Higher Serum C-reactive Protein Research Articles

Prognostic Risk Stratification of Patients with Urothelial Carcinoma of the Bladder with Recurrence After Radical Cystectomy

We identify clinicopathological variables predicting overall survival in patients with recurrent bladder urothelial carcinoma after radical cystectomy. We retrospectively collected data on 114 patients treated with radical cystectomy for bladder urothelial carcinoma who subsequently had remote metastasis and/or local recurrence. The Kaplan-Meier method with the log rank test and multivariate Cox regression models were used to address overall survival after recurrence. During followup 99 of the 114 patients died. Median survival in the 114 patients was 11.2 months. One and 3-year overall survival rates were 48.0% and 12.1%, respectively. On multivariate analysis independent predictors of poorer overall survival included less than 1 year to recurrence, symptoms at recurrence, 2 or more metastatic organs at recurrence, high serum C-reactive protein, high lactate dehydrogenase, no post-recurrence platinum based chemotherapy and no metastasectomy. Based on the 4 variables (time to recurrence, symptoms, number of metastatic organs and C-reactive protein), we constructed a risk model predicting post-recurrence overall survival that classified patients into 3 groups with significantly different overall survival (p <0.0001). Our data confirm that recurrent urothelial carcinoma after radical cystectomy is a highly aggressive, lethal disease. Seven clinicopathological factors were identified that predicted post-recurrence overall survival. Our risk model based on the 4 variables could be useful to provide relevant prognostic information to patients and physicians, and better stratify patients in clinical trials.

Validation of CRP as prognostic marker for renal cell carcinoma in a large series of patients.

BackgroundTo evaluate the prognostic significance of the pre-operative C-reactive protein (CRP) serum level in patients with renal cell cancer (RCC).MethodsWe evaluated 1,161 RCC patients with complete patient and tumour specific characteristics as well as information about their pre-operative CRP-level, who had undergone either radical nephrectomy or nephron-sparing surgery at two German high-volume centres (University Hospitals of Hannover and Ulm). The mean follow-up was 54 months.ResultsThe CRP-level, stratified to three subgroups (CRP ≤ 4, 4–10, and >10 mg/l), correlated significantly with tumour stage (p < 0.001), the risk of presenting nodal disease (2.1, 3.1, and 16.4%) and distant metastasis (2.9, 8.6, and 30.0%; p < 0.001). The Kaplan-Meier 5-year cancer specific survival (CSS) rates were 89.4, 77.9, and 49.5%, respectively (p < 0.001). Multivariate analysis identified CRP as an independent prognosticator for CSS as well as overall survival (p < 0.001). Patients with a CRP of 4–10 and >10 mg/l had a 1.67 and 2.48 fold higher risk of dying due to their RCC compared to those with a pre-operative CRP ≤4 mg/l, respectively.ConclusionsA high preoperative serum CRP level is an independent predictor of poor survival in patients with RCC. Its routine use could allow better risk stratification and risk-adjusted follow-up of RCC patients.

Prognostic role of pre‐transplantation serum C‐reactive protein levels in patients with acute leukemia undergoing myeloablative allogeneic stem cell transplantation

The aim of this study was to identify indicators of outcome prior to transplantation in allogeneic hematopoietic stem cell transplantation (HCT). Clinical data of 106 patients with acute leukemia were retrospectively analyzed. We examined the role of pre-conditioning serum C-reactive protein (CRP) and ferritin levels, HCT-CI and European Group for Blood and Marrow Transplantation (EBMT) scores on transplant toxicities, transplant-related mortality (TRM), progression-free survival (PFS), and overall survival (OS). High pre-conditioning serum CRP levels showed a positive correlation with higher EBMT scores (p < 0.001), HCT-CI (p = 0.004), and ferritin levels (p < 0.001). In univariate Cox regression analysis, serum CRP ≥10 mg/L, serum ferritin ≥1500 ng/mL, and HCT-CI ≥3 had a significant adverse effect on OS. Serum CRP ≥10 mg/L and HCT-CI ≥3 predicted increased risk of TRM in univariate analysis. Multivariate Cox regression analysis showed that HCT-CI score ≥3 independently predicted increased risk of TRM and CRP ≥10 mg/L predicted increased risk of disease progression. Although CRP lost its significance on TRM in multivariate analysis, as an inexpensive and readily available serum biomarker of inflammation, the prognostic role of pre-transplant CRP levels should be analyzed in selected diseases and increased number of patient groups.

Maternal C-Reactive Protein at Hospital Admission Is a Simple Predictor of Funisitis in Preterm Premature Rupture of Membranes

Aim: To analyze the prognostic value of maternal serum C-reactive protein (CRP) in predicting funisitis in patients with preterm premature rupture of membranes (pPROM). Methods: 66 patients (gestational age 24–33 weeks) hospitalized 1–12 h after pPROM were enrolled. White blood cell count (WBC), platelet count (PLT) and plasma concentration of CRP were assessed every 3 days. Histological evidence of chorioamnionitis and funisitis was obtained post-partum. Receiver operating characteristic (ROC) curves were employed to evaluate the role of maternal CRP in predicting funisitis. Results: Funisitis was found in 24 patients (36.3%); 42 patients (63.7%) without funisitis were considered as controls. PLT and WBC at admission and before delivery did not show significant differences and were not statistically different between the two groups. Patients with funisitis had significantly higher CRP levels both at admission to hospital and 24– 48 h before delivery. ROC curve analysis showed that CRP at admission (area under the curve: 0.671, p = 0.021) and before delivery (area under the curve: 0.737, p = 0.001) are predictive of funisitis. Conclusions: High maternal serum CRP levels (>20,000 µg/l) in pPROM patients at admission to hospital may be an early marker which indicates, with a good diagnostic performance, the presence of funisitis.

The Risk Factors for Nosocomial Infection in Chinese Patients with Active Rheumatoid Arthritis in Shanghai

Objective. To analyse the potential risk factors of nosocomial infections in patients with active rheumatoid arthritis (RA). Methods. A total of 2452 active RA patients at Hospitals in Shanghai between January 2009 and February 2011 were analyzed. Their demographic and clinical characteristics were compared with those without infection, and the potential risk factors were determined by logistic regression analysis. Results. Multivariate analysis indicated the gender (OR = 0.70, 95% CI 0.53–0.92), duration in hospital (OR = 1.03 , 95%CI 1.01–1.05), number of organs involved (OR = 0.82, 95%CI 0.72–0.92), number of disease-modifying antirheumatic drugs ((DMARDs) (OR = 1.22, 95%CI 1.061–1.40)), corticosteroid therapy (OR = 1.02, 95%CI 1.01–1.03), peripheral white blood cell counts ((WBC) (OR = 1.04, 95%CI 1.00–1.08)), levels of serum albumin (OR = 0.98, 95%CI 0.97–0.99), and C-reactive protein ((CRP) (OR = 1.03 , 95%CI 1.01–1.04)) that were significantly associated with the risk of infections. Conclusion. The female patients, longer hospital stay, more organs involved, more DMARDs, corticosteroid usage, high counts of WBC, lower serum albumin, and higher serum CRP were independent risk factors of infections in active RA patients.

The role of serum C-reactive protein in women with lower urinary tract symptoms

Some lower urinary tract dysfunction (LUTD) subtypes may be associated with low-grade inflammation. This study aimed to investigate the role of serum C-reactive protein (CRP) levels in women with lower urinary tract symptoms (LUTS). A total of 197 consecutive women with non-stress urinary incontinence (non-SUI) LUTS and 18 healthy women without LUTS (normal controls) were enrolled. LUTS include urinary storage, voiding, and post-micturition symptoms. Patients with previous bladder or urethral surgery, active urinary tract infections, or possible neurogenic lesions were excluded. Serum CRP levels were measured before any treatment was given. Patients were stratified to LUTD subgroups based on a 3-day voiding diary, uroflowmetry, and selective videourodynamic studies. Median CRP levels were significantly higher in women with overactive bladder (OAB) wet (i.e., with urgency incontinence, n = 30, 0.12 mg/dl) than those in women with bladder oversensitivity (n = 68, 0.075 mg/dl, P = 0.008) and the control group (0.055 mg/dl, P = 0.032). Further analysis revealed that body mass index and maximum flow rate were two independent factors that affected CRP levels. The area under the receiver-operating characteristic curve for using CRP to predict OAB wet was 0.55, and the most predictive cutoff point for CRP was 0.15 mg/dl (sensitivity 43.5 %, specificity 72.7 %). High serum CRP levels were found in women with OAB wet, and they were related to lower maximum urinary flow rates and higher body mass indices in non-SUI LUTD. However, serum CRP is not a suitable biomarker for discriminating between subtypes of non-SUI LUTD.

P227 Efficacy of infliximab in paediatric Crohn's disease patients

Background: In recent years, the therapeutic application of the anti-tumour necrosis factor (TNF)-a antibody, infliximab (IFX) has expanded for both inducing and maintaining remission in young Crohn’s disease (CD) patients. However, there are very few outcome reports from Japan in this clinical setting. With this in mind, we became interested to evaluate the clinical efficacy and safety of IFX in paediatric CD patients. Methods: In a single centre setting, we enrolled 15 paediatric CD patients, age 11 17yr, with mild to severe disease, CD activity index (CDAI) 256.3±88.7, and CD duration 4.1±2.5yr. All patients had received 5-aminosalicylic acid based medications, but none had received an immunomodulator (IM) like azathioprine or 6-mercaptopurine. The primary and secondary end points were weeks 10 and 54 following the first IFX infusion. Clinical response was defined as a decrease in CDAI by at least 70 points, while clinical remission was defined as CDAI <150. Further, loss of response was defined as the need for escalating IFX dose to maintain clinical remission. Results: At the primary end point, 12 of 15 patients (80%) responded, of these, 10 patients (66.7%) achieved clinical remission (Remission group). The age at CD diagnosis was shorter in the non-remission group vs remission group, 15.2±1.5 vs 12.8±1.5. At the secondary end point, 6 of 15 patients (40%) had maintained clinical remission (IFX effective group). Nine of 15 patients (60%) had lost response to IFX (IFX failure group). Patients’ weight at first IFX infusion was smaller in the IFX failure group vs IFX effective group, 42.5±11.7 vs 53.4±7.2. Additionally, the L2 type (disease location, colon) and high serum C-reactive protein (CRP) before the first IFX infusion were associated with IFX failure. Only one patient developed mild dyspnoea at the 15th IFX infusion. No other serious adverse event or opportunistic infection during our observation time. Conclusions: The short-term response and remission rate in the present paediatric cohort are similar to the levels in the REACH study and also the study by Colombel JF, et al., while the long-term outcome is less impressive. Likewise, IFX-failure rate was higher in our study as compared with the aforementioned studies. We believe that IFX mono-therapy (without IM) s one factor for weaker long-term efficacy in our cohort vs earlier studies. Accordingly, IFX therapy in paediatric CD patients may be influenced by concomitant IM, CD refractoriness, poor nutrition, and disease location.

Comparative Effects of Glibenclamide and Metformin on C-Reactive Protein and Oxidant/Antioxidant Status in Patients with Type II Diabetes Mellitus.

This study aimed to compare the effects of metformin and glibenclamide on high sensitivity serum C-reactive protein (hs-CRP) and oxidative stress, represented by serum malondialdehyde (MDA) and total antioxidant status (TAS) in newly-diagnosed patients with Type 2 diabetes mellitus (DM) at baseline and after 2 months of therapy in comparison to controls. The subjects, recruited from Al-Wafaa Centre for Diabetes Management and Research, Iraq, November 2009 to January 2011, were 103 newly-diagnosed Type 2 DM patients; 53 were prescribed metformin and 50 glibenclamide. The control group was 40 apparently healthy volunteers. Blood samples were taken from all subjects after overnight fasting. Sera were separated and assays of hs-CRP, MDA and TAS were done. After 2 months monotherapy, the blood samples and assays were repeated. There were significant differences between patients prescribed metformin and glibenclamide and the controls with regard to serum hs-CRP, MDA and TAS. There was a significant reduction in the serum MDA and a significant raise in the serum TAS levels, with no significant effects on serum hs-CRP levels after metformin therapy, but no significant effects on these parameters after glibenclamide therapy. The percentage of variation in these parameters after both drugs, showed a significant raise in serum TAS levels with the metformin therapy with no significant effects in serum MDA and hs-CRP. Metformin positively affected the oxidant/antioxidant balance in newly-diagnosed Type 2 DM patients with no significant effects on acute phase reaction protein. Glibenclamide had no significant effects on oxidant/antioxidant balance and acute phase reaction protein.

Lung Function and Inflammation in Adult Sickle Cell Disease in a West Indian Sickle Cell Cohort

Background: The commonest cause of mortality in sickle cell disease (SCD) is an acute condition called the acute chest syndrome. Little is known of the long term effects of this condition or of its effect on lung function. Objective: To determine lung function in sickle cell disease (SCD) adults and its relation to acute chest syndrome, baseline haemoglobin and systemic inflammation as estimated by serum C-reactive protein. Methods: The lung function in sickle cell disease (SCD) outpatients was compared to that in asymptomatic age and sex matched controls. Stable haemoglobin and serum C-reactive protein (CRP) were measured. Results: 74 controls of mean age 31 years and 154 sickle cell disease (SCD) outpatients with mean age 31 with 44% males were recruited. Controls and sickle cell disease (SCD) patients did not differ in age or sex. 18% sickle cell disease (SCD) patients had at least one episode of acute chest syndrome and 7% had two or more episodes. Forced vital capacity was lower in sickle cell disease (SCD) patients than controls and 47% of sickle cell disease (SCD) patients had a restrictive ventilatory defect. A further 19% had obstruction but the presence of this abnormality was not related to smoking habit. Patients with a history of two or more acute chest syndrome episodes were more likely to have poor lung function. Haemoglobin was positively correlated with forced vital capacity and inversely correlated C-reactive protein. Multivariate analysis showed that haemoglobin in sickle cell disease (SCD) patients was lower if patients also had a low forced vital capacity, high serum C-reactive protein, low body mass index, older age or male gender. Conclusions: Abnormal lung function is common in sickle cell disease (SCD) adults. In sickle cell disease (SCD), adult’s low haemoglobin is related to a restrictive ventilatory defect and systemic inflammation. Severity of stable disease in sickle cell patients is related to poor lung function and systemic inflammation.

Vertebral Bone Mineral Measures and Psychological Wellbeing among Individuals with Modic Changes

PurposeThis case-control pilot study examined whether vertebral bone mineral measures were associated with the presence of chronic low back pain (CLBP) and Modic changes (MCs), and to compare psychological wellbeing and inflammation among individuals with CLBP and MCs, compared to individuals with no history of low back pain and without MCs.MethodsEleven individuals with MRI-defined MCs in the lumbar spine and CLBP (cases) and 10 individuals with no history of CLBP or MCs (controls) responded to standard questionnaires regarding pain characteristics and psychological health. Bone mineral density (BMD) was measured with postero-anterior and lateral-projection dual energy X-ray absorptiometry (DXA) to estimate areal BMD (aBMD) and apparent volumetric BMD (ap.vBMD). High sensitivity serum C-reactive protein (hsCRP) was measured as an index of inflammation.ResultsWhile there was no difference between the groups in measures of depression, anxiety and stress, cases reported significantly greater pain catastrophizing attitudes (P < 0.01). hsCRP concentrations did not differ between groups (P = 0.54). Among the 7 cases where MCs were identified between L3–4, significantly higher mean aBMD was observed at the affected vertebral level, compared to the adjacent, unaffected, cephalad level (P = 0.01–0.04), but not when ap.vBMD was calculated (P = 0.36).ConclusionsVertebral BMD is not reduced among individuals with CLBP and MCs compared to a control group, although pain catastrophizing attitudes are increased among individuals with CLBP and MCs.

Bacteriological analysis of bile in acute cholecystitis according to the Tokyo guidelines

We performed bacteriological analysis of bile in acute cholecystitis (AC) patients graded in severity according to the Tokyo guidelines. We enrolled 163 AC patients in whom bacteriological analysis of bile was performed. Significant differences in age (60 vs. 67 years), body temperature (BT) (37.2 vs. 37.6°C), white blood cell count (13,033 vs. 15,177/mm(3)), and serum C-reactive protein (CRP) (8.9 vs. 16.9 mg/dL) were found between the Mild and Moderate severity groups. The prevalence of bactibilia differed significantly between Mild and Moderate patients (45.3 vs. 67.0%, P = 0.0107); however, there were no significant differences in the bacterial strains, prevalence of antimicrobial resistance, or polymicrobial isolation frequency between the 2 groups. Our local antibiogram revealed that several microorganisms showed higher resistance rates; these were also isolated even in Mild cases. Advanced age, high BT, high serum CRP, and presence of marked local infection were identified as being significantly associated with high risk of bactibilia. Receiver operating characteristic curve analysis indicated the optimal cutoff value of age to be 65 years, of BT to be 37.5°C, and of serum CRP to be 13.4 mg/dL. Adequate broad-spectrum antimicrobial therapy should be administered perioperatively even for Mild patients classified according to the current Tokyo guidelines. These results suggest that more precise severity grades may need to be established, including age and CRP as additional parameters.

Absence of glomerular IgG4 deposition in patients with membranous nephropathy may indicate malignancy

The renal pathological manifestations of malignancy-associated membranous nephropathy (M-MN) and idiopathic membranous nephropathy (I-MN) are similar. It has been suggested that glomerular IgG4 deposition may play an important role in the pathogenesis of I-MN. In the present study, we compared the IgG subclass of immune complex deposition, clinical data and pathological data of patients with M-MN and I-MN. Eight patients with M-MN and 42 patients with I-MN diagnosed between 1997 and 2009 in our hospital were enrolled. The clinical and pathological data were retrospectively collected, and glomerular IgG subclass deposition was detected by immunohistochemistry. Patients with M-MN were older (P = 0.003), with lower serum albumin (P = 0.034) and higher serum C-reactive protein (CRP) level (P = 0.003) than patients with I-MN. The majority of patients with M-MN had earlier pathological stages (P = 0.003) and less IgG deposition in glomeruli (P = 0.029). Absence of IgG4 deposition in glomeruli was notably observed in patients with M-MN (7/8 in M-MN versus 6/42 in I-MN, P < 0.001) and it was an independent predictor for occurrence of malignancy (hazard ratio 0.065, 95% confidence intervals 0.007-0.571, P = 0.014). Absence of glomerular IgG4 deposition, together with older age, severe hypoalbuminemia and high serum CRP level could be useful clues to differentiate M-MN from I-MN.

Predictors of In-Hospital Mortality in Children After Long-Term Ventricular Assist Device Insertion

This study aimed to determine the pre-implantation predictors for in-hospital mortality in children with ventricular assist device (VAD) support. Candidate selection is of critical importance for improved outcomes in patients supported with VAD. However, risk factors for post-VAD survival in children are still not clearly understood. From June 1996 to December 2009, 92 children underwent implantation of a long-term VAD at Germany Heart Institute Berlin. Data on all these patients were retrospectively analyzed, and pre-operative risk factors for in-hospital survival after VAD implantation were identified by multivariate logistic regression. Of the 92 subjects, the median age at implantation was 7 years (range 12 days to 18 years), and the median support time was 35 days (range 1 to 591 days). The overall survival rate to transplantation or recovery of ventricular function was 63%. Independent predictors of in-hospital mortality in children included congenital etiology (odds ratio [OR]: 11.2; 95% confidence interval [CI]: 2.6 to 47.5), norepinephrine requirement (OR: 6.9; 95% CI: 1.4 to 31), C-reactive protein level >6.3 mg/dl (OR: 4.9; 95% CI: 1.1 to 22.1), and central venous pressure >17 mm Hg (OR: 4.6; 95% CI: 1.1 to 20). Congenital etiology, pre-operative norepinephrine requirement, higher serum C-reactive protein, and central venous pressure were associated with increased in-hospital mortality in children with VAD support. Optimal candidate selection and timing of VAD insertion may be of great importance for improved outcomes in children with advanced heart failure.

Clinical and Molecular Characteristics of Invasive and Noninvasive Skin and Soft Tissue Infections Caused by Group A Streptococcus

The severity of skin and soft tissue infections caused by group A Streptococcus (GAS) is variable, and there are only a limited number of studies evaluating the characteristics of these infections in the literature. From May 2005 to November 2007, 73 patients with skin and soft tissue infections caused by group A Streptococcus were included in this study. Among these patients, 34 (46.6%) had invasive diseases. Diabetes mellitus, alcoholism, and hypertension were the most common underlying disorders. The overall mortality rate was 6.8%, and the elderly were predisposed to invasive infections (P < 0.001). Neutrophil percentages of ≥80, serum creatinine levels of ≥2 mg/dl, and high serum C-reactive protein levels were noted more frequently in patients with invasive infections than in patients with noninvasive infections, as were bacteremia and a high mortality rate. Of the 73 isolates, 93.2%, 97.3%, and 37% exhibited susceptibility to erythromycin, clindamycin, and tetracycline, respectively. The five most prevalent emm types were emm106 (24.7%), emm11 (12.3%), emm102 (9.6%), emm4 (8.2%), and emm12 (8.2%). Compared to other types, the emm106 type was significantly more likely to be associated with invasive diseases (P = 0.012). Dendrogram analysis showed a unique SmaI-digested pulsed-field gel electrophoresis pattern of the emm106 type that was particularly prone to cause invasive skin and soft tissue infections (P < 0.001). The results of this study suggest that isolates with the emm106 gene may be an emerging group A Streptococcus strain that causes invasive skin and soft tissue infections. Further surveillance study to understand the significance of this invasive strain is critical.

Clinical significance of C-reactive protein in patients with stage I non-small cell lung cancer

The aim of this study was to investigate the association between preoperative C-reactive protein (CRP) level and pathologic features in patients with stage I non-small cell lung cancer (NSCLC), and also to analyze if CRP provides prognostic information for NSCLC patients. The clinicopathological data of 105 patients with stage I NSCLC, who underwent pulmonary resection in Shanghai Chest hospital from Mar 1999 to Jul 2004, were retrospectively reviewed. The association between preoperative CRP levels and several clinical variables was analyzed by chi square test. Logistic regression analysis was used for multivariate analysis. Kaplan-Meier method and Cox multivariate regression model was used to examine the prognostic significance of the covariates on survival. Among the 105 cases, 69 had CRP at normal level (≤ 5 mg/L) and 36 at increased level (> 5 mg/L). The patients who were male (P < 0.001), smoking (P = 0.002), with squamous cell carcinoma (P < 0.001), poor differentiation (P < 0.001), tumor size larger than 3 cm (P < 0.001) had a higher serum CRP level. The maxmal tumor diameter (P = 0.037) was an independent risk factor for preoperative serum CRP level elevation. The five-year survival rate and five-year disease free survival rate of the higher CRP group were lower than that in the normal CRP group (55.6% vs. 79.7%, P < 0.05, and 41.7%vs. 68.1%, P < 0.05, respectively). Cox regression analysis demonstrated that the CRP level had effect on overall survival (P = 0.009) and disease free survival (P = 0.019). Our findings indicate that the maximal tumor diameter is an independent risk factor for preoperative serum CRP level elevation. The overall survival, disease free survival, five-year survival rate and five-year disease free survival rate of the higher CRP group are lower than that in the normal CRP group.

Skeletal muscle PI3K/Akt signaling and ubiquitin‐related enzyme mRNA expression in lung cancer cachexia

The progressive loss of muscle mass is common in lung cancer. Objective to assess possible changes in signal transduction events that regulate protein synthesis and degradation in skeletal muscle of patients with early lung cancer. Muscle biopsies and blood samples were collected from non-small cell lung cancer (NSCLC) subjects, 8 with and 8 without cachexia, and 8 non-cancer controls undergoing thoracic surgery. The abundance and phosphorylation of proteins of the PI3K/Akt signaling pathway were measured by immunoblotting and expression of ubiquitin ligases and deubiquitinating enzyme USP19 mRNA, by RT-qPCR. Cachectic patients had lost 11.5 ± 1.9% body weight, had lower lean and fat mass and higher serum C-reactive protein, IL-6 and IL-8. Phospho-PRAS40Thr246 and p-FoxO1/3aThr24/32 were higher in cachectic than in other groups, despite similar p-AktSer473, but Akt, PRAS40 and FoxO3a abundance was lower. The abundance of the translational inhibitor eukaryotic initiation factor (eIF) 4E binding protein (4E-BP1) was 65% higher than in controls (P =0.009); eIF4E abundance did not differ. MuRF-1, MAFbx and USP19 mRNA expression was not different among groups. Data show lower expression of components of the PI3K/Akt signaling pathway and greater abundance of 4E-BP1 in early NSCLC cachexia that may indicate decreased mRNA translation in skeletal muscle, which in turn, could lead to muscle loss. (Funded by CIHR)

Significant differences between serum CRP levels in children in different categories of physical activity : The PLAY study

Low-grade systemic inflammation is emerging as a component of the metabolic syndrome. The purpose of this study was to assess the association between serum C-reactive protein (CRP), physical activity and body composition in 193 black children aged 13 to 18 years from a South African township. Demographic information and anthropometric measurements were taken, and fasting blood samples were analysed for high-sensitivity serum CRP. Body fat was measured by air displacement plethysmography. There was a trend towards higher serum CRP in the boys with a higher percentage body fat. After multiple regression analyses, waist circumference in the girls was significantly associated with serum CRP. In the boys, there was an inverse correlation between percentage body fat and fitness, and between fitness and serum CRP. Significant differences were found between serum CRP in the different physical activity categories, with lower serum CRP in the girls in the higher physical activity group. Obesity should be prevented in South African children by encouraging physical activity.

Serum Cathepsin S Is Associated with Serum C-Reactive Protein and Interleukin-6 Independently of Obesity in Elderly Men

Cathepsin S has been suggested provide a mechanistic link between obesity and atherosclerosis, possibly mediated via adipose tissue-derived inflammation. Previous data have shown an association between circulating cathepsin S and inflammatory markers in the obese, but to date, community-based reports are lacking. Accordingly, we aimed to investigate the association between serum levels of cathepsin S and markers of cytokine-mediated inflammation in a community-based sample, with prespecified subgroup analyses in nonobese participants. Serum cathepsin S, C-reactive protein (CRP), and IL-6 were measured in a community-based cohort of elderly men (Uppsala Longitudinal Study of Adult Men; mean age 71 years, n = 991). CRP and IL-6 were also measured at a reexamination after 7 yr. After adjustment for age, body mass index, fasting plasma glucose, diabetes treatment, systolic blood pressure, diastolic blood pressure, hypertension treatment, serum cholesterol, serum high-density lipoprotein cholesterol, prior cardiovascular disease, smoking, and leisure time physical activity, higher cathepsin S was associated with higher CRP (regression coefficient for 1 sd increase, 0.13; 95% confidence interval 0.07-0.19; P < 0.001) and higher serum IL-6 (regression coefficient for 1 sd increase, 0.08; 95% confidence interval 0.01-0.14; P = 0.02). These associations remained similar in normal-weight participants (body mass index <25 kg/m(2), n = 375). In longitudinal analyses, higher cathepsin S at baseline was associated with higher serum CRP and IL-6 after 7 yr. These results provide additional evidence for the interplay between cathepsin S and inflammatory activity and suggest that this association is present also in normal-weight individuals in the community.

Risk Factors for Hearing Loss after Pediatric Meningitis in Japan

We sought to identify predictors for hearing loss in Japanese children with meningitis. We analyzed 155 cases of pediatric meningitis without other entities causing hearing loss in children admitted to Saitama Children's Medical Center between 1990 and 2005 for potential risk factors for hearing loss, using multiple logistic regression. Auditory brain stem response tests were performed to evaluate hearing loss. Of 155 children, 35 (23%) developed hearing loss (21 unilaterally and 14 bilaterally). Profound hearing loss (greater than 90 dB normal hearing level) occurred in 15 patients (9.7%; 4 unilaterally and 11 bilaterally). Of 112 patients with positive cerebrospinal fluid cultures, 27 (24%) developed hearing loss and 13 (12%) showed profound loss. Of 22 patients with Streptococcus pneumoniae meningitis, 11 (50%) developed hearing loss and 7 (32%) showed profound loss. Of 54 patients with Haemophilus influenzae meningitis, 11 (20%) developed hearing loss and 4 (7.4%) showed profound loss. High serum C-reactive protein levels and cerebrospinal fluid cultures positive for Streptococcus pneumoniae were identified as significant risk factors for hearing loss. A high serum C-reactive protein level was first identified as a risk factor for hearing impairment after pediatric meningitis.

High sensitive serum C-reactive protein and its relationship with other cardiovascular risk factors in normoinsulinemic polycystic ovary patients without metabolic syndrome

The aims of the study were to investigate high sensitive serum C-reactive protein (HS-CRP) levels in normoinsulinemic polycystic ovary syndrome (PCOS) patients without metabolic syndrome and whether there was any relationship between HS-CRP and other cardiovascular risk factors such as obesity and serum lipids. A total of 52 normoinsulinemic PCOS women without metabolic syndrome and 48 normoandrogenic ovulatory women were enrolled in the study. Standard clinical examinations, and ultrasonographic and endocrine screening including FSH, LH, total testosterone, free testosterone, sex hormone-binding globulin, dehydroepiandrosterone sulfate, low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol (TC) and triglyceride (TG) were measured. Normal insulin sensitivity was defined on the basis of fasting serum glucose and insulin levels, serum insulin response to an oral glucose tolerance test and homeostatic model of insulin resistance. HS-CRP was assessed spectrophotometrically. PCOS patients had increased HS-CRP compared to the control group (P < 0.0001). HS-CRP was positively correlated with body mass index (BMI) (r = 0.44, P < 0.0001), waist-to-hip ratio (WHR) (r = 0.66, P < 0.0001), LDL (r = 0.62, P < 0.0001), TC (r = 0.56, P < 0.0001) and TG (r = 0.38, P < 0.0001), and negatively correlated with HDL (r = -0.45, P < 0.0001). There was also a strong association between HS-CRP and PCOS status (r = 0.69, P < 0.0001) in the study. Multivariate regression analysis demonstrated that BMI, WHR, LDL, HDL and PCOS status were also the independent variables that influenced HS-CRP in the overall group. Elevated HS-CRP was associated with cardiovascular risk factors in normoinsulinemic PCOS without metabolic syndrome. These patients need more intensive screening or treatment for this disease.