White Blood Cell Count Research Articles

High eosinophil counts aid in diagnosing Kawasaki disease in febrile children

Abstract Background Several recent studies have validated the newfound significance of elevated eosinophils in Kawasaki disease (KD). However, this finding was not incorporated into the suggested laboratory criteria outlined by the Kawasaki Disease Committee of the American Heart Association for assessing children with incomplete KD. Purpose We aimed to determine the potential benefits of including eosinophil levels in the laboratory evaluation of KD. Methods A retrospective cohort study involved 77,934 febrile children (FC, not KD) and 1,970 subjects diagnosed with KD. Participants were recruited from four hospitals, comprising two medical centers and two regional hospitals. The AHA recommends specific laboratory tests—white blood cell count, hemoglobin, platelet count, ALT levels, albumin, and urinalysis—for evaluating incomplete KD in children with a higher CRP than 30mg/dL. The first four items are standard blood assays. Additionally, we introduced high eosinophil counts as a new diagnostic criterion for identifying children with KD. Results All these five laboratory findings (anemia for age defined as below the 5th percentile), platelet count >450,000/mm3, white blood cell>15,000/mm3, ALT>40 U/L, and eosinophil count >190/mm3) are significantly different between KD children and FC. The proportion of having these features is higher in KD children than in FC (19.3% vs. 8.0% in anemia for age, 20.5% vs. 10.3% in thrombocytosis, 37.0% vs. 18.1% in leukocytosis, 45.7% vs. 5.8% in elevated ALT, and 62.6% vs. 29.3% in high eosinophils). Elevated eosinophil counts are most commonly associated with KD among these five parameters. Furthermore, when incorporating the parameter of elevated eosinophil counts, the proportion of KD children with at least two abnormalities rose from 35.4% to 60.7%. In a subgroup analysis of children with KD presenting at least two abnormalities, the proportion rose from 38.7% to 63.5% in the high CRP group (≧ 3.0 mg/L) and 21.6% to 49.0% in the low CRP group (< 3.0 mg/L), respectively. Conclusions Higher eosinophil counts are vital markers in KD children. This aids in the identification of additional potential KD cases, especially in those exhibiting low CRP levels.

Monitoring Cell Activation and Extracellular Vesicle Generation in Platelet Concentrates for Transfusion.

Platelets play a crucial role in blood transfusions, and understanding the changes that occur during their storage is important for maintaining the quality of preparations. In this study, we examined key alternating factors, with a particular focus on platelet activation and the release of extracellular vesicles. Additionally, we compared two detection methods-imaging flow cytometry (IFC) and nanoparticle tracking analysis (NTA)-for their effectiveness in detecting particles. Platelet concentrates were prepared by pooling buffy coats from five blood group-compatible donors in an additive solution. Samples were analysed after one, three, and seven days of storage for residual white blood cells (WBCs), glucose levels, platelet activation, and extracellular vesicle concentrations. Over the storage period, the total platelet concentration decreased slightly, while the residual WBC count remained stable. Glucose levels declined, whereas platelet activation and extracellular vesicle concentration increased, with a positive correlation between the two. The particle size remained relatively unchanged throughout the storage period. Ultimately, despite controlled processing and storage conditions, platelet activation, and the release of extracellular vesicles still occurred, which may have implications for transfusion recipients. Although an optimised method is still needed, IFC has proved to be specific and potentially appropriate for detecting extracellular vesicles in transfusion preparations.

The Impact of Blood Pressure Rhythm and Perioperative Blood Pressure Variability on Short-Term Prognosis in Patients with Type A Aortic Dissection.

Aims/Background Previous studies have indicated a strong correlation between disturbances in blood pressure (BP) circadian rhythm and major cardiovascular adverse events. Similarly, blood pressure variability (BPV) has been closely linked to cerebral small vessel disease and leukoaraiosis. This study aims to investigate the relationship between BP rhythm and BPV with the short-term prognosis of patients with Type A aortic dissection, offering insights for targeted perioperative nursing interventions and improving patient outcomes. Methods This retrospective study included patients undergoing surgical treatment for Type A aortic dissection at Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences) from June 2022 to March 2024. The study followed patients from the completion of surgery to 30 days postoperatively, with all-cause mortality within 30 days as the endpoint representing poor short-term prognosis. Clinical data were compared along with: types of BP rhythm; BPV parameters including the mean 24-hour systolic BP (24hSBP), 24-hour diastolic BP (24hDBP), and pulse pressure; and the coefficient of variability (CV) for 24hSBP, 24hDBP, and pulse pressure. Multivariate logistic regression analysis was utilized to identify risk factors for poor short-term outcomes in these patients, and receiver operating characteristic (ROC) curves were plotted to assess the predictive value of BP rhythm types and BPV indicators. Results The study ultimately included 115 participants, with 31 deaths occurring within 30 days post-surgery, resulting in a postoperative mortality rate of 26.96%. The multivariate logistic regression analysis revealed that white blood cell count, neutrophil count, non-dipping BP rhythm, pulse pressure, and the CV for 24hSBP, 24hDBP, and pulse pressure, were significant risk factors for poor short-term prognosis (p < 0.05). The ROC curve analysis demonstrated that non-dipping BP rhythm, pulse pressure, 24hSBP-CV, 24hDBP-CV, and pulse pressure-CV had areas under the curve (AUC) of 0.685, 0.749, 0.751, 0.773, and 0.763, respectively. The combination of these indicators yielded the highest AUC at 0.918. Conclusion A combination of BP rhythm and BPV indicators provides significant predictive value for poor short-term outcomes in patients with Type A aortic dissection. Clinicians and nursing staff can use these features to formulate targeted preventive measures.

Risk factors of pediatric steroid-induced ocular hypertension.

Steroid-induced ocular hypertension (SIOH) is a significant ocular complication of pediatric steroid administration. In this study, we analyzed the risk factors associated with pediatric SIOH. We retrospectively collected data from 78 children under 20 years of age who received systemic steroids during hospitalization. The data included age, gender, primary disease, intraocular pressure (IOP) before and one month after administration, total monthly steroid dose adjusted for body weight (BW), and one-month changes in red blood cell, white blood cell, and platelet counts. A multivariate analysis was used to identify risk factors related to steroid responsiveness. Thirty patients (38.5%) were classified as steroid responders, and 48 as non-responders. The median IOP during the first month of steroid treatment was 24.0 mmHg (IQR; 23.0-28.3) for responders and 15.0 mmHg (IQR; 12.3-18.0) for non-responders. The Generalized Estimating Equations analysis revealed that younger age, male sex, primary disease, increase the amount of white blood cell (WBC) and total steroid dose per BW in one month were independently associated variables. The receiver operating characteristic analysis also revealed that the cutoff values for age, total monthly steroid dose, the increase amount of WBC were 11.0 years, 40.7mg/kg and 3.40 × 10²/µl respectively. High-dose steroid administration, especially in male, younger patients, necessitates careful monitoring for IOP changes during treatment. WBC count also needs to be monitored during IOP follow-ups. What is known Steroid-induced ocular hypertension (SIOH) is one of the essential complicationsduring steroid administration,but onlylimited analyses have been performed in children. What is new A comprehensive analysis of multiple factors was performed that are predicted to be associated with pediatric SIOH from previous literature. Younger age, male sex, primary disease, increase the amount of WBC, and highertotal monthly steroid dose were extracted as risk factors of SIOH. This study can contribute to the prediction of cases in which ophthalmologic examinations are particularly important during systemic steroid administration in children.

Diagnostic value of ultrasound for community-acquired pneumonia in children and its correlation with serum PCT level and PCIS.

This study aimed to evaluate the diagnostic value of ultrasound for community-acquired pneumonia (CAP) in children. Clinical information of children diagnosed with CAP and a control group of healthy children was collected, and lung ultrasound detection was performed. The lung ultrasound score (LUS) was assessed, and venous blood samples were collected. Serum indexes, including white blood cell count, were analyzed using an automatic immunoassay analyzer, while serum procalcitonin (PCT) level was measured using an enzyme-linked immunosorbent assay. The pediatric critical illness score (PCIS) was also performed for all subjects. White blood cell count, absolute neutrophil count, and respiratory index were significantly higher in the CAP group than those in the control group, while the oxygenation index was markedly lower. Ultrasound detection results showed that the CAP group exhibited significantly higher detection rates of pleural effusion, interstitial lung changes, lung consolidation, B-lines, air bronchogram signs, and reduced or absent lung sliding signs compared with the control group. In addition, the LUS and PCT levels were markedly higher in the CAP group, while the PCIS was notably lower. Further analysis exhibited that the LUS in the CAP group was significantly positively correlated with PCT levels and negatively correlated with PCIS. The receiver operating characteristic curve indicated that the area under the curve of LUS for diagnosing children with lung infection was 0.841. LUS is closely related to serum PCT level and PCIS. Lung ultrasound detection demonstrates high sensitivity and specificity, indicating its valuable clinical diagnostic utility for CAP in children.

Impact of Obesity Severity on Hepatic Steatosis and Systemic Inflammatory Markers: A Comparative Analysis Across Obesity Classes

Introduction: Obesity has become a global health issue, with its prevalence steadily increasing. It is closely linked to several metabolic disorders, cardiovascular diseases, non-alcoholic fatty liver disease, and chronic low-grade inflammation and can progress to more severe liver conditions. This study evaluates the relationship between obesity and inflammatory markers in individuals with different obesity levels. Methods: A cross-sectional study was conducted among 50 patients categorized into three obesity classes based on body mass index (BMI). Blood samples were taken to evaluate inflammatory and metabolic markers, including white blood cell (WBC) count, neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP). Results: There were no statistically significant differences in inflammatory markers such as WBC, NLR, or CRP; a trend toward higher CRP levels was observed in Class 3 obesity. Conclusion: In our study, no statistically significant association was observed between inflammatory markers and the degree of obesity. Although the sample size was relatively small, it is essential to acknowledge that obesity is a multifaceted condition, and genetic variations may play a role in these results.

Biomarker potential of nuclear Nrf2 activation in the ABC subtype of diffuse large B‑cell lymphoma.

Diffuse large B-cell lymphoma (DLBCL) is an aggressive B-cell lymphoma characterized by distinct subtypes and heterogeneous treatment outcomes. Oxidative stress and the dysregulation of related regulatory genes are prevalent in DLBCL, prompting an investigation into the nuclear factor erythroid 2-related factor 2 (Nrf2)-kelch-like ECH-associated protein 1 (Keap1) signaling pathway and associated genes. The present study assessed pathological specimens and clinical data from 43 newly diagnosed patients with DLBCL, comparing the associations and correlations between the expression of Nrf2, Keap1, microtubule-associated protein 1 light chain 3β (LC3B) and nitrotyrosine and the activated B-cell (ABC) and germinal center B-cell (GCB) subtypes of DLBCL using immunohistochemistry and digital image analysis software. Nuclear Nrf2 activation was observed in 33.3% of patients with DLBCL ABC, demonstrating a higher prevalence of hepatitis B surface antigen positivity, calcium ions and significant body weight loss (P<0.05). Total Nrf2 expression was associated with the DLBCL GCB subtype and inversely correlated with Keap1 expression in the DLBCL ABC subtype. Furthermore, a positive correlation was demonstrated between Nrf2 and LC3, indicating that total Nrf2 is inhibited by Keap1 and regulates LC3 expression. The ABC subtype was also associated with lower white blood cell counts and more frequent chemotherapy courses than the GCB subtype. These findings suggest that nuclear Nrf2 could be a biomarker for DLBCL clinical diagnosis.

Haematological effect of a bi-herbal composition on phenyl hydrazine-induced anaemia in Albino Wistar rats

Picralima nitida and Cymbopogon citratus are plants known for their anti-inflammatory, antioxidant, and haematopoietic properties. This study aimed to determine the haematological effect of a dual herb composition of these plants on phenylhydrazine-induced anaemia in albino Wistar rats. Sixty adult male rats were divided into six groups: control, phenylhydrazine group, ferrous sulphate group, and three groups receiving phenylhydrazine plus 100 mg/kg, 200 mg/kg, and 400 mg/kg of the extract. Haematological parameters were measured using an autoanalyzer and analyzed with SPSS software V22. The red blood cell count was significantly higher in the control group compared to other groups (p&lt;0.05). Haemoglobin was significantly higher in the control, ferrous sulphate, 100 mg/kg, and 400 mg/kg groups compared to the phenylhydrazine and 200 mg/kg groups (p&lt;0.05). Mean cell volume was significantly lower in the control group compared to all other groups (p&lt;0.05). Mean cell haemoglobin was significantly lower in the control group compared to other groups while MCHC was higher in the control group compared to phenylhydrazine, ferrous sulphate, 100mg/kg and 200mg/kg groups (p&lt;0.05). RDWSD was significantly lower in the control group compared to all other groups (p&lt;0.05). Total white blood cell count was significantly lower in the control and phenylhydrazine groups compared to others (p&lt;0.05). Lymphocyte was significantly higher in the ferrous sulphate group compared to others, while monocyte count was significantly lower in the control, phenylhydrazine, and ferrous sulphate groups (p&lt;0.05). Neutrophil was significantly higher in the control and phenylhydrazine groups (p&lt;0.05). Platelet was significantly lower in the control group compared to ferrous sulphate, 200 mg/kg, and 400 mg/kg groups (p&lt;0.05). Mean platelet volume was significantly lower in the control, phenylhydrazine, ferrous sulphate, and 100 mg/kg groups compared to the 400 mg/kg group (p&lt;0.05). The study concludes that the biherbal formulation of the plants caused significant alterations in haematological parameters.

Outcome differences of emergency cesarean delivery in the delivery room versus the operating room: A study based on propensity score matching.

This study sought to compare the risks and outcomes associated with category I cesarean section procedures performed in the delivery room versus those performed in the operating room. The analysis included 126 singleton pregnant women who underwent inpatient delivery at the Second People's Hospital of Nanning between January 2021 and May 2024. Following propensity score matching, 21 cases were in the delivery room group, and 105 cases were in the operating room group. Parameters under investigation encompassed decision-to-delivery interval, incision-to-delivery interval, surgical duration, intraoperative blood loss, postoperative antibiotic duration, postoperative hospital stay length, postoperative fever incidence, adverse neonatal outcomes, and blood routine parameters. The decision-to-delivery interval was significantly shorter in the delivery room group than in the operating room group. Conversely, the delivery room group exhibited longer surgical durations, higher blood loss, prolonged postoperative antibiotic usage, extended hospital stays, and elevated white blood cell counts with statistical significance (p < 0.05). Nevertheless, no notable variations were observed between the groups in maternal and neonatal outcome indicators, such as adverse neonatal outcomes and postoperative fever rates. The outcomes suggest that the delivery room group showed increased risks compared with the operating room group, potentially indicating heightened vulnerabilities to bleeding and infection. Hence, it is advisable for patients to undergo surgery in the operating room unless the delivery room is equipped with sterile surgical facilities or in cases of urgent necessity.

Haematological, Serum biochemical indices and lipid profile of finisher broiler chickens fed red and white sorghum based diets, supplemented with tannase enzyme

A 28 days study was carried out to investigate the effects of red sorghum (RS) and white sorghum (WS) based diets, with or without tannase supplementation on the haematological, serum biochemical indices and lipid profile of finisher broiler chickens. Two hundred and forty (240) 4 weeks old Arbor Acre broiler chicks were allotted to eight (8) dietary treatments, which consisted of 30 birds, having 3 replicates of 10 birds each. Diets were formulated to replace maize with red and white sorghum at 4 levels (0%, 100%RS, 100%WS and 50%RS:50%WS), with or without tannase enzyme to have a 4x2 factorial arrangement in a completely randomized design. On 28th day, blood was collected for determination of haematological, serum biochemical and lipid profile. Birds fed 100% RS diet and those fed 50RS: 50WS had the highest (P&lt;0.05) white blood cell count (WBC), while the least WBC value was recorded for birds fed maize-based diet. Haematological indices were not significantly (P&gt;0.05) influenced by the interaction between the sorghum type and tannase supplementation. Birds fed the maize-based diet without tannase had the highest (P&lt;0.05) level of albumin (4.87g/dl), while birds fed 100%WS diet without tannase had the lowest value (3.33g/dl). The lipid profile of boiler chickens was not significantly (P&gt;0.05) influenced by sorghum type, tannase supplementation and their interaction. It was concluded from the study that RS and WS, with or without tannase supplementation, can totally replace maize in the diet of finisher broilers without detrimental effect on the haematological, serumbiochemical indices and lipid profile.

Elevated Platelet Aggregation in Patients with Ovarian Cancer: More than Just Increased Platelet Count.

Background: Patients with ovarian cancer have high platelet counts, which correlate with disease burden, incidence, and lethality of blood clots (thrombosis). We hypothesized that elevated aggregation is associated with both increased platelet number and altered behavior of platelets in patients with ovarian cancer. Methods: Healthy controls and patients with suspected or diagnosed ovarian cancer were evaluated for complete blood counts. To evaluate the effects of platelet count versus platelet behavior, equal platelet-rich plasma (PRP) volumes versus equal platelet numbers were used in platelet aggregation assays. Arachidonic acid, adenosine diphosphate, and collagen platelet agonists were used to induce aggregation. Volunteers were grouped into healthy controls (23), benign/borderline cases (7), and cancer cases (25 ovarian, 1 colorectal, and 2 endometrial). Results: The rate and amount of platelet aggregation were higher in patients compared to healthy controls regardless of whether the same platelet number or PRP volume was used. Compared to healthy controls, patients with untreated ovarian cancer exhibited high levels of platelet activation markers, P-selectin (27.06 vs. 31.06 ng/mL, p = 0.03), and beta-thromboglobulin (3.073 vs. 4.091 µg/mL, p = 0.02) in their plasma. The significance of the elevation and its correlations with platelet number or PRP volume varied depending on the agonist. Platelet (305.88 vs. 134.12, p < 0.0001) and white blood cell (8.459 vs. 5.395, p < 0.01) counts (×109/L) were elevated pre-chemotherapy and decreased post-chemotherapy, respectively. Conclusions: Elevated platelet aggregation is caused by both altered platelet number and behavior in patients with ovarian cancer. These results support the study of antiplatelet agents for thrombosis prevention in these patients.

Central nervous system manifestations in acute and chronic graft-versus-host disease.

Despite the growing evidence supporting the existence of CNS involvement in acute and chronic graft-versus-host disease (CNS-GvHD), the characteristics and course of the disease are still largely unknown. In this multicenter retrospective study, we analyzed the clinical, biological, radiological, and histopathological characteristics, as well as the clinical course of 66 patients diagnosed with possible CNS-GvHD (pCNS-GvHD), selected by predetermined diagnostic criteria. Results were then contrasted depending on whether pCNS-GvHD occurred before or after day 100 following allogeneic hematopoietic stem cell transplantation. Median time between hematopoietic stem cell transplantation and pCNS-GvHD onset was 149 days (IQ25-75 48-321), and pCNS-GvHD onset occurred before day 100 following transplantation in 44% of patients. The most frequent findings at presentation were cognitive impairment (41%), paresis (21%), altered consciousness (20%), sensory impairment (18%), and headache (15%). Clinical presentation did not significantly differ between patients with pCNS-GvHD occurring before or after day 100 following transplantation. Brain MRI found abnormalities compatible with the clinical picture in 57% of patients, while CT detected abnormalities in only 7%. Seven patients had documented spinal cord MRI abnormalities, all of them with pCNS-GvHD occurring after day 100 following transplantation. In the cerebrospinal fluid, white blood cell count was increased in 56% of the population (median 18 cells/μL). Histopathological analyses were performed on 12 specimens and were suggestive of pCNS-GvHD in 10. All compatible specimens showed parenchymal and perivascular infiltration by CD3+ and CD163+ cells. Immunosuppressive therapy was prescribed in 97% of patients, achieving complete clinical response in 27%, partial improvement in 47% and stable disease in 6%. Response to immunosuppressive therapy did not significantly differ between patients with pCNS-GvHD occurring before or after day 100 following transplantation. Clinical relapse was observed in 31% of patients who initially responded to treatment. One-year overall survival following pCNS-GvHD onset was 41%. Onset before day 100 following hematopoietic stem cell transplantation (HR [95%CI]: 2.1 [1.0-4.5]; P=0.041) and altered consciousness at initial presentation (HR [95%CI]: 3.0 [1.3-6.7]; P=0.0077) were associated with a reduced one-year overall survival probability. Among surviving patients, 61% had neurological sequelae. This study supports that immune-mediated CNS manifestations may occur following allo-HSCT. These can be associated with both acute and chronic GvHD and carry a grim prognosis. The clinical presentation as well as the radiological and biological findings appear variable.

Antimutagenic and anticoagulant therapeutic effects of Ag/Ag2O nanoparticles from Olea europaea leaf extract: mitigating metribuzin-induced hepato-and nephrotoxicity.

Silver nanoparticles (Ag/Ag₂O NPs) have garnered attention for their potent antioxidant, antimicrobial, and anti-inflammatory properties, showing promise for therapeutic applications, particularly in mitigating chemical-induced toxicity. This study aimed to synthesize Ag/Ag₂O NPs using Olea europaea (olive) leaf extract as a green, eco-friendly reducing agent and evaluate their protective effects against metribuzin-induced toxicity in Wistar rats, focusing on oxidative stress, hematological parameters, and lipid profiles, with specific dose optimization. Ag/Ag₂O NPs were synthesized using Olea europaea leaf extract, and their properties were confirmed via XRD, FTIR, SEM, EDS, and UV-visible spectroscopy. Wistar rats exposed to metribuzin (110mg/kg/day) were treated with two doses of Ag/Ag₂O NPs (0.062mg/kg and 0.125mg/kg). Hematological and biochemical markers were assessed to evaluate the NPs' protective effects. Physicochemical characterization confirmed the successful formation of Ag/Ag₂O NPs loaded with phytochemicals, exhibiting crystallite sizes of 23nm and 19nm, a particle size of 25nm, and significant peaks in XRD, FTIR, and UV-Vis spectra indicating the formation of Ag/Ag₂O. Metribuzin exposure led to significant hematological disruptions (elevated WBC, reduced RBC and hemoglobin) and worsened lipid profiles (increased cholesterol, LDL, and triglycerides). The lower NP dose (0.062mg/kg) improved WBC, RBC, hemoglobin, and platelet counts, normalized lipid levels, and positively influenced biochemical markers such as serum creatinine and uric acid. In contrast, the higher NP dose (0.125mg/kg) showed mixed results, with some improvements but an increase in triglycerides and continued elevation of ASAT and ALAT enzyme levels. Ag/Ag₂O NPs synthesized via green methods using olive leaf extract effectively mitigated metribuzin-induced toxicity, especially at lower doses, by improving oxidative stress markers and hematological and biochemical profiles. Dose optimization is crucial to maximize therapeutic benefits and minimize adverse effects, underscoring their potential in treating chemical-induced toxicity.

Increased pathogen exposure of a marine apex predator over three decades.

Environmental changes associated with global warming create new opportunities for pathogen and parasite transmission in Arctic wildlife. As an apex predator ranging over large, remote areas, changes in pathogens and parasites in polar bears are a useful indicator of changing transmission dynamics in Arctic ecosystems. We examined prevalence and risk factors associated with exposure to parasites and viral and bacterial pathogens in Chukchi Sea polar bears. Serum antibodies to six pathogens were detected and prevalence increased between 1987-1994 and 2008-2017 for five: Toxoplasma gondii, Neospora caninum, Francisella tularensis, Brucella abortus/suis, and canine distemper virus. Although bears have increased summer land use, this behavior was not associated with increased exposure. Higher prevalence of F. tularensis, Coxiella burnetii, and B. abortus/suis antibodies in females compared to males, however, could be associated with terrestrial denning. Exposure was related to diet for several pathogens indicating increased exposure in the food web. Elevated white blood cell counts suggest a possible immune response to some pathogens. Given that polar bears face multiple stressors in association with climate change and are a subsistence food, further work is warranted to screen for signs of disease.

Association Between White Blood Cell Counts at Diagnosis and Clinical Outcomes in Venous Thromboembolism - From the COMMAND VTE Registry-2.

White blood cell (WBC) counts were reported to be a risk factor for acute adverse events in patients with venous thromboembolism (VTE). However, there are limited data on VTE patients without active cancer. The COMMAND VTE Registry-2 was a multicenter study enrolling 5,197 consecutive patients with acute symptomatic VTE. We divided 3,668 patients without active cancer into 4 groups based on WBC count quartiles (Q1-Q4) at diagnosis: Q1, ≤5,899 cells/μL; Q2, 5,900-7,599 cells/μL, Q3, 7,600-9,829 cells/μL; and Q4, ≥9,830 cells/μL. Patients in Q4 more often presented with pulmonary embolism (PE) than patients in Q1, Q2, and Q3 (68% vs. 37%, 53%, and 61%, respectively; P<0.001). The proportion of massive PEs among all PEs was higher in Q4 than in Q1, Q2, and Q3 (21% vs. 3.4%, 5.8%, and 11%, respectively; P<0.001). Compared with Q1, Q2, and Q3, patients in Q4 had a higher cumulative 5-year incidence of all-cause death (17.0%, 15.2%, 16.1%, and 22.8%, respectively; P<0.001) and major bleeding (10.9%, 11.0%, 10.3%, and 14.4%, respectively; P=0.002). The higher mortality risk of Q4 relative to Q2 was consistent regardless of the presentations of VTEs. An elevated WBC count on VTE diagnosis was associated with a higher risk of mortality and major bleeding regardless of VTE presentation, suggesting the potential usefulness of WBC counts for further risk stratification.

Relationship Between White Blood Cell Count and Bacteremia Using Interval Likelihood Ratios in Hospitalized Patients.

Patients with bacteremia often have elevated white blood cell (WBC) and neutrophil counts, yet these alone are poor predictors of bacteremia. Data on the continuous relationship between WBC response and bacteremia are lacking. This study aims to characterize the relationship of WBC count, neutrophil percentage, and absolute neutrophil count (ANC) to bacteremia using interval likelihood ratios (ILRs) derived from a large sample of hospitalized patients. Retrospective cohort study in a large healthcare system from 2017 to 2018. This study included non-surgical inpatients who had at least one complete blood count (CBC) with differential up to 24hours after admission and a blood culture. Patients with immunosuppression and malignancy or who received antibiotics before negative blood cultures were excluded. Predictors were WBC count, ANC, and neutrophil percentage. The outcome was bacteremia. We compared test discrimination using the area under the receiver operating characteristics curve (AUROC). We calculated ILRs for bacteremia across test value intervals. As a practical example, we assumed a 5% pre-test probability of bacteremia and calculated the post-test probability for each interval. We compared this approach to a threshold approach using a threshold of 70% neutrophils. Of 25,776 patients with a CBC with differential and blood culture, 1160 had bacteremia. AUROC was highest for neutrophil percentage (0.74), followed by ANC (0.63) and WBC count (0.58). Probability of bacteremia increased exponentially from neutrophil percentage 80 to 100%. Odds of bacteremia varied 35-fold based on neutrophil percentage. A threshold approach with a cut-off of 70% significantly underestimated bacteremia risk at higher levels. ILRs offered a more discriminating approach to estimating the probability of bacteremia than a single threshold. Physicians assessing risk of bacteremia should pay attention to the magnitude of abnormality because very high and very low values have much stronger predictive power than dichotomized results.

Scoring model for the diagnosis of colorectal perforation and its differentiation from gastroduodenal perforation.

Distinguishing colorectal from gastroduodenal perforations is clinically important and challenging. We aimed to establish a scoring model based on objective findings (excluding computed tomography findings) for the diagnosis of colorectal perforation and its differentiation from gastroduodenal perforation. Patients diagnosed with colorectal or gastroduodenal perforations between January 2014 and December 2021 were retrospectively studied. Univariate and multivariate analyses were performed to identify independent variables, and a scoring model was developed based on these variables. Among 131 eligible patients, 64 (48.9%) were in the colorectal group and 67 (51.1%) were in the gastroduodenal group. White blood cell count, C-reactive protein, and quick Sequential Organ Failure Assessment score were identified as independent clinical variables associated with the diagnosis of colorectal perforation, which differentiated colorectal perforation from gastroduodenal perforation, and were used to develop a new scoring model. The scores ranged from 0 to 5, with an area under the receiver operating characteristic curve of 0.846. The probabilities of colorectal perforation with scores of 0, 1.5, 2, 3, 3.5, and 5 were 3.2, 20, 55.6, 81.8, 73.9, and 82.4%, respectively. The new scoring model may help in treatment selection and perioperative management of patients with gastrointestinal perforation.

The effect of 12-week high-dose Colostrum Bovinum supplementation on immunological, hematological and biochemical markers in endurance athletes: a randomized crossover placebo-controlled study.

Bovine colostrum (COL) is assumed to be one of the strongest natural immune stimulants. Regular ingestion of COL may contribute to improved immune response in athletes exposed to high training loads. Twenty-eight endurance-trained males aged 31.1 ± 10.2 years (body mass 81.9 ± 9.0kg; height 1.82 ± 0.06m) completed this randomized double-blind placebo(PLA)-controlled crossover study aimed at investigating the effect of 12-week COL supplementation (25gCOL·day-1) on resting (REST), exercise-induced (POST-EX), and short-term post-exercise recovery (REC; 1h after test exercise) changes in selected saliva and blood immunoglobulins (Ig), white blood cell (WBC) count and differential; as well as blood hematological, nutritional status and muscle damage indices. The protocol assumed 4 study visits - before/after supplementation with COL (COLPRE and COLPOST ) and PLA (PLAPRE and PLAPOST ). During testing sessions, incremental rowing test to exhaustion and swimming-specific performance test were introduced as exercise stimuli. At COLPOST visit the secretory IgA (SIgA) concentration in saliva was significantly higher at POST-EX and REC compared to REST (p<0.05). COL supplementation had no effect on blood IgA, IgE, IgD, IgG, and IgM concentrations. Furthermore, after COL supplementation decrease of hematocrit at REC (p<0.05) was revealed. 12-week supplementation with 25 gCOL·day-1 in endurance-trained male athletes resulted in a favorable increase in post-exercise concentration of salivary SIgA. COL seems to be a potential stimulator of local immune defense after exercise-induced homeostasis disturbances. Nevertheless, the lack of effect on blood markers indicates the need for further research in the area of mechanisms underlying the effect of the supposed COL immunological capacity.

Comparative Analysis of the Safety and Feasibility of Laparoscopic Versus Open Segment 7 Hepatectomy.

Laparoscopic hepatectomy has been widely accepted owing to its advantages as a minimally invasive surgery; however, laparoscopic segment 7 (S7) hepatectomy (LSH) has been rarely reported. We aimed to explore the safety and feasibility of LSH by comparing it with open surgical approaches. Twenty-nine patients who underwent S7 hepatectomy between January 2016 and January 2023 were enrolled in this study. The patients' characteristics, intraoperative details, and postoperative outcomes were compared between the 2 groups. No significant differences were observed in the preoperative data. The patients who underwent LSH had significantly shorter hospital stays (P=0.016) but longer operative times (P=0.034) than those who underwent open S7 hepatectomy. No significant differences in blood loss (P=0.614), transfusion (P=0.316), hospital expenses (P=0.391), surgical margin (P=0.442), rate of other complications, postoperative white blood cell count, and alanine aminotransferase and aspartate aminotransferase levels were noted between the 2 groups (P>0.05). For hepatocellular carcinoma, the results showed no differences in either disease-free survival (P=0.432) or overall survival (P=0.923) between the 2 groups. LSH is a safe and feasible surgical procedure that is efficient from an oncological point of view. It may be the preferred technique for lesions in the S7 of the liver.

Preoperative Delta Neutrophil Index, Platelet Lymphocyte Ratio and Immature Granulocyte Count for Differentiating Metastatic Colon Cancer from Non-Metastatic Colon Cancer: A Retrospective Study.

Immature granulocytes show bone marrow activation before neutrophil response and there are studies in the literature showing that the number of immature granulocytes is an auxiliary marker in the diagnosis and treatment of different diseases. The Delta Neutrophil Index (DNI), Immature Granulocyte Count (IGC) have previously been studied as markers in thyroid and breast cancers. The aim of this study was to determine whether immature granulocyte IGC and DNI values measured in preoperative blood parameters have a diagnostic benefit for the detection of advanced colon cancer. A study was conducted on patients who had undergone selective operation for colon cancer in our clinic from February 2015 to February 2020. The patients were divided into two groups: early stage (stage I-III) and advanced stage (stage IV) colon cancer. The IGC and DNI values as well as other hematological parameters, demographic parameters (sex, age) in these two groups were compared. A total of 43 patients with mean age 67.47 (35-96) years were included in the study. Eighteen of the patients were male and 25 were female. When the early stage and advanced stage colon cancer groups were compared, no statistically significant difference was found between age, sex, white blood cell count, lymphocyte-to-monocyte ratio, eosinophil count, basophil count, mean platelet volume and: systemic immune-inflammation index score. It was observed that platelet-to-lymphocyte ratio, IGC and DNI or Immature Granulocyte Percentage (IGP) values were statistically significantly higher in the metastatic colon cancer group compared to the non-metastatic group. When the specificity and sensitivity of laboratory markers in metastatic colon cancer were examined, it was observed that the specificity and sensitivity of DNI or IGP and IGC were statistically higher than other values. DNI, IGC and PLR values, which are the parameters measured in the preoperative period are easily measurable laboratory parameters and do not involve additional costs in differentiating metastatic from non-metastatic colon cancer in the preoperative period.