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Background and aims: High levels of lipoprotein(a) could worsen the outcome of COVID-19 due to prothrombotic and proinflammatory properties of lipoprotein(a). We tested the hypotheses that during COVID-19 hospitalization i) increased thrombotic activity and inflammation are associated with lipoprotein(a) levels, and ii) lipoprotein(a) levels are associated with rate of hospital death and discharge. Methods: We studied 211 patients admitted to Copenhagen University Hospital in 2020 with COVID-19, that is, prior to any vaccination. Thrombotic activity was marked by elevated D-dimer while inflammation was marked by elevated interleukin-6, C-reactive protein, and procalcitonin. Patients were followed until death (N = 36) or discharge (N = 175). Results: A 2-fold higher D-dimer was associated with 14% (95%CI: 8.1–20%) higher lipoprotein(a). Conversely, 2-fold higher interleukin-6, C-reactive protein, and procalcitonin were associated with respectively 4.3% (0.62–7.8%), 5.7% (0.15–5.2%), and 8.7% (5.2–12%) lower lipoprotein(a). For hospital death, the multivariable adjusted hazard ratio per 2-fold higher lipoprotein(a) was 1.26 (95%CI:0.91–1.73). Corresponding hazard ratios per 2-fold higher biomarker were 0.93 (0.75–1.16) for D-dimer, 1.42 (1.17–1.73) for interleukin-6, 1.44 (0.95–2.17) for C-reactive protein, and 1.44 (1.20–1.73) for procalcitonin. For hospital discharge, the multivariable adjusted hazard ratio per 2-fold higher lipoprotein(a) was 0.91 (95%CI:0.79–1.06). Corresponding hazard ratios per 2-fold higher biomarker were 0.86 (0.75–0.98) for D-dimer, 0.84 (0.76–0.92) for interleukin-6, 0.80 (0.71–0.90) for C-reactive protein, and 0.76 (0.67–0.88) for procalcitonin. Conclusions: In COVID-19 patients, thrombotic activity marked by elevated D-dimer was associated with higher lipoprotein(a) while elevated inflammatory biomarkers of interleukin-6, C-reactive protein, and procalcitonin were associated with lower lipoprotein(a); however, elevated lipoprotein(a) was not associated with rate of hospital death or discharge.

Early prognostication of COVID-19 severity will potentially improve patient care. Biomarkers, such as TNF-related apoptosis-inducing ligand (TRAIL), interferon gamma-induced protein 10 (IP-10), and C-reactive protein (CRP), might represent possible tools for point-of-care testing and severity prediction.In this prospective cohort study, we analyzed serum levels of TRAIL, IP-10, and CRP in patients with COVID-19, compared them with control subjects, and investigated the association with disease severity.A total of 899 measurements were performed in 132 patients (mean age 64 years, 40.2% females). Among patients with COVID-19, TRAIL levels were lower (49.5 vs 87 pg/ml, P = 0.0142), whereas IP-10 and CRP showed higher levels (667.5 vs 127 pg/ml, P0.001; 75.3 vs 1.6 mg/l, P0.001) than healthy controls. TRAIL yielded an inverse correlation with length of hospital and intensive care unit (ICU) stay, Simplified Acute Physiology Score II, and National Early Warning Score, and IP-10 showed a positive correlation with disease severity. Multivariable regression revealed that obesity (adjusted odds ratio [aOR] 5.434, 95% confidence interval [CI] 1.005-29.38), CRP (aOR 1.014, 95% CI 1.002-1.027), and peak IP-10 (aOR 1.001, 95% CI 1.00-1.002) were independent predictors of in-ICU mortality.We demonstrated a correlation between COVID-19 severity and TRAIL, IP-10, and CRP. Multivariable regression showed a role for IP-10 in predicting unfavourable outcomes, such as in-ICU mortality.Clinicaltrials.gov, NCT04655521.

Aim: Despite many new generation treatments, it is known that the prognostic markers used to datein patients with metastatic renal cell carcinoma (mRCC), who have a very poor prognosis, can not accurately determine the prognosis in every patient. Therefore, the search for prognostic biomarkers continues. In this study, it was aimed toinvestigate the effect of pre-treatment biochemical parameters on oncological outcomes in mRHC patients.Material and Methods: We retrospectively evaluated the clinical, pathological, survival characteristics and factors affecting survival of 90mRCC patients who were metastatic (stage 4) or local (stage 1-3) at the time of diagnosis in our clinic, who underwent radical nephrectomyand relapsed during follow-up. Descriptive statistical analyzes of patients' demographic, clinicopathological and treatment characteristicswere performed.Results: 21.2% of the patients were female and 78.8 % were male. There was no difference in median OS (overall survival) between womenand men. The median OS duration was statistically significantly lower in patients with metastasis at the time of diagnosis (p=0.001). While themedian OS was 36.2 months in metastatic patients at the time of diagnosis, the median OS was 90.4 months in patients with recurrence atfollow-up. As the ratio of alkaline phosphatase/Albumin (ALP/ALB) increased, survival decreased (p=0.038). While the median OS of thosewith a CRP/ALB ratio of 0.072 (AUC.630p=0.046 cut off:0.072).Conclusion: It has been determined that the CRP/ALB ratio is a biomarker that determines the prognosis. We recommend immunotherapyin patients who progress after first-linetargettherapy. Today, prognosis has become important especially in the treatment decision of mRCC,and we think that our study will shedlight on the search for new prognostic markers., Amaç: Yeni nesil pek çok tedaviye rağmen oldukça kötü prognoza sahip metastatik renal hücrelikarsinom (mRHK) tanılı hastalarda günümüze kadar kullanılan prognostik belirteçlerin her hastadaprognozu doğru tayin edemediği bilinmektedir. Bu nedenle prognostik biyobelirteç arayışı sürmektedir.Bu çalışmada mRHK hastalarında tedavi öncesi biyokimyasal parametrelerin onkolojik sonuçlaraetkisini araştırmak amaçlandı.Gereç ve Yöntemler: Kliniğimizde 2007-2020 tarihleri arasında tanı anında metastatik (Evre 4) veyalokal evrede (Evre 1-3) olup radikal nefrektomi yapılmış ve takipte nüks gelişen 90 mRHK hastasınınklinik, patolojik, sağ kalım özellikleri ve sağ kalım üzerinde etkili olan faktörleri retrospektif olarakdeğerlendirildi. Hastaların demografik, klinikopatolojik ve tedavi özellikleri ile ilgili tanımlayıcı istatistikselanalizler yapıldı.Bulgular: Hastaların %21,2’i kadın, %78,8’si erkekti. Kadınlarla erkekler arasında medyan GS (genelsağkalım) açısından fark yoktu. Tanı anında metastazı olan hastalarda medyan GS süresi istatistikselolarak anlamlı farkla daha düşüktü(p=0,001). Tanı anında metastatik hastalarda medyan GS 36,2 ayiken, takipte nüks olan hastalarda medyan GS 90,4 ay idi. Alkalenfosfataz/Albümin (ALP/ALB) oranıarttıkça sağkalım azalmaktaydı (p=0,038). CRP/ALB oranı 0.072 olanlarda bu süre 51 ay ile kısıtlıydı (AUC.630 p=0.046 cut off:0.072).Sonuç: CRP/ALB oranının prognozu belirleyen bir biyobelirteç olduğu saptanmıştır. Birinci sıra hedeftedavi sonrası progrese olan hastalarda immünoterapi önermekteyiz. Günümüzde özellikle mRHK'nintedavi kararında prognoz önemli hâle gelmiştir ve yeni prognostik belirteçlerin araştırılmasınaçalışmamızın ışık tutacağını düşünüyoruz.

The work was aimed to research into the vital signs, haematological and biochemical parameters, acute-phase protein concentrations (CRP, albumin), progesterone (PG) and anti-Müllerian hormone (AMH) concentrations in bitches with pyometra and their comparison with those in healthy bitches. In addition, the goal of this work was to assess if some of the tested parameters may be used as a biomarker in the diagnostics of pyometra and the monitoring of the postoperative recovery. Forty 3-6-year-old bitches of various breeds were included in the research and allotted to two groups: the control (C, n = 20) and the diseased - bitches diagnosed with pyometra (P, n = 20). Blood samples for the analyses were taken immediately before surgery (0 h), and 12 h, 24 h, 48 h and 72 h after, excepting for AMH and PG concentrations, which were determined only at 0 h. Clinical examination detected significantly higher respiration rates in bitches with pyometra in comparison to healthy ones at all time points, higher heart rates before and 12 h after surgery, and higher body temperature before and 12 h, 48 h and 72 h post operation (p .01). Significantly higher concentrations of CRP (p .01) and lower concentrations of albumin were detected in bitches with pyometra in comparison to their healthy counterparts at all time points. Progesterone and AMH concentration analysis immediately before surgery detected significantly higher levels of the hormone in bitches with pyometra than in the control (p .01). The inflammatory reaction of the endometrium resulted in a significant AMH concentration increase, whilst increased CRP concentrations and lower albumin concentrations throughout the research may be used as biomarkers of proinflammatory activities, that is of the acute-phase response.

Background: Acute cholangitis (AC) is a gastro-intestinal emergency associated with significant mortality. Role of change in the levels of inflammatory markers post drainage in predicting outcome in acute cholangitis is uncertain. Objective: To evaluate the predictive value of changes in C-reactive protein (CRP) and procalcitonin levels after biliary drainage in relation to outcomes (survival or mortality) at 1 month. Methods A prospective observational study of consecutive adults presenting with AC was performed. At admission and at 48 hours post biliary drainage, procalcitonin and CRP were sent. Results: Between August 2020 till December 2020 we recruited 72 consecutive patients of AC. The median age of the patients was 55 years (range 43-62 years) and 42 (58.33%) were females. Although the delta change in serum procalcitonin (P value

Objective To evaluate response rates at week 16 with ixekizumab in patients with radiographic axial SpA (r-axSpA) and elevated or normal/low baseline inflammation measured by serum CRP or spinal MRI using data from two randomized, double-blind, placebo (PBO)-controlled phase III trials. Methods Biologic-naïve (COAST-V) or TNF inhibitor-experienced (COAST-W) adults with active r-axSpA received 80 mg ixekizumab every 2 weeks (IXEQ2W) or 4 weeks (IXEQ4W) or PBO or active reference [40 mg adalimumab every 2 weeks (ADAQ2W) in COAST-V. At week 16, patients receiving ixekizumab continued as assigned and patients receiving PBO or ADA were rerandomized 1:1 to IXEQ2W or IXEQ4W through week 52. Assessment of SpondyloArthritis international Society 40% (ASAS40) response rates were examined by baseline CRP (≤5 or >5 mg/l) and Spondyloarthritis Research Consortium of Canada (SPARCC) MRI spine inflammation score ( Results In the COAST-V/W integrated dataset (N = 567), significantly more patients treated with ixekizumab achieved ASAS40 response at week 16 by CRP ≤5 mg/l (27% IXEQ4W, P 5 mg/l (39% IXEQ4W, P Conclusion Ixekizumab demonstrated efficacy in the treatment of AS/r-axSpA in patients with and without elevated CRP or evidence of spinal inflammation on MRI. Trial registration ClinicalTrials.gov (https://clinicaltrials.gov): NCT02696785, NCT02696798

An analytical approach for computing the coefficient of refrigeration performance (CRP) was described for materials that exhibited a giant inverse magnetocaloric effect (MCE), and their governing thermodynamics were reviewed. The approach defines the magnetic work input using thermodynamic relationships rather than isothermal magnetization data discretized from the literature. The CRP was computed for only cyclically reversible temperature and entropy changes in materials that exhibited thermal hysteresis by placing a limit on their operating temperature in a thermodynamic cycle. The analytical CRP serves to link meaningful material properties in first-order MCE refrigerants to their potential work and efficiency and can be employed as a metric to compare the behaviors of dissimilar alloy compositions or for materials design. We found that an optimum in the CRP may exist that depends on the applied field level and Clausius–Clapeyron (CC) slope. Moreover, through a large literature review of NiMn-based materials, we note that NiMn(In/Sn) alloys offer the most promising materials properties for applications within the bounds of the developed framework.

Serum amyloid A protein A (SAA) is a normal serum protein (serving as a precursor of fibrillar tissue protein AA), synthesized in the liver and a rapidly responding marker of the acute phase of inflammation. A constant high concentration of SAA is one of the factors in the development of AA-amyloidosis. As a rule, secondary amyloidosis develops in patients with long-term and poorly controlled inflammatory diseases, including rheumatic diseases, one of which is ankylosing spondylitis (AS).Objective: to assess the level of SAA in AS patients and its relationship with indicators of disease activity.Patients and methods. The study included 124 patients with AS who met the modified New York 1984 criteria. The disease activity and functional status of patients were assessed according to the recommendations of Russian experts. SAA and CRP, ESR in blood serum were measured in all patients.Results and discussion. The median SAA concentration was 12.5 mg/L [4; 71.6]. Of 124 patients, 31% had SAA levels 5 mg/L. A strong correlation was found between the levels of SAA and CRP (r=0.80, pConclusion. A statistically significant relationship was found between SAA and CRP levels, as well as the AS activity indices. Research has shown that SAA can be used as one of the markers of inflammation in AS.

Background Anatomopathological staging is the primary method to determine the prognosis of patients with colorectal carcinoma (CRC). However, new tools have been developed that can complement it, such as the analysis of the elevation of systemic inflammatory markers.Objective To evaluate the impact of the elevation of scores based on inflammatory markers (the neutrophil-to-lymphocyte ratio [NLR], the Glasgow Prognostic Score [GPS], and isolated C-reactive protein [CRP]) in the prognosis of patients diagnosed with CRC and submitted to potentially curative surgery in Hospital de Braga, Portugal, between January 1st, 2005, and December 31st, 2010.Methods A retrospective analysis of the data of 426 patients was performed, with a collection of several clinico-pathological variables, as well as the levels of lymphocytes, neutrophils, albumin and CRP, in the pre- and postoperative periods, to apply the different scores to the sample.Results From the analysis of the survival curves, we concluded that patients with increased NLR in the pre- and postoperative periods present a lower cancer-related survival than patients with normal NLR (preoperative period: 93.7 versus 122 months; p Conclusion Regarding the scores applied to the sample, the NLR was the one that most consistently related to the prognosis of the patients. However, it would be useful to develop a prospective study that could confirm this relationship.

BackgroundAccumulated senescent cells are proposed to be one of the main drivers of age-related pathology such as dementia and cancer through disruption of tissue structure and function. We recently proposed the Neuro-Immuno-Senescence Integrative Model (NISIM), which relates prefrontally modulated vagal tone and subsequent balance between vagal and sympathetic input to the spleen to inflammatory responses leading to generation of reactive oxygen species and oxidative telomere damage.AimIn this study, we assess inflammation as a mediator in the relationship between prefrontally modulated vagal tone and leukocyte telomere length (LTL). We also assess the relationship between a recently proposed index of vagal neuroimmunomodulation (vagal tone/inflammation ratio; NIM index) and telomere length.MethodsThis study uses participant data from a large nationally representative longitudinal study since 1974 with a total of 45,000 Norwegian residents so far. A sub-sample of 131 participants from which ultrashort recordings (30 s) of vagal tone, c reactive protein, and LTL could be obtained were included in the study. Relationships were analyzed with Pearson’s correlations and hierarchical multiple linear regression using either vagal tone and CRP or the NIM index to predict telomere length.ResultsVagal tone was a significant positive predictor of telomere length but this was not mediated by c reactive protein, even after controlling for confounders. The NIM index was a significant positive predictor of telomere length, also when controlling for confounders. In a follow-up analysis simultaneously comparing telomere length between groups with high and low values of vagal tone, and between groups with high and low NIM index values, telomere length was only significantly different between NIM index groups.ConclusionThis is the first study suggesting that prefrontally modulated vagal neuroimmunomodulation is associated with telomere length thus supporting the NISIM. Results indicate that the NIM index is a more sensitive indicator of vagal neuroimmunomodulation than vagal tone and CRP in isolation.

PURPOSE: Withholding parenteral nutrition (PN) early in critical illness, late-PN, has shown to prevent infections despite a higher peak C-reactive protein (CRP). We investigated whether the accentuated CRP rise was caused by a systemic inflammatory effect mediated by cytokines or arose as a consequence of the different feeding regimens, and whether it related to improved outcome with late-PN. METHODS: This secondary analysis of the EPaNIC-RCT first investigated, with multivariable linear regression analyses, determinants of late-PN-induced CRP rise and its association with cytokine responses (IL-6, IL-10, TNF-α) in matched early-PN and late-PN patients requiring intensive care for ≥ 3 days. Secondly, with multivariable logistic regression and Cox proportional-hazard analyses, we investigated whether late-PN-induced CRP rises mediated infection prevention and enhanced recovery or reflected an adverse effect counteracting such benefits of late-PN. RESULTS: CRP peaked on day 3, higher with late-PN [216(152-274)mg/l] (n = 946) than with early-PN [181(122-239)mg/l] (n = 946) (p

Introduction Coronavirus disease (COVID-19) is a highly contagious disease that poses major public health risks. Fewer studies link high CRP and D-dimer levels to severe COVID-19 infection. Therefore, this study investigates the association of serum CRP and D-dimer concentration with COVID-19 severity in diabetic and non-diabetic patients. Areas covered Relevant published articles were identified using electronic search engines, such as Google Scholar, PubMed, Springer, Science Direct, and Researchgate. A total of 29 articles reporting on 15,282 patients (4,733 diabetes and 10,549 non-diabetes) were included in this systematic review and meta-analysis. RevMan V5.4, STATA V14 software, and SPSS V25 were used for the meta-analysis. Egger’s regression and Begg-Mazumdar’s test were used for assessing publication bias. The pooled result of all studies revealed that serum CRP (Standard mean difference (SMD) 0.41 mg/L; P

Despite interesting properties, the use of 67Cu, 186Re and 47Sc theranostic radionuclides in preclinical studies and clinical trials is curtailed by their limited availability due to a lack of widely established production methods. An IAEA Coordinated Research Project (CRP) was initiated to identify important technical issues related to the production and quality control of these emerging radionuclides and related radiopharmaceuticals, based on the request from IAEA Member States. The international team worked on targetry, separation, quality control and radiopharmaceutical aspects of the radionuclides obtained from research reactors and cyclotrons leading to preparation of a standard recommendations for all Member States. The CRP was initiated in 2016 with fourteen participants from thirteen Member States from four continents. Extraordinary results on the production, quality control and preclinical evaluation of selected radionuclides were reported in this project that was finalized in 2020. The outcomes, outputs and results of this project achieved by participating Member States are described in this minireview.

Aims: The etiopathogenesis of Rheumatoid Arthritis (RA) is not clearly understood. However, the role of the cytokines play an important part in this mechanism. We aimed to bring a new approach to the concept of 'remission' in patients with RA. Background: RA is a chronic, autoimmune, inflammatory disease that involves small joints in the form of symmetrical polyarthritis and progresses with exacerbations and remissions. Pain, swelling, tenderness and morning stiffness are typical of the joints involved. Although it is approached as primary joint disease, a wide variety of extra-articular involvements may also occur. It is an interesting pathophysiological process, the exact cause of which is still unknown, with many environmental, genetic and potentially undiscovered possible factors in a chaotic manner. Objective: In this cross-sectional study, sedimentation rate (ESR), C- Reactive protein (CRP), Tumor necrosis factor (TNF)-α, soluble-TNF-α receptor (TNF-R), Interleukin (IL)-1B and IL-10 were measured in three groups which were healthy volunteers, patients with RA in the active period, and patients with RA in remission. Disease activity score-28 (DAS-28) was calculated in active RA and RA in remission. Methods: This study included 20 healthy volunteers, 20 remission patients with RA and 20 active RA patients. Venous blood samples were collected from patients in both healthy and RA groups. Results: RA group consisted 43 (71.6%) female and 17 (28.4%) male. Control group consisted 11 (55%) female and 9 (45%) male. TNF-R was significantly high only in the active group according to the healthy group (p=0.002). IL-10 was significantly high in active RA, according to RA in remission (p=0.03). DAS-28 was significantly high in active RA, according to RA in remission (p=0.001). : In the active RA group, ESR and TNF-R had a positive correlation (r:0.442; p=0.048). In the active RA group, there was also a positive correlation between TNF-R and CRP (r:0.621; p=0,003). Both healthy and active RA group had significant positive correlation between ESR and CRP (r: 0.481; p=0.032 and r: 0,697; p=0,001 respectively). Conclusion: TNF-R can be the main pathophysiological factor and a marker showing activation. TNF-R can be very important in revealing the effect of TNF on the disease and the value of this effect in the treatment and ensuring the follow-up of the disease with CRP instead of ESR in activation.

Purpose This ambispective observational study aims to evaluate the local utility of peri-operative CRP testing and prophylactic antibiotics in relation to post-operative complications in patients who have undergone major head and neck oncological reconstructive surgery. Results A total of 79 patients were identified for inclusion; CRP testing was undertaken within the first 3 days postoperatively in 78/79 cases. Results demonstrated no benefit of extended prophylactic antibiotic use in reducing post-operative infection. Forty-two post-operative complications arose. In the prospective arm, CRP did not influence the decision to commence antibiotic therapy for any of the surgical site infections. Age, diabetes, smoking, or high body mass index (BMI) did not appear to affect the incidence of postoperative infection (p > 0.05). There is no evidence that more than 24 h of antibiotic prophylaxis is indicated for patients undergoing head and neck reconstructive surgery. Conclusion Everyone who is involved in peri-operative patient care should be educated regarding the appropriate use of CRP testing, with the implementation of protocols required to standardize CRP testing and prophylactic antibiotic prescription.

Hilary C Strollo,1 Seyed M Nouraie,1 Karin F Hoth,2 Craig M Riley,3 Chad Karoleski,1 Yingze Zhang,1 Nicola A Hanania,4 Russell P Bowler,5,6 Jessica Bon,1 Frank C Sciurba1 1University of Pittsburgh Medical Center, Department of Medicine, Department of Pulmonary Allergy and Critical Care Medicine, Pittsburgh, PA, USA; 2University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA, USA; 3Chester County Hospital, University of Pennsylvania Health System, West Chester, PA, USA; 4Baylor College of Medicine, Department of Pulmonary, Critical Care and Sleep Medicine, Houston, TX, USA; 5National Jewish Health, Department of Medicine, Denver, CO, USA; 6University of Colorado School of Medicine, Denver, CO, USACorrespondence: Hilary C StrolloUniversity of Pittsburgh Medical Center, Department of Medicine, Department of Pulmonary Allergy and Critical Care Medicine, NW 628 UPMC Montefiore, 3459 Fifth Avenue, Pittsburgh, PA, 15213, USATel +1 412-692-2210Fax +1 412-692-4842Email strolloh2@upmc.eduRationale: Depression is a prevalent comorbidity of chronic obstructive pulmonary disease (COPD) that, along with COPD, has been associated with inflammation. An association between inflammation and depression in COPD has not been validated in a large COPD cohort.Methods: Individuals from the University of Pittsburgh SCCOR cohort and the COPDGene cohort with tobacco use history and airway obstruction (FEV1/FVC < 0.7) were evaluated using the Beck Depression Inventory II (BDI-II) and the Hospital Anxiety and Depression Scale (HADS), respectively. Participants completed symptom-related questionnaires and plasma IL-6 measurements. T-test, Fisher’s Exact tests and logistic regression were used for statistical analysis.Results: The SCCOR cohort included 220 obstructed participants: 44% female and 21.4% with elevated depressive symptoms. GOLD staging distribution was predominantly stage I and II. The COPDGene cohort included 745 obstructed participants: 44% female and 13.0% with elevated depressive symptoms. GOLD distribution was predominantly stage II and III. In the SCCOR cohort, correlation between IL-6 and depressive symptoms trended toward significance (p= 0.08). Multivariable modeling adjusted for FEV1, age, gender and medical comorbidities showed a significant association (OR = 1.70, 95% CI = 1.08– 2.69). IL-6 was significantly associated with elevated depressive symptoms in COPDGene in both univariate (p=0.001) and multivariable modeling (OR = 1.52, 95% CI =1.13– 2.04).Conclusion: Elevated plasma IL-6 levels are associated with depressive symptoms in individuals with COPD independent of airflow limitation and comorbid risk factors for depression. Our results suggest that systemic inflammation may play a significant and possibly bidirectional role in depression associated with COPD.Keywords: IL-6, depression, beck depression inventory, BDI, HADS, TNF-a, CRP, SCCOR, COPDGene

Aim: The coronavirus disease (COVID-19) has been a public health problem that causes severe acute respiratory syndrome affected all over the word since 2019. The most commonly used parameters as inflammatory response in the clinic are leukocytes, neutrophils, erythrocyte amount and serum C-reactive protein (CRP). In recent years, it has been reported that serum PCT (procalcitonin) level may be useful in the diagnosis of bacterial and viral infections. The aim of our study is to compare blood parameters that may play a supportive role to diagnose of COVID-19 in healthy control and critically COVID-19 patient groups. Material and Methods: This retrospective research was carried out in Malatya Turgut Ozal University Training and Research Hospital, Malatya, Türkiye. Total 88 critically ill patients and 90 healthy people accepted to the study and electronic medical records of patients and control group has been collected from hospital information system (HIS). COVID-19 diagnose has been confirmed by real-time polymerase chain reaction (RT-PCR) results. Results: No statistically significant difference was found between the patient and control groups according to gender in the participants included in the study. A statistically significant increase was observed in CRP, LDH, PCT, D-dimer, urea, sediment, lympocyte and neutrophil levels in COVID-19 patients. According to logistic regression analysis CRP, LDH and sediment values were found to be statistically effective in estimating the COVID-19 infection. These results also supported by ROC analysis, CRP, neutrophil, LDH, PCT and D-dimer results were determined to be distinguishing parameters for COVID-19 patients. Conclusion: We found that CRP, PCT and LDH levels higher in the COVID-19 patients and these parameters can be used to diagnose and estimate the prognose of COVID-19 infection in intensive care patients.

Background: Cerebral palsy (CP) is the most common motor disability in children, which is instigated by damage to the developing brain that affects the ability to control the muscles. The main types of CP are spastic CP, dyskinesia CP and mixed CP. The aim of this work was to estimate the concentrations of complete blood count (CBC), erythrocytic sedimentation rate (ESR), C-reactive protein (CRP), brain-derived neurotrophic factor (BDNF), and tumor necrosis factor-α (TNF-α) in children with CP compared to the control group. Methods: A total of 75 Egyptian children were enrolled in this study, 45 had CP and 30 were controls. CBC, ESR, CRP, BDNF, and TNF-α were assessed. Results: The ESR, CRP and TNF-α levels showed statistically significant increases in cases compared to controls. While the neutrophil/lymphocyte ratio and the BDNF levels were significantly lower in CP compared with the controls. When comparing the different groups of CP with each other; there were no significant differences. Regarding the correlation of BDNF and different studied parameters, our study showed a positive correlation between BDNF and TNF levels only within the group with spastic CP. Conclusions: BDNF may be considered as a biomarker or treatment target for CP to avoid further complications as still there is insufficient progress in the prediction, early diagnosis, treatment, and prevention of CP. Furthermore, searching for new strategies to increase BDNF levels may open a new opportunity for the treatment of CP.

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Background: A pathological/inflamed cellular microenvironment state is an additional risk factor for any cancer type. The importance of a chronic inflammation state in most diffuse types of tumour has already been analysed, except for in Ewing’s sarcoma. It is a highly malignant blue round cell tumour, with 90% of cases occurring in patients aged between 5 and 25 years. Worldwide, 2.9 out of 1,000,000 children per year are affected by this malignancy. The aim of this retrospective study was to analyse the role of C-reactive protein (CRP) as a prognostic factor for Ewing’s sarcomas. Methods: This retrospective study at Klinikum rechts der Isar included 82 patients with a confirmed Ewing’s sarcoma diagnosis treated between 2004 and 2019. Preoperative CRP determination was assessed in mg/dL with a normal value established as below 0.5 mg/dL. Disease-free survival time was calculated as the time between the initial diagnosis and an event such as local recurrence or metastasis. Follow-up status was described as death of disease (DOD), no evidence of disease (NED) or alive with disease (AWD). The exclusion criteria of this study included insufficient laboratory values and a lack of information regarding the follow-up status or non-oncological resection. Results: Serum CRP levels were significantly different in patients with a poorer prognosis (DOD) and in patients who presented distant metastasis (p = 0.0016 and p = 0.009, respectively), whereas CRP levels were not significantly different in patients with local recurrence (p = 0.02). The optimal breakpoint that predicted prognosis was 0.5 mg/dL, with a sensitivity of 0.76 and a specificity of 0.74 (AUC 0.81). Univariate CRP analysis level >0.5 mg/dL revealed a hazard ratio of 9.5 (95% CI 3.5–25.5). Conclusions: In Ewing’s sarcoma cases, we consider a CRP pretreatment value >0.5 mg/dL as a sensitive prognostic risk factor indication for distant metastasis and poor prognosis. Further research with more data is required to determine more sensitive cutoff levels.

Children are particularly vulnerable to the deleterious impacts of toxic environmental exposures, though the effects of some rather ubiquitous toxins have yet to be characterized in youths. One such toxin, radon gas, is known to accumulate to hazardous levels in homes, and has been linked with the incidence of lung cancer in aging adults. However, the degree to which chronic home radon exposure may impact risk for health problems earlier in life is unknown. Herein, we explored the degree to which chronic home radon exposure relates to biomarkers of low-grade inflammation in 68 youths ages 6- to 14 years old residing in an area of the United States prone to high home radon concentrations. Parents completed a home radon test kit, and youths provided a saliva sample to assess concentrations of five biomarkers. Using a multiple regression approach, we found that greater radon exposure was specifically associated with higher levels of C-reactive protein (β = 0.31, p = 0.007) and interleukin-1β (β = 0.33, p = 0.016). The data suggested specificity in associations between chronic home radon exposure and different biomarkers of inflammatory activity and highlight a pathway which may confer risk for future mental and physical health maladies.

BackgroundDepression and overweight are each associated with abnormal immune system activation. We sought to disentangle the extent to which depressive symptoms and overweight status contributed to increased inflammation and abnormal cortisol levels.MethodsParticipants were recruited through the Wellcome Trust NIMA Consortium. The sample of 216 participants consisted of 69 overweight patients with depression; 35 overweight controls; 55 normal-weight patients with depression and 57 normal-weight controls. Peripheral inflammation was measured as high-sensitivity C-Reactive Protein (hsCRP) in serum. Salivary cortisol was collected at multiple points throughout the day to measure cortisol awakening response and diurnal cortisol levels.ResultsOverweight patients with depression had significantly higher hsCRP compared with overweight controls (p = 0.042), normal-weight depressed patients (p < 0.001) and normal-weight controls (p < 0.001), after controlling for age and gender. Multivariable logistic regression showed that comorbid depression and overweight significantly increased the risk of clinically elevated hsCRP levels ⩾3 mg/L (OR 2.44, 1.28–3.94). In a separate multivariable logistic regression model, overweight status contributed most to the risk of having hsCRP levels ⩾3 mg/L (OR 1.52, 0.7–2.41), while depression also contributed a significant risk (OR 1.09, 0.27–2). There were no significant differences between groups in cortisol awakening response and diurnal cortisol levels.ConclusionComorbid depression and overweight status are associated with increased hsCRP, and the coexistence of these conditions amplified the risk of clinically elevated hsCRP levels. Overweight status contributed most to the risk of clinically elevated hsCRP levels, but depression also contributed to a significant risk. We observed no differences in cortisol levels between groups.

Background Elevated concentrations of C-reactive protein (CRP) early after acute coronary syndrome (ACS) may reflect the magnitude of the inflammatory response to myocardial damage and are associated with worse outcome. However, the routine measurement of both CRP and cardiac troponin simultaneously in the setting of ST segment myocardial infarction (STEMI) is not used broadly. Here, we sought to identify and characterize individuals who are prone to an elevated inflammatory response following STEMI using the CRP Troponin test (CTT) and determine their short- and long-term outcome. Material and methods We retrospectively examined 1,186 patients with the diagnosis of acute STEMI, who had at least two successive measurements of combined CRP and cardiac troponin (up to 6 hours apart), all within the first 48 hours of admission. We used Chi-Square Automatic Interaction Detector (CHAID) tree analysis to determine which parameters, timing (baseline vs. serial measurements), and cut-offs should be used to predict mortality. Results Patients with high CRP concentrations (above 90th percentile, >33mg/L) had higher 30 day- and all-cause mortality rates regardless of their troponin test status (above or below 118,000 ng/L); 14.4% vs 2.7%, p Conclusions In conclusion, serial measurements of both CRP and cardiac troponin might detect patients at increased risk for short-and long-term mortality following STEMI. We suggest the future use of the combined CRP Troponin-test (CTT) as a potential early marker for inflammatory-prone patients with worse outcomes following ACS. This sub-type of patients might benefit from early anti-inflammatory therapy such as colchicine and anti-IL-1β agents. Funding Acknowledgement Type of funding sources: None.

Background Bloodstream infections (BSIs) often lead to critical illness and death. The primary aim of this study was to determine the diagnostic accuracy of the biomarkers C-reactive protein (CRP), procalcitonin (PCT), and leukocyte count for the diagnosis of BSI in critically ill patients. Methods This was a nested case–control study based on the Procalcitonin And Survival Study (PASS) trial (n = 1200). Patients who were admitted to the intensive care unit (ICU) Results In total, there were 525 patients (n = 175 cases, 350 controls). The fixed low threshold for all 3 biomarkers (CRP = 20 mg/L; leucocytes = 10 × 109/L; PCT = 0.4 ng/mL) resulted in negative predictive values on day 1: CRP = 0.91; 95% CI, 0.75–1.00; leukocyte = 0.75; 95% CI, 0.68–0.81; PCT = 0.91; 95% CI, 0.84–0.96). Combining the 3 biomarkers yielded similar results as PCT alone (P = .5). Conclusions CRP and PCT could in most cases rule out BSI in critically ill patients. As almost no patients had low CRP and ∼20% had low PCT, a low PCT could be used, along with other information, to guide clinical decisions.

To investigate the association of viral load (VL) with (i) tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), interferon gamma-induced protein-10, C-reactive protein, and a combinatorial score (BV score), and (ii) clinical severity.In this prospective, multicentre cohort substudy, children with respiratory tract infection or fever without source were enrolled. VL for influenza virus, rhinovirus, respiratory syncytial virus, and adenovirus was measured from nasopharyngeal swabs. The reference standard diagnosis was established based on expert panel adjudication.Of 1140 recruited patients, 333 had a virus monodetection. VL for the aggregated data set correlated with TRAIL and IP-10 levels, with the length of oxygen therapy, and inversely with the BV score. At a single viral level, only the influenza VL yielded a correlation with TRAIL, IP-10 levels, and the BV score. Children with a viral reference standard diagnosis had significantly higher VL than those with bacterial infection (p = 0.0005). Low TRAIL (incidence rate ratio [IRR] 0.6, 95% confidence interval [CI] 0.39-0.91) and young age (IRR 0.62, 95% CI 0.49-0.79) were associated with a longer hospital stay, while young age (IRR 0.33, 95% CI 0.18-0.61), low TRAIL (IRR 0.25, 95% CI 0.08-0.76), and high VL (IRR 1.16, 95% CI 1.00-1.33) were predictive of longer oxygen therapy.These findings indicate that VL correlates with biomarkers and may serve as a complementary tool pertaining to disease severity.

Recent studies proposed the existence of a correlation between patients' inflammatory status and therapy response in bipolar disorder (BD). Here we investigated the correlation between levels of inflammatory markers and quetiapine (QUE) effects in BD patients.In 15 hospitalised BD patients, we investigated changes in inflammatory markers such as C-Reactive Protein (CRP), Erythrocyte Sedimentation Rate (ESR) and cytokines after a 6-week treatment with QUE monotherapy.We found QUE treatment to significantly reduce CRP and IL-6 plasma levels. Moreover, we found higher CRP and IL-6 plasma levels at baseline correlated with better improvement of patients' clinical symptoms.The reported results, although preliminary, could be useful in clinical practice, providing not only markers for QUE response, but also allowing for identification of new targets and new therapies for the treatment of this condition.

The aim of this work was to study the dependence of the concentration of C-reactive protein in the blood of patients on the severity of systemic lupus erythematosus (SLE). Material and methods. We examined 26 patients with SLE, the comparison group consisted of patients with rheumatoid arthritis (RA) (n = 88). Results. The hsCRP level was significantly higher in patients with a high degree of activity than in patients with minimal and moderate SLE activity (F = 4.409, p = 0.023). In addition, in patients with SLE, a significant direct correlation was found between hsCRP and ESR values (r = 0.409, p = 0.047), antinuclear factor (r = 0.389, p = 0.021), antibodies to double-stranded DNA (r = 0.226, p = 0.033), leukocytes in urine (r = 0.571, p = 0.002), microalbuminuria (r = 0.727, p = 0.017) AsAT (r = 0.428, p = 0.046), and inverse correlation – with the value of blood leukocytes (r = –0.662, p < 0.001). Conclusion. It was found that an increase in the levels of hsCRP in the sera of SLE patients is accompanied by an increase in the degree of disease activity, which indicates a direct correlation between the level of hsCRP and SLE activity. Consequently, the concentration of hsCRP reflects the acute phase response and the intensity of the inflammatory process in SLE.

Background: It has been recently postulated that inflammation may have an effect on varicose vein development and prognosis, besides increased venous pressure. CRP/albumin (CAR) is a novel inflammatory marker associated with poor prognosis in a various group of patients. Our aim in this study was to investigate the relation between varicose greater saphenous vein (VSM) diameter and CAR. Methods: A total of 150 patients with patients VSM insufficiency (Group 1, n: 114) and normal VSM (n: 36) were included in the study. The diameter of the VSM was measured with B-mode ultrasound, and reflux was quantified based on valve closure time using Doppler spectral tracings. Blood samples were taken during recruitment. The CAR value is determined by dividing the serum CRP level to the albumin level. Results: There were 21 (18.4%) males and 93 (81.5%) females in Group 1 and 7 males and 29 females in Group 2. Mean age of the patients were similar in both groups (48.02 +/- 12.20 years in Group 1 vs. 44.9 +/- 8.92 years in Group 2, p = 0.44). Mean BMI of the patients did not differ significantly (Group 1: 26.4 +/- 3.7 kg/m2 vs. Group 2: 25.7 +/- 4.2 kg/m2, p = 0.13). The mean diameter of VSM was measured 5.70 +/- 0.29 mm in Group 1 whereas 3.21 +/- 0.34 mm in Group 2 (p = 0.0023). Mean CRP and albumin values in Group 1 were 6.18 +/- 4.99 mg/L and 4.45 +/- 0.27 g/dL whereas 4.25 +/- 2.46 mg/L and 6.18 +/- 1.14 g/dL in Group 2, respectively (p value for CRP = 0.049, p value for albumin = 0.074). CRP/albumin was 1.28 +/- 1.34 in Group 1 and 1.11 +/- 1.21 in Group 2, which was not statistically significant (p = 0.58). There was a positive moderately strong correlation between VSM diameter and CRP/albumin ratio as well as superficial venous reflux disease (r: 0.48). Conclusion: CRP/albumin ratio is associated with increased incidence of varicose veins and increased diame-ter of greater saphenous vein; hence, superficial venous reflux disease. The findings support the hypothesis that systemic inflammation may play a role in varicose vein disease. Kontext: Nedávno byl publikován názor, že kromě zvýšeného žilního tlaku může vznik a progresi křečových žil ovlivňovat i zánět. Poměr C-reaktivního proteinu (CRP) a albuminu (CRP/albumin ratio, CAR) představuje nový marker zánětu spojený s nepříznivou prognózou u různých skupin pacientů. Cílem naší studie bylo zjistit vztah mezi průměrem varikózní velké safény (varicose greater saphenous vein, VSM) a parametrem CAR. Metody: Do studie bylo zařazeno celkem 150 pacientů s nedostatečností VSM (skupina 1, n = 114) a nepostiženými VSM (n = 36). Průměr VSM se měřil B-mode ultrazvukem a refl ux se kvantifi koval délkou uzavírání chlopně měřenou spektrální dopplerovskou křivkou. Krevní vzorky se odebíraly při zařazování pacientů do studie. Hodnota CAR se stanovuje vydělením hodnoty CRP hodnotou albuminu v séru. Výsledky: Skupinu 1 tvořilo 21 (18,4 %) mužů a 93 (81,5 %) žen; ve skupině 2 bylo 7 mužů a 29 žen. Průměrný věk pacientů v obou skupinách byl podobný (48,02 ± 12,20 roku ve skupině 1 vs. 44,9 ± 8,92 roku ve skupině 2; p = 0,44). Průměrná hodnota indexu tělesné hmotnosti (BMI) pacientů se významně nelišila (skupina 1: 26,4 ± 3,7 kg/m2 vs. skupina 2: 25,7 ± 4,2 kg/m2 ; p = 0,13). Průměrné hodnoty průměru VSM byly 5,70 ± 0,29 mm ve skupině 1 a 3,21 ± 0,34 mm ve skupině 2 (p = 0,0023). Průměrné hodnoty CRP a albuminu ve skupině 1 byly 6,18 ± 4,99 mg/l, resp. 4,45 ± 0,27 g/dl; ve skupině 2 to bylo 4,25 ± 2,46 mg/l, resp. 6,18 ± 1,14 g/dl (hodnota p pro CRP = 0,049, hodnota p pro albumin = 0,074). Poměr CRP/albumin ve skupině 1 činil 1,28 ± 1,34; ve skupině 2 byla naměřena hodnota 1,11 ± 1,21, tedy statisticky nevýznamný rozdíl (p = 0,58). Byla nalezena středně těsná korelace mezi průměrem VSM a poměrem CRP/albumin i refl uxem povrchových žil (r: 0,48). Závěr: Zvýšený poměr CRP/albumin je spojen se zvýšenou incidencí varixů a větším průměrem velké safény, a tedy i vyšší incidencí refl uxu povrchových žil. Zjištění podporují hypotézu, že ve vzniku křečových žil může hrát jistou úlohu systémový zánět.

Objectives: Serum or plasma levels of C-reactive protein (CRP) and highsensitivity CRP (hsCRP) are widely used clinical markers of inflammation in other branches of medicine, whereas its clinical use in psychiatry has been limited to research studies. We aimed to assess the possibility of using CRP/hsCRP in psychiatric practice. This is a review and evaluation of various lines of evidence supporting the concept of CRP as a biomarker for psychiatric disorders in certain conditions. Methods: We searched the literature for studies which assessed CRP/hsCRP levels in various psychiatric disorders. Results: The accumulating evidence from large studies and meta-analyses allows us to understand the role of CRP in major psychiatric disorders and increase our understanding of specific symptoms and subtypes of disorders. CRP may be considered a “psychiatric biomarker” which can alert clinicians about neuroinflammation, adverse effects of medications, cardiometabolic status, comorbidities, and may also predict clinical outcomes and guide optimal treatment selection. Conclusion: Although the underlying pathophysiological role of CRP and hsCRP is still elusive and the association between CRP and psychiatric disorders is inconsistent, CRP holds promise to become a psychiatric biomarker. WOS:000684418100001 34323645 Q2

Objectives Sex differences in COVID-19 severity and mortality have been described. Key aims of this analysis were to compare the risk of invasive mechanical ventilation (IMV) and mortality by sex and to explore whether variation in specific biomarkers could mediate this difference. Methods This was a retrospective, observational cohort study among patients with severe COVID-19 pneumonia. A survival analysis was conducted to compare time to the composite endpoint of IMV or death by sex. Interaction was formally tested to compare the risk difference by sex in subsets. Mediation analysis with a binary endpoint IMV or death (yes/no) by end of follow-up for a number of inflammation/coagulation biomarkers in the context of counterfactual prediction was also conducted. Results Among 415 patients, 134 were females (32%) and 281 males (67%), median age 66 years (IQR 54-77). At admission, females showed a significantly less severe clinical and respiratory profiles with a higher PaO2/FiO2 (254 mmHg vs 191 mmHg; p=0.023). By 28 days from admission, 49.2% (95% CI: 39.6-58.9%) of males vs. 31.7% (17.9-45.4%) of females underwent IMV or death (log-rank p-value Conclusions Our analysis confirms a difference in the risk of COVID-19 clinical progression by sex and provides a hypothesis for potential mechanisms leading to this. CRP showed a predominant role to mediate the difference in risk by sex.

AIMS: To explore the relationship between inflammatory markers and sarcopenia-related traits in sarcopenic older adults. METHODS: Baseline data of the ongoing Exercise and Nutrition for Healthy AgeiNg (ENHANce) study were used for a secondary, exploratory, cross-sectional analysis. ENHANce is a 5-armed triple blinded randomized controlled trial, in older adults (>65y) with sarcopenia defined according to the revised criteria of the European Working Group of Sarcopenia in Older People (EWGSOP2) aiming to assess the effect of combined anabolic interventions (protein supplement, omega-3 supplement and physical exercise) on physical performance, compared to single/placebo interventions. Inflammatory markers C-reactive protein (hs-CRP), albumin, interleukin-1β (IL-1β), IL-6, IL-8, and tumour necrosis factor-α (TNF-α) were assessed at baseline. Spearman's rho (ρ) correlation coefficients were calculated to associate these inflammatory markers with baseline sarcopenia-defining parameters (handgrip strength, chair stand test, appendicular lean mass [aLM], gait speed, Short Physical Performance Battery), physical activity (step count) and quality of life (SF-36, SarQoL). RESULTS: We included 40 sarcopenic subjects (15 men/25 women, age 77.1 ± 6.8 years). Contrary to expectations, the pro-inflammatory IL-1β correlated positively with handgrip strength (ρ: 0.376; p = 0.024) and IL-6 with aLM (ρ: 0.334; p = 0.0433). IL-6 inversely correlated with step count (ρ:-0.358; p = 0.048). Subgroup analysis revealed important gender differences. IL-8 inversely correlated with handgrip strength in women (ρ: -0.425; p = 0.034) but not in men. In contrast, pro-inflammatory cytokines CRP (ρ: -0.615; p = 0.019), IL-6 (ρ: -0.604; p = 0.029) and TNF-α (ρ: -0.615; p = 0.025) inversely correlated with the SF-36 physical component score in men but not in women. CONCLUSION: Although Inflammageing might play a role in sarcopenia-related traits, this exploratory study highlights an important role of gender. Future research should take this into account when elucidating the Inflammageing-sarcopenia interplay. ispartof: EXPERIMENTAL GERONTOLOGY vol:178 ispartof: location:England status: published

BACKGROUND: Stress precipitates depression and may do so in part by increasing susceptibility to inflammation-induced depressive symptoms. However, this has not been examined among individuals facing a major life stressor. Accordingly, the present study tested the moderating role of stress on the longitudinal association between inflammation and depressive symptoms among women with breast cancer. METHODS: Women recently diagnosed with early-stage breast cancer (N = 187) were enrolled before starting adjuvant/neoadjuvant treatment. Blood draws and self-reported depressive symptoms were collected pre-treatment, post-treatment, and at 6, 12, and 18-month post-treatment follow ups. C-reactive protein (CRP) was used to index inflammation. Measures of psychological stress, including cancer-related stress, general stress perceptions, and childhood stress, were administered pre-treatment. RESULTS: Stress moderated the association between CRP and depressive symptoms, such that higher levels of CRP were associated with elevated depressive symptoms only among women who reported high cancer-related stress (β = .080, p = .002) and perceived stress (β = .053, p = .044); childhood stress effects were non-significant. Moreover, elevated CRP was associated with increased odds of exhibiting clinically significant depressive symptoms (OR = 1.64, p < .001) among women who reported high cancer-related stress. Results were independent of age, BMI, race and cancer-related covariates. CONCLUSIONS: Stress was found to heighten sensitivity to inflammation-associated depressive symptoms over a 2-year period, with notably stronger effects for subjective stress responses to a concurrent life event. Individuals who are most distressed following a major life event may exhibit the greatest risk for inflammation-induced depression.

The development of applied geodetic techniques for mapping and documentation of historical structures, buildings and sites is an important and vital purpose for contribution of any recording of cultural heritage for any country such as Egypt. This is done to preserve and restore any valuable architectural or other cultural monument, as a support to architectural, archaeological and other art-historical research throughout the ages. The purpose of this paper is to use close range photogrammetry technique (CRP) to reconstruct 3D model of architectural and historical mosque facade and comparing the accuracy of using digital commercial non-metric cameras with different resolutions and metric camera with flatbed scanner and photogrammetric scanner for architectural building documentation. El-Nasr Mosque façade in Mansoura city, Egypt was chosen as a case study in this paper. At first, twenty five points were selected at mosque façade at different elevations and distributed at different façade surfaces and observed using total station. Some of these points were selected as control points and the others were selected as check points to validate the results. Effect of control point’s number on image processing and analysis is also studied. Three cameras positions were selected for imaging to get the full details of mosque façade. Close range Digital Workstation (CDW) program was used for processing and analysis of multiple images. The results are indicated that close range photogrammetry using metric camera with photogrammetry scanner instead of flatbed scanner in technique is accurate enough to be beneficial in 3D architectural building documentation. Digital cameras with CRP technique give up different accuracy that depends mainly on the resolution of cameras and camera specifications.

Objectives In this study, we aimed to develop a simple gene model to identify bacterial infection, which can be implemented in general clinical settings. Methods We used a clinically availablereal-time quantitative polymerase chain reaction platform to conduct focused gene expression assays on clinical blood samples. Samples were collected from 2 tertiary hospitals. Results We found that the 8 candidate genes for bacterial infection were significantly dysregulated in bacterial infection and displayed good performance in group classification, whereas the 2 genes for viral infection displayed poor performance. A two-gene model (S100A12 and CD177) displayed 93.0% sensitivity and 93.7% specificity in the modeling stage. In the independent validation stage, 87.8% sensitivity and 96.6% specificity were achieved in one set of case-control groups, and 93.6% sensitivity and 97.1% specificity in another set. Conclusions We have validated the signature genes for bacterial infection and developed a two-gene model to identify bacterial infection in general clinical settings.

Adverse Childhood Experiences (ACE) are a well-known risk-factor for depression. Additionally, (high-sensitive) C-reactive Protein (hsCRP) is elevated in subgroups of depressed patients and high following ACE. In this context the literature considers hsCRP and ACE to be associated with treatment resistant depression. With the data being heterogenous, this study aimed to explore the associations of ACE, hsCRP levels and response to antidepressant treatment in uni- and bipolar depression. N = 76 patients diagnosed with uni- or bipolar depression and N = 53 healthy controls were included. Treatment was over 6 weeks in an inpatient psychiatric setting within an observatory study design. Depressive symptoms were assessed by the Montgomery-Asberg Depression Rating Scale (MADRS), ACE were assessed by the Childhood Trauma Questionnaire (CTQ); the body-mass-index (BMI) and hsCRP were measured. HsCRP levels did not differ between the study population and the healthy controls. While the depressive symptoms decreased, the hsCRP levels increased. Sexual abuse was associated with significant higher and emotional abuse with lower levels of hsCRP after 6 weeks. The baseline hsCRP levels and the ACE subgroups did not show significant associations with the treatment response in unipolar depressed patients. The long-lasting effects of specific forms of ACE may have relevant impact on inflammation, supporting hsCRP to be a suitable biomarker. With ACE and hsCRP not showing any significant associations with treatment response in the unipolar depressed subgroup, a more differentiate research concerning biomarkers and treatment regimens is needed when talking about treatment response.

Background C-reactive protein (CRP) is a non-specific acute phase reactant elevated in infection or inflammation. Higher levels indicate more severe infection and have been used as an indicator of COVID-19 disease severity. However, the evidence for CRP as a prognostic marker is yet to be determined. The aim of this study is to examine the CRP response in patients hospitalized with COVID-19 and to determine the utility of CRP on admission for predicting inpatient mortality. Methods Data were collected between 27 February and 10 June 2020, incorporating two cohorts: the COPE (COVID-19 in Older People) study of 1564 adult patients with a diagnosis of COVID-19 admitted to 11 hospital sites (test cohort) and a later validation cohort of 271 patients. Admission CRP was investigated, and finite mixture models were fit to assess the likely underlying distribution. Further, different prognostic thresholds of CRP were analysed in a time-to-mortality Cox regression to determine a cut-off. Bootstrapping was used to compare model performance [Harrell’s C statistic and Akaike information criterion (AIC)]. Results The test and validation cohort distribution of CRP was not affected by age, and mixture models indicated a bimodal distribution. A threshold cut-off of CRP ≥40 mg/L performed well to predict mortality (and performed similarly to treating CRP as a linear variable). Conclusions The distributional characteristics of CRP indicated an optimal cut-off of ≥40 mg/L was associated with mortality. This threshold may assist clinicians in using CRP as an early trigger for enhanced observation, treatment decisions and advanced care planning.

A systematic review and network meta-analysis examining the effect of exercise modalities on C-reactive protein in cancer surivors.

BackgroundChild maltreatment is a common negative experience and has potential long-lasting adverse consequences for mental and physical health, including increased risk for major depressive disorder (MDD) and metabolic syndrome. In addition, child maltreatment may increase the risk for comorbid physical health conditions to psychiatric conditions, with inflammation as an important mediator linking child maltreatment to poor adult health. However, it remains unresolved whether experiencing child maltreatment increases the risk for the development of comorbid metabolic syndrome to MDD. Therefore, we investigated whether child maltreatment increased the risk for comorbid metabolic syndrome to depressed mood. Subsequently, we examined whether C-reactive protein (CRP), as an inflammatory marker, mediated this association. In addition, we investigated whether effects differed between men and women.MethodsAssociations were examined within cross-sectional data from the multiethnic HELIUS study (N = 21,617). Adult residents of Amsterdam, Netherlands, self-reported on child maltreatment (distinct and total number of types experienced before the age of 16 years) as well as current depressed mood (PHQ-9 score ≥ 10), and underwent physical examination to assess metabolic syndrome. The CRP levels were assessed in N = 5,998 participants. Logistic and linear regressions were applied for binary and continuous outcomes, respectively. All analyses were adjusted for relevant demographic, socioeconomic, and lifestyle characteristics, including ethnicity.ResultsA higher number of maltreatment types as well as distinct types of emotional neglect, emotional abuse, and sexual abuse were significantly associated with a higher risk for current depressed mood. Child maltreatment was not significantly associated with the risk for metabolic syndrome in the whole cohort, nor within individuals with depressed mood. As child maltreatment was not significantly associated with the CRP levels, subsequent mediation analyses were not performed. No significant moderating effects by sex were observed.ConclusionIn this multiethnic urban cohort, child maltreatment was associated with a higher risk for depressed mood. Contrary to our expectations, child maltreatment was not significantly associated with an increased risk for metabolic syndrome, neither in the whole cohort nor as a comorbid condition in individuals with depressed mood. As the data were cross-sectional and came from a non-clinical adult population, longitudinal perspectives in relation to various stages of the investigated conditions were needed with more comprehensive assessments of inflammatory markers.

BackgroundWe evaluated in-hospital mortality and outcomes incidence after hospital discharge due to COVID-19 in a Brazilian multicenter cohort.MethodsThis prospective multicenter study (RECOVER-SUS, NCT04807699) included COVID-19 patients hospitalized in public tertiary hospitals in Brazil from June 2020 to March 2021. Clinical assessment and blood samples were performed at hospital admission, with post-hospital discharge remote visits. Hospitalized participants were followed-up until March 31, 2021. The outcomes were in-hospital mortality and incidence of rehospitalization or death after hospital discharge. Kaplan-Meier curves and Cox proportional-hazard models were performed.Findings1589 participants [54.5% male, age=62 (IQR 50-70) years; BMI=28.4 (IQR,24.9-32.9) Kg/m² and 51.9% with diabetes] were included. A total of 429 individuals [27.0% (95%CI,24.8-29.2)] died during hospitalization (median time 14 (IQR,9-24) days). Older age [vs

Highlights • First study of both serum and DNAm CRP associations with depression/neuroimaging. • Serum CRP is associated with somatic symptoms and reduced entorhinal cortex thickness. • DNAm CRP is associated with widespread reductions in white matter integrity. • Evidence for central effects of peripheral inflammation from serum and DNAm markers., Inflammatory processes are implicated in the aetiology of Major Depressive Disorder (MDD); however, the relationship between peripheral inflammation, brain structure and depression remains unclear, partly due to complexities around the use of acute/phasic inflammatory biomarkers. Here, we report the first large-scale study of both serological and methylomic signatures of CRP (considered to represent acute and chronic measures of inflammation respectively) and their associations with depression status/symptoms, and structural neuroimaging phenotypes (T1 and diffusion MRI) in a large community-based sample (Generation Scotland; NMDD cases = 271, Ncontrols = 609). Serum CRP was associated with overall MDD severity, and specifically with current somatic symptoms- general interest (β = 0.145, PFDR = 6 × 10−4) and energy levels (β = 0.101, PFDR = 0.027), along with reduced entorhinal cortex thickness (β = −0.095, PFDR = 0.037). DNAm CRP was significantly associated with reduced global grey matter/cortical volume and widespread reductions in integrity of 16/24 white matter tracts (with greatest regional effects in the external and internal capsules, βFA= −0.12 to −0.14). In general, the methylation-based measures showed stronger associations with imaging metrics than serum-based CRP measures (βaverage = −0.15 versus βaverage = 0.01 respectively). These findings provide evidence for central effects of peripheral inflammation from both serological and epigenetic markers of inflammation, including in brain regions previously implicated in depression. This suggests that these imaging measures may be involved in the relationship between peripheral inflammation and somatic/depressive symptoms. Notably, greater effects on brain morphology were seen for methylation-based rather than serum-based measures of inflammation, indicating the importance of such measures for future studies.

Objective: investigate epidemiology of infectious complications, intensity of antibacterial therapy, and features of the systemic inflammatory response in patients with prolonged disorders of consciousness.Materials and methods: retrospective case histories analysis of 102 patients with prolonged disorders of consciousness who were treated in the department of anesthesiology and intensive care of Polenov Neurosurgical Institute from 2010 to 2019.Results: during hospitalization all patients (100%) had signs of tracheobronchitis, 86 patients (84,3%) had urinary tract infection, 34 (33,3%) pneumonia, 10 patients (9,8%) meningoventriculitis, and in 9 (8,8%) cases sepsis was diagnosed. Identified bacterial complications required systemic antibacterial therapy. With an average length of hospital stay of 51±42 days, duration of antibiotic therapy was 37±41 days. One-component therapy was applied in half of the cases (54%), slightly less often (43,2%) treatment consisted of two antibiotics, in some cases patient’s condition required prescription of three antibiotics (2,8%). Even in the absence of a focus of infection, temperature and laboratory markers of inflammation in blood samples of patients with prolonged disorders of consciousness were higher than the reference values. CRP was increased with addition of any bacterial complications. Count of white blood cells significantly increased only in case of pneumonia and sepsis. Procalcitonin test was positive in 16,6% observations of urinary tract infection, 30,4% of pneumonia, and 28% of meningoventriculitis.Conclusion: most informative proinflammatory marker of bacterial complications in patients with prolonged disorders of consciousness was CRP. Mild leukocyte response can be explained by immunosuppression in long-term ill patients. Limited value of procalcitonin test may be due to the insufficiency of the semi-quantitative method sensitivity with a threshold level of 0,5 ng/ml, as well as reduced proinflammatory response to local infection in patients with prolonged disorders of consciousness as a result of massive antibacterial therapy, colonization of opportunistic microflora and presence of sympathicotonia (non-infectious systemic inflammatory reaction).

Objective We aimed to clarify clinical and laboratory characteristics of coronavirus disease 2019 (COVID-19) patients, and further explore the features to detect COVID-19 pneumonia at the first visit to community-based hospitals. Methods Diagnoses of COVID-19 were based on positive results from real-time reverse-transcription polymerase chain reaction testing of nasopharyngeal-swab specimens. We retrospectively reviewed the medical records of patients showing positive results. The clinical characteristics and results of blood tests were compared between the patients with and without pneumonia. The risk factors associated with pneumonia were then evaluated by a multivariable analysis. Results The study cohort comprised 154 patients, including 117 patients (76.0%) with pneumonia at first visit. Significant differences were seen in age, the frequency of fever, tachycardia, desaturation (peripheral oxygen saturation ≤95%), any comorbidity, neutrocyte count and fraction, lymphocyte count and fraction, platelet count, lactate dehydrogenase (LDH), C-reactive protein (CRP), and fibrinogen between the patients with and without pneumonia. Using a multivariable analysis, CRP ≥0.3 mg/dL and fibrinogen >400 mg/dL were found to be associated with the presence of pneumonia. Conclusion Community-based settings for screening COVID-19 patients should perform chest X-ray and blood tests for white blood cell fractions, fibrinogen, LDH, and CRP. Of these, elevations in the CRP and fibrinogen levels could be critically associated with the presence of COVID-19 pneumonia.

Introduction Several methods for measuring fibrinolytic capacity in plasma have been developed yielding frequently inconsistent results. We investigated which factors determine fibrinolytic capacity in three plasma-based assays. Material and methods In 80 apparently healthy controls (aged 43 ± 10 years, 50 women [62.5%]) we evaluated fibrinolysis using three assays: (1) by Pieters et al. (CLT2018), (2) by Lisman et al. (CLT), and (3) by Carter et al. (Lys50). Coagulation factors and fibrinolytic proteins, including histidine-rich glycoprotein (HRG) and γ′-fibrinogen, were determined. Regression models were performed to identify determinants of lysis times. Results Positive correlations were observed between CLT2018 and both CLT (r = 0.73) and Lys50 (r = 0.61), as well as between CLT and Lys50 (r = 0.46, all p < 0.001). The main determinants of both CLT2018 and CLT were plasminogen activator inhibitor-1 (PAI-1), followed by thrombin-activatable fibrinolysis inhibitor (TAFI) and α2-antiplasmin. Histidine-rich glycoprotein was a predictor of the longest-normal CLT2018 alone (OR 1.04, 95% CI 1.02–1.06). α2-Antiplasmin and fibrinogen levels, followed by PAI-1 and TAFI determined Lys50. After adjustment for age, sex, and body mass index, C-reactive protein (CRP) was an independent predictor of the top quartiles of the three lysis times. Conclusions We showed that apart from PAI-1, TAFI, and α2-antiplasmin, several other factors, in particular CRP, can affect the results of global fibrinolysis tests used in research. Our findings may help understand why the choice of a specific fibrinolysis assay can affect the presence and/or magnitude of intergroup differences in fibrinolytic capacity in a given disease state

Purpose: To investigate potential associations between selected laboratory markers (CRP, LDH, albumin, sodium, hemoglobin, neutrophils, and neutrophils/lymphocytes ratio [NLR]) and outcomes in patients with non-small cell lung cancer (NSCLC) treated with bevacizumab (BEV) plus chemotherapy. Patients and Methods: We retrospectively analyzed 105 patients with NSCLC from the Czech TULUNG registry treated at University Hospital in Pilsen with BEV + chemotherapy. Response to therapy was tested by Fisher's exact test. Survival statistics were evaluated using the Kaplan-Meier method and Cox analysis. Results: We showed significantly better disease control rate when CRP, albumin, hemoglobin, and NLR were within established “normal” values. In univariate analysis, normal values of CRP, LDH, albumin, sodium, hemoglobin, neutrophils, and NLR were associated with better overall survival (OS). Normal values of CRP, albumin, hemoglobin, neutrophils, and NLR were associated also with better progression-free survival (PFS). In a multivariate Cox model, normal values of LDH, albumin, and NLR were associated with significantly better OS while normal CRP, albumin, and NLR were associated with better PFS. Conclusions: LDH and sodium appear to be possible prognostic markers for BEV treatment in combination with chemotherapy in NSCLC. The parameters associated with inflammatory response (CRP, NLR, albumin, and possibly hemoglobin) appear to be promising predictive markers for this treatment combination.

Introduction To assess the effect of low-dose combined oestradiol and norethindrone acetate hormone therapy (HT) on serum C-reactive protein (CRP) levels and life quality in natural menopause women. Material and methods Forty-five natural menopause women admitted to the clinic during a 1-year period and diagnosed as menopause, who planned to have HT for menopausal symptoms, were enrolled in this prospective study. The serum CRP levels were measured, and vasomotor symptoms scores were graded according to the Blatt-Kupperman menopause index, and life quality scores according to the Menopause-Specific Quality of Life Questionnaire (MENQOL) were recorded before and after (3 months later) hormone therapy. Results The Blatt-Kupperman menopause index and MENQOL scores were significantly decreased after 3 months of low-dose treatment. No significant difference was found between white blood cell counts and serum CRP levels before and after 3 months of hormone therapy. Conclusions Considering all HT types and biochemical effects, low-dose HT, which had positive results in terms of quality of life, was a safe treatment and could be preferred to conventional-dose preparations in cases without contraindications. Low-dose combined HT containing oestradiol and norethindrone acetate did not alter the serum CRP level in postmenopausal cases.

Background: Cancer antigen 125 (CA125) is considered to have high sensitivity but poor specificity for ovarian cancer. New biomarkers utilized to early detect and monitor the progression of ovarian cancer patients are critically needed. Methods: A total of 80 patients including 16 early stage, and matched with 17 late stage, 23 benign ovarian tumor (BOT) and 24 uterine fibroid (UF) patients were utilized to perform plasma proteomics analysis using isobaric tag for relative and absolute quantitation (iTRAQ) method to identify differential diagnostic proteins of ovarian cancer patients. A validation set of 9 early stage, 11 late stage, 17 BOT and 16 UF collected by an independent cohort of samples with the same matching principles was examined to confirm the expressed levels of differential expression proteins by ELISA analysis. Results: CRP and ARHGEF 11 were identified as potential diagnostic biomarkers of ovarian cancer. Results of area under the curve (AUC) analysis suggested that combination of diagnostic proteins and CA125 achieved a much higher diagnostic accuracy compared with CA125 alone (AUC values: 0.98 versus 0.80), especially improved the specificity (0.97 versus 0.77). In addition, elevated plasma CRP levels were associated with increased risk of ovarian cancer. Conclusions: Current study found that plasma protein CRP was an indicator for monitoring the progression of ovarian cancer. Combination of plasma protein biomarkers with CA125 could be utilized to early diagnose of ovarian cancer patients.

Ulcerative colitis (UC) is a chronic disease that can present at various stages of disease activity and severity. Traditionally, severity scoring has focused on disease activity during a single moment with various tools, including patient-reported symptoms, as well as clinical, laboratory-based, endoscopic, histologic, and imaging variables. Optimal delivery of care depends on the accurate assessment of disease severity, which must take longitudinal variables into account. This article reviews the history of severity scoring in UC and provides a concise, clinically oriented approach to assessing disease severity.

The impact and clinical spectrum of COVID-19 infection in liver transplant recipients/solid organ transplants are being unveiled during this recent pandemic. The clinical experience of use of current antiviral drugs and immunomodulators are sparse in solid organ transplantation. We present the clinical course of a 49-year-old male recipient who underwent living donor liver transplant for recurrent gastrointestinal bleed and contracted severe COVID-19 pneumonia during the third postoperative week. Herein we report the successful management of severe COVID-19 pneumonia using convalescent plasma therapy and remdesivir. Recipient’s clinical deterioration was halted after three consecutive convalescent plasma transfusions with improvement in hypoxia and inflammatory markers (interleukin-6 and C-reactive protein). The use of convalescent plasma therapy along with remdesivir may be an ideal combination in the management of severe COVID-19 pneumonia in solid organ transplant recipients.

Ilac salinimli stentlerin (ISS) sistemik anti-inflamatuar ozelliklerinin olabilecegi ve bunun restenoz oranlarindaki dususte rol oynayabilecegi iddia edilmektedir. Bu calismanin amaci, ciplak metal stentler (CMS) ile ilac salinimli stentleri sistemik inflamasyonun iyi bir gostergesi olan C-reaktif protein (CRP) duzeyleri uzerine etkileri acisindan karsilastirmakti. Ayrica inflamasyon duzeyi ile miyonekroz ve istenmeyen kardiyak olaylar arasindaki iliskinin arastirilmasi da amaclandi.Gerec ve Yontem: Elektif koroner stent uygulanan hastalar stent tipine gore CMS (n=70) ve ISS gruplarina (n=42) ayrildi. Bazal ve islem sonrasi 24. saatteki CRP ve CKMB duzeyleri olculerek aradaki fark (?-delta) gruplar arasinda kiyaslandi. Hastalar bir yil boyunca istenmeyen kardiyak olaylar (olumcul olmayan miyokard infarktusu, olum ve hedef damar revaskularizasyonu) acisindan takip edildi.Bulgular: Hastalarin yas ortalamasi 62±11 olup %75'i erkek idi. Iki stent grubu bazal ozellikleri acisindan kiyaslandiginda diyabet, hipertansiyon ve metabolik sendromu olan hastalar CMS grubunda anlamli olarak daha fazlaydi. Her iki stent grubunda da 24. saatte anlamli duzeyde CRP artisi olmasina ragmen ?CRP duzeyi CMS grubunda 2,1 (0,5 ? 6,2) mg/L, ISS grubunda ise 2,3 (0,2 ? 5,2) mg/L olup iki grup arasinda anlamli fark saptanmadi (p=0,703). Her iki stent grubunda ?CKMB duzeyleri ve major kardiyak olay sikligi benzerdi (p=0,897 ve p=0,785). ?CRP duzeyleri ile ?CKMB arasinda her iki stent grubunda da anlamli korelasyon bulunmadi (CMS icin r= -0,090 ve p=0,459, ISS icin r=0,158 ve p= 0,318). Benzer sekilde ?CRP'nin istenmeyen kardiyak olay sikligi uzerine etkisi de anlamli degildi (CMS icin p=0,349 ve ISS icin p=0,135).Sonuc: Bulgularimiz CMS ve ISS uygulanan hastalarda islem sonrasi benzer duzeyde sistemik inflamatuar yanit olustugunu gostermektedir. Benzer sistemik inflamasyon duzeyleri altinda ISS ile saglanan restenoz oranlarindaki dususte, bu stentlerin lokal anti-inflamatuar ozellikleri rol oynuyor olabilir. Abstract It's suggested that drug eluting stents (DES) may have systemic anti-inflammatory properties and this can play a role in decreased restenosis rates. The aim of this study was to compare bare metal stents (BMS) and DES on their effects on C-reactive protein (CRP) levels, a good marker of systemic inflammation. We also aimed to investigate the relation between the inflammation levels and myonecrosis and adverse cardiac events.Materials and methods: The patients undergoing elective stent implantation were grouped according to the stent type as BMS (n=70) and DES (n=42). Basal and 24th hour postprocedural CRP and CKMB levels were measured and the difference (?- delta) was compared between the groups. The patients were followed up for adverse cardiac events (non-fatal myocardial infarction, death and target vessel revascularisation) for one year.Results: Mean age was 62±11 and 75% were males. The patients with diabetes, hypertension and metabolic syndrome were significantly higher in BMS group when the basal characteristics of the stent groups were compared. There was significant CRP rise in both groups at 24th hour, but the ?CRP level was 2,1 (0,5 ? 6,2) mg/L in BMS and 2,3 (0,2 ? 5,2) mg/L in DES group, and the difference was not statistically significant (p=0,703). ?CKMB levels and adverse cardiac event rates were similar between the two groups (p=0,897 and p=0,785). There was no correlation between ?CRP and ?CKMB levels in both groups (r= -0,090 and p=0,459 for BMS, r=0,158 and p= 0,318 for DES group). Similarly, the effect of ?CRP on the incidence of adverse cardiac events was not significant (p=0,349 for BMS group and p=0,135 for DES group).Conclusion: Our findings reveal that patients with BMS and DES implantation exhibit similar grade of systemic inflammation after the procedure. At similar levels of systemic inflammation, the local anti-inflammatory properties of DES can play a role at decreased restenosis rates.

Highlights • Elevated LDH and CRP serum concentrations are associated to respiratory failure in CoVID-19 patients., Objective The dramatic worldwide CoVID-19 infection requires the identification of a reliable and inexpensive tool to quickly discriminate patients with a more unfavorable outcome. Methods We performed routine laboratory tests suitable to identify tissue damage and inflammatory status in 123 consecutive CoVID-19 patients admitted to the Emergency Department of the hospital of Piacenza (Emilia-Romagna, Northern Italy). The results were correlated with patients’ respiratory function evaluated by the partial pressure of arterial oxygen to fraction of inspired oxygen ratio (PaO2/FiO2). Results: The most common laboratory abnormalities were lymphocytopenia and elevated values of C-reactive protein (CRP) and lactate dehydrogenase (LDH). Aspartate aminotransferase (AST), alanine aminotransferase (ALT) and creatine kinase (CK) were also increased. The respiratory performance (PaO2/FiO2) showed a strong inverse correlation with LDH (r= 0.62, r2 0.38, p value< 0.0001) and CRP (r= 0.55, r2 0.31, p value< 0.0001). PaO2/FiO2 values also showed a significant inverse correlation with age (r= -0.37, p< 0.0001), AST (r= -0.31, p