An increase in cellular inflammatory biomarkers directly increases the risk of cardiovascular disease (CVD). Using the social ecological and biomedical theories, the study examined quantitatively how specific inflammatory biomarkers are associated with cardiorenal syndrome (CRS), a potential complication of hypertension and diabetes, and how sociodemographic factors modify this association in the U.S. adult population. A retrospective secondary data analysis of the data collected from National Health and Nutrition Examination Survey (NHANES) 1999-2010 was utilized to evaluate these hypotheses. High sensitivity C-reactive protein, homocysteine (hcy), and fibrinogen had a modifying effect on Type 4 (chronic reno-cardiac etiology), Type 2 CRS (chronic cardio-renal etiology), and a significant additive effect on CRS even after controlling for known CVD and Chronic Kidney Disease (CKD) risk factors. For Type 4 CRS, the adjusted Odds Ratio of CVD in individuals with CKD was elevated, 2.29 (Confidence Interval [CI] 1.17-3.64, p < 0.05), among individuals with elevated hcy levels but close to 1.0 (0.65 CI 0.28-1.53, p > 0.05) among patients with normal hcy after the results were controlled for medical and demographic risk factors. Finally, race modified the effect of inflammatory markers on CRS. Out of all the biomarkers, income only modified the effect of hcy on CRS. Education level modified the effect of every inflammatory marker on CRS. While Ferritin-to-Transferrin ratio (F/T ratio) had a non-significant additive effect, due to the lack of adequate subjects, the modifying effect of F/T ratio could not be tested. This study can help initiate social change by urging healthcare professionals to monitor these biomarkers as a part of preventing hypertension, diabetes, and CRS.

Objectives. Evaluate C-reactive protein (CRP) levels according to weight and physical activity. The study explored how changes in CRP were associated with baseline CRP, weight, and physical activity and changes in these variables. Methods. A randomized controlled study design assigned 348 individuals to the intervention or control group with measurements taken at baseline, 6 weeks, and 6 months of body weight, physical activity, and serum CRP levels. Participants attended an intensive 40-hour educational course delivered over a four-week period. Results. At baseline, CRP was negatively associated with total steps/week, and positively associated with weight, BMI, percent fat, and saturated fat at baseline. CRP significantly decreased through 6 weeks and also through 6 months for only those with high CRP at baseline. For those with high CRP at baseline, the decrease was significant for normal, overweight, and obese groups of people. Changes in weight or physical activity were not significantly associated with changes in CRP. Conclusions. Over 6 week and 6 month follow-up periods, the intervention failed to discriminate changes in CRP. Changes in CRP were only associated with baseline levels of CRP and BMI and were not associated with changes in any of the selected variables considered.

C-reactive protein (CRP) is synthesized in hepatocytes. The serum concentration of CRP increases dramatically during the acute phase response. In human hepatoma Hep3B cells, maximal CRP expression occurs in cells treated with the combination of IL-6 and IL-1β. IL-6 induces transcription of the CRP gene and IL-1β synergistically enhances the effects of IL-6. We investigated the role of IL-6-activated transcription factor STAT3, also known as STAT3α, in inducing CRP expression since we identified four consensus STAT3-binding sites centered at positions - 72, - 108, - 134 and - 164 on the CRP promoter. It has been shown previously that STAT3 binds to the site at - 108 and induces CRP expression. We found that STAT3 also bound to the other three sites, and several STAT3-containing complexes were formed at each site, suggesting the presence of STAT3 isoforms and additional transcription factors in the complexes. Mutation of the STAT3 sites at - 108, - 134 or - 164 resulted in decreased CRP expression in response to IL-6 and IL-1β treatment, although the synergy between IL-6 and IL-1β was not affected by the mutations. The STAT3 site at - 72 could not be investigated employing mutagenesis. We also found that IL-6 activated two isoforms of STAT3 in Hep3B cells: STAT3α which contains both a DNA-binding domain and a transactivation domain and STAT3β which contains only the DNA-binding domain. Taken together, these findings raise the possibility that IL-6 not only induces CRP expression but also regulates the induction of CRP expression by activating STAT3 isoforms and by utilizing all four STAT3 sites.

Obstructive sleep apnea (OSA) occurs commonly in the U.S. population and is seen in both obese as well as non-obese individuals. OSA is a disease characterized by periodic upper airway collapse during sleep, which then results in either apnea, hypopnea, or both. The disorder leads to a variety of medical complications. Neuropsychiatric complications include daytime somnolence, cognitive dysfunction, and depression. Increased incidence of motor vehicle accidents has been documented in these patients and probably reflects disordered reflex mechanisms or excessive somnolence. More importantly, vascular disorders such as hypertension, stroke, congestive cardiac failure, arrhythmias, and atherosclerosis occur frequently in these patients. The lungs may be affected by pulmonary hypertension and worsening of asthma. Recent data from several laboratories demonstrate that obstructive sleep apnea is characterized by an inflammatory response. Cytokines are elaborated during the hypoxemic episodes leading to inflammatory responses as marked clinically by elevated C-reactive protein (CRP). As elevated CRP levels are considered markers of the acute phase response and characterize progression of vascular injury in coronary artery disease, it is likely that obstructive sleep apnea could lead to worsening of vasculopathy. Moreover, as inflammatory mechanisms regulate bronchial asthma, it is also likely that cytokines and superoxide radicals generated during hypoxemic episodes could exacerbate reactive airway disease. Patients with Cough, Obstructive sleep apnea, Rhinosinusitis, and Esophageal reflux clustered together can be categorized by the acronym, "CORE", syndrome. The purpose of this manuscript is to review the inflammatory responses that occur in patients with obstructive sleep apnea and relate them to the occurrence of cardiopulmonary disease.

Our study provided an analysis and comparison of specific blood values, dietary intake, body composition, and inflammatory markers (high sensitivity-C-reactive protein (HS-CRP), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6)) between adults with type 2 diabetes mellitus (T2DM) and prediabetes (PDM) to adults without diabetes. A total of 22 participants (PDM/T2DM n=12, controls n=10) in the San Luis Obispo, CA area completed the study prior to our ending recruitment due to Covid-19. Body composition data were collected through DXA scans. Dietary intake was assessed using a 3-day food record survey and nutritional analysis conducted using ESHA food processing software. In addition, participants completed an overnight fast and early morning blood draw for evaluation of blood glucose regulation, blood lipid profile and inflammatory biomarkers. Analysis included a series of randomization tests that were conducted to determine possible statistical differences between the mean of basic characteristics (age, BMI, weight, HbA1C, fasting plasma glucose, fasting insulin, triglycerides, LDL, HDL, and total cholesterol levels) of the control group and the PDM/T2DM group. Secondly, 2-way ANOVA statistical analyses were conducted to determine the interaction between sex and diabetes status on caloric intake, macronutrient distribution, quality of fat intake, visceral adipose tissue (VAT), and inflammatory biomarkers. We found there was a significant difference in fasting plasma glucose (FPG) and hemoglobin A1C (HbA1C) between the control group and the PDM/T2DM group. We did not find a statistically significant difference in caloric intake, macronutrient distribution, quality of fat intake, visceral adipose tissue (VAT), and inflammatory biomarkers between the PDM/T2DM and control group. Due to the lack of studies that include adults with PDM, we concluded additional future research needs to focus on blood biochemistry values, dietary intake, body composition, and inflammatory markers health-risk factors in both adults with PDM and T2DM since these values can improve diagnosis and treatment of T2DM.

Electrochemical biosensors are renowned for their ability to detect a wide range of analytes in biological fluids for clinical diagnosis. The implementation of biomarkers in electrochemical biosensors for clinical diagnosis is essential for the specific and accurate diagnosis of the disease with high sensitivity and selectivity. Therefore, this thesis evaluates the challenges pertaining to the stability, reproducibility, and obtaining a low limit of detection for the internal/external biomarkers associated with two distinct electrochemical biosensors. The first study tackles the challenge of detecting low analyte concentrations in a label-free biosensor. It introduces an innovative label-free electrochemical biosensing method for the detection of glycosylated hemoglobin (HbA1c) and C-reactive protein (CRP) to predict Coronary Heart Disease (CHD) progression using tailored redox probes, proposing a dual biomarker biosensing platform for future research. Calibration curves reveal an LOD of 5 mg/mL in PBS (8) FeCN (II) and 6 mg/mL in SB for a linear range of 0 – 30 mg/mL of HbA1c. Similarly, an LOD of 0.007 mg/mL and 0.008 mg/mL in PBS (7.4) PcA-NO2 and SB, respectively, is reported for a linear range of 0 – 0.05 mg/mL of CRP. The second study focuses on stabilizing a biomolecule-free sensor for the ultra-low detection of Δ9-tetrahydrocannabinol (THC) in roadside testing. Pre-depositing THC, an external biomarker for drug-impaired driving, onto the biosensor's working electrode enhances its interaction with analytes. However, THC's oxidative nature compromises sensor stability during manufacturing. Consequently, optimal electrode storage conditions were explored, indicating frozen storage as ideal for up to six months, effectively preventing THC oxidation at -18°C, while degradation occurs at 4°C. Modified electrodes stored under optimal conditions exhibit improved calibration curves when exposed to various THC samples. / Thesis / Master of Applied Science (MASc) / An electrochemical biosensor is a sensing device with the ability to detect biological species via the transduction of a specific biological event into electrochemical signals. These sensors are extremely useful for the detection of analytes in biological fluids for clinical diagnostics, to determine the presence or absence of diseases. This manuscript addresses the challenges associated with the stability, reproducibility, and the low limits of detection associated with screen-printed carbon electrodes used in electrochemical biosensing. Subsequently, due to the strong correlation between glycated hemoglobin (HbA1c) and C-reactive protein (CRP) to connote the risk of contracting coronary heart disease (CHD), the manuscript presents a novel label-free electrochemical biosensing method for the detection of HbA1c and CRP with low detection limits. Secondly, the manuscript identifies ambient storage conditions for the long-term stability of a biomolecule-free sensing device for the roadside detection of ultra-low concentrations of Δ9-tetrahydrocannabinol (THC).

Objectives: We sought to examine the gender differences between C - reactive protein (CRP) and muscle strengthening activity (MSA) in U.S. adults (≥20 years of age) Background: Elevated levels of CRP have been shown to be associated with an increase in risk of cardiovascular disease (CVD). Studies analyzing the relationship between physical activity (PA) and CRP by gender have produced mixed results. Methods: The sample (n=9,135) included participants in the 1999-2004 National Health and Nutrition Examination Survey (NHANES). Three categories of reported MSA participation were created: no MSA (referent group), some MSA (≥1 to/wk), and meeting the 2008 Department of Health and Human Services (DHHS) recommendation (>2 d/wk). The dependent variable was elevated CRP (>3 to 10 mg/L). Results: Gender stratified analysis revealed significantly lower odds of having elevated CRP for women reporting some MSA (OR 0.61; 95% CI 0.45-0.83, P=0.0023), or volumes of MSA meeting the DHHS recommendation (OR 0.66; 95% CI 0.54-0.82, P=0.0004). Significantly lower odds of men having elevated CRP was observed in those reporting MSA volumes meeting the recommendation (OR 0.73; 95% CI 0.61-0.88, P=0.0011). Following adjustment for waist circumference (WC) these odds remained significant in men but not women. Conclusions: Women reporting any MSA were found to have lower odds of having elevated CRP when compared to those reporting no MSA prior to adjustment for WC. Significantly lower odds in men were only observed in those meeting the recommendation. These results suggest that WC may mediate the associations between MSA and CRP and this relationship may be stronger in women.

<p>UVOD: Kolorektalna anastomoza koja se formira u dubini karlice radi uspostavljanja kontinuiteta gastrointestinalnog trakta nakon resekcije dijela crijeva ima svoje specifičnosti u toku formiranja, zarastanja, kao i kada se jave komplikacije. Na sam proces zarastanja kolorektalnih anastomoza utiču sistemski, lokalni i tehnički faktori. Bilo kakav kompromis po pitanju ovih principa nosi povećan rizik od komplikacija! Najteža komplikacija na anastomozi je dehiscencija. &bdquo;Samo neučinjena anastomoza neće dehiscirati&ldquo;. Ova stara hirur&scaron;ka poslovica je važeća i danas, a &scaron;to je anastomoza distalnija, mogućnost dehiscencije je veća, posebno kod niskih subperitonealnih anastomoza sa rektumom ili anusom. Učestalost dehiscencija ovih anastomoza u literaturi varira od 0,5 - 69 %, &scaron;to može ukazivati na kvalitet hirur&scaron;kog rada, kori&scaron;ćenje definicije dehiscencije, način dijagnostike, itd. Međunarodna grupa za karcinom rektuma definisala je dehiscenciju anastomoze kao defekt crijevnog zida, uključujući &scaron;avnu ili staplersku liniju neorektalnog rezervoara, &scaron;to dovodi do komunikacije između intra i ekstra luminalnog prostora. CILJEVI: Osnovni cilj ove studije je bio da se utvrde preoperativni i perioperativni faktori rizika značajni za nastanak dehiscencija kolorektalnih anastomoza, kao i značaj prokalcitonina i C-reaktivnog proteina u detekciji dehiscencija kolorektalnih anastomoza u subkliničkoj fazi bolesti. MATERIJAL I METODOLOGIJA: Istraživanjem je obuhvaćeno 100 pacijenata operisanih u elektivnom programu, kod kojih je urađena radikalna operacija karcinoma rektuma uz kreiranje dvostruke staplerske kolorektalne anastomoze. Svi pacijenti uključeni u istraživanje, odabrani metodom slučajnog izbora, bili su podijeljeni u dvije grupe. Grupa A: pacijenti kod kojih je urađena radikalna operacija karcinoma rektuma i kreirana primarna staplerska kolorektalna anastomoza. Grupa B: pacijenti kod kojih je urađena radikalna operacija karcinoma rektuma Hartmanovom procedurom u prvom aktu, a rekonstrukcija kontinuiteta gastrointestinalnog trakta uspostavljena u drugom aktu kreiranjem sekundarne staplerske kolorektalne anastomoze. Primjenom statističkih testova analizirani su preoperativni (pol, godine života, komorbiditeti, ASA skor, indeks tjelesne mase preoperativna primjena hemoradioterapije, laboratorijske analize) i perioperativni (vrijeme trajanja operacije, udaljenost anastomoze od anokutane linije, veličina tumora u cm, intraoperativna primjena krvi) faktori rizika za nastanak dehiscencije anastomoze kod obje grupe. Kod svih pacijenata drugog i četvrtog postoperativnog dana kontrolisane su vrijednosti C reaktivnog proteina i prokalcitonina u serumu, bez obzira da li su postojali ili ne klinički manifestni znaci dehiscencije anastomoze. Takođe, primjenom ROC krive analizirana je senzitivnost, specifičnost i dijagnostička tačnost C reaktivnog proteina i prokalcitonina drugog i četvrtog postoperativnog dana u detekciji dehiscencije kolorektalne anastomoze. REZULTATI: Nema statistički značajne razlike u pojavi dehiscencije anastomoze između primarnih i sekundarnih dvostrukih staplerskih anastomoza. Incidencija dehiscencija anastomoza je bila 11% u ukupnom uzorku. Osam pacijenata je reoperisano, dok su tri pacijenta tretirana konzervativno. Kod tri pacijenta, kod kojih je nastala dehiscencija i koji su reoperisani, zbog posljedice sepse i septičnog &scaron;oka nastupio je smrtni ishod. Pol, godine života, komorbiditeti, stadijum bolesti, dužina trajanja operacije, intraoperativna primjena krvi, nisu statistički značajni faktori rizika (p&gt;0,05) za nastanak dehiscencije primarnih i sekundarnih dvostrukih staplerskih kolorektalnih anastomoza. Udaljenost anastomoze od anokutane linije (&lt;7cm), veličina tumora preko 5 cm su statistički značajni faktori rizika za nastanak dehiscencije anastomoze. Postoji visoko statistički značajna razlika (p&lt;0,001) vrijednosti CRP-a i PCT-a četvrtog postoperativnog dana kod bolesnika sa i bez prisutne dehiscenecije kolorektalne anastomoze. Na osnovu ROC analize CRP&ndash;a za četvrti postoperativni dan, za graničnu vrijednost od 130 mg/l senzitivnost iznosi 82%, specifičnost 96% i dijagnostička tačnost 94%. Za graničnu vrijednost PCT-a od 0,78 ng/ml za četvrti postoperativni dan primjenom ROC krive utvrđena je sezitivnost 91%, specifičnost 92%, dok je dijagnostička tačnost bila 86%. Četvrti postoperativni dan CRP ima veću dijagnostičku tačnost i specifičnost u detekciji dehiscencije kolorektalne anastomoze u odnosu na PCT. ZAKLJUČAK: I pored velikog tehnolo&scaron;kog napretka, usavr&scaron;avanja hirur&scaron;kih tehnika, boljeg razumijevanja prirode maligne bolesti, unapređivanja intraoperativnog i postoperativnog kontinuiranog praćenja bolesnika, uvođenja novih antimikrobnih lijekova, problem u liječenju i pojava dehiscencija kolorektalnih anastomoza su i dalje značajno prisutni. Otkrivanjem dehiscencija kolorektalnih anastomoza u subkliničkoj fazi, identifikovanje preoperativnih i perioperativnih faktora rizika značajnih za nastanak dehiscencija, omogućilo bi da se dehiscencija ranije uoči i efikasnije rije&scaron;i.</p> / <p>INTRODUCTION: Colorectal anastomosis, which is formed deep in the pelvis because of establishment of continuity of gastrointestinal tract after resection of the part of intestines, has got its specifities during forming and healing process and when complications occur. Systemic, local and technical factors influence the healing process of anastomosis itself. Any kind of compromise in terms of these principles causes higher risk of complications! The most serious complication of anastomosis is dehiscence. &ldquo;Only anastomosis which is not carried out will not dehisce.&rdquo; This old surgical saying is still true, and the more distal anastomosis is, the possibility of development of dehiscence is higher, especially in lower subperitoneal anastomosis with rectum and anus. Incidence of dehiscence of these anastomosis in literature varies from 0,5 to 69 %, which may indicate the quality of surgical work, use of definition of dehiscence, kind of diagnostics etc. International group for rectal cancer defined dehiscence of anastomosis as a defect of intestinal wall, including suturing or stapler line of neorectal reservoir, which leads to communication between intra and extra luminal space. AIMS: Basic aim of this study was to determine preoperative and postoperative risk factors significant for the development of dehiscence of colorectal anastomosis, as well as significance of procalcitonin and C-reactive protein in detection of dehiscence of colorectal anastomosis at the subclinical stage of the disease. MATERIAL AND METHODOLOGY: The study included 100 patients operated on in the elective programme, on which radical operation of the rectal cancer was carried out with creation of double stapler colorectal anastomosis. All patients included in the study were randomly chosen and divided into two groups. Group A: the patients on which radical operation of the rectal cancer was carried out and primary stapler colorectal anastomosis created. Group B: the patients on which radical operation of the rectal cancer was carried out using Hartman&#39;s procedure in the first act, and reconstruction of the continuity of gastrointestinal tract was established in the second act by creation of secondary stapler colorectal anastomosis. By application of statistical tests preoperative (sex, age, comorbidities, ASA score, body mass index, preoperative application of haemoradiotherapy, laboratory analyses) and perioperative (duration of operation, distance of anastomosis from anocutaneous line, size of tumor in cm, intraoperative application of blood) risk factors for development of dehiscence of anastomosis in both groups were analysed. In all patients on the second and fourth postoperative day values of C-reactive protein and procalcitonin in the serum were analysed, regardless of the existence of clinically or non-clinically manifested signs of dehiscence of anastomosis. Also, sensitivity, specifity and diagnostically accurate C-reactive protein and procalcitonin on the second and fourth postoperative day in detection of dehiscence of colorectal anastomosis were analysed by application of ROC curve. RESULTS: There is no statistically significant difference in the development of dehiscence of anastomosis between primary and secondary double stapler anastomosis. Incidence of dehiscence of anastomosis was 11% in all samples. Eight patients were reoperated on, whereas three patients were treated conservatively. In three patients who developed dehiscence and were reoperated on, the death occurred due to sepsis and septic shock. Sex, age, comorbidities, stage of the disease, duration of operation, intraoperative application of blood were not statistically significant risk factors (p&gt;0,05) for the development of dehiscence of primary and secondary double stapler colorectal anastomosis. Distance of anastomosis from anocutaneous line (&lt;7cm), size of tumor over 5 cm were statistically significant risk factors for the development of dehiscence of anastomosis. There is highly statistically significant difference (p&lt;0,001) values of CRP and PCT on the fourth postoperative day in patients with and without dehiscence of colorectal anastomosis. On the basis of ROC analysis of CRP for the fourth postoperative day, for the bordering value of 130 mg/l sensitivity is 82%, specificity 96% and diagnostic accuracy 94%. For bordering value of PCT of 0,78 ng/ml for the fourth postoperative day, by application of ROC curve, the following values were determined: sensitivity 91%, specificity 92% and diagnostic accuracy 86%. CRP for the fourth postoperative day has got higher diagnostic accuracy and specificity in detection of dehiscence of colorectal anastomosis in relation to PCT. CONCLUSION: In spite of huge technological advance, improvement of surgical techniques, better understanding of the nature of malignant diseases, improvement of intraoperative and postoperative continuous follow up of the patient, introduction of new antimicrobial medicines, the problem in treating and development of dehiscence of colorectal anastomosis is still significantly present. Detection of dehiscence of colorectal anastomosis at the subclinical stage, identification of preoperative and perioperative risk factors significant for the development of dehiscence would help in early detection of dehiscence and contribute to more effective operations.</p>

INTRODUÇÃO: Em pacientes com síndromes isquêmicas miocárdicas instáveis (SIMI), tanto a hiperatividade simpática quanto a resposta inflamatória exacerbada se associam a pior prognóstico. No entanto, ainda é desconhecido se existe alguma correlação entre esses dois marcadores de evolução desfavorável. OBJETIVOS: Correlacionar a atividade nervosa simpática muscular com marcadores inflamatórios nas fases precoce e tardia de pacientes portadores de SIMI. MÉTODOS: Pacientes hospitalizados com diagnóstico de SIMI e evolução favorável foram incluídos de forma prospectiva desde que apresentassem idade entre 18 e 65 anos e aterosclerose coronária comprovada por cinecoronariografia. Logo após a inclusão no estudo foram coletadas informações basais, e no quarto dia (± 1 dia) de internação os pacientes foram submetidos à avaliação da ANSM e coleta concomitante de amostra sanguínea para dosagem de proteína CReativa ultrassensível (PCR-us), interleucina-6 (IL6), e fosfolipase A2 associada à lipoproteína (Lp-PLA2). ANSM foi obtida pela técnica de microneurografia do nervo fibular. As medidas e respectivas análises de correlação foram repetidas em 1, 3 e 6 meses após a hospitalização. Correlações entre ANSM e marcadores inflamatórios foram analisadas por meio do teste de Pearson (variáveis de distribuição não-paramétrica foram transformadas logaritmicamente). Modelos de regressão linear múltipla foram criados para avaliar os efeitos independentes. RESULTADOS: Foram estudados 34 pacientes com idade média de 51,7±7,0 anos, sendo 79,4% do sexo masculino. A prevalência de hipertensão arterial foi de 64,7%, diabetes mellitus 8,8%, e doença arterial coronária prévia de 20,6%. A apresentação foi IAM com supradesnível de ST em 18 pacientes (52,9%), IAM sem supra de ST em 14 (41,2%) e angina instável em 02 pacientes (5,9%). Tanto ANSM quanto biomarcadores inflamatórios estavam elevados durante a fase aguda das SIMI e diminuíram ao longo do tempo. Na fase hospitalar, a mediana da PCR-us foi 17,75 (8,57; 40,15) mg/L, e IL-6 6,65 (4,45; 8,20) pg/ml, a Lp- PLA2 média foi 185,8 ± 52,2 nmol/min/ml, e ANSM média 64,2 ± 19,3 impulsos/100bpm. Após 6 meses, houve diminuição significativa de todas essas variáveis quando comparadas com a fase hospitalar. Entretanto, não houve correlação significativa entre a atividade simpática e qualquer dos marcadores inflamatórios analisados, em nenhuma das fases analisadas (p > 0,05), Por outro lado, ANSM se correlacionou independentemente com níveis de CKMB na fase aguda (p=0,027), e com fração de ejeção do VE na fase crônica (p=0,026). CONCLUSÃO: Apesar do aumento inicial dos níveis de marcadores inflamatórios e da atividade simpática em pacientes com SIMI, não houve correlação significativa entre esses parâmetros em nenhuma das fases analisadas, sugerindo que as alterações dessas variáveis estariam relacionadas a diferentes vias fisiopatológicas / INTRODUCTION: Previous publications have shown that both sympathetic hyperactivity and enhanced inflammatory response are associated with worse outcomes during acute coronary syndromes (ACS). However, little is known about the correlation between these two pathologic pathways. OBJECTIVE: To correlate muscle sympathetic nerve activity with inflammatory biomarkers in both acute and chronic phase of ACS. METHODS: Patients hospitalized with uncomplicated ACS were enrolled if they were 18-65 years old and have significant atherosclerosis. Baseline characteristics information were collected and at fourth day (± 1 day) of hospitalization they were submitted to muscle sympathetic nerve activity (MSNA) analysis and blood sample were collected for ultrasensitive C-reactive protein (usCRP), interleukin-6 (IL-6) and Lipoprotein-associated phospholipase A2 activity (Lp-PLA2) measurements. MSNA was recorded directly from the peroneal nerve using the microneurography technique. Measurements were repeated at 1, 3 and 6 months after hospitalization. Correlations between MSNA and inflammatory markers and baseline characteristics were made using Pearson\'s test (nonnormally distributed variables were logarithmically transformed) and multivariate regression models were performed to assess the independent effects. RESULTS: Thirty-four patients were included, 79.4% male, mean age 51.7 (SD 7.0 years). The prevalence of hypertension was 64.7%, diabetes mellitus 8.8%, and previous coronary heart disease 20.6%. The ACS presentation was STEMI in 18 patients (52.9%), NSTEMI in 14 (41.2%) and UA in 02 patients (5.9%). Both MSNA and inflammatory markers were elevated during acute phase of ACS and decreased over time. In the hospitalization phase the median usCRP was 17.75 (8.57; 40.15) mg/L, median IL-6 6.65 (4.45; 8.20), mean Lp-PLA2 185.8 ± 52.2 nmol/min/mL, and mean MSNA 64.2 ± 19.3 bursts/100heart beats. All of these variables decreased significantly over 6 months when compared to in-hospital phase. However, there were no significant correlations between the sympathetic activity and inflammatory markers in any of the analyzed phases (p>0.05). After adjusted analyzes, MSNA was independently associated with CKMB levels at acute phase (p=0.027) and with left ventricular ejection fraction at 6 months (p=0.026). CONCLUSION: Despite the increased levels of inflammatory markers and sympathetic activity among patients with ACS, there was no correlation between these assessments, suggesting that although they may be present concomitantly during an ACS they might follow different pathological pathways

Sepse é uma resposta sistêmica do hospedeiro à infecção caracterizada por alterações clínicas e laboratoriais. Em pacientes imunodeprimidos, tais alterações podem não ser nem sensíveis nem específicas para causas infecciosas, assim como agentes etiológicos, focos primários de infecção e evolução clínica podem ser distintos. A identificação de marcador laboratorial de sepse poderia auxiliar no diagnóstico, tratamento e avaliação prognóstica dessa população. O objetivo do presente estudo foi avaliar a evolução clínica, laboratorial e de marcadores inflamatórios em pacientes com infecção pelo HIV/aids e sepse, comparando-os a pacientes sépticos não infectados pelo HIV. Tratou-se de estudo prospectivo observacional de pacientes adultos com sepse grave ou choque séptico associados ou não à infecção pelo HIV/aids e admitidos em unidade de terapia intensiva. Os pacientes foram avaliados à admissão, no terceiro e sétimo dias de internação na unidade de terapia intensiva quanto a parâmetros clínicos, laboratoriais e escores de gravidade, assim como os seguintes marcadores inflamatórios: proteína c-reativa (PCR), procalcitonina (PCT), interleucina-6, interleucina-10 e TNF-. Os pacientes também foram avaliados quanto à sobrevida por ocasião da alta da hospitalar, aos 28 dias e após seis meses de inclusão no estudo. O estudo envolveu 58 pacientes consecutivamente com sepse grave e/ou choque séptico, sendo 36 com infecção pelo HIV/aids e 22 com sorologia negativa para HIV. Todos os pacientes com infecção pelo HIV preencheram critérios para aids (CDC/2008). Os pacientes sépticos com infecção pelo HIV/aids apresentaram maior ocorrência de infecções pulmonares (83,3% versus 40,9% p=0,001) e de etiologia fúngica (44,4% versus 9,1% p=0,001). Apesar dos grupos serem semelhantes em termos de xii gravidade, a mortalidade hospitalar e após 6 meses da admissão foi maior nos pacientes com infecção pelo HIV/aids em comparação aos pacientes não infectados pelo HIV (55,6 versus 27,3% p=0,03, e 58,3 versus 27,3% p=0,02, respectivamente). As concentrações iniciais de PCR e PCT foram mais baixas nos pacientes sépticos com aids que em pacientes soronegativos para HIV (130 versus 168 mg/dL p= 0,005 e 1,19 versus 4,06 ng/mL p= 0,04, respectivamente), com tendência a diminuição progressiva nos pacientes sobreviventes. Não houve diferença significativa entre as concentrações iniciais de IL-6 e TNF- em pacientes com ou sem infecção pelo HIV/aids. As concentrações iniciais de IL-10 foram maiores (4,4 pg/mL versus 1,0 pg/mL; p=0,005) e apresentaram melhor poder em predizer o óbito (área sob a curva ROC =0,74) em pacientes sépticos com infecção pelo HIV/aids. Concluindo, a evolução da sepse foi mais grave em pacientes com aids, sendo mais comuns o foco pulmonar e a etiologia fúngica. Além disso, os marcadores de resposta inflamatória apresentaram concentrações menos elevadas na população séptica soropositiva para HIV, exceto pela IL10, que também mostrou ter importante poder prognóstico nesta população / Sepsis is a systemic host response to infection characterized by clinical and laboratory findings. In immunosuppressed patients, these findings may not be sensitive or specific for infectious insults, and etiologic agents, primary foci of infection and clinical outcome may also be different. The identification of a laboratory marker of sepsis could help in diagnosis, treatment and assessment of prognosis for that population. Therefore, the aim of this study was to evaluate the course of clinical, biochemical and inflammatory markers in HIV-infected and HIV-uninfected patients with sepsis. The study was prospective observational in adult patients with severe sepsis or septic shock associated or not to HIV infection/AIDS, and admitted to intensive care unit. Patients were evaluated on the first, third and seventh day of admission in relation to clinical and laboratory parameters, severity scores, besides the following inflammatory markers: c-reactive protein (CRP), procalcitonin (PCT) interleukin-6, interleukin-10 and TNF-. Patients were evaluated according survival at hospital discharge and after six months of admission on the study. The study involved 58 consecutive patients with severe sepsis or septic shock, 36 with HIV infection/AIDS and 22 non HIV-infected. All patients with HIV infection met criteria for AIDS (CDC/2008). The septic patients with HIV infection/AIDS presented more pulmonary infections (83.3% versus 40.9% p = 0.001) and fungal etiology (44.4% versus 9.1% p = 0.001). Although groups presented similar severity, the mortality rate at hospital discharge, 28 days and 6 months after admission was higher in patients with AIDS compared to patients without HIV infection (55.6 versus 27 3% p=0.03, and 58.3 versus 27.3% p=0.02, respectively). The initial concentrations of CRP and PCT were lower in septic patients with AIDS than in HIV-negative patients (130 versus xiv 168 mg/dL p= 0.005 and 1.19 versus 4.06 ng/mL p=0.04, respectively), with tendency to a progressive decrease in surviving patients. There was no significant difference between the initial concentrations of IL-6 and TNF- in patients with or without HIV infection/AIDS. The initial concentrations of IL-10 were higher (4.4 pg/mL versus 1.0 pg/mL, p = 0.005) and also they were better able to predict death (area under ROC curve = 0.78) in septic patients with HIV infection/AIDS. Concluding, the sepsis course was more severe in patients with AIDS, with more common pulmonary focus and fungal etiology. Furthermore, the markers of inflammatory response showed lower concentrations in septic HIV infected patients, except for IL10, which proved to have a significant prognostic power in this population