Complete Blood Cell Research Articles

Effects of 14-weeks betaine supplementation on pro-inflammatory cytokines and hematology status in professional youth soccer players during a competition season: a double blind, randomized, placebo-controlled trial

ObjectiveSystemic elevations in pro-inflammatory cytokines are a marker of non-functional over reaching, and betaine has been shown to reduce the secretion of pro-inflammatory cytokines in vitro. The aim of this study was to investigate the effects of betaine supplementation on tumor necrosis factor alpha (TNF-α), interleukins-1 beta (IL-1β), − 6 (IL-6) and the complete blood cell (CBC) count in professional youth soccer players during a competitive season.MethodsTwenty-nine soccer players (age, 15.5 ± 0.3 years) were randomly divided into two groups based on playing position: betaine group (BG, n = 14, 2 g/day) or placebo group (PG, n = 15). During the 14-week period, training load was matched and well-being indicators were monitored daily. The aforementioned cytokines and CBC were assessed at pre- (P1), mid- (P2), and post- (P3) season.ResultsSignificant (p < 0.05) group x time interactions were found for TNF-α, IL-1β, and IL-6. These variables were lower in the BG at P2 and P3 compared to P1, while IL-1β was greater in the PG at P3 compared to P1 (p = 0.033). The CBC count analysis showed there was significant group by time interactions for white blood cells (WBC), red blood cells (RBC), hemoglobin (Hb), and mean corpuscular hemoglobin concentration (MCHC). WBC demonstrated increases at P3 compared to P2 in PG (p = 0.034); RBC was less at P3 compared to P1 in BG (p = 0.020); Hb was greater at P2 compared to P1, whilst it was less at P3 compared to P3 for both groups. MCHC was greater at P3 and P2 compared to P1 in BG, whereas MCHC was significantly lower at P3 compared to P2 in the PG (p = 0.003).ConclusionThe results confirmed that 14 weeks of betaine supplementation prevented an increase in pro-inflammatory cytokines and WBC counts. It seems that betaine supplementation may be a useful nutritional strategy to regulate the immune response during a fatiguing soccer season.

Predictive value of platelet lymphocyte ratio in carbon monoxide poisoning

Aim: Carbon monoxide (CO) poisoning has serious mortality and morbidity among patients who are admitted to the Emergency Department (ED) due to poisoning. Tissue hypoxia and cellular damage, caused by CO poisoning can trigger systemic inflammation. To investigate the relationship between CO poisoning and inflammation, the patient’s Complete Blood Cell (CBC) parameters were compared with carboxyhemoglobin (COHb) levels and outcome. Materials and Methods: Patients who presented with CO poisoning to ED between 01 September 2014 and 01 January 2019 were analyzed. Demographic characteristics (age, gender), laboratory parameters including blood gas analysis, CBC counts, and outcomes of patients were recorded. Inflammatory scores like Neutrophil to Lymphocyte Ratio (NLR), Lymphocyte to Monocyte Ratio (LMR), and Platelet to Lymphocyte Ratio (PLR) were calculated. Patients were divided into 4 groups according to COHb levels as non-toxic, mild, moderate, and severe exposure (30%, respectively). Results: A statistically significant difference was detected between groups regarding lymphocyte level, LMR, and PLR when groups were compared with regard to laboratory values and scores (p values were 0.026, 0.041, and 0.002, respectively). PLR was negatively correlated with COHb level (coefficient -0.212, Sig. 0.017). White blood cell and monocyte levels were found significantly different between patients who were discharged and who received hyperbaric oxygen therapy. Conclusion: CBC parameters may be useful for the clinicians in CO poisoning as in many pathologies due to being rapid, inexpensive, and easily available.

Extradural Synovial Cyst of the Cervical Spine in a Saint Bernard

Background: Extradural synovial cysts (ESC) originate from an extrusion of the synovium in unstable or degenerated joints. In the spine, this condition can cause neurological signs such as hyperesthesia, proprioceptive ataxia and paresis. Since extradural presentations of synovial cysts are unusual in dogs, the aim of this manuscript is to report a case of extradural synovial cyst of the cervical spine, as well as the clinical findings, diagnosis, surgical treatment and clinical evolution after therapy.Case: A 3-year-old spayed Saint Bernard weighing 60 kg was presented to a Veterinary Medical Teaching Hospital with a history of acute paraparesis that evolved to non-ambulatory tetraparesis five days after the appearance of the first clinical signs. Neurological examination revealed non-ambulatory tetraparesis, normal muscle tone and segmental spinal reflexes in the thoracic and pelvic limbs, as well as cervical pain associated with limited neck movement. According to the neurological examination, the likely lesion location was the C1-C5 spinal cord segment. The differential diagnosis list included intervertebral disc disease, caudal cervical spondylomyelopathy, neoplasm, infectious or noninfectious inflammatory disease, and cystic diseases. Complete blood (cell) count and serum biochemistry tests were within reference limits. The cerebrospinal fluid analysis revealed 35 mg/dL of protein (&lt; 30 mg/dL) and 27 cells (up to 5 cells/mm3) with a predominance of lymphocytes. In plain radiography, bone proliferations of the C4 (caudal) C5 (cranial) articular processes were observed and, in myelography, extradural spinal cord compression was evident between C4-C5 on the right side. The animal underwent dorsal laminectomy for spinal cord decompression. An extradural synovial cyst and proliferated articular processes were removed. At 1,281 days after surgery, the dog was clinically normal and presented no neurological deficits.Discussion: The etiology of synovial cysts has not been well established. However, it is believed that osteoarthritic degeneration associated with joint mobility could cause a rupture in the articular capsule, leading to a synovial membrane protrusion, which would fill with synovial fluid and compress spinal structures. ESC in the cervical region have been reported, often associated with cervical neoplasm. The case we report had no evidence of bone or intervertebral disc compression in myelographic and radiographic exams, abnormalities that would appear in cervical neoplasm. The patient underwent dorsal laminectomy to confirm the presumptive diagnosis and decompress the spine. In the histopathological exam, the cystic material consisted of connective fibrous tissue with a synovial cell lining layer, compatible with synovial cysts. The fluid drained during surgery was also analyzed, showing similarities to synovial fluid drained from other conventional joints. Cerebrospinal fluid analysis revealed mononuclear pleocytosis, a common finding in ESC. The ESC should be included in the differential diagnosis of dogs with cervical myelopathy, especially in young animals and large breeds. A myelographic exam is an important but not definitive auxiliary tool for diagnosis and the therapeutic plan. Dorsal laminectomy is an effective technique for treating ESC.

Trauma factors among adult and geriatric blunt trauma patients

BackgroundTrauma is known as a third leading cause of mortality among all-aged patients. ObjectiveThe aim of this study is to investigate pre-trauma physiological factors and trauma-related factors that can increase the risk of mortality among the adult and geriatric patients. MethodIn this longitudinal data analysis study, 500 non-penetrating adult trauma patients who were referred to (Shahid Madani Hospital) from January 2019–December 2019 were enrolled. Information such as age, sex, occupation, place of residence, hospitalization and surgical history, underlying illnesses, medications (such as antihypertensive drugs, etc.), lab findings (complete blood cell and creatinine levels) were recorded in the form of a questionnaire. The patients were divided in group A (aged 65 and above) and group B (aged below 65 years). The data obtained was analyzed statistically using SPSSv18. ResultThe mean age of all patients under study was 51.6 years. Among all participants, 68% (341) were male and 32% (159) were female. Regarding the cause of trauma, group A had significantly greater incidence (p-value = 0.001). The two groups were also significantly different in terms of the region of the injury (p-value = 0.014). Furthermore, underlying diseases were also statistically significant among the two groups (p-value = 0.0093). There was a significant difference between the two groups in terms of smoking and drugs (p-value = 0.01 and 0.001, respectively). Finally, the mortality rate in patients older than 65 years old (4.3%) was significantly higher than those in patients under the age of 65 years (2.9%) (p-value = 0.0001). ConclusionThe results of this study showed that among the trauma patients aged below 65 years and those aged 65 years and above, underlying illness, mortality rate, usage of drugs, cause of trauma, type of injury, vital signs, white blood cell count and platelet count, hemoglobin and serum creatinine vary significantly.

Are the preoperative neutrophil/lymphocyte ratio and platelet/lymphocyte ratio predictive for lamina propria invasion in aging patients?

Objective To evaluate if the preoperative neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) are predictive in discriminating between Ta and T1 tumors in aging male patients. Methods We retrospectively evaluated 240 male patient data who were ≥ 65 years old, diagnosed primary non-muscle invasive bladder cancer (NMIBC) with transurethral resection between 2008 and 2020. The patients were divided into the two groups according to the pathological stage, which has a stage of Ta defined group 1 and stage of T1 defined group 2. Before the transurethral resection, serum levels of NLR and PLR were obtained from each patient and compared between the groups. Results About 115 patients enrolled in group 1 (pTa patients) and 106 patients enrolled in group 2 (pT1 patients). The median age was 73 years (range 65–89) in group 1 and 75 years (range 65–98) in group 2. In complete blood cell (CBC) parameters, neutrophil count, NLR and PLR were higher and lymphocyte count was lower in group 2. There was no statistical difference in leukocyte and platelet counts between groups. Conclusion The present study revealed that higher preoperative NLR and PLR were associated with lamina propria invasion in aging male patients with BC and the results have predictive value.

Endoscopic endonasal skull base surgery during the COVID-19 pandemic: A developing country perspective.

Background: Although primarily a respiratory disorder, the coronavirus pandemic has paralyzed almost all aspects of health-care delivery. Emergency procedures are likely continuing in most countries, however, some of them raises certain concerns to the surgeons such as the endoscopic endonasal skull base surgeries. The aim of this study is to present the current situation from a developing country perspective in dealing with such cases at the time of the COVID-19 pandemic.Methods: A cross-sectional analytical survey was distributed among neurosurgeons who performed emergency surgeries during the COVID-19 pandemic in Cairo, Egypt, between May 8, 2020, and June 7, 2020. The survey entailed patients’ information (demographics, preoperative screening, and postoperative COVID-19 symptoms), surgical team information (demographics and postoperative COVID-19 symptoms), and operative information (personal protective equipment [PPE] utilization and basal craniectomy).Results: Our survey was completed on June 7, 2020 (16 completed, 100% response rate). The patients were screened for COVID-19 preoperatively through complete blood cell (CBC) (100%), computed tomography (CT) chest (68.8%), chest examination (50%), C-reactive protein (CRP) (50%), and serological testing (6.3%). Only 18.8% of the surgical team utilized N95 mask and goggles, 12.5% utilized face shield, and none used PAPRs. Regarding the basal craniectomy, 81.3% used Kerrison Rongeur and chisel, 25% used a high-speed drill, and 6.3% used a mucosal shaver. None of the patients developed any COVID-19 symptoms during the first 3 weeks postsurgery and one of the surgeons developed high fever with negative nasopharyngeal swabs.Conclusion: In developing countries with limited resources, preoperative screening using chest examination, CBC, and CT chest might be sufficient to replace Reverse transcription polymerase chain reaction. Developing countries require adequate support with screening tests, PPE, and critical care equipment such as ventilators.

Association between gestational age at delivery and lymphocyte-monocyte ratio in the routine second trimester complete blood cell count.

BackgroundWe aimed to determine whether routine second trimester complete blood cell (CBC) count parameters, including neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), and platelet-lymphocyte ratio (PLR), could predict obstetric outcomes.MethodsWe included singleton pregnancies for which the 50-g oral glucose tolerance test and CBC were routinely performed between 24 and 28 weeks of gestation in our outpatient clinic from January 2015 to December 2017. The subjects were divided into three groups according to their pregnancy outcomes as follows: group 1, spontaneous preterm births, including preterm labor and preterm premature rupture of membranes; group 2, indicated preterm birth due to maternal, fetal, or placental causes (hypertensive disorder, fetal growth restriction, or placental abruption); and group 3, term deliveries, regardless of the indication of delivery. We compared the CBC parameters using a bivariate correlation test.ResultsThe study included 356 pregnancies. Twenty-eight subjects were in group 1, 20 in group 2, and 308 in group 3. There were no significant differences between the three groups in neutrophil, monocyte, lymphocyte, and platelet counts. Although there was no significant difference in NLR, LMR, and PLR between the three groups, LMR showed a negative correlation with gestational age at delivery (r=−0.126, p=0.016).ConclusionWe found that a higher LMR in the second trimester was associated with decreased gestational age at delivery. CBC parameters in the second trimester of pregnancy could be used to predict adverse obstetric outcomes.

An Assessment of Gpu and Cpu based Convolutional Neural Network for Classification of White Blood Cells

White blood cell (Leukocytes) is made up of bone marrow located in the blood and lymph tissue. They are portion of the human body’s immune system, thereby helping the body system to fight against infection and other related diseases. The number of leukocytes in the blood is usually part of a complete blood cell (CBC) test, which may be used to check for conditions such as infection, inflammation, allergies, and leukemia. Automation of variance count of leukocytes offers valuable information to medical pathologist to diagnose and treat of many blood based diseases. Early characterization and classification of blood sample is a major lacuna in the medical field, giving rise to lots of challenges for pathologist to adequately predict blood based disease. Several successful efforts have been made to address the aforementioned challenges with the use of machine learning generally and Convolution Neural Network in particular. However the processor configuration which can result in real time, and accurate classification of the high dimensional pattern is imminent, and a vast number of researchers are not explicit on the system configuration used to obtain the result in their report, which is the crux of this research. In this research,12,500 augment images of blood cells was obtained from the Kaggle Repository online. The leukocytes are contained in the blood smear image and categorized into five major types of their types: Neutrophil, Eosinophil, Basophil, Lymphocyte and Monocyte. The color, geometric and texture features are used by the pathologists to differentiate the leukocytes. The Simulation was done using python programing language and python libraries including Keras, pandas, sklearn, numpy, scipy and matplot for potting of graphs of results. The simulation was done on both CPU and GPU processor to compare the performance of the processors on CNNs based classification of the data. While CPU has faster clock speed GPU has more cores. Hence the evaluation metrics used which are precision, specificity, sensitivity, training accuracy and validation accuracy revealed that GPU processor outperforms CPU in terms of the stated metrics of comparison. Therefore a high configuration processor (GPU), which handles graphics better is recommended for processing image data that involves the use of machine learning techniques

Cell population data-driven acute promyelocytic leukaemia flagging through artificial neural network predictive modelling

A targeted and timely offered treatment can be of benefit for patients with acute promyelocytic leukaemia (APML). The current study made use of potential morphological and immature fraction related parameters (cell population data) generated during complete blood cell (CBC) counting, through

Abstract P5-04-16: Association of circulating immune cells with lifestyle factors, and recurrence and mortality in patients with early stage breast cancer

Abstract Introduction: Lifestyle factors and metabolic derangements have wide-ranging effects including on immune activity. The association of circulating immune cells and outcomes in patients with early stage breast cancer remain incompletely understood. Objective: To evaluate the effects of smoking, body mass index (BMI), and alcohol intake on the association between circulating immune cell levels and patient outcomes. Methods: We retrospectively screened the electronic medical record of 950 patients with early stage breast cancer at the Johns Hopkins Hospital between 2003-2008 with at least 5 years of follow-up data for information on complete blood cell (CBC) counts. Absolute lymphocyte, monocyte, and neutrophil counts were obtained from the CBC differential performed closest to time of diagnosis within a period of ±1 year, and prior to any systemic treatment. Statistical analyses used were t-test for comparison of recurrence vs non-recurrence and Cox proportional hazard models for survival analysis, and linear regression for association between counts and BMI. Covariates adjusted for include grade, stage, smoking status, and alcohol use. Results: A total of 433 patients with stage 0-III breast cancer had complete data and were included in the analytical population. The populations of analyzed and non-analyzed patients were not significantly different in age or ethnic composition. The median age was 53 years old (range 26-86); 24% (n=103) were African American, and 76% (n=330) were Caucasian. Median BMI at baseline was 27 (range 18-53). Breast cancer subtypes were 68% (n=293) hormone receptor-positive, 19% (n=82) HER2 positive, and 13% (n=53) triple negative. 7.6% (n=33) experienced a recurrence and 6.9% (n=30) died of all causes. Patients with the highest quartile of lymphocytes at diagnosis, compared to the lowest quartile, had a significantly lower risk of recurrence (HR=0.23, 95% CI [0.06, 0.87], p=0.031). Patients with the highest quartile of monocytes were also at a lower risk for recurrence (HR= 0.17, 95% CI [0.11, 0.72] p=0.02). This effect was magnified in subgroup analysis among patients with hormone negative (n=125, p=0.017) and grade 3 (n=155, p=0.02) breast cancer. Patients in the highest quartile of both lymphocytes and monocytes had similarly lower recurrence rates (HR=0.24, 95% CI [0.08, 0.88] p=0.034). In subgroup analysis with regard to lifestyle factors, association of higher monocytes with lower recurrence was most significant among those consuming alcohol (n=237, p=0.005). Subgroup analysis of alcohol use was unremarkable for lymphocytes, as was subgroup analysis of smoking history (n=144) for lymphocytes and monocytes. In patients with BMI&amp;gt;30, lower lymphocytes were more strongly associated with recurrence (n=144, p=0.04); conversely, in patients with BMI&amp;lt;30, lower monocytes were more strongly associated with recurrence (n=289, p=0.02). There was no association between BMI and either monocytes or lymphocytes. Conclusion: Higher recurrence rates are observed in patients with early stage breast cancer who have low-normal lymphocyte and monocyte counts at time of diagnosis. This association is stronger in subgroups of patient with high BMI and who consume alcohol, known risk factors for breast cancer. Citation Format: Eric G Xie, Maya M Lapinski, Sarah Talamantes, Kala Visvanathan, Antonio Wolff, Cesar Santa-Maria. Association of circulating immune cells with lifestyle factors, and recurrence and mortality in patients with early stage breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-04-16.

2287. Real-world Use of Tedizolid Phosphate: A Case Series of Long-Term Tolerability

BackgroundTedizolid is an oxazolidinone antibiotic with broad-spectrum Gram-positive activity approved for the treatment of skin and skin structure infections with a 6-day course. Oxazolidinone antibiotics represent appealing options for prolonged antimicrobial therapy due to their available oral formulations with excellent bioavailability and potent in vitro activity against various multidrug-resistant Gram-positive organisms, Mycobacterium spp., and Nocardia spp. Although tedizolid and linezolid offer a similar clinical spectrum based on antimicrobial activity alone, long-term use of linezolid is often limited by serious adverse effects. Preliminary assessments have suggested better tolerability with tedizolid; however, these are limited by shorter exposure duration. The objective of this study was to evaluate the long-term safety and tolerability of tedizolid.MethodsRetrospective cohort of adult patients receiving tedizolid for ≥ 28 days, with baseline complete blood cell (CBC) indices available, and CBC indices drawn ≥ 14 days into tedizolid course. The primary objective was to evaluate the long-term tolerability of tedizolid.Results13 patients met inclusion criteria: median age 61 years (IQR, 51–64 years), 69% male, 85% Caucasian. The majority of patients utilized tedizolid for suppression (85%), and the median duration of tedizolid was 113 days (IQR, 71–204 days). There were no differences in CBC indices when comparing baseline to last laboratory draw throughout tedizolid exposure: platelets (baseline: 203 x 109/L (IQR, 186–283 x 109/L) vs. last: 196 x 109/L (IQR, 161–303 x 109/L; p = 0.65), hemoglobin (baseline: 9.8 g/dL (IQR, 8.8–11.1 g/dL) vs. last: 11.7 g/dL (IQR, 11.0–13.1 g/dL; p = 0.10), and white blood cells (baseline: 6.2 x 109/L (IQR, 5.6–7.6 x 109/L) vs. last: 6.5 x 109/L (IQR, 6.3–7.3 x 109/L; p = 0.45). The final laboratory draws were obtained a median of 78 days (IQR, 44–119 days) into therapy. No patients experienced peripheral neuropathy, optic neuritis/visual changes, or serotonin syndrome during treatment/suppression with tedizolid during the period evaluated.ConclusionLong-term therapy with tedizolid appears to be well-tolerated. Treatment and suppression with tedizolid seems to be a safe alternative to linezolid.Disclosures All authors: No reported disclosures.

WBC COUNT AS A PROGNOSTIC INDICATOR IN THE TREATMENT OF IDIOPATHIC PULMONARY FIBROSIS

SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: Idiopathic pulmonary fibrosis (IPF) is a progressive form of interstitial lung disease resulting in varying degrees of scarring that is further exacerbated by acute inflammatory processes. White blood cell (WBC) count has been established as an inflammatory marker and is a known prognostic indicator in several cardiopulmonary processes. For IPF patients on disease-modifying therapy such as nintedanib or pirfenidone, the correlation between WBC and disease-related events has not been well studied. METHODS: Patient demographics, complete blood cell (CBC) counts, and pulmonary function tests from patients with IPF evaluated at Inova Fairfax Hospital between October 2014 and January 2019 were collected. CBCs were compared before and after initiation of anti-fibrotic therapy. Outcome events collated were respiratory hospitalizations, lung transplant, or death following the initiation of anti-fibrotic therapy. Event-free survival was calculated and compared between patients on nintedanib versus pirfenidone. RESULTS: Sixty-one patients with IPF had CBCs available prior to initiation of anti-fibrotic therapy. WBC range was 3.5 to 16.0 (median 8.0). Subsequently, 28 patients had been started on pirfenidone and 33 patients had been prescribed nintedanib. Of the 61 patients, those with baseline WBC count less than 8 (N=32) had a median event-free survival of 710 days (P=NS) compared with 703 days (P=NS) for those with baseline WBC count greater than 8 (N=29). The median change in WBC count amongst the 61 patients was -0.3. Median event-free survival for those with an increase in WBC count (N=23) after initiating anti-fibrotic therapy was 683 days (P=NS) compared with 761 days (P=NS) for those with no change or a decrease in WBC count (N=38). CONCLUSIONS: Trending the change in WBC count in patients with IPF on anti-fibrotic therapy did not serve as a prognostic indicator with statistical significance. This result may have been influenced by the small sample size of the study. Additionally, although WBC count has been suggested as a biomarker of prognosis in IPF, the mechanism of action of anti-fibrotic therapy may be independent of factors that influence the WBC count. CLINICAL IMPLICATIONS: Based on the findings of this study, further research is indicated to investigate the potential significance of WBC count and its role in inflammation in the evolution of IPF and its management. DISCLOSURES: No relevant relationships by Scott Barnett, source=Web Response Speaker/Speaker's Bureau relationship with Genentech Please note: $5001 - $20000 Added 03/15/2019 by Anne Brown, source=Web Response, value=Honoraria Consultant relationship with Promedior Please note: $5001 - $20000 Added 03/15/2019 by Anne Brown, source=Web Response, value=Consulting fee No relevant relationships by Talha Demirci, source=Web Response Speaker/Speaker's Bureau relationship with Genentech Please note: $1001 - $5000 Added 03/08/2019 by Christopher King, source=Web Response, value=Honoraria Consultant relationship with Roche-Genentech Please note: $20001 - $100000 Added 03/15/2019 by Steven Nathan, source=Web Response, value=Consulting fee Speaker/Speaker's Bureau relationship with Boerhinger-Ingelheim Please note: $20001 - $100000 Added 03/15/2019 by Steven Nathan, source=Web Response, value=Honoraria Consultant relationship with Promedior Please note: $5001 - $20000 Added 03/15/2019 by Steven Nathan, source=Web Response, value=Consulting fee Consultant relationship with Bellerophon Please note: $5001 - $20000 Added 03/15/2019 by Steven Nathan, source=Web Response, value=Consulting fee Advisory Committee Member relationship with United Therapeutics Please note: $1001 - $5000 Added 03/15/2019 by Steven Nathan, source=Web Response, value=Consulting fee

Determination of renal blood flow with Doppler ultrasound and the hypertension prevalence and acid-base level in dogs with chronic renal failure

Chronic renal failure (CRF) is an important cause of morbidity and mortality in dogs. The aim of this study is to investigate the renal Doppler measurements, blood hypertension and acid-base levels in dogs with chronic renal failure. Twenty-six dogs previously diagnosed with chronic renal failure were compared with twenty healthy dogs. A complete blood cell, biochemical profile, urinalysis, blood gasses, blood pressure were analyzed and changes in renal blood flow were measured by renal Doppler ultrasonography. The dogs with CRF had significantly higher serum blood urea nitrogen, creatinine and phosphorus concentration, significantly lower packed cell volume, and urine specific gravity than control dogs. Positive correlation was determined between serum creatinine levels and renal Doppler indices. There were significant decreases in blood pH and bicarbonate. Indirect blood pressure measurements were slightly increased in CRF dogs. Renal Doppler measurement was observed as a helpful tool in diagnosing the CRF in dogs. Identification of acidosis and hypertension may help in developing treatments that slow the rate of progression of chronic renal failure.

The predictive value of scores based on peripheral complete blood cell count for long-term neurological outcome in acute carbon monoxide intoxication.

Growing evidence indicates that inflammation is associated with neurological sequelae after CO poisoning. Several scores incorporating the peripheral complete blood cell (CBC) count have been introduced as indicators of systemic inflammation. This study investigated whether these scores can improve the predictive accuracy for long-term neurological outcome of acute carbon monoxide (CO) poisoning. Two hundred seventy-nine patients who suffered from acute CO poisoning were included. Data on the demographic details, serial peripheral CBC counts and scores based on peripheral CBC counts (neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), platelet-lymphocyte ratio (PLR), systemic immune inflammation index [SII]) over the first 12hours after presentation together with the clinical course during hospitalization and long-term neurological outcome were collected. Both a multivariate logistic regression model with only significant univariate predictors and a model with univariate predictors plus each score for long-term neurological outcome were constructed. Patients with a poor long-term neurological outcome had higher neutrophil and monocyte counts and lower lymphocyte counts over the first 12hours after admission than patients with a good outcome. The diagnostic performance of the NLR, MLR and SII over the first 12hours for predicting long-term neurological outcome was acceptable. These scores at presentation were independently associated with the long-term neurological outcome. Among these scores, only the SII at presentation significantly improved the predictive accuracy of the model when combined with clinical parameters (AUC 0.949, 95% CI 0.916-0.972 vs AUC 0.923, 95% CI 0.884-0.952 for the model with clinical parameters only, P=0.0476). The optimal cut-off value for SII at presentation was 1012.2, resulting in a sensitivity of 97% (84.2%-99.9%) and specificity of 64.6% (58.2%-70.6%). The SII at presentation could significantly improve the prognostic accuracy for predicting the long-term neurological outcome in patients with acute CO poisoning. Because the SII is an inexpensive and easily measurable parameter, it might be used as a prognostic tool in clinical fields.

Comparison of interleukin 18 gene expression and its serum level between Iranian colorectal cancer (CRC) patients and healthy people

Colorectal cancer (CRC), also known as colon cancer, rectal cancer, or colon cancer is one of the important mortal cancers of the gastrointestinal tract in Iran and worldwide. Interleukin 18 is one of the cytokines that causes inflammation and plays a real role in the inhibition of CRC development and evaluation of its rate is significant in cancer patients. The purpose of the present study was to investigate the IL-18 gene expression and its serum levels in Iranian CRC patients compared to healthy people. A total of 35 serum samples and 24 complete blood cells (CBCs) from CRC patients and as well as 20 control samples (healthy people) were collected from Al-Zahra hospital (Isfahan city, Iran) and serum and RNA specimens were isolated for molecular and serological investigations. The expression level of IL-18 gene and its serum level for comparison in both CRC patients and healthy people groups were evaluated by quantitative real-time reverse transcription PCR (q-RT-PCR) technique and ELISA assay. The comparison of IL-18 gene expression and its serum level in blood of the CRC patients and healthy people using real-time PCR and ELISA techniques were showed that this cytokine level was increased significantly in cancer patients (p < 0.05). According to the significant role of IL-18 as a pro-inflammatory cytokine in developing inflammation of gastrointestinal tract and cancer and increasing of this cytokine expression in the results of our research in CRC patients compared to the control subjects, for diagnosing or pre-screen of CRC and other cancer patients, it would be better IL-18 expression level is check in laboratories.

Nadir/pre-chemoradiotherapy ratio of white blood-cell count can predict tumor response and recurrence-free survival in locally advanced rectal cancer: a multi-institutional analysis

The objective of this study was to evaluate whether change of white blood-cell (WBC) count before and during chemoradiotherapy (CRT) might be associated with susceptibility to radiation and tumor response. Medical records of 641 patients with rectal cancer who received preoperative CRT followed by curative surgery were retrospectively reviewed in five tertiary centers. Complete blood cell with differential count was measured weekly during the period of CRT. We assessed nadir/pre-CRT ratio of WBC count as a predictor for tumor response to CRT and a prognostic factor for recurrence-free survival. Enrolled patients were divided into low WBC ratio (LWR) and high WBC ratio (HWR) arms with cut-off value of 0.49 calculated by receiver operating characteristic curve. Of 641 patients, 490 (76.4%) and 151 (23.6%) were categorized into HWR (> 0.49) arm and LWR (≤ 0.49) arms, respectively. Complete pathologic response rate after CRT was significantly higher in LWR arm than that in HWR arm (23.8% vs. 12.2%, p = 0.001). In logistic regression analysis, carcinoembryonic antigen (CEA) level over 5ng/ml [adjusted odds ratio (OR) 0.566, 95% confidence interval (CI) 0.351-0.912; p = 0.019) and HWR (adjusted OR 0.412, 95% CI 0.256-0.663; p = 0.001) were significantly negative factors of pathologic complete response. The 5-year recurrence-free survival rate was significantly higher in the LWR group than that in the HWR group (83.3% vs. 67.6%, p = 0.001). Low nadir/pre-chemoradiotherapy ratio during preoperative CRT can predict good tumor response. It is significantly associated with improved recurrence-free survival in rectal cancer.

Legal Briefs: Was This Case of Necrotizing Enterocolitis Preventable?

A 28 1/7 week gestational age male infant with a birthweight of 1,280 g was born to a 23-year- old gravida 3, para 0-0-2-0 woman. The pregnancy was uneventful until the night before delivery when she developed preterm labor. She received 1 dose of betamethasone 8 hours before delivery. She also received 3 doses of penicillin for unknown group B Streptococcus status. Artificial rupture of membranes occurred a few hours before birth and the amniotic fluid was clear. The birth was via normal spontaneous vaginal delivery. The placenta appeared grossly normal, but subsequent pathologic examination showed mild chorioamnionitis. The infant’s Apgar scores were 8 at 1 minute and 9 at 5 minutes of age. The infant was clinically stable and treated with continuous positive airway pressure. The infant had a normal complete blood cell (CBC) count and was started on antibiotics because of preterm labor. The infant also received intravenous fluids at 80 mL/kg per day. On day 1, caffeine was initiated and phototherapy was started because the infant’s bilirubin was 8.1 mg/dL (138.5 μmol/L). At that time, the infant’s weight was down 11% from birthweight. On day 2, a percutaneous intravenous central catheter (PICC) was placed. On day 3, the infant’s weight loss was down 13% from birthweight and his sodium was 151 mEq/L (151 mmol/L) with a blood urea nitrogen of 30 mg/dL (10.7 mmol/L). The infant was started on trophic breast milk feedings of 1.5 mL every 3 hours. With the intravenous fluids being infused at 122 mL/kg per day, the total volume of fluids was 154 mL/kg per day. The infant did not receive probiotics. As the feedings increased, the volume infused diminished. The plaintiff neonatologist thought that the infant should have had his hydration status better managed to prevent dehydration and that it was inappropriate …

Hemangiosarcoma Associated with Polypropylene Suture in a Cat

Background: Sutures plays an important role in wound repair by providing hemostasis and support for healing suture. Synthetic non-absorbable like polypropylene suture materials induce minimal tissue reaction. Polypropylene has not been associated to neoplasms in domestic animals. The aim this study is to describe the first case of polypropylene suture induced hemangiosarcoma in an abdominal wall of a feline.Case: A 13-year-old female domestic shorthair cat was presented with a ventral abdominal subcutaneous mass. Clinical examination revealed a firm, rough, and irregular, approximately 6 x 4 cm subcutaneous mass involving the caudal ventral abdomen. A complete blood (cell) count (CBC) was within normal limits. Leukemia and FIV tests were negative; andthe results of a chemistry panel revealed elevated creatinine (valor: 2.0 reference range: 0.5-1.9). Abdominal ultrasound revealed a large mass of mixed echogenicity in the mid-ventral abdomen cranial to the bladder, measuring approximately 6 x 4 cm in the middle line with suture deeply embedded within mass suggesting foreign body reaction or neoplasm. There was evidence of sutures (hyperechoic lines) along the caudal abdominal wall extending into the mass. Records indicated that ovariohysterectomy procedure was performed 12 years previously at the same clinic and the closure of the abdominal wall was made with polypropylene sutures. No other abdominal surgery was performed in this cat. A fine-needle aspirate of the mass and contrast-enhanced computed tomography was not performed due to owner’s finance restrains. The catwas referred to surgery and the mass was excised. No evidence of metastasis was noted during surgery. Histologically, the neoplastic cells were oval to round with granular cytoplasm and vesicular nucleus and exhibited moderate cellular and nuclear pleomorphism. A diagnosis of abdominal wall hemangiosarcoma was made with suture deeply embedded within mass. Surgical margins were clear. Chemotherapy was indicated, but the owner declined due to financial reasons. This is the first polypropylene suture mass associated hemangiosarcoma in cats.Discussion: Hemangiosarcoma is a malignant neoplasm of vascular endothelial cells origin and it may be associated with chronic inflammation and neoplastic transformation. It was reported in previous studies, and it could be a hypothesis for the presented clinical case. There are two cases described in the literature of abdominal wall tumor associated with foreignbody and exuberant inflammatory response in cats using different types of suture; one case is a steel staple developing hemangiosarcoma and the other is polyester sutures developed fibrosarcoma. The present study shows a primary hemangiosarcoma diagnosed several years after closure of abdominal wall using polypropylene sutures in a female cat. Polypropylene is a monofilament suture that create less tissue-drag and induces less inflammation than multifilament sutures and is the preferred suture to close abdominal wall. Cats demonstrate a peculiar predisposition to neoplasms at the site of injury. Although the pathogenesis is still unclear, the introduction a “foreign body” may cause inflammatory process that act as a stimulus to neoplasia formation. We believe that polypropylene was the foreign material that may have played arole in tumor development in this case and it has not been reported before. Polypropylene sutures were found on gross examination of excised material. Any uncoated braided non-absorbable material located deeply in tissues may evoke a chronic inflammatory response (granuloma). A granuloma may evolve to malignancy in some cats. Despite polypropylenematerials induce minimal tissue reaction, it may be associated to neoplasm.Keywords: polypropylene suture, hemangiosarcoma, cat, tumor induced by foreign body.

Dynamics of routine blood tests in BALB/c mice with Babesia microti infection

To understand the changes in body weight, spleen weight and complete blood cells in BALB/c mice infected with Babesia microti. For the infection group, six weeks old BALB/c mice were injected intraperitoneally with a dose of 100 μL of B. microti infected blood (20% RBC infection rate, each mouse). For the determination of the progression of B. microti infection up to 28 days of the infection, the microscopic visualization of thin blood smears of tail blood stained with Giemsa staining was performed in the infection group. The experiment was carried out at different intervals on days 0, 7, 14, 21, and 28 after the infection, respectively. The mice were sacrificed, and spleens were collected and weighed, and the body weight of the mice was also determined. The blood cells of the mice were analyzed by using Mindray BC-5300 Vet animal automatic hematology analyzer. On the first day after the infection, B. microti was visualized in RBC of the infection group. The significantly highest infection rate (55%) appeared on the seventh day of the infection, and then steadily decreased; the mice attained the latent infection phase on the 28th day post-infection, when the parasite could not be visualized in the peripheral blood. The mice in the infected group acquired a significantly lowest body weight on the 7th day of the infection, and then gradually returned to normal. The weight of the spleen was the significantly highest on the 14th day of the infection, and then consistently decreased. On the 28th day of infection, the spleen weight was still higher than that of the control group. There were no significant changes in the number of white blood cells (WBC), lymphocytes, and eosinophils in the infected mice; and altered levels were all within the normal mouse reference range. The number of red blood cells, hemoglobin, and platelet count in the infected mice were decreased to the lowest level when the B. microti infection rate achieved to the highest, and then gradually returned to the normal levels. B. microti infection can cause body weight loss, splenic weight gain, and reduction in the number of erythrocytes and platelets in whole blood of the mice. Besides, the whole blood cell analyzer has a diagnostic significance in the identification of babesiosis.

Back to Basics: Red Blood Cell Distribution Width: Clinical Use beyond Hematology.

1. Melissa Kaori Silva Litao, MD* 2. Deepak Kamat, MD, PhD† 1. *Department of Pediatrics, De La Salle Health Sciences Institute College of Medicine, Cavite, Philippines 2. †Children’s Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI * Abbreviations: BNP: : brain natriuretic peptide CBC: : complete blood cell COPD: : chronic obstructive pulmonary disease CRP: : C-reactive protein ESR: : erythrocyte sedimentation rate FMF: : familial Mediterranean fever MCV: : mean cell volume RBC: : red blood cell RDW: : red blood cell distribution width The complete blood cell (CBC) count is a widely available and commonly used inexpensive laboratory test used in clinical practice. Information contained therein includes the white blood cell count and differential count, red blood cell (RBC) count, RBC indices, hemoglobin level, hematocrit concentration, and platelet count. The RBC indices include the mean cell volume (MCV), mean cell hemoglobin, mean cell hemoglobin concentration, and RBC distribution width (RDW). (1) Traditionally, the clinical use of RDW has been limited to helping differentiate certain types of anemias (eg, β-thalassemia minor and iron deficiency anemia, which can both have decreased MCV and decreased mean cell hemoglobin but will differ in their RDW). (2) During the past decade, this quick and inexpensive test has been the subject of several studies attempting to evaluate its use as, among other things, an inflammatory marker, (3)(4)(5)(6)(7)(8) a predictor of all-cause mortality, (9)(10) and a prognostic tool for morbidity and mortality associated with sepsis and cardiovascular disease. (4)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) This article focuses on discussing the RDW as a diagnostic and prognostic tool in various medical conditions. ### What Is the RDW? Each RBC is shaped as a biconcave disk with a depressed center, its volume ranging from 80 to 100 femtoliters (fL; 1 fL = 10-15 L) in adults (represented by the MCV in the CBC count). The RBC membrane is extremely flexible and, in certain conditions, is able to change shape …