Significance of natural killer T like cells in peripheral blood of patients with systemic sclerosis / 中华风湿病学杂志

Objective:To study the expression of peripheral blood NKT-like cells in patients with systemic sclerosis (SSc), to explore the correlation between NKT-like cells and laboratory and clinical indicators of systemic sclerosis, and investigate the role of NKT-like cells in the occurrence and development of Systemic sclerosis.Methods:Forty-six SSc patients (SSc group) were enrolled from Department of Rheumatology and Immunology of Peking University People 's Hospital during December 2018 to December 2019. Thirty healthy subjects with matched age and sex were selected as healthy control group (HC group). The cell count and percentage of NKT-like cells and other lymphocyte subsets in peripheral blood were detected by flow cytometry. At the same time, other laboratory indexes were determined by different methods. Spearman's correlation analysis, Pearson's correlation analysis, Man-Whitney U test and Fisher's exact test were used to analyze the difference and correlation between NKT-like cells and other clinical and laboratory indicators. Results:Compared with HC group [165(72, 226)cells/μl], the cell count of NKT-like cells in peripheral blood of SSc group[30(19, 58)cells/μl] was significantly decreased ( Z=-5.69, P<0.001). Correlation analysis showed that the cell count of NKT-like cells was positively correlated with total T lymphocytes ( r=0.56, P<0.001), CD4 +T cells ( r=0.42, P=0.004), CD8 +T cells ( r=0.60, P<0.001), B cells ( r=0.50, P<0.001) and NK cells ( r=0.33, P=0.024), respectively. The percentage of NKT-like cells in lymphocytes was also positively correlated with the percentage of CD8 +T cells ( r=0.34, P=0.020), but not significantly correlated with other subset of lymphocytes. The ESR of the NKT-like cell decreased group was significantly higher than that of the NKT-like normal group[15(9, 28) mm/1 h vs 8 (4, 16) mm/1 h, Z=-2.04, P=0.042]. Moreover, the cell count of NKT-like cells was negatively correlated with ESR ( r=-0.34, P=0.019). Conclusion:The cell count and percentage of NKT-like cells in peripheral blood of SSc patients decreased significantly. NKT-like cells were not only positively correlated with a variety of lymphocyte subpopulations, but also negatively correlated with ESR. NKT-like cells may be used as an indicator to monitor the disease activity in patients with SSc.

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.

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.

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.

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.

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.

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.

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.

Relationship between erythrocyte sedimentation rate and choroidal and retinal thickness in Behçet's disease / A relação entre a taxa de sedimentação eritrocitária, espessuras de coroide e retina na doença de Behçet

ABSTRACT Purpose: To compare retinal and choroidal thickness in patients with Behçet's disease with and without ocular involvement as well as to evaluate the correlation between erythrocyte sedimentation rate and choroidal thickness among patients with Behçet's disease. Methods: This was a prospective interventional study investigating erythrocyte sedimentation as well as choroidal and retinal thickness among patients with Behçet's disease. Patients who were diagnosed based on The International Criteria for Behçet's Disease with (Group A) or without (Group B) ocular involvement and a matched control group (Group C) participated in the study. Optical coherence tomography measurements and blood tests were performed on the same day. Retinal and choroidal thickness were measured using spectral-domain optical coherence tomography (Spectralis, Heidelberg Engineering, Heidelberg, Germany), and central macular thickness, central subfoveal choroidal thickness, and retinal nerve fiber layer thickness were measured using optical coherence tomography. Results: Average erythrocyte sedimenta­tion values were 9.89 mm/h in Group A, 16.21 mm/h in Group B, and 3.89 mm/h in Group C; average central subfoveal choroidal thickness values were 350.66, 331.74, and 325.95 mm, respectively. Average central macular thickness and retinal nerve fiber layer thickness values of patients in Groups A, B and C were 226.39 and 225.97mm; 234.11 and 92.00 mm; and 97.58 and 99.84 mm, respectively. No significant difference was seen between Group A and B patients in central subfoveal choroidal thickness, central macular thickness, or retinal nerve fiber layer thickness values. Central macular thickness was statistically significantly thinner in Groups A and B than in Group C (p=0.016). Group A had thinning in the nasal quadrant of the retinal and general retinal nerve fiber layers when compared with those in Group C (p=0.010 and 0.041, respectively). A connection could not be established between the erythrocyte sedimentation, central subfoveal cho­roidal thickness, central macular thickness, and retinal nerve fiber layer thickness in the patients with Behçet's disease. Conclusion: The erythrocyte sedimentation rate is typically used to test for activation of Behçet's disease and assess treatment response. In our study, we could not establish a connection between the erythrocyte sedimentation rate and central subfoveal choroidal thickness, central macular thickness, and retinal nerve fiber layer thickness in patients with systematically active Behçet's disease without ocular involvement.

RESUMO Objetivos: Comparar a espessura da retina e da coroide em pacientes com doença de Behçet, com e sem acometimento ocular e avaliar a correlação entre a taxa de sedimentação de eritrócitos e a espessura da coroide em pacientes com doença de Behçet. Métodos: Estudo prospectivo intervencional que investigou a sedimentação de eritrócitos, espessura de coroide e da retina em pacientes com doença de Behçet. Os pacientes que foram diagnosticados com base nos Critérios Internacionais para a Doença de Behçet com (Grupo A) ou sem (Grupo B) envolvimento ocular e um grupo controle correspondente (Grupo C) participaram do estudo. Medidas de tomografia de coerência óptica e exames de sangue foram realizados no mesmo dia. As espessuras da retina e da coroide foram medidas utilizando tomografia de coerência óptica de domínio espectral (Spectralis, Heidelberg Engineering, Hidelberg, Germany) e a espessura macular central, a espessura coroidal subfoveal central e a espessura da camada de fibra nervosa da retina foram medidas usando tomografia de coerência óptica. Resultados: Os valores médios de sedimentação de eritrócitos foram de 9,89 mm/h no Grupo A, 16,21 mm/h no Grupo B e 3,89 mm/h no Grupo C; os valores médios da espessura da coroide subfoveal central foram 350,66, 331,74 e 325,95 mm respectivamente. Os valores médios da espessura macular central e da espessura da camada de fibra nervosa da retina dos pacientes nos grupos A, B e C foram de 226,39, 225,97, 234,11 mm e 92,00, 97,58, 99,84 mm respectivamente. Não houve diferença significativa entre pacientes do Grupo A e B na espessura da coroide subfoveal central, espessura macular central ou valores da espessura da camada de fibra nervosa da retina. A espessura macular central foi estatisticamente significativamente mais fina nos Grupos A e B do que no Grupo C (p=0,016). O Grupo A apresentou afinamento na porção nasal das camadas retiniana e geral da fibra nervosa da retina quando comparado com o Grupo C (p=0,010, p=0,041, respectivamente). Não foi possível estabelecer uma conexão entre a sedimentação dos eritrócitos, a espessura subfoveal central da coroide, a espessura macular central e espessura da camada de fibras nervosas da retina nos pacientes com doença de Behçet. Conclusão: A taxa de sedimentação de eritrócitos é comumente utilizada para testar a ativação da doença de Behçet e avaliar a resposta ao tratamento. Em nosso estudo, não foi possível estabelecer uma conexão entre a taxa de sedimentação de eritrócitos e a espessura da coroide subfoveal central, espessura macular central e espessura da camada de fibras nervosas da retina em pacientes com doença de Behçet sistematicamente ativa sem envolvimento ocular.

Diagnostic Value of Noninvasive Biomarkers in Endoscopic Activity of Ulcerative Colitis / 胃肠病学

Background: Ulcerative colitis (UC) is characterized by a chronic intestinal inflammatory disease with relapsing-remitting course, therefore the evaluation of inflammatory activity is essential for defining reasonable therapy and predicting prognosis. Aims: To evaluate the diagnostic value of noninvasive biomarkers in assessing endoscopic activity of UC. Methods: A total of 56 patients with UC from August 2016 to March 2018 at Xiangyang Central Hospital were enrolled, and 25 patients with irritable bowel syndrome (IBS) were served as controls. Fecal calprotectin (FC) level was measured by ELISA. Clinical activity index (CAI) was assessed, and C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were determined. Endoscopic activity was determined by Mayo score. Diagnostic value of noninvasive biomarkers in assessing endoscopic activity of UC was analyzed. Results: FC level was significantly higher in UC patients than in IBS patients (P<0.001). FC, CAI, CRP, ESR in active UC patients were significantly higher than those in remissive UC patients (P<0.001). Mayo score was correlated with FC (r=0.814), CAI (r=0.724), CRP (r=0.610), ESR (r=0.657) (P all <0.001). FC with a cutoff value of 200 μg/g had sensitivity of 92.3% and specificity of 94.1% for detecting endoscopic activity. Conclusions: Compared with CAI, CRP and ESR, FC can more effectively evaluate the endoscopic active inflammation in UC patients.

Effect of colchicine in the treatment of elderly patients with gouty arthritis and its influence on ESR, CRP and UA / 中国基层医药

Objective@#To investigate the clinical efficacy of colchicine tablets in the treatment of patients with gouty arthritis, and to observe the effect of colchicine tablets on erythrocyte sedimentation rate(ESR), C-reactive protein (CRP) and uric acid (UA).@*Methods@#From March 2016 to March 2017, 70 patients with gouty arthritis in our hospital were randomly divided into control group and observation group according to the random number table method.The control group was treated with celecoxib capsules 0.2g, 2 times a day.The observation group was treated with colchicine tablets 0.5mg three times daily, celecoxib capsules 0.2g, 2 times a day.The visual analogue scale (VAS) was used to evaluate the degree of joint pain in two groups.The Likert scale was used to evaluate the swelling of the two groups before and after treatment.The pain relief time was recorded in both two groups.The ESR, CRP and UA were measured before and after treatment.The clinical effects and adverse reactions in the two groups were analyzed.@*Results@#After treatment, the VAS score of the observation group was (2.04±0.52)points, which was significantly lower than (3.53±1.22)points of the control group(t=6.64, P=0.00). The joint swelling score of observation group after treatment was (0.62±0.24) points, which was significantly lower than (1.21±0.33)points of the control group(t=8.55, P=0.00). After treatment, the VAS score and joint swelling score in the two groups were significantly lower than those before treatment (all P<0.05). The pain relief time of the observation group was significantly shorter than that of the control group [(1.36±0.47)d vs.(1.79±0.63)d, t=3.23, P=0.00]. After treatment, the ESR, CRP and UA levels of the observation group were (12.65±3.17)mm/h, (12.14±2.27)mg/L, (417.82±55.88)μmol/L, respectively, which were significantly lower than those of the control group [(14.77±4.22)mm/h, (14.69±3.16)mg/L, (458.93±62.74)μmol/L, t=2.37, 3.87, 2.37, P=0.02, 0.00, 0.00]. After treatment, the ESR, CRP and UA levels of the two groups were significantly lower than those before treatment (all P<0.05). The total effective rate of the observation group was 80.00%, which was obviously higher than 57.14% of the control group(χ2=7.55, P=0.02). The incidence rate of adverse reaction of the observation group was 8.57%, which of the control group was 5.71%, the difference was not statistically significant (χ2=0.21, P=0.64).@*Conclusion@#Colchicine tablets combined with celecoxib capsules in the treatment of patients with gouty arthritis can reduce ESR, CRP and UA levels, improve the degree of pain and joint swelling, and will not increase the adverse reactions.

The expression of oxidized low density lipoprotein and scavenger receptor that binds phospha-tidylserine and oxidized lipoprotein in patients with rheumatoid arthritis / 中华风湿病学杂志

Objective To investigate the expression level of oxidized low density lipoprotein (ox-LDL) and its scavenger receptor scavenger receptor that binds phosphatidylserine and oxidized lipoprotein (SRPSOX) in patients with rheumatoid arthritis (RA),and to explore the relationship between ox-LDL and disease activity.Methods The serum ox-LDL in RA patients and healthy control group were detected by enzymelinked immunosorbent assay (ELISA),as well as the fluidox-LDL in RA,osteoarthritis (OA) and inflammatory arthritis (IA).The expression of SR-PSOX in mixed cells of RA and IApatients was detected by western blot.The expression of serum ox-LDL between RA groupand the control group was analyzed by t-test and non-parametric test.The correlation of serum ox-LDL expression levels in RA patients with C-reactive protein (CRP),erythrocyte sedimentation rate (ESR) and other inflammatory factors and disease activitywas analyzed by Pearson linear regression.Results The expression of ox-LDL in the serum of RA patients was significantly higher than that of normal control group [(3 076±131) mU/ml,(2 334±84) mU/ml,t=4.242,P＜0.01].The expression of ox-LDL in synovial fluid of RA patients was significantly higher than that of the OA group [(4 963±354) mU/ml],(3 956±347) mU/ml,t=2.372,P＜0.05).The expression of SR-PSOX in synovial fluid mixed cells of RA patients was higher than that of the IA group [(4.92±0.18) vs (0.24±0.04),t=33.53,P＜0.01].The expression of ox-LDL in serum of RA patients was negatively correlated with ESR,CRP and overall disease activity DAS28 (r=-9.42,P=0.009;r=-0.35,P=0.029 7;r=0.42,P=0.008 4).The expression of ox-LDL in the serum of RA patients with moderate disease activity was significantly higher than those patients with high disease activity [(3 302±138) mU/ml vs (2 464±228) mU/ml,t=3.335,P＜0.01],however,those with low disease activity and disease remission had higher serum ox-LDL expression but without statistical significant differences.After treated with anti-rheumatic drugs (DMARDs),serum ox-LDL of RA patients had a trend of slight increasing butwithout sign-ificant difference.The ox-LDL/LDL-C or ox-LDL/HDL-C was negatively not correlated with disease activity score in 28 (DAS28),ESR,CRP.Conclusion In RA patients,the expression of ox-LDL in the serum and synovial fluid is high and the SR-PSOX expressionin synovial fluid is also high.The serum ox-LDL levels are negatively correlated with ESR,CRP and DAS28,which are related to disease activity of RA.These findings suggest that the ox-LDL and the receptor SR-PSOX may play a role in RA pathogenesis,but needs further study.

Clinical correlation of biopsy results in patients with temporal arteritis

Summary Objective: Temporal arteritis is systemic vasculitis of medium and large sized vessels. The lowest incidence rates were reported in Turkey, Japan and Israel. We aimed to investigate the results of patients with biopsy-proven temporal arteritis and those classified according to the American College of Rheumatology criteria from a low-incidence region for temporal arteritis. The results of our study are noteworthy, since there is limited data on pathologic diagnosis of temporal arteritis in Turkey. Method: We studied the medical records, laboratory findings such as erythrocyte sedimentation rate and C-reactive protein levels, biopsy results, and postoperative complications of all the patients operated for temporal artery biopsy at our clinic. We used the computerized laboratory registry that keeps all records of 42 consecutive temporal artery biopsy results from January 2011 to December 2016. Results: The mean age was 66±12.5 years. The most common manifestations on admission were temporal headache, optic neuritis and jaw claudication, respectively. Temporal artery biopsy results confirmed tempoal arteritis in eight out of 42 (19%) patients. There was no statistically significant difference between biopsy-positive and biopsy-negative groups in terms of sex, age, erythrocyte sedimentation rate, C-reactive protein and biopsy length. Conclusion: We were not able to find a correlation between the analysis of biopsy results and clinical evaluation of patients with temporal arteritis. We suggest that diagnosis of temporal arteritis depends on clinical suspicion. Laboratory examination results may not be helpful in accurate diagnosis of tempoal arteritis.

High white blood cell count and erythrocyte sedimentation rate are associated with perforated appendicitis in children

PURPOSE: To investigate the predictors of perforated appendicitis (PA) in pediatric patients with appendicitis seen in the emergency department. METHODS: We retrospectively reviewed 564 pediatric patients ( 13.5 × 109/L (odds ratio [OR], 3.27; confidence interval [CI], 1.49–7.18; P = 0.003) and ESR > 15 mm/h (OR, 3.18; 95% CI, 2.13–4.74; P < 0.001) are independent predictors of PA. CONCLUSION: WBC count and ESR might be better predictors of PA in pediatric patients with appendicitis in the emergency department than the Alvarado score and CRP concentration.

Clinical Applications of Monitoring Serum Infliximab Trough Levels and Antibodies to Infliximab in Crohn's Disease Patients Treated With Infliximab / 胃肠病学

Background:With the extensive use of infliximab (IFX)in treatment of patients with Crohn's disease (CD),some of the patients had losing of response to IFX treatment. The specific mechanism is not clear yet,and may be related to the formation of antibodies to infliximab (ATI). However,there is no report on the positivity rate of ATI in China so far. Aims:To investigate the clinical effects of serum IFX trough levels (IFX-TLs)and ATI in CD patients treated with IFX. Methods:A total of 76 CD patients receiving IFX treatment from Jan. 2016 to Mar. 2017 at Shanghai Renji Hospital were enrolled. Serum IFX-TLs and ATI were detected. CD patients were divided into active stage group and remission group according to CDAI score,and serum IFX-TLs,ATI,C-reactive protein (CRP)and erythrocyte sedimentation rate (ESR) levels were analyzed. Results:Of the 76 patients with CD,positive ATI was found in 2 patients (2. 6%). Forty-five (59. 2%)patients were in remission,while 31 (40. 8%)in active stage. No significant differences in IFX-TLs [2. 84 (1. 30,4. 96)μg/ mL vs. 4. 08 (1. 29,6. 72)μg/ mL,P =0. 484],ATI [8. 00 (5. 27,14. 89)ng/ mL vs. 7. 00 (4. 40, 25. 00)ng/ mL,P = 0. 454]were found between active CD and remission CD. Serum CRP,ESR levels were significantly increased in active CD than in remission CD (P = 0. 038,P = 0. 009). Logistic regression analysis showed that activity of CD was related to CRP (OR = 6. 082,95% CI:1. 348-27. 436,P = 0. 019),but not related to IFX-TLs,ATI and ESR (P > 0. 05). Conclusions:The activity of CD may be correlated with CRP,but not with IFX-TLs,ATI and ESR.

Clinical Study on Endoscopic Index for Evaluating Disease Activity in Patients with Crohn's Disease / 胃肠病学

Background:Small bowel Crohn's disease (CD) is a chronic nonspecific inflammatory disease with unknown etiology.There is no clear criteria for assessing the progression of CD, and the endoscopic index for assessing disease activity in CD patients is limited to a single parameter.Aims:To investigate the clinical value of endoscopic index in evaluating disease activity in patients with CD and the correlation between different parameters.Methods:Sixty cases of CD patients form Jan.2008 to Dec.2012 at Affiliated Hospital of Yanan Uuiversity were collected, 60 healthy adults were served as control group.CECDAI score, CDAI score and Lewis score were used to evaluate disease activity in patients with CD, and their relationship with CRP and ESR were analyzed.Results:Levels of CRP and ESR were significantly increased in CD patients than in controls (P0.05);Lewis score was not correlated with CRP, ESR (P>0.05) in CD patients.Conclusions:CECDAI score, CDAI score, Lewis score, CRP, ESR can reflect disease activity of CD, and can be used together to assess disease activity of CD patients.

Hemorheological and Glycemic Parameters and HDL Cholesterol for the Prediction of Cardiovascular Events / Parâmetros Hemorreológicos e Glicêmicos e HDL- Colesterol para a Predição de Eventos Cardiovasculares

Abstract Background: Hemorheological and glycemic parameters and high density lipoprotein (HDL) cholesterol are used as biomarkers of atherosclerosis and thrombosis. Objective: To investigate the association and clinical relevance of erythrocyte sedimentation rate (ESR), fibrinogen, fasting glucose, glycated hemoglobin (HbA1c), and HDL cholesterol in the prediction of major adverse cardiovascular events (MACE) and coronary heart disease (CHD) in an outpatient population. Methods: 708 stable patients who visited the outpatient department were enrolled and followed for a mean period of 28.5 months. Patients were divided into two groups, patients without MACE and patients with MACE, which included cardiac death, acute myocardial infarction, newly diagnosed CHD, and cerebral vascular accident. We compared hemorheological and glycemic parameters and lipid profiles between the groups. Results: Patients with MACE had significantly higher ESR, fibrinogen, fasting glucose, and HbA1c, while lower HDL cholesterol compared with patients without MACE. High ESR and fibrinogen and low HDL cholesterol significantly increased the risk of MACE in multivariate regression analysis. In patients with MACE, high fibrinogen and HbA1c levels increased the risk of multivessel CHD. Furthermore, ESR and fibrinogen were significantly positively correlated with HbA1c and negatively correlated with HDL cholesterol, however not correlated with fasting glucose. Conclusion: Hemorheological abnormalities, poor glycemic control, and low HDL cholesterol are correlated with each other and could serve as simple and useful surrogate markers and predictors for MACE and CHD in outpatients.

Resumo Fundamento: Parâmetros hemorreológicos e glicêmicos e o HDL-colesterol são utilizados como biomarcadores da aterosclerose e trombose. Objetivo: Investigar a associação e a relevância clínica da velocidade de hemossedimentação (VHS), fibrinogênio, glicose de jejum, hemoglobina glicada (HbA1c) e HDL-colesterol na predição de eventos adversos cardiovasculares (EAC) importantes em pacientes ambulatoriais. Métodos: 708 pacientes estáveis ambulatoriais foram incluídos no estudo e acompanhados por um período médio de 28,5 meses. Os pacientes foram subdivididos em pacientes sem EAC e pacientes com EAC, que incluíram morte súbita cardíaca, infarto agudo do miocárdio, doença coronariana recém-diagnosticada, e acidente vascular cerebral. Comparamos os parâmetros hemorreológicos, glicêmicos, e perfis lipídicos entre os grupos. Resultados: Pacientes com EAC apresentaram níveis significativamente mais elevados de VHS, fibrinogênio, glicose de jejum, e HbA1c, e níveis mais baixos de HDL-colesterol em comparação a pacientes sem EAC. VHS e níveis de fibrinogênio elevados, e baixos níveis de HDL-colesterol aumentaram significativamente o risco de EAC em análise de regressão multivariada. Além disso, VHS e fibrinogênio correlacionaram-se positivamente com HbA1c e negativamente com HDL-colesterol, mas não se correlacionaram com glicose de jejum. Conclusão: Distúrbios hemorreológicos, baixo controle glicêmico e baixo nível de HDL-colesterol correlacionam-se entre si e podem ser usados como marcadores substitutos simples, úteis, e como preditores de EAC e doença coronariana em pacientes ambulatoriais.