Could the neutrophil-to-lymphocyte ratio serve as a marker in the diagnosis and prediction of acute appendicitis complications in children?

INTRODUCTION: Acute appendicitis (AA) is the most common surgical condition of the abdomen in children. The aim of this study was to analyse the possible use of the neutrophil-to-lymphocyte ratio (NLR) in the diagnosis and prediction of AA complications in children. MATERIAL AND METHODS: We included 170 AA patients under 15 years of age, who were divided into the following groups: Group 1 - non-operated patients with AA, and Group 2 - patients who underwent appendectomy. Based on pathologic grades of AA, Group 2 was subdivided into: Group A - phlegmonous, Group B - gangrenous, and Group C - perforated AA. NLR was calculated as the absolute neutrophil count divided by the absolute lymphocyte count. RESULTS: In Group 2 NLR was significantly higher than in Group 1 (5.5 (1.9-9.9) vs. 2.3 (1.2-3.7); p < 0.001). A significant difference in NLR was found between Group C and Group A (p < 0.001), and as well as between Group B and Group A (p = 0.001). The determined optimal cut-off value of NLR in differentiating Group 1 vs. Group 2 was ≥ 3.48 (p < 0.001). In differentiating Group A from Group C the optimal cut-off value of NLR was ≥ 5.61 (p < 0.001). Furthermore, optimal cut-off value of NLR in differentiating Group A from Group B was ≥ 5.45 (p = 0.001). CONCLUSIONS: The obtained results suggest that NLR could be used as a simple and reliable test in the diagnosis and prediction of AA complications in children. However, to draw definite conclusions on the predictive power of NLR as a marker of AA large multicentric studies are required.

Oxidative stress status in elite athletes engaged in different sport disciplines.

Exercise training may increase production of free radicals and reactive oxygen species in different ways. The training type and intensity may influence free radicals production, which leads to differences in oxidative stress status between athletes, but the results of the previous studies are incosistent. The aim of our study was to estimate oxidative stress status in elite athletes engaged in different sport disciplines. The study included 39 male highly skilled professional competitors with international experience (2 Olympic players): 12 wrestlers, 14 soccer players and 13 basketball players in whom we determined the levels of advanced oxidation protein products (AOPP) and malondialdehyde (MDA), as markers of oxidative stress and the total antioxidative capacity (ImAnOX) using commercially available assay kits. The mean AOPP concentration was not significantly different between soccer players, wrestler and basketball players (60.0 ± 23.0 vs. 68.5 ± 30.8 and 80.72 ± 29.1 µmol/L respectively). Mean ImAnOX concentration was not different between soccer players (344.8 ± 35.6 µmol/L), wrestlers (342.5 ± 36.2 µmol/L) and basketball players (347.95 ± 31.3 µmol/L). Mean MDA concentration was significantly higher in basketball players (1912.1 ± 667.7 ng/mL) compared to soccer players (1060.1 ± 391.0 ng/mL, p=0.003). In spite of this fact, oxidative stress markers levels were increased compared to referral values provided by the manufacturer. Type of sports (soccer, wrestler or basketball) have no impact on the levels of oxidative stress markers. Elite sports engagement is a potent stimulus of oxidative stress that leads to the large recruitment of antioxidative defense. Oxidative stress status monitoring followed by appropriate use of antioxidants is recommended as a part of training regime.

Serum activity of Angiotensin converting enzyme and blood pressure response to acute dynamic exercise.

Angiotensin converting enzyme (ACE) plays an important role in blood pressure regulation not only in the state of rest, but also during physical exercise. The aim of this study was to estimate the serum ACE activity in response to acute dynamic exercise. The study involved a group of young, healthy, male volunteers (average 22 years of age). Exercise testing was carried out on ergometer bicycle according to the protocol of individually adjusted continuous, constant workload (3 W/kg). The activity of ACE in serum was measured in venous blood, in the period of rest, in 4th, 8th and 12th minute of exercise and 1st, 3rd and 6th minute of recovery by spectrophotometric method. Marked inter-individual differences in basal serum ACE activity were determined (range 8, 31-63, 72 U/L). Serum ACE activity did not significantly vary during exercise and in the period of recovery. Systolic blood pressure changed during exercise compared to values during rest period in accordance with the applied type of dynamical exercise. Diastolic blood pressure did not vary considerably during exercise. Statistically significant correlation between mean arterial blood pressure and ACE activity in the serum was not found. The lack of increase of ACE activity in the serum, in spite of changes in blood pressure values, most likely shows the presence of alternative ACE independent pathway involved in the production of vasoactive substances that have important role in the regulation of cardiovascular system response to acute dynamic exercise.