Preoperative blood markers and intra-abdominal infection after colorectal cancer resection

BACKGROUND Colorectal cancer(CRC)has one of the highest morbidity and mortality rates among digestive tract tumors.Intra-abdominal infection(IAI)is a common postoperative complication that affects the clinical outcomes of patients with CRC and hinders their rehabilitation process.However,the factors influencing abdominal infection after CRC surgery remain unclear;further,prediction models are rarely used to analyze preoperative laboratory indicators and postoperative complications.AIM To explore the predictive value of preoperative blood markers for IAI after radical resection of CRC.METHODS The data of 80 patients who underwent radical resection of CRC in the Anorectal Surgery Department of Suzhou Hospital affiliated with Anhui Medical University were analyzed.These patients were categorized into IAI(n=15)and non-IAI groups(n=65)based on whether IAI occurred.Influencing factors were compared;general data and laboratory indices of both groups were identified.The relationship between the indicators was assessed.Further,a nomogram prediction model was developed and evaluated;its utility and clinical applic-ability were assessed.RESULTS The risk factors for IAI after radical resection of CRC were neutrophil-lymphocyte ratio(NLR),platelet-lymphocyte ratio(PLR),systemic immune-inflammation index(SII),and carcinoembryonic antigen(CEA)levels.NLR was correlated with PLR and SII(r=0.604,0.925,and 0.305,respectively),while PLR was correlated with SII(r=0.787).The nomogram prediction model demonstrated an area under the curve of 0.968[95%confidence interval(CI):0.948-0.988]in the training set(n=60)and 0.926(95%CI:0.906-0.980)in the validation set(n=20).The average absolute errors of the calibration curves for the training and validation sets were 0.032 and 0.048,respectively,indicating a good model fit.The decision curve analysis curves demonstrated high net income above the 5%threshold,indicating the clinical practicality of the model.CONCLUSION The nomogram model constructed using NLR,PLR,SII,and CEA levels had good accuracy and reliability in predicting IAI after radical resection of CRC,potentially aiding clinical treatment decision-making.

Effects of exercise training on glucose metabolism indicators and inflammatory markers in obese children and adolescents:A metaanalysis

BACKGROUND Obesity in children and adolescents is a serious problem,and the efficacy of exercise therapy for these patients is controversial.AIM To assess the efficacy of exercise training on overweight and obese children based on glucose metabolism indicators and inflammatory markers.METHODS The PubMed,Web of Science,and Embase databases were searched for randomized controlled trials related to exercise training and obese children until October 2023.The meta-analysis was conducted using RevMan 5.3 software to evaluate the efficacy of exercise therapy on glucose metabolism indicators and inflammatory markers in obese children.RESULTS In total,1010 patients from 28 studies were included.Exercise therapy reduced the levels of fasting blood glucose(FBG)[standardized mean difference(SMD):-0.78;95%confidence interval(CI):-1.24 to-0.32,P=0.0008],fasting insulin(FINS)(SMD:-1.55;95%CI:-2.12 to-0.98,P<0.00001),homeostatic model assessment for insulin resistance(HOMA-IR)(SMD:-1.58;95%CI:-2.20 to-0.97,P<0.00001),interleukin-6(IL-6)(SMD:-1.31;95%CI:-2.07 to-0.55,P=0.0007),C-reactive protein(CRP)(SMD:-0.64;95%CI:-1.21 to-0.08,P=0.03),and leptin(SMD:-3.43;95%CI:-5.82 to-1.05,P=0.005)in overweight and obese children.Exercise training increased adiponectin levels(SMD:1.24;95%CI:0.30 to 2.18,P=0.01)but did not improve tumor necrosis factor-alpha(TNF-α)levels(SMD:-0.80;95%CI:-1.77 to 0.18,P=0.11).CONCLUSION In summary,exercise therapy improves glucose metabolism by reducing levels of FBG,FINS,HOMA-IR,as well as improves inflammatory status by reducing levels of IL-6,CRP,leptin,and increasing levels of adiponectin in overweight and obese children.There was no statistically significant effect between exercise training and levels of TNF-α.Additional long-term trials should be conducted to explore this therapeutic perspective and confirm these results.

Predictive model for non-malignant portal vein thrombosis associated with cirrhosis based on inflammatory biomarkers

BACKGROUND Portal vein thrombosis(PVT),a complication of liver cirrhosis,is a major public health concern.PVT prediction is the most effective method for PVT diagnosis and treatment.AIM To develop and validate a nomogram and network calculator based on clinical indicators to predict PVT in patients with cirrhosis.METHODS Patients with cirrhosis hospitalized between January 2016 and December 2021 at the First Hospital of Lanzhou University were screened and 643 patients with cirrhosis who met the eligibility criteria were retrieved.Following a 1:1 propensity score matching 572 patients with cirrhosis were screened,and relevant clinical data were collected.PVT risk factors were identified using the least absolute shrinkage and selection operator(LASSO)and multivariate logistic regression analysis.Variance inflation factors and correlation matrix plots were used to analyze multicollinearity among the variables.A nomogram was constructed to predict the probability of PVT based on independent risk factors for PVT,and its predictive performance was verified using a receiver operating characteristic curve(ROC),calibration curves,and decision curve analysis(DCA).Finally,a network calculator was constructed based on the nomograms.RESULTS This study enrolled 286 cirrhosis patients with PVT and 286 without PVT.LASSO analysis revealed 13 variables as strongly associated with PVT occurrence.Multivariate logistic regression analysis revealed nine indicators as independent PVT risk factors,including etiology,ascites,gastroesophageal varices,platelet count,D-dimer,portal vein diameter,portal vein velocity,aspartate transaminase to neutrophil ratio index,and platelet-to-lymphocyte ratio.LASSO and correlation matrix plot results revealed no significant multicollinearity or correlation among the variables.A nomogram was constructed based on the screened independent risk factors.The nomogram had excellent predictive performance,with an area under the ROC curve of 0.821 and 0.829 in the training and testing groups,respectively.Calibration curves and DCA revealed its good clinical performance.Finally,the optimal cutoff value for the total nomogram score was 0.513.The sensitivity and specificity of the optimal cutoff values were 0.822 and 0.706,respectively.CONCLUSION A nomogram for predicting PVT occurrence was successfully developed and validated,and a network calculator was constructed.This can enable clinicians to rapidly and easily identify high PVT risk groups.

Diagnostic significance of complete blood cell count and hemogramderived markers for neonatal sepsis at Southwest Public Hospitals,Ethiopia

BACKGROUND Neonatal sepsis is defined as an infection-related condition characterized by signs and symptoms of bacteremia within the first month of life.It is the leading cause of mortality and morbidity among newborns.While several studies have been conducted in other parts of world to assess the usefulness of complete blood count parameters and hemogram-derived markers as early screening tools for neonatal sepsis,the associations between sepsis and its complications with these blood parameters are still being investigated in our setting and are not yet part of routine practice.AIM To evaluate the diagnostic significance of complete blood cell count hemogramderived novel markers for neonatal sepsis among neonates attending public hospitals in the southwest region of Oromia,Ethiopia,through a case control study.METHODS A case control study was conducted from October 2021 to October 2023 Sociodemographic,clinical history,and laboratory test results data were collected using structured questionnaires.The collected data were entered into Epi-data 3.1 version and exported to SPSS-25 for analysis.Chi-square,independent sample ttest,and receiver operator characteristics curve of curve were used for analysis.A P-value of less than 0.05 was considered statistically significant.RESULTS In this study,significant increases were observed in the following values in the case group compared to the control group:In white blood cell(WBC)count,neutrophils,monocyte,mean platelet volume(MPV),neutrophils to lymphocyte ratio,monocyte to lymphocyte ratio(MLR),red blood cell width to platelet count ratio(RPR),red blood width coefficient variation,MPV to RPR,and platelet to lymphocyte ratio.Regarding MLR,a cut-off value of≥0.26 was found,with a sensitivity of 68%,a specificity of 95%,a positive predictive value(PPV)of 93.2%,and a negative predictive value(NPV)of 74.8%.The area under the curve(AUC)was 0.828(P<0.001).For WBC,a cutoff value of≥11.42 was identified,with a sensitivity of 55%,a specificity of 89%,a PPV of 83.3%,and a NPV of 66.4%.The AUC was 0.81(P<0.001).Neutrophils had a sensitivity of 67%,a specificity of 81%,a PPV of 77.9%,and a NPV of 71.1%.The AUC was 0.801,with a cut-off value of≥6.76(P=0.001).These results indicate that they were excellent predictors of neonatal sepsis diagnosis.CONCLUSION The findings of our study suggest that certain hematological parameters and hemogram-derived markers may have a potential role in the diagnosis of neonatal sepsis.

Comparative analysis of Nε-carboxymethyl-lysine and inflammatory markers in diabetic and non-diabetic coronary artery disease patients

BACKGROUND Coronary artery disease(CAD)is a major cause of death worldwide,and India contributes to about one-fifth of total CAD deaths.The development of CAD has been linked to the accumulation of Nε-carboxymethyl-lysine(CML)in heart muscle,which correlates with fibrosis.AIM To assess the impact of CML and inflammatory markers on the biochemical and cardiovascular characteristics of CAD patients with and without diabetes.METHODS We enrolled 200 consecutive CAD patients who were undergoing coronary angiography and categorized them into two groups based on their serum glycosylated hemoglobin(HbA1c)levels(group I:HbA1c≥6.5;group II:HbA1c<6.5).We analyzed the levels of lipoproteins,plasma HbA1c levels,CML,interleukin-6(IL-6),tumor necrosis factor alpha(TNF-α),and nitric oxide.RESULTS Group I (81 males and 19 females) patients had a mean age of 54.2 ± 10.2 years, with a mean diabetes duration of4.9 ± 2.2 years. Group II (89 males and 11 females) patients had a mean age of 53.2 ± 10.3 years. Group I had moresevere CAD, with a higher percentage of patients with single vessel disease and greater stenosis severity in the leftanterior descending coronary artery compared to group II. Group I also exhibited a larger left atrium diameter.Group I patients exhibited significantly higher levels of CML, TNF-α, and IL-6 and lower levels of nitric oxide ascompared with group II patients. Additionally, CML showed a significant positive correlation with IL-6 (r = 0.596,P = 0.001) and TNF-α (r = 0.337, P = 0.001) and a negative correlation with nitric oxide (r=-4.16, P = 0.001). Oddsratio analysis revealed that patients with CML in the third quartile (264.43-364.31 ng/mL) were significantlyassociated with diabetic CAD at unadjusted and adjusted levels with covariates.

Use of inflammatory markers as predictor for mechanical ventilation in COVID-19 patients with stagesⅢb-Ⅴchronic kidney disease?

BACKGROUND Studies have shown elevated C-reactive protein(CRP)to predict mechanical ventilation(MV)in patients with coronavirus disease 2019(COVID-19).Its utility is unknown in patients with chronic kidney disease(CKD),who have elevated baseline CRP levels due to chronic inflammation and reduced renal clearance.AIM To assess whether an association exists between elevated inflammatory markers and MV rate in patients with stagesⅢb-ⅤCKD and COVID-19.METHODS We conducted a retrospective cohort study on patients with COVID-19 and stagesⅢb-ⅤCKD.The primary outcome was the rate of invasive MV,the rate of noninvasive MV,and the rate of no MV.Statistical analyses used unpaired t-test for continuous variables and chi-square analysis for categorical variables.Cutoffs for variables were CRP:100 mg/L,ferritin:530 ng/mL,D-dimer:0.5 mg/L,and lactate dehydrogenase(LDH):590 U/L.RESULTS 290 were screened,and 118 met the inclusion criteria.CRP,D-dimer,and ferritin were significantly different among the three groups.On univariate analysis for invasive MV(IMV),CRP had an odds ratio(OR)-5.44;ferritin,OR-2.8;LDH,OR-7.7;D-dimer,OR-3.9,(P<0.05).The admission CRP level had an area under curve-receiver operator characteristic(AUROC):0.747 for the IMV group(sensitivity-80.8%,specificity-50%)and 0.663 for the non-IMV(NIMV)group(area under the curve,sensitivity-69.2%,specificity-53%).CONCLUSION Our results demonstrate a positive correlation between CRP,ferritin,and D-dimer levels and MV and NIMV rates in CKD patients.The AUROC demonstrates a good sensitivity for CRP levels in detecting the need for MV in patients with stagesⅢb-ⅤCKD.This may be because of the greater magnitude of increased inflammation due to COVID-19 itself compared with increased inflammation and reduced clearance due to CKD alone.

Hyperglycemia in COVID-19 infection without diabetes mellitus:Association with inflammatory markers

BACKGROUND New onset hyperglycemia is common in patients with severe coronavirus disease 2019(COVID-19)infection.Cytokine storm due to COVID-19 infection is an essential etiology for new-onset hyperglycemia,but factors like direct severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)-induced pancreaticβ-cell failure have also been postulated to play a role.AIM We plan to investigate further the mechanisms underlying SARS-CoV-2 infection-induced hyperglycemia,particularly the rationale of the cytokine-induced hyperglycemia hypothesis,by evaluating the association between inflammatory markers and new onset hyperglycemia in non-diabetic patients with COVID-19 infection.METHODS We conducted a retrospective case-control study on adults without diabetes mellitus hospitalized for COVID-19 infection.The serum levels of glucose and inflammatory markers at presentation before initiation of corticosteroid were collected.Hyperglycemia was defined as glucose levels≥140 mg/dL.C-Reactive protein(CRP)≥100 mg/L,ferritin≥530 ng/mL,lactate dehydrogenase(LDH)≥590 U/L,and D-dimer≥0.5 mg/L were considered elevated.We used theχ2 test for categorical variables and the Mann-Whitney U test for continuous variables and calculated the logistic regression for hyperglycemia.RESULTS Of the 520 patients screened,248 met the inclusion criteria.Baseline demographics were equally distributed between patients with hyperglycemia and those who were normoglycemic.Serum inflammatory markers in patients with or without new-onset hyperglycemia were elevated as follows:CRP(58.1%vs 65.6%,P=0.29),ferritin(48.4%vs 34.9%,P=0.14),D-dimer(37.1%vs 37.1%,P=0.76)and LDH(19.4%vs 11.8%,P=0.02).Logistic regression analysis showed LDH odds ratio(OR)=1.623(P=0.256).We observed significantly higher mortality(24.2%vs 9.1%,P=0.001;OR=2.528,P=0.024)and length of stay(8.89 vs 6.69,P=0.026)in patients with hyperglycemia.CONCLUSION Our study showed no association between CRP,ferritin,LDH,D-dimer levels,and new-onset hyperglycemia in non-diabetic patients with COVID-19 infection.It also shows an increased mortality risk and length of stay in patients with hyperglycemia.With new-onset hyperglycemia being closely associated with poor prognostic indices,it becomes pivotal to understand the underlying pathophysiological mechanisms behind the SARS-CoV-2 infection-induced hyperglycemia.We conclude that the stress hyperglycemia hypothesis is not the only mechanism of SARS-CoV-2 infection-induced hyperglycemia but rather a multicausal pathogenesis leading to hyperglycemia that requires further research and understanding.This would help us improve not only the clinical outcomes of COVID-19 disease and inpatient hyperglycemia management but also understand the long-term effects of SARS-CoV-2 infection and further management.

Inflammatory response in confirmed non-diabetic foot and ankle infections:A case series with normal inflammatory markers

BACKGROUND The distinction between foot and ankle wound healing complications as opposed to infection is crucial for the appropriate and efficacious allocation of antibiotic therapy.Multiple reports have focused on the diagnostic accuracy of different inflammatory markers,however,mainly in the diabetic population.AIM To evaluate the diagnostic accuracy of white cell count(WCC)and C-reactive protein(CRP)as diagnostic tools for this distinction in the non-diabetic cohort.METHODS Data was reviewed from a prospectively maintained Infectious Diseases Unit database of 216 patients admitted at Leicester University Hospitals–United Kingdom with musculoskeletal infections over the period between July 2014 and February 2020(68 mo).All patients with confirmed diagnosis of diabetes were excluded while only those with confirmed microbiological or clinical diagnosis of foot or ankle infection were included in our study.For the included patients,we retrospectively retrieved the inflammatory markers(WCCs and CRP)at the time of presentation.Values of CRP 0-10 mg/L and WCC 4.0-11.0×109/L were considered normal.RESULTS After exclusion of patients with confirmed diabetes,25 patients with confirmed foot or ankle infections were included.All infections were confirmed microbiolo-gically with positive intra-operative culture results.7(28%)patients with osteomyelitis(OM)of the foot,11(44%)with OM of the ankle,5(20%)with ankle septic arthritis and 2(8%)patients with post-surgical wound infection were identified.Previous bony surgery was identified in 13(52%)patients,either a corrective osteotomy or an open reduction and internal fixation for a foot or ankle fracture with the infection developing on top of the existing metalwork.21(84%)patients did have raised inflammatory markers while 4(16%)patients failed to mount an inflammatory response even with subsequent debridement and removal of metal work.CRP sensitivity was 84%,while WCC sensitivity was only 28%.CONCLUSION CRP has a relatively good sensitivity in the diagnosis of foot and ankle infections in non-diabetic patients,whereas WCC is a poor inflammatory marker in the detection of such cases.In presence of clinically high level of suspicion of foot or ankle infection,a normal CRP should not rule out the diagnosis of OM.

Expression and detection significance of immune markers and inflammatory factors in peripheral blood of children with bronchial asthma

Objective: To explore the expression and detection significance of immune markers and inflammatory factors in peripheral blood of children with bronchial asthma. Method: A total of 86 cases of children with bronchial asthma admitted in our hospital from March 2015 to January 2017 were selected as observation group, and 86 cases of healthy children were selected as control group. The level of peripheral blood immunity included CD3+, CD4+, CD8+, CD4+ /CD8+, Th1, Th2, Th1/Th2, Th9, Th17, and the level of inflammatory factors included interferon-γ (IFN-γ), tumor necrosis factor-ɑ (TNF-ɑ), interleukin-17(IL-17) and interleukin-9 (IL-9) were compared in the two groups. Result: The expression levels of CD3+and CD8+ in the observation group were significantly lower than those in the control group, and the levels of CD4+ and CD4+/CD8+ were significantly higher than those in the control group. The expression levels of Th2, Th9 and Th17 in the observation group were significantly higher than those in the control group, while the expression levels of Th1 and Th1/Th2 were significantly lower than those in the control group. The expression levels of TNF-ɑ, IL-17 and IL-9 in the observation group were significantly higher than those in the control group, while the expression level of IFN-γ was significantly lower than that in the control group. Conclusion: The expression level of peripheral blood immunity and inflammatory factors in children with bronchial asthma plays an important role in the occurrence of bronchial asthma, and it is of great significance in clinical practice.

Prognostic value of preoperative prognostic nutritional index and its associations with systemic inflammatory response markers in patients with stage Ⅲ colon cancer

Background: The prognostic nutritional index(PNI) has been widely applied for predicting survival outcomes of patients with various malignant tumors. Although a low PNI predicts poor prognosis in patients with colorectal cancer after tumor resection, the prognostic value remains unknown in patients with stage Ⅲ colon cancer undergoing curative tumor resection followed by adjuvant chemotherapy. This study aimed to investigate the prognostic value of PNI in patients with stage III colon cancer.Methods: Medical records of 274 consecutive patients with stage Ⅲ colon cancer undergoing curative tumor resection followed by adjuvant chemotherapy with oxaliplatin and capecitabine between December 2007 and December2013 were reviewed. The optimal PNI cutoff value was determined using receiver operating characteristic(ROC) curve analysis. The associations of PNI with systemic inflammatory response markers, including lymphocyte-to-monocyte ratio(LMR), neutrophil-to-lymphocyte ratio(NLR), platelet-to-lymphocyte ratio(PLR), and C-reactive protein(CRP)level, and clinicopathologic characteristics were assessed using the Chi square or Fisher's exact test. Correlation analysis was performed using Spearman's correlation coefficient. Disease-free survival(DFS) and overall survival(OS)stratified by PNI were analyzed using Kaplan-Meier method and log-rank test, and prognostic factors were identified by Cox regression analyses.Results: The preoperative PNI was positively correlated with LMR(r= 0.483, P < 0.001) and negatively correlated with NLR(r =-0.441, P < 0.001), PLR(r =-0.607, P < 0.001), and CRP level(r =-0.333, P < 0.001). A low PNI(≤49.22)was significantly associated with short OS and DFS in patients with stage ⅢC colon cancer but not in patients with stage ⅢA/ⅢB colon cancer.In addition, patients with a low PNI achieved a longer OS and DFS after being treated with6-8 cycles of adjuvant chemotherapy than did those with < 6 cycles. Multivariate analyses revealed that PNI was independently associated with DFS(hazard ratios 2.001; 95% confidence interval 1.157-3.462; P = 0.013).Conclusion: The present study identified preoperative PNI as a valuable predictor for survival outcomes in patients with stage Ⅲ colon cancer receiving curative tumor resection followed by adjuvant chemotherapy.

Utility of serological markers in inflammatory bowel diseases: Gadget or magic?

The panel of serologic markers for inflammatory bowel diseases （IBD） is rapidly expanding. Although antiSaccharornyces cerev/siae antibodies （ASCA） and atypical perinuclear antineutrophil cytoplasmic antibodies （P-ANCA） remain the most widely investigated, an increasing amount of experimental data is available on newly discovered antibodies directed against various microbial antigens. The role of the assessment of various antibodies in the current IBD diagnostic algorithm is often questionable due to their limited sensitivity. In contrast, the association of serologic markers with disease behavior and phenotype is becoming increasingly well-established. An increasing number of observations confirms that patients with Crohn＇s disease expressing multiple serologic markers at high titers are more likely to have complicated small bowel disease （e.g. stricture and/or perforation） and are at higher risk for surgery than those without, or with low titers of antibodies. Creating homogenous disease sub-groups based on serologic response may help develop more standardized therapeutic approaches and may help in a better understanding of the pathomechanism of IBD. Further prospective clinical studies are needed to establish the clinical role of serologic tests in IBD.

Use of blood-based biomarkers for early diagnosis and surveillance of colorectal cancer

Early screening for colorectal cancer(CRC) holds the key to combat and control the increasing global burden of CRC morbidity and mortality. However, the current available screening modalities are severely inadequate because of their high cost and cumbersome preparatory procedures that ultimately lead to a low participation rate. People simply do not like to have colonoscopies. It would be ideal, therefore, to develop an alternative modality based on blood biomarkers as the first line screening test. This will allow for the differentiation of the general population from high risk individuals. Colonoscopy would then become the secondary test, to further screen the high risk segment of the population. This will encourage participation and therefore help to reach the goal of early detection and thereby reduce the anticipated increasing global CRC incidence rate. A blood-based screening test is anappealing alternative as it is non-invasive and poses minimal risk to patients. It is easy to perform, can be repeated at shorter intervals, and therefore would likely lead to a much higher participation rate. This review surveys various blood-based test strategies currently under investigation, discusses the potency of what is available, and assesses how new technology may contribute to future test design.

Fecal markers of inflammation used as surrogate markers for treatment outcome in relapsing inflammatory bowel disease

AIM： To evaluate fecal calprotectin （FC） as a surrogate marker of treatment outcome of relapse of inflammatory bowel disease （IBD） and, to compare FC with fecal myeloperoxidase （MPO） and fecal eosinophil protein X （EPX）. METHODS： Thirty eight patients with IBD, comprising of 27 with ulcerative colitis （UC） and 11 with Crohn＇s disease （CD） were investigated before treatment （inclusion）, and after 4 and 8 wk of treatment. Treatment outcomes were evaluated by clinical features of disease activity and endoscopy in UC patients, and disease activity in CD patients. In addition, fecal samples were analyzed for FC by enzyme-linked immunosorbent assay （ELISA）, and for MPO and EPX with radioimmunoassay （RIA）. RESULTS： At inclusion 37 of 38 （97%） patients had elevated FC levels （〉 94.7 μg/g）. At the end of the study, 31 of 38 （82%） patients fulfilled predefined criteria of a complete response IUC 21/27 （78%）; CD 10/11 （91%）]. Overall, a normalised FC level at the end of the study predicted a complete response in 100% patients, whereas elevated FC level predicted incomplete response in 30%. Normalised MPO or EPX levels predicted a complete response in 100% and 90% of the patients, respectively. However, elevated MPO or EPX levels predicted incomplete response in 23% and 22%, respectively. CONCLUSION： A normalised FC level has the potential to be used as a surrogate marker for successful treatment outcome in IBD patients. However, patients with persistent elevation of FC levels need further evaluation. FC and MPO provide superior discrimination than EPX in IBD treatment outcome.

Utility of preoperative systemic inflammatory biomarkers in predicting postoperative complications after pancreaticoduodenectomy: Literature review and single center experience

BACKGROUND The role of preoperative inflammatory biomarkers(PIBs)in predicting postoperative morbidity has been assessed in colorectal and otorhinolaryngeal surgery.However,data regarding the role that preoperative inflammatory biomarkers have on morbidity after pancreaticoduodenectomiy(PD)are less consistent.AIM To assess the utility of PIBs in predicting postoperative complications after pancreaticoduodenectomy.METHODS A database of 317 consecutive pancreaticoduodenectomies performed from April 2003 to November 2018 has been retrospectively analyzed.Data regarding preoperative neutrophil-to-lymphocyte ratio(NLR),derived NLR and C-reactive protein(CRP),and postoperative complications of 238 cases have been evaluated.Exclusion criteria were:age<18-years-old,previous neoadjuvant treatment,absence of data about PIBs,concomitant hematological disorders,and presence of active infections at the moment of the surgery.PIBs were compared using Mann-Whitney’s test and receiver operating characteristic(ROC)analysis was performed to define the cutoffs.The positive predictive value(PPV)was computed to evaluate the probability to develop complication.P-values<0.05 were considered statistically significant.RESULTS According to the literature findings,only four papers have been published reporting the relation between the inflammatory biomarkers and PD postoperative morbidity.A combination of preoperative and postoperative inflammatory biomarkers in predicting complications after PD and the utility of preoperative NLR in the development of postoperative pancreatic fistula(POPF)have been reported.The combination of PIBs and postoperative day-1 drains amylase has been reported to predict the incidence of POPF.According to our results,CRP values were significantly different between patients who had/did not have postoperative complications and abdominal collections(P<0.05).Notably,patients with preoperative CRP>8.81 mg/dL were at higher risk of both overall complications and abdominal collections(respectively P=0.0037,PPV=0.95,negative predictive value[NPV]=0.27 and P=0.016,PPV=0.59,NPV=0.68).Preoperative derived neutrophil-to-lymphocyte ratio(dNLR)(cut off>1.47)was also a predictor of abdominal collection(P=0.021,PPV=0.48,NPV=0.71).Combining CRP and dNLR,PPV increased to 0.67.NLR(cut off>1.65)was significantly associated with postoperative hemorrhage(P=0.016,PPV=0.17,NPV=0.98).CONCLUSION PIBs may predict complications after PD.During postoperative care,PIB levels could influence decisions regarding the timing of drains removal and the selection of patients who might benefit from second level diagnostic exams.

Neurohumoral,cardiac and inflammatory markers in the evaluation of heart failure severity and progression

Heart failure is common in adult population,accounting for substantial morbidity and mortality worldwide.The main risk factors for heart failure are coronary artery disease,hypertension,obesity,diabetes mellitus,chronic pulmonary diseases,family history of cardiovascular diseases,cardiotoxic therapy.The main factor associated with poor outcome of these patients is constant progression of heart failure.In the current review we present evidence on the role of established and candidate neurohumoral biomarkers for heart failure progression management and diagnostics.A growing number of biomarkers have been proposed as potentially useful in heart failure patients,but not one of them still resembles the characteristics of the"ideal biomarker."A single marker will hardly perform well for screening,diagnostic,prognostic,and therapeutic management purposes.Moreover,the pathophysiological and clinical significance of biomarkers may depend on the presentation,stage,and severity of the disease.The authors cover main classification of heart failure phenotypes,based on the measurement of left ventricular ejection fraction,including heart failure with preserved ejection fraction,heart failure with reduced ejection fraction,and the recently proposed category heart failure with mid-range ejection fraction.One could envisage specific sets of biomarker with different performances in heart failure progression with different left ventricular ejection fraction especially as concerns prediction of the future course of the disease and of left ventricular adverse/reverse remodeling.This article is intended to provide an overview of basic and additional mechanisms of heart failure progression will contribute to a more comprehensive knowledge of the disease pathogenesis.

Predictive significance of cancer related-inflammatory markers in locally advanced rectal cancer

BACKGROUND Locally advanced rectal cancer is treated using neoadjuvant chemoradiation(nCRT),followed by total mesorectal excision(TME).Tumor regression and pathological post-treatment stage are prognostic for oncological outcomes.There is a significant correlation between markers representing cancer-related inflammation,including high neutrophil-to-lymphocyte ratio(NLR),monocyteto-lymphocyte ratio(MLR),and platelet-to-lymphocyte(MLR)and unfavorable oncological outcomes.However,the predictive role of these markers on the effect of chemoradiation is unknown.AIM To evaluate the predictive roles of NLR,MLR,and PLR in patients with locally advanced rectal cancer receiving neoadjuvant chemoradiation.METHODS Patients(n=111)with locally advanced rectal cancer who underwent nCRT followed by TME at the Minimally Invasive Surgery Unit,Siriraj Hospital between 2012 and 2018 were retrospectively analyzed.The associations between post-treatment pathological stages,neoadjuvant rectal(NAR)score and the pretreatment ratios of markers of inflammation(NLR,MLR,and PLR)were analyzed.RESULTS Clinical stages determined using computed tomography,magnetic resonance imaging,or both were T4(n=16),T3(n=94),and T2(n=1).The NAR scores were categorized as high(score>16)in 23.4%,intermediate(score 8-16)in 41.4%,and low(score<8)in 35.2%.The mean values of the NLR,PLR,and MLR correlated with pathological tumor staging(ypT)and the NAR score.The values of NLR,PLR and MLR were higher in patients with advanced pathological stage and high NAR scores,but not statistically significant.CONCLUSION In patients with locally advanced rectal cancer,pretreatment NLR,MLR and PLR are higher in those with advanced pathological stage but the differences are not significantly different.

New serological markers in pediatric patients with inflammatory bowel disease

The spectrum of serological markers associated with inflammatory bowel disease (IBD) is rapidly growing. Due to frequently delayed or missed diagnoses, the application of non-invasive diagnostic tests for IBD, as well as differentiation between ulcerative colitis (UC) and Crohn&#x02019;s disease (CD), would be useful in the pediatric population. In addition, the combination of pancreatic autoantibodies and antibodies against Saccharomyces cerevisiae antibodies/perinuclear cytoplasmic antibody (pANCA) improved the sensitivity of serological markers in pediatric patients with CD and UC. Some studies suggested that age-associated differences in the patterns of antibodies may be present, particularly in the youngest children. In CD, most patients develop stricturing or perforating complications, and a significant number of patients undergo surgery during the disease course. Based on recent knowledge, serum antibodies are qualitatively and quantitatively associated with complicated CD behavior and CD-related surgery. Pediatric UC is characterized by extensive colitis and a high rate of colectomy. In patients with UC, high levels of anti-CBir1 and pANCA are associated with the development of pouchitis after ileal pouch-anal anastomosis. Thus, serologic markers for IBD can be applied to stratify IBD patients into more homogeneous subgroups with respect to disease progression. In conclusion, identification of patients at an increased risk of rapid disease progression is of great interest, as the application of early and more aggressive pharmaceutical intervention could have the potential to alter the natural history of IBD, and reduce complications and hospitalizations.

Is it sufficient to evaluate only preoperative systemic inflammatory biomarkers to predict postoperative complications after pancreaticoduodenectomy?

Postoperative morbidity and mortality rates are still very high among patients undergoing pancreaticoduodenectomy(PD).However,mortality rates secondary to morbidities that are detected early and well-managed postoperatively are lower among patients undergoing PD.Since early detection of complications plays a very important role in the management of these patients,many ongoing studies are being conducted on this subject.Recent endoscopic retrograde cholangiopancreatography and biliary drainage history of the patient study group is important for comparison of C-reactive protein(CRP),an inflammatory parameter evaluated in the retrospective study by Coppola et al published in the World Journal of Gastrointestinal Surgery and titled“Utility of preoperative systemic inflammatory biomarkers in predicting postoperative complications after pancreaticoduodenectomy:Literature review and single center experience”.Therefore,it may be more appropriate to compare CRP values in randomized patients.

土鳖虫化学成分和药理作用的研究进展及其质量标志物(Q-Marker)的预测分析

土鳖虫是我国传统中药,分布于河南、河北、江苏、湖南等地,具有破血逐瘀、续筋接骨的功效。土鳖虫中化学成分种类丰富,主要包括蛋白质及多肽类、氨基酸类、脂肪酸类、生物碱、无机元素、核苷类等。现代药理研究表明,土鳖虫具备抗凝血并防止血栓形成、调节血脂的作用,此外,还具有抗肿瘤、抗炎、增强免疫力、抗氧化等作用。近年来,土鳖虫等动物类中药在临床应用方面备受关注。本文对土鳖虫化学成分和药理作用的研究现状进行总结,在此基础上分析功效作用与化学成分之间的联系,发现蛋白质及多肽类成分与抗凝血、调血脂作用关联紧密,生物碱类成分与抗菌抗炎作用相关。并从传统功效、现代药理、化学成分可测性、中药配伍等角度预测分析其质量标志物(quality marker,Q-Marker),初步确定土鳖虫活性肽组分、纤溶活性蛋白、脂肪酸类成分、生物碱、核苷类成分等可作为其质量标志物。中药质量标志物的研究为鉴定土鳖虫的真假优劣提供依据,也为后续开发土鳖虫新剂型、制定质量标准提供理论基础。

Interaction between inflammatory bowel disease,physical activity,and myokines:Assessment of serum irisin levels

Inflammatory bowel disease(IBD),including Crohn’s disease and ulcerative colitis,showed a wide spectrum of intestinal and extra-intestinal manifestations,which rendered the patients physically inactive and impaired their quality of life.It has been found that physical activity is a non-pharmacological intervention that improves the quality of life for those patients.Irisin is one member of the myokines secreted by muscle contraction during exercise and could be used as an antiinflammatory biomarker in assessing the physical activity of IBD patients.In addition,experimental studies showed that exogenous irisin significantly decreased the inflammatory markers and the histological changes of the intestinal mucosa observed in experimental colitis.Furthermore,irisin produces changes in the diversity of the microbiota.Therefore,endogenous or exogenous irisin,via its anti-inflammatory effects,will improve the health of IBD patients and will limit the barriers to physical activity in patients with IBD.