An exploration of the value of NLR, PLR, LMR, and WBC × CRP for the diagnosis and treatment of influenza B in adults.

The aim of the study was to study the diagnostic and therapeutic utility of NLR (neutrophil-to-lymphocyte ratio), LWR (lymphocyte-to-monocyte ratio), PLR (platelet-to-lymphocyte ratio), and WBC × CRP (WBC: white cell count, CRP: C-reactive protein) in patients with influenza B. This retrospective study included 122 adult patients with influenza B, 176 adult patients with bacterial infection, and 119 adult healthy physical examinees for routine blood examination and CRP testing, calculation of NLR, LMR, PLR, and WBC × CRP for relevant statistical analysis, monitoring of NLR, LMR, PLR and WBC × CRP in patients with influenza B during relevant treatment. All indicators, except for WBC and NLR, had no statistical differences between the influenza B group, the normal control group, and the influenza B group and bacterial infection group, respectively, and showed no statistical significance for the differences between the groups. The diagnostic effect of LMR and WBC × CRP was deemed good or excellent in patients with influenza B, healthy people, and patients with a bacterial infection. Conversely, NLR and PLR could only distinguish patients with influenza B from healthy people but remained unable to identify different pathogens. Moreover, many false negatives were noted for WBC and CRP during the diagnosis of influenza B. Also, NLR, LMR, PLR, and WBC × CRP exerted a good effect in evaluating curative effect and conditions for influenza B. LMR and WBC × CRP have a relatively high value in the early diagnosis of adults suffering from influenza B. Also, NLR and PLR excelled at differentiating adult patients with influenza B from healthy people. Therefore, NLR, PLR, LMR, and WBC × CRP can all be used for disease course monitoring and efficacy evaluation.

Comparison of various surrogate markers for venous congestion in predicting acute kidney injury following cardiac surgery: A cohort study.

BACKGROUND: Venous congestion has been demonstrated to increase the risk of acute kidney injury (AKI) after cardiac surgery. Although many surrogate markers for venous congestion are currently used in clinical settings, there is no consensus on which marker is most effective in predicting AKI. METHODS: We evaluated various markers of venous congestion, including central venous pressure (CVP), inferior vena cava (IVC) diameter, portal pulsatility fraction (PPF), hepatic vein flow pattern (HVF), intra-renal venous flow pattern (IRVF), and venous excess ultrasound grading score (VExUS) in adult patients undergoing cardiac surgery to compare their ability in predicting AKI. RESULTS: Among the 230 patients enrolled in our study, 53 (23.0%) developed AKI, and 11 (4.8%) required continuous renal replacement therapy (CRRT). Our multivariate logistic analysis revealed that IRVF, PPF, HVF, and CVP were significantly associated with AKI, with IRVF being the strongest predictor (odds ratio [OR] 2.27; 95% confidence interval [CI], 1.38-3.73). However, we did not observe any association between these markers and CRRT. CONCLUSION: Venous congestion is associated with AKI after cardiac surgery, but not necessarily with CRRT. Among the markers tested, IRVF exhibits the strongest correlation with AKI.

Comprehensive improvements in the emergency laboratory test process based on information technology.

OBJECTIVE: To explore the application effects of information technology (IT) on emergency laboratory testing procedures. METHODS: In this study, IT-based optimisation of the emergency laboratory testing process was implemented between October and December 2021. Thus, the emergency laboratory test reports from January to September 2021 were placed into the pre-optimised group, while those from January to September 2022 were categorised into the post-optimised group. Besides, the emergency laboratory test report time, emergency laboratory test report time limit coincidence rate, error rate, and employee and patient satisfaction levels in individual months and across the whole period were described. Moreover, changes in the above indicators before and after the implementation of IT-based optimisation were explored and the application effects of IT-based optimisation were also evaluated. RESULTS: The emergency laboratory test report times after the implementation of IT-based optimisation were shorter than those before IT-based optimisation (P < 0.05). The total number of laboratory test items before and after information optimization amounted to 222,139 and 259,651, respectively. Also, IT-based optimisation led to an increase in the emergency laboratory test report time limit coincidence rate from 98.77% to 99.03% (P < 0.05), while the emergency laboratory test report error rate fell from 0.77‱ to 0.15‱ (P < 0.05). Additionally, IT-based optimisation resulted in increases in both employee satisfaction, from 80.65% to 93.55% (N = 31, P > 0.05), and patient satisfaction, from 93.06% to 98.44% (P < 0.05). CONCLUSION: The automation and IT-based optimisation of the emergency laboratory testing process significantly reduces the emergency laboratory test report time and error rate. Additionally, IT-driven optimization enhances the alignment of emergency laboratory test report deadlines and enhances the overall quality and safety of emergency laboratory testing.

Comprehensive interventions to reduce occupational hazards among medical staff in the pathology department of five primary hospitals.

OBJECTIVE: To explore comprehensive interventions to reduce occupational hazards among medical staff in the pathology department of five primary hospitals. METHODS: The indoor air quality in the pathology department of five primary hospitals and the health status of staff were investigated and analyzed. Formaldehyde and benzene concentrations in the technical and diagnostic rooms of the pathology departments were analyzed before and after comprehensive interventions. The Environmental Protection Agency risk assessment paradigm was used to assess the health risks from occupational exposure to benzene and formaldehyde. Consequently, considering the local environment, targeted comprehensive intervention measures were developed, including optimizing management, raising awareness, updating equipment, and replacing reagents. RESULTS: Eye discomfort was higher among technicians in the pathology department than among clinical medical staff (P < 0.05). Before comprehensive interventions, formaldehyde concentrations were higher in the technical room than in the diagnostic room at the five primary hospitals (P < 0.05). However, compared to before interventions, formaldehyde and benzene concentrations in both rooms were significantly lower after comprehensive interventions. Furthermore, although medium risks of occupational exposure to benzene and formaldehyde remained in both rooms before and after comprehensive interventions, the risk values before interventions were higher than after comprehensive interventions. The staff of the technical rooms showed higher risk values that those of the diagnostic rooms before and after comprehensive interventions. Similarly, although hazard quotient (HQ) values for occupational exposure to benzene and formaldehyde were < 1 in both the technical and diagnostic rooms before and after comprehensive interventions, with lower noncarcinogenic risks, the values were higher before than after comprehensive interventions. Moreover, staff in the technical room had higher HQ values before and after comprehensive interventions than those in the diagnostic room. The use of environmentally friendly reagents for the preparation of frozen sections was effective. CONCLUSION: Comprehensive interventions significantly reduced occupational hazards among staff at the pathology department of five primary hospitals, which is of great practical significance to protect the health of staff.

The Predictive Value of Heparin-Binding Protein and D-Dimer in Patients with Sepsis.

Objective: To explore the serial measurement of heparin-binding protein and D-dimer in the prediction of 28-day mortality and efficacy evaluation of critically-ill patients with sepsis. Methods: We recruited a total of 51 patients with sepsis in the ICU of our hospital. They were divided into a survival group or a death group according to their prognosis 28 days after treatment. The HBP and D-dimer levels in these patients were determined on the 1st (24h), 3rd, and 5th days. Besides, the sequential organ failure assessment (SOFA) score of these patients was recorded at admission. The patients in both groups were subjected to comparison regarding HBP and D-dimer levels and SOFA scores within 24h of admission. Additionally, a correlation between the levels of HBP and D-dimer and the SOFA score was statistically measured, while the predictive effectiveness of these factors for the prognosis of patients with sepsis was also determined. Moreover, the dynamic changes in HBP and D-dimer during the treatment of both groups were analyzed. Results: The HBP and D-dimer levels and the SOFA scores in the survival group were considerably lower than those in the death group, and the differences were statistically significant (P<0.05). Additionally, the levels of HBP and D-dimer in sepsis patients were positively correlated with the SOFA score (P<0.05). The area under the curve (AUC) of HBP, D-dimer, and their combination in predicting the prognosis of patients with sepsis was 0.824, 0.771, and 0.830, respectively. Besides, the sensitivity and specificity of their combination in predicting the prognosis of patients with sepsis were 68.42% and 92.31%, respectively. The HBP and D-dimer levels presented a downward trend in the survival group during treatment, while they exhibited an upward trend in the death group. Conclusion: HBP and D-dimer realize high predictive effectiveness for the prognosis of patients with sepsis, while the combined use of these two factors achieves superior effectiveness. Thus, they can be applied to the prediction of 28-day mortality and efficacy evaluation of sepsis patients.

Application of Jiawei Maxing Shigan Tang in the treatment of COVID-19: An observational study.

Objective: To explore the clinical efficacy and adverse reactions of Jiawei Maxing Shigan Tang (JMST; a modified decoction of ephedra, apricot kernel, gypsum, and licorice) combined with western medicine in the symptomatic treatment of COVID-19. Methods: In this study, we retrospectively collected the basic data of 48 patients with COVID-19 who were discharged from our hospital between January 20 and February 28, 2020. Besides, the blood routines, biochemical indexes, nucleic acid detection results, clinical symptoms, lung imaging improvements, adverse reactions, and other clinical data of these patients before and after treatment were recorded. Finally, we drew comparisons between the outcomes and adverse reactions of patients in the combined treatment group (therapeutic regimen recommended by authoritative guidelines and supplemented by JMST) and the conventional treatment group (therapeutic regimen recommended by authoritative guidelines). Results: There were no significant differences in age, gender, clinical classification, and underlying medical conditions between the combined treatment group (28 cases) and the conventional treatment group (20 cases). However, the combined treatment group presented superior results to the conventional treatment group in several key areas. For instance, patients produced negative nasal/throat swab-based nucleic acid detection results in a shorter time, clinical symptoms were more effectively alleviated, and the absorption time of lung exudation was shorter (P < 0.05). Furthermore, the combined treatment group had a shorter length of stay (LOS) and faster lymphocyte recovery duration than the conventional treatment group, although the differences were not statistically significant. Moreover, there were no significant differences concerning gastrointestinal reaction, hepatic injury, renal impairment, myocardial injury, and other adverse reactions between the two groups. Conclusion: The results of this study indicate that JMST combined with the recommended therapeutic regimen enhances the recovery of COVID-19 patients without increasing the risk of adverse reactions. Therefore, this therapy promotes positive outcomes for COVID-19 patients.

Establishment and Evaluation of an Internal Quality Control Method for ESR Relays.

Objective: This study establish and evaluate an internal quality control system for erythrocyte sedimentation rate (ESR) by a "relay" mode based on samples from relevant patients. Methods: The method for establishing a new internal quality control system for ESR by a "relay" mode based on patient's samples was executed from February 2021 to July 2021. In this paper, a total of 219 outpatients were recruited for ESR determination, and their blood samples were stored at 4 °C or room temperature for 24 h. Subsequently, the samples were re-measured for ESR, and the re-measured values were compared with the initial values. The patient samples (15±1mm/h and 50±3mm/h) were selected after the TEST1 ESR analyzer was calibrated, and were stored overnight at 4 °C and measured again the following day. The percentage deviation was determined and entered into the quality control management module for internal quality control. Next, we analyzed the median distribution trend of the patients' ESR values measured by our laboratory every day over five months, as well as the external quality assessment (EQA) results for ESR obtained from the National Center for Clinical Laboratories (NCCL). Results: The ESR of the room temperature samples after 24 h of storage had significantly decreased (P=0.001), while there was no noticeable difference for those stored at 4 °C (P=0.197). Results of the internal quality control in March were satisfactory, and there was no significant deviation in the median ESR relay results within five months. Besides, the EQA results for the ESR data obtained from NCCL were excellent. Conclusion: As a precise and practical new method, the ESR relay internal quality control method can be used to scientifically determine the stability and accuracy of the TEST1 ESR analyzer.

Preparation of ethyl levulinate from wheat stalk over Zr(SO4)2/SiO2.

A series of Zr(SO4)2/SiO2 solid acid catalysts with different Zr(SO4)2 loadings were prepared by water-soluble-impregnation method at room temperature. Then, the prepared catalysts were characterized by Fourier transform infrared spectroscopy, transmission electron microscopy and energy-dispersive X-ray spectrum, X-ray diffraction, adsorption/desorption of N2, and temperature-programmed desorption of NH3. The results showed that the active component Zr(SO4)2 was successfully adhered to the mesoporous SiO2, and the acid amount of Zr(SO4)2/SiO2 increased with the increasing of the Zr(SO4)2 loadings. Finally, the wheat stalk was used as raw material and depolymerized over Zr(SO4)2/SiO2 to produce ethyl levulinate (EL). The reaction mixture was separated and purified by filtration and vacuum distillation. The kinetic characteristics and the reaction pathway were also studied. A comparative study showed that 20 wt.% Zr(SO4)2/SiO2 exhibited higher catalytic activity. When reaction temperature, time, catalyst dosage and Zr(SO4)2 loadings were 190 °C, 50 min, 20 wt.% and 30 wt.%, the EL yield reached a maximum of 17.14%. The relative content of EL exceeded 90% after three steps of distillation.

Service Quality Improvement of Outpatient Blood Collection by Lean Management.

OBJECTIVE: To explore the application effect of lean management in improving the quality of outpatient blood collection services. METHODS: For this study, a total of 146,907 patients whose blood was sampled by outpatient services between April 2020 and September 2020 were selected. We analyzed the influence of various factors on the waiting time and satisfaction levels of the patients for blood collection and eliminated confounders based on the results of the analysis. Lean management for the outpatient blood collection service was implemented in July 2020. Thus, the 38,275 cases sampled on weekday mornings between April and June 2020 were selected as the ordinary management group, while the 39,473 cases sampled on weekday mornings between July and September 2020 belonged to the lean management group. Finally, the changes in waiting time and the satisfaction levels of the patients were evaluated. RESULTS: The age and gender of the patients and the length of service of the staff, who administered blood collection had a negligible effect on the waiting time (Z=-1.243, P=0.418; Z=-1.569, P=0.389; Z = -1.062, P= 0.563), while there was a statistical difference in the waiting time between different days and different sessions (Z = -2.581, P = 0.013 and Z = -4.672, P < 0.001). We also found that the length of service of blood collection staff, day, session, and age and gender of patients did not have a meaningful effect on patient satisfaction (P > 0.05). Overall, the median waiting time of outpatients decreased from 22 min to 13 min after the implementation of lean management (Z =10.522, P < 0.001), while the satisfaction level of outpatients increased from 95.37% to 98.33% (χ 2 = 559.580, P < 0.001). CONCLUSION: The application of lean management can significantly shorten outpatient waiting time for blood collection, improve patients satisfaction levels, and enhance the overall patient experience. Thus, lean management can significantly improve the service quality of outpatient blood collection.

The Diagnostic and Therapeutic Value of the Detection of Serum Amyloid A and C-Reactive Protein in Infants with Rotavirus Diarrhea.

OBJECTIVE: This study explores the significance of serum amyloid A (SAA), C-reactive protein (CRP), and white blood cell (WBC) in the diagnosis and treatment of diarrhea in infants. METHODS: Specimens were collected from 126 children with diarrhea and 66 healthy children undergoing health examination. According to the results of stool culture and rotavirus (RV) antigen, these children were divided into three groups: rotavirus group (70 cases), bacterial infection (56 cases), and control groups (66 cases). On the fourth day of admission, children in the RV group underwent stool culture again. Based on the subsequent results, they were further divided into two groups, ie, no secondary bacterial infection and secondary bacterial infection groups. The levels of RV antigen, bacterial antigen, SAA, CRP, and WBC were detected in all children. Then, ROC curve analysis was performed to determine the diagnostic efficacy of SAA, CRP and WBC. RESULTS: The levels of SAA, CRP, and WBC for the RV group were lower than those of the bacterial infection group, but higher compared with the control group (P<0.05). The diagnostic efficacy of SAA was higher than that of CRP and WBC, with the area under the curve of 0.876, 0.803, and 0.765, respectively. The positive and negative predictive values, specificity, and sensitivity of SAA were slightly better compared with CRP and WBC. The SAA, CRP, and WBC levels of children with a bacterial infection in the RV group on the fourth and seventh days after admission were also significantly higher compared with children without bacterial infection. CONCLUSION: Serum amyloid A, CRP, and WBC levels had a high value in the differential diagnosis of infantile diarrhea. As such, they can be used in the early diagnosis and curative efficacy assessment of children with diarrhea.

The Value of Combined Serum Amyloid A Protein and Neutrophil-to-Lymphocyte Ratio Testing in the Diagnosis and Treatment of Influenza A in Children.

OBJECTIVE: The aim of this study was to explore the value of serum amyloid A protein (SAA) and neutrophil-to-lymphocyte ratio (NLR) testing in the diagnosis and treatment of children with influenza A. METHODS: Specimens were collected from 85 children with influenza A, 85 children with a bacterial infection, and 86 healthy children. The levels of SAA and C-reactive protein (CRP) were measured, and routine blood tests were performed. RESULTS: The levels of SAA and CRP in the bacterial infection group were significantly higher than those in the influenza A group, and the levels in the influenza A group were higher than those in the healthy children. The NLR level in the influenza A group was not different from that in the bacterial infection group, but the NLR levels in the influenza A group and the bacterial infection group were higher than that in the healthy controls. The number of white blood cell (WBC) in the influenza A group was not different from that in healthy children, while the WBC counts in the control and bacterial infection groups were higher than that in the influenza A group. The distribution width of red blood cells in the bacterial infection group was higher than that in healthy controls. The receiver operating characteristic curve analysis showed that the area under the curve for the diagnoses of influenza A for SAA, NLR, and CRP was 0.806, 0.768, and 0.699, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of SAA/NLR (SAA and NLR in the series) were 68.24%/76.47% (57.65%), 84.88%/72.09% (96.76%), 81.69%/73.03% (96.08%), 73.00%/75.61% (70.00%), and 76.61%/74.27% (77.78%), respectively. CONCLUSION: In the early diagnosis of children with influenza A, the values of SAA and NLR are high. Thus, they could be used for monitoring and efficacy evaluation during the course of the disease.

The Value of Serum Amyloid A in the Diagnosis and Management of Ankylosing Spondylitis.

OBJECTIVE: The present study aimed to explore the clinical value of serum amyloid A (SAA) in the diagnosis, treatment, and assessment of ankylosing spondylitis (AS). METHODS: Seventy-eight patients with AS were enrolled as the case group, while the control group consisted of 80 healthy individuals enrolled during the same time period. According to the criteria of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), patients in the case group were divided into those in the remission phase (36 patients) and those in the active phase (42 patients). Levels of SAA, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were measured in all enrolled subjects and analyzed. RESULTS: SAA levels were significantly higher in the AS group (39.65 ± 12.32 ng/mL) than in the control group (7.64 ± 1.32 ng/mL) (p =0.011) and in patients in the active phase (56.18 ± 17.25 ng/mL) compared with those in the remission phase (20.36 ± 5.36 ng/mL) (p =0.015). The sensitivity and specificity of SAA were 79.49% and 77.50%, respectively. There was a positive correlation between SAA level and the BASDAI grade (r = 0.77, p =0.005), CRP level (r = 0.68, p =0.011), and ESR (r = 0.62, p =0.012). CONCLUSION: Not only is SAA a reliable indicator for the presence of AS, it may also be useful for monitoring the activity of this disease.

The Application of the EP9-A Protocol in the Analysis of the Performance of the Immunofluorescence Assay for HCG Detection.

OBJECTIVE: The present study aims to evaluate the comparability of the results of two methodologies for detecting human chorionic gonadotropin (HCG) to assess whether the immunofluorescence method for detecting HCG is adequate for clinical applications. METHODS: Referring to the protocol requirements of the American Clinical Laboratory Standards Institute (CLSI) EP9-A2 (methodological matching and bias assessment with patient samples), we collected 40 fresh serum specimens from our outpatients and inpatients, including 20 specimens with abnormal HCG concentrations (eight samples with different concentration ranges were selected daily and HCG was measured simultaneously with the two testing systems for five consecutive days). The assays were performed on a Dxl 800 fully automated immunoassay analyzer from Beckman Coulter Inc., USA, as a comparative method and on a Jet-iStar 3000 immunoassay analyzer from Zhonghan Shengtai Inc. as an experimental method. Methodological comparison and bias assessment of the results of the two methods for HCG detection were performed. The OLR regression model was used for calculating bias and regression analysis, and Spearman's rank correlation coefficient was used for correlation analysis. The correlation and comparability of the two systems were calculated based on the results of the analysis. RESULTS: A good correlation in HCG results in the range of 5-50,000 U/mL was obtained from the two assay systems (r = 0.998) with the regression equation of y = 1.020x + 12.96. The estimated deviation was within the permissible deviation and acceptable. CONCLUSION: The results of HCG measurement by the two different assay systems were well correlated and comparable.

Acute respiratory distress syndrome emerging after surgical debridement in a patient with extranodal natural killer/T cell lymphoma.

BACKGROUND: Extranodal natural killer/T cell lymphoma (ENKL) is a rare subtype of non-Hodgkin lymphoma, and lung involvement is extremely rare. The patients with pulmonary ENKL always presented unspecific symptoms of the respiratory system, such as cough with sputum and varying degrees of fever, while developing into acute respiratory distress (ARDS) was seldomly reported, especially promoted by the surgical procedure. CASE PRESENTATION: Here we describe a patient with nasal ENKL and most likely lung dissemination that was regarded as an infection at first. After nonresponse to a period of anti-infective therapy, this patient received surgical debridement. While the histopathology did not show the evidence of infection, but consistent with ENKL. The patient got refractory hypoxemia rapidly after surgery, with the LDH surging to a much higher level than before surgery. The ARDS was diagnosed, and he died on the 5th day after surgery. We postulate that ARDS was due to aggressive lymphoma proliferation promoted by the surgical procedure. CONCLUSIONS: Pulmonary ENKL developing into ARDS was scarce, and was likely attributed to the aggressive tumor cell proliferation after surgery in this case.

Efficacy of Early Percutaneous Catheter Drainage in Acute Pancreatitis of Varying Severity Associated With Sterile Acute Inflammatory Pancreatic Fluid Collection.

OBJECTIVE: The aim of the study was to evaluate the efficacy of early percutaneous catheter drainage (PCD) for sterile acute inflammatory pancreatic fluid collection (AIPFC) in acute pancreatitis (AP) of varying severity. METHODS: Retrospective analyses were performed based on the presence of sterile AIPFC and different AP severities according to 2012 Revised Atlanta Classification. RESULTS: Early PCD contributed to obvious decreases in operation rate (OR, P = 0.006), infection rate (IR, P = 0.020), and mortality (P = 0.009) in severe AP (SAP). In moderate SAP with sterile AIPFCs, however, early PCD was associated with increased OR (P = 0.009) and IR (P = 0.040). Subgroup analysis revealed that early PCD led to remarkable decreases in OR for patients with persistent organ failure (OF) within 3 days (P = 0.024 for single OF, P = 0.039 for multiple OF) and in mortality for patients with multiple OF (P = 0.041 for OF within 3 days and P = 0.055 for 3-14 days). Moreover, lower mortality was found in SAP patients with early PCD-induced infections than with spontaneous infections (P = 0.027). CONCLUSIONS: Early PCD may improve the prognosis of SAP with drainable sterile AIPFCs by reducing the OR, IR, and mortality.