Platelet Count Research Articles

Safety and Efficacy of 177Lu-PSMA Therapy Following 223Radium Treatment: A Retrospective Multinational Real-World Analysis

Background177Lu PSMA therapy is increasingly used for metastatic castration-resistant prostate cancer (mCRPC) treatment. However, data on its efficacy and safety in patients previously treated with 223Ra remain limited. MethodsThis retrospective, multicenter study evaluated 233 mCRPC patients treated with 177Lu PSMA at five European centers. The cohort included 27 patients previously treated with 223Ra and 206 Radium-naive patients. Statistical analyses, including Chi-squared, Mann-Whitney U tests, and multivariate logistic regression, were used to assess response and mortality. Predictors of response and mortality were identified using multivariate models. ResultsPatients who experienced a longer interval between castration resistance and the initiation of 177Lu PSMA therapy demonstrated better responses (median 17 months in responders vs. 8.5 months in progressors, p=0.001). Platelet counts were significantly lower in the progressive group compared to the responsive group (p=0.01). Multivariate regression confirmed lower platelet levels as a predictor of poor response (p=0.029). The overall response rate to 177Lu PSMA was 54%, similar between the 223Ra-pretreated and Radium-naive groups. However, mortality was significantly higher in the 223Ra-pretreated group (86%) compared to the Radium-naive group (51%, p=0.003). ECOG performance status (p=0.004) and ALP levels (p=0.030) were significant predictors of mortality, while CRP showed a trend towards significance (p=0.064). Tolerability of 177Lu PSMA was comparable to the safety profile reported in the literature, with 44% of 223Ra-pretreated patients experiencing AEs and 22% experiencing severe AEs (Grade ≥3). Conclusions177Lu PSMA therapy is effective and well-tolerated in mCRPC patients pretreated with 223Ra. However, higher mortality was observed in the 223Ra-pretreated group. ECOG PS, ALP, and platelet counts were significant predictors of response and mortality, and a longer interval between therapies was associated with better outcomes. These findings underscore the importance of treatment sequencing and monitoring prognostic markers. Micro-abstractEven in a real-world setting, 177Lu PSMA remains an effective treatment for mCRPC, achieving response rates up to 54% even in patients previously treated with 223Ra. Our findings indicate that 177Lu PSMA is well-tolerated after 223Ra, with no significant increase in adverse events. However, higher mortality rates were observed in the 223Ra cohort, suggesting a potentially poorer prognosis for patients who received 223Ra as an initial treatment.

Allometric fat mass index and alanine aminotransferase attenuate the associations of platelet parameters with lung cancer risk

We have previously shown that body mass index attenuates a positive association of platelet count (PLT) and inverse of mean platelet volume (MPV) with lung cancer risk in men. It is unclear whether fat mass, lean mass, or liver function tests (LFTs) show similar attenuations. Using bioelectrical impedance measurements (UK Biobank cohort) and multivariable Cox proportional hazards models, we examined the associations of allometric fat-mass index (AFI, fat mass adjusted for height), allometric lean-mass index (ALI, fat-free mass adjusted for height and fat mass), and LFTs with lung cancer risk and their multiplicative and additive interactions with platelet parameters. Based on 1573 lung cancer cases in men and 1473 in women with body composition measurements (1541 in men; 1428 in women with biomarker measurements), AFI in women, ALI in both sexes, alanine aminotransferase (ALT) and total bilirubin in men were inversely associated, while gamma-glutamyl transferase in men and alkaline phosphatase in both sexes were positively associated with lung cancer risk. Only AFI and ALT interacted inversely with PLT and positively with MPV in men. The attenuation of the associations of platelet parameters with lung cancer risk by high-AFI and high-ALT in men suggests that adiposity-related factors hinder lung-cancer-related platelet associations.

Genomic Variants Associated with Haematological Parameters and T Lymphocyte Subpopulations in a Large White and Min Pig Intercross Population.

The breeding of disease-resistant pigs has consistently been a topic of significant interest and concern within the pig farming industry. The study of pig blood indicators has the potential to confer economic benefits upon the pig farming industry, whilst simultaneously providing valuable insights that can inform the study of human diseases. In this study, an F2 resource population of 489 individuals was generated through the intercrossing of Large White boars and Min pig sows. A total of 17 haematological parameters and T lymphocyte subpopulations were measured, including white blood cell count (WBC), lymphocyte count (LYM), lymphocyte count percentage (LYM%), monocyte count (MID), monocyte count percentage (MID%), neutrophilic granulocyte count (GRN), percentage of neutrophils (GRN%), mean platelet volume (MPV), platelet distribution width (PDW), platelet count (PLT), CD4+/CD8+, CD4+CD8+CD3+, CD4+CD8-CD3+, CD4-CD8+CD3+, CD4-CD8-CD3+, and CD3+. The Illumina PorcineSNP60 Genotyping BeadChip was obtained for all of the F2 animals. Subsequently, a genome-wide association study (GWAS) was conducted using the TASSEL 5.0 software to identify associated variants and candidate genes for the 17 traits. Significant association signals were identified for PCT and PLT on SSC7, with 1 and 11 significant SNP loci, respectively. A single nucleotide polymorphism (SNP) on SSC12 was identified as a significant predictor of the white blood cell (WBC) trait. Significant association signals were detected for the T lymphocyte subpopulations, namely CD4+/CD8+, CD4+CD8+CD3+, CD4+CD8-CD3+, and CD4-CD8+CD3+, with the majority of these signals observed on SSC7. The genes CLIC5, TRIM15, and SLC17A4 were identified as potential candidates for influencing CD4+/CD8+ and CD4-CD8+CD3+. A missense variant, c.2707 G>A, in the SLC17A4 gene has been demonstrated to be significantly associated with the CD4+/CD8+ and CD4-CD8+CD3+ traits. Three missense variants (c.425 A>C, c.500 C>T, and c.733 A>G) have been identified in the TRIM15 gene as being linked to the CD4+/CD8+ trait. Nevertheless, only c.425 A>C has been demonstrated to be significantly associated with CD4-CD8+CD3+. In the CLIC5 gene, one missense variant (c.957 T>C) has been identified as being associated with the CD4+/CD8+ and CD4-CD8+CD3+ traits. Additionally, significant association signals were observed for CD4+CD8+CD3+ and CD4+CD8-CD3+ on SSC2 and 5, respectively. Subsequently, a gene ontology (GO) enrichment analysis was conducted on all genes within the quantitative trait loci (QTL) intervals of platelet count, CD4+/CD8+, and CD4-CD8+CD3+. The MHC class II protein complex binding pathway was identified as the most significant pathway among the three immune traits. These results provide guidance for further research in the field of breeding disease-resistant pigs.

Which accessible clinical features and laboratory findings might predict methotrexate success in children with juvenile idiopathic arthritis in Bosnia and Herzegovina?

<p><strong>Aim</strong> To determine whether demographic data, clinical features, and laboratory variables at disease onset can predict the response to methotrexate in juvenile idiopathic arthritis (JIA) patients. <br /><strong>Methods</strong> A cohort of 143 newly diagnosed JIA patients initially treated with methotrexate was enrolled in this study. Demographic, clinical, and laboratory parameters were analysed using univariate and multivariate logistic regression to identify predictors of response to methotrexate. The variables included erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), platelets, IgA, IgG, the number of active joints and age at disease onset. Treatment response was assessed at six months, with patients classified as responders (those who achieved clinically inactive disease according to the American College of Rheumatology - ACR criteria) or non-responders. <br /><strong>Results</strong> Poor response to methotrexate was associated with the number of active joints (p=0.0001; OR=2.7), baseline levels of CRP (p=0.044; OR=1.138), IgA (p =0.004; OR=2.159), and platelet count (p=0.01; OR=1.05). IgG level (P=0.236) did not correlate with the treatment response. <br /><strong>Conclusion</strong> We identified widely available and clinically acceptable biomarkers that can be utilized as predictive indicators of response to methotrexate in JIA patients.</p>

Platelet ultrastructural changes stored at room temperature versus cold storage observed by electron microscopy and structured illumination microscopy

Our study seeks to provide a theoretical foundation for the clinical use of Cold-stored platelets (CSPs) by interpreting ultrastructural images and quantitatively analyzing structural changes. CSPs, room temperature-stored platelets (RTPs), and delayed cold stored platelets(Delayed-CSPs) were continuously observed using scanning electron microscopy and transmission electron microscopy at 8 time points. Super-resolution fluorescence microscopy was employed to observe changes in platelet microtubules and mitochondrial structure and function, while platelet counts, metabolism, and relevant functional indicators were measured concurrently. Quantitative statistical analysis of platelet size, morphology, canalicular systems, and five organelles was performed under electron microscopy. CSPs stored for 1 day, platelet shape changed from circular or elliptical to spherical, with size decreasing from 2.8 × 2.2µm to 2.0 × 2.0µm. CSPs occurred wrinkling and reorganization of platelet microtubule proteins, with organelles aggregating towards the central region. CSPs stored for 14 days and Delayed-CSPs for 10 days exhibited numerous structurally intact and active cells. The structure-intact active cells in both group were 92% . RTPs stored for 5 and 7 days showed minimal changes in size, a normal microtubule skeleton, and were primarily in a resting state. However, RTPs stored for 10 and 14 days displayed swelling, irregular disintegration of the microtubule skeleton, and the presence of membranous structures and vacuolated cells,the structure-intact active cells was only 45% and 7%, respectively. Our findings confirmed that the maximum storage time of platelets was 5-7 days for RTPs, within 10 days for Delayed-CSPs, and 14 days for CSPs.

Multi-domain predictors of grip strength differentiate individuals with and without alcohol use disorder.

Grip strength is considered one of the simplest and reliable indices of general health. Although motor ability and strength are commonly affected in people with alcohol use disorder (AUD), factors predictive of grip strength decline in AUD have not been investigated. Here, we employed a data-driven analysis predicting grip strength from measurements in 53 controls and 110 AUD participants, 53 of whom were comorbid with HIV infection. Controls and AUD were matched on sex, age, and body mass index. Measurements included commonly available metrics of brain structure, neuropsychological functioning, behavioural status, haematological and health status, and demographics. Based on 5-fold stratified cross-validation, a machine learning approach predicted grip strength separately for each cohort. The strongest (top 10%) predictors of grip were then tested against grip strength with correlational analysis. Leading grip strength predictors for both cohorts were cerebellar volume and mean corpuscular haemoglobin concentration. Predictors specific to controls were Backwards Digit Span, precentral gyrus volume, diastolic blood pressure, and mean platelet volume, which together significantly predicted grip strength (R2=0.255, p= 0.001). Unique predictors for AUD were comorbidity for HIV infection, social functioning, insular volume, and platelet count, which together significantly predicted grip strength (R2=0.162, p= 0.002). These cohort-specific predictors were doubly dissociated. Salient predictors of grip strength differed by diagnosis with only modest overlap. The constellation of cohort-specific predictive measurements of compromised grip strength provides insight into brain, behavioural, and physiological factors that may signal subtly affected yet treatable processes of physical decline and frailty.

Hemostasis in patients with primary myelofibrosis treated with ruxolitinib

Aim. To evaluate the effect of ruxolitinib therapy on hemostasis in patients with primary myelofibrosis (PMF).Materials and methods. 30 patients with PMF were examined, 16 of them received ruxolitinib (group 1) at the time of examination and 14 were untreated (group 2). The control group consisted of 30 healthy individuals. A complete blood count was performed, the platelets aggregation, the activity of Willebrand factor, factor VIII and natural anticoagulants were evaluated. In the thrombin generation test, the endogenous thrombin potential (ETP, nM×min) was determined; sensitivity to thrombomodulin and coagulation index were calculated. Kruskal-Wallis test with post hoc Dunn test was used to compare groups.Results. Hemoglobin and platelet count were lower in group 1 compared to group 2 and control. Platelet aggregation with collagen was lower in patients with PMF than in the control group, and lower in group 1 than in group 2: 2.2 (1.6; 5.7) % vs 41.6 (3.4; 64.8) %, p < 0.05. In patients in group 1, the activity of Willebrand factor – 150.0 (122.5; 195) % and factor VIII – 173 (148.5; 200) % was higher (p < 0.05) than in the control: 97 (84.8; 110) % and 104 (85; 130) % respectively. Antithrombin did not differ in the PMF and control group. Protein S was reduced in both groups with PMF: group 1 – 70 (58; 86,6) %, group 2 – 65 (43,6; 107,5) %, control – 102 (86; 109,0) %, p < 0.001. ETP and sensitivity to thrombomodulin in groups 1 and 2 were low, p < 0.001. The coagulation index tended to higher values than in the control: 5.3 (3.0; 11.4) – group 1; 3.2 (2.4; 7.3) – group 2; control – 1.9 (1.6; 2.2), p = 0.073.Conclusion. Ruxolitinib therapy leads to the failure of the platelet hemostasis, the procoagulant activity of plasma with an increase in the activity of Willebrand factor and factor VIII and a decrease in the activity of protein S.

Analysis of Molecular Testing for Suspected Myeloproliferative Neoplasm at a Hybrid Community-Academic Health System

Testing for somatic mutations in JAK2, MPL, and CALR genes is a crucial element in the diagnosis of myeloproliferative neoplasms (MPN). This may have inadvertently led to increased requests for testing to “rule out MPN,” including clinical situations with low pre-test probability. This paper examines JAK2, MPL, and CALR testing by next generation sequencing (NGS) with the goal of formulating practical guidelines to make test utilization more efficient and effective. NGS results from 1482 patients tested between 2015 and March 2022 were retrieved, along with corresponding bone marrow biopsies and CBC results performed within 90 days prior to NGS and 245 (16.5%) cases were positive for pathogenic variants in JAK2, MPL, or CALR genes.The findings showed an increase in the proportion of positive cases with patient age, and a statistically significant difference in RBC counts and platelet counts among patients with positive versus negative results. Utilizing these factors, simple algorithms were constructed to predict positive results with a maximum sensitivity of 91%, while potentially eliminating 28% of negative tests. However, these models still failed to identify ∼9% of patients with MPNs. Among these “missed” patients, many had either primary myelofibrosis or MDS/MPN. Considering a simple triage model to help guide MPN testing could represent a more cost effective approach, particularly if “missed” patients could be further reduced.

Systemic immune-inflammatory index and platelet-to-lymphocyte ratio in intrahepatic cholestasis of pregnancy.

To investigate the role of systemic immune-inflammation index (SII) in the diagnosis and severity of intrahepatic cholestasis of pregnancy (ICP). This case-control research involved 173 pregnant women with ICP and 266 gestational age-related healthy pregnant women as the control group. Criteria for diagnosing ICP were acceptance of increased serum total bile acid (TBA) levels (≥10 μmol/L). The mild ICP group (n=109) had TBA levels ranging between 10-39 µmol/l, while the severe ICP group (n=64) had a minimum TBA level above 40 µmol/l. Sociodemographic data, laboratory results, and SII values were compared between groups. Cut-off values were calculated to predict ICP. The SII was calculated as the platelet count × neutrophil count/lymphocyte count. The leukocyte and neutrophil counts were lower (p<0.01), and the monocyte count was higher (p=0.026) in the severe ICP group compared to the controls. The platelet-to-lymphocyte ratio (PLR) was higher in mild ICP groups than in controls (p<0.01). The optimum PRL cut-off value was 126.2238, with a sensitivity of 57.2% and specificity of 57.1%. Elevated SII values support the evidence for the inflammatory properties of ICP but do not aid in diagnosing and determining its severity. Platelet-to-lymphocyte ratio may be a useful marker in determining ICP.

Comparison of the Predictive and Prognostic Capacities of Neutrophil, Lymphocyte and Platelet Counts and Tumor-infiltrating Lymphocytes in Triple-negative Breast Cancer: Preliminary Results of the PERCEPTION Study.

Triple-negative breast cancer (TNBC) is the most heterogeneous breast cancer subtype, posing numerous challenges in clinical decision-making. Biomarkers are essential to personalize management of TNBC patients. While tumor infiltrating lymphocytes (TILs) are validated prognostic biomarkers, the requirement for tumor biopsy limits their routine use. Therefore, more accessible and reliable quantitative biomarkers are needed. Given the significant role of systemic inflammatory response in tumor onset and progression, assessing inflammatory cells via liquid biopsies emerges as a promising alternative. The PERCEPTION study, conducted at Centre Jean Perrin in France, aims to determine the correlation between TILs and peripheral blood components at diagnosis. An interim analysis was conducted after enrolling 50% of the estimated population, to evaluate study feasibility and preliminary correlations between blood cell counts and TILs. Sixty-one patients were enrolled over 4.5 years, demonstrating a good inclusion rate with minimal missing data. Preliminary results for 36 analyzable patients showed no correlation between the neutrophil-to-lymphocyte ratio (NLR) and TILs (rs=-0.19, 95%CI=-0.49-0.16, p=0.3). However, a moderate, positive, statistically significant correlation was found between NLR and the CD8/FoxP3 TILs ratio (rs=0.36, 95%CI=0.03-0.64, p=0.043). The probabilistic index of 0.7 (p=0.06) between NLR-high and NLR-low groups for this ratio supports the correlation. The interim analysis of the PERCEPTION study confirms the feasibility of correlating blood cell counts with TILs in TNBC. Although no significant correlation was observed between NLR and TILs, the moderate positive correlation between the CD8/FoxP3 ratio and TILs suggests a potential link between systemic inflammation and local immune response. These findings underscore the potential of blood-based markers as non-invasive surrogates for TILs, encouraging further research to enhance prognosis and guide treatment strategies in TNBC.

Role Of Expanded Curb-65 Score In Predicting The Severity Of Community Acquired Pneumonia

Introduction: Assessment of severity and site of care decisions for community-acquired pneumonia patients (CAP) are very important for patients’ safety and optimal use of resources. Late admission to the intensive care unit (ICU) leads to increase the rate of mortality in CAP. We aimed to evaluate the effectiveness of the new expanded CURB-65 score in comparison with CURB-65 in predicting CAP patient outcomes. Materials and Methods: This was a cross sectional study which includes 90 patients presented with CAP in Government hospital for chest and communicable disease, AMC, Visakhapatnam Results: The study included 90 patients hospitalized with CAP of which mean (SD) age distribution is 51.49±16.63 years, with 64.4% being men and 83.3% of CAP patients had associated comorbidities. All patients (100%) had elevated serum LDH (&gt; 230U/L), 87.8% had hypoalbuminemia, 8.9% had thrombocytopenia, and 4.44% had elevated BUN values within 24 hours of admission. Regarding outcomes, the ICU admission rate was 36.7%, the 30-day mortality rate was 14.4%, and 35.6% required mechanical ventilation. There was a significant association between tachypnea (respiratory rate &gt;30/min), confusion, and thrombocytopenia (Platelet Count &lt; 100×103/mm3) with 30-day mortality, according to univariate analysis. The current study found that as 30-day mortality for Expanded CURB score of (0-2), (3-4) and (5-8) is 0,4%and 9% respectively, requirement of mechanical ventilation and ICU admission rate were 2%,22%, 8% and2%,23%,8% respectively. Length of hospital stay increase as the score increase with median length of hospital stay being 7 days. Conclusion: Compared to CURB-65 and other assessment tools, the Expanded-CURB-65 score, which extends independent risk factors to 8 variables in assessing CAP severity, significantly improves identifying high-risk patients and thereby helps in early institution of appropriate therapy

A study of platelet function in patients with chronic immune thrombocytopenia treated with thrombopoietin receptor agonists

BackgroundThrombopoietin receptor agonists (TPO-RAs) are widely used in immune thrombocytopenia (ITP) and are associated with increased thrombotic risk. However, data regarding their impact on platelet function is scarce. MethodsPlatelet function was evaluated in chronic ITP patients enrolled over one year, using light transmission aggregometry and platelet-derived microparticle (PMP) levels measurement with flow cytometry. Aggregation responses to various concentrations of ADP, collagen, ristocetin, and PMP levels were compared between TPO-RA-treated patients, patients treated with other agents and healthy individuals. ResultsTPO-RA-treated patients (n = 24) displayed significantly reduced aggregation responses to 2.5 μM, 5 μM, and 10 μM of ADP and collagen compared to 15 healthy individuals (59.5 % vs. 87.6 %, p < .0001, 43.6 % vs. 79.9 %, p < .0001, 26.1 % vs. 75.2 %, p < .0001, 67.2 % vs. 86 %, p < .0001, respectively). Reduced responses to ADP and collagen were also recorded in patients treated with other agents (n = 16) compared to healthy controls but without difference between the two treatment groups. Aggregation response to ristocetin was normal in all three groups. None of the patients yielded enhanced platelet aggregation. In TPO-RA-treated patients, a strong positive correlation between platelet counts and aggregation response to ristocetin was observed (rs = 0.65, p = .0005). PMP levels were significantly elevated in TPO-RA-treated patients compared to patients treated with other agents (49.5 vs 4.5 events/uL, p < .0001) and healthy controls (5 events/uL, p < .0001). ConclusionsThese results suggest that TPO-RAs may not enhance platelet aggregation responses, whereas impaired responses may be a disease feature. Furthermore, TPO-RAs may increase PMP levels and thus be implicated in the modulation of platelet function in ITP patients.

Hemostatic derangements associated with cardiopulmonary bypass predict outcomes in pediatric patients undergoing corrective heart surgery

BackgroundUnderstanding of the hemostatic and complement alterations associated with cardiopulmonary bypass (CPB) in pediatric patients and the impact of these alterations on outcome is limited. ObjectivesThe present study prospectively characterized these alterations and their association with postoperative outcomes in pediatric CPB. Patients/MethodsAll patients <21 years undergoing CPB at the authors’ institution between 2020 and 2021 that weighed >3 kg, were >36 weeks gestational age, and had no known prothrombotic or hemorrhagic disorders were eligible. Blood samples were analyzed for multiple hemostatic and complement biomarkers pre-, intra-, and 24 hours post-CPB. Biomarker levels were compared to clinical outcomes, including chest tube output (CTO). ResultsFifty consecutive patients were enrolled. CPB resulted in multiple significant alterations in hemostatic and complement components. Lower platelet counts (<80 x 109 platelets/L) at CPB termination were associated with increased postoperative CTO (p=0.003). Lower factor VIII levels (<60 IU/dl) at the end of CPB were associated with a longer hospital stay (p<0.001) and increased postoperative CTO (p<0.001). Patients undergoing staged single ventricle reconstruction were more likely to have lower platelet counts at CPB termination (p=0.009) and higher CTO postoperatively (p=0.001) than patients undergoing other types of surgical repair. These differences were not due to different preoperative platelet counts, increased incidences of circulatory arrest, or longer CPB times. ConclusionsThese data suggest that intraoperative alterations in hemostatic system components may predict postoperative outcomes in pediatric CPB. Further study is needed to determine if interventions targeting platelets or factor VIII could improve outcomes in pediatric CPB.

Point-of-care viscoelastic coagulation monitoring device shows promise for informing resuscitation strategies in a canine hemorrhagic shock model.

To use a point-of-care viscoelastic coagulation monitoring device (VCM-Vet; Entegrion) and traditional tests to assess hemostatic changes during hemorrhagic shock in dogs. 8 healthy, purpose-bred Beagles were enrolled in a hemorrhagic shock model conducted from September through December 2021. Dogs were anesthetized, had baseline hemostatic variables measured after blood pressure was stabilized at 70 to 80 mm Hg for 10 minutes (T1), had blood withdrawn from a jugular vein to achieve a mean blood pressure of 40 ± 5 mm Hg for 10 minutes (T2), were resuscitated with 100% shed blood, and then had hemostatic variables evaluated 10 minutes later (T3). At each time point, hemostatic variables were measured with traditional tests (Hct, WBC count, platelet count, mean platelet volume, prothrombin time, activated partial thromboplastin time [aPTT], and concentrations of fibrinogen, antithrombin, and D-dimer) and the VCM-Vet device (clot time, clot formation time, α-angle, maximum clot formation, amplitude at 10 minutes [A10], amplitude at 20 minutes [A20], clot lysis index at 30 minutes [LI30], and clot lysis index at 45 minutes [LI45]). All dogs survived without complication. At T2 and T3 (vs T1), samples had significantly higher coagulability (increased median α-angle, A10, and A20) and fibrinolysis (decreased median LI30 and LI45) and significantly longer aPTT; however, all values remained within reference limits. The use of VCM-Vet helped identify complex hemostatic disturbances in dogs with hemorrhagic shock. The use of VCM-Vet shows promise in aiding veterinarians in optimizing resuscitation strategies based on real-time clotting data.

Peri-Interventional Hemodynamic Management Strategies for Percutaneous Chemosaturation of the Liver in Metastatic Cancer.

Background: Hepatic chemosaturation for inoperable liver tumors is a palliative treatment option with a beneficial effect on survival. However, the procedure regularly leads to circulatory failure during the filtration phase, and hemodynamic management is challenging. Our study aimed to compare two different strategies for hemodynamic management during chemosaturation to develop hypotheses for improving patient care and reducing peri-interventional morbidity. Methods: We conducted a single-center retrospective cohort study including 66 procedures of chemosaturation between May 2016 and March 2024. Procedures were divided into two groups: group 1 was managed with norepinephrine as the only vasopressor and liberal use of hydroxyethyl starch (HES). Group 2 was managed with norepinephrine and vasopressin and the preferred use of balanced crystalloids. We compared these two groups with respect to hemodynamic parameters, laboratory values, and post-interventional complications. Results: The heart rate was highest and the mean arterial pressure (MAP) was lowest during the filtration phase in both groups (p = 0.868, p = 0.270). The vasoactive inotropic score (VIS) was significantly higher in group 2 during the filtration phase (31.5 vs. 89, p < 0.001). Group 1 received significantly more HES overall (1000 mL vs. 0 mL, p < 0.001). Lactate levels at admission to the ICU were higher in group 1 (22.9 vs. 14.45 mg/dL, p = 0.041). Platelet counts were lower in group 2 from directly after chemosaturation through day 2 (p = 0.022, p = 0.001, p = 0.032). The INR differed significantly directly after chemosaturation (1.13 vs. 1.26, p = 0.015). Overall, group 1 received significantly more blood products peri-interventionally. There were two bleedings and one ischemic stroke in the overall cohort. There was no peri-interventional mortality. Conclusions: Advanced hemodynamic management ensures low peri-interventional mortality and morbidity. High-dose vasopressors, including vasopressin and the preferred use of balanced crystalloids, are sufficient to stabilize circulatory function during chemosaturation.

Association between the systemic immune-inflammation index and stress urinary incontinence: analysis using data from the National Health and Nutrition Examination Survey, 2007-2016

BackgroundInflammation plays a key role in the pathogenesis of stress urinary incontinence (SUI). The present study investigated the association between the systemic immune-inflammation index (SII) and SUI in a nationally representative adult population. MethodsData from the 2007-2016 National Health and Nutrition Examination Survey were analyzed. SUI was determined by self-report of urine leakage caused by activity such as coughing, lifting, or exercise. The SII was calculated as (platelet count × neutrophil count)/lymphocyte count. Survey-weighted logistic regression models were used to analyze the relationship between the SII and SUI. ResultsData from 18,797 participants, of whom 2695 (14.3%) reported SUI, were included. After adjusting for covariates, multivariate logistic models revealed that a high SII was associated with an increased overall likelihood of SUI (odds ratio [OR] 1.116 [95% confidence interval (CI) 1.018–1.223]; P = 0.0206). A higher risk was observed for monthly and weekly SUI (OR 1.144 [95% CI 1.009–1.297]; P = 0.0359, and OR 1.205 [95% CI 1.002–1.449]; P = 0.0478, respectively). Separate interaction analyses revealed no significant effects of age, gender, race, body mass index, marital status, alcohol use, or vigorous recreational activities on the association between the SII and SUI. ConclusionsResults revealed that a high SII associated with an increased risk for SUI. The SII may serve as a novel predictive biomarker in clinical practice to predict the occurrence and progression of SUI symptoms. A physiological mechanism underlying this relationship could be proposed and further evaluated in translational and basic scientific studies.

The Clinical Impact of the Systemic Immune-inflammation Index in Esophageal Cancer Patients Receiving Curative Treatment.

The systemic immune-inflammation index (SII) is a calculated biomarker developed to predict the prognosis of malignant tumors. This study evaluated the influence of the SII in patients with esophageal cancer (EC) who underwent curative resection. Patients who underwent radical esophagectomy and lymph node dissection for EC were enrolled. The SII was calculated as follows: neutrophil count (cell/mm3) × platelet count (cell/mm3 ×103)/lymphocyte count (cell/mm3). The SII, patient characteristics, overall survival (OS), and recurrence-free survival (RFS) were assessed. A total of 180 patients were included in this study. The cutoff value of the SII was set at 500 according to previous studies. Of the 180 patients, 100 were classified into the SII-high group and 80 into the SII-low group. The 3- and 5-year OS rates were 59.0% and 54.0%, respectively, in the SII-high group and 80.0% and 75.0%, respectively, in the SII-low group, showing significant differences between the groups (p=0.001). A multivariate analysis for the OS demonstrated that the SII was an independent prognostic factor (hazard ratio=2.333, 95% confidence interval=1.411-3.860, p<0.001), with similar results obtained for the RFS. Furthermore, hematological recurrence was significantly higher in the SII-high group than in the SII-low group (36.0% vs. 17.5%, p=0.006). The preoperative SII was an independent prognostic factor for OS and RFS in patients with EC who underwent curative resection. Thus, the SII can be a useful marker for the treatment and management of EC.

A retrospective cohort study on the association between nutritional status and prognosis in COVID-19 patients with severe and critical infection.

To evaluate the relationship between nutritional scoring systems, nutritional support methods, and the prognosis of severe and critically ill patients infected with the Omicron variant of coronavirus disease 2019 (COVID-19). Patients with confirmed Omicron variant severe and critical COVID-19, who were admitted to Chongqing Medical University First Hospital between December 2022 and January 2023, were enrolled into this retrospective study. Clinical data of patients who survived for 28 days were compared with those who died during the same period. Nutritional status was assessed using the 2002 Nutrition Risk Screening (NRS) tool and Prognostic Nutritional Index (PNI). Factors influencing patient mortality were identified by multivariate logistic regression, and the relationship between patient nutrition and mortality as the disease progressed was illustrated using Kaplan-Meier curves. The study was registered on the ChiCTR platform (No. ChiCTR2300067595). A total of 508 patients were included (349 survivors and 159 non-survivors). Significant differences were found in sex, age, NRS score, PNI score, albumin level, lymphocyte count, chronic comorbidities, mechanical ventilation, neutrophil count, procalcitonin, and platelet count between survivors and non-survivors. Multivariate analysis revealed that high NRS score (OR 3.87, 95% CI, 1.97, 7.63), fourth-level nutritional support (combined enteral and parenteral nutrition; OR 7.89, 95% CI, 1.32, 47.28), chronic comorbidities (OR 4.03, 95% CI, 1.91, 8.51), and mechanical ventilation (OR 6.03, 95% CI, 3, 12.13) were risk factors for mortality (OR > 1). The malnutrition rate among patients with NRS ≥ 3 was 41.93%. The median (interquartile range) PNI score was 38.20 (35.65, 41.25) for survivors versus 32.65 (29.65, 36.58) for non-survivors. The mortality rate was higher in patients with high nutritional risk within 28 days of hospitalization. The descending order for mortality rate in patients receiving different nutritional support was: dual parenteral and enteral nutrition, no nutritional intervention, single enteral nutrition, and single parenteral nutrition. A high proportion of severe and critically ill patients with COVID-19 experience malnutrition, and various factors are associated with their prognosis. High nutritional risk is significantly related to patient mortality. Early assessment using NRS or PNI is crucial for these patients, and personalized interventions should be implemented to improve overall nutritional status, maintain organ function, and enhance the body's antiviral defence.

Morbidité et mortalité en anesthésie pour arthroplastie totale de la hanche sur terrain de drépanocytose dans un pays à faible revenu : cas du centre hospitalier Monkole

Background: Anaesthesia for hip arthroplasty in patients with sickle cell disease is considered a high-risk procedure. This study investigated morbidity and mortality in a low-income country using Monkole Hospital as an example.Methods. A cross-sectional study of electrophoretically confirmed sickle cell patients anaesthetised at Monkole for hip arthroplasty during the period October 2018 to April 2024. Peri-anaesthetic data up to hospital discharge were collected prospectively and analysed with SPSS 26.0 for p<0.05. Anaesthetic management at Monkole is multidisciplinary. Transfusion exchange, Hb S assay, and systematic cardiorespiratory investigations are not performed. Simple transfusion was carried out with the aim of achieving a haemoglobin level of 7 and 9 g/dl.Results. Eighty-six patients were enrolled. The mean age was 26.02 years, 88.54% were aged 18 and over, and 66.3% were women. BMI was <18.5 kg/mm2 in 48.8%; 84.9% were polytransfused; only 9.3% were on hydroxyurea and only one had received exchange transfusion; 2.3% were icteric and 97.7% were classified ASA III. The mean Hb level was 8.3g/dl, and less than 7g/dL in 15.1% of cases. Antibiotic prophylaxis was administered in all patients with cefazolin ± gentamycin. Spinal anaesthesia (bupivacaine + morphine) was used alone (95.3%), combined with general anaesthesia (3.48%), and the prosthesis was cemented in 95.35% of cases. Intraoperative complications were: arterial hypotension (18.6%), discomfort (4.6%), the effect of cementing (4.6%), poor quality of spinal block (1.6%), haemorrhage (2.3%). Transfusion was required for 79.1% of patients intraoperatively and 3.2% postoperatively. Postoperative complications accounted for 11.6%: anaemia (5.8%), vaso-occlusive crisis (2.3%), urinary retention (2.3%), and vomiting (1.6%). No deaths or acute chest syndrome were recorded. All patients spent one day in intensive care and the average hospital stay was 5 days. Alcohol consumption and procedures lasting longer than two hours were associated with intraoperative complications. Leanness, previous anaesthesia, platelet count below 1500000/mm3, prolonged activated partial thromboplastin time, and the presence of intraoperative complications were associated with postoperative complications.Conclusion. There was no and morbidity was represented by minor complications. It seems possible to anaesthetise patients with sickle cell disease for hip arthroplasty without measuring haemoglobin S or exchanging transfusions, with a lower risk of morbidity and mortality.

Systemic immune-inflammation index and 2-year all-cause mortality in elderly patients with hip fracture

PurposeTo assess the association between systemic immune-inflammation index (SII) and 2-year all-cause mortality in elderly patients with hip fractures. MethodsWe performed a cohort study of hip fracture patients aged 65 years or older who received hip fracture surgery at a tertiary hospital from January 2005 to March 2022. The SII was calculated as: SII = (neutrophil count * platelet count) / lymphocyte count, based on the latest blood test before discharge. Patients were categorized into 3 groups according to SII tertiles: low SII group (≤770.92 × 109/L), medium SII group (770.92 × 109/L -1293.03 × 109/L), and high SII group (>1293.03 × 109/L). The primary outcome was 2-year all-cause mortality. We evaluated the association between SII and 2-year all-cause mortality using the multivariate Cox regression model. ResultsAmong 2,766 patients, 296 patients died during the 2-year follow-up period. The incidence of 2-year all-cause mortality per 1,000 persons was 90.0 (95% CI, 73.2-110.2) in the low SII group, 86.8 (95% CI, 70.3-106.7) in the medium SII group, and 144.3 (95% CI, 123.1-168.5) in the high SII group. Compared with patients in the low SII group, the hazard ratio for 2-year all-cause mortality was 0.97 (95% Cl 0.69-1.37) in the medium SII group and 1.47 (95% Cl 1.07-2.01) in the high SII group (P for trend, 0.001). ConclusionSII is significantly associated with 2-year all-cause mortality in elderly patients with hip fracture. SII may be used to identify patients at high risk of mortality after hip fracture surgery.