Routine Blood Samples Research Articles

Systemic Immune-Inflammatory Index and Other Inflammatory Marker Variations in Oral Squamous Cell Carcinoma Management.

Background and Objectives: With the greatest rate of morbidity and death, OSCC is one of the world's most critical public health problems. Being a complex pathology, the management process that includes diagnostic, surgical, and adjuvant treatments must as well take into account the involvement of the immune system. This study aims to evaluate various biomarkers such as neutrophils, lymphocytes, platelets, SII, and NLR in the different stages of OSCC treatment and in correlation with TNM stages, in order to observe the inflammatory response of the host. Materials and Methods: A total of 154 patients diagnosed with OSCC were included in the present retrospective study. Routine blood samples were collected from all patients both before and after surgery. Using the detected values of platelets, neutrophils, and lymphocyte count, the systemic immune-inflammation index (SII) and neutrophil-to-lymphocyte ratio (NLR) were calculated. Based on the oncologist's recommendation, 46 patients underwent adjuvant radiotherapy as part of their oncologic treatment plan. For these patients, additional blood samples were collected before the first and after the last radiotherapy session for determining the values of platelets, neutrophils, and lymphocyte count, and SII and NLR calculation. Results: Prior to the first radiotherapy session, neutrophils decreased slightly to 4.35, lymphocytes increased to 2.23, and platelets rose to 258.62. The SII and NLR were 641.02 and 2.19, respectively. Following the last radiotherapy session, neutrophils increased substantially to 10.30, while lymphocytes decreased to 1.21. Platelets showed a slight reduction to 227.08. Notably, the SII rose dramatically to 3084.19, and the NLR increased significantly to 15.49, suggesting an important immune and inflammatory response of the host. Conclusions: The host's immunological and inflammatory responses are impacted by both surgery and adjuvant radiation administered following surgery. The parameters assessed-neutrophils, lymphocytes, platelets, SII, and NLR-qualify as significant variables that need to be monitored before, during, and following OSCC therapy. This study's findings validated significant changes in immunological and inflammatory markers in the management of OSCC.

Do I sound sick? Self-perceived and objectively measured voice impairment in acutely decompensated heart failure: fist insights from the AHF-Voice study

Abstract Introduction Acute heart failure (AHF) is a common reason for recurrent hospitalization. Daily smartphone-based recording of vocal biomarkers appears promising for the early detection of impeding AHF. However, the value of patient-reported outcome measures (PROMs), i.e. self-perceived voice alterations during decompensation, is unknown. Methods AHF-Voice is an ongoing monocentric prospective cohort study focusing on voice alterations in patients hospitalized for AHF. Exclusion criteria: listed for heart transplantation, high output HF, cardiogenic shock, history of vocal fold disease or surgery, or life-expectancy <6 months. During hospitalization, medical history & echocardiogram were taken and routine blood sampling was done. Daily voice recordings including sustained vowels and standardized reading were collected using a specially designed smartphone app under supervision. At admission and discharge, the self-perceived level of voice alteration was assessed by the Voice–Handicap Index-12 (VHI-12, 0-48 points) questionnaire and a global voice scale (Likert scale, 0-3 points). For both scales, higher values indicate a more severe voice impairment. Hypervolemia was quantified by body composition analysis. Preprocessing and feature extraction of voice recordings were performed using Praat software. The association of self-perceived voice impairment with surrogates of congestion and vocal biomarkers was assessed by bivariate correlation and linear regression. Results Between Apr 2023 and Feb 2024, 72 hospitalized patients with AHF were included. Four patients withdrew consent, 5 patients were excluded due to limited voice recording quality. Hence, 63 patients were considered for analysis: mean age 75±10 years, 67% men, 91% were in NYHA class III/IV, 49% de novo HF, mean LVEF was 45±16%, and median value of Charlson comorbidity score was 2 [1, 3]. Both measures of self-perceived voice impairment improved between admission and discharge (Table 1A and Figure). Concomitantly, body weight, hypervolemia, NT-proBNP, and vocal biomarkers (total reading time and shimmer) decreased. Bivariate correlation showed that both self-perceived scales of voice impairment were closely correlated, as expected (Spearman’s rho 0.36). Linear regression identified surrogates of congestion and objective voice impairments as predictors for change in both PROMs (Table 1B). However, the explained variance was low, e.g. for change in volume status and NT-proBNP 14% and 1% (VHI-12), and 4% and 7% (Global voice scale), respectively. Conclusion This preliminary analysis in patients with AHF showed that self-perceived voice impairment was sensitive to change during recompensation. Objectively generated voice measures and congestion only partially explained the observed improvement of these PROMs. This might indicate that the self-perceived voice impairment constitutes a complimentary domain of patient well-being and indicator for congestion that should be explored further.

Can simple biomarkers of inflammation guide the diagnosis of psychiatric disorders?

Objective In this study, we wanted to investigate the usability of routine blood samples taken at the beginning of hospitalisation in inpatients to predict the presence of psychotic symptoms in patients. Methods We divided the hospitalised patients into two groups those with and without psychotic symptoms according to their ICD-10 diagnosis codes. Then, we compared the complete blood count, c-reactive protein (CRP), and fasting glucose levels, which can be used as simple markers of inflammation. Results In this retrospective study, which included 349 patients, we found that blood leukocytes, neutrophils, CRP, and fasting glucose levels were higher in patients with psychotic symptoms than in patients without psychotic symptoms (p = 0.015; p = 0.013; p = 0.002; and p = 0.001, respectively). According to regression analysis, patients with high glucose levels were 4.9 times more likely to have psychotic symptoms than those with low glucose levels. In addition, according to the ROC analysis results; when we used 87 mg/dl as the cut-off value for fasting glucose, it was observed that it predicted psychotic symptoms with approximately 69% sensitivity and 71% specificity. Conclusion Although our results still have some limitations, they are promising for the future use of simple biomarkers of inflammation for the differential diagnosis of psychiatric disorders.

Comparison between standard hematological parameters and blood doping biomarkers in dried blood spots within the athlete population of Swiss Sport Integrity.

The study demonstrated the feasibility of incorporating RNA biomarkers, specifically 5-aminolevulinic acid synthase (ALAS2) and carbonic anhydrase 1 (CA1), to improve the hematological module of the Athlete Biological Passport (ABP) in routine antidoping context. The aim was to investigate the implementation of reticulocyte (RET) related biomarkers, specifically ALAS2 and CA1, using quantitative reverse transcription polymerase chain reaction (RT-qPCR) on dried blood spots (DBS) from elite athletes. Hemoglobin changes over time in DBS samples was measured as well. Combining hemoglobin and messenger RNA (mRNA) analyses allowed to monitor alterations of the established marker, "DBS OFF-score". Ten athletes were selected for sampling by the Swiss national antidoping organization, Swiss Sports Integrity (SSI). Samples were collected, transported and analyzed for ABP following the World Anti-Doping Agency (WADA) procedures and spotted onto Protein Saver DBS cards. Most athletes exhibited stable biomarker levels, except for one individual involved in ski mountaineering, who demonstrated a sustained increase in ALAS2 compared to the individual baseline. This elevation could be due to blood withdrawal or other factors, such as doping with substances outside the targeted test menu. In this study, RNA-biomarkers were successfully analyzed in routine blood samples, and the project demonstrated promising results for the implementation of ALAS2 and CA1 in routine analysis to complement the ABP.

Assessment of left ventricle myocardial performance index (Tei index) by myocardial tissue Doppler imaging and its correlation with serum thyroid-stimulating hormone levels and atherogenic index of plasma in patients of subclinical hypothyroidism

ABSTRACT Background: Subclinical hypothyroidism (SCH) is defined as a state of increased serum thyroid-stimulating hormone (TSH) level with circulating thyroxine (T4) and triiodothyronine (T3) in the population reference range. Patients with SCH have an increased risk of subclinical cardiac dysfunction and dyslipidemia. Objective: The primary objective was to assess the left ventricular myocardial performance index (MPI), i.e., the Tei index which is a marker of global MPI in subclinical hypothyroid patients. There were two secondary objectives. The first was to assess the correlation between Left ventricle (LV) Tei index and serum TSH level in patients with SCH. The second was to measure the atherogenic index of plasma (AIP) in patients with SCH and it is correlation with the Tei index. Materials and Methods: This was a cross-sectional, observational study including 100 subclinical hypothyroid patients. All subclinical hypothyroid patients attending outpatient department underwent screening, detailed history taking, and clinical examination. Patients were analyzed for eligibility of the study. After taking consent, all eligible patients underwent tests for routine blood sampling, lipid profile, thyroid profile, antithyroid peroxidase antibodies, electrocardiography, and echocardiography including tissue Doppler imaging. MPI was calculated for each patient. MPI was correlated with serum TSH levels and also with atherogenic plasma index (AIP) using an appropriate statistical analysis tool. Results: Fifty-three percent of subclinical hypothyroid patients had abnormal lateral and medial Tei index. Fifty-one percent of subclinical patients had abnormal mean Tei index despite normal left ventricle ejection fraction. However, there was no correlation between the Tei index and TSH level. In this study, 48% and 29% of patients had high and intermediate cardiovascular risk, respectively, according to AIP. No statistically significant correlation was observed between the Tei index and atherogenic index of plasma. Conclusion: Subclinical hypothyroid patients have significant subclinical cardiac dysfunction (as determined by the Tei index) and dyslipidemia. AIP may serve as an effective screening method to identify subclinical hypothyroid individuals who are at higher risk of cardiovascular events. Large prospective studies are needed to validate the AIP-TSH-MPI relationship.

Nutrient Status and Supplement Use During Pregnancy Following Metabolic Bariatric Surgery: A Multicenter Observational Cohort Study

IntroductionPregnant women with a history of metabolic bariatric surgery (MBS) are at high risk of developing nutrient deficiencies, leading to greater challenges to reach nutritional requirements. This study compared nutrient status of women using specialized “weight loss surgery” multivitamin supplementation (WLS-MVS) to those using standard supplementation (sMVS) during pregnancy following MBS.MethodsMulticenter observational cohort study including 119 pregnant women at 41.0 (18.5–70.0) months after Roux-en-Y gastric bypass (RYGB, n = 80) or sleeve gastrectomy (SG, n = 39). Routine blood samples were analyzed every trimester (T1, T2, T3), and micronutrient serum levels were compared between WLS-MVS and sMVS users.ResultsDuring pregnancy after RYGB, WLS-MVS users demonstrated higher serum concentrations of hemoglobin (7.4 [7.2, 7.5] vs. 7.0 [6.8, 7.3] mmol/L), ferritin (23.2 [15.0, 35.7] vs. 13.7 [8.4, 22.4] µg/L), and folic acid (31.4 [28.7, 34.2] vs. 25.4 [21.3, 29.4] nmol/L) and lower serum vitamin B6 levels (T1: 90.6 [82.0, 99.8] vs. 132.1 [114.6, 152.4] nmol/L) compared to sMVS users. Iron deficiencies and elevated serum vitamin B6 levels were less prevalent in the WLS-MVS group. During pregnancy after SG, WLS-MVS users showed higher serum vitamin D concentrations (89.7 [77.6, 101.8] vs. 65.4 [53.3, 77.4] nmol/L) and lower serum vitamin B1 concentrations (T2: 137.4 [124.2, 150.6] vs. 161.6 [149.0, 174.1] nmol/L, T3: 133.9 [120.1, 147.7] vs. 154.7 [141.9, 167.5] nmol/L) compared to sMVS users.ConclusionLow maternal concentrations of micronutrients are highly prevalent during pregnancy after MBS. The use of specialized multivitamin supplementation generally resulted in higher serum levels during pregnancy compared to standard supplementation. Future research is needed to investigate how supplementation strategies can be optimized for this high-risk population.Graphical

Analysis of The Results of The Rhesus System Blood Group Phenotyping Examination in Routine Type O Blood Donors

The Rhesus (Rh) system is the second most important blood group system after ABO, has the highest immunogenicity and tends to produce alloantibodies that cause most transfusion reactions. In the Rh blood group system, there are more than 55 antigens, but the main ones are D, C, E, c, and e. Currently, only the D antigen is carried out without examining four other important Rh antigens. Still scarce, studies on the proportion of Rh antigens, except D, in Indonesia; in this study we have determined Rh antigens and phenotypes among a population of routine blood donors. The purpose of this study was to determine the phenotypic variation and frequency distribution of the main antigens of the Rhesus blood group system in routine blood type O blood donors at UDD PMI Depok City. This study was descriptive and observational with a cross-sectional design. Primary data are obtained from the Rhesus system antigen examination results on donor blood samples. The sample was 140 blood samples from 140 routine donors. A rhesus phenotyping examination was carried out using the gel method. The study was conducted on 140 routine donor blood samples at UDD PMI Depok City. The characteristics of the subjects were male (69.29%) and female (30.71%), with an average age of 38 years. Samples are analyzed for five major Rhesus antigens. Rhesus antigen test shows D antigen (100%), e antigen (97.14%), C antigen (95.71%), c antigen (36.43%) and E antigen (27.86%). Rhesus phenotype results were R1R1 (DCe/Dce) (62.86%), R1R2 (DCe/DcE) (22.86%), R1r (DCe/dce) (9.29%), R2R2 (DcE/DcE) (2.86%), R2r (DcE/dce) (1.43%), and R1RZ (DCe/DCE) (0.71%). In conclusion, the frequency of phenotypic changes in the Rh blood group system of regular blood donors at UDD PMI Depok City is classified as the most common types: DCe/DCe, DCe/DcE, DCe/dce, DcE/DcE, DcE/dce and DCe/DCE.

Frequency and clinical significance of Herpes simplex virus type 1/2 reactivation in adult patients with mild to moderately severe community-acquired pneumonia: a multicentre cohort study.

This study assessed the frequency, clinical significance, and risk factors for Herpes simplex virus (HSV) reactivation in immunocompetent patients with community-acquired pneumonia (CAP). The study included adult CAP-patients who were enrolled in the CAPNETZ study between 2007 and 2017 and had a residual sputum sample available for analysis. In addition to routine diagnostics, sputum and blood samples were tested for HSV-1/2 using PCR. Demographics, comorbidities, and CRB-65 score were compared between HSV-positive and negative patients using Fisher exact or Mann Whitney test. Logistic regression analyses investigated the influence of HSV reactivation on a modified hospital recovery scale (HRS) until day 7, divided into 3 categories (no oxygen therapy, oxygen therapy, ICU admission or death). Among 245 patients, HSV-1 and HSV-2 were detected in 30 patients (12.2%, 95%CI 8.7-16.9) and 0 patients, respectively. All HSV-positive patients were hospitalized, had a CRB-65 severity score of 0-2 and survived the first 28day. In the HSV-positive group, patients had a non-significantly higher median age (70.5 versus 66years) and a higher rate of oncological comorbidities (16.7% versus 8.8%) compared to the HSV-negative group. Distribution of co-pathogens and outcome parameters did not significantly differ between both groups. In a multivariate logistic regression model, age (AOR 1.029, p = 0.012) and CRB-65 score (AOR 1.709, p = 0.048), but not HSV-1 as single or co-pathogen were independently associated with higher HRS. Our study suggests that HSV-1 reactivation is common in CAP but might not be associated with specific risk factors or a complicated disease course.

Nutritional safety and status following a 12-week strict low FODMAP diet in patients with irritable bowel syndrome.

A low FODMAP diet (LFD) is an established dietary treatment for patients with irritable bowel syndrome (IBS). However, knowledge on the extended effects of the restriction phase regarding nutrient intake, symptom severity, and quality of life (QoL) is sparse. Therefore, our objectives were to evaluate the safety of a dietitian-led 12-week strict LFD on measures of blood biochemistry, nutritional status, symptom severity, and QoL. In this open-label dietitian-led 12-week strict LFD intervention for IBS patients with predominantly diarrhea or mixed stool pattern (IBS-D/-M), we collected data on diet intake (3-day dietary record), overnight fasting routine blood samples, body weight, IBS symptoms (IBS Severity Scoring System (IBS-SSS)), and IBS-related QoL (IBS-QoL) at baseline and after 12 weeks. Thirty-six participants completed the 12-week follow-up (mean age: 37 years, 67% women, IBS-SSS: 242 (101)). All blood parameters measured were within established reference values at both time points. We found no change in intake of macro- or micronutrients, but several micronutrients were below the recommendations both before and after 12 weeks. BMI slightly decreased, primarily driven by participants with BMI >25 (p < 0.005). QoL improved among most subdomains (p ≤ 0.002), except food avoidance and social reaction. An extended dietitian-guided LFD (12 weeks) is not inferior to the participants' baseline diet, since no clinically meaningful changes in nutritionally related blood samples and no changes in macro- or micronutrient intake were observed. However, the intake of several nutrients was below the recommendations at both time points indicating low diet quality.

Evaluating routine blood and cerebrospinal fluid samples in narcolepsy patients

Cerebrospinal fluid hypocretin-1 is proven to be a precise diagnostic marker of narcolepsy Type 1 (NT1). However other characteristics of cerebrospinal fluid and blood parameters have not yet been described. The objective of this study was to evaluate the differences in routine blood and cerebrospinal fluid analyses between NT1 patients and patients suspected of hypersomnia. We collected retrospectively all measures of cerebrospinal fluid hypocretin-1 between 2019 and 2022. This yielded 612 patients out of which 146 were diagnosed with NT1 and the rest (466 patients) were used as a control group. We selected the most relevant routine samples from both blood, plasma and cerebrospinal fluid and compared the two groups. The only significantly different analytes were plasma lactate dehydrogenase and cerebrospinal fluid hypocretin-1. No other differences were found between the groups including thyroid markers, markers of neuroendocrine function, inflammatory markers in blood or cerebrospinal fluid, markers of permeability of the blood brain barrier or metabolic markers in blood samples. We found no significant differences in routine blood or cerebrospinal fluid components, neuroendocrine function, neuroinflammation and metabolic markers. The results reflect that the hypocretin system does not seem to play a chronic major role in regulation of these markers. None of the parameters routinely measured in blood in these patients could differentiate between NT1 and non-NT1 disorders besides CSF-hcrt-1.

Immune Checkpoint Inhibitor Score Predicts Survival Benefit of Immunotherapy in Patients with Non-small Cell Lung Cancer.

The use of immune checkpoint inhibitors (ICIs) in patients with advanced lung cancer is increasing. Despite ongoing studies to predict the efficacy of ICIs, its use in clinical practice remains difficult. Thus, we aimed to discover a predictive marker by analyzing blood cell characteristics and developing a scoring system for patients treated with ICIs. This was a prospective multicenter study in patients with advanced nonsmall cell lung cancer (NSCLC) who received ICIs as second-line treatment from June 2021 to November 2022. Blood cell parameters in routine blood samples were evaluated using an automated hematology analyzer. Immune checkpoint inhibitor score (IChIS) was calculated as the sum of neutrophil count score and immature granulocyte score. A total of 143 patients from four institutions were included. The treatment response was as follows: partial response, 8.4%; stable disease, 37.1%; and progressive disease, 44.8%. Median progression-free survival and overall survival after ICI treatment was 3.0 and 8.3 months, respectively. Median progression-free survival in patients with an IChIS of 0 was 4.0 months, which was significantly longer than 1.9 months in patients with an IChIS of 1 and 1.0 month in those with an IChIS of 2 (p=0.001). The median overall survival in patients with an IChIS of 0 was 10.2 months, which was significantly longer than 6.8 and 1.8 months in patients with an IChIS of 1 and 2, respectively (p&lt;0.001). Baseline IChIS could be a potential biomarker for predicting survival benefit of immunotherapy in NSCLC.

The Effect of Continuous Positive Airway Pressure (CPAP) Therapy on Serum Caspase-3 Level in Patients with Obstructive Sleep Apnea (OSA).

Intermittent hypoxemia has an important role in the physiopathogenesis of obstructive sleep apnea (OSA) complications. Increased apoptosis due to intermittent hypoxemia may be an important clinical entity in OSA. In this study, we aimed to evaluate caspase-3 enzyme level, which is an indirect marker of increased apoptosis in patients with OSA and to evaluate the effect of OSA treatment with continuous positive airway pressure on caspase-3 enzyme level. This study included 141 consecutive patients admitted to the sleep-disordered breathing laboratory within 6 months. Caspase-3 was measured in routine blood samples obtained on the morning of polysomnography (PSG) performed at night. The compliance of the patients to CPAP treatment was evaluated and caspase-3 levels were checked again after treatment. A total of 141 patients, 39 females (27,7%) and 102 males (72,3%) were included in the study. The mean age of the patients was 49 ± 12 years (min-17, max-77). According to PSG results, OSA was detected in 95.7% (135/141) of the cases. Mild OSA was 35 (24.8%), moderate OSA 39 (27.7%) and severe OSA 61 (43.3%) cases. Median caspase-3 enzyme levels were similar in men and women in the study group. There was no statistically significant difference in hemogram parameters and caspase-3 enzyme levels between the groups divided according to the presence and severity of OSA. It was determined that caspase-3 enzyme level did not change significantly after 3 months of CPAP treatment in OSA compared to pretreatment. Caspase-3 was found to have a negative correlation with both the percentage of daily use of CPAP therapy and the percentage of CPAP device use for more than 1 h per night. It was found that the control caspase-3 level decreased statistically significantly as the percentage of daily use of CPAP therapy increased (r = -0.397, p = 0.030). It was found that the control caspase-3 level decreased statistically significantly as the percentage of CPAP therapy use for more than 1 h per night increased (r = -0.411, p = 0.024). The results of this study did not reveal a relationship between the severity of OSA and caspase-3 levels. However, blood caspase-3 levels decreased as treatment compliance increased, suggesting that CPAP treatment may correct increased apoptosis in OSA. There is a need for more comprehensive studies on this issue.

Computed Tomography and Dual-Energy X-Ray Asorptiometry body composition parameter harmonisation to universalise adipose tissue measurements in a population-based cross-sectional study.

To harmonise computed tomography (CT) and dual-energy x-ray absorptiometry (DXA) body composition measurements allowing easy conversion in longitudinal assessments and across cohorts to assess cardiometabolic risk and disease. Retrospective cross-sectional observational study from 1996 to 2008 included participants in the Pennington Center Longitudinal Study (PCLS) (N = 1967; 571 African American/1396 White). Anthropometrics, whole-body DXA and abdominal CT images were obtained. Multi-layer segmentation techniques (Analyze; Rochester, MN) quantified visceral adipose tissue (VAT). Clinical biomarkers were obtained from routine blood samples. Linear models were used to predict CT-VAT from DXA-VAT and examine the effects of traditional biomarkers on cross-sectional-VAT. Predicted CT-VAT was highly associated with measured CT-VAT using ordinary least square linear regression analysis and random forest models (R2 = 0.84; 0.94, respectively, p < .0001). Model stratification effects showed low variability between races and sexes. Overall, associations between measured CT-VAT and DXA-predicted CT-VAT were good (R2 > 0.7) or excellent (R2 > 0.8) and improved for all stratification groups except African American men using random forest models. The clinical effects on measured CT-VAT and DXA-VAT showed no significant clinical difference in the measured adipose tissue areas (mean difference = 0.22 cm2). Random forest modelling seamlessly predicts CT-VAT from measured DXA-VAT to a degree of accuracy that falls within the bounds of universally accepted standard error.

Relationship Between Abdominal Aortic Aneurysm and Inflammatory Markers

Objective: In this study, we aimed to investigate the relationship between abdominal aortic aneurysm and systemic immune inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and other inflammatory markers, especially those derived from complete blood count. &#x0D; Methods: Retrospectively, 72 consecutive patients admitted to our clinic for Abdominal Endovascular Aneurysm Repair (EVAR) for abdominal aortic aneurysm (AAA) between January 2019 and January 2022 were included in the study. Routine blood samples were taken before EVAR operation. NLR, PLR, SII of the patients were calculated and, RDW, Mean Platelet Volume (MPV), C-reactive protein values and other laboratory tests were recorded. They were compared with an age-matched control group.&#x0D; Results: The age of the patients included in the study was 67.7 ± 10.6 years and the majority were male. The frequency of hypertension and coronary artery disease was also higher. In the comparison of hematologic parameters with the control group, MPV was 10.4(9.6-11.2) versus 9.5(8.6-10.1), p

UNNECESSARY PRETRANSFUSION BLOOD SAMPLING IN TRAUMA AND ORTHOPAEDICS IN WALES: A SUSTAINABILITY ISSUE AND FINANCIAL BURDEN

BACKGROUNDTheatre-listed trauma patients routinely require two ‘group and save’ blood-bank samples, in case they need perioperative transfusion. The Welsh Blood Service (WBS) need patients to have one recorded sample from any time in the last 10 years. A second sample, to permit cross-matching and blood issuing, must be within 7 days of transfusion (or within 48 hours if the patient is pregnant, or has been transfused within the last 3 months). The approximate cost of processing a sample is £15.00.AIMTo investigate whether routine pretransfusion blood sampling for trauma admissions exceeds requirements.METHODSElectronic records were used to collect pretransfusion sampling data for all adult non-elective trauma patients listed for theatre under a trauma and orthopaedics consultant between 1/1/2023-31/1/2023. Data were collected on unnecessary samples, rejected samples and total excess samples.RESULTS113 patients (mean age[±SD] 64.09[±19.96]) underwent 132 procedures. On average, unnecessary sampling occurred at a rate of 0.48 samples per operation, equating to a cost of £945.00/month. Samples were rejected by the laboratory at a rate of 0.25 samples per operation. Common reasons for rejection were ‘patient date of birth discrepancy’ (between sample and request form), ‘patient address discrepancy’ and ‘signature discrepancy’. Overall, total excessive sampling occurred at a rate of 0.60 samples per operation.CONCLUSIONNearly half of trauma patients undergo unnecessary blood testing in anticipation of potential perioperative transfusion. This has implications for sustainability, financial cost and patient welfare. This signals poor understanding of WBS requirements and is an area that requires improvement.

Does a preoperative coagulation sheet change the postoperative bleeding rate after adenoidectomy?

Adenoidectomy (AT) represents one of the first and most common surgeries in childhood. A joint statement of the German Society for Anesthesiology & Intensive Care Medicine as well as Pediatric & Adolescent Medicine and Otolaryngology, Head and Neck Surgery was published in 2006 to prevent of a possibly life-threatening postoperative bleeding after AT in Child age. Routine blood sampling should be avoided during preoperative preparations and instead a standardized coagulation questionnaire (GB) should be performed to clarify a coagulation disorder (GS). If the GB is abnormal, there is an indication for coagulation diagnostics (GD). This unicenter, nonrandomized, retrospective study compared the rate of bleeding after AT and Re-AT without (2011 to early 2014) and with (early 2014 to 2018) the use of a GB. 2633 children aged one to six years, were included in the statistical analysis to assess whether the introduction of GB in early 2014 was able to reduce the rate of bleeding after AT and Re-AT. Of the 2633 children, 1451 had GB and 1182 did not. Without GB, there was a bleeding rate of 0.83% and 2,08% with GB. 174 GB were abnormal and 169 GD were performed, 164 of these were unremarkable, 2 resulted in a confirmed mild type 1 von Willebrand syndrome as well as 2 suspected vWS and 1 suspected factor VII deficiency. The sensitivity of the GB was 16% and the specificity was 87.5%. The positive predictive value was 2.8% and the negative predictive value was 98%. The GB is a tool for detecting possible GS, but is not useful for reducing the rate of postoperative bleeding.

Clicker Training as an Applied Refinement Measure in Chickens.

When using chickens in animal studies, the handling of these animals for sample collection or general examinations is considered stressful due to their prey nature. For the study presented here, plasma and salivary corticosterone as well as New Area Test behavior and fecal output were used to evaluate whether it is possible to influence this stress perception using a three-week clicker training program. The results indicate that clicker training seems to be a suitable refinement measure in the sense of cognitive enrichment for the husbandry of this species. However, since it was also shown that three-week training was not sufficient to sustainably reduce the stress perception with regard to prolonged stressor exposure, and since it was also evident that manipulations such as routine blood sampling are perceived as less stressful than assumed, further studies with prolonged training intervals and situations with higher stressor potential are warranted. Also, further parameters for training assessment must be considered. For the general use of training as a supportive measure in animal experiments, its proportionality must be considered, particularly considering the expected stress and adequate training time.

A New Inflammatory Marker of the No-reflow Phenomenon after Percutaneous Coronary Intervention (PCI) to Saphenous Venous in Patients with Coronary Artery Disease

Background: Although numerous mechanisms regarding the no-reflow phenomenon (NRP) have been mentioned, they have not yet been fully elucidated. The NRP can impact the success rate even in a technically flawless percutaneous coronary intervention (PCI), which can be annoying. Before the procedure, there is no specific parameter or index that can assess a significant factor such as NRP that has a direct impact on the success of the PCI. Objectives: The present study aimed to evaluate the relationship between the systemic immune-inflammation index (SII) and NRP in patients who underwent PCI for saphenous vein graft (SVG). Methods: In this retrospective cohort study, 312 coronary artery bypass grafting (CABG) patients admitted to primary or elective SVG and those who underwent PCI between January 2014 and December 2021 were selected. Routine blood samples were taken from the patients at the time of admission, and SII was calculated as the ratio of the product of the total neutrophil count and the total platelet count to the lymphocyte count. The reperfusion rates after PCI were evaluated according to the thrombolysis in myocardial infarction (TIMI) grade flow and myocardial blush grade (MBG). Following the procedure, those with an angiographic TIMI flow grade of ≤ 2 or TIMI flow grade of 3 and a final MBG of &lt; 2 were considered NRP. Results: The number of 85 patients (27.2%) were diagnosed with NRP. The SII and ST-elevation myocardial infarction were found to be independent predictors for NRP in multivariate logistic regression analysis (P&lt;0.05). The SII predicted NRP with a sensitivity of 86% and a specificity of 80% (AUC: 0.866, 95% CI: 0.823 to 0.910, P&lt;0.001) using a cut-off point of 13.45. Conclusion: The SII is an independent predictor that can be easily calculated from the whole blood test to predict no-reflow development, which is a frustrating complication in patients following the PCI to the saphenous vein. This predictor can enable us to pre-evaluate the non-operational reasons affecting the procedure's success.

New Insights into VOC Incidence By Analyzing the Single Cell Quantification of HbF per RBC and Mchbs

Vaso-occlusive crisis (VOC), the main complication of sickle cell disease (SCD), is responsible for more than 50% of the associated deaths. The effect of hydroxyurea, the cornerstone treatment for SCD, on the occurrence of VOC is mainly mediated by increasing HbF levels, which is a protective factor by inhibiting hemoglobin S (HbS) polymerization. 1,2 However, HbF level is variable between patients, and its expression is heterogeneous among the red blood cell (RBC) population. 3 As a result, while an increase in HbF levels is associated with better survival, %HbF only partially explains patients' clinical manifestations. The protective effect of HbF is also related to the HbS content; the more HbS, the more HbF is needed to inhibit its polymerization. In this study, we wondered if the single-cell quantification of HbF that we developed could better explain the VOC incidence of SCD compared to %HbF. Patients and method We analyzed data from the FCDREP1 protocol, aiming to obtain a predictive score for VOC at 1 year. Inclusion criteria were SS and S- S-b 0 Thal SCD patients, more than 1 month after a vaso-occlusive crisis, 3 months after a transfusion, and on a stable dose of hydroxyurea (HU) for at least 3 months. After giving their consent (IRB no. 00003835) during a routine blood sampling visit, an additional sample was taken for HbF single cell quantification, providing HbF/cell distribution. VOC were collected prospectively for 1 year. HbF single cell quantification was measured by flow cytometry using a previously published protocol, 4 data are expressed as histograms representing % RBC in each HbF range in pg for the whole cluster. K-means clustering was performed on different combination of variables containing ranges of HbF/cell distribution versus %HbF, with MCHbS (MCH x %HbS) using UMAP for dimensionality reduction (into 2), after we applied Min-Max scaling to preprocess the features, with python 3 on sklearn and umap library. This clustering approach can group data points based on their similarity, providing insights into distinct patterns or subgroups within the dataset. Results One hundred two patients were included with a mean age of 38 ± 11 years, a sex ratio F/M of 0.56, 63% of patients were on HU. Patients had a total of 74 VOC with a mean of 0.71 ± 1.4 VOC per patient in the year. Analyses were performed finding 4 different clusters in different 2 groups. Group 1: clusters identified by the association of HbF/cell distribution and MCHbS (HbF/Cell) and Group 2: clusters identified by %HbF and MCHbS (%HbF). Clusters were numbered according to increasing HbF levels (Figure 1A and B). There was no significant difference in age or sex ratio between the groups whereas the percentage of patients on HU differed between groups (Figure 1F). The number of patients by cluster was also similar. Cluster analysis of Group 1 showed a decrease in VOC incidence (Figure 1E, blue bars) associated with an increase in HbF level per RBC (Figure 1A). If clusters 1 and 2 are similar regarding the % of HU-treated patients, cluster 1 shows a lower HbF/cell content (Figure 1A) but lower MCHbS and MCH (Figure 1C and 1D), possibly explaining a similar VOC incidence in the 2 clusters. With a higher % of HU-treated (Figure 1F), Cluster 3 and 4 stand out from each other by different HbF expression patterns and VOC incidence (Figure 1A). The clusters of group 2 does not show the same increasing incidence of VOC as a function of median %HbF (Figure 1B and E). If cluster 4, mostly treated with HU, corresponds to patients with high %HbF and low VOC; cluster 1, with little HU treatment and very low %HbF, has few VOCs, not explained by MCHbS. The difference in severity between clusters 2 and 3, which have the same percentage of HU, could be explained by the greater difference in %HbF distribution, with median %HbF values of 11.8 [5-14] and 13.8 [11-15] (p=0.06) respectively, as well as by the low MCHbS of cluster 3. Conclusion : Single cell quantification of HbF in RBC in association with MCHbS could help improve to better understand VOC incidence.

The Relationship between Furin and Chronic Inflammation in the Progression of Cervical Intraepithelial Neoplasia to Cancer: A Cross-Sectional Study.

The current study aimed to delineate the relationship between furin and chronic inflammation while cervical intraepithelial neoplasia progresses to cancer. This cross-sectional study included 81 women who required colposcopic examinations. The study groups were formed based on pathological results: Group I included women with cervical intraepithelial neoplasia (CIN) I (n = 30); Group II included women with CIN II-III (n = 28); and Group III included women with cervical cancer (CC) (n = 23). Furin, ki-67, and p16 levels were evaluated based on immunostaining intensity. The inflammatory indices were calculated in parallel with the literature from routine blood samples retrieved within one week before the procedure. Furin expression gradually increased from CIN I to CIN II-III and from CIN II-III to CC, respectively (p < 0.001, p = 0.005). NLR, MLR, PLR, and SII were significantly higher in the CC group (p < 0.001). ROC curve analysis unveiled that NLR, MLR, PLR, and SII predicted the presence of CC with a cutoff value of 2.39 for NLR (sensitivity: 91.3%, specificity: 63.8%, AUROC: 0.79, p < 0.001); a cutoff value of 0.27 for MLR (sensitivity: 78.3%, specificity: 72.4%, AUROC: 0.77, p = 0.009); a cutoff value of 123 for PLR (sensitivity: 100%, specificity: 41.4%, AUROC: 0.70, p = 0.04); and a cutoff value of 747 for SII (sensitivity: 69.6%, specificity: 90.7%, AUROC: 0.71, p = 0.014). Furin expression increased gradually in parallel with the severity of cervical intraepithelial neoplasia. The inflammatory indices were higher in the presence of CC and denoted a good discrimination ability for predicting cervical cancer.