White Blood Cell Count Research Articles

Impact of solution-focused brief therapy and vacuum sealing drainage on mental health of wound care patients

BACKGROUND Improving mental health is crucial for patients who require wound treatment. AIM To analyze the effects of solution-focused brief therapy (SFBT) combined with vacuum sealing drainage on the psychological health of patients undergoing wound treatment, providing a basis for selecting wound treatment protocols. METHODS A total of 102 patients undergoing wound treatment were included, with the study period from March 2020 to March 2024. Sex was not a factor, and patients were randomly assigned to two groups of 51 cases each. The control group received negative pressure wound therapy (NPWT), while the experimental group received NPWT plus SFBT. The recovery of wounds, granulation tissue scores, and psychological health levels were compared between the two groups. Statistical analysis was conducted using SPSS Windows software version 26.0 and GraphPad Prism 8.0. RESULTS Post-treatment, the levels of high-sensitivity C-reactive protein, white blood cell count, and lactate dehydrogenase in the experimental group were significantly lower than those in the control group (P < 0.05). The two groups had no significant difference in granulation tissue scores (P < 0.05). The psychological health level in the experimental group was significantly higher than in the control group (P < 0.05). CONCLUSION The combination of SFBT and NPWT accelerates wound healing, promotes granulation tissue growth, and improves psychological well-being, making it a valuable approach for clinical application.

Case report: diagnosis of neurobrucellosis in a non-endemic area child using metagenomic next-generation sequencing.

Brucellosis with neurological symptoms at onset is rare in children and is frequently misdiagnosed or overlooked due to nonspecific clinical presentations, particularly in non-endemic areas. We report a case of neurobrucellosis in a child from a non-pastoral area, diagnosed via metagenomic next-generation sequencing (mNGS). The patient presented with headache and altered consciousness, accompanied by fever, projectile vomiting, seizures, and urinary incontinence. Physical examination indicated possible nuchal rigidity. Cerebrospinal fluid (CSF) analysis showed colorless and clear fluid, with a white blood cell count of 259 × 10⁶/L, 4.6% polymorphonuclear cells, positive protein qualitative test, protein level of 0.78g/L, and glucose level of 1.66 mmol/L. Initial diagnosis suggested central nervous system infection, and empirical treatment led to improvement in consciousness. However, after a few days of stable body temperature, the patient experienced recurrent fever. Ultimately, mNGS of CSF identified Brucella melitensis, confirming neurobrucellosis. Following treatment with ceftriaxone, doxycycline, and rifampin, the patient's clinical symptoms improved significantly, and follow-up CSF analysis showed normalization of cell counts. This case highlights the early diagnostic utility of mNGS in CSF for neurobrucellosis and its role in differential diagnosis.

What Clinicians Think About When They Think About Sepsis: Results From a Survey Across the University of Maryland Medical System.

Sepsis, a leading cause of death in the hospital, is a heterogeneous syndrome without a defined or specific set of symptoms. We conducted a survey of clinicians in practice to understand which clinical findings they tend to associate with sepsis. A survey was distributed to physicians and advanced practice providers across a multihospital health system during April 2022 and May 2022 querying likelihood of suspecting sepsis and initiating sepsis care in response to various normal and abnormal clinical findings. Strength of association between clinical findings and suspicion of sepsis were based on median and interquartile range of complete responses. Comparisons between individual questions were performed using Wilcoxon rank-sum testing. Among 179 clinicians who opened the survey, 68 (38%) completed all questions, including 53 (78%) attending physicians representing six different hospitals. Twenty-nine respondents (43%) worked primarily in the ICU, and 16 (24%) worked in the emergency department. The clinical findings most strongly associated with suspicion of sepsis were hypotension, tachypnea, coagulopathy, leukocytosis, respiratory distress, and fever. The abnormal clinical findings least likely to prompt suspicion for sepsis were elevated bilirubin, elevated troponin, and abdominal examination suggesting ileus. On average, respondents were more likely to suspect sepsis with high temperature than with low temperature (p = 0.008) and with high WBC count than with low WBC count (p = 0.003). Clinicians in practice tend to associate the diagnosis of sepsis with signs of severe illness, such as hypotension or respiratory distress, and systemic inflammation, such as fever and leukocytosis. Except for coagulopathy, nonspecific laboratory indicators of organ dysfunction have less influence on decision-making.

Mediating Role of Platelet Count Increase in Unfractionated Heparin Treatment for Sepsis Patients: A Retrospective Cohort Analysis

Aims/Background The role of heparin in sepsis therapy has been widely debated. The controversy surrounding heparin’s use as an anticoagulant in sepsis may stem from differences in sepsis definitions, study designs, timing and dosage of drug administration, treatment duration, complications, and patient severity. In this study, we aimed to determine the optimal timing and dosage of heparin in patients with sepsis, identify specific subgroups that could benefit from heparin therapy, and explore laboratory markers to assess its efficacy. Methods This retrospective cohort study was conducted using the Medical Information Mart for Intensive Care-IV dataset. Data from patients with sepsis were extracted based on the Sepsis 3.0 criteria. Patients were categorized according to heparin use. The effectiveness of early and appropriate heparin administration was assessed, and a subgroup analysis was performed to identify patients most likely to benefit from heparin therapy. Additionally, factors mediating the improvement in sepsis prognosis following heparin treatment were analyzed. Results We recruited 4149 participants who met the inclusion criteria, with an overall 28-day mortality rate of 19.5%. There were 2192 individuals in the heparin group and 1957 in the non-heparin group. After propensity score matching, heparin therapy demonstrated a significantly greater effect on reducing both 28-day and 90-day mortality compared to the non-heparin treatment (18.1% vs. 10.7%, p < 0.001; 18.8% vs. 12.6%, p < 0.001). However, the heparin group had a higher incidence of major bleeding (10.9% vs. 6.3%, p = 0.001), increased use of mechanical ventilation (54.3% vs. 45.1%, p < 0.001), and a longer intensive care unit stay (3.6 vs. 2.5 days, p < 0.001) compared to the non-heparin group. Early administration of high-dose heparin improved 28-day survival. Early and adequate heparin administration was more effective than late and insufficient dosing (p < 0.01), except in patients with sepsis who had low white blood cell counts, alkalosis, or reduced platelet counts. The increase in platelet count had a significant mediating effect on the entire cohort (p < 0.001 for the causal mediation effect), with a mediation proportion of 14%. Conclusion Early and adequate heparin administration can significantly improve the prognosis of sepsis. An increase in platelet count may serve as a potential indicator of the effectiveness of heparin therapy in sepsis.

Case Report: A case of infantile acute hyperleukocytic leukemia treated by leukapheresis

Leukapheresis is a treatment used to reduce leukocytes to decrease the number of white blood cells in circulation and prevent the risks of hyperviscosity and cerebrovascular and pulmonary leukostasis. We present a case of pro-B-cell acute lymphoblastic leukemia (ALL) with hyperleukocytosis in a 6-month-old infant, characterized by a positive KMT2A/AFF1 fusion gene with a leukocyte count of 1,755 × 109/L. After two consecutive sessions of leukapheresis, the white blood cell count decreased to 55 × 109/L. The infant recovered after the high-dose methotrexate chemotherapy. These results demonstrate that leukapheresis is a feasible treatment option for acute hyperleukocytic leukemia in infants with ALL.

Procalcitonin, C-reactive protein, and white blood cell count levels in end-stage cancer patients: A retrospective study on inflammatory markers and their prognostic value.

Procalcitonin (PCT), C-reactive protein (CRP), and white blood cell count (WBC) are commonly recognized as inflammatory markers. Some studies showed that these markers were also related to some cancers. This study aimed to investigate whether these markers were exhibited aberrations in end-stage cancer patients and to assess their correlation with infection and prognosis. The study underscores the potential of inflammatory markers as prognostic indicators in end-stage cancer, proposing that routine monitoring of these markers could substantially enhance patient management and improve outcomes. The medical records of 116 cancer patients were retrospectively reviewed. Data from end-stage cancer patients were collected during the week preceding their death. The control group consisted of cancer patients with a performance status score of 3 to 4 and clinical stage of III to IV. Normally distributed continuous data (mean ± SD) were analyzed using t-test. Non-normally distributed data (median [M] with interquartile range [P25, P75]) were analyzed using Wilcoxon rank-sum test. Numerical data were subjected to Chi-square test. Logistic regression analysis was employed to assess the correlation between inflammatory markers and patient prognosis. There were significant differences between the 2 groups for PCT, WBC, CRP, platelet count, and body mass index. However, subgroup analysis indicated that there were no significant differences in PCT, CRP, and WBC levels between infected and noninfected patients within the deceased group. It is worth noting that elevated levels of PCT (OR = 7.13, 95% confidence interval [CI] = 1.68-30.36, P = .008) and WBC (OR = 2.47, 95% CI = 1.13-1.13, P = .024) were ultimately identified as independent risk factors associated with poor prognosis in cancer patients, as demonstrated by further logistic regression analysis. In the subgroup analysis of noninfected patients, the univariate analysis revealed that both PCT (OR = 11.612, 95% CI = 1.217-110.776, P = .033) and WBC (OR = 3.077, 95% CI = 1.004-9.427, P = .049) had a statistically significant difference in outcomes between the alive group and the deceased group. The PCT, WBC, and CRP levels of end-stage cancer patients were significantly elevated, regardless of infection. An increase in PCT and WBC was associated with an increased risk of death. These findings suggest that monitoring PCT and WBC levels in end-stage cancer patients may provide valuable prognostic information, aiding in clinical decision-making.

Assessment of Inflammatory Biomarkers and Incident Atrial Fibrillation in Older Adults.

Available evidence supports the importance of inflammation in atrial fibrillation (AF) pathogenesis, yet general anti-inflammatory therapies have failed to show benefit for prevention of the arrhythmia. Better understanding of the specific inflammatory pathways involved is necessary to advance therapeutics. We evaluated 9 circulating markers of inflammation measured by immunoassays and incidence of AF in a population-based older cohort. Biomarkers included measures of general inflammation and the NLR (nucleotide-binding oligomerization domain-like receptor) family pyrin domain containing 3 inflammasome, TNF-α (tumor necrosis factor α), monocyte activation markers, and sIL-2 (soluble interleukin-2). Among 5726 participants (median age 72 years), 1836 developed AF over median follow-up of 11.5 years. After adjustment for conventional risk factors, 5 biomarkers were positively associated with incident AF: IL-6 (interleukin-6), hazard ratio (HR), 1.14 (95% CI, 1.07-1.21); hs-CRP (high-sensitivity C-reactive protein), HR, 1.05 (95% CI, 1.01-1.09); white blood cell count, HR, 1.18 (95% CI, 1.04-1.35); sTNFR1 (soluble TNF receptor 1), HR, 1.21 (95% CI, 1.05-1.39); and sIL-2Rα (sIL-2 receptor α), HR, 1.16 (95% CI, 1.05-1.29) (all per doubling of biomarker). sCD14, sCD163, IL-18, and IL-1 receptor antagonist showed no association with AF. Upon concurrent adjustment for all biomarkers, only IL-6 remained significantly associated with the arrhythmia, HR, 1.17 (95% CI, 1.07-1.26). Among older adults, IL-6, hs-CRP, white blood cell count, sTNFR1, and sIL-2Rα were positively associated with incident AF, but only IL-6 retained significance on concurrent adjustment. These findings newly document associations for sTNFR1 and sIL-2Rα and lend support to a preeminent role for IL-6 in development of this arrhythmia. The efficacy of IL-6 blockade for AF prevention awaits completion of appropriate clinical trials.

Enhanced Growth, Haematological and Biochemical Performance in Hybrid Catfish of Clarias gariepinus x Clarias cavernicola

This study evaluated the growth performance, haematological indices, and biochemical parameters of four catfish breeds, including two purebreds (Clarias cavernicola and Clarias gariepinus) and two hybrids (female C. cavernicola x male C. gariepinus and female C. gariepinus x male C. cavernicola). Over four months, growth was assessed by measuring body weight, total length, and standard length. Haematological and biochemical analyses were conducted to assess the health and immune status of the different breeds. The results indicated that the hybrid of female C. cavernicola x male C. gariepinus exhibited the highest growth performance, with significant increases in body weight and length compared to the other breeds. This hybrid also demonstrated the highest white blood cell (WBC) and lymphocyte counts, suggesting a stronger immune response, which was statistically significant (p<0.05) compared to the purebreds. Granulocyte levels were consistent across all breeds, while red blood cell (RBC) and platelet counts showed no significant differences, indicating stability in these parameters. Biochemical analysis revealed that the female C. cavernicola x male C. gariepinus hybrid had the highest total protein and globulin levels, which are indicative of better health and immune function. Albumin levels were higher in both hybrids compared to the purebreds, while cholesterol, creatinine, and glucose levels were similar across all breeds. The alleles associated with better immunity are likely present in the maternal line of C. cavernicola, leading to the superior vigour observed in the C. cavernicola (female) x C. gariepinus (male) hybrid. This enhanced vigour results in improved growth, hematological, and biochemical profiles. Compared to purebred breeds, this hybrid demonstrates better health, increased disease resistance, and a higher potential for productivity in aquaculture.

Predictive Factors of Amputation in Diabetic Foot

Background: Diabetic foot ulcers are a common complication of diabetes mellitus, often leading to progressive sensory deficits, impaired vascularization, and a predisposition to ulceration and gangrene. Untreated ulcers may cause recurrent infections that endanger a patient’s life. Amputation of part of the limb up to a well-vascularized level is one of the treatments employed for untreated ulcers. Objectives: Laboratory data were analyzed with the aim of identifying risk factors related to surgical amputation treatment of diabetic foot. We believe it is useful to identify risk factors that can be altered from a reversible condition in the clinical decision-making of treatment, thus manifesting themselves in a timely manner to provide the patient with an alternative to surgical amputation of the lower limb. Methods: Our retrospective study was conducted by the Department of Orthopedics and Traumatology at the Fondazione Policlinico Universitario Agostino Gemelli IRCCS in Rome. We recruited 200 patients who underwent lower limb amputation for diabetic foot between 2017 and 2021 and had blood tests both 30 days and within 5 days before the first surgery. Results: This case–control study revealed a significant negative correlation between hemoglobin (Hb) levels and the occurrence of leg amputations. In contrast, C-reactive protein (CRP) levels, the neutrophil-to-lymphocyte ratio (NLR), and the platelet-to-lymphocyte ratio (PLR) showed significant positive correlations with leg amputations. A 3-year follow-up of the cases also revealed a significative positive correlation between age, white blood cells (WBC) count, NLR, PLR, and death at 3 years. Conclusions: Our findings suggested that lower Hb levels and elevated CRP, NLR, and PLR levels in patients with diabetic foot disease may be associated with a higher risk of lower-limb amputation. Unexpectedly, this study also demonstrated that elderly age, WBC, CRP, NLR and PLR levels may be associated with a negative prognosis for these patients. These findings highlighted the importance of monitoring these laboratory values in diabetic patients to identify individuals at higher risk of leg amputations and implement appropriate interventions to prevent or minimize the occurrence of this severe complication.

Immunomodulatory Effects of Nellikai Thenural Against Thiamethoxam-Induced Toxicity in Carassius auratus

The accumulation of pesticides in aquatic ecosystems poses significant risks to non-target organisms, particularly fish populations. The study evaluated the protective effects of Nellikai Thenural, a traditional Siddha formulation containing Emblica officinalis and honey, against thiamethoxam-induced toxicity in Carassius auratus (goldfish). The experimental design comprised four groups: control, Nellikai Thenural-treated (733 μg), thiamethoxam-exposed (114.84 mg/L), and co-administered (thiamethoxam + Nellikai Thenural) groups. The LC50 value of Nellikai Thenural was determined at 916 μg/ml/kg body weight through brine shrimp lethality assay. Hematological parameters revealed significant alterations in thiamethoxam-exposed fish, with decreased RBC count, hemoglobin levels, and WBC count. The administration of Nellikai Thenural effectively restored these parameters toward normal levels. Biochemical markers, including plasma proteins, immunoglobulins, and tissue-specific enzymes (ALP, ACP, AST), showed marked improvement in the co-administered group compared to thiamethoxam-exposed fish. Behavioral observations indicated reduced stress responses and improved swimming patterns in fish treated with Nellikai Thenural. The findings demonstrate the potential of Nellikai Thenural as a natural immunostimulant and protective agent against pesticide-induced toxicity in aquatic organisms.

Associations between the Dietary Inflammatory Index and fractional exhaled nitric oxide among United States adults: A cross-sectional study.

Fractional exhaled nitric oxide (FeNo) is a convenient and noninvasive test that measures the concentration of nitric oxide in exhalation as a surrogate biomarker of airway inflammation. This cross-sectional study aimed to determine the associations between Dietary Inflammatory Index (DII) and FeNo in US adults. Adults participating in the 2007-2012 cycles of the US National Health and Nutrition Examination Survey with complete information and available measurement data of DII and FeNo were included. Associations between DII and FeNo were assessed using univariable and multivariable logistic regression models, restricted cubic spline analysis, stratified analysis, and sensitivity analysis. A total of 7677 participants (mean age 45.68 years, 53.03% men) with a mean DII of 1.28 and FeNo of 17.33 ppb were included. The multivariable-adjusted linear regression analysis showed that a one-unit increase in DII was associated with a 0.283-ppb reduction in FeNo level. The beta and 95% CI for the second, third, and fourth DII quartile groups were -1.19 (-2.04 to -0.35), -1.07 (-2.26 to 0.12), and -1.60 (-2.85 to -0.36), respectively (P for trend = 0.04), with the lowest quartile group as the reference. The restricted cubic spline curve showed an inversely linear relationship between DII and FeNo. The study result is robust and did not appear to be affected by the participant's age, sex, race, body mass index, physical activity, diabetes status, or white blood cell or eosinophil counts. A proinflammatory diet, as indicated by a higher DII, is cross-sectionally associated with lower FeNo levels in US adults.

Haematological parameters as predictors of severe dengue: a study from northern districts of West Bengal.

A hike in dengue cases was recorded in last two years, resulting from both single and multiple-serotypes of dengue virus (DENV) and secondary infections, culminating in significant hospitalizations and deaths in India. This study focuses on evaluating symptomatic and haematological parameters in acute dengue patients of the northern part of West Bengal to predict disease severity early on and also to analyze the correlation between circulating DENV serotypes with severity. Dengue patients (N=540) diagnosed as NS1 positives were categorized into 13.7% severe DHF (N=74) and 86.3% mild DF (N=466) and prediction of risk was done using logistic regression. DENV RNA was isolated from blood, converted to cDNA, and detected/serotyped via RT-qPCR by using DENV specific primers. Only 14.48% (N=11) patients showed single serotypic (DENV2 or DENV3) infection of dengue. In contrast, multi-serotypic infections (N=65) with the prevalence of DENV2 and DENV3 co-infections were found among the dengue patients, affecting severe changes in the most critical haematological parameters such as hematocrit and platelet count. The multivariate binary logistic regression model revealed that only six parameters viz., age (p=0.032), presence of joint pain (p=0.015), Haemoglobin level (p<0.001), total RBC count (p=0.024), total WBC count (p=0.003), lymphocyte% (p=0.019) were found to be significantly associated with the risk of DHF. Most prevalent DENV2 and DENV3 infections significantly impact hematocrit and platelet counts in the study region. Our prediction model, incorporating age, joint pain, hemoglobin, RBC, WBC, and lymphocyte, may effectively predict dengue severity.

Relationship between Type 2 Diabetes Mellitus and Red Cell Distribution Width

Background and objectives: Type 2 diabetes mellitus is a prevalent health problem in the Kurdistan region/Iraq. Numerous biochemical parameters are important for screening and monitoring of diabetes mellitus, Red Cell Distribution Width is one of them. Methods: A cross-sectional study was conducted in Erbil Teaching Hospital, Rizgary Teaching Hospital, and Layla Qassim primary health care center in Erbil city-Kurdistan region/Iraq from 1st of August, 2022 to 31st of July, 2023 on one hundred and twenty type 2 diabetic patients. Many biochemical and hematological parameters were evaluated and compared with Red Cell Distribution Width in this study. Results: The mean Red Cell Distribution Width of diabetic patients was (16.64%); 61.7% of them had a high Red Cell Distribution Width. A weak positive correlation was observed between Red Cell Distribution Width -CV and each female gender, Body Mass Index, White Blood Cell count, and triglyceride (p?0.05). A potent positive and significant correlation was noticed between Red Cell Distribution Width -CV and fasting blood sugar (r=0.76, p&lt;0.001) as well as HbA1c level (r=0.92, p&lt;0.001). A moderate positive significant correlation was observed between Red Cell Distribution Width -CV and cholesterol, low-density lipoprotein cholesterol as well as serum creatinine levels (p?0.05). A weak negative correlation between Red Cell Distribution Width -CV and HDL (p&lt;0.001). Conclusion: The red blood cell distribution width might be a helpful marker in monitoring and assessing the severity of type 2 diabetes mellitus and could also help in predicting cardiovascular and renal complications.

FDG PET/CT imaging and circulating biomarkers of inflammation in desmoplakin cardiomyopathy.

Inflammation has been implicated in the pathogenesis of desmoplakin (DSP) cardiomyopathy, and retrospective studies have described abnormal myocardial fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) findings in symptomatic patients eventually diagnosed with DSP cardiomyopathy. We aimed to prospectively investigate if ambulatory patients with DSP cardiomyopathy had myocardial FDG uptake PET/CT imaging indicative of myocardial inflammation and if they had circulating biomarker evidence of inflammation. We prospectively recruited participants with DSP cardiomyopathy and participants with titin cardiomyopathy as a comparator group. Blood samples for clinical labs and proteomic profiling, myocardial perfusion single-photon emission computed tomography (SPECT) and myocardial FDG PET/CT were obtained for all participants. Ten participants with DSP cardiomyopathy (median age 36.5years (28, 60); 80% female; 100% White and non-Hispanic) and four participants with titin cardiomyopathy (median age 55.5years [38.5, 64]; 50% female; 100% White and non-Hispanic) were recruited. There were no significant differences between the groups in white blood cell count, ESR, hsCRP or hsTn. Three participants with DSP cardiomyopathy and two participants with titin cardiomyopathy had non-specific myocardial FDG uptake on PET/CT. All other participants had no myocardial FDG uptake. Integration of miRNA differential expression and their predicted targets from the differential expression proteomics data identified a total of 11 inverse miRNA-mRNA pairs potentially involved in the regulation of top 20 significantly enriched pathways, including pathways involved in metabolism, inflammasome/inflammatory signalling and cell death/pyroptosis. In a group of ambulatory patients with DSP and titin cardiomyopathy, we found no differences in FDG PET/CT findings or clinical circulating biomarkers of inflammation. However, miRNA-seq/proteomics analyses identified several enriched pathways and unique miRNA-protein pairs between DSP and titin cardiomyopathy, including pathways involved in inflammasome/inflammatory signalling. Future work will centre on evaluation during myocarditis-like episodes.

Emergency treatment of obstructive pyelonephritis: A single center series

Objective: This study aims to compare two different drainage methods, percutaneous nephrostomy (PCN) and retrograde ureteral double-J (DJ) stent insertion, in patients with obstructive pyelonephritis (OP).Methods: The study included 77 patients who presented to the emergency department due to stones. Type of decompression treatment (PCN or DJ stent), fever, white blood cell count (WBC), C-reactive protein (CRP) levels, urine culture, blood culture, presence of additional diseases, and antibiotic treatment were evaluated for these patients. Emergency decompressive treatment was not randomly assigned. The clinician chose the appropriate treatment method based on the patient’s condition after obtaining an informed consent. Patients under the age of 18 were categorized into three subgroups: infants, children under 10 years, and adolescents. Results: Of the 77 patients, 31 were in the DJ stent group and 46 were in the PCN group. Patients in the PCN group exhibited significantly higher fever levels before the procedure (37.6 ± 1.0°C). Additionally, the positivity rate of urine and blood cultures was higher in the PCN group. The average time to stone treatment after infection and medical treatment, as well as fever control, was shorter in the PCN group (9 ± 2.3 days). Empiric treatment with Ceftriaxone (1 g IV) was confirmed by sensitivity results of urine or blood culture in 45% of cases. None of the patients developed advanced urosepsis after the procedure, but the resolution of infection parameters was faster in the PCN group (7 ± 3.3 days). Conclusions: Both PCN and DJ stent insertion are effective and safe methods for managing obstructive pyelonephritis. It was observed that the PCN method under local anesthesia was useful in quickly controlling fever and allowing early surgical treatment. Finally, third-generation cephalosporin antibiotics are beneficial for empiric initial treatment.

Comparative analysis of the safety and feasibility of laparoscopic and open approaches for right anterior sectionectomy

Laparoscopic hepatectomy has minimally invasive advantages, but reports on laparoscopic right anterior sectionectomy (LRAS) are rare. Herein, we try to explore the benefits and drawbacks of LRAS by comparing it with open right anterior sectionectomy (ORAS). Between January 2015 and September 2023, 39 patients who underwent LRAS (n = 18) or ORAS (n = 21) were enrolled in the study. The patients’ characteristics, intraoperative details, and postoperative outcomes were compared between the two groups. No significant differences in the preoperative data were observed between the two groups. The LRAS group had significantly lesser blood loss (P = 0.019), a shorter hospital stay (P = 0.045), and a higher rate of bile leak (P = 0.039) than the ORAS group. There was no significant difference in the operative time (P = 0.156), transfusion rate (P = 0.385), hospital expenses (P = 0.511), rate of other complications, postoperative white blood cell count, and alanine aminotransferase and aspartate aminotransferase levels between the two groups (P > 0.05). Beside, there was no significant difference in disease-free survival (P = 0.351) or overall survival (P = 0.613) in patients with hepatocellular carcinoma between the two groups. LRAS is a safe and feasible surgical procedure. It may be preferred for lesions in the right anterior lobe of the liver.

Leukocytosis as a Risk Factor for Coronary Artery Disease: Pathophysiology and Epidemiology.

Coronary artery disease (CAD) is a significant health concern characterized by reduced blood flow to the heart muscle, primarily due to the buildup of atherosclerotic plaques in the coronary arteries. This process begins with endothelial injury, leading to a cascade of biological responses contributing to plaque formation. Endothelial injury attracts the migration of monocytes which differentiate into macrophages upon uptake of oxidized low-density lipoproteins, changing into lipid-laden macrophage or "foam cells." The process of plaque formation is influenced by many factors which have been studied extensively in literature such as smoking, hypertension, and diabetes mellitus. Chronic inflammatory illnesses are often associated with a high prevalence of coronary artery syndromes, prompting the evaluation of markers of inflammation such as white blood cell count and inflammatory markers as independent risk factors for CAD. White blood cells play a remarkable role in the pathophysiology of disease formation and progression. The article below aims to discuss the pathophysiology and epidemiology of leukocytosis as a risk factor for CAD.

Clinical characteristics and in-hospital event rate of chronic obstructive pulmonary disease patients with concurrent acute myocardial infarction

This study was to investigate the clinical features of chronic obstructive pulmonary disease (COPD) patients with concurrent acute myocardial infarction (AMI) and analyze the occurrence of in-hospital adverse events. Patients with AMI who were admitted to Beijing Chaoyang Hospital from January 2019 to August 2023 were retrospectively collected. All patients were divided into COPD with concurrent AMI group and simple AMI group according to whether they were with concurrent COPD. All patients received interventional treatment for AMI. The clinical features and the occurrence of in-hospital adverse events were compared between the two groups. A total of 183 AMI patients aged (65.6±13.6) years were enrolled, including 142 males (77.6%). There were 94 patients (51.4%) in simple AMI group and 89 patients (48.6%) in COPD with concurrent AMI group, respectively. Patients in COPD with concurrent AMI group were older, had higher Killip grade, rate of smoking and previous percutaneous coronary intervention history, creatinine and B-type natriuretic peptide levels, and lower albumin, hemoglobin, low-density lipoprotein cholesterol, white blood cell count and cardiac troponin I than those of simple AMI group (all P<0.05). There were no significant differences in echocardiographic parameters between the two groups (all P>0.05). The proportion of β-blockers, angiotensin-converting enzyme inhibitors/angiotensin-blockers used in COPD with concurrent AMI group was lower (P<0.05). Patients in COPD with concurrent AMI group had longer length of hospital stay than those in simple AMI group (P=0.028). The incidence of primary endpoint events in COPD with concurrent AMI group was higher than that in simple AMI group (27.0% vs 18.0%, P=0.002). The current study indicates that COPD patients with concurrent AMI have longer length of hospital stay and higher incidence of in-hospital events, which are worthy of significant attention in clinical practice.

Is There a Mild Form of Pediatric Appendicitis? An Eight-Year Single-Center Retrospective Review

Introduction: The literature has suggested two variants of appendicitis: a simple variant that may even resolve spontaneously and a more aggressive variant that may proceed to complication. We review two cohorts compatible with “mild” appendicitis: children with acute appendicitis that presented with normal inflammatory markers (NIMs), and confirmed on pathological examination, and children with sonographically confirmed appendicitis that resolved without medical or surgical intervention. Methods: We identified all children diagnosed with appendicitis from June 2016 to June 2024. To confirm the accuracy of the initial sonographic diagnosis of appendicitis in children with spontaneous resolution, two study radiologists, blinded to clinical data, reviewed the images for signs of appendiceal inflammation. We compared cases of NIM with cases presenting with elevated inflammatory markers, and cases of spontaneous resolution with cases of uncomplicated appendicitis treated medically. Results: A total of 999 children were diagnosed with appendicitis, with 845 confirmed on pathology. Of these 845, 17 had NIMs and were less likely to present with vomiting than children with elevated inflammatory markers (24% versus 61%, p = 0.002). Fourteen had spontaneous resolution and twenty-five were treated medically. White blood cell count (14.1 versus 10.2, p = 0.005) and appendiceal diameter (8.6 mm versus 7.6 mm, p = 0.078) were higher for children with conservative treatment. Children receiving medical treatment received intravenous analgesia more frequently (88% versus 50%, p = 0.009). More resources were used for medical treatment—these children had longer hospitalizations (3.5 versus 1.6 days, p = 0.001) and more frequently received repeat bloodwork (68% versus 36%, p = 0.051). Conclusions: Appendicitis that resolves spontaneously, and appendicitis that presents with normal inflammatory markers, may represent rare, low-risk forms of appendicitis that may not be associated with progression to complication. While pediatric appendicitis should not be ruled out in the presence of a normal laboratory evaluation, cases that present without gastrointestinal symptoms, without severe pain, and with an appendiceal diameter and inflammatory markers below a certain threshold may warrant continued observation and serial ultrasound to evaluate for progression prior to initiating therapy.

Clinical Diagnosis of Acute Noma: Essential Infection Markers and Clinical Presentations.

In clinical settings, understanding the markers and clinical signs of infection is critical for timely diagnosis and treatment. However, a point-of-care diagnostic test is lacking for noma, a debilitating orofacial infectious disease. This retrospective study reviewed electronic medical records (EMRs) and paper medical records (PMRs) of noma patients from Facing Africa (235 EMRs), Yekatit 12 Hospital (68 PMRs), and Project Harar (33 PMRs) in Ethiopia to identify essential infection markers and clinical presentations of acute noma. The review identified seven acute noma patients aged 4-9 years. The patients presented with facial edema, pain, anorexia, ecchymosis, excessive salivation, and drooling, as well as specific symptoms such as visual disturbances, high fever, foul odor, halitosis, and local tenderness. Laboratory findings included elevated white blood cell counts (13,500-14,500 cells/mcL), C-reactive protein levels (107-148 mg/L), and erythrocyte sedimentation rates (65-90 mm/hour). At >85 ng/mL, procalcitonin levels were particularly high. Accurate diagnosis of noma requires a comprehensive approach that includes thorough clinical examination, appropriate disease stage classification, medical history review, and laboratory testing. The study highlights the critical infection markers and clinical presentations associated with acute noma that may aid in early diagnosis of the disease. Further research with a much larger number of participants is needed. However, given the difficulty in identifying acute noma cases due to the rapid progression and very high mortality of the disease and the challenge of accessing acute noma cases owing to various socioeconomic barriers, the results of this small study are still relevant.