assays to measure the absolute levels of CD4 and CD8 lymphocytes and SARS-CoV-2 antibodies, respectively. We found that CRP, LDH, HBDH, CD4/CD8 and IgE levels were increased in 6/9 patients, while PA and the absolute numbers of CD4 and CD8 lymphocytes decreased in 7/9 patients. From disease onset through 63 days of follow-up, SARS-CoV-2 IgG levels were consistently higher than those of SARS-CoV-2 IgM, reaching peaks on days 28 and 13, respectively. IgM levels decreased to normal 35 days after disease onset, while IgG levels remained elevated through day 63. IgE levels varied similarly to SARS-CoV-2 IgM. Our results suggest that SARS-CoV-2 may elicit allergic immune responses in patients and that the levels of CRP, PA, LDH, and HBDH, as well as the absolute numbers of CD4 and CD8 lymphocytes could be used as early diagnostic markers of SARS-CoV-2 infection. Lastly, the dynamic variation of SARS-CoV-2 antibodies could guide the timing of blood collection for plasma exchange.

ДО ПИТАНЬ ВПЛИВУ ПОЄДНАНОЇ ДІЇ ЕЛЕКТРОМАГНІТНОГО ВИПРОМІНЮВАННЯ ТА ШУМУ НА СТАН МОРФОЛОГІЧНИХ ЕЛЕМЕНТІВ КРОВІ

The aim. Study of hematological parameters under conditions of combined action on the body of experimental animals. Subject and methods. The effect of electromagnetic radiation on the state of morphological elements of the blood. Hematological, statistical methods. Results. A two-month experiment was performed on white rats exposed to EMR at the levels of 100, 500 and 2500 μW/cm2 and acoustic noise of 85 dBA. The structure of the leukogram changed due to changes in the absolute number of leukocytes (increase), lymphocytes (decrease), monocytes (decrease) and granulocytes (decrease). Since lymphocytes belong to immunocompetent cells and assessing the nature of their changes during 60 days of the experiment, we can assume that there is an increase in regenerative processes in the lymphocyte population and activation of the immune system by damaging factor, followed by gradual depletion of compensatory mechanisms and suppression of suppressor mechanisms. Decreased hemoglobin levels and a decrease in the average concentration of hemoglobin in erythrocytes may indicate low blood O2 saturation and the development of anemia, with the subsequent development of dysfunction of all organs and systems of the body. Conclusions. The nature of changes in hematological parameters during the experiment may be a manifestation of mobilization of functional systems and the formation of adaptive responses aimed at maintaining the stability of homeostasis in the studied factors with possible prolongation of their further disruption, suppression of regenerative processes in the blood and depletion of compensators, or the development of various reparation reactions that provide protective - restorative functional systems to maintain the dynamic balance of the organism with the environment.

Immune disorders after combined treatment of obese patients with endometrial cancer

Background. Immune disorders in antitumor treatment of obese patients may depend on the severity of the inflammatory process, which justifies the need to take into account the intensity of the latter in the analysis of complications of antitumor treatment in obese individuals. Purpose – evaluation of immune disorders after radiation therapy in obese patients with different intensity of the inflammatory process. Materials and methods. 65 patients with stage I–II endometrial cancer underwent pangysterectomy and a postoperative course of remote gamma therapy. Examinations were performed before treatment and after radiation therapy. Subpopulation composition of lymphocytes, phagocytic activity of neutrophils, levels of circulating immune complexes and immunoglobulins G, A, M were determined by standard methods. The SF-3000 «SYSMEX» analyzer was used to evaluate hematological parameters. The level of C-reactive protein (CRP) was determined using an analyzer «RESPONS 910». Insulin and leptin levels were assessed by enzyme-linked immunosorbent assay. Results and discussion. Immune and hematological parameters were evaluated in 3 groups of patients. Group I included patients with normal body weight (BMI &lt; 25), II and III groups consisted of obese patients (BMI &gt; 30). Group II included patients with a CRP level below the median, which was 18,0 mg/l, group III – patients with a CRP level above 18.0 mg/l. In patients of group II there was a higher absolute and relative number of lymphocytes, the absolute number of CD3+-, CD4+- and CD8+-lymphocytes compared with those registered in groups I and III. After radiation therapy, the absolute number of lymphocytes and lymphocyte subpopulations decreased in all groups. As before treatment, higher levels of these indicators were registered in group II. In obese patients, the relative number of NK cells was lower than that determined in patients of group I before and after treatment. Conclusions. Patients with obesity and low intensity of the inflammatory process have less pronounced immune disorders after radiation therapy compared with patients who had a normal body weight and individuals with obesity and high levels of CRP.

Effect of drugs on the morphological indicators of calf blood during the mixed course of cryptosporidiosis and eimeriosis

The aim of the work was to determine the effect of drugs on the morphological parameters of the blood of calves during the mixed course of cryptosporidiosis and eimeriosis. Three groups of calves (n = 7) spontaneously infected with cryptosporidia and eimeria were formed. The treatment with brovitacoccid (group I) and the drug “Amprolev-plus” (group II) was carried out and the change in morphological parameters of the blood was determined before the use of drugs and on the 3rd, 7th, 14th and 21st days. In the spontaneous mixed course of cryptosporidiosis and eimeriosis of calves, the efficacy of brovitacoccid for cryptosporidiosis was 85.7%, for eimeriosis — 100%, while the efficacy of the drug “Amprolev-plus” for cryptosporidiosis was 100%, and for eimeriosis — 85.7%. In the mixed course of cryptosporidiosis and eimeriosis of calves, the restoration of morphological parameters of blood after the use of the drug “Amprolev-plus” was recorded on the 14th day, and brovitacoccid — on the 21st day. The proposed drugs restore the content of erythrocytes to the level of 6.91 ± 0.52 T/l and 6.86 ± 0.55 T/l and hemoglobin 115.85 ± 1.22 g/l and 116.22 ± 0.24 g/l. The number of leukocytes decreased by 28.9% and 35.7% compared to their number before treatment, lymphocytes — by 10.5% and 9.0%, monocytes — 10.5% and 8.8%. A positive correlation between the content of leukocytes and the absolute number of lymphocytes indicates the activation of the cellular immune system

Circulating Cytokines and Lymphocyte Subsets in Patients Who Have Recovered from COVID-19.

To investigate the immune status of people who previously had COVID-19 infections, we recruited two-week postrecovery patients and analyzed circulating cytokine and lymphocyte subsets. We measured levels of total lymphocytes, CD3+ T cells, CD4+ T cells, CD8+ T cells, CD19+ B cells, and CD56+ NK cells and the serum concentrations of interleukin- (IL-) 1, IL-4, IL-6, IL-8, IL-10, transforming growth factor beta (TGF-β), tumor necrosis factor alpha (TNF-α), and interferon gamma (IFN-γ) by flow cytometry. We found that in most postrecovery patients, levels of total lymphocytes (66.67%), CD3+ T cells (54.55%), CD4+ T cells (54.55%), CD8+ T cells (81.82%), CD19+ B cells (69.70%), and CD56+ NK cells (51.52%) remained lower than normal, whereas most patients showed normal levels of IL-2 (100%), IL-4 (80.88%), IL-6 (79.41%), IL-10 (98.53%), TNF-α (89.71%), IFN-γ (100%), and IL-17 (97.06%). Compared to healthy controls, two-week postrecovery patients had significantly lower absolute numbers of total lymphocytes, CD3+ T cells, CD4+ T cells, CD8+ T cells, CD19+ B cells, and CD56+ NK cells, along with significantly higher levels of IL-2, IL-4, IL-6, IL-10, TNF-α, IFN-γ, and IL-17. Among postrecovery patients, T cells, particularly CD4+ T cells, were positively correlated with CD19+ B cell counts. Additionally, CD8+ T cells were positively correlated with CD4+ T cells and IL-2 levels, and IL-6 positively correlated with TNF-α and IFN-γ. These correlations were not observed in healthy controls. By ROC curve analysis, postrecovery decreases in lymphocyte subsets and increases in cytokines were identified as independent predictors of rehabilitation efficacy. These findings indicate that the immune system gradually recovers following COVID-19 infection; however, the sustained hyperinflammatory response for more than 14 days suggests a need to continue medical observation following discharge from the hospital. Longitudinal studies of a larger cohort of recovered patients are needed to fully understand the consequences of the infection.

Demographics, laboratory parameters and outcomes of 1061 patients with coronavirus disease 2019: a report from Tehran, Iran.

We aimed to determine the characteristics of coronavirus disease 2019 (COVID-2019) among the Iranian population. In this study, we collected and analysed the demographics, laboratory findings and outcomes of patients with COVID-19 who were admitted to Masih Daneshvari Hospital in Tehran, Iran between 20 February 2020 and 2 April 2020. Among 1061 patients, 692 (65.2%) were male and the median age was 55 years (interquartile range (IQR), 44–66 years). Totally, 129 (12.2%) patients died during hospitalization in the ward or intensive care unit. From the remaining 932 individuals, 46 (5.0%) were admitted to the intensive care unit and 886 (95.0%) were hospitalized in the ward. Those patients who died were significantly older than those hospitalized in the ward (p < 0.001). The median absolute number of lymphocytes was 1.2 × 103/μL (IQR 0.9 × 103 to 1.6 × 103/μL) and 708 (66.7%) patients had lymphopenia (absolute lymphocyte count <1500/μL). Among the laboratory tests, D-dimer, serum ferritin and albumin had the strongest correlations with mortality (r = 0.455, r = 0.412, r = –0.406, respectively; p < 0.001 for each one). In conclusion, laboratory findings could provide useful information with regard to the management of individuals with COVID-19.

Immune characteristics distinguish patients with severe disease associated with SARS-CoV-2.

This single-center, retrospective study aimed to explore the immune characteristics of COVID-19 and biomarkers to predict the severity of this disease. Patients infected with SARS-CoV-2 (n = 215) treated at the First Affiliated Hospital of Nanchang University from January 24 to March 12, 2020, were included in the study and classified into severe and non-severe groups. Peripheral immunocyte count and cytokine statuses were compared. The correlation between immune status, cytokine levels, and disease severity was analyzed. Leukocyte numbers were normal in both groups; however, they were relatively high (7.19 × 109/L) in patients of the severe group. Leukocyte distributions differed between the two groups; the severe group had a higher percentage of neutrophils and lower percentage of lymphocytes compared with the non-severe group, and absolute lymphocyte numbers were below normal in both groups, and particularly deficient in patients in the severe group. Lymphocyte counts have negative correlation with duration of hospital period whereas neutrophil count has no significant correlation with it. Of tested cytokines, IL-6 levels were significantly higher in the severe group (P = 0.0418). Low level of lymphocyte predicts severity of COVID-19. IL-6 levels were significantly higher in the severe group, especially in some extremely severe patients. But we did not detect the significant correlation between severity of COVID-19 with IL-6 level which may be due to limited case numbers. Our observations encourage future research to understand the underlying molecular mechanisms and to improve treatment outcome of COVID-19.Electronic supplementary materialThe online version of this article (10.1007/s12026-020-09156-2) contains supplementary material, which is available to authorized users.

Dynamics of blood immunological parameters in patients with glial tumors of varying degrees of anaplasia

The patients with glial tumors of varying degrees of anaplasia represent an imbalance in the composition of different subpopulations of immune cells, which leads to both specific immunosuppression and stimulation of the tumor process. For a comprehensive clinical assessment of the state of immunity in the blood, it is recommended to determine the ratio of the absolute level of immune cells, which integrally reflects the violation of certain indicators of innate and acquired immunity. Objective: To determine the relationship between the absolute number of lymphocytes, neutrophils, and platelets in the peripheral blood in glial tumors of varying degrees of anaplasia and at the stages of surgical treatment. Materials and methods. The case histories of 95 patients with glial tumors before surgery, on the 5 th –7 th day after surgery and before reoperation were studied. There were 71 patients initially operated for glial tumors of varying degrees of anaplasia, 40 patients with glioblastomas, 15 patients with anaplastic, and 16 patients with diffuse astrocytomas. Twenty-four patients were re-operated. The comparison group (control) consisted of 28 patients with non-cancerous diseases of the CNS. The age of patients with brain tumors and the comparison group ranged from 35 to 65 years. To analyze blood immunologic parameters, hematologic analyzer Mindray 3000 plus was used to identify the absolute number of platelets, neutrophils, and lymphocytes as well as the ratio index of the absolute number of neutrophils to the absolute number of lymphocytes (n/l), the absolute number of platelets to the absolute content of lymphocytes (p/l), the ratio of the absolute number of platelets to the absolute content of neutrophils (p/n). Results. In malignant glial tumors (glioblastomas and anaplastic astrocytomas), the level of n/l is significantly increased compared to the diffuse astrocytomas, the stimulation of neutrophil production and inhibition of lymphocyte formation are identified. On the 5 th –7 th days after surgery, there is no recovery of subpopulations of immune cells in the peripheral blood. The recurrences of glial tumors are accompanied by the imbalance in the structure of immune cells in peripheral blood that does not depend on the degree of tumors anaplasia. Conclusions. Determining the ratio of the absolute content of immune cells in the peripheral blood can serve as an informative indicator of the direction of disorders in congenital and acquired immune systems, which should be taken into account in the treatment of tumors.

Potential antitumor effects of egg extract and purple fluid from marine Aplysia fasciata against experimental Ehrlich ascites carcinoma

Background: The wide biodiversity of marine animals provides a rich source of potential bioactive materials with biomedical applications. Aim: This study aimed to test the in vitro and in vivo anti-tumor effects of the purple fluid and egg extracts from Aplysia fasciata inhabiting the Egyptian marine water. Methods: The cytotoxicity of both the purple fluid and egg extracts were analysed in vitro against Ehrlich ascites carcinoma (EAC) cells by the trypan blue exclusion, MTT reduction assay and flow cytometry. The anti-EAC immunological effects of both extracts were assessed by blood counting and flow cytometry in mice challenged with EAC cells. Results: In vitro treatment of EAC cells with egg extract and the purple fluid caused significant decreases in the number and viability of EAC cells associated with increases in EAC apoptosis in a dose-dependent manner as compared to untreated EAC cells. In vivo, both the purple fluid extract (20μg/ mouse) and egg extract (6.7 μg/mouse) significantly reduced the numbers of EAC cells by 4.3 and 2.3 folds, respectively. However, the anti-tumour effects of the extracts either in vitro or in vivo were yet lower than that of the anti-tumor reference drug cisplatin. Both extracts induced significant increases in the levels of relative and absolute numbers of lymphocytes, mature macrophages (CD11b+ Ly6G-) while with minimal effects on immature neutrophils (CD11b+ Ly6G+). Conclusion: Both egg extract and the purple fluid of Aplysia fasciata possess potential anti-tumour effects with less toxicity, opening new avenues for further evaluation of the chemical and biological mechanisms behind these effects.

Predictive Value of Risk Factors for Chronic Idiopathic Thrombocytopenic Purpura in Patients with Acute Type of Disease

BACKGROUND: Immune thrombocytopenic purpura (ITP) is an autoimmune disease in which autoantibodies react with platelet surface antigens and results in mild to severe thrombocytopenia due to decreased platelet count or inhibition of platelet production. Given the relatively high prevalence of ITP among children and the lack of standard diagnostic testing for the diagnosis of chronic disease, this study evaluated the predictive value of risk factors for chronic ITP in hospitalized patients.&#x0D; METHODS: This prospective cohort study was performed on 65 children with ITP who referred to Ali Asghar and Rasool Akram Hospitals in Tehran, Iran, during the years 2017 and 2018. Relationships between different risk factors, including age of diagnosis, gender, white cell count, primary platelet count, mean platelet volume (MPV), history and type of the previous patient infection, FCG gene mutation, and type of FCG mutation with a chronic disease incidence were investigated using multiple logistic regression model.&#x0D; RESULTS: Of 65 patients, 31 (47.69%) were male and 34 (52.31%) were female included in the study. Twenty-eight patients (43.08%) had acute ITP and 37 (56.92%) had chronic ITP. Frequency of FCG gene mutation in patients with chronic and acute type ITP was 16.36% and 7.27%, respectively (p = 0.51). No association was found between the history of the previous infection and its type with the chronic incidence of ITP. The multiple logistic regression model showed that three factors, including the absolute number of lymphocytes, age of diagnosis, and primary white blood cells (WBC) count were directly linked to chronic ITP. Furthermore, three factors of platelet, sex, and MPV were indirectly related to chronic ITP. In addition, the absolute number of lymphocytes, age of diagnosis and primary WBC count were significantly associated with chronic ITP. The receiver operating characteristic analysis showed that the cutoff rate of these factors was 0.31. Further analysis of these risk factors in comparison with the gold standard demonstrated that the diagnostic sensitivity and specificity of these risk factors for chronic ITP were 73.08% and their specificity was 88.57%, indicating the high importance and predictive power of these risk factors.&#x0D; CONCLUSIONS: According to the results of this study, for the first time in Iran, six risk factors, including the absolute number of lymphocytes, age at diagnosis, sex, MPV level, platelet level at time of diagnosis, and primary WBC count were considered as the most important risk factors affecting the incidence of chronic ITP. Of course, more comprehensive studies can definitely lead to more comprehensive models.

A single copy of large tumor suppressor 1 or large tumor suppressor 2 is sufficient for normal hematopoiesis.

BackgroundHematopoietic stem cells (HSCs) have the ability to differentiate into all subsets of blood cells and self-renew. Large tumor suppressor 1 (LATS1) and large tumor suppressor 2 (LATS2) kinases are essential for cell cycle regulation, organism fitness, genome integrity, and cancer prevention. Here, we investigated whether Lats1 and Lats2 are critical for the maintenance of the self-renewal and quiescence capacities of HSCs in mice.MethodsQuantitative reverse transcription-polymerase chain reaction was used to determine the expression levels of Lats1 and Lats2 in subsets of progenitor cells and mature bone marrow cells. A clustered regularly interspaced short palindromic repeats system was used to generate Lats1 or Lats2 knockout mice. Complete blood cell counts were used to compare the absolute number of white blood cells, lymphocytes, monocytes, neutrophils, and platelets between Lats1 or Lats2 heterozygotes and littermates. Flow cytometry was used to assess the size of hematopoietic progenitor cells (HPCs) and HSC pools in Lats1 or Lats2 heterozygotes and littermates. The comparison between the two groups was analyzed using Student's t test.ResultsLats1 and Lats2 were widely expressed in hematopoietic cells with higher expression levels in primitive hematopoietic cells than in mature cells. Lats1 or Lats2 knockout mice were generated, with the homozygotes showing embryonic lethality. The size of the HPC and HSC pools in Lats1 (HPC: wild-type [WT] vs. heterozygote, 220,426.77 ± 54,384.796 vs. 221,149.4 ± 42,688.29, P = 0.988; HSC: WT vs. heterozygote, 2498.932 ± 347.856 vs. 3249.763 ± 370.412, P = 0.105) or Lats2 (HPC: WT vs. heterozygote, 425,540.52 ± 99,721.86 vs. 467,127.8 ± 89,574.48, P = 0.527; HSC: WT vs. heterozygote, 4760.545 ± 1518.01 vs. 5327.437 ± 873.297, P = 0.502) heterozygotes were not impaired. Moreover, the depletion of Lats1 or Lats2 did not affect the overall survival of the heterozygotes (Lats1: P = 0.654; Lats2: P = 0.152).ConclusionThese results indicate that a single allele of Lats1 or Lats2 may be sufficient for normal hematopoiesis.

The use of indicators of the regeneration of decubital ulcers in a comprehensive assessment of the nutritional status of patients in a chronic critical illness

Background: Thanks to advances in emergency medical and surgical care, the number of patients experiencing acute critical illnesses is increasing. However, a group of patients in the so-called chronic critical illness (CCI) was formed. In this category of patients, the problem of treating decubital ulcers is relevant, since they are characterized by a combination of prolonged immobilization, severe protein catabolism, neuroendocrine and metabolic disorders, protein-energy malnutrition (PEN) and tissue trophic disorders.&#x0D; Aims: Analyze the correlation of the degree of regeneration of decubital ulcers according to the Bates-Jenson scale in the modification S.Y.R. in relation to indicators of the nutritional status of patients in the CCI after brain damage.&#x0D; Materials and methods: The study included 26 patients with pressure ulcers II, III, IV stage with PEN. To evaluate decubital ulcers, the adapted Bates-Jensen scale in the S.Y.R. modification was used. (with graphic model). The severity of PEN was evaluated by a complex of anthropometric (BMI, shoulder circumference, thickness of the skin-fat fold, circumference of the shoulder muscles) and laboratory (transferrin, absolute lymphocyte count) indicators. The dynamics of anthropometric indicators and the results of laboratory studies were separately considered.&#x0D; Results: As a result, it was found that the change in anthropometric data correlated with laboratory parameters and the healing rate of decubital ulcers in only 26.9% of cases. Moreover, this correlation between the dynamics of transferrin and the absolute number of lymphocytes with the regeneration of decubital ulcers was observed in all patients. The obtained results demonstrated a direct correlation between the dynamics of healing of pressure ulcers and changes in laboratory indicators of nutritional status (as opposed to anthropometry data) in patients who are in a CCI after brain damage.&#x0D; Conclusions: These findings provide an opportunity to review the weight of indicators in assessing the severity of protein-energy malnutrition, as well as introducing the rate of regeneration of a decubital ulcer in the presence of a patient into the assessment of the nutritional status.

Prognostic models for newly-diagnosed chronic lymphocytic leukaemia in adults: a systematic review and meta-analysis

Prognostic models for newly-diagnosed chronic lymphocytic leukaemia in adults: a systematic review and meta-analysis

Preliminary Data on COVID-19 in Patients with Hemoglobinopathies: A Multicentre ICET-A Study.

ObjectivesThis study aims to investigate, retrospectively, the epidemiological and clinical characteristics, laboratory results, radiologic findings, and outcomes of COVID-19 in patients with transfusion-dependent β thalassemia major (TM), β-thalassemia intermedia (TI) and sickle cell disease (SCD).DesignA total of 17 Centers, from 10 countries, following 9,499 patients with hemoglobinopathies, participated in the survey.Main outcome dataClinical, laboratory, and radiologic findings and outcomes of patients with COVID-19 were collected from medical records and summarized.ResultsA total of 13 patients, 7 with TM, 3 with TI, and 3 with SCD, with confirmed COVID-19, were identified in 6 Centers from different countries. The overall mean age of patients was 33.7±12.3 years (range:13–66); 9/13 (69.2%) patients were females. Six patients had pneumonia, and 4 needed oxygen therapy. Increased C-reactive protein (6/10), high serum lactate dehydrogenase (LDH; 6/10), and erythrocyte sedimentation rate (ESR; 6/10) were the most common laboratory findings. 6/10 patients had an exacerbation of anemia (2 with SCD). In the majority of patients, the course of COVID-19 was moderate (6/10) and severe in 3/10 patients. A 30-year-old female with TM, developed a critical SARS-CoV-2 infection, followed by death in an Intensive Care Unit. In one Center (Oman), the majority of suspected cases were observed in patients with SCD between the age of 21 and 40 years. A rapid clinical improvement of tachypnea/dyspnea and oxygen saturation was observed, after red blood cell exchange transfusion, in a young girl with SCD and worsening of anemia (Hb level from 9.2 g/dl to 6.1g/dl).ConclusionsThe data presented in this survey permit an early assessment of the clinical characteristics of COVID 19 in different countries. 70% of symptomatic patients with COVID- 19 required hospitalization. The presence of associated co-morbidities can aggravate the severity of COVID- 19, leading to a poorer prognosis irrespective of age.

Clinical and Immune Features of Hospitalized Pediatric Patients With Coronavirus Disease 2019 (COVID-19) in Wuhan, China.

The epidemiologic and clinical characteristics of pediatric patients with coronavirus disease 2019 (COVID-19) have been reported, but information on immune features associated with disease severity is scarce. To delineate and compare the immunologic features of mild and moderate COVID-19 in pediatric patients. This single-center case series included 157 pediatric patients admitted to Wuhan Children's Hospital with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Data were collected from January 25 to April 18, 2020. Documented SARS-CoV-2 infection. Clinical and immunologic characteristics were collected and analyzed. Outcomes were observed until April 18, 2020. Of the 157 pediatric patients with COVID-19, 60 (38.2%) had mild clinical type with pneumonia, 88 (56.1%) had moderate cases, 6 (3.8%) had severe cases, and 3 (1.9%) were critically ill. The 148 children with mild or moderate disease had a median (interquartile range [IQR]) age of 84 (18-123) months, and 88 (59.5%) were girls. The most common laboratory abnormalities were increased levels of alanine aminotransferase (ALT) (median [IQR], 16.0 [12.0-26.0] U/L), aspartate aminotransferase (AST) (median [IQR], 30.0 [23.0-41.8] U/L), creatine kinase MB (CK-MB) activity (median [IQR], 24.0 [18.0-34.0] U/L), and lactate dehydrogenase (LDH) (median [IQR], 243.0 [203.0-297.0] U/L), which are associated with liver and myocardial injury. Compared with mild cases, levels of inflammatory cytokines including interleukin 6, tumor necrosis factor α, and interferon γ were unchanged, whereas the level of immune suppressive interleukin 10 was markedly increased in moderate cases compared with mild cases (median [IQR], 3.96 [3.34-5.29] pg/mL vs 3.58 [3.10-4.36] pg/mL; P = .048). There was no statistically significant difference in absolute number of lymphocytes (including T cells and B cells) between mild and moderate cases, but moderate cases were associated with a decrease in neutrophil levels compared with mild cases (median [IQR], 2310/μL [1680/μL-3510/μL] vs 3120/μL [2040/μL-4170/μL]; P = .01). Immunoglobin G and the neutrophil to lymphocyte ratio were negatively associated with biochemical indices related to liver and myocardial injury (immunoglobulin G, ALT: r, -0.3579; AST: r, -0.5280; CK-MB activity: r, -0.4786; LDH: r, -0.4984; and neutrophil to lymphocyte ratio, ALT: r, -0.1893; AST: r, -0.3912; CK-MB activity: r, -0.3428; LDH: r, -0.3234), while counts of lymphocytes, CD4+ T cells, and interleukin 10 showed positive associations (lymphocytes, ALT: r, 0.2055; AST: r, 0.3615; CK-MB activity: r, 0.338; LDH: r, 0.3309; CD4+ T cells, AST: r, 0.4701; CK-MB activity: r, 0.4151; LDH: r, 0.4418; interleukin 10, ALT: r, 0.2595; AST: r, 0.3386; CK-MB activity: r, 0.3948; LDH: r, 0.3794). In this case series, systemic inflammation rarely occurred in pediatric patients with COVID-19, in contrast with the lymphopenia and aggravated inflammatory responses frequently observed in adults with COVID-19. Gaining a deeper understanding of the role of neutrophils, CD4+ T cells, and B cells in the pathogenesis of SARS-CoV-2 infection could be important for the clinical management of COVID-19.