Neoplasms

Blood and Lymph Conditions

All Conditions

Heart and Blood Diseases

Symptoms and General Pathology

Substance Related Disorders

Wounds and Injuries

Rare Diseases

Leukemia

Leukemia, Myeloid

Leukemia, Myeloid, Acute

Cardiotoxicity

Neoplasms by Histologic Type

Hematologic Diseases

Heart Diseases

Drug-Related Side Effects and Adverse Reactions

Chemically-Induced Disorders

Radiation Injuries

Myeloid Leukemia

Acute Myeloid Leukemia

Acute Non Lymphoblastic Leukemia

Acute Graft Versus Host Disease

Anti-Infective Agents

All Drugs and Chemicals

Carbamide Peroxide

N,N-dimethylarginine

Enzyme Inhibitors

The study group will include patients with acute myeloid leukemia receiving chemotherapy, aged 18 to 65 years, without clinical signs of heart failure, with an LV ejection fraction of more than 50% before the start of polychemotherapy, in whom in the course of chemotherapy treatment after the next course of treatment a decrease in global longitudinal strain of 15% or more relative to the initial values will be revealed.

The control group will consist of patients with acute myeloid leukemia receiving chemotherapy, aged 18 to 65 years, without clinical signs of heart failure, with an LV ejection fraction of more than 50% before the start of polychemotherapy, in whom no signs of myocardial disease will be detected during chemotherapy. and endothelial dysfunction.

Careful history taking, including using questionnaires, to identify risk factors for the development of cardiovascular diseases using the SCORE scale.

History taking

Anthropometry: measurement of body weight and height. Calculation of body surface area using the Du Bois formula.

Anthropometry

Before and after each course of chemotherapy: Complete blood count with counting the number of erythrocytes, leukocytes, leukocyte formula, platelets, erythrocyte sedimentation rate.

Complete blood count

Before and after each course of chemotherapy: Biochemical blood test with the determination of the amount of total protein, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, creatinine, urea, AlAT, AsAT, LDH, glucose, C-reactive protein, troponin T, proBNP.

Biochemical blood test

Before and after each course of chemotherapy: Coagulogram parameters (fibrinogen, APTT, INR).

Coagulogram

Before the start of the treatment and after each course of chemotherapy: Immunoenzymatic analysis of the level of endothelin-1, asymmetric dimethylarginine.

Immunoenzymatic analysis of the level of endothelin-1, asymmetric dimethylarginine

Before the start of the treatment and after each course of chemotherapy: Stress echocardiography with the definition of global longitudinal deformation of the myocardium.

Stress echocardiography with the definition of global longitudinal deformation of the myocardium

Before the start of the treatment and after each course of chemotherapy: Triplex scanning of neck vessels.

Triplex scanning of neck vessels

Before and after each course of chemotherapy: Electrocardiography.

Electrocardiography

Before the start of the treatment and after each course of chemotherapy: Ultrasound of the abdominal cavity (with calculation of the area of the spleen) and lymph nodes.

Ultrasound of the abdominal cavity (with calculation of the area of the spleen) and lymph nodes

Before the start of the treatment: Cytogenetic examination of the bone marrow to determine genetic abnormalities.

Cytogenetic examination of the bone marrow to determine genetic abnormalities.

Before the start of the treatment and after each course of chemotherapy: Cytological examination of bone marrow cells with cytochemical examination.

Cytological examination of bone marrow cells with cytochemical examination

Before the start of the treatment: Immunophenotypic examination of the bone marrow by flow cytometry.

Immunophenotypic examination of the bone marrow by flow cytometry

Before the start of the treatment: Determination of the presence of a FLT3 mutation using the PCR Method.

Determination of the presence of a FLT3 mutation using the PCR Method

Before the start of the treatment and after each course of chemotherapy: Examination of microcirculation by laser Doppler flowmetry using the LAKK-OP apparatus (NPP Lazma, Moscow, 2011) with respiratory and occlusion tests.

laser Doppler flowmetry

Igor Davydkin, Doctor of Medical Sciences

Angelika Antipova

Igor Davydkin

Acute myeloid leukemia (AML) is a clonal neoplastic disease of the hematopoietic tissue associated with a mutation in the precursor cell of hematopoiesis, which results in a differentiation block and uncontrolled proliferation of immature myeloid cells.

Anthracycline antibiotics have been an integral part of the treatment of acute myeloid leukemia since the 1970s. However, the clinical usefulness of anthracyclines is limited primarily by the high incidence of cardiotoxicity. According to the European Society of Cardiology guidelines for cardio-oncology, cardiovascular toxicity is defined as any impairment of cardiac function associated with anticancer treatment, as the term encompasses both a wide range of possible clinical manifestations and an etiological relationship with various treatments, including chemotherapy, radiation therapy, immunotherapy and treatment with targeted drugs. Cardiovascular toxicity can be acute, subacute or delayed, manifesting many years after chemotherapy or radiation therapy, involving a number of cardiac structures, which can lead to the development of heart failure, coronary heart disease, valvular heart disease, arrhythmias, including cardiac conduction disorders and diseases of the pericardium.

Anthracycline-induced cardiotoxicity is the negative effect of anthracyclines on normal cardiac activity due to their toxic effects on the heart muscle and the cardiac conduction system. Anthracycline-induced cardiotoxicity manifests as asymptomatic left ventricular dysfunction in 57% of treated patients and restrictive or dilated cardiomyopathy leading to congestive heart failure (CHF) in 16% to 20% of patients. Anthracycline-induced congestive heart failure is often resistant to therapy and has a mortality rate of up to 79%. Thus, there is a need for early detection of cardiovascular dysfunction associated with chemotherapy treatment of acute myeloid leukemia in order to timely prescribe drug therapy.

Purpose of the study To optimize the early detection of endothelial dysfunction and left ventricular myocardial contractility in patients with acute myeloid leukemia during chemotherapy treatment based on a comprehensive assessment of instrumental and laboratory research parameters.

Expected results Based on a comprehensive analysis using laser Doppler flowmetry, stress echocardiography with the determination of global longitudinal strain of the myocardium, biochemical markers of endothelial damage and cardiac biomarkers, a correlation between violations of the contractility of the left ventricular myocardium and violations of the vasoregulatory function of the vascular endothelium will be revealed, which will allow developing an algorithm for early detection of cardiomyopathy and vascular complications in patients with acute myeloid leukemia during chemotherapy treatment.

Acute myeloid leukemia (AML) is a clonal neoplastic disease of the hematopoietic tissue associated with a mutation in the precursor cell of hematopoiesis, which results in a differentiation block and uncontrolled proliferation of immature myeloid cells.

It is believed that AML affects an average of 3-5 people per 100,000 people per year. At the same time, the incidence increases sharply at the age of over 60 years and amounts to 12-13 cases per 100 thousand of the population in people over the age of 80 years. The median age of this disease is 65 years. With a population of 140 million inhabitants in Russia, the estimated incidence rate (according to European and American researchers) should be about 5 thousand cases.

Anthracycline antibiotics have been an integral part of the treatment of acute myeloid leukemia since the 1970s. Anthracycline is usually given for 3 days (eg, daunorubicin 45-90 mg/m 2 daily, idarubicin 12 mg/m 2 daily) in combination with cytarabine (100-200 mg/m 2 daily) continuously for 7 days ) ("7+3" mode). Anthracyclines block the synthesis of DNA and RNA by inhibiting the enzyme topoisomerase IIβ and mitochondrial topoisomerase I. The subsequent disruption of DNA replication and transcription prevents the proliferation of rapidly dividing cells. In addition, anthracyclines damage DNA, proteins, and cell membranes by creating free oxygen radicals.

The clinical usefulness of anthracyclines is limited primarily by the high incidence of cardiotoxicity. According to the European Society of Cardiology guidelines for cardio- oncology, cardiovascular toxicity is defined as any impairment of cardiac function associated with anticancer treatment, as the term encompasses both a wide range of possible clinical manifestations and an etiological relationship with various treatments, including chemotherapy, radiation therapy, immunotherapy and treatment with targeted drugs. Cardiovascular toxicity can be acute, subacute or delayed, manifesting many years after chemotherapy or radiation therapy, involving a number of cardiac structures, which can lead to the development of heart failure, coronary heart disease, valvular heart disease, arrhythmias, including cardiac conduction disorders, and diseases of the pericardium.

Anthracycline-induced cardiotoxicity is the negative effect of anthracyclines on normal cardiac activity due to their toxic effects on the heart muscle and the cardiac conduction system. It is believed to be mediated in part by reactive oxygen species generated by anthracycline treatment, which leads to lipid peroxidation and DNA damage in cardiomyocytes. Other putative causes of anthracycline-induced cardiotoxicity include accumulation of cardiotoxic anthracycline metabolites in the heart, disruption of calcium homeostasis, mitochondrial damage, and induction of apoptosis.

Anthracycline-induced cardiotoxicity manifests as asymptomatic left ventricular dysfunction in 57% of treated patients and restrictive or dilated cardiomyopathy leading to congestive heart failure (CHF) in 16% to 20% of patients. Anthracycline-induced congestive heart failure is often resistant to therapy and has a mortality rate of up to 79%. Thus, there is a need for early detection of cardiovascular dysfunction associated with chemotherapy treatment of acute myeloid leukemia in order to timely prescribe drug therapy.

Purpose of the study To optimize the early detection of endothelial dysfunction and left ventricular myocardial contractility in patients with acute myeloid leukemia during chemotherapy treatment based on a comprehensive assessment of instrumental and laboratory research parameters.

Research objectives

1. To assess the state of endothelial function in patients with acute myeloid leukemia receiving chemotherapy based on a comprehensive assessment, including laser Doppler flowmetry and biochemical markers of endothelial damage (endothelin-1, asymmetric dimethylarginine).
2. To characterize the contractility of the left ventricular myocardium in patients with acute myeloid leukemia during chemotherapeutic treatment based on the indicators of stress echocardiography with the determination of global longitudinal deformation of the myocardium, as well as to assess the presence of myocardial damage by determining the level of highly sensitive troponin and brain natriuretic peptide.
3. To study the relationship between dynamic indicators of microcirculation, determined by laser Doppler flowmetry, with indicators of contractility of the left ventricular myocardium, detected using stress echocardiography with the determination of global longitudinal deformation of the myocardium, and the results of laboratory methods for assessing the function of the endothelium and myocardium.
4. To determine the frequency of development of various phenotypes of cardiovascular toxicity.
5. To identify the most significant prognostic criteria for the development of cardiotoxicity in patients with acute myeloid leukemia receiving chemotherapy.

Scientific novelty

1. For the first time, an algorithm for early detection of endothelial dysfunction and left ventricular myocardial contractility in patients with acute myeloid leukemia during chemotherapy treatment will be developed.
2. For the first time, the vasoregulatory function of the endothelium and the contractility of the left ventricular myocardium in patients with acute myeloid leukemia receiving chemotherapy will be studied based on a comprehensive assessment using laser Doppler flowmetry, stress echocardiography with the determination of global longitudinal deformation of the myocardium, biochemical markers of endothelial damage and cardiac biomarkers.

Practical significance It is planned to develop an algorithm for early detection of endothelial dysfunction and left ventricular myocardial contractility in patients with acute myeloid leukemia during chemotherapy treatment based on a comprehensive assessment using laser Doppler flowmetry, stress echocardiography with the determination of global longitudinal myocardial strain, biochemical markers of endothelial damage and cardiac biomarkers. .

Expected results Based on a comprehensive analysis using laser Doppler flowmetry, stress echocardiography with the determination of global longitudinal strain of the myocardium, biochemical markers of endothelial damage and cardiac biomarkers, a correlation between violations of the contractility of the left ventricular myocardium and violations of the vasoregulatory function of the vascular endothelium will be revealed, which will allow developing an algorithm for early detection of cardiomyopathy and vascular complications in patients with acute myeloid leukemia during chemotherapy treatment.

Research hypothesis:

The proposed algorithm for the early detection of cardiovascular complications in patients with acute myeloid leukemia receiving chemotherapy treatment is an effective method for diagnosing cardiovascular complications at subclinical stages for the timely initiation of their therapy.

Study Design In total, it is planned to study 100 patients with acute myeloid leukemia receiving chemotherapy, aged 18 to 65 years, without clinical signs of heart failure, with an LV ejection fraction of more than 50% before the start of polychemotherapy.

The study group will include patients with acute myeloid leukemia receiving chemotherapy, aged 18 to 65 years, without clinical signs of heart failure, with an LV ejection fraction of more than 50% before the start of polychemotherapy, in whom in the course of chemotherapy treatment after the next course of treatment a decrease in global longitudinal strain of 15% or more relative to the initial values will be revealed.

The control group will consist of patients with acute myeloid leukemia receiving chemotherapy, aged 18 to 65 years, without clinical signs of heart failure, with an LV ejection fraction of more than 50% before the start of polychemotherapy, in whom no signs of myocardial disease and endothelial dysfunction will be detected during chemotherapy.

Clinical and Diagnostic Significance of Endothelial Dysfunction and Myocardial Contractility in Patients With AML

Clinical and Diagnostic Significance of Endothelial Dysfunction and Myocardial Contractility in Patients With Acute Myeloid Leukemia

Change of global longitudinal strain of the myocardium according to stress echocardiography by 15% or more relative to the values obtained before the start of chemotherapy treatment.

Change of the microcirculation index according to the results of laser Doppler flowmetry in relation to the values obtained before the start of chemotherapy treatment.

Change of the coefficient of variation of microcirculation according to the results of laser Doppler flowmetry in relation to the values obtained before the start of chemotherapy treatment.

Change of the level of highly sensitive T-troponin, which goes beyond the reference values, in relation to the values obtained before the start of chemotherapy treatment.

Change of the level of brain natriuretic peptide that goes beyond the reference values, in relation to the values obtained before the start of chemotherapy treatment.

Change of the level of asymmetric dimethylarginine that goes beyond the reference values, in relation to the values obtained before the start of chemotherapy treatment.

Change of the level of endothelin-1, which goes beyond the reference values, in relation to the values obtained before the start of chemotherapy treatment.

Samara State Medical University

Hematologic Neoplasms

Leukemia, Myelogenous, Chronic, BCR-ABL Positive

Philadelphia Chromosome

Bone Marrow Diseases

Leukocyte Disorders

Myeloproliferative Disorders

Chronic Disease

Disease Attributes

Chronic Graft Versus Host Disease

Chronic Myeloid Leukemia

Chronic Myeloproliferative Disorders

Antineoplastic Agents

Amino Acids

Nilotinib

Imatinib Mesylate

Tyrosine Kinase Inhibitors

Protein Kinase Inhibitors

Tyrosine

Administered orally as a single agent on a continuous daily schedule given 400 mg bid (twice daily) with food. One cycle comprised of 28 days.

Imatinib

Administered orally as a single agent on a continuous daily schedule of 400 mg bid (2 x 200 mg twice daily) without food. Once cycle comprised of 28 days.

Nilotinib (AMN107)

Novartis Pharmaceuticals

In this study, the efficacy and safety of nilotinib 400 mg twice daily, will be compared with imatinib 400 mg twice daily in patients with a suboptimal response to imatinib for their Philadelphia chromosome-positive (Ph+) Chronic Myelogenous Leukemia in the chronic phase (CML-CP).

This trial was to evaluate the CCyR rate at 12 months of nilotinib therapy when compared to imatinib treatment in patients with suboptimal response to imatinib. The patients were stratified by prior duration of initial imatinib treatment, and were randomized to receive either 400 mg/twice daily of continuous nilotinib or imatinib treatment. The first stratum patients were treated with imatinib = 6 to \< 12 months and having at least a minimal cytogenetic, but no partial cytogenetic response; and the second stratum patients were treated with imatinib = 12 months to \< 18 months and having partial cytogenetic response (PCyR), but no CCyR.

Nilotinib vs Imatinib in Adult Patients With Philadelphia (Ph+) Chronic Myelogenous Leukemia in Chronic Phase (CML-CP)

A Phase III Randomized, Open- Label Multi-center Study of Nilotinib Versus Imatinib in Adult Patients With Ph+ Chronic Myelogenous Leukemia in Chronic Phase (CML-CP) Who Have a Suboptimal Cytogenetic Response (CyR) on Imatinib

Due to early termination of the trial, the number of patients was too small and imbalanced and therefore analysis was not performed.

Patients received 400 mg twice daily, 2 x 200 mg capsules twice daily.

Patients received 400 mg twice daily. Capsules were available in 100 mg and 400 mg formulations.

Total

Age, Categorical

Age Continuous

Sex: Female, Male

Belgium

Germany

Japan

Korea, Republic of

Poland

Region of Enrollment

Study Director

Complete Cytogenetic Response Rate(CCyR) in Patients Who Had a Suboptimal Cytogenetic Response on Imatinib

The trial was terminated early, so only 6 patients were enrolled.

Durable Complete Cytogenetic Response Rate

Overall Study

Adult patients (from 18 - 60 years) diagnosed as AML

CD155 expression by flow cytometric immunophenotyping

Flow cytometric immunophenotyping

Complete blood count with peripheral blood smear examination

Bone marrow aspiration at both diagnosis and follow up of patients

Bone marrow aspiration

Karyotyping or AML fluorescence in situ hybridization (FISH) panel for diagnosis and risk stratification of AML patients

Cytogenetic testing

Detection of FLT3-ITD mutation in AML patinets

FLT3-ITD using High resolution melting curve (HRM) analysis

Nehal Rayan, M.D.

Acute myeloid leukemia (AML) is a heterogeneous hematologic malignancy. It is the most common form of acute leukemia among adults. In the United States, an estimated 19,940 people will be diagnosed with AML in 2020.

CD155 expression was associated with an unfavorable prognosis in solid tumors such as colon cancer, breast cancer, lung adenocarcinoma, pancreatic cancer, melanoma, and glioblastoma, as it correlated with tumor migration, development of metastases, tissue and lymph node invasion, relapse, and poorer survival.

Acute myeloid leukemia (AML) is a heterogeneous hematologic malignancy. It is the most common form of acute leukemia among adults. In the United States, an estimated 19,940 people will be diagnosed with AML in 2020.

T-cell exhaustion is a state of decline in T-cell proliferation and function (secretion of cytokines and cytotoxicity). It is defined by the expression of immune checkpoints including programmed cell death protein-1 (PD1), cytotoxic T-lymphocyte-associated protein-4 (CTLA4), T-cell immunoglobulin and mucin-domain containing-3 (TIM3), lymphocyte-activation gene-3 (LAG3), T-cell immunoreceptor with immunoglobulin and ITIM domains (TIGIT), and CD160. This phenomenon was observed in many cancer cells to escape from antitumor immune responses.

The poliovirus receptor (PVR), also known as CD155, is an immunoglobulin -like adhesion molecule, with an important regulatory role in T-cell and natural killer (NK) cell functions, cell migration and proliferation. It is a major ligand that is expressed on epithelial and myeloid cells of the tumor. PVR is able to bind CD226, DNAX accessory molecule-1 (DNAM-1), T-cell-Activated Increased Late Expression Protein (TACTILE), and TIGIT. Binding to DNAM-1 induces the release of pro-inflammatory cytokines and cytotoxicity of T-cells and NK cells (T-cell activation), while binding to TIGIT induces a rather anti-inflammatory, non-proliferative, and noncytotoxic profile (T-cell exhaustion).

CD155 expression was associated with an unfavorable prognosis in solid tumors such as colon cancer, breast cancer, lung adenocarcinoma, pancreatic cancer, melanoma, and glioblastoma, as it correlated with tumor migration, development of metastases, tissue and lymph node invasion, relapse, and poorer survival.

Stamm et al., demonstrated that high CD155 (PVR) expression correlated with poor outcome in AML. Stamm et al., also showed that antibody blockade of PVR on AML cell lines or primary AML cells or TIGIT blockade on immune cells increased the anti-leukemic effects mediated by purified CD3+ cells in vitro. Zhang et al., assessed the prognostic significance and immune-associated mechanism of CD155 and identified that CD155 was commonly upregulated in most human cancers including AML, and high expression of CD155 was closely correlated with unfavorable clinical outcomes.

Our aim is to study the prognostic and predictive values of CD155 expression in AML patients in our locality.

Peripheral blood or Bone marrow aspiration specimens

CD155 Expression in Acute Myeloid Leukemia

Prognostic and Predictive Values of CD155 in Patients With Acute Myeloid Leukemia

1. Evaluate the prognostic value of CD155 in AML patients and relation of CD155 expression and clinicopathological and laboratory data of the patients.
2. Evaluate the predictive value of CD155 for patients who will receive induction chemotherapy with 3\&7 protocol (Anthracycline and Ara-C).

Assiut University

Assistant Lecturer

Immune System Diseases

Precursor Cell Lymphoblastic Leukemia-Lymphoma

Leukemia, Lymphoid

Lymphoma

Lymphoproliferative Disorders

Lymphatic Diseases

Immunoproliferative Disorders

Acute Lymphoblastic Leukemia

Lymphoblastic Lymphoma

Childhood Acute Lymphoblastic Leukemia

Lymphosarcoma

children aged 2-17 years and diagnosed as new cases of acute lymphoblastic leukemia

healthy age- and sex-matched children without ahistory of any malignancies

1. total RNA is isolated from fresh blood samples
2. RNA is converted into complementary DNA c.DNA
3. cDNA is then analysed by quantitatine Real Time PCR(qRT-PCR) to evaluate the relative expression levels of FoxO3a, PU.1 genes and TATA-binding protein (TBP) ,as an endogenous control gene.

complete blood count

Rania Mohamed Bakry, Professor

Dina Ismail El kady, Lecturer

Acute Lymphoblastic Leukemia (ALL) is one of the four major types of leukemia which is common in both children and adolescents; however, it is the most common pediatric malignancy diagnosed in children younger than 20 years .The disease pathogenesis results from blockade at any stages of normal lymphoid differentiation with uncontrolled proliferation of lymphoid cells. According to the World Health Organization (WHO) definition, ALL is categorized in B-Lymphoblastic Leukemia (B-ALL) And T-Lymphoblastic Leukemia (T-ALL), originated from B- and T-Lineage lymphoid precursor cells, respectively.

Proto-oncogenes and tumor suppressor genes are the most important genes involved in leukemogenesis , which their alterations disrupt normal regulatory processes such as self-renewal, proliferation, differentiation and apoptosis in target cells. Among those genes FoxO3a gene and PU.1 gene.

FoxO(Fork head box ,class O) transcription factors function as a tumor suppressor gene and are important for stem cell maintenance.They are key regulators of the cellular differentiation, growth, survival, cell cycle, metabolism, and cellular stress. There are four members of the foxO transcription factors in humans : foxO1, foxO3a, foxO4, foxO6 .FoxO3a is expressed in various tissues including B - and T-lymphoid cells. Over expression of FoxO3a in B and T cell lines induces cell cycle arrest in G1 phase , so it inhibits cell proliferation . FoxO3a is an important target of PI3K/AKT signaling pathway,which is hyperactivated in various types of cancers .Hyperactivation of this pathway in leukemia leads to inactivation of foxO3a in leukemic cells and enhances tumor growth .

PU .1(Purine-rich box 1) is a member of the E26 transformation-specific (ETS) Family . Normal hematopoiesis is securely controlled by asmall number of lineage-specific transcription factors, so that the disturbed expression or function of this group may be involved in the development of leukemia . PU.1 plays an important role in hematopiotic stem cell (HSC) self renewal and in myeloid and B-lymphoid differentiation. It controls the expression of several genes involved in hematopoiesis.

FoxO3a and PU.1 in Acute Lymphoblastic Leukemia

Value of FoxO3a and PU.1 Expression in Pediatric Acute Lymphoblastic Leukemia

detection of the mean difference in FoxO3a and PU.1 expression levels between cases and controls

principal investigator

Gland and Hormone Related Diseases

Thyroid Neoplasms

Thyroid Diseases

Thyroid Nodule

Goiter

Goiter, Nodular

Endocrine System Diseases

Endocrine Gland Neoplasms

Head and Neck Neoplasms

Selective lichtenstein procedure for inguinal hernia

Complete Blood Count

Thyroid surgery is the most common surgical procedure among endocrine surgeries. It is performed in patients with suspected malignancy, patients diagnosed with malignancy, and for toxic nodular goiter \[1\]. Fine-needle aspiration biopsy (FNAB) is used as a daily technique in preoperative evaluation to differentiate malignant and benign nodules. However, complications including hematoma formation, tumor transplantation along the needle trace, thyroid nodule infarction and vascular proliferation can be seen even in this minimally invasive procedure \[2\]. Therefore, the differentiation of benign and malignant groups using non-interventional methods before surgery has become important.

Cancer-related inflammation, including papillary thyroid carcinoma, is involved in carcinogenesis and progression of neoplastic disease \[3,4\]. Neutrophils induced by the tumor can accelerate tumor metastasis \[3,5\]. Lymphocytes, as the cornerstone of the adaptive immune system, inhibit tumor cell proliferation and migration as well as destroying metastases \[3,6\]. Previous studies have shown that increased lymphocyte count has a positive effect on better survival in patients with advanced cancer \[7\]. Furthermore, Kupffer cells, also known as liver macrophages, destroy circulating cancer cells and help the distribution of tumor cells via circulation. Therefore, routine blood tests have been investigated as a predictive or prognostic factor for carcinomas since blood parameters in these tests show whether there is inflammation. Neutrophil count, lymphocyte count, neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), mean platelet volume (MPV), and platelet distribution width (PDW) have been studied in terms of numerous malignancies \[3\].

Tumor-related inflammation is activated the bone marrow and inflammation induced by malignancies. Inflammatory activity that is poorly controlled or uncontrollable may be responsible for malignant transformation \[8\]. At this point, NLR has previously been shown to be useful in the differentiation of thyroid malignancies and benign thyroid diseases \[9\]. Delta neutrophil index (DNI) / increased number of immature granulocytes (IG) represents active bone marrow. Delta neutrophil index, which is manifested by IG formation in inflammatory and infectious events, shows changes in the white blood cell count \[10\].

This study aimed to evaluate the relation between the automatically calculated DNI/IG count and manually calculated NLR from the preoperative complete blood count (CB) parameters, and thyroid malignancies with a cost-effective non-invasive method before surgery or biopsy as the indicator of the malignant inflammatory response in the differentiation of nodular goiter and thyroid malignancy.

Material-Methods Patients over the age of 18 who underwent thyroid surgery and who were operated on non-malignant benign causes (inguinal hernia) under selective conditions without any thyroid disease between November 2014 and November 2019 in Kahramanmaraş Sütçü İmam University Department of General Surgery were evaluated in this retrospective case-control cohort study. Patients in the thyroid pathology group (Group T) were divided into two subgroups according to their pathologic results: malignant (Group M) and benign thyroid disorders (Group B). Patients operated for inguinal hernia, were selected as control group (Group C).

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Preoperative biopsy results of patients undergoing FNAB in the preoperative period were investigated according to the Bethesda Classification System \[11\]. Neutrophil - lymphocyte count in the routine complete blood count (CBC) values, which were measured in the preoperative period and the postoperative sixth-month follow-ups, were recorded retrospectively and calculated manually. DNI (IG percentage) and IG counts were recorded from the values measured automatically in the CBC performed in the preoperative period and the postoperative sixth-month. Patient data were obtained from patient epicrisis forms and preoperative laboratory and postoperative pathology results recorded in the computer system.

Statistical Analysis The power analysis of the study was conducted with G-Power 3.0.10 programming system. Estimated power analysis and the sample size with an 0.8 power and effect size 0.1 according to three groups evaluation for 2 repeated measures in need of total 246 samples.

Statistical analysis was performed using IBM Social Package for the Social Sciences (SPSS) version 20 software. In the evaluation of independent groups, Kolmogorov-Smirnov and Shapiro-Wilk tests were used to determine if the distrubiton of variables were normal or not. Student t-test or Mann-Whitney U test was used to evaluate the numerical data between Group C and Group T. ANOVA or Kruskal Wallis test was used to evaluate numerical data for subgroup relations with Group C. Chi-square test or Fischer's exact test was used to evaluate categorical data. The repeated-measures ANOVA was used to evaluate the differences between the preoperative and postoperative periods. The data were evaluated using Posthoc Tukey's B test following the variance analysis. Sensitivity and specificity values and cut-off values were obtained via the receiver operating characteristic (ROC) analysis to evaluate the effectiveness of NLR, IG count, and DNI.

Numerical data were expressed as mean ± standard deviation (minimum-maximum values) or median (minimum-maximum values) according to the normal distribution. Categorical values were expressed as percentages (%).

Delta Neutrophil Index and Neutrophil Lymphocyte Ratio in Thyroid Malignancy

Delta Neutrophil Index and Neutrophil Lymphocyte Ratio in Differentiation of Thyroid Malignancy and Nodular Goiter

The correlation between DNI and thyroid cancer

Kahramanmaras Sutcu Imam University

Professor, Assistant

Respiratory Tract (Lung and Bronchial) Diseases

Lung Neoplasms

Respiratory Tract Neoplasms

Thoracic Neoplasms

Lung Diseases

Respiratory Tract Diseases

Group of patients with lung tumor qualified for thoracic surgery intervention with routine, preoperative complete blood count test and routine postoperative histopathological examination of lung tumor.

During routine preoperative blood test complete blood count is taken.

Routine postoperative histopathological examination of lung tumor.

Histopathological examination

Hanna Misiołek, MD PhD

The aim of the study is to assess whether the value of neutrophil-lymphocyte count ratio from the routine preoperative blood test may predict lung tumors' grading.

Lung cancer remains as one of the leading causes of death among oncology patients. Close connection between inflammation and pathogenesis of some neoplasms was determined in a number of studies. Some studies show promise that ratio of neutrophil to lymphocyte count (NLCR) may be recognized as a prognostic marker for several carcinomas: renal, lung and colorectal. The aim of the study is to assess whether the value of neutrophil-lymphocyte count ratio from the routine preoperative blood test may predict lung tumors' grading. During routine preoperative blood tests complete blood count is done and NLCR, WBC, neutrophil and lymphocyte count is noted. After the thoracic surgery intervention and histopathological examination grading of lung tumor is noted.

NLCR in Prediction of the Grade of Lung Tumor.

Preoperative Neutrophil-lymphocyte Count Ratio in Prediction of the Grade of Lung Tumor.

Neutrophil-lymphocyte count ratio is measured during routine preoperative blood tests.

Neutrophil count is measured during routine preoperative blood tests.

Lymphocyte count is measured during routine preoperative blood tests.

Leucocyte count is measured during routine preoperative blood tests.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Clinical and Diagnostic Significance of Endothelial Dysfunction and Myocardial Contractility in Patients With AML	NCT05703126	Acute Myeloid L... Cardiotoxicity Endothelial Dys...	History taking Anthropometry Complete blood ... Biochemical blo... Coagulogram Immunoenzymatic... Stress echocard... Triplex scannin... Electrocardiogr... Ultrasound of t... Cytogenetic exa... Cytological exa... Immunophenotypi... Determination o... laser Doppler f...	18 Years - 65 Years	Samara State Medical University
Nilotinib vs Imatinib in Adult Patients With Philadelphia (Ph+) Chronic Myelogenous Leukemia in Chronic Phase (CML-CP)	NCT00519090	Myelogenous Leu...	Imatinib Nilotinib (AMN1...	18 Years -	Novartis
CD155 Expression in Acute Myeloid Leukemia	NCT06369662	Acute Myeloid L...	Flow cytometric... Complete blood ... Bone marrow asp... Cytogenetic tes... FLT3-ITD using ...	18 Years - 60 Years	Assiut University
Nilotinib vs Imatinib in Adult Patients With Philadelphia (Ph+) Chronic Myelogenous Leukemia in Chronic Phase (CML-CP)	NCT00519090	Myelogenous Leu...	Imatinib Nilotinib (AMN1...	18 Years -	Novartis
FoxO3a and PU.1 in Acute Lymphoblastic Leukemia	NCT04092348	Acute Lymphobla...	complete blood ...	2 Years - 17 Years	Assiut University
Delta Neutrophil Index and Neutrophil Lymphocyte Ratio in Thyroid Malignancy	NCT04425512	Thyroid Cancer Thyroid Nodule Thyroid Disease... Delta Neutrophy... Immature Granul... Neutrophyl to L...	Complete Blood ...	18 Years -	Kahramanmaras Sutcu Imam University
NLCR in Prediction of the Grade of Lung Tumor.	NCT03749512	Lung Neoplasm	Complete blood ... Histopathologic...	18 Years -	Medical University of Silesia
A Study of Imatinib Versus Nilotinib in Adult Patients With Newly Diagnosed Philadelphia Chromosome Positive (Ph+) Chronic Myelogenous Leukemia in Chronic Phase (CML-CP)	NCT00471497	Myelogenous Leu...	nilotinib imatinib	18 Years -	Novartis

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