Age-dependent changes of total and differential white blood cell counts in children

Background:Total and differential white blood cell counts are important for the diagnostic evaluation of suspected diseases.To facilitate the interpretation of total and differential white blood cell counts in pediatric patients,the present study investigated agedependent changes in total and differential white blood cell counts in healthy reference children.Methods:Data were obtained from the Pediatric Reference Intervals in China study(PRINCE),which aims to establish and verify pediatric reference intervals for Chinese children based on a nationwide multicenter cross-sectional study from January 2017 to December 2018.Quantile curves were calculated using the generalized additive models for location,shape,and scale method.The 2.5th,50th,and 97.5th quantile curves were calculated for both total and differential white blood counts.Percents of stacked area charts were used to demonstrate the proportions of differential white blood cells.All statistical analyses were performed using R software.Results:Both 50th and 97.5th quantiles of total white blood cell count and monocyte count were highest at birth,then rapidly decreased in the first 6 months of life;relatively slow reduction continued until 2 years of age.The lymphocyte count was low during infancy and increased to its highest level at 6 months of age;it then exhibited moderate and continuous reduction until approximately 9 years of age.The pattern of neutrophil count changed with age in a manner opposite to that of lymphocyte count.Besides,there were two inter-sections of lymphocyte count and neutrophil count during infancy and at approximately 5 years of age,based on locally weighted regression(LOESS)analysis.There were no apparent age-related changes in eosinophil or basophil counts.Conclusion:These data regarding age-related changes in total and differential white blood cell counts can be used to assess the health of pediatric patients and guide clinical decisions.

Acromioclavicular joint septic arthritis in an immunocompetent child： A case report

Septic arthritis of acromioclavicular （AC） joint is a rare entity. It is generally seen in patients who are immunocompromised. Only 15 cases have been reported till now, with only one case series of 6 patients, We report a case of septic arthritis of AC joint in an immunocompetent child. A 9 years old girl presented with history of pain in left shoulder for 4 days associated with fever, No history suggestive of any immunocompromised state was complained. On local examination, a swelling of around 3 cm in diameter was found over left AC joint region with raised local temperature, tenderness on palpation and positive response in fluctuation test. Total leukocyte count was 18.7 - 109/L with 80% of neutrophils. Erythrocyte sedimentation rate （ESR） was 28 mm/1 h. C-reactive protein （CRP） was 12 mg/L. X-ray showed enlarged left AC joint space. Ultrasound revealed hypoechoic collection in the AC joint and the surrounding area. The aspirate was thick and purulent in nature, revealing Gram positive cocci at staining. Arthrotomy and thorough lavage of AC joint was done. Culture of the aspirate showed Methicillin Resistant Staphylococcus Aureus （MRSA） after 48 hours that was sensitive to amikacin, gentamicin, erythromycin and teicoplanin. Patient was symptom-free at 2 months of follow-up with no signs of osteomyelitis on the radiographs. Thus this is the first case of AC joint septic arthritis in healthy individual. Being proximal to the shoulder joint, AC joint septic arthritis can be confused with the shoulder joint septic arthritis. Thus, high index of suspicion is required for accurate diagnosis.

Efficacy of Saam acupuncture treatment on improvement of immune cell numbers in cancer patients:a pilot study

OBJECTIVE: To collect preliminary data on the effects of Saam acupuncture with regard to the immunity in cancer patients.METHODS: Ten cancer patients were analyzed for improvements in immunity. Acupuncture was applied at the 5 acupuncture points, Jingqu(LU 8), Zutonggu(BL 66), Yanggu(SI 5), Yangchi(TE 4), and Zhongwan(CV 12) for 2 weeks with 4 sessions. We assessed the effect of Korean Saam acupuncture on the immune system in cancer patients by measuring particular blood cell subsets, including CD3 +,CD4+, CD8+, CD19+, and CD56+ cells, as well as total white blood cell count, absolute neutrophil count, and fatigue score. The measurement was performed before and after acupuncture and at a 2-week follow-up.RESULTS: There was a statistically significant increase in the number of CD3+(P=0.023) and CD8+ cells(P<0.001) and T-cell subsets, as well as a decrease in the fatigue severity scale(FSS) score(P=0.001) after Saam acupuncture using the 5 acupoints.CONCLUSION: Acupuncture may improve the immune system by increasing the counts of a few immune cells and relieve fatigue in cancer patients by decreasing FSS scores. Although this was a non-controlled study, it constitutes preliminary research investigating the potential effects of Saam acupuncture in increasing the counts of several immune cells in cancer patients.