急性心肌梗死血清C-反应蛋白和血清淀粉样蛋白A的关系

目的探讨急性心肌梗死(AMI)患者血清C-反应蛋白(CRP)和血清淀粉样蛋白A(SAA)的关系。方法分别测定AMI患者125例,健康对照组50例的血清CRP和SAA水平,并进行比较分析。结果 AMI组CRP、SAA水平分别为(48.5±35.9)mg/L和(342.9±244.3)mg/L,明显高于健康对照组的(11.2±7.2)mg/L和(46.3±21.9)mg/L,差异有统计学意义(P<0.05);CRP水平与SAA水平呈正相关(r=0.816,P<0.05)。结论 AMI患者血清CRP和SAA水平明显升高,血清CRP与SAA水平呈正相关,可作为AMI早期识别及诊断的具有积极意义的辅助诊断及鉴别诊断指标。

C-反应蛋白对慢性阻塞性肺疾病的诊断价值分析

目的:对C‐反应蛋白((C-reactive protein,CRP)在慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)临床诊断中的价值进行深入分析。方法:选取2015年2月~2016年2月本院收治的90例COPD患者纳入研究中,依照病情程度分为研究I组(急性加重期)和研究II组(稳定期),均为45例;选同期45例健康自愿者为对比组,对3组的静脉CRP水平进行比较分析;并对治疗前后急性加重组患者的CRP水平进行ROC曲线分析。结果:在治疗前,研究I组患者的CRP水平均高于其他两组,差异有统计意义(P<0.05);治疗后研究I组患者的CRP水平和研究II组无显著差异(P>0.05);研究II组的CRP水平显著高于对比组(P<0.05);基于ROC曲线把CRP水平>14.6mg/L为停用抗菌药物标准值,敏感性91.3%,特异性92.7%,ROC曲线下面积结果为0.831。结论:COPD患者在不同阶段的CRP水平是有所变化的,能为病情判断提供依据,也是抗菌药物停用的一个指导标准,有着重要的临床价值。

Role of oxygen free radicals in patients with acute pancreatitis

AIM:The generation of oxygen free radicals has been implicated in the pathogenesis of experimental pancreatitis. The aim of this study was to determine the role of oxygen free radicals in patients with acute pancreatitis. METHODS:The plasma levels of C-reactive protein(CRP), lipid peroxide(LPO),myeloperoxidase(MPO)and superoxide dismutase(SOD)were measured in 13 patients with acute pancreatitis and 14 healthy volunteers. RESULTS:Among the patients with acute pancreatitis,there were higher plasma levels of LPO and MPO and lower SOD activity in patients with severe pancreatitis than in those with mild pancreatitis.However,there was no significant difference in the serum marker of oxidative stress no matter what the etiology was.The LPO level was especially correlated with the concentration of serum CRP and CT severity index. CONCLUSION:The oxygen free radicals may be closely associated with inflammatory process and the severity of acute pancreatitis.Especially,the concentration of plasma LPO is a meaningful index for determining the severity of the disease.

Assessment of the validity of the clinical pathway for colon endoscopic submucosal dissection

AIM: To determine the effective hospitalization period as the clinical pathway to prepare patients for endoscopic submucosal dissection (ESD). METHODS: This is a retrospective observational study which included 189 patients consecutively treated by ESD at the National Cancer Center Hospital from May 2007 to March 2009. Patients were divided into 2 groups; patients in group A were discharged in 5 d and patients in group B included those who stayed longer than 5 d. The following data were collected for both groups: mean hospitalization period, tumor site, median tumor size, post-ESD rectal bleeding requiring urgent endoscopy, perforation during or after ESD, abdominal pain, fever above 38 ℃, and blood test results positive for inflammatory markers before and after ESD. Each parameter was compared after data collection. RESULTS: A total of 83% (156/189) of all patients could be discharged from the hospital on day 3 postESD. Complications were observed in 12.1% (23/189) of patients. Perforation occurred in 3.7% (7/189) of patients. All the perforations occurred during the ESD procedure and they were managed with endoscopic clipping. The incidence of post-operative bleeding was 2.6% (5/189); all the cases involved rectal bleeding. We divided the subjects into 2 groups: tumor diameter ≥ 4 cm and < 4 cm; there was no significant difference between the 2 groups (P = 0.93, χ 2 test with Yates correction). The incidence of abdominal pain was 3.7% (7/189). All the cases occurred on the day of the procedure or the next day. The median white blood cell count was 6800 ± 2280 (cells/μL; ± SD) for group A, and 7700 ± 2775 (cells/μL; ± SD) for group B, showing a statistically significant difference (P = 0.023, t-test). The mean C-reactive protein values the day after ESD were 0.4 ± 1.3 mg/dL and 0.5 ± 1.3 mg/dL for groups A and B, respectively, with no significant difference between the 2 groups (P = 0.54, t -test). CONCLUSION: One-day admission is sufficient in the absence of complications during ESD or early postoperative bleeding.

C-reactive protein,procalcitonin,interleukin-6,vascular endothelial growth factor and oxidative metabolites in diagnosis of infection and staging in patients with gastric cancer

AIM:The current study was to determine the serum/pLasma levels of VEGF,IL-6,malondialdehyde (MDA),nitric oxide (NO),PCT and CRP in gastric carcinoma and correlation with the stages of the disease and accompanying infection. METHODS:We examined the levels of serum VEGF,IL-6, PCT,CRP and plasma MDA,NO in 42 preoperative gastric cancer patients and 23 healthy subjects.There were infection anamneses that had no definite origin in 19 cancer patients. RESULTS:The VEGF levels (mean±SD; pg/mL) were 478.05±178.29 and 473.85±131.24 in gastric cancer patients with and without infection,respectively,and these values were not significantly different (P>0.05).The levels of VEGF, CRP,PCT,It-6,MDA and NO in cancer patients were significantly higher than those in healthy controls and the levels of CRP,PCT,It-6,MDA and NO were statistically increased in infection group when compared with non- infection group (P<0.001). CONCLUSION:Although serum VEGF concentrations were increased in gastric cancer,this increase might not be related to infection.CRP,PCT,IL-6,MDA and NO have obvious drawbacks in the diagnosis of infections in cancer patients. These markers may not help to identify infections in the primary evaluation of cancer patients and hence to avoid unnecessary antibiotic treatments as well as hospitalization. According to the results of this study,IL-6,MDA,NO and especially VEGF can be used as useful parameters to diagnose and grade gastric cancer.

Adjusting CA19-9 values to predict malignancy in obstructive jaundice:Influence of bilirubin and C-reactive protein

AIM:To find a possible relationship between inflammation and CA19-9 tumor marker by analyzing data from patients with benign jaundice(BJ) and malignant jaundice(MJ).METHODS:All patients admitted for obstructive jaundice,in the period 2005-2009,were prospectively enrolled in the study,obtaining a total of 102 patients.On admission,all patients underwent complete standard blood test examinations including C-reactive protein(CRP),bilirubin,CA19-9.Patients were considered eligible for the study when they presented obstructive jaundice confirmed by instrumental examinations and increased serum bilirubin levels(total bilirubin > 2.0 mg/dL).The standard cut-off level for CA19-9 was 32 U/mL,whereas for CRP this was 1.5 mg/L.The CA19-9 level was adjusted by dividing it by the value of serum bilirubin or by the CRP value.The patients were divided into 2 groups,MJ and BJ,and after the adjustment a comparison between the 2 groups of patients was performed.Sensitivity,specificity and positive predictive values were calculated before and after the adjustment.RESULTS:Of the 102 patients,51 were affected by BJ and 51 by MJ.Pathologic CA19-9 levels were found in 71.7% of the patients.In the group of 51 BJ patients there were 29(56.9%) males and 22(43.1%) females with a median age of 66 years(range 24-96 years),whereas in the MJ group there were 24(47%) males and 27(53%) females,with a mean age of 70 years(range 30-92 years).Pathologic CA19-9 serum level was found in 82.3% of MJ.CRP levels were pathologic in 66.6% of the patients with BJ and in 49% with MJ.Bilirubin and CA19-9 average levels were significantly higher in MJ compared with BJ(P = 0.000 and P = 0.02),while the CRP level was significantly higher in BJ(P = 0.000).Considering a CA19-9 cut-off level of 32 U/mL,82.3% in the MJ group and 54.9% in the BJ group were positive for CA19-9(P = 0.002).A CA19-9 cut-off of 100 U/mL increases the difference between the two groups:35.3% in BJ and 68.6% in MJ(P = 0.0007).Adjusting the CA19-9 value by dividing it by serum bilirubin level meant that 21.5% in the BJ and 49% in the MJ group remained with a positive CA19-9 value(P = 0.003),while adjusting the CA19-9 value by dividing it by serum CRP value meant that 31.4% in the BJ group and 76.5% in the MJ group still had a positive CA19-9 value(P = 0.000004).Sensitivity,specificity,positive predictive values of CA19-9 > 32 U/mL were 82.3%,45% and 59.1%;when the cutoff was CA19-9 > 100 U/mL they were,respectively,68.6%,64.7% and 66%.When the CA19-9 value was adjusted by dividing it by the bilirubin or CRP values,these became 49%,78.4%,69.4% and 76.5%,68.6%,70.9%,respectively.CONCLUSION:The present study proposes CRP as a new and useful correction factor to improve the diag-nostic value of the CA19-9 tumor marker in patients with cholestatic jaundice.

Significance of preoperative C-reactive protein as a parameter of the perioperative course and long-term prognosis in squamous cell carcinoma and adenocarcinoma of the oesophagus

AIM： C-reactive protein （CRP） is an acute-phase reactant and a known indicator of the malignant potential of the tumour. The aim of this study was to investigate the significance of preoperative CRP as a parameter of the perioperative course and long-term prognosis in patients with squamous cell carcinoma and aclenocarcinoma of the oesophagus. METHODS： Serum CRP was determined preoperatively in 291 of 371 patients undergoing oesophagectomy for cancer from December 1989 to March 2004. Median patient age was 59 （28-79） year, 82.5% of patients were males. Squamous cell carcinoma was diagnosed in 151 （51.9%） and aclenocarcinoma in 122 patients. Transhiatal oesophagectomy was clone in 151 （51.9%） patients and 134 （46.0%） patients underwent the abclominothoracic procedure. RESULTS： In 127 （43.6%） patients the preoperative serum CRP concentration was within the normal range （〈 5 mg/clL）, elevated CRP levels were measured in 164 （56.4%） patients. Tumour extension （P 〈 0.0005） and the number of lymph nodes affected by metastatic spread （P = 0.015） were significantly increased in the group with elevated CRP levels. Among the perioperative parameters both the number of blood transfusions （P = 0.006） and the general complication rate （P = 0.002） were higher in patients with elevated preoperative CRP levels. The long-term survival rate of 13.6 （0-109.8） mo was poorer in the group with elevated CRP levels compared to 18.9 （0-155.4） mo in the group with normal CRP levels （log-rank test： P = 0.107）. Multivariateanalysis with backward variables selection identified preoperative CRP as an independent prognostic factor of the long-term prognosis in patients with oesophageal carcinoma, with a hazard ratio of 1.182 （95% confidence interval： 1.030-1.356）. CONCLUSION： The preoperative serum CRP-level is an easily determined independent prognostic marker in patients with squamous cell carcinoma and adenocarcinoma of the oesophagus.

High sensitivity C-reactive protein and cardfiac resynchronization therapy in patients with advanced heart failure

Background The data on the prognostic values of high sensitivity C-reactive protein （hsCRP） levels in patients with advanced symp-tomatic heart failure （HF） receiving cardiac resynchronization therapy （CRT） are scarce. The aim of present study was to investigate the association of serum hsCRP levels with left ventricle reverse remodeling after six months of CRT as well as long-term outcome. Methods A total of 232 CRT patients were included. The assessment of hsCRP values, clinical status and echocardiographic data were performed at baseline and after six months of CRT. Long-term follow-up included all-cause mortality and hospitalizations for HF. Results During the mean follow-up periods of 31.3 ± 31.5 months, elevated hsCRP （〉3 mg/L） prior to CRT was associated with a significant 2.39-fold increase （P=0.006） in the risk of death or HF hospitalizations. At 6-month follow-up, patients who responded to CRT showed significant reductions or maintained low in hsCRP levels （–0.5 ± 4.1 mg/L reduction） compared with non-responders （1.7 ± 6.1 mg/L increase, P=0.018）. Com-pared with patients in whom 6-month hsCRP levels were reduced or remained low, patients in whom 6-month hsCRP levels were increased or maintained high experienced a significantly higher risk of subsequent death or HF hospitalizations （Log-rank P〈0.001）. The echocardio-graphic improvement was also better among patients in whom 6-month hsCRP levels were reduced or remained low compared to those in whom 6-month hsCRP levels were raised or maintained high. Conclusions Our findings demonstrated that measurement of baseline and follow-up hsCRP levels may be useful as prognostic markers for timely potential risk stratification and subsequent appropriate treatment strategies in patients with advanced HF undergoing CRT.

Chios mastic treatment of patients with active Crohn's disease

AIM: To evaluate the effectiveness of mastic administra-tion on the clinical course and plasma inflammatory me-diators of patients with active Crohn’s disease (CD).METHODS: This pilot study was conducted in patients with established mild to moderately active CD, attend-ing the outpatient clinics of the hospital, and in healthy controls. Ten patients and 8 controls were recruited for a 4-wk treatment with mastic caps (6 caps/d, 0.37 g/cap). All patients successfully completed the protocol. CD Ac-tivity Index (CDAI), Nutritional Risk Index (NRI), C-re-active protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), monocyte chemotactic protein-1 (MCP-1), and total antioxidant potential (TAP) were evaluated in the plasma at baseline and at the end of the treatment period. Results were expressed as mean values ± SE and P < 0.05 was considered to indicate statistical significance.RESULTS: Patients exhibited significant reduction of CDAI (222.9 ± 18.7 vs 136.3 ± 12.3, P = 0.05) as com-pared to pretreament values. Plasma IL-6 was signifi-cantly decreased (21.2 ± 9.3 pg/mL vs 7.2 ± 2.8 pg/ mL, P = 0.027), and so did CRP (40.3 ± 13.1 mg/mL vs 19.7 ± 5.5, P = 0.028). TAP was significantly increased (0.15 ± 0.09 vs 0.57 ± 0.15 mmol/L uric acid, P = 0.036). No patient or control exhibited any kind of side effects. CONCLUSION: The results suggest that mastic signifi-cantly decreased the activity index and the plasma levels of IL-6 and CRP in patients with mildly to moderately ac-tive CD. Further double-blind, placebo-controlled studies in a larger number of patients are required to clarify the role of this natural product in the treatment of patients with CD.

Probiotic intervention has strain-specific anti-inflammatory effects in healthy adults

AIM： To evaluate the effects of three potentially anti-inflammatory probiotic bacteria from three different genera on immune variables in setting based on previous in cytokine responses. healthy adults in a clinical vitro characterization of METHODS： A total of 62 volunteers participated in this randomized, double-blind and placebo-controlled parallel group intervention study. The volunteers were randomized to receive a milk-based drink containing either Lactobacillus rhamnosus GG （LGG）, Bifidobacterium animalis ssp. lactis Bb12 （Bb12）, or Propionibacterium freudenreichii ssp. shermanii JS （PJS） or a placebo drink for 3 wk. Venous blood and saliva samples were taken at baseline and on d 1, 7 and 21. Fecal samples were collected at baseline and at the end of intervention. RESULTS： The serum hsCRP expressed as the median AUC0-21 （minus baseline） was 0.018 mg/L in the placebo group, -0.240 mg/L in the LGG group, 0.090 mg/L in the Bb12 group and -0.085 mg/L in the PJS group （P = 0.014）. In vitro production of TNF-α from in vitro cultured peripheral blood mononuclear cells （PBMC） was significantly lower in subjects receiving LGG vs placebo. IL-2 production from PBMC in the Bb12 group was significantly lower compared with the other groups. CONCLUSION： In conclusion, probiotic bacteria have strain-specific anti-inflammatory effects in healthy adults.

Associations of big endothelin-1 and C-reactive protein in atrial fibrillation

Background Atrial fibrillation （AF） is associated with inflammation and endothelial dysfunction. However, the association between inflammation （as indexed by high-sensitivity C-reactive protein, hs-CRP） and endothelial function [as indexed by big endothelin-1 （ET-1）] in AF patients remains unclear. Methods We enrolled 128 patients with lone AF, among which 83 had paroxysmal AF, and 45 had persistent AF. Eighty-two age- and gender-matched controls of paroxysmal supraventricular tachycardia without AF history were evaluated. Plasma hs-CRP, big ET-1 levels and other clinical characteristics were compared among the groups. Results Patients with persistent AF had higher hs-CRP concentrations than those with paroxysmal AF （P 〈 0.05）, both groups had higher hs-CRP level than controls （P 〈 0.05）. Patients with persistent AF had higher big ET-1 level than those with paroxysmal AF, although the difference did not reach the statistical significance （P 〉 0.05）, and both groups had higher big ET-1 levels than controls （P 〈 0.05）. Multiple regression analyses revealed hs-CRP as an inde- pendent determinant of AF （P 〈 0.001）. Further adjusted for big ET-1, both big ET-1 and hs-CRP were independent predictors for AF （P 〈 0.001）, but the odds ratio for hs-CRP in predicting AF attenuated from 8.043 to 3.241. There was a positive relation between hs-CRP level and big ET-1 level in paroxysmal AF patients （r = 0.563, P 〈 0.05）, however, the relationship in persistent AF patients was poor （r = 0.094, P 〈 0.05）. Conclusions Both plasma hs-CRP and big ET-1 levels are elevated in lone AF patients, and are associated with AF. In paroxysmal lone AF patients, there were significant positive correlations between plasma hs-CRP level and big ET- 1 level.

C-reactive protein levels during a relapse of Crohn’s disease are associated with the clinical course of the disease

AIM： TO explore if C-reactive protein （CRP） levels might serve as a prognostic factor with respect to the clinical course of Crohn＇s disease and might be useful for classification. METHODS： In this retrospective cohort study we enrolled 94 patients from the inflammatory bowel disease （IBD） database of the University Medical Centre Utrecht. CRP levels during relapse were correlated with the number of relapses per year. Severity of relapses was based on endoscopic reports and prednisone use. Furthermore, patients were categorized in a low or high CRP group based on their CRP response during relapse and demographic and clinical features were compared. RESULTS： Overall, a positive correlation between CRP levels, number of relapses, and severity of relapse was found （respectively rs = 0.31, P 〈 0.01 and rs = 0.50, P 〈 0.001）. Employing a cut-off level of 15 mg/L, the index CRP level was found to discriminate patients with respect to the number of relapses per year, as well as for severity of relapses （respectively 0.25 ± 0.16 vs 0.36 ± 0.24, P 〈 0.05 and 4.4 ± 1.2 vs 3.2 ± 1.1 on a 10-point visual analogue scale, P 〈 0.001 for the high CRP and low CRP groups respectively）. In addition, the high CRP group showed more cumulative days of prednisone use per year （107 ± 95 vs 58 ± 48, P 〈 0.05）, as well as a better response to infiiximab （93 % vs 33 %, P = 0.06）. CONCLUSION： A higher CRP level during relapse seems to be associated with a more severe clinical course of disease.

Can mean platelet volume play a role in evaluating the severity of acute pancreatitis?

AIM To investigate serum mean platelet volume(MPV) levels in acute pancreatitis(AP) patients and assess whether MPV effectively predicts the disease severity of AP.METHODS We included 117 consecutive patients with AP as the AP group and 34 consecutive patients with colorectal polyps(before endoscopic treatment) as the control group. Complete blood counts, liver function, platelet indices(MPV), coagulation parameters, lactate dehydrogenase(LDH) and C-reactive protein(CRP) were measured on days 1, 2, 3 and 7 after admission. Receiver operating characteristic curves were used to compare the sensitivity and specificity of MPV, white blood cell(WBC), LDH and CRP in predicting AP severity. The Modified Glasgow Prognostic Score(m GPS) and the 2012 revised Atlanta criteria were used to evaluate disease severity in AP.RESULTS MPV levels were significantly lower in the AP group than in the control group on day 1(P = 0.000), day 2(P = 0.029) and day 3(P = 0.001) after admission.In addition, MPV values were lower on day 1 after admission than on day 2(P = 0.012), day 3(P = 0.000) and day 7(P = 0.002) in all AP patients. Based on the m GPS, 78 patients(66.7%) were diagnosed with mild and 39 patients(33.3%) with severe AP. There was no significant difference in mean MPV levels between patients diagnosed with mild and severe AP based on the m GPS(P = 0.424). According to the 2012 revised Atlanta criteria, there were 98 patients(83.8%) without persistent organ failure(OF) [non-severe acute pancreatitis(non-SAP) group] and 19 patients(16.2%) with persistent OF(SAP group). MPV levels were significantly lower in the SAP group than in the non-SAP group on day 1 after admission(P = 0.002). On day 1 after admission using a cut-off value of 6.65 f L, the overall accuracy of MPV for predicting SAP according to the 2012 revised Atlanta criteria(AUC = 0.716) had a sensitivity of 91.8% and a specificity of 47.4% and was superior to the accuracy of the traditional markers WBC(AUC = 0.700) and LDH(AUC = 0.697).CONCLUSION MPV can be used at no additional cost as a useful, noninvasive biomarker that distinguishes AP with persistent OF from AP without persistent OF on day 1 of hospital admission.

Role of ascites adenosine deaminase in differentiating between tuberculous peritonitis and peritoneal carcinomatosis

AIM： To investigate the usefulness of tumor markers and adenosine deaminase in differentiating between tuberculous peritonitis （TBP） and peritoneal carcinoma- tosis （PC）. METHODS： A retrospective analysis of data was per- formed on consecutive patients who underwent perito- neoscopic and abdominal computed tomography （CT） evaluations. Among 75 patients at the Seoul National University Hospital from January 2000 to June 2010 who underwent both tests, 27 patients （36.0%） and 25 patients （33.3%） were diagnosed with TBP and PC, re- spectively. Diagnosis was confirmed by peritoneoscopic biopsy. RESULTS： Serum c-reactive protein （7.88：1：6.62 mg/ dL vs 3.12 ＋ 2.69 mg/dL, P = 0.01）, ascites adenos- ine deaminase （66.76：1：32.09 IU/L vs 13.89 ：l： 8.95 IU/L, P 〈 0.01）, ascites lymphocyte proportion （67.77 ：1： 23.41% vs 48.36 ＋ 18.78%, P 〈 0.01）, and serum- ascites albumin gradient （0.72 ＋ 0.49 g/dL vs 1.05 ＋ 0.50 g/dL, P = 0.03） were significantly different be- tween the two groups. Among tumor markers, serum and ascites carcinoembryonic antigen, serum carbohy- drate antigen 19-9 showed significant difference be- tween two groups. Abdominal CT examinations showed that smooth involvement of the parietal peritoneum was more common in the TBP group （77.8% vs 40.7%） whereas nodular involvement was more common in the PC group （14.8% vs 40.7%, P = 0.04）. From receiver operating characteristic （ROC） curves ascites adeno- sines deaminase （ADA） showed better discriminative capability than tumor markers. An ADA cut-off level of 21 IU/L was found to yield the best results of differ- ential diagnosis; sensitivity, specificity, positive predic- tive value, and negative predictive value were 92.0%, 85.0%, 88.5% and 89.5%, respectively. CONCLUSION： Besides clinical and radiologic findings, ascitic fluid ADA measurement is helpful in the differen- tial diagnosis of TBP and PC.

Atherosclerosis： from biology to pharmacological treatment

A recent explosion in the amount of cardiovascular risk has swept across the globe. Primary prevention is the preferred method to lower cardiovascular risk. Lowering the prevalence of obesity is the most urgent matter, and is pleiotropic since it affects blood pressure, lipid profiles, glucose metabolism, inflammation, and atherothrombotic disease progression. Given the current obstacles, success of primary prevention remains uncertain. At the same time, the consequences of delay and inaction will inevitably be disastrous, and the sense of urgency mounts. Pathological and epidemiological data confirm that atherosclerosis begins in early childhood, and advances seamlessly and inexorably throughout life. Risk factors in childhood are similar to those in adults, and track between stages of life. When indicated, aggressive treatment should begin at the earliest indication, and be continued for many years. For those patients at intermediate risk according to global risk scores, C-reactive protein, coronary artery calcium, and carotid intima-media thickness are available for further stratification. Using statins for primary prevention is recommended by guidelines, is prevalent, but remains under prescribed. Statin drugs are unrivaled, evidence-based, major weapons to lower cardiovascular risk. Even when low density lipoprotein cholesterol targets are attained, over half of patients continue to have disease progression and clinical events. Though clinical evidence is incomplete, altering or raising the blood high density lipoprotein cholesterol level continues to be pursued. The aim of this review is to point out the attention of key aspects of vulnerable plaques regarding their pathogenesis and treatment.

Is there correlation between pancreatic enzyme and radiological severity in acute pancreatitis?

AIM: To investigate the correlation between the changes of pancreatic enzyme, the biochemical markers and the clinical results according to the Balthazar computer tomography (CT) grade. METHODS: Between July 2004 and July 2005, we reviewed the charts of 119 patients who were admitted to our hospital with acute pancreatitis. RESULTS: Eighty-three patients (69.7%) were male, and the mean age of the patients was 57 ± 15.7 years. The biliary pancreatitis patients had an older mean age. Forty-nine patients (41.1%) had biliary pancreatitis and forty-six (38.6%) had alcoholic pancreatitis. Group 3 patients had a longer duration of pain (2.51 ± 1.16 vs 3.17 ± 1.30 vs 6.56 ± 6.13, P < 0.001), a longer period of fasting (7.49 ± 4.65 vs 10.65 ± 5.54 vs 21.88 ± 13.81, P < 0.001) and a longer hospital stay (9.17 ± 5.34 vs 14.63 ± 8.65 vs 24.47 ± 15.52, P < 0.001) than the other groups. On the univariate analysis, the factors that affected the radiological grade were the leukocyte count at admission (P = 0.048), the hemoglobin (P = 0.016) and total bilirubin concentrations (P = 0.023), serum lipase (P = 0.009), the APACH Ⅱ scores at admission (P = 0.017), the APACH Ⅱ scores after 24 h (P = 0.031), the C-reactive protein (CRP) titer (P = 0.0001) and the follow up CRP titer (P = 0.003). But the CRP level (P = 0.001) and follow up CRP titer (P = 0.004) were only correlated with the radiological grade on multivariate analysis. According to the ROC curve, when we set the CRP cut off value at 83 mg/L, the likelihoodratio for a positive test was 3.84 and the likelihood ratio for a negative test was 0.26 in group 3. CONCLUSION: In conclusion, our study suggests that the CRP with the radiological severity may be used to estimate the severity of acute pancreatitis.

Natural orifice transluminal endoscopic surgeryvs laparoscopic ovariectomy:Complications and inflammatory response

AIM:To compare natural orifice transluminal endoscopic surgery (NOTES) vs standard laparoscopic ovariectomy in mini pigs with respect to technical aspects,complications and parameters of systemic inflammatory response.METHODS:This was a randomized,experimental,survival study.Ten female mini pigs underwent NOTES transgastric ovariectomy (NOTES group) and ten female mini pigs underwent laparoscopic ovariectomy (LAP group).A "percutaneous endoscopic gastrostomy" approach with guidewire and sphincterotome was used for gastrotomy creation.The ovary was resected using standard biopsy forceps and a snare.The access site was closed using a "KING" closure with a single endoloop and several clips.In the laparoscopic group,a three-port laparoscopy and an ovariectomy were performed with the use of standard laparoscopic devices.C-reactive protein (CRP),white blood count and interleukin (IL)-6 plasma levels were used as indicators of systemic inflammatory response.All animals were euthanized 28 d after surgery.RESULTS:All animals survived without complications.The mean procedure time was 41.3 min ± 17.6 min (NOTES group) and 25.7 min ± 5.25 min (LAP group,P < 0.02).Postmortem examinations demonstrated that 50% and 70% of animals were free of any complications in the NOTES and LAP groups,respectively.The remaining animals developed minor complications (adhesions) in a comparable frequency between the two groups.In the NOTES group,one animal developed a small intramural gastric abscess close to the gastrotomy site.A minor serous exudate that was present in 50% and 40% of the animals in the NOTES and laparoscopy groups,respectively,was not considered a complication.In both groups CRP levels increased significantly on the 2nd and 7th postoperative days (POD) and returned to normal after 28 d.On POD 2,an increase of CRP level was significantly higher in the NOTES group compared to the LAP group.Values of IL-6 did not differ from baseline values in either of the groups postoperatively.Interestingly,the platelet count decreased significantly on POD 2,but returned close to baseline values on POD 7 and PODs 28-30.CONCLUSION:Both NOTES and laparoscopic ovariectomies had a similar frequency of minor complications.However,the NOTES technique produced an increased systemic inflammatory response on POD 2.

Markers of systemic inflammation and colorectal adenoma risk: Meta-analysis of observational studies

To perform a meta-analysis of observational studies on inflammatory markers levels and occurrence of colorectal adenoma.METHODSPubMed and EMBASE databases were searched until March 2016 for the articles reporting on the circulating levels of inflammatory markers, including: C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) and risk of colorectal adenoma. Random-effects models were used to calculate summary odds ratios (ORs) with 95%CIs for the highest vs lowest category of exposure. Heterogeneity was assessed by using the Q test and I2 statistic. Subgroup analyses were also performed to test for potential source of heterogeneity.RESULTSA total of 14 case-control studies were included. Ten studies on CRP including a total of 3350 cases and 4168 controls showed non-significant summary (OR = 1.23, 95%CI: 0.98-1.54; I2 = 54%, Pheterogeneity = 0.01) in the general analysis, but significant increased odds when considering only advanced adenoma (OR = 1.59, 95%CI: 1.09-2.32; I2 = 44%, Pheterogeneity = 0.15). Subgroup and stratified analyses revealed a potential influence of smoking status and aspirin use on the association between CRP levels and colorectal adenoma. Five studies examined the association between circulating levels of TNF-α and colorectal adenoma risk, including a total of 1,568 cases and 2,832 controls. The summary OR for the highest vs the lowest category of exposure was 1.00 (95%CI: 0.77-1.29). The relationship between circulating IL-6 levels and colorectal adenoma risk was investigated in 7 studies including a total of 1936 cases and 3611 controls. The summary OR for the highest vs the lowest category of exposure was 1.19 (95%CI: 0.92-1.55).CONCLUSIONSummary of current evidence suggests a positive association of CRP levels and advanced colorectal adenoma risk. The role of potential confounding factors should be further evaluated.

Comparison between surgical outcomes of colorectal cancer in younger and elderly patients

AIM:To compare the outcome of surgical treatment of colorectal adenocarcinoma in elderly and younger patients.METHODS:The outcomes of 122 patients with colorectal adenocarcinoma who underwent surgical treatment between January 2004 and June 2009 were analyzed.The clinicopathological and blood biochemistry data of the younger group(<75 years) and the elderly group (≥75 years) were compared.RESULTS:There were no significant differences between the two groups in operation time,intraoperative blood loss,hospital stay,time to resumption of oral intake,or morbidity.The elderly group had a significantly higher rate of hypertension and cardiovascular disease.The perioperative serum total protein and albumin levels were significantly lower in the elderly than in the younger group.The serum carcinoembryonic antigen level was lower in the elderly than in the younger group,and there was a significant decreasing trend after the operation in the elderly group.CONCLUSION:The short-term outcomes of surgical treatment in elderly patients with colorectal adenocarcinoma were acceptable.Surgical treatment in elderly patients was considered a selectively effective approach.

Comments to ＂Neutrophil-to-lymphocyte ratio compared to N-terminal pro- brain natriuretic peptide as a prognostic marker of adverse events in elderly patients with chronic heart failure＂

We have read the article which entitled ＂Neutrophil-to- lymphocyte ratio compared to N-terminal pro-brain natri- uretic peptide as a prognostic marker of adverse events in elderly patients with chronic heart failure＂ published in Journal of Geriatric Cardiology with great interest, However, we have some comments regarding this study.