Predictive and Prognostic Potentials of Lymphocyte-C-Reactive Protein Ratio Upon Hospitalization in Adult Patients with Acute Pancreatitis.

Purpose: In this study, our objective was to investigate the potential utility of lymphocyte-C-reactive protein ratio (LCR) as a predictor of disease progression and a screening tool for intensive care unit (ICU) admission in adult patients with acute pancreatitis (AP). Methods: We included a total of 217 adult patients with AP who were admitted to the First Affiliated Hospital of Harbin Medical University between July 2019 and June 2022. These patients were categorized into three groups: mild AP (MAP), moderately severe AP (MSAP), and severe AP (SAP), based on the presence and duration of organ dysfunction. Various demographic and clinical data were collected and compared among different disease severity groups. Results: Height, diabetes, lymphocyte count (LYMPH), lymphocyte percentage (LYM%), platelet count (PLT), D-Dimer, albumin (ALB), blood urea nitrogen (BUN), serum creatinine (SCr), glucose (GLU), calcium ion (Ca2+), C-reactive protein (CRP), procalcitonin (PCT), hospitalization duration, ICU admission, need for BP, LCR, sequential organ failure assessment (SOFA) score, bedside index for severity in AP (BISAP) score, and modified Marshall score showed significant differences across different disease severity groups upon hospitalization. Notably, there were significant differences in LCR between the MAP group and the MSAP and SAP combined group, and the MAP and MSAP combined group and the SAP group, and adult AP patients with ICU admission and those without ICU admission upon hospitalization. Conclusion: In summary, LCR upon hospitalization can be utilized as a simple and reliable predictor of disease progression and a screening tool for ICU admission in adult patients with AP.

Identifying the mediating role of inflammation on the relationship between socioeconomic status and Alzheimer's disease: a Mendelian randomization analysis and mediation analysis.

BACKGROUND AND OBJECTIVES: Observational studies have demonstrated a significant association between socio-economic status (SES) and Alzheimer's disease (AD). Nonetheless, the precise biological mechanisms underlying this association remain unclear. Therefore, we adopted a Mendelian Randomization (MR) approach to investigate the causal relationship between SES and genetic susceptibility to AD, as well as to explore the potential mediation effects of inflammation. METHODS: Large-scale cohorts based on publicly available genome-wide association study (GWAS) datasets from European populations were employed for conducting the MR study. The primary criterion utilized was the inverse-variance weighting (IVW) model. Heterogeneity and horizontal pleiotropy were assessed. In addition, multivariate MR (MVMR) was utilized to correct the confounders. Moreover, a two-step MR approach was used to evaluate the potential mediating effects of factors on the causal effects between SES and AD. RESULTS: As indicated by the results of the IVW model, educational years (OR = 0.708, 95% CI 0.610-0.821, P < 0.001) and household income (OR = 0.746, 95% CI 0.566-0.982, P = 0.037) was associated with a decreased genetic susceptibility risk for AD. The univariable results showed that the causal effect of educational years on the lower risk of AD remained significant (OR = 0.643, 95% CI 0.467-0.886, P = 0.006). In addition, our findings indicated that C-reactive protein (CRP) played a role in the causal effect of educational years on AD. The proportions of mediation were - 50.08% (95% CI - 92.78; - 7.38%). DISCUSSION: These findings provided evidence supporting the causal effect of educational attainment lower AD risk, with inflammation playing a mediating role. These findings may inform prevention strategies and interventions directed toward AD. Future studies should explore other plausible biological mechanisms.

Prognostic value of high-sensitivity C-reactive protein in patients undergoing percutaneous coronary intervention with different glycemic metabolism status.

BACKGROUND: High-sensitivity C-reaction protein (hsCRP), a biomarker of residual inflammatory risk, has been demonstrated with poor cardiovascular outcomes. We aimed to investigate the prognostic value of hsCRP in patients undergoing percutaneous coronary intervention (PCI) with or without diabetes mellitus (DM). METHODS: In this large-scale, prospective cohort study, we enrolled 8050 consecutive patients who underwent PCI for coronary artery stenosis. All subjects were stratified as high hsCRP (> 3 mg/L) and low hsCRP (≤ 3 mg/L) and were divided into four groups (hsCRP-L/non-DM, hsCRP-H/non-DM, hsCRP-L/DM, hsCRP-H/DM). The primary endpoint of the study was major adverse cardiovascular events (MACEs), including all-cause mortality, myocardial infarction, stroke, and unplanned vessel revascularization, evaluated at a 3 year follow-up. RESULTS: After 35.7 months (interquartile range: 33.2 to 36.0 months) of median follow-up time, 674 patients suffered from MACEs. We found elevated hsCRP was highly associated with an increased risk of MACEs in both diabetic (hazard ratio [HR] = 1.68, 95% confidence interval CI 1.29-2.19, P < 0.001) and non-diabetic patients (HR = 1.31, 95% CI: 1.05-1.62, P = 0.007) after adjustment for other confounding factors. Kaplan-Meier survival analysis showed the highest incidence of MACEs in hsCRP-H/DM (P < 0.001). In addition, the results of the restricted cubic spline analysis suggested a positive linear relationship between hsCRP and MACEs. CONCLUSION: Elevated hsCRP is an independent risk factors of MACEs in patients undergoing PCI irrespective of glycemic metabolism status.

Effects of extracorporeal shock wave lithotripsy on PCT, renal function and inflammatory index levels in patients with indinavir-related urinary calculi / 西安交通大学学报(医学版)

【Objective】 To investigate the effects of extracorporeal shock wave lithotripsy (ESWL) on procalcitonin (PCT), renal function and inflammatory index levels in patients with indinavir-induced urinary calculi so as to provide reference for clinical practice. 【Methods】 A total of 77 patients with urinary calculi admitted to the Department of Urology of our hospital from January 2017 to January 2021 were selected for retrospective analysis. They were divided into control group (38 cases, non-indinavir related urinary calculi) and observation group (39 cases, indinavir-related urinary calculi) according to the years of the disease. Before treatment and 7 days after treatment, the serum levels of PCT, CRP, Scr, UA, Kim1, VAS scores, and IgG, IgM, MDA, and SOD levels were compared between the two groups. 【Results】 The expressions of serum PCT and CRP at 7 days after treatment in the two groups were significantly lower than those before treatment, and the improvement degree of the observation group was significantly higher than that in the control group (P0.05), but the intraoperative blood loss and MAP 20 min after induction of anesthesia were significantly better than those in the control group. Seven days after treatment, GSH-Px and SOD were significantly better in the observation group than in the control group and before treatment (P<0.05). 【Conclusion】 ESWL treatment for patients with indinavir-induced urinary calculi can effectively reduce the expressions of serum PCT and CRP, improve renal function indexes, reduce intraoperative blood loss, and reduce the level of inflammatory indexes; the clinical effect is good.

Association of LEPTIN and other inflammatory markers with preeclampsia: A systematic review.

Background: Preeclampsia is a serious pregnancy complication that affects 5%-10% of the obstetric population. Objective: To study inflammatory markers associated with preeclampsia. Search Strategy: Searches of articles on the topic published over a 10-year period (2009-2019) were performed in three databases (PubMed, Cochrane, and Embase) using the keywords preeclampsia and inflammatory markers. The PubMed search using 10 years and humans as filters retrieved 124 articles. Using an advanced search strategy, 0 articles were identified in Embase and 10 articles in Cochrane. After screening and eligibility assessment, 13 articles were included in the systematic review and meta-analysis. Meta-analysis and quality assessment of the studies were performed using the Review Manager 5.3 program. Results: For meta-analysis, women with preeclampsia were compared to control women, i.e., pregnancies without arterial hypertension. Leptin levels were significantly higher (p < 0.0002) in women with preeclampsia compared to controls. Total cholesterol was also significantly elevated in women with preeclampsia (p < 0.0001). There was no significant difference in HDL between groups, but women with preeclampsia had significantly increased LDL (p < 0.01). The same was observed for triglycerides, which were significantly increased in women with preeclampsia (p < 0.04) compared to controls. Analysis of TNF-alpha, an important inflammatory marker, showed higher levels in women with preeclampsia (p < 0.03) compared to controls. The same was observed for another important inflammatory marker, interleukin 6, which was significantly increased in women with preeclampsia (p < 0.0002). There was a significant increase of C-reactive protein in women with preeclampsia (p < 0.003) compared to controls. Conclusion: Women with preeclampsia have increased levels of inflammatory markers compared to control women.

A diagnostic test: combined detection of heparin-binding protein, procalcitonin, and C-reactive protein to improve the diagnostic accuracy of bacterial respiratory tract infections.

Background: Respiratory tract infection (RTI) is one of the most common diseases worldwide, and its incidence is rising year by year due to environmental pollution. Sputum culture remains the gold standard for RTI diagnosis, but its performance is limited by difficulties related to the sampling and testing of the sputum specimens. Heparin-binding protein (HBP), procalcitonin (PCT), and C-reaction protein (CRP) are Inflammatory markers. They have the advantage of being fast, accurate and reproducible, but limited by their sensitivity and specificity. We explored the clinical value of the combined detection of them in the diagnosis of bacterial RTIs. Methods: Patients who fulfilled the inclusion criteria were selected as the case group, healthy age- and sex-matched subjects were enrolled as a control group. The subjects' HBP, PCT, and CRP levels were detected. The case group was further divided into two groups according to the bacterial culture results, and the differences in the markers were statistically analyzed. The receiver operating characteristic (ROC) curves were drawn, and the areas under the ROC curve (AUCs) were calculated to analyze the diagnostic values of each marker and their combination in parallel for bacterial RTIs. Results: The plasma HBP, PCT, and CRP levels of patients in the bacterial and non-bacterial infection groups were significantly higher than those of patients in the healthy control group, and were positively correlated to the severity of the disease. for HBP with an AUC of 0.785 [95% confidence interval (CI): 0.686-0.884], a sensitivity of 0.821, a specificity of 0.771; PCT with an AUC of 0.767 (95% CI: 0.664-0.870), a sensitivity of 0.773, a specificity of 0.791, and CRP with an AUC of 0.748 (95% CI: 0.642-0.854), a sensitivity of 0.839, a specificity of 0.696 in the bacterial and non-bacterial infection groups. The combined detection of HBP + CRP had the optimal diagnostic performance, with an AUC of 0.797 (95% CI: 0.698-0.895; P<0.001), a sensitivity of 0.809, a specificity of 0.800. Conclusions: The combined detection of HBP and CRP is valuable for diagnosing bacterial RTIs and may guide the development of reasonable treatment protocols in clinical settings.

Triple signal-enhancing electrochemical aptasensor based on rhomboid dodecahedra carbonized-ZIF67 for ultrasensitive CRP detection.

C-reactive protein (CRP) is one of the most sensitive acute-phase reactants, which is an early stage indicator of cardiovascular disease and infectious inflammation in clinic. However, it is still challenging to accurately quantification the trace content of CRP molecules in plasma samples. In this work, we propose an ultrasensitive electrochemical CRP aptasensor based on rhomboid dodecahedra carbonized-ZIF67 loaded with gold nanoparticle modified by aptamer. Aptamer biomolecules are binded to AuNPs via Au-thiol bonds for selectively capturing CRPs. The ultrasensitivity is achieved based on triple signal enhancing strategy: enhancing the specific surface area via the rhomboid dodecahedra structure of ZIF67, increasing the conductivity via carbonization of ZIF67, and multiplying the number of probe molecules via an enzyme catalyzed reaction. Experimental parameters, including the volume of C-ZIF67 dispersion, electrodeposition time of AuNPs, incubation time of aptamer-CRP and aptamer-CRP concentration, are systemically investigated and optimized. Under optimal conditions, the proposed biosensor shows excellent sensing performance with the limit of detection (LOD) of 0.44 pg mL-1 (S/N = 3), and a broad linear dynamic range of 10 pg mL-1 ‒ 10 µg mL-1 within the total readout time of 5 min. This work provides an effective electrochemical biosensor for CRP assay in plasma, being highly potential for applications in bioanalysis and point-of-care (POC) clinical diagnosis.

Risk factors of ankylosing spondylitis with premature coronary heart disease / 中华风湿病学杂志

Objective:To analyze the risk factors of patients with ankylosing spondylitis (AS) combined with premature coronary atherosclerotic heart disease (PCAD).Methods:A total of 74 patients with AS and coronary atherosclerotic heart disease (CAD) in Peking Union Medical College Hospital from January 1983 to July 2021 were enrolled. According to the age of onset of coronary heart disease, the 74 patients were divided into PCAD group and NPCAD (non-premature coronary heart disease) group. T test and Chi square test were used to analyze the data of the two groups, the risk factors for AS-PCAD were analyzed by multivariate Logistic regression. Results:① There were 37 cases in the PCAD group and 37 cases in the NPCAD group. In the PCAD group, there were 28 men and 9 women; wherease all were men in the NPCAD group. The difference was statistically significant ( χ2=10.25, P=0.001). ② Compared with the NPCAD group, the age of AS-PCAD group was younger [(23±10) years vs (29±12) years, t=-2.28, P=0.026], and the course from AS to CAD was shorter [(25±10) years vs (34±13) years, t=-3.00, P=0.004], hemoglobin (Hb) level was lower [(122±23) g/L vs(132±18) g/L, t=2.10, P=0.039], rate of anemia was higher [38.5%(14/37) vs 16.2%(6/37), χ2=4.39, P=0.037]. Proportion of increased C-reactive protein (CRP) was higher [65.5%(19/29) vs 35.5%(11/31), χ2=5.41, P=0.019]. ③ Juvenile onset AS (JoAS)[ OR(95% CI)=3.45(1.31, 9.10), P=0.012] and high levels of CRP [ OR (95% CI)=3.68 (1.44, 9.40), P=0.006] might berisk factors of AS-PCAD by multiple logisctic regression analysis. Conclusion:Patients with AS have a higher probability of PCAD, especially in those patients with JoAS, persistent inflammation and anemia. It is necessary to be alert to the risk of PCAD and early screening.

Bone-Derived Factors as Potential Biomarkers for Parkinson's Disease.

Background: Parkinson's disease (PD) and osteoporosis are both common aging diseases. It is reported that PD has a close relationship with osteoporosis and bone secretory proteins may be involved in disease progression. Objectives: To detect the bone-derived factors in plasma and cerebrospinal fluid (CSF) of patients with PD and evaluate their correlations with C-reaction protein (CRP) level, motor impairment, and Hoehn-Yahr (HY) stage of the disease. Methods: We included 250 PD patients and 250 controls. Levels of osteocalcin (OCN), osteopontin (OPN), osteoprotegerin (OPG), Sclerostin (SO), Bone morphogenetic protein 2 (BMP2), and Dickkopf-1 (DKK-1) in plasma and CSF were measured by custom protein antibody arrays. Data were analyzed using Mann-Whitney U-test and Spearman's receptor activator of NF-κB (RANK) correlation. Results: Plasma levels of OCN and OPN were correlated with CRP levels and HY stage and motor impairment of PD. Furthermore, the plasma assessment with CSF detection may enhance their potential prediction on PD. Conclusions: OCN and OPN may serve as potential biomarkers for PD. The inflammation response may be involved in the cross-talk between the two factors and PD.

Optimized combination of circulating biomarkers as predictors of prognosis in AECOPD patients complicated with Heart Failure.

Background: Systematic inflammation, nutritional status, and cardiovascular function have been associated with the outcomes of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients with heart failure (HF). However, the value of their relevant biomarkers in predicting mortality has not been well defined yet. We aimed to investigate the prognostic value of circulating biomarkers including C-reaction protein (CRP)/albumin (ALB), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and N-terminal pro-brain natriuretic peptide (NT-proBNP) for AECOPD patients with HF. Methods: A retrospective study was carried out in the Second Clinical College of Jinan University from January 1, 2013 to January 31, 2019. A total of 146 cases of AECOPD complicated with HF were enrolled and classified into survivor group (n=94) and non-survivor group (n=52). The baseline characteristics, CRP/ALB ratio, NLR, PLR, serum levels of NT-proBNP, and other indicators were collected. The predictors for prognosis were analyzed by multivariate logistic regression, and the ability to predict 28-day mortality was evaluated by receiver operating characteristics curve (ROC) and the area under the curve (AUC). Results: The patients in non-survivors had significantly higher levels of CRP, CRP/ALB, NLR, PCT and NT-proBNP, but lower ALB levels compared to the survivors [111.7 (56.9, 186.5) VS. 43.8 (10.3, 96.1) mg/L, 4.6 (2.0, 8.0) VS. 1.4 (0.3, 3.4), 22.2 (11.1, 40.1) VS. 12.0 (6.2, 24.8), 2.6 (0.2, 10.3) VS. 0.08 (0.1, 0.5) ng/ml, 17912.5 (9344.0, 34344.5) VS. 9809.0 (4415.9, 16387.2) ng/ml, 25.8 (23.2, 30.5) VS. 30.7 (27.9, 34.1) g/L; P < 0.001, <0.001, 0.001, <0.001, <0.001, and < 0.001, respectively]. No significant difference in PLR was found between the two groups (P=0.413). The logistic analysis revealed that CRP/ALB (OR=1.303, 95%CI: 1.145-1.483, P<0.001), NT-proBNP (OR=1.041, 95%CI: 1.010-1.073, P=0.009) and NLR (OR=1.010, 95%CI: 0.999-1.022, P<0.001) are independent risk factors for predicting the 28-day mortality. The AUC of the ROC curves were 0.768, 0.767, 0.757, 0.723, 0.716, and 0.668 for CRP/ALB, PCT, CRP, NT-proBNP, ALB, and NLR, respectively. The combination of CRP/ALB, NLR and NT-proBNP as biomarkers was shown to have better accuracy for predicting prognosis (AUC=0.830, 95%CI: 0.761-0.899, P<0.001), with a higher specificity of 80.8% and specificity of 77.7% as compared with each single biomarkers. Conclusions: High levels of NLR, CRP/ALB and NT-proBNP may be clinical usefully predictors for death in AECOPD patients with HF. Combination of NLR with CRP/ALB and NT-proBNP can provide a higher accuracy for predicting 28-day mortality in these patients.

Multi-trajectory analysis of C-reactive protein and low back pain from adolescence to early adulthood.

PURPOSE: To identify low back pain (LBP) trajectories from early adolescence through to early adulthood and to investigate whether sustained levels of elevated subclinical C-reactive protein (CRP) are linked with these LBP trajectories. METHODS: We analysed longitudinal data from 1513 participants who were enrolled in the Raine Study cohort. Data on LBP with impact on daily living and CRP were collected at the ages of 14, 17, 20, and 22. We constructed group-based trajectory models to identify discrete trajectories of LBP with impact. We then evaluated how the CRP trajectories and the LBP with impact trajectories evolved jointly over time using a multi-trajectory analysis. RESULTS: The model identified three LBP trajectories. One subgroup included almost half the participants (46.1%) who had a consistently low probability of LBP. Another subgroup comprising 43.5% of participants had an increasing probability of LBP, while one in ten participants (10.4%) had a decreasing probability of LBP. There were no associations between elevated CRP and LBP trajectory subgroup membership. CONCLUSION: Although young people follow distinct trajectories of LBP, CRP trajectories do not appear to be a distinguishing factor of the LBP trajectories. Previously reported associations between CRP and LBP may be explained by comorbidity or other factors. Future studies undertaking trajectory analysis should consider comorbidity clusters. LEVEL OF EVIDENCE I: Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.

Air temperature variability and high-sensitivity C reactive protein in a general population of China.

BACKGROUND: Along with global climate change, the relationship between temperature variability (TV) and cardiovascular hospitalization and deaths have been well established. However, limited studies were conducted to reveal the underlying mechanism for TV-related cardiovascular diseases. OBJECTIVES: In the current study, a novel TV calculation, taking account for both interday and intraday TV as well as lag effects, was used to investigate the effect of short-term TV on the level of high-sensitivity C reactive protein (hs-CRP), which is a crucial preclinical predictor for cardiovascular disease (CVD). RESULTS: Among the 11,623 Chinese population (46.0% male; mean age 49.8 years), the average hs-CRP was 1.4 mg/ L (standard deviation 1.6 mg/L). Statistical significance between TV and hs-CRP was observed for different TV exposure days (TV01-TV07) in adjusted model, with highest effect for TV06. Specifically, per 1 °C increase in TV06 led to 2.241% (95%CI: 1.552%-2.935%) increase in hs-CRP. Female, obesity and elderly population were more susceptible to TV. The largest mediator for the association of TV and hs-CRP was lipoprotein(a), accounting for 8.68%, followed by smoking status (4.78%), alcohol use (3.95%) and systolic BP (3.20%). CONCLUSION: Short-term TV will significantly increase the level of hs-CRP, suggesting hs-CRP to be the potential biologic mechanisms underlying the cardiovascular effects of TV. And more attention should be paid to unstable weather in the global climate change context. Further developing efficient public health policies on climate change may benefit for global heath.

Analysis of the risk factors for severe hyperlipidemic acute pancreatitis / 中华胰腺病杂志

Objective@#To explore the risk factors for hyperlipidemic acute pancreatitis (HTGP).@*Methods@#The clincial data of 169 HTGP cases admitted in Capital Medical University Attached Xuanwu Hospital from September 2012 to December 2018 were retrospectively analyzed. Patients were divided into severe HTGP group (n=63) and mild or moderately severe HTGP group (n=106). Clinical data were compared between two groups and variables with statistically significance and clinical values were chosen and included for binary logistic regression to explore the independent risk factors for severe HTGP.@*Results@#Severe HTGP patients′ heart beat and respiratory rate were significantly higher than moderately severe or mild HTGP cases, while the percentage of patients with previous AP history in severe HTGP group was obviously lower than moderately severe or mild HTGP cases. There were no statistically significant differences on other baseline data and previous history. Severe HTGP patients had significantly higher white blood cell, mean platelet volume, erythrocyte sedimentation rate, total protein, C-reaction protein on first day, C-reaction protein on third day, amylase, lipase, triacylglycerol, prothrombin time, D-dimer, fibrinogen, CTSI, APACHEⅡ score and Ranson score than those in moderately severe or mild HTGP cases; the lymphocyte count, albumin-globulin ratio, uric acid, apolipoprotein-A1, blood calcium, prothrombin activity were obviously lower than those in moderately severe or mild HTGP cases; and all the differences were statistically significant. Triglyceride and CRP on the first and third day, CTSI, APACHEⅡ score and Ranson score were included for binary logistic regression model, and the results showed that triglyceride on the first day (OR=1.08, 95% CI 1.02-1.14, P=0.01), C-reaction protein on the third day (OR=1.01, 95% CI 1.00-1.01, P<0.01), CTSI score(OR=1.51, 95% CI 1.06-2.13, P=0.02), APACHEⅡ score(OR=1.22, 95% CI 1.07-1.40, P<0.01)were the risk factors of severe HTGP, while triglyceride on the third day (OR=0.8, 95% CI 0.69-0.91, P=0.00)was the protective factor of severe HTGP.@*Conclusions@#Triglyceride on the first day, C-reaction protein on the third day, CTSI score and APACHEⅡ score were the risk factors of severe HTGP, which deserve special attention.

Enhanced recovery after surgery in total laparoscopic radical gastrectomy / 中华普通外科杂志

Objective To investigate the effect of enhanced recovery after surgery (ERAS) on immune function and postoperative recovery in gastric cancer patients undergoing total laparoscopic radical gastrectomy.Methods Patients were randomly divided into ERAS group and control group.Blood CD4 +,CD8+,CD4 + CD25 +,C-reactive protein,postoperative recovery and complications were compared between the two groups.Results On day1,CD4 +,CD8 +,CD4 + CD25 + in the two groups were significantly lower than those before surgery (t =9.070,7.297,5.830,12.870,3.529,10.547,all P＜0.05).The ERAS group had higher CD8 +,CD4 + CD25 + levels than the control group (t =2.163,2.203,P ＜ 0.05).On day3,CD4 + CD25 + in ERAS group was not different from that before surgery (t =1.062,P ＞ 0.05) while the other indexes in the two groups raised but still were lower than preoperative level (t =3.322,5.015,3.418,9.912,all P ＜0.05);CD4 +,CDs +,CD4 + CD25 + in ERAS group were higher than control group (t =2.804,2.040,2.210,all P＜0.05).On day5,CD4+,CD4 + CD25+ in the two groups and CDs+ in ERAS group returned to the preoperative level,while CDs + of the control group was still lower than the preoperative level (t =6.862,P ＜0.05).On day1,3 and 5,the C-reactive protein levels of the two groups were higher than those before surgery(t=-13.338,-13.715,-11.319,-12.286,-13.182,-15.076,all P ＜ 0.05),and ERAS group were lower than the control group (t =-3.246,-2.100,-2.211,all P＜0.05).There was no mortality in neither groups.The time of passage gas by anus,defecation,getting out of bed,oral feeding,and postoperative hospital stay in the ERAS group were less than thoseinthecontrolgroup[(2.8±1.0)dvs.(3.9±0.9)d,t=-5.974;(3.8± 0.9)d vs.(4.3±1.0)d,t=-2.700;(19.1 ±4.0)hvs.(35.9±6.6)h,t=-16.045;(9.9 ±1.6)d vs.(11.5±2.0) d,t =-4.479,all P ＜ 0.05].Conclusions ERAS in the perioperative period of patients with total laparoscopic radical gastrectomy mitigates the stress on the cellular immune system,reduces inflammatory response,and help fast recover the postoperative gastrointestinal function.

Clinical trial of nimodipine combine with butylphthalide in the treatment of patients with mild to moderate vascular cognitive impairment / 中国基层医药

Objective To evaluate the clinical efficacy and safety of nimodipine combine with butylphthalide in the treatment of patients with mild to moderate vascular cognitive impairment(VCI).Methods From January 2012 to December 2016,100 patients with mild to moderate VCI in Jinhua Municipal Central Hospital were randomly divided into control group(n =50) and treatment group(n =50) according to the random number table method.The control group received butylphthalide capsule,200 mg po tid.The treatment group received nimodipine tablets,40mg po tid,on the basis of the control group.The two groups of patients were treated for 24 weeks.Montreal cognitive assessment (MoCA),activities of daily living (ADL),serum hs-CRP,IL-6,TNF-α,clinical efficacy and adverse drug reactions were compared after treatment.Results After treatment,the scores of MoCA and ADL in the treatment group were (24.32 ± 2.87) points,(59.22 ± 6.17) points,respectively,which were significantly higher than those in the control group [(22.76 ± 2.67) points,(55.63 ± 6.3) points,t =2.814,2.870,all P ＜ 0.05].The effective rates in the treatment group and control group were 74.00％ (37/50),52.00％ (26/50),respectively,and there was statistically significant difference between the two groups (x2 =5.191,P ＜ 0.05).After treatment,the levels of hs-CRP [(189.51 ±23.27) mg/L vs.(211.51 ±25.51) mg/L],IL-6[(76.42 ±9.86) ng/L vs.(95.85 ± 10.23) ng/L],TNF-α[(0.24 ±0.08)ng/L vs.(0.32 ±0.10)ng/L] between the treatment group and the control group had statistically significant differences(t =4.505,9.670,4.417,all P ＜ 0.05).The adverse drug reactions were nausea and vomiting in 3 cases in the control group(6.00％),nausea and vomiting in 3 cases and hypotension in 1 case in the treatment group(8.00％),and there was no statistically significant difference between the two groups(P ＞0.05).Conclusion Nimodipine combined with butylphthalide in the treatment of mild to moderate VCI is effective and has high safety.

Clinical trial of nimodipine combine with butylphthalide in the treatment of patients with mild to moderate vascular cognitive impairment / 中国基层医药

Objective@#To evaluate the clinical efficacy and safety of nimodipine combine with butylphthalide in the treatment of patients with mild to moderate vascular cognitive impairment(VCI).@*Methods@#From January 2012 to December 2016, 100 patients with mild to moderate VCI in Jinhua Municipal Central Hospital were randomly divided into control group(n=50) and treatment group(n=50) according to the random number table method.The control group received butylphthalide capsule, 200 mg po tid.The treatment group received nimodipine tablets, 40mg po tid, on the basis of the control group.The two groups of patients were treated for 24 weeks.Montreal cognitive assessment(MoCA), activities of daily living(ADL), serum hs-CRP, IL-6, TNF-α, clinical efficacy and adverse drug reactions were compared after treatment.@*Results@#After treatment, the scores of MoCA and ADL in the treatment group were (24.32±2.87)points, (59.22±6.17)points, respectively, which were significantly higher than those in the control group[(22.76±2.67)points, (55.63±6.3)points, t=2.814, 2.870, all P<0.05]. The effective rates in the treatment group and control group were 74.00%(37/50), 52.00%(26/50), respectively, and there was statistically significant difference between the two groups(χ2=5.191, P<0.05). After treatment, the levels of hs-CRP[(189.51±23.27)mg/L vs.(211.51±25.51)mg/L], IL-6[(76.42±9.86)ng/L vs.(95.85±10.23)ng/L], TNF-α[(0.24±0.08)ng/L vs.(0.32±0.10)ng/L] between the treatment group and the control group had statistically significant differences(t=4.505, 9.670, 4.417, all P<0.05). The adverse drug reactions were nausea and vomiting in 3 cases in the control group(6.00%), nausea and vomiting in 3 cases and hypotension in 1 case in the treatment group(8.00%), and there was no statistically significant difference between the two groups(P>0.05).@*Conclusion@#Nimodipine combined with butylphthalide in the treatment of mild to moderate VCI is effective and has high safety.

Predictive value of procalcitonin in intensive care unit delirium / 中华危重病急救医学

Objective@#To analyze the risk factors of delirium in intensive care unit (ICU) patients, and to investigate the predictive value of C-reactive protein (CRP), procalcitonin (PCT), lactic acid (Lac) and neuron-specific enolase (NSE) in the diagnosis of ICU delirium.@*Methods@#The patients admitted to central ICU and respiratory medicine ICU of Changzhou First People's Hospital from August 2016 to November 2017 were enrolled. The patients were divided into two groups according to whether delirium occurred within 7 days or not, which was evaluated by using the confusion assessment method for ICU (CAM-ICU). The gender, age and blood CRP, PCT, Lac, NSE levels were compared between the two groups. Multivariate Logistic regression model was used to analyze the risk factors of ICU delirium. Receiver operating characteristic curve (ROC) was drawn to assess the predictive value of CRP, PCT, Lac and NSE in the occurrence of ICU delirium.@*Results@#133 patients were enrolled. Delirium occurred in 67 patients, and did not occurred in 66 patients, with a prevalence rate of 50.4%. There was no significant difference in gender or age between the two groups. Compared with non-delirium group, blood CRP, PCT and Lac levels in delirium group were significantly increased [CRP (mg/L): 110.75±77.31 vs. 51.32±36.51, PCT (μg/L): 3.95 (1.01, 23.90) vs. 0.09 (0.06, 0.36), Lac (mmol/L): 2.40 (1.70, 4.30) vs. 1.20 (0.90, 2.00), all P < 0.01], but no significant difference was found in NSE [μg/L: 12.59 (9.61, 17.69) vs. 13.39 (10.14, 19.05), P > 0.05].② It was shown by multivariate Logistic regression analysis that blood PCT and Lac were risk factors of ICU delirium [PCT: odds ratio (OR) = 1.185, 95% confidence interval (95%CI) = 1.006-1.396, P = 0.042; Lac: OR = 1.398, 95%CI = 1.011-1.934, P = 0.043].③ROC curve analysis showed that blood CRP, PCT and Lac had certain predictive value for ICU delirium, and the area under the ROC curve (AUC) of PCT was the highest (0.840 vs. 0.694 and 0.751). When the cut-off value of PCT ≥ 0.55 μg/L, the sensitivity was 72.7%, the specificity was 86.2%, positive predictive value was 84.48%, and negative predictive value was 75.68%. Blood NSE had no predictive value for ICU delirium (AUC = 0.446, P = 0.290).@*Conclusions@#Blood PCT and Lac are the risk factors of ICU delirium. PCT has predictive value for ICU delirium.

Clinical Efficacy of Salvianolate for Injection Combined with the Conventional Therapy in Ischemic Stroke / 中国药师

Objective:To investigate the clinical efficacy of salvianolate in the treatment of ischemic stroke(IS) and its effect on the serum levels of uric acid, hypoxia Inducible Factor-1α (HIF-1α), neuroglobin (NGB), hypersensitive C-reaction protein (hs-CRP),regulatory T cell(Treg) and helper T lymphocyte 17 (Th17). Methods:Totally 196 IS patients in our hospital were analyzed and divided into the control group(n=96) and the observation group(n=96). The patients in the control group were treated with the traditional therapy,and the patients in the observation group were treated with salvianolate additionally. The clinical effect and disabili-ty were observed;and the serum levels of uric acid,HIF-1α,NGB,hs-CRP,Treg and Th17 were compared between the groups. Re-sults:Before the treatment,there were no differences in uric acid,HIF-1α,NGB,hs-CRP,Treg and Th17 between the groups(P>0.05). After the 14-day treatment,the effective rate was 69.79% in the observation group,which was higher than that in the control group (P<0.05). NIHSS scores and mRS scores of the two groups were lower than baseline values (55.21%,P<0.05). After 3-month follow-up,NIHSS scores,mRS scores and the disability rate(12.5%) in the observation group were obviously lower than those in the control group(P<0.05). After the 14-day treatment,the serum levels of uric acid,HIF-1α,NGB,and hs-CRP in the obser-vation group were lower than those in the control groups (P<0.05). Besides, the patients in the observation group were with more Treg and fewer Th17 than the control group and baseline value (P<0.05). Conclusion:The application of salvianolate in the treat-ment of ischemic stroke can effectively improve the disability and neurological function defects,which should be recommended for the clinical use as an effective drug.

The effects of antidepressants on inflammatory factors of frontal lobe in depression model rats / 中华行为医学与脑科学杂志

Objective To investigate the effect of antidepressants on frontal lobe inflammatory factors in depressed model rats.Methods Thirty SD rats were randomly divided into 5 groups (n=6):contorl group(Cn),depression group (Dn),citalopram group (Dx),venlafaxine group (Dw) and reboxetine group (Dr).The open field test and sugar consumption test were performed to observe the depression behavior and the changes of FGF-1,TNF-α,IL-1 and CRP were measured in frontal lobe of rats by ELISA.Pearson linear correlation analysis was used to evaluate the correlation between behavioral score and inflammatory factors level in rats.Results (1)Compared with the Cn group,the scores of Dn,Dr,Dw,Dx group were decreased on Open field test and sugar consumption test (P＜0.05).Compared with the Dn group,the scores of the Dx,Dw,Dr group were increased in Open field test and sugar consumption test (P＜0.05).(2)Compared with Cn group,the levels of TNF-α,IL-1 and CRP increased in Dn group and FGF-1 level decreased (P＜0.01).Compared with Dn group,the levels of FGF-1 increased in Dx ((86.54±2.56) ng/L),Dw((79.82±4.89) ng/L)and Dr ((68.50 ± 3.61) ng/L) group,however,the levels of TNF-α decreased in Dx ((150.21±5.65) ng/L),Dw ((161.28±8.80) ng/L),Dr ((175.78±9.67) ng/L) group,and the level of IL-1 also decreased in Dx ((30.87±4.48) ng/L),Dw ((36.65±3.33) ng/L),Dr ((40.14±2.81)ng/L) group,and the levels of CRP also decreased in Dx ((374.88 ± 14.15) ng/L),Dw ((394.21 ± 17.03) ng/L),Dr ((414.34± 10.97)ng/L) (P＜0.01).(3)The behavioral score of each group was positively correlated with of FGF-1 and negatively correlated with TNF-a,IL-1 and CRP (P＜0.05).Conclusion Antidepressants can reduce the level of proinflammatory factors and increase the level of anti-inflammatory factors of frontal lobe in depression model rats,suggesting that antidepressants may play an antidepressant effect by regulating the concentration of inflammatory factors.

Clinical Significance of SAA, CRP and hsCRP in HBV Hepatopathy Patients / 现代检验医学杂志

Objective To explore the diangostic value of serumhigh sensitive C-reaction prtein (hsCRP) serum amyloid a (SAA) and C-reaction protein (CRP) in patients who had HBV hepatopathy.Method 127 subjects with hepatopathy caused by HBV infection and 50 control subjects were incorporated in this research,and 47 cases with HBV hepatitis,35 cases with HBV cirrhosis and 45 cases with hepatic failure and SAA and CRP hsCRP of every sample was detected.Results ①Levels of CRP and hsCRP in cases were significantly higher than controls (Mann-Whitney U test,Z=-2.792,-8.458,P＜0.01).②The hsCRP levels in the three different groups of cases were different (Kruskal-Wallis test,x2=11.625,P＜ 0.01).③The hsCRP level of group 2 and 3 was significantly higher than group 1 in the hepatic damage groups (Mann-Whitney U test,Z=-2.849,-2.902,P＜0.01).④But the level of SAA had no statistically significant in any group.⑤The seropositivity of hsCRP in cases group was 76.29 ％ and it was higher than CRP (11.34 ％) and SAA(26.80 ％).Conclusion The diangosic value of CRP and hsCRP may better than SAA in the patients who got HBV hepatic damage which maybe caused by detection method as hsCRP is better than CRP.