Clinical comprehensive treatment protocol for managing diabetic foot ulcers:A retrospective cohort study

BACKGROUND Diabetic foot ulcers(DFUs)are a common complication of diabetes,often leading to severe infections,amputations,and reduced quality of life.The current standard treatment protocols for DFUs have limitations in promoting efficient wound healing and preventing complications.A comprehensive treatment approach targeting multiple aspects of wound care may offer improved outcomes for patients with DFUs.The hypothesis of this study is that a comprehensive treatment protocol for DFUs will result in faster wound healing,reduced amputation rates,and improved overall patient outcomes compared to standard treatment protocols.AIM To compare the efficacy and safety of a comprehensive treatment protocol for DFUs with those of the standard treatment protocol.METHODS This retrospective study included 62 patients with DFUs,enrolled between January 2022 and January 2024,randomly assigned to the experimental(n=32)or control(n=30)group.The experimental group received a comprehensive treatment comprising blood circulation improvement,debridement,vacuum sealing drainage,recombinant human epidermal growth factor and anti-inflammatory dressing,and skin grafting.The control group received standard treatment,which included wound cleaning and dressing,antibiotics administration,and surgical debridement or amputation,if necessary.Time taken to reduce the white blood cell count,number of dressing changes,wound healing rate and time,and amputation rate were assessed.RESULTS The experimental group exhibited significantly better outcomes than those of the control group in terms of the wound healing rate,wound healing time,and amputation rate.Additionally,the comprehensive treatment protocol was safe and well tolerated by the patients.CONCLUSION Comprehensive treatment for DFUs is more effective than standard treatment,promoting granulation tissue growth,shortening hospitalization time,reducing pain and amputation rate,improving wound healing,and enhancing quality of life.

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.

Heparin-binding protein combined with human serum albumin in early assessment of community-acquired pneumonia:A retrospective study

Objective:To investigate the application of heparin-binding protein along with albumin(HBP+ALB)in evaluating the severity of community-acquired pneumonia(CAP)and compares it with single HBP,white blood cells(WBCs),C-reactive protein(CRP),and procalcitonin(PCT).Methods:A total of 226 patients with CAP admitted to the Emergency Department of Zhujiang Hospital,Southern Medical University,Guangdong,China,between March 1,2021,and March 1,2022,were enrolled.The patients were grouped into two groups:mild CAP(n=175)and severe CAP(sCAP)(n=51).Patients'characteristics and laboratory data were obtained.ROC curve and the value of the area under the curve(AUC)were used to evaluate the predictive values of HBP,ALB,WBC,CRP,and PCT.Results:WBC count,CRP,PCT,HBP,creatinine,and D-dimer were higher in the sCAP group,while ALB was lower in the sCAP group(P<0.05)than those in the mild CAP group.The AUCs of WBC,CRP,PCT,HBP,and HBP+ALB were 0.633(95%CI:0.545-0.722,P<0.05),0.635(95%CI:0.542-0.729,P<0.05),0.705(95%CI:0.619-0.791,P<0.05),0.809(95%CI:0.736-0.883,P<0.05),and 0.889(95%CI:0.842-0.936,P<0.05),respectively.Conclusions:HBP+ALB has a higher predictive value than single HBP,PCT,CRP and WBC used alone for the early assessment of CAP.

Research Progress of Combined Detection of WBC, CRP and SAA in Early Diagnosis of Respiratory Tract Infection in Children

Objective: To investigate the application of WBC, CRP and SAA combined detection in the early diagnosis of respiratory tract infection in children. Methods: Collect the literature reports on the early diagnosis of respiratory tract infection in children by the combined detection of WBC, CRP and SAA in recent years, and follow up the relevant literature reports from the selection of “new three routine” laboratory items for rapid diagnosis in pediatric outpatient department and the application of the combined detection of WBC, CRP and SAA in the early diagnosis of respiratory tract infection in children. Results: Many literature studies found that the combined detection of WBC, CRP and SAA has important clinical significance in the early diagnosis of respiratory tract infection in children. Conclusion: Through reviewing the relevant literature, we can understand the application of WBC, CRP and SAA combined detection in the early diagnosis of respiratory tract infection in children. To provide more accurate and reliable laboratory data for the early diagnosis and treatment of respiratory tract infection in children in the future.

Comparison of total splenic artery embolization and partial splenic embolization for hypersplenism

AIM:To evaluate whether total splenic artery embolization(TSAE) for patients with hypersplenism delivers better long-term outcomes than partial splenic embolization(PSE).METHODS:Sixty-one patients with hypersplenism eligible for TSAE(n = 27,group A) or PSE(n = 34,group B) were enrolled into the trial,which included clinical and computed tomography follow-up.Data on technical success,length of hospital stay,white blood cell(WBC) and platelet(PLT) counts,splenic volume and complications were collected at 2 wk,6 mo,and 1,2,3,4 years postoperatively.RESULTS:Both TSAE and PSE were technically successful in all patients.Complications were significantly fewer(P = 0.001),and hospital stay significantly shorter(P = 0.007),in group A than in group B.Postprocedure WBC and PLT counts in group A were significantly higher than those in group B from 6 mo to 4 years(P = 0.001),and post-procedure residual splenic volume in group A was significantly less than that observed in group B at 1,2,3 and 4 years post-procedure(P = 0.001).No significant differences were observed in red blood cell counts and liver function parameters between the two groups following the procedure.CONCLUSION:Our results indicate that TSAE for patients with hypersplenism not only delivers a better longterm outcome,but is also associated with lower complication rates and a shorter hospital stay than PSE.

Procalcitionin as a diagnostic marker to distinguish upper and lower gastrointestinal perforation

AIM To assess the accuracy of serum procalcitionin(PCT)as a diagnostic marker in verifying upper and lower gastrointestinal perforation(GIP).METHODS This retrospective study included 46 patients from the surgical intensive care unit(ICU)of the Second Affiliated Hospital of Harbin Medical University who were confirmed to have GIP between June 2013 and December 2016.Demographic and clinical patient data were recorded on admission to ICU.Patients were divided into upper(n=19)and lower(n=27)GIP groups according to the perforation site(above or below Treitz ligament).PCT and WBC count was obtained before laparotomy and then compared between groups.Meanwhile,the diagnostic accuracy of PCT was analyzed.RESULTS Patients with lower GIP exhibited significantly higher APACHE II score,SOFA score and serum PCT level than patients with upper GIP(P=0.017,0.004,and0.001,respectively).There was a significant positive correlation between serum PCT level and APACHE II score or SOFA score(r=0.715 and r=0.611,respectively),while there was a significant negative correlation between serum PCT level and prognosis(r=-0.414).WBC count was not significantly different between the two groups,and WBC count showed no significant correlation with serum PCT level,APACHE II score,SOFA score or prognosis.The area under the receiver operating characteristic curve of PCT level to distinguish upper or lower GIP was 0.778.Patients with a serum PCT level above 17.94 ng/d L had a high likelihood of lower GIP,with a sensitivity of 100%and a specificity of 42.1%.CONCLUSION Serum PCT level is a reliable and accurate diagnostic marker in identifying upper or lower GIP before laparotomy.

Assessment of a five-color flow cytometric assay for verifying automated white blood cell differentials

Background White blood cell （WBC） counts and differentials performed using an automated cell counter typically require manual microscopic review. However, this last step is time consuming and requires experienced personnel. We evaluated the clinical efficiency of using flow cytometry （FCM） employing a six-antibody/five-color reagent for verifying automated WBC differentials. Methods A total of 56 apparently healthy samples were assessed using a five-color flow cytometer to verify the normal reference ranges of WBC differentials. WBC differentials of 622 samples were also determined using both a cell counter and FCM. These results were then confirmed using manual microscopic methods. Results The probabilities for all of the parameters of WBC differentials exceeded the corresponding normal reference ranges by no more than 7.5%. The resulting WBC differentials were well correlated between FCM and the cell counter （r 〉0.88, P 〈0.001）, except in the case of basophils. Neutrophils, lymphocytes, and eosinophils were well correlated between FCM and standard microscopic cytology assessment （r 〉0.80, P 〈0.001）. The sensitivities of FCM for identification of immature granulocytes and blast cells （72.03% and 22.22%, respectively） were higher than those of the cell counter method （44.92% and 11.11%, respectively）. The specificities of FCM were all above 85%, substantially better than those of the cell counter method. Conclusion These five-color FCM assays could be applied to accurately verify abnormal results of automated assessment of WBC differentials.

White blood cell count and the incidence of hyperuricemia:insights from a community-based study

Hyperuricemia(HUA)is a risk factor for chronic kidney disease(CKD).The relationship between HUA and white blood cell(WBC)count remains unknown.A sampling survey for CKD was conducted in Sanlin community in 2012 and 2014.CKD was defined as proteinuria in at least the microalbuminuric stage or an estimated GFR of 60 mL/(min·1.73 m2).HUA was defined as serum uric acid>420µmol/L in men and>360µmol/L in women.This study included 1024 participants.The prevalence of HUA was 17.77%.Patients with HUA were more likely to have higher levels of WBC count,which was positively associated with HUA prevalence.This association was also observed in participants without CKD,diabetes mellitus,hyperlipidemia,or obesity.Multivariate logistic regression analysis showed that WBC count was independently associated with the risk for HUA in male and female participants.Compared with participants without HUA,inflammatory factors such as high-sensitivity C-reactive protein,tumor necrosis factor-α,and interleukin 6 increased in participants with HUA.Hence,WBC count is positively associated with HUA,and this association is independent of conventional risk factors for CKD.

Fecal lactoferrin accurately reflects mucosal inflammation in inflammatory bowel disease

BACKGROUND Studies have demonstrated a potential role for fecal biomarkers such as fecal calprotectin(FC)and fecal lactoferrin(FL)in monitoring inflammatory bowel diseases(IBD)-Crohn's disease(CD)and ulcerative colitis(UC).However,their correlation to endoscopic scores,disease severity and affected intestinal surface has not been extensively investigated.AIM To correlate FL,and for comparison white blood cell(WBC)and C-reactive protein(CRP),with endoscopic scores,disease extent and location in CD and UC.METHODS Retrospective analysis in 188 patients who had FL,CRP and WBC determined within 30 d of endoscopy.Disease location,disease extent(number of intestinal segments involved),disease severity(determined by endoscopic scores),timing of FL testing in relation to colonoscopy,as well as the use of effective fast acting medications(steroids and biologics)between colonoscopy and FL measurement,were recorded.RESULTS In 131 CD and 57 UC patients,both CRP and FL-but not WBC-distinguished disease severity(inactive,mild,moderate,severe).In patients receiving fastacting(steroids or biologics)treatment in between FL and colonoscopy,FL showed a higher correlation to endoscopic scores when tested before vs after the procedure(r=0.596,P<0.001,vs r=0.285,P=0.15 for the Simple Endoscopic Score for CD;and r=0.402,P=0.01 vs r=0.054 P=0.84 for Disease Activity Index).Finally,FL was significantly correlated with the diseased mucosal surface(colon-ileocolon>small bowel)and the number of inflamed colon segments.CONCLUSION FL and CRP separated disease severity categories with FL showing lower discriminating P-values.FL showed a close correlation with the involved mucosal surface and with disease extent and was more closely correlated to endoscopy when determined before the procedure–this indicating that inflammatory activity changes associated with therapy might be rapidly reflected by FL levels.FL can accurately and timely characterize intestinal inflammation in IBD.

Daclizumab prevents acute renal allograft rejection: 1 year analysis

Objective：To investigate the clinical effect of Daclizumab on preventing acute rejection in renal transplant recipients. Methods：71 patients were randomly divided into two groups：Daclizumab group （n =26） and control group （n = 45）. Baseline regimen of mycophenolate mofetil （MMF）, cyclosporin （CsA）, methylprednisolone （MPD） and prednisone （Pred） were administered to all patients. The treatment of Daclizumab was based on baseline regimen. The Daclizumab group received Daclizumab twice before and after renal transplant. The occurrence of post-transplantation acute rejection, renal function and T lymphocyte subtypes were sequentially monitored; meanwhile adverse events, infection episode, and patient and graft survival were observed. All of patients received a follow-up of 12 months at least. Results：The occurrence of acute rejection in Daclizumab group in 1, 3, 6 and 12 months after renal transplantation was 7.7%, 19.2%, 23.1% and 30.8%, respectively,while it was 15.6% ,28.9%, 35.6% and 46.7% in the control group. There was significant difference between the two group（P 〈 0.05）. There was no difference in infection episodes and adverse events between the Daclizumab group and control group. One year patient survival was 92.3% in Daclizumab group, 91.1% in control group （P 〉 0.05）, compared with graft survival of 96.2 % and 93.3 % for Daclizumab and control group, respectively （P 〉 0. 05）. The renal function in Daclizumab group in 1, 6 and 12 months after renal transplantation was better than that in control group （P 〈 0,05）. The CD3＋ and CD4＋ subtypes decreased in both two groups after operation but no significant difference （P 〉 0.05）. Conclusion：Daclizumab combined with MMF,CsA,MPD and Pred therapeutic regimen was effective to reduce the occurrence of acute rejection in renal transplant recipients and have no influence on T lymphocyte subtypes.

The serum levels of MMP-9, sICAM-1, CRP and WBC increased in patients with acute coronary syndrome

Objective：To evaluate the association of the peripheral levels of the defined inflammatory markers with different types of acute coronary syndrome （ACS） and stable angina, and the role inflammation played in the pathogenesis of ACS. Methods ：For understanding the variation of serum concentrations of matrix metalloproteinase-9 （MMP-9）, soluble intercellular adhesion molecule-1 （sICAM-1） ,C-reactive protein （CRP）, and white blood cell count （WBC） and their association with ACS, 90 patients with coronary heart disease （CHD） and 30 healthy volunteers were recruited. The enrolled people were assigned into four equal groups, including acute myocardial infarction （AMI） group, unstable angina pectoris（UAP） group, stable angina pectoris（SAP） group and healthy control group. The serum levels of MMP-9 and sICAM-1 were measured with ELISA kits, CRP were measured with im munoturbidimetric assay, and WBC number were assessed all before any treatment was administrated. Results： （1）The serum levels of MMP-9 ,sICAM-1 ,CRP and WBC in the patients with ACS were significantly higher than those in the control group （P 〈 0.01 ）. （2）Compared with control group, patients with SAP only had higher serum level of sICAM-1 （P 〈 0.01 ）. While the levels of MMP-9, CRP, and WBC had no significant difference between them （P 〉 0.05 all）. （3）Significant positive correlation between the serum levels of MMP-9 and sICAM-1 and CRP and WBC all were observed in the patients with ACS （P 〈 0.05）. Conclusion： The elevation of serum concentrations of inflammatory markers including MMP-9, slCAM-1, CRP and WBC were associated with initiation and progression of ACS, and they may help predicting cardiovascular events.

Prevalence and risk factors of chronic post-thoracotomy pain in Chinese patients from Peking Union Medical College Hospital

Background In clinical practice, the mechanisms underlying chronic post-surgical pain （CPSP） remain insufficiently understood. The primary goals of this study were to determine the incidence of chronic pain after thoracic surgery and to identify possible risk factors associated with the development of chronic post-thoracotomy pain in Chinese patients. The secondary goal was to determine whether the difference between pre- and post-operative white blood cell （WBC） counts could predict the prevalence of CPSP after thoracotomy. The impact of chronic pain on daily life was also investigated. Methods We contacted by phone 607 patients who had undergone thoracotomy at our hospital during the period February 2009 to May 2010. Statistical comparisons were made between patients with or without CPSP. Results Results were ultimately analyzed from 466 qualified patients. The overall incidence of CPSP was 64.5%. Difference between pre- and post-operative WBC counts differed significantly between patients with or without CPSP （P 〈0.001） and was considered as an independent risk factor for the development of CPSP following thoracotomy （P 〈0.001）. Other predictive factors for chronic pain included younger age （〈60 years, P 〈0.001）, diabetes mellitus （P=0.023）, acute post-operative pain （P=0.005） and the duration of chest tube drainage （P 〈0.001）. At the time of interviews, the pain resulted in at least moderate restriction of daily activities in 15% of the patients, of which only 16 patients had paid a visit to the doctor and only three of them were satisfied with the therapeutic effects, Conclusions Chronic pain is common after thoracotomy. WBC count may be a new independent risk factoring surgical patients during peri-operative period. Besides, age, diabetes mellitus, acute post-operative pain, and duration of chest tube drainage may also play a role in chronic post-surgical pain occurrence.

Protective Effect of Renshen Yangrong Decoction(人参养荣汤) on Bone Marrow against Radiation Injury in Mouse

Objective：To explore the effect of Renshen Yangrong Decoction（人参养荣汤,RYD） in protecting bone marrow from radiation injury.Methods：One hundred and eighty Kuming mice were subjected to the three tests for anti-radiation injury effect evaluation,i.e.the test of peripheral white blood cell（WBC） count, the test of bone marrow nucleated cell count,and the bone marrow micronucleus test,using 60 mice for each test.The mice in each test were divided into 6 groups：the blank control group,the model control group,the positive control group treated by Shiyiwei Shenqi Tablet（十一味参芪片,1.0 g/kg）,and three RYD groups treated with high（42.0 g/kg）,moderate（21.0 g/kg）,and low（10.5 g/kg） doses of crude drugs of RYD,with 10 mice in each group.The treatment was given by gastrogavage perfusion continuously for 7-14 days before mice received ^（60）Co-γray radiation and continued until the end of the experiment.The body weights of the mice were monitored,the changes in peripheral WBC and bone marrow nucleated cells were counted,and the variation in bone marrow micronucleated cells was observed on the respective appointed days.Results：A significant decrease in body weight,peripheral WBC count,and bone marrow nucleated cell count,as well as marked changes in bone marrow micronucleated cells were observed in the mice after radiation,indicating that the radiation injury model was successfully established.As compared with the model control group,the decrease in body weight,peripheral WBC count,and bone marrow nucleated cell count,as well as the increase in bone marrow micronucleus cell count in the high dosage RYD treated group were obviously inhibited or lessened （P0.05 or P0.01）.Conclusion：RYD showed obvious protective effect in mice with bone marrow injury induced by radiation.

Correlations between the Maximum Standard Uptake Value of Positron Emission Tomography/Computed Tomography and Laboratory Parameters before and after Treatment in Patients with Lymphoma

Background： After the first examination of patients with lymphoma diagnosis, important laboratory tests such as complete blood count; albumin, kidney and liver function tests; uric acid; 132-microglobulin; C-reactive protein （CRP）; erythrocyte sedimentation rate （ESR）; and lactate dehydrogenase （LDH） examinations are recommended. In this study, our aim was to find the relationship between laboratory parameters and the maximum standard uptake value （SUVmax） of positron emission tomography/computed tomography （PET/CT） in patients with lymphoma at the diagnosis and after treatment. Methods： Thirty-tbur lymphoma patients treated at Mustafa Kemal University Internal Medicine Clinic between 2014 and 2017 were included in this retrospective study. Results ofCRP, ESR, LDH, albumin, and white blood cell （WBC） count were recorded betbre each PET scan test, and each parameter was analyzed for correlation with SUV measurements. Results： Spearman＇s correlation test showed that the after-treatment SUV values were significantly correlated with the alter-treatment LDH, ESR, and CRP values （for LDH, ESR, and CRP, R2： 0.453, 0.426, and 0.351; P = 0.007, 0.012, and 0.042, respectively）. On the other hand, albumin and WBC count did not show a significant correlation with the after-treatment SUVmax values （all P 〉 0.05）. Conclusions： CRP, ESR, and LDH values may also be good predictors in patients for whom PET/CT imaging cannot be performed.