Higher Leukocyte Counts Research Articles

Impact of COVID-19 Pandemic on Paediatric Appendicitis at a Tertiary Care Paediatric Hospital in New DelhiA Retrospective Study

Introduction: Across the globe the healthcare system was severely affected by Coronavirus Disease-19 (COVID-19) pandemic. Measures taken to curtail the spread of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus have severely affected the paediatric patients presenting with Acute Appendicitis (AA). Aim: To assess the impact of COVID-19 on paediatric Acute Appendicities patients at tertiary care center in New Delhi. Materials and Methods: A retrospective analysis of patient demographics, symptomatology including delay in presentation to hospital, haematological, intraoperative findings and complications of all paediatric AA patients who underwent appendectomy from 23rd March 2020 to 22nd July 2020 (Pandemic Group- PG group) were performed. Patients presenting in corresponding time period in the year 2019 were also compared {Non Pandemic Group (NPG) group}. Group comparisons for continuously distributed data were made using Independent sample t-test. For non normally distributed data, non parametric tests in the form of Wilcoxon test were used. Chi-squared test was used for group comparisons for categorical data. Results: A total of 72 patients were included with 39 in NPG and 33 in PG group respectively. There were no significant differences between the two groups in terms of age (p-value=0.759) and sex distribution (p-value=0.93). Patients in PG group had higher leukocyte counts as compared to NPG group (16748.48±7744.08 vs 12510.26±7736.58, p-value <0.007). There was no significant difference in delay in presentation, symptomatology, duration of hospital stay and postoperative complications rate between the two groups. Conclusion: There has been no significant change in the number of patients presenting with AA and the symptomatology during COVID-19 pandemic.

Characteristics of Diabetic Foot Ulcer Patients Pre- and During COVID-19 Pandemic: Lessons Learnt From a National Referral Hospital in Indonesia.

Background:Diabetic foot ulcer (DFU) is one of the most terrifying diabetic complications for patients, due to the high mortality rate and risk for amputation. During the COVID-19 pandemic, many diabetic patients limited their visits to the hospital, resulting in delays for treatment especially in emergency cases.Objective:This study aimed to compare the characteristics of patients with DFU pre- and during COVID-19 pandemic period. Methods: This study was a retrospective cohort study using foot registry data. We compared our patients’ characteristics pre-COVID-19 pandemic period (1 March 2019-28 February 2020) and during COVID-19 pandemic period (1 March 2020-28 February 2021).Results:Cohorts of 84 and 71 patients with DFU pre- and during COVID-19 pandemic period, respectively, were included in this study. High infection grade (66.7% vs 83.1%, P = .032), osteomyelitis event (72.6% vs 87.3%, P = .04), leukocyte count (15 565.0/μL vs 20 280.0/μL, P = .002), neutrophil-to-lymphocyte ratio (7.7 vs 12.1, P = .008), waiting time-to-surgery (39.0 h vs 78.5 h, P = .034), and number of major amputation (20.2% vs 39.4%, P = .014) were significantly higher during the COVID-19 pandemic period.Conclusion:During the COVID-19 pandemic, patients with DFU had more severe infection, higher proportion of osteomyelitis, longer waiting time for getting surgical intervention, and higher incidence of major amputation.

Association between shift work and inflammatory markers in workers at an electronics manufacturing company

Shift work is known to be associated with cardiovascular disease (CVD). It has been found that inflammatory reactions are involved in the onset and progression of CVD. Therefore, the purpose of this study was to investigate the association between shift work and inflammatory markers. Among workers at an electronics manufacturing company, 2,329 workers who had a health checkup from January 2019 to December 2019 were targeted. The general and biochemical characteristics of daytime workers and shift workers were compared through the Independent-test and the χ2 test. Through multiple linear regression analysis, the association with shift work and inflammatory markers was investigated. Through multiple logistic regression analysis, the association with shift work and high inflammatory markers. The mean total leukocytes, neutrophils, monocytes, lymphocytes of shift workers were significantly higher than those of daytime worker. The mean high-sensitivity C-reactive protein (hs-CRP) of shift workers was also higher than that of daytime workers but not significantly. In multiple linear regression, shift work was associated with increase of total leukocyte count (β = 0.367, p < 0.001) and hs-CRP (β = 0.140, p = 0.005) after adjusting for all variables. In multiple logistic regression analysis, shift work showed 2.27 times risk of high leukocyte count and 1.8 times risk of high hs-CRP level compared to daytime work after adjusting for all variables. This study confirmed that shift work is associated with high inflammatory markers. Considering that high inflammatory markers is independent indicator of CVD, the association between shift work and high inflammatory markers may help to understand the CVD risk of shift workers.

Proinflammatory cytokines and circulating tumor cells in ovarian cancer patients treated with platinum-containing chemotherapy

Summary. Circulating tumor cells (CTCs) are a potential source of tumor progression. Systemic tumor-associated inflammation can influence the cancer prognosis both independently and by changing the characteristics of CTCs. Data on the role of proinflammatory cytokines and CTCs in the ovarian cancer (OC) chemosensitivity are few and contradictory. Aim of the study. To assess the IL-17A, IL-18 levels and the number of CTCs in primary patients with OC before treatment and after 3 courses of standard platinum-containing chemotherapy, and the possibility of using these cytokines as a marker of the presence of CTCs. Materials and methods. The study included 72 patients with OC. The comparison group included 16 patients with benign ovarian tumors, the control group included 20 healthy women. The number of CTCs (CD45-/EpCam+/CK+) was determined immunofluorometrically before and after 3 courses of chemotherapy. The content of cytokines was assessed by ELISA. Statistica 13.0, jamovi 1.6.5.0 were used for data processing. Results. The level of IL-17A in blood in the benign tumors group was increased in comparison with OC (р=0.012) and control (р=0.042). The content of IL-17A increased over time in the subgroup of adjuvant chemotherapy (р=0.017). During treatment, IL-17A was higher among patients with platinum-sensitive tumors than with non-sensitive ones (р=0.054). High levels of IL-18 before treatment were associated with the development of platinum-refractory relapse (р=0.014). IL-18 levels before (р=0.027) and during treatment (p=0.052) were lower in patients with cytoreductive surgery in first line of treatment. Progression-free survival (PFS) (p = 0.012) and overall survival (OS) (p = 0.030) were lower in the cluster with high IL-18 and pretreatment leukocyte counts than in the cluster with low scores. Higher quantity of the pretreatment CTCs was associated with longer PFS in a multivariate analysis (HR 0.82 95% CI 0.69–0.98, р=0.028). The number of CTCs before treatment greater than 5 was associated with a decrease in OS (HR 1.31, 95% CI 0.98–1.73, р=0.064). Conclusions. A high level of IL-17A in the blood during treatment is associated with more favorable clinical characteristics of OC, while a high level of IL-18 in the blood before treatment is associated with less favorable characteristics and a worse prognosis. The number of CTCs in patients with OC is not related to the blood levels of IL-17A and IL-18. A greater number of CTCs before treatment in OC is associated with an increase in PFS, but a decrease in overall survival.

Atypical Kawasaki disease in an early infant, a diagnostic challenge: Case report

A 4.5-month-old girl presented to us with continuous fever for 10 days and loose stools for 2 days. She received short courses of multiple oral antibiotics during this period however, was not relieved. Initial investigations were suggestive of urinary tract infection for which broad spectrum antibiotics were started. However, fever persisted even after 72 h of antibiotics. Blood counts showed persistently high total leukocyte count and increasing platelet count, along with high C-reactive protein. Consequently, a diagnosis of Kawasaki disease (KD) was suspected, which was supported by echocardiographic findings. After she received intravenous immunoglobulins, her fever subsided and lab parameters showed significant improvement. This case highlights an unusual presentation of KD in an uncommonly young age group without much clinical pointers except for persistent fever.

Granulocyte transfusions made with modified fluid gelatin in pediatric and adolescent patients with prolonged neutropenia.

Granulocyte transfusions (GT) are used to treat progressive systemic or local infections in prolonged neutropenic patients with antibiotic or antifungal resistance. Granulocytes are most commonly collected from whole blood by apheresis using hydroxyethyl starch (HES) as the red blood cell (RBC) sedimentation agent. This is the first study on the safety and efficacy of transfusing granulocytes collected with modified fluid gelatin (MFG) instead of HES to pediatric patients. Clinical data from 46 pediatric and adolescent patients receiving at least one MFG-based granulocyte transfusion and in total 295 granulocyte concentrates from July 2013 to August 2019 at our local university medical center were evaluated retrospectively. Forty-one patients (89%) survived at least 21 days after their last granulocyte transfusion. These survivors had lower CRP values and higher leukocyte counts after GT than non-survivors (mean delta of -5.34 mg/dl vs. -11.99 mg/dl and +0.62 × 103 /μl vs. +0.18 × 103 /μl of all GT, respectively). The neutrophil corrected count increment (CCI) was 68.72 mm2 /ml in survivors versus 28.00 mm2 /ml in non-survivors. There were no major or severe adverse events. This study suggests that modified fluid gelatin is a safe and effective alternative to hydroxyethyl starch for the collection of granulocytes for transfusion to prolonged neutropenic patients with progressive systemic or local infections refractory to antibiotic or antifungal therapy.

Graptophyllum pictum Extract in the Treatment of Experimental Hemorrhoids: Effects on Vascular Leakage and Matrix Metalloproteinase-9 Levels

BACKGROUND: The micronized purified flavonoid fraction, which has been shown to be effective for the treatment of hemorrhoids, is too expensive for Indonesian patients and is not included in the National Formulary. AIM: The aim of this study was to investigate the effects of Graptophyllum pictum extract (GPE), a phlebotropic drug, as it is a cheaper and safer alternative medication for the treatment of hemorrhoids. MATERIALS AND METHODS: Twenty-eight male Wistar rats were randomly divided into four groups. Hemorrhoids were induced in groups 2, 3, and 4 using 6% croton oil. After induction, group 1 (negative control) and group 2 (positive control) were administered normal saline, whereas groups 3 and 4 were administered 100 mg/kg BW and 300 mg/kg BW GPE, respectively. On the 9th day, blood samples were collected to measure serum matrix metalloproteinase (MMP)-9 levels. The anus, containing the internal and external sphincters, was resected. Vascular leakage was measured based on edema and extravascular leukocyte count. The edema was measured using the rectoanal coefficient. RESULTS: The highest rectoanal coefficient was observed in groups 2 (3.13 ± 0.85) and 3 (2.46 ± 0.41); that in group 4 (2.60 ± 0.34) was significantly lower than that in group 2 (p &lt; 0.05). The highest leukocyte count was observed in groups 2 (1003.28 ± 99.30) and 3 (900.14 ± 48.09); that in group 4 (835.85 ± 42.65) was significantly lower than that in group 2 (p &lt; 0.05). The highest mean serum MMP-9 level was observed in groups 2 (1840.25 ±437.84) and 3 (525.78 ± 577.33); that in group 4 (1122.03±675.76) was significantly lower than that in group 2 (p &lt; 0.05). CONCLUSIONS: GPE effectively reduced vascular leakage (edema and extravascular leukocyte count) and MMP-9 level in this experimental model of hemorrhoids.

Hematopoietic Stem Cell Transplantation for Pediatric Chronic Myeloid Leukemia

Chronic myeloid leukemia (CML) accounts for approximately 2 to 3% of all pediatric leukemias. Compared to adults, children tend to present with more aggressive features, such as higher leukocyte counts and massive splenomegaly, and are more likely to be diagnosed with advanced stage disease. Before the advent of tyrosine kinase inhibitors, a couple of decades ago, allogeneic hematopoietic stem cell transplantation (allo-HSCT) was the mainstay of treatment for this disease. This, however, was associated with considerable treatment-related morbidity and mortality. Even so, despite its secondary and somewhat limited indication today, allo-HSCT remains an important alternative and the only curative treatment for CML. In 2020, the Brazilian Group for Pediatric Bone Marrow Transplantation of the Brazilian Society for Blood and Marrow Transplantation and Cellular Therapy (SBTMO) convened a task force to provide evidence-based guidance on the use of allo-HSCT for the appropriate management of childhood CML, the results of which are presented here.

Importance of mannose-binding lectin2 polymorphism (rs1800450) in infections in children

Purpose Mannose-binding lectin (MBL) is a serine protease belonging to the collectins and an important factor in the inherited immune system. We aimed to reveal the distribution of different MBL2 genotypes in patients diagnosed with acute bronchiolitis and pneumonia. Material and methods A total of 147 patients who applied to Paediatric Emergency between 01.12.2019 and 31.12.2020 were included in the study. Patients were divided into two subgroups: Bronchiolitis and pneumonia. Results AA genotype was found to be significantly higher in healthy controls (p = 0.039). In the pneumonia group, both AB/BB genotype was significantly higher compared to healthy controls (p = 0.001). While the AA genotype was more common in patients with acute bronchiolitis, AB/BB genotypes were more common in the pneumonia group (p = 0.001). The presence of fever, crepitation, tachypnoea, pathological x-ray finding, and high leukocyte count are significantly more common in patients with AA genotype, while more than 3 days of follow-up duration and severe clinical picture were more common in patients with AB/BB genotypes (p < 0.05, for all). Conclusions Genotypes with low MBL expression were significantly more common in patients with pneumonia and severe infection. All these results reveal the importance of MBL polymorphisms and their expression in infections.

Myeloproliferative Hypereosinophilic Syndrome with Concomitant Ischemic Events

▪Background:Eosinophils are versatile reactionary cells that play a key role in the inflammatory response. Excessive proliferation and aggregation of eosinophils have been implicated in the pathogenesis of ischemic neurologic and cardiac events. We present a rare case of hypereosinophilic syndrome (HES) in a patient hospitalized for simultaneous acute cerebrovascular accident (CVA) and acute coronary syndrome.Case:A 53-year-old male with past medical history of hypertension and diabetes mellitus presented with new onset bifrontal headache, right arm numbness and apraxia, and concurrent typical angina. On physical examination, he had small non-tender raised nodules on the bilateral upper and lower limbs. MRI of the brain demonstrated multifocal infarcts in a watershed distribution. Biochemical investigation revealed rising troponins. Splenomegaly of 16.4 cm was found on CT imaging. He was admitted for management of acute CVA and non-ST segment elevation myocardial infarction (NSTEMI). Complete blood count (CBC) revealed leukocytosis (34.4 K/mcL) with an eosinophilia of 85% and an absolute eosinophil count (AEC) of 29.2 x 10 3 eosinophils/µL. Serum tryptase was 29.2 µg/L. The patient was started on a high dose steroid with subsequent resolution of his neurologic and cardiac symptoms. Due to high suspicion for HES, FISH panel and bone marrow biopsy were performed. A small focus of marrow on his biopsy showed abundant eosinophils and bland spindle cells (>15 mast cells in aggregate). FISH panel was positive for 4q12 rearrangement, consistent with a FIP1L1/PDGFRA fusion mutation. Skin biopsy of his lesions demonstrated superficial and deep inflammation with eosinophils. He was diagnosed with myeloproliferative HES with features of mastocytosis and started on imatinib.Discussion:The defining features of HES consist of eosinophilia greater than 1500/µL for greater than 6 months with evidence of eosinophil induced tissue infiltration and injury. The ability of eosinophils to induce pathologic outcomes is influenced by a variety of parameters, including the number of eosinophils present, their location, and the degree of activation. Published data suggests that neurologic and cardiac ischemic events occur in HES patients with a higher leukocyte count and AEC than what we present with in this case. Our patient meets the main lab criteria of HES and our case highlights that simultaneous clinical manifestations can occur in the absence of markedly elevated peripheral eosinophilia. As with most cases involving unexplained hypereosinophilia, a wide range of diagnostic testing was necessary. The presence of a PDGFRA fusion mutation established a clonal disorder, supporting the diagnosis of myeloproliferative HES variant. The presence of eosinophils and the lack of mast cells on skin biopsy further supports myeloproliferative HES variant rather than a true systemic mastocytosis. Despite recent advances in molecular and immunologic therapies, treatment for HES remains challenging due to the wide variety of etiological classifications necessitating targeted treatments. At the time of submission, KIT mutation analysis is pending. Identification of a KIT D816V mutation would support use of midostaurin or the recently approved avapritinib for treatment of overlap syndrome. DisclosuresNo relevant conflicts of interest to declare.

Patients with Acute Myeloid Leukemia on Non-Intensive Therapy: Applicability of the European Leukemia Net Risk Classification

BACKGROUNDThe revised genetic risk classification established by the European Leukemia Net (ELN) in 2017 stratifies patients diagnosed with acute myeloid leukemia (AML) into 3 prognostic categories (favourable, intermediate, and adverse) based on cytogenetic and molecular characteristics.The ELN classification is widely accepted in AML patients despite the fact that validation studies were performed in participants who received exclusively first-line treatment with intensive chemotherapy. For this reason, it is not well established whether the ELN risk groups are applicable to patients on non-intensive first-line treatment.OBJECTIVES- To describe and compare baseline characteristics at diagnosis between patients with AML treated with intensive and non-intensive therapy.- To assess whether the ELN prognostic classification is applicable in these subgroups of patients.METHODSWe retrospectively analysed patients with newly diagnosed AML admitted to our center between 2007 and 2020. Patients with acute promyelocytic leukemia (M3), patients younger than 18 years old and/or patients who received exclusively supportive treatment were excluded. Demographic and clinical data, disease characteristics at diagnosis and first-line treatment were collected. Cytogenetic and molecular characteristics were used to classify patients in ELN risk groups.RESULTSOf the total of patients (n=218), one hundred and fifty-six (71.6%) received intensive chemotherapy treatment, while 62 (28.4%) were treated with non-intensive strategies. Idarubicin and cytarabine based schemes regimens (IA) were administered in most patients (98.6%) who received intensive treatment while the rest received fludarabine based regimens. One patient (0.6%) was treated with danurubicin and cytarabine liposome (CPX-351). Fifty-four (87%) patients treated with non-intensive regimens received hypomethylating agents, mostly azacitidine. Five patients (8%) were treated with venetoclax in combination with a hypomethylating agent.Table 1 shows the characteristics at diagnosis in both groups of patients. Patients who received intensive chemotherapy were younger and had higher leukocyte count, LDH values and a higher percentage of blasts in peripheral blood and bone marrow with a median of 40% and 62% blasts respectively. On the other hand, patients under non-intensive treatment more frequently presented a past history of hemopathy and a higher percentage of bone marrow dysplasia.Regarding ELN stratification significant differences were found between both groups. Patients who received aggressive chemotherapy vs patients who did not, were classified in low (28% vs. 7%), intermediate (36% vs. 58%) and high risk (36% vs. 35%) respectively (Figure 1).At the end of the follow-up, 41% of the patients who had received intensive therapy were alive while only 6.5% of the patients who had received non-intensive treatment were alive. Significant differences in survival were observed between both groups (p<0.01); with 1-year overall survival (OS) of 65.8% for intensive therapy group and 49.6% for non-intensive therapy group.In the intensive chemotherapy group, significant differences in survival were observed according to ELN risk stratification (p<0.01), with 5-year OS of 55%, 29% and 23.9% for low, intermediate and high-risk groups respectively. For low-risk patients, median OS was not reached while it was 20 months for the intermediate risk group and 12.2 months for the high-risk group.However, in patients receiving non-intensive therapies, there were no significant differences in survival among different prognostic categories (p=0.06). In this group, 1-year OS was 25%, 57.6% and 40.7% and median OS was 2.1, 14.8 and 10.1 months for low, intermediate and high-risk groups respectively. See Figure 2.CONCLUSIONS:As validated in previous trials, ELN classification constitutes an adequate prognostic marker for patients with newly diagnosed AML treated with intensive chemotherapy. In our series, this classification does not appear to be a good predictor of survival for patients diagnosed with AML who initiated non-intensive treatments. Further validation in prospective studies are needed to better classify this growing subgroup of patients in clinical practice. [Display omitted] DisclosuresMartín-Rojas: Celgene-BMS: Consultancy, Membership on an entity's Board of Directors or advisory committees; Gilead: Membership on an entity's Board of Directors or advisory committees; Pfizer: Membership on an entity's Board of Directors or advisory committees. Font Lopez: Pfizer: Membership on an entity's Board of Directors or advisory committees; GILEAD: Membership on an entity's Board of Directors or advisory committees; CELGENE-BMS: Consultancy, Membership on an entity's Board of Directors or advisory committees. Kwon: Novartis, Celgene, Gilead, Pfizer: Consultancy, Honoraria.

Molecular detection of Trypanosoma species and haematological alterations in four trypanosome-infected Nigerian horses

Trypanosomes cause anaemia and are responsible for widespread morbidity and mortality particularly in imported breeds of animals found in sub-tropical and tropical parts of the world. Light microscopy and polymerase chain reaction (PCR) were used to detect trypanosomes in naturally infected Nigerian crossbred horses at Obollo-Afor abattoir, Udenu Local Government Area, Enugu State Nigeria. Blood was collected via the jugular outflow from a total of 200 horses of varying ages and either sex. Conventional procedures were followed during the PCR assay, parasite identification in wet mount, Leishman-stained thin blood and buffy coat smears on glass slides. Light microscopy revealed Trypanosoma species with an elongated, streamlined and tapered body, highly suggestive of T. brucei brucei or its subspecies T. evansi or T. equiperdum. PCR assay produced the expected fragment size of 700 bp specific for ITS-1 region of the 18SrRNA gene of Trypanosoma species in 4 (2%) of 200 blood samples against the routine blood and buffy coat smear examination, which revealed trypanosomes in 3 (1.5%) out of 200 blood samples. Sex and age were not significantly (p&gt;0.05) associated with the trypanosome infection. One of the Trypanosoma infected anaemic horses had microcytic normochromic anaemia, high erythrocyte sedimentation rate and normal leukocyte count, while one of the Trypanosoma species infected non-anaemic horses had erythrocytic parameters and ESR values that are within the reference range, with leukocytosis. It was concluded that the prevalence of equine trypanosomosis was very low, and it’s characterized by mild to moderate anaemia in clinical cases.

Evaluation of risk factors associated with first episode febrile seizure.

Febrile convulsion (FC) is one of the most common neurological findings in children. This study was aimed to investigate the difference in laboratory parameters between Febrile Seizure and control groups. In this study, 169 children admitted to the pediatric emergency department with their first episode of FS and 189 control groups were retrospectively analyzed. The demographic characteristics and laboratory parameters of children were obtained from their files. Upper respiratory tract infection (URTI) was determined the most common disease (81.6%) in the FC group followed by acute gastroenteritis (AGE) (15.4%) and urinary tract infection (UTI) (3%), respectively. Similarly, URTI was detected as the most common disease (81.8%) in control groups. It was determined that there was no statistically significant difference between the two groups in terms of diseases. The leukocyte and neutrophil counts of the children with FC were significantly higher but the mean corpuscular volume of lenfosit and lenfosit/neutrophil ratio was significantly lower than the control groups (p= 0.009, <0.001, 0.001, <0.001, <0.001, respectively). Children with FC had significantly higher blood glucose, urea, creatinine, creatine kinase, alkaline phosphatase and albumin levels compared with the control groups (p<0.001, in all parameters). On the other hand, the potassium, sodium and chlorine levels of the Children with FCs were significantly lower than control groups (p=0.017, <0.001, p <0.001, respectively). To conclude, febrile patients with high leukocyte counts, high neutrophil counts, and several biochemical parameters should be carefully monitored for FCs due to the increasing seizure risk.

In-hospital clinical complications of COVID-19: a brief overview.

In-hospital clinical complications of COVID-19: a brief overview.

Predictors of in-hospital Outcomes in Patients With Cirrhosis and Coronavirus Disease-2019

BackgroundCoronavirus disease-2019 (COVID-19) cases continue to increase globally. Poor outcomes in patients with COVID-19 and cirrhosis have been reported; predictors of outcome are unclear. The existing data is from the early part of the pandemic when variants of concern (VOC) were not reported.AimsWe aimed to assess the outcomes and predictors in patients with cirrhosis and COVID-19. We also compared the differences in outcomes between the first wave of pandemic and the second wave.MethodsIn this retrospective analysis of a prospectively maintained database, data on consecutive cirrhosis patients (n = 221) admitted to the COVID-19 care facility of a tertiary care center in India were evaluated for presentation, the severity of liver disease, the severity of COVID-19, and outcomes.ResultsThe clinical presentation included: 18 (8.1%) patients had compensated cirrhosis, 139 (62.9%) acute decompensation (AD), and 64 (29.0%) had an acute-on-chronic liver failure (ACLF). Patients with ACLF had more severe COVID-19 infection than those with compensated cirrhosis and AD (54.7% vs. 16.5% and 33.3%, P < 0.001). The overall mortality was 90 (40.7%), the highest among ACLF (72.0%). On multivariate analysis, independent predictors of mortality were high leukocyte count, alkaline phosphatase, creatinine, child class, model for end-stage liver disease (MELD) score, and COVID-19 severity. The second wave had more cases of severe COVID-19 as compared to the first wave, with a similar MELD score and Child score. The overall mortality was similar between the two waves.ConclusionPatients with COVID-19 and cirrhosis have high mortality (40%), particularly those with ACLF (72%). A higher leukocyte count, creatinine, alkaline phosphatase, Child class, and MELD score are predictors of mortality.

A novel upregulated LncRNA-AC026150.8 promotes chemo-resistance and predicts poor prognosis in acute myeloid leukemia.

BackgroundAML is a common hematological malignancy with poor prognosis, the pathogenesis is still unclear. lncRNA takes part in occurrence and development of AML. This research aims to explore new differentially expressed lncRNAs and their effects on AML.MethodsDatabase‐based bioinformatics analysis was performed to screen differentially expressed lncRNA in AML, real‐time PCR was used to analyze gene expression. Kaplan–Meier survival analysis was performed to determine prognostic effect of AC026150.8 in AML. The cell drug resistance experiment was performed to test effect of AC026150.8 on chemo‐resistance of AML cells. Catrapid online software and RNA pull‐down, mass spectrometry, western‐blot were used to predict and verify the combination of AC026150.8 and RNA splicing factors.ResultsAC026150.8 was upregulated in AML patients and related to poor prognosis. High leukocyte counts, FAB classification, MLL‐AF9 expression and NPM1 mutations were associated with high AC026150.8 expression. Upregulated of AC026150.8 increased the drug resistance of AML cells. AC026150.8 could be combined with splicing factor PCBP1.ConclusionsFor the first time, our study found that the upregulated AC026150.8 in AML is related to poor prognosis, overexpression of AC026150.8 could increase drug resistance of AML cells, and confirmed its scaffolding effect in combination with splicing factors. It is necessary to further study AC026150.8 and its downstream target genes to clarify the mechanism of AC026150.8 in AML.

Similar Inflammatory Biomarkers Reflect Different Platelet Reactivity in Percutaneous Coronary Intervention Patients Treated With Clopidogrel: A Large-Sample Study From China.

Background: Platelet reactivity is closely associated with adverse events in percutaneous coronary intervention (PCI) patients. Inflammation plays a crucial role in the development of coronary heart disease (CHD).Aim: To investigate the association of inflammatory biomarkers such as leukocyte count and high-sensitivity C reactive proteins (hs-CRP) with platelet reactivity in PCI patients treated with clopidogrel.Method: We examined 10,724 consecutive PCI patients in Fuwai hospital from January 2013 to December 2013. High on-treatment platelet reactivity (HTPR) was defined as adenosine diphosphate (ADP)-induced platelet maximum amplitude [MA(ADP)] of thromboelastogram (TEG) > 47 mm, and low on-treatment platelet reactivity (LTPR) MA(ADP) < 31 mm.Results: Finally, 6,772 PCI patients treated with clopidogrel who had the results of postoperative TEG were enrolled. Among them, 2,070 (30.57%) presented HTPR and 2,568 (37.92%) presented LTPR. As for LTPR, multivariate logistic regression showed that leukocyte count (OR: 1.153, 95% CI 1.117–1.191) and hs-CRP (OR: 0.920, 95% CI 0.905–0.936) were independent predictors, along with diabetes mellites, hemoglobin, platelet count and glucose. As for HTPR, multivariate logistic regression showed that leukocyte count (OR: 0.885, 95% CI 0.854–0.917) and hs-CRP (OR: 1.094, 95% CI 1.077–1.112) were independent predictors, along with sex, hemoglobin, platelet count and glucose.Conclusions: This was the first large real-world study reporting that both leukocyte count and hs-CRP were the independent factors for platelet reactivity in PCI populations treated with clopidogrel, among which higher leukocyte count was associated with more LTPR while higher hs-CRP was associated with more HTPR, providing new insights on individualized antiplatelet therapy.

Effects of Extracorporeal Shock Waves on Microcirculation and Angiogenesis in the in vivo Wound Model of the Diver Box

Introduction: Extracorporeal shock waves (ESWs) have been shown to have a positive effect on skin wound healing; however, little is known on the regeneration of the microcirculation and angiogenesis as well as the different application modes. Methods: A total of 40 BALB/c mice were provided with dorsal skin fold chambers and were divided into 3 therapy groups (n = 30) and one control group (n = 10). The 3 therapy groups were treated with shock waves at different pulse rates (500–1,000 pulses/min) and application frequencies (day 0 and day 6 or day 0 only). Photographic documentation and intravital microscopy were carried out on day 1, 2, 4, and 6 after wounding. Results: Using the newly developed Diver Box, shock waves could be applied in vivo without mechanical tissue damage. Shock wave therapy to skin wounds demonstrated to induce faster wound closure rates in the beginning than controls in groups with higher pulse rates and frequencies of the shock waves. Furthermore, the regeneration of microcirculation and perfusion in the healing skin was significantly improved after the application of, in particular, higher pulse rates as given by increased numbers of perfused capillaries and functional vessel density. The study of inflammation showed, especially in high-pulse ESW groups, higher leukocyte counts, and rolling leukocytes over time until day 6 as a response to the induction of inflammatory reaction after ESW application. Angiogenesis showed a marked increase in positive areas as given by sprouts, coils, and recruitments in all ESW groups, especially between days 4 and 6. Conclusion: The major findings of this trial demonstrate that ESW therapy to skin wounds is effective and safe. This is demonstrated by the initially faster wound closure rate, but later the same wound closure rate in the treatment groups than in controls. Furthermore, during the regeneration of microcirculation and perfusion in the healing skin, a significant improvement was observed after the application of, in particular, higher ESW pulse rates, suggesting an ESW-related increase in nutrient and oxygen supply in the wound tissue.

Allogeneic Hematopoietic Stem Cell Transplantation for Chronic Myelomonocytic Leukemia: Clinical and Molecular Genetic Prognostic Factors in a Nordic Population

Chronic myelomonocytic leukemia (CMML) is an aggressive disease in which survival after allogeneic hematopoietic stem cell transplantation (HCT) remains relatively poor. An assessment of prognostic factors is an important part of treatment decision making and has the potential to be greatly improved by the inclusion of molecular genetics. However, there is a significant knowledge gap in the interpretation of mutational patterns. This study aimed to describe outcomes of allogeneic HCT in patients with CMML in relation to clinical and molecular genetic risk factors. This retrospective study included 64 patients with CMML who underwent allogeneic HCT between 2008 and 2018, with a median follow-up of 5.4 years. Next-generation sequencing using targeted myeloid panels was carried out on saved material from 51 patients from the time of transplantation. Kaplan-Meier and Cox regression were used for analysis of overall survival (OS), and cumulative incidence with competing risks and Fine and Gray models were used for analysis of relapse and nonrelapse mortality (NRM). Mutations were detected in 48 patients (94%), indicating high levels of minimal residual disease (MRD) positivity at transplantation, even among those in complete remission (CR) (n=14), 86% of whom had detectable mutations. The most frequently mutated genes were ASXL1 (37%), TET2 (37%), RUNX1 (33%), SRSF2 (26%), and NRAS (20%). Risk stratification using the CMML-specific Prognostic Scoring System molecular score (CPSS-Mol) resulted in 45% of patients moving to a higher risk-group compared with risk stratification using the CPSS. High leucocyte count (≥13×109/L), transfusion requirement, and previous intensive chemotherapy were associated with higher incidence of relapse. Being in CR was not linked to better outcomes. Neither ASXL1 nor RUNX1 mutation was associated with a difference in OS, relapse, or NRM, despite being high risk in the nontransplantation setting. TET2 mutations were associated with a significantly higher 3-year OS (73% versus 40%; P=.039). Achieving MRD-negative CR was rare in this CMML cohort, which may explain why we did not observe better outcomes for those in CR. This merits further investigation. Our analyses suggest that the negative impact of ASXL1 and RUNX1 mutations can be overcome by allogeneic HCT; however, risk stratification is complex in CMML and requires larger cohorts and multivariate models, presenting an ongoing challenge in this rare disease.

Clinical value of blood markers to assess the severity of coronavirus disease 2019

BackgroundSevere acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is threatening the world with the symptoms of seasonal influenza. This study was conducted to investigate the patient characteristics and clinical value of blood markers to assess the severity of coronavirus disease 2019 (COVID-19).Methods187 patients, diagnosed with COVID-19 (non-severe and severe cases) and admitted to hospital between January 27th and March 8th of 2020, were enrolled in the present study.ResultsA higher proportion of clinical symptoms, including cough, expectoration, myalgia, and fatigue were observed in the non-severe group. The level of white blood cell count, neutrophils, CRP, IL-6 and IL-8 were significantly increased, while the platelet count was remarkedly decreased in the severe group. The risk model based on lymphocyte, IL-6, IL-8, CRP and platelet counts had the highest area under the receiver operator characteristic curve (AUROC). The baseline of IL-6, IL-8 and CRP was positively correlated with other parameters except in the cases of lymphocyte, hemoglobin and platelet counts. The baseline of the platelet count was negatively correlated with other parameters except in the lymphocyte and hemoglobin counts. Additionally, there was no connection between the severity of COVID-19 and cultures of blood, sputum or catheter secretion.ConclusionsThe present study suggested that high leucocyte and low platelets counts were independent predictive markers of the severity of COVID-19.