Erythrocyte Sedimentation Rate and C-Reactive Protein in Acute Inflammation

Establishment and Evaluation of an Internal Quality Control Method for ESR Relays

Objective

This study establish and evaluate an internal quality control system for erythrocyte sedimentation rate (ESR) by a "relay" mode based on samples from relevant patients.

Methods

The method for establishing a new internal quality control system for ESR by a "relay" mode based on patient's samples was executed from February 2021 to July 2021. In this paper, a total of 219 outpatients were recruited for ESR determination, and their blood samples were stored at 4 °C or room temperature for 24 h. Subsequently, the samples were re-measured for ESR, and the re-measured values were compared with the initial values. The patient samples (15±1mm/h and 50±3mm/h) were selected after the TEST1 ESR analyzer was calibrated, and were stored overnight at 4 °C and measured again the following day. The percentage deviation was determined and entered into the quality control management module for internal quality control. Next, we analyzed the median distribution trend of the patients' ESR values measured by our laboratory every day over five months, as well as the external quality assessment (EQA) results for ESR obtained from the National Center for Clinical Laboratories (NCCL).

Results

The ESR of the room temperature samples after 24 h of storage had significantly decreased (P=0.001), while there was no noticeable difference for those stored at 4 °C (P=0.197). Results of the internal quality control in March were satisfactory, and there was no significant deviation in the median ESR relay results within five months. Besides, the EQA results for the ESR data obtained from NCCL were excellent.

Conclusion

As a precise and practical new method, the ESR relay internal quality control method can be used to scientifically determine the stability and accuracy of the TEST1 ESR analyzer.

Relationship Between C-Reactive Protein/Serum Albumin Ratio, Neutrophil/Lymphocyte Ratio, and ANCA-Associated Vasculitis Activity: A Retrospective Single Center Cohort Study

Objectives

To evaluate the role of C-reactive protein/albumin ratio (CAR), neutrophil/lymphocyte ratio (NLR), and mean platelet volume (MPV) in newly diagnosed AAV patients and examine their clinical significance.

Methods

Data from 79 untreated newly diagnosed AAV patients were collected and 76 health examination subjects were included in the healthy control group. All clinical characteristics of AAV patients were extracted from their medical records. The NLR, CAR, and MPV levels of AAV patients and the healthy controls were compared and the correlation between these markers and clinical characteristics was analyzed. Patients were then divided into two groups based on the 2003 Birmingham Vasculitis Activity Score (BVAS). The correlation between NLR, CAR, and MPV and disease activity was analyzed and their effects on the cumulative survival rate were analyzed.

Results

Compared with the healthy control group, elevated CAR, NLR, and MPV were observed in AAV patients. CAR (r = 0.701, P < 0.0001) and NLR (r = 0.369, P < 0.05) were positively correlated with the BVAS while MPV did not show any significant correlation (P = 0.85). The optimal cutoff value for disease activity evaluation using CAR was 0.80 (sensitivity: 85% and specificity: 82%, P < 0.05). The optimal cutoff value for disease activity evaluation using NLR was 5.15 (sensitivity: 66% and specificity: 72%, P < 0.05). Kaplan–Meier survival analysis revealed that the all-cause mortality rate was higher in patients with CAR ≥ 0.8 than in patients with CAR < 0.8 (P < 0.05). Patients with low NLR also showed a lower cumulative survival rate (P < 0.05).

Conclusions

NLR and CAR can reflect the inflammatory response and disease activity in AAV patients, while MPV is not significantly correlated with disease activity in AAV patients. The all-cause mortality rate was higher in patients with high CAR and NLR than in patients with low CAR and NLR.

Erythrocyte sedimentation: Effect of aggregation energy on gel structure during collapse

The erythrocyte (or red blood cell) sedimentation rate (ESR) is commonly interpreted as a measure of cell aggregation and as a biomarker of inflammation. It is well known that an increase of fibrinogen concentration, an aggregation-inducing protein for erythrocytes, leads to an increase of the sedimentation rate of erythrocytes, which is generally explained through the formation and faster settling of large disjoint aggregates. However, many aspects of erythrocyte sedimentation conform well with the collapse of a particle gel rather than with the sedimentation of disjoint aggregates. Using experiments and cell-level numerical simulations, we systematically investigate the dependence of ESR on fibrinogen concentration and its relation to the microstructure of the gel-like erythrocyte suspension. We show that for physiological aggregation interactions, an increase in the attraction strength between cells results in a cell network with larger void spaces. This geometrical change in the network structure occurs due to anisotropic shape and deformability of erythrocytes and leads to an increased gel permeability and faster sedimentation. Our results provide a comprehensive relation between the ESR and the cell-level structure of erythrocyte suspensions and support the gel hypothesis in the interpretation of blood sedimentation.

What is pneumonia?

The diagnosis of pneumonia is both simple and complex. Recent research is challenging our concept of pneumonia and radiological gold standards that have underpinned research for decades. In particular, the accuracy of chest radiographs in diagnosing pneumonia is now highly questionable when compared with computed tomography scans. Depending on the question being asked, pneumonia can be defined in clinical, pathological, radiological, or microbiological contexts, or frequently a combination of all of these. However, while the field is changing, until we have new studies defining pneumonia in new ways, clinicians can be reassured that existing guidelines based on “old” standards remain as valid as they have always been.

Recent research has challenged our concept of pneumonia. New studies will define pneumonia in new ways, but clinicians can be reassured that existing guidelines based on “old” standards remain valid.https://bit.ly/3kJiV2N

Clinical application of low erythrocyte sedimentation rate/high C-reactive protein to antineutrophil cytoplasmic antibody-associated vasculitis

BACKGROUND

This study investigated whether the discordance between erythrocyte sedimentation rate (ESR) and C-reactive protein at diagnosis could estimate the simultaneous clinical and laboratory variables and predict the poor outcomes during follow-up in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV).

METHODS

The medical records of 254 AAV patients were reviewed. Clinical and laboratory and AAV-specific indices at diagnosis and all-cause mortality, relapse and end-stage renal disease during follow-up were obtained. ESR and CRP levels were categorised as high and low based on the median values. Accordingly, the patients were divided into the following four groups: high ESR/low CRP; low ESR/high CRP; low ESR/low CRP; and high ESR/high CRP.

RESULTS

Of the 254 AAV patients, 51 patients exhibited discordance between ESR and CRP. Among the 51 AAV patients, the median age was 59.0 years, and 20 patients were men (29 MPA, 13 GPA and 9 EGPA). Cardiovascular and nervous systemic manifestations were observed more frequently in AAV patients with low ESR/high CRP than in those with high ESR/low CRP. Six patients from the low ESR/high CRP group died. AAV patients with low ESR/high CRP exhibited significantly lower cumulative patients' survival rates than both those with high ESR/low CRP and those with low ESR/low CRP. Also, AAV patients with low ESR/high CRP exhibited significantly higher simultaneous BVAS than those with low ESR/low CRP.

CONCLUSIONS

Low ESR/high CRP at diagnosis could not only estimate the simultaneous high BVAS but also predict all-cause mortality during follow-up in AAV patients.

Changes of pituitary adenylate cyclase activating polypeptide (PACAP) level in polytrauma patients in the early post-traumatic period

In polytrauma patients who survive the primary insult, the imbalance between the pro- and anti-inflammatory processes seems to be responsible for life-threatening complications such as sepsis or multiple organ dysfunction syndrome. Measurement of C-reactive protein (CRP) and procalcitonin (PCT) is a standard way for differentiating between infectious (bacterial) and non-infectious inflammation. Monitoring of immune cell functions, like leukocyte anti-sedimentation rate (LAR) can also be useful to diagnose infectious complications. Pituitary adenylate cyclase activating polypeptide (PACAP) is a neuropeptide with well-known immunomodulatory and anti-inflammatory effects. The aim of our study was to determine the changes of PACAP38 levels in polytrauma patients in the early post-traumatic period in intensive care unit and analyse possible correlation of its level with conventional (CRP, PCT) and unconventional (LAR) laboratory parameters. Twenty polytrauma patients were enrolled. Blood samples were taken daily for five days. We observed significant correlation between PACAP38 and CRP levels on day 4 and 5 as well as between PACAP38 and LAR levels all of the days. This could be due to the anti-inflammatory and cytoprotective functions of PACAP38 as part of an endogenous response to the trauma induced systemic inflammatory response syndrome. These significant correlations could have clinical importance in monitoring the dynamic balance of pro- and anti-inflammatory processes in case of polytraumatic patients.

Policies and practices in the field of laboratory hematology in Croatia - a current overview and call for improvement

OBJECTIVES

In 2019 The Croatian Working Group for Laboratory Hematology, on behalf of the Croatian Society of Medical Biochemistry and Laboratory Medicine, wanted to explore the background in field of laboratory hematology routine practice among Croatian laboratories in order to develop future strategies for producing national recommendations, if needed.

METHODS

During April and May 2019, a comprehensive survey covering all main parts of the total testing process within the field of laboratory hematology among Croatian medical laboratories was conducted. The survey comprised 49 inquiries. Data was collected using Survey Monkey (Palo Alto, CA, USA). All collected data was anonymized.

RESULTS

The response rate was 72%. There is still a substantial number of laboratories that have only three-part differential hematology analyzers (9%). Furthermore, a very high number of laboratories did not perform analyzer verification prior to implementation into routine work (31%). Out of those who have verified their analyzers, a diversity of guidelines and recommendations were used. Nearly 10% of the laboratories do not have a defined policy regarding specimen rejection. The majority of the participants perform internal quality control daily (83%), however, only 51% of respondents evaluate the agreement between different hematology analyzers on daily basis. Although more than 90% of Croatian laboratories have a defined policy regarding specimen rejection, only 61% of respondents continuously monitor quality indicators in routine practice.

CONCLUSIONS

The survey revealed substantial differences in all aspects of laboratory hematology practices among Croatian medical laboratories, indicating the need for universal recommendations at the national level.

Efficacy and Safety of the Cudrania tricuspidata Extract on Functional Dyspepsia: A Randomized Double-Blind Placebo-Controlled Multicenter Study

Cudrania tricuspidata is a folk remedy used to treat inflammation in patients with tumors or liver damage. This study investigated the efficacy of Cudrania tricuspidata extract (CTE) for relieving the symptoms of functional dyspepsia. In an 8-week, randomized, double-blind, placebo-controlled study, 100 adults with any condition featured in the Rome IV criteria and a Gastrointestinal Symptoms Scale (GIS) score ≥4 were randomly allocated to take either a placebo (maltodextrin) or a 50 mg CTE tablet, which equally included celluloses, magnesium stearate, and silicon dioxide, twice daily, 20 January 2020, and 3 August 2020. Among the 83 participants finally analyzed, the CTE group was associated with a significant reduction in the gastrointestinal symptom rating scale (day 0: 8.0 ± 5.2, day 28: 4.7 ± 3.9, and day 56: 2.3 ± 2.4, p < 0.001, respectively) in comparison with the control group (day 0: 8.1 ± 4.7, day 28: 7.8 ± 5.7, and day 56: 7.5 ± 6.6, p > 0.05) after adjusting for smoking, drinking, eating habits, stress levels, and caffeine intake. The CTE group resulted in significant improvements of GIS, Nepean Dyspepsia Index (Korean version), and functional dyspepsia-related quality of life over time. There were no different adverse events (p = 0.523). These findings suggest that CTE is safe and efficacious for alleviating gastrointestinal symptoms in patients with functional dyspepsia.

Role of Monocyte-to-lymphocyte Ratio, Mean Platelet Volume-to-Platelet Count Ratio, C-Reactive Protein and Erythrocyte Sedimentation Rate as Predictor of Severity in Secondary Traumatic Brain Injury: A Literature Review

BACKGROUND: Secondary traumatic brain injury (TBI) is injury to the brain following primary TBI because of neuroinflammation as consequences of neuronal and glial cell injury which cause release of various inflammation cytokine and chemokine. Biomarker examination to predict the severity of secondary TBI is important to provide appropriate treatment to the patient. This article reviews possibility several common laboratory parameter such as monocyte-to-lymphocyte ratio (MLR), mean platelet volume-to-platelet count (PC) ratio (MPV-PCR), c-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) to predict severity of secondary TBI. LITERATURE REVIEW: TBI activates microglia which increase infiltration and proliferation of monocyte. Neuroinflammation also increases thrombopoiesis which leads to increase megakaryocytes production. In the other hand, due to disruption of brain blood vessels because of trauma, coagulation cascade is also activated and leads to consumptive coagulopathy. These are reflected as high monocyte count, low PC, and high MPV. Lymphocyte count is reported low in TBI especially in poor outcome patients. CRP is an acute phase reactant that increased in inflammation condition. In TBI, increased production of Interleukin-6 leads to increase CRP production. In head injured patients, ESR level does not increase significantly in the acute phase of inflammation but last longer when compared to CRP. CONCLUSION: MLR, MPV-PCR, CRP, and ESR could be predictor of severity in secondary TBI.

Study of the changes in immune indexes, pathogenic characteristics and related risk factors in children with viral diarrhea

BACKGROUND

Infectious diarrhea is a serious hazard to children under 5 years old. The causative microorganisms are mostly viruses and bacteria, with different treatment required for each. Currently, early clinical differential diagnosis is difficult with the available testing methods. Therefore, new and more sensitive indicators of viral infection reflect the early stage of infection are needed.

METHODS

We collected blood samples and fresh fecal samples from 100 children diagnosed with viral diarrhea who were treated in the outpatient clinic at Changzhou Tumor Hospital Affiliated to Soochow University from January 2018 to December 2020. The levels of interleukin-2 (IL-2), IL-6, tumor necrosis factor-α (TNF-α), and C-reactive protein (CRP) in serum, the erythrocyte sedimentation rate (ESR) and enterovirus were measured and compared with those in a matched healthy control group. Patients' demographic and risk factor data were collected by interviewing parents.

RESULTS

The mean levels of IL-2, IL-6, TNF-α, ESR, and CRP in the viral diarrhea group were higher than those in the healthy control group. Except for IL-6, the differences in inflammatory factors between groups were statistically significant (P<0.05). Human rotavirus (HRV) infection was the highest. Children's hand-washing habits, weekly disinfection of toys, and vaccination were protective factors for viral diarrhea, and indoor flies were an important risk factor (P<0.05).

CONCLUSIONS

The serum levels of markers were significantly increased in the children with viral diarrhea. HRV was the main pathogen, and mixed infections existed. Infection control requires hand washing, regular disinfection of toys, vaccination and preventing indoor flies.

Case Report of Infectious Spondylitis Caused by Kytococcus sedentarius

Background: Kytococcus species has not been considered a pathogen, but infections caused by this species are increasing. There are several cases of infections caused by Kytococcus sedentarius, but no case of infectious spondylitis has been reported yet. Case presentation: A 79-year-old female patient was hospitalized because of back pain for several months. She was diagnosed with infectious spondylitis, and K. sedentarius was cultured from the pus and specimen obtained during the surgical procedure. The patient recovered completely without recurrence after 6 months of treatment with ciprofloxacin alone for 8 weeks. Conclusion: This is the first case report of infectious spondylitis caused by K. sedentarius.

Salivary Heme Oxygenase-1: A Potential Biomarker for Central Neurodegeneration

BACKGROUND

Parkinson disease (PD) is the second most common neurodegenerative disease, affecting 2% of the population over 65 years of age. PD diagnosis is based on clinical examination and can only be confirmed during autopsy. In 2018, we reported that heme oxygenase-1 (HO-1), an inducible stress response protein important for heme catabolism and implicated in PD pathology, was higher in PD saliva relative to healthy controls, suggesting that salivary HO-1 may serve as a potential biomarker of PD.

OBJECTIVES

To ascertain whether HO-1 protein levels are elevated in PD saliva relative to degenerative neurological, non-degenerative neurological and healthy controls.

METHODOLOGY

The study included 307 participants comprising 75 participants with idiopathic PD and 3 control groups: 162 non-neurological, 37 non-PD degenerative neurological, and 33 non-degenerative neurological participants. Salivary HO-1 and total protein concentrations were measured using ELISA and BCA assay, respectively. Receiver operating characteristic (ROC) curves were used to estimate model discrimination. Analyses were adjusted by age, sex, total protein, and relevant comorbidities.

RESULTS

Elevated HO-1 concentrations were observed in the PD group and other neurodegenerative conditions compared to subjects with no neurological or non-degenerative neurological conditions. ROC curves using HO-1 levels and covariates yielded areas under the curve above 85% in models for PD or neurodegenerative conditions versus controls.

CONCLUSIONS

Salivary HO-1 concentrations in combination with covariates may provide a biomarker signature that distinguishes patients with neurodegenerative conditions from persons without.

CLASSIFICATION OF EVIDENCE

This study provides Class III evidence that salivary HO-1 multivariable models can distinguish neurodegenerative conditions.

Preventive effects of Pycnogenol® on cardiovascular risk factors (including endothelial function) and microcirculation in subjects recovering from coronavirus disease 2019 (COVID-19)

BACKGROUND

The aim of this open supplement study was to evaluate the effects of Pycnogenol® in comparison with controls on symptoms of post-COVID-19 syndrome and in improving endothelial function, microcirculation, inflammatory markers and oxidative stress over 3 months in symptomatic subjects recovering from COVID-19.

METHODS

Sixty subjects recovering from symptomatic COVID-19 were included. One group of 30 followed a standard recovery management while 30 comparable subjects received a supplement of 150 mg Pycnogenol® daily (in 3 doses of 50 mg) in addition to standard management.

RESULTS

Two groups of selected subjects were comparable at baseline. The groups progressively improved both with the SM (standard management) and with the SM in combination with the supplement. Patients, supplemented with Pycnogenol® showed significantly better improvement compared to the control group patients. No side effects from the supplementation were observed; tolerability was optimal. The progressive evolution over time was visible in all target measurements. Physiological tests. Endothelial function, low in all subjects at inclusion was assessed by flow mediated dilation (FMD) and finger reactive hyperemia in the microcirculation (laser Doppler measurements) after the release of an occluding suprasystolic cuff). It was significantly improved in the Pycnogenol® group after one month and after 3 months (p<0.05 vs controls). The rate of ankle swelling (RAS) by strain gauge decreased significantly in the supplemented group (p<0.05) in comparison with controls showing an improvement of the capillary filtration rate. At inclusion, the kidney cortical flow velocity indicated a decrease in perfusion (lower systolic and diastolic flow velocity) in all patients. Kidney cortical flow velocity increased significantly with the supplement (p<0.05) in comparison with controls with improvement in systolic velocity and in diastolic component. High sensitivity CRP (hs-CRP) and Il-6 plasma levels decreased progressively over 3 months with a significant more pronounced decrease in the supplement group (p<0.05). The number of patients with normal plasma IL-6 levels at the end of the study was higher (p<0,05) with the supplement. ESR followed the same pattern with a progressive and a more significant decrease in the supplemented subjects (p<0.02). Oxidative stress decreased significantly in the supplemented group (p<0.05) compared with the control group. Blood pressure and heart rate were normalized in all subjects in the supplement group; systolic pressure was significantly lower in the supplemented group (p<0,05) at the end of the study. Finally, the scores of Quality-of-life, mood and fatigue questionnaire and the Karnofsky scale performance index significantly improved in the supplement group (p<0.05) compared to controls after 1 and 3 months. All other blood parameters (including platelets and clotting factors) were within normal values at the end of the study.

CONCLUSIONS

In conclusion, Pycnogenol® may offer a significant option for managing some of the signs and symptoms associated with post-COVID-19 syndrome. This pilot evaluation offers some potential rationale for the use of Pycnogenol® in this condition that will have significant importance in the coming years.

Mean platelet volume (MPV): new diagnostic indices for co-morbidity of tuberculosis and diabetes mellitus

Background

Tuberculosis (TB) and type 2 diabetes mellitus (DM) are global health diseases with high morbidity and mortality. Few studies have focused on platelet indices in TB-DM coinfection patients. The objective of this work was to analyze the platelet indices in TB, DM and TB-DM patients to assess the predictive value of the platelet index for the risk of these diseases.

Methods

In total, 246 patients admitted to our hospital were distributed into three groups (113TB, 59 DM and 74TB+DM). A total of 133 individuals were also recruited as healthy controls (HC). Platelet indices, namely, platelet count (PC), mean platelet volume (MPV), plateletcrit (PCT) and platelet distribution width (PDW), were compared among the four groups, and the relationship with inflammatory markers was explored by using statistical software.

Results

Our study discovered that MPV and PCT were significantly downregulated in TB+DM patients (9.951.25fL, 0.200.05%, P<0.0001, P=0.0121, separately) compared with DM individuals (10.921.17fL, 0.220.04%). Moreover, the changes in MPV were significantly higher in TB+DM patients (9.951.25fL, P=0.0041) than in TB patients (9.421.01fL). No differences were found in PLT and PDW among the four groups (P>0.05). The sensitivity and specificity of MPV in the differential diagnosis of DM patients vs TB+DM patients were 64.9 and 66.1% (P<0.0001), respectively, and the sensitivity and specificity of MPV between TB patients and TB+DM patients was 60.8 and 66.4%, respectively (P=0.003). MPV improved the diagnosis sensitivity when it was combined with clinical parameters, such as fasting blood glucose in DM and Mycobacterium tuberculosis culture result in TB (76.3% vs 64.9, 72.6% vs 60.8%, P<0.0001, P=0.001, respectively). In addition, the sensitivity and specificity of PCT in the differential diagnosis of DM patients vs TB+DM patients were 69.5 and 59.4%, respectively (P=0.008). PCT improved the diagnosis sensitivity when combined with fasting blood glucose in DM (72.9% vs 64.9%, P=0.004). In addition, MPV was linked to CRP (C-reactive protein) and ESR (erythrocyte sedimentation rate) in the TB+DM patients (r=0.3203, P=0.0054, r=0.2504, P=0.0307) but PCT was not (r=0.1905, r=0.008675, P>0.05, respectively).

Conclusions

Our research shows that MPV and PCT might be good clinical laboratory markers to distinguish TB+DM patients from TB or DM individuals, thus providing support for earlier clinical diagnosis, prevention, and therapy.

Hypoalbuminemia as Surrogate and Culprit of Infections

Hypoalbuminemia is associated with the acquisition and severity of infectious diseases, and intact innate and adaptive immune responses depend on albumin. Albumin oxidation and breakdown affect interactions with bioactive lipid mediators that play important roles in antimicrobial defense and repair. There is bio-mechanistic plausibility for a causal link between hypoalbuminemia and increased risks of primary and secondary infections. Serum albumin levels have prognostic value for complications in viral, bacterial and fungal infections, and for infectious complications of non-infective chronic conditions. Hypoalbuminemia predicts the development of healthcare-associated infections, particularly with Clostridium difficile. In coronavirus disease 2019, hypoalbuminemia correlates with viral load and degree of acute lung injury and organ dysfunction. Non-oncotic properties of albumin affect the pharmacokinetics and pharmacodynamics of antimicrobials. Low serum albumin is associated with inadequate antimicrobial treatment. Infusion of human albumin solution (HAS) supplements endogenous albumin in patients with cirrhosis of the liver and effectively supported antimicrobial therapy in randomized controlled trials (RCTs). Evidence of the beneficial effects of HAS on infections in hypoalbuminemic patients without cirrhosis is largely observational. Prospective RCTs are underway and, if hypotheses are confirmed, could lead to changes in clinical practice for the management of hypoalbuminemic patients with infections or at risk of infectious complications.

Clinical manifestations, laboratory markers, and renal ultrasonographic examinations in 1-month to 12-year-old Iranian children with pyelonephritis: a six-year cross-sectional retrospective study

BACKGROUND

Upper urinary tract infection (UTI) or pyelonephritis may increase the pathogenesis rate and risk of severe complications in children due to kidney atrophy.

OBJECTIVE

A set of clinical symptoms, laboratory markers, and ultrasound findings were assessed to achieve the early diagnosis and prognosis of pyelonephritis in hospitalized pediatrics.

METHODS

A cross-sectional study with 104 Iranian children (95 girls and 9 boys) aged 1 month to 12 years with acute pyelonephritis during 2012-2018 was conducted. The ultrasound examination of kidneys and urinary tract during hospitalization, the incidence of clinical symptoms, and laboratory markers in blood and urine were monitored to identify the best predictive factors of early diagnosis of this bacterial infection.

RESULTS

Three-fourth of the patients had one of the four clinical symptoms of abdominal pain, constipation, dysuria, and vomiting, while others were asymptomatic. A much frequency of pyuria (88.46%), Escherichia coli in urine (92.31%), leukocytosis (81.73%), and high ESR (> 10 mm/h, 92.30%) and CRP (> 10 mg/L, 82.82%) was observed. The kidney and urinary tract ultrasonography only in 32.7% of children revealed findings in favor of pyelonephritis (cystitis, ureteral stones, and hydronephrosis).

CONCLUSION

There was a high frequency of clinical signs and laboratory markers associated with pyelonephritis. Ultrasound alone was not an efficient tool to track febrile UTI as most patients presented normal sonography.

Mediterranean Personalized Diet Combined with Physical Activity Therapy for the Prevention of Cardiovascular Diseases in Italian Women

Cardiovascular diseases (CVDs) and inflammatory risk indexes are used to calculate the exposure to morbidity. Most of them are suggested by the American College of Cardiology/American Heart Association to predict the risk of CVDs diagnosis in primary prevention, instead of treating the ongoing pathology. Prevention starts from habit changes with the prescription of diet and physical activity (PA). The aim of the study is to investigate the effectiveness of a personalized Mediterranean Diet (MD) and a PA intervention, on the risk indexes Atherogenic Index of Plasma (AIP), Lipid Accumulation Product (LAP) and Fatty Liver Index (FLI) in a population of women at risk of CVDs with different pathological conditions. After treatment, patients achieved the best results in body composition (BC) and laboratory tests. The BC analysis showed a significant reduction of total body Fat Mass (FM). CVDs risk indexes significantly decreased, except for Neutrophil/Lymphocyte (NLR) and Platelet/Lymphocyte Ratios (PLR). The reduction of the CVDs indexes associated with lipid profile was linked to both weight and FM decrease. AIP and LAP were significantly reduced when losing fat mass and body weight, respectively. A personalized MD therapy plus a PA program led to body weight loss, BC remodelling and risk indexes reduction.

The association of erythrocyte sedimentation rate, high-sensitivity C-reactive protein and diabetic kidney disease in patients with type 2 diabetes

BACKGROUND

To evaluate the association between high-sensitivity C-reactive protein (hsCRP) and erythrocyte sedimentation rate (ESR), and diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus (T2DM).

METHODS

A cross-sectional study was conducted in 1210 patients with T2DM, among whom 265 had DKD. The severity of DKD was assessed by estimated-glomerular filtration rate (eGFR) and urinary albumin creatinine ratio (ACR). The relationship between ESR, hsCRP and DKD was analyzed by multivariate logistic analysis. The relationship between ESR and eGFR, ESR or ACR was analyzed by multivariate linear regression.

RESULTS

ESR (23.0 [12.0 ~ 41.5] mm/h versus 12.0 [7.0 ~ 22.0] mm/h, P <  0.001) and hsCRP (3.60 [2.20 ~ 7.65] versus 2.90 [1.80 ~ 5.60] mg/L mg/L, P <  0.01) values were significantly higher in patients with DKD than those without. Patients with higher ESR or hsCRP had lower eGFR and higher ACR. After adjusted for gender, age, hemoglobin, plasma proteins, HbA_1c, lipid profiles, and the usage of renin-angiotensin system inhibitors, ESR but not hsCRP was independently associated with the rate and severity of DKD in patients with T2DM.

CONCLUSION

ESR was independently associated with the rate and severity of DKD in patients with T2DM.

Higher Physiologic Platelet Counts in Whole Blood Are Not Associated With Improved ACL Cross-sectional Area or Signal Intensity 6 Months After Bridge-Enhanced ACL Repair

Background:

A bridge-enhanced anterior cruciate ligament (ACL) repair (BEAR) procedure places an extracellular matrix implant, combined with autologous whole blood, in the gap between the torn ends of the ligament at the time of suture repair to stimulate healing. Prior studies have suggested that white blood cell (WBC) and platelet concentrations significantly affect the healing of other musculoskeletal tissues.

Purpose/Hypothesis:

The purpose of this study was to determine whether concentrations of various blood cell types placed into a bridging extracellular matrix implant at the time of ACL repair would have a significant effect on the healing ligament cross-sectional area or tissue organization (as measured by signal intensity). We hypothesized that patients with higher physiologic platelet and lower WBC counts would have improved healing of the ACL on magnetic resonance imaging (MRI) (higher cross-sectional area and/or lower signal intensity) 6 months after surgery.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

A total of 61 patients underwent MRI at 6 months after bridge-enhanced ACL repair as part of the BEAR II trial. The normalized signal intensity and average cross-sectional area of the healing ligament were measured from a magnetic resonance stack obtained using a gradient echo sequence. The results were stratified by sex, and univariate and multivariate regression analyses determined significant correlations between blood cell concentrations on these 2 magnetic resonance parameters.

Results:

In unadjusted analyses, older age and male sex were associated with greater healing ligament cross-sectional area (P < .04) but not signal intensity (P > .15). Adjusted multivariable analyses indicated that in female patients, a higher monocyte concentration correlated with a higher ACL cross-sectional area (β = 1.01; P = .049). All other factors measured, including the physiologic concentration of platelets, neutrophils, lymphocytes, basophils, and immunoglobulin against bovine gelatin, were not significantly associated with either magnetic resonance parameter in either sex (P > .05 for all).

Conclusion:

Although older age, male sex, and monocyte concentration in female patients were associated with greater healing ligament cross-sectional area, signal intensity of the healing ligament was independent of these factors. Physiologic platelet concentration did not have any significant effect on cross-sectional area or signal intensity of the healing ACL at 6 months after bridge-enhanced ACL repair in this cohort. Given these findings, factors other than the physiologic platelet concentration and total WBC concentration may be more important in the rate and amount of ACL healing after bridge-enhanced ACL repair.