Decrease In C-reactive Protein Levels Research Articles

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...

Increased Serum C-Reactive Protein Level Is Associated with Increased Storage Lower Urinary Tract Symptoms in Men with Benign Prostatic Hyperplasia

ObjectiveChronic inflammation is considered as one of the contributing mechanisms of lower urinary tract symptoms (LUTS). Serum C-reactive protein (CRP) level is the widely used biomarker of inflammatory status. This study investigated the association between serum CRP level in men with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) before and after medical treatment.MethodsA total of 853 men with BPH and LUTS were enrolled. All patients completed the International Prostate Symptoms Score (IPSS) questionnaire and urological examinations. The parameters of uroflowmetry (maximum flow rate, Qmax; voided volume, VV), post-void residual (PVR), total prostate volume (TPV) and transition zone index (TZI), serum prostate specific antigen (PSA), and serum CRP levels were obtained. All patients were treated with alpha-blocker or antimuscarinic agent based on the IPSS voiding to storage subscore ratio (IPSS-V/S). Correlation analyses were performed between serum CRP levels with age, IPSS, TPV, TZI, Qmax, PVR, VV, PSA and between baseline and post treatment.ResultsThe mean age was 66.9±11.6 years old and the mean serum CRP levels were 0.31±0.43 mg/dL. Univariate analyses revealed serum CRP levels were significantly associated with age (p<0.001), PSA levels (p = 0.005) and VV (p = 0.017), but not significantly associated with TPV (p = 0.854) or PVR (p = 0.068). CRP levels were positively associated with urgency (p<0.001) and nocturia (p<0.001) subscore of IPSS, total IPSS (p = 0.008) and storage IPSS (p<0.001) and negatively associated with IPSS- V/S ratio (p = 0.014). Multivariate analyses revealed that serum CRP levels were significantly associated with age (p = 0.004) and storage IPSS subscore p<0.001). Patients with IPSS-V/S<1 and treated with tolterodine for 3 months had significant decrease of CRP levels after treatment.ConclusionSerum CRP levels are associated with storage LUTS and sensory bladder disorders, suggesting chronic inflammation might play a role in the patients with storage predominant LUTS.

Inflammation and growth in young children with obstructive sleep apnea syndrome before and after adenotonsillectomy.

Background. Obstructive sleep apnea (OSA) is associated with growth impairment that usually improves following effective treatment. In this study we investigated the mechanisms underlying the growth processes in young children diagnosed with OSA, before and after adenotonsillectomy (T&A). Methods. Young children (6–36 months old) were enrolled and evaluated before and several months after T&A surgery for height, weight, circulating high sensitive C-reactive protein (CRP), and insulin-like growth factor 1 (IGF-1) levels. Caloric intake was assessed by a validated Short Food Frequency Questionnaire (SFFQ). Results. Following T&A, children added 4.81 cm and 1.88 kg to their height and weight, respectively (P < 0.001 for both) and had a significant increase in BMI Z score (P = 0.002). Increased caloric intake of 377 kcal/day was noted (P < 0.001), with increased protein and decreased fat intake. The decrease in CRP levels correlated with the increase in body weight in boys (P < 0.05, adjusted for caloric intake). Conclusions. Adenotonsillectomy results in enhanced somatic growth in young children that correlates with a decrease in systemic inflammation and caloric intake increment. Our findings imply that systemic inflammation may have an important role in this OSA-related morbidity.

Randomized controlled trial: moxibustion and acupuncture for the treatment of Crohn's disease.

To evaluate the clinical efficacy and safety of acupuncture and moxibustion for the treatment of active Crohn's disease (CD). Ninety-two patients were equally and randomly divided into the treatment group and received herb-partitioned moxibustion combined with acupuncture, and the control group received wheat bran-partitioned moxibustion combined with superficial acupuncture. The patients received three treatment sessions per week for 12 wk and were followed up for 24 wk. The main outcome was evaluated using the CD Activity Index (CDAI) score, and the secondary outcomes were evaluated using laboratory indicators such as hemoglobin (HGB), C-reactive protein (CRP), erythrocyte sedimentation rate, quality-of-life, endoscopic ratings, and intestinal histology scores. The CDAI scores of both the treatment and control groups were significantly reduced after treatment compared with those measured before treatment. However, the degree of improvement in the treatment group was significantly greater than that of the control group. The improvement in symptoms in patients of the treatment group was sustained at follow-up, whereas that of the control group was not. The overall efficacy of the treatment was significantly greater than that of the control. Both groups demonstrated significant improvements in quality-of-life ratings after treatment, but the improvement was significantly greater in the treatment group than in the control group. In addition, the patients in the treatment group showed significantly increased HGB and significantly decreased CRP levels and histopathological scores at the end of treatment, whereas the control group did not exhibit significant changes. Moxibustion with acupuncture provided significant therapeutic benefits in patients with active CD beyond the placebo effect and is therefore an effective and safe treatment for active CD.

Roles of peroxisome proliferator-activated receptors polymorphisms, haplotypes, levels on C-reactive protein and their interactions with abnormal body weight

To explore the roles of peroxisome proliferator-activated receptors (PPARs) on the levels of serum C-reactive protein(CRP)and the interactions of PPARs haplotypes with abnormal body weight. Subjects(n = 644)were randomly selected from the cohort 'Prevention of Multiple metabolic disorders and Metabolic syndrome in Jiangsu province(PMMJS)' Variance test, t test and lineal regression were used to analyze the associations between PPARs polymorphisms and the levels of CRP. The association between PPARs haplotypes and serum CRP levels as well as the interaction of PPARs haplotypes with abnormal body weight were analyzed, under the SNPStats software. After adjusting for sex, age, blood pressure, cigarette smoking, alcohol drinking and so on, data showed that both rs1800206 and rs9794 were associated with the changes along with the levels of CRP (P < 0.05). After adjusting for the same factors, haplotypes of AVG and CVG in PPARα, CG in PPARd appeared to be associated with the increase (P < 0.05)while haplotypes of CC in PPARδ, CPCAC in PPARγ were associated with the decrease of CRP levels (P < 0.05). Results from the Interaction analysis also noted that the interactions did exist between abnormal body weight and both AVG, CVG in PPARα, and CG in PPARδ. PPARs polymorphisms and haplotypes were associated with CRP. Interaction between PPAR a/d and abnormal body weight might contribute to the levels of CRP.

Association Between Serum C-Reactive Protein and Albumin Levels and Psychiatric Comorbidities in Liver Transplant Recipients

BackgroundOrthotopic liver transplantation (OLT) is the definitive treatment for patients with end-stage liver disease. Many post-OLT patients have psychiatric comorbidities. The relationship between psychiatric comorbidities and biological factors, such as C-reactive protein (CRP) and albumin levels, in OLT recipients has seldom been investigated. MethodsWe analyzed medical charts of all patients aged over 18 who underwent orthotopic OLT at a tertiary medical center between September 2008 and July 2010 for serum CRP and albumin levels before and 1 month after OLT. Data for baseline characteristics, such as gender, age, and body mass index (BMI), were also collected. Patients who had a psychiatric consultation or took psychotropic medications during the hospitalization were categorized as “with psychiatric comorbidities.” ResultsPsychiatric comorbidities existed in 51 (33.8%) of 151 OLT recipients. By analysis of covariance adjusted for age and BMI, post-OLT CRP levels in patients with psychiatric comorbidities were significantly higher than those without psychiatric comorbidities (P = .015). For patients with psychiatric comorbidities, the paired t test showed significantly increased CRP levels at 1 month after when compared to the pre-OLT baseline levels (P = .044). Patients without psychiatric comorbidities had significantly decreased CRP levels at 1 month after when compared with the pre-OLT baseline levels (P = .009). ConclusionsElevated CRP levels may indicate activation of a systemic inflammatory process caused by psychiatric comorbidities in OLT recipients.

AB0578 Tocilizumab influence on the serum lipid profiles and rapid progression of intima media-thickness in patients with rheumatoid arthritis

BackgroundRheumatoid arthritis (RA) is characterized by a high risk of cardiovascular events (CVE) associated with atherosclerosis (AS). A key role in the development of AS belongs to rheumatoid inflammation. Influence...

THU0392 Beta-confident-registry: Efficacy and safety of canakinumab in cryopyrin associated periodic syndrome - 18 month follow-up

BackgroundCanakinumab (CAN, Ilaris®), a fully human anti-IL-1β monoclonal antibody, selectively inhibits IL-1β and has been approved for the treatment of cryopyrin-associated periodic syndrome (CAPS), an extremely rare inherited inflammatory disorder.ObjectivesThe...

Trends in C-Reactive Protein Levels in US Adults From 1999 to 2010

C-reactive protein (CRP) is a well-known biomarker of systemic inflammation and cardiovascular disease. We investigated the trends in prevalence of elevated CRP levels (>3.0 mg/L) in a general population of US adults. Data from 27,214 subjects aged ≥20 years in the 1999-2010 National Health and Nutrition Examination Survey were analyzed. After adjustment for age, sex, race/ethnicity, body mass index (weight (kg)/height (m)(2)), and medications for lowering blood pressure, glucose, and lipids, the prevalence of elevated CRP decreased significantly from 36.7% in 1999-2002 to 32.0% in 2007-2010, corresponding to a decrease in mean CRP level from 1.92 to 1.66 mg/L (both P < 0.001). The trend remained significant after additional adjustment for several traditional cardiovascular risk factors and use of different medications, including statins. However, the decreasing trends were attenuated after additional adjustment for total bilirubin (P = 0.08 and 0.02), which increased from 0.62 to 0.73 mg/dL over 12 years (P < 0.001). The decreasing trend of CRP levels is encouraging and may be related to the increase in total bilirubin levels. Such trends may be explained in part by the increasing use of medications such as statins, which can increase bilirubin levels and decrease CRP levels.

1921 PROGNOSTIC IMPACT OF C-REACTIVE PROTEIN KINETICS FOR ADVANCED RENAL CELL CARCINOMA TREATED WITH SUNITINIB

You have accessJournal of UrologyKidney Cancer: Advanced (II)1 Apr 20131921 PROGNOSTIC IMPACT OF C-REACTIVE PROTEIN KINETICS FOR ADVANCED RENAL CELL CARCINOMA TREATED WITH SUNITINIB Tetsuo Fujita, Masatsugu Iwamura, Takahiro Hirayama, Daisuke Ishii, Ken-ichi Tabata, Kazumasa Matsumoto, and Kazunari Yoshida Tetsuo FujitaTetsuo Fujita Kanagawa, Japan More articles by this author , Masatsugu IwamuraMasatsugu Iwamura Kanagawa, Japan More articles by this author , Takahiro HirayamaTakahiro Hirayama Kanagawa, Japan More articles by this author , Daisuke IshiiDaisuke Ishii Kanagawa, Japan More articles by this author , Ken-ichi TabataKen-ichi Tabata Kanagawa, Japan More articles by this author , Kazumasa MatsumotoKazumasa Matsumoto Kanagawa, Japan More articles by this author , and Kazunari YoshidaKazunari Yoshida Kanagawa, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2340AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Since the introduction of sunitinib for patients with advanced renal cell carcinoma (RCC), significant objective responses have been reported. It is now widely approved for the first-line treatment of advanced RCC. A prognostic marker is required for selecting patients who will benefit most from sunitinib. We have previously revealed that pretreatment normal C-reactive protein (CRP) predicts better oncological outcomes of sunitinib. However, CRP kinetics of sunitinib have never been described. In the cytokine era, CRP kinetics have an impact on survival in patients with metastatic RCC. As such, in the present study, we evaluate CRP kinetics in advanced RCC patients treated with sunitinib. METHODS Between December 2008 and July 2012, 52 consecutive patients with advanced RCC who were treated with sunitinib, were enrolled. Patients divided into 3 groups according to the pretreatment CRP level and CRP kinetics: (i) normal CRP cohort; defined as pretreatment CRP levels ≤ 0.30 mg/dL, (ii) normalized CRP cohort; defined as pretreatment CRP > 0.30 mg/dL and normalized CRP within 2 cycles of treatment, (iii) non-normalized CRP cohort; defined as pretreatment CRP > 0.30 mg/dL and not normalized CRP after the initiation of sunitinib. Disease control rates, non-parametiric estimates of progression-free survival time and overall survival time were evaluated. RESULTS The normal CRP cohort comprised 16 patients (30.8%), the normalized CRP cohort comprised 8 patients (15.4%), and the non-normalized CRP cohort comprised 28 patients (53.8%). Disease control rates of the normal, normalized, and non-normalized CRP cohorts were 93.8%, 75.0%, and 32.1%, respectively. The normal and normalized CRP cohorts showed statistically significant better disease control rates than the non-normalized CRP cohort (P = 0.0003). The normal CRP cohort showed significantly longer progression-free survival time than the non-normalized CRP cohort (median 19.0 months vs 5.0 months, P = 0.0023). Also, the normal CRP cohort showed significantly longer overall survival time than the non-normalized CRP cohort (median 30.0 months vs 9.0 months, P = 0.0012). CONCLUSIONS CRP revealed prognostic significance in advanced RCC patients treated with sunitinib. Pretreatment CRP level could be a useful prognostic marker for sunitinib effectiveness. And a decrease of CRP level during sunitinib treatment predicts better response. CRP kinetics is a prognostic indicator as well as pretreatment CRP level for patients with advanced RCC treated with sunitinib. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e788 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tetsuo Fujita Kanagawa, Japan More articles by this author Masatsugu Iwamura Kanagawa, Japan More articles by this author Takahiro Hirayama Kanagawa, Japan More articles by this author Daisuke Ishii Kanagawa, Japan More articles by this author Ken-ichi Tabata Kanagawa, Japan More articles by this author Kazumasa Matsumoto Kanagawa, Japan More articles by this author Kazunari Yoshida Kanagawa, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Apolipoprotein A-II

Apolipoprotein A-II

Cancer-related Fatigue, Inflammation and Thyrotropin-releasing Hormone

Aging and aging related illnesses such as cancer have been associated with inflammatory changes. Cancer-related behavioral comorbidities such as fatigue, sleep disturbances, depression have also been associated with inflammation, hypothalamic-pituitary-adrenal (HPA) axis dysregulation and other neuroendocrine changes. From a clinical perspective, cancer-related fatigue demonstrates striking similarities with the cytokine-induced sickness phenomenon in animal models. Thyrotopin-releasing hormone (TRH) plays a homeostatic role in its interaction with several biological systems, including a critical role in its interactions with the immune system. Considerable evidence supports a pivotal role for TRH in the inflammatory processes with specific relevance to the "cytokine-induced sickness behavior" paradigm. Additionally, TRH exerts arousing and analeptic effects in instances of behavioral depression. In a small proof-of-concept study conducted by our group, we investigated TRH administration as a treatment fatigue in cancer survivors in comparison with saline administration using a double-blind, crossover design. We also evaluated impact of TRH/saline administration on the inflammatory markers in these patients. TRH administration was associated with significant improvement (p < 0.05) in fatigue levels as measured by the Visual Analog Scale-Energy (VAS-E), was associated with significant (p < 0.05) improvement in sleep disturbances and improved quality of life. Notably, TRH administration was associated with decrease in C-reactive protein (CRP) levels, a marker of inflammation. This decrease in CRP level with TRH administration was associated with improvement in energy levels as measured by the VAS-E. The present review supports potential utility of TRH-based therapeutics in medical and psychiatric disorders with underlying inflammatory processes.

Measurement of the Silver Ion Concentration in Wound Fluids after Implantation of Silver-Coated Megaprostheses: Correlation with the Clinical Outcome

Background. Tumor patients and patients after traumas are endangered by a reduced immune defense, and a silver coating on their megaprostheses may reduce their risks of infection. The aim of this study was to determine the silver ion concentration directly measured from the periprosthetic tissue and the influence on the clinical outcome. Material and Methods. Silver ions were evaluated in 5 mL wound fluids two days postoperatively and in blood patients 7 and 14 days after surgery using inductively coupled plasma emission spectrometry in 18 patients who underwent total joint replacement with a silver-coated megaendoprosthesis. Results. The concentration of silver ions averaged 0.08 parts per million. Patients who showed an increased silver concentration in the blood postoperatively presented a lower silver concentration in the wound fluids and a delayed decrease in C-reactive protein levels. There were significantly fewer reinfections and shorter hospitalization in comparison with a group that did not receive a silver-coated megaprosthesis. Conclusion. An increased concentration of silver in the immediate surroundings of silver-coated prostheses was demonstrated for the first time in cohorts of patients with trauma or tumors. An elevated concentration of silver ions in the direct periprosthetic tissue may have reduced the infection rate.

Effect of Periodontal Therapy on Serum C-Reactive Protein Levels in Patients with Gingivitis and Chronic Periodontitis: A Clinicobiochemical Study

The aim of the present study was to evaluate the effect of periodontal therapy on serum C-reactive protein (CRP) levels in patients with gingivitis and chronic periodontitis. A total of 60 subjects (30 males and 30 females) were included in the study with 20 subjects in each of the groups classified based on community periodontal index (CPI) scores: I: Healthy, II: Gingivitis, III: Mild periodontitis. Periodontal therapy was performed on groups II and III patients. Venous blood was collected from each subject at baseline and 3 months after periodontal therapy. The collected sample was subjected to biochemical analysis to detect CRP levels by using immunoturbidimetric method. The present study demonstrated that the periodontitis group had a higher mean CRP levels (2.49 ± 0.47 ng/ml) as compared to the gingivitis group (1.40 ± 0.32 ng/ml) and healthy group (0.56 ± 0.20 ng/ml). The mean CRP values after periodontal therapy were found to be reduced to 0.44 ± 0.23 ng/ml in group II and 1.30 ± 0.36 ng/ml in group III patients. Within the limitations of this study, it can be concluded that CRP level progressively increases from periodontal health to disease. A decrease in CRP levels with periodontal treatment was also observed. Due to its opsonizing abilities CRP plays an important role in the innate host defence. It can be hypothesized that CRP is a potential biomarker of periodontal disease. A number of studies have reported elevated serum CRP levels in periodontitis subjects. Long standing periodontal disease and raised CRP levels enhance the risk of cardiovascular disease, cerebrovascular accidents and preterm low birth weight infants. There is also evidence that effective periodontal therapy can lower serum CRP levels. However, the data of interventional studies on CRP in gingivitis and periodontitis is scarce.

The effect of periodontal treatment on C-reactive protein: A clinical study.

Background:Chronic periodontitis in amultifactorial inflammatory disease which is caused by various microorganisms. Many studies have found close association between chronic periodontitis and C-reactive protein (CRP). CRPis an inflammatory marker which increases in all inflammatory condition.Aims and Objective:The present clinical study was designed to show the effect of periodontal treatment on the CRP levels of gingival crevicular fluid and to determine the effect of nonsurgical therapy in minimizing the CRP levels in chronic generalized periodontitis.Material and Method:Gingival crevicular fluid was collected using a micro capillary pipette that was hand calibrated at every 1 mm till 10 mm, from selected sites in the subjects on the 1st, 14th and 45th days.Results and Conclusion:Decreased CRP levels of gingival crevicular fluid were observed at the end of the study. There was a 37% reduction in probing pocket depth and 45% gain in clinical attachment level and a reduction of about 57% after 14 days and 90% reduction of CRP levels in gingival crevicular fluid after 45 days. Thus, the results show that the presence of CRP level is more significant in gingival crevicular fluid and confirms the underlying inflammatory component of the disease activity in chronic periodontitis.

Abstract 9303: C-Reactive Protein Trends and Associations with Total Mortality in United States Adults between 1999-2010

Introduction: C-reactive protein (CRP) is a well-known biomarker of systemic inflammation. Elevation of CRP levels is predictive of incident cardiovascular disease morbidity and mortality. We investigated the trends in prevalence of elevated CRP levels (x003E;3.0 mg/L), as well as mean CRP levels, in a general population of United States adults and then determine the associations with mortality. Methods: Data from the 27,214 subjects aged ≥20 years in the National Health and Nutrition Examination Survey (NHANES) 1999-2010 were analyzed. Among them, 12,259 subjects from NHANES 1999-2004 had mortality data followed up through December 31, 2006. Results: After adjusting for age, sex, race/ethnicity, body mass index, and medications for lowering blood pressure, glucose and lipids, the prevalence of elevated CRP decreased significantly from 36.7% in 1999-2002 to 32.0% in 2007-2010, corresponding to a decrease in mean CRP levels from 1.92 to 1.66 mg/L (both P &lt;0.001). The trend remained significant after additional adjustment for several traditional cardiovascular risk factors and use of medications, including statins, angiotensin-converting enzyme inhibitors, metformin, aspirin and clopidogrel. However, the decreasing trends were attenuated after additional adjustment for total bilirubin ( P =0.076 and 0.024), which increased from 0.62 to 0.73 mg/dL over 12 years ( P &lt;0.001). Of note, higher CRP levels were modestly associated with a higher risk of total mortality (adjusted hazard ratio: 1.07 [95%CI, 1.03-1.12] per 10 mg/L increase, P =0.001), and this association tended to be stronger in subjects with higher total bilirubin levels ( P for interaction&lt;0.001). Conclusion: The decreasing trend of CRP levels is encouraging and may be related to the increase in total bilirubin levels. Such trends may be explained in part by the increasing use of some medications such as statins that can increase bilirubin levels and decrease CRP levels. Moreover, the prediction of total mortality by CRP levels seems to be stronger in subjects with higher total bilirubin levels.

Efficacy of Erythropoietin Combined With Enteral Nutrition for the Treatment of Anemia in Crohn's Disease

Anemia is a common and serious complication in patients with inflammatory bowel disease. The present study was dedicated to evaluate the therapeutic efficacy of erythropoietin (EPO) combined with enteral nutrition (EN) in anemic Crohn's disease (CD) patients, in terms of hemoglobin level, treatment success rate, adverse events, and predictor of this therapy. We performed a prospective study in CD patients. On the basis of hemoglobin level, all enrolled patients were divided into anemic and nonanemic groups. The anemic group was further divided into EPO and non-EPO subgroups, depending on whether EPO was prescribed. Hematological and other parameters were measured initially and in the first 4 weeks after starting treatment. In total, 109 patients (49 nonanemic and 60 anemic, including 38 EPO and 22 non-EPO) were included. The prevalence of anemia in CD was 55.05%. Age, disease behavior, Crohn's Disease Activity Index scores, C-reactive protein, and erythrocyte sedimentation rate were significantly different between anemic and nonanemic groups. An increase in hemoglobin level and a significant decrease in C-reactive protein level were observed in the EPO treatment group. Treatment success rate was 63.16% in the EPO group, whereas none of patients achieved treatment success in the non-EPO group. EPO combined with EN can improve the hemoglobin level in anemic CD patients.

C-reactive protein (CRP) gene polymorphisms, CRP levels and risk of incident essential hypertension: findings from an observational cohort of Han Chinese

C-reactive protein (CRP), an acute phase reactant and marker of inflammation, has been shown to be associated with CRP genetic variants and incident hypertension, but it is unclear whether this link is causal. We therefore conducted a prospective, nested case-control study to examine the relationship between single-nucleotide polymorphisms (SNPs) within the CRP gene, circulating CRP levels and the development of hypertension. Plasma CRP levels and the genotypes of eight SNPs were determined in 2000 unrelated Shanghai residents, including 908 hypertensive individuals and 1092 normotensive individuals. Among the 1092 normotensives, 968 subjects were followed up for 2 years, during which 71 developed hypertension. Plasma CRP levels were independently associated with the development of hypertension in the follow-up study (odds ratio per quartile=1.64; 95% confidence interval: 1.18-2.26; P<0.001). The minor alleles of rs1130864 (P<0.001) and rs3093059 (P<0.001) were significantly associated with elevated CRP levels, and the minor alleles of rs1205, rs1800947 and rs2246469 (all P<0.001) were associated with decreased CRP levels. A haplotype-based analysis strengthened the results of single-locus analysis. However, none of the SNPs or haplotypes was significantly associated with blood pressure, incident hypertension or changes between baseline and follow-up blood pressure levels. Taken together, our findings demonstrated that plasma CRP levels were substantially associated with common genetic variants in the CRP gene and could predict the development of hypertension. However, the relationship between genotype and CRP levels was not associated with a change in hypertension risk.

Local infusion analgesia using intra-articular double lumen catheter after total knee arthroplasty: a double blinded randomized control study

Although intra-operative local infiltration analgesia has gained increasing popularity in joint replacement surgery, it is not clear whether postoperative local infusion analgesia using an indwelling catheter provides clinically important additional effects. We, therefore, conducted a randomized controlled trial to clarify the efficacy of the originally developed local infusion analgesia technique in total knee arthroplasty. Forty patients were randomly allocated to the local infusion analgesia or control group. Patients in the local infusion analgesia group received intermittent bolus intra-articular injection of analgesics consisting of ropivacaine, dexamethasone, and isepamicin until postoperative 48 h. Primary outcome was pain severity at rest using 100-mm visual analogue scale. Pain severity in patients of the local infusion analgesia group was lower than control group, and there were significant differences between groups at POD1 (p = 0.025) and POD3 (p = 0.007). Reduction of postoperative pain was associated with a decrease in C-reactive protein level and earlier achievement of straight leg raise. In addition, postoperative drain volume was reduced in the local infusion analgesia group. Although larger studies are needed to examine its safety, the local infusion analgesia alone provided clinically significant analgesic effects and rapid recovery in total knee arthroplasty.

Diagnostic contribution of C-reactive protein kinetics for gastric metastasis from renal cell carcinoma

C-reactive protein (CRP) has been reported as a useful biomarker for renal cell carcinoma (RCC). Here, we report a case in which CRP kinetics of a continuous increase in CRP levels led to the detection of RCC metastasis to the stomach, a rare metastatic site. A 58-year-old man diagnosed with metastatic RCC underwent cytoreductive nephrectomy. Four months after the surgery, his CRP level started to increase continuously. Thus, we suspected disease progression. Extensive studies, including thoracoabdominal computed tomography and bone scan, however, detected neither local recurrences nor metastatic lesions. A further increase in CRP levels and gradual progression of anemia prompted us to investigate the digestive tract. Gastric endoscopy finally revealed gastric metastasis. After partial gastrectomy, his CRP level immediately decreased to a normal level. The patient is currently alive with no evidence of disease progression and his CRP level remains within the normal range, 44 months after his metastatic RCC diagnosis. The continuous increase in CRP levels reflected the development of gastric metastasis. The decrease in CRP levels after partial gastrectomy was indicative of a good response to treatment. This case demonstrates that CRP kinetics may be helpful in predicting disease progression as well as response to therapeutic intervention.