جستجوی مقالات مرتبط با کلیدواژه "neutrophil-to-lymphocyte ratio" در نشریات گروه "پزشکی"

Muscle relaxants are used for two general purposes. One is to ease endotracheal intubation, and the other is provide surgical relaxation.
This study has been designed with the aim of assessing the impact of atracurium and cisatracurium on patients at the anesthesia induction and the neutrophil to lymphocyte ratio.

This is a randomized clinical trial that was performed in 2022-2023 in Kashani hospital in Isfahan, Iran on patients that were candidates for elective surgery under general anesthesia by atracurium or cisatracurium. A total number of 80 patients entered and were randomized into two group’s one receiving group atracurium 0.5mg/kg, and other group received cisatracurium 0.15mg/kg over 60 seconds as NMB. Blood sample were taken base time, after 3, and 20 minutes following intubation. Qualitative data is reported as frequency with percentage. And quantitative data as average with standard deviation. Statistical analysis was done using SPSS version 25. Qualitative data were analyzed using chi-square tests and quantitative data using independent T test. Significance level was defined as p value <0.05.

Overall, 80 patients were enrolled in this study. 40 of them belonged to the cisatracurium group and 40 to the atracurium group. Average age of the participants was 42.86 (±14.52) years old. Mean arterial pressure (MAP) in cisatracurium group dropped significantly following intubation (p<0.005), while it rose significantly in the atracurium group (p<0.05). However neutrophil to lymphocyte ratio (NLR) was significantly higher in the cisatracurium group following intubation (P<0.05).

While the use of atracurium in patients is still safe, is yet more correlated with pronounced hemodynamic instability compared to cisatracurium.

 Bacillus Calmette-Guérin (BCG) immunotherapy is a standard treatment for high-risk non-muscle invasive bladder cancer (NMIBC) after tumor resection. However, not all patients respond to BCG therapy. Reliable prognostic markers are needed to predict treatment outcomes.

 This study reviewed the prognostic value of systemic immune-inflammation index (SII) and related markers in BCG response.

 A systematic literature search was conducted in PubMed, Web of Science, and Scopus databases from inception to October 2023 for studies on SII index, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) in bladder cancer patients receiving BCG therapy. Four retrospective studies involving 1124 patients met the inclusion criteria and were included in qualitative synthesis. Three studies were included in the meta-analysis of progression-free survival (PFS) and recurrence-free survival (RFS). Data on study characteristics and demographics, follow-up duration, cancer stage/grade, and pre-treatment marker levels were extracted. Hazard ratios (HRs) were pooled using a random effects model.

 Elevated pre-treatment SII was associated with significantly worse PFS (HR: 3.72, 95% CI: 1.74-7.98, P<0.001) and RFS (HR: 3.72, 95% CI: 1.42-9.77, P=0.007). However, significant heterogeneity was found among trials in the overall survival (OS) (I2 =83.49, P=0.002) and RFS (I2 =89.69%, P=0.002). In multivariate analysis, SII>672.75 was an independent predictor of BCG failure (OR: 2.229, 95% CI: 1.172-4.238, P=0.015). NLR, PLR, and MLR also showed potential prognostic value with area under the curve (AUC) values ranging from 0.592 to 0.663 for predicting non-response to BCG therapy. Specifically, NLR>3.0435, PLR>123.4398, and MLR>0.1995 were significantly associated with non-response to BCG (P<0.001 for all). In univariate analysis, BCG non-response was associated with high pre-treatment levels of PLR, NLR, and MLR (P<0.001).

 Pre-treatment SII and other inflammatory markers may predict poor outcomes after BCG immunotherapy in bladder cancer patients. SII holds promise as an accessible prognostic biomarker that can guide treatment decisions. Further large prospective studies are warranted to validate these preliminary findings.

Fragmented QRS (fQRS) might be associated with certain characteristics in ST?elevation myocardial infarction (STEMI) patients and inhospital adverse events.

A sum of 500 patients were gone over retrospectively. Patients with STEMI, all undergone percutaneous coronary intervention, were grouped as fQRS (?) and fQRS (+). Characteristics of the patients, major adverse cardiac event (MACE), death in hospital, nonfatal myocardial infarction (MI), stent thrombosis, slow flow myocardial perfusion, development of ventricular tachycardia (VT) and fibrillation, cardiogenic shock and cardiopulmonary arrest were filtered.

FQRS (?) group was composed of 207 patients whose mean age was 61.1 ± 12.1, whereas 293 patients were there in fQRS (+) with a mean age of 66.7 ± 10.6 (P < 0.001). Thrombolysis in MI (TIMI) (P < 0.01), the global registry of acutecoronary events (GRACE) (P < 0.01) scores, white blood cell count, neutrophil/lymphocyte ratio, MACE and the ratio of death in hospital and VT in the hospital were significantly higher in fQRS (+) group (P < 0.001, for remaining all). In multivariate logistic regression analysis, TIMI scores above 2 and GRACE scores above 109 were determined as independent predictors of MACE in the entire patient group (odds ratio [OR]: 2.022; 95% confidence interval [CI]; 1.321–3.424, P = 0.003; OR: 1.712; 95% CI: 1.156–2.804, P = 0.008).

FQRS (+) and fQRS (?) patients markedly differ from each other in terms of certain demographic and clinical features and TIMI and GRACE scores have a significant predictive value for MACE in all STEMI patients’ group.

 Hemodialysis (HD) is the treatment of end-stage renal disease (ESRD), which leads to increased inflammation and mortality. This study aimed to investigate the relationship of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) with high sensitivity C-reactive protein (hs-CRP) levels to predict inflammatory conditions in HD patients.

 A total of 100 eligible maintenance HD patients referred to 22 Bahman and 17 Shahrivar hospitals in Mashhad were enrolled in this cross-sectional study. We collected demographic and clinical data, as well as values of inflammatory markers such as NLR, PLR, and hs-CRP, from the patient’s medical records.

 Forty-six of the patients were female. The mean age of the patients was 37.96±10.29 years, and the mean duration of HD was 54.32±50 months. The mean hs-CRP levels, NLR, and PLR were 6.08±5.70 mg/L, 2.79±1.18, and 125.80±57.14, respectively. The results showed a statistically significant and direct relationship between PLR and hs-CRP levels (P=0.01). There was no correlation between NLR and hs-CRP levels (P=0.8). Additionally, PLR was inversely correlated with hs-CRP in hypertensive patients (r=-0.283, P=0.04), female patients (r=0.3, P=0.04), and patients with HD duration of less than five years (r=0.3, P=0.001).

 Based on these findings, the PLR is a useful inflammatory marker in HD patients with ESRD that correlates with hs-CRP levels. We recommend further investigations to establish its accuracy in clinical care.

Platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) are novel inflammatory markers known for inflammatory and cardiovascular diseases. This study aimed to examine PLR and NLR as predictors of calcification aortic stenosis (CAS) severity.  This study investigated a total of 155 individuals who were referred to Chamran Heart Center in Esfahan, Iran between 2018 and 2019. The participants included 53 patients with severe AS, 50 patients with mild to moderate AS, and 52 individuals as a control group. The severity of aortic stenosis was evaluated in all participants using echocardiography. The study also calculated the PLR and NLR from CBC.  The results of this study indicate that there was no significant difference in PLR among those with severe AS (108±66), mild to moderate AS (103±43), and the control group (110±50) (p=0.813). However, the NLR was significantly higher in those with severe AS (3.13±2.3) compared to mild to moderate AS (2.08±0.7) and the control group (2.1±1.3) (p=0.019). Age and diabetes mellitus were found to be significant and independent factors correlated with PLR, while the severity of AS was not. Additionally, severe AS was found to be an independent predictor of NLR, along with age and sex.  This study elucidated the intricate relationship between inflammatory markers and CAS, emphasizing the significance of NLR as an indicator of pro-inflammatory and anti-inflammatory contrast. Surprisingly, PLR exhibited no relationship with CAS severity. we suggest that future studies examine the effect of ethnic variation on the relationship between inflammatory markers and CAS. Also, explore the potential impact of additional inflammatory markers on new indices that may provide stronger predictive value for CAS severity.

 The neutrophil-to-lymphocyte ratio (NLR) is an inflammation biomarker in patients with liver cirrhosis. While increased NLR is linked to poor clinical outcomes and mortality in diseases like cancers, its association with cirrhosis complications has been sparsely examined.

 This study aimed to evaluate the association between NLR and cirrhosis complications in patients with compensated liver cirrhosis.

 This retrospective cohort study was conducted on 256 patients with compensated liver cirrhosis visiting the Gastroenterology Clinic of Imam Khomeini Hospital, Ahvaz, Iran, in 2020. The peripheral blood lymphocyte and neutrophil counts were evaluated, and the NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count. Cirrhosis complications were assessed based on clinical and laboratory evaluation during 1 year of follow-up.

 During the retrospective follow-up period, 59 patients (23.05%) experienced cirrhosis complications such as spontaneous bacterial peritonitis (n = 23), gastrointestinal bleeding (n = 22), and hepatic encephalopathy (n = 14). The baseline NLR, Model for End-Stage Liver Disease (MELD) score and Child-Pugh score were significantly higher in patients who later developed complications than in those who did not (P < 0.0001). The NLR with an optimal cut-off of > 1.95 had a sensitivity of 84.75% and specificity of 93.91% in predicting complications during the 1-year follow-up (AUC = 0.905, P < 0.0001).

 Our results indicated that the NLR is a simple, non-invasive, and cost-effective marker for predicting short-term complications in patients with compensated liver cirrhosis.

Pemphigus vulgaris (PV) is a rare autoimmune disease characterized by the development of flaccid blisters on the skin and mucous membranes. Detection of anti-desmoglein (Dsg) 1 and anti- Dsg3 antibodies are frequently used for diagnosing the disease and evaluating disease activity. Recently, the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV) were introduced as new biomarkers indicating inflammation in autoimmune and autoinflammatory diseases. We aimed to evaluate the possible associations of NLP, PLR, and MPV with pemphigus disease severity and anti-Dsg1/3 levels. Thirty-three newly diagnosed cases of PV and 33 age and sex-matched controls were included in this study. A complete blood count (CBC) was obtained from the participants to evaluate NLP, PLR, and MPV. Serological anti-Dsg1/3 and Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) were assessed in patients based on ELISA assay and clinical examination, respectively. The median (interquartile range) NLR and PLR values in patients were 2.50 (1.94–6.59) and 90.30 (71.60–196.80), respectively, compared with 1.69 (1.45–2.30) and 56.00 (50.00–85.00) in controls. The NLR and PLR were significantly higher in patients than in controls (P < 0.001 for both). However, no significant difference regarding MPV levels was detected. Neither the ABSIS nor the anti- Dsg1/3 levels correlated with the studied inflammatory markers. Our study revealed that NLR and PLR are elevated in patients with PV but do not correlate with disease activity (evaluated by the ABSIS) or anti-Dsg1/3 levels. These laboratory parameters can be considered inflammatory markers of PV but cannot predict the disease activity.

Pulmonary hypertension (PH) is a hemodynamic and pathophysiological disease defined by a mean pulmonary artery pressure of  ≥20 mm Hg. Pulmonary hypertension severity and prognosis play an essential role in the management of these patients. The aim of this study was to evaluate the prognostic value of platelet to lymphocyte ratio (PLR) and neutrophil to lymphocyte ratio (NLR) in patients with PH referred to Masih Daneshvari Hospital, Tehran, Iran.
A total of 61 patients with PH referred to Masih Daneshvari Hospital in Tehran were enrolled. Patients’ information such as age, sex, type of PH, echocardiographic data, and blood cell count, including platelet, lymphocyte, and neutrophil count, hemoglobin, and RDW, were collected in each follow-up.
Out of 61 patients with PH, 27 (44.3%) were male, and 34 (55.7%) were female. The mean age of the patients was 43.19 ± 2.25 years. Our results showed that during hospitalization, PLR decreased from 13.2 to 9.7, and NLR also decreased from 4.49 to 3.08. Neither PLR nor NLR was associated with gender. However, both PLR and NLR showed a significant difference between deceased vs. discharged patients and were significantly lower in the patients who died.
Both PLR and NLR decreased during hospitalization in patients with PH, and this decrease was greater in the patients who died, suggesting these indicators as potential prognostic markers for the disease.

The neutrophil-to-lymphocyte ratio (NLR), obtained from a peripheral blood sample, is considered an indicator of subclinical inflammation. The aim of this study was to determine the NLR pattern in the deceased and survivor patients with coronavirus disease 2019 (COVID-19) during hospitalization.

This was a cross-sectional analytical study that was performed in TohidHospital in Sanandaj, Iran, from March to July 2021. In our study, 30 patients had received the treatments for COVID-19 and did not need to be admitted to the intensive care unit (ICU). They were discharged from the hospital and considered "Group A". Besides, 21 patients who were admitted to the ICU but were discharged were considered "Group B". Finally, 40 patients with COVID-19 who were hospitalized in the ICU and died were considered "Group C". Complete blood count (CBC) test was performed for all patients at 3 different times (at the time of admission, mid-hospitalization, and the last day of hospitalization). In the end, the data were analyzed by one-way analysis of variance (ANOVA) and the Kruskal-Wallis H test.

91 patients were included in this study. The NLR index during hospitalization in Group C was significantly higher than in Group B and in Group B was significantly higher than in Group A. On the other hand, in Group C, the NLR was significantly increased at three consecutive times during hospitalization; however, in Group B and Group A, at the end of hospitalization, this ratio was lower than in mid-hospitalization.

The NLR was an important indicator in predicting patients' prognoses. Pulmonary inflammation in patients with COVID-19 will be accompanied dominantly by neutrophils; thus, the NLR parameter could be important in the progress of the clinical status.

The present study aimed to compare inflammatory markers of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, and maternal platelet count in patients with and without chorioamnionitis with premature preterm rupture of membrane (PPROM).

Women with PPROM and gestational age less than 34 weeks were enrolled in this cohort study. PPROM was confirmed with sterile speculum examination or the AmniSure test. A blood sample was drawn from mothers for complete blood count (CBC) and differential count (Diff) before administering antibiotics and corticosteroids. Another blood sample was drawn for CBC-Diff tests at the time of pregnancy termination. The status of mothers and fetuses was carefully monitored during hospitalization through the following indicators: vital signs, daily abdominal examination, uterus discharge, daily non-stress test, and weekly ultrasonography. All samples were collected in one year.

A total of 110 patients were examined. The reason for pregnancy termination was gestational age of 34 weeks in 30 patients (27.3%), chorioamnionitis in 19 cases (17.3%), pain and dilation in 32 cases (29.1%), and miscellaneous in 29 cases (26.4%). Among the study parameters, only NLR was significantly different between groups, and the order of values from highest to lowest was in the chorioamnionitis, pain and dilatation, miscellaneous, and gestational age of 34 weeks groups. We found that NLR at a cut-off point of 3.2 - 3.5 had an acceptable sensitivity and low specificity to detect the cases of chorioamnionitis. Raised NLR was associated with (95% CI) histological chorioamnionitis with a sensitivity of 86% and a specificity of 43%.

According to the findings of our study, NLR can be a suitable indicator for predicting chorioamnionitis in women who deliver preterm without clinical signs and symptoms of infection. It can be used for expectant management for PPROM after 34 weeks. 

Metabolic syndrome is a critical health concern associated with an elevated risk of chronic health problems including cardiovascular disease and diabetes. There are shreds of evidence that novel inflammatory ratios including neutrophil-to-lymphocyte, platelet-to-lymphocyte and lymphocyte-to-monocyte ratios serve as prognostic biomarkers for metabolic syndrome (MetS). This hypothesis was investigated in a cohort of the Iranian population.

selection of MetS + subjects was based on the National Cholesterol Education Program Adult Treatment Panel III criteria 3 (NCEP ATP 3). The control group consisted of participants negative for any of the five MetS criteria. Demographic and laboratory data were extracted from the Tabari cohort study.

A total of 1930 subjects including 965 Mets positive and 965 MetS criteria negative participants were evaluated. Diabetes (84.8%), hypertension (48.9%), hypertriglyceridemia (81.7%), low HDL cholesterol (70.3%), and high waist circumference (78.9%) were observed in patients. There were no differences between NLR (1.66±0.71 vs. 1.69±0.72 P=0.42), LMR (11.23±3.13 vs. 11.30±11.99, P= 0.86) and PLR (113.85±68.67 vs 114.11±35.85, P=0.91) between case and control groups, respectively. Logistic regression analysis revealed no association between ratios and MetS risk even after adjusting for potential confounders including age, gender, living place, and BMI.

In a relatively large population from Northern Iran, no association was observed between CBC-derived inflammatory ratios and the presence of MetS.

The Neutrophil to Lymphocyte Ratio (NLR) and Platelet to Lymphocyte Ratio (PLR) have recently been reported as potentially useful indicators of inflammation. In this study, the authors investigated their predictive role for postoperative complications of Coronary Artery Bypass Graft (CABG). This study was conducted on the medical records of patients who had undergone isolated CABG in 2019-2020 in Isfahan, Iran. The baseline clinical characteristics were obtained from medical records. The diagnosis of postoperative Acute Kidney Injury (AKI) was defined based on the Kidney Disease Improving Global Outcomes guideline. The postoperative bleeding amount was measured from the total chest tube output during the Intensive Care Unit (ICU) admission after surgery. NLR and PLR were measured by dividing the neutrophil and platelet counts by the lymphocyte count, respectively. All data were analyzed using the Statistical Package for Social Sciences (SPSS) version 24. Of 356 patients, data of 280 patients, including 219 males and 61 females, were recruited. The mean age among all patients was 63.78±9.07 years. There were no significant differences between the bleeding group and non-bleeding group regarding NLR (2.33(1.89-2.73) vs. 2.20(1.63-3)) and PLR (119.26(94.41-146.39) vs. 110.26(82.13-136.34)) (p=0.742, p=0.228 respectively). NLR and PLR were significantly higher in AKI-positive patients (P< 0.001 and P=0.002, respectively). Only NLR showed the potential ability to predict postoperative AKI in the crude model (P<0.001) based on the regression tests. Moreover, no significant correlation was seen between both NLR and PLR and hospital stay time, ICU stay time, and in-hospital mortality. The authors found that an increased NLR is associated with a higher risk for AKI after CABG. The authors also found no significant correlations between NLR and PLR with bleeding, hospital stay, ICU stay, and mortality.

 Breast cancer, the most common cancer in women, has a significant challenge in the early diagnosis of medicine. This study aimed to evaluate the diagnostic value of the neutrophil-to-lymphocyte ratio in differentiating benign and malignant breast masses by an economical and straightforward test of Complete Blood Count (CBC).

 This study was a retrospective cross-sectional that was performed on 75 patients with breast masse (40 had benign breast mass and 35 had malignant mass). Data was obtained from the patient’s hospital sheets with health ministry ethics permission. This information was demographic data including CBC, CBC diff, neutrophil/lymphocyte ratio, BMI, and pathologic results of biopsies. Data were analyzed by chi-square, Mann-Whitney, fisher’s exact tests, t-test, and ROC maps in SPSS version 16 software.

 The diagnostic power of neutrophil-to-lymphocyte ratio in the diagnosis of malignant tumor or benign according to the cut-off point was 1.74, and significant. Sensitivity and specificity were 85.71 and 45%, respectively, and their positive and negative predictive value was also found to be 57.76 and 78.26%, respectively, and the overall accuracy of the test was 64%.

 The neutrophil-to-lymphocyte ratio has high sensitivity and low specificity that can help identify positive malignant breast masses. Due to the low specificity, the negative results, however, cannot detect the nature of breast masses with high precision. Therefore, this test is considered a preliminary method that is complementary to other more explicit tests used for the identification of malignant breast masses.

The availability of the COVID-19 vaccine during the pandemic has changed the disease course in the entire world. The current study aimed to compare various hematological parameters among COVID-19 patients with and without vaccination.

The present retrospective study included 26 vaccinated and 26 non-vaccinated COVID-19 patients. Various clinical and biochemical parameters of RT-PCR-positive patients were collected. The values are expressed in Mean±SD or median values IQR. Mann-Whitney U test was used for comparison between the groups. 

Among the vaccinated individuals, 17 cases (65.4%) were asymptomatic, one patient (3.8%) had moderate, eight cases (30.8%) had mild COVID-19 infection and all 26 patients were completely recovered. Among non-vaccinated COVID-19 patients, 25 cases (96.2%) had severe, one case (3.8%) had moderate COVID-19, and 16 patients (61.5%) recovered but ten cases succumbed to COVID-19. There were statistically significant differences in SpO2, total leucocyte count, and differential counts of neutrophils, lymphocytes, eosinophils, monocytes, and basophils between vaccinated and non-vaccinated patients (P<0.001). The neutrophil/lymphocyte ratio was found to be at a higher level (P<0.01) among non-vaccinated patients [10.9(4.28-23.63)]  compared to vaccinated [1.55(1.09-2.28)]. The blood urea, total and direct bilirubin, serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), and inflammatory markers, like C-reactive protein (CRP), D-dimer, ferritin, and lactate dehydrogenase (LDH) were highly elevated in non-vaccinated patients (P<0.001). Moreover, lower values of total protein, serum albumin, and albumin and globulin (A/G) ratio were noted in the non-vaccinated compared to vaccinated individuals (P<0.001).

Vaccinated patients had milder disease with fewer derangements of hematological parameters compared to non-vaccinated patients. It can be concluded that vaccine has played a vital role during the COVID-19 pandemic in reducing mortality.

Recently, many research studies with equivocal results, have found Neonatal Sepsis (NS) biomarkers and focused on single regions. Therefore, the aim of this study was to evaluate serum and urine C - Reactive Protein (CRP), Mean Platelet Volume (MPV) and Neutrophil/ Lymphocyte Ratio (NLR) as diagnostic values in NS.

This case-control study was performed on 147 cases (79 overweight or obese children and 68 normal weight children). For evaluating quality of life, the original version of the PedsQL, quality of life questionnaire, was used.

This descriptive-analytical research analyzed Shahid Beheshti Hospital’s probable NS patients. All individuals got a complete blood count, white blood differential, CRP, blood culture, and urine culture. Data was analyzed by SPSS v24.

The data indicated that NS infants had substantially higher mean serum levels of MPV (10.63 ± 1.03 vs. 8.63 ± 0.96, P<0.001), NLR (2.08 ± 1.24 vs. 1.01 ± 0.5, P<0.001), and CRP (12.97 ± 5.09 vs 5.83 ± 2.6 and 9.61 ± 3.25 vs 4.9 ± 3.4, P<0.001).The optimum cut-off points for serum and urine CRP, NLR, and MVP were 10, 6.7, 1.2, and 9.5. The highest Area under the Curve (AUC) was detected in MPV (0.909), and the other AUC for serum and urine CRP and NLR were 0.872, 0.831, and 0.804, respectively. Serum CRP had the lowest sensitivity (73.3%) among urine, NLR, and MPV. Serum CRP had the best specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV), identified as 96.7 %, 88%, and 90%, respectively.

Sepsis increases MPV, serum and urine CRP, and NLR in neonates. MPV and serum CRP may detect NS early.

In this study, we evaluated the predictability of a modified Club Urológico Español de Tratamiento Oncológico (CUETO) scoring model and preoperative neutrophil-to-lymphocyte ratio (NLR) in patients with non-muscle invasive bladder cancer (NMIBC).

From August 2005 to May 2016, a total of 281 patients received intravesical bacillus Calmette–Guérin therapy after transurethral resection of a bladder tumor. The pathologic stage of all patients was Ta or T1. Of 281 patients, 84 (29.9%) experienced recurrence and 14 (5.0%) developed progression. The mean follow-up period was 46 months. The cut-off value for NLRs was 2.29.

One hundred-eight patients (38.4%) displayed a high NLR (> 2.29). In Kaplan–Meier curve analysis, a high NLR was associated with lower recurrence-free survival (RFS) (P < .001) and progression-free survival (PFS) (P = .002). CUETO scores were associated with RFS (P < .001), but not with PFS (P = .423). A combination of NLRs and the CUETO risk model correlated with RFS (P < .001) and PFS (P = .002). In multivariate analysis, female gender, concomitant carcinoma in situ (CIS), tumor number >3, recurrent tumors, and a high NLR were independent factors predicting recurrence (all P < .05). Concomitant CIS, recurrent tumors, and a high NLR were independent factors for predicting progression (all P < .05).

In patients with NMIBC, an NLR >2.29 was identified as a significant factor for predicting tumor recurrence and progression. Inclusion of preoperative NLR enhanced the accuracy of the CUETO model to predict disease progression.

Silver nanoparticles (Ag-NPs) are among the most widely used nanomaterials in the world. Nanotoxicological data on these additives remain unclear. The aim of this study is to evaluate the in vivo effects of Ag-NPs bioaccumulation on the hematological cells of adult zebrafish Danio rerio after three weeks of oral exposure. Four concentrations of Ag-NPs (65 nm nanosphere), are used: control group 1 (0.00 g/kg of food), group 2 (0.05 g/kg of food), group 3 (5 g/kg of food) and group 4 (50 g/kg of food). The experiment is conducted in triplicate. Cytological and histological results show, a significant increase in neutrophils associated with a significant decrease in lymphocytes in both group 3 and 4 compared to the control group (p<0,05 and p<0,005, respectively). This reflects an elevated neutrophil/lymphocyte ratio (NLR), suggesting a biased immune response associated with hyperplasia of the hematopoietic tissue and histopathological images of nephrological lesions, following medium to high dose of Ag-NPs intake. Besides, microscopic observation of cell morphology revealed lymphocyte activation only in groups 2 and 3 (p<0,005 and p<0,05, respectively). These results suggest that Ag-NPs induce a dose-dependent bioeffects on the immune system in zebrafish. This study reports that at low doses, Ag-NPs may activate lymphocytes but do not alter the NLR, thus demonstrating an immunostimulatory effect. The present investigation is the first study, as far as we know, reporting that Ag-NPs induce a dose-dependent immunomodulation in zebrafish.

Kawasaki disease is a systemic vasculitis of unknown etiology that is common in the pediatric patients. The primary therapeutic strategy includes aspirin and Intravenous Immunoglobulin. The present study aimed to investigate the Neutrophil to Lymphocyte Ratio (NLR) in the patients with Kawasaki and its relationship with the resistance to IVIg therapy.

The present study included the patients presenting to the Motahari Hospital, Urmia, Iran, whom diagnosed with Kawasaki disease and received IVIg during 2008-2019. The authors collected the data from the patients' medical records and re-assessed the patients' data for meeting the diagnostic criteria for Kawasaki. Afterward, the data of eligible patients entered the analysis.

The data from 460 patients were obtained and assessed for meeting the diagnostic criteria for Kawasaki. Of 460 patients, 241 met the eligibility criteria, and the data for other patients that meet exclusion criteria were excluded from the study. According to the results of our study, response to IVIg therapy had a significant relationship with the variables of blood and urinary leukocyte counts (p=0.013 and p=0.01, respectively). However, we didn’t find any significant relationship between the response to IVIg therapy and the variables of age, gender, NLR, neutrophil count, lymphocyte count, C-Reactive Protein (CRP), serum albumin level, ALT, hemoglobin, platelet count, and the interval between onset of symptoms and treatment initiation.

High blood leukocyte count along with low urinary leukocyte count can predict the response to IVIg treatment and subsequent prognosis in the patients affected by the Kawasaki disease. However, the NLR did not show clinical relevance.

Rheumatoid arthritis is a chronic inflammatory autoimmune disease characterized by synovial involvement, inflammation, andjoint destruction that, if not properly controlled, can damage cartilage, bone, ligaments, and tendons and, in some cases, lead todisability. The aim of this study was to identify inflammatory biomarkers in rheumatoid arthritis patients.This case-control study was performed on 50 rheumatoid arthritis patients who referred to the Rheumatology Clinic of ShahidMostafa Khomeini Hospital in Ilam and their healthy counterparts. All patients were examined by a rheumatologist for diseaseactivity based on DAS28 (Disease Activity Score Calculator for Rheumatoid Arthritis) criteria.The results of this study showed that the mean lymphocyte count in the case group was lower than the control group, and therewas a statistically significant relationship between lymphocyte level in the two groups. The mean neutrophil count was higher inthe case group than in the control group, and this relationship was significant. The mean neutrophil/lymphocyte ratio was higherin patients with rheumatoid arthritis than in controls and in women more than men. Stepwise logistic regression also showed thatage, sex, DAS28, VitD (Vitamin D), RF (rheumatoid factor), and NLR (neutrophil-to-lymphocyte ratio) significantly predict theincidence of rheumatoid arthritis (p value < 0.05). Therefore, NLR can be used as a prognostic factor.

To explore the risk factors and predictive factors of systemic inflammatory response syndrome (SIRS) after flexible ureteroscopy (fURS) for upper urinary tract stones.

Patients who underwent fURS from January 2014 to September 2019 were retrospec-tively analyzed, which were divided into the SIRS group and non-SIRS group. Clinical data of all patients, includ-ing gender, age, American society of anesthesia score, diabetes, etc., were collected. Univariate and multivariate logistic regression was used to determine the independent risk factors for SIRS after fURS, and the receiver oper-ating characteristic (ROC) curve was drawn to verify the validity of the results. In addition, patients from October 2019 to January 2020 were prospectively collected to verify the results.

A total of 369 patients were retrospectively included. Univariate analysis showed significant differences in postoperative stone residuals (P = 0.039), preoperative neutrophil/ lymphocyte ratio (NLR) (P < 0.001), and lymphocyte/monocyte ratio (LMR) (P = 0.001) between two groups. Further, preoperative NLR and postoperative stone residuals were independent according to multivariate logistic regression analysis. The optimal cut-off value of preoperative NLR by ROC curve was 2.61, and the area under ROC curve was 77.9%. Prospective analysis based on 53 patients showed that the incidence of SIRS in patients with NLR > 2.61 was significantly higher than that in other patients. (RR = 4.932, P = 0.040).

Preoperative NLR can be used as a predictive factor for SIRS in patients with fURS according to our study. It may provide an evidence for clinicians to make preoperative decisions or medical plans