Serum hs-CRP Research Articles

The correlation between NAFLD and serum uric acid to serum creatinine ratio.

With the prevalence of non-alcoholic fatty liver disease (NAFLD) increasing worldwide, many noninvasive techniques have been used to improve its diagnosis. Recently, the serum uric acid/creatinine (sUA/sCr) ratio was identified as an indicator of fatty liver disease. Therefore, we examined the relationship between sUA/sCr levels and ultrasound-diagnosed NAFLD in Korean adults. This study included 16,666 20-year-olds or older who received health checkups at a university hospital's health promotion center from January to December 2021. Among them, 11,791 non-patients with and without NAFLD were analyzed, excluding those without abdominal ultrasound, those without data on fatty liver, cancer, or chronic kidney disease severity, those with a history of alcohol abuse, and those with serum hs-CRP <5 mg/L. The odds ratio (OR) and 95% confidence interval (CI) of the sUA/sCr ratio according to the presence or absence of fatty liver disease and severity were calculated after correcting for confounding variables using logistic regression analysis. The receiver operating characteristic (ROC) curve and area under the curve (AUC) of the sUA/sCr ratio confirmed and compared the sensitivity and specificity of NAFLD and serum uric acid. sUA/sCr increased with fatty liver severity, and the post-correction OR in the NAFLD group was 1.183 (95% CI: 1.137-1.231) compared to the group without NAFLD. Concerning the fatty liver severity, the post-correction OR in the mild NAFLD group increased to 1.147 (95% CI: 1.099-1.196), and that in the moderate-to-severe NAFLD group increased to 1.275 (95% CI: 1.212-1.341) compared to the group without NAFLD. The sensitivity of sUA/sCr to fatty liver severity was 57.9% for the non-NAFLD group, 56.7% for the mild NAFLD group, and 59.0% for the moderate-to-severe NAFLD group; the specificity of sUA/sCr to fatty liver severity 61.4% for the non-NAFLD group, 57.3% for the mild NAFLD group, and 65.2% for the moderate-to-severe NAFLD group. NAFLD severity is associated with sUA/sCR.

The nano-micellar curcumin improves International Prostate Symptoms Score (IPSS) in patients with benign prostatic hyperplasia: a randomized clinical trial.

Benign prostatic hyperplasia (BPH) is the main prevalent disorder in men over forty years, usually revealing itself with lower urinary tract symptoms. Despite the existence of different treatments, the incidence of BPH is increasing, so further studies for better management are a necessity. This research was designed to assay the effectiveness of nano-micellar curcumin on biomedical indicators of patients with BPH. The present research was a double-blind, randomized, and placebo-controlled trial that enrolled fifty-two patients with BPH between June 2021 and December 2021. Participants were randomized to receive 160mg/d nano-micellar curcumin (n = 26) or placebo (n = 26) as soft gel during 3months. Primary end point was changes in International Prostate Symptoms Score (IPSS). Data gathering was occurred using a standard inquiry form and measuring other biomedical parameters based on routine laboratory techniques. To compare the distribution of demographics and covariates, independent t-test and Chi-square were used. Nano-micellar curcumin had significant effect on IPSS (p value: 0.010), low effect on high-sensitive C-reactive protein (hs-CRP) (p value: 0.032), and low to intermediate effect on malondialdehyde (MDA) (p value: 0.014) level as secondary end points after the intervention. The effect of nano-micellar curcumin on other parameters was negligible. Overall, this trial indicated 3-month intake of nano-micellar curcumin had considerable effects on IPSS as the most common clinical symptom and also two biomedical parameters including serum hs-CRP and MDA. http://www.irct.ir : IRCT20170430033730N3.

Biochemical and Clinical profile of COVID-19 patients and its association with severity of the disease: A study at tertiary care centre

: The Novel Corona Virus pandemic caused significant morbidity and mortality worldwide. The biochemical parameters in affected individuals can differentiate between moderate and severe COVID-19 infection. Early identification will facilitate appropriate care and reduce the mortality.: In the present study, we are exploring the possibility of association of the data of biochemical investigations done at the time of admission with COVID-19 severity in patients, as timely modulation in medical management could reduce the mortality and shorten hospital stay.: A cross sectional study including 452RT-PCR positive, moderate to severe cases of COVID-19 patients admitted to a tertiary care centre, New Delhi were enrolled in the study, in the months of June to October 2020.Biochemical profile of moderate and severe COVID 19 patients was evaluated on admission and correlated with severity of the disease.Out of 452 patients, 331 patients had moderate disease while 121 had severe disease. Total bilirubin in moderate disease was 0.6mg/dl(0.4-0.9) and 0.6mg/dl(0.4-0.8) in severe disease (p=0.780). AST was 46U/L(31-73.75) and 45 U/L(30-76) in moderate and severe disease respectively (p=0.544), while ALT was 42U/L(25-78.25) and 42U/L(26-72)(p=0.936) respectively in moderate and severe disease. The ALP was 111U/L(86.5-165.5) and 106U/L(77-157) in moderate and severe disease respectively (p=0.828). The serum urea in moderate COVID-19 patients was 32mg/dl(22-61) while 42mg/dl(22-94) in severe disease (p=0.016). The serum creatinine in moderate disease was 0.7mg/dl(0.6-1.1) while 0.8mg/dl(0.6-1.8)(p=0.143) in severe disease. The median (IQR) serum HsCRP in moderate disease was 103.2mg/L(9.7-202) and in severe disease it was 103.76mg/L(19.53-181.26)(p=0.132). The median (IQR) LDH level in moderate COVID-19 patients was 245U/L(137.25-372.25) while in severe disease it was 385U/L(278-598)(p&amp;#60;0.001).: The serum biomarkers Urea and inflammatory marker LDH could serve as potential biomarkers to differentiate between moderate and severe COVID-19 patients.

Association of Circulating Matrix Metalloproteinase-9 and the Risk of Coronary Heart Disease in Young Smokers

Introduction: Smoking causes cardiovascular risk which may alter the stability between the production and degradation of the extracellular matrix. Matrix metalloproteinase-9 (MMP-9) is a zinc-containing endopeptidase that degrades the extracellular matrix and plays a vital role in tissue remodeling. As a result, elevated serum MMP-9 levels produced by smoking, particularly at young age, raise the risk of future CHD. So this study aims to find out the possible relationship between circulating MMP-9 and the risk of cardiovascular disease in young smokers. Methods: The study was conducted on smokers with CHD subjects attending cardiology and medicine OP of the SRM Medical College Hospital and research center Tamil Nadu, India. The study group was divided into three groups. Group 1 includes 120 healthy controls as nonsmokers, Group 2 includes 120 smokers with Coronary heart disease (CHD), and Group 3 includes 120 smokers with diabetes and CHD subjects in the age group of 20-55 years. Serum MMP-9, hs-CRP, and APO-E levels were measured using the ELISA method and the lipid level was measured enzymatically using AU480 automatic analyzer (back man coulter). Results: The mean serum MMP-9, hs-CRP, and APO-E levels were significantly higher in both groups (p&lt;0.05) when compared to controls. The study also shows a significant positive association between MMP-9 with hs-CRP, APO-E, smoking burden, and smoking intensity. Conclusion: The study concludes a significant association exists between cigarette smoking with MMP-9 and also relative exposure to circulating inflammation markers plays a potential role in the pathogenesis of CHD.

Implications of Inflammatory markers for disease management in patients with chronic kidney disease and COVID-19 infection: A cross-sectional study from North India

ABSTRACT Background: The world witnessed the emergence of a global pandemic. Individuals with chronic illnesses like chronic kidney disease (CKD), already known to be immunologically compromised, have the potential to develop a scenario of an acute-on-chronic condition on coronavirus disease 2019 (COVID-19) contraction. Measurement of serum inflammatory biomarkers like interleukin (IL-6), high-sensitivity C-reactive protein (hsCRP) and ferritin may foresee the prognosis despite the pre-existing low-grade inflammation in these patients. Aims: To determine the utility of serum IL-6, hsCRP and Ferritin levels to determine COVID-19 severity and probable prognosis in CKD patients with COVID-19. Materials and Methods: A cross-sectional study was performed on 100 adult known cases of stage 5 of CKD, recently diagnosed as COVID-19 positive by real-time reverse transcription-polymerase chain reaction. The study population was divided into two groups according to COVID-19 severity: A non-severe and a severe group based on guidelines given in the Clinical Management Protocol: COVID-19. Their clinical and laboratory data obtained on the day of admission were analysed. Results: The severe group (n = 17) had 65% of males and 35% of females. A significant difference was found with respect to the age, body mass index and serum IL-6, hsCRP and ferritin levels between the two groups (P &lt; 0.05). Among the three inflammatory biomarkers, hsCRP was found to have the maximum potential to categorise COVID-19 as severe or non-severe disease. Conclusion: Similar to patients with uncomplicated COVID-19 disease, higher serum levels of inflammatory biomarkers – IL-6, hsCRP and ferritin are seen in patients of CKD with severe COVID-19 illness in comparison to those with non-severe COVID-19, despite having a pre-existing background of low-grade chronic inflammation. The serum levels of IL-6, hsCRP and ferritin can be utilised to determine COVID-19 severity and probable prognosis in CKD patients with COVID-19.

Efficacy of Nonsurgical Periodontal Treatment on the Levels of Serum Highly Sensitive Capsule Reactive Protein, Blood Cell Count, and Erythrocyte Sedimentation Rate in Patients with Stage II and Stage III Forms of Moderately Progressing Periodontitis: An Interventional Study

Background: Relationship between the severity of periodontitis and its treatment outcome on systemic biomarkers like highly sensitive capsule reactive protein (hsCRP), complete blood cell count (CBCC), and erythrocyte sedimentation rate (ESR) was dynamic and inconclusive over their impact on systemic inflammation. Aim: To evaluate the efficacy of nonsurgical periodontal treatment (NSPT) in systemically healthy patients having stage II and stage III types of moderately progressive periodontitis (grade B) on the laboratory levels (LL) of serum hsCRP and blood parameter (BP) of CBCC and ESR. Materials and Methods: One hundred and fourteen patients were examined, among them 75 were recruited and divided into three groups, 25 each: Group I (Gr I): Healthy controls, Group II (Gr-II): Stage II and Grade B periodontitis, and Group III (Gr-III): Stage III and grade B periodontitis. Periodontal clinical parameters (PCP) and blood samples were obtained and examined at baseline (BL) and 30 days after NSPT. The collected data were analyzed using the one-way ANOVA, t-test, and Pearson correlation. Results: Comparing BL and after 30 days of NSPT in Gr-II and Gr-III, showed significant differences in PCP, LL of hsCRP and BP such as total leukocyte count, neutrophil count, red blood cell count, hemoglobin, mean corpuscular volume, platelet count, and ESR. When comparing Gr-II and Gr-III, no major differences were found in all PCP and LL of hsCRP and BP obtained 30 days after NSPT. Conclusion: PCP and LL of hsCRP and BP improved in Grade B periodontitis at stage II and stage III after NSPT. Clinical Significance: NSPT is efficiently reducing the levels of hsCRP, CBCC, and ESR after 30 days.

Longitudinal profile of high-sensitivity C-reactive protein in women with pre-eclampsia.

C-reactive protein (CRP) is a marker for inflammation and its role as a possible biomarker for an early prediction of pre-eclampsia (PE) is unclear. The present study investigates the levels of high-sensitivity CRP (hs-CRP) longitudinally across pregnancy in women with PE and compares them to women without PE (non-PE). A total of 324 pregnant women [216 non-PE and 108 PE women] were included in this study. Maternal blood was taken at four different intervals (V1 = 11-14 weeks, V2 = 18-22 weeks, V3 = 26-28 weeks, and V4 = at delivery). Maternal serum hs-CRP levels were higher at V1, V2, and V3 (p < .05 for all) in the PE group compared to the non-PE group. The hs-CRP levels were associated with maternal blood pressure throughout pregnancy. Maternal hs-CRP levels did not differ among early and late onset PE. Higher maternal hs-CRP levels were associated with the increased risk of PE in unadjusted model in early pregnancy. However, there was no significance after adjusting for confounding factors. Our findings suggest although the levels of hs-CRP were higher in PE in early pregnancy, they are not associated with an increased risk of PE.

Efficacy of a proprietary combination of Tamarindus indica seeds and Curcuma longa rhizome extracts in osteoarthritis: a clinical investigation.

NXT15906F6 (TamaFlex™) is a proprietary blend containing standardized Tamarindus indica seeds and Curcuma longa rhizome extracts. Earlier, NXT15906F6 supplementation demonstrated reduced knee joint pain and improved musculoskeletal functions in healthy and knee osteoarthritis (KOA) subjects. The present randomized, double-blind, placebo-controlled study was focused on validating the clinical efficacy of NXT15906F6 in a larger number of subjects with KOA. Male and female subjects (age: 40-70 years; body mass index [BMI]: 20-29 kg/m2] were randomized into three groups receiving placebo (n = 50), NXT15906F6 (n = 50) or a blend of C. longa and Boswellia serrata extracts (CLBS) (n = 50). Subjects consumed 250 mg NXT15906F6, 1,000 mg CLBS or a matched placebo daily after breakfast over a period of 30 consecutive days. The primary efficacy outcome was the improvement in total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, and the secondary efficacy measures included various tests on joint pain and musculoskeletal functions and evaluations ofserum high-sensitivity C-reactive protein (hs-CRP) and a cartilage degradation marker, C-terminal telopeptide of type II collagen in urine (uCTX-II). NXT15906F6 significantly (P < 0.001) reduced the WOMAC scores and improved musculoskeletal function scores in the participants as compared with baseline and placebo. NXT15906F6 participants reduced knee pain and improved musculoskeletal functions as early as day 5 of supplementation. In contrast, CLBS supplementation failed to show early efficacies in pain and functional scores, except for 30s-CST and primary knee flexion. The NXT1506F6-supplemented participants significantly reduced serum hs-CRP and uCTX-II levels from baseline and as compared with the placebo. Both supplementations did not alter the subjects' clinical chemistry, hematology, and vital parameters. The anti-inflammatory botanical composition NXT15906F6 supplementation mitigated joint pain and improved musculoskeletal functions and joint motility in KOA subjects. This botanical composition was also well-tolerated by the volunteers.

Rivaroxaban in patients with abdominal aortic aneurysm and high-sensitivity C-reactive protein elevation (BANBOO): study protocol for a randomized, controlled trial

BackgroundAbdominal aortic aneurysm (AAA) is a fatal disease due to the tendency to rupture. The drug treatment for small AAA without surgical indications has been controversial. Previous studies showed that high-sensitivity C-reactive protein (hs-CRP) had become a potential biomarker of the disease, and the anti-inflammatory effect of rivaroxaban for AAA had been well established. Thus, we hypothesized that rivaroxaban could control the progression of AAA in patients with hs-CRP elevation.MethodsThe study is a prospective, open-label, randomized, controlled clinical trial. Sixty subjects are recruited from the General Hospital of Northern Theatre Command of China. Subjects are randomly assigned (1:1) to the intervention arm (rivaroxaban) or control arm (aspirin). The primary efficacy outcome is the level of serum hs-CRP at 6 months. The secondary outcomes include imaging examination (the maximal diameter of AAA, the maximal thickness of mural thrombus, and the length of aneurysm), major adverse cardiovascular and cerebrovascular events (MACCE, including AAA transformation, non-fatal myocardial infarction, acute congestive heart failure, stent thrombosis, ischemia-driven target vessel revascularization, vascular amputation, stroke, cardiovascular death, and all-cause death), and other laboratory tests (troponin T, interleukin 6, D-dimer, and coagulation function).DiscussionThe BANBOO trial tested the effect of rivaroxaban on the progression of AAA in patients with elevated Hs-CRP for the first time.Trial registrationChiCTR2100051990, ClinicalTrials.gov, registered on 12 October 2021.

#5951 INFLUENCE OF DIETARY INTAKE ON GASTROINTESTINAL SYMPTOMS AND INFLAMMATION MARKERS IN PERITONEAL DIALYSIS PATIENTS IN SLOVENIA

Abstract Background and Aims Gastrointestinal symptoms are prevalent in patients with end-stage renal disease. Gastrointestinal symptoms in such patients are related to gastric hypomotility, increased medication intake, uremia, and changes in diet. In addition GI symptoms and problems associated with bowel dysfunction are a common cause of technique failure and poor dialysis efficacy. The reason for presence of some gastrointestinal symptoms is also chronic inflammatory state. Inflammation can have many negative effects, including decreased appetite, accelerated protein skeletal muscle breakdown and hypercatabolism. Method 14 peritoneal dialysis patients were included in single Department of Nephrology in the University Medical Center in Ljubljana. All patients were interviewed by a dietitian and nutritional assessment was conducted. Gastrointestinal symptom Rating Scale (GSRS) with 7-grade Likert scale was used to evaluate the intensity of GI symptoms and Bristol Stool Form Scale (BSFS) to classify patient's stool. The dietary intake of peritoneal dialysis patients was assessed using 7-day food diaries and analyzed with Prodi program (PRODI® 6.4 Expert program, Stuttgart, Deutschland). Body composition has been measured with bio impedance spectroscopy. Routine blood analysis was performed. Results Among 14 patients undergoing peritoneal dialysis, most of them were male (71.4%) with average age of 53.07 ± 12.32 years. Average energy intake of 14 patients was 21.05 ± 5.72 kcal/kg body weight per day, average protein intake was 0.87 ± 0.39 g/ kg body weight per day and average fiber intake was 13.75 ± 7.25 g per day. They were inadequate according to the dietary guidelines for peritoneal dialysis patients. Average dietary protein-fiber index was 6.86 ± 3.81 per day. Average PRAL value was 15.84 ± 13.44 for women and 6.52 ± 17.99 for men. Average dietary potassium intake was 1917.80 ± 790.08 mg per day which corresponds to the guidelines for peritoneal dialysis patients and average potassium serum value 4.45 ± 0.42 mmol/L. GSRS questionnaire showed peritoneal patients had minor to mild discomfort in abdominal pain, constipation and indigestion GI symptom cluster. Patients’ self-analysis of stool showed BSFS Types 3.23 ± 1.64 if BSFS Types 3–5 are defined as normal stools. Dietary protein intake strongly correlated with dietary energy intake (r = 0.76, p = 0.003), dietary protein-fiber index strongly correlated with PRAL value (r = 0.70, p = 0.007) and dietary potassium intake moderately to strongly correlated with dietary fiber intake (r = 0.62, p = 0.025). Serum value of IL-6 strongly correlated with dietary potassium intake (r = 0.72, p = 0.006) and moderately to strongly correlated with dietary fiber intake (r = 0.6, p = 0.034). The correlation between dietary potassium intake and serum hsCRP was significant (p = 0.042). The correlation between Bristol stool consistency value and serum hsCRP was significant (p = 0.0255). The correlation between total GSRS score and serum value of albumin was significant (p = 0.0010). The correlation between total GSRS score and dietary potassium intake was significant (p = 0.0015). The correlation between total GSRS score and dietary protein-fiber index was significant (p = 0.0403). Conclusion Gastrointestinal diseases in peritoneal dialysis patients are comparatively understudied in the literature, despite having a significant impact on dialysis efficacy and the quality of life. Analysis of GSRS questionnaire showed that abdominal pain, constipation and indigestion caused minor to mild discomfort in PD patients. The analysis also showed that fiber intake, potassium intake and gastrointestinal symptoms are significantly associated with inflammation markers and are important contributing factors to chronic inflammatory state in these patients. Patients still lack the basic knowledge of nutrition, thus in the future nutritional consultations, innovative teaching techniques and help will be crucial to prevent the decline in nutritional status.

#4322 MEDIATION ANALYSIS OF THE RELATIONSHIP BETWEEN INFLAMMATION AND CONTRAST INDUCED ACUTE KIDNEY INJURY IN PATIENTS WITH CHRONIC KIDNEY DISEASE

Abstract Background and Aims Decreased kidney function is a risk factor for the development of contrast-associated acute kidney injury (CA-AKI) in chronic kidney disease (CKD). Although the relationship between CKD and CA-AKI is well established, the mechanistic link between the two, particularly the extent to which this interaction is mediated by inflammation, remains poorly understood. We examined the association between CKD and CA-AKI, as well as potential mediators, including serum albumin and high-sensitivity C-reactive protein (hs-CRP) levels. Method A total of 3,738 patients were enrolled for analysis from 5,299 patients and fulfilled the inclusion criteria among 12,742 patients who underwent coronary angiography (CAG) between 1 January 2007, and 31 December 2016. Multivariable logistic regression and mediation analyses were performed. In addition to the effect as risk factors, direct and indirect effects were also estimated. Results Among 3,738 subjects, 414 developed AKI (11.1%). Pre-procedural albumin and Lnhs-CRP (log-transformed) were independently associated with CA-AKI (odds ratio [OR], 95% confidence interval [CI]): 0.320 (0.272–0.3787), P &amp;lt;0.001 and 1.211 (1.132-1.296), P&amp;lt;0.001, respectively. Direct, and indirect effects were also estimated. Patients with CKD were found to be more likely to exhibit lower serum albumin and higher serum hs-CRP levels. Simple mediation analyses showed that 33.8% and 52.3% of the relationship between CKD and CA-AKI was mediated by the serum albumin and hs-CRP levels, respectively with co-mediation being 13.9%. Conclusion These results represent that, in addition to reduced kidney function, inflammatory parameters are also risk factors and mediators of CA-AKI in patients with CKD.

#4124 SEX AND CARDIOVASCULAR DISEASE IN STAGE G2-5 CKD PATIENTS

Abstract Background and Aims Male sex is considered a major risk factor for cardiovascular (CV) disease in the general population, but the role of this factor in the high risk for CV disease in the pre-dialysis CKD population is still debated. Methods We tested the relationship between sex and fatal and non-fatal major CV events (myocardial infarction, heart failure, arrhythmia, angina, stroke, transient ischemic attack, peripheral vascular disease, major arterial or venous thrombotic episodes and sudden death) in a cohort including 759 stage 2-5 CKD consecutively recruited from 22 Nephrology units in southern Italy between October 2005 and September 2008. After the initial assessment, patients were followed up for a median time of 36 months (range 0.3–48 months). Results Four hundred fifty-five patients were males (60%). The proportion of smokers was about 4 times higher in males (71.4%) than in females (17.4%). Males and females differed in the prevalence of diabetes (38.5% versus 29.6%) and the frequency of background CV comorbidities (35.6% versus 19.7%, P&amp;lt;0.001). Waist circumference (100.9±12.4 versus 96±14.1 cm), eGFR (37.5±13.4 versus 33±12.7 ml/min/1.73 m2), 24-hour urinary protein excretion (median: 0.7 g/24h, IQR: 0.2-1.6 g/24h versus 0.5, IQR: 0.2-1.2 g/24 h), and haemoglobin (13.4±1.9 versus 12.0±1.4 g/dL) were higher in males than in females. Serum phosphate (3.6±0.75 versus 3.9±0.75 mg/dL), hs-CRP (median; 2.2 mg/dl, IQR: 1-4.7mg/dl versus 2.8 mg/dl, IQR: 1.2-6.4 mg/dl) and total cholesterol (178.3±42.1 versus 198.8±45.6 mg/dl) were lower in males than in females. During follow-up, 42 patients died, and 118 had fatal and non-fatal CV events. On univariate Cox regression analyses, male gender failed to be associated with all-cause mortality but was strongly related to the incidence rate of fatal and non-fatal major CV events [HR 1.75, 95% CI: 1.18-2.60, P=0.006]. Data adjustment for a series of major potential confounders did not materially affect the strength of this relationship [HR:1.78, 95% CI: 1.03-3.09]. Further analysis testing the effect of age on major CV outcomes by gender showed an effect modification by this risk factor on the same outcome (P=0.037) because the hazard ratio of male versus female CV events increased progressively with ageing (Figure 1). Conclusion The excess risk for CV mortality by the male gender in the general population holds in stage G2-5 CKD patients. Age is a modifier for the excess risk for CV events in CKD patients because the risk excess of the male gender increases linearly across a wide age spectrum in CKD patients.

#3706 EFFECT OF CHOLECALCIFEROL INTAKE ON NOVEL INFLAMMATORY INDICATORS IN HEMODIALYSIS PATIENTS

Abstract Background and Aims Hemodialysis patients (HD) are in a chronic state of systemic inflammation, with vast majority of these patients are vitamin D deficient. Vitamin D appears to be a strong controller of inflammation. It's well known that C-reactive protein (CRP) is considered the gold of inflammatory markers. Recently, neutrophil- to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been shown to be inexpensive, readily available indicators of systemic inflammation. This study is to demonstrate the pleotropic effects, the efficacy and the safety of two dosing regimens of cholecalciferol; (weekly regimen vs monthly regimen) on novel inflammatory indicators in HD population. Method A prospective, randomized trial was carried out to evaluate the effect of weekly versus, monthly oral cholecalciferol, on vitamin D (25(OH)D) levels, on inflammatory markers and secondary hyperparathyroidism in HD patients. Fifty eligible HD patients were randomly assigned to either Group A (Once weekly oral 50.000IU Cholecalciferol) or Group B (One monthly, oral 200.000IU Cholecalciferol), for 3 months’ period. Serum levels of high sensitive CRP (hsCRP), NLR, PLR, were all assessed at baseline and at the end of the study. Results Cholecalciferol significantly increased serum levels of 25(OH)D in both groups. A significant decrease in serum hsCRP levels (p &amp;lt;0.001) and NLR was noted only in Group A. No significant difference in calcium or phosphorus levels was noticed. No side effects or adverse events were reported. Conclusion Weekly (50.000 IU) oral cholecalciferol appears to have a beneficial action on replenishing 25(OH)D levels in HD patients, with an ameliorative action on inflammatory status as well. NLR seems to be an effective, non-expensive inflammatory indicator in HD.

The relationship between neuron-specific enolase, high sensitivity C reactive protein, and diabetic peripheral neuropathy in Chinese patients with type 2 diabetes: A prospective nested case–control analysis

BackgroundDiabetic peripheral neuropathy (DPN) involves a very complex pathogenesis, and there is no neuro-specific marker for risk prediction. Neuron-specific enolase (NSE), a key enzyme in glycolysis, has a broad spectrum neurotrophic and neuroprotective effect on neurons, and also cause injury and inflammatory response of peripheral nerves. The relationship between neuron-specific enolase, highly sensitive c-reactive protein (hsCRP), and diabetic peripheral neuropathy remains unclear. We aimed to investigate whether elevated serum NSE and hsCRP levels increased the risk of DPN in patients with type 2 diabetes.Materials and methodsIn this prospective nested case–control study, a total of 1072 eligible subjects with type 2 diabetes constituted the follow-up cohort. Demographic data and parameters including serum NSE and hsCRP were collected at baseline. Two neuropathy screening scales (MNSI and MDNS) were used to assess DPN during follow-up period. Nerve conduction studies were performed at the end of follow-up. Conditional logistic regression was used to inspect the risk factors of the incidence of DPN.ResultsDuring an average follow-up period of 5.1 years, 176 subjects developed DPN. Serum NSE and hsCRP levels at baseline were significantly higher in DPN group than in matched non-DPN groups (p < 0.001). NSE was positively correlated with age and hsCRP (p < 0.001). The amplitude of sensory nerve action potential and compound muscle action potential of the lower extremity nerves were significantly decreased in the high tertile of NSE. After adjustment for matching and confusing factor, conditional logistic regression showed the risk of DPN in the high tertile of NSE level was still 3.176 times higher than that in the low tertile of NSE level (p < 0.001).ConclusionElevated serum NSE levels predicted the high incidence of DPN in Chinese patients with type 2 diabetes for an average of 5.1 years, which may be associated with increased neuroinflammatory response caused by high NSE levels, but further studies are needed.

Preparation, Properties and Therapeutic Effect of a TPL Nanoparticle Thermosensitive Gel for Intra-Articular Injection.

Most injectable preparations for the articular cavity are solution-type preparations that are frequently administered because of rapid elimination. In this study, triptolide (TPL), an effective ingredient in the treatment of rheumatoid arthritis (RA), was prepared in the form of a nanoparticle thermosensitive gel (TPL-NS-Gel). The particle size distribution and gel structure were investigated by TEM, laser particle size analysis and laser capture microdissection. The effect of the nanoparticle carrier material PLGA on the phase transition temperature was investigated by 1H variable temperature NMR and DSC. The tissue distribution, pharmacokinetic behavior, four inflammatory factors and therapeutic effect were determined in a rat RA model. The results suggested that PLGA increased the gel phase transition temperature. The drug concentration of the TPL-NS-Gel group in joint tissues was higher than that in other tissues at different time points, and the retention time was longer than that of the TPL-NS group. After 24 days of administration, TPL-NS-Gel significantly improved the joint swelling and stiffness of the rat models, and the improvement degree was better than that of the TPL-NS group. TPL-NS-Gel significantly decreased the levels of hs-CRP, IL-1, IL-6 and TNF-α in serum and joint fluid. There was a significant difference between the TPL-NS-Gel and TPL-NS groups on Day 24 (p < 0.05). Pathological section results showed that inflammatory cell infiltration was lower in the TPL-NS-Gel group, and no other obvious histological changes were observed. Upon articular injection, the TPL-NS-Gel prolonged drug release, reduced the drug concentration outside the articular tissue and improved the therapeutic effect in a rat RA model. The TPL-NS-Gel can be used as a new type of sustained-release preparation for articular injection.

Elevation of preoperative serum hs-CRP is an independent risk factor for malnutrition in patients with gastric cancer.

Recent studies have reported hypersensitive C-reactive protein (hs-CRP) linked to clinicopathological characteristics and nutritional status of the tumor, but its clinical significance in GC remains unclear. This study aimed to investigate the relationship between preoperative serum hs-CRP level and clinicopathological features and nutritional status in gastric cancer (GC) patients. The clinical data of 628 GC patients who met the study criteria were analyzed retrospectively. The preoperative serum hs-CRP level was divided into two groups (<1 mg/L and ≥1 mg/L) to evaluate clinical indicators. Nutritional Risk Screening and nutritional assessment of GC patients were performed by the Nutritional Risk Screening 2002 (NRS2002) and the Patient-Generated Subjective Global Assessment (PG-SGA), respectively. The data were subjected to chi-square test, univariate and multivariate logistic regression analyses, respectively. The analysis of 628 GC cases revealed that 338 patients (53.8%) were on malnutrition risk(NRS2002≥3 points), and 526(83.8%) had suspected/moderate to severe malnutrition(PG-SGA≥ 2 points). Preoperative serum hs-CRP level was significantly correlated with age, tumor maximum diameter (TMD), peripheral nerve invasion (PNI), lymph-vascular invasion (LVI), depth of tumor invasion (DTI), lymph node metastasis (LNM), pTNM stage, body weight loss (BWL), body mass index (BMI), NRS2002 score, PG-SGA grade, hemoglobin (HB), total protein (TP), albumin (ALB), prealbumin (PAB) and total lymphocyte count (TLC). Multivariate logistic regression analysis revealed that hs-CRP (OR=1.814, 95%CI=1.174-2.803; P=0.007), age, ALB, BMI, BWL and TMD were independent risk factors for existing malnutritional risk in GC. Similarly, non-malnutrition and suspected/moderate to severe malnutrition groups presented that hs-CRP (OR=3.346, 95%CI=1.833-6.122; P< 0.001), age, HB, ALB, BMI and BWL were independent risk factors for malnutrition in GC. In addition to the generally used nutritional evaluation indicators such as age, ALB, BMI, and BWL, the hs-CRP level may be used as a nutritional screening and evaluation indicator for GC patients.

Determination of high-sensitivity C-reactive protein reference intervals for apparently healthy children in Addis Ababa, Ethiopia

Objective: Since then, the reference intervals of serum hsCRP in apparently healthy Ethiopian children are unknown. Therefore, this study aimed to determine the reference intervals of serum hsCRP for apparently healthy children. Methods: In this cross-sectional study, a total of 492 apparently healthy children aged 5–17 years were recruited from residents of Addis Ababa. Well-trained professionals took anthropometric measurements. The biochemical analysis was performed with the automatic biochemical analyzer Cobas Integra 400 Plus from Roche. The 2.5th and 97.5th percentile limits were calculated using a non-parametric method as per the Clinical Laboratory Standard Institute (CLSI) guide. A box plot was used to show the distribution of hsCRP by age and gender. Furthermore, bivariate and multivariable logistic regression analyses were carried out to evaluate factors associated with elevated hsCRP levels. Percentiles were displayed by age subgroup and sex. p-values &lt;0.05 were considered statistically significant. Results: The study included 245 boys and 247 girls. For the age group of 5–11 years, the combined 2.5th and 97.5th percentiles, which can be used as a reference interval for children in Addis Ababa, were 0.15–6.78 mg/L, while for the older age group (12–17 years), the determined percentile was 0.14–4.40 mg/L. Likewise, the current study shows that never or occasionally eating vegetables and/or fruits (AOR = 2.28, 95% CI, 0.84–4.97), and being obese (AOR = 3.63, 95% CI, 1.14–11.53) were independent risk factors for elevated serum hsCRP concentrations. Conclusion: This study is the first to determine the reference intervals of hsCRP concentrations among apparently healthy Ethiopian children. Notable differences were observed in the established percentiles of hsCRP in comparison with published literature.

Relation between erythropoietin resistance and metabolic syndrome in hemodialysis patients: A multicentric propensity score matched analysis.

Erythropoietin (EPO) resistance is frequently reported in hemodialysis (HD) patients. Metabolic syndrome (MetS) is a common biochemical condition that comprises central obesity, dyslipidemia, hypertension, and hyperglycemia. The present study aimed to assess the relation between MetS and EPO resistance in HD patients. The present multicentric study included 150 patients with EPO resistance and 150 patients without EPO resistance. Short-acting EPO resistance was diagnosed if the erythropoietin resistance index is ≥1.0 IU/kg/gHb. Comparison between patients with EPO resistance and patients without resistance revealed that the former group had significantly higher body mass index, lower hemoglobin levels, lower albumin levels, higher ferritin levels, and higher high-sensitivity C-reactive protein (hsCRP) levels. In addition, patients in the EPO resistance group had significantly higher frequency of MetS (75.3% vs 38.0%, p < 0.001) and higher number of MetS components (2.7 ± 1.3 vs 1.8 ± 1.6, p < 0.001). Multivariate logistic regression analysis identified lower albumin levels (OR (95% CI): 0.072 (0.016-0.313), p < 0.001), higher ferritin levels (OR (95% CI): 1.05 (1.033-1.066), p< 0.001), higher hsCRP levels (OR (95% CI): 1.041 (1.007-1.077), p = 0.018), and MetS (OR (95% CI): 36.68 (2.893-465.05), p = 0.005) as predictors of EPO resistance in the studied patients. The present study identified MetS as a predictor of EPO resistance in HD patients. Other predictors include serum ferritin, hsCRP, and albumin levels.

Synergistic effects of overweight/obesity and high hemoglobin A1c status on elevated high-sensitivity C-reactive protein in Chinese adults: a cross-sectional study.

High-sensitivity C-reactive protein (hs-CRP) is an inflammatory marker that has been suggested as a predictor of cardiovascular diseases. High glycated hemoglobin (HbA1c) levels and overweight/obesity are independently associated with elevated hs-CRP; meanwhile, high HbA1c levels are frequently accompanied by overweight or obesity. However, their joint effect on elevated hs-CRP levels has not been well-established. Therefore, we evaluated whether overweight/obesity modified the association between high HbA1c levels and elevated hs-CRP. Based on cross-sectional data from the Chinese Urban Adults Diet and Health Study (CUADHS) in 2016, we included 1,630 adults aged 18-75 years (mean age 50.16 years and 33.6% male). Elevated hs-CRP was defined as serum hs-CRP ≥ 3 and <10 mg/L. The interactive effects of BMI and HbA1c levels on the risk of elevated hs-CRP levels were calculated by using multiple logistic regression models, followed by strata-specific analyses. Individuals with elevated hs-CRP had a higher rate of HbA1c level than those without elevated (25.3 vs. 11.3%, P < 0.001), as well as a higher rate of overweight/obesity (67.1 vs. 43.5%, P < 0.001). Higher HbA1c levels were independently associated with an increased risk of elevated hs-CRP [adjusted odds ratio (aOR) = 2.31, 95% confidence interval (CI): 1.47, 3.65], as well as overweight/obesity with the risk of elevated hs-CRP (aOR = .31, 95% confidenc-3.73). Furthermore, overweight/obesity showed a significant synergistic effect on high HbA1c levels with a higher aOR of 5.25 (2.77, 9.95) (Pinteraction < 0.001). This synergistic effect was more prominent when stratified by age (in 18-44 years old, aOR, 95% CI = 30.90, 4.40-236.47 for interaction vs. 6.46, 1.38-30.23 for high HbA1c only) and gender (in women, aOR, 95% CI = 8.33, 3.80-18.23 for interaction vs. 2.46,1.38-4.40 for high HbA1c only). There are synergistic effects of high HbA1c levels and overweight/obesity on the risk of elevated hs-CRP in Chinese adults, with more significant effects in adults aged 18-44 years or females. Intervention strategies for preventing high blood glucose levels and body weight simultaneously may be important for reducing hs-CRP-related diseases. Further studies are needed to confirm this finding in other populations, and its molecular mechanisms need to be elucidated.

A combination of Sophoraflavescens alkaloids and Panaxquinquefolium saponins attenuates coxsackievirus B3‑induced acute myocarditis in mice via NF‑κB signaling.

Timely treatment of viral myocarditis (VMC), a form of cardiac inflammation caused by viral infections, can reduce the occurrence of dilated cardiomyopathy and sudden death. Our previous study demonstrated the anti-inflammatory and anti-fibrotic effects of KX, a combination of Sophora flavescens alkaloids and Panax quinquefolium saponins, on an autoimmune myocarditis model in vivo. The present study explored the effects of KX on coxsackievirus B3 (CVB3)-induced acute VMC in mice. Mice were randomly divided into four groups: Control, VMC, KX-high (275 mg/kg) and KX-low (138 mg/kg). Mice in the VMC, KX-high and KX-low groups received injections of CVB3 to establish the VMC model, and those in the KX-high and KX-low groups also received KX by gavage (10 ml/kg) 2 h after virus injection until euthanasia was performed on day 7 or 21. Mice in the control group received an equal KX volume of purified water. The levels of lactate dehydrogenase (LDH), creatine kinase-myocardial band (CK-MB), cardiac troponin I (cTn-I), IL-1β, IL-6, TNF-α and high-sensitive C-reactive protein (hs-CRP) in mouse serum was measured using ELISA. Myocardial tissue structure and degree of injury were observed using hematoxylin and eosin staining. Western blotting and reverse transcription-quantitative PCR were performed to detect the expression levels of NF-κB pathway-related mRNA and protein in myocardial tissue. The results showed that the inflammation and myocardial damage levels of the mice in the VMC group were higher at 7 days than those at 21 days. At both 7 and 21 days, KX decreased the serum CK-MB, LDH, cTn-I, IL-6, TNF-α and hs-CRP levels, and inhibited NF-κB pathway-related mRNA and protein expression in the myocardium of mice. These findings indicated that KX may reduce the inflammatory response and attenuate the pathological damage in the acute and subacute phases of CVB3-induced VMC through the NF-κB pathway.