Erythrocyte sedimentation rate. From folklore to facts

Early stage of erythrocyte sedimentation rate test: Fracture of a high-volume-fraction gel

Erythrocyte sedimentation rate (ESR) is a clinical parameter used as a nonspecific marker for inflammation, and recent studies have shown that it is linked to the collapse of the gel formed by red blood cells (RBCs) at physiological hematocrits (i.e. RBC volume fraction). Previous research has suggested that the observation of a slower initial dynamics is related to the formation of fractures in the gel. Moreover, RBC gels present specific properties due to the anisotropic shape and flexibility of the RBCs. Namely, the onset of the collapse is reached earlier and the settling velocity of the gel increases with increasing attraction between the RBCs, while the gel of spherical particles shows the opposite trend. Here, we report experimental observations of the gel structure during the onset of the collapse. We suggest an equation modeling this initial process as fracturing of the gel. We demonstrate that this equation provides a model for the motion of the interface between blood plasma and the RBC gel, along the whole time span. We also observe that the increase in the attraction between the RBCs modifies the density of fractures in the gel, which explains why the gel displays an earlier onset when the aggregation energy between the RBCs increases. Our work uncovers the detailed physical mechanism underlying the ESR and provides insights into the fracture dynamics of an RBC gel. These results can improve the accuracy of clinical measurements.

Non-invasive method for assessment of inflammation

This article explores the potential of non-invasive measurement for elevated levels of erythrocyte aggregation in vivo, which have been correlated with a higher risk of inflammatory processes. The study proposes utilizing a dynamic light scattering approach to measure aggregability. The sensor modules, referred to as "mDLS," comprise VCSEL and two photodiodes. Two of these modules are placed on an inflatable transparent cuff, which is then fitted to the subject's finger root, with one sensor module positioned on each side. By temporarily halting blood flow for one minute using over-systolic inflation of the cuff, signals from both sensors are recorded. The study involved three distinct groups of subjects: a control group consisting of 65 individuals, a group of 29 hospitalized COVID-19 patients, and a group of 34 hospitalized patients with inflammatory diseases. Through experimental results, significant differences in signal kinetic behavior were observed between the control group and the two other groups. These differences were attributed to the rate of red blood cell (RBC) aggregation, which is closely associated with inflammation. Overall, the study emphasizes the potential of non-invasive diagnostic tools in evaluating inflammatory processes by analyzing RBC aggregation.

Clinical application of a new method for determination of the erythrocyte sedimentation rate using the BC-720 automated hematology analyzer

BACKGROUND

The erythrocyte sedimentation rate (ESR) is a nonspecific inflammatory indicator and is widely used in clinical diagnosis. Westergren is the gold standard method recommended by the International Committee for Standardization of Hematology (ICSH), but it is time-consuming and inconvenient and has biosafety risks. A new alternate method for ESR (Easy-W ESR) measurement was designed and integrated into the Mindray BC-720 series automated hematology analyzer to meet the clinical needs of hematology laboratories for efficiency, safety, and automation. In this study, the performance of the new ESR method was evaluated based on the ICSH recommendations on modified and alternate ESR methods.

METHODS

Methodological comparisons using the BC-720 analyzer, TEST 1, and the Westergren method were performed to assess repeatability, carryover, sample stability, reference range validation, factors influencing the ESR, and clinical applicability in rheumatology and orthopedics.

RESULTS

The correlation between the BC-720 analyzer and the Westergren method was good (Y = 2.082 + 0.9869X, r = 0.9657, P > 0.0001, n = 342), carryover was <1%, the repeatability standard deviation was ≤1 mm/h, and the coefficient of variation (CV) was ≤5%. The reference range meets the manufacturer's claim. For rheumatology patients, the BC-720 analyzer showed a good correlation with the Westergren method (Y = 1.021X-1.941, r = 0.9467, n = 149). For orthopedic patients, the BC-720 analyzer also showed a good correlation with the Westergren method (Y = 1.037X + 0.981, r = 0.978, n = 97).

CONCLUSION

This study verified the clinical and analytical performance of the new ESR method, indicating that the results are very similar to those obtained using the Westergren method.

α2-fraction and haptoglobin as biomarkers for disease activity in oligo- and polyarticular juvenile idiopathic arthritis

OBJECTIVES

Unlike in adult rheumatology, for most forms of juvenile idiopathic arthritis (JIA) no reliable biomarkers currently exist to assess joint and disease activity. However, electrophoresis is frequently found changed in active juvenile arthritis. The objective of this study was to evaluate the α2-fraction of serum electrophoresis and its main components as biomarkers for JIA, categories extended/persistent oligoarthritis and seronegative polyarthritis, in comparison with the conventionally used erythrocyte sedimentation rate and C-reactive protein.

METHODS

Serum samples and clinical data from 181 patients with JIA were collected. Serum electrophoresis and α2-fraction and its components were determined using standard methods. Relationship between calculated α2-fraction of serum electrophoresis (CA2F) and its components, acute-phase parameters and cJADAS27 was assessed using Pearson's correlation coefficient and linear regression modelling, adjusting for confounding effects. Results were confirmed in a second cohort with 223 serum samples from 37 patients, using a mixed model to account for repeated measures.

RESULTS

Compared to ESR and CRP, CA2F showed higher correlation to cJADAS27, in particular for persistent oligoarthritis. Of the three components of the α2-fraction, haptoglobin showed the highest correlation to cJADAS27. Regression analysis demonstrated higher ability to predict cJADAS27 for CA2F, and especially for haptoglobin as a component thereof, than for CRP and ESR.

CONCLUSION

Compared to conventional methods, α2-fraction of serum electrophoresis and specifically, haptoglobin show higher correlations with disease activity in common subtypes of JIA, representing excellent candidates as biomarkers for disease activity. Further studies are necessary to determine diagnostic value and correlations in other subtypes.

Intermittent peri-tubal instillation of dexamethasone and ropivacaine on postoperative analgesia after percutaneous nephrolithotomy: A prospective randomized controlled trial

OBJECTIVES

Percutaneous nephrolithotomy and placement of nephrostomy tube are performed for renal stones >2 cm in diameter. Attempts have been made to infiltrate local anesthetics with or without adjuvants into the surgical site to reduce pain. We hypothesized that there would be a significant prolongation of the analgesic effect of local anesthetic instillation along the nephrostomy tube due to the adjuvant dexamethasone.

METHODS

After ethical approval and Clinical Trials Registry - India registration (CTRI/2020/03/024332), 64 American Society of Anesthesiologists classification 1 and 2 adult patients were enrolled in this randomized double-blinded prospective study divided into Group R-received 20 mL 0.2% Ropivacaine and Group R + D-received 20 mL 0.2% Ropivacaine with dexamethasone 8 mg, injected through a multi-lumen wound infiltration catheter.

RESULTS

The demographic profile of patients was similar in both groups. The mean duration of analgesia was longer in Group R + D (21.3 ± 2.1 hrs) versus Group R (10 ± 1.9 hrs, P = 0.001). The mean numeric rating scale scores of Group R + D were significantly lower at all time intervals (P = 0.001). Also, the cumulative dose of ropivacaine and the total use of fentanyl postoperatively in Group R was much higher (70 ± 10.4 vs 56 ± 8.9 μg, P = 0.02). The C-reactive protein levels were significantly lower in Group R + D (13.8 ± 1.5 vs 23.1 ± 1.2 mg/L, P = 0.001 and 16.5 ± 1.3 vs 28.5 ± 1.7 mg/L, P = 0.001, at 24 and 48 hrs, respectively).

CONCLUSION

We conclude that dexamethasone can be used as a suitable adjuvant to intermittent local anesthetic infiltration after percutaneous nephrolithotomy with a nephrostomy tube for the prolongation of analgesia.

Serum inflammatory markers and leukocyte profiles accurately describe hidradenitis suppurativa disease severity

BACKGROUND

Inflammatory markers and leukocyte profiles have not been longitudinally evaluated as objective signs of hidradenitis suppurativa (HS) severity. We sought to assess C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6), and leukocyte profiles as reliable indicators of HS severity.

METHODS

Retrospective cohort study of 404 patients seen at the Einstein/Montefiore HS Center, Bronx, New York, between March 2019 and November 2020. Associations of disease severity (HS-Physician Global Assessment) with inflammatory markers and leukocyte profiles were assessed by odds ratios (OR) and 95% confidence intervals (95% CI) incorporating up to four visits per patient, adjusting for baseline gender, age, BMI, and smoking status.

RESULTS

Patients with severe disease had elevated CRP (OR 1.87; 95% CI 1.49, 2.34), ESR (OR 1.04; 95% CI 1.03, 1.04), IL-6 (OR 1.08; 95% CI 1.00, 1.16), leukocytes (OR 1.22; 95% CI 1.14, 1.31), neutrophils (OR 1.31; 95% CI 1.20, 1.42), eosinophils (OR 14.40; 95% CI 2.97, 69.74), basophils (OR 2.53; 95% CI 1.09, 5.85), monocytes (OR 5.36; 95% CI 2.49, 11.53), and neutrophil-lymphocyte ratios (OR 1.63; 95% CI 1.35, 1.96) but decreased lymphocytes (OR 0.86; 95% CI 0.68, 1.10).

CONCLUSIONS

This novel longitudinal study of inflammatory markers and leukocyte profiles offers critical laboratory measures to confirm clinically determined disease severity over time.

The VES-Matic 5 system: performance of a novel instrument for measuring erythrocyte sedimentation rate

OBJECTIVES

The VES-Matic 5 is an automated analyzer that assesses erythrocyte sedimentation rate based on a modified Westergren sedimentation technique. Instrument performance was established by addressing the recommendations of the International Council for Standardization in Haematology.

METHODS

Comparison against the reference Westergren method was performed for all samples, and further for the low, middle, and upper third of the analytical range. Intra-run precision, inter-run precision, and interference studies were further assessed. This study included the evaluation of reference ranges.

RESULTS

The comparison of methods by Passing-Bablok analysis has shown a good agreement without systematic or proportional differences. The regression equation was y=-0.646 + 0.979x. The mean bias of -0.542 was obtained by Bland-Altman analysis and the upper limit of 8.03 with the lower limit of -9.11 can be considered clinically acceptable. Intra-run and inter-run precision were good for each parameter and interference studies did not show any significant bias with exception of anemia samples, which showed a proportional difference when comparing high erythrocyte sedimentation rate values. Using the local adult reference population, we verified the reference ranges in comparison to those available in the literature, and according to the Clinical Laboratory Standards Institute (CLSI) EP28-A3C document. We determined the upper limit partitioned by gender and the following age groups: from 18 to 50, from 50 to 70, and over 70.

CONCLUSIONS

The VES-Matic 5 analyzer presented good comparability with the reference method. As there are commercial quality control and suitable external quality assessment (EQA) material and programs, the VES-Matic 5 can be employed appropriately for routine purposes.

Erythrocyte Sedimentation: Collapse of a High-Volume-Fraction Soft-Particle Gel

The erythrocyte sedimentation rate is one of the oldest medical diagnostic methods whose physical mechanisms remain debatable today. Using both light microscopy and mesoscale cell-level simulations, we show that erythrocytes form a soft-particle gel. Furthermore, the high volume fraction of erythrocytes, their deformability, and weak attraction lead to unusual properties of this gel. A theoretical model for the gravitational collapse is developed, whose predictions are in agreement with detailed macroscopic measurements of the interface velocity.

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.

Adapted Murine Sepsis Score: Improving the Research in Experimental Sepsis Mouse Model

The Murine Sepsis Score (MSS) is used to assess the severity of sepsis in rats and mice based on observational characteristics. The quantitative variables of glycemia, body weight, and temperature are predictors of severity in experimental models of sepsis. Therefore, our study sought to adapt the MSS with the same variables to indicate earlier the severity of the disease in murine models of the disease. Sepsis mice presented hypoglycemia, weight loss, and hypothermia. Therefore, these variables were included in the Adapted Murine Sepsis Score (A-MSS). The A-MASS presented 100% specificity and 87.5% sensibility been able to differentiate the early sepsis symptoms and its severity. The A-MSS allows an early and more complete diagnosis of sepsis in mice and might be considered as a procedure to improve the analysis of systemic sepsis dysfunction in murine experimental models.

"A study protocol for a randomised controlled trial on the efficacy of yoga as an adjuvant therapy for patients with Ankylosing spondylitis amidst COVID-19 pandemic"

Background

Amidst the adversities of the COVID-19 pandemic, the health care system has seen a new paradigm shift towards e-health or telehealth services. In the advent of catering to the geometrically increasing health care needs of the patients suffering from various chronic health conditions when in social isolation, the need for such shifts is paramount. Patients with Ankylosing spondylitis using immunosuppressants with variable degrees of disabilities are at higher risk from this isolated status. This study aims to assess the efficacy of e-Yoga as a treatment option for these patients.

Methods

The proposed study is a single-center, parallel-group prospective randomized, open-blinded end-point trial. Patients aged between 30 and 50 years will be recruited from the members of Antardhwani: A society of ankylosing spondylitis based in Ahmedabad, Gujarat. Yoga experts will administer a scientifically developed and validated Yoga module via e-Yoga modalities. A total of 135 patients will be recruited and randomly allocated to Yoga and control groups. Data will be recorded at baseline and three months on disease activity, degree of functional limitations in patients, quality of life, inflammatory biomarkers, depression, and anxiety using Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), AS Quality of Life index (ASQOL), C reactive protein (CRP), Erythrocyte sedimentation rate (ESR), Physical health questionnaire-4 (PHQ-4), respectively.

Discussion

The study will report the efficacy of e-Yoga in catering to the physical and mental insufficiencies of inpatients with Ankylosing spondylitis amidst COVID-19 pandemic. The study is prospectively registered in the Clinical Trial Registry of India (CTRI/2020/08/027215)

Acanthocyte Sedimentation Rate as a Diagnostic Biomarker for Neuroacanthocytosis Syndromes: Experimental Evidence and Physical Justification

(1) Background: Chorea-acanthocytosis and McLeod syndrome are the core diseases among the group of rare neurodegenerative disorders called neuroacanthocytosis syndromes (NASs). NAS patients have a variable number of irregularly spiky erythrocytes, so-called acanthocytes. Their detection is a crucial but error-prone parameter in the diagnosis of NASs, often leading to misdiagnoses. (2) Methods: We measured the standard Westergren erythrocyte sedimentation rate (ESR) of various blood samples from NAS patients and healthy controls. Furthermore, we manipulated the ESR by swapping the erythrocytes and plasma of different individuals, as well as replacing plasma with dextran. These measurements were complemented by clinical laboratory data and single-cell adhesion force measurements. Additionally, we followed theoretical modeling approaches. (3) Results: We show that the acanthocyte sedimentation rate (ASR) with a two-hour read-out is significantly prolonged in chorea-acanthocytosis and McLeod syndrome without overlap compared to the ESR of the controls. Mechanistically, through modern colloidal physics, we show that acanthocyte aggregation and plasma fibrinogen levels slow down the sedimentation. Moreover, the inverse of ASR correlates with the number of acanthocytes (R2=0.61, p=0.004). (4) Conclusions: The ASR/ESR is a clear, robust and easily obtainable diagnostic marker. Independently of NASs, we also regard this study as a hallmark of the physical view of erythrocyte sedimentation by describing anticoagulated blood in stasis as a percolating gel, allowing the application of colloidal physics theory.

Evaluation of Optical and Radar Based Motion Capturing Technologies for Characterizing Hand Movement in Rheumatoid Arthritis-A Pilot Study

In light of the state-of-the-art treatment options for patients with rheumatoid arthritis (RA), a detailed and early quantification and detection of impaired hand function is desirable to allow personalized treatment regiments and amend currently used subjective patient reported outcome measures. This is the motivation to apply and adapt modern measurement technologies to quantify, assess and analyze human hand movement using a marker-based optoelectronic measurement system (OMS), which has been widely used to measure human motion. We complement these recordings with data from markerless (Doppler radar) sensors and data from both sensor technologies are integrated with clinical outcomes of hand function. The technologies are leveraged to identify hand movement characteristics in RA affected patients in comparison to healthy control subjects, while performing functional tests, such as the Moberg-Picking-Up Test. The results presented discuss the experimental framework and present the limiting factors imposed by the use of marker-based measurements on hand function. The comparison of simple finger motion data, collected by the OMS, to data recorded by a simple continuous wave radar suggests that radar is a promising option for the objective assessment of hand function. Overall, the broad scope of integrating two measurement technologies with traditional clinical tests shows promising potential for developing new pathways in understanding of the role of functional outcomes for the RA pathology.

Comparison of the StaRRsed Interliner device with Westergren method in erythrocyte sedimentation rate measurement

INTRODUCTION

With recent advances in technology, many manual tests are being replaced by automated devices due to a wide range of advantages. One of these tests is the erythrocyte sedimentation rate (ESR) test that is used to determine inflammatory activity. This study aimed to evaluate the agreement between the Starrsed Interliner sedimentation device and the gold standard method, that is the Westergren method, used in ESR measurement.

METHODS

One hundred fifty-one patients who presented to Gaziantep University Faculty of Medicine, Şahinbey Training and Research Hospital were included in this study. ESR values were measured simultaneously within 2 hours using the ESR analyzer Starrsed Interliner device and the gold standard method of measuring ESR, that is the Westergren method, from blood samples collected from the same patients in EDTA and citrate tubes.

RESULTS

Agreement between the results from the Starrsed Interliner device and the Westergren method was evaluated using the Intraclass Correlation method. Consequently, a poor correlation was observed at values <20 mm/h, a moderate correlation was observed at values 20 to 80 mm/h and >80 mm/h, and an excellent correlation was observed when all results were considered. Method comparison was conducted according to the Passing-Bablok regression analysis (y = -1.50 + 0.75x) (P < .0001). The mean difference between the two methods was 10.1 according to the Bland-Altman analysis.

CONCLUSIONS

Despite the advantages of the Starrsed Interliner device, such as lower laboratory workloads, lower costs and turnaround time, the difference between the two methods, as found in this study, may lead to different clinical interpretations for results in some patient.

Neutrophil–lymphocyte ratio and response to plasmapheresis in Guillain–Barré syndrome: a prospective observational study

Background

Guillain–Barré Syndrome (GBS) is one of the most severe neurological diseases that causes marked disability and even death.

Aim

The aim of this study is to investigate the role of the neutrophil–lymphocyte ratio (NLR) as a prognostic marker for GBS and response to treatment with plasmapheresis.

Methods

Seventy-five subjects (35 GBS patients and 40 healthy controls) were recruited. Complete general and neurological examinations were performed and Hughes disability scale score was evaluated for assessing functional motor deficits in GBS patients. In addition, NLR, erythrocyte sedimentation rate, and C-reactive protein level were calculated.

Results

NLR was significantly higher in GBS patients than in controls (p < 0.001) and was significantly higher in axonal form than other demyelinating and mixed subtypes (p < 0.02). Patients with a poor outcome had a significantly high NLR than patients with a good outcome (p = 0.006). NLR was also positively correlated with Hughes disability scale score (p < 0.001). The cut-off value for NLR to predict a good response of patients to plasmapheresis was ≤ 4.4.

Interpretation

NLR may be a rapid, simple, inexpensive biomarker for predicting the severity of GBS, outcome of patients, and their response to plasmapheresis.

Rapid determination of erythrocyte sedimentation rate (ESR) by an electrically driven blood droplet biosensor

In healthcare practice, the sedimentation rate of red blood cells (erythrocytes) is a widely used clinical parameter for screening of several ailments such as stroke, infectious diseases, and malignancy. In a traditional pathological setting, the total time taken for evaluating this parameter varies typically from 1 to 2 h. Furthermore, the volume of human blood to be drawn for each test, following a gold standard laboratory technique (alternatively known as the Westergren method), varies from 4 to 5 ml. Circumventing the above constraints, here we propose a rapid (∼1 min) and highly energy efficient method for the simultaneous determination of hematocrit and erythrocyte sedimentation rate (ESR) on a microfluidic chip, deploying electrically driven spreading of a tiny drop of blood sample (∼8 μl). Our unique approach estimates these parameters by correlating the same with the time taken by the droplet to spread over a given radius, reproducing the results from more elaborate laboratory settings to a satisfactory extent. Our novel methodology is equally applicable for determining higher ranges of ESR such as high concentration of bilirubin and samples corresponding to patients with anemia and patients with some severe inflammation. Furthermore, the minimal fabrication steps involved in the process, along with the rapidity and inexpensiveness of the test, render the suitability of the strategy in extreme point-of-care settings.

A single dose of eHSP72 attenuates sepsis severity in mice

High levels of extracellular 72 kDa heat shock protein (eHSP72) can be detected in the serum of septic patients and are associated with increased oxidative profiles and elevated rates of mortality among these patients. However, a possible immunomodulatory role for this protein, resulting in tissue protection during sepsis, has never been assessed. In this study, we investigated whether eHSP72 administration could attenuate the severity of sepsis in a mouse peritonitis model. Animals (90-day-old male C57BL/6J mice) were divided into Sepsis (n = 8) and Sepsis + eHSP72 (n = 9) groups, which both received injections of 20% fecal solution [1 mg/g body weight (wt), intraperitoneal (i.p.)], to trigger peritonitis induced-sepsis, whereas a Control group (n = 7) received a saline injection. eHSP72 was administered (1.33 ng/g body wt) to the Sepsis+eHSP72 group, 12 h after sepsis induction. All animals were evaluated for murine sepsis score (MSS), hemogram, core temperature, and glycemia (before and 4, 12, and 24 h after sepsis induction). Treatment with eHSP72 promoted reduced sepsis severity 24 h after sepsis induction, based on MSS scores (Control = 1.14 ± 1.02; Sepsis = 11.07 ± 7.24, and Sepsis + eHSP72 = 5.62 ± 1.72, P < 0.001) and core temperatures (°C; Control = 37.48 ± 0.58; Sepsis = 35.17 ± 2.88, and Sepsis + eHSP72 = 36.94 ± 2.02; P = 0.006). eHSP72 treatment also limited the oxidative profile and respiratory dysfunction in mice with sepsis. Although sepsis modified glycemic levels and white and red blood cell counts, these variables were not influenced by eHSP72 treatment (P > 0.05). Finally, eHSP72 improved the survival rate after sepsis (P = 0.0371). Together, our results indicated that eHSP72 may ameliorate sepsis severity and possibly improve some sepsis indices in mice.

Sedimentation rate of erythrocyte from physics prospective

An erythrocytes sedimentation rate (ESR) measures how fast a blood sample sediments along a test tube in one hour in a clinical laboratory. Since elevated level of ESR is associated with inflammatory diseases, ESR is one of the routine hematology test in a clinical laboratory. In this paper, the physics of erythrocyte (RBC) sedimentation rate as well as the dynamics of the RBC is explored by modeling the dynamics of the cells as the motion of Brownian particle moving in a viscous medium. The viscous friction of blood γ is considered to decrease as the temperature of the medium increases. The results obtained in this work show that the ESR increases as the number of red blood cells (that bind together in the sedimentation process) steps up. The room temperature also affects the sedimentation rate. As the room temperature rises up, the ESR steps up. Furthermore the dynamics of the RBC along a Westergren pipet that is held in an upright position is explored. The exact analytic result depicts that the velocity of cells increases as the number of cells that form rouleaux steps up. Since our study is performed by considering physiological parameters, the results obtained in this work not only can be justified experimentally but also helps to understand most hematological experiments that are conducted in vitro.

Early and Accurate Prediction of Clinical Response to Methotrexate Treatment in Juvenile Idiopathic Arthritis Using Machine Learning

Background and Aims: Accurately predicting the response to methotrexate (MTX) in juvenile idiopathic arthritis (JIA) patients before administration is the key point to improve the treatment outcome. However, no simple and reliable prediction model has been identified. Here, we aimed to develop and validate predictive models for the MTX response to JIA using machine learning based on electronic medical record (EMR) before and after administering MTX.

Materials and Methods: Data of 362 JIA patients with MTX mono-therapy were retrospectively collected from EMR between January 2008 and October 2018. DAS44/ESR-3 simplified standard was used to evaluate the MTX response. Extreme gradient boosting (XGBoost), support vector machine (SVM), random forest (RF), and logistic regression (LR) algorithms were applied to develop and validate models with 5-fold cross-validation on the randomly split training and test set. Data of 13 patients additionally collected were used for external validation.

Results: The XGBoost screened out the optimal 10 pre-administration features and 6 mix-variables. The XGBoost established the best model based on the 10 pre-administration variables. The performances were accuracy 91.78%, sensitivity 90.70%, specificity 93.33%, AUC 97.00%, respectively. Similarly, the XGBoost developed a better model based on the 6 mix-variables, whose performances were accuracy 94.52%, sensitivity 95.35%, specificity 93.33%, AUC 99.00%, respectively.

Conclusion: Based on common EMR data, we developed two MTX response predictive models with excellent performance in JIA using machine learning. These models can predict the MTX efficacy early and accurately, which provides powerful decision support for doctors to make or adjust therapeutic scheme before or after treatment.

Biomarkers of Systemic Lupus Erythematosus and Systemic Sclerosis diseases activity in a sample of Egyptian patients :Soluble Intercellular Adhesion Molecule-1 and Soluble Interleukin-2 Receptor, Case Control Study

Systemic Lupus Erythematosus (SLE) and systemic sclerosis (SSc) are systemic inflammatory autoimmune disorders characterized by a large spectrum of clinical and laboratory features. The aim of the present study was to investigate the possible use of serum level of soluble intercellular adhesion molecule-1(sICAM-1) and soluble interleukin-2 receptor (sIL-2Ra) as biomarkers for monitoring of SLE and SSc disease activity. Moreover, it aimed to compare the specificity and sensitivity as well as cut-off value of both biomarkers in a sample of Egyptian patients. 50 SLE patients, 30 SSc patients and 60 age and sex matched healthy controls were enrolled in our study. sICAM-1and sIL-2Ra were measured in serum samples obtained from all participants. In addition to Erythosedimentation rate (ESR), complete blood count (CBC), Antineuclearantibodies (ANA) estimation, disease activity of both diseases were also assessed. sICAM-1and sIL-2Ra levels were higher in SLE and SSc patients versus control. Both parameters are correlated with each other as well as the activity parameters. A cut-off levels of 455.59 (ng/ml) &2525935 (pg/ml) in both SLE & SSs respectively was observed with the highest specificity and sensitivity. It could be concluded that sICAM-1 and sIL-2Ra are noninvasive biomarkers for SLE and SSc that could play a pathophysiologic role in development and progression of both diseases. Moreover, sICAM-1 and sIL-2Ra are correlated with the disease activity at cut-off values of 455.59 (ng/ml) & 2525935(pg/ml) respectively.

Elevated serum globulin gap as a highly reliable marker of elevated erythrocyte sedimentation rate in patients with systemic rheumatic diseases

OBJECTIVE

Serum C-reactive protein (CRP) level and erythrocyte sedimentation rate (ESR) are the two most commonly used markers of inflammation in clinical practice. Reducing the need for these tests could lead to considerable cost savings without sacrificing the quality of patient care.

METHODS

The electronic medical records of patients with systemic rheumatic diseases seen between May 2015 and June 2017 in the rheumatology clinics at a single academic medical center were retrospectively reviewed. Correlations and receiver operator characteristic (ROC) curves between serum CRP level and ESR vs serum globulin gap (the difference between levels of total protein and albumin) and albumin-to-globulin (A:G) ratio were determined.

RESULTS

In two independent cohorts (discovery: 263 subjects, 446 entries; validation: 438 subjects, 1959 entries), the globulin gap and A:G ratio correlated (p < 0.001) with CRP level and ESR, with correlation coefficients being greater for ESR than for CRP level. ROC curve analyses demonstrated better area-under-curve for ESR than for CRP level. The percentages of entries with elevated globulin gap (≥4.0 g/dl) and low A:G ratio (<0.8) were ∼8.4% and ∼2.6%, respectively, and each had a positive predictive value of ≥0.960 for elevated ESR. Among patients with high globulin gap, the change in globulin gap over time faithfully reflected changes in ESR.

CONCLUSION

In the subset of systemic rheumatic disease patients who harbor an elevated globulin gap, the ESR is almost always elevated. This novel observation sets the conceptual foundation and rationale for subsequent prospective studies that assess whether ESR testing in this subset of rheumatic disease patients could be reduced without sacrificing patient care. Ultimately, ordering an ESR test may often be unnecessary, thereby resulting in cost savings.

Extremely Elevated Erythrocyte Sedimentation Rates: Associations With Patients' Diagnoses, Demographic Characteristics, and Comorbidities

OBJECTIVE

To study associations between extreme erythrocyte sedimentation rate (ESR) elevations (≥100 mm/h) and diseases, age, sex, race, Charlson Comorbidity Index (CCI), and C-reactive protein (CRP) level.

PATIENTS AND METHODS

This was a retrospective cohort study of 4807 patients with extreme ESR values examined at Mayo Clinic, Rochester, Minnesota, from January 1, 2002, through December 31, 2011. Independent variables included diseases (infection, autoimmune, malignancy, renal disease, or miscellaneous), subcategories of diseases, patient demographic characteristics (age, sex, and race), CRP level, and CCI. The Wilcoxon rank sum test was used to assess comparisons of ESR between patients with and without disease as well as relationships between extreme ESR values and demographic characteristics of patients within disease categories. Associations between ESR and CRP level were determined using the Pearson correlation coefficient.

RESULTS

The leading diagnosis associated with extreme ESR elevations (n [%]) was infection (1932 [40]), followed by autoimmune (1839 [38]) and malignancy (1736 [36]) (P<.01). Extreme elevations in ESR varied by sex, with higher ESRs in men (mean, 117±13.3 mm/h) than in women (mean, 115.9±12.5 mm/h) (P=.008). Extreme ESR elevations correlated inversely with the CCI (P=.008) and did not correlate with the CRP level. There were no correlations between extreme elevations in ESR and age or race.

CONCLUSION

We found that almost all patients have an identifiable etiology for extreme ESR elevations and that infection is the most common disease association. Unlike previous research, we identified higher ESRs in men than in women and no associations with age, race, and comorbid illness. These findings may enhance the diagnostic evaluation of patients with extreme ESR elevations.

Laser-induced changes of in vitro erythrocyte sedimentation rate

The study of the effects of low-level laser (LLL) radiation on blood is important for elucidating the mechanisms behind the interaction of LLL radiation and biologic tissues. Different therapy methods that involve blood irradiation have been developed and used for clinical purposes with beneficial effects. The aim of this study was to compare the effects of different irradiation protocols using a diode-pumped solid-state LLL (λ = 405 nm) on samples of human blood by measuring the erythrocyte sedimentation rate (ESR). Human blood samples were obtained through venipuncture into tubes containing EDTA as an anticoagulant. Every sample was divided into two equal aliquots to be used as an irradiated sample and a non-irradiated control sample. The irradiated aliquot was subjected to a laser beam with a wavelength of 405 nm and an energy density of 72 J/cm². The radiation source had a fixed irradiance of 30 mW/cm². The ESR change was observed for three different experimental protocols: irradiated whole blood, irradiated red blood cells (RBCs) samples re-suspended in non-irradiated blood plasma, and non-irradiated RBCs re-suspended in irradiated blood plasma. The ESR values were measured after laser irradiation and compared with the non-irradiated control samples. Irradiated blood plasma in which non-radiated RBCs were re-suspended was found to result in the largest ESR decrease for healthy human RBCs, 51%, when compared with RBCs re-suspended in non-irradiated blood plasma. The decrease in ESR induced by LLL irradiation of the plasma alone was likely related to changes in the plasma composition and an increase in the erythrocyte zeta potential upon re-suspension of the RBCs in the irradiated blood plasma.

The Clinical Significance of Increased Serum Proinflammatory Cytokines, C-Reactive Protein, and Erythrocyte Sedimentation Rate in Patients with Hidradenitis Suppurativa

Objectives

To assess inflammatory serum markers including serum proinflammatory cytokines, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) according to the clinical inflammatory activity of patients with hidradenitis suppurativa (HS).

Patients and Methods

Seventy-four patients with HS were studied based on the Hidradenitis Suppurativa-Physician Global Assessment (HS-PGA) score and Hurley staging system. Proinflammatory cytokines were measured using a multiplex cytokine assay. Twenty-two healthy volunteers were recruited.

Results

Serum interleukin- (IL-) 6, IL-23, soluble tumour necrosis factor alpha (TNF-α) receptor I (sTNF-RI), CRP, and ESR were different in the patients with HS compared with those in the healthy controls (P < 0.05). The levels of IL-1β, IL-6, IL-8, IL-10, IL-12p70, IL-17A, sTNF-RII, CRP, and ESR were significantly elevated according to inflammatory activity based on HS-PGA scores (r > 0.25, P < 0.05). The levels of IL-6 (r = 0.53, P < 0.001), CRP (r = 0.54, P < 0.001), and ESR (r = 0.60, P < 0.001) were especially well correlated with clinical inflammatory activity based on HS-PGA scores. The levels of IL-6, IL-8, sTNF-RI, sTNF-RII, CRP, and ESR were significantly elevated according to Hurley staging system.

Conclusions

Serum proinflammatory cytokines, CRP, and ESR are increased in relation to the clinical inflammatory activity of patients with HS compared with healthy controls. Serum IL-6, CRP, and ESR are effective biomarkers for evaluating the severity of HS.

Higher levels of matrix metalloproteinase-3 in patients with RA reflect disease activity and structural damage

AIMS

To evaluate the serum levels of matrix metalloproteinase-3 (MMP-3) as a potential marker of disease activity and joint damage in 92 patients with rheumatoid arthritis (RA), compared to 24 osteoarthritis (OA) patients and 26 healthy controls.

METHODS

The concentrations of MMP-3 were measured by ELISA using the commercial kit AESKULISA DF MMP-3 (AESKU.Diagnostics, Germany) and compared with other laboratory parameters routinely used to assess the disease status, clinical score (DAS28) and radiographic stage in the group of RA patients.

RESULTS

The mean serum concentrations of MMP-3 were 199.1 ± 160 ng/mL in RA patients, 113.9 ± 96.9 ng/mL in OA patients and 48.3 ± 19.2 in healthy controls. The differences were highly significant: RA patients and healthy controls (P<0.0001), RA and OA patients (P=0.008) as well as between OA patients and controls (P=0.009). MMP-3 concentrations were further compared with other laboratory parameters and clinical and structural damage data. There were correlations between MMP-3 and CRP (r=0.304, P<0.01), DAS28 (r=0.301, P<0.05), levels of anti-cyclic citrullinated peptide antibodies (r=0.241, P<0.05), erythrocyte sedimentation rate (r=0.200, P=0.059) and radiographic disease stage (r=0.197, P=0.063).

CONCLUSION

These results demonstrated that measurement of MMP-3 could become a marker of disease activity in RA patients.

A portable microfluidic system for rapid measurement of the erythrocyte sedimentation rate

The erythrocyte sedimentation rate (ESR) is a frequently used 30 min or 60 min clinical test for screening of several inflammatory conditions, infections, trauma, and malignant diseases, as well as non-inflammatory conditions including prostate cancer and stroke. Erythrocyte aggregation (EA) is a physiological process where erythrocytes form face-to-face linear structures, called rouleaux, at stasis or low shear rates. In this work, we proposed a method for ESR measurement from EA. We developed a microfluidic opto-electro-mechanical system, using which we experimentally showed a significant correlation (R² = 0.86) between ESR and EA. The microfluidic system was shown to measure ESR from EA using fingerprick blood in 2 min. 40 μl of whole blood is filled in a disposable polycarbonate cartridge which is illuminated with a near infrared emitting diode. Erythrocytes were disaggregated under the effect of a mechanical shear force using a solenoid pinch valve. Following complete disaggregation, transmitted light through the cartridge was measured using a photodetector for 1.5 min. The intensity level is at its lowest at complete disaggregation and highest at complete aggregation. We calculated ESR from the transmitted signal profile. We also developed another microfluidic cartridge specifically for monitoring the EA process in real-time during ESR measurement. The presented system is suitable for ultrafast, low-cost, and low-sample volume measurement of ESR at the point-of-care.

Erythrocyte sedimentation rate of human blood exposed to low-level laser

This study is designed to investigate in vitro low-level laser (LLL) effects on rheological parameter, erythrocyte sedimentation rate (ESR), of human blood. The interaction mechanism between LLL radiation and blood is unclear. Therefore, research addresses the effects of LLL irradiation on human blood and this is essential to understanding how laser radiation interacts with biological cells and tissues. The blood samples were collected through venipuncture into EDTA-containing tubes as an anticoagulant. Each sample was divided into two equal aliquots to be used as a non-irradiated sample (control) and an irradiated sample. The aliquot was subjected to doses of 36, 54, 72 and 90 J/cm(2) with wavelengths of 405, 589 and 780 nm, with a radiation source at a fixed power density of 30 mW/cm(2). The ESR and red blood cell count and volume are measured after laser irradiation and compared with the non-irradiated samples. The maximum reduction in ESR is observed with radiation dose 72 J/cm(2) delivered with a 405-nm wavelength laser beam. Moreover, no hemolysis is observed under these irradiation conditions. In a separate protocol, ESR of separated RBCs re-suspended in irradiated plasma (7.6 ± 2.3 mm/h) is found to be significantly lower (by 51 %) than their counterpart re-suspended in non-irradiated plasma (15.0 ± 3.7 mm/h). These results indicate that ESR reduction is mainly due to the effects of LLL on the plasma composition that ultimately affect whole blood ESR.

Acute Phase Reactants in Infections: Evidence-Based Review and a Guide for Clinicians

There is increasing evidence to support the role of various acute phase reactants as an adjunct to clinical judgement in the management of various infections. Procalcitonin is more specific in diagnosing bacterial infections and has a wider role in the management of complex infections. Procalcitonin based antibiotic guidance is helpful in antibiotic management in patients with pneumonia and sepsis

Acute-phase reactants such as erythrocyte sedimentation rate and C-reactive protein have traditionally been used as markers for inflammation and as a measure of “sickness index” in infectious and noninfectious conditions. In the last decade, more data have become available on the wider and more specific role for these markers in the management of complex infections. This includes the potential role in early diagnosis, in differentiating infectious from noninfectious causes, as a prognostic marker, and in antibiotic guidance strategies. A better defined role for biological markers as a supplement to clinical assessment may lead to more judicious antibiotic prescriptions, and it has the potential for a long-term favorable impact on antimicrobial stewardship and antibiotic resistance. Procalcitonin as a biological marker has been of particular interest in this regard. This review examines the current published evidence and summarizes the role of various acute-phase markers in infections. A MEDLINE search of English-language articles on acute-phase reactants and infections published between 1986 and March 2015 was conducted. Additional articles were also identified through a search of references from the retrieved articles, published guidelines, systematic reviews, and meta-analyses.

Estrogen deprivation does not affect vascular heat shock response in female rats: a comparison with oxidative stress markers

Hot flashes, which involve a tiny rise in core temperature, are the most common complaint of peri- and post-menopausal women, being tightly related to decrease in estrogen levels. On the other hand, estradiol (E2) induces the expression of HSP72, a member of the 70 kDa family of heat shock proteins (HSP70), which are cytoprotective, cardioprotective, and heat inducible. Since HSP70 expression is compromised in age-related inflammatory diseases, we argued whether the capacity of triggering a robust heat shock (HS) response would be still present after E2 withdrawal. Hence, we studied the effects of HS treatment (hot tub) in female Wistar rats subjected to bilateral ovariectomy (OVX) after a 7-day washout period. Twelve h after HS, the animals were killed and aortic arches were surgically excised for molecular analyses. The results were compared with oxidative stress markers in the plasma (superoxide dismutase, catalase, and lipoperoxidation) because HSP70 expression is also sensitive to redox regulation. Extracellular (plasma) to intracellular HSP70 ratio, an index of systemic inflammatory status, was also investigated. The results showed that HS response was preserved in OVX animals, as inferred from HSP70 expression (up to 40% rise, p < 0.01) in the aortas, which was accompanied by no further alterations in oxidative stress, hematological parameters, and glycemic control either. This suggests that the lack of estrogen per se could not be solely ascribed as the unique source of low HSP70 expression as observed in long-term post-menopausal individuals. As a consequence, periodic evaluation of HSP70 status (iHSP70 vs. eHSP70) may be of clinical relevance because decreased HS response capacity is at the center of the onset of menopause-related dysfunctions.

How to use the erythrocyte sedimentation rate in paediatrics

The erythrocyte sedimentation rate (ESR) has become a ubiquitously used technique in medicine as a marker of systemic illness. The test involves placing anticoagulated whole blood into an upright test tube and monitoring the rate at which red blood cells (RBC) fall over time. Negative charges keep RBC from sticking together. If this charge is neutralised, RBC stack into chains, or rouleaux, and fall more rapidly. ESR can be measured with a variety of tests: Westergren and modified Westergren; Wintrobe; micro-ESR. The Westergren is the most commonly used method of performing the ESR. Technical factors, such as temperature, time from specimen collection, tube orientation and vibration, can affect the results. RBC size, shape and concentration impact the ESR. Plasma characteristics are also important determinants of the ESR. Other factors that can change ESR include age, sex, race, medications and disease states, such as obesity, hypofibrinogenaemia and congestive heart failure. Other acute-phase reactants besides the ESR include C-reactive protein, fibrinogen, complement, ferritin, plasma viscosity, serum amyloid A and albumin. When clinical suspicion for infection or inflammation is low, a normal ESR can reassure that there is no active disease. The slow rise (48 h) and fall of the ESR relative to other acute-phase reactants may make it superior for monitoring inflammation in more chronic conditions. In conjunction with physical findings and other laboratory values, the ESR value can be used to screen for disease or disease complications, aid in disease diagnosis or assess disease activity or response to therapy.

Clinical significance of prognosis using the neutrophil-lymphocyte ratio and erythrocyte sedimentation rate in patients undergoing radical nephroureterectomy for upper urinary tract urothelial carcinoma

OBJECTIVES

To evaluate the clinical significance of preoperative erythrocyte sedimentation rate (ESR) and neutrophil-lymphocyte ratio (NLR) as prognostic factors in patients undergoing radical nephroureterectomy for upper tract urothelial carcinoma (UTUC).

PATIENTS AND METHODS

A total of 410 patients were retrospectively reviewed. An elevated NLR was defined as ≥2.5 and a normal ESR was considered to be in the range of 0-22 mm/h in men and 0-27 mm/h in women. Patients were divided into three groups: those with ESR and NLR in the normal range (group 0, n = 168), those with either elevated ESR or elevated NLR (group I, n = 169), and those with both elevated ESR and elevated NLR (group II, n = 73).

RESULTS

The median patient age was 64 years and the median follow-up duration was 40.2 months. In all, 35.6 and 41.2% of patients had elevated NLRs and ESRs, respectively. Group II was associated with advanced tumour status in terms of size, grade, stage, lymph node and margin status (P < 0.05). Preoperative ESR (hazard ratio [HR] 1.784, 95% confidence interval [CI] 1.173-2.712), NLR (HR 1.704, 95% CI 1.136-2.556), and prognostic grouping (HR 2.285, 95% CI 1.397-3.737 for group I; HR 2.962, 95% CI 1.719-5.102 for group II) were independent predictors of progression-free survival (PFS) in the multivariate model (P < 0.05). Prognostic grouping was also an independent prognostic factor for cancer-specific survival (CSS) and overall survival (OS). Time-dependent area under the receiver-operating characteristic curves showed that NLR plus ESR had a greater diagnostic value than NLR alone regarding oncological outcomes (P < 0.05).

CONCLUSIONS

Prognostic grouping using ESR and NLR was identified as an independent prognostic marker in patients with UTUC. The addition of ESR improved the prognostic value of NLR alone in predicting oncological outcomes. The combination of preoperative ESR and NLR might be a new prediction tool in patients with UTUC after radical nephroureterectomy.

Serum C-reactive protein level and distribution in chronic obstructive pulmonary disease versus healthy controls: a case-control study from Iran

Inflammation has a contributive role in the development and progression of chronic obstructive pulmonary disease (COPD).The present study was designed to determine the level and the distribution of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) in COPD compared with controls. Ninety patients with COPD presented to an outpatient hospital clinic and 50 controls who were selected among personals of the same hospital entered the study. Serum high sensitive CRP (hs-CRP) was measured by immunoturbidimetric method and the ESR by Westergren method. Receiver operating characteristic curve was applied to determine a cutoff point for differentiation of the COPD and control group. In statistical analysis, the patients and controls were compared regarding levels and distribution of hs-CRP and ESR. Mean age of patients and controls was 67 ± 11.6 and 51.3 ± 6.7 years, respectively (p = 0.001). Mean hs-CRP was significantly higher (4.76 ± 5.6 vs 1.72 ± 1.68 mg/L, p = 0.001) but mean ESR was nonsignificantly higher (9.1 ± 11.2 vs 7.2 ± 7.4 m/h, p = 0.95) in patients than control. Serum hs-CRP at 1.55 mg/L, differentiated patients and controls at sensitivity of 77.3 % and specificity of 60 %. Serum hs-CRP >3 mg/L was observed in 39 (44.3 %) patients and 9 (18 %) controls (p = 0.001) and >6 mg/L in 22 (25 %) patients and 2 (4 %) controls (p = 0.001).Serum hs-CRP was significantly correlated with ESR in patient but not in control group (Spearman correlation coefficient = 0.516, p = 0.001). Serum hs-CRP and ESR was not correlated with age, weigh, smoking, and the severity of COPD. The results of this study indicated a systemic inflammatory process in COPD. Since inflammation has an important contribution in development of future pulmonary and extrapulmonary complications, serum CRP assessment will provide additional information beyond that achieved by conventional method of pulmonary function test.

IVIG Effects on Erythrocyte Sedimentation Rate in Children

Background. Erythrocyte sedimentation rate (ESR) is a valuable laboratory tool in evaluation of infectious, inflammatory, and malignant diseases. Red blood cells in outside from the body precipitate due to their higher density than the plasma. In this study we discuss the IVIG effect on ESR in different diseases and different ages. Methods and Materials. Fifty patients under 12 years old who had indication to receive IVIG enrolled in this study. Total dose of IVIG was 2 gr/kg (400 mg/kg in five days or 2 gr/kg in single dose). ESR before infusion of IVIG and within 24 hours after administration of the last dose of IVIG was checked. Results. 23 (46%) patients were males and 27 (54%) were females. The mean of ESR before IVIG was 31.8 ± 29.04 and after IVIG it was 47.2 ± 36.9; this difference was meaningful (P = 0.05). Results of ESR changes in different age groups, 6 patients less than 28 days, 13 patients from 1 month to 1 year, 20 patients from 1 to 6 years old, and 11 patients from 6 to 12 years have been meaningful (P = 0.001, P = 0.025, and P = 0.006, resp.). Conclusion. In patients who are receiving IVIG as a therapy, ESR increased falsely (noninflammatory rising); therefore use of ESR for monitoring of response to treatment may be unreliable. Although these results do not apply to neonatal group, we suggest that, in patients who received IVIG, interpretation of ESR should be used cautiously on followup.

Different subsets of macrophages in patients with new onset tuberculous pleural effusion

OBJECTIVE

Macrophages are the infiltrate components of tuberculous pleural effusion (TPE). This study is aimed at examining the role of different subsets of macrophages in pleural fluid (PF) and peripheral blood (PB) from patients with new onset TPE.

METHODS

The numbers of PB and PF CD163(+), CD206(+) and CD115(+) macrophages in 25 patients with new onset TPE and 17 healthy controls (HC) were determined by flow cytometry. The concentrations of serum and PF cytokines were determined by cytometric bead array (CBA) and enzyme-linked immunosorbentassay (ELISA). The potential association between the numbers of different subsets of macrophages and the values of clinical measures in TPE patients were analyzed.

RESULTS

The numbers of PB CD14(+)CD163(-) M1-like and CD14(+)CD163(-) interleukin (IL)-12(+) M1 macrophages were significantly higher than that in the HC, but lower than PF, and the numbers of PF CD14(+)CD163(+), CD14(+)CD163(+)CD206(+), CD14(+)CD163(+)CDll5(+) M2-like, and CD14(+)CD163(+)IL-10(+) M2 macrophages were less than PB in the TPE patients. The levels of serum IL-1, IL-6, IL-8, IL-12, tumor growth factor (TGF)-β1, and tumor necrosis factor (TNF)-α in the TPE patients were significantly higher than that in the HC, but lower than that in the PF. The levels of PF IL-10 were significantly higher than that in the PB of patients and HC. In addition, the levels of serum IL-12 and TNF-α were correlated positively with the values of erythrocyte sedimentation rate (ESR) and the numbers of ESAT-6- and culture filtrate protein 10 (CFP-10)-specific IFN-γ-secreting T cells, and the levels of PF TNF-α were correlated positively with the levels of PF adenosine deaminase (ADA) and lactate dehydrogenase (LDH) in those patients.

CONCLUSION

Our data indicate that Mycobacterium tuberculosis (M. tb) infection induces M1 predominant pro-inflammatory responses, contributing to the development of TPE in humans.

Increased serum procalcitonin levels in pregnant patients with asymptomatic bacteriuria

Background

Among the pregnancy urinary tract infections, asymptomatic bacteriuria (ASB) is the most common one. Untreated ASB can progress to pyelonephritis in 30-50% of the patients and can also result in prematurity in 27% of the pregnancy so it needs immediate diagnosis and treatment. In this study, we wanted to evaluate procalcitonin levels, compared to other inflammatory in pregnant women with ASB.

Methods

The study was designed between the period of January 2012 and February 2013 at Sakarya University School of Medicine, Department of Gynecology and Obstetrics. The study population included 30 pregnant patients with asymptomatic bacteriuria and 39 healthy pregnant controls.

Results

Mean age was 28 (SD, 5.5) of the study population; mean maternal weight was 70 (SD, 8) kilogram. There were no statically significant differences between the groups according to the routine biochemical parameters, but gestational age was significantly lower in the ASB group compared to the controls (20.4 vs 28.6, respectively; p < 0.001). Serum procalcitonin levels were negative in all of the controls. In ASB group, 9 (30%) patients had procalcitonin levels greater than >0.05 ng/ml and 21(70%) patients had negative procalcitonin levels (Chi-squrae, p < 0.001). The sensitivity and specificity of procalcitonin assay for ASB was calculated as 30% and 100%, respectively. The positive predictive value was 100% and the negative predictive value was 65%. The most frequent microorganisms in the urine culture were Escherichia coli (26 patients, 87%), Proteus mirabilis (3 patients, 10%) and Klebsiella (1 patient, 3%) in the ASB group. We experienced four (44%) recurrences among nine positive procalcitonin in ASB patients after completion of treatment of the first ASB diagnosis.

Discussion

Procalcitonin levels were significantly higher in ASB group than the control group and serum procalcitonin levels were higher in pregnant women with recurrent ASB. This finding is an important result revealed that high procalcitonin level can predict the further urinary tract infection risk. Finally, serum procalcitonin levels were normal in healthy pregnant women while other inflammatory markers such as WBC, ESR and CRP levels were higher.

Effect of exposure to solid wastes in relation to employment duration on some important markers of health and disease in waste management workers of Ogun State in southwest Nigeria

Waste management workers (WMWs) around the world are at risk of work-related health disorders. The influence of employment duration on individuals occupationally exposed to solid waste was investigated in this study. The study comprised (n = 280) 180 WMWs and 100 controls. Employment duration was obtained from questionnaire survey and categorized into three groups: group I (0.5-2 years), group II (>2-4 years) and group III (>4-6 years). Blood sample (10 ml) was collected from the antecubital vein of subjects for analysis. WMWs exhibited significantly (p < 0.001) elevated inflammatory markers (erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and ceruloplasmin (Cp)) relative to control. While Cp increased, ESR and CRP decreased with increasing WMWs' employment duration. Alteration in oxidant/antioxidant markers was characterized by significant (p < 0.001) decrease in ferric-reducing ability of plasma (FRAP) and catalase activity together with marked (p < 0.01) elevation of thiobarbituric acid reactive substances (TBARS) and uric acid (UA). TBARS, UA and FRAP increased while catalase decreased with WMWs' employment duration. In addition, WMWs exhibited significantly (p < 0.01) elevated immunoglobulin A (IgA) and IgG, which also increased and decreased, respectively, with job duration. The significantly (p < 0.01) decreased haemoglobin and haematocrit levels as well as the significantly (p < 0.001) elevated total leukocytes in WMWs increased with employment duration. Alanine aminotransferase increased and albumin decreased significantly (p < 0.05) in WMWs, and these changes also increased and decreased, respectively, with job duration. Data suggest that levels of alteration of important systemic markers of health/disease are related to WMWs' employment or exposure duration.

High-sensitivity C-reactive protein and erythrocyte sedimentation rate in systemic lupus erythematosus

Levels of C-reactive protein (CRP) have been shown to rise in acute illnesses such as infections and some autoimmune diseases, but not in flares of systemic lupus erythematosus (SLE). Our goal was to investigate the high-sensitivity CRP (hsCRP) response to infection versus disease flare in patients with SLE, and to compare this with the erythrocyte sedimentation rate (ESR) response in these patients. We aimed to determine the hsCRP level that distinguishes between infection and flare in SLE, and investigated the correlation between hsCRP and organ involvement in SLE. We reviewed electronic medical records of all patients with SLE admitted to Cedars Sinai Medical Center between 28 August 2001 and 27 April 2008. Patients were divided into three groups based on the reason for hospitalization: 1) lupus flare; 2) active infection; and 3) both lupus flare and active infection. Data were collected on patient demographics, medication use, microbial culture results, organ involvement in lupus flare, ESR and CRP levels. Data were collected on 85 eligible patients, of whom 54 had a lupus flare, 22 had active infection and eight had both. While the ESR levels did not differ significantly between patients with disease flare and active infection, the hsCRP level was significantly lower in the lupus flare group than in the infection group. Most patients in the lupus flare group who had a significantly high hsCRP level had serositis. We found that at a cut-off of above 5 mg/dl, hsCRP level was correlated with infection with a specificity of 80%. At a cut-off of above 6 mg/dl, hsCRP correlated with infection with a specificity of 84%. hsCRP level was found to be significantly higher in patients with pulmonary involvement than without. hsCRP levels are significantly lower in SLE patients with disease flare than in those with active infection. Elevated hsCRP levels can be used as a predictor of active infection in SLE patients with a high specificity. We review the relationship between IL-6 and hsCRP production in lupus patients.

Shortened erythrocyte sedimentation rate evaluation is applicable to hospitalised patients

BACKGROUND

Westergren method, commonly used for erythrocyte sedimentation rate (ESR) determination, is simple and inexpensive. However, the 60 min required for the test are disadvantageous, especially for those departments/facilities where prompt evaluation is necessary. We investigated the possibility that earlier ESR recordings might correlate with standard 60-minute ESR and/or be predictive of the latter.

METHODS

Demographic and clinical data were collected from 220 randomly chosen adult patients hospitalised for various diseases in a medical department. ESR, determined by slightly modified Westergren method, was recorded at 15, 30 and 60 min. Correlation coefficients (r) between the standard and early ESR measurements were calculated for the entire group and for the separate subgroups divided according to patient age, sex and presence of anaemia or of inflammation.

RESULTS

Mean+/-SD age of the patients was 61.3+/-19.6, 55% were males; 45% had some inflammatory condition. Mean+/-SD ESR values (mm) at 15, 30 and 60 min were 9.0+/-12.1, 21.4+/-21.8 and 35.9+/-27.5, respectively. A statistically significant correlation was found between ESR measurements at 15 and 60 min (r=0.833, p<0.001). However, the strongest correlation was observed between 30 and 60 min measurements (r=0.926, p<0.001), irrespective of age, sex and presence of anaemia or of inflammation. Based on the ESR determination at 30 min (X), the predicted ESR value at 60 min (Y) could be calculated by a simple equation: Y=10.7+1.2X.

CONCLUSION

Sixty-minute ESR values can be predicted by the 30-minute estimation. Shortening the test by half an hour might bear practical importance.

Surgical treatment of intrathoracic hydatid disease: a 5-year experience in an endemic region

PURPOSE

To present our recent surgical experience in treating patients with intrathoracic hydatidosis.

METHODS

This study reviewed the files of patients with pulmonary/intrathoracic extrapulmonary hydatid cysts treated surgically between 2003 and 2009. Demographic, laboratory and radiological data, clinical manifestations, site of the cyst, surgical approaches, and final outcome were noted and analyzed.

RESULTS

Forty patients underwent 42 operations (21 females, 19 males, mean age 36 years). Thirty-six patients (90%) had pulmonary (56.7% were intact/uncomplicated), three (7.5%) had intrathoracic extrapulmonary, and one (2.5%) had both pulmonary/intrathoracic extrapulmonary hydatid cysts. The right lung was involved in 64.9%. Larger pulmonary cysts ruptured more commonly (P = 0.007). Most patients (95%) were symptomatic, mostly dyspneic (72.5%). The mean forced expiratory volume in 1 s value was significantly reduced in cases with a large (P < 0.0001), or ruptured cyst (P = 0.05). The erythrocyte sedimentation rate was elevated in case of rupture (P = 0.05). A thoracotomy was performed for all patients. A cystotomy and capitonnage was performed more commonly than cystotomy without capitonnage for the pulmonary, and total excision was performed for the intrathoracic extrapulmonary hydatid cysts. The mortality was 0% and the morbidity was 17.5%. All patients received antihelminthic therapy postoperatively. There was no recurrence.

CONCLUSION

Surgery is considered to be the optimal treatment for intrathoracic hydatid disease. In addition, recurrence is very low when all such patients receive postoperative antihelminthic therapy.

Inflammatory laboratory markers in periprosthetic hip fractures

The purpose of this study was to determine the prevalence of increased inflammatory laboratory markers in patients with periprosthetic fractures. We also studied the likelihood of the elevation of these values in predicting deep prosthetic joint infection. From 2000 to 2006, 204 patients with periprosthetic hip fractures were treated at our institution. Patients had white blood cell, erythrocyte sedimentation rate, and C-reactive protein obtained on initial evaluation; these were then compared with subsequent hip aspiration, surgical pathology, and deep cultures obtained at the time of revision surgery. A true infection was diagnosed in 11.6%. White blood cell count was increased in 16.2%, erythrocyte sedimentation rate increased in 33.3%, and C-reactive protein increased in 50.5%. The positive elaborate predictive value for these markers for infection was poor (18%, 21%, and 29%, respectively). These findings suggest that increased inflammatory laboratory values in patients with periprosthetic fracture are not good indicators for deep periprosthetic infection and do not necessarily warrant additional evaluations before definitive surgical treatment.

Autoantibodies to Tumor Necrosis Factor in Patients with Rheumatoid Arthritis and Systemic Lupus Erythematosus

Objective.

To detect autoantibodies to tumor necrosis factor (TNF) in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), and to determine their clinical correlates.

Methods.

Ninety-two patients with RA and 62 with SLE were studied. Sera were examined for autoantibodies to TNF by enzyme linked immunoassay. Levels of these autoantibodies were analyzed in respect to markers of inflammation such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and joint erosions, as well as other clinical, laboratory, and therapeutic aspects of RA and SLE.

Results.

Anti-TNF levels were higher in those RA patients without erosions, but did not correlate with ESR or CRP.

Conclusion.

These observations suggest that autoantibody anti-TNF may be part of the innate immune system and may contribute to decreased inflammation in patients with RA.