Significant Differences In CRP Research Articles

Association of ANA seropositivity with RF, CRP, Brucellosis test in patients with SLE, a compression between immunofluorescence technique and latex agglutination

Objectives The present study aims to inspect the connection between patients with SLE and RF, CRP, Brucellosis and compression between immunofluorescence technique and latex agglutination method to detect ANA.Methods A total of 90 serum sample collected from patients with symptoms and signs of SLE those send to the immunity lab in Al-Hussein hospital. The immunofloriscent ANA test, SLE latex agglutination test, RF, CRP and Rose Bengal tests were done to all these samples.Results The results show that there was significant difference between males (16%) and females (84%) patients with sign and symptom of SLE, while there was no significant difference in CRP, RF, in patients with SLE positive (50%,17%) and SLE negative patients (48.5%,17%), continuously Rose Bengal test is higher in SLE negative patients than in SLE positive patients (15.2%, 8.3%). Finally, there is significant difference in diagnosis of SLE disease between IF technique and latex agglutination test (41.6%, 100%).Conclusions Latex agglutination test for ANA detection is reliable, specific but less sensitive test when compared to SLE IF test. There are significance differences in Rose Bengal test in SLE negative and in SLE positive patient’s, while there are non-significance difference in CRP, RF in SLE positive samples and in SLE negative samples.

Abstract P314: Higher C-Reactive Protein Levels Among Women with a History of Hypertensive Disorders of Pregnancy

Introduction: Women with a history of pregnancy complications, including hypertensive disorders of pregnancy (HDP: preeclampsia and gestational hypertension) and preterm delivery (<37 weeks), have an increased risk of cardiovascular disease (CVD). There is limited knowledge of the pathway linking pregnancy outcomes and CVD, but chronic inflammation may play a role. Methods: We selected parous women from the Nurses’ Health Study II who had the inflammatory biomarkers C-reactive protein (CRP; n=2,987) or interleukin (IL)-6 (n=2,916) assessed in stored blood samples provided after pregnancy, between 1996 and 1999. Women were selected from previous nested case-control biomarker studies. Robust linear regression models were used to separately evaluate the mean differences in CRP and IL-6 and 95% confidence intervals (CIs) associated with a history of HDP compared to no such history and with a history of preterm delivery compared to no such history. Models were adjusted for age at blood draw, pre-pregnancy body mass index and smoking, and variables related to lab selection. Results: Ten percent (285 of 2,987) of women had a history of HDP, while 12% (358 of 2,987) had at least one preterm delivery prior to blood draw. Median time from first pregnancy to blood draw was 17 years (range: 1-37 years). Mean CRP levels were 2.00 mg/L and 1.57 mg/L, while mean IL-6 levels were 1.56 pg/mL and 1.42 pg/mL in women with and without a history of HDP, respectively. In women with and without preterm delivery, mean CRP levels were 1.54 mg/L and 1.62 mg/L and mean IL-6 levels were 1.39 pg/mL and 1.44 pg/mL, respectively. Plasma levels of CRP were 0.36 mg/L (95% CI: 0.12, 0.60) higher, on average, in women with a history of HDP compared to those with all normotensive pregnancies. Plasma IL-6 levels were not significantly higher among women with a history HDP (0.06 pg/mL, 95% CI: -0.16, 0.27). There were no significant differences in CRP (-0.11 mg/L, 95% CI: -0.30, 0.07) or IL-6 (-0.08 pg/mL, 95% CI: -0.25, 0.10) levels in women with a history of preterm delivery. Conclusion: CRP was elevated in women with a history of HDP in the decades following pregnancy, suggesting a potential inflammatory response. An altered inflammatory profile was not present in women with a history of preterm delivery. Further investigation is needed to confirm these inflammatory responses in women with a history of pregnancy complications and to evaluate the utility of CRP as a potential risk marker in CVD screening.

PWE-017 Prospective Evaluation of The Safety and Efficacy of Switching Stable Patients with Inflammatory Bowel Disease from Remicade™ to Biosimilar Infliximab (IFX)

Introduction Biosimilar IFX (CT-P13; RemsimaTM/InflectraTM) became available in the UK in February 2015 offering significant savings to the NHS. Efficacy and safety data in inflammatory bowel disease (IBD) is limited. From May 2015 IBD patients at the Royal Devon and Exeter NHSFT were switched from RemicadeTM to Biosimilar IFX. We reviewed efficacy and safety data during this switch. Methods Treatment was evaluated in IBD patients who met the following criteria: i) RemicadeTM treatment for greater than 6 months prior to switch ii) minimum follow-up data of 6 months following switch. Disease activity scores (Harvey-Bradshaw Index for Crohn’s disease [CD] and Simple Colitis Score for ulcerative colitis [UC]), CRP, drug levels and total anti-drug antibody levels were collected immediately prior to biosimilar switch and then every 16 weeks. All adverse events were recorded. Results 104 patients (54 male) met the inclusion criteria with a mean age of 43 years (range 17–71). 73 had CD, 29 had UC and 2 had IBD-unclassified. The median duration of RemicadeTM therapy prior to switch was 1137 days (95% confidence interval = 933–1290). Missing cases were excluded on a variable by variable basis. There was no significant difference in CRP (median pre-switch = 2, post-switch = 2, P = 0.81) or disease activity score (median pre-switch = 1, post-switch = 1, P = 0.44) after switching from RemicadeTM to Biosimilar IFX. 85% were in remission before compared with 81% six months following switch (P = 0.51). There was no difference in the number of people with detectable total anti-drug antibody levels (pre-switch = 29, post-switch = 27, P = 0.88) but a fall in drug levels was noted after switching (median pre-switch =5.4, post-switch = 2.8, P = 0.01). 41% had significant anti-drug antibodies pre-switch compared to 36% at 6 months post switch (P = 0.50). 11% of patients had positive anti-drug antibodies with undetectable drug levels pre-switch compared to 7% at 6 months (P = 0.35). 4 patients had adverse events within eight months of switching to biosimilar IFX; 2 minor infusion reactions and 2 anti-TNF induced skin disease. 19 patients stopped within six months of switching; 6 electively, 9 due to loss of response and 4 for other reasons. Conclusion This uncontrolled data suggests biosimilar IFX is safe and effective with no significant change observed in CRP, disease severity index and drug antibody levels six months after switch. The fall in IFX drug level after switch warrants further investigation. Disclosure of Interest K. Bennett: None Declared, G. Heap Grant/research support from: Hospira, Knapp, Abbvie, MSD, S. Hawkins: None Declared, T. Ahmad Grant/research support from: Hospira, Knapp, Abbvie, MSD

The Relationship of Red-Cell Distribution Width and Carotid Intima Media in Chronic Kidney Disease

OBJECTIVE: Red-cell distribution width (RDW) is a parameter routinely used for diagnosis of different anemia types. Recent studies have shown the RDW relationship with mortality in general population and patients with cardiovascular disease. However, the number of studies on RDW in chronic kidney disease (CKD) is insufficient. We evaluated the relationship between RDW and carotid intima media thickness (IMT), which is a predictor of atherosclerosis, in patients with CKD. MATERIAL and METHODS: 30 healthy controls, 30 patients with CKD, 37 hemodialysis patients were included. IMT was measured with ultrasonography. RESULTS: We identified statistically significant differences in CRP (p: 0.039), hemoglobin (p<0.001), IMK (p<0.001), RDW (p<0.001), urea (p<0.001), creatinine (p<0.001), albumin (p<0.001), uric acid (p<0.001) and ferritin (p<0.001) levels among three groups. In post hoc analysis, the IMK value was statistically significantly higher in the predialysis (p<0.001) and hemodialysis group than healthy controls. IMK value was not statistically different in the hemodialysis group than the predialysis group (p: 0.988). The RDW value was higher in the predialysis group than controls with a trend to statistical significance (p: 0.067). RDW value showed positive correlation with IMK (r: 0.356 P: 0.012) and CRP (r: 0.361 P: 0.004). CONCLUSION: RDW is associated with inflammation and intima media thickness in patients with CKD. KEy wORDS: RDW, Atherosclerosis, Chronic kidney disease

Prophylactic embolization of the cystic artery prior to radioembolization of liver malignancies--an evaluation of necessity.

Prior to radioembolization (RE) of hepatic tumors, many centers prophylactically occlude the cystic artery (CA) during evaluation angiography (EVA) to prevent radiation-induced cholecystitis. There is no conclusive evidence for the protective effect of CA embolization and it bears the risk of inducing ischemic cholecystitis. The aim of this study is to evaluate the justification for CA embolization by comparing clinical and morphologic imaging parameters between patients undergoing coil occlusion of the cystic artery (COCA) and those with uncoiled CA (UCCA). Retrospective comparison of 37 patients with UCCA versus 68 patients with COCA in terms of clinical findings (CRP, leukocyte count, body temperature, upper abdominal pain) and morphologic imaging parameters associated with cholecystitis (gallbladder (GB) wall thickness, free fluid in GB bed, bremsstrahlung SPECT) after EVA, after RE, and at 6-week follow-up. At none of the 3 time points (EVA, RE, 6-week follow-up) was there any significant difference in CRP, leukocyte count, body temperature, or upper abdominal pain between the UCCA and COCA group. There was also no significant difference between the two groups with regard to GB wall thickness, fluid in the GB bed, and bremsstrahlung in SPECT. One patient of the UCCA group and two patients of the COCA developed cholecystitis requiring treatment. Comparison of clinical and imaging findings between patients with and without CA embolization prior to RE identified no predictors of radiogenic or ischemic cholecystitis after RE. Our study provides no evidence for a benefit of prophylactic CA embolization before RE.

AB0361 Influence of Total Knee Arthroplasty on Various Parameters about Local and General Disease Activity in Patients with Rheumatoid Arthritis

BackgroundTotal knee arthroplasty (TKA) is used as a part of the treatment of the rheumatoid arthritis (RA) all over the world. It can provide pain and restoration of mobility for...

ABSTRACT 421

Background and aims: Mycoplasmal infection is an important aetiology in children pneumonia. Aims: To measure PCT and CRP in children with MPP and evaluate its clinical significance. Methods: The 74 cases MPP patients were diagnosed in PICU of our hospital from 2005 to 2009, including 51 cases in acute stage and 23 cases in recovery stage. The specimen was drawn from peripheral vein within 24hr after admission, meanwhile the specimen from 13 children in normal as control.Fluorescent immunoassay was employed to measure PCT. Results: PCT levels of acute and recovery stage were 0.3(0.12–0.50) ng/ml and 0.18(0.13–0.23) ng/ml, respectively; it was 0.1(0.13–0.16) ng/ml in control group. There were a significant difference in PCT between acute and recovery stage group (P<0.01), and no difference between recovery stage and the normal control group (P>0.05). CRP levels of acute stage and recovery stage were 12.2 (1–25.5) mg/L and 8 (2–8) mg/L, respectively.There were a significant difference in CRP between acute stage nd recovery stage group (P<0.01), and there were no difference between recovery stage and the normal control group.(P>0.05). Conclusions: PCT and CRP elevated mildly in MPP during actue stage, then returned to normal level in recovery stage. PCT detection was beneficial for differential diagnosis between bacterial and non-bacterial infection. However, PCT detection could not distinguish viral from mycoplasmal infection. In addition to clinical features, aetiology study, including viral examination and mycoplasma antibody detection should be employed in differential diagnosis of MPP.

Epidemiology, Diagnosis, and Treatment of Pericapsular Pyomyositis of the Hip in Children

The yield of synovial fluid cultures in patients meeting clinical criteria for septic hip arthritis remains low. In the presence of positive blood cultures, these patients are diagnosed and treated as "presumed septic arthritis." We hypothesized that some of these patients may instead have an extra-articular infection, such as pericapsular pyomyositis. An IRB-approved prospective study of children with suspected septic hip arthritis at a tertiary care children's hospital over a 2-year time period was conducted. Children were evaluated with a previously published clinical algorithm with the addition of magnetic resonance imaging (MRI). Of the 53 patients presenting with an acutely irritable hip, 32% were found to have pericapsular pyomyositis, whereas 15% were diagnosed with septic arthritis. Although C-reactive protein (CRP, ≥33.1 mg/L) performed well at predicting infection, there were no significant differences in CRP, erythrocyte sedimentation rate, white blood cell count, temperature, or weight-bearing status in children with septic arthritis compared with pericapsular pyomyositis. In addition to MRI, there was a difference in the size of hip effusion on ultrasound, which was significantly smaller in cases of pericapsular pyomyositis. CRP (≥74.3 mg/L) was found to be predictive of need for surgical intervention in children with pericapsular pyomyositis. Correct anatomic diagnosis of the site of infection is essential for the efficient care of the child. Herein, we found that pericapsular pyomyositis is twice as common as septic arthritis in children presenting with an acutely irritable hip. Clinical algorithms are incapable of differentiating these pathologies suggesting that both be considered under the current diagnosis previously referred to as "presumed septic arthritis." Incorrect diagnosis of a septic arthritis in the presence of a pericapsular pyomyositis could potentially lead to unnecessary debridement of the joint in the presence of extra-articular infection, thus contaminating the joint. Conversely, debriding the joint instead of the epicenter of the infection can prolong the infectious process. For these reasons, we conclude that MRI has the potential to improve the clinical care of children by providing a more precise diagnosis. Level II-"Diagnostic" [Development of diagnostic criteria on the basis of consecutive patients (with universally applied reference "gold" standard)].

OC-041 Enhanced Monocyte Function and Surface TLR Expression Predict Post-Operative Systemic Inflammatory Response Syndrome in Patients Immediately following Major Hepatic and Pancreatic Resection

<h3>Introduction</h3> Patients undergoing major surgery are at risk of systemic inflammatory response syndrome (SIRS) and life-threatening post-operative sepsis. Early identification of high-risk patients would allow for tailored post-operative care. We tested the hypothesis that post-operative SIRS could be predicted by differences in innate immune function in peripheral blood mononuclear cells (PBMC) taken from patients undergoing major abdominal surgery in the perioperative period. <h3>Methods</h3> Serial blood samples were taken from consenting, adult patients undergoing major hepatic or pancreatic surgery pre-operatively and on days one and two postoperatively. Patients with inflammatory co-morbidities, pre-operative sepsis and those taking anti-inflammatory or immunomodulatory medication were excluded. PBMCs were isolated, stimulated for 24 hours with lipopolysaccharide (LPS) or flagellin and cytokine production was quantified by ELISA. PBMC surface expression of CD14, TLR4 and TLR5 was assessed by flow cytometry. SIRS was defined by the American College of Chest Physicians/Society of Critical Care Medicine consensus criteria. <h3>Results</h3> We included 32 patients, nine of whom developed SIRS on day five or later. There were no significant pre-operative differences between the SIRS and the non-SIRS groups in TLR-induced IL-6 and TNFa production nor TLR4 and TLR5 expression. LPS- and flagellin- induced IL-6 concentrations were significantly greater in the SIRS group on day two (1532pg/µl vs 153pg/µl; p &lt; 0.0002). Monocyte expression of both TLR4 and TLR5 was significantly greater in the SIRS group on both day one (p &lt; 0.002) and day two (p &lt; 0.001). There was no significant difference in CRP or other clinical predictors of SIRS between the groups in the early post-operative period. <h3>Conclusion</h3> Patients who develop SIRS show increased cytokine production in response to TLR stimulation in the early post-operative period. This is associated with elevated surface TLR4 and TLR5 expression in monocytes. These data indicate that there are early functional differences in innate immune responses in patients who develop SIRS compared to those who do not, and that these differences are detectable days before the onset of clinical symptoms. Such assays can help to identify at-risk patients in whom intensive therapy can be targeted. <h3>Disclosure of Interest</h3> None Declared

SAT0101 Abatacept Treatment Suppresses T Cell Activation in Anti-Cyclic Citrullinated Peptide Antibody (ACPA) Positive RA Patients but not in Acpa Negative RA Patients

BackgroundWe have reported that abatacept (ABA) treatment suppressed T cell activation and reduced plasma levels of interleukin (IL)-6 in rheumatoid arthritis (RA) patients. Anti-cyclic citrullinated peptide antibodies (ACPA) are highly...

Comparison of urinary neutrophil gelatinase-associated lipocalin, C-reactive protein and procalcitonin in the diagnosis of late onset sepsis in preterm newborns

Abstract Abstract Objective: We aimed to determine the value of uNGAL levels in the early diagnosis of late-onset sepsis in preterms, and to compare CRP and PCT. Materials and Methods: Preterm infants admitted to the NICU between the ages of 7 to 28 days, were divided into two groups: 24 cases with clinical sepsis (gestational age 32.88±1.45w) and 20 cases as the control group (gestational age 33±1.49w). Laboratory analyses (CBC, uNGAL, CRP and PCT measurements) were performed at the onset of treatment in the two groups. In the sepsis group, the patients were re-evaluated. Results: On the first and seventh days of treatment in the sepsis group, CRP (median: 25.09mg/L vs 8.63mg/L), PCT (median; 17.11ng/ml vs 1.39ng/ml) and uNGAL levels were determined as 45.69±18.37ng/ml, 7.89±4.19ng/ml, respectively. We found significant differences in CRP, PCT and uNGAL levels between the groups. On the seventh day of treatment, CRP, PCT and uNGAL levels were found to have significantly decreased.We found the sensitivity, specificity, positive and negative predictive values, respectively as: for CRP, 58.3%, 80%, 77.8% and 61.5%; for PCT, 91.7%, 75%, 81.5% and 88.2%; and for uNGAL, 91.7%, 100%, 100% and 90.9% Conclusion: Urinary NGAL seems to be a more sensitive and specific, reliable biomarker than serum CRP and PCT. We believe that unlike other biomarkers, uNGAL does not require a blood sample, non-invasive and non-sterile conditions, and with small amounts of urine collection in newborn sepsis it may be an ideal biomarker.

Inflammatory markers in chronic obstructive pulmonary disease patients with different α1 antitrypsin genotypes.

IntroductionChronic obstructive pulmonary disease (COPD) has been recently defined as a systemic pulmonary inflammatory disease, and congenital α1 antitrypsin deficiency is one of the well-established genetic risk factors for chronic obstructive pulmonary disease. The aim of our study was to evaluate the possible associations of α1 antitrypsin with inflammatory markers – CRP, sCD14, TNF-α, sTNFR-1, and sTNFR-2 – in patients with COPD with different α1 antitrypsin genotypes.Material and methodsSerum biomarkers from patients (n = 355) with COPD, defined according to the GOLD criteria, were analyzed using commercial ELISA kits; α1 antitrypsin concentrations were determined by nephelometry, and α1 antitrypsin phenotyping was carried out by means of isoelectric focusing.ResultsNo significant differences in CRP, TNF-α, sTNFR-1, sTNFR-2, and sCD14 levels were found comparing COPD patients with different genotypes. In patients without α1 antitrypsin deficiency (PI*MM), a significant negative correlation between lung function (FEV1) and serum α1 antitrypsin (r = –0.522, p = 0.03) and CRP concentration (r = –0.590, p = 0.011) was detected. The level of α1 antitrypsin positively correlated with: a) CRP concentration (r = 0.671, p = 0.005), b) sCD14 (r = 0.510, p = 0.008) and c) sTNFR-1 (r = 0.567, p = 0.007).ConclusionsIn patients without α1 antitrypsin deficiency, the positive association of α1 antitrypsin concentration with CRP, sCD14, and sTNFR-1 and the negative association with FEV1 show the importance of α1 antitrypsin as a marker of systemic inflammation.

Early resolution of systemic inflammation mirrors improvement in meld score and predicts survival after first presentation of alcoholic liver disease

IntroductionAlcoholic Liver Disease (ALD) is a spectrum of disease, from steatosis to cirrhosis. Despite years of research it is still unclear why some patients will not progress while others develop...

Assessing the association of the HNF1A G319S variant with C-reactive protein in Aboriginal Canadians: a population-based epidemiological study

BackgroundC-reactive protein (CRP), a biomarker of inflammation, has been associated with increased risk of developing cardiovascular disease. Common variants of the hepatocyte nuclear factor 1A (HNF1A) gene encoding HNF-1α have been associated with plasma CRP in predominantly European Caucasian samples. HNF1A might therefore have an impact on vascular disease and diabetes risk that is mediated by CRP. In an Aboriginal Canadian population, a private polymorphism, HNF1A G319S, was associated with increased prevalence of type 2 diabetes. However, it has not been investigated whether this association is mediated by CRP. We aimed to investigate whether CRP was mediating the association between HNF1A G319S and type 2 diabetes in an Aboriginal Canadian population with a high prevalence of diabetes.MethodsA total of 718 individuals who participated in a diabetes prevalence and risk factor survey were included in the current analysis. Participants were genotyped for HNF1A G319S. Fasting plasma samples were analyzed for CRP. Fasting plasma glucose and a 75-g oral glucose tolerance test were obtained to determine type 2 diabetes.ResultsThe prevalence rate of type 2 diabetes was 17.4% (125/718) using the 1999 World Health Organization definition and was higher among S319 allele carriers compared to G/G homozygotes (p < 0.0001). Among participants without type 2 diabetes, CRP levels were higher among G/G homozygotes (1.64 [95% confidence interval 1.35-2.00] mg/l) than in S319 carriers (1.26 [1.04-1.54] mg/l) (p = 0.009) after adjustment for age, sex, 2-h post-load glucose, waist circumference, and serum amyloid A. CRP levels were elevated among those with diabetes after similar adjustment (4.39 [95% confidence interval 3.09-6.23] and 4.44 [3.13-6.30] mg/L, respectively), and no significant difference in CRP was observed between S319 carriers and non-carriers (p = 0.95).ConclusionsCRP levels were lower in S319 allele carriers of the HNF1A gene compared to non-carriers among individuals without diabetes, but this difference was not present among those with diabetes, who uniformly had elevated CRP levels. Therefore, while HNF1A appears to influence CRP concentrations in the non-diabetic state, chronic elevation of CRP is unlikely mediating the association between the HNF1A polymorphism and the high prevalence of type 2 diabetes in this Aboriginal population.

332 PEROXIDIZED FATTY ACIDS MAY INDUCE A PRO-INFLAMMATORY RESPONSE IN THE LIVER AND MAY TRIGGER THE OUTBREAK OF NON-ALCOHOLIC STEATOHEPATITIS (NASH)

Background: Retinal vessel diameter has been shown to be associated with CAD in the general population. However, it has not been studied in persons with NAFLD. Aim: Evaluate the relationship between Retinal vessel diameter and carotid arteries Intima-Media thickness (IMT) and coronary artery disease (CAD), in patients with NAFLD. Methods: 29 Patients with fatty liver (age 50±7) and low risk for CAD were included. Patients with Diabetes and Hypertension were excluded. 22 healthy individuals matched for age, gender and BMI served as controls. CAD was defined as a stenosis of >50% in at least 1 major coronary artery by Cardiac CT. Fatty Liver was defined as liver – spleen density (CT) <-10 HU. We measured (IMT) by Doppler US (IMT normal <0.7 women, <0.8 men), Retinal artery and vein diameter by retinal angiography, and biomarkers of insulin resistance, inflammation and oxidation. Results: NAFLD patients showed higher prevalence of CAD (38% vs. 14%, P < 0.001), coronary plaques (67% vs. 34%, P < 0.001), Higher IMT (0.98±0.3 Vs 0.83±0.1, P < 0.04), higher carotid plaques (60% Vs 40%, P < 0.001) higher HOMA (4.0±3.4 vs. 2.0±1.0, P < 0.005) and higher TG levels (200±80 vs. 150±60, P < 0.005) but Lower retinal artery-vein ratio (0.66±0.06 Vs 0.71±0.02. P < 0.01) and narrower retinal artery diameter (92.4±13 Vs 100.6±7, P < 0.04) than healthy controls. No significant difference in CRP, MDA, and Paraoxonase biomarkers levels was noted between the two groups. Multiple logistic regression showed IMT to be the strongest predictor of CAD (OR 2.3, CI 0.8–3.3, P < 0.001) in patients with NAFLD, followed by retinal A-V ratio (OR 1.5, CI 0.5–3, P < 0.01). Conclusion: Smaller retinal artery caliber and retinal A-V ratio may indicate an increased risk of CAD in patients with fatty liver even without diabetes and without hypertension.

The impact of difficulties encountered during embryo transfer on the outcome of IVF and ICSI

Objective: The aim of this work was to investigate the impact of technical difficulties encountered during embryo transfer on the clinical pregnancy (CPR) and implantation rates (IR) in patients undergoing treatment with in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), when the transfer was performed by the same clinician. Design: Data from patients attending our assisted conception unit for treatment with IVF and ICSI were retrospectively analyzed to study the relation between difficulties encountered during embryo transfer and the clinical pregnancy and implantation rates. All embryo transfers were performed by the same clinician. Materials/Methods: Data from 785 cycles in 655 patients treated with IVF and ICSI were analyzed. The factors analyzed were the necessity of negotiating the cervical canal, the use of a volsellum during embryo transfer, the necessity of changing the transfer catheter during transfer, the retention of some or all of the embryos inside the catheter (repeat transfer), the presence of blood on the outer wall of the catheter, on the tip of the catheter or blood coming from the cervix after embryo transfer. The relationship between the type of catheter used and the difficulties encountered was also studied. Results: Compared to easy transfers, negotiating the cervix and the use of a volsellum did not affect the CRP or IR, but changing the catheter resulted in a significant reduction in the CPR (p <0.05) and in the IR (p <0.001). There were no pregnancies in 7 cycles where embryos were retained inside the catheter and re-transferred (repeat transfers) and in one cycle where trans-vaginal trans-myometrial transfer was performed. The presence of blood on the outer wall of the catheter and blood coming from the cervix did not affect the CPR or the IR, compared to bloodless transfers. However, blood present on the tip of the catheter resulted in a significant reduction in the CPR (p <0.05) and IR (p <0.01). There were no statistically significant differences in CRP or IR with the use of the rigid pre-loading type catheter (Frydman) compared to the rigid after-loading catheter (TDT). However, the CPR was significantly higher with the ball-pointed after-loading catheter (Labotect) (p <0.05) compared to the rigid Frydman catheter, but not the IR. The after-loading soft catheter (Ultrasoft) performed best and was associated with a significantly higher CPR (p <0.0005) and IR (p <0.01) compared to the rigid pre-loading Frydman catheter. Conclusions: It is concluded that negotiating the cervix with the embryo transfer catheter, the use of a volsellum and the presence of blood on the outer wall of the catheter or on the cervix during embryo transfer have no affect on the CPR or IR. Changing the catheter and the presence of blood on the tip of the ET catheter significantly diminish the CPR and IR. The soft after-loading catheter was associated with the highest CPR and IR. Supported by: Alexandria Fertility Center.