Neutrophil Platelet Research Articles

CX3CR1 Depletion Promotes the Formation of Platelet-Neutrophil Complexes and Aggravates Acute Peritonitis.

Peritonitis is a life-threatening condition on intensive care units. Inflammatory cytokines and their receptors drive inflammation, cause the formation of platelet-neutrophil complexes (PNCs) and therefore the migration of polymorphonuclear neutrophils (PMNs) into the inflamed tissue. CX3CL1 and its receptor CX3CR1 are expressed in various cells, and promote inflammation. The shedding of CX3CL1 is mediated by a disintegrin and metalloprotease (ADAM) 17. The role of the CX3CL1-CX3CR1 axis in acute peritonitis remains elusive. In zymosan-induced peritonitis, we determined the formation of PNCs in the blood and the expression of PNC-related molecules on PNCs. PMN migration into the peritoneal lavage was evaluated in wild-type (WT) and CX3CR1-/- animals by flow cytometry. CX3CL1, ADAM17, and the expression of various inflammatory cytokines were detected. Further, we determined the inflammation-associated activation of the intracellular transcription factor extracellular signal-regulated kinase 1/2 (ERK1/2) by Western blot. The PMN accumulation in the peritoneal lavage and the PNC formation in the circulation were significantly raised in CX3CR1-/- compared with WT animals. The expression of PNC-related selectins on PNCs was significantly increased in the blood of CX3CR1-/- animals, as well as cytokine levels. Further, we observed an increased activation of ERK1/2 and elevated ADAM17 expression in CX3CR1-/- during acute inflammation. Selective ERK1/2 inhibition ameliorated inflammation-related increased ADAM17 expression. A CX3CR1 deficiency raised the release of inflammatory cytokines and increased the PNC formation respectively PMN migration via an elevated ERK1/2 activation during acute peritonitis. Further, we observed a link between the ERK1/2 activation and an elevated ADAM17 expression on PNC-related platelets and PMNs during inflammation. Our data thus illustrate a crucial role of CX3CR1 on the formation of PNCs and regulating inflammation in acute peritonitis.

Effect of systemic immune-inflammation index on prognostic parameters and survival in patients with breast cancer under the age of 40 years

Objective: Systemic immune inflammation index, which is one of the systemic inflammatory markers obtained by using peripheral blood cells, neutrophils, lymphocyte and platelet counts, has been previously shown to be prognostic in many types of cancer, and it has been also shown in previous studies that SII was associated with prognosis in patients who received adjuvant and neoadjuvant therapy in breast cancer. In our study, the evaluation of the potential prognostic importance of SII in patients with breast cancer diagnosed before the age of 40 was aimed.
 Material and method: For the study, demographic, histopathological, clinical and file data of 129 patients who were diagnosed with breast cancer in the tertiary medical oncology outpatient clinic and were 40 years old and younger at the time of diagnosis were recorded retrospectively. SII was calculated according to the neutrophil count x platelet number/lymphocyte (NxP / L) formula, and those below the optimal cut-off value obtained by ROC analysis were classified as low SII, and those above it as High SII. The relationship between breast cancer clinicopathological variables and SII was evaluated by Chi-Square test. While the effect of SII on survival was evaluated by Kaplan Meiermethod, the Logrank test was used to evaluate survival in low and high groups.
 Results: For the study, 1400 patients diagnosed with breast cancer were reviewed and 129 patients who were under the age of 40 at the time of diagnosis were included. Patients who had insufficient follow-up or whose pre-treatment hemogram values could not be reached, who had medication use that could affect their hemogram parameters, and those with inflammatory diseases were not included. The median age in the study was 35, and the youngest patient was 21 years old. In the study group, based on the SII cut-off value of 720 calculated according to the roc analysis, 73 patients were in the low SII group and 56 patients were in the high SII group. When the relationship between prognostic factors of the patients and SII was examined, no statistically significant relationship was observed between age, hormone receptor status, Her-2 status, histological subtype, clinical stage, grade, Ki 67 status, lymph node involvement and SII. However, in the survival analysis, although the median value could not be reached between the two groups, there was a significant difference in overall survival with SII (p = 0.051) and it was observed that survival was worse in the high SII group, and the 3 and 5-year survival rates were worse in the high group compared to the low ones.
 Conclusion: In our study, we reached the conclusion that SII can be an independent prognostic factor for survival in patients with breast cancer diagnosed at 40 years of age or younger. Considering the SII status together with other prognostic factors in diagnosis, a more intensive treatment plan can be made for the patients. However, well-designed prospective studies including more patients are needed for the routine use of SII.

How important are mean platelet volume and neutrophil values in diabetic foot amputation decision?

Previous studies have shown mean platelet volume (MPV) levels to be an important biomarker in the formation of foot ulcers in diabetic patients. The aim here was to show whether MPV, monocyte, platelet, and neutrophil levels could guide diabetic foot amputation. Two groups of patients diagnosed with type 2 diabetes and homogeneous in terms of age, sex, diabetes duration, body mass index (BMI), and hemoglobulinA1C (HbA1C) levels were included. The first group consisted of 36 patients with amputation, and the second group consisted of 30 patients with ulceration but no indication for amputation. Besides overall demographic characteristics, preoperative HbA1C, MPV, platelet, monocyte, and neutrophil levels were determined in both groups. The amputated group had higher MPV and neutrophil levels than the non-amputated control group (p = 0.028 and p < 0.001, respectively). Neutrophil levels could differentiate amputations at a rate of 69.44% and non-amputations at 76.67%. Platelet levels were not statistically significant in differentiating between amputated and non-amputated patients (p = 0.064). Neutrophil levels were 1.207 times higher, and platelet levels were 1.005 higher in the amputation group (p < 0.05). The atherosclerotic process that occurs during the course of diabetes is thought to be associated with high MPV levels in patients with diabetic foot ulcers. However, the findings obtained here support the use of neutrophil and platelet levels as a marker to predict amputation in diabetic foot monitoring. Further prospective studies with larger numbers of patients are needed to determine the role of MPV levels in the follow-up of diabetic foot ulcers. Level III, risk/prognostic study.

Haploidentical hematopoietic stem cell transplantation for patients with myeloid sarcoma: a single center retrospective study

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) has been regarded as a potential strategy for myeloid sarcoma (MS). The previous reports focused mainly on matched sibling donor (MSD) or matched unrelated donor (MUD) transplantation. There are no reports on haploidentical HSCT (haplo-HSCT) in MS. We retrospectively reviewed 14 MS patients who underwent haplo-HSCT. All patients achieved complete donor engraftment. The median time for neutrophil engraftment and platelet engraftment were 10 (12-21) days and 18 (8-31) days. The 100-day cumulative incidence of grade II-IV acute graft-versus-host disease (GVHD) and 3-year cumulative incidence of chronic GVHD were 37.7% (95%CI, 23.2-52.1%) and 35.7% (95%CI, 22.2-49.2%). Cytomegalovirus (CMV) reactivation was documented in 86% patients, and only one patient developed CMV pneumonia. Treatment-related mortality occurred in one (7%) patient. The 1- and 3-year cumulative incidence of relapse was 21.4% (95%CI, 11.8-31.1%) and 35.7% (95%CI, 22.4-49.0%). The probability of overall survival at 1 and 3years was 71.4% (95%CI, 51.3-99.5%) and 64.3% (95%CI, 43.5-95.0%), respectively. The probability of disease-free survival at 1 and 3years was 71.4% (95%CI, 51.3-99.5%) and 57.1% (95%CI, 36.3-89.9%), respectively. In conclusion, haplo-HSCT is a feasible method for patients with MS who have no MSD or MUD.

The effect of Mmoringaoleifera leaf extract on mean platelet volume and neutrophil to lymphocyte ratio in lupus

Introduction: No definitive treatment is available for Lupus. Moringaoleiferais one of promisingnovel treatments in Lupus trough anti inflammation and immunosupresion. Mean platelet volume andneutrophil to lymphocyte ratio used to measure degree of lupus activities.&#x0D; Objective: Our study wasaimed to identify the effect of Moringaoleiferaextract on the Mean platelet volume and neutrophil to lymphocyte ratio in lupus.&#x0D; Methods: This experimental study was conducted in 30 lupus patients,located in the rheumatology clinic at Moewardi General Hospital in January-March 2019. The studygroup was divided into two groups: the treatment research group received 2 grams of moringa extractper day and the placebo group. The study was conducted for 4 weeks and was evaluated when thestudy was completed. MPV and NLR examination using a hemocytometer. Statistical analysis wasperformed using paired T test, independent T-test. The p value was considered significant when the p &lt; 0.05.&#x0D; Results: The results showed a decrease in MPV (delta MPV = 4.141; r 0.656; p-0.02) anda decrease in Neurophil to lymfocyte ratio (delta NLR = 4.1391; r 0.489; p-0.04)&#x0D; Conclusion: Thestudy demonstrated the effect of Moringaoleiferaleaf extract on reduced Mean platelet volume andneutrophil to lymphocyte ratio in lupus&#x0D; Bangladesh Journal of Medical Science Vol.20(1) 2021 p.68-73

Predictive Value of Neutrophil Lymphocyte Ratio and Platelet Lymphocyte Ratio in Immediate Outcomes of ST-elevation Myocardial Infarction: A Cross-sectional Study

Introduction: There have been various inflammatory markers implicated in the pathogenesis of Acute Coronary Syndromes (ACS). However, the role of the Neutrophil Lymphocyte Ratio (NLR) and Platelet Lymphocyte Ratio (PLR) as prognostic markers in ST-elevation Myocardial Infarction (STEMI) remains poorly researched. Aim: To determine the prognostic value of NLR and PLR to predict the immediate outcomes in patients with acute STEMI, and if any association exists between NLR/PLR and Thrombolysis in Myocardial Infarction (TIMI) risk score. Materials and Methods: This was a cross-sectional study conducted at a tertiary care centre, Puducherry, India, where 190 patients who presented to casualty with STEMI were enrolled. The patient co-morbidities, personal and family history were obtained. The routine laboratory parameters including platelets, lymphocytes, neutrophils and their corresponding ratios were calculated. Patients were grouped into low and high NLR/PLR groups and were assessed for occurrence of in-hospital mortality or Major Adverse Cardiovascular Events (MACE). Analysis was made to see if there is an association between NLR/PLR and MACE. Chi-square test and one-way ANOVA test was used for statistical significance. Results: Among 190 subjects, 157 male and 33 female with mean age of 55.72±11.24 years were included. A total of 8.94% patients 8.94% had MACE. NLR was positively associated with MACE (p-value=0.0006), whereas PLR was not associated with MACE. Patients with high NLR had 1.45 times higher odds of having MACE. NLR was significantly associated with TIMI risk score. Both NLR (F ratio=6.341) and PLR (F ratio=4.600) showed significant association with Killip classification, however NLR showed higher association (p-value &lt;0.001). Conclusion: NLR can be used as a powerful prognostic marker for predicting immediate MACE and death in STEMI patients. In addition, NLR showed positive correlation with Killip classification and TIMI risk score.

Dynamics in perioperative neutrophil-to-lymphocyte*platelet ratio as a predictor of early acute kidney injury following cardiovascular surgery

Background In this study, we applied a composite index of neutrophil-lymphocyte * platelet ratio (NLPR), and explore the significance of the dynamics of perioperative NLPR in predicting cardiac surgery-associated acute kidney injury (CSA-AKI). Methods During July 1st and December 31th 2019, participants were prospectively derived from the ‘Zhongshan Cardiovascular Surgery Cohort’. NLPR was determined using neutrophil counts, lymphocyte and platelet count at the two-time points. Dose-response relationship analyses were applied to delineate the non-linear odds ratio (OR) of CSA-AKI in different NLPR levels. Then NLPRs were integrated into the generalized estimating equation (GEE) to predict the risk of AKI. Results Of 2449 patients receiving cardiovascular surgery, 838 (34.2%) cases developed CSA-AKI with stage 1 (n = 658, 26.9%), stage 2–3 (n = 180, 7.3%). Compared with non-AKI patients, both preoperative and postoperative NLPR were higher in AKI patients (1.1[0.8, 1.8] vs. 0.9[0.7,1.4], p < 0.001; 12.4[7.5, 20.0] vs. 10.1[6.4,16.7], p < 0.001). Such an effect was a ‘J’-shaped relationship: CSA-AKI’s risk was relatively flat until 1.0 of preoperative NLPR and increased rapidly afterward, with an odds ratio of 1.13 (1.06–1.19) per 1 unit. Similarly, patients whose postoperative NLPR value >11.0 were more likely to develop AKI with an OR of 1.02. Integrating the dynamic NLPRs into the GEE model, we found that the AUC was 0.806(95% CI 0.793–0.819), which was significantly higher than the AUC without NLPR (0.799, p < 0.001). Conclusion Dynamics of perioperative NPLR is a promising marker for predicting acute kidney injury. It will facilitate AKI risk management and allow clinicians to intervene early so as to reverse renal damage.

Detecting the Presence of Inflammation in Fibromyalgia Syndrome With Neutrophil/Lymphocyte Ratio, Platelet/Lymphocyte Ratio, and Mean Platelet Volume

Aim: Our purpose was to determine the presence of inflammation in Fibromyalgia Syndrome (FMS), whether the parameters of neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) and mean platelet volume (MPV) can be used as inflammation markers.Materials and Methods: FMS patients who applied to Hatay State Hospital Physical Medicine and Rehabilitation Clinic in the last two years were analyzed retrospectively from the patient records. 92 participants were enrolled in the study, 43 of them were FMS patients, and 49 were healthy control group. Hemogram, glucose levels, hepatic panel and renal function tests, thyroid and parathyroid function testing, vitamin B12 and 25-hydroxyvitamin D, serum iron panel, folate, lipid panel, erythrocyte sedimentation rate (ESR), C-reactive protein, RF, Bucella agglutination test results were evaluated. Thus, patients with diseases that could affect NLR, PLR, and MPV were not enrolled in the study.Results: No significant difference between the groups in terms of gender distribution was found (p = 0.999). No significant difference between the groups in terms of age was found (p=0.327). When the groups were compared in terms of MPV, the values were found to be lower in the FMS group. Statistically significant difference was not found in both groups in terms of NLR, PLR, White blood count (WBC) and Platelet (PLT) levels (p=0.106; p=0.710; p=0.271; p=0.141, respectively).Conclusion: A significant difference was not found in both groups in terms of NLR and PLR, which were thought to be inflammation markers. The statistically significant higher values of mean ESR values in the FMS group indicate that inflammation may be present in the pathogenesis of FMS, but NLR and PLR cannot be used as indicators of inflammation, so correlating these rates with the severity of symptoms would be meaningless.

New inflammatory markers in diagnosing acute appendicitis

Aim: Acute appendicitis (AA) is the most common cause of abdominal pain, acute abdomen and emergency abdominal operation. The diagnosis of AA is usually based on clinical history and physical examination. Assessment of the systemic inflammatory response of the neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR), which can be achieved through a simple blood count such as a complete blood count, is shown as a new biomarker. The aim of our study is to examine whether readily available markers such as NLR, PLR, RDW, and MPV can be used to distinguish AA whether complicated and uncomplicated appendicitis cases.Materials and Methods: We retrospectively reviewed the patients who had been admitted to the Erzurum Regional Education and Research Hospital between January 2016 and June 2016 with abdominal pain complaints and applied appendectomy. Preoperative and postoperative CRP, leukocyte, RDW, neutrophil, platelet values were recorded. The NLO and PLO values were manually calculated from the complete blood count.Results: Preop NLR was found 5.58 ± 4.44 in the appendicitis group and 4.65 ± 4.93 in the complicated appendicitis group. Post op NLO values were 2.87 ± 1.76 and post op NLR in the appendicitis group. Postop NLO and CRP values significantly decreased compared to Preop values. ( p<0.04 and p< 0.00, respectively). In ROC analysis, NLO ≥1.6 had 90% sensitivity and 90% specificity and CRP 1.01 had 86% sensitivity and 80% specificity inpredicting acute appendicitis. Conclusion: Postop NLR and CRP values significantly decreased compared to preop values. As a result, NLR value calculated from a simple hemogram test, which can be obtained in almost every health care facility, which can be obtained more easily than CRP, which has better sensitivity and specificity in the diagnosis of acute appendicitis, can be used to diagnose appendicitis.

Evaluation of Neutrophil–lymphocyte Ratio and Platelet–lymphocyte Ratio as Markers of Diabetic Kidney Disease in Bangladeshi Patients with Type 2 Diabetes Mellitus

Background: The roles of neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) as novel surrogate markers of diabetic kidney disease (DKD) are promising. Objective: The aim of this study was to evaluate whether NLR and PLR can predict DKD in type 2 diabetes mellitus (T2DM). Subjects and Methods: This cross-sectional study was conducted from July 2018 to June 2019, among 312 patients with T2DM recruited from eight tertiary hospitals throughout Bangladesh. Complete blood count (CBC) was performed in fully automated hematology analyzers, and NLR and PLR were calculated. The urine albumin-to-creatinine ratio (ACR) was measured in a random single-voided urine sample. The diagnosis of DKD was made based on the presence of albuminuria (ACR ≥30 mg/g) and/or reduced estimated glomerular filtration rate (eGFR &lt;60mL/min/1.73 m2) in the absence of signs or symptoms of other primary causes of kidney damage. Results: Among 312 study subjects, 150 (48.1%) had DKD. The mean age (51.9 ± 11.9 vs. 48.6 ± 9.6 years), fasting plasma glucose (10.3 ± 4.1 vs. 9.2 ± 3.0 mmol/L), 2-h postprandial plasma glucose (14.6 ± 5.6 vs. 12.8 ± 4.5 mmol/L), glycated hemoglobin (HbA1c) (9.2 ± 2.1 vs. 8.4 ± 1.9%), and serum triglyceride (213.6 ± 109.9 vs. 185.5 ± 100.8) were higher (P ≤0.05 in each instance) in subjects with DKD in comparison to those without DKD. DKD group had higher mean absolute neutrophil count (6.0 ± 2.0 vs. 5.4 ± 1.9 ×109/L, P = 0.022), platelet count (310.4 ± 87.3 vs. 287.0 ± 78.7 ×109/L, P = 0.013), NLR (2.16 ± 1.1 vs. 1.92 ± 0.96, P = 0.040), and PLR (115.45 ± 57.07 vs. 101.02 ± 40.06, P = 0.010). The levels of hemoglobin, total leukocyte count, absolute lymphocyte count, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, and red cell distribution width were similar in the two groups. Conclusion: In this study, we found higher NLR and PLR in subjects with DKD than those without DKD. NLR and PLR may be considered as cheap, readily available alternative markers of DKD in resource-poor settings.

Comparison of neutrophil lymphocyte ratio, platelet lymphocyte ratio, and mean platelet volume and PCR test in COVID-19 patients.

The polymerase chain reaction test, used in the diagnosis of COVID-19, can be positive with delay, and thorax tomography is used for the diagnosis of the disease. We aimed to compare the relation between thorax tomography findings, PCR test results, and neutrophil lymphocyte ratio; platelet lymphocyte ratio and mean platelet volume neutrophil lymphocyte ratio; platelet lymphocyte ratio and mean platelet volume in COVID-19 patients. COVID-19 patients were divided into three groups, according to baseline laboratory and thorax tomography findings: Group A: thorax tomography finding positive - polymerase chain reaction test positive; Group B: thorax tomography finding negative - polymerase chain reaction test positive; and Group C: thorax tomography finding positive - polymerase chain reaction test negative. Neutrophil lymphocyte ratio, platelet lymphocyte ratio, and mean platelet volume values were compared between these three groups. Group C neutrophil lymphocyte ratio level and polymerase chain reaction level were statistically higher than that of group B (p<0.001 in both). Mean platelet volume was not statistically significant between groups (p>0.005 for all). A positive correlation was detected between neutrophil lymphocyte ratio and C-reactive protein (r=0.421, p<0.001). Similarly, positive correlation was found with polymerase chain reaction and C-reactive protein (r=0.243, p=0.001). The thorax tomography finding can be detected earlier in the disease before the polymerase chain reaction test. The sensitivity of the polymerase chain reaction test varies according to the tester, the way of performing it, and the quality of the test. Therefore, especially in patients with polymerase chain reaction negative and thorax tomography findings, neutrophil lymphocyte ratio and platelet lymphocyte ratio levels should be evaluated, and patients should be followed up upon suspicion of COVID-19 diagnosis.

Novel coronavirus disease 2019 and combined autoimmune neutropenia and thrombocytopenia: a case report

Background: Combined autoimmune neutropenia (AIN) and immune thrombocytopenia (ITP) is a rare disease that can present as extremely low neutrophil count and platelet count, respectively [1]. Case Presentation: We describe the first case, to the authors’ knowledge, of the novel SARS CoV-2 infection and combined AIN and ITP in a healthy 27-year-old male. Conclusion: Viruses have been known to trigger autoimmune diseases in people with genetic predisposition. We speculate that the patient’s selective IgM deficiency predisposed him to have autoimmune cytopenia, and SARS-COV-2 triggered him to acquire combined AIN and ITP. Our hypothesis is supported by a lack of evidence of malignancy, a normal morphology on the smear, and an immediate response to IVIG infusion with significant improvement in platelet and neutrophilic count.

Association of systemic immune-inflammation index (SII) with presence of isolated coronary artery ectasia.

IntroductionThe systemic immune-inflammation index (SII) has been developed based on the calculation of N×P/L (N, P and L represent neutrophil count, platelet count and lymphocyte count, respectively), and it is widely used as a marker of inflammation and an indicator of cardiovascular outcomes in patients with coronary artery disease. We examined a possible association between SII and the presence of isolated coronary artery ectasia (CAE).Material and methodsIn this retrospective case-control study, a total of 4400 patients who underwent elective coronary angiography between June 2015 and July 2020 were retrospectively screened. Following the application of exclusion criteria, our study population consisted of 139 CAE patients and 141 age- and gender-matched subjects who proved to have normal coronary angiograms.ResultsThe median value of SII was found to be statistically significantly higher in patients with CAE (p < 0.01). SII level ≥ 809 measured on admission had 48% sensitivity and 82% specificity in predicting isolated CAE in ROC curve analysis. In this ROC analysis, the predictive powers of neutrophil-to-lymphocyte ratio (NLR) and SII in determining the presence of ectasia were compared, and the predictive power of SII was significantly stronger than N/L ratio (p = 0.003). In the multivariate analysis, hyperlipidaemia (OR = 1.978, 95% CI: 1.168–3.349, p = 0.01), smoking (OR = 1.86, 95% CI: 1.090–3.127, p = 0.023) N/L ratio (OR = 1.192, 95% CI: (1.114–1.997, p = 0.07) and SII (OR = 1.002, 95% CI: 1.001–1.003, p < 0.01) were independent predictors of the presence of isolated CAE.ConclusionsSII is a readily available clinical laboratory value that is associated with the presence of isolated CAE. Our findings may indicate a common pathophysiological mechanism between CAE and coronary artery disease.

Factors affecting pathological response and survival following neoadjuvant chemoradiotherapy in rectal cancer patients.

Despite all advanced treatment methods for rectal cancer, not all patients can provide an adequate response, and hence, possible prognostic factors must be evaluated. The aim of this study was to evaluate the relationship between systemic inflammatory markers and pathological response, overall survival (OS) and disease-free survival (DFS) in patients treated with neoadjuvant chemoradiotherapy (nCRT). We evaluated data of 117 patients for the period 2010 to 2017. Serum measurements of albumin, hemoglobin, C-reactive protein, modified Glasgow prognostic score (mGPS), and white cell counts were obtained. Rodel scoring system was used to determine pathologic tumor regression. Overall, 77% of the patients were in the good response group according to the radiological images. A total of 48% of patients were categorized as a good pathologic response. Pathologic response to treatment was associated with a mGPS of 0 (P = 0.001), normal platelet lymphocyte ratio (PLR) (P = 0.003), TNM stage (P = 0.03), pathologic T stage (P = 0.001), radiologic response to nCRT (P = 0.04), tumor differentiation (P = 0.001), lymphovascular invasion (LVI) (P = 0.001) and perineural invasion (P = 0.02). LVI (P = 0.04), albumin level (P = 0.05), C-reactive protein (P = 0.01), neutrophil platelet score (NPS) (P = <0.001) and mGPS (P = 0.01) had a statistically significant effect on OS. Operation type (P = 0.03), tumor differentiation (P = 0.01), depth of invasion (P = 0.03), NPS (P < 0.01), mGPS (P = 0.01), PLR (P = 0.004), neutrophil-lymphocyte ratio (P = 0.01) and LVI (P = 0.05) were statistically significant on DFS. There was an association between systemic inflammatory markers and pathologic response and also, between OS and DFS. This study can be preliminary data for prospective controlled studies.

Novel Coronavirus Disease 2019 (COVID-19) and Combined Autoimmune Neutropenia (AIN) and Thrombocytopenia (ITP): A Case Report and Literature Review

Combined autoimmune neutropenia (AIN) and Immune thrombocytopenia (ITP) is a rare disease that can present as extremely low neutrophil count and platelet count, respectively [1]. We describe the first case, to our knowledge, of the novel SARS CoV-2 infection and combined autoimmune neutropenia (AIN) and immune thrombocytopenia (ITP) in a healthy 27-year-old male

Exogenous hydrogen sulfide inhibits neutrophils extracellular traps formation via the HMGB1/TLR4/p-38 MAPK/ROS axis in hyperhomocysteinemia rats

Hydrogen sulfide (H2S) prevents platelet activation and neutrophils extracellular traps (NETs) formation. However, the mechanism of sodium hydrosulfide (NaHS, a donor that produces H2S) inhibits the formation of NETs in hyperhomocysteinemia (HHcy) rats has not been previously investigated. In the experiment, the expressions of HMGB1 of platelets, the expressions of TLR4, PAD4 and the phosphor-p38 of neutrophils were measured. The NETs formations, the concentration of DNA in the serum and the culture solution of cultured neutrophils which was stimulated by platelet-rich plasma (PRP) were tested. Additionally, the cellular ROS level and SOD activity were detected. The platelets were activated and the expression of HMGB1 of platelets and NETs formation, the concentration of DNA, and the expressions of TLR4, phosphor-p38 and PAD4, the ROS level were all increased while the activity of SOD decreased in the HHcy group compared to the control group. NaHS significantly inhibited the activation of platelets, the production of ROS and the formation of NETs in neutrophils, reversed the expressions of HMGB1, TLR4, phosphor-p38, PAD4 and decreased concentration of DNA which was caused by high homocysteine. Our results demonstrate that the donor of H2S inhibits NETs formation of neutrophils via the HMGB1/TLR4/p38 MAPK/ROS pathway in hyperhomocysteinemia.

Correlation of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and type 2 diabetic retinopathy

AIM: To investigate the relationship between neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and type 2 diabetic retinopathy (DR). METHODS: A total of 200 cases with type 2 diabetes mellitus were involved. All patients were divided into three groups according to the fundus examination: diabetes mellitus (DM, n=100), non-proliferative diabetic retinopathy (NPDR, n=62) and proliferative diabetic retinopathy (PDR, n=38). 100 healthy persons were selected as the normal control group (NCG, n=100). The related indicators, such as neutrophil count, lymphocyte count and platelet count, were measured. RESULTS: The value of NLR was significantly higher in PDR group patients than in NC group (1.81), DM group (1.76) and NPDR group (1.85) (P&lt;0.05). The value of PLR was significantly higher in PDR group patients (126.18) than in DM group (111.64) (P&lt;0.05). Logistic regression analysis showed that age (β= -0.047) was protective factor, course of diabetes (β=0.071) and systolic blood pressure (β=0.024) were risk factors for diabetic retinopathy (P&lt;0.05), but the value of NLR and PLR was not statistically significant in the Logistic regression analysis. CONCLUSION: The value of NLR and PLR increased in the PDR group, but it is not independent risk factor for diabetic retinopathy.

Stem Cell Transplantation for Diamond–Blackfan Anemia. A Retrospective Study on Behalf of the Severe Aplastic Anemia Working Party of the European Blood and Marrow Transplantation Group (EBMT)

Data on stem cell transplantation (SCT) for Diamond-Blackfan Anemia (DBA) is limited. We studied patients transplanted for DBA and registered in the EBMT database. Between 1985 and 2016, 106 DBA patients (median age, 6.8 years) underwent hematopoietic stem cell transplantation from matched-sibling donors (57%), unrelated donors (36%), or other related donors (7%), using marrow (68%), peripheral blood stem cells (20%), both marrow and peripheral blood stem cells (1%), or cord blood (11%). The cumulative incidence of engraftment was 86% (80% to 93%), and neutrophil recovery and platelet recovery were achieved on day +18 (range, 16 to 20) and +36 (range, 32 to 43), respectively. Three-year overall survival and event-free survival were 84% (77% to 91%) and 81% (74% to 89%), respectively. Older patients were significantly more likely to die (hazard ratio, 1.4; 95% confidence interval, 1.06 to 1.23; P < .001). Outcomes were similar between sibling compared to unrelated-donor transplants. The incidence of acute grades II to IV of graft-versus-host disease (GVHD) was 30% (21% to 39%), and the incidence of extensive chronic GVHD was 15% (7% to 22%). This study shows that SCT may represent an alternative therapeutic option for transfusion-dependent younger patients.

Cardiospecific autoantibodies in people with vibration disease and type 2 diabetes mellitus

Background . Metabolic syndrome and diabetes mellitus (DM), as well as a number of environmental factors increase the risk of cardiovascular diseases, which are the leading causes of mortality among working population. Objective . To assess the levels of specific autoantibodies in individuals with vibration disease and type 2 DM. Design and methods . People with vibration disease (group I), patients with type 2 DM (group II), and patients with vibration disease and type 2 DM (group III) were examined. The serum level content of autoantibodies related to vascular state was studied using enzyme immunoassay. Results . More than a quarter of all examined patients had elevated levels of antibodies to the РАРР-А. The changes in the serum level of cardiospecific autoantibodies indicate endothelial damage, alterations of thrombus formation and vascular inflammation. People with vibration disease showed increased incidence of hypoimmunoreactivity of antibodies to collagen, nitric oxide synthase, platelet membrane components, neutrophil and endotheliocyte cytoplasm. Patients with DM had the highest levels of autoantibodies to collagen, nitric oxide synthase, and platelet membrane components. In these patients, increased level of specific autoantibodies to nitric oxide synthase and collagen were found more common. Patients with comorbid pathology showed similar changes: higher rate of reduced level of antibodies to platelet membrane components, nitric oxide synthase and increased level of autoantibodies to nitric oxide synthase and collagen.

D-Dimer as a potential biomarker for disease severity in COVID-19.

IntroductionThis study seeks to determine the utility of D-dimer levels as a biomarker in determining disease severity and prognosis in COVID-19.MethodsClinical, imaging and laboratory data of 120 patients whose COVID-19 diagnosis based on RT-PCR were evaluated retrospectively. Clinically, the severity of COVID-19 was classified as noncomplicated or mild or severe pneumonia. Radiologically, the area of affected lungs compatible with viral pneumonia in each patient's computed tomography was classified as either 0–30% or ≥ 31% of the total lung area. The D-dimer values and laboratory data of patients with COVID-19 were compared with inpatient status, duration of hospitalization, and lung involvement during treatment and follow-up. To assess the predictive value of D-dimer, receiver operating characteristic (ROC) analysis was conducted.ResultsD-dimer elevation (> 243 ng/ml) was detected in 63.3% (76/120) of the patients. The mean D-dimer value was calculated as 3144.50 ± 1709.4 ng/ml (1643–8548) for inpatients with severe pneumonia in the intensive care unit. D-Dimer values showed positive correlations with age, duration of stay, lung involvement, fibrinogen, neutrophil count, neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR). When the threshold D-dimer value was 370 ng/ml in the ROC analysis, this value was calculated to have 77% specificity and 74% sensitivity for lung involvement in patients with COVID-19.ConclusionD-Dimer levels in patients with COVID-19 correlate with outcome, but further studies are needed to see how useful they are in determining prognosis.