Lower Serum C-reactive Protein Research Articles

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.

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.

Comparative clinical efficacy of single-incision thoracoscopic bullectomy combined with C-shaped electrocautery pleurodesis vs. chemical pleurodesis in the management of spontaneous pneumothorax.

This study aims to observe the clinical efficacy of single-incision thoracoscopic bullectomy combined with C-shaped electrocautery pleurodesis compared to traditional iodine chemical pleurodesis in the treatment of patients with spontaneous pneumothorax. A total of 128 patients with spontaneous pneumothorax who underwent surgical treatment at our institution from January 2021 to December 2022 were selected. Patients were categorized into the study group (n = 65) and the control group (n = 63) based on the surgical method used. The study group received C-shaped pleura cautery for pleurodesis, while the control group underwent traditional iodine chemical pleurodesis. Surgical and clinical outcomes were evaluated, and recurrence rates within one year postoperatively were compared. Serum C-reactive protein (CRP) levels and visual analog scale (VAS) scores were measured at different time points. No significant differences were observed between the two groups regarding surgical duration, intraoperative blood loss, or postoperative hospital stay (p > 0.05). However, the study group demonstrated significantly lower serum CRP levels and VAS scores on postoperative days 1 and 2, as well as reduced drainage volumes compared to the control group (p < 0.05). The recurrence rates of pneumothorax within one year postoperatively did not differ significantly between the groups (p > 0.05). Single-incision thoracoscopic bullectomy combined with C-shaped electrocautery pleurodesis is an effective treatment for spontaneous pneumothorax. Compared to traditional iodine chemical pleurodesis, this method causes less pleural irritation, results in lower postoperative pain and drainage, and facilitates patient recovery, making it a safe and reliable option for the management of spontaneous pneumothorax.

Serum C-reactive protein value on day 14 as a possible prognostic factor of aneurysmal subarachnoid hemorrhage.

Serum C-reactive protein (CRP), as a reflection of early brain injury at onset, is a prognostic factor in aneurysmal subarachnoid hemorrhage (aSAH). However, in some severe cases, patients exhibit a good prognosis despite their elevated serum CRP level. Therefore, we examined the relationship between serum CRP transitions in the acute phase of aSAH and the prognosis. We recruited 63 patients with aSAH and retrospectively analyzed the relationships between the serum CRP transitions during the acute phase and the prognosis, patient background, and clinical course. Serum CRP values on days 1, 3, and 14 were significantly lower in the good prognosis group than those in the poor prognosis group. Moreover, serum CRP values on days 1 and 14 significantly affected the prognosis in the multiple regression analysis. A low serum CRP value on day 14, in addition to that on day 1 as reported previously, is associated with a good prognosis of aSAH. Furthermore, a good prognosis of aSAH is determined not only by absence of early brain injury at onset but also by appropriate management to obtain a low serum CRP value on day 14.

Association of heart rate variability and C-reactive protein in patients with depression.

Depression has been shown to be correlated with cardiovascular (CV) morbidity and mortality. Inflammation and autonomic nervous system (ANS) dysfunction are possible causes. Numerous clinical studies have found an association between inflammatory pathways and the ANS. The aim of this study was to investigate the relationship between different heart rate variability (HRV) parameters and C-reactive protein (CRP) levels in depressed patients without concomitant diseases. Sixty-five depressed patients who were not taking medication participated in this cross-sectional study. The Tenth Revision of the International Classification of Diseases and Related Health Problems (ICD-10) categorization of mental and behavioral disorders served as the basis for the diagnosis of depression. HRV processing and analysis were performed using ADInstrument's Pro LabChart (PowerLab 8Pro) data analysis software. HRV was recorded for 5 min in an upright sitting position using a lead II electrocardiogram (ECG) (short-term HRV). CRP levels were measured using an ELISA (enzyme-linked immunosorbent assay) test. None of the measures of HRV showed a significant relationship with pulse rate, systolic blood pressure, diastolic blood pressure, or body mass index (BMI). Weight and BMI were strongly positively related (r = 0.420, P = 0.003) to pRR50 (percentage of successive RR intervals differing by more than 50 ms). Very low frequency (VLF), low frequency (LF), and the LF/HF (high frequency) ratio were all strongly positively correlated with CRP (r = 0.595, P = 0.001), whereas HF was also significantly negatively correlated (r = 0.383, P = 0.007). CRP had a significant negative correlation with the logarithm (ln) HF and a significant positive correlation with lnVLF, lnLF, and lnLF/HF. Measurement of resting HRV and CRP may be helpful in detecting CV disease in depressed patients. Low HRV and elevated serum CRP should prompt physicians to begin treatment for risk CV as soon as possible.

Prognostic significance of peripheral and tumor-infiltrating lymphocytes in newly diagnosed stage III/IV non-small-cell lung cancer.

Lymphocytes are effector cells that fight cancer by killing tumor cells. Here, we aim to explore the prognostic significance of both peripheral and tumor-infiltrating lymphocytes (TILs) in newly diagnosed stage III/IV non-small-cell lung cancer (NSCLC). In total, 105 cases of newly diagnosed stage III/IV NSCLC from July 2017 to October 2022 at the Tianjin Beichen Hospital were retrospectively investigated. Peripheral blood samples at the time of diagnosis and tumor tissue slices from these patients were collected. General peripheral blood cell composition and TILs were measured and analyzed via an automatic blood analyzer and immunofluorescence staining analysis. The overall survival (OS) time of all patients was also obtained and analyzed. The median overall survival (mOS) of all patients is 12 months. The 1-, 2-, and 3-year overall survival rates were 60.5, 28.4, and 18.6%, respectively. Peripheral lymphocyte and neutrophil percentages, serum C-reactive protein (CRP) expression, tumor size, and tumor pathology are the prognostic factors of OS for newly diagnosed stage III/IV NSCLC patients. Moreover, patients with high tumor CD4+ and CD8+ T cell infiltration survived significantly longer compared to patients with low tumor CD4+ and CD8+ T cell infiltration (p < 0.0001 and p = 0.011, respectively). Compared to low tumor CD33+ cell infiltration, high tumor CD33+ cell infiltration was associated with worse OS (p = 0.018). High tumor CD8+ T cell infiltration was associated with lower peripheral lymphocyte number, lower serum CRP expression, smaller tumor size, and better tumor pathology (p = 0.012, p = 0.040, p = 0.012, and p = 0.029, respectively). Increased numbers of peripheral lymphocytes, CD33+ cells, CD4+ TILs, and CD8+ TILs were significantly associated with OS in newly diagnosed stage III/IV NSCLC patients, which were positively associated with several basic clinical factors.

Serum C-reactive protein level and sleep characteristics in obstructive sleep apnea syndrome comorbid with panic disorder: a preliminary study

ObjectiveInvestigate the sleep characteristics of patients with obstructive sleep apnea syndrome (OSAS) comorbidity with panic disorder (PD), exploring its potential association with serum C-reactive protein (CRP) levels.Patients and methodsFifty-four patients (25 OSAS patients with PD and 29 without PD) and 25 healthy controls (HCs) were included. The Self-rating anxiety scale (SAS), self-rating depression scale (SDS), and Pittsburgh sleep quality index (PSQI) were used to assess the mood and sleep quality of the subjects. All patients had circulating CRP levels and polysomnography was performed.ResultsOSAS with PD had higher SAS, SDS, PSQI than the OSAS without PD. Compared to OSAS without PD, OSAS with PD had higher percentage of non- rapid eye movement sleep 1 and 2 (N1 and N2%), sleep latency, and a lower percentage of rapid eye movement sleep (REM%). Respiratory-related microarousal index, AHI, and time below 90% oxygen saturation (T90) were low, and the lowest oxygen saturation (LO2) was high. Serum CRP levels in OSAS patients with PD were lower than that in OSAS patients without PD, but higher than that in HCs. In OSAS patients with PD, serum CRP levels were negatively correlated with wake time after sleep onset and SAS scores but positively correlated with sleep efficiency and N2%. Serum CRP levels were positively correlated with T90 and negatively correlated with LO2.ConclusionOSAS patients with PD had worse sleep quality, less severe OSAS, and low serum CRP levels. Serum CRP levels in OSAS patients with PD were associated with poorer sleep quality and duration of hypoxia rather than AHI.

Potential blood markers as screening tools for subjects with low back pain: an age- and gender-matched cross-sectional analysis

Background Mechanical and inflammatory factors were suggested as the causes of spine degeneration and low back pain (LBP). Previous studies partly reported the association of LBP with inflammation. However, none of them compared patients with LBP and asymptomatic subjects in terms of complete blood count and inflammatory markers in detail. We aimed to analyze the association of serum white blood cell (WBC) count, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) with chronic LBP by comparing the patients with chronic LBP and age- and gender-matched asymptomatic subjects. Methods Lumbar intervertebral disc degeneration and vertebral end-plates were evaluated using Pfirrmann grading and Modic classification on lumbar spine magnetic resonance images, respectively. Serum WBC counts, CRP levels, and ESRs were recorded from chart reviews. Results We included 147 patients with chronic LBP and 101 asymptomatic subjects. Patients with chronic LBP had significantly higher serum neutrophil, monocyte, and basophil counts, higher neutrophil-to-lymphocyte ratio, higher ESR, and lower serum CRP levels compared to the asymptomatic subjects. Serum monocyte and basophil cell counts and ESR were the most remarkable predictive factors for chronic LBP, severe IVDD, and Modic changes. Higher serum monocyte and basophil cell counts and higher serum ESR above cut-off values of 0.42 × 103/μL, 0.025 × 103/μL, and 3.5 mm/hour could be used as screening tools for subjects with persistent LBP in primary care. Discussion Higher serum monocyte and basophil counts and serum ESR above new cut-off values should highlight the need to obtain early spinal imaging to prevent chronicity in patients with LBP.

Clinical risk factors for peritoneal dialysis withdrawal at different dialysis duration

Background The duration of patients maintained on peritoneal dialysis (PD) varied. This study investigated the clinical risk factors for PD withdrawal at different dialysis duration. Methods Patients who initiated PD from 1994 to 2011 were recruited and followed for at least 10 years until 2021. Patients were grouped into four groups according to dialysis duration or time on treatment (TOT) when withdrew PD. Results A cohort of 586 patients were enrolled (mean age of 54.9 years, median dialysis duration or TOT of 47.9 months). Patients who maintained PD for longer than 10 years were younger, with lower prevalence of diabetes, lower serum C-reactive protein (CRP) level and white blood cell (WBC) count, higher serum albumin and pre-albumin level, higher normalized protein catabolic rate (nPCR) and residual kidney function, and more common use of renin–angiotensin system inhibitors (RASi) at baseline (p < 0.05 for all). Peritonitis related death and ultrafiltration failure related HD transferring increased along with time on PD (p < 0.001). Old age, diabetes, low serum albumin, high WBC count, hypertensive nephropathy, and nonuse of RASi were associated with increased risk of non-transplantation related PD withdrawal (p < 0.05 for all). Low baseline CRP and use of RASi were independent predictors for long-term PD maintenance (p < 0.05 for all). Conclusions Long-term PD patients demonstrated young age, low prevalence of diabetes, better nutrition status, absence of inflammation, better residual kidney function, and higher proportion of RASi usage at baseline. Absence of inflammation and use of RASi were independently associated with long-term PD maintenance.

Clinical Characteristics of Retroperitoneal Fibrosis Patients at a Tertiary Hospital in Japan.

Retroperitoneal fibrosis (RPF) is a rare cause of hydronephrosis and progressive renal dysfunction with unidentified origin. RPF is categorized into idiopathic RPF with/without immunoglobulin G4 (IgG4)-related disease (IgG4-RD), and secondary RPF. Identifying the underlying cause is challenging and often associated with delayed diagnosis or therapeutic interventions. We investigated RPF's clinical characteristics based on different etiologies and factors that may help distinguish the underlying causes. We analyzed the cases of 49 patients with RPF that was radiographically diagnosed at our institution (2008-2022). The cohort was 77.6% males; 75.5% had idiopathic RPF and 24.5% had secondary RPF. Among the idiopathic patients, 54.1% had IgG4-RD. The patients were likely to have abdominal pain, lower back pain/lumbago, and constitutional symptoms including generalized fatigue and fever. The idiopathic patients were likely to have higher serum IgG4 and IgG levels and lower serum C3 levels compared to secondary RPF. The IgG4-RPF patients were likely to have higher serum IgG4 levels and lower serum C-reactive protein, ferritin, and C3 levels compared to the idiopathic RPF patients without IgG4-RD. These findings might reflect underlying systemic inflammatory responses. Comprehensive laboratory testing, including serum inflammatory markers and immunological panels, is recommended for radiologically diagnosed RPF patients.

Low C-reactive Protein and Urea Distinguish Primary Nonfunction From Early Allograft Dysfunction Within 48 Hours of Liver Transplantation.

A retrospective study of adult patients that underwent LT between January 2010 and April 2020 was performed. Clinical parameters, absolute values and trends of C-reactive protein (CRP), blood urea, creatinine, liver function tests, platelets, and international normalized ratio in the initial 48 h after LT were compared between the EAD and PNF groups. There were 1937 eligible LTs, with PNF and EAD occurring in 38 (2%) and 503 (26%) patients, respectively. A low serum CRP and urea were associated with PNF. CRP was able to differentiate between the PNF and EAD on postoperative day (POD)1 (20 versus 43 mg/L; P < 0.001) and POD2 (24 versus 77; P < 0.001). The area under the receiver operating characteristic curve (AUROC) of POD2 CRP was 0.770 (95% confidence interval [CI] 0.645-0.895). The urea value on POD2 (5.05 versus 9.0 mmol/L; P = 0.002) and trend of POD2:1 ratio (0.71 versus 1.32 mmol/L; P < 0.001) were significantly different between the groups. The AUROC of the change in urea from POD1 to 2 was 0.765 (95% CI 0.645-0.885). Aspartate transaminase was significantly different between the groups, with an AUROC of 0.884 (95% CI 0.753-1.00) on POD2. The biochemical profile immediately following LT can distinguish PNF from EAD; CRP, urea, and aspartate transaminase are more effective than ALT and bilirubin in distinguishing PNF from EAD in the initial postoperative 48 h. Clinicians should consider the values of these markers when making treatment decisions.

Association Between Life's Simple 7 and Biomarkers of Cardiovascular Disease: Aldosterone, Interleukin-6, C-Reactive Protein.

Background To promote ideal cardiovascular health, the American Heart Association recommends adhering to Life's Simple 7 (LS7)-achieving healthy targets for body mass index, physical activity, dietary intake, blood pressure, fasting plasma glucose, and cholesterol, along with smoking abstinence. Poorer achievement of LS7 (lower score) has been associated with the development of hypertension and cardiovascular disease. However, less is known about the associations between LS7 and specific biomarkers linked to cardiovascular health: aldosterone, CRP (C-reactive protein), and IL-6 (interleukin-6). Methods and Results We analyzed 379 individuals (age 18-66 years) from the HyperPATH (International Hypertensive Pathotype), who were maintained on ≥200 mEq of sodium daily for 1 week. We calculated a 14-point summative LS7 score according to participants' baseline data. Based on the range of LS7 score in this population (3-14), we classified participants as "inadequate" (3-6), "average" (7-10), and "optimal" (11-14). Regression analyses found that a higher LS7 score group was associated with lower levels of serum and urinary aldosterone (Ptrend<0.001 and Ptrend=0.001, respectively), lower plasma renin activity (Ptrend<0.001), and a blunted increase in serum aldosterone with angiotensin II infusion (Ptrend=0.023). Being in the "optimal" LS7 score group was associated with lower serum CRP (Ptrend=0.001) and IL-6 (Ptrend=0.001). Conclusions A higher LS7 score was associated with a lower activity of the renin-angiotensin-aldosterone system and lower levels of the inflammatory markers CRP and IL-6. These findings offer a possible link between ideal cardiovascular health targets and biomarkers known to play a central role in the development of cardiovascular disease.

Association of fruits, vegetables, and fiber intake with COVID-19 severity and symptoms in hospitalized patients: A cross-sectional study.

Background and aimsFruits and vegetables are rich in fiber and a good source of anti-inflammatory and immune-boosting vitamins, minerals, and antioxidants. We investigated the association between fruits, vegetables, and fiber intake and severity of COVID-19 and related symptoms in hospitalized patients.MethodsA total of 250 COVID-19 hospitalized patients aged 18 to 65 years were recruited for this cross-sectional study in Kashan, Iran, between June and September of 2021. Dietary intakes were assessed using an online validated 168-item food frequency questionnaire (FFQ). COVID-19 severity and symptoms were evaluated using the National Institutes of Health (NIH) COVID-19 Treatment Guidelines. Moreover, we examined COVID-19 symptoms, inflammatory biomarkers, and additional factors.ResultsThe mean age of participants was 44.2 ± 12.1 years, and 46% had severe COVID-19. Patients with higher consumption of fruits (OR: 0.28; 95% CI: 0.14-0.58, P-trend <0.001), vegetables (OR: 0.33; 95% CI: 0.16-0.69, P-trend <0.001), and dietary fiber (OR: 0.25; 95% CI: 0.12-0.53, P-trend <0.001) had lower odds of having severe COVID-19. In addition, they had shorter hospitalization and convalescence periods, lower serum C-reactive protein (CRP), and a reduced risk of developing COVID-19 symptoms such as sore throat, nausea and vomiting, dyspnea, myalgia, cough, weakness, fever, and chills.ConclusionHigher consumption of fruits, vegetables, and fiber was inversely linked with COVID-19 severity, clinical symptoms, hospitalization and convalescence duration, and CRP concentrations. The results should be interpreted with caution in light of the limitations, and prospective cohort studies are required to further evaluate these findings.

Association among Terminally Differentiated T Cells, Frailty, and Dependency in a Group of Cuban Centenarians

Introduction: Centenarians are considered a model of successful aging. Cuba exhibits one of the oldest populations in Latin America with more than two thousand centenarians. Methods: This study aimed to evaluate the immune phenotype of forty-three Cuban centenarians, their clinical characteristics such as comorbidities, frailty, body mass index, and some hemochemical parameters. Results: Centenarians had normal body mass indexes, relatively good health status, and 21.95% of them had no comorbidities; 53.6% were classified as frail, and 7% were classified as robust. In addition, 17% of centenarians were independent, and 41.46% were moderately dependent. The seroprevalence against cytomegalovirus was 100%. Concerning pro-inflammatory markers, the majority of them had very low cytokine levels and serum C-reactive protein around the normal limit. We also found the predominance of memory subsets over naive compartments in CD4+ and CD8+ T cells. Terminally differentiated CD8+CD28− T cells were higher in frail centenarians than in pre-frail, while CD8+CD57+ and CD8+EMRA T cells were higher in moderately and severely dependent individuals than in independent individuals. Severely dependent centenarians had a lower CD4+/CD8+ ratio. Conclusion: This study describes for the first time the predominance of memory subsets over naive compartments in CD4+ and CD8+ T cells, as well as its relation to frailty and/or dependency in a group of Cuban centenarians. Further studies are needed to continue understanding the natural biological aging mechanism and the relationship between terminally differentiated lymphocytes and inflammaging in the context of extreme longevity.

Effects of canagliflozin and metformin on insulin resistance and visceral adipose tissue in people with newly-diagnosed type 2 diabetes

BackgroundThe current study was to evaluate the effects of canagliflozin and metformin on insulin resistance and visceral adipose tissue in people with newly-diagnosed type 2 diabetes.MethodsThis is an open-label, parallel and controlled study. Participants were divided into canagliflozin (100 mg/qd) or metformin (1000 mg/bid) groups. At baseline and after 12 weeks’ therapy, insulin resistance [Homeostatic Model Assessment of Insulin Resistance (HOMA-IR)], subcutaneous and visceral adipose tissue, fasting blood glucose (FBG), glycated hemoglobin A1c (HbA1c), C-reactive protein (CRP) and nitric oxide (NO) were evaluated and compared.ResultsThere was no significant between-group difference in baseline characteristics. After 12 weeks’ therapy, in canagliflozin group (n = 67), compared to baseline, FBG, HbA1c and HOMA-IR were decreased, accompanying with reduction of visceral adipose tissue. Compared to metformin group (n = 73), FBG, HbA1c and HOMA-IR were lower in canagliflozin group, accompanying with less visceral adipose tissue and lower serum CRP level and higher NO level. After multivariable regression analysis, age, visceral adipose tissue and CRP remained associated with increased insulin resistance, while canagliflozin treatment and higher NO level were associated with reduced insulin resistance. Body mass index, waist/hip ratio, CRP and HOMA-IR remained associated with increased visceral adipose tissue, while canagliflozin treatment and higher NO level were associated with reduced visceral adipose tissue. There was no difference in adverse event between these two groups.ConclusionCanagliflozin reduces visceral adipose tissue and improves blood glucose, insulin resistance and systemic inflammation in people with newly-diagnosed type 2 diabetes.

Minor salivary gland infection as origin of peritonsillitis – novel theory and preliminary results

Background Peritonsillitis (PT) is defined as cellulitis in peritonsillar tissue without pus. The pathogenesis of peritonsillar infections is controversial. Objective To explore whether minor salivary glands are involved in the development of PT and to identify clinical findings that predict the evolution of PT to peritonsillar abscess (PTA). Material and methods We included 146 adult patients treated for acute tonsillitis (AT; n = 54), PT (n = 34), or PTA (n = 58) at the Helsinki University Hospital. The treating physician recorded tonsillar, oropharyngeal, and dental findings. We analysed serum C-reactive protein (S-CRP) and amylase (S-Amyl). For PTA, pus samples were analysed; for AT and PT, throat cultures were collected. Patients with PT or PTA (PT/PTA; n = 92) were classified into groups with or without tonsillar exudate or hyperaemia (tonsillar findings). Results The PT group without tonsillar findings had lower S-CRP than the PT group with tonsillar findings (p=.0275). The PT/PTA group without tonsillar findings had higher S-Amyl than the PT/PTA group with tonsillar findings (p=.0278). Three out of 34 (8.8%) patients with PT returned to the emergency department; 1 (2.9%) developed PTA. Conclusions Elevated S-Amyl in the PT/PTA group without tonsillar findings suggests that minor salivary glands are sometimes involved in the development of peritonsillar infections.

Vitamin K2 Supplementation for the Prevention and Treatment of Rheumatoid Arthritis

ObjectivesTo investigate the effects of vitamin K2 supplementation on the prevention and treatment of rheumatoid arthritis(RA). MethodsVitamin K2 and rheumatoid arthritis were searched in Pubmed from inception until December 2020. ResultsStudy 1: Vitamin K2 inhibited the proliferation of mitogen-activated PBMCs of RA patients with an IC50 value of 3,288.47 ± 4,910.02 ng/mL. There was a significant correlation between IC50 values of vitamin K2 and patient-related factors of RA patients (p < 0.05), such as C-reactive protein (CRP), rheumatoid factor, anti-cyclic citrullinated peptide antibody (ACPA), matrix metalloproteinase-3, Pre-DAS-28 (CRP), and ∆DAS-28 (CRP). Methotrexate inhibited the proliferation of mitogen-activated PBMCs of RA patients with a IC50 value of 22.83 ± 12.47 ng/mL. IC50 values of methotrexate only showed significant correlation with ACPA (p = 0.0158, r = 0.6905); Study 2: A significant decrease in MK-7 treated group for the levels of undercarboxylated osteocalcin (ucOC), erythrocyte sedimentation rate (ESR), disease activity score assessing 28 joints with ESR (DAS28-ESR), C-reactive protein (CRP) and matrix metalloproteinase (MMP-3) was found. In MK-7 treated group, a marked decrease in RA clinical and biochemical markers for moderate and good response compared to non-responders was observed in ucOC, ESR and DAS28-ESR. A marked increase in the levels of MK-7 for the moderate and good responders compared to non-responders was observed; Study 3: as compared to the MK-4-naïve group, the MK-4-treated group showed lower serum CRP (1.7 ± 0.2 vs. 0.5 ± 0.1 mg/dl; P < 0.001), MMP-3 (220.4 ± 21.9 vs. 118.0 ± 14.4 ng/ml; P < 0.001), and DAS28-CRP (2.9 ± 0.1 vs. 2.4 ± 0.1; P < 0.05). The patients who were additionally treated with MK-4 showed significant decreases in serum CRP (1.1 ± 0.2 to 0.6 ± 0.2 mg/dl; P < 0.001), MMP-3 (160.1 ± 25.6 to 125.0 ± 17.8 ng/ml; P < 0.05), and DAS28-CRP (3.1 ± 0.2 to 2.4 ± 0.1; P < 0.001). ConclusionsVitamin K2 supplementation could provide a benefit for the prevention and treatment of RA patients via its immunosuppressive function and improving disease activity. Funding SourcesNo.

Kawasaki disease with low C-reactive protein levels

Kawasaki disease (KD) is an acute febrile systemic vasculitis that primarily affects children, and coronary artery lesions (CALs) are severe complications. Clinical features and outcomes of patients with KD associated with low serum C-reactive protein (CRP) levels (&lt; 3.0 mg/dL) before initial treatment remain unclear. The objective of this retrospective study was to elucidate the clinical features and outcomes of patients with KD and low serum CRP levels. Data were included from 220 patients with KD who underwent acute-phase treatment from January 2009 to February 2021 in our department. Patients were divided into low group (n = 50) and high group (n = 170) according to serum CRP levels before initial treatment. The rates of incomplete KD (48.0% vs. 10.6%, P &lt; 0.001) and serum albumin levels (g/dL) before initial treatment (median 3.60 vs. 3.30, P &lt; 0.001) were significantly different between the groups. The rate of patients who required intravenous immunoglobulin (IVIG) therapy was significantly lower in the low group compared to the high group (74.0% vs. 97.1%, P &lt; 0.001). However, the rates of initial IVIG therapy resistance (10.8% vs. 25.5%, P= 0.055) and CALs (2.0% vs. 4.7%, P= 0.475) were similar between the groups. No patient in the low group experienced CALs one month after KD onset. The severity of the disease in patients with KD and low CRP levels was milder than in those with high CRP levels.

A healthy Nordic diet score and risk of incident CHD among men: the Kuopio Ischaemic Heart Disease Risk Factor Study.

Healthy Nordic diet has been beneficially associated with CHD risk factors, but few studies have investigated risk of developing CHD. We investigated the associations of healthy Nordic diet with major CHD risk factors, carotid atherosclerosis and incident CHD in middle-aged and older men from eastern Finland. A total of 1981 men aged 42-60 years and free of CHD at baseline in 1984-1989 were investigated. Diet was assessed with 4-d food recording and the healthy Nordic diet score was calculated based on the Baltic Sea Diet Score. Carotid atherosclerosis was assessed by ultrasonography of the common carotid artery intima-media thickness in 1053 men. ANCOVA and Cox proportional hazards regression analyses were used for analyses. Healthy Nordic diet score was associated with lower serum C-reactive protein (CRP) concentrations (multivariable-adjusted extreme-quartile difference 0·66 mg/l, 95 % CI 0·11, 1·21 mg/l) but not with serum lipid concentrations, blood pressure or carotid atherosclerosis. During the average follow-up of 21·6 years (sd 8·3 years), 407 men had a CHD event, of which 277 were fatal. The multivariable-adjusted hazard ratios in the lowest v. the highest quartile of the healthy Nordic diet score were 1·15 (95 % CI 0·87, 1·51) for any CHD event (Ptrend 0·361) and 1·44 (95 % CI 0·99, 2·08) (Ptrend 0·087) for fatal CHD event. We did not find evidence that adherence to a healthy Nordic diet would be associated with a lower risk of CHD or with carotid atherosclerosis or major CHD risk factors, except for an inverse association with serum CRP concentrations.

A Korean-Style Balanced Diet Has a Potential Connection with Ruminococcaceae Enterotype and Reduction of Metabolic Syndrome Incidence in Korean Adults.

Metabolic syndrome is associated with usual dietary patterns that may be involved in enterotypes. We aimed to understand the potential relationship of enterotypes and dietary patterns to influence metabolic syndrome in the Koreans. Using the Korea National Health and Nutrition Examination Survey (KNHANES)-VI in 2014, metabolic parameters were also analyzed among the dietary patterns classified by principal component analysis in Korean adults. The fecal microbiota data of 1199 Korean adults collected in 2014 were obtained from the Korea Centers for Disease Control and Prevention. Enterotypes were classified based on Dirichlet multinomial mixtures (DMM) by Mothur v.1.36. The functional abundance of fecal bacteria was analyzed using the PICRUSt2 pipeline. Korean adults were clustered into three dietary patterns including Korean-style balanced diets (KBD, 20.4%), rice-based diets (RBD, 17.2%), and Western-style diets (WSD, 62.4%) in KNHANES. The incidence of metabolic syndrome was lowered in the order of RBD, WSD, and KBD. The participants having a KBD had lower serum C-reactive protein and triglyceride concentrations than those with RBD and WSD (p < 0.05). Three types of fecal bacteria were classified as Ruminococcaceae type (ET-R, 28.7%), Prevotella type (ET-P, 52.2%), and Bacteroides type (ET-B, 42.1%; p < 0.05). ET-P had a higher abundance of Prevotella copri, while ET-R contained a higher abundance of Alistipes, Akkermansia muciniphila, Bifidobacterium adolescentis, and Faecalibacterium prausnitzii. ET-B had a higher abundance of the order Bilophila (p < 0.05). Metabolism of propanoate, starch, and sucrose in fecal microbiome was higher in ET-P and ET-R, whereas fatty acid metabolism was enhanced in ET-B. Fecal microbiota in ET-P and ET-B had higher lipopolysaccharide biosynthesis activity than that in ET-R. The metabolic results of KBD and RBD were consistent with ET-R and ET-P’s gut microbiota metabolism, respectively. In conclusion, Korean enterotypes of ET-P, ET-B, and ET-R were associated with RBD, WSD, and KBD, respectively. This study suggests a potential link between dietary patterns, metabolic syndrome, and enterotypes among Korean adults.