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Diagnostic value of biomarkers for sepsis in adult patients in the emergency department: Don't forget the neutrophil-lymphocyte count ratio

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Journal of Acute Disease 2019年第2期8卷 45-52页

作者： G Visveswari Bernadette Tan Qiao Min Fatimah Lateef Year 4 Medical Students Yong Loo Lin School of MedicineNational University of SingaporeSingapore MBBS FRCS(Edin)(A&E)FAMS(Em Med)Senior Consultant/Director of Training and EducationDepartment of Emergency MedicineSingapore General HospitalSingapore Professor Dukes-NUS Graduate Medical School and Yong Loo Lin School of MedicineNational University of SingaporeSingapore Director Singhealth Duke NUS Institute of Medical SimulationSingapore

Objective: To determine and compare the diagnostic efficiency of various biomarkers [C-reactive protein, neutrophil percentage, neutrophil-lymphocyte ratio (NLCR), lactate, procalcitonin, blood culture] in the identification of septic patients in emergency department (ED), and to assess the predictive value of combination of markers. Methods: This was a prospective, single centre study conducted in the ED of an urban, tertiary care hospital. We included patients who were admitted to the ED with symptoms of a possible infection. Blood cultures and serum measurement of the biomarkers were collected from 131 patients. Patients were determined to be septic or non-septic, based on the systemic inflammatory response syndrome criteria and the diagnosis was made at the ED. Sensitivity, specificity, positive predictive value, negative predictive value and area under curves (AUC) were calculated. Results: A total of 126 patients, 61 with sepsis and 65 without sepsis were eventually included in the study. Neutrophil to lymphocyte ratio displayed the highest accuracy in diagnosing sepsis (AUC 0.735, 95% CI=0648-0.822, P<0.001). The best combination of markers in predicting sepsis was NLCR and white blood cell (AUC: 0.801, 95% CI=0.724-0.878, P<0.001). Conclusions: The results of this small study showed that NLCR outperforms other markers in diagnosing sepsis in ED. It is readily available, cost efficient, non invasive and independent. It may be insufficient to rely on this single marker to diagnose sepsis, so some other diagnostic utilities should be taken into account as one part of the overall assessment. Our study also showed that combination of NLCR and white blood cell provides the highest diagnostic accuracy. More large scale studies across different population groups will be needed to confirm this finding.

关键词： Biomarkers Emergency department Sepsis Systemic inflammatory response to infection Neutrophil lymphocyte count ratio

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Brentuximab Vedotin Monotherapy and Combined with Low Dose Donor lymphocyte Infusion to Control Minimal Residual Disease and Sustain Clinical Remission in a Child with Relapsed Anaplastic Large Cell Lymphoma

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Journal of Cancer Therapy 2017年第8期8卷 683-690页

作者： Alina S.Fedorova Maria V.Stegantseva Nina V.Minakovskaya Olga V.Aleinikova Clinical Research Department Belarusian Research Center for Pediatric OncologyHematology and ImmunologyMinsk RegionBelarus Laboratory of Genetic Biotechnology Belarusian Research Center for Pediatric OncologyHematology and ImmunologyMinsk RegionBelarus Department of Bone Marrow Transplantation Belarusian Research Center for Pediatric OncologyHematology and ImmunologyMinsk RegionBelarus

Minimal residual disease (MRD) appears to have a strong negative predictive value for disease recurrence in children with anaplastic large cell lymphoma (ALCL). Brentuximab vedotin (BV) can be a therapeutic option for MRD-positive patients to achieve molecular remission and to decrease risk of subsequent relapse. We here report a 4-year-old child with ALCL progression during relapse treatment who received BV as a bridging therapy before haploidentical hematopoietic stem-cell transplantation, and as a maintenance therapy post-transplant alone or combined with simultaneous low dose donor-lymphocyte infusions. MRD monitoring showed a complete molecular response and reflected both BV efficiency and graft-versus-lymphoma effect.

关键词： Anaplastic Large Cell Lymphoma Relapse Brentuximab Vedotin Donor lymphocyte Infusion Minimal Residual Disease

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A Review: Interactions of Equine Herpesvirus-1 with Immune System and Equine lymphocyte

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Open Journal of Veterinary Medicine 2014年第12期4卷 294-307页

作者： Nor Dini Rusli Khairiyah Binti Mat Hasnita Che Harun Faculty of Agro Based Industry Universiti Malaysia Kelantan Jeli Campus Kelantan Malaysia

Equine herpesvirus-1 (EHV-1) remains one of the most common viral pathogens affecting horses worldwide presenting as a persistent infection which can establish latency in nerve ganglia (trigeminal ganglion), lymphoid tissues of the respiratory tract and peripheral blood lymphocytes. EHV-1 infection induces both humoral and cellular immune responses in horses. Virus neutralising antibody, particularly in the nasopharynx, is to kill free virus shed from infected epithelial cells. Hence this antibody has important functions in reducing virus shedding and spreading infection to cohorts. Cellular immune responses, particularly those carried out by cytotoxic T lymphocyte (CTL), have been shown to be effective in killing virus-infected cells in vitro. This review underlines the state of knowledge regarding immunity to EHV-1 and also its interaction with equine lymphocyte. Finally, the review also includes the importance of the viral immediate early (IE) protein in the pathogenesis of EHV-1. This information can be used as the basis for future research.

关键词： Equine Herpesvirus-1 (EHV-1) lymphocyte Cytotoxic T lymphocyte (CTL) Immune Response Peripheral Blood Mononuclear cell (PBMC)

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Dynamic analysis of lymphocyte subsets of peripheral blood in patients with acute self-limited hepatitis B

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Health 2010年第7期2卷 736-741页

作者： Bo Liu Jun Li Yaping Han Yuan Liu Lianhua Kong Yang Cao Zuhu Huang 不详

Purpose: To investigate dynamic changes and significance of lymphocyte subsets (T lymphocytes, B lymphocytes, NK cells and T cell subsets) of peripheral blood in patients with acute self-limited hepatitis B (AHB). Methods: Immune cells of peripheral blood were compared among 17 cases of self-limited acute hepatitis B patients, 36 patients with chronic hepatitis B (CHB) and 32 healthy controls by flow cytometry (FCM). CD4+/CD8+ was monitored dynamically, meanwhile relations between T lymphocyte subsets and ALT and clearance of HBV DNA were explored. Results: Dynamic changes of lymphocyte subsets were found in AHB, the level of CD3+T cells was significantly higher compared to CHB group and healthy control group. Frequencies of CD3+CD4+ T cells in the third and fourth week and CD4+/CD8+ in the second week were higher compared to other groups. Frequ- ency of NK cells was low and was significantly lower compared to other groups in the third week specially. It was showed that CD4+/CD8+ was low followed by high abnormal ALT during early stage by dynamic monitoring of CD4+/CD8+, and CD4+/CD8+ was increasing accompanied by normal ALT set by set, but CD4+/CD8+ had no significant relation to ALT and HBV DNA. Conclusion: Immune status of AHB, compared to CHB and healthy controls, was significantly different and dynamic changes of lymphocyte sub- sets may be related to progress of disease.

关键词： Acute Hbv Self-Limited lymphocyte Subsets Facs

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Anchoring of c-myc on nuclear matrix proteins in process of mouse thymic T lymphocyte proliferation induced by ConA

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Science China(Life Sciences) 1996年第5期39卷 511-516页

作者：曾丛梅蔡树涛周凤兰张锦珠王平 Institute of Biophysics Chinese Acadcmy of Sciences Beijing 100101 China School of Life Science Peking University Beijing 100871 China

Isolation and characteriation of functional nudear matrix proteins involved in DNA anchoring and gene expression is one of the major subjects of current nudear matrix research. Southwestern blotting (DNA-protein hybridization) was applied to studying the anchoring of c-myc on the nudear matrix proteins in mouse thymic T lymphocytes. The results showed that c-myc bound to the lamin, p34 and p36 nudear matrix proteins specifically. In the process of mouse thymic PNA T lymphocytes proliferation induced by ConA, the anchoring of c-myc on p34 and p36 nudear matrix proteins changed dynamically.

关键词： nuclear matrix protein c-myc T lymphocyte activation concanavalin A.

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PICOT promotes T lymphocyte proliferation by down-regulating cyclin D2 expression

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World Journal of Immunology 2020年第1期10卷 1-12页

作者： Pinakin Pandya Noah Isakov The Shraga Segal Department of Microbiology Immunology and GeneticsFaculty of Health Sciences and the Cancer Research CenterBen Gurion University of the NegevBeer Sheva 84105Israel Department of Computational and System biology UPMC Hillman Cancer CenterUniversity of PittsburghSchool of MedicinePittsburghPA 15232United States

The mammalian protein kinase C-interacting cousin of thioredoxin(PICOT;also termed glutaredoxin 3)is a multi-domain monothiol glutaredoxin that is involved in a wide variety of signaling pathways and biological processes.PICOT is required for normal and transformed cell growth and is critical for embryonic development.Recent studies in T lymphocytes demonstrated that PICOT can translocate to the nucleus and interact with embryonic ectoderm development,a polycomb group protein and a core component of the polycomb repressive complex 2,which contributes to the maintenance of transcriptional repression and chromatin remodeling.Furthermore,PICOT was found to interact with chromatin-bound embryonic ectoderm development and alter the extent of histone 3 lysine 27 trimethylation at the promoter region of selected polycomb repressive complex 2 target genes.PICOT knockdown in Jurkat T cells led to increased histone 3 lysine 27 trimethylation at the promoter region of CCND2,a cell cycle-regulating gene which encodes the cyclin D2 protein.As a result,the expression levels of CCND2 mRNA and protein levels were reduced,concomitantly with inhibition of the cell growth rate.Analysis of multiple data sets from the Cancer Genome Atlas revealed that a high expression of PICOT correlated with a low expression of CCND2 in a large number of human cancers.In addition,this parameter correlated with poor patient survival,suggesting that the ratio between PICOT/CCND2 mRNA levels might serve as a predictor of patient survival in selected types of human cancer.

关键词： Protein kinase C-interacting cousin of thioredoxin Glutaredoxin 3 Cyclin D2 Histone methylation T lymphocyte Histone 3 lysine 27 trimethylation

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Prognostic Value of lymphocyte Vascular Density and E-Cadherin in Inflammatory Breast Cancer

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Journal of Cancer Therapy 2014年第14期5卷 1380-1387页

作者： Paul H. Levine Heather J. Hoffman Audra MacNeil Salman Hashmi Sherry X. Yang Stephen Hewitt Kenneth L. van Golen Sandra M. Swain Department of Epidemiology and Biostatistics Milken Institute School of Public Health The George Washington University Washington DC USA National Clinical Target Validation Laboratory Division of Cancer Treatment & Diagnosis National Cancer Institute Bethesda USA Laboratory of Pathology Center for Cancer Research National Cancer Institute Bethesda USA Department of Biological Sciences Center for Translational Cancer Research The University of Delaware Newark USA Washington Cancer Institute MedStar Washington Hospital Center Washington DC USA

Background: We recently evaluated four laboratory assays, vascular endothelial growth factor D (VEGF-D), E-cadherin, lymphatic vessel density (LVD) measured by podoplanin, and intra-lymphatic tumor emboli (ILTE), which showed notable differences between inflammatory breast cancer (IBC) and non-inflammatory locally advanced breast cancer (LABC). In this study we investigated the potential of the three most quantitatively measured markers, E-cadherin, LVD and VEGF-D, to predict survival in the IBC patients. Materials and Methods: This study involved the 100 cases identified in the Inflammatory Breast Cancer Registry (IBCR) whose tumors were previously evaluated for the four assays noted above. Living patients were recontacted and survival data were available for up to 17 years. Overall survival (OS) was analyzed through the Kaplan-Meier method stratified by E-cadherin, LVD, VEGF-D, and response to chemotherapy. The differences in OS curves were compared using the log-rank test. Results: The median OS for patients with high LVD was 6.63 years (95% CI: 4.06 to 10.14), compared to median at 10 years not reached in those with low LVD (p = 0.03). There was a trend towards a longer median OS in patients with high E-cadherin (10.14, 95% CI: 6.63 to 11.67), compared with those with low E-cadherin (6.26, 95% CI: 3.42 to undeterminable). VEGF-D levels showed no correlation with survival. Conclusion: Low LVD significantly predicts better survival. High E-cadherin expression, as with non-IBC breast cancer and several other malignancies, tends to be associated with a better prognosis.

关键词： IBC Prognostic Markers E-Cadherin lymphocyte Vascular Density

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Risk of extended viral shedding of Omicron BA.2 in Shanghai:Implications for vaccination strategy optimization

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Chinese Medical Journal Pulmonary and Critical Care Medicine 2023年第4期1卷 241-248页

作者： Jingwen Huang Lin Huang Jing Xi Yong Li Jianping Zhou Zhiyao Bao Qijian Cheng Qingyun Li Min Zhou Ren Zhao Yanan Li Department of Pulmonary and Critical Care Medicine Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghai 200025China Institute of Respiratory Diseases Shanghai Jiao Tong University School of MedicineShanghai 200025China Shanghai Key Laboratory of Emergency Prevention Diagnosis and Treatment of Respiratory Infectious DiseasesShanghai 200025China Medical Department Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghai 200025China Department of General Surgery Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghai 200025China

Background:In late March 2022,an outbreak of coronavirus disease 2019(COVID-19)caused by the Omicron BA.2 strain occurred in Shanghai,China.This retrospective study aimed to investigate the clinical characteristics,laboratory parameters,and vaccine protectiveness related to this disease in China.Methods:We conducted a single-center retrospective study on 735 patients with COVID-19 hospitalized from March 17 to May 14,2022.Clinical characteristics were analyzed based on vaccination status and viral shedding time(VST).The least absolute shrinkage and selection operator(LASSO)regression and 5-fold cross-validation were applied to screen factors linked to the rate of the VST.Generalized linear models were further applied to estimate the odds ratios for factors influencing the VST.Results:The median VST of unvaccinated patients was 13(11-16)days,which was longer than that of patients vaccinated with one or two doses(11[9-13]days)and with completed booster doses(11[8-12]days).A LASSO regression model and 5-fold cross-validation showed that age of≥60 years(β=0.01),pneumonia(β=0.53),and higher number of comorbidities(β=0.69)were positively associated with the VST,whereas the platelet count(β=-8.0×10-5)was inversely associated with the VST.Subgroup analysis revealed that the number of vaccinations was significantly associated with a decreased VST among patients with renal dysfunction(odds ratio[OR],0.65;95%confidence interval[CI],0.44-0.97;P=0.034)and patients with two or more comorbidities(OR,0.09;95%CI,0.03-0.28;Plymphocyte count was significantly associated with a decreased VST among patients aged<60 years(OR,0.51;95%CI,0.30-0.85;P=0.011),patients with normal renal function(OR,0.41;95%CI,0.21-0.80;P=0.009),and patients with fewer than two comorbidities(OR,0.49;95%CI,0.30-0.80;P=0.005).Conclusion:Our preliminary results suggest that the complete and booster vaccination contributes to the viral clearance of Omicron BA.2 variants,while the protectiveness of vaccination is most imperative in patients with impai

关键词： Omicron Vaccination status Viral shedding Platelet lymphocyte

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Alterations of cardiac and lymphocyte β-adrenoceptors in rat with chronic heart failure

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Science China(Life Sciences) 1997年第2期40卷 113-121页

作者：张萍韩启德张幼怡许开明田斌吕志珍郭静萱陈明哲 Institute of Vascular Medicine Third Hospital Beijing Medical University Beijing 100083 China

The alterations of cardiac and lymphocyte β-adrenoceptors were observed in the rats with chronic heart failure produced by constriction of both abdominal aorta and renal artery. The results showed that β1-adrenocep-tor density and mRNA levels were increased, whereas these levels remained unchanged for β2 The concentration-contractile response curve for isoproterenol was shifted to the right in cardiac atrium, whereas the concentration-cAMP accumulation response curve for isoproterenol in myocardium was not changed. The number of β-adrenoceptors in blood lymphocyte was markedly reduced. Thus in the heart-failure rats the density of cardiac β-adrenoceptor was increased accompanying reduced β-adrenoceptor-mediated positive inotropic response, suggesting a post adenylate cyclase dys-function or impaired contractile components. In contrast, the alteration of β-adrenoceptor in lymphocyte is consistent with the reduced β-adrenoceptor-mediated inotropic response in heart.

关键词： β-adrenoceptor heart lymphocyte heart failure.

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The relation between differential leukocyte count, neutrophil to lymphocyte ratio and the presence and severity of coronary artery disease

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Open Journal of Internal Medicine 2012年第3期2卷 163-169页

作者： Hatice Selcuk Lale Dinc Mehmet Timur Selcuk Orhan Maden Ahmet Temizhan Cardiology Department Turkiye Yuksek Ihtisas Hospital Ankara Turkey

Objectives: Total leukocyte count, a marker of inflammation has long been reported to be related with coronary artery disease (CAD). Recently, differenttial leukocyte count and elevated neutrophil to lymphocyte ratio (N/L) has been shown to indicate an increased long-term risk of mortality in patients with stable CAD, myocardial infarction and undergoing cardiovascular surgery. Thses studies offer incremental prognostic value to total leukocyte count. We sought to determine the relationship between the leukocyte subtypes and N/L ratio and the presence and extent of CAD. Study design: The study consisted of 107 patients [70 (65.4%) men, 37 (34.6%) women, mean age 59.5 ± 10.6 years] referred to coronary angiography with suspected CAD. The subjects were classified into two groups according to the presence of significant CAD and the extent of CAD was determined by the Gensini method. Results: The lymphocyte count was found to be lower (2031 ± 741 cells/μL vs 2392 ± 611 cells/μL, p: 0.010) and the N/L ratio was found to be higher in patients with CAD (2.86 ± 1.57 vs 2.04 ± 1.01, p p: 0.005]. Conclusion: Our findings reveal that N/L ratio, a simple marker which can be derived from a routine complete blood count test was significantly and independently related to presence and severity of coronary atherosclerosis.

关键词： Leukocyte Neutrophil lymphocyte Coronary Artery Disease lymphocyte Ratio

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