Serum Growth Arrest-Specific Protein 6 Levels are a Reliable Biomarker of Disease Activity in Systemic Lupus Erythematosus

Purpose

Growth arrest-specific protein 6 (Gas6) has been suggested to be a biomarker of disease activity in patients with systemic lupus erthematosus (SLE). We investigated the clinical significance of this protein in Korean SLE.

Methods

Blood samples were collected from 150 SLE patients and 50 normal controls (NC). In addition, follow-up samples were collected from 50 SLE patients.

Results

Serum Gas6 levels of SLE patients (43.01?±?28.02 ng/mL) were higher than those of NC (20.15?±?9.23 ng/mL, p?<?0.001). When evaluated sensitivity and specificity of the Gas6 for diagnosing SLE using ROC curves, the sensitivity and specificity were 72.7 % and 84 % with a cut-off value of 25.3 ng/mL. In the ROC analysis of Gas6, anti-dsDNA antibody, ESR, complement 3 and complement 4 to identify patients with active lupus, area under the curve (AUC) of Gas6 was highest with 0.763. Serum Gas6 levels were significantly higher in the patients with serositis (70.04?±?30.85 ng/mL) and renal disorder (65.66 ±32.28 ng/mL) compared to those without (41.88?±?27.44 ng/mL, p?=?0.033, 40.3?±?26.33 ng/mL, p?=?0.001, respectively). Gas6 levels were correlated positively with anti-dsDNA antibody (r?=?0.199, p?=?0.015), ESR (r?=?0.204, p?=?0.013) and SLEDAI (r?=?0.512, p?<?0.001). In addition, serum Gas6 levels were correlated negatively with hemoglobin (r?=??0.165, p?=?0.043), lymphocyte count (r?=??0.165, p?=?0.043), complement 3 (r?=??0.343, p?<?0.001) and complement 4 (r?=??0.316, p?<?0.001). Furthermore, change in serum Gas6 levels was correlated with change in SLEDAI levels in the SLE patients that were followed up (r?=?0.524, p?<?0.001).

Conclusion

These results suggest that serum Gas6 can be a reliable clinical marker for monitoring disease activity and treatment response in SLE.     

Serum Levels of Calreticulin in Correlation with Disease Activity in Patients with Rheumatoid Arthritis

Objective

The aim of our study was to investigate the contribution of serum calreticulin (CRT) in the assessment of disease activity in rheumatoid arthritis (RA).

Methods

Serum CRT levels were measured by ELISA in 70 patients with established RA, 30 systemic lupus erythematosus (SLE), 25 other autoimmune diseases, 20 osteoarthritis (OA), and 35 of healthy controls (HC). Correlations of CRT serum levels with disease activity [Disease Activity Score for 28 joints (DAS28)], erythrocyte sedimentation rate(ESR) and C-reactive protein (CRP) were assessed. Serum CRT levels were also detected in RA patients whose RF, anti-CCP and anti- MCV antibodies were positive and negative.

Results

Serum CRT levels in RA patients (4.817?±?2.425 ng/ml) was significantly higher (P <0.05) compared with those in the serum of OA (3.574?±?0.942 ng/ml), SLE (4.013?±?1.536 ng/ml), other autoimmune diseases (3.882?±?0.837 ng/ml) and HC (3.726?±?0.627 ng/ml). Significant positive correlation of CRT with DAS28, ESR and CRP was found in RA patients. Furthermore, RA patients whose anti-CCP and anti-MCV antibodies were positive had higher levels of CRT (P?<?0.01).

Conclusion

Serum CRT levels were increased in patients with RA compared with those controls. Moreover, a significant correlation was observed between serum CRT levels and disease activity in RA. It might be used as a potential biomarker for clinical diagnosis and provide additional information regarding disease activity along with the traditional indices such as ESR and CRP.     

Sodium caseinate induces mouse granulopoiesis

Objective and design

Sodium caseinate (CasNa) induces differentiation and M-CSF production in mouse band granulocytes in vitro; however, it is not yet known if this molecule can also induce the proliferation and activation of the granulocyte lineage in vivo. In this work we evaluated the induction in vivo of granulopoiesis and the activation of granulocytes in mice treated with CasNa.

Material or subjects

BALB/c male mice 8–12?weeks old were used.

Treatment

The animals were inoculated intraperitoneally with 1?ml of CasNa (10% in PBS p/v) four times (every 48?h).

Methods

Granulocyte proliferation was evaluated by flow cytometry; activation was evaluated by phagocytic indices. The cytokine was measured using an ELISA assay.

Results

We show that CasNa increased bone marrow granulopoiesis percentage (38.35?±?10.88 vs. 64.94?±?34.14 BrdU+/Gr-1+ cells) and the granulocytes generated presented increased phagocytic indices (0.3?±?0.1 vs. 0.6?±?0.11, p?p?Conclusions CasNa induces granulopoiesis with functional granulocytes, suggesting that this molecule could be an innate immune system activator.     

Usefulness of C-reactive protein as a marker of early post-infarct left ventricular systolic dysfunction

Objective

To assess the usefulness of in-hospital measurement of C-reactive protein (CRP) concentration in comparison to well-established risk factors as a marker of post-infarct left ventricular systolic dysfunction (LVSD) at discharge.

Materials and methods

Two hundred and four consecutive patients with ST-segment-elevation myocardial infarction (STEMI) were prospectively enrolled into the study. CRP plasma concentrations were measured before reperfusion, 24?h after admission and at discharge with an ultra-sensitive latex immunoassay.

Results

CRP concentration increased significantly during the first 24?h of hospitalization (2.4?±?1.9 vs. 15.7?±?17.0?mg/L; p?p?p?p?p?Conclusion Measurement of CRP plasma concentration at discharge may be useful as a marker of early LVSD in patients after a first STEMI.     

The Contralateral Extremity has Also Benefit from the Locally Administered Bone Marrow-Derived Mononuclear Cells and Cord Blood Serum in Diabetic Ischemic Wound Healing

Objective

Impaired wound healing could be a disaster especially in diabetes and amputation is the major risk. The aim of this study was to evaluate the benefit of BMMCs and CBS on wound healing.

Methods

Diabetic rats were underwent bilateral limb ischemia and wounding of skin defects on both extremities. The groups were formed as BMMCs (group A), BMMCs and CBS (group B), only CBS (group C), and phosphate buffer solution (group D) that were injected into wounds on right legs.

Results

The complete recovery of right legs was established as a mean of 21.4?±?1.1 days, 12.9?±?1.5 days, 30.0?±?0.0 days and 38.1?±?1.5 days according to Groups A, B, C, and D (p?<?0.05). The recovery of left legs were calculated as a mean of 27.0?±?0.0 days, 24.0?±?0.0 days, 35.6?±?1.1 days and 37.3?±?1.6 days according to Groups A, B, C and D (p?<?0.05). At the end of the recovery, the HE staining showed that vascularity was increased in groups A and B.

Conclusion

Transplantation of BMMCs and CBS to the ischemic wounds of the diabetic rats accelerate the repair. The recovery was also superior in the same group although the treatment was not applied to the left extremity directly.     

Stereological evaluation of the volume and volume fraction of newborns’ brain compartment and brain in magnetic resonance images

Purpose

Brain development in early life is thought to be critical period in neurodevelopmental disorder. Knowledge relating to this period is currently quite limited. This study aimed to evaluate the volume relation of total brain (TB), cerebrum, cerebellum and bulbus+pons by the use of Archimedes’ principle and stereological (point-counting) method and after that to compare these approaches with each other in newborns.

Methods

This study was carried out on five newborn cadavers mean weighing 2.220?±?1.056?g with no signs of neuropathology. The mean (±SD) age of the subjects was 39.7 (±1.5) weeks. The volume and volume fraction of the total brain, cerebrum, cerebellum and bulbus+pons were determined on magnetic resonance (MR) images using the point-counting approach of stereological methods and by the use of fluid displacement technique.

Results

The mean (±SD) TB, cerebrum, cerebellum and bulbus+pons volumes by fluid displacement were 271.48?±?78.3, 256.6?±?71.8, 12.16?±?6.1 and 2.72?±?1.6?cm³, respectively. By the Cavalieri principle (point-counting) using sagittal MRIs, they were 262.01?±?74.9, 248.11?±?68.03, 11.68?±?6.1 and 2.21?±?1.13?cm³, respectively. The mean (±?SD) volumes by point-counting technique using axial MR images were 288.06?±?88.5, 275.2?±?83.1, 19.75?±?5.3 and 2.11?±?0.7?cm³, respectively. There were no differences between the fluid displacement and point-counting (using axial and sagittal images) for all structures (p?>?0.05).

Conclusion

This study presents the basic data for studies relative to newborn’s brain volume fractions according to two methods. Stereological (point-counting) estimation may be accepted a beneficial and new tool for neurological evaluation in vivo research of the brain. Based on these techniques we introduce here, the clinician may evaluate the growth of the brain in a more efficient and precise manner.     

Poor Sleep Quality is Associated with Depressive Symptoms in Patients with Heart Disease

Background

Depression in cardiac patients has gained importance due to increased mortality. Although sleep disturbances are a core symptom of depression, the prevalence and patterns of sleep disturbances in heart disease have hardly been examined regarding depression.

Purpose

This cross-sectional study aims to examine sleep disturbances and depressive symptoms in consecutively admitted cardiac patients and depressed patients.

Methods

Two hundred four inpatients (113 male, 91 female) were examined: 94 cardiac inpatients (mean age 49.3?±?14.3?years) with different heart diseases and 110 psychiatric inpatients (mean age 41.6?±?13.0?years) with depressive disorders (DP). A depressive episode according to International Classification of Diseases (ICD)-10 was also diagnosed in 14 of the cardiac patients (DCP). The Pittsburgh Sleep Quality Index (PSQI) and the Beck Depression Inventory (BDI) were used to assess subjective sleep quality and severity of depressive symptoms.

Results

Poor sleep quality (PSQI?>?5) was reported in all comorbid DCP (PSQI 12.00?±?3.53, BDI 17.86?±?4.28), in 60% of the 80 non-DCP (PSQI 5.59?±?3.73, BDI 4.47?±?3.07), and in 86.4% of the DP (PSQI 11.76?±?4.77, BDI 27.11?±?10.54). The cardiac inpatients showed a significant correlation between increased depressive symptoms and the PSQI components subjective sleep quality (r?=?0.40) and daytime dysfunction (r?=?0.34). Both sleep components were significant predictors of self-rated depression (R2?=?0.404).

Conclusions

Most cardiac patients experience poor sleep quality. Self-reported sleep disturbances in heart disease could serve as predictors of clinical or subclinical comorbid depression outside of a psychiatric setting in cardiology and other fields, and such patients should be referred to consultation-liaison psychiatry or polysomnography where sleep disorders like sleep apnea are suspected.     

Effects of Preoperative Short Term Use of Atorvastatin on Endothelial Progenitor Cells after Coronary Surgery: A Randomized, Controlled Trial

Objectives

We investigated the effects of short-term use of atorvastatin on CD34+/VEGF-R2+/CD133+/CD45- endothelial progenitor cell (EPC) count after on-pump coronary artery bypass surgery (CABG).

Methods

Between Feb-2010 and May-2010, we randomly assigned, in a placebo-controlled, double-blind study, 60 consecutive patients who underwent isolated, first-time CABG to receive either 14-day atorvastatin (40 mg/day) or placebo preoperatively. Urgent CABG and recent myocardial infarction were excluded. EPCs were quantified (cells/μl) by flow cytometric phenotyping obtained from venous blood samples collected preoperatively (T₁), 6-hours (T₂), and on the 5th day postoperatively (T₃). Levels of markers of inflammation and serum cardiac troponin I were also measured preoperatively and daily until day-5 after surgery.

Results

There were no differences in baseline risk factors including cholesterol profiles, and EuroSCORES between the groups. The composite primary end-point, favored statin group with higher amount of circulating, early EPC count (cells/μl) at all time points compared with placebo (T₁, 2.30?±?0.02 versus 1.58?±?0.03, p?2, 5.00?±?0.06 versus 2.19?±?0.06, p?3, 3.03?±?0.08 versus 1.78?±?0.02, p?1, 0.8?±?0.1 versus 2.2?±?1.5, p?2, 72.9?±?3.2 versus 96.0?±?3.6, p?3, 4.3?±?1.2 versus 11.4?±?4.1, p?p?=?0.02).

Conclusions

Short-term atorvastatin use increases circulating early EPCs both pre- and post-operatively and is associated with better preservation of sinus rhythm and reduced hsCRP levels. (ClinicalTrials.gov number, NCT01096875)     

Long-term treatment with methanandamide attenuates LPS-induced periodontitis in rats

Objective

Evidence exists of the anti-inflammatory and immunological properties of endocannabinoids in various tissues; the aim of the present study was therefore to assess the effect of long-term treatment with the synthetic cannabinoid methanandamide (Meth-AEA) on the progression of periodontitis in rats.

Materials and methods

Periodontitis was induced by injecting LPS (1?mg/ml) into the gingiva around the neck of the first upper and lower molars, and into the inter-dental space between the first and second molars. This protocol was repeated for 6?weeks on days 1, 3, and 5 of each week.

Results

Long-term treatment with topical Meth-AEA (500?ng/ml), applied daily to gingival tissue of rats induced with periodontitis, significantly diminished the alveolar bone loss, measured as the distance between the cemento-enamel junction and the alveolar crest, in both maxillary and mandibular first molars, compared to rats without treatment (P?P?P?Conclusion These results demonstrate the beneficial effects of treatment with Meth-AEA on gingival tissue of rats with periodontitis.     

Exhaled breath condensate pH in patients with cystic fibrosis

Objective and design

Exhaled breath condensate (EBC) pH has been proposed as a useful, non-invasive marker of airway inflammation in pulmonary diseases. In this study we tested whether cystic fibrosis (CF) is associated with acidification of EBC, when pH is assessed by the CO₂ gas standardization method.

Methods

EBC was collected using two different devices (EcoScreen and R-Tube) in 46 stable CF patients during routine clinical visits and in 28 healthy controls.

Results

Mean EBC pH in CF patients and in healthy controls was similar (EcoScreen: CF patients: 6.38?±?0.03 versus controls: 6.39?±?0.03, p?=?0.699; R-tube: CF patients: 5.94?±?0.04 versus controls: 6.02?±?0.03, p?=?0.159). Inflammatory cell counts in spontaneously expectorated sputum obtained in a subset of patients (n?=?20) showed no correlation with pH values. EBC samples collected with the R-tube were more acidic than those collected with the EcoScreen device (p?Conclusions Our data suggest that EBC pH does not discriminate between healthy controls and those with CF disease indicating that the clinical applicability of EBC pH measurements for assessing airway inflammation in CF is limited.     

In vitro and in vivo safety evaluation of Dipteryx alata Vogel extract

Background

The skin is chronically exposed to endogenous and environmental pro-oxidant agents, leading to the harmful generation of reactive oxygen species. Antioxidant is vital substances which possess the ability to protect the body from damage cause by free radicals induce oxidative stress. Alpinia zerumbet, a traditionally important economic plant in Okinawa, contains several interesting bioactive constituents and possesses health promoting properties. In this regard, we carried out to test the inhibitory effect of crude extracts and isolated compounds from A. zerumbet on antioxidant and skin diseases-related enzymes.

Methods

The antioxidant activities were examined by DPPH, ABTS and PMS-NADH radical scavenging. Collagenase, elastase, hyaluronidase and tyrosinase were designed for enzymatic activities to investigate the inhibitory properties of test samples using a continuous spectrophotometric assay. The inhibitory capacity of test samples was presented at half maximal inhibitory concentration (IC₅₀).

Results

The results showed that aqueous extract of the rhizome was found to have greater inhibitory effects than the others on both of antioxidant and skin diseases-related enzymes. Furthermore, 5,6-dehydrokawain (DK), dihydro-5,6-dehydrokawain (DDK) and 8(17),12-labdadiene-15,16-dial (labdadiene), isolated from rhizome, were tested for antioxidant and enzyme inhibitions. We found that DK showed higher inhibitory activities on DPPH, ABTS and PMS-NADH scavenging (IC₅₀?=?122.14?±?1.40, 110.08?±?3.34 and 127.78?±?4.75???g/ml, respectively). It also had stronger inhibitory activities against collagenase, elastase, hyaluronidase and tyrosinase (IC₅₀?=?24.93?±?0.97, 19.41?±?0.61, 19.48?±?0.24 and 76.67?±?0.50???g/ml, respectively) than DDK and labdadiene.

Conclusion

Our results indicate that the rhizome aqueous extract proved to be the source of bioactive compounds against enzymes responsible for causing skin diseases. Moreover, DK could be used as a potent inhibitor and be further exploited to be used in anti-skin disease formulations.     

Wedging of vertebral bodies at the thoracolumbar junction in asymptomatic healthy subjects on magnetic resonance imaging

Purpose

Wedging of the vertebral body on radiological examination is a valuable indicator of a vertebral compression fracture, although it can also be observed in subjects with no history of trauma. The purpose of this study was to elucidate the normative value of vertebral wedging at the thoracolumbar junction in asymptomatic healthy subjects for differential diagnosis of vertebral compression fractures using MRI.

Methods

A total of 115 subjects without back pain at the time of the examination and without history of spinal trauma was included (68 males, 47 females, mean age 49.5?years). They underwent MRI of the thoracic and lumbar spine, and the ratio of anterior vertical height to posterior vertical height of the vertebral body (APR) was determined from T10 to L2 on T2 weighted sagittal images.

Results

APR was 0.92?±?0.08 at T10, 0.92?±?0.08 at T11, 0.90?±?0.06 at T12, 0.89?±?0.06 at L1, and 0.90?±?0.07 at L2, indicating that vertebral bodies at the thoracolumbar junction appear wedge-shaped rather than rectangular. Males, thinner subjects, smokers, and subjects with abnormalities of the endplates such as a Schmorl nodule had a significantly smaller APR than females, fatter subjects, non-smokers, and those without endplate abnormalities.

Conclusion

The normative values of APR obtained in the present study can represent a valuable reference in the diagnosis of vertebral compression fracture to help prevent confusion with physiological vertebral wedging.     

Middle patellar tendon to posterior cruciate ligament (PT–PCL) and normalized PT–PCL: New magnetic resonance indices for tibial tubercle position in patients with patellar instability

Background

To demonstrate whether the distance between the middle point of the patellar tendon and posterior cruciate ligament (PT–PCL) calculated on a single axial MR image could be an alternative measure to tibial tubercle–PCL (TT–PCL) distance for TT lateralization without the need of imaging processing. To show that normalization of PT–PCL (nPT-PCL) against the maximum diameter of the tibial plateau may help to identify patients with patellar instability (PI).

The association between interleukin-6 polymorphisms and rheumatoid arthritis: a meta-analysis

Objective

The aim of this study was to determine whether the functional interleukin-6 (IL-6) promoter ?174 G/C and ?572 G/C polymorphisms confer susceptibility to rheumatoid arthritis (RA) in ethnically different populations.

Methods

Meta-analysis was conducted on the associations between these IL-6 polymorphisms and RA.

Results

A total of nine studies involving 3,851 subjects (RA 2,053 and controls 1,798) were considered in this study and ethnicity-specific meta-analysis was performed on European subjects. In all study subjects, meta-analysis revealed a trend toward to an association between RA and the IL-6 ?174 G allele (odds ratio [OR]?=?0.699, 95?% confidence interval [CI]?=?0.463–1.054, p?=?0.088). Stratification by ethnicity indicated a significant association between RA and the IL-6 ?174 G/C polymorphism in Europeans using the dominant (OR?=?0.329, 95?% CI?=?0.155–0.699, p?=?0.004) and recessive (OR?=?0.823, 95?% CI?=?0.679–0.997, p?=?0.047) models. Meta-analysis of the IL-6 ?572 G/C polymorphism showed no association between RA and the IL-6 ?572 G allele in all study subjects (OR?=?1.641, 95?% CI?=?0.613–4.397, p?=?0.324).

Conclusions

This meta-analysis shows that the IL-6 ?174 G/C polymorphism may confer susceptibility to RA in Europeans.     

Simultaneous Positivity for Anti-DNA, Anti-Nucleosome and Anti-Histone Antibodies is a Marker for More Severe Lupus Nephritis

Objective

The purpose of this study is to examine autoantibody profile of systemic lupus erythematosus (SLE) patients with lupus nephritis (LN) and to establish the correlation between the antibody reactivity and disease activity of LN.

Methods

Autoantibodies and serological parameters were measured and analyzed in 589 SLE patients. The associations of the co-positivity of anti-dsDNA, -nucleosome and –histone antibodies (3-pos) with clinical, serological and outcome parameters were analyzed.

Results

At the study entry, the prevalence for anti-dsDNA (61.52 % vs. 34.11 %, P?<?0.0001), anti-nucleosome (56.09 % vs. 37.21 %, P?=?0.0002) and anti-histone (49.35 % vs. 33.33 %, P?=?0.0013) antibodies in patients with LN were significantly higher than that in patients without LN. Patients with 3-pos had a higher proportion of proliferative renal lesions (class III?+?IV). The incidence of a poor renal outcome (7.14 % vs. 2.52 %, P?=?0.0174) in LN patients with 3-pos was significantly higher than those without 3-pos. Moreover, the rate of remission (73.63 % vs. 82.37 %, P?=?0.0245) was significantly reduced and recurrence increased (58.90 % vs. 23.44 %, P?<?0.0001) in 3-pos patients as compared to that in non 3-pos within the LN group.

Conclusion

Our data indicate a strong association between the 3-pos and renal disease activities, especially proliferative glomerulonephritis. The ability of 3-pos to predict renal flares may lead to major additional benefits in the follow-up of these patients.     

Electroacupuncture at the ST36 acupoint increases interleukin-4 responsiveness in macrophages, generation of alternatively activated macrophages and susceptibility to Leishmania major infection

Background

Electroacupuncture (EA) has been used to treat inflammatory diseases. Alternatively activated macrophages (AAMo) stimulated by cytokines such as interleukin (IL)-4, IL-10 and IL-13 are anti-inflammatory and mildly microbicidal. This study aimed to evaluate whether EA at the Zusanli acupoint (ST36) would change the profile of healthy murine macrophages, particularly the generation of AAMo and susceptibility to Leishmania major infection.

Methods

BALB/c mice were treated with EA (15/30?Hz) at the ST36 acupoint for 20?min/d for 5 d. After the final EA session, the mice were euthanized and their peritoneal cells were harvested and counted for determination of arginase activity, nitric oxide (NO) production and microbicidal activity after culture in the presence or absence of IL-4, interferon-?? (IFN??) or lipopolysaccharide (LPS) or both IFN?? and LPS. Twelve mice were infected with L. major promastigotes into the footpads after the final EA session and the infection course was monitored.

Results

Peritoneal cells freshly obtained from EA-treated mice had similar arginase and microbicidal activities to cells from sham-treated mice. After culture with IL-4, cells from EA-treated mice exhibited significant increases in the arginase activity (sham: 58?±?11.3 vs. EA: 80.7?±?4.6%, P?=?0.025) and number of parasites/infected cell (sham: 2.5?±?0.4 vs. EA: 4.3?±?0.8 cells, P?=?0.007). The NO production was lower in cells from EA-treated mice cultured in the presence of a combination of IFN?? and LPS (sham: 31.6?±?6.5 vs. EA: 22.3?±?2.1???M, P?=?0.025). The lesion size in mice infected with L. major promastigotes was larger in EA-treated mice (sham: 3.26?±?0.29 vs. EA: 2.23?±?0.4?mm, P?=?0.039).

Conclusion

EA at the ST36 acupoint increases IL-4 responsiveness in macrophages, Generation of AAMo and susceptibility to L. major infection     

Self-Weighing Frequency Is Associated with Weight Gain Prevention over 2 Years Among Working Adults

Background

Little is known about the association between self-weighing frequency and weight gain prevention, particularly in worksite populations.

Purpose

The degree to which self-weighing frequency predicted 2-year body weight change in working adults was examined.

Method

The association between self-weighing frequency (monthly or less, weekly, daily, or more) and 24-month weight change was analyzed in a prospective cohort analysis (n?=?1,222) as part of the larger HealthWorks trial.

Results

There was a significant interaction between follow-up self-weighing frequency and baseline body mass index. The difference in weight change ranged from ?4.4?±?0.8?kg weight loss among obese daily self-weighers to 2.1?±?0.4?kg weight gain for participants at a healthy weight who reported monthly self-weighing.

Conclusion

More frequent self-weighing seemed to be most beneficial for obese individuals. These findings may aid in the refinement of self-weighing frequency recommendations used in the context of weight management interventions.     

Energy expenditure of extreme competitive mountaineering skiing

Purpose

Multi-hour ski mountaineering energy balance may be negative and intake below recommendations.

Methods

Athletes on the ‘Patrouille des Glaciers’ racecourses (17 on course Z, 27 km, +2,113 m; 11 on course A, 26 km, +1,881 m) volunteered. Pre-race measurements included body mass, stature, VO_2max, and heart rate (HR) vs VO₂ at simulated altitude; race measurements HR, altitude, incline, location, and food and drink intake (A). Energy expenditure (EE) was calculated from altitude corrected HR derived VO₂.

Results

Race time was 5 h 7 min ± 44 min (mean ± SD, Z) and 5 h 51 min ± 53 min (A). Subjects spent 19.2 ± 3.2 MJ (Z), respectively, 22.6 ± 2.9 MJ (A) during the race. Energy deficit was ?15.5 ± 3.9 MJ (A); intake covered 20 ± 7 % (A). Overall energy cost of locomotion (EC) was 9.9 ± 1.3 J m^?1 kg^?1 (Z), 8.0 ± 1.0 J m^?1 kg^?1 (A). Uphill EC was 11.7 ± 1 J m^?1 kg^?1 (Z, 13 % slope) and 15.7 ± 2.3 J m^?1 kg^?1 (A, 19 % slope). Race A subjects lost ?1.5 ± 1.1 kg, indicating near euhydration. Age, body mass, gear mass, VO_2max and EC were significantly correlated with performance; energy deficit was not.

Conclusions

Energy expenditure and energy deficit of a multi-hour ski mountaineering race are very high and energy intake is below recommendations.     

Restless legs syndrome in patients with depressive disorders

Aim

Recent community-based studies have shown strong associations between restless legs syndrome (RLS) and major depressive disorder and panic disorder. The aim of the study was to investigate whether patients with a manifest depressive disorder have an increased prevalence of RLS and whether there is an association with different depressive disorders.

Methods

Three psychiatry departments in two countries (Germany and Australia) each recruited 100?consecutive patients with current depression. All patients completed a standardized questionnaire including diagnostic questions for RLS, the Center for Epidemiologic Studies Depression Scale (CES-D), and the International RLS Severity Scale (IRLS), if RLS was present. The treating doctors completed a second standardized questionnaire including RLS diagnostic questions and comorbidities.

Results

A total of 277?questionnaires could be evaluated, 184 in Germany (96 in Bremen, 88 in Freiburg) and 93 in Australia. The Australian patients were younger than the German patients (45.4?±?13.8 vs. 49.7?±?15.0?years, p?=?0.02); the gender distribution was not different (p?=?0.71). The minimal diagnosis criteria for RLS were fulfilled by 8.3% of the German and 17.0% of the Australian patients (p?=?0.02). The treating physicians rated 4.3% of the German and 12.4% of the Australian patients as RLS cases. RLS prevalence was similar across all subtypes of depression.

Conclusion

RLS is not more frequent in patients with manifest depression in Germany as compared to the general population. Possible reasons for the higher prevalence of RLS in depressive patients in Australia are discussed.