Circulating Platelets as Mediators of Immunity, Inflammation, and Thrombosis

Platelet count trajectory patterns and prognosis in critically ill patients with thrombocytopenia: Based on latent growth mixture model analysis

BACKGROUND

The role of longitudinal platelet count trajectories in critically ill patients with thrombocytopenia is unclear. This study aimed to identify the association between trajectory patterns and prognosis and assess whether these patterns could enhance the predictive capability of Acute Physiology and Chronic Health Evaluation (APACHE) IV or Sequential Organ Failure Assessment (SOFA) scores for mortality.

METHODS

This retrospective cohort study employed latent growth mixture modeling (LGMM) to identify platelet count trajectory patterns. Cox proportional hazards model was used to evaluate the association between the patterns and mortality. Receiver Operating Characteristic (ROC) curves were plotted, and the areas under the curves (AUCs) were compared between models using the APACHE IV or SOFA score alone and those incorporating trajectory patterns.

RESULTS

A total of 1683 patients from the eICU Collaborative Research Database (eICU-CRD) and 931 patients from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database were included. Two trajectory patterns were identified: Class 1, characterized by "Gradual increase," and Class 2, with "Persistent low." Patients in Class 2 had higher ICU mortality (eICU-CRD: 2.273[1.457-3.546]; MIMIC-IV database: 1.991[1.162-3.412]). Incorporating trajectory patterns into the APACHE IV or SOFA scores substantially enhanced the AUC of these scoring systems alone in predicting ICU mortality (eICU-CRD: P < 0.001; MIMIC-IV database: P = 0.0018).

CONCLUSION

The longitudinal platelet count trajectory patterns are complementary predictors of survival in critically ill patients with thrombocytopenia. Persistently low platelet counts are significantly associated with unfavorable clinical outcomes.

MONOCYTES AND B CELLS MEDIATE ALTERATIONS IN THE GENETIC ASSOCIATION BETWEEN PLATELETS AND SEPSIS VIA CLEC SIGNALING PATHWAY

ABSTRACT

Background: Sepsis is a life-threatening condition characterized by multiple organ dysfunction. Blood cells abnormalities play a significant role in the onset and progression of sepsis; however, the potential causal relationship between platelets and sepsis remains unclear, as does whether immune cells mediate the interaction between platelets and sepsis. This study aims to explore the potential causal relationship between platelets and sepsis and analyze the mediating effect of immune cells. In addition, cell-to-cell communication was analyzed to explore the interaction between blood cells and immune cells. Material and methods: In this study, genome-wide association study data were utilized to examine the association between blood cells and sepsis. Two-sample Mendelian randomization (MR) and reverse MR were performed to investigate the potential causal relationship between blood cells and sepsis, with a specific focus on the relationship between platelets and sepsis. Subsequently, two-step MR was employed to identify the immune cells that mediate the interaction between platelets and sepsis and to assess their potential mediating effects. Cellchat software was used to analyze cell-to-cell communication. Results: The results of two-sample MR indicated that platelets were negatively correlated with sepsis (OR = 0.976, 95% CI 0.959-0.993, P = 0.005), suggesting that platelets have a protective effect against sepsis. Additionally, reverse MR demonstrated that sepsis had no significant effect on platelets (OR = 0.909, 95% CI 0.156-5.296, P = 0.916). The mediating effect analysis revealed that monocytes and B cells were important mediators in the relationship between platelets and sepsis. Notably, the correlation between platelets and sepsis shifted from negative to positive with the involvement of monocytes and B cells. The number and strength of cell-cell interactions were decreased in sepsis. Monocytes and B cells primarily regulate platelets through the CLEC signaling pathway, contributing to the pathogenesis of sepsis. Conclusion: This study confirmed the protective role of platelets in sepsis. Monocytes and B cells mediate changes in the genetic association between platelets and sepsis. Monocytes and B cells primarily interact with platelets via the CLEC pathway, thereby modulating the genetic association between platelets and sepsis. These findings indicate that thrombocytopenia, especially when accompanied by elevated monocytes and B cells, may serve as a potential marker for sepsis.

Pharmacological effects of betulinic acid and its protective mechanisms on the cardiovascular system

BACKGROUND

Betulinic acid (BA), a pentacyclic triterpenoid saponin widely found in plants, has attracted attention for its diverse pharmacological activities. Recent studies highlight its cardioprotective potential, promoting its relevance in cardiovascular research.

AIM OF THE REVIEW

This review summarizes BA's physicochemical properties, structure-activity relationships, natural sources, and synthesis strategies. It further discusses its pharmacokinetics and toxicity to evaluate its drug development potential, with emphasis on cardioprotective effects and related signaling pathways.

METHODS

Literature was collected from databases such as PubMed and Web of Science, focusing on studies addressing BA's chemical characteristics, biological activities, pharmacokinetics, and cardiovascular relevance.

RESULTS

BA exerts cardioprotective effects via multiple signaling pathways, including NRF2, NF-κB, MAPK, and NFAT. These contribute to its antioxidant, anti-inflammatory, anti-apoptotic, and anti-proliferative actions, as well as its enhancement of endothelial function through nitric oxide signaling. BA also reduces lipid accumulation. Combined with favorable physicochemical properties and synthetic accessibility, these findings support BA as a promising multifunctional lead compound in cardiovascular pharmacology.

CONCLUSION

BA shows strong potential as a cardioprotective natural compound. Although further research is needed to validate its clinical efficacy and safety, its multi-target actions and structural versatility provide a solid basis for development in cardiovascular drug discovery.

A machine learning model for predicting severe mycoplasma pneumoniae pneumonia in school-aged children

OBJECTIVE

To develop an interpretable machine learning (ML) model for predicting severe Mycoplasma pneumoniae pneumonia (SMPP) in order to provide reliable factors for predicting the clinical type of the disease.

METHODS

We collected clinical data from 483 school-aged children with M. pneumoniae pneumonia (MPP) who were hospitalized at the Children's Hospital of Soochow University between September 2021 and June 2024. Difference analysis and univariate logistic regression were employed to identify predictors for training features in ML. Eight ML algorithms were used to build models based on the selected features, and their effectiveness was validated. The area under the curve (AUC), accuracy, five-fold cross-validation, and decision curve analysis (DCA) were utilized to evaluate model performance. Finally, the best-performing ML model was selected, and the Shapley Additive Explanations (SHAP) method was applied to rank the importance of clinical features and interpret the final model.

RESULTS

After feature selection, 30 variables remained. We constructed eight ML models and assessed their effectiveness, finding that the CatBoost model exhibited the best predictive performance, with an AUC of 0.934 and an accuracy of 0.9175. DCA was used to compare the clinical benefits of the models, revealing that the CatBoost model provided greater net benefits than the other ML models within the threshold probability range of 34% to 75%. Additionally, we applied the SHAP method to interpret the CatBoost model, and the SHAP diagram was used to visually show the influence of predictor variables on the outcome. The results identified the top six risk factors as the number of days with fever, D-dimer, platelet count (PLT), C-reactive protein (CRP), lactate dehydrogenase (LDH), and the neutrophil-to-lymphocyte ratio (NLR).

CONCLUSIONS

The interpretable CatBoost model can help physicians accurately identify school-aged children with SMPP. This early identification facilitates better treatment options and timely prevention of complications. Furthermore, the SHAP algorithm enhances the model's transparency and increases its trustworthiness in practical applications.

Retrospective perspectives and future trends in nanomedicine treatment: from single membranes to hybrid membranes

At present, various diseases seriously threaten human life and health, and the development of nanodrug delivery systems has brought about a turnaround for traditional drug treatments, with nanoparticles being precisely targeted to improve bioavailability. Surface modification of nanoparticles can prolong blood circulation time and enhance targeting ability. The application of cell membrane-coated nanoparticles further improves their biocompatibility and active targeting ability, providing new hope for the treatment of various diseases. Various types of cell membrane biomimetic nanoparticles have gradually attracted increasing attention due to their unique advantages. However, the pathological microenvironment of different diseases is complex and varied, and the single-cell membrane has several limitations because a single functional property cannot fully meet the requirements of disease treatment. Hybrid cell membranes integrate the advantages of multiple biological membranes and have become an emerging research hotspot. This review summarizes the application of cell membrane biomimetic nanoparticles in the treatment of various diseases and discusses the advantages, challenges and future development of biomimetic nanoparticles. We propose that the fusion of multiple membranes may be a reasonable trend in the future to provide some ideas and directions for the treatment of various diseases.

Low functional capacity in peripheral artery disease is associated with increased platelet activity and cardiovascular events

BACKGROUND AND AIMS

Low functional capacity is an independent risk factor for cardiovascular (CV) events. Regular physical activity may reduce CV risk through suppression of inflammation and reduced platelet activity. We aimed to investigate the association of functional capacity quantified by the validated Duke Activity Status Index (DASI) with platelet activity and incident major adverse CV and limb events (MACLE) in individuals with peripheral artery disease (PAD) undergoing lower extremity revascularization (LER).

METHODS

Light transmission aggregometry and platelet RNAseq were performed on specimens isolated from men and women prior to LER. Functional capacity was assessed using DASI. Prospective follow-up occurred at 1, 6, 12, and every 6 months following the LER. Subjects were separated into tertiles of DASI scores and incidence rates for MACLE were calculated using log-rank tests. Mediation analysis using linear regression fit with least squares was performed to test whether DASI exerted its effect on MACLE via platelet aggregation.

RESULTS

281 patients completed the DASI questionnaire with scores ranging from 0.0 to 50.2 (bottom tertile: 0.0-9.95). Mean age was 74.4 ± 10.9 years and 32.4 % were female. During a median follow-up of 19 months, 163 (58.0 %) participants experienced a MACLE. After correction for demographics and CV risk factors, individuals in the lowest DASI tertile experienced significantly more MACLE than participants in other tertiles. The association between DASI and MACLE was consistent across multiple subgroups stratified by age, sex, body mass index, antiplatelet therapy, and clinical comorbidities. Mediation analyses suggested higher platelet aggregation to epinephrine in the bottom DASI tertile mediated 24.7 % [5.0 %, 103 %] of increased MACLE risk. Platelet mRNA demonstrated upregulation of inflammation pathways in the most sedentary individuals (lowest DASI tertile).

CONCLUSIONS

Patients with PAD and low functional capacity have increased platelet activity and high incidence of MACLE. Our data suggest that elevated platelet aggregation mediates one-quarter of the MACLE risk in persons with low functional capacity undergoing LER. Our findings support a potential platelet-mediated mechanism for improved CV outcomes associated with regular physical activity.

Circulating Tumor Microenvironment in Metastasis

Activation of invasion and metastasis is a central hallmark of cancer, contributing to the primary cause of death for patients with cancer. In the multistep metastatic process, cancer cells must infiltrate the circulation, survive, arrest at capillary beds, extravasate, and form metastatic clones in distant organs. However, only a small proportion of circulating tumor cells (CTC) successfully form metastases, with transit of CTCs in the circulation being the rate-limiting step. The fate of CTCs is influenced by the circulating tumor microenvironment (cTME), which encompasses factors affecting their biological behaviors in the circulation. This liquid and flowing microenvironment differs significantly from the primary TME or the premetastatic niche. This review summarizes the latest advancements in identifying the biophysical cues, key components, and biological roles of the cTME, highlighting the network among biophysical attributes, blood cells, and nonblood factors in cancer metastasis. In addition to the potential of the cTME as a therapeutic target for inhibiting metastasis, the cTME could also represent as a biomarker for predicting patient outcomes and developing strategies for treating cancer.

Neutrophil-to-lymphocyte ratio; platelet-to-lymphocyte ratio; systemic immune-inflammatory Index: inflammatory indicators of cognitive impairment in schizophrenia patients

Objective

The present study sought to evaluate the correlation between cognitive impairment (CI) and inflammatory indicators such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammatory index (SII) in schizophrenia patients.

Methods

This study included 331 schizophrenia inpatients. General data and laboratory findings (neutrophil, lymphocyte, platelet, etc.) were gathered, and then calculating NLR, PLR, and SII. A Chinese version of the Mini Mental State Examination (MMSE) was used for the assessment of cognitive function, and then the patients in the CI group were categorized into mild CI, moderate CI, and severe CI groups. Comparing the differences in NLR, PLR, and SII between the CN group and the CI group, as well as different CI groups, and analyzing the relationship between the NLR, PLR, and SII and the mechanism of CI in schizophrenia.

Results

There were 145 (43.8%) patients with cognitive impairment. Compared to the CN group, the CI group had higher NLR, PLR, and SII than the CN group, although their lymphocyte was lower. The NLR and SII were higher in the moderate CI group than in the mild CI group. NLR, PLR, and SII were significantly inversely correlated with the total score of cognitive function and scores across all aspects, whereas lymphocytes were considerably positively correlated. Higher NLR, PLR, and SII were substantially related to an increased risk of CI, but higher lymphocytes were associated with a decreased risk of CI.

Conclusion

NLR, PLR, and SII may be serum inflammatory markers of CI in schizophrenia, and lymphocytes may be protective variables for cognitive function in schizophrenia.

Nbeal2 knockout mice are not protected against hypoxia-induced pulmonary vascular remodeling and pulmonary hypertension

ABSTRACT

Inflammation drives the initiation and progression of pulmonary hypertension (PH). Platelets, increasingly recognized as immune cells, are activated and increased in the lungs of patients with PH. Platelet activation leads to the release of α-granule chemokines, many of which are implicated in PH. We hypothesized that hypoxia-induced secretion of platelet α-granule-stored proteins and PH would be prevented in Neurobeachin-like 2 knockout (Nbeal2-/-) α-granule-deficient mice. Wild-type (WT) and Nbeal2-/- mice were maintained in normoxia or exposed to 10% hypobaric hypoxia for 3, 14, 21, or 35 days. We observed macrothrombocytopenia, increased circulating neutrophils and monocytes, and increased lung interstitial macrophages (IMs) in Nbeal2-/- mice at baseline. Hypoxia-induced platelet activation was attenuated, and hypoxia-induced increase in lung platelet factor 4 (PF4) and platelets was delayed in Nbeal2-/- mice compared with in WT mice. Finally, although pulmonary vascular remodeling (PVR) and PH were attenuated at day 21, Nbeal2-/- mice were not protected against hypoxia-induced PVR and PH at day 35. Although this mutation also affected circulating monocytes, neutrophils, and lung IMs, all of which are critical in the development of experimental PH, we gained further support for the role of platelets and α-granule proteins, such as PF4, in PH progression and pathogenesis and made several observations that expand our understanding of α-granule-deficient mice in chronic hypoxia.

A mendelian randomization study on the association between 731 types of immune cells and 91 types of blood cells with venous thromboembolism

BACKGROUND

Venous thromboembolism (VTE) is a grave medical condition characterized by the blockage of distant blood vessels due to blood clots or detached vessel wall fragments, leading to ischemia or necrosis of the affected tissues. With the recent introduction of immunothrombosis, the significance of immune cells in the process of thrombus formation has gained prominent attention. Complex cross-talk occurs between immune cells and blood cells during infection or inflammation, with immune cells actively participating in blood clot formation by promoting platelet recruitment and thrombin activation. Nevertheless, comprehensive studies on the genetic association between immune cells phenotypes and VTE remain scarce. This article employed Mendelian randomization (MR) to investigate the association between the incidence of VTE and a range of 731 immune cell types, along with 91 blood cell perturbation phenotypes, utilizing single nucleotide polymorphisms as instrumental variables.

METHODS

Through the utilization of publicly available genetic data, a two-sample bi-directional MR analysis was conducted. Sensitivity analyses included Cochran's Q test, MR-Egger intercept test, MR-pleiotropy residual sum and outlier (MR-PRESSO) and leave-one-out analysis. For significant associations, replication analysis was conducted using GWAS data from deep vein thrombosis (DVT) and pulmonary embolism (PE).

RESULTS

We firstly investigated the causal relationship between 731 immune cells and VTE risk. All the GWAS data were obtained from European populations and from men and women. The IVW analysis revealed that CD20 on naive-mature B cell, CD20 on IgD- CD38dim B cell, and CD20 on unswitched memory B cell may increase the risk of VTE (P < 0.05). CD28- CD8dim T cell %T cell, CD64 on monocyte and CD64 on CD14 + CD16- monocyte may be protective factors against DVT (P < 0.05). Then disturbed blood cells types as exposure were analyzed to examine its association with occurrence of VTE. Initial and replication analysis both revealed that environmental KCl-impacted red blood cells and butyric acid-impacted platelet accelerated incidence of VTE (P < 0.05), while colchicine -impacted eosinophil, KCl-impacted reticulocyte and Lipopolysaccharide (LPS) -impacted neutrophil reduced VTE risk (P < 0.05). Sensitivity analyses confirmed the robustness and reliability of these positive findings.

CONCLUSIONS

Our study presents evidence of a causal link between six immune cell phenotypes and VTE. Additionally, we have identified two types of blood cells that are associated with both VTE and DVT, and three types of blood cells that are relevant to both VTE and PE.

CLINICAL TRIAL NUMBER

Not applicable.

Platelet Reactivity to Zika and Dengue Non-Structural Protein 1 (NS1) Assessed by Flow Cytometry, Atomic Force Microscopy, and Quartz Crystal Microbalance

BACKGROUND

Platelets, besides being traditionally associated with hemostasis, have been recently positioned as immune cells. Alterations in platelet number and function have been reported in some viral infections. Zika virus (ZIKV) and Dengue virus (DENV) are arboviruses that encode for a non-structural protein 1 (NS1). NS1 is mainly involved in the viral replication process and can also be secreted by infected cells and has been associated with immune response evasion. The assessment of platelet reactivity against these viral agents and their proteins, through the use of different innovative technologies such as flow cytometry (FC), atomic force microscopy (AFM), and quartz crystal microbalance (QCM), will allow further study of the pathophysiology of these emerging diseases.

AIM

The aim of this study was to assess platelet reactivity to ZIKV and DENV NS1 protein through the use of FC, AFM, and QCM.

METHODS

Platelet-rich plasma (PRP) was stimulated with ZIKV and DENV NS1 protein in individual assays. The expression of P-selectin and the activity of the glycoprotein IIb-IIIa, platelet activation markers, were assessed by FC, morphological changes were assessed by AFM, and interaction between NS1 protein and platelet were evaluated by QCM.

RESULTS

An increased expression of P-selectin and GP IIb-IIIa activity (p < 0.001) was observed when PRP was stimulated with ZIKV and DENV NS1 proteins. AFM images showed an increase in cell size and the appearance of pseudopods upon stimulation with the viral proteins. QCM results showed a significant increase in the oscillation frequency of the quartz precoated with ZIKV or DENV NS1 when PRP was injected (p < 0.001).

CONCLUSION

FC, AFM, and QCM are techniques that can be used in the study of platelet response to viral structures such as NS1 protein, broadening the range of existing methodologies in the study of these cells. It is imperative to study platelets in arboviral infections to better understand their involvement in these diseases.

IRAP Drives Ribosomal Degradation to Refuel Energy for Platelet Activation during Septic Thrombosis

Platelets play crucial roles in multiple pathophysiological processes after energy-dependent activation. It is puzzling how such a small cellular debris has abundant energy supply. In this study, it is shown that insulin-regulated aminopeptidase (IRAP), a type II transmembrane protein, is a key regulator for platelet activation by promoting energy regeneration during septic thrombosis. Through interaction with certain endosome membrane proteins, IRAP can not only promote granule release, but also facilitate lysosomal degradation of theoretically discarded ribosomes in an mTORC1- and S-acylation-dependent manner in activated platelets. Plentiful amino acids obtained from IRAP-mediated ribophagy are recruited to aerobic glycolysis and then promote energy metabolism reprogramming, thereby producing abundant energy for platelet life extension and prolonged activation. Consequently, targeted blocking IRAP can dramatically alleviate platelet hyperactivation and septic thrombosis.

Shear Stress Promotes Remodeling of Platelet Glycosylation via Upregulation of Platelet Glycosidase Activity: One More Thing

Mechanical circulatory support (MCS) is a mainstay of therapy for advanced and end-stage heart failure. Accompanied by systemic anticoagulation, contemporary MCS has become less thrombogenic, with bleeding complications emerging as a major cause of readmission and 1-year mortality. Shear-mediated platelet dysfunction and thrombocytopenia of undefined etiology are primary drivers of MCS-related bleeding. Recently, it has been demonstrated that deprivation of platelet surface glycosylation is associated with the decline of hemostatic function, microvesiculation, and premature apoptosis. We test the hypothesis that shear stress induces remodeling of platelet surface glycosylation via upregulation of glycosidase activity, thus facilitating platelet count decline and intense microvesiculation.Human gel-filtered platelets were exposed to continuous shear stress in vitro. Platelets and platelet-derived microparticles (PDMPs) were quantified via flow cytometry using size standard fluorescent nanobeads. Platelet surface glycosylation and NEU1 expression were evaluated using lectin- or immune-staining and multicolor flow cytometry; lectin blotting was utilized to verify glycosylation of individual glycoproteins. Platelet neuraminidase, galactosidase, hexosaminidase, and mannosidase activities were quantified using 4-methylumbelliferone-based fluorogenic substrates.We demonstrate that shear stress promotes selective remodeling of platelet glycosylation via downregulation of 2,6-sialylation, terminal galactose, and mannose, while 2,3-sialylation remains largely unchanged. Shear-mediated deglycosylation is partially attenuated by neuraminidase inhibitors, strongly suggesting the involvement of platelet neuraminidase in observed phenomena. Shear stress increases platelet NEU1 surface expression and potentiates generation of numerous NEU1+ PDMPs. Platelets exhibit high basal hexosaminidase and mannosidase activities; basal activities of platelet neuraminidase and galactosidase are rather low and are significantly upregulated by shear stress. Shear stress of increased magnitude and duration promotes an incremental decline of platelet count and immense microvesiculation, both being further exacerbated by neuraminidase and partially attenuated by neuraminidase inhibition.Our data indicate that shear stress accumulation, consistent with supraphysiologic conditions of device-supported circulation, promotes remodeling of platelet glycosylation via selective upregulation of platelet glycosidase activity. Shear-mediated platelet deglycosylation is associated with platelet count drop and increased microvesiculation, thus offering a direct link between deglycosylation and thrombocytopenia observed in device-supported patients. Based on our findings, we propose a panel of molecular markers to be used for reliable detection of shear-mediated platelet deglycosylation in MCS.

Potential Predictive Value of Platelet Distribution Width for Functional Outcome After Ischemic Stroke

Complete blood cell count (CBC) is the most common and readily available laboratory test in clinical practice. The relationships of some CBC indices with ischemic stroke have been reported in observational studies; however, the causal direction is not specified. This study aimed to explore the causal relationships between CBC indices and the modified Rankin Scale (mRS) score at 3 months after ischemic stroke. Genetic associations of 22 blood cell traits were obtained from the UK Biobank database (n = 350,475). The outcome data for ischemic stroke were obtained from the Genetic Ischemic Stroke Functional Outcome (GISCOME) network (n = 6021). We implemented two-sample Mendelian randomization (TSMR) and several complementary analyses to assess the causal association between blood traits and unfavorable outcome (3-month mRS > 2). The clinical cohort was validated based on the results of the MR analysis. TSMR result indicated causal association between genetically determined platelet distribution width (PDW) and adverse functional outcome after ischemic stroke (OR 1.48; 95% CI 1.13-1.95; p = 0.005). Complementary analyses showed negligible causal effect of genetic variants on stroke subtypes. In cohort study (n = 351), higher level of PDW was observed in the unfavorable outcome group. However, the multivariable logistic regression analysis failed to identify the improvement in predictive performance of stroke outcomes by adding PDW to the prediction model. Further correlation analysis revealed that PDW is positively correlated with serum glucose levels, and the level of PDW in the non-thrombolysed group was significantly higher than that in the thrombolysis group, indicating that PDW may be involved in stroke prognosis in an indirect way.

Establishment of a nomogram-based prognostic model (LASSO-Cox regression) for predicting platelet storage lesions under different storage conditions

Introduction

Platelet concentrates (PCs) are critical blood products used for transfusion, but stored platelets often experience quality deterioration, resulting in reduced efficacy post-transfusion. Currently, the lack of effective prediction models hinders the assessment of platelet storage quality. To address this, we developed a miRNA-based prognosis prediction model that comprehensively evaluates platelet quality under diverse storage conditions, offering valuable insights into platelet shelf life.

Methods

We enrolled 249 eligible PC samples, divided into a training dataset and internal validation dataset (7:3). Through microRNA sequencing, we identified 13 differentially expressed miRNAs with platelets storage lesions (PSLs). Leveraging the LASSO-Cox regression model, we constructed a nomogram-based classifier based on the association between miRNA expression and the duration of PSLs-free survival. Performance evaluation using measures like concordance index, area under the curve, calibration curves, and decision curve analyses to confirm the model's robustness.

Results

The nomogram classifier, incorporating miRNAs (miR-4485-3p, miR-12136, miR-25-5p, miR-148b-5p) and storage method, effectively categorized PCs into high-risk and low-risk groups. Notably, significant differences in PSLs-free survival were observed across all datasets, underscoring the precision and accuracy of our nomogram-based model.

Discussion

This innovative classifier provides clinicians with a reliable tool to predict PSLs occurrence in PCs stored under different methods, facilitating improved clinical decision-making.

Deficiency in platelet 12-lipoxygenase exacerbates inflammation and disease severity during SARS-CoV-2 infection

Platelets, known for maintaining blood balance, also participate in antimicrobial defense. Upon severeacute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, platelets become hyperactivated, releasing molecules such as cytokines, granule contents, and bioactive lipids. The key effector biolipids produced by platelets include 12-hydroxyeicosatetraenoic acid (12-HETE) and 12-hydroxyeicosatrienoic acid (12-HETrE), produced by 12-lipoxygenase (12-LOX), and prostaglandins and thromboxane, produced by cyclooxygenase-1. While prostaglandin E2 and thromboxane B2 were previously associated with lung inflammation in severe COVID-19, the role of platelet 12-LOX in SARS-CoV-2 infection remains unclear. Using mice deficient for platelets' 12-LOX, we report that SARS-CoV-2 infection resulted in higher lung inflammation characterized by histopathological tissue analysis, increased leukocyte infiltrates, and cytokine production relative to wild-type mice. In addition, distinct platelet and lung transcriptomic changes, including alterations in NOD-like receptor (NLR) family pyrin domain-containing 1 (NLRP1) inflammasome-related gene expression, were observed. Mass spectrometry lipidomic analysis in 12-LOX-deficient-infected mice revealed significant changes in bioactive lipid content, including reduced levels of 12-HETrE that inversely correlated with disease severity. Finally, platelet 12-LOX deficiency was associated with increased morbidity and lower survival rates relative to wild type (WT) mice. Overall, this study highlights the complex interplay between 12-LOX-related lipid metabolism and inflammatory responses during SARS-CoV-2 infection. The findings provide valuable insights into potential therapeutic targets aimed at mitigating severe outcomes, emphasizing the pivotal role of platelet enzymes in the host response to viral infections.

Clinical value of inflammatory indices in predicting poor prognosis and post-hemorrhagic hydrocephalus in patients with intraventricular hemorrhage

BACKGROUND

Hemorrhagic stroke has a high mortality and disability rate. Among them, intraventricular hemorrhage (IVH) is an important factor leading to adverse outcomes. IVH can induce acute obstructive hydrocephalus and chronic communicating hydrocephalus. However, there are currently no effective predictive factors for the early prediction of post-hemorrhage hydrocephalus (PHH).

OBJECTIVES

To assess the role of inflammatory indicators in predicting PHH and poor prognostic outcomes in patients with ventricular hemorrhage.

DESIGN

Single center retrospective case-control study.

METHODS

We retrospectively examined IVH patients treated at our institution from April 2017 to March 2022. Patient characteristics, laboratory data, imaging findings, and 3-month follow-up results were recorded and analyzed.

RESULTS

Among the 145 patients included in the analysis, 102 eventually developed adverse outcomes. There were significant differences between patients with good and poor prognosis in terms of age at admission, GCS score, prevalence of hypertension, lymphocyte count, albumin level, red blood cell distribution width, neutrophil count, NLR, PLR, NAR, PIV, and SII; in addition, among the 110 surviving patients, 36 eventually developed posthemorrhagic hydrocephalus within 3 months. Multivariate logistic regression showed that age and NAR are independent predictors of poor prognosis in IVH patients, while albumin is an independent predictor of posthemorrhagic hydrocephalus within 3 months.

CONCLUSION

The NLR and NAR are independent risk factors for poor prognosis in IVH patients. Additionally, albumin is an independent predictor of chronic hydrocephalus development within 3 months in IVH patients. The NLR, NAR and albumin level could provide prognostic information about IVH patients.

Association of novel inflammatory markers with osteoporosis index in older spine osteoporosis patients: NHANES 1999-2018 cross-sectional study

This study aimed to examine the relationships of osteoporosis with Osteoporosis indices in elderly patients, and investigate the associations of novel inflammatory markers with variations of Osteoporosis indices. Senior citizens were recruited from the National Health and Nutrition Examination Survey (NHANES). Dual-energy X-ray absorptiometry was used to detect bone mineral density tests. Osteoporosis indices and diagnosis of osteoporosis were evaluated using multivariate weighted logistic regression models. Novel inflammatory markers were calculated based on lymphocyte, neutrophil, monocyte, platelet, and albumin counts. The relationships between the Osteoporosis indices and novel inflammatory markers were evaluated with multivariate weighted logistic regression models. Totally 837 elderly patients were enrolled, including 494 men and 343 women, and their weighted average age was 68.28 ± 7.60 years. Our results indicated that the osteoporosis indices were positively correlated with the presence of osteoporosis and that these three indices measured the severity of osteoporosis. After multivariate weighted logistic regression model analysis of the novel inflammatory markers and osteoporosis index, AIRI, SIRI, and SII were significantly correlated with the osteoporosis indices. There may be a close relationship between inflammation and senile osteoporosis. The novel inflammatory markers are convenient and objective for predicting low BMD or osteoporosis risk in older patients. Among these markers, elderly patients with high levels of AISI, SIRI, and SII should focus on the risk of osteoporosis. However, this study has some limitations. It is essential to expand the sample size to a wider population to investigate the relationship between inflammation and osteoporosis.

Advances in the study of polysaccharide-based hydrogel wound dressings

Due to the complexity of wound healing, the rapid promotion of wound healing has been a major unresolved challenge for the medical community. If a suitable wound dressing is not found, it can easily induce wound infection and slow down the wound repair process. Hydrogels have been recognized as the best alternative to traditional wound dressings due to their unique water-retention properties as well as their drug-carrying properties. We first outlined the entire process of wound healing, while introducing the biological activities of ten different natural polysaccharides and their mechanisms for promoting wound healing. Subsequently, we summarized the advantages and limitations of various polysaccharides in use and proposed corresponding solutions. In addition, wound dressings for a wide range of wounds, including diabetes, burns, and radiation, have also been reviewed, providing a comprehensive understanding of the applications of these hydrogels in different wound types. This paper provides an important reference for the biomedical application and clinical research of natural polysaccharide-based hydrogel in wound dressings.

New Biomarkers for Patients With Fungal Keratitis From Blood Routine Examination: Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio

Purpose: To assess the potential of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as novel diagnostic and prognostic biomarkers in fungal keratitis (FK). Methods: This study was carried out retrospectively in 77 FK patients and 77 matched cataract controls from Henan Eye Hospital. Peripheral venous blood samples were collected via venipuncture and analyzed using complete blood count for routine clinical evaluation. FK patients were classified into three subgroups: Fusarium, Aspergillus, and Candida groups. Inflammation severity was quantified using standardized clinical scoring. The treatment modalities were used to divide the FK patients into enucleation and nonenucleation groups. Results: NLR and PLR were significantly elevated in FK versus controls (p < 0.001). NLR correlated strongly with inflammation scores (r = 0.535, p < 0.0001), exceeding PLR's moderate correlation (r = 0.311, p=0.0059). FK patients in the enucleation group had significantly higher NLR (p=0.012) and PLR (p=0.021) values than those in the nonenucleation group. There were no significant biomarker differences across fungal species (p > 0.05). Conclusion: Elevated NLR and PLR values during routine laboratory testing might serve as supplementary indicators for early suspicion of FK and monitoring inflammatory progression, particularly in resource-limited settings where specialized ophthalmic diagnostics are unavailable.

NebulaPlate: a droplet microfluidic platform to analyze platelet aggregation

The accurate assessment of platelet activity is crucial in clinical practice and scientific research owing to the pivotal role of platelets in the progression of cardiovascular conditions, such as arterial thrombotic diseases. However, conventional platelet activity assessment methods are currently limited by their requirement of substantial blood samples and inadequate high-throughput capabilities, and therapeutic resistance induced by antiplatelet agents impedes treatment efficacy. In this study, we developed a microdroplet-based platelet function detection method, referred to as NebulaPlate, to achieve miniaturized and robust platelet activity assessment, thereby overcoming current challenges. NebulaPlate supports the merging of platelet samples with drugs confined in picoliter microdroplets and leverages an imaging-based analysis to automatically identify platelets, evaluate their aggregation, and determine P-selectin expression within the anchored microdroplets. We experimentally confirmed the feasibility of aggregation assays on NebulaPlate using various representative antiplatelet drugs. Requiring only 0.3 mL whole blood/chip, which corresponds to approximately 100 platelets/reaction, NebulaPlate reduced the consumption of platelet samples in a single assay. This represents a reduction of 10 times compared to that of conventional techniques. Moreover, our experimental results confirmed the validity and reproducibility of platelet function assays performed using NebulaPlate. Our research highlights important developments in the field of platelet activity assessment and provides fresh prospects for future antiplatelet therapies and personalized medicine. Moreover, it introduces new possibilities for research and clinical practice related to arterial thrombotic diseases.

Fucosylated Glycosaminoglycan Oligosaccharide HS14, Derived from Sea Cucumbers, Is a Novel Inhibitor of Platelet Toll-like Receptor 2

(1) Background: Toll-like receptor 2 (TLR2) on platelets is increasingly recognized as a pivotal mediator in infection-induced platelet activation and aggregation, contributing to both inflammatory and thrombotic diseases. Targeting TLR2 on platelets offers a promising therapeutic strategy for inflammatory and thrombotic-related disorders. However, inhibitors targeting platelet TLR2 have not yet been reported. (2) Methods: Platelet aggregation was assessed using a light transmission aggregometer. Platelet activation was evaluated by measuring the release of P-selectin and von Willebrand factor (vWF) via ELISA. Intracellular Ca2+ mobilization was quantified using Fluo 3-AM fluorescence, recorded by flow cytometry. Static platelet adhesion was visualized under a microscope, and the formation of platelet-granulocyte aggregates in human whole blood was analyzed by flow cytometry. (3) Results: Fucosylated glycosaminoglycan (FG) tetradecasaccharide HS14 inhibited the activation and aggregation of human platelets induced by the synthetic bacterial lipopeptide Pam3CSK4 in a concentration-dependent manner. This inhibitory effect gives rise to significant anti-inflammatory and anti-thrombotic activities, as evidenced by reduced platelet adhesion and decreased platelet-granulocyte aggregates formation in human whole blood. (4) Conclusions: This study is the first to identify FG oligosaccharide HS14 as a promising inhibitor of platelet TLR2/TLR1, demonstrating significant therapeutic potential for inflammatory and thrombotic-related diseases.

Angiotensin II promotes intramural hematoma of aorta in juvenile mice at early stage

OBJECTIVES

Intramural hematoma (IMH) is a serious aortic condition characterized by the presence of a contained hematoma within the aortic media. However, the animal model with a high incidence of IMH was lacking, and the specific pathological characteristics of IMH have not been thoroughly characterized.

METHODS AND RESULTS

We conducted an experimental study using 4-week-old male, 4-week-old female, and 8-week-old male C57BL/6J mice. These mice were subjected to angiotensin II infusion at a rate of 1000 ng/kg/min for a period of 4 days. In situ imaging was performed, and aorta was harvested and serially sectioned. Histological staining and immunostaining techniques were employed, and the subcellular structure was examined using transmission electron microscopy. Our findings revealed that 4-week-old male mice exhibited a higher susceptibility to angiotensin II-induced IMH, characterized by more circumferential appearances and larger affected areas. Furthermore, IMH was more likely to occur in the upper segment of the descending aorta rather than the lower segment. Within the IMH, older fibrinous thrombus was predominantly observed near the adventitia, while younger red thrombus was more prevalent near the lumen. Additionally, platelet activation and degranulation were observed, along with fibrin cross-linking and thrombus organization, indicating a potential relationship between platelet activation and the progression of IMH.

CONCLUSION

Our study demonstrated that angiotensin II infusion promoted the development of IMH during the early stages, especially in juvenile mice. Furthermore, the presence of platelet activation and thrombus organization suggested their potential involvement in the progression of IMH.

Beclin 1 of megakaryocytic lineage cells is locally dispensable for platelet hemostasis but functions distally in bone homeostasis

The crosstalk between megakaryocytic lineage cells and the skeletal system has just begun to be explored but remains largely elusive. Using conditional gene knockout mouse models, we demonstrated that loss of Beclin 1 (Becn1), a major regulator of mammalian autophagy, exclusively in the megakaryocytic lineage disrupted autophagy in platelets but did not compromise megakaryopoiesis or the formation and function of platelets. Unexpectedly, conditional Becn1 deletion in male mice led to a remarkable increase in bone mass with improved bone quality, in association with a decrease in sex hormone binding globulin (SHBG) and an increase in free testosterone (FT). In vivo Becn1 overexpression in megakaryocytic lineage-specific cells reduced bone mass and quality, along with an increase in SHBG and a decrease in FT. Transplantation of wild-type bone marrow cells into megakaryocytic lineage Becn1-deficient male mice restored bone mass and normalized SHBG and FT. Furthermore, bilateral orchiectomy of Becn1f/f;Pf4-iCre mice, which are crippled with the production of testosterone, resulted in a reduction in bone mass and quality, whereas in vivo overexpression of SHBG, specifically in the liver of Becn1f/f;Pf4-iCre mice, decreased FT and reduced bone mass and quality. In addition, metformin treatment, which induces SHBG expression, reduced FT and normalized bone mass in Becn1f/f;Pf4-iCre mice. We thus concluded that Becn1 of the megakaryocytic lineage is dispensable locally for platelet hemostasis but limits bone mass by increasing SHBG, which in turn reduces the FT of male mice. Our findings highlight a mechanism by which Becn1 from megakaryocytic lineage cells distally balances bone growth.

Biphasic Effect of Thyroid Hormone on Megakaryopoiesis and Platelet Production

Background: Abnormal platelet counts are frequently observed in patients with thyroid dysfunction; however, the direct impact of thyroid hormones on thrombopoiesis remains largely undefined. Methods: This study elucidates the dose-response effect of the thyroid hormone triiodothyronine (T3) on megakaryocyte (MK) development and thrombopoiesis using both a murine model of hyperthyroidism/hypothyroidism and in vitro cultures of human cord blood CD34+ cell-derived MKs. After the application of inhibitors to MKs, the examination of total and phosphorylated protein levels of the phosphoinositide 3-kinase (PI3K)/AKT pathway was utilized to assess the specific mechanisms of T3 action. The use of autophagy dual-staining lentivirus and transmission electron microscopy was employed to evaluate the impact of T3 on the autophagy flux in MKs. Mouse whole-body irradiation and bone marrow transplantation models are applied to assess the influence of T3 on the recovery of MKs/platelets in vivo. Results: We found that physiological or slightly elevated thyroid hormone levels are essential for sustaining MK development and thrombopoiesis, primarily through the TRα-PI3K/AKT signaling pathway. In contrast, supraphysiological thyroid hormone concentrations induce MK apoptosis via excessive autophagy, thereby reducing platelet production. Conclusions: Here, we present evidence that the thyroid hormone influences MK development and platelet production in a concentration-dependent manner, exhibiting a dualistic role. Our discoveries shed new light on the intricate relationship between thyroid hormones and platelet formation, offering novel perspectives on the pathophysiological consequences of thyroid disorders.

Polydatin mitigates thrombosis by inhibiting PHD2-induced proline hydroxylation on collagen, reducing platelet adhesion

BACKGROUND

Platelet adhesion to collagen, a critical initial step in thrombus formation, remains an underexplored therapeutic target in thrombosis. Current disease treatment strategies primarily focus on platelet activation and aggregation, often overlooking the crucial initial adhesion phase. Reynoutria japonica (Huzhang, HZ), utilized in traditional Chinese medicine to enhance blood circulation and resolve blood stasis, lacks comprehensive insights into its active components and their anti-thrombotic mechanisms.

PURPOSE

This study investigated the antithrombotic effects and mechanisms of polydatin, a stilbene derived from HZ, with a focus on its effect on platelet adhesion.

METHODS

An acute pulmonary infection model was used, along with metabolomic and proteomic analyses, to investigate the antithrombotic efficacy of the active component polydatin and identify its targets. Chemical biology, protein mass spectrometry analyses, and molecular interaction analysis were performed to investigate its mechanism. Multiple models of circulatory disorders, including disseminated intravascular coagulation (DIC) and atherosclerosis in mice, with or without targeted gene knockdown, were employed to assess the role of polydatin in modulating platelet adhesion.

RESULTS

Our investigation revealed that polydatin targets prolyl hydroxylase 2 (PHD2), thereby inhibiting hydroxylation of proline residues on collagen. This disruption in collagen assembly and the von Willebrand factor (VWF)-collagen interaction reduces platelet adhesion, significantly impacting circulation in both DIC and atherosclerosis. This represents a novel mechanism of antithrombotic action, distinct from currently available therapies.

CONCLUSION

Targeting PHD2 to modulate collagen structure and platelet adhesion presents a promising novel therapeutic strategy for thrombosis-related circulatory disorders.

Predictive value of the Hemoglobin, Albumin, Lymphocyte and Platelet score for mortality in geriatric patients presenting to the emergency department

AIM

The Hemoglobin, Albumin, Lymphocyte and Platelet (HALP) score, calculated as hemoglobin × albumin × lymphocytes / platelets, serves as a novel biomarker that can provide insights into a patient's nutritional status, anemia status and inflammatory processes. This study aimed to investigate the predictive value of the HALP score for mortality among geriatric patients presenting to the emergency department.

METHODS

This retrospective study was carried out at the emergency department of a tertiary hospital. Patients aged ≥65 years who presented to the emergency department between 1 January 2018 and 1 January 2024 were included in the study. A total of 62 262 patients who visited our emergency department were enrolled. Patient data, including hemoglobin, albumin, lymphocyte and platelet values; age; sex, the reason for hospital presentation; and outcome (mortality or discharge) were obtained from electronic medical records. HALP scores were calculated for the patients, and statistical analyses were carried out.

RESULTS

Of the patients, 32 410 were men, and the mean age was 73 years. Within this cohort, in-hospital mortality occurred in 3093 of the patients. The HALP score was significantly lower in patients who died compared with those who were discharged (P < 0.001).

CONCLUSION

Due to its cost-effectiveness and ease of calculation, the HALP score appears to be more feasible in predicting mortality in the emergency department compared with other scoring systems. Geriatr Gerontol Int 2025; 25: 387-391.

Systemic immune-inflammation index and long-term mortality in patients with hypertension: a cohort study

OBJECTIVE

The objective of this study was to examine the relationship between systemic inflammation and long-term mortality in patients with hypertension.

METHODS

The study employed a retrospective cohort design. The study population was derived from the National Health and Nutrition Examination Survey (NHANES), and the mortality data for this population was acquired from the National Death Index (NDI) database. Systemic inflammation was quantified by the Systemic Immune Inflammation Index (SII) and the Systemic Inflammatory Response Index (SIRI), which were then categorized into four groups (Q1-Q4, with Q4 representing the highest level of SII or SIRI). Weighted Cox regression models were constructed to investigate the association between mortality and SII and SIRI, with hazard ratios (HRs) subsequently calculated.

RESULTS

A total of 7431 participants were included in the analysis. The highest quantile (Q4) of SII was associated with a higher risk of all-cause mortality (hazard ratio 1.36, 95% CI 1.1-1.69, P  < 0.001). After adjustment for important covariates, the association remained significant (hazard ratio 1.70, 95% CI 1.27-2.30, P  < 0.001). The highest quantile (Q4) of SIRI was also associated with the highest risk of mortality (hazard ratio 2.11, 95% CI 1.64-2.70, P  < 0.001), and this association remained significant after adjustment for important covariates (hazard ratio 1.64, 95% CI 0.61-1.22, P  = 0.001).

CONCLUSION

Both SII and SIRI scores were found to be associated with mortality rates in patients with hypertension. The findings suggest that these scores may serve as complementary biomarkers to the neutrophil-to-lymphocyte ratio (NLR) for assessing mortality risk in patients with hypertension. Further investigation is warranted to elucidate the underlying mechanisms that underpin this association.

A Pilot Study on the Role of TRAFs in the Development of SARS-CoV-2 Infection Before and After Immunization with AstraZeneca Chadox1 in Mice

The TRAF family of molecules are intracellular signaling adaptors that regulate various signaling pathways. These pathways are not only mediated by the TNFR superfamily and the Toll-like receptor/IL-1 receptor superfamily but also by unconventional cytokine receptors like IL-6 and IL-17 receptors. Overactive immune responses caused by TRAF signaling following the activation of these receptors frequently result in inflammatory and autoimmune diseases such as rheumatoid arthritis, inflammatory bowel disease, psoriasis, and autoinflammatory syndromes. Therefore, it is crucial to comprehend the signaling processes controlled by TRAFs, which have a significant influence on the determination of cell fate (life or death) and the functioning, specialization, and endurance of cells in the innate and adaptive immune systems. Our data indicate that the dysregulation of cellular expression and/or signaling of TRAFs leads to the excessive production of pro-inflammatory cytokines, hence promoting abnormal activation of immune cells. The objective of our investigation was to comprehend the function of these molecules in SARS-CoV-2 infection both prior to and during SARS-CoV-2 vaccination. Our results demonstrate a clear inactivation of the TRAF5 and TRAF6 genes when infection occurs after immunization, in contrast to infection without prior vaccination. This can bolster the belief that immunization is essential while also demonstrating the involvement of these molecules in the pathogenesis of SARS-CoV-2.

Moderate aerobic exercise improves haematological indices without altering cardio-metabolic enzyme activities in sedentary healthy young adults

BACKGROUND

Regular aerobic exercise regulates cardiorespiratory functions by its effect on specific enzyme activities. This study investigated the immediate effects of moderate aerobic exercise on haematological parameters and cardio-metabolic enzymes activity in healthy young male and female adults.

METHODS

Forty young healthy sedentary subjects, twenty males (25 ± 5.6 years; 65 ± 4.0 kg; 176.9 ± 2.5 cm) and twenty females (25 ± 4.5 years, 62 ± 2.9 kg, 175 ± 1.3 cm) volunteered for the study. The exercise regimen was of moderate intensity lasting for 20 min daily on a treadmill at incremental speed of 3 km/h to 13 km/h for 14 consecutive days. The weight and height of participants were measured. Blood sample was collected via antecubital vein for haematological and biochemical analysis. The haematological parameters namely red blood cell and indices, leukocyte and differential white blood cell count, platelet and platelet indices were assessed. Cardiac troponin-T, creatine kinase, lactate dehydrogenase and N-acetyl-cysteine activated creatine kinase activities were assessed before and after exercise.

RESULTS

The result showed a significant (p < 0.05) increase in RBC (males 7%, females 11%) haemoglobin (males 8%, females 8.3%), haematocrit (males 5%, females 14%) leukocyte (males 54%, females 40%) and monocyte count (males 68%, females 55%) after 14 days of exercise. The enzymatic activities of lactate dehydrogenase, N-acetyl-cysteine activated creatine kinase (CK-NAC), creatine kinase (CK-MB) and cardiac troponin-T showed no significant change after 14 days of exercise.

CONCLUSION

It is concluded that moderate aerobic exercise increased haematological parameters and maintained cardio-metabolic enzymes activities in young male and female adults.

The Regenerative Marriage Between High-Density Platelet-Rich Plasma and Adipose Tissue

The use of autologous biological preparations (ABPs) and their combinations fills the void in healthcare treatment options that exists between surgical procedures, like plastic reconstructive, cosmetic, and orthopedic surgeries; non-surgical musculoskeletal biological procedures; and current pharmaceutical treatments. ABPs, including high-density platelet-rich plasma (HD-PRP), bone marrow aspirate concentrates (BMACs), and adipose tissue preparations, with their unique stromal vascular fractions (SVFs), can play important roles in tissue regeneration and repair processes. They can be easily and safely prepared at the point of care. Healthcare professionals can employ ABPs to mimic the classical wound healing cascade, initiate the angiogenesis cascade, and induce tissue regenerative pathways, aiming to restore the integrity and function of damaged tissues. In this review, we will address combining autologous HD-PRP with adipose tissue, in particular the tissue stromal vascular fraction (t-SVF), as we believe that this biocellular combination demonstrates a synergistic effect, where the HD-PRP constituents enhance the regenerative potential of t-SVF and its adipose-derived mesenchymal stem cells (AD-MSCs) and pericytes, leading to improved functional tissue repair, tissue regeneration, and wound healing in variety of clinical applications. We will address some relevant platelet bio-physiological aspects, since these properties contribute to the synergistic effects of combining HD-PRP with t-SVF, promoting overall better outcomes in chronic inflammatory conditions, soft tissue repair, and tissue rejuvenation.

Thrombocytopenia in Sepsis

Platelets, traditionally known for their role in hemostasis, have emerged as key players in immune response and inflammation. Sepsis, a life-threatening condition characterized by systemic inflammation, often presents with thrombocytopenia, which at times, can be significant. Platelets contribute to the inflammatory response by interacting with leukocytes, endothelial cells, and the innate immune system. However, excessive platelet activation and consumption can lead to thrombocytopenia and exacerbate the severity of sepsis. Understanding the multifaceted roles of platelets in sepsis is crucial for developing effective therapeutic strategies. Targeting platelet-mediated inflammatory responses and promoting platelet production may offer potential avenues for improving outcomes in septic patients with thrombocytopenia. Future research should focus on elucidating the mechanisms underlying platelet dysfunction in sepsis and exploring novel therapeutic approaches to optimize platelet function and mitigate inflammation. This review explores the intricate relationship between platelets, inflammation, and thrombosis in the context of sepsis.

An in-depth understanding of the role and mechanisms of T cells in immune organ aging and age-related diseases

T cells play a critical and irreplaceable role in maintaining overall health. However, their functions undergo alterations as individuals age. It is of utmost importance to comprehend the specific characteristics of T-cell aging, as this knowledge is crucial for gaining deeper insights into the pathogenesis of aging-related diseases and developing effective therapeutic strategies. In this review, we have thoroughly examined the existing studies on the characteristics of immune organ aging. Furthermore, we elucidated the changes and potential mechanisms that occur in T cells during the aging process. Additionally, we have discussed the latest research advancements pertaining to T-cell aging-related diseases. These findings provide a fresh perspective for the study of T cells in the context of aging.

Dynamic perioperative platelet activity and cardiovascular events in peripheral artery disease

OBJECTIVE

Patients with peripheral artery disease (PAD) undergo lower extremity revascularization (LER) for symptomatic relief or limb salvage. Despite LER, patients remain at increased risk of platelet-mediated complications, such as major adverse cardiac and limb events (MACLEs). Platelet activity is associated with cardiovascular events, yet little is known about the dynamic nature of platelet activity over time. We, therefore, investigated the change in platelet activity over time and its association with long-term cardiovascular risk.

METHODS

Patients with PAD undergoing LER were enrolled into the multicenter, prospective Platelet Activity and Cardiovascular Events study. Platelet aggregation was assessed by light transmission aggregometry to submaximal epinephrine (0.4 μmol/L) immediately before LER, and on postoperative day 1 or 2 (POD1 or POD2) and 30 (POD30). A hyperreactive platelet phenotype was defined as >60% aggregation. Patients were followed longitudinally for MACLEs, defined as the composite of death, myocardial infarction, stroke, major lower extremity amputation, or acute limb ischemia leading to reintervention.

RESULTS

Among 287 patients undergoing LER, the mean age was 70 ± 11 years, 33% were female, 61% were White, and 89% were on baseline antiplatelet therapy. Platelet aggregation to submaximal epinephrine induced a bimodal response; 15.5%, 16.8%, and 16.4% of patients demonstrated a hyperreactive platelet phenotype at baseline, POD1, and POD30, respectively. Platelet aggregation increased by 18.5% (P = .001) from baseline to POD1, which subsequently returned to baseline at POD30. After a median follow-up of 19 months, MACLEs occurred in 165 patients (57%). After adjustment for demographics, clinical risk factors, procedure type, and antiplatelet therapy, platelet hyperreactivity at POD1 was associated with a significant hazard of long-term MACLE (adjusted hazard ratio, 4.61; 95% confidence interval, 2.08-10.20; P < .001).

CONCLUSIONS

Among patients with severe PAD, platelet activity increases after LER. Platelet hyperreactivity to submaximal epinephrine on POD1 is associated with long-term MACLE. Platelet activity after LER may represent a modifiable biomarker associated with excess cardiovascular risk.

Risk of atherosclerosis-related diseases in polymyositis and dermatomyositis patients: A large-scale population-based study

BACKGROUND AND AIMS

Several systemic autoimmune diseases predispose to the enhancement of Atherosclerotic Cardiovascular Disease (ASCVD). These findings underline the role of inflammation in atherogenesis. Dermatomyositis (DM) and polymyositis (PM) are polygenic autoimmune disorders involving mainly skeletal muscles. The association between PM/DM and ASCVD has not been well addressed and explored. We aimed to investigate the association between PM/DM and ASCVD events, we examined the incidence, mortality, and interaction of disease-modifying agents, autoantibodies, and traditional cardiovascular disease (CVD) risk factors in a large population-based sample.

METHODS

We conducted a retrospective cohort study using the electronic database of Clalit Health Services (CHS), the largest health organization in Israel. All DM and PM patients diagnosed between 2000 and 2016 were included and matched with healthy controls by age and sex in a 1:5 ratio. Follow-up continued until the first diagnosis of ASCVD or death. The incidence of ASCVD was compared between the groups using univariate and multivariate models adjusting for baseline cardiovascular risk factors.

RESULTS

The study population included 1899 PM/DM patients and 7676 controls. The mean age at the index date was 32.5 years (SD ± 19 years), and the female proportion was 60.3 %, similar for both groups. Traditional cardiovascular risk factors were similar in both groups. The Median follow-up time was 8.4 years (3.6-12.8) in the PM/DM group compared to 8.6 (3.7-12.9) in the control group. 47 (3.0 %) PM/DM patients were diagnosed with ischemic heart disease (IHD) compared to 1.8 % (140) in the controls, yielding a multivariate HR (95%CI) of 1.61 (1.15-2.25). Multivariate HR for cerebrovascular accident (CVA) in the PM/DM group was (95%CI) 2.45 (1.63-3.70). Multivariate HR for ASCVD. (95%CI) was 1.75 (1.35-2.27) in the PM/DM group. APLA-associated antibodies presence was more associated with ASCVD among PM/DM groups than non-ASCVD PM and DM patients (OR 2.33, 95 % CI 1.41-3.86, p < 0.001).

CONCLUSIONS

Our study demonstrates that PM and DM are associated with an increased risk of IHD and CVA. Furthermore, PM and DM patients positive for APLA-associated antibodies exhibited excessive rates of ASCVD. These findings support the increased need for awareness and surveillance of cardiological, neuronal, and vascular outcomes in patients suffering from PM/DM.

Platelet related gene IQGAP1 contributes to the onset and abnormal immune landscape of ischemic stroke patients

INTRODUCTION

Ischemic stroke (IS) is a complex illness resulting from a combination of numerous environmental and genetic risk factors. Recent reports have shed light on the vital role that platelets play in the pathophysiology of IS. Here, we aimed to explore the potential platelet-related genes in IS and investigate the effect of platelet-related genes in the immune microenvironment of IS.

METHODS

The data of IS were retrieved from the Gene Expression Omnibus database. Firstly, we screened the platelet-related genes that were correlated with the onset of IS using differential expression analysis, enrichment analyses, and protein-protein interaction (PPI) network. Moreover, we analyzed the clinical value and functional information of platelet-related genes in IS. Finally, we explored the correlation between platelet-related genes and immune cells' infiltration.

RESULTS

Ten platelet-related genes that were correlated with the onset of IS were identified, among which IQGAP1 was located at the core of the PPI network. IQGAP1 was found to be expressed in the normal brain tissue and its expression was significantly elevated in IS samples. The area under the curve (AUC) values for IQGAP1 in both the GSE16561 and GSE58294 datasets were close to 1. IQGAP1 knockdown might increase OGD/R‑induced HT22 cell viability. Additionally, FoxO signaling pathway, NOD-like receptor signaling pathway, Phagosome and Platelet activation pathways were significantly activated in IS patients with high IQGAP1 expression compared to those with low IQGAP1 expression. The IS patients in the IQGAP1high and IQGAP1low groups showed dramatically different proportions of immune cells and immune-related functions, and the IQGAP1 expression was correlated with the immune cell' infiltration in IS.

CONCLUSIONS

In this study, we identified the IQGAP1 might serve as a potential diagnostic marker for IS, and the IQGAP1 expression was very relevant in determining the immune cell' infiltration in IS patients.

Predictors of cytomegalovirus infection in patients with connective tissue disease treated by pulsed methylprednisolone therapy: a multicenter retrospective cohort study

BACKGROUND

Cytomegalovirus (CMV) can cause life-threatening diseases in immunosuppressed patients. Some of the patients with connective tissue disease develop CMV infection, and approximately half of this group has been reported to have received pulsed-methylprednisolone (p-MPSL) therapy. This study aimed to identify predictors of the onset of CMV infection in patients receiving p-MPSL therapy for connective tissue disease.

METHODS

This was a retrospective, multicenter cohort study. We included patients who received p-MPSL therapy for connective tissue disease and had CMV antigenemia measured between April 2011 and December 2020. Peripheral blood cell data before the start of p-MPSL therapy and at the start of steroid tapering were collected in addition to baseline characteristics, including age, sex, and body mass index. CMV infection was defined as detection of one or more CMV antigen-positive cells (CMV-positive). The study examined and compared the CMV-positive group with the CMV-negative group. Logistic regression analysis was used to explore the factors associated with CMV antigen positivity. Receiver operating characteristic curve analysis was used to identify the cut-off values for the factors associated with CMV antigen sensitivity.

RESULTS

Of the 200 patients included, 87 had antigen positivity. Logistic regression analysis showed that age ≥ 65 years [adjusted odds ratio (aOR): 2.75, 95% confidence interval (CI): 1.54-4.92] and platelet count less than 30.20 × 104 /µL [aOR: 4.38, 95%CI: 2.21-8.68] at baseline were significantly associated with CMV antigen positivity. Lymphocyte count < 1440 /µL [aOR: 5.36, 95% CI: 1.96-14.65], neutrophil-to-lymphocyte ratio (NLR) ≥ 3.42 [aOR: 7.31, 95% CI: 2.52-21.22], and platelet-to-lymphocyte ratio (PLR) ≥ 145.28 [aOR:6.10, 95% CI: 2.24-16.64] at the start of steroid tapering also increased the OR for CMV infection. The areas under the receiver operating characteristic curves for lymphocytes, NLR, and PLR were 0.742, 0.693, and 0.673 respectively.

CONCLUSION

Platelet count, lymphocyte count, NLR, and PLR may be crucial predictors of the onset of CMV infection in patients with connective tissue disease. These easily obtainable factors may be clinically useful as predictors of CMV infection. A potential research area would be to validate the parameters in a prospective patient population.

Immune Profile Differences between IgG4-Related Diseases and Primary Sjögren's Syndrome

Purpose

Immunoglobulin G4-related disease (IgG4-RD) share clinical features with primary Sjögren's syndrome (pSS). This study aimed to identify altered serological parameters and potential biomarkers of IgG4-RD and pSS.

Methods

Forty IgG4-RD patients, 40 pSS patients, and 40 healthy controls (HC) were enrolled in this study. Routine serological parameters and clinical manifestations were assessed. IgG subclasses (IgGSc) were detected using a Siemens BN P, and lymphocyte subsets were analyzed using flow cytometry. Cytokines assays were performed using cytometric bead array.

Results

Compared to pSS, IgG4-RD patients had higher IgG4 (p <0.001) and lower IgG1 (p =0.014). The natural killer (NK) cells (p = 0.004), CD4+ T cells (p = 0.028), and TBNK cells (p = 0.040) were increased in IgG4-RD compared to pSS. IgG4 used to differentiate IgG4-RD from pSS produced an area under the curve (AUC) of up to 0.952. In addition, we compared serum parameters, immune cells, and cytokines of IgG4-RDwith mouth dryness or eye dryness with those of pSS with the same symptoms, and similar serological changes were observed. IgG4-RD patients with mouth dryness had higher IgG4 (p <0.001) and Th cells (p = 0.016) but lower IgG1 (p = 0.009) compared to pSS with dry mouth. IgG4-RD patients with eye dryness had higher levels of IgG4 (p <0.001), Treg cells (p = 0.037), and NK cells (p = 0.017) than pSS patients with eye dryness. Moreover, IgG4-RD patients with mouth and eye dryness had higher levels of B (p = 0.006), Th (p = 0.026), Th2 (p = 0.007), and Treg cells (p = 0.028) than IgG4-RD patients without mouth and eye dryness.

Conclusion

Immune system disorder is an outstanding feature of IgG4-RD, and its feature differ from pSS. Assessment of immune status is important in the diagnosis and differential diagnosis of IgG4-RD.

Antithrombotic and anticariogenic activity of peptide fractions from cowpea (Vigna unguiculata) protein hydrolysates

BACKGROUND

Protein-derived peptide fractions can play a key role in the physiological and metabolic regulation and modulation of the body, which suggests that they could be used as functional ingredients to improve health and to reduce the risk of disease. This work aimed to evaluate the in vitro antithrombotic and anticariogenic bioactivity of hydrolysates and protein fractions obtained from cowpea (Vigna unguiculata) by biocatalysis.

RESULTS

Cowpea protein concentrate was hydrolyzed by sequential action with two enzyme systems, Pepsin-Pancreatin or Alcalase-Flavourzyme. There was extensive enzymatic hydrolysis, with degrees of hydrolysis of 34.94% and 81.43% for Pepsin-Pancreatin and Alcalase-Flavourzyme, respectively. The degree of hydrolysis for the control treatments, without the addition of the enzymes Pepsin-Pancreatin and Alcalase-Flavourzyme was 1.1% and 1.2%, respectively. The hydrolysates were subjected to fractionation by ultrafiltration, with five cut-off points according to molecular weight (<1, 1-3, 3-5, 5-10 and >10 kDa). The Alcalase-Flavourzyme hydrolysate led to 100% inhibition of platelet aggregation, while the Pepsin-Pancreatin hydrolysate showed 77.41% inhibition, but this was approximately 100% in the ultrafiltered fractions. The highest anticariogenic activity was obtained with the Pepsin-Pancreatin system, with 61.55% and 56.07% for calcium and phosphorus demineralization, respectively.

CONCLUSION

Hydrolysates and their peptide fractions from Vigna unguiculata exhibited inhibition of platelet aggregation and protection of tooth enamel and have the potential for use in the development of functional products with beneficial health effects. © 2024 Society of Chemical Industry.

A nomogram for predicting neonatal acute respiratory distress syndrome in patients with neonatal pneumonia after 34 weeks of gestation

Objective

To establish a prediction nomogram for early prediction of neonatal acute respiratory distress syndrome (NARDS).

Methods

This is a retrospective cross-sectional study conducted between January 2021 and December 2023. Clinical characteristics and laboratory results of cases with neonatal pneumonia were compared in terms of presence of NARDS diagnosis based on the Montreux Definition. The NARDS group and non-NARDS group were then compared to establish a prediction nomogram for early prediction of NARDS. The predictive accuracy and compliance of the model were evaluated using subject operating characteristic curves, area under the ROC curve, and calibration curves, and the model performance was estimated by self-lifting weight sampling. The Hosmer-Lemeshow test was used to assess the goodness of fit of the model.

Findings

NARDS group consisted of 104, non-NARDS group consisted of 238 newborns in our study. Gestational age, triple concave sign, blood glucose measurement after birth (Glu), Apgar score at the 5th minute (Apgar5), neutrophil count (ANC) and platelet count (PLT) are independent predictors of NARDS in late preterm and term newborns who present with progressive respiratory distress and require varying degrees of respiratory support within the first 24 h of life to minimize work of breathing and restore organismal oxygenation. The area under the ROC curve was 0.829 (95% CI = 0.785-0.873), indicating the model's strong predictive power. In addition, decision curve analysis showed that the model had significantly better net benefits.

Conclusion

In this study, a predictive column-line plot was constructed based on six clinically accessible conventional variables. Early application of this model has a better predictive effect on the early diagnosis of NARDS, thus facilitating more timely and effective interventions.

Correlation between the white blood cell/platelet ratio and 28-day all-cause mortality in cardiac arrest patients: a retrospective cohort study based on machine learning

Objective

This study aims to evaluate the association between the white blood cell-to-platelet ratio (WPR) and 28-day all-cause mortality among patients experiencing cardiac arrest.

Methods

Utilizing data from 748 cardiac arrest patients in the Medical Information Mart for Intensive Care-IV (MIMIC-IV) 2.2 database, machine learning algorithms, including the Boruta feature selection method, random forest modeling, and SHAP value analysis, were applied to identify significant prognostic biomarkers. Key patient characteristics, encompassing demographic data, comorbidities, hematological and biochemical indices, and vital signs, were extracted using PostgreSQL Administration Tool (pgAdmin) software. The Cox proportional hazards model assessed the impact of WPR on mortality outcomes, while Kaplan-Meier survival curves and restricted cubic spline (RCS) analysis further validated the findings. Subgroup analyses stratified the prognostic value of WPR by demographic and clinical factors.

Results

WPR demonstrated the highest prognostic significance among the variables studied, showing a strong association with 28-day all-cause mortality. In the unadjusted Model 1, hazard ratios (HRs) for WPR quartiles ranged from 1.88 (95% CI: 1.22-2.90) in Q2 to 3.02 (95% CI: 2.04-4.47) in Q4 (Ptrend <0.05). Adjusted models (Models 2-4) confirmed the robustness of these associations, even after accounting for demographic and clinical covariates. Kaplan-Meier and RCS analyses revealed a significant U-shaped relationship between WPR and mortality risk. Subgroup analyses indicated that elevated WPR was particularly associated with increased mortality in males, elderly patients, married individuals, and those with chronic pulmonary disease.

Conclusion

WPR serves as an independent and reliable prognostic biomarker for 28-day mortality in cardiac arrest patients. Its integration into clinical decision-making may enhance the early identification of high-risk patients and guide tailored therapeutic interventions.

Cellular and Molecular Mechanisms Leading to Air Travel-Induced Thrombosis

Venous thromboembolism, characterized by deep vein thrombosis and pulmonary embolism, is the third cardiovascular disease in the world. Deep vein thrombosis occurs when a blood clot forms in areas of impaired blood flow, and it is significantly affected by environmental factors. Local hypoxia, caused by venous stasis, plays a critical role in deep vein thrombosis under normal conditions, and this effect is intensified when the Po2 decreases, such as during air travel or high-altitude exposure. The lower oxygen levels and reduced pressure at high altitudes further contribute to deep vein thrombosis development. These conditions increase the pro-coagulant activity of neutrophils, platelets, and red blood cells, which interact on the surface of activated endothelial cells, promoting clot formation. Understanding the mechanisms involved in thrombus formation when Po2 is reduced, with or without pressure reduction, is crucial for preventing the development of venous thromboembolisms in such conditions and identifying innovative therapeutic targets. This literature review explores the mechanisms involved in thrombus formation related to high-altitude conditions and discusses the pro-coagulant consequences induced by environmental disturbances.

Platelet-derived extracellular vesicles in cardiovascular disease and treatment - from maintaining homeostasis to targeted drug delivery

PURPOSE OF REVIEW

Cardiovascular disease (CVD) remains a major global health burden. Rising incidences necessitate improved understanding of the pathophysiological processes underlying disease progression to foster the development of novel therapeutic strategies. Besides their well recognized role in CVD, platelet-derived extracellular vesicles (PEVs) mediate inter-organ cross talk and contribute to various inflammatory diseases.

RECENT FINDINGS

PEVs are readily accessible diagnostic biomarkers that mirror pathophysiological disease progression but also may confer cardioprotective properties. Monitoring the effects of modulation of PEV signatures through pharmacotherapies has also provided novel insights into treatment efficacy. Furthermore, exploiting their inherent ability to infiltrate thrombi, atherosclerotic plaques and solid tumours, PEVs as well as platelet-membrane coated nanoparticles are emerging as novel effective and targeted treatment options for CVD and cancer.

SUMMARY

Collectively, in-depth characterization of PEVs in various diseases ultimately enhances their use as diagnostic or prognostic biomarkers and potential therapeutic targets, making them clinically relevant candidates to positively impact patient outcomes.

Demographic diversity in platelet function and response to antiplatelet therapy

Recent studies have highlighted the complexity of platelet biology, revealing their diverse roles beyond hemostasis. Pathological platelet activation is now recognized as a key contributor to thrombosis and inflammation that are both central to cardiovascular disease (CVD). Emerging research emphasizes the significant impact of demographic factors - such as age, sex, race, and ethnicity - on CVD risk and responses to antiplatelet therapies. These population-based differences, shaped by genetic and non-genetic factors, highlight the need for reevaluation of antiplatelet strategies. We address current knowledge and emphasize the pressing need for further research into platelet biology and cardiovascular outcomes across diverse populations. In this review we advocate for tailored therapeutic approaches in CVD based on the recent demographic-focused findings.

The biological role and future therapeutic uses of nitric oxide in extracorporeal membrane oxygenation, a narrative review

BACKGROUND

Nitric oxide (NO) is a gas naturally produced by the human body that plays an important physiological role. Specifically, it binds guanylyl cyclase to induce smooth muscle relaxation. NO's other protective functions have been well documented, particularly its protective endothelial functions, effects on decreasing pulmonary vascular resistance, antiplatelet, and anticoagulation properties. The use of nitric oxide donors as vasodilators has been known since 1876. Inhaled nitric oxide has been used as a pulmonary vasodilator and to improve ventilation perfusion matching since the 1990s. It is currently approved by the United States Food and Drug Administration for neonates with hypoxic respiratory failure, however, it is used off-label for acute respiratory distress syndrome, acute bronchiolitis, and COVID-19.

PURPOSE

In this article we review the currently understood biological action and therapeutic uses of NO through nitric oxide donors such as inhaled nitric oxide. We will then explore recent studies describing use of NO in cardiopulmonary bypass and extracorporeal membrane oxygenation and speculate on NO's future uses.

Lipid-Lowering Drugs and Pulmonary Vascular Disease: A Mendelian Randomization Study

The therapeutic value of lipid-lowering drugs in pulmonary vascular disease remains uncertain due to insufficient studies and evidence. This study aims to investigate the causal effects of lipid-lowering drugs (specifically, inhibitors of APOB, CETP, HMGCR, NPC1L1, and PCSK9) on pulmonary vascular diseases using a Mendelian randomization (MR) approach. We utilized summary-level statistics from genome-wide association studies (GWAS) to simulate the exposure to low-density lipoprotein cholesterol (LDL-C) and its outcomes on pulmonary arterial hypertension (PAH), pulmonary embolism (PE), and pulmonary heart disease (PHD). Single-nucleotide polymorphisms (SNPs) within or near drug target-associated LDL-C loci were selected as proxies for the lipid-lowering drugs. Data from the FinnGen cohort and UK Biobank (UKB) were incorporated to enhance the robustness and generalizability of the findings. The inverse variance weighted (IVW) and MR-Egger methods were employed to estimate MR effects. Our MR analysis indicated that LDL-C mediated by NPC1L1 (odds ratio [OR] = 104.76, 95% confidence interval [CI] = 2.01-5457.01, p = 0.021) and PCSK9 (OR = 10.20, 95% CI = 3.58-29.10, p < 0.001) was associated with an increased risk of PAH. In contrast, LDL-C mediated by APOB was associated with a decreased risk of PE (FinnGen: OR = 0.74, 95% CI = 0.60-0.91, p = 0.005; UKB: OR = 0.998, 95% CI = 0.996-1.000, p = 0.031) and PHD (FinnGen: OR = 0.73, 95% CI = 0.59-0.91, p = 0.004). However, LDL-C mediated by CETP and HMGCR did not show significant associations with the risks of PAH, PE, or PHD. This MR study revealed the causal effects of NPC1L1 and PCSK9 inhibitors on increased PAH risk, while APOB inhibitors appear to reduce the risks of PE and PHD. These findings enhance our understanding of the potential roles of lipid-lowering drugs in pulmonary vascular disease.

Hemogram and inflammatory indices in pain-free periods in migraine patients without aura

OBJECTIVES

Since neurogenic inflammation and hemoconcentration have a prominent role in the pathophysiology of migraine, evaluation of hemogram parameters and indices showing inflammation can yield important information. In this study, we have investigated blood cell counts and ratios, systemic inflammation index (SII), systemic inflammation response index (SIRI) and red cell index (RCI) in the painless periods between pain attacks in patients with episodic migraine without aura.

METHODS

Hemogram data of both 309 patients diagnosed with migraine without aura related to pain-free periods and 199 healthy individuals were retrospectively retrieved from hospital records. Data related to erythrocyte, leukocyte, lymphocyte, platelet, monocyte, eosinophil counts; hemoglobin, hematocrit, mean corpuscular volume, red blood cell distribution width (RDW), mean platelet volume (MPV), neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, monocyte/lymphocyte ratio (MLR), and neutrophil/monocyte ratio, SII, SIRI and RCI values were scanned to reveal intergroup differences in terms of these parameters.

RESULTS

A comparison of laboratory parameters revealed that certain indices differed significantly between the migraine and control groups. MLR (p = 0.005) and RDW (p < 0.001) values were significantly lower, while platelet (p = 0.016), MPV (p < 0.001) and hematocrit (p = 0.014) were significantly higher in the migraine patient group compared to the control group. There was no significant difference between the two groups regarding other parameters.

DISCUSSION

Higher hematocrit, platelet, mean platelet volume and lower monocyte/lymphocyte ratio values in this study support that hemoconcentration and chronic inflammation persist even in the absence of pain attacks in migraine patients without aura.

Establishment and evaluation of nomogram for predicting acute respiratory distress syndrome in meconium-stained amniotic fluid neonates

OBJECTIVE

To delineate risk factors and develop a predictive nomogram for acute respiratory distress syndrome (ARDS) in neonates exposed to meconium-stained amniotic fluid (MSAF).

METHODS

We conducted a comprehensive retrospective analysis of neonates with MSAF, classifying them into ARDS and non-ARDS groups based on the onset of ARDS within the first week after birth. Clinical and laboratory data are collected to screen the risk factors for ARDS in MSAF neonates, multivariate logistic regression was performed to identify independent predictors and establish a nomogram to predict the occurrence of neonatal ARDS.

RESULTS

We recognized five variables as independent risk factors for ARDS with MSAF neonates via logistic regression analysis, consisting of 1-min Apgar score (Apgar 1 min), white blood cell (WBC), platelet (PLT), red cell distribution width (RDW) and serum calcium (Ca). These predictors were integrated into a nomogram designed to estimate the individual risk of ARDS development in neonates. The predictive model achieved a C-index of 0.942 (95% CI: 0.915-0.970), indicating high predictive accuracy. Additionally, the nomogram was internally validated, demonstrating excellent calibration and practical utility for clinical decision-making.

CONCLUSIONS

The validated nomogram, based on five pivotal factors, provides clinicians with a reliable tool for early identification and management of ARDS in MSAF neonates, potentially improving outcomes by facilitating timely and appropriate therapeutic interventions.

Assessing platelet-derived extracellular vesicles for potential as therapeutic targets in cardiovascular diseases

INTRODUCTION

Cardiovascular disease (CVD) is the leading cause of death worldwide. Platelet-derived extracellular vesicles (PEV) have attracted extensive attention in cardiovascular disease research in recent years because their cargo is involved in a variety of pathophysiological processes, such as thrombosis, immune response, promotion or inhibition of inflammatory response, promotion of angiogenesis as well as cell proliferation and migration.

AREAS COVERED

This review explores the role of PEV in various cardiovascular diseases (such as atherosclerosis, myocardial infarction, ischemia-reperfusion injury, and heart failure), with relation to its molecular cargo (nucleic acids, bioactive lipids, proteins) and aims to provide new insights in the pathophysiologic role of PEV, and methods for preventing and treating cardiovascular diseases based on PEV.

EXPERT OPINION

Studies have shown that the cargo of PEV may be dysregulated during cardiovascular disease and delivery to tissues can result in detrimental pathophysiologic effects. Counteracting this process might have the potential to inhibit inflammation, promote angiogenesis, and inhibit cardiomyocyte death. In addition, PEV have potential as biocompatible and autologous drug carriers. Therefore, better research on the mechanisms how PEV act during cardiovascular disease and could be implemented as a therapeutic will provide new perspectives for the treatment of cardiovascular disease.

Inflammatory Markers and Risk of Parkinson's Disease: A Population-Based Analysis

Objected: Parkinson's disease (PD) is an important cause of neurological dysfunction, and the aim of this study was to explore whether neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic inflammatory response (SIRI), and systemic immune inflammation (SII) are associated with the risk of developing PD. Based on this, we may identify people at high risk for PD and intervene early. Method: Our study included 31,480 participants from the National Health and Nutrition Examination Survey (NHANES) between 2001 and 2018. Basic information and inflammation-related indicators were obtained by questionnaires and laboratory tests, respectively. NLR, PLR, LMR, SIRI, SII, and PD risk were analyzed using weighted logistic regression models. Results: There were 261 and 31,219 in the PD and non-PD groups, respectively, and the prevalence of PD was 0.83%. Separate analyses of NLR and PLR were conducted after fully adjusting for confounding factors. According to our analysis, there was an increased risk of PD for both NLR and PLR in the higher level group (Q4) as compared with the lower level group (Q1) (OR = 1.83 and 95% confidence interval (CI) = 1.09-3.07, and OR = 1.92 and 95% CI = 1.20-3.08). However, we did not find similar relationships in LMR, SIRI, and SII. Conclusions: There was a significant association between elevated levels of NLR, PLR, and PD risk, while LMR, SIRI, and SII were not statistically significant. It suggests that NLR or PLR could be used to screen people at risk of PD at an early stage. It is essential to conduct more large-scale prospective studies to investigate the role that NLR and PLR play in PD.