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Aldo Lorenzetti M.D, Internal Medicine & Hepatology, Milano - SIMEDET Delegate
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The impact of #obesity and adiposity on #inflammatory markers in patients with rheumatoid arthritis

http://onlinelibrary.wiley.com/doi/10.1002/acr.23229/abstract;jsessionid=6ABE3049C7C34DEB2F93B17F4A5FB5BE.f04t01

Obesity is associated with greater CRP and ESR in women with RA. This association is related to fat mass and not RA disease activity. Low BMI is associated with greater CRP in men with RA – this unexpected finding remains incompletely explained but likely is not a direct effect of adiposity.
Childhood onset #inflammatory bowel disease and risk of #cancer: a Swedish nationwide cohort study 1964-2014
http://www.bmj.com/content/358/bmj.j3951

To assess risk of cancer in patients with childhood onset inflammatory bowel disease in childhood and adulthood bowel disease had first cancers, compared with 2256 (1.5 per 1000 person years) in the general population comparators (hazard ratio 2.2, 95% confidence interval 2.0 to 2.5).

Hazard ratios for any cancer were 2.6 in ulcerative colitis (2.3 to 3.0) and 1.7 in Crohn’s disease (1.5 to 2.1). Patients also had an increased risk of cancer before their 18th birthday (2.7, 1.6 to 4.4; 20 cancers in 9405 patients, 0.6 per1000 person years). Gastrointestinal cancers had the highest relative risks, with a hazard ratio of 18.0 (14.4 to 22.7) corresponding to 202 cancers in patients with inflammatory bowel disease. The increased risk of cancer (before 25th birthday) was similar over time (1964-1989: 1.6, 1.0 to 2.4; 1990-2001: 2.3, 1.5 to 3.3); 2002-06: 2.9, 1.9 to 4.2; 2007-14: 2.2, 1.1 to 4.2).

Conclusion Childhood onset inflammatory bowel disease is associated with an increased risk of any cancer, especially gastrointestinal cancers, both in childhood and later in life. The higher risk of cancer has not fallen over time
Midlife systemic #inflammatory markers are associated with late-life #brain volume
The ARIC study
http://m.neurology.org/content/early/2017/11/01/WNL.0000000000004688

Plasma levels of systemic inflammatory markers (fibrinogen, albumin, white blood cell count, von Willebrand factor, and Factor VIII) were assessed at baseline in 1,633 participants (mean age 53 5 years, 60% female, 27% African American) enrolled in the Atherosclerosis Risk in Communities Study.

Compared to participants with no elevated (4th quartile) midlife inflammatory markers, participants with elevations in 3 or more markers had, on average, 5% smaller hippocampal and Alzheimer disease signature region volumes. The association between midlife inflammation and late-life brain volume was modified by age and race, whereby younger participants and white participants with higher levels of systemic inflammation during midlife were more likely to show reduced brain volumes subsequently.

Conclusions: Our prospective findings provide evidence for what may be an early contributory role of systemic inflammation in neurodegeneration and cognitive aging
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Oral #NaHCO3 Activates a Splenic Anti-#Inflammatory Pathway: Evidence That Cholinergic Signals Are Transmitted via Mesothelial Cells

http://www.jimmunol.org/content/early/2018/04/14/jimmunol.1701605

We tested the hypothesis that oral NaHCO3 intake stimulates splenic anti-inflammatory pathways. Following oral NaHCO3 loading, macrophage polarization was shifted from predominantly M1 (inflammatory) to M2 (regulatory) phenotypes, and FOXP3+CD4+ T-lymphocytes increased in the spleen, blood, and kidneys of rats. Similar anti-inflammatory changes in macrophage polarization were observed in the blood of human subjects following NaHCO3 ingestion. Surprisingly, we found that gentle manipulation to visualize the spleen at midline during surgical laparotomy (sham splenectomy) was sufficient to abolish the response in rats and resulted in hypertrophy/hyperplasia of the capsular mesothelial cells. Thin collagenous connections lined by mesothelial cells were found to connect to the capsular mesothelium. Mesothelial cells in these connections stained positive for the pan-neuronal marker PGP9.5 and acetylcholine esterase and contained many ultrastructural elements, which visually resembled neuronal structures. Both disruption of the fragile mesothelial connections or transection of the vagal nerves resulted in the loss of capsular mesothelial acetylcholine esterase staining and reduced splenic mass.


Our data indicate that oral NaHCO3 activates a splenic anti-inflammatory pathway and provides evidence that the signals that mediate this response are transmitted to the spleen via a novel neuronal-like function of mesothelial cells
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#Inflammatory Bowel Diseases Were Associated With Risk of #Sexual Dysfunction in Both Sexes: A Meta-analysis

https://academic.oup.com/ibdjournal/advance-article-abstract/doi/10.1093/ibd/izy345/5203495?redirectedFrom=fulltext

Synthesis of results revealed that IBD was significantly associated with an elevated risk of SD in male subjects (7 studies, RR = 1.41, 95% CI, 1.09–1.81, P = 0.008; heterogeneity: I2 = 80.2%, P < 0.001) and female subjects (5 studies, RR = 1.76, 95% CI, 1.28–2.42, P < 0.001; heterogeneity: I2 = 69.6%, P = 0.011). Stratified analysis by the mean age of the individuals indicated that patients with IBD with a relatively young age (male: younger than 50 years; female: younger than 40 years) exhibited a significantly increased odds of SD. Sensitivity analyses showed that no single study dominated the overall combined RR.

Conclusion
Evidence from this meta-analysis revealed that both male and female patients with IBD have a significantly increased risk of SD, which should remind both gastroenterologists and urologists to be aware of the potential hazardous effect of IBD for developing SD.
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Association of Nonsteroidal Anti- #inflammatory Drug Prescriptions With #Kidney Disease Among Active Young and Middle-aged Adults

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2724772

137 108 (17.9%) were dispensed 1 to 7 mean total defined daily doses per month, and 124 594 (16.3%) received more than 7 defined daily doses per month. There were 2356 acute kidney injury outcomes (0.3% of participants) and 1634 chronic kidney disease outcomes (0.2%) observed. Compared with participants who received no medication, the highest exposure level was associated with significantly higher adjusted hazard ratios (aHRs) for acute kidney injury (aHR, 1.2; 95% CI, 1.1-1.4) and chronic kidney disease (aHR, 1.2; 95% CI, 1.0-1.3), with annual outcome excesses per 100 000 exposed individuals totaling 17.6 cases for acute kidney injury and 30.0 cases for chronic kidney disease.

Conclusions and Relevance Modest but statistically significant associations were noted between the highest observed doses of NSAID exposure and incident kidney problems among active young and middle-aged adults
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Common #mental disorders within chronic #inflammatory disorders: a primary care database prospective investigation

https://ard.bmj.com/content/early/2019/03/07/annrheumdis-2018-214676

Among 538 707 participants, the incidence of depression ranged from 14 per 1000 person-years (severe psoriasis) to 9 per 1000 person-years (systemic vasculitis), substantively higher compared with their comparison group (5–7 per 1000 person-years). HRs of multiple depression and anxiety events were 16% higher within inflammatory disorders (HR, 1.16, 95% CI 1.12 to 1.21, p<0.001) compared with the matched comparison group. The incidence of depression and anxiety was strongly associated with the age at inflammatory disorder onset. The overall HR estimate for depression was 1.90 (95% CI 1.66 to 2.17, p<0.001) within early-onset disorder (<40 years of age) and 0.93 (95% CI 0.90 to 1.09, p=0.80) within late-onset disorder (≥60 years of age).

Conclusions
Primary care patients with inflammatory disorders have elevated rates of depression and anxiety incidence, particularly those patients with early-onset inflammatory disorders. This finding may reflect the impact of the underlying disease on patients’ quality of life, although the precise mechanisms require further investigation.
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Hospitalization Outcomes for #Inflammatory #Bowel Disease in Teaching vs Nonteaching Hospitals

https://academic.oup.com/ibdjournal/advance-article-abstract/doi/10.1093/ibd/izz089/5482270?redirectedFrom=fulltext

Hospitalizations contribute significantly to the annual health care expenditure for inflammatory bowel disease (IBD), and reducing cost of care without compromising outcomes is a rising priority. Teaching hospitals (THs) have higher costs and utilize trainees in care to a greater extent than community hospitals, and it is unknown how hospital teaching status (HTS) affects outcomes. We therefore sought to investigate the impact of HTS on IBD hospitalization outcomes.

Unadjusted mean LOS, mean DC, and 30-day RR were greater among THs for both UC and CD. Unadjusted MR was greater among major THs for UC but not CD. After multivariable analysis, only 30-day RR for UC was increased in major THs relative to non-THs (1.98%; 95% confidence interval, 0.33%–3.61%).

Conclusions
Differences in metrics of cost-effective hospital care for patients with IBD appear to be driven by disease severity rather than HTS. Future research should attempt to better characterize factors driving resource utilization for IBD hospitalizations.
Distinct #inflammatory profiles distinguish #COVID-19 from #influenza with limited contributions from #cytokine storm
https://2medical.news/2020/11/29/distinct-inflammatory-profiles-distinguish-covid-19-from-influenza-with-limited-contributions-from-cytokine-storm/

We pursued a study of immune responses in COVID-19 and influenza cohorts. Compared to influenza patients, COVID-19 patients exhibited largely equivalent lymphocyte counts, fewer monocytes, and lower surface HLA-class II expression on select monocyte populations. Furthermore, decreased HLA-DR on intermediate monocytes was a significant predictor of COVID-19 disease severity. In contrast to prevailing assumptions about COVID-19 disease immunopathology, very few (7 of 168) COVID-19 patients …
#EPA and #DHA differentially modulate monocyte #inflammatory response in subjects with chronic inflammation in part via plasma specialized pro-resolving lipid mediators: A randomized, double-blind, crossover study
https://2medical.news/2020/12/12/epa-and-dha-differentially-modulate-monocyte-inflammatory-response-in-subjects-with-chronic-inflammation-in-part-via-plasma-specialized-pro-resolving-lipid-mediators-a-randomized-double-blind-cr/

The independent effects of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) on chronic inflammation through their downstream lipid mediators, including the specialized pro-resolving lipid mediators (SPM), remain unstudied. Therefore, we compared the effects of EPA and DHA supplementation on monocyte inflammatory response and plasma polyunsaturated fatty acids (PUFA) SPM lipidome.. After a 4-week lead-in phase (baseline), 9 men and 12 postmenopausal women (50–75 years) with …