The Importance of Eosinopenia for Predicting Treatment Response in Patients with Cholangitis

Abstract

Objective: To compare recovery of eosinopenia, C-reactive protein (CRP) and procalcitonin levels in predicting the response to treatment in patients with cholangitis. Study Design: Descriptive, analytical study. Place and Duration of Study: Department of Gastroenterology, Sakarya Training and Research Hospital, Turkey between September 2018 and February 2019. Methodology: Patients with cholangitis, who underwent endoscopic retrograde cholangiopancreatography (ERCP), were inducted. Those with choledocholic thiasis alone were considered controls. Eosinophil count above 100.5 cells/mu L was the limit value accepted as improvement. ERCP repeat was decided according to eosinophil count below 100.5 and not clinically improving. Relationship between inflammatory markers such as CRP, procalcitonin and eosinopenia values in patients with stone-associated cholangitis was investigated. Results: The cholangitis group was comprised of 62 patients [mean age 67 +/- 14.57 years; 26 (41.9%) female], while control group was comprised of 57 patients [mean age 57.4 +/- 18.10 years; 39 (68.4%) females, p=0.004]. At time of admission, median eosinophils was significantly lower in cholangitis group at 17.50 [9.82-84] x10(3)/mu L compared to control group at 168 [100.11-270] x10(3)/mu L (p=0.001). ERCP were repeated on two patients as their clinical conditions and unremitting eosinophil counts worsened. Eosinophil and CRP markers and clinical improvement were observed after second ERCP procedure. Conclusion: Eosinopenia may be used as inflammatory marker in evaluation of response to treatment and for predicting the need to repeat ERCP during clinical follow-up of patients who undergo cholangitis treatment. Gamma-rays and fast and thermal neutron attenuation features of (Bi2O3)(x)-(TeO2)((100-x)) (where x = 5, 8, 10, 12, and 15 mol%) and [(TeO2)(0.7)-(B2O3)(0.3)]((1-x))-(Bi2O3)(x) (where x = 0.05, 0.10, 0,15, 0.20, 0.25, and 0.3 mol%) glass systems have been explored and compared. For all samples, mass attenuation coefficients (mu/rho) are estimated within 0.015-15 MeV photon energy range by MCNP5 simulation code and correlated with WinXCom results, which showed a satisfactory agreement between computed mu/rho values by these both methods. Additionally, effective atomic number (Z(eff)), effective electron density (N-eff), half-value layer (HVL), tenth-value layer (TVL), mean free path (MFP), total atomic cross-section (sigma(a)), and total electronic cross-section (sigma(e)) are calculated by utilizing mu/rho values. The mu/rho, Z(eff), and N-eff are energy dependent and have higher values at the lowest energy and smaller values at higher energies. Moreover, using the G-P fitting method as a function of penetration depth (up to 40 mfp) and incident photon energy (0.015-15 MeV range), exposure buildup factors (EBFs) and energy absorption buildup factors (EABFs) are evaluated. Both 85TeO(2)-15Bi(2)O(3) (mol%) and 49TeO(2)-21B(2)O(3)-30Bi(2)O(3) (mol%) samples, by possessing higher values of Z(eff), exhibit minimum EBF and EABF values. Highest mu/rho, Z(eff) values and lowest HVL, TVL, MFP values of 49TeO(2)-21B(2)O(3)-30Bi(2)O(3) (mol%) sample indicated its better gamma-ray absorption capability among all selected glasses. Further, macroscopic effective removal cross-section for fast neutrons (sigma(R)), coherent scattering cross-section (sigma(cs)), incoherent scattering cross-section (sigma(ics)), absorption cross-section (sigma(A)), and total cross-section (sigma(T)) values for thermal neutron attenuation have been computed. Among all samples, 49TeO(2)-21B(2)O(3)-30Bi(2)O(3) (mol%) glass possesses a better sigma(R) value for fast neutron attenuation, while the largest 'sigma(T)' value of 66.5TeO(2)-28.5B(2)O(3)-5Bi(2)O(3) (mol%) sample suggests its good thermal neutron absorption efficiency. For five B2O3-Bi2O3 glasses, detailedly, gamma, neutron, & proton, alpha, and electron (charged particles) shielding efficacies were assessed in this work. The crucial photon attenuating (interaction probabilities) parameter i.e., mass attenuation coefficient (mu/rho) was calculated by Phy-X/PSD software and procured mu/rho results have been verified through MCNPX, Geant4, & FLUKA codes mu/rho findings from which a quality unanimity among them was noticed over an energy range of 15 KeV-15 MeV. Following mu/rho & linear attenuation coefficient (mu) outcomes, Z(eff), N-eff, HVL, TVL, and MFP have been reckoned and found that all mu/rho, Zeff, Neff, HVL, TVL, & MFP highly rest on glass chemical contents & photon energy. Z(eq) and by applying geometric progression (G-P) fitting parameters (a, b, c, d, & X-k coefficients) EBFs & EABFs were appraised at ten specific penetration depths up to 40 mfp, at energy range of 0.015-15 MeV. The inferred RPE quantities confirmed all chosen glasses quintessential absorption competence for lower energy gamma-rays. Utilizing SRIM code the mass stopping powers (MSPs) & projected ranges (PRs) for protons ((Psi(P))&(Phi(P))) and alpha particles (Psi(A))&(Psi(A)), and with the help of ESTAR database, electron MSP (Psi(E)) & continuous slowing down approximation (CSDA) ranges for electrons have been approximated at 0.015 -15 MeV KE. The fast neutron removal cross-sections (Sigma(R)) were estimated and obtained Sigma(R) was diversified at 0.10978-0.12144 cm(-1) range relying on Bi2O3 inclusion in glasses. Based on all acquired outputs, 57.5B(2)O(3)-42.5Bi(2)O(3) (mol%) glass possesses superior attenuation capacity for gamma-rays and fast neutrons as well as charged particles. (C) 2020 The Author(s). Published by Elsevier B.V. The pulse plasma process is a kind of surface modification technique. In this study, the microstructure and mechanical properties of pulse plasma -treated AISI 4140 steel were studied. Four different sample -plasma gun nozzle distances and three different pulses were chosen for the surface modification at a constant battery capacity of 800 mf. The samples were subjected to optical microscope, SEM and EDS analyses, microhardness testing and X-ray diffraction (XRD) analysis. The columnar and fine grained structures were formed in modified layer. New and hard phases were formed on the modified layer. Hence, the hardness increased five times after pulse plasma treatment. The amount of wear for all specimens was evaluated by using the reciprocating wear (linear wear test machine) test with a 0.15 m/s constant sliding speed under 5, 7, and 9 N loads along a 200 m sliding distance. A WC ball (with 6 mm diameter) was used in this test. The friction coefficient and wear rate were changed in accordance with the applied load. The friction coefficient values decreased and the wear resistance increased in the surface -modified specimens compared to the non-modified ones. The wear rate and the friction coefficient were changed with the wear debris and load. The debris was increased by the resistance to wear of surface. The worn surfaces of the specimens were studied by using atomic force microscopy (AFM), scanning electron microscopy (SEM) and electron dispersive spectroscopy (EDS). The abrasive wear was shown on worn surface. (C) 2019 The Author. Published by Elsevier B.V.