Absolute Value Of Lymphocytes Research Articles

Interpretable prediction of 3-year all-cause mortality in patients with chronic heart failure based on machine learning

BackgroundThe goal of this study was to assess the effectiveness of machine learning models and create an interpretable machine learning model that adequately explained 3-year all-cause mortality in patients with chronic heart failure.MethodsThe data in this paper were selected from patients with chronic heart failure who were hospitalized at the First Affiliated Hospital of Kunming Medical University, from 2017 to 2019 with cardiac function class III-IV. The dataset was explored using six different machine learning models, including logistic regression, naive Bayes, random forest classifier, extreme gradient boost, K-nearest neighbor, and decision tree. Finally, interpretable methods based on machine learning, such as SHAP value, permutation importance, and partial dependence plots, were used to estimate the 3-year all-cause mortality risk and produce individual interpretations of the model's conclusions.ResultIn this paper, random forest was identified as the optimal aools lgorithm for this dataset. We also incorporated relevant machine learning interpretable tand techniques to improve disease prognosis, including permutation importance, PDP plots and SHAP values for analysis. From this study, we can see that the number of hospitalizations, age, glomerular filtration rate, BNP, NYHA cardiac function classification, lymphocyte absolute value, serum albumin, hemoglobin, total cholesterol, pulmonary artery systolic pressure and so on were important for providing an optimal risk assessment and were important predictive factors of chronic heart failure.ConclusionThe machine learning-based cardiovascular risk models could be used to accurately assess and stratify the 3-year risk of all-cause mortality among CHF patients. Machine learning in combination with permutation importance, PDP plots, and the SHAP value could offer a clear explanation of individual risk prediction and give doctors an intuitive knowledge of the functions of important model components.

Development and validation of a nomogram for the prediction of brain metastases in small cell lung cancer.

The aim was to develop and validate a nomogram for the prediction of brain metastases (BM) in small cell lung cancer (SCLC), to explore the risk factors and assist clinical decision-making. We reviewed the clinical data of SCLC patients between 2015 and 2021. Patients between 2015 and 2019 were included to develop, whereas patients between 2020 and 2021 were used for external validation. Clinical indices were analysed by using the least absolute shrinkage and selection operator (LASSO) logistic regression analyses. The final nomogram was constructed and validated by bootstrap resampling. A total of 631 SCLC patients between 2015 and 2019 were included to construct model. Gender, T stage, N stage, Eastern Cooperative Oncology Group (ECOG), haemoglobin (HGB), the absolute value of lymphocyte (LYMPH #), platelet (PLT), retinol-binding protein (RBP), carcinoembryonic antigen (CEA) and neuron-specific enolase (NSE) were identified as risk factors and included into the model. The C-indices were 0.830 and 0.788 in the internal validation by 1000 bootstrap resamples. The calibration plot revealed excellent agreement between the predicted and the actual probability. Decision curve analysis (DCA) showed better net benefits with a wider range of threshold probability (net clinical benefit was 1%-58%). The model was further externally validated in patients between 2020 and 2021 with a C-index of 0.818. We developed and validated a nomogram to predict the risk of BM in SCLC patients, which could help clinicians to rationally schedule follow-ups and promptly implement interventions.

A study on expression level and nutritional status of IGFBP-2 after left neck anastomosis combined with placement of feeding nutritional applicators carrying ^(125)I particles in the treatment of esophageal cancer.

To explore the changes and significance of the expression level and nutritional status of human insulin-like growth factor binding protein-2 (IGFBP2) after the treatment of esophageal cancer with left neck anastomosis combined with placement of feeding nutritional applicators carrying ^(125)I particles. A total of 110 patients with esophageal cancer (observation group: left neck anastomosis combined with placement of feeding nutritional applicators carrying ^(125)I particles) and 100 healthy people (control group) were enrolled at the same period. Then enzyme-linked immunosorbent assay (ELISA) was carried out to detect level of IGFBP-2. Lymphocyte count and serum albumin were measured by immune analyzer and automatic protein analyzer to evaluate nutritional status. Logistic regression analysis was used to analyze the relationship between serum IGFBP-2, nutritional status and prognosis of esophageal cancer after combined treatment. The albumin, lymphocyte absolute value and PNI detection value of the control group were lower than those of the observation group 1 month after treatment, and the difference was statistically significant compared with the control group. The detection value of IGFBP-2 in early patients before and after treatment was lower than that in middle and late patients, and the detection values of albumin, lymphocyte absolute value and PNI were higher than those in middle and late patients, the differences were statistically significant. Serum IGFBP-2 level was negatively correlated with PNI, and albumin and lymphocyte absolute value were positively correlated with PNI. The detection value of IGFBP-2 in patients with good prognosis was significantly lower than that in patients with poor prognosis, and the detection values of albumin, lymphocyte absolute value and PNI were significantly higher than those in patients with poor prognosis. The AUC (0.887,95% CI: 0.799-0.975) of IGFBP-2, albumin, lymphocyte absolute value and PNI in predicting poor prognosis of esophageal cancer was the largest, and the sensitivity and specificity were 94.12% and 92.47%, respectively. Left neck anastomosis combined with ^(125)I particle application nutritional tube is helpful for the decrease of serum IGFBP-2 and the increase of various nutritional status indicators, which is beneficial for the improvement of the patient's condition.

Blood transcriptome analysis and identification of genes associated with supernumerary teats in Chinese Holstein cows.

In dairy cows, supernumerary teats (SNT) are not desired as they are considered a repository for bacteria; thus, SNT are a risk factor for mastitis. Supernumerary teats are a heritable oligo- or polygenic trait. The incidence of SNT in offspring must be reduced by genomic selection. However, in modern dairy farming, farmers often ignore the effects of SNT on cows. The study aimed to elucidate the effects of SNT on dairy cows from the blood transcriptome level and identify genes associated with SNT in Chinese Holstein cows. We selected 6 SNT cows (Yes) and 6 non-SNT cows (No). In the 6 SNT cows, 3 cows had 1 SNT (One) and 3 cows had 2 SNT (Two). They were divided into 3 comparison groups (One vs. No; Two vs. No; and Yes vs. No). RNA was extracted from blood white membrane cells of 12 cows, and RNA sequencing was performed. Differential gene expression analysis based on the negative binomial distribution was used to detect differentially expressed genes in the One versus No and Two versus No comparison groups. Genes that were significantly upregulated or downregulated both in the One versus No and Two versus No groups (shared genes, SG) were obtained for further analysis. We also performed gene set enrichment analysis for all genes expressed in the Yes versus No group, correlation analysis between SG and the hematological parameters, protein-protein interaction network analysis of SG to select hub genes, and alternative splicing analysis for Yes versus No group to explore the functions of differentially spliced genes. We detected 289 SG. Gene set enrichment analysis, gene ontology, and the Kyoto Encyclopedia of Genes and Genomes enrichment analysis results showed that SNT affect immunity, inflammation, and lactation-related pathways in dairy cows. Correlation analysis showed that LOC104968484, SLC25A6, GADD45G, BAX, APAF1, ATM, XIAP, MDM4, BDP1, CEP350, MED13, TAOK1, SMG1, and RIF1 are associated with white blood cell count and absolute value of lymphocytes in SNT cows only, so they might be genes associated with SNT in Chinese Holstein cows. We found 2 genes (BAX and MDM4) were also differentially spliced genes. However, the causal relationship between these genes and the SNT phenotype needs to be further studied. This study is the first to reveal the adverse effects of SNT on dairy cows at a transcriptional level, and the genes we found can be used as a reference for further searching for candidate genes for the SNT phenotype.

Clinical diagnosis and etiology of patients with Chlamydia psittaci pneumonia based on metagenomic next-generation sequencing.

The incidence of severe Chlamydia psittaci (C. psittaci) pneumonia and coinfections is increasing. Early detection of this condition is needed to prevent negative outcomes, along with detailed descriptions of its associated clinical characteristics. Our study contributes by undertaking etiological analysis of patients with C. psittaci pneumonia based on metagenomic next-generation sequencing (mNGS). A retrospective analysis of 30 patients with C. psittaci pneumonia was undertaken and confirmed by mNGS or polymerase chain reaction (PCR). Clinical manifestations of the severe and non-severe C. psittaci pneumonia groups were compared for clinical reference. Etiological analyses were also performed to comprehensively understand pathogeny and coinfection with other respiratory pathogens in C. psittaci patients. The absolute value of lymphocytes (LYM) in the severe group was lower than in the non-severe group. At the same time, neutrophil-to-lymphocyte ratio (NLR), procalcitonin (PCT), alanine aminotransferase (ALT), D-II polymer, brain natriuretic peptide (BNP), myoglobin (MYO), and cardiac troponin I (cTnI) were significantly higher (P < 0.05) in the severe group. mNGS has a broader pathogen spectrum and can more sensitively detect C. psittaci and other low-abundance pathogens with a higher positive detection rate (100%, 13/13 vs. 46%, 6/13, P <0.05) than conventional culture methods. mNGS detected the following dominant species associated with C. psittaci in patients: bacteria (53.2%, 39% gram-positive, 61% gram-negative), fungi (12.9%), and viruses (33.9%). A total of 73.3% (11/15) of patients had suspected coinfections, with a coinfection rate of 91.7% (11/12) in the severe group. No coinfection or death occurred in the non-severe group. Prognosis in the severe group was poor, with a mortality rate of 27.3% (3/11) for patients with coinfection. Eight of 11 patients with coinfections (72.7%) recovered. In conclusion, the clinical symptoms of severe C. psittaci pneumonia manifested as abnormal inflammatory indicators, impaired liver function, myocardial injury, coagulation, and relatively low immune responses. The higher proportion of patients with coinfections in our study supports the use of mNGS for comprehensive early detection of respiratory infections in patients with C. psittaci pneumonia. Simultaneous early identification of coinfections would further improve the clinical treatment of these patients.

A Simple Nomogram for Predicting Osteoarthritis Severity in Patients with Knee Osteoarthritis.

Objective To explore the influencing factors of knee osteoarthritis (KOA) severity and establish a KOA nomogram model. Methods Inpatient data collected in the Department of Joint Surgery, Chengde Medical University Affiliated Hospital from January 2020 to January 2022 were used as the training cohort. Patients with knee osteoarthritis who were admitted to the Third Hospital of Hebei Medical University from February 2022 to May 2022 were taken as the external validation group of the model. In the training group, the least absolute shrinkage and selection operator (LASSO) method was used to screen the factors of KOA severity to determine the best prediction index. Then, after combining the significant factors from the LASSO and multivariate logistic regressions, a prediction model was established. All potential prediction factors were included in the KOA severity prediction model, and the corresponding nomogram was drawn. The consistency index (C-index), area under the receiver operating characteristic (ROC) curve (AUC), GiViTi calibration band, net classification improvement (NRI) index, and integrated discrimination improvement (IDI) index evaluation of a model predicted KOA severity. Decision curve analysis (DCA) and clinical influence curves were used to study the model's potential clinical value. The validation group also used the above evaluation indexes to measure the diagnostic efficiency of the model. Spearman correlation was used to investigate the relationship between nomogram-related markers and osteoarthritis severity. Results The total sample included 572 patients with knee osteoarthritis, including 400 patients in the training cohort and 172 patients in the validation cohort. The nomogram's predictive factors were age, pulse, absolute value of lymphocytes, mean corpuscular haemoglobin concentration (MCHC), and blood urea nitrogen (BUN). The C-index and AUC of the model were 0.802. The GiViTi calibration band (P = 0.065), NRI (0.091), and IDI (0.033) showed that the modified model can distinguish between severe KOA and nonsevere KOA. DCA showed that the KOA severity nomogram has clinical application value with threshold probabilities between 0.01 and 0.78. The external verification results also show the stability and diagnosis of the model. Age, pulse, MCHC, and BUN are correlated with osteoarthritis severity. Conclusions A nomogram model for predicting KOA severity was established for the first time that can visually identify patients with severe KOA and is novel for indirectly evaluating KOA severity by nonimaging means.

Predicting the Risk of Diabetic Foot Ulcers From Diabetics With Dysmetabolism: A Retrospective Clinical Trial.

BackgroundDiabetic foot ulcer (DFU) in patients with type 2 diabetes mellitus (T2D) often leads to amputation. Early intervention to prevent DFU is urgently necessary. So far, there have been no studies on predictive models associated with DFU risk factors. Our study aimed to quantify the predictive risk value of DFU, promote health education, and further develop behavioral interventions to reduce the incidence of DFU.MethodsData from 973 consecutive patients with T2D was collected from two hospitals. Patients from the Guangxi Medical University First Affiliated Hospital formed the training cohort (n = 853), and those from the Wuming Hospital of Guangxi Medical University formed the validation cohort (n = 120). Independent variable grouping analysis and multivariate logistic regression analysis were used to determine the risk factors of DFUs. The prediction model was established according to the related risk factors. In addition, the accuracy of the model was evaluated by specificity, sensitivity, predictive value, and predictive likelihood ratio.ResultsIn total, 369 of the 853 patients (43.3%) and 60 of the 120 (50.0%) were diagnosed with DFUs in the two hospitals. The factors associated with DFU were old age, male gender, lower body mass index (BMI), longer duration of diabetes, history of foot disease, cardiac insufficiency, no use of oral hypoglycemic agent (OHA), high white blood cell count, high platelet count, low hemoglobin level, low lymphocyte absolute value, and high postprandial blood glucose. After incorporating these 12 factors, the nomogram drawn achieved good concordance indexes of 0.89 [95% confidence interval (CI): 0.87 to 0.91] in the training cohort and 0.84 (95% CI: 0.77 to 0.91) in the validation cohort in predicting DFUs and had well-fitted calibration curves. Patients who had a nomogram score of ≥180 were considered to have a low risk of DFU, whereas those having ≥180 were at high risk.ConclusionsA nomogram was constructed by combining 12 identified risk factors of DFU. These 12 risk factors are easily available in hospitalized patients, so the prediction of DFU in hospitalized patients with T2D has potential clinical significance. The model provides a reliable prediction of the risk of DFU in patients with T2D.

PB2137: INFLUENCE OF PREVIOUS RADIOTHERAPY ON THE EFFECT OF CART CELL THERAPY IN AGGRESSIVE B-CELL LYMPHOMA

Background: In previous studies, radiotherapy has an effect on the number and function of lymphocytes. In recent years, with the advent of CART cell therapy, the PFS and OS of relapsed and refractory highly aggressive B-cell lymphoma have been significantly improved. Whether previous radiotherapy is effective for CART cell therapy The impact is inconclusive. Aims: To investigate the influence of the radiotherapy history before CART cell therapy on the culture, expansion and treatment effect of CART cells in patients with aggressive B-cell lymphoma. Methods: A retrospective study from December 2018 to September 2021 in adult patients with aggressive B-cell lymphoma treated with CART cells at our center who underwent radiotherapy before lymphocyte collection. The patient’s previous radiotherapy dose, radiotherapy distance from lymphocyte collection time, peripheral blood lymphocyte count before lymphocyte collection, CART cell culture dose, reinfusion dose, and curative effect statistics of 3 months after CART cell reinfusion were counted. Statistical methods such as logistic regression and spearman correlation analysis were used for analysis. Results: 16 males and 18 females were eligible, with a median age of 45.5 years (18-86 years). These included 2 Burkitt lymphoma, 26 unspecified diffuse large B-cell lymphoma, 5 primary mediastinal B-cell lymphoma, and 1 primary central lymphoma. The median time from lymphocyte collection to previous radiotherapy was 151 (5-4772) days, and the median radiation dose was 46 (4-66) Gy. The absolute value of lymphocytes before the collection of lymphocytes was 0.79 (0.14-2.58)×10^9/L, which was lower than the normal reference value. The median culture dose of CART cells was 0.837(0.1-7.03)×10^6/kg, and the median infusion dose was 0.837(0.1-4.2)×10^6/kg. After CART cell infusion, the peak CART cell expansion was 18.6(0-919)×10^6/kg, 3-month CR: 20.59%, 3-month ORR: 44.12%. The time interval between previous radiotherapy and lymphocyte collection had a significant effect on 3-month CR, P=0.0417. The effect on 3-month ORR was not statistically significant, P=0.1388. There was no significant effect of previous radiotherapy dose on CR/ORR at 3 months, with P values ​​of 0.9188/0.5078, respectively. The effect of previous radiotherapy dose on the CART cell culture dose and the maximum value of CART cell expansion was not found to be statistically significant. CR and ORR at 3 months after reinfusion were significantly correlated with the reinfusion dose, with P values ​​of 0.0102 & 0.0121, respectively. There was no significant relationship between the absolute value of lymphocytes and the proportion of lymphocytes, the culture dose and the CR/ORR of the curative effect. Summary/Conclusion: Radiotherapy affects the number and cell quality of lymphocytes, the median culture dose is significantly lower than the 2×10^6/kg reported in the literature. In patients with aggressive B-cell lymphoma who had a history of radiotherapy, the CR/ORR at 3 months after CART cell therapy was significantly lower than that reported. This adverse effect was independent of radiation dose. The CR rate is affected by the time interval between radiotherapy and lymphocyte collection. The longer the interval, the greater the adverse effect.

Influencing factors related to transcatheter arterial chemoembolization for hepatocellular carcinoma patients achieved tumor response.

To investigate the influencing factors of transcatheter arterial chemoembolization (TACE) on patients with hepatocellular carcinoma (HCC) for tumor response (complete and partial response, CR + PR). This research conducted a retrospective study of the hospital charts of patients treated with TACE successfully renewed from October 2014 to December 2015 at Sun Yat-sen University Cancer Center (Guangzhou, China). Univariate analysis (Chi-square test and repeated-measures ANOVA) selected nine influential tumor response factors from 22 core factors. The nine variables were included in a forward multiple logistic regression model predicting patients treated with TACE to achieve tumor response. Overall survival was calculated using the Kaplan-Meier method. Data of 277 of 282 patients were included in the analysis. Nine variables were analyzed by univariate analysis and independently associated with tumor response (tumor capsule integrity, nausea and vomiting, microwave ablation, liver dysfunction, the absolute value of lymphocyte (LYM), alpha-fetoprotein, and gamma-glutamyl transpeptidase (GGT). By multivariate analysis, GGT (odds ratio [OR] =0.996), liver dysfunction (OR = 0.395), combined with microwave ablation (OR = 0.503), and tumor capsule integrity (OR = 1.894) were the significant predictors of the tumor response group compared with the standard deviation group (P < 0.05). This study suggests that TACE combined with ablation on patients with complete tumor capsules may have a better prognosis in tumor response and OS; additionally, liver dysfunction and nausea and vomiting were the independent predictors of tumor response.

Low Circulating B Lymphocytes in Newly Diagnosed Follicular and Diffuse Large B Cell Lymphoma: Differences Compared to Normal Subjects and Possible Prognostic Role

Introduction: Reduction of the lymphocyte to monocyte ratio (LMR) has an unfavorable impact on overall survival in Diffuse Large B Cell Lymphoma (DLBCL), and on treatment response in Follicular Lymphoma (FL). Abnormal LMR seems primarily due to a reduction in absolute value of lymphocytes. Based on these observations, we have prospectively investigated peripheral blood (PB) and Bone Marrow (BM) lymphocyte subpopulations in a series of previously untreated DLBCL and FL. Aim of the study was: i. to assess whether LMR alteration is linked to a distinct lymphocyte subset; ii. to correlate PB with BM cell subpopulations; iii. to compared DLBCL and FL with regards to PB and BM lymphocyte subpopulations. Methods: Overall, PB cells from 58 DLBCL and 27 FL at diagnosis were investigated; BM cell populations were analyzed in 77 DLBCL and 54 FL. None of the studied patients had BM involvement nor circulating lymphoma cells detectable by cytometry; in addition, none of the patients had been previously treated with immunosuppressive drugs. PB from 40 healthy subjects and BM samples from 69 subjects without primary BM dysfunctions were used as control. Multicolor flow cytometry (MFC) was used to evaluate percentages and absolute values of the following cell subsets: CD3+ T cell, CD3-CD56+ NK cells, CD19+CD20+ B cells. Among B cells, t he analysis included transitional (CD38+high/CD24+high/IgD+/CD27-), naive (CD38+/CD24+/IgD+/CD27-), memory IgD+ (CD38-/+CD24+/IgD+/CD27+), and memory IgD- (CD38-/CD24+high/IgD-/CD27+) subsets; B cell precursors were investigated as CD19+CD20-CD10+ and mature B cells as CD19+CD20+CD10-. Results: A significant reduction in median absolute lymphocyte count was seen in PB from lymphoma patients (median: 1,526/µL) compared to controls (median: 2,195/ µL). Moreover, absolute lymphocytes were more markedly reduced in DLBCL (median: 1,386 /µL) compared to FL (median: 1883/µl) (p<0.001). This resulted in a significantly lower median PB-LMR in DLBCL (median LMR: 3) compared to FL patients (median LMR: 5) (p=0.001). Among PB cell subpopulations, a marked reduction in circulating B cells was observed in lymphoma patients (median 96/µL) compared to controls (median 224/µL). Again, loss of circulating B-cells was more markedly pronounced in DLBCL (median: 81.5 cell/µL) compared to FL (median: 150 cell/µL) (p=0.013). Differences in circulating B-cells among DLBCL, FL and controls are shown in Figure 1A. At BM analysis, a reduction of B cell precursor (CD19+/CD20-/CD10+) could be documented only in DLBCL. A reduction in circulating T-lymphocytes in lymphoma patients compared to controls was detected as well, although at a lower extent compared to B-cells. No significant abnormalities in the amount of circulating NK-cells was seen in both DLBCL and FL patients. When these data were matched with treatment outcome, the reduction of circulating B cells proved to be associated with an unfavorable outcome in younger patients with DLBCL. Indeed, among DLBCL patients aged < 60 yrs, a poorer progression free survival was seen in those having less than 96 B-cells/µL compared to those with PB B-cells equal or above 96 B-cells/µl (Figure 1B). Conclusions: The study indicates that circulating B lymphocytes are significantly reduced in both DLBCL and FL compared to age-matched healthy controls; however, their loss is much more pronounced in DLBCL compared to FL. Indeed, abnormalities in B-cell progenitors are present in BM from DLCBL but not from FL. In addition, B-cell reduction may have an unfavorable impact in the long-term outcome of DLBCL, at least in younger patients. Lastly, both B and T-cell subsets are decreased in DLBCL and FL whereas circulating NK subset does not seem to be affected. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Influencing Factors in the Chronicity of Immune Thrombocytopenia in Children

To explore the influencing factors in children with chronicity immune thrombocytopenia (ITP), and to provide basis for judging the prognosis and treatment in children with ITP. The clinical data of children with ITP admitted to The Second Affiliated Hospital of Anhui Medical University in the past 5 years were retrospectively analyzed and followed up for more than 1 year. According to the inclusion criteria, the eligible cases (328 cases in total) were selected and collected through medical record system retrieval, outpatient clinic and telephone follow-up. Independent influencing factors affecting the prognosis of children with ITP were obtained through single-factor and multi-factor logistic analysis, and their predictive value for the prognosis of ITP in children were evaluated. Of 328 children with ITP, 208 were newly diagnosed with ITP (64%), 54 were persistent ITP (16%), 66 were chronic ITP (20%), and the remission rate within 1 year was 79.9%. The results of univariate analysis showed that, age, pre-morbidity history of infection and vaccination, antinuclear antibodies, initial absolute lymphocyte count（ALC） and treatment options were related to the prognosis of the children (P<0.05). Multivariate analysis showed that the history of infection and vaccination before onset, initial treatment options, and ALC at the time of initial diagnosis were independent factors affecting the prognosis of children with ITP (P<0.05). The time for platelet recovery to 100×109/L in the initial treatment group combined with intravenous immunoglobulin (IVIG) was shorter than that in the single corticosteroids group (P<0.01). The receivers operating characteristic (ROC) was drawn with the development of chronic disease (course >12 months) as state variable and ALC or ALC combined with preceding infection or vaccination history as test variable. The results showed that when the absolute value of lymphocytes was 3.80×109/L, the area under the curve was the largest (0.787), the sensitivity was 80.6%, and the specificity was 65.53% (P<0.01), the combined results showed that the maximum area under the curve was 0.859, the sensitivity was 77.61%, and the specificity was 78.41%. The initial treatment plan combined with IVIG can reduce the occurrence of chronicity in children with ITP, and its efficacy is better than that of the single corticosteroids group (the platelet recovery time is shorter); history of preceding infection or vaccination, ALC at the time of initial diagnosis are independent factors affecting the prognosis of children with ITP, and the combination of the two shows a better predictive value for the prognosis.

Clinical features of 141 fatal cases of coronavirus disease in Jinyintan Hospital in Wuhan, China

Objective: To describe the epidemiological characteristics and clinical features of patients with fatal coronavirus disease (COVID-19), in order to provide evidence for clinical diagnosis and treatment. Methods: In this retrospective study, we analyzed data on 141 fatal cases of confirmed COVID-19 that occurred among patients in Jinyintan Hospital in Wuhan, China, from January 20 to March 6, 2020. We analyzed their epidemiological characteristics, clinical and radiological features, laboratory results, and treatment. Results: Of the 141 patients (49 females, 92 males), the median age was 77 years (range: 24-92 years). The most likely source of exposure included the Huanan seafood market (n=3, 2%), family members (n=6, 4%), and hospital-acquired infection (n=8, 6%). The remaining 116 patients (72%) had no known source of exposure. Of the patients, 101 (72%) had chronic diseases. The most common comorbidities were hypertension, diabetes and coronary heart disease. The most common clinical manifestations were fever (n=121, 85%), dry cough (n=77, 54%), shortness of breath (n=23, 16%), and chest pain (n=15, 10%). Less common clinical manifestations included fatigue (n=7, 4%), headache (n=3, 2%), disorders of consciousness (n=2, 1%), diarrhea (n=2, 1%) and lumbago (n=1, 0.7%). In terms of laboratory tests, the absolute value of lymphocytes in most patients was reduced (n=132, 94%), but C-reactive protein (n=141, 100%), procalcitonin(n=121, 89%), serum amyloid (n=140, 99%) were significantly increased. The most common findings on imaging of the lungs were bilateral multiple mottling and ground-glass opacity (n=101, 72%), mainly in the lower lobes (n=15, 10%), with lesions being more common on the right. Other imaging findings included diffuse consolidation (n=4, 3%), ground-glass opacity and consolidation (n=20, 14%), and pneumothorax (n=1, 0.7%). All patients were treated with antibiotics and antiviral drugs. Other treatments included immunoglobulin (n=49, 35%), corticosteroids (n=45, 32%), continuous renal replacement therapy (n=24, 17%), and extracorporeal membrane oxygenation (n=12, 9%). All patients were treated with oxygen therapy. The mode of administration included invasive mechanical ventilation (n=61, 43%), noninvasive mechanical ventilation (n=65, 46%), and nasal catheter oxygen inhalation (n=15, 11%). The direct causes of death were acute respiratory distress syndrome (n=90, 64%), multiple organ failure (n=24, 17%), sudden cardiac arrest (n=11, 8%), viral myocarditis (n=8, 5%), acute myocardial infarction (n=4, 3%), cerebrovascular accident (n=3, 2%), and acute gastrointestinal bleeding (n=1, 0.7%). Conclusions: Risk factors for death due to COVID-19 included older age, male sex, and the presence of comorbidities. The most common direct causes of death were acute respiratory distress syndrome, multiple organ failure, sudden cardiac arrest, and viral myocarditis.

Prognostic value of the preoperative lymphocyte-to-monocyte ratio for survival after lung cancer surgery

BackgroundThe aim of this study was to assess the effect of the lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio on overall survival and disease-free survival in patients with lung cancer treated with radical surgery.MethodsWe performed a retrospective review of patients with lung cancer who prospectively underwent radical resection between 2004 and 2012. Blood samples were taken as part of the preoperative workup. The inflammatory markers studied were absolute values of lymphocytes, monocytes, neutrophils and platelets, with subsequent calculation of ratios. Median follow-up was 52 months.ResultsTwo hundred and sixty-eight patients underwent surgery, of whom 218 (81.3%) were men. Mean age was 62.9 ± 8.7 years. A lymphocyte-to-monocyte ratio ≥ 2.5 was independently associated with longer disease-free survival (hazard ratio [HR] 0.476 (0.307–0.738), p = 0.001) and longer overall survival (HR, 0.546; 95% CI: 0.352–0.846; p = 0.007), in models adjusted for age, sex, stage, and type of resection. No other systemic inflammatory marker showed a significant association.ConclusionPreoperative LMR is an independent prognostic factor of overall survival and recurrence-free survival in patients with surgically-resected early stage lung cancer.

Changes in thyroid antibody and T lymphocyte subsets after radiofrequency ablation of thyroid nodules in patients with autoimmune thyroiditis.

The aim was to study the changes in thyroid antibody and T lymphocyte subsets after radiofrequency ablation (RFA) of thyroid nodules in patients with autoimmune thyroiditis. Patients (n = 135) with autoimmune thyroiditis and thyroid nodules were treated by RFA. The indices of thyroid function and thyroid antibody and T lymphocyte subsets were examined preoperation and on the 1st day and the 1st month after ablation. Any complications were recorded. The software SPSS 17.0.0 (version: 2008-8-23) running under Windows 8 was used for statistical analysis. The measurement data were expressed as x ± s, with P < 0.01 indicating a significant difference in the statistical data. Levels of free triiodothyronine, free thyroxine, and thyroid-stimulating hormone were in the normal range before ablation, and no significant changes occurred on the 1st day or in the 1st month after ablation. The change in the percentage of CD8+T cells and the absolute value of B cells were not statistically significant (P > 0.01), and the values were in the normal range. Compared with values recorded preoperation, the value of TG-Ab, TPO-Ab, CD4+/CD8+, the percentage of CD4+T cells, the absolute values of lymphocytes, T cells, CD4+T cells, and CD8+T cells decreased significantly at the 1st day after ablation (P < 0.01) and then recovered to preoperative levels during the first 30 days after ablation (P > 0.01). Within 1 month after ablation, none of the patients had complications such as active bleeding, infection, recurrent laryngeal nerve injury, parathyroid gland injury, skin scald, and so on. After RFA of thyroid nodules in patients with autoimmune thyroiditis, thyroid function is not affected and no serious complications occurred. TG-Ab and TPO-Ab levels can be significantly decreased, and the distribution of T lymphocyte subsets can be changed in the short term after ablation.

Value of lymphocyte subset testing in predicting HBsAg decline in chronic hepatitis B patients receiving antiviral therapy

Objective To investigate whether there are differences in lymphocyte subsets between chronic hepatitis B (CHB) patients receiving different antiviral treatment regimens, and to determine related predictive factors for HBsAg decline. Methods A retrospective analysis was performed for 68 treatment-experienced CHB patients who attended the outpatient service in Department of Infectious Diseases, Henan Provincial People's Hospital, from October to December 2019, and according to the antiviral treatment regimen, they were divided into PEG-IFNα treatment group with 10 patients, PEG-IFNα+nucleos(t)ide analogues (NAs) treatment group with 21 patients, and NAs treatment group with 37 patients. Related data were recorded, including demographic features, blood routine, albumin, HBsAg, and measurement of lymphocyte subsets. A one-way analysis of variance was used for comparison of normally distributed continuous data between groups, and the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups; the multivariate logistic regression analysis was used to investigate independent influencing factors for HBsAg decline. Results There were significant differences between the three groups in HBsAg decline (H=8.348, P=0.015), absolute value of lymphocytes (F=4.643, P=0.013), and T lymphocyte count (F=7.721, P=0.001). The multivariate logistic regression analysis showed that sex (odds ratio [OR]=0.227, 95% confidence interval [CI]: 0.059-0.878, P=0.032), age (OR=0.931, 95%CI: 0.868-0.999, P=0.047), antiviral treatment regimen (PEG-IFN-α treatment group vs NAs treatment group: OR=9.600, 95%CI: 1.982-46.498, P=0.005; PEG-IFN-α+NAs treatment group vs NAs treatment group: OR=4.800, 95%CI: 1.336-17.243, P=0.016), and T lymphocyte count (OR=0.804, 95%CI: 0.684-0.944, P=0.008) were independent influencing factors for HBsAg decline. Conclusion For CHB patients receiving PEG-IFNα alone or in combination with NAs, monitoring of lymphocyte subsets during the treatment process may help to judge HBsAg decline, and the lower the absolute value of T lymphocytes, the greater the possibility of HBsAg decline.

3044 Cases reveal important prognosis signatures of COVID-19 patients.

Critical patients and intensive care unit (ICU) patients are the main population of COVID-19 deaths. Therefore, establishing a reliable method is necessary for COVID-19 patients to distinguish patients who may have critical symptoms from other patients. In this retrospective study, we firstly evaluated the effects of 54 laboratory indicators on critical illness and death in 3044 COVID-19 patients from the Huoshenshan hospital in Wuhan, China. Secondly, we identify the eight most important prognostic indicators (neutrophil percentage, procalcitonin, neutrophil absolute value, C-reactive protein, albumin, interleukin-6, lymphocyte absolute value and myoglobin) by using the random forest algorithm, and find that dynamic changes of the eight prognostic indicators present significantly distinct within differently clinical severities. Thirdly, our study reveals that a model containing age and these eight prognostic indicators can accurately predict which patients may develop serious illness or death. Fourthly, our results demonstrate that different genders have different critical illness rates compared with different ages, in particular the mortality is more likely to be attributed to some key genes (e.g. ACE2, TMPRSS2 and FURIN) by combining the analysis of public lung single cells and bulk transcriptome data. Taken together, we urge that the prognostic model and first-hand clinical trial data generated in this study have important clinical practical significance for predicting and exploring the disease progression of COVID-19 patients.

Clinical characteristics and viral shedding kinetics of 38 asymptomatic patients with coronavirus disease 2019: A retrospective observational study.

This study aims to investigate the clinical characteristics and viral shedding kinetics of asymptomatic patients with coronavirus disease 2019 (COVID-19).The data of 38 asymptomatic patients positive for SARS-CoV-2 nucleic acid were collected from February to March 2020 in Tuanfeng County, Huanggang, Hubei, China. The epidemiology, laboratory examination, chest imaging, viral nucleic acid test results, clinical characteristics, and viral shedding time were summarized in this retrospective study.The study included 20 family members of patients with COVID-19, 10 medical personnel participating in COVID-19 treatment or working in a fever clinic, 6 personnel from quarantine places, 1 individual with a close contact history with confirmed patients, and 1 local epidemic prevention personnel. All were positive for SARS-CoV-2 nucleic acid. The white blood cell (WBC) count, the absolute value of lymphocytes, C-reactive protein (CRP), and D-dimer were normal. Pneumonia manifestations were not found in the chest computed tomography (CT) scan of 36 patients; the remaining 2 cases included a 1-year-old child and a pregnant woman, and they did not undergo chest CT. The viral shedding time was 6 days.All asymptomatic patients with COVID-19 had a history of close contact or exposure. Laboratory tests were normal. Chest imaging did not show any pneumonia manifestation. The viral shedding time was <10 days, which is shorter than that of patients with COVID-19. A timely discovery of such asymptomatic infections is crucial for blocking the spread of the virus and strengthening the prevention and control measures.

Risk Factors and Psychological Analysis of Chronic Immune Thrombocytopenia in Children.

ObjectiveTo study the risk factors and psychological changes in children with chronic immune thrombocytopenia (CITP).MethodsThis was a retrospective analysis of 234 children with ITP diagnosed and treated in the Affiliated Hospital of Southwest Medical University from January 2016 to December 2018. The clinical characteristics and related laboratory factors of all patients were collected, and their impact on the chronicity of ITP was analyzed. The Eysenck Personality Questionnaire-Children’s Version (7–15 years old) is a psychological assessment of children with chronic ITP (CITP).ResultsUnivariate analysis found that the course of the initial diagnosis (χ2 =6.879, P<0.05), the age of onset (χ2 =13.846, P<0.05) and the absolute value of the initial diagnosis of peripheral blood lymphocytes (χ2 =6.436, P<0.05) had statistical differences in the chronicity of ITP in children; a multivariate analysis of the course of the first diagnosis, the age of onset and absolute lymphocyte count (ALC) revealed that ALC is an independent factor in children’s chronic ITP (P<0.05). Compared with normal children, children with CITP had statistical significance in extraversion (t=−3.476, P<0.05); compared with newly diagnosed children, they had statistical significance in extraversion (E) and lying (L) (P<0.05); and there was no statistical difference compared with persistent children (P>0.05).ConclusionThe age of onset, the absolute value of lymphocytes at the initial diagnosis, and the course of the initial diagnosis are important for predicting the chronicity of ITP in children. ALC is an independent predictor; children with chronic ITP have psychological problems.

Clinical characteristics comparative analysis of imported and local cases with COVID-19 in Hainan

Objective To observe the epidemiology, clinical features, auxiliary examinations and prognosis of 69 cases with COVID-19 in Hainan province. Methods The epidemiological history, past history, clinical manifestations, laboratory examination results and imaging examination results of 69 patients with COVID-19 in Hainan People's Hospital from January 22 to March 7, 2020 were collected. They were divided into non severe group and severe group according to patients ' condition, and imported cases and indigenous cases according to the epidemiological history. And then we retrospectively analyzed their epidemiological and clinical data, further compared the differences between the two groups. Mann-Whitney U test and chi-square test were used in statistical analysis. Results Among the 69 patients, 41 were male, and 28 were female, aged 28-83 years, and 30 had a history of underlying disease. The main clinical manifestations were cough (85.51%), fever (81.16%), asthenia (46.38%). Nasal obstruction and pharyngeal discomfort were rare. 9 cases had increased white blood cells, 25 cases had increased neutrophil percentage, 33 cases had decreased lymphocyte percentage, 42 cases had decreased lymphocyte absolute value, and 66 cases had lung inflammation by imaging examination. Clinical classification: 3 cases were mild, 54 cases were normal, 3 cases were severe, 9 cases were critical, i.e., 57 cases were non-severe (normal/mild), 12 cases were severe (critical / severe). Among 69 patients, 54 (78.26%) were imported cases and 15 were local cases. There was no significant difference between the two groups in clinical manifestations neither clinical typing( P >0.05). Conclusion The main clinical types of COVID-19 patients are moderate type and mild type. There is no difference in clinical manifestations and clinical types between imported cases and indigenous cases. 摘要：目的 观察、了解海南省69例新型冠状病毒肺炎患者的流行病学特征、临床特征、辅助检査和预后。 方法 收集海南省人民医院2020年1月22日至3月7日收治的69例新型冠状病毒肺炎患者的流行病学史、既往史、临 床表现、实验室检査结果和影像学检査结果进行归纳与分析。根据病情分为普通/轻症组, 危重/重症组, 根据流行病学 史分为输人病例与本地病例, 回顾性分析其流行病学特征及临床资料, 进一步对比两组间临床资料的差异。统计学处 理采用Mann-Whitney U 检验或 χ 2 检验。 结果 69例患者中, 男性41例, 女性28例, 年龄28~83岁, 30例既往有基础疾 病史。主要临床表现为咳嗽(85.51%)、发热（81.16%)、乏力(46.38%), 鼻塞、咽部不适少见。白细胞升髙者9例, 中性 粒细胞百分比升髙25例, 淋巴细胞百分比降低33例 , 淋巴细胞绝对值减少42例 , 影像学检査肺部有炎症者66例。临 床分型 : 轻型3例, 普通型54例, 重型3例, 危重型9例, 即非重症组(普通/轻型)57例, 重症组(危重/重型）12例。69例患 者, 输人病例54例, 78.26%, 本地病例15例, 两组临床表现与临床分型差异无统计学意义( P >0.05)。 结论 海南省COVID-19患者以普通型与轻型为主, 输人性病例与本土病例临床特征相似

Therapeutic plasma exchange therapy support for critical COVID‐19: A case report

On 4 February 2020, a 67-year-old man, with a medical history of chronic obstructive pulmonary disease, hypertension, and diabetes presented to the hospital with a 1-week history of cough, fatigue, and sputum with fever. Temperature (T) was 37.5°C; CURB-65 score was 3. White blood cell count 3.33 × 1012/L, lymphocyte absolute value 0.55 × 109/L, procalcitonin 16.66 μg/L, C-reactive protein (CRP) 16 mg/L, interleukin (IL-6) 357.3 pg/mL (0-7 pg/mL), and IL-6 level were measured by using the ELISA method. Computed tomography (CT) scan showed progressive infiltrate and diffuse gridding shadow in both lungs. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test was positive. The patient received oseltamivir and lopinavir plus ritonavir as antiviral therapy and methylprednisolone to alleviate lung inflammation. On day 3, his vital signs were unstable: respiratory rate (RR) 30 breaths/min, heart rate (HR) 113 beats/min, blood pressure (BP) 120/70 mmHg, SpO2 88% (oxygen 3 L/min), and T 39.5, and oxygenation index was down to 108; he was transferred to intensive care unit immediately and received high-flow nasal cannula oxygen therapy (55% concentration, flow rate 40 L/min). On day 4, RR increased to 35 breaths/min and oxygen saturation decreased to 70%, and then he was changed to invasive mechanical ventilation (MV). The noradrenaline was started with a dose of 0.30 μg kg−1 min−1. On day 15, the tracheostomy was performed due to prolonged duration of MV support. Plasma exchange was performed using the Diapact CRRT system, and a filter membrane-based apparatus (BBraun, Melsungen, Germany) through the extracorporeal system and therapeutic plasma exchange (TPE) set was used. Fresh frozen plasma was used as the replacement fluid, and the total amount was 3000 mL. We did not have a protocol or consensus in treating coronavirus disease (COVID-19) patients with TPE, and we also did not get “cut-off” values or indications; the TPE treatment was started depending on the initiative and experience of the critical care staff. In this case, TPE was administered for 2 hours a day for 3 consecutive days. In order to make sure the antibiotics, antiviral, antifungal drugs, and other drugs were not cleared by TPE, they were given after the completion of TPE. After three sessions of TPE, the serum IL-6 level was decreased from 3815 pg/mL to 286.9 pg/mL, and CRP decreased from 50.2 mg/L to 19.6 mg/L. The chest CT revealed improvement of both lungs (Figure 1). The circulatory efficiency significantly improved, and noradrenaline was discontinued. In the pathophysiological progress of COVID-19 patients and following secondary infection, it was shown that pro-inflammatory cytokines were dramatically increased in the patients with COVID-19 and the plasma cytokine concentrations were much higher in critical patients.1 The inflammatory cytokine storm may occur when cytokines reach a certain threshold in the patients.2 Inflammatory cytokine storm and immunopathology through the dysregulation of chemokines and cytokines resulted in the apoptosis of epithelial and endothelial cells, caused vascular leakage and infiltration of macrophages and neutrophils, which together induced severe lung injuries.3 One study showed that some COVID-19 patients deteriorated in the later stage and soon went into the state of multiple organ dysfunction, which correlated with the sudden initiation of an inflammatory cytokine storm in critical patients.4 Similarly, our study informed that in this case report, the COVID-19 patient had a sustainable high concentration of IL-6. It has been proposed that IL-6 > 100 pg/mL could represent the appearance of inflammatory cytokine storm. The potential limitations were large amounts of FFP are needed for every treatment, some drugs are depleted incalculably, and SARS-CoV-2 antibodies were also removed from the patient's serum.5 However, TPE would be still prescribed as an important treatment in alleviating inflammatory cytokine storm when needed in COVID-19 patients.