Decrease In CRP Research Articles

The use of a heated helium-oxygen mixture in patients with severe COVID-19 and ARDS against the background of standard therapy and noninvasive ventilation

Introduction. One of the insufficiently studied methods of Acute Respiratory Distress Syndrome (ARDS) therapy is therapy with a heated helium-oxygen mixture. Due to physico-chemical properties, helium demonstrates high efficiency in the treatment of various diseases of the pulmonological profile.Aim. To study the effect of a heated helium-oxygen mixture on the course of a severe form of COVID-19 occurring with the development of ARDS.Materials and methods. The study involved 58 patients with severe and extremely severe coronavirus infection and ARDS, divided into the NVL + t-He/O2 group (n = 30) and the NVL+O2 control group (n = 28). In addition to standard treatment, patients of the NVL + t-He/O2 group received noninvasive ventilation (NVL) and therapy with a heated helium-oxygen mixture, according to clinical recommendations. In the main group, inhalations took place daily for 60 minutes per day for 5 days.Results. Against the background of therapy with a heated helium-oxygen mixture, a more intense increase in the level of lymphocytes was observed: 1.39 (1.09–1.66) × 109/l in the NVL + t-He/O2 group versus 1.02 (0.78–1.40) × 109/l (p = 0.02). Also, as a result of treatment, there was a significant decrease in RR, D-dimer and CRP in the study group: the level of RR (21 (20–22)/minute versus 22.5 (21–24)/minute, p = 0.003), D-dimer (0.44 (0.29–0.60) FEU ng/ml versus 0.79 (0.42–1.34) FEU ng/ml, p = 0.02) and CRP (1.1 (0.7–3.1)mg/l versus 16.6 (8.5–29.5) mg/l, p = 0.03), respectively. Similarly to the NVL + t-He/O2 group, an increase in the level of PaO2 and the oxygenation index was noted. In addition, there were significantly fewer patients with grade III and IV lung damage in the NVL + t-He/O2 group compared with the control (p = 0.05).Conclusion. The use of a heated helium-oxygen mixture in patients with severe COVID-19, occurring with the development of ARDS, against the background of standard therapy and NIV has shown its safety and effectiveness: there was a decrease in the intensity of inflammation, improved oxygenation and a reduction in the need for respiratory support.

Assessing Changes in Vascular Inflammation and Urate Deposition in the Vasculature of Gout Patients After Administration of Pegloticase Using Positron Emission Tomography and Dual-Energy Computed Tomography—A Pilot Study

We assessed changes in vascular inflammation and monosodium urate (MSU)-coded deposits after administration of Pegloticase in the vasculature of tophaceous gout patients using 18F-fluorodeoxyglucose (18F-FDG) Positron emission tomography/computed tomography (PET/CT) and dual-energy CT (DECT). Ten patients with tophaceous gout, intolerant or refractory to urate-lowering therapy (ULT), were treated with Pegloticase every two weeks for six months. 18F-FDG PET/CT and DECT were performed at baseline and after Pegloticase therapy to detect vessel wall inflammation (Standard uptake value, SUVmean, and SUVmax) and vascular MSU-coded deposition (MSU volume). Data were summarized using means and standard deviations. Baseline and follow-up values were compared for each variable using mixed-effect models. Significant decreases in SUVmean (p = 0.0003) and SUVmax (p = 0.009) were found with a trend towards a decrease in vessel wall MSU volume after treatment. There was a significant decrease in serum urate, correlating with reduction in SUVmean (R2 = 0.65), with a trend towards a decrease in CRP and blood pressure in all patients. Despite the small sample size, we were able to demonstrate a decrease in vessel wall inflammation and a trend towards a decrease in MSU volume by intensively lowering serum urate. These findings suggest that MSU-coded deposits and hyperuricemia may play a role in vascular wall inflammation. It remains to be seen whether this correlates with a decrease in adverse cardiovascular outcomes.

Biomarkers of Frailty in Patients with Advanced Chronic Liver Disease Undergoing a Multifactorial Intervention Consisting of Home Exercise, Branched-Chain Amino Acids, and Probiotics

Frailty in cirrhosis or advanced chronic liver disease (ACLD) is a relevant prognostic factor. In the present study, we aimed to analyze potential biomarkers associated with frailty and its improvement in patients with ACLD. We analyzed the serum of outpatients with ACLD who participated in a previous study (Román, Hepatol Commun 2024) in which frailty was assessed using the liver frailty index (LFI), and patients who were frail or prefrail were randomized to a multifactorial intervention (home exercise, branched-chain amino acids, and probiotics) or control for 12 months. We determined a biomarker battery of inflammation, bacterial translocation, and liver damage in blood and urine and blood metabolomics by 1H-NMR. Thirty-seven patients were included. According to the LFI, 32 patients were frail or prefrail, and 5 were robust. At baseline, LFI correlated with LBP, sCD163, mtDNA, FGF-21, urinary NGAL, urinary claudin-3, and the metabolites mannose, ethanol, and isoleucine. During the study, patients in the intervention group showed an improvement in LFI and a decrease in CRP, LBP, sCD163, and ccK18 compared to the control group. Metabolomics showed a decrease in dimethyl sulfone and creatinine and an increase in malonate, ornithine, isoleucine, and valine in the intervention group. We conclude that frailty in patients with ACLD is associated with biomarkers of systemic inflammation, bacterial translocation, and liver damage, and alterations of amino acid and short-chain fatty acid metabolism.

Effectiveness of Dexamethasone in Reducing Arrhythmia in Patients Undergoing Coronary Artery Bypass Grafting.

Introduction Coronary artery bypass grafting (CABG) carries the risk of postoperative arrhythmias. Our study focusseson the efficacy of dexamethasone in both on-pump CABG (ONCAB) andoff-pump CABG (OPCAB). Methods This single center randomized control trial was conducted from July 1st, 2018 to January 20th, 2019 in patients undergoing conventional ONCABand OPCABat the National Cardiovascular Center Harapan Kita (NCCHK). All arrhythmia incidents were recorded postoperatively with routine monitoring done every hour until the patient was discharged. Results One hundred and twenty patientswere included in the study and arrhythmias occurred in 24.2% of patients. In the ONCAB groups, there was an association between dexamethasone versus placebo in reducing the incidence of arrhythmias (p = 0.02; OR 0.23 [0.064-0.831]). However, in patientswho underwent OPCAB, there was no association between dexamethasone administration and the incidence of arrhythmias (p = 0.347; OR 0.55 [0.157-1.931]). Patients on dexamethasone in both ONCAB and OPCAB groups showed a significant decrease in IL-6, CRP, and procalcitonin (p = 0.001 for all). Overall, arrhythmic subjects had significantly higher levels of inflammatory markers IL-6 (p = 0.013), CRP (p = 0.025), and procalcitonin (p = 0.001). Conclusion Dexamethasone reduced postoperative arrhythmias, likely by modulating systemic inflammation, as shown by the decrease ininflammatory markers in ONCAB patients compared to those given a placebo.

The Role of Immunomodulatory Therapy with Oxiris in COVID-19 with Renal Failure and Immune Dysfunction

Introduction: The main objective of this study was to evaluate the impact of hemoadsorption on the elimination of inflammatory mediators. Methods: A prospective, bicenter, observational cohort study was conducted between March 2020 and February 2022 to explore the immunomodulatory response, demographic and clinical characteristics of individuals with COVID-19 admitted to the ICU with severe acute respiratory failure and in need of CRRT with Oxiris® with or without AKI. Results: Sixty-four patients were analyzed. Statistically significant differences were observed between exposed and unexposed groups, in relation to the reduction in D-dimer levels −15,614 (24,848.9) versus −4,136.5 (9,913.47) (p 0.031, d: 1.59, 95% CI: −21,830, −1,126). An increase in PCT was observed 0.47 (2.08) versus −0.75 (2.3) (p 0.044 95% CI: 0.03, 2.44). No differences were found in a decrease in CRP −4.21 (7.29) versus −1.6 (9.02) (p 0.22) nor in the rest of inflammatory parameters fibrinogen, IL-6, ferritin, lymphocytes, and neutrophils. Subgroup analysis in patients exposed to therapy also showed a significant decrease in D-dimer of 55% from baseline: 6,000 (1,984.5–27,750) pre-therapy versus 2,700 (2,119.5–6,145) (95% CI: −23,000, −2,489) post-therapy with a strong effect size (p 0.001, d: 0.65). Conclusion: The hemoadsorptive therapy in COVID-19 was associated with a significant decrease in D-dimer parameters without showing decreases in the rest of the clinical, inflammatory parameters and severity scales analyzed.

Results of a 12-Week Open-Label, Non-Interventional Study of the Efficacy and Safety of Olokizumab Therapy in Patients with Rheumatoid Arthritis after Switching from Anti-B-Cell Therapy during the SARS-CoV-2 Pandemic.

The purpose of the study was to evaluate the efficacy and safety of the drug Artlegia® (olokizumab), solution for subcutaneous injection, 160 mg/ml-0.4 ml, manufactured by R-Pharm JSC, Russia) for the treatment of patients with rheumatoid arthritis in real clinical practice after switching with rituximab during the COVID-19 pandemic. The study included 14 patients with a confirmed diagnosis of rheumatoid arthritis (RA), who were previously on rituximab therapy at a dose of 1000-500 mg twice with an interval of 2 weeks, who received at least one course of therapy with this drug. As RA worsened, patients were switched to olokizumab against the background of standard DMARDs. On weeks 0, 4, 8, and 12 after the switch, the severity of pain was assessed on the VAS scale, the number of tender and swollen joints (TJC28 and SJC28), the level of acute-phase inflammation markers, the DAS28 (disease activity score), ESR, CRP, CDAI (clinical activity index), and the functional state index HAQ (Health Assessment Questionnaire) were determined, as well as the safety profile of therapy was assessed. Data analysis was performed using median values (Me) were used for data analysis. A significant decrease in TJC28 was detected after 8 and 12 weeks of treatment with olokizumab (Artlegia®) (Me baseline = 10, Me 8 weeks = 4, Me 12 weeks = 4, p < 0.05) and a decrease in TSC28 was detected after 4, 8, and 12 weeks of treatment (Me baseline = 9, Me 4 weeks = 3.5, Me 8 weeks = 2.5, Me 12 weeks = 2.0, p < 0.05). Laboratory markers of inflammation showed a decrease in CRP and ESR levels after 4 weeks of treatment (CRP: Me4 weeks = 21, Me4 weeks = 1, p < 0.05, ESR: Mesno = 31, Me4 weeks = 7, p < 0.05). Positive dynamics persisted on 8 and 12 weeks (CRP: Me 8 weeks = 1, Me 12 weeks = 0; ESR: Me 8 weeks = 4, Me 12 weeks = 5). The level of CRP by week 4 became within the normal range, regardless of the initial values. All activity indices improved from week 4 in each evaluation period compared to baseline: DAS28-ESR: Me baseline = 5.52, Me 4 weeks = 3.59, Me 8 weeks = 3.33, Me 12 weeks = 3.22, p < 0.05; DAS28CRP: Me baseline = 5.39, Me 4 weeks = 3.71, Me 8 weeks = 3.35, Me 12 weeks = 3.45, p < 0.05; CDAI: Me baseline = 28.5, Me 4 weeks = 18.0, Me 8 weeks = 16.5, Me 12 weeks = 16.0, p < 0.05. All patients showed a reduction in pain (VAS scale) by week 8. The functional status of patients, according to the HAQ index, showed a significant decrease only by week 12 of the study: Me baseline = 1.62, Me 12 weeks = 1.31, p < 0.05. The study found that switching from rituximab to olokizumab was effective and safe during the COVID-19 pandemic.

Results of a 24-week open-label, non-interventional study on the efficacy and safety of olokizumab therapy in patients with rheumatoid arthritis after switching from anti-B-cell therapy during the SARS-CoV-2 pandemic

In the context of the new coronavirus infection (NCI) COVID-19 pandemic, the rheumatological community is facing new challenges in the treatment of immune-inflammatory rheumatic diseases (IIRDs). It has been shown that rheumatological patients have an increased risk of infections and a severe course of NCI and that IIRD therapy also influences the disease outcomes. In particular, the use of the anti-B-cell medication rituximab (RTM) is associated with a higher risk of severe NCI and increased mortality. The COVID-19 pandemic has highlighted the need to find alternative and safe treatment options for these patients. This work is the continuation of a 12-week study on the efficacy and safety of olok-izumab (OKZ) therapy in patients with rheumatoid arthritis (RA) after switching from anti-B-cell therapy during the SARS-CoV-2 pandemic. Objective: to evaluate the efficacy and safety of OKZ (Artlegia®; solution for subcutaneous administration, 160 mg/ml – 0.4 ml) for the treatment of patients with RA in real-life clinical practice after switching from RTM during the COVID-19 pandemic. Material and methods. The study included 19 patients with a confirmed diagnosis of RA who had received RTM at a dose of 500–1000 mg twice every 14 days at least 6 months ago. As disease activity increased, RTM was replaced with OKZ while therapy with synthetic disease-modifying anti-rheumatic drugs (DMARDs) was continued. At weeks 0, 4, 8, 12 and 24 after switching the biologic DMARD, the number of tender (TJN) and swollen (SJN) joints out of 28, pain intensity on a visual analogue scale, ESR, CRP level, disease activity indices CDAI, DAS28-ESR, DAS28-CRP, HAQ index and the safety profile of the therapy were assessed at each visit. Results and discussion. After 4, 8, 12 and 24 weeks of OKZ administration, there was a statistically significant decrease in mean TJN (from 10 to 6.0, 3.0, 5.0 and 4.0, respectively; p &lt; 0.05) and SJN (from 7.0 to 3.0 by week 4 and to 2.0 by weeks 8, 12 and 24; p &lt; 0.05). At the same time, a decrease in CRP and ESR values was also observed: median CRP decreased from 18 to 0.6 mg/l by week 4 and to 0.5 mg/l by weeks 8, 12 and 24 (p &lt; 0.05), ESR from 30 to 5 mm/h in each study period (p &lt; 0.05). CRP levels normalized by week 4, regardless of baseline values. All RA activity indices showed a positive dynamic compared to baseline values from week 4 onwards in each assessment period. After weeks 4, 8, 12 and 24, the median DAS28-ESR decreased from 5.50 to 3.57; 3.30; 3.08 and 3.01 (p &lt; 0.05); DAS28-CRP – from 5.30 to 3.46; 3.23; 3.26 and 3.12 (p &lt; 0.05); CDAI – from 27.0 to 17.0; 12.0; 15.0 and 12.0 (p &lt; 0.05), respectively. All patients showed a decrease in pain by the 4th week of observation. A statistically significant improvement in functional status was observed after the 4th week of therapy and was maintained until week 24. The median HAQ index decreased from 1.62 to 1.50 at weeks 4, 8 and 12 and to 1.12 at week 24 (p &lt; 0.05). Conclusion. The study showed that the non-medical switch from RTM to OKZ during the COVID-19 pandemic was effective and safe.

Olokizumab in patients with inflammatory phenotype of osteoarthritis, treatment experience

Objective: to investigate the efficacy and safety of olokizumab (OKZ) in patients with knee osteoarthritis (OA) with synovitis, persistent pain and ineffectiveness of previous conservative therapy. Material and methods. The study included 15 patients with stage II–III knee OA who fulfilled the ACR criteria and had pain ≥50 mm on a visual analogue scale (VAS), synovitis and treatment failure. The age of patients ranged from 54 to 75 years; the duration of the disease was from 1 to 23 years. The duration of the study was 12 weeks, during which the patients received 3 subcutaneous injections of OKZ at a dose of 64 mg. The effectiveness of the treatment was assessed by the dynamics of pain intensity according to VAS, WOMAC and KOOS indices, the values of the DN4 questionnaire and the quality of life according to EQ-5D. In addition, the general assessment of the patient's health (GHA) according to VAS, the assessment of treatment efficacy by doctor and patient and the need for non-steroidal anti-inflammatory drugs (NSAIDs) were considered. All patients underwent laboratory testing. Results and discussion. During treatment, there was a significant decrease in pain intensity according to VAS, a statistically significant improvement in the KOOS and WOMAC indices (p&lt;0.05), quality of life according to the EQ-5D questionnaire and GHA. Patients and doctors rated the treatment results very positively: an improvement or significant improvement was observed in 92.3% of cases. Adverse events were identified in 4 patients, which in 2 cases served as the reason for discontinuation of OKZ treatment and termination of participation in the study. During treatment with OKZ, a statistically significant decrease in CRP and ESR values, an increase in the concentration of interleukin 6 (p = 0.003), COMP (p = 0.03) and PIINP (p = 0.01) were observed. Conclusion. The results obtained suggest a significant symptomatic and anti-inflammatory effect of OKZ in patients with the inflammatory phenotype of OA.

Supplementation with Silybum marianum Extract, Synbiotics, Omega-3 Fatty Acids, Vitamins, and Minerals: Impact on Biochemical Markers and Fecal Microbiome in Overweight Dogs.

Overweight and obese dogs can develop metabolic dysfunction, characterized by an inflammatory response and involvement of liver functions. If a modulation of the gut microbiome and its interaction with the gut-liver axis is implicated in the development of metabolic dysfunction, exploration becomes necessary. Over the past decade, diverse therapeutic approaches have emerged to target pathogenic factors involved in metabolic dysfunction. This study investigated the impact of a supplement with hepatoprotective activity, containing extracts of Silybum marianum, prebiotics, probiotics, n-3 polyunsaturated fatty acids, vitamins, and minerals on hematological markers of liver functions and inflammation, as well as on the intestinal microbiota of 10 overweight adult dogs over a 35-day time span. Animals underwent clinical and laboratory evaluations every 7 days, both before the administration of the supplement (T0) and after 7, 14, 21, 28, and 35 days (T1, T2, T3, T4, and T5). In comparison to T0, a significant (p < 0.05) decrease in ALP, glucose, direct bilirubin, and CRP was observed from T3 to T5. The alpha diversity of the fecal microbiota significantly decreased (p < 0.05) only at T1, with high variability observed between dogs. Total short-chain fatty acid and lactic acid were also lower at T1 (p < 0.05) compared to the other times of sampling. The beta diversity of the fecal microbiota failed to show a clear pattern in relation to the sampling times. These results of blood parameters in overweight dogs show a reduction of the inflammation and an improvement of metabolic status during the study period, but the effective contribution of the supplement in this clinical outcome deserves further investigation. Furthermore, the considerable individual variability observed in the microbiome hinders the confident detection of supplement effects.

P877 A comparison of vedolizumab and ustekinumab treatment in patients with Ulcerative Colitis after failure of treatment with tumor necrosis factor inhibitor

Abstract Background Data comparing vedolizumab (VDZ) and ustekinumab (UST) in patients with ulcerative colitis (UC) previously treated with tumor necrosis factor inhibitor (TNFi) and followed with regular serum-drug measurements are scarce. In the national pharmaceutical tender system of Norway, VDZ was listed as the first drug of choice after failed TNFi treatment from 2016 to 2019 and UST from 2020 to 2022. We aimed to compare drug persistence, effectiveness, drug dosing and disease activity in patients treated with VDZ or UST after failed TNFi therapy. Methods We included patients who had failed at least one TNFi and started either VDZ treatment (years 2016-2019) or UST (years 2020-2022). Patients were followed for one year after initiating the treatment or until discontinuation. Prospectively recorded data were obtained from the electronic patient journal (EPJ) and the local IBD-registry. Clinical remission was defined as 6-point Mayo Score ≤1, and biochemical remission was defined as CRP&amp;lt;5 mg/L and FC&amp;lt;250 µg/g. Patients were followed with regular serum-drug measurements and dose adjustments were made at the discretion of the treating physician based on serum-drug measurements and clinical activity at follow-up visits. Wilcoxon signed rank and Mann Whitney U test were used to assess differences in paired and unpaired data, respectively. Results A total of 116 patients were included, 59 treated with VDZ and 57 with UST. At 52 weeks, there was no difference in estimated drug persistence with 85% [73-92] for VDZ and 92% [80-96] for UST. Clinical remission increased significantly in both groups (Table 1), and no difference was found between UST and VDZ for clinical remission at week 0 and 52 (OR=2.1 [0.9-4.5] and OR=0.9 [0.3-2.3]). Contrary to the VDZ group, there was a significant decrease in CRP from week 0 to 52 in the UST group, while FC decreased significantly in both groups (Table 1). The proportion of patients in biochemical remission increased in the UST group while there was no significant change in the VDZ group. Significantly more patients treated with UST received an intensified treatment regime at 52 weeks (interval less than eight weeks) compared to VDZ treated patients (87% (95% CI [74-94]) vs 59% (95% CI [45-72])). Conclusion This study demonstrates that one-year drug persistence and clinical remission were high and comparable in both UST and VDZ treated UC patients with previous TNFi failure. Treatment with UST, but not VDZ, was associated with a significant increase in the proportion of patients in biochemical remission from induction to 52 weeks. However, a significantly larger proportion of patients treated with UST received intensified dosing at 52 weeks compared with VDZ treated patients.

P1162 Upadacitinib in Crohn’s Disease Patients: for what type of patients in real world setting ?

Abstract Background The oral selective JAK kinase inhibitor, Upadacitinib (UPA; Rinvoq®) has been shown to induce and maintain clinical response and remission in Crohn’s disease (CD), but also in rheumatic and skin diseases. We report here on the largest Swiss experience in "off label" use of this drug. Methods A chart review of the Crohn’s and Colitis Center Beaulieu Lausanne and Gastroenterology Center Bulle of CD patients was conducted. Results Eighty-nine IBD patients were exposed to UPA treatment. After exclusion of 22 patients (UC and unknown consent status) we analyzed patients’ characteristics of 67 CD patients (72% women) treated between April 2019 and Nov. 2023. All patients had previously failed or were intolerant to, at least, one anti-TNF agent, 75% had been exposed to 4 or more biologics/ small molecules and two-third had received all classes of biologics. Disease location and behavior were mostly ileo-colonic and inflammatory (L3B1) or ileal only and stricturing (L1B2). Half of the patients had co-existing extraintestinal manifestations (mostly spondylarthritis and arthralgias). Advanced combination therapy was used in 27% of cases with anti-TNF agents (n=10), vedolizumab (n=6) and ustekinumab (n=2). UPA was prescribed after a median disease duration of 14 years (range 1-68) for a mean treatment duration of 14 months (mo) (+/- 9.1 SD; range 1-37). Forty-four CD patients (66%) were still on UPA at the time of study completion. A partial or complete response was observed in 51/67 patients (76%) with a mean decrease of CRP of 10.4 mg/l (+/- 17.6 SD) and calprotectin of 610 mcg/g (+/- 1165 SD). Adverse events were mostly viral infections, acnea, hypercholesterolemia, fatigue and headaches. Conclusion Upadacitinib is a good treatment option in difficult to treat CD patients with aggressive disease behavior, alone or in combination in case of concomitant rheumatic and gastrointestinal indications.

COVID-19 Hastalarında TNF-α Düşüşünü Etkileyen Faktörler

Aim: Tumor necrosis factor-alpha (TNF-α) have several functions, including cell survival, differentiation, and proliferation. TNF-α may effect the cell death during the cytokine storm that occurred during COVID-19 infection. We aimed to investigate, the factors that affects the TNF-α decrease in COVID-19 patients.&#x0D; Material and Methods: Totally 44 individuals with COVID-19 infection were included the study. Blood counts, biochemical examinations and D-dimer examinations were obtained. Comorbidities and initial symptoms of the patients were recorded. TNF-α, CRP and ferritin values were measured twice on the 1st and 7th days of hospitalization. The change in this values were examined according to comorbidities, initial symptoms and steroid usage.&#x0D; Results: Of a total of 44 patients, 56.8% were male (25/44) and 43.2 % were female (19/44). TNF-α decrease was found to be statistically significant in non-diabetic patients, while TNF-α decrease was found to be insignificant in diabetic patients. CRP decrease was found to be statistically significant in both diabetic and non-diabetic patients while ferritin decrease was insignificant in both diabetic and non-diabetic patients. While TNF-α and CRP decreased statistically significantly in those without lung disease, it was observed that both TNF-α and CRP decreases were not significant in those with lung disease. The decrease in TNF-α and CRP was statistically insignificant in those who did not treated with steroids, while the decrease in TNF-α and CRP was significant in those who treated with steroids.&#x0D; Conclusion: Steroids decreases the TNF-α levels. TNF decrease is not significant in those with diabetes and lung disease.

Meta-analysis of the efficacy and safety of Ginkgolide Meglumine Injection combined with Butylphthalide in the treatment of Acute Ischemic Stroke.

To evaluate the efficacy and safety of Ginkgolide Meglumine Injection (GMI) combined with Butylphthalide in the treatment of Acute Ischemic Stroke (AIS), and provide reference for rational clinical medication. PubMed, Embase, Web of science, CNKI, Wanfang, VIP and other databases were searched for published studies on the treatment of AIS with GMI combined with Butylphthalide in both Chinese and English. The search period was from the establishment of the database to July 2023. The included studies that met the inclusion criteria were analyzed using RevMan 5.3 software for Meta-analysis. A total of 25 studies involving 2362 patients (experimental group = 1182, control group = 1180) were included. The results of meta-analysis showed that the overall effective rate of the experimental group was significantly higher than that of the control group [RR = 1.21, 95% CI (1.16, 1.26), P< 0.00001]. In addition, compared with the control group, the experimental group showed significant improvement in NIHSS score [SMD = -1.59, % CI (-2.00-1.18), P< 0.00001] and ADL score [SMD = 2.12, 95% CI (1.52, -2.72), P<0.00001], significant decrease in CRP [SMD = -2.24, 95% CI (-3.31, -1.18), P<0.0001] and TNF-α [SMD = -2.74, 95% CI (-4.45, -1.03), P< 0.005] levels, and improvement in plasma viscosity [SMD = -0.86, 95% CI (-1.07, -0.66), P< 0.00001]. However, the influence on homocysteine level remains inconclusive. Furthermore, there was no significant difference in the incidence of adverse reactions between the two groups [SMD = 0.95, 95% CI (0.71, 1.28), P> 0.05]. GMI combined with Butylphthalide shows good clinical application effects and good safety in the treatment of AIS. However, more large-sample, multicenter, randomized controlled are needed to confirm these findings.

Treating Periprosthetic Joint Infection With Silver-Impregnated Carbon-Coated Spacers: Mid-Term Outcomes

Background. Periprosthetic joint infection (PJI) is a severe complication of arthroplasty. The widely accepted treatment standard for PJI is a two-stage revision arthroplasty involving the articulating spacers. The implant surface provides an ideal environment for bacterial adhesion, facilitating mature biofilm formation. To prevent bacterial adhesion effectively, the surface of the implanted device must be modified with an efficient coating. The ability of a modified coating based on two-dimensional linear carbon chains (2D LCC) with silver (Ag) impregnation to inhibit biofilm formation and provide efficient bacterial eradication has been investigated in several experimental studies. However, there is a lack of publications on clinical studies evaluating the effectiveness of such coatings.&#x0D; The aim of the study — to assess mid-term outcomes of knee and hip PJI treatment using spacers coated with two-dimensional linear carbon chains impregnated with silver.&#x0D; Methods. This study is based on the results of the examination and two-stage revision arthroplasty of 144 patients with newly diagnosed knee and hip PJI. Patients were divided into two groups: the first (main) group received articulating spacers coated with 2D LCC+Ag, while the second (control) group received articulating spacers with antibiotics. Anamnestic, clinical, laboratory, microbiological, and statistical methods were used in this study. The evaluation of short-term results was performed using the KSS, Harris, VAS, and EQ-5D-5L scales at 3 months after surgery, and mid-term results were assessed at 2 years.&#x0D; Results. The study confirmed the high antibiofilm activity and safety of spacers coated with 2D LCC+Ag. Both groups showed a reduction in inflammation markers during treatment. Before the second stage of treatment, both groups experienced a statistically significant decrease in CRP, procalcitonin, and presepsin levels, as well as synovial cytosis and neutrophil content. The frequency of recurrences after two-stage treatment was significantly lower in the first group compared to the second group. In the mid-term period, the first group had higher scores on the KSS and Harris scales by 20.5 and 7.0 points, respectively. Results on the EQ-5D-5L were 10/0.08 points higher, and the intensity of pain according to VAS was three times lower in the first group.&#x0D; Conclusion. The use of spacers coated with 2D LCC+Ag allows for a faster resolution of the inflammatory process, reduces the incidence of PJI recurrences, and predicts active protection of the implant surface from microbial colonization and biofilm formation. This, combined with antibiotic prophylaxis, provides a favorable therapeutic and preventive effect against PJI recurrence.

The Effect of Fiberoptic Bronchoscopy Combined with Alveolar Lavage in the Treatment of Severe Lung Infection After Gastric Cancer Surgery

Objective: To explore the effect of fiberoptic bronchoscopy combined with alveolar lavage in the treatment of severe lung infection after gastric cancer surgery. Methods: 60 patients with severe lung infection after gastric cancer surgery who were admitted into The First Hospital of Nanping from January 2020 to June 2023 were selected as study subjects. The patients were randomly divided into a control group and an experimental group, with 30 cases in each group. The control group was treated with conventional treatment methods, and the experimental group was treated with fiberoptic bronchoscopy combined with alveolar lavage. The clinical efficacy of the treatment and the blood gas index levels (PaO2, PaCO2, SpO2) and serum inflammatory factor levels (CRP, IL-6, IL-8) of the two groups were evaluated. Results: The treatment received in the experimental group was more effective than that of the control group (P &lt; 0.01). Besides, the PaO2 and SpO2 of the patients in the experimental group were higher than those of the control group after treatment; the PaCO2 of the experimental group was lower than that of the control group; and the differences were statistically significant (P &lt; 0.01). Both groups showed a significant decrease in CRP, IL-6, and IL-8 levels after the treatment (P &lt; 0.01). Conclusion: Fiberoptic bronchoscopy combined with alveolar lavage is effective in treating severe lung infection after gastric cancer surgery, so it should be popularized in clinical practice.

Comparison of Changes in Inflammation Markers NLR, CRP, and LCR after Corticosteroid Therapy in Severe and Critical COVID-19 Patients

Corticosteroid, an immunomodulator agent for treating hyperinflammation, is widely used in severe and critical COVID-19 patients. This study is a retrospective observational cohort clinical study comparing changes in NLR, CRP, and LCR values with and without corticosteroid therapy in critically ill COVID-19 patients. Those samples were chosen due to widespread access and economically sound to be examined repetitively. Samples were collected by total sampling of medical records of patients admitted to the COVID-19 intensive care unit at RSUD Dr Soetomo between March 2020 to July 2021. Inclusion criteria are complete medical records of patients &gt; 18 years with a confirmed COVID-19 diagnosis with severe and/or acute symptoms according to the WHO criteria and receiving corticosteroids (dexamethasone 6 mg/24 h or equivalent dose) for a minimum of 3 days. Patients not receiving corticosteroid treatment were included in the control group. NLR, CRP, and LCR were evaluated on day-0, day-3, day-6, and day-10 after initiation of corticosteroid therapy; in the control group, their hospital admission was designated as day-0. Comorbidities, complications, and other therapies that may affect NLR, CRP, and LCR values are noted. A total of 460 patients were included in the inclusion criteria. The control group had no significant median NLR, CRP, and LCR changes during observation (p-value &gt; 0.05). In the therapy group, there was a significant increase in NLR and LCR and a decrease in CRP (p-value &lt; 0.0001). When compared between control and therapy groups, the median changes in NLR and CRP differed significantly (p-value &lt; 0.05), while significant differences in LCR occurred on days 6 and 10. Corticosteroid increases NLR and LCR and decreases CRP with significant differences between groups. HIGHLIGHTS Corticosteroid treatment significantly increases NLR and LCR levels, while CRP levels decrease significantly in severe and critical COVID-19 patients NLR measurements are unsuitable as indicators of post-therapy inflammatory status during the ongoing immunopathological process of COVID-19 or due to a period of neutrophilia caused by the steroid itself LCR measurement can detect alterations in inflammatory status up to the tenth day following corticosteroid treatment in patients with severe COVID-19 CRP measurements remain a reliable indicators of inflammatory status changes for up to 10 days following corticosteroid therapy in severe and critical COVID-19 patients GRAPHICAL ABSTRACT

Clinical Features and Disease Course of Cancer Patients Infected with Sars-Cov-2 During Anticancer Treatments

Abstract Cancer patients infected with SARS-CoV-2 during their active anticancer treatment represent a highly vulnerable population. We aimed this investigation to show clinical features and outcomes of the patients who had mild to moderate COVID-19 symptoms or were asymptomatic at the admission to the COVID Center. The retrospective study included 25 cancer patients confirmed with SARS-CoV-2 within seven days of their last anticancer treatment. Clinical data were collected from medical records and processed by methods of descriptive and inferential statistics. Patients' mean age was 68.1±10.4 years. More than 2/3 of the patients were with ECOG PS 0 and 1, and about 4/5 of patients were in III or IV cancer stage. The most frequently applied types of therapy were radiotherapy and combined radio/chemotherapy. Eleven (44.0%) patients had bilateral while 4 (16%) had unilateral pneumonia. The most frequent symptoms were fever (72%), fatigue (72%), dyspnea (32%), and cough (32%). 1/5 of the patients needed oxygen support. Mean neutrophil (2.6±1.2), lymphocyte (0.9±0.6) and platelets (200.1±88.1) number significantly increased from admission to discharge (p=0.004, p=0.005, p&lt;0.001). Median CRP significantly decreased from 40.4 (6.2-96.2) at admission to 11.35 (3.75-27.65) at discharge (p=0.008). Twenty-four patients were cured, and one patient died. Naso-pharyngeal SARS-CoV-2 clearance time was 19.4±6.9 days; the minimum was seven, and the maximum was 39 days. Cancer patients infected with SARS-CoV-2 during active anticancer treatment can successfully overcome COVID-19 without developing further respiratory or other complications during hospitalization. An increase in lymphocyte and neutrophil counts, with a decrease in CRP, may be markers of a favorable prognosis.

Soluble P2X7 Receptor Plasma Levels in Obese Subjects before and after Weight Loss via Bariatric Surgery

Obesity is a systemic disease frequently associated with important complications such as type 2 diabetes and cardiovascular diseases. It has also been proven that obesity is a disease associated with chronic low-grade systemic inflammation and that weight loss improves this low-grade chronic inflammatory condition. The P2X7 purinergic receptor (P2X7R), belonging to the family of the receptors for extracellular ATP, is a main player in inflammation, activating inflammasome and pro-inflammatory cytokine production. In this study, we evaluated the plasma levels of soluble P2X7R (sP2X7R) measured in a group of obese patients before and one year after bariatric surgery. Furthermore, we evaluated the relation of sP2X7R to inflammatory marker plasma levels. We enrolled 15 obese patients who underwent laparoscopic sleeve gastrectomy, evaluating anthropometric parameters (weight, height, BMI and waist circumference) before and after surgery. Moreover, we measured the plasma levels of inflammatory markers (CRP, TNFα and IL-6) before and after weight loss via bariatric surgery. The results of our study show that one year after bariatric surgery, obese patients significantly decrease body weight with a significant decrease in CRP, TNF-alfa and IL-6 plasma levels. Similarly, after weight loss, obese subjects showed a significant reduction in sP2X7R plasma levels. Moreover, before surgery, plasma levels of sP2X7R were inversely related with those of CRP, TNF-alfa and IL-6. Given the role of P2X7R in inflammation, we hypothesized that, in obese subjects, sP2X7R could represent a possible marker of chronic low-grade inflammation, hypothesizing a possible role as a mediator of obesity complications.

Treatment effect of respiratory therapy with intermittent hypoxic-hyperoxic training (IHHT) on functional capacity in patients with post COVID19 conditions: a controlled treatment trial

Abstract Introduction COVID-19 can cause long-term lung and systemic damage that will lead to increasing numbers of patients disabled by reduced functional capacity. Intermittent hypoxia-hyperoxia training (IHHT) is a respiratory therapeutic concept which has been suggested to improve exercise performance via controlled hypoxic conditioning. The purpose of the present study is to investigate the therapeutic effect of IHHT on the recovery process during inpatient rehabilitation in post-COVID conditions. Methods A prospective, single-center, randomized controlled trial was conducted in 145 (37 men) patients with post COVID19 conditions aged 27-84 years, who were admitted to a hospitalized rehabilitation program (duration 27±5 days). Patients were 1:1 allocated to the standard rehabilitation program or IHHT on top of standard rehabilitation. The patients in IHHT group attended regular (alternate days) treatments of hypoxia-hyperoxia breathing sessions (10–12% O2 hypoxia breathing followed by 30-35% O2 hyperoxia breathing in 6-8 cycles for a total of 45 min). The primary endpoint of the trial was improvement in walking distance in a six-minute walk test (6MWT) between groups. Further endpoints of functional testing included stair climbing test (SCT), patient global assessment, fatigue assessment scale (FAS) and Quality of life (QoL) assessed by EQ5-D analog scale. Subjective perceived health was assessed by Median Corona Recovery Score (MCRS). Results The IHHT group demonstrated in comparison to controls a significant improved primary endpoint (6MWT difference, IHHT group vs controls: 91.7 vs. 32.5m, P&amp;lt;0.001), improved stair climbing (SCT -1.9 vs. -0.5 sek, P&amp;lt;0.001), improved QoL (EQ5-D analog scale change 31.3 vs. 2.9, P&amp;lt;0.001), improved fatigue (FAS -8.9 vs. 3.6, P&amp;lt;0.001) and improved perceived health (MCRS -10.3 vs. -2, P&amp;lt;0.001, all IHHT group vs. controls). The IHHT group exhibited a significant increase in hemoglobin content and a significant decrease in CRP compared to baseline (P&amp;lt;0.001), whereas these changes were not observed in the control group. Conclusion Respiratory treatment by IHHT in patients with post COVID conditions resulted in improved functional capacity in multiple of functional tests and in improved QoL and perceived health.

The use of “Acellbia” – a biosimilar of rituximab in systemic sclerosis

Introduction. The possibilities of modern therapy for systemic sclerosis (SSc) remains limited, since most of the used drugs do not have a diseasemodifying effect. This encourages the study of new approaches that potentially affect the fundamental pathological processes underlying the disease. One example is anti-B cell therapy, in particular rituximab (RTX). Until now RTX do not have a registration for the treatment of SSc, but there is a large positive experience of its use, which is reflected in recent meta-analyses and clinical recommendations. Complicated and expensive methods for obtaining genetically engineered biological preparations have contributed to the emergence of more accessible biosimilars, one of which is the RTX biosimilar, Acellbia (Biocad, Russian Federation). The “biosimilar” versions of RTX might reduce the cost of therapy and increase patients accessibility to this treatment option. The RTX biosimilar Acellbia (ACB) has received approval in Russian Federation in 2014 for all indications held by reference RTX (including rheumatoid arthritis and ANCA-associated vasculitis).The aim of this study was to investigate the efficacy and safety of Acellbia in patients with systemic sclerosis.Material and methods. Our prospective uncontrolled study included 20 patients (14 women) aged 50±14 years, with a disease duration of 3.5±2.7 years. Indications for the prescribing of ACB were high disease activity and the presence of risk factors for progression. All patients had radiological signs of interstitial lung disease, 13 (65%) were positive for antibodies to topoisomerase 1. None of the patients had previously been treated with biological therapy. All patients received glucocorticoids in low doses and 15 (75%) patients were not on concomitant immunosuppressants during the study. ACB was administered in doses of 2 g (two doses of 1 g with a weekly interval) at inclusion of the study and after 6–8 months according to the same scheme, cumulative dose – 4 g. An assessment of basic measurements was obtained at baseline (Point 0), before the second course (after 7.2±1.7 mo, Point 1) and at the end of follow-up (13.4±1.6 mo, Point 2). The results are presented in the form of mean values and standard deviations.Results. There was a positive effect on the main manifestations of the disease, which accompanied by stable depletion of CD19+ B lymphocytes in the peripheral blood. At the intermediate assessment (between points 0–1), no significant changes were observed, with the exception of the skin score. At the end of the study, most of the parameters showed a significant improvement between points 0–2. The activity of the disease (EScSG-AI) decreased, and the skin score decreased from 12.8±11 to 6.2±5.6 (p=0.002). The forced vital capacity (% of predicted) increased from 89±18.2 to 98.26±16.13% (p=0.0002), and the diffusion capacity of the lungs (% of predicted) increased from 56.8±15.7 to 61.9±17.2% (p&lt;0.019). A significant decrease in CRP, antitopoisomerase-1 antibodies, as well as IgG (from 12.6±2.6 to 10.2±2.2 g/l) was noted. Repopulation to normal level of B lymphocytes did not occur in any case, and complete depletion of B lymphocytes at the end of the study was maintained in 83% of patients (15 of 18). The quality of life questionnaire SHAQ improved (p=0.0001), and the average dose of prednisolone was reduced from 11.0±2.7 to 9.4±2.3 mg/day (p=0.03). Positive changes according to HRCT was evident in 9 (45%) patients due to a decrease in ground glass opacity. The frequency and spectrum of adverse events (AEs) corresponded to those already known for RTX. Of the 20 patients who received 2 courses of ACB, two withdrew from the evaluation at Point 2 due to pregnancy (1) and lung cancer (1). A total of 11 (55%) AEs were reported in 9 (45%) patients, most of them were classified as mild. Infectious complications developed in 7 (35%) patients: respiratory infections of the upper respiratory tract (4), positivity in the TB skin test (2), otitis (1), cystitis (1) and cholecystitis (1). One patient developed calf vein thrombosis and lung cancer was diagnosed in one case.Conclusion. Our data suggest that Acellbia could be used for the treatment of SSc. A short-term, prospective, uncontrolled study showed good efficacy and acceptable safety of the ACB biosimilar in SSc. A significant decrease of skin fibrosis and improvement of lung functions have been proven. The clinical effect of ACB manifested by the 6th month from the start of therapy and reached its maximum one year after its initiation. Due to the positive efficacy of ACB, it can be prescribed for the patients with SSc with ineffectiveness and/or intolerance to immunosuppressants, and could be considered as a first-line therapy. Our data should be confirmed by the results of controlled clinical trials.