Increased Serum C-reactive Protein Levels Research Articles

New-onset of giant cell arteritis with ischemic optic neuropathy following the seventh-dose of COVID-19 mRNA vaccination: A case report and literature review.

Coronavirus disease (COVID-19) vaccines have demonstrated excellent efficacy in reducing the morbidity and severity of the disease. However, some patients have been reported to develop systemic rheumatic diseases, such as rheumatoid arthritis, myocarditis, Guillain-Barre syndrome, and giant cell arteritis (GCA) following COVID-19 vaccination. We present a case of GCA with ischemic optic neuropathy following COVID-19 mRNA vaccination. A 73-year-old woman developed headache, myalgia, scalp tenderness, and jaw claudication 4 days after her seventh dose of the vaccination; she also developed severe visual disturbances 1 month after the vaccination. The blood examination tests showed an increased serum C-reactive protein level and erythrocyte sedimentation rate. The echogram for the temporal artery showed a halo sign. Ophthalmic examination revealed ischemic optic neuropathy in both eyes. The patient was treated with a high-dose glucocorticoid and tocilizumab under the diagnosis of GCA with ischemic optic neuropathy, obtaining mild improvement of the symptoms. This report underscores the need for clinical vigilance and further data collection regarding GCA cases after COVID-19 vaccination.

Serum anti-Müllerian hormone recovery after ovarian cystectomy for endometriosis: A retrospective study among Korean women.

Serum anti-Müllerian hormone (sAMH) is a useful marker of ovarian reserve. In many patients, the sAMH levels gradually recover after falling to the lowest level after surgery (nadir phenomenon). This study aimed to analyze the factors related to sAMH recovery from the nadir after an ovarian cystectomy for endometriosis among Korean women. A total of 159 patients with ovarian endometriosis were included in the study. The sAMH levels were measured before surgery and at least twice within 12 months after the surgery. The patients were divided into two groups: those with recovery (nadir group) and those without recovery (reduction group). Postoperative recovery of the sAMH levels from the nadir was not related to the stage and bilaterality of the lesion, surgical methods, such as robot-assisted or laparoscopic surgery, or surgical time. In the nadir group, the level of preoperative cancer antigen 125 was significantly higher, and it decreased significantly after the surgery than in the reduction group (P = .02 and P = .02). Additionally, the postoperative C-reactive protein (CRP) level was significantly higher in the nadir group, and it increased significantly after the surgery than in the reduction group (P = .03 and P = .04). The increasing degree of perioperative CRP level showed a cutoff value on the receiver operating characteristic curve (0.735 mg/dL, area under curve = 0.604; P = .04). Increased serum CRP levels after surgery are significantly related to the recovery of sAMH levels from the nadir. Therefore, postoperative serum CRP level could be used as a marker to predict the sAMH nadir after surgery.

C-reactive protein is associated with impaired working capacity in Chinese patients with ankylosing spondylitis in paid employment: the real-world evidence from Smart-phone SpondyloArthritis Management System

To investigate the relationship between serum C-reactive protein (CRP) levels and work impairment in patients with ankylosing spondylitis (AS) based on real-world evidence. Outpatients with confirmed AS at Chinese PLA General Hospital were recruited consecutively by Smart-phone SpondyloArthritis Management System (SpAMS) from April 2016 to April 2018. The relationship between CRP and work productivity and activity impairment questionnaire (WPAI) were evaluated. Five hundred and fifty-one outpatients with AS in paid employment were recruited. The presenteeism, overall work impairment, and activity impairment rates increased by 1.4% (1.1%, 1.8%), 1.1% (0.5%, 1.6%), and 1.7% (1.3%, 2.1%), respectively, for every 10 mg/L increase in the CRP level (all P value<0.01). However, the CRP level was not associated with absenteeism after adjusting for covariates [0.5%(-0.4%, 1.0%),P>0.05]. There is a significant association between increased serum CRP levels at baseline and the previous 7-day work impairment in patients with AS. Higher CRP levels contribute to worse presenteeism, overall work impairment, and activity impairment rates, which suggests the necessity of monitoring CRP on treatment, and also indicates that anti-inflammatory therapy may be effective for improving work productivity.

КЛИНИКО-ЛАБОРАТОРНЫЕ ОСОБЕННОСТИ ТРОМБОЭМБОЛИИ ЛЁГОЧНОЙ АРТЕРИИ У ПАЦИЕНТОВ С КОРОНАВИРУСНОЙ ИНФЕКЦИЕЙ SARS-COV-2 И АБДОМИНАЛЬНЫМ ОЖИРЕНИЕМ

Background. At the present time more than 185 million people are infected with the new coronavirus infection (CVI) SARS-CoV-2, which caused COVID-19 pandemic according to WHO. The issue of increased risk of pulmonary embolism (PE) and associated severe course of the disease in persons with abdominal obesity (AO) is actively discussed in national and foreign publications. Objective of the study. To determine the clinical and laboratory features of PE in patients with abdominal obesity infected with SARS-CoV-2 Material and Methods. An analysis of 11.056 medical records of inpatients treated in the infectious disease departments for patients with COVID-19 of the 4th City Clinical Hospital named after N.E. Savchenko of Minsk during the period from April 1, 2020 to May 31, 2021 was performed. AO in subjects included in the retrospective analysis was determined according to WHO criteria as a body mass index greater than or equal to 30 kg/m2, waist circumference greater than 94 cm in men and 80 cm in women, respectively. To determine clinical and laboratory features of PE, as well as the effect of AO on the severity of this complication, inclusion/exclusion/exclusion criteria were developed and a sample of medical records of patients with COVID-19 (n=33), whose diagnosis of PE was verified by computed tomographic angiography of the chest (CTA chest) was formed. Clinical and instrumental parameters and laboratory characteristics were analyzed in the studied groups at the moment of admission to the hospital and at the time of PE development. Results. According to the results of a retrospective analysis of 11 056 medical records, the proportion of patients in whom the final diagnosis of PE was present was 3.68% (n=407), among whom AO was observed in 22.11% (n=90) of patients. The prevalence of subjects with impaired lipid metabolism among those included in the analysis was 11.38% (n=1259). PE developed in 90 patients with CVI and AO (0.81%) and in 317 patients without AO (2.87%). The prevalence of patients with PE (n=90) in the CVI and AO group (n=1259) was 7.15%; among those with CVI without AO (n=9797) - 3.24% (n=317). In the formed group with AO, C-reactive protein (CRP) and fibrinogen levels at hospitalization were higher than in the group of patients without AO: 116.64 (80.38-134.08) mg/L versus 30.21 (15.11-57.21) mg/L (U=36.04; p&lt;0.01) and 6.97 (6.11 to 8.03) g/L versus 4.71 (4.02 to 5.59) g/L (U=12.0, p&lt;0.01) respectively. On the day of suspected PE, CRP levels were higher in the group of patients with AO and COVID-19 than in the group of patients without AO: 71.01 (50.59-105.06) mg/L versus 34.01 (18.85-60.81) mg/L (U=49.00; p&lt;0.05). In patients with CVI and PE, there was a moderate positive relationship between the presence of AO and the severe course of COVID-19 (r=0.41; p&lt;0.05), AO and elevated fibrinogen levels on admission to the hospital (r=0.58 p &lt;0.05), a strong positive relationship between the presence of AO and increased serum CRP level at the time of hospitalization (r = 0.76; p &lt; 0.01), a moderate positive relationship between AO and CRP level determined at the time of development of PE (r = 0.51; p &lt; 0.01). Conclusion. Among the patients with COVID-19 and AO complicated by the development of PE in comparison with patients without AR was determined a higher prevalence of individuals with a severe course of CVI (χ2=5,18; p&lt;0.05), lower oxygen saturation values at admission and at the time of PE development (U =46.5; p&lt;0.05) and (U=49.5; p&lt;0.05), respectively, higher fibrinogen and CRP levels at the time of hospitalization (U=12.0; p&lt;0.01) and (U=36.04; p&lt;0.01), respectively, higher CRP values at the manifestation of PE (U=49.00; p&lt;0.05). The obtained data indicates in favor of the fact that AO can be considered as a risk factor for the severe course of COVID-19. The pathophysiological basis of the development, course and prognosis of thromboembolic complications in patients with COVID-19 and AO requires further clarification during prospective follow-up of this category of patients.

Psychological distress and C-reactive protein in a South African national survey.

To examine the association of psychological distress with serum C-reactive protein (CRP) in a South African cohort. Data were analysed on individuals aged ≥15 years from the South African National Health and Nutrition Examination Survey (SANHANES) of 2012. Psychological distress was evaluated using the Kessler Psychological Distress Scale. Linear regression models assessed the association of psychological distress with serum CRP, adjusting for possible confounding factors. The analytic sample comprised n = 3944 individuals (mean age = 40 and sex = 36% males). Psychological distress was significantly associated with increased serum CRP levels (B = 0.31 and p = 0.001). This association was no longer significant after adjusting for demographic variables, lifestyle factors, cardiac disease, diabetes, hypertension, trauma and anti-inflammatory medication use (B = 0.15 and p = 0.062). Psychological distress was associated with elevated levels of CRP among South African adults. However, the association was confounded by a range of factors, with demographic variables (age, sex and population group) having the largest confounding effect. These findings indicate that CRP is not a useful biomarker of psychological distress, and that additional work is needed on the underlying psychobiology of psychological distress.

Capnocytophaga canimorsus peritonitis diagnosed by mass spectrometry in a diabetic patient undergoing peritoneal dialysis: a case report

BackgroundBacterial peritonitis is a serious complication of patients undergoing peritoneal dialysis (PD). Although the identification of causative organisms and use of appropriate antibiotics are essential for treatment, rare and fastidious bacteria are sometimes difficult to detect by conventional biochemical assays. Capnocytophaga canimorsus is a fastidious and slow-growing bacterium that forms a part of the normal oral flora of dogs and cats and is extremely rare as a peritonitis-causing organism. This report demonstrates the usefulness of a mass spectrometry-based technique in identifying such a rare organism in PD-related peritonitis and discusses the diagnosis and treatment of C. canimorsus peritonitis.Case presentationA 49-year-old woman with type 2 diabetes mellitus underwent PD for two years. Repeated exit-site infections led to subcutaneous pathway diversion two months ago. She was hospitalized with fever and abdominal pain as well as cloudy dialysis effluent. Laboratory data revealed increased serum C-reactive protein level and white blood cell (WBC) count in the effluent. Her exit site had no sign of infection, leading to the diagnosis of PD-related peritonitis. Initial therapy with intraperitoneal ceftazidime immediately ameliorated her symptoms, and the WBC count in the effluent normalized in five days. Culture test results of the dialysis effluent on admission were negative with no information regarding the infection route. However, mass spectrometry (MALDI Biotyper, Bruker Daltonics) successfully obtained the specific spectral pattern for C. canimorsus. She had four cats in her house and was advised not to allow the cats in the room where the bag exchange took place.ConclusionsC. canimorsus is a rare cause of peritonitis in PD patients and is usually susceptible to intraperitoneal third-generation cephalosporins. This mass spectrometry-based bacterial identification method could provide more opportunities to identify uncommon causes and promote appropriate antibiotics therapy in PD-related peritonitis.

Relationship Between Visceral Obesity and Postoperative Inflammatory Response Following Minimally Invasive Esophagectomy.

Esophagectomy for esophageal cancer is one of the most invasive surgeries. However, the factors influencing postoperative systemic inflammatory response following esophagectomy have not been elucidated. Recently, visceral fat has been shown to play an important role in both chronic and acute inflammation. In this study, we assessed the relationship between visceral obesity and postoperative inflammatory response following minimally invasive esophagectomy (MIE). Visceral fat area (VFA) was measured using computed tomography in 152 patients undergoing MIE for esophageal cancer. We assessed perioperative serum C-reactive protein (CRP) levels preoperatively and on postoperative days (PODs) 1-5 and analyzed the relationship between VFA and perioperative serum CRP levels. VFA was positively associated with preoperative serum CRP level (P < 0.001). Univariate analysis revealed that VFA was significantly associated with increased serum CRP levels on PODs 1-5 (P < 0.001 for each day), whereas multivariate analysis revealed that it was independently associated with increased serum CRP levels on PODs 1-4 (P = 0.033, 0.035, 0.001, and 0.006, respectively). Similar results were observed in patients who did not have postoperative infectious complications, such as pneumonia, anastomotic leak, and surgical site infection. VFA was not an independent risk factor for the occurrence of these postoperative infectious complications. Visceral obesity might be associated with chronic inflammation in patients with esophageal cancer and promote postoperative inflammatory response following MIE.

Prognostic value of C-reactive protein levels in patients with bone neoplasms: A meta-analysis.

ObjectiveThe aim of this study was to conduct a meta-analysis of retrospective studies that investigated the association of preoperative C-reactive protein (CRP) levels with the overall survival (OS) of patients with bone neoplasms.MethodsA detailed literature search was performed in the Cochrane Library, Web of Science, Embase and PubMed databases up to August 28, 2017, for related research publications written in English. We extracted the data from these studies and combined the hazard ratios (HR) and 95% confidence intervals (CIs) to assess the correlation between CRP levels and OS in patients with bone neoplasms.ResultsFive studies with a total of 816 participants from several countries were enrolled in this current meta-analysis. In a pooled analysis of all the publications, increased serum CRP levels had an adverse prognostic effect on the overall survival of patients with bone neoplasms. However, the combined data showed no significant relationship between the level of CRP and OS in Asian patients (HR = 1.73; 95% CI: 0.86–3.49; P = 0.125). Similar trends were observed in patients with bone neoplasms when stratified by ethnicity, histology, metastasis and study sample size.ConclusionsThe results of this meta-analysis suggest that increased CRP expression indicates a poorer prognosis in patients with bone neoplasms. More prospective studies are needed to confirm the prognostic significance of CRP levels in patients with bone neoplasms.

Prognostic implications of plasma fibrinogen and serum Creactive protein levels in non-small cell lung cancer resection and survival

Purpose : To investigate the prognostic implications of plasma fibrinogen and serum C-reactive protein (CRP) levels in tumour resection and survival following successful tumour resection in patients with nonsmall cell lung cancer (NSCLC). Methods : One hundred and fifty-three NSCLC patients who underwent surgical resection at a tertiary care hospital from January 2006 through December 2010 were enrolled. Pre-operative serum CRP and plasma fibrinogen levels were measured. The levels of these biomarkers correlated with tumour size and pathologic TNM stage. The possibility of complete resection and associated findings are reported. Results : Plasma fibrinogen (r = 0.381, p = 0.002) and serum CRP (r = 0.471, p < 0.001) levels were positively associated with tumour diameter. Increased levels of these biomarkers were significantly associated with sex, smoking status, histological type, tumour stage, and clinical stage. Partial tumour resection occurred in 28 % (27/95) of patients with an increased plasma fibrinogen level compared to 10 % (6/58) with a normal fibrinogen level (p = 0.008), and in 30 % (29/97) of patients with an increased serum CRP level compared to 11 % (6/56) with a normal CRP level (p = 0.006). Patients with elevated CRP and fibrinogen concentrations demonstrated higher susceptibility to disease advancement and survival compared to patients with normal fibrinogen and CRP levels. Conclusion : Pre-operative functional concentrations of serum CRP and plasma fibrinogen could serve as indicators of tumour resectability wherein a high tumour resection rate is possible in patients with favourable pre-operative levels of these biomarkers. Increased concentrations of serum CRP and plasma fibrinogen are associated with poor overall survival and progression-free survival. Key words : Plasma fibrinogen, serum C-reactive protein, biomarker, non-small cell lung cancer

Increased serum C-reactive protein levels are associated with shorter survival and development of second cancers in chronic lymphocytic leukemia

Background: Chronic lymphocytic leukemia (CLL) is characterized by a heterogeneous clinical course, ranging from stable to more aggressive disease. Herein, we determined the prognostic significance of serum C-reactive protein (CRP) levels in patients with CLLMethods: A retrospective cohort study reviewing the records of 107 consecutive treatment naïve patients with CLL and a control group comprised of apparently healthy individuals attending for periodic health examinations.Results: The median CRP level of patients with CLL was 0.19 mg/dL (0–2.9). In univariate analysis, high-CRP levels (≥0.4 mg/dL) were significantly associated with an increased risk of mortality (HR = 3.97, 95%CI 1.64–9.62, p = .002) and development of second solid cancers (HR = 4.54, 95%CI 1.57–13.11, p = .005), compared to low-CRP values (<0.4 mg/dL). In multivariate analysis, high-CRP retained statistical significance for all-cause mortality (HR = 2.81, 95%CI 1.04–7.57, p = .04) and the development of second solid malignancies (HR = 4.54, 95%CI 1.57–13.11, p = .005). Moreover, when compared to an apparently healthy population, CLL patients with high CRP levels had more than an eightfold risk of cancer.Conclusions: Elevated baseline CRP levels are associated with shorter survival and development of second cancers in patients with CLL. We suggest that increased CRP in patients with CLL may justify a more rigorous search for second cancers.KEY MESSAGESElevated CRP levels are associated with a shorter overall survival in CLL.Elevated CRP levels are associated with an increased risk of second cancers in CLL.Increased CRP in patients with CLL may justify a more rigorous search for second cancers.

Observational and mechanistic links between C-reactive protein and blood pressure in elderly women

It is hypothesized that chronic systemic inflammation contributes to the age-related decline in cardiovascular function. The aim of the present study was to combine an assessment of the relationship between the serum level of C-reactive protein (CRP) and systolic and diastolic blood pressure in 108 elderly women (65 and 70 years) with an in-vitro exploration of the effects of CRP on the proliferative and angiogenic potential of endothelial cells exposed to serum in elderly women. Based on the median CRP level in our population, LowCRP (CRP<1.3mg/L) and HighCRP (>1.3mg/L) groups were identified. Body mass index, waist circumference, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were significantly higher in the HighCRP group than in the LowCRP group (p<0.05). The influence of CRP on SBP and DBP remained significant after adjustments for BMI and use of antihypertensive medication (p<0.05). When adjusting for waist circumference the observed influence of CRP on SPB was attenuated (p=0.062). We next evaluated the ability to form capillary tubes (angiogenesis assay) and the proliferation rate of endothelial cells exposed to the sera of elderly women. Increased serum CRP levels were associated with an increased doubling time of endothelial cells (R2=0.39; p<0.05) and decreased capillary tube length (R2=0.30; p<0.05), indicating a reduction in the proliferation rate of endothelial cells and angiogenic potential. In conclusion, chronic inflammation influences blood pressure in elderly women and compromises endothelial cell function, thus contributing to the age-related decline in vascular health.

Oxidative Stress and IgG Antibody Modify Periodontitis-CRP Association

In a previous report, we demonstrated the inverse association of high serum 8-isoprostane levels, a marker for oxidative stress, with decreased serum IgG antibodies to oral bacteria. The association between increased serum IgG with increased plaque and periodontitis (increased probing depths) was attenuated by high systemic oxidative stress. Other investigations have reported a role for systemic oxidative stress as a stimulus of hepatic C-reactive protein (CRP) response. These observations led us to hypothesize that the reported relationship of periodontitis to elevated serum CRP, a systemic inflammatory marker, may be modified by oxidative stress and that the levels of serum antibodies to oral bacteria might be an intermediary explanatory variable linking the association of systemic oxidative stress, periodontal disease, and levels of CRP. This hypothesis was explored as a secondary analysis of the Dental ARIC (Atherosclerosis Risk in Communities) study using serum levels of CRP, serum IgG levels to 16 oral organisms, serum levels of 8-isoprostane, and periodontal status. The findings indicate periodontitis is associated with high CRP in the presence of elevated oxidative stress that serves to suppress the IgG response. Only within the highest 8-isoprostane quartile was periodontitis (pocket depth) associated with increased serum CRP levels (P = 0.0003). Increased serum IgG antibody levels to oral bacteria were associated with lowered serum CRP levels. Thus, systemic oxidative stress, which has been demonstrated to be associated with increased levels of CRP in other studies, appears to be associated with the suppression of bacterial-specific IgG levels, which in the presence of periodontal disease can result in an enhanced systemic CRP response. Conversely, individuals with increased serum IgG antibodies to plaque bacteria exhibit lowered serum CRP levels. These 2 factors, oxidative stress and the serum IgG response, appear to function in opposing directions to modify serum levels of CRP and the association with periodontitis.

Assessment of Soluble Urokinase-Type Plasminogen Activator Receptor (supAR) in Chronic Obstructive Pulmonary Disease

Background: Chronic obstructive pulmonary disease (COPD) is a disease characterized by a progressive airflow limitation. Soluble urokinase-type plasminogen activator receptor (suPAR) is released from the membrane-bound plasminogen activator, and is positively correlated with the activation of immune system.Aims: Release of inflammatory mediators is increased in chronic obstructive pulmonary disease (COPD), particularly during exacerbations. The objective of this study was to compare plasma levels of suPAR and serum levels of C-reactive protein (CRP) during exacerbation and stable periods in patients with COPD.Study Design: Prospective clinical study. Methods: The patients with COPD were divided into 3 groups for evaluations: those with stable COPD [SCOPD] (n= 54), pre-treatment acute exacerbation COPD [AECOPD] (n= 53), and post-treatment AECOPD (n= 52). Plasma suPARand serum CRP levels were assessed for each patient.Results: Whereas the increased serum CRP levels of the participants were 54.82±56.63 mg/l during acute exacerbation period, during the stable period it was 5.02±6.31 mg/l and statistically significant (p= 0.0001). The suPAR level was 1.28±0.52ng/ml during the acute exacerbation period vs.1.21±0.59ng/ml during the stable period, without a difference (p= 0.49). There was a statistically significant decrease in the CRP serum levels; yet, although not statistically significant  a remarkable decrease was seen in the suPAR levels obtained before and after the management of exacerbations (p= 0.001 and p= 0.06 respectively).Conclusion: These results support the idea that suPAR, a novel biomarker, might be an important indicator if verified with further prospective studies in evaluating COPD exacerbations and treatment response like CRP used for decades.

Systemic levels of the endothelium-derived soluble adhesion molecules endocan and E-selectin in patients with suspected deep vein thrombosis.

The initial evaluation of patients with suspected deep vein thrombosis includes the use of biomarkers reflecting activation of the coagulation system. However, the thromboembolic process and neighboring inflammatory responses also affect endothelial cells, and endothelial cell markers may therefore be altered by the disease. In the present population-based single-center study, we investigated the plasma levels of the endothelium-specific biomarkers soluble E-selectin and endocan in a consecutive and unselected group of 120 patients admitted to hospital for suspected deep vein thrombosis. Blood samples were collected when patients arrived at the hospital. DVT patients showed evidence for an acute phase reaction with increased serum C-reactive protein levels, but this was similar to many other patients admitted with suspected but not verified thrombosis. Plasma endocan and E-selectin levels did not differ between patients with thrombosis, healthy controls and the patients without verified thrombosis (i.e. patients with other causes of their symptoms, including various inflammatory and non-inflammatory conditions). However, the combined use of endothelial biomarkers, C-reactive protein and D-dimer could be used to identify patient subsets with different frequencies of venous thrombosis. Thus, analysis of plasma biomarker profiles including endothelial cell markers may be helpful in the initial evaluation of patients with deep vein thrombosis.

Usefulness of the neutrophil/lymphocyte ratio measured preoperatively as a predictor of peritoneal metastasis in patients with advanced gastric cancer.

The prognosis for gastric cancer patients with peritoneal metastasis is poor. Many studies have reported that the neutrophil/lymphocyte ratio (NLR) might be useful to predict the degree of progression of gastric cancer. In this study, we attempted to evaluate whether the NLR and other related laboratory parameters might be reliable predictors of the presence of peritoneal metastasis in patients with advanced gastric cancer. The data of 359 patients who underwent gastric surgery between June 2008 and December 2011 were reviewed. A retrospective analysis of the preoperative blood data in relation to the presence of peritoneal metastasis was carried out. An increased serum C-reactive protein level (P = 0.022), APTT (P = 0.017) and NLR (P < 0.001), and a decreased serum Alb (P = 0.014) were significantly related to the presence of peritoneal metastasis. A multivariate analysis showed that a NLR >2.37 (OR = 2.59, 95 % CI = 1.38-4.93, P = 0.003) and clinical T4 stage (OR = 4.36, 95 % CI = 2.33-8.24, P < 0.001) were independent predictors of the presence of peritoneal metastasis. Our results suggest that the preoperative NLR was a significant independent predictor of the presence of peritoneal metastasis in patients with advanced gastric cancer.

Feeding common carp Cyprinus carpio with β-glucan supplemented diet stimulates C-reactive protein and complement immune acute phase responses following PAMPs injection

The effect of β-glucan as a feed additive on the serum and gene profile of C-reactive protein (CRP) and complement acute phase responses was ascertained in common carp Cyprinus carpio. In addition effects of subsequent intraperitoneal injections of pathogen-associated molecular patterns (PAMPs), i.e. LPS or poly(I:C), to mimic bacterial or viral infection respectively, were studied. Carp were first orally fed with β-glucan (MacroGard®) with a daily β-glucan intake of 6 mg per kg body weight or with control food for 25 days and then injected with PBS containing either LPS (4 mg/kg) or poly(I:C) (5 mg/kg) or PBS alone. Fish were sampled during the 25 days of the feeding period and up to 7 days post-PAMPs injections for serum and liver, head kidney and mid-gut tissues. Oral administration of β-glucan for 25 days significantly increased serum CRP levels and alternative complement activity (ACP). In addition, the subsequent LPS and poly(I:C) challenges significantly affected CRP and complement related gene expression profiles (crp1, crp2, c1r/s, bf/c2, c3 and masp2), with the greatest effects observed in the β-glucan fed fish. However, in fish fed β-glucan the PAMPs injections had less effects on CRP levels and complement activity in the serum than in control fed fish, suggesting that the 25 days of β-glucan immunostimulation was sufficient enough to reduce the effects of LPS and poly(I:C) injections. Results suggest that MacroGard® stimulated CRP and complement responses to PAMPs immunological challenges in common carp thus highlighting the beneficial β-glucan immunostimulant properties.

Erythema Annulare Centrifugum

A45-year-old woman suffering from undifferentiated connective tissue disease presented with a 3-year history of recurrent crops of expanding annular plaques on her neck, chest, proximal arms and back (Figure 1A). Lesions began as urticarial-type papules and enlarged by peripheral extension to form ringed, arcuate or polycyclic figures with central clearing (Figure 1B). Systemic symptoms included low-grade fever and arthralgia. Laboratory examination showed an increased serum C-reactive protein level and erythrocyte sedimentation rate and raised titers of serum antinuclear and antiribonucleoprotein antibodies.

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

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

Role of systemic markers in periodontal diseases: a possible inflammatory burden and risk factor for cardiovascular diseases?

Background:Periodontitis is a local inflammatory process mediating destruction of periodontium triggered by bacterial insult leading to systemic inflammatory mayhem in the host. Epidemiologically, it has been modestly associated with cardiovascular diseases (CVD) with elevated acute-phase reactant C-reactive protein (CRP) and rheological variables such as total leukocyte count and differential leukocyte count (TLC and DLC), which are potential predictors of CVD.Aim:The aim of this study was to investigate the serum CRP level, leukocyte count in chronic periodontitis patients and their relation to the severity of chronic periodontitis.Subjects and Methods:This cross-sectional study comprised 30 subjects, of which 20 were diagnosed as chronic periodontitis based on the Gingival index, probing depth and clinical attachment levels and 10 healthy subjects as controls. Following, which peripheral blood samples were drawn and serum CRP, TLC and DLC were quantified using the turbidimetric immunoassay. Data was analyzed using Intercooled Stata 9.2 version, (Stata corporation, LP, USA) ANOVA, Mann Whitney U test and Newman-Keuls post hoc procedures. P values less than) 0.05 were considered as significantResults:The mean serum CRP levels were statistically significant (P < 0.05) in severe and moderate periodontitis subjects when compared with healthy controls. Leukocytes were significantly elevated in severe periodontitis compared with moderate periodontitis and controls; this finding was primarily explained by the increase in number of neutrophils.Conclusion:The increased serum CRP levels and neutrophils in chronic periodontitis subjects suggest an addition to the inflammatory burden of the individual potentially striking toward an increasing risk for cardiovascular events. Further research is needed to determine the specificity of these markers and their role in the inflammatory burden of one's systemic health.

Clinical courses and outcomes of hospitalized adult patients with seasonal influenza in Korea, 2011–2012: Hospital-based Influenza Morbidity &amp; Mortality (HIMM) surveillance

Influenza is an acute respiratory illness, which can be accompanied by complications such as pneumonia. This study was conducted to survey the clinical courses and outcomes of hospitalized adult patients with laboratory-confirmed seasonal influenza. A prospective case-control study was performed in adult influenza patients who were admitted to hospitals participating in the Hospital-based Influenza Morbidity and Mortality (HIMM) surveillance system in Korea from October 2011 to May 2012. Cases with complicated influenza were compared to those without complications. A total of 123 (5.6%) patients among 2184 laboratory-confirmed adult influenza patients were hospitalized during the 2011-2012 influenza epidemic season. Forty (32.5%) experienced 50 complication episodes. Age older than 60 years (P<0.01), male sex (P=0.04), diabetes (P<0.01), chronic cardiovascular disease (P<0.01) and neuromuscular disease (P=0.02) were significantly related to development of complications in univariate analysis. Multivariate logistic regression analysis revealed that diabetes (odds ratio [OR] 3.63, 95% confidence interval [CI] 1.15-11.51, P=0.02) was an independent risk factor for complicated seasonal influenza. C-reactive protein (CRP) was discriminative between complicated and uncomplicated influenza (cutoff value 13mg/L, sensitivity 70%, specificity 74%). Complicated patients received antibiotics more frequently (P<0.01) with longer hospital stays (P=0.01). In conclusion, diabetic patients are at great risk for complicated influenza, and CRP would be useful to predicting complication. Therefore, early interventions such as antiviral therapy should be considered for high risk patients with diabetes, especially those with increased serum CRP level.