Postoperative Low Absolute Lymphocyte Counts may Predict Poor Outcomes of Hepatocellular Carcinoma After Liver Resection

Background：The absolute lymphocyte counts （ALCs） have been reported as one of worse prognostic factors for hepatocellular carcinoma （HCC） patient after liver transplantation.The aim of this study was to assess the influence of ALCs on the outcomes of patients with hepatitis B virus （HBV）-related HCC within the Milan criteria following liver resection.Methods：Data of patients with HCC within the Milan criteria who received liver resection between January 2007 and June 2013 were reviewed,and perioperative ALCs were carefully monitored.All potential risk factors were statistically analyzed by uni-and multi-variate analyses.The receiver operating characteristic （ROC） curve was used to determine the optimalALCs cut-offvalue to predict HCC recurrence after liver resection.Results：A total of 221 patients were enrolled in the current study.During the follow-up period,106 patients experienced recurrence,and 38 patients died.Multivariate analysis suggested microvascular invasion （MVI）,a tumor grade ≥2,and a low postoperative ALCs in the 1^st postoperative month increased the incidence of postoperative recurrence,besides,MVI,intraoperative transfusion,and a low postoperative ALCs in the 1 st postoperative month were associated with poor overall survival （OS）.An ROC analysis showed that a cut-offvalue of 1.5 × 10^9/L for ALCs in the 1^st postoperative month predicted postoperative recurrence.The 5-year recurrence-free survival （RFS） and OS rates of patients with low postoperative ALCs were 34.5% and 64.8%,respectively,which were significantly lower than those of patients with high postoperative ALC （58.5% for RFS and 86.5% for OS）.Conclusion：Low ALCs in the 1^st postoperative month may be associated with high recurrence incidence and poor OS for patients with HBV-related HCC within the Milan criteria after liver resection.

Preliminary evidence in treatment of eosinophilic gastroenteritis in children:A case series

BACKGROUND Eosinophilic gastroenteritis is a rare inflammatory disorder in children.However,there is still no standard guideline in the treatment of pediatric eosinophilic gastroenteritis.AIM To report our experience with the diagnosis and treatment of children with eosinophilic gastroenteritis.METHODS From January 2017 to December 2019,a total of 22 children were diagnosed with eosinophilic gastroenteritis.RESULTS Endoscopic examination showed eosinophil infiltration in the duodenum[mean number of eosinophils/high-power field(HPF)=53.1±81.5],stomach(mean number of eosinophils/HPF=36.8±50.5),and terminal ileum(mean number of eosinophils/HPF=49.0±24.0).All 18 children with low eosinophil infiltration(<14%)responded well to the initial drug treatment without relapse,while two of four children with high eosinophil infiltration(>14%)relapsed after initial methylprednisolone/montelukast treatment.In addition,children with high eosinophil infiltration(>14%)showed symptomatic relief and histological remission without further relapse after receiving budesonide/methylprednisolone as initial or relapse treatment.CONCLUSION Methylprednisolone/montelukast is still the best treatment for children with low eosinophil infiltration(<14%).Budesonide can be considered as the initial or relapse treatment for children with high eosinophil infiltration(>14%).

Hematological indices as predictors of mortality in dengue shock syndrome: A retrospective study

Objective:To explore predictive hematological parameters on admission which are associated with mortality in NS1 positive dengue shock syndrome patients.Methods:Demographic characteristics,hematological parameters,and the outcome of NS1 positive dengue shock syndrome patients without any comorbidity and coexisting infections were collected from the Intensive Care Unit and the results were compared between the survivor and non-survivor groups.Results:The mean age was(30.77±11.48)years and 56(56.6%)patients were males.Out of the total 99 patients,72(72.27%)patients were successfully discharged and 27(27.27%)patients eventually succumbed to death.The most common hematological finding was thrombocytopenia(95.95%),followed by anemia(52.52%)and decreased mean platelet volume(37.37%).After controlling other variables,logistic regression analysis showed that absolute neutrophil count and mean platelet volume were associated with mortality.Conclusions:Total leucocyte count,absolute neutrophil count,and total platelet count are significantly higher,and mean platelet volume is significantly lower in the non-survivor group as compared to the survivor group.Absolute neutrophil count and mean platelet volume are predictors associated with mortality.

The Lower Peripheral Blood Lymphocyte to Monocyte Ratio Following Completion of First Line Chemotherapy Is a Risk Factor for Predicting Relapse in Patients with Diffuse Large B-Cell Lymphoma

Background and objective: During routine follow up, there is no specific predictor to ascertain relapse after standard first line chemotherapy in diffuse large cell lymphoma. Therefore, this study was designed to assess the prognostic significance of the ratio between absolute lymphocyte and monocyte counts (LMR) in the peripheral blood to verify relapse in diffuse large B cell lymphoma. Patients and methods: A total of 139 patients with newly diagnosed diffuse large B cell lymphoma (DLBCL) were evaluated and treated with CHOP or R-CHOP between the years 2009 and 2016. Three months following completion of first line therapy, Lymphocyte/monocyte ratio (LMR) was calculated from the routine automated complete blood cell count (CBC) attained a plateau after the bone marrow recovery after first line chemotherapy. The absolute lymphocyte count/absolute monocyte count ratio (LMR) was calculated by dividing the ALC by the AMC. Results: ROC curve analysis of 139 patients established 2.8 as cutoff point of LMR for relapse with AUC of 0.97 (95% CI 0.93 - 0.99, P ≤ 0.001). Cox regression analysis was performed to identify factors predicting relapse. In univariate regression analysis, ALC (95% CI 0.003 - 0.03, p ≤ 0.001), AMC (95% CI 15.4 - 128.8, p ≤ 0.001), LMR (95% CI 0.001 - 0.01, p ≤ 0.001), and LDH (95% CI 0.1 - 0.5, p ≤ 0.001) following completion of therapy are significant factors for relapse. Other significant factors for relapse are Ann Arbor stage (95% CI 1.1 - 6.9, P = 0.03), extranodal sites (95% CI 1.2 - 6.1, P = 0.01), age (95% CI 1.3 - 6.5, P = 0.01) and treatment of CHOP protocol (95% CI 0.05 - 0.6, P = 0.007). In a multivariate analysis LMR following completion of therapy was predictive for relapse (95% CI 0.001 - 0.2, P = 0.005). ALC was also significant in multivariate analysis (95% CI 0.01 - 0.8, P = 0.03). LDH following completion of therapy (95% CI 0.2 - 14.9, P = 0.5), AMC following completion of therapy (95% CI 0.3 - 43.1, P = 0.3), age (95% CI 0.9 - 205.4, P = 0.06), extra-nodal sites (95% CI 0.04 - 9.8, P = 0.8), Ann Arbor stage (95% CI 0.3 - 28.7, P = 0.3), and Treatment of CHOP protocol (95% CI 0.01 - 2.4, P = 0.2) were not statistically significant. Conclusion: This study observed that LMR assessed after first line chemotherapy during routine follow up is an independent predictor of relapse and clinical outcome in DLBCL patients. LMR at follow up can be used a simple inexpensive biomarker to alert clinicians for relapse during follow up after standard first line chemotherapy in DLBCL patients.

The Influence of Age and Sex on the Cell Counts of Peripheral Blood Leukocyte Subpopulations in Chinese Rhesus Macaques

Non-human primates such as Chinese rhesus macaques are the favorable models for preclinical study of potential therapeutic drugs,vaccines and mechanisms of human diseases.Little is known about the normal levels of leukocyte subpopulations of Chinese rhesus macaques.To obtain these data,100 blood samples from Chinese rhesus macaques were collected.The normal range of major leukocyte subpopulations,such as T lymphocytes,B lymphocytes,monocytes,myeloid dendritic cells(mDCs)and plasmacytoid dendritic cells(pDCs),were quantitatively analyzed by flow cytometry through BD trucount tubes.The influence of age and sex on the cell counts of leukocyte subpopulations was analyzed.The counts of CD3^(+)T cells,CD3+CD4^(+)T cells,CD3+CD8^(+)T cells and B cells decreased with age,but those of monocytes,mDCs and pDCs had no significant correlation with age.Significant differences existed in the cell counts of most leukocyte subpopulations between the male and female groups except pDCs.Furthermore the values of the females were higher than those of the males.The study provided basic information about the leukocyte subpopulations of Chinese rhesus macaques,and it may be valuable for immunobiological study of Chinese rhesus macaques.