Changes In C-reactive Protein Research Articles

The Clinical Impact of Splanchnic Ischemia on Patients Affected by Thoracoabdominal Aortic Aneurysms Treated with Fenestrated and Branched Endografts

Fenestrated/branched endografts for aortic repair (FB-EVAR) are valid options to treat thoracoabdominal aortic aneurysms (TAAAs). Successful repair requires manipulation of target visceral vessels (TVVs) with possible splanchnic ischemia. The aim of the study was to evaluate the clinical impact of splanchnic ischemia occurring in FB-EVAR for TAAA. Between 2010 and 2015, patients with TAAAs undergoing FB-EVAR were prospectively enrolled. Clinical, morphological, procedural, and 30-day data were evaluated. Splanchnic ischemia was defined as the presence of splanchnic ischemic lesions (SILs) visible at perioperative computed tomography angiography. Preoperative, postoperative, and 30-day hepatic/pancreatic/renal laboratory functions were analyzed. End points were incidence of SILs, laboratory splanchnic functions worsening (≥25% of baseline), and presence of related clinical/morphological and procedural risk factors. Thirty-six patients (male: 78%; age: 73 ± 7years) with 27 (75%) type I-III and 9 (25%) type IV TAAA who underwent FB-EVAR for a total of 127 TVV (branches: 47-60%; fenestrations: 53-67%). Fourteen SILs occurred in 12 (33%) patients: 4 (29%) in pancreas, 3 (21%) in spleen, 2 (14%) in bowel, 5 (36%) in kidney. The cause was embolic in 79% and thrombotic in 21%. No preoperative clinical/morphological data or procedural data were correlated with SIL. Pancreatic, hepatic, or renal function worsening occurred at 24 hr in 16 (44%), 16 (44%), and 9 (25%) cases, respectively. Overall, SILs were associated with increased values of C-reactive protein (CRP) (17.9±0.4 vs. 9.9±9.0mg/dL; P = 0.03) and bilirubin (1.2±2.3 vs. 1.0±0.5mg/dL; P = 0.02) at 24 hr. Specifically, SIL of the celiac trunk and superior mesenteric and renal arteries' parenchyma were associated with the significant laboratory function changes 24 hr. SIL of the superior mesenteric artery was associated with increased 30-day mortality (50% vs. 7 %; P=0.002). Pancreatic, hepatic, or renal function worsening occurred at 30 days in 2 (6%), 0 (0%), and 4 (12%) cases, with similar laboratory tests in patients with and without SIL. SIL can be frequently detected after FB-EVAR for TAAA and appears mainly of embolic origin. No clinical, morphological, or procedural predictors could be identified in our series. Postoperative laboratory changes of CRP, bilirubin, activated partial thromboplastin time, and amylases are associated with SIL but disappear without clinical consequences within 30 days. However, SIL occurring in the superior mesenteric artery are associated with an increased 30-day mortality.

Lung injury prediction scores: Clinical validation and C-reactive protein involvement in high risk patients.

A study was made to validate two previously derived lung injury prediction scores (LIPS) for the prediction of acute respiratory distress syndrome (ARDS) in high risk intensive care patients, with the incorporation of C-reactive protein (CRP) for improving score accuracy. A prospective, observational cohort study was carried out. A total of 200 patients with APACHE II score ≥15 and at least one ARDS risk factor upon ICU admission were included. Calculation of LIPS using formulas developed by Cartin-Ceba et al. (2009) and Trillo-Alvarez et al. (2011) (LIPS-2009 and LIPS-2011). C-reactive protein was measured upon admission (CRP-0) and after 48h (CRP-48). Independent variables: LIPS-2009, LIPS-2011 and CRP values. Dependent variable: development of ARDS. Eighty-eight patients (44%) developed ARDS after a median (Q1-Q3) of 2.5 (1.3-6.8) days. The LIPS-2009 and LIPS-2011 scores were 4 (3-6) and 5 (3.6-6.5) in ARDS patients compared to 2 (1-4) and 3.5 (1.5-4.5) in non-ARDS patients (p<0.001). CRP-48 was 96 (67.5-150.3)mg/L and 48 (24-96)mg/L in the two groups, respectively (p<0.001). ΔCRP (i.e., CRP-48 minus CRP-0) was significantly higher in the ARDS patients (p<0.001). The AUC was 0.740 and 0.738 for LIPS-2011 and LIPS-2009, respectively - the difference being nonsignificant (p=0.9, 0.9 and 0.8 for pairwise comparison of the different ROC curves). Integrating ΔCRP with LIPS-2011 using binary logistic regression analysis identified a new score (LIPS-N) with AUC 0.803, which was significantly higher than the AUC of LIPS-2011 (p=0.01). Both LIPS scores are equally effective in predicting ARDS in high risk ICU patients. Integrating the change in CRP within the score might improve its accuracy.

EFFECTIVENESS OF ACETYLSALICYLIC ACID IN CORRECTION OF POST-STROKE FATIGUE DURING ACUTE CEREBROVASCULAR EVENTS

Post-stroke fatigue (PSF) is a common and often debilitating sequela of strokes that affects more than one third of stroke patients. Recent investigations revealed etiologic and pathogenetic heterogeneity of PSF depending on the time after acute cerebrovascular event (ACE). PSF that occur during acute stroke is associated predominantly with biological factors, including stroke-inducing immune and inflammatory reactions. In particular, we found significant associations between clinical features of PSF and certain regularities of C-reactive protein (CRP) and interleukin (IL)-1β levels in blood serum during the first 3 months after ACE occurrence. Given that there is not a clearly defined etiology for PSF, there are no rationally informed interventions. Іf dysregulation of the immune response isan important contributing factor to PSF, interventions that lessen inflammation would be appropriate treatment strategies. Іt would be reasonable to consider ASA, albeit at a higher dose than is normally used for secondary stroke prevention, as a treatment for PSF. Thus, it is advisable to study effects of ASA at the anti-inflammatory dose (300 mg a day) on markers of system inflammation an don PSF clinical course during the first 3 months after ACE occurrence. Objective: to study effectiveness of ASA at the anti-inflammatory dose (300 mg a day) on PSF clinical course and ASA effects on markers of system inflammation during the first 3 months after acute cerebrovascular event (ACE) occurrence. We recruited in the study 39 in hospital patients with ischemic strokes and transient ischemic attacks (TIA) who needed to take acetylsalicylic acid (ASA). All patients had been diagnosed with PSF within the first 3 days after ACE onset. PSF was diagnosed by use of questionnaire – Fatigue Assessment Scale (FAS). We formed two groups of patients. The first group (control PSF group) consisted of 24 patients who used ASA according to «Unified clinical protocol for medical care. Ischemic stroke (emergency, primary, secondary (specialized) medical aid, medical rehabilitation)» - after excluding hemorrhagic stroke by neuroimaging it was started ASA intake in the doses of 150-300 mg a day enterally during hospital stay with subsequent intake of 75-150 mg a day (prophylactic dose) continuously after hospital discharge. The second group (ASA PSF group) had 15 patients who started to use ASA just after excluding hemorrhagic stroke in the dosage of 300 mg a day for 3 months with subsequent dose reduction to 75-150 mg a day (prophylactic dosage) continuously. Diagnosis of PSF presence/absence, measurement of PSF severity and simultaneous measurement of systemic inflammatory markers in blood serum were carried out at the certain time points after ACE onset: at the first 3 days, at 1 month and at 3 months. Concentrations of СRP, IL-1β andIL-6 in blood serum were measured by enzyme-linked immunosorbent assay. The use of ASA in the dose of 300 mg a day during 3 months in patients who had been diagnosed with PSF within the first days after ACE occurrence is associated with significant decreasing of PSF intensity due to FAS in comparison with using of preventive ASA doses. The use of ASA in the dose of 300 mg a day during 3 months after ACE occurrence is associated with significant modification of post-stroke inflammatory response in form of CRP and IL-1β blood level changes.

Effect of a Probiotic and a Specifically Immunized Egg Powder on Blood C‐Reactive Protein in a Subclinical Population

The purpose of this study was to examine the effects of a specifically immunized egg powder taken with a probiotic on blood C‐Reactive Protein (an inflammatory marker) in healthy subjects with subclinical GI complaints. In a randomized, double‐blind placebo‐controlled study, sixteen subjects were divided into two groups. One group received a probiotic plus 2 grams of a specifically immunized egg powder (treatment group) while the other group received a placebo. Blood C‐Reactive Protein (CRP) was measured prior to supplementation and immediately after a 4‐week supplementation phase. There was no change in the blood CRP for the placebo group. Blood CRP for the treatment group was reduced and approached significance (p=.07). The treatment group had a greater percent change in blood CRP compared to the placebo group (p &lt; 0.05). Preliminary analysis suggests that a combination of a probiotic and a specifically immunized egg powder may contribute to lower blood CRP levels in healthy subjects with subclinical GI complaints.Support or Funding InformationIgY NutritionThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Longitudinal effects of race, ethnicity, and psychosocial disadvantage on systemic inflammation

ObjectivePsychosocial factors likely contribute to racial and ethnic inequalities in cardiovascular diseases (CVDs). However, precise social, psychological, and physiological pathways linking race and ethnicity to the development of CVDs are not well understood. Systemic inflammation, commonly indexed by C-reactive protein (CRP), is a biomarker for CVD risk and progression. The objective of this study was to identify mediating pathways from race and ethnicity to CRP through social, psychological, and behavioral variables. MethodsUsing data from 12,382 participants aged 51 and older in the Health and Retirement Study, structural equation models tested for direct and indirect effects of race and ethnicity on CRP measured over four years through educational disadvantage, everyday discrimination, depressive symptoms, external locus of control, and smoking. ResultsEducational disadvantage mediated Black-White and Hispanic-White disparities in baseline CRP directly, as well as indirectly through elevated depressive symptoms, higher external locus of control, and smoking. Educational disadvantage also mediated Black-White and Hispanic-White disparities in CRP change directly, as well as indirectly through higher external locus of control and smoking. Independent of education, discrimination mediated Black-White differences in baseline CRP via elevated depressive symptoms, higher external locus of control, and smoking. Discrimination also mediated Black-White disparities in CRP change via external locus of control. ConclusionsResults from this population-based, longitudinal study support the view that racially patterned social disadvantage is prospectively associated with longitudinal inflammatory processes, and some of these effects are independently mediated by psychological and behavioral factors. Biopsychosocial pathways to health disparities also differ between minority groups.

Determinants of change in resting energy expenditure in patients with stage III/IV colorectal cancer

Resting energy expenditure (REE) is variable in cancer and might be influenced by changes in tumor burden, systemic inflammation, and body composition. The objective of this study was to assess REE change and the predictors of such in patients with stage III or IV colorectal cancer. REE was measured via indirect calorimetry and fat mass and fat-free mass (FFM) were assessed using dual X-ray absorptiometry as part of a unique analysis of two studies. C-reactive protein (CRP) was measured as an inflammatory marker. Linear regression was used to assess the determinants of REE at baseline and REE change, with days between baseline and follow-up measures included as a covariate. One-hundred and nine patients were included at baseline (59.6% male; 67±12 years; body mass index 24.1±4.3kg/m2); 49 had follow-up data (61.2% male; 65±12 years; body mass index 25.4±4.3kg/m2), with median follow-up of 119 days (interquartile range: 113-127 days). At baseline, age, FFM, and CRP explained 68.9% of the variability in REE. A wide variability in REE change over time was observed, ranging from-156 to 370kcal/day, or-13.0 to 15.7%/100 days. CRP change (1.7±0.4mg/L, p<0.001) and stage (81.3±38.7, p=0.042) predicted REE change in multivariate analysis, controlling for age, FFM change, and days between visits (R2: 0.417±88.2, p<0.001). Age, FFM, and CRP predicted REE at a single time point. REE change was highly variable and explained by inflammation and stage. Future research should investigate the validity and feasibility of incorporating these measures into energy needs recommendations.

Sex differences in the association of baseline c-reactive protein (CRP) and acute-phase treatment outcomes in major depressive disorder: Findings from the EMBARC study

Peripheral inflammation is associated with poor response to antidepressant treatments. However, whether sex differentially affects this association remains unknown. Participants of Establishing Moderators and Biosignatures of Antidepressant Response for Clinical Care (EMBARC) with baseline plasma samples were included in this study (n = 220; male n = 75, female n = 145). Depression severity [Hamilton Rating Scale for Depression 17-item (HAMD-17)] was measured at baseline and weeks- 1, 2, 3, 4, 6, and 8. Plasma c-reactive protein (CRP) was measured with commercially-available ELISA kits at baseline, week-1, and week-8. Sex difference in prediction of baseline-to-week-8 HAMD-17 change by baseline CRP was tested with sex-by-baseline-CRP-by-time interaction in mixed model analysis. Additionally, changes in CRP from baseline-to-week-8 CRP and its association with HAMD-17 changes over that period were also evaluated. Covariates included body mass index, site, smoking status, and age. There was a significant sex difference in association of baseline-to-week-8 HAMD-17 reduction with baseline CRP (p = 0.033). Higher baseline CRP was associated with lower baseline-to-week-8 HAMD-17 reduction in females (p < 0.0001) but not in males (p = 0.632). Additionally, CRP was significantly reduced (p = 0.041, effect size = 0.254) from baseline-to-week-8, but there were no sex differences in this reduction (p = 0.249). Baseline-to-week-8 changes in HAMD-17 and CRP were not significantly associated either overall (p = 0.348) or based on sex (p = 0.370). In a large study of depressed outpatients, we replicated previous findings that elevated baseline CRP levels are associated with worse antidepressant treatment outcomes. However, this effect was limited only to females. These findings emphasize the importance of studying sex differences in biological mechanisms linking inflammation and depression.

Effects of Xingnaojing injection on PCT, CRP and WBC in elderly patients with severe pneumonia

Objective To investigate the effect of Xingnaojing injection combined with ambroxol hydrochloride on precalcitonin (PCT), C-reactive protein (CRP) and white blood cell count (WBC) in the elderly patients with severe pneumonia, and to observe the clinical effect. Methods From December 2013 to March 2015, 94 cases of severe pneumonia in Zhejiang Quhua Hospital were selected and divided into treatment group and control group according to the random digital table method, with 47 cases in each group.The control group was treated with ambroxol hydrochloride, while the treatment group was treated with Xingnaojing injection on the basis of the control group.The main symptom scores, blood gas analysis indicators, PCT, CRP and WBC changes and therapeutic effects were compared between the two groups before and after treatment. Results After treatment, the fever score and cough score in the treatment group [(1.03±0.25)points, (1.12±0.29)points] were significanly lower than those in the control group [(2.17±0.42)points, (2.34±0.71)points] (t=15.989, 10.905, all P<0.05). After treatment, the PaO2 of the treatment group [(89.47±8.41)mmHg] was higher than that of the control group [(76.39±5.63)mmHg], while PaCO2 [(48.37±7.19)mmHg] was lower than that in the control group [(63.27±3.48)mmHg], the differences were statistically significant (t=8.860, 12.780, all P<0.05). After treatment, the serum levels of PCT, CRP and WBC in the treatment group were (5.41±0.97)ng/L, (48.98±8.97)mg/L, (7.82±1.23)×109/L, respectively, which were significanly lower than those in the control group [(7.98±1.47)ng/L, (76.45±12.54)mg/L and (12.56±1.89)×109/L] (t=10.004, 12.214, 14.410, all P<0.05). The total effective rate in the treatment group(91.49%) was higher than that in the control group (72.34%), and there was statistically significant difference (χ2=5.817, P<0.05). Conclusion Xingnaojing injection combined with ambroxol can reduce the changes of serum PCT, CRP and WBC in the elderly patients with severe pneumonia, and the curative effect is significant.It is worthy of clinical study. Key words: Pneumonia; Calcitonin; C-reactive protein; Leukocyte count; Xingnaojing injection; Ambroxol hydrochloride; Aged

C-reactive protein velocity and the risk of acute kidney injury among ST elevation myocardial infarction patients undergoing primary percutaneous intervention.

Elevated C-reactive protein (CRP) was shown to be associated with an increased risk for acute kidney injury (AKI) in ST elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI), however, the optimal time frame to measure CRP for risk stratification is not known. We evaluated the relation between the change in CRP over time (CRP velocity-CRPv) and AKI among STEMI patients treated with primary PCI. We included 801 STEMI who presented between 2007 and 2017 and had their CRP measured with a wide range assay (wr-CRP) at least twice during the 24h after admission. CRPv was defined as the change in wr-CRP concentration (mg/l) divided by the change in time (in h) between the two measurements. Patient's medical records were reviewed for occurrence of AKI. Mean age was 62 ± 16 and 80% were males. Patients with AKI had significantly higher CRPv (1.47 versus 0.4mg/l/h, p < 0.001). In a multivariate regression model CRPv was independently associated with AKI (OR 1.03, 95% CI 1.01-1.0 5, p = 0.001). On receiver operating characteristic (ROC) curve the optimal cutoff value of CRPv to predict AKI was measured as more than 0.8mg/l/h, with 70% sensitivity and 65% specificity (AUC 0.712, 95% CI 0.64-0.78, p < 0.001). CRPv might be an independent and rapidly measurable biomarker for AKI following primary PCI in STEMI patients.

Effect of sitagliptin and glimepiride on C-reactive protein (CRP) in overweight Type-2 diabetic patients.

Objectives:To compare the anti-inflammatory effect of sitagliptin and glimepiride by measuring CRP in overweight Type-2 diabetic patients.Methods:This clinical trial was conducted at diabetic clinic of Islam Central Hospital, Sialkot over a period of six months from June to November 2017. A total of 110 overweight Type-2 diabetic patients were divided in to two groups. Group-A was given tablet sitagliptin 50mg while Group-B was given tablet glimepiride 2mg for a period of 12 weeks. The dose was titrated according to blood sugar level. The primary outcome was measuring changes in CRP while secondary outcomes was changes in BMI, blood sugar, HbA1C, lipid profile and CRP from baseline in both study group using SPSS 16.Results:After 12 weeks treatment, body weight increased in glimepiride but slightly reduced in sitagliptin, however comparison between them was non significant (p=0.07). Although both groups reduced blood sugar and HbA1c but comparison between them was non significant (p=0.59 and p=0.17 respectively) value. However lipid profile improved significantly in sitagliptin vs. glimepiride group i.e total cholesterol (-25±32.5 vs +1.5±45.4 P=0.02) triglycerides (-19±44.6 vs-1.8±48.7 P=0.001) LDL- cholesterol (-10±22.4 vs-0.8±18.7 P=0.001) HDL-cholesterol (-2.6±6.2 vs 1.2±5.2 P=0.03).Sitagliptin significantly reduced CRP in comparison to glimepiride (-2.3±1.8 vs0.8±1.5 P=0.001).Conclusion:Sitagliptin has strong anti inflammatory effect marked by reduction in CRP level in comparison to glimepiride in overweight type-2 diabetic patients. It also exerted beneficial effect on glycemic and lipid profiles.

12-year follow-up study of the c-reactive protein in Iranian middle-aged women: Isfahan cohort study

Background: As an important inflammatory marker, study of C-reactive protein (CRP) changes over time may lead to better identification of risk factors of cardiovascular disease. We evaluated the relationship between CRP changes and lifestyle, metabolic syndrome (MS) and body mass index (BMI) in middle-aged women and explored potential bias from attrition. Materials and Methods: We studied 1234 participants in the Isfahan cohort study – a longitudinal population-based study of adults older than 35 years living in urban and rural areas of three counties in central Iran. Data were collected every 6 years since 2001 (3 points). Random effects model was used to evaluate the effects of behavioural risk factors and MS on CRP, with pattern mixture model to account for cohort attrition. Results: Mean CRP levels decreased over time (Est = −0.066, P

Prognostic significance of the dynamic changes of systemic inflammatory response in metastatic renal cell carcinoma.

ABSTRACTPurpose:To elucidate the prognostic value of systemic inflammatory response in patients with metastatic renal cell carcinoma (mRCC) who are treated with sunitinib, we evaluated the prognostic role of C-reactive protein (CRP) kinetics. This study also compared prognostic models containing CRP kinetics and neutrophil-to-lymphocyte ratio (NLR) kinetics.Materials and Methods:A consecutive cohort of 94 patients with mRCC who were treated with sunitinib was retrospectively included from Fudan University Shanghai Cancer Center. According to dynamic changes in CRP and the NLR, patients were divided into three groups for analysis of CRP and NLR kinetics. The associations between survival and potential prognostic factors were assessed. The incremental value of prognostication was evaluated.Results:A significant difference (P<0.001) in overall survival (OS) was observed among the three groups of CRP kinetics. The median OS of the non-elevated group was nearly 1.3-fold longer than that of the normalized group (33.0 vs. 26.3 months), and two times longer than that of the non-normalized group (33.0 vs. 14.0 months). Multivariate analysis showed that CRP and NLR kinetics were independent prognostic indicators. The model containing CRP kinetics had a better predictive accuracy than that with NLR kinetics, which was supported by the C-index (0.731 vs. 0.684) and the likelihood ratio χ2 test (79.9% vs. 44.9%).Conclusion:Our study suggests that dynamic changes in CRP can better predict survival in patients with mRCC who are treated with sunitinib. Routine assessment of CRP before and after targeted therapy would help identify patients at risk of a poor outcome.

The Effects of Menopausal Hormone Therapy on Serum Level of C-reactive Protein in Postmenopausal Korean Women.

ObjectivesInflammation is a major mechanism underlying coronary heart disease (CHD) and C-reactive protein (CRP) is a marker of inflammation. When administered soon after menopause, menopausal hormone therapy (MHT) prevents CHD. This study was conducted to examine the impact of estrogen by administration route on CRP in postmenopausal Korean women using micronized progesterone (MP4) for endometrial protection.MethodsThis retrospective cohort study included 129 healthy women without CHD risk factors. Eighty-nine women took oral estrogen (conjugated equine estrogen, 0.625 mg/day or equivalent), and 40 women applied a 1.5-mg/day 0.1% percutaneous estradiol gel. MP4 was added in 82 women with an intact uterus. The CRP level was measured at baseline and three and six months after initiation of MHT.ResultsThe baseline characteristics were comparable between the MHT groups except current age and age at menopause. After controlling for age, menopausal age, body mass index, and basal CRP, no significant change in CRP was observed in the oral estrogen group (n = 29). Follow-up CRP levels were also similar to the baseline in the percutaneous estrogen group (n = 18). However, three-month CRP was significantly lower than six-month CRP, and there was a significant time trend within the percutaneous estrogen group. However, the group difference did not reach statistical significance. CRP also did not differ by addition of MP4 in either group.ConclusionsIn postmenopausal Korean women, no change in CRP was observed with oral estrogen, while percutaneous estrogen might decrease CRP. The estrogenic impacts were not influenced by adding MP4.

The Relationship between Histological Chorioamnionitis and Bronchopulmonary Dysplasia in Low-Birth Weight Infants: Changes of C-Reactive Protein in Bronchopulmonary Dysplasia

Objective: Intrauterine inflammation caused by chorioamnionitis has been related with various perinatal morbidities which increase the risk of bronchopulmonary dysplasia (BPD). C-reactive protein (CRP) is a well known biomarker of inflammation. We aimed to investigate the relationship between histological chorioamnionitis (HCA) and BPD, and also to observe the changes of CRP in BPD. Methods: Low-birth-weight infants (LBWIs) admitted to the neonatal intensive care unit between January 2011 and October 2017 were reviewed. Perinatal morbidities associated with BPD including maternal HCA were observed. Also, changes of CRP were analyzed. Results: A total of 584 LBWIs were analyzed and 168 (28.8%) had HCA and 46 (7.9%) had BPD. The development of BPD was associated with gestational age, birth weight, 1 and 5 minutes Apgar scores, the presence of preterm premature rupture of membrane, prenatal antibiotics, respiratory distress syndrome (RDS), ventilator application, early onset sepsis, necrotizing enterocolitis, intraventricular hemorrhage, retinopathy of prematurity, patent ductus arteriosus and HCA. The multiple logistic regression model for BPD showed that the risk factors of BPD were lower gestational age, lower birth weight, patent ductus arteriosus (PDA). Chorioamnionitis was not a significant risk factor for BPD (aOR, 1.477; 95% CI, 0.376-5.806). Infants with BPD were likely to have higher CRP on day 0 and day 7. Conclusion: Our study suggests that the primary risk factors of BPD in LBWIs are lower gestational age, lower birth weight, RDS, ventilator application and PDA rather than HCA. In infants with BPD, CRP was significantly higher on day 0 and day 7.

The effect of inspiratory muscle training on the quality of life, immune response, inspiratory and lower limb muscle strength of older adults: a randomized controlled trial

Abstract Objective: To evaluate the impact of inspiratory muscle training (IMT) on the quality of life, immune response, inspiratory and lower limb muscle strength of older adults. Method: A randomized clinical trial was conducted with 30 institutionalized older adults. They were allocated into two groups: the IMT group (n=15), which underwent IMT with PowerBreathe Classic, using a load of 60% of maximal inspiratory pressure (MIP). This was performed using a 30 repetition protocol, three times a week, for six weeks. The second group was the control group (n=15) which did not perform any type of therapeutic intervention. In both groups, MIP, lower limb strength by sit-up test, quality of life by the SF-36 questionnaire and C-reactive protein (CRP) were evaluated. Results: The results demonstrated the homogeneity between the groups regarding the demographic and clinical variables. The IMT group showed an increase in the variation of MIP (9.20±7.36 cmH2O) compared to the control (0.93±8.79 cmH2O). Improvement was also observed in the sitting and standing test (p&lt;0.05) (Tukey Test) in the difference between the values before and after the IMT. In terms of quality of life, two of the eight SF-36 domains were influenced by the IMT, namely: functional capacity and limitations due to physical factors. There were no changes in CRP in either group. Conclusion: IMT improved the inspiratory muscle strength, lower limb strength and quality of life of institutionalized older adults. These findings reinforce the contribution of this therapy to reducing the deleterious effects of aging.

Increased interleukin-6 and C-reactive protein levels after instrumented lumbar spine fusion in older patients.

Interleukin 6 (IL-6) and the acute phase C-reactive protein (CRP) blood concentrations after lumbar spine fusion may be affected by age. The purpose of this prospective observational study was to assess postoperative serum levels of pro-inflammatory IL-6 and CRP after instrumented lumbar spine fusion surgery. We hypothesized that older patients would have increased levels of IL-6 and CRP after surgery. IL-6 and high-sensitive CRP biochemical marker levels were measured before instrumented spinal fusion, and postoperatively at 1 and 3 days, 6 weeks, and 3 months. The 49 patients in this sample were divided into two groups: age ≤ 60 years ( n = 23) and age > 60 years ( n = 26). Acute changes in IL-6 high-sensitivity and CRP from preoperative levels to postoperative day (POD) 1 increased with age. Mean (95% CI) difference between the age-groups in changes of IL-6 at PODs 1 and 3 was 45 pg/ml (10-83, p = 0.014) and 20 pg/ml (5-36, p = 0.021), respectively. Mean (95% CI) difference between groups in changes of CRP at PODs 1 and 3 was 9.6 mg/l (-3.5 to 22.7, p = 0.47) and 24.8 mg/l (-17 to 67, p = 0.33), respectively. Both groups had decreased IL-6 and CRP levels at 6 weeks after surgery compared to the preoperative level. Elevation of IL-6 and CRP is stronger in patients over 60 years old after instrumented lumbar spinal fusion. The CRP and IL-6 are sensitive markers for acute postoperative inflammation. Even high acute CRP values do not necessarily indicate postoperative infection.

Serum amyloid A protein in the course of infectious mononucleosis.

Background:Serum amyloid A (SAA) protein is a major acute phase protein. Increased concentrations have been reported in many inflammatory diseases. In bacterial infections, high levels correlate with those of C-reactive protein (CRP). In viral infections, where CRP changes are weaker, SAA is of value for establishing early diagnosis, monitoring the severity, and the evolution of the disease.Objective:Evaluation of SAA as a marker for diagnosis of infectious mononucleosis, including severe forms.Material and methods:A total of 31 patients with non-complicated and severe, complicated infectious mononucleosis were examined. SAA and CRP were measured by immuniturbidimetric assays at the day of admission and 4.97 ± 1.35 days later.Results:SAA increases significantly than those in a control group, without correlation with the etiologic agent. It decreases when full recovery appears. In the subgroup of subjects with complications, we observed significant increased SAA when Epstein-Barr virus /EBV/ was the etiologic agent, in the course of bacterial and viral secondary infection. SAA is higher than CRP in non-complicated group. In cases of bacterial superinfections, both increase simultaneously and treatment have to be adapted. Second, serum sample for CRP is normal in patients without full recovery where SAA stay increased.Conclusion:In viral infections, high SAA concentrations are indicative for early diagnosis, severe course of the diseases, effect of the treatment, early recovery, and disease outcome. When SAA and CRP increase simultaneously, bacterial co-infection is suspected, and relevant antibiotic treatments have to be initiated.

Sanhuang Xiexin decoction promotes good functional outcome in acute ischemic stroke.

ObjectivesTo explore the efficiency and safety of Sanhuang Xiexin decoction in the treatment of acute ischemic stroke (AIS) patients after endovascular intervention examination.MethodsIn this prospective observational study, 121 AIS patients admitted in our hospital were enrolled from January 2012 to December 2015. They were randomly divided into two groups, 61 patients received Sanhuang Xiexin decoction + basic treatment (SX group) and 60 patients received basic treatment (control group). The prescription of Sanhuang Xiexin decoction was taken in the SX group, with one dose (100 ml), twice a day for 7 days orally. For all patients, blood samples were drawn on the first morning and sixth morning after endovascular intervention examination under fasting state for Fib (fibrinogen), PAgT (platelet aggregation test), CRP (C‐reactive protein), and TMAO (trimethylamine oxide) tested. Estimate the changes in plasma Fib, PAgT, CRP, and TMAO levels and the syndrome of fire‐heat scores.ResultsThe plasma Fib, PAgT, CRP, and TMAO levels in the SX group were significantly lower than those in the control group (PFib < 0.01, PPAgT < 0.01, PCRP = 0.02, PTMAO < 0.01). The syndrome of fire‐heat scores in the SX group was significantly lower than that in the control group (p < 0.01). The incidences of ischemic cerebrovascular events within 3 and 6 months after endovascular intervention treatment in the SX group were lower than those in the control group (P3 month = 0.04, P6month = 0.03).ConclusionsThe prescription of Sanhuang Xiexin is efficient and safe in the treatment of AIS patients after endovascular intervention examination through reducing the inflammatory factors.

A Meta-analysis of Randomized Control Trials: The Impact of Vitamin C Supplementation on Serum CRP and Serum hs-CRP Concentrations.

The present meta-analysis was designed to assess the effects of vitamin C supplementation on serum C-reactive Protein (CRP) levels. We conducted a comprehensive systematic search of the literature in Scopus, PubMed and Google Scholar until May 2018. The pooled Weighted Mean Difference (WMD) and its 95% Confidence Interval (CI) in baseline and at the end of the trial were calculated to assess the net change in serum CRP by using random-effects model. The heterogeneity was assessed by I2 test. Combined and stratified analyses were used in the metaanalysis. From 306 articles found and screened in our initial search, 12 studies were included with 446 participants in supplementation groups and 447 in control groups. The pooled effect size analysis showed a significant reducing effect of vitamin C supplementation on circulating CRP level (-0.23 mg/L, 95% CI, -0.44, -0.03, p=0.02), with a significant heterogeneity effect across the studies involved. Subgroup analyses showed that vitamin C supplementation significantly lowered CRP among trials. The most significant effect was found 1) on hs- CRP as the representative inflammatory marker (-0.43 mg/L, 95% CI -0.76, -0.1) 2) in subjects with a baseline CRP≥3 (-1.48 mg/L, 95% CI -2.84, -0.11) 3) in subjects under <60 years old of age (-0.23 mg/L, 95% CI -0.44,- 0.01) 4) or using intravenous administration of vitamin C (-0.89 mg/L, 95% CI -1.49,-0.3). The present meta-analysis shows that vitamin C supplementation reduces serum CRP level, particularly in younger subjects, with higher CRP baseline level, at a lower dosage and intravenous administration.

Self-reported Instances of Major Discrimination, Race/Ethnicity, and Inflammation Among Older Adults: Evidence From the Health and Retirement Study.

This study examines the relationship between self-reported instances of major discrimination and inflammation among older adults, and explores whether this relationship varies in accordance with race/ethnicity. We hypothesized that self-reported instances of major discrimination would be associated with higher levels of high-risk inflammation and that this relationship would be stronger for racial/ethnic minorities than whites. Data from the 2006/2008 Health and Retirement Study, an ongoing biennial nationally representative sample of older adults in the United States, were used to collect measures of self-reported instances of major discrimination and high-risk C-reactive protein (CRP), which was assayed from blood samples. Modified Poisson regression with robust standard errors was applied to estimate the prevalence ratios of self-reported instances of major discrimination, as it relates to high-risk CRP (CRP ≥ 22 kg/m2), and test whether this relationship varies by race/ethnicity. Respondents who experienced any instances of major discrimination had a higher likelihood of high-risk CRP (prevalence ratio [PR]: 1.14, 95% confidence interval [CI] = 1.07-1.22) than those who did not report experiencing any instances of major discrimination. This association was independent of differences in newly diagnosed health conditions and socioeconomic status. The relationship between any self-reported instance of major discrimination and high-risk CRP was weaker for blacks than whites (PR: 0.81, 95% CI = 0.69-0.95). Our study confirms that self-reported instances of major lifetime discrimination is a psychosocial factor that is adversely associated with high-risk CRP among older adults; this association is especially pronounced among older whites. Future studies among this population are required to examine whether the relationship between self-reported instances of major discrimination and high-risk CRP changes over time.