Lower Lymphocyte Percentage Research Articles

Differences in blood composition between deceased and living donors: Could it affect crossmatches?

Until recently, most deceased donor crossmatches performed in our laboratory used cells isolated from node or spleen. However, due to changes at the OPO level it has become difficult to obtained pre-harvest node for crossmatches and donor blood is now routinely used. Since donors often receive blood transfusions and drugs in an attempt to save their lives, the effect of these factors on blood composition needs to be evaluated. We analyzed blood samples collected from deceased and living donors for white blood cell count (WBC) and percentage of lymphocytes, monocytes, and granulocytes using the COULTER® ACT diff2™ Analyzer. We found that deceased donors had a markedly different blood composition than living donors. The WBC count of deceased donor (14.2 × 103 cells/ μ L) was statistically higher than that of living donor (6.58 × 103 cells/ μ L, p 0.05). Further, deceased donors had a significantly lower percentage of lymphocytes (13.1% vs 25.3%) and higher percentage of granulocytes (81.8% vs 66.7%) in their blood than living donors. No statistical difference was found in the percentage of monocytes. The observed differences in blood composition resulted in changes in cell preparation when the samples were separated using Ficoll. After Ficoll separation, cell preparations obtained from the blood of deceased donors had an average composition of 34.8% lymphocytes, 16.4% monocytes and 48.7% granulocytes, while cell preparations from living donors had an average of 82.8% lymphocytes, 9.3% monocytes and 7.8% granulocytes. The changes in percentage of lymphocytes and granulocytes were statistically significant ( p 0.05 ). Our data indicates that blood composition varies between deceased and living donors and that Ficoll alone may not be an optimal isolation method for deceased donor blood. An excessive amount of granulocytes in cell preparations may affect crossmatch results as the expression of HLA may differ between lymphocytes and granulocytes. Additionally, this raises the questions as to whether the factors influencing the blood compartment of deceased donors also affect the expression of HLA class I and II on lymphocytes. Further studies will be needed to address whether the expression of HLA class I and II on lymphocytes isolated from decease donors differs from that of lymphocytes isolated from living donors.

Acute phase cytokines, TAC1, and toll-like receptor4 mRNA expression and health associated with group size in veal calves

Chronic stressors are a major health and well-being issue in animals. Immune status of animals under chronic stress is compromised, thus reducing disease resistance and compromising well-being of the animal. The objective of this study was to determine the influence of group size of veal calves on immune status and leukocyte mRNA expression of acute phase cytokines, toll-like receptor 4 (TLR4) and tachykinin 1 (TAC1) over a five-month finishing period. Holstein bull calves (n=168), 44±3 days of age were assigned to one of three treatments; 2, 4, or 8calves/pen (pen space allowance of 1.82m2/calf). Jugular blood samples were collected at the day of grouping and then monthly for 4 months. The differential leukocyte counts were determined and mRNA was extracted from the leukocytes. Reverse transcription-qPCR was used to measure the gene expression of interleukin-1 (IL-1β), IL-1 receptor antagonist (IL-1Ra), tumor necrosis factor (TNF-α), TLR4, and TAC1 in leukocytes. Health was evaluated before grouping and monthly for 4 months. On the 1st month after grouping, veal calves that were housed in groups of 8 have greater expression of IL-1β mRNA than calves housed in groups of 4 or 2 (treatment×month, P=0.04). Also at 1 month, groups of 8 had greater TAC1 expression (P<0.05) than calves housed in groups of 4 or 2. However, the expression of IL-1Ra, TNF-α, and TLR4 were not influenced by group size. In the first month of the trial, calves in groups of 8 coughed more (P<0.05) than calves in groups of 2 and coughed more than calves in groups of 4 and 2 during the 2nd month (treatment×month, P=0.03). Calves housed in groups of 8 tended to have greater neutrophil percentage (P=0.09), neutrophil to lymphocyte ratio (P=0.06), and had lower lymphocyte percentage (P=0.06) than those housed in groups of 4 or 2. In conclusion, the number of veal calves in a group, given the same space during the finishing period did not alter IL-1Ra, TNF-α, and TLR4 mRNA expression. However, housing of calves in groups of 8 was associated with greater expression of IL-1β and TAC1 mRNA in peripheral blood leukocytes, and coughing during the first 2 months after grouping. Therefore, housing of veal calves in larger groups may lead to greater susceptibility to respiratory disease and stress.

Immunoreactivity to food antigens in patients with chronic urticaria

The goal of study was better understanding of complex immune mechanisms that can help to evaluate patients with chronic urticaria (CU), especially those with unknown etiology. The study involved 55 patients with CU. Control group consisted of up to 90 healthy persons. The presence and intensity of serum IgG, IgA, IgM and IgE antibodies to common food antigens: cow’s milk proteins (CMP), gliadin and phytohemagglutinin were determined by ELISA. Determination of subpopulations of immunocompetent cells was performed by flow cytometry. Significantly enhanced IgE, but also IgA immunity to CMP was found in patients with CU in comparison to healthy controls: (p < 0.000004) and (p < 0.002), respectively. Notably, in 40 out of 55 CU patients, the increased levels of some type of immunoglobulin reactivity to CMP were found. Regarding gliadin, only the levels of serum IgE anti-gliadin antibodies were significantly enhanced in patients with CU (p < 0.04). Significantly enhanced percentage of CD89+ cells accompanied with significantly lower percentage of lymphocytes and significantly higher mean fluorescence intensity of CD26 expression on lymphocytes were found in patients with CU in comparison to healthy controls (p < 0.04), (p < 0.02) and (p < 0.003), respectively. Results of this study may help in better understanding the complex immune disturbances in patients with CU.

Behavioral Inhibition in Rhesus Monkeys (Macaca mulatta) Is Related to the Airways Response, but Not Immune Measures, Commonly Associated with Asthma

Behavioral inhibition reflects a disposition to react warily to novel situations, and has been associated with atopic diseases such as asthma. Retrospective work established the relationship between behavioral inhibition in rhesus monkeys (Macaca mulatta) and airway hyperresponsiveness, but not atopy, and the suggestion was made that behavioral inhibition might index components of asthma that are not immune-related. In the present study, we prospectively examined the relationship between behavioral inhibition and airway hyperresponsiveness, and whether hormonal and immune measures often associated with asthma were associated with behavioral inhibition and/or airway hyperresponsiveness. In a sample of 49 yearling rhesus monkeys (mean = 1.25 years, n = 24 behaviorally inhibited animals), we measured in vitro cytokine levels (IL-4, IL-10, IL-12, IFN-γ) in response to stimulation, as well as peripheral blood cell percentages, cortisol levels, and percentage of regulatory T-cells (CD3+CD4+CD25+FOXP3+). Airway reactivity was assessed using an inhaled methacholine challenge. Bronchoalveolar lavage was performed and the proportion of immune cells was determined. Behaviorally inhibited monkeys had airway hyperresponsiveness as indicated by the methacholine challenge (p = 0.031), confirming our earlier retrospective result. Airway hyperresponsiveness was also associated with lower lymphocyte percentages in lavage fluid and marginally lower plasma cortisol concentrations. However, none of the tested measures was significantly related to both behavioral inhibition and airway hyperresponsiveness, and so could not mediate their relationship. Airway hyperresponsiveness is common to atopic and non-atopic asthma and behavioral inhibition has been related to altered autonomic activity in other studies. Our results suggest that behavioral inhibition might index an autonomically mediated reactive airway phenotype, and that a variety of stimuli (including inflammation within lung tissue that is not specifically associated with behavioral inhibition) may trigger the airways response.

Mesenchymal stem cell enhances chondral defects healing in horses

The purpose of this study was to evaluate the effect of intralesional Mesenchymal Stem Cells (MSC) on the treatment of experimentally induced articular chondral defects in horses, emphasizing the benefits of this application in veterinary medicine. Chondral defects were induced in the medial femoral trochlea of both hind limbs of four horses. Thirty days post induction; the horses were divided into two groups. The G1 was submitted to treatment with MSC and the G2 was the control group. Clinical evaluations, synovial fluid analysis and synovial Prostaglandin E2 (PGE2) assessment were performed prior to defects and fortnightly up to 120 and 150 days. Macroscopic, histopathological and histochemical evaluations were performed at the end of the experiment. The treatment with MSC reduced the intraarticular inflammatory process. The G1 showed lower PGE2 concentrations in the synovial fluid and greater percentage of mononuclear cells and lower percentages of lymphocytes and neutrophils. The treatment improved the macro and microscopic aspects of repair tissue. No difference was observed in the scores of lameness between the G1 and G2. The use of MSC in the treatment of chondral defects minimized joint inflammation, as confirmed by synovial fluid analysis. The treatment resulted in an improved repair tissue, verified by macroscopic examination, histochemical and histopathological analysis.

Predictive Value of Low Relative Lymphocyte Count in Patients Hospitalized for Heart Failure With Reduced Ejection Fraction

Background— Low lymphocyte count has been shown to be an independent prognostic marker in heart failure (HF) in the outpatient setting. Limited data exist regarding whether relative lymphocyte count correlates with postdischarge outcomes in patients hospitalized for HF. Methods and Results— We performed a post hoc analysis of the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial, which randomized 4133 patients hospitalized for worsening HF with an ejection fraction ≤40% within 48 hours of admission to tolvaptan or placebo for a median follow-up of 9.9 months. The primary end points of all-cause mortality and cardiovascular mortality or HF hospitalization were analyzed in patients with available baseline complete blood counts (n=3717). Lymphocyte percentage was analyzed as a continuous variable. Times to events were compared using log-rank tests and multivariable Cox regression models. Patients with low lymphocyte percentage tended to be older and had higher rates of comorbid disease (diabetes mellitus, atrial fibrillation, and renal insufficiency). Low lymphocyte counts were associated with wide QRS duration, high natriuretic peptides, and low ejection fraction, blood pressure, and serum sodium. These patients were less likely to receive evidence-based HF medications. After adjusting for 22 known clinical risk factors, a 10% decrease in lymphocytes was associated with an increased hazard of all-cause mortality (adjusted hazard ratio 1.31 [95% CI: 1.14–1.150], P &lt;0.001) and cardiovascular mortality or HF hospitalization (adjusted hazard ratio 1.14 [95% CI: 1.04–1.25], P =0.007) in the first 100 days postdischarge. Lymphopenia during hospitalization normalizes in majority of patients in the early postdischarge period. Conclusions— Low relative lymphocyte count during hospitalization for HF is an independent predictor of poor outcomes in the early postdischarge period, beyond traditional prognostic indicators.

Immune competence of the mammary gland as affected by somatic cell and pathogenic bacteria in ewes with subclinical mastitis

Immune competence of the ewe mammary gland was investigated by monitoring the leukocyte differential count, cytokine pattern, and endogenous proteolytic enzymes in milk samples with different somatic cell counts (SCC) and pathogenic bacteria. Furthermore, the leukocyte differential count and T-lymphocyte populations were evaluated in ewe blood. A total of 1,500 individual milk samples were randomly selected from the pool of the samples collected during sampling and grouped into 5 classes of 300 samples each, on the basis of SCC. Classes were <300,000cells/mL, from 300,000 to 500,000cells/mL, from 501,000 to 1,000,000cells/mL, from 1,001,000 to 2,000,000cells/mL, and >2,000,000cells/mL. Microbiological analyses of ewe milk were conducted to detect mastitis-related pathogens. Sheep whose udders were without clinical abnormalities, and whose milk was apparently normal but with at least 103cfu/mL of the same pathogen were considered to have subclinical mastitis and therefore defined as infected. Polymorphonuclear neutrophilic leukocytes (PMNL) and macrophages increased with SCC, whereas lymphocytes decreased. Milk samples with SCC >1,000,000cells/mL showed differences in leukocyte populations between uninfected and infected ewes, with higher percentages of PMNL and macrophages and lower percentages of lymphocytes in infected animals. Nonviable PMNL levels were the highest in ewe milk samples with SCC <300,000cells/mL; starting from SCC >500,000cells/mL, nonviable PMNL were higher in uninfected ewes than in infected ones. In infected animals giving milk with SCC >1,000,000cells/mL, a higher CD4+/CD8+ ratio was observed, suggesting that the presence of pathogens induced an activation of both CD4+ and CD8+. The levels of tumor necrosis factor-α and IL-12 were higher in infected than uninfected ewes, irrespective of SCC. Plasmin activity increased along with SCC and was always higher in infected than uninfected animals; cathepsin D increased starting from 1,001,000cells/mL in milk samples from noninfected ewes and starting from 301,000cells/mL in milk samples from infected animals. The associations between somatic cells, cytokines, endogenous proteolytic enzymes, and pathogenic bacteria can be used to better understand the pathogenesis of subclinical mastitis in ewes and the effect on the immune response of ewe mammary gland.

Inverse production of IL-6 and IL-10 by abdominal aortic aneurysm explant tissues in culture

Abdominal aortic aneurysm is considered an atherosclerosis-related disease, but the mechanisms underlying abdominal aortic aneurysm remain poorly defined. Despite the large number of cytokines identified in an aneurysm sample, the relative importance of particular cytokines in aneurysm formation is unknown. We have studied the production of interleukin-6 and interleukin-10 cytokines in plasma and cultures of abdominal aortic aneurysm explant samples obtained from patients subjected to elective surgery and their correlation with cellular composition. Inflammatory cells from the abdominal aortic aneurysm samples were phenotypically characterized using specific monoclonal antibodies (anti-CD3, -CD4, -CD8, -CD19, -CD38, -CD68, -HLA-DR) by means of immunocytochemistry staining. Production of interleukin-6 and interleukin-10 in culture supernatants of abdominal aortic aneurysm explant samples expanded in vitro for 24 h was measured by enzyme-linked immunosorbent assay. We showed that the levels of interleukin-6 and interleukin-10 in supernatants of abdominal aortic aneurysm sample cultures were higher by 73 and 86 times compared to their levels in plasma, respectively. In individual abdominal aortic aneurysm explant cultures, a negative correlation between interleukin-6 and interleukin-10 production was observed. Such inverse correlation was not detected in plasma. Based on these results, we divided abdominal aortic aneurysm into two cytokine-producing groups and showed that the interleukin-6(hi)/interleukin-10(lo) group contained higher percentages of granulocytes, HLA-DR(+), and CD68(+) cells but lower percentages of lymphocytes and plasma cells compared to the interleukin-6(lo)/interleukin-10(hi) group. Exogenously added interleukin-10 suppresses the production of interleukin-6 by abdominal aortic aneurysm explants. These results suggest that interleukin-6 and interleukin-10 may have a different role in the pathogenesis of abdominal aortic aneurysm.

Blood leukocytes in heart failure with preserved ejection fraction: Impact on prognosis

Heart failure (HF) with preserved ejection fraction (HFpEF) is an emerging problem of cardiovascular medicine with increasing prevalence and poor prognosis [1,2]. The pathophysiological mechanisms of HFpEF are still poorly understood. Leukocytes play important role in the pathogenesis and prognosis of HF with reduced ejection fraction (HFrEF) via their contribution to inflammation, extracellular matrix remodelling, and reparatory processes [3]. Relative lymphopenia is a strong predictor of mortality in severe HFrEF [4,5]. In contrast, neutrophils are often increased in HFrEF and pose an increased risk of all-cause and cardiovascular mortality [6]. However, only scarce data are available on the impact of leukocytes on pathophysiology and outcome in HFpEF. In this study we aimed to compare levels of neutrophiles, lymphocytes and monocytes between patients with HFrEF and HFpEF and to establish their impact on the mortality in HFpEF. The total number of 1019 HF patients referred the Cardiology Clinic of the Grodno Regional Clinical Hospital in 2008–2009 with either HFpEF (n=856, age 55[49–64], 81% males) or HFrEF (n=163, age 58[51–65], 56% males) were included into the study. The diagnosis of HFrEF or HFpEF was established according to the current ESC guidelines [7]. Patients with life expectancy b1 year due to noncardiac courses (e.g., cancer) and those with terminal HF (NYHA class IV) were not included. All subjects underwent transthoracic echocardiography with LVEF measured using the modified Simpson's biplane method and diastolic function assessed by evaluating E/A ratio. The leucocytes were measured using an automatic haematocytometer (Micros-60 Horiba, ABX Diagnostics, France). The patients were followed for at least 1 year with median (interquartile range) follow-up duration of 17[14–20]months with the end-point of any-cause death registered. The study was approved by the Institutional Research Board of the Grodno State Medical University. The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology [8]. Most patients had mild HF (NYHA I–II class in 98% of HFpEF, 82% of HFrEF) predominantly of ischemic aetiology (74% of HFpEF, 73% of HFrEF). Patients with HFrEF had lower body mass index (p=0.017), and proportion of patients with history of hypertension (pb0.001), higher proportions of males (pb0.001), and subjects with history of previous myocardial infarction (p=0.002). PatientswithHFpEF as comparedwithHFrEF had significantly lower neutrophil count (4140[3498–5293] vs. 3933[3247–4760] per μl, p=0.004) and percentage (63[58–68]% vs. 65[59–69]%, p=0.018) and higher lymphocyte percentage (30[26–34]% vs. 29[24–33], p=0.004). On regression analysis, significant clinical predictors of reduced LVEF in the whole study population were advanced age, male sex, history of hypertension and atrial fibrillation (pb0.05). Among leukocytes, high neutrophil count and percentage and low lymphocyte percentage were associated with reduced LVEF and remained so after adjustment for the clinical predictors above (pb0.05). During the follow-up period, 41 deaths (4.02%) occurred (28 in HFpEF and 13 in HFrEF). Using logistic regression analysis, a history of hypertension was the only significant clinical predictor of death in HFpEF. Among leukocytes, high monocyte count was predictive of death in HFpEF before (p=0.01) and after (p=0.012) adjustment for age, LVEF, and hypertension (p=0.012) (Table 1). In HFpEF 0167-5273/$ – see front matter © 2011 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2011.12.049

Abstract 5583: Innate immune profile of inflammatory breast cancer patients

Abstract Background: Inflammatory breast cancer (IBC) is a rare but highly aggressive form of the disease but the immune profile associate with pathology and disease progression is poorly characterized. The cells of the innate immune system including natural killer (NK) and dendritic cells (DC) can establish the conditions for an adaptive response to the tumor and can actively kill tumor cells. Alternatively, the inflammatory conditions created by these cells can promote processes like metastasis and invasion. Here we report that immune activation in IBC is associated with a poor prognosis. Methods: A total of 76 breast cancer (BC) patients starting a new line of therapy (22 IBC, 23 metastatic IBC, 8 locally advanced breast cancer, and 23 metastatic) were evaluated for immune phenotypes and cytokine synthesis by DC activated through toll-like receptors (TLR) 7 and 8. Results: Among evaluable patients, 39 (58%) had hormone receptor positive (HR+) primary tumors, 20 (31%) were Her2 positive, and 18 (26%) were triple negative (TN). Among IBC patients, 23 (49%) were HR+, 15 (33%) were Her2+, and 14 (31%) were TN. Among non-IBC patients, 16 (73%) were HR+, 5 (22%) were Her2+, and 4 (17%) were TN. With a mean follow-up time of 7.8 months, 11 (16%) of the patients (10 IBC) died of disease. Most strikingly, BC survivors had a higher median CD4 count than deceased patients (p = .023) and was a significant predictor of outcome (p = 0.01). CD3 and CD19 lymphocytes of BC survivors had higher expression of CXCR4 than deceased patients (p = .038 and p = .029). In contrast, survivors also had lower lymphocyte percentages of all NK sub-types including ADCC NK (p = .008), non-ADCC NK (p = .001), exhausted (p = .014) and non-exhausted NK (p = .005) than deceased patients. Although DC counts were not significantly different, the percentage of TLR-induced pDC producing IFN-α was lower in BC survivors than deceased patients (p = 0.025). Conversely, the percentage of pDC constitutively producing the anti-inflammatory cytokine IL-10 was higher in survivors compared to non-survivors (p = .007). Compared with IBC non-survivors, IBC survivors had a higher % of pDC producing IL-10 (p = 0.005) and fewer mDC producing TNF-α (p = .030) following TLR activation. With respect to antigen presentation, mDC of BC survivors had lower expressions of the co-stimulatory molecules CD40 (p= .036), CD80 (p = .013) and CD86 (p = .006) than mDC of deceased patients. Conclusion: We observed low CD4 counts in IBC that were associated with a poor prognosis. Additionally, immune activation as evidenced by DC pro-inflammatory cytokine production, expression of costimulatory molecules, and increased NK counts was associated with poor prognosis. Together, these data suggest that the innate immune system is highly active in the late stages of disease but the adaptive response is severely compromised by factors still unknown that can contribute to the peculiar clinical presentation and aggressive features of the disease. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 5583.

Ocena odsetka limfocytów B z ekspresją koreceptorów CD40, CD22 i CD72 w przerosłych migdałkach gardłowych dzieci chorych na wysiękowe zapalenie ucha

In hypertrophied adenoid lymphocytes B make up about 60% all lymphocytes. When the lymphocytes B come in interaction with antigens this membranes signal be passed through their receptor (BCR) to interior of cell. This signal affect modulation on gene expression, activation from which depends activation, anergy or apoptosis of lymphocyte B. Accompany BCR co-receptors regulate his functions influence stimulate or inhibitive. To the most important co-receptors stepping out on lymphocyte B belong: CD40, CD22, CD72. The aim of study was evaluation of lymphocytes B (CD19) with co-expression with CD72 and CD40 receptors in hypertrophied adenoid with at children with otitis media with effusion. An investigation was executed in hypertrophied adenoids with or without otitis media with effusion. By flow cytometry percentage of lymphocytes B with co-receptors CD 40, CD22 and CD72 in was analyzed. The percentages of CD19+CD72+ lymphocytes in the group of children with adenoid hypertrophy and exudative otitis media were lower as compared to the reference group. However, the percentages of CD19+CD22+, CD19+CD40+ in the study group was approximate to the reference group. The lower percentage of lymphocytes B CD72 + near approximate percentages of lymphocytes B CD40+ and BCD22+ at children with otitis media with effusion can be the cause of incorrect humoral response in hypertrophied adenoid at children. Maybe it is cause reduced spontaneous production IgA and IgG through lymphocyte at children with otitis media with effusion.

Environmental Contaminants in White-Winged Doves (Zenaida asiatica asiatica) from the Lower Rio Grande Valley of Texas, USA

Our study determined if white-winged doves (WWDs; Zenaida asiatica asiatica) breeding in locations where environmentally persistent contaminants occur in the Lower Rio Grande Valley of Texas have levels of contaminants that can hinder reproduction. During summer 2003, 70 (32 males, 38 females) adult WWDs were collected from 8 at-risk sites. Liver tissues were analyzed for ten major and trace elements and muscle tissues were analyzed for 20 organochlorine compounds, 21 polychlorinated biphenyl congeners, and toxaphene. Samples were compared to ten (five male, five female) captive-raised control WWDs. Arsenic, chromium, and lead were not detected or were below the detection limit, whereas copper, zinc, selenium, mercury, nickel, cadmium, and silver were detected in 70 (100%), 70 (100%), 52 (74%), 21 (30%), 4 (6%), 1 (1%), and 1 (1%) WWDs, respectively. None of the detected elements had significant sampling site, bird gender, or Site x Gender interactions, and each occurred at background levels. Toxaphene and polychlorinated biphenyls were not detected, whereas DDE, dieldrin, gamma-BHC, and chlordane were detected in 13 (19%), 5 (7%), 2 (3%), and 1 (1%) field-collected WWDs, respectively, but all concentrations occurred at background levels. Concentrations of elements and compounds in field-collected WWDs did not significantly differ from those of the controls. Correlations between leukocyte counts and detectable contaminants generally indicated no correlation between each percentage of leukocyte type present and levels of selenium, copper, zinc, mercury, or DDE detected. One sample that had 0.072 mug/g dieldrin exhibited a low lymphocyte percentage (66%) out of only five samples. Comparisons could not be made with gamma-BHC, chlordane, or the other elements that had a low number of samples with detectable levels. Overall, concentrations of elements and organochlorines found in WWDs were below levels known to impair reproduction and survival in birds.

Factors associated with mortality in an inpatient acute palliative care unit at a comprehensive cancer center

20756 Background: Predicting inpatient mortality has clinical and financial implications and helps improve the care of advanced cancer patients and their families. Models are available for mortality prediction in intensive care units with excellent validity and reliability. The purpose of this study was to determine factors associated with increased likelihood of mortality in an acute palliative care unit (PCU). Methods: We reviewed the medical records of 357 patients admitted to the PCU and collected information regarding demographic factors, tumor type, hospital length of stay, source of admission, and insurance type. Symptom intensity, vital signs, relevant laboratory tests and presence/absence of delirium were obtained from the palliative care consultation preceding PCU admission. Univariate and multivariate analyses were conducted to compare factors in patients who died in the PCU vs. those who were discharged alive. Results: 93 (26%) patients died in the PCU. The results for univariate and multivariate analyses are described in the table. Surprisingly, no statistically significant association was found between inpatient death and delirium or low lymphocyte percentage. Borderline association was found between inpatient death and high bilirubin, high LDH, elevated white blood cell counts and also with hematologic malignancy. Conclusion: We have observed significant association of certain factors with increased likelihood of PCU death in advanced cancer patients. These findings need to be validated in a larger prospective study to develop a model predicting PCU mortality for advanced cancer patients. Factor Univariate Analysis Multivariate Analysis OR p OR p Medicare/Medicaid vs. Private or Self pay 0.59 0.044 Age ≥ 65 vs. < 65 0.49 0.010 0.36 0.001 Consultation team referral vs. Emergency Center 2.54 0.114 1.74 0.380 Consultation team referral vs. outpatient center 4.03 0.005 3.93 0.009 Low platelets (<140.000) 2.15 0.003 Low sodium (<135) 1.81 0.021 2.75 0.001 High sodium (>147) 3.67 0.047 3.05 0.110 Low CO2 (<23) 2.29 0.004 High BUN (>20) 1.93 0.014 High heart rate (≥101) 2.07 0.006 High respiratory rate (≥21) 1.88 0.010 1.80 0.036 Supplemental O2 use 2.80 < 0.001 2.35 0.003 Dyspnea * 1.16 0.002 * Not included in the multivariate model. No significant financial relationships to disclose.

Características hematológicas e fator de condição relativo (Kn) associados ao parasitismo em Schizodon borellii (Osteichthyes, Anostomidae) e Prochilodus lineatus (Osteichthyes, Prochilodontidae) do ri

Forty-two adult specimens of “piava”, Schizodon borellii (Boulenger, 1900), and 42 adult specimens of “curimbata”, Prochilodus lineatus (Valenciennes, 1836), were captured in the floodplain of the upper Parana River, PR, Brazil, in February 1994 and in March 1995. The aim of the present research was to verify changes caused by parasitism in the blood profile of the above species. The number of erythrocytes (Er), hematocrit (Ht), hemoglobin rate (Hb), percentage of leukocytes were determined and absolute hematimetric indexes, mean corpuscular volume, mean corpuscular hemoglobin and mean corpuscular hemoglobin concentration were calculated. Parasites collected from gills and intestines were processed by routine methods. Nine specimens of S. borellii were infested with Dactylogyridae in the gills showing mean infestation intensity (MII) of 278.3 (1 to 1740) and 16 were infested with Cucullanus pinnai (Nematoda: Cucullanidae) in the intestine (MII = 3.3; 1 to 9). Six other fish were infested with Dactylogyridae (MII = 121.5; 2 to 360) and with C. pinnai (MII = 2.0; 1 to 4). No parasite infestation occurred in eleven fish. With regard to this species, no significant change in leukocytes differential counts or in the red series for parasitized fish was found. Individuals with Dactylogyridae were the only ones with special granulocytic cell and without eosinophils. Ten P. lineatus showed Dactylogyridae in the gills with MII = 86.9 (1 to 239), six were infested with Ergasilidae (MII = 27.5; 1 to 81), just one presented Neoechinorhynchus curemai (Acantocephala: Neoechinorhynchidae) in the intestine, and 25 were not parasitized. Dactylogyridae infestation in gills of this species caused only a decrease in hemoglobin rate. Significant differences occurred in Hb and in lymphocyte, neutrophil and monocyte percentages in fish infested with Ergasilidae. The specimen with N. curemai had low percentage of lymphocytes and a high percentage of neutrophils and monocytes. Relative condition factor (Kn) registered that parasites do not affect significantly the hosts’ condition.

PERIPHERAL BLOOD COUNT FOR DENGUE SEVERITY PREDICTION: A PROSPECTIVE STUDY IN THAI CHILDREN

INTRODUCTION: Dengue viral infection has a wide range of severity levels and requires different levels of medical attention. Early severity prediction using clinical features is difficult. Certain lymphocytic subtypes can be used to predict severity; we postulate that peripheral blood counts can also predict severity, which would be more useful in smaller rural hospitals. OBJECTIVE: We aimed to compare the peripheral blood counts between patients with mild dengue infection and those with severe dengue infection and identify simple yet sensitive early severity predictors. METHODS: We enrolled 91 patients with serologically confirmed dengue infection who were admitted to King Chulalongkorn Memorial Hospital. Their leukocytic counts on admission were compared. Potential predictors were identified by using receiver-operating-characteristic analysis. RESULTS: Compared with patients with mild infection, those with severe infection (dengue hemorrhagic fever grade II or worse) had a higher leukocyte count (3580 vs 3050 cells per μL; P = .04), and fewer had leukopenia on admission (70% vs 89%; P = .03). They also had a lower percentage of “typical” lymphocytes (24% vs 40%; P = .02). Two predictors were identified; either one classified ∼19% of all admitted patients as being at low risk. Typical lymphocyte counts of &amp;lt;40% excluded patients with mild disease with 89% sensitivity and 24% specificity (negative predictive value: 77%; positive predictive value: 45%). A combination of parameters [(white blood cells per μL) + 470 × (% typical lymphocytes) + 5 × (atypical lymphocytes per μL) ≥−14 950] improved the sensitivity and specificity to 92% and 26% (negative predictive value: 82%; positive predictive value: 46%). CONCLUSIONS: The absence of leukopenia and a low percentage of typical lymphocytes predict severe dengue illness. Simple hematologic parameters may be used to reduce unnecessary admissions of patients with suspected dengue infection in the absence of more sophisticated predictors.

Safety and efficacy of intravesical bacillus Calmette-Guérin instillations in steroid-treated and immunocompromised patients

14507 Background: We assess the safety and efficacy of intravesical bacillus Calmette-Guérin (BCG) for high-risk superficial bladder cancer in steroid-treated and immunocompromised patients. Methods: We retrospectively reviewed charts of 697 patients treated with BCG instillations from 1991 to 2004. In 24 patients (3.5%), either an underlying comorbidity directly affecting the immune system was diagnosed before BCG administration, or steroids were administered at least 6 weeks before and at the time of BCG instillations. The immunosuppressive effect of the steroids was assessed by percentage of lymphocytes. End-points were BCG response at 6 months (defined as normal cystoscopy, cytology, and biopsy when available) and treatment-related toxicity. Results: Four patients (17%) had an active lymphoma or chronic lymphocytic leukemia during administration of BCG, and 21 (88%) had a concurrent condition for which oral steroids (11 patients), inhaled steroids (14 patients), or both (4 patients) were administered. Patients treated with oral steroids had a lower percentage of lymphocytes (12.3%) compared to patients treated with inhaled steroids (17.5%) or 15 age-matched patients with high-risk superficial bladder cancer and no steroid treatment (18.6%). The overall BCG response rate at 6 months was 58%. Of the 24 patients, 10 had disease recurrence and 3 had disease progression at a median follow-up of 63.5 months (IQR 19.5, 89). One patient treated with oral steroids developed a self-limited febrile disease and worsening of myalgia 48 hours after his third BCG cycle. No other systemic adverse event following BCG therapy was recorded, and all patients completed their scheduled treatments. Conclusions: Intravesical BCG is a viable therapeutic option for patients with high-risk superficial bladder cancer and concomitant lymphoma or chronic lymphocytic leukemia, treatment with low-dose oral steroids, or treatment with inhaled steroids. The BCG response rate at 6 months and the side effects profile associated with BCG therapy in these patients are comparable to patients with no evidence of immunosuppression. Further studies are warranted to assess the safety and efficacy of BCG instillations in critically immunocompromised patients. No significant financial relationships to disclose.

A low lymphocyte percentage is a predictor of mortality and hospitalization in hemodialysis patients

Lymphocyte percentage (LYM%), an independently measured value to reflect peripheral lymphocyte count and a possible nutritional marker, may be related to clinical outcome in maintenance dialysis (MHD) patients. We examined the associations of the baseline white blood cell count (WBC) and LYM% with 12-month mortality and three measures of hospitalization in a cohort of 1,283 MHD patients from 10 outpatient DaVita dialysis clinics in Los Angeles County, as well as in a subcohort of 372 MHD patients with additional measures of inflammation, nutrition and comorbidity. Multi-variate Cox and Poisson models that included 13 co-variates including case-mix features, dialysis dose, blood hemoglobin and serum albumin were explored. Patients, aged 57.8 +/- 15.2 years, included 49% men and 49% diabetics. Baseline WBC was 7,353 +/- 2.427 per microl, and LYM% was 21.2 +/- 7.3%. LYM% had significant correlations with "malnutrition-inflammation score" and inverse correlations with serum interleukin-6. The WBC and LYM% had significant but opposite predicting values for mortality and hospitalization, indicating that a high WBC and a low LYM% were each independently associated with increased mortality. After dividing each variable into four quartiles, only the highest WBC quartile (> or = 8,500) but not the other middle two quartiles, predicted increased mortality. However, all three lower quartiles of LYM% vs. the highest quartile (based on quartile cutoffs of 16%, 20.3% and 25.5%) were significantly and progressively associated with greater risks of mortality and hospitalizations. The absolute lymphocyte count (LYM% times WBC/100) exhibited somewhat similar trends but its outcome predictability was not as strong as LYM%. A high WBC and a low LYM% are associated with significant increase in mortality and hospitalization in MHD patients. Lymphocyte percentage, compared to absolute lymphocyte count, appears to be a better nutritional and anti-inflammatory marker and a more sensitive predictor of mortality and hospitalization in MHD patients.

Evaluation of Bronchoalveolar Lavage Fluid Phospholipids and Cytokine Release by Alveolar Macrophages as Prognostic Markers in Sarcoidosis

Background: The clinical course of sarcoidosis is unpredictable and reliable laboratory prognostic parameters are lacking. Objectives: The aim of the present study was to estimate the prognostic value of bronchoalveolar lavage fluid (BALF) phospholipids and cytokine production by alveolar macrophages (AM) in pulmonary sarcoidosis. Methods: We investigated BALF parameters in 64 subjects (55 patients with sarcoidosis and 9 healthy volunteers as controls). After a period of 12 months, the total sarcoidosis study population was divided into three groups according to radiological, functional and laboratory dynamics: the group with a favorable (n = 15), the one with an unfavorable (n = 16) and the one with an intermediate clinical course of the disease (n = 24). Results: The group of patients with a poor clinical outcome was characterized by a lower percentage of lymphocytes in BALF [20% (4–56%)], rather small amounts of cytokines [TNF-α: 1.5 ng/ml/10⁶(0.08–8.6), IL-6: 5.75 ng/ml/10⁶ (1.7–22.5)] and a significant decrease in BALF phospholipids [total lipid phosphorus (TLP): 29.9 µmol/l (13.8–68.3) as compared to 67.5 µmol/l (33.2–127.2) in controls]. Patients with a favorable clinical outcome were shown to have higher lymphocytosis (40%, range 6–64, p < 0.05 versus poor outcome), intensive TNF-α and IL-6 release by AM, and close to normal phospholipid content in BALF. Conclusions: The level of TNF-α secretion by AM <3.9 ng/ml/10⁶ and total lipid phosphorus in BALF less than 30 µmol/l may serve as markers of poor prognosis in pulmonary sarcoidosis.

The Grade of Acute Thymus Involution in Neonates Correlates with the Duration of Acute Illness and with the Percentage of Lymphocytes in Peripheral Blood Smear

In various stressful conditions, the thymus is subjected to incidental involution, mostly due to the thymocytolytic effect of secreted glucocorticosteroids. The aim of this study was to examine acute thymic involution in sick neonates and to compare the morphological grade with some clinical and laboratorial parameters. The influence of the illness on thymus tissue was investigated in 100 neonates who were treated and died in a neonatology intensive care unit. The preterm infants (n = 73) were born before the 37th week of gestation. Analysis of 57 placentas showed inflammation in 32% and circulatory disturbances in 23% of the cases. The causes of death were confirmed by autopsy: 35 were preterm infants with respiratory distress syndrome without infection, 22 were malformed, and 10 had birth trauma or asphyxia. In contrast, 29 of the preterm infants had an infection, mostly pneumonia or sepsis, and 4 of the term infants had such infections. Acute thymus involution was histologically graded (0–4) according to the method of van Baarlen (see text). Resting state (grade 0) was found in 25 of 38 neonates who lived <12 h. In 13 of 38 neonates who lived <12 h, thymus involution suggested prenatal stress. The grade of thymus involution related to the duration of illness (p < 0.001). Placental inflammation was associated with features of thymus involution (p < 0.048). Infection as a cause of death was connected to advanced thymus involution (p < 0.001). In preterm newborns, infection was more often connected with acute thymus involution than was respiratory distress syndrome (p < 0.003). Among the parameters measured in all avaiable peripheral blood samples taken 24 h before death, only the lymphocyte count related to the grade of acute thymus involution (p < 0.05), with an increase in percentage of lymphocytes in peripheral blood smears from grade 0 to 2 and a decrease from grade 2 to 4. Although the white blood cell count is highly variable, a low percentage of lymphocytes might be a sign of advanced accidental thymus involution following acute stress.

Immunohistochemical characterization of estrogen and progesterone receptors in lymphoma of horses.

Immunohistochemical techniques were used to examine 29 cases of equine lymphoma for estrogen receptor (ER) and progesterone receptor (PR) expression. The lymphomas examined included T-cell-rich large B-cell lymphomas, B-cell neoplasms, and T-cell lymphomas. The individual cases were also classified according to the anatomic location of the tumors. One normal equine lymph node was also examined for ER and PR expression. All of the cases of equine lymphoma and the normal lymph node were negative for Er. A total of 16/29 (55%) PR-positive lymphomas were identified. Seven of the 12 (58%) T-cell-rich large B-cell lymphomas were positive, 7/11 (64%) B-cell tumors were positive, and 2/6 (33%) T-cell neoplasms were positive. Anatomically, 6/9 (66%) subcutaneous lymphomas were PR positive, 3/5 (60%) intrathoracic lymphomas were positive, 1/4 (25%) intra-abdominal lymphomas were positive, 2/5 (40%) intra-abdominal/intrathoracic lymphomas were positive, 1/2 (50%) upper airway lymphomas were positive, and 3/3 (100%) splenic lymphomas were positive. One case involving abdominal and thoracic tumors and leukemia was negative for PR expression. The normal lymph node contained a low percentage (1.9%) of PR-positive lymphocytes. The presence of PR in neoplastic equine lymphoid tissue indicates that these tumors may be responsive to serum progesterone. Also, identification of PR-positive cells in the normal lymph node suggests that PR may be constitutively expressed in normal equine lymphocytes. Further studies are needed to quantify PR levels in normal and malignant equine lymphoid tissue and to determine the usefulness of either progestin or antiprogestin drugs in the management of equine lymphoma.