Raised CRP levels in obese patients : symptoms of depression have an independent positive association

Background: Depression and obesity, the two common ailments of modern society, are associated with increased risk of coronary artery disease and raised C-reactive protein (CRP) levels. Are the effects of depression and obesity related or do they influence CRP levels independently?

Objective: In 493 consecutive patients presenting for obesity surgery, we explored the relationship between symptoms of depression and raised CRP levels after controlling for confounding factors.

Methods and Procedures: Depression was measured using the Beck Depression Inventory (BDI). Confounding variables were age, gender, BMI, waist and hip measures, smoking and alcohol habits, medications, biochemical measures of the metabolic syndrome, and indirect measures of insulin resistance. General linear regression sought variables independently associated with CRP levels.

Results: These patients had a BMI range from 31 to 91 kg/m2, participants age ranged from 14 to 71 years, and 76% were women. The median CRP concentration was 7.7 mg/l (interquartile range: 3.9–14), 40% had an abnormally raised concentration (>10 mg/l). The mean BDI score was 17.0 ± 9.0, indicating symptoms of moderate depression. We found five independent factors associated with raised CRP levels. In order of strength of association, these were: higher BMI (β = 0.36, P < 0.001), female gender (β = −0.19, P < 0.001), estrogen therapy (β = 0.18, P < 0.001), higher BDI score (β = 0.11, P = 0.01), and insulin resistance index (β = 0.11, P = 0.01), and with a combined R 2 = 0.24, (P < 0.001). Discussion: In obese patients, symptoms of depression were associated with raised CRP levels after controlling for confounding variables. Obese women on estrogen therapy are at risk of high CRP levels.

Creatine and the creatine transporter: a review

The cellular role of creatine (Cr) and Cr phosphate (CrP) has been studied extensively in neural, cardiac and skeletal muscle. Several studies have demonstrated that alterations in the cellular total Cr (Cr + CrP) concentration in these tissues can produce marked functional and/or structural change. The primary aim of this review was to critically evaluate the literature that has examined the regulation of cellular total Cr content. In particular, the review focuses on the regulation of the activity and gene expression of the Cr transporter (CreaT), which is primarily responsible for cellular Cr uptake. Two CreaT genes (CreaT1 and CreaT2) have been identified and their chromosomal location and DNA sequencing have been completed. From these data, putative structures of the CreaT proteins have been formulated. Transcription products of the CreaT2 gene are expressed exclusively in the testes, whereas CreaT1 transcripts are found in a variety of tissues. Recent research has measured the expression of the CreaT1 protein in several tissues including neural, cardiac and skeletal muscle. There is very little information available about the factors regulating CreaT gene expression. There is some evidence that suggests the intracellular Cr concentration may be involved in the regulatory process but there is much more to learn before this process is understood. The activity of the CreaT protein is controlled by many factors. These include substrate concentration, transmembrane Na+ gradients, cellular location, and various hormones. It is also likely that transporter activity is influenced by its phosphorylation state and by its interaction with other plasma membrane proteins. The extent of CreaT protein glycosylation may vary within cells, the functional significance of which remains unclear.

Effects of gamma-tocopherol supplementation on thrombotic risk factors

Objective: The antioxidant activity of vitamin E is derived primarily from alpha-tocopherol (α-T) and gammatocopherol (γ-T). Results of epidemiological studies have demonstrated an inverse relationship between vitamin E intake and coronary disease. However, the results of clinical trials using α-T are equivocal. We determined the effect of 5 weeks of 100 mg/d or 200 mg/d γ-T supplementation on thrombotic markers such as platelet reactivity, lipid profile and the inflammation marker C-reactive protein (CRP). Methods and results: Fourteen healthy subjects consumed 100 mg/day while 13 consumed 200 mg/d of γ-T and 12 received placebo (soybean capsules with less than 5 mg/d γ-T) in a double-blinded parallel study design. Fasting pre and post dose blood samples were analysed. Blood γ-T concentrations increased significantly (p<0.05) relative to dose during the intervention period. Both groups receiving active ingredients showed significantly lower platelet activation after supplementation (p<0.05). Subjects consuming 100 mg/d γ-T had significantly decreased LDL cholesterol, platelet aggregation and mean platelet volume (MPV) (p<0.05). Little effect of γ-T was observed on other parameters. Conclusions: These data suggest that γ-T  supplementation may have a permissive role in decreasing the risk of
thrombotic events by improving lipid profile and reducing platelet activity.

Effects of creatine loading and prolonged creatine supplementation of body composition, fuel selection, sprint and endurance performance in humans

Most research on creatine has focused on short-term creatine loading and its effect on high-intensity performance capacity. Some studies have investigated the effect of prolonged creatine use during strength training. However, studies on the effects of prolonged creatine supplementation are lacking. In the present study, we have assessed the effects of both creatine loading and prolonged supplementation on muscle creatine content, body composition, muscle and whole-body oxidative capacity, substrate utilization during submaximal exercise, and on repeated supramaximal sprint, as well as endurance-type time-trial performance on a cycle ergometer. Twenty subjects ingested creatine or a placebo during a 5-day loading period (20g·day^-1) after which supplementation was continued for up to 6 weeks (2g·day^-1). Creatine loading increased muscle free creatine, creatine phosphate (CrP) and total creatine content (P<0.05). The subsequent use of a 2g·day^-1 maintenance dose, as suggested by an American College of Sports Medicine Roundtable, resulted in a decline in both the elevated CrP and total creatine content and maintenance of the free creatine concentration. Both short- and long-term creatine supplementation improved performance during repeated supramaximal sprints on a cycle ergometer. However, whole-body and muscle oxidative capacity, substrate utilization and time-trial performance were not affected. The increase in body mass following creatine loading was maintained after 6 weeks of continued supplementation and accounted for by a corresponding increase in fat-free mass. This study provides definite evidence that prolonged creatine supplementation in humans does not increase muscle or whole-body oxidative capacity and, as such, does not influence substrate utilization or performance during endurance cycling exercise. In addition, our findings suggest that prolonged creatine ingestion induces an increase in fat-free mass.

Long-term risk factor control after a cardiac rehabilitation programme

This study examined the hypothesis that Phase II cardiac rehabilitation participants (CRP) had better long-term risk factor control, self-rated perception of health and return to work rates than non-participants (NP) between 18 and 36 months post myocardial infarction (MI). It was a comparative study in a 550 bed hospital.

Approximately half of both groups did not achieve a total cholesterol (TC) of 5.5mmol/L or less. Compared with NP, CRP were significantly more likely to have a TC<=6.5mmol/L (7% vs. 28%) (p=0.006). NP with TC>6.5mmol/L were significantly less likely to be on treatment (p=0.002). CRP were more likely to regularly exercise than NP (79% vs. 61%) (p=0.038). The success rate for blood pressure targets, return to work rates and self-rated perception of health were similar in both groups.

In conclusion, CRP had better long-term control of some risk factors than NP. The study provides comparative longer term patient outcomes after an Australian cardiac rehabilitation (CR) programme and forms the basis for further outcome measurement.

Markers of inflammation in South Asian and European infants from birth to 2 years in Manchester, UK

Inflammatory markers, including serum C-reactive protein (CRP), are predictors of coronary heart disease (CHD) in adults. South Asians in the UK have higher rates of CHD in adulthood than national rates.We tested the hypotheses that South Asian infants would have higher serum concentrations of CRP and homocysteine than European infants up to 2 years of age and that higher infant weight is associated with elevation of inflammatory markers. Infants of South Asian and European origin were investigated in a mixed cross sectional-longitudinal cohort study. Mothers were recruited ante-natally from St Mary’s Hospital,Manchester by postal invitation and telephone call to non-responders. Infants with metabolic or congenital abnormalities, known syndromes or pre-maturity were excluded. Measurements were collected at birth and either 3, 6, 12 or 24 months. High sensitivity CRP and homocysteine were measured by an immulite immunoassay. We used mixed linear modelling to assess whether infant weight, ethnicity, length of follow-up or their interaction were associated with inflammatory makers in infants during follow-up. Data are presented on 306 infants (109 South Asian and 197 European). We found that European infants had higher serum CRP than South Asian infants during follow-up which was of borderline significance.There was no difference in serum homocysteine between ethnic groups during followup and no significant interaction between ethnicity and follow-up. Infant weight was significantly associated with CRP but not homocysteine. In this ongoing longitudinal study,we found little difference in inflammatory markers in infants from birth to 2 years despite markedly higher rates of CHD in South Asian than European adults. Life course exposure to risk factors may play a more dominant role in the development of CHD.

Inflammation, hepatic enzymes and resistance training in individuals with metabolic risk factors

Aims Increases in inflammatory markers, hepatic enzymes and physical inactivity are associated with the development of the metabolic syndrome (MetS). We examined whether inflammatory markers and hepatic enzymes are correlated with traditional risk factors for MetS and studied the effects of resistance training (RT) on these emerging risk factors in individuals with a high number of metabolic risk factors (HiMF, 2.9 ± 0.8) and those with a low number of metabolic risk factors (LoMF, 0.5 ± 0.5).

Methods Twenty-eight men and 27 women aged 50.8 ± 6.5 years (mean ± sd) participated in the study. Participants were randomized to four groups, HiMF training (HiMFT), HiMF control (HiMFC), LoMF training (LoMFT) and LoMF control (LoMFC). Before and after 10 weeks of RT [3 days/week, seven exercises, three sets with intensity gradually increased from 40–50% of one repetition maximum (1RM) to 75–85% of 1RM], blood samples were obtained for the measurement of pro-inflammatory cytokines, C-reactive protein (CRP), -glutamyltransferase (GGT) and alanine aminotransferase (ALT).

Results At baseline, HiMF had higher interleukin-6 (33.9%), CRP (57.1%), GGT (45.2%) and ALT (40.6%) levels, compared with LoMF (all P < 0.05). CRP, GGT and ALT correlated with the number of risk factors (r = 0.48, 0.51 and 0.57, respectively, all P < 0.01) and with other anthropometric and clinical measures (r range from 0.26 to 0.60, P < 0.05). RT did not significantly alter inflammatory markers or hepatic enzymes (all P > 0.05).

Conclusions HiMF was associated with increased inflammatory markers and hepatic enzyme concentrations. RT did not reduce inflammatory markers and hepatic enzymes in individuals with HiMF.

Creatine supplementation increases muscle total creatine but not maximal intermittent exercise performance

This study investigated creatine supplementation (CrS) effects on muscle total creatine (TCr), creatine phosphate (CrP), and intermittent sprinting performance by using a design incorporating the time course of the initial increase and subsequent washout period of muscle TCr. Two groups of seven volunteers ingested either creatine [Cr; 6 × (5 g Cr-H2O + 5 g dextrose)/day)] or a placebo (6 × 5 g dextrose/day) over 5 days. Five 10-s maximal cycle ergometer sprints with rest intervals of 180, 50, 20, and 20 s and a resting vastus lateralis biopsy were conducted before and 0, 2, and 4 wk after placebo or CrS. Resting muscle TCr, CrP, and Cr were unchanged after the placebo but were increased (P < 0.05) at 0 [by 22.9 ± 4.2, 8.9 ± 1.9, and 14.0 ± 3.3 (SE) mmol/kg dry mass, respectively] and 2 but not 4 wk after CrS. An apparent placebo main effect of increased peak power and cumulative work was found after placebo and CrS, but no treatment (CrS) main effect was found on either variable. Thus, despite the rise and washout of muscle TCr and CrP, maximal intermittent sprinting performance was unchanged by CrS.

Impact of medical Qigong on quality of life, fatigue, mood and inflammation in cancer patients : a randomized controlled trial

Background: Substantial numbers of cancer patients use complementary medicine therapies, even without a supportive evidence base. This study aimed to evaluate in a randomized controlled trial, the use of Medical Qigong (MQ) compared with usual care to improve the quality of life (QOL) of cancer patients. Patients and methods: One hundred and sixty-two patients with a range of cancers were recruited. QOL and fatigue were measured by Functional Assessment of Cancer Therapy—General and Functional Assessment of Cancer Therapy—Fatigue, respectively, and mood status by Profile of Mood State. The inflammatory marker serum C-reactive protein (CRP) was monitored serially. Results: Regression analysis indicated that the MQ group significantly improved overall QOL (t144 = −5.761, P < 0.001), fatigue (t153 = −5.621, P < 0.001), mood disturbance (t122 =2.346, P = 0.021) and inflammation (CRP) (t99 = 2.042, P < 0.044) compared with usual care after controlling for baseline variables. Conclusions: This study indicates that MQ can improve cancer patients’ overall QOL and mood status and reduce specific side-effects of treatment. It may also produce physical benefits in the long term through reduced inflammation.

Exploiting side information in distance dependent Chinese restaurant processes for data clustering

Multimedia contents often possess weakly annotated data such as tags, links and interactions. The weakly annotated data is called side information. It is the auxiliary information of data and provides hints for exploring the link structure of data. Most clustering algorithms utilize pure data for clustering. A model that combines pure data and side information, such as images and tags, documents and keywords, can perform better at understanding the underlying structure of data. We demonstrate how to incorporate different types of side information into a recently proposed Bayesian nonparametric model, the distance dependent Chinese restaurant process (DD-CRP). Our algorithm embeds the affinity of this information into the decay function of the DD-CRP when side information is in the form of subsets of discrete labels. It is flexible to measure distance based on arbitrary side information instead of only the spatial layout or time stamp of observations. At the same time, for noisy and incomplete side information, we set the decay function so that the DD-CRP reduces to the traditional Chinese restaurant process, thus not inducing side effects of noisy and incomplete side information. Experimental evaluations on two real-world datasets NUS WIDE and 20 Newsgroups show exploiting side information in DD-CRP significantly improves the clustering performance.

Towards a cohesive theory of cohesion

Conventional wisdom suggests that group cohesion is strongly related to performance. This may be based on the notion that better cohesion leads to the sharing of group goals. However, empirical and meta-analytic studies have been unable to consistently demonstrate a relationship between cohesion and performance. Partially, this problem could be attributed to the disagreement on the precise definition of cohesion and its components. Further, when the cohesion construct is evaluated under Cohen’s Cumulative Research Program (CRP), it is surprisingly found to belong to the category of early-to-intermediate stage of theory development. Therefore, a thorough re-examination of the cohesion construct is essential to advance our understanding of the cohesion-productivity relationship. We propose a qualitative approach because it will help establish the definitions, enable us to better test our theories about cohesion and its moderators, and provide insights into how best to enlist cohesion to improve team performance.

Clinical features and risk factors of oedematous Mycobacterium ulcerans lesions in an Australian population: beware cellulitis in an endemic area

Introduction
Oedematous lesions are a less common but more severe form of Mycobacterium ulcerans disease. Misdiagnosis as bacterial cellulitis can lead to delays in treatment. We report the first comprehensive descriptions of the clinical features and risk factors of patients with oedematous disease from the Bellarine Peninsula of south-eastern Victoria, Australia.

Methods
Data on all confirmed Mycobacterium ulcerans cases managed at Barwon Health, Victoria, were collected from 1/1/1998–31/12/2012. A multivariate logistic regression model was used to assess associations with oedematous forms of Mycobacterium ulcerans disease.

Results
Seventeen of 238 (7%) patients had oedematous Mycobacterium ulcerans lesions. Their median age was 70 years (IQR 17–82 years) and 71% were male. Twenty-one percent of lesions were WHO category one, 35% category two and 41% category three. 16 (94%) patients were initially diagnosed with cellulitis and received a median 14 days (IQR 9–17 days) of antibiotics and 65% required hospitalization prior to Mycobacterium ulcerans diagnosis. Fever was present in 50% and pain in 87% of patients. The WCC, neutrophil count and CRP were elevated in 54%, 62% and 75% of cases respectively. The median duration of antibiotic treatment was 84 days (IQR 67–96) and 94% of cases required surgical intervention. On multivariable analysis, there was an increased likelihood of a lesion being oedematous if on the hand (OR 85.62, 95% CI 13.69–535.70; P<0.001), elbow (OR 7.83, 95% CI 1.39–43.96; p<0.001) or ankle (OR 7.92, 95% CI 1.28–49.16; p<0.001), or if the patient had diabetes mellitus (OR 9.42, 95% CI 1.62–54.74; p = 0.02).

Conclusions
In an Australian population, oedematous Mycobacterium ulcerans lesions present with similar symptoms, signs and investigation results to, and are commonly mistakenly diagnosed for, bacterial limb cellulitis. There is an increased likelihood of oedematous lesions affecting the hand, elbow or ankle, and in patients with diabetes.