Value Of Inflammatory Markers Research Articles

Influences of advanced age in rheumatoid arthritis: A multicentre ultrasonography cohort study.

We aimed to evaluate the effects of age on clinical characteristics and outcomes in biologic or targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD)-naïve patients with rheumatoid arthritis (RA). We analysed the cases of 234 Japanese b/tsDMARD-naïve RA patients who underwent b/tsDMARD treatment in a multicentre ultrasound prospective observational cohort. We compared the clinical characteristics at baseline and outcomes at 12 months between those aged ≥60 years and those <60 years. Compared to the <60-year-old group (n = 78), the ≥60-year-old group (n = 156) had higher inflammatory marker values and ultrasound combined scores, especially wrist joints, at baseline. Age at baseline positively correlated significantly with the ultrasound scores at baseline; however, age was not a significant variable by the multiple regression analysis. The patients treated with different MOAs in the ≥60-year-old group had comparable outcomes and multiple regression analysis revealed that mechanism of action (MOA) was not a significant contributor to the Clinical Disease Activity Index at 12 months. RA patients with advanced age demonstrated distinctive clinical characteristics. The MOAs were not associated with clinical outcomes and ultrasound outcomes in RA patients with advanced age.

Prognostic Values of Inflammatory Markers in Patients with High-grade Lamina Propria-invasive Bladder Cancer

Prognostic Values of Inflammatory Markers in Patients with High-grade Lamina Propria-invasive Bladder Cancer

Correlation of Hemoglobin Level With New Inflammatory Markers in the Emergency Department: A Retrospective Study Exploring Neutrophil-to-Lymphocyte, Monocyte-to-Lymphocyte, Platelet-to-Lymphocyte, and Mean Platelet Volume-to-Platelet Count Ratios.

Background Anemia of chronic disease is known to be associated with inflammation. However, the relationship between hemoglobin (Hb) levels and potential inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume-to-platelet count ratio (MPV/PC) has not been extensively studied. The primary objective of this retrospective analytical study conducted at Al Zahraa Hospital University Medical Center (ZHUMC), Beirut, was to investigate the correlation between Hb levels andpotential inflammatory markers (NLR, MLR, PLR, MPV/PC) in patients visiting the emergency department (ED), across different genders and age groups. The secondary objectives were to compare Hb levels and inflammatory markers values between the referred medical ward group (thehospitalized patients who were admitted to the medical ward), and the non-referred to medical ward group (the patients who were discharged home from the ED), and to evaluate the predictability of inflammatory markers and Hb levels for referral to the medical ward, including the determination of optimal cutoffvalues for hospital admission to the medical ward. Methods We analyzed the blood parameters of 379 adult patients who presented to the ED with various medical complaints between September 1, 2022, and November 30, 2022 (three months). These patients were included in the study after we checked their eligibility regarding the verification of all our inclusion and exclusion criteria. Results Our findings revealed a significant negative correlation between Hb levels and PLR (r = -0.24) in both genders and across different age groups. The group referred to the medical ward exhibited lower Hb levels and higher NLR, MLR, and PLR values (P < 0.001). NLR/Hb ratio emerged as a predictive factor for admission in genitourinary (R² = 0.158; OR = 5.62) and respiratory groups (R² = 0.206; OR = 5.89), with specific cutoff values of 0.533 (Sensitivity = 57.1% & Specificity = 84.2%) and 0.276 (Sensitivity = 85% & Specificity = 51.1%), respectively. Conclusions Our study demonstrates that hemoglobin level negatively correlates with PLR. NLR, MLR, and PLR stand as important inflammatory markers. Moreover, we present the first study in the literature to show that NLR/Hb ratio can serve as a predictor for referral to the medical ward, particularly in the genitourinary and respiratory patient groups, underscoring its value in risk assessment as a prognostic marker reflecting the need for admission when the case is more serious.

Bacterial Community- and Hospital-Acquired Pneumonia in Patients with Critical COVID-19-A Prospective Monocentric Cohort Study.

The impact of bacterial pneumonia on patients with COVID-19 infection remains unclear. This prospective observational monocentric cohort study aims to determine the incidence of bacterial community- and hospital-acquired pneumonia (CAP and HAP) and its effect on mortality in critically ill COVID-19 patients admitted to the intensive care unit (ICU) at University Hospital Olomouc between 1 November 2020 and 31 December 2022. The secondary objectives of this study include identifying the bacterial etiology of CAP and HAP and exploring the capabilities of diagnostic tools, with a focus on inflammatory biomarkers. Data were collected from the electronic information hospital system, encompassing biomarkers, microbiological findings, and daily visit records, and subsequently evaluated by ICU physicians and clinical microbiologists. Out of 171 patients suffering from critical COVID-19, 46 (27%) had CAP, while 78 (46%) developed HAP. Critically ill COVID-19 patients who experienced bacterial CAP and HAP exhibited higher mortality compared to COVID-19 patients without any bacterial infection, with rates of 38% and 56% versus 11%, respectively. In CAP, the most frequent causative agents were chlamydophila and mycoplasma; Enterobacterales, which were multidrug-resistant in 71% of cases; Gram-negative non-fermenting rods; and Staphylococcus aureus. Notably, no strains of Streptococcus pneumoniae were detected, and only a single strain each of Haemophilus influenzae and Moraxella catarrhalis was isolated. The most frequent etiologic agents causing HAP were Enterobacterales and Gram-negative non-fermenting rods. Based on the presented results, commonly used biochemical markers demonstrated poor predictive and diagnostic accuracy. To confirm the diagnosis of bacterial CAP in our patient cohort, it was necessary to assess the initial values of inflammatory markers (particularly procalcitonin), consider clinical signs indicative of bacterial infection, and/or rely on positive microbiological findings. For HAP diagnostics, it was appropriate to conduct regular detailed clinical examinations (with a focus on evaluating respiratory functions) and closely monitor the dynamics of inflammatory markers (preferably Interleukin-6).

Exploring the relations of NLR, hsCRP and MCP-1 with type 2 diabetic kidney disease: a cross-sectional study

Type 2 diabetic kidney disease (T2DKD) is a common microvascular complication of type 2 diabetes mellitus (T2DM), and its incidence is significantly increasing. Microinflammation plays an important role in the development of T2DKD. Based on this, this study investigated the value of inflammatory markers including neutrophil–lymphocyte ratio (NLR), high-sensitivity C-reactive protein (hs-CRP), monocyte chemoattractant protein-1 (MCP-1) in the prediction of T2DKD. This was a cross-sectional survey study. A total of 90 patients with T2DM, who were hospitalized in the nephrology and endocrinology departments of the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from June 2021 to January 2022, were included and divided into three groups (A1, A2, A3) according to the urinary albumin-to-creatinine ratio (UACR). Observe and compare the basic information, clinical and laboratory data, and the inflammatory markers NLR, hs-CRP, MCP-1. Results revealed that high levels of NLR (OR = 6.562, 95% CI 2.060–20.902, P = 0.001) and MCP-1 (OR = 1.060, 95% CI 1.026–1.095, P < 0.001) were risk factors in the development of T2DKD. Receiver operating characteristic curve analysis showed that the area under curve of NLR and MCP-1 in diagnosing T2DKD were 0.760 (95% CI 0.6577–0.863, P < 0.001) and 0.862 (95% CI 0.7787–0.937, P < 0.001). Therefore, the inflammatory markers NLR and MCP-1 are risk factors affecting the development of T2DKD, which of clinical value may be used as novel markers of T2DKD.

Neutrophil-to-lymphocyte ratio to predict metachronous cancer after curative resection of early gastric cancer.

313 Background: We investigate the predictive value of inflammatory markers for occurrence of metachronous cancers among patients who underwent endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) and are judged as curative resection (CR). Methods: We enrolled patients who were diagnosed as EGC and underwent ESD during 2006 and 2020. We retrospective collected data of inflammatory indexes such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and erythrocyte sediment ratio (ESR). Results: A total of 1,011 patients underwent ESD for EGC, achieved CR and were followed up more than 12 months. Among them, 86 patients had metachronous cancers (85/1011, 8.4%) during 53.4 months of follow-up. Compared with patients without metachronous cancers, those with metachronous cancers were significantly older (66.9 vs. 63.8 years, P=0.004) and had higher NLR (2.1 vs. 1.8, P=0.002), however, other inflammatory indexes such as PLR and ESR were not significantly different between two groups. Kaplan-Meier analysis showed that patients with NLR ≥ 2.0 had significantly higher possibility of metachronous cancer compared with patients with NLR &lt; 2.0 ( P=0.049 by log rank test). After adjusting age, atrophy and Helicobacter pylori status, NLR was the only significant risk factor for metachronous cancer (odds ratio: 1.33, 95% confidence interval: 1.007-1.665, P=0.011). Conclusions: NLR may have a predictive value for occurrence of metachronous cancer after CR of EGC by ESD. Further thorough investigation is necessary to validate this outcome.

Effect of vaccination on the course of novel coronavirus infection in young patients

The features of the course of the new coronavirus infection in vaccinated and unvaccinated young patients (aged 18–35 years) were assessed. In total, 111 patients with new coronavirus infection were examined, and they were divided into two groups. The first group included 32 people vaccinated against the new coronavirus infection (21 men and 11 women; average age, 22. 31 ± 5. 04 years), and the second group included 79 unvaccinated people (70 men and 9 women; average age, 20. 76 ± 3. 674 years). A direct dependence of hospitalization time on the presence of vaccination was observed. The average volume of erythrocytes was significantly greater in the vaccinated group than in the unvaccinated group, and the average concentration of hemoglobin in erythrocytes was higher in the unvaccinated group, both at disease onset and over time. In addition, in the vaccinated group, the values of inflammatory markers in the blood such as erythrocyte sedimentation rate, C-reactive protein, ferritin, procalcitonin, and D-dimer, increase much faster. According to the results of repeated computed tomography, the unvaccinated group had longer persistence of signs of viral pneumonia. The primary pathology recorded on the electrocardiogram, particularly bradycardia, was more frequently recorded in the unvaccinated group. Overall, most patients, regardless of vaccination, had a mild course of new coronavirus infection. This may indicate a negative dependence of the severity of the new coronavirus infection on the age of the patient. Despite the low risk of developing complications of coronavirus infection at a young age, to prevent and quickly recover from a new coronavirus infection, all age groups are encouraged to receive vaccination, which will reduce the number of hospitalizations, burden on healthcare, and economic costs of medical care.

Considering Histologic Remission in Ulcerative Colitis as a Long-Term Target.

Monitoring disease activity in inflammatory bowel disease (IBD) is challenging since clinical manifestations do not represent reliable surrogates for an accurate reflection of the inflammatory burden. Endoscopic remission had been the most significant endpoint target in the last years; nevertheless, a remarkable proportion of patients continue to relapse despite a normal-appearing mucosa, highlighting that endoscopy may underestimate the true extent of the disease. A subtle hint of the importance that histology plays in the long-term course of the disease has been endorsed by the STRIDE-II consensus, which recommends considering histologic healing for ulcerative colitis (UC), even though it is not stated to be a compulsory formal target. It is a continuum-changing paradigm, and it is almost a certainty that in the near future, histologic healing may become the new formal target for ulcerative colitis. It must be emphasized that there is great heterogeneity in defining histological remission, and the main criteria or cut-off values for inflammatory markers are still in an ill-defined area. The complexity of some histologic scores is a source of confusion among clinicians and pathologists, leading to low adherence in clinical practice when it comes to a homogenous histopathological report. Therefore, a standardized and more practical approach is urgently needed.

Nomogram for Predicting Postoperative Pulmonary Metastasis in Hepatocellular Carcinoma Based on Inflammatory Markers.

Uncertainty surrounds the usefulness of inflammatory markers in hepatocellular carcinoma (HCC) patients for predicting postoperative pulmonary metastasis (PM). The purpose of this study was to assess the predictive value of inflammatory markers as well as to create a new nomogram model for predicting PM. Cox regression was utilized to identify independent prognostic variables and to create a nomogram that predicted PM for comparison with a validation cohort and other prediction systems. We retrospectively analyzed a total of 1109 cases with HCC were included. The systemic inflammatory response index (SIRI) and aspartate aminotransferase-to-platelet ratio index (APRI) were independent risk factors for PM, with a concordance index of .78 (95% CI: .74-.81) for the nomogram. The areas under the curve of the nomograms for PM predicted at 1-, 3-, and 5-year were .82 (95% CI: .77-.87), .82 (95% CI: .78-.87) and .81 (95% CI: .75-.86), respectively, which were better than those of Barcelona Clinic Liver Cancer and China liver cancer stage. Decision curve analyses demonstrated a broader range of nomogram threshold probabilities. A nomogram based on SIRI and APRI can accurately predict postoperative PM in HCC.

The role of cardiovascular system in the SARS-CoV-2 infection and aggravation in human

The coronavirus disease (COVID-19) has several clinical manifestations, highlighting a large number of cases and deaths in patients with specific comorbidities, such as cardiovascular diseases. For this reason, the objective was to analyze the role of the cardiovascular system in SARS-CoV-2 infection and complications in patients with pre-existing cardiovascular alterations. For this, a systematic search was carried out following the PRISMA guidelines in the Latin American and Caribbean Health Sciences Literature databases (Lilacs) and PubMed/Medline, using the association of descriptors: (“Cardiovascular System” OR Cardiovascular Diseases OR “Heart Failure” OR “Hypertension” OR “Cardiac Insufficieny”) AND (“COVID 19”). Original studies published from 2020 onwards were included. Results: About 16/18 studies dealt with complications and 2 with a higher rate of infection in patients with preexisting CVD. The cardiovascular comorbidity most associated with the severity of COVID-19 was systemic arterial hypertension. And through a meta-analysis of the included studies, it was concluded that previously hypertensive patients may be up to 2.49 times more likely to have a worse prognosis. Related to a higher infection rate, both studies showed that patients with SAH have a greater amount of angiotensin-converting enzyme 2 (ACE 2), which functions as a receptor for the binding of SAR-CoV-2, presenting a potentially greater risk of infection. The 16 studies on complications associated the manifestations of venous, arterial and microvascular thrombosis with increased prothrombotic signaling and increased release of von Willebrand factor and platelet activation/aggregation, in addition to increased anti-fibrinolytic and immunoactivating activity specific to cardiac fibroblasts in the hearts of patients with COVID-19. Severe cases were associated with systemic microcirculatory changes with endothelial dysfunction, higher troponin levels, higher values of inflammatory markers, with pro-inflammatory and procoagulant status, atrial fibrillation, and high rates of septic shock. Conclusion: It is inferred that COVID-19 in patients with previous CVD, mainly SAH, have a greater chance of infection due to increased expression of ACE 2 and to present manifestations of thrombosis associated with a pro-coagulant state and inflammatory manifestations associated with a pro-state. -inflammatory triggering a higher rate of hospitalization, resulting in serious complications, requiring intensive treatment, and in some cases death.

Study of inflammatory markers and their diagnostic effectiveness in patients with COVID-19 patients

The study examines the relationship between the levels of laboratory serum markers of inflammation and severity in patients with COVID-19. The purpose of the study. To investigate the mechanisms of interaction of inflammatory markers and calculate their diagnostic effectiveness in patients with COVID-19 in assessing the severity and prognosis of the disease. Materials and methods. We conducted a retrospective cohort study of the blood of 104 patients aged 20–84 years admitted to the hospital. The patients were divided into groups: group 1 – mild degree (n = 14); group 2 – moderate degree (n = 50); group 3 – severe degree (n = 40). The concentration of procalcitonin (PCT), C-reactive protein (CRP), interleukin-6 (IL-6), presepsin (PSP), proadrenomedullin (MRpro-ADM), ferritin (F), components of the complement system C 3, C 4 were determined using original reagent kits on automated systems. Results. In the obtained results of primary studies in the general group, an increase in the average values of inflammatory markers from reference values was noted. Correlation analysis revealed reliable direct medium and weak connections between markers of inflammation. Thresholdvalues were obtained when comparing groups with mild and moderate severity for MRpro-ADM, PCT, F, and in the group with moderate and severe severity for PCT, PSP, CRP and IL-6, above which we can talk about the transition of the disease to a moderate and severe degree of the disease, respectively. Conclusions. Determination of concentration and threshold values with parameters of diagnostic sensitivity of acute-phase markers of inflammation serves as an additional criterion for assessing the severity of the disease, prognosis, monitoring of treatment, but not specific diagnosis and allows you to understand the mechanisms of the immune system response.

Prognostic potential of inflammatory markers, oxidative status, thrombocyte indices, and renal biochemical markers in neonatal calf diarrhoea-induced systemic inflammatory response syndrome

The study aimed to assess the prognostic value of inflammatory markers, indicators of oxidative stress, thrombocyte indices, and renal biochemical markers in neonatal calf diarrhoea (NCD) induced by systemic inflammatory response syndrome (SIRS) upon admission. A prospective, observational, and case-control study was conducted on 56 calves diagnosed with NCD. Mean concentrations of interleukin-6 (IL-6), malondialdehyde (MDA), glutathione (GSH), mean platelet volume (MPV), platelet distribution width (PDW), blood urea nitrogen (BUN), and creatinine (Crea) were measured. Furthermore, the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were also calculated for SIRS survivors [SIRS (survivor)] and non-survivors [SIRS (non-survivor)] induced by NCD. A prognostic cut-off value for predicting the prognosis of the SIRS’s induced by NCD was obtained via receiver operating characteristic (ROC) curve analysis. Upon admission, the SIRS (non-survivor) calves had significantly higher (P < .001) average levels of IL-6, MDA, BUN, Crea, MPV, and PDW compared to the SIRS (survivor) calves and significantly lower (P < .001) average levels of GSH. Despite an apparent increase in the NLR and PLR values of calves diagnosed with SIRS, no significant difference was found between the survival and non-survivor SIRS cases. Positive predictive values (PPVs) for survival were determined as 100 %, 100 %, 80 %, 100 %, 80 %, and 80 %, respectively, using cut-off values of IL-6 (≤259.67 ng/L), MDA (≤2.87 nmol/mL), MPV (≤12.5 fL), PDW (≤34.25 %), BUN (≤168.3 mg/dL), and Crea (≤2.11 mg/dL). The determined threshold values are those obtained upon admission to the hospital. Based on the sensitivity, specificity, and PPVs derived from the ROC analysis, it has been concluded that IL-6, MDA, MPV, PDW, BUN, and Crea are the most relevant biomarkers used for predicting the prognosis of NCD-induced SIRS in calves. Furthermore, it is also noteworthy that IL-6 exhibited the highest effectiveness among all biomarkers.

Effects of cardiac rehabilitation on inflammatory biomarkers in unstable ischemic heart disease patients following percutaneous coronary intervention: a randomized controlled study.

Several blood inflammatory markers, such as high-sensitivity C-reactive protein (hs-CRP), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), are linked to increased risk for cardiovascular diseases. This study aimed to evaluate these inflammatory markers after cardiac rehabilitation (CR) in patients with unstable ischemic heart disease (UIHD) who underwent successful percutaneous coronary intervention (PCI). A cohort of 115 patients with successful PCI due to UIHD enrolled in the study from January 2018 to March 2021. We used a permuted block stratified randomization technique (2 : 1 ratio). Seventy-seven patients were randomized to the CR group and 38 patients to the control group. The CR group underwent a 12-week pre-specified CR regimen. Blood samples were taken at baseline and follow-up at 12 weeks for both groups. Among the 115 patients, 33 patients were female. The mean age was (53 ± 5.55 years) in the control and (53 ± 6.09 years) in the CR group. The two groups were comparable regarding their baseline characteristics and the values of the inflammatory markers. By contrast, at 12 weeks, the inflammatory marker values were significantly lower in the CR group compared to the control group; hs-CRP: 0.11 [0.08-0.14] vs. 0.21 [0.19-0.21], P-value <0.001; NLR: 2.17 [1.42-2.43] vs. 2.26 [2.07-2.6], P-value: 0.016; PLR: 91.2821 [63.3333-103.2000] vs. 92.600 [84.6154-110.0000], P-value: 0.027. CR after PCI in UIHD patients may attenuate some inflammatory markers, which might benefit cardiovascular health. Further studies are required to evaluate these findings with longer follow-up and the powered to measure major cardiovascular event rates.

Inflammatory Markers Showed Significant Incremental Value for Predicting Post-Hepatectomy Liver Failure in Hepatocellular Carcinoma Patients.

Post-hepatectomy liver failure (PHLF) remains a complication with the potential risk of mortality for hepatocellular carcinoma (HCC) patients. The systemic inflammatory response (SIR) has been demonstrated to be associated with a bad prognosis of liver cirrhosis and tumors. This study aims to evaluate the incremental prognostic value of inflammatory markers in predicting PHLF in patients with HCC. Clinical characteristics and variables were retrospectively collected in 2824 patients diagnosed with HCC who underwent radical hepatectomy from the First Medical Center of the General Hospital of the People's Liberation Army. A recently published prognostic model for PHLF was used as the reference model. The increase in AUC (ΔAUC), integrated discrimination improvement (IDI), and the continuous version of the net reclassification improvement (NRI) were applied for quantifying the incremental value of adding the inflammatory markers to the reference model. A p value < 0.05 was considered statistically significant. The reference PHLF model showed acceptable prediction performance in the current cohort, with an AUC of 0.7492 (95%CI, 0.7191-0.7794). The calculated ΔAUC associated with procalcitonin (PCT) was the only one that was statistically significant (p < 0.05), with a value of 0.0044, and demonstrated the largest magnitude of the increase in AUC. The continuous NRI value associated with the systemic immune-inflammation index (SII) was 35.79%, second only to GPS (46.07%). However, the inflammatory markers of the new models with statistically significant IDI only included WBC count, lymphocyte count, and SII. IDI associated with SII, meanwhile, was the maximum (0.0076), which was consistent with the performance of using the ΔAUC (0.0044) to assess the incremental value of each inflammatory variable. Among a wide range of inflammatory markers, only PCT and SII have potential incremental prognostic value for predicting PHLF in patients with radical resectable HCC.

Prognostic value of inflammatory markers for mortality in hemodialysis patients: a retrospective study with over 3-year follow-up

Aims: In chronic kidney disease (CKD), chronic systemic inflammation contributes to premature ageing and morbidity; it is a predictor of overall mortality. In this study, we aimed to investigate prognostic value of inflamatory markers including systemic immune-inflammation index (SII), pan-immune-inflammation value (PIV), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) for mortality outcomes in hemodialysis patients.&#x0D; Methods: In this retrospective study, CKD patients on maintenance hemodialysis between January 1, 2020 and January 31, 2020 were included. SII, PIV, NLR, PLR values of the patients were calculated. SII was calculated by (neutrophil count x platelet count)/lymphocyte count; PIV was calculated by (neutrophil count x platelet count x monocyte count)/lymphocyte count. Mortality rate of the study population during approximately 38-month follow-up period was calculated. The relationships of inflamatory markers and other variables with mortality were analysed.&#x0D; Results: Of 162 patients, 53.1% were male and 46.9% were female (mean age: 61.6±13.5). During 38-month follow-up period, a total of 60 patients (37%) died. Compared with surviving group, NLR values, mean age and the rate of diabetes mellitus (DM) and coronary artery disease (CAD) comorbidities were higher (p=0.012, p

The role of predictive and prognostic values of inflammatory markers in acute pancreatitis: a narrative review

Pancreatitis is an inflammatory condition affecting the pancreas and is classified into 2 types, acute and chronic, which can manifest in various forms. This review article summarizes the role of predictive and prognostic values of inflammatory markers in the pathogenesis of acute pancreatitis, mainly focused on preclinical and clinical studies. It includes serum amyloid A (SAA), monocyte chemotactic protein-1 (MCP-1), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6), C-reactive protein (CRP), IL-10, myeloperoxidase, pentraxin 3, and plasminogen activator inhibitor 1. SAA3 plays a crucial role in developing acute pancreatitis by triggering a receptor-interacting protein 3–dependent necroptosis pathway in acinar cells. Targeting SAA3 could be a potential strategy for treating acute pancreatitis. The recruitment of monocytes/macrophages and the activation of the systemic MCP-1 signaling pathway play a role in the progression of pancreatitis, and blocking MCP-1 may have a suppressive effect on the development of pancreatic fibrosis. The ESR can predict severe acute pancreatitis with slightly lower accuracy than CRP. When ESR and CRP levels are combined at 24 hours, they predict severe acute pancreatitis accurately. IL-6 plays a crucial role in activating the Janus kinase/signal transducers and activators of the transcription pathway, exacerbating pancreatitis and contributing to the initiation and progression of pancreatic cancer. Endogenous IL-10 plays a crucial role in controlling the regenerative phase and limiting the severity of fibrosis and glandular atrophy induced by repeated episodes of acute pancreatitis in mice. The predictive and diagnostic roles of these inflammatory factors in pancreatitis were introduced in detail in this review.

Treat-to-target strategies for the management of familial Mediterranean Fever in children

BackgroundThe objective of this initiative was to develop a treat-to-target (T2T) approach for the management of patients with Familial Mediterranean Fever (FMF), including the definition of a complex treatment target, and establish strategies that improve patient care and long-term outcome.MethodsAn initial set of statements as well as a flow chart visualising the proposed concept was developed. To adapt the preliminary statements to the current state of knowledge, a systematic literature search was performed and the modified statements were subject to a Delphi approach. To ensure the applicability of the statements in daily practice, an online survey was conducted among paediatric rheumatologists in Germany. In addition, data from the national AID-NET registry were analysed with respect to therapeutic response.ResultsThis T2T initiative yielded a total of 26 statements guiding FMF management with respect to diagnosis, treatment targets, treatment strategies and monitoring. The online survey identified cut-off values for inflammatory markers indicating treatment intensification and appropriate measures in case of colchicine intolerance or non-adherence. The analysis of data derived from the national AID-NET showed that colchicine therapy was successfully terminated in 61% of patients (27 out of 44) with heterozygous MEFV mutations. Multidimensional treatment targets incorporating objective and subjective reported outcome measures were developed. These provide the basis for stratifying patients into the following treatment paths: continue colchicine, persisting attacks / inflammation, colchicine intolerance, persisting arthritis, colchicine reduction and adjustment/reduction of biologics.ConclusionsThe proposed consensus treatment plan for the management of FMF incorporates multidimensional targets allowing transparent treatment decisions, which will promote personalised disease management and increase adherence to therapy.

Eichhornia crassipes Ameliorated Rheumatoid Arthritis by Modulating Inflammatory Cytokines and Metalloproteinase Enzymes in a Rat Model.

Background and Objectives: This study was planned to investigate the anti-arthritic property of flowers of E. crassipes in a Sprague-Dawley rat model by administering Freund's Complete Adjuvant (FCA). Materials and Methods: Arthritis was induced at day 0 in all rats except negative controls, while arthritic progress and paw edema were analyzed on specific days (8th, 13th, 18th, and 23rd) via the macroscopic arthritic scale and a digital Vernier caliper, respectively. Histopathological parameters were examined using a Hematoxylin and Eosin (H&E) staining method. Blood samples were withdrawn from rats to investigate the effects of the E. crassipes flower on the mRNA expression values of inflammatory markers, via a reverse transcription PCR technique. Serum samples were used to determine prostaglandin E2 (PGE2) levels using enzyme-linked immunosorbent assay (ELISA). Values of alanine transaminase (ALT), aspartate aminotransferase (AST), creatinine, and urea, besides hematological parameters, i.e., the hemoglobin (Hb) content and complete blood count (CBC), were investigated. Results: The data showed that E. crassipes inhibited the arthritic progress and ameliorated the paw edema. The amelioration of parameters assessed via the histopathological analysis of ankle joints, as well as via hematological analysis, confirmed the diminution of rheumatoid arthritis (RA) in the plant-treated groups. Treatment with E. crassipes inhibited the expression levels of tumor necrosis factor-α (TNF-α), interleukins (IL-1β and IL-6), nuclear factor KappaB (NF-κB), matrix metalloproteinase (MMP-2 and MMP-3), and vascular endothelial growth factor (VEGF). Serum PGE2 levels were also found to be reduced in treatment groups. A biochemical investigation revealed the improvements in hepatic markers in plant-treated groups. The data indicated that the plant has no hepatotoxic or nephrotoxic effects at the studied dose. GC-MS (Gas Chromatography-Mass Spectrometry) analysis displayed the presence of phytochemicals having known anti-inflammatory and antioxidant properties. Conclusions: Therefore, it may be concluded that E. crassipes possesses anti-arthritic characteristics that could be attributed to the modulation of pro-inflammatory cytokines, MMPs, and PGE2 levels.

Anti-inflammatory treatment improves systolic and diastolic tissue doppler parameters in patients with newly diagnosed rheumatoid arthritis

Background The frequency of cardiovascular system involvement is increased in rheumatoid arthritis (RA) and may result in serious morbidity and mortality. Early intervention and control of the disease activity may reduce the risk of cardiovascular events. The purpose of this study is to examine the effects of steroids and methotrexate (Mtx) on the heart functions of newly diagnosed RA patients. Methods Our study is a prospective cohort study involving thirty-six newly diagnosed RA patients according to the American Society of Rheumatology classification criteria. Right and left ventricular echocardiography, and Doppler parameters were evaluated in these patients thrice; before treatment, after one month of steroid treatment, and after three months of Mtx treatment, and laboratory/clinical parameters were noted. Results The mean age of the patients was 52.66 ± 13.66 years. After the treatment, a significant decrease was observed in the values of inflammatory markers (ESR and CRP) and disease activity score (DAS28) [p < .05]. Left ventricular tissue Doppler showed an increase in lateral S, septal S, and mitral S waves compared to baseline (8.37 ± 1.89 vs 10.0 ± 1.8 cm/s p = .001). While there was a decrease in tissue Doppler tricuspid a wave (18.33 ± 4.76 vs 15.63 ± 4.36 p = .016), an increase in Tricuspid E/e’ value and Tricuspid tissue Doppler e/a value was detected after treatment (0.76 ± 0.30) vs 0.94 ± 0.53) p < .010). Significant changes were found to be more prominent after the Mtx treatment. Conclusion In RA patients, steroid and Mtx treatment significantly positively affects left ventricular systolic and right ventricular diastolic functions.

Hemogram-Derived Ratios in the Prognosis of Acute Diverticulitis.

Background and Objectives: It is crucial to quickly identify those patients who need immediate treatment in order to avoid the various complications related to acute diverticulitis (AD). Although several studies evaluated the neutrophil-to-lymphocyte ratio (NLR) suggesting its predictive value in assessing the severity of AD, results have been inconclusive. Therefore, we aimed to assess the relationship between the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), the monocyte-to-lymphocyte ratio (MLR), and systemic immune inflammation (SII) with the severity of AD, the ability to predict the presence or absence of complications, and the recurrence rate, based on the values of inflammatory markers. Materials and Methods: We retrospectively reviewed 147 patients diagnosed with AD between January 2012 to February 2023. Patients were divided into 2 groups, uncomplicated and complicated AD. The characteristics and full blood count between both groups were compared. Results: A total of 65 (44.22%) patients were classified as having complicated AD. The area under the ROC curve (AUROC) defining a Hinchey score ≥ 1b was as follows: SII, 0.812 (95% confidence interval (CI), 0.73 -0.888); NLR, 0.773 (95% CI, 0.676-0.857); PLR, 0.725 (95% CI, 0.63-0.813); MLR: 0.665 (95% CI, 0.542 -0.777). An SII cutoff value of > 1200 marked the highest yield for diagnosing complicated AD, with a sensitivity of 82% and a specificity of 76%. The cumulative recurrence rate was not significantly different in the groups of SII ≥ median vs. SII < median (p = 0.35), NLR ≥ median vs. NLR < median (p = 0.347), PLR ≥ median vs. PLR < median (p = 0.597), and MLR ≥ median vs. MLR < median (p = 0.651). Conclusions: Our study indicates that SII, NLR, and PLR are statistically significant and clinically useful classifying ratios to predict higher Hinchey scores. However, they cannot predict recurrences.