Alterations In C-reactive Protein Research Articles

Metabolic Syndrome and Sleep Apnea: The Impact of Lifestyle Interventions

Abstract Contemporary healthcare focuses on assessing the efficacy of dietary and exercise interventions in mitigating metabolic syndrome and its association with sleep apnea. Results demonstrate notable reductions in the HOMA Index and triglyceride levels among treated cohorts, indicating improved glycemic control and lipid profile. Additionally, intervention groups exhibit significant decreases in cholesterol levels, indicative of enhanced lipid profile. Marginal alterations in C-Reactive Protein imply limited impact on systemic inflammation, while consistent uric acid levels suggest potential autonomy from the interventions. Remarkable correlations between clinical parameters and sleep apnea risk underscore the pivotal role of lifestyle modifications in metabolic syndrome management, offering insights into underlying mechanisms. The aim of this study is to further investigate the underlying mechanisms behind the observed improvements in metabolic parameters following dietary and exercise interventions, with a specific focus on elucidating the relationship between these interventions and the risk of sleep apnea in individuals with metabolic syndrome. These findings elucidate the intricate interplay between metabolic risk factors and sleep apnea susceptibility, thereby informing therapeutic and preventive approaches for individuals with metabolic syndrome.

Association of mTOR Pathway and Conformational Alterations in C-Reactive Protein in Neurodegenerative Diseases and Infections.

Inflammatory biomarkers have been very useful in detecting and monitoring inflammatory processes along with providing helpful information to select appropriate therapeutic strategies. C-reactive protein (CRP) is a nonspecific, but quite useful medical acute inflammatory biomarker and is associated with persistent chronic inflammatory processes. Several studies suggest that different levels of CRP are correlated with neurological disorders such as Alzheimer's disease (AD). However, dynamics of CRP levels have also been observed in virus/bacterial-related infections leading to inflammatory responses and this triggers mTOR-mediated pathways for neurodegeneration diseases. The biophysical structural transition from CRP to monomeric CRP (mCRP) and the significance of the ratio of CRP levels on the onset of symptoms associated with inflammatory response have been discussed. In addition, mTOR inhibitors act as immunomodulators by downregulating the expression of viral infection and can be explored as a potential therapy for neurological diseases.

Exosomal MicroRNA-223, MicroRNA-146, and MicroRNA-21 Profiles and Biochemical Changes in Laryngeal Cancer.

Laryngeal squamous cell carcinoma (LSCC) is one of the most aggressive cancers, and its early diagnosis is urgent. Exosomes are believed to have diagnostic significance in cancer. However, the role of serum exosomal microRNAs, miR-223, miR-146, and miR-21, and phosphatase and tensin homologue (PTEN) and hemoglobin subunit delta (HBD) mRNAs in LSCC is unclear. Exosomes were isolated from the blood serum of 10 LSCC patients and 10 healthy controls to perform scanning electron microscopy and liquid chromatography quadrupole time-of-flight mass spectrometry analyses to characterize them and to undergo reverse transcription polymerase chain reaction to identify miR-223, miR-146, miR-21, and PTEN and HBD mRNA expression phenotypes. Biochemical parameters, including serum C-reactive protein (CRP) and vitamin B12, were also obtained. Serum exosomes of 10-140 nm were isolated from LSCC and controls. Serum exosomal miR-223, miR-146, and PTEN were found to be significantly decreased (p < 0.05), in contrast to serum exosomal miRNA-21 (p < 0.01), and serum vitamin B12 and CRP (p < 0.05) were found to be significantly increased, in LSCC vs controls. Our novel data show that the combination of reduced serum exosomal miR-223, miR-146, and miR-21 profiles and biochemical alterations in CRP and vitamin B12 levels may be useful indicators of LSCC that could be validated by large studies. Our findings also suggest a possible negative regulatory effect of miR-21 on PTEN in LSCC, encouraging a more extensive investigation of its role.

Alterations in the Expression of IFN Lambda, IFN Gamma and Toll-like Receptors in Severe COVID-19 Patients.

Contradictory results have been reported regarding interferon (IFN) lambda (λ1-3) and IFN gamma (γ) production in COVID-19 patients. To gain insight into the roles played by these IFNs in SARS-CoV-2 infection, IFNλ1-3 and IFNγ mRNA expression was evaluated in peripheral blood mononuclear cells (PBMCs) (n = 32) and in cells of paired bronchoalveolar lavages (BALs) (n = 12). Lower IFNλ1-3 values (p < 0.001 for IFNλ1 and 3 and p = 0.013 for IFNλ2) in the PBMCs of severely ill patients were found compared to healthy donors (n = 15). Reduced levels of IFNγ were also detected in patients' PBMCs (p < 0.01) and BALs (p = 0.041) compared to healthy donors. The presence of secondary bacterial infections was associated with decreased IFNλ amounts in PBMCs (p = 0.001, p = 0.015 and p = 0.003, respectively) but increased concentrations of IFNλ3 (p = 0.022) in BALs. Patients with alterations in C-reactive protein, lactate dehydrogenase and D-dimer levels had decreased IFNλ1 and 3 (p = 0.003 and p < 0.001) and increased IFNγ (p = 0.08) in PBMCs. Analyzing Toll-like receptors (TLRs) involved in IFN production, we found that TLR3 was highly expressed (p = 0.033) in patients with bacterial superinfections, while TLR7 and 8 (p = 0.029 and p = 0.049) were reduced in BALs of deceased patients. Overall, severe COVID-19 might be characterized by dysregulation in IFNγ, IFNλ and TLR3, 7 and 8 production.

Covid-19 orthopedic trauma patients characteristics and management during the first pandemic period: report from a single institution in Italy.

PurposeCOVID-19 disease is a declared pandemic, affecting all aspects of healthcare, including orthopedics. The aim of this study is to describe the COVID-19 orthopedic trauma patients characteristics and management in a dedicated Orthopedic and Traumatology Hospital in Italy during the first pandemic period.Material and methodsA cohort of 25 consecutive patients with suspected or confirmed COVID-19 infection were retrospectively analyzed. Health system rearrangement, patients’ clinical presentation, diagnostic tools role, laboratory finding, treatment and outcomes were evaluated.ResultsHealth system rearrangement was fast. There was no clear prevalence of comorbidity or surgery type between confirmed and suspected COVID-19 cases. Nine positive swabs tests and 14 cases with only suspected CT scan findings were recorded. Several laboratory changes have been reported since the onset of symptoms: anemia, leukocytosis, lymphopenia, coagulation abnormalities, alkaline phosphatase, liver enzymes and C-reactive protein alterations. Nineteen patients were treated by oxygen supplement, three patients were administered antivirals, eight antibiotic therapy, and nine hydroxychloroquine. The number of discharges reported in this study was greater than 52% and the number of deaths reached 20%.ConclusionTo our experience, the development of patient management algorithms allows the differentiation of the clinical pathways of negative and suspected/positive patients, reducing exposure, and virus spreading. The execution of swabs on all patients allows an early diagnosis and a more adequate management. Considering the different therapy patterns used, there were no significant differences, but anti-thromboembolic prophylaxis administered to all the orthopedic patients may have contributed to complications and mortality rates reduction.

Correlation of Low Levels of α-1 Antitrypsin and Elevation of Neutrophil to Lymphocyte Ratio with Higher Mortality in Severe COVID-19 Patients.

Background Variations in COVID-19 prevalence, severity, and mortality rate remain ambiguous. Genetic or individual differences in immune response may be an explanation. Moreover, hyperinflammation and dysregulated immune response are involved in the etiology of severe forms of COVID-19. Therefore, the aim of the present study was to analyze serum alpha-1 antitrypsin (AAT) levels, as an acute-phase plasma protein with immunomodulatory effect and neutrophil to lymphocyte ratio (NLR) as a marker of inflammation response in severe COVID-19 illness. Methods In this retrospective observational cohort study, 64 polymerase chain reaction (PCR) positive COVID-19 hospitalized patients were studied for AAT, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), troponin, complete blood count (CBC), random blood sugar, serum glutamate oxaloacetate transaminase (SGOT), serum glutamate pyruvate transaminase (SGPT), and arterial oxygen saturation (O2sat) at admission and during hospitalization. Results The results showed that hospitalized patients with COVID-19 had low serum levels of AAT and high CRP levels at the first days of hospitalization. In particular, the percentages of individuals with low, normal, and high AAT levels were 7.80%, 82.80%, and 9.40%, respectively, while high and low values of CRP accounted for 86.70% and 13.30% of patients. Most of the patients had an upward neutrophil to lymphocyte ratio (NLR) trend, with a higher mortality rate (p < 0.05) and troponin levels (p < 0.05). However, comorbidities, CRP alterations, ESR alterations, nonfasting blood sugar, SGOT, SGPT, O2sat, RBC, and PLT values were not significantly different between the NLR downward and upward trend groups. Conclusions The current study revealed that severe COVID-19 patients had low serum AAT levels related to CRP values. Therefore, AAT response may be considered as a new mechanism by which some COVID-19 patients show immune dysregulation and more severe symptoms.

Proteomic alterations in the plasma of Beagle dogs induced by Toxocara canis infection

Toxocara canis causes ocular larva migrans and visceral larva migrans in humans. Knowledge about the molecular mechanism of T. canis-hosts interaction is limited. The proteomic alterations in the plasma of Beagle dogs induced by T. canis infection were studied by the quantitative mass spectrometry-based data-independent acquisition (DIA). 418, 414 and 411 plasma proteins were identified at 24 h post-infection (hpi), 96 hpi and 36 days post-infection (dpi), including 6, 5 and 23 proteins with differential abundance, respectively. At 24 hpi, the altered proteins, retinoic acid receptor responder protein 2 (RARRES2), WD repeat-containing protein 1 (WDR1), moesin and filamin-A, may participate in pro-inflammatory reaction or promote larvae migration. At 96 hpi, the altered protein C and fibroleukin may maintain the stability of the coagulation system to protect the lung. At 36 dpi, the alterations of C-reactive protein (CRP), ficolin (FCN), complement factor H-related protein 5 (CFHR5) and other complements can affect the three traditional complement system, including the classic pathway, lectin pathway and alternative pathway. These proteins may play important roles in the interaction between T. canis and its definitive hosts. Further study on these altered proteins triggered by T. canis infection may discovery novel therapeutic or diagnostic targets for toxocariasis. Significance of the studyToxocara canis is one of the globally distributed soil-transmitted helminths, which causes ocular larva migrans and visceral larva migrans in humans and a wide range of warm-blooded animals. T. canis adapts to different microenvironments by resisting and adjusting various biological processes of the hosts. Knowledge about the molecular mechanism of T. canis-hosts interaction is limited. Plasma proteins are good marker for monitoring the occurrence and development of diseases. The proteomic alterations in the plasma of Beagle dogs induced by T. canis infection were studied by the quantitative mass spectrometry-based data-independent acquisition (DIA) in this study. A total of 418, 414 and 411 plasma proteins were identified at 24 h post-infection (hpi), 96 hpi and 36 days post-infection, respectively. Ten protein with differential abundances were validated by using parallel reaction monitoring (PRM). Collectively, our deep proteomic analysis of plasma revealed that proteins alterations were affected by disease development, and proteomic analysis is an ideal method for quantifying changes in circulating factors on a global scale in response to pathophysiological perturbations such as T. canis infection.

Meta-analysis of cytokine and C-reactive protein levels in high-risk psychosis

ObjectiveSchizophrenia is associated with aberrant blood cytokine and C-reactive protein (CRP) levels. However, less is known about alterations in these markers prior to the onset of psychosis. We performed a meta-analysis of blood cytokines and CRP in subjects at high-risk for psychosis. MethodWe identified articles by systematic searches of PubMed, PsycINFO, and Web of Science databases, and the reference lists of identified studies. Eight studies met the inclusion criteria, including seven studies of high-risk psychosis versus controls, and four studies of high-risk subjects who converted to a psychotic disorder versus non-converters. ResultsBlood IL-6 levels were significantly higher (SMD = 0.31, 95% CI 0.02–0.59, p = 0.04) and blood IL-1β levels were significantly lower (SMD = −0.66, 95% CI −1.27 to −0.05, p = 0.05) in subjects at high-risk for psychosis versus controls. Between-study heterogeneity was not significant for either IL-1β or IL-6, and there was no evidence of publication bias. There was a non-significant trend for higher blood IL-12 levels in converters versus non-converters (SMD = 0.86, 95% CI −0.06–1.79, p = 0.07). ConclusionWe found limited evidence for blood cytokine and CRP alterations in subjects at high-risk for psychosis. Our findings should be interpreted with caution in light of a small number of studies, cumulative sample size, and heterogeneity of high-risk criteria, but warrant investigation in larger samples. This includes studies of subjects at high-risk of developing psychosis and controls, as well as the potential of inflammation as a predictor of conversion to psychosis. These findings have important potential implications for our understanding of the pathophysiology of schizophrenia.

Platelet Counts and Liver Enzymes After Gastric Bypass Surgery

BackgroundObesity is associated with chronic inflammation, liver steatosis and increased liver enzymes such as gamma-glutamyltransferase (GGT) and alanine aminotransferase (ALT), markers for non-alcoholic fatty liver disease (NAFLD) and liver fat content. Increased platelet counts (PCs) are a biomarker reflecting inflammation and the degree of fibrosis in NAFLD. We investigated alterations in PCs, GGT, ALT, C-reactive protein (CRP) and ferritin after Roux-en-Y gastric bypass (RYGBP).MethodsOne hundred twenty-four morbidly obese non-diabetic patients were evaluated before (baseline) and 12 months after (follow-up) RYGBP.ResultsBody mass index (BMI) was reduced from 43.5 kg/m2 (baseline) to 31.1 kg/m2 (follow-up), and p < 0.001 and weight declined from 126.2 to 89.0 kg. PCs decreased from 303 × 109 to 260 × 109/l, p < 0.001. GGT was reduced from 0.63 to 0.38 μkat/l, p < 0.001. ALT decreased from 0.69 to 0.59 μkat/l, p = 0.006. CRP was lowered from 7.3 to 5.4 mg/l p < 0.001 and ferritin from 106 to 84 μg/l p < 0.001. The alterations in PCs correlated with the changes in CRP (r = 0.38, p = 0.001), BMI (r = 0.25, p = 0.012), weight (r = 0.24, p = 0.015) and inversely correlated with ferritin (r = 21, p = 0.036).ConclusionsPCs, GGT and ALT (markers for NAFLD), and CRP and ferritin (markers for inflammation) decreased in morbidly obese after RYGBP. The decrease in PCs correlated with alterations in CRP, BMI, weight and ferritin. The lowering of liver enzymes may reflect a lowered liver fat content and decreased general inflammation.

Emotional reactivity, functioning, and C-reactive protein alterations in remitted bipolar patients: Clinical relevance of a dimensional approach.

Inter-episode mood instability has increasingly been considered in bipolar disorder. This study aimed to investigate emotional reactivity as a major dimension for better characterizing remitted bipolar patients with subthreshold mood symptoms and functional status. This study also aimed to investigate whether high-sensitivity C-reactive protein, a marker of low-grade inflammation, could be a biological marker of emotional dysregulation in bipolar disorder (BD). Cross-sectional study of 613 subjects who met Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition criteria for BD recruited from the FondaMental Advanced Centers of Expertise in Bipolar Disorders cohort from 2009 to 2014. All patients had been in remission for at least 3 months before assessment. Patients were classified into three groups according to levels of emotional reactivity. Emotional reactivity was assessed by using the Multidimensional Assessment of Thymic States, and functional status was assessed by the Functioning Assessment Short Test. Clinical characteristics and blood sample were collected from all patients. In total, 415 (68%) patients had abnormal emotional reactivity. Independent of potential confounders, including age, gender and subthreshold mood symptoms, serum levels of high-sensitivity C-reactive protein were significantly higher in patients with emotional hyper-reactivity (median = 4.0 mg/L, interquartile range = 2.7-5.6), and with emotional hypo-reactivity (median = 3.0 mg/L, interquartile range = 1-4) compared with patients with normal emotional reactivity (median = 0.95 mg/L, interquartile range = 0.4-1.9, p < 0.001). Patients with emotional hyper-reactivity showed significant cognitive functioning impairment ( p < 0.001). Emotional reactivity appears to be a relevant dimension for better characterizing remitted bipolar patients with subthreshold mood symptoms. Levels of high-sensitivity C-reactive protein may be an objective marker of emotional dysregulation in BD. Further studies are needed to confirm our findings.

C-reactive protein alterations in bipolar disorder: a meta-analysis.

There is growing evidence that bipolar disorder (BD) is associated with inflammation, including abnormal levels of acute-phase C-reactive protein (CRP). Our meta-analysis was conducted to estimate the size of the association between CRP levels and BD, accounting also for subgroup differences (mood phases and treatment). MEDLINE, EMBASE, PsycINFO, and ISI Web of Science and references of identified articles were searched up to June 2013 using the keywords (bipolar disorder) AND (C-reactive protein OR CRP). English language studies measuring blood levels of CRP in patients with BD and control subjects were selected, 136 abstracts were reviewed, 20 articles retrieved, and 11 studies included. Two independent reviewers extracted data. All studies were included in the primary analyses, and between-group differences for subanalyses were also reported. This meta-analysis was performed using random-effects models. Eleven studies comprising 1,618 subjects were eligible for inclusion. Overall, CRP levels were significantly elevated in patients with BD versus controls (standardized mean difference [SMD] = 0.39; 95% CI, 0.24 to 0.55; P < .0001). CRP levels were significantly higher in manic (SMD = 0.73; 95% CI, 0.44 to 1.02; P < .001) and euthymic (SMD = 0.26; 95% CI, 0.01 to 0.51; P = .04), but not in depressed (SMD = 0.28; 95% CI, -0.17 to 0.73; P = .22) patients with BD compared to controls. CRP levels were unrelated to use of lithium or antipsychotic medication. This meta-analysis supports an association between increased CRP levels and BD. Given that an elevated level of CRP is a marker of low-grade inflammation and a risk factor for cardiovascular and malignant diseases, measurement of CRP level might be relevant to the clinical care of bipolar patients.

Su1664 Predictors of Recurrence and Post Recurrence Survival in Patients With Resected Ampullary Adenocarcinoma

BACKGROUND Previous studies have evaluated the ability of biological markers to detect disease relapse in Crohn's disease (CD). Yet no studies have targeted a method to anticipate recurrence after surgical resection. C-Reactive Protein (CRP) is a valuable marker for predicting the outcome of several diseases including CD. The exact role of CRP as a prognostic factor for future recurrence in CD is not yet determined. Moreover no data are available investigating specific CRP modifications in these patients following surgery. Objective of present study was to determine the perioperative behaviour of the CRP in CD patients undergoing elective ileo-cecal resection. Our hypothesis is that perioperative CRP changes are disease-specific and therefore could detect subset of patient with more aggressive disease. Secondary objective was to investigate the role of CRP as a potential early prognostic marker for future recurrence. METHODS 52 patients undergoing IC resection for CD were prospectively enrolled. Serial CRP levels were assessed perioperatively: time 0, postoperative day (POD) 1 and POD 6. CD patients' perioperative CRP findings were compared against same interval assessments of two control groups undergoing right colectomy and appendicectomy. Crohn's Disease Activity Index (CDAI) and Rutgeerts' score (RS) were evaluated for recurrence during 3 year follow-up protocol. RESULTS As expected, in all 3 groups CRP significantly increased 24 hours after surgery vs baseline but the increase was significantly higher in CD patients than in controls (p, 0.001). Comparing to control groups CRP remained remarkably high in CD (mean 32.2mg/L) at POD 6. Difference between groups was statistical significant (p 0.03). All CD patients evaluated at 3 year follow up were in clinical remission. Endoscopic recurrence (RS .2) was found in 51% at 1 year and in 42% at 3 years. Possible relation between endoscopic recurrence rate or severity and perioperative CRP levels was investigated: multivariate ordinal regression showed that postoperative increment of CRP is a prognostic factor of recurrence at 3 years. CONCLUSION Present preliminary data show disease-specific perioperative CRP levels for CD patients that reflect immunomodulation impairment involved in disease etiology. The degree of such immunitary change and consequent severity of disease might be explored early after surgery by determining CRP alterations. Data from larger series can confirm that perioperative CRP levels might be considered a novel prognostic factors of surgical recurrence.

Variations in population-based levels of C-reactive protein, cardiovascular morbidity and all-cause mortality: An analysis of the relationship between C-reactive protein, Troponin-T, cardiovascular morbidity and death rates in an unselected population in Southwest Norway

Background Large population-based studies link inflammation to the prospective development of cardiovascular events. We investigated the time-dependent associations between variations in infectious disease as reflected by alterations of C-reactive protein (CRP)-levels in the general population and the number of cardiovascular events and death rates. Methods Retrospectively, we studied CRP- and Troponin T (TNT) values drawn for any clinical reason, the number of cardiovascular events and the death rates in the population of Southern Rogaland, Norway over a 2 year period. Results The mean and the sum of CRP values per week were significantly correlated with the number of patients with a TNT ≥ 0.03 µg/l in the same week ( R = 0.42, R = 0.43, respectively, p < 0.001 for both analysis). Further, we found a significant correlation between the mean and the sum of CRP values per week and the number of patients admitted with a cardiovascular event 2 weeks later ( R = 0.20, R = 0.26; p = 0.047, p = 0.009, respectively). The sum of CRP values per week was significantly correlated to the death rates in the following week ( R = 0.30, p = 0.002). Conclusions These findings further support the hypothesis that inflammation assessed by CRP levels is linked to the prospective development of cardiovascular events and all cause mortality.

Homocysteine and Nitric Oxide Are Related to Blood Pressure and Vascular Function in Small-for-Gestational-Age Children

Leptin, homocysteine (Hcy), and C-reactive protein are risk factors potentially useful in predicting future cardiac events. These plasma biomarkers may participate in the regulation of cardiovascular function through an NO-dependent mechanism. Our purpose was to investigate whether alterations in C-reactive protein, Hcy, leptin, and NO are present in small-for-gestational-age children and to determine whether the levels of these plasma biomarkers are associated with birth weight, vascular function, and blood pressure. Concentrations of leptin, Hcy, C-reactive protein, and NO were measured in 69 children (36 boys and 33 girls; ages 8 to 13 years). Leptin (means difference: 1.4 ng/mL; 95% CI: 0.4 to 2.4) and Hcy (means difference: 0.9 micromol/L; 95% CI: 0.3 to 1.5) levels were significantly elevated in children born small for gestational age compared with those with appropriate birth weight. Nevertheless, NO (means difference: 342.9 micromol; 95% CI: 124.2 to 561.6) concentration was significantly reduced in small birth weight children, and the levels of C-reactive protein remained unchanged. There was a significant association between the circulating levels of both NO and Hcy with vascular function, as well as with blood pressure levels, in our population. Because both Hcy and NO are associated with a risk of cardiovascular disease, it is possible that part of the association of low birth weight with elevated risk for vascular and metabolic disease in later life is mediated by perturbation in pathways for these biomarkers.

C-Reactive Protein in Lone Atrial Fibrillation

An inflammatory cause of atrial fibrillation (AF) has been proposed on the basis of the presence of lymphocytic infiltrates in the biopsy results of patients with lone AF, alterations of C-reactive protein (CRP) and interleukin-6 levels in subjects with AF, and the time course of postoperative AF. Many previous studies exploring inflammatory factors in AF have been confounded by concomitant medical illnesses. Subjects with lone AF provide a unique opportunity to eliminate the effects of associated conditions. We therefore sought to determine CRP levels in homogenous cohorts of patients with lone AF or AF and hypertension. One hundred twenty-one subjects with lone AF, 52 subjects with AF and hypertension, and 75 control subjects were enrolled and studied. Plasma CRP levels were determined using a commercially available immunoassay. There was no significant difference in CRP levels between subjects with lone AF and controls (1.34 vs 1.21 mg/L, p = 0.18). CRP levels in subjects with AF and hypertension were elevated compared with those of controls and those of subjects with lone AF, although this difference was attributable to increased body mass indexes. CRP levels were not elevated in subjects with lone AF compared with controls. In conclusion, these findings clarify previous observations of elevations in CRP levels in subjects with AF and suggest that this marker of systemic inflammation is associated not with the arrhythmia per se, but rather with underlying cardiovascular disease.

Alterations in acute-phase reactants (CRP, rheumatoid factor, complement, Factor B, and immune complexes) following an ultramarathon

Objectives. The human body initiates an acute phase response (APR) in response to a wide range of homeostatic disturbances. This complex series of reactions serves to activate repair processes and prevent ongoing tissue damage. An important aspect of the APR is the de novo synthesis of acute phase proteins (APP), many of which have not been thoroughly investigated. Main outcome measures. Alterations in CRP (C-reactive protein), C1est, C3, C4, C6, rheumatoid factor (RF) and Factor B were determined before and after an ultramarathon. Data were analysed using a one-way analysis of variance comparing values to pre-exercise levels. Significance was set at p &lt; 0.05. Design. Venepunctures were performed on athletes participating in an ultramarathon (90 km) 24 hours before, immediately post-exercise (IPE), and 3h, 24h and 72h after the race. Serum was stored at –80°C until analysed. CRP levels in serum were assessed using the N Latex CRP kit. The levels of circulating immune complexes (CIC) were determined using particle-enhanced nephelometry. Complement proteins C1est, C3, C4 and RF were measured using laser nephelometry. C6 and Factor B were determined by radial immunodiffusion. Results. CRP was significantly elevated IPE (58%), 3h post (77%), 24h post (87%) and 72h post (69%). Pre-race CRP levels were above the normative range (5.10 ± 3.08 mg/l), C6 was significantly elevated (p &lt; 0.05) at 24h post (7.8%) and 72h post (8.8%) exercise. Factor B was significantly elevated (p &lt; 0.05) at 72h post exercise (12.8%). RF was significantly elevated at 72h post exercise (6.7%). Conclusion. Significant increases in selected acutephase reactants occur several days after the exercise event. In addition, as indicated by elevated resting levels of CRP, the athletes began the race with some degree of inflammation, presumably as a result of the cumulative training and racing mileage in preparation for the ultramarathon. SA Sports Medicine Vol.16(2) 2004: 17-21

Alterations in acute-phase reactants (CRP, rheumatoid factor, complement, Factor B, and immune complexes) following an ultramarathon

Objectives. The human body initiates an acute phase response (APR) in response to a wide range of homeostatic disturbances. This complex series of reactions serves to activate repair processes and prevent ongoing tissue damage. An important aspect of the APR is the de novo synthesis of acute phase proteins (APP), many of which have not been thoroughly investigated. Main outcome measures. Alterations in CRP (C-reactive protein), C1est, C3, C4, C6, rheumatoid factor (RF) and Factor B were determined before and after an ultramarathon. Data were analysed using a one-way analysis of variance comparing values to pre-exercise levels. Significance was set at p &lt; 0.05. Design. Venepunctures were performed on athletes participating in an ultramarathon (90 km) 24 hours before, immediately post-exercise (IPE), and 3h, 24h and 72h after the race. Serum was stored at –80°C until analysed. CRP levels in serum were assessed using the N Latex CRP kit. The levels of circulating immune complexes (CIC) were determined using particle-enhanced nephelometry. Complement proteins C1est, C3, C4 and RF were measured using laser nephelometry. C6 and Factor B were determined by radial immunodiffusion. Results. CRP was significantly elevated IPE (58%), 3h post (77%), 24h post (87%) and 72h post (69%). Pre-race CRP levels were above the normative range (5.10 ± 3.08 mg/l), C6 was significantly elevated (p &lt; 0.05) at 24h post (7.8%) and 72h post (8.8%) exercise. Factor B was significantly elevated (p &lt; 0.05) at 72h post exercise (12.8%). RF was significantly elevated at 72h post exercise (6.7%). Conclusion. Significant increases in selected acutephase reactants occur several days after the exercise event. In addition, as indicated by elevated resting levels of CRP, the athletes began the race with some degree of inflammation, presumably as a result of the cumulative training and racing mileage in preparation for the ultramarathon. SA Sports Medicine Vol.16(2) 2004: 17-21

Minimal access surgery for cholelithiasis induces an attenuated acute phase response

Background: Some benefits of laparoscopic (LC) and minilaparotomy (MC) cholecystectomy may reflect attenuation of the acute phase response. The authors examined components of this response. Methods: Patients were randomized to LC (n = 11) or MC (n = 11). C-reactive protein (CRP), α-1-antitrypsin (AAT), retinol-binding protein (RBP), transferrin, and albumin were measured preoperatively and on postoperative days 1, 2, 4, and 7. Interleukin-1 receptor antagonist (IL-1ra), IL-6, and tumor necrosis factor (TNF-α) were measured more frequently perioperatively. Peak expiratory flow rate, forced expiratory volume in 1 second, and forced vital capacity were measured daily. Results: The IL-6 increase was more persistent and marked in the MC patients from hour 8 to day 7 postoperatively ( P <0.05). Alterations in CRP, AAT, and albumin were similar. Postoperative deficits of respiratory function correlated with the magnitude of acute phase protein alteration. Conclusions: Minimal access surgery induces an acute phase response that is less prominent after a laparoscopic technique.