Sedimentation Rate Research Articles

High Neutrophil Alkaline Phosphatase Activity in Adult-Onset Still's Disease.

Adult-onset Still's disease (AOSD) is an autoinflammatory disorder characterized by reactive neutrophilia and dysregulated cytokine release. Mature neutrophils exhibit increased alkaline phosphatase enzyme activity within cytoplasmic granules, particularly in response to inflammation or acute infection. However, whether neutrophil alkaline phosphatase (NAP) activity is elevated in active AOSD, a hyperinflammatory state, remains unclear. We enrolled 114 patients diagnosed with AOSD, 47 patients with diffuse large B-cell lymphoma(DLBCL), 25 patients with antiphospholipid syndrome (APS), 25 patients with systemic lupus erythematosus (SLE), and 30 healthy controls. Blood samples were collected and smears were prepared, stained, and analyzed to calculate the NAP score. Our findings demonstrated that NAP scores were significantly elevated in patients with active AOSD compared to those with inactive disease, other rheumatic diseases, and healthy controls (HCs). Further analysis revealed strong positive correlations between the NAP score and white blood cell (WBC) count, neutrophil ratio (NE%), absolute neutrophil count (ANC), ferritin, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), alkaline phosphatase (ALP), and systemic disease activity score. Additionally, among patients with AOSD-pre-macrophage activation syndrome (MAS), NAP scores were significantly higher than in those with active AOSD without MAS. Receiver operating characteristic (ROC) curves showed that NAP scores were more effective than other clinical features in distinguishing active AOSD without MAS from patients with AOSD-pre-MAS. Unexpectedly, in patients with AOSD-MAS, NAP scores were significantly reduced compared to those with active AOSD without MAS, likely due to leukopenia. Our findings revealed that NAP scores were elevated in active AOSD and positively correlated with disease activity.

Inflammatory cytokines, soluble interleukin-6 receptors, and fragmented cytokeratin-18 as indicators of non-alcoholic steatohepatitis

Aim. To evaluate inflammatory cytokines, such as tumor necrosis factor α (TNF-α), interleukin (IL)-1β, 8, 6, soluble IL-6 receptors (sIL-6R) and fragmented cytokeratin-18 (FCK-18) as indicators of non-alcoholic steatohepatitis (NASH). Materials and methods. 173 NASH patients aged 47.0±10.8 years were examined: 118 (68.2%) – men, 55 (31.8%) – women. The following markers were determined: TNF-α (Human TNFα Platinum ELISA, eBioscience, Austria), IL-1β, 8, 6 (Vector-Best, Russia), sIL-6R (Human sIL-6R ELISA, eBioscience, Austria), FCK-18 (TPS ELISA, Biotech, Sweden), insulin (Insulin TEST System, USA), HOMA-IR (Homeostasis Model Assessment of Insulin Resistance) and NAFLD fibrosis score (NFS) were calculated. Results. The highest level in NASH patients compared with healthy individuals was observed for IL-6 – 8.4±1.6 pg/ml versus 2.8±0.9 pg/ml (p=0.001), FCK-18 – 295.3±56.3 U/l versus 110.5±30.2 U/l (p=0.0001), then IL-8 – 17.3±6.7 pg/ml vs 7.6±1.9 pg/ml (p=0.003), TNF-α – 6.3±0.4 pg/ml versus 4.1±0.8 pg/ml (p=0.0001), sIL-6R – 151.5±21.2 ng/ml vs 95.9±12.5 ng/ml (p0.05); IL-1β did not change – 5.3±1.4 pg/ml versus 4.7±1.5 pg/ml (p=0.3) respectively. FCK-18 showed the highest correlations with TNF-α (r=0.73), HOMA-IR (r=0.73), alanine aminotransferase (r=0.71), erythrocyte sedimentation rate (r=0.23), IL-6 (r=0.22); p0.05. TNF-α correlated with FCK-18 (r=0.73), cholesterol (r=0.61), albumin (r=-0.42), fibrinogen (r=0.21), leukocyte count (r=0.21); p0.05. IL-8 correlated with triglycerides (r=0.79) and HDL (r=-0.77), IL-6 – with NFS (r=0.63) and FCK-18 (r=0.22), rIL-6R – with aspartate aminotransferase (r=0.62); p0.05. Conclusion. TNF-α, IL-8, 6, sIL-6R and FCK-18 should be used as non-invasive biomarkers of NASH.

Comparison of clinical features between patients with and without renal involvement in IgG4-related disease

ObjectiveThe kidney is one of the organs most frequently affected in immunoglobulin G4-related disease (IgG4-RD). Early identification of IgG4-RD with renal injury by clinical features is a current challenge. There is a paucity of data regarding the clinical features of renal involvement in IgG4-RD.MaterialsPatients with the diagnosis of IgG4-RD with and without renal injury were included in the retrospective cohort study. Cox regression analyses were used to investigate the risk factors for disease relapse and to construct the nomogram model.ResultsFrom December 2014 to February 2022, 54 patients with IgG4-RD were retrospectively enrolled. Renal involvement in IgG4-RD was observed in 55.6% of the patients. The differences of age and lacrimal gland accumulation were statistically significant (P < 0.001, and P = 0.034, respectively). Age was significantly higher in the kidney injury group. Regarding laboratory findings, basophil counts, hemoglobin levels, and serum cholinesterase level were significantly lower in patients with renal involvement (P = 0.033, P = 0.006 and P = 0.019). Erythrocyte sedimentation rate level was significantly higher in patients with renal involvement (P = 0.017). Seven (23.4%) patients in the kidney injury group relapsed during follow-up with mean recurrence time 9.86 ± 7.08 months. Early diagnosis plays a key role in patient outcomes. Female, elevated erythrocyte sedimentation rate level, and elevated complement component 4 are the risk factors for the disease relapse of IgG4-RD patients. Moreover, an effective nomogram model has been developed to predict disease relapse in patients with IgG4-RD.

Daily Versus Alternate-Day Prednisolone Regimen and its Correlation With DAS-28 Score in Patients with Rheumatoid Arthritis

Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease requiring corticosteroids for symptom control, but long-term use is associated with adverse effects. The efficacy of alternate-day corticosteroid regimens compared to daily dosing remains unclear, particularly in disease activity reduction and side effect mitigation. Objective: To compare the efficacy of daily versus alternate-day prednisolone regimens in reducing disease activity in RA patients, measured by Disease Activity Score-28 (DAS-28), and to assess metabolic adverse effects. Methods: This randomized controlled trial included 108 RA patients (n = 54 per group) meeting the 2010 ACR/EULAR criteria. Participants were randomized to receive either 7.5 mg daily or 15 mg alternate-day prednisolone for six weeks. The primary outcome was DAS-28 reduction, with secondary outcomes including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and adverse events. Ethical approval was obtained (IRB/2023-RA-019), and statistical analysis was performed using SPSS v27, employing independent t-tests and Chi-square tests with Bonferroni correction. Results: DAS-28 scores decreased significantly in both groups (daily: 4.5 ± 1.2 to 3.2 ± 1.0; alternate-day: 4.3 ± 1.1 to 3.0 ± 0.9, p = 0.73). No significant differences were observed in ESR (p = 0.61), CRP (p = 0.52), or adverse events (p &gt; 0.05). Conclusion: Both dosing regimens effectively reduce disease activity, with alternate-day dosing showing comparable efficacy and potentially fewer metabolic side effects. Future studies should evaluate long-term outcomes and individualized corticosteroid strategies.

The status and correlation factors of fatigue in patients with ankylosing spondylitis (FACIT-F): a cross-sectional study based on the Chinese population

ObjectiveTo analyze the status and correlation factors of fatigue in patients with ankylosing spondylitis (AS), and provide a reference for improving the fatigue status of patients with AS.MethodUsing the AS-specific disease database of the Chinese Rheumatology Registration and Research Information Platform, patients with AS from 9 centers in China were selected as study subjects from March 2022 to September 2023. Functional Assessment of Chronic Illness Therapy Scale (FACIT-F) score, AS disease activity score-C-reactive protein (ASDAS-CRP), AS disease activity score-erythrocyte sedimentation rate (ASDAS-ESR), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Function Index (BASFI), Bath Ankylosing Spondylitis Measurement Index (BASMI), Patient Global Assessment (PGA) score, night pain score, Depression Anxiety Stress Scale (DASS-21) and AS International Community Health Index Assessment (ASAS-HI) were observed. Human leukocyte antigen B27 (HLA-B27), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) of the patients were detected. The data were analyzed by Spearman correlation and multiple linear regression.ResultA total of 338 patients with AS were included in this study. Spearman correlation analysis results of 338 AS patients with fatigue showed that age, disease course, ASDAS-CRP, ASDAS-ESR, BASDAI, PGA, BASFI, BASMI, ASAS-HI and so on were the main correlation factors of fatigue (P < 0.05); Multiple linear regression analysis showed that BASDAI, ASAS-HI, depression and so on were independent predictors of fatigue in AS patients (P < 0.05). Spearman correlation analysis of no or very mild fatigue group showed that age, ASDAS-CRP, ASDAS-ESR, BASDAI, BASFI, ASAS-HI and so on were the main correlation factors of fatigue (P < 0.05); Multiple linear regression analysis showed that age, BASDAI, ASAS-HI were the independent predictor of fatigue in AS patients (P < 0.05). Spearman correlation analysis in the mild and moderate fatigue group showed that ASDAS-CRP, BASDAI, PGA, BASFI, ASAS-HI and so on were the main factors influencing fatigue (P < 0.05); Multiple linear regression analysis showed that BASDAI, depression and stress were independent predictors of fatigue in AS patients (P < 0.05).ConclusionIn this study, fatigue was obvious in 37.9% of AS patients, and patients’ fatigue levels were closely related to disease activity (ASDAS, BASDAI and PGA) and psychological factors (anxiety, depression and stress). At the same time, the higher the degree of fatigue, the more obvious the impact of disease activity and psychological factors on fatigue.

Global Profiling of Lactylation Proteomics and Specific Lactylated Site Validation in Rheumatoid Arthritis Patients.

Protein lactylation is a novel post-translational modification that has rarely been investigated in rheumatoid arthritis (RA). This study aimed to explore lactylation proteomics in RA patients and validate sorted candidate lactylation sites. Synovial tissues from ten RA and six osteoarthritis (OA) patients were subjected to lactylation proteomics via affinity enrichment and LC-MS/MS. Four candidate lactylated modification sites were validated by immunoprecipitation. Totally, 566 sites and 250 proteins with lactylated modifications in RA patients and 548 sites and 220 proteins with lactylated modifications in OA patients were identified. By comparison, 24 upregulated but 2 downregulated lactylated modification sites and 18 upregulated but 1 downregulated lactylated modification protein were discovered in RA patients versus OA patients. The dysregulated lactylated proteins were mainly enriched in biological processes such as positive regulation of plasma membrane repair by GO analysis; pathways such as neutrophil extracellular trap formation by KEGG analysis; and two metabolism-related items by COG/KOG analysis. Immunoprecipitation confirmed that FTH1-K69la (P = 0007) and PKM2-K166la (P = 0.003), but not ANXA2-K115la (P = 0.127) or ANXA5-K76la (P = 0.361), were more abundant in RA patients versus OA patients. Moreover, FTH1-K69la was positively correlated with erythrocyte sedimentation rate (ESR) in RA patients (P = 0.037). Conclusively, this study describes a general landscape of lactylation proteomics in the RA.

Nomogram to predict periprosthetic joint infection after total hip arthroplasty using laboratory tests

BackgroundPeriprosthetic joint infection (PJI) is a catastrophic complication after joint arthroplasty. This study aimed to analyze the relationship between laboratory tests and PJI and establish a nomogram for predicting risks of PJI after total hip arthroplasty (THA).Materials and methodsThe clinical data of patients who underwent THA from January 2015 to December 2020 were retrospectively analyzed. Demographic and relevant clinical information of patients was collected; independent risk factors associated with PJI were determined by univariate and multivariate logistic regression analysis, and receiver operating characteristics (ROC) were drawn to analyze the specificity and sensitivity of each risk factor. Risk factors are included in the nomogram. Calibration curve and decision curve analysis were used to evaluate the predictive accuracy and discriminability of the model.ResultsA total of 589 patients were enrolled in the study, of whom 87 were eventually diagnosed with PJI. Multivariate logistic regression analysis showed that serum C-reactive protein, erythrocyte sedimentation rate, polymorphonuclear neutrophils, D-dimer, and platelet count were independent risk factors for PJI after THA. The ROC curve analysis model of multivariate combined diagnosis had good diagnostic value, sensitivity was 77.01%, and specificity was 75.51%. The calibration curve shows good agreement between the prediction of the line graph and the actual observed results. The decision curve shows that the nomogram has a net clinical benefit.ConclusionsThe changes in serum C-reactive protein, erythrocyte sedimentation rate, polymorphonuclear neutrophils, D-dimer, and platelet count are related to the occurrence of PJI after hip arthroplasty. The nomogram prediction model established in this study is promising for the screening of PJI after hip arthroplasty.Level of evidence: Level III evidence. Non-randomized controlled cohort/follow-up study.

Triggering role of environmental and individual factors in rheumatoid arthritis and preclinical joint symptoms

BACKGROUND: Rheumatoid arthritis (RA) is a phenotypically heterogeneous disease. AIM: The study aimed to identify the role of triggers in the onset of RA and preclinical joint symptoms, as well as their association with clinical and laboratory parameters. METHODS: Data on potential disease triggers and preclinical joint symptoms were collected from patients with early RA (n = 461) and their relatives (n = 247). Moreover, 299 healthy participants (control group) were examined for past infections within the previous 6–12 months. Anxiety levels, number of childbirths, age at onset of menopause, and body mass index (BMI) were assessed. Additionally, the association of triggers with composite disease activity indices, morning stiffness duration, severity of functional joint impairment, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) levels, anti-citrullinated peptide antibodies (ACPA), and rheumatoid factor (RF) was assessed. Data were analyzed using the Mann–Whitney test, multiple regression analysis, and Spearman correlation. RESULTS: The most common triggers for RA and preclinical joint symptoms were menopause (17.6%, 11.7%), infections (13.4%, 15.8%), and psychological stress (15.2%, 18.2%). Preclinical joint symptoms were additionally provoked by physical exertion (19.8%). RA triggered by infections or menopause was associated with an increased frequency and duration of infections (p 0.001) and higher BMI (p = 0.019 and p = 0.024, respectively) compared with controls. A similar association was observed between preclinical joint symptoms triggered by infections and increased frequency and duration of infections (p 0.001). Additionally, joint symptoms triggered by physical exertion were associated with more frequent and prolonged infections compared with the control group (p = 0.015 and p = 0.016, respectively). ESR levels exhibited a heightened response when preclinical joint symptoms were associated with infections (p = 0.010), menopause (p = 0.033), or physical exertion (p = 0.020) in comparison with their response to psychological stress. The arthralgia score was highest when provoked by menopause compared with cases provoked by infection (p = 0.053) or childbirth (p = 0.012). Preclinical joint symptoms triggered by psychological stress were associated with a higher arthralgia score than those provoked by physical exertion (p = 0.002). In the preclinical group, ESR and CRP levels correlated with BMI (p = 0.005 and p = 0.028, respectively). In patients with RA, ACPA (p = 0.044) and RF (p = 0.009) concentrations were associated with personal anxiety levels. CONCLUSION: The influence of triggers on clinical and laboratory parameters is evident in preclinical RA. The highest arthralgia scores were observed in cases triggered by menopause or psychological stress. Joint symptoms associated with infections, menopause, or physical exertion were associated with higher ESR levels.

Accelerated Type VII collagen turnover in systemic sclerosis patients, reflected by serological neo-epitope fragment biomarkers

BackgroundSystemic sclerosis (SSc) is a rare autoimmune disease characterized by microvasculopathy, autoantibody production, and fibrosis of the skin and internal organs. Disrupted collagen turnover in SSc leads to excessive collagen accumulation, but the remodeling of type VII collagen, a key component of the skin’s basement membrane, is not well understood. This study investigates type VII collagen turnover in SSc by measuring serum levels of its formation (PRO-C7) and degradation (C7M) biomarkers and characterizing their association with other ECM biomarkers and clinical manifestations.MethodsAn automated immunoassay, PRO-C7, was developed to quantify type VII collagen formation. Additionally, C7M, along with type III, IV, and VI collagen turnover biomarkers, were analyzed in a post-hoc study of SSc patients. The normality of all variables of interest was assessed using the Shapiro-Wilk test. Spearman’s correlation and Welch’s T-testtests were used to assess associations and differences in biomarker levels between SSc patients and healthy controls. A linear regression model was used to assess the relationship between biomarker levels and the modified Rodnan skin score (mRSS).To control the type I errors in multiple comparisons, the Bonferroni Correction was applied to adjust the significance levels.ResultsResults showed significantly elevated levels of type VII and VI collagen turnover biomarkers in SSc patients and controls. PRO-C3 and PRO-C6 levels were significantly correlated with mRSS score (R2 = 0.156, p = 0.0004; R2 = 0.222, p < 0.0001 respectively), while PRO-C7 and C7M were not. Moderate but significant correlations were observed between both PRO-C7 and C7M with C-reactive protein and Erythrocytes sedimentation rate, respectively (ρ = 0.39, p = 0.0006; ρ = 0.24 p = 0.045 for PRO-C7; ρ = 0.31, p = 0.0076; ρ = 0.28, p = 0.014 for C7M). C7M showed a significant correlation with type III, type IV, type VI collagen formation and degradation biomarkers, while PRO-C7 correlated significantly only with PRO-C6 and C6M. Furthermore, C7M levels were higher in SSc patients with renal dysfunction, and elevated PRO-C7 levels were associated with anti-dsDNA, while lower PRO-C7 levels were linked to capillary abnormalities in SSc.ConclusionsIn conclusion, PRO-C7 and C7M, reflecting type VII collagen turnover, show promise as new serological biomarkers for SSc.

Synovial D-dimer is a novel and accurate test for diagnosis of chronic knee periprosthetic joint infection.

Synovial D-dimer is a novel and accurate test for diagnosis of chronic knee periprosthetic joint infection.

Clinico-epidemiological and immunological characteristics of rickettsioses in a Sri Lankan patient cohort 2018–2023

BackgroundRickettsioses, caused by intracellular bacteria of the genera Rickettsia and Orientia, are transmitted to humans through arthropod vectors such as ticks, fleas, and mites. Over the past two decades, this disease has been recognized as a significant cause of acute febrile illness in Sri Lanka. However, only a limited number of studies have focused on clinico-epidemiological characteristics of patients and immunological diagnostic approaches for disease confirmation.MethodA cross-sectional study was conducted at the Rickettsial Disease Diagnostic and Research Laboratory (RDDRL), University of Kelaniya, Sri Lanka, from 2018 to 2023 from the clinically suspected patients referred for disease confirmation. Clinical, demographic, epidemiological, biochemical, and laboratory data were collected via a questionnaire by reviewing the archived records. The serological finding of the immunofluorescence assay (IFA) conducted for patients samples were retrieved. The patients who were positive for IFA-IgG (> 1:128 as per presumptive confirmation of acute rickettsial illness) were taken as the test group and the negative group was taken as the control group. Data were analyzed using chi-square tests followed by a Correlation analysis between the variables using Pearson correlation.ResultsOut of 1,221 cases, 249 (20.4%) were serologically “confirmed” as positive for rickettsial infection. The test group consisted predominantly of males, similar to the control group. Most cases were males and < 9 years of age followed by 10–19 years. Among the age groups, 10–19 years and 50–59 years, categories indicated a significant positive relationship according to the chi-squared statistics (P < 0.05). A seasonal trend was observed, with higher case numbers reported from January to February. Laboratory findings indicated significant differences between test and control groups in leucopenia (P = 0.005, χ²=7.87), increased neutrophil count (P = 0.0004, χ²=12.71), elevated alanine aminotransferase (P = 0.0001, χ²=14.64), elevated aspartate aminotransferase (P = 0.0001, χ²=18.24), urine occult blood (P = 0.024, χ²=5.09), and raised erythrocyte sedimentation rate (P = 0.034, χ²=4.51). Clinical manifestations showed no major deviations. Notably, eschar was more prevalent in O. tsutsugamushi cases (33.3%) compared to SFG rickettsioses (13.3%).ConclusionThis study highlights the need for improved awareness, diagnostic facilities, and vector control measures to manage rickettsial infections effectively in Sri Lanka. Understanding epidemiological patterns and clinical manifestations is crucial for developing effective surveillance and prevention strategies.Clinical trialNot applicable.

Settling velocities of microplastics with different shapes in sediment-water mixtures.

Settling velocities of microplastics with different shapes in sediment-water mixtures.

Targeted Detection of 76 Carnitine Indicators Combined with a Machine Learning Algorithm Based on HPLC-MS/MS in the Diagnosis of Rheumatoid Arthritis.

Early diagnosis and treatment of rheumatoid arthritis (RA) are essential to reducing disability. However, the diagnostic criteria remain unclear, relying on clinical symptoms and blood markers. Using high-performance liquid chromatography-mass spectrometry (HPLC-MS/MS) targeted detection, we evaluated 76 carnitine indicators (55 carnitines and 21 corresponding ratios) in the serum of patients with RA to investigate the role of carnitine in RA. A total of 359 patients (207 patients with RA and 152 healthy controls) were included in the study. Screening involved three methods and integrated 76 carnitine indicators and 128 clinical indicators to identify candidate markers to establish a theoretical basis for RA diagnosis and new therapeutic targets. The diagnostic model derived from the screened markers was validated using three machine learning algorithms. The model was refined using eight candidate indicators (C0, C10:1, LYMPH, platelet distribution width, anti-keratin antibody, glucose, urobilinogen, and erythrocyte sedimentation rate (ESR)). The receiver operating characteristic curve, sensitivity, specificity, and accuracy of the V8 model obtained from the training set were >0.948, 79.46%, 92.99%, and 89.18%, whereas those of the test set were >0.925, 78.89%, 89.22%, and 85.87%, respectively. Twenty-four carnitines were identified as risk factors of RA, with three significantly correlating with ESR, four with anti-cyclic citrullinated peptide antibody activity, two with C-reactive protein, five with immunoglobulin-G, eight with immunoglobulin-A levels, and eleven with immunoglobulin-M levels. Carnitine is integral in the progression of RA. The diagnostic model developed shows excellent diagnostic capacity, improving early detection and enabling timely intervention to minimize disability associated with RA.

Application of metagenomic next-generation sequencing in the diagnosis of pathogens in patients with diabetes complicated by community-acquired pneumonia.

To explore the clinical utility and optimal timing of metagenomic next-generation sequencing (mNGS) in diagnosing pathogens in patients with diabetes complicated by community-acquired pneumonia (CAP). The study included 50 hospitalized patients diagnosed with diabetes complicated by CAP who underwent conventional microbiological testing (CMT) and mNGS using bronchoalveolar lavage fluid. Among the 50 cases, 16% presented no respiratory symptoms. There were significant increases in inflammatory markers such as C-reactive protein, erythrocyte sedimentation rate, and interleukin-6, with patchy imaging changes being the most prevalent. The positive rates for pathogen detection by mNGS and CMTs were 78 and 21% (P < 0.05). The mNGS was significantly better than the CMTs in the detection of rare pathogens such as Anaerobes, Chlamydia psittaci, Legionella pneumophila, Mycobacterium bovis, Aspergillus fumigatus, and Pneumocystis japonicus (P < 0.05). After clinical interpretation, 85% (22/26) of viruses, 24% (9/37) of bacteria, and 25% (2/8) of fungi were non-pathogen organisms by mNGS. There was a significant difference in the rates of adjustment in anti-infection treatment strategies based on the pathogen detection results from CMTs and mNGS, which were 2 and 46%, respectively (P < 0.05). We found that mNGS was superior to CMTs in terms of the positive rate of pathogen detection, detecting mixed infection incidence, rare pathogen detection rates, and the adjustment of treatment strategies. However, mNGS results need to be interpreted in the context of the clinic.

Serum selenium levels and subacute thyroiditis: associations with disease course and long-term outcomes in a case-control study

BackgroundSubacute thyroiditis (SAT) is an inflammatory disease that induces thyrotoxicosis. Selenium is an essential trace element in thyroid physiology, which has anti-inflammatory and antioxidant properties. However, the relationship between serum selenium levels and SAT has not been well studied. The objective of this study was to evaluate serum selenium levels in patients with SAT compared to healthy controls and to investigate potential correlations between selenium status and clinical outcomes, including disease severity, delayed remission, recurrence, and the development of permanent hypothyroidism.MethodsThis case-control study included 59 patients with SAT and 50 healthy control subjects. Serum selenium levels were analysed using inductively coupled plasma mass spectrometry.ResultsThe serum selenium levels of patients with SAT were 69.10 (24.60–130.20) µg/L, while those of the control group were 64.20 (39.21–106.80) µg/L (p = 0.121). A negative correlation was detected between serum selenium levels and erythrocyte sedimentation rate, C-reactive protein, neutrophil-to-lymphocyte ratio, free thyroxine, and pain severity. Serum selenium levels did not significantly differ in terms of the response to initial treatment, recurrence, and permanent hypothyroidism.ConclusionThe study results showed no significant difference in serum selenium levels between patients with SAT and the control group. These results suggest that although lower serum selenium levels may be associated with a more severe and painful SAT course, there is no impact on the long-term prognosis.

The biopsy site is critical for bacterial culture after percutaneous biopsy in patients with pyogenic spondylodiscitis.

Previous studies have found that the positive rate of bacterial culture after percutaneous needle biopsy in patients with suspected pyogenic spondylodiscitis is influenced by a number of factors. At the same time, the choice of puncture site in percutaneous biopsy has been controversial. To explore the factors influencing the positive rate of bacterial culture after percutaneous biopsy in patients with pyogenic spondylodiscitis. The medical records of 186 patients with suspected spinal infection who underwent C-type arm-guided percutaneous biopsy in Beijing Chest Hospital Affiliated to Capital Medical University from January 2023 to December 2023 were retrospectively analyzed. According to inclusion and exclusion criteria, a total of 116 patients with suspected pyogenic spondylodiscitis were included. The positive rate of bacterial culture was calculated, and the effects of age, gender, course of disease, preoperative fever, preoperative antibiotic use, preoperative white blood cell count, C-reactive protein (CRP), erythrocyte sedimentation rate and puncture site on the positive rate of culture were discussed. Logistic regression analysis was used to identify the relevant factors affecting the positive rate of culture. Among the 116 patients, 63 were males and 53 were females. Age ranged from 13 to 87 years, with a median age of 59.5 years. The results of bacterial culture in 42 patients were positive, with a positive rate of 36.2% (42/116), including Staphylococcus aureus in 12 cases, streptococcus in 5 cases, Brucella in 5 cases, Escherichia coli in 4 cases, Staphylococcus epidermidis in 3 cases, Pseudomonas aeruginosa in 2 cases, Enterococcus faecalis in 2 cases, anaerobic bacteria in 2 cases and other bacteria in 7 cases. The positive rate of bacterial culture was 22.6% (14/62) in patients with vertebral body puncture and 51.9% (28/54) in patients with intervertebral disc puncture, and there was a significant difference between the two groups (P=0.001). Logistic regression analysis showed that the course of disease, the increase of C-reactive protein before puncture and the site of puncture were the factors influencing the positive rate of culture. The course of disease, the elevation of CRP before puncture and the site of puncture were the factors influencing the positive rate of bacterial culture in percutaneous biopsy of pyogenic spondylodiscitis patients. The positive rate of obtaining intervertebral disc in percutaneous puncture was significantly higher than that of vertebral body, suggesting that intervertebral disc is a more critical puncture site.

Comprehensive assessment of patients with symptomatic hand osteoarthritis: Cross-sectional insights into links with other joints.

Symptomatic hand osteoarthritis (HOA) significantly affects daily activities and quality of life, but its associations with osteoarthritis (OA) in other joints and systemic factors remain unclear. This study aimed to comprehensively assess patients with symptomatic HOA by examining their laboratory findings and radiographic features across multiple joints. This cross-sectional study enrolled 53 patients with symptomatic HOA who initially presented to the outpatient clinic with hand pain and were subsequently diagnosed. Radiographic assessments of the hands, knees, hips, and spine were performed using the grading system of Kellgren-Lawrence (KL). The sum of the KL scores for all joints in both hands was calculated as the hand KL score. In total, 79.2% of patients had coexistent knee OA. Elevated triglyceride levels and erythrocyte sedimentation rates were observed in >50% of the cohort. Hand KL scores displayed weak positive correlations with C-reactive protein levels (r=0.34) and knee KL scores (r=0.35). This study highlights the frequent coexistence of knee OA in patients with symptomatic HOA and suggests potential links between HOA, systemic inflammation, and lipid metabolism. These findings provide insights into the multifactorial nature of HOA and underscore the importance of comprehensive evaluation in clinical practice.

Natural course of postoperative C-reactive protein and erythrocyte sedimentation rate in unilateral and simultaneous bilateral total knee arthroplasty

BackgroundC-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are valuable markers for detecting periprosthetic joint infection (PJI) post-total knee arthroplasty (TKA). However, their prolonged elevation after TKA diminishes diagnostic reliability. This study investigates CRP and ESR trends in unilateral (U-TKA) and simultaneous bilateral TKA (SB-TKA) patients, comparing their patterns.MethodsBetween 2017 and 2023, preoperative and postoperative (weeks 2, 4, 6) CRP and ESR levels were assessed in U-TKA (32 patients) and SB-TKA (29 patients) groups for gonarthrosis.ResultsMedian preoperative CRP levels were 1.13 mg/dL (U-TKA) and 0.2 mg/dL (SB-TKA), with corresponding ESR levels of 13.50 mm/h and 10 mm/h. While CRP and ESR increased more in SB-TKA, differences were statistically insignificant (p > 0.05). Both groups showed significant differences in CRP and ESR values at all time points (p < 0.05). U-TKA patients reached CRP < 5 mg/dL and ESR < 30 mm/h by the 6th postoperative week. SB-TKA patients did not exhibit significantly higher CRP and ESR levels at various intervals compared to U-TKA patients (p > 0.05).ConclusionThis study delineates postoperative CRP and ESR trends in U-TKA and SB-TKA for osteoarthritis. CRP values decreased below 5 mg/dL, and ESR values below 30 mm/h within 6 weeks in both groups. Statistically significant differences in CRP and ESR values were observed at all time points. No significant differences were found in CRP and ESR trends between both groups. These findings aid physicians in interpreting laboratory reports for PJI determination.Level of Evidence: III.

The diagnostic accuracy of blood C-reactive protein and erythrocyte sedimentation rate in periprosthetic joint infections – A 10-year analysis of 1510 revision hip and knee arthroplasties from a single orthopaedic center

BackgroundDespite the availability of many highly accurate biomarkers and novel criteria, serum C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are still the basis for diagnosing periprosthetic joint infection (PJI). This study aims to analyze the influence of different demographical and clinical factors on the cut-off values and accuracy of CRP and ESR in diagnosing chronic PJI.MethodsA total number of 4757 patients (with ICD-10 codes T84.0 and T84.5) operated on between January 2014 to December 2023 in a single orthopaedic center were screened in terms of the inclusion and exclusion criteria. Finally, 1510 patients (1032 aseptic revisions and 478 periprosthetic joint infections [PJI]) were included in the analysis. The best cut-off values, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for both CRP and ESR for all cohort and for subgroups divided depending on the demographical (gender, joint and BMI) and clinical factors (prosthesis fixation, specific diagnostic criteria, and virulence of the bacteria) were calculated.ResultsFor all cohort, the best cut-off value for CRP was 9.6 mg/L with an area under the curve (AUC) of 0.93 and for ESR was 29 mm/h with the AUC of 0.891. For CRP the sensitivity was higher (84.9%) than for ESR (75.1%), with the same values of specificity (90.5% and 90.8%, respectively). According to the specific subgroups, for CRP higher sensitivity was observed for males (89.6%) than for females (82.6%) if lower thresholds were used. Similarly, when the higher cut-off value for CRP was applied, better specificity for high-virulent (94.8%) than for low-virulent pathogens (88.9%) was observed. For ESR, superior sensitivity values were observed if a fistula was observed, for lower BMI thresholds and for infections caused by high-virulent pathogens. Higher optimal threshold and better specificity were observed for knees than for hips, without the appearance of fistula, when minor criteria were used and infection was caused by high-virulent pathogens.ConclusionsOur study indicates better sensitivity for CRP than ESR and similar specificity values for diagnosing chronic PJI. If results oscillate close to 10 mg/L for CRP and between 25 and 30 mm/h for ESR we propose to use different cut-off values depending on the demographic and/or clinical factors to increase diagnostic accuracy.

Atypical pathogen community-acquired pneumonia: an analysis of clinical characteristics, drug treatment, and prognosis in the related patients.

Serious respiratory infections can occur in both in-hospital and out-of-hospital settings. These infections are known as community-acquired pneumonias (CAPs). Streptococcus pneumoniae and other microorganisms commonly cause atypical pneumonia. This study examined the clinical features, medication therapy, and prognosis of 85 cases of community-acquired pneumonia (CAP) caused by Mycoplasma pneumoniae (MPP) and Chlamydia psittaci(C. psittaci)neumoniae (CPP). A retrospective analysis was conducted at Shaoxing People's Hospital from July 2021 to August 2024, using targeted next-generation sequencing (tNGS) of bronchoalveolar lavage fluid (BALF). Patients were classified into the MPP group (54 patients) and the CPP group (31 patients). Compared with the control group, the CPP group had a significantly lower proportion of patients with a contact history of poultry and birds, a shorter length of hospital stay, and a lower percentage of severe pneumonia cases. The MPP group demonstrated higher incidences of cough and sputum production; conversely, the occurrences of fever, fatigue, diminished appetite, and generalised myalgia were comparatively lower. The MPP group exhibited markedly diminished levels of neutrophils, C-reactive protein, procalcitonin, erythrocyte sedimentation rate, heparin-binding protein, alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, direct bilirubin, pH, lactic acid, and D-dimer compared with the CPP group. In contrast, the MPP group had a markedly higher lymphocyte count, platelet count, albumin levels, as well as higher concentrations of blood sodium and blood chloride. The drug treatment regimens differed between the two groups, resulting in one unfavourable outcome within the MPP group. In summary, fatigue, fever, and reduced appetite are more prominent symptoms in patients with CPP, whereas cough and sputum production are the primary manifestations of MPP. Pleural effusion is more prevalent in patients with CPP, Additionally, these patients also have increased inflammatory responses and decreased immune function.