Lower C-reactive Protein Research Articles

C-reactive protein expression in acute ischemic stroke blood clots: Implications for etiology.

C-reactive protein (CRP) is a prototypic inflammation marker, with elevated levels associated with an increased risk of cerebrovascular events. To determine whether CRP could be a useful biomarker of stroke etiology, we investigated CRP expression in acute ischemic stroke (AIS) clots from large-artery atherosclerosis (LAA), cardio-embolism (CE) and cryptogenic (Crypt) subtypes. We analysed clot samples from AIS patients (LAA, CE, Crypt; n = 50 each), collected across five stroke centres in France, Serbia, Spain, and Japan between February 2021 and February 2024, as part of the prospective Clotbase International Registry of 460 patients who underwent mechanical thrombectomy. Clot components were assessed using Martius Scarlet Blue staining. CRP expression was examined using immunohistochemistry and its co-localisation with clot components was detected using immunofluorescence. Clinical parameters were compared across etiologies. CRP expression varied significantly among clots. Most clots (65%) had minimal (⩽1%) CRP and 35% showed substantial (>1%) CRP. CE group had significantly more clots with substantial CRP than LAA and Crypt (48% vs 30% and 26%; p = 0.048). Clots with substantial CRP contained more fibrin (28.9%) than those with low CRP (20.6%; p = 0.005). Confocal microscopy showed CRP co-localised with fibrin and white blood cells (WBCs). Significantly more AIS clots of CE expressed substantial CRP compared to those of LAA and Crypt, suggesting CE strokes may be more strongly linked to inflammation. Clots with substantial CRP expression displayed significantly more fibrin compared to those with minimal CRP expression, suggesting a potential association between inflammation and fibrin-rich clots. Further study of the relationship between CRP, fibrin and WBCs in clots may improve our understanding of the processes of thrombo-inflammation.

Frequent detection of anti-nuclear antibodies and low-titer rheumatoid factor in female patients with undifferentiated peripheral spondyloarthritis in Japan: a prospective observational study.

Studies on the clinical features of undifferentiated peripheral spondyloarthritis (upSpA) are limited. This study explores sex-based manifestations of upSpA and compares upSpA with rheumatoid arthritis (RA) under conditions of low human leukocyte antigen B27 positivity in Japan. In this multicenter prospective observational study, physical and laboratory findings from 29 upSpA cases (19 females, 10 males) were collected to investigate sex differences. Fourteen patients with RA were also enrolled as a control group to evaluate clinical parameters distinguishing upSpA and RA. Tenderness at the humeral epicondyles and the Achilles tendon were more common in female patients with upSpA than in males. Serum C-reactive protein (CRP) levels were lower in female patients with upSpA than in male patients. Serum rheumatoid factor (RF) levels were lower in upSpA cases than in RA, with a cut-off value of 84 IU/mL differentiating RA from upSpA. An anti-nuclear antibodies (ANA) test at a dilution of ≥1:160 was detected in about half of the female upSpA cases but not in male cases. Among upSpA and RA cases, female patients with upSpA frequently present with multiple enthesitis, low serum CRP levels, low-titer RF positivity, and a high incidence of ANA positivity.

Towards the Measurement of Acute-Phase Proteins in Saliva in Farm Conditions: Development and Validation of a Lateral Flow Assay for the Measurement of C-Reactive Protein in Pigs

Point-of-care diagnostic tests, such as lateral-flow immunoassay (LFIA), have emerged as a fast diagnostic tool in both human and veterinary medicine. In this paper, a gold nanoparticle-based LFIA device was developed for the measurement of C-reactive protein (CRP) in porcine saliva, using a monoclonal anti-porcine CRP antibody. The dilution ratio for the saliva samples was optimized at 1:5 with an assay buffer. The reaction time was optimized to 20 min, since this provided a positive signal with high CRP concentration saliva samples, but a negative result with an assay buffer or samples with a low CRP concentration. Linear results were observed when two samples with a high CRP concentration were serially diluted. Also, a linear relationship was observed with a validated quantitative method. The assay was precise when samples with high CRP concentration were measured five times in a single assay run. No overlap was observed when samples from healthy and diseased animals were analyzed. The LFIA allowed the detection of high CRP concentrations in porcine saliva samples. The intensity of the result was proportional to the CRP concentration obtained with the quantitative method, allowing for the possible use of the test for semiquantitative purposes.

The role of Anti-Müllerian hormone in women health.

Anti-Müllerian hormone (AMH), also known as Müller duct inhibitory factor and primarily known for its role in sexual differentiation. In female fetuses, AMH production by granulosa cells begins around the 36th week of gestation and continues in women until menopause. It is becoming more significant in the endocrine and gynecological diagnosis of adult women. The suppressive effect of AMH on follicle-stimulating hormone (FSH)-induced aromatase production likely plays a role in hyperandrogenism in polycystic ovary syndrome (PCOS) and may increase insulin resistance. Female adolescent with type 1 diabetes (T1D) have an increased likelihood of developing PCOS, but it is not known whether they also show elevated AMH levels. The elevated AMH levels observed in prepubertal girls with T1D suggest that there are more small follicles in their ovaries, probably in response to insulin treatment. Elevated levels of androgens and anti-Müllerian hormone have been previously reported in non-pregnant women with diabetes. The increased AMH concentrations can be associated with reduced systemic inflammation [lower c-reactive protein (CRP) values], irrespective of the type of diet and greater insulin sensitivity in old obese males. AMH can also serve as a valuable marker for granulosa cell tumors (folliculomas) and their recurrence. In these clinical scenarios, AMH levels can be significantly elevated and correspond with the size of the tumor.

Short-term Outcomes of Intracorporeal Versus Extracorporeal Totally Stapled Anastomosis after Laparoscopic Colectomy: A Propensity Score-matched Cohort Study

To describe detailed surgical techniques for totally stapled intracorporeal anastomosis (TSIA) and determine their feasibility and safety by comparing short-term outcomes with those of conventional totally stapled extracorporeal anastomosis (TSEA). In total, 59 consecutive patients who underwent laparoscopic colectomy between June 2018 and August 2021 were retrospectively assessed. Linear staplers were used for all anastomoses. The TSIA and TSEA groups included 23 and 36 patients, respectively. Following a comprehensive description of each surgical technique, propensity score matching analysis was conducted to compare matched groups on the basis of clinicopathological characteristics, surgical and perioperative outcomes, complications, and postoperative inflammatory reactions. After matching, 17 cases each were analyzed in the TSIA and TSEA groups. Both groups were well matched. The TSIA group had significantly lesser blood loss than did the TSEA group (10 versus 20 mL, p=0.002), although this result was not clinically significant. The skin excision length (4 versus 6 cm, p<0.001) and postoperative hospital stay length (6 versus 7 days, p<0.001) were significantly shorter in the TSIA group than in the TSEA group. Increasing C-reactive protein (CRP) values at 1, 3, and 6 postoperative days were significantly lower in the TSIA group than in the TSEA group (p=0.016, p=0.011, and p=0.012, respectively). TSIA is a simple, feasible, and efficient surgical technique; compared with TSEA, it is less invasive and associated with lesser blood loss, shorter skin incision lengths, shorter postoperative hospital stays, and lower CRP level increases.

P0901 Infliximab chronotherapy: timing of intravenous infliximab administration affects inflammatory markers and clinical outcomes in inflammatory bowel disease

Abstract Background Inflammatory bowel disease (IBD) is characterized by an exaggerated inflammatory response causing intestinal inflammation. As with most human biological processes, the inflammatory response is controlled by the circadian clock1. Peak inflammatory response occurs in the late evening/early night, with peak TNFα levels at 09:00PM2. We therefore hypothesized that intravenous (IV) infliximab, an anti-TNFα with immediate systemic drug exposure, would be more effective when given prior to peak inflammatory response. Methods This retrospective study included IBD patients age&amp;gt;18 who received inpatient infliximab between 1/1/2010 and 11/30/2023. Time and dose of infliximab were documented. Cases were grouped into "at peak" or "late" (administered between 6:00PM to 12:00AM) and "before peak" or "early" (administered between 12:00PM to 6:00PM) inflammatory activity. Outcomes assessed were IBD-related readmission and surgery at 30 days, change in c-reactive protein (CRP) at 72 hours and trend over 40 days, and change in albumin at 7 and 30 days. Fisher’s Exact test was used for proportions and simple linear regression for CRP trend. Results 113 IBD patients were included. Demographics and disease characteristics, including proportion of men, average age, average body mass index, race/ethnicity, disease location/severity and infliximab dose were similar between groups. At first glance, "late" group had marginally higher surgery and readmission rates at 30 days compared to "early" (9.38% vs 7.41% for surgery and 9.38% vs 8.64% for readmission). However, there were striking differences for women: surgery rates of 15.38% vs 11.11% for "late" vs "early" compared to 5.26% vs 4.44% in men, and readmission rates of 15.38% vs 8.33% for "late" vs "early" compared to 5.26% and 8.89% respectively for men [Figure 1]. Rates of 72-hour CRP response were lower in "late" compared to "early" (71% vs 83%). Over 40 days, "early" had a significant improvement in CRP compared to "late" (simple linear regression p=0.0582, and p=0.0006 when omitting patients with surgery/readmission at 30 days)[Figure 2]. At 7 days, albumin worsened in "late" compared to "early" (-17% vs +8% respectively) but improved in both groups at 30 days (+16% vs +29% respectively) compared to baseline. Conclusion IBD patients that received IV infliximab "early" had 1) lower surgery/readmission rates at 30 days, 2) higher 72-hour CRP response, 3) lower CRP at 30 days, and 4) more favorable change in albumin at 7 and 30 days compared to the "late" group. This suggests that IV infliximab administered prior to peak inflammatory response (i.e., before 6 PM) leads to better control of the inflammatory response with improved clinical outcomes.

Transforaminal interbody debridement and fusion with antibiotic-impregnated bone graft to treat pyogenic discitis and vertebral osteomyelitis: a comparative study in Asian population.

A retrospective cohort study. To evaluate whether using antibiotic-impregnated bone graft (AIBG) enhances infection control and shortens the postoperative course of pyogenic discitis and vertebral osteomyelitis (PDVO). Surgical treatment of PDVO is indicated for neurological deficit, instability, unknown pathogen, or poorly controlled infection. The posterior-only approach is effective but requires 4-6 weeks of antibiotic treatment postoperatively. We hypothesized that AIBG used in an all-posterior approach could enhance infection control and shorten the postoperative course of PDVO. Thirty patients with PDVO of the lumbar or thoracic spine treated with transforaminal interbody debridement and fusion (TIDF) with AIBG between March 2014 and May 2022 were reviewed (AIBG group). For comparative analysis, 28 PDVO patients who underwent TIDF without AIBG between January 2009 and June 2011 were enrolled (non-AIBG group). The minimum follow-up duration was 2 years. Clinical characteristics and surgical indications were comparable in the two groups. C-reactive protein (CRP) levels and the postoperative antibiotics course were compared between the two groups. Surgical treatment for PDVO resulted in clinical improvement and adequate infection control. Despite the shorter postoperative intravenous antibiotic duration (mean: 19.0 days vs. 39.8 days), the AIBG group had significantly lower CRP levels at postoperative 4 and 6 weeks. The mean Visual Analog Scale pain scores improved from 7.3 preoperatively to 2.2 at 6 weeks postoperatively. The average angle correction at the last follow-up was 7.9°. TIDF with AIBG for PDVO can achieve local infection control with a faster reduction in CRP levels, leading to a shorter antibiotic duration.

Tumor‐infiltrating CD8+ T‐cell numbers and serum C‐reactive protein levels as a prognostic biomarker in hepatocellular carcinoma patients receiving atezolizumab plus bevacizumab

AbstractAimAtezolizumab plus bevacizumab is an established first‐line treatment for unresectable hepatocellular carcinoma (HCC). Our previous research identified CD8+ tumor‐infiltrating lymphocytes (TILs) as a potential biomarker for predicting patient response to this therapy. However, not all HCC patients with CD8+ TILs respond favorably to atezolizumab and bevacizumab. Moreover, elevated serum C‐reactive protein (CRP) levels have been associated with poor outcomes in patients treated with immune checkpoint inhibitors across various cancer types. The aim of this study was to determine whether CD8+ TIL numbers combined with serum CRP levels could collectively predict the response to atezolizumab and bevacizumab better than CD8+ TIL numbers alone.MethodsA total of 46 HCC patients who provided liver biopsy samples were included. CD8+ TIL numbers in liver tissue were measured using immunohistochemistry.ResultsA group of 13 patients (28.3%) with high CD8+ TIL numbers and low (≤0.54 mg/dl) serum CRP levels demonstrated the highest treatment response rate. Furthermore, this group had a significantly longer median overall survival and progression‐free survival than the remaining 33 patients. Multivariate analysis revealed that high CD8+ TIL numbers with low CRP levels (HR 0.264; p = 0.037) and Child–Pugh class A (HR 0.277; p = 0.009) were associated with improved overall survival.ConclusionsThese findings suggest that the combination of CD8+ TIL numbers and serum CRP levels may serve as a useful biomarker for predicting the efficacy of atezolizumab plus bevacizumab in HCC patients.

Gender disparities in adult patients undergoing emergency appendicectomy: A comparative analysis.

Emergency appendicectomy (EA) is a common procedure, yet few studies have focused on gender differences in these patients. This study aims to evaluate the demographics, preoperative investigations, intraoperative findings, and clinical outcomes between males and females undergoing EA. A multicenter retrospective observational study was conducted across four hospitals involving patients who underwent EA between August 2018 and November 2025. Patients were identified through pathology records, and data were collected on demographics, preoperative blood tests, imaging, operative details, and clinical outcomes and results compared. 1128 patients were included, with 57.5% being male. Males were younger (median age: 34 vs 40 years, P < .001). There was no significant difference in preoperative white cell or neutrophil counts, although males had lower C-reactive protein levels (median 72 vs 97, P < .001). Females were more likely to undergo pre-operative imaging, including ultrasound (20.7% vs 1.5%, P < .001) and CT scans (61.8% vs 54.9%, P = .020). Open surgery was more common in males (14% vs 6.5%, P < .001). No differences were observed in the severity of appendicitis, negative EA rates, hospital stay duration, postoperative complications, or 30-day readmission rates. Although differences exist between genders in terms of age, imaging usage, and surgical approach, clinical outcomes are comparable.

Surprisingly low C-reactive protein levels in the hospital sudden death statistics. A retrospective Polish single-center analysis

Surprisingly low C-reactive protein levels in the hospital sudden death statistics. A retrospective Polish single-center analysis

C-Reactive Protein Levels and Outcomes in Infarct-Related Cardiogenic Shock: Data from the ECLS-SHOCK Trial.

The impact of systemic inflammation in acute myocardial infarction complicated by cardiogenic shock (AMI-CS) is still a matter of debate. The present ECLS-SHOCK sub-study investigates the association of C-reactive protein (CRP) levels with short-term outcomes in patients with AMI-CS. Patients with AMI-CS enrolled in the multicenter, randomized ECLS-SHOCK trial between 2019 and 2022 were included. The prognostic impact of CRP levels on admission, as well as the effect of extracorporeal life support (ECLS), stratified by CRP levels, was tested with regard to the primary endpoint of 30-day all-cause mortality. In 371 patients with AMI-CS and available CRP level on baseline, the median CRP level was 18.0 mg/L. Patients with CRP levels in the highest tertile were older and less often resuscitated from cardiac arrest. The highest tertile (i.e., CRP >61.0 mg/L) was associated with an increased risk of 30-day all-cause mortality compared to patients with lower CRP levels (lowest tertile: ≤5.0 mg/L) (adjusted Odds Ratio (OR): 3.54; 95% confidence interval (CI) 1.88-6.68; p=0.001). The use of ECLS did not reduce 30-day all-cause mortality, irrespective of CRP levels on admission. The additional inclusion of CRP to the IABP-SHOCK II score was associated with a slight improvement of the prediction of 30-days all-cause mortality (area under the curve (AUC): 0.74; 95% CI 0.68-0.79). Higher CRP levels were independently associated with the risk of 30-day all-cause mortality in AMI-CS. The additional inclusion of CRP to a validated CS risk score may further improve the prediction of short-term prognosis.

The role of C-reactive protein and genetic predisposition in the risk of psoriasis: results from a national prospective cohort

BackgroundPsoriasis is an immune-mediated chronic inflammatory disease associated with multiple factors. To evaluate the extent to which C-reactive protein (CRP) and genetic predisposition affect the incidence of psoriasis.MethodsThe cohort study retrieved 420,040 participants without psoriasis at baseline from the UK Biobank. Serum CRP was categorized into two levels: < 2 mg/L (normal) and ≥ 2 mg/L (elevated). The polygenic risk score (PRS) was used to estimate genetic predisposition, and was characterized as low, moderate and high PRS. The possible interaction and joint associations between CRP and PRS were assessed using Cox proportional hazards models.ResultsParticipants with high CRP levels had an increased risk of incident psoriasis compared to those with low CRP levels (HR: 1.26, 95% CI: 1.18–1.34). Participants with high CRP levels and high PRS had the highest risk of incident psoriasis [2.24 (95% CI: 2.01, 2.49)], compared with those had low CRP levels and low PRS. Significant additive and multiplicative interaction were found between CRP and PRS in relation to the incidence of psoriasis.ConclusionsOur results suggest that higher CRP concentration may be associated with higher psoriasis incidence, with a more pronounced association observed in individuals with high PRS for psoriasis. So, clinicians should be aware that the risk of incident psoriasis may increase in general population with high CRP levels and high PRS, so that early investigation and intervention can be initiated.

Comparison of surgical results and technical performance between robotic and laparoscopic approaches for Kasai portoenterostomy in biliary atresia: a multicenter retrospective study.

Many variables, including age at surgery, disease type, surgical approaches and perioperative management factors have been demonstrated to influence efficacy in BA infants, however, the effect of surgical performance remains unclear. The objective of this retrospective study was to compare the postoperative efficacy and surgical performance of robotic (RKPE) versus laparoscopic Kasai portoenterostomy (LKPE) for BA. Between October 2018 and June 2023, 158 type III BA patients undergoing minimally invasive surgery (RKPE = 66, LKPE = 92) were included in this multicenter retrospective study. All procedures were performed by surgical teams experienced in Kasai portoenterostomy techniques. Technical performance was quantified and analyzed using the Objective Structured Assessments of Technical Skills (OSATS) and Generic Error Rating Tool instruments (GERT). Postoperative outcomes and surgical performance were compared. Compared with LKPE group, RKPE group had shorter fibrous cone transection time (48.92 ± 6.98 vs. 61.45 ± 8.98min; p < 0.001), shorter hepaticojejunostomy time (47.55 ± 6.57 vs. 59.93 ± 7.88min; p < 0.001) and less estimated intraoperative bleeding [7.00 (5.00-10.00) vs. 13.50 (10.50-16.50) mL; p < 0.001]. More importantly, RKPE group showed a superior OSATS score [30.50 (29.00-31.00) vs. 28.00 (28.00-29.00); p < 0.001], number of errors (46.62 ± 6.32 vs. 56.40 ± 6.82 times/case; p < 0.001), and number of events [9.40 (8.40-10.40) vs. 16.00 (14.00-17.80) times/case; p < 0.001]. On postoperative days 1 and 3, RKPE group had lower C-reactive protein levels (19.87 ± 12.28 vs. 27.05 ± 11.16mg/L, p < 0.001; 14.88 ± 7.11 vs. 20.73 ± 9.09mg/L, p < 0.001). During follow-up, RKPE group had higher jaundice clearance rate at 3 (68.18% vs. 51.09%; p = 0.032) and 6months (78.79% vs. 64.13%; p = 0.047) postoperatively. However, the cholangitis rate within 1year postoperatively (46.97% vs. 50.00%; p = 0.707), as well as one-year (75.76% vs. 72.83%; p = 0.678) and two-year survival with native liver rates (68.42% vs. 66.67%; p = 0.857), were comparable between two groups. RKPE provided superior technical skill performance and a higher jaundice clearance rate than LKPE, indicating that it may be a better minimally invasive option for BA. In addition, the survival with native liver rate showed no significant difference between the two cohorts, which needs to be confirmed by further study.

Association of Systemic Inflammation with Dietary Intake, Nutrition Impact Symptoms, and Eating-Related Distress Among Patients with Advanced Cancer.

Serum C-reactive protein (CRP) levels are correlated with patient outcomes in cancer. This study aimed to determine associations between the CRP level and the dietary intake, symptoms, and eating-related distress (ERD). We conducted a multicenter survey among advanced cancer patients. Information on patient characteristics was retrieved from the electronic medical records. Data on patient outcomes were obtained through the questionnaire. Patients were categorized into the low CRP group (<5 mg/dL) and the high CRP group (≥5 mg/dL). Comparisons were calculated using the Mann-Whitney U test or chi-squared test. To assess associations between CRP levels and ERD, multivariate logistic regression analysis was performed. A total of 191 patients were enrolled and divided into the low CRP group (n = 117) and the high CRP group (n = 74). The high CRP group had a more reduced dietary intake (p = 0.002) and more severe appetite loss (p = 0.008). The total scores of the ERD questionnaire (both the long and short versions) were significantly higher in the high CRP group (p = 0.040 and 0.029). The high CRP group also had significantly higher risks for ERD, as assessed using the long and short versions of the questionnaire (odds ratio [OR] 2.13, 95% confidence interval [CI] 1.10-4.11; OR 2.06, 95% CI 1.05-4.05). High CRP levels were significantly associated with reduced dietary intake, appetite loss, and ERD. A serum CRP value of 5 mg/dL may be a useful indicator for initiating cancer cachexia care.

Predictive Factors of Amputation in Diabetic Foot.

Background: Diabetic foot ulcers are a common complication of diabetes mellitus, often leading to progressive sensory deficits, impaired vascularization, and a predisposition to ulceration and gangrene. Untreated ulcers may cause recurrent infections that endanger a patient's life. Amputation of part of the limb up to a well-vascularized level is one of the treatments employed for untreated ulcers. Objectives: Laboratory data were analyzed with the aim of identifying risk factors related to surgical amputation treatment of diabetic foot. We believe it is useful to identify risk factors that can be altered from a reversible condition in the clinical decision-making of treatment, thus manifesting themselves in a timely manner to provide the patient with an alternative to surgical amputation of the lower limb. Methods: Our retrospective study was conducted by the Department of Orthopedics and Traumatology at the Fondazione Policlinico Universitario Agostino Gemelli IRCCS in Rome. We recruited 200 patients who underwent lower limb amputation for diabetic foot between 2017 and 2021 and had blood tests both 30 days and within 5 days before the first surgery. Results: This case-control study revealed a significant negative correlation between hemoglobin (Hb) levels and the occurrence of leg amputations. In contrast, C-reactive protein (CRP) levels, the neutrophil-to-lymphocyte ratio (NLR), and the platelet-to-lymphocyte ratio (PLR) showed significant positive correlations with leg amputations. A 3-year follow-up of the cases also revealed a significative positive correlation between age, white blood cells (WBC) count, NLR, PLR, and death at 3 years. Conclusions: Our findings suggested that lower Hb levels and elevated CRP, NLR, and PLR levels in patients with diabetic foot disease may be associated with a higher risk of lower-limb amputation. Unexpectedly, this study also demonstrated that elderly age, WBC, CRP, NLR and PLR levels may be associated with a negative prognosis for these patients. These findings highlighted the importance of monitoring these laboratory values in diabetic patients to identify individuals at higher risk of leg amputations and implement appropriate interventions to prevent or minimize the occurrence of this severe complication.

Nutritional therapy among adult patients with severe burns: A retrospective observational study.

The objective of this study was to examine the effects of nutritional therapy in adult patients with severe burns. Sixty adult patients with severe burns were enrolled. Data on nutritional intake through enteral nutrition (EN) or parenteral nutrition (PN) on days 7, 14, 21, and 28 post-injury were collected. Patients were divided into target and non-target groups according to whether their energy or protein intake reached the target. Age, length of ventilation, and total bilirubin (TBIL), albumin (ALB), prealbumin (pALB), and C-reactive protein (CRP) concentrations of patients were recorded. The percentage of protein targets with protein delivery was lower than that of energy target with energy delivery. The ratio of PN protein to total protein was lower than that of PN energy to total energy on days 7, 14, 21, and 28 (p<0.001, p<0.001, p=0.001, and p=0.003, respectively). Compared to the non-target group on day 21, the target group was younger, had lower TBIL on day 7, higher ALB and pALB on day 21, and lower CRP on day 14 (p=0.025, p=0.021, p=0.028, p=0.029, and p=0.049, respectively). Multivariate logistic regression analysis showed that older age and longer ventilation were independent risk factors in patients who did not meet the nutritional target on day 21 (p=0.026 and p=0.043, respectively). The protein intake of adult patients with severe burns was low. Compared to the non-target group, the target group had better laboratory test results. Older age and longer ventilation were independent risk factors for patients not meeting the nutritional target.

Effects of APOE ε4 on novel blood biomarkers of amyloid‐β pathology and inflammation in midlife adults at risk of Alzheimer’s disease

AbstractBackgroundIn APOE ε4 allele carriers at increased risk for Alzheimer’s disease (AD), midlife (age 40‐65 years) is a critical window when amyloid‐β (Aβ) pathology could progress without overt cognitive decline, but AD‐related biomarkers may be present. Blood measures of phosphorylated tau at Thr217 (p‐tau217) indicate aggregated Aβ pathology in the preclinical stage of AD, whereas ApoE protein levels are associated with the clearance of Aβ. C‐reactive protein (CRP) and serum amyloid A (SAA) are acute phase reactants within the inflammatory pathway, but SAA is also related to ApoE levels and Aβ clearance. This study aims to investigate the cross‐sectional effects of APOE ε4 carriage on blood biomarkers of Aβ pathology (p‐tau217 and ApoE) and inflammation (CRP and SAA) in midlife adults at risk of AD.MethodBaseline data from an ongoing clinical trial (NIH R01AG058919) were analyzed. Participants (n = 75, age = 57±6.15 years) were cognitively normal, middle‐aged adults with a family history of AD. APOE ε4 carriage was determined from passive drool saliva samples. Fasting samples were collected, centrifuged at 2,000 g for 12 min at 4°C and 0.5 ml of serum/plasma was aliquoted into tubes and frozen at 80°C. All biomarkers were measured using electro‐chemiluminescence immunoassays. After winsorizing at z = 2‐2.5, analyses of covariance compared the biomarkers between APOE ε4 carriers (n = 31) and non‐carriers (n = 44) with age, sex, education, and BMI as covariates.ResultAfter covariate adjustments, APOE ε4 carriage was associated with all serum/plasma biomarkers. APOE ε4 carriers had higher p‐tau217 (p = 0.05), lower ApoE (p&lt;0.0001), lower CRP (p&lt;0.05), and lower SAA (p&lt;0.05) compared with non‐carriers.ConclusionBlood biomarkers of greater Aβ aggregation and less systemic inflammation were found in cognitively normal, APOE ε4 carriers in midlife. This data suggests that even in midlife adults at risk for AD due to APOE ε4 carriage, blood biomarkers provide crucial information about early changes in Aβ pathology and provide a potential conduit for maximizing brain health by pinpointing optimal timing for interventions that mitigate risk of progression to AD. The content of this abstract is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Impact of oral health on COVID-19 outcomes in patients with pre-existing cardiovascular conditions: a questionnaire-based analysis of disease severity, recovery time, and C-reactive protein

Aim: This study aimed to assess oral health’s influence on COVID-19 outcomes in recovered individuals with pre-existing cardiovascular conditions. Methods: In the main study employing a cross-sectional design based on a questionnaire survey, 464 Egyptian patients who had recovered from COVID-19 were enrolled, with 86 individuals who had pre-existing cardiovascular conditions included in a subgroup analysis. Oral health was classified as poor and good based on scores from an 18-question survey with higher scores indicating better health. Severe COVID-19 was defined by criteria that included elevated respiratory and heart rates, severe dyspnea low oxygen saturation, high fever, and need for hospitalization or ICU care. Participants’ recovery duration was classified into three groups: fast (≤ 2 weeks), intermediate (4 weeks), and delayed (6 weeks), characterized by symptom-free status. Moreover, C-reactive protein (CRP) levels (&gt; 18 mg/L) were considered elevated. Results: Our results revealed that cardiac patients with poor oral health showed a significant association with severe COVID-19 cases, elevated CRP levels (&gt; 18 mg/L), and a prolonged recovery period (6 weeks) (p &lt; 0.001). In contrast, participants demonstrating good oral health were associated with milder COVID-19 cases, lower CRP levels, and faster recovery (p &lt; 0.001). Conclusions: Our findings indicate a significant link between the condition of oral health and the experienced severity of COVID-19 in cardiac patients. Poor oral health was associated with elevated CRP levels, delayed recovery, and more severe symptoms. These results highlight the importance of good oral hygiene as a modifiable factor in reducing infection severity, especially in vulnerable cardiac populations.

Integrating Rehabilitation Services into Routine Care of Rheumatoid Arthritis May Reduce the Inflammatory Response: A Hospital-Based Follow-Up Study in Taiwan.

Background and Objectives: For persons with rheumatoid arthritis (RA), the accompanying systemic inflammatory conditions often insidiously damage extra-glandular organs, causing poor outcomes. Despite evidence manifesting the application of rehabilitation services (RSs), the association between RSs use and changes in the inflammatory response among persons with RA has not yet been established. With that in mind, this study aimed to evaluate changes in C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) before and after long-term RSs use. Materials and Methods: For this two-group pre and posttest study, medical data of 4505 persons with RA aged 20-70 years between 2012 and 2017 were retrieved from an electronic medical record database held by a hospital in Taiwan. Of them, 1387 subjects were categorized as RSs users, who received RSs at least six times within the first year of RA onset. Generalized estimating equations analysis was then employed to compare the changes in ESR and CRP at baseline, and at 12, 18, 24, 30, and 36 months after RA onset. Results: After adjusting for inherent differences and mature impact, those receiving standard care plus RSs were found to have a lower CRP level than those without receiving RSs. This benefit was maintained within a 3-year follow-up period. Additionally, a slight but nonsignificant reduction in ESR existed over the same timeframe. Conclusions: Integrating RSs into conventional care may be helpful to modulate the inflammation for RA patients, but further research via randomized controlled trials is needed to validate the application of RSs.

The association between dietary obesity-prevention score (DOS) and polycystic ovary syndrome: a case-control study.

Polycystic ovary syndrome (PCOS) is one of the most prevalent obesity-related diseases in women of reproductive age. Linkage between diet and PCOS are still controversial. Dietary obesity prevention score (DOS) is one of the new indicators of diet evaluation which have been previously linked to obesity. To the best of our knowledge, this study was the first to investigate the relationship between DOS and PCOS. In this case-control study, 100 newly diagnosed women with PCOS and 100 age-matched women without PCOS were assayed from clinics affiliated to Kashan university of medical sciences, Kashan, Iran. A validated semi-quantitative food frequency questionnaire was used to evaluate food intakes. DOS was calculated based on previous published guideline. Anthropometric measurements were carefully measured by a trained nutritionist. A 10-houres fasting plasma blood sample was collected for all participants. Fasting blood sugar (FBS), triglyceride (TG), total cholesterol (CHOL), High density lipoprotein (HDL), Low density lipoprotein (LDL) and C - reactive protein (CRP) were measured based on laboratory methods. The mean age and BMI of study participants was 23.6 year and 24.9kg/m2 respectively. After adjustment for potential confounders, adherence to DOS score was inversely associated with CRP levels. People in the top tertile of DOS had lower CRP level compared to people in the bottom tertile (3.71 compared to 4.48mg/dl) (P = 0.04). In addition, participant in the top tertile of DOS had marginally significant higher level of FBS compared to participants in the bottom tertile (92.3 vs. 88.9mg/dl, P = 0.051). After adjustment for all confounding factors people in the highest tertile of DOS had a 46% non-significant lower odds for PCOS compared to people in the lowest tertile (95% CI: 0.23-1.25; P-trend = 0.15). In the present study, an inverse significant association was seen between adherence to DOS and inflammation. However, no significant relationship was observed between DOS and odds of having PCOS. Further longitudinal studies are suggested to investigate the association between DOS and PCOS.