Decrease In C-reactive Protein Levels Research Articles

Ácidos graxos ômega‐3, estado inflamatório e marcadores bioquímicos de pacientes com lúpus eritematoso sistêmico: estudo piloto

BackgroundStudies have shown that omega‐3 fatty acids reduce the concentrations of eicosanoids, cytokines, chemokines, C‐reactive protein (CRP) and other inflammatory mediators. ObjectiveTo investigate the effects of omega‐3 fatty acids on circulating levels of inflammatory mediators and biochemical markers in women with systemic lupus erythematosus (SLE). MethodsExperimental clinical study (clinical trial: NCT02524795); 49 women with SLE (ACR1982/1997) were randomized: 22 to the omega‐3 group (daily intake of 1080mg EPA+200mg DHA, for 12 weeks) and 27 to the control group. The inflammatory mediators and biochemical markers at T0 and T1 in omega‐3 group were compared using Wilcoxon test. U‐Mann‐Whitney test was used to compare variations of measured variables [ΔV=pre‐treatment (T0) minus post‐treatment (T1) concentrations] between groups. p<0.05 was considered significant. ResultsThe median (interquartile range ‐ IQR) of age was 37 (29‐48) years old, of disease duration was 7 (4‐13) years, and of SLEDAI‐2K was 1 (0‐2). The median (IQR) of variation in CRP levels between the two groups showed a decrease in omega‐3 group while there was an increase in control group (p=0.008). The serum concentrations of IL‐6 and IL‐10, leptin and adiponectin did not change after a 12 week treatment. ConclusionsSupplementation with omega‐3 had no impact on serum concentrations of IL‐6, IL‐10, leptin and adiponectin in women with SLE and low disease activity. There was a significant decrease of CRP levels as well as evidence that omega‐3 may impact total and LDL‐cholesterol

Impact of sertraline on serum concentration of CRP in hemodialysis patients with depression.

Introduction: Depression is the most prevalent psychological problem among hemodialysis (HD) patients. Inflammatory factors have been reported to play an important role in the pathogenesis of depression. The association between depression and inflammatory factors was established in chronic kidney disease (CKD) patients. Sertraline, a selective serotonin reuptake inhibitor (SSRI) antidepressant, decreases serum levels of inflammatory factors in patients with depression. Objectives: This study was designed to assess the effect of sertraline on serum concentration of C-reactive protein (CRP), hemoglobin and albumin of depressed hemodialysis (HD) patients. Patients and Methods: During a clinical trail, 35 depressed HD patients, and CRP >5 were allocated to receive sertraline for 12 weeks. Patients’ depression was assessed using Beck depression inventory second edition (BDI-II) biochemical parameters (hemoglobin, serum albumin, etc) and CRP levels were measured at baseline and at weeks 4, 8 and 12 of the study. BDI-II score was evaluated before and after 12 weeks treatment with sertraline. Results: Sertraline significantly improved depression symptoms in HD patients. At the end of the study, BDI-II scores significantly changed from baseline (P=0.001) and serum levels of CRP significantly decreased at week 12 of initiation of the study (P=0.001). However, the concentration of hemoglobin and serum albumin concentration and weight was not changed significantly (P=0.995 and P=0.328, respectively). Conclusion: Sertraline significantly decreases CRP levels and can be a promising strategy to reduce the systemic inflammation and to treat depression in HD patients.

The association between vitamin D and C-reactive protein levels in patients with inflammatory and non-inflammatory diseases

ObjectiveA direct, inverse correlation between 25-hydroxy vitamin D (25(OH) vitamin D) levels and C-reactive protein (CRP), a sensitive biomarker for inflammation, was found in some, but not all, studies. These effects were seen in healthy subjects as well as in some inflammatory diseases. Design and methodsCRP and 25(OH) vitamin D data (2011–2013) from 923 in- and outpatients (males/females 340/583; median age: 76years (95% confidence interval (CI): 75–77) were analyzed. A standardized diagnosis according to the Dutch diagnosis coding standard for each patient was obtained. Each diagnosis was categorized as either inflammatory or non-inflammatory disease. Analysis of variance was performed with age, gender, inflammatory status (inflammatory disease/non-inflammatory disease), and season as corrective factors. ResultsThe correlation between (log) ln-25(OH) vitamin D and ln-CRP was highly significant (p<0.001) with a regression coefficient of −0.879. In the inflammatory disease group, the R2 value was 0.726 and in the non-inflammatory disease group it was 0.502. It was shown that increasing 25(OH) vitamin D levels are associated with decreasing CRP levels, with a stronger effect in the inflammatory disease group compared to the non-inflammatory disease group. ConclusionsOur study shows an inverse correlation between 25(OH) vitamin D and CRP in a large patient cohort but more importantly shows that this effect is more pronounced in patients with inflammatory diseases compared to patients with non-inflammatory diseases.

TIME COURSE OF CHANGES IN BLOOD LIPID PARAMETERS IN PATIENTS WITH EARLY RHEUMATOID ARTHRITIS DURING TREAT-TO-TARGET ANTIRHEUMATIC THERAPY: ACCORDING TO 18-MONTH FOLLOW-UP FINDINGS

The mechanisms for lowering a cardiovascular risk (CVR) in patients with early rheumatoid arthritis (RA) when implementing the treat-to-target strategy remain inadequately investigated. Objective: to estimate the time course of changes in blood lipid parameters in patients with early RA during Treat-totarget antirheumatic therapy at an 18-month follow-up. Subjects and methods. Seventy-four patients (73% women; median age, 56 years) with early RA meeting the respective 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria and moderate or high activity (median DAS28-ESR score of 5.4) were examined within the framework of the REMARCA trial. After 6-month treatment, RA activity significantly reduced (p < 0.05). At months 6 to 18, no significant change in RA activity was recorded. After 18 months, remission was observed in 31 (42%) patients: in 17 (55%) on methotrexate (MTX) monotherapy and in 14 (45%) on combined therapy with MTX and a biological agent. Blood lipid levels were determined at inclusion in the investigation, 6 and 18 months later. The values of lipid parameters were estimated in terms of the total CVR. 67.6% of the patients were classified as at very high CVR. At 18 months of treatment, 34 (46%) patients were treated with statins (median atorvastatin and rosuvastatin doses were 10 mg/day each). Results and discussion. Only 12% of the patients had optimal baseline values of just all lipid parameters. The concentration of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) correlated negatively with C-reactive protein (CRP) levels, DAS28-ESR, DAS28-CRP, and HAQ (p < 0.05). After 6-month treatment, there were increases in TC by 7%, LDL-C by 12.5%, and HDL-C by 19.7%, and a decrease in the atherogenic index by 16% (p < 0.05). ΔCRP negatively correlated with ΔTC, ΔLDL-C, and ΔHDL-C (r = -0.3; p < 0.05). A correlation of TC and LDL-C with inflammation markers broke off in the presence of lower RA activity; the investigators began recording a relationship of these lipid parameters to traditional CVR factors. Between 6th and 18th month of treatment, there was no significant change in lipid parameters. Statin therapy resulted in no considerable change in lipid concentrations. Conclusion. The level of lipids negatively correlates with disease activity in the patients with early RA. During antirheumatic treatment, the lipid concentrations are more elevated with a more intensive decrease in CRP levels. With lowered RA activity, the level of lipids correlates with traditional CVR factors more strongly than with inflammation markers.

C-reactive protein and glycemic control in adults with type 2 diabetes mellitus

Objective: To find a correlation between glycemic control and C-reactive protein (CRP) in patients with type 2 diabetes mellitus (T2DM) and to assess if good control of glycosylated hemoglobin (HbA1c) decreases the CRP values. Materials and Methods: The study included 50 patients with T2DM whose detailed clinical history and physical examination were done. Evaluation of parameters such as height, weight, waist–hip ratio, body mass index, Hb, total blood count, differential count, erythrocyte sedimentation rate, blood urea, and serum creatinine was done. Urine examination and blood samples were obtained for analysis of CRP, fasting blood sugar, postprandial blood sugar, HbA1c, serum total cholesterol, serum triglycerides, high-density lipoprotein, and low-density lipoprotein. CRP was correlated with HbA1 statistically. Result: The study reveals that levels of CRP and HbA1c were bi-directionally correlated with P < 0.05. Better glycemic control is leading to the reduction in HbA1c also resulted in a decrease in CRP levels (P = 0.000). Conclusion: There exists a strong correlation between HbA1c and CRP in T2DM. Hence, CRP is an additional marker of better glycemic control.

The Association of Peroxisome Proliferator-Activated Receptor δ and Additional Gene-Gene Interaction with C-Reactive Protein in Chinese Population.

Aims. To examine the association between 4 single nucleotide polymorphisms (SNPs) of peroxisome proliferator-activated receptors δ (PPARδ) polymorphisms and C-reactive protein (CRP) level and additional gene-gene interaction. Methods. Line regression analysis was performed to verify polymorphism association between SNP and CRP levels. Generalized multifactor dimensionality reduction (GMDR) was employed to analyze the interaction. Results. A total of 1028 subjects (538 men, 490 women) were selected. The carriers of the C allele (TC or CC) of rs2016520 were associated with a significant decreased level of CRP, regression coefficients was −0.338, and standard error was 0.104 (p = 0.001). The carriers of the G allele (CG or GG) of rs9794 were also significantly associated with decreased level of CRP, regression coefficients was −0.219, and standard error was 0.114 (p = 0.012). We also found a potential gene-gene interaction between rs2016520 and rs9794. Subjects with rs2016520-TC or CC, rs9794-CG or GG genotypes have lowest CRP level, difference (95% CI) = −0.50 (−0.69 to −0.21) (p < 0.001), compared to subjects with rs2016520-TT and rs9794-CC genotypes. Conclusions. rs2016520 and rs9794 minor allele of PPARδ and combined effect between the two SNP were associated with decreased CRP level.

Effects of coenzyme Q10 supplementation on C-reactive protein and homocysteine as the inflammatory markers in hemodialysis patients; a randomized clinical trial.

Background: The most leading cause of death in end-stage renal disease (ESRD) patients are cardiovascular disease and inflammatory markers are related to coronary events. CO-Q10 (coenzyme Q10) is a protective supplement from free radical oxidative damage. In addition, hyperhomocysteinemia is an independent coronary artery disease (CAD) risk factor. Objectives: Due to increasing oxidative stress in dialysis patients, and the effect of CO-Q10 in decrease oxidative stress, in this work, we assessed the effect of CO-Q10 on C-reactive protein (CRP) level as an inflammatory marker and homocysteine in dialysis patients. Patients and Methods: This was a single-blind, randomized cross over clinical trial. Patients with ESRD were randomly allotted to two groups. All patients received placebo and C0- Q10 100mg/d during the three months in each stage, with two week washout period. Plasma level of CRP and homocysteine from the start of the work and at the conclusion of each menses, are evaluated. Results: Thirty-four patients randomized, but 26 patients complete study protocol. The treatment effect of CO-Q10 on CRP level is significant (P < 0.001) (95% CI = -20.1 to -10.5) and it was also significant for the increasing albumin level. (P = 0.044) (95% CI = 0. 0-0.6), But there was not any substantial effect on serum homocysteine level (P = 0.630). Conclusions: CO-Q10 could significantly decrease CRP level as an inflammatory marker and can protect cardiovascular events.

Effect of Bosentan on Claudication Distance and Endothelium-Dependent Vasodilation in Hispanic Patients With Peripheral Arterial Disease

Endothelin (ET) is involved in the etiopathogenesis of peripheral arterial disease (PAD). We hypothesized that ET antagonism might improve the endothelial function, inflammatory status, and symptoms in PAD. This pilot randomized clinical trial was designed to determine the clinical efficacy, pleiotropic effects, and safety of dual ET-receptor antagonist bosentan in Hispanic patients with PAD presenting intermittent claudication. The Bosentan Population-Based Randomized Trial for Clinical and Endothelial Function Assessment on Endothelin Antagonism Therapy was a 12-month, randomized, controlled, parallel-group, double-blind, proof-of-concept pilot study evaluating the effect of bosentan on absolute claudication distance (primary efficacy end point), flow-mediated arterial dilation, and C-reactive protein levels (primary pleiotropic end points) in patients with PAD with Rutherford category 1 to 2 of recent diagnosis. Secondary end points included ankle-brachial index, subjective claudication distance, and safety. Of the 629 screened subjects, 56 patients were randomized 1:1 to receive bosentan for 12 weeks (n = 27) or placebo (n = 29). Six months after the initiation, a significant treatment effect in flow-mediated arterial dilation of 2.43 ± 0.3% (95% CI 1.75 to 3.12; p = 0.001), absolute claudication distance of 283 ± 23 m (95% CI 202 to 366; p = 0.01), ankle-brachial index of 0.16 ± 0.03 (95% CI 0.09 to 0.23; p = 0.001), and a decrease in C-reactive protein levels of -2.0 ± 0.5 mg/L (95% CI -2.8 to -1.1; p = 0.02) were observed in the bosentan-treated group compared to the control group. No severe adverse effects were found in the bosentan group. In conclusion, in Hispanic patients with intermittent claudication, bosentan was well tolerated and improved endothelial function and claudication distance as well as inflammatory and hemodynamic states.

Effect of azithromycin sequential therapy on inflammatory cytokines and humoral immune function in the treatment of children with mycoplasma pneumonia

Objective To explore the effect of azithromycin sequential therapy on inflammatory cytokines and humoral immune function in the treatment of children with mycoplasma pneumonia. Methods 342 children with mycoplasma pneumonia were divided into control group(168 cases) treated with erythromycin sequential therapy and observation group (174 cases) treated with azithromycin sequential therapy based on the random number table.The changes of inflammatory cytokines and humoral immune function were recorded and compared. Results The levels of interleukin 4(IL-4), interleukin 6(IL-6), C-reactive protein(CRP) and tumor necrosis factor-α(TNF-α) had no significant differences between the two groups before accepting different treatments (P>0.05). The decreased levels of IL-4, IL-6, CRP and TNF-α of the observation group after treatment were greater than the control group(t=10.913, 11.047, 9.919, 53.207, all P 0.05). After treatment, the decrease of IgM and IgG between the two groups had significant differences (t=3.178, 3.034, all P<0.01). Conclusion Azithromycin sequential therapy for the treatment of children with mycoplasma pneumonia has better clinical efficacy than erythromycin sequential therapy, which can improve inflammatory cytokines index and regulate humoral immune function.It has considerable value in the clinical application. Key words: Pneumonia, mycoplasma; Azithromycin; Inflammatory cytokines; Immunity, body fluid; Children; Administer drug

Dexamethasone Therapy for Septic Arthritis in Children.

Prospective studies of children with septic arthritis report that adding dexamethasone to antibiotic therapy contributes significantly to clinical and laboratory improvement. This study sought to evaluate the effect of this regimen outside of a randomized controlled trial. The sample consisted of children with septic arthritis hospitalized at a tertiary pediatric medical center in 2008 to 2013. Disease course and outcome were compared between children treated with antibiotics alone or with adjuvant dexamethasone, according to the admitting department policy. The cohort included 116 patients, 90 treated with antibiotics alone and 26 treated with antibiotics+dexamethasone. The groups were similar for age, symptom duration before hospitalization, body temperature, acute-phase reactant levels, and rate of positive fluid cultures (21.6% total). Compared with monotherapy, antibiotics+dexamethasone treatment was associated with a shorter duration of fever (mean 2.3 vs 3.9 days, P = .002), more rapid clinical improvement (mean 6.3 vs 10.0 days to no pain/limitation, P < .001), more rapid decrease in C-reactive protein level to <1 mg/dL (mean 5.3 vs 8.4 days, P = .002), shorter duration of parenteral antibiotic treatment (mean 7.1 vs 11.4 days, P < .001), and shorter hospital stay (mean 8.0 vs 10.7 days, P = .004). Recurrent symptoms of fever and joint pain occurred in 4 patients in the antibiotics+dexamethasone group after completion of the steroid course. Children with septic arthritis treated early with a short course of adjuvant dexamethasone show earlier improvement in clinical and laboratory parameters than children treated with antibiotics alone.

Comparison of anti-inflammatory effect of atorvastatin with rosuvastatin in patients of acute coronary syndrome.

Objectives:To compare anti-inflammatory effect of atorvastatin and rosuvastatin in patients of acute coronary syndrome.Materials and Methods:The study was a prospective, open-labeled, randomized and single-center study conducted on 100 patients of acute coronary syndrome. Patients were assigned to atorvastatin 40 mg daily or rosuvastatin 20 mg daily for 4 weeks. C-reactive protein (CRP) levels, lipid profiles, erythrocyte sedimentation rate (ESR) and adverse effects were measured at beginning and at the end of 4 weeks.Results:Baseline parameters and clinical profile did not differ between the two groups. CRP levels significantly decreased from beginning to the end of 4 weeks in both atorvastatin and rosuvastatin groups (from 35.48 to 23.07 mg/l and from 35.88 to 19.91 mg/l respectively, both P < 0.001). However, there was significant difference between the levels of CRP in patients of the rosuvastatin group as compared to the atorvastatin group (19.91 ± 6.32 vs 23.07 ± 7.47, P < 0.05). In addition, both the drugs were associated with a reduction in total cholesterol, LDL levels and ESR at the end of 4 weeks as compared to the beginning (P < 0.001 for all comparisons).Conclusion:Both atorvastatin (40 mg) and rosuvastatin (20 mg) are effective in decreasing CRP and LDL cholesterol levels even in a short duration of 4 weeks. Rosuvastatin was found to be more effective in decreasing CRP levels.

CRP, but not TNF-α or IL-6, decreases after weight loss in patients with morbid obesity exposed to intensive weight reduction and balneological treatment.

The aim of this study was to evaluate the concentrations of C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and the degree of homeostasis model assessment-insulin resistance (HOMA-IR) in patients with morbid obesity exposed to a three-week low-calorie diet and balneotherapy. The study included 33 patients (25 females and 8 males; mean age 46 years) with body mass index (BMI) values of >40 kg/m(2). Evaluations of CRP, IL-6, TNF-α, lipid profile, HOMA-IR, and fasting glucose were carried out before (baseline data) and three weeks after the treatment. The control group consisted of 20 healthy volunteers (15 females and 5 males) with a mean age of 39 years and BMI values of ≤24.9 kg/m(2). In the blood of patients with morbid obesity we found significantly elevated levels of CRP, TNF-α, triglycerides, HOMA-IR and fasting glucose, but a decreased level of high density lipoprotein (HDL)-cholesterol, compared with the healthy individuals. The treatment resulted in about a 9.4% reduction in body weight from 122.5 to 111.0 kg and a significant decrease in the concentration of CRP, but no change in TNF-α or IL-6. HOMA-IR was significantly reduced. The decrease in CRP level without changes in TNF-α or IL-6 concentrations after the low-calorie diet and balneological treatment, suggests that an essential amount of adipose tissue must be removed before proper adipocyte function is restored. The decrease in HOMA-IR indicates an improvement in insulin sensitivity, which is beneficial in obese patients.

C-reactive protein enhances IgG-mediated phagocyte responses and thrombocytopenia

AbstractImmune-mediated platelet destruction is most frequently caused by allo- or autoantibodies via Fcγ receptor-dependent phagocytosis. Disease severity can be predicted neither by antibody isotype nor by titer, indicating that other factors play a role. Here we show that the acute phase protein C-reactive protein (CRP), a ligand for Fc receptors on phagocytes, enhances antibody-mediated platelet destruction by human phagocytes in vitro and in vivo in mice. Without antiplatelet antibodies, CRP was found to be inert toward platelets, but it bound to phosphorylcholine exposed after oxidation triggered by antiplatelet antibodies, thereby enhancing platelet phagocytosis. CRP levels were significantly elevated in patients with allo- and autoantibody-mediated thrombocytopenias compared with healthy controls. Within a week, intravenous immunoglobulin treatment in children with newly diagnosed immune thrombocytopenia led to significant decrease of CRP levels, increased platelet numbers, and clinically decreased bleeding severity. Furthermore, the higher the level of CRP at diagnosis, the longer it took before stable platelet counts were reached. These data suggest that CRP amplifies antibody-mediated platelet destruction and may in part explain the aggravation of thrombocytopenia on infections. Hence, targeting CRP could offer new therapeutic opportunities for these patients.

Variation in C-reactive protein following weight loss in obese insulin resistant postmenopausal women: is there an independent contribution of lean body mass?

We showed that obese insulin resistant postmenopausal women are characterized by higher lean body mass and elevated C-reactive protein. Although counterintuitive, we hypothesized that losses in muscle mass following caloric restriction and increase in muscle quality will be associated with improvements in glucose homeostasis through decreases in C-reactive protein. To determine 1) if improvements in C-reactive protein concentrations occurs through losses in lean body mass; and 2) if decreases in C-reactive protein levels contribute to improvements in insulin sensitivity. 50 postmenopausal women (body mass index>26 kg/m(²)) with impaired glucose disposal (<7.5 mg/kg/min) completed a 6-month caloric restriction program. Outcome measures were: Glucose disposal rate: M value (by hyperinsulinemic-euglycemic clamp), body composition (total, trunk, and appendicluar). LBM and FM by DXA), LBM index (LBM (kg)/height (m(2)), body fat distribution (VAT and SAT by CT scan) and plasma high-sensitive C-reactive protein (hsCRP) and interleukin-6 (Il-6). Significant correlations were observed between Δ hsCRP levels with Δ Il-6 (r=0.33, p≤0.05), Δ total LBM index (r=0.44, p≤0.01), Δ trunk LBM (r=0.38, p≤0.01) Δ SAT (r=0.35, p≤0.05) and ∆ glucose disposal rate (r=- 0.44, p≤0.01). After including all the correlated variables in Stepwise linear regression model, Δ LBM index was the only independent predictor of the reduction in hsCRP levels (R(2)=0.20, p≤0.01). Losses in total lean body mass are independently associated with improvements in inflammatory state (CRP levels) in obese postmenopausal women with impaired glucose disposal.

Study of effects of metformin on C-reactive protein level in Type-2 diabetes mellitus

Background: Diabetes mellitus (DM) is extremely common; represent a significant global health problem. Type-2 DM is considered to be associated with a low grade inflammation, which may play a significant role in development of cardiovascular complications evidenced by C-reactive protein (CRP) is a an extremely sensitive marker of systemic inflammation. The study was undertaken to check the effect of metformin on CRP level in Type-2 DM. Methods: The study was prospective and non-randomized. Thirty newly diagnosed Type-2 DM selected for metformin therapy by medicine personnel were enrolled in the study based on inclusion and exclusion criteria. Patients were divided into pre-treatment (before starting metformin therapy) and post-treatment group. Fasting blood sugar (FBS), postprandial blood sugar (PP 2 BS), CRP level were measured at the time of enrolment and 3 months after starting metformin monotherapy. Results: Results were analyzed using pair t-test. Metformin therapy was found to decrease CRP level significantly along with FBS, PP 2 BS level. p<0.05 value considered as statistically significant. Value was expressed as mean ± standard deviation. Conclusions: Treatment with 3 months metformin monotherapy for newly diagnosed Type-2 DM has shown a significant decrease in high-sensitivity-CRP level in Type 2 diabetes. This positive effect may be because of the decreased in the expression of proinflammatory cytokines and other mediators, including adhesion molecules, suggests that these processes may contribute to atherogenesis because atherosclerosis is also an inflammatory condition. However, this effect is probably dependent on improving glycemic control.

AB0001 Genotype and Haplotype Effects of 7 Single-Nucleotide Polymorphisms in the CRP Gene on Levels of C-Reactive Protein and DAS28 in Two Cohorts of Treatment NaÏVe, Recent Onset Rheumatoid Arthritis Patients

BackgroundSingle nucleotide polymorphisms (SNPs) in the C-reactive protein (CRP) gene are implicated in the regulation of the constitutional CRP expression and its response to pro-inflammatory stimuli. Previous reports suggest that...

Effect of aerobic training on insulin resistance and C-reactive protein (CRP) levels and subcutaneous abdominal in obese women

This study examined the effect of three training intensities on abdominal obesity, insulin resistance, and C-reactive protein (CRP) levels. Forty-three young obese women (age 20–30 years; body mass index 30–40 kg/m2) underwent 12 weeks of walking programs (i.e., 5 days/week). They were randomly assigned to one of four groups: low-intensity training group [G1, 50 % of heart rate reserve (HRR), n = 11], high-intensity training group (G2, 75 % of HRR, n = 10), alternated-intensity training group (G3, 50–75 % of HRR, n = 12), and control group (G0, n = 10). They were tested before (T0) and after (T1) 12 weeks of aerobic training to determine changes in body mass, body mass index (BMI), total fat, waist circumference (WC), leptin, HOMA-IR, glucose and CRP. Body mass, BMI, total fat, and WC were significantly lower at T1 than T0 (p < 0.001) in all training groups. However, the decrease was higher in G2 than G1 and G3. Leptin levels decreased significantly in G1, G2, and G3 (p < 0.05). Only G1 showed significant decreases in CRP levels (p < 0.05). Insulin, HOMA-IR, and glucose levels decreased in the three training groups with higher decrease in G1. The low-intensity training is more effective than the high-intensity training or alternated-intensity training for improving insulin sensitivity and reducing subclinical inflammation.

Predictors of response to enteral nutrition in abdominal enterocutaneous fistula patients with Crohn's disease

Enterocutaneous fistula (ECF) is a serious complication of Crohn's disease (CD). Enteral nutrition (EN) is believed as one of therapeutic strategies of CD. This study is dedicated to identify predictors of response to EN in CD, which may lead to a better selection of fistula patients for this therapy. Forty-eight CD patients with ECF treated with short-peptide-based EN for 3 months were included in this study. All patients were followed up for at least 6 months. Logistic regression was performed to investigate the potential predictors of response to EN in these patients. In total, 30 out of 48 patients were confirmed with a successful closure of fistula after 3 months' EN therapy. The average closure time was 32.4±8.85 days. Inflammatory parameters (erythrocyte sedimentation rate, C-reactive protein (CRP) and platelet count) improved significantly after EN therapy in all enrolled patients. Specifically, the improvement of CRP after therapy in closed group was more important compared with that in unclosed group (P=0.035). Nutrition status (body weight, body mass index (BMI), hemoglobin, serum albumin (ALB), serum prealbumin and total protein (TP)) improved as well (P<0.05). Similarly, after treatment, the improvement of serum albumin (P=0.046) and prealbumin (P=0.006) in closed group was much more important than those in unclosed group. Logistic regression analysis discovered that a decreased CRP level and an elevated BMI level would be beneficial to the response to EN in CD patients with ECF. In CD patients with ECF, lower CRP and higher BMI are associated with higher possibility of closure after EN treatment. EN therapy can lead to a closure of ECF in a certain proportion of patients. EN therapy could also ameliorate inflammatory condition and improve nutrition status.

Increased TLR2 and TLR4 Expression in Peripheral Neutrophils Isolated from Kawasaki Disease

Background: Since neutrophils are important in innate immunity against invading microorganisms, this study investigated the expression of TLR2 and TLR4 in neutrophils derived from infants and children aged 12 years or younger as a marker of such immune functions. Methods: We enrolled 70 patients aged 12 years or younger: 18 patients with microbial infections, 14 patients with Kawasaki disease (KD), and 38 patients without infection, who first presented to the pediatric department at Toho University Omori Medical Center, Tokyo, Japan. The expression of TLR2 and TLR4 in neutrophils was assayed by flow cytometry, using phycoerythrin-conjugated antihuman monoclonal TLR2 or TLR4. Results: TLR2 and TLR4 expression in neutrophils derived from patients aged 1–5 years old without infection were significantly higher than in patients younger than 1 year and 6 years or older. In addition, TLR2 expression was greater than TLR4 expression in patients aged 12 years or younger with and without infections. The coefficients between expression of TLR2 and TLR4 in patients with and without infections were 0.8730 and 0.8393 respectively. Similar findings were obtained in patients with KD, and the coefficient was 0.9095. C-reactive protein (CRP) serum concentration and TLR2 and TLR4 expression in neutrophils gradually decreased during the follow-up period in patients with KD. Conclusions: The function of neutrophils matured between the ages of 1 and 5 years. The pattern of decrease in CRP levels was correlated to levels of toll-like receptors (TLRs) expression, especially TLR2, in KD.

Postinduction serum infliximab trough level and decrease of C-reactive protein level are associated with durable sustained response to infliximab: a retrospective analysis of the ACCENT I trial

BackgroundSerum infliximab trough levels correlate with efficacy; dose escalation is often beneficial in patients with Crohn's disease who stop responding to infliximab treatment.ObjectiveTo carry out a post hoc analysis of...