Red cell distribution width/platelet ratio estimates the 3-year risk of decompensation in Metabolic Dysfunction-Associated Steatotic Liver Disease-induced cirrhosis

BACKGROUND For compensated advanced chronic liver disease(cACLD)patients,the first decompensation represents a dramatically worsening prognostic event.Based on the first decompensation event(DE),the transition to decompensated advanced chronic liver disease(dACLD)can occur through two modalities referred to as acute decompensation(AD)and non-AD(NAD),respectively.Clinically Significant Portal Hypertension(CSPH)is considered the strongest predictor of decompensation in these patients.However,due to its invasiveness and costs,CSPH is almost never evaluated in clinical practice.Therefore,recognizing noninvasively predicting tools still have more appeal across healthcare systems.The red cell distribution width to platelet ratio(RPR)has been reported to be an indicator of hepatic fibrosis in Metabolic Dysfunction-Associated Steatotic Liver Disease(MASLD).However,its predictive role for the decompensation has never been explored.AIM In this observational study,we investigated the clinical usage of RPR in predicting DEs in MASLD-related cACLD patients.METHODS Fourty controls and 150 MASLD-cACLD patients were consecutively enrolled and followed up(FUP)semiannually for 3 years.At baseline,biochemical,clinical,and Liver Stiffness Measurement(LSM),Child-Pugh(CP),Model for End-Stage Liver Disease(MELD),aspartate aminotransferase/platelet count ratio index(APRI),Fibrosis-4(FIB-4),Albumin-Bilirubin(ALBI),ALBI-FIB-4,and RPR were collected.During FUP,DEs(timing and modaities)were recorded.CSPH was assessed at the baseline and on DE occurrence according to the available Clinical Practice Guidelines.RESULTS Of 150 MASLD-related cACLD patients,43(28.6%)progressed to dACLD at a median time of 28.9 months(29 NAD and 14 AD).Baseline RPR values were significantly higher in cACLD in comparison to controls,as well as MELD,CP,APRI,FIB-4,ALBI,ALBI-FIB-4,and LSM in dACLD-progressing compared to cACLD individuals[all P<0.0001,except for FIB-4(P:0.007)and ALBI(P:0.011)].Receiving operator curve analysis revealed RPR>0.472 and>0.894 as the best cut-offs in the prediction respectively of 3-year first DE,as well as its superiority compared to the other non-invasive tools examined.RPR(P:0.02)and the presence of baseline-CSPH(P:0.04)were significantly and independently associated with the DE.Patients presenting baseline-CSPH and RPR>0.472 showed higher risk of decompensation(P:0.0023).CONCLUSION Altogether these findings suggest the RPR as a valid and potentially applicable non-invasive tool in the prediction of timing and modalities of decompensation in MASLD-related cACLD patients.

Mortal condition in an unusual localization,analysis of isolated tongue and tongue base abscesses

BACKGROUND Tongue abscess(TA)is a very rare clinical condition and its treatment is very important.Surgical drainage is at the forefront in the treatment.Our study includes patients with tongue and tongue base abscesses.AIM To discuss the clinical and laboratory findings of these patients emphasizing the underlying causes and treatment options with the largest patient series in the English literature.METHODS We included patients with isolated TA who applied to our clinic between January 1,2020 and January 1,2023.Those who lack the recorded data,those who are not between the ages of 18-66,those who have not undergone surgery-interventional procedure,and those who have infection and/or abscess in another place were excluded from the study.RESULTS There were two female(18%)and nine male(82%)patients in our series consisting of 11 patients.Their ages ranged from 18 to 66,and the mean±SD was 48.63±16.3.Considering the localization of the abscess,three anterior abscesses(27%),two lateral abscesses(18%),and six abscesses at the base of the tongue(54%)were detected.CONCLUSION Tongue abscesses can cause acute upper airway obstruction and respiratory collapse.It may be necessary to act quickly for the tracheotomy procedure and this procedure can usually be performed under local anesthesia as intubation cannot be achieved.When we encounter an abscess in an unexpected organ,difficulties may be encountered in the management of the patient.

Screening of active ingredients of Taohong Siwu Decoction on platelet membrane receptor

OBJECTIVE To screen the active ingredients preventing platelet aggregations from Taohong Siwu Decoction. METHODS Fresh blood from healthy adult volunteer was collected with vacuum tube for preparation of platelet suspension. Platelet suspension was incubated with Taohong Siwu Decoction for one hour at 37℃,then centrifuged. The precipitate was washed and desorbed with buffer solutions.The differences of chemical constituents between incubated and unincubated were identified with high performance liquid chromatography-diode array detector. RESULTS According to the chromatograph at 254 nm,at least three kinds of different components were detected in Taohong siwu decoction before and after incubated with platelet. CONCLUSION Platelet suspension can be used for screening active ingredients on platelet membrane receptor from the traditional Chinese medicine.

BLOOD PLATELETS AND OXIDIZED LOW DENSITY LIPOPROTEIN

Functional morphological alterations of human blood platelets induced by oxidatively modified low density lipoprotein (LDL) were studied with an in vitro model by means of electron microscopy, reflection contrast microscopy and quantitative image analysis. The oxidized LDL (50-300 μg/ml) induced the disc-sphere transformation of platelets, the formation of pseudopodia, centralization of granules and degranulation. Platelet plasma membrane was damaged by oxidized LDL leading to a lower electron density of he cytoplasm compared to controls. In an incubation chamber, oxidized LDL-treated platelets sedimented onto the

Correlation study between pre-operative platelet aggregation rate and peri-operative blood product application in patients with off-pump coronary artery bypass grafting

Objective To explore the impact of pre-operative platelet aggregation rate(PAR)on off-pump coronary artery bypass grafting(OPCABG),meanwhile to study the relationship between platelet function and blood product application during peri-operative period in relevant patients.Methods A total of 172 patients receiving OPCABG in our hospita from 2014-01 to 2015-09 were en-

Platelet Distribution Width on Admission Predicts In-Stent Restenosis in Patients with Coronary Artery Disease and Type 2 Diabetes Mellitus Treated with Percutaneous Coronary Intervention

Background： It is known that there is a definite association between platelet distribution width （PDW） and poor prognosis in patients with coronary artery disease （CAD） and type 2 diabetes mellitus （T2DM）. However, there are no data available regarding the prognostic significance of PDW for in-stent restenosis （ISR） in patients with CAD and T2DM. We aimed to determine the value of PDW on admission that predicted ISR in patients with CAD and T2DM. Methods： Between January 2012 and December 2013, a total of 5232 consecutive patients diagnosed with CAD and T2DM undergoing percutaneous coronary intervention were admitted. Three years of retrospective tbllow-up was undertaken. A total of 438 patients with second angiography operations were included. ISR was defined as ≥50% luminal stenosis of the stent or peri-stent segments. Continuous data were presented as the mean ± standard deviation or median （P25, P75） and were compared by one-way analysis of variance or Kruskal-Wallis H-test. Categorical variables were presented as percentages and were compared by Chi-square test or Fisher＇s exact test. The association between PDW and ISR was calculated by logistic regression analysis. A two-sided value of P 〈 0.05 was considered statistically significant. Statistical analyses were pertbrmed by SPSS version 22.0 for windows. Results： Fifty-nine patients with ISR, accounting for 13.5% of the total, were included. ISR was significantly more frequent in patients with higher PDW quartiles compared with lower quartiles. We observed that PDW had a strong relationship with mean platelet volume （r=0.6474 95% confidence interval [CI]： 0.535-0.750, P 〈 0.0001 ）. The receiver-operating characteristic curves showed that the PDW cutoffvalue for predicting ISR rate was 13.65 fl with sensitivity of 59.3% and specificity of 72.4% （area under curve [AUC] = 0.701,95% CI： 0.625-0.777, P 〈 0.001 ）. Multivariate analysis showed that the risk of ISR increased approximately 30% when PDW increased one unit （odds ratio [OR]： 1.289, 95% （7： I. 110 1.498, P = 0.001 ）. Patients with higher PDW, defined as more than 13.65 fl, had a 4-fold higher risk oflSR compared with lower PDW （OR： 4.241,95% CI： 1.879 9.572, P = 0.001 ）. Furthemlore, when patients were divided by PDW quartiles values, PDW was able to predict ISR （Q2： OR = 0.762, 95% CI： 0.189-3.062, P= 0.762; Q3： OR = 2.782, 95% CI：0.865 8.954, P = 0.086; and Q4： OR = 3.849, 95% CI： 1.225 12.097, P - 0.021, respectively; P for trend 〈0.0001 ）. Conclusion： PDW is an independent predictor of ISR in patients with CAD and T2DM.

Head to Head Comparison of Two Point-of-care Platelet Function Tests Used for Assessment of On-clopidogrel Platelet Reactivity in Chinese Acute Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention

Background：Platelet function tests are widely used in clinical practice to guide personalized antiplatelet therapy.In China,the thromboelastography （TEG） test has been well accepted in clinics,whereas VerifyNow,mainly used for scientific research,has not been used in routine clinical practice.The aim of the current study was to compare these two point-of-care platelet function tests and to analyze the consistency between the two tests for evaluating on-clopidogrel platelet reactivity in Chinese acute myocardial infarction patients undergoing percutaneous coronary intervention （PCI）.Methods：A total of 184 patients admitted to Fuwai Hospital between August 2014 and May 2015 were enrolled in the study.On-clopidogrel platelet reactivity was assessed 3 days after PCI by TEG and VerifyNow using adenosine diphosphate as an agonist.Based on the previous reports,an inhibition of platelet aggregation （IPA） 〈30% for TEG or a P2Y12 reaction unit （PRU） 〉230 for VerifyNow was defined as high on-clopidogrel platelet reactivity （HPR）.An IPA 〉70% or a PRU 〈178 was defined as low on-clopidogrel platelet reactivity （LPR）.Correlation and agreement between the two methods were analyzed using the Spearman correlation coefficient （r） and kappa value （κ）,respectively.Results：Our results showed that VerifyNow and TEG had a moderate but significant correlation in evaluating platelet reactivity （r =-0.511）.A significant although poor agreement （κ =0.225） in identifying HPR and a significantly moderate agreement in identifying LPR （κ =0.412） were observed between TEG and VerifyNow.By using TEG as the reference for comparison,the cutoffvalues of VerifyNow for the Chinese patients in this study were identified as PRU 〉205 for HPR and PRU 〈169 for LPR.Conclusions：By comparing VerifyNow to TEG which has been widely used in clinics,VerifyNow could be an attractive alternative to TEG for monitoring on-clopidogrel platelet reactivity in Chinese patients.

Protectin DX Exhibits Protective Effects in Mouse Model of Lipopolysaccharide-Induced Acute Lung Injury

Background：Acute lung injury （ALI） is a severe disease with high mortality and poor prognosis.Protectin DX （PDX）,a pro-resolving lipid mediator,exhibits protective effects in ALI.Our experiment aimed to explore the effects and related mechanisms of PDX in mice with ALI induced by lipopolysaccharide （LPS）.Methods：BALB/c mice were randomly divided into five groups：sham,LPS,LPS plus 1 ng ofPDX （LPS ＋ PDX-1 ng）,LPS plus 10 ng ofPDX （LPS ＋ PDX-10 ng）,and LPS plus 100 ng ofPDX （LPS ＋ PDX-100 ng）.Bronchoalveolar lavage fluids （BALFs） were collected after 24 h,and total cells,polymorphonuclear leukocytes,monocyte-macrophages,and lymphocytes in BALF were enumerated.The concentration of interleukin （IL）-1 β3,IL-6,IL-10,tumor necrosis factor-alpha （TNF-α）,macrophage inflammatory protein （MIP）-1 cα,and MIP-2 in BALF was determined,and histopathological changes of the lung were observed.The concentration of protein in BALF and lung wet/dry weight ratios were detected to evaluate pulmonary edema.After determining the optimal dose of PDX,neutrophil-platelet interactions in whole blood were evaluated by flow cytometry.Results：The highest dose of PDX （100 ng/mouse） failed to provide pulmonary protective effects,whereas lower doses of PDX （1 ng/mouse and 10 ng/mouse）,especially 1 ng PDX,alleviated pulmonary histopathological changes,mitigated LPS-induced ALI and pulmonary edema,inhibited neutrophil infiltration,and reduced pro-inflammatory mediator （IL-1β,IL-6,TNF-α,and MIP-lα） levels.Meanwhile,1 ng PDX exhibited pro-resolving functions in ALI including upregulation of monocyte-macrophage numbers and anti-inflammatory mediator IL-l 0 levels.The flow cytometry results showed that PDX could inhibit neutrophil-platelet interactions in ALI.Conclusion：PDX exerts protective effects in LPS-inducedALI by mitigating pulmonary inflammation and abrogating neutrophil-platelet interactions.