Prognostic significance of preoperative platelet count in patients with gallbladder cancer

AIM:To investigate the prognostic value of preoperative platelet count(PLT) in patients with primary gallbladder cancer(GBC).METHODS:The clinical data of 223 GBC patients after surgery was retrospectively reviewed.A receiver operating characteristic(ROC) curve was plotted to verify the optimum cutoff point for PLT.Univariate and multivariate survival analyses were performed to identify the factors associated with the prognosis.RESULTS:The ROC curve showed that the optimum cutoff point for PLT was 178 × 109/L,and the entire cohort was stratified into group A with PLT 178 × 109/L and group B with PLT ≤ 178 × 109/L.Group A had a better survival than group B(P 0.001).There was an obvious difference between the two groups in terms of the differentiation degree,advanced tumor stage,lymph node metastasis(P 0.001) and pathological type(P 0.05).The univariate analysis demonstrated that tumor location,differentiation degree,TNM stage,Nevin stage,lymph node metastasis and PLT were associated with overall survival(P 0.001).In the multivariate analysis,PLT(P = 0.032),lymph node metastasis(P = 0.007),tumor location(P 0.001) and TNM stage(P = 0.005) were independent prognostic factors.CONCLUSION:PLT is closely correlated with GBC prognosis and could be used to identify the population with a poorer prognosis after surgery.     

经颈静脉肝内门体静脉分流术治疗肝硬化静脉曲张出血预后因素分析

目的 分析经颈静脉肝内门体静脉分流(TIPS)术治疗肝硬化静脉曲张出血患者的预后因素.方法 收集2003年1月至2008年12月162例行TIPS术的肝硬化静脉曲张出血患者基本资料、术前7 d内相关生化指标,定期随访观察术后情况和生存期资料.Cox回归模型评估影响预后生存的指标.结果 TIPS术成功率99%(161/162).中位随访时间21个月.Child-Pugh评分和血小板计数与生存密切相关(P值分别=0.003和0.024).Child-Pughr评分<9分者的累积生存率[75%(102/136)]高于评分≥9分者[50%(13/26),χ2=9.12,P=0.003].血小板计数>47×109/L者的累积生存率[74%(82/112)]高于≤47×109/L者[66%(33/50),χ2=4.528,P=0.033].肝功能Child-Pugh A、B、C级术后1年累积生存率分别为92%、85%、55%.结论 Child-Pugh评分和血小板计数是预测TIPS术治疗肝硬化静脉曲张出血者生存情况的独立因素,当ChildPugh评分≥9分和(或)血小板计数≤47×109/L时术后危险性增加.

Abstract：

Objective To analyze the prognostic factors in treating variceal hemorrhage patients of liver cirrhosis and portal hypertension with transjugular intrahepatic portosystemic shunt (TIPS).Methods From January 2003 to December 2008, the data of 162 variceal hemorrhage patients with liver cirrhosis and portal hypertension treated with TIPS was collected, which included basic information, biochemical examination results within 7 days before the operation, regular follow-up observation after the surgery and survival data. The survival prognostic indexes were assessed with Cox regression model. Results The successful rate of TIPS was 99% (161/162). The median follow up duration was 21 months. Child-Pugh score and blood platelet count (PLT) were closely correlated with survival (P = 0. 003 and 0. 024). The total cumulative survival rate in patients with Child-Pugh score below nine (75%, 102/136) was higher than over nine (50%, 13/26) (χ2 = 9. 12,P=0. 003).The total cumulative survival rate of patients with PLT count over 47 ×109/L (74%, 82/112) was higher than below 47 × 109/L(66 %, 33/50, χ2 =4. 528, P = 0. 033). The one year after operation cumulative survival rate of liver function Child-Pugh class A, B, and C was 92%, 85%, 55% respectively. Conclusion Child-Pugh score and platelet count are independent predictable factors for the survival of variceal hemorrhage patients with liver cirrhosis and portal hypertension treated by TIPS. The risk increase after operation when Child-Pugh score over 9 and/or PLT count less 47×109 /L.     

Prognostic value of perioperative leukocyte count in resectable gastric cancer

AIM: To investigate the prognostic significance of perioperative leukopenia in patients with resected gastric cancer.METHODS: A total of 614 eligible gastric cancer patients who underwent curative D2 gastrectomy and adjuvant chemotherapy were enrolled in this study. The relationship between pre- and postoperative hematologic parameters and overall survival was assessed statistically, adjusted for known prognostic factors.RESULTS: The mean white blood cell count(WBC) significantly decreased after surgery, and 107/614(17.4%) patients developed p-leukopenia, which was defined as a preoperative WBC ≥ 4.0 × 109/L and postoperative WBC 4.0 × 109/L, with an absolute decrease ≥ 0.5 × 109/L. The neutrophil count decreased significantly more than the lymphocyte count. P-leukopenia significantly correlated with poor tumor differentiation and preoperative WBC. A higher preoperative WBC and p-leukopenia were independent negative prognostic factors for survival [hazard ratio(HR) = 1.602, 95% confidence interval(CI): 1.185-2.165; P = 0.002, and HR = 1.478, 95%CI: 1.149-1.902; P = 0.002, respectively] after adjusting for histology, Borrmann type, p TNM stage, vascular or neural invasion, gastrectomy method, resection margins, chemotherapy regimens, and preoperative WBC count. The patients with both higher preoperative WBC and p- leukopenia had a worse prognosis compared to those with lower baseline WBC and no p-leukopenia(27.5 mo vs 57.3 mo, P 0.001). CONCLUSION: Preoperative leukocytosis alone or in combination with postoperative leukopenia could be independent prognostic factors for survival in patients with resectable gastric cancer.     

Non-surgical contraindication for acute appendicitis with secondary thrombocytopenia: A case report

A 26-year-old man presented with migrated right lower abdominal pain and without any history of hematological systemic diseases.Blood routine test showed a leukocyte count of 22.74 × 109/L, with91.4% neutrophils, and a platelet count of 4 × 109/L before admission.The case question was whether the team should proceed with surgery.Obviously, a differential diagnosis is essential before making such a decision.Acute appendicitis was easily diagnosed based on clinical findings, including migrating abdominal pain, a leukocyte count of 22.74 × 109/L and the result of abdominal computed tomography scan.However, it was not clear whether the severe thrombocytopenia was primary or secondary.So smear of peripheral blood and aspiration of bone marrow were ordered to exclude hematological diseases.Neither of the tests indicated obvious pathological hematological changes.There was no hepatosplenomegaly found by ultrasound examination of the liver and spleen.Therefore, operative intervention may be a unique clinical scenario in acute severe appendicitis patients with secondary thrombocytopenia.     

Association of primary biliary cirrhosis with idiopathic thrombocytopenic purpura

Although both primary biliary cirrhosis （PBC） and idiopathic thrombocytopenic purpura （ITP） are autoimmune diseases, the association of the 2 diseases is rare. Here, we report a case of ITP that developed during the follow-up of PBC in a 74-year- old man. The patient had been diagnosed with PBC 12 years previously, and had received treatment with ursodeoxycholic acid. The platelet count decreased from approximately 60 × 109/L to 8 × 109/L, and the association of decompensated liver cirrhosis （PBC） with ITP was diagnosed. Steroid and immune gamma globulin therapy were successful in increasing the platelet count. Interestingly, human leukocyte antigen genotyping detected the alleles DQB10601 and DRB10803, which are related to both PBC and ITP in Japanese patients. This case suggests common immunogenetic factors might be involved in the development of PBC and ITP.     

Low platelet count: Predictor of death and graft loss after liver transplantation

BACKGROUND The impact of platelets on liver transplantation(LT) is well recognized, but not completely understood. Platelets exert dichotomous effects on the graft and on the patient. On the one hand, they are essential for primary hemostasis and tissue repair and regeneration. On the other hand, they support ischemia/reperfusion injury and inflammatory processes. Recent evidence has shown a new role for platelet count(PC) in predicting outcomes after LT.AIM To evaluate if low PC is a predictor of short-and long-term outcomes after LT.METHODS Four hundred and eighty consecutive LT patients were retrospectively assessed.PC from the preoperative to the seventh postoperative day(POD) were considered. C-statistic analysis defined the ideal cutoff point for PC. Cox regression was performed to check whether low PC was a predictor of death,retransplantation or primary changes in graft function within one year after LT.RESULTS The highest median PC was 86 × 109/L [interquartile range(IQR) = 65–100 ×109/L] on seventh POD, and the lowest was 51 × 109/L(IQR = 38–71 × 109/L) on third POD. The C-statistic defined a PC 70 × 109/L on fifth POD as the ideal cutoff point for predicting death and retransplantation. In the multivariate analysis, platelets 70 × 109/L on 5 POD was an independent risk factor for death at 12 mo after LT [hazard ratio(HR) = 2.01; 95% confidence interval(CI) 1.06-3.79;P = 0.031]. In the Cox regression, patients with PC 70 × 109/L on 5 POD had worse graft survival rates up to one year after LT(HR = 2.76; 95%CI 1.52-4.99; P =0.001).CONCLUSION PC 70 × 109/L on 5 POD is an independent predictor of death in the first year after LT. These results are in agreement with other studies that indicate that low PC after LT is associated with negative outcomes.     

Influence of lactulose on interventional therapy for HCC patients with hepatocirrhosis and hypersplenism

Objective: To investigate the influence of lactulose on immunity of hepatocellular carcinoma(HCC) patients with hepatocirrhosis and hypersplenism after double-interventional therapies. Methods: A total of 40 HCC patients with hepatocirrhosis and hypersplenism, hospitalized during January 2013 to June 2014, were enrolled and randomized into control group and observation group. Both groups received partial splenic embolization combined with transcatheter arterial chemoembolization. Besides, observation group orally took lactulose 30 m L/d. Four days before interventional therapies and at day 1, 3, 7 and 14 after therapies, fasting venous blood was collected to detect white blood cell count, red blood cell count(RBC), and platelet count(PLT). Four days before therapies and at day 7 and 14 after therapies, the levels of alanine aminotransferase, aspartate transaminase, total bilirubin, malondialdehyde, super-oxide dismutase(SOD), IFN-α, and IL-4 as well as the distribution of T cell subsets in peripheral blood were tested. Complications were observed after interventional therapies. Results: Before interventional therapies the levels of white blood cell count, PLT and RBC in both groups showed no difference, while after interventional therapies the levels of PLT and RBC in both groups showed an increasing tendency(P0.05). At day 14 after interventional therapies, the level of blood cell as well as that of SOD, IFN-α and IL-4 in serum were significantly higher than that before therapies; meanwhile, the levels of alanine aminotransferase and total bilirubin of observation group after therapies were significantly lower than before and control group(P0.05), the levels of CD4+/CD8+, SOD and IFN-α were all higher than before and control group(P0.05). Conclusions: Oral administration of lactulose could adjust the imbalance of oxidation system/antioxidant system in HCC patients with hepatocirrhosis and hypersplenism after interventional therapies, and improve the antitumor immunity and prognosis.     

青蒿琥酯对斯氏狸殖吸虫病大鼠肝脏组织病理改变及功能的影响

Objective To observe the effects of artesunate on hepatic histopathologic change and function of rats infected with Pagumogonimus skrjabini. Methods Thirty-six Wistar rats were randomly divided into 6 groups. Each rat of 5 groups was intra-abdominally injected with 25 metacercaria of P. Skrjabini, 6 rats of one group were remained as normal control. Thirty days after the rats were infected with the metacercaria of P.skrjabini, the intragastric administration was performed in the experimental groups according to following schedule: artesunate 50 mg/(kg·d), 100 mg/(kg·d) and 150 mg/(kg·d), for consecutive 7 d, praziquantel 150 mg/kg q. O. D, for 3 times. Model control group was not treated. The rats were sacrificed for pathological examination with microscope after 30 d. Alanine aminotransferase (ALT)、 aspartate aminotransferase (AST)、albumin (ALB) 、globulin(GLO) were detected in serum by automatic biochemical analyzer. Results Artesunate 50 mg/(kg · d) and 100 mg/(kg·d) treatment could reduce the liver inflammation of the rats infected with the metacercaria of P. Skrjabini. There were significant differences between these two experimental groups and the control group(P ＜ 0.05), on the levels of ALB 、GLO 、A/G、AST in serum. Conclusion Appropriate dose of artesunate may improve the hepatic function of rats infected with P. Skrjabini.     

Prognostic significance of blood count at the time of achieving morphologic leukemia-free state in adults with acute myeloid leukemia

正Objective To explore prognostic significance of blood count at the time of achieving first morphologic leukemia-free state[complete remission(CR,ANC≥1×109/L and PLT≥100×109/L),CR with incomplete PLT recovery(CRp)and CR with incomplete ANC and PLT recovery(CRi)]in adult patients with de novo acute myeloid leukemia(AML).Methods From January     

Inhibitory Effect of Clopidogrel on Release of Soluble CD40 Ligand by ADP-activated Platelet in Patients With Non-ST-segment-elevation Acute Coronary Syndromes

Objectives To investigate the inhibitory effect of clopidogrel on release of soluble CD40 ligand （sCD40L） by ADP-activated platelet in patients with non-ST-segment elevation acute coronary syndromes（NSTEACS）. Methods Forty-two patients with NSTEACS were treated with clopidogrel for 6 - 8 days. In order to obtain platelet rich plasma （PRP） samples, the venous blood was drawn before and after treatment, respectively. The platelets were activated by adenosine diphosphate （ADP） , thus releasing sCD40L, sCD40L levels were determined by en- zyme-linked immunosorbent assay （ELISA） at different time of the reaction. Results Plasma sCD40L concentration before treatment was （0. 199 ± 0. 155 ） ng/mL, and （0. 190 ± 0. 176） ng/mL after treatment （ P 〉 0.05 ）. Before treatment the PRP sCD40L level at 20-minute of platelet activation was （4.34 ± 2.51 ） ng/mL, and decreased to （2.79 ±1.93 ） ng/mL after treatment （ P 〈 0. 001 ）. The corresponding level at 40 - minute of platelet activation was （5.29 ± 3. 13 ） ng/mL before treatment and （ 2.87 ± 1.59 ） ng/mL after treatment（ P 〈 0. 001 ）. Conclusions Short-term clopidogrel administration might inhibit the release of sCD40L by ADP-activated platelet in patients with NSTEACS, suggesting that, in addition to its antiplatelet potency, clopidogrel may still have an anti-inflammatory effect.     

Depression of platelet counts in apparently healthy children with asymptomatic malaria infection in a Nigerian metropolitan city

Asymptomatic malaria infection is a common feature of malaria endemic regions in the tropics. In this prospective cross sectional survey, involving 240 children aged 1 to 8 years (Boys = 117, Girls = 123; Ratio 1:1.05), the median platelet count was 115 x 10(9)/L (IQR 97.5-190). Thirty-three out of 240 (13.75%) of the children had thrombocytopenia (platelet count < 100 x 10(9)/L). Malaria parasite was found to exert significant reduction in platelet count. This reduction was more pronounced in children under 5 years and also at higher parasite counts. An inverse relationship was established between parasite density and platelet count (y = -0.017x + 96.2, r = -0.2). Thrombocytopenia is not only a feature of acute malaria infection but also that of asymptomatic malaria infection in the tropics and might be a useful indicator of malaria in children.     

重症患者血小板输注的临床研究

目的：探明重症患者血小板（PLT）减少的发生率及PLT输注的目的、指征、效果以及血小板减少对患者预后的影响。方法：采用回顾性方法分析临床资料,血小板减少定义为PLT〈100×109/L,根据PLT减少的程度分为轻度减少,PLT〈100×109/L;中度减少,PLT〈50×109/L;重度减少,PLT〈20×109/L。结果：53.4%（206例）重症患者住院期间曾出现PLT〈100×109/L,与PLT未减少患者相比PLT减少患者有较高的死亡率（P〈0.05）,需要输注较多的血小板（P〈0.05）、新鲜冰冻血浆（P〈0.05）和红细胞（P〈0.05）。结论：约50%重症监护病房住院患者在住院过程中出现过PLT〈100×109/L,血小板减少患者需要较多的输血支持,有较高的死亡率。     

Antithyroid drug-induced agranulocytosis: special reference to normal white blood cell count agranulocytosis.

This retrospective study was aimed at revealing the incidence of normal white blood cell (WBC) count agranulocytosis in patients treated with antithyroid drugs (ATDs). From January 1975 to December 2001, 109 patients (0.35%) presented with ATD-induced agranulocytosis at our clinic. In 18 patients (16.5%), the WBC count exceeded 3.0 x 10(9)/L at the onset of agranulocytosis. Ten showed a downward trend in WBC count (3.0-3.9 x 10(9)/L) after the initiation of ATDs. Four had symptoms of infection. In the remaining 4 patients, routine WBC and granulocyte count monitoring detected an agranulocytosis. During the first 3 months of ATD treatment, 3347 patients (10.9%) had WBC count 3.0-3.9 x 10(9)/L even once with no symptom and normal granulocyte count and 26672 patients had WBC count >or= 4.0 x 10(9)/L with no symptom and normal granulocyte count. When agranulocytosis was found, twelve patients with normal WBC count agranulocytosis (0.36%) had WBC count 3.0-3.9 x 10(9)/L with no symptom, whereas only 2 patients with agranulocytosis (0.008%) had WBC count >or= 4.0 x 10(9)/L with no symptom. In conclusion, clinicians should take normal WBC count agranulocytosis into consideration at least during the first 3 months of antithyroid drug therapy, especially when WBC count is 3.0-3.9 x 10(9)/L.     

Activity of azithromycin against Leishmania major in vitro and in vivo

Azithromycin, an azalide antibiotic of the macrolide family, concentrates in the tissues and especially in macrophages. Because Leishmania parasites reside in these cells, we tested this antibiotic for a possible antileishmanial activity in vitro and in vivo. Azithromycin decreased the Leishmania major promastigote count in cell-free cultures at log phase approximately 50-fold. In macrophage cultures infected with L. major amastigotes, azithromycin caused a significant decrease in parasite levels with an ED50 of 12 microg/ml. The activity in vivo was evaluated after infection of the footpads of susceptible BALB/cByJ mice and resistant C57BL/6J mice with L. major. Treatment of BALB/cByJ mice with azithromycin, 100 to 200 mg/kg/d, resulted in a significant decrease in lesion size and in the number of parasites per lesion, whereas no effect was seen in the treated C57BL/6J mice. Azithromycin has activity against L. major in vitro and in vivo. Given the severity of the disease and the limitations of the available therapeutic agents, azithromycin may have a significant role in the treatment of this group of diseases.     

急诊经皮冠状动脉介入治疗术后中性粒细胞升高与预后的相关性

目的 探讨经皮冠状动脉介入治疗(PCI)后中性粒细胞水平与急性ST段抬高心肌梗死(STEMI)患者近、远期预后的关系.方法 连续人选发病12 h内接受成功PCI的初发急性STEMI患者226例.PCI术前及术后2 h分别记录18导联心电图,PCI后12 h内进行中性粒细胞计数检测.采用logistic回归评价PCI后中性粒细胞水平与患者心电图ST段回落以及30 d和2年内发生心脏不良事件的关系.采用Kaplan-Meier生存曲线分析不同中性粒细胞水平的患者30 d和2年生存率的不同.结果 所有患者PCI后的中性粒细胞计数在(2.83～18.74)×109/L,25百分位数、中位数及75百分位数分别为5.66×109/L、7.38×109/L和9.34×109/L.校正其他影响因素后,PCI后中性粒细胞计数每升高1×109/L,急性STEMI患者PCI后心电图ST段未回落的风险增加2.28倍(OR:2.28,P=0.009),30 d内发生心力衰竭(OR:1.16,P=0.035)和死亡(OR:1.63,P=0.010)的风险分别增加1.16和1.63倍,2年内发生心力衰竭(OR:1.20,P=0.007)和死亡(OR:1.29,P=0.003)的风险分别增加1.20和1.29倍,而发生非致死性再次心肌梗死的风险无明显改变.PCI后中性粒细胞计数≥9.34×109/L的患者30 d累积生存率(89.1%比99.1%比98.2%,P=0.010)和2年累积生存率(82.4%比96.1%比96.3%,P=0.003)明显低于(5.66～9.33)×109/L以及＜5.66×109/L的患者.结论 PCI后中性粒细胞升高是初发急性STEMI患者成功PCI后近期和远期发生死亡和心力衰竭的独立预测因子.     

Autoimmune Neutropenia With Cyclic Oscillation of Neutrophil Count After Steroid Administration

A 16-year-old female patient was evaluated for pancytopenia. She had a white blood cell count of 1.6 x 10(9)/L with 0.02 neutrophils and a platelet count of 19 x 10(9)/L. In the bone marrow, mature granulocytes were markedly decreased in number, but no atypical cells were present. Antineutrophil antibody was demonstrated by flow cytometry, and the level of platelet-associated immunoglobulin G was increased. A diagnosis of autoimmune neutropenia and thrombocytopenia was made. Interestingly, neutrophil and platelet counts fluctuated cyclically after the initiation of prednisolone therapy. The neutrophil count fluctuated between 0.1 x 10(9)/L and 7 x 10(9)/L, and the platelet count fluctuated between 19 x 10(9)/L and 175 x 10(9)/L, in 4-week cycles. Following splenectomy, neutrophil and platelet counts normalized. We believe the immune mechanism of recurrent neutropenia in this patient differs from that in other patients with cyclic neutropenia reported with stem cell disorders.     

Potential of the Panama strain of Plasmodium vivax for the testing of malarial vaccines in Aotus nancymai monkeys

Aotus monkeys were infected with a strain of Plasmodium vivax from Panama to determine its potential for the testing of malarial vaccines. After sporozoite inoculation, 3 splenectomized Aotus nancymai that had been infected previously with Plasmodium falciparum and P. vivax had prepatent periods of 13, 15, and 15 days with maximum parasite counts of 12,726/microl, 5,310/microl, and 9,180/microl. Three other A. nancymai previously infected with P. falciparum only had prepatent periods of 17, 15, and 15 days with maximum parasite counts of 44,460/microl, 31,500/microl, and 42,660/microl. One monkey with no previous history of infection had a prepatent period of 14 days after sporozoite inoculation, and a maximum parasite count of 100,000/microl; detectable parasitemia persisted for almost 500 days with 13 recognizable peaks in the parasite count. Anopheles dirus, Anopheles freeborni, Anopheles stephensi, and Anopheles quadrimaculatus mosquitoes were readily infected with the Panama strain.     

Efficacy of Helicobacter pylori eradication in raising platelet count in adult patients with idiopathic thrombocytopenic purpura

BACKGROUND AND OBJECTIVES: There are data consistent with an association between idiopathic thrombocytopenic purpura (ITP) and Helicobacter pylori (HP) infection. In addition, a significant increase of platelet count following HP eradication has been reported in a proportion of ITP patients. We describe here our experience on the efficacy of anti-HP treatment in ITP patients. DESIGN AND METHODS: Between December 1998 and May 2001 sixteen adult patients with ITP and documented HP infection were treated with standard antibiotic therapy for HP eradication (amoxicillin and clarithromycin plus pantoprazole combination). Of these patients, 7 had untreated ITP with mild/moderate thrombocytopenia (median platelet count 70x10(9)/L, range 41-91), 5 had relapsed following a previous steroid treatment (median platelet count 39x10(9)/L, range 30-90) and 4 were refractory to steroids (median platelet count 18.5x10(9)/L, range 9-30). RESULTS: An improvement of platelet count was observed in 11/15 patients (73.3%) who achieved HP eradication. The difference between the mean platelet count SD before and after HP eradication was statistically significant (51.6 28.2x10(9)/L vs. 143.3 131.1x10(9)/L; p=0.01). Complete or partial responses were obtained in 11/16 treated patients (68.7%). This result still persisted after a median follow-up of 11.7 months. INTERPRETATION AND CONCLUSIONS: Our data confirm the efficacy of Helicobacter pylori eradication in increasing platelet count in adult ITP patients.     

Depression of platelet counts in apparently healthy children with asymptomatic malaria infection in a Nigerian metropolitan city

Asymptomatic malaria infection is a common feature of malaria endemic regions in the tropics. In this prospective cross sectional survey, involving 240 children aged 1 to 8 years (Boys?=?117, Girls?=?123; Ratio 1:1.05), the median platelet count was 115?×?10⁹/L (IQR 97.5–190). Thirty-three out of 240 (13.75%) of the children had thrombocytopenia (platelet count?<?100?×?10⁹/L). Malaria parasite was found to exert significant reduction in platelet count. This reduction was more pronounced in children under 5 years and also at higher parasite counts. An inverse relationship was established between parasite density and platelet count (y?=??0.017x?+?96.2, r?=??0.2). Thrombocytopenia is not only a feature of acute malaria infection but also that of asymptomatic malaria infection in the tropics and might be a useful indicator of malaria in children.