Validation of the New MINI-CUBE for Clinic Determination of Erythrocyte Sedimentation Rate.

Background: Erythrocyte sedimentation rate (ESR) indirectly measures blood fibrinogen, and it is altered by all those pathological conditions that modify the aggregation of red blood cells. The international guidelines by the International Council for Standardization in Hematology (ICSH) define the Westergren method as the gold standard for ESR, although it is completely operator-dependent, time-consuming, and requires a patient's blood consumption. Therefore, the validation of new ESR analyzers is needed. The aim of this study is the validation of a new automated ESR analyzer, MINI-CUBE (DIESSE, Diagnostica Senese, Italy). Methods: The samples (n = 270) were collected at the University Hospital of the University of Rome Tor Vergata. A comparison between the automated instrument and the gold standard was performed. Statistical analyses were processed by MedCalc software. Results: The comparison analysis performed on the overall samples reported a good agreement, showing a Spearman rank correlation coefficient of 0.94 (P < 0.001), compared to the Westergren test. The Bland-Altman analysis showed a mean bias of 1.5 (maximum (max.):19.6; minimum (min.): -16.6). Inter-run (level 1 coefficient of variation (CV): 4.9%; level 2 CV: 0.8%), intra-run (level 1 CV: 21.1%; level 2 CV: 3.2%), and inter-instrument (level 1 CV: 27.1%; level 2 CV: 5.6%) precision were also assessed. The hematocrit value did not interfere with the analysis: Spearman rank correlation coefficient of 0.929 (P < 0.001); mean bias of 1.3 (max.:18.3; min.: -15.6). Conclusions: Overall results from MINI-CUBE asserted a good correlation rate with the gold standard, and it could be considered an accurate, and objective alternative for the Westergren test.

The role of miR1 and miR133a in new-onset atrial fibrillation after acute myocardial infarction.

BACKGROUND: The development of new-onset atrial fibrillation (NOAF) after acute myocardial infarction (AMI) is a clinical complication that requires a better understanding of the causative risk factors. This study aimed to explore the risk factors and the expression and function of miR-1 and miR-133a in new atrial fibrillation after AMI. METHODS: We collected clinical data from 172 patients with AMI treated with emergency percutaneous coronary intervention (PCI) between October 2021 and October 2022. Independent predictors of NOAF were determined using binary logistic univariate and multivariate regression analyses. The predictive value of NOAF was assessed using the area under the receiver operating characteristic (ROC) curve for related risk factors. In total, 172 venous blood samples were collected preoperatively and on the first day postoperatively; the expression levels of miR-1 and miR-133a were determined using the polymerase chain reaction. The clinical significance of miR-1 and miR-133a expression levels was determined by Spearman correlation analysis. RESULTS: The Glasgow prognostic score, left atrial diameter, and infarct area were significant independent risk factors for NOAF after AMI. We observed that the expression levels of miR-1 and miR-133a were significantly higher in the NOAF group than in the non-NOAF group. On postoperative day 1, strong associations were found between miR-133a expression levels and the neutrophil ratio and between miR-1 expression levels and an increased left atrial diameter. CONCLUSIONS: Our findings indicate that the mechanism of NOAF after AMI may include an inflammatory response associated with an increased miR-1-related mechanism. Conversely, miR-133a could play a protective role in this clinical condition.

Analysis of the characteristics of blood lipid metabolism in twin pregnancy.

To investigate the characteristics of blood lipid metabolism in twin pregnancy combined with gestational diabetes mellitus (GDM) or pregnancy-induced hypertension (PIH). This study retrospectively analyzed 96 cases of twin pregnancy and 232 cases of full-term singleton pregnancy. General data and blood lipid levels, including triglyceride (TG) and total cholesterol (TC), between twin and singleton pregnancies were compared. Blood lipid levels between GDM (PIH) and non-GDM (non-PIH) groups in twin pregnancy were compared. The TG level for twin pregnancy was higher than that for singleton pregnancy (p<0.05), while there was no significant difference in the TC level between them (p>0.05). The TG level in the GDM group was higher than that in the non-GDM group (p<0.05), while the TC level in the GDM group was not different from that in the non-GDM group (p>0.05). The TG level in the PIH group was higher than that in the non-PIH group (p<0.05), while there was no difference in the TC level between them (p>0.05). Logistic regression analysis showed that age was a risk factor for GDM and PIH in singleton and twin pregnancies. The lipid levels in twin pregnancy increased with the increase of gestational age, and the TG level in twin pregnancy complicated with GDM or PIH was higher than that in twin pregnancy without GDM or PIH, indicating that the blood lipid metabolism was related to the occurrence of GDM and PIH in twin pregnancy to some extent.

The relationship between albumin, erythrocyte sedimentation rate, platelet/lymphocyte ratio, neutrophil/lymphocyte ratio and the degree of coronary artery disease in children with Kawasaki disease / 中国医师杂志

Objective:To explore the relationship between serum albumin (ALB), erythrocyte sedimentation rate (ESR), platelet/lymphocyte ratio (PLR), neutrophil/lymphocyte ratio (NLR) and coronary artery disease in children with Kawasaki disease (KD).Methods:120 KD children diagnosed in the Affiliated Hospital of Jining Medical College from December 2016 to November 2021 were selected as the research objects. They were divided into observation group (KD with coronary artery disease) and control group (KD with coronary artery disease) according to whether they had coronary artery disease, with 60 cases in each group; the serum ALB, ESR, PLR, NLR values of the two groups of children were compared. Receiver operating characteristic (ROC) curve was used to analyze the value of the above indicators in diagnosing KD children with coronary artery disease. The serum ALB, ESR, PLR, NLR levels of KD children with different degrees of coronary artery disease were analyzed.Results:The main manifestations of coronary artery disease in 60 children with KD combined with coronary artery disease were left main coronary artery and left anterior descending branch widening [56.67%(34/60)], left main coronary artery and left anterior descending branch widening [20.00%(12/60)], left anterior descending branch widening [16.67%(10/60)], left main coronary artery widening [11.67%(7/60)]. The serum ALB in the observation group was significantly lower than that in the control group ( P<0.05), and ESR was significantly higher than that in the control group ( P<0.05). There was no significant difference in serum PLR and NLR between observation group and control group (all P>0.05). The sensitivity, specificity and area under curve (AUC) value of serum ALB in diagnosing coronary artery disease in KD children were 73.61%, 78.42% and 0.813 respectively; The sensitivity, specificity and AUC of ESR in diagnosing coronary artery disease in KD children were 88.36%, 83.14% and 0.892 respectively; The sensitivity, specificity and AUC value of ESR combined with ALB in diagnosing coronary artery disease in KD children were 90.67%, 97.54% and 0.953 respectively. Among 60 children with KD complicated with coronary artery disease, 39 were diagnosed as coronary artery dilatation and 21 had coronary artery aneurysm. The serum ALB of children in the coronary artery aneurysm group was significantly lower than that in the coronary artery dilatation group ( P<0.05), and ESR was significantly higher than that in the coronary artery dilatation group ( P<0.05). There was no significant difference in PLR and NLR between the coronary artery aneurysm group and the coronary artery dilatation group (all P>0.05). Conclusions:Children with KD and coronary artery disease have lower serum ALB levels and higher ESR level. The above two indicators are of great value for the diagnosis of children with KD and coronary artery disease.

Clinical efficacy of etocoxib combined with low dose colchicine in the treatment of acute gouty arthritis in 37 patients / 中国基层医药

Objective:To investigate the clinical efficacy of etocoxib combined with low-dose colchicine in the treatment of acute gouty arthritis in 37 patients.Methods:A total of 74 patients with acute gouty arthritis who received treatment in The Second People's Hospital of Liaocheng from October 2019 to October 2021 were included in this study. They were randomly assigned to undergo treatment with etocoxib alone (control group, n = 37) or etocoxib combined with low-dose colchicine (observation group, n = 37). All patients were treated for 1 week. Clinical efficacy, Visual Analogue Scale score, laboratory indicators, incidence of adverse reactions, and Quality of Life Comprehensive Assessment Questionnaire-74 score were compared between the two groups. Results:The total response rate in the observation group was significantly higher than that in the control group [95% (35/37) vs. 65% (24/37)]. At 1, 3, and 6 days after treatment, the Visual Analogue Scale score in the observation group was significantly lower than that in the control group ( t = 19.77, 15.43, 29.01, all P < 0.001). After treatment, blood uric acid, C-reactive protein, and erythrocyte sedimentation rate in the observation group was (432.26 ± 31.26) μmol/L, (16.25 ± 1.62) mg/L, (31.26 ± 1.25) mm/h, respectively, which was significantly lower than (485.26 ± 39.62) μmol/L, (45.26 ± 3.88) mg/L, (46.52 ± 2.82) mm/h in the control group ( t = 6.39, 41.97, 30.09, all P < 0.001). Quality of Life Comprehensive Assessment Questionnaire-74 score in the observation group was significantly higher than that in the control group ( t = 13.41, 17.73, 16.09, 11.77, all P < 0.001). There was no significant difference in the incidence of adverse reactions between the two groups ( P > 0.05). Conclusion:Etocoxib combined with low-dose colchicine can effectively reduce pain and inflammatory reactions in patients with acute gouty arthritis and improve quality of life, with a low incidence of adverse reactions.

Analysis of misdiagnosed cases of neck, shoulder, waist and leg pain caused by bone metastases and early warning measures / 中国基层医药

Objective:To investigate the cause of misdiagnosis of neck, shoulder, waist, and leg pain caused by bone metastases and to improve the outpatient diagnosis rate.Methods:Five misdiagnosed cases of bone metastases who were admitted to the Traditional Chinese Medicine Department of Orthopedics and Traumatology, School of Traditional Chinese Medicine, Southern Medical University from January 2019 to July 2020 were included in this study. Their clinical manifestations, diagnosis results (outside hospital diagnosis and outpatient diagnosis), and imaging manifestations were retrospectively analyzed.Results:Five cases of bone metastases were misdiagnosed to have cervical spondylosis, lumbar disc herniation, femoral head necrosis, femoral shaft fracture, and ankle sprain. Accelerated red blood cell sedimentation rate and increased C-reactive protein level were found in all five cases. Bone metastases were confirmed by X-ray, CT, and MRI examination results. All of them had warning signs for bone metastasis: age > 50 years, history of a tumor, unexplained weight loss, general malaise, neck, shoulder, waist, and leg pain without an obvious cause, sudden worsening of pain, night pain, resting pain, pain on direct palpation, no obvious improvements in these symptoms after symptomatic treatment for 1 month, disease development not conforming to the general law of cervical spondylosis, lumbar disc herniation, femoral head necrosis, femoral shaft fracture, and ankle sprain, increases in red blood cell sedimentation rate, C-reactive protein, and alkaline phosphatase levels, which are not consistent with the symptoms of cervical spondylosis, lumbar disc herniation, femoral head necrosis, femoral shaft fracture, and ankle sprain, and slight external force leading to fractures.Conclusion:Further tests and imaging examinations should be performed according to warning signs. Clinical schemes of malignant bone tumors suitable for general practitioners can easily, economically, and effectively identify malignant bone tumors.

The diagnostic value of some inflammatory markers for knee joint periprosthetic joint infection / 中华骨科杂志

Objective:To investigate the diagnostic value of erythrocyte sedimentation rate/C-reactive protein (ECR), fibrinogen and D-dimer in periprosthetic infection after artificial knee replacement.Methods:A total of 205 patients, including 62 males and 143 females, aged 66.9±9.5 years (range 26-84 years), who underwent revision of artificial knee joint at Department of Joint Surgery, The First Affiliated Hospital of Xinjiang Medical University from January 2017 to December 2021 were retrospectively collected.122 cases of periprosthetic joint infection (PJI), including 43 cases of acute infection; 79 cases of chronic infection (13 cases of chronic infection combined with rheumatoid arthritis were analyzed separately); there were 83 cases without PJI, including 73 cases of aseptic loosening, 8 cases of prosthesis dislocation and 2 cases of joint stiffness. Erythrocyte sedimentation rate, C-reactive protein, white blood cell count, fibrinogen and D-dimer levels were examined before surgery, and the sensitivity and specificity of the indicators were calculated using the receiver operating characteristic (ROC) curve. The diagnostic value of different inflammatory markers was compared according to the area under curve (AUC).Results:The levels of ECR, erythrocyte sedimentation rate, C-reactive protein, fibrinogen, and D-dimer in acute PJI group were 2.47±2.91, 50 (38, 62) mm/1 h, 31.6 (13.9, 79.3) mg/L, 4.25±0.94 g/L, 763 (453, 1 157) ng/ml, respectively. The chronic PJI group was 3.06±2.95, 50 (34, 64) mm/1 h, 20.4(12.7, 43.3) mg/L, 4.19±0.91 g/L, 586 (317, 1 122) ng/ml, and the non-PJI group was 6.20±4.64, 22 (15, 34) mm/1 h, 4.6 (2.7, 7.74) mg/L, 3.10±0.59 g/L and 363 (181, 591)ng/ml were statistically significant ( P<0.05). The AUC of ECR, erythrocyte sedimentation rate, C-reactive protein, fibrinogen, and D-dimer in the acute PJI group were 0.82, 0.85, 0.90, 0.88, and 0.76, respectively.The optimal critical values were 2.89, 37.00 mm/1 h, 13.6 mg/L, 3.86 g/L, and 443.0 ng/ml, respectively, with sensitivity of 76.7%, 79.1%, 76.7%, 69.8%, and 82.4%, and specificity of 79.5%, 78.3%, 94.0%, 94.0%, 90.4%, and 63.8%, respectively. The AUC of ECR, erythrocyte sedimentation rate, C-reactive protein, fibrinogen, D-dimer, and white blood cell count in the chronic PJI group were 0.77, 0.82, 0.87, 0.85, 0.67, and 0.63, respectively. The optimal critical values are 2.91, 33.00 mm/1 h, 10.9 mg/L, 4.01 g/L, 558.5 ng/ml, and 5.575×10 9 /L, respectively, with sensitivity of 68.2%, 78.8%, 81.8%, 63.6%, 57.9%, and 75.8%, and specificity of 79.5%, 73.5%, 88.0%, 95.2%, 72.5%, and 49.4%, respectively. Conclusion:Fibrinogen has a higher diagnostic value for knee joint PJI, followed by ECR, and D-dimer has the lowest diagnostic value for knee joint PJI.

Comparative study of reliability of inflammatory markers over 18-FDG−PET CT scan in monitoring skull base osteomyelitis / Estudo comparativo da confiabilidade entre marcadores inflamatórios e PET/TC com 18F-FDG no monitoramento da osteomielite da base do crânio

Abstract Introduction The end point of treatment in skull base osteomyelitis is a matter of debate. A treatment based on symptoms alone is fraught with recurrence. There is a need to restrict imaging though more informative. The inflammatory markers like C-reactive protein and erythrocyte sedimentation rate used commonly need a detailed evaluation to optimize its utility. Objectives To compare the diagnostic accuracy of inflammatory markers with a hybrid PET scan in monitoring skull base osteomyelitis. The secondary objective was to obtain a cut-off value of these markers to decide upon antibiotic termination. Methods A prospective cohort study was conducted in a tertiary care center with fifty-one patients with skull base osteomyelitis meeting eligibility criteria. Patients diagnosed with skull base osteomyelitis were serially monitored with weekly markers and PET scan after the initiation of treatment. A hybrid scan was taken at 6-8 weeks of treatment and repeated if required. The follow-up period varied from 6 weeks to 15 months. The outcome measures studied were the values of markers and the metabolic activity of PET scan when the patient became asymptomatic and when disease-free. Results C-reactive protein and erythrocyte sedimentation rate had a statistically significant correlation to disease activity in PET tomography scan as a prognostic marker. Both showed good clinical correlation. A cut off value of ≤ 3.6 mg/L for C-reactive protein and ≤ 35 mm/hour for erythrocyte sedimentation rate were taken as normalized values. Conclusion A consistent normalized value of C-reactive protein and erythrocyte sedimentation rate for 8-12 weeks in an asymptomatic patient may be an indicator of disease control, though not cure. So, relying solely on markers alone for antibiotic termination may cause relapse. It may be used cautiously in a peripheral setting without access to more specific hybrid scans. In a tertiary care, follow-up scans may be done based on the titres, thereby limiting the radiation exposure.

Resumo Introdução O endpoint do tratamento da osteomielite da base do crânio ainda é uma questão de debate. Um tratamento baseado apenas em sintomas é sujeito a altas taxas de recorrência. Por outro lado, embora sejam mais informativos, o uso dos exames de imagem tem sido cada vez mais restringido. Os marcadores inflamatórios como a proteína-C reativa e a velocidade de hemossedimentação, VHS, comumente usados, precisam de uma avaliação detalhada para aprimorar sua utilidade. Objetivos Comparar a acurácia diagnóstica de marcadores inflamatórios em relação à tomografia computadorizada por emissão de pósitrons, PET-TC, no monitoramento de osteomielite da base do crânio. O objetivo secundário foi obter um valor de corte desses marcadores para decidir sobre o momento da interrupção do antibiótico. Método Um estudo de coorte prospectivo foi conduzido em um centro de atendimento terciário com 51 pacientes com osteomielite da base do crânio que atendiam aos critérios de elegibilidade. Os pacientes com diagnóstico de osteomielite da base do crânio foram monitorados semanalmente por meio de exames seriados de marcadores e PET-CT após o início do tratamento. O exame de imagem foi feito em 6 a 8 semanas de tratamento e repetido se necessário. O período de acompanhamento variou de 6 semanas a 15 meses. As medidas de desfecho estudadas foram os valores dos marcadores inflamatórios e a atividade metabólica obtida por PET-CT quando o paciente se tornou assintomático e quando estava livre da doença. Resultados Proteína-C reativa e VHS apresentaram uma correlação estatisticamente significante com a atividade da doença ao PET-TC como marcadores prognósticos. Ambos mostraram boa correlação clínica. Um valor de corte de ≤ 3,6 mg/L para proteína-C reativa e ≤ 35 mm/hora para VHS foi considerado como normalizado. Conclusão Um valor normalizado consistente de proteína-C reativa e VHS por 8 a 12 semanas em um paciente assintomático pode ser um indicador de doença controlada, embora não de cura. Portanto, o uso apenas nesses marcadores para a interrupção do antibiótico pode ser causa de recidiva. Eles devem ser usados com cautela quando não há acesso a exames mais específicos. Em centros de atendimento terciários, o seguimento com exames de imagem pode ser feito com base nos títulos desses marcadores inflamatórios, o que limita a exposição dos pacientes à radiação.

Evaluation of host biomarkers for monitoring treatment response in spinal tuberculosis: A 12-month cohort study.

BACKGROUND: Monitoring treatment response is an important precaution in spinal tuberculosis (TB), particularly when the condition was clinically diagnosed rather than bacteriologically confirmed and when drug susceptibility testing was not performed. Conventional monitoring measures have limitations and there is a need for favourable alternatives. Therefore, this study aimed to investigate changes in immune biomarkers over the course of treatment for spinal TB and to compare these responses to the conventional monitoring measure, erythrocyte sedimentation rate (ESR). METHODS: Patients with spinal TB were recruited from a tertiary hospital in the Western Cape, South Africa, and provided blood samples at 0, 3, 6, 9 and 12 months of TB treatment. Blood samples were analysed for ESR, using standard techniques, and for 19 cytokines, using a multiplex platform. Changes in ESR and cytokine levels were investigated using a mixed model ANOVA and Least Significant Difference post-hoc testing. RESULTS: Twenty-six patients with spinal TB were included in the study although only fifteen remained in follow-up at 12 months. Seven biomarkers changed significantly over the course of treatment (CRP, Fibrinogen, IFN-γ, Ferritin, VEGF-A, ApoA1 and NCAM, p < 0.01) with a further three showing a strong trend towards change (CCL1, CXCL9 and GDF-15, 0.05 ≥ p ≤ 0.06). Responsive biomarkers could be approximately grouped according to patterns of progressive, initial or delayed change. ESR performed similarly to CRP, Fibrinogen and IFN-γ with all showing significant decreases between 0, 6 and 12- months of treatment. Individual ESR responses were variable. DISCUSSION: Individual ESR responses may be unreliable and support the investigation of multi-marker approaches to evaluating treatment response in spinal TB. Biomarkers of treatment response identified in the current study require validation in a larger study, which may also incorporate aspects such as evaluating biomarkers within the first week of treatment and the inclusion of a healthy control group.

Continuous Percoll Gradient Centrifugation of Erythrocytes-Explanation of Cellular Bands and Compromised Age Separation.

(1) Background: When red blood cells are centrifuged in a continuous Percoll-based density gradient, they form discrete bands. While this is a popular approach for red blood cell age separation, the mechanisms involved in banding were unknown. (2) Methods: Percoll centrifugations of red blood cells were performed under various experimental conditions and the resulting distributions analyzed. The age of the red blood cells was measured by determining the protein band 4.1a to 4.1b ratio based on western blots. Red blood cell aggregates, so-called rouleaux, were monitored microscopically. A mathematical model for the centrifugation process was developed. (3) Results: The red blood cell band pattern is reproducible but re-centrifugation of sub-bands reveals a new set of bands. This is caused by red blood cell aggregation. Based on the aggregation, our mathematical model predicts the band formation. Suppression of red blood cell aggregation reduces the band formation. (4) Conclusions: The red blood cell band formation in continuous Percoll density gradients could be explained physically by red blood cell aggregate formation. This aggregate formation distorts the density-based red blood cell age separation. Suppressing aggregation by osmotic swelling has a more severe effect on compromising the RBC age separation to a higher degree.

Verification of automatic analysers Roller 20PN and iSED for measuring erythrocyte sedimentation rate.

INTRODUCTION: Automated erythrocyte sedimentation rate (ESR) analysers are based on different methodology than Westergren method. It is questionable whether ESR values obtained from those analysers are comparable with determined values with Westergren method. The aim was verification of the precision, method comparison and accuracy of automated ESR analysers: Roller 20PN (Alifax S.p.A., Polverara, Italy) and iSED (Alcor Scientific, Smithfield, USA). MATERIALS AND METHODS: Blood samples (N = 752 for Roller 20PN and N = 213 for iSED) were sampled into K2EDTA (Kima, Italy) tubes for automated and 3.8% Na-citrate tubes (Kima, Italy) for Westergren method. The data was divided into three groups according to the ESR values obtained with the Westergren method: Group Low (L) (ESR ≤ 20 mm), Group Medium (M) (ESR 21-60 mm), and Group High (H) (ESR ≥ 61 mm). Method agreement was assessed by Bland-Altman analysis and Passing-Bablok regression. RESULTS: Analyser iSED has shown better comparability with Westergren method (bias 0.0 (95%Cl -1.4 to 1.5) range than Roller 20 PN (bias = - 6.4 (95%Cl - 7.1 to -5.7) in the whole measuring. For Roller 20 PN, Passing-Bablok regression has shown constant and proportional difference for Groups L and M, and for iSED only for Group H. Roller 20 PN had lower sensitivity (0.51 (95%Cl: 0.45-0.57) than iSED (0.72 (95%Cl: 0.59-0.80) while they had comparable specificity (> 0.90) and accuracy (≥ 0.80) in comparison with the Westergren method. CONCLUSION: Both analysers are not comparable with the Westergren method and should not be used interchangeably.

Comparative study of reliability of inflammatory markers over 18-FDG-PET CT scan in monitoring skull base osteomyelitis.

INTRODUCTION: The end point of treatment in skull base osteomyelitis is a matter of debate. A treatment based on symptoms alone is fraught with recurrence. There is a need to restrict imaging though more informative. The inflammatory markers like C-reactive protein and erythrocyte sedimentation rate used commonly need a detailed evaluation to optimize its utility. OBJECTIVES: To compare the diagnostic accuracy of inflammatory markers with a hybrid PET scan in monitoring skull base osteomyelitis. The secondary objective was to obtain a cut-off value of these markers to decide upon antibiotic termination. METHODS: A prospective cohort study was conducted in a tertiary care center with fifty-one patients with skull base osteomyelitis meeting eligibility criteria. Patients diagnosed with skull base osteomyelitis were serially monitored with weekly markers and PET scan after the initiation of treatment. A hybrid scan was taken at 6-8 weeks of treatment and repeated if required. The follow-up period varied from 6 weeks to 15 months. The outcome measures studied were the values of markers and the metabolic activity of PET scan when the patient became asymptomatic and when disease-free. RESULTS: C-reactive protein and erythrocyte sedimentation rate had a statistically significant correlation to disease activity in PET tomography scan as a prognostic marker. Both showed good clinical correlation. A cut off value of ≤ 3.6mg/L for C-reactive protein and ≤ 35mm/hour for erythrocyte sedimentation rate were taken as normalized values. CONCLUSION: A consistent normalized value of C-reactive protein and erythrocyte sedimentation rate for 8-12 weeks in an asymptomatic patient may be an indicator of disease control, though not cure. So, relying solely on markers alone for antibiotic termination may cause relapse. It may be used cautiously in a peripheral setting without access to more specific hybrid scans. In a tertiary care, follow-up scans may be done based on the titres, thereby limiting the radiation exposure.

Comparative analysis of clinical laboratory indicators between Kawasaki disease and systemic juvenile idiopathic arthritis / 中国基层医药

Objective:To explore the differences of clinical laboratory indicators between Kawasaki disease (KD) and systemic juvenile idiopathic arthritis (SJIA), providing objective evidence for diagnosis and differential diagnosis of these diseases.Methods:A total of 41 children patients with KD (KD group) and 33 children patients with SJIA (SJIA group) who received treatment in Huainan Maternal and Child Health Hospital between September 2017 and January 2022 were retrospectively analyzed. An additional 50 healthy children who concurrently received physical examination in the same hospital were included in the control group. Platelet count (PLT), white blood cell count (WBC), and erythrocyte sedimentation rate (ESR) as well as C-reactive protein (CRP), serum procalcitonin (PCT), interleukin-6 (IL-6), interleukin-10 (IL-10), and serum ferritin (SF) levels were compared among groups before treatment.Results:One-way analysis of variance and pairwise q test were performed to compare laboratory indicators among KD, SJIA and control groups. CRP, ESR, SF and IL-6 levels in the KD group were significantly lower than those in the SJIA group [CRP: (57.80 ± 25.23) mg/L vs. (77.72 ± 45.64) mg/L; ESR: (67.02 ± 28.80) mm/h vs. (83.84 ± 47.64) mm/h; SF: (320.21 ± 182.53) μg/L vs. (945.58 ± 604.65) μg/L; IL-6: (50.35 ± 20.54) ng/L vs. (89.35 ± 45.54) ng/L, q = 4.34, 3.42, 11.51, 8.85, all P < 0.05]. IL-10 level in the KD group was significantly higher than that in the SJIA group [(18.52 ± 16.71) ng/L vs. (10.01 ± 3.24) ng/L, q = -5.25, P < 0.05]. WBC, CRP, ESR, PCT, PLT, IL-6, IL-10 and SF in the KD and SJIA groups were significantly higher than those in the control group (all P < 0.05). Conclusion:Detection of CRP, ESR, SF, IL-6, IL-10 in blood can provide objective evidence for the early diagnosis and differential diagnosis of KD and SJIA, thereby reducing the misjudgment of clinical diagnosis.

Eritrosedimentación extremadamente elevada en pacientes adultos hospitalizados en una institución de alta complejidad en la ciudad de medellín, colombia entre 2016 y 2018 / Extremely elevated erythrosedimentation in adult patients hospitalized in a high complexity institution in the city of medellín, colombia between 2016 and 2018

Resumen Introducción: La eritrosedimentación es una medida indirecta de inflamación, se eleva ante un aumento de proteínas (reactantes de fase aguda) durante trastornos inflamatorios, un valor extremadamente elevado ≥100mm/hora) tiene una alta especificidad para el diagnóstico de enfermedades infecciosas, neoplásicas y autoinmunes. Objetivo: Caracterizar a los pacientes hospitalizados con una elevación extrema de la eritrosedimentación, y explorar su asociación con otros factores determinantes. Métodos: Estudio descriptivo de corte transversal. Se incluyeron pacientes mayores de 18 años, con eritrosedimentación extrema, internados en el Hospital Pablo Tobón Uribe de la ciudad de Medellín, desde Noviembre de 2016 hasta Junio de 2018. Resultados: Se seleccionaron 1007 pacientes de la base de datos del hospital, las infecciones, con 743 (73,8%) afectados, fueron el principal diagnóstico relacionado. Se evidenció una correlación negativa de la eritrosedimentación con la hemoglobina -0.092(-0.155 a -0.029) P <0.01 y con el hematocrito -0.087(-0.150 a -0.024) P 0.01, y una positiva significativa débil con la PCR 0.080 (0.014 a 0.146) p 0.02. Discusión: Acorde a otros estudios, las infecciones representaron el primer grupo de elevación extrema, contrario a otro estudio se evidenció una correlación directa, débil y estadísticamente significativa entre la Proteina C reactiva y la eritrosedimentación extremadamente elevada. Conclusión: Las infecciones fueron el principal grupo de enfermedades con eritrosedimentación extrema, se evidenció una correlación inversa entre la eritrosedimentación con la hemoglobina y el hematocrito, y una correlación positiva débil con la proteína C reactiva. MÉD.UIS.2021;34(3): 39-45.

Abstract Sedimentation rate is an indirect inflammation measure, it rises when increase proteins (acute phase reactants) during inflammatory disorders, extreme high value (≥100mm / hour) has a high specificity for the diagnosis of infectious, neoplastic, and autoimmune diseases. Objective: To characterize inpatients with an extreme elevation of the sedimentation rate, and to establish the correlation between determinant factors and extreme sedimentation. Methods: Observational and cross-sectional study, including patients older than 18 years, with an extremely sedimentation rate, hospitalized in Hospital Pablo Tobon Uribe in Medellin city, during November of 2016 to June of 2018. Results: We selected 1007 patients from the data base, Infections were the most common diagnosis (743, 73.8%), and the main type were urinary tract infections (133, 13%). We evidence a negative correlation with the hemoglobin -0.092(0.155 a -0.029) and with the hematocrit -0.087(0.150 a -0.024), and a positive and weak significant correlation with the C-reactive protein 0.080 (0.014 a 0.146) p 0.02. Discussion: The infections, as in other studies, represent the main etiology associated with an extreme sedimentation. Different to other analyzed investigations, we observed a direct, weak and statistically significant correlation between the PCR and the extreme VSG. Conclusions: Infections were the main cause of extreme sedimentation rate. We evidence an inverse correlation between the blood sedimentation and the hemoglobin and the hematocrit, and a weak correlation with the C-reactive protein. MÉD.UIS.2021;34(3): 39-45.

Spinal Surgery and Subsequent ESR and WBC Changes Pattern: A Single Center Prospective Study.

OBJECTIVE: Postoperative inflammation and infections are common complications of spinal surgery and have similar symptoms. However, postoperative infection may lead to a poor outcome and must be differentiated from postoperative inflammation. The objective of this study is determine the changing pattern of postoperative ESR and WBC counts, and investigate the effects of different variables. METHODS: A total of 61 patients who underwent spinal surgery were enrolled in this prospective study. The erythrocyte sedimentation rate (ESR) and white blood cell (WBC) counts were measured the day before surgery and on 1st, 3rd, 5th, 7th, and 14th postoperative days. RESULTS: WBC counts increased on the 1st postoperative day in comparison with the preoperative day (p<0.001), and they gradually decreased until the preoperative value was reached on the 14th postoperative day (p=0.14). The ESR also increased postoperatively, reaching a peak on the 5th postoperative day in comparison with the preoperative day (p<0.001) and gradually decreased thereafter. However, on the 14th postoperative day, the ESR was significantly greater than the preoperative value (p<0.001). In addition, a significant positive correlation was observed between ESR and age, duration of surgery, intraoperative blood loss, and duration of anesthesia. CONCLUSION: WBC count continued to rise and was the highest on the 1st postoperative day, after which it gradually decreased and attained normal values on the 14th postoperative day, while the ESR increased on the 1st postoperative day, reached the highest level in patients with and without simultaneous instrumentation on 7th and 5th postoperative days, respectively, and gradually decreased.

The prognostic significance of erythrocyte sedimentation rate in COVID-19

SUMMARY OBJECTIVE: There are limited data about the significance of erythrocyte sedimentation rate as a single prognostic parameter for the prognosis and mortality of COVID-19. This study aimed to investigate the diagnostic utility of erythrocyte sedimentation rate as a prognostic factor for the disease severity and mortality in patients with COVID-19. METHODS: A total of 148 consecutive patients with a confirmed diagnosis of COVID-19 and hospitalized at the intensive care unit or non-the intensive care unit were included in the study. The patients were allocated to groups as severe/critical disease versus nonsevere disease and survivors and nonsurvivors. The prognostic role and predictable values of erythrocyte sedimentation rate were analyzed. RESULTS: Erythrocyte sedimentation rate was found to be higher among patients with severe/critical disease compared to those with nonsevere disease (p<0.001) and among nonsurvivors compared to survivors (p<0.001). The logistic regression analysis showed that erythrocyte sedimentation rate was an independent parameter for predicting disease severity and mortality. The role of erythrocyte sedimentation rate in the assessment of severity and mortality in patients with COVID-19 was analyzed using the receiver operating characteristic curve and was found to be significant in both. The analyses suggested that the optimum erythrocyte sedimentation rate cutoff point for disease severity and mortality were 52.5 mm/h with 65.5% sensitivity and 76.3% specificity and 56.5 mm/h with 66.7% sensitivity and 72.5% specificity. CONCLUSION: Our results suggest that erythrocyte sedimentation rate was an independent prognostic factor for severity and mortality in patients with COVID-19.

A Review of Clinical and Laboratory Predictors of Severe COVID-19 Disease.

INTRODUCTION: In late December 2019, the coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China. It quickly spread and emerged as a global pandemic with far-reaching impacts on society. As clinical research on this novel virus emerges, there is a limited amount of data that review clinical and laboratory predictors of severe disease. We present a case of a patient with severely elevated inflammatory markers who remained clinically stable during his hospital course. CASE DISCUSSION: A 53-year-old male presented to the emergency room with 11 days of persistent fevers and new-onset anterior chest tightness. He was admitted to the hospital due to a reported oxygen desaturation at home to 87% (taken by his spouse, a healthcare professional) and ambulatory oxygen desaturation down to 87%. He was noted to have severely elevated inflammatory markers, lymphopenia, and computed tomography pulmonary angiograph findings consistent with COVID-19. He remained on room air and clinically stable throughout his 3-day hospital course. While his C-reactive protein levels improved, his ferritin and erythrocyte sedimentation rate continued to elevate. He was discharged home and was symptom-free within 4 days of hospital discharge. DISCUSSION: COVID-19 has proven to be a viral disease with a high transmission rate, that has caused over 100,000 deaths in the United States, thus far. The decision to admit a patient must balance the risks of transmission with the benefit of being readily available to provide urgent supportive care should the patient develop complications. Thus, there is a significant benefit to being able to predict poor outcomes. We performed a targeted review of the literature, focusing on clinical and laboratory predictors of poor outcomes in COVID-19. Our case report and narrative review outline these findings within the context of our case.

Serum inflammation index and synovial fluid analysis in the diagnosis of periprosthetic joint infection in patients with rheumatoid arthritis / 中华骨科杂志

Objective:To investigate the threshold of serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), synovial fluid white blood-cell count (WBC) and polymorphonuclear cells (PMN) proportion in the diagnosis of periprosthetic joint infection (PJI) in patients with rheumatoid arthritis (RA).Methods:The clinical data of 246 patients with RA and osteoarthritis (OA) who had previously undergone total knee and hip arthroplasty from January 2006 to December 2019 was retrospectively analyzed. The patients were divided into four groups according to the disease type and whether PJI occurred, namely 46 patients in the RA-PJI group, 64 patients in the RA-non-PJI group, 72 patients in the OA-PJI group, and 64 patients in the OA-non-PJI group. The receiver operating characteristics (ROC) curve was used to determine the optimum cut-off values of CRP, ESR, synovial fluid WBC and PMN proportion for diagnosing the RA-PJI and OA-PJI. The optimal cut-off values of serum and synovial fluid indexes were evaluated for the diagnostic efficacy of RA-PJI by comparing the area under curve (AUC) of each index. Further, the values were applied for joint test analysis.Results:For PJI prediction, the results of serological and synovial fluid indexes were different between RA-PJI group and OA-PJI group. The results of ROC curve analysis showed that the optimal cut-off values of each detection index were as follows. The optimal cut-off value of CRP for diagnosing RA-PJI was 14.4 mg/L, ESR was 39 mm/1 h, synovial fluid WBC was 3 654×10 6 /L, and PMN proportion was 0.659. The optimal cut-off value for diagnosing OA-PJI were 8.16 mg/L, 31 mm/1 h, 2 452×10 6 /L, and 0.625, respectively. In the RA-PJI group, the difference between the AUC of each detection index and AUC=0.5 was statistically significant ( P<0.05). Among them, the specificity of synovial fluid WBC was 92.3%, AUC was 0.879 (95% CI: 0.776, 0.982) with 87.8% positive predictive value and 10.21 positive likelihood ratio. These values were higher than those of CRP, ESR, and PMN proportion. The results of joint test analysis for the diagnosis of RA-PJI were as follows. The specificity of the series test was 100%, and the sensitivity of the parallel test was 100%; the specificity of the joint index diagnostic test was 100%, AUC was 0.926 (95% CI: 0.848, 1.000), the difference between AUC and AUC=0.5 was statistically significant ( P<0.05). Conclusion:The optimum cut-off values of CRP, ESR, synovial fluid WBC and PMN proportion for the diagnosis of PJI in patients with RA are all higher than those of patients with OA. Their optimal cut-off values can be used as important auxiliary indexes for a clear diagnosis of PJI in patients with RA. Compared with other indexes, the synovial fluid WBC has strong predicting power and lower misdiagnosis rate, which could be the best detection index for identifying PJI in patients with RA. The joint test could improve the sensitivity or specificity of PJI diagnosis in patients with RA. The combination with multiple detection indexes could provide a reference for the early and accurate diagnosis of PJI in patients with RA.

Effects of acupuncture plus spinal manipulations on physical functioning and biochemical indicators in patients with ankylosing spondylitis / 针灸推拿医学（英文版）

Objective: To observe the effects of acupuncture plus spinal manipulations on the physical functioning and levels of alkaline phosphatase (ALP), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and osteoprotegerin (OPG) in patients with ankylosing spondylitis (AS). Methods: A total of 128 AS cases were allocated into a control group and an observation group using random number table method, with 64 cases in each group. Patients in both groups took sulfasalazine and meloxicam. Patients in the observation group received additional acupuncture plus spinal manipulations. The efficacy, Bath AS functional index (BASFI), Bath AS disease activity index (BASDAI), and the levels of ALP, ESR, CRP and OPG were compared between the two groups after eight weeks of treatment. Results: After treatment, the symptom scores of traditional Chinese medicine in both groups were decreased (all P<0.05), and these scores in the observation group were significantly lower than in the control group (all P<0.05); the VAS, BASFI and BASDAI scores in both groups were decreased (all P<0.05), and these scores in the observation group were significantly lower than in the control group (all P<0.05); and the ALP, ESR, CRP and OPG levels in both groups were decreased (all P<0.05), and these levels in the observation group were significantly lower than in the control group (all P<0.05). The total efficacy rate was 92.2％ in the observation group, versus 78.1％ in the control group, presenting a statistical significance (P<0.05). Conclusion: Conventional medication combined with acupuncture and spinal manipulations can improve clinical symptoms, accelerate the recovery of physical functioning, and reduce the ALP, ESR, CRP and OPG levels.

Diagnostic Value of Erythrocyte Sedimentation Rate and C Reactive Protein in detecting Diabetic Foot Osteomyelitis; a Cross-sectional Study.

INTRODUCTION: Osteomyelitis is one of the complications of diabetic foot infection. The present study aimed to evaluate the diagnostic value of erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) in detection of osteomyelitis in patients with diabetic foot. METHODS: In this cross-sectional study, serum levels of ESR and CRP were measured for patients with diabetic foot referring to emergency department or endocrinology clinic and the screening performance characteristics of these markers in detection of osteomyelitis were calculated. The diagnosis of osteomyelitis was based on clinical examination and positive probe-to-bone test, which was confirmed by plain x-rays or MRI. RESULTS: 142 diabetic patients with an average age of 61.2 ± 11.8 years were evaluated (66.2 % male). The area under the ROC curve of ESR in detection of osteomyelitis in diabetic foot cases was 0.70 (95% CI: 0.62-0.79). The best ESR cut-off point in this regard was 49 mm/hour. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of ESR in 49 mm/Hour cut-point were 74.6% (95% CI: 62.9-83.9), 57.7% (95% CI: 45.5-69.2), 63.9% (95% CI: 52.5-73.9), 69.5 % (95% CI: 56.0-80.0), 1.8 (95% CI: 1.3-2.4) and 0.4 (95% CI: 0.3-0.7), respectively. The area under the ROC curve of CRP in detection of osteomyelitis was 0.67 (95% CI: 0.58-0.76). The best cut-off point for CRP in this regard was 35 mg/liter with sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of 76% (95% CI: 64.2-85), 54.9% (95% CI: 42.7-66.6), 62.8% (95% CI: 51.6-72.8), 69.6% (95% CI: 51.7-80.8), 1.7 (95% CI, 1.3-2.2), and 0.4 (95% CI: 0.3-0.7), respectively. CONCLUSION: Based on the findings of ROC curve analysis, ESR and CRP had fair and poor accuracy, respectively, in detecting the diabetic foot cases with osteomyelitis.