Acute phase proteins in the monitoring of inflammatory disorders

Periodontal Disease in Obese Patients; Interleukin-6 and C-Reactive Protein Study: A Systematic Review

Periodontal disease (PD) and obesity are characterized by a dysregulated inflammatory state. Both conditions trigger inflammatory and immune responses with an increase in proinflammatory cytokines such as Interleukin 6 (IL-6) and the release of inflammatory mediators such as C-reactive protein (CRP). Individuals with a high body mass index (BMI) present a chronic inflammatory state. The aim of the present study was to perform a systematic review of inflammatory markers (IL-6 and CRP) in obese patients with PD and their possible relationship by analyzing the levels of these markers. A digital literature search was performed in three databases-PubMed, SciElo and Medigraphic-through an advanced search for original articles, employing IL-6 and CRP in obese patients with PD, within a publication period from 2010 to 2021. PRISMA guidelines, the JADAD scale and a qualitative analysis of scientific evidence were performed using the Cochrane collaboration method and the RoB 2 assessment tool. Ten articles were included in this analysis with the variables recorded and associated with subjects with obesity and PD. Of the ten articles included, three analyzed IL-6 and CRP, four analyzed IL-6 and three analyzed CRP. In conclusion, and based on the available evidence, the aforementioned markers of inflammation demonstrate that there is a relationship between PD and obesity.

Faecal microbiota in two-week-old female dairy calves during acute cryptosporidiosis outbreak - Association with systemic inflammatory response

In the present study, relationships between the intestinal microbiota and innate immunity response, acute cryptosporidiosis, and weight gain in female dairy calves were investigated. A total of 112 calves born during a natural outbreak of cryptosporidiosis on one dairy farm was included in the study. Microbiota composition was analysed by means of 16S ribosomal RNA gene amplicon sequencing from faecal samples collected during the second week of life, while the status of Cryptosporidium spp. infection was determined using immunofluorescence. Serum samples from the second week of life were colourimetrically analysed for the following markers of acute inflammation: acute-phase proteins (serum amyloid A and haptoglobin) and pro-inflammatory cytokines (interleukin-1 beta, interleukin-6, and tumour necrosis factor-alpha). Statistical analyses were performed using random forest analysis, variance-partitioning, and negative binomial regression. The faecal microbiota of the two-week old calves was composed of the phyla Firmicutes, Bacteroidetes, Proteobacteria, Fusobacteria, and Actinobacteria (in order of decreasing abundance). Microbial diversity, measured in terms of the Shannon index, increased with the age of the calves and decreased if a high count of Cryptosporidium spp. oocysts was found in the faeces. Fusobacterium was positively associated with Cryptosporidium spp. oocyst count and serum amyloid A concentration. Peptostreptococcus was positively associated with haptoglobin and serum amyloid A concentrations, and negatively associated with average daily weight gain at 9 months of age. The markers of innate immunity, in combination with age, explained 6% of the microbial variation. These results suggest that some components of the intestinal microbiota may have a long-lasting negative effect on animal growth through the stimulation of the systemic innate immune response.

Monosodium urate deposition in the lumbosacral spine of patients with gout compared with non-gout controls: A dual-energy CT study

BACKGROUND

Gout is the most common cause of inflammatory arthritis in adults. Gout predominantly affects the peripheral joints, but an increasing number of published cases report gout affecting the spine. We used dual-energy CT (DECT) to assess the prevalence of monosodium urate (MSU) deposition in the spine of gout patients compared to controls, and to investigate whether gout or spinal MSU deposition is associated with low back pain.

METHODS

25 controls and 50 gout subjects (non-tophaceous and tophaceous) were enrolled. Demographics, gout history, Aberdeen back pain score, serum urate (sU), ESR and CRP were ascertained. Subjects underwent DECT of the lumbosacral spine, which was analyzed using manufacturer's default post-processing algorithm for MSU deposition as well as a maximally-specific algorithm to exclude potential artifact.

FINDINGS

72 subjects were analyzed (25 control, 47 gout). Gout subjects had greater BMI, serum creatinine, sU, CRP, and ESR versus controls. Using the default algorithm, MSU-coded volumes in the lumbosacral spines were significantly higher among the gout subjects vs controls (p = 0.018). 34% of gout subjects vs 4% of controls had spinal MSU-coded deposition (p = 0.0036). Applying the maximally-specific DECT post-processing algorithm, 18% of gout patients vs 0% of controls continued to demonstrate spinal MSU-coded deposition (p = 0.04). Non-tophaceous and tophaceous subjects did not differ in spinal MSU-coded deposition or sU. Gout patients had more back pain than controls.

INTERPRETATION

A significant subpopulation of gout patients have spinal MSU-coded lesions. Default and maximally-specific MSU post-processing algorithms yielded different absolute MSU-coded volumes, but similar patterns of results. Gout patients had more back pain than controls. Spinal MSU deposition in gout patients may have implications for clinical picture and treatment.

A pH-responsiveness injectable hyaluronic acid hydrogel towards regulation of inflammation and remodeling of extracellular matrix for diabetic wound

Diabetes is a universal disease in the world. A critical mediator of proper wound healing is the production, assembly, and remodeling of the ECM by fibroblasts, but in the wound...

Survival Time among Young and Old Breast Cancer Patients in Relation to Circulating Blood-Based Biomarkers, Acute Radiation Skin Reactions, and Tumour Recurrence

INTRODUCTION

It has been suggested that age could influence the treatment-induced side effects and survival time of cancer patients. The influence of age on blood-based biomarkers, acute radiation skin reactions (ARSRs), and survival time of breast cancer patients was analysed.

MATERIALS AND METHODS

Two hundred ninety-three individuals, 119 breast cancer patients, and 174 healthy blood donors were included.

RESULTS

Before radiotherapy (RT), decreased levels of lymphocytes, interleukin 2, platelet-derived growth factors, and tumour necrosis factor but increased levels of monocyte-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, C-reactive protein, and macrophage inflammatory protein 1b (MIP1b) were detected in the patient group. All of the patients developed ARSRs and intensity of ARSRs was inversely related to the MIP1b level before RT. Fifteen out of 119 (13%) patients deceased during follow-up time. No influence of age (≤50 compared to >50 years) on survival time was detected (p = 0.442). Tumour recurrence, found in 11 out of 119 (9%) patients, had impact on survival time of these patients (p < 0.001).

CONCLUSIONS

The level of circulating MIP1b before RT was associated with intensity of ARSRs. Tumour recurrence, but not age, was associated with poor survival time. Analysis of circulating MIP1b was low cost, rapid, and could be done in routine laboratory facility. Since RT almost always induces ARSRs, the possibility of using MIP1b as a prognostic biomarker for ARSRs is of interests for further investigation.

Sustainable positive effects of Ramadan intermittent fasting in rheumatoid arthritis

The short-term positive effects of intermittent fasting during the month of Ramadan on rheumatic inflammatory diseases have been previously evaluated. The objective of this study was to assess the sustainability of these effects on rheumatoid arthritis (RA) activity. This prospective study included 35 patients with RA, who observed fasting during Ramadan 2019. The disease activity was assessed and compared between three time points: T1 (6 months before the beginning of Ramadan), T2 (during the month between the 7th day of fasting and the 7th day after Ramadan), and T3 (averagely 3.4 months after fasting). The disease activity score 28 (DAS28) was used to evaluate the disease activity. After a significant decrease of all disease activity parameters between T1 and T2, a gradual increase of clinical and biological outcomes was seen between T2 and T3. Except for CRP, which was significantly higher at T3 (p = 0.02), the changes of the other disease activity parameters were not statistically significant. By reference to baseline data (T1), the decrease of ESR, DAS28 CRP, and DAS28 ESR induced after Ramadan fast was maintained until T3, with statistically significant differences. We can therefore conclude that this study has been conducted at the beginning of the fading-out of the effects of Ramadan fast, and that the duration of 3 months may be the recommended interval between fasting periods to maintain the positive effects of intermittent fasting on RA activity. Key Points • Intermittent fasting can induce a rapid improvement of rheumatoid arthritis activity. • The positive effects of this model of fasting can last up to 3 months. • The recommended interval between fasting periods may be estimated at 3 months.

2018 Chinese Guidelines for the Diagnosis and Treatment of Rheumatoid Arthritis

A multidisciplinary guideline development group was established to formulate this evidence-based diagnosis and treatment guidelines for rheumatoid arthritis (RA) in China. The grading of recommendations, assessment, development, and evaluation (GRADE) system was used to rate the quality of the evidence and the strength of recommendations, which were derived from research articles and guided by the analysis of the benefits and harms as well as patients' values and preferences. A total of 10 recommendations for the diagnosis and treatment of RA were developed. This new guideline covered the classification criteria, disease activity assessment and monitoring, and the role of disease modifying antirheumatic drugs (DMARDs), biologics, small molecule synthetic targeting drugs, and glucocorticoids in the treat-to-target approach of RA. This guideline is intended to serve as a tool for clinicians and patients to implement decision-making strategies and improve the practices of RA management in China.

Study of the relation between serum levels of long-acting penicillin and the inflammatory markers: C-reactive protein and interleukin-6 in patients with chronic rheumatic heart disease

Background

There is an evidence of a chronic inflammatory state in patients with chronic rheumatic valvular heart disease (RHD) as shown by high serum levels of high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL6). Despite the efficacy of long-acting penicillin (LAP) in secondary prevention of rheumatic fever, its effect on this inflammatory state is still unknown. So, we sought to study the effect of LAP on the inflammatory markers, CRP and IL-6, in patients with chronic rheumatic heart disease.

Results

Eighty RHD patients coming to our hospital’s outpatient clinic for rheumatic fever secondary prophylaxis by regular administration of LAP were enrolled in the study. Patients were divided into 3 groups: group A, 70 patients with RHD already on prophylactic LAP, group B, 10 patients with RHD who have not yet started prophylactic LAP, and group C, control group of 10 healthy individuals not known to have RHD. Serum levels of LAP, IL-6, and CRP were measured for the three groups.

Group A had significantly lower IL-6 levels than group B (25.22 ± 33.50 vs. 126.1 ± 33.76nng/ml, respectively, p < 0.0001). IL-6 levels were significantly lower in control subjects compared to patients in group B (3.600 ± 2.319, 25.22 ± 33.50 ng/ml, respectively, p < 0.0001). However, IL-6 levels in the control group were lower but non-significantly different compared to group A. CRP level was lower in group A than group B (8419 ± 4935 vs. 14400 ± 3375 mg/dl, respectively, p = 0.0002). CRP levels were significantly lower in control subjects compared to patients in group A and group B. IL-6 values were positively correlated with CRP values (r = 0.6387, p < 0.0001).

CRP values were negatively correlated with LAP values (r = -0.5277, p < 0.0001). IL-6 values were negatively correlated with LAP values (r = − 0.4401, p < 0.0001). There was a highly significant difference between LAP level in compliant and non-compliant patients (1.045 ± 1.270 vs. 0.0785 ± 0.1057 ng/ml, respectively, p value < 0.0001).

There was also a highly significant difference between CRP level in compliant and non-compliant patients (7640 ± 4558 vs. 13090 ± 4717 mg/dl, respectively, p = 0.005). Moreover, there was a significant difference between IL-6 levels in compliant and non-compliant patients (21.53 ± 32.70 vs. 47.40 ± 30.91 ng/ml, respectively, p value 0.03).

Conclusion

Serum LAP has a strong negative correlation with IL-6 and CRP levels. Regular administration of LAP strongly ameliorates the inflammatory state seen in patients with RHD.

Role of plasma fibrinogen in assessing disease activity of patients with gout

BACKGROUND

Gout is an inflammatory disease characterized by the deposition of monosodium urate (MSU) in synovial fluid and other tissues. Many studies have shown that the activation of coagulation system had been proposed correlated with systemic inflammation. The concentrations of plasma fibrinogen and D-dimer are increased in abnormal coagulation, emerging as available indicators to predict systemic inflammation. The aim of this study is to reveal the predictive value of plasma fibrinogen, D-dimer in the disease activity of gout patients.

METHODS

This retrospective study included 334 gout patients and 101 age- and gender- matched healthy controls. The gout patients were divided into two groups according to the gout activity score (GAS = 0.09 × last 12 month attacks + 1.01 × sUA + 0.34 × VAS patient + 0.53 × ln(1 + tophi number). The remission group included 46 patients with GAS of lower than 2.5 and the active group included 288 patients with GAS of 2.5 or higher. Clinical and laboratory data were recorded. The correlations between plasma fibrinogen, D-dimer and GAS were analyzed by Spearman's correlation analysis and Partial correlation analysis. Receiver operating characteristic (ROC) was used to evaluate the diagnostic value for the active group compared with remission group. The predictive value of fibrinogen, D-dimer to the disease activity of gout patients was tested by Binary logistic regression analysis.

RESULTS

Plasma fibrinogen and D-dimer in gout patients (3.66 (2.88, 5.20), 0.29 (0.22, 0.80)) were increased as compared with the control group (2.88 (2.51, 3.24), 0.22 (0.22, 0.32), both P < 0.001). Fibrinogen and D-dimer in active group (3.91 (3.00, 5.53), 0.34 (0.22, 0.86)) were higher than those in remission group (2.88 (2.34, 3.22), 0.22 (0.22, 0.26), both P < 0.001)). Plasma fibrinogen, D-dimer, ESR and CRP were positively correlated with GAS (r = 0.606, r = 0.419, r = 0.570, r = 0.440, all P < 0.001). ROC curve showed fibrinogen yielded a highest AUC than D-dimer, ESR, CRP. In addition, the optimal cutoff value of fibrinogen for active group was 3.60, with a specificity of 89.1% and sensitivity of 58.3%. Binary logistic regression analysis showed fibrinogen (odds ratio = 2.71, 95% confidence interval: 1.28-5.74, p = 0.011) was a predictor for gout disease activity.

CONCLUSION

Fibrinogen was increased in active gout group. Fibrinogen can serve as a reliable inflammatory marker for monitoring inflammatory response and disease activity in gout patients.

Imaging and Laboratory Workup for Hand Infections

Hand infections can lead to significant morbidity if not treated promptly. Most of these infections, such as abscesses, tenosynovitis, cellulitis, and necrotizing fasciitis, can be diagnosed clinically. Laboratory values, such as white blood cell count, erythrocyte sedimentation rate, C-reactive protein, and recently, procalcitonin and interleukin-6, are helpful in supporting the diagnosis and trending disease progression. Radiographs should be obtained in all cases of infection. Ultrasound is a dynamic study that can provide quick evaluation of deeper structures but is operator dependent. Computed tomographic and MRI studies are useful for evaluating deep space or bony infections and preoperative surgical planning.

Impact of preanalytical storage on the measurement of erythrocyte sedimentation rate using an infrared microphotometer system (TEST1)

This study examined the influence of temperature and time on the pre-analytical stability of the erythrocyte sedimentation rate (ESR) measured on a TEST1 system. The first experiment included 102 samples stored at room temperature and the second experiment included 112 subjects and investigated refrigerated (2-8 °C) storage. Our study showed a stable ESR results at room temperature (15-25 °C) up to 8 h (p = 0.512). Samples stored at 2-8 °C for 24 h were stable (p = 0.280) for 24 h.

Value of procalcitonin for diagnosing perioperative pneumonia, urinary infections and superficial surgical site infections in patients undergoing primary hip and knee arthroplasty

Serum procalcitonin (PCT) levels may be helpful for the diagnosis of infections during the perioperative period of arthroplasty. However, there is much debate in the literature regarding the appropriate cut-off value for different types of surgery and local bacterial infection. The present study aimed to evaluate serum PCT levels in patients undergoing arthroplasty and to determine the cut-off value that may represent perioperative pneumonia, urinary infections and superficial surgical site infections. The present retrospective study included a total of 500 patients treated between July 2014 and August 2015. The case group contained 25 patients with perioperative infections (pneumonia, urinary and superficial surgical site infections), and the control group contained 25 patients without any post-surgical complications. Serum levels of PCT and white blood cells (WBC) were measured pre-operatively (D0) and at post-operative D4, D6 and D8, and the sensitivity, specificity and predictive value of these parameters were assessed. Regarding the comparison of the mean PCT levels between the case and the control group, a significant difference was seen at D8 (P=0.007), while no significant differences were observed at D0 (P=0.010), D4 (P=0.069) and D6 (P=0.093). No statistically significant differences in WBC levels between groups were observed for (P>0.01). In the control group, the PCT levels at D4 (0.062±0.020 ng/ml) were 2-fold of the mean baseline value, followed by a decrease until D6 (0.051±0.019 ng/ml) and a return close to the normal range by D8 (0.032±0.015 ng/ml). The PCT levels in the case group had rapidly increased on D4 (0.510±1.208 ng/ml). In contrast to the control group, they continuously increased on D6 (0.527±1.360 ng/ml) and D8 (0.686±1.117 ng/ml). From a clinical point of view, infection events were indicated in these patients during post-operative follow-up. For PCT, the area under the receiver operating characteristic curve (AUC) was 0.978 [95% confidence interval (CI), 0.933-1.022], and for WBC, the AUC was 0.562 (95% CI, 0.398-0.0.726). Based on the above data, the PCT value was a significant predictor of infection (AUC>0.9). For PCT, the cut-off point of 0.0995 ng/ml was associated with a sensitivity of 96% and a specificity of 100%. However, WBC were not a significant predictor of infection (0.5<AUC<0.7), and the cut-off value of 7.05×10⁹/l was associated with a sensitivity of 64% and a specificity of 44%. In conclusion PCT was found to be a promising marker for diagnosing bacterial infections post-arthroplasty due to its high specificity. Based on the sensitivity and the specificity, detecting PCT may be more valuable than using WBC in the diagnosis of sepsis-associated pathological changes in the perioperative period.

Elderly Patients Exhibit Stronger Inflammatory Responses during Gout Attacks

Gout attacks are often accompanied by systemic inflammatory response. The aim of the retrospective study was to compare gout patients in different age groups in terms of their clinical features at gout attacks. Patients, who were treated for gout attack in two tertiary medical centers between January 2000 and April 2014, were divided into young (≤ 50 years), middle-aged, and elderly (> 65 years) groups. Patients in three age groups were compared in terms of presence of fever (> 37.8°C), C-reactive protein (CRP) levels, and erythrocyte sedimentation ratio (ESR) at the gout attacks. Monocytes, which were isolated from 10 consecutive patients who previously experienced gout attacks, were stimulated with monosodium urate (MSU) crystals and cytokine production was measured by flow cytometry. Among 254 patients analyzed in this study, 48 were young, 65 were middle-aged, and 141 were elderly. The elderly patients were more likely to have fever (51.1%) during the attack than the young (20.8%) and middle-aged (30.8%) patients (P < 0.001 by χ² test). They were also more likely to have higher ESR and CRP levels than the young patients (P = 0.002 for ESR, P < 0.001 for CRP). Patients' age correlated significantly with CRP and ESR levels (both P < 0.001). After stimulation with MSU, the production of interleukin-1β by monocytes increased with patients' age (r = 0.670, P = 0.03). In conclusion, gout attacks in elderly patients are associated with fever and higher ESR and CRP levels, often resembling a septic arthritis.

Corticosteroid transdermal delivery significantly improves arthritis pain and functional disability

Arthritis is characterized by pain and functional limitation affecting the patients' quality of life. We performed a clinical study to investigate the efficacy of a betamethasone valerate medicated plaster (Betesil) in improving pain and functional disability in patients with arthritis and osteoarthritis. We enrolled 104 patients affected by osteoarthritis (n = 40) or arthritis (n = 64) in different joints. Patients received diclofenac sodium cream (2 g, four times a day) or a 2.25-mg dose of Betesil applied to the painful joint every night before bedtime for 10 days. Pain and functional disability were assessed, by the Visual Analogue Scale (VAS) and Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) scores. Redness was assessed by clinical inspection, and edema by the "fovea sign" method. C-reactive protein (CRP) was also measured; CRP can be used to cost-effectively monitor the pharmacological treatment efficacy and is increased during the acute-phase response, returning to physiological values after tissue recovery and functional restoration. All measurements were at baseline and at 10-day follow-up. At 10-day follow-up, a greater improvement in VAS and WOMAC pain and WOMAC stiffness and functional limitation scores from baseline was observed in patients treated with Betesil compared with diclofenac (all p < 0.01). At 10-day follow-up, improvement in redness, edema, and CRP levels from baseline was also greater in patients treated with Betesil compared with diclofenac (all p < 0.01). This study demonstrates the safety and efficacy of transdermal delivery of betamethasone valerate in patients affected by arthritis and osteoarthritis.

Procalcitonin levels predict infectious complications and response to treatment in patients undergoing cytoreductive surgery for peritoneal malignancy

BACKGROUND

Cytoreductive-surgery for peritoneal-malignancy (PM) involves extensive intra-abdominal surgery and a massive post-operative systemic-inflammatory-response (SIRS). It is often challenging to differentiate SIRS that are solely surgery-associated from those of post-operative infections. White-Cell-Counts (WCC) and C-Reactive-Protein (CRP) are routinely used as markers for infection, but are non-specific and their elevation is often delayed in PM cases. Other markers need to be evaluated to assist early identification/prediction of post-operative infections.

METHODOLOGY

Prospective evaluation of serum procalcitonin (PCT), CRP and WCC in 50 patients pre-operatively (Day0), and on post-operative days (POD) 1, 3 & 6, following cytoreductive-surgery with or without splenectomy.

RESULTS

Day0 PCT, CRP and WCC values were within normal limits, but increasing physiologically in post-operative period without infection, with noticeable higher PCT in splenectomized patients. In our cohort post-operative infections were diagnosed in 14 patients, often within 48 h. There was a trend for faster rise in serum PCT on POD1 compared to CRP and WCC, and faster PCT decline following appropriate therapy on POD3 and POD6 when infected cases were clinically resolving while WCC and CRP continued to rise, particularly in non-spelenectomised patients. The AUC on POD1 was significantly higher for PCT (0.689) vs. WCC (0.476) and CRP (0.477) (p = 0.04). Sensitivity, specificity, positive-predictive-value and negative-predictive-values for PCT ranged between (57%-100%), (22%-74%), (33%-47%) & (81%-100%), for CRP (28%-78%), (5.5%-86%), (18%-44.4%) & (40%-75.5%) and for WCC (14%-26.5%), (65.5-80.5%), (22%-25%), (67%-70%) respectively.

CONCLUSION

PCT, like WCC and CRP, needs to be interpreted with extreme cautions in the context of infections post-cytoreductive-surgery and should only be used in association with other clinical and investigational findings.

Prognostic Significance of Serum Inflammatory Response Markers in Newly Diagnosed Non-Small Cell Lung Cancer before Chemoirradiation

PURPOSE

To identify whether the serum's baseline C-reactive protein (CRP) and albumin (Alb) levels related to clinicopathological parameters and overall survival (OS) in non-small cell lung cancer (NSCLC).

METHODS

In total, 100 consecutive patients (mean age = 68.38 ± 10.85 years) that underwent chemoradiotherapy were studied. Measurements of CRP and Alb were performed before any treatment.

RESULTS

Serum CRP levels were significantly associated with histological grade (P < 0.001), TNM stage (P < 0.001), PS (P = 0.009), and Alb (P < 0.001). Additionally CRP and Alb levels were found significantly associated with overall survival in univariate analysis (log-rank test, P < 0.001 and P = 0.002, resp.) and CRP remained significant after controlling for age, alcohol, performance status, and TNM stage, whereas albumin showed a borderline effect on the hazard rate (P = 0.052).

CONCLUSIONS

CRP and Alb are both promising biomarkers in identification of NSCLC patients with poor prognosis and form a possible target for intensifying their therapies.

Comparison of the DAS28-CRP and DAS28-ESR in patients with rheumatoid arthritis

AIM

To compare the Disease Activity Score with 28 joint (DAS28) using erythrocyte sedimentation rate (ESR) (DAS28-ESR) and DAS28 using C-reactive protein (CRP) (DAS28-CRP) with thresholds validated for DAS28-ESR in Turkish patients with rheumatoid arthritis.

METHOD

The DAS28 data of 112 patients with rheumatoid arthritis followed in a local outpatient clinic were used. First, the correlation between DAS28-CRP and DAS28-ESR and the correlation between their unique components ([0.36 × In (CRP + 1) + 0.96] and [0.70 × In (ESR)]) were analyzed. Second, a Bland-Altman plot was constructed for the evaluation of the level of agreement between DAS28-CRP and DAS28-ESR. Lastly, the agreement between these two methods was analyzed by κ coefficient.

RESULTS

Although there was a strong correlation between DAS28-CRP and DAS28-ESR, the correlation between their unique components was fair. Although more than 95% of the point data fall between the upper and lower bounds of the limit of agreement, the percentage error (46%) was higher than the acceptable proportion of 30%. The κ coefficient of agreement between DAS28- ESR and DAS28-CRP with validated thresholds for DAS28-ESR was 0.42, which was close to the lower boundary for moderate agreement.

CONCLUSION

The results of this study demonstrated that there is discordance between DAS28-ESR and DAS28-CRP with the validated thresholds for DAS28-ESR. Using the DAS28-CRP with threshold values validated for DAS28-ESR may lead to errors in the determination of disease activity and therefore may lead to errors in the management of patients with rheumatoid arthritis.

Relationships between Causes of Fever of Unknown Origin and Inflammatory Markers: A Multicenter Collaborative Retrospective Study

OBJECTIVE

Although inflammatory markers, such as the white blood cell (WBC) count, erythrocyte sedimentation rate (ESR) and levels of C-reactive protein (CRP) and procalcitonin, are widely used to differentiate causes of fever of unknown origin (FUO), little is known about the usefulness of this approach. We evaluated relationships between the causes of classical FUO and the levels of inflammatory markers.

METHODS

A nationwide retrospective study including 17 hospitals affiliated with the Japanese Society of Hospital General Medicine was conducted.

PATIENTS

This study included 121 patients ≥18 years old diagnosed with "classical FUO" (axillary temperature ≥38.0°C at least twice over a ≥3-week period without elucidation of the cause on three outpatient visits or during three days of hospitalization) between January and December 2011.

RESULTS

The causative disease was infectious diseases in 28 patients (23.1%), non-infectious inflammatory disease (NIID) in 37 patients (30.6%), malignancy in 13 patients (10.7%), other in 15 patients (12.4%) and unknown in 28 patients (23.1%). The rate of malignancy was significantly higher for a WBC count of <4,000/μL than for a WBC count of 4,000-8,000/μL (p=0.015). Among the patients with a higher WBC count, the rate of FUO due to NIID tended to be higher and the number of unknown cases tended to be lower. All FUO patients with malignancy showed an ESR of >40 mm/h. A normal ESR appeared to constitute powerful evidence for excluding a diagnosis of malignancy. In contrast, the concentrations of both serum CRP and procalcitonin appeared to be unrelated to the causative disease.

CONCLUSION

The present study identified inflammatory markers that should be considered in the differential diagnosis of classical FUO, providing useful information for future diagnosis.

Association between serum vitamin D concentrations and inflammatory markers in the general adult population

OBJECTIVE

In recent years links among vitamin D deficiency, inflammation and cardio-metabolic disease were proposed. As information regarding the associations between vitamin D and inflammatory markers in the general population is sparse, we investigated the associations of 25-hydroxy vitamin D [25(OH)D] with high-sensitivity C-reactive protein (hs-CRP), fibrinogen and white blood cell count (WBC).

MATERIALS/METHODS

The study population comprised 2723 men and women aged 25-88 years from the first follow-up of the Study of Health in Pomerania. Analyses of variance, linear and logistic regressions were performed to assess the associations between 25(OH)D and the three inflammatory markers. The models were adjusted for age, sex, waist circumference, diabetes mellitus, dyslipidemia, anti-inflammatory medication and month of blood sampling. The association between 25(OH)D and WBC was assessed separately in smokers (n = 718) and non-smokers (n = 2005) as effect modification was observed.

RESULTS

We detected a U-shaped association between 25(OH)D and hs-CRP with a nadir of 21-25 ng/ml in fully-adjusted linear regression models with restricted cubic splines (p < 0.01; p' < 0.01). We further detected an inverse association between 25(OH)D and fibrinogen (p < 0.01). In addition, there was an inverse association between 25(OH)D and WBC in smokers (p = 0.02) but no association in non-smokers (p = 0.73).

CONCLUSION

Our study confirms a potential role of 25(OH)D in chronic inflammation. Yet, different inflammatory biomarkers are differently associated with 25(OH)D. Beneficial effects of increasing 25(OH)D were observed for fibrinogen and WBC (in smokers only). In contrast, the U-shaped association between 25(OH)D and hs-CRP indicates that ever-increasing 25(OH)D concentrations may also be related to proinflammatory states.

C-reactive protein + 1059 G>C polymorphism in type 2 diabetes and coronary artery disease patients

Human C-reactive protein (CRP) is an acute phase reactant involved in chronic and acute inflammation. CRP is associated with metabolic syndrome, obesity, atherosclerosis, unstable angina, insulin resistance and diabetes. The present study evaluates the association of + 1059 G>C silent polymorphism in exon 2 of CRP gene in 581 cases [CAD (206), T2D (266), T2D with CAD (109)] and 235 controls in the population of Punjab (North-West India). The frequency of + 1059 G allele is highest in CAD (98.3%) followed by T2D (98.1%), T2D + CAD cases (97.7%) and controls (94.7%). G-allele is associated with increased risk of T2D [P = 0.003, OR = 2.93 (1.39–6.17)] and CAD [P = 0.004, OR = 3.25 (1.39–7.60)] in comparison to controls. Recessive model shows that GG genotype increases the risk of CAD by 4 fold (P = 0.003, OR = 4.19, 1.62–10.80), T2D by 3 fold (P = 0.008, OR = 3.23, 1.36–7.60) and T2D + CAD by 3.5 fold (P = 0.029, OR = 3.64, 1.14–11.66). Factor analyses show that BMI, WC, and WHR are core predictors for CAD and T2D, whereas CHO, TG and VLDL for T2D + CAD. The present study concludes that GG genotype of CRP + 1059 G>C polymorphism and clustering of obesity and dyslipidemia underlie the risk towards CAD, T2D and T2D + CAD in the North-West Indian population of Punjab.

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CRP + 1059 G>C SNP analyzed in 266 T2D, 109 T2D with CAD, 206 CAD, and 235 controls

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GG genotype increases the risk towards T2D, CAD, and T2D + CAD in population of Punjab.

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GC genotype provides protection towards T2D, CAD, and T2D + CAD in population of Punjab.

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Clustering of obesity and dyslipidemia underlies the risk towards T2D, CAD, and T2D + CAD.

Admission inflammatory markers and isolation of a causative organism in patients with spontaneous spinal infection

INTRODUCTION

The purpose of this study was to investigate the significance of the inflammatory markers on admission in the isolation of a causative pathogen in patients with spinal infection. Spinal infection is treated frequently at spinal units and can encompass a broad range of clinical entities. Its diagnosis is often delayed because of the difficulty of identifying the responsible pathogen.

METHODS

Patients with spinal infection treated in our institution over a period of eight years were identified and their notes studied retrospectively. Admission C-reactive protein (CRP), white cell count (WCC) as well as co-morbidities and mode of pathogen identification were recorded. Overall, 96 patients were included in the study.

RESULTS

The CRP levels on admission were correlated significantly with the overall potential for isolation of a pathogen (p<0.0001) and positive biopsy cultures (p=0.0016). Admission WCC levels were associated significantly with the overall potential for isolation of a pathogen (p=0.0003) and positive biopsy cultures (p=0.0023). Both CRP and WCC levels were significantly negatively correlated with the duration of the preceding symptoms (p=0.0003 and p<0.0001 respectively). Delay in presentation was significantly negatively correlated with organism isolation (p=0.0001). Multivariate analyses identified the delay in presentation as the strongest independent variable for organism isolation (p=0.014) in cases of spontaneous spinal infection when compared with the admission CRP level (p=0.031) and WCC (p=0.056).

CONCLUSIONS

In spontaneous spinal infection, delay in presentation is the strongest independent variable for organism isolation. High inflammatory marker levels on admission are a useful prognostic marker for the overall potential of isolating a causative organism either by blood cultures or by biopsy in patients with negative blood cultures. Furthermore, the admission inflammatory marker levels allow for treating surgeons to counsel their patients of the likelihood of achieving a positive microbiological yield from biopsy.

Interactions between nutrition and immune function: using inflammation biomarkers to interpret micronutrient status

The immune response promotes a complex series of reactions by the host in an effort to prevent ongoing tissue damage, isolate and destroy the infective organism and activate the repair processes that are necessary for restoring normal function. The homoeostatic process is known as inflammation and the early set of reactions that are induced are known as the acute phase response (APR). The APR has marked effects on the circulation, metabolism in the liver and the plasma concentration of many nutrients. The changes in nutrient concentrations follow a cyclic pattern; occurring before any clinical evidence of disease, being at their most pronounced during the disease and remaining in convalescence when all evidence of disease or trauma has disappeared. Therefore, where susceptibility to disease is high as in people who are HIV+ but still apparently healthy, obtaining an accurate measurement of nutritional status may not be possible. Accurate measurements of status are important for national statistics to plan for the proper utilisation of government resources and they are especially important to evaluate the effectiveness of nutritional interventions. Many acute phase proteins (APP) are synthesised during inflammation and they are used to monitor the progress of disease and recovery but, individually, none of their lifecycles compare well with those of the nutritional biomarkers. Nevertheless, recognising the presence of inflammation can help interpret data and, using two APP, this review paper will illustrate the methods we have developed to assist interpretation of plasma retinol, ferritin and zinc concentrations in apparently healthy, HIV+, Kenyan adults.

Preliminary study of highly cross-linked hyaluronic acid-based combination therapy for management of knee osteoarthritis-related pain

Background

Hyaluronic acid has been extensively used for treatment of knee osteoarthritis due to its anti-inflammatory properties and its ability to act as a synovial lubricant. Furthermore, it has found application in combination with other drugs in the dermatological field and in pre-clinical studies in animal models of osteoarthritis. Experimental evidence suggests that a combination of this macromolecule with other drugs may act as a slow-release depot. However, to date, to the best of our knowledge, no one has tested local intra-articular delivery of highly cross-linked hyaluronic acid combined with bisphosphonate or nonsteroidal anti-inflammatory drugs for management of knee osteoarthritis pain in the clinical setting. The aim of the present randomized double-blind study was to investigate, for the first time, the effect of a highly cross-linked hyaluronic acid, Variofill^®, alone or in combination with diclofenac sodium or sodium clodronate, for management of bilateral knee osteoarthritis-related pain.

Methods

Sixty-two patients with symptomatic bilateral medial tibiofemoral knee osteoarthritis (Kellgren–Lawrence grade II and III) and pain in both knees corresponding to a daily visual analog scale (VAS) score ≥ 30 in the month before the beginning of the study were included in this investigation. Patients were divided into three groups: group 1, treated with an injection of hyaluronic acid alone (66 mg) into each knee; group 2, treated with an injection of hyaluronic acid (49.5 mg) plus diclofenac sodium (5 mg) into each knee; group 3, treated with an injection of hyaluronic acid (49.5 mg) plus sodium clodronate (5 mg) into each knee. Patients also underwent blood tests for measurement of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) immediately before and at 6-month follow-up.

Results

Hyaluronic acid alone and in combination with sodium clodronate or diclofenac sodium produced a significant improvement in mean VAS pain score at 3 and 6-month follow-up. At 6-month follow-up, therapy with hyaluronic acid plus sodium clodronate was the most beneficial in terms of percentage improvement in VAS pain score. A significant improvement in ESR and CRP was observed at 6-month follow-up in each treatment group. No significant difference was observed when the percentage change from baseline related to these parameters was compared among the groups. No dropout was observed in any group. No serious adverse events were observed.

Conclusion

Further studies are necessary to determine the effect of a therapy based on hyaluronic acid combined with diclofenac sodium or sodium clodronate in larger cohorts of patients affected by knee osteoarthritis and in longer-term follow-up.

A double-blind, placebo-controlled pilot study to evaluate the effect of calcium fructoborate on systemic inflammation and dyslipidemia markers for middle-aged people with primary osteoarthritis

The objective of this pilot study was to determine whether 15 days of dietary supplementation with calcium fructoborate could acutely modulate inflammatory and lipid blood markers in individuals diagnosed with primary osteoarthritis. During 2 weeks, a placebo-controlled, randomized, double-blind study was conducted on 116 subjects that were initially recruited. Seventy-two subjects started the study, being divided into four groups, and only 60 completed the study as designed. The aim was to compare the effects of calcium fructoborate to placebo on subjects diagnosed with knee primary osteoarthritis. The obtained outcomes were inflammation biomarkers (C-reactive protein, fibrinogen, and erythrocyte sedimentation rate) and lipid markers (triglycerides, total cholesterol, LDL cholesterol, and HDL cholesterol). No serious adverse events were reported. The calcium fructoborate showed beneficial effect on the inflammatory markers for all groups subjected to the treatment when compared with the placebo group and slight changes in the lipid metabolism. This study suggests that short-term (2 weeks) calcium fructoborate supplementation in patients with osteoarthritis symptoms has a favorable prognosis on inflammation diseases.

Study of C-reactive protein and myocardial infarction in the Indian population

To analyse the association of high sensitivity C-reactive (hsCRP) protein levels and -717A/G single nucleotide polymorphism of CRP with acute myocardial infarction (AMI) in the Indian population. Study population included 100 MI cases wherein 32 patients had experienced previous MI (MI-Group-1), 68 MI cases were recruited at presentation (MI-Group-2) and equal number of age and gender matched healthy individuals. hsCRP levels were determined by ELISA and genotyping of -717A/G was carried out by polymerase chain reaction-based restriction digestion method. The -717A/G genotypes did not influence hsCRP level and their distribution did not differ between groups. However, in the present study hsCRP demonstrated significant correlation with BMI in controls of both the genders and with triglycerides in females of AMI at presentation who otherwise are with low risk profile. Identifying traditional risk factors associated with inflammation may help in controlling the acute event.

Association between erythrocyte sedimentation rate and IQ in Swedish males aged 18-20

OBJECTIVE

To investigate if signs of inflammation are associated with performance on a contemporaneous IQ-test in males aged 18-20.

DESIGN

Cohort study using data from the conscript register on performance on an IQ-test and on erythrocyte sedimentation rates (ESR) measured in 1969/70. Data on cardiovascular risk factors measured at conscription and national register data on childhood circumstances at age 10 were considered as potential sources of confounding. Data from national registers was linked to the cohort in order to explore long term associations between ESR at age 18-20 and mortality between the years 1971-2006.

SETTING

49,321 Swedish males aged 18-20, screened for general health and for mental and physical capacity at compulsory conscription examination before military service.

RESULTS

We found an inverse correlation between ESR and performance on an IQ-test. While an association was observed across IQ bands and ESR ranges, independent of cardiovascular risk factors or childhood circumstances, the association was slightly attenuated by adjustment for childhood socioeconomic position (SEP). An association between childhood SEP and ESR was detected that remained after adjusting for IQ. The ESR was also associated with future mortality following adjustment for childhood SEP.

CONCLUSIONS

Low-grade inflammation, as indicated by the ESR, is associated with reduced cognitive abilities already at age 18-20.

Evidence for chronically elevated serum protein oxidation in systemic lupus erythematosus patients

Serum protein oxidation levels in people with the autoimmune disease systemic lupus erythematosus (SLE) have previously been shown to (a) be elevated at a single time point and (b) correlate with disease activity. This study investigates whether this elevation is a chronic phenomenon, by analysis of multiple serum samples collected from 21 SLE patients and nine controls over a period of up to 38 months. Protein thiols were chronically decreased in SLE patients with stable or variable disease activity compared to controls, whilst protein-bound carbonyls and glycine were chronically increased. 2D-gel analysis of carbonyl distribution showed albumin and immunoglobulins to be particularly affected. In SLE patients with stable disease activity, higher long-term protein oxidation correlated with higher long-term disease activity. SLE patients with variable disease activity exhibited varying correlations between protein oxidation and disease activity markers. These results further support a role for oxidative stress in the pathogenesis of SLE.

C-reactive protein to distinguish pneumonia from acute decompensated heart failure

BACKGROUND

Patients with acute decompensated heart failure (ADHF) are frequently treated with unnecessary antibiotics since they are confused with pneumonia patients.

AIM

To study the efficacy of measuring C-reactive protein (CRP) levels on admission and CRP velocity in differentiating ADHF from pneumonia.

METHODS

A retrospective observational study of ADHF and pneumonia patients admitted to a tertiary hospital during 2 years. Patients who were already treated with antibiotics on admission were excluded. Efficacy of CRP as a diagnostic marker was evaluated by using receiver operator curves (ROC).

RESULTS

Overall, 72 ADHF and 50 pneumonia patients were included in the study. The mean CRP levels on admission were 13.5+/-13.5 mg/L for the ADHF patients and 127+/-84 mg/L for the pneumonia patients (p<0.001). CRP increases of > or =0.56 mg/L/h were diagnostic of pneumonia. CRP levels on admission together with CRP increases had a sensitivity of 0.96 and a specificity of 0.972 (p<0.001) as markers to distinguish pneumonia from ADHF.

CONCLUSIONS

This study emphasizes the dynamic nature of biomarkers. Demonstrating the efficiency of repeated CRP measurements in an acute setting will provide clinicians with a valuable tool for establishing the correct diagnosis and refraining from unnecessary use of antibiotics.

Expression levels of immune markers in Actinobacillus pleuropneumoniae infected pigs and their relation to breed and clinical symptoms

Background

In pigs little is known about the role of innate immune defence in bacterial infections of the respiratory tract, despite their major role in pig production. In the present study we characterized and compared in vitro and in vivo activation of immune markers of different pig breeds 7 days before, and 4 and 21 days after an experimental aerosol infection with Actinobacillus (A.) pleuropneumoniae.

Results

In vitro stimulation of bronchoalveolar lavage fluid (BALF) and blood leukocytes with A. pleuropneumoniae, Streptococcus suis, PMA and LPS led to production of different amounts of H₂O₂, NO and TNF-α, depending on the stimulus, individual, breed and time of infection. Generally, significant responses to in vitro stimulation were observed only in blood leukocytes, whereas the alveolar macrophages showed a high basal activation. In addition, the production of haptoglobin and cytokines (TNF-α, IFN-γ and IL-10) in vivo was measured in plasma and BALF. Plasma haptoglobin levels mirrored the clinical manifestations at 4 days post-infection. In plasma and BALF TNF-α could not be detected, whereas variable levels of IFN-γ were found at pre- and post-infection times. IL-10 was found in some plasma but in none of the BALF samples. The different expression levels in individuals within the breeds correlated for some markers with the severity of clinical manifestations, e.g. H₂O_2, plasma haptoglobin and BALF IFN-γ for German Landrace pigs.

Conclusion

Our findings revealed differences in the activation of the immune markers with respect to infection time, individuals and breeds. Moreover, results showed different correlation grades between the immune markers produced in vitro or in vivo and the clinical manifestations. Further analyses will have to show whether these markers may serve as correlates of protection against porcine respiratory infections.

Development and validation of an ELISA for the quantification of pig major acute phase protein (Pig-MAP)

Measurement of acute phase proteins (APPs) levels in blood is increasingly being used for monitoring health and welfare in farm animals. In this work a sandwich-type ELISA for the quantification of pig Major Acute phase Protein (Pig-MAP), one of the main APP in pigs, has been developed and validated. Two Pig-MAP specific monoclonal antibodies were developed in mouse. One of the monoclonal antibodies was fixed to microtiter plates and the other was coupled to horseradish peroxidase and used as detection antibody. To calibrate the assay dilutions of a standard pig serum of known Pig-MAP concentration were added to the plate in each assay. The assay showed good accuracy, kept linearity under dilution and recovery was proportional. The detection limit was 0.1 microg/mL. Precision was adequate with coefficients of variation lower than 8% for both inter and intra-assays. A good linear correlation between Pig-MAP concentration values obtained by ELISA and by radial immunodiffusion, used as reference method, was found (r = 0.978; beta = 1.02). Pig-MAP concentration was analysed in serum samples obtained from two pig herds of different health status (10 animals per age and herd, of 10, 12, 14, 18 weeks of age). Mean values obtained in the farm of low health status were higher than the obtained in the farm of high health status (p<0.001). In the farm of high health status, mean Pig-MAP concentration remained constant at the different ages analysed (mean values of 0.83+/-0.18 mg/mL) whereas in the farm of low health status differences between age groups were found. In this farm (low health status) mean values for the total of pigs analysed were of 1.68+/-0.74 mg/mL.

Exaggerated neointima formation in human C-reactive protein transgenic mice is IgG Fc receptor type I (Fc gamma RI)-dependent

Neointima formation after vascular injury is exaggerated in ovariectomized (OVX) human C-reactive protein transgenic mice (CRPtg) compared to nontransgenic mice (NTG). We tested the hypothesis that this CRP-mediated exacerbation requires IgG Fc receptors (Fc gamma Rs). OVX NTG, CRPtg, and CRPtg lacking Fc gamma RI, Fc gamma RIIb, Fc gamma RIII, or the common gamma chain (FcR gamma) had their common carotid artery ligated. Twenty-eight days later neointimal thickening in CRPtg/Fc gamma RI(-/-) and CRPtg/FcR gamma (-/-) was significantly less than in CRPtg and no worse than in NTG, whereas in CRPtg/Fc gamma RIIb(-/-) and CRPtg/Fc gamma RIII(-/-) neointimal thickness was equal to or greater than in CRPtg. Immunohistochemistry revealed human CRP in the neointima of CRPtg, but little or none was observed in those lacking Fc gamma RI or FcR gamma. Real-time reverse transcriptase-polymerase chain reaction demonstrated that Fc gamma R types I to III were expressed in the CRPtg arteries, with Fc gamma RI expression increasing by threefold after ligation injury. Levels of serum complement (C3), neointimal deposition of complement (C3d), and cellular composition (monocytes, macrophages, lymphocytes) in the neointima did not differ among the different CRPtg genotypes. However, by immunofluorescence a neointimal population of F4/80+CRP+ cells was revealed only in OVX CRPtg. The exaggerated response to vascular injury provoked by CRP in OVX CRPtg depends on Fc gamma RI and probably requires its expression by F4/80+ cells.

Pig-MAP and haptoglobin concentration reference values in swine from commercial farms

Pig-MAP (Major Acute-phase Protein) and haptoglobin concentrations were determined in pigs from commercial farms, and reference intervals obtained for different productive stages. Pig-MAP serum concentrations were lower in sows than in adult boars (mean values 0.81 vs. 1.23 mg/mL) and the opposite was observed for haptoglobin (1.47 vs. 0.94 mg/mL). No differences were found between parities, except for a minor decrease in haptoglobin concentration in the 4th parity. A linear correlation between pig-MAP and haptoglobin concentration was observed. In the period 4-12 weeks of life, pig-MAP mean concentrations were around 1mg/mL, being lower in the finishing period (0.7-0.8 mg/mL). Haptoglobin concentrations increased with time, from around 0.6 mg/mL at 4 weeks of age to 1.4 mg/mL at 12 weeks. Mean values of around 0.9 mg/mL were observed in the finishing period. A wider distribution of values was observed for haptoglobin than for pig-MAP concentrations. Differences between herds were observed, with the highest values obtained in a herd with signs of respiratory disease.

Established rheumatoid arthritis: clinical assessments

Clinical assessment of established rheumatoid arthritis (RA) can have several purposes. It can be used to evaluate prognosis, disease course or interventions at both the individual and the group level (i.e. in a clinical trial), over the short or long term. The instruments used for the different purposes are not always the same. For example, information on prognosis is very useful when assessing the risk:benefit ratio of early aggressive pharmacotherapy; however, established prognostic factors are currently of limited use in individual patients with established RA. As, at the individual patient level, disease activity, disability and joint damage have variable courses, the course of the disease should be evaluated regularly both with process (i.e. erythrocyte sedimentation rate, joint counts) and with outcome (i.e. radiological progression, sum of past process) measures. For the evaluation of interventions, 'core sets' of valid measures to assess disease activity, outcome and specific criteria for improvement are used; these can, to some extent, be useful in clinical practice.

C-Reactive Protein Gene Polymorphisms, C-Reactive Protein Blood Levels, and Cardiovascular Disease Risk

C-reactive protein (CRP), a blood marker of inflammation and a hallmark of the acute-phase response, has been shown to be a powerful and specific predictor of cardiovascular event risk in populations of otherwise healthy persons. Here we review what is known about CRP gene polymorphisms, discuss how these might affect the epidemiology of CRP and our understanding of CRP's contribution to cardiovascular disease, and examine their potential clinical usefulness. Evidence shows that certain subtle variations in the CRP gene sequence, mostly single nucleotide polymorphisms, predictably and strongly influence the blood level of CRP. Some of these variations are associated with clinical correlates of cardiovascular disease. If future studies can establish with certainty that CRP influences cardiovascular biology, then CRP gene profiling could have clinical utility.

Evaluating the efficacy of serum haptoglobin concentration as an indicator of respiratory-tract disease in dairy calves

The serum concentration of haptoglobin (S-Hp) was measured in 833 group-housed dairy calves from nine herds in south-west Sweden once at 24-56 days of age to evaluate the potential of S-Hp as an indicator of clinical respiratory-tract disease (CRD). Presence of disease (treated and non-treated) was assessed clinically by farmers and by a project veterinarian visiting the farms every third week. The median S-Hp of healthy calves was 0.06g/L (80% central range: 0.04-0.23), of calves with diarrhoea within the 10 days before sampling 0.07g/L (80% central range: 0.04-0.63), and of calves with CRD within the 14 days before sampling 0.09g/L (80% central range: 0.04-0.69). Eight different cut-off values were used to define a positive S-Hp analysis result: >0.05, >0.06, >0.07, >0.08, >0.09, >0.10, >0.15 and >0.20g/L. A rectal temperature >39.5 degrees C was denoted as fever. A positive result of five different diagnostic tests for CRD was defined as: (1) a positive S-Hp with fever absent, (2) a positive S-Hp with fever present, (3) either a positive S-Hp or fever, (4) both a positive S-Hp and fever, and (5) fever (regardless of S-Hp). The sensitivity (Se) and specificity (Sp) of each test were calculated from regression coefficients of generalized linear mixed models of the binary test results, applying a logit link. Apart from CRD status (within the 14 days before sampling; no or yes), the models included sex (bull or heifer), and for the test based on S-Hp alone, also rectal temperature (fever, no or yes). Confidence intervals (CI) of Se and Sp were estimated by simulation. Based on Se, Sp, and areas under Receiver Operating Characteristics curves, test 3 was considered the best. At optimal performance, giving equal importance to type I and II errors, i.e. at a S-Hp cut-off of 0.15g/L in heifer calves, Se was 0.64 (95% CI 0.50-0.77) and Sp 0.71 (95% CI 0.60-0.80), and at a S-Hp cut-off of 0.08g/L in bulls, Se was 0.52 (95% CI 0.40-0.64) and Sp 0.80 (95% CI 0.74-0.85). The other tests were judged as unsatisfactory indicators of CRD. In heifers, the proportion of CRD-positive calves in the herd was strongly associated with the proportion of test positives (S-Hp or fever; S-HP and fever), suggesting potential as a herd-level indicator.

Comparison of the erythrocyte sedimentation rate measured by the Micro Test 1 sedimentation analyzer and the conventional Westergren method

BACKGROUND

The erythrocyte sedimentation rate (ESR) remains the most widely used laboratory test for monitoring infections, inflammatory diseases and some types of cancer. Several test methods have been developed recently, and as a result, the safety and reliability of ESR testing procedures have improved. The purpose of this study was the comparison of two methods, the traditional manual Westergren method (reference method of the International Committee on Standardization in Hematology) and a new semiautomated technique, the Micro Test 1 for determining the ESR.

SUBJECTS AND METHODS

Blood samples were collected after a night's fasting from 200 hospitalized and ambulatory patients. Undiluted blood samples anticoagulated with K3 EDTA that had Micro Test 1 values ranging from 2-82 mm/h were used for comparison with the Westergren method.

RESULTS

Linear regression analysis comparing the Micro Test 1 and the reference method yielded satisfactory correlations and regression for samples (r=0.910; P=0.0001; y=4.91+0.86 x; Sy/x=6.85). A Bland-Altman analysis showed no evidence of systematic bias between the Micro Test 1 and the reference method.

CONCLUSION

The Micro Test 1 system was easy to use, had a satisfactory operative practicability, required minimal maintenance, and reduced contact with potential biohazards.

The comparative study of Sprague-Dawley and Lewis rats in adjuvant-induced arthritis

The outbred Sprague-Dawley (SD) rats, similar to the inbred Lewis (LEW) rats, have been recently demonstrated to be highly susceptible to adjuvant-induced arthritis (AIA). We herein compared AIA in SD and LEW rats in terms of clinical, histological, radiological, and immuno-inflammatory features. The results showed that, following inoculation with a ground Mycobacterium tuberculosis (MT) suspension, SD and LEW rats manifested closely similar disease progression, with 100% incidence and similar severity. The development of arthritis was accompanied by significantly higher erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels than in control rats. Radiographic examination of the hind paws showed that both SD and LEW AIA rats manifested conspicuous soft tissue swelling, bone matrix resorption, periosteal new bone formation and bone erosion, while histopathological analysis of the synovial joints revealed marked cellular infiltration, angiogenesis, synovial hyperplasia, pannus formation, narrowing of joint space, and cartilage and bone destruction. Moreover, in relation to disease progression, serum tumor necrosis factor-alpha (TNF-alpha), interleukin-1beta (IL-1beta), and IL-6 levels were markedly overexpressed in both SD and LEW AIA versus control rats, and SD and LEW AIA rats exhibited divergent profiles for the expression of TNF-alpha and IL-1beta. Taken together, these results demonstrated that the SD rat AIA model shares several arthritic features with the comparable model in LEW rats. Hence, given the more favorable characteristics of SD rats than LEW rats (i.e., lower cost, wider availability, and heterogenic background), this SD rat AIA model is more cost effective and advantageous for screening and testing novel anti-arthritic agents.

C-reactive protein levels in subjects with Prader-Willi syndrome and obesity

PURPOSE

Prader-Willi syndrome is characterized by infantile hypotonia, feeding difficulties, hypogonadism, small hands and feet, mental deficiency, behavioral problems, and hyperphagia leading to obesity in early childhood. To date there have been no studies examining the associated risk of cardiovascular disease related to obesity in Prader-Willi syndrome, nor of circulating biomarkers such as C-reactive protein known to be predictive of cardiovascular disease. Therefore, we have measured the levels of C-reactive protein in a descriptive study of a cohort of Prader-Willi syndrome and comparison subjects.

METHODS

An immunoassay was used to quantify C-reactive protein in plasma samples from subjects with Prader-Willi syndrome and obesity and compared to anthropometric and body composition data.

RESULTS

The mean circulating C-reactive protein concentration for 28 subjects with Prader-Willi syndrome (13 females, 15 males; mean age 24.6 +/- 11.6 years; mean body mass index 35.9 +/- 11.9) was 10.3 +/- 8.8 mg/L. The mean C-reactive protein concentration for 22 nonsyndromic obese subjects (16 females, 6 males; mean age 32.3 +/- 12.2 years; mean body mass index 36.6 +/- 10.7) was 8.8 +/- 10.9 mg/L. The reported mean value for C-reactive protein was 2.6 +/- 3.0 mg/L from 100 healthy adults.

CONCLUSIONS

The mean C-reactive protein values were similar between the subjects with Prader-Willi syndrome and obesity but significantly higher in Prader-Willi syndrome and obese subjects relative to normative data. Increased levels of C-reactive protein (>3.0 mg/L) are associated with cardiovascular disease suggesting subjects with Prader-Willi syndrome as well as obese subjects are at a similar increased risk.

ITIH4 (inter-alpha-trypsin inhibitor heavy chain 4) is a new acute-phase protein isolated from cattle during experimental infection

We have isolated from calf serum a protein with an apparent M(r) of 120,000. The protein was detected by using antibodies against major acute-phase protein in pigs with acute inflammation. The amino acid sequence of an internal fragment revealed that this protein is the bovine counterpart of ITIH4, the heavy chain 4 of the inter-alpha-trypsin inhibitor family. The response of this protein in the sera was determined for animals during experimental bacterial and viral infections. In the bacterial model, animals were inoculated with a mixture of Actinomyces pyogenes, Fusobacterium necrophorum, and Peptostreptococcus indolicus to induce an acute-phase reaction. All animals developed moderate to severe clinical mastitis and exhibited remarkable increases in ITIH4 concentration in serum (from 3 to 12 times the initial values, peaking at 48 to 72 h after infection) that correlated with the severity of the disease. Animals with experimental infections with bovine respiratory syncytial virus (BRSV) also showed increases in ITIH4 concentration (from two- to fivefold), which peaked at around 7 to 8 days after inoculation. Generally, no response was seen after a second infection of the same animals with the virus. Because of the significant induction of the protein in the animals in the mastitis and BRSV infection models, we can conclude that ITIH4 is a new positive acute-phase protein in cattle.