Revalidation of a prognostic score model based on complete blood count for nasopharyngeal carcinoma through a prospective study

Objective： In our previous work, we incorporated complete blood count （CBC） into TNM stage to develop a new prognostic score model, which was validated to improve prediction efficiency of TNM stage for nasopharyngeal carcinoma （NPC）. The purpose of this study was to revalidate the accuracy of the model, and its superiority to TNM stage, through data from a prospective study.Methods： CBC of 249 eligible patients from the 863 Program No. 2006AA02Z4B4 was evaluated. Prognostic index （PI） of each patient was calculated according to the score model. Then they were divided by the PI into three categories： the low-, intermediate-and high-risk patients. The 5-year disease-specific survival （DSS） of the three categories was compared by a log-rank test. The model and TNM stage （Tth edition） were compared on efficiency for predicting the 5-year DSS, through comparison of the area under curve （AUC） of their receiver-operating characteristic curves.Results： The 5-year DSS of the low-, intermediate- and high-risk patients were 96.0%, 79.1% and 62.2%, respectively. The low- and intermediate-risk patients had better DSS than the high-risk patients （P〈0.001 and P〈0.005, respectively）. And there was a trend of better DSS in the low-risk patients, compared with the intermediate-risk patients （P=0.049）. The AUC of the model was larger than that of TNM stage （0.726 vs. 0.661, P：0.023）. Conclusions： A CBC-based prognostic score model was revalidated to be accurate and superior to TNM stage on predicting 5-year DSS of NPC.

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.

Cardiorespiratory fitness,white blood cell count,and mortality in men and women

Background:We examined the associations of cardiorespiratory fitness(CRF) and white blood cell count(WBC) with mortality outcomes.Methods: A total of 52,056 apparently healthy adults completed a comprehensive health examination,including a maximal treadmill test and blood chemistry analyses.CRF was categorized as high,moderate,or low by age and sex;WBC was categorized as sex-specific quartiles.Results:During 17.8± 9.5 years(mean± SD) of follow-up,a total of 4088 deaths occurred.When regressed jointly,significantly decreased allcause mortality across CRF categories was observed within each quartile of WBC in men.Within WBC Quartile 1,all-cause mortality hazard ratios(HRs) with a 95% confidence interval(95%CI) were 1.0(referent),1.29(95%CI:1.06-1.57),and 2.03(95%CI:1.42-2.92) for high,moderate,and low CRF categories,respectively(p for trend <0.001).Similar trends were observed in the remaining 3 quartiles.With the exception of cardiovascular disease(CVD) mortality within Quartile 1(p for trend=0.743),there were also similar trends across CRF categories within WBC quartiles in men for both CVD and cancer mortality(p for trend <0.01 for all).For women,there were no significant trends across CRF categories for mortality outcomes within Quartiles 1-3.However,we observed significantly decreased all-cause mortality across CRF categories within WBC Quartile 4(HR=1.05(95%CI:0.76-1.44),HR=1.63(95%CI:1.20-2.21),and HR=1.87(95%CI:1.29-2.69) for high,moderate,and low CRF,respectively(p for trend=0.002)).Similar trends in women were observed for CVD and cancer mortality within WBC Quartile 4 only.Conclusion:There are strong joint associations between CRF,WBC,and all-cause,CVD,and cancer mortality in men;these associations are less consistent in women.

Laboratory Diagnosis of Acute Leukemia in Kenya: The Gaps and Opportunities

Acute leukemia (AL) is a malignant disease of the bone marrow in which hematopoietic precursors are arrested in an early stage of development. The diagnosis of leukemia and lymphomas, beyond morphology, is limited in low-resource countries including Kenya. Morphological diagnosis includes Cytological and Histological assessment of blood, bone marrow aspirates and tissues on suspected Acute leukemia patients. The World Health Organization (WHO, 2016) international guidelines on Acute leukemia diagnosis recommend that cytogenetic analysis, appropriate molecular genetics, Fluorescent in situ Hybridization (FISH) testing, and flow cytometric immuno-phenotyping should be done in addition to a morphologic assessment of Acute Leukemia. In facilities where resources are relatively available, immunophenotypic and genetic features have resulted not only in providing a more accurate leukemia diagnosis but also in identifying antigens or genes that can then be targeted for therapy. This article will look at the gaps in the diagnosis of Acute leukemia in low-resource settings like Kenya and opportunities available to improve diagnosis.

Coconut oil nanoemulsion attenuates methotrexate-induced hepatotoxicity and nephrotoxicity in Ehrlich ascites carcinoma-bearing mice

Objective:To evaluate the protective effect of the coconut oil nanoemulsion against methotrexate-induced hepatotoxicity and nephrotoxicity in Ehrlich ascites carcinoma-bearing Swiss albino mice.Methods:Forty mice were divided into four groups.GroupⅠserved as the untreated Ehrlich ascites carcinoma-bearing mice while Ehrlich ascites carcinoma-bearing mice in groupsⅡ–Ⅳreceived an intraperitoneal injection of 0.2 m L/kg coconut oil nanoemulsion,20 mg/kg methotrexate as well as 0.2 m L/kg coconut oil nanoemulsion mixed with 20 mg/kg methotrexate,respectively.The toxicities of the treatments were assessed by determining the complete blood count,performing the serum analysis for liver and kidney functions,evaluating the oxidative status and visualizing histological changes in the liver and kidney tissues.Results:Treatment with methotrexate and coconut oil nanoemulsion markedly diminished the liver parameters including aspartate aminotransferase,alanine aminotransferase,alkaline phosphatase,total protein,direct bilirubin and total bilirubin which were raised by methotrexate treatment(P<0.05).Similarly,creatinine and blood urea nitrogen,as the indicators of kidney function,were dramatically lowered in the combination treatment group compared to the methotrexate group(P<0.05).In addition,treatment with methotrexate and coconut oil nanoemulsion reduced the malondialdehyde and increased catalase,glutathione reductase and superoxide dismutase,in the liver and kidney tissues(P<0.05).The treatment with methotrexate and coconut oil nanoemulsion reduced white blood cell count and increased the hemoglobin amount(P<0.05),but did not cause any change in platelets and red blood cell count.Conclusions:Coconut oil nanoemulsion as a nanocarrier has great potential in reducing the adverse side effects induced by methotrexate.

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.

Development of the personalized criteria for microscopic review following four different series of hematology analyzer in a Chinese large scale hospital

Background A generally accepted guideline （＂41 rules＂） published by the International Consensus Group for Hematology Review （ICGHR） can not be suitable for all the laboratories because the facility type, laboratory requirements, sample volume, review rate, turn around time, instrument model and characters etc. are quite different from each other, which may cause a higher workload for microscopy review or lead to false or misleading results. Therefore, we decided to develop the personalized review criteria for 4 series of hematology analyzers in the same hospital, and describe all the implement procedures in detail. Methods The total 1770 blood samples were collected from Peking Union Medical College Hospital. Referring to the suggested criteria by international consensus group for hematology review （＂41 rules＂）, the personalized review criteria for 4 series of hematology analyzers including Siemens Advia 2120, Sysmex XE-2100, Sysmex XT-1800i and Sysmex XS-800i were established and validated by adjusting the rules in order to reduce the false positive rate and keep the false negative acceptable by clinical. Results Using the ＂41 rules＂, high review rates of 37.94%, 35.56%, 33.44% and 37.94% were got respectively in Siemens Advia 2120, Sysmex XE-2100, Sysmex XT-1800i and Sysmex XS-800i. Three false positive rules mainly were observed in all of 4 analyzers： white blood cell 〈3×10^9/L or 〉30×10^9/L, platelet 〈100×10^9/L or 〉1000×10^9/L and immature granulocyte. Specialized rules were observed in different series of analyzers, atypicaVvariant lymphs flag were found mainly in Sysmex XE-2100, Aniso-RBC were found mainly in Sysmex XT-1800i, flag of ＂immature granulocyte＂ mainly in Sysmex XS-800i, Micro-RBC, Macro-RBC and Aniso-RBC mainly in Siemens Advia 2120. Rules of immature granulocyte blast, and NRBC flag would be mainly triggered by hematology malignant tumor. We could not delete these rules due to the risk of false negative of serious disease, other rules were deleted or revised. After continually optimizing to the rules, we finalized the criteria suitable for Siemens Advia 2120, Sysmex XE-2100, Sysmex XT-1800i and Sysmex XS-800i in our laboratory. The false negative rates were 2.94%, 2.86%, 3.10% and 2.78%, the review rates were 31.07%, 30.00%, 30.01% and 30.09%, and there was no hematology malignant tumor missed. Validated by 547 samples, the false negative rates of our optimized rules were 0.37%, 0.55%, 0.55%, and 0.91% respectively. Conclusion The criteria can be based on the criteria established by International Consensus Group for Hematology Review but must be optimized according to the different requirements.