Inflammation
George Feuer, Felix A. de la Iglesia in Molecular Biochemistry of Human Disease, 2020
During the inflammatory process, fluid leaks out from the capillaries into the tissue, and plasma proteins remain behind in the vessels. The increased protein coats the red cells making them clump together. This clumping process causes an increase in the normal settling out of red cells, i.e., the sedimentation of these relatively dense particles in the fluid medium. If the blood of a healthy individual is treated with heparin to prevent coagulation, the erythrocytes settle out very slowly. In contrast, if the blood of a patient with acute or chronic inflammation is allowed to stand, the erythrocytes will settle very rapidly, being heavier than the plasma density. Red blood cells are normally kept in suspension by the colloid action of serum proteins, particularly albumins. The relative amounts and composition of serum proteins are altered in disease, thus the colloid stability is interfered with resulting in accelerated sedimentation rate of erythrocytes. In addition, the sedimentation rate is faster when the particles in the blood are larger, as is the case of red blood cell clumping in inflammation.
Nina: The Use of Potent Opioids in a Complex Chronic Pain Patient
Michael S. Margoles, Richard Weiner in Chronic PAIN, 2019
At her next visit on 9/18/96, she stated that morning stiffness (due to onset of cold weather) had become a problem. She was noted to be in moderate severe distress. On the symptom chart, all the patterns mentioned on 9/10/96 were present, plus there was radicular pain and paresthesias into the right upper extremity. She was premedicated with 8 mg of Dilaudid®, 40 mg of Benadryl®, and 0.5 cc of 2% Xylocaine®. The upper rectus abdominis trigger points were injected on both sides using 0.25% Marcaine. There was one local twitch response per muscle and three jump signs accompanying each injection. The patient was sent for a comprehensive panel of laboratory testing which revealed the following results: Complete blood count was within normal limits. The sedimentation rate was at 44 (normal range = 1–20). The chemistry showed no abnormalities of glucose, urea nitrogen, iron, calcium, phosphatase, and uric acid. The electrolyte panel revealed that the patient’s potassium was at 3.6 (normal range = 3.5–5.5). She stated that she had had some upper respiratory symptoms at the time on that drawing, and she had been vomiting secondary to the upper respiratory infection. Liver function tests were within normal limits. Free thyroxin was 1.3 (normal range = 0.75–2.0 ng/dl). Urinalysis was within normal limits. The estradiol (now under the care of Dr. Renraw) was 469 pg/ml.
Thyroiditis
David S. Cooper, Jennifer A. Sipos in Medical Management of Thyroid Disease, 2018
During the first phase of silent thyroiditis, the serum T4 and T3 levels are increased and serum TSH is decreased. The T4/T3 ratio is higher in silent thyroiditis than in Graves’ disease, reflecting glandular hormonal stores. The radioactive iodine uptake is very low. Thyroglobulin levels are increased, which may be useful in distinguishing silent thyroiditis from factitious thyrotoxicosis. Serum thyroglobulin concentrations may remain slightly increased even one to two years after recovery of normal thyroid function (16). Thyroid autoantibody levels are increased approximately 30 to 50% of the time. However, approximately 50% of the positive antibody titers become negative within six months after thyroid recovery (10, 12). The white cell count is usually normal. The sedimentation rate is normal in 50% of cases, with only mild elevation in the remaining cases (17). Fine-needle aspiration (FNA) of the thyroid shows lymphocytic infiltration, but aspiration is rarely needed to make the diagnosis. Biopsies show that silent thyroiditis lacks some of the features of chronic lymphocytic thyroiditis, such as Hürthle cells and germinal centers (13).
Relationship between serum-soluble receptor for advanced glycation end products (sRAGE) and disease activity in rheumatoid arthritis patients
Published in Modern Rheumatology, 2019
Mohammad Reza Jafari Nakhjavani, Mahdi Jafarpour, Amir Ghorbanihaghjo, Sima Abedi Azar, Aida Malek Mahdavi
Five milliliters of venous blood samples was collected after 12-h overnight fasting. The serum samples were separated from whole blood and were kept at −70 °C until biochemical analysis. Serum sRAGE (BioVendor Research and Diagnostic Products), anti-cyclic citrullinated peptide (Anti-CCP) (Medizym., Berlin, Germany), and C-reactive protein (CRP) (Monobined Inc., Lake Forest, CA) levels were measured by ELISA according to the manufacturer’s recommendations, using an ELISA plate reader (Model stat fax 2100, Awareness, Ramsey, MN). Serum creatinine, blood urea nitrogen (BUN), and rheumatoid factor (RF) were measured by the standard enzymatic colorimetric method (Pars Azmoon Co, Tehran, Iran) with an automated chemical analyzer (Abbott analyzer, Abbott laboratories, Abbott Park, North Chicago, IL). The erythrocyte sedimentation rate (ESR) was measured using whole blood and complete blood counts with differential counts analyzed by the H1-Technicon blood cell counter.
Repeated cobalt and chromium ion measurements in patients with large-diameter head metal-on-metal ReCap-M2A-Magnum total hip replacement
Published in Acta Orthopaedica, 2019
Heikki Mäntymäki, Petteri Lankinen, Tero Vahlberg, Aleksi Reito, Antti Eskelinen, Keijo Mäkelä
All participating patients had their blood samples taken from the antecubital vein using a 21-gauge BD Vacutainer Eclipse blood collection needle (Becton, Dickinson and Co, Franklin Lakes, NJ, USA). The first 10 mL tube of blood was used for analysis of standard laboratory tests such as C-reactive protein and erythrocyte sedimentation rate measurement. The second blood sample was taken in Vacuette NH trace elements tube (Greiner Bio-One GmbH, Kremsmünster, Austria) containing sodium heparin. Cobalt and chromium analyses from whole blood were performed using an accredited method with Inductively Coupled Plasma Mass Spectrometry (ICP-MS, VITA Laboratory, Helsinki, Finland in collaboration with Medical Laboratory of Bremen, Germany). The detection limit for Cr was 0.2 ppb and for Co 0.2 ppb. The intra-assay variation for WB Cr and Co was 2.2% and 2.7% and inter-assay variation was 6.7% and 7.9%, respectively.
Mavrilimumab: a unique insight and update on the current status in the treatment of rheumatoid arthritis
Published in Expert Opinion on Investigational Drugs, 2019
Chiara Crotti, Martina Biggioggero, Andrea Becciolini, Elena Agape, Ennio Giulio Favalli
The first inhuman randomized, double-blind, placebo-controlled, dose-escalating phase I study with mavrilimumab was performed in 32 adult onset RA patients [50], with active disease (Disease Activity Score 28-joint assessment [DAS28] ≤4.8) despite a stable methotrexate (MTX) dosage (10–25 mg/week). Patients were randomized 5:1 to receive a single, escalating intravenous dose of mavrilimumab (0.01, 0.03, 0.1, 0.3, 1.0, 3.0 and 10.0 mg/kg) or placebo on study day 0 and were followed up for 24 weeks. The main outcome was the safety profile, and secondary objectives were pharmacokinetics and clinical activity (reduction in DAS28 score and reduction of C-reactive protein [CRP] and erythrocyte sedimentation rate [ESR] levels). DAS28 score at week 4 was significantly reduced in patients receiving mavrilimumab with moderate disease activity (baseline DAS28 > 3.2) at baseline, compared with controls. A post hoc analysis conducted n mavrilimumab subjects with elevated CRP (>5 mg/l) at baseline showed that mean CRP levels were significantly reduced for 4 weeks when compared with baseline.