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Objectives: To determine if there is an association between the neutrophil to lymphocyte ratio (NLR) and prognosis in patients with epithelial ovarian cancer (EOC) diagnosed and treated in a Spanish population. Material and methods: Retrospective cohort of patients with epithelial ovarian cancer who had neutrophil and lymphocyte values in complete blood count before the histopathological diagnosis and survival of at least three months, in an intermediate complexity hospital. Convenience sampling. Measured variables included age, menopausal stage, parity, International Federation of Gynecology and Obstetrics (FIGO) stage, treatment type, residual tumor, lymph node involvement, presence of ascites, cytology, histologic type, differentiation grade, and CA-125 values. Additionally, outcomes, overall survival, disease/progression-free survival were also measured. Bivariate inferential and Cox regression analyses were performed. Results: Out of 78 candidates, 60 women with EOC were included. Of them, 24 (40%) had a low NLR (≤ 2,9) while 36 (60%) had a high NLR (> 2,9). An association was found between high NLR levels and suboptimal cytoreductive surgery. High NLR ratios were associated with lower overall survival (Hazard ratio (HR): 4.1; 95% CI: 1.4-11.8) and lower 5-year disease-free survival (HR: 2.6; 95% CI: 1.2-5.7). Conclusions: A plasma neutrophil to lymphocyte ratio of more than 2.9 was associated with poor prognosis in patients with epithelial ovarian cancer in our setting. There is a need to establish the optimal cut-off point and conduct prospective studies with larger patient numbers in order to support this information.

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Objetivos: evaluar si hay asociación entre los valores del cociente plasmático neutrófilos/ linfocitos (NLR) y el pronóstico en pacientes con cáncer epitelial de ovario (CEO) diagnosticadas y tratadas en una población española. Materiales y métodos: cohorte retrospectiva de pacientes con cáncer epitelial de ovario que tuvieran un recuento de neutrófilos y linfocitos en hemograma previo al diagnóstico histopatológico en un hospital de nivel medio de complejidad y posterior sobrevida de, al menos, 3 meses. Muestreo por conveniencia. Se midieron: edad, estado menopáusico, paridad, estadio Federación International de Ginecología y Obstetricia (FIGO), tipo de tratamiento, tumor residual, afectación ganglionar, presencia de ascitis, citología, tipo histológico, grado de diferenciación y cifras de CA-125; como desenlaces, sobrevida global y sobrevida libre de enfermedad o progresión. Análisis inferencial bivariado y por regresión de Cox. Resultados: de 78 candidatas, ingresaron 60 mujeres con CEO. De ellas, 24 (40%) presentaron un NLR bajo (≤ 2,9) y 36 (60 %) elevado (> 2,9). Se encontró asociación entre los niveles altos de NLR y cirugía citoreductora subóptima. Los niveles altos de NLR se asociaron a menor sobrevida global (Hazard ratio (HR): 4,1; IC 95%: 1,4-11,8) y menor sobrevida libre de enfermedad a los 5 años (HR:2,6; IC 95 %: 1,2-5,7). Conclusiones: un cociente plasmático neutrófilos/linfocitos mayor de 2,9 se asoció a un mal pronóstico en pacientes con cáncer epitelial de ovario en nuestro medio. Se necesita determinar el punto de corte óptimo y realizar estudios prospectivos con mayor número de pacientes que avalen esta información.

Asunto(s)

Carcinoma Epitelial de Ovario , Linfocitos , Neutrófilos , Neoplasias Ováricas , Humanos , Femenino , Estudios Retrospectivos , Neoplasias Ováricas/mortalidad , Neoplasias Ováricas/sangre , Neoplasias Ováricas/patología , Neoplasias Ováricas/diagnóstico , Neoplasias Ováricas/cirugía , Carcinoma Epitelial de Ovario/sangre , Carcinoma Epitelial de Ovario/mortalidad , Carcinoma Epitelial de Ovario/patología , Carcinoma Epitelial de Ovario/cirugía , Pronóstico , Persona de Mediana Edad , Linfocitos/patología , Anciano , Adulto , Estudios de Cohortes , Procedimientos Quirúrgicos de Citorreducción , España/epidemiología , Supervivencia sin Enfermedad , Recuento de Linfocitos , Tasa de Supervivencia , Periodo Preoperatorio , Recuento de Leucocitos

RESUMEN

OBJECTIVE: The study aimed to assess the predictive significance of inflammatory parameters as potential markers for malignancy in individuals with thyroid nodules. METHOD: Nine hundred and ninety-one patients with thyroid nodules who had undergone thyroid fine-needle aspiration biopsy were included and classified according to the Bethesda system. Neutrophil lymphocyte ratio (NLR) and systemic immune-inflammation index (SII) values obtained from hemogram parameters were determined for each patient. The study examined the correlation between the Bethesda classification and NLR/SII levels. In addition, a comparison was made between the inflammatory parameters of the benign and malignant Bethesda groups. RESULTS: Five hundred and seventy-three patients were classified as Bethesda 2 (benign), 34 as Bethesda 6 (malignant). A correlation was observed between the Bethesda classification and NLR and SII levels (r: 0.230, p < 0.001; r: 0.207 p < 0.001, respectively). NLR and SII values were significantly higher in the malignant group (p < 0.001). The cutoff value for SII in predicting benign and malignant thyroid nodules was 489.86 × 103/mm3 with a sensitivity of 88.2% and a specificity of 63.7%. The cutoff value for NLR for the same prediction was 2.06 with a sensitivity of 82.4% and a specificity of 83.4%. CONCLUSIONS: The findings of this study indicate that SII and NLR may be valuable prognostic markers for predicting the malignancy of thyroid nodules.

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OBJETIVO: Evaluar parámetros inflamatorios como posibles marcadores de malignidad en individuos con nódulos tiroideos. MÉTODO: Se incluyeron 991 pacientes con nódulos tiroideos que se sometieron a biopsia por aspiración con aguja fina y se clasificaron según el sistema de Bethesda. Se determinaron los valores de la relación neutrófilo-linfocito (NLR) y el índice de inflamación inmunitaria sistémica (SII). El estudio exploró la correlación entre la clasificación de Bethesda y los valores de NLR/SII, y comparó los parámetros inflamatorios de los grupos benignos y malignos de Bethesda. RESULTADOS: Se clasificaron 573 pacientes como Bethesda 2 (benigno) y 34 como Bethesda 6 (maligno). Se observó una correlación entre la clasificación de Bethesda y los valores de NLR y SII (r: 0.230; r: 0.207). Los valores de NLR y SII fueron mayores en el grupo maligno (p < 0.001). El valor de corte para SII en la predicción de nódulos tiroideos benignos y malignos fue de 489.86 × 103/mm3, con una sensibilidad del 88.2% y una especificidad del 63.7%; para NLR fue de 2.06, con una sensibilidad del 82.4% y una especificidad del 83.4%. CONCLUSIONES: El SII y el NLR pueden ser valiosos marcadores pronósticos para predecir la malignidad de los nódulos tiroideos.

Asunto(s)

Inflamación , Neutrófilos , Neoplasias de la Tiroides , Nódulo Tiroideo , Humanos , Nódulo Tiroideo/patología , Nódulo Tiroideo/sangre , Nódulo Tiroideo/clasificación , Femenino , Masculino , Persona de Mediana Edad , Adulto , Biopsia con Aguja Fina , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/sangre , Neoplasias de la Tiroides/clasificación , Neoplasias de la Tiroides/diagnóstico , Inflamación/sangre , Linfocitos/patología , Anciano , Sensibilidad y Especificidad , Biomarcadores de Tumor/sangre , Recuento de Linfocitos , Adulto Joven , Valor Predictivo de las Pruebas

RESUMEN

Paracoccidioides fungi are thermodimorphic microorganisms that cause paracoccidioidomycosis (PCM), an autochthonous disease from Latin America, with most cases in Brazil. Humans become infected by inhaling conidia or mycelial fragments that transform into yeast at body temperature. These fungi cause chronic-granulomatous inflammation, which may promote fibrosis and parenchyma destruction in the lungs. In response to stress imposed by the host, fungi Paracoccidioides spp. increase the expression of heat shock proteins (HSP), which protect them by sustaining cellular proteostasis. Our group has studied the role of HSP60 in PCM, and previous data show that the recombinant HSP60 (rHSP60) has a deleterious effect when used in a single dose as therapy for experimental PCM. Here, we investigated the mechanism by which rHSP60 could worsen the disease. We found that rHSP60 caused the viability loss of splenic or lymph node cells from both immunized and non-immunized mice, including in splenic T lymphocytes under polyclonal stimulation with concanavalin A, probably by undergoing apoptosis. Among analyzed splenic cells, lymphocytes were indeed the main cells to die. When we investigated the death mechanisms, remarkably, we found that there was no viability loss in rHSP60-stimulated splenic cells from mice deficient in Toll-like receptor 4, TRIF adapter protein, and TNF receptor 1(TNFR1), as well as rHSP60-stimulated WT cells incubated with anti-TNF antibody. Besides, caspase-8 inhibitor IETD-CHO blocked the rHSP60 effect on splenic cells, suggesting that rHSP60 induces the extrinsic apoptosis pathway dependent on signaling via TLR4/TRIF and TNFR1.

Asunto(s)

Paracoccidioides , Paracoccidioidomicosis , Humanos , Ratones , Animales , Receptor Toll-Like 4 , Receptores Tipo I de Factores de Necrosis Tumoral , Inhibidores del Factor de Necrosis Tumoral , Paracoccidioidomicosis/microbiología , Factor de Necrosis Tumoral alfa , Inflamación , Linfocitos/patología , Proteínas Adaptadoras del Transporte Vesicular

RESUMEN

INTRODUCTION AND AIMS: Gastric adenocarcinoma is among the high-ranking tumors, with respect to frequency and mortality, worldwide. The inflammatory process and immune system activity are associated with oncologic control. Our aim was to identify whether the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and other variables are prognostic factors for survival in patients with metastatic gastric cancer in a Mexican population. MATERIAL AND METHODS: Patients diagnosed with metastatic gastric adenocarcinoma, hospitalized within the time frame of December 2011 to 2021, were analyzed. The NLR, PLR, and albumin and hemoglobin levels obtained from blood samples were calculated. Functional status (ECOG and Karnofsky), sex, histology, and the presence of signet ring cells were also considered possible prognostic factors. Each factor's prognostic value for overall survival was determined through univariate and multivariate analyses. RESULTS: The study included 956 patients diagnosed with metastatic gastric cancer, of whom 494 (51.7%) were men and 462 (48.3%) were women. The main histologic finding was diffuse adenocarcinoma (n = 619, 64.7%), followed by intestinal adenocarcinoma (n = 293, 30.6%), and the presence of signet ring cells was found in 659 (68.9%) patients. Diagnostic laparoscopy was performed on 238 patients (24.9%) to confirm peritoneal carcinomatosis. The multivariate analysis showed that an NLR above 3.2 (HR 1.51, 95% CI 1.27-1.8; p < 0.001), albumin below 3.5 g/dl (HR 1.25, CI 1.06-1.47; p = 0.006), and an ECOG performance status of 2 or higher (HR 1.39, CI 1.10-1.76; p = 0.005) were independent factors that predicted a lower survival rate, whereas a Karnofsky score above 70% (HR 0.69, CI 0.53-0.91; p = 0.008) was associated with a better survival rate. Lastly, the PLR was not statistically significant in the multivariate analysis. CONCLUSIONS: The NLR, nutritional status assessed through albumin measurement, and functional status can act as independent prognostic survival factors in hospitalized Mexican patients diagnosed with metastatic gastric adenocarcinoma and be taken into account during therapeutic decision-making.

Asunto(s)

Adenocarcinoma , Neoplasias Gástricas , Humanos , Neoplasias Gástricas/mortalidad , Neoplasias Gástricas/patología , Neoplasias Gástricas/sangre , Masculino , Femenino , México/epidemiología , Adenocarcinoma/mortalidad , Adenocarcinoma/secundario , Adenocarcinoma/sangre , Persona de Mediana Edad , Pronóstico , Anciano , Adulto , Anciano de 80 o más Años , Estudios Retrospectivos , Neutrófilos , Metástasis de la Neoplasia , Linfocitos/patología , Tasa de Supervivencia

RESUMEN

Blood cell biomarkers, such as the neutrophil-lymphocyte ratio (NLR) and the platelet-lymphocyte ratio (PLR), have been recently used as prognostic markers in tumors. In this study, we investigated the association between NLR and PLR with sociodemographic, clinical, anthropometric, and quality of life factors of hospitalized women with non-metastatic breast cancer. A cross-sectional observational study was conducted at a reference center for oncological treatment in Southeast Brazil. Female participants aged over 18 years, with a histopathological diagnosis of stage I, II or III breast cancer, in any phase of antineoplastic treatment, were included. Our study revealed a high risk for participants, with high mean values of NLR and PLR, indicating low antitumor activity and worse prognosis. The binary logistic regression model showed that there was a significant association of the NLR marker and marital status (OR = 3.1; 95%CI = 1.06-8.57; p = 0.03) and, in relation to PLR, a trend was shown for a higher chance in women of black ethnicity to have increased PLR compared to white women (OR = 4.13; 95%CI = 0.96-17.70; p = 0.05). However, the inflammatory markers (NLR and PLR) did not show any significant association with nutritional factors. NLR and PLR are inflammatory biomarkers that can be easily obtained and measured in clinical practice.

Asunto(s)

Neoplasias de la Mama , Neutrófilos , Humanos , Femenino , Adulto , Persona de Mediana Edad , Neutrófilos/patología , Estado Nutricional , Neoplasias de la Mama/tratamiento farmacológico , Calidad de Vida , Estudios Transversales , Linfocitos/patología , Pronóstico , Biomarcadores , Estudios Retrospectivos

RESUMEN

BACKGROUND: Inflammatory biomarkers, including C-reactive protein, erythrocyte sedimentation rate, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and the systemic immune-inflammation index, have been proposed as prognostic factors diverse pathologies. However, their application for deep neck infections has yet to be clarified. MATERIAL AND METHODS: We performed a retrospective study of 163 adult patients with diagnosis of deep neck infections with the aim to evaluate the association between serological biomarkers with complications and outcomes of patients with DNI. Studied variables included demographic data, complications of DNI, outcomes, complications and death of the included subjects. The evaluated serological biomarkers were hemoglobin, leukocytes, neutrophils, lymphocytes, platelets, glucose, creatinine, albumin, CRP, and ESR. NLR, PLR, and SIII index were estimated. RESULTS: The patients' mean age was 40.6 ± 15.3 years. Complications of DNI were observed in 19.6% (n=32) patients, being the need for tracheostomy due to airway obstruction (11%, n=18) and mediastinitis (8.6%, n= 14) the most common. Evaluated subjects had an increased value of serological biomarkers (SII index 2639.9 ± 2062.9, NLR 11.3 ± 8.5, PLR 184.1 ± 108.5, CRP 12.6 ± 8.9 mg/dL, ESR 20.7 ± 9.1 mm/h). Patients with complications had a significantly higher value of all inflammatory parameters (p < 0.05). A SII index cut-off value of 2975 was selected from a ROC curve analysis. A sensitivity of 93.8%, specificity of 86.3%, a positive predictive value of 62.5%, and a negative predictive value of 98.3% are reported. The SII index was found to have an increased positive predictive value compared to NLR, PLR, and CRP for DNI complications. CONCLUSIONS: Our analysis concluded that the SII index, NLR, and PLR are valuable biomarkers to assess the risk of complications from DNI. SII index showed a high accuracy for prediction of DNI complications with a cut-off value of 2975.

Asunto(s)

Inflamación , Linfocitos , Adulto , Humanos , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Biomarcadores , Linfocitos/patología

RESUMEN

BACKGROUND: Breast cancer-related inflammation is critical in tumorigenesis, cancer progression, and patient prognosis. Several inflammatory markers derived from peripheral blood cells count, such as the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR), and systemic immune-inflammation index (SII) are considered as prognostic markers in several types of malignancy. METHODS: We investigate and validate a prognostic model in early patients with breast cancer to predict disease-free survival (DFS) based on readily available baseline clinicopathological prognostic factors and preoperative peripheral blood-derived indexes. RESULTS: We analyzed a training cohort of 710 patients and 2 external validation cohorts of 980 and 157 patients with breast cancer, respectively, with different demographic origins. An elevated preoperative NLR is a better DFS predictor than others scores. The prognostic model generated in this study was able to classify patients into 3 groups with different risks of relapse based on ECOG-PS, presence of comorbidities, T and N stage, PgR status, and NLR. CONCLUSION: Prognostic models derived from the combination of clinicopathological features and peripheral blood indices, such as NLR, represent attractive markers mainly because they are easily detectable and applicable in daily clinical practice. More comprehensive prospective studies are needed to unveil their actual effectiveness.

Asunto(s)

Neoplasias de la Mama , Humanos , Femenino , Pronóstico , Neoplasias de la Mama/patología , Neutrófilos/patología , Recurrencia Local de Neoplasia/patología , Linfocitos/patología , Biomarcadores , Inflamación/patología , Estudios Retrospectivos

RESUMEN

Syphilis can mimic, clinically and microscopically, many other diseases. By microscopy, typically syphilis presents with plasma cell infiltration, admixed with lymphocytes and macrophages, in lichenoid and/or perivascular/perineural distribution pattern. When exuberant, this inflammatory infiltrate can mimic a lymphoproliferative disorder (LPD), notably plasma cell neoplasia or lymphoma. To date, about 12 cases of secondary syphilis, all but one in extraoral location, suggesting initially a LPD, have been published. Here, to our knowledge, we report an unusual case of intraoral primary syphilis initially suggesting LPD, notably lymphoid hyperplasia (pseudolymphoma); however, mucosa-associated lymphoid tissue (MALT) lymphoma and follicular lymphoma could not be disregarded. Polyclonality of plasma cells on immunohistochemistry, in strict clinical correlation, was essential to arrive at the correct diagnosis.

Asunto(s)

Linfoma de Células B de la Zona Marginal , Trastornos Linfoproliferativos , Sífilis , Humanos , Sífilis/diagnóstico , Sífilis/patología , Trastornos Linfoproliferativos/diagnóstico , Trastornos Linfoproliferativos/patología , Linfoma de Células B de la Zona Marginal/patología , Linfocitos/patología , Diagnóstico Diferencial

RESUMEN

BACKGROUND AND PURPOSE: Sepsis-surviving adult individuals commonly develop immunosuppression and increased susceptibility to secondary infections, an outcome mediated by the axis IL-33/ILC2s/M2 macrophages/Tregs. Nonetheless, the long-term immune consequences of paediatric sepsis are indeterminate. We sought to investigate the role of age in the genesis of immunosuppression following sepsis. EXPERIMENTAL APPROACH: Here, we compared the frequency of Tregs, the activation of the IL-33/ILC2s axis in M2 macrophages and the DNA methylation of epithelial lung cells from post-septic infant and adult mice. Likewise, sepsis-surviving mice were inoculated intranasally with Pseudomonas aeruginosa or by subcutaneous inoculation of the B16 melanoma cell line. Finally, blood samples from sepsis-surviving patients were collected and the concentration of IL-33 and Tregs frequency were assessed. KEY RESULTS: In contrast to 6-week-old mice, 2-week-old mice were resistant to secondary infection and did not show impairment in tumour controls upon melanoma challenge. Mechanistically, increased IL-33 levels, Tregs expansion, and activation of ILC2s and M2-macrophages were observed in 6-week-old but not 2-week-old post-septic mice. Moreover, impaired IL-33 production in 2-week-old post-septic mice was associated with increased DNA methylation in lung epithelial cells. Notably, IL-33 treatment boosted the expansion of Tregs and induced immunosuppression in 2-week-old mice. Clinically, adults but not paediatric post-septic patients exhibited higher counts of Tregs and seral IL-33 levels. CONCLUSION AND IMPLICATIONS: These findings demonstrate a crucial and age-dependent role for IL-33 in post-sepsis immunosuppression. Thus, a better understanding of this process may lead to differential treatments for adult and paediatric sepsis.

Asunto(s)

Interleucina-33 , Sepsis , Humanos , Ratones , Animales , Niño , Inmunidad Innata , Linfocitos/metabolismo , Linfocitos/patología , Terapia de Inmunosupresión

RESUMEN

Background: Appendicitis is the main cause of acute surgical abdomen in pediatrics. Delay in the diagnosis implies serious consequences. Objective: To know the utility of inflammation markers for predicting complicated acute appendicitis (CAA) in children. Material and methods: Analytical cross-sectional retrolective study. We included patients from 3 to 17 years, with and without acute appendicitis (AA), who had complete blood count (CBC). Presurgical CBC, surgical findings and histopathologic results were recorded; group I, CAA; group II, uncomplicated acute appendicitis (UAA); and group III, without AA, with stratified analysis by age group. Results: 377 patients were included, 9 years of age (IQR 5-12.5), group I (n = 94), group II (n = 94) and group III (n = 189). Group I showed elevation in the values of Neutrophil/lymphocyte ratio (NLR), Platelet/lymphocyte ratio (PLR) and Systemic immune inflammation (SII) index and lower levels for the Lymphocyte/monocyte ratio (LMR). For AA, in preeschoolers, NLR (sensitivity [S]: 0.85; specificity [E]: 0.98), PLR (S: 0.76; E: 0.85), SII (S: 0.92; E: 0.92) was observed; school children, NLR (S: 0.90; E: 0.96), PLR (S: 0.70: E: 0.86), SII (S: 0.91; E: 0.91); adolescents, NLR (S: 0.85; E: 0.97), PLR (S: 0.26; E: 0.95), SII (S: 0.86; E: 0.86); in CAA, S and E decreased. NLR, PLR, LMR and SII were associated with AA in all ages; PLR and SII in preschoolers, LMR in school children were associated with CAA. Conclusion: NLR, PLR, LMR and SII are predictors of AA in pediatric age, and for AAC, PLR and SII in preschoolers and LMR in school children.

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Introducción: la apendicitis es la principal causa de abdomen agudo quirúrgico en pediatría; el retraso en su diagnóstico implica consecuencias graves. Objetivo: conocer la utilidad de los índices inflamatorios para predicción de apendicitis aguda complicada (AAC) en niños. Material y métodos: estudio transversal, analítico, retrolectivo. Incluimos pacientes de 3 a 17 años, con y sin apendicitis aguda (AA), con biometría hemática completa (BHC). Se registró BHC prequirúrgica, hallazgos quirúrgicos y resultado histopatológico; grupo I, AAC; grupo II, apendicitis aguda no complicada (AANC) y grupo III, sin AA; con análisis estratificado por grupo etario. Resultados: se incluyeron 377 pacientes, edad 9 años (RIC 5-12.5), grupo I, 94; grupo II, 94, y grupo III, 189. El grupo I mostró elevación de los índices neutrófilos/linfocitos (INL), plaquetas/linfocitos (IPL) e inmuno/sistémico (IIS) y menor índice linfocitos/monocitos (ILM). Para AA, se observó en preescolares, INL (sensibilidad [S]: 0.85; especificidad [E]: 0.98), IPL (S: 0.76; E: 0.85), IIS (S: 0.92; E: 0.92); escolares, INL (S: 0.90; E: 0.96), IPL (S: 0.70; E: 0.86), IIS (E: 0.91; S: 0.91); adolescentes, INL (S: 0.85; E: 0.97), IPL (S: 0.26; E: 0.95), IIS (S: 0.86; E: 0.86); en AAC, S y E disminuyeron. INL, IPL, ILM e IIS se asociaron con AA en todas las edades; IPL e IIS en preescolares e ILM en escolares se asociaron con AAC. Conclusión: INL, IPL, ILM e IIS son predictores de AA en edad pediátrica, así como, IPL e IIS en preescolares e ILM en escolares lo son de AAC.

Asunto(s)

Apendicitis , Adolescente , Humanos , Niño , Apendicitis/complicaciones , Apendicitis/diagnóstico , Apendicitis/cirugía , Estudios Transversales , Estudios Retrospectivos , Linfocitos/patología , Inflamación

RESUMEN

Macrophage migration inhibitory factor (MIF) is present in high amounts in the BALF and serum of asthmatic patients, contributing to the pathogenesis of experimental asthma induced by OVA in mice. Whether MIF contributes to the physiopathology on a more complex and relevant asthma model has not been characterized. Mif-deficient (Mif-/- ) or WT mice treated with anti-MIF antibody were challenged multiple times using house dust mite (HDM) extract by the intranasal route. HDM-challenged Mif-/- mice presented decreased airway hyperresponsiveness, lung infiltration of eosinophils, mucus hypersecretion, and subepithelial fibrosis compared to HDM-challenged WT mice. Amounts of IL-4, IL-5, and IL-13 were decreased in the lungs of Mif-/- mice upon HDM challenges, but the increase of CCL11 was preserved, compared to HDM-challenged WT mice. We also observed increased numbers of group 2 innate lymphoid cells and Th2 cells in the BALF and mediastinal LNs (mLN)-induced challenged by HDM of WT mice, but not in HDM-challenged Mif-/- mice. Anti-MIF treatment abrogated the airway infiltration of eosinophils, mucus hypersecretion, and subepithelial fibrosis in the lungs of HDM-challenged mice. In conclusion, MIF ablation prevents the pathologic hallmarks of asthma in HDM-challenged mice, reinforcing the promising target of MIF for asthma therapy.

Asunto(s)

Asma , Factores Inhibidores de la Migración de Macrófagos , Animales , Ratones , Pyroglyphidae , Factores Inhibidores de la Migración de Macrófagos/genética , Inmunidad Innata , Linfocitos/patología , Pulmón , Inflamación/patología , Fibrosis

RESUMEN

BACKGROUND Jessner's lymphocytic infiltration of the skin (JLIS) is a rare and benign process of unknown cause. This disorder affects both sexes, most commonly in the young adult population. However, the demographic characteristics remain largely unknown, due to limited information. JLIS clinical presentation is heterogeneous; lesions can be indurated papular or erythematous plaques on the upper body. Symptoms are variable, from asymptomatic to pruritus and burning sensation. CASE REPORT A female patient aged 73 years presented with 10-day asymptomatic dermatosis on the left malar area after an insect sting. At the beginning, the lesion was clinically classified as an abscess and antibiotic therapy was prescribed with ciprofloxacin 500 mg every 12 hours for 5 days. However, due to the lack of clinical response, a biopsy was performed, which reported a predominantly lymphocytic nodular dermatitis. JLIS diagnosis was confirmed after laboratory and imaging tests. Intralesional infiltrations of triamcinolone (0.5 ml) twice within 15 days and mineral sunscreen 3 times a day were prescribed. After the treatment, the lesion had a complete resolution without recurrence to date. CONCLUSIONS The present case reports JLIS in an older woman who presented a complete healing resolution of the lesion without recurrences after triamcinolone intralesional infiltrations and sunscreen protection.

Asunto(s)

Seudolinfoma , Protectores Solares , Masculino , Humanos , Femenino , Anciano , Piel/patología , Linfocitos/patología , Seudolinfoma/patología , Triamcinolona

RESUMEN

PURPOSE: This study aimed to evaluate neutrophil to lymphocyte ratio (NLR) as a laboratory biomarker in radioactive iodine-refractory (RAIR) locally advanced and/or metastatic differentiated thyroid cancer (DTC) and determine its correlation with overall survival (OS). METHODS: We retrospectively included 172 patients with locally advanced and/or metastatic RAIR DTC admitted between 1993 and 2021 at INCA. Age at diagnosis, histology, presence of distant metastasis (DM), DM site, neutrophil-to- lymphocyte ratio (NLR), imaging studies such as PET/CT results, progression free survival (PFS) and overall survival (OS) data were analyzed. NLR was calculated at the time of locally advanced and/or metastatic disease diagnosis and the cutoff value was 3. Survival curves were established using the Kaplan-Meier method. The confidence interval is 95%, and a p-value of less than 0.05 was considered statistically significant RESULTS: Out of 172 patients, 106 were locally advanced, and 150 presented DM at some point during follow-up. Regarding NLR data, 35 had NLR over 3 and 137 had NLR under 3. Higher NLR at was associated with shorter OS (6 vs. 10; p = 0.05) and with highest SUV on FDG PET-CT (15.9 vs. 7.7, p = 0.013). We found no association between higher NLR and age at diagnosis, DM or final status. CONCLUSION: NLR higher than 3 at the time of locally advanced and/or metastatic disease diagnosis is an independent fator for shorter OS in RAIR DTC patients. Noteworthy higher NLR was also associated with highest SUV on FDG PET-CT in this population.

Asunto(s)

Adenocarcinoma , Neoplasias de la Tiroides , Humanos , Neutrófilos , Radioisótopos de Yodo/uso terapéutico , Tomografía Computarizada por Tomografía de Emisión de Positrones , Fluorodesoxiglucosa F18 , Estudios Retrospectivos , Neoplasias de la Tiroides/radioterapia , Neoplasias de la Tiroides/patología , Linfocitos/patología , Pronóstico , Adenocarcinoma/patología

RESUMEN

BACKGROUND: The underlying pathology of isolated coronary artery ectasia (CE) has not been fully elucidated. OBJECTIVE: We aimed to examine the relationship between the systemic immune inflammation index (Sii), which corresponds to the multiplying of the neutrophil-to-lymphocyte ratio (NLR) and the platelet counts, and isolated CE. METHOD: The retrospective study population included 200 patients with isolated CE, 200 consecutive with obstructive coronary artery disease, and 200 consecutive with a normal coronary artery angiogram. A 2-sided p-value of <0.05 was considered significant. RESULTS: Sii, NLR, platelet-to-lymphocyte ratio (PLR), and monocyte-to-high density lipoprotein cholesterol ratio (MHR) were significantly higher in the CE group compared with the other groups (all p<0.001). In multivariate analysis, Sii (p<0.001, OR = 1.005, 95% CI =1.004-1.005) was found to be an independent predictor of isolated CE. In Receiver Operating Characteristic curve analysis, Sii had a higher Area Under the Curve than NLR, PLR, and MHR. Sii value of >517.35 has 79% sensitivity, 76% specificity for the prediction of the CE [AUC: 0.832, (p<0.001)]. Sii had a significant correlation with the number of ectatic coronary arteries and Markis classification (r:0.214 p=0.002; r:-0.195, p=0.006, respectively). CONCLUSION: To the best of our knowledge, this is the first study that Sii was significantly associated with isolated CE presence and anatomical severity.

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FUNDAMENTO: A patologia subjacente da ectasia da artéria coronária (EC) isolada não foi totalmente elucidada. OBJETIVO: Nosso objetivo foi examinar a relação entre o índice de inflamação imune sistêmica (Sii), que corresponde à multiplicação da razão neutrófilos-linfócitos (RNL) e as contagens de plaquetas, e EC isolada. MÉTODO: A população do estudo retrospectivo incluiu 200 pacientes com EC isolada, 200 consecutivos com doença arterial coronariana obstrutiva e 200 consecutivos com angiografia coronária normal. Um valor de p bicaudal <0,05 foi considerado significativo. RESULTADOS: Sii, RNL, razão plaqueta-linfócito (RPL) e razão monócito-colesterol de lipoproteína de alta densidade (MHR) foram significativamente maiores no grupo EC em comparação com os outros grupos (todos p<0,001). Na análise multivariada, Sii (p<0,001, OR = 1,005, IC 95% =1,004-1,005) foi considerado um preditor independente de EC isolada. Na análise da curva Receiver Operating Characteristic (ROC), Sii teve uma área sob a curva maior em comparação com RNL, RPL e MHR. O valor de Sii >517,35 tem 79% de sensibilidade, 76% de especificidade para a predição do EC [AUC: 0,832, (p<0,001)]. Sii teve correlação significativa com o número de artérias coronárias ectásicas e classificação de Markis (r: 0,214 p=0,002; r:-0,195, p=0,006, respectivamente). CONCLUSÃO: Até onde sabemos, este é o primeiro estudo em que Sii foi significativamente associado à presença isolada de EC e gravidade anatômica.

Asunto(s)

Aneurisma Coronario , Vasos Coronarios , Humanos , Dilatación Patológica/diagnóstico por imagen , Estudios Retrospectivos , Vasos Coronarios/diagnóstico por imagen , Inflamación , Linfocitos/patología , Neutrófilos/patología

RESUMEN

BACKGROUND: The aim of this study is to analyze the role of neutrophil-lymphocyte ratio (NLR) and its variation pre- and postoperatively (delta NLR) in the overall survival after pancreatectomy for pancreatic ductal adenocarcinoma (PDAC) at a single center and to identify factors associated with overall survival. METHODS: A retrospective study of consecutive patients undergoing pancreatectomy due to PDAC or undifferentiated carcinoma from January 2010 to January 2020 was performed. Association between the evaluated factors and overall survival was analyzed using a log-rank test and Cox proportional hazard regression model. RESULTS: Overall, 242 patients underwent pancreatectomy for PDAC or undifferentiated carcinoma. OS was 22.8 months (95% confidence interval (CI): 19.5-29), and survival rates at 1, 3, and 5 years were 72%, 32.5%, and 20.8%, respectively. NLR and delta NLR were not significantly associated with survival (hazard ratio (HR) = 1.14, 95%CI: 0.77-1.68, p = 0.5). Lymph node ratio was significantly associated (HR = 1.66, 95%CI: 1.21-2.26, p = 0.001) in the bivariate analysis. In multivariable analysis, the only factors that were significantly associated with survival were perineural invasion (HR = 1.94, 95%CI: 1.21-3.14, p = 0.006), surgical margin (HR = 1.83, 95%CI: 1.10-3.02, p = 0.019), tumor size (HR = 1.01, 95%CI: 1.003-1.027, p = 0.16), postoperative CA 19-9 level (HR = 1.001, p < 0.001), and completion of adjuvant treatment (HR = 0.53, 95%CI: 0.35-0.8, p = 0.002). CONCLUSION: Neutrophil-lymphocyte ratio and delta NLR were not associated with the overall survival in this cohort. Risk factors such as perineural invasion, surgical margins, CA19-9 level, and tumor size showed worse survival in this study, whereas completing adjuvant treatment was a protective factor.

Asunto(s)

Carcinoma Ductal Pancreático , Neoplasias Pancreáticas , Humanos , Neutrófilos/patología , Pronóstico , Estudios Retrospectivos , Neoplasias Pancreáticas/patología , Carcinoma Ductal Pancreático/patología , Linfocitos/patología , Neoplasias Pancreáticas

RESUMEN

BACKGROUND: It is difficult to distinguish the clinical and histopathological aspects of oral lichen planus lesions from those of oral lichenoid reaction. Some criteria were proposed to distinguish them, mainly because they have different biological behaviors. The aim of the present study was to compare the lymphocyte population and the expression of E-selectin between these lesions. METHODS: Participants with a clinical diagnosis of oral lichen planus (GOLP) and oral lichenoid reaction (GOLR) who needed to perform a biopsy were selected. The tissue was frozen and immunostaining was performed for CD3/CD4, CD3/CD8, CD4/CLA, CD8/CLA, and CD62E. The analysis of each immunostaining was accomplished using the ImageJ program. RESULTS: In total, 25 participants with oral lichen planus and 11 with oral lichenoid reaction were seen. In the evaluation of CD3 + CD4+/CD3 + and CD3 + CD8+/CD3 + proportions, there was a higher percentage of these cells in the oral lichen planus group when compared with the oral lichenoid reaction group (p = 0.027 and p = 0.038 respectively). The average number of CLA + lymphocytes for CD4+/CLA + and CD8+/CLA + in both groups was not statistically significant (p = 0.840; d = 0.363). In GOLP, the number of CD4 + CLA+/E-selectin and CD8 + CLA+/E-selectin was not statistically significant (p = 0.951 and p = 0.454 respectively); neither in GOLR (p = 0.454 and p = 0.989 respectively). CONCLUSION: Our results indicate that CD3 + CD4+, CD3 + CD8+, CD4 + CLA+, CD8 + CLA + lymphocytes and E-selectin are present in both lesions. However, the proportion of CD3 + CD4+/CD3 + and CD3 + CD8/CD3 + cells is higher in the oral lichen planus group when compared with the oral lichenoid reaction group, suggesting that these cells may be important for the etiopathogenic mechanism of these lesions.

Asunto(s)

Liquen Plano Oral , Liquen Plano , Erupciones Liquenoides , Enfermedades de la Boca , Humanos , Liquen Plano Oral/patología , Erupciones Liquenoides/diagnóstico , Liquen Plano/patología , Linfocitos/patología

RESUMEN

BACKGROUND: To assess the existence of association between neutrophil to lymphocyte ratio (NLR) and the risk of sarcopenia in COVID-19 patients. METHODS: A retrospective cross-sectional study was conducted in a university hospital with patients with an active COVID-19 infection admitted to the nursing ward or intensive care unit (ICU) between September to December 2020. Sarcopenia risk was assessed using the Strength, Assistance for walking, Rise from a chair, Climb stairs and Falls (SARC-F). Biochemical analyses were assessed by circulating of C-reactive protein, D-dimer, neutrophils, lymphocytes count and NLR. Sixty-eight patients were evaluated and divided into tertiles of NLR values and the association between NLR and sarcopenia risk were tested using the linear regression analyses and p<0.05 were considered as significant. RESULTS: Sixty-eight patients were evaluated and divided in NLR tertiles being the 1st (men=52.2%; 71.1±9.0 y; NLR: 1.1-3.85), 2nd (women=78.3%; 73.2±9.1 y; NLR: 3.9-6.0) and 3rd (men=72.7%; 71.7±10.4 y; NLR: 6.5-20.0). There was a difference between the tertiles in relation to the first to the biochemical parameters of total neutrophils count (p=0.001), C-reactive protein (p=0.012), and D-dimer (p=0.012). However, no difference was found in linear regression analysis between tertiles of NLR and SARC-F, if in total sample (p=0.054) or divided by sex, if men (p=0.369) or women (p=0.064). CONCLUSION: In elderly patients hospitalized with COVID-19, we do not find an association between the risk of sarcopenia and NLR.

Asunto(s)

COVID-19 , Sarcopenia , Masculino , Humanos , Femenino , Anciano , Neutrófilos/química , Neutrófilos/patología , Sarcopenia/complicaciones , COVID-19/complicaciones , Proteína C-Reactiva/análisis , Estudios Retrospectivos , Estudios Transversales , Linfocitos/química , Linfocitos/patología

RESUMEN

BACKGROUND: The neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR), platelet-to-lymphocyte ratio (PLR), and red blood cell distribution width (RDW) have been previously studied as predictors of survival in different malignancies. OBJECTIVE: The aim of this study was to evaluate the predictive value of these hematologic inflammatory biomarkers for patients with brain metastases (BM). METHODS: We reviewed a consecutive cohort of patients at Instituto do Cancer do Estado de São Paulo (ICESP-FMUSP) from 2011 to 2016 with ≥ 1 BM treated primarily by surgical resection. The primary outcome was 1-year survival. We optimized the NLR, MLR, PLR, and RDW cutoff values, preserving robustness and avoiding overestimation of effect size. RESULTS: A total of 200 patients (mean age 56.1 years; 55.0% female) met inclusion criteria. Gross-total resection was achieved in 89.0%. The median (quartiles) preoperative and postoperative KPS scores were 60 (50-80) and 80 (60-90), respectively. Preoperative NLR was significantly associated with survival (HR 2.66, 95% CI: 1.17-6.01, p = 0.019). A NLR cutoff value of 3.83 displayed the most significant survival curve split. CONCLUSIONS: Preoperative NLR is an independent predictor of survival in newly diagnosed BM. We propose a cutoff value of 3.83 for preoperative NLR testing may be clinically useful as predictor of poor survival in this population. The wide accessibility of the NLR favors its inclusion in clinical decision-making processes for BM management.

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ANTECEDENTES: Os neutrófilos para linfócitos (NLR), monócitos para linfócitos (MLR), proporção de plaquetas para linfócitos (PLR) e largura de distribuição de glóbulos vermelhos (RDW) foram previamente estudados como preditores de sobrevivência em diferentes malignidades. OBJETIVO: O objetivo deste estudo foi avaliar o valor preditivo desses biomarcadores inflamatórios hematológicos para pacientes com metástases cerebrais (MB). MéTODOS: Nós revisamos uma coorte consecutiva de pacientes no Instituto do Câncer do Estado de São Paulo (ICESP-FMUSP) de 2011 a 2016 com ≥ 1 MB tratados principalmente por ressecção cirúrgica. O desfecho primário foi a sobrevida em 1 ano. Otimizamos os valores de corte de NLR, MLR, PLR e RDW, preservando a robustez e evitando superestimação do tamanho do efeito. RESULTADOS: Um total de 200 pacientes (idade média de 56,1 anos; 55,0% mulheres) preencheram os critérios de inclusão. A ressecção grosseira total foi obtida em 89,0%. A mediana (quartis) dos escores KPS pré-operatório e pós-operatório foram 60 (50­80) e 80 (60­90), respectivamente. O NLR pré-operatório foi significativamente associado à sobrevida (HR 2,66, IC 95%: 1,17­6,01, p = 0,019). Um valor de corte de NLR de 3,83 exibiu a divisão da curva de sobrevivência mais significativa. CONCLUSõES: O NLR pré-operatório é um preditor independente de sobrevida em MBs recém-diagnosticados. Propomos que um valor de corte de 3,83 para o teste de NLR pré-operatório pode ser clinicamente útil como preditor de baixa sobrevida nesta população. A ampla acessibilidade do NLR favorece sua inclusão nos processos de tomada de decisão clínica para o gerenciamento de BM.

Asunto(s)

Neoplasias Encefálicas , Neutrófilos , Humanos , Femenino , Persona de Mediana Edad , Masculino , Pronóstico , Estudios Retrospectivos , Brasil , Linfocitos/patología , Plaquetas/patología , Neoplasias Encefálicas/patología

RESUMEN

BACKGROUND: Recent studies from eastern centers have demonstrate an association between inflammatory response and long-term outcomes after hepatocellular carcinoma (HCC) resection. However, the prognostic impact of inflammatory markers in western patients, with distinct tumor and epidemiologic features, is still unknown. AIM: To evaluate the prognostic impact of preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR), as well as their impact according to tumor size (< 5 cm, 5-10 cm, > 10 cm) in patients undergoing HCC resection with curative intent. METHODS: Optimal cut-off values for NLR, PLR, and MLR were determined by plotting the receiver operator curves. Overall survival (OS) and disease-free survival (DFS) curves were calculated using the Kaplan-Meier method and compared using the log-rank test. The Cox method was used to identify independent predictors of OS and DFS. RESULTS: In total, 161 consecutive adult patients were included. A high NLR (> 1.715) was associated with worse OS (P = 0.018). High NLR (> 2.475; P = 0.047) and PLR (> 100.25; P = 0.028) were predictors of short DFS. In HCC < 5 cm, MLR (> 1.715) was associated with worse OS (P = 0.047). In the multivariate analysis, high PLR was an independent predictor of worse DFS [hazard ratio (HR) 3.029; 95%CI 1.499-6.121; P = 0.002]. CONCLUSION: Inflammatory markers are useful tools to predict long-term outcomes after liver resection in western patients, high NLR was able to stratify subgroups of patients with short OS and DFS, an increased PLR was an independent predictor of short DFS, while high MLR was associated with short OS in patients with early HCC.

Asunto(s)

Carcinoma Hepatocelular , Neoplasias Hepáticas , Adulto , Biomarcadores de Tumor , Carcinoma Hepatocelular/patología , Carcinoma Hepatocelular/cirugía , Humanos , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/cirugía , Linfocitos/patología , Neutrófilos/patología , Pronóstico , Derivación y Consulta , Estudios Retrospectivos

RESUMEN

PURPOSE: Peptide Receptor Radionuclide Therapy (PRRT) with 177Lu-DOTATATE is a palliative therapeutic option for advanced Neuroendocrine Tumors (NETs). Prognostic factors can predict long-term outcomes and determine response to therapy. Among those already explored, biomarkers from full blood count, including neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) has shown value for other solid tumors and for NETs patients submitted to other forms of therapy. However, its relation to PRRT response and patients' prognosis is still to be determined. METHODS: Medical records from 96 patients submitted to PRRT between 2010 and 2017 were reviewed, median NLR and PLR were calculated from baseline flood blood count and dichotomized as high or low. Progression-free survival (PFS) and Overall Survival (OS) were calculated. RESULTS: NLR and PLR median values were 1.8 and 123, respectively. Patients with low NLR had a significantly longer OS (estimated median of 77.5 months, 95% CI: 27.3-127.7) when compared to patients with high NLR (estimated median of 47.7 months, 95% CI: 34.7-60.8); p = 0.04. Patients with low NLR had a trend toward a longer median PFS when compared to patients with high NLR [estimated medians of 77 months (95% CI: 27.3-127.7), and 47.7 months, (95% CI: 34.7-60.7)], respectively, p = 0.08. CONCLUSION: Patients with advanced-stage NET with NLR higher than 1.8 have worse long term clinical outcomes after PPRT. Larger studies are needed to validate the optimal cutoff for this biomarker.

Asunto(s)

Tumores Neuroendocrinos , Neutrófilos , Biomarcadores , Humanos , Recuento de Linfocitos , Linfocitos/patología , Tumores Neuroendocrinos/diagnóstico , Tumores Neuroendocrinos/patología , Tomografía de Emisión de Positrones , Pronóstico , Cintigrafía , Estudios Retrospectivos