High-sensitivity C-reactive Protein Research Articles

Cerebrovascular risk in rheumatoid arthritis patients: insights from carotid artery atherosclerosis in the Paracelsus 10,000 study

Rheumatoid arthritis (RA) is a chronic autoimmune disease marked by systemic inflammation. While RA primarily affects the joints, its systemic effects may lead to an increased cerebro- and cardiovascular risk. Atherosclerosis of the carotid arteries is a significant risk factor for cerebrovascular events and serves as a surrogate marker for cardiovascular risk. This study explores the link between RA and carotid artery atherosclerosis with data from the Paracelsus 10,000 Study. Baseline assessments were conducted on individuals randomly selected from Salzburg and its surrounding regions. Participants diagnosed with RA based on ACR-EULAR classification criteria and who underwent carotid artery ultrasound were included. Data were gathered from a total of 9729 participants, among whom 299 were diagnosed with RA. Carotid arteries were examined using ultrasound imaging. The primary endpoint was the difference in the prevalence of plaque presence between the RA and non-RA groups. One univariate (Model I) and three multivariate analyses were conducted, with adjustments in Model II incorporating SCORE 2, while Model III accounted for metabolic syndrome, age and sex. Additionally, Model IV included further adjustments for high-sensitivity C-reactive protein (hs-CRP). Plaque presence was defined as the ultrasound detection of plaque formation larger than 0 mm2, regardless of whether it was unilateral or bilateral. Additional assessments included carotid stenosis, intima-media thickness (IMT) and total plaque area (TPA). RA patients had a higher prevalence of plaque (50%) compared to non-RA individuals (38%). The odds ratio (OR) for plaque presence in RA patients versus non-RA individuals was 1.64 (95% CI 1.30–2.06). This association persisted after adjusting for SCORE2, with an adjusted odds ratio (aOR) of 1.65 (95% CI 1.26–2.15). The association remained significant when adjusting for metabolic syndrome, age and sex (aOR = 1.32, 95% CI 1.02–1.72) and also in Model IV, which included further adjustment for hs-CRP (OR = 1.33, 95% CI 1.02–1.74). The findings underscore an increased risk of cerebrovascular disease associated with RA. This study highlights the importance of thorough cerebrovascular and cardiovascular risk assessments, along with proactive management, for RA patients to reduce this risk. Recognizing the substantial impact of RA on stroke and cerebrovascular disease is important for enhancing patient care strategies. Carotid ultrasound appears to be an effective method for atherosclerosis screening in RA patients.

Short-term predictive value of sST2 in patients with STEMI following primary PCI: a prospective observational study

AimThe objective of this study was to investigate the level of soluble suppression of tumorigenicity-2 (sST2) in patients with acute ST-segment elevation myocardial infarction (STEMI) following primary percutaneous coronary intervention (PCI), and to provide a new biomarker for clinical management and prognosis assessment.MethodThis was a prospective study. 148 STEMI patients following primary PCI were enrolled and divided into 2 groups by the median value of sST2 and afterwards followed up for 30 days to access the occurrence of major adverse cardiac events (MACEs), which were defined as cardiovascular death, heart failure and recurrent MI.ResultssST2 ranged from 20.57 to 98.96 ng/mL. High sST2 group had higher MACEs rate compared to low sST2 group (28.8% vs. 8.0%, P = 0.001). sST2 was positively correlated with age (r = 0.181, P = 0.027), SYNTAX score (r = 0.257, P = 0.002), high-sensitive C-reactive protein (hs-CRP) (r = 0.225, P = 0.006), B-type natriuretic peptide (BNP) (r = 0.225, P = 0.006) and negatively with left ventricle ejection fraction (LVEF) (r = -0.197, P = 0.016). After adjustment for clinical variables, sST2 level (OR 3.680, P = 0.015) and LVEF (OR 0.880, P < 0.001) remained independent predictors of 30-days MACEs. In receiver operating characteristic curve (ROC) analyses, the area under the curve (AUC) of sST2 for predicting 30-days MACEs was 0.755(P < 0.001). The AUC of sST2 combining hs-CRP and LVEF for prediction was 0.828(95%CI [0.743–0.912], P < 0.001).ConclusionsST2 level after primary PCI was an independent risk factor of MACEs in STEMI patients through 30 days follow-up.

Association between Mediterranean diet and metabolic health status among adults was not mediated through serum adropin levels

BackgroundPrevalence of metabolic disorders has been increased in recent years around the world. The relationship between Mediterranean diet (MD) with metabolic health status and serum adropin levels has been less examined in Iranian adults. We investigated the association between MD compliance with metabolic health status and adropin hormone in Iranian adults.MethodsThis observational study was conducted on 527 men and women. Food intakes were evaluated by a validated food frequency questionnaire. Blood pressure and anthropometric parameters were measured. Fasting blood samples were drawn to measure serum adropin concentrations, blood glucose, triglycerides, high-density lipoprotein cholesterol, high sensitive C-reactive protein and insulin. Metabolic unhealthy (MU) status was defined as having ≥ 2 cardio-metabolic risk factors.ResultsAfter adjustments for potential confounders, subjects in highest versus lowest tertile of MD had 52% lower odds of MU status (OR = 0.48, 95%CI: 0.23–0.97). Stratified analysis revealed a significant association in normal-weight participants (OR = 0.12; 95%CI: 0.02–0.64), but not in those with overweight/obesity (OR = 0.66, 95%CI: 0.27–1.57). By excluding each component of MD, the association disappeared, except for three components (vegetables, nuts and grains). MD adherence was not significantly related to serum adropin levels in multivariable-adjusted model (unstandardized B= -0.19, 95%CI: -4.97, 4.59; P = 0.94). Serum adropin hormone levels were also not substantially different among metabolic healthy versus unhealthy subjects (P = 0.66).ConclusionsThis cross-sectional study showed an inverse association between adherence to MD and odds of MU status, especially in subjects with normal-weight. Serum adropin concentrations were not associated with MD adherence or metabolic health status.

Blood Biomarkers as a Non-Invasive Method for the Assessment of the State of the Fontan Circulation

The Fontan operation has become the primary palliative treatment for patients with a functionally univentricular heart. The population of patients with Fontan circulation is constantly growing and aging. As the number of Fontan patients surviving into adulthood increases, there is a clear need for research on how best to follow these patients and manage their complications. Monitoring blood biomarkers is a promising method for the non-invasive assessment of the Fontan circulation. In this article, we provide a comprehensive review of the available evidence on this topic. The following biomarkers were included: natriuretic peptides, red blood cell distribution width (RDW), cystatin C, high-sensitivity C-reactive protein, vitamin D, parathyroid hormone, von Willebrand factor, carbohydrate antigen 125, lipoproteins, hepatocyte growth factor, troponins, ST2 protein, galectin-3, adrenomedullin, endothelin-1, components of the renin–angiotensin–aldosterone system, norepinephrine, interleukin 6, tumor necrosis factor α, and uric acid. We did not find strong enough data to propose evidence-based recommendations. Nevertheless, significantly elevated levels of brain natriuretic peptide (BNP)/N-terminal prohormone of BNP (NT-proBNP) are most likely associated with the failure of the Fontan circulation. The use of the RDW is also promising. Several biomarkers appear to be useful in certain clinical presentations. Certainly, robust longitudinal, preferably multicenter, prospective studies are needed to determine the sensitivity, specificity, evidence-based cut-off values and overall predictive value of different biomarkers in monitoring Fontan physiology.

Associations between body mass index, high-sensitivity C-reactive protein, and depressive symptoms: NHANES 2015-2016

ObjectiveStudies have shown associations between Body Mass Index (BMI), High-Sensitivity C-reactive protein (HSCRP), and depressive symptoms(DP). However, the complex relationship between them remains uncertain. The objective of this research is to examine the correlation between them in a substantial sample that is representative of the national level.MethodsOur analysis was based on the 2015-2016National Health and Nutrition Examination Survey (NHANES).DP was measured by the Patient Health Questionnaire-9 (PHQ-9). Using multivariable logistic regression analysis and stratified analysis, we examined the relationship between BMI, HSCRP, and DP. We applied generalized additive models to explore the non-linear relationships among variables.ResultsThis study included a total of 4834 participants. The results revealed that BMI (P=0.002) and HSCRP (P=0.008) were risk factors for DP. The relationship between BMI and DP (P=0.035), BMI and HSCRP (P&amp;lt;0.001) were non-linear. The nonlinear association between HSCRP and DP (P=0.031), BMI and DP (P=9e-04) is significant in females when stratified by gender. No nonlinear association was found between BMI and DP (P =0.677) and between HSCRP and DP (P =0.439) in males. The results of the interaction test reveal a significant interaction between HSCRP and gender.ConclusionsResearch has found both BMI and HSCRP are risk factors for DP and the relationship between them was non-linear. The nonlinear associations between BMI and DP, as well as between HSCRP and DP, are gender-dependent.

The Effect of Prebiotics, Alone or as Part of Synbiotics, on Cardiometabolic Parameters in Women with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background/Objectives: This systematic review and meta-analysis aimed to investigate the effect of prebiotics, alone or as part of synbiotics, on cardiometabolic parameters in polycystic ovary syndrome (PCOS) women. Methods: Databases, including PubMed, Scopus, ISI Web of Science, Embase, and the Cochrane Central Register of Controlled Trials, were searched for relevant randomized-controlled trials (RCTs) until 12 December 2024. Changes in mean ± standard deviations were extracted and combined using a random-effects model. Bias was assessed using Cochrane risk of bias and evidence quality with GRADE. Results: Twenty RCTs with 1271 participants were included. Results showed high-quality evidence supporting prebiotics’ effects, alone or as part of synbiotics, in reducing body-mass index [n = 853; weighted-mean difference (WMD): −0.510, 95%CI: −0.669, −0.351 kg/m2] and diastolic blood pressure (WMD: −2.218, 95%CI: −4.425, −0.010 mmHg), moderate-quality evidence for weight, waist-to-hip ratio, and triglycerides improvements, and low or very-low-quality evidence for waist circumference (WC), fat mass, fasting plasma glucose, fasting insulin, low-density lipoprotein (LDL), total cholesterol (TC), high sensitive-C reactive protein, total testosterone, follicle-stimulating hormone and free androgen index improvements. Subgroup analyses revealed possible reduction in LDL with prebiotics, as well as possible decreases in WC, TC, and total testosterone with synbiotics. Dietary approaches to stop hypertension diet improved insulin sensitivity. Conclusions: This study suggests that prebiotics may beneficially affect several cardiometabolic parameters in PCOS women. Approximately one-third of the results were based on moderate-to-high-quality evidence. This study highlights the need for future well-designed, larger RCTs with longer treatment duration to strengthen the evidence base and guide clinical decision-making.

The Era of Risk Factors Should End; the Era of Biologic Age Should Begin

Introduction: Risk factors, a 75-year-old concept, are instrumental in the management of the general population. Newer biomarkers can explain residual risk and protection from risk. The population needs a new platform to make more comprehensible the importance of managing risk. Biologic age, the number of years left to live, is the platform that will receive the attention of patients. Method: Risk factor odds ratios are used to approximate the years lost to the modifiable risk, calculating a biologic age. Newer biomarkers confirm the predication and can be used to explain the pleomorphic properties of medications and unrealized risk. The biomarkers represent the following biologic processes: repair, inflammation, immune function, hematologic, clotting factors, metabolic-nutritional, organ maintenance, anthropomorphic, environmental, endothelial function, sleep, co-morbidities, frailty, and electromagnetic. Risk factors and biomarkers are ranked in the order of significance in reducing biologic age. Results: A six-step method of patient management using biologic age and biomarkers is presented. Conclusions: Knowledge of risk factors and therapies to improve risk has increased over the last 75 years. Biologic age is more appropriate in explaining the significance of this knowledge and may improve patient compliance to lifestyle changes and medication compliance. Appropriate counseling with utilization of biomarkers of biologic processes, such as high sensitivity-CRP, circulating stem cells, number of co-morbidities, frailty, electrocardiogram, and pulse wave velocity will improve compliance and personalize care. The 6-minute walk should be incorporated into the vital signs due to prognostic significance.

Associations of Exposure to 56 Serum Trace Elements with the Prevalence and Severity of Acute Myocardial Infarction: Omics, Mixture, and Mediation Analysis.

Several studies have reported associations between specific heavy metals and essential trace elements and acute myocardial infarction (AMI). However, there is limited understanding of the relationships between trace elements and AMI in real-life co-exposure scenarios, where multiple elements may interact simultaneously. This cross-sectional study measured serum levels of 56 trace elements using inductively coupled plasma mass spectrometry. We identified individual trace elements linked to AMI using four feature selection methods and evaluated their associations with AMI prevalence and severity through multiple-element logistic regression. Restricted cubic spline analysis was employed to examine non-linear associations. Additionally, we explored the associations between trace element mixtures and AMI prevalence and severity using Bayesian kernel machine regression (BKMR) and element risk score (ERS). Finally, we investigated the potential mechanisms linking trace element exposure to AMI. We detected stable positive associations and linear relationships between Cu and Rb and AMI prevalence and severity. Furthermore, lower Fe concentrations were associated with higher AMI prevalence, while higher Sb concentrations were linked to greater AMI severity. Both BKMR and ERS models indicated positive associations between trace element mixtures and AMI prevalence and severity. Mediation analysis suggested that high-sensitivity C-reactive protein partially mediated the associations between trace elements and AMI prevalence and severity. We provide the first epidemiological evidence of the associations between serum trace element mixtures and AMI prevalence and severity. Under conditions of trace element co-exposure, Cu, Rb, Fe, and Sb were closely associated with AMI. Additionally, our results indicate that hsCRP (inflammation) may be a potential mechanism linking trace elements to AMI.

Elevated High Sensitivity C-Reactive Protein and Risk of Abdominal Aortic Aneurysm: A Prospective Population Based Study in The Norwegian HUNT Study.

Inflammation seems to be crucial in the pathogenesis of abdominal aortic aneurysm (AAA). Previous research links inflammatory biomarkers, such as high sensitivity C-reactive protein (HS-CRP), to AAA. Few studies, however, have used a prospective design. The aim of this study was to examine whether individuals with elevated HS-CRP have increased risk of AAA, using a prospective and population based design. This prospective, population based, cohort study included 46 322 participants in the Trøndelag Health Study (HUNT) in Norway (53.7% women). During a median follow up time of 12.6 years (range 0 - 26 years), 407 individuals were diagnosed with AAA (28.8% women). Cox proportional hazard regression was applied to examine associations between HS-CRP and risk of AAA. HS-CRP was treated either as a continuous or a categorical variable (dichotomised at 2 mg/L, 1 mg/L, median (1.2 mg/L), or as quartiles). The hazard ratio (HR) of developing AAA per 1 mg/L increase in HS-CRP (continuous HS-CRP) was 1.02 (95% CI 1.01 - 1.03) in the analysis adjusted for smoking, coronary heart disease, hypertension, diabetes, body mass index, and total cholesterol. Individuals with HS-CRP 2 mg/L or above had almost twice the risk of AAA compared with individuals with HS-CRP less than 2 mg/L (adjusted HR 1.84; 95% CI 1.51 - 2.25). Dichotomising HS-CRP at a clinical cut off point of 1 mg/L (adjusted HR 2.13, 95% CI 1.64 -2.76), or at the median of 1.2 mg/L (adjusted HR 2.12, 95% CI 1.62 - 2.76), slightly strengthened the HR. The adjusted HR gradually increased through the ordered HS-CRP quartiles, and was almost four times higher (HR 3.87, 95% CI 2.54 - 5.92) in the highest HS-CRP quartile (HS-CRP > 2.7 mg/L) compared with the lowest quartile (HS-CRP ≤ 0.6 mg/L). Individuals with elevated HS-CRP had significantly increased risk of developing AAA.

Mendelian Randomization Study on hs-CRP and Dyslipidemia in Koreans: Identification of Novel SNP rs76400217

High-sensitivity C-reactive protein (hs-CRP) is a marker of systemic inflammation and is associated with developing dyslipidemia. However, the causality between hs-CRP and dyslipidemia remains unresolved. This study aimed to investigate the relationship between hs-CRP concentrations and dyslipidemia and to explore the potential causal link using Mendelian randomization (MR) analysis. A nested case–control study was conducted with 1174 participants, and genotype data were analyzed using the Korean Chip. A genome-wide association study (GWAS) identified rs76400217 as a suitable instrumental variable (IV) due to its significant association with hs-CRP (p &lt; 10−8). Logistic regression models, adjusted for confounders, were used to evaluate the association between hs-CRP and dyslipidemia. An MR analysis was performed using a two-stage least squares (2SLS) method, with rs76400217 as the IV to assess causality. Logistic regression showed a significant association between hs-CRP concentrations and dyslipidemia (OR 2.08, 95% CI: 1.81–2.39, p &lt; 0.001). This association remained significant after adjusting for factors such as age, sex, alcohol consumption, and BMI. The MR analysis using rs76400217 as the IV confirmed the strong associations with hs-CRP concentrations (p &lt; 0.001) in all models, but the causality between hs-CRP and dyslipidemia was not statistically significant. Thus, no evidence of a causal relationship between hs-CRP and the risk of dyslipidemia was found in the Korean population. The strong association observed between hs-CRP and dyslipidemia may be due to other contributing factors rather than a direct cause.

AZD2693, a PNPLA3 antisense oligonucleotide, for the treatment of MASH in 148M homozygous participants: two randomized phase I trials.

A common genetic variant (rs738409) encoding isoleucine to methionine at position 148 in the PNPLA3 protein is a determinant of hepatic steatosis, inflammation, fibrosis, cirrhosis, and liver-related mortality. AZD2693 is a liver-targeted antisense oligonucleotide against PNPLA3 mRNA. We evaluated the safety, tolerability, pharmacokinetics, and pharmacodynamics in single ascending dose (SAD) and multiple ascending dose (MAD) studies. AZD2693 was assessed in 3D cultures of homozygous PNPLA3 148M primary human hepatocytes and mice expressing human PNPLA3. The SAD study investigated 2-110 mg doses in overweight/mildly obese but otherwise healthy volunteers. The MAD study investigated three monthly doses (25 mg, 50 mg and 80 mg) in participants with magnetic resonance imaging proton density fat fraction (MRI-PDFF) ≥ 7%. Changes in liver fat content were assessed at baseline, weeks 8 and 12 by MRI-PDFF. PNPLA3 mRNA and protein knockdown levels were evaluated for the 80 mg dose. AZD2693 potently reduced PNPLA3 expression in human hepatocytes and livers of mice. Clinically, AZD2693 was generally well tolerated (no adverse events leading to discontinuation or treatment related serious adverse events). Half-life was 14-33 days across investigated doses. A least-square (LS) mean liver PNPLA3 mRNA knockdown of 89% and reduction of protein levels demonstrated target engagement. Changes in hepatic steatosis at week 12 were -7.6% and -12.2% (placebo-corrected LS means) for the 25 mg and 50 mg doses, respectively. There was a dose-dependent increase of polyunsaturated fatty acids in serum triglycerides and decreases vs placebo in high-sensitivity C-reactive protein and interleukin 6. AZD2693 reduced liver PNPLA3 with an acceptable safety and tolerability profile. These findings support the continued development of AZD2693. NCT04142424, NCT04483947 IMPACT AND IMPLICATIONS: Clinical treatment options for MASH are limited. The genetic risk factor with the largest effect size for progressing to poor liver-related outcomes in MASH is a single-nucleotide polymorphism in the gene PNPLA3 (p.I148M). In Phase 1 SAD and MAD studies, AZD2693, a liver-targeted antisense oligonucleotide was well tolerated, reduced liver PNPLA3 mRNA and protein levels, and dose dependently reduced liver fat content in homozygous PNPLA3 148M risk allele carriers. These data support continued development of AZD2693 as a potential precision medicine treatment for MASH. The Phase 2b FORTUNA study is now ongoing.

Effect of Probiotics on C-Reactive Protein Levels in Schizophrenia: Evidence from a Systematic Review and Meta-Analysis.

Inflammatory markers play a pivotal role in schizophrenia, as they provide insight into the neuroinflammatory processes occurring in the context of the disorder. Elevated levels of these markers, particularly C-reactive protein (CRP), can indicate an underlying immune system dysregulation, potentially influencing symptom severity and progression. Recognizing these markers has led to investigate the use of probiotics as an adjuvant to improve the treatment of schizophrenia. The main objective of this study is to rigorously evaluate the efficacy of probiotics in reducing plasma levels of CRP in patients with schizophrenia. A systematic search and meta-analysis were conducted to review randomized clinical trials following the PRISMA methodology. The following search strategy ((SCHIZO* OR PSYCHOTIC OR PSYCHOSES) AND (PROBIOTIC* OR BIFIDOBACTER* OR LACTOBACILL*)) was used for searching publications between June-December 2024 on the PubMed, Web of Science, and APA PsycINFO databases. Individual study quality was assessed with the Cochrane risk of bias (RoB2) and the certainty of total evidence was assessed with the GRADE system. The primary outcome assessed was the impact of probiotic supplementation on plasma CRP levels. Out of 78 studies initially identified, 4 were finally included in the meta-analysis. Three out four studies found a significant reduction in high-sensitivity C-reactive protein levels in the supplemented compared with the placebo group. The pooled analysis revealed a significant reduction in CRP levels with probiotic supplementation, with a standardized mean difference (SMD) of -0.46, (95% CI -0.719; -0.201; p = 0.001). The synthesis and meta-analysis of available literature provide evidence for the potential role of probiotics in the reduction of serum CRP in schizophrenia compared with placebo. However, more clinical trials with better control of experimental design are needed before a clear recommendation as adjuvant therapy can be made.

Association of Estimated Glomerular Filtration Rate (eGFR) and High-Sensitivity C-Reactive Protein (Hs-CRP) with the Risk of New-Onset Atrial Fibrillation in Patients with Diabetes.

Both renal function decline and systemic inflammation may synergistically increase the risk of atrial fibrillation (AF). This study investigates the association between estimated glomerular filtration rate (eGFR) and high-sensitivity C-reactive protein (hs-CRP) levels with the risk of new-onset AF in patients with diabetes mellitus. We included diabetic patients without AF who participated in physical exams in the Kailuan Study from 2006 to 2010. Participants were categorized into four groups based on baseline eGFR and hs-CRP levels: 1) high eGFR (≥60 mL/min/1.73m²) and low hs-CRP (<3 mg/L) (n=6,915), 2) high eGFR and high hs-CRP (≥3 mg/L) (n=3,154), 3) low eGFR (<60 mL/min/1.73m²) and low hs-CRP (n=4,638), 4) low eGFR and high hs-CRP (n=1,809). We employed multivariable Cox regression analysis to evaluate the relationships between eGFR, hs-CRP, and new-onset AF, adjusting for confounders including smoking status, alcohol consumption, blood pressure, fasting blood glucose (FBG), heart rate, lipid levels, body mass index (BMI), and medication usage. Competing risk analysis was also performed. Among 16,516 patients, 222 developed new-onset AF over a mean follow-up of 12.6 years. After adjusting for confounders, elevated hs-CRP and reduced eGFR were significantly associated with higher risk of new-onset AF compared to the high eGFR/low hs-CRP group. These findings remained consistent after excluding AF cases within the first 2-year. No significant interaction between eGFR and hs-CRP was observed (P=0.227). Subgroup analysis revealed that the combination of eGFR and hs-CRP had predictive value primarily in males under 60 years of age, individuals with FBG <9mmol/L, hypertension, and those not on hypoglycemic medications. In diabetic patients, decreased eGFR and elevated hs-CRP were independently linked to an increased risk of new-onset AF, emphasizing the importance of monitoring these factors for early detection and prevention of AF.

Efficacy and safety evaluation of Boswellia serrata and Curcuma longa extract combination in the management of chronic lower back pain: A randomised, double-blind, placebo-controlled clinical study.

Chronic lower back pain (CLBP) is a major condition that leads to disability and reduced quality of life (QoL). This randomised, double-blind, placebo-controlled clinical study evaluated the efficacy and safety of a novel Boswellia serrata and Curcuma longa combination (CL20192) for the treatment of CLBP. Participants with CLBP were randomised to receive either a 300 mg CL20192 capsule (n = 45) or placebo capsule (n = 45) once daily for 90 days. Efficacy was evaluated using the Descriptor Differential Scale and Oswestry Disability Index scores for pain, unpleasantness, and disability. Additionally, the 36-item short form questionnaire was used for QoL evaluation. Frequency of painkiller use, serum levels of inflammatory biomarkers (tumour necrosis factor-α, interleukin-6, and high-sensitivity C-reactive protein), and phytoconstituents (total boswellic acids and curcuminoids) were determined. Therapy satisfaction was assessed using the Physician and Patient Global Assessment Scales. All randomised participants completed the study. CL20192 supplementation significantly reduced Descriptor Differential Scale pain, unpleasantness, and Oswestry Disability Index scores compared with the placebo group (p < 0.001 for all parameters). Critical QoL scores greatly improved in the CL20192 group. Serum phytoconstituent levels were elevated in the CL20192-treated group. This group demonstrated a significant reduction in inflammatory biomarker levels (tumour necrosis factor-α, interleukin-6, and high-sensitivity C-reactive protein), confirming efficacy in abating CLBP compared with the placebo. Moreover, therapy satisfaction scores were significantly high in the CL20192-treated group, and intervention with CL20192 was well tolerated. Intervention with 300 mg CL20192 capsules, containing a novel combination of Boswellia serrata and Curcuma longa extracts, effectively alleviated pain, unpleasantness, and disability in patients with CLBP compared with the placebo. This outcome was consistent with a decrease in serum inflammatory markers and improved therapy assessment scores.

Impact of Vitamin D Deficiency on Cardiovascular Risk in Diabetic Patients

An accumulating body of evidence has established that one of the clinical implications of vitamin D deficiency in diabetes mellitus (DM) is the contribution of cardiovascular disease (CVD) among different groups. Objectives: This study aims to investigate the correlation of Vitamin D levels with cardiovascular risk and their association in diabetic patients compared to healthy controls, along with the correlation with significant biomarkers. Materials and Methods: This cross-sectional study was conducted on 240 participants (120 diabetic patients and 120 control group). Standardized approaches were used to evaluate Serum Vitamin D concentrations, lipid profiles, glycaemic parameters, pro-oxidant biomarkers, and inflammatory biomarkers. T-tests and correlation analyses were performed to conduct statistical analyses of significant associations. Results: The diabetic group had significantly lower vitamin D status (13±5 ng/mL) compared to healthy subjects (28.2±8 ng/mL, p&lt;0.001). Vitamin D was found to have strong inverse correlations with low-density lipoprotein (LDL) (r = -0.65, p &lt; 0.001), high-sensitivity C-reactive protein (hs-CRP) (r = -0.58, p &lt; 0.001), and systolic blood pressure (r = -0.52, p &lt; 0.001). Based on sex, it was found that the prevalence of vitamin D deficiency was 65 % among women as compared to 45 % among men (p &lt; 0.05).

IINS Vs CALLY Index: A Battle of Prognostic Value in NSCLC Patients Following Surgery.

This research sought to assess the predictive potential of the inflammation-immunity-nutrition score (IINS) and the high-sensitivity C-reactive protein-albumin-lymphocyte (CALLY) index in individuals with NSCLC post-surgery. The study enrolled 506 patients with NSCLC undergoing R0 resection at the First Affiliated Hospital of Xi'an Jiaotong University. The training cohort was analyzed utilizing X-tile software to identify the ideal threshold values for categorizing high-sensitivity C-reactive protein, albumin, lymphocyte count, and the CALLY index. The predictive significance of the IINS and CALLY index was evaluated through Kaplan-Meier survival curves and univariate and multivariate Cox regression analyses. Predictive capabilities of the IINS and CALLY index were compared utilizing receiver operating characteristic (ROC) curve analysis, time-dependent ROC curve analysis, and decision curve analysis (DCA). Internal validation was performed in the validation cohort and all data from both the training and validation cohorts using Kaplan-Meier curves and DCA. Patients with lower IINS exhibited prolonged overall survival (OS), whereas those with lower CALLY had shorter OS. Multivariate analysis identified N stage, NSE, and IINS as independent prognostic factors for individuals with NSCLC. ROC analysis revealed that IINS provided superior prognostic performance to CALLY and other traditional indicators (CAR, PLR, and NLR). Time-dependent ROC analyses and DCA further confirmed the superior prognostic value of IINS over the CALLY index at 1, 2, and 3 years. This study reveals that both the IINS and CALLY index are effective in forecasting the prognosis of individuals with NSCLC following surgery, with the IINS demonstrating superior prognostic efficacy to the CALLY index.

Serum angiopoietin-2/angiopoietin-1 ratio is associated with cardiovascular and all-cause mortality in peritoneal dialysis patients: a prospective cohort study

Introduction Our objective was to examine the factors associated with the serum angiopoietin-2/angiopoietin-1 (Angpt-2/Angpt-1) ratio in peritoneal dialysis (PD) patients and to investigate the association between Angpt-2/Angpt-1 ratio and cardiovascular and all-cause mortality. Methods Patients on PD who were prevalent between January 2014 and April 2015 in the center of Renji Hospital were enrolled. At the time of enrollment, serum and dialysate samples were collected to detect biochemical parameters, serum angiopoietin-2 and angiopoietin-1 levels. Patients were dichotomized into two groups according to a median of Angpt-2/Angpt-1 ratio and followed up prospectively until the end of the study. Results A total of 325 patients were enrolled, including 168 males (51.7%) with a mean age of 56.9 ± 14.2 years and a median PD duration of 32.4 (9.8-55.9) months. Multiple linear regression showed pulse pressure (β = 0.206, p < .001) and high-sensitivity C-reactive protein (hs-CRP) (β = 0.149, p = .011) were positively correlated with serum Angpt-2/Angpt-1 ratio, while residual renal function (RRF) (β= −0.219, p < .001) was negatively correlated with serum Angpt-2/Angpt-1 ratio. Multivariate Cox regression analysis showed the high serum Angpt-2/Angpt-1 ratio was an independent predictor of cardiovascular mortality (hazard ratio (HR)=2.467, 95% confidence interval (CI) 1.243–4.895, p = .010) and all-cause mortality (HR = 1.486, 95%CI 1.038–2.127, p = .031). In further subgroup analysis by gender, a significant association was shown in high Angpt-2/Angpt-1 ratio with all-cause mortality in male (p < .05), but not in female patients (p>.05). Conclusions High Angpt-2/Angpt-1 ratio is an independent risk factor for cardiovascular and all-cause mortality in PD patients.

Effect of long term treatment with antiepileptic drugs on carotid intima-media thickness as an indicator of atherosclerosis

Purpose: The aim of current study was to investigate the possible relation between antiepileptic drugs (AEDs) and atheosclerotic risk factors and carotid intima media thickness (IMT) as a marker of atherosclerosis. Materials and Methods: Ninety-two patients, who had used carbamazepine (CBZ) and valproic acid (VPA) for three or more years and who had used a second AED (polytherapy) for two years in addition to CBZ or VPA monotherapy, were included in the study. The control group was composed of 31subjects with similiar demographics. Fasting blood glucose, liver and renal function tests, lipid profile, homocysteine, serum high sensitivity C-Reactive Protein (Hs-CRP), uric acid (UA), lipoprotein (a) (Lp (a)), folate and vitamine B12 levels were examined in both groups. Results: Homocysteine levels were higher in the VPA, CBZ and politherapy groups compared to the control group. UA levels were higher in the VPA monotherapy group when compared to the CBZ monotherapy and polytherapy group. In the CBZ monotherapy group, Hs-CRP levels were higher than in the VPA monotherapy, polytherapy and control groups. Total cholesterol levels were higher in the CBZ monotherapy group when compared to the VPA monotherapy and control groups. Conclusion: The findings showed no correlation between IMT values and duration of disease, duration of drug usage and dose, which suggests that long-term AED usage does not increase the development of atherosclerosis.

The relationship between serum vitamin C levels and high-sensitivity C-reactive protein in children

The relationship between serum vitamin C levels and high-sensitivity C-reactive protein in children

Analysis of Mortality in Patients with Acute Myocardial Infarction after Revascularization

Annotation. The objective of the study was to conduct a comparative analysis of the clinical and functional characteristics of the course of acute myocardial infarction (STEMI) after revascularization in patients who died and those who survived. The study included 286 patients with an average age of 62.8±9.8 years. Among the participants, 202 (70.6%) were men and 84 (29.4%) were women. All patients were hospitalized within 12 hours from the onset of pain syndrome, and all underwent urgent coronary angiography and stenting of the infarct-related artery. All patients underwent a general clinical examination, laboratory diagnostics including the determination of hemoglobin, glucose, creatinine, cystatin C, troponin I, C-reactive peptide; coronaroventriculography, 12-lead electrocardiography, and echocardiography according to the standard protocol. Statistical analysis of the obtained results was performed using the STATISTICA 6.1 software package, version No. ВХХR901E246022FA, and Microsoft Excel. It was found that 28 individuals (9.8%) died during the hospitalization stage. The average age of the deceased was 62.5 (55.5; 70.5) years, which does not significantly differ from that of the surviving patients. There was no statistical difference in gender characteristics either, with 21 (75.0%) men among the deceased and 181 (70.2%) men among the survivors, p=0.59. In the group of deceased patients, there was a significantly higher number of individuals with multivessel coronary artery disease, specifically 13 (46.4%) compared to 74 (28.7%), p=0.005. Among the surviving patients, there was a significantly higher number of individuals with single-vessel disease: 6 (21.4%) compared to 102 (39.5%), p=0.06. Among the deceased patients, acute heart failure Killip IV, p=0.009, and conduction disorders, p=0.01, were significantly more frequently diagnosed. In the group of deceased individuals, the levels of C-reactive peptide were significantly higher at 13.2 (5.5; 19.5) compared to 10.0 (6.0; 16.0), p=0.05; cystatin C levels were 1.61 (0.98; 1.51) compared to 1.23 (0.97; 1.38), p=0.05; and glucose levels were 8.8 (5.8; 12.1) compared to 7.1 (5.9; 10.0), p=0.05. So, among patients with STEMI, 28 individuals (9.8%) died during the hospital stage after urgent revascularization. Among the deceased patients, acute heart failure Killip IV and conduction disorders (sinoatrial and atrioventricular block) were significantly more frequently diagnosed, which became the cause of death. One of the most clinically and statistically significant factors distinguishing the comparison groups was the predominance of patients with multivessel disease. In the group of patients who died in the hospital, significantly higher levels of CRP, cystatin C, and glucose were noted. The level of cystatin C is a more sensitive diagnostic criterion in deceased patients compared to creatinine.