Lower CRP Levels Research Articles

Predictive factors for successful weaning from mechanical ventilation in the internal medicine department.

The aging of the Israeli population along with a shortage of ICU beds have led to hospitalization of invasive mechanical ventilation patients in internal medicine departments, where, as opposed to ICU, the treatment is less than optimal. The aims of the study were to evaluate the predictive factors for successful weaning from mechanical ventilation in ventilated patients admitted to internal medicine departments. A retrospective study that included non-COVID 19 ventilated patients in internal medicine departments in a university affiliated hospital in Israel between the years 2018-2019. We compared datapoints between patients who were weaned from ventilators versus those who remained ventilated during the hospitalization, and defined demographic and clinical predictive factors for successful weaning. Data were collected from electronic medical records and included demographic, clinical, laboratory and ventilator information. The study group included 348 patients. The rate of successful weaning was 19%; patients who were successfully weaned were primarily functionally independent prior to ventilation, ventilated with low PEEP values, had high hemoglobin and albumin levels alongside with low CRP and lactate levels. Those who remained ventilated either required vasopressor treatment, had positive blood cultures or had lower GFR levels. The overall in-hospital mortality rate was 60%, while the 30-day mortality rate was lower in the extubated group [214 (76%) vs. 6 (9%), P < 0.0001]. Our findings highlight the low rate of weaning from ventilation in the department of medicine, with higher mortality rate among the remained ventilated patients. Various favorable clinical parameters might predict successful weaning.

Complement 3 and 4 impact in osteoarthritis.

Aim: To investigate the association between serum complement 3 and 4 (C3 and C4) levels and clinical characteristics in osteoarthritis (OA) patients.Methods: This retrospective study included 361 OA patients divided into groups based on complement levels. Clinical data and laboratory test results, including C3, C4, ESR and CRP levels, were analyzed using non-parametric tests, Spearman correlation and multivariate regression.Results: The AC-OA group had lower PA, C3, C4, ESR, CRP and IgA levels compared with controls. C3 levels were positively correlated with ESR (r=0.260, p<0.001) and CRP (r=0.243, p<0.001). C4 levels also correlated with ESR (r=0.175, p=0.001) and CRP (r=0.263, p<0.001) and were significantly associated with the number of affected joints.Conclusion: Serum C4 levels are effective indicators of disease activity in OA, particularly in terms of joint involvement and CRP levels, while C3 levels showed no significant association. These findings suggest a potential role for C4 in predicting OA activity.

CO2 field-flooding devices offer potential value for cardiopulmonary bypass procedures for CHD performed via a right-side small incision approach

ObjectiveThis study sought to evaluate the value of a CO2 field-flooding device in cardiopulmonary bypass (CPB) surgical procedures for congenital heart disease (CHD) performed via a right-side small incision approach.MethodsBetween April 2022 and December 2023, 234 children with simple CHD who underwent CPB via a right-side small incision approach were separated into a control group (n = 93) without the use of a CO2 field-flooding device and a treatment group (n = 141) in which this device was added to the traditional surgical manual exhaust. Demographic, perioperative, arterial blood gas (ABG), and laboratory test data were then compared between these groups of patients.ResultsThere was a significant difference in abnormal electrocardiogram (ECG) after aorta de-clamping during CPB, and interventions for abnormal ECG after aorta de-clamping during CPB between the control and treatment groups (17(18.3%) vs.14(9.9%), P = 0.048;12(85.7%) vs.7(50%),P = 0.013). The treatment group exhibited a lower pH (7.34 ± 0.07 vs. 7.36 ± 0.06, P = 0.039) and a higher PaCO2 (43.08 ± 7.36 vs. 38.86 ± 5.65 mmHg, P = 0.042) at the time of 30 min after initiation of CPB. A significant reduction in postoperative CK-MB was observed in treatment group (41.20 ± 17.88 vs. 56.57 ± 22.99 U/L, P = 0.002). Lower 3-day postoperative CRP levels were also observed in the treatment group relative to control (5.77 ± 0.48 vs. 9.45 ± 0.98 mg/L, P < 0.001). The S100ß concentration in the relevant patient cohort increased significantly from the time just after induction, intubation, and installation of the right central venous line to the time of admission to CCU (71.61 ± 11.83 vs. 124.04 ± 38.80, P = 0.01) and at the time of 24 h after operation (71.61 ± 11.83 vs. 101.97 ± 30.31, P = 0.01). No differences on S100β serum concentration level were found at the time of installation of the right central venous line between two groups. But there were statistically significant differences in S100β serum concentration level at the time of admission to CCU between control group and treatment group. (161.19 ± 6.62 vs. 86.89 ± 9.69 pg/ml, P = 0.01). Similar results were observed at the time of 24 h after operation. (127.62 ± 19.44 vs. 76.33 ± 10.40, P = 0.01).ConclusionThese data suggest that the CO2 field-flooding device can safely be used when performing CPB surgical procedures via a right-side small incision approach to treat CHD without hypercapnia. The use of such a CO2 field-flooding device at a flow rate of 5 L/min may help protect against cardiac and nervous system damage in children undergoing CHD surgery.

P0679 Therapeutic Drug Monitoring of the Infliximab (anti-TNF) Level with Bedside Kit in Inflammatory Bowel Disease

Abstract Background Approximately half (10-40%) of the Inflammatory Bowel Disease (IBD) patients using Infliximab (IFX) develop secondary loss of response due to drug levels falling below the therapeutic range. This study aims to identify drug levels, influencing factors and parameters that may be useful in predicting target drug levels. Methods The pre-infusion drug levels and associated laboratory parameters were evaluated in IBD patients on maintenance dose of IFX (5-15 mg/kg every 4-8 weeks) between Nov2021 - Oct2024. Drug levels were measured using a bedside kit capable of quantitatively detecting values between 0.4-20 µg/ml. Results In total, 931 single pre-infusion measurements from 415 different patients, and dual measurements at weeks 4 and 8 from 116 patients were separately evaluated. 82% of the patients in the single measurement group, and 84% in the double measurement group had Crohn’s disease(CD), rest having Ulcerative Colitis. The most used doses in the single measurement group were 5 mg/8 weeks and 10 mg/4 weeks (Table 1). In the single measurement group, median albumin was 4.4 (IQR: 0.5), and median CRP was 3.1 (IQR: 6.4). Drug levels were below 5 µg/ml in 33% of measurements. CRP showed a significant difference according to drug level groups (Table 2), while no such difference was observed for albumin. In the measurable IFX range (0.4-20 µg/ml), correlation analysis revealed a weak negative correlation between CRP and drug levels (r: -0.09, p: 0.03). Regression analysis showed that lower CRP, higher drug dose, and CD diagnosis were independently associated with achieving &amp;gt;5 µg/ml drug levels. In the dual measurement group: The median CRP levels of patients at weeks 4 and 8 were 2.1 (5.1) and 2.6 (6.2), respectively (p&amp;gt;0.05). Among patients with IFX levels &amp;gt;20 µg/ml at week 4, 79% maintained levels &amp;gt;5 µg/ml at week 8, while this rate dropped to 71% for those with levels &amp;gt;10 µg/ml. Only 67% of patients with levels &amp;gt;5 µg/ml at week 4 maintained a level of &amp;gt;5 µg/ml at week 8 (all p-values &amp;lt;0.001). Conclusion As drug levels increase, significant reductions in CRP levels are observed. Therefore, low CRP levels may predict the likelihood of achieving the therapeutic range. Dose adjustment should be considered in cases with high CRP levels. Achieving a high drug level (&amp;gt;20 µg/ml) at 4th week is an important indicator of achieving at least an acceptable drug level (&amp;gt;5 µg/ml) at the end of treatment. (8th week).

P0411 Utility of Intestinal Ultrasound as a predictor of Severe Ulcerative Colitis response to treatment

Abstract Background Severe Acute Ulcerative Colitis (ASUC) is a serious complication of UC that requires an early response to treatment assessment and which clinical and analytical evaluations are often inadequate. In this setting, intestinal ultrasound (IUS) could be helpful, given its accuracy in evaluating inflammatory activity and non-invasiveness. The aim of this study was to determine whether basal IUS findings and index could predict ASUC patients’ response to corticosteroid treatment. Methods A retrospective descriptive study was done including ASUC patients admitted to our hospital between January 2019 and January 2024 whose IUS had been performed before corticosteroid treatment. Variables related to clinical and analytical activity at admission and after treatment, corticosteroids response and second-line therapy requirement were also collected. In addition, the need for colectomy during the episode and at 52 weeks of follow-up was analysed. Results 43 patients were included. Their and IBD baseline characteristics are summarized in Table 1. The 58% (25) of patients responded to corticosteroids. Regarding clinical response, the responders presented lower mean SAI index of 6.6, than non-responders (7.82), finding statistically significant differences (p=0.02). Truelove-Witts severity index was also lower among responders (16.75) than between corticosteroid-refractory patients (18.1), although no statistical significance was observed (p=0.11). Responders showed lower levels of CRP (18.5 mg/L) and FC (2007.5 µg/g) than refractory patients (CRP= 26.2 mg/L, FC=3185.1 µg/g) although the differences found were not significant (CRP, p=0.24; FC, p=0.23). Regarding baseline IUS, the responders had less parietal thickness (5.9 mm) compared to non-responders (5.8 mm), p=0.78. In addition, non-responders obtained major Simple US Score (11.1) than the other group (8.93), finding statistically significance (p=0.04). However, no significant differences (p=0.089) were observed in UCIUS score (responders 8.88, non-responders 8.97) or baseline MUC (p=0.78) between both groups (10.35 responders, 10.2 non-responders). Conclusion ASUC-IUS activity is related with corticosteroid clinical and analytical response, which demonstrates the role of IUS in early response to treatment assessment. Having found statistically significance or very close to significance differences with a limited sample size, statistical power and therefore, a greater risk of committing type 2 error make results even more paramount. Therefore, our study shows that IUS is a useful predictor of ASUC response to treatment. We hope that with this evidence the use of IUS monitoring becomes a closer reality to ASUC patients.

Key Taxa of the Gut Microbiome Associated with the Relationship Between Environmental Sensitivity and Inflammation-Related Biomarkers.

Individual differences in environmental sensitivity are linked to stress-related psychiatric symptoms. In previous research, we found that high environmental sensitivity can be a risk factor for increased inflammation and gut permeability, particularly when gut microbiome diversity is low. However, the specific gut bacterial taxa involved in this interaction remain unclear. As a preliminary study, this research aimed to identify the key gut microbiome taxa associated with this relationship. Environmental sensitivity, gut microbiome composition, gut permeability (lipopolysaccharide-binding protein, LBP), and inflammation (C-reactive protein, CRP) biomarkers were evaluated in 88 participants. The interaction between environmental sensitivity and the relative abundance of the family Marinifilaceae (genus Butyricimonas) was a predictor of CRP levels. Similarly, the interaction between environmental sensitivity and relative abundance of the family Barnesiellaceae (genus Coprobacter), the family Akkermansiaceae (genus Akkermansia), the genus Family XIII AD3011 group, the genus GCA-900066225, or the genus Ruminiclostridium 1 predicted LBP levels. Individuals with high environmental sensitivity exhibited elevated CRP or LBP levels when the relative abundance of these taxa was low. Conversely, highly sensitive individuals had lower CRP or LBP levels when the relative abundance of these taxa was high. This study suggests that specific taxa serve as one of the protective factors against inflammation and gut permeability in individuals with high environmental sensitivity. Further in-depth studies are needed to confirm these associations and understand the underlying mechanisms.

C-REACTIVE PROTEIN LEVELS AMONG LGB OLDER ADULTS: INTERSECTIONAL ASSOCIATIONS OF RACE, ETHNICITY, AND EDUCATION

Abstract Objectives This paper assesses the intersection between sexual orientation, race, and ethnicity as they relate to CRP levels among middle-aged and older adults in the Health and Retirement Study (HRS). It will also explore how educational attainment, a commonly used demographic correlate with socioeconomic status, may differently benefit racially, ethnically, and sexually diverse middle-age and older adults. Methods This study uses data from the 2016 Health and Retirement study. C-reactive protein levels, sexual orientation, race and ethnicity, educational attainment, and covariate variables were collected using serum samples and survey responses from 1,426 older adults enrolled in the study. Individuals were included if they had reported measures for key independent and dependent variables. Multiple imputation was used to address missing values across control variables. Associations and moderators were assessed using ordinary least squares (OLS) regression. Results This study found lesbian, gay, and bisexual (LGB) respondents had lower CRP levels when they had higher educational attainment compared to similarly educated straight respondents. Additionally, Black LGB respondents had less inflammation than Black and straight or White and LGB respondents. Discussion This study’s findings indicate educational attainment may differently benefit LGB older adults compared to straight older adults, and respondents who are Black and LGB experience greater protection from elevated CRP levels compared to only Black or LGB respondents. These findings suggest educational attainment may be differently used to protect against systemic inflammation among sexual minority populations. Furthermore, these results suggest additional nuance is necessary to understand how CRP levels impact diverse populations.

Studying The Role Of Cartilago Oligomer Matrix Protein (Comp) In Joint Structure Changes In Osteoarthritis

To study the role of cartilage oligomeric matrix protein in structural changes in joints in patients with osteoarthritis (OA). Material and methods: We observed 50 patients diagnosed with osteoarthritis aged 54.5±4.4 years, of whom 43.8% had radiographic stage 0, 40% had stage I, and 16.2% had stage II. Patients in the main group received treatment aimed at reducing the amount of cartilage oligomeric matrix protein, while patients in the control group received traditional treatment. Results: In addition to clinical improvement and a decrease in the intensity of pain in the knee joint, patients in the main group also had lower levels of SOMP, CRP, and ESR in the blood serum compared to patients in the control group. Conclusions: The treatment method aimed at the dynamics of COMP differs from the traditional one in that it is aimed at suppressing the reactions of cartilage destruction in OA

C‐reactive protein diagnostic value for bacterial infections in the paediatric emergency department setting

AimC‐reactive protein (CRP) is commonly used to assess the probability of bacterial infection and the need for empiric antibiotic treatment. We assessed the relationship between CRP levels and bacterial infection in the paediatric emergency room (PER) setting.MethodsA retrospective cohort study. Relative risks (RRs) were calculated for the relation between CRP levels and various demographic, clinical and diagnosis parameters. Additionally, the sensitivity and specificity of different CRP levels (2, 5, 7 and 10 mg/dL) for bacterial infection diagnosis was calculated.ResultsOverall, 13 092 cases were recorded. Fever, leucocytosis, hospitalisation and bacterial infection diagnosis were associated with elevated CRP levels, while lower CRP levels were associated with young age. Gender, ethnicity, hypoxemia and neutrophilia were not associated with CRP levels. The sensitivity of CRP ≥2 mg/dl for bacterial disease was 65%–70%, declining to &lt;50% in CRP ≥5 mg/dL. The specificity of CRP ≥2 mg/dL for bacterial disease was ~60%, increasing to &gt;80% in CRP ≥5 mg/dL.ConclusionsCRP levels of ≥5 mg/dl high specificity for bacterial disease, allow for its use as an indicator to start empiric antibiotic treatment, while the low sensitivity of various CRP levels probably excludes the possibility of withholding empiric antibiotic treatment, based only on CRP level.

Association of Laboratory and Imaging Parameters in Different Types of Pancreatitis in Children in a Tertiary Care Hospital in Bangladesh

Background: Pancreatitis is an inflammatory condition of the pancreas, which might extend to local and distant extra-pancreatic tissues. It can be acute, acute recurrent or may be chronic. The diagnosis of different types of pancreatitis is based on a combination of clinical signs and symptoms, laboratory investigations and imaging techniques. Objective: To describe and find out the association of the laboratory and imaging profiles of different variety of pancreatitis in children. Methods: It was a an observational study conducted at the department of Paediatric Gastroenterology and Nutrition of Bangabandhu Sheikh Mujib Medical University from July 2018 through June 2020. A total of 48 cases were included in this study. The diagnosis of acute, acute recurrent and chronic pancreatitis was based on diagnostic criteria made by INSPPIRE group. Clinical characteristics, hematological, biochemical and imaging profile of the different variety of pancreatitis and their hospital outcome were observed. Result: Among 48 cases, acute recurrent pancreatitis were 56.3%. Mean age of the patients at presentation was 10.3 years. Laboratory tests showed serum calcium and C-reactive protein was significantly altered among acute, acute recurrent and chronic pancreatitis with characteristic imaging findings. Among imaging modalities, abdominal ultrasonogram showed swollen pancreas (58.3%) was significantly common in acute recurrent pancreatitis than chronic pancreatitis, whereas shrunken pancreas (28%) was significantly common findings in chronic pancreatitis. In addition to ultrasonogram, MRCP aided diagnosis of chronic pancreatitis. Complications developed in 25% of acute pancreatitis cases, which included hypocalcemia (58.3%), ascites (86.7%), pleural effusion (66.7%), pseudocyst (33.3%) and pancreatic necrosis (25%). Hospital stay was significantly prolonged in acute pancreatitis cases, when compared to other types of pancreatitis . Conclusion: Low calcium level and high CRP level were found in acute pancreatitis than in acute recurrent and chronic pancreatitis. Swollen pancreas with beaded and tortuous pancreatic ducts were found in case of chronic pancreatitis. Bangladesh J Child Health 2023; Vol 47 (2) : 95-102

Early mNGS testing for diagnose and prognostic prediction of early onset pneumonia among in-hospital cardiac arrest patients undergoing extracorporeal cardiopulmonary resuscitation.

Metagenomic next-generation sequencing (mNGS) is emerging as a novel diagnostic technology for various infectious diseases; however, limited studies have investigated its application in etiological diagnosis of early onset pneumonia (EOP) among patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) following in-hospital cardiac arrest (IHCA), The clinical significance of early mNGS in predicting short-term prognosis of IHCA patients after ECPR remains unclear. This retrospective study included 76 patients with IHCA who underwent ECPR at the First Affiliated Hospital of Zhengzhou University from January 2018 to December 2022. Baseline characteristics and etiological data of all patients during their hospitalization were collected and statistically analyzed. The primary outcome of this study was the diagnosis of EOP, while the secondary outcomes included successful extracorporeal membrane oxygenation (ECMO) weaning and survival at discharge. Additionally, the characteristics of bronchoalveolar lavage fluid (BALF) flora in these patients were compared by analyzing both mNGS results and culture results. Multivariate logistic regression were employed to analyze the predictors of ECMO weaning failure, mortality at discharge, and the incidence of EOP. Ultimately, patients with lower SOFA scores on admission [OR (95%CI): 1.447 (1.107-1.890), p=0.007] and those who underwent early mNGS testing within 48 hours after ECPR [OR (95%CI): 0.273 (0.086-0.865), p=0.027] demonstrated a higher probability of successful weaning from ECMO. Patients with higher SOFA scores on admission [OR (95%CI): 2.404 (1.422-4.064), p=0.001], and elevated lactate levels [OR (95%CI): 1.176 (1.017-1.361), p=0.029] exhibited an increased likelihood of mortality at discharge. Furthermore, early mNGS detection [OR (95%CI): 0.186 (0.035-0.979), p=0.047], and lower CRP levels (48h-7d after ECMO) [OR (95%CI):1.011 (1.003-1.019), p=0.006] were associated with a reduced incidence of EOP. In addition, the pathogens detected by mNGS within 48 hours after ECPR were mainly oral colonizing bacteria and viruses, and viruses were in the majority, while all BALF cultures were negative. In contrast, between 48 hours and 7 days after ECPR, BALF cultures were positive in all EOP patients. Early mNGS testing to identify microbial flora facilitates timely adjustment of antibiotic regimens, thereby reducing the incidence of EOP and improving short-term prognosis in patients undergoing ECPR following IHCA.

Low handgrip strength as a marker of severity in the diagnostic criteria for cancer cachexia

Background & AimsThe diagnostic criteria for cachexia, as proposed by the Asian Working Group for Cachexia (AWGC), include weight loss, a low body mass index, and additional factors such as a low handgrip strength (HGS), anorexia, or elevated CRP levels. This study aimed to evaluate the significance of low HGS as a diagnostic criterion in patients with advanced cancer. MethodsThis single-centre, retrospective cohort study was conducted between April 2019 and March 2023. Patients aged ≥18 years with malignant diseases were included. Patients without records on HGS were excluded. Low HGS was defined as a HGS <28 kg for men and <18 kg for women. The overall median survival time (MST) was analysed by univariate and multivariate analyses. ResultsA total of 894 patients were analysed. Cachexia was prevalent in 74%, though only 3.4% were diagnosed based solely on low HGS. The MST in patients with cachexia was 122 days, and in those with low HGS was 73 days. The associations between low HGS and high mortality remained significant after adjusting for AWGC criteria, modified weight loss grading system, age, gender, performance status, calf circumferenceand fluid retention. The MST varied with the number of additional factors being met: 422 days for one criterion, 92 days for two, and 55 days for all three (p <0.0001). ConclusionThis study supports that HGS serve as important prognostic tool in patients with various cancers.

High eosinophil counts aid in diagnosing Kawasaki disease in febrile children

Abstract Background Several recent studies have validated the newfound significance of elevated eosinophils in Kawasaki disease (KD). However, this finding was not incorporated into the suggested laboratory criteria outlined by the Kawasaki Disease Committee of the American Heart Association for assessing children with incomplete KD. Purpose We aimed to determine the potential benefits of including eosinophil levels in the laboratory evaluation of KD. Methods A retrospective cohort study involved 77,934 febrile children (FC, not KD) and 1,970 subjects diagnosed with KD. Participants were recruited from four hospitals, comprising two medical centers and two regional hospitals. The AHA recommends specific laboratory tests—white blood cell count, hemoglobin, platelet count, ALT levels, albumin, and urinalysis—for evaluating incomplete KD in children with a higher CRP than 30mg/dL. The first four items are standard blood assays. Additionally, we introduced high eosinophil counts as a new diagnostic criterion for identifying children with KD. Results All these five laboratory findings (anemia for age defined as below the 5th percentile), platelet count &amp;gt;450,000/mm3, white blood cell&amp;gt;15,000/mm3, ALT&amp;gt;40 U/L, and eosinophil count &amp;gt;190/mm3) are significantly different between KD children and FC. The proportion of having these features is higher in KD children than in FC (19.3% vs. 8.0% in anemia for age, 20.5% vs. 10.3% in thrombocytosis, 37.0% vs. 18.1% in leukocytosis, 45.7% vs. 5.8% in elevated ALT, and 62.6% vs. 29.3% in high eosinophils). Elevated eosinophil counts are most commonly associated with KD among these five parameters. Furthermore, when incorporating the parameter of elevated eosinophil counts, the proportion of KD children with at least two abnormalities rose from 35.4% to 60.7%. In a subgroup analysis of children with KD presenting at least two abnormalities, the proportion rose from 38.7% to 63.5% in the high CRP group (≧ 3.0 mg/L) and 21.6% to 49.0% in the low CRP group (&amp;lt; 3.0 mg/L), respectively. Conclusions Higher eosinophil counts are vital markers in KD children. This aids in the identification of additional potential KD cases, especially in those exhibiting low CRP levels.

Vulvar necrotizing wounds: Unveiling mortality-associated parameters and assessing the efficacy of VAC therapy

IntroductionVulvar Necrotizing Fasciitis (VNF) is a critical, severe soft tissue infection characterized by aggressive progression and significant morbidity and mortality. Rapid diagnosis and immediate, comprehensive treatment, including antibiotic therapy, meticulous surgical debridement, and multidisciplinary care, are crucial for improving outcomes. This study aimed to investigate mortality-related factors in VNF and evaluate treatment modalities, focusing on Vacuum-Assisted Closure (VAC) therapy versus traditional debridement. MethodsThis retrospective study analyzed data from 22 VNF patients. Criteria included adults diagnosed with vulvar necrotizing infections, excluding those transferred or not completing treatment at the center. The study examined mortality-related factors and the efficacy of VAC therapy compared to debridement, considering treatment costs and outcomes. ResultsAnalysis divided patients into survivors (13) and non-survivors (9). Higher heart rate, elevated WBC and CRP levels, and higher Clavien-Dindo scores were associated with increased mortality. VAC therapy, compared to traditional debridement, resulted in significantly lower CRP levels and reduced treatment costs. However, other parameters such as the length of hospital stay and debridement frequency showed no significant differences. ConclusionThe study highlights that older age, systemic inflammation, and severe postoperative complications are key factors associated with higher mortality in VNF. VAC therapy emerges as a promising modality, effectively reducing systemic inflammation and healthcare costs. Nonetheless, the retrospective nature and the small sample size of the study limit the generalizability of the findings. Future research, particularly larger, multicentric studies, is essential to further explore and validate the effectiveness of VAC therapy in VNF management.

Clinical Effectiveness and Biochemical Impacts of Minimally Invasive versus Open Transforaminal Lumbar Interbody Fusion: A Meta-Analysis

Objective: This meta-analysis aimed to assess and compare the clinical effectiveness, safety, and biochemical impacts of two spinal surgery techniques: open transforaminal lumbar interbody fusion (open-TLIF) and minimally invasive TLIF (MIS-TLIF). Methods: A comprehensive search of the literature up to April 2023 was conducted across several databases, including PUBMED, Cochrane Library, SCOPUS, Web of Science, EMBASE, and CNKI. The search focused on the terms "transforaminal lumbar interbody fusion" or "TLIF" combined with "minimally invasive" or "open." From this search, 44 studies met the inclusion criteria and were analyzed. Results: The meta-analysis revealed that MIS-TLIF is associated with increased intraoperative radiological exposure but reduced intraoperative blood loss, decreased postoperative drainage volumes, shorter hospital stays, and improved outcomes as measured by the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). Biochemically, MIS-TLIF is linked to lower levels of CRP, creatine kinase-muscle/brain (CK-MM), and creatine phosphokinase (CPK) at 24 hours post-operation compared to open TLIF. Conclusions: MIS-TLIF offers superior clinical effectiveness, improved safety profiles, and reduced muscular injury relative to conventional open TLIF. These findings suggest that MIS-TLIF may be a preferable option in spinal surgery settings where the reduction of tissue trauma and rapid recovery are prioritized.

Genetic susceptibility and clinical features of CYP2D6 associated with systemic lupus erythematosus in a Chinese population.

This study aims to explore possible susceptibility genes and clinical features for systemic lupus erythematosus (SLE) patients in a Chinese population. Expanding on the results of a prior single-center observational study involving 60 systemic lupus erythematosus patients, a subsequent single-center prospective observational study was conducted on SLE patients undergoing treatment at Nanfang Hospital Affiliated to Southern Medical University from 2021 to 2023. The identification process for drug-related target genes entailed an extensive search across PharmGKB (https://www.pharmgkb.org/), the Clinical Pharmacogenetics Implementation Consortium (CPIC),and PubMed literature databases, to pinpoint common drugs and target single nucleotide polymorphisms(SNPs)for SLE. Blood samples were individually collected and genotyped using MassARRAY® high-throughput nucleic acid mass spectrometry. Genotype frequency differences were assessed through Chi-square tests against both the larger East Asian population as well as kidney transplant recipients. Data collection relied on electronic medical records, encompassing demographic details(age, gender),medication regimens(hormones, NSAIDs, hydroxychloroquine, DMARDs, biologic agents, stomach medications, calcitriol, etc.),laboratory indicators(RF, Anti-CCP antibody, ESR, CRP, anti-ANA antibodies, dsDNA antibodies, anti-SM antibodies, S m. RNP antibodies, A LT, ALB, CR, UA, WBC, PLT, HGB, Ca, K, Glu, CHOL, TG, LDL-C, HDL-C) and lupus activity scores(SLEDAI-2K). Possible disease susceptibility genes were categorized, and SPSS26 software facilitated statistical analyses. The research encompassed a total of 137 SLE patients along with 50 SNPs. After conducting statistical analyses, it emerged that there existed significant disparities in CYP2D6 gene (rs1065852) distribution when compared against allele mutation rates within both East Asian populations (p < .05) and kidney transplant patients(p < .05). Wild-type gene (GG) constituted 14% of cases while mutant gene (GA + AA) constituted 86%. Allele mutation rate (A63.6%) was significantly higher among SLE patients (RR = 0.802; p = .0355). Furthermore, the variant rs1065852 genotype (GA + AA) demonstrated significant associations with lower CRP levels, higher HGB levels, and higher HDL-C levels (p < 0 0.05). The metabolic enzyme CYP2D6 may be used as susceptibility gene for predicting systemic lupus erythematosus and are correlated with CRP and other indicators.

Effect of Combination of Point-of-Care C-Reactive Protein Testing and General Practitioner Education and Long-Term Effect of Education on Reducing Antibiotic Prescribing for Children Presenting with Acute Infections in General Practice in Latvia: A Randomized Controlled Intervention Study.

Antibiotics are often overprescribed in children in general practice. We investigated whether the availability of C-reactive protein point-of-care testing (CRP POCT) in daily practice and general practitioner (GP) education reduces antibiotic prescribing for children with acute infections and whether GP education has a long-term effect on antibiotic prescribing. This was a randomized controlled intervention study with randomization at the GP practice level. Eligible patients were children aged 1 month to 17 years presenting to general practice with an acute infection. In the first study period, one GP group received combined interventions (CRP POCT was provided for daily use in combination with a live educational session), while the second GP group continued usual care. During the second study period, the GP groups were switched. During this period, the long-term education effect was evaluated in the GP group, which had previously received both interventions: the CRP POCT was no longer available in their practices in accordance with the study protocol, but education could have a lasting effect. Antibiotic prescribing at index consultation. GP with combined intervention enrolled 1784 patients, GP with usual care enrolled 886 patients, and GP with long-term education effect enrolled 647 patients. Most of the patients had upper (76.8%) and lower (18.8%) respiratory infections. In total, 29.3% of the study patients received antibiotic prescriptions. Adjusted binary logistic regression analysis showed no differences for the primary outcome between GPs with usual care and GPs with combined intervention (aOR 0.89 (0.74-1.07), p = 0.20), but significantly lower antibiotic prescribing was observed for GPs with long-term education in comparison with GPs with usual care (aOR 0.75 (0.59-0.96), p = 0.02); however, after multilevel analyses, any differences in the antibiotic prescription between intervention groups became non-significant. GPs widely used CRP POCT when it was available in practice (for 69.1% of patients in the combined intervention group), but rarely measured CRP in the laboratory in the usual care group (8.8% (n = 78)) or long-term education group (14.8% (n = 98)). The majority of the tested patients had low CRP levels (below 20 mg/L); despite this, up to 35.4% of them received antibiotic prescriptions. Our results show that the availability of CRP POCT and educational training for GPs together did not reduce antibiotic prescribing, and one-time education did not have a long-term effect on antibiotic prescribing.

Comparison of the therapeutic effects of three minimally invasive approaches for laparoscopic cholecystectomy combined with common bile duct exploration—— a 5-year retrospective analysis

ObjectiveThe aim of this retrospective study was to explore the indications for three minimally invasive approaches—T-tube external drainage, double J-tube internal drainage, and primary closure—in laparoscopic cholecystectomy combined with common bile duct exploration.MethodsThree hundred eighty-nine patients with common bile duct stones who were treated at the Second People's Hospital of Hefei between February 2018 and January 2023 were retrospectively included. Patients were divided into three groups based on the surgical approach used: the T-tube drainage group, the double J-tube internal drainage group, and the primary closure group. General data, including sex, age, and BMI, were compared among the three groups preoperatively. Surgical time, length of hospital stay, pain scores, and other aspects were compared among the three groups. Differences in liver function, inflammatory factors, and postoperative complications were also compared among the three groups.ResultsThere were no significant differences among the three groups in terms of sex, age, BMI, or other general data preoperatively (P > 0.05). There were significant differences between the primary closure group and the T-tube drainage group in terms of surgical time and pain scores (P < 0.05). The primary closure group and double J-tube drainage group differed from the T-tube drainage group in terms of length of hospital stay, hospitalization expenses, and time to passage of gas (P <0.05). Among the three groups, there were no statistically significant differences in inflammatory factors or liver function, TBIL, AST, ALP, ALT, GGT, CRP, or IL-6, before surgery or on the third day after surgery (P > 0.05). However, on the third day after surgery, liver function in all three groups was significantly lower than that before surgery (P<0.05). In all three groups, the levels of CRP and IL-6 were significantly lower than their preoperative levels. The primary closure group had significantly lower CRP and IL-6 levels than did the T-tube drainage group (P < 0.05). The primary closure group differed from the T-tube drainage group in terms of the incidences of bile leakage and electrolyte imbalance (P < 0.05). The double J-tube drainage group differed from the T-tube drainage group in terms of the tube dislodgement rate (P < 0.05).ConclusionAlthough primary closure of the bile ducts has clear advantages in terms of length of hospital stay and hospitalization expenses, it is associated with a higher incidence of postoperative complications, particularly bile leakage. T-tube drainage and double J-tube internal drainage also have their own advantages. The specific surgical approach should be selected based on the preoperative assessment, indications, and other factors to reduce the occurrence of postoperative complications.

CORRELATION OF DIASTOLIC BLOOD PRESSURE WITH HIGH SENSITIVITY C-REACTIVE PROTEIN IN MIDDLE AGED CORONARY HEART DISEASE PATIENTS

Background and objectives: C-reactive protein is a plasma protein to determine the levels of inflammation inside our body. There are low levels of CRP in our blood but moderate to severe elevated levels can be seen in bacterial infection and any other autoimmune diseases. Hypertension is considered to be the significant risk factor in coronary heart disease. Our objective of study is to determine the correlation of hs-CRP with diastolic blood pressure in middle aged coronary heart disease individuals. Methods: This is a descriptive cross sectional study conducted among two groups i.e coronary heart disease and control (n=150). Their CRP levels as well as two readings of diastolic blood pressure are taken. Data and results collected, compiled and analyzed with SPSS version 23. Results: Hypertension is an important risk factor for coronary events. Results of our study has shown strong correlation between CRP and diastolic blood pressure having mean values about 146.3±2.14 (P&lt; 0.001) in coronary heart disease individuals and 92.14±17.14 in control group ( P value 0.008). Conclusion: It was observed that hs-crp has strong association with diastolic blood pressure in middle aged coronary heart disease individuals.

Comparative analysis of lysophospholipid metabolism profiles and clinical characteristics in patients with high vs. low C-reactive protein levels in acute exacerbations of chronic obstructive pulmonary disease

BackgroundThe precise role of lysophospholipids (LysoPLs) in the pathogenesis of acute exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD) remains unclear. In this study, we sought to elucidate the differences in serum LysoPL metabolite profiles and their correlation with clinical features between patients with low versus high CRP levels. MethodsA total of 58 patients with AECOPD were enrolled in the study. Patients were classified into two groups: low CRP group (CRP < 20 mg/L, n = 34) and high CRP group (CRP ≥ 20 mg/L, n = 24). Clinical data were collected, and the LysoPL metabolite profiles were analyzed using Liquid Chromatography-Mass Spectrometry (LC-MS) and identified by matching with the LipidBlast library. ResultsNineteen differential LysoPLs were initially identified through Student's t-test (p < 0.05 and VIP > 1). Subsequently, four LysoPLs, LPC(16:0), LPE(18:2), LPC(22:0), and LPC(24:0), were identified by FDR adjustment (adjusted p < 0.05). These four lysoPLs had a significant negative correlation with CRP. Integrative analysis revealed that LPC (16:0) and LPC (22:0) correlated with less hypercapnic respiratory failure and ICU admission. ConclusionAECOPD patients with high CRP levels demonstrated a distinctive LysoPL metabolism profile, with LPC (16:0), LPE(18:2), LPC(22:0), and LPC(24:0) being the most significantly altered lipid molecules. These alterations were associated with poorer clinical outcomes.